1 00:00:05,400 --> 00:00:09,400 >>I'M JANINE AUSTIN CLAYTON 2 00:00:09,400 --> 00:00:12,800 THE ASSOCIATE DIRECTOR FOR 3 00:00:12,800 --> 00:00:14,800 WOMEN'S HEALTH AND IT'S MY 4 00:00:14,800 --> 00:00:16,920 PLEASURE TO WELCOME YOU TO THE 5 00:00:16,920 --> 00:00:23,760 2022 IMPROVE AWARDEE WORKSHOP. 6 00:00:23,760 --> 00:00:30,640 I'M HERE WITH MY CO-CHAIR OF THE 7 00:00:30,640 --> 00:00:32,960 MATERNAL TASK FORCE AND I'LL SET 8 00:00:32,960 --> 00:00:35,800 THE STAGE AND PASS THE MIC. 9 00:00:35,800 --> 00:00:37,800 IT'S WELL KNOWN NOW, FOR 10 00:00:37,800 --> 00:00:39,920 EXAMPLE, THE UNITED STATES IS 11 00:00:39,920 --> 00:00:41,160 THE MOST DANGEROUS PLACE IN THE 12 00:00:41,160 --> 00:00:43,360 DEVELOPED WORLD TO HAVE A BABY. 13 00:00:43,360 --> 00:00:49,320 AND THIS DISPARITY IS GREATLY 14 00:00:49,320 --> 00:00:55,480 INCREASED IN AFRICAN AMERICAN 15 00:00:55,480 --> 00:00:57,720 AND NATIVE INDIAN AND MORE 16 00:00:57,720 --> 00:01:01,360 LIKELY TO DIE TO PREGNANCY 17 00:01:01,360 --> 00:01:03,320 RELATED PEOPLE AND THIS EXISTS 18 00:01:03,320 --> 00:01:05,200 BY AGE AND GEOGRAPHY WITH WOMEN 19 00:01:05,200 --> 00:01:07,320 OVER 35 OR THOSE RESIDING IN 20 00:01:07,320 --> 00:01:12,960 RURAL AREAS AT HIGHER RISK. 21 00:01:12,960 --> 00:01:15,760 WE KN 22 00:01:15,760 --> 00:01:17,880 WE KNOW SOCIAL DETERMINATES PLAY 23 00:01:17,880 --> 00:01:20,680 A ROLE AND SOCIAL STRUCTURE AND 24 00:01:20,680 --> 00:01:23,280 ACCESS AND DELIVERY PLAY A ROLE 25 00:01:23,280 --> 00:01:26,520 AND CAN PERPETUATE AND MAGNIFY 26 00:01:26,520 --> 00:01:28,480 MATERNAL RISK FOR WOMEN OF COLOR 27 00:01:28,480 --> 00:01:30,280 IN INDIGENOUS COMMUNITIES. 28 00:01:30,280 --> 00:01:32,720 THE INSTITUTIONAL FACTORS ARE 29 00:01:32,720 --> 00:01:33,840 CRITICAL TO TAKE ADVANTAGE OF 30 00:01:33,840 --> 00:01:35,200 AND TO LEVERAGE AS WE MOVE 31 00:01:35,200 --> 00:01:37,200 FORWARD IN ADDRESSING THESE 32 00:01:37,200 --> 00:01:44,000 ISSUES. 33 00:01:44,000 --> 00:01:48,080 WE USE AN INTEGRATIVE LIFE 34 00:01:48,080 --> 00:01:51,360 COURSE LENS AND THE CONTEXT MUST 35 00:01:51,360 --> 00:01:53,280 BE VIEWED TO WHAT CAME BEFORE 36 00:01:53,280 --> 00:02:01,160 AND AFTER AND RIGOROUS STUDY HAS 37 00:02:01,160 --> 00:02:05,760 SHOWN PREGNANCY AND MENOPAUSE IS 38 00:02:05,760 --> 00:02:08,880 WHERE WE CAN HAVE GREAT IMPACT 39 00:02:08,880 --> 00:02:11,880 AND PUSH TO INTEGRATE RESEARCH 40 00:02:11,880 --> 00:02:14,800 TO IMPROVE THE HEALTH OF WOMEN 41 00:02:14,800 --> 00:02:16,720 AND VIEWING THE HEALTH OF WOMEN 42 00:02:16,720 --> 00:02:19,840 PRE PREGNANCY AND DURING AND 43 00:02:19,840 --> 00:02:20,800 POSTPARTUM AND EVERYTHING BEFORE 44 00:02:20,800 --> 00:02:22,760 AND IN BETWEEN AND BEYOND IS 45 00:02:22,760 --> 00:02:33,240 NEEDED TO HAVE MAXIMAL IMPACT. 46 00:02:33,240 --> 00:02:37,000 IF PRENATAL CARE IS HIGH 47 00:02:37,000 --> 00:02:40,160 PREGNANCY IS SAFER. 48 00:02:40,160 --> 00:02:41,560 STEPS LIKE BLOOD PRESSURE 49 00:02:41,560 --> 00:02:43,000 MONITORING DURING PREGNANCY CAN 50 00:02:43,000 --> 00:02:46,080 DO A LONG WAY IN DETECTING 51 00:02:46,080 --> 00:02:49,200 PREGNANCY RELATED HYPER TENSION 52 00:02:49,200 --> 00:02:52,360 AND PREVENTING POOR OUTCOMES. 53 00:02:52,360 --> 00:02:57,040 IF POSTPARTUM PEOPLE ARE LINKED 54 00:02:57,040 --> 00:03:04,160 TO CARE WE CAN TAKE ADVANTAGE 55 00:03:04,160 --> 00:03:06,240 REVEALING SUSCEPTIBLE TO 56 00:03:06,240 --> 00:03:09,120 GESTATIONAL DIABETES OR 57 00:03:09,120 --> 00:03:09,440 PREECLAMPSIA. 58 00:03:09,440 --> 00:03:14,680 SO IN CONSIDERING THE WOMEN'S 59 00:03:14,680 --> 00:03:19,960 LIFE COURSE I'D BE REMISS IF I 60 00:03:19,960 --> 00:03:23,160 DIDN'T MENTION A PUBLICATION 61 00:03:23,160 --> 00:03:24,520 SHOWING THAT HOMICIDE IS THE 62 00:03:24,520 --> 00:03:27,200 LEADING CAUSE OF DEATH DURING 63 00:03:27,200 --> 00:03:29,080 PREGNANCY AND THE POSTPARTUM 64 00:03:29,080 --> 00:03:34,120 PERIOD BETWEEN 2018 AND 2019. 65 00:03:34,120 --> 00:03:35,280 THESE RESEARCHERS FOUND 66 00:03:35,280 --> 00:03:41,520 U.S. WOMEN WHO WERE PREGNANT 67 00:03:41,520 --> 00:03:45,280 DIED BY HOMICIDE MORE THAN TWICE 68 00:03:45,280 --> 00:03:49,840 THE RATE OF PLACENTAL DISORDERS 69 00:03:49,840 --> 00:03:52,880 USUALLY THE HIGHEST CAUSE AND IT 70 00:03:52,880 --> 00:03:54,920 INCREASES THE RISK BY HOMICIDE. 71 00:03:54,920 --> 00:03:57,200 BETWEEN THE AGES OF 10 AND 44 72 00:03:57,200 --> 00:03:59,440 YEARS WHICH WOULD WERE PREGNANT 73 00:03:59,440 --> 00:04:01,520 OR HAD THEIR PREGNANCY END IN 74 00:04:01,520 --> 00:04:03,680 THE LAST YEAR WERE KILLED AT A 75 00:04:03,680 --> 00:04:05,720 RATE 16% HIGHER THAN WOMEN WHO 76 00:04:05,720 --> 00:04:10,840 WERE NOT PREGNANT. 77 00:04:10,840 --> 00:04:19,920 AND OVERALL, WOMEN OF ANY RACE 78 00:04:19,920 --> 00:04:22,840 HAD HIGHER NUMBERS AND LOOKING 79 00:04:22,840 --> 00:04:23,880 AT INTIMATE PARTNER HOMICIDE 80 00:04:23,880 --> 00:04:27,520 RATES OF NON PREGNANCY 81 00:04:27,520 --> 00:04:29,240 ASSOCIATED INTIMATE PARTNER 82 00:04:29,240 --> 00:04:30,840 HOMICIDE VICTIMIZATION WERE 83 00:04:30,840 --> 00:04:33,800 SIMILAR BETWEEN BLACK AND WHITE 84 00:04:33,800 --> 00:04:35,560 WOMEN BUT SIGNIFICANT 85 00:04:35,560 --> 00:04:36,920 DIFFERENCES WERE SEEN WHEN 86 00:04:36,920 --> 00:04:40,320 COMPARING PREGNANCY RELATED 87 00:04:40,320 --> 00:04:43,160 HOMICIDE SUCH THAT BLACK WOMEN 88 00:04:43,160 --> 00:04:44,760 HAD PREGNANCY ASSOCIATE THE 89 00:04:44,760 --> 00:04:47,840 RAPES MORE THAN THREE TIMES 90 00:04:47,840 --> 00:04:49,600 HIGHER THAN RATES IN HISPANIC 91 00:04:49,600 --> 00:04:52,080 AND WHITE AND WE KNOW PARTNER 92 00:04:52,080 --> 00:04:54,960 VIOLENCE CAN HAVE A DEFINITIVE 93 00:04:54,960 --> 00:04:57,880 IMPACT ON THE BIRTHING PERSON 94 00:04:57,880 --> 00:05:02,880 AND IN UTERO DEVELOPMENT LEADING 95 00:05:02,880 --> 00:05:06,120 TO AFFECTING MILK PRODUCTION AND 96 00:05:06,120 --> 00:05:07,520 ACCESS TO CARE THROUGHOUT AND 97 00:05:07,520 --> 00:05:09,440 AFTER THE PREGNANCY. 98 00:05:09,440 --> 00:05:12,480 TO ADDRESS THESE ISSUES ORW WITH 99 00:05:12,480 --> 00:05:14,440 OUR PARTNERS AT NICHD AND THE 100 00:05:14,440 --> 00:05:15,880 OFFICE OF THE DIRECTOR HAVE 101 00:05:15,880 --> 00:05:17,360 DEVELOPED THE IMPLEMENTING AND 102 00:05:17,360 --> 00:05:20,320 MATERNAL HEALTH AND PREGNANCY 103 00:05:20,320 --> 00:05:21,840 OUTCOME VISION FOR EVERYONE TO 104 00:05:21,840 --> 00:05:24,080 ADDRESS THE RISING RATES OF 105 00:05:24,080 --> 00:05:26,360 PREGNANCY RELATED DEATH AND MA 106 00:05:26,360 --> 00:05:27,520 TERRIBLE MORBIDITY. 107 00:05:27,520 --> 00:05:34,120 THIS WORKSHOP CONTACTS SOME 108 00:05:34,120 --> 00:05:40,160 AWARD RECIPIENTS AND ADDRESS THE 109 00:05:40,160 --> 00:05:45,000 GAPS IN MATERNAL RESEARCH AND IT 110 00:05:45,000 --> 00:05:45,760 SUPPORTS NOT ONLY THROUGH 111 00:05:45,760 --> 00:05:47,960 RESEARCH AND BY CONNECTING 112 00:05:47,960 --> 00:05:49,160 AWARDEES TO EACH OTHER AND NIH. 113 00:05:49,160 --> 00:05:53,080 BEING ABLE TO TAP INTO THE 114 00:05:53,080 --> 00:05:55,640 EXPERTISE OF ALL ALL THE 115 00:05:55,640 --> 00:05:56,360 PARTICIPATING INSTITUTES AND 116 00:05:56,360 --> 00:05:58,560 CENTERS PROVIDES AN OPPORTUNITY 117 00:05:58,560 --> 00:06:01,760 TO CREATE A COMPREHENSIVE 118 00:06:01,760 --> 00:06:04,160 APPROACH TO MATERNAL HEALTH 119 00:06:04,160 --> 00:06:06,520 RESEARCH AND ADDRESSING MATERNAL 120 00:06:06,520 --> 00:06:09,160 MORTALITY AND MORBIDITY AND 121 00:06:09,160 --> 00:06:11,760 GRATEFUL TO THE I.C.s FOR THEIR 122 00:06:11,760 --> 00:06:13,840 SUPPORT AND IT'S INCLUDE THE IN 123 00:06:13,840 --> 00:06:16,760 THE STRATEGIC PLAN AND WE LOOK 124 00:06:16,760 --> 00:06:17,760 ACROSS NIH IN COMPLIMENTARY 125 00:06:17,760 --> 00:06:19,600 MANNER TO GENERATE THE EVIDENCE 126 00:06:19,600 --> 00:06:20,760 THROUGH RIGOROUS RESEARCH AND 127 00:06:20,760 --> 00:06:25,360 STUDYING THE IMPLEMENTATION OF 128 00:06:25,360 --> 00:06:28,080 EVIDENCE-BASED INTERVENTIONS. 129 00:06:28,080 --> 00:06:29,760 WORKSHOPS SUCH AS THIS ALLOW 130 00:06:29,760 --> 00:06:31,920 SOLUTION ARE EVIDENCE-BASED AND 131 00:06:31,920 --> 00:06:35,880 EFFECTIVE FOR ALL POPULATIONS. 132 00:06:35,880 --> 00:06:39,120 NOW I'D LIKE TO PASS THE MIC TO 133 00:06:39,120 --> 00:06:40,360 DR. BIANCHI. 134 00:06:40,360 --> 00:06:41,800 >> THANK YOU FOR GIVING US THE 135 00:06:41,800 --> 00:06:50,240 BROAD FRAMEWORK. 136 00:06:50,240 --> 00:06:51,760 THIS IS YOUR LAST SLIDE. 137 00:06:51,760 --> 00:06:53,360 I WANTED TO TAKE THAT BROAD 138 00:06:53,360 --> 00:06:58,200 FRAMEWORK AND GIVE YOU 139 00:06:58,200 --> 00:07:00,160 HISTORICAL BACKGROUND AND PLACE 140 00:07:00,160 --> 00:07:01,600 THE IMPROVE INITIATIVE INTO THE 141 00:07:01,600 --> 00:07:02,960 CONTEXT OF TODAY'S WORKSHOP TO 142 00:07:02,960 --> 00:07:08,440 TRACE THE BEGINNINGS OF IMPROVE 143 00:07:08,440 --> 00:07:10,600 TO A MEETING DR. PEREZ-STABLE 144 00:07:10,600 --> 00:07:16,160 AND DR. GIBBONS AND I HAD WITH 145 00:07:16,160 --> 00:07:20,480 THE BLACK MATERNAL HEALTH CAUCUS 146 00:07:20,480 --> 00:07:20,680 EVENT. 147 00:07:20,680 --> 00:07:25,760 AND THAT WAS HELD INTERESTINGLY 148 00:07:25,760 --> 00:07:27,160 JUST PRIOR TO THE PANDEMIC AND 149 00:07:27,160 --> 00:07:29,920 WAS A MEMORABLE MEETING IT WAS 150 00:07:29,920 --> 00:07:34,400 WELL ATTENDED AND AT 7:30 IN THE 151 00:07:34,400 --> 00:07:38,360 MORNING AND WE WERE TAKEN TO 152 00:07:38,360 --> 00:07:41,240 TASK AND ASKED TO DO MORE IN 153 00:07:41,240 --> 00:07:42,880 TERMS OF COORDINATING EFFORTS 154 00:07:42,880 --> 00:07:44,600 AND RESEARCH AND MEMBERS OF 155 00:07:44,600 --> 00:07:46,160 CONGRESS WERE DEEPLY CONCERN 156 00:07:46,160 --> 00:07:51,640 ABOUT THE HEALTH DISPARITIES IN 157 00:07:51,640 --> 00:07:53,200 MATERNAL HEALTH. 158 00:07:53,200 --> 00:07:56,280 COMING FROM THAT, WE ESTABLISHED 159 00:07:56,280 --> 00:07:58,720 A TASK FORCE THAT HAS GROWN OVER 160 00:07:58,720 --> 00:08:01,240 TIME AND WE'LL BE ACKNOWLEDGING 161 00:08:01,240 --> 00:08:03,360 MANY OF THE MEMBERS OF THE TASK 162 00:08:03,360 --> 00:08:04,560 FORCE THAT CONTRIBUTED TO THE 163 00:08:04,560 --> 00:08:05,120 OVERALL VISION FOR THIS 164 00:08:05,120 --> 00:08:10,840 INITIATIVE. 165 00:08:10,840 --> 00:08:14,280 WE CAME UP WITH AN ACRONYM WHICH 166 00:08:14,280 --> 00:08:20,360 YOU KNOW AS IMPROVE AND IT 167 00:08:20,360 --> 00:08:22,440 INCLUDES BOTH FOUNDATIONAL 168 00:08:22,440 --> 00:08:24,520 BIOLOGY AND BIO AND SOCIAL 169 00:08:24,520 --> 00:08:25,000 RESEARCH. 170 00:08:25,000 --> 00:08:26,200 FROM THE BEGINNING WE RECOGNIZED 171 00:08:26,200 --> 00:08:28,480 WE NEEDED PARTNERSHIPS WITH THE 172 00:08:28,480 --> 00:08:28,800 COMMUNITY. 173 00:08:28,800 --> 00:08:34,920 WE NEEDED TO LISTEN TO THE 174 00:08:34,920 --> 00:08:35,520 COMMUNITY. 175 00:08:35,520 --> 00:08:37,280 WE NEEDED TO UNDERSTAND LOCAL 176 00:08:37,280 --> 00:08:39,560 CULTURE TO HAVE EFFECTIVE 177 00:08:39,560 --> 00:08:39,880 INTERVENTIONS. 178 00:08:39,880 --> 00:08:40,840 SO THIS GRAPHIC WAS MEANT TO 179 00:08:40,840 --> 00:08:45,880 SHOW WE WERE LOOKING BOTH AT 180 00:08:45,880 --> 00:08:46,960 WILL BIOMARKERS AS WELL AS 181 00:08:46,960 --> 00:08:49,720 DEMOGRAPHIC ISSUES THAT WOULD 182 00:08:49,720 --> 00:08:54,240 AFFECT RISK FOR MATERNAL 183 00:08:54,240 --> 00:08:54,960 MORBIDITY AND MORALITY AS WELL 184 00:08:54,960 --> 00:08:55,960 AS PLACING THE INDIVIDUAL 185 00:08:55,960 --> 00:08:57,480 PREGNANT PERSON IN THE CONTEXT 186 00:08:57,480 --> 00:09:13,520 OF THE COMMUNITY. 187 00:09:13,520 --> 00:09:15,360 AS A RESULT OF THAT WE HAD 188 00:09:15,360 --> 00:09:16,280 FUNDING AND INDIVIDUAL 189 00:09:16,280 --> 00:09:18,480 INSTITUTES AND CENTERS ALSO 190 00:09:18,480 --> 00:09:21,720 CONTRIBUTED MONEY THAT 191 00:09:21,720 --> 00:09:24,560 EVENTUALLY BECAME A $7 MILLION 192 00:09:24,560 --> 00:09:26,000 POOL WHICH SUPPORT THE FIRST 193 00:09:26,000 --> 00:09:29,280 ROUND OF 36 PROJECTS. 194 00:09:29,280 --> 00:09:34,280 THE TASK FORCE HAD MANY 195 00:09:34,280 --> 00:09:35,800 DISCUSSIO 196 00:09:35,800 --> 00:09:37,720 DISCUSSIONS ON HOW TO FOCUS THE 197 00:09:37,720 --> 00:09:44,360 REQUEST FOR SUPPLEMENTS AND 198 00:09:44,360 --> 00:09:48,960 CHOSE TO FOCUS ON HEALTH 199 00:09:48,960 --> 00:09:51,320 DISPARITIES INCLUDING 200 00:09:51,320 --> 00:09:53,400 CARDIOVASCULAR EVENTS AND THE 201 00:09:53,400 --> 00:09:57,040 AFFECTS OF MENTAL HEALTH ON 202 00:09:57,040 --> 00:09:57,760 MATERNAL MORTALITY AND MORBIDITY 203 00:09:57,760 --> 00:09:59,880 AND WE'LL HEAR WITH THE AREAS OF 204 00:09:59,880 --> 00:10:05,520 RESEARCH THE INITIAL GROUP OF 205 00:10:05,520 --> 00:10:09,080 AWARDEE 206 00:10:09,080 --> 00:10:10,640 AWARDEES FOCUSSED ON WITH 207 00:10:10,640 --> 00:10:11,920 HEMORRHAGE AND MATERNAL HEALTH 208 00:10:11,920 --> 00:10:13,040 AND WE'RE EXCITED TO HEAR WHAT 209 00:10:13,040 --> 00:10:23,240 YOU'VE DONE IN THE PAST YEAR. 210 00:10:23,240 --> 00:10:25,560 MOVING FORWARD WE DID NOT HAVE A 211 00:10:25,560 --> 00:10:27,520 DEDICATED POOL OF FUNDING 212 00:10:27,520 --> 00:10:30,120 BECAUSE OF THE GREAT INTEREST IN 213 00:10:30,120 --> 00:10:32,880 MATERNAL HEALTH AS WELL AS 214 00:10:32,880 --> 00:10:34,000 MATERNAL HEALTH AGAINST THE 215 00:10:34,000 --> 00:10:37,200 BACKGROUND OF BOTH THE PANDEMIC 216 00:10:37,200 --> 00:10:41,560 AND EVENTS OF 2020 DEMONSTRATING 217 00:10:41,560 --> 00:10:43,960 THE AFFECTS OF STRUCTURAL RACISM 218 00:10:43,960 --> 00:10:45,720 ON MATERNAL HEALTH AND IT WAS 219 00:10:45,720 --> 00:10:50,960 DIFFERENT ON 2021 AND BECAUSE OF 220 00:10:50,960 --> 00:10:52,920 OUR SUCCESS IN GETTING EXCELLENT 221 00:10:52,920 --> 00:10:55,280 APPLICANTS TO THE FIRST ROUND OF 222 00:10:55,280 --> 00:10:57,160 SUPPLEMENTS WE WERE ABLE TO 223 00:10:57,160 --> 00:10:58,280 SCOMBIEN FUNDING FOR BOTH THE 224 00:10:58,280 --> 00:11:00,880 OFFICE OF THE DIRECTOR 225 00:11:00,880 --> 00:11:02,760 AND AND INSTITUTES AND CENTERS 226 00:11:02,760 --> 00:11:04,560 AND DOUBLE FUNDING FOR A SMALLER 227 00:11:04,560 --> 00:11:06,040 NUMBER OF PROJECTS BUT WE WERE 228 00:11:06,040 --> 00:11:08,360 ABLE TO GIVE MORE MONEY TO EACH 229 00:11:08,360 --> 00:11:11,800 INDIVIDUAL PROJECT AND WE HOPE 230 00:11:11,800 --> 00:11:19,800 TO HEAR FROM THE 2021 GRANTEES 231 00:11:19,800 --> 00:11:20,840 IN THE NEAR FUTURE. 232 00:11:20,840 --> 00:11:22,680 BECAUSE WE WERE ONLY FUNDING IN 233 00:11:22,680 --> 00:11:25,200 TERMS OF SUPPLEMENTS, THERE IS 234 00:11:25,200 --> 00:11:29,960 AN IMPLICIT BIAS IN TERMS OF 235 00:11:29,960 --> 00:11:31,400 USING SUPPLEMENTS AND ONLY ABLE 236 00:11:31,400 --> 00:11:35,000 TO GIVE ADDITIONAL MONEY TO 237 00:11:35,000 --> 00:11:40,400 PEOPLE WHO ALREADY ARE GRANTEES. 238 00:11:40,400 --> 00:11:42,760 THAT IN A SENSE BIAS AGAINST 239 00:11:42,760 --> 00:11:44,640 PEOPLE WHO MAY HAVE A DIFFERENT 240 00:11:44,640 --> 00:11:45,040 PERSPECTIVE. 241 00:11:45,040 --> 00:11:52,160 WITH THE SUPPORT OF CONGRESS WE 242 00:11:52,160 --> 00:11:56,800 WERE IEABLE TO BRING THE MORE 243 00:11:56,800 --> 00:11:58,680 SUSTAINED FUNDING AND THAT GOT 244 00:11:58,680 --> 00:12:01,160 THROUGH TO THE PROPOSED 245 00:12:01,160 --> 00:12:03,320 PRESIDENT'S BUDGET WHICH SETS 246 00:12:03,320 --> 00:12:07,760 ASIDE $30 MILLION AS A TRANS-NIH 247 00:12:07,760 --> 00:12:10,760 BUDGET FOR IMPROVE AND MOST 248 00:12:10,760 --> 00:12:11,800 IMPORTANTLY THAT WOULD PROVIDE 249 00:12:11,800 --> 00:12:13,560 SUSTAINABILITY AND WOULD ALLOW 250 00:12:13,560 --> 00:12:16,760 US TO GO INTO MECHANISMS OTHER 251 00:12:16,760 --> 00:12:18,160 THAN SUPPLEMENTAL FUNDING. 252 00:12:18,160 --> 00:12:22,680 AS YOU KNOW, WE STILL DON'T HAVE 253 00:12:22,680 --> 00:12:25,480 AN NATIONAL BUDGET FOR FISCAL 254 00:12:25,480 --> 00:12:31,160 '22 AND OPERATING UNDER A 255 00:12:31,160 --> 00:12:33,200 CONTINUING RESOLUTION WHERE WE 256 00:12:33,200 --> 00:12:35,880 CAN'T INCREASE FUNDING FOR 257 00:12:35,880 --> 00:12:37,200 ANYTHING UNTIL WE HAVE A BUDGET 258 00:12:37,200 --> 00:12:38,720 BUT ARE EXPECTING TO HAVE A 259 00:12:38,720 --> 00:12:40,520 BUDGET, HOPEFULLY, AND PREPARED 260 00:12:40,520 --> 00:12:46,360 TO MOVE FORWARD IF AND WHEN WE 261 00:12:46,360 --> 00:12:54,720 DO GET A BUDGET AFTER THE MARCH 262 00:12:54,720 --> 00:12:55,840 11 DEADLINE. 263 00:12:55,840 --> 00:12:58,880 YOU CAN SEE THE AMOUNT OF PEOPLE 264 00:12:58,880 --> 00:13:01,560 WE'VE BEEN ABLE TO INCLUDE THE 265 00:13:01,560 --> 00:13:02,960 PERSPECTIVES OF DIFFERENT NIH 266 00:13:02,960 --> 00:13:04,200 STAFF MEMBERS WITH DIFFERENT 267 00:13:04,200 --> 00:13:05,480 AREAS OF EXPERTISE. 268 00:13:05,480 --> 00:13:08,000 JUST LOOK AT THE INSTITUTES AND 269 00:13:08,000 --> 00:13:08,960 CENTERS THAT ARE REPRESENTED 270 00:13:08,960 --> 00:13:18,280 HERE AND SEE THIS IS TRULY TRANS 271 00:13:18,280 --> 00:13:22,160 NIH EFFORT AND WOULD LIKE TO 272 00:13:22,160 --> 00:13:23,280 THANK THE ACTIVE PARTICIPATION 273 00:13:23,280 --> 00:13:27,200 AND ENGAGEMENT OF EVERYONE ON 274 00:13:27,200 --> 00:13:29,160 THE LIST AS WELL AS OTHERS. 275 00:13:29,160 --> 00:13:31,960 IN ADDITION THE NAME I DON'T SEE 276 00:13:31,960 --> 00:13:35,040 IS DR. ACLAND AND SHE WILL CLOSE 277 00:13:35,040 --> 00:13:37,440 OUT THE CONFERENCE AT THE END OF 278 00:13:37,440 --> 00:13:43,840 THE DAY. 279 00:13:43,840 --> 00:13:45,960 WITH THAT I'LL HAND IT OVER AND 280 00:13:45,960 --> 00:13:48,680 COURTNEY IS SMILING AND I'M 281 00:13:48,680 --> 00:13:51,360 GOING TO HAND OVER THE VIRTUAL 282 00:13:51,360 --> 00:14:01,480 MIC TO OUR MODERATOR. 283 00:14:01,480 --> 00:14:05,720 >> THANK YOU, EVERYONE. 284 00:14:05,720 --> 00:14:09,960 I'M FROM NHLBI THE SENIOR 285 00:14:09,960 --> 00:14:11,800 ADVISER FOR WOMEN'S HEALTH AND 286 00:14:11,800 --> 00:14:13,280 ASSOCIATE DIRECTOR FOR 287 00:14:13,280 --> 00:14:15,440 PREVENTION AND POPULATION 288 00:14:15,440 --> 00:14:17,320 SCIENCES IN OUR DIVISION OF 289 00:14:17,320 --> 00:14:21,840 CARDIOVASCULAR SCIENCES IT'S MY 290 00:14:21,840 --> 00:14:26,560 PLEASURE TO MODERATE THE SESSION 291 00:14:26,560 --> 00:14:30,680 ON CARDIOVASCULAR RISK AND 292 00:14:30,680 --> 00:14:31,560 PREECLAMPSIA. 293 00:14:31,560 --> 00:14:34,160 AND OUR FIRST SPEAKER WILL BE 294 00:14:34,160 --> 00:14:41,240 SPEAKING ON A COMORBIDITY 295 00:14:41,240 --> 00:14:50,960 SCREENING TOOL TO PREDICT 296 00:14:50,960 --> 00:14:57,840 COMORBIDI 297 00:14:57,840 --> 00:14:58,160 COMORBIDITY. 298 00:14:58,160 --> 00:15:01,800 WHEN YOU'RE AT THE NINE-MINUTE 299 00:15:01,800 --> 00:15:05,080 MARK I'LL PROBABLY INTERRUPT AND 300 00:15:05,080 --> 00:15:13,520 LET YOU KNOW YOU HAVE ONE MINUTE 301 00:15:13,520 --> 00:15:15,960 REMAINING TO SAVE FIVE MINUTES 302 00:15:15,960 --> 00:15:17,840 OF Q&A FOR THE AUDIENCE AND USE 303 00:15:17,840 --> 00:15:19,640 THE ZOOM FUNCTION TO TYPE IN 304 00:15:19,640 --> 00:15:20,680 YOUR QUESTIONS. 305 00:15:20,680 --> 00:15:26,000 I'LL PASS THE MIC ON TO YOU. 306 00:15:26,000 --> 00:15:27,320 >> THANKS SO MUCH FOR THE 307 00:15:27,320 --> 00:15:28,960 OPPORTUNITY AND TO TELL YOU 308 00:15:28,960 --> 00:15:32,360 ABOUT THE PROJECT TODAY. 309 00:15:32,360 --> 00:15:35,640 AS WE ALL JUST HEARD THE RATES 310 00:15:35,640 --> 00:15:36,920 OF PREGNANCY RELATED MORTALITY 311 00:15:36,920 --> 00:15:39,120 IN THE UNITED STATES HAVE BEEN 312 00:15:39,120 --> 00:15:39,960 INCREASING AND THAT I THINK WILL 313 00:15:39,960 --> 00:15:42,360 CONTINUE TO BE TRUE AS WE LOOK 314 00:15:42,360 --> 00:15:43,200 AT HOW MANY DEATHS THERE'S BEEN 315 00:15:43,200 --> 00:15:46,000 IN ADDITION TO OUR BASELINE FROM 316 00:15:46,000 --> 00:15:49,480 COVID-19 OVER THE PAST TWO 317 00:15:49,480 --> 00:15:54,200 YEARS. 318 00:15:54,200 --> 00:15:56,920 MORE THAN 60% ARE PREVENTIBLE SO 319 00:15:56,920 --> 00:16:00,560 HOW CAN WE IDENTIFY AT RISK 320 00:16:00,560 --> 00:16:01,360 PATIENTS EARLIER TOE TAKE 321 00:16:01,360 --> 00:16:06,600 MEASURES TO DECREASE MORTALITY 322 00:16:06,600 --> 00:16:10,080 AND MORBIDITY. 323 00:16:10,080 --> 00:16:15,080 ONE SUCH PUBLIC HEALTH AT 324 00:16:15,080 --> 00:16:17,120 BRIGHAM'S HOSPITAL WAS DESIGNED 325 00:16:17,120 --> 00:16:20,600 BY DR. EASTER AND ORIGINALLY THE 326 00:16:20,600 --> 00:16:21,840 MATERNAL COMORBIDITY INDEX WAS 327 00:16:21,840 --> 00:16:23,760 USED AS A TOOL FOR GIVING ONE 328 00:16:23,760 --> 00:16:27,400 NUMBER TO PREDICT MATERNAL 329 00:16:27,400 --> 00:16:28,480 COMORBIDITIES WHEN LOOKING AT 330 00:16:28,480 --> 00:16:31,600 VARIOUS OUTCOMES IN PREGNANCY 331 00:16:31,600 --> 00:16:33,240 FROM LARGE DATABASES WHICH 332 00:16:33,240 --> 00:16:35,720 DR. BATEMAN HAS PUBLISHED AND 333 00:16:35,720 --> 00:16:38,280 DR. EASTER WORKING TOGETHER WITH 334 00:16:38,280 --> 00:16:42,040 DR. BATEMAN AND SEVERAL OTHER 335 00:16:42,040 --> 00:16:43,560 COLLABORATORS HERE AT BRIGHAM 336 00:16:43,560 --> 00:16:44,520 AND WOMEN'S HOSPITAL THOUGHT 337 00:16:44,520 --> 00:16:47,920 THEY CAN TAKE THE COOL AND USE 338 00:16:47,920 --> 00:16:52,560 IT IN CLINICAL CARE TO PREDICT 339 00:16:52,560 --> 00:16:56,800 WHO WAS AT RISK AND ADDED 340 00:16:56,800 --> 00:16:58,360 ADDITIONAL FEATURES WHO WERE NOT 341 00:16:58,360 --> 00:17:01,200 POSSIBLE PREVIOUSLY INCLUDING 342 00:17:01,200 --> 00:17:05,360 THE DELIVERY OF PLACENTAL 343 00:17:05,360 --> 00:17:09,040 ABNORMALITIE 344 00:17:09,040 --> 00:17:09,360 ABNORMALITIES. 345 00:17:09,360 --> 00:17:12,320 WHAT YOU SEE IS THE SCORES AND 346 00:17:12,320 --> 00:17:14,960 THE FEATURES INCLUDED IN THE 347 00:17:14,960 --> 00:17:15,160 OBCMI. 348 00:17:15,160 --> 00:17:18,760 THEY RANGE FROM PREGNANCY 349 00:17:18,760 --> 00:17:22,240 CONDITIONS TO MATERNAL 350 00:17:22,240 --> 00:17:24,320 COMORBIDITIES AND AGE SUBSTANCE 351 00:17:24,320 --> 00:17:26,200 USE AND BODY MASS INDEX. 352 00:17:26,200 --> 00:17:27,600 WHAT DR. EASTER AND COLLEAGUES 353 00:17:27,600 --> 00:17:32,040 FOUND INDEED THE OB-CMI DID 354 00:17:32,040 --> 00:17:34,760 PREDICT SEVERE MATERNAL 355 00:17:34,760 --> 00:17:37,240 MORBIDITY AT DELIVERY AND THOSE 356 00:17:37,240 --> 00:17:41,400 WHAT HAD A SCORE OF 0 HAD A 357 00:17:41,400 --> 00:17:43,080 LOWER CHANCE AND THOSE WITH 9 OR 358 00:17:43,080 --> 00:17:47,720 GREATER HAD ALMOST A 20% CHANCE 359 00:17:47,720 --> 00:17:52,880 OF SEEING MATERNAL MORBIDITY AND 360 00:17:52,880 --> 00:17:57,240 HEMORRHAGE WAS THE MOST COMMON 361 00:17:57,240 --> 00:18:02,400 REASON AT DELIVERY AND USED THE 362 00:18:02,400 --> 00:18:04,240 OBSTETRIC CARE CONSENSUS 363 00:18:04,240 --> 00:18:06,360 DOCUMENT YOU CAN READ MORE 364 00:18:06,360 --> 00:18:07,520 ABOUT. 365 00:18:07,520 --> 00:18:10,720 SO LOOKING AT THIS DATA HERE AT 366 00:18:10,720 --> 00:18:12,160 BRIGHAM AND WOMEN'S HOME WE 367 00:18:12,160 --> 00:18:13,920 THOUGHT WE COULD ENHANCE THE 368 00:18:13,920 --> 00:18:20,000 TOOL OF THE OB-CMI BY 369 00:18:20,000 --> 00:18:24,000 INTEGRATING INTO THE BIO BANK 370 00:18:24,000 --> 00:18:25,960 CALLED LIFE COACH. 371 00:18:25,960 --> 00:18:27,040 IT'S BEEN AT THE HOSPITAL SINCE 372 00:18:27,040 --> 00:18:29,080 2006 AND COLLECTED MORE THAN 373 00:18:29,080 --> 00:18:31,600 5,000 PREGNANCY TO DATE. 374 00:18:31,600 --> 00:18:45,520 IT ENROLLS ALL COMERS AND ASKS 375 00:18:45,520 --> 00:18:45,920 QUESTIONAIRES. 376 00:18:45,920 --> 00:18:50,640 THIS SAY RICH RESOURCE WITH MANY 377 00:18:50,640 --> 00:18:52,000 BIOLOGIC MEASURES AS WELL AS 378 00:18:52,000 --> 00:18:54,280 CLINICAL DATA FOR IMPLEMENTATION 379 00:18:54,280 --> 00:18:56,120 AND INFORMATION A TOOL SUCH AS 380 00:18:56,120 --> 00:18:56,320 THIS. 381 00:18:56,320 --> 00:18:58,160 THE MAIN QUESTIONS WE AIM IT 382 00:18:58,160 --> 00:19:05,320 ANSWER WERE CAN THE OB-CMI BE 383 00:19:05,320 --> 00:19:10,240 USED AT THE INITIATION OF PRE 384 00:19:10,240 --> 00:19:12,960 NATAL CARE AND WHAT CAN BE 385 00:19:12,960 --> 00:19:16,240 INTEGRATED IN TO ENHANCE 386 00:19:16,240 --> 00:19:17,960 PREDICTIVE CAPABILITIES AND CAN 387 00:19:17,960 --> 00:19:20,960 GENETIC AND OTHER PREDICTORS OF 388 00:19:20,960 --> 00:19:24,720 PREECLAMPSIA A DRIVER OF THE 389 00:19:24,720 --> 00:19:27,160 OB-CMI ENHANCE THE RISK 390 00:19:27,160 --> 00:19:29,640 PREDICTION BEYOND THE OB-CMI. 391 00:19:29,640 --> 00:19:32,040 SO FOR THIS PROJECT I'VE BEEN 392 00:19:32,040 --> 00:19:34,200 WORKING WITH AMAZING MEDICAL 393 00:19:34,200 --> 00:19:45,040 STUDENTS TOOK THE OB-CMI AT THE 394 00:19:45,040 --> 00:19:46,760 PRESENTATION TO CARE AND 395 00:19:46,760 --> 00:19:47,480 DELIVERY AND WE'RE IN THE 396 00:19:47,480 --> 00:19:48,840 PROCESS OF IDENTIFYING ALL THE 397 00:19:48,840 --> 00:19:50,760 CASES AND HAVE DONE THIS BACK TO 398 00:19:50,760 --> 00:19:52,720 2018 AND WE'RE INTEGRATING IT 399 00:19:52,720 --> 00:19:57,240 WITH OTHER FACTORS IN LIFE CODES 400 00:19:57,240 --> 00:20:00,680 TO SEE WHAT FACTORS INFLUENCE 401 00:20:00,680 --> 00:20:01,880 THIS PREDICTION MODEL. 402 00:20:01,880 --> 00:20:05,080 AS YOU SEE HERE THE FACTORS 403 00:20:05,080 --> 00:20:07,120 INCLUDED IN THE OB-CMI FOR THEIR 404 00:20:07,120 --> 00:20:08,680 PREVALENCE IN OUR LIFE CODES 405 00:20:08,680 --> 00:20:10,080 POPULATION ARE LISTED HERE AND 406 00:20:10,080 --> 00:20:13,040 I'LL POINT OUT 16% OF OUR 407 00:20:13,040 --> 00:20:15,760 PATIENTS HAVE SOME TYPE OF 408 00:20:15,760 --> 00:20:17,800 HYPERTENSION OR PREECLAMPSIA. 409 00:20:17,800 --> 00:20:21,200 THERE'S A POPULATION AND 410 00:20:21,200 --> 00:20:22,840 SIGNIFICANT CARDIAC POPULATION 411 00:20:22,840 --> 00:20:24,800 AS WELL AS A SIGNIFICANTLY OLDER 412 00:20:24,800 --> 00:20:26,960 POPULATION OF DELIVERIES WHICH 413 00:20:26,960 --> 00:20:29,080 REFLECTS WHAT WE SEE IN BOSTON 414 00:20:29,080 --> 00:20:33,200 AND 10% OF PROJECT OBESE BEYOND 415 00:20:33,200 --> 00:20:39,680 40. 416 00:20:39,680 --> 00:20:43,400 WE FOUND THEY DID REFLECT THE 417 00:20:43,400 --> 00:20:46,760 PILOT AT BRIGHAM AND OB-CMI WAS 418 00:20:46,760 --> 00:20:51,480 ASSOCIATED WHERE INDIVIDUALS 419 00:20:51,480 --> 00:20:54,760 WITH A GREATER THAN 9 OB-CMI HAS 420 00:20:54,760 --> 00:20:58,400 HAVING A MORE THAN 20% RISK AND 421 00:20:58,400 --> 00:21:03,160 REPLICATE WHAT'D HAD BEEN SEEN 422 00:21:03,160 --> 00:21:06,520 IN THE PAPER AND THERE WERE 423 00:21:06,520 --> 00:21:06,960 CORRELATION. 424 00:21:06,960 --> 00:21:08,120 SOMETHING INTERESTING WE FOUND 425 00:21:08,120 --> 00:21:11,760 WHEN WE WERE ABLE TO LOOK AT WHO 426 00:21:11,760 --> 00:21:13,920 HAD DELIVERY AND LOOK AT THEIR 427 00:21:13,920 --> 00:21:15,920 OB-CMI SCORES FROM THE 428 00:21:15,920 --> 00:21:18,880 AMBULATORY PERIOD IS WHAT WE SAW 429 00:21:18,880 --> 00:21:21,840 IS PEOPLE WHO EXPERIENCED SMM 430 00:21:21,840 --> 00:21:24,160 HAD DELIVERY HAD AN INCREASE IN 431 00:21:24,160 --> 00:21:25,360 THEIR OB-CMI FROM THEIR 432 00:21:25,360 --> 00:21:33,440 INITIATION OF PRE NATAAL CARE 433 00:21:33,440 --> 00:21:34,760 AND SHOWS HOW CHANGES FROM 434 00:21:34,760 --> 00:21:36,320 PREGNANCY FROM THE TIME OF 435 00:21:36,320 --> 00:21:38,520 INITIATION OF CARE TO DELIVERY 436 00:21:38,520 --> 00:21:40,160 ARE AN IMPORTANT COMPONENT OF 437 00:21:40,160 --> 00:21:44,120 ASSESSING WHO IS AT RISK AND WAS 438 00:21:44,120 --> 00:21:48,360 DRIVEN BY THE DEVELOPMENT OF 439 00:21:48,360 --> 00:21:50,480 PREECLAMPSIA AND GESTATIONAL 440 00:21:50,480 --> 00:21:52,640 DIABETES, INTERESTINGLY, BMI 441 00:21:52,640 --> 00:21:54,760 GREATER THAN 40. 442 00:21:54,760 --> 00:21:57,600 PEOPLE WHO CROSSED INTO THAT 443 00:21:57,600 --> 00:22:00,880 CATEGORY HAD AN INCREASED RISK 444 00:22:00,880 --> 00:22:02,760 OF MORBIDITY AND PLACENTAL 445 00:22:02,760 --> 00:22:03,360 DISORDERS. 446 00:22:03,360 --> 00:22:05,040 HOW DO OTHER FACTORS RELATE TO 447 00:22:05,040 --> 00:22:05,960 THE OB-CMI. 448 00:22:05,960 --> 00:22:08,160 THIS IS SOMETHING WE'RE JUST 449 00:22:08,160 --> 00:22:09,200 BEGINNING TO EXPLORE WITH THE 450 00:22:09,200 --> 00:22:11,280 NEW DATA SET AND INTERESTINGLY 451 00:22:11,280 --> 00:22:15,360 WHEN WE LOOK ACROSS MATERNAL 452 00:22:15,360 --> 00:22:17,640 RACE, ETHNICITY, INSURANCE TYPE 453 00:22:17,640 --> 00:22:20,360 AND LEVEL OF EDUCATION AND FOR 454 00:22:20,360 --> 00:22:22,400 INDIVIDUALS WITH AN OB-CMI OF 5 455 00:22:22,400 --> 00:22:24,680 OR GREATER IT'S REFLECTED ACROSS 456 00:22:24,680 --> 00:22:30,360 ALL POPULATIONS OF THESE 457 00:22:30,360 --> 00:22:33,560 CATEGORIES AND SO INDIVIDUALS 458 00:22:33,560 --> 00:22:36,600 WITH A HIGH OB-CMI ARE NOT 459 00:22:36,600 --> 00:22:38,560 CONCENTRATED IN ANY INSURANCE 460 00:22:38,560 --> 00:22:41,160 TYPE GROUP OR PARTICULAR LEVEL 461 00:22:41,160 --> 00:22:42,720 OF EDUCATION OR CONCEPTION TYPE. 462 00:22:42,720 --> 00:22:44,160 IT AFFECTS ALL INDIVIDUALS 463 00:22:44,160 --> 00:22:51,000 THROUGHOUT THESE CATEGORIES. 464 00:22:51,000 --> 00:22:53,760 WHAT WE DO TAKING FORWARD THE 465 00:22:53,760 --> 00:22:55,640 DATA IN OUR RICH LIFE CODES 466 00:22:55,640 --> 00:22:57,200 POPULATION IS TO UNDERSTAND 467 00:22:57,200 --> 00:23:02,440 WHETHER GENETIC AND BIOLOGIC 468 00:23:02,440 --> 00:23:05,720 DISORDERS ENHANCE THE RISK OF 469 00:23:05,720 --> 00:23:08,240 SEVERE MATERNAL MORBIDITY. 470 00:23:08,240 --> 00:23:10,200 ONE OF THE BIGGEST CHANGES AND 471 00:23:10,200 --> 00:23:13,240 WITH THE HIGHEST NUMBER OF 472 00:23:13,240 --> 00:23:20,280 POINTS GIVEN TO PREDICTION DUE 473 00:23:20,280 --> 00:23:27,160 TO THIS IS PREE -- PREECLAMPSIA 474 00:23:27,160 --> 00:23:29,160 AND TO UNDERSTAND WHO WILL 475 00:23:29,160 --> 00:23:30,320 PREDICT THAT OUTCOME ARE VERY 476 00:23:30,320 --> 00:23:32,000 IMPORTANT TO UNDERSTANDING WHO 477 00:23:32,000 --> 00:23:36,440 IS AT RISK FOR SMM. 478 00:23:36,440 --> 00:23:39,040 SO IN A JOINT OR COLLABORATIVE 479 00:23:39,040 --> 00:23:42,600 OR PARALLEL PROJECT, WE HAVE A 480 00:23:42,600 --> 00:23:44,000 TOP MED AWARD THAT INCLUDES LIFE 481 00:23:44,000 --> 00:23:52,160 CODES IN A PROJECT CALLED THE 482 00:23:52,160 --> 00:23:58,960 BOSTON COLOMBIA COLLABORATIVE 483 00:23:58,960 --> 00:24:01,520 AND WE TAKE IN THE CODES AND TOP 484 00:24:01,520 --> 00:24:04,800 MED SAY TRANS OMICS OR PRECISION 485 00:24:04,800 --> 00:24:08,360 MEDICINE PROJECT BY THE NHLBI 486 00:24:08,360 --> 00:24:13,760 THAT START IN 2014 WITH MANY 487 00:24:13,760 --> 00:24:18,040 STUDIES AND IT WAS THE FIRST 488 00:24:18,040 --> 00:24:20,280 YEAR ANY PREGNANCY COHORT HAD 489 00:24:20,280 --> 00:24:22,960 BEEN INCLUDED SO OUR PROJECT 490 00:24:22,960 --> 00:24:24,760 JOINED WITH THE NEW MOMS TO BE 491 00:24:24,760 --> 00:24:32,200 STUDY IN THAT YEAR. 492 00:24:32,200 --> 00:24:34,960 WE UNDER GO GENOME SEQUENCING 493 00:24:34,960 --> 00:24:37,040 AND INCLUDES THE CASES AND LIFE 494 00:24:37,040 --> 00:24:38,800 CODES AND WE'LL HAVE GENETIC 495 00:24:38,800 --> 00:24:41,680 DATA AS WELL AS OTHER OMIC DATA 496 00:24:41,680 --> 00:24:44,160 TO INTEGRATE CLOSELY WITH THE 497 00:24:44,160 --> 00:24:45,360 MEASURES OF COMORBIDITY TO 498 00:24:45,360 --> 00:24:46,760 DETERMINE OTHER PREDICTORS THAT 499 00:24:46,760 --> 00:24:49,920 CAN AUGMENT OUR PREDICTION OF 500 00:24:49,920 --> 00:24:52,400 SEVERE MATERNAL MORBIDITY AT 501 00:24:52,400 --> 00:24:53,040 DELIVERY. 502 00:24:53,040 --> 00:24:59,440 IN VIM, IT'S A USEFUL TOOL FOR 503 00:24:59,440 --> 00:25:00,560 UNDERSTANDING DELIVERY AND THE 504 00:25:00,560 --> 00:25:03,520 CHANGE TO DELIVERY IS IMPORTANT. 505 00:25:03,520 --> 00:25:09,400 THIS OCCURS ACROSS ALL SOCIO 506 00:25:09,400 --> 00:25:11,000 DEMOGRAPHIC CATEGORIES AND HOW 507 00:25:11,000 --> 00:25:12,560 OTHER FACTORS INTEGRATE IS AN 508 00:25:12,560 --> 00:25:14,560 IMPORTANT AREA OF ONGOING WORK 509 00:25:14,560 --> 00:25:16,360 IN OUR COHORT. 510 00:25:16,360 --> 00:25:20,320 AND THERE'S MANY PEOPLE TO THANK 511 00:25:20,320 --> 00:25:24,240 ACROSS BWH AND ALL THE FUNDERS 512 00:25:24,240 --> 00:25:29,320 INCLUDING THE NHLBI AND 513 00:25:29,320 --> 00:25:43,440 PREECLAMPSIA FOUNDATION AND 514 00:25:43,440 --> 00:25:48,120 MICAYLA FLORES. 515 00:25:48,120 --> 00:25:51,360 >> IF ANY PANELISTS WOULD LIKE 516 00:25:51,360 --> 00:25:53,000 TO ASK A QUESTION, RAISE YOUR 517 00:25:53,000 --> 00:25:54,760 HAND AND I'LL CALL ON YOU AND I 518 00:25:54,760 --> 00:25:57,480 HAVE ONE QUESTION TO START US 519 00:25:57,480 --> 00:25:59,240 OFF. 520 00:25:59,240 --> 00:26:02,760 I WAS WONDERING IF YOU CAN TELL 521 00:26:02,760 --> 00:26:05,280 US THE DEMOGRAPHICS OF THE LIFE 522 00:26:05,280 --> 00:26:06,760 CODES AND THE MINORITY 523 00:26:06,760 --> 00:26:07,440 REPRESENTATION GIVEN THEIR HIGH 524 00:26:07,440 --> 00:26:11,520 RISK OF SMM AND MORTALITY. 525 00:26:11,520 --> 00:26:13,400 THE QUESTION TOUCHES ON 526 00:26:13,400 --> 00:26:14,120 GENERALIZABILITY OF YOUR 527 00:26:14,120 --> 00:26:14,360 FINDINGS. 528 00:26:14,360 --> 00:26:21,840 >> THANK YOU. 529 00:26:21,840 --> 00:26:23,320 >> OUR LIFE CODES POPULATION IS 530 00:26:23,320 --> 00:26:26,800 ABOUT 20% WHITE AND 15% BLACK 531 00:26:26,800 --> 00:26:40,360 AND 15% ASIA AND 15% HISPANIC. 532 00:26:40,360 --> 00:26:41,360 >> THANK YOU. 533 00:26:41,360 --> 00:26:41,960 VERY DIVERSE. 534 00:26:41,960 --> 00:26:49,760 WONDERFUL TO HEAR. 535 00:26:49,760 --> 00:26:52,000 I DO NOT SEE HANDS UP OR ANY 536 00:26:52,000 --> 00:26:54,760 OTHER QUESTIONS SO I'LL ASK ONE. 537 00:26:54,760 --> 00:26:56,160 AS YOU KNOW AND YOU'LL HEAR FROM 538 00:26:56,160 --> 00:27:02,320 SEVERAL SPEAKERS OF THE SESSION, 539 00:27:02,320 --> 00:27:03,160 MATERNAL MORBIDITY EXPANDS TO 540 00:27:03,160 --> 00:27:04,520 THE POSTPARTUM PERIOD. 541 00:27:04,520 --> 00:27:07,280 DO YOU HAVE FINDINGS IN YOUR 542 00:27:07,280 --> 00:27:09,280 ANALYSES OR DO YOU PLAN TO DO 543 00:27:09,280 --> 00:27:11,760 ADDITIONAL ANALYSES ON THE 544 00:27:11,760 --> 00:27:13,840 PREDICTABILITY OF THE OB-CMI 545 00:27:13,840 --> 00:27:17,160 INTO THE POSTPARTUM CARE? 546 00:27:17,160 --> 00:27:19,360 >> WHEN WE'RE ASCERTAINING OUR 547 00:27:19,360 --> 00:27:21,880 CASES OF SMM WE'LL BE USING 548 00:27:21,880 --> 00:27:25,280 BILLING CODES FROM OUR 549 00:27:25,280 --> 00:27:29,680 INSTITUTION TO IDENTIFY SEVERE 550 00:27:29,680 --> 00:27:33,240 CASES AND LONGER TERM WE AIM TO 551 00:27:33,240 --> 00:27:34,440 FOLLOW CARDIOVASCULAR EVENTS AND 552 00:27:34,440 --> 00:27:37,240 THEIR RELATIONSHIP TO THIS SCORE 553 00:27:37,240 --> 00:27:40,200 AND THE LIFE CODES BIO BANK IS 554 00:27:40,200 --> 00:27:42,240 WELL SUITED TO DO THAT. 555 00:27:42,240 --> 00:27:44,360 >> THAT'S WONDERFUL TO HEAR AND 556 00:27:44,360 --> 00:27:47,640 NOT JUST THE POSTPARTUM PERIOD 557 00:27:47,640 --> 00:27:50,720 BUT YEARS LATER WHEN WE HEAR IT 558 00:27:50,720 --> 00:27:52,160 CAN IMPACT WHAT HAPPENS TO OUR 559 00:27:52,160 --> 00:27:53,160 HEALTH DOWN THE LINE. 560 00:27:53,160 --> 00:27:56,520 THAT'S WONDERFUL TO HEAR. 561 00:27:56,520 --> 00:28:00,800 THANK YOU. 562 00:28:00,800 --> 00:28:04,240 I SEE A QUESTION HERE WHAT DO 563 00:28:04,240 --> 00:28:06,960 YOU HOPE TO LEARN FROM THE 564 00:28:06,960 --> 00:28:09,280 GENETIC DATA OR HOW WILL IT BE 565 00:28:09,280 --> 00:28:10,520 USED IN PREDICTION MODELS? 566 00:28:10,520 --> 00:28:18,120 >> THOSE ARE GOOD QUESTIONS. 567 00:28:18,120 --> 00:28:20,160 I THINK IT WILL TAKE SOME 568 00:28:20,160 --> 00:28:20,480 EXPLORATION. 569 00:28:20,480 --> 00:28:22,200 I CAN TELL YOU FROM OTHER 570 00:28:22,200 --> 00:28:24,000 STUDIES ONGOING ABOUT THE 571 00:28:24,000 --> 00:28:26,280 GENETICS OF PRE-ECLAMPSIA AND 572 00:28:26,280 --> 00:28:29,280 WHAT WE'VE SEEN IS MOTHERS WHO 573 00:28:29,280 --> 00:28:31,760 HAVE A GENETIC PRE DISPOSITION 574 00:28:31,760 --> 00:28:34,200 TO HYPERTENSION ARE AT HIGHER 575 00:28:34,200 --> 00:28:37,440 RISK OF PREECLAMPSIA. 576 00:28:37,440 --> 00:28:39,120 UNDERSTANDING THE SPECIFIC 577 00:28:39,120 --> 00:28:40,160 BIOLOGIC PATHWAYS INVOLVED FOR 578 00:28:40,160 --> 00:28:45,120 INDIVIDUAL WHO'S HAVE THAT 579 00:28:45,120 --> 00:28:49,240 GENETIC PRE-DISPOSITION AND 580 00:28:49,240 --> 00:28:50,560 INTEGRATING THAT INTO CARE IS A 581 00:28:50,560 --> 00:28:52,240 WAY TO UNDERSTAND THE PORTION OF 582 00:28:52,240 --> 00:29:03,680 THE RISK THAT'S PRESENT. 583 00:29:03,680 --> 00:29:06,360 >> I DON'T SEE ANY MORE 584 00:29:06,360 --> 00:29:08,800 QUESTIONS SO THANK YOU, 585 00:29:08,800 --> 00:29:10,920 DR. GRAY. 586 00:29:10,920 --> 00:29:14,320 OUR NEXT SPEAKER IS FROM KAISER 587 00:29:14,320 --> 00:29:15,480 PERMANENTE NORTH CALIFORNIA. 588 00:29:15,480 --> 00:29:20,560 THE TITLE OF HER TALK IS SEVERE 589 00:29:20,560 --> 00:29:23,360 MATERNAL MORBIDITY DURING 590 00:29:23,360 --> 00:29:24,440 DELIVERY HOSPITALIZATION AND 591 00:29:24,440 --> 00:29:26,960 RACIAL AND ETHNIC DISPARITIES 592 00:29:26,960 --> 00:29:29,280 RELATED TO CHRONIC HYPER TENSION 593 00:29:29,280 --> 00:29:35,160 AND PREECLAMPSIA. 594 00:29:35,160 --> 00:29:39,840 WHEN YOU'RE AT THE NINE MINUTE 595 00:29:39,840 --> 00:29:41,640 MARK AGAIN IF I SEE YOU'RE NOT 596 00:29:41,640 --> 00:29:47,600 CLOSE TO THE FINAL SLIDE I MAY 597 00:29:47,600 --> 00:29:57,000 INTERRUPT. 598 00:29:57,000 --> 00:30:00,560 >> THANK YOU VERY MUCH FOR THE 599 00:30:00,560 --> 00:30:04,040 INVITATION TO PRESENT THIS 600 00:30:04,040 --> 00:30:05,600 ONGOING PROJECT WORK WITH A 601 00:30:05,600 --> 00:30:07,360 PARTICULAR FOCUS ON RACIAL AND 602 00:30:07,360 --> 00:30:10,160 ETHNIC DISPARITIES RELATED TO 603 00:30:10,160 --> 00:30:20,160 CHRONIC HYPER TENSION AND PREEE 604 00:30:20,160 --> 00:30:21,200 PREECLAMPSIA AND IT'S THE 605 00:30:21,200 --> 00:30:27,360 LEADING RISK FACTOR FOR SEVERE 606 00:30:27,360 --> 00:30:30,800 MATERNAL MORBIDITY AND MORE FOR 607 00:30:30,800 --> 00:30:33,200 BLACK WOMEN VERSUS WHITE WOMEN 608 00:30:33,200 --> 00:30:34,040 WHICH TRY CONTRIBUTE TO THE 609 00:30:34,040 --> 00:30:36,280 RACIAL AND ETHNIC DISPARITIES IN 610 00:30:36,280 --> 00:30:38,120 MATERNAL HEALTH OUTCOMES. 611 00:30:38,120 --> 00:30:42,600 A RECENT PUBLICATION IN 2021 BY 612 00:30:42,600 --> 00:30:47,960 CHAN ET AL HAS A COHORT OF OVER 613 00:30:47,960 --> 00:30:50,400 2 MILLION U.S. WOMEN WHO 614 00:30:50,400 --> 00:30:56,000 DELIVERED BETWEEN 2010 AND 2014. 615 00:30:56,000 --> 00:30:58,240 THESE ARE MEDICAID DATA AND 616 00:30:58,240 --> 00:30:59,160 COMMERCIAL CLAIM DATA AND THE 617 00:30:59,160 --> 00:31:03,240 POPULATION HAD A RATE OF 2.2% 618 00:31:03,240 --> 00:31:04,920 AND THAT'S A VERY DIVERSE RACIAL 619 00:31:04,920 --> 00:31:09,120 AND ETHNIC POPULATION WHILE THE 620 00:31:09,120 --> 00:31:09,960 COMMERCIAL INSURANCE POPULATION 621 00:31:09,960 --> 00:31:13,160 ESTIMATED SMM AT THE RATE OF 622 00:31:13,160 --> 00:31:16,520 1.7% BUT THERE WAS NO DATA ON 623 00:31:16,520 --> 00:31:18,880 RACE AND ETHNICITY IN THE 624 00:31:18,880 --> 00:31:19,120 SAMPLE. 625 00:31:19,120 --> 00:31:22,280 THE STUDY OBJECTIVES ARE TO 626 00:31:22,280 --> 00:31:26,200 EVALUATE THE ROLE OF PRIOR 627 00:31:26,200 --> 00:31:29,200 CHRONIC HYPER TENSION AND 628 00:31:29,200 --> 00:31:32,440 HYPERTENSIVE DISORDERS TO 629 00:31:32,440 --> 00:31:32,960 MATERNAL MORBIDITY AND 630 00:31:32,960 --> 00:31:34,560 UNDERSTAND THE DISPARITIES. 631 00:31:34,560 --> 00:31:38,520 THE SECOND OBJECTIVE IS TO 632 00:31:38,520 --> 00:31:40,440 EVALUATE IDENTIFY THE JOINT 633 00:31:40,440 --> 00:31:45,320 ASSOCIATION OF PRE EXISTING 634 00:31:45,320 --> 00:31:52,240 HYPER TENSION AND PREECLAMPSIA 635 00:31:52,240 --> 00:31:54,840 CONSULTING FOR SOCIAL FACTORS 636 00:31:54,840 --> 00:31:56,640 AND WE'RE USING ELECTRONIC 637 00:31:56,640 --> 00:32:01,160 HEALTH RECORDS FROM THE KAISER 638 00:32:01,160 --> 00:32:09,880 PERMANENTE POPULATION. 639 00:32:09,880 --> 00:32:12,760 AND THE WOMEN WERE 18 TO 45 640 00:32:12,760 --> 00:32:15,600 YEARS OF AGE AND CARE WAS 14 641 00:32:15,600 --> 00:32:18,720 WEEKS, DELIVERY AT HOSPITALS AND 642 00:32:18,720 --> 00:32:22,160 LEFT IN THE STARTING SAMPLE 643 00:32:22,160 --> 00:32:23,440 PEOPLE WITH DIABETES OR CHRONIC 644 00:32:23,440 --> 00:32:24,720 HYPER TENSION BUT TOOK OUT OTHER 645 00:32:24,720 --> 00:32:30,720 SERIOUS DISEASES. 646 00:32:30,720 --> 00:32:33,240 AND THE AUTOMATION DOESN'T SEEM 647 00:32:33,240 --> 00:32:38,480 TO BE MOVING THE SLIDE FORWARD. 648 00:32:38,480 --> 00:32:41,360 WE EXCLUDED WOMEN WITH PRYOR 649 00:32:41,360 --> 00:32:42,080 CHRONIC HYPERTENSION. 