1 00:00:07,492 --> 00:00:08,827 >> OKAY, GOOD AFTERNOON, 2 00:00:08,827 --> 00:00:09,628 EVERYONE. 3 00:00:09,628 --> 00:00:12,064 AND WELCOME TO THE NIMHD 4 00:00:12,064 --> 00:00:13,799 DIRECTOR'S SEMINAR SERIES. 5 00:00:13,799 --> 00:00:20,372 MY NAME IS ELISEO PEREZ-STABLE, 6 00:00:20,372 --> 00:00:21,473 AND THANK YOU FOR JOINING US 7 00:00:21,473 --> 00:00:22,774 TODAY. 8 00:00:22,774 --> 00:00:24,977 THIS IS THE SECOND LECTURE OF 9 00:00:24,977 --> 00:00:27,079 2024, AND WE ARE EXCITED TO 10 00:00:27,079 --> 00:00:28,413 CONTINUE THIS SERIES WITH 11 00:00:28,413 --> 00:00:30,682 TODAY'S ESTEEMED SPEAKERS. 12 00:00:30,682 --> 00:00:34,019 I'M DELIGHTED TO INTRODUCE 13 00:00:34,019 --> 00:00:35,821 MIGUEL MARINO AND JOHN HEINTZMAN 14 00:00:35,821 --> 00:00:37,356 FROM OREGON HEALTH AND SCIENCE 15 00:00:37,356 --> 00:00:38,991 UNIVERSITY. 16 00:00:38,991 --> 00:00:40,726 WHO WILL PRESENT ON THE ROLE OF 17 00:00:40,726 --> 00:00:42,060 PRIMARY CARE IN LATINO HEALTH 18 00:00:42,060 --> 00:00:45,364 EQUITY. 19 00:00:45,364 --> 00:00:46,765 GIVEN TODAY'S ANNOUNCEMENT ABOUT 20 00:00:46,765 --> 00:00:52,037 THE PROPOSED NEW NIH -- FOR 21 00:00:52,037 --> 00:00:53,872 HEALTH NETWORK THIS TOPIC IS 22 00:00:53,872 --> 00:00:56,174 MOST APPROPRIATE FOR US TO HEAR 23 00:00:56,174 --> 00:00:57,075 ABOUT. 24 00:00:57,075 --> 00:00:59,144 BACHELOR OF MATHEMATICS, MASTERS 25 00:00:59,144 --> 00:01:01,113 IN BIOSTATISTICS, I A WARDED A 26 00:01:01,113 --> 00:01:02,647 PH.D. IN BIOSTATISTICS FROM 27 00:01:02,647 --> 00:01:04,282 HARVARD IN 2011. 28 00:01:04,282 --> 00:01:05,317 DR. HEINTZMAN ATTENDED THE 29 00:01:05,317 --> 00:01:07,019 UNIVERSITY OF MICHIGAN FOR HIS 30 00:01:07,019 --> 00:01:08,887 UNDERGRADUATE DEGREE IN 31 00:01:08,887 --> 00:01:10,622 PSYCHOLOGY AND GRADUATED FROM 32 00:01:10,622 --> 00:01:13,325 TEMPLE UNIVERSITY SCHOOL OF 33 00:01:13,325 --> 00:01:14,359 MEDICINE IN 2002. 34 00:01:14,359 --> 00:01:16,328 HE COMPLETED A RESIDENCY IN 35 00:01:16,328 --> 00:01:18,630 FAMILY MEDICINE AND MASTERS IN 36 00:01:18,630 --> 00:01:20,165 PUBLIC HEALTH AND IN CLINICAL 37 00:01:20,165 --> 00:01:21,366 RESEARCH AT OREGON HEALTH 38 00:01:21,366 --> 00:01:22,868 SCIENCES UNIVERSITY. 39 00:01:22,868 --> 00:01:25,037 AS HE JOINED THE FACULTY IN 40 00:01:25,037 --> 00:01:27,606 DEPARTMENT OF FAMILY MEDICINE. 41 00:01:27,606 --> 00:01:29,808 MIGUEL AND JOHN ARE RENOWNED 42 00:01:29,808 --> 00:01:31,009 EXPERTS IN THEIR FIELDS AND THEY 43 00:01:31,009 --> 00:01:32,177 BRING A WEALTH OF KNOWLEDGE AND 44 00:01:32,177 --> 00:01:33,512 EXPERIENCE TO TODAY'S 45 00:01:33,512 --> 00:01:33,945 DISCUSSION. 46 00:01:33,945 --> 00:01:35,480 MIGUEL IS CURRENTLY AN ASSOCIATE 47 00:01:35,480 --> 00:01:36,681 PROFESSOR OF BIOSTATISTICS IN 48 00:01:36,681 --> 00:01:37,983 THE DEPARTMENT OF FAMILY 49 00:01:37,983 --> 00:01:40,352 MEDICINE AT OHSU, AND ALONGSIDE 50 00:01:40,352 --> 00:01:42,054 WITH JOHN, HE CO-DIRECTS THE 51 00:01:42,054 --> 00:01:44,222 PRIMARY CARE LATINO HEALTH 52 00:01:44,222 --> 00:01:47,759 EQUITY RESEARCH CENTER, OR 53 00:01:47,759 --> 00:01:49,494 PRIMER, WHICH IS DEDICATED TO 54 00:01:49,494 --> 00:01:50,562 UNDERSTANDING DISPARITIES IN 55 00:01:50,562 --> 00:01:52,330 EQUITY AND PRIMARY CARE FOR 56 00:01:52,330 --> 00:01:54,399 HISPANIC LATINO COMMUNITIES. 57 00:01:54,399 --> 00:01:56,268 MIGUEL IS FIRST GENERATION 58 00:01:56,268 --> 00:01:57,035 MEXICAN-AMERICAN WHO ESTABLISHED 59 00:01:57,035 --> 00:01:59,538 HIS CAREER IN PRIMARY CARE AND 60 00:01:59,538 --> 00:02:02,507 HEALTH SERVICES RESEARCH, PUBLIC 61 00:02:02,507 --> 00:02:03,942 HEALTH AND BIOSTATISTICS. 62 00:02:03,942 --> 00:02:05,677 HIS RESEARCH FOCUSES ON 63 00:02:05,677 --> 00:02:07,312 DEVELOPING AND IMPLEMENTING 64 00:02:07,312 --> 00:02:08,513 STATISTICAL METHODOLOGIES TO 65 00:02:08,513 --> 00:02:10,182 ADDRESS THE COMPLEXITIES 66 00:02:10,182 --> 00:02:12,451 ASSOCIATED WITH USING ELECTRONIC 67 00:02:12,451 --> 00:02:14,786 HEALTH RECORDS TO STUDY HEALTH 68 00:02:14,786 --> 00:02:16,088 EQUITY AND CHANGES IN HEALTH 69 00:02:16,088 --> 00:02:17,622 POLICY AMONG LOW INCOME AND 70 00:02:17,622 --> 00:02:19,491 DISADVANTAGED POPULATIONS, 71 00:02:19,491 --> 00:02:20,826 SEEKING CARE IN PRIMARY CARE 72 00:02:20,826 --> 00:02:22,661 CLINICS. 73 00:02:22,661 --> 00:02:26,031 MIGUEL SERVES AS EDITOR FOR JAMA 74 00:02:26,031 --> 00:02:30,102 HEALTH FORUM, CO-CHAIR OF THE 75 00:02:30,102 --> 00:02:32,170 COMMUNITY ALLIANCE OR SEAL AND 76 00:02:32,170 --> 00:02:33,638 NEEDS ASSESSMENT EVALUATION WORK 77 00:02:33,638 --> 00:02:33,839 GROUP. 78 00:02:33,839 --> 00:02:36,041 AND A MEMBER OF THE NATIONAL 79 00:02:36,041 --> 00:02:37,542 ADVISORY COMMITTEE ON RACIAL, 80 00:02:37,542 --> 00:02:38,410 ETHNIC AND OTHER POPULATIONS FOR 81 00:02:38,410 --> 00:02:41,680 THE U.S. CENSUS BUREAU. 82 00:02:41,680 --> 00:02:44,216 HE'S ALSO AN E ELECTED MEMBER OF 83 00:02:44,216 --> 00:02:46,618 THE NATIONAL ACADEMIES OF 84 00:02:46,618 --> 00:02:47,486 SCIENCES ENGINEERING AND 85 00:02:47,486 --> 00:02:47,752 MEDICINE. 86 00:02:47,752 --> 00:02:49,654 IN RECOGNITION OF HIS 87 00:02:49,654 --> 00:02:52,424 SIGNIFICANT CONTRIBUTIONS TO THE 88 00:02:52,424 --> 00:02:54,126 FIELD, MIGUEL HAS PUBLISHED OVER 89 00:02:54,126 --> 00:02:56,228 200 PAPERS AND RECEIVED SEVERAL 90 00:02:56,228 --> 00:02:57,529 AWARDS, INCLUDING THE NORTH 91 00:02:57,529 --> 00:02:59,197 AMERICAN PRIMARY CARE RESEARCH 92 00:02:59,197 --> 00:03:02,601 GROUP NEW INVESTIGATOR RESEARCH 93 00:03:02,601 --> 00:03:02,934 AWARD. 94 00:03:02,934 --> 00:03:04,736 JOHN IS AN ASSOCIATE PROFESSOR 95 00:03:04,736 --> 00:03:06,104 OF FAMILY MEDICINE AT OREGON 96 00:03:06,104 --> 00:03:07,639 HEALTH SCIENCES UNIVERSITY. 97 00:03:07,639 --> 00:03:10,709 AND HE IS A BOARD CERTIFIED 98 00:03:10,709 --> 00:03:12,144 FAMILY PHYSICIAN, HEALTH EQUITY 99 00:03:12,144 --> 00:03:13,745 RESEARCHER AND PRACTICING 100 00:03:13,745 --> 00:03:14,646 COMMUNITY HEALTH CENTER 101 00:03:14,646 --> 00:03:16,081 CLINICIAN. 102 00:03:16,081 --> 00:03:19,618 JOHN'S RESEARCH CAREER FORMALLY 103 00:03:19,618 --> 00:03:21,453 BEGAN WITH A CAREER DEVELOPMENT 104 00:03:21,453 --> 00:03:23,722 AWARD FROM AHRQ, THE AGENCY FOR 105 00:03:23,722 --> 00:03:25,590 HEALTH RESEARCH AND QUALITY IN 106 00:03:25,590 --> 00:03:28,560 2012, FOCUSED ON PREVENTIVE 107 00:03:28,560 --> 00:03:30,962 SERVICES FOR LATINO IMMIGRANTS. 108 00:03:30,962 --> 00:03:33,265 HE IS FUNDED THROUGH MULTIPLE 109 00:03:33,265 --> 00:03:34,900 NIH PROJECTS AND COLLABORATES 110 00:03:34,900 --> 00:03:37,869 CLOSELY WITH MIGUEL, THUS WE 111 00:03:37,869 --> 00:03:40,705 HAVE A TWO FOR ONE TODAY, FIRST 112 00:03:40,705 --> 00:03:43,875 TIME EVER IN AND NIMHD 113 00:03:43,875 --> 00:03:44,776 DIRECTOR'S SEMINAR. 114 00:03:44,776 --> 00:03:50,448 JOHN HAS ALSO RECEIVED AWARDS 115 00:03:50,448 --> 00:03:53,518 FROM A NON-PROFIT EQUITY SERVING 116 00:03:53,518 --> 00:03:55,720 COMMUNITY HEALTH CENTERS IN 117 00:03:55,720 --> 00:03:56,955 LATINO PATIENTS NATIONWIDE 118 00:03:56,955 --> 00:03:58,423 AMONGST OTHER POPULATION GROUPS. 119 00:03:58,423 --> 00:04:00,492 CURRENTLY HE'S DUAL PI FOR THE 120 00:04:00,492 --> 00:04:01,493 ADVANCED CLINICAL RESEARCH 121 00:04:01,493 --> 00:04:03,895 NETWORK AND CO-CHAIR OF THE 122 00:04:03,895 --> 00:04:05,430 PATIENT-CENTERED OUTCOMES 123 00:04:05,430 --> 00:04:06,364 RESEARCH NETWORK RESEARCH 124 00:04:06,364 --> 00:04:07,499 COMMITTEE. 125 00:04:07,499 --> 00:04:09,801 HE HAS PUBLISHED OVER 80 PEER 126 00:04:09,801 --> 00:04:11,570 REVIEWED PAPERS, RECEIVED 127 00:04:11,570 --> 00:04:13,972 SEVERAL AWARDS, INCLUDING THE 128 00:04:13,972 --> 00:04:15,941 OHSU'S ALUMNI ASSOCIATION EARLY 129 00:04:15,941 --> 00:04:17,475 CAREER ACHIEVEMENT AWARD. 130 00:04:17,475 --> 00:04:19,444 TODAY'S TALK WILL EXPLORE THE 131 00:04:19,444 --> 00:04:21,513 PERSISTENT HEALTH AND HEALTHCARE 132 00:04:21,513 --> 00:04:23,682 INEQUITIES FACED BY LATINO 133 00:04:23,682 --> 00:04:24,583 POPULATIONS ACROSS NUMEROUS 134 00:04:24,583 --> 00:04:25,984 HEALTH CONDITIONS. 135 00:04:25,984 --> 00:04:27,752 MIGUEL AND JOHN WILL DISCUSS HOW 136 00:04:27,752 --> 00:04:29,654 UNDERSTANDING AND IMPROVING 137 00:04:29,654 --> 00:04:31,923 THESE INEQUITIES REQUIRE A 138 00:04:31,923 --> 00:04:33,024 COMPREHENSIVE AND MULTI-LEVEL 139 00:04:33,024 --> 00:04:33,291 APPROACH. 140 00:04:33,291 --> 00:04:36,428 SO WE ARE THRILLED TO HAVE YOU, 141 00:04:36,428 --> 00:04:39,030 AND PLEASE GIVE THEM A VIRTUAL 142 00:04:39,030 --> 00:04:40,232 WELCOME TO MIGUEL MARINO AND 143 00:04:40,232 --> 00:04:43,268 JOHN HEINTZMAN . 144 00:04:43,268 --> 00:04:44,970 MIGUEL AND JOHN. 145 00:04:44,970 --> 00:04:47,138 >> YEAH, THANK YOU, THANK YOU, 146 00:04:47,138 --> 00:04:48,306 ELISEO, FOR THE INTRODUCTION, 147 00:04:48,306 --> 00:04:49,307 AND FOR THE INVITATION TO 148 00:04:49,307 --> 00:04:51,509 PRESENT OUR WORK IN PRIMARY CARE 149 00:04:51,509 --> 00:04:52,711 AND LATINO HEALTH. 150 00:04:52,711 --> 00:04:54,246 IT REALLY IS AN HONOR TO BE PART 151 00:04:54,246 --> 00:04:56,548 OF THIS SERIES, AND WE HOPE TO 152 00:04:56,548 --> 00:04:57,182 INSPIRE CONVERSATION THAT 153 00:04:57,182 --> 00:04:58,416 CONTINUES TO BUILD ON THE 154 00:04:58,416 --> 00:05:00,151 IMPORTANCE OF IMPROVING HEALTH 155 00:05:00,151 --> 00:05:03,088 AND HEALTHCARE FOR LATINOS IN 156 00:05:03,088 --> 00:05:06,057 THE UNITED STATES. 157 00:05:06,057 --> 00:05:07,826 SO I'M A BIOSTATISTICIAN WITH 158 00:05:07,826 --> 00:05:10,095 DEEP ROOTS IN PRIMARY CARE, AND 159 00:05:10,095 --> 00:05:11,663 THAT LED -- THAT WAS A PATH THAT 160 00:05:11,663 --> 00:05:13,064 TOOK A WHILE, I THINK, YOU KNOW, 161 00:05:13,064 --> 00:05:15,400 WHEN I GRADUATED WITH MY PH.D. 162 00:05:15,400 --> 00:05:16,568 IN BIOSTATISTICS 13 YEARS AGO, 163 00:05:16,568 --> 00:05:17,902 THERE COULD HAVE BEEN MANY AREAS 164 00:05:17,902 --> 00:05:20,305 I COULD HAVE APPLIED MY TRADE 165 00:05:20,305 --> 00:05:22,173 IN, AND I DID FOR A WHILE, SO I 166 00:05:22,173 --> 00:05:23,842 WORKED ON MANY TOPICS FROM AIDS 167 00:05:23,842 --> 00:05:26,011 RESEARCH TO CANCER RESEARCH, 168 00:05:26,011 --> 00:05:28,113 GENETICS WORK, AND SO MANY 169 00:05:28,113 --> 00:05:29,981 OTHERS, BUT THROUGH IT ALL, AT 170 00:05:29,981 --> 00:05:31,182 THE END OF THE DAY, THERE WAS 171 00:05:31,182 --> 00:05:32,284 THIS INTEREST IN REALLY TRYING 172 00:05:32,284 --> 00:05:35,020 TO UNDERSTAND HOW TO IMPROVE 173 00:05:35,020 --> 00:05:36,988 COMMUNITY-BASED HEALTH, AND SO 174 00:05:36,988 --> 00:05:38,423 LONG STORY SHORT, I DECIDED TO 175 00:05:38,423 --> 00:05:39,491 DEDICATE MY WORK IN 176 00:05:39,491 --> 00:05:40,492 UNDERSTANDING THE ROLE OF 177 00:05:40,492 --> 00:05:41,826 PRIMARY CARE IN IMPROVING 178 00:05:41,826 --> 00:05:42,894 COMMUNITY HEALTH AND IN 179 00:05:42,894 --> 00:05:44,829 PARTICULAR, LATINO HEALTH. 180 00:05:44,829 --> 00:05:46,865 >> THANK YOU AGAIN, ELISEO, FOR 181 00:05:46,865 --> 00:05:48,033 THAT INTRODUCTION, AND FOR 182 00:05:48,033 --> 00:05:48,933 HAVING US TODAY. 183 00:05:48,933 --> 00:05:51,002 I'M JOHN HEINTZMAN, CO-DIRECTOR 184 00:05:51,002 --> 00:05:52,237 OF THE CENTER WITH MIGUEL AND AS 185 00:05:52,237 --> 00:05:53,371 HE SAID, I'M A FAMILY PHYSICIAN 186 00:05:53,371 --> 00:05:55,607 BY TRAINING AND MY FIRST JOB OUT 187 00:05:55,607 --> 00:05:57,175 OF RESIDENCY WAS AT A COMMUNITY 188 00:05:57,175 --> 00:06:00,011 HEALTH CENTER HERE IN OREGON AND 189 00:06:00,011 --> 00:06:03,214 I FELT LIKE MANY OF MY PATIENTS, 190 00:06:03,214 --> 00:06:05,383 I DIDN'T UNDERSTAND THE FULL 191 00:06:05,383 --> 00:06:06,818 BARRIERS THAT THEY FACED IN 192 00:06:06,818 --> 00:06:09,654 OBTAINING CARE, AND SO SET ABOUT 193 00:06:09,654 --> 00:06:11,423 KIND OF A JOURNEY TO GET 194 00:06:11,423 --> 00:06:12,624 RESEARCH SKILLS, A LOT OF 195 00:06:12,624 --> 00:06:14,693 CONTENT KNOWLEDGE BUT ALSO A LOT 196 00:06:14,693 --> 00:06:16,661 OF RELATIONSHIPS AND 197 00:06:16,661 --> 00:06:17,762 QUESTION-ASKING AND DIDN'T 198 00:06:17,762 --> 00:06:19,264 REALLY KNOW WHAT I WAS DOING BUT 199 00:06:19,264 --> 00:06:21,266 BY SOME KIND OF SET OF SMALL 200 00:06:21,266 --> 00:06:23,535 MIRACLES, I GOT A CAREER 201 00:06:23,535 --> 00:06:24,536 DEVELOPMENT AWARD AND THAT'S 202 00:06:24,536 --> 00:06:26,504 WHERE I MET MIGUEL AND WE 203 00:06:26,504 --> 00:06:28,039 STARTED HATCHING IDEAS FOR THAT 204 00:06:28,039 --> 00:06:29,107 PROJECT AS WELL AS OTHERS IN THE 205 00:06:29,107 --> 00:06:32,110 LAST 12 YEARS HAVE BEEN SUPER 206 00:06:32,110 --> 00:06:33,078 FORTUNATE TO BUILD A TEAM AND 207 00:06:33,078 --> 00:06:36,681 VISION UNDERSTANDING HOW EQUITY 208 00:06:36,681 --> 00:06:37,882 WITH LATINO PATIENTS IN PRIMARY 209 00:06:37,882 --> 00:06:38,083 CARE. 210 00:06:38,083 --> 00:06:40,418 >> WE WANT TO THANK OUR FUNDERS, 211 00:06:40,418 --> 00:06:43,355 SEVERAL NIH INSTITUTES, FAMILY 212 00:06:43,355 --> 00:06:44,222 FOUNDATION FOR SUPPORTING ALL 213 00:06:44,222 --> 00:06:45,557 THE WORK THAT THEY HAVE, IT'S 214 00:06:45,557 --> 00:06:47,459 SOMETHING WE'RE GOING TO TALK 215 00:06:47,459 --> 00:06:49,627 ABOUT TODAY AS WELL AS OUR 216 00:06:49,627 --> 00:06:56,301 PARTNERS, CHAIRED BY DR 217 00:06:56,301 --> 00:06:59,804 DR. JENNIFER -- FELLOW TRAVELER 218 00:06:59,804 --> 00:07:02,107 ON THIS JOURNEY AND ADVANCE THE 219 00:07:02,107 --> 00:07:05,910 CLINICAL RESEARCH NETWORK FOR 220 00:07:05,910 --> 00:07:08,046 THE INSTITUTION. 221 00:07:08,046 --> 00:07:09,214 PREMIER IS ABOUT TEAM SCIENCE 222 00:07:09,214 --> 00:07:10,749 AND ALL OF THESE PEOPLE, I WISH 223 00:07:10,749 --> 00:07:12,751 WE COULD TALK ABOUT EACH ONE OF 224 00:07:12,751 --> 00:07:13,585 THEM TODAY, THEIR CONTRIBUTIONS 225 00:07:13,585 --> 00:07:14,686 AND UNIQUENESS, AND WE DON'T 226 00:07:14,686 --> 00:07:16,121 HAVE TIME, BUT THEY HAVE ALL 227 00:07:16,121 --> 00:07:19,324 MESH CONTRIBUTED TO THE WORK YOE 228 00:07:19,324 --> 00:07:20,725 GOING TO HEAR ABOUT AND MAKE 229 00:07:20,725 --> 00:07:22,127 MIGUEL AND I FEEL HONORED AND 230 00:07:22,127 --> 00:07:23,128 GRATEFUL TO BE ON THIS JOURNEY 231 00:07:23,128 --> 00:07:26,464 WITH ALL OF THEM. 232 00:07:26,464 --> 00:07:29,801 >> BRF BEFORE I FORGET, JOHN ANI 233 00:07:29,801 --> 00:07:30,702 DON'T HAVE ANY CONFLICTS OF 234 00:07:30,702 --> 00:07:31,436 INTEREST TO DECLARE. 235 00:07:31,436 --> 00:07:32,971 WE WANT TO START OFF TODAY'S 236 00:07:32,971 --> 00:07:35,039 TALK WITH SOME GENERAL HIGH 237 00:07:35,039 --> 00:07:36,708 LEVEL TOPICS ABOUT LATINOS AND 238 00:07:36,708 --> 00:07:39,043 PRIMARY CARE, AND THEN REALLY 239 00:07:39,043 --> 00:07:39,978 FOCUS DOWN ON THEIR 240 00:07:39,978 --> 00:07:40,645 INTERSECTION. 241 00:07:40,645 --> 00:07:43,915 SO FIRST I WILL PROVIDE SOME 242 00:07:43,915 --> 00:07:45,150 INFORMATION ABOUT LATINOS IN THE 243 00:07:45,150 --> 00:07:45,483 U.S. 244 00:07:45,483 --> 00:07:46,985 HERE AS YOU CAN SEE IN THESE TWO 245 00:07:46,985 --> 00:07:48,753 FIGURES, IN 2021, LATINOS 246 00:07:48,753 --> 00:07:49,821 ACCOUNTED FOR ABOUT 19% OF THE 247 00:07:49,821 --> 00:07:51,589 U.S. POPULATION MAKING IT THE 248 00:07:51,589 --> 00:07:52,690 LARGEST RACIAL OR ETHNIC 249 00:07:52,690 --> 00:07:54,559 MINORITY GROUP. 250 00:07:54,559 --> 00:07:59,798 THE CENSUS PROJECTS BY 2045, THE 251 00:07:59,798 --> 00:08:01,900 LATINO POPULATION WILL CONSIST 252 00:08:01,900 --> 00:08:03,067 OF 1 OUT OF EVERY 4 PEOPLE IN 253 00:08:03,067 --> 00:08:03,535 THE U.S. 254 00:08:03,535 --> 00:08:05,570 SO WITH THIS CONTINUING AS FAR 255 00:08:05,570 --> 00:08:05,970 AS 2060. 256 00:08:05,970 --> 00:08:07,739 IT'S ALSO IMPORTANT TO NOTE THAT 257 00:08:07,739 --> 00:08:09,808 LATINOS ARE NOT A HOMOGENEOUS 258 00:08:09,808 --> 00:08:10,108 GROUP. 259 00:08:10,108 --> 00:08:11,643 I THINK MANY OF US KNOW THAT 260 00:08:11,643 --> 00:08:11,843 HERE. 261 00:08:11,843 --> 00:08:14,379 THE LATINO POP RANG POPULATION E 262 00:08:14,379 --> 00:08:16,014 U.S. HAS NOTABLE VARIATION BY 263 00:08:16,014 --> 00:08:20,051 COUNTRY OF ORIGIN, IMMIGRATION 264 00:08:20,051 --> 00:08:27,725 STATUS, 265 00:08:27,725 --> 00:08:38,036 [PLEASE STAND BY] 266 00:08:41,473 --> 00:08:43,942 AND SO BY LUMPING INTO A BROAD 267 00:08:43,942 --> 00:08:45,477 LATINO CATEGORY, IT IGNORES 268 00:08:45,477 --> 00:08:46,211 SIGNIFICANT VARIATION THAT 269 00:08:46,211 --> 00:08:48,179 EXISTS WITHIN THAT BROAD 270 00:08:48,179 --> 00:08:51,249 CATEGORY, SO THINGS LIKE 271 00:08:51,249 --> 00:08:53,451 IMMIGRATION PATTERNS, LIVED 272 00:08:53,451 --> 00:08:54,552 EXPERIENCE, ACCULTURATION, 273 00:08:54,552 --> 00:08:55,787 VARIATION IN SOCIAL DETERMINANTS 274 00:08:55,787 --> 00:08:57,989 OF HEALTH AND MANY OTHER THINGS 275 00:08:57,989 --> 00:08:59,157 THAT MAY PLAY AN IMPORTANT ROLE 276 00:08:59,157 --> 00:09:00,024 IN HEALTH OUTCOMES. 277 00:09:00,024 --> 00:09:01,659 SO WE'LL TALK A LITTLE BIT ABOUT 278 00:09:01,659 --> 00:09:03,228 THE POTENTIAL FOR UNDERSTANDING 279 00:09:03,228 --> 00:09:05,730 THIS HETEROGENEITY LATER IN THE 280 00:09:05,730 --> 00:09:07,899 PRESENTATION. 281 00:09:07,899 --> 00:09:11,336 IT'S ALSO WELL ESTABLISHED THAT 282 00:09:11,336 --> 00:09:13,204 BROADLY, LOWER SOCIOECONOMIC 283 00:09:13,204 --> 00:09:14,606 STATUS, SO FOR EXAMPLE THINGS 284 00:09:14,606 --> 00:09:16,808 LIKE LOW LEVELS OF INCOME AND 285 00:09:16,808 --> 00:09:18,009 EDUCATION IS ASSOCIATED WITH 286 00:09:18,009 --> 00:09:20,845 GREATER MORTALITY AND MORBIDITY. 287 00:09:20,845 --> 00:09:21,946 AND WHAT THE LITERATURE HAS 288 00:09:21,946 --> 00:09:24,849 CITED OVER AND OVER AGAIN IS 289 00:09:24,849 --> 00:09:26,651 THAT RELATIVE TO NON-LATINO 290 00:09:26,651 --> 00:09:29,287 WHITES, LATINOS HAVE A LOWER 291 00:09:29,287 --> 00:09:31,189 SOCIOECONOMIC STATUS PROFILE. 292 00:09:31,189 --> 00:09:33,424 SO RESEARCH HAS CONSISTENTLY 293 00:09:33,424 --> 00:09:34,526 DOCUMENTED THAT LATINOS HAVE 294 00:09:34,526 --> 00:09:36,294 SOME OF THE LOWEST HOUSEHOLD 295 00:09:36,294 --> 00:09:37,195 INCOMES, SOME OF THE LOWEST 296 00:09:37,195 --> 00:09:39,464 RATES OF HEALTH INSURANCE 297 00:09:39,464 --> 00:09:40,765 COVERAGE, HIGH FOOD INSECURITY, 298 00:09:40,765 --> 00:09:43,401 AMONG MANY OTHER FACTORS THAT 299 00:09:43,401 --> 00:09:45,069 ARE IMPORTANT THAT ARE DRIVERS 300 00:09:45,069 --> 00:09:48,239 OF HEALTH. 301 00:09:48,239 --> 00:09:49,974 SO SURVEY-BASED STUDIES 302 00:09:49,974 --> 00:09:51,075 CONSISTENTLY DOCUMENT THAT 303 00:09:51,075 --> 00:09:52,043 LATINOS TEND TO HAVE WORSE 304 00:09:52,043 --> 00:09:53,478 ACCESS TO HEALTHCARE, THEY 305 00:09:53,478 --> 00:09:55,480 EXPERIENCE WORSE MORBIDITY AS A 306 00:09:55,480 --> 00:09:56,648 RESULT OF LACK OF CARE OR 307 00:09:56,648 --> 00:09:58,616 TREATMENT AND THEY RECEIVE 308 00:09:58,616 --> 00:09:59,817 POORER QUALITY OF CARE WHEN 309 00:09:59,817 --> 00:10:02,120 COMPARED TO NON-LATINO WHITE 310 00:10:02,120 --> 00:10:02,453 AMERICANS. 311 00:10:02,453 --> 00:10:04,889 AND YET, EVEN THOUGH I SORT OF 312 00:10:04,889 --> 00:10:08,393 MENTIONED ALL THOSE THINGS, EVEN 313 00:10:08,393 --> 00:10:10,595 THOUGH LATINOS HAVE AN OVERALL 314 00:10:10,595 --> 00:10:11,362 LOWER SOCIOECONOMIC STATUS 315 00:10:11,362 --> 00:10:13,197 COMPARED TO NON-LATINO WHITES, 316 00:10:13,197 --> 00:10:15,266 OVER THE PAST FEW DECADES, 317 00:10:15,266 --> 00:10:17,335 RESEARCH HAS CONSISTENTLY SHOWN 318 00:10:17,335 --> 00:10:19,003 THE LIFE EXPECTANCY IS HIGHER 319 00:10:19,003 --> 00:10:21,172 AMONG LATINOS THAN NON-LATINO 320 00:10:21,172 --> 00:10:21,940 WHITE AMERICANS. 321 00:10:21,940 --> 00:10:27,545 SO THIS FINDING IS NO -- LATINO 322 00:10:27,545 --> 00:10:28,413 MORTALITY PARADOX AND THERE'S 323 00:10:28,413 --> 00:10:29,847 STILL A LOT TO UNPACK HERE THAT 324 00:10:29,847 --> 00:10:31,149 COULD PROVIDE INSIGHTS INTO WHAT 325 00:10:31,149 --> 00:10:32,116 ARE THE POSITIVE THINGS THAT 326 00:10:32,116 --> 00:10:36,321 CONTRIBUTE TO HEALTH. 327 00:10:36,321 --> 00:10:37,655 IT IS IMPORTANT TO NOTE THAT THE 328 00:10:37,655 --> 00:10:40,024 MORE RECENT DATA SUGGESTED THAT 329 00:10:40,024 --> 00:10:41,326 THE COVID-19 PANDEMIC MAY HAVE 330 00:10:41,326 --> 00:10:44,062 BEEN PARTICULARLY IMPACTFUL ON 331 00:10:44,062 --> 00:10:45,063 LATINO MORTALITY IN THE U.S., SO 332 00:10:45,063 --> 00:10:48,666 DURING THE PANDEMIC, THE LATINOS 333 00:10:48,666 --> 00:10:50,301 HAD HIGHER SPECIFIC DEATH RATES 334 00:10:50,301 --> 00:10:53,371 FROM COVID, AND MORTALITY IN 335 00:10:53,371 --> 00:10:54,038 GENERAL. 336 00:10:54,038 --> 00:10:56,007 SO THIS HERE SHOWS WHILE LATINOS 337 00:10:56,007 --> 00:10:57,742 HAVE A LIFE EXPECTANCY OF ABOUT 338 00:10:57,742 --> 00:10:59,611 82 YEARS IN 2019, WHICH WAS 339 00:10:59,611 --> 00:11:02,347 GREATER THAN ALL OTHER 340 00:11:02,347 --> 00:11:03,114 RACE/ETHNICITY GROUPS OTHER THAN 341 00:11:03,114 --> 00:11:05,350 ASIAN AMERICANS, THAT DROPPED IN 342 00:11:05,350 --> 00:11:09,253 2020 AND 2021 AND WAS MORE 343 00:11:09,253 --> 00:11:11,222 SIMILAR TO NON-LATINO WHITE. 