1
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THANK YOU ALL FOR TAKING TIME

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00:00:07,440 --> 00:00:10,960
OUT OF WHAT I'M SURE IS A VERY

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BUSY SCHEDULE TO JOIN MYSELF AND

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00:00:13,280 --> 00:00:14,840
MY FRIEND AND COLLEAGUE,

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00:00:14,840 --> 00:00:16,720
DR. BENSON, FOR THIS NATIONAL

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SYMPOSIUM THAT WE FEEL IS GOING

7
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TO ADDRESS A VERY PREVALENT AND

8
00:00:21,600 --> 00:00:23,720
RELEVANT AND COMMON ISSUE, WHICH

9
00:00:23,720 --> 00:00:26,920
IS INEQUITIES IN ACCESS AND

10
00:00:26,920 --> 00:00:28,240
DELIVERY IN ACUTE STROKE CARE.

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I AM PART OF THE BRAIN ATTACK

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COALITION, WHICH IS AN

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ORGANIZATION THAT MEETS UNDER

14
00:00:32,560 --> 00:00:35,960
THE AUSPICES OF THE NINDS.

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THE CONSTITUENCIES OF THE BRAIN

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ATTACK COALITION INCLUDE A LOT

17
00:00:39,160 --> 00:00:40,320
OF PUBLIC AND PROFESSIONAL

18
00:00:40,320 --> 00:00:42,240
GROUPS THAT ARE INVOLVED IN ALL

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ASPECTS OF STROKE CARE,

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INCLUDING PRE-HOSPITAL CARE,

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HOSPITAL CARE, AND THEN POST

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HOSPITAL CARE EDUCATION,

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00:00:49,840 --> 00:00:51,600
NON-PROFIT GROUPS, AND THE LIKE.

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00:00:51,600 --> 00:00:53,240
SO AGAIN, THANK YOU SO MUCH FOR

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00:00:53,240 --> 00:00:54,600
TAKING TIME OUT OF YOUR BUSY

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SCHEDULE TO JOIN US.

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00:00:56,240 --> 00:00:59,080
NOW I'LL INTRODUCE MY CO-CHAIR,

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DR. RICHARD BENSON.

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RICHARD?

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>> THANK YOU, DR. ALBERTS.

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IT'S TRULY A PLEASURE TO BE WITH

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YOU THIS MORNING.

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AND IT MY HONOR, IT'S BEEN MY

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HONOR TO WORK WITH YOU AS WELL

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00:01:11,600 --> 00:01:13,480
AS MEMBERS OF BRAIN ATTACK

36
00:01:13,480 --> 00:01:15,080
COALITION AND MEMBERS OF THE

37
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WORKING GROUPS.

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OVER THE LAST THREE YEARS, THE

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00:01:19,040 --> 00:01:21,040
SARS COVID-19 PANDEMIC HAS

40
00:01:21,040 --> 00:01:23,000
HIGHLIGHTED HEALTH INEQUITIES

41
00:01:23,000 --> 00:01:25,840
RELATED TO UNMANAGED MEDICAL

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00:01:25,840 --> 00:01:28,960
COMORBIDITIES AND THE IMPACT OF

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00:01:28,960 --> 00:01:30,360
SOCIODETERMINANTS OF HEALTH LIKE

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00:01:30,360 --> 00:01:31,760
HOUSING, JOB AND FOOD

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00:01:31,760 --> 00:01:37,640
INSECURITY, POVERTY, INACCESS TO

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00:01:37,640 --> 00:01:38,840
QUALITY MEDICAL CARE, PROVIDER

47
00:01:38,840 --> 00:01:41,320
LEVEL BIAS AND MEDICAL MISTRUST.

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00:01:41,320 --> 00:01:42,840
COINCIDENT WITH THE COVID

49
00:01:42,840 --> 00:01:43,840
PANDEMIC HAS BEEN A GLOBAL

50
00:01:43,840 --> 00:01:46,000
RECOGNITION OF RACISM,

51
00:01:46,000 --> 00:01:48,200
PARTICULARLY STRUCTURAL AND

52
00:01:48,200 --> 00:01:48,840
INTERPERSONAL, WITH THE MURDER

53
00:01:48,840 --> 00:01:50,680
OF GEORGE FLOYD AND OTHERS.

