>>MY NAME IS MARRAH SCROGGINS,
PROGRAM DIRECTOR IN DIVISION OF
LUNG DISEASES AT THE NATIONAL
HEART LUNG AND BLOOD INSTITUTE.
I'M SERVING AS CO-CHAIR OF THE
INSTITUTE WOMEN'S HEALTH WORKING
GROUP.
AND ON BEHALF OF AN NIH
TRANS-NIH ORGANIZING COMMITTEE
FOR THIS WORKSHOP, I WOULD LIKE
TO EXTEND A WELCOME TO THE
NEARLY 800 ATTENDEES WHO WILL BE
JOINING US TODAY AND TOMORROW
FOR THE BUILDING UNIFYING
SYSTEMS OF CARE ADDRESSING
CO-MORBIDITIES IN WOMEN AND
GIRLS WORKSHOP WHICH IS
SPONSORED BY THE NATIONAL HEART
LUNG AND BLOOD INSTITUTE.
NEXT SLIDE.
I WOULD LIKE TO KICK OFF WITH A
FEW SLIDES HIGHLIGHTING THE THE
WORKSHOP CHARGE AND PURPOSE.
THE PURPOSE OF THE WORKSHOP IS
TO ADDRESS A NEED TO DEVELOP
SUPPORT CONTINUUMS OF CARE WHICH
WILL ADVANCE THE HEALTH OF
RACIALETH IN THIS CASE DIVERSE
WOMEN OF REPRODUCTIVE AGE WITH
COMPLEX HEALTH CONDITIONS.
TO ACHIEVE THIS GOAL THIS
WORKSHOP WILL ADDRESS CURRENT
GAPS AND OPPORTUNITIES TO
IMPLEMENTING COMMUNITY ENGAGE
RESEARCH, DESIGNED TO INCREASE
THE ADOPTION OF INTEGRATED SET
OF EVIDENCE BASED PRACTICES THAT
ARE DELIVERED ACROSS HEALTHCARE
SYSTEMS INCLUDING PRIMARY
SPECIALTY BEHAVIORAL HEALTH AND
COMMUNITY BASED HEALTHCARE
SETTINGS.
SEVERAL GOALS OF THIS WORKSHOP
INCLUDE PROMOTING EDUCATION AND
TRAINING ON INTEGRATIVE
HEALTHCARE SUPPORTING
INTEGRATION AND COORDINATION OF
HEALTHCARE SERVICES, TO MEET THE
NEEDS OF HEALTH AND SOCIAL
DEVELOPMENT OF RACIAL ETHNIC
UNDERSERVED WOMEN OF
REPRODUCTIVE AGE ALL THE WHILE
LEVERAGING EXISTING FEDERAL
STATE AND LOCAL RESOURCES AS
WELL AS COLLABORATIONS FOR
ALIGNING COMMUNITY AND CLINICAL
SERVICES ALL WITH THE GOAL OF
ADDRESSING MULTI-MORBIDITY FOR
WOMEN ACROSS LIFESPANS.
RISING RATES IN ANXIETY AND
DEPRESSION AMONG U.S. WOMEN ARE
ACTING AS IMPORTANT DRIVERS FOR
THE SHARP INCREASE OF HARMFUL
ALCOHOL AND SUBSTANCE USE.
IT MAYBE ALSO RELATED TO
INCREASES IN OVERDOSE RELATED
DEATH, PARTICULARLY IN WOMEN OF
REPRODUCTIVE AGE.
OVER THE PAST TWO DECADES
OVERDOSES IN WOMEN HAS INCREASE
BY 400% AND OPIOID CRISIS
DISPROPORTIONATELY AFFECTS
RACIAL ETHNIC WOMEN.
ADDITIONALLY MENTAL ILLNESS
INCLUDING MAJOR DEPRESSIVE
DISORDERS AS WELL AS ABUSE OF
SUBSTANCES OBESITY AND
UNDERLYING METABOLIC DISORDERS
SUCH AS DIABETES INCREASES THE
RISK FOR CARDIOVASCULAR AND
OTHER CARDIO PULMONARY DISEASE
IN WOMEN.
THE INTERSECTION OF THESE
PROCESSES MAYBE PARTICULARLY
IMPORTANT AND IMPACT MATERNAL
HEALTH ACROSS PREGNANCY
CHILDBIRTH SUCH AS INCREASING
THE RISK OF PREECLAMPSIA, AND
MAY ALSO RELATE TO CONDITIONS
BEYOND PREGNANCY INCLUDING
POSTPARTUM DEPRESSION.
RESEARCH HAS FOUND THAT THERE
ARE MULTIPLE FACTORS THAT
CONTRIBUTE TO THESE DISPARITIES
SUCH AS ACCESS TO QUALITY
HEALTHCARE MULTIPLE CHRONIC
UNDERLYING CONDITIONS,
STRUCTURAL RACISM AND IMPLICIT
BIAS.
TO ADDRESS THESE COMMON
CO-OCCURRING CONDITIONS WE HAVE
BROUGHT TOGETHER VARIOUS EXPERTS
AND STAKEHOLDERS TO HELP US FIND
A PATH TOWARDS CONTINUUM OF CARE
APPROACH THAT INTEGRATE PRIMARY
CARE REPRODUCTIVE HEALTH
BEHAVIORAL HEALTH AND CARDIO
PULMONARY SPECIALTIES THAT
ADDRESS HEALTH IN EACH DOMAIN
AND HAVE GREATEST IMPACT TO
HEALTH OF RACIAL ETHNIC WOMEN
WHO ARE AT HIGHER RISK FOR LIFE
LONG CHRONIC HEALTH CONDITIONS.
BEFORE I INTRODUCE YOU TO
REMAINDER OF THE WORKSHOP
ORGANIZING TEAM I WANT TO TAKE A
MOMENT TO RECOGNIZE ONE OUR
COLLEAGUES DR. REBECCA WIG GINS.
WE HEARD OF HER PASSING AND I
WANTED TO GIVE HER A MOMENT OF
REMEMBRANCE AT THIS WORKSHOP AS
SHE WAS A TIRELESS ADVOCATED FOR
WOMEN'S HEALTH RESEARCH.
MANY ATTENDEES AT THIS WORKSHOP
MAY HAVE WORKED WITH HER OVER
DURING THE 30 YEARS FEDERAL
SERVICE AND HER TIME AT THE NIH
AND REISN'TLY WORKING IN OFFICE
OF RESEARCH WOMEN'S HEALTH
SUPPORTING SPECIALIZED ON SEX
DIFFERENCES PROGRAMS VARIOUS
INTERSECTION OF SEX AND GENDER
RESEARCH PROGRAMS AS WELL AS
BEING A CORE TEAM MEMBER OF THE
SEX AS BIOLOGICAL VARIABLE
RESEARCH PROGRAM.
REBECCA WILL BE MISSED AND IF
YOU WISH YOU MAY LEAVE MEMORIES
FOR HER FRIENDS AND FAMILY AT
THE LINK PROVIDED IN THIS SLIDE.
NEXT SLIDE PLEASE.
AT THIS TIME I WANT TO RECOGNIZE
OUR TWO WORKSHOP CO-CHAIRS DR.
JOHNSON AND GENDER, BOTH
INSTRUMENTAL HELPING IDENTIFY
SUBJECT MATTER EXPERTS TO
PRESENT AT THIS WORKSHOP.
THEY WILL HELP FACILITATE
CONVERSATION BETWEEN YOU AS
ATTENDEES AS PANELIST, AS A
WORKSHOP PARTICIPANT YOU CAN
SUBMIT QUESTIONS IN THE Q&A
MODULE DURING THE WORKSHOP TO
ENGAGE ANY PRESENTERS.
THE CO-CHAIRS WILL LEAD THE
WORKSHOP CLOSE OUT SESSION ON
DAY TWO WHERE GROUP OF PANELISTS
WILL DISCUSS MANY GAPS IN THE
HEALTHCARE DELIVERY SYSTEM AND
HOW WE CAN BE LEVERAGING VARIOUS
OPPORTUNITIES DURING THE THE
TRANSITION PERIODS TO IMPLEMENT
EVIDENCE BASED PRACTICES THAT
FACILITATE THE DELIVERY OF
INTEGRATIVE INTERVENTIONS TO
ADDRESS THE INTERSEXUALITY OF
COMMON CO-OCCURRING CONDITIONS
AND ADDRESS RACIAL ETHNIC
DISPARITIES AND ENGAGEMENT
RECEIPT AND RETENTION IN THE
HEALTHCARE TREATMENT AMONG
HISTORICALLY MARGINALIZED WOMEN
WITH CO-MORBIDITIES.
NEXT SLIDE.
IT IS MY PLEASURE TO INTRODUCE
YOU TO REMAINDER OF THE
TRANS-NIH ORGANIZING COMMITTEE
WHO ARE MEMBERS OF THE TRANS-NIH
WORKING GROUP ON ADDRESSING
COMMON CO-MORBIDITIES IN WOMEN
AN GIRLS.
DR. LAURIE DONZE FROM NHLBI DR.
TAMARA JOHNSON NIMH, DR. DIEDRA
ROACH FROM NIAAA AND DR. SMITH
AND HOLLY MOORE FROM NIDA.
EACH OF THESE MEMBERS WILL BE
FACILITATING CONVERSATIONS
THROUGHOUT THE WORKSHOP AND MANY
OF THEM WILL ALSO BE MODERATING
OUR WORKSHOP SESSIONS.
NEXT SLIDE.
TO HELP US KICK OFF THIS MEETING
WE WILL HAVE SOME WELCOMING
REMARKS FROM DR. KOOB, DIRECTOR
OF NATIONAL INSTITUTE ON ALCOHOL
ABUSE AND ALCOHOLISM AND HAS
BEEN A STRONG CHAMPION FOR THE
WORK OF THE TRANS-NIH WORKING
GROUP ON ADDRESSING COMMON
CO-MORBIDITIES IN WOMEN AND
GIRLS, SINCE INCEPTION TWO YEARS
AGO.
SINCE THEN HE'S CONSISTENTLY
OFFERED SUPPORT AND GUIDANCE TO
OUR WORKING GROUP AND HAS
SIGNIFICANTLY EXPANDED THE
CONVERSATION ON BUILDING
UNIFYING SYSTEMS OF CARE TO
ADDRESS MULTI-MORBIDITY IN WOMEN
AND GIRLS AMONG THE RANKS OF NIH
SENIOR LEADERSHIP.
AFTER DR. KOOB WE WILL HAVE AN
INTRODUCTION FROM DR.IA JEAN
CLAYTON ASSOCIATE DIRECTOR FOR
RESEARCH ON WOMEN'S HEALTH AND
DIRECTOR OF THE OFFICE OF
RESEARCH ON WOMEN'S HEALTH WHO
WILL BRIEFLY HIGHLIGHT HOW THIS
WORKSHOP FITS WITHIN THE 2019,
2023 TRANS-NIH STRATEGIC PLAN
FOR WOMEN'S HEALTH RESEARCH.
FOLLOWING THE TWO DIRECTORS
REMARKS WE WILL HAVE DR. TEMKIN
WHO SERVES AS ASSOCIATE DIRECTOR
FOR CLINICAL RESEARCH AT OFFICE
OF WOMEN'S HEALTH AND SHE WILL
STRESS THE IMPORTANCE OF
ADDRESSING CHRONIC DEBILITATING
CONDITIONS IN WOMEN AS A
FRAMEWORK FOR WHY WE NEED TO
CREATE HEALTHCARE CONTINUUMS
THAT ADDRESS MULTI-MORBIDITY
ACROSS THE LIFE SPAN.
WITH THAT, I WOULD LIKE TO THANK
YOU ONCE AGAIN FOR JOINING OUR
WORKSHOP AND I WILL TURN THIS
MEETING OVER TO DR. KOOB.
>> GOOD MORNING.
GOOD DAY, EVERYONE.
SO I WOULD LIKE TO EXTEND A WARM
WELCOME TO THE SPEAKERS AND
AUDIENCE MEMBERS TO WHAT
PROMISES TO BE A VERY THOUGHT
PROVOKING WORKSHOP.
I AM DIRECTOR OF THE NATIONAL
INSTITUTE ON ALCOHOL ABUSE AND
ALCOHOLISM AND OF COURSE ALCOHOL
IS A TERRIFIC BURDEN ON THE
TARGETS THAT Y'ALL ARE
INTERESTED IN IN TODAY'S
WORKSHOP.
FROM MY PERSPECTIVE THE
CONVERSATION WE ARE ABOUT TO
BEGIN COULD NOT BE MORE TIMELY
OR MORE CRITICALLY IMPORTANT.
THE PROPORTION OF U.S. ADULTS
WITH CHRONIC CONDITIONS MULTIPLE
CHRONIC CONDITIONS ESTIMATED TO
BE 42% OR HIGHER PARTICULARLY
AMONG ADULTS 65 AND OLDER AND
THIS ME RICK SEEMS TO BE
STEADILY INCREASING.
THE PREVALENCE OF MULTIPLE
CHRONIC CONDITIONS MAYBE TWICE
AS HIGH AMONG PEOPLE LIVING IN
POVERTY COMPARED TO THOSE LIVING
AT 400% OR MORE POVERTY LEVEL,
COVID PANDEMIC HAS ADDED FUEL TO
THIS ALREADY RAGING FIRE CAUSING
BY FAR THE GREATEST NUMBER OF
HOSPITALIZATIONS AND DEATH AMONG
THOSE WITH MULTIPLE CHRONIC
CONDITIONS.
PARTICULARLY AGAIN AMONG
UNDERSERVED POPULATIONS.
LESS WELL KNOWN MOUNTING
EVIDENCE THE PHENOMENON OF
MULTIPLE CHRONIC CONDITIONS IS
HAVING A SIGNIFICANTLY GREATER
AMONG WOMEN AND GIRLS THAN MEN
AND AMONG SOME OTHER GROUPS IS
VERY IMPORTANT.
AND BECOMING MORE AND MORE
EVIDENT.
EVEN BEFORE COVID THE DATA WERE
ALREADY TELLING US THAT WITH
REGARD TO MENTAL HEALTH AND
SUBSTANCE USE DISORDERS U.S. --
IN THE U.S. WOMEN ARE IN STATE
OF CRISIS.
IS EVIDENCE BY SOME OF THE
FOLLOWING.
THERE'S SIGNIFICANT INCREASE IN
THE NUMBER OF ADOLESCENTS WITH
PAST YEAR MAJOR DEPRESSSIVE
EPISODES DRIVEN BY INCREASE IN
MAJOR DEPRESSION AMONG GIRLS.
INCREASE RATES ATTEMPTED
COMPLETED SUICIDE AMONG
ADOLESCENT GIRLS AND YOUNG
WOMEN, RAPIDLY ESCALATING RATES
OF ALCOHOL RELATED EMERGENCY
DEPARTMENT VISITS.
WITH THE RATE AMONG WOMEN
OUTPACING RATE AMONG MEN IN
EVERY AGE GROUP BETWEEN 2000 AND
2015, INCREASE IN AGE ADJUSTED
DEATH RATE FROM ALCOHOL RELATED
LIVER CIRRHOSIS IN WOMEN.
IN A RECENT INTERACTION WITH THE
AMERICAN SOCIETY OF LIVER
DISEASE THEY BASICALLY ARE
TALKING ABOUT A PANDEMIC OF
ALCOHOL ASSOCIATED LIVER DISEASE
THAT HAS BEEN EXACERBATED BY THE
PANDEMIC.
THE COVID PANDEMIC.
SO THERE ARE SPECIFIC TIMES IN
LIFE CYCLE OF WOMEN WHEN THEY
ARE UNIQUELY VULNERABLE TO HEART
AND MENTAL HEALTH CO-MORBIDITIES
INCLUDING THE PERIPARTUM AND THE
MENOPAUSE TRANSITION.
BEFORE NOW THE BIOMEDICAL
RESEARCH ENTERPRISE APPROACH
COMMONLY OCCURRING
CO-MORBIDITIES FOR THE MOST PART
AND FRAGMENTED WAY MA MIRRORS
THE FRAGMENTED WAY THAT ARE
ADDRESSED IN MEDICAL PRACTICE IN
GENERAL MULTIPLE ISOLATED
CONDITIONS EXISTING SIDE BY SIDE
IN THE SAME PERSON.
THIS WORKSHOP IS PARTS OF
GROWING EFFORT TO SHIFT THE
CONVERSATION AWAY FROM THE
NARRATIVE THAT FRAMES THE
PHENOMENON MULTI-MORBIDITY AMONG
WOMEN AS MULTIPLE ISOLATED
CONDITIONS OCCURRING IN A SINGLE
WOMAN OR GIRL.
A BROKEN AND FRAGMENTED FRAME TO
WHICH IS ENDEMIC FRAME THAT
RECOGNIZES THAT THESE CONDITIONS
OFTEN HAVE COMMON SOCIAL MENTAL
HEALTH DETERMINANTS OVERLAPPING
PATHOPHYSIOLOGY COMPLEX CLINICAL
COURSE MORE SEVERE THAN
CONDITION IN ISOLATION AN
COMPLEX TREATMENT AND CLINICAL
SUPPORT EXTENDING FAR BEYOND THE
NEED FOR APPROPRIATE TREATMENT
OF ACUTE DISEASE AND
EXACERBATION OF CHRONIC DISEASE.
I THINK EVERYBODY WHO IS
PARTICIPATED IN OUR MEDICAL
SYSTEM HAS PROBABLY EXPERIENCED
WHAT I JUST OUTLINED AND WE
REALLY NEED WHAT Y'ALL ARE GOING
TO BE COVERING TODAY IN THIS
WORKSHOP.
THE WORKSHOP BRINGS TOGETHER
SOME OF THE BEST LINES IN THE
FIELD WITH SHARED UNDERSTANDING
THAT MEETING THESE UNPRECEDENTED
CHALLENGES WILL REQUIRE
UNPRECEDENTED CREATIVITY AND
INNOVATION HELPING THE BEST OF
EXISTING RESOURCES AND
GENERATING NEW RESOURCES THAT
WILL ENABLE EFFECTIVE
INTEGRATIVE APPROACHES TO THE
PREVENTION SCREENING DIAGNOSIS
AND TREATMENT OF MULTIPLE
CHRONIC CONDITIONS.
IN WOMEN AND GIRLS.
EQUALLY IMPORTANT, THIS WORKSHOP
WILL HIGHLIGHT KEY
INFRASTRUCTURE NECESSARY TO
DELIVER STATE OF THE ART
INTEGRATIVE TREATMENT WITHIN
UNIFIED DATA DRIVEN SYSTEMS OF
CARE.
SO AGAIN I WOULD LIKE TO EXTEND
A WARM WELCOME TO EVERYONE AND
TO SOME OF THE MOST BRILLIANT
MINDS IN THE FIELD WHO WILL BE
PARTICIPATING FROM OUR SPEAKERS
AND AUDIENCE MEMBERS AND AGAIN I
THINK THIS WILL BE A REALLY
EXCELLENT WORKSHOP AND WE ARE
REALLY EXCITED AND GRATEFUL FOR
THIS OPPORTUNITY TO LEARN FROM
YOU.
CARRY ON.
>> THANK YOU, DR. KOOB FOR THOSE
GREAT WORDS, I APPRECIATE THE
STATISTICS YOU PROVIDED, IT
DRIVES POINT HOME THAT THIS
IMPORTANT TIMELY WORKSHOP IS
HAPPENING NOW AND I WOULD LIKE
TO TURN IT OVER TO DR. CLAYTON.
THANK YOU.
GOOD MORNING, EVERYONE.
I'M GOING TO GET THIS SET UP
JUST RIGHT FOR YOU.
I'M EXCITED TO BE HERE AND I
WANT TO THANK DR. MARRAH
LACHOWICZ SCROGGINS FOR INVITING
ME AND THE NATIONAL HEART LUNG
AND BLOOD INSTITUTE FOR
LEADERSHIP AND VISION IN
CREATING THIS WORKSHOP.
I HOPE THAT THIS AND OTHER
EFFORTS WILL LEAD TO NIH WIDE
COLLABORATION IN THIS SPACE.
THIS WORKSHOP IS SO IMPORTANT,
YOU HEARD FROM DR. KOOB
STAGGERING STATISTICS AROUND
ALCOHOL USE AND THERE ARE OTHER
STATISTICS AROUND THE WORLD OF
TRAUMA AND VIOLENCE THAT ARE
VERY DISTURBING INDEED.
IN ORDER TO SHARE REMARKS I
REALLY DELIGHTED THAT I WAS
ASKED TO CHAIR A LITTLE ABOUT
OFFICE OF RESEARCH WOMEN'S
HEALTH, THE OFFICE WIDE AND
CONTEXTUALIZE OUR REMARKS TODAY.
THE U.S. CONGRESS IS
PARTICULARLY INTERESTED IN
WOMEN'S HEALTH AND RECENTLY
ASKED NIH TO CONSIDER OUR
RESEARCH PORTFOLIO IN THIS SPACE
WITH ATTENTION TO MATERNAL
MORBIDITY MORTALITY CERVICAL
CANCER AND CHRONIC DEBILITATING
CONDITIONS IN WOMEN.
AS A RESULT OF THAT REQUEST WE
RECENTLY HOST AD WOMEN'S HEALTH
CONFERENCE AND THE CONFERENCE
REPORT FROM THAT CONFERENCE WILL
BE AVAILABLE SOON.
THE CHRONIC DEBILITATING
CONDITIONS ARENA WAS ONE OF
INTENSE CONVERSATIONS.
IN ADDITION THE RECENTLY
RELEASED NIH WIDE STRATEGIC PLAN
COVERING ALL DISEASES AND
CONDITIONS AND ALL INSTITUTES
AND CENTERS WAS ALSO RECENTLY
RELEASED.
THAT NEW PLAN CONTINUES TO
ADVANCE VISION FOR BIOMEDICAL
RESEARCH CAPACITY DIRECTION
CAPACITY AND STEWARDSHIP AND
INCLUDES FIVE CROSS CUTTING
THEMES WHICH ENHANCING WOMEN'S
HEALTH IS ONE.
ONE OF THE THEME ALSO ADDRESSING
PUBLIC HELP CHALLENGES ACROSS
THE LIFE SPAN AND PROMOTING
COLLABORATIVE SCIENCE.
ALL RELEVANT TO DISCUSSION YOU
ARE GOING TO HAVE TODAY.
I WAS PARTICULARLY EXCITED TO
HEAR ABOUT THE VARIETY OF AREAS
THIS WORKSHOP WILL BE ADDRESSING
BUILDING UNIFYING SYSTEMS OF
CARE ADDRESSING CO-MORBIDITIES
IN WOMEN AND GIRLS.
TOPICS RELATED TO DEPRESSION
CARDIO PULMONARY DISORDER
SUBSTANCE USE DISORDERS, OBESITY
DIABETES AND HIV AIDS WILL BE
DISCUSSED.
AND THERE WILL BE SPECIFIC
ATTENTION TO CRITICAL LIFE
PERIODS INCLUDING PREGNANT AND
POST PAR THEM WOMEN I WOULD BE
REMISS IF I DIDN'T INCLUDE JUST
ONE SLIDE ON THE NIH SEX AS
BIOLOGICAL VARIABLE AS YOU KNOW
IN 2016 THIS POLICY WENT INTO
EFFECT IN A NUTSHELL STATES NIH
SEX BIOLOGICAL VARIABLE BE
FACTORED TO RESEARCH DESIGNS
ANALYSES AND REPORTING FOR
VERTEBRAL ANIMAL HUMAN STUDIES
AN JUSTIFICATION FOR LITERATURE
OR OTHER RELEVANT CONSIDERINGS
MUST BE PROVIDED FOR
APPLICATIONS PROPOSING TO STUDY
ONLY ONE SEX.
IF WE CAN INTEGRATE SABB INTO
THE PRE-CLINICAL RESEARCH THAT
INFORMS THAT CLINICAL RESEARCH
WE CAN GENERATE NEW KNOWLEDGE
ABOUT FEMALE BIOLOGY AND FEMALE
PATHOPHYSIOLOGY.
OUR SCHEMATIC FOR THINKING ABOUT
THIS IN TERMS OF THE ENTIRE
RESEARCH CONTINUUM IS
INCORPORATING SEX AND GENDER
ACROSS THIS RESEARCH CONTINUUM
FROM THOSE PRE-CLINICAL STUDIES
TO TRANSLATION AND CLINICAL
TRIALS CAN ADVANCE RIGOR
DISCOVERY INNOVATION AND EQUITY.
WITH SEX SPECIFIC RESULTS
REPORTING, WE CAN UNDERSTAND
BETTER TREATMENT EFFECTS IN MEN
AND WOMEN AND SIDE EFFECTS IN
MEN AND WOMEN.
WE INTEGRATE PERSPECTIVES INTO
INTERPROFESSIONAL EDUCATION,
MEDICAL STUDENTS, TRAINEES AND
POST DOCS LEARN ABOUT SEX AND
GENDER HAVE ON HEALTH AND
DISEASE.
OF COURSE ALL THAT CAN INFORM
POLICY AND SHOULD LEAD TO
DELIVERY OF SEX AND GENDER WHERE
CLINICAL CARE TO EACH AND EVERY
PERSON.
NIH WIDE STRATEGIC PLAN FOR
WOMEN'S HEALTH RESEARCH WE PUT
FORWARD THIS MULTI-DIMENSIONAL
FRAMEWORK REPRESENTING AN
INTERSECTION OF FACTORS
AFFECTING THE HEALTH OF WOMEN.
IT ALSO PUTS FORWARD RIGHT IN
THE CENTER THERE THE LIFE COURSE
PERSPECTIVE THAT IS SO IMPORTANT
FOR UNDERSTANDING THE HEALTH OF
WOMEN.
WE HAVE BIOLOGICAL FACTORS SUCH
AS SEX BUT OTHER MOLECULAR
SECTOR PHYSIOLOGICAL FACTORS AS
WELL THAT OPERATE AND WE HAVE
EXTERNAL FACTORS THAT AFFECT
HEALTH SUCH AS SOCIAL
DETERMINANTS OF HEALTH INCLUDING
GENDER ENVIRONMENTAL EXPOSURES
OR POLICIES, THEN INTERACT WITH
EACH OTHER ACROSS THE LIFE
COURSE TO AFFECT THE HEALTH OF
WOMEN.
THIS INTEGRATED LIFE COURSE
PERSPECTIVE IS CRITICAL TO
UNDERSTANDING THE HEALTH OF
WOMEN.
IF YOU THINK ABOUT THIS LIFE
COURSE FROM CHILDHOOD THROUGH
PUBERTY AND PREGNANCY MENOPAUSE
AND OLD AGE YOU CAN SEE
GRAPHICALLY REPRESENTED HERE ON
THIS EKG TRACING HOW IMPORTANT
IT IS TO UNDERSTAND THAT FOR
EXAMPLE DEPRESSION AND PUBERTY
CAN PREDICT DEPRESSIVE EPISODES
IN MENOPAUSE.
OBESITY AND GESTATIONAL DIABETES
AND PREECLAMPSIA WITH CONTRIBUTE
TO CARDIOVASCULAR DISEASE LATER
IN LIFE AND NHLBI STUDIES SHOWN
US THAT PRE-ECLAMPSIA CAN
ACTUALLY BE ASSOCIATED WITH
DIAGNOSIS OF HYPERTENSION WITHIN
THREE YEARS OF PREGNANCY.
THIS PARTICULAR PERSPECTIVE
WHERE WE HAVE REALIZED THAT
EVERYTHING THAT CAME BEFORE IN
WOMEN'S LIFE IS AFFECTING HER
HEART STATE OF HEALTH IS SO
IMPORTANT TO UNDERSTANDING THE
HEALTH OF WOMEN.
SO I CONCLUDE MY REMARKS IT IS
REALLY IMPORTANT FOR US TO THINK
ABOUT PRIORITIZING CHRONIC
DISEASE HOW WE DEFINE CHRONIC
DISEASE IN WOMEN, THINK ABOUT
THE HEALTH SPAN VERSUS LIFE SPAN
SO THE HEALTHY YEARS IS THE
HEALTH SPAN.
WE KNOW WOMEN LIVE LONGER THAN
MEN BUT MORE YEARS WITH
DISABILITY SO THEIR HEALTH SPAN
IS CERTAINLY SHORTER THAN LIFE
SPAN.
THINKING MULTI-SYSTEM
MANIFESTATIONS OF DISEASE THAT
ARE COMMON IN WOMEN, THESE
DISEASES DON'T EXIST IN SILOS.
AND ARE STRUCTURES AT NIH ARE A
BIT SILOED AT TIMES HOW CAN WE
BRIDGE THAT DIVIDE THINKING
CO-MORBIDITIES HOW THESE
CONDITIONS AND CONDITIONS
TOGETHER TO LEAD TO BETTER
UNDERSTANDING OF THAT
PATHOPHYSIOLOGY.
MENTAL HEALTH AND I MENTION A AT
THE BEGINNING VIOLENCE AND
TRAUMA LINKAGE BETWEEN CARDIO
PULMONARY DISEASE AND ANXIETY
DEPRESSION OBESITY AND
DEPRESSION AND WHOLE PERSON
PERSPECTIVE IS SORELY NEEDED.
SOME INSTITUTES AND CENTERS ARE
TAKING THIS ON IN A VIGOROUS
WAY.
SO I WOULD END WITH FOUR
QUESTIONS.
HOW DO WE MOVE BEYOND POLICY
PROGRAM TO DRIVE FUNDAMENTAL
CHANGE.
WHAT CHECKS AND BALANCES DO WE
NEED TO HAVE IN THE SYSTEM TO
MAKE SURE THAT WE ARE ADDRESSING
QUESTIONS LIKE THIS TODAY.
HOW CAN WE INCENTIVIZE CROSS
SECTOR INNOVATION TO DRIVE
DISCOVERY IN THE AREA OF CHRONIC
DISEASE AND WOMEN'S HEALTH AND
MOST IMPORTANTLY WHAT PART ARE
YOU GOING TO PLAY.
THANK YOU VERY MUCH FOR INVITING
ME TO PARTICIPATE IN THIS
WORKSHOP AND PROVIDE SOME
OPENING REMARKS.
BACK TO YOU, DR. LAW RA
LACHOWICZ SCROGGINS.
>> I APPRECIATE THE PARTNERSHIP
AND THE DRIVE TO MOTIVATE US AND
THE NIH TO WORK ON THIS
TOGETHER.
SO I WOULD LIKE TO INTRODUCE
AGAIN DR. TEMKIN FROM ORWH WHO
WILL DIVE DEEPER INTO THE
IMPORTANCE OF CHRONIC
DEBILITATING CONDITIONS.
I'M SO HAPPY TO BE HERE TODAY
AND THANK YOU FOR INVITING ME TO
DISCUSS RECENT OFFICE OF
RESEARCH WOMEN'S HEALTH
ACTIVITIES RELATED TO CHRONIC
DEBILITATING DISEASES IN WOMEN
AND MULTI-MORBIDITY.
AS DR. CLAYTON MENTIONED IN FY
21 APPROPRIATIONS BILLS THE
HOUSE AND SENATE PROBATIONS
COMMITTEE REQUESTED THE NIH
REVIEW ACTIVITIES RELATED TO
WOMEN'S HEALTH AND CONVENE A
CONFERENCE TO ADDRESS THE FUTURE
OF RESEARCH OF WOMEN'S HEALTH.
THE THREE TOPICS AS PUBLIC
HEALTH CONCERNS FOR RISING RATES
OF MATERNAL MORBIDITY AND
MORTALITY, RISING RATES OF
DEBILITATING CONDITIONS IN WOMEN
AND CERVICAL CANCER SURVIVAL
RATES THAT ARE SECOND.
SO I'M GOING TO -- I'M GOING TO
CONCENTRATE MY REMARKS ON THE
ACTIVITIES RELATED TO CHRONIC
DEBILITATING CONDITIONS IN
WOMEN.
DR. CLAYTON SHOWED THIS SLIDE AS
WELL BUT IT DEMONSTRATES THE
RESPONSE TO THE CONGRESSIONAL
REQUEST ORWH BROUGHT INPUT FROM
VARIOUS STAKEHOLDERS INCLUDING
THE COORDINATING COMMITTEE ON
RESEARCH ON WOMEN'S HEALTH,
ADVISORY COMMITTEE ON RESEARCH
FOR WOMEN'S HEALTH, AND PUBLIC.
FEDERAL SUBJECT MATTER EXPERTS
FORMED CLUSTERS TO REVIEW THE
NIH PORTFOLIOS AND THE THREE
FOCUS FOPICS THAT WERE TAR --
TOPICS MENTIONED IN THE
CONGRESSIONAL SIGNIFICANT ITEM
INFORMATION WAS PRESENTED TO OUR
ADVISORY COMMITTEE ON RESEARCH
FOR WOMEN'S HEALTH IN ORDER TO
FACILITATE PLANNING OF WOMEN'S
HEALTH CONFERENCE.
I WILL FOCUS REALLY ON THE
REVIEW THAT WAS PERFORMED BY
SUBJECT MATTER EXPERTS ACROSS
THE FEDERAL SYSTEM ON THE
CURRENT NIH ACTIVITIES OF
CHRONIC DEBILITATING CONDITIONS
AMONG WOMEN.
THE FIRST CHALLENGE FACING THIS
GROUP OF EXPERTS WAS TO DEFINE
CHRONIC DEBILITATING CONDITIONS
IN WOMEN AS NO AVAILABLE
DEFINITION OF CHRONIC DISEASE
WAS SPECIFIC TO WOMEN.
OR WOMEN'S HEALTH.
IN 2010 HHS DEFINED CHRONIC
DISEASE AS CONDITIONS THAT LAST
A YEAR OR MORE, AND REQUIRE
ONGOING MEDICAL ATTENTION AND/OR
LIMIT ACTIVITIES OF DAILY
LIVING.
WE ENDED UP USING THIS ACTIVITY
-- THIS DEFINITION PRIMARILY BUT
ALSO USED AT CMS DEFINITION THAT
DEFIANCE CHRONIC DISEASES AS A
LIST OF CONDITIONS THAT ARE
PERIODICALLY UPDATED.
OF THE 21 CONDITIONS INCLUDED BY
CMS CHRONIC CONDITIONS
PREVALENCE DATA IS AVAILABLE
THAT IS DISAGGREGATED BY SEX.
THIS DEMONSTRATES CERTAIN
CONDITIONS ARE MORE COMMON IN
WOMEN COMPARED TO MEN.
THESE INCLUDE HYPERTENSION
ARTHRITIS DEPRESSION DEMENTIA,
OSTEOPOROSIS AND ASTHMA.
YOU CAN SEE THE FEMALE
PREVALENCE IN ORANGE AND BLUE --
MALE PREVALENCE IN BLUE, THERE
ARE OTHER CONDITIONS THAT ARE
MORE COMMON IN MEN THAN WOMEN.
MULTI-MORBIDITY ARE
CO-OCCURRENCE OF TWO OR MORE
CHRONIC DISEASE IN ONE
INDIVIDUAL ALSO MORE COMMON IN
BEAM.
THIS MAY BE PARTLY BECAUSE WOMEN
TYPICALLY LIVE LONGER THAN MEN
BUT ALSO WOMEN HAVE ATYPICAL
SYMPTOMS THAT RESULT IN DELAYS
IN DIAGNOSIS AND POTENTIALLY
POOR RESPONSE TO FIRST LINE
THERAPIES. INTERACTIONS BETWEEN
CONDITIONS IN WOMEN AND
DEVELOPMENT OF MULTI-MORBIDITY
IS POORLY UNDERSTOOD IN WOMEN.
WE DEVELOPED A FRAMEWORK
SPECIFIC TO CHRONIC DEBILITATING
CONDITIONS IN WOMEN.
WE USE DISABILITY ADJUSTED LIFE
YEARS OR DAILIES THE NUMBER OF
YEARS LOST DUE TO I WILL HEALTH
DISABILITY OR EARLY DEATH AS
METRIC TO MEASURE BURDEN OF
DISEASE ACROSS WOMEN IN THE
UNITED STATES.
CHRONIC DISEASE IN WOMEN WERE
SEPARATED IN TO FEMALE SPECIFIC
MORE COMMON IN WOMEN OR HIGHER
MORBIDITY IN WOMEN POTENTIALLY
UNDERSTUDIED IN WOMEN AND LASTLY
HIGH MORBIDITY IN WOMEN
CONDITIONS.
THE CONDITIONS WITH THE HIGHEST
BURDEN OF DISEASE MEASURED BY
DAILIES ARE THE LEFT SIDE OF THE
CHART AND DECLINE AS WE MOVE
RIGHT.
BECAUSE WE WERE LIMITED IN OUR
ABILITY TO DO QUANTITATIVE
REVIEW OF NIH ACTIVITIES IN
CHRONIC DEBILITATING CONDITIONS
IN WOMEN BECAUSE OF OUR LACK OF
DEFINITION, AND BECAUSE THERE'S
NO UNIFYING CODE OR METRIC WE
PERFORMED WHAT WE CALL LIMITED
SNAP SHOT, A BRIEF QUALITATIVE
OVERVIEW OF IC ACTIVITIES IN
THIS SPACE.
ICs PARTICIPATING IN THE
CONFERENCE PLANNING WERE ASKED
TO SUBMIT HIGHEST FUNDED
PROJECTS AND CHRONIC DISEASE IN
WOMEN.
184 PROJECTS FROM 11 ICS WERE
RECEIVED IN CATEGORIZED INTO THE
FRAMEWORK THAT I PRESENTED ON
THE LAST SLIDE.
THIS LIMITED SNAP SHOT
DEMONSTRATED NIH ACTIVITY ACROSS
ALL THE DOMAINS OF THE FRAMEWORK
MOST ICO DESIGNATED CHRONIC
CONDITIONS IN WOMEN WAS IN
CONDITIONS CONSIDERED MORE
COMMON IN WOMEN FOLLOWED BY
POTENTIALLY NEGLECTED IN WOMEN
THAN HIGH MORBIDITY IN WOMEN
WITH LOWEST NUMBER OF SUBMITTED
PROJECTS ON FEMALE SPECIFIC
CONDITIONS.
THERE WERE SO MANY LIMITATIONS
TO THIS SNAP SHOT BUT WE USED IT
TO PROVIDE A ROUGH ESTIMATE OF
THE NIH ACTIVITIES AND
PRIORITIES RELATED TO CHRONIC
DEBILITATING CONDITIONS IN
WOMEN.
THE CLUSTER ENDED WITH THIS
SUMMARY.
THERE IS A NEED FOR A STANDARD
DEFINITION OF CHRONIC DISEASES
THAT NIH WIDE.
WOMEN HAVE HIGHER CHRONIC
DISEASE -- HIGHER RATES OF
CHRONIC DISEASE AND
MULTI-MORBIDITY COMPARED TO MEN
BUT FEW STUDIES FOCUS
SPECIFICALLY ON THIS TOPIC.
NIH WIDE ACTIVITY ENOUGH WOMEN
CROSSES PURVIEW OF MANY ICs
THAT THERE ARE FEW CURRENT NIH
WIDE EFFORTS IN THIS REALM.
THE RECOMMENDATION WAS TO ALIGN
RESEARCH ACTIVITIES WITH THE
SPECIFIC NEEDS OF WOMEN THROUGH
A MORE GRANULAR IDENTIFICATION
AND DEFINITION OF CHRONIC
DEBILITATING DISEASES IN WOMEN.
WE ALSO RECEIVED INPUT FROM THE
PUBLIC RELATED TO THIS TOPIC
FOLLOWING REQUEST FOR
INFORMATION PUBLISHED IN JULY.
OF 247 COMMENTS RECEIVED 182
MENTIONED CHRONIC DEBILITATING
DISEASES IN WOMEN.
THE MAJORITY MENTIONED FEMALE
SPECIFIC DISEASES FOLLOWED BY
THOSE POTENTIALLY UNDER STUDY
AND THOSE COMMON IN WOMEN WITH
THE FEWEST COMMENTS ON
CONDITIONS WITH HIGH MORBIDITY
IN WOMEN.
THESE PROPORTIONS ARE NOTABLY
DISSIMILAR TO THOSE IDENTIFIED
IN THE NIH SNAP SHOT.
ON OCTOBER 20 THE ADVANCING
ADVANCE WOMEN HEALTH THIS SLIDE
SHOWS AGENDA ITEMS SPECIFIC TO
CHRONIC DISEASE IN WOMEN,
INCLUDED AN OVERVIEW OF THE
TOPIC FOLLOWED BY TALKS AND
BREAK OUT SESSIONS ON PREVENTION
FEMALE SPECIFIC CONDITIONS,
CONDITIONS THAT CAUSE HIGH
MORBIDITY IN WOMEN AND
DISPARITIES.
OVER 1100 ATTENDEES JOINED IN A
CONFERENCE WITH HIGH ATTENDANCE
IN BOTH MATERNAL MORBIDITY AND
MORTALITY AND CHRONIC
DEBILITATING CONDITIONS BREAK
OUT SESSIONS.
ON THE FOLLOWING DAY OCTOBER
21ST ADVISORY COMMITTEE ON
RESEARCH FOR WOMEN'S HEALTH MET
SUMMARIZE MEETING AND DEVELOPED
THIS SET OF OPPORTUNITIES FOR
NIH RESEARCH ON CHRONIC
DEBILITATING CONDITIONS IN
WOMEN.
THEIR RECOMMENDATIONS WERE TO
DEVELOP DEFINITIONS IN A
FRAMEWORK SPECIFIC TO CHRONIC
DISEASES IN WOMEN.
TO ALIGN CLINICAL RESEARCH WITH
THE NEEDS OF WOMEN INCLUDING
STUDY OBJECTIVES AND END POINTS
TO INCREASE RESEARCH ACTIVITIES
AND FEMALE SPECIFIC DISEASES.
MENOPAUSE AND AGING TO CREATE
CLINICAL RESEARCH NETWORKS THAT
ARE SPECIFIC TO RESEARCH ON
CHRONIC DISEASES IN WOMEN AND TO
ENCOURAGE RESEARCH THROUGH THE
DEVELOPMENT OF FUNDING
OPPORTUNITIES AROUND
MULTI-MORBIDITY.
SO THANK YOU SO MUCH FOR HAVING
ME HERE, HAPPY TO ANSWER ANY
QUESTIONS AND PLEASE CHECK IN
WITH OUR WEBSITE WITH VIDEOS AND
SUMMARY OF THIS ACTIVITY ARE
FORTHCOMING.
>> THANK YOU, DR. TEMKIN.
I APPRECIATE IN YOUR SLIDES HOW
YOU HIGHLIGHTED SOME OF THE
REMAINING GAPS AND OPPORTUNITIES
FOR OUR ONGOING COLLABORATIVE
EFFORTS.
I THINK IT IS IMPORTANT TO THINK
ABOUT THOSE TODAY AND TOMORROW
AS WE GO OUT THROUGHOUT THE
WORKSHOP.
RIGHT NOW WE ARE GOING TO MOVE
ON TO SESSION ONE WHICH IS
MAKING THE CASE FOR INTEGRATIVE
HEALTHCARE SYSTEMS FOR WOMEN AND
GIRLS DR. JOHNSON IS GOING TO BE
MODERATING THIS SESSION AND SHE
WILL INTRODUCE TO EACH SPEAKER
AS WELL.
IF YOU HAVE QUESTIONS FOR DR.
KOOB, DR. CLAYTON OR DR. TEMKIN
YOU CAN PACE THEM INTO THE Q&A
BOX AND THEY WILL HAVE AN
OPPORTUNITY TO JOIN THE
MODERATED PANELISTS AT THE END
OF SESSION ONE.
THANK YOU.
>> THANK YOU, DR. LACHOWICZ
SCROGGINS.
I'M TAMARA LEWIS JOHNSON, CHIEF
OF WOMEN'S MENTAL HEALTH
RESEARCH PROGRAM AT THE NATIONAL
INSTITUTE OF MENTAL HEALTH.
I AM HONORED TO BE THE MODERATOR
FOR SESSION ONE TODAY I WILL
INTRODUCE EACH OF THE SPEAKERS
AND THEY WILL DO THEIR
PRESENTATIONS AND WE WILL HAVE A
QUESTION-AND-ANSWER PERIOD AT
THE END OF THE SESSION.
WITH NO FURTHER ADIEU ALLOW ME
TO INTRODUCE OUR KEYNOTE
SPEAKER.
DR. MELISSA SIMON.
SHE IS THE GEORGE GARDENER
PROFESSOR OF CLINICAL GYNECOLOGY
AND VICE CHAIR OF RESEARCH
DEPARTMENT OF OBSTETRICS AND
GYNECOLOGY AT NORTHWESTERN
UNIVERSITY FINE BROOK SCHOOL OF
MEDICINE.
FOUNDER AND DIRECTOR FOR CENTER
FOR HEALTH EQUITY TRANSFORMATION
AND CHICAGO CANCER HEALTH EQUITY
COLLABORATIVE AND SHE'S
RECOGNIZED WITH NUMEROUS AWARDS
FOR SUBSTANTIAL CONTRIBUTION TO
EXCELLENT AND HEALTH EQUITY
SCHOLARSHIP, WOMEN HEALTH AND
MENTOR SHIP EXEMPLIFIED BY
RECENT ELECTION TO NATIONAL
ACADEMY OF MEDICINE.
WITH NO FURTHER ADIEU, ALLOW ME
TO INTRODUCE DR. MELISSA SIMON
WHO WILL GIVE THE TALK AND HOW
CAN EVIDENCE BASED PRACTICES
ADDRESS CO-OCCURRING CONDITIONS
OF MULTI-MORBIDITY AND AT RISK
WOMEN AND GIRLS.
DR. SIMON.
>> THANK YOU, VERY MUCH FOR
THOSE VERY KIND WORDS DR. LEWIS
JOHNSON, THANK YOU FOR THE
INVITATION, I'M HONORED TO BE
HERE TODAY.
I HAVE TO SAY THAT MATERIALS
PROVIDED IN THIS PRESENTATION
REFLECT MY INDIVIDUAL VIEWS AND
DO NOT REPRESENT THE VIEWS OR
RECOMMENDATIONS OF THE UNITED
STATES PREVENTIVE SERVICES TASK
FORCE I'M CONSULTANT FOR AND
IMMEDIATE PAST MEMBER OR THE
OFFICE OF RESEARCH WOMEN HEALTH
ADVISORY COMMITTEE FOR RESEARCH
WOMEN HEALTH WHICH I AM A
MEMBER.
SO THE OVERALL PRESENTATION
SHOULD BE BE A-- SHOULDN'T BE
ATTRIBUTED TO EITHER OF THEM.
MY GOAL FOR THE TALK IS TO SET
INTENTION IN FRAMING TO
HIGHLIGHT SOME KEY TOPICS INTO
REALLY INTEGRATE SOME OF THE
THINGS THAT DR. CLAYTON AND DR.
KOOB AND DR. TEMKIN HAVE JUST
HIGHLIGHTED APPROPRIATELY SO.
TO REALLY START TO GET THE
JUICES FLOWING AND GET SOME OF
YOU FIRED UP MOPEFULLY ALL OF US
TO MOVE THIS FORWARD.
SO LET'S START WITH DEFINITIONS
AND FRAMING.
EVERYONE SEEN THIS, WE KNOW THAT
ARCHITECTURE AND DESIGN ARE
SUPER CRITICAL TO A WELL
FUNCTIONING CELL IN OUR BODY.
THE HARMONY AND ORCHESTRA
ORCHESTRATION OF ALL THOSE CELLS
TOGETHER HELP IMPACT HEALTH IN
MANY WAYS SO ARCHITECTURE AND
DESIGN MATTER MORE THAN THAT.
THEY MATTER IN EVERYTHING WE DO
EVERY STRUCTURE EVERY POLICY.
SO REALLY YOU HAVE TO ASK THE
RIGHT QUESTIONS INVOLVE THE
RIGHT PEOPLE TO GET OUTPUT MOST
REPRESENTATIVE OF THE ISSUE WE
ARE TRYING TO IMPROVE CRITICAL
FOR RESEARCH THAT TRANSLATES TO
IMPACT IMPROVEMENT IN THIS CASE
WOMEN AND GIRLS HEALTH SO WE
HAVE TO ASK THE RIGHT QUESTIONS,
WE DON'T WANT GARBAGE IN AND GET
GARBAGE OUT WE HAVE TO LOOK
UNDER THE HOOD OF THE CAR.
TO EMBED EQUITY ORIENTATION INTO
THE RESEARCH PROCESS, THAT SEEKS
TO IMPROVE HEALTH FOR EARN
PERSON IN THIS CASE WOMEN AND
GIRLS.
WE HAVE TO SCRUTINIZE ALL
RELATED PROCESSES AND STRUCTURE.
SO TO LEVEL SET NEVER ASSUME
ANYBODY KNOWS THE TERMINOLOGY
REGARDLESS OF THE AUDIENCE.
INEQUALITY AND AGAIN THIS IS A
TREE AND IT IS ORGANIC BUT THESE
STRUCTURE POLICY PRACTICES,
RESEARCH ET CETERA IS NOT
ORGANIC.
IT TENDS TO BE HUMAN MADE, HUMAN
IMPOSED, CREATED.
I'M JUST USING THIS AS AN
EXAMPLE.
INEQUALITY MEANS IN THE UP PER
LEFT HAND CORNER THAT THE TREE
OR THE STRUCTURE, THE POLICY,
THE PRACTICE, THE RESEARCH
QUESTION, THE RESEARCH APPROACH,
ET CETERA IS FUNDAMENTALLY BENT.
AND ACTIVELY FAVORING ONE PERSON
OR PEOPLE AND ACTIVELY
DISADVANTAGING ANOTHER GROUP OF
PERSONS OR PEOPLE.
AND IN THE UPPER RIGHT HAND
CORNER EQUALITY MEANS THAT WE
SAY OH WELL WE ARE ALL EQUAL,
THIS IS AN EQUAL COUNTRY, WE ARE
EQUAL UNDER THE CONSTITUTION AND
PRACTICES AND POLICY,
FUNDAMENTAL PRACTICE POLICY
RESEARCH PROJECT EXCLUSION OR
INCLUSION CRITERIA ET CETERA ARE
BENT, WE ARE STILL NOT GOING TO
HELP EVERYBODY GET TO THAT GOAL
WHICH IN THIS CASE IS GETTING AN
APPLE.
OR ACHIEVING HEALTH.
THE LOWER LEFT HAND CORNER
EQUITY FRAMEWORK WHY WE USE
EQUITY IS WE ACKNOWLEDGE
EVERYBODY NEEDS A DIFFERENT LIFT
DIFFERENT SUPPORT DIFFERENT TYPE
OF APPROACH TO GET TO THAT APPLE
OR INTENDED OUTCOME.
FINALLY THE CRITICAL QUESTIONS
TO ASK AND THAT IS WHAT
MULTI-LEVEL SYSTEMS APPROACHES
ARE REALLY IMPORTANT
TRANSDISCIPLINARY TO THINK ABOUT
AND IMPROVE THE HEALTH ACROSS
THE HEALTH SPAN AND LIFE SPAN, I
APPRECIATE THAT, DR. CLAYTON.
WE ASK FUNDAMENTAL QUESTIONS IS
WHY IS THE DARN TREE BENT IN THE
FIRST PLACE.
HOW DO WE UNBEND THE TREE.
I SAY UNDERSTOOD BEND AND NOT
STRAIGHTEN ON PURPOSE BECAUSE WE
ARE TRYING BECAUSE INITIALLY IT
MADE NOT BE FULLY STRAIGHTEN AND
YOU MAY HAVE TO BEND THE OTHER
WAY OR DO SOMETHING DIFFERENT OR
PLAN A NEW TREE, CREATE THE
WHOLE -- BLOW UP THE ORIGINAL
PRACTICE AND START NEW.
SO NOW THAT WE HAVE REVIEWED
DEFINITIONS, LET'S CONSIDER
ENVIRONMENT.
WE TALK A LOT ABOUTSOME
DETERMINANTS OF HEALTH AND HOW
THOSE ARE SO IMPORTANT.
SOCIAL ECONOMIC POLITICAL
FACTORS.
SO ALL OF THESE THINGS SOCIAL
ENVIRONMENT, TRANSPORTATION
EDUCATION EMPLOYMENT, HEALTH
SYSTEMS AND HEALTHCARE DELIVERY
HOUSING INCOME, JOB
OPPORTUNITIES AND NOT JUST JOBS
BUT CAREER PATH OPPORTUNITIES
AND PHYSICAL BUILT ENVIRONMENT
AND WORKPLACE ENVIRONMENTS ARE
CRITICAL AND THEY ACTIVELY ARE
BENT.
THEY ACTIVELY ARE FAVORING SOME
POPULATIONS AND ACTIVELY
DISADVANTAGING OTHERS.
THE UNDERLYING THAT BENTNESS IS
SYSTEMATIC RACISM THAT IS
DRIVING PROMULGATION OF SOCIAL
ECONOMIC POLITICAL FACTORS THAT
ARE DICES ADVANTAGING GIRLS AND
WOMEN ESPECIALLY GIRLS AND WOMEN
OF COLOR.
ANOTHER WAY WAY TO LOOK AT THIS
IS TWO SEPARATE CLIFFS AND WHY
ARE GREEN PERSONS IN THAT
DRAWING CLOSE STARTING CLOSER TO
END OF THE CLIFF WE CALL THEM AT
RISK, I DON'T LIKE CALLING THEM
AT RISK.
THEY ARE SYSTEMATICALLY
EXCLUDED.
SYSTEMATICALLY ON PRESSED
BECAUSE OF THOSE BENT TRIES AND
THAT SYSTEMIC RACISM.
ANOTHER TYPE OF ENVIRONMENT IS
THE RESEARCH PIPELINE.
WE GOT TO THINK ABOUT THIS
BECAUSE THIS IS AN NIH TALK.
I WOULD BE REMISS IF DIDN'T TALK
ABOUT ALL THE POSSIBLE
STRUCTURAL INEQUITIES AND RACISM
AND BIAS ALONG THE ENTIRE
PROCESS.
THAT STARTS WITH AND WHAT IS
REALLY IMPORTANT WE HAVE AN
EVOLVING DEMOGRAPHY AND ABOUT 20
YEARS FROM NOW WHICH IS NOT THAT
MUCH TIME, OUR POPULATION OF OUR
COUNTRY IS GOING TO BE TOTALLY
DIFFERENT.
WE WILL HAVE MORE DIVERSE
PERSONS OF MULTIPLE DIVERSE
BACKGROUNDS, THAT IS SO CRITICAL
BECAUSE IF THEY INPUT OF OUR
RESEARCH AND THE OUTPUT OF OUR
RESEARCH RIGHT NOW IS NOT REALLY
MEETING THE NEEDS OF DIVERSE
POPULATION TO DECADES FROM NOW,
WE ARE IN TROUBLE.
THIS IS FEDERAL MONEY SO WE NEED
TO THINK ABOUT THIS PROCESS AND
HOW WE ARE INVESTING IN OUR
APPROACH TO RESEARCH.
THE FUNDING ANNOUNCEMENT IN
UPPER LEFT HAND CORNER MAKES A
DIFFERENCE, HOW IT IS DESIGNED
AND HOW THAT IS DESIGNED IS
IMPACTED BY THE FEDERATED
STRUCTURE OF NIH FOR EXAMPLE
THINK ABOUT NIH FUNDING.
THIS CAN BE APPLIED TO MULTIPLE
FUNDERS NOT JUST NIH.
SO WE NEED TO THINK ABOUT HOW IS
THE FEDERATED SYSTEM DESIGNED
AND IS THERE AN INSTITUTE THAT
CAN ACTUALLY DO A STANDING PA
PROGRAM ANNOUNCEMENT OR FUNDING
OPPORTUNITY ANNOUNCEMENT OR
STANDING ONE WHICH ARGUABLY
OPENS THE DOORS FOR THE MOST
INNOVATIVE RESEARCH IMPACTFUL
RESEARCH BECAUSE IT GIVES YOU
THE MOST TIME TO DEVELOP THE
TRANSDISCIPLINARY TEAM REQUIRED
FOR THIS TYPE OF WORK.
THAT IS NOT AVAILABLE NOW
BECAUSE THE OFFICE OF RESEARCH
WOMEN HEALTH FOR EXAMPLE IS A
OFFICE AND NOT A IC.