344 00:11:11,222 --> 00:11:13,391 SO THIS OBSERVATION LED TO SOME 345 00:11:13,391 --> 00:11:14,492 RESEARCHERS DISCUSSING THE 346 00:11:14,492 --> 00:11:15,693 PANDEMIC AS THE END OF THE 347 00:11:15,693 --> 00:11:19,330 LATINO PARADOX. 348 00:11:19,330 --> 00:11:19,864 OR MAYBE NOT. 349 00:11:19,864 --> 00:11:22,166 SO THE LIFE EXPECTANCY ESTIMATES 350 00:11:22,166 --> 00:11:23,601 PUBLISHED A FEW MONTHS AGO 351 00:11:23,601 --> 00:11:24,702 SUGGEST THAT THE PARADOX MIGHT 352 00:11:24,702 --> 00:11:27,305 NOT BE OVER. 353 00:11:27,305 --> 00:11:29,841 SO THE 2022 ESTIMATES OF LIFE 354 00:11:29,841 --> 00:11:31,242 EXPECTANCY WENT UP FOR LATINOS 355 00:11:31,242 --> 00:11:33,544 TO ABOUT 80 YEARS, WHICH IS 356 00:11:33,544 --> 00:11:34,646 CONSISTENTLY HIGHER AGAIN THAN 357 00:11:34,646 --> 00:11:37,281 ALL GROUPS EXCEPT FOR ASIANS, 358 00:11:37,281 --> 00:11:39,717 AND SO AGAIN, THE SET OF SERIES 359 00:11:39,717 --> 00:11:41,219 OF THESE LAST SLIDES REALLY 360 00:11:41,219 --> 00:11:43,955 HIGHLIGHTS THAT THERE'S A LOT TO 361 00:11:43,955 --> 00:11:45,056 UNPACK HERE THAT COULD PROVIDE 362 00:11:45,056 --> 00:11:46,157 INSIGHTS INTO WHAT ARE THE 363 00:11:46,157 --> 00:11:47,558 POSITIVE THINGS THAT CONTRIBUTE 364 00:11:47,558 --> 00:11:49,427 TO HEALTH, NOT ONLY AMONG 365 00:11:49,427 --> 00:11:53,698 LATINOS BUT FOR ALL AMERICANS. 366 00:11:53,698 --> 00:11:55,166 SO THIS RELATIVE MORTALITY 367 00:11:55,166 --> 00:12:00,104 ADVANTAGE HAS BEEN NOTED MOST 368 00:12:00,104 --> 00:12:01,406 PROMINENTLY IN MAJOR DRIVERS OF 369 00:12:01,406 --> 00:12:02,173 SOCIETAL MORTALITY. 370 00:12:02,173 --> 00:12:03,574 SO FOR EXAMPLE WHEN WE LOOK AT 371 00:12:03,574 --> 00:12:05,777 CANCER INCIDENCE AND MORTALITY, 372 00:12:05,777 --> 00:12:06,744 LATINOS CONSISTENTLY OVER TIME 373 00:12:06,744 --> 00:12:08,546 HAVE HAD LOWER OVERALL CANCER 374 00:12:08,546 --> 00:12:09,580 INCIDENCE AND MORTALITY COMPARED 375 00:12:09,580 --> 00:12:12,350 TO NON-LATINO WHITE AMERICANS. 376 00:12:12,350 --> 00:12:13,818 WHEN WE LOOK AT ANOTHER MAJOR 377 00:12:13,818 --> 00:12:16,754 DRIVER OF MORTALITY AT HEART 378 00:12:16,754 --> 00:12:18,289 DISEASE, LATINOS HAVE HAD A 379 00:12:18,289 --> 00:12:19,957 SLIGHT DECREASE IN AGE-ADJUSTED 380 00:12:19,957 --> 00:12:21,125 DEATH RATES FOR HEART DISEASE 381 00:12:21,125 --> 00:12:22,126 AND CONSISTENTLY LOWER COMPARED 382 00:12:22,126 --> 00:12:24,896 TO NON-LATINO WHITES. 383 00:12:24,896 --> 00:12:27,098 AND THIS IS TRUE EVEN THOUGH 384 00:12:27,098 --> 00:12:28,132 LATINOS DISPROPORTIONATELY HAVE 385 00:12:28,132 --> 00:12:29,867 HIGHER RATES OF CARDIOVASCULAR 386 00:12:29,867 --> 00:12:32,270 RISK FACTORS COMPARED TO 387 00:12:32,270 --> 00:12:33,371 NON-LATINOS, SO FOR EXAMPLE 388 00:12:33,371 --> 00:12:35,039 ILLUSTRATED HERE ON THE LEFT, 389 00:12:35,039 --> 00:12:37,008 LATINOS ARE 20% MORE LIKELY TO 390 00:12:37,008 --> 00:12:38,309 BE OBESE AND HAVE HIGHER RATES 391 00:12:38,309 --> 00:12:40,378 OF DIABETES COMPARED TO 392 00:12:40,378 --> 00:12:44,348 NON-LATINO WHITES. 393 00:12:44,348 --> 00:12:45,550 SO JUST PUTTING EVERYTHING 394 00:12:45,550 --> 00:12:46,751 TOGETHER, LATINOS ARE A DIVERSE 395 00:12:46,751 --> 00:12:52,090 AND GROWING POPULATION AND THEIR 396 00:12:52,090 --> 00:12:53,191 OVERALL LOWER SOCIOECONOMIC 397 00:12:53,191 --> 00:12:54,392 STATUS DOES NOT ALWAYS TRANSLATE 398 00:12:54,392 --> 00:12:55,593 TO WORSE OUTCOMES. 399 00:12:55,593 --> 00:12:57,261 AND AS I MENTIONED EARLIER, 400 00:12:57,261 --> 00:12:59,030 THERE'S A LOT TO LEARN ABOUT THE 401 00:12:59,030 --> 00:13:02,400 RESILIENCE AND STRUGGLES OF 402 00:13:02,400 --> 00:13:03,935 LATINO POPULATION SPACE AS THEY 403 00:13:03,935 --> 00:13:06,137 ENCOUNTER THE U.S. HEALTHCARE 404 00:13:06,137 --> 00:13:06,370 SYSTEM. 405 00:13:06,370 --> 00:13:07,805 SO WHEN WE THINK OF THE 406 00:13:07,805 --> 00:13:09,874 HEALTHCARE SYSTEM, FOR 407 00:13:09,874 --> 00:13:11,075 UNDERSTANDING AND ADDRESSING 408 00:13:11,075 --> 00:13:12,410 HEALTHCARE INEQUITIES MAY BE TO 409 00:13:12,410 --> 00:13:15,446 MORE DIRECTLY OBSERVE HOW LATINO 410 00:13:15,446 --> 00:13:16,347 POPULATIONS INTERACT WITH THE 411 00:13:16,347 --> 00:13:19,650 U.S. HEALTHCARE SYSTEM. 412 00:13:19,650 --> 00:13:21,085 SO I'LL PASS THIS ON TO JOHN TO 413 00:13:21,085 --> 00:13:22,286 TALK A LITTLE MORE ABOUT PRIMARY 414 00:13:22,286 --> 00:13:23,821 CARE IN THE U.S. AS A WINDOW TO 415 00:13:23,821 --> 00:13:25,389 THAT SYSTEM. 416 00:13:25,389 --> 00:13:27,125 >> AS MIGUEL SAID, WE ARE 417 00:13:27,125 --> 00:13:28,893 INTERESTED IN UNDERSTANDING SOME 418 00:13:28,893 --> 00:13:30,628 OF THOSE FACTORS THAT PLAY INTO 419 00:13:30,628 --> 00:13:34,332 THAT COMPLEX PROCESS WHEN IT 420 00:13:34,332 --> 00:13:35,366 COMES TO LATINO PATIENTS. 421 00:13:35,366 --> 00:13:40,271 THIS IS DATA THAT SHOWS THAT 422 00:13:40,271 --> 00:13:42,406 85 TO 90% OF FOLKS IN THE UNITED 423 00:13:42,406 --> 00:13:44,942 STATES HAVE A USUAL SOURCE OF 424 00:13:44,942 --> 00:13:46,711 CARE THAT DOES NOT INCLUDE THE 425 00:13:46,711 --> 00:13:47,678 EMERGENCY DEPARTMENT. 426 00:13:47,678 --> 00:13:50,181 BUT AMONG THOSE THAT USUAL 427 00:13:50,181 --> 00:13:52,917 SOURCE OF CAROL, THERE ARE 428 00:13:52,917 --> 00:13:55,653 500 MILLION PRIMARY CARE VISITS 429 00:13:55,653 --> 00:13:57,088 IN THE UNITED STATES EVERY YEAR. 430 00:13:57,088 --> 00:14:01,726 HALF A BILLION. 431 00:14:01,726 --> 00:14:02,794 PRIMARY CARE, AS MANY OF YOU 432 00:14:02,794 --> 00:14:04,495 KNOW, IS DEFINED BY THE WORLD 433 00:14:04,495 --> 00:14:06,063 HEALTH ORGANIZATION AS FIRST 434 00:14:06,063 --> 00:14:07,598 CONTACT MEDICAL CARE THAT'S 435 00:14:07,598 --> 00:14:09,167 COMPREHENSIVE, IT'S CONTINUOUS, 436 00:14:09,167 --> 00:14:10,434 AND IT'S COORDINATED. 437 00:14:10,434 --> 00:14:14,939 THERE'S A RELATIVELY ROBUST 438 00:14:14,939 --> 00:14:16,874 EVIDENCE BASE, ESPECIALLY FROM 439 00:14:16,874 --> 00:14:19,544 THE EARLY 2000s, BARBARA 440 00:14:19,544 --> 00:14:20,611 STARRFIELD AND MANY OF HER 441 00:14:20,611 --> 00:14:21,379 COLLEAGUES DEMONSTRATE THAT 442 00:14:21,379 --> 00:14:22,613 PRIMARY CARE RESOURCES IN A 443 00:14:22,613 --> 00:14:24,448 GIVEN COMMUNITY ARE ASSOCIATED 444 00:14:24,448 --> 00:14:26,417 WITH FAVORABLE OUTCOMES, 445 00:14:26,417 --> 00:14:28,085 MORTALITY, MAJOR ISSUES OF 446 00:14:28,085 --> 00:14:31,355 MORBIDITY, EVEN WHEN YOU ADJUST 447 00:14:31,355 --> 00:14:32,456 FOR OTHER HEALTHCARE RESOURCES 448 00:14:32,456 --> 00:14:35,726 AND NUMEROUS OTHER THINGS 449 00:14:35,726 --> 00:14:40,031 FACTORS IN THAT COMMUNITY, AND 450 00:14:40,031 --> 00:14:45,603 THERE ARE 1.6 PRIME RYE CARE PRS 451 00:14:45,603 --> 00:14:46,804 PER PERSON IN THE UNITED STATES. 452 00:14:46,804 --> 00:14:49,207 WE KNOW THOSE AREN'T DISTRIBUTED 453 00:14:49,207 --> 00:14:50,474 EQUITABLY, BUT A SPECIFIC REASON 454 00:14:50,474 --> 00:14:51,776 WE ARE INTERESTED IN PRIMARY 455 00:14:51,776 --> 00:14:55,313 CARE, MIGUEL'S LAST COUPLE 456 00:14:55,313 --> 00:14:56,781 SLIDES WHERE HE TALKED ABOUT THE 457 00:14:56,781 --> 00:14:58,216 MAJOR DRIVERS OF HEALTH 458 00:14:58,216 --> 00:15:00,017 OUTCOMES, THE MAJOR CONDITIONS, 459 00:15:00,017 --> 00:15:01,485 WHEN YOU LOOK AT THE GUIDELINE 460 00:15:01,485 --> 00:15:03,154 AND EVIDENCE BASE SERVICES THAT 461 00:15:03,154 --> 00:15:04,555 ARE GEARED TO ADDRESS THOSE 462 00:15:04,555 --> 00:15:05,756 THINGS, TO DRIVE DOWN MORTALITY, 463 00:15:05,756 --> 00:15:07,158 TO DRIVE DOWN MORBIDITY AND 464 00:15:07,158 --> 00:15:08,926 DRIVE UP QUALITY OF LIFE, THOSE 465 00:15:08,926 --> 00:15:12,296 ARE PLACED SOLELY -- SQUARELY IN 466 00:15:12,296 --> 00:15:14,065 THE LAP OF PRIMARY CARE. 467 00:15:14,065 --> 00:15:15,066 THAT IS WHERE THEY'RE OFTEN 468 00:15:15,066 --> 00:15:16,567 AIMED AND IT'S OUR CENTER'S 469 00:15:16,567 --> 00:15:18,202 INTEREST TO BEST UNDERSTAND HOW 470 00:15:18,202 --> 00:15:20,605 OUR COUNTRY'S PRIMARY CARE 471 00:15:20,605 --> 00:15:21,839 SYSTEM, CLINICS AND PROVIDERS 472 00:15:21,839 --> 00:15:25,643 SERVE PATIENTS AND WE'RE 473 00:15:25,643 --> 00:15:27,612 INTERESTED IN -- THIS HALF A 474 00:15:27,612 --> 00:15:28,613 BILLION PRIMARY CARE VISITS, 475 00:15:28,613 --> 00:15:30,681 WHAT HAPPENS TO LATINO PATIENTS 476 00:15:30,681 --> 00:15:34,518 IN THOSE VISITS? 477 00:15:34,518 --> 00:15:35,953 BUT OUR INTEREST ACTUALLY GETS A 478 00:15:35,953 --> 00:15:36,387 LITTLE MORE FOCUSED. 479 00:15:36,387 --> 00:15:38,356 WE ARE SPECIFICALLY INTERESTED 480 00:15:38,356 --> 00:15:39,223 IN THE CARE DELIVERED THROUGH 481 00:15:39,223 --> 00:15:40,725 OUR NATION'S NETWORK OF 482 00:15:40,725 --> 00:15:42,460 COMMUNITY HEALTH CENTERS. 483 00:15:42,460 --> 00:15:43,628 THEY'RE OUR PRIMARY CARE CLINICS 484 00:15:43,628 --> 00:15:45,162 THAT HAVE SPECIFIC MANDATES, 485 00:15:45,162 --> 00:15:46,264 GUIDELINES AND FEDERALLY 486 00:15:46,264 --> 00:15:47,465 SUPPORTED FUNDING STRUCTURES TO 487 00:15:47,465 --> 00:15:49,000 PROVIDE CARE REGARDLESS OF 488 00:15:49,000 --> 00:15:50,968 PATIENTS' ABILITY TO PAY. 489 00:15:50,968 --> 00:15:52,236 THEY'RE OFTEN TARGETED AND 490 00:15:52,236 --> 00:15:54,171 PLACED IN LOW INCOME 491 00:15:54,171 --> 00:15:55,172 COMMUNITIES, WHILE THERE'S GREAT 492 00:15:55,172 --> 00:15:56,607 VARIATION IN WHO GETS SEEN AT A 493 00:15:56,607 --> 00:15:58,643 COMMUNITY HEALTH CENTER. 494 00:15:58,643 --> 00:15:59,911 MY MIDDLE CLASS FAMILY GETS SEEN 495 00:15:59,911 --> 00:16:01,545 IN A COMMUNITY HEALTH CENTER. 496 00:16:01,545 --> 00:16:04,248 THERE'S VARIATIONS NATIONWIDE. 497 00:16:04,248 --> 00:16:05,449 COMMUNITY HEALTH CENTERS CARE 498 00:16:05,449 --> 00:16:06,651 FOR 10% OF THE UNITED STATES 499 00:16:06,651 --> 00:16:07,318 POPULATION. 500 00:16:07,318 --> 00:16:08,419 AND WE ARE SPECIFICALLY 501 00:16:08,419 --> 00:16:10,121 INTERESTED IN SETTING PRIMARY 502 00:16:10,121 --> 00:16:11,289 CARE DELIVERED AT COMMUNITY 503 00:16:11,289 --> 00:16:14,759 HEALTH CENTERS OR CHCs 504 00:16:14,759 --> 00:16:15,660 BECAUSE -- FOR TWO REASONS 505 00:16:15,660 --> 00:16:16,060 REALLY. 506 00:16:16,060 --> 00:16:18,162 NUMBER ONE, THE SETTING TAKES 507 00:16:18,162 --> 00:16:20,598 DISPROPORTIONATE CARE OF LATINO 508 00:16:20,598 --> 00:16:22,166 PATIENTS AND COMMUNITIES. 509 00:16:22,166 --> 00:16:23,401 1 IN 6 LATINOS IN THE UNITED 510 00:16:23,401 --> 00:16:24,402 STATES GETS THEIR CARE AT A 511 00:16:24,402 --> 00:16:26,570 COMMUNITY HEALTH CENTER. 512 00:16:26,570 --> 00:16:28,105 THEY'RE ALSO IN GENERAL -- THEY 513 00:16:28,105 --> 00:16:29,440 DO SERVE FOLKS WHO EXPERIENCE 514 00:16:29,440 --> 00:16:31,943 BARRIERS TO HEALTHCARE AND 515 00:16:31,943 --> 00:16:33,144 HEALTH -- POSITIVE HEALTH 516 00:16:33,144 --> 00:16:36,080 OUTCOMES, SO IF YOU'RE CONCERNED 517 00:16:36,080 --> 00:16:37,848 ABOUT FOLKS EXPERIENCING THOSE 518 00:16:37,848 --> 00:16:38,916 BARRIERS, IT IS A NATIONAL 519 00:16:38,916 --> 00:16:41,185 SETTING TO STUDY SAYING THAT WE 520 00:16:41,185 --> 00:16:43,854 HAVE TO BE CONCERNED ABOUT, AND 521 00:16:43,854 --> 00:16:46,724 THAT'S WHERE WE KIND OF PUT OUR 522 00:16:46,724 --> 00:16:50,227 FOCUS. 523 00:16:50,227 --> 00:16:51,762 WE WORK WITH A NON-PROFIT 524 00:16:51,762 --> 00:16:53,731 COOPERATIVE OF COMMUNITY HEALTH 525 00:16:53,731 --> 00:16:54,865 CENTERS, 35-PLUS STATES IT'S 526 00:16:54,865 --> 00:16:57,134 MORE THAN THAT NOW, SERVING 527 00:16:57,134 --> 00:16:58,769 HUNDREDS OF SYSTEMS, THOUSANDS 528 00:16:58,769 --> 00:17:01,639 OF CLINICS, THAT'S ABOUT 529 00:17:01,639 --> 00:17:03,407 6 MILLION PLUS, I THINK IT'S 530 00:17:03,407 --> 00:17:07,244 PROBABLY MORE FOR -- GREATER TO 531 00:17:07,244 --> 00:17:08,913 LATINO. 532 00:17:08,913 --> 00:17:10,214 THIS IS -- THESE ARE CLINICS, 533 00:17:10,214 --> 00:17:11,983 EACH ONE OF THESE POINTS 534 00:17:11,983 --> 00:17:12,950 REPRESENTS MULTIPLE CLINICS. 535 00:17:12,950 --> 00:17:16,887 AND THERE ARE DATA PARTNERS BUT 536 00:17:16,887 --> 00:17:19,223 OUR PARTNER OVERALL. 537 00:17:19,223 --> 00:17:21,292 >> SO NOW THAT WE PROVIDED SOME 538 00:17:21,292 --> 00:17:22,360 CONTEXT, WE WANT TO SHARE THE 539 00:17:22,360 --> 00:17:23,160 OBJECTIVES OF TODAY'S 540 00:17:23,160 --> 00:17:23,828 PRESENTATION. 541 00:17:23,828 --> 00:17:24,462 SO FIRST WE'RE GOING TO TALK 542 00:17:24,462 --> 00:17:27,164 ABOUT THAT INTERSECTION BETWEEN 543 00:17:27,164 --> 00:17:29,333 PRIMARY CARE AND LATINO HEALTH. 544 00:17:29,333 --> 00:17:31,335 WE'LL THEN TOUCH A LITTLE BIT ON 545 00:17:31,335 --> 00:17:33,104 THEN WHAT'S THE FURTHER -- THE 546 00:17:33,104 --> 00:17:35,406 ROLE OR THE INTERSECTION THEN 547 00:17:35,406 --> 00:17:37,575 WITH SOCIAL DETERMINANTS OF 548 00:17:37,575 --> 00:17:37,908 HEALTH. 549 00:17:37,908 --> 00:17:39,477 WE'LL THEN TALK ABOUT LATINO, 550 00:17:39,477 --> 00:17:42,646 HOW DO WE UNDERSTAND THAT LATINO 551 00:17:42,646 --> 00:17:43,514 VARIATION. 552 00:17:43,514 --> 00:17:47,251 AND LATINO SUBIMREUPS, SUBGROUPY 553 00:17:47,251 --> 00:17:48,552 TALK ABOUT INTERVENTIONS GOING 554 00:17:48,552 --> 00:17:50,187 ON, PRIMARY CARE, U.S. 555 00:17:50,187 --> 00:17:51,822 HEALTHCARE SYSTEM IS DYNAMIC AND 556 00:17:51,822 --> 00:17:53,924 CHANGING OVER TIME, SO HOW CAN 557 00:17:53,924 --> 00:17:55,760 WE LEVERAGE PRIMARY CARE TO 558 00:17:55,760 --> 00:17:58,295 UNDERSTAND REAL WORLD 559 00:17:58,295 --> 00:17:59,730 INTERVENTIONS. 560 00:17:59,730 --> 00:18:01,565 SO WE'LL START OFF BY TALKING 561 00:18:01,565 --> 00:18:03,067 ABOUT THE UNIQUE AND STRATEGIC 562 00:18:03,067 --> 00:18:04,435 SETTING OF PRIMARY CARE IN WHICH 563 00:18:04,435 --> 00:18:07,171 TO STUDY LATINO HEALTH EQUITY. 564 00:18:07,171 --> 00:18:10,141 SO TO START OFF, BECAUSE OF 565 00:18:10,141 --> 00:18:11,976 PRIMARY CARE'S COMPREHENSIVENESS 566 00:18:11,976 --> 00:18:13,878 AND COMPLEXITY, WE BELIEVE THAT 567 00:18:13,878 --> 00:18:15,146 STUDYING THE LATINO HEALTH 568 00:18:15,146 --> 00:18:16,480 EQUITY IN THE CONTEXT OF PRIMARY 569 00:18:16,480 --> 00:18:17,782 CARE REQUIRES THE USE OF 570 00:18:17,782 --> 00:18:19,016 MULTIPLE METHODS AND APPROACHES 571 00:18:19,016 --> 00:18:22,186 TO MORE FULLY CONNECT THE SET OF 572 00:18:22,186 --> 00:18:23,054 COMPREHENSIVE HEALTH OUTCOMES, 573 00:18:23,054 --> 00:18:24,822 SOCIAL CHALLENGES, AND 574 00:18:24,822 --> 00:18:26,057 MULTILEVEL FACTORS THAT MAY 575 00:18:26,057 --> 00:18:28,192 CONTRIBUTE TO HEALTH OUTCOMES IN 576 00:18:28,192 --> 00:18:29,727 LATINO POPULATIONS. 577 00:18:29,727 --> 00:18:32,029 AND SO WE'VE FOUND THAT THE 578 00:18:32,029 --> 00:18:33,764 NIMHD RESEARCH FRAMEWORK TO BE A 579 00:18:33,764 --> 00:18:35,533 HELPFUL PARADIGM IN HOW WE THINK 580 00:18:35,533 --> 00:18:36,834 ABOUT THAT MULTILEVEL WORK 581 00:18:36,834 --> 00:18:38,569 NEEDED TO UNDERSTAND LATINO 582 00:18:38,569 --> 00:18:39,904 HEALTH EQUITY, AND SO AS MANY OF 583 00:18:39,904 --> 00:18:42,339 YOU KNOW, THIS FRAMEWORK COVERS 584 00:18:42,339 --> 00:18:43,574 DIFFERENT LEVELS OF INFLUENCE 585 00:18:43,574 --> 00:18:44,809 AND DOMAINS OF INFLUENCE AND WE 586 00:18:44,809 --> 00:18:46,243 WANT TO HIGHLIGHT HERE THAT THE 587 00:18:46,243 --> 00:18:48,412 HEALTH SYSTEM IS SPECIFICALLY 588 00:18:48,412 --> 00:18:50,614 INCLUDED IN THIS FRAMEWORK AS IT 589 00:18:50,614 --> 00:18:52,683 PLAYS AN IMPORTANT ROLE IN 590 00:18:52,683 --> 00:18:54,752 HEALTH DISPARITIES THROUGH 591 00:18:54,752 --> 00:18:56,087 PREVENTION, CARE, AND MANAGEMENT 592 00:18:56,087 --> 00:19:00,057 OF DISEASES ACROSS THE LIFESPAN. 593 00:19:00,057 --> 00:19:02,960 >> BUT OUR FOCUS IN PRIMARY 594 00:19:02,960 --> 00:19:05,596 CARE, WE CAN TRY TO TAKE THAT 595 00:19:05,596 --> 00:19:08,099 FRAMEWORK AND APPLY TO THE CARE 596 00:19:08,099 --> 00:19:09,200 ENVIRONMENT. 597 00:19:09,200 --> 00:19:09,867 THIS IS IMPORTANT BECAUSE AS 598 00:19:09,867 --> 00:19:11,268 MANY OF YOU KNOW IF YOU'RE A 599 00:19:11,268 --> 00:19:12,870 CLINICIAN OR EVEN IF YOU'RE NOT, 600 00:19:12,870 --> 00:19:14,472 CARE IS A MULTI-STEP PROCESS. 601 00:19:14,472 --> 00:19:16,540 IT'S NOT A SINGLE-STEP PROCESS. 602 00:19:16,540 --> 00:19:18,476 SO FROM PRESENTATION, GETTING 603 00:19:18,476 --> 00:19:21,712 THE DOOR, DIAGNOSIS, TREATMENT, 604 00:19:21,712 --> 00:19:23,013 COMPLICATIONS, FOLLOW-UP, HOME 605 00:19:23,013 --> 00:19:23,881 MANAGEMENT, PREVENTION, ALL OF 606 00:19:23,881 --> 00:19:27,218 THESE THINGS, THE STRUCTURAL 607 00:19:27,218 --> 00:19:29,086 FACTORS THAT CAN CONTRIBUTE TO 608 00:19:29,086 --> 00:19:33,691 ANY ONE OF THOSE POINTS, THEY 609 00:19:33,691 --> 00:19:36,827 MIGHT ACT DIFFERENTLY, BUT 610 00:19:36,827 --> 00:19:39,363 EQUITY OR INEQUITY ISN'T A 611 00:19:39,363 --> 00:19:41,332 MONOLITH IN EVERY INSTANCE. 612 00:19:41,332 --> 00:19:42,433 UNDERSTANDING POINTS OF 613 00:19:42,433 --> 00:19:44,335 STRENGTH, VULNERABILITY, 614 00:19:44,335 --> 00:19:46,070 GOOD/BAD ARE, WE CAN BE REALLY 615 00:19:46,070 --> 00:19:48,572 BEST POISED TO CREATE A 616 00:19:48,572 --> 00:19:49,673 HEALTHCARE SYSTEM THAT WORKS. 617 00:19:49,673 --> 00:19:50,875 THIS IS A WORKING MODEL THAT WE 618 00:19:50,875 --> 00:19:52,309 USE AS WE FORMULATE MANY OF OUR 619 00:19:52,309 --> 00:19:53,477 RESEARCH QUESTIONS AND WE'LL 620 00:19:53,477 --> 00:19:56,714 SHOW TO YOU AGAIN. 621 00:19:56,714 --> 00:19:58,349 >> AND WHILE EARLIER WE TALKED 622 00:19:58,349 --> 00:19:59,617 ABOUT LATINOS IN THE U.S. 623 00:19:59,617 --> 00:20:00,751 OVERALL, I DO WANT TO SPEND A 624 00:20:00,751 --> 00:20:02,286 MINUTE TALKING ABOUT LATINOS AND 625 00:20:02,286 --> 00:20:03,387 THEIR INTERACTION WITH COMMUNITY 626 00:20:03,387 --> 00:20:03,921 HEALTH CENTERS. 627 00:20:03,921 --> 00:20:05,623 SO AS JOHN MENTIONED EARLIER, 628 00:20:05,623 --> 00:20:06,657 COMMUNITY HEALTH CENTERS ACROSS 629 00:20:06,657 --> 00:20:08,959 THE U.S. SEE ABOUT 32 MILLION 630 00:20:08,959 --> 00:20:11,462 PATIENTS A YEAR, AND OF THESE 631 00:20:11,462 --> 00:20:13,597 32 MILLION, ABOUT 32% 632 00:20:13,597 --> 00:20:14,565 SELF-IDENTIFY AS LATINOS OR TO 633 00:20:14,565 --> 00:20:16,433 PUT IT IN OTHER WORDS AS JOHN 634 00:20:16,433 --> 00:20:18,102 MENTIONED THIS, ABOUT 1 IN 635 00:20:18,102 --> 00:20:20,070 6 LATINOS IN THE U.S. SEEK CARE 636 00:20:20,070 --> 00:20:21,172 A COMMUNITY HEALTH CENTERS. 637 00:20:21,172 --> 00:20:22,439 IN FACT IN MANY STATES, LATINOS 638 00:20:22,439 --> 00:20:23,874 ARE THE MAJORITY USERS OF 639 00:20:23,874 --> 00:20:27,077 COMMUNITY HEALTH CENTERS. 640 00:20:27,077 --> 00:20:28,646 AND WHILE THERE HAVE BEEN SOME 641 00:20:28,646 --> 00:20:30,181 STUDIES SHOWING THAT LATINOS 642 00:20:30,181 --> 00:20:31,715 TRUST IN THE HEALTHCARE SYSTEM 643 00:20:31,715 --> 00:20:33,350 AND CLINICIANS IN PARTICULAR ARE 644 00:20:33,350 --> 00:20:35,419 NOT AS HIGH AS OTHER GROUPS, 645 00:20:35,419 --> 00:20:37,421 THERE ARE SOME FINDINGS THAT 646 00:20:37,421 --> 00:20:38,923 SUGGEST THAT THIS MAY NOT BE THE 647 00:20:38,923 --> 00:20:40,591 CASE FOR COMMUNITY HEALTH 648 00:20:40,591 --> 00:20:41,392 CENTERS. 649 00:20:41,392 --> 00:20:44,061 SO CHCs ARE MISSION-DRIVEN 650 00:20:44,061 --> 00:20:45,162 ORGANIZATIONS THAT ARE WIDELY 651 00:20:45,162 --> 00:20:47,131 VIEWED AS PROVIDERS OF 652 00:20:47,131 --> 00:20:48,265 CULTURALLY COMPETENT CARE. 653 00:20:48,265 --> 00:20:50,534 SO THIS INCLUDES SERVICES LIKE 654 00:20:50,534 --> 00:20:52,303 MULTILINGUAL SERVICES, THE 655 00:20:52,303 --> 00:20:54,038 INCLUSION OF BILINGUAL STAFF, 656 00:20:54,038 --> 00:20:56,473 AND CULTURALLY TAILORED OUTREACH 657 00:20:56,473 --> 00:20:56,907 PROGRAMS. 658 00:20:56,907 --> 00:20:58,075 SO BECAUSE OF THEIR SPECIALIZED 659 00:20:58,075 --> 00:20:59,743 KNOWLEDGE ABOUT TREATING 660 00:20:59,743 --> 00:21:00,844 UNDERSERVED POPULATIONINGS 661 00:21:00,844 --> 00:21:01,845 INCLUDING LATINOS, THEY ARE 662 00:21:01,845 --> 00:21:03,247 ABOUT TO PLAY AN IMPORTANT ROLE 663 00:21:03,247 --> 00:21:05,749 IN ELIMINATING RACIAL AND ETHNIC 664 00:21:05,749 --> 00:21:07,351 DISPARITIES IN CARE, QUALITY AND 665 00:21:07,351 --> 00:21:10,588 HEALTH OUTCOMES. 666 00:21:10,588 --> 00:21:12,323 >> BUT DO THEY INDEED? 667 00:21:12,323 --> 00:21:13,857 SO WE LOOK AT SPECIFICS, DO WE 668 00:21:13,857 --> 00:21:15,259 SEE EMPIRIC EVIDENCE THAT 669 00:21:15,259 --> 00:21:16,260 COMMUNITY HEALTH CENTERS 670 00:21:16,260 --> 00:21:18,095 CONTRIBUTE TO MORE POSITIVE 671 00:21:18,095 --> 00:21:19,663 OUTCOMES IN LATINO PATIENTS AND 672 00:21:19,663 --> 00:21:21,599 LATINO COMMUNITIES? 673 00:21:21,599 --> 00:21:24,001 SO LET'S TAKE A COUPLE REAL 674 00:21:24,001 --> 00:21:26,337 WORLD EXAMPLES. 