650 00:32:42,080 --> 00:32:44,680 WE TOOK THEM OUT AS A SEPARATE 651 00:32:44,680 --> 00:32:50,000 SAMPLE AND THAT'S 5.1% AND THAT 652 00:32:50,000 --> 00:32:53,240 LEFT US ABOUT 254,000 WOMEN WITH 653 00:32:53,240 --> 00:32:56,160 NO HYPER TENSION AND INCLUDED 654 00:32:56,160 --> 00:32:58,560 THOSE WITH A HISTORY OF 655 00:32:58,560 --> 00:33:02,160 PREECLAMPSIA AND LEFT WITH A 656 00:33:02,160 --> 00:33:06,840 RISK SAMPLE WITH NO HISTORY OF 657 00:33:06,840 --> 00:33:10,960 PREECLAMPSIA AND OUR TOTAL 658 00:33:10,960 --> 00:33:17,040 SAMPLE SIZE IS 263,000 WOMEN IN 659 00:33:17,040 --> 00:33:19,560 COMBINING THE LORE RISK SAMPLE 660 00:33:19,560 --> 00:33:22,200 AND THIS SLIDE SHOWS YOU THE 661 00:33:22,200 --> 00:33:26,440 TOTAL SAMPLE OF OUR LOW RISK 662 00:33:26,440 --> 00:33:28,200 PLUS CHRONIC HYPER TENSION AND 663 00:33:28,200 --> 00:33:30,440 THE RACIAL ETHNIC DISTRIBUTION 664 00:33:30,440 --> 00:33:37,240 WHICH IS 37% WHITE AND 26% 665 00:33:37,240 --> 00:33:40,800 HISPANIC AND 1% NATIVE HAWAIIAN, 666 00:33:40,800 --> 00:33:43,960 PACIFIC ISLANDERS AND A SMALL 667 00:33:43,960 --> 00:33:46,200 NUMBER OF AMERICAN AND ALASKAN 668 00:33:46,200 --> 00:33:49,240 NATIVE AND THE DISTRIBUTION BY 669 00:33:49,240 --> 00:33:52,000 RACE ETHNICITY CHANGES DEPENDING 670 00:33:52,000 --> 00:33:56,760 ON WHETHER THE WOMEN WERE IN THE 671 00:33:56,760 --> 00:34:00,160 LOW-RISK, NO-HYPER TENSIVE 672 00:34:00,160 --> 00:34:02,360 DISORDER SAMPLES AND REPRESENTED 673 00:34:02,360 --> 00:34:06,360 OF THE LARGER SAMPLE AND MAKES 674 00:34:06,360 --> 00:34:09,840 UP THE VAST MAJORITY AND PRIOR 675 00:34:09,840 --> 00:34:11,560 CHRONIC HYPER TENSION IS 676 00:34:11,560 --> 00:34:13,760 DISTRIBUTED DIFFERENTIALLY WITH 677 00:34:13,760 --> 00:34:14,800 DOUBLING OF THE PROPORTION OF 678 00:34:14,800 --> 00:34:17,280 BLACK WOMEN, 14% WHO HAVE 679 00:34:17,280 --> 00:34:19,520 CHRONIC HYPER TENSION AND FEWER 680 00:34:19,520 --> 00:34:21,760 ASIAN WOMEN AND THE OTHER RACIAL 681 00:34:21,760 --> 00:34:23,680 ETHNIC GROUP WERE STABLE IN IT 682 00:34:23,680 --> 00:34:25,280 TERMS OF THE RACIAL ETHNIC 683 00:34:25,280 --> 00:34:26,000 DISTRIBUTION. 684 00:34:26,000 --> 00:34:28,000 THESE ARE SOME OF THE KEY RISK 685 00:34:28,000 --> 00:34:29,960 FACTORS, AGE AND BMI IN THE 686 00:34:29,960 --> 00:34:31,840 POPULATION. 687 00:34:31,840 --> 00:34:34,920 YOU CAN SEE THE BLACK, HISPANIC 688 00:34:34,920 --> 00:34:36,960 AND NATIVE HAWAIIAN PACIFIC 689 00:34:36,960 --> 00:34:40,000 ISLANDERS GROUPS ARE HIGHER 690 00:34:40,000 --> 00:34:41,240 PROPORTION UNDER AGE 30. 691 00:34:41,240 --> 00:34:44,240 THEY'RE SLIGHTLY YOUNGER AND THE 692 00:34:44,240 --> 00:34:48,040 BMI GROUPS ARE DIFFERENCES BY 693 00:34:48,040 --> 00:34:49,120 RACE ETHNICITY WITH THE SAME 694 00:34:49,120 --> 00:34:51,080 GROUPS HAVING A HIGHER 695 00:34:51,080 --> 00:34:53,320 PROPORTION OF WOMEN WITH CLASS 696 00:34:53,320 --> 00:34:55,280 1, 2 OR 3 OBESITY. 697 00:34:55,280 --> 00:34:59,080 MORE THAN A THIRD OF THE NATIVE 698 00:34:59,080 --> 00:35:00,160 HAWAIIANS AND BLACK WOMEN AND 699 00:35:00,160 --> 00:35:03,440 THOSE ARE RISK FACTORS FOR HYPER 700 00:35:03,440 --> 00:35:09,280 TENSION AND PRE-ECLAMPSIA AND WE 701 00:35:09,280 --> 00:35:15,760 LOOKED AT THE RISK FACTOR IN THE 702 00:35:15,760 --> 00:35:17,840 SAME SUB GROUPS. 703 00:35:17,840 --> 00:35:21,160 WE DID ESTIMATE SEVERE MATERNAL 704 00:35:21,160 --> 00:35:22,240 MORBIDITY AND WHAT THE 705 00:35:22,240 --> 00:35:25,280 PROPORTION WOULD BE IN OUR 706 00:35:25,280 --> 00:35:30,560 PARTICULAR SAMPLE AND THESE ARE 707 00:35:30,560 --> 00:35:33,880 AND THIS IS COMING FROM 708 00:35:33,880 --> 00:35:34,760 ELECTRONIC HEALTH RECORDS FROM 709 00:35:34,760 --> 00:35:37,280 THE ENTIRE PREGNANCY AND DURING 710 00:35:37,280 --> 00:35:39,560 THE DELIVERY AND 711 00:35:39,560 --> 00:35:39,960 HOSPITALIZATION. 712 00:35:39,960 --> 00:35:44,000 IN OUR POPULATION THERE ARE 5589 713 00:35:44,000 --> 00:35:47,600 WOMEN WITH THE DISORDER OR 2.1%. 714 00:35:47,600 --> 00:35:52,320 OF OUR SAMPLE AND THIS SHOWS THE 715 00:35:52,320 --> 00:35:59,760 DISTRIBUTION OF NO PRIOR CHRONIC 716 00:35:59,760 --> 00:36:02,520 HYPER TENSION AND PRIOR CHRONIC 717 00:36:02,520 --> 00:36:06,200 HYPER TENSION AND SEE THE HIGHER 718 00:36:06,200 --> 00:36:10,000 RATES OF MATERNAL MORBIDITY WITH 719 00:36:10,000 --> 00:36:13,560 THOSE WITH PRIOR HYPER TENSION 720 00:36:13,560 --> 00:36:16,160 AND HIGHER RATES AMONG BLACK, 721 00:36:16,160 --> 00:36:18,600 ASIAN AND HISPANIC COMPARED TO 722 00:36:18,600 --> 00:36:21,360 WHITE WOMEN WITH A HIGH 723 00:36:21,360 --> 00:36:23,240 PROPORTION AMONG THE NATIVE 724 00:36:23,240 --> 00:36:26,360 HAWAIIAN PACIFIC ISLANDER GROUP. 725 00:36:26,360 --> 00:36:28,320 THIS SLIDE SHOWS THE FIVE SUB 726 00:36:28,320 --> 00:36:31,320 GROUPS OF LOOKING WITHIN WOMEN 727 00:36:31,320 --> 00:36:34,280 WHO HAD NO PRIOR CHRONIC HYPER 728 00:36:34,280 --> 00:36:36,480 TENSION BUT DEVELOPED 729 00:36:36,480 --> 00:36:40,240 HYPERTENSIVE DISORDERS SUCH AS 730 00:36:40,240 --> 00:36:42,040 GESTATIONAL HYPERTENSION IN THE 731 00:36:42,040 --> 00:36:44,720 BLUE BARS AND THE RED SHOWING 732 00:36:44,720 --> 00:36:46,560 THOSE WITH CHRONIC HYPER TENSION 733 00:36:46,560 --> 00:36:52,600 AND HAD NO PREECLAMPSIA AND 734 00:36:52,600 --> 00:36:57,240 THOSE WHO DID AND THIS SHOWS 735 00:36:57,240 --> 00:36:58,040 STATISTICAL DIFFERENCES WITHIN 736 00:36:58,040 --> 00:36:59,720 THE GROUPS OF THE LIGHT BARS AND 737 00:36:59,720 --> 00:37:02,560 THE COMPARISONS OF EACH SUB 738 00:37:02,560 --> 00:37:05,080 GROUP TO WHITE WOMEN AND THE 739 00:37:05,080 --> 00:37:06,800 LOWEST RISK ARE IN THE WHITE 740 00:37:06,800 --> 00:37:11,920 WOMEN OVERALL BUT YOU SEE THESE 741 00:37:11,920 --> 00:37:17,160 DISTINCT HIGHER PROPORTION OF 742 00:37:17,160 --> 00:37:18,440 SEVERE MATERNAL MORBIDITY IN 743 00:37:18,440 --> 00:37:20,960 WOMEN WITH NO HYPER TENSION WHO 744 00:37:20,960 --> 00:37:22,160 DEVELOPED PRE-ECLAMPSIA AND 745 00:37:22,160 --> 00:37:25,160 THOSE WHO DID WHO DEVELOP 746 00:37:25,160 --> 00:37:27,600 PRE-ECLAMPSIA AND THEY HAVE 747 00:37:27,600 --> 00:37:29,560 HIGHER RATES THAN THE WHITE 748 00:37:29,560 --> 00:37:31,760 WOMEN AND IN PARTICULAR FOR THE 749 00:37:31,760 --> 00:37:36,960 ASIANS AND SIMILAR HIGHER RATES 750 00:37:36,960 --> 00:37:40,400 OF SEVERE MATERNAL MORBIDITY 751 00:37:40,400 --> 00:37:49,800 WHEN WOMEN DEVELOP PRE-ECLAMPSIA 752 00:37:49,800 --> 00:37:53,080 AND THESE ARE THE PROPORTIONS OF 753 00:37:53,080 --> 00:37:57,560 WOMEN WHO DEVELOPED UPPER 754 00:37:57,560 --> 00:37:58,960 IMPOSED PRE-ECLAMPSIA AND WE 755 00:37:58,960 --> 00:38:05,160 HAVE OVER 13,000 WOMEN IN OUR 756 00:38:05,160 --> 00:38:08,920 SAMPLE WITH PRIOR CHRONIC HYPER 757 00:38:08,920 --> 00:38:12,480 TENSION AND WE SEE HIGHER 758 00:38:12,480 --> 00:38:16,560 PROPORTION OF PRE-ECLAMPSIA 759 00:38:16,560 --> 00:38:19,200 COMPARED TO THE WHITE WOMEN AND 760 00:38:19,200 --> 00:38:22,200 THOSE WITH THE NATIVE HAWAIIAN 761 00:38:22,200 --> 00:38:24,560 PACIFIC ISLANDER AND THE LOW 762 00:38:24,560 --> 00:38:27,760 RISK GROUP WITH NO HISTORY OF 763 00:38:27,760 --> 00:38:33,280 PRRNGS 764 00:38:34,240 --> 00:38:36,520 AND THE GESTATIONAL HYPER 765 00:38:36,520 --> 00:38:38,080 TENSION WITH SIGNIFICANT 766 00:38:38,080 --> 00:38:39,800 VARIATION IN SOME LOWER RISK IN 767 00:38:39,800 --> 00:38:42,200 THE SAME SUB GROUPS SUCH AS 768 00:38:42,200 --> 00:38:44,160 ASIANS AND HISPANICS. 769 00:38:44,160 --> 00:38:48,640 SO THIS IS THE MODELLING THAT'S 770 00:38:48,640 --> 00:38:51,320 THE FINAL ANALYSIS OF THESE RISK 771 00:38:51,320 --> 00:38:53,680 FACTORS WE MENTIONED ALONG WITH 772 00:38:53,680 --> 00:38:57,280 A FEW OTHERS INCLUDING SMOKING, 773 00:38:57,280 --> 00:38:58,960 DIABETES STATUS AND NEIGHBORHOOD 774 00:38:58,960 --> 00:39:04,040 DEPRIVATION INDEX WHICH I SHOWED 775 00:39:04,040 --> 00:39:08,720 YOU WE ARE SHOWING THE ADJUSTED 776 00:39:08,720 --> 00:39:14,880 ODDS RATIOS OF MATERNAL 777 00:39:14,880 --> 00:39:16,280 MORBIDITY AND THE WHITE GROUP IS 778 00:39:16,280 --> 00:39:17,560 THE REFERENCE GROUP FOR ALL THE 779 00:39:17,560 --> 00:39:25,320 GRAPHS AND YOU CAN SEE THE WOMEN 780 00:39:25,320 --> 00:39:28,280 WHO DEVELOPED PRE-ECLAMPSIA HAVE 781 00:39:28,280 --> 00:39:32,720 SIMILAR SIX TO SEVENFOLD HIGHER 782 00:39:32,720 --> 00:39:34,560 ODDS OF SEVERE MATERNAL 783 00:39:34,560 --> 00:39:35,600 MORBIDITY AT HOSPITALIZATION 784 00:39:35,600 --> 00:39:37,840 COMPARED TO THE WHITE GROUP. 785 00:39:37,840 --> 00:39:39,000 THAT IS CONSISTENT ACROSS ALL 786 00:39:39,000 --> 00:39:43,560 THE RACIAL AND ETHNIC GROUPS 787 00:39:43,560 --> 00:39:45,240 WITH SOME HIGHER RATES I 788 00:39:45,240 --> 00:39:49,280 HIGHLIGHTED FOR BLACK WOMEN AND 789 00:39:49,280 --> 00:39:51,240 SUBSTANTIALLY HIGHER ODDS OF 790 00:39:51,240 --> 00:39:54,040 SEVERE MATERNAL MORBIDITY AND A 791 00:39:54,040 --> 00:39:55,960 STAND OUT FOR THE NATIVE 792 00:39:55,960 --> 00:39:58,120 HAWAIIAN PACIFIC ISLANDER OF A 793 00:39:58,120 --> 00:40:03,280 10 TO 14 HIGHER ODDS OF THIS 794 00:40:03,280 --> 00:40:05,040 SEVERE MATERNAL MORBIDITY. 795 00:40:05,040 --> 00:40:09,240 WHERE YOU SEE SOMEWHAT HIGHER 796 00:40:09,240 --> 00:40:12,600 FOR THE OTHER CONDITIONS 797 00:40:12,600 --> 00:40:16,040 COMBINED WITH AND WITHOUT 798 00:40:16,040 --> 00:40:18,160 CHRONIC HYPER TENSION AND 799 00:40:18,160 --> 00:40:20,640 PREECLAMPSIA DRIVING THE 800 00:40:20,640 --> 00:40:22,040 INCREASED RISK OF SEVERE 801 00:40:22,040 --> 00:40:22,640 MATERNAL MORBIDITY. 802 00:40:22,640 --> 00:40:25,240 THE CONCLUSIONS FROM THE 803 00:40:25,240 --> 00:40:27,200 ANALYSIS THUS FAR ARE RELATED TO 804 00:40:27,200 --> 00:40:31,560 HIGHER RISK OF SMM DURING 805 00:40:31,560 --> 00:40:34,320 DELIVERY HOSPITALIZATION, 806 00:40:34,320 --> 00:40:36,360 PREECLAMPSIA SHOWED COMPARABLE 807 00:40:36,360 --> 00:40:39,800 HIGH RATES OF MORBIDITY WITH 808 00:40:39,800 --> 00:40:42,360 GROUPS WITH PRIOR HYPER TENSION 809 00:40:42,360 --> 00:40:45,400 AND WITHOUT HIRE TENSION AND 810 00:40:45,400 --> 00:40:48,440 HIGHEST RATES OF MORBIDITY WERE 811 00:40:48,440 --> 00:40:51,040 FOUND AMONG PACIFIC ISLANDER 812 00:40:51,040 --> 00:40:52,560 INDIVIDUALS FOLLOWED BY BLACK, 813 00:40:52,560 --> 00:40:55,040 ASIAN AND HISPANIC GROUPS 814 00:40:55,040 --> 00:40:57,760 INDEPENDENT OF AGE, OBESITY, 815 00:40:57,760 --> 00:40:59,560 SMOKING AND SOCIAL FACTORS AND 816 00:40:59,560 --> 00:41:01,880 MODIFICATION OF SMM RISK FACTORS 817 00:41:01,880 --> 00:41:04,680 ARE CRUCIAL TO ELIMINATING 818 00:41:04,680 --> 00:41:06,400 MATERNAL HEALTH DISPARITIES. 819 00:41:06,400 --> 00:41:08,600 I'D LIKE TO ACKNOWLEDGE OUR 820 00:41:08,600 --> 00:41:10,360 STUDY TEAM. 821 00:41:10,360 --> 00:41:14,120 THIS IS A COLLABORATIVE EFFORT 822 00:41:14,120 --> 00:41:16,200 AND ACKNOWLEDGE THE FUNDING 823 00:41:16,200 --> 00:41:17,840 SOURCE FOR THE PRIMARY R01 AND 824 00:41:17,840 --> 00:41:22,200 WE HAVE A FOUNDATIONAL PAPER 825 00:41:22,200 --> 00:41:24,600 JUST PUBLISHED IN HYPER TENSION 826 00:41:24,600 --> 00:41:27,520 THIS MONTH, FEBRUARY 2022 THAT 827 00:41:27,520 --> 00:41:29,480 LOOKS AT OUR BLOOD PRESSURE 828 00:41:29,480 --> 00:41:29,760 PATTERNS. 829 00:41:29,760 --> 00:41:37,960 THANK YOU FOR YOUR ATTENTION. 830 00:41:37,960 --> 00:41:53,560 >> WE'RE OPEN FOR Q&A. 831 00:41:53,560 --> 00:41:56,560 AS AN ASIAN AMERICAN I SEE THE 832 00:41:56,560 --> 00:42:01,920 NUMBER YOU HAVE IN YOUR 833 00:42:01,920 --> 00:42:02,240 ANALYSES. 834 00:42:02,240 --> 00:42:08,520 WE'RE OFTEN UNDER STUDIED IN 835 00:42:08,520 --> 00:42:13,640 RESEARCH. 836 00:42:13,640 --> 00:42:17,800 AND DO YOU HAVE THE ABILITY TO 837 00:42:17,800 --> 00:42:19,040 SEPARATE THE DATA TO 838 00:42:19,040 --> 00:42:20,920 DISAGGREGATE THEM BY THE 839 00:42:20,920 --> 00:42:26,120 DIFFERENT ASIAN AMERICAN 840 00:42:26,120 --> 00:42:26,880 SUBGROUPS? 841 00:42:26,880 --> 00:42:28,600 >> THAT'S OUR NEXT STEP. 842 00:42:28,600 --> 00:42:32,800 I'M GLAD YOU ASKED THAT 843 00:42:32,800 --> 00:42:33,840 QUESTION. 844 00:42:33,840 --> 00:42:34,520 IT'S VERY IMPORTANT. 845 00:42:34,520 --> 00:42:43,040 WE HAVE SOME ABILITY. 846 00:42:43,040 --> 00:42:46,200 WE WANT TO VALIDATE THE 847 00:42:46,200 --> 00:42:46,880 DIFFERENT GROUPINGS. 848 00:42:46,880 --> 00:42:50,000 WE HAVE PUBLISHED IN THE PAST ON 849 00:42:50,000 --> 00:42:52,280 FILIPINOS IN TERMS OF THEIR 850 00:42:52,280 --> 00:42:57,560 HIGHER RISK OF CARDIO MYOPATHY 851 00:42:57,560 --> 00:43:01,080 IN THE KAISER PERMANENTE DATA. 852 00:43:01,080 --> 00:43:04,960 WE'LL HAVE THE GROUPS SPECIFY. 853 00:43:04,960 --> 00:43:16,960 YOUR POINT IS WELL TAKEN. 854 00:43:16,960 --> 00:43:17,080 855 00:43:17,080 --> 00:43:19,760 >> YOU MENTIONED YOU CONTROL FOR 856 00:43:19,760 --> 00:43:22,040 AGE, OBESITY AND SMOKE AND 857 00:43:22,040 --> 00:43:25,320 FACTORS IN YOUR REGRESSION. 858 00:43:25,320 --> 00:43:27,320 CAN YOU EXPAND ON WHAT VARIABLES 859 00:43:27,320 --> 00:43:30,960 ARE THE SOCIAL FACTORS YOU 860 00:43:30,960 --> 00:43:35,840 CONTROLLED FOR AND WHY THE 861 00:43:35,840 --> 00:43:37,240 EXTREME HIGH ODDS AMONG THE 862 00:43:37,240 --> 00:43:41,960 PACIFIC ISLANDERS AND I THINK 863 00:43:41,960 --> 00:43:43,880 AMONG THE NH. 864 00:43:43,880 --> 00:43:49,480 >> NATIVE HAWAIIAN PACIFIC 865 00:43:49,480 --> 00:43:56,840 ISLANDER. 866 00:43:56,840 --> 00:44:02,400 AND SO THERE ARE TWO PARTS TO 867 00:44:02,400 --> 00:44:09,720 THIS QUESTION. 868 00:44:09,720 --> 00:44:12,920 WHY ARE WE SEEING THE HIGHER 869 00:44:12,920 --> 00:44:13,280 ODDS. 870 00:44:13,280 --> 00:44:15,240 WE'RE NOT SURE. 871 00:44:15,240 --> 00:44:20,680 WE DO KNOW THAT POPULATION HAS 872 00:44:20,680 --> 00:44:22,600 HIGHER RATES OF OBESITY AND MORE 873 00:44:22,600 --> 00:44:24,720 SEVERE OBESITY AND PERHAPS MORE 874 00:44:24,720 --> 00:44:25,760 CHRONIC HYPER TENSION BUT 875 00:44:25,760 --> 00:44:28,320 HAVEN'T LOOKED AT THEM 876 00:44:28,320 --> 00:44:28,720 CAREFULLY. 877 00:44:28,720 --> 00:44:30,040 I THINK WE HAVE A LOT OF TO 878 00:44:30,040 --> 00:44:33,320 LEARN AND WE HAVE TO DETERMINE 879 00:44:33,320 --> 00:44:37,040 THE IMPACT OF THE DELINQUENTAL 880 00:44:37,040 --> 00:44:40,240 FACTORS, SOCIAL FACTORS AND 881 00:44:40,240 --> 00:44:43,160 OTHER CULTURAL FACTORS AND 882 00:44:43,160 --> 00:44:43,440 MONITORING. 883 00:44:43,440 --> 00:44:45,560 I ALSO WANTED TO MENTION IN 884 00:44:45,560 --> 00:44:48,920 TERMS OF CHRONIC HYPER TENSION, 885 00:44:48,920 --> 00:44:53,000 WHEN YOU SAW PREECLAMPSIA WAS 886 00:44:53,000 --> 00:44:55,440 COMBINED WITH OR WITHOUT CHRONIC 887 00:44:55,440 --> 00:44:57,760 HYPERTENSION HAD THE HIGHEST 888 00:44:57,760 --> 00:45:01,920 RATES OF SEVERE MATERNAL 889 00:45:01,920 --> 00:45:05,480 MORBIDITY WE HAVE A REGIONAL 890 00:45:05,480 --> 00:45:08,560 PERINATAL PROGRAM THAT MONITORS 891 00:45:08,560 --> 00:45:10,440 BLOOD PRESSURE. 892 00:45:10,440 --> 00:45:15,560 THIS IS ANOTHER AREA TO EXPLORE. 893 00:45:15,560 --> 00:45:17,480 I THINK THIS IS THE FIRST STUDY 894 00:45:17,480 --> 00:45:18,920 TO LOOK AT THIS CAREFULLY. 895 00:45:18,920 --> 00:45:21,280 THE SOCIAL FACTORS YOU 896 00:45:21,280 --> 00:45:21,560 MENTIONED. 897 00:45:21,560 --> 00:45:22,960 RIGHT NOW WE HAVE THE 898 00:45:22,960 --> 00:45:27,400 NEIGHBORHOOD DEPRIVATION INDEX 899 00:45:27,400 --> 00:45:30,560 WHICH IS BASED ON CENSUS BLOCK 900 00:45:30,560 --> 00:45:30,840 GEOCODING. 901 00:45:30,840 --> 00:45:37,160 WE DO HAVE A TASK FORCE IN OUR 902 00:45:37,160 --> 00:45:38,560 KAISER PERMANENTE SYSTEM LOOKING 903 00:45:38,560 --> 00:45:41,240 TO MEASURE SOCIAL FACTORS IN 904 00:45:41,240 --> 00:45:42,960 OBTAINING SOME OF THOSE FROM 905 00:45:42,960 --> 00:45:44,000 ELECTRONIC HEALTH RECORDS. 906 00:45:44,000 --> 00:45:45,080 MORE TO COME WE HOPE WITH BETTER 907 00:45:45,080 --> 00:45:48,000 DEFINITION. 908 00:45:48,000 --> 00:45:51,160 >> THANK YOU, DR. GUNDERSON AND 909 00:45:51,160 --> 00:45:53,240 EVERYONE FOR YOUR CONTRIBUTIONS 910 00:45:53,240 --> 00:45:53,680 TO THE Q&A. 911 00:45:53,680 --> 00:45:56,040 WE'LL GO AHEAD AND MOVE ON TO 912 00:45:56,040 --> 00:45:59,040 OUR NEXT SPEAKER WHICH IS 913 00:45:59,040 --> 00:46:00,440 DR. MILLER FROM COLOMBIA 914 00:46:00,440 --> 00:46:00,760 UNIVERSITY. 915 00:46:00,760 --> 00:46:03,800 THE TITLE OF HER TALK IS 916 00:46:03,800 --> 00:46:09,000 NEUROVASCULAR UNIT DYSFUNCTION 917 00:46:09,000 --> 00:46:38,040 IN WOMEN WITH SEVERE 918 00:46:38,040 --> 00:46:51,080 PRE-ECLAMPSIA. 919 00:46:51,080 --> 00:46:52,960 >> THANK YOU FOR INVITING ME AND 920 00:46:52,960 --> 00:46:57,280 IT'S EXCITING TO SEE THIS KIND 921 00:46:57,280 --> 00:47:06,320 OF RESEARCH GOING ON. 922 00:47:06,320 --> 00:47:08,760 I THINK I'M THE ONLY PUBLIC 923 00:47:08,760 --> 00:47:38,160 HEALTH THAT CAME THROUGH NINDS. 924 00:47:38,160 --> 00:47:41,040 AND THESE ARE STROKES OR OTHER 925 00:47:41,040 --> 00:47:42,880 ACUTE CEREBRAL VASCULAR 926 00:47:42,880 --> 00:47:45,320 CONDITIONS AND THEY ARE NOT 927 00:47:45,320 --> 00:47:52,520 MILD. 928 00:47:52,520 --> 00:47:55,960 MANY HAVE SEVERE MORBIDITY AND 929 00:47:55,960 --> 00:47:58,240 PEOPLE ARE LEFT WITH SEVERE 930 00:47:58,240 --> 00:47:59,560 DISABILITY AND TRAUMA AFTER AN 931 00:47:59,560 --> 00:48:08,120 EVENT LIKE THIS. 932 00:48:08,120 --> 00:48:11,200 HERE'S THE CAUSES OF MATERNAL 933 00:48:11,200 --> 00:48:16,000 MORTALITY AND THEY SHOW A 934 00:48:16,000 --> 00:48:16,600 CEREBRAL VASCULAR ACCIDENT 935 00:48:16,600 --> 00:48:20,040 ACCOUNT FORD 8.2% OF MATERNAL 936 00:48:20,040 --> 00:48:22,160 MORTALITY AND YOU SEE THIS OTHER 937 00:48:22,160 --> 00:48:24,760 GROUP OF WOMEN WITH HIRE TENSIVE 938 00:48:24,760 --> 00:48:27,160 DISORDERS OF PREGNANCY AND 939 00:48:27,160 --> 00:48:29,040 WHAT'S NOT SHOWN HERE IS THAT IN 940 00:48:29,040 --> 00:48:32,520 THIS GROUP WHERE THE UNDERLYING 941 00:48:32,520 --> 00:48:37,160 CAUSE OF DEATH IS HYPER TENSIVE 942 00:48:37,160 --> 00:48:41,280 DISORDER IN SOME CASES 70% OF 943 00:48:41,280 --> 00:48:44,400 THE MECHANISM WAS INTERCEREBRAL 944 00:48:44,400 --> 00:48:48,800 HEMORRHAGE A SEVERE AND DREADED 945 00:48:48,800 --> 00:48:52,280 COMPLICATION OF PRE-ECLAMPSIA 946 00:48:52,280 --> 00:48:57,520 AND ECLAMPSIA. 947 00:48:57,520 --> 00:49:00,360 AND THIS WOMAN DEVELOPED SEVERE 948 00:49:00,360 --> 00:49:02,320 HEADACHE AFTER HER DELIVERY AND 949 00:49:02,320 --> 00:49:08,840 AROUND DAY TWO OR THREE SHE WAS 950 00:49:08,840 --> 00:49:09,720 AFRICAN AMERICAN AND SOUGHT 951 00:49:09,720 --> 00:49:11,720 MEDICAL TENSION AND WAS GIVEN 952 00:49:11,720 --> 00:49:15,120 PAIN MEDICATION AND SENT HOME 953 00:49:15,120 --> 00:49:19,320 AND PRESENTED ON POSTPARTUM DAY 954 00:49:19,320 --> 00:49:26,560 8 WITH SEIZURE AND THIS IS AN 955 00:49:26,560 --> 00:49:37,160 EXAMPLE OF THE POSTERIOR 956 00:49:37,160 --> 00:49:45,120 ENCEPHALOPATHY AND YOU SEE THIS 957 00:49:45,120 --> 00:49:46,880 IS VASAL PREDICTION WHICH IS 958 00:49:46,880 --> 00:49:49,200 ANOTHER PART OF THE KIND OF 959 00:49:49,200 --> 00:49:52,280 COMPLEX SYNDROME THAT WE SEE IN 960 00:49:52,280 --> 00:49:55,200 THE POSTPARTUM PERIOD OF 961 00:49:55,200 --> 00:49:57,280 PRE-ECLAMPSIA AND ECLAMPSIA AND 962 00:49:57,280 --> 00:50:00,240 THE WORD REVERSIBLE IS IN BOTH 963 00:50:00,240 --> 00:50:02,240 OF THOSE AND IT MAKES IT SOUND 964 00:50:02,240 --> 00:50:04,680 LIKE IT'S NO BIG DEAL. 965 00:50:04,680 --> 00:50:11,680 SOMETIMES IT'S REVERSIBLE. 966 00:50:11,680 --> 00:50:14,160 SOMETIMES IT'S NOT. 967 00:50:14,160 --> 00:50:15,840 THIS IS ANOTHER PATIENT THAT 968 00:50:15,840 --> 00:50:18,680 PRESENTED WITH THE SAME 969 00:50:18,680 --> 00:50:21,520 SITUATION AND ALSO DISMISSED AND 970 00:50:21,520 --> 00:50:23,600 SENT HOME WITH MEDICATION WHEN 971 00:50:23,600 --> 00:50:25,960 SHE PRESENTED WITH A SEVERE 972 00:50:25,960 --> 00:50:29,240 HEADACHE AND THIS IS A SEVERE 973 00:50:29,240 --> 00:50:31,720 HEMORRHAGE AND HERNIATION AND 974 00:50:31,720 --> 00:50:35,960 ALSO HAD BAD VASO CONSTRICTION 975 00:50:35,960 --> 00:50:39,280 AND THIS PERSON HAD A TERRIBLE 976 00:50:39,280 --> 00:50:49,560 OUTCOME BUT DID NOT DIE. 977 00:50:49,560 --> 00:50:51,360 SOW SHE WOULDN'T HAVE BEEN 978 00:50:51,360 --> 00:50:53,440 COUNTED IN THE STATISTICS FOR 979 00:50:53,440 --> 00:50:56,280 THIS BUT I REVIEWED OUR OWN 980 00:50:56,280 --> 00:50:59,360 CASES AND FOUND THERE WAS THIS 981 00:50:59,360 --> 00:51:01,480 PRE DOMINANCE IN THE FIRST 982 00:51:01,480 --> 00:51:04,280 COUPLE OF WEEKS WE SAW THESE 983 00:51:04,280 --> 00:51:06,400 COMPLICATIONS SO DEVASTATING. 984 00:51:06,400 --> 00:51:08,360 I GOT INTERESTED IN THAT INITIAL 985 00:51:08,360 --> 00:51:10,480 TWO WEEK PERIOD AND THOUGHT WHAT 986 00:51:10,480 --> 00:51:11,240 IS GOING ON. 987 00:51:11,240 --> 00:51:15,560 THAT'S ACTUALLY THE TOPIC OF MY 988 00:51:15,560 --> 00:51:15,720 K23. 989 00:51:15,720 --> 00:51:18,680 THIS FOR ME IS A SUPPLEMENT TO 990 00:51:18,680 --> 00:51:23,320 MY K AWARD AND THAT IS REALLY A 991 00:51:23,320 --> 00:51:25,440 PHYSIOLOGICAL-BASED STUDY AND 992 00:51:25,440 --> 00:51:27,760 HAS AN IN VITRO COMPONENT 993 00:51:27,760 --> 00:51:30,320 STUDYING THE AFFECTS MUCH 994 00:51:30,320 --> 00:51:33,160 PRE-ECLAMPSIA ON THE 995 00:51:33,160 --> 00:51:34,840 NEUROVASCULAR UNIT AND LOOK AT 996 00:51:34,840 --> 00:51:38,760 BLOOD BRAIN BARRIER DYSFUNCTION 997 00:51:38,760 --> 00:51:42,080 AND YEAR THREE OF MY K BUT THIS 998 00:51:42,080 --> 00:51:42,840 SUPPLEMENT CAME ALONG AND A 999 00:51:42,840 --> 00:51:44,560 THOUGHT WE DON'T HAVE TIME FOR 1000 00:51:44,560 --> 00:51:46,360 KNOW GET THROUGH MY WHOLE K AND 1001 00:51:46,360 --> 00:51:47,840 FIGURE IT ALL OUT. 1002 00:51:47,840 --> 00:51:50,120 WE NEED TO INTERVENE AND DO 1003 00:51:50,120 --> 00:51:52,280 SOMETHING TO TRY TO PREVENT 1004 00:51:52,280 --> 00:51:52,480 THIS. 1005 00:51:52,480 --> 00:51:55,880 SO THAT'S WHAT THE GOAL OF THE 1006 00:51:55,880 --> 00:51:57,560 IMPROVE SUPPLEMENT WAS FOR ME 1007 00:51:57,560 --> 00:51:59,360 WAS TO SAY OKAY EVEN IF WE DON'T 1008 00:51:59,360 --> 00:52:01,160 QUITE GET IT AND EVEN IF WE 1009 00:52:01,160 --> 00:52:04,280 DON'T FULLY UNDERSTAND THE 1010 00:52:04,280 --> 00:52:06,680 PHYSIOLOGICAL MECHANISMS 1011 00:52:06,680 --> 00:52:08,840 UNDERLYING THIS TERRIBLE 1012 00:52:08,840 --> 00:52:10,000 COMPLICATION, LET'S SEE WHAT WE 1013 00:52:10,000 --> 00:52:12,400 CAN DO TO PREVENT IT BECAUSE 1014 00:52:12,400 --> 00:52:14,080 MAYBE THERE'S THINGS WE CAN DO. 1015 00:52:14,080 --> 00:52:18,560 I WANTED TO DEVELOP A COUPLE 1016 00:52:18,560 --> 00:52:19,120 CLINICAL PROTOCOLS. 1017 00:52:19,120 --> 00:52:21,800 THE AIM ONE OF THE SUPPLEMENT 1018 00:52:21,800 --> 00:52:27,560 WAS TO LOOK AT WHAT DO 1019 00:52:27,560 --> 00:52:29,240 OBSTETRICS PROVIDERS KNOW ABOUT 1020 00:52:29,240 --> 00:52:31,560 NEUROLOGY AND WARNING SIGNS. 1021 00:52:31,560 --> 00:52:33,360 WHY DID THOSE TWO WOMEN GET SENT 1022 00:52:33,360 --> 00:52:34,760 AWAY WHEN THEY SHOULDN'T HAVE 1023 00:52:34,760 --> 00:52:39,840 AND THE SECOND PART IS CAN WE 1024 00:52:39,840 --> 00:52:41,760 COME UP WITH TOOLS LIKE WITH 1025 00:52:41,760 --> 00:52:43,760 SAFETY BUNDLES AND COULD WE COME 1026 00:52:43,760 --> 00:52:53,960 UP WITH SOMETHING TO PREVENT THE 1027 00:52:53,960 --> 00:52:54,440 EVENTS. 1028 00:52:54,440 --> 00:52:57,040 THIS IS FROM AN INTERNAL SURVEY 1029 00:52:57,040 --> 00:53:01,200 OF OUR PROVIDERS BUT WE FOUND 1030 00:53:01,200 --> 00:53:05,160 THAT BASICALLY PEOPLE ARE VERY 1031 00:53:05,160 --> 00:53:09,280 IN NEUROLOGY AND THERE WERE GAPS 1032 00:53:09,280 --> 00:53:11,720 IN KNOWLEDGE AMONG OBSTETRICIANS 1033 00:53:11,720 --> 00:53:13,360 AND EMERGENCY MEDICINE PROVIDERS 1034 00:53:13,360 --> 00:53:15,520 WHO WEREN'T ABLE TO IDENTIFY RED 1035 00:53:15,520 --> 00:53:17,760 FLAG FEATURES OF HEADACHE. 1036 00:53:17,760 --> 00:53:19,560 DIDN'T KNOW THE POSTPARTUM 1037 00:53:19,560 --> 00:53:21,280 PERIOD WERE THE HIGHEST RISK AND 1038 00:53:21,280 --> 00:53:23,360 WERE ENTHUSIASTIC ABOUT THE IDEA 1039 00:53:23,360 --> 00:53:25,360 YES, WE'D LIKE TO HAVE SOME 1040 00:53:25,360 --> 00:53:27,920 GUIDES, SOME PROTOCOLS TO HELP 1041 00:53:27,920 --> 00:53:28,560 US KNOW WHEN WE SHOULD GET 1042 00:53:28,560 --> 00:53:37,240 WORRIED. 1043 00:53:37,240 --> 00:53:40,920 I ENDED UP PARTNERING WITH AN 1044 00:53:40,920 --> 00:53:47,160 AMAZING ORGANIZATION FUNDED BY 1045 00:53:47,160 --> 00:53:49,800 HHRQ AND THEY DEVELOPING 1046 00:53:49,800 --> 00:53:51,600 MATERIALS FOR TREATMENT OF 1047 00:53:51,600 --> 00:53:53,880 MATERNAL CARDIAC ARREST. 1048 00:53:53,880 --> 00:53:56,080 I STARTED COLLABORATING WITH 1049 00:53:56,080 --> 00:53:58,600 THEM AND CAME UP WITH A WHOLE 1050 00:53:58,600 --> 00:53:59,800 SET OF EDUCATIONAL MATERIALS 1051 00:53:59,800 --> 00:54:02,360 SPECIFIC TO MATERNAL STROKE 1052 00:54:02,360 --> 00:54:03,280 PREVENTION AND TREATMENT. 1053 00:54:03,280 --> 00:54:06,200 AND THOSE ARE GOING TO BE 1054 00:54:06,200 --> 00:54:07,880 PUBLISHED IN THE FORM OF A 1055 00:54:07,880 --> 00:54:10,120 MANUAL A PRACTICAL GUIDE SO THIS 1056 00:54:10,120 --> 00:54:13,240 IS EXCITING AND I'M EXCITED AND 1057 00:54:13,240 --> 00:54:16,360 FOR AN EXAMPLE OF ONE OF THESE 1058 00:54:16,360 --> 00:54:21,280 TOOLS AND WE COULD PUBLISH THIS 1059 00:54:21,280 --> 00:54:23,760 AND CAME UP WITH THE MNEMONIC 1060 00:54:23,760 --> 00:54:25,800 CALLED SCAN ME WHICH IDENTIFIED 1061 00:54:25,800 --> 00:54:27,600 RED FLAG FEATURES OF HEADACHE 1062 00:54:27,600 --> 00:54:29,880 FOR PEOPLE WHO DON'T HAVE 1063 00:54:29,880 --> 00:54:33,160 TRAINING IN NEUROLOGY. 1064 00:54:33,160 --> 00:54:35,560 IT'S NOT EXACTLY EVIDENCE BASED 1065 00:54:35,560 --> 00:54:39,000 THOUGH WE GOT FEEDBACK FROM 1066 00:54:39,000 --> 00:54:40,840 EXPERTS BUT THIS STUFF THAT YOU 1067 00:54:40,840 --> 00:54:43,600 KNOW IF SOMEONE COMES IN WITH A 1068 00:54:43,600 --> 00:54:45,320 BAD HEADACHE AND HAS THESE 1069 00:54:45,320 --> 00:54:46,880 FEATURES YOU SHOULD AT LEAST 1070 00:54:46,880 --> 00:54:48,760 INVESTIGATE MORE OR WATCH THAT 1071 00:54:48,760 --> 00:54:49,760 PERSON CAREFULLY. 1072 00:54:49,760 --> 00:54:53,240 THEY MIGHT OR MIGHT NOT NEED 1073 00:54:53,240 --> 00:54:54,360 IMAGING BUT YOU CERTAINLY 1074 00:54:54,360 --> 00:54:55,960 SHOULDN'T SEND THEM HOME. 1075 00:54:55,960 --> 00:54:57,760 THAT'S THAT WAS A FUN 1076 00:54:57,760 --> 00:55:03,040 COLLABORATION THAT CAME FROM 1077 00:55:03,040 --> 00:55:04,360 THIS. 1078 00:55:04,360 --> 00:55:05,480 THE SECOND WAS MORE TECHNICAL. 1079 00:55:05,480 --> 00:55:08,160 I WANTED TO COME UP WITH A 1080 00:55:08,160 --> 00:55:12,440 LITTLE BIT MORE OF A BRAIN 1081 00:55:12,440 --> 00:55:14,320 FOCUSSED WAY TO IDENTIFY 1082 00:55:14,320 --> 00:55:15,960 PERFUSION PROBLEMS IN MATERNAL 1083 00:55:15,960 --> 00:55:21,000 BRAIN WHEN WOMEN WERE ACTUALLY 1084 00:55:21,000 --> 00:55:22,560 ADMITTED WITH POSTPARTUM 1085 00:55:22,560 --> 00:55:23,960 PRE-ECLAMPSIA OR EMERGENCY AND 1086 00:55:23,960 --> 00:55:27,200 TRY TO PILE THOUGH THE PROTOCOL. 1087 00:55:27,200 --> 00:55:30,480 I USED NEAR INFRARED 1088 00:55:30,480 --> 00:55:32,200 SPECTROSCOPY AND IT'S BEEN USED 1089 00:55:32,200 --> 00:55:35,560 MOSTLY IN THE O.R. OR ICU 1090 00:55:35,560 --> 00:55:38,200 SETTING BECAUSE IT REQUIRES IF 1091 00:55:38,200 --> 00:55:40,680 YOU WANT TO DO THIS IN THE 1092 00:55:40,680 --> 00:55:45,960 POPULATION YOU NEED THE PRESSURE 1093 00:55:45,960 --> 00:55:52,760 MONITORING WHICH AND THERE'S A 1094 00:55:52,760 --> 00:55:53,920 BLOOD PRESSURE MONITOR AND USING 1095 00:55:53,920 --> 00:55:59,400 THE SUPPLEMENT WE WERE ABLE TO 1096 00:55:59,400 --> 00:56:02,600 GET THE EQUIPMENT AND THIS 1097 00:56:02,600 --> 00:56:03,800 CONTRAPTION WAS FUN TO BUILD AND 1098 00:56:03,800 --> 00:56:06,080 STILL A WORK IN PROGRESS. 1099 00:56:06,080 --> 00:56:07,320 WE'RE ADDING PARTS HERE AND 1100 00:56:07,320 --> 00:56:09,960 THERE AND BASICALLY WE NEED A 1101 00:56:09,960 --> 00:56:11,640 PORTABLE MONITOR TO TAKE INTO 1102 00:56:11,640 --> 00:56:16,960 THE E.D. OR LABOR TRIAGE OR KEEP 1103 00:56:16,960 --> 00:56:18,560 IT BEDSIDE AND BE ABLE TO 1104 00:56:18,560 --> 00:56:21,160 UNDERSTAND WHAT'S GOING ON WITH 1105 00:56:21,160 --> 00:56:24,520 THE PERSON'S CEREBRAL 1106 00:56:24,520 --> 00:56:25,160 AUTOREGULATION IN THE MOMENT 1107 00:56:25,160 --> 00:56:27,480 WHICH CAN HAVE A BIG IMPACT ON 1108 00:56:27,480 --> 00:56:29,040 THE BLOOD PRESSURE MANAGEMENT. 1109 00:56:29,040 --> 00:56:31,600 WHAT WE DID WAS PUT THIS 1110 00:56:31,600 --> 00:56:34,280 TOGETHER AND TEST IT THE 1111 00:56:34,280 --> 00:56:36,160 FEASIBILITY AND ENROLLED SOME 1112 00:56:36,160 --> 00:56:40,280 WOMEN AND WE HAD THREE TO DATE 1113 00:56:40,280 --> 00:56:43,360 AND THEY GIVE FEEDBACK ON YOU 1114 00:56:43,360 --> 00:56:45,720 GOT TO MAKE IT DIFFERENT AND WE 1115 00:56:45,720 --> 00:56:48,640 CHANGE THE PROTOCOL SLIGHTLY AND 1116 00:56:48,640 --> 00:56:50,720 USUALLY WHEN PEOPLE HAVE THIS 1117 00:56:50,720 --> 00:56:52,880 KIND OF MONITORING THEY'RE 1118 00:56:52,880 --> 00:56:53,360 UNCONSCIOUS. 1119 00:56:53,360 --> 00:56:57,240 WE NEED TO ADAPT THE SETUP TO 1120 00:56:57,240 --> 00:56:59,040 ACCOMMODATE THE NEED OF 1121 00:56:59,040 --> 00:56:59,960 POSTPARTUM INDIVIDUALS NOT 1122 00:56:59,960 --> 00:57:03,520 FEELING WELL AT ALL. 1123 00:57:03,520 --> 00:57:06,240 WE DID THAT AND WE HAVE EXCITING 1124 00:57:06,240 --> 00:57:07,760 FUTURE DIRECTIONS COMING AND ALL 1125 00:57:07,760 --> 00:57:09,960 OF THIS IS KIND OF WRAPPED INTO 1126 00:57:09,960 --> 00:57:13,920 THE IDEA I HAVE ABOUT WHAT I 1127 00:57:13,920 --> 00:57:16,960 WOULD CALL NEUROOBSTETRICS. 1128 00:57:16,960 --> 00:57:19,840 SIMILAR TO CARDIO OBSTETRICS AND 1129 00:57:19,840 --> 00:57:23,120 IT'S A CROSS-DISCIPLINARY FIELD 1130 00:57:23,120 --> 00:57:25,280 GOING FROM BENCH AND THINGS LIKE 1131 00:57:25,280 --> 00:57:27,760 STUDYING BLOOD BRAIN BARRIER IN 1132 00:57:27,760 --> 00:57:31,680 PREGNANT AND POSTPARTUM PEOPLE 1133 00:57:31,680 --> 00:57:34,200 TO HEALTH AND MEDICAL EDUCATION 1134 00:57:34,200 --> 00:57:37,120 AND COLLABORATING AND BIO 1135 00:57:37,120 --> 00:57:38,760 ENGINEERING AND PUTTING TOGETHER 1136 00:57:38,760 --> 00:57:40,960 MACHINES AND THIS UNDER THE 1137 00:57:40,960 --> 00:57:42,480 UMBRELLA AND IT'S BEEN EXCITING 1138 00:57:42,480 --> 00:57:44,440 TO BE PART OF IT. 1139 00:57:44,440 --> 00:57:46,160 WITH THAT I WOULD LIKE TO THANK 1140 00:57:46,160 --> 00:57:51,960 ALL OF MY COLLABORATORS AND YOU 1141 00:57:51,960 --> 00:57:56,560 CAN SEE THEY COME FROM DIFFERENT 1142 00:57:56,560 --> 00:57:57,920 FIELD INCLUDING SOME ENGINEERS 1143 00:57:57,920 --> 00:58:00,160 WHO HAVE BEEN HELPING ME AND I 1144 00:58:00,160 --> 00:58:02,440 WOULD LIKE TO THANK MY PATIENTS. 1145 00:58:02,440 --> 00:58:04,320 SHE WAS GENEROUS TO SHARE HER 1146 00:58:04,320 --> 00:58:09,640 STORY ON FACEBOOK AS PART OF MY 1147 00:58:09,640 --> 00:58:11,400 HOSPITAL'S MATERNAL MORBIDITY 1148 00:58:11,400 --> 00:58:12,600 AND MORTALITY HEALTH INITIATIVE 1149 00:58:12,600 --> 00:58:17,320 AND YOU CAN SEE SHE HAD A 1150 00:58:17,320 --> 00:58:20,440 HEMORRHAGIC STROKE AND 1151 00:58:20,440 --> 00:58:22,960 INTRACEREBRAL HEMORRHAGE AND DID 1152 00:58:22,960 --> 00:58:28,320 WELL AND SURVIVED AND THIS IS 1153 00:58:28,320 --> 00:58:29,240 HER BABY. 1154 00:58:29,240 --> 00:58:31,800 >> THANK YOU, DR. MILLER. 1155 00:58:31,800 --> 00:58:35,120 WE HAVE A COUPLE MINUTES LEFT 1156 00:58:35,120 --> 00:58:36,920 FOR QUESTIONS. 1157 00:58:36,920 --> 00:58:38,920 PEOPLE CAN TYPE THEM IN I DON'T 1158 00:58:38,920 --> 00:58:44,840 SEE ANY AT THIS POINT SO I HAVE 1159 00:58:44,840 --> 00:58:50,640 A QUESTION. 1160 00:58:50,640 --> 00:58:54,640 DO YOU MIND WHAT TELLING US WHAT 1161 00:58:54,640 --> 00:58:59,080 MATERNAL OCIMETRY IS? 1162 00:58:59,080 --> 00:59:04,560 >> IT'S USED COMMONLY BY NEURAL 1163 00:59:04,560 --> 00:59:07,080 ANESTHESIOLOGISTS IN THE O.R. 1164 00:59:07,080 --> 00:59:09,520 AND IN NEURAL CRITICAL CARE. 1165 00:59:09,520 --> 00:59:12,560 PEOPLE ARE LIKE IN A COMA AND 1166 00:59:12,560 --> 00:59:14,960 GENERALLY PEOPLE WITH TRAUMATIC 1167 00:59:14,960 --> 00:59:17,080 BRAIN INJURY OR HEMORRHAGIC 1168 00:59:17,080 --> 00:59:19,880 STROKES AND CRITICAL ILLNESS AND 1169 00:59:19,880 --> 00:59:22,160 IT'S BASICALLY STICKERS ON YOUR 1170 00:59:22,160 --> 00:59:25,760 HEAD AND IT MONITORS SOMETHING 1171 00:59:25,760 --> 00:59:29,320 CALLED A TISSUE OXYGENATION 1172 00:59:29,320 --> 00:59:35,360 INDEX THE RATIO OF DE-OXYGENATED 1173 00:59:35,360 --> 00:59:39,680 HEMOGLOBIN AND A PROXY FOR 1174 00:59:39,680 --> 00:59:41,080 CEREBRAL BLOOD FLOW AND THERE'S 1175 00:59:41,080 --> 00:59:45,040 DIFFERENT WAYS TO MEASURE IT. 1176 00:59:45,040 --> 00:59:47,760 YOU CAN'T ALWAYS STICK THINGS IN 1177 00:59:47,760 --> 00:59:50,840 PEOPLE'S BRAINS ESPECIALLY WHEN 1178 00:59:50,840 --> 00:59:52,960 THEY'RE AWAKE AND IT'S 1179 00:59:52,960 --> 00:59:55,520 NON-INVASIVE IT'S NOT PERFECT 1180 00:59:55,520 --> 00:59:56,520 BUT REALLY EASY. 1181 00:59:56,520 --> 00:59:58,080 IT DOESN'T REQUIRE A LOT OF 1182 00:59:58,080 --> 00:59:58,360 EXPERTISE. 1183 00:59:58,360 --> 00:59:59,960 YOU JUST STICK THE STICKERS ON. 1184 00:59:59,960 --> 01:00:03,240 ONE OF OUR ADAPTIVE 1185 01:00:03,240 --> 01:00:05,680 INTERVENTIONS WAS TO MAKE A SOFT 1186 01:00:05,680 --> 01:00:07,760 SPECIAL HEAD BAND. 1187 01:00:07,760 --> 01:00:14,160 THE EEG GAUZE ON THE COMATOSE 1188 01:00:14,160 --> 01:00:16,600 PEOPLE BUT WITH POSTPARTUM 1189 01:00:16,600 --> 01:00:18,360 PEOPLE ARE UP AND TALKING AND 1190 01:00:18,360 --> 01:00:20,840 WANT TO LOOK NICE SO WE MADE A 1191 01:00:20,840 --> 01:00:21,760 FANCY HEAD BAND. 1192 01:00:21,760 --> 01:00:22,840 >> THERE'S A FOLLOW-UP QUESTION 1193 01:00:22,840 --> 01:00:24,680 ON THAT. 1194 01:00:24,680 --> 01:00:31,240 THE SKIN TONE IMPACT OF THE 1195 01:00:31,240 --> 01:00:32,480 CEREBRAL OCCIPITAL MEASURE. 1196 01:00:32,480 --> 01:00:33,800 >> IT DOES NOT. 1197 01:00:33,800 --> 01:00:37,200 THAT'S WHY IT'S NICE BECAUSE 1198 01:00:37,200 --> 01:00:40,040 IT'S VERY EASY AND OF COURSE 1199 01:00:40,040 --> 01:00:45,680 LIKE ALL THESE OTHER TERRIBLE 1200 01:00:45,680 --> 01:00:55,240 CONDITIONS THE STROKES AND ALL 1201 01:00:55,240 --> 01:00:58,000 THESE COMPLICATIONS 1202 01:00:58,000 --> 01:00:59,200 DISPROPORTIONATELY AFFECT PEOPLE 1203 01:00:59,200 --> 01:01:01,760 OF COLOR WHICH IS AN AIM WE NEED 1204 01:01:01,760 --> 01:01:04,280 OBJECTIVE AND CRITERIA TO HELP 1205 01:01:04,280 --> 01:01:08,160 PEOPLE MANAGE THIS AND PREVENT 1206 01:01:08,160 --> 01:01:10,280 THIS SO PEOPLE ARE NOT AT LEAST 1207 01:01:10,280 --> 01:01:12,320 TRY TO MITIGATE THE AFFECTS OF 1208 01:01:12,320 --> 01:01:18,920 THE UNCONSCIOUS BIASES SAYING 1209 01:01:18,920 --> 01:01:20,400 HON 1210 01:01:20,400 --> 01:01:23,000 HONEY, YOU'RE FINE, GET SLEEP 1211 01:01:23,000 --> 01:01:23,840 AND YOU'LL BE BETTER. 1212 01:01:23,840 --> 01:01:26,320 THIS IS WHAT WE WANT TO AVOID. 1213 01:01:26,320 --> 01:01:26,800 >> THANK YOU VERY MUCH 1214 01:01:26,800 --> 01:01:30,960 DR. MILLER. 1215 01:01:30,960 --> 01:01:32,480 SO MOVING ON TO OUR SPINAL 1216 01:01:32,480 --> 01:01:38,160 SPEAKER FOR THIS SESSION WHICH 1217 01:01:38,160 --> 01:01:39,080 FROM THE UNIVERSITY OF 1218 01:01:39,080 --> 01:01:39,360 PITTSBURGH. 1219 01:01:39,360 --> 01:01:44,920 HE TITLE IS PRECONCEPTION 1220 01:01:44,920 --> 01:01:47,000 CONTRIBUTORS TO MORBIDITY IN 1221 01:01:47,000 --> 01:01:52,120 BLACK AND WHITE WOMEN. 1222 01:01:52,120 --> 01:02:45,480 GO AHEAD. 1223 01:02:45,480 --> 01:02:48,720 >> THERE YOU GO. 1224 01:02:48,720 --> 01:02:50,280 WE ALL NEED TO BE PATIENT. 1225 01:02:50,280 --> 01:02:52,200 IF YOU CAN PUT IT IN SLIDE MODE. 1226 01:02:52,200 --> 01:02:53,200 >> THANK YOU. 1227 01:02:53,200 --> 01:02:54,360 YES, PATIENCE. 1228 01:02:54,360 --> 01:02:55,760 IT'S ONE OF THE MESSAGES. 1229 01:02:55,760 --> 01:03:00,680 SOME DAY I MAY LEARN THAT. 1230 01:03:00,680 --> 01:03:01,360 THANKS SO MUCH. 1231 01:03:01,360 --> 01:03:02,960 I FEEL HONORED TO BE HERE WITH 1232 01:03:02,960 --> 01:03:06,080 ALL YOU EVER AND TO BE SHARING 1233 01:03:06,080 --> 01:03:11,280 THIS MORNING PANEL WITH MANY OF 1234 01:03:11,280 --> 01:03:18,120 MY ESTEEMED COLLEAGUES MUCH HAS 1235 01:03:18,120 --> 01:03:22,080 BEEN SAID WITH THE DISPARITIES 1236 01:03:22,080 --> 01:03:23,960 IN THE DATA OF MATERNAL 1237 01:03:23,960 --> 01:03:26,280 MORTALITY AND I'LL TALK ABOUT 1238 01:03:26,280 --> 01:03:26,960 SEVERE MATERNAL MORBIDITY AND 1239 01:03:26,960 --> 01:03:28,560 THE PANEL ON THE BOTTOM OF THIS 1240 01:03:28,560 --> 01:03:35,160 SCREEN IS OUTDATED. 1241 01:03:35,160 --> 01:03:37,040 RATES OF SEVERE MATERNAL 1242 01:03:37,040 --> 01:03:38,760 MORBIDITY ARE STILL INCREASING 1243 01:03:38,760 --> 01:03:41,280 AND THERE'S PROFOUND RACIAL 1244 01:03:41,280 --> 01:03:45,280 DISPARITIES AND RATES ARE 1245 01:03:45,280 --> 01:03:47,800 INCREASING AT LEAST ACROSS ALL 1246 01:03:47,800 --> 01:03:49,240 RACE ETHNICITY GROUPS. 1247 01:03:49,240 --> 01:03:52,440 I'VE HIGHLIGHTED THESE ARE 1248 01:03:52,440 --> 01:03:54,360 CAUSES OF MATERNAL DEATHS. 1249 01:03:54,360 --> 01:03:55,760 WE'VE SEEN THIS SLIDE A COUPLE 1250 01:03:55,760 --> 01:03:57,760 TIMES ALREADY THIS MORNING AND 1251 01:03:57,760 --> 01:03:59,760 HIGHLIGHTED THOSE THAT COULD BE 1252 01:03:59,760 --> 01:04:01,360 THOUGHT TO BE CARDIOVASCULAR 1253 01:04:01,360 --> 01:04:02,400 RELATED INCLUDING IN THE DASHED 1254 01:04:02,400 --> 01:04:05,880 LINES THOSE THAT MAY BE RELATED 1255 01:04:05,880 --> 01:04:08,520 TO OTHER CARDIOVASCULAR RISK 1256 01:04:08,520 --> 01:04:09,760 FACTORS LIKE OBESITY AND 1257 01:04:09,760 --> 01:04:14,160 HEMORRHAGE AND EMBOLISM WE KNOW 1258 01:04:14,160 --> 01:04:17,160 ARE MORE COMMON IN WOMEN WITH 1259 01:04:17,160 --> 01:04:18,600 PRE-PREGNANCY OBESITY. 1260 01:04:18,600 --> 01:04:20,320 THE PURPOSE OF OUR IMPROVED 1261 01:04:20,320 --> 01:04:21,680 PROJECT WHICH WAS A SUPPLEMENT 1262 01:04:21,680 --> 01:04:24,520 TO AN R21 WHERE WE WERE LOOKING 1263 01:04:24,520 --> 01:04:28,280 AT LIFE COURSE APPROACHES TO 1264 01:04:28,280 --> 01:04:29,640 CARDIOVASCULAR RISK FACTORS 1265 01:04:29,640 --> 01:04:31,760 ASSOCIATED WITH ADVERSE 1266 01:04:31,760 --> 01:04:33,920 PREGNANCY OUTCOMES. 1267 01:04:33,920 --> 01:04:37,240 OUR GROUP HAS BEEN KEEN ON THIS 1268 01:04:37,240 --> 01:04:38,800 IDEA AS WE LAUNCHED THE 1269 01:04:38,800 --> 01:04:39,600 CONVERSATION ABOUT THE 1270 01:04:39,600 --> 01:04:41,240 IMPORTANCE OF A LIFE SPAN 1271 01:04:41,240 --> 01:04:45,040 APPROACH NOT ONLY TO PREGNANCY 1272 01:04:45,040 --> 01:04:49,240 HEALTH BUT MATERNAL HEALTH AS 1273 01:04:49,240 --> 01:04:51,160 WELL. 1274 01:04:51,160 --> 01:04:53,920 WE WERE INTERESTED IN 1275 01:04:53,920 --> 01:05:05,840 UNDERSTANDING PRE-PREGNANCY 1276 01:05:05,840 --> 01:05:06,640 ANTECEDENTS AND CARDIOVASCULAR 1277 01:05:06,640 --> 01:05:09,760 AND SOCIAL FACTORS CONTRIBUTE TO 1278 01:05:09,760 --> 01:05:11,680 SEVERE MATERNAL MORBIDITY AND 1279 01:05:11,680 --> 01:05:14,800 HOW THEY'RE AT PLAY IN THE 1280 01:05:14,800 --> 01:05:17,120 PRE-PREGNANCY PERIOD ARE LESS 1281 01:05:17,120 --> 01:05:17,360 STUDIED. 1282 01:05:17,360 --> 01:05:20,760 OUR HYPOTHESIS WAS POOR 1283 01:05:20,760 --> 01:05:22,840 CARDIOVASCULAR HEALTH AND 1284 01:05:22,840 --> 01:05:25,360 ADVERSE PSYCHOSOCIAL STRESS 1285 01:05:25,360 --> 01:05:26,960 BEFORE PREGNANCY WOULD 1286 01:05:26,960 --> 01:05:29,080 CONTRIBUTE TO RACIAL DISPARITIES 1287 01:05:29,080 --> 01:05:31,840 AND MORBIDITY. 1288 01:05:31,840 --> 01:05:34,640 OUR STUDY IS USING THE CARDIO 1289 01:05:34,640 --> 01:05:39,880 STUDY OF AMAZING LONG STANDING 1290 01:05:39,880 --> 01:05:43,080 RESOURCE FROM NHLBI AND OUR 1291 01:05:43,080 --> 01:05:44,400 STUDY INCLUDED ABOUT 1400 WOMEN 1292 01:05:44,400 --> 01:05:50,440 AND BY DESIGN, CARDIA IS HALF 1293 01:05:50,440 --> 01:05:52,520 MEN, HALF WOMEN, HALF BLACK AND 1294 01:05:52,520 --> 01:05:56,640 HALF WHITE AND THERE WERE ABOUT 1295 01:05:56,640 --> 01:06:04,160 2400 POST-ENROLLMENT BIRTH AND 1296 01:06:04,160 --> 01:06:05,160 WE CHARACTERIZED THIS USING 1297 01:06:05,160 --> 01:06:09,000 ESTABLISHED CHRIST ADAPTED NOR 1298 01:06:09,000 --> 01:06:11,440 STUDY SO THE DOMINANT 1299 01:06:11,440 --> 01:06:13,360 IDENTIFICATION OF SEVERE 1300 01:06:13,360 --> 01:06:18,160 MATERNAL MORBIDITY ARE DELIVERY 1301 01:06:18,160 --> 01:06:20,600 EPISODES AND RECORDS IN CARDIA 1302 01:06:20,600 --> 01:06:25,280 WE ONLY HAD RECORDS FOR A THIRD 1303 01:06:25,280 --> 01:06:26,440 OF THE BIRTHS. 1304 01:06:26,440 --> 01:06:30,200 BECAUSE CARDIA IS ONGOING AND 1305 01:06:30,200 --> 01:06:33,040 LONGITUDINAL, PARTICIPANTS 1306 01:06:33,040 --> 01:06:33,960 SELF-REPORT HOSPITALIZATIONS 1307 01:06:33,960 --> 01:06:35,520 EVERY SIX MONTHS TO A YEAR AS 1308 01:06:35,520 --> 01:06:37,600 PART OF THE STUDY PROTOCOL. 1309 01:06:37,600 --> 01:06:40,000 WE IDENTIFIED HOSPITALIZATIONS 1310 01:06:40,000 --> 01:06:44,480 UP TO A YEAR POSTDELIVERY AND 1311 01:06:44,480 --> 01:06:45,840 CURATED THEM TO BE LINKED TO 1312 01:06:45,840 --> 01:06:50,320 CONDITIONS THAT ARE PART OF THE 1313 01:06:50,320 --> 01:06:51,200 ESTABLISHED MATERNAL MORBIDITY 1314 01:06:51,200 --> 01:06:51,920 CRITERIA. 