IT CAN'T HAVE A PA.
IT IS JUST ONE EXAMPLE.
THE SCIENTISTS WHO CREATES THAT
SCIENTIST, WHO GETS TO BE A
SCIENTIST, WHO GETS TO BE A PI
OF AN NIH GRANT.
WE KNOW PIPELINE IS WROUGHT WITH
WEEKS AND PATHWAYS THAT ARE NOT
NECESSARILY AMENABLE FOR DIVERSE
PERSONS IN THE RESEARCH
PIPELINE.
FOR THAT DEVELOPMENT THINKING
THROUGH THAT.
STUDY PROTOCOL DESIGN INCLUSION
EXCLUSION CRITERIA, CRITICAL FOR
INVOLVING DIVERSE PERSONS OR
ACTUALLY ACTIVELY EXCLUDING
DIVERSE PERSONS, THINKING ABOUT
WHO PARTNERS ALONG THE WAY WITH
THIS TEAM THE HISTORY OF
DISTRUST AND DISCRIMINATION IN
BIAS RESEARCH PARTICIPATION, HOW
THOSE RESEARCH FINDINGS ARE
SHARED WITH THE COMMUNITY AND
THE PARTICIPANTS WHO PARTICIPATE
IN THE RESEARCH DISSEMINATION
AND IMPACT.
LET'S LOOK.
THIS IS NIH.
ALL THE DIFFERENT 27 ICs THEY
ARE EACH INDIVIDUAL AND WHERE IS
THE WOMAN AND GIRL MANY THE
WOMEN AND GIRLS HEALTH RESEARCH
AND ANY OF THESE?
THEY ARE ACROSS EVERYTHING.
THE FEMALE LOOKING WILD ON THE
RIGHT HAND CORNER IS KIND OF AT
THE CORNER AND AFTER THOUGHT OF
THAT.
WHAT WE REALLY NEED TO DO IF WE
ARE GOING TO ADDRESS NIH AS A
MISSION TO NOT ONLY GENERATE
KNOWLEDGE BUT TO ALSO APPLY THAT
KNOWLEDGE TO ENHANCE HEALTH
LENGTH AND LIFE AND REDUCE
ILLNESS AND DISABILITY.
WE CAN DO SYSTEMS THINKING
ACROSS THE LIFE SPAN AND HEALTH
SPAN TO ADVANCE INTEGRATIVE CARE
AND REDUCE MORBIDITY AND
OPTIMIZE HEALTH ALONG THAT
COURSE FOR WOMEN AN GIRLS.
THIS SIDE ROAD APPROACH OF ICs
DICTATES HOW FUNDING
ANNOUNCEMENTS ARE DESIGNED AND
HOW RESEARCH PROPOSALS ARE
CREATED.
THAT POSES A CHALLENGE WHEN
TRYING TO DO THIS WORK.
LET'S CONSIDER EXAMPLES OF
DISPARITIES.
YOU HEARD FROM DR. TEMKIN,
MENTAL HEALTH NOT ONLY DO WOMEN
BEAR THE BRUNT OF MENTAL HEALTH
DISPARITIES IN THE U.S. BUT WHEN
DATA EXAMINED BY RACE AND
ETHNICITY CLEAR MINOR ADVERTISED
GROUPS ARE MORE -- MINORITIZED
GROUPS EXPERIENCE RISK FACTORS
AND MORE LIKELY TO PERSIST.
THERE ARE WIDE ACCESS GAPS TO
CARE.
ESPECIALLY IN OTHER LANGUAGES
BESIDES ENGLISH.
THE BURDEN OF CART OWE VASCULAR
DISEASE OBESITY OSTEOARTHRITIS
AND OTHER CHRONIC DEBILITATING
CONDITIONS ARE SHOULDERED BY
BLACK AND LATINA OR LATINA
WOMEN, IT IS ALMOST EVERY STUDY
OF WOMEN OF COLOR ARE
UNDER-REPRESENTED.
MENOPAUSE FOR EXAMPLE BLACK
WOMEN EXPERIENCE MORE SYMPTOMS
YET SUBSTANTIALLY
UNDER-REPRESENTED IN THE
RESEARCH ESPECIALLY CLINICAL
TRIALS.
BLACK AND LATINO WOMEN HAVE
HIGHER RISK OF DEMENTIA AND
ALZHEIMER'S RELATED ASSOCIATED
DISEASE AND PREVENTIVE SERVICES
THAT CAN PREVENT CHRONIC
DEBILITATING CONDITIONS THERE'S
SUBSTANTIAL RESEARCH GAPS THAT
LIMIT APPLICABILITY GUIDELINES
AND RECOMMENDATIONS CONCORDANT
CARE.
HAVE SUBSTANTIAL IMPLEMENTATION
AND UPTAKE GAPS ACROSS THE
COUNTRY.
RECOMMENDATIONS ARE NOT
IMPLEMENTED IN THE SAME WAY BY
THAT SOMETIMES DETERMINED BY ZIP
CODE OR CLINIC THAT YOU GO TO.
FOR EXAMPLE LUNG CANCER
SCREENING IS A GREAT EXAMPLE OF
LOW IMPLEMENTATION UPTAKE AND
PRACTICE.
SO THESE CONDITIONS CHRONIC
DEBILITATING CONDITIONS START
DURING CHILDHOOD OR EARLY HAD
LESS SENSE OR WOMEN HOOD WITH
CUMULATIVE BUILD UP
OPPORTUNITIES FOR PREVENTION
TREATMENT TO MITIGATE IMPACT.
THAT IMPACTS THE HEALTH SPAN
WHICH IS IMPORTANT AND NOT JUST
MORE SYMPTOMS BUT ATYPICAL
SYMPTOMS THAT WOMEN GET.
CORE RESPONSES TO FIRST LINE
TREATMENT.
CO-MORBIDITY IS A PROXY FOR
POORLY UNDERINADEQUATELY COMPLEX
MORBIDITY.
SO LET'S CONSIDER INTEGRATIVE
MULTI-LEVEL APPROACHES.
IMPLEMENTATION SCIENCE SYSTEMS
THINKING. IMPLEMENTATION
SCIENCE IS SUPPOSED TO REALLY
CLOSE THAT SCIENCE PRACTICE GAP.
THIS IS ONE OF MANY
IMPLEMENTATION SCIENCE FRAME
WORKS, THIS IS CONSOLIDATED
FRAMEWORK FOR IMPLEMENTATION
RESEARCH.
REALLY THIS IS WHAT IT LOOKS
LIKE.
SO YOU ARE REALLY LOOKING AT
DIFFERENT ENVIRONMENTS AND
PLACES THAT IMPACT ULTIMATELY
THE CARE WORK FLOW, ET CETERA SO
THERE IS OUTER SETTING AND INNER
SETTING AND INDIVIDUALS INVOLVED
THERE IS AN ITERATIVE PROCESS OF
EXAMINING THIS SO RAPID
ASSESSMENT IS IMPORTANT IN THIS
TYPE OF WORK.
RAPID CYCLE PROCESS IMPROVEMENT
AND OTHER THINGS.
IF WE LOOK AT THIS, IF WE LOOK
UNDER THE HOOD OF THE CAR THERE
IS OPPORTUNITY WE HAVE TO ALSO
MARRY HEALTH EQUITY AND
ANTI-RACISM APPROACHES AND
IMPLEMENTATION SCIENCE SYSTEM
THINKING IN ORDER TO DO THESE
TYPES OF PROJECTS AND IN ORDER
TO BEST GET THE END RESULT WE
WANT TO APPLY TO ALL
POPULATIONS.
SO WE NEED TO THINK ABOUT BIAS
THROUGHOUT SOCIETY SOCIO
POLITICAL STRUCTURE, POLICY
PRACTICES ORGANIZATIONAL CULTURE
EXPECTATIONS AND NORMS WHO IS ON
THE RESEARCH TEAM IS ALSO REALLY
IMPORTANT, WHO IS FUNDING THE
RESEARCH, HOW IS THAT FUNDING
OPPORTUNITY DESIGNED BECAUSE HOW
IT IS DESIGNED IS HOW RESEARCHER
LIKE ME IS GOING TO WRITE IT
BECAUSE THAT IS WHAT YOU TOLD ME
YOU HAVE TO DO TO ADDRESS IN MY
RESEARCH PROPOSAL IN ORDER THE
GET A GOOD REVIEW POTENTIALLY IN
ORDER TO GET FUNDED.
WHAT ARE THE JOURNALS THAT ARE
PUBLISHED IN THE RESEARCH.
THERE IS A LOT OF ISSUES WITH
PUBLICATION AND BIAS, WHO GETS
TO BE PUBLISHED IN CERTAIN
JOURNALS.
AGAIN, THIS IS A SYSTEMS
APPROACH.
SO THAT WAS IMPLEMENTATION
SCIENCE, THIS IS A SYSTEMS
APPROACH AND WHEN YOU ARE
LOOKING AT SYSTEMS YOU HAVE
EVIDENCE BASED INTERVENTIONS
THAT WORDS ON THE TOP, YOU GOT
ACROSS THE HEALTH SPAN AND LIFE
SPAN OF INDIVIDUAL GIRL OR
WOMEN.
YOU HAVE IMPLEMENTATION RESEARCH
GOING SICKICALLILY ITERATIVELY
RAPID CYCLE PROCESSES, RAPID
APPROACHES, YOU GOT IN THE
MIDDLE THE CORE LENS THAT YOU
WANT TO DO.
THAT YOU WANT TO LOOK THROUGH,
MAKE SURE THAT HEALTH EQUITY
STRUCTURAL RACISM THOSE ARE ALL
ADDRESS, BIAS MODELS AND SOCIAL
NORMS EXIST AND YOU HAVE TO
UNDERSTAND THAT AND YOU WANT TO
ALSO COMBAT THAT DISINFORMATION
HAPPENING AT THE SAME TIME.
LIVING IN THIS PANDEMIC THAT
INCLUDES DISINFORMATION.
L THESE ARE SOME EXAMPLES OF
CROSS CUTTING PRIORITY AREAS IN
THE BLUE H. ACCESS TO FOODS
ACTIVITIES, THE BUILT WORK
ENVIRONMENT SCHOOLS MENTAL
HEALTH ISSUES HEALTHCARE
DELIVERY, THE CRITICAL COMMUNITY
PARTNERSHIPS AND PRIVATE
PARTNERSHIPS FEDERAL ASSISTANCE
PROGRAMS.
THIS IS AN EXAMPLE AND IT IS NOT
MEANT FOR YOU TO READ IT.
WHAT IT IS MEANT FOR YOU TO DO
IS PIQUE YOUR CURIOSITY, I HAVE
THE WEBSITE, FROM NATIONAL
ACADEMY OF SCIENCE ENGINEERING
AND MEDICINE ROUND TABLE ON
OBESITY.
WHAT THIS IS, IS A SYSTEMS
APPROACH, I WAS PART OF THIS,
SYSTEMS MAP COMBINING SYSTEMS
AND SOLUTIONS FOR OBESITY, THIS
IS JUST OBESITY.
THIS IS WHAT NEEDS TO BE DONE
AND ADDRESSED AND SOMEHOW
APPROACHED IN ORDER TO GET TO
THE OUTCOME OF REDUCING OBESITY
IN THIS COUNTRY.
THAT IS HOW COMPLEX IT IS.
THAT IS WHAT I'M CHALLENGING
Y'ALL TO THINK ABOUT OF HOW WE
WOULD APPLY THIS AND FOR THE
OTHER -- ALL THE OTHER
CONDITIONS WE ARE TALKING ABOUT
TODAY AND THE OTHER CONDITIONS
IN GENERAL.
ONE VERY SPECIFIC EXAMPLE, WE
ARE NOT TALKING CERVICAL CANCER
IN THE TWO DAY AGENDA, BUT THIS
IS A LITTLE MORE SPECIFIC AND
PRACTICAL.
THE WHO WORLD HEALTH
ORGANIZATION SAY THERE'S THREE
COLORS OF CERVICAL CANCER
ELIMINATION.
YOU HAVE TO DO ALL THREE IN
ORDER TO GET TO INCIDENCE LESS
THAN FOUR FOR HUNDRED THOUSAND
CASES PER YEAR AND THIS IS
POSSIBLE IN OUR COUNTRY.
BUT OUR RATES OF CERVICAL CANCER
HAVING STAGNANT FOR A DECADE
BECAUSE WE CAN'T DO THIS WELL.
WE HAVEN'T DONE ALL THREE.
THE HPV VACCINATION, SCREENING
AND FOLLOW UP AND TREATMENT YOU
NEED ALL THREE AND IN ORDER TO
DO THIS, THERE IS ALREADY A
MYRIAD OF WONDERFULLY FUNDED NCI
AND NIH STUDIES FOR EXAMPLE THAT
ACTUALLY HAVE PROVEN EVIDENCE
BASE INTERVENTIONS.
YOU NEED TO BE ABLE TO IMPLEMENT
ALL THREE EVIDENCE BASED
INTERVENTIONS ADDRESSING ALL
THREE PILLARS.
SO YOU NEED TO BE ABLE TO TAILOR
TO THE INDIVIDUAL CLINIC IN
TERMS OF WHAT ON THE MENU OF
EACH OF THESE PILLARS THAT ARE
EVIDENCE BASED INTERVENTIONS
BECAUSE THERE IS MORE THAN ONE
FOR EACH THREE PILLARS WHICH
ONES WORK FOR THE PARTICULAR
CLINIC.
THAT'S HOW DETAILED YOU HAVE TO
GET.
SO THAT IS REALLY IMPORTANT TO
THINK ABOUT WHAT THE COMPLEXITY
AND THE VOLUME AND SCALE THAT
NEEDS TO BE DONE IN ORDER TO
ACHIEVE WHAT Y'ALL WANT TO
ACHIEVE.
HERE IS THE EXAMPLE FROM
CHICAGO.
I WILL TAKE BREAST CANCER THIS
IS WHAT I HAVE DONE A LOT OF.
OUR BREAST CANCER DISPARITIES IN
CHICAGO BETWEEN BLACK AND WHITE
WOMEN WERE EGREGIOUS.
THE MAGENTA LINE IS BLACK
MORTALITY TO BREAST CANCER AND
THE GRAY LINE ON THIS GRAPH IS
WHITE MORTALITY.
SOMEWHERE THEY START AROUND THE
SAME MORTALITY RATES IN EARLY
'80s AND SOMEWHERE ALONG THE
WAY IN THE MID 90s THOSE
MORTALITY LINES DIVERGE.
BY 2007 BLACK WOMEN IN CHICAGO
ALL THE WAY AT THE RIGHT OF THE
YOUR GRAPH BLACK WOMEN IN
CHICAGO WERE DYING AT A RACE 62%
GREATER THAN WHITE WOMEN.
WHY IS THIS HAPPENING?
WE KNEW THAT IN NEW YORK THE
RATE WAS 27%, UNITED STATES IT
WAS IN THE 40s, WHAT WAS GOING
ON IN CHICAGO?
TREES WERE BENT.
AND THEY WERE BENT ACROSS
MULTIPLE POLICIES MULTIPLE
PRACTICES, RED LINING,
DISINVESTMENT IN COMMUNITIES ON
THE WEST AND SOUTH SIDE BLACK
WOMEN WERE CONCENTRATED, OVER
DECADES.
ACCESS ISSUES, ISSUES AROUND THE
MAMMOGRAPHY SCREENING FOLLOW-UP,
ALL THESE THINGS.
WHEN YOU TAKE A SYSTEMS APPROACH
AND STRUCTURAL ELEMENTS OF
ECOLOGY TO THINK ABOUT SOCIAL
ECOLOGICAL MODEL WHAT YOU NEED
TO DO INTERPERSONAL BARRIERS
COMMUNITY BARRIERS NEEDED
PATIENT NAVIGATION APPROACH.
THE HEALTH SYSTEM BARRIERS AND
COMMUNITY BARRIERS NEEDED
IMPLEMENTATION SCIENCE AND
QUALITY IMPROVEMENT APPROACHES,
RAPID CYCLE APPROACHES.
THEN THERE NEEDED TO BE ADVOCACY
POLICY AND CERTAINLY GOOD
COMMUNICATION.
SO PATIENT NAVIGATION IS AN
EVIDENCE BASED INTERVENTION, IT
IS A COMPLETE EDI WE KNOW THIS.
IT IS NOT ONE SIZE FITS ALL, IT
IS MORE THAN JUST INDIVIDUAL
NAVIGATORS, THE CORE PRINCIPLES
ARE PATIENT CENTERED AND
COMMUNITY CENTERED.
CAN ADJUST DIFFERENT HEALTHCARE
SETTINGS.
AND IT IS TO ELIMINATE BARRIERS
TO TIMELY CARE ACROSS ALL PHASES
OF THE HEALTHCARE CONTINUUM AND
DOES A SYSTEMS APPROACH.
IT IS VITAL TO SCALE UP PATIENT
NAVIGATION APPROACHES THAT EMBED
EQUITY AND ANTI-RACISM
PRINCIPLES.
THAT IS HOW, IT IS CRITICAL.
THAT IS NOT THE ONLY THING WE
DID.
WE HAD TO THINK ABOUT OTHER
PATIENT NAVIGATION APPROACHES
AND ONE IS THIS CHECKLIST.
THIS IS AN EXAMPLE OF WHAT OUR
TEAM HAS DEVELOPED FOR OUR
SEQUENCE.
THIS IS JUST ONE EXAMPLE FOR
BREAST CANCER, WHAT WE DID IS WE
TOOK A GANT CHART WE WORKED WITH
SYSTEMS ENGINEERS, WE TOOK A
GANT CHART AND PUT ALL THE
POSSIBLE THINGS A PATIENT NEEDED
TO GO THROUGH WHEN THEY STARTED
BREAST CANCER SURGERY, ALL THE
LIST.
THE REASON WHY THE LIST AND
BEING A PAPER FORM IS SO
CRITICAL, ONE CHECK BOX IS NOT
CHECKED, IT GIVES PATIENT AND
CAREGIVER AGENCY TO SAY HEY DOC
OR TEAM OR NURSE, HEY WHATEVER,
WHY IS THIS BOX NOT CHECKED?
WHEN YOU HAVE LOW LITERACY AND
ALL THE OTHER ISSUES, EXPERIENCE
DISTRUST IN THE HEALTHCARE
SYSTEM, HAVING IT SIMPLE LIKE
THIS, BEING ABLE TO SAY THAT BOX
ISN'T CHECKED AND WHEN IS IT
GOING TO GET CHECKED HELPS
TREMENDOUSLY.
THAT IS THE BACK OF THAT PAPER
THE DIFFERENT CONTACTS FOR EACH
OF THOSE DIFFERENT THINGS.
THE OTHER THING SYSTEMS
APPROACHES IMPLEMENTATION
SCIENCE DOES IS BRING PEOPLE
TOGETHER.
WE HAVE STUDIED THAT IT BRINGS
-- BUILDS MORE RELATIONSHIPS
BETWEEN THE WRAP AROUND SERVICE
AGENCIES THAT ARE SO CRITICAL IN
A COMMUNITY TO ADDRESSING THE
SOCIAL ECONOMIC DETERMINANTS OF
HEALTH.
SO WHEN YOU HAVE RELATIONSHIPS
AND AGENCIES COMING TOGETHER TO
WRAP AROUND CARE BECAUSE THE
HEALTH SYSTEMS CANNOT ADDRESS
ALLSOME DETERMINANTS OF HEALTH.
THAT IS WHAT IMPROVES CARE
DELIVERY IN A SYSTEMS WAY.
VERY COLLABORATIVE AND ITERATIVE
EFFORT WE WERE ABLE TO CLOSE THE
GAP.
THIS WAS 2017, WE CLOSE AROUND
36% MORTALITY SO LOOK AT THE FAR
RIGHT.
THAT IS A CONTINUUM OF THE GRAPH
THAT I ALREADY SHOWED EARLIER.
THAT TOOK A LOT OF SYSTEMS
APPROACH IMPLEMENTATION SCIENCE
AND A LOT OF ITERATION.
IT WAS PREDICATED ON THINGS LIKE
COLLABORATIVE LIKE CHICAGO
CANCER HEALTH EQUITY
COLLABORATIVE ACROSS THE CITY,
THANKS TO FUNDING FROM NCI, IT
TOOK COMMUNITY PARTNERSHIPS,
AGAIN FUNDED BY SEVERAL FUNDERS
INCLUDING NIH, IT TOOK
PARTNERSHIPS WITH THE LIBRARIES
AND WE ARE STILL DOING THIS,
NLM.
AGAIN COMMUNITY SCIENTISTS AND
BRINGING THEM INTO OUR BENCH
INTO OUR RESEARCH TEAMS TO
IMPROVE THIS APPROACH.
BUT IT REQUIRED MULTIPLE
INSTITUTES AND MULTIPLE
PROPOSALS MULTIPLE FAILURE AND
MANY YEARS.
THE OTHER THINGS TO CONSIDER AS
I CLOSE TODAY IS OPTIMIZING
TRAINING CAREER MENTORSHIP
PATHWAYS TO DO THIS WORK, NOT
ALL PEOPLE KNOW HOW TO DO THIS
WORK AND HOW TO MENTOR IT.
THAT'S CRITICAL.
ENHANCING DIVERSION COMMUNITY
OPTIMIZING COMMUNITY ENGAGEMENT
INVOLVEMENT SUPPORT AND NOT
EVERYBODY KNOWS HOW TO DO THAT
EITHER.
I APPRECIATE SOME GREAT CURRENT
NIH EXAMPLES OF THE UNITE
INITIATIVE, THE FIRST GRANT, THE
CL INITIATIVE, OFFICE OF
RESEARCH WOMEN'S HEALTH HAVE A
VARIETY OF INITIATIVES BESIDES
SCORE GRANT, THIS CURRENT NOTICE
OF SPECIAL INTEREST TO U 3
MECHANISM NHLBI IS MATERNITY
HEALTH COMMUNITY IMPLEMENTATION
PROJECT THAT I'M PART OF NIMH
HAS A GREAT MENOPAUSE TRANSITION
RFA THAT I APPRECIATE.
IN CONCLUSION CURRENT RESEARCH
FUNDING DESIGN NIH STRUCTURE
CREATES DOESN'T ALIGN WITH THIS
NIH MISSION TO TURN THIS INTO
HEALTH AND WE ARE TALKING WOMEN
AND GIRLS CHRONIC CONDITIONS,
AND TRYING TO PREEMPT THEM.
IT DOESN'T READILY ALLOW
RESEARCH TEAMS TO
COMPREHENSIVELY AND ADEQUATELY
ADDRESS THE NUANCE SEX SPECIFIC
GENDER AND VERGE WITH HEALTH
SPAN AND LIFE SPAN MULTI-SYSTEMS
IMPLEMENTATION APPROACHES NEEDED
TO ADDRESS THE WHOLE WOMAN AND
ESPECIALLY WOMEN OF COLOR.
IT DOESN'T MEET TRUE WOMEN'S
CRITICAL CARE NEEDS AND WOMEN
ARE 50.6% U.S. POPULATION.
SO INSTEAD OF THIS, THESE
INDIVIDUAL ROADS THAT HAVE
CRACKS AND GAPS IN TREES THAT
ARE BENT.
WE WANT THIS.
THIS IS A WAY WE WANT TO GO.
THANK YOU SO MUCH, I APPRECIATE
YOU INVITING ME HERE.
HERE IS MY CONTACT INFORMATION
IF YOU HAVE ANY QUESTIONS I LOOK
FORWARD TO OUR QUESTION AND
ANSWER.
>> THANK YOU SO MUCH, DR. SIMON,
FOR THAT OUTSTANDING KEYNOTE
ADDRESS.
NOW WE WILL GO INTO OUR
PANELIST, THE FIRST OF WHOM IS
DR. KIM TEMPLETON, PROFESSOR OF
ORTHOPEDIC SURGERY UNIVERSITY OF
KANSAS MEDICAL CENTER IN KANSAS
CITY.
AND DEPARTMENT VICE CHAIR FOR
DIVERSITY EQUITY AND INCLUSION.
SHE WAS THE FIRST MCCAN
PROFESSOR OF WOMEN AND SCIENCE
IN THE UNITED STATES.
SHE RECEIVED NUMEROUS AWARDS
FROM THE UNIVERSITY AS WELL AS
NATIONAL ORGANIZATIONS TO
RECOGNIZE LEADERSHIP IN HER WORK
ADVANCING THE CAUSE OF WOMEN IN
MEDICINE.
DR. TEMPLETON IS A PAST
PRESIDENT OF THE U.S. PHONE AND
JOINT INITIATIVE AND THE
AMERICAN MEDICAL WOMEN'S
ASSOCIATION.
SHE IS THE PAST VICE CHAIR OF
THE AMA WOMEN PHYSICIAN SECTION
AND PAST CHAIR OF THE AMA
ORTHOPEDIC SECTION SHE INITIATED
AND WORKED WITH THE AMA
DEVELOPING NEW POLICY TO
RECOGNIZE AND EXPAND DEFINITION
OF WOMEN'S HEALTH.
SHE IS A MEMBER OF THE BONE AND
JOINT EXPERT REVIEW COMMITTEE OF
THE NCQA AND ADVISORY COMMITTEE
TO THE OFFICE OF RESERGE SEARCH
ON WOMEN'S HEALTH.
SHE WILL TALK THIS AFTERNOON
ABOUT THE IMPACT OF CHRONIC
DEBILITATING CONDITIONS ON
WOMEN.
WITH NO FURTHER ADIEU, DR.
TEMPLETON.
>> THANK YOU SO MUCH FOR THE
KIND INTRODUCTION AND
OPPORTUNITY TO SPEAK TODAY.
SO I WILL TALK CHRONIC
DEBILITATING CONDITIONS FOCUSING
ON ONE, THAT IS OSTEOARTHRITIS.
THE REASON I AM FOCUSING ON
THAT, IS OSTEOARTHRITIS IS
LEADING CAUSE OF DISABILITY
ACROSS THE GLOBE AS WELL AS
WITHIN THE UNITED STATES.
THERE IS ALSO HIGHER PREVALENCE
AMONG WOMEN.
WHETHER YOU DEFINE THIS AS
PATIENT REPORTED PHYSICIAN
REPORTED, RADIOGRAPHIC
OSTEOARTHRITIS, ANY DEFINITION
YOU USE, WOMEN ARE MORE COMMONLY
AFFECTED.
YOU CAN SEE THE GRAPH ON THE
LEFT SHOWING PROPORTION OF WOMEN
TO MEN.
THIS IS ACROSS LIFE SPAN
STARTING AGE 40 YOU SEE
DISPARITIES BETWEEN WOMEN AND
MEN.
THE PREVALENCE LIFETIME RISK FOR
DEVELOPING OSTEOARTHRITIS IS
25%, ABOUT 30% WOMEN AND 20% FOR
MEN.
EVEN THOUGH WE KNOW
OSTEOARTHRITIS IS MORE COMMON
AMONG WOMEN WHAT WE DON'T
UNDERSTAND IS WHY IT IS MORE
COMMON, ONCE WE UNDERSTAND THAT
ARE THERE WAYS WE CAN PREVENT
THIS BECAUSE OSTEOARTHRITIS IS A
DEBILITATING CONDITION AND IT IS
EXPENSIVE TO TREAT.
IF YOU LOOK ANT GRAPH ON THE
RIGHT MOST JOINTS OTHER THAN
SHOULDER OSTEOARTHRITIS IS MORE
COMMON IN WOMEN THAN MEN THOUGH
DATA FOR SHOULDER IS POOR SO
THERE MAYBE A DIFFERENCE THERE.
WHERE YOU SEE GREATEST GAP IS IN
THE PREVALENCE OF
NEOOSTEOARTHRITIS, REPRESENTING
ABOUT 80 PERCENT OF THE BURDEN
OF DISEASE FROM OA SO I WILL
FURTHER FOCUS ON THAT AND SHOW
SOME OF THE ISSUES THAT WE SEE
AMONG WOMEN.
SO IF YOU LOOK AT SEX AND GENDER
SPECIFIC RISK FACTORS THERE ARE
A VARIETY OF THEM THAT HAVE BEEN
DISCUSSED IN THE LITERATURE
WHETHER ACQUIRED DUE TO INJURY,
INHERENT DUE TO VARIOUS ANATOMIC
DIFFERENCE GATE PATTERNS IMPACT
OF SEX HORMONE LEVELS MUSCLE
STRENGTH, FOR A LOT OF THIS WHAT
YOU GET TO IS A CORE DIFFERENCE
IN INFLAMMATORY RESPONSE.
WHETHER INFLAMMATORY RESPONSE TO
INJURIES, OBESITY, OR JUST OA
DEVELOPS THERE IS INFLAMMATORY
REACTION WHICH MAY BE
SELF-PERPETUATING LEADING TO
FURTHER CARTILAGE INJURY SO
LOOKING FIRST AT JOINT INJURIES,
JOINT INJURIES SPECIALLY KNEE
INJURIES LIGAMENT INJURY
SIGNIFICANTLY HIGHER AMONG WOMEN
THAN MEN, THERE IS A VARIETY OF
REASONS FOR THAT, MOST RESEARCH
WENT TO DIFFERENCES IN
NEUROMOOSE SKYLAR CONTROL.
WHEN YOU LOOK AT -- NEUROMS.
SKEWS LAR CONTROL.
WHEN YOU LOOK AT ATHLETES.
THE RISK OF DEVELOPING
OSTEOARTHRITIS IS HIGHER IN
WOMEN THAN MEN AND RISK HAPPENS
ABOUT -- STARTS INCREASING ABOUT
15 YEARS EARLIER.
WHEN YOU LOOK AT EVEN MORE
RECENT DATA THAT'S FOLLOWING FOR
LONGER PERIOD OF TIME THE STATE
IS STILL HOLDS UP.
BUT WHY?
WHY WITH THE SAME INJURY, THE
SAME LEVEL OF DAMAGE ARE WOMEN
MORE LIKELY TO DEVELOP
OSTEOARTHRITIS, THERE'S SOME
INFLAMMATORY RESPONSE TO INJURY
PERHAPS THAT LEADS TO FURTHER
CARTILAGE LOSS BUT WE DON'T KNOW
THAT'S WHERE WE HAVE A LARGE GAP
IN THE DATA.
EVEN AFTER KNEE RECONSTRUCTION
OR ACL RECONSTRUCTION THIS GAP
STILL EXISTS, STILL RISK OF
OSTEOARTHRITIS.
WHEN YOU LOOK AT THE DATA PART
OF THE PROBLEM LIKE MANY
CONDITIONS IS LACK OF
DISAGGREGATION OF RESULTS BASED
ON SEX OR GENDER.
WE DID A SYSTEMATIC REVIEW
IMPRESSED AT THIS POINT WHAT ARE
THE RESULTS FROM THE ONLY A
THIRD OF STUDIES REPORTED
RESULTS AT ACL RECONSTRUCTION
BASED ON SEX OR GENDER, WITHOUT
THE DATA HARD TO KNOW WHAT THE
DIFFERENCES ARE, AND WHY AND
THEN WHAT CAN WE DO IN TERMS OF
INTERVENTION.
ONE INTERVENTION WE KNOW WORKS
SEX BASED DIFFERENCES, AND
PREVENTION MEASURES FOR KNEE
INJURY, UNFORTUNATELY THESE ARE
NOT CONSISTENTLY IMPLEMENTED.
OTHER RISK FACTORS FOR
OSTEOARTHRITIS OF THE KNEE, A
VARIETY OF THINGS DISCUSSED, A
LOT OF IT INHERENT ANATOMIC
DIFFERENCES, OTHER THINGS
DIFFERENT INTEND TO ARE HAVE
GREATER VOLUME ON KNEE CARTILAGE
BASED ON BODY AND SIZE.
THE DIFFERENT FOR WOMEN, WOMEN
HAVE LARGER PROMINENT ANTERIOR
CHON DIAL ALONG THE FEMUR.
WHEN YOU LOOK AT THESE THINGS
INCLUDING THE Q ANGLE, IN TERMS
OF CAUSING ISSUES WITH THE KNEE,
THESE RAISE CONCERNS ABOUT
INCREASE RISK OF OSTEOARTHRITIS,
BUT NONE OF THESE ARE THINGS
THAT YOU CAN ADDRESS.
NONE OF THESE ARE THINGS THAT
YOU CAN IN WHICH YOU CAN
INTERVENE TO PREVENT
OSTEOARTHRITIS.
THOUGH INTERESTING, THERE IS NOT
A LOT WE CAN DO ABOUT IT.
I THINK PROBABLY BETTER THINGS
TO LOOK AT ARE MORE DYNAMIC
MEASURES, THERE ARE VARIOUS SEX
BASE DIFFERENCES THAT ARE
IDENTIFIED IN TERMS OF FORCES
AND MOMENTS AROUND THE KNEE AND
THOSE WITHOUT OSTEOARTHRITIS.
THOSE DIFFERENCES LEAD TO SEX
BASED DIFFERENCE IN LOADING
ARTICULATE CARTILAGE BUT WHAT WE
DON'T KNOW IS DOES THAT IMPACT
THE RISK OF DEVELOPING
OSTEOARTHRITIS.
IF SO THEN ARE THESE PLACES IN
WHICH WE CAN INTERVENE AND
ADDRESS ISSUES WITH WOMEN
DEVELOPING OSTEOARTHRITIS.
WE KNOW THERE ARE EFFECTS OF
ESTROGEN ON ARTICULAR CARTILAGE,
THIS IS A STUDY LOOKING AT MICE
WITH A MODEL INDUCED
OSTEOARTHRITIS, O VARYECTOMY LED
TO INCREASE CARTILAGE INJURY.
UNKNOWN IF THAT WAS DIRECT
IMPACT ON CARTILAGE, THOUGH
CARTILAGE CONTAINS ESTROGEN
RECEPTORS, MAYBE WAS INDIRECT
EFFECT BECAUSE OF LOSS OF SUB
BONE BUT WHAT WE DO WITH THIS AS
MAN AL STUDY DOES THIS TRANSLATE
TO INCREASE RISK OF
OSTEOARTHRITIS OF THE KNEE WE
SEE IN WOMEN AFTER MENOPAUSE.
THERE'S RECENT STUDIES THAT SHOW
LEVELS OF SEX HORMONE HAVE NO
IMPACT ON CARTILAGE VOLUME AMONG
MEN HOWEVER AMONG WOMEN THERE
WAS INCREASE LEVEL OF CARTILAGE
FOR THOSE HIGHER LEVELS OF
PROGESTERONE AND LOWER ESTRADIOL
LEVELS CORRELATED WITH BONE
MARROW LESIONS SUGGESTED TO
INTERCARTILAGE.
INTERESTING BUT IS THERE A
CAUSATIVE FACTOR, THIS WHERE WE
NEED MORE RESEARCH.
MUSCLE STRENGTH BOTH INHERENT AS
WELL AS ACQUIRED, IN THIS STUDY
WE LOOK AT WOMEN THAT HAD
OSTEOARTHRITIS PLUS OR MINUS
HAVING X-RAY CHANGES.
THE GRAPH AT THE RIGHT THE SCALE
IS A MEASURE OF DEGREE OF
OSTEOARTHRITIS 0 TO 1 MILD 3 TO
4 IS SEVERE.
AMONG THOSE AS YOU CAN SEE FROM
THIS THE HIGHER THE SCORE OR THE
GREATER DEGREE OF OSTEOARTHRITIS
THE WEAKER THE QUADRICEP
STRENGTH.
INTERESTING ANY IN THE STUDY
HALF PARTICIPANTS HAD PAIN SO
YOU CAN'T ENTIRELY ATTRIBUTE THE
LOSS OF STRENGTH TO PAIN IN THIS
STUDY.
SO DID THE LOSS OF STRENGTH LEAD
TO OSTEOARTHRITIS, IS THAT
ANOTHER ADDITIONAL CONTRIBUTING
FACTOR, ESPECIALLY RADIOGRAPHIC
CHANGES BUT NOT SYMPTOMS FROM
THIS, IS THIS AN AREA WHERE WE
CAN POTENTIALLY HAVE IMPACT IF
THERE IS A RELATIONSHIP BETWEEN
QUADRICEP OR OTHER STRENGTH
WEAKNESS AND ABILITY TO
STABILIZE THE JOINT AND RISK OF
DEVELOPING OSTEOARTHRITIS
ESPECIALLY A WOMEN BECAUSE YOU
DON'T SEE THE SAME RELATIONSHIP
IN MEN, THIS GIVES AN AREA WHERE
WE CAN POTENTIALLY HAVE IMPACT
IN TERMS OF PREVENTION IF NOT
TRYING TO RELIEVE SYMPTOMS.
WE KNOW HIGHER LEVELS OF BMI
PLACE ADDITIONAL STRESSORS ON
CARTILAGE, THIS RELATIONSHIP OF
RISK OF CARTILAGE DAMAGE WITH
INCREASING BMI IS GREATER AMONG
WOMEN THAN MEN.
THIS IS A POPULATION BASED CASE
CONTROL STUDY, LOOKING AT THOSE
PATIENTS THAT WERE WAITING FOR
ARTHROPLASTY COMPARED TO SEX AGE
MATCH CONTROLS.
ON THE RIGHT BMI INCREASE THERE
WAS INCREASING ODDS RATIO OF
HAVING SYMPTOMATIC
OSTEOARTHRITIS.
THERE WAS INTERACTION BETWEEN
BMI AND OTHER ISSUES SUCH AS
PREVIOUS INJURY BUT ESPECIALLY
IN WOMEN, THAT RELATIONSHIP WAS
MORE THAN ADDITIVE.
THE RISK ASSOCIATED WITH PIECETY
TENDED TO BE HIGHER WOMEN THAN
MEN THOUGH DEGREE OF RISK WAS
NOT DESCRIBED IN THE STUDY.
SO FOR BOTH MEN AND WOMEN THERE
IS AN IMPACT OF BMI PUTTING
STRESS ON CARTILAGE ON THE RISK
OF OA BUT THAT RELATIONSHIP IN
WOMEN IS HIGHER.
WHY IS IT HIGHER?
IS IT RELATED TO OTHER THINGS
PRIOR INJURY?
INFLAMMATION THERE IS HIGHER
INFLAMMATORY RESPONSE AMONG
THOSE THAT ARE OBESE SO IS THIS
WITH GREATER INFLAMMATORY
RESPONSE WOMEN, IS IT AN
INFLAMMATION RELATED RESPONSE?
THE WOMEN ALSO TEND TO HAVE
HIGHER ASSOCIATION BETWEEN
METABOLIC SYNDROME
OSTEOARTHRITIS.
THE STUDY EFFECT OF OBESITY
GREATER FOR WOMEN THAN MEN.
THE HIGHER THE LAWRENCE SCALE
LOOKING AT HIGHER DEGREE OF
OSTEOARTHRITIS ON THE RIGHT MORE
SIGNIFICANT AMONG WOMEN THAN MEN
WHEN YOU GET HIGHER LEVELS OR
DEGREE OF OSTEOARTHRITIS.
COULD THIS BE MEDIATED BY
INFLAMMATION, POTENTIALLY
THROUGH LEPTON WAITING TO LOW
GRADE CHRONIC INFLAMMATION.
BUT ARE THERE OTHER DIFFERENCES
IN INFLAMMATORY RESPONSE?
WE KNOW THERE IS THE FIBER
CARTILAGE IN KNEES IN WOMEN
TENDS TO RELEASE INTEND TO HAVE
HIGHER LEVEL OF INFLAMMATION OR
HIGHER INFLAMMATORY BIOMARKER.
SO ONCE THERE'S CARTILAGE DAMAGE
THE RELEASE OF INFLAMMATORY
BIOMARKERS IS GREATER IN WOMEN
THAN MEN SO COULD THIS BE
SELF-PERPETUATING.
WHEN DOES THIS START?
UNFORTUNATELY WE KNOW OBESITY
CAN OCCUR EARLY, THIS IS A STUDY
LOOKING AT ADOLESCENCE WHO ARE
OBESE AND LOOK AT THEIR
DIFFERENCES IN KNEE PAIN AND
DIFFERENCES IN ARTICULAR
CARTILAGE BASED ON MRI.
AND WHAT THEY FOUND IS THAT THE
GREAT, THE HIGHER THE BMI THE
MORE CARTILAGE DAMAGE YOU SAW ON
THE MRI AND THE MORE LIKELY THEY
WERE TO HAVE SYMPTOMS SYMPTOMS ESPECIALLY
PAIN AND IMPACT ON DAILY
ACTIVITY WITH GREATER BMI.
THIS STUDY LIKE MANY STUDIES WAS
NOT DISAGGREGATED BY SEX.
BUT IS OSTEOARTHRITIS YET
ANOTHER PEDIATRIC OR ADOLESCENT
CONDITION THAT DOESN'T MANIFEST
UNTIL ADULTHOOD.
LOOKING AT OSTEOARTHRITIS A MAY
JR. PRESENTING SYMPTOM IS PAIN
BUT THERE'S SEX AND GENDER
DIFFERENCES IN PAIN.
SO PART OF THE INCREASE
INCIDENCE OF SIMILAR TO MATTIC
OSTEOARTHRITIS IN WOMEN BASED ON
ONLY ON WHAT IS GOING ON IN
JOINT BUT PAIN EXPERIENCE HEALTH
AND HOW PATIENT GOES THROUGH THE
EXPERIENCE.
THERE'S SEX BASED DIFFERENCES IN
TEEMS OF HOW NEUROCHEMICAL
IMPACT OF SEX STEROIDS
INFLAMMATORY IMPACT ON LOGIC
PAIN IS EXPERIENCE AND GENDER IN
TERMS OF PSYCHOSOCIAL, SOCIAL
CULTURAL EXPERIENTIAL IMPACT ON
EXPERIENCE OF PAIN.
SO HOW DOES THAT FIT INTO HIGHER
RISK SYMPTOMATIC OSTEOARTHRITIS
AMONG WOMEN.
HOW ARE SEX AND GENDER
DIFFERENCES IN OSTEOARTHRITIS
MANIFESTED.
WAITING FOR ARTHROPLASTY, IN THE
12 MONTHS PRIOR TO SURGERY,
WOMEN ARE MORE LIKELY TO SEEK
AND RECEIVE OPIOID, NON-OPIOID,
OBJECTIONS PHYSICAL THERAPY, IF
THEY ARE WAITING FOR SURGERY,
YOU HAVE TO ASSUME RADIOGRAPHIC
LIKELY SYMPTOMATIC EQUIVALENCE
BETWEEN MEME AN MEN BUT IF SO
WHY ARE WOMEN RECEIVING MORE
INTERVENTION?
A VARIETY OF EXPLANATIONS HAVE
BEEN SUGGESTED, PERHAPS WOMEN
HAVE RAPID PROGRESSION OF
DISEASE.
THERE'S SOME SUGGESTION
OSTEOARTHRITIS IN WOMEN IS A
DIFFERENT CONDITION THAN IT IS
IN MEN.
BUT ONCE IT STARTS IT IS RAPIDLY
PROGRESSIVE WHY WOMEN NEED
INTERVENTION BEFORE THEY UNDERGO
SURGERY.
RELATED TO HOW THEY EXPERIENCE
PAIN?
RADIOGRAPHICALLY NO DIFFERENCE
BETWEEN THE SEX BUS THE PAIN
EXPERIENCE IS DIFFERENT.
SO WOMEN SEEN MORE INTERVENTION
BECAUSE THEY ARE EXPERIENCING
MORE PAIN.
IS IT BECAUSE WOMEN ARE LIKELY
TO BE REFERRED FOR SURGICAL
REPLACEMENT IN JOIN REPLACEMENT.
WE KNOW WOMEN ARE REFERRED LATER
THAN MEN FOR ARTHROPLASTY
ESPECIALLY UNDERREPPED MINORITY
WOMEN SO MAYBE IN THIS 12 MONTHS
PRIOR TO SURGERY MAYBE THEY
SHOULD HAVE BEEN REFERRED
EARLIER FOR SURGERY SO THEY ARE
IN WORSE CONDITION, THEY HAVE
MORE PAIN, WORSE FUNCTION AND
THEREFORE NEED MORE
INTERVENTIONS WHILE WAITING FOR
THEIR SURGERY.
OTHER SEX BASED DIFFERENCES YOU
SEE SEX BASED DIFFERENCES IN
SURGICAL OUTCOMES.
MEN AND WOMEN IMPROVE PAIN AND
FUNCTION AFTER JOINTS REPLACE,
HOWEVER IN ALMOST EVERY STUDY
WOMEN ARE FOUND WITH LOWER
SCORES IN PAIN AND FUNCTION AT
ALL TIME POINTS.
BUT WE NEED TO UNDERSTAND WHY
BUT WE TRY TO FIGURE OUT HOW TO
FIX THIS.
THIS IS RELATED TO PAIN
EXPERIENCE, RELATED TO PAIN AND
FUNCTION AT THE TIME OF SURGERY.
THIS STUDY THIS IS AGAIN LOOKING
AT PATIENTS BOTH MEN AND WOMEN
WHO ARE WAITING -- WITH
OSTEOARTHRITIS WHO ARE WAITK FOR
HIP REPLACEMENT OR KNEE
REPLACEMENT, WOMEN HAVE
SIGNIFICANTLY POOR HEALTH
RELATED QUALITY OF LIFE SCORSES
SELF-EFFICACY CONFIDENCE AND
MANAGEMENT OF PAIN FATIGUE AND
FUNCTION.
IF WOMEN COME TO SURGERY WITH
WORSE PAIN AND WORSE FUNCTION,
THEN IF THEY ARE GOING TO GET
BETTER AFTER SURGERY THEY HAVE
MORE GROUNDS TO MAKE UP.
SO BUT AGAIN IT GETS BACK TO IS
THIS A DIFFERENCE IN THEIR
DISEASE PROCESS, OR A GENDER
SOCIETAL BASED ISSUE U IN WOMEN
ESPECIALLY UNDER-REPRESENTED
MINORITY WOMEN BEING REFERRED AT
LATER STAGE FROM SURGERY.
HOWEVER, OTHER SUGGESTIONS HAVE
BEEN MADE IN TERMS OF WHY WOMEN
DON'T DO AS WELL AFTER JOINT
REPLACEMENT SURGERY.
IN THIS STUDY PATIENTS WITH MEN
AND WOMEN WERE REFERRED BECAUSE
THEY HAD PAINFUL JOINT
REPLACEMENTS.
WOMEN ACROSS THE BOARD HIGHER
LEVELS OF PAIN THAN DID MEN BUT
WOMEN HIGHER RATES OF SEVERITY
MENTAL SENSITIZATION.
IS THIS AN ISSUE MORE WITH THEIR
REACTION TO THE METAL OR THE
ARTHROPLASTY AS OPPOSED TO PAIN
AND FUNCTION PRIOR TO SURGERY,
THAT'S SOMETHING WE STILL DON'T
KNOW.
HOWEVER PAIN FUNCTION AFTER
JOINT REPLACEMENT SURGERY SEX
AND GENDER BASED DIFFERENCES IS
MORE COMPLEX THAN METAL AND WHAT
TYPE OF KNEE REPLACEMENT WAS
USED IN THIS STUDY WOMEN AND MEN
AFTER ARTHROPLASTY FOR WOMEN,
MOST STUDIES SIGNIFICANTLY WORSE
IN TERMS OF PAIN AND FUNCTION
AFTER WORDS BUT IF YOU LOOK
PREOP OPERATIVELY THEY HAVE
WORSE PAIN FUNCTION HIGHER
LEVELS OF DEPRESSION OBESITY AND
HAD MORE JOINTS INVOLVED.
IF YOU INCLUDE FACTORS TO LOOK
AT THEIR POST-OPERATIVE OUTCOME
THE EFFECTS OF SEX IS LESS
ESPECIALLY IF YOU FACTOR IN
PRE-OPERATIVE PAIN AND FUNCTION
PRE-SURGE ARE I PAIN LOW BACK
PAIN HIGHER LEVEL DEPRESSION
SIGNIFICANTLY ASSOCIATED WITH
WORSE PAIN SCORES, SIX MONTHS
BOTH WOMEN AND MEN BUT ALL
GREATER AMONG WOMEN SO IS THAT
CAUSING THE WORSE OUTCOMES AMONG
WOMEN?
IF YOU INCLUDED ALL THESE
VARIABLES, AND ESPECIALLY
LOOKING AT THE PRESENCE OF
CO-MORBIDITIES SEX THEN NO
LONGER FACTORED IN AS AN
INDEPENDENT VARIABLE.
SO AGAIN I THINK IT IS MORE
COMPLEX THAN WOMEN DO WORSE
AFTER KNEE REPLACEMENT THEREFORE
WE NEED TO DESIGN A KNEE
REPLACEMENT FOR THEM,THAT'S BEEN
TRIED IN THE PAST DIDN'T MAKE
OUTCOMES BETTER.
LOOKING MORE IN DEPTH IN TERMS
OF PAIN, AND FUNCTION AND
DEPRESSION AND OTHER
CO-MORBIDITIES BECAUSE WE KNOW
THIS IMPACTS WOMEN'S FUNCTION
AND PAIN AFTER THEY HAVE HAD THE
DEFINITIVE TREATMENT OF SURGERY.
WHY DO WE CARE?
TWO THINGS.
ONE LIFE DISABILITY BUT FACTORS
IN MOW CO-MORBIDITIES.
SO OSTEOARTHRITIS LEADS TO
CHRONIC PAIN, DIFFICULTY WITH
ACTIVITIES OF DAILY LIVING.
LOOK AT THIS GRAPH ON THE LEFT
IF YOU LOOK SPECIFICALLY UNDER
ARTHRITIS, THIS IS AMONG PEOPLE
WITH SELF-REPORTED LIMITATION
AND ACTIVITIES OF DAILY LIVING
FOR ARTHRITIS MUCH MORE COMMON
TO BE WHEN THAN MEN, LOOK AT THE
GRAPH ON THE RIGHT.
THESE PATIENTS HAD SELF-REPORTED
OSTEOARTHRITIS, YOU CAN SEE
WOMEN CONSTITUTE MAJORITY BUT
LOOK AT THE LAST SECTION ON THE
FAR RIGHT LOOK AT TOTAL LOST
DAYS FROM WORK, MORE LIKELY TO
BE AMONG WOMEN THAN MEN.
WE KNOW WOMEN LOSE MORE DAYS
FROM WORK THAN DO MEN, THE ODDS
RATIO FOR WOMEN IS TWO TIMES FOR
THOSE COMPARED TO THOSE THAT
DON'T HAVE OA, A LITTLE OVER 1.5
FOR MEN.
LOOK AT THOSE WHO LOST TIME OFF
OF WORK, WOMEN HAVE MORE DAYS
LOST OFF OF WORK ONCE THEY TAKE
TIME OFF WORK BECAUSE OF PAIN
THAN DO MEN SO THIS HAS THE
SIGNIFICANT IMPACT ON QUALITY OF
LIFE.
AND THEIR ABILITY TO EARN A
LIVING.
ALSO AS IMPACT OF OSTEOARTHRITIS
ON OR BY OTHER CHRONIC HEALTH
CONDITIONS.
LOOK AT GRAPH ON THE RIGHT THIS
IS DATA FROM CDC LOOK AT COMMON
CONDITIONS OBESITY DIABETES
HEART DISEASE, MUCH MORE LIKELY
TO PATIENTS IN -- WITH EACH OF
THESE DISEASE PROCESSES MUCH
MORE LIKELY TO HAVE ARTHRITIS
AND NOT TO HAVE ARTHRITIS.
NOT DISAGGREGATED ON SEX BUT
SOMETHING TO KEEP IN MIND.
IN THIS STUDY LOOKING AT BOTH
MEN AND WOMEN AND AT
CO-MORBIDITIES, HYPERTENSION
DEPRESSION COPD COMMON
CONDITIONS AMONG WOMEN MEN WITH
OA.
WITH PREVALENCE OF CONDITIONS
MORE COMMON AMONG WOMEN THAN
MEN, AND WOMEN HAD HIGHER NUMBER
OF CO-MORBIDITIES.
SO LOOKING AT OSTEOARTHRITIS IT
IS NOT JUST OSTEOARTHRITIS, WHAT
ELSE DOES IT IMPACT AND WHAT
ELSE IMPACTS ARTHRITIS.
DOES THIS REFLECTS COMMON
PATHWAYS SUCH AS INFLAMMATION,
DOES THAT LEAD TO INCREASE
CARDIOVASCULAR DISEASE WHICH
IMPACTS OSTEOARTHRITIS.
IS IT THE PAINFUL JOINT THAT
LIMITS ABILITY TO ADDRESS OTHER
HEALTH CONDITIONS.
SO IF YOU HAVE PAIN AND DECREASE
FUNCTION YOU CAN'T EXERCISE.
IF YOU USE EXERCISE TOY ADDRESS
OBESITY DIABETES OR HEART
DISEASE IT IS HARD TO IF YOU
HAVE A PAINFUL JOINT.
SOS IS IT FUNCTION,
INFLAMMATION, SOME OTHER
UNDERLYING PATHWAY.
>> A MINUTE.
>> SO LOOK AT JUST
CARDIOVASCULAR DISEASE, LOOK AT
WOMEN MORTALITY, INCREASE ALL
CAUSE MORTALITY FOR WOMEN WITH
OSTEOARTHRITIS BUT ONLY PAINFUL
NOT JUST RAIDS OWE GRAPHIC.
SO -- RADIOGRAPHIC SO IF YOU
HAVE KNEE PAIN AND RADIOGRAPHIC
97% INCREASE IN MORTALITY RISK.
BUT THIS IS SEEN ONLY THOSE WITH
KNEE OA, NOT HAND, OA SO GETS
BACK TO FUNCTIONAL ISSUE NOT
INFLAMMATORY IF OA OF THE HAND
DOESN'T LEAD TO INCREASE
MORTALITY BUT OF THE KNEE WHICH
MORE SIGNIFICANTLY IMPACT
FUNCTION DOES.
PART ISSUE WITH ALL OF THIS IS
LACK OF RESULTS REPORTED BASED
ON SEX, THIS IS ARTICLE FROM
LAST YEAR AT OA AS WELL AS
INJURIES ABOUT A THIRD STUDIES
REPORTED RESULTS BASED ON SEX SO
THAT IS PART OF THE PROBLEM WE
NEED BETTER DATA BETTER
DISAGGREGATION OF DATABASED ON
SEX.
SO WHAT IS THE TROUBLE WITH
SILOS WITH WOMEN'S HEALTH
ESPECIALLY IF YOU ARE TREATK
OSTEOARTHRITIS?
IT IS UNDERSTANDING FROM
EVERYONE'S PERSPECTIVE
ADDRESSING OA IS NOT JUST ABOUT
TREATING PAINFUL JOINTS.
BECAUSE IF YOU DO THAT YOU MISS
THE INTERCONNECTIONS EARLIER AND
LATER AND THAT MISSING
ENTERCONNECTS FROM PATIENT
PERSPECTIVE AS WELL AS
HEALTHCARE PERSPECTIVE AS WELL
AS RESEARCHER PERSPECTIVE.
IF IN SILOS WITH RELESS ABLE TO
RECOGNIZE IMPACT OF OTHER
CONDITIONS ON AND BY
OSTEOARTHRITIS AND HOW DOES
TREATING PAIN ESPECIALLY
FUNCTION IMPACT THESE OTHER
CONDITIONS.
AND THEIR TREATMENT, HOW DOES IT
IMPACT QUALITY OF LIFE.
MORBIDITY MORTALITY.
IN TERMS OF FUTURE DIRECTION WE
NEED CONTINUED EXPLORATION OF
IMPACT OF SEX AND GENDER ON
OSTEOARTHRITIS NOT JUST RESEARCH
OSTEOARTHRITIS IN GENERAL IN
TERMS OF ONSET RISK FACTORS,
RESPONSE TO TREATMENT,
INTERACTION WITH OTHER HEALTH
CONDITIONS.
ALL THESE NEEDS TO BE DICES
AGGREGATESSED BASED ON SEX.