675 00:21:26,337 --> 00:21:29,506 WE'RE COMING -- WE'RE EMERGING 676 00:21:29,506 --> 00:21:30,941 FROM, STILL IN AN AREA WHERE 677 00:21:30,941 --> 00:21:33,043 VACCINATION IS A CRUCIAL TOPIC, 678 00:21:33,043 --> 00:21:36,747 AND AS MANY OF US COULD ATTEST 679 00:21:36,747 --> 00:21:38,382 TO, AROUND THE IDEA OF VACCINE 680 00:21:38,382 --> 00:21:40,584 HESITANCY. 681 00:21:40,584 --> 00:21:42,319 THIS CONCEPT WAS OFTENTIMES 682 00:21:42,319 --> 00:21:44,588 PEOPLE OF COLOR, LATINO 683 00:21:44,588 --> 00:21:44,888 INDIVIDUALS. 684 00:21:44,888 --> 00:21:45,656 NOW THE PAPER THAT YOU SEE 685 00:21:45,656 --> 00:21:47,258 BEFORE YOU JUST KIND OF 686 00:21:47,258 --> 00:21:52,630 DEMONSTRATES THAT, THAT IT'S NOT 687 00:21:52,630 --> 00:21:53,831 CRITIQUE IN ANY WAY OF THIS 688 00:21:53,831 --> 00:21:55,366 COLLEGE AND INDEED THESE PIECES 689 00:21:55,366 --> 00:21:56,567 ALL HAD VERY DIFFERENT THINGS TO 690 00:21:56,567 --> 00:21:58,302 SAY ABOUT PIECES OF THAT TOPIC, 691 00:21:58,302 --> 00:22:01,372 BUT THE POINT IS -- IN THE 692 00:22:01,372 --> 00:22:03,007 SCIENTIFIC LITERATURE THAT 693 00:22:03,007 --> 00:22:04,108 LINKED VACCINE HESITANCY TO 694 00:22:04,108 --> 00:22:07,511 LATINO PEOPLES. 695 00:22:07,511 --> 00:22:10,047 COMMUNITY HEALTH CENTERS, WE SAW 696 00:22:10,047 --> 00:22:11,782 EVIDENCE OF A DIFFERENT STORY. 697 00:22:11,782 --> 00:22:13,217 WE WANT TO TALK ABOUT THAT. 698 00:22:13,217 --> 00:22:17,254 THESE TWO FIGURES ARE -- DEAL 699 00:22:17,254 --> 00:22:19,423 WITH CHILDREN AND ADOLESCENTS 700 00:22:19,423 --> 00:22:20,958 AND VACCINATIONS IN RELATIVELY 701 00:22:20,958 --> 00:22:21,859 LARGE SAMPLES OF PATIENTS. 702 00:22:21,859 --> 00:22:26,930 SO THE LEFT, THERE IS 155,000 703 00:22:26,930 --> 00:22:27,965 CHILDREN, THERE'S A 704 00:22:27,965 --> 00:22:29,199 SUBPOPULATION HERE OF ABOUT 705 00:22:29,199 --> 00:22:31,402 20,000 CHILDREN WITH ASTHMA, 706 00:22:31,402 --> 00:22:33,604 WITH VERY SIMILAR FINDINGS. 707 00:22:33,604 --> 00:22:34,571 INFLUENZA VACCINATION RATES. 708 00:22:34,571 --> 00:22:39,276 THE SPECIFIC ANALYSIS WAS 709 00:22:39,276 --> 00:22:40,044 FOCUSING ON -- WHY THESE 710 00:22:40,044 --> 00:22:42,479 CATEGORIES WERE USED, BUT LATINO 711 00:22:42,479 --> 00:22:46,483 CHILDREN HAD A HIGHER RATE OF 712 00:22:46,483 --> 00:22:47,484 INFLUENZA VACCINATION AND THAT 713 00:22:47,484 --> 00:22:49,286 WHITE CHILDREN AND THE ABSOLUTE 714 00:22:49,286 --> 00:22:50,788 RATE AREN'T SHOWN, 715 00:22:50,788 --> 00:22:52,122 APPROPRIATENESS, APPROACHING ONE 716 00:22:52,122 --> 00:22:53,190 PER YEAR. 717 00:22:53,190 --> 00:22:57,428 ON THE RIGHT IS A ANALYSIS OF 718 00:22:57,428 --> 00:22:59,797 HPV, HUMAN PAPILLOMAVIRUS, 719 00:22:59,797 --> 00:23:01,699 VACCINE INITIATION, BROKEN DOWN 720 00:23:01,699 --> 00:23:04,335 BY NUMEROUS LATINO SUBGROUPS AND 721 00:23:04,335 --> 00:23:05,469 THAT WOULD BE PLACE OF BIRTH, 722 00:23:05,469 --> 00:23:06,737 AND WHEN THAT WASN'T AVAILABLE, 723 00:23:06,737 --> 00:23:08,272 PREFERRED LANGUAGE. 724 00:23:08,272 --> 00:23:11,809 THIS SHOWED THAT LATINO 725 00:23:11,809 --> 00:23:13,344 ADOLESCENTS HAD A MUCH HIGHER 726 00:23:13,344 --> 00:23:15,412 ADJUSTED PREVALENCE OF 727 00:23:15,412 --> 00:23:18,048 INITIATING VACCINE THAN WHITE 728 00:23:18,048 --> 00:23:19,249 CHILDREN, REPRESENTED BY BLUE 729 00:23:19,249 --> 00:23:22,319 BARS ON THE WAY ON THE FAR LEFT. 730 00:23:22,319 --> 00:23:24,955 AND IN ADULTS, WE SEE SOME 731 00:23:24,955 --> 00:23:26,390 SIMILAR, SOME SLIGHTLY DIFFERENT 732 00:23:26,390 --> 00:23:27,624 FINDINGS OF VACCINATIONS. 733 00:23:27,624 --> 00:23:29,760 ON THE LEFT, YOU SEE AN ANALYSIS 734 00:23:29,760 --> 00:23:34,365 OF INFLUENZA AND PNEUMOCOCCAL 735 00:23:34,365 --> 00:23:35,699 VACCINATION, PNEUMONIA VACCINE 736 00:23:35,699 --> 00:23:38,202 FOR OLDER ADULTS, AND THOSE BLUE 737 00:23:38,202 --> 00:23:40,571 BARS ARE SPANISH REFERRING 738 00:23:40,571 --> 00:23:42,940 LATINO PATIENTS WHO IN ALL 739 00:23:42,940 --> 00:23:49,747 OUTCOMES, SOME ARE -- EVER 740 00:23:49,747 --> 00:23:51,915 HAVING A VACCINE, LATER 741 00:23:51,915 --> 00:23:55,386 VACCINATION, COMPLETION OF TWO 742 00:23:55,386 --> 00:23:57,221 VACCINES AND WHETHER THE PATIENT 743 00:23:57,221 --> 00:23:59,123 WAS 50 TO 65 WITH CERTAIN 744 00:23:59,123 --> 00:24:00,457 CONDITIONS THAT REQUIRED 745 00:24:00,457 --> 00:24:05,662 VACCINATION OR OVER 65 -- HAD 746 00:24:05,662 --> 00:24:07,831 MORE VACCINE. 747 00:24:07,831 --> 00:24:09,066 YOU SEE A SEPARATION BETWEEN THE 748 00:24:09,066 --> 00:24:10,734 RED AND BLUE THERE, AND THAT'S 749 00:24:10,734 --> 00:24:11,468 IMPORTANT AND WE'RE GOING TO M 750 00:24:11,468 --> 00:24:13,670 COME BACK TO THAT. 751 00:24:13,670 --> 00:24:18,509 BUT THEN ON THE RIGHT, A IN 752 00:24:18,509 --> 00:24:22,112 PROCESS, NOT PEER REVIEWED YET 753 00:24:22,112 --> 00:24:24,782 ANALYSIS OF COVID VACCINATION IN 754 00:24:24,782 --> 00:24:27,618 LATINO PATIENTS VERSUS 755 00:24:27,618 --> 00:24:28,919 NON-HISPANIC WHITE PATIENTS THAT 756 00:24:28,919 --> 00:24:32,222 SHOWS A CLEAR SIGNIFICANT 757 00:24:32,222 --> 00:24:35,192 DIFFERENCE IN VACCINE PREVALENCE 758 00:24:35,192 --> 00:24:36,493 IN LATINO PATIENTS. 759 00:24:36,493 --> 00:24:38,562 SO HERE'S WHAT'S IMPORTANT FOR 760 00:24:38,562 --> 00:24:40,297 ALL THESE FIGURES. 761 00:24:40,297 --> 00:24:41,832 YOU KNOW, GENERIC VACCINE 762 00:24:41,832 --> 00:24:45,335 HESITANCY NARRATIVE IN LATINO 763 00:24:45,335 --> 00:24:47,337 COMMUNITIES IS INSUFFICIENT. 764 00:24:47,337 --> 00:24:48,739 POSSIBLE STRENGTHS OF THE 765 00:24:48,739 --> 00:24:50,174 COMMUNITY, POSSIBLE STRENGTHS OF 766 00:24:50,174 --> 00:24:51,708 THE DELIVERY SYSTEM AND THE 767 00:24:51,708 --> 00:24:53,677 POSSIBLE SYNERGIES BETWEEN THE 768 00:24:53,677 --> 00:24:56,313 TWO, AND YOU SEE PART OF THE 769 00:24:56,313 --> 00:24:58,182 CULTURAL CONVERSATION. 770 00:24:58,182 --> 00:24:59,716 BUT ALSO PEOPLE SAY WE'RE 771 00:24:59,716 --> 00:25:00,818 MISSING SOMETHING BY JUST 772 00:25:00,818 --> 00:25:01,752 LOOKING AT COMMUNITY HEALTH 773 00:25:01,752 --> 00:25:02,519 CENTERS. 774 00:25:02,519 --> 00:25:03,420 I THINK WE MAY BE MISSING 775 00:25:03,420 --> 00:25:05,155 SOMETHING IF WE DON'T. 776 00:25:05,155 --> 00:25:06,290 HOWEVER, THE SECOND POINT HERE I 777 00:25:06,290 --> 00:25:09,159 THINK AS WELL, WE'RE PRACTICALLY 778 00:25:09,159 --> 00:25:10,694 CONCERNED WITH HOW TO ACHIEVE 779 00:25:10,694 --> 00:25:11,929 THE EQUITABLE DELIVERY OF 780 00:25:11,929 --> 00:25:12,629 HEALTHCARE SERVICES. 781 00:25:12,629 --> 00:25:16,433 WE NEED TO KNOW THE SETTINGS IN 782 00:25:16,433 --> 00:25:17,434 WHICH IT IS DELIVERED TO 783 00:25:17,434 --> 00:25:20,237 UNDERSTAND PATTERNS OF SERVICE 784 00:25:20,237 --> 00:25:20,537 UTILIZATION. 785 00:25:20,537 --> 00:25:22,139 AS THAT FIGURE SHOWS ON THE 786 00:25:22,139 --> 00:25:23,607 LEFT, NOT ALL LATINO PATIENTS 787 00:25:23,607 --> 00:25:25,209 WERE GETTING THE SAME THING IN 788 00:25:25,209 --> 00:25:26,410 THE SAME SITUATION, AND THAT 789 00:25:26,410 --> 00:25:28,045 THEME, THAT NUANCE OF THE NEED 790 00:25:28,045 --> 00:25:31,215 TO DISSECT THINGS BY STEP AND 791 00:25:31,215 --> 00:25:32,216 WHILE SOME GROUPS CONTINUE TO 792 00:25:32,216 --> 00:25:33,851 SHOW UP AS WE CONSIDER OTHER 793 00:25:33,851 --> 00:25:35,152 SERVICES. 794 00:25:35,152 --> 00:25:36,487 WE'LL COME BACK TO OUR WORKING 795 00:25:36,487 --> 00:25:37,688 MODEL, AND IMMUNIZATION IS ONE 796 00:25:37,688 --> 00:25:40,424 OF THOSE THINGS THAT YOU COULD 797 00:25:40,424 --> 00:25:43,894 IMAGINE IS A SINGLE STEP IN 798 00:25:43,894 --> 00:25:44,661 HEALTHCARE BUT WHAT ABOUT 799 00:25:44,661 --> 00:25:45,696 SOMETHING A LITTLE MORE COMPLEX, 800 00:25:45,696 --> 00:25:50,501 A CONDITION THAT REARS MORE REQE 801 00:25:50,501 --> 00:25:51,368 STEPS? 802 00:25:51,368 --> 00:25:52,569 ASTHMA AS A COMMON DISCUSSED 803 00:25:52,569 --> 00:25:54,104 CONDITION IN LATINO COMMUNITIES, 804 00:25:54,104 --> 00:25:56,507 IT'S A PROBLEM, MUCH OF 805 00:25:56,507 --> 00:25:57,808 SCHOLARSHIP IN THE LAST 30 OR 40 806 00:25:57,808 --> 00:25:59,643 YEARS HAS FOCUSED ON PREVALENCE 807 00:25:59,643 --> 00:26:03,514 AND PREVALENCE DIFFERENCE FOR 808 00:26:03,514 --> 00:26:05,749 PUERTO RICAN INDIVIDUALS HAVE A 809 00:26:05,749 --> 00:26:08,185 HIGH PREVALENCE OF ASTHMA, 810 00:26:08,185 --> 00:26:09,953 MEXICAN ORIGIN FOLKS HAVE MUCH 811 00:26:09,953 --> 00:26:10,387 LOWER. 812 00:26:10,387 --> 00:26:13,257 BUT THE EVIDENCE WOULD GENERALLY 813 00:26:13,257 --> 00:26:15,225 SUGGEST THAT REGARDLESS OF 814 00:26:15,225 --> 00:26:16,093 SUBGROUPS, ASTHMA OUTCOMES CAN 815 00:26:16,093 --> 00:26:20,230 BE WORSE IN LATINO PATIENTS AND 816 00:26:20,230 --> 00:26:25,936 COMMUNITIES, THIS IS CDC DATA 817 00:26:25,936 --> 00:26:27,571 THAT DOUBLES FOR LATINO PATIENTS 818 00:26:27,571 --> 00:26:28,772 COMPARED TO NON-HISPANIC WHITE 819 00:26:28,772 --> 00:26:34,344 PATIENTS. 820 00:26:34,344 --> 00:26:36,213 IN OUR WORK, WE'VE SEEN SLIGHTLY 821 00:26:36,213 --> 00:26:39,950 DIFFERENT DYNAMICS AT PLAY. 822 00:26:39,950 --> 00:26:43,320 THAT ARE I THINK WORTH EXPLOR 823 00:26:43,320 --> 00:26:44,655 EXPLORING. 824 00:26:44,655 --> 00:26:49,159 THIS IS BY KAUFMANN, LATINO 825 00:26:49,159 --> 00:26:51,161 CHILDREN DID ACTUALLY HAVE MORE 826 00:26:51,161 --> 00:26:53,463 ASTHMA EXACERBATIONS CODED AS 827 00:26:53,463 --> 00:26:55,866 SUCH IN THE MEDICAL RECORD, 828 00:26:55,866 --> 00:26:56,967 ASTHMA, FLARE OF THEIR SYMPTOMS. 829 00:26:56,967 --> 00:26:58,302 THEY ACTUALLY WENT TO THE 830 00:26:58,302 --> 00:27:00,571 CLINIC, THE COMMUNITY HEALTH 16 831 00:27:00,571 --> 00:27:02,573 TE PRIMARY HEALTH CLINIC AND NOT 832 00:27:02,573 --> 00:27:03,240 THE EMERGENCY DEPARTMENT. 833 00:27:03,240 --> 00:27:04,207 THOSE FAMILIAR WITH THE 834 00:27:04,207 --> 00:27:06,843 MANAGEMENT OF ASTHMA, MOST 835 00:27:06,843 --> 00:27:09,580 ASTHMA FLARES CAN BE HANDLED IN 836 00:27:09,580 --> 00:27:11,114 PRIMARY CARE, THEY HAVE THE 837 00:27:11,114 --> 00:27:12,849 EXPERTISE NECESSARY TO DO THAT, 838 00:27:12,849 --> 00:27:14,184 MINORITY ACTUALLY NEED TO GO TO 839 00:27:14,184 --> 00:27:16,353 THE EMERGENCY DEPARTMENT. 840 00:27:16,353 --> 00:27:20,924 SO WHILE THERE WAS A DISPARITY, 841 00:27:20,924 --> 00:27:23,160 THEY ACTUALLY WENT TO THE BETTER 842 00:27:23,160 --> 00:27:25,462 PLACE TO HAVE THAT DEALT WITH 843 00:27:25,462 --> 00:27:27,064 THAT'S CHEAPER AND FASTER AND 844 00:27:27,064 --> 00:27:28,031 PROBABLY MORE CONVENIENT FOR 845 00:27:28,031 --> 00:27:29,366 THEM. 846 00:27:29,366 --> 00:27:31,001 AND THE SAME LATINO CHILDREN IN 847 00:27:31,001 --> 00:27:35,238 THIS ANALYSIS WHO WILL GO INTO 848 00:27:35,238 --> 00:27:37,240 THE HEALTH CLINIC FOR THEIR 849 00:27:37,240 --> 00:27:38,475 EXACERBATIONS WERE GIVEN 850 00:27:38,475 --> 00:27:40,644 PREVENTIVE MEDICATIONS, MORE 851 00:27:40,644 --> 00:27:41,678 APPROPRIATE IMMUNIZATIONS AND 852 00:27:41,678 --> 00:27:44,581 MORE REGULAR VISITS. 853 00:27:44,581 --> 00:27:49,953 AND INDEED WE -- WITH THAT 854 00:27:49,953 --> 00:27:51,588 ANALYSIS HAD MANUSCRIPTS ON 855 00:27:51,588 --> 00:27:55,525 ASTHMA PRESCRIBING, SO 856 00:27:55,525 --> 00:27:56,727 PRESCRIBING MEDICATIONS AND 857 00:27:56,727 --> 00:27:59,329 INHALERS IS A BIG PART OF ASTHMA 858 00:27:59,329 --> 00:28:00,130 MANAGEMENT, NOT THE ONLY PART 859 00:28:00,130 --> 00:28:01,198 BUT IT IS A BIG PART. 860 00:28:01,198 --> 00:28:09,640 AND THIS ANALYSIS LOOKED AT 861 00:28:09,640 --> 00:28:13,243 SPANISH -- ENGLISH -- 862 00:28:13,243 --> 00:28:14,111 COMPARATIVE GROUP IN THE 863 00:28:14,111 --> 00:28:15,012 VERTICAL LINE. 864 00:28:15,012 --> 00:28:16,313 GENERALLY, NOT COMPLETELY BUT 865 00:28:16,313 --> 00:28:19,950 GENERALLY, THE PATTERN WITH 866 00:28:19,950 --> 00:28:21,351 SPANISH LATINO CHILDREN HAD 867 00:28:21,351 --> 00:28:22,786 HIGHER ODDS OF HAVING A 868 00:28:22,786 --> 00:28:25,522 PRESCRIPTION WRITTEN FOR THEM, 869 00:28:25,522 --> 00:28:27,691 WHEN IN ASTHMA -- THIS ANALYSIS 870 00:28:27,691 --> 00:28:29,826 KIND OF GOES ACROSS ALL THOSE 871 00:28:29,826 --> 00:28:31,161 ROWS ARE DIFFERENT MEDICATION 872 00:28:31,161 --> 00:28:32,696 CLASSES OR DIFFERENT SEVERITIES 873 00:28:32,696 --> 00:28:36,500 OF ASTHMA, AND ESPECIALLY 874 00:28:36,500 --> 00:28:37,367 CORTICOSTEROID INHALERS, THOSE 875 00:28:37,367 --> 00:28:39,002 ARE PREVENTIVE MEDICINES, 876 00:28:39,002 --> 00:28:39,803 CONTROLLER MEDICINES THAT ARE 877 00:28:39,803 --> 00:28:43,940 MEANT TO REDUCE THE NUMBER OF 878 00:28:43,940 --> 00:28:44,975 FLARES AND EXACERBATIONS. 879 00:28:44,975 --> 00:28:47,344 SO AGAIN, A COUPLE IDEAS HERE. 880 00:28:47,344 --> 00:28:48,879 NUMBER ONE, YOU ACTUALLY SEE IN 881 00:28:48,879 --> 00:28:49,846 A COMMUNITY HEALTH CENTER SOME 882 00:28:49,846 --> 00:28:52,616 GROUPS OF LATINOS, SOME GROUPS 883 00:28:52,616 --> 00:28:55,452 GETTING SEEMINGLY WHAT THEY NEED 884 00:28:55,452 --> 00:28:57,220 OR SOME STEPS IN THE CARE 885 00:28:57,220 --> 00:29:01,058 PROCESS BEING POSITIVE. 886 00:29:01,058 --> 00:29:01,925 THERE'S -- WE STILL HEAR THAT 887 00:29:01,925 --> 00:29:04,528 WITH THE PREVIOUS SLIDE WHERE 888 00:29:04,528 --> 00:29:06,063 THERE'S MORE EXACERBATIONS, AND 889 00:29:06,063 --> 00:29:09,599 AGAIN, THAT CONCEPT THAT 890 00:29:09,599 --> 00:29:11,902 CONTEXT, SPECIFIC CONTEXT, 891 00:29:11,902 --> 00:29:13,303 SPECIFIC STEP IN CARE MATTERS 892 00:29:13,303 --> 00:29:15,272 AND MAKE IT A SPECIFIC WINDOW 893 00:29:15,272 --> 00:29:16,907 INTO THE DRIVERS OF INEQUITY. 894 00:29:16,907 --> 00:29:19,309 SO IN THIS SETTING, PROVIDERS 895 00:29:19,309 --> 00:29:22,612 ARE INDEED WRITING THAT BUT 896 00:29:22,612 --> 00:29:25,449 THAT'S NOT ENTIRE STORY, THERE'S 897 00:29:25,449 --> 00:29:26,550 DEFICIT IN COMMUNICATION, 898 00:29:26,550 --> 00:29:27,684 THERE'S PROBLEMS FILLING, 899 00:29:27,684 --> 00:29:29,052 PROBLEMS USING IT, THERE'S 900 00:29:29,052 --> 00:29:32,456 ENVIRONMENTAL EXPOSURE, 901 00:29:32,456 --> 00:29:33,123 OVERWHELMS THE USE OF THE 902 00:29:33,123 --> 00:29:34,324 MEDICATION TO BEGIN WITH, BUT 903 00:29:34,324 --> 00:29:36,626 THAT GRANULARITY, THAT 904 00:29:36,626 --> 00:29:40,230 SPECIFICITY IS HELPFUL FOR, I 905 00:29:40,230 --> 00:29:42,232 THINK, INCLUDING THE SYSTEM 906 00:29:42,232 --> 00:29:43,867 OVERALL AND SHOWS UP I THINK IN 907 00:29:43,867 --> 00:29:47,671 OTHER CONDITIONS AS WELL. 908 00:29:47,671 --> 00:29:50,273 >> SO OTHER CONDITIONS LIKE 909 00:29:50,273 --> 00:29:51,408 DIABETES, SO WE TURN OUR 910 00:29:51,408 --> 00:29:52,809 ATTENTION TO ANOTHER CHRONIC 911 00:29:52,809 --> 00:29:55,879 CONDITION HIGHLY REF PLANT IN 912 00:29:55,879 --> 00:29:58,849 LATINOS, WE KNOW U.S. LATINOS 913 00:29:58,849 --> 00:30:00,050 DISPROPORTIONATELY FACE 914 00:30:00,050 --> 00:30:01,351 DIABETES-RELATED DISPARITIES 915 00:30:01,351 --> 00:30:06,289 COMPARED TO LCOMPARE NON-LATINOO 916 00:30:06,289 --> 00:30:07,624 THEY'VE BEEN CONSISTENTLY LINKED 917 00:30:07,624 --> 00:30:09,025 TO THESE DISPARITIES. 918 00:30:09,025 --> 00:30:10,927 SO WE WANTED TO SEE IF THIS WAS 919 00:30:10,927 --> 00:30:12,629 ALSO TRUE IN COMMUNITY HEALTH 920 00:30:12,629 --> 00:30:12,863 CENTERS. 921 00:30:12,863 --> 00:30:16,133 SO A COMMON APPROACH FOR 922 00:30:16,133 --> 00:30:19,970 MONITORING DIABETES IS TO HAVE 923 00:30:19,970 --> 00:30:24,841 CONSISTENT H1AC TESTING SO IN 924 00:30:24,841 --> 00:30:29,112 THIS STUDY WE AIM TO CAROL HBA1C 925 00:30:29,112 --> 00:30:31,648 TESTING RATES AND LEVELS AMONG 926 00:30:31,648 --> 00:30:33,717 THOSE WITH ENGLISH AND SPANISH 927 00:30:33,717 --> 00:30:34,351 PREFERENCE IN COMMUNITY HEALTH 928 00:30:34,351 --> 00:30:34,684 CENTERS. 929 00:30:34,684 --> 00:30:36,553 HERE THERE ARE ALSO TWO KEY 930 00:30:36,553 --> 00:30:38,321 TAKEAWAYS. 931 00:30:38,321 --> 00:30:41,024 SO FIRST, LOOKING AT THIS HERE, 932 00:30:41,024 --> 00:30:44,094 SPANISH PREFERRING LATINOS HAD 933 00:30:44,094 --> 00:30:45,228 HIGHER HBA1C TESTING RATES 934 00:30:45,228 --> 00:30:47,731 COMPARED TO NON-LATINO WHITES AS 935 00:30:47,731 --> 00:30:48,832 EVIDENCED BY THESE GREEN LINES 936 00:30:48,832 --> 00:30:51,468 ON THE WHITE. 937 00:30:51,468 --> 00:30:54,738 ALTERNATIVELY, SPANISH -- 938 00:30:54,738 --> 00:30:56,606 COMPARED TO NON-LATINO WHITES 939 00:30:56,606 --> 00:31:03,280 SEEN BY THESE YELLOW LINES HERE. 940 00:31:03,280 --> 00:31:04,347 THE SECOND TAKE AWAY BY THE TOP 941 00:31:04,347 --> 00:31:05,682 RIGHT PORTION OF THE SLIDE, 942 00:31:05,682 --> 00:31:07,317 SPANISH PREFERRING LATINOS 943 00:31:07,317 --> 00:31:08,084 DISPROPORTIONATELY FACED A 944 00:31:08,084 --> 00:31:11,154 HIGHER PREVALENCE OF HAVING 945 00:31:11,154 --> 00:31:12,923 HBA1C ABOVE 9%, WHICH AS 946 00:31:12,923 --> 00:31:14,591 RECOMMENDED BY THE AMERICAN 947 00:31:14,591 --> 00:31:15,659 DIABETES ASSOCIATION SHOULD LEAD 948 00:31:15,659 --> 00:31:19,062 THE PATIENT TO RECEIVE HBA1C 949 00:31:19,062 --> 00:31:20,363 TESTING AT LEAST THREE TIMES PER 950 00:31:20,363 --> 00:31:21,598 YEAR IN ORDER TO CONTINUOUSLY 951 00:31:21,598 --> 00:31:22,465 ASSESS PROGRESS. 952 00:31:22,465 --> 00:31:26,436 AND SO THE TESTING OF THOSE WITH 953 00:31:26,436 --> 00:31:27,838 HBA1C GREATER THAN 9% IS 954 00:31:27,838 --> 00:31:28,738 REPORTED HERE IN THE BOTTOM 955 00:31:28,738 --> 00:31:30,273 RIGHT PORTION OF THE SLIDE. 956 00:31:30,273 --> 00:31:31,508 SO OVERALL, ALL GROUPS ARE 957 00:31:31,508 --> 00:31:32,776 RECEIVING LESS THAN THE 958 00:31:32,776 --> 00:31:34,511 RECOMMENDED ADA TESTING RATE. 959 00:31:34,511 --> 00:31:40,350 WITH A SLIGHT LEHIGHER LY HIGHEY 960 00:31:40,350 --> 00:31:43,053 AMONG SPANISH PREFERRING LATI 961 00:31:43,053 --> 00:31:43,286 LATINOS. 962 00:31:43,286 --> 00:31:44,120 SO THEY ARE GETTING APPROPRIATE 963 00:31:44,120 --> 00:31:44,754 CARE MORE OFTEN. 964 00:31:44,754 --> 00:31:46,523 THAT DOESN'T NECESSARILY EQUAL 965 00:31:46,523 --> 00:31:50,827 DIABETES CONTROL. 966 00:31:50,827 --> 00:31:52,596 >> WE'VE SEEN A SIMILAR PATTERN 967 00:31:52,596 --> 00:31:54,331 WITH SOME OF THE WORK WE'VE DONE 968 00:31:54,331 --> 00:31:56,199 WITH HYPERTENSION. 969 00:31:56,199 --> 00:32:00,136 THIS IS AN ANALYSIS OF PATIENTS 970 00:32:00,136 --> 00:32:01,371 IN 23 STATES THAT LOOKED AT 971 00:32:01,371 --> 00:32:04,074 DIFFERENT ASPECTS OF THE CARE 972 00:32:04,074 --> 00:32:04,808 CASCADE FOR HYPERTENSION. 973 00:32:04,808 --> 00:32:05,909 SO FIRST HYPERTENSION 974 00:32:05,909 --> 00:32:06,276 ACKNOWLEDGMENT. 975 00:32:06,276 --> 00:32:08,211 THAT WAS DEFINED AS IF THERE ARE 976 00:32:08,211 --> 00:32:09,946 ELEVATED BLOOD PRESSURES TO 977 00:32:09,946 --> 00:32:11,648 DIAGNOSTIC CRITERIA ON THE 978 00:32:11,648 --> 00:32:12,082 CHART. 979 00:32:12,082 --> 00:32:14,017 THERE'S TIERP TENSION, HIGH 980 00:32:14,017 --> 00:32:15,785 BLOOD PRESSURE GET ON TO THE 981 00:32:15,785 --> 00:32:17,220 ELECTRONIC HEALTH RECORD PROBLEM 982 00:32:17,220 --> 00:32:20,190 LIST, OFFICIAL DOCUMENTATION. 983 00:32:20,190 --> 00:32:21,958 LATINO PATIENTS IT HAPPENED MORE 984 00:32:21,958 --> 00:32:24,027 OFTEN, ESPECIALLY SPANISH 985 00:32:24,027 --> 00:32:25,128 PREFERRING LATINO PATIENTS, BUT 986 00:32:25,128 --> 00:32:26,663 THOSE GROUPS ACTUALLY HAD THEIR 987 00:32:26,663 --> 00:32:28,865 HYPERTENSION ACKNOWLEDGED ON THE 988 00:32:28,865 --> 00:32:30,700 CHART. 989 00:32:30,700 --> 00:32:32,369 ONCE THAT WAS ACKNOWLEDGED, 990 00:32:32,369 --> 00:32:33,904 SPANISH PREFERRING LATINO 991 00:32:33,904 --> 00:32:38,508 PATIENTS WERE MORE LIKELY TO 992 00:32:38,508 --> 00:32:39,643 HAVE PRESCRIPTION PRESCRIBED. 993 00:32:39,643 --> 00:32:40,944 THAT'S GOOD GENERALLY SPEAKING 994 00:32:40,944 --> 00:32:43,680 HOWEVER THIS DID NOT NECESSARILY 995 00:32:43,680 --> 00:32:47,851 EQUATE TO HIGHER RATE OF CONTROL 996 00:32:47,851 --> 00:32:51,254 AND HULL GROUPS ALL GROUPS HAD E 997 00:32:51,254 --> 00:32:55,625 AMOUNT OF CONTROL, ABOUT 60% OF 998 00:32:55,625 --> 00:32:56,960 OVERALL BLOOD PRESSURE VALUES 999 00:32:56,960 --> 00:32:59,930 AFTER TREATMENT WAS INITIATED, 1000 00:32:59,930 --> 00:33:01,698 SO FOR LATINO PATIENTS, SOME 1001 00:33:01,698 --> 00:33:04,868 GOOD CARE STEPS DID, IN FACT, 1002 00:33:04,868 --> 00:33:07,904 HAPPEN, BUT DIDN'T NECESSARILY 1003 00:33:07,904 --> 00:33:10,340 RESPOND TO MORE -- TO BETTER 1004 00:33:10,340 --> 00:33:10,607 OUTCOMES. 1005 00:33:10,607 --> 00:33:12,208 THIS IS AN IMPORTANT KIND OF 1006 00:33:12,208 --> 00:33:17,380 CUTOFF TO THEM. 1007 00:33:17,380 --> 00:33:19,316 >> IF WE TURN OUR ATTENTION TO 1008 00:33:19,316 --> 00:33:21,084 CANCER, COLORECTAL CANCER, WHAT 1009 00:33:21,084 --> 00:33:23,286 WE KNOW IS IMPROVEMENTS IN 1010 00:33:23,286 --> 00:33:24,287 COLORECTAL CANCER MORTALITY HAVE 1011 00:33:24,287 --> 00:33:25,655 NOT BEEN EQUITABLE IN THE LAST 1012 00:33:25,655 --> 00:33:26,456 20 YEARS. 1013 00:33:26,456 --> 00:33:28,658 THERE HAS BEEN SOME SURVEY-BASED 1014 00:33:28,658 --> 00:33:29,292 CROSS-SECTIONAL RESEARCH THAT 1015 00:33:29,292 --> 00:33:31,695 HAS SHOWN THAT THERE IS A 1016 00:33:31,695 --> 00:33:33,997 REDUCED COLORECTAL CANCER 1017 00:33:33,997 --> 00:33:34,798 SCREENING IN LATINOS. 