1315 01:06:51,920 --> 01:06:58,240 WE ALSO USED THE CARDIA DATA 1316 01:06:58,240 --> 01:07:00,360 CHARACTERIZED CARDIOVASCULAR 1317 01:07:00,360 --> 01:07:02,880 HEALTH AND CHARACTERIZED STRESS 1318 01:07:02,880 --> 01:07:05,280 AND WOMEN SELF-REPORTED ADVERSE 1319 01:07:05,280 --> 01:07:08,640 PREGNANCY OUTCOMES AND WE 1320 01:07:08,640 --> 01:07:11,040 MODELLED THOSE RELATED TO RISK 1321 01:07:11,040 --> 01:07:16,320 OF AN SMM EVENT AND STRATIFIED 1322 01:07:16,320 --> 01:07:18,880 THE RESULT BUSINESS RISK. 1323 01:07:18,880 --> 01:07:28,000 THE PRE-PREGNANCY FARCT -- 1324 01:07:28,000 --> 01:07:30,880 FACTORS WERE PART OF A LIFE 1325 01:07:30,880 --> 01:07:31,880 SIMPLE SEVEN WITH BLOOD 1326 01:07:31,880 --> 01:07:35,080 PRESSURE, BMI, PHYSICAL 1327 01:07:35,080 --> 01:07:37,080 ACTIVITY, GLUCOSE MEASUREMENTS, 1328 01:07:37,080 --> 01:07:40,280 SMOKE AND CHOLESTEROL AND A 1329 01:07:40,280 --> 01:07:44,640 HIGHER SCORE OF THAT INDICATES 1330 01:07:44,640 --> 01:07:45,840 BETTER CARDIOVASCULAR HEALTH SO 1331 01:07:45,840 --> 01:07:47,760 HIGHER IS HEALTHIER. 1332 01:07:47,760 --> 01:07:50,560 FOR STRESSFUL EVENTS AT BASELINE 1333 01:07:50,560 --> 01:07:52,680 AND YEAR TWO THERE WAS AN 1334 01:07:52,680 --> 01:07:54,880 ASSESSMENT OF STRESSFUL LIFE 1335 01:07:54,880 --> 01:07:55,600 EVENTS. 1336 01:07:55,600 --> 01:07:58,760 THIS WAS AN ACCRUAL OF EVENTS 1337 01:07:58,760 --> 01:08:00,160 THAT HAPPENED IN EACH 1338 01:08:00,160 --> 01:08:01,920 PARTICIPANT'S LIFE THEY 1339 01:08:01,920 --> 01:08:03,360 SELF-REPORTED WERE SCORED AND IN 1340 01:08:03,360 --> 01:08:09,400 THIS METRIC A HIGHER SCORE OF 1341 01:08:09,400 --> 01:08:14,880 STRESSFUL LIFE EVENT IS ADVERSE 1342 01:08:14,880 --> 01:08:19,920 AND THERE WERE PRE-TERM BIRTH 1343 01:08:19,920 --> 01:08:21,320 AND GESTATIONAL DIABETES AND 1344 01:08:21,320 --> 01:08:23,400 DEFINED SMM USING DELIVERY 1345 01:08:23,400 --> 01:08:25,320 RECORDS OR SELF-REPORTED 1346 01:08:25,320 --> 01:08:25,960 HOSPITALIZATIONS. 1347 01:08:25,960 --> 01:08:31,160 THESE WERE THE PRIMARY DIAGNOSES 1348 01:08:31,160 --> 01:08:34,960 AND SEPSIS AND CARDIO MYOPATHY 1349 01:08:34,960 --> 01:08:37,360 AND OTHERS FACTORS AND ALONG 1350 01:08:37,360 --> 01:08:39,360 WITH REVIEW CRITERIA 1351 01:08:39,360 --> 01:08:41,360 HOSPITALIZATIONS WITHIN A YEAR 1352 01:08:41,360 --> 01:08:44,920 OF DELIVERY IF THEY WERE 1353 01:08:44,920 --> 01:08:46,960 CARDIOVASCULAR IN NATURE OR 1354 01:08:46,960 --> 01:08:47,680 INVOLVED DEPRESSION OR DOMESTIC 1355 01:08:47,680 --> 01:08:50,240 VIOLENCE OR OVERDOSE WERE 1356 01:08:50,240 --> 01:08:52,040 INCLUDED IN SEVERE MATERNAL 1357 01:08:52,040 --> 01:08:53,680 MORBIDITY AND ALIGNED WITH 1358 01:08:53,680 --> 01:08:56,240 NATIONAL DATA ABOUT 60% OF THE 1359 01:08:56,240 --> 01:08:59,360 EVENTS IN THE CARDIA COHORT WERE 1360 01:08:59,360 --> 01:09:03,800 AFTER DELIVERY AND ABOUT 40% AT 1361 01:09:03,800 --> 01:09:04,080 DELIVERY. 1362 01:09:04,080 --> 01:09:07,640 WE DID NOT SEE RACE DIFFERENCES 1363 01:09:07,640 --> 01:09:09,840 IN THE OCCURRENCE OF SEVERE 1364 01:09:09,840 --> 01:09:12,600 MATERNAL MORBIDITY EVENTS 1365 01:09:12,600 --> 01:09:14,360 OVERALL IT WAS 1.9%. 1366 01:09:14,360 --> 01:09:18,000 AS I SAID, WE WERE PARTICULARLY 1367 01:09:18,000 --> 01:09:21,320 INTERESTED IN DIFFERENCES BY 1368 01:09:21,320 --> 01:09:21,520 RACE. 1369 01:09:21,520 --> 01:09:23,080 THIS SHOWS OUR GROUPS. 1370 01:09:23,080 --> 01:09:28,800 WOMEN WERE ENROLLED IN CARDIA 1371 01:09:28,800 --> 01:09:30,720 RELATIVE YOUNG IN THEIR 20s AND 1372 01:09:30,720 --> 01:09:34,040 SAW DIFFERENCES FROM RACE AND 1373 01:09:34,040 --> 01:09:35,360 SEVERE MORBIDITY OCCURRENCE IN 1374 01:09:35,360 --> 01:09:35,600 EDUCATION. 1375 01:09:35,600 --> 01:09:38,560 VERY MODEST DIFFERENCES IN 1376 01:09:38,560 --> 01:09:40,840 TRADITIONAL CARDIOVASCULAR RISK 1377 01:09:40,840 --> 01:09:43,640 FACTORS BUT WHEN THEY ARE 1378 01:09:43,640 --> 01:09:44,280 AGGREGATED INTO THIS 1379 01:09:44,280 --> 01:09:45,520 CARDIOVASCULAR HEALTH METRIC, A 1380 01:09:45,520 --> 01:09:47,520 COUPLE THINGS ARE NOTEWORTHY 1381 01:09:47,520 --> 01:09:48,400 HERE. 1382 01:09:48,400 --> 01:09:53,640 FIRST OF ALL, BLACK WOMEN IN THE 1383 01:09:53,640 --> 01:09:56,880 STUDY HAD WORSE CARDIOVASCULAR 1384 01:09:56,880 --> 01:09:58,400 HEALTH EVEN COMPARED TO WHITE 1385 01:09:58,400 --> 01:10:02,000 WOMEN WITH OR WITHOUT SEVERE 1386 01:10:02,000 --> 01:10:04,880 MATERNAL MORBIDITY. 1387 01:10:04,880 --> 01:10:07,800 THAT'S NOTEWORTHY. 1388 01:10:07,800 --> 01:10:09,280 PARTICULARLY LOWER RATES OF 1389 01:10:09,280 --> 01:10:11,080 CARDIOVASCULAR HEALTH IN BLACK 1390 01:10:11,080 --> 01:10:15,920 WOMEN WITH SEVERE MATERNAL 1391 01:10:15,920 --> 01:10:16,160 MORBIDITY. 1392 01:10:16,160 --> 01:10:18,280 YOU SEE CARDIOVASCULAR HEALTH 1393 01:10:18,280 --> 01:10:20,240 SCORES CAN BE ANALYZED AS A 1394 01:10:20,240 --> 01:10:21,720 CONTINUOUS SUCH THAT HIGHER IS 1395 01:10:21,720 --> 01:10:24,600 BETTER, LOWER IS MORE ADVERSE 1396 01:10:24,600 --> 01:10:26,800 AND THEN WE ALSO USE CLINICAL 1397 01:10:26,800 --> 01:10:30,760 CUT POINTS TO IDENTIFY POOR, 1398 01:10:30,760 --> 01:10:32,320 IMMEDIATE OR IDEAL 1399 01:10:32,320 --> 01:10:34,040 CARDIOVASCULAR HEALTH AND VERY 1400 01:10:34,040 --> 01:10:36,200 NOTEWORTHY YOU CAN SEE BLACK 1401 01:10:36,200 --> 01:10:38,560 WOMEN WITH SEVERE MATERNAL 1402 01:10:38,560 --> 01:10:40,240 MORBIDITY EVENTS ACTUALLY NONE 1403 01:10:40,240 --> 01:10:41,960 OF THEM HAD IDEAL CARDIOVASCULAR 1404 01:10:41,960 --> 01:10:45,680 HEALTH PRIOR TO PREGNANCY AND 1405 01:10:45,680 --> 01:10:48,800 MORE THAN 40% WERE IN THE POOR 1406 01:10:48,800 --> 01:10:50,120 CARDIOVASCULAR HEALTH RANGE. 1407 01:10:50,120 --> 01:10:53,880 AGAIN, NOTEWORTHY, BLACK WOMEN 1408 01:10:53,880 --> 01:10:56,760 WITHOUT SEVERE MATERNAL 1409 01:10:56,760 --> 01:10:58,240 MORBIDITY EVENTS HAD WORSE 1410 01:10:58,240 --> 01:10:59,280 CARDIOVASCULAR HEALTH COMPARED 1411 01:10:59,280 --> 01:11:01,240 TO THEIR WHITE COUNTERPARTS WITH 1412 01:11:01,240 --> 01:11:21,080 OR WITHOUT SEVERE EVENTS. 1413 01:11:21,080 --> 01:11:24,360 SOME WERE WE ARE ADVERSE TO 1414 01:11:24,360 --> 01:11:25,960 STRESSFUL EVENTS THAN BLACK 1415 01:11:25,960 --> 01:11:27,600 WOMEN WITHOUT SEVERE MATERNAL 1416 01:11:27,600 --> 01:11:28,960 MORBIDITY EVENTS AND HIGHER THAN 1417 01:11:28,960 --> 01:11:31,760 BLACK OR WHITE WOMEN WITH OR 1418 01:11:31,760 --> 01:11:32,880 WITHOUT SEVERE MATERNAL 1419 01:11:32,880 --> 01:11:33,440 MORBIDITY EVENTS. 1420 01:11:33,440 --> 01:11:39,160 WE PUT THE DATA TOGETHER IN A 1421 01:11:39,160 --> 01:11:40,840 MODEL BECAUSE WE KNOW WE'RE 1422 01:11:40,840 --> 01:11:42,880 PRESSURING THE INDEXES. 1423 01:11:42,880 --> 01:11:48,760 WE THOUGHT THEY'D BE MORE 1424 01:11:48,760 --> 01:11:52,200 STRONGLY CORRELATED THERE WAS 1425 01:11:52,200 --> 01:11:54,360 WEAK CORRELATION AND WAS 1426 01:11:54,360 --> 01:11:54,960 STATISTICALLY SIGNIFICANT BUT 1427 01:11:54,960 --> 01:12:02,840 WITH A DIFFERENCE 6%. 1428 01:12:02,840 --> 01:12:06,600 WHEN WE LOOKED AT THEM TOGETHER 1429 01:12:06,600 --> 01:12:08,160 AMONG BLACK WOMEN, 1430 01:12:08,160 --> 01:12:09,680 CARDIOVASCULAR HEALTH WAS HIGHLY 1431 01:12:09,680 --> 01:12:12,080 PROTECTIVE AGAINST RISK OF 1432 01:12:12,080 --> 01:12:13,560 SEVERE MATERNAL MORBIDITY 1433 01:12:13,560 --> 01:12:13,760 EVENTS. 1434 01:12:13,760 --> 01:12:16,680 IT WAS RATHER UNRELATED AT LEAST 1435 01:12:16,680 --> 01:12:21,560 IN THESE IT DATA AMONG WHITE 1436 01:12:21,560 --> 01:12:23,960 WOMEN THE STORY ABOUT STRESS WAS 1437 01:12:23,960 --> 01:12:27,280 MORE NUANCED AND LESS PRECISE. 1438 01:12:27,280 --> 01:12:31,520 THE RISK OF SEVERE MATERNAL 1439 01:12:31,520 --> 01:12:33,760 MORBIDITY WAS SLIGHTLY HIGHER IN 1440 01:12:33,760 --> 01:12:35,120 BLACK WOMEN WITH HIGHER 1441 01:12:35,120 --> 01:12:38,080 PRE-PREGNANCY STRESS BUT NOT 1442 01:12:38,080 --> 01:12:42,640 UNDID YOU -- UNDETECTED IN 1443 01:12:42,640 --> 01:12:45,280 WHILE THE WOMEN AND THE FINDING 1444 01:12:45,280 --> 01:12:49,240 FOR CARDIOVASCULAR HEALTH WERE 1445 01:12:49,240 --> 01:12:52,200 STRIKI 1446 01:12:52,200 --> 01:12:58,080 STRIKING AND THE ADVERSE 1447 01:12:58,080 --> 01:12:59,280 PREGNANCY OUTCOMES MATTERED BUT 1448 01:12:59,280 --> 01:13:02,360 DID NOT DIMINISH THE ASSOCIATION 1449 01:13:02,360 --> 01:13:05,080 OF PRE-PREGNANCY OF 1450 01:13:05,080 --> 01:13:06,320 CARDIOVASCULAR HEALTH IN TERMS 1451 01:13:06,320 --> 01:13:08,760 OF RISK FOR SEVERE MATERNAL 1452 01:13:08,760 --> 01:13:09,400 MORBIDITY EVENTS. 1453 01:13:09,400 --> 01:13:12,280 SO OUR DATA WERE RELATIVELY 1454 01:13:12,280 --> 01:13:15,280 STRIKING AT BETTER PRE-PREGNANCY 1455 01:13:15,280 --> 01:13:15,840 CARDIOVASCULAR HEALTH AND 1456 01:13:15,840 --> 01:13:18,320 STRONGLY ASSOCIATED WITH REDUCED 1457 01:13:18,320 --> 01:13:19,560 RISK OF SEVERE MATERNAL 1458 01:13:19,560 --> 01:13:21,160 MORBIDITY EVENTS IN BLACK BUT 1459 01:13:21,160 --> 01:13:26,520 NOT IN OUR DATA IN WHITE WOMEN 1460 01:13:26,520 --> 01:13:30,920 AND STRESSFUL EVENTS DID APPEAR 1461 01:13:30,920 --> 01:13:35,920 TO MEASURE AND WE COULD NOT 1462 01:13:35,920 --> 01:13:36,560 DISENTANGLE DIFFERENCES AMONG 1463 01:13:36,560 --> 01:13:38,560 BLACK AND WHITE WOMEN AND WE'RE 1464 01:13:38,560 --> 01:13:41,080 STILL LOOKING AT THE DATA. 1465 01:13:41,080 --> 01:13:44,360 I'D LIKE TO THANK THE 1466 01:13:44,360 --> 01:13:47,360 LONG-ESTABLISHED CARDIA STUDY. 1467 01:13:47,360 --> 01:13:51,960 THE CENTERS INVOLVED IN CARDIA 1468 01:13:51,960 --> 01:13:56,360 AS WELL AS OUR STUDY TEAM ALSO 1469 01:13:56,360 --> 01:14:06,280 WOULD LIKE TO THANK ERICA 1470 01:14:06,280 --> 01:14:06,760 GUNDERSON A LONG-TERM 1471 01:14:06,760 --> 01:14:09,280 COLLABORATOR. 1472 01:14:09,280 --> 01:14:12,280 THANK YOU. 1473 01:14:12,280 --> 01:14:15,600 >> I HAVE A QUESTION FROM THE 1474 01:14:15,600 --> 01:14:15,880 AUDIENCE. 1475 01:14:15,880 --> 01:14:17,840 HOW WERE STRESSFUL EVENTS 1476 01:14:17,840 --> 01:14:23,560 DEFINED DID IT TAKE INTO ACCOUNT 1477 01:14:23,560 --> 01:14:26,200 RACISM AND SOCIAL DETERMINATES 1478 01:14:26,200 --> 01:14:27,960 OF HEALTH? 1479 01:14:27,960 --> 01:14:30,160 >> SO CARDIA ENROLLED 1480 01:14:30,160 --> 01:14:32,920 PARTICIPANTS IN THEIR 20s IN THE 1481 01:14:32,920 --> 01:14:36,920 MID 1980s TO IT WAS A TIME AGO 1482 01:14:36,920 --> 01:14:39,000 BUT WE KNOW THE FACTORS WERE AT 1483 01:14:39,000 --> 01:14:41,160 PLAY IN THE 1980s AS WELL. 1484 01:14:41,160 --> 01:14:43,720 SO THERE ARE QUESTIONS IN THAT 1485 01:14:43,720 --> 01:14:46,080 STRESSFUL LIFE EVENTS AROUND 1486 01:14:46,080 --> 01:14:46,800 DISCRIMINATION, RACIAL 1487 01:14:46,800 --> 01:14:48,720 DISCRIMINATION, SEX 1488 01:14:48,720 --> 01:14:49,080 DISCRIMINATION. 1489 01:14:49,080 --> 01:14:50,280 WE COULDN'T DISENTANGLE IT 1490 01:14:50,280 --> 01:14:52,160 BECAUSE IT WAS ONLY ONE 1491 01:14:52,160 --> 01:14:54,880 QUESTION. 1492 01:14:54,880 --> 01:14:59,640 CARDIA ASKED A QUESTIONNAIRE ON 1493 01:14:59,640 --> 01:15:00,920 RACIAL DISCRIMINATION BUT NOT 1494 01:15:00,920 --> 01:15:03,760 UNTIL YEAR SEVEN OF FOLLOW-UP 1495 01:15:03,760 --> 01:15:06,800 AND BECAUSE CARDIA IS LARGE BUT 1496 01:15:06,800 --> 01:15:09,120 STILL ARE STUDYING RELATIVELY 1497 01:15:09,120 --> 01:15:11,280 RARE EVENTS. 1498 01:15:11,280 --> 01:15:16,280 WE WANTED TO INCLUDE IT ALL. 1499 01:15:16,280 --> 01:15:20,120 ALL THE OTHERS IN THE LIFE EVENT 1500 01:15:20,120 --> 01:15:21,960 CATEGORY ARE DID YOU EXPERIENCE 1501 01:15:21,960 --> 01:15:23,920 VIOLENCE, DID YOU LIVE AN 1502 01:15:23,920 --> 01:15:26,520 HOUSEHOLD WITH POVERTY. 1503 01:15:26,520 --> 01:15:30,120 WERE YOUR PARENTS DIVORCED. 1504 01:15:30,120 --> 01:15:32,200 IT'S A BROAD SURVEY OF STRESSFUL 1505 01:15:32,200 --> 01:15:33,040 LIFE EVENTS. 1506 01:15:33,040 --> 01:15:33,800 >> THANK YOU. 1507 01:15:33,800 --> 01:15:36,160 ANOTHER QUESTION IS THE SAME 1508 01:15:36,160 --> 01:15:40,720 THING, SO YOU ADDRESSED THAT AND 1509 01:15:40,720 --> 01:15:44,360 I'LL ASK THE FINAL QUESTION VERY 1510 01:15:44,360 --> 01:15:45,280 INTRIGUING RESULTS. 1511 01:15:45,280 --> 01:15:51,560 HOW DO YOU EXPLAIN THE POSITIVE 1512 01:15:51,560 --> 01:15:55,280 FINDINGS ABOUT BETTER 1513 01:15:55,280 --> 01:15:56,680 CARDIOVASCULAR HEALTH BUT NOT IN 1514 01:15:56,680 --> 01:15:57,920 WHITE WOMEN. 1515 01:15:57,920 --> 01:16:04,320 >> BLACK WOMEN WERE MORE HEAVILY 1516 01:16:04,320 --> 01:16:05,560 BURDENED BIG POORER 1517 01:16:05,560 --> 01:16:07,120 CARDIOVASCULAR HEALTH AND THAT 1518 01:16:07,120 --> 01:16:12,160 PRE-PREGNANCY WAS A RISK FACTOR 1519 01:16:12,160 --> 01:16:13,760 FOR SEVERE MAH MATERNAL 1520 01:16:13,760 --> 01:16:14,800 MORBIDITY. 1521 01:16:14,800 --> 01:16:16,880 IT'S NOT THAT THE CARDIOVASCULAR 1522 01:16:16,880 --> 01:16:18,320 HEALTH DOESN'T MATTER FOR WHITE 1523 01:16:18,320 --> 01:16:22,280 WOMEN BUT IT WAS LESS ADVERSELY 1524 01:16:22,280 --> 01:16:28,280 AFFECTED AT YOUNGER AGES IN 1525 01:16:28,280 --> 01:16:31,440 WHITE WOMEN COMPARED TO LOOK 1526 01:16:31,440 --> 01:16:32,560 WOMEN IN THE OCCURRENCE OF 1527 01:16:32,560 --> 01:16:34,040 POORER CARDIOVASCULAR HEALTH. 1528 01:16:34,040 --> 01:16:35,960 WE'RE INTERESTED IN REPLICATING 1529 01:16:35,960 --> 01:16:37,640 THIS IN MORE CONTEMPORARY 1530 01:16:37,640 --> 01:16:40,920 COHORTS BUT WE KNOW 1531 01:16:40,920 --> 01:16:46,000 PRE-CONCEPTION DATA ARE HARDER 1532 01:16:46,000 --> 01:16:50,320 TO GET OUR HANDS ON AND IT'S 1533 01:16:50,320 --> 01:16:51,760 NOT THAT BETTER HEALTH DOESN'T 1534 01:16:51,760 --> 01:16:54,560 MATTER FOR ALL OF US BUT CERTAIN 1535 01:16:54,560 --> 01:16:59,360 POPULATIONS ARE MORE BURDENED BY 1536 01:16:59,360 --> 01:17:00,880 CARDIOVASCULAR HEALTH. 1537 01:17:00,880 --> 01:17:01,920 >> THANK YOU. 1538 01:17:01,920 --> 01:17:04,360 I WANT TO TAKE THIS TIME TO 1539 01:17:04,360 --> 01:17:08,280 THANK ALL THE SPEAKERS FOR THE 1540 01:17:08,280 --> 01:17:08,640 QUESTION. 1541 01:17:08,640 --> 01:17:09,800 VERY INFORMATIVE AND WONDERFUL 1542 01:17:09,800 --> 01:17:11,480 TO SEE THE FRUITS OF THEIR LABOR 1543 01:17:11,480 --> 01:17:14,120 FROM THE IMPROVED INITIATIVE 1544 01:17:14,120 --> 01:17:14,360 FUNDING. 1545 01:17:14,360 --> 01:17:16,320 AS WE ALL COLLECTIVE MOVE 1546 01:17:16,320 --> 01:17:18,280 TOWARDS IMPROVING MATERNAL IT 1547 01:17:18,280 --> 01:17:20,520 HEALTH AND CLOSE THE EQUITY GAP. 1548 01:17:20,520 --> 01:17:22,320 WITH THAT THAT CONCLUDES THE 1549 01:17:22,320 --> 01:17:23,760 FIRST SESSION SO WE'LL NOW HAVE 1550 01:17:23,760 --> 01:17:29,160 OUR LUNCH BREAK. 1551 01:17:29,160 --> 01:17:34,760 PANELISTS STAY CONNECT ED. 1552 01:17:34,760 --> 01:17:36,160 PLEASE RETURN AT 12:40. 1553 01:17:36,160 --> 01:17:40,120 THE MEET AGENDA WILL RESTART 1554 01:17:40,120 --> 01:17:42,080 PROPERLY FIVE MINUTES AFTER 1555 01:17:42,080 --> 01:17:42,360 12:45. 1556 01:17:42,360 --> 01:17:45,840 HAVE A GOOD LUNCH BREAK. 1557 01:17:45,840 --> 01:17:48,000 >> WELCOME TO THE SESSION FOR 1558 01:17:48,000 --> 01:17:51,960 IDENTIFICATION AND PREVENTION OF 1559 01:17:51,960 --> 01:17:54,480 MATERNAL MORBIDITY AND RISK 1560 01:17:54,480 --> 01:17:56,000 SESSION. 1561 01:17:56,000 --> 01:17:59,600 I'M A PROGRAM DIRECTOR AT NINR. 1562 01:17:59,600 --> 01:18:01,840 I'M HONORED TO BE A MODERATOR 1563 01:18:01,840 --> 01:18:04,720 FOR THE SESSION TODAY. 1564 01:18:04,720 --> 01:18:08,280 BEFORE WE START I'D LIKE TO 1565 01:18:08,280 --> 01:18:11,160 REMIND EACH SPEAKER EACH 1566 01:18:11,160 --> 01:18:12,960 PRESENTATION IS FIVE TO TEN 1567 01:18:12,960 --> 01:18:16,640 MINUTES PLUS FIVE MINUTES OF 1568 01:18:16,640 --> 01:18:17,200 Q&A. 1569 01:18:17,200 --> 01:18:19,480 I'LL GIVE A WARNING FOR ONE 1570 01:18:19,480 --> 01:18:22,360 MINUTE BUT I'LL MONITOR THE TIME 1571 01:18:22,360 --> 01:18:26,440 AND AFTER THE PRESENTATION I'LL 1572 01:18:26,440 --> 01:18:29,040 TAKE QUESTIONS USING Q&A 1573 01:18:29,040 --> 01:18:31,360 FUNCTION IN THE ZOOM AND SO IF 1574 01:18:31,360 --> 01:18:32,680 YOU HAVE ANY QUESTIONS, PLEASE 1575 01:18:32,680 --> 01:18:41,320 POST YOUR QUESTIONS THERE. 1576 01:18:41,320 --> 01:18:47,680 OUR FIRST SPEAKER IS DR. EDLOW 1577 01:18:47,680 --> 01:18:52,320 FROM MASSACHUSETTS GENERAL 1578 01:18:52,320 --> 01:18:55,320 HOSPITAL FOR MATERNAL OBESITY 1579 01:18:55,320 --> 01:19:02,480 AND SARS COV2 AND MATERNAL BLOOD 1580 01:19:02,480 --> 01:19:07,320 AND FETAL IMMUNE RESPONSE. 1581 01:19:07,320 --> 01:19:07,840 YOU'RE GOOD TO GO. 1582 01:19:07,840 --> 01:19:09,080 >> YES, THANK YOU. 1583 01:19:09,080 --> 01:19:11,080 IT'S AN HONOR TO BE HERE TO 1584 01:19:11,080 --> 01:19:14,760 SHARE THE RESULTS OF OUR 1585 01:19:14,760 --> 01:19:20,760 IMPROVED FUNDED STUDIES. 1586 01:19:20,760 --> 01:19:30,800 I HAVE ONE ONLY HAVE ONE 1587 01:19:30,800 --> 01:19:32,000 DISCLOSURE I'M A CONSULTANT AND 1588 01:19:32,000 --> 01:19:33,720 I DON'T HAVE TO TELL THE 1589 01:19:33,720 --> 01:19:36,720 AUDIENCE THE MOST RECENT DATA 1590 01:19:36,720 --> 01:19:38,840 FROM THE CDC DEMONSTRATE THE 273 1591 01:19:38,840 --> 01:19:41,080 PREGNANT INDIVIDUALS HAVE DIED 1592 01:19:41,080 --> 01:19:42,160 FROM COVID-19 SINCE THE START OF 1593 01:19:42,160 --> 01:19:42,720 THE PANDEMIC IN THE UNITED 1594 01:19:42,720 --> 01:19:50,000 STATES ALONE. 1595 01:19:50,000 --> 01:19:52,400 WOE KNOW PREGNANT APPRECIATES 1596 01:19:52,400 --> 01:19:55,680 WITH COVID-19 ARE LIKELY TO NEED 1597 01:19:55,680 --> 01:20:01,360 ICU ADMISSION OR NEED A HEART 1598 01:20:01,360 --> 01:20:02,560 LUNG BYPASS MACHINE AND LIKELY 1599 01:20:02,560 --> 01:20:04,240 TO DIE. 1600 01:20:04,240 --> 01:20:07,160 IN ADDITION TO THE NETWORK 1601 01:20:07,160 --> 01:20:11,920 PUBLISHED LAST WEEK IN JAMA 1602 01:20:11,920 --> 01:20:15,200 SHOWED AN INCREASE RISK OF OB 1603 01:20:15,200 --> 01:20:19,480 OBSTETRICS RELATED TO HYPER 1604 01:20:19,480 --> 01:20:31,840 TENSIVE DISORDER OF PREGNANCY 1605 01:20:31,840 --> 01:20:35,200 POSTPARTUM RISK FACTORS. 1606 01:20:35,200 --> 01:20:39,960 DATA FROM THE CDC STUDIES 1607 01:20:39,960 --> 01:20:41,960 CONDUCTED ACROSS 12 SITES IN THE 1608 01:20:41,960 --> 01:20:43,640 UNITED STATES SHOWED A BMI 1609 01:20:43,640 --> 01:20:46,080 GREATER OR EQUAL TO 30 WAS 1610 01:20:46,080 --> 01:20:47,760 ASSOCIATED WITH A 1.4 FOLD 1611 01:20:47,760 --> 01:20:50,320 RELATIVE RISK OF SEVERE DISEASE. 1612 01:20:50,320 --> 01:20:53,840 AND A MORE RECENTLY PUBLISHED 1613 01:20:53,840 --> 01:20:56,800 SYSTEMATIC REVIEW OF 63 STUDIES 1614 01:20:56,800 --> 01:21:01,400 SHOWED ONE-THIRD OF PREGNANT 1615 01:21:01,400 --> 01:21:02,720 WOMEN HOSPITALIZED WERE OBESE. 1616 01:21:02,720 --> 01:21:04,840 HOWEVER, THE UNDERLYING 1617 01:21:04,840 --> 01:21:06,840 MECHANISMS THAT DRIVE THE 1618 01:21:06,840 --> 01:21:10,440 INCREASED RISK OF MATERNAL 1619 01:21:10,440 --> 01:21:12,000 SEVERE MORBIDITY OR MORTALITY 1620 01:21:12,000 --> 01:21:14,320 REMAIN TO BE ELUCIDATED. 1621 01:21:14,320 --> 01:21:16,440 WE SOUGHT TO DETERMINE HOW IT 1622 01:21:16,440 --> 01:21:20,760 ALTERS THE MATERNAL CELLULAR 1623 01:21:20,760 --> 01:21:23,240 MONOCYTE AND T CELL RESPONSE TO 1624 01:21:23,240 --> 01:21:27,480 SARS COV2 INFECTION AND HOW IT 1625 01:21:27,480 --> 01:21:30,520 IMPACTS THE FETAL MACROPHAGE 1626 01:21:30,520 --> 01:21:32,760 SINGLE CELL TRANSCRIPT OME. 1627 01:21:32,760 --> 01:21:35,040 TO EVALUATE THE IMMUNE RESPONSE 1628 01:21:35,040 --> 01:21:39,160 WE STARTED WITH 110 PREGNANT 1629 01:21:39,160 --> 01:21:40,280 INDIVIDUALS INCLUDING CONTROL 1630 01:21:40,280 --> 01:21:43,080 AND 74 PREGNANT INDIVIDUALS WITH 1631 01:21:43,080 --> 01:21:43,280 COV2. 1632 01:21:43,280 --> 01:21:49,720 ALL OF THESE PARTICIPANTS ALL 1633 01:21:49,720 --> 01:21:55,560 WERE UNVACCINATE. 1634 01:21:55,560 --> 01:22:00,680 THESE WERE DIVIDED BETWEEN OBESE 1635 01:22:00,680 --> 01:22:03,440 AND NON-OBESE AND 1636 01:22:03,440 --> 01:22:08,720 NON-COMPARATIVE REPRODUCTIVE AGE 1637 01:22:08,720 --> 01:22:10,440 WOMEN AND SOME SARS COV2 1638 01:22:10,440 --> 01:22:14,720 NEGATIVE CONTROLS AND THESE WERE 1639 01:22:14,720 --> 01:22:17,240 DIVIDED EVEN BY BETWEEN OBESE 1640 01:22:17,240 --> 01:22:19,320 AND LEAN AND MONITORED NUCLEAR 1641 01:22:19,320 --> 01:22:22,400 CELLS FROM THESE INDIVIDUALS AND 1642 01:22:22,400 --> 01:22:26,080 SPUN THEIR BLOOD FOR PLASMA AND 1643 01:22:26,080 --> 01:22:31,480 FROM THE PBMC WE FURTHER 1644 01:22:31,480 --> 01:22:34,360 FRACTIONATE THE CELLS AND USED 1645 01:22:34,360 --> 01:22:38,120 CD14 POSITIVE BEADS AND TREATED 1646 01:22:38,120 --> 01:22:43,240 MONOCYTES WITH LOW DOSE LDS. 1647 01:22:43,240 --> 01:22:49,000 FOR THE T CELLS WE STEM 1648 01:22:49,000 --> 01:22:53,680 STIMULATED THEM AND PERFORMED 1649 01:22:53,680 --> 01:22:58,320 MULTI-COLOR FLOW CTOMETRY AND WE 1650 01:22:58,320 --> 01:22:59,280 ALSO COLLECTED STOOL FROM MANY 1651 01:22:59,280 --> 01:23:01,360 OF THESE PARTICIPANTS AND ARE 1652 01:23:01,360 --> 01:23:05,440 CURRENTLY SEQUENCING THE GUT 1653 01:23:05,440 --> 01:23:07,280 MICROBIOME TO DETERMINE HOW IT 1654 01:23:07,280 --> 01:23:08,040 MAY INFLUENCE THE IMMUNE 1655 01:23:08,040 --> 01:23:10,840 RESPONSE TO SARS COV2 AND 1656 01:23:10,840 --> 01:23:12,480 WHETHER THERE'S A BI-DIRECTIONAL 1657 01:23:12,480 --> 01:23:14,720 CROSS TALK THERE. 1658 01:23:14,720 --> 01:23:22,000 TO EVALUATE THE FETAL PLACENTAL 1659 01:23:22,000 --> 01:23:24,800 MACROPHAGE TRANSCRIPT OME WE 1660 01:23:24,800 --> 01:23:28,160 LOOKED AT 12 PLACENTAS IN TOTAL 1661 01:23:28,160 --> 01:23:30,680 AND 4 WHO TESTED POSITIVE FOR 1662 01:23:30,680 --> 01:23:32,680 SARS COV2 IN THE THIRD TRIMESTER 1663 01:23:32,680 --> 01:23:34,600 AND SOME NEGATIVE CONTROLS WHO 1664 01:23:34,600 --> 01:23:37,240 NEVER HAD COVID. 1665 01:23:37,240 --> 01:23:41,240 WE PERFORMED SINGLE CELL 1666 01:23:41,240 --> 01:23:43,280 SEQUENCING AND IDENTIFIED 1667 01:23:43,280 --> 01:23:46,200 EXPRESSED GENES BETWEEN COVID 1668 01:23:46,200 --> 01:23:50,120 EXPOSE AND EXPOSED USING A FALSE 1669 01:23:50,120 --> 01:23:54,120 DISCOVERY RATE OF .1 AND 1670 01:23:54,120 --> 01:23:56,000 PERFORMED ANALYSES TO UNDERSTAND 1671 01:23:56,000 --> 01:23:57,720 WHAT GENES MAY BE INVOLVED AND 1672 01:23:57,720 --> 01:24:01,000 TURNING TO OUR RESULTS FOR THE 1673 01:24:01,000 --> 01:24:02,000 MATERNAL IMMUNE RESPONSE. 1674 01:24:02,000 --> 01:24:05,680 WE FOUND MONOCYTES FROM HEALTHY 1675 01:24:05,680 --> 01:24:08,040 PREGNANT WOMEN WERE MORE 1676 01:24:08,040 --> 01:24:10,360 REACTIVE THAN THOSE FROM 1677 01:24:10,360 --> 01:24:11,080 NON-REACTIVE CONTROLS. 1678 01:24:11,080 --> 01:24:16,840 THE YELLOW COLOR INDICATES MORE 1679 01:24:16,840 --> 01:24:19,520 INFLAMMATORY CYTOKINE PRODUCTION 1680 01:24:19,520 --> 01:24:21,040 AND THEY'RE HERE ACROSS THE 1681 01:24:21,040 --> 01:24:22,880 BOTTOM AND SEE IN THE TOP BAND 1682 01:24:22,880 --> 01:24:27,040 OF NON-PREGNANT CONTROLS MORE 1683 01:24:27,040 --> 01:24:32,760 BLUE MEANING LESS CYTOKINE 1684 01:24:32,760 --> 01:24:36,960 PRODUCTION AND YOU CAN SEE THE 1685 01:24:36,960 --> 01:24:39,320 EFFECT OF COVID-19 ON MATERNAL 1686 01:24:39,320 --> 01:24:42,840 MONOCYTES WHERE IN A SARS COV2 1687 01:24:42,840 --> 01:24:44,680 NEGATIVE CONTROLS WE STILL HAD A 1688 01:24:44,680 --> 01:24:47,120 LOT OF CYTOKINE PRODUCTION BUT 1689 01:24:47,120 --> 01:24:48,440 AS COVID SEVERITY INCREASES 1690 01:24:48,440 --> 01:24:49,600 DOWNWARD WITH SEVERE AND 1691 01:24:49,600 --> 01:24:51,280 CRITICAL CASES ON THE BOTTOM, WE 1692 01:24:51,280 --> 01:24:53,840 SEE MONOCYTES ARE EITHER 1693 01:24:53,840 --> 01:24:57,440 EXHAUSTED AND CAN NO LONGER 1694 01:24:57,440 --> 01:25:01,240 PRODUCE THESE OR POTENTIALLY 1695 01:25:01,240 --> 01:25:02,480 EXPRESSED SO WE DON'T KNOW 1696 01:25:02,480 --> 01:25:05,280 WHETHER THIS IS REFLECTIVE OF 1697 01:25:05,280 --> 01:25:08,360 MORE PRO-INFLAMMATORY CYTOKINE 1698 01:25:08,360 --> 01:25:10,640 PRODUCTION DURING THE ILLNESS OR 1699 01:25:10,640 --> 01:25:12,480 IF THE SUPPRESSION COULD BE 1700 01:25:12,480 --> 01:25:14,000 DRIVING THE PATHOPHYSIOLOGY BUT 1701 01:25:14,000 --> 01:25:18,720 A SIMILAR EFFECT HAS BEEN 1702 01:25:18,720 --> 01:25:20,640 OBSERVED IN NON-PREGNANT 1703 01:25:20,640 --> 01:25:23,320 OBSERVATIONS AND HAVE SEEN THIS 1704 01:25:23,320 --> 01:25:26,320 IN OBESE AND LEAN PARTICIPANTS. 1705 01:25:26,320 --> 01:25:30,200 YOU CAN SEE HERE CONTROLS IN RED 1706 01:25:30,200 --> 01:25:34,720 AND AS YOU PROGRESS ACROSS THE 1707 01:25:34,720 --> 01:25:38,120 SPECTRUM OF SEVERITY THIS IS 1708 01:25:38,120 --> 01:25:40,480 DURING THE ACUTE ILLNESS THAT 1709 01:25:40,480 --> 01:25:42,000 THESE SAMPLES WERE COLLECTED AND 1710 01:25:42,000 --> 01:25:47,520 THEN WE SEE SOME RECOVERY OF THE 1711 01:25:47,520 --> 01:25:49,360 MONOCYTE INFLAMMATORY PRODUCING 1712 01:25:49,360 --> 01:25:51,080 CAPABILITIES WITH CONVALESCENCE 1713 01:25:51,080 --> 01:25:53,640 USUALLY FROM THE SAME 1714 01:25:53,640 --> 01:25:53,960 PARTICIPANTS. 1715 01:25:53,960 --> 01:25:56,280 WE DID FIND AN OBESITY IMPACT IN 1716 01:25:56,280 --> 01:25:59,280 THE T CELL RESPONSE SO WE SAW 1717 01:25:59,280 --> 01:26:02,600 MATERNAL OBESITY WAS ASSOCIATED 1718 01:26:02,600 --> 01:26:03,840 WITH PROINFLAMMATORY PHENOTYPE 1719 01:26:03,840 --> 01:26:05,600 OF CD4 POSITIVE T CELLS. 1720 01:26:05,600 --> 01:26:08,120 TO ORIENT YOU, ALL THE 1721 01:26:08,120 --> 01:26:13,440 INDIVIDUALS DEPICTED HERE HAD 1722 01:26:13,440 --> 01:26:14,440 COVID-19 AND OBESE INDIVIDUALS 1723 01:26:14,440 --> 01:26:17,640 ARE DEPICTED IN BLUE AND LEAN IN 1724 01:26:17,640 --> 01:26:18,000 RED. 1725 01:26:18,000 --> 01:26:20,440 HERE YOU CAN SEE THE CD4 1726 01:26:20,440 --> 01:26:22,040 POSITIVE T CELL PRODUCE 1727 01:26:22,040 --> 01:26:26,440 SIGNIFICANTLY MORE IL2, IL4, TNF 1728 01:26:26,440 --> 01:26:28,640 ALPHA AND INTERFERON GAMMA WHEN 1729 01:26:28,640 --> 01:26:32,720 THE INDIVIDUALS ARE OBESE IN 1730 01:26:32,720 --> 01:26:34,280 PREGNANCY AND THIS INCREASE AS 1731 01:26:34,280 --> 01:26:37,160 SEEN IN THE PREGNANCY WAS NOT AS 1732 01:26:37,160 --> 01:26:39,160 PROMINENT IN THE NON-PREGNANCY 1733 01:26:39,160 --> 01:26:39,720 POPULATION. 1734 01:26:39,720 --> 01:26:43,280 THIS WAS PERFORMED IN 1735 01:26:43,280 --> 01:26:48,360 COLLABORATION WITH AN 1736 01:26:48,360 --> 01:26:48,920 IMMUNOLOGIST. 1737 01:26:48,920 --> 01:26:53,440 WE SAW A SIMILAR PATTERN IN CD8 1738 01:26:53,440 --> 01:26:54,720 POSITIVE T CELLS WHERE IN 1739 01:26:54,720 --> 01:26:55,800 PREGNANT OBESE INDIVIDUALS HERE 1740 01:26:55,800 --> 01:26:57,680 IN BLUE WE SAW INCREASED 1741 01:26:57,680 --> 01:27:01,520 PRODUCTION OF IL2, INTERFERON 1742 01:27:01,520 --> 01:27:04,400 GAMMA AND TNF ALPHA. 1743 01:27:04,400 --> 01:27:07,240 TURNING TO OUR RESULTS ABOUT THE 1744 01:27:07,240 --> 01:27:08,120 FETAL IMMUNE RESPONSE TO 1745 01:27:08,120 --> 01:27:10,240 COVID-19, JUST TO GIVE YOU A 1746 01:27:10,240 --> 01:27:15,760 SENSE OF THE RATIONALE FOR THE 1747 01:27:15,760 --> 01:27:19,400 EXPERIMENTS THE FUNDING WAS 1748 01:27:19,400 --> 01:27:22,880 AROUND USING PLA CENTRAL 1749 01:27:22,880 --> 01:27:24,800 MACROPHAGES AS A CELL TYPE FOR 1750 01:27:24,800 --> 01:27:27,360 FETAL BRAIN MICROGLIA. 1751 01:27:27,360 --> 01:27:30,440 THEY SHARE A COMMON YOKE SACK 1752 01:27:30,440 --> 01:27:31,360 ORIGIN AND THE IMMUNE CELLS OF 1753 01:27:31,360 --> 01:27:35,200 THE BRAIN MAY BE PROGRAMMED BY 1754 01:27:35,200 --> 01:27:38,240 THE INTRAUTERINE ENVIRONMENT 1755 01:27:38,240 --> 01:27:42,280 THAT CAN COME TO BEAR ON LATER 1756 01:27:42,280 --> 01:27:47,240 LIFE RISK FOR DISEASES THOUGHT 1757 01:27:47,240 --> 01:27:56,600 TO BE MEDIATE MICROGLIAL 1758 01:27:56,600 --> 01:27:58,440 IMPACTS. 1759 01:27:58,440 --> 01:28:00,800 BRAIN MICROGLIA REMAIN 1760 01:28:00,800 --> 01:28:02,800 UNACCESSIBLE AND WE'RE SEEKING 1761 01:28:02,800 --> 01:28:04,600 TO DETERMINE WHETHER A CELL TYPE 1762 01:28:04,600 --> 01:28:10,440 WITH A COMMON ORIGIN CAN PROVIDE 1763 01:28:10,440 --> 01:28:12,240 INFORMATION ON THE VARIOUS 1764 01:28:12,240 --> 01:28:13,280 EXPOSURES INCLUDING OBESITY. 1765 01:28:13,280 --> 01:28:15,280 THIS SINGLE CELL SEQUENCING WAS 1766 01:28:15,280 --> 01:28:16,960 PERFORMED IN OUR MOUSE MODEL AND 1767 01:28:16,960 --> 01:28:20,200 WE SAW SIMILARITIES BETWEEN 1768 01:28:20,200 --> 01:28:24,920 SPECIFIC CLUSTERS OF THESE 1769 01:28:24,920 --> 01:28:25,120 CELLS. 1770 01:28:25,120 --> 01:28:28,640 AND SO THAT'S WHY THE PARTICULAR 1771 01:28:28,640 --> 01:28:31,800 INTEREST IN THE CELLS IN HUMAN 1772 01:28:31,800 --> 01:28:38,720 PLACENTAS AND WE SEPARATED THEM 1773 01:28:38,720 --> 01:28:47,320 AND AND SHOWED THESE CELLS HAVE 1774 01:28:47,320 --> 01:28:49,360 SEVEN DISTINCT CLUSTERS AND SIX 1775 01:28:49,360 --> 01:28:51,520 ARE FETAL IN ORIGIN AND ONE IN 1776 01:28:51,520 --> 01:28:53,400 MATERNAL ORIGIN WHEN WE DID 1777 01:28:53,400 --> 01:28:55,400 MAPPING OVER THE CLUSTERS. 1778 01:28:55,400 --> 01:28:58,160 WE SAW THE COVID-19 WAS 1779 01:28:58,160 --> 01:29:02,720 ASSOCIATED WITH A DISTINCT PLA 1780 01:29:02,720 --> 01:29:04,880 CENTRAL MACROPHAGE WITH GENES IN 1781 01:29:04,880 --> 01:29:11,280 THE CELLS IN THE SETTING OF THE 1782 01:29:11,280 --> 01:29:14,120 OF COVID-19 AND IN PERFORMING 1783 01:29:14,120 --> 01:29:14,680 FUNCTIONAL ANALYSIS ON THE 1784 01:29:14,680 --> 01:29:15,400 EXPRESSED GENES TO UNDERSTAND 1785 01:29:15,400 --> 01:29:17,920 WHAT THE GENES MIGHT BE DOING, 1786 01:29:17,920 --> 01:29:21,360 WE FOUND MATERNAL COVID-19 WAS 1787 01:29:21,360 --> 01:29:24,360 ASSOCIATED WITH ALTERED 1788 01:29:24,360 --> 01:29:26,240 INFLAMMATORY SIGNALLING AND 1789 01:29:26,240 --> 01:29:26,880 MITOCHONDRIAL DYSFUNCTION AND 1790 01:29:26,880 --> 01:29:29,120 CELL DEATH WITH DIFFERENTIAL 1791 01:29:29,120 --> 01:29:31,400 IMPACT DEPENDING ON THE CLUSTER. 1792 01:29:31,400 --> 01:29:35,640 IN CONCLUSION, WE FIELD THE 1793 01:29:35,640 --> 01:29:37,040 INCREASE PROINFLAMMATORY 1794 01:29:37,040 --> 01:29:39,960 POTENTIAL IN OBESE PREGNANCY MAY 1795 01:29:39,960 --> 01:29:43,000 HELP ELUCIDATE THE INCREASED 1796 01:29:43,000 --> 01:29:44,160 RISK OF MATERNAL MORBIDITY IN 1797 01:29:44,160 --> 01:29:46,320 THE SETTING OF OBESITY AND THE 1798 01:29:46,320 --> 01:29:49,200 IMPACT OF COVID-19 ON PLACENTAL 1799 01:29:49,200 --> 01:29:50,920 MACROPHAGES SUGGESTING FETAL 1800 01:29:50,920 --> 01:29:54,240 IMMUNE AFFECTS IN THE ABSENCE OF 1801 01:29:54,240 --> 01:29:56,520 VERTICAL TRANSMISSION AND FUTURE 1802 01:29:56,520 --> 01:29:58,640 DIRECTION WILL FOCUS ON MODELS 1803 01:29:58,640 --> 01:30:01,120 USING MORE ACCESSIBLE PROXY CELL 1804 01:30:01,120 --> 01:30:03,640 TYPES IN HUMANS INCLUDING CORD 1805 01:30:03,640 --> 01:30:19,760 BLOOD MONOCYTES AND HOFBAUER 1806 01:30:19,760 --> 01:30:20,760 CELLS AND I'M HAPPY TO TAKE ANY 1807 01:30:20,760 --> 01:30:21,680 QUESTIONS. 1808 01:30:21,680 --> 01:30:23,320 1809 01:30:35,440 --> 01:30:36,520 >> YOU FOR THE INTERESTING 1810 01:30:36,520 --> 01:30:36,840 PRESENTATION. 1811 01:30:36,840 --> 01:30:37,400 THANK YOU FOR SHARING. 1812 01:30:37,400 --> 01:30:51,840 I DON'T SEE ANY QUESTIONS. 1813 01:30:51,840 --> 01:30:56,320 SO I BELIEVE THAT SOME 1814 01:30:56,320 --> 01:30:59,080 EXPRESSIONS MAY BE DIFFERENCE SO 1815 01:30:59,080 --> 01:31:00,680 I'M WONDERING, WHAT TIME POINT 1816 01:31:00,680 --> 01:31:05,360 WAS THE BLOOD SAMPLE COLLECTED 1817 01:31:05,360 --> 01:31:08,680 EITHER EARLY OR LATE COVID STAGE 1818 01:31:08,680 --> 01:31:10,400 OR SOME OTHER TIME POINT? 1819 01:31:10,400 --> 01:31:11,880 >> THAT'S AN IMPORTANT QUESTION, 1820 01:31:11,880 --> 01:31:14,840 THANKS FOR LETTING ME CLARIFY 1821 01:31:14,840 --> 01:31:15,040 THAT. 1822 01:31:15,040 --> 01:31:16,840 SO THESE DATA PRESENTED TODAY 1823 01:31:16,840 --> 01:31:19,240 ARE CONFINED JUST TO 1824 01:31:19,240 --> 01:31:20,840 PARTICIPANTS FOR WHOM WE WERE 1825 01:31:20,840 --> 01:31:24,880 ABLE TO COLLECT A BLOOD SIMPLE 1826 01:31:24,880 --> 01:31:29,440 SIMPLE -- SAMPLE AT THE TIME OF 1827 01:31:29,440 --> 01:31:30,120 HOSPITALIZATION FOR COVID-19 AND 1828 01:31:30,120 --> 01:31:32,240 THOSE SYSTEMATIC AND BEING 1829 01:31:32,240 --> 01:31:33,760 EVALUATED FOR COVID-19 OR BEING 1830 01:31:33,760 --> 01:31:35,400 ADMITTED FOR COVID-19 AND ALL 1831 01:31:35,400 --> 01:31:38,240 BLOOD SAMPLES ARE OBTAINED PRIOR 1832 01:31:38,240 --> 01:31:42,440 TO THE INITIATION OF TREATMENTS 1833 01:31:42,440 --> 01:31:50,200 OR THERAPIES ESPECIALLY 1834 01:31:50,200 --> 01:31:50,840 DEXAMETHAZONE AND THERE WERE 1835 01:31:50,840 --> 01:31:53,040 SAME INDIVIDUALS RECOVERED FROM 1836 01:31:53,040 --> 01:31:54,840 COVID WHEN THEY WENT ON TO 1837 01:31:54,840 --> 01:31:56,800 DELIVERY FOR A PREGNANT 1838 01:31:56,800 --> 01:31:57,080 POPULATION. 1839 01:31:57,080 --> 01:31:58,520 SO THAT'S WHERE WE WERE ABLE TO 1840 01:31:58,520 --> 01:32:01,840 SEE RECOVERY OF THE MONOCYTE 1841 01:32:01,840 --> 01:32:02,480 FUNCTION FOR EXAMPLE. 1842 01:32:02,480 --> 01:32:05,480 DID THAT ANSWER YOUR QUESTION? 1843 01:32:05,480 --> 01:32:07,240 >> YES, THANK YOU. 1844 01:32:07,240 --> 01:32:08,160 >> YOU'RE WELCOME. 1845 01:32:08,160 --> 01:32:10,560 >> I'M LOOKING AT THE TIME SO 1846 01:32:10,560 --> 01:32:15,840 IT'S 1:00 AND I'D LIKE TO KEEP 1847 01:32:15,840 --> 01:32:19,960 THE TIME FOR THE NEXT SESSION 1848 01:32:19,960 --> 01:32:30,440 SO -- LET ME SEE ONE QUESTION -- 1849 01:32:30,440 --> 01:32:37,320 ALSO IN HYPOTHESIZING THE 1850 01:32:37,320 --> 01:32:38,320 HOFBAUER EFFECTS INDICATED 1851 01:32:38,320 --> 01:32:42,120 MATERNAL CELL EFFECTS AND MAY BE 1852 01:32:42,120 --> 01:32:50,720 SOME OF THE POSTPARTUM 1853 01:32:50,720 --> 01:32:52,640 HEMORRHAGES REPORTED. 1854 01:32:52,640 --> 01:32:55,120 >> I'LL BE VERY BRIEF. 1855 01:32:55,120 --> 01:32:57,680 WE'RE HIGH BOTH SIZING THE 1856 01:32:57,680 --> 01:33:00,240 HOFBAUER CELL TRANSCRIPT OME MAY 1857 01:33:00,240 --> 01:33:08,520 BE MORE REFLECTIVE OF THE 1858 01:33:08,520 --> 01:33:09,640 PROGRAMMING MIGHT OCCUR AND I'M 1859 01:33:09,640 --> 01:33:11,160 HAPPY IF YOU WANT TO E-MAIL ME 1860 01:33:11,160 --> 01:33:12,080 TO GIVE ME FURTHER INFORMATION 1861 01:33:12,080 --> 01:33:14,760 ABOUT THAT. 1862 01:33:14,760 --> 01:33:16,440 THANK YOU. 1863 01:33:16,440 --> 01:33:17,440 >> THANK YOU. 1864 01:33:17,440 --> 01:33:27,080 >> SO WE'RE MOVING TO THE NEXT 1865 01:33:27,080 --> 01:33:31,320 PRESENTER. 1866 01:33:31,320 --> 01:33:33,680 NEXT SPEAKER FROM RUSH 1867 01:33:33,680 --> 01:33:37,640 UNIVERSITY AND DR. CASKEY FROM 1868 01:33:37,640 --> 01:33:38,720 THE UNIVERSITY OF ILLINOIS 1869 01:33:38,720 --> 01:33:40,720 CHICAGO AND THE PRESENTATION 1870 01:33:40,720 --> 01:33:42,160 TITLE IS ADDRESSING MATERNAL 1871 01:33:42,160 --> 01:33:43,880 MORBIDITY AND MORTALITY IN 1872 01:33:43,880 --> 01:33:52,040 COMMUNITY HEALTH CENTERS. 1873 01:33:52,040 --> 01:33:55,480 WHO IS GOING TO START FIRST? 1874 01:33:55,480 --> 01:33:58,240 >> THANK YOU. 1875 01:33:58,240 --> 01:34:00,040 THANK YOU SO MUCH FOR THE 1876 01:34:00,040 --> 01:34:02,720 OPPORTUNITY TO PRESENT TODAY ON 1877 01:34:02,720 --> 01:34:05,200 OUR PROJECT TITLED LINK MOMS 1878 01:34:05,200 --> 01:34:05,840 ADDRESSING MATERNAL MORBIDITY 1879 01:34:05,840 --> 01:34:07,120 AND MORTALITY IN COMMUNITY 1880 01:34:07,120 --> 01:34:07,880 HEALTH CENTERS. 1881 01:34:07,880 --> 01:34:11,280 WE THANK THE FUNDER FOR THE 1882 01:34:11,280 --> 01:34:16,040 OPPORTUNITY TO DO THE WORK. 1883 01:34:16,040 --> 01:34:17,400 TODAY I'LL BE SPEAK ON BEHALF 1884 01:34:17,400 --> 01:34:20,680 OUR TEAM OF RESEARCHERS. 1885 01:34:20,680 --> 01:34:26,040 I'M AN OB-GYN AT RUSH AND 1886 01:34:26,040 --> 01:34:33,240 DR. CASK IS HERE WITH ME AND 1887 01:34:33,240 --> 01:34:35,040 WE'VE BEEN COLLABORATING WITH AN 1888 01:34:35,040 --> 01:34:37,040 ORGANIZATION CALLED ALLIANCE 1889 01:34:37,040 --> 01:34:41,040 CHICAGO AND OUR CO-COLLABORATORS 1890 01:34:41,040 --> 01:34:41,640 THERE. 1891 01:34:41,640 --> 01:34:43,200 ASSIGN CHICAGO IS AN 1892 01:34:43,200 --> 01:34:43,760 ORGANIZATION THAT BRINGS 1893 01:34:43,760 --> 01:34:46,360 TOGETHER A LARGE NETWORK OF 1894 01:34:46,360 --> 01:34:48,080 FEDERALLY QUALIFIED HEALTH 1895 01:34:48,080 --> 01:34:53,440 CENTERS TO IMPROVE PERSONAL, 1896 01:34:53,440 --> 01:34:54,280 COMMUNITY HEALTH THROUGH 1897 01:34:54,280 --> 01:34:55,240 ORGANIZATIONS THROUGH ENGAGING 1898 01:34:55,240 --> 01:34:59,760 IN SUPPORTIVE NETWORKS OF HEALTH 1899 01:34:59,760 --> 01:35:01,640 CENTERS TO COME TOGETHER AS 1900 01:35:01,640 --> 01:35:03,440 PROVIDERS AND PATIENTS THROUGH 1901 01:35:03,440 --> 01:35:04,800 HEALTH INFORMATION TECHNOLOGY. 1902 01:35:04,800 --> 01:35:08,520 THEY HAVE A UNIFIED ELECTRONIC 1903 01:35:08,520 --> 01:35:09,720 MEDICAL SYSTEM, MEDICAL RECORD 1904 01:35:09,720 --> 01:35:12,480 SYSTEM WHICH ALLOWS FOR QUALITY 1905 01:35:12,480 --> 01:35:13,920 IMPROVEMENT, RESEARCH AND 1906 01:35:13,920 --> 01:35:14,200 EDUCATION. 1907 01:35:14,200 --> 01:35:15,880 THIS IS A NETWORK WHICH SPANNED 1908 01:35:15,880 --> 01:35:17,040 A NUMBER OF HEALTH CENTERS 1909 01:35:17,040 --> 01:35:20,640 AROUND THE COUNTRY. 1910 01:35:20,640 --> 01:35:21,640 SO ALLIANCE CHICAGO AGAIN WE 1911 01:35:21,640 --> 01:35:23,360 HAVE BEEN COLLABORATING A NUMBER 1912 01:35:23,360 --> 01:35:26,800 OF YEARS HAS A NETWORK OF 74 1913 01:35:26,800 --> 01:35:28,840 SAFETY NET COMMUNITY HEALTH 1914 01:35:28,840 --> 01:35:31,320 CENTERS SPAN 20 STATES AND 1915 01:35:31,320 --> 01:35:32,480 ALLOWS FOR DATA AND REPORTING ON 1916 01:35:32,480 --> 01:35:33,320 A LARGE SCALE. 1917 01:35:33,320 --> 01:35:34,520 THEY HAVE AN INFRASTRUCTURE TO 1918 01:35:34,520 --> 01:35:40,120 GIVE US DATA ON CLOSE TO 4 1919 01:35:40,120 --> 01:35:41,200 MILLION PATIENTS ACROSS THE 1920 01:35:41,200 --> 01:35:42,440 COUNTRY AND WE HAVE WORKED WITH 1921 01:35:42,440 --> 01:35:44,840 THEM TO THINK HOW TO LEVERAGE 1922 01:35:44,840 --> 01:35:46,360 THIS WIDE REACH ACROSS COMMUNITY 1923 01:35:46,360 --> 01:35:48,440 HEALTH CENTER TO THINK ABOUT 1924 01:35:48,440 --> 01:35:53,640 INNOVATIVE WAYS TO MEET IMPROVE 1925 01:35:53,640 --> 01:35:55,080 MATERNAL HEALTH AND MEET 1926 01:35:55,080 --> 01:35:57,960 PATIENTS WHERE THEY'RE AT AT THE 1927 01:35:57,960 --> 01:35:59,040 HEALTH CENTERS. 1928 01:35:59,040 --> 01:36:01,160 BEFORE I JUMP INTO TALKING ABOUT 1929 01:36:01,160 --> 01:36:02,560 THIS PROJECT, LINK MOMS, I'LL 1930 01:36:02,560 --> 01:36:05,960 TALK ABOUT OUR PARENT PROJECT. 1931 01:36:05,960 --> 01:36:08,720 OUR PARENT RO1 ON WHICH WE BUILT 1932 01:36:08,720 --> 01:36:10,680 THE LINK MOM PROJECT. 1933 01:36:10,680 --> 01:36:13,760 WE WERE FUNDED TO CONDUCT AN RO1 1934 01:36:13,760 --> 01:36:16,600 TO LOOK AT HOW TO IMPROVE 1935 01:36:16,600 --> 01:36:19,440 MATERNAL OUTCOMES TO ENHANCED 1936 01:36:19,440 --> 01:36:21,240 OUTCOMES TO POSTCONTRACEPTION 1937 01:36:21,240 --> 01:36:22,840 AND CARE. 1938 01:36:22,840 --> 01:36:25,040 WE THOUGHT HOW TO DO THIS AT THE 1939 01:36:25,040 --> 01:36:26,920 SYSTEM LEVEL AND REMOVE BARRIERS 1940 01:36:26,920 --> 01:36:30,040 TO ACCESSING CARES AND OFFERING 1941 01:36:30,040 --> 01:36:30,680 MOTHERS MORE OPPORTUNITIES TO 1942 01:36:30,680 --> 01:36:32,640 GET POSTPARTUM CARE AND 1943 01:36:32,640 --> 01:36:33,960 CONTRACEPTION BY LINKING THEIR 1944 01:36:33,960 --> 01:36:35,120 CARE WITH THE WELL BABY VISIT 1945 01:36:35,120 --> 01:36:36,360 AND INFANT CARE. 1946 01:36:36,360 --> 01:36:38,240 THIS STUDY CURRENTLY UNDERWAY 1947 01:36:38,240 --> 01:36:40,680 AND WE HAVE THIS LINKED MODEL 1948 01:36:40,680 --> 01:36:41,600 ACROSS SEVEN COMMUNITY HEALTH 1949 01:36:41,600 --> 01:36:43,960 CENTERS ACROSS THE COUNTRY 1950 01:36:43,960 --> 01:36:45,040 CURRENTLY AND THE ULTIMATE GOAT 1951 01:36:45,040 --> 01:36:46,720 GOAL IS TO IMPROVE ACCESS TO 1952 01:36:46,720 --> 01:36:49,040 CARE AND TIMELY CARE FOR MOMS 1953 01:36:49,040 --> 01:36:52,560 AND THE MOST PARTUM PERIOD AND 1954 01:36:52,560 --> 01:36:54,920 ULTIMATELY DECREASE MATERNAL 1955 01:36:54,920 --> 01:36:56,720 MORALITY AND IMPACT OUTCOMES IN 1956 01:36:56,720 --> 01:36:57,640 OTHER WAYS. 1957 01:36:57,640 --> 01:36:59,440 THE PARENT PROJECT LAID AN IDEAL 1958 01:36:59,440 --> 01:37:01,240 FOUNDATION TO FURTHER DEVELOP A 1959 01:37:01,240 --> 01:37:04,560 MODEL TO LOOK AT HOW TO IDENTIFY 1960 01:37:04,560 --> 01:37:08,640 MOTHERS AT RISK FOR MATERNAL 1961 01:37:08,640 --> 01:37:10,360 MORBIDITY AND MORTALITY AND USE 1962 01:37:10,360 --> 01:37:12,280 THIS ELECTRONIC MEDICAL RECORD 1963 01:37:12,280 --> 01:37:17,520 AND IDENTIFY RISK FACTORS IN 1964 01:37:17,520 --> 01:37:20,760 POSTPARTUM THAT CAN BE USED TO 1965 01:37:20,760 --> 01:37:22,440 LINK MOTHERS TO OTHER CARE IN 1966 01:37:22,440 --> 01:37:25,120 ADDITION TO CONTRACEPTION. 