THAT REQUIRES DISAGGREGATION OF
DATA ALL STUDY BASED ON SEX AND
TARGETED RESEARCH FUNDING OA
AMONG WOMEN GIVEN DIFFERENT
RISKS CONTRIBUTING FACTORS, AS
WELL AS IMPACT ON OTHER HEALTH
CONDITIONS ENHANCED HEALTH
EDUCATION SEX GENDER TO TRAIN
THE NEXT GENERATION OF
CLINICIANS AND RESEARCHERS ON
ALL HEALTH CONDITIONS AND
REMOVING SILOS THAT WE DISCUSS
RESEARCH TREAT OA ACROSS AGE
SPECTRUM AND ACROSS DISCIPLINES
AND PROFESSIONS.
THANK YOU VERY MUCH.
>> THANK YOU SO MUCH DR.
TEMPLETON FOR YOUR PRESENTATION.
IT WAS VERY THOUGHT PROVOKING.
WE ARE NOW GOING TO GO TO OUR
NEXT PANELIST, WHO IS DR.
CAMILLE CLARE.
CHAIR DEPARTMENT OF OBSTETRICS
GYNECOLOGY AND PROFESSOR AT
COLLEGE OF MEDICINE AND SCHOOL
OF PUBLIC HEALTH AT THE SUNY
DOWN STATE HEALTH SCIENCES
UNIVERSITY.
SHE RECEIVED HER MEDICAL DEGREE
FROM ALBERT EINSTEIN COLLEGE OF
MEDICINE IN THE BRONX NEW YORK
AND COMPLETED HER OBSTETRICS
GYNECOLOGY RESIDENCY AT THE
STATE UNIVERSITY OF NEW YORK AT
BUFFALO.
SHE OBTAINED A MASTERS PUBLIC
HEALTH AND HEALTH POLICY
MANAGEMENT AT NEW YORK MEDICAL
COLLEGE AND MAY 2018 DR. CLARE
WAS INDUCKED TO THE ALPHA OMEGA
ALPHA HONOR SOCIETY CHAPTER IN
NEW YORK AND IS NEW YORK MEDICAL
COLLEGE AS A FACULTY MEMBER.
WITH NO FURTHER ADIEU, SHE IS
GOING TO BE PRESENTING ON
POLICIES AND INFRASTRUCTURE THAT
SUPPORT QUALITY INTEGRATED CARE
FOR MEDICALLY UNDERSERVED AND
ATTENTION TO DIVERSITY INCLUSION
AND SYSTEMS OF CARE.
DR. CLARE.
>> THANK YOU SO MUCH FOR MY
COLLEAGUES AND THANK YOU TO DR.
JOHNSON FOR THE INVITATION AND
DR. MOSES SIMON PEER MENTOR AS
WELL AS DR. JANINE CLAYTON AND
COLLEAGUES FOR GIVING INSIGHT.
SO I'M NOT GOING TO SPEAK ABOUT
OBSTETRICS AND GYNECOLOGY THOUGH
MY FAVORITE THING TO SPEAK
ABOUT.
HOPEFULLY SLIDES WILL ADVANCE.
I HAVE NO FINANCIAL DISCLOSURES
H HOWEVER I SIT ON THE BOARD OF
DIRECTORS FOR AMERICAN COLLEGE
OF OBSTETRICIAN AND
GYNECOLOGISTS AND ON THE BOARD
OF TRUSTEES, THE NATIONAL
MEDICAL ASSOCIATION.
SO WE ARE TALK ABOUT STATE OF
WOMEN ACADEMIC MEDICINE FROM
WORK FORCE PERSPECTIVE, MAKE A
CASE WHY MORE WOMEN LEADERS ARE
NEEDED IN HEALTHCARE DELIVERY
SYSTEMS, AND TALK SOME
SOLUTIONS.
AS WE CAN SEE, FROM THIS SLIDE,
THE WOMEN AND ACADEMIC MEDICINE
WHO ARE MEDICAL SCHOOL
APPLICANTS HAS BEEN ABOUT 51%,
THOSE WHO HAVE GRADUATED IS
ABOUT 48%.
THOSE WHO OBTAINED RESIDENCY 46%
DECLINED BY THE TIME YOU GET TO
FACULTY LEVEL OF 41%.
SIMILARLY LEADERSHIP THERE IS
ONLY 29% WHO ARE DIVISION
CHIEFS, ONLY QUARTER OF FULL
PROFESSORS, ABOUT THIRD SENIOR
ASSOCIATE DEANS MEDICAL SCHOOL
LEVEL AND 18% ARE DEPARTMENT
CHAIRS AS WELL AS DEANS, THIS IS
DATA FROM AAMC.
IN THE SCIENCES AND DOCTORAL
PROGRAM, WOMEN ARE 58% GRADUATE
STUDENTS ENROLLED IN THESE TYPE
OF PROGRAMS.
AMEND THESE NUMBERS HAVE BEEN
DECLINING OF WOMEN IN THE
SCIENCES SINCE 2008.
OF THE SIX ACADEMIC DEPARTMENTS
CLINICAL DEPARTMENTS WITH 50% OR
MORE FULL TIME WOMEN FACULTY
INCLUDING MY OWN 64% OBSTETRICS
GYNECOLOGY, 51% IN DERMATOLOGY.
DEPARTMENTS WITH LESS THAN 50%
OF WOMEN ARE SMALLEST PROPORTION
OF WOMEN FULL TIME FACULTY
INCLUDING SUCH THINGS AS
ORTHOPEDIC SURGERY, OF MY
COLLEAGUE DR. TEMPLETON WHO
SPOKE BEFORE SURGERY AS WELL AS
SOME OF THE BASIC SCIENCE
DISCIPLINES SHOWN HERE.
AGAIN WOMEN WHO ACHIEVED SECTION
CHIEF DIVISION CHIEF HAS NEARLY
DOUBLED SINCE 2004.
ONLY LESS THAN A THIRD OF WOMEN
WHO ARE CHIEF OF THE DEPARTMENT
IN 2018.
SIMILARLY AT THE CENTER
INSTITUTE DIRECTOR LEVEL BY
GENDER, WOMEN ARE LESS THAN A
THIRD CENTER INSTITUTE
DIRECTORS.
IN TERMS OF ROLES WOMEN FACULTY
HAVE IN ACADEMIC MEDICAL
CENTERS, LESS THAN HALF HAVE
FORMAL ADMINISTRATIVE ROLE
SOLELY DEDICATED TO WOMEN AND
GENDER ISSUES, THIS AMOUNTS TO
.38 FTE.
THIS IS BEYOND TITLE NINE
COMPLIANCE ROLES.
ABOUT 20% SCHOOLS DID NOT HAVE
ANY LOCAL WOMEN IN MEDICINE OR
SCIENCE ORGANIZATIONS 10%
WITHOUT ORGANIZATIONS STILL HAVE
TARGETED PROGRAMMING AND 10%
HAVE BOTH NO PROGRAMMING AS WELL
AS NO WOMEN AND IN MEDICINE AND
SCIENCE ORGANIZATION.
WHAT DO I MEAN?
ACCORDING TO THE AAMC WOMEN
GROUP MEDICINE SCIENCE IS A
GROUP THAT ADVANCES SUCCESSFUL
AND FULL PARTICIPATION AND
INCLUSION OF WOMEN WITH ACADEMIC
MEDICINE BY ADDRESSING SUCH
ISSUE AS GENDER EQUITY
RECRUITMENT AND RETENTION AWARDS
AND RECOGNITION AN CAREER
ADVANCEMENT ALL WHICH ARE
EXTREMELY IMPORTANT TO ADVANCE
THE MISSION AS MENTIONED IN THIS
PRESENTATION TODAY.
LOOK AT OUTCOMES FOR PHYSICIAN,
THIS IS ESTABLISHED IN 2017 BY
-- LOOKING AT MATERNAL MORTALITY
AND READMISSION RATES BASED ON
PHYSICIANS TREATED BY MALE OR
FEMALE PHYSICIANS.
THEY LOOK AT RANDOM SAMPLE OF
20% MEDICARE FEE FOR SERVICE
BENEFICIARIES OVER 65 YEARS OF
AGE AND OLDER WHO ARE
HOSPITALIZED WITH A GENERAL
MEDICAL CONDITION.
THAT WERE TREATED BY INTERNISTS
IN PERIOD OF TIME FROM 2011 TO
2014.
THEY ASSOCIATED BASED ON SEX
IDENTITY OF THE PHYSICIAN.
THEY FOUND ELDERLY PATIENTS WHO
RECEIVED INPATIENT CARE FROM
FEMALE INTERNISTS HAD A LOWER 30
DAY MORTALITY AND READMISSION
RATED COMPARED TO PATIENTS CARED
FOR BY MALE INTERNISTS.
THIS WAS ACROSS MULTIPLE
CONDITIONS ACROSS MULTIPLE
SEVERITY TESTIFY ILLNESS,
INTERNISTS HAVE BETTER OUTCOMES
FOR IN PATIENT CARE COMPARED TO
MALE COLLEAGUES.
THIS RELATED TO MULTIPLE
MEASURES OF QUALITY SEEN IN
PREVIOUS STUDIES, FEMALE
PHYSICIAN MORE LIKELY TO
PRACTICE EVIDENCE BASED
MEDICINE, THEY PERFORMED AS WELL
OR BETTER THAN STANDARDIZED
EXAMINATION AND PERFORMED
PATIENT CENTERED CARE.
THE PATIENTS ALSO HAD FEWER
MERGE DEPARTMENT VISITS AS
WELCOME PAIRED TO MALE COUNTER
PARTS.
SO I WAS ASKED TO TALK HOW WOMEN
PHYSICIAN PLAY A ROLE IMPROVING
SEX SPECIFIC CONDITIONS.
MENT I WANTED TO DEFINE WHAT
THIS MEANS FOR THE GROUP.
SEX SPECIFIC CARE IS CARE
RELATED TO THE HEALTH NEEDS
UNIQUE TO WOMEN SUCH AS
PREGNANCY, AND MENOPAUSE.
SEX AWARE -- CARE IS CARE FOR
CONDITIONS THAT AGAIN ARE
DIAGNOSED OR TREATED DIFFERENTLY
IN WOMEN COMPARED TO MEN SUCH AS
HEART DISEASE NEURODEGENERATIVE
DISEASE AS MENTION AND GENDER
SENSITIVE CARE PROVIDING WAYS
INCLUSIVE OF GENDER SPECIFIC
PREFERENCES INCLUDING LGBTQIA
HEALTH NEEDS, SPECIFICALLY.
IF WE THINK ABOUT HOW WOMEN
PHYSICIANS IMPROVE THE CARE FOR
SEX SPECIFIC CONDITIONS
ESPECIALLY WOMEN WITH
CO-MORBIDITIES, SOME OF THE
STRATEGIES THAT HAVE BEEN
OFFERED INCLUDING ENDING
POLITICAL OMITTYIZATION OF
WOMEN'S HEALTHCARE ACROSS THE
LIFE COURSE AND I ALSO INCLUDE
TRANSMEN AS WELL IN THIS
CONVERSATION MOSTLY SPEAKING
ABOUT MULTIPLE GENDER IDENTITIES
CREATING A FRAMEWORK THAT REALLY
TRANSFORMS PRIMARY HEALTHCARE TO
THINK OF AGAIN WOMEN ACROSS ALL
RANKS ALL STAGE OF LIFE WHICH IS
WELL OUTLINED BY DR. CLAYTON IN
HER INTRODUCTORY COMMENTS AND
DELIVERS CARE THAT SEX SPECIFIC
SEX AWARE, GENDER SENSITIVE AND
REALLY ADAPTS TO AND COORDINATES
CARE ACROSS VARIETY OF
HEALTHCARE EXPERIENCES.
PRIMARY HEALTHCARE MODELS REALLY
NEED TO BE FUNDED AND NEED TO BE
SUPPORTED.
INVESTMENTS REALLY NEED TO BE
MADE, COMPANIES THAT ARE WOMEN
HEALTH FOCUSED AND REALLY
WORKING TO PROMOTE GENDER
DIVERSITY FROM A FINANCIAL
PERSPECTIVE.
IF WE THINK THE ROLE OF WOMEN
WHO ARE LEADERS IN HEALTHCARE
DELIVERY SYSTEMS IN A STUDY BY
THE BUREAU OF ECONOMIC
STATISTICS WE KNOW THAT ALMOST
80% HEALTH SERVICES WORK FORCE
ARE WOMEN.
AND ABOUT THREE OUT OF FOUR
EMPLOYEES IN HOSPITALS ARE
WOMEN.
ALL DIFFERENT VARIETY OF JOBS.
SO EQUAL EMPLOYMENT OPPORTUNITY
COMMISSION SHOWS IN THE
MANAGERIAL LEVEL FOR POSITIONS
THAT ARE EXECUTIVE OR SENIOR
ADMINISTRATIVE LEVEL WOMEN ARE
ALSO ACCOUNTED FOR ALMOST 72%.
THIS MEANS 3 MILLION
PROFESSIONAL WHOSE ARE IN
HEALTHCARE OR SOCIAL ASSISTANT
PRIVATE SECTORS, 80% WHOM ARE
WOMEN.
IF WE THINK ABOUT THE C SUITE OF
HIGHEST LEVEL CHIEF OFFICE OF
POSITIONS IN THE HOSPITAL, OR IN
THE HEALTHCARE SYSTEM, THERE ARE
HUGE STILL GENDER DISPARITIES.
WE DID A SURVEY IN 2012 LOOKING
AT EXPERIENCE OF WOMEN IN
HEALTHCARE SECTORS COMPARING IT
TO MEN WITH SAME AMOUNT OF
EXPERIENCE.
AND ONLY 11% WOMEN ACHIEVE LEVEL
CHIEF EXECUTIVE OFFICER COMPARED
TO 22% OF WOMEN.
AGAIN AMERICAN COLLEGE OF
HEALTHCARE EXECUTIVES LOOK AT
THIS DATA.
NOT MUCH CHANGED SINCE EARLY
1990s.
11% OF WOMEN ROSE TO CEO
POSITIONS, DECREASED A LITTLE
BIT 1995, TO 8%, 12% IN 2006,
MORE RECENT DATA I SAW IN JAMA
IT IS ONLY ABOUT 50% OF WOMEN
CURRENTLY IN THESE CEO ROLES.
WE KNOW THERE IS EXTREME BENEFIT
TO LEADERSHIP DIVERSITY ACROSS
VARIETY OF INDUSTRIES.
INCLUDING HEALTHCARE IN THE
UNITED STATES AND ACROSS OTHER
ECONOMIES THAT ARE SIMILAR THIS
WILL CANADA AND GREAT BRITAIN.
WE KNOW BENEFITS ARE SOCIALLY
DIVERSE TEAMS ARE INNOVATIVE,
MORE LIKELY THE BREAK DOWN
BARRIERS TO CARE.
TEAMS ARE MORE LIKELY TO BE MORE
EFFECTIVE AS WE HAVE SEEN IN THE
COVID-19 PANDEMIC ARE ABLE TO
ACTIVATE RESILIENCE DURING TIMES
OF CRISIS AS WE HAVE SEEN IN
MULTIPLE TIME POINTS IN
HEALTHCARE DELIVERY.
WHEN WOMEN ARE REPRESENTED IN
SUCH THINGS AS LEGISLATIVE
BODIES, ABLE TO DISCUSS AND
IMPLEMENT THESE WOMEN POLICY
PRIORITIES, THAT ARE IMPORTANT
TO WOMEN, THESE PRIORITIES AGAIN
TEND TO INCREASE.
SO IF HOSPITAL LEADERSHIP CAN
REFLECT GENDER DIVERSE WORK
FORCE IN THE COMMUNITIES THEY
SERVE, MORE BENEFITS ARE
ACHIEVED.
THIS IS IMPORTANT IN THE
HEALTHCARE SERVICE DELIVERY
SYSTEM, WHICH IS COMPLEX AND
FOCUSES ON ACUTE CARE DELIVERY.
IN A MORE RECENT STUDY BY JASON
MOST LOOKING AT A AGAIN WOMEN
MANY TOP EXECUTIVE POSITIONS IN
MEDICAL SURGICAL HOSPITALSES,
THIS WAS A STUDY LOOKING AT
PROPORTION OF WOMEN IN THESE
LEADERSHIP POSITIONS, TO
DETERMINE IF THERE ARE ANY
FACTORS AT THE HOSPITAL LEVEL
AND COMMUNITY LEVEL IMPACT OF
WOMEN BEING EXECUTIVE
CONDITIONS. THESE DATA FROM
4300 HOSPITALS FROM THE AMERICAN
HOSPITAL ASSOCIATION, TO
CALCULATE PROPORTION OF WOMEN
WHO ARE IN THESE ROLES.
THEY FOUND WOMEN EXECUTIVES WERE
UNDER-REPRESENTED IN ALL
POSITIONS, WITH EXCEPTION OF
CHIEF HUMAN RESOURCES POSITION.
AS WELL AS CHIEF NURSING OFFICE
POSITION.
SO HUMAN RESOURCES IT WAS ABOUT
73% AND CHIEF NURSING OFFICE --
OFFICER POSITIONS WAS 91%.
SO AS MENTIONED WOMEN IN THIS
MOST RECENT STUDY, ACCOUNTED FOR
ABOUT 13% CEO AT SYSTEM LEVEL
AND THIRD CEO AT HOSPITAL LEVEL.
THIS WAS LOOKING AT NUMBER OF
HOSPITALS EVALUATED IN STUDY AND
SIZE OF HOSPITAL.
SO WOMEN WHO WERE AT LARGE
HOSPITALS TALKING ABOUT 400 BEDS
OAR MORE, LESS LIKELY TO HOLD
CHIEF POSITIONS COMPARED TO
THOSE WORKING IN SMALLER
HOSPITAL SETTINGS. SO TWO
CRITICAL COMPONENTS HOSPITALS
NEED TO ENCOURAGE LEADERSHIP
DIVERSITY INCLUDING GENDER
DIVERSITY IN ORDER TO BE
SUCCESSFUL IN THEIR ROLE.
ACCORDING TO NATIONAL GLASS
CEILING COMMISSION IN 1995, THEY
IDENTIFIED MULTIPLE BARRIERS,
THREE CATEGORIES TO WOMEN
ASCENDING TO THOSE ROLES.
SO THERE ARE BARRIERS AT LEVEL
OF SOCIETY, INTERNAL BARRIERS OR
GOVERNMENT BARRIERS, LACK OF
EDUCATIONAL OPPORTUNITIES,
PREJUDICE DISCRIMINATION AND
BIAS RELATED TO THE
INTERSECTIONALITY AND GENDER,
GENDER IDENTITY, RACE AND
ETHNICITY AS WELL AS RECRUITMENT
PRACTICES, WE TALKED ABOUT
FORMALLY KNOWN AS PIPELINES OR
PATHWAY BARRIERS THAT REALLY
PREVENT ADVANCEMENT OF WOMEN,
LACK OF APPROPRIATE MENTORING,
LACK OF GOVERNMENT MONITORING
ENFORCEMENT THAT RESTRAINS WOMEN
ADVANCING TO TOP ROLES.
IN OTHER DATA WE LOOK AT THE
HEALTHCARE MANAGER, AND
ADMINISTRATIVE RANKS, THIS IS
BASED ON WOMEN WHO GRADUATED IN
THE EARLY 1990s, OF ABOUT 6300
WOMEN WITH HIGHER LEVEL DEGREES,
69% WERE AWARDED TO WOMEN, WE
ARE TALKING ABOUT MBA,
HEALTHCARE ADMINISTRATION,
MANAGEMENT DEGREES, 46% IN
PARTICULAR HAD MBAs.
OTHER CATEGORIES ACCOUNTING AND
FINANCE, A LITTLE OVER 60% WERE
AWARDED TO WOMEN, SO PATHWAY
COMPONENTS ARE NOT THE ONLY
EXPLANATION TO WHY WOMEN ARE NOT
ACHIEVING THESE TOP LEADERSHIP
POSITIONS.
ACCORDING TO WALT DISNEY, THE
BEST WAY THE GET STARTED IS TO
QUIT TALKING, WE ARE DOING A LOT
OF TALKING TODAY BUT HOPEFULLY
WE ARE ABLE TO MOVE OUR
CONVERSATIONS TO SOLUTIONS AND
TO BEGIN IMPLEMENTING SUCH
SOLUTIONS THEY INCLUDE HOW WE
CAN INVESTIGATE IDENTIFY LOOK AT
OUR RETENTION PRACTICES
PROMOTION PRACTICES, CULTURE OF
ORGANIZATIONS WHICH WE ARE WORK
AND ANY OTHER FACTORS THAT MIGHT
BE FOUND TO SHUT OUT QUALIFIED
WOMEN ESPECIALLY IN LARGER
HOSPITAL SYSTEMS WE WORK.
HOSPITAL INVEST INTERVENTIONS TO
IMPROVE THEIR ATTENTION
RECRUITMENT AND PROMOTION OF
WOMEN MANY THESE ROLES.
SO THIS REQUIRES NEW
INTERVENTIONS NEW APPROACH SUCH
AS SPONSORSHIP AND IN ADDITION
TO MENTORSHIP.
CULTURALLY SUPPORTIVE
ENVIRONMENT FOR WOMEN,
INTERSEXUALITY OF MANY.
I'M BLACK WOMAN IN MEDICINE I
CANNOT REALLY SEPARATE THOSE TWO
CATEGORIES OR SELF-IDENTITIES
WHICH I FALL INTO.
THIS REQUIRES A MULTI-PRONG
APPROACH CONCERTED, TOP HOSPITAL
LEADERSHIP HAS TO WORK ON THIS,
BECAUSE WE KNOW GENDER DIVERSITY
REFLECTED IN THE HOSPITAL WORK
FORCE AS MENTIONED.
SO I KNOW MY COMMENTS WERE MUCH
BRIEFER THAN ANTICIPATED.
I AM ON SOCIAL MEDIA AND I CAN
BE FOUND THERE AS WELL AS LINKED
IN, HAPPY TO ADDRESS QUESTIONS
THAT MAY COME UP DURING THE Q&A
SESSION.
THANKS AGAIN FOR THE OPPORTUNITY
TO SPEAK.
>> THANK YOU SO MUCH, DR. CLARE,
FOR YOUR PRESENTATION, VERY
INFORMATIVE AND ALSO VERY
THOUGHT PROVOKING.
OUR FINAL TALK FOR SESSION 1 IS
WILL BE GIVEN BY DR. ADAM WILK.
HE IS A HEALTH ECONOMIST AND
HEALTH SERVICES RESEARCHER IN
THE DEPARTMENT OF HEALTH POLICY
AND MANAGEMENT AT EMORY
UNIVERSITY ROLAND SCHOOL OF
PUBLIC HEALTH.
HIS RESEARCH EXAMINES THE
RELATIONSHIPS AMONG POLICY,
HEALTH STRUCTURE, AND THE
CLINICAL OPERATIONAL DECISION OF
INDIVIDUAL PROVIDERS THAT SERVE
UNDERSERVE LOW INCOME AND RACIAL
ETHNIC MINORITY POPULATIONS WITH
CHRONIC ILLNESS.
DR. WILK'S WORK IS PARTICULARLY
FOCUSED ON RACE -- RACIAL ETHNIC
AND SOCIAL ECONOMIC DISPARITIES
AND ACCESS TO KIDNEY
TRANSPLANTATION.
AND HOME DIALYSIS AMONG
INDIVIDUALS WITH KIDNEY FAILURE
AS PROVIDER ORGANIZATIONAL AND
SYSTEM LEVEL FACTORS THAT
INFLUENCE THEM.
HE WILL BE PRESENTING ON A MODEL
FOR DELIVERING POPULATION HEALTH
ACROSS THE CARE CONTINUES WOMB.
DR. WILKCONTINUUM.
>> THANK YOU TO BE HERE TODAY
AND PRIVILEGE TO BE HERE WITH
Y'ALL.
HAS DR. LEWIS JOHNSON SUGGESTED
I WILL TALK A MODEL FOR
DELIVERING POPULATION HEALTH
ACROSS THE CARE CONTINUUM AND
USE IT TO INFORM MY COMMENTS
ABOUT OPPORTUNITIES AND BARRIERS
DELIVERING WHOLE PERSON CARE
SYSTEMS LEVEL.
START WITH BIG PICTURE WE ARE
ALL SUPPORTIVE OF INCREASING
WHOLE PERSON CARE DELIVERY
VERSUS CONVENTIONAL CARE FOR
WOMEN AN GIRLS.
WHAT I MEAN BY THESE TERMS AND
WHAT IT LOOKS LIKE TO BOOST
WHOLE PERSON CARE.
WHAT WE ARE AIMING FOR SHOULD
LOOK LIKE THIS.
FIGURE COMES FROM A STUDY BY
JANE AND MYSELF AND COLLEAGUES
AND CARE TEAM BALANCE OF
PREVENTION AND WELL CARE VERSUS
DISEASE MANAGEMENT FORGIVEN
INDIVIDUAL AT DIFFERENT POINTS
IN TIME RELATIVE TO PROGRESSION
OF ONE OR MORE CHRONIC
ILLNESSES.
LEFT IDENTIFY GUSH PRIOR TO
DIAGNOSIS OF CHRONIC ILLNESS,
IDEAL CARRIES IN PHASE 1
PREVENTION AND WELL CARE.
THE PRIORITY SHOULD BE PLACED ON
RISK REDUCTION HEALTHY BEHAVIOR
APPROPRIATE SCREENING AND
AVOIDING WORSENING IN ACUTE
ILLNESS.
THAT IS PRIMARY SECONDARY AND
TERTIARY INTERVENTIONMENT IF YOU
LOOK AT BROAD VIEW OF ACTIVITIES
ENCOMPASSING ALL PATIENT NEEDS
THIS REPRESENTS WHOLE PERSON
CARE PRIOR TO ANY PERSON
DIAGNOSED WITH CHRONIC ILLNESS.
AFTER DIAGNOSIS, IN PHASE 2 TO
SEIZE MANAGEMENT RAMPS UP WITH
INITIAL TREATMENT BY CYCLES OF
ONGOING ADDITIONAL CONTROL AND
FOLLOW-UP CARE AFTER
EXACERBATION.
WHEN CONDITION IS LESS SEVERE OR
IS WELL CONTROLLED, SOME
PRIORITY GIVEN SO SECONDARY AND
TERTIARY PREVENTION.
TAS CONDITION BECOMES MORE
SEVERE OR LESS WELL CONTROLLED,
GREATER PRIORITY GIVEN TO
DISEASE MANAGEMENTS.
OVERALL IN POPULATIONS WITH
GREATER CONDITION HEIGHTENED
FOCUS ON DISEASE MANAGEMENT THE
CARE MANAGEMENT TEAM SHOULD BY
NO MEANS IGNORE OTHER SERVICES
THAT COULD HELP MEET INDIVIDUAL
BROADER NEEDS ALONGSIDE CHRONIC
DISEASE MANAGEMENT.
SO THIS IS WHAT IT LOOK LIKE FOR
WOMAN OR GIRL WITH CHRONIC
CONDITIONS IN GENERAL THOUGH
DETAILS VARY FROM PERSON TO
PERSON.
WE ARE CONCERNED ALL TOO OFTEN
THIS IS WHAT CONVENTIONAL CARE
MIGHT LOOK LIKE FOR WOMAN OR
GIRL WITH ONE OR MORE CHRONIC
CONDITIONS.
A HEAVY EMPHASIS ON DISEASE
MANAGEMENT BASICALLY TO
EXCLUSION OF CARE OR PREVENTION,
THE OPPOSITE OF WHOLE PERSON
CARE.
SO HOW DO WE ACHIEVE WELL
COORDINATED INTEGRATED CARE THAT
LOOKS MORE LIKE THIS FOR WOMEN
OR GIRLS WITH CHRONIC
CONDITIONS.
MIGHT BE HELPFUL TO ASK WHO IS
RESPONSIBLE HERE?
FOUR MAIN ACTORS IN DETERMINING
STRUCTURE OF COUNTRY'S
HEALTHCARE DELIVERY MODELS ARE
THE PATIENT PAYER AND POLICY
MAKER THE HEALTH SYSTEM AND
FRONT LINE CLINICIAN.
THE CLINICIAN THAT SEES PATIENTS
AND MAKES CARE PLANS.
ALL BARE RESPONSIBILITY WHETHER
PAYERS POLICY MAKERS SETTING
REGULATORY BOUNDARIES AND
INCENTIVE SYSTEMS, HEALTH
SYSTEMS ORGANIZING CLINICIANS OF
CARE NETWORKS.
CLINICIANS WORKING WITH HEALTH
SYSTEM LEADER SHIPBUILDING CARE
PLANS PROVIDING TREATMENT AND
PATIENTS BY GUIDING CARE PLANS
AND PROVIDING FEEDBACK TO PAYERS
AND POLICY MAKERS.
THOUGH PATIENT PROBABLY BEARS
LEAST RESPONSIBILITY AMONG
ENTITIES.
IN OUR PAPER MY CO-AUTHORS AND I
FOCUS ON FRONT LINE CLINICIAN
AND HEALTH SYSTEMS LEADERSHIP
AND CONFLICTING INCENTIVES WHEN
ORGANIZING CARE MODELS.
I WOULD ARGUE IT WOULD BE EASY
TO OVERLOOK CONFLICT BETWEEN
FRONT LINE CLINICIAN AND HEALTH
SYSTEMS LEADERS ESPECIALLY IF
YOU ARE NOT ADMINISTRATOR.
THESE ARE AMONG MOST IMPORTANT
BARRIERS TO SEEING WHOLE PERSON
CARE ROUTINELY IN THE U.S..
WHAT DO I MOO EN?
LOTS OF POTENTIAL SOURCES OF
TENSION BETWEEN HEALTH SYSTEMS
AND FRONT LINE CLINICIANS.
WORKING DOWN THE LIST, HEALTH
SYSTEMS ARE RESPONSIBLE FOR
TAKING A POPULATION OF
PERSPECTIVE ON HEALTH.
AND FOR EXAMPLE, USING
POPULATION LEVEL DATA TO INFORM
WHAT GUIDANCE THEY GET FRONT
LINE CLINICIAN OR IDENTIFYING
PRIORITY FROM CO-MORBID SYSTEMS
AND IMPLEMENTING CARE SYSTEMS TO
FILL IN GAPS.
FRONT LINE CLINICIAN DON'T SEE
EYE THE EYE WITH SYSTEM LEADER
SHIP AND IN PART BECAUSE THEY
TRAINING AND EXPERIENCE
SIGNIFICANTLY EMPHASIZED DISEASE
MANAGEMENT AND MEETING THE NEEDS
OF PATIENT AND EXAM.
ONE AT A TIME.
THIS IS TRUE OF SPECIALISTS.
PAYMENT SYSTEMS FEED INTO THIS
CONFLICT IN A BIG WAY.
THEY TRAIN DURING ERA WHEN FEE
FOR SERVICES CAME AND CARE
MODELS SET UP ACCORDINGLY.
VALUE BASED PAYMENTS AND
FINANCIAL RISK SHARING ARE
COMING IF THEY HAVEN'T TAKEN
HOLD ALREADY.
AS FRONT LINE CLINICIAN LEARN
WHAT VALUE PACE BASED PAYMENT
AND RISK SHARING AND WHAT IT
MEANS FOR PRACTICE, HEALTH
SYSTEM FACILITATE ANNOTATION AND
HEALTH SYSTEMS AREN'T HAVING TO
SUCCEED IN DOING THAT WELL.
ONE PART IS INVOLVING INTERNAL
COMPENSATION MODELS FOR
CLINICIANS, WHO ARE HEALTH
SYSTEM EMPLOYEES.
THE DATA ARE NOT DETAILED BUT
CLINICIANS ACCEPT A SALARY WITH
SOME ADJUSTMENT OR BONUS FOR
PATIENT CARE VOLUME OR SELECT
QUALITY METRICS.
IT IS GENERALLY UNCLEAR WHETHER
QUALITY METRICS IN THESE
COMPENSATION MODELS ARE WELL
ALIGNED WITH THOSE IN HEALTH
SYSTEMS CONTRACTS WITH PAYERS OR
WHETHER THERE'S MISCONNECTION
THERE.
THEY PROMOTE WHOLE PERSON CARE
OR JUST NARROW FOCUS ON MEASURED
CARE LIKE BREAST CANCER SCREENS
TO BE EXCLUSION OF METRIC CARE.
I WANT TO BE CLEAR ABOUT PICKER
PICTURE.
A WHOLLY POPULATION HEALTH
PERSPECTIVE DOESN'T REPRESENT
WHOLE PERSON CARE.
DISEASE MANAGEMENT DOESN'T
REPRESENT WHOLE PERSON CARE.
THE ANSWER LIES IN THE BALANCE
OF THE TWO.
STRIKING THAT BALANCE IS
DIFFICULT FOR MANY REASONS.
HOWEVER, AND I'LL BE GETTING TO
SOME OF THOSE AND I WALK THROUGH
REAL WORLD EXAMPLES.
EFFORTS TO BETTER INTEGRATE
MENTAL HEALTH OR BEHAVIORAL
HEALTHCARE IN PRIMARY CARE
CLINICS HAVE BEEN GOING ON FOR
YEARS NOW.
AND THE EVIDENCE HAS GROWN.
THERE'S EVIDENCE THAT
COLLABORATIVE CARE MODEL AND
OTHER LIKE MODELS ASSOCIATED
WITH BETTER ACCESS TO TREATMENT
AND OUTCOMES.
WITH MY NOD TO MY FELLOW
PANELIST THERE IS IS ALSO
EVIDENCE THAT SUPPORTS PERINATAL
DEPRESSION.
THERE IS SOME MANY THIS
LITERATURE AND INCLUDING
BEHAVIORAL HEALTH CONDITIONS
OTHER THAN DEPRESSION, AND
IDENTIFYING THE MOST ESSENTIAL
PIECES OF INTEGRATED BEHAVIORAL
HEALTH MODELS WHEN THEY NEED TO
BE ADAPTED AND IN MEASURING
EQUITY.
AND IMPACT BY GENDER RACE
ETHNICITY, SOCIOECONOMIC STATUS
AND OTHER IDENTITIES.
TWO BARRIERS TO INTEGRATED
BEHAVIORAL HEALTH.
FIRST THESE PRACTICE LEVEL
SERVICE TRANSFORMATIONS ARE
COMPLEX.
OUTSIDE EXPERTS HIRED BY HEALTH
SYSTEM MIGHT BE NEEDED TO
IMPLEMENT AND THIS CAN RAISE
TENSIONS BETWEEN CLINICIAN AND
HEALTH SYSTEM LEADER SHIM.
SETTING UP FINANCIAL MODELS TO
SUSTAIN STRUCTURE CAN BE
CRITICAL, HEALTH SYSTEM MAY TAKE
THE LEAD THERE.
SOME CONTEXT FOR THE TWO
EXAMPLES CARE AND SUPPORT
SETTINGS HEALTHCARE AND
NON-HEALTHCARE PROVIDERS IN
CONVENTIONAL TERMS ARE NOT
INCLUDED IN DIALOGUE BETWEEN
HEALTH SYSTEM LEADERS AND FRONT
LINE CLINICIANS.
A KEY REASON IS HEALTH COMES
HAVE CONFLICTING INCENTIVES
SPECIFICALLY SETTINGS MEET CARE
NEEDS AND SUPPORT NEEDS FOR
DISPROPORTIONATELY LOW INCOME
AND UNDERINSURED POPULATIONS.
SO AS HEALTH SYSTEMS TAKE MORE
RISK IN THEIR PAYER CONTRACTS
THESE POPULATIONS LOOK RISKIER.
THESE CAN BE EFFECTIVE IN
ENGAGING WOMEN AND GIRLS IN
PREVENTION ESPECIALLY CONCERNING
SOCIAL RISK FACTORS.
ALSO RELEVANT TRAIN TRAINING AND
CONTINUITY OF CARE IS HELPFUL IN
BUILDING STRONG RELATIONSHIPS
WITH INDIVIDUALS IDENTIFYING
NEEDS EXPECTATIONS AND
PREFERENCES WELL.
MY NEXT TWO EXAMPLES ILLUSTRATE
THIS IN CONTEXT OF SCHOOLS, AND
DIALYSIS FACILITIES.
SCHOOL MENTAL HEALTH FIRST.
IN GENERAL SCHOOL MENTAL HEALTH
IS ASSOCIATED WITH BETTER ACCESS
ENGAGEMENT AND TREATMENT THAT
CONVECTIONAL COMMUNITY BASED OUT
OUTPATIENT MEN DATA TREATMENT,
WHERE YOU HAVE REGULATE SCHOOL
AND TRAVEL OFF SITE TO RECEIVE
CARE.
SOME ADMINISTRATIVE BURDEN THE
MAKING SCHOOL MENTAL HEALTH
MODELS WORK.
REDUCING GEOGRAPHIC LOGISTICAL
BARRIERS MAKE A DIFFERENCE.
AT CONTROLLING FOR OTHER FACTORS
ADOLESCENT GIRLS TEND TO USE
SCHOOL MENTAL HEALTH SERVICE
MORRIS THAN ADOLESCENT BOYS.
SCHOOL MENTAL HEALTH IS
ASSOCIATED WITH REDUCED
DISPARITIES IN TREATMENT,
IMPROVE QUALITY OF LIFE AND A
ACADEMIC PERFORMANCE AND LOWER
COST OF CARE.
KEY POINT HERE THE WHOLE PERSON
CARE EXTENDS BEI DON'T
UNDERSTAND THE FOCAL CHRONIC
CONDITION LIKE MENTAL HEALTH AND
INCLUDES OTHER THINGS THAT
FAMILIES CARE ABOUT AND
INDIVIDUALS CARE ABOUT.
LIKE ACADEMIC, BEHAVIOR,
DISCIPLINARY OUTCOMES AND OTHER
SOCIAL OUTCOMES MEETING YOUTH
WHERE THEY ARE OUTSIDE OF YOUTH
SETTINGS BRING IN PERSPECTIVES
TO PRIORITIZE OTHER OUTCOMES WE
CARE ABOUT.
SWITCHING TO KIDNEY DISEASE FOR
CONTEXT MORE WOMEN THAN MEN HAVE
KKED DUE TO LONGER LIFE
EXPECTANCY.
THAT IS MORE COMMON IN OLDER
ADULTS.
THE AGE GRADIANT EXPLAIN WISE
THEY ARE UNLIKELY TO UNDERGO
CONSERVATIVE MANAGEMENT VERSUS
WHEN KIDNEYS FAIL.
WHEN ON DIALYSIS, WOMEN'S
QUALITY OF LIFE IS POORER THAN
MEN AND REPORT HIGHER SYMPTOM
BURDEN AND GREATER SYMPTOM
SEVERITY THAN MEN.
TIED TO WOMEN OLDER AGE ON
AVERAGE IN THIS POPULATION MORE
GERIATRIC NON-DISEASE SPECIFIC
SYNDROMES WHICH ARE NOT WELL
MANAGED IN CONVECTIONAL CARE
MODELS.
SO WHOLE PERSON CARE IS NEEDED
FOR WOMEN IN THIS CONTEXT.
KEY POINT FOR PATIENTS
UNDERGOING DIALYSIS IS TIME AND
ENERGY IS SEVERELY CONSTRAINED,
DIALYSIS TREATMENT.
THEY TEND TO RELY ON NEFFOLOGIST
FOR CARE NEEDS.
EVIDENCE SUGGESTS CARE MODELS
YIELD SUBOPTIMAL PRIMARY CARE
RELATED OUTCOMES.
COLLEAGUES HIGHLIGHTED KEY
BARRIERS EFFECTIVELY DELIVERING
PRIMARY CARE MANY THESE
SETTINGS, TALK ABOUT LACK OF
PRIVATE SPACE FOR PATIENT
CONSULTATION WHICH OFTEN HAPPEN
IN MIDDLE OF DIALYSIS UNITS.
PROVIDERS HAVE LIMITED KNOWLEDGE
OF SKILLS OR TIME MAYBE LITTLE
INTERNS IN ADDRESSING GENERAL
MEDICINE NEEDS AND NEFFOLOGISTS
AND PRIMARY CARE PHYSICIANINGS
CAN BE UNCLEAR ABOUT WHO IS
RESPONSIBLE FOR WHICH GENERAL
MEDICINE CARE NEEDS.
THEN LOWER REIMBURSEMENT FOR
MANAGEMENT OF NON-KIDNEY ISSUES
SO SPECIALISTS LIKE NEFFOLOGIST,
FEE FOR SERVICE PAYMENT
ENINCENTIVIZES HIGHER FEE FOR
CARE SERVICES OVER LOWER FEE FOR
GENERAL MEDICINE SERVICES.
HEALTH SYSTEMS LED PAYMENT
REFORMS THAT FOSTER GREATER
PAYMENT EQUITY, OR SET NEW
INCENTIVES FOR SPECIALIST LIKE
UNDER GLOBAL PAYMENT OR SHARED
SAVINGS PAYMENT MODELS WOULD
LEAD TO MAJOR CHANGES IN
INFRASTRUCTURE TRAINED STAFFING,
TASK ALLOCATION, AND DIEIAL
SISES FACILITIES ALL THE ABOVE.
SO A KEY LESSON HERE IN MY
OPINION IS FIXING THE PAYMENT
ISSUE LEAD TO THE OTHERS IN A
BIG WAY.
THE LAST POINT ON PAYMENT, BRING
US BACK TO THE QUESTION OF WHO
IS PRIMARILY RESPONSIBLE FOR
BRINGING ABOUT WHOLE PERSON
CARE.
NOW, I MENTIONED FINANCING
MULTIPLE TIMES, MAYBE PAYERS AND
POLICY MAKERS HAVE POWERFUL
TOOLS.
PUSHING HEALTH SYSTEMS
CLINICIANS TO ADOPT WHOLE PERSON
CARE MODELS.
A CAVEAT REFORMS LIKE USUALLY
MOST EFFECTIVE WHEN IMPLEMENTED
COLLABORATIVELY IN THE WIDER
COMMUNITY -- PROVIDER COMMUNITY.
SO BACK TO HEALTH SYSTEMS AND
FRONT LINE CLINICIANS AND THEIR
ROLES IN WHOLE PERSON CARE.
FINANCING HEALTH SYSTEM LEADER
NEGOTIATE CONTRACTS WITH PAYERS
SO INCENTIVES ARE ALIGNED BETTER
WITH THIS GOAL.
CLINICIAN CAN DO LIKEWISE
NEGOTIATING CLINICAL TRIALS TO
HEALTH SYSTEMS.
CLINICIANS TOGETHER TO ESTABLISH
MANAGE PREVENTION CARE TEAMS AND
NETWORKS AND IMPLEMENTING
POPULATION HEALTH DATA TOOLS.
CLINICIANS PROVIDE REGULAR
FEEDBACK TO HEALTH SYSTEM ABOUT
HOW WELL THEY ARE DOING.
AND WHETHER THEY SEE ANY REAL
BARRIERS TO DELIVERING WHOLE
PERSON CARE AT THE POINT OF
CARE.
BOTTOM LINE HERE IS THAT WHILE
LOT OF THIS FALLS ON HEALTH
SYSTEM LEADERSHIP INCLUDING
COORDINATING WITH NON-HEALTHCARE
SETTINGS I MENTIONED, WHOLE
PERSON CARE HAPPENS WHEN HEALTH
SYSTEMS AND FRONT LINE
CLINICIANS ARE ALIGNED IN THEIR
INCENTIVES AND SUPPORT ONE
ANOTHER.
HEALTH ECONOMIST I WAS ASKED TO
COMMENT ON COST EFFECTIVENESS IN
THE CONTEXT OF INTEGRATED CARE
MODELS, THERE IS A WORKING
DEFINITION OF COST EFFECTIVENESS
ON THIS SLIDE HERE BUT I WOULD
LIKE TO SKIP DOWN TO WAYS TO
LOOKING FOR COST EFFECTIVE WAYS
ONE WAY LOOKS FOR ECONOMIES OF
SCALE AT THE POPULATION SO WE
INVEST IN RELATIVELY IF U BUT
LARGER SCALE INITIATIVES.
THE -- OTHER WAY IS LEADING
INDIVIDUAL PATIENT NEEDS AND
NEED TO INVEST IN DIFFERENT
INITIATIVES TARGETED.
BOTH EASIER SAID THAN DONE AND
BOTH WORK YET PROBABLY THE BEST
BALANCE IS BETWEEN THE TWO.
HERE IS MY RECIPE FOR COST
EFFECTIVE INTEGRATED CARE
INITIATIVES.
FIRST FIND LOW COST SCREENING
FOR RISK FACTORS.
PARSIMONIOUS DEATH AND
SUFFICIENT ALGORITHMS TO BUILD
RISK PROFILES.
SECOND REDUCE COST OF TARGETING
THE INITIATIVE.
YOU ARE LOOKING TO MAXIMIZE
POPULATION COVERAGE AND MINIMIZE
UNNEEDED INTERVENTION USE, HIGH
SENSITIVITY AND HIGH
SPECIFICITY.
BUT AS PROTIP, YOU CAN OFTEN
IMPROVE EFFICIENCY HERE BY
COMPROMISING SOME ON PRECISION.
100% IS NEVER THE MOST COST
EFFECTIVE APPROACH.
FINALLY, MAKES SURE YOUR
INTERVENTION IS EFFECTIVE FOR
THE TARGETED POPULATION.
EVEN IF INTERVENTION ITSELF IS
ON EXPENSIVE SIDE IF YOU ARE
SCREENING AND TARGETING
APPROACHES ARE EFFICIENT YOU CAN
STILL HAVE A COST EFFECTIVE
INITIATIVE OVER ALL IF
EFFECTIVE.
I WILL WRAP UP BY POINTING OUT
THAT COST EFFECTIVE IS NOT
MEANING COST SAVING.
IF YOU ARE HOLDING OUT COST
SAVINGS WHEN CHOOSING A MODEL TO
IMPLEMENT, YOU MIGHT BE WAITING
A WHILE.
THIS IS A CALL BACK TO DR.
CLARE'S QUOTE FROM WALT DISNEY,
GET DOING.
SO WITH THAT, I'LL THANK YOU,
VERY MUCH FOR THE OPPORTUNITY TO
JOIN Y'ALL TODAY, LOOK FORWARD
TO THE PANEL DISCUSSION.
>> THANK YOU, DR. WILK FOR THAT
VERY INFORMATIVE PRESENTATION.
NOW WE ARE OFFICIALLY IN TO THE
Q&A SESSION.
SO THERE IS STILL TIME TO -- IF
YOU ARE PARTICIPATING IN THE
WORKSHOP THIS AFTERNOON, AND
WOULD LIKE TO PUT SOME QUESTIONS
IN, FEEL FREE.
IF YOU HAVE QUESTIONS TO DR.
KOOB, DR. CLAYTON, DR. TEMKIN,
YOU CAN ALSO PUT QUESTIONS IN
THAT Q&A AREA.
I CAN MAKE SURE THEY HAVE AN
OPPORTUNITY TO RESPOND TO THOSE
QUESTIONS.
SO LET'S REALLY GET TO THE
QUESTIONS THAT ARE AVAILABLE.
SO THE FIRST QUESTION IS, HOW
CAN WE EFFECTIVELY ADDRESS
PROBLEMS, THESE PROBLEMS WHEN
THE MEDICAL SYSTEM AND
PHARMACEUTICAL INDUSTRY ARE
BASED ON GENERATING PROFITS NOT
PREVENTING ILLNESS AND DISEASE
GREATER FOR THOSE WITH CHRONIC
CONDITIONS?
WITHOUT A SYSTEM THAT
PRIORITIZES PUBLIC HEALTH AND
PREVENTION FOR ALL AMERICANS
EVEN THE BEST SCIENCE WHICH WE
NEED MAY NOT STILL SUCCEED
WITHOUT CHARGING LARGER SYSTEMS,
THE PANDEMIC HAS SHOWN THIS SO
STARKLY.
INCLUDING DISPARATE IMPACT ON
WOMEN ESPECIALLY WOMEN OF COLOR
AND THE POOR.
I THINK THIS QUESTION IS
DIRECTED TO DR. SIMON.
CAN YOU RESPOND?
WHAT DO WE VALUE AS SOCIETY?
DO WE VALUE HUMAN?
LAST I CHECKED REGARDLESS OF
SKIN COLOR, REGARDLESS GENDER
SEXUAL ORIENTATION, RURAL URBAN,
WHATEVER COUNTRY OR COME FROM,
REGARDLESS OF LANGUAGE, ET
CETERA, ET CETERA, ET CETERA,
WHO WE WORSHIP INCLUDED WE ARE
ALL HUMAN AND IF WE VALUE HUMAN
AND HUMANITY, THERE IS A MORAL
IMPERATIVE.
WHAT THIS STARTS WITH IS HIGHEST
ELECTED LEADERS.
COUNTRIES, REPRESENTATIVES ON
THE HILL, TAKE THE UNITED
STATES, LEADER IN INSTITUTIONS,
IN OUR HEALTHCARE SYSTEMS, WHO
ARE POLICY MAKERS, WHO ARE THE
GATE KEEPERS.
THEY ARE CRUCIAL AT EVERY STEP
OF THE PROCESS.
IF THEY DON'T VALUE HUMANITY AND
THIS MORAL IMPERATIVE TO DO
BETTER, BECAUSE WE CAN DO
BETTER, TO TRY TO GET TOWARDS
GETTING IT RIGHT, WE ARE NOT
GOING TO GET THERE.
SO I REALLY -- SO COMES DOWN TO
THINGS LIKE CIVIC ENGAGEMENT AND
VOTING AND MAKING SURE IN SEARCH
COMMITTEES AND INSTITUTIONS THAT
THERE IS DIVERSITY CHAMPIONS
THAT WE PUSH THE NEEDLE IN ALL
LEVELS WHEN IT COMES TO ELECTING
GATE KEEPERS WHETHER NATIONAL
LEVEL OR INSTITUTION LEVEL OR
DIVISION OR DEPARTMENT OR CENTER
LEVEL.
ALL CRITICAL IN EVERYTHING WE
DO.
THANK YOU VERY MUCH.
ANOTHER QUESTIONS QUESTION FROM
ODD YEN.
DO YOU THINK LACK OF TRANSITION
IS DUE TO OUR SEX IN GENERAL,
FEMALE SEX?
THE FACT THAT WE MAY NEED DAYS
OFF FOR REPRODUCTIVE CYCLES SUCH
AS MENSTRUATION OR HAVING
CHILDREN, THE POSSIBILITY THAT
WE MAY NEED TO HAVE OPERATIONS
TO REMOVE THESE ORGANS BECAUSE
OF HEALTH RISKS?
WHAT SORT OF NATIONAL POLICIES
WILL BOOST THE OPPORTUNITY FOR
WOMEN AND GIRLS OF CO-MORBID
CONDITIONS TO BE ABLE TO TAKE
BETTER CARE OF THEMSELVES, AND
GET THE LEAVE TIME THEY NEED TO
CARE FOR THEIR -- THEMSELVES.
>> AGREE, IT COMES DOWN TO
STRUCTURE AND POLICIES WHETHER
THE TREES BEND, WHERE ARE
POLICIES AND PRACTICES USING FOR
A LONG TIME, WHERE ARE THEY BENT
TOWARDS NOT FAVORING WOMEN'S
HEALTH SURGERIES OR HEALTH
RELATED PROCEDURES, IN THE
HEALTHCARE SYSTEM VERSUS MALE
RELATED PROCEDURES.
THERE ARE INEQUITIES AT EVERY
SINGLE SPOT AND SO WE REALLY
NEED MORE PEOPLE TO BE AWARE OF
THESE INEQUITIES AND TO ACTUALLY
START ASKING THOSE QUESTIONS.
WHY ARE WE NOT REIMBURSING THE
SAME, WHY IS ONE MEDICATION FOR
SUPPORTING SEXUAL PROWESS AND
SEXUALITY, FOR ONE SEX AND NOT
FOR ANOTHER?
WHY ARE THESE HAPPENING?
WHEN MORE PEOPLE ASK WHY, THEN
WE START TO MOVE THINGS FORWARD
WITH MAYBE WE SHOULD RETHINK
THAT POLICY OR PRACTICE.
>> LIKE ANYTHING WE IMMEDIATE
NOR DATA.
-- NEED MORE DATA.
SO THERE'S ASSUMPTIONS BUT NOT A
LOT OF DATA TO BACK UP SO LOOK
AT PROGRESS IN WOMEN'S MEDICINE
THAT IS GOOD EXCUSE, BUT NOT A
GOOD REASON.
THAT IS PART OF THE ISSUE WHEN
YOU SEE ISSUES WITH BURN OUT IN
WOMEN LEAVING THE HEALTHCARE
PROFESSION, IN MY OPINION BASIS
OF IT IS THAT WE ARE NOT SEEN OR
NOT HEARD AND NOT VALUED.
PEOPLE DON'T ASK US WHAT IT IS
THAT WE NEED TO SUCCEED AND HOW
THE SYSTEM IN GENERAL CAN HELP
IF A LOT OF ASSUMPTIONS WHAT MAY
OR MAY NOT HAPPEN AND UNTIL OR
UNLESS WE INTERVENE AND ENGAGE
WOMEN IN THAT DISCUSSION, IN
TERMS OF CAREER PROGRESSION, YES
NOT GOING TO GET FAR.
>> THANK YOU, DR. TEMPLETON, HOW
DO WE ADDRESS SILOS RELATED TO
WOMEN WITH OSTEOARTHRITIS OR
OTHER CHRONIC HEALTH CONDITIONS?
>> GREAT QUESTION.
I THINK PART GETS BACK TO
EDUCATION.
AND IMPROVING SEX AND GENDER
BASED EDUCATION IN HEALTH
PROFESSIONS.
INCREASING UNDERSTAND THING THAT
SEX AND GENDER IMPACTS EVERY
HEALTH CONDITION BUT THOSE
AREN'T SILOED.
SO WHEN YOU ARE SEEING A PATIENT
WITH OSTEOARTHRITIS, ONE
QUESTION THAT CAME UP IS WHY ARE
WOMEN REFERRED LATER, IN
ADDITION TO THE ANSWER I REPLIED
ONE ISSUE IS PEOPLE THINK IT IS
JUST JOINT PAIN.
THAT IS TRUE EVERY OTHER CHRONIC
CONDITION AMONG WOMEN, ASSUMED
JUST CONDITION X OR Y, YOU ARE
MISSING THE INNER CONNECTIONS,
UNTIL YOU SEE A WOMAN AS A WHOLE
AND SEE EVERY HEALTH CONDITION
THEY HAVE IS LIKELY GOING TO
IMPACT OTHER HEALTH CONDITIONS
THEN YOU ARE GOING TO NOT
IMPROVE THEIR CARE.
SO ADDRESSING SILOS, IT IS
IMPROVING EDUCATION SYSTEM FROM
UNDERGRADUATE TO CONTINUING
MEDICAL EDUCATION, TO BETTER --
HAVE BROADER MORE EXPANSIVE
DISCUSSION ON WHAT IS WOMEN'S
HEALTH, AND HOW ISSUES
INTERCONNECT SO WHEN TEACHING WE
HAVE TO TALK ABOUT INNER
CONNECTIONS.
>> THANK YOU SO MUCH DR.
TEMPLETON.
FOR RESPONDING TO THAT QUESTION.
DR. CLARE, THERE IS A QUESTION
FOR YOU.
FROM THE AUDIENCE THERE SAYING
THANK YOU FOR YOUR TALK, HAVE
YOU ENCOUNTERED OR DO YOU HAVE
ANY INSIGHT ON HOW TO DETER
HAZING MENTALITY SENIOR WOMEN
MADE IT HAVE TOWARDS WOMEN MORE
JUNIOR THAN THAT?
>> THIS QUESTION SPOKE TO ME, I
WORKED FOR WOMEN MAJORITY OF MY
CAREER BEFORE MY CURRENT ROLE
AND WAS CHALLENGED THROUGHOUT MY
WHOLE CAREER, ABOUT THIS
SPECIFIC ISSUE.
SO FOR THOSE ROLES WE ARE, WE
HAVE A RESPONSIBILITY TO MENTOR
AND SPONSOR AND OPEN THE DOOR
AND KICK DOWN THE DOOR AS DR.
SIMON MENTIONED, PERHAPS
DEMOLISH THE TREE FOR OUR
COLLEAGUES WE HAVE A RESPONSIBLE
RESPONSIBILITY TO DO SO.