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00:01:50,680 --> 00:01:52,200
AND THE NEGATIVE HEALTH IMPACT

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00:01:52,200 --> 00:01:54,240
OF THIS.

56
00:01:54,240 --> 00:01:57,600
THESE PARALLEL PANDEMICS SPARCED

57
00:01:57,600 --> 00:02:00,600
SEVERAL TRANS-NIH INITIATIVES

58
00:02:00,600 --> 00:02:02,480
LIKE UNITE, THE NIH FIRST

59
00:02:02,480 --> 00:02:04,440
PROGRAM, AND INTRAI.C.

60
00:02:04,440 --> 00:02:05,320
INITIATIVES TO SPECIFICALLY

61
00:02:05,320 --> 00:02:08,440
ADDRESS THE IMPACT OF RACISM ON

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00:02:08,440 --> 00:02:09,920
THE NIH MISSION.

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00:02:09,920 --> 00:02:12,040
AT THE NINDS, WE ARE COMPLETING

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A TWO-YEAR HEALTH EQUITY

65
00:02:14,160 --> 00:02:16,520
STRATEGIC PLANNING EFFORT THAT

66
00:02:16,520 --> 00:02:17,840
WILL HELP SHAPE OUR INITIATIVES

67
00:02:17,840 --> 00:02:20,280
OVER THE NEXT FIVE TO 10 YEARS.

68
00:02:20,280 --> 00:02:22,680
UNDER THE DIRECTION OF A

69
00:02:22,680 --> 00:02:24,800
30-MEMBER DIVERSE PANEL OF

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00:02:24,800 --> 00:02:26,160
EXPERT, THE WORKSHOP FOCUSED ON

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00:02:26,160 --> 00:02:27,640
HEALTH DISPARITIES AND

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INEQUITIES IN NEUROLOGICAL

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DISEASES.

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FEEDBACK FROM MULTIPLE COMMUNITY

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STAKEHOLDERS WAS OBTAINED AND

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00:02:34,880 --> 00:02:36,840
RECOMMENDATIONS PROVIDED TO THE

77
00:02:36,840 --> 00:02:39,720
NINDS AT THE END OF THE PROCESS.

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THIS INFORMATION WILL BE OPEN

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AND AVAILABLE FOR THE PUBLIC IN

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00:02:42,640 --> 00:02:46,480
COMING MONTHS.

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00:02:46,480 --> 00:02:48,560
THIS BRAIN ATTACK COALITION

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00:02:48,560 --> 00:02:50,080
SYMPOSIUM IS ANOTHER MEANS TO

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00:02:50,080 --> 00:02:52,400
ADDRESS A HIGHLY RELEVANT

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00:02:52,400 --> 00:02:53,240
NEUROLOGICAL CONDITION WITH

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00:02:53,240 --> 00:02:54,480
GREAT INEQUITIES:  STROKE.

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00:02:54,480 --> 00:02:55,880
IT IS OUR HOPE THAT THE

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00:02:55,880 --> 00:02:57,360
INFORMATION PROVIDED BY OUR

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00:02:57,360 --> 00:02:58,560
WORKING GROUPS AND THE

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00:02:58,560 --> 00:02:59,840
DISCUSSION OVER THE NEXT TWO

90
00:02:59,840 --> 00:03:02,280
DAYS WILL LEAD TO SUBSTANTIVE

91
00:03:02,280 --> 00:03:04,040
CHANGE IN STROKE TREATMENT,

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00:03:04,040 --> 00:03:08,840
CARE, AND THE NEGATIVE OUTCOMES.

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00:03:08,840 --> 00:03:10,000
AND NOW IT IS MY DISTINCT

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00:03:10,000 --> 00:03:11,280
PLEASURE TO INTRODUCE OUR

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KEYNOTE SPEAKER, DR. DAVID

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00:03:17,280 --> 00:03:17,640
SATCHER.

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00:03:17,640 --> 00:03:18,560
DR. SATCHER HAS ALWAYS BEEN A

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ROLE MODEL TO ME.