1967 01:37:25,120 --> 01:37:28,120 THE LINK MOMS PROJECT USE AS A 1968 01:37:28,120 --> 01:37:29,880 POPULATION-BASED APPROACH 1969 01:37:29,880 --> 01:37:32,400 THROUGH THE ELECTRONIC MEDICAL 1970 01:37:32,400 --> 01:37:35,200 RECORD TO CREATE A REGISTRY TO 1971 01:37:35,200 --> 01:37:37,640 IDENTIFY THOSE AT HIGHEST RISK 1972 01:37:37,640 --> 01:37:40,640 AND LINK TO CARE. 1973 01:37:40,640 --> 01:37:41,920 PREVENTION OF SEVERE MATERNAL 1974 01:37:41,920 --> 01:37:43,080 MORBIDITY AND MORTALITY IS 1975 01:37:43,080 --> 01:37:46,080 OFFERING TIMELY ACCESS TO 1976 01:37:46,080 --> 01:37:46,880 QUALITY HEALTH CARE. 1977 01:37:46,880 --> 01:37:49,040 WE LEVERAGED OUR EXISTING 1978 01:37:49,040 --> 01:37:50,040 PARTNERSHIPS AND THE LARGE DATA 1979 01:37:50,040 --> 01:37:52,400 SET AVAILABLE TO US THROUGH 1980 01:37:52,400 --> 01:37:53,680 ALLIANCE CHICAGO'S NETWORK TO 1981 01:37:53,680 --> 01:37:55,040 CREATE A TOOL TO IDENTIFY THOSE 1982 01:37:55,040 --> 01:37:55,640 AT RISK. 1983 01:37:55,640 --> 01:37:58,880 WE HAVE TAKEN THE OPPORTUNITY TO 1984 01:37:58,880 --> 01:38:00,520 INCORPORATE WHAT WE'VE ALREADY 1985 01:38:00,520 --> 01:38:02,760 LEARN THE PARENT STUDY WHICH 1986 01:38:02,760 --> 01:38:04,600 LINKS CONTRACEPTION AND WELL 1987 01:38:04,600 --> 01:38:06,440 BABY CARE TO THINK HOW DO WE 1988 01:38:06,440 --> 01:38:08,160 THEN FURTHER IDENTIFY PATIENTS 1989 01:38:08,160 --> 01:38:10,040 AT HIGHEST RISK FOR MORBIDITY BY 1990 01:38:10,040 --> 01:38:11,200 INCLUDING THE VOICES OF THE 1991 01:38:11,200 --> 01:38:13,480 PROVIDERS AND PATIENTS AND OTHER 1992 01:38:13,480 --> 01:38:16,040 SUBJECT MATTER EXPERTS AS WE 1993 01:38:16,040 --> 01:38:17,840 DEVELOPED THIS LINKED MOM TOOL. 1994 01:38:17,840 --> 01:38:20,240 SO OUR AIMS ARE TO BUILD A 1995 01:38:20,240 --> 01:38:22,680 POPULATION-HEALTH INTERFACE TO 1996 01:38:22,680 --> 01:38:24,280 IDENTIFY THOSE AT RISK THROUGH 1997 01:38:24,280 --> 01:38:25,240 THE ELECTRONIC HEALTH RECORD AND 1998 01:38:25,240 --> 01:38:28,080 THEN CREATE A REGISTRY USING 1999 01:38:28,080 --> 01:38:29,680 THAT TOOL AND THEN TO ACTUALLY 2000 01:38:29,680 --> 01:38:32,000 VALIDATE IT TO THEN TAKE A STEP 2001 01:38:32,000 --> 01:38:33,480 BACK SAYING DID THIS TOOL THAT 2002 01:38:33,480 --> 01:38:35,200 WE USED TO CREATE THE REGISTRY 2003 01:38:35,200 --> 01:38:37,240 OF PATIENTS AT HIGHEST RISK 2004 01:38:37,240 --> 01:38:39,160 ACTUALLY WORK BY VALIDATION 2005 01:38:39,160 --> 01:38:40,840 THROUGH THE COMMUNITY HEALTH 2006 01:38:40,840 --> 01:38:41,080 CENTERS. 2007 01:38:41,080 --> 01:38:43,040 LASTLY, WE WANT TO FOCUS ON HOW 2008 01:38:43,040 --> 01:38:44,480 WE WOULD IMPLEMENT SOMETHING 2009 01:38:44,480 --> 01:38:45,880 LIKE THIS IN REAL WORLD 2010 01:38:45,880 --> 01:38:46,240 PRACTICE. 2011 01:38:46,240 --> 01:38:48,880 OUR THIRD AIM IS TO CREATE AN 2012 01:38:48,880 --> 01:38:50,760 IMPLEMENTATION PLAN TO USE THE 2013 01:38:50,760 --> 01:38:52,200 LINK MOMS REGISTRY ACROSS HEALTH 2014 01:38:52,200 --> 01:38:53,440 CENTERS. 2015 01:38:53,440 --> 01:38:55,080 I MENTIONED WE'RE USING A 2016 01:38:55,080 --> 01:38:57,160 POPULATION-HEALTH APPROACH AND I 2017 01:38:57,160 --> 01:38:59,720 WANT TO MAKE THIS DISTINCTION 2018 01:38:59,720 --> 01:39:02,360 BECAUSE WE'RE NOT OFTEN WE USE A 2019 01:39:02,360 --> 01:39:04,360 ONE POINT IN TIME DATA POINT TO 2020 01:39:04,360 --> 01:39:06,840 THEN DELIVER CARE AND IMPROVE 2021 01:39:06,840 --> 01:39:07,320 OUTCOMES. 2022 01:39:07,320 --> 01:39:09,320 WE'RE THINK ABOUT THIS TO LOOK 2023 01:39:09,320 --> 01:39:11,440 AT MULTIPLE FACTOR CAN IDENTIFY 2024 01:39:11,440 --> 01:39:14,640 A COHORT OF PATIENT COULD BE AT 2025 01:39:14,640 --> 01:39:18,160 HIGHEST RISK SUCH AS FACTORS 2026 01:39:18,160 --> 01:39:19,280 AROUND CLINICAL DIAGNOSES, 2027 01:39:19,280 --> 01:39:20,800 SOCIAL FACTORS AND OTHER FACTORS 2028 01:39:20,800 --> 01:39:22,840 THAT COULD THEN BE ASSOCIATED 2029 01:39:22,840 --> 01:39:25,880 WITH A COHORT OF PATIENTS AT 2030 01:39:25,880 --> 01:39:28,240 HIGHEST RISK FOR POORER 2031 01:39:28,240 --> 01:39:28,520 OUTCOMES. 2032 01:39:28,520 --> 01:39:30,480 WE'RE USING A PLATFORM CALLED 2033 01:39:30,480 --> 01:39:34,680 THE HEALTH CATALYST THIS IS 2034 01:39:34,680 --> 01:39:36,160 SOMETHING WE'RE ABLE TO 2035 01:39:36,160 --> 01:39:36,440 LEVERAGE. 2036 01:39:36,440 --> 01:39:38,880 THIS IS PART OF OUR HEALTH 2037 01:39:38,880 --> 01:39:40,480 INFORMATICS SYSTEM. 2038 01:39:40,480 --> 01:39:42,280 WE'RE USING A SPECIFIC PROGRAM 2039 01:39:42,280 --> 01:39:44,760 CALLED THE POPULATION BUILDER 2040 01:39:44,760 --> 01:39:46,440 WHICH HELPS TO IDENTIFY PATIENTS 2041 01:39:46,440 --> 01:39:48,440 ON VARIOUS FACTORS SO THIS IS AN 2042 01:39:48,440 --> 01:39:51,360 EXAMPLE HERE OF LOOKING AT A 2043 01:39:51,360 --> 01:39:55,920 COHORT OF PATIENTS WITH DIABETES 2044 01:39:55,920 --> 01:39:56,240 R 2045 01:39:56,240 --> 01:39:57,480 UNRELATED TO OUR PROJECT AND 2046 01:39:57,480 --> 01:39:59,440 FILTER ON MULTIPLE LEVELS ON THE 2047 01:39:59,440 --> 01:40:03,280 TOOL SO FILTER FOR DEMOGRAPHICS, 2048 01:40:03,280 --> 01:40:05,800 DIAGNOSES AND LABS AND TO CREATE 2049 01:40:05,800 --> 01:40:08,720 A SYSTEM WE THINK WILL HELP 2050 01:40:08,720 --> 01:40:10,440 IDENTIFY PATIENTS MOST AT RISK 2051 01:40:10,440 --> 01:40:12,160 BY USING THE CHARACTERISTICS WE 2052 01:40:12,160 --> 01:40:13,720 PUT INTO THE FILTER AND IDENTIFY 2053 01:40:13,720 --> 01:40:14,560 THE COHORT AND CREATE A 2054 01:40:14,560 --> 01:40:19,240 REGISTRY. 2055 01:40:19,240 --> 01:40:23,480 I'M GOING TURN IT OVER TO 2056 01:40:23,480 --> 01:40:26,480 DR. CASKEY FOR FURTHER OUTCOMES. 2057 01:40:26,480 --> 01:40:35,040 >> SO WE'LL GIVE YOU AN UPDATE 2058 01:40:35,040 --> 01:40:35,920 IN THE PROCESS. 2059 01:40:35,920 --> 01:40:37,800 THE FIRST WAS TO BUILD THE 2060 01:40:37,800 --> 01:40:42,440 POPULATION HEALTH INTERFACE AND 2061 01:40:42,440 --> 01:40:44,600 WE CONDUCTED TWO EXPERT PANELS 2062 01:40:44,600 --> 01:40:46,400 SUBJECT MATTER EXPERT PANELS 2063 01:40:46,400 --> 01:40:48,840 THAT INCLUDED PROVIDERS THAT 2064 01:40:48,840 --> 01:40:50,000 WORKED AT COMMUNITY HEALTH 2065 01:40:50,000 --> 01:40:51,920 CENTERS AND OB-GYN AND INTERNAL 2066 01:40:51,920 --> 01:40:56,760 MEDICINE AND SO FORTH. 2067 01:40:56,760 --> 01:40:58,560 THOSE SESSIONS PROVIDED ROBUST 2068 01:40:58,560 --> 01:41:00,680 DATA TO HELP GUIDE THE PROCESS. 2069 01:41:00,680 --> 01:41:04,480 WE HAVE TRANSCRIPTS AND WE 2070 01:41:04,480 --> 01:41:06,320 EXTRACTED VARIABLES TO IDENTIFY 2071 01:41:06,320 --> 01:41:07,400 PEOPLE MOST AT RISK FOR 2072 01:41:07,400 --> 01:41:08,640 MORBIDITY AND MORTALITY RELATED 2073 01:41:08,640 --> 01:41:14,440 TO PREGNANCY. 2074 01:41:14,440 --> 01:41:17,320 WE ALSO EXPLORED DOCUMENTATION S 2075 01:41:17,320 --> 01:41:18,880 AND THIS GETS INTO HOW AN 2076 01:41:18,880 --> 01:41:19,600 ELECTRONIC HEALTH RECORD IS 2077 01:41:19,600 --> 01:41:20,040 USED. 2078 01:41:20,040 --> 01:41:22,440 AS DESCRIBED, THIS TOOL IS GOING 2079 01:41:22,440 --> 01:41:25,840 USE EMR DATA TO HELP IDENTIFY 2080 01:41:25,840 --> 01:41:27,440 THOSE PREGNANT PEOPLE MOST AT 2081 01:41:27,440 --> 01:41:27,640 RISK. 2082 01:41:27,640 --> 01:41:31,440 HOUR JUST BECAUSE THERE IS A 2083 01:41:31,440 --> 01:41:34,000 VARIABLE OR A FIELD DOES NOT 2084 01:41:34,000 --> 01:41:34,960 MEAN IT'S USED. 2085 01:41:34,960 --> 01:41:36,200 WE SPENT A LOT OF TIME 2086 01:41:36,200 --> 01:41:38,200 UNDERSTANDING WHAT FIELD AND SEM 2087 01:41:38,200 --> 01:41:43,000 PLATES ARE USED DID I CLINICIANS 2088 01:41:43,000 --> 01:41:45,120 AND WHICH ARE TYPICALLY NOT 2089 01:41:45,120 --> 01:41:47,040 USED. 2090 01:41:47,040 --> 01:41:50,120 WE THEN CONSTRUCTED A LIST TO 2091 01:41:50,120 --> 01:41:51,120 INCLUDE VARIABLES MOST USEFUL TO 2092 01:41:51,120 --> 01:41:52,240 THIS PROCESS AND THE DRAFT 2093 01:41:52,240 --> 01:41:55,240 VARIABLES IN RED ARE THE ONES WE 2094 01:41:55,240 --> 01:41:57,760 FOUND ACROSS THE BOARD TO BE 2095 01:41:57,760 --> 01:41:59,440 MOST USEFUL THROUGH SUBJECT 2096 01:41:59,440 --> 01:42:01,120 MATTER EXPERTS OR THROUGH 2097 01:42:01,120 --> 01:42:02,080 FURTHER DISCUSSION ABOUT USE OF 2098 01:42:02,080 --> 01:42:07,480 THE VARIABLES WITHIN THE EMR. 2099 01:42:07,480 --> 01:42:09,160 THE FINAL LIST WAS USED TO 2100 01:42:09,160 --> 01:42:11,200 CREATE A TOOL TO TEST AND 2101 01:42:11,200 --> 01:42:12,440 VALIDATE ITS ACCURACY AND 2102 01:42:12,440 --> 01:42:17,840 IDENTIFYING PEOPLE AT RISK. 2103 01:42:17,840 --> 01:42:20,640 FOR AIM 2, WE'RE IN THE PROCESS 2104 01:42:20,640 --> 01:42:22,240 OF VALIDATING THE REGISTRY. 2105 01:42:22,240 --> 01:42:24,880 OUR FIRST DRAFT OF THE REGISTRY 2106 01:42:24,880 --> 01:42:27,040 WAS BUILT AND HAS BEEN DEPLOYED 2107 01:42:27,040 --> 01:42:28,600 AT FIVE COMMUNITY HEALTH 2108 01:42:28,600 --> 01:42:29,040 CENTERS. 2109 01:42:29,040 --> 01:42:31,080 OF THOSE FIVE COMMUNITY HEALTH 2110 01:42:31,080 --> 01:42:32,480 CENTERS, JUST UNDER 4,000 2111 01:42:32,480 --> 01:42:35,200 PREGNANT PEOPLE WERE IDENTIFIED 2112 01:42:35,200 --> 01:42:40,360 AND THE TOOL WE BUILT IDENTIFY 2113 01:42:40,360 --> 01:42:42,640 2930 HAVE BEEN FLAGGED FOR ONE 2114 01:42:42,640 --> 01:42:43,400 OF THE VARIABLES SUGGESTING RISK 2115 01:42:43,400 --> 01:42:44,840 FOR AN ADVERSE OUTCOME. 2116 01:42:44,840 --> 01:42:47,320 THIS IS A LARGE PERCENTAGE OF 2117 01:42:47,320 --> 01:42:50,600 THE PREGNANT PEOPLE SO OUR NEXT 2118 01:42:50,600 --> 01:42:54,240 STEP IS A MORE HANDS ON 2119 01:42:54,240 --> 01:42:57,640 VALIDATION PROCESS TO CREATE A 2120 01:42:57,640 --> 01:43:01,160 TOOL AND CONDUCT A CHART REVIEW 2121 01:43:01,160 --> 01:43:04,480 PORTION OF THE PATIENTS TO HELP 2122 01:43:04,480 --> 01:43:05,240 UNDERSTAND WERE THESE 2123 01:43:05,240 --> 01:43:07,240 INDIVIDUALS TRULY AT RISK, WAS 2124 01:43:07,240 --> 01:43:10,440 THERE A MISCODING OR 2125 01:43:10,440 --> 01:43:17,880 DOCUMENTATION BEING FLAGGED 2126 01:43:17,880 --> 01:43:20,560 INAPPROPRIATELY BY THE TOOL AND 2127 01:43:20,560 --> 01:43:22,680 THAT WILL BE FLAGGED IN THE 2128 01:43:22,680 --> 01:43:23,440 SPRING AFTER THE VALIDATION 2129 01:43:23,440 --> 01:43:25,520 PROCESS WE'LL BE CONDUCTING MORE 2130 01:43:25,520 --> 01:43:26,800 QUALITATIVE WORK. 2131 01:43:26,800 --> 01:43:29,240 WASN'T TO HEAR FROM MOTHERS AS 2132 01:43:29,240 --> 01:43:30,640 WELL AS PROVIDERS VOICES. 2133 01:43:30,640 --> 01:43:32,760 WE WANT TO GET MOTHER'S INPUTS 2134 01:43:32,760 --> 01:43:34,480 ON PREFERENCES AND NEEDS AND 2135 01:43:34,480 --> 01:43:35,840 FEEDBACK ON THE REGISTRY WE 2136 01:43:35,840 --> 01:43:38,000 BUILD AND HOW IT CAN BE USED TO 2137 01:43:38,000 --> 01:43:39,320 IDENTIFY AND LINK INDIVIDUALS 2138 01:43:39,320 --> 01:43:41,040 POTENTIALLY AT RISK FOR ADVERSE 2139 01:43:41,040 --> 01:43:43,080 OUTCOMES WITH CARE AND SUPPORT 2140 01:43:43,080 --> 01:43:43,640 AS NEEDED. 2141 01:43:43,640 --> 01:43:46,880 IMPORTANTLY TOO WE WANT TO GET 2142 01:43:46,880 --> 01:43:48,760 PROVIDER'S VOICES AND WE'LL BE 2143 01:43:48,760 --> 01:43:49,640 USING CLINICIAN DATA TO BUILD 2144 01:43:49,640 --> 01:43:52,840 THE REGISTRY AND WANT TO 2145 01:43:52,840 --> 01:43:55,320 IDENTIFY BARRIERS AND 2146 01:43:55,320 --> 01:43:57,960 FACILITATORS TO UTILIZATION 2147 01:43:57,960 --> 01:44:01,080 BEFORE IT IS DISSEMINATED MORE 2148 01:44:01,080 --> 01:44:01,440 BROADLY. 2149 01:44:01,440 --> 01:44:03,040 OUR FUTURE DIRECTION IS THE 2150 01:44:03,040 --> 01:44:04,920 OPPORTUNITY TO USE IT WITHIN THE 2151 01:44:04,920 --> 01:44:06,120 NETWORK MORE BROADLY. 2152 01:44:06,120 --> 01:44:08,080 WHERE SITES CAN USE THE TOOL TO 2153 01:44:08,080 --> 01:44:10,080 RUN REPORTS TO IDENTIFY PREGNANT 2154 01:44:10,080 --> 01:44:11,280 PEOPLE AT RISK. 2155 01:44:11,280 --> 01:44:13,360 SHARE FINDINGS AND DATA POINTS 2156 01:44:13,360 --> 01:44:14,440 THAT MIGHT BE FOUND OVER TIME 2157 01:44:14,440 --> 01:44:17,440 AND NATIONALLY TO BE MOST 2158 01:44:17,440 --> 01:44:17,760 PREDICTIVE. 2159 01:44:17,760 --> 01:44:19,880 AND THEN ALLOW THE VALIDATED 2160 01:44:19,880 --> 01:44:21,600 APPROACH TO BE ADAPTED AND 2161 01:44:21,600 --> 01:44:23,200 UTILIZED BY OTHERS OUTSIDE THE 2162 01:44:23,200 --> 01:44:27,000 ALLIANCE NETWORK AS WELL. 2163 01:44:27,000 --> 01:44:27,720 WE'LL STOP THERE FOR YOUR 2164 01:44:27,720 --> 01:44:31,360 QUESTIONS. 2165 01:44:31,360 --> 01:44:34,080 THANK YOU SO MUCH. 2166 01:44:34,080 --> 01:44:39,320 >> THANK YOU VERY MUCH FOR YOUR 2167 01:44:39,320 --> 01:44:51,480 INTERESTING PRESENTATION. 2168 01:44:51,480 --> 01:44:55,560 THERE'S ONE QUESTION. 2169 01:44:55,560 --> 01:45:00,680 HOW DID YOU EDUCATE THEM TO FEEL 2170 01:45:00,680 --> 01:45:02,320 COMFORTABLE IN THE ROLE WITH THE 2171 01:45:02,320 --> 01:45:03,080 RESEARCH PROJECT? 2172 01:45:03,080 --> 01:45:17,280 I SEE THE DEFINITION SLIDES. 2173 01:45:17,280 --> 01:45:17,720 2174 01:45:17,720 --> 01:45:18,680 >> WE HAVE CLINICIAN AND 2175 01:45:18,680 --> 01:45:19,440 PROFESSIONAL STAKE HOLDERS AND 2176 01:45:19,440 --> 01:45:21,600 LAY STAKEHOLDERS AND WE TALK TO 2177 01:45:21,600 --> 01:45:22,400 A LOT OF PATIENTS. 2178 01:45:22,400 --> 01:45:24,440 SO THE WAY WE WORK ON THAT IS 2179 01:45:24,440 --> 01:45:27,160 REALLY TO TRY TO ENGAGE THEM AS 2180 01:45:27,160 --> 01:45:28,080 AN IMPORTANT PART OF THIS 2181 01:45:28,080 --> 01:45:29,560 PROCESS AND MAKE IT CLEAR IF WE 2182 01:45:29,560 --> 01:45:30,920 MAKE SOMETHING THAT DOESN'T MAKE 2183 01:45:30,920 --> 01:45:33,360 SENSE TO PREGNANT PEOPLE OR 2184 01:45:33,360 --> 01:45:36,200 ISN'T USEFUL THE WORK IS IN 2185 01:45:36,200 --> 01:45:36,640 VAIN. 2186 01:45:36,640 --> 01:45:38,560 SO FAR WE'VE HAD PRETTY GOOD 2187 01:45:38,560 --> 01:45:40,600 SUCCESS ENGAGING LAY 2188 01:45:40,600 --> 01:45:41,680 STAKEHOLDERS IN VIEWS AND 2189 01:45:41,680 --> 01:45:51,840 DISCUSSIONS AROUND OUR WORK. 2190 01:45:51,840 --> 01:45:55,080 I SEE A QUESTION ABOUT 2191 01:45:55,080 --> 01:45:56,280 POPULATION BUILDER PART OF THE 2192 01:45:56,280 --> 01:45:57,040 E.H.R. SYSTEM. 2193 01:45:57,040 --> 01:45:59,680 THINK IT AS SOMETHING NEXT TO 2194 01:45:59,680 --> 01:45:59,840 IT. 2195 01:45:59,840 --> 01:46:02,280 HAVE YOU YOUR E.H.R. AND IT 2196 01:46:02,280 --> 01:46:05,360 EXTRACTS DATA IN REPORTS AND THE 2197 01:46:05,360 --> 01:46:07,520 IDEA IS TO CREATE A TOOL THAT 2198 01:46:07,520 --> 01:46:09,920 FLAGS CERTAIN IDENTIFIER WITHIN 2199 01:46:09,920 --> 01:46:11,240 THE E.H.R. FOR POTENTIAL RISK 2200 01:46:11,240 --> 01:46:13,240 FOR AN ADVERSE OUTCOME RELATED 2201 01:46:13,240 --> 01:46:15,760 TO PREGNANCY AND THEN A SITE AN 2202 01:46:15,760 --> 01:46:19,040 DECIDE HOW TO ACT ON IT. 2203 01:46:19,040 --> 01:46:21,800 THEY CAN DIED TO IDENTIFY A 2204 01:46:21,800 --> 01:46:23,360 SMALL PERCENTAGE MOST AT RISK 2205 01:46:23,360 --> 01:46:25,120 AND IDENTIFY BASED ON CERTAIN 2206 01:46:25,120 --> 01:46:28,320 RISK FACTORS TO BE USED IN A 2207 01:46:28,320 --> 01:46:29,520 NUMBER DIFFERENT WAYS. 2208 01:46:29,520 --> 01:46:30,440 >> I'LL TAKE THE NEXT QUESTION 2209 01:46:30,440 --> 01:46:32,760 IF YOU WANT. 2210 01:46:32,760 --> 01:46:37,280 THERE'S A QUESTION HERE ABOUT 2211 01:46:37,280 --> 01:46:41,360 THE WHAT THE KEY FACTORS ARE A 2212 01:46:41,360 --> 01:46:42,000 COMBINATION OF SOCIAL 2213 01:46:42,000 --> 01:46:43,480 DETERMINATE AND CLINICAL 2214 01:46:43,480 --> 01:46:44,560 FACTORS. 2215 01:46:44,560 --> 01:46:44,840 ABSOLUTELY. 2216 01:46:44,840 --> 01:46:45,480 ONE THING WE'RE TRYING TO 2217 01:46:45,480 --> 01:46:47,640 BALANCE IS THE APPROACH OF HOW 2218 01:46:47,640 --> 01:46:49,640 MUCH WE PUT IN THE TOOL TO MAKE 2219 01:46:49,640 --> 01:46:55,640 IT PRACTICAL AND USEFUL FOR THE 2220 01:46:55,640 --> 01:46:58,240 CENTERS BALANCING HOW MANY TO 2221 01:46:58,240 --> 01:46:59,480 INCORPORATE TOGETHER BUT IT'S 2222 01:46:59,480 --> 01:47:01,880 PART OF THE WORK TRYING TO 2223 01:47:01,880 --> 01:47:03,320 FIGURE OUT AND FINDING THE 2224 01:47:03,320 --> 01:47:04,960 BALANCE SO IT'S USEFUL. 2225 01:47:04,960 --> 01:47:07,320 IN OUR FIRST PASS OF CREATING 2226 01:47:07,320 --> 01:47:09,440 THE REGISTRY WHEN WE PUT THE 2227 01:47:09,440 --> 01:47:10,960 FACTORS IN ALMOST ALL PATIENTS 2228 01:47:10,960 --> 01:47:14,640 AT THE COMMUNITY HEALTH CENTERS 2229 01:47:14,640 --> 01:47:16,280 AND WE'RE TRYING TO BALANCE THAT 2230 01:47:16,280 --> 01:47:17,120 WITH UTILITY AND THERE'LL BE A 2231 01:47:17,120 --> 01:47:19,000 COMBINATION OF FACTORS THAT ARE 2232 01:47:19,000 --> 01:47:24,480 USED KNOWING THAT MANY OF THOSE 2233 01:47:24,480 --> 01:47:26,840 FACTORS THE SOCIAL DETERMINATES 2234 01:47:26,840 --> 01:47:28,600 FACTOR JUST AS IMPORTANT IN 2235 01:47:28,600 --> 01:47:30,240 PREDICTING OUTCOMES AND THE 2236 01:47:30,240 --> 01:47:31,760 SUBJECT MATTER EXPERTS HAVE 2237 01:47:31,760 --> 01:47:33,880 HIGHLIGHTED THE NEED TO THINK 2238 01:47:33,880 --> 01:47:35,560 ABOUT THAT STRATEGICALLY AND 2239 01:47:35,560 --> 01:47:37,360 INCORPORATE IT INTO THE WORK. 2240 01:47:37,360 --> 01:47:39,200 >> I'LL ADD TO THAT AND ONE OF 2241 01:47:39,200 --> 01:47:41,680 THE BIGGEST CHALLENGES WE'VE HAD 2242 01:47:41,680 --> 01:47:44,440 IS HOW SOCIAL DETERMINATES ARE 2243 01:47:44,440 --> 01:47:45,320 DOCUMENTED IN THE ELECTRONIC 2244 01:47:45,320 --> 01:47:50,800 HEALTH RECORD OR IF THEY'RE 2245 01:47:50,800 --> 01:47:51,360 DOCUMENTED. 2246 01:47:51,360 --> 01:47:54,960 SO THEY'RE NOT THE STRONGEST 2247 01:47:54,960 --> 01:47:57,240 SUIT OF MANY EMRs AND SO THAT'S 2248 01:47:57,240 --> 01:47:59,320 ONE OF OUR CHALLENGES AS WELL. 2249 01:47:59,320 --> 01:48:02,440 >> THANK YOU. 2250 01:48:02,440 --> 01:48:04,400 I HAVE A QUICK QUESTION BUT I 2251 01:48:04,400 --> 01:48:07,120 THINK WE'RE RUNNING OUT OF TIME. 2252 01:48:07,120 --> 01:48:12,440 I THINK I MOVE -- I HAVE TO 2253 01:48:12,440 --> 01:48:13,040 MOVE TO THE NEXT SPEAKER. 2254 01:48:13,040 --> 01:48:21,000 IN OUR YOUR PRESENTATION. 2255 01:48:21,000 --> 01:48:26,320 OUR LAST PRESENTATION IS FROM 2256 01:48:26,320 --> 01:48:28,840 THE UNIVERSITY OF CALIFORNIA LOS 2257 01:48:28,840 --> 01:48:33,080 ANGELES AND FROM MOUNT SINAI 2258 01:48:33,080 --> 01:48:35,360 MEDICAL CENTER. 2259 01:48:35,360 --> 01:48:39,080 DR. GREGORY WILL PRESENT THE 2260 01:48:39,080 --> 01:48:40,400 TITLE IS MATERNAL RISK 2261 01:48:40,400 --> 01:48:44,080 APPROPRIATE CARE ASSOCIATED WITH 2262 01:48:44,080 --> 01:48:47,360 DECREASED SEVERE MATERNAL 2263 01:48:47,360 --> 01:48:50,720 MORBIDITY FOR NORMAL 2264 01:48:50,720 --> 01:48:52,360 PRESENTATION PRELIMINARY 2265 01:48:52,360 --> 01:49:06,200 RESEARCH STUDY. 2266 01:49:06,200 --> 01:49:06,760 PLEASE GO AHEAD. 2267 01:49:06,760 --> 01:49:07,280 >> THANK YOU. 2268 01:49:07,280 --> 01:49:08,120 GOOD AFTERNOON. 2269 01:49:08,120 --> 01:49:08,880 THANK YOU FOR THE OPPORTUNITY TO 2270 01:49:08,880 --> 01:49:11,080 PRESENT OUR WORK AND FOR THE 2271 01:49:11,080 --> 01:49:11,400 SUPPLEMENT. 2272 01:49:11,400 --> 01:49:20,920 I'D LIKE TO ACKNOWLEDGE MY 2273 01:49:20,920 --> 01:49:23,400 CO-INVESTIGATORS. 2274 01:49:23,400 --> 01:49:26,160 WE'RE ALL AWARE MATERNAL 2275 01:49:26,160 --> 01:49:27,400 MORTALITY IS GOING ONE WAY IN 2276 01:49:27,400 --> 01:49:28,800 THE UNITED STATES AND IN 2277 01:49:28,800 --> 01:49:31,400 CALIFORNIA IT'S GOING DOWN WE 2278 01:49:31,400 --> 01:49:36,320 THINK IT'S DUE IN PART TO THE 2279 01:49:36,320 --> 01:49:38,040 HYPERTENSION AND HEMORRHAGE 2280 01:49:38,040 --> 01:49:38,800 BUNDLE ATTENTION AND MORBIDITY 2281 01:49:38,800 --> 01:49:44,360 STILL A SIGNIFICANT PROBLEM IN 2282 01:49:44,360 --> 01:49:47,360 3% OF ALL PREGNANCY AND THE 2283 01:49:47,360 --> 01:49:52,360 DEFINITION BY THE CDC IS 21 2284 01:49:52,360 --> 01:49:53,760 CONDITIONS AND THE SPECTRUM 2285 01:49:53,760 --> 01:49:55,320 DISORDER AND BEARS THE QUESTION 2286 01:49:55,320 --> 01:49:57,360 WHILE YOU CAN SEE DIC AND SHOCK 2287 01:49:57,360 --> 01:50:00,280 ARE POTENTIALLY PREVENTIBLE, 2288 01:50:00,280 --> 01:50:01,560 TRANSFUSION AND HYSTERECTOMY 2289 01:50:01,560 --> 01:50:02,880 WHICH ARE HIGHLIGHTED IN GREEN 2290 01:50:02,880 --> 01:50:05,760 ARE ACTUALLY PART OF THE 2291 01:50:05,760 --> 01:50:08,080 TREATMENT FOR THE CONDITION AND 2292 01:50:08,080 --> 01:50:13,800 SO IT MAY NOT BE FAIRNESSLY TO 2293 01:50:13,800 --> 01:50:15,960 INCLUDE THESE IN THE DEFINITION 2294 01:50:15,960 --> 01:50:18,400 OF SMM. 2295 01:50:18,400 --> 01:50:26,920 WITH REGARD TO VENTILATION MANY 2296 01:50:26,920 --> 01:50:28,400 USE THIS AND IT'S RAISED AS A 2297 01:50:28,400 --> 01:50:47,960 CAVEAT TO COME BACK TO LATER. 2298 01:50:47,960 --> 01:50:50,760 WE COLLECTED DATA ON THESE. 2299 01:50:50,760 --> 01:50:53,320 SO THERE WERE A SERIES OF PAPERS 2300 01:50:53,320 --> 01:50:55,440 THAT OUTLINED WHAT THEY FELT 2301 01:50:55,440 --> 01:50:59,320 WERE THE CRITERIA FOR BEING 2302 01:50:59,320 --> 01:51:00,920 CENTERS OF EXCELLENCE. 2303 01:51:00,920 --> 01:51:05,360 THEY WERE SUMMARIZED IN AN 2304 01:51:05,360 --> 01:51:07,320 ARTICLE IN THE AMERICAN JOURNAL 2305 01:51:07,320 --> 01:51:12,040 OF OB-GYN AND REINFORCED WITH A 2306 01:51:12,040 --> 01:51:24,360 CONSENSUS STATEMENT IN 2018. 2307 01:51:24,360 --> 01:51:25,480 AND WANTED TO LOOK AT HOSPITAL 2308 01:51:25,480 --> 01:51:29,440 PROCEDURE VOLUME AND THE 2309 01:51:29,440 --> 01:51:30,000 SERVICES PROVIDE AND THE 2310 01:51:30,000 --> 01:51:31,400 HOSPITAL MATERNAL LEVEL OF CARE 2311 01:51:31,400 --> 01:51:32,720 DESIGNATION IF WE HAD THEM. 2312 01:51:32,720 --> 01:51:34,160 THESE ARE THE CRITERIA 2313 01:51:34,160 --> 01:51:35,760 SUMMARIZED BY THE ARTICLE AND 2314 01:51:35,760 --> 01:51:37,200 I'M NOT GOING READ THEM BECAUSE 2315 01:51:37,200 --> 01:51:37,880 I'LL COVER THEM IN THE RESULTS 2316 01:51:37,880 --> 01:51:40,560 SECTION. 2317 01:51:40,560 --> 01:51:42,680 FOR THE TIME PERIOD THAT WE'LL 2318 01:51:42,680 --> 01:51:45,880 BE STUDYING 2016 TO 2018 THERE 2319 01:51:45,880 --> 01:51:49,960 WERE 1.3 MILLION DELIVERIES IN 2320 01:51:49,960 --> 01:52:04,040 CALIFORNIA AND ABOUT 1600 ACC 2321 01:52:04,040 --> 01:52:06,600 ACCREDA AND SUGGESTING THERE IS 2322 01:52:06,600 --> 01:52:09,720 SOME TYPE OF INFORMAL TRIAGE AND 2323 01:52:09,720 --> 01:52:11,520 REGIONALIZATION OF CARE FOR THE 2324 01:52:11,520 --> 01:52:19,120 DISORDERS. 2325 01:52:19,120 --> 01:52:22,040 AND SOME WERE IDENTIFIED AS HIGH 2326 01:52:22,040 --> 01:52:23,320 FOL VUM AND GREATER THAN OR 2327 01:52:23,320 --> 01:52:26,000 EQUAL TO 6 CASES PER YEAR AND 2328 01:52:26,000 --> 01:52:28,400 THE RANGE WAS FROM 6 TO 14 CASES 2329 01:52:28,400 --> 01:52:30,480 PER YEAR. 2330 01:52:30,480 --> 01:52:35,320 WE INTERVIEWED THE OB CHIEF 2331 01:52:35,320 --> 01:52:36,000 THORAZIOR 2332 01:52:36,000 --> 01:52:40,320 THE DESIGNEE AND THEY WERE NOW 2333 01:52:40,320 --> 01:52:42,200 TRANSFERRING THE PATIENTS 2334 01:52:42,200 --> 01:52:44,760 LEAVING 27 HOSPITALS TOTAL. 2335 01:52:44,760 --> 01:52:46,520 WE'VE COMPLETED 20 INTERVIEWS 2336 01:52:46,520 --> 01:52:48,000 AND FIVE HOSPITALS INITIALLY 2337 01:52:48,000 --> 01:52:49,880 DECLINED BECAUSE THEY WERE 2338 01:52:49,880 --> 01:52:51,280 CONCERNED ABOUT ANONYMITY AND 2339 01:52:51,280 --> 01:52:55,320 SUBSEQUENTLY PRESENTED OUR STUDY 2340 01:52:55,320 --> 01:52:59,280 TO THE CHIEF MEDICAL OFFICERS OF 2341 01:52:59,280 --> 01:53:01,240 THE HOSPITALS AND AFTER GETTING 2342 01:53:01,240 --> 01:53:03,280 SITE SPECIFIC IRB HAVE BEEN 2343 01:53:03,280 --> 01:53:04,640 GIVEN PERMISSION TO PROCEED. 2344 01:53:04,640 --> 01:53:06,600 SO OUR STUDIES TO DATE AND AGAIN 2345 01:53:06,600 --> 01:53:09,360 THESE ARE LOOKING AT THE 2346 01:53:09,360 --> 01:53:10,640 RESOURCES AND RECOMMENDED 2347 01:53:10,640 --> 01:53:11,960 SERVICES THAT SHOULD BE 2348 01:53:11,960 --> 01:53:13,920 AVAILABLE IN THE CENTERS AND WE 2349 01:53:13,920 --> 01:53:15,960 FOUND VARIATION IN THE NUMBER OF 2350 01:53:15,960 --> 01:53:19,240 CENTER PERFORMED CONFIRM TRY MRI 2351 01:53:19,240 --> 01:53:22,240 WITH 55% DOING ROUTINELY OR 2352 01:53:22,240 --> 01:53:25,040 SOMETIMES AND 40% NOT DOING IT 2353 01:53:25,040 --> 01:53:26,360 AT ALL. 2354 01:53:26,360 --> 01:53:33,280 80% OF THE INSTITUTIONS DO 2355 01:53:33,280 --> 01:53:35,080 PRE-OPERATIVE OPTIMIZATION AND 2356 01:53:35,080 --> 01:53:36,320 OVER HALF OF THE FACILITIES 2357 01:53:36,320 --> 01:53:39,960 ADMIT THE PATIENTS IN ADVANCE 2358 01:53:39,960 --> 01:53:43,320 FOR PRE-OP ASSESSMENT AND 75% OF 2359 01:53:43,320 --> 01:53:47,160 HOSPITALS FELT THEY NET CRITERIA 2360 01:53:47,160 --> 01:53:49,440 FOR HAVING A TEAM AND THE RATE 2361 01:53:49,440 --> 01:53:51,880 OF PHYSICIANS PROVIDING SURGICAL 2362 01:53:51,880 --> 01:53:55,360 SKILLS ONE 1-15. 2363 01:53:55,360 --> 01:54:00,040 70% OF THE HOSPITALS PLACE A 2364 01:54:00,040 --> 01:54:02,000 ARTERIAL LINE AND 55% HAVE 2365 01:54:02,000 --> 01:54:07,280 ACCESS TO RADIOLOGY WHERE THEY 2366 01:54:07,280 --> 01:54:15,440 MAY DO IN INTER OR OR 2367 01:54:15,440 --> 01:54:17,680 PRE-OPERATIVE ASSESSMENTS AND 2368 01:54:17,680 --> 01:54:21,720 100% OF FACILITIES HAD 24 HOUR 2369 01:54:21,720 --> 01:54:25,800 ACCESS TO BLOOD BANK AND 2370 01:54:25,800 --> 01:54:28,120 PRODUCTS AND TRANSFUSION 2371 01:54:28,120 --> 01:54:28,400 PROTOCOL. 2372 01:54:28,400 --> 01:54:32,160 90% HAVE A PROFUSIONIST AND 50% 2373 01:54:32,160 --> 01:54:35,440 DID FORMAL DE BRIEFING AFTER THE 2374 01:54:35,440 --> 01:54:39,600 PROCEDURES AND 60% PLANNED PREON 2375 01:54:39,600 --> 01:54:43,800 OPERATIVELY TO GO TO A 2376 01:54:43,800 --> 01:54:44,440 HYSTERECTOMY AND AFTER ASKING 2377 01:54:44,440 --> 01:54:47,240 THE FINAL TWO QUESTIONS 65% FELT 2378 01:54:47,240 --> 01:54:49,360 THEIR INSTITUTION WAS OR IS 2379 01:54:49,360 --> 01:54:50,280 DESIGNATED IN THE CENTER AND 2380 01:54:50,280 --> 01:54:52,000 WHEN ASKED ABOUT THE MATERNAL 2381 01:54:52,000 --> 01:54:56,760 LEVEL OF CARE THE RANGE WAS FROM 2382 01:54:56,760 --> 01:54:59,440 2 TO 4 USING THE DESIGNATION. 2383 01:54:59,440 --> 01:55:02,240 IN SUMMARY ALMOST ALL CENTERS A 2384 01:55:02,240 --> 01:55:04,440 MULTI-DISCIPLINARY TEAM THAT WAS 2385 01:55:04,440 --> 01:55:06,880 IN GENERAL HEADED BY AN MFM AND 2386 01:55:06,880 --> 01:55:09,080 HAD A SKILLED. 2387 01:55:09,080 --> 01:55:12,440 THE CENTERS VARIED WITH 2388 01:55:12,440 --> 01:55:13,160 MONITORING AND PROPHYLACTIC 2389 01:55:13,160 --> 01:55:14,200 PROCEDURES AND VARIED WHETHER 2390 01:55:14,200 --> 01:55:15,960 THERE WAS A SINGLE SURGEON 2391 01:55:15,960 --> 01:55:17,520 SERVICE A ROTATING TEAM OF 2392 01:55:17,520 --> 01:55:21,960 SURGEONS AND THE TYPE OF SIRJON. 2393 01:55:21,960 --> 01:55:25,960 -- SURGEON AND MOST HAD A 2394 01:55:25,960 --> 01:55:28,200 PROTOCOL AND VARIED WITH THE 2395 01:55:28,200 --> 01:55:35,360 TYPE OF ANESTHESIA. 2396 01:55:35,360 --> 01:55:41,040 SO WE CONCLUDE IF YOU HAVE SEEN 2397 01:55:41,040 --> 01:55:51,240 ONE ACCRETA CENTER YOU'VE SEEN 2398 01:55:51,240 --> 01:55:52,840 ONE AND THE CENTERS SEEM TO HAVE 2399 01:55:52,840 --> 01:55:54,440 MORE THE CRITERIA FOR EXCELLENCE 2400 01:55:54,440 --> 01:55:57,360 AND A PASSIONATE DEDICATED 2401 01:55:57,360 --> 01:55:58,960 PERSON ON EACH OF THE 2402 01:55:58,960 --> 01:55:59,560 MULTI-DISCIPLINARY TEAMS AND 2403 01:55:59,560 --> 01:56:02,760 TRUE OF THE URBAN AND ACADEMIC 2404 01:56:02,760 --> 01:56:03,320 CENTERS. 2405 01:56:03,320 --> 01:56:05,560 PRIMARY SURGEON EXPERTISE RANGE 2406 01:56:05,560 --> 01:56:10,920 FROM THE OB-GYN SPECIALIST TO 2407 01:56:10,920 --> 01:56:15,840 THE ONCOLOGY SUB SPECIALISTS AND 2408 01:56:15,840 --> 01:56:18,200 MOST TALKED ABOUT THE LOW RATE 2409 01:56:18,200 --> 01:56:18,840 OF TRANSFUSIONS REQUIRED THE 2410 01:56:18,840 --> 01:56:21,840 FACT THAT MOST OF THEIR PATIENTS 2411 01:56:21,840 --> 01:56:24,080 WENT TO A REGULAR POSTPARTUM 2412 01:56:24,080 --> 01:56:25,160 FLOOR AFTER THE PROCEDURE AND 2413 01:56:25,160 --> 01:56:28,160 MANY DID NOT NEED A 2414 01:56:28,160 --> 01:56:28,480 HYSTERECTOMY. 2415 01:56:28,480 --> 01:56:30,640 ONE OF THE NICE THINGS OF HAVING 2416 01:56:30,640 --> 01:56:32,640 A QUALITATIVE STUDY LIKE THIS 2417 01:56:32,640 --> 01:56:33,840 AND DOING THE INTERVIEWS MYSELF 2418 01:56:33,840 --> 01:56:37,840 WAS LEARNING ABOUT THE UNIQUE 2419 01:56:37,840 --> 01:56:40,240 OPPORTUNITIES FOR SUBSEQUENT 2420 01:56:40,240 --> 01:56:40,560 STUDY. 2421 01:56:40,560 --> 01:56:42,000 SO FOR EXAMPLE ONE CENTER HAD A 2422 01:56:42,000 --> 01:56:45,160 CRITERIA WHERE THEY HAD TO HAVE 2423 01:56:45,160 --> 01:56:49,760 TWO OUT OF THREE MFNs ON 2424 01:56:49,760 --> 01:56:50,800 ULTRASOUND READING IN ORDER TO 2425 01:56:50,800 --> 01:56:54,840 PROCEED WITH THE HYSTERECTOMY 2426 01:56:54,840 --> 01:56:56,680 OTHERWISE THEY'D ATTEMPT TO 2427 01:56:56,680 --> 01:56:57,960 REMOVE THE PLACENTA AND ANOTHER 2428 01:56:57,960 --> 01:57:00,120 HAD A NURSE THAT STAYED WITH THE 2429 01:57:00,120 --> 01:57:01,320 FAMILY THROUGHOUT THE HOSPITAL 2430 01:57:01,320 --> 01:57:01,520 STAY. 2431 01:57:01,520 --> 01:57:04,680 ONE HOSPITAL HAD A SOCIAL WORKER 2432 01:57:04,680 --> 01:57:08,760 AND PSYCH INVOLVED TO ADDRESS 2433 01:57:08,760 --> 01:57:09,840 PTSD POSTOPERATIVELY. 2434 01:57:09,840 --> 01:57:11,400 SOME CENTERS HAD DE BRIEFINGS 2435 01:57:11,400 --> 01:57:13,640 THAT INCLUDED THE PATIENT. 2436 01:57:13,640 --> 01:57:15,440 ONE SNSHT HAD A MONTHLY BUCKET 2437 01:57:15,440 --> 01:57:18,440 WHERE THE SPECIMEN IS COMPARED 2438 01:57:18,440 --> 01:57:20,840 TO THE ULTRASOUND OR MLI IN THE 2439 01:57:20,840 --> 01:57:29,200 PRESENCE OF SURGEON AND IMAGING 2440 01:57:29,200 --> 01:57:29,480 CONSULTANT. 2441 01:57:29,480 --> 01:57:33,960 SOME AND PROVIDE THE IMAGING 2442 01:57:33,960 --> 01:57:35,360 CONSULTANT FEEDBACK AT THE 2443 01:57:35,360 --> 01:57:38,440 SURGERY TO CONFIRM THE FALSE 2444 01:57:38,440 --> 01:57:38,760 POSITIVES. 2445 01:57:38,760 --> 01:57:45,720 ONE CENTER AFTER THE DELIVERY IF 2446 01:57:45,720 --> 01:57:46,920 THE BLADDER INVOLVED THEY CLAIM 2447 01:57:46,920 --> 01:57:50,560 AN ESTIMATED BLOOD LOSS OF LESS 2448 01:57:50,560 --> 01:57:54,840 THAN 100 AT THE TIME AND SEVERAL 2449 01:57:54,840 --> 01:57:56,760 CENTER HAVE ANNUAL SIMULATIONS 2450 01:57:56,760 --> 01:58:01,160 WITH THEIR TEAMS. 2451 01:58:01,160 --> 01:58:08,680 OUR NEXT STEP IS TO EVALUATE 2452 01:58:08,680 --> 01:58:10,520 INCLUDING AND EXCLUDEING 2453 01:58:10,520 --> 01:58:14,040 HYSTERECTOMY AND WE THINK WE 2454 01:58:14,040 --> 01:58:15,080 OUGHT TO BE CONSIDERING A 2455 01:58:15,080 --> 01:58:19,200 DIFFERENT METRIC OF SMM FOR 2456 01:58:19,200 --> 01:58:20,240 CLINICIANS. 2457 01:58:20,240 --> 01:58:27,400 WE WANTED TO DETERMINE IF 2458 01:58:27,400 --> 01:58:28,440 THERE'S DIFFERENT OUTCOMES WITH 2459 01:58:28,440 --> 01:58:30,680 RACE AND ETHNICITY AND LOOK AT 2460 01:58:30,680 --> 01:58:31,640 STUDY PARTICIPANTS AS THEY WERE 2461 01:58:31,640 --> 01:58:32,840 ALL EXCITED AND WANTED TO KNOW 2462 01:58:32,840 --> 01:58:34,160 WHAT OTHERS WERE DOING. 2463 01:58:34,160 --> 01:58:36,320 PROPOSE A QUALITY METRIC TO 2464 01:58:36,320 --> 01:58:37,640 DETERMINE HOW WELL THE DIFFERENT 2465 01:58:37,640 --> 01:58:38,640 CENTERS ARE DOING MANAGING THE 2466 01:58:38,640 --> 01:58:41,160 CONDITIONS AND WE DON'T THINK 2467 01:58:41,160 --> 01:58:44,160 THE CURRENT MACHINE OF SMM IS A 2468 01:58:44,160 --> 01:58:47,360 GOOD OPPORTUNITY TO CAPTURE THAT 2469 01:58:47,360 --> 01:58:52,320 AND TERMS WE SHOULD BE 2470 01:58:52,320 --> 01:58:53,280 PROCEEDING WITH A PATIENT 2471 01:58:53,280 --> 01:58:54,800 REGISTRY AND ARE THERE POLICIES 2472 01:58:54,800 --> 01:58:57,640 AN PROCEDURES THAT SHOULD BE 2473 01:58:57,640 --> 01:58:59,000 UNIVERSAL FOR OPTIMAL OUTCOME 2474 01:58:59,000 --> 01:59:00,120 ACROSS ALL SITES. 2475 01:59:00,120 --> 01:59:02,680 I'D LIKE TO THANK THE STUDY 2476 01:59:02,680 --> 01:59:03,320 PARTICIPANTS FOR GIVING ME THEIR 2477 01:59:03,320 --> 01:59:05,040 TIME AND I'D LIKE TO THANK THE 2478 01:59:05,040 --> 01:59:06,200 AUDIENCE FOR HAVING THE 2479 01:59:06,200 --> 01:59:07,400 OPPORTUNITY TO PRESENT THESE 2480 01:59:07,400 --> 01:59:07,640 RESULTS. 2481 01:59:07,640 --> 01:59:09,040 I HOPE THERE'S TIME FOR 2482 01:59:09,040 --> 01:59:21,120 QUESTIONS. 2483 01:59:21,120 --> 01:59:21,720 >> THANK YOU. 2484 01:59:21,720 --> 01:59:22,840 I DON'T SEE ANY QUESTIONS NOW SO 2485 01:59:22,840 --> 01:59:27,720 I SEE A QUESTION. 2486 01:59:27,720 --> 01:59:33,200 I'M WONDERING, IS THERE ANY 2487 01:59:33,200 --> 01:59:37,440 GEOGRAPHIC AVAILABILITY FOR THE 2488 01:59:37,440 --> 01:59:43,200 OUTCOMES OR FINDS AMONG 2489 01:59:43,200 --> 01:59:44,720 PARTICIPATING HOSPITALS SUCH AS 2490 01:59:44,720 --> 01:59:48,600 FOR RURAL AREAS AND OBVIOUSLY 2491 01:59:48,600 --> 01:59:50,720 RURAL AREA THE PARTICIPATING 2492 01:59:50,720 --> 01:59:54,720 HOSPITALS MAY NOT HAVE MUCH 2493 01:59:54,720 --> 01:59:56,080 RESOURCES COMPARED TO OTHER SO 2494 01:59:56,080 --> 01:59:56,800 I'M WONDERING -- 2495 01:59:56,800 --> 01:59:59,840 >> THE HOSPITALS WERE PRETTY 2496 01:59:59,840 --> 02:00:01,200 SPREAD OUT ACROSS CALIFORNIA SO 2497 02:00:01,200 --> 02:00:07,320 THERE WERE SOME REGIONAL CENTERS 2498 02:00:07,320 --> 02:00:10,320 IN MORE RURAL AREAS WHERE IN 2499 02:00:10,320 --> 02:00:13,960 SMALLER HOPTZ WOULD REFER -- 2500 02:00:13,960 --> 02:00:15,960 HOSPITALS WOULD REFER INTO THOSE 2501 02:00:15,960 --> 02:00:17,880 CENTERS. 2502 02:00:17,880 --> 02:00:20,520 >> DID YOU FIND THE LOCATION 2503 02:00:20,520 --> 02:00:23,400 LIKE OPEN HOME HOSPITALS WHETHER 2504 02:00:23,400 --> 02:00:26,200 THEY MANAGE DIFFERENTLY THAN THE 2505 02:00:26,200 --> 02:00:26,840 RURAL? 2506 02:00:26,840 --> 02:00:32,320 THERE'S NO DIFFERENCE? 2507 02:00:32,320 --> 02:00:34,440 >> THE BIGGEST DIFFERENCE IS 2508 02:00:34,440 --> 02:00:38,080 WHAT TYPE OF SUB SPECIALIST WAS 2509 02:00:38,080 --> 02:00:41,920 THE PRIMARY SEARCH ENGINE AND SO 2510 02:00:41,920 --> 02:00:44,640 THE LESS URBAN AND LESS ACADEMIC 2511 02:00:44,640 --> 02:00:47,960 THE MORE LIKELY YOU WOULD HAVE A 2512 02:00:47,960 --> 02:00:49,400 GENERALIST OR SPECIALIST BE THE 2513 02:00:49,400 --> 02:00:52,000 PRIMARY SURGEON AND IN GENERAL 2514 02:00:52,000 --> 02:00:57,560 THE FEWER THE SMALLER THE TEAM 2515 02:00:57,560 --> 02:00:58,600 THE MORE RURAL. 2516 02:00:58,600 --> 02:01:00,400 IT'S LOOK LIME THE MORE RURAL 2517 02:01:00,400 --> 02:01:02,280 THE MORE DEDICATED THE TEAM. 2518 02:01:02,280 --> 02:01:07,360 THAT'S WHAT I'M TRYING TO SAY. 2519 02:01:07,360 --> 02:01:11,560 >> OH VERY INTERESTING. 2520 02:01:11,560 --> 02:01:19,480 >> WE HAVE ONE QUESTION HERE -- 2521 02:01:19,480 --> 02:01:25,720 WHY DOES ACCERTA REQUIRE 2522 02:01:25,720 --> 02:01:26,040 HYSTERECTOMY? 2523 02:01:26,040 --> 02:01:30,200 IT SEEMS SO EXTREME. 2524 02:01:30,200 --> 02:01:40,880 >> IT'S INTERESTING. 2525 02:01:40,880 --> 02:01:41,720 AS THEY GOT MORE SPECIFIC ABOUT 2526 02:01:41,720 --> 02:01:46,320 THEIR PROTOCOLS IF YOU PROCEED 2527 02:01:46,320 --> 02:01:50,040 TO A PLANNED CAESAREAN 2528 02:01:50,040 --> 02:01:51,560 HYSTERECTOMY THERE'S LESS 2529 02:01:51,560 --> 02:01:52,880 OVERALL BLOOD LOSS AND LESS 2530 02:01:52,880 --> 02:01:55,040 MORBIDITY SO IN GENERAL THAT'S 2531 02:01:55,040 --> 02:01:56,800 THE RECOMMENDATION YOU PROCEED 2532 02:01:56,800 --> 02:02:00,280 WITH A PLANNED CAESAREAN 2533 02:02:00,280 --> 02:02:02,200 HYSTERECTOMY BUT IT'S NOT 2534 02:02:02,200 --> 02:02:04,000 NECESSARILY WHAT EVERYONE IS 2535 02:02:04,000 --> 02:02:07,040 DOING AND THERE'S ACTUALLY AN 2536 02:02:07,040 --> 02:02:08,440 ORGANIZATION THE PAN AMERICAN 2537 02:02:08,440 --> 02:02:11,440 SOCIETY FOR P.A.S. DISORDERS 2538 02:02:11,440 --> 02:02:13,240 WHERE THERE'S OTHER SITES 2539 02:02:13,240 --> 02:02:14,280 ADVOCATING FOR DIFFERENT THINGS 2540 02:02:14,280 --> 02:02:17,840 AND IT MAY IN FACT BENEFIT FROM 2541 02:02:17,840 --> 02:02:19,320 BEING A PATIENT-CENTERED 2542 02:02:19,320 --> 02:02:20,440 DECISION BUT YOU HAVE TO 2543 02:02:20,440 --> 02:02:21,640 UNDERSTAND IF IT IS A 2544 02:02:21,640 --> 02:02:23,480 PATIENT-CENTERED DECISION YOU'RE 2545 02:02:23,480 --> 02:02:27,120 ACCEPTING THE POSSIBILITY OF 2546 02:02:27,120 --> 02:02:34,880 INCREASED MORBIDITY. 2547 02:02:34,880 --> 02:02:36,240 >> THANK YOU. 2548 02:02:36,240 --> 02:02:38,280 I THINK WE DON'T BE ABLE TO TAKE 2549 02:02:38,280 --> 02:02:39,360 MORE QUESTIONS BECAUSE IT'S TIME 2550 02:02:39,360 --> 02:02:41,200 FOR US TO CLOSE. 2551 02:02:41,200 --> 02:02:45,960 SO THIS IS THE END THIS SECOND 2552 02:02:45,960 --> 02:02:46,200 SESSION. 2553 02:02:46,200 --> 02:02:48,440 THANK YOU FOR ALL YOUR 2554 02:02:48,440 --> 02:02:49,480 PRESENTATIONS TO SHARE TODAY. 2555 02:02:49,480 --> 02:02:52,520 AND WE WILL NOW HAVE A 10-MINUTE 2556 02:02:52,520 --> 02:02:55,880 BREAK AND WE WILL RESTART FOR 2557 02:02:55,880 --> 02:02:57,960 THE NEXT SESSION IN 10 MINUTES 2558 02:02:57,960 --> 02:03:03,680 AND NEXT SESSION IS GOING TO BE 2559 02:03:03,680 --> 02:03:06,480 STRUCTURAL AND SYSTEMIC 2560 02:03:06,480 --> 02:03:07,240 CONTRIBUTORS TO MATERNAL 2561 02:03:07,240 --> 02:03:07,760 MORBIDITY AND MORTALITY. 2562 02:03:07,760 --> 02:03:09,040 THANK YOU, EVERYONE. 2563 02:03:09,040 --> 02:03:10,720 >> WELCOME BACK. 2564 02:03:10,720 --> 02:03:13,040 I'M JENNIFER ALVIDREZ AND I'LL 2565 02:03:13,040 --> 02:03:17,680 BE MODERATING STRUCTURAL AND 2566 02:03:17,680 --> 02:03:18,240 SYSTEMATIC CONTRIBUTORS TO 2567 02:03:18,240 --> 02:03:20,920 MATERNAL MORBIDITY AND 2568 02:03:20,920 --> 02:03:21,200 MORTALITY. 2569 02:03:21,200 --> 02:03:22,200 WE HAVE FIVE SPEAKERS. 2570 02:03:22,200 --> 02:03:26,680 YOU CAN LOOK AT THEIR BIOS ON 2571 02:03:26,680 --> 02:03:27,600 THE REGISTRATION PAGE. 2572 02:03:27,600 --> 02:03:30,080 I MAY POP IN AROUND THE 2573 02:03:30,080 --> 02:03:31,320 NINE-MINUTE MARK IF IT SEEMS 2574 02:03:31,320 --> 02:03:36,360 LIKE YOU'RE NOT WINDING UP YOUR 2575 02:03:36,360 --> 02:03:38,120 PRESENTATIONS AND FOR THE 2576 02:03:38,120 --> 02:03:42,680 AUDIENCE FEEL FREE TO PUT IN 2577 02:03:42,680 --> 02:03:49,280 QUESTIONS IN THE Q&A AND THE 2578 02:03:49,280 --> 02:04:00,640 FIRST SPEAKER IS PINKA 2579 02:04:00,640 --> 02:04:00,920 CHATTERJI. 2580 02:04:00,920 --> 02:04:02,800 >> THANK YOU. 2581 02:04:02,800 --> 02:04:04,400 I'M FROM THE ECONOMICS 2582 02:04:04,400 --> 02:04:09,960 DEPARTMENT AND HAPPY TO BE HEAR. 2583 02:04:09,960 --> 02:04:14,200 MY COLLABORATORS ARE FROM EMORY 2584 02:04:14,200 --> 02:04:15,320 UNIVERSITY AND FROM SYRACUSE 2585 02:04:15,320 --> 02:04:15,720 UNIVERSITY. 2586 02:04:15,720 --> 02:04:19,560 THIS PROJECT IS AN 2587 02:04:19,560 --> 02:04:20,480 ADMINISTRATIVE SUPPLEMENT TO A 2588 02:04:20,480 --> 02:04:22,200 LARGER STATE POLICY AND 2589 02:04:22,200 --> 02:04:22,800 EDUCATIONAL ATTAINMENT AND 2590 02:04:22,800 --> 02:04:30,680 MORTALITY. 2591 02:04:30,680 --> 02:04:32,680 JUST TO SUMMARIZE WHAT WE'VE 2592 02:04:32,680 --> 02:04:34,440 BEEN HEARING IS WE KNOW IF YOU 2593 02:04:34,440 --> 02:04:36,040 COMPARE THE UNITED STATES TO 2594 02:04:36,040 --> 02:04:38,880 OTHER SIMILAR INDUSTRIALIZED 2595 02:04:38,880 --> 02:04:40,280 COUNTRIES, RATES AND MATERNAL 2596 02:04:40,280 --> 02:04:42,120 MORTALITY RATES ARE HIGHER AND 2597 02:04:42,120 --> 02:04:45,120 WE KNOW OVER THE LAST FEW 2598 02:04:45,120 --> 02:04:46,680 DECADES THE RATES ARE RISING 2599 02:04:46,680 --> 02:04:48,680 RAPIDLY AND HEARD ABOUT RISK 2600 02:04:48,680 --> 02:04:49,920 FACTORS FOR MATERNAL MORBIDITY 2601 02:04:49,920 --> 02:04:51,760 AND MORTALITY INCLUDE LOW SES 2602 02:04:51,760 --> 02:04:56,480 AND ADVANCED MATERNAL RACE AND 2603 02:04:56,480 --> 02:04:58,280 RACE/ETHNICITY AND THERE'S 2604 02:04:58,280 --> 02:05:00,480 EMPHASIS ON THE GROWING EVIDENCE 2605 02:05:00,480 --> 02:05:02,800 OF THE IMPORTANCE OF 2606 02:05:02,800 --> 02:05:05,000 PRE-CONCEPTION HEALTH IN 2607 02:05:05,000 --> 02:05:06,200 DETERMINING PREGNANCY AND 2608 02:05:06,200 --> 02:05:06,480 OUTCOMES. 2609 02:05:06,480 --> 02:05:08,080 THE FOCUS OF THE PRESENTATION IS 2610 02:05:08,080 --> 02:05:10,320 THE IDEA THAT RISING SMM RATES 2611 02:05:10,320 --> 02:05:13,160 HIGHLIGHT THE UNMET NEED FOR 2612 02:05:13,160 --> 02:05:14,320 CONTINUOUS AND COMPREHENSIVE 2613 02:05:14,320 --> 02:05:17,520 HEALTH INSURANCE COVERAGE FOR 2614 02:05:17,520 --> 02:05:18,200 WOMEN. 2615 02:05:18,200 --> 02:05:21,880 MEDICAID PLAYS AN OUTSIZED ROLE 2616 02:05:21,880 --> 02:05:23,360 IN INSURING THIS POPULATION. 2617 02:05:23,360 --> 02:05:25,600 TWO OF THREE ADULT WOMEN 2618 02:05:25,600 --> 02:05:29,480 ENROLLED IN MEDICAID ARE IN 2619 02:05:29,480 --> 02:05:32,160 REPRODUCTIVE YEARS AND MEDICAID 2620 02:05:32,160 --> 02:05:41,000 FINANCED ABOUT 42% OF 2621 02:05:41,000 --> 02:05:43,600 U.S. BIRTHS AND COVERS WOMEN 2622 02:05:43,600 --> 02:05:45,600 FROM CONCEPTION TO 60-DAYS 2623 02:05:45,600 --> 02:05:48,800 POSTPARTUM LEAVING LARGE NUMBERS 2624 02:05:48,800 --> 02:05:54,720 UNINSURED OR SWITCHING IN PLANS 2625 02:05:54,720 --> 02:05:59,800 PRIOR TO CONCEPTION. 2626 02:05:59,800 --> 02:06:02,120 SO IN 2014 UNDER THE AFFORDABLE 2627 02:06:02,120 --> 02:06:04,600 CARE ACT, 37 STATES AND D.C. 2628 02:06:04,600 --> 02:06:10,920 EXPANDED MEDICAID TO INCLUDE 2629 02:06:10,920 --> 02:06:13,800 LOW-INCOME ADULTS AND THE 2630 02:06:13,800 --> 02:06:15,520 MEDICAID EXPANSION MAY HAVE 2631 02:06:15,520 --> 02:06:17,000 IMPROVED THE CONTINUITY OF 2632 02:06:17,000 --> 02:06:22,720 MEDICAID FROM THE PRECONCEPTION 2633 02:06:22,720 --> 02:06:26,440 BY EXTENDED TO ADULTS WITHIN THE 2634 02:06:26,440 --> 02:06:27,600 FEDERAL POVERTY LINE. 2635 02:06:27,600 --> 02:06:31,200 WE FOCUSSED ON THE IDEA WOMEN 2636 02:06:31,200 --> 02:06:32,680 MAY HAVE MORE OPPORTUNITIES FOR 2637 02:06:32,680 --> 02:06:33,200 PRECONCEPTION INSURANCE 2638 02:06:33,200 --> 02:06:46,040 COVERAGE. 