THERE ARE INDIVIDUALS THAT DO
BELIEVE I DID IT ON MY OWN YOU
SHOULD BE ABLE TO DO IT, YOU
SHOULD WALK THE PATH ON YOUR
OWN.
THAT IS NOT RESPONSIBLE FOR OUR
COLLEAGUES.
WE HAVE ALREADY MENTIONED
THROUGH THE WORK FORCE DATA I
SHARED WITH YOU, THERE ARE MORE
WOMEN IN MEDS SIN.
THIS WAS 40% IN MY MEDICAL
SCHOOL CLASS NOW OVER 50%.
I WAS WORRIED DOING CERTAIN
ROTATIONS HOW I WOULD BE
TREATED.
SO WE HAVE A RESPONSIBILITY TO
REALLY LEAD TEAGUES BY THE HAND,
GIVE SPECIFIC TOOLS, MENTORS AND
SPONSORS FOR THEM AND DEMOLISH
BOTH SYSTEMS.
THAT DATA IS OUT THERE,
REGARDING GENDER DISPARITIES AND
OBGYN THAT DATA IS OUT THERE,
MORE OF US WENT TO OBSTETRICS
GYNECOLOGY THAT REIMBURSEMENT IS
THERE SO WE HAVE TO BELIEVE THE
DATA AND WE HAVE TO DO SOMETHING
ABOUT IT SO HOPE THAT ANSWERS MY
COLLEAGUE'S QUESTION.
>> HERE IS ANOTHER QUESTION I
THINK FOR YOU, DR. CLARE, FROM
THE AUDIENCE.
SHOULD MEDICAL EDUCATION INVOLVE
FROM A DISEASE MANAGEMENT MODEL
TO A POPULATION HEALTH MODEL
GIVEN ANTICIPATED POLICY CHANGES
TOWARDS WHOLE PERSON -- WHOLE
PATIENT CARE AND INTEGRATED
CARE?
THE
>> I THINK WHEN I GOT MY MASTERS
OF PUBLIC HEALTH I DEFINITELY
CHANGED MY PERSPECTIVE IN TERMS
OF TAKING CARE OF ONE INDIVIDUAL
OPPOSED TO I CAN TAKING CARE
POPULATIONS AND COMMUNITIES SO
OUR PERSPECTIVE IN TERMS OF
PREVENTIVE MEDICINE NOT JUST
ILLNESS BASED MED MEDICINE AND
THE GREAT SLIDE DR. CLAYTON
MENTIONED REGARDING LIFE COURSE
IS REALLY CRITICAL.
WE HAVE SEEN THAT FOR THOSE OF
US IN OBSTETRICS GYNECOLOGY
WOMEN HAD POOR HEALTH OUTCOMES
DURING PREGNANCY THAT MIRRORS
WHAT WILL HAPPEN LATER.
THOSE WILL DEVELOP
CARDIOVASCULAR DISEASE, WHO HAS
PREECLAMPSIA DURING PREGNANCY OR
GESTATIONAL DIABETES SO
IMPORTANT TO THINK ABOUT THE
WHOLE PERSON POPULATION ANSWER
COMMUNITY WHICH SOMEONE LIVES
ALL THOSE SOCIAL DETERMINANTS,
WHERE THEY CAME FROM AS
ILLUSTRATED IS VERY, VERY
IMPORTANT.
COMES FROM POLICIES AN PRACTICES
RACISM THAT WE HAVE TO ADDRESS.
WE HAVE TO BELIEVE ABLE TO LOOK
IN THE MIRROR AND REALLY
ADDRESS.
>> THANK YOU.
I THINK THIS IS A QUESTION FOR
-- THAT I WILL HAVE DR. WILK
RESPOND TO.
WE -- COMMENT FROM THE AUDIENCE
IS THAT WE ARE SAYING TOO MUCH
IN THE INDIVIDUAL LEVEL SOCIO
ECOLOGICAL MODEL AND NOT HOW WE
CAN CHANGE THE SYSTEM.
HOW MUCH DATA DO WE NEED, WE
HAVE BEEN COLLECTING DATA ON
WOMEN AND GIRLS.
SEEING A WOMAN AS A WHOLE PERSON
IS STILL ON AN INDIVIDUAL LEVEL
AND HOW WE MOVE FROM THE
INDIVIDUAL TO SYSTEMS.
>> DR. TEMPLETON MADE AN
EXCELLENT POINT ON THIS WHICH IS
IN SO MUCH OF OUR RESEARCH,
RESULTS ARE NOT REPORTED IN A
DISAGGREGATED WAY FOR EACH
DIFFERENT SUBPOPULATION WHOM
THESE INTERVENTIONS NEED TO WORK
BEST.
SO IF THEY WORK WELL ON AVERAGE
WHICH IS WHAT A LOT OF OUR DATA
SHOWS, THEY MAY STILL NOT WORK
WELL FOR INDIVIDUALS WITH
PARTICULAR INTERSECTIONAL
IDENTITIES.
SO THAT IS REALLY IMPORTANT TO
KEEP THE DATA FLOWING SO THAT
EVERY INTERVENTION AND
INITIATIVE CAN BE MORE AND MORE
PRECISELY TARGETED.
AND PLEA AGREEMENTED IN WAY THAT
MAXIMIZES BENEFIT IF WE ARE
LUCKY REDUCES SPENDING TO L A
ATTORNEYTIVE INTERVENTIONS.
SO -- ALTERNATIVE INTERVENTIONS
SO WE HAVE A LOT OF DATA THAT
SUPPORT OBJECTIVES OF THIS
CONFERENCE IN WAYS BUT DOING THE
DIRTY WORK OF FINDING THE RIGHT
INTERVENTION AND PUTTING IT INTO
PLACE EFFECTIVELY, IS SOMETHING
THAT WE DON'T HAVE NEARLY ENOUGH
DATA ABOUT IN MY OPINION.
>> THANK YOU.
THIS IS A RELATED QUESTION.
FOR DR. WILK.
THE PERSON SAYS ENJOYING YOUR
TALK AND KEY INTERPLAY BETWEEN
FRONT LINE CLINICIANS HEALTH
SYSTEMS PAYER/POLICY MAKERS.
THE GOAL TO ADVANCE FOCUS ON
POPULATION HEALTH AND
PARTNERSHIP WITH CLINICIANS AND
RESEARCHERS, SOUNDS CONSISTENT
WITH THE EMERGING LEARNING
HEALTH SYSTEMS LITERATURE.
WHAT ARE YOUR THOUGHTS ON HOW
LEARNING HEALTH SYSTEMS ARE
RELATED TO YOUR GOALS FOR
IMPROVING POPULATION HEALTH.
>> CLOSELY RELATED, AND RELATED
TO THE POINT THAT I WAS MAKING
ABOUT THE IMPORTANCE OF GETTING
INTERVENTIONS RIGHT FOR TARGET
POPULATIONS THAT ANY
INTERVENTION IS TARGETING.
SO LEARNING HEALTH SYSTEMS ARE
-- WHEN IMPLEMENTED WELL, CAN BE
QUITE GOOD AT COLLECTING THE
RIGHT DATA ON THE POPULATIONS
THAT YOU WANT TO TARGET, AND
USING THAT DATA TO CONTINUOUSLY
REFINE AND IMPROVE THE
INTERVENTIONS AND SYSTEMS IN
PLACE.
THIS GOES BACK TO MY POINT ABOUT
IMPORTANCE OF PROVIDERS
THEMSELVES WHOSE ARE AT THE
LEADING EDGE OF CARE.
PROVIDING FEEDBACK TO HEALTH
SYSTEMS AND ADMINISTRATORS WHO
ARE EMPLOYING OR COLLABORATING
WITH THEM SO THEY CAN REPORT
WHAT THEY SEE AS WORKING WELL OR
NOT WORKING WELL AND THEN
LOOKING WITH THE SYSTEMS
LEADERSHIP TO REFORM THESE
INTERVENTIONS AND INITIATIVES TO
MAKE SURE WOMEN HEALTH IS
MAXIMIZED.
LEARNING HEALTH SYSTEMS IS NOT
THE ONLY FRAMEWORK FOR THAT.
I MENTIONED IN RESPONSE TO
ANOTHER QUESTION IN THE Q&A THE
IDEA OF ACCOUNTABLE CARE
COMMUNITIES.
THIS IS AN EXPANSION OF
ACCOUNTABLE CARE ORGANIZATIONS
WHICH YOU HEARD ABOUT A DECADE
AGO.
THEY INVOLVE MORE ROUTINELY
GETTING USEFUL INPUT FROM LOT OF
COMMUNITY ORGANIZATIONS AND
STAKEHOLDERS SO AGAIN THINGS ARE
MEASURE AND DATA IS USED TO
REDIRECT THE EFFORTS BUILDING
TOWARDS WHOLE PERSON CARE.
DR. SIMON MAYBE I SAID SOMETHING
THAT OFFENDED YOU AND YOU WOULD
LIKE TO RESPOND?
>> NO OFFENSE WHATSOEVER.
YOU ARE SPOT ON BUT RAISED MY
HAND BECAUSE I TOO SUPPORT THAT,
THE LEARNING HEALTH SYSTEM
APPROACH IS NOT SOMETHING OR THE
SYSTEMS APPROACH IN GENERAL IS
NOT SOMETHING WE DO ENOUGH OF
AND AGAIN PATIENT NAVIGATION FOR
EXAMPLE ARE COMMUNITY HEALTH
WORKER MODELS, THINGS THAT ARE
DEPLOYED ACROSS MANY DIFFERENT
SPACES, ACROSS THE WORLD, HAVE
NOT BEEN ACTUALLY EXAMINED IN
THE LEARNING HEALTH SYSTEMS
APPROACH.
COMMUNITY HEALTH WORKERS FROM --
PATIENT NAVIGATORS, WHATEVER YOU
WANT TO CALL THOSE INDIVIDUALS
HELP US LEARN WHERE GAPS ARE.
IF WE CAN REFER TO ACTIVITIES IN
A VARIETY OF PATIENTS AND PEOPLE
IN A VARIETY OF SETTINGS WE CAN
ACTUALLY LEARN AND IMPROVE OUR
HEALTHCARE DELIVERY SYSTEMS.
THAT'S CRITICAL WHEN TALKING
ABOUT THIS PARTICULAR TOPIC OF
CHRONIC CO-MORBID CONDITIONS,
AND WOMEN AND GIRLS AND HOW TO
REALLY ACROSS THE ENTIRE LIFE
SPAN.
USING DR. TEMPLETON EXAMPLE IS
GREAT.
IF YOU DON'T HAVE ACCESS TO
HEALTHY FOODS WHEN PREGNANT AND
WHEN YOU ARE A CHILD, WHAT DOES
THAT SAY?
YOU WENT FOR OBESITY, RIGHT AND
THE SYSTEMS OF OPPRESSION AND
ALL THOSE OTHER THINGS THAT
IMPACT YOU AS AN INDIVIDUAL
ACROSS THAT LIFE AND HEALTH SPAN
IS GOING TO IMPACT YOUR
DEVELOPMENT OF OSTEOARTHRITIS
LATER ON.
OBESE, YOU HAVE WEIGHT BARING
ISSUES.
THERE WAS A QUESTION IN THE CHAT
-- IN THE Q&A BUT THOSE ALL
MATTER.
SO THIS LEARNING HEALTH SYSTEM
APPROACHES IS CRITICAL.
IN YOUR RECIPE WHERE SHOULD
INTERVENTIONS OCCUR IN PRIMARY
CARE I WILL GIVE A COP OUT
ANSWER, IT DOES DEPEND, I THINK
THERE ARE SOME INTERVENTIONS.
AND IT DEPENDS IMPORTANTLY ON
EXPERTISE OF THE AVAILABLE
INDIVIDUALS INTERVENTIONS
SCREEN, ET CETERA, SO I MENTION
THE CASE OF SCHOOL MENTAL
HEALTH.
CAN BE LOCATED AT SCHOOLS OR IN
COMMUNITY OUTPATIENT MENTAL
HEALTH TREATMENT CENTERS OR IN
MANY OTHER DIFFERENT PLACES,
COMMUNITY HEALTH CENTERS, WOMEN
HEALTH CLINIC, SO ON.
DO THAT WHEN YOU CAN BECAUSE OF
ADVANTAGES WITH RESPECT TO
OVERCOMING LIST SOMEWHERICAL AND
GEOGRAPHIC BARRIERS.
BUT FOR HOSPITALS OF OTHER
INTERVENTIONS AND SCREENINGS.
IT MAYBE HARD TORE LOCATE
INDIVIDUALS AT SCHOOLS AND OTHER
CLINIC SETTINGS, SEPARATE FROM
AND EXMOTHER THE DIFFERENCE IN
TERMS OF OUTCOMES, ACCESS
ENGAGEMENT IN DIFFERENT
SETTINGS.
BECAUSE IF THERE IS A BIG
DIFFERENCE, IN THE OUTCOMES THAT
SHOULD TIP YOU OFF TO WHERE
POTENTIAL EFFICIENCIES OR
IMPROVED EFFECTIVENESS CAN BE
GARNERED DEPENDING HOW YOU
IMPLEMENT THESE.
ON THIS HEALTH STRATEGY.
SO THE PERSON FROM AUDIENCE IS
SHARINGs PERNSES ABOUT --
EXPERIENCES IN HER LIFE AND
HAVING HYPERTENSION AND ORGAN
FAILURE AND HOW WOULD ONE BEGIN
TO ADDRESS COMPLEXITY OF WOMEN'S
LIVES?
DR. TEMPERATURE TON CAN YOU
RESPOND TO THAT?
>> I WAS GIVING A BRIEF
RESPONSE, GET BACK TO ISSUE WITH
OSTEOARTHRITIS AND JOINT PAIN
STUDIES LOOK AT PATIENTS WHO
PRESENT WITH CHRONIC
MUSCULOSKELETAL PAIN, A THIRD
HAVE PREVIOUSLY UNDIAGNOSED
UNTREATED DEPRESSION AND ANXIETY
ANXIETY.
SIGNIFICANT PORTION OF THOSE
HAVE DOMESTIC VIOLENCE AN PTSD
SO GETS BACK TO THE EARLIER
QUESTION IF YOU DO SCREENING IT
NEEDS TO BE BIDIRECTIONAL, IF
YOU ARE PRIMARY -- IF YOUR
PRIMARY CARE PROVIDER YOU HAVE
GOT TO BE ASKING ABOUT SPECIALTY
THINGS LIKE JOINT PAIN OR ANY
OTHER MORE SPECIFIC HEALTH
CONDITION.
IF YOU ARE SPECIALIST YOU NEED
TO ASK ABOUT THESE OTHER THINGS
SO IF YOU HAVE PATIENTS COMING
IN DUE TO CHRONIC JOIN PAINT
UNLESS YOU ASK ABOUT OR
INVESTIGATING HISTORY OF MENTAL
HEALTH ISSUES AND WHETHER THEY
ARE VICTIMS OF DOMESTIC
VIOLENCE, NO MATTER HOW AWESOME
THE MENTAL IS YOU CAN PUT IN --
METAL IS TO PUT IN, THEY ARE NOT
GOING TO GET BETTER AS I
MENTIONED IN ONE STUDY, SEVERAL
STUDIES, PRE-EXISTING DEPRESSION
AND OTHER MENTAL HEALTH ISSUES
LEADS TO PEOPLE EVEN AFTER WHAT
WOULD SEEM SUCCESSFUL SURGERY
NOT GETTING BETTER.
SO THIS -- DOMESTIC VIOLENCE
ISSUE DOES DESCRIBE THE
COMPLEXITY OF WOMEN'S HEALTH, IT
HAS TO BE EVERYONE LOOKING AT
EVERYTHING, IF YOU COME IN
BECAUSE YOUR KNEE HURTS I NEED
TO FIND OUT WHAT ELSE IS GOING
ON IN YOUR LIFE.
MAYBE YOU ARE HURTING BECAUSE
YOU ARE A VICTIM OF DOMESTIC
VIOLENCE OR YOU HAVE PTSD.
WE NEED TO BE ASKING ABOUT THAT,
SO IT GETS TO MY EARLIER ANSWER,
THIS BACK TO EDUCATION, TEACHING
COMPLEXITIES AN DIVERSITY OF SEX
AND GENDER BASED DIFFERENCES
ALONG ALL HEALTH CONDITIONS AT
EVERY LEVEL OF EDUCATION AND HOW
THESE CONDITIONS INTERACT AND
INTERPLACE.
-- INTERPLAY.
>> THANK YOU SO MUC MUCH NOR THAT
DR. TEMPLETON.
HERE IS ANOTHER QUESTION FROM
THE AUDIENCE.
BY PARTICIPANT/GROUP
CHARACTERISTICS SEEM LACK OF
INTEREST FROM FUNDING AGENCIES.
AND JOURNAL EDITORS.
/REVIEWS AND INCREASING
ACCEPTABILITY AS OUTCOME.
RATHER THAN ASKING ACCEPTABLE WE
NEED TO ASK FOR WHOM AND WHEN
INTERVENTION ACCEPTABLE BUT
FEELS LIKE THE FIELD IS ONLY
INTERESTED IN SEEING
EFFECTIVENESS IN -- ON AVERAGE,
IF THE VULNERABLE PARTICIPANTS
DON'T ACCEPT INTERVENTION IT
WILL NEVER BE EFFECTIVE FOR
THEM.
HOW DO WE EXPRESS THE IMPORTANCE
OF ACCEPTABILITY AS VARIABLE ON
ITS OWN SEPARATE FROM EFFICACY?
DR. SIMON CAN YOU RESPOND TO
THAT AND PERHAPS ALL THE
PANELISTS MAY WANT TO TAKE
RESPONSE TO THAT.
>> DEFINITELY APPRECIATE THAT.
AND I ENCOURAGE IF YOU HEARD MY
TALK A LITTLE BIT, THERE'S TALKS
REPORTED SO I DID TOUCH ON THIS.
THERE IS BIAS ALONG THE ENTIRE
PIPELINE TO IMPACT THE PERSON
LEVEL OR COMMUNITY LEVEL.
SO WHEN WE THOUGH BIASES IN EACH
PART OF THE RESEARCH AND
PUBLICATION, WE CAN SEE WHAT IS
GOING ON BUT WE NEED TO ASK
THOSE CRITICAL QUESTIONS AT
EVERY STATE -- EVERY STEP IN
THAT GATE KEEPING PROCESS.
SO ACCEPTABILITY PATIENT CENTER
CENTERED WHAT DOES THAT MEAN TO
DELIVER PATIENT TRULY PATIENT
CENTERED CARE UNDERSTANDING
COMPLEXITY AND CONTEXT OF WOMEN
WITHIN GIRLS LIVES AND PEOPLE'S
LIVES IN GENERAL.
SO THOSE ARE IMPORTANT WHETHER
ORTHO POD OR GYN OR OB OR
WHATEVER YOU ARE, EVEN HEALTH
ECONOMIST, DR. WILK, WE ALL NEED
TO RECOGNIZE THAT AND THAT'S HOW
WE DO A BETTER JOB ONCE WE
PAUSE, WE ACT FOLIAGE WHAT IT IS
OUR LIMITATIONS ARE ON OUR
KNOWLEDGE AND PERSONAL LIFE
EXPERIENCE, WE REFLECT ON THAT
BECAUSE THAT IS HOW WE ACTIVELY
MANAGE BIAS IN EVERY SINGLE
SITUATION, AND THEN DECIDE RYE
TO WORK WITH PARTICULAR PATIENT
OR PERSON AND LOVED ONES
CAREGIVERS DEPENDING ON SCENARIO
AND DEVELOP A CARE PLAN AND
APPROACH CENTERED ACKNOWLEDGING
CONTEXT AND COMPLEXITY OF EACH
INDIVIDUAL PERSON.
>> THANK YOU SO MUCH, DR. SIMON.
THERE WAS A QUESTION THAT I SAW
EARLIER THAT I WANT THAT I
DIDN'T HAVE AN OPPORTUNITY TO
ADDRESS THAT I WILL SAY NOW.
SOMEONE FROM THE AUDIENCE MADE
OBSERVATION THAT THE TALKS HAVE
BEEN REFLECTING CIS GENDER
WOMEN, WHEN WE TALK ABOUT
CO-MORBID CO-OCCURRING
CONDITIONS, AND TRANSGENDER
WOMEN AN GIRLS WHAT SYSTEMS OF
CARE DO WE NEED THE HAVE, HOW DO
WE INCLUSIVE THE RANGE OF WOMEN
AND INDIVIDUALS WHO IDENTIFY
BEING WOMEN?
DR. SIMON CAN YOU RESPOND TO
THAT?
>> I WOULD LIKE TO GIVE ONE
PANELIST A CHANCE, DR. CLARE AND
DR. TEMPLETON BOTH HAD THEIR
HANDS UP SO I WILL LET THEM --
>> OKAY.
GREAT.
>> I WOULD SAY FIRST THIS IS AN
INCREDIBLY IMPORTANT QUESTION.
UNDERSTANDING THE, ISSUES OF
TRANSGENDER WOMEN THE
TRANSPOPULATION IN GENERAL IS
IMPORTANT BUT I THINK PART OF
THE ISSUE THAT WE HAVE NOW IS WE
DON'T HAVE GOOD DATA OR GOOD
UNDERSTANDING OF WHAT HAPPENS ON
A SEX BASED LEVEL FOR WOMEN.
WHAT DOES IT MEAN TO BE XX OR XY
OR PERMUTATION THEREOF.
ANYWHERE FROM 25 TO 30% ARTICLES
DISAGGREGATE REPORT DATA ON SEX.
SO UNTIL WE UNDERSTAND THE BASIC
INFLUENCE OF GENETICS IN THE
PHYSIOLOGY OF BEING XX OR XY,
UMIAKS IT CHALLENGEOGRAPHY GUSH
OUT THEN WHAT HAPPENS IF WHEN
YOU ARE TRANSGENDER.
FROM BOTH THE PHYSIOLOGIC AND
HORMONAL LEVEL AND MEDICATIONS
AND THE STRUCTURAL LEVEL AND THE
SOCIETAL GENDER BASED COMPONENT
OF IT SO IT IS INCREDIBLY
IMPORTANT TO LOOK AT BUT I WORRY
UNTIL WE UNDERSTAND BETTER
REPORT BETTER PHYSIOLOGY, HOW DO
WE THEN UNDERSTAND THE
TRANSPOPULATION.
SO IT'S REALLY STARTING AT THE
BASICS.
WE DON'T HAVE THAT YET.
SO IT DOESN'T MEAN WE CAN'T WORK
WITH LOOKING AT CIS AND
TRANSGENDER POPULATIONS IN
PARALLEL.
BUT WE NEED TO DO A WHOLE LOT
BETTER IN REPORTING DATA JUST
BASED ON CHROMOSOMES AT THIS
POINT.
>> DR. CLARE DID YOU WANT TO
RESPOND TO THAT QUESTION?
>> YES.
I THIS I SOME OF THE STRATEGIES
IS ONE IN THE ELECTRONIC MEDICAL
REPORT CAPTURING THAT SOGI DATA,
SEXUAL ORIENTATION GENDER
IDENTITY IS CRITICAL.
NOT ALL SYSTEMS CAPTURE THAT, IT
IS PRETTY GOOD ONE EXAMPLE, THE
OTHER THING IS AT THE LEVEL OF
MEDICAL EDUCATION, AS I KNOW DR.
SIMON HAS DONE WORK IN THIS
AREA, AS WELL, LOOKING AT
CURRICULUM AND JUST EDUCATING
LEARNERS ON GETTING MORE
COMFORTABLE IN EVALUATING
PATIENTS THAT ARE NOT CIS GENDER
PATIENTS, FROM A CURRICULUM
PERSPECTIVE.
SO WORK NEEDS TO BE DONE, MANY
ORGANIZATIONS ARE MOVING GENDER
NEUTRAL LANGUAGE AS WELL SO
SPEAKING ABOUT GIRLS IN THIS
PARTICULAR PANEL BEING AWARE OF
GENDER IDENTITIES AND THAT WILL
SPECTRUM IS CRITICAL AS AUDIENCE
MEMBER MENTIONED SO REALLY
IMPORTANT POINT TO ELUCIDATE.
>> THANK YOU SO MUCH, DR. CLARE
FOR RESPONDING TO THAT.
>> CAN I JUST ADD TO THAT,
MEDICAL LITERATURE, SEX AND
GENDER ARE VERY, VERY OFTEN
CONFLATED OR CONFUSED SO THAT IS
SOMETHING THAT WE WOULD LIKE TO
SEE DONE BETTER ACROSS THE
BOARD.
THERE ARE CERTAIN GROUPS WORKING
ON REPRODUCIBLE DATA CAPTURE FOR
GENDER WHICH IS NECESSARY TO
EVEN BEGIN TO ADDRESS SOME OF
THE SEX AND GENDER DIFFERENCES
IN OUR POPULATION HEALTH.
THE LAST THING TO ADD IS THAT
THE OFFICE RESEARCH WOMEN'S
HEALTH HAS NOTICE OF SPECIAL
INTEREST SUPPLEMENT PROGRAM THAT
IS LOOKING AT UNDERSERVED
UNDER-REPRESENTED
UNDERRESEARCHED COMMUNITIES.
I JUST PUT THAT TO THE CHAT
BECAUSE WE ARE VERY INTERESTED
IN SEEING APPLICATIONS FOR
RESEARCH RELATED TO THESE
TOPICS.
>> THANK YOU SO MUCH DR. TEMKIN
FOR THAT RESPONSE.
I WANTED TO PUT THIS QUESTION TO
THE PANELISTS INCLUDING YOU, DR.
TEMKIN.
HOW WILL MORE PERSPECTIVE
RESEARCH ESPECIALLY OR
SPECIFICALLY LONGITUDINAL
COHORTS IN RANDOMIZED CLINICAL
TRIALS BE USEFUL TO PROVIDE
DEFINSIVE EVIDENCE
MULTI-MORBIDITY ON WOMEN AND
GIRLS?
DR. TEMKIN DO YOU WANT TO
RESPOND?
>> ONE THING WE DISCOVERED IN
PREPARING FOR THE WOMEN'S HEALTH
CONFERENCE THIS FALL WAS HOW
LITTLE DATA THERE IS THAT'S AS
WE HAVE BEEN TALKING ABOUT
DISAGGREGATED BY SEX AND GENDER
IN THE MEDICAL LITERATURE ON
CHRONIC CONDITIONS AND ON
MULTI-MORBIDITY.
WE KNOW THAT WOMEN HAVE MORE
CHRONIC CONDITIONS THAN MEN THAT
THEY HAVE MORE MULTI-MORBIDITY
THAN MEN.
WE DON'T EVEN -- I THINK ONE OF
THE OTHER THINGS DR. TEMPLETON
HAVE BEEN TALKING ABOUT IS
ACCUMULATION OF MORBIDITY IN
WOMEN, AND HOW IT'S DIFFERENT
FROM THE ACCUMULATION OF
MORBIDITY IN MEN.
WOMEN HAVE DELAYS IN DIAGNOSIS,
THEY HAVE DIFFERENT PROBLEMS
WITH ACCESS TO CARE AND ALL
THOSE THINGS ACCUMULATE.
I THINK PROSPECTIVELY STUDYING
THESE ISSUES IN WOMEN CAN GIVE
US DATA REGARDING HOW TO FIX
SOME OF THESE PROBLEMS.
>> THANK YOU, DR. TEMKIN, ANYONE
ELSE WANT TO RESPOND TO THAT
QUESTION?
>> DR. TEMKIN'S TOTALLY RIGHT.
THE DESIGN OF THE FUNDING
OPPORTUNITY YOU ALL FOR EXAMPLE
AT NIH DO, IS SO CRITICAL.
I UNDERLINE AND BOLD AND
CAPITALIZE SO CRITICAL.
TO HOW WE AS SCIENCE, SCIENTISTS
RESEARCH ASSEMBLE THE RESEARCH
TEAM, COMMUNITY PARTNER ASSEMBLE
COMMUNITY PARTNERS, CENTER ALL
THOSE VOICES.
THIS THAT IS SO CRITICAL.
HOW YOU DESIGN THE FUNDING
OPPORTUNITY ANNOUNCEMENT IS HOW
THE SCIENTIFIC TEAM WILL APPLY
FOR THE OPPORTUNITY.
AND WILL THEN DESIGN THAT
PROTOCOL OR THE RESEARCH METHODS
AND APPROACHES TO MEET THE
REQUIREMENTS OF THAT FUNDING
OPPORTUNITY.
GO BACK TO THAT PIPELINE
PICTURE, THAT I FLASHED UP ON MY
SCREEN DURING MY TALK, IT IS
CRITICAL AND IS REALLY -- I
CAN'T EMPHASIZE THAT MORE.
>> WE HEAR YOU, DR. SIMON.
WE DO HEAR YOU AND I WANT TO ADD
THAT IT'S REALLY IMPORTANT FOR
WHEN WE PUT OUT REQUEST FOR
INFORMATION, WHEN WE ARE
DEVELOPING NEW STRATEGIC PLANS
THAT WE HEAR FROM YOU FORMALLY,
AT NIH RESPOND TO THOSE RFIs,
RESPOND TO THOSE OPPORTUNITIES
TO HAVE YOUR VOICE HEARD AS AN
ASSOCIATION, AS A CITIZEN, AS A
PATIENT, THAT INFORMATION MAKES
A DIFFERENCE.
I WANT TO MAKE SURE FOLKS KNOW
ABOUT THOSE OPPORTUNITIES.
>> THANK YOU, DR. CLAYTON SO
MUCH FOR RESPONDING TO THAT
QUESTION.
HERE IS ANOTHER FROM THE
AUDIENCE, HOW DO WE WORK THROUGH
DISPARITIES OF TREATMENT OPTIONS
SUCH AS BREAST CANCER
MEDICATION, THAT ARE PRESENTED
ON TELEVISION COMMERCIALS.
THE PHYSICIAN SEES THE TREATMENT
AS VIABLE OPTIONS BUT INSURANCE
DENIES PAYMENT.
THIS IS MORE OF A FINANCING
MEDICATION QUESTION H. DOES
ANYONE WANT TO RESPOND TO THAT
LAST ONE?
>> COMES BACK TO CIVIC
ENGAGEMENT WHO WE ELECT AS
LEADERS, THE WHOLE SYSTEM NEEDS
TO BE INFLUENCED.
SO WHO IS CREATING THOSE
POLICIES AND PRACTICES, WHO IS
CREATING HEALTHCARE, SYSTEMS FOR
THE UNITED STATES, OF AMERICA,
THOSE ALL IMPACT THEN THE
DISPARITY IN TREATMENT
AVAILABLE, HOW ARE PHARMA
REGULATED.
IS THE SAME THING WITH RESPECT
TO COVID VACCINATION, HOW THAT
WAS DEVELOPED AND HOW THAT WAS
THEN DISTRIBUTED IN TERMS OF THE
PHASED SYSTEM SO ALL THESE
POLICIES PRACTICES AND THE
SYSTEMS LOOKING AT THE TREE AND
WHERE IT IS BENT IS CRITICAL.
BEING EMPOWERED TO ASK THE RIGHT
QUESTIONS ABOUT WHY IS TREE BENT
AND HOW CAN WE CHANGE THAT.
>> I LOVE THAT METAPHOR, DR.
SIMON.
ON THAT RESPONSE WE ARE GOING TO
CLOSE THIS SESSION.
WE ARE AT TIME.
THANK YOU TO ALL THE PANELIST,
THUS FAR, ALL THE SPEAKERS, THEY
HAVE BEEN VERY INVIGORATING.
AUDIENCE PLEASE STAY WITH US AS
WE MOVE INTO OUR NEXT SESSION.
THANK YOU.
>> THANK YOU VERY MUCH.
>> I WOULD LIKE TO ECHO TAMARA'S
SENTIMENTS THANKS TO SESSION 1
PANELISTS AND NIH LEADERS WHO
KICKED OFF WORKSHOP.
MANY INTRIGUING POINTS WERE
RAISED ABOUT BARRIERS TO CARE
FOR WOMEN AND GIRLS INCLUDING
SYSTEMIC ISSUES, HIGHLIGHTING
HOW INEQUITIES MEDICAL
LEADERSHIP FOR WOMEN PHYSICIANS
CONTRIBUTE TO LOWER ACCESS TO
QUALITY CARE.
AND HOW PAYER POLICIES CAN BE
BARRIER TO INTEGRATED HEALTH
SYSTEMS FOR ADDRESSING
CO-MORBIDITIES.
ADDITIONALLY WE HEARD SEVERAL
TALKS HIGHLIGHTING MANY
CONDITIONS WITH HIGHER
PREVALENCE AND HEALTHCARE
DISPARITIES FOR WOMEN AND GIRLS.
I WOULD ASK WE CONTINUE TO THINK
ABOUT ALL THESE AS WE GO THROUGH
THE REMAINING SESSIONS TO FIND
UNIFYING THEMES WHERE WE CAN
FIND OPPORTUNITIES FOR ACTION.
AT THIS TIME ON OUR SCHEDULE WE
ARE SCHEDULED TO TAKE A SHORT
BREAK.
WE'LL HAVE A TIMER PUT UP ON THE
SCREEN AND WE ASK YOU TO COME
BACK FOR SESSION 2.
>> WELCOME BACK FOR THE SECOND
SESSION FOR THE WORKSHOP IN
BILLING UNIFYING SYSTEMS OF
CARE.
ADDRESSING CO-MORBIDITIES FOR
WOMEN AN GIRLS.
THIS SESSION AND COMPONENT OF
INTEGRATIVE HEALTHCARE SYSTEMS
FOR WOMEN AND GIRLS WILL BE
MODERATED BY ONE WORKSHOP
CO-CHAIRS, DR. JENNIFER JOHNSON.
WHO IS A CLINICAL PSYCHOLOGIST
AND ECS ENDOWED PROFESSOR OF
PUBLIC HEALTH, AND PROFESSOR OF
OBGYN, PROFESSOR PSYCHIATRY
BEHAVIORAL MEDICINE MICHIGAN
STATE UNIVERSITY.
HER EXPERTISE IS IMPLEMENTATION
AND EFFECTIVENESS TRIALS OF
MENTAL HEALTH SUBSTANCE USE
INTERVENTIONS FOR VULNERABLE
POPULATION INCLUDING PERINATAL
WOMEN AND INDIVIDUALS INVOLVED
IN THE CRIMINAL JUSTICE SYSTEM.
AT THIS TIME I WOULD LIKE TO
TURN OVER THE WORKSHOP TO DR.
JOHNSON.
>> THANK YOU VERY MUCH.
LET ME INTRODUCE OUR OTHER TWO
SPEAKERS AT THE BEGINNING AND
THEN WE CAN MOVE THROUGH OUR
FIRST SPEAKER WILL BE DR. AMY
BOARD.
HEALTH SCIENTIST WITH PRE-NATAL
SUBSTANCE I EXPOSURE
SURVEILLANCE RESEARCH TEAM AT
THE CDC.
AND HER FOCUS IS ON SCREENING
AND INTERVENTION SERVICES ON
POLYSUBSTANCE USE IN PREGNANCY.
ONE INTERESTING FACT ABOUT HER
IS SHE HAS BACKGROUND IN SOCIAL
WORK WORK AS PROGRAM MANAGER FOR
REFUGEE RESETTLEMENT AGENCY.
OUR SECOND SPEAKER WILL BE DR.
STEVEN ONDERSMA PROFESSOR
DEPARTMENT OBGYN AN DIVISION
PUBLIC HEALTH MICHIGAN STATE
UNIVERSITY.
HE HIS PRIMARY INTEREST IS
POPULATION LEVEL INTERVENTION
PROMOTE MATERNAL CHILD HEALTH IN
UNDERSERVED COMMUNITIES
ESPECIALLY USING TECHNOLOGY,
INTERESTING FACT ABOUT HIM, HE
IS A SUPER NICE PERSON AND
FANTASTIC COLLEAGUE, GREAT TO BE
JOINED OUR DEPARTMENT ABOUT A
YEAR AGO AND HAS BEEN FANTASTIC
TO HAVE HIM.
SO WE'LL JUST GO RIGHT THROUGH
IN ORDER, DR. BOARD, ONDERSMA
AND THEN WE WILL SAVE ALL
QUESTIONS FOR THE 20 MINUTES AT
THE END.
>> THANK YOU SO MUCH.
GOOD AFTERNOON, EVERYONE.
THANK YOU SO MUCH FOR THE
OPPORTUNITY TO PRESENT TODAY.
I'M GOING TO TALK ABOUT THE WORK
THAT CDC IS GOING RELATED TO
SURVEILLANCE, PREVENTION, IN
SCREENING AND BRIEF INTERVENTION
TO REDUCE ALCOHOL AND OTHER
SUBSTANCE USE DURING PREGNANCY.
SO FIRST I WOULD LIKE TO PROVIDE
A BRIEF OVERVIEW OF SURVEILLANCE
DATA RELATED TO ADULT ALCOHOL
USE AND BING DRINKING INCLUDING
ALCOHOL AN AND OTHER SUBSTANCE USE
DURING PREGNANCY.
SUBSTANCE USE IN PREGNANCY HAVE
NEGATIVE EFFECTS ON PREGNANT
PERSON AND THE DEVELOPING BABY.
ALCOHOL USE DURING PREGNANCY CAN
CAUSE A RANGE OF LIFE LONG BIRTH
DEFECTS AND DEVELOPMENTAL
DISABILITIES AND MIGHT INCREASE
RISK FOR MISCARRIAGE AND
STILLBIRTH.
THESE DISABILITIES ARE KNOWN AS
FETAL ALCOHOL SPECTRUM
DISORDERS.
SMOKING DURING PREGNANCY
INCREASES THE RISK OF PRE-TERM
BIRTH, LOW BIRTH WEIGHT, AND
ORAL FACIAL COLLAPSE.
SMOKING DURING AND AFTER
PREGNANCY ALSO INCREASES RISK OF
SUDDEN INFANT DEATH SYNDROME.
IN I A DIVISION eCIGARETTE eCIGARETTES ARE NOT SAFE IN
PREGNANCY.
OPIOID USE DURING PREGNANCY IS
LINKED TO POOR FETAL GROWTH,
PRE-TERM BIRTH, STILLBIRTH
SELECTED BIRTH DETECTS AND
NEONATAL ABSTINENCE SYNDROME OR
NAS.
CDC PUBLISHED A REPORT THAT
EXAMINED BEHAVIORAL RISK FACTOR
SUR VASE LENS SYSTEM DATA FROM
2011 TO 2018.
WE FOUND THAT BOTH CURRENT
ALCOHOL USE AND BINGE DRINKING
THE LAST 30 DAYS INCREASED
SLIGHTLY AMONG PREGNANT WOMEN
AGE 18 TO 44 YEARS IN THE UNITED
STATES.
CURRENT DRINKING INCREASED FROM
9.2% TO 11.3%, BINGE DRINKING
FROM 2.5% TO 4.0%.
CDC ALSO ANALYZED NATIONAL
SURVEY ON DRUG USE AN HEALTH
DATA FROM PREGNANT RESPONDENTS
12 TO 44 YEARS OF AGE FROM 2015
TO 2018.
WE LOOKED AT PAST 30 DAY
CO-OCCURRING USE OF OTHER
SUBSTANCES AMONG RESPONSE DENS
WHO DRANK ALCOHOL.
NEARLY 10% REPORTED PAST 30 DAY
DRINKING.
AMONG THOSE WHO REPORTED
DRINKING MANY THE PAST 30 DAYS,
40% REPORTED ALSO USING ONE OR
MORE OTHER SUBSTANCE.
THE MOST FREQUENTLY USED
SUBSTANCES OF ALCOHOL WERE
TOBACCO AND MARIJUANA AT 28% AND
21% RESPECTIVELY.
IN THE NEXT TWO SLIDES, I WILL
DIVE DEEPER INTO THE FINDINGS
FROM THOSE STUDY.
THIS GRAPH PAST 30 DAY BINGE
DRINKING HAVING FOUR OR MORE
DRINKS ON ONE OCCASION BY
TRIMESTER IN PREGNANCY.
RESPOND DENS IN FIRST TRIMESTER
REPORTED HIGHER PAST 30 DAY
DRINKING THAN RESPONDENTS IN
SECOND OR THIRD.
19.6% IN THEIR FIRST TRIMESTER
OF PREGNANCY REPORTED PAST 30
DAY DRINKING WHILE 10.5%
REPORTED PAST 30 DAY BINGE
DRINKING.
IN CONTRAST, 4.7% RESPONDENTS IN
THEIR SECOND OR THIRD TRIMESTER
PREGNANCY REPORTED PAST 30 DAY
DRINKING AND 1.4% REPORTED PAST
30 DAY BINGE DRINKING.
SO THESE FINDINGS SUGGEST THAT
RESPONDENTS DECREASE THEIR
ALCOHOL USE ONCE THEY KNEW THEY
WERE PREGNANT.
THESE PIE GRAPH THE SAME REPORT
ILLUSTRATE DISTRIBUTION OF PAST
12 MONTH, PAST 30 DAY DRINKING
ALONEND IN COMBINATION WITH
OTHER SUBSTANCES IN PREGNANT
RESPONDENTS.
NEARLY 65% RESPONDENTS REPORTED
PAST 12 MONTH DRINKING.
38% REPORTED DRINKING WITHOUT
USING OTHER SUBSTANCES AND 27%
REPORTED DRINKING AND USING ONE
OR MORE OTHER SUBSTANCE.
NEARLY 10% REPORTED PAST 30 DAY
DRINKING, 6% REPORTED DRINKING
WITHOUTIOUSING OTHER SUBSTANCES
AND 4% REPORTED DRINKING AND
USING ONE OR MORE OTHER
SUBSTANCES.
FOR BOTH PAST 12 MONTH AND PAST
30 DAY YOU, THE SUBSTANCES MOST
COMMONLY REPORTED AMONG THOSE
WHO REPORTED ALCOHOL USE WERE
TOBACCO AND MARIJUANA.
CDC MONITORS ALCOHOL USE AMONG
PEOPLE IN WOMEN AND REPRODUCTIVE
AGE AND FREQUENCY OF ALCOHOL
SCREENING AND BRIEF INTERVENTION
USING BOTH PATIENT AND PROVIDERS
DATA.
THERE ARE SEVERAL POPULATION
BASED PUBLIC USE DATA SETS
AVAILABLE THAT WE USE AS WELL AS
CONVENIENCE PANEL SURVEY.
THE BEHAVIORAL RISK FACTOR
SURVEILLANCE SYSTEM IS A HEALTH
RELATED SYSTEM SURVEY THAT
COLLECTS STATE SPECIFIC DATA
ABOUT U.S. RESIDENTS REGARDING
THEIR HEALTH RELATED RISK
BEHAVIORS CHRONIC HEALTH
CONDITIONS AND USE OF PREVENTIVE
SERVICES.
-- WAS ESTABLISHED IN 1984 WITH
15 STATES.
NOW COLLECTS DATA IN ALL 50
STATES AS WELL AS DISTRICT OF
COLUMBIA, AND THREE U.S.
TERRITORIES.
COMPLETES MORE THAN 400,000
ADULT INTERVIEWS EACH YEAR
MAKING IT THE LARGEST
CONTINUOUSLY CONDUCTED HEALTH
SURVEY SYSTEM IN THE WORLD.
THERE ARE ALCOHOL CONSUMPTION
QUESTIONS THAT ARE ASKED WITH
EVERY SURVEY AND ALSO ADDED
OPTIONAL MODULE FOCUSED ON
ALCOHOL SCREENING AN BRIEF
INTERVENTION.
INDIVIDUAL WHOSE REPORTED HAVING
A CHECK UP IN THE LAST TWO YEARS
WERE ASKED QUESTIONS ABOUT
WHETHER THEY WERE SCREENED AND
ADVISED ABOUT ALCOHOL USE DURING
THAT CLINICAL ENCOUNTER.
WE ARE FIELDING THE ALCOHOL
SCREENING AND BRIEF INTERVENTION
MODULE AGAIN MANY 2022 WITH 16
STATES.
WE ALSO LIKE DATA FROM SAMHSA
NATIONAL SURVEY ON DRUG USE AN
HEALTH AND ANNUAL NATIONALLY
REPRESENTATIVE SURVEY THAT ASKS
ABOUT WIDE RANGE OF SUBSTANCES,
INCLUDING ALCOHOL USE.
UNLIKE BFFS IN THIS STEP WE LOOK
AT USE BY TRIMESTER AT
PREGNANCY.
WE ALSO ANALYZE DATA FROM
PREGNANCY MONITORING SYSTEM
WHICH CAPTURES DATA FROM WOMEN
WHO DELIVERED LIVE BIRTH.
THERE IS A FOLLOW BACK SURVEY
FOCUSED ON OPIOIDS, AND AS AN
ADD ON WE ADDED QUESTIONS AROUND
ALCOHOL SCREENING AND BRIEF
INTERVENTION.
THE FOLLOW BACK VARY INCLUDES
DATA FROM PARTICIPANTS IN SEVEN
STATES.
FINALLY WE ANALYZE DOC STYLES
DATA WHICH IS A PANEL SURVEY AS
A CONVENIENCE SAMPLE OF
PHYSICIANS.
THIS PROVIDER DATA IS AN
IMPORTANT COMPLIMENT TO DATA
FROM PATIENTS THAT WE GET FROM
PRAMS.
SO NOW SURVEILLANCE DATA I WOULD
LIKE TO SHIFT GEAR AND TALK CDC
PROJECT RELATED TO PREVENTION OF
ALCOHOL AND OTHER SUBSTANCE USE
DURING PREGNANCY.
U.S. PREVENTATIVE SERVICES TASK
FORCE RECOMMENDS SCREENING FOR
UNHEALTHY ALCOHOL USE IN PRIMARY
CARE SETTINGS, IN ADULTS 18
YEARS OR OLDER INCLUDING
PREGNANT PEOPLE, AND PROVIDING
PERSONS ENGAGED IN RISKY OR
HAZARDOUS DRINKING WITH BRIEF
BEHAVIORAL COUNSELING
INTERVENTIONS TO REDUCE
UNHEALTHY ALCOHOL USE.
THE U.S. PREVENTIVE SERVICES
TASK FORCE ALSO RECOMMENDS THAT
CLINICIANS ASK ALL PREGNANCY
PEOPLE ABOUT TOBACCO USE, ADVICE
THEM TO STOP USING TOBACCO AN
PROVIDE BEHAVIORAL INTERVENTIONS
FOR CESSATION TO PREGNANT PEOPLE
TO USE TOBACCO.
MEDICATION FOR OPIOID USE
DISORDER DURING PREGNANCY LEAD
TO FAVORABLE OUTCOMES.
SO WHAT DOES THIS LOOK LIKE.
IN PRACTICE?
RECENT CDC FOUND 81% U.S. ADULTS
IN 13 STATES DISTRICT OF
COLUMBIA REPORTED BEING ASKED BY
HEALTHCARE PROVIDER ABOUT
ALCOHOL USE DURING ROUTINE CHECK
UP IN THE LAST TWO YEARS.
HOWEVER, THIS REPORT ALSO FOUND
80% RESPONDENTS WHO REPORTED
CURRENTLY BINGE DRINKING AND WHO
ARE ASKED ALCOHOL USE AT LAST
CHECK UP WERE NOT ADVISED TO
RECUSE THEIR DRINKING.
SO GIVEN THESE FINDINGS, CDC
CURRENTLY HAS COOPERATIVE
AGREEMENTS IN PLACE WITH FOUR
HEALTH SYSTEMS OR UNIVERSITIES.
THESE PROJECTS FOCUS ON ALCOHOL
SCREENING AND BRIEF INTERVENTION
IMPLEMENTATION WITHIN HEALTH
SYSTEMS PROVIDING WOMEN HEALTH
SERVICES.
WITH THE AIM OF REDUCING RISKY
ALCOHOL USE AMONG WOMEN
REPRODUCTIVE AGE.
GOALS OF THE COOPERATIVE
AGREEMENT INCLUDE INTEGRATING
EVIDENCE BASED SUSTAINABLE
ALCOHOL SCREENING AND BRIEF
INTERVENTION PROTOCOLS IN LARGE
HEALTH SYSTEMS.
EVALUATING FEASIBILITY AND
IMPACT OF IMPLEMENTATION
EFFORTS, DOCUMENTING LESSONS
LEARNED ON IMPLEMENTATION
APPROACHES FOR EXAMPLE
ELECTRONIC HEALTH RECORD
INTEGRATION, AND SHARING
PROMISING PRACTICES AND MODELS.
TO DATE THESE PROJECTS HAVE
IMPLEMENTED ALCOHOL SCREENING
AND BRIEF INTERVENTION IN 67
CLINICS.
JUST TO HIGHLIGHT A FEW SPECIFIC
PROJECTS OUR PANELISTS TODAY IS
CO-PI OF PROJECT HENRY FORD
HEALTH SYSTEM WHICH HAS LAUNCHED
ELECTRONIC SCREENING AN BRIEF
INTERVENTION PROGRAM.
BOSS SON MEDICAL HAS DEVELOP AD
THREE PART PODCAST CALLED
ALCOHOL AND PREGNANCY THE MORE
YOU KNOW.
THE SERIES FEATURES INTERVIEWS
WITH PEDIATRICIAN PATIENT
ADVOCATE, SOCIAL WORKER AND
MOTHER WHOSE CHILD IS EFFECTED
BY PRE-NATAL ALCOHOL EXPOSURE.
THE PODCAST IS DOWN LOWED 1,100
TIMES WITH 104 CLAIMING
CONTINUING EDUCATION CREDIT.
SINCE SEPTEMBER 2019 WE WORK
WITH A FEDERALLY FUNDED RESEARCH
DEVELOPMENT CENTER TO CREATE
STANDARD BASED VENDOR NEUTRAL
CLINICAL DECISION SUPPORT OR
CDS, BASED ON ESTABLISHED
GUIDELINES.
CREATION AND IMPLEMENTATION CAN
HELP FACILITATE CLINICAL
DECISIONS NEEDED TO DELIVER
SCREENING AND INTERVENTION IN
PRIMARY CARE STUDIES.
MINOR DEVELOPED SEMISTRUCTURED
LOGIC AND STRUCTURED CODE FOR
THREE SCREENING INSTRUMENTS, TWO
ALCOHOL ONLY AND ONE IS FOCUSED
ON SUBSTANCE USE SCREENING.
AS WELL AS TWO BRIEF
INTERVENTION TOOLS.
IMPLEMENTATION GUIDE COMPANY
EACH PRODUCT AND ARE ALSO
AVAILABLE THIS MEANS THAT
SYSTEMS CAN INTEGRATE THE TOOLS
INTO THEIR ELECTRONIC HEALTH
RECORDS AND DIGITAL FORMATS TO
IMPROVE DECISIONS, AND IMPROVE
HEALTHCARE DELIVERY.
THESE TOOLS ARE NOW AVAILABLE
VIA CDS CONNECT AND ONLINE
REPOSITORY DISSEMINATE CDS TOOLS
ON BIDE RANGE OF HEALTH TOPICS.
ALSO THE SOFTWARE DEVELOP CDS
AND TEST TO TOOLS PRIOR TO
ELECTRONIC HEALTH REPORT
INTEGRATION IS POSTED ON GITHUB
AND ONLINE PLATFORM DEVELOPERS
AND CODERS POST AND SHARE CODE
IN SOFTWARE.
PILOT PROJECT TO TEST SELECT
TOOLS IS UNDERWAY WHERE WE ARE
WORKING WITH MIDR AND ALLIANCE
CHICAGO TO INTEGRATE TOOL WITHIN
THE ELECTRONIC HEALTH RECORD
SYSTEM OF SEVERAL CLINICAL
LOCATIONS IN CHICAGO ILLINOIS
THE HEART LAND HEALTH CENTERS.
WE ALSO HAVE COOPERATIVE
AGREEMENTS WITH FIVE HEALTHCARE
PROFESSIONAL ORGANIZES AND
UNIVERSITIES TO PROMOTE THE
PREVENTION AND FASD THAT ARE
ACTIVE HEALTH PROFESSIONAL
MEMBERSHIPS RATHER THAN PREGNANT
WOMEN AND WOMEN OF REPRODUCTIVE
AGE.
THE GOALS OF THIS PROJECT
INCLUDE ASSESSING AND PROMOTING
AWARENESS OF ALCOHOL USE
INCLUDING USE DURING PREGNANCY,
BUILDING AND EXPANDING CHAMPIONS
NETWORKS TO SUPPORT AWARENESS
ACTIVITIES AND DISSEMINATION OF
RESOURCES DEVELOPING
IMPLEMENTING RECERTIFICATION
REQUIREMENTS, PROMOTING USE OF
SCIENCE BASED MESSAGES THROUGH
TESTING AND DISSEMINATION OF CDC
PRODUCTS, AND PROMOTING CLINICAL
GUIDELINES AND POLICIES THAT
SUPPORT IMPLEMENTATION OF
ALCOHOL SCREENING AND BRIEF
INTERVENTION.
SOME HIGHLIGHTS FROM THIS WORK
ARE AMERICAN ACADEMY OF FAMILY
PHYSICIANS AS RECORDED SOME
MICROLEARNINGS TO BRIEFLY
ADDRESS HOW TO BREAK DOWN
BARRIERS TO IMPLEMENTING ALCOHOL
SCREENING AND BRIEF INTERVENTION
AND PRACTICE.
FOR OUR PROJECT WITH THE
AMERICAN COLLEGE OF
OBSTETRICIANS AN GYNECOLOGISTS,
WE HAVE A SUCCESSFUL SPEAKERS
BUREAU MODEL OBGYN CHAMPIONS ARE
PAIRED WITH A BIRTH MOTHER FROM
FASD UNITED FORNALLY KNOWN AS
NOFAS TO SHARE LIVED EXPERIENCE.
ADDITIONALLY, OUR PROJECT WITH
THE UNIVERSITY OF NEVADA RENO
HAS CREATED HEALTHY PREGNANCIES
PRODUCTS INTENDED TO MAXIMIZE
THE LIMITED TIME MEDICAL
ASSISTANTS HAVE WITH PATIENTS
DURING APPOINTMENTS AND PROVIDE
IMPORTANT REMINDERS ABOUT
ALCOHOL USE.
CDC IS WORKING TO DEVELOP
MESSAGES FOR HEALTHCARE
PROVIDERS ON THE IMPORTANCE OF
PROVIDING ALCOHOL SCREENING AND
BRIEF INTERVENTION TO WOMEN OF
REPRODUCTIVE AGE.
AND TO ENHANCE PATIENT PROVIDER
COMMUNICATION ABOUT ALCOHOL USE
AND ITS RISKS DURING PREGNANT
SCHISM WE HAVE A TWO YEAR
CONTRACT TO FORMALLY TEST
PREVIOUSLY DEVELOPED CONCEPTS,
DEVELOP FINAL PRODUCT, DEVELOP
AND TEST MESSAGES FOR A GUIDES
FOR FASD RELATED MESSAGING.
COMPLETED MESSAGE TESTING AND
DATA COLLECTION IN THE ANALYSIS
CURRENTLY UNDERWAY.
THE PROJECT COMPLETED ONLINE
DISCUSSION BOARDS WITH 47
HEALTHCARE PROFESSIONALS AND 44
WOMEN OF REPRODUCTIVE AGE AND IN
DEPTH INTERVIEWS WITH 21
HEALTHCARE PROFESSIONAL WHOSE
PARTICIPATED IN THE ONLINE
DISCUSSION BOARDS.
THEY ALSO COMPLETED 12 FOCUS
GROUPS IN CHICAGO IN MINNEAPOLIS
WITH 49 WOMEN.
FINDINGS FROM THIS COMMUNICATION
RESEARCH IS GOING TO INFORM
FUTURE MATERIALS.
SO FINALLY, I WANT TO MAKE YOU
AWARE OF ADDITIONAL RESOURCE
ADDRESSING POLYSUBSTANCE USE IN
PREGNANCY.
ON AUGUST 18, 2020 CDC HOSTED
PUBLIC HEALTH GRAND ROUNDS
REDUCING POLYSUBSTANCE USE IN
PREGNANCY.
THE SESSION DISCUSSED ADVERSE
MATERNAL CHILD HEALTH OUTCOMES
CAUSED BY POLYSUBSTANCE USE.