1018 00:33:34,798 --> 00:33:36,199 WHAT'S LESSER KNOWN IS WHAT'S 1019 00:33:36,199 --> 00:33:37,500 GOING ON IN PRIMARY CARE. 1020 00:33:37,500 --> 00:33:40,236 SO WE SOUGHT OUT TO TRY TO 1021 00:33:40,236 --> 00:33:43,540 EMPLPROVIDE A WINDOW INTO THE 1022 00:33:43,540 --> 00:33:44,741 COLORECTAL SCREENING PRACTICES 1023 00:33:44,741 --> 00:33:45,942 IN COMMUNITY HEALTH CENTERS 1024 00:33:45,942 --> 00:33:48,345 AMONG LATINOS, SO WHAT WE FOUND 1025 00:33:48,345 --> 00:33:49,579 AS SHOWN HERE ON THE FIGURE ON 1026 00:33:49,579 --> 00:33:52,182 THE LEFT WAS THAT LATINO 1027 00:33:52,182 --> 00:33:54,284 PATIENTS -- AND THIS WAS A 1028 00:33:54,284 --> 00:33:57,120 SAMPLE OF OLDER PATIENTS, 50 1029 00:33:57,120 --> 00:33:58,555 YEARS AND OLDER. 1030 00:33:58,555 --> 00:34:00,991 SO LATINO PATIENTS AND IN 1031 00:34:00,991 --> 00:34:01,925 PARTICULAR SPANISH PREFERRING 1032 00:34:01,925 --> 00:34:03,293 LATINOS WERE MORE LIKELY TO 1033 00:34:03,293 --> 00:34:05,161 RECEIVE STOOL-BASED SCREENING 1034 00:34:05,161 --> 00:34:08,231 TESTS FOR COLORECTAL CANCER 1035 00:34:08,231 --> 00:34:09,332 SCREENING THAN NON-HISPANIC 1036 00:34:09,332 --> 00:34:09,666 WHITES. 1037 00:34:09,666 --> 00:34:10,867 BUT IF YOU LOOK AT THE FIGURE ON 1038 00:34:10,867 --> 00:34:12,535 THE RIGHT, THIS SHOWS THAT 1039 00:34:12,535 --> 00:34:15,038 LATINOS WERE LESS LIKELY TO 1040 00:34:15,038 --> 00:34:16,806 RECEIVE ENDOSCOPY REFERRALS THAN 1041 00:34:16,806 --> 00:34:17,507 NON-HISPANIC WHITE. 1042 00:34:17,507 --> 00:34:19,642 SO EVEN WHEN EXPERIENCING A 1043 00:34:19,642 --> 00:34:21,511 POSITIVE STOOL-BASED SCREENING 1044 00:34:21,511 --> 00:34:24,447 TEST, WHICH SHOULD TRIGGER A 1045 00:34:24,447 --> 00:34:26,783 FOLLOW-UP REFERRAL OR AN ORDER 1046 00:34:26,783 --> 00:34:28,752 FOR COLONOSCOPY, SO THIS LEADS 1047 00:34:28,752 --> 00:34:31,154 US TO THINK OF WAYS TO EXTEND 1048 00:34:31,154 --> 00:34:33,456 THIS WORK TO UNDERSTAND THIS 1049 00:34:33,456 --> 00:34:36,192 BREAKDOWN MORE FULLY. 1050 00:34:36,192 --> 00:34:37,694 SO IN PARTICULAR IT HIGHLIGHTS 1051 00:34:37,694 --> 00:34:38,495 POE TEPTION AREAS OF 1052 00:34:38,495 --> 00:34:39,729 INTERVENTIONS IN COMMUNITY 1053 00:34:39,729 --> 00:34:41,498 HEALTH CENTERS AND PERHAPS 1054 00:34:41,498 --> 00:34:43,233 BEYOND THAT COULD ENCOURAGE 1055 00:34:43,233 --> 00:34:47,804 REFERRALS FOR LOWER GI ENDOSCOPY 1056 00:34:47,804 --> 00:34:49,372 TO IMPROVE COLORECTAL CANCER 1057 00:34:49,372 --> 00:34:49,806 OUTCOMES. 1058 00:34:49,806 --> 00:34:51,341 AND IF WE TURN OUR ATTENTION TO 1059 00:34:51,341 --> 00:34:53,209 BREAST CANCER SCREENING, IN A 1060 00:34:53,209 --> 00:34:55,412 RECENT STUDY, WE CONDUCTED AN 1061 00:34:55,412 --> 00:34:57,147 ANALYSIS OF MAMMOGRAPHY ORDER 1062 00:34:57,147 --> 00:34:59,582 RATES IN LATINAS, SO BY LANGUAGE 1063 00:34:59,582 --> 00:35:00,683 PREFERENCE OVER A 10-YEAR 1064 00:35:00,683 --> 00:35:01,684 PERIOD. 1065 00:35:01,684 --> 00:35:03,086 SO WE EVALUATE TWO OUTCOMES. 1066 00:35:03,086 --> 00:35:05,188 SO THE FIRST WAS DID ELIGIBLE 1067 00:35:05,188 --> 00:35:06,623 PATIENTS EVER HAVE A MAMMOGRAM 1068 00:35:06,623 --> 00:35:09,692 ORDERED DURING THE STUDY PERIOD, 1069 00:35:09,692 --> 00:35:10,927 AND THOSE RESULTS ARE DISPLAYED 1070 00:35:10,927 --> 00:35:11,995 ON THE X AXIS. 1071 00:35:11,995 --> 00:35:14,497 HERE WE ALSO LOOKED AT ANNUAL 1072 00:35:14,497 --> 00:35:16,266 RATES, SO HOW MANY TIMES OVER 1073 00:35:16,266 --> 00:35:18,234 TIME OF MAMMOGRAPHY ORDERS, AND 1074 00:35:18,234 --> 00:35:19,335 THOSE RESULTS ARE DISPLAYED ON 1075 00:35:19,335 --> 00:35:20,470 THE Y AXIS. 1076 00:35:20,470 --> 00:35:22,338 AND SO I'LL WALK THROUGH THESE 1077 00:35:22,338 --> 00:35:23,106 RESULTS SINCE THERE'S A LOT 1078 00:35:23,106 --> 00:35:23,907 GOING ON HERE. 1079 00:35:23,907 --> 00:35:26,076 SO WE FOCUS ON LATINAS WHO 1080 00:35:26,076 --> 00:35:27,844 PREFER ENGLISH, SO THIS RED 1081 00:35:27,844 --> 00:35:29,579 SYMBOL HERE. 1082 00:35:29,579 --> 00:35:31,347 THEY ESSENTIALLY HAVE SIMILAR 1083 00:35:31,347 --> 00:35:33,249 ODDS OF RECEIVING AT LEAST ONE 1084 00:35:33,249 --> 00:35:34,617 MAMMOGRAM ORDER COMPARED TO 1085 00:35:34,617 --> 00:35:37,020 NON-LATINO WHITE PATIENTS. 1086 00:35:37,020 --> 00:35:39,255 HOWEVER, AMONG THOSE RECEIVING 1087 00:35:39,255 --> 00:35:40,957 MAMMOGRAM ORDERS, ENGLISH 1088 00:35:40,957 --> 00:35:42,725 PREFERRING LATINAS HAD LOWER 1089 00:35:42,725 --> 00:35:44,928 MAMMOGRAM ORDER RATES THAN 1090 00:35:44,928 --> 00:35:46,663 NON-LATINO WHITE WOMEN, SO ABOUT 1091 00:35:46,663 --> 00:35:48,665 8% LESS ORDER. 1092 00:35:48,665 --> 00:35:50,400 SO ENGLISH PREFERRING LATINAS 1093 00:35:50,400 --> 00:35:52,836 HAD SIMILAR ODDS OF GETTING AT 1094 00:35:52,836 --> 00:35:56,439 LEAST ONE ORDER, BUT COMPARED TO 1095 00:35:56,439 --> 00:35:58,208 NOP LATINO WHITE PATIENTS, THEY 1096 00:35:58,208 --> 00:35:59,409 HAD OVERALL LOWER RATES OF 1097 00:35:59,409 --> 00:36:02,245 MAMMOGRAM ORDERS OVER TIME. 1098 00:36:02,245 --> 00:36:06,583 SO IF WE TURN OUR ATTENTION TO 1099 00:36:06,583 --> 00:36:08,218 LATINOS WHO PREFER SPANISH, THEY 1100 00:36:08,218 --> 00:36:09,719 SEEM TO BE AN OUTLIER IN A WAY. 1101 00:36:09,719 --> 00:36:11,621 THIS SUGGESTS THAT SPANISH 1102 00:36:11,621 --> 00:36:12,589 PREFERRING LATINAS HAD HIGHER 1103 00:36:12,589 --> 00:36:15,125 ODDS OF EVER HAVING A MAMMOGRAM 1104 00:36:15,125 --> 00:36:18,061 ORDERED THAN NON-LATINO WHITES 1105 00:36:18,061 --> 00:36:19,262 SO MORE THAN DOUBLE, SO IF THEY 1106 00:36:19,262 --> 00:36:20,964 EVER HAD A HIGHER RATE OF ANNUAL 1107 00:36:20,964 --> 00:36:22,332 MAMMOGRAM ORDERS, A LITTLE OVER 1108 00:36:22,332 --> 00:36:23,633 50% MORE ORDERS OVER TIME. 1109 00:36:23,633 --> 00:36:25,969 SO THESE FINDINGS SUGGEST THAT 1110 00:36:25,969 --> 00:36:27,103 BREAST CANCER DETECTION VARIES 1111 00:36:27,103 --> 00:36:28,638 IN LOW INCOME LATINOS MAY NOT 1112 00:36:28,638 --> 00:36:30,807 STEM FROM A LACK OF ORDERS IN 1113 00:36:30,807 --> 00:36:33,109 PRIMARY CARE, BUT IN SUBSEQUENT 1114 00:36:33,109 --> 00:36:35,345 ACCESSIBILITY OF RECEIVING 1115 00:36:35,345 --> 00:36:36,312 ORDERED SERVICES. 1116 00:36:36,312 --> 00:36:37,947 SO EVEN IN CANCER SCREENING, 1117 00:36:37,947 --> 00:36:40,283 SOME STEPS WORK WELL FOR SOME 1118 00:36:40,283 --> 00:36:42,886 LATINOS AND LATINAS ACROSS THE 1119 00:36:42,886 --> 00:36:44,654 CONTINUUM AND SOME NOT. 1120 00:36:44,654 --> 00:36:46,623 BUT RIGOROUSLY EVALUATING THESE 1121 00:36:46,623 --> 00:36:47,190 STUDIES IN COMMUNITY HEALTH 1122 00:36:47,190 --> 00:36:48,491 CENTERS CAN PROVIDE A WINDOW 1123 00:36:48,491 --> 00:36:49,526 INTO WHAT'S WORKING IN PRIMARY 1124 00:36:49,526 --> 00:36:50,627 CARE SETTINGS, SOMEWHERE IT 1125 00:36:50,627 --> 00:36:52,662 BREAKING DOWN IN THE CANCER CARE 1126 00:36:52,662 --> 00:36:53,997 CONTINUUM, AND WHERE CAN WE 1127 00:36:53,997 --> 00:36:55,865 INTERVENE TO IMPROVE PREVENTIVE 1128 00:36:55,865 --> 00:36:57,400 SERVICES TO IMPROVE CANCER CARE 1129 00:36:57,400 --> 00:37:01,538 AND MORE BROADLY TO IMPROVE 1130 00:37:01,538 --> 00:37:04,941 CHRONIC CONDITION CARE AMONG 1131 00:37:04,941 --> 00:37:05,441 LATINOS. 1132 00:37:05,441 --> 00:37:07,810 SO I KNOW WE THREW A LOT OUT 1133 00:37:07,810 --> 00:37:09,379 THERE, WE PRESENTED A LOT, BUT I 1134 00:37:09,379 --> 00:37:11,981 THINK WHAT WE SEE IS THE BROAD 1135 00:37:11,981 --> 00:37:14,117 RANGE OF POTENTIAL INSIGHTS INTO 1136 00:37:14,117 --> 00:37:16,186 LATINO EQUITY AND LATINO 1137 00:37:16,186 --> 00:37:16,953 HEALTHCARE DELIVERY THROUGH 1138 00:37:16,953 --> 00:37:18,288 STUDIES IN PRIMARY CARE FROM 1139 00:37:18,288 --> 00:37:20,823 MULTIPLE DISEASES TO MULTIPLE 1140 00:37:20,823 --> 00:37:26,196 LATINO GROUPS, OVER TIME, AND 1141 00:37:26,196 --> 00:37:27,664 WENT NUANCE OF WHEN HEALTH 1142 00:37:27,664 --> 00:37:28,865 SYSTEMS WORK AND WHEN IT BREAKS 1143 00:37:28,865 --> 00:37:31,701 DOWN AND WHERE WE CAN INTERVENE. 1144 00:37:31,701 --> 00:37:33,336 SO THESE DISPARATE FINDINGS 1145 00:37:33,336 --> 00:37:34,571 STILL UNDERLIE THE IMPORTANCE OF 1146 00:37:34,571 --> 00:37:35,672 PRIMARY CARE, BUT WE HAVE A 1147 00:37:35,672 --> 00:37:37,407 FOUNDATION FOR NEXT STEPS AND 1148 00:37:37,407 --> 00:37:38,841 THAT IS THEN TO NOW THINK ABOUT 1149 00:37:38,841 --> 00:37:40,310 THESE CLINICS, THEY'RE PART OF 1150 00:37:40,310 --> 00:37:40,910 NEIGHBORHOODS, THESE PATIENTS 1151 00:37:40,910 --> 00:37:41,811 ARE PART OF NEIGHBORHOODS, HOW 1152 00:37:41,811 --> 00:37:43,479 DO WE THINK ABOUT THE SOCIAL 1153 00:37:43,479 --> 00:37:45,982 DETERMINANTS OF HEALTH WHEN WE 1154 00:37:45,982 --> 00:37:47,884 STUDY PRIMARY CARE AND LATINO 1155 00:37:47,884 --> 00:37:49,953 COMMUNITIES. 1156 00:37:49,953 --> 00:37:51,387 SO WE'LL SPEND A COUPLE MINUTES 1157 00:37:51,387 --> 00:37:52,155 TALKING ABOUT SOCIAL 1158 00:37:52,155 --> 00:37:53,256 DETERMINANTS OF HEALTH. 1159 00:37:53,256 --> 00:37:54,691 >> WE'RE GOING TO TALK ABOUT A 1160 00:37:54,691 --> 00:37:56,893 VERY SMALL SLICE OF THAT PIE 1161 00:37:56,893 --> 00:37:58,528 TODAY. 1162 00:37:58,528 --> 00:38:02,131 THAT PIE, SOCIAL DETERMINANTS IS 1163 00:38:02,131 --> 00:38:06,536 BIG, THOSE OF US IN HEALTH -- 1164 00:38:06,536 --> 00:38:07,604 SPEND TIME ARGUING ABOUT WHAT 1165 00:38:07,604 --> 00:38:08,605 PIECE OF THAT PIE IS IMPORTANT, 1166 00:38:08,605 --> 00:38:10,607 HOW BEST TO STUDY THAT PIE, WHAT 1167 00:38:10,607 --> 00:38:11,908 THAT PIE SHOULD BE CALLED. 1168 00:38:11,908 --> 00:38:13,676 WE'RE NOT GOING TO DO THAT 1169 00:38:13,676 --> 00:38:13,876 TODAY. 1170 00:38:13,876 --> 00:38:16,112 WE'RE GOING TO SHOW YOU A REAL 1171 00:38:16,112 --> 00:38:17,213 SMALL SLICE ABOUT HOW SOME OF 1172 00:38:17,213 --> 00:38:20,049 THE ISSUES THAT WE CAN COME 1173 00:38:20,049 --> 00:38:22,685 ACROSS, TACKLE, AS WE TRY TO 1174 00:38:22,685 --> 00:38:24,687 UNDERSTAND HOW COMMUNITY 1175 00:38:24,687 --> 00:38:27,423 ENVIRONMENT, CONTEXT IMPACTS THE 1176 00:38:27,423 --> 00:38:30,827 PRIMARY CARE PROCESS, HOW THOSE 1177 00:38:30,827 --> 00:38:35,331 THINGS INTERRELATE, INTERACT IN 1178 00:38:35,331 --> 00:38:37,100 LATINO PATIENTS. 1179 00:38:37,100 --> 00:38:38,635 >> JUST SO WE'RE ALL ON THE SAME 1180 00:38:38,635 --> 00:38:40,069 PAGE, I DID WANT TO PUT THE 1181 00:38:40,069 --> 00:38:40,837 DEFINITION, AT LEAST THE ONE 1182 00:38:40,837 --> 00:38:43,339 THAT WE USE ABOUT WHAT IS A 1183 00:38:43,339 --> 00:38:44,474 SOCIAL DETERMINANT OF HEALTH AND 1184 00:38:44,474 --> 00:38:46,009 I'LL READ IT OUT LOUD AS WELL. 1185 00:38:46,009 --> 00:38:46,743 SOCIAL DETERMINANTS OF HEALTH 1186 00:38:46,743 --> 00:38:48,211 ARE THE CONDITIONS IN THE 1187 00:38:48,211 --> 00:38:49,178 ENVIRONMENTS WHERE PEOPLE ARE 1188 00:38:49,178 --> 00:38:52,482 BORN, LIVE, LEARN, WORK, PLAY, 1189 00:38:52,482 --> 00:38:54,550 WORSHIP, AND AGE THAT AFFECT A 1190 00:38:54,550 --> 00:38:56,319 WIDE RANGE OF HEALTH, 1191 00:38:56,319 --> 00:38:57,854 FUNCTIONING, AND QUALITY OF LIFE 1192 00:38:57,854 --> 00:38:59,422 OUTCOMES AND RISKS. 1193 00:38:59,422 --> 00:39:00,356 SO THERE HAVE BEEN A LOT OF 1194 00:39:00,356 --> 00:39:01,591 EFFORT TO FIGURE OUT HOW TO 1195 00:39:01,591 --> 00:39:02,792 COLLECT SOCIAL DETERMINANTS OF 1196 00:39:02,792 --> 00:39:03,893 HEALTH DATA. 1197 00:39:03,893 --> 00:39:05,828 INCLUDING A REALLY VALUABLE 1198 00:39:05,828 --> 00:39:07,830 SOURCE IN THE PHOENIX TOOLKIT. 1199 00:39:07,830 --> 00:39:09,599 SO THESE ECONOMIC ENVIRONMENTAL 1200 00:39:09,599 --> 00:39:12,435 AND SOCIAL INFLUENCES AT AN 1201 00:39:12,435 --> 00:39:14,304 INDIVIDUAL LEVEL ARE IMPORTANT. 1202 00:39:14,304 --> 00:39:15,838 BUT THERE STILL NEEDS TO BE A 1203 00:39:15,838 --> 00:39:18,174 BIGGER DISCUSSION AS HOW DO WE 1204 00:39:18,174 --> 00:39:19,809 INCORPORATE THIS INTO THE 1205 00:39:19,809 --> 00:39:22,645 CLINICAL WORKFLOW SINCE PRIMARY 1206 00:39:22,645 --> 00:39:24,314 CARE CLINICS ARE EXTREMELY BUSY 1207 00:39:24,314 --> 00:39:27,283 AND TO THINK OF ADDING EVEN 1208 00:39:27,283 --> 00:39:29,585 FIVE, SIX, SEVEN, 20 QUESTIONS, 1209 00:39:29,585 --> 00:39:31,888 IT MAY BE HARD AND THERE'S 1210 00:39:31,888 --> 00:39:32,889 DEFINITELY A LOT OF COMPLEXITY 1211 00:39:32,889 --> 00:39:33,456 THERE. 1212 00:39:33,456 --> 00:39:35,825 BUT IN THE MEANTIME, ARE THERE 1213 00:39:35,825 --> 00:39:38,261 WAYS TO LEVERAGE PRIMARY CARE 1214 00:39:38,261 --> 00:39:39,595 SETTINGS AND AGAIN SPECIFICALLY 1215 00:39:39,595 --> 00:39:40,997 COMMUNITY HEALTH SETTINGS TO 1216 00:39:40,997 --> 00:39:41,964 UNDERSTAND THE INFLUENCE OF 1217 00:39:41,964 --> 00:39:45,835 SOCIAL DETERMINANTS OF HEALTH ON 1218 00:39:45,835 --> 00:39:46,602 LATINO HEALTH? 1219 00:39:46,602 --> 00:39:49,639 >> SO WE THINK THERE IS, 1220 00:39:49,639 --> 00:39:51,841 SPECIFICALLY IN THE COLLECTION 1221 00:39:51,841 --> 00:39:53,810 OF ADDRESS DATA, COLLECTING OR 1222 00:39:53,810 --> 00:39:57,613 VERIFYING ADDRESSES AT EVERY 1223 00:39:57,613 --> 00:40:03,786 VISIT AND THE POTENTIAL OF 1224 00:40:03,786 --> 00:40:05,355 UNDERSTANDING THE CONNECTION 1225 00:40:05,355 --> 00:40:07,023 BETWEEN ENVIRONMENT NEIGHBORHOOD 1226 00:40:07,023 --> 00:40:10,560 AND CARE PROVIDED IS ACTUALLY 1227 00:40:10,560 --> 00:40:11,561 POWERFUL, BUT A COUPLE OF THINGS 1228 00:40:11,561 --> 00:40:14,197 HAVE COME UP WHEN YOU TRY TO DO 1229 00:40:14,197 --> 00:40:14,731 THAT. 1230 00:40:14,731 --> 00:40:16,933 NUMBER ONE, WE LIVE IN A -- 1231 00:40:16,933 --> 00:40:17,934 SOCIETY, PEOPLE MOVE. 1232 00:40:17,934 --> 00:40:19,469 LOW INCOME FOLKS, MAYBE EVEN 1233 00:40:19,469 --> 00:40:19,902 MORE. 1234 00:40:19,902 --> 00:40:22,238 SO THIS SLIDE TALKS A LITTLE BIT 1235 00:40:22,238 --> 00:40:23,973 ABOUT OUR KIND OF EXPLORATIONS 1236 00:40:23,973 --> 00:40:25,608 INTO THAT IDEA. 1237 00:40:25,608 --> 00:40:27,810 THE GRAPH ON THE LEFT, WE'RE 1238 00:40:27,810 --> 00:40:30,246 LOOKING AT ALL OF THE ADDRESSES 1239 00:40:30,246 --> 00:40:31,981 ADDED TO THE DATASET OVER EACH 1240 00:40:31,981 --> 00:40:34,317 YEAR, AND WHAT YOU SEE THOSE RED 1241 00:40:34,317 --> 00:40:37,286 LINE BOXES ARE BASICALLY THE 1242 00:40:37,286 --> 00:40:38,821 ADDRESS IS NOT A FIRST ADDRESS. 1243 00:40:38,821 --> 00:40:40,690 SO IT ESSENTIALLY IS THE DATASET 1244 00:40:40,690 --> 00:40:43,626 OF ADDRESSES INCREASES, YOU GET 1245 00:40:43,626 --> 00:40:45,561 MORE AND MORE SECOND, THIRD AND 1246 00:40:45,561 --> 00:40:46,162 FOURTH ADDRESSES. 1247 00:40:46,162 --> 00:40:50,867 ON THE RIGHT, IT'S A TABLE THAT 1248 00:40:50,867 --> 00:40:52,068 SHOWS SOME BASIC ASSOCIATIONS 1249 00:40:52,068 --> 00:40:54,837 BETWEEN THIS IDEA OF ADDRESS 1250 00:40:54,837 --> 00:40:58,007 CHANGE AND CARE RECEIPTS. 1251 00:40:58,007 --> 00:41:00,843 SO THESE ARE CHILDREN WITH 1252 00:41:00,843 --> 00:41:02,812 ASTHMA, AND IT SHOWS A COUPLE 1253 00:41:02,812 --> 00:41:03,279 THINGS. 1254 00:41:03,279 --> 00:41:06,349 ON THE BOTTOM, MANY OF US MIGHT 1255 00:41:06,349 --> 00:41:09,452 NOT BE SURPRISED AT, THE MORE 1256 00:41:09,452 --> 00:41:11,187 MOVES THAT A CHILD HAD IN THEIR 1257 00:41:11,187 --> 00:41:12,088 CHART, MORE ADDRESS CHANGES, 1258 00:41:12,088 --> 00:41:15,358 EXCUSE ME, THE LESS REGULAR -- 1259 00:41:15,358 --> 00:41:17,260 THIS IS A CHILD WITH A CHRONIC 1260 00:41:17,260 --> 00:41:18,227 DISEASE, ASTHMA, THE LESS 1261 00:41:18,227 --> 00:41:21,531 REGULAR VISITS THEY HAD, AND 1262 00:41:21,531 --> 00:41:26,135 THEIR INFLUENZA VACCINATION RATE 1263 00:41:26,135 --> 00:41:26,702 DROPPED. 1264 00:41:26,702 --> 00:41:27,603 AGAIN, NOT SURPRISING BUT 1265 00:41:27,603 --> 00:41:29,872 IMPORTANT TO KNOW. 1266 00:41:29,872 --> 00:41:31,741 ABOVE, WE'VE ALSO DONE 1267 00:41:31,741 --> 00:41:32,341 EXPLORATIONS OF THE TYPE OF 1268 00:41:32,341 --> 00:41:35,745 NEIGHBORHOOD OR FEATURES OF THE 1269 00:41:35,745 --> 00:41:38,114 NEIGHBORHOOD WHERE PEOPLE MOVE 1270 00:41:38,114 --> 00:41:39,148 TO, IN GENERAL WHAT WE FOUND 1271 00:41:39,148 --> 00:41:44,387 HEHERE, OTHER PLACES TO, WHEN A 1272 00:41:44,387 --> 00:41:46,355 NEIGHBORHOOD HAS MORE 1273 00:41:46,355 --> 00:41:47,557 DEPRIVATION, AS MEASURED IN 1274 00:41:47,557 --> 00:41:49,559 SEVERAL VALIDATED INDICES THAT 1275 00:41:49,559 --> 00:41:52,862 MEASURE ADVERSITY IN A 1276 00:41:52,862 --> 00:41:54,797 NEIGHBORHOOD, SOCIAL, ECONOMIC 1277 00:41:54,797 --> 00:41:57,400 DIVERSITY, THAT CARE IS -- 1278 00:41:57,400 --> 00:41:58,701 UTILIZATION GOES UP, AND SO 1279 00:41:58,701 --> 00:42:00,336 THAT'S ANOTHER JUST A PEACE OF 1280 00:42:00,336 --> 00:42:01,671 THIS PICTURE. 1281 00:42:01,671 --> 00:42:04,073 THOSE FINDINGS, THOSE ARE PRETTY 1282 00:42:04,073 --> 00:42:06,275 MODEST CHANGES, AND I THINK IN 1283 00:42:06,275 --> 00:42:07,477 SOME WAYS DIFFICULT TO 1284 00:42:07,477 --> 00:42:10,480 INTERPRET, BUT I THINK A 1285 00:42:10,480 --> 00:42:14,016 TAKE-HOME IS THAT A NEIGHBORHOOD 1286 00:42:14,016 --> 00:42:15,218 AFFECT SOMEONE'S HEALTH AND 1287 00:42:15,218 --> 00:42:17,053 HEALTHCARE OVER TIME, AND YOUR 1288 00:42:17,053 --> 00:42:17,820 CARE CHANGES OVER TIME. 1289 00:42:17,820 --> 00:42:21,457 BOTH OF THESE THINGS ARE 1290 00:42:21,457 --> 00:42:23,125 LONGITUDAL PHENOMENA. 1291 00:42:23,125 --> 00:42:24,927 YOU DON'T GET A SENSE OF THIS IN 1292 00:42:24,927 --> 00:42:26,729 ONE TIME POINT, TWO TIME POINTS 1293 00:42:26,729 --> 00:42:27,730 OR THREE TIME POINTS. 1294 00:42:27,730 --> 00:42:30,366 WE TAKE A PRIMARY CARE 1295 00:42:30,366 --> 00:42:32,235 PERSPECTIVE BECAUSE PRIMARY CARE 1296 00:42:32,235 --> 00:42:33,102 VALUES CONTINUITY AND WE WANT TO 1297 00:42:33,102 --> 00:42:34,136 KNOW WHAT IS HAPPENING OVER TIME 1298 00:42:34,136 --> 00:42:35,438 TO THE FUTURE, IN THE 1299 00:42:35,438 --> 00:42:36,873 ENVIRONMENT, IN THE CARE SYSTEM, 1300 00:42:36,873 --> 00:42:39,408 AND WHILE THESE -- IN OUR 1301 00:42:39,408 --> 00:42:41,310 ABILITY TO GIVE UNDERSTANDING, 1302 00:42:41,310 --> 00:42:42,945 THIS KIND OF APPROACH IS 1303 00:42:42,945 --> 00:42:44,146 NECESSARY TO FULLY UNDERSTAND 1304 00:42:44,146 --> 00:42:47,083 THESE MULTILEVEL INFLUENCES OVER 1305 00:42:47,083 --> 00:42:47,283 TIME. 1306 00:42:47,283 --> 00:42:49,485 BUT THIS LEADS US TO A MOBILITY 1307 00:42:49,485 --> 00:42:50,887 ISSUE THAT WE'VE BEEN THINKING 1308 00:42:50,887 --> 00:42:53,189 ABOUT THAT IS DISPROPORTIONATELY 1309 00:42:53,189 --> 00:42:55,057 PRESENT IN SOME LOW INCOME 1310 00:42:55,057 --> 00:42:56,292 FAMILIES, ESPECIALLY ON THE WEST 1311 00:42:56,292 --> 00:42:59,262 COAST, OTHER PLACES AS WELL, AND 1312 00:42:59,262 --> 00:43:01,030 THAT'S OF BEING A SEASONAL 1313 00:43:01,030 --> 00:43:01,330 FARMWORKER. 1314 00:43:01,330 --> 00:43:03,132 SOME OF YOU MAY KNOW, THAT'S AN 1315 00:43:03,132 --> 00:43:05,635 OFFICIAL BUREAU OF LABOR 1316 00:43:05,635 --> 00:43:07,737 DESIGNATION FOR FOLKS IN 1317 00:43:07,737 --> 00:43:11,040 AGRICULTURE THAT MOVE BASED 1318 00:43:11,040 --> 00:43:11,807 ON -- SEASONS AND COMMUNITY 1319 00:43:11,807 --> 00:43:15,678 HEALTH 16 CENTERS COLLECT THAT A 1320 00:43:15,678 --> 00:43:16,312 ON TENS OF THOUSANDS OF 1321 00:43:16,312 --> 00:43:16,579 PATIENTS. 1322 00:43:16,579 --> 00:43:19,715 AND THIS IS AN ANALYSIS THAT 1323 00:43:19,715 --> 00:43:23,286 LOOKED AT THE PREVIOUS ANALYSIS 1324 00:43:23,286 --> 00:43:27,990 OF ASTHMA EXACERBATIONS, AND IT 1325 00:43:27,990 --> 00:43:31,260 SHOWED THAT LATINO CHILDREN IN 1326 00:43:31,260 --> 00:43:34,363 FARMWORKER FAMILIES HAVE MORE 1327 00:43:34,363 --> 00:43:35,064 EXACERBATIONS BUT THEY SHOULD GO 1328 00:43:35,064 --> 00:43:36,132 TO THE CLINIC FOR THOSE AND HAD 1329 00:43:36,132 --> 00:43:40,503 A LOWER RATE OF EMERGENCY 1330 00:43:40,503 --> 00:43:41,604 DEPARTMENT USE. 1331 00:43:41,604 --> 00:43:43,139 I THINK THE PROGRESS HERE IN 1332 00:43:43,139 --> 00:43:47,109 THESE FINDINGS, CLINICS COLLECT 1333 00:43:47,109 --> 00:43:49,378 MATCHING THIS KIND OF SOCIAL 1334 00:43:49,378 --> 00:43:51,681 DETERMINANTS DATA THAT IS 1335 00:43:51,681 --> 00:43:54,250 SPECIFICALLY -- INTO LATINO 1336 00:43:54,250 --> 00:43:55,651 FAMILIES IS POTENTIALLY VERY 1337 00:43:55,651 --> 00:43:56,686 POWERFUL. 1338 00:43:56,686 --> 00:43:57,987 ALSO THERE'S THE INKLING, KIND 1339 00:43:57,987 --> 00:43:59,288 OF A FOUNDATION HERE THAT A 1340 00:43:59,288 --> 00:44:03,125 HEALTH SYSTEM THAT MIGHT BE 1341 00:44:03,125 --> 00:44:04,226 ACTUALLY AWARE OF DIFFERENT 1342 00:44:04,226 --> 00:44:05,761 SOCIAL DETERMINANTS MIGHT 1343 00:44:05,761 --> 00:44:07,663 ACTUALLY HAVE A BENEFICIAL 1344 00:44:07,663 --> 00:44:10,066 IMPACT, SOME THINGS CAN BE 1345 00:44:10,066 --> 00:44:11,267 MITIGATED. 1346 00:44:11,267 --> 00:44:13,002 THAT'S -- WE'RE JUST GETTING 1347 00:44:13,002 --> 00:44:16,439 INTO THAT, WHAT THIS MIGHT MEAN 1348 00:44:16,439 --> 00:44:21,177 AND A LOT MORE TO COME THERE. 