2639 02:06:46,040 --> 02:06:47,800 THE FIRST AIM WERE USING RECORDS 2640 02:06:47,800 --> 02:06:50,160 FROM 2011 TO 2018. 2641 02:06:50,160 --> 02:06:51,840 OUR SECOND AIM IS TO DETERMINE 2642 02:06:51,840 --> 02:06:54,720 WHETHER THE MEDICAID EXPANSIONS 2643 02:06:54,720 --> 02:06:57,000 HAD AFFECTS BASED ON MATERNAL 2644 02:06:57,000 --> 02:07:00,560 AGE WITH A FOCUS ON OLDER 2645 02:07:00,560 --> 02:07:02,680 MOTHERS AND THIS IS OUR 2646 02:07:02,680 --> 02:07:03,880 ESTIMATED INFLATION. 2647 02:07:03,880 --> 02:07:06,000 WE USED A DIFFERENT METHOD WHICH 2648 02:07:06,000 --> 02:07:09,600 IS ESSENTIALLY A BEFORE AND 2649 02:07:09,600 --> 02:07:13,560 AFTER COMPARISON AND THE VAR L 2650 02:07:13,560 --> 02:07:16,720 VARIABLE IS AN INDICATOR FOR 2651 02:07:16,720 --> 02:07:20,520 MATERNAL HEALTH OUTCOME WITHIN 2652 02:07:20,520 --> 02:07:22,400 STATE J AND THE MOST IMPORTANT 2653 02:07:22,400 --> 02:07:26,120 COVARIANT IS AN INDICATOR OF 2654 02:07:26,120 --> 02:07:30,000 MEDICAID EXPANSION AND WE 2655 02:07:30,000 --> 02:07:35,000 MEASURED THE EXPOSURE DURING THE 2656 02:07:35,000 --> 02:07:35,320 P 2657 02:07:35,320 --> 02:07:36,720 CONCEPTION PERIOD AND ONE IS 2658 02:07:36,720 --> 02:07:38,360 USING THE INDICATOR FOR WHICH 2659 02:07:38,360 --> 02:07:39,600 THE MOTHER LIVING IN THE STATE 2660 02:07:39,600 --> 02:07:42,680 THAT HAD ELIGIBILITY FOR 2661 02:07:42,680 --> 02:07:45,400 MEDICAID AT 138% OF THE FEDERAL 2662 02:07:45,400 --> 02:07:47,280 POVERTY LINE FOR CHILDLESS 2663 02:07:47,280 --> 02:07:49,080 ADULTS AND THE 12 MONTHS PRIOR 2664 02:07:49,080 --> 02:07:52,640 TO THE CONCEPTION DATE OF THE 2665 02:07:52,640 --> 02:07:54,560 INFANT AND STATED ELIGIBILITY IN 2666 02:07:54,560 --> 02:07:56,680 THE 12 MONTHS PRIOR TO 2667 02:07:56,680 --> 02:07:57,200 CONCEPTION. 2668 02:07:57,200 --> 02:07:58,680 WE INCLUDE INDIVIDUAL 2669 02:07:58,680 --> 02:07:59,880 CHARACTERISTICS SUCH AS MATERNAL 2670 02:07:59,880 --> 02:08:06,680 AGE AND RACE AND WE INCLUDE PER 2671 02:08:06,680 --> 02:08:09,520 CAPITA INCOME AND OB-GYNs IN THE 2672 02:08:09,520 --> 02:08:13,000 COUNTY AND THE MODELS INCLUDE 2673 02:08:13,000 --> 02:08:16,920 YEAR FIXED AFFECTS, STATE 2674 02:08:16,920 --> 02:08:19,480 SPECIFIC TIME TRENDS AND THEY'RE 2675 02:08:19,480 --> 02:08:19,760 CLUSTERED. 2676 02:08:19,760 --> 02:08:21,160 SO THIS APPROACH IS PRETTY 2677 02:08:21,160 --> 02:08:22,000 STANDARD IN THE LITERATURE AT 2678 02:08:22,000 --> 02:08:31,200 THIS POINT. 2679 02:08:31,200 --> 02:08:35,520 WE'RE IN THE PROCESS OF ADDING 2680 02:08:35,520 --> 02:08:37,240 AND IN THE PRESENTATION FOR THE 2681 02:08:37,240 --> 02:08:38,720 RESULTS WE'RE LOOKING AT THE 2682 02:08:38,720 --> 02:08:41,400 BIRTHS AT MOTHERS 15 TO 25 AND 2683 02:08:41,400 --> 02:08:42,680 THE REASON WE'RE FOCUSSING ON 2684 02:08:42,680 --> 02:08:44,760 FIRST BIRTHS IS BECAUSE I WANT 2685 02:08:44,760 --> 02:08:47,320 TO MAKE A COMPARISON. 2686 02:08:47,320 --> 02:08:48,680 PEOPLE HAVING THEIR FIRST BIRTHS 2687 02:08:48,680 --> 02:08:51,480 ARE THOSE CHILDLESS AT THE TIME 2688 02:08:51,480 --> 02:08:53,400 OF CONCEPTION SO THEY CAN 2689 02:08:53,400 --> 02:08:55,520 POTENTIALLY BE MOST EXPOSED TO 2690 02:08:55,520 --> 02:08:57,440 THE MEDICAID EXPANSION FOCUSSING 2691 02:08:57,440 --> 02:08:59,720 ON CHILDLESS ADULTS AND FOCUS ON 2692 02:08:59,720 --> 02:09:03,400 MOTHERS WITHOUT A COLLEGE DEGREE 2693 02:09:03,400 --> 02:09:04,600 SINCE THEY'RE LIKELY TO BE 2694 02:09:04,600 --> 02:09:09,080 ELIGIBLE FOR MEDICAID. 2695 02:09:09,080 --> 02:09:13,320 MOST USES BIRTH CERTIFICATES 2696 02:09:13,320 --> 02:09:13,520 DATA. 2697 02:09:13,520 --> 02:09:15,360 THE ANALYSIS ARE AT THE STATE 2698 02:09:15,360 --> 02:09:19,200 AND YEAR LEVEL BECAUSE AT THIS 2699 02:09:19,200 --> 02:09:26,000 POINT THE NATIONAL IN PATIENT 2700 02:09:26,000 --> 02:09:30,000 SAMPLE NOT USED AND ANALYSES OF 2701 02:09:30,000 --> 02:09:30,960 SUB SAMPLES IS STILL POSSIBLE 2702 02:09:30,960 --> 02:09:35,040 BECAUSE THE RATES OF SMM BY 2703 02:09:35,040 --> 02:09:36,000 CERTAIN SUB SAMPLES FOR EXAMPLE 2704 02:09:36,000 --> 02:09:36,480 BY AGE. 2705 02:09:36,480 --> 02:09:38,680 ALL THE RESULTS ARE BASED ON 2706 02:09:38,680 --> 02:09:39,760 SAMPLES THAT INCLUDE STATES THAT 2707 02:09:39,760 --> 02:09:41,600 OFFERED ANY LEVEL OF MEDICAID 2708 02:09:41,600 --> 02:09:43,480 COVERAGE FOR CHILDLESS ADULTS 2709 02:09:43,480 --> 02:09:47,280 PRIOR TO 2014 AND HAD AN 2710 02:09:47,280 --> 02:09:49,080 EXPANSION AFTER 2014 OR HIGH 2711 02:09:49,080 --> 02:09:51,800 DEGREE OF MISINFORMATION AND 2712 02:09:51,800 --> 02:09:52,880 SPECIFICALLY MATERNAL EDUCATION 2713 02:09:52,880 --> 02:09:54,040 AND INTERESTS. 2714 02:09:54,040 --> 02:09:55,880 THIS IS A VERY LIMITED SAMPLE 2715 02:09:55,880 --> 02:09:56,640 FOR THIS PRESENTATION BUT WE 2716 02:09:56,640 --> 02:10:00,400 HAVE OTHER RESULTS BASED ON A 2717 02:10:00,400 --> 02:10:03,880 MORE BROAD SAMPLE THAT'S MORE 2718 02:10:03,880 --> 02:10:04,120 SIMILAR. 2719 02:10:04,120 --> 02:10:06,320 I'LL SKIP STRAIGHT TO THE 2720 02:10:06,320 --> 02:10:06,560 RESULTS. 2721 02:10:06,560 --> 02:10:08,720 SO THIS INFORMATION IS COLLECTED 2722 02:10:08,720 --> 02:10:10,200 FROM BIRTH CERTIFICATES. 2723 02:10:10,200 --> 02:10:13,800 WE CLASSIFIED THEM AT HEALTH 2724 02:10:13,800 --> 02:10:16,120 PROBLEMS BEFORE PREGNANCY AND AT 2725 02:10:16,120 --> 02:10:16,400 DELIVERY. 2726 02:10:16,400 --> 02:10:17,400 THE RATES OF HEALTH PROBLEMS 2727 02:10:17,400 --> 02:10:21,400 JUST TO MAKE A FEW COMMENTS 2728 02:10:21,400 --> 02:10:23,320 BEFORE PREGNANCY ARE QUITE 2729 02:10:23,320 --> 02:10:25,960 COMMON AND AMONG OLDER VERSUS 2730 02:10:25,960 --> 02:10:26,600 YOUNGER MOTHERS. 2731 02:10:26,600 --> 02:10:30,040 THE RATE IS 14.2% UNDER AGE 35 2732 02:10:30,040 --> 02:10:34,400 AND 25.7% AMONG OTHERS 35 TO 55. 2733 02:10:34,400 --> 02:10:37,480 HEALTH PROBLEMS AT DELIVERY RARE 2734 02:10:37,480 --> 02:10:39,680 AND THEY'RE RARE FOR BOTH AGE 2735 02:10:39,680 --> 02:10:41,200 GROUPS COMPARED TO DURING AND 2736 02:10:41,200 --> 02:10:43,520 BEFORE PREGNANCY IF YOU LOOK 2737 02:10:43,520 --> 02:10:45,280 ACROSS AGE. 2738 02:10:45,280 --> 02:10:50,160 WE ALSO USE STATE YOUR DATA ON 2739 02:10:50,160 --> 02:10:52,760 MATERNAL MORBIDITY AND THE 2740 02:10:52,760 --> 02:10:55,280 SEVERE RATE AND IT'S 68 PER 2741 02:10:55,280 --> 02:10:56,680 10,000 LIVE BIRTHS. 2742 02:10:56,680 --> 02:10:59,800 SO I'LL QUICKLY SUMMARIZE OUR 2743 02:10:59,800 --> 02:11:00,040 RESULTS. 2744 02:11:00,040 --> 02:11:03,480 THIS IS AN EVENT STUDIO GRAPH. 2745 02:11:03,480 --> 02:11:06,200 IT'S 2013 AS THE BASELINE YEAR. 2746 02:11:06,200 --> 02:11:08,000 WE'RE COMPARING MOTHERS LIVING 2747 02:11:08,000 --> 02:11:11,400 IN STATES TO CHILDLESS ADULTS TO 2748 02:11:11,400 --> 02:11:13,800 THOSE THAT DIDN'T EXTEND 2749 02:11:13,800 --> 02:11:15,440 MEDICAID AND COMPARING THEM 2750 02:11:15,440 --> 02:11:18,600 BEFORE AND AFTER MEDICAID WAS 2751 02:11:18,600 --> 02:11:19,120 EXPANDED. 2752 02:11:19,120 --> 02:11:20,440 ON THE HORIZONTAL AXIS THE YEAR 2753 02:11:20,440 --> 02:11:22,800 OF CONCEPTION AND 2011 AND 2022 2754 02:11:22,800 --> 02:11:24,080 THERE WERE NO DIFFERENCES 2755 02:11:24,080 --> 02:11:26,200 BETWEEN MOTHERS THAT LIVED IN 2756 02:11:26,200 --> 02:11:28,000 STATES THAT EXPANDED MEDICAID 2757 02:11:28,000 --> 02:11:28,720 THAT DID AND DIDN'T. 2758 02:11:28,720 --> 02:11:30,480 IT SUGGESTS OUR COMPARISON GROUP 2759 02:11:30,480 --> 02:11:33,000 IS A GOOD COMPARISON GROUP. 2760 02:11:33,000 --> 02:11:35,360 AFTER 2013 YOU SEE THE 2761 02:11:35,360 --> 02:11:35,920 DIFFERENCE BETWEEN MOTHERS 2762 02:11:35,920 --> 02:11:38,200 LIVING IN STATES THAT EXTENDED 2763 02:11:38,200 --> 02:11:39,960 MEDICAID AND THOSE THAT DID NOT 2764 02:11:39,960 --> 02:11:42,480 EXPAND MEDICAID AND THE VERTICAL 2765 02:11:42,480 --> 02:11:45,640 LINES ARE 95% CONFIDENCE 2766 02:11:45,640 --> 02:11:46,720 INTERVAL THE RED LINES REPRESENT 2767 02:11:46,720 --> 02:11:49,720 THE SAMPLE LIMITED TO OLDER 2768 02:11:49,720 --> 02:11:54,640 MOTHERS, 35 TO 55 AND THE BLACK 2769 02:11:54,640 --> 02:11:56,600 LINES REPRESENT MANY CONFIDENCE 2770 02:11:56,600 --> 02:11:58,000 INTERVALS FOR MOTHERS YOUNGER 2771 02:11:58,000 --> 02:11:58,720 THAN 35 YEARS OLD 2772 02:11:58,720 --> 02:12:01,080 THE TAKEAWAY MESSAGE IS THAT FOR 2773 02:12:01,080 --> 02:12:03,000 BOTH OLDER AND YOUNGER MOTHERS 2774 02:12:03,000 --> 02:12:06,200 YOU SEE AN INCREASE IN IDENTIFY 2775 02:12:06,200 --> 02:12:08,160 HEALTH PROBLEMS IN 2014 AND 2015 2776 02:12:08,160 --> 02:12:10,400 THE FIRST COUPLE YEARS AFTER 2777 02:12:10,400 --> 02:12:11,760 EXPANSION COMPARED TO 2013 AND 2778 02:12:11,760 --> 02:12:14,200 THE RESULT GOES AWAY STARTING IN 2779 02:12:14,200 --> 02:12:16,200 2016. 2780 02:12:16,200 --> 02:12:18,440 THIS IS THE SAME SET OF RESULTS 2781 02:12:18,440 --> 02:12:20,040 BUT NOW I'M LOOKING AT HEALTH 2782 02:12:20,040 --> 02:12:21,880 PROBLEMS DURING DELIVERY. 2783 02:12:21,880 --> 02:12:24,760 HERE YOU SEE DIFFERENCES BETWEEN 2784 02:12:24,760 --> 02:12:26,880 OLDER AND YOUNGER MOTHERS AND 2785 02:12:26,880 --> 02:12:30,760 THE MEDICAID EXPANSIONS APPEAR 2786 02:12:30,760 --> 02:12:38,200 TO BE ASSOCIATED WITH INCREASED 2787 02:12:38,200 --> 02:12:44,840 HEALTH PROBLEMS. 2788 02:12:44,840 --> 02:12:47,720 HERE WE DON'T SEE AFFECT ON THE 2789 02:12:47,720 --> 02:12:49,200 MEDICAID EXPANSION ON THESE 2790 02:12:49,200 --> 02:12:49,440 OUTCOMES. 2791 02:12:49,440 --> 02:12:52,440 WE CAN LOOK AT THE RESULTS BY 2792 02:12:52,440 --> 02:12:54,360 SPECIFIC HEALTH OUTCOME AND THIS 2793 02:12:54,360 --> 02:12:58,880 GIVES THE GENERAL PATTERN MUCH 2794 02:12:58,880 --> 02:12:59,880 RESULTS AND WHAT SHOULD AND 2795 02:12:59,880 --> 02:13:02,200 SHOULDN'T BE INCLUDED IN SMM 2796 02:13:02,200 --> 02:13:04,080 BECAUSE SOME HEALTH PROBLEMS AT 2797 02:13:04,080 --> 02:13:05,880 DELIVERY SHOULD PROBABLY NOT BE 2798 02:13:05,880 --> 02:13:07,800 INCLUDE LIKE MATERNAL 2799 02:13:07,800 --> 02:13:10,480 TRANSFUSION AND HYSTERECTOMY BUT 2800 02:13:10,480 --> 02:13:12,160 BASICALLY THE BOTTOM LINE IS WE 2801 02:13:12,160 --> 02:13:14,160 SEE INCREASES IN HEALTH PROBLEMS 2802 02:13:14,160 --> 02:13:15,320 BEING IDENTIFIED BEFORE AND 2803 02:13:15,320 --> 02:13:17,360 DURING THE PREGNANCY AND THESE 2804 02:13:17,360 --> 02:13:20,160 ARE FAIRLY LARGE IN MAGNITUDE. 2805 02:13:20,160 --> 02:13:22,040 AMONG MOTHERS YOUNGER THAN 35 2806 02:13:22,040 --> 02:13:23,360 YEARS OLD THE MEDICAID 2807 02:13:23,360 --> 02:13:26,200 EXPANSIONS ARE ASSOCIATED WITH A 2808 02:13:26,200 --> 02:13:27,680 3% INCREASE IN THE LIKELIHOOD OF 2809 02:13:27,680 --> 02:13:29,160 HAVING ANY PROB IDENTIFIED 2810 02:13:29,160 --> 02:13:34,800 BEFORE OR AFTER PREGNANCY AND AN 2811 02:13:34,800 --> 02:13:36,360 INCREASE AT THE MEAN. 2812 02:13:36,360 --> 02:13:39,840 THESE SHOW RESULTS BY SUBSAMPLES 2813 02:13:39,840 --> 02:13:42,320 BY SMM AND AFTER THIS SLIDE I'LL 2814 02:13:42,320 --> 02:13:45,200 FINISH AND OVERALL WE DON'T SEE 2815 02:13:45,200 --> 02:13:46,640 ANY AFFECT OF THE MEDICAID 2816 02:13:46,640 --> 02:13:47,320 EXPANSIONS ON THE STATE LEVEL 2817 02:13:47,320 --> 02:13:50,120 RATE OF SMM AND WE DO SEE SOME 2818 02:13:50,120 --> 02:13:53,800 POSITIVE FINDINGS FOR CERTAIN 2819 02:13:53,800 --> 02:13:54,680 SUBSAMPLES. 2820 02:13:54,680 --> 02:13:56,160 SPECIFICALLY YOUNGER MOTHERS, 2821 02:13:56,160 --> 02:13:58,600 LATINOS, MOTHERS OF OTHER RACE, 2822 02:13:58,600 --> 02:14:00,520 MOTHERS IN THE LOWEST INCOME 2823 02:14:00,520 --> 02:14:00,800 QUARTILE. 2824 02:14:00,800 --> 02:14:03,760 MOTHERS IN NON-METROPOLITAN 2825 02:14:03,760 --> 02:14:05,360 AREAS AND LIVING IN PUBLIC 2826 02:14:05,360 --> 02:14:05,880 HOSPITALS. 2827 02:14:05,880 --> 02:14:07,680 I DIDN'T GET TO TALK MUCH ABOUT 2828 02:14:07,680 --> 02:14:09,880 OTHER LITERATURE BUT I WANT TO 2829 02:14:09,880 --> 02:14:11,800 MENTION THAT ONE INTERPRETATION 2830 02:14:11,800 --> 02:14:14,160 OF THE FINDINGS IS THE ACA 2831 02:14:14,160 --> 02:14:15,600 MEDICAID EXPANSIONS MAY HAVE 2832 02:14:15,600 --> 02:14:17,400 INCREASED IDENTIFICATION OF 2833 02:14:17,400 --> 02:14:18,240 HEALTH PROBLEMS PRIOR TO AND 2834 02:14:18,240 --> 02:14:20,920 DURING PREGNANCY AND ONE THING 2835 02:14:20,920 --> 02:14:26,200 WE NEED TO INVESTIGATE 2836 02:14:26,200 --> 02:14:28,600 SUBSIDIZED INSURANCE AND WE SEE 2837 02:14:28,600 --> 02:14:30,760 MIXED AFFECTS DURING DELIVERY 2838 02:14:30,760 --> 02:14:35,400 SURPRISING AND HARD TO EXPLAIN 2839 02:14:35,400 --> 02:14:37,200 AND ONE CITATION IS USING A 2840 02:14:37,200 --> 02:14:43,080 SIMILAR SET UP AND ONE SAMPLE IS 2841 02:14:43,080 --> 02:14:46,280 SIMILAR TO OURS AND I THINK 2842 02:14:46,280 --> 02:14:48,560 THEY'RE QUITE SIMILAR SO I'M 2843 02:14:48,560 --> 02:14:50,120 INTERESTED IN CONNECTING AFTER 2844 02:14:50,120 --> 02:14:52,720 THE TALK AND LOOKING AT MEDICAID 2845 02:14:52,720 --> 02:14:54,200 EXPANSION AT THE COMPOSITION OF 2846 02:14:54,200 --> 02:14:56,200 MOTHERS AND ARE THERE ISSUES ON 2847 02:14:56,200 --> 02:14:58,640 THE SUPPLY SIDE FOR EXAMPLE THE 2848 02:14:58,640 --> 02:15:01,040 DENSITY OF PROVIDERS. 2849 02:15:01,040 --> 02:15:01,640 I APPRECIATE ANY COMMENTS AND 2850 02:15:01,640 --> 02:15:01,960 SUGGESTIONS. 2851 02:15:01,960 --> 02:15:13,800 THANK YOU. 2852 02:15:13,800 --> 02:15:15,400 >> FEEL FREE TO PUT ONLY 2853 02:15:15,400 --> 02:15:17,000 QUESTIONS YOU HAVE IN THE Q&A. 2854 02:15:17,000 --> 02:15:21,800 I DON'T SEE QUESTIONS YET. 2855 02:15:21,800 --> 02:15:24,280 WERE YOU ABLE TO LOOK AT 2856 02:15:24,280 --> 02:15:25,520 INTERACTIONS LIKE RACE/ETHNICITY 2857 02:15:25,520 --> 02:15:27,600 BY AGE AND DID YOU FIND ANYTHING 2858 02:15:27,600 --> 02:15:28,160 INTEREST THERE? 2859 02:15:28,160 --> 02:15:29,720 >> THAT'S A GREAT IDEA AND WHERE 2860 02:15:29,720 --> 02:15:32,480 WE NEED TO GO NEXT. 2861 02:15:32,480 --> 02:15:33,440 ONE OF THE ADVANTAGE OF USING 2862 02:15:33,440 --> 02:15:35,560 BIRTH CERTIFICATE DATA IS A HUGE 2863 02:15:35,560 --> 02:15:36,720 SAMPLE. 2864 02:15:36,720 --> 02:15:39,400 WE'LL BE ABLE TO LOOK AT 2865 02:15:39,400 --> 02:15:40,240 RACE/EDUCATION SUBSAMPLES WHICH 2866 02:15:40,240 --> 02:15:46,480 I THINK IS A GREAT IDEA. 2867 02:15:46,480 --> 02:15:48,960 AND WE'RE USING DATA THAT'S 2868 02:15:48,960 --> 02:15:50,560 ALREADY BEEN AGGREGATED AND 2869 02:15:50,560 --> 02:15:54,720 THAT'S WITH THAT OUTCOME WE'RE 2870 02:15:54,720 --> 02:15:58,120 MORE LIMITED. 2871 02:15:58,120 --> 02:16:00,320 WHAT IS YOUR VIEW ABOUT QUALITY 2872 02:16:00,320 --> 02:16:02,400 OF DATA ON SMM? 2873 02:16:02,400 --> 02:16:04,680 IT SEEMS UNDERESTIMATED TO ME? 2874 02:16:04,680 --> 02:16:10,160 >> THINK WE HAVE THE SAME 2875 02:16:10,160 --> 02:16:11,800 CONCERN AND THAT'S WHY TODAY'S 2876 02:16:11,800 --> 02:16:14,160 BEEN SO HELPFUL TO US. 2877 02:16:14,160 --> 02:16:18,640 IN TAKING THE DATA FROM THE NIS 2878 02:16:18,640 --> 02:16:22,720 BASED ON ICD9 AND ICD10 NOW 2879 02:16:22,720 --> 02:16:24,480 CODES AND PROCEDURES AND 2880 02:16:24,480 --> 02:16:26,800 DIAGNOSES DURING THE DELIVERY 2881 02:16:26,800 --> 02:16:30,120 AND THEY'RE USING THE CDC SAME 2882 02:16:30,120 --> 02:16:32,040 AND LIST OF CONDITIONS SHOWED 2883 02:16:32,040 --> 02:16:32,240 THERE. 2884 02:16:32,240 --> 02:16:35,920 THAT DATA TO ME THE QUALITY 2885 02:16:35,920 --> 02:16:39,800 SEEMS DIFFERENT FROM THE BIRTH 2886 02:16:39,800 --> 02:16:40,560 CERTIFICATE DATA. 2887 02:16:40,560 --> 02:16:45,760 AND QUALITY IS CHANGING OVER 2888 02:16:45,760 --> 02:16:49,280 TIME IN DIFFERENT STATES A.D 2889 02:16:49,280 --> 02:16:54,560 >> AND EXPANDING ACCESS TO 2890 02:16:54,560 --> 02:16:55,600 MEDICAID AND FACILITATING PEOPLE 2891 02:16:55,600 --> 02:16:57,840 TO SIGN UP ARE TWO DIFFERENT 2892 02:16:57,840 --> 02:16:58,080 THINGS. 2893 02:16:58,080 --> 02:16:59,960 COULD THAT HAVE PLAYED A ROLE 2894 02:16:59,960 --> 02:17:02,120 ABOUT THERE WAS AN IMPACT EARLY 2895 02:17:02,120 --> 02:17:05,720 ON BUT NOT LATER? 2896 02:17:05,720 --> 02:17:07,640 >> THAT'S A GREAT POINT AND A 2897 02:17:07,640 --> 02:17:08,800 WISH WE COULD ADDRESS THAT. 2898 02:17:08,800 --> 02:17:11,000 WE HAVE THE MOTHER'S INSURANCE 2899 02:17:11,000 --> 02:17:15,480 STATUS ON THE BIRTH CERTIFICATE 2900 02:17:15,480 --> 02:17:17,000 BUT A LOT OF MOTHERS GET SIGNED 2901 02:17:17,000 --> 02:17:19,400 UP LATE IN PREGNANCY OR AFTER 2902 02:17:19,400 --> 02:17:20,880 DELIVERY BUT THERE'S OTHER DATA 2903 02:17:20,880 --> 02:17:23,440 SETS THAT HAVE INFORMATION 2904 02:17:23,440 --> 02:17:24,400 THOUGH ON MOTHERS INSURANCE 2905 02:17:24,400 --> 02:17:26,160 STATUS BEFORE GIVING BIRTH AND 2906 02:17:26,160 --> 02:17:27,400 JUST AFTER BIRTH AND THERE'S 2907 02:17:27,400 --> 02:17:30,760 OTHER RESEARCHERS WORKING ON 2908 02:17:30,760 --> 02:17:32,200 THAT AND IF I CAN STATE THE 2909 02:17:32,200 --> 02:17:34,600 RESULTS CORRECTLY I THINK THE 2910 02:17:34,600 --> 02:17:38,160 FOUND THE MEDICAID EXPANSIONS 2911 02:17:38,160 --> 02:17:38,920 INCREASE MEDICAID COVERAGE 2912 02:17:38,920 --> 02:17:41,320 AROUND THE TIME OF BIRTH AND 2913 02:17:41,320 --> 02:17:43,400 THAT'S A GREAT POINT WE CAN'T 2914 02:17:43,400 --> 02:17:56,720 REALLY ADDRESS IN THE STUDY. 2915 02:17:56,720 --> 02:17:57,200 >> THANK YOU SO MUCH. 2916 02:17:57,200 --> 02:17:58,760 I DON'T SEE MORE QUESTIONS SO WE 2917 02:17:58,760 --> 02:18:02,280 CAN MOVE ON. 2918 02:18:02,280 --> 02:18:10,640 OUR NEXT SPEAKER DR. NORMAN AND 2919 02:18:10,640 --> 02:18:11,520 DR. BLAKE. 2920 02:18:11,520 --> 02:18:18,360 AND YOUR SLIDES ARE UP SO TAKE 2921 02:18:18,360 --> 02:18:19,120 IT AWAY. 2922 02:18:19,120 --> 02:18:26,200 >> 2923 02:18:26,200 --> 02:18:29,160 >> MITIGATING THE IMPACT ON 2924 02:18:29,160 --> 02:18:30,000 MATERNAL MORBIDITY AND MORTALITY 2925 02:18:30,000 --> 02:18:32,160 FOR AFRICAN AMERICAN WOMEN. 2926 02:18:32,160 --> 02:18:36,000 THIS IS A COLLABORATIVE EFFORT 2927 02:18:36,000 --> 02:18:42,000 BETWEEN DETROIT AND ATLANTA THAT 2928 02:18:42,000 --> 02:18:46,520 BEGAN IN MICHIGAN. 2929 02:18:46,520 --> 02:18:48,560 TO BEGIN I'D LIKE TO INTRODUCE 2930 02:18:48,560 --> 02:18:57,000 YOU TO OUR LEADERSHIP TEAM. 2931 02:18:57,000 --> 02:18:59,800 IN MICHIGAN WE HAVE THE CURRENT 2932 02:18:59,800 --> 02:19:02,880 P.I. AND MYSELF, AND IN ATLANTA 2933 02:19:02,880 --> 02:19:06,680 WE HAVE DR. DUNLOP AS PRINCIPLE 2934 02:19:06,680 --> 02:19:10,680 INVESTIGATOR AND DR. BLAKE AS 2935 02:19:10,680 --> 02:19:12,200 THE CO-INVESTIGATOR. 2936 02:19:12,200 --> 02:19:14,800 I WANT TO EXPLAIN WHY IMPLICIT 2937 02:19:14,800 --> 02:19:16,280 BIAS HAS BECOME A TARGET FOR 2938 02:19:16,280 --> 02:19:17,680 INTERVENTION IN THIS RESEARCH 2939 02:19:17,680 --> 02:19:21,080 AND THE IMPORTANT ROLE IMPLICIT 2940 02:19:21,080 --> 02:19:23,400 BIAS PLAYS IN PREGNANCY 2941 02:19:23,400 --> 02:19:23,680 OUTCOMES. 2942 02:19:23,680 --> 02:19:26,560 THE IOM NOTED ATTITUDE AND 2943 02:19:26,560 --> 02:19:27,880 BEHAVIORS OF HEALTH CARE 2944 02:19:27,880 --> 02:19:29,520 PROVIDERS IDENTIFIED AS FACTORS 2945 02:19:29,520 --> 02:19:31,440 THAT CONTRIBUTE TO HEALTH 2946 02:19:31,440 --> 02:19:32,800 DISPARITIES AND UNRECOGNIZED 2947 02:19:32,800 --> 02:19:35,880 BIAS AGAINST RACIAL AND ETHNIC S 2948 02:19:35,880 --> 02:19:41,600 MAY AFFECT COMMUNICATION WITH 2949 02:19:41,600 --> 02:19:47,040 PROVIDERS IN THE RECEIPT OF CARE 2950 02:19:47,040 --> 02:20:00,000 AND IT WAS RELATED TO HEALTH 2951 02:20:00,000 --> 02:20:00,480 OUTCOMES THAN TO ACTUAL 2952 02:20:00,480 --> 02:20:08,720 TREATMENT PROCESSES. 2953 02:20:08,720 --> 02:20:11,880 SO OUR DETROIT COLLABORATION 2954 02:20:11,880 --> 02:20:15,720 DEVELOPED FOCUS GROUP INTERVIEW 2955 02:20:15,720 --> 02:20:16,800 GUIDES FOR AFRICAN AMERICAN 2956 02:20:16,800 --> 02:20:17,000 WOMEN. 2957 02:20:17,000 --> 02:20:18,200 ONE TO UNDERSTAND THEIR 2958 02:20:18,200 --> 02:20:22,120 EXPERIENCES IN SEEK PRENATAL AND 2959 02:20:22,120 --> 02:20:23,360 DELIVERY CARE ADDRESSING THE 2960 02:20:23,360 --> 02:20:26,120 STRUCTURAL AND SOCIAL BARRIERS 2961 02:20:26,120 --> 02:20:28,120 TO ACHIEVING RACIAL EQUITY AND 2962 02:20:28,120 --> 02:20:30,680 TWO TO DETERMINE HOW BEST TO 2963 02:20:30,680 --> 02:20:31,640 OPTIMIZE HEALTH CARE SERVICE. 2964 02:20:31,640 --> 02:20:33,760 WE ALSO CO-CREATED INTERVIEW 2965 02:20:33,760 --> 02:20:35,720 GUIDES FOR HEALTH CARE PROVIDERS 2966 02:20:35,720 --> 02:20:38,640 TO GAUGE THEIR KNOWLEDGE OF THE 2967 02:20:38,640 --> 02:20:44,160 ROLE OF IMPLICIT BIAS ON THE 2968 02:20:44,160 --> 02:20:46,760 PRENATAL DELIVERY AND POSTPARTUM 2969 02:20:46,760 --> 02:20:47,320 CARE. 2970 02:20:47,320 --> 02:20:48,760 OUR WORK IN THE ECHO COHORT WAS 2971 02:20:48,760 --> 02:20:52,080 EXPANDED TO FOCUS ON REDUCING 2972 02:20:52,080 --> 02:20:52,720 MATERNAL MORBIDITY AND MORTALITY 2973 02:20:52,720 --> 02:20:54,200 TO THE VOICES OF WOMEN AND 2974 02:20:54,200 --> 02:21:06,680 HEALTH CARE PROVIDERS. 2975 02:21:06,680 --> 02:21:09,160 IT'S A REGIONAL QUALITY 2976 02:21:09,160 --> 02:21:11,360 COLLABORATIVE IN MICHIGAN'S 2977 02:21:11,360 --> 02:21:17,280 REGION 10 AS A COLLABORATOR. 2978 02:21:17,280 --> 02:21:27,320 AND BRINGS TOGETHER FAMILIES AND 2979 02:21:27,320 --> 02:21:28,640 FAITH-BASED ORGANIZATIONS. 2980 02:21:28,640 --> 02:21:29,480 AN PROVIDED A PLATFORM FOR THE 2981 02:21:29,480 --> 02:21:32,800 LAUNCH OF THE STUDY AND FOR 2982 02:21:32,800 --> 02:21:34,720 ONGOING COMMUNICATION WITH 2983 02:21:34,720 --> 02:21:38,400 COMMUNITY STAKEHOLDERS. 2984 02:21:38,400 --> 02:21:41,400 THE GOAL OF THE STUDY WAS 2985 02:21:41,400 --> 02:21:44,840 THROUGH THE CONDUCT OF 2986 02:21:44,840 --> 02:21:46,000 COMMUNITY-BASED PARTICIPATORY 2987 02:21:46,000 --> 02:21:48,440 RESEARCH TO REDUCE THE IMPACT OF 2988 02:21:48,440 --> 02:21:50,600 BIAS THAT MAY CONTRIBUTE TO 2989 02:21:50,600 --> 02:21:51,960 INCREASED RISK FOR MATERNAL 2990 02:21:51,960 --> 02:21:53,440 MORBIDITY AND MORTALITY IN 2991 02:21:53,440 --> 02:21:55,120 HIGH-RISK POPULATIONS. 2992 02:21:55,120 --> 02:21:57,680 WE'RE ENGAGING AFRICAN AMERICAN 2993 02:21:57,680 --> 02:21:58,720 MOTHERS AND COMMUNITY HEALTH 2994 02:21:58,720 --> 02:22:01,840 ADVOCACY ORGANIZATIONS AND 2995 02:22:01,840 --> 02:22:04,600 HEALTH CARE PROVIDERS AND 2996 02:22:04,600 --> 02:22:05,680 UTILIZING A MIXED METHOD 2997 02:22:05,680 --> 02:22:07,840 APPROACH AND THE DATA WILL BE 2998 02:22:07,840 --> 02:22:09,720 USED TO DEVELOP A TOOL KIT OF 2999 02:22:09,720 --> 02:22:10,680 STRATEGIES FOR MOTHERS TO 3000 02:22:10,680 --> 02:22:13,160 COUNTER NEGATIVE INTERACTIONS 3001 02:22:13,160 --> 02:22:16,680 AND TO OBTAIN PATIENT-CENTERED 3002 02:22:16,680 --> 02:22:17,440 RESPECTFUL CARE. 3003 02:22:17,440 --> 02:22:18,760 WE HAD TO AIMS AND THEY'RE THE 3004 02:22:18,760 --> 02:22:19,800 TWO PHASES. 3005 02:22:19,800 --> 02:22:22,600 ONE IS TO IDENTIFY FACILITIES 3006 02:22:22,600 --> 02:22:26,200 AND BARRIERS AND TO GAIN IMPACT 3007 02:22:26,200 --> 02:22:29,040 OF IMPLICIT BIAS AND RACISM ON 3008 02:22:29,040 --> 02:22:30,600 AFRICAN AMERICAN BASED ON INPUT 3009 02:22:30,600 --> 02:22:34,640 FROM KEY INFORMANTS INCLUDING 3010 02:22:34,640 --> 02:22:35,760 AFRICAN AMERICAN WOMEN AND PHASE 3011 02:22:35,760 --> 02:22:38,160 TWO TO DEVELOP STRATEGIES THAT 3012 02:22:38,160 --> 02:22:39,840 WILL OPTIMIZE UTILIZATION FOR 3013 02:22:39,840 --> 02:22:41,320 EFFECTIVENESS OF HEALTH CARE 3014 02:22:41,320 --> 02:22:41,920 SERVICES FOR AFRICAN AMERICAN 3015 02:22:41,920 --> 02:22:46,040 MOTHERS. 3016 02:22:46,040 --> 02:22:50,240 AND WE INTERVIEWED THREE OB-GYNs 3017 02:22:50,240 --> 02:23:04,760 AND MID WIVES AND FOUR DOULAS 3018 02:23:04,760 --> 02:23:07,800 AND WE HAD INTERVIEWS AND 3019 02:23:07,800 --> 02:23:09,400 PARTICIPANTS WITH 60 TO 90 3020 02:23:09,400 --> 02:23:11,160 MINUTE INTERVIEWS BETWEEN JUNE 3021 02:23:11,160 --> 02:23:13,080 AND DECEMBER 2021. 3022 02:23:13,080 --> 02:23:18,960 AND GIFT CARDS WERE ALSO 3023 02:23:18,960 --> 02:23:22,280 PROVIDED. 3024 02:23:22,280 --> 02:23:23,600 WE'LL BE COLLABORATING WITH THE 3025 02:23:23,600 --> 02:23:25,520 ANALYSIS OF THE DATA AND WE'LL 3026 02:23:25,520 --> 02:23:27,640 TURN IT TO DR. SARA BLAKE TO 3027 02:23:27,640 --> 02:23:28,280 DISCUSS THE PROGRESS AND EARLY 3028 02:23:28,280 --> 02:23:32,960 FINDINGS. 3029 02:23:32,960 --> 02:23:40,560 >> ON BEHALF OF THE COHORT LED 3030 02:23:40,560 --> 02:23:41,920 AND FOCUSES ON MATERNAL 3031 02:23:41,920 --> 02:23:44,120 MORTALITY THROUGH THE VOICES OF 3032 02:23:44,120 --> 02:23:44,960 WOMEN AND HEALTH CARE PROVIDERS 3033 02:23:44,960 --> 02:23:48,160 IN GEORGIA. 3034 02:23:48,160 --> 02:23:50,400 YOU MAY BE AWARE, GEORGIA HAS 3035 02:23:50,400 --> 02:23:53,640 AMONG THE HIGHEST RATES OF 3036 02:23:53,640 --> 02:23:56,320 MATERNAL MORTALITY HAVING WITH 3037 02:23:56,320 --> 02:24:02,320 1.6 TIMES MORE DEATHS THAN WHITE 3038 02:24:02,320 --> 02:24:04,440 WOMEN AND HEALTH DISPARITIES 3039 02:24:04,440 --> 02:24:05,960 LOOKS AT DISCRIMINATION AND 3040 02:24:05,960 --> 02:24:07,200 SYSTEMIC RACISM AND 3041 02:24:07,200 --> 02:24:08,200 INSTITUTIONAL BARRIERS AND 3042 02:24:08,200 --> 02:24:08,680 QUALITY CARE. 3043 02:24:08,680 --> 02:24:10,800 THE IMPLICATIONS OF BLACK 3044 02:24:10,800 --> 02:24:13,720 WOMAN'S VOICE AND THE SUPPORT OF 3045 02:24:13,720 --> 02:24:15,960 SOLUTION CRITICAL TO ACHIEVING 3046 02:24:15,960 --> 02:24:18,480 MATERNAL HEALTH EQUITY. 3047 02:24:18,480 --> 02:24:26,680 THE RESEARCH FROM THE COHORT 3048 02:24:26,680 --> 02:24:29,520 CAPITALIZED WITH LOOKING AT THE 3049 02:24:29,520 --> 02:24:31,080 COHORT AND USED A 3050 02:24:31,080 --> 02:24:32,760 COMMUNITY-BASED PARTICIPATORY 3051 02:24:32,760 --> 02:24:37,600 APPROACH AND WORKED WITH THE 3052 02:24:37,600 --> 02:24:38,640 ATLANTA-BASED BLACK CENTERED 3053 02:24:38,640 --> 02:24:39,560 WELLNESS TO ADDRESS THEIR 3054 02:24:39,560 --> 02:24:41,880 BELIEFS AND EXPERIENCES WITH 3055 02:24:41,880 --> 02:24:43,400 IMPLICIT BIAS AND RACISM IN 3056 02:24:43,400 --> 02:24:43,880 HEALTH CARE. 3057 02:24:43,880 --> 02:24:45,520 THIS WORK SERVE TO DEVELOP 3058 02:24:45,520 --> 02:24:46,680 CRITICAL STRATEGY FOR REDUCING 3059 02:24:46,680 --> 02:24:55,640 OR MITIGATING THE IMPACT OF THE 3060 02:24:55,640 --> 02:24:57,520 EXPOSURES AND THE EFFECT ON 3061 02:24:57,520 --> 02:24:59,680 THESE WOMEN AND FAMILIES. 3062 02:24:59,680 --> 02:25:03,400 TO LIFT UP OUR PARTNERS IN 3063 02:25:03,400 --> 02:25:06,400 ATLANTA THEY HAVE SERVED BLACK 3064 02:25:06,400 --> 02:25:08,800 WOMEN AND THEIR FAMILIES IN THE 3065 02:25:08,800 --> 02:25:11,640 AREA AND THEY BROADEN AWARENESS 3066 02:25:11,640 --> 02:25:14,480 OF THE HEALTH ISSUES AFFECTING 3067 02:25:14,480 --> 02:25:16,320 BLACK WOMEN AND PROVIDING 3068 02:25:16,320 --> 02:25:17,520 PREVENTIVE HEALTH SERVICE FOR 3069 02:25:17,520 --> 02:25:18,720 WOMEN IN THE ATLANTA AREA AND 3070 02:25:18,720 --> 02:25:22,280 THEY SERVE OVER 300 MOTHERS AND 3071 02:25:22,280 --> 02:25:25,320 CHILDREN ANNUALLY. 3072 02:25:25,320 --> 02:25:31,240 THE CENTER FOR BLACK CENTER 3073 02:25:31,240 --> 02:25:31,640 WEN 3074 02:25:31,640 --> 02:25:32,360 WELLNESS AND WE PRESENT 3075 02:25:32,360 --> 02:25:35,240 ADDITIONAL WORK IN THE PROJECT. 3076 02:25:35,240 --> 02:25:39,400 I WANT TO BRIEFLY SHOW YOU IN 3077 02:25:39,400 --> 02:25:42,680 THE FIGURE OUR WORK WAS BY A 3078 02:25:42,680 --> 02:25:44,000 CONCEPTUAL MODEL THAT ADDRESS 3079 02:25:44,000 --> 02:25:46,680 THE ROLE OF IMPLICIT BIAS AND 3080 02:25:46,680 --> 02:25:49,480 ILLUSTRATE THE PATHWAYS THROUGH 3081 02:25:49,480 --> 02:25:51,240 WHICH IT MAY AFFECT THE PATIENT 3082 02:25:51,240 --> 02:25:54,760 PROVIDER RELATIONSHIP AND 3083 02:25:54,760 --> 02:26:02,560 RELATED PROCESSES. 3084 02:26:02,560 --> 02:26:04,440 UNAWARE THAT PERCEPTIONS AND 3085 02:26:04,440 --> 02:26:06,120 DECISIONS WERE DISTORTED BY 3086 02:26:06,120 --> 02:26:06,840 IMPLICIT BIAS. 3087 02:26:06,840 --> 02:26:09,760 ALSO SHOWN IN THAT IS AT THE MAY 3088 02:26:09,760 --> 02:26:12,000 AFFECT TREATMENT THROUGH THE 3089 02:26:12,000 --> 02:26:13,480 EFFECTS ON PATIENT PROVIDER 3090 02:26:13,480 --> 02:26:13,960 COMMUNICATION. 3091 02:26:13,960 --> 02:26:17,920 SO OUR HYPOTHESIS IN THIS WORK 3092 02:26:17,920 --> 02:26:26,680 IS ELUCIDATINE INING GUIDANCE CAN 3093 02:26:26,680 --> 02:26:27,800 OFFER INFORMATION USEFUL IN 3094 02:26:27,800 --> 02:26:29,360 IMPROVING BLACK WOMEN'S 3095 02:26:29,360 --> 02:26:29,960 TREATMENT IN THE HEALTH CARE 3096 02:26:29,960 --> 02:26:33,400 SETTING AND THE UTILIZATION AND 3097 02:26:33,400 --> 02:26:34,080 PARTICIPATION IN HEALTH CARE 3098 02:26:34,080 --> 02:26:38,880 THERE BE REDUCING DISPARITIES 3099 02:26:38,880 --> 02:26:40,400 AND ADVERSE MATERNAL HEALTH 3100 02:26:40,400 --> 02:26:40,680 OUTCOMES. 3101 02:26:40,680 --> 02:26:42,600 OUR AIMS ARE SIMILAR TO THE 3102 02:26:42,600 --> 02:26:45,160 DETROIT ECHO PROJECT AND THAT WE 3103 02:26:45,160 --> 02:26:46,680 ARE THROUGH THIS WORK 3104 02:26:46,680 --> 02:26:48,160 IDENTIFYING FACILITATORS AND 3105 02:26:48,160 --> 02:26:49,520 BARRIERS TO EQUITABLE AND 3106 02:26:49,520 --> 02:26:50,800 RESPECTFUL CARE TO BLACK WOMEN 3107 02:26:50,800 --> 02:26:52,440 BUT ALSO HOPING TO DEVELOP 3108 02:26:52,440 --> 02:26:55,000 STRATEGIES FOR A CULTURE OF 3109 02:26:55,000 --> 02:26:58,000 RESPECTFUL CARE AND CULTURAL 3110 02:26:58,000 --> 02:26:59,960 HUMILITY FOR BUILDING PATIENT 3111 02:26:59,960 --> 02:27:02,480 TRUST AND BUILDING 3112 02:27:02,480 --> 02:27:03,160 PATIENT-PROVIDER COMMUNICATION. 3113 02:27:03,160 --> 02:27:06,640 WE ARE UNDERTAKING A TWO-PHASE 3114 02:27:06,640 --> 02:27:09,200 ADD APPROACH. 3115 02:27:09,200 --> 02:27:12,680 WE COMPLETED PHASE 1 AND THESE 3116 02:27:12,680 --> 02:27:15,000 DATA WILL BE USED TO HELP INFORM 3117 02:27:15,000 --> 02:27:18,040 PHASE 2 WHERE WE'RE WORKING 3118 02:27:18,040 --> 02:27:21,280 TOWARDS SOLUTIONS AND ALSO 3119 02:27:21,280 --> 02:27:21,800 HELPING PROVIDERS GAIN 3120 02:27:21,800 --> 02:27:24,200 ADDITIONAL TREATMENT IN IMPLICIT 3121 02:27:24,200 --> 02:27:27,000 BIAS AND RESPECTFUL AND 3122 02:27:27,000 --> 02:27:27,800 EQUITABLE CARE. 3123 02:27:27,800 --> 02:27:30,800 >> WE'RE AT ABOUT NINE MINUTES. 3124 02:27:30,800 --> 02:27:33,560 >> AND JUST TO SHOW WE COMPLETED 3125 02:27:33,560 --> 02:27:36,600 PHASE 1 AND DID INTERVIEWS WITH 3126 02:27:36,600 --> 02:27:38,160 PROVIDERS HERE THROUGH 60-MINUTE 3127 02:27:38,160 --> 02:27:42,000 INTERVIEWS AND JUST COMPLETED 3128 02:27:42,000 --> 02:27:44,160 FOCUS GROUPS IN THE ATLANTA AREA 3129 02:27:44,160 --> 02:27:49,200 AND ACROSS ATLANTA WITH BLACK 3130 02:27:49,200 --> 02:27:50,720 WOMEN REPRESENTING VARIOUS 3131 02:27:50,720 --> 02:27:52,080 GROUPS IN THE GEORGIA 3132 02:27:52,080 --> 02:27:53,000 COMMUNITIES. 3133 02:27:53,000 --> 02:27:56,000 I WANT TO SHARE WITH YOU BRIEFLY 3134 02:27:56,000 --> 02:27:58,480 MAYBE WE CAN MOVE TOWARD OUR 3135 02:27:58,480 --> 02:27:59,760 FINDINGS A COUPLE SLIDES DOWN TO 3136 02:27:59,760 --> 02:28:02,120 GIVE US INSIGHT INTO OUR 3137 02:28:02,120 --> 02:28:06,200 FINDINGS FROM THE PROVIDER 3138 02:28:06,200 --> 02:28:06,640 INTERVIEWS. 3139 02:28:06,640 --> 02:28:10,600 WE ADDRESSED IMPLICIT BIAS ON 3140 02:28:10,600 --> 02:28:12,520 CLINICAL CARE AND PROVIDERS 3141 02:28:12,520 --> 02:28:13,440 ACKNOWLEDGED THEY HAD SOME 3142 02:28:13,440 --> 02:28:15,600 IMPLICIT BIAS THAT PLAYED A ROLE 3143 02:28:15,600 --> 02:28:17,880 IN THEIR CARE AND NOTICED THE 3144 02:28:17,880 --> 02:28:22,080 CARE OF THEIR COLLEAGUES. 3145 02:28:22,080 --> 02:28:23,640 THEY RECOGNIZED BLACK WOMEN 3146 02:28:23,640 --> 02:28:26,200 EXPERIENCE LIFE LONG STRESS 3147 02:28:26,200 --> 02:28:30,080 INFLUENCED BY A HISTORY OF 3148 02:28:30,080 --> 02:28:32,240 DISCRIMINATORY PRACTICE BUT 3149 02:28:32,240 --> 02:28:34,160 WEREN'T SURE HOW TO ADDRESS THIS 3150 02:28:34,160 --> 02:28:34,960 IN THEIR CARE. 3151 02:28:34,960 --> 02:28:38,680 WE ASKED TO PROVIDERS TO TALK 3152 02:28:38,680 --> 02:28:40,120 ABOUT THEIR UNDERSTANDING OF 3153 02:28:40,120 --> 02:28:42,440 RESPECTFUL CARE AND DEFINE IT IN 3154 02:28:42,440 --> 02:28:44,440 MANY WAYS SUCH AS LISTENING TO 3155 02:28:44,440 --> 02:28:46,560 PATIENTS AND ACKNOWLEDGING THEIR 3156 02:28:46,560 --> 02:28:48,360 CONCERNS AND TO ENSURE 3157 02:28:48,360 --> 02:28:49,520 RESPECTFUL CARE THEY MUST 3158 02:28:49,520 --> 02:28:50,680 ADDRESS THEIR CONCERNS INCLUDING 3159 02:28:50,680 --> 02:28:53,080 AND SPECIFICALLY THE SAFETY OF 3160 02:28:53,080 --> 02:28:54,600 PREGNANCY AND DELIVERY WOMEN 3161 02:28:54,600 --> 02:28:56,120 OFTEN RAISED. 3162 02:28:56,120 --> 02:28:59,800 AND FINALLY EQUITABLE CARE. 3163 02:28:59,800 --> 02:29:01,080 PROVIDERS PROVIDE IT AS 3164 02:29:01,080 --> 02:29:03,600 PROVIDING THE SAME STANDARDS OF 3165 02:29:03,600 --> 02:29:05,080 QUALITY AND MATERNAL HEALTH 3166 02:29:05,080 --> 02:29:06,680 CARE. 3167 02:29:06,680 --> 02:29:10,680 TA -- AND PATIENT-CENTERED CARE 3168 02:29:10,680 --> 02:29:12,000 AND ADDRESSING THEIR OWN BIASES 3169 02:29:12,000 --> 02:29:13,800 TO OVERCOME THEM AS THEY CARE 3170 02:29:13,800 --> 02:29:14,600 FOR BLACK WOMEN. 3171 02:29:14,600 --> 02:29:19,120 THAT'S A QUICK SUMMARY OF OUR 3172 02:29:19,120 --> 02:29:26,200 PRELIMINARY FINDINGS AND HOPE TO 3173 02:29:26,200 --> 02:29:30,200 BE JOINED TO SHARE ADDITIONAL 3174 02:29:30,200 --> 02:29:32,000 VOICES EN OUR STUDIES OF BLACK 3175 02:29:32,000 --> 02:29:34,440 WITH OUR STUDY AND THANK YOU AND 3176 02:29:34,440 --> 02:29:36,520 WE WELCOME ANY QUESTIONS. 3177 02:29:36,520 --> 02:29:38,440 >> WE HAVE ONE QUESTION. 3178 02:29:38,440 --> 02:29:40,360 DID YOU FIND DIFFERENCE IN THE 3179 02:29:40,360 --> 02:29:42,320 IMPLICIT BIAS BETWEEN DIFFERENT 3180 02:29:42,320 --> 02:29:45,800 PROVIDERS FOR EXAMPLE DOULAS 3181 02:29:45,800 --> 02:29:47,160 COMPARED TO PHYSICIANS? 3182 02:29:47,160 --> 02:29:50,000 >> I'LL ANSWER THAT FIRST AND WE 3183 02:29:50,000 --> 02:29:55,520 DID NOT INTERVIEW DOULAS. 3184 02:29:55,520 --> 02:29:56,160 WE INTERVIEWED JUST PHYSICIANS 3185 02:29:56,160 --> 02:30:03,760 AND NURSE MIDWIVES. 3186 02:30:03,760 --> 02:30:05,760 THERE WERE RECOGNITIONS OF 3187 02:30:05,760 --> 02:30:10,320 IMPLICIT BIAS AND EQUITABLE AND 3188 02:30:10,320 --> 02:30:13,880 RESPECTFUL CARE. 3189 02:30:13,880 --> 02:30:14,960 NURSE MIDWIVES HAVE MORE 3190 02:30:14,960 --> 02:30:16,600 STRATEGIES AND RECOMMENDATIONS 3191 02:30:16,600 --> 02:30:20,480 HOW TO ADDRESS IMPLICIT BIAS IN 3192 02:30:20,480 --> 02:30:22,880 THEIR CARE AND WERE I THINK MUCH 3193 02:30:22,880 --> 02:30:26,640 MORE AWARE OF THE IMPORTANCE OF 3194 02:30:26,640 --> 02:30:28,400 TRAINING AND THE NEED FOR 3195 02:30:28,400 --> 02:30:30,920 ADDITIONAL EXPOSURE TO THESE 3196 02:30:30,920 --> 02:30:34,760 ISSUES ACROSS THEIR HOSPITAL 3197 02:30:34,760 --> 02:30:35,000 SYSTEMS. 3198 02:30:35,000 --> 02:30:36,280 BUT DR. NORMA, WHAT DID YOU 3199 02:30:36,280 --> 02:30:46,480 FIND? 3200 02:30:46,480 --> 02:30:49,480 >> ONE THING WE FOUND WITH OUR 3201 02:30:49,480 --> 02:30:52,720 DOULAS IS THEY DID HAVE 3202 02:30:52,720 --> 02:30:56,280 DIFFICULTY AND DIDN'T HAVE 3203 02:30:56,280 --> 02:30:58,160 PROBLEMS WITH OB-GYNS IN THE 3204 02:30:58,160 --> 02:30:59,320 LABOR AND DELIVERY SETTING AND 3205 02:30:59,320 --> 02:31:02,360 TALKED ABOUT THE IMPLICIT 3206 02:31:02,360 --> 02:31:04,840 BIASSED THEY WITNESSED AND WE 3207 02:31:04,840 --> 02:31:06,680 ASKED AMONG EACH OF THE GROUPS 3208 02:31:06,680 --> 02:31:08,640 WHAT DID THEY SEE AMONG THEIR 3209 02:31:08,640 --> 02:31:08,840 PEERS. 3210 02:31:08,840 --> 02:31:13,000 WE SAW IT OCCASIONALLY WITH THE 3211 02:31:13,000 --> 02:31:15,200 NURSE MIDWIVES BUT THE DOULAS 3212 02:31:15,200 --> 02:31:16,920 SAY THEY DIDN'T SEE IT AMONG 3213 02:31:16,920 --> 02:31:18,280 THEIR PEERS BUT IN THE DELIVERY 3214 02:31:18,280 --> 02:31:20,080 SUITE THEY ENCOUNTERED IMPLICIT 3215 02:31:20,080 --> 02:31:35,400 BIAS. 3216 02:31:35,400 --> 02:31:35,560 3217 02:31:35,560 --> 02:31:38,600 >> HOW REPRESENTATIVE DO YOU 3218 02:31:38,600 --> 02:31:41,400 THINK CLINICIAN SAMPLES WERE? 3219 02:31:41,400 --> 02:31:43,480 DID THE CLINICIANS WHO HAVE MORE 3220 02:31:43,480 --> 02:31:47,400 CULTURAL SENSITIVE OR HUMILITY 3221 02:31:47,400 --> 02:31:49,480 WERE THEY LIKELY TO PARTICIPATE 3222 02:31:49,480 --> 02:31:56,600 IN THE VIEWS? 3223 02:31:56,600 --> 02:31:58,360 -- INTERVIEWS. 3224 02:31:58,360 --> 02:32:02,680 >> ALMOST ALL HAD EXPOSURE TO 3225 02:32:02,680 --> 02:32:05,640 TRAINEE AND THEY VARIED IN SOME 3226 02:32:05,640 --> 02:32:07,880 WERE MORE CYNICAL ABOUT THE 3227 02:32:07,880 --> 02:32:10,360 VALUE OF ADDITIONAL TRAINING OR 3228 02:32:10,360 --> 02:32:13,600 ONE-OFF TRAININGS WERE NOT 3229 02:32:13,600 --> 02:32:15,600 NECESSARILY ENOUGH AND REQUIRED 3230 02:32:15,600 --> 02:32:17,400 A HOSPITAL-BASED OR 3231 02:32:17,400 --> 02:32:21,120 SYSTEMS-BASED CULTURE CHANGE BUT 3232 02:32:21,120 --> 02:32:22,200 WE ARE IN THE NEXT PHASE TO TEST 3233 02:32:22,200 --> 02:32:25,520 THAT MORE AS WE'RE WORKING WITH 3234 02:32:25,520 --> 02:32:28,400 COLLABORATIVE PARTNERS TO 3235 02:32:28,400 --> 02:32:30,720 DEVELOP ADDITIONAL HIGHER LEVEL 3236 02:32:30,720 --> 02:33:02,200 IMPLICIT BIAS TRAINING. 3237 02:33:02,200 --> 02:33:03,680 >> SOMETIMES IT'S OUTRIGHT HARM. 3238 02:33:03,680 --> 02:33:04,920 HOW DOES THAT FIGURE INTO THE 3239 02:33:04,920 --> 02:33:10,680 RESEARCH AND SOLUTIONS? 3240 02:33:10,680 --> 02:33:16,840 >> WHAT DID YOU SAY ABOUT 3241 02:33:16,840 --> 02:33:19,760 IMPLICIT BIAS -- IT'S EXCLUSIVE 3242 02:33:19,760 --> 02:33:22,200 BIAS, OUTRIGHT HARM AND HOW DO 3243 02:33:22,200 --> 02:33:24,520 YOU TAKE THAT INTO ACCOUNT? 3244 02:33:24,520 --> 02:33:27,360 >> WE DID ASK ABOUT IMPLICIT 3245 02:33:27,360 --> 02:33:32,200 BIAS AND SOMETIMES THEY WOULD 3246 02:33:32,200 --> 02:33:34,480 VOLUNTARILY MENTION THEY WOULD 3247 02:33:34,480 --> 02:33:35,400 SEE WHERE THE PROVIDER WAS 3248 02:33:35,400 --> 02:33:37,560 COGNIZANT OF WHAT THEY WERE 3249 02:33:37,560 --> 02:33:38,800 DOING BUT THAT'S ONE OF THE 3250 02:33:38,800 --> 02:33:39,800 THINGS WE'RE STILL IN THE 3251 02:33:39,800 --> 02:33:46,640 PROCESS OF DOING THE ANALYSIS OF 3252 02:33:46,640 --> 02:33:48,120 THAT INFORMATION. 3253 02:33:48,120 --> 02:33:49,960 >> THERE'S ONE MORE QUESTION BUT 3254 02:33:49,960 --> 02:33:50,840 IN THE INTEREST OF TIME MAYBE 3255 02:33:50,840 --> 02:33:52,200 YOU CAN BOTH TYPE THE ANSWER TO 3256 02:33:52,200 --> 02:33:54,440 THAT ONE AND WE CAN MOVE ON TO 3257 02:33:54,440 --> 02:33:56,800 OUR NEXT SPEAKER SO THANK YOU 3258 02:33:56,800 --> 02:33:57,280 BOTH VERY MUCH FOR YOUR 3259 02:33:57,280 --> 02:33:57,600 PRESENTATION. 3260 02:33:57,600 --> 02:34:00,680 >> THANK YOU. 3261 02:34:00,680 --> 02:34:02,760 >> THE NEXT PRESENTER IS 3262 02:34:02,760 --> 02:34:07,760 DR. EMILY HARVILLE FROM TULANE 3263 02:34:07,760 --> 02:34:08,120 UNIVERSITY. 3264 02:34:08,120 --> 02:34:09,520 A PUBLIC HEALTH EXPOSOME 3265 02:34:09,520 --> 02:34:17,720 APPROACH TO MATERNAL MORTALITY. 3266 02:34:17,720 --> 02:34:18,600 >> CAN YOU HEAR ME? 3267 02:34:18,600 --> 02:34:19,920 >> YES. 3268 02:34:19,920 --> 02:34:21,760 >> AND YOU SEE MY SLIDES? 3269 02:34:21,760 --> 02:34:22,200 >> YES. 3270 02:34:22,200 --> 02:34:26,680 >> THANK YOU FOR INVITING US TO 3271 02:34:26,680 --> 02:34:31,280 PRESENT TODAY. 3272 02:34:31,280 --> 02:34:36,120 I'LL BE SPEAK ON PUBLIC HEALTH 3273 02:34:36,120 --> 02:34:38,760 EXPOSOME APPROACH TO MATERNAL 3274 02:34:38,760 --> 02:34:39,000 MORTALITY. 3275 02:34:39,000 --> 02:34:40,840 AIM OF THE PARENT GRANT WAS TO 3276 02:34:40,840 --> 02:34:45,000 LOOK AT SOCIAL CONTEXTS THAT 3277 02:34:45,000 --> 02:34:47,600 INCREASE THE RISK FOR PREGNANCY 3278 02:34:47,600 --> 02:34:49,600 RELATED MORTALITY AND PREGNANCY 3279 02:34:49,600 --> 02:34:51,440 RELATED HOMICIDE AND THE AIM WAS 3280 02:34:51,440 --> 02:34:55,760 TO USE AN EXPOSOME WIDE 3281 02:34:55,760 --> 02:34:58,720 COMPUTATIONAL APPROACH FOR 3282 02:34:58,720 --> 02:34:59,800 PREDICTORS OF MATERNAL MORTALITY 3283 02:34:59,800 --> 02:35:03,000 FOR BOTH THE UNITED STATES AS A 3284 02:35:03,000 --> 02:35:13,000 WHOLE AND LOUISIANA. 3285 02:35:13,000 --> 02:35:16,640 AND SO TO IDENTIFY POSSIBLE 3286 02:35:16,640 --> 02:35:18,640 POINTS OF INTERVENTION THAT 3287 02:35:18,640 --> 02:35:20,720 OCCURRED CLINICALLY AND AT 3288 02:35:20,720 --> 02:35:22,680 PLACES, POLICY AND SOCIETAL 3289 02:35:22,680 --> 02:35:28,680 STRUCTURES. 3290 02:35:28,680 --> 02:35:31,680 DEALING WITH THE EXPOSURES 3291 02:35:31,680 --> 02:35:32,840 REQUIRES INNOVATION IN 3292 02:35:32,840 --> 02:35:33,160 METHODOLOGY. 3293 02:35:33,160 --> 02:35:35,360 WE'RE DRAWING ON A DATA SOURCE 3294 02:35:35,360 --> 02:35:37,200 WHICH IS CALLED THE PUBLIC 3295 02:35:37,200 --> 02:35:40,360 HEALTH EXPOSOME AND THIS IS A 3296 02:35:40,360 --> 02:35:42,680 DATA REPOSITORY OF VARIABLES GEO 3297 02:35:42,680 --> 02:35:46,240 GEOCODE AND HARMONIZED AT A 3298 02:35:46,240 --> 02:35:52,480 COUNTY LEVEL AND 6500 ARE FROM 3299 02:35:52,480 --> 02:35:54,600 2014 TO 2018 AND THEY'RE TAKEN 3300 02:35:54,600 --> 02:35:56,080 FROM FIVE DOMAINS. 