HOW DATA IMPROVE UNDERSTANDING
OF POLYSUBSTANCE USE, HOW
SCREENING BRIEF INTERVENTION
REDUCE PRE-NATAL SUBSTANCE
EXPOSURE AN IMPROVE HEALTH OF
PREGNANT PERSONS AND INFANTS.
IF YOU FOLLOW THE LINK ON THIS
SLIDE AND CLICK ON MATERNAL
HEALTH, YOU WILL FIND THE
SESSION AND CAN VIEW THE
REPORTING FROM THE GRAND ROUNDS
INCLUDING THE PRESENTATIONS AS
WELL AS THE LIVE Q&A SEGMENT.
PODCAST CALLED BEYOND THE DATA
IN THE CDC WEB PAGE ON
POLYSUBSTANCE USE IN PREGNANCY.
SO THANK YOU SO MUCH FOR GIVING
ME THE OPPORTUNITY TO PROVIDE
QUICK OVERVIEW OF CDC
SURVEILLANCE AND PREVENTION
ACTIVITIES RELATED TO ALCOHOL
AND OTHER SUBSTANCE USE DURING
PREGNANCY.
AS I WRAP UP I WANTED TO MENTION
WE HAVE DEVELOPED A NEW WORKING
GROUP WITHIN THE INTERAGENCY
COORDINATING COMMITTEE ON FETAL
ALCOHOL SPECTRUM DISORDERS
FOCUSED ON SCREENING AND BRIEF
INTERVENTION FOR PREGNANT AND
POSTPARTUM PEOPLE.
IT MEETS MONTHLY INCLUDING
REPRESENTATIVES FROM KEY FEDERAL
AGENCIES INVOLVED IN THIS WORK
WITH THE GOAL OF RESOURCE
SHARING AND ENHANCING
COMMUNICATION AND CORD NATION
AMONG FED -- COORDINATION AMONG
AGENCIES.
REACH OUT TO THE EMAIL ON THE
SLIDE IF YOU ARE INTERESTED IN
LEARNING MORE ABOUT THE EFFORTS
I MENTIONED IN THIS
PRESENTATION.
AND ALSO HAPPY TO TAKE ANY
QUESTIONS DURING THE Q&A
SESSION.
SO I WILL STOP SHARING MY SCREEN
NOW AND TURN IT OVER TO OUR NEXT
PRESENTER.
>> DR. BOHR IS A HARD ACT TO
FOLLOW BUT AT THE SAME TIME I
COULDN'T HAVE ASKED FOR A BETTER
BACKDROP TO TALKING HOW
TECHNOLOGY MIGHT BE AN IMPORTANT
TECHNIQUE FOR SCREENING AND
BRIEF INTERVENTION IN HEALTHCARE
SETTINGS AND IN UNIFYING AND
INTEGRATING SYSTEMS OF CARE
DURING THE PROCESS.
THANKFUL TO HAVE BEEN GIVEN THIS
OPPORTUNITY.
TALK ABOUT THREE SPECIFIC
ISSUES, I WILL GO OVER
IMPORTANCE OF REACH AND WHY I
THINK INTEGRATION AND HEALTHCARE
SYSTEM IS SUCH AN IMPORTANT
ANSWER TO THAT.
ATTEND TO NON-TREATMENT SEEKING
AS A CRITICAL BARRIER.
I WILL TALK ABOUT TECHNOLOGY CAN
PROMOTE REACH THROUGH
INTEGRATION HEALTHCARE SETTINGS
AND INTEGRATION OF OTHER SYSTEMS
OF CARE.
SO FIRST IN TERMS OF REACH, I
THINK ABOUT REACH IN TERMS OF
THAT CLASSIC PUBLIC HEALTH
FORMULA IN WHICH POPULATION PACT
IS FUNCTION OF EFFECTIVE
INTERVENTION AND THE PROPORTION
OF AFFECTEDVINGS WHO RECEIVE
THAT INTERVENTION.
WE HAVE DONE BETTER MANY TERMS
OF DEVELOPING EFFECTIVE
INTERVENTION THAN WE HAVE AT
REACHING EFFECTIVE INDIVIDUALS
AND THAT IS THUS A HUGE BARRIER
TO ACHIEVING POPULATION IMPACT
THAT WE WANT.
FOR EXAMPLE, THESE ARE DATA FROM
NATIONAL SURVEY ON DRUG USE AN
HEALTH SHOWING THAT VAST
MAJORITY OF PEOPLE CERTAINLY
WITH RESPECT TO SUBSTANCE USE
DISORDERS HAVE NOT RECEIVED ANY
TREATMENT IN THE PAST YEAR.
90% HAVE NOT RECEIVED ANY
TREATMENT IN THE PAST YEAR.
FOR OTHER MENTAL HEALTH
DISORDERS, 57% HAVE NOT RECEIVED
TREATMENT IN THE PAST YEAR AND
EVEN 36% THOSE WITH SERIOUS
MENTAL ILLNESS HAVE NOT RECEIVED
TREATMENT IN THE PAST YEAR.
SO WHAT WE GENERALLY LEAP TO
WHEN CONFRONTED WITH DATA LIKE
THIS, IS THE ANSWER THAT YEAH
STIGMA IS A BIG ISSUE AND ACCESS
TO CARE IS A ISSUE, AND WE HAVE
TO DO SOMETHING ABOUT THAT.
THEY ARE BIG ISSUES.
WE HAVE TO DO SOMETHING ABOUT
THEM BUT PRIMARY GOAL HERE IS TO
OR ORIENT THINKING ABOUT THE
GAPS THAT WE ARE LOOKING AT AND
WHERE THEY MIGHT BE COMING FROM.
NATIONAL SURVEY AND DRUG USE
HEALTH DATA OF THAT PROPORTION
THAT HAS NOT RECEIVED TREATMENT
IN THE PAST YEAR FOR SUBSTANCE
USE DISORDER 95% DIDN'T FEEL
TREATMENT WAS NECESSARY.
ONLY A VERY SMALL SLIVER AS WE
SEE HERE ACTUALLY SOUGHT
TREATMENT AND WAS UNABLE TO GET
I WANT.
WHEN YOU PUT TOGETHER NOT
GETTING TREATMENT AND LACK OF
FUELING THAT CARE NEEDED, 85%
NEITHER RECEIVED TREATMENT NOR
FEEL THEY NEEDED.
SO FEE FACT IN REORIENT HOW TO
ACHIEVE THE REACH WE WOULD LIKE
TO ACHIEVE.
FOR MENTAL ILLNESS WITHIN THE
HALF THAT DIDN'T RECEIVE
TREATMENT OF THOSE 27% FELT
UNMET NEED FOR SERVICES AND
RECENT VARY FROM SAFETY AND LAB,
45% DIDN'T RECEIVE TREATMENT
MOSTLY BECAUSE OF LACK OF
CONFIDENCE AN MENTAL HEALTH
TREATMENT LACK OF KNOWLEDGE TO
WHERE TO FIND IT, OR EVEN
PREFERRING SELF HELP TREATMENT
SO MORE PEOPLE PREFER SELF HELP
THAN SAID DIDN'T HAVE ACCESS
COULDN'T AFFORD CARE OR
CONCERNED ABOUT STIGMA.
SO WHAT MIGHT WE DO AND HOW
MIGHT TECHNOLOGY HELP WITH THIS
REACHING THE NON-SEEKING
MAJORITY?
I HAVE TO SAY AS WE JUST HEARD,
IN THAT EXCELLENT PRESENTATION
SCREENING AN BRIEF INTERVENTION
IS A WELL ESTABLISHED WELL KNOWN
APPROACH FOR NON-TREATMENT
SEEKING INDIVIDUALS, IT HAS TWO
KEY COMPONENTS THAT MAKE IT
PERFECT FOR THAT.
ONE INVOLVES UNIVERSAL AND
PROACTIVE SCREENING, NOT TO
PEOPLE WHO ARE IDENTIFIED
BECAUSE THEY HAVE A PARTICULAR
HIGH RISK AND NOT TO PEOPLE WHO
RAISE THEIR HAND AND SAY THEY
WANT HELP BUT SIMPLY EVERYBODY
IN HEALTHCARE SETTING GETS
SCREENED.
PROACTIVELY.
THAT'S ONE KEY PIECE.
THE SECOND KEY PIECE IS THAT
THEY ARE OFFERED AN INTERVENTION
THAT IS BRIEF ENOUGH ALMOST
EVERYBODY WILL SAY SURE WHY NOT
I WILL DO THAT.
SURE, I WILL HAVE A FIVE TO TEN
TO 15 MINUTE CONVERSATION WITH
MY HEALTHCARE PROVIDER.
WHY NOT.
IF WE ARE ASKING TO ATTEND
TREATMENT AT ANOTHER SETTING, 12
SESSIONS OVER FEW MONTHS WE GET
MUCH LOWER UPTAKE BUT IF WE SAY
CAN WE CHAT ABOUT THIS, AND
NOTICE THAT YOU SAID THAT YOU
HAVE BEEN DRINKING FAIRLY
FREQUENTLY AND THAT SOMETIMES
YOU HAVE TROUBLE IN THE MORNING.
IS THAT OKAY IF WE HAVE A TALK?
VERY DIFFERENT PROPOSITION MAKES
SCREENING AND INTERVENTION SO
IMPORTANT.
EVIDENCE SUGGESTS SMALL
REDUCTION IN SUBSTANCE USE FROM
FROM JEANING AN BRIEF
INTERVENTION, CERTAINLY ALCOHOL
AND TOBACCO, MUCH WEAKER
EVIDENCE FOR DRUG USE.
BUT ALSO THAT WE STRUGGLE WITH
IMPLEMENTATION, THUS FOUR
PROGRAMS THE CDC IS WORKING ON
TO GET THAT SCALABILITY AND
IMPLEMENTATION AND WE DON'T GET
PROMOTION OF CONNECTION TO OTHER
SERVICES THAT WE WOULD LIKE TO
GET.
TECHNOLOGY POTENTIALLY HELP BE
THESE THINGS.
TECHNOLOGY CAN HELP SCALE MORE
QUICKLY, CAN HELP CONNECT WITH
OTHER SERVICES MORE READILY.
AND CAN EXTEND BRIEF ENCOUNTERS
OVER TIME.
BRIEF INTERACTION WITH
TECHNOLOGY MIGHT MEET TO
SUBSEQUENT TEXT MESSAGES OR
OTHER TOUCHES.
SUCH THAT OVER TIME, THERE IS
INITIAL HEALTHCARE CONTACT IN
WHICH RISK IS IDENTIFIED,
BASELINE BRIEF INTERVENTION AND
PROMOTION OF CONNECTION TO
AVAILABLE CARE.
THAT CAN BE FOLLOWED BY TAYLOR
TEXT MESSAGING THAT INDIVIDUAL
TRYING TO FURTHER PROMOTE THOSE
CONNECTIONS.
THROUGH PATIENT PORTALS MADE
AVAILABLE AND THE USE OF THESE
PATIENT PORTALS LIKE MY CHART
FROM EPIC HAS GROWN
EXPONENTIALLY DURING THE
PANDEMIC, IT'S ONE SMALL SILVER
LINING OF THIS.
THAT'S ANOTHER GREAT WAY TO
PROMOTE AND ENHANCE CONNECTION
TO CARE.
WITH REPEATED HEALTHCARE VISITS
WE CAN DO IT ALL OVER AGAIN.
WE NEED THINK ABOUT WHAT WE
MIGHT LOSE WHEN WE TAKE AWAY A
PERSON DELIVERED INTERVENTION
BUT WE ALSO HAVE TO KEEP IN MIND
THE THINGS LIKE THIS THAT WE
MIGHT GAIN WITH THE TECHNOLOGY
APPROACH.
WHAT IS THE EVIDENCE?
I WILL TALK HERE ABOUT THE
EVIDENCE THAT WE HAVE SO FAR FOR
HOW WELL THIS IS WORKING.
THE STUDIES THAT I WILL BE
PRESENTING HAVE A FEW THINGS
THAT ARE IN COMMON, PRIMARILY
ABOUT A ROUGHLY 15 MINUTE
TECHNOLOGY DELIVERED BRIEF
INTERVENTION WITH NO THERAPIST
OR HEALTHCARE CONTACT, MOST
INVOLVE FOLLOW-UP TAILORED
MESSAGING OF SOME KIND INITIALLY
MAIL, FLAIRS AND SUCH AND
TAILORED TEXT MESSAGING AND THEY
ARE DELIVERED WITH PARTICIPANT
AND STAFF INPUT.
WE USE A TREATMENT AS USUAL
CONTROL IN THESE CONTROL TRIALS.
WE TAKE A PRAGMATIC APPROACH AND
EXPLANATORY APPROACH, WE USE
MINIMAL ELIGIBILITY CRITERIA,
MOST SAMPLES ARE
UNDER-REPRESENTED MINORITIES ALL
THE TRIALS PRE-REGISTER AND
BLINDED WITH BIOVERIFICATION AND
INTENT TO TREAT ANALYSIS
APPROACH.
PRIMARY OUTPUT BEING ABSTINENCE.
IN TERMS OF FEASIBILITY THIS WAS
A KEY ACCORDANCE, ARE THEY LIKE
IT, DOES IT WORK IS IT HELPFUL?
RATINGS ARE EXTREMELY GOOD IN
THIS REGARD.
TURNS OUT THAT IF YOU BUILD YOUR
TECHNOLOGY WITH USABILITY IN
MIND, AND INTERVENTION CONTENT
WITH PARTICIPANT AND STAFF INPUT
YOU CAN GENERALLY GET GOOD
RESPONSES SO VERY HIGH RATINGS
FOR EASE OF USE AND OVERALL
LIKING OF THE INTERVENTION AND
OVERALL RESPECTFULNESS OF THE
INTERVENTIONS.
FIND MOST SAY THAT IT MADE THEM
LIKELY TO CHANGE.
MAJORITY SAID THEY PREFERRED THE
SOFTWARE OVER A PERSON AND
MINORITY SAID RATHER TALK ABOUT
THESE WITH DOCTOR OR NURSE.
THIS IS A REPLICATION STUDY WE
PLEATED A WHILE AGO FOLLOWING UP
ON EARLIER STUDY THIS INVOLVED
POST PAR THEM WOMEN AFTER GIVING
BIT AFTER SLEEPING BEFORE BEING
DISCHARGED, RECEIVING THAT BRIEF
INTERVENTION AND FOLLOWED UP
THREE AN SIX MONTHS P WE FOUND
EFFECT ON OVERALL DRUG USE ON --
AT THREE MONTH FOLLOW-UP, NOT
SIGNIFICANT AT SIX MONTHS.
BUT OVERALL EFFECT SIZE OF
INTERVENTION WAS QUITE
ENCOURAGING IN THIS TOBACCO USE
IN PREGNANCY WE SAW SIGNIFICANT
EFFECTS ON ABSTINENCE AT BIRTH.
EVALUATED PRIOR TO LEAVING
HOSPITAL AND WE SAW THIS
PROMOTION OF TALKING TO THE
DOCTOR OR NURSE ABOUT SMOKING.
WE THOUGHT THAT WAS POSITIVE.
SO WE YOU HEARD EARLIER BRIEF
INTERVENTIONS THOUGH THEY HAVE
SOME IMPACT ON SUBSTANCE USE,
AREN'T AS GOOD CONNECTING PEOPLE
TO OTHER SERVICES TRADITIONALLY,
TURNS OUT THAT MAYBE IF YOU TRY
PROMOTE SOMETHING THAT IS LESS
DISTAL BUT MORE PROXIMAL,
SOMETHING CLOSE SIMPLY TALKING
TO DOCTOR OR NURSE, YOU MIGHT BE
ABLE TO HAVE BETTER LUCK AND WE
ARE INTERESTED IN FOLLOWING UP
ON THAT FINDING.
ALCOHOL USE THIS PREGNANCY ARE
CURRENT HI IN THE MIDST OF FULLY
POWERED RA RANDOMIZE TRIAL FUNDED
BY NIAA.
THIS IS THE PILOT STUDY THAT LED
TO WORK, THOUGH NOT SIGNIFICANT
DIFFERENCE AS EXPECTED WITH
SAMPLE SIZE WE FOUND ENCOURAGING
EFFECT SIZES ON BIRTH OUTCOME AS
WELL AS ABSTINENCE AT CHILDBIRTH
CHILDBIRTH.
FINALLY A QUESTION WE GET IS HOW
THIS LOOKS COMPARED TO A PERSON
DELIVERED BRIEF INTERVENTION SO
I WILL TALK ABOUT A STUDY LED MY
COLLEAGUES KIM YONKERS AND STEVE
WITH NIDA FUNDING COMPARING
BRIEF PERSON DELIVERED SCREENING
BRIEF INTERVENTION TO TECHNOLOGY
DELIVERED SCREENING AND BRIEF
INTERVENTION, TO ENHANCE USUAL
CARE CONDITION AMONG 439 WOMEN
RECEIVING REPRODUCTIVE
HEALTHCARE AND HEALTHCARE
SETTING.
17% WHOM WERE PREGNANT.
THE SCREENING BRIEF INTERVENTION
BOTH OF THE SCREENING BRIEF
INTERVENTION CONDITIONS
OUTPERFORMED THE ENHANCED
TREATMENT AS USUAL CONDITION.
AND WHILE THIS WAS NOT A
SUPERIORITY TRIAL, THE EFFECT
SIZE FOR THE COMPUTER DELIVERED
BRIEF INTERVENTION COMPARED
QUITE WELL.
WE ALSO IMPORTANTLY HAD A
DETAILED COST ANALYSIS CONNECTED
TO THIS STUDY LED BY TODD
OLMSTED AND ELECTRONIC SCREENING
BRIEF INTERVENTION WAS MORE COST
EFFECTIVE FROM THE CLINIC AND
THE PATIENT PERSPECTIVE.
THAT IS INTEGRATION WITHIN
HEALTHCARE AND HOW THAT MIGHT
WORK.
WHAT ABOUT REAL WORK CONNECTIONS
WHEN WE GE GET AWAY FROM FUNDED
STUDY WITH RA DOING ALL THE WORK
CAN WE GET INTO ONGOING CARE IN
A COMMUNITY SETTING.
ON TOP OF THAT CAN WE USE THAT
TECHNOLOGY BIT TO LEVERAGE
CONNECTION TO OTHER SORTS OF
CARE, THAT MIGHT BE AVAILABLE
AROUND THAT PARTICULAR
COMMUNITY.
SO ONE STEP IN THIS HAS BEEN
HEALTHCARE INTEGRATION WITH THE
MOMS HEALTH CHECK UP APP WHICH
IS WHAT WE CALL HIGH TOUCH
HIGH-TECH PROGRAM BEING
DISSEMINATED THROUGHOUT MICHIGAN
MULTIPLE SITES, USED BY
THOUSANDS OF WOMEN SO FAR WITH
HIGH RATINGS FOR ACCEPTABILITY.
AND HIGH RATES OF TECH
INTRODUCTION BY FRONT DESK STAFF
SO PRE-PANDEMIC WE WERE GETTING
MORE THAN 90% NEW OB INTAKES
BEING GIVEN iPAD BY FRONT DESK
STAFF COMPLETING THE APP AND
HANDING IT BACK.
WE ARE EXCITED.
IT CAN BE DONE TWO WAYS.
YOU CAN HAND OUT THE TABLET AT
LIVE IN PERSON APPOINTMENT LIKE
I SAID, OR THEY CAN BE HANDED A
FLYER AND USE THEIR OWN DEVICE,
THAT IS AN EXAMPLE OF ONE OF
THOSE FLYERS.
SO THEY CAN SIMPLY FLASH THIS QR
CODE OR GO TO WEBSITE AND
COMPLETE THE SCREENING AND BRIEF
INTERVENTION THAT WAY.
ALL THE CONTENT IS DEVELOPED
BOTH WITH PREGNANT WOMEN AND
COMMUNITY PARTNERS IN TERMS OF
WORK FLOW THAT PROVIDES
ELECTRONIC SCREENING AND
BRIEFING INTERVENTIONS AND WE
HAVE ADD AD PROVIDER SUMMARY IN
THIS PARTICULAR PROJECT.
SO THAT HEALTHCARE PROVIDERS GET
OUTPUT AND MAKING
RECOMMENDATIONS FOR SERVICES,
PROGRAMS IN THE AREA, THEY MIGHT
REFER TO.
WE FURTHER TAYLOR TO EACH NEW
SITE.
NOT EXACTTY SAME APP FOR EACH
CLINIC.
A LITTLE DIFFERENT FOR EACH ONE
AND WE ARE ABLE TO DO THAT
BECAUSE WE USE A PARTICULAR
PLATFORM AN NIH SUPPORTED
ELECTRONIC INTERVENTION
AUTHORING TOOL TO LEARN MORE
ABOUT AT SIAS.APP,
NON-COMMERCIAL NIH SUPPORTED
OPEN SOURCE AND LETS ANYBODY
MAKE THEIR OWN CONTENT SHARE
THEIR CONSENT AND DEPLOY IT IN
STUDIES AT NO COST.
THERE IS ANOTHER LEVEL, WE WANT
TO ENHANCE CONNECTION TO OTHER
SERVICES OUTSIDE OF THAT
PARTICULAR CLINIC.
WE HAVE GOOD LUCK WITH THIS, ONE
WAY WE DO THAT IS USING
SOMETHING YOU CAN SEE IN THIS
FIRST SCREEN HERE WHERE WE TELL
THEM ABOUT THE IMPORTANCE OF
HOME VISITING HOW IT IS FREELY
AVAILABLE TO ANY WOMAN IN
MICHIGAN COVERED BY MEDICAID.
HOW IT IS AVAILABLE FOR FREE AND
BE SUPPORTED BOTH DURING
PREGNANCY AND AFTER.
WE ASK IF THEY ARE INTERESTED
AND IF THEY SAY THEY ARE, WE ASK
FOR PERMISSION TO SEND THEIR
INFORMATION TO THE LOCAL A HOME
VISITING PROGRAMS SO THAT THEY
CAN REACH OUT TO THEM.
GET HIGHER RATES ENDORSEMENT OF
THIS, WE GIVE THE INFORMATION TO
THE HEALTHCARE PROGRAM THEY
REACH OUT TO THE PARENT.
THEY FOUND THAT THIS IS A REALLY
GOOD WAY TO HELP GET WOMEN
CONNECTED TO THAT IMPORTANT
SERVICE.
WE ALSO ARE EXPERIMENTING WITH
ONLINE IMMEDIATE CONNECTION TO
TELEHEALTH WITH BEHAVIORAL
HEALTH CONSULTANT AND THEN
FINALLY WE ARE WORKING ON THE
TECHNOLOGY TO ALLOW US TO DO
LIVE INSTANT TEXT MESSAGING THAT
IS SECURE.
SO THEY CAN TAP A LITTLE BUTTON
THAT SAYS I WANT TO CHAT WITH
SOMEBODY RIGHT NOW.
AND GET INFORMATION GET HELP,
GET SET UP FOR OTHER SERVICES OR
SIMPLY ASK QUESTIONS.
SO THIS IS A LITTLE BIT HOW WE
HAVE BEEN USING TECHNOLOGY THE
ADDRESS CHALLENGES RELATED TO
REACH AND TO TRY TO BETTER
INTEGRATE SERVICES AROUND A
PARTICULAR PREGNANT PATIENT.
SO MUCH MORE THAT COULD BE DONE.
I'M SURE THERE ARE GREAT IDEAS
OUT THERE, THIS IS SOME OF WHAT
WE HAVE BEEN DOING, GRATEFUL FOR
YOUR ATTENTION AND WE WILL YIELD
TO THE NEXT SPEAKER.
THANK YOU VERY MUCH.
>> THANK YOU SO MUCH, DOCTOR.
FOR THAT GREAT TALK.
ALL RIGHT.
HERE WE GO.
ACTUALLY THE PREVIOUS TWO TALKS
I THINK A NICE JOB TALKING ABOUT
SOME OF THE WAYS TO INTEGRATE
TREATMENT TO MENTAL HEALTH AND
SUBSTANCE USE DISORDERS AND TO
PRIMARY CARE, DR. ONDERMAN
LISTED SEVERAL WAYS THAT ARE
GREAT TO DO THAT.
TODAY I AM -- WILL TALK ABOUT AN
EXAMPLE, ONE EXAMPLE AS A WAY TO
MAKE LARGER POINT.
I WAS WORKING IN FLINT,
MICHIGAN.
HERE IS AN EXAMPLE FROM WHERE I
AM.
SO I'M SITTING IN FLINT.
OUR RATE IS ABOUT 40%, IN THE
COUNTY THE POVERTY RATE IS 18%,
MICHIGAN OVERALL IS ABOUT 14%.
KEEP IN MIND THAT ABOUT 47% OF
U.S. BIRTHS ARE COVERED BY
MEDICAID SO IF YOU LOOK AT THE
RISK FACTORS FOR POOR MATERNAL
INFANT HEALTH OUTCOMES, YOU SEE
BETWEEN INFANT DEATH LOW BIRTH
WEIGHT BIRTH MOTHERS WHO SMOKED,
THAT THEY ARE ONE RATE MICHIGAN
HIGHER IN THE COUNTY AND MUCH
HIGHER IN FLINT.
THESE THINGS TEND TO BE
CORRELATED WITH SOCIOECONOMIC
DISADVANTAGE.
SO IT HAS TO DO WITHSOME
DETERMINANTS AND THESE LARGER
SYSTEMIC ISSUES.
SOCIAL DETERMINANTS AND LARGER
ISSUES.
MANY SYSTEMS SERVING MEDICAID
WOMEN OR WOMEN ON MEDICAID ARE
LOW RESOURCE SYSTEMS, WE HAVE
FEDERALLY QUALIFIED HEALTH
CENTERS, HERE IS A SIGN FROM
SOMEBODY WHO WAS TRYING TO
CONVINCE OUR HEALTH SYSTEM NOT
TO CLOSE DOWN LOCAL HOSPITALS,
OR THEY ARE NOT TREATMENT
SYSTEMS AT ALL.
DR. -- JUSTICE SYSTEMS AND HOW
THEY END UP INTERSECTING WITH A
LOT OF FOLKS WITH MENTAL ILLNESS
THAT WE HAVE HOUSING SYSTEMS,
CHILD WELFARE, CRISIS SERVICES,
MINIMUM WAGE FOOD QUALITY
SOCIETAL GENDER BASED VIOLENCE
PEOPLE WAGE EQUAL OPPORTUNITY
EDUCATION JOB CHILD CARE
ENVIRONMENTAL EQUITY, ALL OF
THESE EFFECT OBVIOUSLY HEALTH OF
WOMEN, HEALTH OF FAMILIES AND
HEALTH OF PREGNANT WOMEN.
AND THEY ARE NOT EQUITABLY
DISTRIBUTED AND ESPECIALLY LOWER
INCOME WOMEN AND WOMEN OF COLOR.
HERE IS THE EXAMPLE I'M GOING TO
GIVE, LOOP AROUND TO LARGER
POINT.
IT IS FROM STUDY DR. KAREN AND I
-- TOGETHER AND LET ME TELL YOU
A LITTLE BIT ABOUT THAT.
SO POSTPARTUM DEPRESSION EFFECTS
ONE IN SEVEN MOM, ONE AND THREE
OR FOUR LOWER INCOME MOMS.
THE REASONS FOR THAT ARE
MANIFOLD, THEY HAVE HIGHER
STRESS LEVELS, THERE IS A LOT
GOING ON.
LOWER INCOME MOMS ARE LESS
LIKELY TO GET CONNECTED TO CARE.
SO THEY ARE NOT ONLY MORE LIKELY
TO BE DEPRESSED, LESS LIKELY TO
BE ABLE TO EFFECTIVELY PREPARE
AND EFFECTS OF POSTPARTUM
DEPRESSION ARE MORE SEVERE IN
TERMS OF MATERNAL CARE GIVING
INFANT DEVELOPMENT AND WHAT NOT.
MY POINT HERE, IT GOES NICELY
WITH SLIDES YOU SEE LATER --
EARLIER TODAY IS THAT SCREENING
AND TREATMENT ARE IMPORTANT BUT
PREVENTION IS EVEN BETTER.
OVER ON THE LEFT IS ACOG
RECOMMENDATION ABOUT SCREENING
DURING THE PERINATAL PERIOD OR
MOOD AND EMOTIONAL WELL BEING
AND FOLLOWING UP WITH REFERRALS.
THERE IS SOME TRACTION MADE WITH
THIS, I KNOW SEVERAL HEALTH
SYSTEMS STILL WORKING ON THIS
BUT FOLKS ARE TRYING.
AND YET IF THERE WAS A WAY THAT
WE COULD PREVENT POSTPARTUM
DEPRESSION ENTIRELY, THAT WOULD
BE GREAT ESPECIALLY FOR THESE
MOMS LOWER INCOME MOMS WHO LIKE
I SAID HAVE HIGHER RATES OF
DEPRESENTATION AND MORE
DIFFICULTY GETTING CONNECTED.
SO ROSE MY COLLEAGUE DEVELOPED A
CLASS, A FOUR SESSION CLASS
CALLED ROSE, REACH OUT STAND
STRONG ESSENTIALS FOR MOTHERS,
FOUR SESSIONS DURING PREGNANCY,
ONE POSTPARTUM CHECK IN, SHE
INTENTIONALLY FRAMED AS A CLASS
RATHER THAN TREATMENT TO SET
ASIDE MENTAL HEALTH STIGMA.
IT IS PREVENTION NOT TREATMENT.
IT IS STRUCTURED,
PSYCHOEDUCATIONAL, DELIVERED BY
NURSE, COMMUNITY HEALTH WORKERS
DO HEALTH EDUCATORS WITH GOOD
FIDELITY AND WE HAVE
INTERVENTION MATERIALS IN
ENGLISH AND SPANISH AND WISH
LIST OF OTHER LANGUAGES.
YOU CAN HERE THE SENSE OF CLASS
MEMBER WORK SHE DESIGNED IT TO
BE WELCOMING FRIENDLY.
ROSE -- I THINK FOR PSYCHOSOCIAL
INTERVENTION DELIVERED IN PERSON
IS HAS NICE FEATURES TO MAKE IT
FLEXIBLE AND SCALABLE DOESN'T
MATTER GROUP OF INDIVIDUALS,
DOESN'T MATTER OFFICE HOME
TELEMEDICINE, DOESN'T MATTER
WHEN DURING PREGNANCY OR SESSION
CAN BE DIFFERENT FOR NURSE
VISITING HOME VISITING PROGRAMS,
IF THEY WANT TO DO IT IN MORE 20
MINUTE PIECES THAT'S FINE, IF
THEY WANT TO LUMP SESSIONS
TOGETHER THAT'S FINE.
IN THIS PROJECT WE WERE
TARGETING ANY SETTING OFFERING
OUTPATIENT PRE-NATAL SERVICES,
THAT MORE THAN HALF OF THEIR
MOMS THEY SAW WERE ON MEDICAID.
THE GOOD NEWS IS, THIS SIMPLE
INTERVENTION WORKS REMARKABLY
WELL FOR PREVENTING POSTPARTUM
DEPRESSION.
FIVE CLINICAL TRIALS,
INTERVENTION PREVENT ABOUT HALF
CASES POSTPARTUM DEPRESSION
AMONG MOMS LOWER INCOME MOMS ON
MEDICAID.
AS A RESULT OF THAT IT IS NOW
RECOMMENDED BY THE U.S.
PREVENTIVE SERVICES TASK FORCE
TO PREVENT POSTPARTUM
DEPRESSION.
SO THE SUSTAINMENT STUDY LOOKS
AT PARTNERING WITH 98 AGENCIES
NATIONALLY, EVERYTHING FROM S
2HCs TO SAFETY NET OBGYN
CLINICS TO DUAL ORGANIZATION, TO
HEALTHY START TO VARIETY OF
AGENCIES.
THAT SERVE PREGNANT WOMEN.
WE ARE LOOKING AT HOW MUCH
TRAINING AND TECHNICAL
ASSISTANCE DO THESE AGENCIES
NEED TO IMPLEMENT, SUSTAIN OVER
TIME AND WHAT ARE COST AND
BENEFITS OF THIS SUPPORT.
SO BRIEFLY WHAT WE DO IS TRAIN
AGENCIES AT THE BEGINNING IT IS
THOROUGH, WE GO THROUGH THAT
PROCESS, HELP IMPLEMENT IF THEY
ARE STRUGGLING THEY CAN GET
RANDOMIZE TO RECEIVE ONE OF TWO
OTHER SUPPORTS WHICH IS
FEEDBACK, MONTHLY COACHING AND
FEEDBACK.
WE ARE LOOKING AT THIS IN TERMS
OF OUTCOMES OF HOW MANY MONTHS
SUSTAIN WITH ADEQUATE FIDELITY,
THE REACH DR. ONDERMAN TALKED
ABOUT RECEIVING AGENCY, COST AND
COST EFFECTIVENESS OF THESE
SUPPORTS.
TO THE AGENCIES.
AGENCY CAPACITY AND ON THE OTHER
HAND SHIP OF ROSE EFFORTS, WE
ARE LOOKING AT QUANTITATIVE
MEASURES OVER 30 MONTHS BUT
QUALITATIVE INTERVIEWS, AT 12
MONTHS AND 30 MONTHS, IT IS FROM
THAT IN THE TECHNICAL ASSISTANCE
THAT I WANT TO TELL YOU THIS
LARGER POINT THAT RELATE
INTEGRATING SYSTEMS FOR WOMEN AT
RISK OF MULTI-MORBID CONDITIONS.
LIKE I SAID THERE'S SEVERAL
THINGS WE TRY TO DO BOTH IN
TERMS OF DEVELOPING AND IN TERMS
OF IMPLEMENTING TO ADDRESS
DISPARITY, RACIAL ETHNIC AND
SOCIAL ECONOMICS.
IT WAS CREATE AS A CLASS THAT
TEACHES USEFUL SKILLS FOR ALL
MOMS, TREATMENT FOR STIGMA, IT
WAS TESTD WITH DIVERSE
POPULATIONS USES PRINCIPLES,
RELATIONSHIP SKILLS SOCIAL
SUPPORT HEALTHCARE THAT
TRANSLATES ACROSS CULTURES.
IT CAN BE DELIVERED VIA VIDEO
CONFERENCE, EASIER FOR RURAL
PROGRAMS, AND WE HAVE BEEN HAPPY
THAT A LOT OF AGENCIES INVOLVED
IN THE LARGER PROJECT ARE RUN BY
OR HAVE MANY MINORITY PROVIDERS.
WE ARE ALSO LOOKING AT COST
EFFECTIVENESS TO INFORM POLICY
CHANGE.
SO ALL THAT IS CONTEXT FOR WHAT
I AM ABOUT TO SAY.
SO AS WE ARE TALKING, WE HAVE
THESE INTERVIEWS AT 12 AND 30
MONTHS, A GROUP OF AGENCIES
HAVING STRUGGLES IMPLEMENTING
THAT WE ARE TALKING TO QUARTERLY
IF NOT MONTHLY.
WE TALKED WITH A LOT OF FOLKS
ALL ACROSS THE COUNTRY.
HERE IS WHAT WE ARE FINDING.
SO THIS GETS TO THIS LARGER
ISSUE OF HOW DO YOU INTEGRATE
HEALTH SERVICES INTO PRIMARY
CARE OR MORE STANDARD CARE
SETTING.
WHAT WE ARE FINDING IS IT IS A
LOT BETTER IF ROSE CAN BE
INTEGRATED TO REGULAR WORK FLOW
AND NOT SET UP AS A NEW PROCESS.
FOR EXAMPLE, THERE ARE SOME
GROUPS THAT WORK WITH CHILDBIRTH
EDUCATION OR HAVE A CHILDBIRTH
EDUCATION GROUP THEY REGULARLY
REFER TO AS MUCH EASIER TO DO IT
AS PART OF THAT THAN IT IS FOR
AGENCY TO SET UP AN ENTIRELY NEW
GROUP MEETING STRUCTURE OR FOR
VISITING NURSES, IF THEY ARE
SEEING PEOPLE INDIVIDUALLY THAT
INCORPORATED THAT DON'T TRY TO
CREATE A WHOLE SYSTEM SYSTEM IS
HARDER.
THE OTHER THING WE ARE SEEING,
IMPORTANT TO NOTICE HERE IS THAT
THE AGENCY THEY ARE NOT HAVING
TROUBLE INTEGRATING AS MUCH AS
HAVING TROUBLE KEEPING DOORS
OPEN.
EVEN WITHIN HEALTH SYSTEMS
FAIRLY WELL RESOURCED.
OB CLINIC THAT HE'S THE MEDICAID
MOM WE MOVE ACROSS THE STREET, I
HOPE YOU DON'T MIND AND NOT
PROVIDE SERVICES.
IT'S HARD FOR HEALTHCARE
PROVIDERS RIGHT NOW BECAUSE OF
COVID AND OTHER REASONS, SO
PROVIDERS PEOPLE WHO ARE THERE
ARE TRYING TO ALSO COVER THE
FRONT DESK OR LIKE I SAID,
POWERS THAT BE OH, BASIC THINGS
KEEPING DOORS OPEN AND THAT IS A
REAL EYE OPENER FOR ME BECAUSE I
EXPECT THAT IN THE IMMUNITY
BASED ORGANIZATION, DULA GROUPS,
SOMEBODY SAID THESE ARE NOT THE
SERVICES THAT MONEY PUBLIC
HEALTH YOU WOULD HI THEY WOULD
VALUE THOSE DOING WORK MORE BUT
THEY DON'T.
EVEN OBs, MIDWIVES MEDICAL
PROVIDERS.
THAT IS A CONCERN.
LIKE I SAID, FOR A WILD --
95%ICALLY MIX WHO STRUGGLE TO
IMPLEMENT ROSE HASN'T BEEN
BECAUSE OF POOR FIDELITY BUT IT
WAS PROVIDER COTED OR KICKED THE
DOORS OPEN OR CLINIC WAS MOVED,
ALL THESE THINGS THAT HAPPEN.
SO STRUCTURAL CHALLENGE AT THE
AGENCY SO MY FIRST TAKE HOME
WOULD BE AGAIN, ECHOS WHAT WAS
SAID IN THE FIRST SESSION TO DR.
WILK CALLED IT WHOLE PERSON
PAYER.
IF I WAS GOING TO INVEST A
DOLLAR IN PUBLIC HEALTH IT WOULD
BE TOWARD PREGNANT WOMEN AND YET
EVEN THEN THESE AREN'T THE
SERVICES GETTING PRIORITIZED,
ESPECIALLY WOMEN WITH CHALLENGES
SUCH AS SOCIAL DETERMINANTS OF
HEALTH.
THIS IS LARGER INTEGRATION PLAN
TO MAKE ABOUT MEDICAL CARE AND
MENTAL HEALTHCARE.
UNDER MY UNDERSTANDINGS UNDER
THE ABARD FORDABLE CARE ACT WITH
INTERVENTION WITH U.S.
PREVENTIVE SERVICES TASK FORCE
WHICH HAS -- ROSE HAS, ARE
SUPPOSED TO BE FULLY COVERED BY
HEALTH INSURANCE INCLUDING
MEDICAID BUT ALL INSURANCE.
THIS HAPPENED IN 2019, IT IS
2021 AND WE HAVE BEEN IN
CONVERSATION SOME WITH A
MECHANICSA, WITH DIFFERENT FOLKS
Z LET ME TELL YOU WHERE THE
CHALLENGE S. ROSE IS
PSYCHOEDUCATIONAL, IT CAN BE
DELIVERED BY FIDELITY BUT THEY
ARE NOT BILLABLE PROVIDERS SO IN
HONESTLY THIS IS NOT THE BEST
USE OF PHYSICIAN TIME, THIS IS
BASIC, PRETTY STRAIGHT FORWARD,
IT WAS MEANT TO BE THAT WAY.
BUT PEOPLE AVAILABLE PROVIDERS,
LIKE MENTAL HEALTH TREATMENT
STAFF, NOT THE BEST USE OF THEIR
TIME, THEY ARE DEALING WITH
CRISES AND TREATMENT, AND
THEREFORE THE PEOPLE IN THE
SYSTEM, THAT CAN DO THESE
PREVENTSIVE INTERVENTIONS ARE
BILLABLE PROVIDERS GENERAL FOR
VARY OF BILLING CODES SO THAT IS
A CHALLENGE TO INTEGRATING SOME
OF THESE EASIER TO USE SERVICES.
IN ADDITION IN THEORY IF THERE
IS A MENTAL HEALTH PERSON WHO
HAS TIME, WE ARE SEEING
POSTPARTUM PSYCHOSIS, SAY YOU
DID HAVE TIME,ED THE MENTAL
HEALTH TREATMENT CODES REQUIRE
THE PROCEDURE CODE AND DIAGNOSIS
CODE AND THE MENTAL HEALTH
PROVIDERS MOST TIME IN MOST
STATES YOU CAN'T BILL UNDER
PREGNANCY DIAGNOSIS.
SO YOU HAVE TO BILL UNDER MENTAL
HEALTH WHICH UNDERMINES THE
PURPOSE OF PREVENTION.
SO PREVENTION IS TRYING TO
PREVENT DIAGNOSIS.
SO IF YOU HAVE A MENTAL HEALTH
PROVIDERS THERE IS A CHALLENGE
THAT WAY.
THERE ARE SOME PATIENT EDUCATION
CODES THAT CAN BE BILLED TO
PHYSICIANS OR OTHER QUALIFIED
HEALTHCARE PROFESSIONALS, BUT
THERE ARE NOT -- ONLY REIMBURSED
IN ONE STATE THAT I KNOW OF.
IF PERINATAL SETTING RECEIVESES
BUNDLE PATIENTS AS MOST
PERINATAL SERVICE DOS, THESE
EXTRA SERVICES CAN'T BE BILLED
SEPARATELY.
EACH STATE DECIDES WHAT MEDICAL
TO BE REIMBURSED.
IT IS INTERESTING BECAUSE AS WE
HAVE BEEN TALKING TO PEOPLE THAT
HAVE -- I DON'T THINK THIS IS
THE CASE FOR THIS PARTICULAR
ISSUE BUT IT GOES BACK TO
TIMING.
THERE'S TIMES AS STATE
LEGISLATURE WILL PASS LAW THAT
SOMETHING PARTICULAR HAS TO BE
REIMBURSED BUT THEN PUT
STIPULATIONS SO IT IS BASICALLY
IMPOSSIBLE TO DO.
EVEN WHEN SOMETHING IS MANDATED
WE ARE IN A FUNNY CASE WHERE
THIS IS SUPPOSED TO BE COVERED
UNDER THE AFFORDABLE CARE ACT
YET FOR THE LIFE OF US WE ARE
STRUGGLING TO TRY TO FIGURE HOUR
TO WORK AROUND THE CODES SO NO
PERSON IS RESPONSIBLE FOR MAKING
SURE THAT HAPPENS.
IN A PERFECT WORLD I WOULD LOVE
PEOPLE TO MANDATE THAT
POSTPARTUM DEPRESSION PREVENTION
IS PART OF BUNDLED PRE-NATAL
SERVICES AND INCREASE
ACCORDINGLY.
ALLOW MENTAL HEALTH
PROFESSIONALS TO BILL UNDER
PREGNANCY DIAGNOSIS CODE.
THAT WOULD SOFA LOT OF PROBLEMS
OR MAKE PREVENTION KEY CODE,
MANDATE MEDICAID HAS TO
REIMBURSE CPT CODES USED FOR
THIS.
FINE SOME WAY TO MAKE THESE
CONDITIONALLY BILLABLE PROVIDERS
ABLE TO PROVIDE SOME OF THESE
PREVENTIVE SERVICES BECAUSE THEY
ARE ONLY ONES IN AGENCY WHO WILL
HAVE TIME.
I WANT TO MAKE A POINT, SO
INTERESTING IN THIS CASE WITH
ROSE WHERE SOLUTION WE DON'T
HAVE ENOUGH PEOPLE TOLL PROVIDE
INTERVENTION HOW BETTER
SCREENING TO GET PREVENTSIVE
INTERVENTION.
RECENTLY WE WERE LOOKING AT THIS
FOR ROSE AND ROSE TO DELIVER IS
SO LOW COST DEPENDING ON GROUP
INDIVIDUALS MAYBE 100 TO $200
MOST AGENCIES WE TALK WITH DON'T
HAVE GOOD SCREENING AND REFERRAL
SYSTEMS LIKE FOR THEM TO MOUNT A
SCREENING REFERRAL SYSTEM.
WOULD BE HARD.
THEY ARE NOT -- THEY DON'T HAVE
GOOD TECHNOLOGY, THEY DON'T HAVE
GOOD INFRASTRUCTURE SOURCES TO
CREATE IT.
SO MOST WANT TO GIVE IT TO
EVERYONE WHERE RATHER THIS THAN
FIGURE WHO TO GIVE IT TO IS
EASIER.
TURNS OUT THE COST IF YOU MISS
THE ONE WHO WOULD HAVE GOTTEN
POST TO PARTUM DEPRESSION, EVEN
THE HEALTH SYSTEM COST OF THAT
IS TENS OF THOUSANDS OF DOLLARS
VERSUS INTERVENTION THAT CALL IT
150-DOLLARS IT IS COST EFFECTIVE
MORE COST EFFECTIVE TO GIVE IT
TO EVERYONE THAN IT IS TO CREATE
SCREENING REFERRAL SYSTEM IN
SETTINGS THAT JUST AREN'T SET UP
TO DO THAT.
SO I WANT TO PUT THAT OUT AS
POSSIBILITY.
UNIVERSAL PREVENTION IS MORE
EFFECTIVE.
MORE COST EFFECTIVE THAN
PINPOINTING WHO YOU SHOULD GIVE
IT TO.
I WANT TO MAKE THIS POINT, IN
THE SETTINGS, I SAID TO SOME
EXTENT THE SAFETY NET OB CLINIC
S 2 HC EVEN MORE SYSTEM SERVICE
JUSTICE INVOLVED INDIVIDUAL
THERE'S NOT ENOUGH PROVIDERS
THAT WILL NEVER BE.
SO LOOKING MORE SAYING THIS
HAPPENED AROUND THE WORLD I HAVE
COLLEAGUES IN ETHIOPIA, TEN
YEARS AGO IF YOU HAD ONE
PSYCHIATRIST PER 11 MILLION
PEOPLE THAT WILL BE RAY WILL
HARD SO MORE GREAT RESEARCH, IT
IS EFFECTIVE, BUT QUESTION IS
HOW WE MAKE POLICY BILLING CODES
WHATEVER FIT SO THAT YOU CAN USE
YOUR COMMUNITY HEALTH WORKER OR
SOMEONE ELSE TO DO THIS WORK AND
NOT REQUIRE OB CAN'T DO IT.
SO ONE OF TAKE HOME POINTS ABOUT
INTEGRATION OF PRIMARY CARE AND
MENTAL HEALTH AND SUBSTANCE USE
WE HAVE IT IN SOME WAY A PERFECT
CASE IN RESEARCH PERSPECTIVE, WE
HAVE INTERVENTION THAT IS SHOWN
TO BE EFFECTIVE, COST EFFECTIVE,
DELIVERED BY CARE PROFESSIONALS
WITH SCALABLE TRAINING IS
SCALABLE, BUT REIMBURSABLE BUT
IT ISN'T.
THERE IS SYSTEM SIC ADVOCACY
NEEDED AROUND FUNDING POLICY,
SPECIFICALLY AROUND GREAT MENTAL
HEALTH PROVIDERS BILL UNDER
PREGNANCY DIAGNOSIS AND WE CAN
MAKE OTHER PARAPROFESSIONAL
PROVIDERS BILLABLE BUT EVEN THEN
OVERALL SYSTEMIC SUPPORT FOR
SAFETY NET AGENCIES ISN'T THERE,
THEY ARE NOT THE MONEY MAKERS
AND ARE GOING TO THE BOTTOM OF
THE RUN TO THE EXTENT IT HAS
BEEN SHOCKING TO ME AS WE HAVE
TALK WITH THEM OVER SEVERAL
YEARS.
HERE IS MY OTHER POINT.
NOT LIKE WE DON'T KNOW HOW TO DO
THESE, THESE MEANING SCREENING
PREVENTION TREATMENT CREATING
SYSTEMS THAT GET THEM TO THE
PEOPLE WHO NEED THEM THE MOST.
PART OF THE MULTI-MORBIDITY IS
WOMEN AT RISK WENT THROUGH
SOCIAL DETERMINANTS OF HEALTH
INTERSECT TO CREATE DIFFICULT
CIRCUMSTANCES TO OVERCOME.
I WOULD ADD MY VOICE TO OTHERS,
SO FAR IN THE WORKSHOP, WE KNOW
HOW TO DO THIS, THE SCIENTIFIC
KNOWLEDGE IN CASES EXIST, HOW TO
GET IN THE WORLD AND MAKE IT
HAPPEN, CREATE THE POLITICAL
WILL HOW TO REALIGN INCENTIVES
FROM A FUNDING PERSPECTIVE TO
ENSURE WHAT WE KNOW SHOULD
HAPPEN DOES HAPPEN.
THIS IS MY TEAM.
REACH OUT IF UP QUESTIONS OR
COMMENTS, I WILL STOP THERE.
I AM MODERATING QUESTIONS.
CORRECT?
>> CURRENTLY WE DON'T HAVE ANY
IN THE Q&A BOX BUT I WOULD
ENCOURAGE ATTENDEES TO POST ANY
QUESTIONS THAT YOU HAVE FOR
PANELISTS SPEAKERS IN THIS
SESSION INTO THE Q&A BOX.
THERE IS A QUESTION IN THE
COMMENT WHICH I WILL READ, IT IS
NOT -- IT SAYS IS THERE A SCREEN
TO TEST RISK FOR POSTPARTUM
DEPRESSION?
AND WHY IS PREGNANCY NOT VALID
DIAGNOSIS CODE SECOND QUESTION
FIRST.
IT IS NOT ROSE, THE DIAGNOSIS
CODES AND THE PROCEDURE CODES
ARE LINKED TO THE KINDS OF
PROVIDER.
MENTAL HEALTH PROFESSIONALS
AREN'T ALLOWED TO BILL UNDER
PREGNANCY DIAGNOSIS CODE.
SO YOU CAN HAVE AN OB DELIVERIES
BILLABLE BUT NOT GOOD USE OF
THEIR TIME.
IF YOU HAD A MENTAL HEALTH
PROFESSIONAL, LIKE AS MENTAL
HEALTH PROFESSIONAL I HAVE TO
PUT DEPRESSION OR ANXIETY, IF
SOMEBODY DOESN'T HAVE A
DIAGNOSIS ALREADY FOR PREVENTION
THEY DON'T, I CAN'T BILL UNDER A
PREGNANCY DIAGNOSIS CODE AND THE
PEOPLE REALLY DOING THIS
INTERVENTION MORE
PARAPROFESSIONAL, THEY ARE NOT
BILLABLE.
SO THAT'S THE CHALLENGE.
IT IS RECOMMENDED U.S.
PREVENTIVE SERVICES TASK FORCE
STILL HAVE FUNDING POLICY
ISSUES.
REIMBURSEMENT ISSUES.
THEN THERE WAS THE FIRST
QUESTION, IS THERE A SCREEN TO
TEST RISK FOR DEPRESSION, THAT
IS AN INTERESTING QUESTION.
THE ANSWER IS YES KIND OF BUT
WHAT AGENCY DOS BUT IS NOT
EMPIRICALLY SUPPORTED IS TEST
FOR SYMPTOMS.
THERE IS THE COOPER SURVEY
QUESTIONNAIRE, NOT USER
FRIENDLY.
SO THERE ARE THINGS PEOPLE DO
THEY WILL TALK ABOUT PAST E
PRESSSIVE EPISODES, EDENBURG BUT
MOSTLY NOT SCREENING FOR RISK
AND TO SCREEN FOR RISK IS
SURPRISINGLY CHALLENGING FOR A
LOT OF THE AGENCIES AND THEY
HAVE DECIDED TO USE ROWS ACROSS
THE BOARD, MANY THINK THAT IS
EASIER.
CAN I SAY A LITTLE BIT ABOUT
WHAT THE CLASS INTERVENTION
ENTAILS AND INCLUDES, YES.
THAT SLIDE TO TRY TO GO FASTER
BUT BASED ON PRINCIPLES OF
INTERPERSONAL PSYCHOTHERAPY ONE
OF THE FRONT LINE TREATMENT
PERINATAL DEPRESSION, IT IS CORE
COST, ABOUT AN HOUR EACH.
IT IS BASIC SEGUE TO PATIENT
ABOUT WHAT IS POSTPARTUM
DEPRESSION, WHAT IS POSTPARTUM
PSYCHOSIS, HOW DO YOU KNOW, IT
USES THIS IDEA OF THIS IS A TIME
IN YOUR LIFE THAT YOU WILL NEED
MORE HELP THAN USUAL.
DON'T TRY TO BE A HERO, GET
SUPPORT SYSTEMS SETS UP, TEACH
COMMUNICATION SKILLS HOW TO TALK
WITH PEOPLE, SELF CARE SKILLS
AND HELP THEM FOLLOW THROUGH.
INTERESTING BECAUSE IT IS NOT ON
THE ONE HAND NOT ROCKET SCIENCE,
OTHER HAND MASSIVELY EFFECTIVE.
I WISH THAT I THINK THINKING
BACK TO WHEN I WAS PREGNANT
COUPLE OF DECADES AGO BUT I WISH
SOMEBODY SAT DOWN AND TOLD ME
THESE THINGS.
SOMETHING ABOUT HAVING SOMEONE
SIT DOWN AND WALK YOU THROUGH IT
HELPS AND PREVENTS ABOUT HALF
THE CASES OF POSTPARTUM
DEPRESSION. ARE THERE OTHER
QUESTIONS, I DON'T SEE OTHER
QUESTIONS.
ARE THERE OTHER QUESTIONS?
YOU CAN PUT IN THE Q&A.
>>S IN MARRAH, I WONDER IF WE
CAN ENGAGE YOU AND THE OTHER TWO
SPEAKERS ON HOW MAYBE THE SBIRT
COULD BE APPLIED TO OTHER
INTERVENTIONS THAT WE HAVEN'T --
WE DIDN'T -- WE GAVE EXAMPLES OF
WHAT HAS BEEN DONE BUT HOW
EASILY APPLIED TO OTHER
INTERVENTIONS TO ADDRESS
CO-MORBIDITIES AND WHAT MAYBE
THE OPPORTUNITIES ARE OR THE
CHALLENGES MIGHT BE.
>> WOULD YOU LIKE THE TAKE THAT
ONE?
>> SURE, I WOULD LOVE TO SPEAK
ON THAT A LITTLE BIT.
THERE IS A STUDY I CITE QUITE
OFTEN 2003 I BELIEVE IN AJPH
THEY ADDED UP PREVENTIVE
SERVICES TASK FORCE A AND B
RECOMMENDATIONS AND FIGURED HOW
LONG IT WOULD TAKE AVERAGE
PRIMARY CARE PHYSICIAN TO DO
THEM.
IT WORKED OUT TO 4.8 HOURS PER
WORKING DAY TO DO THOSE.
I THINK THAT THERE IS A LOT WE
WANT TO HAVE HAPPEN THAT DOESN'T
NECESSARILY FIT WELL IN TO THOSE
SETTINGS.
THAT TECHNOLOGY MAY BE ONE WAY
THAT WE CAN BUILD A LOT OF THAT
IN.
SO TO THE QUESTION, IF WE USE
TECHNOLOGY AS NATURAL PART OF
THE WORK FLOW.
YOU COME IN OR BEFORE YOU COME
IN, YOU ANSWER QUESTIONS BRIEFLY
LIKE A SYMPTOM CHECKLIST, GIVE
THEM GOOD -- CARE TEAM GOOD
SENSE OF WHERE YOU ARE AT AND
WHAT YOU STRUGGLE WITH, ET
CETERA, THAT INCLUDES A LOT OF
QUESTIONS AND DRIVE A LOT OF
THINGS, IT DOESN'T HAVE TO BE
JUST ONE.
IT IS BETTER THAN JUST ONE.