1349 00:44:21,177 --> 00:44:22,878 >> SO WE KNOW WE PRESENTED JUST 1350 00:44:22,878 --> 00:44:24,680 A SMALL SLIVER AS JOHN MENTIONED 1351 00:44:24,680 --> 00:44:25,881 AND WE THINK THERE'S A LOT OF 1352 00:44:25,881 --> 00:44:27,750 POTENTIAL AND WE'D BE HAPPY TO 1353 00:44:27,750 --> 00:44:28,751 DISCUSS THAT SOME MORE. 1354 00:44:28,751 --> 00:44:30,086 BUT WE DO WANT TO TURN THE TOPIC 1355 00:44:30,086 --> 00:44:31,821 NOW TO OPPORTUNITIES FOR 1356 00:44:31,821 --> 00:44:33,723 STUDYING DATA DISAGGREGATION IN 1357 00:44:33,723 --> 00:44:35,558 LATINO COMMUNITIES. 1358 00:44:35,558 --> 00:44:36,993 SO AS I MENTIONED EARLIER, 1359 00:44:36,993 --> 00:44:39,428 LATINOS ARE A HETEROGENEOUS 1360 00:44:39,428 --> 00:44:40,730 GROUP SO WHAT WE SEE IN A 1361 00:44:40,730 --> 00:44:41,631 MAJORITY OF RESEARCH AS I 1362 00:44:41,631 --> 00:44:42,632 MENTIONED EARLIER IS THAT 1363 00:44:42,632 --> 00:44:45,334 LATINOS ARE AGGREGATED INTO ONE 1364 00:44:45,334 --> 00:44:46,936 LARGE GROUP, AND IT IGNORES THE 1365 00:44:46,936 --> 00:44:48,337 SIGNIFICANT VARIATION THAT 1366 00:44:48,337 --> 00:44:49,639 EXISTS WITHIN THOSE BROAD 1367 00:44:49,639 --> 00:44:49,939 CATEGORIES. 1368 00:44:49,939 --> 00:44:52,141 THIS REALLY LIMITS OUR ABILITY 1369 00:44:52,141 --> 00:44:52,942 TO TARGET RESOURCES WHERE 1370 00:44:52,942 --> 00:44:54,343 THEY'RE NEEDED MOST, 1371 00:44:54,343 --> 00:44:55,077 SPECIFICALLY THOSE GROUPS THAT 1372 00:44:55,077 --> 00:44:57,847 ARE EXPERIENCING DISPARITIES. 1373 00:44:57,847 --> 00:45:00,182 SO THIS TOPIC OF DATA 1374 00:45:00,182 --> 00:45:01,817 DISAGGREGATION, THIS IDEA OF 1375 00:45:01,817 --> 00:45:03,586 BREAKING OUT DATA BY MORE 1376 00:45:03,586 --> 00:45:04,353 GRANULAR KEY CHARACTERISTICS IS 1377 00:45:04,353 --> 00:45:07,323 NOT A NEW TOPIC. 1378 00:45:07,323 --> 00:45:09,191 THIS GOES BACK AS FAR AT 1985 1379 00:45:09,191 --> 00:45:10,292 WITH THE HECKLER REPORT. 1380 00:45:10,292 --> 00:45:11,627 SINCE THEN, MULTIPLE 1381 00:45:11,627 --> 00:45:13,963 ORGANIZATIONS LIKE THE AMERICAN 1382 00:45:13,963 --> 00:45:14,764 MEDICAL ASSOCIATION AND POLICIES 1383 00:45:14,764 --> 00:45:16,132 LIKE THE AFFORDABLE CARE ACT 1384 00:45:16,132 --> 00:45:18,000 HAVE HIGHLIGHTED THE IMPORTANCE 1385 00:45:18,000 --> 00:45:19,869 OF DATA DISAGGREGATION OF 1386 00:45:19,869 --> 00:45:21,404 GREATER UNDERSTANDING OF HEALTH 1387 00:45:21,404 --> 00:45:21,871 INEQUITIES. 1388 00:45:21,871 --> 00:45:24,573 THIS LED US TO THINK, HOW CAN 1389 00:45:24,573 --> 00:45:25,508 COMMUNITY HEALTH CENTERS PROVIDE 1390 00:45:25,508 --> 00:45:29,311 AN OPPORTUNITY TO LOOK INTO THIS 1391 00:45:29,311 --> 00:45:31,647 IDEA OF DATA DISAGGREGATION TO 1392 00:45:31,647 --> 00:45:33,082 PRODUCE MORE NUANCED HEALTH 1393 00:45:33,082 --> 00:45:34,950 EQUITY RESEARCH IN LATINOS? 1394 00:45:34,950 --> 00:45:36,385 THE FIRST QUESTION WE ASKED IS 1395 00:45:36,385 --> 00:45:38,054 DO WE EVEN COLLECT THIS DATA. 1396 00:45:38,054 --> 00:45:39,455 SO WE ENDEAVOR TO DESCRIBE THE 1397 00:45:39,455 --> 00:45:40,556 EXTENT TO WHICH COUNTRY OF BIRTH 1398 00:45:40,556 --> 00:45:43,959 IS RECORDED IN COMMUNITY HEALTH 1399 00:45:43,959 --> 00:45:45,861 CENTERS, IN THEIR EHRs ACROSS 1400 00:45:45,861 --> 00:45:48,397 COMMUNITY HEALTH CENTERS. 1401 00:45:48,397 --> 00:45:50,332 >> THIS IS A BRIEF DESCRIPTION 1402 00:45:50,332 --> 00:45:51,233 OF THAT. 1403 00:45:51,233 --> 00:45:53,869 ONE POSSIBLE AXES FOR 1404 00:45:53,869 --> 00:45:55,404 DISAGGREGATION, BUT THIS IS WHAT 1405 00:45:55,404 --> 00:45:56,172 WE EXPLORED HERE. 1406 00:45:56,172 --> 00:45:57,540 IT SHOWED COMMUNITY HEALTH 1407 00:45:57,540 --> 00:46:00,643 CENTERS DID INDEED COLLECT -- IN 1408 00:46:00,643 --> 00:46:01,811 22 DIFFERENT STATES HOWEVER, 1409 00:46:01,811 --> 00:46:02,712 THAT WAS HIGHLY CLUSTERED IN 1410 00:46:02,712 --> 00:46:05,147 ABOUT EIGHT OR NINE STATES. 1411 00:46:05,147 --> 00:46:06,449 NOW THIS IS A COUPLE YEARS OLD, 1412 00:46:06,449 --> 00:46:10,086 THIS GRAPH IS KIND OF FILLED -- 1413 00:46:10,086 --> 00:46:11,787 FILLED UP MORE WITH DATA BUT 1414 00:46:11,787 --> 00:46:14,356 THAT WAS STILL GETTING COLLECTED 1415 00:46:14,356 --> 00:46:19,962 OVER 782 CLINICS SERVING 1416 00:46:19,962 --> 00:46:23,232 782 PATIENTS TOTAL, THERE'S 1417 00:46:23,232 --> 00:46:25,000 ABOUT -- OVER THAT DENOMINATOR 1418 00:46:25,000 --> 00:46:27,970 IN CLINICS ABOUT THAT SIZE, 1419 00:46:27,970 --> 00:46:30,906 984 PATIENTS. 1420 00:46:30,906 --> 00:46:33,042 WHAT ABOUT WHEN THIS DATA IS 1421 00:46:33,042 --> 00:46:34,577 COLLECTED, IS IT ASSOCIATED WITH 1422 00:46:34,577 --> 00:46:42,985 ANYTHING MEANINGFUL CLINICALLY? 1423 00:46:42,985 --> 00:46:44,687 WE LOOKED AT THE PREVALENCE OF 1424 00:46:44,687 --> 00:46:45,755 CARDIOVASCULAR DISEASE, HEART 1425 00:46:45,755 --> 00:46:49,391 DISEASE, AND ITS RISK FACTORS, 1426 00:46:49,391 --> 00:46:50,860 HIGH CHOLESTEROL, HIGH BLOOD 1427 00:46:50,860 --> 00:46:53,429 PRESSURE, DIABETES, OBESITY, IN 1428 00:46:53,429 --> 00:46:54,530 GROUPS BY NATIVITY. 1429 00:46:54,530 --> 00:46:57,833 FIRST WHAT WE DID HERE IS, WE 1430 00:46:57,833 --> 00:47:02,905 LOOKED AT IT BY BIG GROUPS. 1431 00:47:02,905 --> 00:47:04,140 NON-U.S. BORN LATINO OR LATINOS 1432 00:47:04,140 --> 00:47:06,642 WITHOUT PLACE OF BIRTH COLLECTED 1433 00:47:06,642 --> 00:47:08,310 IN THE DATASET, AND YOU CAN SEE 1434 00:47:08,310 --> 00:47:11,514 THESE THINGS ARE -- THE 1435 00:47:11,514 --> 00:47:13,582 DIAGNOSIS PREVALENCE IS 1436 00:47:13,582 --> 00:47:15,017 CLUSTERED, REALLY PRETTY CLOSE 1437 00:47:15,017 --> 00:47:18,287 TOGETHER. 1438 00:47:18,287 --> 00:47:20,890 WHEN WE TOOK THE FOREIGN BOARD 1439 00:47:20,890 --> 00:47:21,924 LATINO GROUP AND SPLIT THEM OUT 1440 00:47:21,924 --> 00:47:25,528 BY THE COUNTRIES THAT WERE MOST 1441 00:47:25,528 --> 00:47:28,864 PREVALENT, ALL OF A SUDDEN -- 1442 00:47:28,864 --> 00:47:31,333 SOME NOT SO MUCH, 10 TO 15, 1443 00:47:31,333 --> 00:47:34,170 ALMOST 20% DIFFERENCES. 1444 00:47:34,170 --> 00:47:39,074 HYPERLIP TELIPIDEMIA, 28% FOR MN 1445 00:47:39,074 --> 00:47:39,375 INDIVIDUALS. 1446 00:47:39,375 --> 00:47:41,710 SO YOU SEE ALL OF A SUDDEN THIS 1447 00:47:41,710 --> 00:47:42,678 DISAGGREGATION STARTS TO BECOME 1448 00:47:42,678 --> 00:47:46,549 A LITTLE MORE CLINICALLY 1449 00:47:46,549 --> 00:47:54,323 RELEVANT. 1450 00:47:54,323 --> 00:47:57,193 LOOKED AT STATIN ELIGIBILITY IN 1451 00:47:57,193 --> 00:47:58,561 PRESCRIBING, SO A STATIN IS A 1452 00:47:58,561 --> 00:47:59,829 MEDICATION USED TO LOWER 1453 00:47:59,829 --> 00:48:01,030 CHOLESTEROL AND LOWER HEART 1454 00:48:01,030 --> 00:48:05,968 DISEASE RISK. 1455 00:48:05,968 --> 00:48:08,437 THIS TABLE JUST LOOKED AT THE 1456 00:48:08,437 --> 00:48:09,738 CRITERIA FOR PRESCRIBING THESE 1457 00:48:09,738 --> 00:48:12,808 HAVE SEVERAL DIFFERENT POSSIBLE 1458 00:48:12,808 --> 00:48:14,910 ELEMENTS THAT CAN QUALIFY 1459 00:48:14,910 --> 00:48:16,145 SOMEONE FOR ELIGIBILITY. 1460 00:48:16,145 --> 00:48:20,182 AND THIS ANALYSIS, IT JUST BROKE 1461 00:48:20,182 --> 00:48:21,517 OUT THE FOREIGN LATINO PATIENTS 1462 00:48:21,517 --> 00:48:23,953 BY COUNTRY OF BIRTH TO SEE WHICH 1463 00:48:23,953 --> 00:48:25,721 CHARACTERISTIC OF THE CRITERIA 1464 00:48:25,721 --> 00:48:27,623 WAS RESPONSIBLE FOR THEM BEING 1465 00:48:27,623 --> 00:48:27,890 ELIGIBLE. 1466 00:48:27,890 --> 00:48:30,659 AND YOU SEE DIFFERENCES, YOU SEE 1467 00:48:30,659 --> 00:48:31,327 DIFFERENCES. 1468 00:48:31,327 --> 00:48:36,031 SO FOR INSTANCE, ASCVD HEART 1469 00:48:36,031 --> 00:48:36,899 DISEASE, PRESENCE OF A HEART 1470 00:48:36,899 --> 00:48:40,469 DISEASE DIAGNOSIS, 6.5% OF CUBAN 1471 00:48:40,469 --> 00:48:41,770 BORN INDIVIDUALS, THAT WAS THEIR 1472 00:48:41,770 --> 00:48:46,609 REASON FOR BEING E ELIGIBLE FORA 1473 00:48:46,609 --> 00:48:48,811 STATIN, WHEREAS IT WAS ABOUT 1474 00:48:48,811 --> 00:48:54,216 HALF, 3.7% FOR MEXICANS. 1475 00:48:54,216 --> 00:48:56,986 DIABETES, 41% OF CUBANS, WHERE 1476 00:48:56,986 --> 00:48:58,888 74% OF MEXICAN INDIVIDUALS DID. 1477 00:48:58,888 --> 00:49:04,593 AND SO THE IDEA HERE, THIS 1478 00:49:04,593 --> 00:49:05,261 DISAGGREGATED DATA IS BECOMING 1479 00:49:05,261 --> 00:49:06,462 MORE AND MORE RELEVANT TO 1480 00:49:06,462 --> 00:49:07,930 FACTORS THAT ARE CLINICALLY 1481 00:49:07,930 --> 00:49:10,032 RELEVANT FOR THE POINT OF CARE 1482 00:49:10,032 --> 00:49:13,502 FOR DECISION-MAKING. 1483 00:49:13,502 --> 00:49:15,137 BUT AS WE KIND OF MENTIONED, 1484 00:49:15,137 --> 00:49:20,142 THIS IS 180,000 PEOPLE IN A 1485 00:49:20,142 --> 00:49:21,443 DENOMINATOR OF A MILLION 1486 00:49:21,443 --> 00:49:23,345 LATINOS, SO IT'S PROPORTIONATELY 1487 00:49:23,345 --> 00:49:24,213 A MINORITY, AND THAT'S A 1488 00:49:24,213 --> 00:49:25,080 PROBLEM. 1489 00:49:25,080 --> 00:49:26,415 AND MIGUEL IS GOING TO TALK A 1490 00:49:26,415 --> 00:49:28,817 LITTLE BIT ABOUT HOW WE'VE 1491 00:49:28,817 --> 00:49:30,886 APPROACHED THAT TO A DEGREE. 1492 00:49:30,886 --> 00:49:34,323 >> SO A BIG LIMITATION OF THOSE 1493 00:49:34,323 --> 00:49:36,792 STUDIES IS OF THE 1 MILLION 1494 00:49:36,792 --> 00:49:39,628 LATINO PATIENTS IN THIS 1495 00:49:39,628 --> 00:49:40,629 COMMUNITY NETWORK, COUNTRY OF 1496 00:49:40,629 --> 00:49:41,864 BIRTH WAS ONLY COLLECTED IN 1497 00:49:41,864 --> 00:49:42,932 ABOUT 14% OF THOSE PATIENTS. 1498 00:49:42,932 --> 00:49:44,266 SO THERE ARE A LOT OF LATINO 1499 00:49:44,266 --> 00:49:45,601 PATIENTS THAT ARE GOING TO BE 1500 00:49:45,601 --> 00:49:47,536 LEFT OUT OF ANY FURTHER 1501 00:49:47,536 --> 00:49:48,537 ANALYSES, AND SO ONE OF THE 1502 00:49:48,537 --> 00:49:49,905 GOALS OF OUR CENTER IS TO 1503 00:49:49,905 --> 00:49:51,573 IMPROVE APPROACHES TO STUDYING 1504 00:49:51,573 --> 00:49:52,975 LATINO DISPARITIES BY DEVELOPING 1505 00:49:52,975 --> 00:49:55,844 AND VALIDATING NOVEL METHODS TO 1506 00:49:55,844 --> 00:49:57,479 DO LATINO SUBGROUP DATA 1507 00:49:57,479 --> 00:49:58,247 DISAGGREGATION AGAIN FOR THE 1508 00:49:58,247 --> 00:50:00,382 PURPOSES OF PRODUCING MORE 1509 00:50:00,382 --> 00:50:01,817 NUANCED HEALTH EQUITY RESEARCH 1510 00:50:01,817 --> 00:50:04,119 AMONG ALL LATINOS. 1511 00:50:04,119 --> 00:50:06,088 SO WHAT WE -- AL ILLUSTRATED IN 1512 00:50:06,088 --> 00:50:08,123 THE TOP RIGHT IS TO BREAK UP 1513 00:50:08,123 --> 00:50:09,658 THIS LARGE LATINO CATEGORY TO 1514 00:50:09,658 --> 00:50:11,560 MORE GRANULAR IS UP GROUPS TO 1515 00:50:11,560 --> 00:50:13,429 REALLY FULLY APPRECIATE THE 1516 00:50:13,429 --> 00:50:14,463 HETEROGENEITY OF LATINO 1517 00:50:14,463 --> 00:50:15,965 POPULATIONS BY UTILIZING ALL 1518 00:50:15,965 --> 00:50:17,599 LATINO DATA AND NOT JUST IGNORE 1519 00:50:17,599 --> 00:50:19,301 OR THROW AWAY THOUSANDS OF ROWS 1520 00:50:19,301 --> 00:50:23,572 OF VALUABLE INFORMATION THAT 1521 00:50:23,572 --> 00:50:26,508 INCLUDES LATINOS FROM ACROSS THE 1522 00:50:26,508 --> 00:50:27,343 U.S. 1523 00:50:27,343 --> 00:50:29,111 AT THIS MOMENT MOMENT BEFORE WE 1524 00:50:29,111 --> 00:50:30,079 GO INTO SPECIFICS WHAT WE DID IN 1525 00:50:30,079 --> 00:50:31,313 THIS WORK, I DO WANT TO 1526 00:50:31,313 --> 00:50:32,614 HIGHLIGHT THAT OUR PROPOSED 1527 00:50:32,614 --> 00:50:34,850 METHODOLOGY IS NOT INTENDED AT 1528 00:50:34,850 --> 00:50:39,421 THE PATIENT LEVEL TO PROVIDE 1529 00:50:39,421 --> 00:50:41,991 CARE, TO AN INDIVIDUAL APART 1530 00:50:41,991 --> 00:50:43,625 FROM THEIR OWN SELF 1531 00:50:43,625 --> 00:50:44,093 IDENTIFICATION. 1532 00:50:44,093 --> 00:50:47,162 SO IN THE ABSENCE OF WIDESPREAD 1533 00:50:47,162 --> 00:50:50,766 SELF-REPORTED DATA LINKED TO 1534 00:50:50,766 --> 00:50:53,869 RICH OBJECTIVE HEALTHCARE DATA, 1535 00:50:53,869 --> 00:50:55,671 THIS APPROACH IF IT WORKS REALLY 1536 00:50:55,671 --> 00:50:57,973 STARTS TO IDENTIFY IN WHAT 1537 00:50:57,973 --> 00:50:59,842 CIRCUMSTANCES AND IN WHAT HEALTH 1538 00:50:59,842 --> 00:51:01,076 CONDITIONS COUNTRY OF BIRTH DATA 1539 00:51:01,076 --> 00:51:02,077 MIGHT BE BENEFICIAL TO COLLECT 1540 00:51:02,077 --> 00:51:05,681 IN THE FEWER TOUR. 1541 00:51:05,681 --> 00:51:06,015 FUTURE. 1542 00:51:06,015 --> 00:51:08,150 SO TO START OFF OUR THINKING, WE 1543 00:51:08,150 --> 00:51:09,151 THOUGHT WELL, COULD A MACHINE 1544 00:51:09,151 --> 00:51:10,486 LEARNING APPROACH IN THIS 1545 00:51:10,486 --> 00:51:11,286 SETTING BE USEFUL? 1546 00:51:11,286 --> 00:51:12,721 SO IN THIS STUDY, WHICH IS A 1547 00:51:12,721 --> 00:51:15,124 SMALL PILOT STUDY OF ASTHMA 1548 00:51:15,124 --> 00:51:17,459 CHILDREN, SO ABOUT 20,000 LATINO 1549 00:51:17,459 --> 00:51:22,297 CHILDREN WITH ASTHMA, WE USE 1550 00:51:22,297 --> 00:51:23,866 MACHINE LEARNING METHODS WITH 1551 00:51:23,866 --> 00:51:26,201 UTILIZING SURNAME, CLINICAL AND 1552 00:51:26,201 --> 00:51:30,339 NEIGHBORHOOD LABEL DATA. 1553 00:51:30,339 --> 00:51:35,277 AND -- SPECIFIC COUNTRY OF 1554 00:51:35,277 --> 00:51:36,578 BIRTH, LIMITED TO MEXICO, 1555 00:51:36,578 --> 00:51:38,914 GUATEMALA AND CUBA DUE TO THE 1556 00:51:38,914 --> 00:51:39,782 SAMPLE SIZE RESTRICTION. 1557 00:51:39,782 --> 00:51:42,117 SO ALL MODELS SHOW OUTSTANDING 1558 00:51:42,117 --> 00:51:43,152 DISCRIMINATION BETWEEN 1559 00:51:43,152 --> 00:51:44,453 FOREIGN-BORN STATUS AND SPECIFIC 1560 00:51:44,453 --> 00:51:52,394 COUNTRY OF BIRTH. 1561 00:51:52,394 --> 00:51:53,762 >> ABOUT 20,000 CHILDREN, WE 1562 00:51:53,762 --> 00:51:55,397 WANTED TO SEE IF WE WERE ABLE TO 1563 00:51:55,397 --> 00:51:59,268 EXTEND TH THESE PREDICTIONS TO 1564 00:51:59,268 --> 00:52:01,870 ADULTS, WE UTILIZED 1.5 MILLION 1565 00:52:01,870 --> 00:52:05,607 LATINO ADULT PATIENTS IN THE C 1566 00:52:05,607 --> 00:52:06,809 NETWORK, SIMILARLY AS TO THE 1567 00:52:06,809 --> 00:52:08,377 PREVIOUS PILOT STUDY, COUNTRY OF 1568 00:52:08,377 --> 00:52:10,979 BIRTH WAS RECORDED IN ABOUT 12% 1569 00:52:10,979 --> 00:52:12,147 OF LATINO ADULT PATIENTS. 1570 00:52:12,147 --> 00:52:14,016 SO SIMILAR TO THE PREVIOUS STUDY 1571 00:52:14,016 --> 00:52:15,551 WE DID DEVELOP A MACHINE 1572 00:52:15,551 --> 00:52:16,952 LEARNING ALGORITHM TO REFER 1573 00:52:16,952 --> 00:52:18,320 FOREIGN BORN STATUS AND SPECIFIC 1574 00:52:18,320 --> 00:52:20,055 COUNTRY OF BIRTH USING SURNAME 1575 00:52:20,055 --> 00:52:22,291 AND NEIGHBORHOOD COMPOSITION AND 1576 00:52:22,291 --> 00:52:24,259 WE SAW OUTSTANDING TO EXCELLENT 1577 00:52:24,259 --> 00:52:25,194 PREDICTION OF FOREIGN BORN 1578 00:52:25,194 --> 00:52:26,395 STATUS AND SPECIFIC COUNTRIES 1579 00:52:26,395 --> 00:52:27,496 AMONG LATINOS. 1580 00:52:27,496 --> 00:52:29,665 AND AGAIN BECAUSE OUR GOAL -- 1581 00:52:29,665 --> 00:52:30,666 OUR OVERALL GOAL FOR THIS WORK 1582 00:52:30,666 --> 00:52:34,236 IS TO USE THOSE PREDICTIONS IN 1583 00:52:34,236 --> 00:52:35,437 SUBSEQUENT DISPARITIES RESEARCH, 1584 00:52:35,437 --> 00:52:37,072 WE STARTED OUT WORKING ON 1585 00:52:37,072 --> 00:52:38,440 UTILITY ON THAT END. 1586 00:52:38,440 --> 00:52:40,843 SO AS A TEST CASE, AND THIS IS 1587 00:52:40,843 --> 00:52:45,247 ALSO A WORK IN PROGRESS, WE USE 1588 00:52:45,247 --> 00:52:47,449 THOSE MODEL -- OF LATINO 1589 00:52:47,449 --> 00:52:50,419 SUBGROUPS TO EVALUATE COLORECTAL 1590 00:52:50,419 --> 00:52:51,920 CANCER SCREENING -- BY FOREIGN 1591 00:52:51,920 --> 00:52:53,322 BORN STATUS, SO COMPARING 1592 00:52:53,322 --> 00:52:55,057 LATINOS FOREIGN-BORN VERSUS U.S. 1593 00:52:55,057 --> 00:52:55,390 BORN. 1594 00:52:55,390 --> 00:52:57,259 SO IN OUR CASE EXAMPLE, USING 1595 00:52:57,259 --> 00:52:58,861 THE ACTUAL KNOWN FOREIGN-BORN 1596 00:52:58,861 --> 00:53:01,463 STATUS THAT'S COLLECTED AT THE 1597 00:53:01,463 --> 00:53:05,067 CLINIC, WE OBSERVED THAT U.S. 1598 00:53:05,067 --> 00:53:07,236 U.S.-BORN LATINOS HAD LOWER ODDS 1599 00:53:07,236 --> 00:53:09,571 OF SCREENING, ABOUT HALF AS 1600 00:53:09,571 --> 00:53:11,340 MUCH, AND THAT'S DENOTED HERE ON 1601 00:53:11,340 --> 00:53:13,242 THAT BLUE LINE. 1602 00:53:13,242 --> 00:53:17,579 AND SO THE -- IS 0.5. 1603 00:53:17,579 --> 00:53:18,814 SO THAT'S USING THE KNOWN 1604 00:53:18,814 --> 00:53:19,148 INFORMATION. 1605 00:53:19,148 --> 00:53:20,616 SO WHEN WE REPLACE THE KNOWN 1606 00:53:20,616 --> 00:53:22,484 STATUS WITH THE PREDICTED -- 1607 00:53:22,484 --> 00:53:23,585 FROM THESE MACHINE LEARNING 1608 00:53:23,585 --> 00:53:26,188 MODELS, WE SEE AN ASSOCIATION 1609 00:53:26,188 --> 00:53:27,456 HERE IN GREEN THAT IS IN A 1610 00:53:27,456 --> 00:53:29,558 SIMILAR DIRECTION BUT IS 1611 00:53:29,558 --> 00:53:31,860 SLIGHTLY BIASED. 1612 00:53:31,860 --> 00:53:32,995 THEN WHEN WE EXTEND THESE 1613 00:53:32,995 --> 00:53:34,296 PREDICTIONS TO THE FULL SAMPLE, 1614 00:53:34,296 --> 00:53:35,931 SO EVEN THOSE THAT DID NOT HAVE 1615 00:53:35,931 --> 00:53:37,833 COUNTRY OF BIRTH, WE ACTUALLY 1616 00:53:37,833 --> 00:53:39,034 SEE AN ASSOCIATION, AGAIN, IN A 1617 00:53:39,034 --> 00:53:40,802 SIMILAR DIRECTION BUT, AGAIN, 1618 00:53:40,802 --> 00:53:41,904 SLIGHTLY BIASED. 1619 00:53:41,904 --> 00:53:43,605 SO THIS IS A SIMPLE USE CASE AND 1620 00:53:43,605 --> 00:53:44,706 WE'RE ACTIVELY WORKING ON 1621 00:53:44,706 --> 00:53:46,141 METHODS TO ADDRESS THIS BIAS AND 1622 00:53:46,141 --> 00:53:48,810 TO REALLY FULLY UNDERSTAND HOW 1623 00:53:48,810 --> 00:53:52,981 TO INCORPORATE -- GENERALLY IN 1624 00:53:52,981 --> 00:53:54,483 THE WORK WE DO. 1625 00:53:54,483 --> 00:53:56,919 SO AT PRESENT, THIS APPROACH IS 1626 00:53:56,919 --> 00:53:59,154 NOT SUITABLE FOR CLINICAL AND 1627 00:53:59,154 --> 00:54:01,356 HEALTHCARE USE, USE IN POLICY 1628 00:54:01,356 --> 00:54:02,891 DESIXES, AND ALTHOUGH PREDICTION 1629 00:54:02,891 --> 00:54:05,327 ALGORITHMS ARE IMPERFECT AND 1630 00:54:05,327 --> 00:54:08,030 CANNOT REPLACE SELF-REPORTED -- 1631 00:54:08,030 --> 00:54:10,132 IN COUNTRY OF ORIGIN, THIS 1632 00:54:10,132 --> 00:54:12,000 HOPEFULLY PROVIDES A STARTING 1633 00:54:12,000 --> 00:54:12,968 POINT ABOUT WHEN AND WHERE THIS 1634 00:54:12,968 --> 00:54:14,469 DATA SHOULD BE COLLECTED, 1635 00:54:14,469 --> 00:54:15,804 ESPECIALLY WHEN WE THINK ABOUT 1636 00:54:15,804 --> 00:54:18,507 JUST THE SETTING OF BUSY PRIMARY 1637 00:54:18,507 --> 00:54:21,977 CARE CLINICS. 1638 00:54:21,977 --> 00:54:23,845 SO I WANT TO END, WE ONLY HAVE A 1639 00:54:23,845 --> 00:54:25,013 FEW MINUTE LEFT SO WE WANT TO 1640 00:54:25,013 --> 00:54:27,416 TAKE THIS OPPORTUNITY TO LOOK AT 1641 00:54:27,416 --> 00:54:28,817 REAL WORLD INTERVENTIONS IN 1642 00:54:28,817 --> 00:54:30,452 HEALTH EQUITY AND PRIMARY CARE 1643 00:54:30,452 --> 00:54:33,722 AMONG LATINOS. 1644 00:54:33,722 --> 00:54:36,892 >> SO WHILE THIS IS 1645 00:54:36,892 --> 00:54:39,494 OBSERVATIONAL, IT DOESN'T 1646 00:54:39,494 --> 00:54:40,963 MEAN -- EVALUATE INTERVENTIONS. 1647 00:54:40,963 --> 00:54:42,931 THIS WORK ISN'T ACTUAL WILL 1648 00:54:42,931 --> 00:54:44,700 FUNDAMENTALLY OURS, THIS IS SOME 1649 00:54:44,700 --> 00:54:46,635 OF OUR TEAM MEMBERS ON THIS 1650 00:54:46,635 --> 00:54:49,271 TEAM, SO SHOUT OUT TO OUR 1651 00:54:49,271 --> 00:54:51,540 COLLEAGUES, THE WONDERFUL FOLKS 1652 00:54:51,540 --> 00:54:56,011 AT UCSF, DR. LAURA GOTTLIEB, 1653 00:54:56,011 --> 00:55:00,549 THEY HAVE FOR SEVEN YEARS DONE 1654 00:55:00,549 --> 00:55:02,084 -- IN COMMUNITY HEALTH CENTERS 1655 00:55:02,084 --> 00:55:03,719 NATIONWIDE, SO LITERALLY ONE OF 1656 00:55:03,719 --> 00:55:04,653 THE PAPER QUESTIONNAIRES ABOUT 1657 00:55:04,653 --> 00:55:07,923 SOCIAL CONTEXT, SOCIAL 1658 00:55:07,923 --> 00:55:09,124 ADVERSITY, TO TRY TO CONNECT 1659 00:55:09,124 --> 00:55:10,158 PATIENTS WITH RESOURCES AND 1660 00:55:10,158 --> 00:55:11,727 INTERVENE. 1661 00:55:11,727 --> 00:55:14,363 THIS IS THE RESULT OF AN 1662 00:55:14,363 --> 00:55:17,432 INCREDIBLE AMOUNT OF INFORMATION 1663 00:55:17,432 --> 00:55:19,901 AVAILABLE, CONNECTED, CONNECT 1664 00:55:19,901 --> 00:55:21,770 TODAY CLINICAL INFORMATION. 1665 00:55:21,770 --> 00:55:23,505 BUT THERE ARE -- THERE'S A LOT 1666 00:55:23,505 --> 00:55:26,742 TO BE STUDIED, FOR EXAMPLE, IN 1667 00:55:26,742 --> 00:55:29,144 THIS FOLLOW-UP ANALYSIS THAT 1668 00:55:29,144 --> 00:55:31,246 THEY DID SEVERAL YEARS AFTER THE 1669 00:55:31,246 --> 00:55:32,014 INITIATION OF SCREENING IS 1670 00:55:32,014 --> 00:55:34,082 LOOKING AT WHO WAS SCREENED. 1671 00:55:34,082 --> 00:55:36,218 FOR INSTANCE, BLACK LATINOS AND 1672 00:55:36,218 --> 00:55:37,753 BLACK NON-HISPANIC PATIENTS WERE 1673 00:55:37,753 --> 00:55:42,491 TWICE AS LAKELY T LIKELY TO BE , 1674 00:55:42,491 --> 00:55:44,159 AND LATINO PATIENT, ONLY 20% 1675 00:55:44,159 --> 00:55:45,861 LESS LIKELY TO BE SCREENED THAN 1676 00:55:45,861 --> 00:55:46,428 NON-HISPANIC WHITE PATIENTS. 