3301 02:35:56,080 --> 02:35:57,760 WE HAVE THE NATIONAL 3302 02:35:57,760 --> 02:35:58,600 ENVIRONMENTS THAT INCLUDES 3303 02:35:58,600 --> 02:36:03,120 THINGS LIKE CLIMATE, WATER, 3304 02:36:03,120 --> 02:36:05,160 POLLUTION, HEAT, AIR. 3305 02:36:05,160 --> 02:36:06,640 WE HAVE THE BUILT ENVIRONMENT 3306 02:36:06,640 --> 02:36:12,480 THAT'S LAND USE AND BUILDINGS, 3307 02:36:12,480 --> 02:36:13,040 TRANSPORTATION AS WELL AS 3308 02:36:13,040 --> 02:36:17,800 CERTAIN HOUSING TERMS AND SOCIAL 3309 02:36:17,800 --> 02:36:18,400 ENVIRONMENT, ECONOMICS AND 3310 02:36:18,400 --> 02:36:20,520 POVERTY AND SO FORTH AND THE 3311 02:36:20,520 --> 02:36:22,680 POLICY ENVIRONMENT IN THIS CASE 3312 02:36:22,680 --> 02:36:26,680 IS PRIMARILY GOVERNMENT 3313 02:36:26,680 --> 02:36:31,160 EXPENDITURES AND BENEFIT TERMS 3314 02:36:31,160 --> 02:36:34,280 AND HEALTH CARE AVAILABILITY AND 3315 02:36:34,280 --> 02:36:34,680 OUTCOMES. 3316 02:36:34,680 --> 02:36:36,360 WE HYPOTHESIZED THE COMBINATION 3317 02:36:36,360 --> 02:36:39,080 OF BEING EXPOSED TO ALL THESE 3318 02:36:39,080 --> 02:36:40,880 DOMAINS OVER TIME AFFECTS THE 3319 02:36:40,880 --> 02:36:44,800 RISK OF DEATH DURING PREGNANCY 3320 02:36:44,800 --> 02:36:47,000 AND POSTPARTUM AND DIFFERENTIAL 3321 02:36:47,000 --> 02:36:50,520 EXPOSURES TO THE EXPOSOME 3322 02:36:50,520 --> 02:36:52,400 PRODUCE MATERNAL POPULATION 3323 02:36:52,400 --> 02:36:53,480 BASED HEALTH INEQUITIES. 3324 02:36:53,480 --> 02:36:56,040 SO FOR OUR ANALYSIS FOR THE 3325 02:36:56,040 --> 02:36:58,640 NATIONAL LEVEL WE'RE USING THE 3326 02:36:58,640 --> 02:37:00,600 PREGNANCY RELATED DEATHS FILES 3327 02:37:00,600 --> 02:37:04,800 FROM NCHS FROM 2015 TO 2018 AND 3328 02:37:04,800 --> 02:37:07,120 FOR LOUISIANA USING VITAL 3329 02:37:07,120 --> 02:37:10,400 RECORDS DATA WITH VERIFIED 3330 02:37:10,400 --> 02:37:14,600 MATERNAL DEATHS 2016 TO 2018 AND 3331 02:37:14,600 --> 02:37:27,360 FOR LOUISIANA WE HAVE DATA. 3332 02:37:27,360 --> 02:37:31,040 I'LL GIVE A SIMPLIFIED OVERVIEW 3333 02:37:31,040 --> 02:37:34,640 OF WHAT THE METHODS LOOK LIKE. 3334 02:37:34,640 --> 02:37:38,640 WE START WITH A HETEROGENEOUS 3335 02:37:38,640 --> 02:37:40,840 SOURCE OF DATA AND THERE'S 3336 02:37:40,840 --> 02:37:43,200 HIGHLY CORRELATED VARIABLES AND 3337 02:37:43,200 --> 02:37:46,200 WE DEVELOPED AN ALGORITHM TO 3338 02:37:46,200 --> 02:37:46,800 REDUCE CORRELATES WITHIN THE 3339 02:37:46,800 --> 02:37:50,560 DATA SET. 3340 02:37:50,560 --> 02:37:53,640 THEN WE GROUP IT IN VARIOUS 3341 02:37:53,640 --> 02:37:54,800 WAYS. 3342 02:37:54,800 --> 02:38:01,280 CORRELATION MATRICES AND GRAPHS. 3343 02:38:01,280 --> 02:38:05,960 BROADLY WE HAVE THE SUPERVISED 3344 02:38:05,960 --> 02:38:08,040 ANALYSIS AND WHERE UNSUPERVISED 3345 02:38:08,040 --> 02:38:11,400 AND WE LOOK AT WHICH GROUPS HAVE 3346 02:38:11,400 --> 02:38:13,160 MATERNAL MORTALITY IN THEM. 3347 02:38:13,160 --> 02:38:18,320 ONCE WE HAVE THE GROUPS WE PULL 3348 02:38:18,320 --> 02:38:25,200 OUT SUBSETS AND CAN APPLY MODEL 3349 02:38:25,200 --> 02:38:25,800 ORG REGRESSION OF ANALYSIS TO 3350 02:38:25,800 --> 02:38:36,080 OUR RESULTS. 3351 02:38:36,080 --> 02:38:39,440 ONE THING WE NOTICED IS THAT THE 3352 02:38:39,440 --> 02:38:45,560 DATA SET WAS DRAWN FROM A WHOLE 3353 02:38:45,560 --> 02:38:47,800 BUNCH OF PLACES AND FACTORS 3354 02:38:47,800 --> 02:38:48,960 ASSOCIATED COME FROM A WIDE 3355 02:38:48,960 --> 02:38:50,680 VARIETY OF SOURCES. 3356 02:38:50,680 --> 02:38:55,400 SO WE HAVE NATIONAL STATISTICS 3357 02:38:55,400 --> 02:38:57,920 AND BEHAVIORAL RISK FACTORS, 3358 02:38:57,920 --> 02:38:59,600 SMOKING, POOR HEALTH OR LACK OF 3359 02:38:59,600 --> 02:39:00,400 SLEEP. 3360 02:39:00,400 --> 02:39:02,920 FOR THE CENSUS WE HAVE POVERTY. 3361 02:39:02,920 --> 02:39:04,400 FROM THE DIABETES SURVEILLANCE 3362 02:39:04,400 --> 02:39:12,600 WE HAVE LACK OF LEISURE TIME 3363 02:39:12,600 --> 02:39:24,000 ACTIVITY AND FROM ATSCR AND WE 3364 02:39:24,000 --> 02:39:26,840 HAVE TEENAGE PREGNANCY. 3365 02:39:26,840 --> 02:39:28,400 FROM HOUSING DEVELOPMENT WE HAVE 3366 02:39:28,400 --> 02:39:31,360 INCOME AND FROM THE LAND USE 3367 02:39:31,360 --> 02:39:35,600 DATA WE HAVE EXTREME HEAT. 3368 02:39:35,600 --> 02:39:37,320 ONCE WE HAVE A SET OF VARIABLES 3369 02:39:37,320 --> 02:39:39,640 WE CAN INCORPORATE THEM INTO A 3370 02:39:39,640 --> 02:39:41,400 GRAPH THAT LOOKS LIKE THIS 3371 02:39:41,400 --> 02:39:42,440 BECAUSE THEY'RE HIGHLY 3372 02:39:42,440 --> 02:39:43,640 CORRELATED WITH EACH OTHER AND 3373 02:39:43,640 --> 02:39:46,680 THEN WE CAN DO THINGS LIKE 3374 02:39:46,680 --> 02:39:48,120 ANALYSIS AND THEN HERE WHAT WE 3375 02:39:48,120 --> 02:39:50,680 SEE IS THE THREE FACTORS THAT 3376 02:39:50,680 --> 02:39:54,720 WERE DIRECTLY UPSTREAM PREDICT 3377 02:39:54,720 --> 02:39:55,560 PREDICTORS AFTER THE COUNTY 3378 02:39:55,560 --> 02:39:58,960 LEVEL WERE OVERALL YEARS OF 3379 02:39:58,960 --> 02:40:02,640 POTENTIAL LIFE LOFT AND LACK OF 3380 02:40:02,640 --> 02:40:05,080 PHYSICAL ACTIVITY AND EXTREME 3381 02:40:05,080 --> 02:40:05,640 HEAT. 3382 02:40:05,640 --> 02:40:14,400 IF WE MOVE TO OUR UNSUPERVISED 3383 02:40:14,400 --> 02:40:16,920 ANALYSIS FINDING CLUSTERS IN 3384 02:40:16,920 --> 02:40:21,480 VARIES WAYS THE CLUSTER THAT 3385 02:40:21,480 --> 02:40:22,800 CONTAINS THE MATERNAL MORTALITY 3386 02:40:22,800 --> 02:40:25,200 THE FIRST THING IS IT CONTAINED 3387 02:40:25,200 --> 02:40:29,120 ALL THE MATERNAL MORTALITY 3388 02:40:29,120 --> 02:40:30,240 VARIABLES. 3389 02:40:30,240 --> 02:40:32,320 OVERALL AS WELL AS THE ETHNIC 3390 02:40:32,320 --> 02:40:33,520 VARIABLES THEY CAME INTO A 3391 02:40:33,520 --> 02:40:34,320 SINGLE GROUP. 3392 02:40:34,320 --> 02:40:35,640 WE NOTICED THE VARIABLES THAT 3393 02:40:35,640 --> 02:40:40,160 SEEMED TO CLUSTER COME FROM 3394 02:40:40,160 --> 02:40:41,160 DIFFERENT DOMAINS. 3395 02:40:41,160 --> 02:40:43,160 BLUE FROM THE BUILT ENVIRONMENT, 3396 02:40:43,160 --> 02:40:44,280 PURPLE FROM THE HEALTH AND 3397 02:40:44,280 --> 02:40:45,360 HEALTH CARE AND YELLOW FROM THE 3398 02:40:45,360 --> 02:40:46,720 NATURAL AND RED FROM THE SOCIAL 3399 02:40:46,720 --> 02:40:49,880 ENVIRONMENT. 3400 02:40:49,880 --> 02:40:52,880 THESE FACTORS ARE ALL THE 3401 02:40:52,880 --> 02:40:54,720 DOMAINS ARE CLUSTERING WITH 3402 02:40:54,720 --> 02:41:03,040 MATERNAL MORTALITY. 3403 02:41:03,040 --> 02:41:04,240 WE CAN DEAL WITH THIS DATA IN 3404 02:41:04,240 --> 02:41:04,720 TWO WAYS. 3405 02:41:04,720 --> 02:41:07,600 WE CAN DO A SIMILAR ANALYSIS AS 3406 02:41:07,600 --> 02:41:10,240 WE GET TO THE NATURAL LEVEL WITH 3407 02:41:10,240 --> 02:41:11,800 THE WHOLE PUBLIC HEALTH EXPOSOME 3408 02:41:11,800 --> 02:41:14,760 AND APPLY IT TO MULTI-LEVEL OR 3409 02:41:14,760 --> 02:41:15,640 INDIVIDUAL LEVEL DATA. 3410 02:41:15,640 --> 02:41:18,520 THE SECOND THING WE CAN DO IS 3411 02:41:18,520 --> 02:41:20,000 TAKE RESULTS FROM THE NATIONAL 3412 02:41:20,000 --> 02:41:21,800 LEVEL AND APPLY THEM WITH 3413 02:41:21,800 --> 02:41:22,720 ADDITIONAL CONTROL FOR 3414 02:41:22,720 --> 02:41:26,600 CONFOUNDING. 3415 02:41:26,600 --> 02:41:28,440 THESE ARE ONGOING BUT IF WE LOOK 3416 02:41:28,440 --> 02:41:31,880 AT THE NATIONAL LEVEL DATA WE 3417 02:41:31,880 --> 02:41:36,520 SEE SPECTRAL IRRADIANTS 3418 02:41:36,520 --> 02:41:38,600 BASICALLY SUN EXPOSURE IS 3419 02:41:38,600 --> 02:41:39,640 CORRELATED WITH PREGNANCY 3420 02:41:39,640 --> 02:41:41,760 RELATED MORTALITY BUT HIGHER IN 3421 02:41:41,760 --> 02:41:42,800 LOUISIANA ESPECIALLY IF WE 3422 02:41:42,800 --> 02:41:48,880 REMOVE OUTLIERS. 3423 02:41:48,880 --> 02:41:54,480 IF WE LOOK AT RESULTS FROM THE 3424 02:41:54,480 --> 02:41:58,400 NATIONAL LEVEL DATA WE'RE ABLE 3425 02:41:58,400 --> 02:42:02,960 TO LOOK AT CONFOUNDERS AND 3426 02:42:02,960 --> 02:42:05,160 CONTINUE TO SEE ASSOCIATIONS 3427 02:42:05,160 --> 02:42:07,440 WITH POTENTIAL YEARS OF LIFE 3428 02:42:07,440 --> 02:42:10,680 LOSS AND HEALTHY FOOD AND 3429 02:42:10,680 --> 02:42:14,360 ENVIRONMENT. 3430 02:42:14,360 --> 02:42:18,760 WE'RE WORKING WITH A NATIONAL 3431 02:42:18,760 --> 02:42:20,160 DATA SET WE ARE DOING COUNTY 3432 02:42:20,160 --> 02:42:20,960 LEVEL CORRELATIONS. 3433 02:42:20,960 --> 02:42:23,400 THE ABSOLUTE NUMBERS OF MATERNAL 3434 02:42:23,400 --> 02:42:25,160 DEATHS ARE SMALL AND THE RATES 3435 02:42:25,160 --> 02:42:28,800 CAN BE UNSTABLE. 3436 02:42:28,800 --> 02:42:33,200 WE STILL HAVE A FAIR NUMBER OF 3437 02:42:33,200 --> 02:42:38,200 AUTOCORRELATED VARIABLES AND 3438 02:42:38,200 --> 02:42:43,360 REREDUCED IT BY HALF BUT IN THE 3439 02:42:43,360 --> 02:42:44,800 POLICY ENVIRONMENT WE ONLY HAVE 3440 02:42:44,800 --> 02:42:46,240 BENEFITS AND GOVERNMENT 3441 02:42:46,240 --> 02:42:46,600 EXPENDITURES. 3442 02:42:46,600 --> 02:42:48,000 THERE'S A WIDE RANGE OF POLICY 3443 02:42:48,000 --> 02:42:48,640 THAT COULD BE INCLUDED THAT'S 3444 02:42:48,640 --> 02:42:52,920 NOT HERE. 3445 02:42:52,920 --> 02:42:57,360 TO CONCLUDE, WHAT WE DETERMINED 3446 02:42:57,360 --> 02:43:03,280 IF THECONTEXTUAL FACTORS 3447 02:43:03,280 --> 02:43:06,840 CONTRIBUTE TO MORTALITY AND THE 3448 02:43:06,840 --> 02:43:08,440 IDEA MATERNAL MORTALITY 3449 02:43:08,440 --> 02:43:09,920 CORRELATES WITH OVERALL 3450 02:43:09,920 --> 02:43:11,120 POPULATION HEALTH AND IT'S NOT A 3451 02:43:11,120 --> 02:43:17,840 SEPARATE PHENOMENON FROM ALL THE 3452 02:43:17,840 --> 02:43:19,200 FACTORS THAT PREDICT MATERNAL 3453 02:43:19,200 --> 02:43:19,960 HEALTH. 3454 02:43:19,960 --> 02:43:22,360 THE DATA-DRIVEN COMPUTATIONAL 3455 02:43:22,360 --> 02:43:24,080 METHODS CAN BE HELPFUL FOR 3456 02:43:24,080 --> 02:43:25,840 ADDRESSING THE REAL WORLD 3457 02:43:25,840 --> 02:43:27,200 CLEMENT AND THERE'S A NEED FOR 3458 02:43:27,200 --> 02:43:34,000 METHODS AND ANALYTICS AND THAT 3459 02:43:34,000 --> 02:43:42,640 OUR RESULTS WERE DRAWN FROM 3460 02:43:42,640 --> 02:43:46,920 DIFFERENT DATA SOURCE USED TO 3461 02:43:46,920 --> 02:43:49,280 ADDRESS AND IMPROVE THE PROB. 3462 02:43:49,280 --> 02:43:55,880 I PUT UP THE CONTACT INFORMATION 3463 02:43:55,880 --> 02:43:58,080 FOR VARIOUS PEOPLE. 3464 02:43:58,080 --> 02:43:59,320 IF YOU HAVE INTEREST PLEASE GET 3465 02:43:59,320 --> 02:44:02,640 IN TOUCH AND I'D BE HAPPY TO 3466 02:44:02,640 --> 02:44:04,520 TAKE ANY QUESTIONS. 3467 02:44:04,520 --> 02:44:09,880 >> I DON'T SEE QUESTIONS SO FAR 3468 02:44:09,880 --> 02:44:12,600 IN THE CHAT SO ONE QUESTION IS 3469 02:44:12,600 --> 02:44:14,280 HOW DO YOU TRANSLATE FINDINGS 3470 02:44:14,280 --> 02:44:16,920 FROM THE COMPUTATIONAL MODELS 3471 02:44:16,920 --> 02:44:18,400 INTO POLICY CHANGE? 3472 02:44:18,400 --> 02:44:21,080 HAVE YOU WORKED WITH, PARTNERED, 3473 02:44:21,080 --> 02:44:22,200 COMMUNICATIONS WITH POLICY 3474 02:44:22,200 --> 02:44:28,280 MAKERS AROUND YOUR FINDINGS? 3475 02:44:28,280 --> 02:44:30,600 >> OUR FINDINGS ARE PRELIMINARY 3476 02:44:30,600 --> 02:44:36,840 AT THIS PART BUT IT IS 3477 02:44:36,840 --> 02:44:40,840 INSTRUCTIVE TO LOOK AT POVERTY 3478 02:44:40,840 --> 02:44:42,200 OR MAKE IT CLEAR THERE'S 3479 02:44:42,200 --> 02:44:43,840 ATTENTION ON MATERNAL MORTALITY 3480 02:44:43,840 --> 02:44:49,040 BUT IT'S PART OF A BROADER 3481 02:44:49,040 --> 02:44:53,960 SOCIAL FACTOR AND THEY'RE 3482 02:44:53,960 --> 02:44:54,600 SOCIETY WIDE PROBLEMS NOTE JUST 3483 02:44:54,600 --> 02:45:04,200 ADDRESSED AT THE HOSPITAL. 3484 02:45:04,200 --> 02:45:08,520 >> A RELATED ISSUE, THERE HASN'T 3485 02:45:08,520 --> 02:45:10,600 BEEN THAT MUCH IN THIS COUNTRY 3486 02:45:10,600 --> 02:45:15,000 LOOKING AT THE IMPACT OF CLIMATE 3487 02:45:15,000 --> 02:45:20,800 CHANGE ON MORBIDITY. 3488 02:45:20,800 --> 02:45:25,600 CAN YOU SPEAK TO THAT. 3489 02:45:25,600 --> 02:45:27,840 >> WE CAME AT IT EXPECTING TO 3490 02:45:27,840 --> 02:45:29,240 SEE POVERTY AND TO SEE HEAT POP 3491 02:45:29,240 --> 02:45:31,120 UP SO MANY TIMES IN OUR ANALYSIS 3492 02:45:31,120 --> 02:45:36,040 WAS SOMETHING THAT WAS STRIKE 3493 02:45:36,040 --> 02:45:42,600 AND WORRISOME GIVEN THE TRENDS. 3494 02:45:42,600 --> 02:45:45,440 IT'S DIFFICULT WITH THE NUMBERS 3495 02:45:45,440 --> 02:45:51,440 BUT WANT TO CONTINUE LOOKING AT 3496 02:45:51,440 --> 02:45:56,240 THAT AND SOME SAY IT'S BECAUSE 3497 02:45:56,240 --> 02:45:57,560 IT'S THE SOUTH AND THE HUGE HAS 3498 02:45:57,560 --> 02:45:59,400 WORSE OUTCOMES AND WE WANTED TO 3499 02:45:59,400 --> 02:46:01,800 LOOK AT PICKING UP RESIDUAL OR 3500 02:46:01,800 --> 02:46:02,480 CONFOUNDING BUT IT'S INTERESTING 3501 02:46:02,480 --> 02:46:09,800 THAT CAME UP SEVERAL TIMES. 3502 02:46:09,800 --> 02:46:12,280 WHEN WE DID THE ANALYSIS. 3503 02:46:12,280 --> 02:46:13,200 >> THANK YOU. 3504 02:46:13,200 --> 02:46:15,760 IS ANALYSES LIKE THIS IN MOST 3505 02:46:15,760 --> 02:46:17,480 PARTS OR DOES LOUISIANA HAVE 3506 02:46:17,480 --> 02:46:22,680 OVERLAP OF THE GREAT DATA 3507 02:46:22,680 --> 02:46:22,920 SOURCES? 3508 02:46:22,920 --> 02:46:31,200 >> WE ARE ABLE TO LOOK AT THE 3509 02:46:31,200 --> 02:46:36,040 MULTI-LEVEL COMPONENT AND YES 3510 02:46:36,040 --> 02:46:45,240 MOST OF THE COUNTRY MOST LOOK AT 3511 02:46:45,240 --> 02:46:47,520 THE COUNTRY AND WE LOOKED AT OUR 3512 02:46:47,520 --> 02:46:49,640 ANALYSIS TO COUNTIES WITH AT 3513 02:46:49,640 --> 02:46:52,400 LEAST 1,000 BIRTHS SO OUR RATES 3514 02:46:52,400 --> 02:46:53,800 ARE A LITTLE MORE STABLE SO THAT 3515 02:46:53,800 --> 02:46:58,920 MEANS THERE'S CERTAIN PARTS OF 3516 02:46:58,920 --> 02:47:00,760 LIKE UPPER MIDWEST THAT DON'T 3517 02:47:00,760 --> 02:47:01,600 HAVE ENOUGH PEOPLE TO GET GOOD 3518 02:47:01,600 --> 02:47:08,120 ANALYSIS. 3519 02:47:08,120 --> 02:47:13,920 >> SO YOU SHOW THE APPLICATION 3520 02:47:13,920 --> 02:47:19,000 TO LOUISIANA -- DOES THAT 3521 02:47:19,000 --> 02:47:25,160 PROFILE LOOK SIMILAR TO OTHER 3522 02:47:25,160 --> 02:47:25,680 STATES IN THE SOUTH? 3523 02:47:25,680 --> 02:47:31,600 >> LOUISIANA GENERALLY HAS 3524 02:47:31,600 --> 02:47:33,160 POORER HEALTH OUTCOMES OVERALL 3525 02:47:33,160 --> 02:47:34,600 SO IT'S PROBABLY AT THE BOTTOM 3526 02:47:34,600 --> 02:47:36,760 FOR SOME OF THIS STUFF. 3527 02:47:36,760 --> 02:47:39,680 I SUSPECT MANY FACTORS WOULD BE 3528 02:47:39,680 --> 02:47:41,720 SIMILAR BUT I'D BE HAPPY DISCUSS 3529 02:47:41,720 --> 02:47:42,480 IT WITH ANYONE WHO HAS DATA IN 3530 02:47:42,480 --> 02:47:50,280 MORE DETAIL. 3531 02:47:50,280 --> 02:47:51,160 >> GREAT. 3532 02:47:51,160 --> 02:47:53,080 I DON'T SEE ADDITIONAL 3533 02:47:53,080 --> 02:47:53,600 QUESTIONS. 3534 02:47:53,600 --> 02:47:54,720 WE CAN MOVE ON. 3535 02:47:54,720 --> 02:47:59,600 THERE'S A QUESTION IN THE CHAT 3536 02:47:59,600 --> 02:48:02,640 ABOUT IS THERE A SEASONAL 3537 02:48:02,640 --> 02:48:05,160 PATTERN GIVEN EXTREME HEAT 3538 02:48:05,160 --> 02:48:05,800 MORTALITY. 3539 02:48:05,800 --> 02:48:10,640 >> I DON'T KNOW THE ANSWER 3540 02:48:10,640 --> 02:48:17,600 ACTUALLY GIVEN THE RARITY. 3541 02:48:17,600 --> 02:48:18,760 >> THANK YOU VERY MUCH. 3542 02:48:18,760 --> 02:48:27,280 >> THANK YOU. 3543 02:48:27,280 --> 02:48:29,000 NEXT WE HAVE DR. WAGNER THERE 3544 02:48:29,000 --> 02:48:32,400 THE UNIVERSITY OF SOUTH CAROLINA 3545 02:48:32,400 --> 02:48:37,880 UNDERSTANDING MATERNAL VITAMIN D 3546 02:48:37,880 --> 02:48:38,720 DEFICIENCY IN RURAL WOMEN IN 3547 02:48:38,720 --> 02:48:44,280 SOUTH CAROLINA. 3548 02:48:44,280 --> 02:48:59,400 WHAT WE'RE GOING TO DISCUSS THIS 3549 02:48:59,400 --> 02:49:05,400 AND OTHER THAN OUR GRANT FUNDING 3550 02:49:05,400 --> 02:49:06,840 NO OTHER DISCLOSURES. 3551 02:49:06,840 --> 02:49:10,520 SO WHO IS AT RISK FOR VITAMIN D 3552 02:49:10,520 --> 02:49:13,000 DEFICIENCY AND WHY'S IT MATTER? 3553 02:49:13,000 --> 02:49:16,960 RELEVANT TO THIS TOPIC IS THAT 3554 02:49:16,960 --> 02:49:23,280 UNDER REPRESENTED MINORITIES 3555 02:49:23,280 --> 02:49:24,800 INCLUDING AFRICAN AMERICANS HAVE 3556 02:49:24,800 --> 02:49:28,200 THE HIGHEST RISK OF MATERNAL 3557 02:49:28,200 --> 02:49:28,560 COMPLICATIONS. 3558 02:49:28,560 --> 02:49:35,800 SO VITAMIN D IS A STEROID 3559 02:49:35,800 --> 02:49:37,400 HORMONE AND UNLIKE THE OTHERS IN 3560 02:49:37,400 --> 02:49:40,520 OUR BODY WE CAN MAKE 3561 02:49:40,520 --> 02:49:44,160 ENDOGENOUSLY VITAMIN D IS 3562 02:49:44,160 --> 02:49:46,600 DEPENDENT ON SYNTHESIS DEPENDENT 3563 02:49:46,600 --> 02:49:51,280 ON SUNLIGHT EXPOSURE TO OUR 3564 02:49:51,280 --> 02:49:51,480 SKIN. 3565 02:49:51,480 --> 02:49:53,240 IT'S CERTAINLY THE DARKER THE 3566 02:49:53,240 --> 02:49:55,320 PIGMENT THE MORE SUNLIGHT YOU 3567 02:49:55,320 --> 02:49:55,520 NEED. 3568 02:49:55,520 --> 02:49:59,720 WITH MODERN DAY LIVING WE HAVE 3569 02:49:59,720 --> 02:50:01,560 CERTAINLY GREATER RISK OF 3570 02:50:01,560 --> 02:50:01,840 DEFICIENCY. 3571 02:50:01,840 --> 02:50:04,760 THERE'S SEARCH STUDIES FROM 3572 02:50:04,760 --> 02:50:06,720 AROUND THE WORLD THAT SUGGEST 3573 02:50:06,720 --> 02:50:14,080 THERE'S BENEFITS OF VITAMIN D 3574 02:50:14,080 --> 02:50:18,400 SUPPLEMENTATION AND SUSTAIN IT'S 3575 02:50:18,400 --> 02:50:21,360 ASSOCIATED WITH THE RISK OF 3576 02:50:21,360 --> 02:50:27,040 PREECLAMPSIA AND C SECTION AND 3577 02:50:27,040 --> 02:50:31,720 WHEN WE LOOKED AT THIS NOW MORE 3578 02:50:31,720 --> 02:50:35,160 THAN A DECADE AGO IN SUNNY SOUTH 3579 02:50:35,160 --> 02:50:36,880 CAROLINA, WHAT WE FOUND IF YOU 3580 02:50:36,880 --> 02:50:39,160 WOULD LOOK USING THE INSTITUTE 3581 02:50:39,160 --> 02:50:44,040 OF MEDICINE'S DEFINITION LESS 3582 02:50:44,040 --> 02:50:51,080 THAN 20 NANOGRAMS PER ML IN 3583 02:50:51,080 --> 02:50:53,040 ORANGE YOU WILL SEE THAT GREATER 3584 02:50:53,040 --> 02:50:55,600 THAN 75% OF OUR BLACK AMERICAN 3585 02:50:55,600 --> 02:50:58,720 WOMEN, 33% OF OUR HISPANIC WOMEN 3586 02:50:58,720 --> 02:51:02,720 AND 22% OF OUR WHITE WOMEN MET 3587 02:51:02,720 --> 02:51:04,840 THE DEFINITION OF VITAMIN D 3588 02:51:04,840 --> 02:51:13,360 DEEFFICIENT -- DEFICIENCY AND 3589 02:51:13,360 --> 02:51:14,760 YOU SEE THIS A SIGNIFICANT 3590 02:51:14,760 --> 02:51:17,800 AMOUNT AND MORE THAN 50% MET THE 3591 02:51:17,800 --> 02:51:28,400 DEFINITION OF DEFICIENCY AND IF 3592 02:51:28,400 --> 02:51:34,000 YOU LOOK A DECADE LATER WE SEE 3593 02:51:34,000 --> 02:51:36,520 THAT BECAUSE OF OUR REGIONAL 3594 02:51:36,520 --> 02:51:41,680 MESSAGE WE FIND LESS DE FIFICIENCY 3595 02:51:41,680 --> 02:51:44,280 BUT IN RURAL AREAS IT REMAINS 3596 02:51:44,280 --> 02:51:44,800 HIGH. 3597 02:51:44,800 --> 02:51:47,160 IN OUR STUDIES WE BLIND BLACK 3598 02:51:47,160 --> 02:51:48,600 AMERICAN AND HISPANIC WOMEN ARE 3599 02:51:48,600 --> 02:51:50,680 THE MOST AFFECTED. 3600 02:51:50,680 --> 02:51:54,760 VIRTUALLY ALL INFANTS I'M A 3601 02:51:54,760 --> 02:51:56,800 NEONATOLOGIST ADMITTED TO OUR 3602 02:51:56,800 --> 02:51:58,400 INTENSIVE CARE UNIT WHO ARE 3603 02:51:58,400 --> 02:52:00,720 BLACK AMERICAN HAVE NOT ONLY 3604 02:52:00,720 --> 02:52:04,920 VITAMIN D DEFICIENCY BUT SEVERE 3605 02:52:04,920 --> 02:52:09,000 VITAMIN D DEFICIENCY LESS THAN 3606 02:52:09,000 --> 02:52:10,280 10 NANOGRAMS WE ARE ML. 3607 02:52:10,280 --> 02:52:14,200 WE DID A FIELD TRIAL BETWEEN 3608 02:52:14,200 --> 02:52:20,000 2015 AND 2017 DOING VITAMIN D 3609 02:52:20,000 --> 02:52:21,840 SCREENING AND SUPPLEMENTATION. 3610 02:52:21,840 --> 02:52:26,760 WHAT YOU CAN SEE WITH GESTATION 3611 02:52:26,760 --> 02:52:29,400 GESTATIONAL WEEKS AT BIRTH AND 3612 02:52:29,400 --> 02:52:33,680 CLOSEST TO DELIVERY ON THE Y 3613 02:52:33,680 --> 02:52:39,960 AXIS GESTATION AND 25OHD WE 3614 02:52:39,960 --> 02:52:44,960 LOOKED AT ALMOST 2,000 WOMEN AND 3615 02:52:44,960 --> 02:52:48,440 LOOKED AT 480 WOMEN WHO HAD 3616 02:52:48,440 --> 02:52:50,400 INITIAL 25HG LESS THAN 20 AND IN 3617 02:52:50,400 --> 02:52:57,040 OUR RANDOMIZED CONTROL TRIALS. 3618 02:52:57,040 --> 02:53:00,200 THERE'S A CAUGHT POINT WHERE THE 3619 02:53:00,200 --> 02:53:04,400 RISK OF PRE-TERM BIRTH IS LEFT 3620 02:53:04,400 --> 02:53:06,600 AND AT THE EXTREMES WITH LESS 3621 02:53:06,600 --> 02:53:13,840 THAN 20 YOU SEE MUCH LOWER 3622 02:53:13,840 --> 02:53:22,520 GESTATIONAL AGE. 3623 02:53:22,520 --> 02:53:25,000 IN THIS ENGAGEMENT GRANT OUR 3624 02:53:25,000 --> 02:53:26,800 OVER ARCHING GOAL WAS TO 3625 02:53:26,800 --> 02:53:28,520 UNDERSTAND MATERNAL AND HEALTH 3626 02:53:28,520 --> 02:53:32,240 CARE PROFESSIONAL ATTITUDES AND 3627 02:53:32,240 --> 02:53:36,000 BELIEFS ABOUT VITAMIN D 3628 02:53:36,000 --> 02:53:38,560 DEFICIENCY IN A RURAL PORTION 3629 02:53:38,560 --> 02:53:42,720 AND WE HAD TWO ACTIVE 3630 02:53:42,720 --> 02:53:43,760 OBSTETRICAL PRACTICES AND HAVE 3631 02:53:43,760 --> 02:53:45,200 THREE AIMS. 3632 02:53:45,200 --> 02:53:49,160 THE FIRST WAS TO TRACK BASELINE 3633 02:53:49,160 --> 02:53:52,240 VITAMIN D DEFICIENCY LIVING 3634 02:53:52,240 --> 02:53:53,640 THROUGH ELECTRONIC MEDICAL 3635 02:53:53,640 --> 02:53:56,200 RECORDS TO DOCUMENT SEVERITY OF 3636 02:53:56,200 --> 02:54:00,600 THE PROBLEM AND RATES AND 3637 02:54:00,600 --> 02:54:03,840 PREGNANCY OUTCOMES AND PERFORMED 3638 02:54:03,840 --> 02:54:24,840 INTERVIEWS ANDIME IMPLEMENTING AND 3639 02:54:24,840 --> 02:54:26,600 SOUGHT WHO WERE AT GREATEST 3640 02:54:26,600 --> 02:54:27,000 RISK. 3641 02:54:27,000 --> 02:54:30,720 THE GRANT PERIOD RAN FROM 3642 02:54:30,720 --> 02:54:34,160 SEPTEMBER 20, 2020 THROUGH MARCH 3643 02:54:34,160 --> 02:54:38,600 21, 2021. 3644 02:54:38,600 --> 02:54:44,840 AND QUICKLY ALL THESE INTERVIEWS 3645 02:54:44,840 --> 02:54:47,520 WERE CONDUCTED THROUGH MICROSOFT 3646 02:54:47,520 --> 02:54:49,440 TEAMS BECAUSE OF THE AREA OF 3647 02:54:49,440 --> 02:54:52,400 COVID AND THERE WERE 3648 02:54:52,400 --> 02:54:54,800 FACILITATORS TO USING PRENATAL 3649 02:54:54,800 --> 02:54:57,640 SUPPLEMENTS AS WELL AS VITAMIN D 3650 02:54:57,640 --> 02:54:58,880 SUPPLEMENTS AND LOOK AT DECISION 3651 02:54:58,880 --> 02:55:01,520 MAKE AROUND VITAMIN D AND 3652 02:55:01,520 --> 02:55:02,200 SUPPLEMENT ADHERENCE. 3653 02:55:02,200 --> 02:55:07,000 WE ANALYZED THE DATA USING THE 3654 02:55:07,000 --> 02:55:07,720 QUALITATIVE ANALYSIS SOFTWARE 3655 02:55:07,720 --> 02:55:10,560 AND LOOKED AT RELIABILITY AND 3656 02:55:10,560 --> 02:55:14,720 VALIDITY OF ANALYSES AND 3657 02:55:14,720 --> 02:55:17,320 CONDUCTED FREQUENCY ANALYSES. 3658 02:55:17,320 --> 02:55:23,920 SO OUR ELECTRONIC HEALTH RECORD 3659 02:55:23,920 --> 02:55:27,000 OR E.H.R. DATA ANALYSIS TWLR 3660 02:55:27,000 --> 02:55:28,440 WOMEN HAVING AN INITIAL VISIT 3661 02:55:28,440 --> 02:55:31,680 BETWEEN MAY 2019 AND APRIL 2020 3662 02:55:31,680 --> 02:55:33,480 WITH SUBSEQUENT DELIVERY. 3663 02:55:33,480 --> 02:55:39,240 THERE WERE FOUR WITH MULTIPLE 3664 02:55:39,240 --> 02:55:41,960 GESTATIONS EXCLUDED AND THE 3665 02:55:41,960 --> 02:55:43,200 MAJORITY WERE BLACK AMERICAN AND 3666 02:55:43,200 --> 02:55:44,720 PUBLIC INSURANCE AND RESIDED 3667 02:55:44,720 --> 02:55:47,720 GREATER THAN 10 MILES FROM THE 3668 02:55:47,720 --> 02:55:50,040 HOSPITAL AND IN FACT 14.5% LIVED 3669 02:55:50,040 --> 02:55:52,280 MORE THAN 30 MILES AWAY. 3670 02:55:52,280 --> 02:55:54,000 THE MEAN PRENATAL VISIT NUMBER 3671 02:55:54,000 --> 02:55:56,120 WAS 10 WITH THE EXPECTED BEING 3672 02:55:56,120 --> 02:55:58,600 BETWEEN 12 AND 14 VISITS DURING 3673 02:55:58,600 --> 02:55:59,160 THE PREGNANCY. 3674 02:55:59,160 --> 02:56:00,880 VIRTUALLY ALL THE WOMEN IN THE 3675 02:56:00,880 --> 02:56:02,960 COHORT EXPERIENCED A LIVE BIRTH 3676 02:56:02,960 --> 02:56:04,880 HOWEVER, 11% OF THESE INFANTS 3677 02:56:04,880 --> 02:56:07,200 WERE PRETERM WITH A GESTATIONAL 3678 02:56:07,200 --> 02:56:08,760 AGE LESS THAN 37 WEEKS. 3679 02:56:08,760 --> 02:56:14,640 AND THEY WERE SERIOUS PREGNANCY 3680 02:56:14,640 --> 02:56:16,240 COMPLICATIONS NOT SURPRISING 3681 02:56:16,240 --> 02:56:18,120 HYPER TENSIVE DISORDERS OF 3682 02:56:18,120 --> 02:56:21,360 PREGNANCY AT 18.9%, GESTATIONAL 3683 02:56:21,360 --> 02:56:26,680 DIABETES AT 7.4% AND 3684 02:56:26,680 --> 02:56:29,560 PRE-EXISTING TYPE 2 DIABETES 3685 02:56:29,560 --> 02:56:30,640 1.1%. 3686 02:56:30,640 --> 02:56:37,200 FOCUSSING ON VITAMIN D STATUS, 3687 02:56:37,200 --> 02:56:37,920 THE INDICATOR OF VITAMIN D 3688 02:56:37,920 --> 02:56:42,160 STATUS WAS MEASURED IN 8.4% OF 3689 02:56:42,160 --> 02:56:45,600 THESE WOMEN AND 1.9% HAD AN 3690 02:56:45,600 --> 02:56:48,240 ICD10 CODE LISTED IN THE MEDICAL 3691 02:56:48,240 --> 02:57:05,800 RECORD FOR VITAMIN D DEFICIENCY. 3692 02:57:05,800 --> 02:57:14,760 57% OF THE COHORT HAD A 3693 02:57:14,760 --> 02:57:17,160 MEASUREMENT OF THIS AND IN THE 3694 02:57:17,160 --> 02:57:18,920 COHORT OF VERY AT RISK WOMEN 3695 02:57:18,920 --> 02:57:21,720 ONLY 9.1% WERE PRESCRIBED 3696 02:57:21,720 --> 02:57:26,160 VITAMIN D SUPPLEMENTATION. 3697 02:57:26,160 --> 02:57:28,400 IN THE FOCUS GROUP INTERVIEWS WE 3698 02:57:28,400 --> 02:57:36,240 HAD 400 ELIGIBLE WOMEN AND ONLY 3699 02:57:36,240 --> 02:57:41,040 9 PARTICIPATE AND OF TO THE 3700 02:57:41,040 --> 02:57:42,520 THOSE THREE PARTICIPATED IN THE 3701 02:57:42,520 --> 02:57:43,760 TWO FOCUS GROUPS. 3702 02:57:43,760 --> 02:57:45,520 REASON FOR NOT PARTICIPATING OR 3703 02:57:45,520 --> 02:57:48,520 TOO LITTLE TIME DURING THE 3704 02:57:48,520 --> 02:57:49,960 PANDEMIC ARE FUNDING DID NOT 3705 02:57:49,960 --> 02:57:52,440 ALLOW US TO HAVE A DESIGNATED 3706 02:57:52,440 --> 02:57:54,760 PERSON AT THE SITES TO RECRUIT 3707 02:57:54,760 --> 02:57:56,480 PARTICIPANTS AND WE HAD TO 3708 02:57:56,480 --> 02:57:58,400 DEPEND ON THE CLINICAL STAFF TO 3709 02:57:58,400 --> 02:58:00,720 HAND OUT STUDY FLYERS. 3710 02:58:00,720 --> 02:58:04,240 OF THOSE WHO PARTICIPATED THEIR 3711 02:58:04,240 --> 02:58:05,800 COMMENTS ABOUT VITAMIN D WAS 3712 02:58:05,800 --> 02:58:07,920 REMEMBERING WAS THE HARDEST 3713 02:58:07,920 --> 02:58:08,160 CHALLENGE. 3714 02:58:08,160 --> 02:58:10,480 SOMETIMES I FORGET ABOUT IT AND 3715 02:58:10,480 --> 02:58:13,200 DON'T SEE TANGIBLE BENEFITS. 3716 02:58:13,200 --> 02:58:15,440 NONE DESCRIBED AN IN DEPTH 3717 02:58:15,440 --> 02:58:16,960 LINKAGE BETWEEN VITAMIN D AND 3718 02:58:16,960 --> 02:58:19,000 PREGNANCY AND ONE OF THE THREE 3719 02:58:19,000 --> 02:58:21,000 FELT THERE WAS A POTENTIAL 3720 02:58:21,000 --> 02:58:21,640 ASSOCIATION BETWEEN LOW VITAMIN 3721 02:58:21,640 --> 02:58:25,640 D LEVELS AND PRENATAL RISKS. 3722 02:58:25,640 --> 02:58:28,640 OF THE THREE PARTICIPATING ONE 3723 02:58:28,640 --> 02:58:30,840 WOMAN DESCRIBED HER DOCTOR 3724 02:58:30,840 --> 02:58:33,280 STATING HER LEVEL WAS LOW AND 3725 02:58:33,280 --> 02:58:35,800 THEY THOUGHT FAMILY MEMBERS WERE 3726 02:58:35,800 --> 02:58:38,240 THE MOST TRUSTED SOURCE OF THEIR 3727 02:58:38,240 --> 02:58:43,520 DECISION MAKE ABOUT THEIR 3728 02:58:43,520 --> 02:58:45,320 PREGNANCY AND SOMETIMES SOUGHT 3729 02:58:45,320 --> 02:58:47,320 OUT INFORMATION FROM THEIR 3730 02:58:47,320 --> 02:58:52,160 PRENATAL CARE PROVIDER BUT AGAIN 3731 02:58:52,160 --> 02:58:54,960 THEIR EXTENDED SOCIAL NETWORK 3732 02:58:54,960 --> 02:59:07,160 WAS VIEWED AS MORE IMPORTANT. 3733 02:59:07,160 --> 02:59:10,240 THERE WERE SEVEN TWO AGREED THAT 3734 02:59:10,240 --> 02:59:12,560 THERE WERE BARRIERS TO VITAMIN D 3735 02:59:12,560 --> 02:59:20,960 USAGE AND LACK OF INSURANCE AND 3736 02:59:20,960 --> 02:59:26,480 NOT CLEAR ABOUT WHAT THE 3737 02:59:26,480 --> 02:59:28,400 BENEFITS WERE ABOUT VITAMIN D 3738 02:59:28,400 --> 02:59:30,800 GIVEN THERE'S LACK OF 3739 02:59:30,800 --> 02:59:35,560 STANDARDIZATION. 3740 02:59:35,560 --> 02:59:37,760 THE E.H.R. DATA SHOWED HIGH 3741 02:59:37,760 --> 02:59:39,600 PREVALENCE OF VITAMIN D 3742 02:59:39,600 --> 02:59:41,000 DEFICIENCY OF WOMEN LIVING IN 3743 02:59:41,000 --> 02:59:43,520 THIS AREA FEWER WERE TEST AND 3744 02:59:43,520 --> 02:59:46,400 FEWER RECEIVED VITAMIN D 3745 02:59:46,400 --> 02:59:48,200 SUPPLEMENT. 3746 02:59:48,200 --> 02:59:51,360 MORE THAN LIVED OR THE THAN 10 3747 02:59:51,360 --> 02:59:54,240 MILES OF THE HOSPITAL AND THE 3748 02:59:54,240 --> 02:59:56,200 LINK BETWEEN VITAMIN D 3749 02:59:56,200 --> 03:00:00,120 DEFICIENCY AND ADVERSE PREGNANCY 3750 03:00:00,120 --> 03:00:03,920 OUTCOMES AND PHYSICIANS HAD 3751 03:00:03,920 --> 03:00:04,680 CONFLICTING DATA AND COMPLIANCE 3752 03:00:04,680 --> 03:00:07,280 EVEN WHEN TAKING PRENATAL 3753 03:00:07,280 --> 03:00:07,760 VITAMINS. 3754 03:00:07,760 --> 03:00:09,280 WE MENTIONED A LOT OF SOCIAL 3755 03:00:09,280 --> 03:00:11,920 BARRIERS AND ACCESS CARE AFFECTS 3756 03:00:11,920 --> 03:00:17,560 EVERY ASPECT OF PREGNANCY 3757 03:00:17,560 --> 03:00:20,520 OUTCOMES AND IF WE'RE TO IMPROVE 3758 03:00:20,520 --> 03:00:23,560 MATERNAL AND FETAL HEALTH WITH 3759 03:00:23,560 --> 03:00:24,280 FOCUS ON VITAMIN D STATUS THEN 3760 03:00:24,280 --> 03:00:27,400 WE HAVE TO UNDERSTAND THE 3761 03:00:27,400 --> 03:00:29,040 PROCESSES INVOLVED IN DIAGNOSING 3762 03:00:29,040 --> 03:00:32,240 TREATING AND EDUCATING PREGNANT 3763 03:00:32,240 --> 03:00:34,680 WOMEN ON ITS HEALTH EFFECTS AND 3764 03:00:34,680 --> 03:00:35,400 HAVE NEED EDUCATION AND FUNDING 3765 03:00:35,400 --> 03:00:37,560 FOR THAT. 3766 03:00:37,560 --> 03:00:44,360 THANK YOU. 3767 03:00:44,360 --> 03:00:45,440 >> PEOPLE CAN PUT QUESTIONS IN 3768 03:00:45,440 --> 03:00:46,040 THE Q&A. 3769 03:00:46,040 --> 03:00:47,880 I DON'T SEE QUESTIONS RIGHT NOW 3770 03:00:47,880 --> 03:00:50,960 SO I CAN ASK A QUESTION ABOUT 3771 03:00:50,960 --> 03:00:53,560 THE POTENTIAL ROLE FOR MORE 3772 03:00:53,560 --> 03:00:58,520 CLEAR GUIDANCE FROM ACOG DO YOU 3773 03:00:58,520 --> 03:00:59,600 THINK IT WOULD MATTER IN 3774 03:00:59,600 --> 03:01:00,320 ADDRESSING SOME OF THE 3775 03:01:00,320 --> 03:01:07,400 DISPARITIES? 3776 03:01:07,400 --> 03:01:08,600 >> THE INSTITUTE OF MEDICINE 3777 03:01:08,600 --> 03:01:13,920 WHICH IS NOW THE NATIONAL 3778 03:01:13,920 --> 03:01:17,160 ACADEMY OF SCIENCES THEIR LAST 3779 03:01:17,160 --> 03:01:18,400 RECOMMEND ON VITAMIN D WAS IN 3780 03:01:18,400 --> 03:01:20,000 2011 AND THEY DID NOT HAVE THE 3781 03:01:20,000 --> 03:01:23,840 DATA THAT HAS BEEN AMASSED ON 3782 03:01:23,840 --> 03:01:32,960 VITAMIN D'S EFFECT ON IMMUNITY. 3783 03:01:32,960 --> 03:01:35,480 AND I THINK ACOG CAN HAVE A MORE 3784 03:01:35,480 --> 03:01:43,000 DEFINITIVE RECOMMENDATION. 3785 03:01:43,000 --> 03:01:46,720 >> ARE THERE OTHER COUNTRIES 3786 03:01:46,720 --> 03:01:49,880 THAT MAY HAVE THEIR DEADLINES 3787 03:01:49,880 --> 03:01:52,360 THAT DO BETTER AT VITAMIN D 3788 03:01:52,360 --> 03:01:52,720 SUPPLEMENTATION? 3789 03:01:52,720 --> 03:01:55,280 >> UNFORTUNATELY NOT. 3790 03:01:55,280 --> 03:01:57,560 I THINK THEY TAKE THE LEAD FROM 3791 03:01:57,560 --> 03:01:58,720 US AND THERE ARE AREAS OF THE 3792 03:01:58,720 --> 03:02:01,520 WORLD WHERE THERE'S MUCH MORE 3793 03:02:01,520 --> 03:02:09,240 PROFOUND DEFICIENCY. 3794 03:02:09,240 --> 03:02:12,760 AND IT'S A PRE-FORM HORMONE SO 3795 03:02:12,760 --> 03:02:14,480 SOME EFFECTS ARE SUBTLE AND 3796 03:02:14,480 --> 03:02:21,000 INSIDIOUS AND THAT'S PART OF IT. 3797 03:02:21,000 --> 03:02:24,920 I DON'T SEE ANY QUESTIONS SO WE 3798 03:02:24,920 --> 03:02:29,240 CAN MOVE ON TO THE NEXT SPEAKER. 3799 03:02:29,240 --> 03:02:39,200 >> GWENDOLYN HAS HER HAND UP? 3800 03:02:39,200 --> 03:02:42,200 >> I'M AWARE OF THERE BE A HIGH 3801 03:02:42,200 --> 03:02:43,520 COST RELATED TO TESTING VITAMIN 3802 03:02:43,520 --> 03:02:45,800 D I WONDER IF THAT WOULD HAVE 3803 03:02:45,800 --> 03:02:47,600 BEEN A BARRIER ALSO BECAUSE 3804 03:02:47,600 --> 03:02:48,800 THEIR INSURANCE WOULD NOT COVER 3805 03:02:48,800 --> 03:02:50,240 THE COST? 3806 03:02:50,240 --> 03:02:51,680 >> IN THE STATE OF SOUTH 3807 03:02:51,680 --> 03:02:53,600 CAROLINA WE HAD AN AGREEMENT 3808 03:02:53,600 --> 03:02:55,680 WITH THE INSURANCE COMPANIES TO 3809 03:02:55,680 --> 03:02:57,800 PAY FOR THAT AND THAT'S ACTUALLY 3810 03:02:57,800 --> 03:03:01,520 A GOOD POINT AND THAT'S CHANGED 3811 03:03:01,520 --> 03:03:05,760 RECENTLY BUT ANY WOMAN WHO HAS A 3812 03:03:05,760 --> 03:03:07,400 RISK FOR VITAMIN D DEFICIENCY 3813 03:03:07,400 --> 03:03:09,280 THAT CAN BE JUSTIFIED IT WILL BE 3814 03:03:09,280 --> 03:03:13,200 PAID PARTICULARLY IF IT'S A 3815 03:03:13,200 --> 03:03:14,440 PUBLIC ASSISTANCE PATIENT WHO IS 3816 03:03:14,440 --> 03:03:23,400 AT GREATEST RISK. 3817 03:03:23,400 --> 03:03:26,680 >> MOVING ON TO THE NEXT 3818 03:03:26,680 --> 03:03:28,080 SPEAKER. 3819 03:03:28,080 --> 03:03:31,480 WE HAVE DOCTOR CLAIR MARGERISON 3820 03:03:31,480 --> 03:03:35,680 AND YOU'LL SAY THE PROPER 3821 03:03:35,680 --> 03:03:38,720 PRONUNCIATION IF I DIDN'T BEEN 3822 03:03:38,720 --> 03:03:41,600 MEDICAID EXPANSION AND 3823 03:03:41,600 --> 03:03:42,560 POSTPARTUM HEALTH. 3824 03:03:42,560 --> 03:03:45,800 >> THANK YOU FOR HAVING ME 3825 03:03:45,800 --> 03:03:48,760 TODAY. 3826 03:03:48,760 --> 03:03:54,720 I'M APPRECIATIVE OF THE 3827 03:03:54,720 --> 03:03:55,640 SUPPLEME 3828 03:03:55,640 --> 03:03:55,960 SUPPLEMENT. 3829 03:03:55,960 --> 03:03:58,640 >> I'M SEEING THE PRESENTER 3830 03:03:58,640 --> 03:04:04,240 VIEW. 3831 03:04:04,240 --> 03:04:07,080 >> SO I'M GOING TO BE TALKING 3832 03:04:07,080 --> 03:04:09,320 TODAY ABOUT OUR SUPPLEMENT TO 3833 03:04:09,320 --> 03:04:10,800 OUR OVERALL GRANT AND POLICY 3834 03:04:10,800 --> 03:04:12,680 CHANGE IN WOMEN'S HEALTH. 3835 03:04:12,680 --> 03:04:14,720 AND WHAT I'M GOING TO BE TALKING 3836 03:04:14,720 --> 03:04:16,200 ABOUT IS MEDICAID EXPANSION AND 3837 03:04:16,200 --> 03:04:18,720 POSTPARTUM HEALTH AND I 3838 03:04:18,720 --> 03:04:20,120 APPRECIATE THE PREVIOUS 3839 03:04:20,120 --> 03:04:21,760 PRESENTER FOR LAYING DOWN SOME 3840 03:04:21,760 --> 03:04:23,400 OF THE BACKGROUND SO I CAN GO 3841 03:04:23,400 --> 03:04:28,480 THROUGH THAT MORE QUICKLY. 3842 03:04:28,480 --> 03:04:30,680 TO REVIEW A LITTLE BIT ABOUT 3843 03:04:30,680 --> 03:04:32,320 MEDICAID DURING THE POSTPARTUM 3844 03:04:32,320 --> 03:04:35,640 PERIOD, SO FEDERAL LAW REQUIRES 3845 03:04:35,640 --> 03:04:37,160 STATES PROVIDE MEDICAID COVERAGE 3846 03:04:37,160 --> 03:04:41,920 FOR LOW-INCOME PEOPLE WHEN THEY 3847 03:04:41,920 --> 03:04:43,880 BECOME PREGNANT AND THE CURRENT 3848 03:04:43,880 --> 03:04:49,160 THRESHOLD IS A HOUSEHOLD INCOME 3849 03:04:49,160 --> 03:04:51,840 AT OR BELOW 138% OF THE FEDERAL 3850 03:04:51,840 --> 03:04:53,600 POVERTY LEVEL. 3851 03:04:53,600 --> 03:04:57,160 SOME STATES HAVE MUCH HIGHER 3852 03:04:57,160 --> 03:04:57,480 THRESHOLDS. 3853 03:04:57,480 --> 03:05:04,600 SOME COVER UP TO 200% OR 300% OF 3854 03:05:04,600 --> 03:05:07,760 FEDERAL POVERTY. 3855 03:05:07,760 --> 03:05:10,320 SO PRIOR TO THE AFFORDABLE CARE 3856 03:05:10,320 --> 03:05:12,360 ACT, THOSE NEW PARENTS WHO HAD 3857 03:05:12,360 --> 03:05:15,720 BEEN COVERED WITH MEDICAID 3858 03:05:15,720 --> 03:05:17,360 DURING PREGNANCY THE OPTIONS 3859 03:05:17,360 --> 03:05:20,040 THEY WOULD HAVE ARE EITHER 3860 03:05:20,040 --> 03:05:22,320 OBTAIN OR PURCHASE PRIVATE 3861 03:05:22,320 --> 03:05:26,480 INSURANCE, BECOME UNINSURED OR 3862 03:05:26,480 --> 03:05:35,400 COULD POSSIBLY RE-QUALIFY UNDER 3863 03:05:35,400 --> 03:05:41,320 DIFFERENT THRESHOLDS AROUND AND 3864 03:05:41,320 --> 03:05:43,320 SOME COULD QUALIFY DURING 3865 03:05:43,320 --> 03:05:45,000 PREGNANCY IN MICHIGAN BUT TO 3866 03:05:45,000 --> 03:05:46,800 QUALIFY AS A PARENT IT WOULD 3867 03:05:46,800 --> 03:05:48,400 HAVE TO BE BELOW 50% OF THE 3868 03:05:48,400 --> 03:05:49,360 FEDERAL POVERTY LEVEL. 3869 03:05:49,360 --> 03:05:55,520 SO THERE'S A BIG GAP THERE. 3870 03:05:55,520 --> 03:05:58,200 THE AFFORDABLE CARE ACT INTENDED 3871 03:05:58,200 --> 03:06:04,480 IT WOULD EXPAND TO ALL BELOW 3872 03:06:04,480 --> 03:06:07,600 138% OF FEDERAL POVERTY. 3873 03:06:07,600 --> 03:06:08,760 THIS COULD PROVIDE CONTINUOUS 3874 03:06:08,760 --> 03:06:13,120 INSURANCE PRIOR TO PREGNANCY, 3875 03:06:13,120 --> 03:06:16,920 DURING PREGNANCY AND IN THE 3876 03:06:16,920 --> 03:06:18,360 POSTPARTUM PERIOD AND NOT ALL 3877 03:06:18,360 --> 03:06:18,680 PARTICIPATED. 3878 03:06:18,680 --> 03:06:24,080 WE FOCUSSED ON THOSE THAT DID 3879 03:06:24,080 --> 03:06:25,960 EXPAND IN 2014. 3880 03:06:25,960 --> 03:06:27,480 THERE'S ABOUT 28 STATES PLUS 3881 03:06:27,480 --> 03:06:27,640 D.C. 3882 03:06:27,640 --> 03:06:38,600 MANY EXPANDED SINCE THEN. 3883 03:06:38,600 --> 03:06:41,400 AND WE LOOKED AT POSTPARTUM 3884 03:06:41,400 --> 03:06:43,520 COVERAGE INSURANCE AND MENTAL 3885 03:06:43,520 --> 03:06:50,800 HEALTH AND RELATED MORTALITY. 3886 03:06:50,800 --> 03:06:53,000 THERE'S A PREGNANCY RISK 3887 03:06:53,000 --> 03:06:55,000 MONITORING SYSTEM AND THIS SAY 3888 03:06:55,000 --> 03:06:56,960 SET OF STATE WIDE REPRESENTATIVE 3889 03:06:56,960 --> 03:06:59,200 SURVEYS AND INDIVIDUALS WHO HAVE 3890 03:06:59,200 --> 03:07:03,160 RECENTLY GIVEN A LIVE BIRTH FROM 3891 03:07:03,160 --> 03:07:05,360 THIS WE OBTAINED THE PERSON'S 3892 03:07:05,360 --> 03:07:06,200 SELF-REPORTED MEDICAID COVERAGE 3893 03:07:06,200 --> 03:07:10,120 AT THE TIME OF THE SURVEY. 3894 03:07:10,120 --> 03:07:14,720 SO POSTPARTUM AND SELF-REPORTED 3895 03:07:14,720 --> 03:07:16,360 POSTPARTUM DEPRESSIVE SYMPTOMS. 3896 03:07:16,360 --> 03:07:19,240 WE USED U.S. VITAL STATISTICS 3897 03:07:19,240 --> 03:07:22,280 DATA TO ASSESS PREGNANCY RELATED 3898 03:07:22,280 --> 03:07:22,560 MORTALITY. 3899 03:07:22,560 --> 03:07:24,800 WE USE DATA FROM STATES USING 3900 03:07:24,800 --> 03:07:26,720 THE REVISED DEATH CERTIFICATE 3901 03:07:26,720 --> 03:07:28,800 AND WE CALCULATE THE PREGNANCY 3902 03:07:28,800 --> 03:07:30,840 ASSOCIATED DEATH RATIO THE 3903 03:07:30,840 --> 03:07:34,720 NUMBER OF DEATHS DURING 3904 03:07:34,720 --> 03:07:37,080 PREGNANCY OR POSTPARTUM PER 3905 03:07:37,080 --> 03:07:38,720 100,000 LIVE BIRTHS IN A STATE 3906 03:07:38,720 --> 03:07:44,080 OR YEAR. 3907 03:07:44,080 --> 03:07:46,560 AND THERE'S A PREGNANCY CHECK 3908 03:07:46,560 --> 03:07:47,800 BOX THAT ASKED WHETHER THE 3909 03:07:47,800 --> 03:07:50,720 PERSON WHO DIED WAS PREGNANCY, 3910 03:07:50,720 --> 03:07:56,960 HAD BEEN PREGNANT WITHIN 42 DAYS 3911 03:07:56,960 --> 03:07:59,560 OF THEIR DEATH OR PREGNANT 3912 03:07:59,560 --> 03:08:02,000 WITHIN 365 DAYS BEFORE THEIR 3913 03:08:02,000 --> 03:08:02,200 DEATH. 3914 03:08:02,200 --> 03:08:05,800 AND WE INCLUDE DEATHS DUE TO ALL 3915 03:08:05,800 --> 03:08:06,120 CAUSES. 3916 03:08:06,120 --> 03:08:12,320 THESE ARE NOT JUST THE DEATHS 3917 03:08:12,320 --> 03:08:17,800 CONSIDERED RELATED TO PREGNANCY 3918 03:08:17,800 --> 03:08:19,840 AND WE ARE LOOKING AT ANOTHER 3919 03:08:19,840 --> 03:08:21,480 FUNDED PROJECT WE FOUND OVER 20% 3920 03:08:21,480 --> 03:08:24,480 OF DEATHS DURING PREGNANCY AND 3921 03:08:24,480 --> 03:08:26,600 POSTPARTUM ARE DUE TO CAUSES 3922 03:08:26,600 --> 03:08:28,200 SUCH AS DRUG RELATED DEATH, 3923 03:08:28,200 --> 03:08:30,000 SUICIDE AND HOMICIDE AND THESE 3924 03:08:30,000 --> 03:08:32,600 ARE NOT TYPICALLY INCLUDED IN 3925 03:08:32,600 --> 03:08:34,400 PREGNANCY RELATED DEATH RATIOS 3926 03:08:34,400 --> 03:08:36,960 OR MATERNAL MORTALITY RATIOS BUT 3927 03:08:36,960 --> 03:08:39,000 WE INCLUDE THESE ESPECIALLY 3928 03:08:39,000 --> 03:08:40,680 BECAUSE MANY OF THESE DEATHS 3929 03:08:40,680 --> 03:08:42,720 OCCUR IN THAT LATER POSTPARTUM 3930 03:08:42,720 --> 03:08:45,320 PERIOD WHICH IS WHEN PEOPLE 3931 03:08:45,320 --> 03:08:48,400 WOULD LOSE MEDICAID IN 3932 03:08:48,400 --> 03:08:50,400 NON-EXPANSION STATES. 3933 03:08:50,400 --> 03:08:55,520 OUR HYPOTHESIS ARE THESE ACAUSES 3934 03:08:55,520 --> 03:09:01,520 OF DEATHS AMENABLE TO -- THESE 3935 03:09:01,520 --> 03:09:03,520 ARE CAUSES OF DEATH. 3936 03:09:03,520 --> 03:09:06,240 AND WE USED A DIFFERENT APPROACH 3937 03:09:06,240 --> 03:09:08,360 AND I WON'T GO INTO THAT. 3938 03:09:08,360 --> 03:09:16,200 I'M HAPPY TO TALK MORE ABOUT IT 3939 03:09:16,200 --> 03:09:20,280 AND THE DIFFERENT METHOD WE USED 3940 03:09:20,280 --> 03:09:21,680 THE RESULTS CAN BE INTERPRETED 3941 03:09:21,680 --> 03:09:23,080 AS THE PERCENTAGE POINT CHANGE 3942 03:09:23,080 --> 03:09:24,400 IN THE OUTCOME THAT IS 3943 03:09:24,400 --> 03:09:25,560 ASSOCIATED WITH MEDICAID 3944 03:09:25,560 --> 03:09:37,160 EXPANSION. 3945 03:09:37,160 --> 03:09:41,120 PEOPLE REPORTED THEY HAD 3946 03:09:41,120 --> 03:09:53,160 MEDICAID POSTPARTUM. 3947 03:09:53,160 --> 03:09:58,200 WE DID NOT SEE IMPACT OF 3948 03:09:58,200 --> 03:10:00,280 MEDICAID EXPANSION ON POSTPARTUM 3949 03:10:00,280 --> 03:10:02,600 SYMPTOMS AND WE LOOKED AT 3950 03:10:02,600 --> 03:10:03,160 PRE-PREGNANCY MEASURES AND 3951 03:10:03,160 --> 03:10:05,800 LOOKED AT SOME IMPROVEMENTS AT 3952 03:10:05,800 --> 03:10:06,400 PRE-PREGNANCY SELF-REPORTED 3953 03:10:06,400 --> 03:10:11,240 DEPRESSION. 