SO WHEN I'M SCREENING EVEN IF
I'M DOING A STUDY SPECIFICALLY
ABOUT ALCOHOL OR TOBACCO USE, I
CERTAINLY DONE JUST ASK, I ASK
WHOLE HEALTH.
TRY THE GET A SENSE OF THIS IS
JUST A HEALTH CHECK UP THAT IS
BROAD AND SUPPORTIVE.
SO BEING ABLE TO DRIVE DIFFERENT
RESPONSES EVIDENCE BASED
RESPONSES FORKY PRESENTATION,
PARTNER VIOLENCE, SUBSTANCE USE,
HEALTHCARE NEEDS, SOCIAL
DETERMINANTS, ANY SOCIAL NEEDS,
THAT IS AN IMPORTANT AND LIKELY
REALLY POSITIVE WAY TO TAKE THIS
TREMENDOUS AMOUNT OF NEED OUT
THERE, AND NUMBER SOME WAY AND
DEAL WITH IT IN SOME WAY THAT
DOESN'T PUT ON TOP OF HEALTHCARE
SYSTEM.
>> DID YOU HAVE ANYTHING TO ADD
TO THAT?
>> I DON'T KNOW THAT I CAN.
PROVIDE AD GREAT RESPONSE.
WHETHER SCREENING BRIEF
INTERVENTION OR HOW ADDRESS
HEALTHCARE IN GENERAL IS SO
IMPORTANT TO THINK HOLISTICALLY
AND COORDINATING CARE AS BEST
THEY CAN AT EVERYTHING THAT WE
ARE DOING.
>> WE HAVE A QUESTION IN THE
QUESTION BOX.
I UNDERSTAND THE QUESTION BUT I
WILL ANSWER THE QUESTION, I
THINK IS THERE AND IF NOT RIGHT
YOU CAN TYPE IT IN.
THE QUESTION IS HAS EXPERIENCE
BEEN MOST WOMEN DON'T ASK
SUPPORT FOR POSTPARTUM
DEPRESSION BECAUSE THEY FEEL HAY
RISK NOT BEING ABLE TO STAY HOME
WITH CHILDREN WHILE RECEIVING
SERVICES.
WHAT I DO KNOW, IT IS RARELY
INTERESTING, WE ARE WORKING WITH
VARIETY OF AGENCIES ALL ACROSS
THE COUNTRY.
WE ARE FINDING THAT THE MORE
MARGINALIZED, THE MORE
INTERSECTIONAL IDENTITIES WOMEN
THEY SERVE HAVE IN SOME WAYS
LESS AMENABLE TO SCREEN I MIGHT
SEE COMMENTS ON THIS AFTER.
WE HAVE AGENCY WORKING WITH THAT
HAVE UNDOCUMENTED MOMS, AND IT
IS MUCH LESS THREATENING FOR
THEM TO OFFER ROSE AS UNIVERSAL
PREVENTION FOR EVERYONE, LIKE
EVERYONE GETS IT SCREENING, I
THINK YOU ARE AT RISK WITH
POSTPARTUM DEPRESSION, THAT MOM
IS TERRIFIED BECAUSE SHE IS
AFRAID THAT PUTS HER ON A
GOVERNMENT LIST AND SHE WILL
FIND AND REPORT IT.
LOW COST INTERVENTION
PREVENTIVE, UNIVERSAL PREVENTION
IS GOOD IN SOME WAYS, SEEMED
GOOD ESPECIALLY MARGINALIZED
GROUPS BECAUSE IT DOESN'T SINGLE
FOLKS OUT.
I WOULD BE CURIOUS TO SEE WHAT
YOUR EXPERIENCE WITH THIS
WHETHER WOMEN FIND IT LESS
THREATENING, IF YOU HAD A
DIFFERENT EXPERIENCE WITH THAT.
OUR AGENCIES SERVE THE MOST
MARGINALIZED WOMEN ARE YEAH WE
ARE NOT DOING THAT, WE'RE GOING
TO DO UNIVERSAL PREVENING.
>> WE CERTAINLY HAD IT WELL
RECEIVED IN TERMS OF WILLING TO
DO IT.
AND SEEING THAT WAS POSITIVE AND
NOT SAYING PLEASE TAKE THIS AWAY
OR I DON'T WANT TO DO THIS, IT
IS RARE.
IN TERMS OF UNIVERSAL PRIMARY
PREVENTION, JUST ABOUT ANYTHING
INTERESTED IN IT.
WHY SCREEN IF IT COSTS MONEY AND
DOESN'T GIVE YOU ANY BENEFIT.
IF IT IS EASIER SIMPLY TO
PROVIDE THE SERVICE.
I'M TRYING TO THINK ABOUT HOW
THAT MIGHT CONNECT TO KINDS OF
WORK THAT I DO IDENTIFICATION OF
SUBSTANCE USE, AND HOW I PROVIDE
A SERVICE TO EVERYBODY
REGARDLESS, IT WOULD HAVE TO BE
-- IT WOULD HAVE TO A BROAD
INTERVENTION ABOUT HEALTHY
PREGNANCY.
GIVING ABSOLUTELY EVERYBODY
INFORMATION ABOUT SUB STANCE
USE, AND DEPRESSION AND SLEEP
AND NUTRITION.
BUILDING IT ALL IN THERE.
GIVING IT TO EVERYBODY AND
GIVING THEY WILL AN OPTION IF
THEY WANT MORE HERE IS WHERE
THEY MIGHT GO.
SEEMS LIKE THAT MIGHT BE
ANALOGOUS.
THAT MAKES SENSE.
I WORRY ABOUT NOT HAVING THE
DATA TO DO MORE TARGETED
INTERVENTION WHAT WE DO NOW IS
PRETTY BASED HEAVILY ON
INFORMATION THEY HAVE GIVEN US.
IN TERMS OF ACTUAL SUBSTANCE
USE, HOW THEY FEEL ABOUT IT.
THE THINGS GOOD FOR THEM ABOUT
IT.
NOT SO GOOD FOR THEM ABOUT IT.
VERY DETAILED CONVERSATION SO
THAT NECESSARILY INVOLVES
GETTING THE INFORMATION.
PERHAPS COULD BE FLIPPED, AND
MAYBE THAT IS SOMETHING THAT
MAYBE THAT IS PARTLY WHAT YOU
HAVE IN MIND SO EVERYBODY GETS
COMPUTER DELIVERED HEALTHY
PREGNANCY, THESE ARE SOME THINGS
THAT ARE GOOD.
AND THEN IF THEY SAY MAYBE I
WOULD LIKE MORE ON THIS OR MAYBE
NEED MORE ON THIS, FLIPPING,
SORT OF A BIS INSTEAD OF SBI.
>> AND WHEN YOU ARE TALKING,
SOMEBODY -- I WANT TO MAKE ONE
DISTINCTION, NOT SAYING DON'T
SCREEN, THAT NOT WHAT I'M
SAYING.
SOMEBODY ASKED A QUESTION IN THE
CHAT THERE IS A DISTINCTION
HERE.
OUR PREGNANT WOMEN TYPICALLY
SCREENED FOR SUBSTANCE USE
SYMPTOMS AND DEPRESSIVE
SYMPTOMS?
THE ANSWER IS THEY ARE SUPPOSED
TO BE.
THAT IS THAT ACOG
RECOMMENDATION.
RIGHT?
ARE THEY, YOU HAVE SEEN PEOPLE
WORKING IF I HAD TO BALLPARK
MAYBE 50 TO 70% MAYBE PART WITH
UNIVERSAL PREVENTION LIKE
ABSOLUTELY EXISTING PROBLEMS
100% SHOULD BE SCREENED BUT PART
ISSUE WITH ROSE IS PREVENTING
SOMETHING IN THE FUTURE SO
SCREENING FUTURE RISK OF
SOMETHING IS PREDICTION IS NOT
SUPER GOOD.
EVEN THEN THOUGH I GUESS ONE
THING I'M NOT SAYING DON'T
SCREEN.
I'M SAYING ABSOLUTELY SCREEN FOR
CURRENT DEPRESSIVE SYMPTOMS
CURRENT SUB STANCE USE AND
WHATEVER BUT IN THIS CASE WE ARE
PREVENTING FUTURE THING FUTURE
PREDICTION IS ALWAYS A LITTLE
DICEY AND SO INTERVENTION LOW
COST, A LOT OF AGENCIES,
EVERYONE WE DON'T WANT TO TRY TO
GO WITH THAT.
IF THAT MAKES SENSE.
>> TON OF SENSE.
THANK YOU.
THAT HELPS A GREAT DEAL.
NOT ONLY SCREENING FOR THIS
FUTURE RISK BE UNNECESSARILY
IMPERFECT AT BEST BUT ALSO IS
UNNECESSARY IF YOU HAVE AN
INTERVENTION THAT IS EASY TO
IMPLEMENT THAT FIND POSITIVE AND
ENGAGING AND WANT TO DO
REGARDLESS WHY WOULD YOU LIMIT
IT?
SO IF A WOMAN DOESN'T SCREEN
POSITIVE BUT WOULD HAVE AGREED
TO DO IT, WHY WOULD YOU RULE
THAT PARTICULAR PERSON OUT.
AGREE, THAT SIMPLY MAKING IT
AVAILABLE AND TO ANYBODY WHO IS
WILLING TO DO IT.
WOULD ABSOLUTELY MAKE A GREAT
DEAL OF SENSE.
>> 100% THAT'S WHERE MOST AGENCY
ARE, TRYING TO IMPLEMENT -- A
LOT OF HEALTH SYSTEMS AND REALLY
WORK TO GETTING IDEALLY
PRENATALLY AND POSTPARTUM, THE
DEPRESSION SCREENING SUBSTANCE
USE SCREENING, BUT IF NOT AT
LEAST ONCE.
WHAT PERCENT OF PREGNANT WOMEN
DO YOU THINK GET SCREENED FOR
SUBSTANCE USE IN ANY EFFECTIVE
VALIDATED WAY.
>> HE IS THAT LAST LITTLE --
THAT IS VERY IMPORTANT.
VERY HIGH PROPORTION DO GET
ASKED BUT IT IS OFTEN IN A
NON-EVIDENCE BASED WAY, SIMPLY
THE -- IT IS KIND OF STEREOTYPE
BUT UNFORTUNATELY OFTEN TRUE,
YOU DON'T USE, YOU DON'T DRINK A
LOT DO YOU OKAY NO.
IT IS DONE IN -- SO IT IS A
PERSON DELIVERED WAY, WHICH WE
KNOW SUPPRESSES DISCLOSURE, NOT
USING EVIDENCE BASED APPROACH
AND PROBABLY THE BEST, ANDERSON
ET AL, SURVEY ACOG WAS PART OF
THAT SURVEY I BELIEVE.
SHOWING THAT MOST OBGYN REPORTED
SCREENING EVERYBODY IN THEIR
CLINICS.
BUT VERY FEW USED EVIDENCE BASED
SCREENER.
VERY FEW USED ALL RECOMMENDED
BRIEF INTERVENTION ELEMENTS EVEN
WHEN THEY DID SOME FORT OF
INTERVENTION.
WE GET A LOT HIGHER RATES OF
DISCLOSURE USING EVIDENCE BASED
COMPUTER DELIVERED SCREENING.
OR DIGITAL SCREENING TREATMENT
IS USUAL.
>> BEAUTY OF THAT IS PROVIDER
ONLY HAS TO REMEMBER OR NOT
EVEN, THEY DON'T HAVE TO
REMEMBER THE RIGHT WAY TO ASK A
QUESTION,.
>> IT HAPPENS IN THE WAITING
AREA OR BEFORE THEY GET THERE,
IT IS A REPORT WITH INFORMATION
AND WITH RECOMMENDATION TALKING
POINTS.
>> SO WE HAVE TWO QUESTIONS IN
OUR Q&A THAT HAVE COME UP.
NOW CERTIFIED PEER SPECIALIST
RECOVERY SPECIALIST WHAT WOULD
THE ROLE BE AS POSSIBLE WARM
HAND OFF RESOURCES TO WORK WITH
INDIVIDUALS IN GETTING THEM TO
AVAILABLE RESOURCE, TYPE
REFERRAL COST EFFECTIVE
RESOURCE.
>> AMY, DO YOU WANT TO TAKE THAT
ONE?
>> BE HAPPY TO.
SO WHEN THERE IS PEER RECOVERY
COACH, PEER NAVIGATOR AVAILABLE
IN A CLINIC WHERE WE ARE
IMPLEMENTING THE TECHNOLOGY, I
AM THRILLED TO DEATH THAT I HAVE
THAT ABILITY TO SAY ONE OF THE
THINGS AVAILABLE TO YOU IS THIS
PERSON WHO IS PROBABLY JUST A
FEW FEET AWAY RIGHT NOW, KNOW
SOMETHING ABOUT WHAT YOU ARE
GOING THROUGH AND WOULD BE HAPPY
TO TALK WITH YOU, I WOULD LOVE
TO DO THAT AND WHERE IT IS
AVAILABLE I TAKE ADVANTAGE OF
IT.
EXACTLY WHAT WE WANT TO LEVERAGE
WITH THAT LIFE CHAT FEATURE THAT
WE ARE BUILDING IN FOR CLINICS
THAT DON'T HAVE SOMEBODY LIKE
THAT AVAILABLE, RIGHT THEN AND
THERE THEY CAN CLICK AND
ACTUALLY CHAT WITH SOMEONE.
I THINK A LOT OF PEOPLE YOUNGER
CERTAINLY THAN ME REALLY PREFER
TO COMMUNICATE THROUGH THAT SORT
OF LIVE CHAT TEXTING MEDIUM.
AND THEN THAT CAN THEN BE USED
TO PROMOTE OTHER SORTS OF
SERVICES PERHAPS IN PERSON.
I'M A HUGE PROPONENT OF THAT,
THE LITERATURE IS GOOD ON THAT
APPROACH MAKING AVAILABLE
REMOTELY OR IN PERSON TO EXTENT
POSSIBLE.
IS REALLY A PERFECT OPTION FOR
BRIDGING THAT GAP FOR SOMEBODY
WHO NEEDS MORE INTENSIVE
SERVICES.
BUT MAJORITY OF WHOM AREN'T
READY AND WILLING TO TAKE
ADVANTAGE OF THEM.
HAVING A CHAT WITH SOMEBODY
THERE IN CLINIC FOR A MINUTE WHO
HAS BEEN THROUGH IT WHO ISN'T
PSYCHIATRIST OR PSYCHOLOGIST,
THAT IS GREAT VERSION I WOULD
LOVE TO SEE.
>> WE ARE GETTING MORE
QUESTIONS.
THERE IS ONE THAT SAYS HOW TO
ACKNOWLEDGE BOOTS ON THE GROUND
OPPOSED TO SCIENTISTS IN THE
LAB.
I WANT TO SAY SOMETHING I FORGOT
TO SAY WHEN I WAS TALKING WAS SO
INTERESTING, LIKE I SAID,
AGENCIES THE AGENCIES ALL
PROVIDERS WE ARE WORKING WITH
ARE SO PASSIONATE AND COMMIT AND
THEY ARE TRYING TO KEEP THE
SERVICES GOING ON SHOE STRING
AND DESPITE OBSTACLES IT IS IN A
QUALITATIVE INTERVIEW BECAUSE
SOME CAN DO IT RIGHT OFF THE
BAT, SOME STRUGGLE BARRIERS
WORKING TO GET IT STARTED BUT
ONE OF THE THINGS THAT IS
INTERESTING BUT SORT OF
QUALITATIVE INTERVIEW HOW GUILT
THEY FEEL THEY CAN'T DO MORE WE
CAN TRY TO SAY THIS IS NOT --
YOU ARE DOING AMAZING EFFORTS
WITH RESOURCES YOU HAVE BEEN
GIVEN, TO DO ANY OF THIS IS
AMAZING.
BUT THIS IS ALMOST UNIVERSAL.
SO THE BOOTS ON THE GROUND WITH
PROVIDERS, WITH THE PEOPLE WHO
ARE TRYING TO MAKE THE AGENCIES
RUN, WHO ARE SEEING THEM ON DAY
TO DAY AND TRYING TO CREATE A
SYSTEM OF CARE WE ARE TALKING
ABOUT WHERE IT DOESN'T EXIST
ACROSS SOCIAL DETERMINANTS,
THERE'S PEOPLE PUTTING
THEMSELVES IN TO FILL THOSE
GAPS.
HEROIC AND ALSO THE FACT THE
SYSTEM ISN'T REALLY SET UP TO
SUPPORT THEM OR THE MOM BECAUSE
IT IS FRAGMENTED.
IT IS UNNECESSARY HUMAN TOLL ON
THE PROVIDERS.
>> GREAT ANSWER.
I WOULD ADD THAT KINDS OF THINGS
JENNIFER AND I ARE DOING WHICH
INVOLVE NOT AN RA OR A
SCIENTIFIC TEAM COMING IN AND
DOING IT WITH THE ACTUAL
HEALTHCARE TEAM DOING THESE
SORTS OF PREVENTIVE ACTIVITIES,
IS A HUGE STEP AND GIVES THEM A
TOOL, GIVES THEM SOMETHING THEY
CAN DO THEY CAN KNOW WORKS WE
HAVE TO BE CAREFUL ABOUT HOW
MUCH WE ASK AND HOW MUCH WE ADD.
THERE IS THAT FINE LINE THERE.
THEY NEED TOOLS THAT WANT TO
HELP -- THEY WANT TO DO THINGS,
WE HAVE TO MAKE IT POSSIBLE AND
FEASIBLE FOR THEM.
>> I WAS TALKING ABOUT MY
BUILDING SUGGESTION, ONE OF MY
THINGS WAS MANDATED AND I HAD A
RESPONSE FROM COLLEAGUE WHO
CANNOT MANDATE ONE MORE THING,
CAN'T DO IT.
I MET WITH MORE PAYMENT, MORE
RESOURCES.
I NEED -- WITHOUT RESOURCES.
HERE IS A QUESTION THAT SAYS
WOULD UNIVERSAL HOME VISITING
BEING SOMETHING YOU SEE FEASIBLE
AND THAT EVERYONE WOULD BENEFIT.
I DON'T KNOW THAT I KNOW THE
ANSWER TO THAT.
I DON'T THINK IT IS FEASIBLE
RIGHT NOW.
I THINK FOLKS MIGHT BENEFIT FROM
IT.
IT WOULD BE GREAT IF AN OPTION
IS AVAILABLE TO EVERYONE.
ONE OF THE THINGS WE HAVE IN
MICHIGAN, HOW IT IS IN OTHER
STATES BUT HOME VISITING
PROGRAMS THE COMMUNITIES MOST AT
RISK, THERE IS LOWER UPTAKE
THERE IS TRUST BUILDING THAT
NEEDS TO BE DONE.
BUT I DON'T -- I GUESS I DON'T
-- I DON'T HAVE A STRONG THOUGHT
ABOUT WHETHER IT IS FEASIBLE.
IT WOULD BE NICE.
DR. BOHR, DO YOU HAVE THOUGHTS
ABOUT THAT?
>> ONE OF THE THINGS INTERESTING
IN MICHIGAN, ANY WOMAN WITH
MEDICAID CAN GET HOME VISITING,
AND IN MANY OF THE MORE RURAL
AREAS, THAT'S JUST ABOUT WHAT IS
AVAILABLE IS BACK TO THEM IN
TERMS OF SERVICES.
SO THAT IS BECAUSE THAT IS WHAT
THEY HAVE, THAT IS WHAT WE
PROMOTE AND WE CERTAINLY COULD
DO WORSE.
I'M DELIGHTED TO HAVE THAT
SERVICE AVAILABLE TO THEM,
THERE'S RICH LITERATURE ON THE
STRENGTHS AND THE PROS AND CONS
OF PROVIDING THAT PARTICULAR
SERVICE, I WISH WE HAD MORE.
BUT ANYTHING THAT PEOPLE CAN
ACCESS EASILY AND THAT COMES TO
THEM, THAT IS A GREAT STARTING
POINT FOR SURE.
>> SOMEBODY SAID FEASIBLE IN
CALIFORNIA, CALIFORNIA IS BY
DELAY THE ONLY STAY THAT HAS
GOOD REIMBURSEMENT STRUCTURE FOR
ROSE SO KUDOS TO CALIFORNIA.
THEY SHOULD BE A MODEL FOR REST
OF US AROUND THIS.
SO WE HAVE STEVE THERE IS A
QUESTION FOR YOU IN THE CHAT.
I WILL LET YOU TRY TO ANSWER IN
THE CHAT.
I WILL TAKE THIS ONE ABOUT PTSD.
AND SO WANTED TO ASK REQUEST
INFORMATION ABOUT PTSD AND MAJOR
COMPLICATIONS DURING PREGNANCY.
YES, I DO WORK IN THAT AREA, IT
IS INTERESTING -- SO -- CAN BE
TRAUMATIC HIGH RATE OF PTSD, IT
DOES LAST, THIS IS ABSOLUTELY AN
UNDERRECOGNIZE CONCERN THERE ARE
THINGS THAT CAN HELP WITH IT AND
I GUESS I WILL -- I WILL PUT MY
EMAIL IN THE CHAT FOR EVERYONE
AND IF YOU WANT TO EMAIL ME,
EMAIL ME.
PTSD FOR PREGNANCY
COMPLICATIONS, ABSOLUTELY.
>> ONE QUESTION I THINK WAS
ABOUT BRIEF INTERVENTION
AVAILABILITY RATHER THAN HOME
VISITATION IN TERMS OF THE BRIEF
INTERVENTION WE HAVE FUNDING
FROM THE MICHIGAN DEPARTMENT OF
HEALTH AND HUMAN SERVICES, TO
MAKE AVAILABLE ANYWHERE AT ANY
CLINIC THAT WANTS IT, WE PROVIDE
IT FOR FREE.
THE CHALLENGE IS NOT SO MUCH THE
COST BUT HIPAA AND SECURITY
SORTS OF REGULATIONS THAT SLOW
US DOWN.
STEVE WILL YOU ANSWER THERE IS A
QUESTION ABOUT AI CAN YOU TYPE
IT -- AN ANSWER.
TO THE Q&A.
>> LET ME GRAB THAT, I WAS
LOOKING AT THE OTHER.
>> WE GOT TO BE DONE BY I THINK
THAT WANT AN ANSWER TO THAT ONE
SO ANSWER THAT WILL BE GREAT.
>> LET ME GRAB THAT.
>> THANK YOU FOR ANSWERING THE
LAST QUESTION.
I WANT TO THANK SESSION TWO
PANELIST.
AS WE MOVE FROM SESSION ONE
WHICH SET THE STAGE FOR BROAD
ISSUES THE SESSION TWO PROVIDED
DATA ON SBIRT AS APPROACH TO
DELIVERY OF EARLY INTERVENTION
AND TREATMENT FOR VARIOUS TYPES
OF INTERVENTIONS WHICH DURING
THE DISCUSSION WE FOUND THAT
MIGHT BE ABLE TO APPLY TO NEW
PROGRAMS AND NEW MEDICAL
INTERVENTIONS FOR WOMEN AND
GIRLS.
IN ORDER FOR SOMETHING REALLY TO
BE MOVED INTO EVIDENCE BASED
PRACTICE, NEW INTERVENTIONS DO
NEED TO BE TESTED TO UNDERSTAND
THE INTERVENTION WORKS OR
IMPROVES THE CONDITIONS THAT
INTERVENTION IS TRYING TO TREAT.
THAT CONCEPT PROVIDING
INTERVENTION THAT MAY PREVENT
FUTURE RISK GLOBALLY WAS ALSO AN
INTERESTING QUESTION POSED IN
THE DISCUSSION.
SHOULD LOW COST EASY UPTAKE
INTERVENTIONS BE MORE WIDELY
AVAILABLE.
SO WE SHOULD THINK ABOUT THIS A
LITTLE BIT MORE THROUGHOUT THE
WORKSHOP.
ALSO WE SAW SEVERAL EXAMPLES HOW
WE CAN USE MODERN TECHNOLOGIES
FOR OUTREACH AND MEANS FOR
INTERVENTION TO IMPROVE HEALTH
CARE DELIVERY AND CARE OVERALL.
WE ALSO SAW EXAMPLES OF HOW
PREVENTION IS KEY FOR REDUCING
HEALTHCARE DISPARITIES IN BOTH
PRE- AND POSTPARTUM PERIODS SO
THE SPEAKERS HERE REALLY
PRESENTED THAT THERE ARE MANY
GOOD MODELS THAT COULD BE
APPLIEDED TO NEW AREAS WE ARE
THINKING ABOUT ACROSS MULTIPLE
CONDITIONS THAT REQUIRE NEW
INTERVENTION TO ADDRESS
CO-MORBIDITIES IN WOMEN AND
GIRLS.
SO WE SHOULD KEEP TALKING ABOUT
THESE AND CONSIDER THESE AS
POTENTIAL RESEARCH OPPORTUNITIES
SO AT THIS TIME WHICH ARE GOING
TO TAKE ANOTHER SHORT BREAK THEN
WE'LL RETURN FOR SESSION 3 WHICH
WILL BE OUR FINAL SESSION FOR
THE DAY.
THANK YOU.
>> WELCOME BACK.
WE WILL HAVE OUR FINAL SESSION
OF TODAY.
TITLED IMPLEMENTING ESSENTIAL
COMPONENTS OF INTEGRATIVE
HEALTHCARE SYSTEMS FOR WOMEN AND
GIRLS, CHALLENGES AND SUCCESSES.
THIS SESSION WILL BE MODERATED
BY DR. LAURIE DONZE FROM NHLBI.
I'LL TURN IT OVER TO LAURIE.
>> HI, EVERYONE.
I'M LAURIE FRIEDMAN DONZE,
PROGRAM DIRECTOR MARKNAL HEART
LUNG AND BLOOD INSTITUTE AT NIH.
I'M PLEASED TO MODERATE THIS
SESSION AND INTRODUCE OUR FOUR
ESTEEMED PRESENTERS.
I'M GOING TO INTRODUCE THEM
TOGETHER AND TURN IT OVER TO THE
FIRST PRESENTER.
SO OUR FIRST PRESENTER WILL BE
DR. DOOR CHAR MEHTA, INTERNAL --
DARSHAN MEHTA, ASSISTANT
PROFESSOR MEDICINE HARVARD
MEDICAL SCHOOL.
WHERE HE SERVES AS THE DIRECTOR
OF EDUCATION FOR THE OSHA CENTER
AT BRIGHAM AND WOMEN'S HOSPITAL
AND HARVARD MEDICAL SCHOOL.
THE MEDICAL DIRECTOR OF THE BOSS
-- BENEFITSON HENRY INSTITUTE
FOR MIND BODY MEDICINE,
MASSACHUSETTS GENERAL HOSPITAL
AND DIRECTOR OF THE OFFICE FOR
WELL BEING WITH CENTER FOR
FACULTY DEVELOPMENT AT MASS
GENERAL.
HIS EDUCATIONAL AND RESEARCH
INTEREST INCLUDE CURRICULAR
DEVELOPMENT IN COMPLIMENTARY
INTEGRATIVE MEDICINE AND MIND
BODY EDUCATIONAL INTERVENTION
AND HEALTH PROFESSIONS TRAINING.
THE SECOND SPEAKER WILL BE DR.
LISA MASINTER, BOARD CERTIFIED
GENERAL OBSTETRICIAN
GYNECOLOGIST WITH BACKGROUND IN
PUBLIC HEALTH AND HEALTH
SERVICES RESEARCH.
SHE IS SENIOR DIRECTOR OF
RESEARCH AT ALLIANCE CHICAGO SHE
OVERSEES TEAM OF TEN MANAGING A
PORTFOLIO OF APPROXIMATELY 40
ACTIVE PROJECTS.
SHE WAS PREVIOUS LEMEDCAL
DIRECTOR BUREAU OF MATERNAL
INFANT CHILD AND ADOLESCENT
HEALTH CHICAGO DEPARTMENT OF
HEALTH WHERE SHE SPEARHEADED
INCREASE IN DATA DRIVEN
PRACTICE.
T DR. MASINTER IS CONTENT EXPERT
WITH FUNDING AND PEER REVIEW
PUBLICATIONS IN REPRODUCTIVE AND
MATERNAL HEALTH EQUITY.
DR. RACHEL CHAMBERS IS
BEHAVIORAL SCIENTIST AND PUBLIC
HEALTH RESEARCHER WITH OVER TEN
YEARS EXPERIENCE WORKING TO
IMPROVE HEALTH OUTCOMES, ALONG
NATIVE AMERICAN FAMILIES.
SHE IS AN ASSISTANT SCIENTIST AT
JOHNS HOPKINS BLOOMBERG SCHOOL
OF PUBLIC HEALTH AND CURRENTLY
COMPLETING A FELLOWSHIP AT THE
CENTER FOR AIDS RESEARCH IN THE
IMPLEMENTATION SCIENCE.
DR. CHAMBERS UTILIZES COMMUNITY
BASED PARTSTORY RESEARCH TO
IDENTIFY IMPLEMENT AND EVALUATE
COMMUNITY DRIVEN SOLUTIONS THAT
ADDRESS PRESSING HEALTH
DISPARITIES IN INDIAN COUNTRY.
OUR LAST PRESENTATION WILL BE
FROM DR. LAUREN FIECHTNER BOARD
CERTIFIED PEDIATRICIAN,
PEDIATRIC GASTROENTEROLOGIST,
CLINICAL EPIDEMIOLOGIST AND
OBESITY AND FOOD INSECURITY
RESEARCHER.
SHE DIRECTOR NUTRITION AT
MASSACHUSETTS GENERAL HOSPITAL
FOR CHILDREN, ASSISTANT
PROFESSOR PEDIATRICS AT HARVARD
MEDICAL SCHOOL, AND SENIOR
HEALTH AND RESEARCH ADVISOR AT
GREATER BOSTON FOOD BANK.
NOW I WOULD LIKE TO TURN IT BACK
TO OUR FIRST PRESENTER, DR.
DARSHAN MEHTA.
>> THANK YOU, LAURIE.
SHARE MY SCREEN HERE.
THANK YOU AGAIN, AN HONOR
PRIVILEGE TO BE WITH YOU THIS
AFTERNOON.
I WILL TALK IN THE NEXT 20
MINUTES ABOUT TAKING A BIG BIRDS
EYE VIEW OF INTEGRATIVE HEALTH
IN THE MODERN HEALTHCARE SYSTEM
AS RELATES WE THINK ABOUT WOMEN
AN GIRLS AND OFFER PERSPECTIVES
AS WHICH I IN ADDITION, AS A
CLINICIAN, MEDICAL DIRECTOR AND
HOW SYSTEMS AND HOW SYSTEMS COME
TOGETHER ESPECIALLY THINKING
ABOUT INTEGRATIVE HEALTH AND
THEN ALSO AS EDUCATOR.
P P SO WHAT I HOPE TO ACHIEVE
MT. NEXT FEW MINUTES TOGETHER IS
TO UNDERSTAND HOW INTEGRATIVE
HEALTH IS INCORPORATED IN
PRIMARY CARE, WOMEN GIRL AND
REVIEW SUCCESS AND CHALLENGES IN
IMPLEMENTATION AND UNDERSTAND
THE NEED TO INCREASE
PARTICULARLY INPATIENT ANALYSIS
VIRTUAL SETTINGS AS WELL.
IF I WANT TO THINK ABOUT FROM A
BIG PICTURE PERSPECTIVE, THIS IS
A DR. HERBERT BENSON SOME OF YOU
MAY BE FAMILIAR WITH, HE TALKED
ABOUT THE THREE LEGGED STOOL AND
HE IS ONE MENTOR AT THE BENSON
HENRY INSTITUTE FOR MIND BODY
MEDICINE.
WHEN WE THINK ABOUT THE OVERALL
PARADIGM OF HEALTH WE WANT TO
OBVIOUSLY MAKE SURE WE HAVE THE
BEST PHARMACEUTICALS OR EVEN
NUTRI SUITCALS AS WE THINK ABOUT
IT, SURGERY AND PROCEDURES OR
ANY LOGICALLY BASED
INTERVENTIONS AND THEN THE THING
THAT IS LEFT OUT IS SELF CARE
PIECE PARTICULARLY, THAT SORT OF
BECAME THE FRAMEWORK FOR
THINKING MIND BODY MEDICINE.
I WILL TALK MORE DETAIL IN A
MOMENT.
ONE OF THE THINGS IS WE OFTEN
FOCUS ON THE PHARMACEUTICAL
SURGERY OR PROCEDURAL PIECES,
THERE MAYBE VARIOUS INCENTIVES
TO WHY THAT IS THE CASE BUT WE
LEAVE OUT SELF CARE PIECE AND
HOPE TO LEAVE YOU WITH THE
PEELING ONE THING INTEGRATED IF
WE THINK TRUE INTEGRATIVE HEALTH
IN MEDICINE, IT IS A BLEND OF
ALL THREE OF THESE, HOW WE
COTHAT IN A COMPLEX HEALTHCARE
ENVIRONMENT.
SO I WANT TO GIVE GIVE YOU A
SENSE WHERE I'M BASED AT THE
MIND BODY MEDICINE AT MG AGE AND
THIS IS A INDEPENDENT TEAM
CENTER MASSACHUSETTS GENERAL
HOSPITAL WHICH INVOLVES CLINICAL
PRACTICE RESEARCH AND EDUCATION,
THAT BUILDING THAT YOU SEE IN
THE PICTURE WHERE WE ARE
LOCATED, IRONICALLY ONE OF THE
MOST STRESSFUL LOCATIONS IN
BOSTON BUT WE STUDY THE WAYS TO
COMBAT STRESS ENHANCE RESILIENCY
RESILIENCY, OUR WORK FOCUSED ON
LOOKING AT RESILIENCE FROM
MULTIPLE DOMAIN, ONE IS
OBVIOUSLY THINKING THE MECHANISM
LOOK AT EPIGENETIC AND
NEUROSCIENTIFIC MECHANISMS OF
RESILIENCY AND WELL BEING.
WE ARE LOOKING AT HEALTH OUTCOME
AS WELL.
HOW WE ACTUALLY TRAIN PROVIDERS
TO DELIVER THIS WORK AND
BEGINNING LOOK CRITICALLY WHAT
DOES IT TAKE TO TRAIN SOMEONE IN
THIS WORK AND SO THEY CAN
DELIVER IT IN THE WAYS WE THINK
ARE MEANINGFUL EFFECTIVE FOR
EFFECTIVE HEALTH OUTCOMES SO WE
FOCUS ON MIND BODY PRACTICE MANY
THE HEALTHCARE SYSTEM INCLUDING
MED AGENT THE OTHER PLACE
MENTIONED WAS OSHA SENT FOR
INTEGRATIVE MEDICINE HARVARD
MEDICAL SCHOOL HARVARD, SO THE
INSTITUTE IS FOCUSED ON THE SELF
CARE APPROACHES, LIKE MEDITATION
AND SUCH THE OSHA CENTER IS
UNIQUE SITE AND IT IS LOOKING
PROVIDER BASED APPROACHES OFTEN
TIMES SO THIS IS A CENTER THAT
FOCUS ON RESEARCH AND CLINICAL
ACTIVITY AROUND HOLISTIC PATIENT
CARE BY COMBINING THE BEST
TREATMENT AVAILABLE TO
UNDERSTAND INNOVATIVE RESEARCH
BETTER UNDERSTANDING PHYSICAL
PSYCHOLOGICAL BENEFITS O VARIOUS
THERAPIES, APPROACHES LIKE
CHIROPRACTIC CARE, MASSAGE
THERAPY, AMONG OTHERS
ACUPUNCTURE EDUCATING THE EX IN
GENERATION OF INTEGRATIVE
MEDICINE PRACTICERS AND LOOKING
AT CHRONIC PAIN CONDITIONS AND
AS WELL AS STRESS RELATED
CONDITIONS.
SO MY FOR RAY INTO THIS WORK, I
THINK FOR OFTEN TIME MANY OF US,
WE ARE INFORMED BY PATIENT I
DISTINCTLY REMEMBER IN
RESIDENCY, DURING MY RESIDENCY
IN INTERNAL MEDICINE IN
UNIVERSITY OF ILLINOIS PATIENT
CAME TO ME, THIS 44-YEAR-OLD
WOMAN, WITH PAST MEDICAL HISTORY
SIGNIFICANT FOR ROUTINE PHYSICAL
EXAM CAME WITH COMPLAINTS OF
MILDLY PAIN ASSOCIATED WEIGHT
GAIN, FAMILY HISTORY WAS NOT
CONTRIBUTORY, SOCIAL HISTORY
TOBACCO ALCOHOL ELICIT DRUG USE,
AND EAT A LOT OF FAST FOOD.
I'M PHYSICAL EXAM BODY MASS
INDEX WAS 31, BLOOD PRESSURE 135
OVER 90 NO REMARKABLE FINDINGS,
LABORATORY TESTING WAS PRIMARILY
UNREMARKABLE EXCEPT KNEE
RADIOGRAPH DEGENERATIVE CHANGE.
AT THAT TIME WE WERE BASICALLY
OKAY DO SOME DIET EXERCISE
COUNSELING, BLOOD PRESSURE AT
THE BORDER LINE LEVEL MAYBE
THINK ABOUT DO YOU WANT TO START
MEDICATION OR NOT.
BUT DIET AND EXERCISE WAS QUITE
LIMITED IN HOW WE WERE EDUCATED.
WHICH IS DIET COUNSELING
BASICALLY WE TOLD PATIENTS EAT
LESS AND EXERCISE COUNSELING WAS
DO MORE.
WHEN SHE SAID WELL, SHE WANTED
TO ASK THE FOLLOWING, WHAT DO
YOU THINK, THIS IS -- I HAVE NO
FINANCE, TIES TO THESE PRODUCTS
BUT I LITERALLY WHAT SHE BROUGHT
IN WAS SAMI OR ME THIONEINE.
HELP SUPPORT HEALTHY MOOD AND
JOINT COMFORT.
THE OTHER WAS THE -- MIDDLE OF
MY RESIDENCY TRAINING IN 2003,
HIGHER MIND CAN -- HOW YOUR MIND
CAN HEAL YOUR BODY, NEW WAYS TO
BEAT THE BLEW BLUES.
THIS IS SPECIAL ISSUE IN TIME
MAGAZINE.
ONE THING YOU SEE OFF THE BAT IS
CHALLENGES ASSOCIATED IN
HEALTHCARE SYSTEM HOW DO YOU
ADDRESS THIS.
IF YOU LOOK AT ANY BOX OF
DIETARY SUPPLEMENTS THAT SAYS IF
YOU HAVE ANY QUESTION, TREAT
CONDITION OR MEDICAL CONDITION,
AND ASK YOUR HEALTHCARE PROVIDER
BEFORE USING WHICH IS A VERY
DIFFICULT ONUS PUT ON MANY
HEALTHCARE PROVIDERS
PARTICULARLY PHYSICIANS, BECAUSE
THEY HAVE NO IDEA HOW TO ANSWER
SOME OF THESE QUESTION.
WE ARE NOT TRAINED IN HOW TO
ANSWER THESE QUESTIONS, OUR BUT
YET THESE ARE READILY AVAILABLE
PRODUCT, AND NOT TO SAY THEY ARE
BAD PRODUCTS NECESSARILY BUT
EVEN IF YOU UNTHINK OF WHAT IS
THE BENEFIT ASSOCIATED IS VERY
CHALLENGING.
WHAT TRAINING IS NEEDED BECOMES
A VERY INTERESTING ISSUE IN A
COMPLEX HOW DO YOU FEEL
PROFICIENT TO COUNCIL PATIENT
AROUND THIS AND WHAT SKILLS ARE
NEEDED, AND THE SECOND QUESTION
IS WHO IS ENGAGING IN THIS
THING?
ONE THING THAT OCCURRED THE PAST
COUPLE OF YEARS AS WE BEGIN TO
LOOK AT HOW WHO HAS ACCESS TO
THIS YOU CAN SEE IMAGES HERE OF
THIS PARTICULAR INDIVIDUAL IN
THE TINY PICTURE WHAT IS
PERPETUATED THE PROTOTYPICAL
INDIVIDUAL THAT ACTS ANDEAN YOU
CAN SEE THAT WE RARELY SEE
INDIVIDUALS PEOPLE FROM PERSONS
OF COLOR ENGAGING IN THIS TYPE
OF HAVING FRONT PAGE SORT OF
DEPICTION ON POPULAR USE PIECE
MAGAZINE, IT IS I THINK
PERPETUATES AGAIN THIS IS
PERHAPS AS LONGER TALK FOR
ANOTHER TIME BUT JUST SOMETHING
TO THINK ABOUT, BEDO NEED TO BE
AWARE OF WHAT UNCONSCIOUS BIASES
ARE CREATING AND BODY TYPE IS
ALLOWED TO ENGAGE IN THESE TYPES
OF PRACTICES.
WE EXCLUDING PEOPLE.
PREVALENCE IS THAT WE KNOW ABOUT
A THIRD HAVE U.S. ADULTS USE
COMPLIMENTARY HEALTH APPROACH OF
8TH OF CHILDREN USED IT IN THE
PAST YEAR, THOSE NUMBERS HAVE
BEEN STABLE.
THE CORRELATES OF USE ARE
INDIVIDUALS WHERE WHITE WOMEN
USE SIGNIFICANTLY MORE THAN MEN
IN HIGHER SOCIOECONOMIC STATUS
HIGHER EDUCATION LEVELS AND
INCOME LEVELS.
SO WHAT IS THE -- NOW TO GET
INTO VOCABULARY BECAUSE
SOMETIMES WE HEAR WORDS AND --
ACCORDING AGAIN THIS IS NCCIH
DEFINITION, MAINSTREAM PRACTICE
IS USED WITH CONVENTIONAL
MEDICINE IT IS CONSIDERED
COMPLIMENTARY.
IF A NON-MAINSTREAM PRACTICE
USED IN PLACE OF CONVENTION IT
IS ALTERNATIVE.
INTEGRATED HEALTH EMPHASIZE THE
HOLISTIC PATIENT FOCUS
APPROACHES TO HEALTHCARE AND
WELLNESS OFTEN INCLUDING MENTAL
EMOTIONAL FUNCTIONAL SPIRITUAL
SOCIAL COMMUNITY ASPECT.
TREATING THE WHOLE PERSON IT
AIMS FOR WELL COORDINATED CARE
BETWEEN PROVIDERS AND
INSTITUTIONS.
IT IS COMBINING THE BEST
EVIDENCE BASED INTEGRATIVE
THERAPIES, EMPHASIZES PATIENT
PARTICIPATION INCLUDING EXERCISE
DIET STRESS MANAGEMENT AND
MAXIMIZING HEALTH, THERE IS
IMPORTANCE OF PATIENT PROVIDER
RELATIONSHIP AND IMPORTANCE OF
SHARED DECISION MAKING, THERE IS
EMPHASIS CONTRIBUTION OF
THERAPEUTICKENT COUNTER AND
SEEKS TO OPTIMIZE INDIVIDUAL
INNATE HEELING CAPACITY.
IF YOU THINK DOMAINS OF
INTEGRATED MEDICINE THERE ARE
WAYS IT IS SEPARATED, THERE IS
ALWAYS DEBATE BUT JUST TO GIVE
YOU A BROAD SORT OF DEPICTION
BIOLOGICALLY BASED PRACTICE
INCLUDE HERBAL DIETARY
SUPPLEMENTS DIET AS WELL, ENERGY
THERAPIES HEALING AND
THERAPEUTIC TOUCH AND MIND BODY
MEDICINE, MEDITATION YOGA AND
TAI CHI MANIPULATION BODY SIZE
PRACTICES AND WHOLE SYSTEMS LIKE
TRADITIONAL CHINESE MEDICINE
NATUREOPATHY THAT HAVE
COMPONENTS THAT SPAN ACROSS
THESE DOMAINS.
ONE THING TO RECOGNIZE IS IN
THIS FIELD THERE ARE HUDDLES --
HURDLES INCLUDING CLINICAL
EFFICACY AND SPECIFIC CONDITIONS
DETERMINING SPECIAL -- SPECIFIC
BIOLOGICAL MECHANISM COST
EFFECTIVENESS OVERCOMING BIAS AN
CONVINCING SKEPTICS CREATING
CULTURE CHANGE IN MEDICINE
BROADENING ACCESSIBILITY AND
SUSCEPTIBILITY AND USING
EVIDENCE TO CONVINCE PAYERS AND
GOVERNMENTS,.
ACCEPTABILITY AND ACCESSIBILITY
IN THE COMMUNITY MARGINALIZED
VULNERABLABLE POPULATIONS ARE
NOT ABLE TO ACCESS INTEGRATE
I'VE HEALTH SERVICES LIKE
COMPARED TO THOSE THAT CAN'T
AFFORD IT.
SO WHERE DO WE BEGIN.
I THINK THE OPPORTUNITIES HERE'S
SPECIALLY FOR WOMEN AND GIRLS IS
THINKING HOW TO BEGIN EARLY.
IN -- WE OFTEN THINK OF THIS AS
A TREATMENT O OPTION BUT
OPPORTUNITIES IN THE EDUCATIONAL
SYSTEM CAN WE BEGIN EARLY THERE
IS SKILLS BASED CURRICULUM, THIS
PRIMORDIAL PREVENTION BEFORE IT
IS EVEN -- REALLY CREATING A
REALLY A SKILLS THAT CAN ALLOW
PEOPLE TO -- ALLOW CHILDREN TO
BE FULLEST SORT OF POSSIBILITIES
TO FULLEST EXTENT THEY CAN.
CHALLENGE IS WHO DOES TEACHING
WHO IS GOING TO FUND IT.
PREVIOUSLY WHAT ACTUALLY IS
BEING PERPETUATED, IF YOU USE
DIVERSITY EQUITY INCLUSIVE LENS
WHAT ARE WE PERPETUATING WHEN WE
SEND UM IMAGINES AROUND
INTEGRATIVE HEALTH.
WE KNOW FOR EXAMPLE, HERE IS A
BEAUTIFUL DRAMATIC REVIEW MEHTA
ANALYSIS HA SHOWED THAT
CURRICULUM BASED INTERVENTIONS
INCLUDING YOGA MINDFULNESS
SOCIAL PERSONAL SKILLS
INTERVENTION, BASIC ENTERSIZE
INTERVENTION ON AVERAGE REALLY
PROMOTE UNIVERSAL
SELF-REGULATION IN CHILDREN AND
ADOLESCENTS, BUT AGAIN ONE OF
THE THINGS WE SEE IS THAT ON ONE
HAND WE HAVE THIS ABILITY TO
PROMOTE REGULATION AT THE SAME
TIME CONTENDING WITH IMAGES THAT
ARE OFTEN PARTICULAR BODY TYPE
PARTICULAR RACE AND PARTICULAR
IMAGE.
KNOW WHEN WE INCOOPERATE
INTEGRATIVE HEALTH SERVICES MIND
BODY APPROACHES THEY ACTUALLY
HAVE HEALTH EFFECTS THAT ARE
QUITE SIGNIFICANT THAT INCLUDES
MORTALITY BENEFITS THREE MONTH
THIS IS AN EXAMPLE CARDIAC
REHABILITATION, INCORPORATED
MIND BODY COMPONENTS ACTUALLY
DECREASE MORTALITY THREE YEARS
VERSUS THOSE WENT TO CARDIAC
REHAB BUT DIDN'T HAVE THAT
COMPONENT.
IRONICALLY THESE TURN INTENSIVE
CARDIAC REHAB PROGRAMS APPROVED
BY MEDICARE SEPARATE BILLING
CODE ASSOCIATED WITH THAT.
UTILIZATION WE KNOW THAT WHEN
INDIVIDUALS ENGAGE IN MIND BODY
PRACTICES PARTICULARLY THEY
ACTUALLY USE THE HEALTH SYSTEM
LESS AND THEY ARE POTENTIAL COST
SAVINGS, THIS IS RETROSPECTIVE
STUDY, THESE TYPES OF STUDIES
ARE THE ONES THAT NEED TO BE
THOUGHT THROUGH MORE CRITICALLY,
AND ESPECIALLY THINKING
INTEGRATED HEALTH SYSTEM FOR
WHAT THAT MEANS ESPECIALLY FOR
WOMEN AND GIRLS THINKING ABOUT
WHAT IS UTILIZATION PATTERNS AND
HOW DO THESE THINGS AFFECT
HEALTHCARE UTILIZATION PATTERNS.
WHEN WE THINK ABOUT PROVIDER
BASED APPROACHES, LIKE
ACUPUNCTURE WE KNOW ALREADY
STUDIES OUT THERE, THAT SUPPORT
USE CONSIDERATION IN THE
MANAGEMENT AND TREATMENT OF
CONDITIONS, BOTHERSOME MENOPAUSE
SYSTEM, THESE A STUDY THAT FOUND
INDIVIDUALS HAD IMPROVEMENT IN
SYMPTOMS IN AS LITTLE AS SICK
WEEKS.
SO I THINK WE ESPECIALLY AS A
CLINICIAN LEADER ADMINISTRATOR,
HOW DO WE ACTUALIZE THESE
PRACTICES INTO CLINICAL CARE,
THE RESEARCH OFTEN TIMES MANY
TIMES SUGGESTIVE AND SOMETIMES
QUITE COMPELLING, BUT HOW DO WE
ACTUALLY -- WHAT IS SYSTEMS
PERSPECTIVE AND CHIROPRACTIC
MIGRAINE WORKING WITH NEUROLOGY
COLLEAGUES HOW BEST TO RECRUIT
PATIENTS INTO THESE TYPES OF
CARE OPTIONS UNDERSTANDING
ACTIVE INGREDIENT, AND OBVIOUSLY
THERE IS A BIAS THAT HAS TO BE
FACED, THE QUESTION IS AS A
CLINICIAN WHO TO REFER TO WHEN
AND HOW IS NOT PROVIDERS OF THE
SAME BUT IT DOES ALLOW POSSIBLY
NEW OPPORTUNITY AS
NON-PHARMACOLOGIC INTERVENTION.
THE OTHER THINGS THAT THAT CAN
BE COST EFFECTIVE CHALLENGES ARE
NOT OFTEN COVERED BY THIRD PARTY
PAYERS THOUGH CHIROPRACTIC CARE
IS, ACUPUNCTURE IS BEGINNING TO
AND MASSAGE THERAPY IS NOT, IT
IS HETEROGENEITY OF TREATMENT,
AROUND IMPORTANTLY HOW WE
COMMUNICATE WITH ALLO PATHIC
CONVENTIONAL HEALTHCARE
PROVIDERS?
AGAIN AS I MENTION, LICENSURE,
ONE THING JUST TO THINK ABOUT
FRAMEWORKS THAT WE WANT TO DO IS
HOW DO WE THINK ABOUT SHOULD
THERAPY BE RECOMMENDED AVOIDED
BEGIN TO THINK ABOUT LOOKING AT
DOMAINS OF SAFETY EFFICACY,
BALANCING THAT WITH QUALITY BUT
CENTER OF THIS IS PATIENT
PREFERENCE AND H IS GOING TO BE
CRITICAL IN THINKING DEVELOPING
A -- AS WE BEGIN TO THINK ABOUT
MU TYPES OF HEALTHCARE SYSTEMS.
SO JUST FINISH UP, JUST TO TALK
LALE BIT ABOUT ONE OF THE
PROGRAMS WE HAVE OFFERED AT THE
HENRY INSTITUTE AROUND STRESS
MANAGEMENT RESILIENCY TRAINING
PROGRAM, AND THAT FRAMEWORK
RESILIENCY CAN BE BUILT THROUGH
THREE TIERED PROCESS WHICH
INCLUDE ONGOING PRACTICE OF
TECHNIQUES WHICH ELICIT
RELAXATION RESPONSE BUILDING
AWARENESS OF STRESS AND NEGATIVE
EFFECT AND PROMOTING SOCIAL
CONNECTEDNESS AND LIFESTYLE
BEHAVIOR SO EIGHT WEEK
MULTI-MODAL PROGRAM, WHICH
INCORPORATE ELEMENTS WITH
TRADITIONS THROUGH MIND BODY
PRACTICE.
THERE'S SIGNIFICANT HEALTHCARE
EFFECT IN THE -- IN TERMS OF
HEALTH OUTCOMES, INCLUDING
MEDICAL PSYCHIATRIC SYMPTOMS AND
HELPING INDIVIDUALS INCREASE
HEALTH PROMOTING LIFE STYLES BUT
ALSO FOUND IT IMPROVES
HEALTHCARE PROVIDER WELL BEING
WITH NON-CLINICAL SETTING AND
HAVE PUBLISHED THESE TYPES OF
WORK.
AGAIN AS WE THINK ABOUT PANDEMIC
AND THE DOUBLE PANDEMIC OF
HEALTHCARE PROVIDERS BURN OUT,
THESE TYPES OF INTERVENTIONS ARE
GOING TO BE CRITICAL.
SO FINALLY, REALLY THIS IS THE
-- I THINK REALLY WE THINK ABOUT
THIS IN A HEALTHCARE SYSTEM WHAT
WE NEED TO DO IS TEACH CONTINUE
TO ASK OPEN ENDED NON-JUDGMENTAL
QUESTIONS ABOUT USE OF
INTEGRATED HEALTH, YOU WILL
CURLY SENSITIVE AND APPROPRIATE
QUESTIONS -- CURL CHURLLY
SENSITIVE AND APPROPRIATE
QUESTIONS, USING EXPECTATIONS
AND UNDERSTANDING THEM FOR
INTEGRATED MEDICINE.
WE WANT TO MAKE SURE THESE ARE
INTEGRATED NOT AS INDEPENDENT
SYSTEMS WHERE PEOPLE OPERATE
SEPARATELY OR WHERE THERE IS A
QUOTE UNQUOTE PHYSICIAN LEAD
THAT ONLY PHYSICIAN GETS TO DO
IT BUT THINK OF
INTERPROFESSIONAL MODEL THAT IS
COLLABORATIVE IN NATURE AND HAS
PATIENT CENTERED CARE FOCUS.
>> TWO MINUTES.
>> SO TO FINISH, REALLY WE
WANTED TO BE CAREFUL ABOUT NOT
-- IF WE HAVE A MISA APPLIED
MODEL THE FOCUS ON HEALING WHEN
CURE IS MORE APPROPRIATE FAILING
TO CURE THE CURABLE AND AGAIN,
THAT IS ONE THING COMPLICATES
THE INTERVENTIONS.
AND WASTES RESOURCES AN LIVES
BUT ULTIMATELY WHAT WE ARE
TALKING ABOUT HERE IS WHEN
PEOPLE FOCUS ON CURING WHEN
HEALING IS MORE APPROPRIATE AND
IN THIS -- IF WE DO THIS IT ENDS
UP DEPERSONALIZING INTERACTION
FAVORING SCIENCE OVER VALUES AND
DISENFRANCHISING THE PATIENT.
SO INTEGRATIVE HEALTH MEDICINE
FILE CONTINUOUS HEALTH HEALING
RELATIONSHIPS CUSTOMIZATION
BASED ON PATIENT NEED AND
VALUES.
THE PATIENT IS SOURCE OF
CONTROL, EVIDENCE BASED DECISION
MAKING AND SHARED KNOWLEDGE FREE
AND FULL OF INFORMATION.
SO I WILL PAUSE THERE AND WE
WILL WELCOME DISCUSSION LATER
ON.
>> OKAY.
THANK YOU, VERY MUCH, DR. MEHTA,
VERY INTERESTING.
OUR NEXT PRESENTER IS DR. LISA
MASINTER.
>> HELLO, THANK YOU FOR HAVING
ME, I WILL SHARE MY SCREEN SO
BARE WITH ME.
>> THANK YOU SO MUCH, HONOR TO
BE HERE, MY NAME IS LISA
MASINTER AND I WANT TO SAY I
DEFINITELY STAND HERE ON BEHALF
OF A LARGE GROUP OF
COLLABORATIVE EFFORT LOCATED
HERE IN CHICAGO AS A PLEASURE
AND JOY TO SHARE THE WORK THAT
WE HAVE BEEN ABLE TO DO.
I WILL GIVE BACKGROUND WHERE
WHAT WE ARE DOING WHO WE ARE,
OVERVIEW AND SHOG SHYING
COLLABORATIVE MATERNAL HEALTH
WITH TOUCHING BASE ON CHALLENGES
IN THIS EFFORT.