1677 00:55:46,428 --> 00:55:48,363 SO THE FULL UNDERSTANDING OF HOW 1678 00:55:48,363 --> 00:55:50,832 THESE ONGOING EVOLVING 1679 00:55:50,832 --> 00:55:53,502 INNOVATIONS IN CARE, PRIMARY 1680 00:55:53,502 --> 00:55:58,307 CARE IS STILL LACKING ABOUT HOW 1681 00:55:58,307 --> 00:56:00,676 WE CAN BEST USE THINGS THAT ARE 1682 00:56:00,676 --> 00:56:02,277 ONGOING TO UNDERSTAND HOW BEST 1683 00:56:02,277 --> 00:56:04,913 TO SERVE LATINO PATIENTS. 1684 00:56:04,913 --> 00:56:06,348 IT'S GOING TO LOOK AT THIS 1685 00:56:06,348 --> 00:56:07,416 LATINO PATIENTS AND CONNECTIONS 1686 00:56:07,416 --> 00:56:12,020 TO CANCER CARE, BUT THE POINT OF 1687 00:56:12,020 --> 00:56:14,389 THIS OPPORTUNITY TO STUDY IN 1688 00:56:14,389 --> 00:56:17,659 REALTIME INNOVATIONS IN HOW IT 1689 00:56:17,659 --> 00:56:18,393 AFFECTS LATINO PATIENTS. 1690 00:56:18,393 --> 00:56:20,028 >> WE'LL TALK ABOUT ANOTHER 1691 00:56:20,028 --> 00:56:20,896 INNOVATION I THINK MANY OF YOU 1692 00:56:20,896 --> 00:56:24,533 ARE FAMILIAR WITH, IT'S TELEHEL. 1693 00:56:24,533 --> 00:56:24,966 TELEELT. 1694 00:56:24,966 --> 00:56:26,535 PRIOR TO THE COVID-19 PANDEMIC, 1695 00:56:26,535 --> 00:56:28,737 MOST PRIMARY CARE SERVICES, 1696 00:56:28,737 --> 00:56:30,372 ESPECIALLY CHRONIC CARE 1697 00:56:30,372 --> 00:56:32,040 MANAGEMENT, WAS DELIVERED DURING 1698 00:56:32,040 --> 00:56:33,008 IN-PERSON VISITS. 1699 00:56:33,008 --> 00:56:34,376 SO RESTRICTIONS TO KEEP PATIENTS 1700 00:56:34,376 --> 00:56:35,110 SAFE AND REDUCE THE SPREAD OF 1701 00:56:35,110 --> 00:56:36,912 THE VIRUS SHIFTED. 1702 00:56:36,912 --> 00:56:39,514 MOST OF THAT IN-PERSON VISITS TO 1703 00:56:39,514 --> 00:56:40,415 TELEHEALTH. 1704 00:56:40,415 --> 00:56:42,884 AND CHC, THEY ROSE TO THIS 1705 00:56:42,884 --> 00:56:43,251 CHALLENGE. 1706 00:56:43,251 --> 00:56:46,988 SO THIS FIGURE HERE SHOWS THE 1707 00:56:46,988 --> 00:56:48,890 TOTAL NUMBER OF TELEHEALTH 1708 00:56:48,890 --> 00:56:52,127 ENCOUNTERS IN THE MILLIONS THAT 1709 00:56:52,127 --> 00:56:52,961 COMMUNITY HEALTH CENTERS 1710 00:56:52,961 --> 00:56:56,164 PROVIDED EACH YEAR IN THE OCHA 1711 00:56:56,164 --> 00:56:56,765 NETWORK. 1712 00:56:56,765 --> 00:56:59,134 THERE WAS VERY LITTLE TELEHEALTH 1713 00:56:59,134 --> 00:57:00,635 UTILIZATION AND IT STEADILY 1714 00:57:00,635 --> 00:57:02,037 INCREASED OVER 2020 TO 2022 1715 00:57:02,037 --> 00:57:04,272 DURING THE THICK OF THE 1716 00:57:04,272 --> 00:57:04,740 PANDEMIC. 1717 00:57:04,740 --> 00:57:05,974 THERE WERE SEVERAL QUESTIONS 1718 00:57:05,974 --> 00:57:09,544 ABOUT WHETHER CURRENT TELEHEALTH 1719 00:57:09,544 --> 00:57:11,613 USE HAS DECREASED AS THE 1720 00:57:11,613 --> 00:57:12,748 EMERGENCY FOR COVID-19 HAS 1721 00:57:12,748 --> 00:57:15,150 EXPIRED AND WHETHER THESE TRENDS 1722 00:57:15,150 --> 00:57:17,953 DIFFER BY ETHNICITY IN LANGUAGE 1723 00:57:17,953 --> 00:57:19,087 GROUPS WHO MAY EXPERIENCE 1724 00:57:19,087 --> 00:57:20,355 DIFFERENT BARRIERS TO 1725 00:57:20,355 --> 00:57:20,655 TELEHEALTH. 1726 00:57:20,655 --> 00:57:23,925 SO WHAT WE CAN SEE HERE FROM 1727 00:57:23,925 --> 00:57:27,329 WORK THAT IS EXPLORATORY AND IN 1728 00:57:27,329 --> 00:57:29,798 PROGRESS, WE SEE UTILIZATION AT 1729 00:57:29,798 --> 00:57:30,766 LEAST AT COMMUNITY HEALTH 1730 00:57:30,766 --> 00:57:31,900 CENTERS, THEY'RE NOT GOING DOWN. 1731 00:57:31,900 --> 00:57:35,437 SO IN 2023, IT INCREASED TO 1732 00:57:35,437 --> 00:57:36,638 ABOUT 1.75 MILLION ENCOUNTERS 1733 00:57:36,638 --> 00:57:39,141 AND PROJECTIONS SHOW BASED OFF 1734 00:57:39,141 --> 00:57:40,308 OF 2024 DATA THAT THIS COULD 1735 00:57:40,308 --> 00:57:41,877 ACTUALLY HIT 2 MILLION 1736 00:57:41,877 --> 00:57:43,245 ENCOUNTERS THIS YEAR. 1737 00:57:43,245 --> 00:57:44,780 SO WE ALSO OBSERVED THAT THE 1738 00:57:44,780 --> 00:57:47,816 PROPORTION OF TELEHEALTH VISITS, 1739 00:57:47,816 --> 00:57:50,986 SO TELEVISITS DIVIDED BY PLUS 1740 00:57:50,986 --> 00:57:51,953 IN-PERSON VISITS SO THE 1741 00:57:51,953 --> 00:57:53,755 PROPORTION OF TELEVISIT AMONG 1742 00:57:53,755 --> 00:57:54,723 LATINO ENGLISH PREFERRING 1743 00:57:54,723 --> 00:57:56,158 PATIENTS ARE HERE IN BLUE, IT 1744 00:57:56,158 --> 00:57:58,960 INCREASED FROM 16.7% IN 2020 TO 1745 00:57:58,960 --> 00:58:01,363 ABOUT 29% IN 2022 AND THEN IT 1746 00:58:01,363 --> 00:58:04,533 HAS DECREASED SLIGHTLY IN MORE 1747 00:58:04,533 --> 00:58:08,870 RECENT DATA IN 2024. 1748 00:58:08,870 --> 00:58:10,939 NON-HISPANIC WHITE PATIENTS SAW 1749 00:58:10,939 --> 00:58:16,211 SIMILAR TREND TO NON-ENGLISH -- 1750 00:58:16,211 --> 00:58:17,546 ACTUALLY SAW SIMILAR INCREASE 1751 00:58:17,546 --> 00:58:21,383 THROUGHOUT THE PANDEMIC BUT MOST 1752 00:58:21,383 --> 00:58:22,284 RECENT PROPORTION OF 1753 00:58:22,284 --> 00:58:23,351 TELEMEDICINE VISITS ARE LOWER 1754 00:58:23,351 --> 00:58:24,886 COMPARED TO OTHER GROUPS, SO THE 1755 00:58:24,886 --> 00:58:27,189 KEY TAKEAWAY FROM THIS INITIAL 1756 00:58:27,189 --> 00:58:29,424 WORK IS THAT AT LEAST IN THE 1757 00:58:29,424 --> 00:58:31,960 U.S., COMMUNITY HEALTH CENTERS 1758 00:58:31,960 --> 00:58:33,595 CONTINUE TO DELIVER A LARGE 1759 00:58:33,595 --> 00:58:36,765 VOLUME OF TELEHEALTHCARE, UNDER 1760 00:58:36,765 --> 00:58:39,901 UNDERSCORING THEIR ROLE IN SER 1761 00:58:39,901 --> 00:58:42,838 SERVING THOSE POPULATIONS. 1762 00:58:42,838 --> 00:58:44,272 -- FUTURE WORK SHOULD STUDY HOW 1763 00:58:44,272 --> 00:58:47,642 THAT MAY IMPACT THE TYPE OF CARE 1764 00:58:47,642 --> 00:58:48,944 RECEIVED AND ITS IMPACT IF ANY 1765 00:58:48,944 --> 00:58:54,049 ON THEIR HEALTH. 1766 00:58:54,049 --> 00:58:56,918 >SO WANT TO JUST SHARE SOME 1767 00:58:56,918 --> 00:58:58,587 CONCLUDING THOUGHTS. 1768 00:58:58,587 --> 00:58:59,454 COMMUNITY HEALTH CENTERS CARE 1769 00:58:59,454 --> 00:59:00,989 FOR ABOUT 1 IS IN 6 LATINOS IN 1770 00:59:00,989 --> 00:59:02,090 THE U.S. AND THEY DO THIS 1771 00:59:02,090 --> 00:59:03,592 CONTINUOUSLY OVER TIME. 1772 00:59:03,592 --> 00:59:05,760 SO THEY SEE PATIENTS, 1773 00:59:05,760 --> 00:59:06,628 SPECIFICALLY LATINO PATIENTS OF 1774 00:59:06,628 --> 00:59:07,996 ALL BACKGROUNDS FROM LOW AND 1775 00:59:07,996 --> 00:59:10,732 HIGH INCOMES, TO SEASONAL MY 1776 00:59:10,732 --> 00:59:16,271 GRANT WORKERS TO UNINSURED, SO 1777 00:59:16,271 --> 00:59:17,539 COMMUNITY HEALTH CENTERS AND THE 1778 00:59:17,539 --> 00:59:19,007 CARE THEY PROVIDE ALLOWS US TO 1779 00:59:19,007 --> 00:59:20,242 PUT ANOTHER PIECE IN THE PUZZLE 1780 00:59:20,242 --> 00:59:21,543 IN REALLY UNDERSTANDING LATINO 1781 00:59:21,543 --> 00:59:23,445 HEALTH IN THE U.S. 1782 00:59:23,445 --> 00:59:28,216 >> IN SECOND -- FINDINGS THAT 1783 00:59:28,216 --> 00:59:30,619 UNDERSTANDING HEALTHCARE 1784 00:59:30,619 --> 00:59:32,254 HEALTHCARE EQUITY AND INEQUITY 1785 00:59:32,254 --> 00:59:35,123 IN LATINO PATIENTS THAT DEMANDS 1786 00:59:35,123 --> 00:59:36,992 PRIMARY CARE -- ESPECIALLY 1787 00:59:36,992 --> 00:59:37,993 COMMUNITY HEALTH CENTERS, 1788 00:59:37,993 --> 00:59:41,329 BECAUSE THERE ARE TRENDS, 1789 00:59:41,329 --> 00:59:43,865 NUANCES, PATTERNS THAT MORE 1790 00:59:43,865 --> 00:59:45,500 SPECIFICALLY PAIFNT THE 1791 00:59:45,500 --> 00:59:50,305 DISPAPAINT THEDISPARITIES PICTUO 1792 00:59:50,305 --> 00:59:51,773 ABOUT COMMUNITIES AND CLINICS, 1793 00:59:51,773 --> 00:59:54,009 AGAIN, EQUITY OR INEQUITY IS IN 1794 00:59:54,009 --> 00:59:55,310 THIS SORT OF VAGUE GENERAL 1795 00:59:55,310 --> 00:59:57,178 MONOLITH, BUT SPECIFIC FORCES 1796 00:59:57,178 --> 00:59:58,780 AND FACTORS THAT ACT MORE OR 1797 00:59:58,780 --> 01:00:00,649 LESS AT SPECIFIC POINTS. 1798 01:00:00,649 --> 01:00:02,817 AND AS WE TRY AND CREATE A 1799 01:00:02,817 --> 01:00:04,119 SYSTEM THAT SERVES PATIENTS 1800 01:00:04,119 --> 01:00:05,520 BETTER, METHODS AND EVALUATION 1801 01:00:05,520 --> 01:00:08,023 THAT HAS THIS AS THE MINDSET, WE 1802 01:00:08,023 --> 01:00:11,560 THINK IS NECESSARY. 1803 01:00:11,560 --> 01:00:13,261 >> THE THIRD BULLET THERE IS 1804 01:00:13,261 --> 01:00:17,098 GENERALLY TRYING TO CAPTURE THAT 1805 01:00:17,098 --> 01:00:19,401 JUST BECAUSE OF THE RELATIONSHIP 1806 01:00:19,401 --> 01:00:20,468 WITH COMMUNITY HEALTH CENTERS 1807 01:00:20,468 --> 01:00:22,404 AND LATINO PATIENTS, THERE IS 1808 01:00:22,404 --> 01:00:25,273 THIS CRUCIAL DATA THAT IS 1809 01:00:25,273 --> 01:00:26,341 SELECTED IN SOCIAL DETERMINANTS 1810 01:00:26,341 --> 01:00:29,144 OF HEALTH DATA, DATA THAT 1811 01:00:29,144 --> 01:00:30,946 INFORMS DATA DISAGGREGATION, SO 1812 01:00:30,946 --> 01:00:34,282 REALLY THIS IS CRUCIAL IN 1813 01:00:34,282 --> 01:00:35,951 UNDERSTANDING THE HEALTH OF 1814 01:00:35,951 --> 01:00:37,319 LATINO COMMUNITIES, AND THIS IS 1815 01:00:37,319 --> 01:00:38,853 BEING COLLECTED AND THERE'S 1816 01:00:38,853 --> 01:00:43,358 STILL A LOT TO THINK ABOUT HOW 1817 01:00:43,358 --> 01:00:44,559 DO WE EVEN FURTHER DATA 1818 01:00:44,559 --> 01:00:46,828 COLLECTION TO TRY TO GET AT MANY 1819 01:00:46,828 --> 01:00:54,102 MO ARE ESSENTMORE SOCIAL DETERM- 1820 01:00:54,102 --> 01:00:55,403 HOPEFULLY THESE INITIAL 1821 01:00:55,403 --> 01:00:55,971 EXPLORATIONS SHOW THERE'S 1822 01:00:55,971 --> 01:00:58,173 PROMISE HERE. 1823 01:00:58,173 --> 01:01:01,610 >> LASTLY, PRIMARY CARE IS 1824 01:01:01,610 --> 01:01:02,677 EVOLVING, RAPIDLY CHANGING, IT'S 1825 01:01:02,677 --> 01:01:07,415 NOT WAITING FOR THE RFP -- 1826 01:01:07,415 --> 01:01:10,652 METHODS THAT OBSERVE CHANGES ON 1827 01:01:10,652 --> 01:01:12,654 THE GROUND, YOU KNOW, ON THE 1828 01:01:12,654 --> 01:01:14,322 GROUND INNOVATIONS IN REALTIME 1829 01:01:14,322 --> 01:01:16,157 AS MUCH AS POSSIBLE AND IT CAN 1830 01:01:16,157 --> 01:01:19,527 EXAMINE HOW THESE LARGE CHANGES 1831 01:01:19,527 --> 01:01:21,396 AFFECT GROUPS -- LATINO 1832 01:01:21,396 --> 01:01:21,730 COMMUNITIES. 1833 01:01:21,730 --> 01:01:24,265 THAT WILL CONTINUE TO BE OUR 1834 01:01:24,265 --> 01:01:25,634 PRIORITY AND HOPE IT'S A BROADER 1835 01:01:25,634 --> 01:01:26,167 PRIORITY AS WELL. 1836 01:01:26,167 --> 01:01:27,469 >> AND BEFORE WE END FOR THE Q & 1837 01:01:27,469 --> 01:01:28,870 A PART OF THIS TALK, WE DO WANT 1838 01:01:28,870 --> 01:01:32,173 TO SHARE THAT OUR CENTER HOSTS, 1839 01:01:32,173 --> 01:01:33,575 LATINO HEALTH SERVICES RESEARCH 1840 01:01:33,575 --> 01:01:36,411 SEMINAR SERIES, NATIONAL THOUGHT 1841 01:01:36,411 --> 01:01:38,313 LEADERS DELIVER VIRTUAL 1842 01:01:38,313 --> 01:01:39,347 PRESENTATIONS WITH A QUESTION 1843 01:01:39,347 --> 01:01:40,582 AND ANSWER SESSION ON LATEST 1844 01:01:40,582 --> 01:01:41,583 FINDINGS, CURRENT CHALLENGES, 1845 01:01:41,583 --> 01:01:42,617 FUTURE DIRECTIONS FOR THE FIELD. 1846 01:01:42,617 --> 01:01:44,152 SO IT HAPPENS EVERY TWO MONTHS. 1847 01:01:44,152 --> 01:01:47,055 IF YOU'RE INTERESTED, DO LET US 1848 01:01:47,055 --> 01:01:48,690 KNOW, SEND US AN EMAIL, WE'D BE 1849 01:01:48,690 --> 01:01:49,691 HAPPY TO ADD YOU TO THE 1850 01:01:49,691 --> 01:01:50,692 LISTSERV. 1851 01:01:50,692 --> 01:01:51,559 SO WITH THAT SAID, JUST THANK 1852 01:01:51,559 --> 01:01:56,431 YOU SO MUCH FOR YOUR ATTENTION, 1853 01:01:56,431 --> 01:01:57,332 AND HAPPY TO START THE 1854 01:01:57,332 --> 01:01:57,632 DISCUSSION. 1855 01:01:57,632 --> 01:02:03,571 >> THANK YOU. 1856 01:02:03,571 --> 01:02:05,173 >> THANK YOU SO MUCH, MIGUEL AND 1857 01:02:05,173 --> 01:02:06,141 JOHN, THAT WAS GREAT, AND YOU 1858 01:02:06,141 --> 01:02:08,143 PULLED OFF A DUO HERE LIKE I 1859 01:02:08,143 --> 01:02:11,780 HAVE NOT SEEN, REALLY, EVER. 1860 01:02:11,780 --> 01:02:13,014 SO IT'S CLEAR THE TWO OF YOU 1861 01:02:13,014 --> 01:02:14,082 CONNECT WELL AND WORK WELL WITH 1862 01:02:14,082 --> 01:02:18,953 EACH OTHER, AND REALLY ARE 1863 01:02:18,953 --> 01:02:20,155 SYNERGISTIC IN YOUR APPROACHES. 1864 01:02:20,155 --> 01:02:22,857 I'M JUST GOING TO ASK A COUPLE 1865 01:02:22,857 --> 01:02:23,992 OF GLOBAL QUESTIONS BECAUSE 1866 01:02:23,992 --> 01:02:24,893 AUDIENCE QUESTIONS ARE ROLLING 1867 01:02:24,893 --> 01:02:25,326 IN. 1868 01:02:25,326 --> 01:02:29,698 IN YOUR SORT OF PRESENTATION 1869 01:02:29,698 --> 01:02:31,199 ABOUT THE LATINO PARADOX, YOU 1870 01:02:31,199 --> 01:02:33,134 DIDN'T REALLY QUESTION ITS 1871 01:02:33,134 --> 01:02:33,935 EXISTENCE, WHICH SOME PEOPLE 1872 01:02:33,935 --> 01:02:36,604 STILL HAVE OR PEOPLE HAVE 1873 01:02:36,604 --> 01:02:37,939 POSTULATED, OH, IT'S GOING TO GO 1874 01:02:37,939 --> 01:02:42,877 AWAY WITH THE -- AS MORE PEOPLE 1875 01:02:42,877 --> 01:02:46,681 ARE MORE ACU ACCULTURATED AND 1876 01:02:46,681 --> 01:02:48,249 U.S.-BORN, AND YET WE HAVE YET 1877 01:02:48,249 --> 01:02:51,252 TO SEE THAT HAPPEN. 1878 01:02:51,252 --> 01:02:53,955 YOU DID SHOW THAT THOSE WHO 1879 01:02:53,955 --> 01:02:56,057 PREFER SPANISH, YOU DIDN'T HAVE 1880 01:02:56,057 --> 01:02:56,991 THIS DISAGGREGATION FOR WHICH I 1881 01:02:56,991 --> 01:03:02,363 DO HAVE A QUESTION ON, BUT I 1882 01:03:02,363 --> 01:03:04,332 DIDN'T HEAR MUCH MENTION ABOUT 1883 01:03:04,332 --> 01:03:04,799 SOCIOECONOMIC STATUS. 1884 01:03:04,799 --> 01:03:08,069 SO GENERALLY PEOPLE THINK YOU'RE 1885 01:03:08,069 --> 01:03:11,773 GOING TO FQAC OR COMMUNITY 1886 01:03:11,773 --> 01:03:13,942 HEALTH CLINIC, YOU'RE NOT OF THE 1887 01:03:13,942 --> 01:03:15,910 HIGHER SOCIOECONOMIC STATUS OR 1888 01:03:15,910 --> 01:03:17,278 YOU IMPLY THAT THAT'S NOT ALWAYS 1889 01:03:17,278 --> 01:03:17,612 THE CASE. 1890 01:03:17,612 --> 01:03:19,581 DO YOU HAVE A SENSE OF THIS 1891 01:03:19,581 --> 01:03:23,451 SAMPLE OF A -- MAJORITY MEDICAID 1892 01:03:23,451 --> 01:03:28,156 COVERED, ARE THEY UNINSURED, ARE 1893 01:03:28,156 --> 01:03:29,491 THEY PRIVATE INSURANCE? 1894 01:03:29,491 --> 01:03:33,194 GIVE US A SENSE BECAUSE CLEARLY 1895 01:03:33,194 --> 01:03:36,364 ROBUST STUDIES, TREMENDOUS DATA, 1896 01:03:36,364 --> 01:03:39,100 ANAND A REALLY IMPORTANT GROUP O 1897 01:03:39,100 --> 01:03:39,701 STUDY. 1898 01:03:39,701 --> 01:03:41,136 SO JUST WONDER WHETHER YOU HAD 1899 01:03:41,136 --> 01:03:42,337 THAT AND HOW YOU THINK THAT 1900 01:03:42,337 --> 01:03:44,005 INFLUENCES SOME OF THOSE 1901 01:03:44,005 --> 01:03:46,441 FINDINGS. 1902 01:03:46,441 --> 01:03:52,080 >> SO EVERY ANALYSIS WE DO DOES 1903 01:03:52,080 --> 01:03:55,283 INCORPORATE SORT OF THE 1904 01:03:55,283 --> 01:03:57,552 INFORMATION ON HOUSEHOLD INCOME. 1905 01:03:57,552 --> 01:03:58,720 WE DO HAVE ACCESS TO THAT. 1906 01:03:58,720 --> 01:04:03,091 WE HAVE ACCESS TO INSURANCE, 1907 01:04:03,091 --> 01:04:05,260 CONTINUOUSLY OVER TIME. 1908 01:04:05,260 --> 01:04:09,497 WE ALSO ADJUST FOR CERTAIN 1909 01:04:09,497 --> 01:04:09,864 COMORBIDITIES. 1910 01:04:09,864 --> 01:04:11,266 WE DON'T HAVE THINGS LIKE 1911 01:04:11,266 --> 01:04:15,003 EDUCATION, BUT BASICALLY INCOME, 1912 01:04:15,003 --> 01:04:17,272 INSURANCE, IS DEFINITELY 1913 01:04:17,272 --> 01:04:18,473 ADJUSTED FOR. 1914 01:04:18,473 --> 01:04:19,674 NOW THAT DOESN'T NECESSARILY 1915 01:04:19,674 --> 01:04:21,676 TALK ABOUT HIGH VERSUS LOW 1916 01:04:21,676 --> 01:04:23,344 INCOME, BUT GENERALLY SPEAKING, 1917 01:04:23,344 --> 01:04:25,980 OUR WORK DOES ACCOUNT FOR THAT. 1918 01:04:25,980 --> 01:04:28,950 >> YEAH, ALSO TO YOUR POINT, IT 1919 01:04:28,950 --> 01:04:32,353 IS -- THERE'S VARIATION IN THIS 1920 01:04:32,353 --> 01:04:34,255 SAMPLE. 1921 01:04:34,255 --> 01:04:36,257 IT IS A HEAVIER SLICE OF A LOWER 1922 01:04:36,257 --> 01:04:36,891 INCOME PIECE. 1923 01:04:36,891 --> 01:04:40,862 SO FOR INSTANCE, WHEN WE WILL 1924 01:04:40,862 --> 01:04:44,833 BREAK FOLKS UP INTO, YOU KNOW, 1925 01:04:44,833 --> 01:04:46,801 LEVEL 100, 200, 300, ONCE YOU 1926 01:04:46,801 --> 01:04:48,736 GET ABOVE 300, THE NUMBERS FALL 1927 01:04:48,736 --> 01:04:49,370 OFF DRAMATICALLY. 1928 01:04:49,370 --> 01:04:51,172 SO YOU DEFINITELY -- WHICH 1929 01:04:51,172 --> 01:04:55,410 AFFECTS OUR ABILITY TO REALLY -- 1930 01:04:55,410 --> 01:04:56,945 YOU CAN'T REALLY LOOK AT THE 1931 01:04:56,945 --> 01:05:00,849 ENTIRE RANGE OF INCOME LEVELS SO 1932 01:05:00,849 --> 01:05:02,517 THAT'S A FACTOR THAT IS A 1933 01:05:02,517 --> 01:05:04,018 LIMITATION IN A LOT OF OUR WORK. 1934 01:05:04,018 --> 01:05:06,054 OBVIOUSLY WE THINK IT'S 1935 01:05:06,054 --> 01:05:08,356 IMPORTANT TO FOCUS ON WHAT'S 1936 01:05:08,356 --> 01:05:09,557 LARGELY A LOW INCOME SYSTEM, WE 1937 01:05:09,557 --> 01:05:12,794 DON'T GET THAT ENTIRE RANGE AND 1938 01:05:12,794 --> 01:05:14,095 CAN'T EVALUATE THAT SPECIFIC 1939 01:05:14,095 --> 01:05:14,329 DYNAMIC. 1940 01:05:14,329 --> 01:05:16,197 >> AND SO JUST TO GIVE YOU 1941 01:05:16,197 --> 01:05:17,565 SPECIFIC NUMBERS, SO EACH STUDY 1942 01:05:17,565 --> 01:05:19,734 HAS DIFFERENT 1943 01:05:19,734 --> 01:05:21,603 INCLUSION/EXCLUSION CRITERIA, SO 1944 01:05:21,603 --> 01:05:22,737 CHILDREN IS DIFFERENT INSURANCE 1945 01:05:22,737 --> 01:05:25,974 RATES, BUT GENERALLY, ESPECIALLY 1946 01:05:25,974 --> 01:05:27,742 WHEN WE'RE LOOKING AT LATINOS, 1947 01:05:27,742 --> 01:05:29,811 IF WE'RE LOOKING AT UNINSURED 1948 01:05:29,811 --> 01:05:31,079 RATES, WE KNOW COMMUNITY HEALTH 1949 01:05:31,079 --> 01:05:33,581 CENTERS DO SERVE PEOPLE WHO ARE 1950 01:05:33,581 --> 01:05:35,016 UNDERINSURED AND UNINSURED, AND 1951 01:05:35,016 --> 01:05:37,051 SO I THINK THAT'S SOMEWHERE IN 1952 01:05:37,051 --> 01:05:40,455 THE 10 TO 20% RANGE. 1953 01:05:40,455 --> 01:05:41,422 PUBLIC INSURANCE, PROBABLY IN 1954 01:05:41,422 --> 01:05:43,758 THE 60% RANGE AND THEN PRIVATE 1955 01:05:43,758 --> 01:05:44,893 IN SORT OF THE LAST WHATEVER 1956 01:05:44,893 --> 01:05:47,095 THAT IS, LIKE 10, 20% AS WELL. 1957 01:05:47,095 --> 01:05:48,863 SO THE MAJORITY IS PUBLIC 1958 01:05:48,863 --> 01:05:51,032 INSURANCE. 1959 01:05:51,032 --> 01:05:53,835 AND BECAUSE THERE'S A LOT OF 1960 01:05:53,835 --> 01:05:55,803 PEOPLE WHO ARE SEEN REGARDLESS 1961 01:05:55,803 --> 01:05:58,640 OF THEIR INSURANCE STATUS, WE DO 1962 01:05:58,640 --> 01:06:00,675 SEE SOME -- A SIZABLE, 10 TO 20% 1963 01:06:00,675 --> 01:06:02,810 OF UNINSURED PATIENTS. 1964 01:06:02,810 --> 01:06:03,144 >> ALL RIGHT. 1965 01:06:03,144 --> 01:06:04,746 THANK YOU. 1966 01:06:04,746 --> 01:06:07,615 AND IT IS 20% OF LATINOS BETWEEN 1967 01:06:07,615 --> 01:06:09,684 18 AND 64 WHO ARE UNINSURED 1968 01:06:09,684 --> 01:06:11,653 ACROSS THE COUNTRY, SO THAT 1969 01:06:11,653 --> 01:06:13,755 WOULD SEEM APPROPRIATE. 1970 01:06:13,755 --> 01:06:15,023 IN OTHER WORK THAT I'VE BEEN 1971 01:06:15,023 --> 01:06:17,759 INVOLVED WITH, WE'VE SEEN A 1972 01:06:17,759 --> 01:06:22,230 TREND THAT IF YOU BECOME MORE 1973 01:06:22,230 --> 01:06:24,265 ACCULTURATED BUT REMAIN OF LOWER 1974 01:06:24,265 --> 01:06:25,500 SOCIOECONOMIC STATUS, THAT'S 1975 01:06:25,500 --> 01:06:26,901 WHERE YOU HAVE THE WORST HEALTH 1976 01:06:26,901 --> 01:06:29,637 OUTCOMES. 1977 01:06:29,637 --> 01:06:33,741 AND THE LESS ACU ACCULTURATED WO 1978 01:06:33,741 --> 01:06:35,076 MOVE UP THE SOCIAL ECONOMIC 1979 01:06:35,076 --> 01:06:36,144 LADDER ACTUALLY DO PRETTY WELL. 1980 01:06:36,144 --> 01:06:39,847 SO THERE IS THIS DYNAMIC THAT IS 1981 01:06:39,847 --> 01:06:41,382 NOT FULLY CAPTURED BY LANGUAGE 1982 01:06:41,382 --> 01:06:42,417 PREFERENCE, BUT I THINK WE NEED 1983 01:06:42,417 --> 01:06:43,751 TO STRATIFY AND LOOK AT SOME 1984 01:06:43,751 --> 01:06:48,790 MEASURE OF SOASH Y SOCIOECONOMIA 1985 01:06:48,790 --> 01:06:56,297 TIS, ZOTSTATUS.DIVIDING UP BY WE 1986 01:06:56,297 --> 01:06:57,532 BORN IN THE U.S. OR NOT IS 1987 01:06:57,532 --> 01:06:58,866 GREAT, AND THEN THE COUNTRY 1988 01:06:58,866 --> 01:07:00,902 WHERE YOU WERE BORN, HOWEVER, 1989 01:07:00,902 --> 01:07:02,236 70% OF LATINOS ARE BORN IN THE 1990 01:07:02,236 --> 01:07:06,374 U.S. 1991 01:07:06,374 --> 01:07:07,475 SO THE HERITAGE QUESTION IS THE 1992 01:07:07,475 --> 01:07:08,509 ONE THAT I WOULD BE CURIOUS 1993 01:07:08,509 --> 01:07:11,713 ABOUT, SO WHAT'S GOING ON WITH 1994 01:07:11,713 --> 01:07:14,983 THE SECOND -- AND IS THAT IN THE 1995 01:07:14,983 --> 01:07:15,950 DATA, IN THE DATA INFRASTRUCTURE 1996 01:07:15,950 --> 01:07:17,485 THAT YOU HAVE -- THAT YOU WORK 1997 01:07:17,485 --> 01:07:19,253 WITH? 1998 01:07:19,253 --> 01:07:24,559 >> THAT IS A GREAT QUESTION. 1999 01:07:24,559 --> 01:07:25,626 AND UNFORTUNATELY, WE ARE LIMIT 2000 01:07:25,626 --> 01:07:27,395 TODAY WHAT DATA IS COLLECTED IN 2001 01:07:27,395 --> 01:07:31,299 COMMUNITY HEALTH CENTERS, SO 2002 01:07:31,299 --> 01:07:33,334 COUNTRY OF BIRTH IS A DISCRETE 2003 01:07:33,334 --> 01:07:35,636 FIELD EMBEDDED IN THE EHR. 2004 01:07:35,636 --> 01:07:39,140 SO THAT IS INCLUDED, SO THAT'S 2005 01:07:39,140 --> 01:07:42,276 TYPICALLY WHAT WE USE, AND WE 2006 01:07:42,276 --> 01:07:45,480 UNDERSTAND THAT THE BACKGROUND 2007 01:07:45,480 --> 01:07:46,914 THAT IS IMPORTANT -- HERITAGE IS 2008 01:07:46,914 --> 01:07:48,282 IMPORTANT. 