3954 03:10:11,240 --> 03:10:13,600 MOVING ON TO THE FINDINGS OF 3955 03:10:13,600 --> 03:10:16,400 PREGNANCY RELATED MORTALITY. 3956 03:10:16,400 --> 03:10:19,600 THESE ARE NOT PUBLISHED YET. 3957 03:10:19,600 --> 03:10:23,200 WE DIVIDED THIS UP INTO THE TIME 3958 03:10:23,200 --> 03:10:24,960 PERIOD SO BECAUSE WE 3959 03:10:24,960 --> 03:10:26,240 HYPOTHESIZED THAT THE TIME 3960 03:10:26,240 --> 03:10:28,720 PERIOD OF THE DEATHS BECAUSE WE 3961 03:10:28,720 --> 03:10:31,160 HYPOTHESIZED THE MAIN IMPACTS OF 3962 03:10:31,160 --> 03:10:34,760 MEDICAID EXPANSION WOULD BE ON 3963 03:10:34,760 --> 03:10:36,520 DEATHS IN THE LATER POSTPARTUM 3964 03:10:36,520 --> 03:10:38,440 PERIOD BUT LOOKED DURING 3965 03:10:38,440 --> 03:10:40,080 PREGNANCY AND EARLY POSTPARTUM 3966 03:10:40,080 --> 03:10:40,400 AS WELL. 3967 03:10:40,400 --> 03:10:41,560 THE WAY I'M PRESENTING THE 3968 03:10:41,560 --> 03:10:46,720 RESULTS ARE DIFFERENT THAN THE 3969 03:10:46,720 --> 03:10:49,280 PREVIOUS ONES YOUR LOOKING FOR 3970 03:10:49,280 --> 03:10:50,960 POINT ESTIMATES ASSOCIATION 3971 03:10:50,960 --> 03:10:53,720 BETWEEN MEDICAID EXPANSION AND 3972 03:10:53,720 --> 03:10:55,360 PREGNANCY RELATED MORTALITY. 3973 03:10:55,360 --> 03:10:58,240 TO THE RIGHT OF THE ORANGE BAR 3974 03:10:58,240 --> 03:10:59,520 AND THAT'S BECAUSE WHEN THAT'S 3975 03:10:59,520 --> 03:11:00,600 WHEN THE INTERVENTION TOOK PLACE 3976 03:11:00,600 --> 03:11:03,840 AND WE'RE LOOKING AT POINT 3977 03:11:03,840 --> 03:11:06,720 ESTIMATES STATISTICALLY 3978 03:11:06,720 --> 03:11:08,360 DIFFERENT FROM ZERO. 3979 03:11:08,360 --> 03:11:09,920 THESE GRAPHS LET US SEE WHETHER 3980 03:11:09,920 --> 03:11:12,040 THERE'S AN IMPACT OF MEDICAID 3981 03:11:12,040 --> 03:11:13,000 EXPANSION THAT MAYBE HAPPENED 3982 03:11:13,000 --> 03:11:18,800 RIGHT AWAY AND PETERED OUT OVER 3983 03:11:18,800 --> 03:11:19,600 TIME OR MAYBE HAPPENED LATER IN 3984 03:11:19,600 --> 03:11:20,720 THE TIME PERIOD. 3985 03:11:20,720 --> 03:11:25,560 ADDS YOU CAN SEE THERE'S 3986 03:11:25,560 --> 03:11:30,480 STATISTICALLY SIGNIFICANT 3987 03:11:30,480 --> 03:11:36,640 ASSOCIATIONS BETWEEN MEDICAID 3988 03:11:36,640 --> 03:11:37,840 AND THE CONFIDENCE LINES AND 3989 03:11:37,840 --> 03:11:41,160 THERE'S NO SIGNIFICANT IMPACTS 3990 03:11:41,160 --> 03:11:42,720 WITHIN 42 DAYS POSTPARTUM OR IN 3991 03:11:42,720 --> 03:11:44,440 THE LATER POSTPARTUM PERIOD 3992 03:11:44,440 --> 03:11:46,000 WHICH IS WHEN WE HAD 3993 03:11:46,000 --> 03:11:46,960 HYPOTHESIZED WE WOULD SEE AN 3994 03:11:46,960 --> 03:12:03,600 ASSOCIATION. 3995 03:12:03,600 --> 03:12:06,520 THERE'S ALSO NO SIGNIFICANT 3996 03:12:06,520 --> 03:12:07,800 IMPACT AMONG NON-HISPANIC BLACK 3997 03:12:07,800 --> 03:12:11,400 PEOPLE BUT YOU SEE A TREND WHERE 3998 03:12:11,400 --> 03:12:13,600 PREGNANCY ASSOCIATED MORTALITY 3999 03:12:13,600 --> 03:12:15,000 THE ASSOCIATION BETWEEN MEDICAID 4000 03:12:15,000 --> 03:12:18,480 EXPANSION AND MORTALITY APPEARS 4001 03:12:18,480 --> 03:12:20,600 TO BE AN ASSOCIATION THAT'S 4002 03:12:20,600 --> 03:12:22,440 GROWING OVER TIME WHERE THE 4003 03:12:22,440 --> 03:12:25,120 MEDICAID EXPANSION IS ASSOCIATED 4004 03:12:25,120 --> 03:12:29,040 WITH A REDUCTION IN PREGNANCY 4005 03:12:29,040 --> 03:12:29,800 RELATED MORTALITY AMONG 4006 03:12:29,800 --> 03:12:30,800 NON-HISPANIC BLACK PEOPLE. 4007 03:12:30,800 --> 03:12:33,040 THAT'S NOT SIGNIFICANT BUT THIS 4008 03:12:33,040 --> 03:12:36,200 IS A RARE OUTCOME SO WE'RE 4009 03:12:36,200 --> 03:12:37,720 WORKING WITH PRETTY SMALL SAMPLE 4010 03:12:37,720 --> 03:12:39,440 SIZES AND LOOK FORWARD TO 4011 03:12:39,440 --> 03:12:40,160 GETTING FUTURE YEARS OF DATA AND 4012 03:12:40,160 --> 03:12:43,400 CONTINUING TO LOOK AT THIS. 4013 03:12:43,400 --> 03:12:47,160 WE ALSO DID NOT SEE AN 4014 03:12:47,160 --> 03:12:49,560 ASSOCIATION AMONG NON-HISPANIC 4015 03:12:49,560 --> 03:12:52,080 WHITE PEOPLE. 4016 03:12:52,080 --> 03:12:54,320 IN CONCLUSION, MEDICAID 4017 03:12:54,320 --> 03:12:56,840 EXPANSION THE 2014 MEDICAID 4018 03:12:56,840 --> 03:12:59,520 EXPANSION LIKELY INCREASED 4019 03:12:59,520 --> 03:13:00,400 MEDICAID EXPANSION IN THE 4020 03:13:00,400 --> 03:13:01,520 POSTPARTUM PERIOD. 4021 03:13:01,520 --> 03:13:03,280 HOWEVER, THERE WERE NO 4022 03:13:03,280 --> 03:13:05,960 SIGNIFICANT IMPACT OF MEDICAID 4023 03:13:05,960 --> 03:13:07,760 EXPANSION ON DEPRESSIVE SYMPTOMS 4024 03:13:07,760 --> 03:13:09,960 OR PREGNANCY RELATED MORTALITY. 4025 03:13:09,960 --> 03:13:12,040 ONE OF THE CONCLUSIONS FROM THIS 4026 03:13:12,040 --> 03:13:14,680 IS WE THINK INSURANCE COVERAGE 4027 03:13:14,680 --> 03:13:17,120 ALONE IS LIKELY NECESSARY BUT 4028 03:13:17,120 --> 03:13:20,680 NOT SUFFICIENT TO REDUCE THE 4029 03:13:20,680 --> 03:13:26,080 PREVALENCE OF OR RACIAL ETHNIC 4030 03:13:26,080 --> 03:13:31,120 INEQUITIES IN MORBIDITY OR 4031 03:13:31,120 --> 03:13:33,680 MORTALITY AND I THANK NICHD FOR 4032 03:13:33,680 --> 03:13:34,480 THE FUNDING AND COLLABORATORS 4033 03:13:34,480 --> 03:13:35,280 AND HAPPY TO ANSWER ANY 4034 03:13:35,280 --> 03:13:39,800 QUESTIONS. 4035 03:13:39,800 --> 03:13:40,400 >> THANK YOU SEARCH. 4036 03:13:40,400 --> 03:13:45,440 PLEASE PUT ANY QUESTIONS IN THE 4037 03:13:45,440 --> 03:13:45,600 Q&A. 4038 03:13:45,600 --> 03:13:51,520 I TOOK A PEEK AT SOME OF YOUR 4039 03:13:51,520 --> 03:13:55,600 EXTRA SLIDES YOU HAD. 4040 03:13:55,600 --> 03:13:57,440 OWN YOUR LAST SLIDE YOU FOUND 4041 03:13:57,440 --> 03:13:59,920 SOME RACIAL ETHNIC DIFFERENCES 4042 03:13:59,920 --> 03:14:06,080 IN THE LIKELIHOOD OF DEPRESSIVE 4043 03:14:06,080 --> 03:14:06,480 SYMPTOMS. 4044 03:14:06,480 --> 03:14:08,160 CAN YOU SPEAK TO THOSE A LITTLE 4045 03:14:08,160 --> 03:14:10,640 AND WHAT YOU THINK THEY MIGHT 4046 03:14:10,640 --> 03:14:17,320 MEAN? 4047 03:14:17,320 --> 03:14:22,480 >> THAT'S A LITTLE BIT OF A 4048 03:14:22,480 --> 03:14:24,080 DIFFERENT ANALYSIS. 4049 03:14:24,080 --> 03:14:26,720 I HOPED TO HAVE TIME TO TALK 4050 03:14:26,720 --> 03:14:29,600 ABOUT IT HIT BUT NOT INCLUDE IT 4051 03:14:29,600 --> 03:14:31,400 IN THE MAIN PRESENTATION. 4052 03:14:31,400 --> 03:14:34,520 SOME MM ARE SEEKING FEDERAL 4053 03:14:34,520 --> 03:14:38,640 WAIVERS TO EXTEND THE MEDICAID 4054 03:14:38,640 --> 03:14:40,240 60 DAYS TO 12 MONTHS POSTPARTUM. 4055 03:14:40,240 --> 03:14:42,360 AS PART OF THE AMERICAN RESCUE 4056 03:14:42,360 --> 03:14:43,720 PLAN ALLOWED STATES TO DO THAT 4057 03:14:43,720 --> 03:14:45,240 UNTIL APRIL 1 OF THIS YEAR AND 4058 03:14:45,240 --> 03:14:46,680 THEN THEY HAVE TO GET THESE 4059 03:14:46,680 --> 03:14:49,800 WAIVERS TO CONTINUE IT. 4060 03:14:49,800 --> 03:14:53,200 SO WE DID ANOTHER ANALYSIS. 4061 03:14:53,200 --> 03:14:55,400 THIS IS ALSO PRELIMINARY TRYING 4062 03:14:55,400 --> 03:14:57,480 TO PREDICT HOW MANY PEOPLE WOULD 4063 03:14:57,480 --> 03:15:01,720 GAIN MEDICAID FROM THOSE 4064 03:15:01,720 --> 03:15:02,080 EXTENSIONS. 4065 03:15:02,080 --> 03:15:04,640 AND IT'S NOT REALLY EXPANDING 4066 03:15:04,640 --> 03:15:08,280 ELIGIBILITY IT'S EXTENDING 4067 03:15:08,280 --> 03:15:10,440 MEDICAID TO 12 MONTHS 4068 03:15:10,440 --> 03:15:10,760 POSTPARTUM. 4069 03:15:10,760 --> 03:15:13,520 WE FOUND THAT 20% TO 26% OF 4070 03:15:13,520 --> 03:15:16,600 PEOPLE WOULD GAIN MEDICAID BUT 4071 03:15:16,600 --> 03:15:19,000 THERE ARE LARGER GAINS FOR BLACK 4072 03:15:19,000 --> 03:15:21,280 AND HISPANIC PEOPLE AND THEN WE 4073 03:15:21,280 --> 03:15:28,000 ALSO LOOKED USING PROGRAM -- 4074 03:15:28,000 --> 03:15:31,040 PRAMS AT REGAINING IT IN THE 4075 03:15:31,040 --> 03:15:32,600 POSTPARTUM PERIOD OR USING THE 4076 03:15:32,600 --> 03:15:35,040 DATA WE HAD WOULD ONLY HAPPEN IF 4077 03:15:35,040 --> 03:15:37,640 A PERSON RE-QUALIFIED AS A 4078 03:15:37,640 --> 03:15:37,880 PARENT. 4079 03:15:37,880 --> 03:15:39,480 WE HAD PEOPLE WHO WOULD HAVE 4080 03:15:39,480 --> 03:15:40,720 CONTINUOUS COVERAGE AND THOSE 4081 03:15:40,720 --> 03:15:45,040 WHO WOULD LOSE MEDICAID BASED ON 4082 03:15:45,040 --> 03:15:47,720 THEIR INCOME AND WE FOUND 4083 03:15:47,720 --> 03:15:48,600 RETAINING MEDICAID IN THE 4084 03:15:48,600 --> 03:15:50,560 POSTPARTUM PERIOD WAS ASSOCIATED 4085 03:15:50,560 --> 03:15:52,800 WITH AN INCREASE IN GETTING A 4086 03:15:52,800 --> 03:15:55,480 POSTPARTUM CHECK UP THAT WAS 4087 03:15:55,480 --> 03:15:59,880 ONLY SIGNIFICANT AMONG HISPANIC 4088 03:15:59,880 --> 03:16:03,760 PEOPLE AND WAS ACTUALLY IN THE 4089 03:16:03,760 --> 03:16:04,800 OPPOSITE DIRECTION OF BLACK 4090 03:16:04,800 --> 03:16:07,120 PEOPLE AND RETAINING MEDICAID 4091 03:16:07,120 --> 03:16:10,360 WAS ASSOCIATED WITH AN DOES HE 4092 03:16:10,360 --> 03:16:15,800 CREASE IN POSTPARTUM DEPRESSIVE 4093 03:16:15,800 --> 03:16:18,640 SYMPTOMS BUT ONLY AMONG WHITE 4094 03:16:18,640 --> 03:16:20,600 PEOPLE AND THESE ARE PRELIMINARY 4095 03:16:20,600 --> 03:16:21,720 FINDINGS WE'RE STILL WORK ON. 4096 03:16:21,720 --> 03:16:25,960 >> THERE'S A QUESTION IN THE 4097 03:16:25,960 --> 03:16:27,520 CHAT, WHAT IS THE POPULATION 4098 03:16:27,520 --> 03:16:28,880 INCLUDED IN YOUR ANALYSIS ENTIRE 4099 03:16:28,880 --> 03:16:44,280 U.S. OR SPECIFIC REGIONS? 4100 03:16:44,280 --> 03:16:46,400 WITH THE PRAMS DATA IT'S NOT 4101 03:16:46,400 --> 03:16:47,160 INCLUDED IN THE NATIONAL DATA 4102 03:16:47,160 --> 03:16:49,840 SET BECAUSE THEY DON'T HAVE HIGH 4103 03:16:49,840 --> 03:16:51,880 ENOUGH PARTICIPATION RATE OR 4104 03:16:51,880 --> 03:16:55,480 RESPONSE RATE SO WE DON'T HAVE 4105 03:16:55,480 --> 03:16:57,000 EVERY STATE IN THE PRAMS DATA 4106 03:16:57,000 --> 03:16:58,680 AND WITH THE PREGNANCY 4107 03:16:58,680 --> 03:17:00,200 ASSOCIATED MORTALITY OUTCOME WE 4108 03:17:00,200 --> 03:17:02,800 ARE USING VITAL STATISTICS DATA 4109 03:17:02,800 --> 03:17:07,360 AND THAT INCLUDES 33 STATES AND 4110 03:17:07,360 --> 03:17:08,840 D.C. AGAIN BASED ON THE STATES 4111 03:17:08,840 --> 03:17:10,640 THAT HAVE THE DATA POINT WE 4112 03:17:10,640 --> 03:17:14,360 NEED. 4113 03:17:14,360 --> 03:17:15,800 >> AND A QUESTION FROM ME SINCE 4114 03:17:15,800 --> 03:17:18,440 I DON'T SEE ANYTHING IN THE 4115 03:17:18,440 --> 03:17:21,440 CHAT, DO YOU HAVE THE ABILITY SO 4116 03:17:21,440 --> 03:17:24,600 YOU FOUND THAT JUST MEDICAID 4117 03:17:24,600 --> 03:17:26,720 EXPANSION ISN'T SUFFICIENT. 4118 03:17:26,720 --> 03:17:28,520 ARE YOU ABLE TO LOOK AT OTHER 4119 03:17:28,520 --> 03:17:30,160 STATE CHARACTERISTICS LIKE OTHER 4120 03:17:30,160 --> 03:17:34,720 STATE LAWS LIKE MINIMUM WAGE 4121 03:17:34,720 --> 03:17:37,520 LAWS OR MATERNAL LEAVE OR OTHER 4122 03:17:37,520 --> 03:17:39,280 POLICIES? 4123 03:17:39,280 --> 03:17:41,200 >> WE ARE ABLE TO TIME WISE. 4124 03:17:41,200 --> 03:17:49,480 WE HAVE NOT DONE THAT YET. 4125 03:17:49,480 --> 03:17:51,760 THERE ARE OTHER STUDIES LOOKING 4126 03:17:51,760 --> 03:17:59,400 AT SPECIFIC POLICIES, PARENTAL 4127 03:17:59,400 --> 03:18:01,400 LEAVE AND WE'VE LOOKED AT THE 4128 03:18:01,400 --> 03:18:10,560 HEALTH OF THE INCOME. 4129 03:18:10,560 --> 03:18:13,040 THERE'S ROOM TO EXAMINE OTHER 4130 03:18:13,040 --> 03:18:14,800 POLICIES BUT HAVE NOT YET. 4131 03:18:14,800 --> 03:18:18,160 >> I THINK WE ARE AT TIME THANK 4132 03:18:18,160 --> 03:18:19,720 YOU VERY MUCH FOR YOUR 4133 03:18:19,720 --> 03:18:20,040 PRESENTATION. 4134 03:18:20,040 --> 03:18:22,680 AND THANK YOU TO ALL OF OUR 4135 03:18:22,680 --> 03:18:23,920 SPEAKERS IN THIS PANEL. 4136 03:18:23,920 --> 03:18:28,400 WE WILL NOW MOVE TO A BREAK AND 4137 03:18:28,400 --> 03:18:29,000 RETURN BACK AT 3:05. 4138 03:18:29,000 --> 03:18:37,280 THANK YOU VERY MUCH. 4139 03:18:37,280 --> 03:18:45,800 I'M LAUREN HILL AND I'LL BE 4140 03:18:45,800 --> 03:18:46,360 MODERATING OUR FINAL PANEL OF 4141 03:18:46,360 --> 03:18:58,360 THE DAY. 4142 03:18:58,360 --> 03:19:00,520 WE HAVE THREE SPEAKERS AND YOU 4143 03:19:00,520 --> 03:19:02,800 CAN GET MORE INFORMATION ON 4144 03:19:02,800 --> 03:19:04,320 THEIR BIOS ON THE REGISTRATION 4145 03:19:04,320 --> 03:19:07,440 PAGE AND IF YOU HAVE QUESTIONS 4146 03:19:07,440 --> 03:19:10,440 PLEASE DO PUT THEM IN THE Q&A 4147 03:19:10,440 --> 03:19:12,560 BOX AND AT THE CONCLUSION OF 4148 03:19:12,560 --> 03:19:16,200 EACH TALK BY EACH SPEAKER WE'LL 4149 03:19:16,200 --> 03:19:17,200 TAKE QUESTIONS. 4150 03:19:17,200 --> 03:19:19,680 SPEAKERS, I WILL BE HERE TO GIVE 4151 03:19:19,680 --> 03:19:23,400 YOU THE ONE-MINUTE WARNING IF 4152 03:19:23,400 --> 03:19:23,760 NEEDED. 4153 03:19:23,760 --> 03:19:25,000 SO WELCOME AGAIN EVERYONE. 4154 03:19:25,000 --> 03:19:30,040 THE TITLE OF OUR PANEL IS MENTAL 4155 03:19:30,040 --> 03:19:31,440 AND BEHAVIORAL HEALTH AND I WILL 4156 03:19:31,440 --> 03:19:35,240 TURN IT OVER TO OUR FIRST 4157 03:19:35,240 --> 03:19:56,600 SPEAKER, DR. KARA ZIVIN. 4158 03:19:56,600 --> 03:19:59,680 WE'RE LOOK AT SEVERE MATERNAL 4159 03:19:59,680 --> 03:20:01,840 MORBIDITY IN COMMERCIALLY 4160 03:20:01,840 --> 03:20:02,320 INSURED INDIVIDUALS. 4161 03:20:02,320 --> 03:20:06,920 I WANT TO GIVE CONTEXT FOR OUR 4162 03:20:06,920 --> 03:20:07,120 WORK. 4163 03:20:07,120 --> 03:20:08,680 I CHOSE A FOREST THEME FOR OUR 4164 03:20:08,680 --> 03:20:12,200 WORK AND THE PARENT STUDY 4165 03:20:12,200 --> 03:20:13,680 FOCUSSED ON MATERNAL BEHAVIORAL 4166 03:20:13,680 --> 03:20:19,400 HEALTH AND SO THAT INCLUDED THE 4167 03:20:19,400 --> 03:20:20,200 AFFORDABLE CARE ACT AND WE'VE 4168 03:20:20,200 --> 03:20:23,560 LOOKED AT THE IMPACT OF THOSE 4169 03:20:23,560 --> 03:20:25,840 POLICY CHANGES ON INDIVIDUALS 4170 03:20:25,840 --> 03:20:31,680 WITH PERINATAL MOOD AND ANXIETY 4171 03:20:31,680 --> 03:20:42,120 DISORDERS. 4172 03:20:42,120 --> 03:20:46,640 WE LOOKED AT THOSE INDIVIDUALS 4173 03:20:46,640 --> 03:20:48,560 WITH SUBSTANCE USE DISORDERS AND 4174 03:20:48,560 --> 03:20:51,600 WE HAD A STUDY RECENTLY FUNDED 4175 03:20:51,600 --> 03:20:54,520 WHERE WE'LL BE BRINGING IN 4176 03:20:54,520 --> 03:20:57,920 COMMUNITY LEVEL DATA AND ADDING 4177 03:20:57,920 --> 03:20:59,040 MEDICAID AND PRAM AS OTHER DATA. 4178 03:20:59,040 --> 03:21:01,160 ON THE NEXT SLIDE I DRILLED DOWN 4179 03:21:01,160 --> 03:21:02,800 MORE SHOWING THE COMPARISON 4180 03:21:02,800 --> 03:21:08,840 BETWEEN THE PARENT STUDY AND THE 4181 03:21:08,840 --> 03:21:16,600 SUPPLEMENT WHERE AGAIN WITH 4182 03:21:16,600 --> 03:21:18,200 WE'VE LOOKED AT PEOPLE 4183 03:21:18,200 --> 03:21:23,800 CONTINUOUSLY ENROLLED ONE YEAR 4184 03:21:23,800 --> 03:21:28,760 BEFORE AND THE STUDY AND WE 4185 03:21:28,760 --> 03:21:33,120 LOOKED AT DELIVERY OUTCOMES 4186 03:21:33,120 --> 03:21:34,920 INCLUDING SEVERE MORBIDITY AND 4187 03:21:34,920 --> 03:21:37,000 IN THE CURRENT STUDY WE'LL BE 4188 03:21:37,000 --> 03:21:40,000 LOOKING AT DIFFERENT ELEMENTS OF 4189 03:21:40,000 --> 03:21:42,600 PARITY LAWS, RACE, ETHNICITY AND 4190 03:21:42,600 --> 03:21:43,040 INCOME. 4191 03:21:43,040 --> 03:21:47,520 SO ON THE NEXT SLIDE I WILL 4192 03:21:47,520 --> 03:21:48,200 PRESENT OUR FIRST PAPER THAT'S 4193 03:21:48,200 --> 03:21:52,160 COME OUT OF THIS WORK THAT CAME 4194 03:21:52,160 --> 03:21:57,000 OUT IN DECEMBER FOCUSSING ON 4195 03:21:57,000 --> 03:21:59,160 SEVERE MATERNAL MORBIDITY AND 4196 03:21:59,160 --> 03:22:00,520 THE NAMES OF MY COLLEAGUES ARE 4197 03:22:00,520 --> 03:22:02,960 LISTED ON THE STUDY WHERE WE 4198 03:22:02,960 --> 03:22:05,400 WANTED TO LOOK NOT JUST AT 4199 03:22:05,400 --> 03:22:06,680 MATERNAL MORBIDITY RELATED TO 4200 03:22:06,680 --> 03:22:11,480 WHAT OCCURRED DURING THE 4201 03:22:11,480 --> 03:22:19,240 DELIVERY HOSPITALIZATION BUT UP 4202 03:22:19,240 --> 03:22:24,720 TO ONE YEAR POST FINDING AND WE 4203 03:22:24,720 --> 03:22:26,760 SEPARATED OUT BLOOD TRANSFUSION 4204 03:22:26,760 --> 03:22:29,880 FROM OTHER FORMS OF MORBIDITY 4205 03:22:29,880 --> 03:22:37,040 BECAUSE THE DIFFERENCE AND WE 4206 03:22:37,040 --> 03:22:38,560 LOOKED AT THE CONTINUES THAT 4207 03:22:38,560 --> 03:22:43,560 WERE THE LEADING CAUSES OF 4208 03:22:43,560 --> 03:22:44,200 SEVERE MATERNAL MORBIDITY 4209 03:22:44,200 --> 03:22:45,720 SHOWING DELIVERY HOSPITALIZATION 4210 03:22:45,720 --> 03:22:48,360 AND FROM DISCHARGE TO 42 DAYS 4211 03:22:48,360 --> 03:22:54,280 AND FROM 43 DAYS TO 365 DAYS 4212 03:22:54,280 --> 03:22:58,600 POST DELIVERY. 4213 03:22:58,600 --> 03:22:59,800 THE MOST SEVERE CONDITIONS 4214 03:22:59,800 --> 03:23:01,960 VARIED OVER THE TIME FRAME WHICH 4215 03:23:01,960 --> 03:23:09,920 WE HEARD FROM OTHERS TODAY. 4216 03:23:09,920 --> 03:23:12,360 WITH BLOOD TRANSFUSION AND 4217 03:23:12,360 --> 03:23:13,320 ECLAMPSIA AND SOME DELIVERING 4218 03:23:13,320 --> 03:23:15,360 FROM TIME OF DELIVERY INCLUDING 4219 03:23:15,360 --> 03:23:18,200 THINGS LIKE SEPSIS AND ADULT 4220 03:23:18,200 --> 03:23:22,360 RESPIRATORY DISTRESS SYNDROME. 4221 03:23:22,360 --> 03:23:24,480 THIS SLIDE I WANT TO DRAW YOUR 4222 03:23:24,480 --> 03:23:26,240 ATTENTION TO THE DIFFERENCES 4223 03:23:26,240 --> 03:23:32,840 THAT WE COMPARED BETWEEN THOSE 4224 03:23:32,840 --> 03:23:37,000 WITH AND WITHOUT BLOOD 4225 03:23:37,000 --> 03:23:40,200 TRANSFUSION AND LOOKED AT RACE 4226 03:23:40,200 --> 03:23:44,000 AND ETHNICITY AND MOOD 4227 03:23:44,000 --> 03:23:44,240 DISORDERS. 4228 03:23:44,240 --> 03:23:49,280 THESE WERE THE RACE AND ETHNIC 4229 03:23:49,280 --> 03:23:51,560 GROUPS WE HAD AND DIDN'T HAVE 4230 03:23:51,560 --> 03:23:52,640 THE OPPORTUNITY FOR OTHER GROUPS 4231 03:23:52,640 --> 03:24:02,040 OR MULTI-RACIAL. 4232 03:24:02,040 --> 03:24:05,920 BLACK PARTICIPANTS HAD THE 4233 03:24:05,920 --> 03:24:08,760 HIGHEST RATES WITH AND WITHOUT 4234 03:24:08,760 --> 03:24:14,840 BLOOD TRANSFUSION AND HISPANIC 4235 03:24:14,840 --> 03:24:18,120 AND LOOKING AT A MOOD OR ANXIETY 4236 03:24:18,120 --> 03:24:20,720 DISORDER COMPARED TO THOSE THAT 4237 03:24:20,720 --> 03:24:26,720 HAD HIGHER RATES OF SEVERE 4238 03:24:26,720 --> 03:24:30,480 MATERNAL MORBIDITY AND THAT WAS 4239 03:24:30,480 --> 03:24:32,760 FOCUSSING ON WITH AND WITHOUT 4240 03:24:32,760 --> 03:24:34,880 BLOOD TRANSFUSION AND WE SHARED 4241 03:24:34,880 --> 03:24:39,200 THIS INFORMATION AND WENT TO THE 4242 03:24:39,200 --> 03:24:41,880 NEXT STUDY WHERE WE'RE TRYING TO 4243 03:24:41,880 --> 03:24:43,800 LAYER IN THE IMPACT OF THE 4244 03:24:43,800 --> 03:24:45,600 FEDERAL HEALTH POLICY CHANGES 4245 03:24:45,600 --> 03:24:49,880 DURING OUR STUDY PERIOD FROM 4246 03:24:49,880 --> 03:24:53,360 2008 TO 2019. 4247 03:24:53,360 --> 03:24:54,800 IS WE ARE STILL PLAYING WITH THE 4248 03:24:54,800 --> 03:24:55,960 FUNCTIONAL FORMS OF OUR MODELS. 4249 03:24:55,960 --> 03:24:58,360 WE'RE SEEING IN ADDITION TO 4250 03:24:58,360 --> 03:25:04,360 OVERALL DECREASES IN SEVERE 4251 03:25:04,360 --> 03:25:08,280 MATERNAL MORBIDITY THE LINES 4252 03:25:08,280 --> 03:25:09,440 COME CLOSER AMONG THOSE WITH 4253 03:25:09,440 --> 03:25:10,280 MOOD DISORDERS LATER TO AT THE 4254 03:25:10,280 --> 03:25:34,720 BEGINNING. 4255 03:25:34,720 --> 03:25:36,000 WE STILL NEED LOOK AT OVER PLANS 4256 03:25:36,000 --> 03:25:37,840 AND WE HAVE THE LINKED INFANTS 4257 03:25:37,840 --> 03:25:39,920 AS PART OF OUR STUDY. 4258 03:25:39,920 --> 03:25:42,240 WE CAN EXAMINE THINGS SUCH AS 4259 03:25:42,240 --> 03:25:44,920 HOW DO OUTCOMES COMPARE FOR 4260 03:25:44,920 --> 03:25:54,120 INFANTS OF OTHERS WHO HAD SEVERE 4261 03:25:54,120 --> 03:25:56,120 MATERNAL MORBIDITY AND WE'LL GET 4262 03:25:56,120 --> 03:25:57,600 ACCESS TO MEDICAID DATA SOON AND 4263 03:25:57,600 --> 03:25:59,680 WE CAN SEE HOW OUR FINDINGS 4264 03:25:59,680 --> 03:26:02,880 DIFFER FROM THOSE IN THE 4265 03:26:02,880 --> 03:26:20,720 COMMERCIALLY INSURED POPULATIONS 4266 03:26:20,720 --> 03:26:21,360 AS WELL AS MEDICAID I'LL PAUSE 4267 03:26:21,360 --> 03:26:23,680 HERE AND HAPPY TO ANSWER 4268 03:26:23,680 --> 03:26:25,200 QUESTIONS AND THE NEXT SLIDE IS 4269 03:26:25,200 --> 03:26:31,720 THE PARENT GRANT AND SUPPLEMENT. 4270 03:26:31,720 --> 03:26:33,040 >> AUDIENCE ENTER QUESTIONS IN 4271 03:26:33,040 --> 03:26:37,800 THE Q&A. 4272 03:26:37,800 --> 03:26:39,760 I HAVE A QUESTION. 4273 03:26:39,760 --> 03:26:41,800 IT SEEMED LIKE THE FOLKS WHO HAD 4274 03:26:41,800 --> 03:26:44,200 THE MOST DIFFICULTIES WITH 4275 03:26:44,200 --> 03:26:49,920 PERINATAL MOOD AND ANXIETY 4276 03:26:49,920 --> 03:26:51,760 DISORDERS ALSO HAD OTHER TYPES 4277 03:26:51,760 --> 03:26:59,240 OF MORBIDITY AND MORTALITY. 4278 03:26:59,240 --> 03:27:04,600 DO YOU HAVE AN IDEA WHAT IS 4279 03:27:04,600 --> 03:27:09,880 DRIVING THOSE ARE THERE VARIABLE 4280 03:27:09,880 --> 03:27:15,800 OR CAUSAL? 4281 03:27:15,800 --> 03:27:22,880 >> WE ARE LOOKING AT OTHER CORE 4282 03:27:22,880 --> 03:27:24,680 MORBID CONDITIONS AND WHAT DOES 4283 03:27:24,680 --> 03:27:27,680 SEF OVER MATERNAL MORBIDITY LOOK 4284 03:27:27,680 --> 03:27:30,560 LIKE WITH AND WITHOUT PERINATAL 4285 03:27:30,560 --> 03:27:32,800 MOOD AND ANXIETY DISORDER AND 4286 03:27:32,800 --> 03:27:38,280 OTHER CONDITIONS AND IT SEEMS TO 4287 03:27:38,280 --> 03:27:50,240 ALMOST BE LAYERED AFFECTS AND 4288 03:27:50,240 --> 03:27:52,320 WHETHER THEY HAD MENTAL HEALTH 4289 03:27:52,320 --> 03:27:54,000 CONDITIONS COMING INTO PREGNANCY 4290 03:27:54,000 --> 03:27:56,760 VERSUS NO ONSET DURING AND 4291 03:27:56,760 --> 03:27:56,960 AFTER. 4292 03:27:56,960 --> 03:27:58,720 WE CAN LOOK AT SOME OF THOSE 4293 03:27:58,720 --> 03:28:00,880 THINGS THOUGH SOME IS BASED ON 4294 03:28:00,880 --> 03:28:03,800 HOW OFTEN THEY COME IN OR WHO 4295 03:28:03,800 --> 03:28:05,240 DETECTS WHAT. 4296 03:28:05,240 --> 03:28:07,560 I THINK IT'S INTERESTING AND 4297 03:28:07,560 --> 03:28:08,760 IMPORTANT BECAUSE I THINK 4298 03:28:08,760 --> 03:28:10,120 SOMETIMES WE WANT TO SPLIT OUT 4299 03:28:10,120 --> 03:28:12,800 THINK ABOUT MENTAL HEALTH FROM 4300 03:28:12,800 --> 03:28:13,800 PHYSICAL HEALTH OUTCOMES AND YET 4301 03:28:13,800 --> 03:28:16,520 AS WE ALL PROBABLY KNOW HERE ON 4302 03:28:16,520 --> 03:28:21,000 THE CALL THAT THEY OVERLAP AND 4303 03:28:21,000 --> 03:28:21,600 MAY BE MUTUALLY INFLUENCING ONE 4304 03:28:21,600 --> 03:28:30,600 ANOTHER. 4305 03:28:30,600 --> 03:28:32,040 >> THANK YOU. 4306 03:28:32,040 --> 03:28:33,400 IS THERE A REASON YOU USED 4307 03:28:33,400 --> 03:28:35,320 DISCHARGE TO 42 DAYS INSTEAD OF 4308 03:28:35,320 --> 03:28:39,160 60 DAYS AS ACA COVERS POSTPARTUM 4309 03:28:39,160 --> 03:28:41,920 CARE UNTIL 60 DAYS CURRENTLY? 4310 03:28:41,920 --> 03:28:45,360 >> REMEMBER THIS IS PRIVATELY 4311 03:28:45,360 --> 03:28:47,240 INSURED SO WE'RE NOT LOOKING AT 4312 03:28:47,240 --> 03:28:48,680 MEDICAID AND USED THE 42 DAYS 4313 03:28:48,680 --> 03:28:50,200 BECAUSE THAT'S HOW I BELIEVE THE 4314 03:28:50,200 --> 03:28:54,640 CDC HAS BEEN LOOKING PRIMARILY 4315 03:28:54,640 --> 03:28:57,320 AT AND OUR PREVIOUS SPEAKER 4316 03:28:57,320 --> 03:28:59,920 CATEGORIZED THE SEVERE MATERNAL 4317 03:28:59,920 --> 03:29:01,000 MORBIDITY IN THE SAME WAY WHEN 4318 03:29:01,000 --> 03:29:03,360 WE LOOKED AT THE TIME WINDOWS 4319 03:29:03,360 --> 03:29:03,800 TYPICALLY USED. 4320 03:29:03,800 --> 03:29:07,160 I BELIEVE WE COULD EASILY DO 4321 03:29:07,160 --> 03:29:09,360 WHAT WE DID AND USE THE 60 DAY 4322 03:29:09,360 --> 03:29:11,840 WINDOW AND SEE WHAT WE WOULD 4323 03:29:11,840 --> 03:29:12,880 FIND. 4324 03:29:12,880 --> 03:29:15,360 WE COULD DEFINITELY DO THAT BUT 4325 03:29:15,360 --> 03:29:18,240 THAT'S WHY WE USED THE 42 DAYS. 4326 03:29:18,240 --> 03:29:20,920 >> OKAY. 4327 03:29:20,920 --> 03:29:21,320 THANK YOU. 4328 03:29:21,320 --> 03:29:25,200 WE'LL NOW ON TO OUR NEXT 4329 03:29:25,200 --> 03:29:27,560 SPEAKER, DR. GUILLE. 4330 03:29:27,560 --> 03:29:32,040 I HOPE I SAID THAT CORRECTLY. 4331 03:29:32,040 --> 03:29:34,680 SHE'LL BE SHEIKING ON LEVERAGING 4332 03:29:34,680 --> 03:30:00,200 TECHNOLOGY TO IMPROVE SCREENING. 4333 03:30:00,200 --> 03:30:01,360 >> IT'S A PLEASURE TO BE HERE. 4334 03:30:01,360 --> 03:30:03,720 I WANT TO TALK ABOUT HOW WE'RE 4335 03:30:03,720 --> 03:30:05,760 LEVERAGING TECHNOLOGY TO IMPROVE 4336 03:30:05,760 --> 03:30:08,120 SCREENING INTERVENTION FOR 4337 03:30:08,120 --> 03:30:10,360 PREGNANT AND POSTPARTUM PERSONS. 4338 03:30:10,360 --> 03:30:15,760 THERE'LL BE TIME WHEN I REFER TO 4339 03:30:15,760 --> 03:30:21,880 WOMEN AND I'LL TRY TO USE MORE 4340 03:30:21,880 --> 03:30:23,200 GENDER NEUTRAL TERMS GOING 4341 03:30:23,200 --> 03:30:23,600 THROUGH. 4342 03:30:23,600 --> 03:30:26,760 BRIEF BACKGROUND ON THIS. 4343 03:30:26,760 --> 03:30:31,360 MATERNAL MENTAL HEALTH COMMONS 4344 03:30:31,360 --> 03:30:35,440 ARE PROBLEM AND THE CARRY A 4345 03:30:35,440 --> 03:30:36,480 SIGNIFICANT MATERNAL MORBIDITY 4346 03:30:36,480 --> 03:30:39,360 AND MORTALITY FOR BIRTHING 4347 03:30:39,360 --> 03:30:41,960 PERSONS AND AFFECT CHILDREN'S 4348 03:30:41,960 --> 03:30:51,800 HEALTH AND THEIR DEVELOPMENT. 4349 03:30:51,800 --> 03:30:55,960 WE KNOW 1 IN 9 ARE DUE TO 4350 03:30:55,960 --> 03:30:57,000 MATERNAL HEALTH CONDITIONS AND 4351 03:30:57,000 --> 03:31:02,640 THEY'RE 100% PREVENTIBLE AND 4352 03:31:02,640 --> 03:31:06,360 WE'RE SCREENING EVERYONE FOR 4353 03:31:06,360 --> 03:31:11,400 MENTAL HEALTH AND SUBSTANCE USE 4354 03:31:11,400 --> 03:31:12,800 AND INTIMATE PARTNER VIOLENCE 4355 03:31:12,800 --> 03:31:13,960 AND THERE'S RACIAL DISPARITIES 4356 03:31:13,960 --> 03:31:17,000 IN THAT. 4357 03:31:17,000 --> 03:31:22,320 SO SIMILARLY WE KNOW 1 IN 4 4358 03:31:22,320 --> 03:31:23,840 WOMEN WILL MAKE IT TO TREATMENT 4359 03:31:23,840 --> 03:31:27,200 AND SIGNIFICANT RACIAL 4360 03:31:27,200 --> 03:31:28,920 DISPARITIES WITH BLACK WOMEN 4361 03:31:28,920 --> 03:31:30,080 SIGNIFICANTLY LESS LIKELY TO 4362 03:31:30,080 --> 03:31:31,360 MAKE IT TO TREATMENT IN 4363 03:31:31,360 --> 03:31:33,360 COMPARISON TO WHITE WOMEN. 4364 03:31:33,360 --> 03:31:35,440 WE KNOW A LOT ABOUT WHY THIS 4365 03:31:35,440 --> 03:31:37,040 SCREENING AND BRIEF INTERVENTION 4366 03:31:37,040 --> 03:31:38,800 OR TREATMENT DOESN'T HAPPEN IN 4367 03:31:38,800 --> 03:31:39,520 PRACTICE. 4368 03:31:39,520 --> 03:31:40,320 PROVIDERS WILL TELL US THEY 4369 03:31:40,320 --> 03:31:41,960 DON'T HAVE THE TIME AND NOT 4370 03:31:41,960 --> 03:31:42,800 FAMILIAR WITH THE TOOLS AND 4371 03:31:42,800 --> 03:31:44,000 DON'T HAVE THE KNOWLEDGE TO 4372 03:31:44,000 --> 03:31:46,400 ASSESS THESE CONDITIONS OR TREAT 4373 03:31:46,400 --> 03:31:49,200 THEM OR THEY DON'T HAVE THE 4374 03:31:49,200 --> 03:31:50,800 PROVIDERS AVAILABLE TO REFER THE 4375 03:31:50,800 --> 03:31:56,600 PATIENTS TO TREAT THEM. 4376 03:31:56,600 --> 03:32:00,440 FOR PATIENTS STIGMA IS A BARRIER 4377 03:32:00,440 --> 03:32:02,800 IN SEEK TREATMENT AND FEAR OF 4378 03:32:02,800 --> 03:32:06,000 SOCIAL AND LEGAL CONSEQUENCES 4379 03:32:06,000 --> 03:32:08,440 AND THERE'S A LACK OF ACCESSIBLE 4380 03:32:08,440 --> 03:32:08,720 PROVIDERS. 4381 03:32:08,720 --> 03:32:11,080 ALL THESE BARRIERS SEEM TO BE 4382 03:32:11,080 --> 03:32:14,000 MORE PRONOUNCED IN BLACK WOMEN 4383 03:32:14,000 --> 03:32:25,200 COMPARED TO WHITE WOMEN. 4384 03:32:25,200 --> 03:32:26,440 WE STARTED THINKING ABOUT THE 4385 03:32:26,440 --> 03:32:31,080 BARRIERS TO SCREENING AND HOW TO 4386 03:32:31,080 --> 03:32:33,480 LEVERAGE TECHNOLOGY TO OVERCOME 4387 03:32:33,480 --> 03:32:35,000 BARRIERS AND WE NAMED THE 4388 03:32:35,000 --> 03:32:36,000 PROGRAM LISTENING TO WOMEN AND 4389 03:32:36,000 --> 03:32:41,360 THAT WAS WHAT THE WOMEN WANTED 4390 03:32:41,360 --> 03:32:47,920 US TO NAME IT. 4391 03:32:47,920 --> 03:32:53,600 IT LOOKS LIKE WOMEN COMING TO 4392 03:32:53,600 --> 03:32:58,480 PRENATAL CARE AND SAID WE'LL 4393 03:32:58,480 --> 03:33:01,040 MONITOR AND DO THAT VIA TEXT 4394 03:33:01,040 --> 03:33:02,800 MESSAGE IF THAT'S OKAY AND THEY 4395 03:33:02,800 --> 03:33:04,600 GIVE THEIR NUMBER AND CELL PHONE 4396 03:33:04,600 --> 03:33:06,040 CARRIER AND SEND A TEXT MESSAGE 4397 03:33:06,040 --> 03:33:07,480 THAT GOES THROUGH THE SCREENING 4398 03:33:07,480 --> 03:33:08,040 PROCESS. 4399 03:33:08,040 --> 03:33:10,360 THEY CAN DO THE SCREENINGS WHILE 4400 03:33:10,360 --> 03:33:11,800 WAITING FOR THE PROVIDER OR WHEN 4401 03:33:11,800 --> 03:33:14,000 THEY GET HOME. 4402 03:33:14,000 --> 03:33:15,320 AS SOON AS THEY COMPLETE A 4403 03:33:15,320 --> 03:33:16,880 SCREENING OUR CARE COORDINATOR 4404 03:33:16,880 --> 03:33:18,600 IS NOTIFIED AND CAN GO IN THE 4405 03:33:18,600 --> 03:33:19,880 SYSTEM AND SEE WHO THE HIGH 4406 03:33:19,880 --> 03:33:25,240 PRIORITY PEOPLE TO CALL AND SEE 4407 03:33:25,240 --> 03:33:27,480 ALL THE SCREENING INFORMATION 4408 03:33:27,480 --> 03:33:31,600 THEY SCREEN POSITIVE PEOPLE BY 4409 03:33:31,600 --> 03:33:40,360 PHONE AND DO THIS WITH THE EARLY 4410 03:33:40,360 --> 03:33:42,360 FACTORS AND FOR SOCIAL 4411 03:33:42,360 --> 03:33:44,720 DETERMINATES OF HEALTH AND USE 4412 03:33:44,720 --> 03:33:46,000 MOTIVATIONAL INTERVIEWING TO GET 4413 03:33:46,000 --> 03:33:48,120 THEM TO TREATMENT AND THEN THE 4414 03:33:48,120 --> 03:33:49,240 COORDINATOR SUMMARIZES THE 4415 03:33:49,240 --> 03:33:51,320 INFORMATION AND SENDS THE NOTE 4416 03:33:51,320 --> 03:33:52,800 TO THE PRIMARY CARE TEAM THAT 4417 03:33:52,800 --> 03:33:55,200 WOMAN IS WORKING WITH SO 4418 03:33:55,200 --> 03:33:57,520 EVERYBODY KNOWS WHAT'S HAPPENING 4419 03:33:57,520 --> 03:33:59,000 WITH THIS PERSON'S MENTAL HEALTH 4420 03:33:59,000 --> 03:34:00,480 OR SUBSTANCE USE TREATMENT. 4421 03:34:00,480 --> 03:34:02,320 WE DO THE SCREENING IN PREGNANCY 4422 03:34:02,320 --> 03:34:05,320 AND IT CAN OCCUR AT EACH 4423 03:34:05,320 --> 03:34:06,880 TRIMESTER ONE MONTH AFTER 4424 03:34:06,880 --> 03:34:11,600 DELIVERY AND EVERY THREE MONTHS 4425 03:34:11,600 --> 03:34:13,880 FROM DELIVERY 18 MONTHS 4426 03:34:13,880 --> 03:34:19,280 POSTPARTUM WE PILOT SYSTEM AND 4427 03:34:19,280 --> 03:34:20,560 WOMEN WERE WILLING TO TAKE PART 4428 03:34:20,560 --> 03:34:21,800 IN THIS. 4429 03:34:21,800 --> 03:34:24,320 WE COMPARED THEIR OUTCOMES IN 4430 03:34:24,320 --> 03:34:27,760 TERMS OF BEING SCREENED AND 4431 03:34:27,760 --> 03:34:28,360 SCREENING POSITIVE AND RECEIVING 4432 03:34:28,360 --> 03:34:31,640 TREATMENT TO THE WOMEN IN THE 4433 03:34:31,640 --> 03:34:36,960 CLINIC BEFORE GETTING THE 4434 03:34:36,960 --> 03:34:38,080 INTERVENTION REFERRAL TO 4435 03:34:38,080 --> 03:34:39,360 TREATMENT. 4436 03:34:39,360 --> 03:34:41,240 WE MADE SURE THE GROUPS WERE 4437 03:34:41,240 --> 03:34:42,200 SIMILAR AND WHERE THEY WEREN'T 4438 03:34:42,200 --> 03:34:45,480 WE CONTROLLED FOR AGE, RACE AND 4439 03:34:45,480 --> 03:34:46,360 MARITAL STATUS. 4440 03:34:46,360 --> 03:34:48,120 SO THIS IS OUR MAIN OUTCOME AND 4441 03:34:48,120 --> 03:34:50,240 WHAT WE SEE HERE IS THAT WHEN 4442 03:34:50,240 --> 03:34:53,200 WOMEN WERE ENROLLED IN LISTENING 4443 03:34:53,200 --> 03:34:55,520 TO WOMEN IN COMPARISON THEY WERE 4444 03:34:55,520 --> 03:34:57,200 MORE LIKELY TO BE SCREENED 4445 03:34:57,200 --> 03:35:00,600 OVERALL AND TWICE AS LIKELY TO 4446 03:35:00,600 --> 03:35:01,600 SCREEN POSITIVE AND ONE AND A 4447 03:35:01,600 --> 03:35:03,400 HALF MORE TIMES LIKELY TO BE 4448 03:35:03,400 --> 03:35:04,280 REFERRED TO TREATMENT AND FIVE 4449 03:35:04,280 --> 03:35:06,680 TIMES MORE LIKELY TO MAKE IT TO 4450 03:35:06,680 --> 03:35:06,960 TREATMENT. 4451 03:35:06,960 --> 03:35:11,360 WE LOOKED AT RACE FOR BLACK 4452 03:35:11,360 --> 03:35:12,760 VERSUS WHITE WOMEN AND WITHIN 4453 03:35:12,760 --> 03:35:13,760 EACH SCREENING METHOD. 4454 03:35:13,760 --> 03:35:16,360 I'LL PULL THE RESULTS FOR YOU. 4455 03:35:16,360 --> 03:35:17,840 WHAT WE SEE IS THE IN PERSON 4456 03:35:17,840 --> 03:35:21,520 SCREENING VERSUS LISTENING TO 4457 03:35:21,520 --> 03:35:24,000 WOMEN AND BLACK WOMEN ARE LESS 4458 03:35:24,000 --> 03:35:26,280 LIKELY TO SCREEN POSITIVE IN 4459 03:35:26,280 --> 03:35:27,960 COMPARISON TO WHITE WOMEN AND IN 4460 03:35:27,960 --> 03:35:29,800 PERSON SCREENING BLACK WOMEN ARE 4461 03:35:29,800 --> 03:35:31,360 SIGNIFICANTLY LESS LIKELY TO 4462 03:35:31,360 --> 03:35:32,800 MAKE IT TO TREATMENT IN 4463 03:35:32,800 --> 03:35:35,360 COMPARISON TO WHITE WOMEN AND 4464 03:35:35,360 --> 03:35:36,600 DIDN'T SEE THAT SAME FINDING 4465 03:35:36,600 --> 03:35:37,520 WITH LISTENING TO WOMEN. 4466 03:35:37,520 --> 03:35:41,280 THE IMPROVED STUDY IS WE WANTED 4467 03:35:41,280 --> 03:35:42,600 TO WORK WITH WOMEN TO UNDERSTAND 4468 03:35:42,600 --> 03:35:44,000 WHAT THEY THOUGHT OF THIS 4469 03:35:44,000 --> 03:35:47,600 PROGRAM TO REALLY GET THEIR 4470 03:35:47,600 --> 03:35:50,680 FEEDBACK AND MAKE ANY NECESSARY 4471 03:35:50,680 --> 03:35:53,880 MODIFICATIONS TO THE CONTRARY OF 4472 03:35:53,880 --> 03:36:03,560 OR FUNCTION AND CERTAIN WOMEN 4473 03:36:03,560 --> 03:36:05,880 MET CRITERIA FOR ANY MENTAL 4474 03:36:05,880 --> 03:36:07,080 HEALTH OR SUBSTANCE USE DISORDER 4475 03:36:07,080 --> 03:36:10,280 AND WE RECRUITED THEM TRUE TRIAL 4476 03:36:10,280 --> 03:36:12,000 FACT AND SOCIAL MEDIA AND 4477 03:36:12,000 --> 03:36:13,960 INDIRECTLY THROUGH OUR OBSTETRIC 4478 03:36:13,960 --> 03:36:15,960 AND MATERNAL HEALTH PROVIDERS 4479 03:36:15,960 --> 03:36:18,240 AND PEER-RECOVERY ORGANIZATIONS. 4480 03:36:18,240 --> 03:36:20,600 THE WAY THEY WORKED WAS ALL VIA 4481 03:36:20,600 --> 03:36:21,720 ZOOM. 4482 03:36:21,720 --> 03:36:24,480 THIS WAS COLLECTED DURING COVID 4483 03:36:24,480 --> 03:36:26,360 AND USED INTERVIEW GUIDES AND 4484 03:36:26,360 --> 03:36:28,080 GOT FEEDBACK FROM WOMEN ABOUT 4485 03:36:28,080 --> 03:36:29,840 THE OVERALL PROGRAM AND FUNCTION 4486 03:36:29,840 --> 03:36:35,000 AND CONTENT AND WHAT THEY 4487 03:36:35,000 --> 03:36:36,520 RECOMMENDED AND BELIEFS ABOUT 4488 03:36:36,520 --> 03:36:38,000 MENTAL HEALTH AND SUBSTANCE USE 4489 03:36:38,000 --> 03:36:41,920 PARTICULARLY FOR PERI PARTUM 4490 03:36:41,920 --> 03:36:44,760 PEOPLE. 4491 03:36:44,760 --> 03:36:48,600 WE DID QUALITATIVE ANALYSES. 4492 03:36:48,600 --> 03:37:02,720 OVER 11 MONTHS WE ENROLLED 85. 4493 03:37:02,720 --> 03:37:05,040 MEAN AGE IS 28. 4494 03:37:05,040 --> 03:37:08,600 WE HAVE A PREDOMINANT 4495 03:37:08,600 --> 03:37:10,000 NON-HISPANIC BLACK POPULATION. 4496 03:37:10,000 --> 03:37:11,000 AND MENTAL HEALTH CONDITIONS 4497 03:37:11,000 --> 03:37:14,760 OVER 40% HAD A MENTAL HEALTH 4498 03:37:14,760 --> 03:37:16,600 CONDITION MOOD OR ANXIETY 4499 03:37:16,600 --> 03:37:19,320 DISORDER AND A LITTLE OVER A 4500 03:37:19,320 --> 03:37:23,080 THIRD HAD MARIJUANA OR ALCOHOL 4501 03:37:23,080 --> 03:37:24,200 USE DISORDER AND WANTED TO HEAR 4502 03:37:24,200 --> 03:37:25,200 FROM WOMEN WHO DIDN'T HAVE 4503 03:37:25,200 --> 03:37:25,840 MENTAL HEALTH CONDITIONS AS 4504 03:37:25,840 --> 03:37:36,360 WELL. 4505 03:37:36,360 --> 03:37:40,680 AND IN THIS NAVIGATING REMARKS 4506 03:37:40,680 --> 03:37:43,360 WERE IT DIDN'T TAKE MUCH TIME 4507 03:37:43,360 --> 03:37:44,040 AND WAS STRAIGHTFORWARD. 4508 03:37:44,040 --> 03:37:45,920 THE SECOND WAS COMFORT ON 4509 03:37:45,920 --> 03:37:48,200 ANSWERING THE QUESTIONS VIA TEXT 4510 03:37:48,200 --> 03:37:51,760 MESSAGE AND TALKING ON THE PHONE 4511 03:37:51,760 --> 03:37:56,160 WIN SOMEBODY THEY NEVER MET 4512 03:37:56,160 --> 03:37:57,120 RELATED TO SUBSTANCE USE AND 4513 03:37:57,120 --> 03:37:59,720 PEOPLE PREFERRED THE TEXT 4514 03:37:59,720 --> 03:38:01,200 MESSAGING AND HAVING SOMEBODY TO 4515 03:38:01,200 --> 03:38:03,600 TALK TO BY PHONE JUST FELT LIKE 4516 03:38:03,600 --> 03:38:05,880 THEY HAD MORE PRIVACY AND THEY 4517 03:38:05,880 --> 03:38:06,800 WEREN'T BEING JUDGED IN PERSON 4518 03:38:06,800 --> 03:38:08,400 AND DIDN'T HAVE THE FACE TO FACE 4519 03:38:08,400 --> 03:38:11,400 COMPONENT AND THE MORE THEY WERE 4520 03:38:11,400 --> 03:38:13,000 REASSURED THIS WAS CONFIDENTIAL 4521 03:38:13,000 --> 03:38:14,000 THE MORE COMFORTABLE THEY SAID 4522 03:38:14,000 --> 03:38:15,360 THEY'D BE TO USE IT. 4523 03:38:15,360 --> 03:38:17,360 THEY ALSO REALLY LIKED THE CARE 4524 03:38:17,360 --> 03:38:19,200 COORDINATOR WAS GOING TO HELP 4525 03:38:19,200 --> 03:38:20,200 NAVIGATE SOME COMPLEX SYSTEMS IN 4526 03:38:20,200 --> 03:38:22,240 TERMS OF MENTAL HEALTH AND 4527 03:38:22,240 --> 03:38:23,720 SOCIAL SERVICES AND THAT SORT OF 4528 03:38:23,720 --> 03:38:28,600 THING IF THAT WERE RELEVANT. 4529 03:38:28,600 --> 03:38:31,000 SO ONE OF THE THEMES THAT CAME 4530 03:38:31,000 --> 03:38:32,600 WAS POTENTIAL BARRIERS TO EVEN 4531 03:38:32,600 --> 03:38:34,920 DISCUSSING MENTAL HEALTH AND 4532 03:38:34,920 --> 03:38:36,960 SUBSTANCE USE AND WOMEN TALKED 4533 03:38:36,960 --> 03:38:39,320 ABOUT WHAT THEY GREW UP IN IN 4534 03:38:39,320 --> 03:38:40,480 THEIR CULTURE AND A LOT OF 4535 03:38:40,480 --> 03:38:41,920 FAMILIES SAID YOU DON'T TALK 4536 03:38:41,920 --> 03:38:47,800 ABOUT THIS. 4537 03:38:47,800 --> 03:38:51,040 YOU DON'T SHARE YOUR PROBLEMS 4538 03:38:51,040 --> 03:38:53,720 AND YOU PRAY ABOUT THIS AND IN 4539 03:38:53,720 --> 03:38:55,560 THE BLACK COMMUNITY THEY'LL CALL 4540 03:38:55,560 --> 03:38:56,600 YOU CRAZY AND SAID EVERYBODY 4541 03:38:56,600 --> 03:38:58,000 WENT THROUGH THIS AND WE DEALT 4542 03:38:58,000 --> 03:39:03,440 WITH IT IT'S NOT THAT BAD IT'S 4543 03:39:03,440 --> 03:39:11,520 JUST A PHASE. 4544 03:39:11,520 --> 03:39:14,440 THAT'S WHAT THEY GREW UP WITH. 4545 03:39:14,440 --> 03:39:17,000 AND THEY HAD DISTRUST WITH 4546 03:39:17,000 --> 03:39:19,200 DEPARTMENT OF SOCIAL SERVICES 4547 03:39:19,200 --> 03:39:21,160 INTERVENTION IF THEY HAD A 4548 03:39:21,160 --> 03:39:22,480 SUBSTANCE USE ISSUE AND TALKED 4549 03:39:22,480 --> 03:39:23,480 ABOUT THE HEALTH SYSTEM LETTING 4550 03:39:23,480 --> 03:39:26,280 THEM DOWN WHEN THEY TOLD PEOPLE 4551 03:39:26,280 --> 03:39:29,760 ABOUT THESE PROBLEMS IT WASN'T 4552 03:39:29,760 --> 03:39:34,480 ALWAYS FOLLOWED UP ON OR A 4553 03:39:34,480 --> 03:39:36,400 PERSON HAD TO LEAVE AND TURNOVER 4554 03:39:36,400 --> 03:39:37,920 IN STAFF AND SOME INSURANCE 4555 03:39:37,920 --> 03:39:40,680 WEREN'T ALWAYS ACCEPTED SO A LOT 4556 03:39:40,680 --> 03:39:42,280 OF BARRIERS TO TREATMENT. 4557 03:39:42,280 --> 03:39:47,200 ON FACILITATORS, ONE THING WAS 4558 03:39:47,200 --> 03:39:48,120 TALKING ABOUT SEEING OTHER BLACK 4559 03:39:48,120 --> 03:39:49,440 HEALTH CARE WORKERS AND HOW 4560 03:39:49,440 --> 03:39:52,720 IMPORTANT THAT WAS TO TALK ABOUT 4561 03:39:52,720 --> 03:39:54,600 SOME CONDITIONS AND APPRECIATED 4562 03:39:54,600 --> 03:39:55,800 WHEN PROVIDERS PUT IT OUT AND 4563 03:39:55,800 --> 03:39:57,640 TALKED ABOUT THIS AND PROVIDED 4564 03:39:57,640 --> 03:39:58,960 INFORMATION AND SAID, HEY, THIS 4565 03:39:58,960 --> 03:40:01,120 IS COMMON, DON'T BE ASHAMED. 4566 03:40:01,120 --> 03:40:02,320 IF YOU NEED HELP IT'S AVAILABLE 4567 03:40:02,320 --> 03:40:05,880 AND OVERALL LISTENING AND 4568 03:40:05,880 --> 03:40:06,320 HEARING THEIR NEEDS. 4569 03:40:06,320 --> 03:40:08,840 IN SUMMARY, WHAT WE FOUND SO FAR 4570 03:40:08,840 --> 03:40:11,160 IS THIS PROGRAM IS EASY TO USE. 4571 03:40:11,160 --> 03:40:13,160 PEOPLE PREFER THE TEXT MESSAGING 4572 03:40:13,160 --> 03:40:14,800 AND THE PHONE BASED INTERVENTION 4573 03:40:14,800 --> 03:40:17,880 OPPOSED TO PHASE TO PHASE 4574 03:40:17,880 --> 03:40:19,520 INTERVIEWS ON THE ISSUES. 4575 03:40:19,520 --> 03:40:23,600 THE MODIFICATIONS, WE TALK ABOUT 4576 03:40:23,600 --> 03:40:25,640 CONFIDENTIALITY A LOT WHEN WE 4577 03:40:25,640 --> 03:40:27,200 ENROLL SYSTEM BUT WE NEED TO 4578 03:40:27,200 --> 03:40:28,240 EMPHASIZE THAT MORE AT 4579 03:40:28,240 --> 03:40:31,360 ENROLLMENT AND VIA THE CARE 4580 03:40:31,360 --> 03:40:31,640 COORDINATOR. 4581 03:40:31,640 --> 03:40:35,160 WE WANT TO BE ABLE TO PROVIDE 4582 03:40:35,160 --> 03:40:35,960 MORE CONCORDANCE IN TERMS OF 4583 03:40:35,960 --> 03:40:39,000 RACE AND CAN DO THAT IN TERMS OF 4584 03:40:39,000 --> 03:40:41,520 REFERRALS WANT TO STIGMA AND 4585 03:40:41,520 --> 03:40:42,800 CONCERNS AND DISTRUST AROUND THE 4586 03:40:42,800 --> 03:40:44,360 HEALTH CARE SYSTEM AND CAN DO 4587 03:40:44,360 --> 03:40:55,920 THAT IN ENROLLMENT AND WITH OUR 4588 03:40:55,920 --> 03:40:56,240 CA 4589 03:40:56,240 --> 03:40:57,560 COORDINATOR. 4590 03:40:57,560 --> 03:41:01,000 HAVING PERI PARTUM WOMEN TALKING 4591 03:41:01,000 --> 03:41:02,760 ABOUT THESE DESTIGMATIZES IT FOR 4592 03:41:02,760 --> 03:41:03,840 OTHER WOMEN AND INTEGRATING THIS 4593 03:41:03,840 --> 03:41:08,320 FOR ALL WOMEN COMING THROUGH IN 4594 03:41:08,320 --> 03:41:09,080 PREGNANCY OR POSTPARTUM IN 4595 03:41:09,080 --> 03:41:09,600 GETTING SCREENED. 4596 03:41:09,600 --> 03:41:11,520 I WANT TO THANK OUR FUNDERS AND 4597 03:41:11,520 --> 03:41:12,040 OUR COLLABORATORS. 4598 03:41:12,040 --> 03:41:15,680 WE HAVE A FANTASTIC TEAM AND 4599 03:41:15,680 --> 03:41:17,880 JUST I WANTED TO ACKNOWLEDGE 4600 03:41:17,880 --> 03:41:18,080 THAT. 4601 03:41:18,080 --> 03:41:25,720 I'LL STOP THERE. 4602 03:41:25,720 --> 03:41:26,760 >> THAT WAS GREAT. 4603 03:41:26,760 --> 03:41:32,520 I HAVE LOTS OF QUESTIONS. 