SO AGAIN A LITTLE BACKGROUND AND
INTRODUCTION TO WHY WE WERE
INVITED HERE.
ALLIANCE CHICAGO IS A HRSA
FUNDED NETWORK OVER 70 SAFE ANY
NET CENTERS FEDERALLY QUALIFIED
HEALTH CENTERS FOR COMMUNITY
HEALTH CENTERS SPANNING 20
STATES YOU CAN SEE THE
DISTRIBUTION ACROSS THE COUNTRY
HEALTH CENTERS ACROSS THE
PARTNERSHIP.
WE PROVIDE A COMMON
INFRASTRUCTURE WITH MANY HEALTH
CENTERS RECEIVING ELECTRONIC
HEALTH RECORD WE SUPPORT ON THE
FRONT END.
ON THE BACK END GIVES ABILITY TO
COLLECT DATA IN ELECTRONIC DATA
WAREHOUSE WE HAVE DATA
REPRESENTING OVER 3 HILL PATIENT
LIVES IN OUR DATA WAREHOUSE.
AND WHAT I WANT TO SAY IS THE
REASON WHY I'M IN ALLIANCE
CHICAGO IS TO WORK ON THE FRONT
LINES AND SUPPORT THE FRONT LINE
PROVIDERS IN THESE COMMUNITY
HEALTH SETTINGS TO LEVERAGE DATA
TO IMPROVE OUTCOMES TORR
PATIENTS THAT SEEK CARE IN THE
SAFETY NET.
FOR THOSE THAT ARE NOT FAMILIAR
WITH FQHCs THESE ARE FEDERALLY
FUNDED CLINICS IN AREAS OF
HIGHEST NEED ACROSS THE COUNTRY.
THEY PROVIDE COMPREHENSIVE
SERVICES AND OPEN TO ALL
PATIENTS REGARDLESS OF ABILITY
TO PAY.
ONE INTERESTING THING ABOUT
FEDERALLY QUALIFIED HEALTH
CENTERS IS GOVERNING BODY AND
BOARDS CONSIST OF PATIENTS THAT
REPRESENT DECISION MAKERS IN
THESE CLINICS.
THE MOST RECENT ESTIMATE PUTS
FQHCs ACROSS THE COUNTRY SERVE
CLOSE TO 30 MILLION PATIENTS.
SO IT IS A VAST HEALTH CENTER
MODEL AND PLACE I'M PROUD TO
HAVE PRACTICE MEDICINE IN SINCE
I GRADUATED FROM RESIDENCY.
A BIT ABOUT ME, I WORK IN
ALLIANCE CHICAGO AS THE SENIOR
DIRECTOR OF RESEARCH ALSO
GENERAL OBGYN AS MENTIONED
BEFORE AND SEE PATIENTS IN
PARTNER HEALTH CENTERS IN
CHICAGO AND HA IS WHERE I WAS
THIS MORNING. SO ZOOMING IN ON
CHICAGO ONE THING WE THINK ABOUT
A LOT ARE THE HEALTH DISPARITIES
THAT WE HAVE IN OUR CITY.
THIS WAS A STUDY IN 2019 AND
MADE THE LOCAL NEWSPAPER IN
MAINSTREAM NEWS ABOUT THE REAL
GAP IN HEALTH OUTCOMES FOR
RESIDENTS THROUGHOUT THE CITY.
THIS WAS A 30 YEAR DIFFERENCE IN
LIFE SPAN.
THIS WAS USING DATA FROM CDC
DEATH BY 2020 AND 2015 COMMUNE
TEARIA IN CHICAGO.
FURTHER STUDIES SHOW THIS AND WE
KNOW ACROSS THE CITY THERE ARE
TREMENDOUS HEALTH DISPARITIES.
FROM 2012 TO 2017 THE LIFE
EXPECTANCY GAP BETWEEN BLACK
RESIDENTS AND NON-BLACK GREW SO
THERE IS WORK TO BE DONE IN
LOCAL AREA IN CHICAGO IN TERMS
OF HEALTH EQUITY.
WHEN WE TALK ABOUT MATERNAL
MORTALITY WHICH SAN AREA
MATERNAL MORTALITY PREVENTION I
THINK ABOUT ALL THE TIME, THE
STATISTICS MIRROR GENERAL
MORTALITY STATISTICS THAT I JUST
SHARED.
STATE OF ILLINOIS PUBLISHES A
REPORT ANNUALLY AROUND MATERNAL
MORBIDITY AND MORBIDITY IN THE
STATE AND 2021 REPORT BASED ON
DATA FROM 2016 AND 2017.
WHAT THEY FOUND WAS THAT WHEN
YOU ARE THINKING -- LOOKING AT
THE RATES OF PREGNANCY RELATED
MORTALITY DUE TO MEDICAL CAUSES,
CHICAGO HAS HIGHEST RATE IN THE
STATE, CHICAGO AREA, LIKEWISE A
LARGE DISPARITY AGAIN BETWEEN
BLACK INDIVIDUALS AND WHITE
PATIENTS.
LIKEWISE THERE IS A MEDICAL
COVERAGE DISPARITY WITH PATIENTS
RECEIVING MEDICAID MORE LIKELY
TO DIE THAN THOSE WITH PRIVATE
COVERAGE.
WHAT IS IMPORTANT TO NOTE IN
TERMS OF THINKING MATERNAL
MORTALITY IS IN ILLINOIS AND
LIKEWISE NATIONAL DATA ARE
STARTING TO SHOW THAT A LOT OF
THE DEATH ARE ACTUALLY HAPPENING
OUTSIDE AND AFTER PATIENTS GO
HOME AFTER BIRTH.
SO THE MOST RECENT DATA IN
ILLINOIS SHOW THAT ABOUT 63%
DEATH POSTPARTUM AND 33 PERSES
HAPPENING AFTER TWO MONTHS
POSTPARTUM.
ACROSS THE BOARD MAJORITY OF
DEATH ARE PREVENTABLE.
THERE IS A LOT OF EFFORT PUT
INTO MATERNAL MORTALITY
PREVENTION AND REDUCTION EFFORTS
IN THE HOSPITAL SETTING BUT
THESE DATA SUGGEST WE NEED TO BE
BROADENING OUR PERSPECTIVE AND
LOOKING AT COMMUNITY BASED
EFFORTS TO SUPPORT PATIENTS
AFTER PREGNANCY.
TO PROMOTE HEALTH AND PROMOTE --
PREVENT MORTALITY.
WHAT ARE WE DOING AND WHY AM I
HERE?
IN 2019 THIS PARTNERSHIP OF
BROAD ARRAY OF ORGANIZATIONS
SUBMIT PROPOSAL THAT WE ARE
GRATEFUL WAS FUNDED TO THE MERCK
SAFER CITIES FOR CHILD BIT.
WE FORMED THE CHICAGO
COLLABORATIVE WITH MATERNAL
HEALTH WITH CHICAGO ALLIANCE AND
OUR COLLEAGUES AT EVERY THRIVE
ILLINOIS BEING LEAD ORGANIZES TO
TAKE THIS EFFORT FORWARD ON
BEHALF OF THE STAKEHOLDERS
THERE.
BROADLY, WE ENVISION CHICAGO
WHERE ALL PEOPLE IN COMMUNITIES,
THRIVE BECAUSE HEALTHCARE
PROVIDERS POLICY MAKERS
COMMUNITY ORGANIZATIONS
INDIVIDUALS AND FAMILIES PARTNER
WITH INTENTION TO IMPROVE
MATERNAL HEALTH.
THIS EFFORT HAS THREE MAIN AIMS
AND TODAYLY FOCUS ON ONE WHICH
IS THE AIM ALLIANCE CHICAGO AND
NETWORK OF FQHCs ARE WORKING
ON BUT WHAT WE ARE DOING IS WE
DEVELOPED A QI COLLABORATIVE FOR
AMBULATORY CARE PROVIDERS
FOCUSED ON BEST PRACTICE
MATERNAL HEALTH FOR SYSTEMS AND
CULTURE CHANGE.
OUR PARTNERS AT EVERY THRIVE
ILLINOIS STATE ADVOCACY MATERNAL
HEALTH COMMUNITY EDUCATION AND
COMMUNITY ENGAGEMENT
ORGANIZATION ARE DOING A
COMMUNITY ENGAGEMENT EFFORT AS
WELL AS POLICY EFFORT BUT FOR
PURPOSES OF TODAY I WILL FOCUS
ON AIM 1.
THIS GIVES AN IDEA OF THE
STRUCTURE OF THE COLLABORATIVE
THAT WE DEVELOPED AND AGAIN
TODAY I WILL FOCUS ON THE
QUALITY IMPROVEMENT SUBCOMMITTEE
WHICH OUR TEAM AT ALLIANCE
CHICAGO IS SUPPORTING.
THIS GIVES AN IDEA OF ACTIVITIES
WE HAVE TAKEN ON TO DATE.
WE STARTED BY IDENTIFYING AND
WORKING WITH A GROUP OF
STAKEHOLDERS WHO CAMING TO TO
WANT TO ENGAGE MANY THE QUALITY
IMPROVEMENT EFFORT TO IDENTIFY
WHAT WE WANTED TO DO, WE WANTED
TO DO A NEEDS ASSESSMENT AND
ENSURE THAT WHATEVER WE TAKE ON
WE ARE NOT BRINGING TO PARTNERS
BUT ALLOWING PARTNERS TO CHOOSE
AS WELL AS DEVELOPING COMMITTEE
OF STAKEHOLDERS, ONCE WE HAD A
TOPIC TAKE ON DO LITERATURE AND
UNDERSTAND WHAT EVIDENCE MIGHT
BE OUT THERE IN TERMS OF WHAT WE
CAN DO AND DECIDE WHAT ARE WE
GOING TO DO.
WE DEVELOP A PROTOCOL WE ARE
FINISHING NOW WITH SITES,LY GET
INTO THE DETAILS MORE, STARTING
TO EVALUATE THE PROTOCOL WE
DEVELOPED AND WE ARE THINKING
ABOUT NEXT STEPS SUSTAINABILITY
BEYOND THIS FIRST EFFORT.
THIS SLIDE I WANT TO SHOW THAT
WE AT THE BEGINNING BROUGHT
TOGETHER A GROUP WE HAD 13
AMBULATORY CARE SITES THAT
WANTED TO PARTICIPATE AS MANY OF
YOU MIGHT IMAGINE GETTING PEOPLE
WHO WANT TO PARTICIPATE IN ANY
INTERVENTION ESPECIALLY DURING
COVID IS INCREDIBLY CHALLENGING.
IF YOU ARE THINKING ABOUT
RELATIVELY RESOURCE POOR
ORGANIZATIONS LIKE FEDERALLY
QUALIFIED HEALTH CENTERS THAT
ARE STRAPPED, TO GET THEM TO THE
TABLE IN OUR OPINION AS EVEN
BIGGER ACCOMPLISHMENT SO WE ARE
PROUD THAT 13 STAKEHOLDERS CAME
TOGETHER TO THINK HOW TO DO THIS
HOW TO IMPLEMENT THIS AND DECIDE
WHAT TO DO.
THIS SLIDE SHOWS WE HAD
BASICALLY A SURVEY AT THE
BEGINNING TO WORK WITH ALL OF
OUR DIFFERENT STAKEHOLDERS, WHAT
ARE THE THINGS WE WANT TO WORK
ON, WHAT WE WANT TO TAKE ON AND
THE ONE WITH THE STAR WHICH IS
WHAT WE FOCUSED ON OVER THE LAST
YEAR, WHAT I WILL SHARE ABOUT
TODAY IS TOPIC QUALITY
IMPROVEMENT INITIATIVE WE CAME
UP WITH P AMONG PATIENT WITH
HIGH RISK MEDICAL PREGNANCY TO
LINK THEM TO BACK TO PRIMARY
CARE PROVIDER MEDICAL HOME AFTER
THE POSTPARTUM PERIOD, THE
IMMEDIATE POSTPARTUM PERIOD
ENDS, MANY KNOW THAT PEOPLE COME
AFTER BIRTH, RECOMMENDED TO BE
SEEN AS POSTPARTUM VISIT BY SIX
WEEKS AND NOW THERE IS EARLY ONE
RECOMMENDED AS WELL.
WHAT ARE PARTNER FOUND AND SHARE
ANECDOTALLY AS CLINICIAN AND WE
DO HAVE FAIRLY GOOD RETENTION
FOR THOSE POSTPARTUM VISITS BUT
IT IS AFTER THAT FOR THE
PATIENTS THAT HAVE HIGH RISK
MEDICAL CONDITIONS WE WANT THE
GET BACK INTO MEDICAL CARE AND
PREVENTIVE CARE, WE DON'T KNOW
IF THEY ARE FOLLOWING UP.
THIS IS WHAT OUR COLLEAGUES
WANTED TO WORK ON, SEVERAL OTHER
POSTPARTUM INITIATIVES WERE
IDENTIFIED, THEY ARE ALL IN THE
BOX THERE.
THAT YOU CAN SEE.
SO THOSE THE POSTPARTUM PERIOD
WAS WHAT THE FOCUS OF THIS
EFFORT WAS GOING TO BE.
THIS IS WHAT WE CALL OUR KEY
DRIVER DIAGRAM WITH GLOBAL AIM
TO IMPROVE NUMBER OF PATIENTS
WITH PREGNANCIES COMPLICATED BY
MEDICAL CONDITIONS WHO WERE
LINKED TO PRIMARY CARE OR
MEDICAL HOME WITHIN SIX MONTHS.
THAT IS WHAT WE DECIDED TO DO.
ALL THINGS TO THE RIGHT INCLUDE
MEASURES FOLLOWING OVER THE
COURSE OF THE INTERVENTION BUT
THE ONE HIGHLIGHTED IN YELLOW IS
AGAIN BOTTOM LINE METRIC WE ARE
LOOKING AT AS PERCENT OF
PATIENTS LINKED TO PRIMARY CARE
PROVIDER OR BACK INTO THE
MEDICAL HOME.
SIX MONTHS AFTER POST DELIVERY.
AS I MENTIONED BEFORE 13 SITES
CAME TO TABLE TO TALK TO US TO
HELP US THINK ABOUT WHAT WE WERE
GOING TO DO.
SIX AMAZING SITES THAT FORM THE
PARTNERSHIP TO TAKE ON THIS
WORK.
AND TAKE A LOOK AT PERCENTAGES
AND SEE IF WE CAN MOVE THE
NEEDLE IN TERMS OF KEEPING
PEOPLE ENGAGED IN CARE.
WHEN WE TALK ABOUT WHAT WE ARE
GOING TO DO, WE HAVE TO THINK
THROUGH WHAT WE HAVE CHOSEN TO
DO IS WE WANT PRIORITIZE HEALTH
SERVICES TO BE RECEIVED IN THE
POSTPARTUM PERIOD WITH BOLDED
ONE BEING ONE WHO WANTED TO
FOCUS ON FOR THIS FIRST
INITIATIVE.
SO HOW ARE WE GOING TO DO THIS.
MANY SMALLER GROUP OF THREE
HEALTH CENTERS CAME TO SUPPORT
DETERMINING THAT WHAT WAS OUR
APPROACH GOING TO BE.
WHAT WE ENDED DECIDING IS
APPROACH WOULD BE A POPULATION
HEALTH INTERVENTION MEANING WE
WERE GOING TO DEVELOP
ESSENTIALLY A REGISTRY OR LIST
OF ALL THE PATIENTS AT
PARTICIPATING SITES THAT WANT TO
TAKE PART IN THIS INITIATIVE WHO
THEIR HIGH RISK PATIENTS WERE.
WE WORK WITH THE SITES TO NUMBER
ONE WE HAVE TO FIGURE OUT WHO
WERE THE PATIENTS THEY WANTED TO
FOLLOW AND NUMBER TWO WE WANT TO
DETERMINE HOW, HOW ARE WE GOING
TO FOLLOW THE PATIENTS, WHAT WAS
THE MECHANISM WHICH WE WERE
GOING TO KEEP TRACK OF THEM.
WHO WAS KEEPING TRACK, WHO WAS
COMMUNICATING WITH THEM BECAUSE
THIS IS A CASE MANAGEMENT
INTERVENTION WHEREBY SOMEBODY IS
FOLLOWING THESE PATIENTS
CONNECTING WITH THEM AND MAKING
SURE FACILITATING THEY GET BACK
INTO CARE.
THIS JUST DEMONSTRATES WHAT WE
DID WITH THE SIX PARTICIPATING
SITES THAT WE ARE WORKING WITH,
WE WORK WITH THEM TO IDENTIFY
WHAT ARE THE HIGH RISK CRITERIA
FOR THE PATIENTS THAT YOU WOULD
WANT TO MOST PRIORITIZE FOR
COMING BACK TO THE MEDICAL HOME.
YOU CAN SEE ALL THE SITES WANTED
TO WORK WITH PATIENTS WITH
DIABETES OR GESTATIONAL
DIABETES.
LARGE MAJORITY WANTED TO WORK
WITH HYPERTENSION PREECLAMPSIA.
SOME HAD OTHER ADDITIONAL HIGH
RISK CONDITIONS INCLUDING BEING
TRANSFERRED OUT TO A HIGH RISK
OB PROVIDER AND A THIRD SITE
WANTED TO WORK AND FOLLOW
PATIENTS WHO HAD DEPRESSION.
PROGRESSION OF COLOR IS PROCESS.
OVER TO THE LEFT WE FOLLOWED THE
PROCESS AND WANTED TO SHOW HERE
AND WHAT WE ARE TRACKING IS
BEGINNING OF THIS INITIATIVE
NONE OF OUR SITES WERE FOLLOWING
OR HAD ANY PROCESS IN PLACE TO
COORDINATE CARE FOR PATIENTS TO
MEDICAL HOME AFTER HIGH RISK
PREGNANCY.
AND WE WERE PROUD TO SAY BY
OCTOBER ALL OUR SITES HAD
PROCESS IN PLACE.
IT IS A JOURNEY WITH OUR SITES
TO WORK THROUGH THIS POPULATION
HEALTH PROCESS BUT THEY ARE ALL
MOVING ON ALL CYLINDERS NOW.
MORE PROCESS MEASURES TO SHOW
THE NUMBER OF STAFF TRAINED
ACROSS THE SIX ORGANIZATIONS
THAT WERE WORKING WITH AND THE
NUMBER LLC MEANS LOCATION OF
CARE, HOW MANY INDIVIDUAL
CLINICS SITES IN CITY OF CHICAGO
ARE IS THIS INTERVENTION TAKING
PLACE, ONE THING THAT I WANT TO
KNOW ABOUT OUR PARTNER SITES IS
THAT IN 2020 ACROSS THESE SITES
THESE ORGANIZATIONS SAW OVER
12,000 PRE-NATAL PATIENTS IN
EACH OF THESE SITES ARE LOCATED
IN NEIGHBORHOODS IN CHICAGO WITH
HIGHER RISK OF ADVERSE PERINATAL
OUTCOMES.
THIS SHOWS PROGRESS ON MAIN
OUTCOME.
WHAT YOU SEE TO LEFT OF PURPLE
LINE IS BASELINE PERCENT OF
PATIENTS IDENTIFIED HIGH RISK IN
EACH DIFFERENT SITES THAT WERE
DOCUMENTED IN THE YEAR 2020 TO
HAVE BEEN RECONNECTED TO A
PRIMARY CARE VISIT AFTER THE
POSTPARTUM PERIOD.
DEFINE THE TIME LINE WE WERE
FOLLOWING WAS SIX MONTHS.
ONCE WE STARTED THE INITIATIVE
YOU CAN SEE OVER TIME WE MORE
THAN DOUBLE NUMBER OF PATIENTS
IN THIS EFFORT RECONNECTED AND
HAD A VISIT WITH THE PRIMARY
CARE PROVIDER AROUND THEIR
PREVENTIVE HEALTH OPTIMIZATION
FOR THEIR CHRONIC CONDITION.
BECAUSE OF THE FINDING WE HAD OR
ANECDOTAL FINDING THAT WE
THOUGHT PATIENTS WERE DROPPING
OFF BETWEEN POSTPARTUM VISIT AND
PRIMARY CARE VISIT, WE WANTED TO
DO A SECONDARY DATA ANALYSIS,
USING THE DATA WAREHOUSE THAT I
MENTIONED HAS THREE MILLION
LIVES.
WHAT WE LOOK AT IS WHAT WAS
HAPPENING ACROSS ALL THE SITES
FOR WHOM ALLIANCE CHICAGO HAS
DATA.
WERE PATIENTS COMING BACK TO
PRIMARY CARE SIX MONTHS
POSTPARTUM IF THEY WERE HIGH
RISK AND PREDICTORS WESTERN
LOOKING AT IS HIGH RISK STATUS
IF THEY LOST INSURANCE AFTER 12
WEEKS POSTPARTUM, AND WE USE A
METRIC OF ENGAGEMENT AND CARE
WHETHER ENGAGED IN CARE
PRE-PREGNANCY, THEY STARTED THIS
PREGNANCY IN FIRST TRIMESTER AND
OR IF THEY WENT TO POSTPARTUM
VISIT.
WE DID UNADJUSTED AND ADJUSTED
ANALYSES.
WHAT WE FOUND LARGER COHORT OF
OVER 7,000 PATIENTS WAS THAT
ABOUT 85% DOCUMENTED POSTPARTUM
VISIT BUT AS SUSPECTED THAT
DROPPED OFF TREMENDOUSLY WITH
17% FOLLOWING PRIMARY CARE
VISIT.
RISK INSURANCE LOSS OF
ENGAGEMENT WERE PREDICTORS OF
PRIMARY CARE VISIT WITH
INSURANCE LOSS BEING NEGATIVELY
ASSOCIATED.
THEN AGAIN, EVEN AMONG THE HIGH
RISK COHORT WE LIMITED THE
COHORT TO JUST THE ONE -- UNDER
2000 PATIENTS WHO MET HIGH RISK
CRITERIA AND ONLY 25% PATIENTS
WENT TO PRIMARY CARE VISIT.
WHAT THESE LARGER DATA SHOW PLUS
OUR DATA FROM OUR PILOT IN
ANECDOTALLY AS A CLINICIAN IS
MAJORITY OF PATIENTS DON'T MAKE
THAT TRANSITION AND THAT HAPPENS
EVEN AMONG HIGHEST RISK PATIENTS
AND WHILE INSURANCE LOSS
CONTRIBUTES WE KNOW THAT
INSURANCE LOSS ALONE ISN'T THE
ONLY THING AT PLAY AND EVEN WITH
PATIENTS WHO HAD INSURANCE THEY
STILL HAVE -- HAD OR STABLE
INSURANCE THEY HAD LOW RATES OF
POSTPARTUM UTILIZATION OF
PRIMARY CARE PROVIDER.
KEY MILESTONES WHAT I WOULD SAY
ARE SUCCESSES IS THAT WE BROUGHT
TOGETHER A ROBUST COLLABORATIVE
OF VOLUNTARY PARTICIPATION OF
FQHCs AND AMBULATORY CARE
CENTERS WHO CAME TOGETHER TO
WORK WITH US TO DEVELOP THIS
PROTOCOL WE HAD SIX SITES THAT
CAME TO THE TABLE RARING TO GO
TO IMPLEMENT AND WE ARE PROUD OF
THE WORK THEY HAVE DONE, THEY
HAVE TAKEN THIS WORK, THEY ARE
THE ONES DOING CASE MANAGEMENT,
WE DEVELOPED AN EHR ALGORITHM TO
IDENTIFY AND TRACK HIGH RISK
PATIENTS USED TO CREATE THE
COHORT AND BUILD POPULATION AS
WELL AS USE IN OUR EHR SECONDARY
DATA ANALYSIS.
WE ARE IN THE PROCESS OF
DISSEMINATION OF DATA AND
FINALIZING EVALUATION AND
SUSTAINABILITY ONGOING.
THE L CHALLENGES HAVE BEEN
VARIATION ELECTRONIC HEALTH
RECORD DOCUMENTATION, OBVIOUSLY
RESOURCES AND CAPACITY AND
RECOGNIZING THAT WE ARE VISITING
TESTING WHETHER VISIT ACTUALLY
HAPPENED AND WE NEED TO START
DIVING INTO THE QUALITY OF THOSE
VISITS, PATIENT EXPERIENCE AND
OTHER METRICS EQUALLY AS
IMPORTANT AND UNDERSTAND WHY
PATIENTS MIGHT DROP OUT OF CARE.
SO WITH THAT I WANT TO MAKE A
QUICK ACKNOWLEDGMENT FOR STAFF
AT ALLIANCE CHICAGO.
I HAVEN'T READ THE PERSON WHO IS
MY RIGHT HAND AND I COULDN'T DO
THIS WITHOUT HER, SHE IS DRIVING
THIS BUS.
SHE IS ON HERE TODAY AND I
PUBLICLY THANK HER FOR ALL
AMAZING WORK SHE'S DONE.
THESE ARE PARTNER ORGANIZATIONS
AND JUST TO GIVE OUR THANKS TO
MARK FOR MOTHERS FOR SUPPORT TO
DO THIS.
THESE ARE SOME OF THE SOURCES
FOR THE THINGS THAT I MENTIONED
EARLIER AND I THANK YOU AND WISH
Y'ALL A VERY HAPPY HOLIDAY
SEASON.
I WILL PASS IT ON TO THE NEXT
SPEAKER.
THANK YOU.
>> THANK YOU, DR. MASINTER.
NEXT IS DR. RACHEL CHAMBERS.
PASSING IT TO YOU.
>> SHARE MY SCREEN HERE.
SORRY ABOUT THAT.
SORRY.
CAN EVERYBODY SEE MY SCREEN?
>> LOOKS GOOD.
>> WONDERFUL.
BEFORE I START I WANT TO DO A
LAND ACT KNOW LENG.
, JOHNS HOPKINS CENTER FOR
AMERICAN INDIAN HEALTH.
JOHNS HOPKINS IS IN BALTIMORE
MARYLAND AND I STAY MYSELF IN
MADISON WISCONSIN SO IN THE
SPIRIT OF HEALING I HONOR THE
NATIONS THE ORIGINAL PEOPLE OF
THE LAND WHICH JOHNS HOPKINS
UNIVERSITY OCCUPIES THE ORIGINAL
PEOPLES OF THE LAND I SIT TODAY
IN MADISON, WISCONSIN.
WE GIVE THANKS TO THE PAST
PRESENT AND FUTURE STEWARDS OF
THE LAND AND RESPECT TRIBAL
NATION SOVEREIGNTY AND RIGHT TO
SELF-DISCRIMINATION.
WE AIM TO HOLD OURSELVES
UNIVERSITY COMMUNITY ACCOUNTABLE
TO TRIBAL NATIONS.
WITH THAT MY NAME IS RACHEL
CHAMBERS.
I AM ASSISTANT SCIENTIST AT
JOHNS HOPKINS SCHOOL OF PUBLIC
HEALTH IN THE INTERNATIONAL
HEALTH DEPARTMENT AND I SIT
WITHIN A CENTER HOUSEDDE HOUSEDDED IN THE
INTERNATIONAL DEPARTMENT OF
HEALTH CALLED THE JOHNS HOPKINS
CENTER FOR AMERICAN INDIAN
HEALTH. I WANT TO TALK A LITTLE
BIT ABOUT THE CONTINUUM OF CARE
SPECIFICALLY ONE PROGRAM THAT
ADDRESSES CERTAIN TIME OF LIFE
BUT I WILL TALK ABOUT OUR CENTER
AND HOW IT WORKS ACROSS THE
CONTINUUM OF CARE.
SO WHEN WE THINK WOMEN'S HEALTH
IT IS IMPORTANT TO THINK ABOUT
NOT ONLY REPRODUCTIVE HEALTH
YEARS BUT STAGES OF LIFE AND
EACH CONTRIBUTE TO CYCLE OF
GROWTH OUTCOMES AND IMPORTANCE
OF INTERVENING ACROSS THE LIFE
CYCLE.
SO HERE WE HAVE SOME HEALTH
RELATED OUTCOMES HOW THEY FEED
INTO EACH OTHER ACROSS THE LIFE
CYCLE SO NOT BEING PREPARE FORD
PREGNANCY ADOLESCENT MAY LEAD TO
LATE PRE-NATAL CARE.
THIS IS TRUE ACROSS DIABETES AND
OBESITY SO THERE IS A LOT OF
RESEARCH ABOUT THE TRANSFER OF
OBESITY AND DIABETES ACROSS THE
GENERATIONS SO THIS IS JUST A
CYCLE ACROSS ONE GENERATION TO
THE NEXT ACROSS PERSON'S LIFE
SPAN, OPHIDIANS OVERWEIGHT AND
PREGNANCY AND OFTEN LEADS TO
HIGH BIRTH WEIGHT, THAT LEADS TO
LATER OBESITY, OBESITY DIABETES
AND AGAIN DIABETES OVERWEIGHT
AND PREGNANCY.
SO AT THE CENTER WE THINK ABOUT
EACH STAGE OF OUR LIVES AND HOW
WE CAN INTERVENE IN EACH STAGE
TO IMPROVE REPRODUCTIVE HEALTH
OUTCOMES AND IMPROVE DIABETES
OBESITY PROVIDED OUTCOMES.
SO WACK GROUND ON NATIVE
AMERICAN POPULATIONS, WE ARE
GENERALIZING I WORK PRIMARILY
WITH TRIBAL COMMUNITIES IN SOUTH
WESTERN UNITED STATES.
SO THESE STATISTICS ARE
NATIONWIDE BUT I WANT TO
RECOGNIZE THAT THERE IS A BIG
DIFFERENCE TRIBAL NATION ARE NOT
ALL THE SAME AND TRIBAL PEOPLE
ARE NOT ALL THE SAME.
BUT OVERALL NATIVE AMERICAN VIEW
SO WITH THE YOUTH ADOLESCENCE
PRE-CONCEPTION NATIVE AMERICAN
YOUTH HAVE HIGHEST TEEN BIRTH
WEIGHT, ALSO HAVE SUFFER FROM
HIGH BURDEN OF CHLAMYDIA
GONORRHEA AND OTHER SEXUALLY
TRANSMITTED INFECTION.
LESS LIKELY TO USE CONTRACEPTION
COMPARED TO NON-HISPANIC WHITE
POPULATION.
IN ADDITION TO THESE SEXUAL
HEALTH DISPARITIES WE HAVE THIS
DIABETES AND OBESITY DISPARITIES
GOING ON SO NATIVE YOUTH HAVE
HIGH PREVALENCE OF TYPE 2
DIABETES AND OBESITY WHEN
COMPARED TO OTHER RACIAL ETHNIC
GROUPS.
SO NOW LOOKING AT PREGNANCY AND
MATERNAL HEALTH AND THESE ARE
JUST STATISTICS, ALL OF THEM BUT
SO NATIVE WOMEN ARE MUCH LESS
LIKELY TO RECEIVE PRE-NATAL CARE
AT ALL OR MORE LIKELY TO RECEIVE
PRE-NATAL CARE LATER IN
PREGNANCY.
THEY ARE ALSO THREE TO FOUR MORE
TIMES LIKELY TO DIE DURING
CHILDBIRTH, OF COMPLICATIONS
DURING CHILDBIRTH.
IN ADDITION TO THAT, THERE ARE
ALSO MUCH MORE LIKELY TO BE
DIAGNOSED WITH GESTATIONAL
DIABETES AND DIAGNOSED WITH
GESTATIONAL HYPERTENSION SO WE
HAVE THESE REPRODUCTIVE HEALTH
DISPARITIES GOING ON SUCH AS
PRE-NATAL CARE AND WE HAVE SOME
OBESITY DIABETES OUTCOME
DISPARITIES GOING ON.
INFANT HEALTH AMERICAN INDIANS
HAVE TWICE INFANT MORTALITY
RATE, AS NON-HISPANIC WHITES,
44% LIKELY TO HAVE BASE LOW
BIRTH WEIGHT BUT FLIP SIDE HAVE
GREATER PERCENTAGE OF AMERICAN
INDIAN WOMEN GIRTH BIRTH TO
LARGE FOR GESTATIONAL AGE BABY.
SO DOUBLE BURDEN.
LOW BIRTH WEIGHT AND
MALNUTRITION BUT ALSO HAVE THE
HIGH BIRTH WEIGHT AND
OVERNUTRITION HERE.
SO THAT IS SORT OF WHAT BRINGS
US TO WHAT CENTER HAS BEEN DOING
LATELY AND I WANT TO GIVE A
QUICK BACKGROUND ON WHAT THE
CENTER IS AND WHO WE ARE.
WE WERE FOUNDED BY A DOCTOR IN
1991, HE MOVED -- HE WAS DOING
RESIDENCY IN PEDIATRICS AND
MOVED OUT TO THE APATCHY
RESERVATION AND DID -- APATCHY
AND DID WORK THERE AS
PEDIATRICIAN AND DID RESEARCH
FOR THE TRIBAL COMMUNITIES
THERE, WHO ARE FIVE TO TEN YEARS
AND THEN HE CAME BACK TO HOPKINS
AND SAID WE NEED TO DO SOMETHING
ABOUT SOME OF THESE HEALTH
DISPARITIES IN NATIVE
POPULATIONS SO HE FOUNDED THE
CENTER FOR AMERICAN INDIAN
HEALTH AND YOU CAN READ OUR
MISSION THERE.
THE CENTER NOW HAS THREE CORE
AREAS, WE HAVE A TRAINING ARM,
THE TRAINING ARM IS TASKED WITH
DOING IS HELPING TO RAISE
SELF-SUFFICIENCY AND EDUCATION.
MOST OF NATIVE POPULATIONS.
SO WE PROVIDE SCHOLARSHIPS, TO
NATIVE SCHOLARS, AT HOPKINS AND
OTHER ORGANIZATIONS, WE PROVIDE
INSTITUTE COURSE THAT IS FOCUSED
ON NATIVE HEALTH AND PROVIDE
SUPPORT TO NATIVE PEOPLES
PURSUING BACHELORS DEGREE OR
MASTERS OR DOCTORATE.
WE ALSO HAVE INFECTIOUS DISEASE
PREVENTION ARM WHICH
HISTORICALLY IS FOCUSED MORE ON
PNEUMOCOCCAL DISEASE AND RSV IN
LAST TWO YEARS SHIFTED TO COVID
BUT WE STILL DO OTHER INFECTIOUS
DISEASE ESPECIALLY THOSE THAT
ARE LARGE BURDEN WITH INFANTS
AND BABIES.
WE HAVE BEHAVIORAL HEALTH MENTAL
HEALTH PROMOTION.
THIS STARTED IN EARLY 2000 AS
BURDEN OF DISEASE SHIFTING FROM
MENTAL HEALTH PROMOTION.
THIS IS WHERE THE WORK THAT I DO
IS WORK IS IN REPRODUCTIVE
HEALTH AND SOME WORK ON DIABETES
AND OBESITY.
WE HAVE A WIDE BREADTH OF WORK
IN THIS AREA.
SO THE HEADQUARTERS IS IN BALL
MORE MARYLAND SCHOOL OF PUBLIC
HEALTH, WE HAVE ADMINISTRATIVE
OFFICES IN DULUTH MINNESOTA AND
IN ALBUQUERQUE NEW MEXICO, AND
WE HAVE SITE OFFICES ACROSS THE
SOUTHWEST.
WE EMPLOY 120 PEOPLE AND
MAJORITY ARE NATIVE AND MANY ARE
FROM THE COMMUNITIES IN WHICH
THEY WORK.
SATISFY AT SITES ARE OFTEN FROM
COMMUNITIES.
SO THERE IS THREE ASPECT OF A
MODEL FOR ALL THE WORK THAT WE
DO AT THE CENTER THAT IS
IMPORTANT ESPECIALLY WHEN DOING
RESEARCH WITH TRIBAL COMMUNITIES
AND ONE IS COMMUNITY BASED
PARTICIPATORY RESEARCH.
WE WORK WITH THE TRIBE TO
IDENTIFY WHAT ISSUES ARE SALIENT
FOR THE COMMUNITY AND IDENTIFY
SOLUTIONS TOGETHER AND REALLY
COMMUNITY BASED PARTICIPATORY
RESEARCH IS ABOUT MUTUAL RESPECT
AND MUTUAL TRUST.
AND IS REALLY HELPFUL THAT WE
HAVE STAFF IN THE COMMUNITIES TO
HELP GUIDE THE WORK.
ANOTHER MODEL WE OFTEN USE, NOT
ALL THE TIME BUT IS THE
COMMUNITY HEALTH WORKER MODEL,
COMMUNITY HEALTH WORKERS HAVE A
HUGE ADVANTAGE, THEY UNDERSTAND
THE LOCAL CONTEXT AND BELIEF,
THEY SPEAK A LOT OF THEM SPEAK
THE NATIVE LANGUAGE ESPECIALLY
THE OLDER POPULATION SOME DON'T
SPEAK ENGLISH SO YOU NEED
SOMEONE THERE THAT UNDERSTANDS
THE NATIVE LANGUAGE.
THEY DON'T NEED A FORMAL DEGREE
AND WHILE MORE NATIVE AMERICAN
PEOPLE ARE PURSUING DEGREES AND
BECOMING NURSES AND AND GETTING
OTHER ADVANCE DEGREES IT IS HARD
IN SOME RESERVATION COMMUNITIES
TO FIND PEOPLE WITH DEGREES.
YOU HAVE TO PROVIDE EXTENSIVE
TRAINING AND FOR MOST PROJECTS
WE ALSO PROVIDE MANUALIZED
CURRICULA TO HELP GUIDE
CONVERSATION.
THEN LAST WHICH I SORT OF TALKED
ABOUT IS WE BELIEVE THAT WE DO
IMMEDIATE TO INTERVENE ACROSS
THE LIFE SPAN, THAT ONE -- NOT
ONE PART OF HUMAN LIFE CYCLE IS
NOT NECESSARILY MORE IMPORTANT
THAN ANOTHER.
ESPECIALLY WHEN THINKING ABOUT
ACROSS THE GENERATION.
SO IN MANY POPULATIONS ACROSS
THE U.S. INCLUDING NATIVE
COMMUNITIES, IS REALLY NOT
THINKING ABOUT TODAY, THINKING
ABOUT THE NEXT GENERATIONS GOING
TO DO SO WE WANT OUR WORK TO
THINK ABOUT HOW CAN WE IMPACT
GREAT, GREAT, GREAT
GRANDCHILDREN AND WHERE WE NEED
TO INTERVENE IN ORDER TO STOP
THE CYCLE OF THESE HEALTH
DISPARITIES WE ARE SEEING.
SO THIS IS JUST SOME OF OUR
PROJECTS WE HAVE MANY MORE GOING
ON BUT THE PROJECTS THAT ARE
HIGHLIGHTED IN BLUE FOCUS ON
REPRODUCTIVE HEALTH AND ONES
THAT ARE BOLDED ARE FOCUSED ON
DIABETES OBESITY TYPE OUTCOMES.
SO YOU CAN SEE SOME OF THEM
OVERLAP BOTH.
TODAY I WILL TALK ABOUT FAMILY
SPIRIT WHICH IS PROGRAM THAT IS
FOR PARENTS AND YOUNG CHILDREN.
SO FAMILIES SOME PEOPLE MAY BE
FAMILIAR WITH THIS BUT LARGEST
ONLY EVIDENCE BASED CULTURALLY
TAILORED HOME VISITING IS
INTERVENTION PROGRAM FOR EVERY
NATIVE AMERICAN FAMILIES.
IT IS DELIVERED BY
PARAPROFESSIONALS OR INDIAN
HEALTH SERVICE, OFTEN DELIVERED
BY COMMUNITY HEALTH
REPRESENTATIVES.
IT IS SUPPORT YOUNG NATIVE
PARENTS FROM PREGNANCY TO THREE
YEARS POSTPARTUM.
SO IN THIS PROGRAM HOME VISITORS
TALK ABOUT A SLEW OF TOPICS OVER
63 LESSONS.
A LONG PROGRAM BUT HELPS GUIDE
THESE MOMS FROM LAST TRIMESTER
OF PREGNANCY THROUGH THREE YEARS
AGO CHILDBIRTH.
SO FAMILY SPIRIT HAS HAD GREAT
OUTCOMES WE HAVE DONE RANDOMIZED
CRIMINAL TRIALS OF IT, THESE ARE
OUTCOMES THAT WAS CONSTRUCT
CONDUCT MISDEMEANOR THE LATE
2000s, AND REALLY WE SAW
POSITIVE IMPACT ACROSS THE
PARENTING DOMAIN, MOTHERS
OUTCOME INCLUDING DECREASED
DEPRESSION AND CHILD OUTCOME
INCLUDING SOME OF THESE
IMPORTANT FACTORS THAT WE KNOW
ARE SET THE STAGE FOR AD LESS
DENSE AND LATER HEALTH
DISPARITIES INCLUDING SOCIAL
EMOTIONAL BEHAVIORAL PROBLEMS
THROUGH AGE 3 SO INTERNALIZED
EXTERNALIZING FACTORS BEGIN MUCH
LOWER AMONG THOSE WHO RECEIVED
THE INTERVENTION COMPARED TO
THOSE WHO DIDN'T AT AGE 3.
SO THIS PROGRAM HAS BEEN
REPLICATED IN MANY NATIVE
COMMUNITIES AND IT'S GOT STRONG
EVIDENCE BASE, BASED ON SOME OF
THE FEEDBACK WE RECEIVED FROM
OUR LOCAL COMMUNITIES REALLY
UNDERSTANDING THE LITERATURE
THAT HAS COME OUT OVER DECADE
EVEN LONGER, ABOUT THE
IMPORTANCE OF THIS THOUSAND DAYS
OF LIFE FROM PREGNANCY THROUGH
TWO YEARS AS A CRITICAL POINT
FOR INTERVENING FOR OBESITY
ACROSS THE ENTIRE LIFE SPAN.
YES RECEIVED FUNDING FROM THE
ROBERT WOOD JOHNSON FOUNDATION
TO DEVELOP FAMILY SPIRIT NURTURE
WHICH IS A COMPLIMENT FAMILY
SPIRIT PROGRAM AND FOCUSES ON
CHILDHOOD MALL NUTRITION OBESITY
FOOD AND WATER INSECURITY.
THE RATIONALE BEHIND THIS WHICH
I DESCRIBED IS THAT WE KNOW
CHILDREN WHO ARE INTRODUCE
BEFORE SIX MONTHS ARE MORE
LIKELY TO BE OBESE AT AGE SIX,
WE KNOW THE MORE SERVICE
SWEETENED SUGAR BEVERAGES UNDER
AGE 1 THE MORE LIKELY OBESE
LATER IN LIFE.
WE ALSO KNOW AS I HAD PREVIOUS
SLIDE THAT NATIVE AMERICAN
CHILDREN ARE SUFFERING FROM
HIGHEST RATES OF OVERWEIGH AND
OBESE, IN A STUDY CONDUCTED A
BIT AGO ABOUT 42% NATIVE
PRE-SCHOOLERS WERE OVER WEIGHT.
WE ALSO KNOW THERE ARE KNOWN
RISK AMONG HEALTH AND CHILDREN
SO EARLY INTRODUCTION TO
SWEETENED BEVERAGES AND POOR
FEEDING PRACTICES.
OUR TEAM IN CONSULTATION WITH
SOME EXPERTS AROUND CHILD
FEEDING AND BREAST FEEDING,
SPECIFICALLY RESPONSIVE FEEDING
WITH OUR COMMUNITY PARTNERS, PUT
TOGETHER A PROGRAM THAT WE CALL
FAMILY SPIRIT NURTURE AND TESTED
THROUGH A STUDY THAT WE CALL
PICO 1, THERE IS A # I WON'T
TALK ABOUT TODAY BUT I HAVE MY
CONTACT INFORMATION AND CONTACT
INFORMATION OF A COLLEAGUE IF
YOU WANT MORE INFORMATION ABOUT
PICO 2 A MUCH LONGER
INTERVENTION.
ESSENTIALLY LOOKING AT SIX HOME
BASE LESSONS FOCUSED ON REDUCING
SUGAR SWEETENED BEVERAGE INTAKE
RESPONSIVE FEEDING BREAST
FEEDING COMPARED TO CONTROL
WHICH ARE HOME BASED INJURY
PREVENTION EDUCATION.
THOSE WERE DELIVERED WHEN THE
KIDS WERE 3 TO 6 MONTHS OF AGE
AND THEN WE ALSO DELIVER WATER
FROM SIX TO NINE MONTHS OF AGE.
I WILL SHOW IN ANOTHER SLIDE
WATER IS A SECURITY ISSUE ON
NAVAHO NATION, SOME STUDIES 40%
WATER INSECURE MANY THIS STUDY
MOMS 60% REPORTED THEY ARE WATER
INSECURE.
WE'LL GET TO THAT IN A MINUTE.
FIRST I WANT TO SHOW YOU THE
STUDY DESIGN AND TALK ABOUT THE
FAMILY SPIRIT CURRICULUM LESSONS
THREE TO SIX MONTHS POSTPARTUM,
SO ESSENTIALLY WE RECRUITED MOMS
WHO ENROLLED IN THE STUDY AND
EITHER RANDOMIZE TO INTERVENTION
CONTROL AND WE DID CONTROL FOR
WATER SECURITY STATUS INSECURE
VERSUS SECURE, AND WE DELIVERED
THE INTERVENTION FROM 3 TO 6
MONTHS POSTPARTUM.
FROM SIX TO NINE MONTHS WHEN
KIDS ARE SIX TO NINE MONTHS OF
AGE WE DELIVERED WATER AND
DELIVERED TO EVERYONE TO EVEN
THE PLAYING FIELD.
HERE ARE FOCUS AREAS FAMILY
SPIRIT NURTURE CURRICULUM, WE
TALKED -- WE TRIED TO FOCUS ON
MATERNAL OUTCOMES AND MATERNAL
BEHAVIORS AND BEHAVIORS WITH
THEIR CHILDREN INCLUDING ROUTINE
SO WE KNOW MEALS AND SLEEPING
AND PHYSICAL ACTIVITY IS REALLY
IMPORTANT WITH THESE LITTLE
ONES.
SO INCORPORATING THAT INTO THE
LESSONS.
SO AT THE END OF ONE STUDY
MOTHERS AN INFANTS IN
INTERVENTION GROUP INCREASED
SUGAR SWEETENED INCREASE BREAST
-- INCREASE RESPONSE TO FEEDING
COMPARED TO CONTROL GROUP, THEY
HAD HEALTHIER BMI SCORES
COMPARED TO CONTROL SO I WILL
SHOW SOME I WILL FLY THROUGH
THESE SLIDES BUT THIS IS THE
RESPONSE OF FEEDING SCALE SO
BASELINE IS WHEN KIDS ARE THREE
MONTHS AND THEN THIS IS THREE TO
SIX MONTHS SO WE SAW IMPROVEMENT
IN RESPONSE TO FEEDING AMONG THE
INTERVENTION GROUP AND CONTROL
GROUP WENT DOWN AND AT SIX TO
NINE MONTHS IT WAS SIGNIFICANT
BUT WE ARE TAPERING -- HAVE A
TAPERING EFFECT AT 12 MONTH TIME
POINT.
BEALSO SAW LONGER BREAST FEEDING
DURATION.
87% MOMS INITIATED BREAST
FEEDING AND BREAST FEEDING AND
RATES WERE COMPARABLE BETWEEN
STUDY GROUP AND RAPID DECLINE IN
THOSE WHO ARE IN THE CONTROL
GROUP.
LONGER DURATION IN THE
INTERVENTION GROUP.
AND THEN WE HAVE INFANT SSV
SUGAR SWEETENED BEVERAGE
CONSUMPTION AND YOU CAN SEE HERE
THE CONTROL SLOWLY INCREASES
WITH THE BIG SPIKE AT 12 MONTHS,
INTERVENTION STAYS A LITTLE BIT
LOWER.
WE SAW DECREASE CHILDHOOD
OBESITY, ON AVERAGE KIDS IN THE
CONTROL GROUP WERE STARTING TO
REACH THAT 85TH PERCENTILE AT
YEAR OF LIFE WHEREAS
INTERVENTION GROUP IS LITTLE
FURTHER DOWN HERE.
WE HAVE SSB INTAKE AMONG THE
MOMS AND WITH THE CONTROL GROUP
AND INTERVENTION THEY BOTH
DECREASE IN THE FIRST COUPLE OF
MONTHS, THE CONTROL REBOUNDS
INTERVENTION CONTINUES TO FALL
AND REBOUNDS SLOWER RATE.
SO THOSE ARE SOME OF THE
OUTCOMES JUST ON FACE VALUE, BUT
I THINK I WANTED TO TALK A
LITTLE BIT BECAUSE IN THINKING
ABOUT THIS EDUCATION WE ARE
PROVIDING WHAT ENVIRONMENTAL
CONTEXT ARE THESE WOMEN LIVING
IN.
AND ONE OF THE THINGS THAT WE
STARTED TO THINK A LOT ABOUT IS
THIS WATER.
WE HAD DECIDED WHEN WE WROTE THE
GRANT TO THINK ABOUT WHY DOES
WATER MATTER WE DECIDED WE
PROVIDE WATER TO THE FAMILIES,
AND EXPLORE PROVISION OF WATER
REDUCES SSB INTAKE.
ALSO INTERVENTION OR EDUCATION
CHANGE EITHER OF THESE.
THIS WORK AND WE ARE DIGGING
INTO THIS DATA RIGHT NOW SO NOT
GOING TO PRESENT FINDINGS.
I WILL PRESENT SOME STUFF WE ARE
THINKING IN TRYING TO FIGURE OUT
WHAT IT MEANS.
AS I SAID BEFORE 60%
PARTICIPANTS WERE WATER INSECURE
SOME POINT IN STUDY.
62% HAVE BETTER IN THEIR HOME
BUT 82% REPORTED BOTTLED WATER
PRIMARY SOURCE OF DRINKING.
WE ARE DOING INTERVIEWS AND
FOCUS GROUPS TO UNDERSTAND WHAT
IS GOING ON HERE, 62% HAVE --
MOST USING BOTTLED WATER AS MAIN
SOURCE OF DRINKING.
WITH HISTORY OF WHAT IS HAPPENED
OUT ON THE NAVAHO NATION WITH
MINING AND ARSENIC IS NOT
SURPRISING PEOPLE ARE NOT
TRUSTING COMING INTO THEIR HOMES
BUT WE ARE DOING INTERVIEW AND
FOCUS GROUPS TO UNDERSTAND WHAT
IS GOING ON AND WHY PEOPLE DON'T
WANT TO DRINK THE WATER IN THEIR
HOMES.
SO NEXT I WANT TO SHOW YOU THIS
I CAN'T GO TOO MUCH DETAIL, THIS
IS SOMETHING WE ARE THINKING
ABOUT.
THIS IS SSB INTAKE BY TIME
POINT.
BY THOSE INSECURE VERSUS THOSE
SECURE.
WATER SECURE.
YOU CAN SEE WATER SECURE IS MUCH
NICER THE INTERVENTION SEEM TO
DECREASE SSV INTAKE AMONG MOMS
AN IT SORT OF SLOWLY INCLINE BUT
STILL STAY BELOW CONTROL GROUP.
WE ARE TRYING TO FIGURE OUT WHAT
IS GOING ON HERE, THIS IS WHEN
THE WATER DELIVERY OCCURRED.
YOU CAN SEE INTERVENTION UP AND
SLOWLY DOWN AGAIN BUT CONTROL
GROUP GOES UP AND DOWN.
THE NEXT ONE IS THE KIDS AND
AGAIN WITH WATER SECURE FAMILIES
THAT REALLY SEEMS LIKE THE
INTERVENTION STAGE OFF THIS SSB
INTAKE.
REGARDLESS WHEN WATER DELIVERY
OCCURRED, HERE WE THINK IS
PRETTY INTERESTING BUT THERE NO
STATISTICAL SIGNIFICANCE, A LOW
N BUT YOU HAVE SORT OF IN THE
INTERVENTION STAYING LOW HERE,
INSECURE WATER INSECURE FAMILIES
YOU HAVE INCREASE BUT THEN IT
SLOWLY GOES DOWN AS WE DELIVER
THE WATER.
SO AGAIN DIGGING A LITTLE MORE
INTO THAT.
TO FIGURE OUT WHAT THAT MEANS.
WE ARE DOING A HYDRATION PROJECT
I WON'T GO INTO DETAIL ABOUT, WE
ARE ALSO DOING A LONGER TERM
FOLLOW-UP SO FOLLOWING THESE
KIDS UNTIL THEY ARE FIVE YEARS
OF AGE TO SEE IF THESE TRENDS WE
SEE STICK.
WE ARE DISSEMINATING THE FAMILY
SPIRIT PROGRAM NURTURE
JURISTHOSE BOOSTER SESSIONS
ACROSS THE COUNTRY.
HERE IS WHERE WE DISSEMINATED
THE PROGRAM TO THUS FAR AND
THERE ARE NEW AFFILIATES THAT
ARE TRAINED IN THIS PROGRAM ALL
THE TIME.
FINALLY I WANT TO SAY THANK YOU
TO NAVAHO NATION AS WELL AS OUR
-- NAVAJO NATION AS WELL AS OUR
STAFF.
THIS IS A STAFF TEAM WHO WORK ON
HYDRATION PROJECT NOW AND THEN
FAMILY SPIRIT NURTURE TEAM.
ALSO THANKS TO STAFF AND YOU CAN
EMAIL MYSELF OR SUMMER IF YOU
HAVE QUESTIONS ABOUT ME OF WHAT
I DISCUSSED.
THANK YOU.
THANK YOU FOR INVITING ME AND
THE CENTER TO TALK ABOUT OUR
WORK.
>> THANK YOU SO MUCH, DR.
CHAMBERS, EXCELLENT.
SO OUR LAST TALK TODAY WILL BE
DR. LAUREN FIECHTNER.
>> GREAT, IS THAT BETTER?
THANKS SO MUCH FOR HAVING ME,
EXCITED TO CLOSE TODAY'S AMAZING
DAY OFF OFFER LOTS OF GREAT
SPEAKERS.
I WILL BE SPEAKING PRIMARY CARE
INTERVENTION AND CHILDHOOD
OBESITY AND I WILL FIRST TALK
ABOUT THREE TRANSLATIONAL
INTERVENTION THAT HAVE INFORMED
OUR CURRENT DISSEMINATION AND
IMPLEMENTATION GRANT.
THE FIRST STUDY IS CONNECT FOR
HEALTH WHICH WAS A RANDOMIZE
TRIAL IN CHILDREN TWO TO 12
YEARS WITH OVERWEIGHT OR
OBESITY, WE TARGETED SIX
PEDIATRIC IN MASSACHUSETTS WE
LOOK FOR PRACTICES CARING FOR
CHILDREN WITH HIGHEST PREVALENCE
OVERWEIGHT AND/OR OBESITY.
WE ENROLLED 721 CHILDREN AND
THEIR PARENTS AND GUARDIANS IN
THE INTERVENTION.
THE INTERVENTION WAS ONE YEAR IN
DURATION, INTERVENTION
COMPONENTS INCLUDED ELECTRONIC
DECISION SUPPORT TOOLS WHICH
INCLUDED BMI FOR THE
PEDIATRICIAN.
THEY WOULD ALSO BE ENCOURAGED TO
COUNCIL CHILDREN AND PARENTS
NUTRITIONAL AND PHYSICAL
ACTIVITY.
THEY ALSO RECEIVE BEHAVIORAL
CHANGE MATERIALS FOR PATIENTS
AND FAMILIES AND THEN THE
PARENTS RECEIVED MESSAGING AND
NEIGHBORHOOD RESOURCES.
ONE ARM WAS -- THOUGH WE FOUND
IT TO BE NOT STATISTICALLY
SIGNIFICANTLY DIFFERENT IN
IMPROVING BMI.
OUR OUTCOMES MEDIA EVALUATED
WERE IMPROVING BMI MANY CHILD
QUALITY OF LIFE FAMILY CENTERED
CARE AND PARENTAL EMPOWERMENT ON
THE LEFT YOU CAN SEE BMI OVER
TIME, BETWEEN BASELINE AND
PRE-BASELINE BOTH ARMS IN THE
INTERVENTION BMI SCORES
INCREASE.