2009 01:07:48,282 --> 01:07:49,684 UNFORTUNATELY WE CAN'T DO THAT 2010 01:07:49,684 --> 01:07:53,087 NOW IN EHR BASED APPROACHES, BUT 2011 01:07:53,087 --> 01:07:54,889 THERE IS A THOUGHT THAT IF 2012 01:07:54,889 --> 01:07:56,224 MACHINE LEARNING APPROACHES -- 2013 01:07:56,224 --> 01:07:58,726 AT LEAST WITH EHRs, IF THIS IS 2014 01:07:58,726 --> 01:08:00,428 SUITABLE, WE CAN FIGURE OUT HOW 2015 01:08:00,428 --> 01:08:01,963 TO DEBIAS THIS A BIT, THERE MAY 2016 01:08:01,963 --> 01:08:03,831 BE OPPORTUNITIES TO EXTEND THAT 2017 01:08:03,831 --> 01:08:05,566 WORK IN SURVEY-BASED RESEARCH. 2018 01:08:05,566 --> 01:08:09,504 SO I THINK OF THE SEOUL STUDY 2019 01:08:09,504 --> 01:08:11,472 WHERE THEY DO COLLECT SOME OF 2020 01:08:11,472 --> 01:08:12,940 THIS INFORMATION, PARTNERING, 2021 01:08:12,940 --> 01:08:18,112 THICKINTHINKING OF CREATIVE WAYS 2022 01:08:18,112 --> 01:08:19,480 LEVERAGING CURRENT LATINO 2023 01:08:19,480 --> 01:08:21,015 COHORTS TO SEE AND COMPARE IF 2024 01:08:21,015 --> 01:08:22,216 IT'S A SUITABLE APPROACH IN 2025 01:08:22,216 --> 01:08:23,818 OTHER SETTINGS. 2026 01:08:23,818 --> 01:08:25,486 >> IT IS A CRUCIAL ISSUE, THIS 2027 01:08:25,486 --> 01:08:27,588 IS KIND OF THE LOW HANGING FRUIT 2028 01:08:27,588 --> 01:08:29,023 FOR LACK OF A BETTER TERM 2029 01:08:29,023 --> 01:08:34,996 BECAUSE WE HAVE THAT DATA, IT -- 2030 01:08:34,996 --> 01:08:36,964 FEELS LIKE A MAJOR THING WE'RE 2031 01:08:36,964 --> 01:08:40,435 MISSING, EXPLORED USING -- SOME 2032 01:08:40,435 --> 01:08:43,604 OF THE WORK WE'VE WORKED ON HAS 2033 01:08:43,604 --> 01:08:46,340 BEEN LINKS OR LINKING MOMS AND 2034 01:08:46,340 --> 01:08:47,975 KIDS, LINKING THEIR RECORDS, AND 2035 01:08:47,975 --> 01:08:52,113 SO THAT YOU HAVE MOM'S PLACE OF 2036 01:08:52,113 --> 01:08:53,848 BIRTH, SO YOU BUILD UP A LITTLE 2037 01:08:53,848 --> 01:08:55,283 BIT OF FIRST GENERATION FOLKS, 2038 01:08:55,283 --> 01:08:59,187 YOU CAN HAVE THAT BUT YET STILL, 2039 01:08:59,187 --> 01:09:02,590 IT'S -- THAT STILL MAY NOT GET 2040 01:09:02,590 --> 01:09:04,225 EVERYTHING YOU WON'T, PROBABLY 2041 01:09:04,225 --> 01:09:05,993 LOW, SO THAT'S KIND OF THAT NEXT 2042 01:09:05,993 --> 01:09:08,362 PIECE THAT YOU HAVE TO FIND WAYS 2043 01:09:08,362 --> 01:09:12,500 TO LINK DATA, TO UNDERSTAND THE 2044 01:09:12,500 --> 01:09:15,703 HERITAGE PIECE, WHICH IS JUST -- 2045 01:09:15,703 --> 01:09:19,974 YEAH, IT'S CRUCIAL TO PUT ALL 2046 01:09:19,974 --> 01:09:20,508 THESE QUESTIONS. 2047 01:09:20,508 --> 01:09:21,742 >> THANK YOU FOR THAT. 2048 01:09:21,742 --> 01:09:25,613 AS YOU PROBABLY ARE AWARE, ON 2049 01:09:25,613 --> 01:09:31,052 THE DIRECTIVE 15 WAS REVISED IN 2050 01:09:31,052 --> 01:09:34,255 MARCH, AND IT NOW -- ONE OF THE 2051 01:09:34,255 --> 01:09:35,456 REQUIREMENTS, IT'S NOT JUST TO 2052 01:09:35,456 --> 01:09:40,394 COLLECT "AMERI IDENTITY, BIG CA, 2053 01:09:40,394 --> 01:09:41,729 BUT ALSO THE SECOND LEVEL THAT I 2054 01:09:41,729 --> 01:09:43,498 ASKED ABOUT, MOSTLY GEOGRAPHIC 2055 01:09:43,498 --> 01:09:45,466 ORIGIN OF HERITAGE. 2056 01:09:45,466 --> 01:09:47,235 OR HERITAGE. 2057 01:09:47,235 --> 01:09:48,302 FOR ALL RACIAL AND ETHNIC 2058 01:09:48,302 --> 01:09:48,769 GROUPS. 2059 01:09:48,769 --> 01:09:50,838 SO FOR WHITES, BLACKS, LATINOS 2060 01:09:50,838 --> 01:09:52,240 AND ALL THE OTHER RACE AND 2061 01:09:52,240 --> 01:09:53,641 ETHNIC GROUPS AS WELL, INCLUDING 2062 01:09:53,641 --> 01:09:55,409 A NEW CATEGORY OF MIDDLE EASTERN 2063 01:09:55,409 --> 01:09:57,145 AND NORTH AFRICAN. 2064 01:09:57,145 --> 01:09:58,446 SO LET ME -- MAYBE WE CAN CHANGE 2065 01:09:58,446 --> 01:10:00,548 THE SYSTEM. 2066 01:10:00,548 --> 01:10:03,618 WE CAN TURN TO THE QUESTIONS. 2067 01:10:03,618 --> 01:10:05,286 I HAVE ONE HERE AND I'LL READ 2068 01:10:05,286 --> 01:10:05,553 IT. 2069 01:10:05,553 --> 01:10:09,524 IN THE CASE OF THE HIGHER 2070 01:10:09,524 --> 01:10:11,893 MAMMOGRAM SCREENING RATIOS IN 2071 01:10:11,893 --> 01:10:13,694 SPANISH SPEAKING LATINAS VERSUS 2072 01:10:13,694 --> 01:10:15,963 ENGLISH SPEAKING LAHTI 2073 01:10:15,963 --> 01:10:16,597 NEAS/NON-HISPANIC WOMEN, COULD 2074 01:10:16,597 --> 01:10:17,698 THE CAUSE OF THE INCREASE IN 2075 01:10:17,698 --> 01:10:19,200 SCREENINGS DUAL TO CULTURAL 2076 01:10:19,200 --> 01:10:19,534 FACTORS? 2077 01:10:19,534 --> 01:10:21,068 I'M A SECOND-YEAR MEDICAL 2078 01:10:21,068 --> 01:10:22,170 STUDENT AND I VOLUNTEER AT A 2079 01:10:22,170 --> 01:10:23,371 FREE CLINIC IN NEW ORLEANS. 2080 01:10:23,371 --> 01:10:25,740 I NOTICED THAT LATINA WOMEN TEND 2081 01:10:25,740 --> 01:10:27,408 TO REQUEST PAP SMEARS YEARLY, 2082 01:10:27,408 --> 01:10:28,709 WHICH GOES AGAINST THE STANDARD 2083 01:10:28,709 --> 01:10:31,078 TIME FRAMES USED IN 2084 01:10:31,078 --> 01:10:31,846 GYNECOLOGICAL GUIDELINES. 2085 01:10:31,846 --> 01:10:33,781 I WAS JUST WONDERING IF CULTURAL 2086 01:10:33,781 --> 01:10:35,283 BACKGROUND COULD BE A REASON FOR 2087 01:10:35,283 --> 01:10:40,588 THIS OUTLIER IN SCREENINGS. 2088 01:10:40,588 --> 01:10:41,989 >> IT'S A GREAT QUESTION. 2089 01:10:41,989 --> 01:10:42,857 I THINK THE GENERAL ANSWER IS 2090 01:10:42,857 --> 01:10:44,625 YES. 2091 01:10:44,625 --> 01:10:46,627 I THINK THAT'S POSSIBLE. 2092 01:10:46,627 --> 01:10:52,333 YOU KNOW, THOSE FINDINGS THAT WE 2093 01:10:52,333 --> 01:10:54,001 FIRST PRESENTED AT A MEETING IN 2094 01:10:54,001 --> 01:10:54,902 SAN ANTONIO AND SAT BASICALLY 2095 01:10:54,902 --> 01:10:59,607 THE SCIENCE OF CANCER AND 2096 01:10:59,607 --> 01:11:00,775 LATINOS, WE HAD SPOKEN WITH ONE 2097 01:11:00,775 --> 01:11:04,378 OF OUR MENTORS ABOUT THOSE 2098 01:11:04,378 --> 01:11:06,581 FINDINGS AND SHE HAD POSITED 2099 01:11:06,581 --> 01:11:07,982 THIS SPECIFICALLY ABOUT 2100 01:11:07,982 --> 01:11:09,517 MAMMOGRAPHY THAT ESPECIALLY -- 2101 01:11:09,517 --> 01:11:12,186 FORGIVE ME I'M GOING TO BUTCHER 2102 01:11:12,186 --> 01:11:13,821 HER ANSWER, BUT HER INPUT WAS 2103 01:11:13,821 --> 01:11:17,091 THAT IN CERTAIN LATINA 2104 01:11:17,091 --> 01:11:18,025 COMMUNITIES, ESPECIALLY IN 2105 01:11:18,025 --> 01:11:19,193 BORDER STATE, THERE JUST 2106 01:11:19,193 --> 01:11:21,028 WASN'T -- THERE WAS A SPECIFIC 2107 01:11:21,028 --> 01:11:22,897 CULTURAL DIALOGUE ABOUT 2108 01:11:22,897 --> 01:11:25,433 MAMMOGRAPHY. 2109 01:11:25,433 --> 01:11:27,335 AND SHE THOUGHT WOULD CONTRIBUTE 2110 01:11:27,335 --> 01:11:28,903 WOULD MAKE SENSE TO HER, SO I 2111 01:11:28,903 --> 01:11:30,204 THINK THERE ARE THOSE -- JUST 2112 01:11:30,204 --> 01:11:32,039 THOSE DIALOGUES THAT TAKE HOLD 2113 01:11:32,039 --> 01:11:33,774 IN NOT JUST LATINO CULTURES BUT 2114 01:11:33,774 --> 01:11:39,814 ANY CULTURE. 2115 01:11:39,814 --> 01:11:41,182 BASED ON THAT SPECIFIC SERVICE 2116 01:11:41,182 --> 01:11:42,116 COULD BE THE CASE. 2117 01:11:42,116 --> 01:11:43,284 IT INTERESTING, THERE'S SOME 2118 01:11:43,284 --> 01:11:44,285 WORK UNDER REVIEW THAT WE HAVE 2119 01:11:44,285 --> 01:11:45,386 THAT ACTUALLY SHOWS THAT NOT 2120 01:11:45,386 --> 01:11:48,322 ONLY IS IT ORDERS BUT ACTUAL 2121 01:11:48,322 --> 01:11:49,390 ACTUALLY -- LATINOS ARE ACTUALLY 2122 01:11:49,390 --> 01:11:52,960 MORE UP TO DATE WITH COMPLETION, 2123 01:11:52,960 --> 01:11:54,262 THAT'S STILL EARLY, WE'RE STILL 2124 01:11:54,262 --> 01:11:55,129 WORKING THROUGH SOME OF THAT 2125 01:11:55,129 --> 01:11:56,297 DATA, BURY THINK THE ANSWER TO 2126 01:11:56,297 --> 01:11:56,964 THAT QUESTION IS YES. 2127 01:11:56,964 --> 01:11:58,532 >> AND I JUST WANT TO HIGHLIGHT 2128 01:11:58,532 --> 01:12:00,901 THAT, AGAIN, THERE ARE THESE 2129 01:12:00,901 --> 01:12:02,436 POSITIVES, AND FOR US TO SORT OF 2130 01:12:02,436 --> 01:12:04,338 SHOWCASE OR HIGHLIGHT THOSE AND 2131 01:12:04,338 --> 01:12:05,673 THEN DO TRY TO FIGURE OUT WAYS 2132 01:12:05,673 --> 01:12:07,808 TO DO SUBSEQUENT WORK, WE TRY 2133 01:12:07,808 --> 01:12:08,676 AND UNDERSTAND WHAT ARE THE 2134 01:12:08,676 --> 01:12:10,411 DRIVERS THAT ARE LEADING TO 2135 01:12:10,411 --> 01:12:12,346 THESE IMPROVED RATES OF 2136 01:12:12,346 --> 01:12:13,347 SCREENING, SO I THINK THERE'S A 2137 01:12:13,347 --> 01:12:15,983 LOT OF WORK TO BE DONE AND THE 2138 01:12:15,983 --> 01:12:17,451 HOPE IS THAT WE CAN TRY TO 2139 01:12:17,451 --> 01:12:18,919 IDENTIFY WHAT ARE THE SPECIFIC 2140 01:12:18,919 --> 01:12:24,759 COMPONENTS HERE TO TRY TO LEARN 2141 01:12:24,759 --> 01:12:28,029 FROM THAT TO THEN LEARN HOW TO 2142 01:12:28,029 --> 01:12:30,665 INCORPORATE THAT INTO 2143 01:12:30,665 --> 01:12:30,998 INTERVENTIONS. 2144 01:12:30,998 --> 01:12:33,067 >> MAMMOGRAPHY, IF YOU LOOKED AT 2145 01:12:33,067 --> 01:12:35,002 JUST THE ABSOLUTE RATES, THEY 2146 01:12:35,002 --> 01:12:37,405 WERE NOT OVERRECOMMENDATION, 2147 01:12:37,405 --> 01:12:39,073 THEY WERE ACTUAL RECOMMENDED 2148 01:12:39,073 --> 01:12:40,741 LEVELS, BETWEEN EVERY YEAR OR 2149 01:12:40,741 --> 01:12:42,176 TWO KIND OF A THING, SO IN THAT 2150 01:12:42,176 --> 01:12:44,111 CASE, THEY WERE -- THAT SEEMED 2151 01:12:44,111 --> 01:12:47,548 TO BE A APPROPRIATE 2152 01:12:47,548 --> 01:12:50,885 PRESCRIBING -- OR EXCUSE ME -- 2153 01:12:50,885 --> 01:12:52,653 ORDER RANGE FOR LATINOS. 2154 01:12:52,653 --> 01:12:53,587 IT'S A GREAT QUESTION. 2155 01:12:53,587 --> 01:12:56,257 >> THE DATA YOU SHOWED FOR MY 2156 01:12:56,257 --> 01:12:58,292 OWN CLARIFICATION WAS AN ANNUAL 2157 01:12:58,292 --> 01:12:59,627 RECOMMENDATION OR EVERY TWO-YEAR 2158 01:12:59,627 --> 01:12:59,994 RECOMMENDATION? 2159 01:12:59,994 --> 01:13:01,062 BECAUSE WITH THE STANDARD 2160 01:13:01,062 --> 01:13:01,896 RECOMMENDATION IT'S EVERY TWO 2161 01:13:01,896 --> 01:13:03,431 YEARS, RIGHT? 2162 01:13:03,431 --> 01:13:04,799 >> YES. 2163 01:13:04,799 --> 01:13:07,501 THAT WAS -- LIKE THESE ARE EVERY 2164 01:13:07,501 --> 01:13:11,038 TWO YEARS FOR SOMEONE WHO'S HAD 2165 01:13:11,038 --> 01:13:12,006 NORMALS, SO FORTH. 2166 01:13:12,006 --> 01:13:13,541 WE DIDN'T ACTUALLY SHOW THE 2167 01:13:13,541 --> 01:13:18,012 ABSOLUTE RATES IN OUR FIGURE, 2168 01:13:18,012 --> 01:13:19,714 BUT -- THEY WERE ABOUT WHAT YOU 2169 01:13:19,714 --> 01:13:22,750 WOULD EXPECT, LIKE I THINK IT'S 2170 01:13:22,750 --> 01:13:23,884 .5 A YEAR OR SOMETHING LOO IK 2171 01:13:23,884 --> 01:13:24,085 THAT. 2172 01:13:24,085 --> 01:13:25,720 >> AND YOU EMPHASIZED THAT IT 2173 01:13:25,720 --> 01:13:29,924 WAS ORDERS BULL M BUT ARE MOST M 2174 01:13:29,924 --> 01:13:30,825 DONE, DO YOU THINK? 2175 01:13:30,825 --> 01:13:34,195 >> SO WE ACTUALLY PULLED THAT 2176 01:13:34,195 --> 01:13:36,530 SLIDE OUT, BUT WE DO HAVE A 2177 01:13:36,530 --> 01:13:38,733 STUDY THAT IS CURRENTLY UNDER 2178 01:13:38,733 --> 01:13:41,135 REVIEW THAT IS LOOKING AT SH DID 2179 01:13:41,135 --> 01:13:42,136 THEY ACTUALLY RECEIVE IT AND 2180 01:13:42,136 --> 01:13:43,337 LOOKING AT TIME FROM 50TH 2181 01:13:43,337 --> 01:13:45,206 BIRTHDAY TO THE RECEIPT, AND 2182 01:13:45,206 --> 01:13:50,077 SIMILAR TREND SHOWS THAT SPANISH 2183 01:13:50,077 --> 01:13:52,480 SPEAKING LATINAS, IN THIS CASE 2184 01:13:52,480 --> 01:13:53,948 ACTUALLY IT WAS FOREIGN-BORN 2185 01:13:53,948 --> 01:13:55,716 WHICH WAS A LITTLE BIT OF AN 2186 01:13:55,716 --> 01:13:57,651 OVERLAP, BUT LATINAS DO HAVE 2187 01:13:57,651 --> 01:13:59,420 MORE UP TO DATE AND GENERALLY 2188 01:13:59,420 --> 01:14:00,488 THEY'RE MORE UP TO DATE. 2189 01:14:00,488 --> 01:14:01,489 >> OKAY. 2190 01:14:01,489 --> 01:14:04,992 >> IT'S AN INTERESTING -- WHEN 2191 01:14:04,992 --> 01:14:10,297 WE FIRST -- YOU HAVE RESULTED 2192 01:14:10,297 --> 01:14:12,366 BECAUSE OF THE WAY EHR IS 2193 01:14:12,366 --> 01:14:15,503 STRUCTURED WHEN YOU GO OUT AND 2194 01:14:15,503 --> 01:14:19,106 IN TIME HAS GONE ON, IT EVOLVES, 2195 01:14:19,106 --> 01:14:20,474 IS MORE INTERCONNECTED THEN 2196 01:14:20,474 --> 01:14:22,209 WE'RE ABLE TO DO THIS MORE FULL 2197 01:14:22,209 --> 01:14:23,177 ANALYSIS THAT'S UNDER REVIEW. 2198 01:14:23,177 --> 01:14:24,278 >> EXCELLENT. 2199 01:14:24,278 --> 01:14:25,780 SO ANOTHER QUESTION, THIS IS 2200 01:14:25,780 --> 01:14:29,717 FROM ONE OF OUR PROGRAM STAFF, 2201 01:14:29,717 --> 01:14:31,385 CAN YOU SPEAK TO WHAT YOU'VE 2202 01:14:31,385 --> 01:14:33,554 LEARNED IN YOUR RESEARCH ABOUT 2203 01:14:33,554 --> 01:14:35,656 SPECIFIC PROTECTIVE FACTORS THAT 2204 01:14:35,656 --> 01:14:38,592 COUNTRY OF BIRTH AND RELEVANT 2205 01:14:38,592 --> 01:14:40,694 SOCIAL DETERMINANTS OF HEALTH 2206 01:14:40,694 --> 01:14:42,630 FACTORS IN LATINO POPULATIONS 2207 01:14:42,630 --> 01:14:44,398 MAY HAVE ON PRE-CLINICAL 2208 01:14:44,398 --> 01:14:47,601 PRESENTATION OF DISEASE AND IN 2209 01:14:47,601 --> 01:14:48,803 PREFERRED SPANISH SPEAKING 2210 01:14:48,803 --> 01:14:50,237 POPULATIONS OR POPULATIONS THAT 2211 01:14:50,237 --> 01:14:51,872 PREFER SPANISH, COMPARED TO 2212 01:14:51,872 --> 01:14:54,041 THOSE WHO PREFER ENGLISH, AND 2213 01:14:54,041 --> 01:14:56,143 LEADING TO SPECIFIC HEALTH 2214 01:14:56,143 --> 01:14:58,579 OUTCOMES, SECONDARY/TERTIARY 2215 01:14:58,579 --> 01:15:00,314 PREVENTION AND MANAGEMENT? 2216 01:15:00,314 --> 01:15:02,416 DID YOU GET ALL THAT? 2217 01:15:02,416 --> 01:15:03,451 >> YEAH, YEAH, YEAH. 2218 01:15:03,451 --> 01:15:06,287 >> IT'S IN THE CHAT, BUT -- 2219 01:15:06,287 --> 01:15:11,692 >> I THINK I WOULD SAY TWO 2220 01:15:11,692 --> 01:15:11,992 THINGS. 2221 01:15:11,992 --> 01:15:13,127 GREAT QUESTION. 2222 01:15:13,127 --> 01:15:15,729 LOTS TO SAY ABOUT IT. 2223 01:15:15,729 --> 01:15:20,301 I THINK -- BECAUSE WHEN I 2224 01:15:20,301 --> 01:15:23,804 DON'T -- WHAT WE -- IN THIS 2225 01:15:23,804 --> 01:15:28,008 REALLY BROAD CATEGORY WORK, WE 2226 01:15:28,008 --> 01:15:29,510 DON'T -- WE'RE CAREFUL ABOUT 2227 01:15:29,510 --> 01:15:30,511 EXTRAPOLATING TOO MUCH OF THIS 2228 01:15:30,511 --> 01:15:32,146 SPECIFIC THING THAT WE THINK IS 2229 01:15:32,146 --> 01:15:33,247 RESPONSIBLE FOR IT, BUT IN 2230 01:15:33,247 --> 01:15:36,717 GENERAL -- GENERALLY, THERE IS 2231 01:15:36,717 --> 01:15:41,755 THAT SUGGESTION THAT THE 2232 01:15:41,755 --> 01:15:42,957 MAMMOGRAPHY THING IS A GOOD 2233 01:15:42,957 --> 01:15:44,692 EXAMPLE, WHEN YOU START TO GET 2234 01:15:44,692 --> 01:15:47,528 OTHER EXPERTS, TRIANGULATE WITH 2235 01:15:47,528 --> 01:15:50,064 OTHER WORK THAT IS AWARE OF 2236 01:15:50,064 --> 01:15:58,038 THOSE DIALOGS AND -- YOU START 2237 01:15:58,038 --> 01:15:59,974 TO UNDERSTAND THAT THERE ARE 2238 01:15:59,974 --> 01:16:04,512 THOSE CONDITIONS, THOSE -- THOSE 2239 01:16:04,512 --> 01:16:06,614 CULTURAL DIALOGUES THAT CAN BE 2240 01:16:06,614 --> 01:16:07,915 REALLY POSITIVE, PROTECTIVE. 2241 01:16:07,915 --> 01:16:12,186 AND THE OTHER THING, I THINK, IS 2242 01:16:12,186 --> 01:16:15,256 THAT IS THIS KIND OF IDEA THAT 2243 01:16:15,256 --> 01:16:18,859 AS WE LEARNED THIS DISRUPTION 2244 01:16:18,859 --> 01:16:19,927 OF -- IMMUNIZATION IS A GOOD 2245 01:16:19,927 --> 01:16:22,663 EXAMPLE, JUST KIND OF WHAT WE'VE 2246 01:16:22,663 --> 01:16:25,533 HEARD A LOT, VACCINE HESITANT, 2247 01:16:25,533 --> 01:16:27,034 THAT'S AN OVERGENERALIZATION BUT 2248 01:16:27,034 --> 01:16:28,269 THAT'S ACTUALLY NOT THE CASE. 2249 01:16:28,269 --> 01:16:30,671 AND SO JUST TO BE VERY PRACTICAL 2250 01:16:30,671 --> 01:16:34,708 AND PRAGMATIC ABOUT IT, -- THAT 2251 01:16:34,708 --> 01:16:36,110 ARE BEING RECEIVED REGARDLESS OF 2252 01:16:36,110 --> 01:16:36,810 THE EXPLANATION THAT SOMETHING 2253 01:16:36,810 --> 01:16:38,579 IS WORKING THERE. 2254 01:16:38,579 --> 01:16:41,482 AND SO IT REQUIRED THAT TO GO VR 2255 01:16:41,482 --> 01:16:45,152 BY VR TO UNDERSTAND, WHAT'S 2256 01:16:45,152 --> 01:16:47,254 BEING DELIVERED AND WHAT'S NOT. 2257 01:16:47,254 --> 01:16:49,957 IT HARD TO EXTRAPOLATE ON EXACT 2258 01:16:49,957 --> 01:16:51,492 POTENTIAL FACTORS FOR THESE 2259 01:16:51,492 --> 01:16:52,793 FINDINGS, BUT IT STARTS TO 2260 01:16:52,793 --> 01:16:53,694 UNCOVER THAT. 2261 01:16:53,694 --> 01:16:55,429 >> AND THEN I'LL ADD ANOTHER 2262 01:16:55,429 --> 01:16:56,630 LAYER, I THINK ANOTHER WAY TO 2263 01:16:56,630 --> 01:16:59,600 THINK ABOUT IT IS WHAT SHOULD 2264 01:16:59,600 --> 01:17:02,202 PRIMARY CARE CLINICIANS BE 2265 01:17:02,202 --> 01:17:05,005 LOOKING AT WHEN THEY CARE FOR 2266 01:17:05,005 --> 01:17:06,907 LATINO COMMUNITIES, RIGHT? 2267 01:17:06,907 --> 01:17:09,209 SO WHEN YOU SEE THAT ENGLISH 2268 01:17:09,209 --> 01:17:11,211 PREFERRING LATINOS HAVE SIMILAR 2269 01:17:11,211 --> 01:17:14,048 OR WORSE ODDS OF ANY OF THESE 2270 01:17:14,048 --> 01:17:14,815 SERVICES, IS THAT SOMETHING 2271 01:17:14,815 --> 01:17:16,116 PRIMARY CARE CLINICIANS SHOULD 2272 01:17:16,116 --> 01:17:18,085 TRY TO UNDERSTAND WITHIN THEIR 2273 01:17:18,085 --> 01:17:22,022 OWN CLINIC, SO MAYBE LATINO 2274 01:17:22,022 --> 01:17:24,558 COMES IN, HAVING SOME 2275 01:17:24,558 --> 01:17:27,494 INFORMATION ABOUT TYPICALLY YOU 2276 01:17:27,494 --> 01:17:29,897 GET LESS SERVICES, SO THEN 2277 01:17:29,897 --> 01:17:30,998 SHOULD THEN THAT BE AN 2278 01:17:30,998 --> 01:17:33,834 OPPORTUNITY FOR A PRIMARY CARE 2279 01:17:33,834 --> 01:17:35,202 CLINICIAN TO START THAT DIALOGUE 2280 01:17:35,202 --> 01:17:36,537 TO UNDERSTAND WHY. 2281 01:17:36,537 --> 01:17:39,773 SO I THINK PART OF THIS IS 2282 01:17:39,773 --> 01:17:41,642 CAPTURING -- IN WHAT INSTANCES 2283 01:17:41,642 --> 01:17:46,447 DOES THIS INFORMATION HELP, SO 2284 01:17:46,447 --> 01:17:48,749 THE BROADER AUDIENCE, SCIENTIFIC 2285 01:17:48,749 --> 01:17:50,384 AUDIENCE, BUT HOW DOES THIS 2286 01:17:50,384 --> 01:17:51,018 IMPACT PRIMARY CARE? 2287 01:17:51,018 --> 01:17:53,320 I THINK THAT'S ALSO AN IMPORTANT 2288 01:17:53,320 --> 01:17:54,254 DISCUSSION THAT WE'RE TRYING TO 2289 01:17:54,254 --> 01:17:55,623 FIGURE OUT WHAT'S THE RIGHT 2290 01:17:55,623 --> 01:17:56,056 BALANCE. 2291 01:17:56,056 --> 01:17:57,791 DO YOU NEED TO KNOW THE COUNTRY 2292 01:17:57,791 --> 01:18:00,728 THEY COME FROM, DO YOU NEED TO 2293 01:18:00,728 --> 01:18:02,696 KNOW -- SO IT'S ALMOST AS THEY 2294 01:18:02,696 --> 01:18:03,864 DO -- WHEN DOES THAT HAPPEN. 2295 01:18:03,864 --> 01:18:05,966 I THINK THAT'S ANOTHER BIGGER 2296 01:18:05,966 --> 01:18:06,734 PICTURE DISCUSSION WE NEED TO 2297 01:18:06,734 --> 01:18:08,068 HAVE. 2298 01:18:08,068 --> 01:18:10,671 >> AND JUST TO PIGGY BACK ON 2299 01:18:10,671 --> 01:18:13,407 THAT, IN THIS CASE, THE DIALOGUE 2300 01:18:13,407 --> 01:18:16,677 STARTED -- IT'S NOT LIKE THIS 2301 01:18:16,677 --> 01:18:20,047 IS -- IF WE CAN GET -- AND -- TO 2302 01:18:20,047 --> 01:18:24,118 HAVE A DIALOGUE WITH COMMUNITY 2303 01:18:24,118 --> 01:18:27,287 HEALTH SERVICE CLINICIANS, THIS 2304 01:18:27,287 --> 01:18:32,960 IDEA IS PEOPLE'S HEADS, NOT IN A 2305 01:18:32,960 --> 01:18:33,827 DETERMINISTIC WAY, BUT TO GET 2306 01:18:33,827 --> 01:18:35,262 THOSE KIND OF IDEAS AND THOSE 2307 01:18:35,262 --> 01:18:37,431 KIND OF DYNAMICS IN PEOPLE'S 2308 01:18:37,431 --> 01:18:43,570 HEADS CAN BE A BIG SPRINGBOARD, 2309 01:18:43,570 --> 01:18:46,306 AND BETTER PREVENTION AND BETTER 2310 01:18:46,306 --> 01:18:47,541 CARE OVERALL. 2311 01:18:47,541 --> 01:18:49,243 >> EXCELLENT. 2312 01:18:49,243 --> 01:18:51,779 YOU KNOW, I WOULD SAY 2313 01:18:51,779 --> 01:18:52,346 UNEQUIVOCALLY THAT IT'S 2314 01:18:52,346 --> 01:18:54,615 IMPORTANT TO KNOW WHO YOUR 2315 01:18:54,615 --> 01:18:56,350 PATIENT IS IN TERMS OF THE 2316 01:18:56,350 --> 01:18:58,318 SOCIAL CONTEXT, REGARDLESS OF 2317 01:18:58,318 --> 01:18:59,853 THEIR RACE AND ETHNICITY. 2318 01:18:59,853 --> 01:19:01,488 YOU START WITH LANGUAGE, THEY 2319 01:19:01,488 --> 01:19:02,923 DON'T SPEAK ENGLISH, YOU NEED 2320 01:19:02,923 --> 01:19:04,558 SOMEONE WHO SPEAKS SPANISH WITH 2321 01:19:04,558 --> 01:19:05,092 THEM. 2322 01:19:05,092 --> 01:19:06,794 AND THEN KNOWING THEIR CONTEXT, 2323 01:19:06,794 --> 01:19:11,098 YOU KNOW, I THINK IF YOU'RE 2324 01:19:11,098 --> 01:19:12,232 GOING TO PRACTICE MEDICINE, IT 2325 01:19:12,232 --> 01:19:13,667 WAS ALWAYS IMPORTANT TO THE 2326 01:19:13,667 --> 01:19:15,669 PEOPLE, WHERE THEY CAME FROM, 2327 01:19:15,669 --> 01:19:17,571 HOW LONG THEY'VE BEEN HERE, WHAT 2328 01:19:17,571 --> 01:19:20,741 WAS THEIR FAMILY AND PERSONAL -- 2329 01:19:20,741 --> 01:19:21,775 SO A COUPLE MORE QUESTIONS FOR 2330 01:19:21,775 --> 01:19:22,109 YOU. 2331 01:19:22,109 --> 01:19:25,145 THIS IS FROM AN ACADEMIC 2332 01:19:25,145 --> 01:19:27,214 PEDIATRICIAN THANKING YOU FOR 2333 01:19:27,214 --> 01:19:27,681 YOUR PRESENTATION. 2334 01:19:27,681 --> 01:19:29,416 THIS PERSON WORKS IN MARYLAND 2335 01:19:29,416 --> 01:19:30,517 WITH LATINO CHILDREN AND 2336 01:19:30,517 --> 01:19:33,220 IMMIGRANT FAMILIES. 2337 01:19:33,220 --> 01:19:34,555 ANY INTERVENTIONS IN PRIMARY 2338 01:19:34,555 --> 01:19:36,423 CARE OR BY REFERRAL FROM PRIMARY 2339 01:19:36,423 --> 01:19:38,959 CARE THAT SHOW PROMISE IN 2340 01:19:38,959 --> 01:19:41,662 ADDRESSING HEALTH DISCARROTS 2341 01:19:41,662 --> 01:19:42,796 REGARDING SUSTAINABILITY AND 2342 01:19:42,796 --> 01:19:44,064 SCALABILITY, ESPECIALLY FOR 2343 01:19:44,064 --> 01:19:46,100 MENTAL HEALTH OR OBESITY? 