4604 03:41:32,520 --> 03:41:37,960 ONE QUESTION I HAVE IS WITH THE 4605 03:41:37,960 --> 03:41:38,920 COORDINATORS THEY NOT ONLY WORK 4606 03:41:38,920 --> 03:41:40,800 WITH WOMEN ON THEIR MENTAL 4607 03:41:40,800 --> 03:41:42,000 HEALTH AND SUBSTANCE USE ABOUT 4608 03:41:42,000 --> 03:41:43,400 THE SOCIAL NEEDS THEY HAD. 4609 03:41:43,400 --> 03:41:45,680 DO YOU THINK THAT MAY HAVE 4610 03:41:45,680 --> 03:41:49,920 HELPED TO LEAD TO SOME OF THE 4611 03:41:49,920 --> 03:41:50,480 POSITIVE OUTCOMES YOU FOUND? 4612 03:41:50,480 --> 03:41:52,600 >> I THINK SO. 4613 03:41:52,600 --> 03:41:54,640 IF YOU'RE IN THE MODE OF -- IF 4614 03:41:54,640 --> 03:41:55,360 YOU HAVE FOOD SCARCITY OR 4615 03:41:55,360 --> 03:41:56,680 HOUSING INSTABILITY, THOSE ARE 4616 03:41:56,680 --> 03:41:57,920 YOUR PRIORITIES. 4617 03:41:57,920 --> 03:42:01,120 YOU CAN'T PRIORITIZE YOUR OWN 4618 03:42:01,120 --> 03:42:02,360 MENTAL HEALTH AND WELL BEING 4619 03:42:02,360 --> 03:42:03,840 UNLESS EVERYTHING ELSE IS TAKEN 4620 03:42:03,840 --> 03:42:04,920 CARE OF. 4621 03:42:04,920 --> 03:42:07,520 WE KNOW WE NEED TO MAKE SURE 4622 03:42:07,520 --> 03:42:08,960 WOMEN FEEL SAFE AND STABLE AND 4623 03:42:08,960 --> 03:42:11,440 THEIR FAMILIES FEEL SAFE AND 4624 03:42:11,440 --> 03:42:12,880 STABLE TO CONTEMPLATE TAKING 4625 03:42:12,880 --> 03:42:14,480 CARE OF THEMSELVES. 4626 03:42:14,480 --> 03:42:16,000 I THINK IT HELPS. 4627 03:42:16,000 --> 03:42:17,560 I WOULD LOVE TO LOOK AT THAT AND 4628 03:42:17,560 --> 03:42:19,040 SEE IF THERE'S MEDIATING AFFECT 4629 03:42:19,040 --> 03:42:34,120 IN GETTING TO TREATMENT. 4630 03:42:34,120 --> 03:42:35,520 >> THANK YOU. 4631 03:42:35,520 --> 03:42:37,800 MENTIONED ABOUT THE RATES OF 4632 03:42:37,800 --> 03:42:42,480 DEPRESSION AMONG BLACK WOMEN. 4633 03:42:42,480 --> 03:42:49,560 IN THE IN PERSON USUAL 4634 03:42:49,560 --> 03:42:55,200 INTERVENTION SELF-REPORT OR A 4635 03:42:55,200 --> 03:42:56,960 PROVIDER SCREEN TOOL. 4636 03:42:56,960 --> 03:42:58,960 >> IT'S A SCREENING TOOL AND 4637 03:42:58,960 --> 03:43:00,280 THAT'S WHAT I MEAN BY POSITIVE 4638 03:43:00,280 --> 03:43:04,000 SCREEN IF THEY ENDORSED THOSE 4639 03:43:04,000 --> 03:43:09,760 THAT ARE STRUCTURED AND 4640 03:43:09,760 --> 03:43:10,800 STANDARDIZED. 4641 03:43:10,800 --> 03:43:12,800 >> WERE SOME SELF-REPORTING OR A 4642 03:43:12,800 --> 03:43:13,760 PROVIDER DOING THE SCREENING? 4643 03:43:13,760 --> 03:43:14,360 >> THE PROVIDER WAS DOING THE 4644 03:43:14,360 --> 03:43:20,240 SCREENING. 4645 03:43:20,240 --> 03:43:21,240 >> THANK YOU FOR THAT 4646 03:43:21,240 --> 03:43:21,600 CLARIFICATION. 4647 03:43:21,600 --> 03:43:23,120 HERE'S A QUESTION FROM THE Q&A. 4648 03:43:23,120 --> 03:43:25,520 THIS IS WONDERFUL WORK, LIKE HOW 4649 03:43:25,520 --> 03:43:27,720 YOU HAVE INTEGRATED PATIENT 4650 03:43:27,720 --> 03:43:29,800 NAVIGATION AND HEALTH WITH 4651 03:43:29,800 --> 03:43:30,400 SOCIAL DETERMINATES OF HEALTH 4652 03:43:30,400 --> 03:43:31,360 WITH SCREENING. 4653 03:43:31,360 --> 03:43:36,640 THIS IS A GREAT ROLE TO ADD FOR 4654 03:43:36,640 --> 03:43:37,160 LAY HEALTH CARE/PATIENT 4655 03:43:37,160 --> 03:43:39,840 NAVIGATORS TO DO TEXT-BASED 4656 03:43:39,840 --> 03:43:41,760 SCREENING AND LINKAGE TO CARE. 4657 03:43:41,760 --> 03:43:47,680 THAT WAS A BIG THUMBS UP. 4658 03:43:47,680 --> 03:43:49,960 ONE OTHER QUESTION, WHAT 4659 03:43:49,960 --> 03:43:51,000 STANDARDIZED SCREENING TOOLS DID 4660 03:43:51,000 --> 03:43:55,360 YOU USE? 4661 03:43:55,360 --> 03:44:02,720 >> WITHIN OUR STATE SOUTH 4662 03:44:02,720 --> 03:44:03,760 CAROLINA DID YOUR PARENTS USE, 4663 03:44:03,760 --> 03:44:06,200 DID YOUR PEER USE, DID YOUR 4664 03:44:06,200 --> 03:44:07,720 PARTNER USE, HAVE YOU USED IN 4665 03:44:07,720 --> 03:44:08,400 THE PAST MONTH. 4666 03:44:08,400 --> 03:44:10,200 THAT'S A SENSITIVE SCREENING FOR 4667 03:44:10,200 --> 03:44:12,000 SUBSTANCE USE. 4668 03:44:12,000 --> 03:44:14,720 IF A WOMAN CHECKS OFF ANY OF 4669 03:44:14,720 --> 03:44:20,840 THOSE ITEMS SHE'LL GET THE 4670 03:44:20,840 --> 03:44:22,840 NIAIDA SPECIFIC SCREENING TOOL 4671 03:44:22,840 --> 03:44:24,760 FOR SUBSTANCE AND IF SHE CHECKS 4672 03:44:24,760 --> 03:44:27,200 OFF IN THE LAST WEEK OR TWO 4673 03:44:27,200 --> 03:44:30,240 STRUGGLES WITH MOOD OR ANXIETY 4674 03:44:30,240 --> 03:44:31,800 SHE'LL COMPLETE A DEPRESSION 4675 03:44:31,800 --> 03:44:33,320 SCALE AND WE HAVE ALCOHOL 4676 03:44:33,320 --> 03:44:33,960 QUESTIONS AS WELL. 4677 03:44:33,960 --> 03:44:36,360 IF SOMEONE CHECKS OFF THEY ARE 4678 03:44:36,360 --> 03:44:38,520 FEELING UNSAFE IN ANY WAY IN 4679 03:44:38,520 --> 03:44:40,840 THEIR HOME, THEY'RE ALSO GOING 4680 03:44:40,840 --> 03:44:43,640 COMPLETE THE DEPRESSION SCALE AS 4681 03:44:43,640 --> 03:44:43,920 WELL. 4682 03:44:43,920 --> 03:44:45,800 SO THOSE ARE OUR SCALES. 4683 03:44:45,800 --> 03:44:49,880 >> THANK YOU VERY MUCH, DR. 4684 03:44:49,880 --> 03:44:50,760 DR. GUILLE. 4685 03:44:50,760 --> 03:44:51,480 >> THANK YOU. 4686 03:44:51,480 --> 03:44:56,200 OUR NEXT SPEAKER OF THE DAY IS 4687 03:44:56,200 --> 03:44:57,120 DR. SUAREZ PRESENTING POSTPARTUM 4688 03:44:57,120 --> 03:44:58,440 OPIOID MORTALITY IN MEDICAID 4689 03:44:58,440 --> 03:44:58,720 PATIENTS. 4690 03:44:58,720 --> 03:45:16,440 WELCOME. 4691 03:45:16,440 --> 03:45:18,120 >> SO THANKS SO MUCH FOR HAVING 4692 03:45:18,120 --> 03:45:21,000 ME HERE TO PRESENT OUR WORK ON 4693 03:45:21,000 --> 03:45:23,000 POSTPARTUM OPIOID RELATED 4694 03:45:23,000 --> 03:45:24,040 MORTALITY IN MEDICAID PATIENTS 4695 03:45:24,040 --> 03:45:25,520 MIAMI I'M PRESENTING THIS ON 4696 03:45:25,520 --> 03:45:29,240 BEHALF OF OUR PROJECT P.I.s AND 4697 03:45:29,240 --> 03:45:31,440 ALSO ON BEHALF OF THE REST OF 4698 03:45:31,440 --> 03:45:35,120 OUR PROJECT TEAM. 4699 03:45:35,120 --> 03:45:36,520 A BRIEF BACKGROUND. 4700 03:45:36,520 --> 03:45:38,000 OPIOID OVERDOSE ACCOUNTS FOR UP 4701 03:45:38,000 --> 03:45:41,640 TO 10% OF THE ASSOCIATED DEATHS 4702 03:45:41,640 --> 03:45:44,600 AND WE THINK PREGNANT PATIENTS 4703 03:45:44,600 --> 03:45:46,440 WITH OPIOID USE DISORDERS MAY BE 4704 03:45:46,440 --> 03:45:48,560 PARTICULARLY VULNERABLE TO OTHER 4705 03:45:48,560 --> 03:45:50,120 CAUSES OF DEATH IN THE 4706 03:45:50,120 --> 03:45:51,200 POSTPARTUM PERIOD BUT THERE 4707 03:45:51,200 --> 03:45:53,360 HASN'T BEEN GREAT DATA TO BE 4708 03:45:53,360 --> 03:45:54,600 ABLE TO CHARACTERIZE THE DEATHS 4709 03:45:54,600 --> 03:45:55,560 IN THIS SPECIFIC OPIOID USE 4710 03:45:55,560 --> 03:46:08,640 DISORDER POPULATION. 4711 03:46:08,640 --> 03:46:10,280 MEDICAID COVERS ABOUT 75% OF 4712 03:46:10,280 --> 03:46:12,360 THIS POPULATION AND NOW WE CAN 4713 03:46:12,360 --> 03:46:14,120 USE A LINKAGE TO THE NATIONAL 4714 03:46:14,120 --> 03:46:16,000 DEATH INDEX. 4715 03:46:16,000 --> 03:46:17,760 NOW WE CAN LOOK AT COMORBIDITIES 4716 03:46:17,760 --> 03:46:21,840 AND PATTERNS AND OTHER FACTORS 4717 03:46:21,840 --> 03:46:26,120 THAT LEAD TO THE DEATH IN THIS 4718 03:46:26,120 --> 03:46:28,440 POPULATION. 4719 03:46:28,440 --> 03:46:29,880 THE OBJECTIVES OF THE STUDY WERE 4720 03:46:29,880 --> 03:46:31,800 FIRST TO FACILITATE THE LINKAGE 4721 03:46:31,800 --> 03:46:35,760 OF THE DATA BETWEEN OUR MEDICAID 4722 03:46:35,760 --> 03:46:37,280 DATA AND THEN DO DESCRIPTIVE 4723 03:46:37,280 --> 03:46:40,640 WORK AROUND THE TIMING AND RISK 4724 03:46:40,640 --> 03:46:42,160 FACTORS FOR POSTPARTUM MATERNAL 4725 03:46:42,160 --> 03:46:42,360 DEATHS. 4726 03:46:42,360 --> 03:46:47,880 WE'RE TALKING ABOUT DEATHS 4727 03:46:47,880 --> 03:46:53,800 HAPPENING AND THEN WE WANT TO 4728 03:46:53,800 --> 03:46:56,640 ZOOM IN ON THE PREGNANT PATIENTS 4729 03:46:56,640 --> 03:46:57,800 WITH HAVE OPIOID USE DISORDER 4730 03:46:57,800 --> 03:46:59,840 AND BE ABLE TO DESCRIBE THE 4731 03:46:59,840 --> 03:47:03,480 CAUSES OF THEIR NON-OPIOID 4732 03:47:03,480 --> 03:47:04,120 OVERDOSE RELATED DEATHS IN THE 4733 03:47:04,120 --> 03:47:12,160 POSTPARTUM PERIOD. 4734 03:47:12,160 --> 03:47:14,200 TO DO THIS WE HAVE AN 4735 03:47:14,200 --> 03:47:16,200 ESTABLISHED COHORT IN THIS DATA 4736 03:47:16,200 --> 03:47:19,720 FOR THIS PROJECT WE'RE LOOKING 4737 03:47:19,720 --> 03:47:22,000 AT YEARS 2006 THROUGH 2013. 4738 03:47:22,000 --> 03:47:24,040 2013 IS NOT AS RECENT AS WE'D 4739 03:47:24,040 --> 03:47:26,840 LIKE IT TO BE BUT UNFORTUNATELY 4740 03:47:26,840 --> 03:47:30,800 THAT'S THE LATEST AVAILABLE DATA 4741 03:47:30,800 --> 03:47:33,640 FOR THE NATIONAL DEATH INDEX. 4742 03:47:33,640 --> 03:47:35,600 THE MEDICAID DATA INCLUDES 4743 03:47:35,600 --> 03:47:37,160 PATIENTS COVERED UNDER STATE 4744 03:47:37,160 --> 03:47:41,320 MEDICAID TERMS AND LINKED THAT 4745 03:47:41,320 --> 03:47:42,760 TO DATA WHICH GIVES OUR DATA 4746 03:47:42,760 --> 03:47:48,640 DEATH IN OUR PRIMARY AND LEADING 4747 03:47:48,640 --> 03:47:53,600 CAUSE OF DEATH. 4748 03:47:53,600 --> 03:47:57,080 WE HAD PREGNANCIES WITH A DEATH 4749 03:47:57,080 --> 03:47:59,040 DOCUMENTED BETWEEN THE END OF 4750 03:47:59,040 --> 03:48:01,360 DELIVERY AND POSTPARTUM YEAR AND 4751 03:48:01,360 --> 03:48:05,360 102 WOMEN WHO DIED WITH A 4752 03:48:05,360 --> 03:48:06,280 DOCUMENTED DIAGNOSIS OF OPIOID 4753 03:48:06,280 --> 03:48:08,440 USE DISORDER WHICH IN OUR CASE 4754 03:48:08,440 --> 03:48:11,880 IS EITHER A DIAGNOSIS CODE FOR 4755 03:48:11,880 --> 03:48:14,120 OPIOID USE DISORDER OR EVIDENCE 4756 03:48:14,120 --> 03:48:19,000 OF METHADONE TREATMENT AND WE 4757 03:48:19,000 --> 03:48:20,720 HAD ABOUT 5 MILLION PREGNANCY 4758 03:48:20,720 --> 03:48:26,520 DID NOT END IN DEATH. 4759 03:48:26,520 --> 03:48:29,520 AND FOR OUR FIRST AIM WE ARE 4760 03:48:29,520 --> 03:48:30,640 DESCRIBING OPIOID RELATED 4761 03:48:30,640 --> 03:48:31,800 OVERDOSE DEATHS. 4762 03:48:31,800 --> 03:48:36,920 SO WE DEFINED THIS USING THE 4763 03:48:36,920 --> 03:48:38,880 SUBSTANCE USE DEFINITION. 4764 03:48:38,880 --> 03:48:44,360 PATIENTS NEED TO HAVE A PRIMARY 4765 03:48:44,360 --> 03:48:45,360 CAUSE OF DEATH CONTRIBUTING TO 4766 03:48:45,360 --> 03:48:49,920 OVERDOSE AND A CAUSE OF DEATH 4767 03:48:49,920 --> 03:48:51,200 RELATED TO OPIOIDS. 4768 03:48:51,200 --> 03:48:53,000 AND THEN IN AIM 202:WE'RE LOOK 4769 03:48:53,000 --> 03:48:56,760 AT OTHER CAUSES OF DEATH. 4770 03:48:56,760 --> 03:48:58,800 WE USED THE CODE DO CREATE 4771 03:48:58,800 --> 03:49:01,720 CATEGORIES WHICH ARE INCLUDED IN 4772 03:49:01,720 --> 03:49:02,560 THE TABLE HERE. 4773 03:49:02,560 --> 03:49:16,800 ANYTHING PREGNANCY RELATED, 4774 03:49:16,800 --> 03:49:18,800 CIRCULETORY SYSTEM AND 4775 03:49:18,800 --> 03:49:20,680 ACCIDENTS, OTHER DISEASES WHICH 4776 03:49:20,680 --> 03:49:22,480 IS A BIT OF A CATCHALL OF 4777 03:49:22,480 --> 03:49:23,600 EVERYTHING THAT DIDN'T GET 4778 03:49:23,600 --> 03:49:25,560 CAPTURED BY ANY CATEGORIES ABOVE 4779 03:49:25,560 --> 03:49:28,720 AND HAVE A PROPORTION OF DEATHS 4780 03:49:28,720 --> 03:49:32,160 THAT DIDN'T HAVE AN IC10 PRIMARY 4781 03:49:32,160 --> 03:49:33,000 CAUSE OF DEATH REPORT IN THE 4782 03:49:33,000 --> 03:49:38,520 NDI. 4783 03:49:38,520 --> 03:49:40,080 WE DO A RISK FACTOR ANALYSIS AS 4784 03:49:40,080 --> 03:49:41,280 PART OF THIS WORK WHERE WE'RE 4785 03:49:41,280 --> 03:49:43,520 LOOKING AT RISK FACTORS FOR 4786 03:49:43,520 --> 03:49:45,320 OPIOID OVERDOSE DEATH AND 4787 03:49:45,320 --> 03:49:48,000 BECAUSE OF THE NATURE OF 4788 03:49:48,000 --> 03:49:48,880 MEDICAID DATA WE'RE NOT 4789 03:49:48,880 --> 03:49:49,800 NECESSARILY OBSERVING A WOMAN 4790 03:49:49,800 --> 03:49:52,800 FOR THE ENTIRE TIME FROM 4791 03:49:52,800 --> 03:49:57,800 DELIVERY UNTIL THE END ONE-YEAR 4792 03:49:57,800 --> 03:50:00,000 PERIOD. 4793 03:50:00,000 --> 03:50:03,000 WE MATCHED THE PATIENT TO THOSE 4794 03:50:03,000 --> 03:50:04,600 THAT DIDN'T HAVE EVIDENCE OF 4795 03:50:04,600 --> 03:50:07,360 DEATH ON THE TIME AVAILABLE 4796 03:50:07,360 --> 03:50:08,280 OBSERVED IN THE DATABASE. 4797 03:50:08,280 --> 03:50:11,080 AT THE TIME OF THE DEATH WE 4798 03:50:11,080 --> 03:50:12,000 MATCHED TO A PATIENT STILL UNDER 4799 03:50:12,000 --> 03:50:13,800 OBSERVATION AND STILL HAD A 4800 03:50:13,800 --> 03:50:16,200 MEDICAID ENROLLMENT ON THE SAME 4801 03:50:16,200 --> 03:50:17,800 NUMBER OF DELIVERY AND ALSO 4802 03:50:17,800 --> 03:50:21,680 MATCHED WITH STATE. 4803 03:50:21,680 --> 03:50:23,280 ONCE WE HAVE THIS MATCH 4804 03:50:23,280 --> 03:50:27,200 POPULATION WE DEFINED A SERIES 4805 03:50:27,200 --> 03:50:28,800 OF BASELINE RISK FACTORS 4806 03:50:28,800 --> 03:50:29,760 SPECIFICALLY MEASURED IN THE 4807 03:50:29,760 --> 03:50:31,680 LAST THREE MONTHS BEFORE THE 4808 03:50:31,680 --> 03:50:33,480 DELIVERY AND THEN SOME RISK 4809 03:50:33,480 --> 03:50:34,800 FACTORS THAT AREN'T MEASURED 4810 03:50:34,800 --> 03:50:36,920 BETWEEN THE DELIVERY DATE UNTIL 4811 03:50:36,920 --> 03:50:38,520 THE MATCHED DEATH DATE. 4812 03:50:38,520 --> 03:50:40,960 OR AT LEAST THE MATCHED NUMBER 4813 03:50:40,960 --> 03:50:45,760 OF DAYS POST DELIVERY. 4814 03:50:45,760 --> 03:50:48,360 SO WE'LL JUMP INTO RESULTS. 4815 03:50:48,360 --> 03:50:50,160 FIRST I'LL PRESENT OUR 4816 03:50:50,160 --> 03:50:52,880 CUMULATIVE MORTALITY INCIDENTS. 4817 03:50:52,880 --> 03:50:55,240 SO FIRST THIS IS IN ALL PREGNANT 4818 03:50:55,240 --> 03:50:57,920 PATIENTS IN OUR MEDICAID 4819 03:50:57,920 --> 03:51:01,480 POPULATION FROM 2007 TO 2013 AND 4820 03:51:01,480 --> 03:51:04,400 THE NUMBERS ARE CUMULATIVE 4821 03:51:04,400 --> 03:51:05,760 INCIDENT ESTIMATES AT ONE YEAR 4822 03:51:05,760 --> 03:51:08,280 AND YOU CAN SEE IT IN THE FIGURE 4823 03:51:08,280 --> 03:51:08,760 BELOW. 4824 03:51:08,760 --> 03:51:11,360 SO AMONG ALL PREGNANT PATIENTS 4825 03:51:11,360 --> 03:51:13,960 THE ALL-CAUSE MORTALITY 4826 03:51:13,960 --> 03:51:16,440 CUMULATIVE INCIDENTS WAS 51 PER 4827 03:51:16,440 --> 03:51:17,680 100,000 DELIVERIES AND 4828 03:51:17,680 --> 03:51:20,400 SPECIFICALLY FOR OPIOID OVERDOSE 4829 03:51:20,400 --> 03:51:26,160 IT WAS 5.4 PER 100,000 4830 03:51:26,160 --> 03:51:26,800 DELIVERIES. 4831 03:51:26,800 --> 03:51:30,640 IF WE ZOOM IN ON THE POPULATION 4832 03:51:30,640 --> 03:51:31,920 OF OPIOID USE DISORDER THE 4833 03:51:31,920 --> 03:51:34,080 DEATHS ARE HIGHER IN THIS 4834 03:51:34,080 --> 03:51:34,400 POPULATION. 4835 03:51:34,400 --> 03:51:39,960 ALL CAUSE MORTALITY IS ABOUT SIX 4836 03:51:39,960 --> 03:51:43,680 TIMES HIGHER AND OPIOID OVERDOSE 4837 03:51:43,680 --> 03:51:47,160 DEATH IS MUCH HIGHER AT 115 PER 4838 03:51:47,160 --> 03:51:50,040 100,000 DELIVERIES IN THE OPIOID 4839 03:51:50,040 --> 03:52:00,200 USE DISORDER POPULATION. 4840 03:52:00,200 --> 03:52:04,400 SOW A ROUGH COMPARISON BETWEEN 4841 03:52:04,400 --> 03:52:10,720 OUR OPIOID USE DISORDER PREG 4842 03:52:10,720 --> 03:52:12,680 PREGNANCIES IN RED AND THIS IS 4843 03:52:12,680 --> 03:52:13,560 RANKED BY CAUSE. 4844 03:52:13,560 --> 03:52:18,120 OPIOID OVERDOSE DEATH IS ON TOP 4845 03:52:18,120 --> 03:52:20,360 AND THEN THE NEXT MOST COMMON 4846 03:52:20,360 --> 03:52:22,800 CAUSE OF DEATH IN THIS GROUP WAS 4847 03:52:22,800 --> 03:52:24,280 OVER OVERDOSE WHICH BECAUSE WE 4848 03:52:24,280 --> 03:52:26,240 ARE RELYING ONLY ON THE PRIMARY 4849 03:52:26,240 --> 03:52:28,600 AND CONTRIBUTING CAUSES, THIS 4850 03:52:28,600 --> 03:52:31,360 OTHER OVERDOSE CATEGORY MAY 4851 03:52:31,360 --> 03:52:32,680 INCLUDE SOME WOMEN THAT DIED OF 4852 03:52:32,680 --> 03:52:34,360 OPIOID OVERDOSE BUT DIDN'T HAVE 4853 03:52:34,360 --> 03:52:37,120 THE PROPER CODING. 4854 03:52:37,120 --> 03:52:39,800 AND WE HAVE SUICIDE AND 4855 03:52:39,800 --> 03:52:41,960 PREGNANCY AND DELIVERY RELATED 4856 03:52:41,960 --> 03:52:43,440 DEATHS AS THE NEXT MOST COMMON 4857 03:52:43,440 --> 03:52:43,920 CAUSES. 4858 03:52:43,920 --> 03:52:46,600 AND I THINK A BIG TAKEAWAY FROM 4859 03:52:46,600 --> 03:52:48,760 THIS FIGURE IS THAT THE 4860 03:52:48,760 --> 03:52:50,600 INCIDENTS OF DEATH ACROSS ALL 4861 03:52:50,600 --> 03:52:53,120 THESE CATEGORIES IS SO MUCH 4862 03:52:53,120 --> 03:52:56,800 HIGHER IN THE OUD PREGNANCIES 4863 03:52:56,800 --> 03:52:57,920 THAN IN THE FULL POPULATION. 4864 03:52:57,920 --> 03:52:59,360 REGARDLESS OF CAUSE EXCEPT FOR 4865 03:52:59,360 --> 03:53:02,680 THE CANCER CATEGORY ON THE 4866 03:53:02,680 --> 03:53:05,920 BOTTOM WHICH WE DIDN'T HAVE ANY 4867 03:53:05,920 --> 03:53:11,960 DEATHS REPORTED BUT ACROSS ALL 4868 03:53:11,960 --> 03:53:14,800 INCIDENT THE INCIDENTS ARE MUCH 4869 03:53:14,800 --> 03:53:15,000 HIGHER. 4870 03:53:15,000 --> 03:53:16,600 I'LL BRIEFLY TALK THROUGH THE 4871 03:53:16,600 --> 03:53:21,120 RISK FACTORS FOR OPIOID OVERDOSE 4872 03:53:21,120 --> 03:53:25,000 DEATH SPECIFICALLY. 4873 03:53:25,000 --> 03:53:27,600 I'LL GIVE THE HIGHLIGHTS HERE. 4874 03:53:27,600 --> 03:53:29,920 SOME OF THESE THINGS ARE 4875 03:53:29,920 --> 03:53:34,560 NON-RISK FACTORS FOR OPIOID 4876 03:53:34,560 --> 03:53:36,480 OVERDOSE DEATHS AND MORE COMMON 4877 03:53:36,480 --> 03:53:37,560 AMONG WHITE PREGNANT PATIENTS 4878 03:53:37,560 --> 03:53:44,520 THAN OTHER RACES. 4879 03:53:44,520 --> 03:53:45,880 OBSTETRIC MORBIDITY AND MENTAL 4880 03:53:45,880 --> 03:53:47,040 HEALTH MORBIDITY WERE ASSOCIATED 4881 03:53:47,040 --> 03:53:49,000 WITH AN INCREASED RISK OF 4882 03:53:49,000 --> 03:54:09,720 OVERDOSE DEATH. 4883 03:54:09,720 --> 03:54:13,160 AND WE LOOKED AT OPIOID 4884 03:54:13,160 --> 03:54:19,760 DISPENSING DURING PREGNANCY AND 4885 03:54:19,760 --> 03:54:25,920 PVRP AND THOSE WITH -- 4886 03:54:29,360 --> 03:54:31,760 AND SOME HAD HIGHER UTILIZATION 4887 03:54:31,760 --> 03:54:34,040 THAN THEIR MATCH CONTROLS 4888 03:54:34,040 --> 03:54:38,640 OVERALL SO IN PATIENT 4889 03:54:38,640 --> 03:54:39,280 HOSPITALIZATIONS AND OUT-PATIENT 4890 03:54:39,280 --> 03:54:44,320 VISITS. 4891 03:54:44,320 --> 03:54:46,200 HERE I'M SWITCHING BACK TO 4892 03:54:46,200 --> 03:54:48,520 LOOKING AT THE POPULATION WITH 4893 03:54:48,520 --> 03:54:49,640 OPIOID USE DISORDER AND 4894 03:54:49,640 --> 03:54:51,760 HIGHLIGHT A COUPLE FACTORS. 4895 03:54:51,760 --> 03:54:56,000 AGAIN WE SEE AN ASSOCIATION WITH 4896 03:54:56,000 --> 03:54:58,240 WHITE RACE ETHNICITY VERSUS 4897 03:54:58,240 --> 03:55:00,040 OTHER GROUPS UNFORTUNATELY OUR 4898 03:55:00,040 --> 03:55:01,360 SAMPLE SIZE IS A LITTLE TOO 4899 03:55:01,360 --> 03:55:05,440 SMALL TO GET MORE SPECIFIC WITH 4900 03:55:05,440 --> 03:55:08,680 THOSE CATEGORIES HERE AND THEN 4901 03:55:08,680 --> 03:55:10,640 OF COURSE DOCUMENTATION OF OTHER 4902 03:55:10,640 --> 03:55:12,920 SUBSTANCE USE DISORDER NOT JUST 4903 03:55:12,920 --> 03:55:14,440 THE OPIOID CODES WHERE 4904 03:55:14,440 --> 03:55:15,560 ASSOCIATED WITH AN INCREASE OF 4905 03:55:15,560 --> 03:55:17,680 OPIOID OVERDOSE DEATH IN THIS 4906 03:55:17,680 --> 03:55:18,120 POPULATION. 4907 03:55:18,120 --> 03:55:21,840 AND THEN WE SEE A PRETTY STRONG 4908 03:55:21,840 --> 03:55:23,600 PROTECTIVE ASSOCIATION FOR THE 4909 03:55:23,600 --> 03:55:26,600 USE OF OPIOID AGONISTS IN 4910 03:55:26,600 --> 03:55:27,800 PREGNANCY AND POSTPARTUM. 4911 03:55:27,800 --> 03:55:41,880 THIS IS DOCUMENTED USE OF 4912 03:55:41,880 --> 03:55:44,800 METHADONE AND THOSE WHO HAD 4913 03:55:44,800 --> 03:55:46,960 OPIOID AGONIST TREATMENT DURING 4914 03:55:46,960 --> 03:55:48,240 THE DIFFERENT PERIOD. 4915 03:55:48,240 --> 03:55:50,560 AMONG THE PATIENT WHO'S DID DIE 4916 03:55:50,560 --> 03:55:54,720 OF AN OPIOID OVERDOSE DEATH 13% 4917 03:55:54,720 --> 03:55:56,160 HAD TREATMENT POSTPARTUM 4918 03:55:56,160 --> 03:55:58,560 COMPARED TO 41% AND 34% IN THE 4919 03:55:58,560 --> 03:56:01,280 PATIENT DID NOT DIE. 4920 03:56:01,280 --> 03:56:03,400 THESE COUNTS ARE PROBABLY A 4921 03:56:03,400 --> 03:56:05,880 LITTLE BIT LOW BECAUSE IT'S 4922 03:56:05,880 --> 03:56:07,360 CAPTURING MEDICAID REIMBURSEMENT 4923 03:56:07,360 --> 03:56:12,040 OPIOID AGONIST THERAPY BUT THE 4924 03:56:12,040 --> 03:56:14,160 STRONG ASSOCIATION WOULD STILL 4925 03:56:14,160 --> 03:56:23,360 HOLD. 4926 03:56:23,360 --> 03:56:26,800 WE SAW WHAT WAS ASSOCIATED WITH 4927 03:56:26,800 --> 03:56:30,320 OVERDOSE DEATH AND DURING 4928 03:56:30,320 --> 03:56:31,480 PREGNANCY AND POSTPARTUM 4929 03:56:31,480 --> 03:56:33,920 UTILIZING BUT WE DIDN'T FIND 4930 03:56:33,920 --> 03:56:36,360 OBSTETRIC MORBIDITY AND OTHER 4931 03:56:36,360 --> 03:56:38,000 MENTAL HEALTH MORBIDITY WAS NOT 4932 03:56:38,000 --> 03:56:44,560 STRONGLY ASSOCIATED WITH RISK OF 4933 03:56:44,560 --> 03:56:47,320 OPIOID RISK OF DEATH AND THERE'S 4934 03:56:47,320 --> 03:56:48,320 A HIGH MORBIDITY IN THESE 4935 03:56:48,320 --> 03:56:51,160 POPULATIONS OVERALL. 4936 03:56:51,160 --> 03:56:54,800 IN SUMMARY, WE DO SEE PREGNANT 4937 03:56:54,800 --> 03:56:56,240 PATIENTS WITH OPIOID USE 4938 03:56:56,240 --> 03:56:57,680 DISORDER HAD SIX TIMES HIGHER 4939 03:56:57,680 --> 03:56:59,160 INCIDENTS OF DEATH IN THE YEAR 4940 03:56:59,160 --> 03:57:01,800 FOLLOWING DELIVERY IN OUR 4941 03:57:01,800 --> 03:57:03,280 GENERAL POPULATION AND THE 4942 03:57:03,280 --> 03:57:05,480 INCIDENT HIGHER REGARDLESS OF 4943 03:57:05,480 --> 03:57:06,800 THE CAUSE WE LOOKED AT. 4944 03:57:06,800 --> 03:57:08,480 OPIOID AGONIST THERAPIES WERE 4945 03:57:08,480 --> 03:57:10,440 STRONGLY ASSOCIATED WITH THE 4946 03:57:10,440 --> 03:57:12,800 DECREASED RISK OF OVERDOSE DEATH 4947 03:57:12,800 --> 03:57:17,480 BUT WE ALSO SEE PATIENTS WITH 4948 03:57:17,480 --> 03:57:19,200 OVERDOSE DEATHS STILL HAD 4949 03:57:19,200 --> 03:57:19,880 CONTACT WITH HEALTH CARE SYSTEM 4950 03:57:19,880 --> 03:57:21,760 BETWEEN DELIVERY AND DEATH. 4951 03:57:21,760 --> 03:57:22,880 POTENTIALLY THERE WERE AVENUES 4952 03:57:22,880 --> 03:57:24,600 FOR INTERVENTION THAT WERE NOT 4953 03:57:24,600 --> 03:57:28,360 MEANT FOR THESE PATIENTS. 4954 03:57:28,360 --> 03:57:29,840 THAT'S WHAT I HAVE AND HAPPY TO 4955 03:57:29,840 --> 03:57:31,720 TAKE SOME QUESTIONS. 4956 03:57:31,720 --> 03:57:35,880 >> THANK YOU, DR. SUAREZ. 4957 03:57:35,880 --> 03:57:38,400 WE DO HAVE A QUESTION IN THE 4958 03:57:38,400 --> 03:57:39,560 Q&A. 4959 03:57:39,560 --> 03:57:40,280 GREAT PRESENTATION. 4960 03:57:40,280 --> 03:57:43,120 I NOTICED FENTANYL WAS CODED AS 4961 03:57:43,120 --> 03:57:47,920 PART OF OPIOID RELATED DEATHS. 4962 03:57:47,920 --> 03:57:52,000 GIVEN THE SUBSTANCE USE DEATHS 4963 03:57:52,000 --> 03:57:53,880 BEING DRIVEN BY FENTANYL IS 4964 03:57:53,880 --> 03:57:55,800 THERE A REASON IT WAS NOT 4965 03:57:55,800 --> 03:57:56,760 INCLUDED IN THE ANALYSIS? 4966 03:57:56,760 --> 03:58:01,560 >> NOT INCLUDED IN THE ANALYSIS 4967 03:58:01,560 --> 03:58:13,000 MEANING? 4968 03:58:13,000 --> 03:58:13,800 >> IT'S MAYBE REFERRING TO THE 4969 03:58:13,800 --> 03:58:17,880 LIST OF CAUSES RELATED TO 4970 03:58:17,880 --> 03:58:18,560 OPIOIDS. 4971 03:58:18,560 --> 03:58:22,040 >> IF YOU CAN TYPE A 4972 03:58:22,040 --> 03:58:24,960 CLARIFICATION IN THE MEANTIME 4973 03:58:24,960 --> 03:58:25,600 THAT WOULD BE GREAT. 4974 03:58:25,600 --> 03:58:30,560 I HAVE A QUESTION QUESTION -- A 4975 03:58:30,560 --> 03:58:34,360 QUESTION THAT MAY BE NAIVE. 4976 03:58:34,360 --> 03:58:36,080 ARE YOU ABLE TO DETERMINE 4977 03:58:36,080 --> 03:58:37,920 WHETHER THE WOMEN DYING IN THE 4978 03:58:37,920 --> 03:58:39,520 POSTPARTUM PERIOD FROM 4979 03:58:39,520 --> 03:58:43,480 APPARENTLY OVERDOSES ARE THEY 4980 03:58:43,480 --> 03:58:44,800 USING DURING PREGNANCY OR HAD A 4981 03:58:44,800 --> 03:58:48,120 PERIOD OF ABSTINENCE AND THEN 4982 03:58:48,120 --> 03:58:49,160 RESTART? 4983 03:58:49,160 --> 03:58:50,680 I KNOW YOU CAN'T GATHER THIS 4984 03:58:50,680 --> 03:58:52,520 THERE THE DATA BUT I'M WONDERING 4985 03:58:52,520 --> 03:58:57,720 IF YOU KNOW ANYTHING ABOUT THAT? 4986 03:58:57,720 --> 03:59:02,360 >> I CAN'T CAPTURE ACTIVE USE. 4987 03:59:02,360 --> 03:59:07,360 WE CAN CAPTURE PRESCRIPTIONS IN 4988 03:59:07,360 --> 03:59:08,560 PREGNANCY AND POSTPARTUM WHICH 4989 03:59:08,560 --> 03:59:11,840 WE DID SEE WAS ASSOCIATED WITH 4990 03:59:11,840 --> 03:59:13,760 AN INCREASE IN OVERDOSE DEATH. 4991 03:59:13,760 --> 03:59:16,600 I DON'T HAVE MUCH MORE INSIGHT 4992 03:59:16,600 --> 03:59:18,120 INTO WHEN THESE MAY BE ACTIVELY 4993 03:59:18,120 --> 03:59:19,440 USING OR NOT. 4994 03:59:19,440 --> 03:59:22,040 WE DO SEE WHEN THEY POTENTIALLY 4995 03:59:22,040 --> 03:59:24,640 ARE ON ACTIVE OPIOID AGONIST 4996 03:59:24,640 --> 03:59:26,440 TREATMENT WHEN IT'S COVERED BY 4997 03:59:26,440 --> 03:59:27,720 MEDICAID THERE'S SOME METHADONE 4998 03:59:27,720 --> 03:59:29,360 TREATMENT WE'RE PROBABLY NOT 4999 03:59:29,360 --> 03:59:30,000 CAPTURING FUNDED THROUGH OTHER 5000 03:59:30,000 --> 03:59:34,560 SOURCES. 5001 03:59:34,560 --> 03:59:38,040 IT'S HARD TO SAY. 5002 03:59:38,040 --> 03:59:40,480 MEDICAID DATA HAS A LOT OF RICH 5003 03:59:40,480 --> 03:59:44,000 DATA BUT NOT SO MUCH IN OTHER 5004 03:59:44,000 --> 03:59:44,240 ARENAS. 5005 03:59:44,240 --> 03:59:45,160 >> STILL VERY INTERESTING 5006 03:59:45,160 --> 03:59:45,360 THOUGH. 5007 03:59:45,360 --> 03:59:51,360 LET ME SEE IF WE HAVE WE 5008 03:59:51,360 --> 03:59:51,760 CLARIFICATION. 5009 03:59:51,760 --> 03:59:53,680 IT'S REFERRING TO THE LIST OF 5010 03:59:53,680 --> 03:59:55,120 CAUSES OF DEATH. 5011 03:59:55,120 --> 03:59:56,520 FENTANYL IS NOT LISTED. 5012 03:59:56,520 --> 03:59:58,240 I'M WONDERING WHY THAT WAS NOT 5013 03:59:58,240 --> 04:00:04,880 INCLUDED IN THE LIST OF DRUGS. 5014 04:00:04,880 --> 04:00:07,400 >> SO THIS GOES OFF THE 5015 04:00:07,400 --> 04:00:10,000 SUBSTANCE USE AND MENTAL HEALTH 5016 04:00:10,000 --> 04:00:11,000 SERVICES ADMINISTRATION 5017 04:00:11,000 --> 04:00:11,320 DEFINITION. 5018 04:00:11,320 --> 04:00:12,800 WE DIDN'T CREATE THE DEFINITION 5019 04:00:12,800 --> 04:00:13,560 ON OUR OWN. 5020 04:00:13,560 --> 04:00:16,040 I'M ASSUMING MAYBE THERE'S NOT A 5021 04:00:16,040 --> 04:00:17,960 SPECIFIC IC10 CODE RELATED AND 5022 04:00:17,960 --> 04:00:21,800 WOULD PROBABLY BE CAPTURED UNDER 5023 04:00:21,800 --> 04:00:23,360 OTHER CODES LISTED THERE BUT I 5024 04:00:23,360 --> 04:00:28,040 DON'T HAVE ANY GREATER INSIGHT 5025 04:00:28,040 --> 04:00:29,280 ON FENTANYL SPECIFICALLY BUT 5026 04:00:29,280 --> 04:00:31,680 ASSUMING IT WOULD STILL BE 5027 04:00:31,680 --> 04:00:33,600 CAPTURED IT UNDER ONE OF THE 5028 04:00:33,600 --> 04:00:36,600 CATEGORIES OVER HERE. 5029 04:00:36,600 --> 04:00:39,120 IT'S ALSO A GOOD TIME TO NOTE 5030 04:00:39,120 --> 04:00:41,600 WE'RE LIMITED BY WHAT IS PUT IN 5031 04:00:41,600 --> 04:00:44,040 THE CODES IN THE NDI. 5032 04:00:44,040 --> 04:00:46,320 I THINK WE SAW THE PATIENTS 5033 04:00:46,320 --> 04:00:48,360 STILL HAD A -- THE SECOND 5034 04:00:48,360 --> 04:00:51,120 LEADING CAUSE OF DEATH WAS 5035 04:00:51,120 --> 04:00:53,200 OVERDOSES THAT DIDN'T MEET OUR 5036 04:00:53,200 --> 04:00:57,640 DEFINITIONS SO I'M SURE THERE'S 5037 04:00:57,640 --> 04:01:00,280 OVERDOSES IN THAT GROUPING THAT 5038 04:01:00,280 --> 04:01:08,000 COULD BE ATTRIBUTE ID TO 5039 04:01:08,000 --> 04:01:12,680 OVERDOSING NOT CAPTURED IN THE 5040 04:01:12,680 --> 04:01:13,120 CODES. 5041 04:01:13,120 --> 04:01:15,600 >> THAT MAKE SENSE YOU'RE 5042 04:01:15,600 --> 04:01:17,600 WORKING WITH JUST THAT HAS BEEN 5043 04:01:17,600 --> 04:01:18,000 CODED TO DATE. 5044 04:01:18,000 --> 04:01:18,840 >> YEAH. 5045 04:01:18,840 --> 04:01:19,800 >> OKAY. 5046 04:01:19,800 --> 04:01:20,840 WELL, THANK YOU VERY MUCH. 5047 04:01:20,840 --> 04:01:23,440 WITH THAT I THINK WE WILL WRAP 5048 04:01:23,440 --> 04:01:25,960 UP AND GET READY TO TURN IT OVER 5049 04:01:25,960 --> 04:01:29,520 TO DR. AKLIN TO CLOSE US OUT. 5050 04:01:29,520 --> 04:01:30,720 I WANT TO SAY THANK YOU VERY 5051 04:01:30,720 --> 04:01:33,360 MUCH TO ALL THREE OF OUR 5052 04:01:33,360 --> 04:01:33,640 PANELISTS. 5053 04:01:33,640 --> 04:01:35,360 THOSE WERE REALLY VERY 5054 04:01:35,360 --> 04:01:36,600 INTERESTING PRESENTATIONS AND 5055 04:01:36,600 --> 04:01:37,960 GOOD LUCK WITH YOUR CONTINUED 5056 04:01:37,960 --> 04:01:42,680 WORK. 5057 04:01:44,200 --> 04:01:45,920 >> THANK YOU AND GOOD AFTERNOON 5058 04:01:45,920 --> 04:01:47,600 AND FULL RECOGNITION I'M IN 5059 04:01:47,600 --> 04:01:49,280 BETWEEN ALL OF YOU AND THE REST 5060 04:01:49,280 --> 04:01:51,560 OF YOUR AFTERNOON, NICE 5061 04:01:51,560 --> 04:01:57,920 PICTURE -- I HADN'T SEEN THAT 5062 04:01:57,920 --> 04:01:59,400 SLIDE I'LL KEEP REMARKS BRIEF 5063 04:01:59,400 --> 04:02:04,240 BUT I FIRST WANT TO SAY TO ALL 5064 04:02:04,240 --> 04:02:06,800 OF YOU THANK YOU FOR THE TIME 5065 04:02:06,800 --> 04:02:09,640 YOU TOOK TODAY TO SHARE WITH US 5066 04:02:09,640 --> 04:02:11,960 YOUR WORK WE HAVE BEEN EXCITED 5067 04:02:11,960 --> 04:02:13,320 TO INTEREST THE OPPORTUNITY TO 5068 04:02:13,320 --> 04:02:14,680 HIGHLIGHT THIS WORK AND MAKE IT 5069 04:02:14,680 --> 04:02:16,040 CLEAR WE'RE SUPPORTIVE OF YOUR 5070 04:02:16,040 --> 04:02:17,760 WORK AND THANK YOU. 5071 04:02:17,760 --> 04:02:19,760 THANK YOU TO DR. LAUREN HILL FOR 5072 04:02:19,760 --> 04:02:22,200 CLOSING OUR FINAL PANEL AND THE 5073 04:02:22,200 --> 04:02:25,160 REST OF OUR ENFORCE MEMBERS 5074 04:02:25,160 --> 04:02:28,600 DOING AN AMAZING JOB GETTING 5075 04:02:28,600 --> 04:02:31,160 THIS WORKSHOP GOING AND TO OUR 5076 04:02:31,160 --> 04:02:31,480 SPEAKERS. 5077 04:02:31,480 --> 04:02:33,600 IT'S BEEN A WONDERFUL WEALTH OF 5078 04:02:33,600 --> 04:02:34,360 KNOWLEDGE AND INFORMATION AND 5079 04:02:34,360 --> 04:02:37,640 I'M SURE I DON'T HAVE TO TELL 5080 04:02:37,640 --> 04:02:41,760 YOU BECAUSE BY VIRTUE OF YOUR 5081 04:02:41,760 --> 04:02:42,880 ATTENDANCE WE RECOGNIZE HOW TO 5082 04:02:42,880 --> 04:02:44,920 IMPORTANT THE TOPIC IS BUT IT 5083 04:02:44,920 --> 04:02:48,240 CONTINUES TO BE AN URGENT 5084 04:02:48,240 --> 04:02:50,040 REMINDER WHILE WE MADE STRIDES 5085 04:02:50,040 --> 04:02:52,000 AND WE STILL HAVE WORK TO DO. 5086 04:02:52,000 --> 04:02:53,520 THERE'S STILL TOO MANY STORIES 5087 04:02:53,520 --> 04:02:55,440 LIKE THE ONE SHARED OF WOMEN WHO 5088 04:02:55,440 --> 04:02:57,560 PRESENT TO OUR HEALTH CARE 5089 04:02:57,560 --> 04:03:04,000 PROVIDERS INDICATING I'VE GOT A 5090 04:03:04,000 --> 04:03:06,440 PROBLEM BUT BEING SENT HOME AND 5091 04:03:06,440 --> 04:03:07,240 MEDICATION AND UNDER SCORING THE 5092 04:03:07,240 --> 04:03:08,800 WORK YOU'RE DOING HERE. 5093 04:03:08,800 --> 04:03:11,400 WE NEED TO CONTINUE TO BROADEN 5094 04:03:11,400 --> 04:03:13,240 OUR EVIDENCE BASED FOR NEW 5095 04:03:13,240 --> 04:03:14,160 INTERVENTIONS AND STRENGTHEN OUR 5096 04:03:14,160 --> 04:03:15,880 INFORMATION OF THE CAUSES BEHIND 5097 04:03:15,880 --> 04:03:16,480 THE DISPARITIES MANY SPOKE TO 5098 04:03:16,480 --> 04:03:20,440 TODAY. 5099 04:03:20,440 --> 04:03:22,520 I'M EXCITED WE'RE DOING THIS 5100 04:03:22,520 --> 04:03:23,600 WORK AND HOPE IT WILL CONTINUE 5101 04:03:23,600 --> 04:03:25,880 TO ASSIST US IN COMING UP WITH 5102 04:03:25,880 --> 04:03:27,360 PREVENTION TO TAKE DOWN SOME OF 5103 04:03:27,360 --> 04:03:29,480 THE STORIES WE HEARD TODAY. 5104 04:03:29,480 --> 04:03:30,760 THE EXAMPLE BEING ABLE TO 5105 04:03:30,760 --> 04:03:31,440 EDUCATE OUR HEALTH CARE 5106 04:03:31,440 --> 04:03:34,560 PROVIDERS TO LOOK FOR SCIENCE OF 5107 04:03:34,560 --> 04:03:34,840 DISTRESS. 5108 04:03:34,840 --> 04:03:36,600 SPENDING THE TIME UP FRONT TO 5109 04:03:36,600 --> 04:03:38,320 ASSESS THE SOCIAL FACTORS ALONG 5110 04:03:38,320 --> 04:03:41,480 WITH THE HEALTH FACTORS WHEN WE 5111 04:03:41,480 --> 04:03:42,440 DO OUR ASSESSMENTS. 5112 04:03:42,440 --> 04:03:44,800 WHAT I ALSO HEARD TODAY WAS THE 5113 04:03:44,800 --> 04:03:46,720 POSSIBILITY OF COLLABORATION. 5114 04:03:46,720 --> 04:03:49,000 I LOVED HEAR FROM THE SPEAKERS 5115 04:03:49,000 --> 04:03:50,560 SAYING I'D LIKE TO TALK TO YOU 5116 04:03:50,560 --> 04:03:51,960 OFFLINE LATER BECAUSE YOUR WORK 5117 04:03:51,960 --> 04:03:53,680 ALIGNS WITH MY WORK. 5118 04:03:53,680 --> 04:03:56,240 THAT IS ALWAYS SOMETHING WE WANT 5119 04:03:56,240 --> 04:03:58,880 DO IS TO CATALYZE CONTINUED 5120 04:03:58,880 --> 04:03:59,560 COLLABORATIONS IN THE SPACE AND 5121 04:03:59,560 --> 04:04:00,880 FULL RECOGNITION IT'S A TEAM 5122 04:04:00,880 --> 04:04:05,640 EFFORT AND TOGETHER YOU ARE A 5123 04:04:05,640 --> 04:04:06,240 TEAM. 5124 04:04:06,240 --> 04:04:07,760 ALSO WANTING TO TALK ABOUT HOW 5125 04:04:07,760 --> 04:04:11,240 IMPORTANT IT IS WE CONTINUE TO 5126 04:04:11,240 --> 04:04:12,200 EXAMINE POTENTIAL TARGETS FOR 5127 04:04:12,200 --> 04:04:12,680 ADDITIONAL RESEARCH. 5128 04:04:12,680 --> 04:04:14,520 WE HEARD A CONVERSATION ABOUT 5129 04:04:14,520 --> 04:04:17,240 THE INTERSECTION OF PRE-EXISTING 5130 04:04:17,240 --> 04:04:17,560 CONDITIONS. 5131 04:04:17,560 --> 04:04:19,000 THE ROLE HEALTH CARE COVERAGE AT 5132 04:04:19,000 --> 04:04:21,000 A STATE AND NATIONAL LEVEL PLAY. 5133 04:04:21,000 --> 04:04:23,400 THE ABILITY TO ASSESS MORE THAN 5134 04:04:23,400 --> 04:04:25,920 THE HEALTH CARE STATUS AND THE 5135 04:04:25,920 --> 04:04:29,000 UTILIZATION OF DIGITAL 5136 04:04:29,000 --> 04:04:29,720 TECHNOLOGY AND HEALTH RECORDS 5137 04:04:29,720 --> 04:04:32,800 AND SO MANY WAYS TO PARTNER TO 5138 04:04:32,800 --> 04:04:33,120 DO THIS. 5139 04:04:33,120 --> 04:04:35,480 I WANT TO TAKE A MOMENT TO TALK 5140 04:04:35,480 --> 04:04:36,160 ABOUT COVID-19. 5141 04:04:36,160 --> 04:04:39,400 WE'RE ALL AWARE THE PANDEMIC HAS 5142 04:04:39,400 --> 04:04:41,560 IMPACTED ALL OF US AND THE 5143 04:04:41,560 --> 04:04:42,800 DISPARITIES WE'VE SEEN WITH 5144 04:04:42,800 --> 04:04:44,560 MATERNAL CARE HAS ONLY BEEN 5145 04:04:44,560 --> 04:04:46,080 HEIGHTENED BY THIS DISPARITY 5146 04:04:46,080 --> 04:04:48,200 THAT HAS COME WITH THE PANDEMIC 5147 04:04:48,200 --> 04:04:50,680 AND IN ESSENCE OF TIME I WON'T 5148 04:04:50,680 --> 04:04:52,800 FOCUS TOO MUCH HERE BUT TO SHARE 5149 04:04:52,800 --> 04:04:54,200 WHILE WE'RE INFORMATION SOME OF 5150 04:04:54,200 --> 04:04:56,360 THE SHORT TERM IMPACTS, FOR 5151 04:04:56,360 --> 04:04:58,120 EXAMPLE, KNOWING THAT PEOPLE WHO 5152 04:04:58,120 --> 04:05:01,480 ARE PREGNANT THAT EXPERIENCE 5153 04:05:01,480 --> 04:05:02,360 COVID-19 THE SYMPTOMS ARE AT 5154 04:05:02,360 --> 04:05:05,080 HIGHER RISK FOR ADVERSE 5155 04:05:05,080 --> 04:05:05,360 OUTCOMES. 5156 04:05:05,360 --> 04:05:07,560 RECOGNIZING THE PHYSICAL, 5157 04:05:07,560 --> 04:05:09,520 EMOTION AND SOCIO ECONOMIC 5158 04:05:09,520 --> 04:05:12,000 COMPONENTS HAVE A MAJOR IMPACT. 5159 04:05:12,000 --> 04:05:13,200 THE OTHER THING WE'VE TALKED 5160 04:05:13,200 --> 04:05:15,480 ABOUT IS CONTINUING TO STUDY THE 5161 04:05:15,480 --> 04:05:16,760 LONG-TERM IMPACT OF THE PANDEMIC 5162 04:05:16,760 --> 04:05:19,080 AND SO AGAIN WITH THE DATA WE'VE 5163 04:05:19,080 --> 04:05:20,000 HEARD PRESENTED TODAY THERE'S 5164 04:05:20,000 --> 04:05:29,800 GAI ST-- A GOOD STEP FORD -- 5165 04:05:29,800 --> 04:05:31,960 FORWARD TO DO THAT AND HAVE 5166 04:05:31,960 --> 04:05:32,960 HIGHLIGHTED INFORMATION OF THE 5167 04:05:32,960 --> 04:05:36,800 DISPARITIES SHARED TODAY. 5168 04:05:36,800 --> 04:05:37,800 I'M EXCITED TO BE ABLE TO 5169 04:05:37,800 --> 04:05:40,200 CONTINUE ON OUR JOURNEY WE 5170 04:05:40,200 --> 04:05:42,000 STARTED WITH IMPROVE. 5171 04:05:42,000 --> 04:05:46,560 YOU HEARD FROM DR. BIANCHI AND 5172 04:05:46,560 --> 04:05:49,800 CLAYTON THIS IS NOT ONLY URGENT 5173 04:05:49,800 --> 04:05:52,600 BUT IMPORTANT MATTER. 5174 04:05:52,600 --> 04:05:54,840 DR. FRANCIS COLLINS CHARGED US 5175 04:05:54,840 --> 04:05:56,560 TO CONTINUE TO MAKE SURE WE 5176 04:05:56,560 --> 04:05:59,040 FOUND THE EVIDENCE, SUPPORT THE 5177 04:05:59,040 --> 04:06:01,800 EVIDENCE AND CONTINUE MOVE 5178 04:06:01,800 --> 04:06:02,600 FORWARD IN THIS SPACE. 5179 04:06:02,600 --> 04:06:04,600 I WANT TO TAKE A MOMENT TO SHARE 5180 04:06:04,600 --> 04:06:06,600 WITH YOU WHAT WE'RE THINK AS WE 5181 04:06:06,600 --> 04:06:16,480 MOVE FORWARD AS DESCRIBED IN THE 5182 04:06:16,480 --> 04:06:24,720 NIH STRATEGIC PLAN DECREASE 5183 04:06:24,720 --> 04:06:26,000 MATERNAL DEATHS IN THE U.S. AND 5184 04:06:26,000 --> 04:06:28,760 IN MANY OF THE STUDIES YOU 5185 04:06:28,760 --> 04:06:30,600 REPORTED BACK ON THESE TWO 5186 04:06:30,600 --> 04:06:31,560 GROUPS CONTINUE TO EXPERIENCE 5187 04:06:31,560 --> 04:06:37,600 ACROSS THE BOARD DISPARITIES. 5188 04:06:37,600 --> 04:06:39,600 THE MATERNAL NEUTRALITY TASK 5189 04:06:39,600 --> 04:06:41,680 FORCE WILL MAKE SURE WE'RE 5190 04:06:41,680 --> 04:06:43,040 STEWARDING THE RESEARCH AND 5191 04:06:43,040 --> 04:06:45,280 HAVING WORK SHOPS LIKE TODAY 5192 04:06:45,280 --> 04:06:48,000 WILL CONTINUE TO GIVE US 5193 04:06:48,000 --> 04:06:49,960 ADDITIONAL INFORMATION TO SHARE 5194 04:06:49,960 --> 04:06:52,800 FORWARD AND TODAY AS THIS 5195 04:06:52,800 --> 04:06:53,960 REGARDING IS BEING DONE WE'LL 5196 04:06:53,960 --> 04:06:56,800 CONTINUE TO SHARE THESE. 5197 04:06:56,800 --> 04:06:59,000 TO CLOSE, WE'RE REALLY EXCITED 5198 04:06:59,000 --> 04:07:00,040 AGAIN FOR THE OPPORTUNITY TO 5199 04:07:00,040 --> 04:07:02,880 CONTINUE TO SEE THE WORK YOU'RE 5200 04:07:02,880 --> 04:07:03,080 DOING. 5201 04:07:03,080 --> 04:07:05,920 FOR OUR AWARDEES FROM HERE 20 5202 04:07:05,920 --> 04:07:11,840 AND 2021 THANK YOU FOR YOUR2 5203 04:07:11,840 --> 04:07:14,880 ATTENDANCE IN BEING HER0ATTENDANCE IN BEIN G HERE. 5204 04:07:14,880 --> 04:07:17,560 YOUR20ATTENDANCE IN BEING HERE. 5205 04:07:17,560 --> 04:07:18,480 THE FOR YOUR CONTINUED 5206 04:07:18,480 --> 04:07:18,800 CONVERSATION. 5207 04:07:18,800 --> 04:07:20,960 BE AWARE ALL THE PROCEEDINGS FOR 5208 04:07:20,960 --> 04:07:25,200 TODAY WILL BE AVAILABLE ON OUR 5209 04:07:25,200 --> 04:07:28,800 IMPROVE WEBSITE AND AGAIN, THANK 5210 04:07:28,800 --> 04:07:29,320 YOU FOR BEING HERE THIS 5211 04:07:29,320 --> 04:07:30,200 AFTERNOON. 5212 04:07:30,200 --> 04:07:30,280 5213 04:07:37,960 --> 04:07:41,680 I SEE DIANA AND JANINE IF 5214 04:07:41,680 --> 04:07:42,720 THERE'S ANY COMMENTS YOU'D LIKE 5215 04:07:42,720 --> 04:07:44,520 TO CLOSE OUT PLEASE SHARE. 5216 04:07:44,520 --> 04:07:46,400 >> I'D LIKE TO ACKNOWLEDGE THE 5217 04:07:46,400 --> 04:07:49,080 WONDERFUL JOB THE MODERATORS DID 5218 04:07:49,080 --> 04:07:50,840 IN SPARKING QUESTIONS WHEN THERE 5219 04:07:50,840 --> 04:07:53,920 WAS A MOMENTARILY PAUSE BUT 5220 04:07:53,920 --> 04:07:55,040 KEEPING EVERYONE ON TIME. 5221 04:07:55,040 --> 04:07:57,800 I'D ALSO LIKE TO ACKNOWLEDGE OUR 5222 04:07:57,800 --> 04:07:59,080 CONTRACTORS FOR THEIR WONDERFUL 5223 04:07:59,080 --> 04:08:02,800 AND SMOOTH AV SUPPORT. 5224 04:08:02,800 --> 04:08:04,600 IT'S BEEN A GREAT DAY. 5225 04:08:04,600 --> 04:08:06,920 IT'S ILLUSTRATED TO ME HOW 5226 04:08:06,920 --> 04:08:10,200 COMPLEX A PROB THIS IS AND THERE 5227 04:08:10,200 --> 04:08:12,120 ARE DIFFERENT PIECES OF THE 5228 04:08:12,120 --> 04:08:14,600 PUZZLE BUT BY COMING TOGETHER 5229 04:08:14,600 --> 04:08:16,440 THERE ARE NEW INSIGHTS THAT WILL 5230 04:08:16,440 --> 04:08:18,120 HELP US ALL MOVE TOWARDS THE 5231 04:08:18,120 --> 04:08:22,800 GOAL OF REDUCING SEVERE MATERNAL 5232 04:08:22,800 --> 04:08:24,520 MORBIDITY AND MORTALITY. 5233 04:08:24,520 --> 04:08:26,280 OVER TO YOU, JANINE FOR THE LAST 5234 04:08:26,280 --> 04:08:26,520 WORD. 5235 04:08:26,520 --> 04:08:30,880 >> I'LL PICK UP ON YOUR COMING 5236 04:08:30,880 --> 04:08:35,160 TOGETHER BECAUSE I THINK THE 5237 04:08:35,160 --> 04:08:42,800 PRESENTATION S EXEMPLIFY COMING 5238 04:08:42,800 --> 04:08:44,800 TOGETHER AND I'D LOVE TO SEE THE 5239 04:08:44,800 --> 04:08:46,680 CONNECTIONS BETWEEN THE 5240 04:08:46,680 --> 04:08:48,000 INVESTIGATORS AND MORE WE'LL BE 5241 04:08:48,000 --> 04:08:50,280 ABLE TO DO AND GROW IN THE 5242 04:08:50,280 --> 04:08:54,400 FUTURE, FINGERS CROSSED. 5243 04:08:54,400 --> 04:08:56,520 THANK YOU EVERYONE WHO HELPED 5244 04:08:56,520 --> 04:08:58,200 PLAN THE MEETING AND EXECUTE AND 5245 04:08:58,200 --> 04:09:00,080 OUR AWARDEES. 5246 04:09:00,080 --> 04:09:02,160 WE'RE EXCITED TO HEAR ABOUT THE 5247 04:09:02,160 --> 04:09:03,160 AMAZING SCIENCES AND HOPE YOU'LL 5248 04:09:03,160 --> 04:09:05,360 CONTINUE TO UPDATE US AND LOOK 5249 04:09:05,360 --> 04:09:08,320 FORWARD TO HEARING FROM OUR '21 5250 04:09:08,320 --> 04:09:08,880 AWARDEES IN THE FUTURE. 5251 04:09:08,880 --> 04:09:09,760 THANK YOU, EVERYONE. 5252 04:09:09,760 --> 04:09:11,600 >> AND LET US KNOW ABOUT 5253 04:09:11,600 --> 04:09:17,440 UPCOMING PUBLICATIONS SO THAT 5254 04:09:17,440 --> 04:09:19,880 THE OFFICE OF COMMUNICATION AND 5255 04:09:19,880 --> 04:09:21,960 DIRECTOR CAN HELP PROMOTE YOUR 5256 04:09:21,960 --> 04:09:27,120 SCIENCE AND THAT IN TURN HELPS 5257 04:09:27,120 --> 04:09:29,760 BROADEN AWARENESS AND WE'RE 5258 04:09:29,760 --> 04:09:30,320 PARTNERS TOGETHER IN THAT 5259 04:09:30,320 --> 04:09:33,120 JOURNEY. 5260 04:09:33,120 --> 04:09:34,160 >> WITH THAT, THANK YOU VERY 5261 04:09:34,160 --> 04:09:36,400 MUCH AND WE LOOK FORWARD TO YOUR 5262 04:09:36,400 --> 04:09:36,800 CONTINUED EFFORTS.