HOWEVER FROM BASELINE TO
FOLLOW-UP YOU CAN SEE THERE WAS
STATISTICALLY SIGNIFICANT
DECREASE IN BMI SCORE.
THE SECOND IS MATH IN MOTION,
WHOLE COMMUNITY INTERVENTION.
WE ENROLLED 2 TO 12-YEAR-OLDS TO
ON SITE HEALTHY WEIGHT CLINIC.
187 CHILDREN AND PARENTS AND
PARENTS AND GUARDIANS
PARTICIPATED IN THIS
INTERVENTION.
INTERVENTION WAS TWO YEARS IN
DURATION.
THE COMPONENTS INCLUDED
ELECTRONIC DECISION SUPPORT
TOOLS SIMILAR TO CONNECT FOR
HEALTH SO FLAGGING AGAIN OF
CHILD ELEVATED BMI AND
ENCOURAGING THE PEDIATRICIAN TO
COUNCIL CHILD AND FAMILY ON
NUTRITION AND PHYSICAL ACTIVITY
CHANGES I WANT THEY WERE
PROVIDED BEHAVIORAL CHANGE
MATERIALS AND THEN REFERRAL TO
HEALTHY WEIGHT CLINIC ON SITE
MULTI-DISCIPLINARY WEIGHT
MANAGEMENT.
THIS WAS CONDUCTED BY COMMUNITY
HEALTH WORKER DIETITIAN AND
PEDIATRICIAN OR NURSE
PRACTICERS.
WE HAVE TRAINED THE OTHER
PRIMARY CARE PROVIDERS AND
PRACTICE, TO PEDIATRIC WEIGHT
MANAGEMENT INTERVENTION AND WELL
CHILD VISITS.
OVER TIME THE BMI FOR THESE
CHILDREN WHO ARE PARTICIPATING
IN THE HEALTHY WEIGHT CLINIC
DECREASE EACH YEAR BY .07 DURING
THE INTERVENTION.
SOP THIS LAST TRIAL IN OUR MOST
RECENT TRIAL IS WHAT I WILL
SPEAK MOST ABOUT.
AND THIS IS CLINIC COMMUNITY
APPROACHES TO HEALTHY WEIGHT
TRIAL, IT WAS A RANDOMIZE
NON-INFERIORITY TRIAL.
HEALTHY WEIGHT CLINIC TO MASS IN
MOTION EQUALLY EFFECTIVE AS THE
YMCA HEALTHY WEIGHT AND YOUR
CHILD PROGRAM.
IN THIS INTERVENTION WE ENROLLED
WITH SIX OVERWEIGHT OBESITY TO
FEDERALLY QUALIFIED HEALTH
CENTERS THAT SERVE HISPANIC
POPULATION AND LOW INCOME
POPULATION.
WE ARE ABLE TO ENROLL 407
CHILDREN AND PARENTS AND
GUARDIANS TO THE INTERVENTION
AND IT WAS ONE YEAR IN DURATION.
I WILL GET MORE DETAIL AROUND
HEALTHY WEIGHT CLINIC.
BUT THEY WERE INDIVIDUAL GROUP
VISITS, STAFFED BY DIETITIAN AND
COMMUNITY HEALTH WORKER AND
MEDICAL PROVIDER AND 30 HOURS OF
CONTACT WHICH IS CONSISTENT WITH
USPSTF GUIDELINES FOR CHILDHOOD
OBESITY TREATMENT AND THE YMCA
PROGRAM, THIS WAS STAFFD BY TWO
TRAINED GROUP LEADER THEY WERE
OFFERED OVER 50 HOURS CONTACT
AND OUTCOMES WE STUDY WERE
IMPROVEMENT IN BMI SLEEP, DIET
PHYSICAL ACTIVITY AND COST.
HERE YOU CAN SEE OVERALL FLOW OF
THE STUDY WE HAD TEN FEDERALLY
QUALIFIED HEALTH CENTERS IN
MASSACHUSETTS, WE CHOSE
COMPARISON SITES TO ACT AS USUAL
CARE AND IN THOSE COMPARISON
SITES WE TRIED IF GET THEM AS
DEMOGRAPHICALLY MATCHED AS OUR
TWO INTERVENTION SITES.
WE LOOK AT 6 TO 12-YEAR-OLDS IN
SITES WITH BMI GREATER THAN 85
PERCENTILE AND WE ARE ABLE TO
PULL ABOUT 4,000 RECORDS FROM
THAT.
OUR INTERVENTION SITES AGAIN,
THE ENROLLMENT CRITERIA WAS SIX
TO 12-YEAR-OLDS WITH BMI OVER 85
PERCENTILE AND PRIMARY CARE
PHYSICIAN WOULD RECOGNIZE THEY
MET THAT CRITERIA PRIMARY CARE
VISIT.
AND THEN THEY WOULD REFER THEM
TO STUDY COORDINATOR
INDIVIDUALLY RANDOMIZE THEM TO
HEALTHY WEIGHT CLINIC OR YMCA
BASE PROGRAM.
ALL INTERVENTIONS RECEIVE
PRIMARY CARE TRAINING AROUND
WEIGHT MANAGEMENT, INCLUDING
STIGMA AND WE ALLOWED FOR
EDUCATIONAL MATERIALS AND
INTERACTIVE TEXT MESSAGES FOR
ALL PARTICIPANTS IN THE
INTERVENTION, THEY ALSO GOT
RESOURCES FOR UNMET SOCIAL NEEDS
SO WE WOULD SCREEN THEM AT
BASELINE SEX MONTHS AND 12
MONTHS AND REPORT THIS BACK TO
THE PCP AND ALSO PROVIDE FAMILY
WITH LOCAL RESOURCES.
HERE YOU CAN SEE TABLE ONE OR
BASELINE CHARACTERISTICS OF
THOSE CHILDREN PARTICIPATING IN
THIS TRIAL.
AND THIS IS COMPARING THE
INTERVENTION SITES TO OUR
COMPARISON GROUPS AND YOU CAN
SEE THERE WAS A HIGHER
PREVALENCE OF PATIENT
IDENTIFYING AS HISPANIC IN
INTERVENTION GROUPS WITH 93% OF
THOSE CHILDREN IDENTIFYING AS
HISPANIC VERSUS 46 PERCENT IN
OUR COMPARISON SITES. WE HAD A
HIGHER PREVALENCE OF SEVERE
PIECETY AND TWO INTERVENTION
SITES COMPARED TO COMPARISON
SITE SO WITH 30% THOSE CHILDREN
ENROLLED IN THE INTERVENTION
HAVING SEVERE OBESITY VERSUS THE
18% IN COMPARISON SITE.
THE NICE THING ABOUT THIS IS
THAT WE USED EHR BMI
MEASUREMENTS AS OUTCOME SO WE
HAD FOLLOW-UP UP TO 1.8 YEARS
AFTER INTERVENTION.
WHICH ALLOWED US TO SEE THE LONG
LASTING EFFECT OF THESE
INTERVENTIONS.
HERE YOU CAN SEE PARTICIPANT
CHARACTERISTICS OF JUST THOSE
CHILDREN WHO ARE ENROLLED IN TO
THE HEALTHY WEIGHT CLINIC OR THE
YMCA PROGRAM.
THE AVERAGE HEALTHY WEIGHT
CLINIC VISITS ATTENDED WERE 3.2
COMPARED TO THE Y WHICH WAS ABLE
TO ACHIEVE A BETTER ATTENDANCE
OF FIVE VISITS.
ALSO YOU CAN SEE THAT THE
PARENTS HAD HIGH PREVALENCE OF
OVERWEIGHT AND OBESITY WITH 26%
OF PARENTS ENROLLED IN THE
INTERVENTION HAVING OVERWEIGHT,
24% CLASS 1 OBESITY, 18% HAVING
CLASS 2 OBESITY AND 13% HAVING
CLASS 3 OBESITY.
68% FAMILIES MAKING LESS THAN
$20,000 PER YEAR.
THERE WAS A HIGH PREVALENCE OF
PARENTAL DEPRESSION AT 35% FOOD
INSECURITY AT 48% AND HOUSING
INSECURITY AT 30%.
THESE ARE THE FIGURES THAT
DEPICT THE PREDICTED VALUES OF
BMI OVER TIME AND MANY THE BLUE
DASH FIGURE YOU CAN SEE THE
HEALTHY WEIGHT CLINIC SLOPE OF
BMI OVER TIME SO FROM
PRE-BASELINE TO ENROLLMENT YOU
CAN SEE BMI WERE INCREASING.
BUT AFTER ENROLLMENT TWO AND A
HALF YEARS BEYOND DECREASE
SIGNIFICANTLY.
THE YMCA AND COMPARISON SITE BMI
SLOPES REMAIN THE SAME.
YOU CAN SEE PERCENT OF THE 95
PERCENTILE WHICH IS BETTER
MEASURE FOR CHILDREN WITH SEVERE
OBESITY AND WE HAD A BETTER
HEALTHY WEIGHT CLINIC USING THAT
MEASURE.
THIS SLIDE SHOWS CHILDREN WITH
OVERWEIGHT AND OBESITY AND NOT
SEVERE OBESITY.
AND WE HAVE EVEN STRONGER
IMPROVEMENT IN BMI IN THOSE
CHILDREN IN THE HEALTHY WEIGHT
CLINIC.
THESE ARE THE ADJUSTED HEALTHY
LIFESTYLE BEHAVIOR CHANGES OF
PARTICIPANTS FROM BASELINE TO
ONE YEAR.
AND YOU CAN SEE THAT THE HEALTHY
WEIGHTICALLY MIC PARTICIPANTS
IMPROVE THEIR SUGARRY BEVERAGE
INTAKE, FAST FOOD INTAKE SLEEP
DURATION, SCREEN TIME AND
PHYSICAL ACTIVITY.
AND PERCH INTAKE AND PHYSICAL
ACTIVITY.
BECAUSE THEY WERE TALKING ABOUT
MOMS AND WOMEN, ACROSS THE LIFE
SPAN AND BECAUSE PARENTS WERE
INVOLVED IN THIS INTERVENTION WE
ALSO HAD NON-BMI BASELINE AND 12
MONTHS, YOU CAN SEE THERE WASN'T
A STATISTICALLY SIGNIFICANT
DIFFERENCE IN IMPROVEMENT OF BMI
BUT WE WERE FORTUNATE ENOUGH TO
SEE THE BMI REMAIN STABLE IN
BOTH INTERVENTIONS.
WE DID ALSO EXAMINE PARENTAL
STRESS DURING THE INTERVENTION
AND FOR THOSE IN HEALTHY WEIGHT
CLINIC AND OVERALL THERE WAS
DECREASE IN PARENTAL STRESS FROM
BASELINE TO 12 MONTHS.
WE ALSO EXAMINED PARENTING
BEHAVIOR SO WE LOOK AT PARENTS
EXERCISING REGULARLY WHICH MIGHT
NOT BOTH INTERVENTION WE ALSO
EXAMINE WHETHER THEY TOOK CHILD
EXERCISE AND INCREASE MANY THE
YMCA PROGRAM, WHETHER PARENTS
ARE MODELING EATING HEALTHY
FOODS INCREASE IN BOTH PROGRAMS
FROM BASELINE TO 12 MONTHS AND
KEEPING HEALTHY FOOD AT HOME
INCREASE IN BOTH INTERVENTIONS.
SO SUMMARY RESULTS FOR THE
CLINIC AND COMMUNITY HEALTHY
WEIGHT TRIAL SHOW COMPARED TO
COMPARISON SITES FOR A YEAR
CHILDREN IN HEALTHY WEIGHT
CLINIC AT .23 BMI DECREASE.
HEALTHY WEIGHT CLINIC ASSOCIATED
WITH IMPROVEMENT IN HEALTHY
LIFESTYLE BEHAVIORS, THERE WAS
NO BE,MI EFFECT IN YMCA PROGRAM
UNFORTUNATELY.
MATERNAL BMI DID NOT DECREASE,
REMAIN STABLE IN BOTH
INTERVENTION PARENTAL STRESS
IMPROVE MISDEMEANOR THE HEALTHY
WEIGHT CLINIC AND PARENTING
BEHAVIOR IMPROVED IN BOTH
INTERVENTIONS.
I WILL TALK ABOUT CLASS FINDINGS
WHICH OTHER PAMELA TALKED HOW
IMPORTANT THIS IS, SO WE
COLLABORATED WITH HARVARD SCHOOL
OF PUBLIC HEALTH CHOICES TEAM
THEY HAVE A MODEL WHICH SIMILAR
RATES U.S. POPULATION OVER TEN
YEARS AND THEY THEN ESTIMATE
THAT COST EFFECTIVENESS OF
INTERVENTION TO PREVENT OBESITY
FOLLOWING GUIDELINES OF SECOND
U.S. PANEL ON CLASS
EFFECTIVENESS, SO THIS MODEL
PROJECTS INTERVENTIONS TO REACH
IMPACT BMI AND ALSO ON BMI
ASSOCIATED HEALTHCARE
EXPENDITURES SO IN CHILDREN THIS
LEADS TO ROUGHLY ESTIMATE OF
$200 PER YEAR OF EXCESS ANNUAL
MEDICAL EXPENDITURES DUE TO
OBESITY.
IN THIS MODEL WE INCLUDE COSTS,
INCLUDING DIRECT AND INDIRECT
OPPORTUNITY COSTS IN FACT WE
SURVEY THE FAMILIES ON HOW LONG
IT WAS TAKING FOR THEM THE GET
TO CLINICS OR GET THE GROCERY
STORE TO BUY EXTRA FRUITS AND
VEGETABLES FOR THEIR CHILDREN
AND EXTRA COSTS THEY WERE PAYING
FOR POTENTIAL PHYSICAL ACTIVITY
GROUPS KIDS ARE PARTICIPATING
IN.
AND HEALTHCARE COSTS CONSIDERED.
USING THIS MODEL WE IMPLEMENTED
THIS IN EVERY FEDERALLY
QUALIFIED HEALTH SEPTEMBERER IN
THE UNITED STATES FOR CHILDREN
SIX TO 12 YEARS OF AGE WITH
OVERWEIGHT OR OBESITY AND WE USE
THE ENROLLMENT PERCENTAGE OF
WHAT WE SAW IN OUR TRIAL WE
REACH ABOUT MILLION CHILDREN
OVER TEN YEARS.
THE COST IS LOW AT 6606 AND 450
BY IS PAID BY INSURER OR THE
HEALTH CENTER THE REST PAID BY
FAMILY.
SO WE ESTIMATE THAT WE WOULD
SAVE ABOUT $9.2 MILLION
HEALTHCARE SYSTEM.
WITH THIS INTERVENTION BEING
IMPLEMENTEDNA,NALLY.
60,000 YEARS WITH OBC PREVENTED.
THIS IS A HEALTH EQUITY
INDICATOR WHICH ESSENTIALLY IS
COMPARING THE LIKELIHOOD OF
DIFFERENT POPULATIONS RESPONDING
TO THE INTERVENTION VERSUS WHITE
NON-HISPANICS.
BECAUSE MORE BLACK HISPANIC
CHILDREN ARE CARED FOR BY
FEDERALLY QUALIFIED HEALTH
CENTERS AND ALSO MORE IMPACTED
BY OVERWEIGHT OBESITY.
THERE IS GREATER LIKELIHOOD THAT
THESE POPULATIONS WOULD BENEFIT
FROM THE INTERVENTION AND THAT
WE WOULD BE ABLE TO REDUCE
DISPARITIES IF WE WERE ABLE TO
DISSEMINATE IT NATIONALLY.
SO JUST TO SUMMARIZE COST
RESULTS IF IMPLEMENTED
NATIONALLY FOR SIX TO
12-YEAR-OLDS AT ALL FEDERALLY
QUALIFIED HEALTH CENTERS WE
ESTIMATE 60,000 YEARS OF OBESITY
WOULD BE PREVENTED IN 2030.
WE ESTIMATE PROGRAMS COST ABOUT
660 PER CHILD OR 450 BY
HEALTHCARE SYSTEM.
AND WE WOULD SAVE $9.2 MILLION
IN HEALTHCARE COSTS OVER TEN
YEARS.
AND THEN WE PROJECT THAT GREATER
HEALTH BENEFITS ACCRUE AMONG
HISPANIC AND BLACK POPULATIONS.
THIS WORK HAS INFORMED OUR
CURRENT DISSEMINATION
IMPLEMENTATION GRANT AND WE ARE
LUCKY TO BE ONE OF FIVE GRANTEES
ON SOME CDC TO TAKE PEDIATRIC
WEIGHT MANAGEMENT INTERVENTIONS
DEVELOP IMPLEMENTATION PACKAGE,
TEST IN DIFFERENT AREAS USE
IMPLEMENTATION SCIENCE TO
IMPROVE IT.
AND THEN THEIR GOAL IS FOR THESE
TO BE OFF THE SHELF PACKAGES
THAT DIFFERENT ORGANIZATIONS CAN
IMPLEMENT.
SO WHAT ARE PACKAGES BASED ON
HEALTHY WEIGHT CLINIC YOU HEARD
IN THE OTHER TRIALS AND WE ARE
LUCKY TO BE PARTNERING WITH
AMERICAN AKEYPAD MY OF
PEDIATRICS TO DESIGN THIS
PROGRAM AND WHAT OUR PACKAGE
INCLUDES IS TRAINING TECHNICAL
ASSISTANCE AND TOOLS AND
RESOURCES FOR COMMUNITY HEALTH
CENTER TO BUILD THEIR OWN
HEALTHY WEIGHT CLINIC AND HAVE A
SUCCESSFUL SUSTAIN PROGRAM SO WE
ON BOARD THE THE PROVIDERS WE
CAN BUILD THEIR SYSTEM, ENGAGE
HELP ENGAGE FAMILIES AND REFINE
OUR SYSTEMS.
HELP IMPLEMENT HEALTHY WEIGHT
CLINIC AND LEARN ABOUT BILLING
AND REIMBURSEMENT SO THIS CAN BE
SUSTAINABLE FOR THEM.
SO WHAT DOES HEALTHY WEIGHT
CLINIC LOOK LIKE AT A GLANCE?
STARTS ATWELLNESS WHERE THE
ELECTRONIC DECISION SUPPORT
TOOLS I TALKED ABOUT WOULD BE
IMPLEMENTED AND IT GOES TO AN
INDIVIDUAL CLINIC VISIT WITH THE
COMMUNITY HEALTH WORKER THAT
DIETITIAN AND MEDICAL PROVIDER,
THIS ALTERNATES WITH GROUP
SESSIONS ONCE A MONTH AND THEN
WE RECEIVED HELP ON CHECK INs
WITH COMMUNITY HEALTH WORKER AND
DIETITIAN TWICE PER MONTH TO
SUPPORT THEM OUTSIDE OF THE
CLINIC.
THE TEXT MESSAGING MANY THE
TRIALS IS PART OF THIS
INTERVENTION.
THE LAST SIX MONTHS IS THE
MAINTENANCE AND THEY ONLY
RECEIVE INDIVIDUAL VISITS WITH
THE COMMUNITY HEALTH WORKER THE
DIETITIAN AND THE MEDICAL
PROVIDER, THEY CONTINUE TO
RECEIVE TELEPHONE CHECK INs
WITH COMMUNITY HEALTH WORKER
DIETITIAN TWICE PER MONTH.
SO I HAVE COVERED THE HEALTHY
WEIGHT CLINIC TEAM MEMBER AND
ROLES WE HAVE MEDICAL PROVIDER
WHICH COULD BE A NURSE PRACTICE
EVERYTHING, PEDIATRICIAN AND
FAMILY MEDICINE DOCK, TO WE HAVE
A DIETITIAN OR NUTRITIONIST AND
THEN COMMUNITY HEALTH WORKER
WHICH IS REALLY IMPORTANT TO
LINK TO RELEVANT COMMUNITY
RESOURCES, AND ADDRESSING UNMET
SOCIAL NEEDS.
THIS IMPLEMENTATION GRANT WE
HAVE EXPANDED THE POPULATION AS
WE HEARD FROM STAKEHOLDERS, IT
IS REALLY IMPORTANT FOR THIS
PACKAGE TO ADDRESS ALL KIDS IN
NEED.
AND THEN TO GIVE A FLAVOR WHAT
THIS LOOKS LIKE INCLUDES VIRTUAL
LEARNING SESSIONS FOR ALL OF OUR
TEAMS IMPLEMENTING THE PROGRAM,
THERE IS RECORDED MODULES FOR
PROVIDERS AND WE HAVE SOME
RESOURCES AND TOOLS THAT THEY
CAN USE FOR ENGAGEMENT AND
TECHNICAL ASSISTANCE AS WELL SO
H IS ONE OF THE PROVIDER
TRAINING MODULES, AND THERE IS
ABOUT 15 HOURS OF TRAINING
ONLINE THEY DO, SEPARATE FROM
THE VIRTUAL LEARNING
COLLABORATIVE.
THIS IS IMPORTANT TO ME BUT WE
HAVE A COMMUNITY RESOURCE GUIDE
MODULE WHERE THEY LEARN TO
REALLY CREATE THEIR OWN TAILORED
COMMUNITY RESOURCE GUIDE.
SOME GROUP SESSION RESOURCES ARE
HERE YOU CAN SEE POWERPOINT THAT
FAIL AT A TIME OUR GUIDE AND
PATIENT HAND OUTS AND ALSO SHOW
YOU A VIDEO THAT SUMMARIZES WHAT
WE DO IN THE CURRICULUM IN ONE
AND A HALF MINUTES.
EVERYONE ASKS ME WHAT IS IN THE
GROUP CONTENT AND YOU CAN SEE
FOCUSES ON NUTRITION, PHYSICAL
ACTIVITY THREE TIMES WEEK AND
SOCIAL EMOTIONAL WELLNESS.
>> GREAT.
I WILL PLAY THIS VIDEO.
>> AS PARENTS AND GUARDIANS YOU
ARE POWERFUL AND IMPORTANT
PARTNERS IN KEEPING YOUR
CHILDREN HEALTHY, STILL
PARENTING CAN BE CHALLENGING AND
SOMETIMES VERY STRESSFUL.
NOTICING WHEN YOUR CHILD IS
DOING SOMETHING WELL AND
ACKNOWLEDGING IT IS EFFECTIVE
WAY TO ENCOURAGE GOOD HABITS.
PRAISE WHEN SPECIFIC GENUINE
HELPS KIDS FEEL CONFIDENT AND
CAPABLE.
YOU MAY WANT THE START SMALL BY
PRAISING A FEW BEHAVIORS AND
LIMBING ANY NEGATIVE COMMENTS.
BE PATIENT AND KIND.
LOVE TO YOUR CHILD AND YOURSELF
CHANGE TAKES TIME.
CHILDREN RESPOND WELL TO
ROUTINES AN LIMITS, WHEN
CHILDREN KNOW WHAT WE EXPECT OF
THEM THEY ARE CALMER.
FOR TEENS AND LIMITS ALLOW US TO
SPEND MORE TIME ON POSITIVE
INTERACTIONS WITH OUR KIDS.
GIVING CHILDREN A COUPLE OF GOOD
CHOICES IS ALSO IMPORTANT.
ALLOWING THEM TO CHOOSE BETWEEN
TWO HEALTHY OPTIONS BUILDS
DECISION MAKING SKILLS AND
ENCOURAGES THEM TO TALK TO US.
VALUABLE WAY TO SUPPORT OUR
CHILDREN IS ROLE MODELING.
OUR CHILDREN LOOK UP TO US.
AND WE ARE THEIR FIRST TEACHERS
AND ROLE MODELS.
SO WE NEED TO SHOW THEM HOW TO
MAKE HEALTHIER CHOICES LIKE
EATING HEALTHY AND BEING
PHYSICALLY ACTIVE.
WHEN MODELING PREFERRED HEALTHY
BEHAVIOR BE CONSISTENT.
WHEN SUPPORTING HEALTHY BEHAVIOR
BE KIND AND OFFER PRAISE.
MORE INFORMATION ON THESE AND
OTHER STRATEGIES FOR HEALTHY
LIFESTYLES, TALK TO YOUR HEALTHY
WEIGHT CLINIC TEAM.
>> AS YOU CAN SEE THIS --
>> AS PARENTS AND GUARDIANS YOU
ARE POWERFUL AND IMPORTANT
PARTNERS IN KEEPING --
>> OKAY.
SO THAT AS YOU CAN SEE A FAMILY
APPROACH AND HOPING TO I DRESS
THE PARENT AND THE CHILD AND
THEN JUST LIKE TO ACKNOWLEDGE MY
TEAM AT THE AMERICAN ACADEMY OF
PEDIATRICS AND MY MGHS TEAM
SUPPORTED ME THROUGHOUT THIS
WORK AND ALL OUR FUNDERS SO
THANK YOU SO MUCH.
>> GREAT.
THANK YOU, SO MUCH.
DR. FIECHTNER.
LET'S SEE.
SCREEN LOOKS DIFFERENT WE ARE
STILL SHARING DR. FIECHTNER.
THANKS.
NOW WE ARE GOING TO DO THE YEAH
AND ANSWER.
SO IF YOU HAVE QUESTIONS PLEASE
PUT THEM IN THE QUESTION AND
ANSWER BOX.
THERE WAS ONE IN THERE THAT I
WANTED TO POSE TO DR. MEHTA
THOUGH HE ANSWERED IT FOR THE
BENEFIT OF EVERYONE ELSE.
THIS COMMENT SAYS THANK YOU
DARSHAN GREAT PRESENTATION.
DO YOU SEE ANY WAY FOR
RESEARCHERS TO DEVELOP AND TEST
MIND BODY INTERVENTIONS TO
IMPROVE GENERAL WELL BEING AND
PREVENT ILLNESS AMONG
UNDERSERVED AND VULNERABLE
POPULATIONS THAT CAN BE
IMPLEMENTED WITHIN HEALTHCARE
SETTING.
THESE INTERVENTIONS EXIST BUT
OUTSIDE THE HEALTHCARE SETTING
MOSTLY TO THE POPULATION YOU
MENTIONED HIGH SES, PETS OR
SLIGHTLY MORE AVAILABLE FOR
PEOPLE WITH DIAGNOSE ILLNESS.
THEY ARE USUALLY NOT AVAILABLE
AS PREVENTATIVE CARE FOR
INDIVIDUALS OF HIGH RISK OF
DEVELOPING ILLNESS.
WHAT WILL IT TAKE FOR INSURANCE
TO COVER MINDFULNESS BASE STRESS
REDUCTION COMMUNITY ADAPTED AND
CULTURALLY RELEVANT SO THAT IS A
VERY INTERESTING QUESTION.
DR. MEHTA, WOULD YOU MIND
SHARING YOUR ANSWER TO THAT.
>> IT IS A GREAT QUESTION AND
VERY IMPORTANT ONE SO THERE ARE
TWO PARTS TO THE ANSWER, ONE IS
THAT WE ARE -- I THINK WE ARE
SEEING MORE THINGS BEING COVERED
THAT AND THEN I THINK IT TAKES A
BIG DISRUPTER LIKE IN THE COVID
PANDEMIC TO CREATE NEW
INNOVATIONS AND SOLUTIONS, FOR
EXAMPLE, THE ADVENT OF VIRTUAL
HEALTH PLATFORMS ET CETERA
SPECIALLY MIND BODY MEDICINE WAS
NEVER A POSSIBILITY NOW IT IS
95% OF THE CLINICAL PRACTICE I
CURRENTLY LEAD IS THAT IS A VERY
PRIME EXAMPLE WHERE SOMETHING
LIKE THIS REALLY IF THERE IS A
SILVER LINING TO BE SEEN
DISRUPTED THE WAY WE DELIVERED
HEALTHCARE AND THOUGHT OF
HEALTHCARE AND NOW WE HAVE NEW
WAYS.
THE SECOND PIECE IS THAT IT IS A
MESSAGING PIECE, I SEE AGAIN HOW
WE THINK ABOUT SOME OF THESE
APPROACHES ET CETERA SPECIALLY
SELF CARE AND MIND BODY MEDICINE
AS AN EXAMPLE, WE AREN'T
OPTIMIZING THE LAST FEW SLIDES
THAT YOU HAVE IN THE -- WHICH I
DIDN'T GET A CHANCE TO DISCUSS
IS LOOKING AT -- WE KNOW FOR A
FACT LIFESTYLE FACTORS ARE THE
BIGGEST RISK FACTORS FOR THOSE
BY SEVERE CONSEQUENCES OF
COVID-19 PANDEMIC AND WHEN YOU
THINK ABOUT THE MESSAGING WE DO
A LOT OF MESSAGING AROUND RISK
MITIGATION HAND WASHING MASK
WEARING VACCINES BUT WE DON'T
TALK ABOUT -- WE SEE LITTLE
DIALOGUE ATTORNEY CERTAINLY LAY
MEDIA BUT ALSO SCIENTIFIC HOW WE
ADDRESS THIS IF THAT IS A INDEED
WE KNOW IT IS A MAJOR FACTOR AND
WE HAVEN'T DONE A GOOD JOB DOING
THAT.
ON THE FLIP SIDE, THINKING NOW
THAT WE ARE THINKING BOOSTERS AN
VACCINES, WHAT IS BOOSTING A
VACCINE?
TURNS OUT THAT WE HAVE CERTAINLY
SUGGESTIVE EVIDENCE AT LEAST BUT
CERTAINLY MORE THAN SUGGESTIVE
EVIDENCE WHEN PEOPLE LEARN THEY
ARE VACCINE RESPONSE IS BOOSTED,
WE HAVE NOT DONE A GOOD JOB
SENDING MESSAGING SO ONCE WE
BEGIN TO SEE HOW PANDEMIC CAN
DISRUPT EVERYTHING.
AND BEGIN TO INVADE MIX MESSAGES
THESE ARE MESSAGES I SAY WHEN I
GIVE PRESENTATIONS BUT I HAVE N
OF ONE AND I HI THE OTHER MORE
THAN THIS HAPPENS ESPECIALLY IN
THE SCIENTIFIC AUDIENCE CREATES
OPPORTUNITIES FOR FUNDING.
BECAUSE WAIT WILL IS SOMETHING
HERE HA NEED TORR FURTHER
INVESTIGATED AND WE COME UP WITH
MORE INVASIONS AND RESEARCH AND
SOLUTIONS FOR IMPLEMENTATION.
>> THANK YOU, I HAVE A FOLLOW-UP
QUESTION TO THAT TO THE FIRST
QUESTION AND I WAS WONDERING IF
YOU CAN SAY MORE ABOUT WHO
UTILIZES THE STRESS MANAGEMENT
AND RESILIENCE PROGRAM, WHO IS
UTILIZING IT AND HAVE GREATER
REACH.
>> SO AGAIN IN CLINICAL
POPULATION WE -- THERE IS A
CERTAINLY ET CETERA SPECIALLY
PROGRAMS LIKE MINDFULNESS BASE
STRESS REDUCTION THE PROGRAM WE
HAVE AT THE HENRY STRESS
MANAGEMENT RESILIENCE TRAINING
PROGRAM USE IN WIDE VARIETY OF
PATIENT POPULATION AND AGAIN
PART OF INTERVENTION CAN YOU
TREAT THE CONDITION OR BE PART
OF ADJUNCT TREATMENT OPTION,
WHAT IS NOW BEING FURTHER
INVESTIGATED AGAIN THROUGH SOME
OF THE INTERESTING MECHANISTIC
STUDIES IS WE CAN START EARLIER,
ON AND SEE CAN WE PREVENT AND WE
ARE USING IT IN NON-CLINICAL
POPULATIONS AND ONE THAT COMES
TO MIND IS HEALTHCARE PROVIDERS,
USING AGAIN BECAUSE OF THE
PANDEMIC HEALTHCARE PROVIDERS
EXITING THE WORK FORCE FOR HOST
OF REASONS PRESENT PRIOR TO THE
ACTUAL COVID-19 PANDEMIC ONLY
AMPLIFIED AND THAT BECOMES A BIG
-- WE ARE SEEING EXACTLY THE
CONSEQUENCE WHICH IS THERE IS
VERY LITTLE WIGGLE ROOM FOR US
TO SUSTAIN ANY INCREASE MANY THE
NEED FOR ACUTE HEALTHCARE.
SO I THINK AGAIN WE ARE
UTILIZING IT EXTENSIVELY AT OUR
HOSPITALS AROUND ESPECIALLY IN
OUR CLINICAL AMONG PEERS AND
EMPLOYEE IN OUR SYSTEM IS
EMPLOYEE BENEFIT TURNS OUT.
WE HAVE BEEN ABLE TO CREATE
EMPLOY BENEFIT AROUND THIS AS
WELL.
>> THAT IS GREAT.
THANK YOU.
SO THERE IS A QUESTION FOR DR.
FIECHTNER, HOW DO YOU IMPLEMENT
YOUR MODELS IN COMMUNITIES WITH
FOOD DESERTS AND HOW TO ADAPT
YOUR MODEL TO REACH THESE
COMMUNITIES?
>> OUR CURRENT INTERVENTION TWO
CURRENT INTERVENTION SITES ARE
IN THE DELTA WORLD, MAY ONLY
HAVE ONE GROCERY STORE WAL-MART
AND THEY RUN OUT OF FOOD AND WE
KNOW FAMILIES ARE RELYING ON
DOLLAR STORE ET CETERA FOR FOOD
SO WE ARE WORKING THERE, THEY
HAVE A LARGEING A YOU WILL CHURL
COMMUNITY AND SO WORKING ON WITH
BARNES TO SEE IF WE CAN HELP
PROVIDE ACCESS TO FRUITS AND
VEGETABLES, WE ALSO HEARD FROM
FAMILIES USE FROZEN FRUITS AND
VEGETABLES AND THEN I THINK YOU
MIGHT HAVE HEARD MY ROLE IN MY
LICENSE TO BE THE SENIOR HEALTH
AND RESEARCH ADVISOR THE GREATER
BOSTON FOOD BANK SO REALLY
PARTNERING WITH OUR FOOD
PANTRIES AND FOOD BANKS AS MUCH
AS WE CAN TO ADDRESS THIS HAS
BEEN WHAT WE HAVE BEEN DOING.
I THINK THAT THERE WILL BE MORE
ENGAGEMENT WITH FAMILIES AN
LEARN MORE AS WE IMPLEMENT THIS
FURTHER IN RURAL MISSISSIPPI FOR
SURE.
BUT IT IS SOMETHING I THINK NEED
TO BE ADDRESSED CURRENTLY WITH
TREATMENT OF CHILDHOOD OBESITY
FOR SURE.
>> THANK YOU.
ANOTHER QUESTION FOR YOU, JUST
TO CLARIFY WHERE INTERVENTION IT
IS SAME IN THE HEALTHY WEIGHT
CLINIC AND THE YMCA?
IF SO, WOULD YOU EXPLAIN THE
DIFFERENCE IN RESILIENCE?
>> THEY WEREN'T THE SAME.
THE YMCA IS STAFFED BY TWO
USUALLY HIGH SCHOOL EDUCATED
LEADERS AND WE HAD HOPED THAT
THEY WOULD BE EQUALLY EFFECTIVE,
BASED OFF THE MEN PROGRAM THE
ADAPTED THAT WHICH HAS A LOT OF
EFFECTIVENESS DATA.
TURNS OUT AFTER THE TRIAL, THE
YMCA MODIFIED THEIR PROGRAM THEY
DISSEMINAYED NATIONALLY, SO I
DON'T THINK IT IS COMPLETELY
CONGRUENT TO COMPARE THOSE TWO.
THE HUGE BENEFIT OF THE HEALTHY
WEIGHT CLINIC IS THE
PEDIATRICIAN BEING PART OF THAT
TEAM.
FAMILIES IN THE COMMUNITY HEALTH
CENTERS THAT DON'T HAVE TO
TRAVEL AS FAR TO GET TO THE
WMCA.
SO WE SAW A BENEFIT OF THAT, BUT
I THINK IT IS THIS PROVIDER
CHAMPION WE ARE SEEING
IMPLEMENTATION TO THAT IS SO KEY
TO GETTING FAMILIES TO COME BACK
AND BE INVOLVED AND BE MAKING
THESE CHANGES.
THE OTHER THING I THINK IS
IMPORTANT TO THE HEALTHY WEIGHT
MODEL IS THOSE CALLS FROM THE
COMMUNITY HEALTH WORKER AND
DIETITIAN IN BETWEEN VISITS TO
MAKE SURE THEY AREN'T ABLE TO
ACCESS FOOD IN FOOD DESERTS WHAT
RESOURCES COULD THERE BE, ET
CETERA.
I THINK THAT IS IMPORTANT AND
THAT IS NOT BUILT INTO THE YMCA
PROGRAM.
AND I KNOW DR. JOHNSON MENTIONED
BEFORE THESE ARE THINGS THAT ARE
NOT COVERED BY INSURANCE SO I
THINK AS WE MOVE FORWARD WE NEED
TO THINK ABOUT THESE SIMPLE
INTERVENTIONS THAT COULD WORK
THAT DON'T REQUIRE SOMEBODY WHO
CAN BUILD BILL.
>> THANK YOU FOR THAT ANSWER.
THIS IS A QUESTION FOR DR.
CHAMBERS IS WATER DELIVERED IN
PLASTIC OR GLASS, THAT MAKES A
HUGE DIFFERENCE ON THE
ENVIRONMENTAL TOW LOAD.
>> THANKS FOR YOUR QUESTION.
SO IT WAS DELIVERED IN MASSIVE
PLASTIC THINGS.
WE SPENT HOURS AND HOURS NO IDEA
HOW MUCH TIME TRYING TO FIGURE
LOGISTICS IN WATER FOR THESE
REMOTE COMMUNITIES A LOT HOURS
AWAY FROM OUR SITES. ON A
REGULAR BASIS FOR THREE MONTHS
ON ISSUES -- ON A SHOE STRING
BUDGET AND WHAT I -- WE
RECOGNIZE THE ENVIRONMENTAL
STRAIN OF WHAT WE DID BUT WE DID
COLLECT THE PLASTIC AND REFILL
IT AND BRING IT BACK OUT SO IT
WASN'T TOSSED AWAY.
BUT REALLY, AT END OF THE DAY WE
HAD A BUDGET AND WE HAD TO DO --
IT WASN'T ABOUT SUSTAINING WATER
DELIVERY.
IT WAS REALLY ABOUT IDENTIFYING
IF WATER DELIVERY IMPACT SUGAR
SWEETENED BEVERAGE SO TAKE AWAY
WATER INSECURITY FOR THREE
MONTHS FOR THESE FAMILIES, IT IS
OFN'-- IT WASN'T A SOLUTION LONG
TEAR: IF WE CAN FIGURE
SUSTAINABLY HOW IMPORTANT THE
ENVIRONMENTAL CONTEXT OF OBESITY
IS.
>> REALLY IMPORTANT FINDING.
WHEN YOU DESCRIBE AT THIS
SEMINATION OF INTERVENTIONS IT
WAS INCREDIBLE SO I'M WONDERING
HOW HAVE THOSE BEEN FUNDED?
>> THE INDIAN HEALTH SERVICE HAS
FUNDED THE US SEMINATION OF
THIS.
AND -- DISSEMINATION OF THIS AND
THE FOLKS THAT DELIVER ARE
CALLED COMMUNITY HEALTH
REPRESENTATIVES.
A LOT OF THEIR -- THEY ARE
SIMILAR TO COMMUNITY HEALTH
WORKER SO UNLIKE MOST HEALTH
ORGANIZATIONS ACROSS THE U.S.
INDIAN HEALTH SERVICE FUNDS
COMMUNITY HEALTH WORKER TO DO
THIS WORK.
SO THEY ARE ABLE TO DELIVER
INTERVENTIONS AND PROVIDE
SUPPORT TALKING ABOUT AND IT IS
FUNDED.
WHICH IS REALLY GREAT.
SPECIFICALLY FOR THE FAMILY
SPIRIT PROGRAM, OBAMA PUT IN THE
MATERNAL INFANT HEALTH CHILD
PROGRAM, THE TRIBAL
ORGANIZATIONS GET FUNDING FROM
THAT MECHANISM.
IN ORDER TO FUND COMMUNITY
HEALTH WORKER TO GO DELIVER THIS
PROGRAM SO IT IS A REALLY NICE
IT IS A HUGE ADVANTAGE ANDNDIAN
HEALTH PROGRAM.
LET'S SEE.
I WONDER IF YOU CAN JUST SAY A
LITTLE BIT MORE ABOUT THE
INTERVENTION.
THE SECOND ONE YOU DESCRIBE IN
THE RESPONSIVE FEEDING AND WHAT
HOW THAT IS TAUGHT AND WHAT THAT
ENTAILS.
IT MODELS CURRICULUM WHICH IS A
REALLY GOT A MANUALIZED
COMMUNITY HEALTH WORKER TO USE
AND THERE IS A FLIP CHART WITH
PARENTS SEE AND ALL PICTURES
WERE DRAFTED OR CREATED BY
INDIGENOUS ARTISTS SO THEY SHOW
A NATIVE PERSON PROVIDING FOR
HAIR CHILD AND AROUND RESPONSIVE
FEEDING WE TALK ABOUT IMPORTANCE
OF BREAST FEEDING, THE
IMPORTANCE OF REDUCTION SUGAR
SWEETENED BEVERAGE AND
RESPONSIVE FEEDING TRYING TO
READ YOUR CHILD QUEUES.
SORT OF HOW TO DO THAT AND WHAT
IS REALLY WONDERFUL IS FOR MOST
OF OUR COMMUNITY HEALTH WORKERS
THEY HAVE BEEN MOTHERS OR HELP
SIBLING WITH A CHILD SO THEY
HAVE EXPERIENCE AND CAN BE IN
THERE ON THE GROUND PROVIDING
SUPPORT OUTSIDE THE WRITTEN
CURRICULUM.
SO IT IS A DIDACTIC PROCESS AND
IT IS REALLY A LOT OF
INTERVENTIONS WE DO NOT ONLY
NURTURE BUT ALL THE OTHER
PROJECTS IS REALLY RELATIONSHIP
AND ABILITY TO COME INTO THE
HOME AND LOOK AT THE ENVIRONMENT
IN A HOME AND HELP ADDRESS
BARRIERS TO HEALTHY EATING OR
THE ABILITY TO HAVE RESPONSIVE
FEEDING TO TURN OFF TV THINGS
LIKE THAT.
AND IDENTIFY THOSE WITH THE
PARTICIPANT IS REALLY IMPORTANT.
SO I THINK THAT THAT -- THE
CURRICULUM IS VERY IMPORTANT TOO
BUT TRAINING REALLY DOES GO INTO
IDENTIFY THINGS THAT ARE
HAPPENING IN THE HOME, IS WILL A
TDM ALL THE TIME, HOW CAN YOU
ADDRESS THAT WITH A PARTICIPANT
AND ALSO TEACHING THEM THE
QUEUES OF CHILD WHEN A CHILD IS
HUNGRY, WHEN NOT HUNGRY, DON'T
FEED THEM WHEN THEY CRY BECAUSE
YOU MAY CHECK OTHER THINGS.
I HOPE THAT ANSWERED YOUR
QUESTION, I DON'T KNOW --
>> I FIGURED IT WAS LIKE THAT
BUT WANTED TO HEAR YOU
ARTICULATE THAT.
SO THANK YOU FOR SHARING THOSE
DETAILS.
HERE IS ANOTHER QUESTION FOR ALL
THE PANELISTS IN THIS SESSION.
COULD YOU SHARE ANY EXPERIENCES
WITH USING IMPLEMENTATION
THEORIES MODELS AND FRAME WORKS
IN YOUR RESEARCH, ARE THERE
PARTICULAR THEORIES MODELS
AND/OR FRAME WORKS YOU FAVOR IN
IMPLEMENTATION SCIENCE.
DOES ANYONE WANT TO GO FIRST?
>> HAPPY TO ANSWER.
I DON'T KNOW IF LISA WANTS TO
ANSWER TOO.
WE HAVE BEEN USING THE
CONSOLIDATED FRAMEWORK FOR
IMPLEMENTATION RESEARCH AND I
FIND IT TO BE EASY TO USE AND I
HAVE DONE WORK IN IMPLEMENTATION
AT THE FOOD BANK TOO AND I'M A
LITTLE NERVOUS, THE CLINICAL
WORK WITHIN TRANS-- WOULDN'T
TRANSLATE AS MUCH BUT I FOUND IT
TO BE HELPFUL, CAN BE TAILORED
AND USER FRIENDLY, AND FOR
OUTCOMES RESEARCH FRAMEWORK WE
-- A LOT OF PEOPLE TEND TO USE
REAIM AND THAT IS WHAT WE ARE
USING IN OUR CURRENT
IMPLEMENTATION GRANT AS WELL.
>> WOULD ANYONE ELSE LIKE TO
ANSWER THE --
>> I THINK IT DEPENDS WHERE YOU
ARE IN THE IMPLEMENTATION WORLD.
I THINK REALLY HELPFUL DESCRIBE
LAY OUT WHAT YOU ARE DOING AS
FAR AS IMPLEMENTATION BUT I ALSO
LIKE TRENDS TRANSDOMAIN
FRAMEWORK, TO IDENTIFY BARRIERS
AND ALMOST PRE-IMPLEMENTATION
STUDY TYPE THING THAT LOOKS AT
WHAT ARE ALL THE BARRIERS AND
FACILITATORS TO IN IMPLEMENTING
EVIDENCE BASED PROGRAM.
SO THAT TO ME LIKE WHEN YOU ARE
IN THE BEGINNING STAGE OF TRYING
TO FIGURE HOW TO IMPLEMENT WHAT
YOU ARE GOING TO DO AND IDEAS TO
TEST IMPLEMENTATION THAT CHEMFUL
AND THE REAIM I AGREE WITH
LAUREN IS AN OUTCOMES FRAMEWORK.
>> DR. MASINTER, DO YOU WANT TO
ADD ANYTHING TO THAT IN
>> I WILL SAY THAT NOT A TON
MOSTLY BECAUSE WE WERE WORKING
SORT OF IN A QUALITY IMPROVEMENT
MIND SET MORE THAN AT LEAST FOR
THIS PROJECT WE ARE WORKING ON.
WHEN AND IF WE MOVE TO A MORE
COMPARATIVE EXPERIMENTAL DESIGN
I WOULD AGREE REAIM IS A REALLY
GREAT MODEL TO USE AND
IMPLEMENTATION SETTING.
>> ANOTHER QUESTION ABOUT YOUR
PRESENTATION.
IT DID SEEM WHAT YOU WERE
PRESENTING IS MOSTLY TRACKING
THE DATA OF WHAT IS ACTUALLY
DONE IN TERMS OF WOMEN RECEIVING
FOLLOW-UP CARE DELIVERY.
SO GIVEN THAT THERE IS A LARGE
PERCENTAGE WHO DON'T HAVE THAT
FOLLOW-UP WHO ARE AT RISK, DO
YOU HAVE IDEAS OR IS YOUR
PROJECT GOING TO BE WORKING ON
SOME WAY TO CHANGE THAT?
TO GET THE WOMEN BACK IN?
>> YES, SO WE -- FIRST I THINK
THAT WE ARE LEARNING A LOOT
THROUGH THE PROCESS OF WHAT THAT
MIGHT BE AND I THINK THAT IS
ALSO ANOTHER NEXT STEP TO TRY
LIKE I SAID TO TALK TO PATIENTS
AND DO A QUALITATIVE EXPLORATION
TO GAIN UNDERSTANDING, I THINK
WE KNOW THERE IS A LOT OF
BARRIERS UTILIZING CARE AND I
THINK FOR ANYONE THAT HAD A
BABY, IT IS UNDERSTANDABLE THAT
YOU COME BACK FOR THE BABY AND
THE WELL CHILD VISIT.
OFTEN AS MANY PARENTS DO
PRIORITIZE THE CHILD OVER YOUR
OWN HEALTH WHAT WE LEARNED FROM
DOING THIS QUALITATIVELY WE ARE
STARTING TO DO QUALITATIVE
EXPLORE RATION.
IT IS INTERESTING THAT PEOPLE
DON'T UNDERSTAND WHAT PREVENTIVE
CARE MEANS OR AT LEAST THAT IS
WHAT WE ARE HEARING.
THE PEOPLE HOE EXCUSE ME IF YOU
CAN HEAR MY DOG BARKING.
THERE IS PRE-NATAL CARE
PEDIATRIC CARE ARE VERY -- IT IS
VERY CONCRETE ON COMING TO CHECK
THE BABY HEART BEAT, COMING TO
CHECK BLOOD PRESSURE AND COMING
TO GET SHOTS BUT PREVENTIVE
PRIMARY CARE AFTER THE
POSTPARTUM PERIOD IS MORE
NEBULOUS SO WE ARE TRYING TO
BUILD CONTENT AROUND SHARING
PROVIDERS PATIENTS TO HAVE THE
CONVERSATION PRE-NATAL PERIOD
ABOUT THE POSHES OF WHAT
PREVENTIVE CARE MEANS AFTER THE
BABY COMES OUT.
ESPECIALLY IN TERMS OF LODGE
TERM OUTCOMES AND THERE IS MORE
DATA COMING OUT ABOUT THE
IMPLICATION OF MEDICAL
CONDITIONS DURING PREGNANCY AND
LONG TERM OUTCOMES.
>> YEAH, THAT'S GREAT.
THAT WILL BE GOOD.
WELL I WAS JUST NOTICING THE
TIME AND WE ARE AT 5:15.
SO I THINK I'M GOING TO TURN IT
BACK OVER TO MARRAH TO CLOSE US
OUT AND LET ME JUST THANK ALL OF
MY PANELISTS IN SESSION 3,
REALLY GREAT PRESENTATIONS AND
VERY INTERESTING DISCUSSION
AFTERWARDS SO THANK YOU FOR
BEING HERE TODAY.
HOPEFULLY WE WILL SEE YOU AGAIN
TOMORROW.
TURNING IT OVER TO DR. MARRAH.
>> THANK YOU.
I ALSO WANT TO ECHO LORI AND
THANK SESSION THREE PANELISTS
WHO BEGAN TO MAKE THE CASE FOR
CONTINUUMS OF CARE PROVIDING
EXAMPLES OF ACTIVE PROGRAMS.
FIRST WE HEARD ABOUT INTEGRATED
HEALTH APPROACH FOCUSING ON THE
MIND AND THE BODY LOOK ATWELL
BEING REALLY IN A HOLISTIC
MANNER FROM BOTH SCIENTIFIC
PERSPECTIVE OF RISK PREVENTION
AND ALSO DELIVERY OF COMMUNITY
AND CULTURALLY RELEVANT TYPES OF
SELF CARE APPROACHES THAT ALLOW
PATIENT TO PARTICIPATE IN HER
OWN CARE BY PROVIDING WITH
EMPOWERMENT FOR HELPING PRODUCT
CONDITIONS.
NEXT WE HEARD ABOUT THE CCMH
MODEL THAT SHOWED THERE ARE
CHALLENGES BUT ALSO
OPPORTUNITIES TO ADDRESSING
MATERNAL MORBIDITY AND MORTALITY
WHERE THEY DEFINE MOST MATERNAL
DEATH OCCUR IN THE POSTPARTUM
PERIOD AND THEIR INTERVENTION
ATTEMPTS TO REDUCE RISK BY
CREATING A CONTINUUM FOR
POSTPARTUM CARE BY LINKING THE
MOTHERS TO PRIMARY CARE
FOLLOW-UP AFTER THE POSTPARTUM
VISIT.
DURING OUR SPOTLIGHT ON THE
INDIGENOUS COMMUNITIES WE HEARD
ABOUT HEALTHCARE DISPARITIES
THAT EXIST WITHIN THESE
COMMUNITIES, RELATED TO LOW
ACCESS TO HEALTHCARE RESOURCES
FOR YOUTH, HIGHER RATES OF
OBESITY, THESE RELATED TO
MATERNAL HEALTH COMPLICATIONS
LATER IN LIFE.
THIS MODEL DOES SHOW CONTINUUMS
OF CARE IN THE CONTEXT OF
COMMUNITY BASED PARTICIPATORY
RESEARCH ALLOWS THESE
COMMUNITIES TO FOCUS ON THE TRUE
COMMUNITY NEEDS WHERE THE
SOLUTIONS ARE GUIDED BY STAFF
FROM BEEN COMMUNITY,
PARTICULARLY USING COMMUNITY
HEALTH REPRESENTATIVES TO
DELIVER THE CARE AND THE
INTERVENTION.
OUR FINAL TALK ADDRESSED HOW
EARLY INTERVENTION AT YMCA
DECREASE BMI AND O BIASTY A
STRATEGY TO PREVENT LIFE LONG
OBESITY AND HEALTHY FOOD CHOICE
LIFE STYLES WHICH WE KNOW CAN
REDUCE RISK FOR LATER LIFE
COMPLICATIONS.
ALSO HOW THIS PROVIDES COST
SAVINGS ACROSS THE LIFE SPAN.
THE LAST FEW MINUTES OF OUR
WORKSHOP I WOULD LIKE TO INVITE
OUR WORKSHOP CO-CHAIRS, DR.
JOHNSON TO SEE IF THEY WANT TO
ADD ADDITIONAL THOUGHTS TO THE
TOPICS DISCUSSED, MAJOR TAKE
HOME POINTS FROM TODAY, AND
CONCEPTS THAT WE SHOULD CONTINUE
TO FOLLOW-UP WITH IN THE
PRESENTATIONS TOMORROW.
>> HAD SOME THOUGHTS EARLIER,
(INAUDIBLE)
>> HI.
I THINK FOR ME, WHAT I WAS
REALLY STRUCK BY AND I THINK
PERSISTED THROUGHOUT THE
AFTERNOON, WAS REALLY THE TRUE
APPRECIATION EMERGING MULTIPLE
CO-MORBIDITIES AND THAT IN TRUTH
KNOW SPECIFIC DISEASE OR MEDICAL
CONDITION OCCURS WITHIN A VACUUM
AND SO SORT OF REALLY TRYING TO
BREAK DOWN THESE SILOS, I HI
WHICH WE HAVE HEARD QUITE A BIT
ABOUT TODAY, HOW DO WE OPTIMALLY
BREAK DOWN SILOS AND BRIDGE
DIFFERENT ENTITIES TO REALLY
OPTIMIZE HEALTH WOMEN AND GIRLS
AND I THINK THINKING THROUGH
THEM EVERYONE MORE AS WE MOVE
FORWARD ULTIMATELY THE ONLY WAY
WE CAN TRULY MARKEDLY IMPROVE
THE HEALTH OF WOMEN AND GIRLS IS
TO TO REALLY THINK HOLISTICALLY
AND SO I HAVE BEEN IMPRESSED AND
ALSO AWED BY THE WORK CURRENTLY
BEING DONE BUT ALSO REFLECTING
ON HOW MUCH MORE THERE IS THAT
WE SHOULD BE DOING.
THAT IS MY GENERAL THOUGHT, WE
WILL HAVE MORE TOMORROW
AFTERNOON AS WELL.
>> I WILL ADD TO THAT
(INAUDIBLE) HOW MUCH SO MANY OF
US TAKE A LOOK AROUND THE
STRUCTURE TO MAKE IT WORK
BETTER.
COMMUNITY HEALTH WORKERS OR BY
DOING -- LET YOU KNOW THE HEALTH
SYSTEM AND LOT OF SYSTEMS
ADJUSTINGSOME DETERMINANTS OF
HEALTH DON'T ENTERSECOND AND
THEY ARE NOT REALLY OPTIMIZE TO
PRIORITIZE PREVENTION AND PUBLIC
HEALTH AND WHAT NOT, SO WE ARE
SPENDING TIME TRYING TO WORK
AROUND THAT AND MORE AND MORE OF
THAT I THINK I'M A CLINICAL
PSYCHOLOGIST TRAINED INDIVIDUAL
PSYCHOLOGY BUT MORE CHANGE
HEALTH POLICY MIGHT BE THE
NUMBER ONE THING TO IMPROVE
HEALTH.
THAT IS MY THOUGHT.
>> I WANT TO THANK EVERYBODY FOR
THE ENGAGING WORKSHOP AND
PARTICIPATION TODAY.
LOOK FORWARD TO SEEING Y'ALL
BACK TOMORROW FOR DAY TWO.
WITH THAT, I WILL CLOSE OUT THE
WORKSHOP FOR TODAY.
THANK YOU VERY MUCH.