2344 01:19:46,100 --> 01:19:50,104 BIG PROBLEMS. 2345 01:19:50,104 --> 01:19:52,906 >> LET ME THINK ABOUT THAT. 2346 01:19:52,906 --> 01:20:00,114 >> SO I'LL -- THIS MAY NOT BE A 2347 01:20:00,114 --> 01:20:00,547 SATISFYING ANSWER. 2348 01:20:00,547 --> 01:20:01,415 NOT THAT I KNOW. 2349 01:20:01,415 --> 01:20:02,783 IT'S A GREAT QUESTION, AND IT'S 2350 01:20:02,783 --> 01:20:03,784 ACTUALLY CLOSE TO OUR MINDS 2351 01:20:03,784 --> 01:20:04,318 RIGHT NOW. 2352 01:20:04,318 --> 01:20:10,324 WE HAD A MEETING WITH A PARTN 2353 01:20:10,324 --> 01:20:11,325 PARTNER -- IMMUNIZATIONS WERE 2354 01:20:11,325 --> 01:20:13,393 JUST STARTING TO CHARACTERIZE 2355 01:20:13,393 --> 01:20:14,261 APPROPRIATELY, ABOUT WHETHER WE 2356 01:20:14,261 --> 01:20:17,431 COULD HELP WITH SOME OF OUR DATA 2357 01:20:17,431 --> 01:20:18,632 NEEDS, AND WHAT THEY WANTED TO 2358 01:20:18,632 --> 01:20:20,267 TRY TO UNDERSTAND IS 2359 01:20:20,267 --> 01:20:22,436 SPECIFICALLY MENTAL BEHAVIORAL 2360 01:20:22,436 --> 01:20:25,706 HEALTH FOR LATINO PATIENTS AND 2361 01:20:25,706 --> 01:20:27,608 WHAT RESOURCES ARE BEING 2362 01:20:27,608 --> 01:20:29,343 ACCESSED AND UTILIZED AND HOW 2363 01:20:29,343 --> 01:20:30,944 THERE'S SUS A PAUCITY OF DATA 2364 01:20:30,944 --> 01:20:31,945 ABOUT HOW THAT WORKS WELL. 2365 01:20:31,945 --> 01:20:35,215 I THINK WE'RE OPTIMISTIC JUST 2366 01:20:35,215 --> 01:20:36,850 BECAUSE IN MOST COMMUNITY HEALTH 2367 01:20:36,850 --> 01:20:39,052 CENTERS, IT IS MORE COMMON TO 2368 01:20:39,052 --> 01:20:40,354 HAVE RESOURCES CO-LOCATED IN 2369 01:20:40,354 --> 01:20:43,423 THOSE CASES, AND INDEED, I THINK 2370 01:20:43,423 --> 01:20:44,625 WE HAVE A FIRST ANALYSIS THAT 2371 01:20:44,625 --> 01:20:46,794 DID SHOW THAT LATINO PATIENTS 2372 01:20:46,794 --> 01:20:54,234 ROW W -- USEDTHOSE AT SOME LEVE. 2373 01:20:54,234 --> 01:20:55,435 BUT IT'S STILL VERY GENERAL. 2374 01:20:55,435 --> 01:20:57,304 I DON'T THINK -- THERE'S NOT 2375 01:20:57,304 --> 01:21:00,040 GREAT DATA, THAT DOESN'T MEAN 2376 01:21:00,040 --> 01:21:02,109 THERE HAVEN'T BEEN SUCCESSFUL 2377 01:21:02,109 --> 01:21:02,910 INTERVENTIONS IN CERTAIN 2378 01:21:02,910 --> 01:21:03,644 LOCATIONS. 2379 01:21:03,644 --> 01:21:04,511 I'M JUST NOT AWARE. 2380 01:21:04,511 --> 01:21:07,014 >> SO I THINK YOU'VE HIT ON AN 2381 01:21:07,014 --> 01:21:09,316 IMPORTANT LIMITATION WITH THIS 2382 01:21:09,316 --> 01:21:14,154 WORK, SO TZ LARGE SCALE 2383 01:21:14,154 --> 01:21:16,423 MULTISTATE MULTIYEAR, SO IT IS 2384 01:21:16,423 --> 01:21:19,092 REALLY HARD TO IDENTIFY SPECIFIC 2385 01:21:19,092 --> 01:21:21,728 INTERVENTION OF THAT FROM 2386 01:21:21,728 --> 01:21:23,497 SPECIFIC STUDIES OR -- THE WORK 2387 01:21:23,497 --> 01:21:27,201 WE DO IS THE SORT OF MORE BROAD 2388 01:21:27,201 --> 01:21:30,470 OBSERVATIONAL WORK. 2389 01:21:30,470 --> 01:21:32,239 NOW WHAT WE COULD DO IS LOOK AT 2390 01:21:32,239 --> 01:21:33,006 POLICY INTERVENTIONS. 2391 01:21:33,006 --> 01:21:36,376 SO WE KNOW THAT THE AFFORDABLE 2392 01:21:36,376 --> 01:21:37,744 CARE ACT AIMED TO INCREASE 2393 01:21:37,744 --> 01:21:40,881 INSURANCE COVERAGE FOR LOWER 2394 01:21:40,881 --> 01:21:45,118 INCOME FOLKS R, SO THINGS LIKE 2395 01:21:45,118 --> 01:21:47,421 THAT, WE HAVE DONE THESE 2396 01:21:47,421 --> 01:21:49,323 INTERVENTIONS, THE AFFORDABLE 2397 01:21:49,323 --> 01:21:50,958 CARE ACT DID INCREASE INSURANCE 2398 01:21:50,958 --> 01:21:52,159 RATES IN SOME PEOPLE THAT LED TO 2399 01:21:52,159 --> 01:21:54,127 MORE SERVICES, SO FROM THE WORK 2400 01:21:54,127 --> 01:21:55,429 WE DO, THE CENTER DOES, IT'S 2401 01:21:55,429 --> 01:21:57,831 MORE LOOKING AT THOSE KIND OF 2402 01:21:57,831 --> 01:21:59,066 INNOVATIONS AND INTERVENTIONS, 2403 01:21:59,066 --> 01:22:00,767 SO WE'RE NOW LOOKING INTO -- WE 2404 01:22:00,767 --> 01:22:01,869 HAVE A GRANT WHERE WE'RE GOING 2405 01:22:01,869 --> 01:22:04,738 TO LOOK AT HOW DOES THE IMPACT 2406 01:22:04,738 --> 01:22:06,807 OF INTRODUCING THIS NEW 2407 01:22:06,807 --> 01:22:07,808 TECHNOLOGY IMPACT DELIVERY OF 2408 01:22:07,808 --> 01:22:09,243 CARE, CHANGES IN HEALTH OUT 2409 01:22:09,243 --> 01:22:10,844 COME, SO WE HAVE A LOT MORE TO 2410 01:22:10,844 --> 01:22:11,845 BE DONE, BUT I THINK WE'RE 2411 01:22:11,845 --> 01:22:13,046 TALKING ABOUT SPECIFIC 2412 01:22:13,046 --> 01:22:14,047 INTERVENTIONS, KIND OF HARD TO 2413 01:22:14,047 --> 01:22:16,984 TELL, BUT THE MORE SORT OF BROAD 2414 01:22:16,984 --> 01:22:18,852 POLICY AND JUST GENERAL 2415 01:22:18,852 --> 01:22:19,853 INNOVATIONS, THAT'S SOMETHING 2416 01:22:19,853 --> 01:22:22,789 IT'S EASIER TO CAPTURE WITH A 2417 01:22:22,789 --> 01:22:23,590 PRE/POST DESIGN OF SOME SORT. 2418 01:22:23,590 --> 01:22:25,092 >> THE THING IS, I THINK IT ALSO 2419 01:22:25,092 --> 01:22:27,628 GETS THE IDEA OF -- AND WE 2420 01:22:27,628 --> 01:22:28,629 STRUGGLE -- ALL THOAL WE'RE 2421 01:22:28,629 --> 01:22:30,697 TRYING TO -- ESPECIALLY THE TWO 2422 01:22:30,697 --> 01:22:33,066 CONDITIONS YOU LISTED OFTEN 2423 01:22:33,066 --> 01:22:34,101 INVOLVE OTHER MEMBERS OF THE 2424 01:22:34,101 --> 01:22:36,270 TEAM, HEALTHCARE TEAM, SO 2425 01:22:36,270 --> 01:22:39,907 WHETHER THAT'S IN LATINO 2426 01:22:39,907 --> 01:22:41,975 COMMUNITIES, COMMUNITY HEALTH 2427 01:22:41,975 --> 01:22:45,145 WORKERS OR OBVIOUSLY MENTAL 2428 01:22:45,145 --> 01:22:46,780 BEHAVIORAL HEALTH STAFF OR 2429 01:22:46,780 --> 01:22:48,081 NUTRITIONISTS, SOME OF THOSE ARE 2430 01:22:48,081 --> 01:22:49,416 AVAILABLE IN THE RECORDS THAT WE 2431 01:22:49,416 --> 01:22:50,284 STUDY, TRYING TO FIGURE OUT DO 2432 01:22:50,284 --> 01:22:53,687 YOU DO THAT, HOW DO YOU ME SURE 2433 01:22:53,687 --> 01:22:55,822 THAT TEAM -- AND WHETHER THOSE 2434 01:22:55,822 --> 01:22:57,324 TEAMS, A LOT OF THOSE OTHER 2435 01:22:57,324 --> 01:23:00,394 TYPES OF CLINICIANS ARE KIND OF 2436 01:23:00,394 --> 01:23:02,496 EFFECTIVELY INCORPORATED IS A 2437 01:23:02,496 --> 01:23:04,464 PIECE OF THAT THAT WE'RE TRYING 2438 01:23:04,464 --> 01:23:07,968 TO FIGURE OUT HOW TO STUDY AT 2439 01:23:07,968 --> 01:23:11,004 SCALE, OR VERY, VERY SLIGHTLY, 2440 01:23:11,004 --> 01:23:12,506 BUT I THINK IT'S AN IMPORTANT 2441 01:23:12,506 --> 01:23:14,141 ELEMENT TO -- WHEN YOU THINK 2442 01:23:14,141 --> 01:23:16,576 ABOUT -- WHEN YOU THINK ABOUT 2443 01:23:16,576 --> 01:23:18,845 REAL WORLD INTERVENTIONS, THE 2444 01:23:18,845 --> 01:23:19,846 LAST 15 YEARS HAS BEEN 2445 01:23:19,846 --> 01:23:21,281 TEAM-BASED CARE SO HOW DO YOU 2446 01:23:21,281 --> 01:23:22,449 REALLY UNDERSTAND HOW THAT HAS 2447 01:23:22,449 --> 01:23:28,221 BEEN BENEFICIAL OR NOT TO LOOK 2448 01:23:28,221 --> 01:23:28,789 FOR LATINO PATIENTS. 2449 01:23:28,789 --> 01:23:30,390 >> RIGHT, LET ME ADD THERE ARE 2450 01:23:30,390 --> 01:23:32,459 OTHER STUDIES THAT SORT OF FOCUS 2451 01:23:32,459 --> 01:23:34,428 ON INTERVENTIONS RELATED TO 2452 01:23:34,428 --> 01:23:37,197 MANAGEMENT OF OBESITY AND 2453 01:23:37,197 --> 01:23:39,833 ADOLESCENTS OR CHILDREN, AS WELL 2454 01:23:39,833 --> 01:23:41,835 AS MENTAL HEALTH ISSUES IN 2455 01:23:41,835 --> 01:23:45,305 FAMILIES THAT ARE OBVIOUSLY NOT 2456 01:23:45,305 --> 01:23:46,506 THIS SCALE, THIS SIZE, WITH 2457 01:23:46,506 --> 01:23:49,876 HUNDREDS OF THOUSANDS THAT SHOW 2458 01:23:49,876 --> 01:23:53,880 EFFICACY OF APPROACHES. 2459 01:23:53,880 --> 01:23:55,749 I'M THINKING PARTICULARLY WILLIE 2460 01:23:55,749 --> 01:23:59,152 P RA. ADO WHO WE HOSTED AT A 2461 01:23:59,152 --> 01:24:01,121 DIRECTOR'S SEMINAR OVER A YEAR 2462 01:24:01,121 --> 01:24:02,990 AGO AND HIS STUDIES FOCUSING ON 2463 01:24:02,990 --> 01:24:04,191 ISSUES AROUND MENTAL HEALTH AND 2464 01:24:04,191 --> 01:24:05,859 BEHAVIOR RELATED TO SEXUAL RISK 2465 01:24:05,859 --> 01:24:08,462 FACTORS AND SUBSTANCE USE WITH 2466 01:24:08,462 --> 01:24:09,830 FAMILIES IS VERY MUCH EMBEDDED 2467 01:24:09,830 --> 01:24:11,098 IN THE FAMILY APPROACH, AND I 2468 01:24:11,098 --> 01:24:14,768 THINK LATINOS IN GENERAL ARE, A, 2469 01:24:14,768 --> 01:24:16,470 JUST GENERALIZING WITHOUT -- 2470 01:24:16,470 --> 01:24:18,905 OBVIOUSLY EVERYONE IS DIFFERENT, 2471 01:24:18,905 --> 01:24:22,209 ARE ACCEPTING OF A MENTAL HEALTH 2472 01:24:22,209 --> 01:24:23,543 PROBLEM AND APPROACH, THINKING 2473 01:24:23,543 --> 01:24:28,982 OF THE MIND-BODY CONNECTION, SO 2474 01:24:28,982 --> 01:24:30,083 THE CHALLENGE IS ACCESS TO 2475 01:24:30,083 --> 01:24:31,385 PEOPLE WHO CAN SEE THEM. 2476 01:24:31,385 --> 01:24:32,719 PARTICULARLY IF THEY DON'T SPEAK 2477 01:24:32,719 --> 01:24:34,588 ENGLISH. 2478 01:24:34,588 --> 01:24:36,823 THAT'S A HUGE CHALLENGE. 2479 01:24:36,823 --> 01:24:38,158 SO I HAVE A COUPLE MORE WE CAN 2480 01:24:38,158 --> 01:24:41,561 GET IN, MAYBE AT LEAST ONE. 2481 01:24:41,561 --> 01:24:43,330 THANK YOU FOR SUCH A WONDERFUL 2482 01:24:43,330 --> 01:24:43,730 PRESENTATION. 2483 01:24:43,730 --> 01:24:46,133 HOWEVER, I HAVE A CONCERN. 2484 01:24:46,133 --> 01:24:47,901 THE ENTIRE RESULTS COMPARE 2485 01:24:47,901 --> 01:24:49,436 LATINOS AND WHITE NON-LATINOS. 2486 01:24:49,436 --> 01:24:51,571 ARE WE ASSUMING THAT THE STUDY 2487 01:24:51,571 --> 01:24:54,174 LATINOS ARE WHITE? 2488 01:24:54,174 --> 01:24:55,809 WHERE DO BLACK LATINOS FALL IN 2489 01:24:55,809 --> 01:24:56,243 THESE RESULTS? 2490 01:24:56,243 --> 01:24:57,778 DID YOU HAVE A WAY TO EXCLUDE 2491 01:24:57,778 --> 01:24:59,679 THEM SO THAT YOU COULD ONLY 2492 01:24:59,679 --> 01:25:02,149 COMPARE WHITE LATINOS WITH WHITE 2493 01:25:02,149 --> 01:25:03,717 NON-LATINOS, OR ARE THEY PART OF 2494 01:25:03,717 --> 01:25:04,818 THE LATINO GROUPS? 2495 01:25:04,818 --> 01:25:06,887 IF YES, I MIGHT INCLUDE BLACKS 2496 01:25:06,887 --> 01:25:08,922 AS WELL IN THE COMPARISON 2497 01:25:08,922 --> 01:25:10,524 BECAUSE OF SKIN COLOR FACTORS DO 2498 01:25:10,524 --> 01:25:12,759 A LOT IN HEALTH DISPARITIES. 2499 01:25:12,759 --> 01:25:13,860 PLEASE CLARIFY. 2500 01:25:13,860 --> 01:25:15,595 >> YEAH, NO, THAT IS A GREAT 2501 01:25:15,595 --> 01:25:19,232 QUESTION. 2502 01:25:19,232 --> 01:25:22,702 AND SO IN THE MAJORITY OF OUR 2503 01:25:22,702 --> 01:25:27,974 WORK, WE DO ONLY LOOK AT 2504 01:25:27,974 --> 01:25:30,510 ETHNICITY, SO THE WAY THE OMB 2505 01:25:30,510 --> 01:25:32,379 CATEGORY, LATINO OR NON-LATINO, 2506 01:25:32,379 --> 01:25:35,649 AND THEN WE THEN FURTHER FOR THE 2507 01:25:35,649 --> 01:25:37,517 NON-LATINO DO LOOK AT WHITES. 2508 01:25:37,517 --> 01:25:39,252 SO FOR -- WE DID THIS FOR A FEW 2509 01:25:39,252 --> 01:25:41,855 REASONS. 2510 01:25:41,855 --> 01:25:45,258 SO ONE IS, OUR EXPERIENCE, OUR 2511 01:25:45,258 --> 01:25:46,993 SORT OF -- AT LEAST WITH MY 2512 01:25:46,993 --> 01:25:49,863 LIVED EXPOSURE, IS IN A LATINO 2513 01:25:49,863 --> 01:25:52,532 COMMUNITY. 2514 01:25:52,532 --> 01:25:55,068 AND WE BELIEVE TO REALLY DO 2515 01:25:55,068 --> 01:25:57,904 JUSTICE TO UNDERSTAND JUST 2516 01:25:57,904 --> 01:26:04,010 LATINOS BROADLY, IT DOES REQUIRE 2517 01:26:04,010 --> 01:26:05,879 LOOKING AT A LATINO GROUP IN 2518 01:26:05,879 --> 01:26:08,248 COMPARISON TO OTHER GROUPS AS 2519 01:26:08,248 --> 01:26:13,153 WELL, SO IN OUR WORK, WE TRY TO 2520 01:26:13,153 --> 01:26:15,722 FOCUS -- HAVE THE FOCUS ON THE 2521 01:26:15,722 --> 01:26:17,891 LATINO GROUP. 2522 01:26:17,891 --> 01:26:20,227 THIS ARE -- MANY OF OUR STUDIES 2523 01:26:20,227 --> 01:26:22,395 INCLUDE LATINO BLACK AND 2524 01:26:22,395 --> 01:26:24,498 NON-HISPANIC BLACK PATIENTS AS 2525 01:26:24,498 --> 01:26:25,031 WELL. 2526 01:26:25,031 --> 01:26:29,503 BUT WE TRY TO LET OUR CO-AUTHORS 2527 01:26:29,503 --> 01:26:32,005 WHO HAVE EXPERTISE IN THAT LEAD 2528 01:26:32,005 --> 01:26:33,874 THE WAY THERE. 2529 01:26:33,874 --> 01:26:35,542 SO THERE'S THIS REALLY NICE 2530 01:26:35,542 --> 01:26:37,144 PAPER FROM ELLE THAT TALKED 2531 01:26:37,144 --> 01:26:39,246 ABOUT HEALTH EQUITY TOURISM. 2532 01:26:39,246 --> 01:26:41,481 AND IT REALLY HELPED US SORT OF 2533 01:26:41,481 --> 01:26:42,516 THINK ABOUT WHAT ARE THE RIGHT 2534 01:26:42,516 --> 01:26:45,385 TIMES FOR US TO THINK ABOUT 2535 01:26:45,385 --> 01:26:47,454 INCLUDING NON-LATINO GROUPS IN 2536 01:26:47,454 --> 01:26:50,924 OUR WORK, AND SO I THINK 2537 01:26:50,924 --> 01:26:53,126 GENERALLY SPEAKING, WHEN WE HAVE 2538 01:26:53,126 --> 01:26:55,328 THE RIGHT EXPERTISE IN THE TEAM, 2539 01:26:55,328 --> 01:26:56,830 BECAUSE THE TEAM IS BIG AND SOME 2540 01:26:56,830 --> 01:27:01,434 PEOPLE HAVE EXPERTISE AND SOME 2541 01:27:01,434 --> 01:27:03,703 HAVE -- IT WAS IN CARDIOVASCULAR 2542 01:27:03,703 --> 01:27:04,871 DISEASE, SO WHEN THE EXPERTISE 2543 01:27:04,871 --> 01:27:06,506 IS THERE, WE DO TRY TO THINK 2544 01:27:06,506 --> 01:27:07,607 ABOUT INCLUSION OF OTHER GROUPS 2545 01:27:07,607 --> 01:27:09,242 AS WELL BUT OUR PRIMARY FOCUS IS 2546 01:27:09,242 --> 01:27:13,346 ON LATINO AND WE DO INCLUDE IN 2547 01:27:13,346 --> 01:27:14,881 THE LATINO GROUP BLACK LATINOS. 2548 01:27:14,881 --> 01:27:17,217 SO THE OTHER THING IS AS WE NOW 2549 01:27:17,217 --> 01:27:21,721 SORT OF ENTERED A SCENARIO WHERE 2550 01:27:21,721 --> 01:27:25,792 WE DO HAVE MORE DATA, IN OUR 2551 01:27:25,792 --> 01:27:27,227 INITIAL STUDIES WE WERE ALWAYS 2552 01:27:27,227 --> 01:27:28,528 LIMITED BY DATA SAMPLE SIZE. 2553 01:27:28,528 --> 01:27:30,630 IN OUR MOST RECENT DATA POLLS, 2554 01:27:30,630 --> 01:27:32,365 WE HAVE NOW SUFFICIENT SAMPLE 2555 01:27:32,365 --> 01:27:33,466 SIZE AND WE ARE LOOKING TO THINK 2556 01:27:33,466 --> 01:27:39,673 ABOUT WAYS TO INCORPORATE AFRO 2557 01:27:39,673 --> 01:27:41,408 LATINOS, AFRO LATINAS INTO THIS 2558 01:27:41,408 --> 01:27:42,742 WORK BY SAMPLE SIZE 2559 01:27:42,742 --> 01:27:43,610 CONSIDERATIONS AND ALSO TEAM 2560 01:27:43,610 --> 01:27:45,345 EXPERTISE AND IN GENERAL, WE 2561 01:27:45,345 --> 01:27:46,913 WANT TO DO IT JUSTICE AND DO IT 2562 01:27:46,913 --> 01:27:47,314 RIGHT. 2563 01:27:47,314 --> 01:27:50,317 >> YEAH, WE DON'T ASSUME. 2564 01:27:50,317 --> 01:27:54,221 IT REALLY WAS -- THERE'S -- 2565 01:27:54,221 --> 01:27:55,288 BECAUSE IT'S REALLY JUST A WAY 2566 01:27:55,288 --> 01:27:58,225 THAT THE NETWORK HAD DEVELOPED 2567 01:27:58,225 --> 01:28:01,895 THAT MOST OF THE NUMBERS OF 2568 01:28:01,895 --> 01:28:03,630 PATIENT WHO IDENTIFIED AS BLACK 2569 01:28:03,630 --> 01:28:07,267 ANDLY TA AND LATINO WERE VERY ST 2570 01:28:07,267 --> 01:28:11,071 LED TO A LOT MORE -- A DIFFERENT 2571 01:28:11,071 --> 01:28:12,505 CATEGORY OR BEING VERY CAREFUL 2572 01:28:12,505 --> 01:28:13,506 ABOUT THE ANALYSIS AND 2573 01:28:13,506 --> 01:28:15,609 IMPLICATIONS FROM THAT, BUT WE 2574 01:28:15,609 --> 01:28:18,011 DON'T ASSUME ALL OF THOSE 2575 01:28:18,011 --> 01:28:19,546 PATIENTS ARE WHITE LATINOS. 2576 01:28:19,546 --> 01:28:23,149 >> AGAIN, I WOULD ADD THAT 2577 01:28:23,149 --> 01:28:26,386 NATIONAL DATA DO HELP HERE, AND 2578 01:28:26,386 --> 01:28:28,355 BASED ON CONSISTENCY OVER THE 2579 01:28:28,355 --> 01:28:29,556 LAST THREE CENSUSES, AT LEAST, 2580 01:28:29,556 --> 01:28:34,427 YOU KNOW, ABOUT HALF OF LATINOS 2581 01:28:34,427 --> 01:28:37,097 IDENTIFIED AS WHITE AS WELL IN 2582 01:28:37,097 --> 01:28:41,034 THE CENSUS, SOMEWHERE AROUND 40% 2583 01:28:41,034 --> 01:28:42,569 PUT OTHER OR I ALREADY TOLD YOU 2584 01:28:42,569 --> 01:28:43,970 WHY ARE YOU ASKING ME AGAIN, AND 2585 01:28:43,970 --> 01:28:46,206 THESE ARE MOSTLY THE LATINOS WHO 2586 01:28:46,206 --> 01:28:48,475 ARE CLEARLY MIXED USUALLY WITH 2587 01:28:48,475 --> 01:28:49,476 INDIGENOUS AMERICANS, AND THERE 2588 01:28:49,476 --> 01:28:53,079 ARE SOMEWHERE IN THAT 5 TO 10% 2589 01:28:53,079 --> 01:28:57,250 RANGE OF LATINOS WHO WOULD 2590 01:28:57,250 --> 01:28:59,152 SELECT BEING AFRO LATINO OR 2591 01:28:59,152 --> 01:29:01,454 BLACK LATINOS, BUT THEIR FIRST 2592 01:29:01,454 --> 01:29:02,455 IDENTITY IS STILL LATINO. 2593 01:29:02,455 --> 01:29:03,657 THAT IS THE CHALLENGE HERE. 2594 01:29:03,657 --> 01:29:05,325 SO I DO THINK THAT YOU ARE 2595 01:29:05,325 --> 01:29:07,193 CAPTURING THEIR DATA, YOU JUST 2596 01:29:07,193 --> 01:29:09,696 TONIGHT HAVE THE ABILITY TO 2597 01:29:09,696 --> 01:29:10,897 SEPARATE THEM OUT TO SEE HOW 2598 01:29:10,897 --> 01:29:11,998 DIFFERENT THEY ARE. 2599 01:29:11,998 --> 01:29:15,535 YOU CITED ELIZABETH ARIAS 2600 01:29:15,535 --> 01:29:16,936 EARLIER FROM NATIONAL CENTER FOR 2601 01:29:16,936 --> 01:29:18,238 HEALTH STATISTICS, AND SHE'S 2602 01:29:18,238 --> 01:29:20,674 PUBLISHED A PAPER LOOKING AT 2603 01:29:20,674 --> 01:29:22,542 MORTALITY BY WHITE LATINO VERSUS 2604 01:29:22,542 --> 01:29:25,045 BLACK LATINO, AND THE MAIN 2605 01:29:25,045 --> 01:29:30,617 MESSAGE IS THEY'RE BOTH LOWER 2606 01:29:30,617 --> 01:29:36,756 FOR WHITE NON-LATINOS, BUT 2607 01:29:36,756 --> 01:29:37,991 BLACK -- HIGHER THAN WHITE 2608 01:29:37,991 --> 01:29:39,326 LATINOS I THINK AS I RECALL 2609 01:29:39,326 --> 01:29:40,960 PARTICULARLY FOR FEMALES, BUT SO 2610 01:29:40,960 --> 01:29:43,496 THERE IS BEGINNING TO ARE 2611 01:29:43,496 --> 01:29:45,098 MORE -- THE SEOUL STUDY YOU 2612 01:29:45,098 --> 01:29:46,099 MENTIONED ALSO HAS RACE DATA, 2613 01:29:46,099 --> 01:29:48,101 BUT AGAIN, THE OVERWHELMING 2614 01:29:48,101 --> 01:29:49,636 MAJORITY EITHER PUT OTHER OR 2615 01:29:49,636 --> 01:29:50,704 WHITE. 2616 01:29:50,704 --> 01:29:51,805 SO -- BUT THERE ARE -- THERE IS 2617 01:29:51,805 --> 01:29:55,475 A SUBSET OF LATINOS IN SEOUL WHO 2618 01:29:55,475 --> 01:29:57,010 SAY THEY IDENTIFIED AS BLACK, 2619 01:29:57,010 --> 01:29:59,479 AND THERE'S DATA FROM THE PEW 2620 01:29:59,479 --> 01:30:02,482 FOUNDATION THAT HAS DONE MORE 2621 01:30:02,482 --> 01:30:04,818 WORK ON THIS THAN THE U.S. 2622 01:30:04,818 --> 01:30:06,353 CENSUS, THAT LATINOS WHO ARE 2623 01:30:06,353 --> 01:30:08,988 BLACK PREFER TO IDENTIFY AS AFRO 2624 01:30:08,988 --> 01:30:11,291 LATINO OR AFRO CARIBBEAN IN MANY 2625 01:30:11,291 --> 01:30:12,726 CASES, MANY OF THEM ARE FROM THE 2626 01:30:12,726 --> 01:30:16,229 CARE PCARIBBEAN COUNTRIES, BUT E 2627 01:30:16,229 --> 01:30:18,198 ARE BLACK MEXICANS AS WELL. 2628 01:30:18,198 --> 01:30:19,099 AND IN LATIN AMERICA, THE 2629 01:30:19,099 --> 01:30:22,602 QUESTION OF RACE FOR PEOPLE OF 2630 01:30:22,602 --> 01:30:24,003 AFRICAN HERITAGE, BLACK, HAS 2631 01:30:24,003 --> 01:30:27,006 BEEN ADDED TO AT LEAST NOT ONLY 2632 01:30:27,006 --> 01:30:30,944 BRAZIL BUT ALSO THE COUPLE OF 2633 01:30:30,944 --> 01:30:34,214 CARIBBEAN ISLANDS, CUBA, MEXICO, 2634 01:30:34,214 --> 01:30:35,882 AND SO WE'RE GOING TO SEAL MORE 2635 01:30:35,882 --> 01:30:36,850 DATA COMING FROM LATIN AMERICA 2636 01:30:36,850 --> 01:30:38,818 ON THIS AS WELL. 2637 01:30:38,818 --> 01:30:39,486 ALL RIGHT. 2638 01:30:39,486 --> 01:30:42,655 SO WE'VE HIT 5:00. 2639 01:30:42,655 --> 01:30:44,324 THE LAST QUESTION I DIDN'T ASK 2640 01:30:44,324 --> 01:30:45,658 YOU WAS, WHAT IS THE BEST WAY 2641 01:30:45,658 --> 01:30:47,627 FOR US TO COLLECT DATA FROM 2642 01:30:47,627 --> 01:30:49,262 LATINOS, AND I THINK WE ALREADY 2643 01:30:49,262 --> 01:30:50,964 TALKED ABOUT THAT TO SOME EXTENT 2644 01:30:50,964 --> 01:30:52,165 FROM THE LATINO COMMUNITY. 2645 01:30:52,165 --> 01:30:54,434 SO AGAIN, I WANT TO REALLY THANK 2646 01:30:54,434 --> 01:30:57,971 YOU FOR BEING -- SETTING THE 2647 01:30:57,971 --> 01:31:00,807 CONTEXT, AND THEN REALLY DOING 2648 01:31:00,807 --> 01:31:02,008 THE PRESENTATION BASED ON YOUR 2649 01:31:02,008 --> 01:31:04,110 OWN WORK, WHICH IS REALLY WHAT I 2650 01:31:04,110 --> 01:31:06,980 WANT THESE SEMINARS TO BE. 2651 01:31:06,980 --> 01:31:09,149 WHERE IS THE SCIENCE THAT YOU'VE 2652 01:31:09,149 --> 01:31:12,085 DONE WITH ALL THE GRANULARITY OF 2653 01:31:12,085 --> 01:31:13,787 THE GOOD THINGS AND THE BUMPS, 2654 01:31:13,787 --> 01:31:15,321 THAT'S WHAT WE WANT TO SEE, 2655 01:31:15,321 --> 01:31:16,990 BECAUSE THAT'S WHAT I WANT OUR 2656 01:31:16,990 --> 01:31:18,525 AUDIENCE TO HEAR. 2657 01:31:18,525 --> 01:31:20,794 AND THE FOCUS AGAIN ON PRIMARY 2658 01:31:20,794 --> 01:31:23,096 CARE IS VERY TIMELY, AND OF 2659 01:31:23,096 --> 01:31:25,632 COURSE IN MY OWN INDIVIDUAL 2660 01:31:25,632 --> 01:31:27,600 INTEREST, FOCUSED ON LATINO 2661 01:31:27,600 --> 01:31:28,802 HEALTH IS ALWAYS ALSO OF GREAT 2662 01:31:28,802 --> 01:31:29,369 INTEREST. 2663 01:31:29,369 --> 01:31:31,571 SO THANKS AGAIN, JOHN AND 2664 01:31:31,571 --> 01:31:33,773 MIGUEL, FOR A WONDERFUL 2665 01:31:33,773 --> 01:31:34,107 PRESENTATION. 2666 01:31:34,107 --> 01:31:35,041 >> THANK YOU SO MUCH. 2667 01:31:35,041 --> 01:31:37,076 >> THANK YOU FOR THE INVITE AND 2668 01:31:37,076 --> 01:31:38,144 THANKS EVERYBODY FOR LISTENING. 2669 01:31:38,144 --> 01:31:39,813 >> ALL RIGHT. 2670 01:31:39,813 --> 01:31:41,448 THANK YOU. 2671 01:31:41,448 --> 01:31:43,082 , EVERYONE, FOR SUPPORTING THE 2672 01:31:43,082 --> 01:31:53,393 PRESENTATION TOO.