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00:03:19,040 --> 00:03:22,720
IN FACT, HIS BROTHER, DR. ROBERT

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SATCHER, SENIOR, WAS MY DEAN IN

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00:03:26,040 --> 00:03:26,960
UNDERGRADUATE SCHOOL AND

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DR. DAVID SATCHER WAS MY

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PRESIDENT WHEN I ATTENDED

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00:03:30,920 --> 00:03:31,400
MEDICAL COLLEGE.

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00:03:31,400 --> 00:03:33,240
BOTH OF THESE IN NASHVILLE,

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00:03:33,240 --> 00:03:33,880
TENNESSEE.

107
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SO AS DR. SATCHER TOLD ME

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RECENTLY, I HAD BEEN FULLY

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00:03:45,200 --> 00:03:45,480
SATCHERIZED.

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00:03:45,480 --> 00:03:47,200
HE HAS AN EXTENSIVE TRACK RECORD

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00:03:47,200 --> 00:03:48,200
OF LEADERSHIP, RESEARCH AND

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00:03:48,200 --> 00:03:49,720
COMMUNITY ENGAGEMENT.

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00:03:49,720 --> 00:03:52,600
HE IS A PHI BETA KAPPA GRADUATE

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00:03:52,600 --> 00:03:53,600
OF MOREHOUSE COLLEGE AND HOLDS

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00:03:53,600 --> 00:03:58,440
AN M.D. AND PH.D. DEGREES FROM

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00:03:58,440 --> 00:04:00,440
CASE WESTERN UNIVERSITY WHERE HE

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00:04:00,440 --> 00:04:01,840
WAS ALSO ELECTED TO THE HONOR

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00:04:01,840 --> 00:04:02,840
SOCIETY.

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00:04:02,840 --> 00:04:04,560
DR. SATCHER SERVED AS THE 16TH

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00:04:04,560 --> 00:04:05,840
SURGEON GENERAL OF THE UNITED

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00:04:05,840 --> 00:04:10,160
STATES FROM 1998 TO 2002, AND

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00:04:10,160 --> 00:04:11,240
THE TENTH ASSISTANT SECRETARY

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00:04:11,240 --> 00:04:13,560
FOR HEALTH IN THE DEPARTMENT OF

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00:04:13,560 --> 00:04:15,520
HEALTH AND HUMAN SERVICES FROM

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00:04:15,520 --> 00:04:16,400
1998 TO 2001.

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00:04:16,400 --> 00:04:19,040
HE ALSO SERVED AS DIRECTOR OF

127
00:04:19,040 --> 00:04:20,080
THE CENTERS FOR DISEASE CONTROL

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00:04:20,080 --> 00:04:21,680
AND PREVENTION, AND

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00:04:21,680 --> 00:04:22,920
ADMINISTRATOR OF THE AGENT SILL

130
00:04:22,920 --> 00:04:27,600
FOAGENCY FORTOXIC SUBSTANCES AND
DISEASE

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00:04:27,600 --> 00:04:28,240
REGISTRY.

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00:04:28,240 --> 00:04:31,200
HE HE'S ALSO HELD TOP LEADERSHIP

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00:04:31,200 --> 00:04:32,680
POSITIONS AT THE DREW UNIVERSITY

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00:04:32,680 --> 00:04:36,000
OF MEDICINE AND SCIENCE AND THE

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00:04:36,000 --> 00:04:36,600
MORE HOUSE SCHOOL OF MEDICINE.

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00:04:36,600 --> 00:04:38,560
HE HAS RECEIVED OVER 50

137
00:04:38,560 --> 00:04:39,240
HONORARY DEGREES AND HAS

138
00:04:39,240 --> 00:04:41,200
RECEIVED NUMEROUS AWARDS FROM

139
00:04:41,200 --> 00:04:42,080
DIVERSE ORGANIZATIONS AND

140
00:04:42,080 --> 00:04:42,800
AGENCIES.

141
00:04:42,800 --> 00:04:44,880
CURRENTLY DR. SATCHER IS THE

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00:04:44,880 --> 00:04:46,640
FOUNDING DIRECTOR OF A SENIOR --

143
00:04:46,640 --> 00:04:49,000
AND SENIOR ADVISOR FOR THE

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00:04:49,000 --> 00:04:50,520
SATCHER HEALTH LEADERSHIP

145
00:04:50,520 --> 00:04:52,520
INSTITUTE AT THE MOREHOUSE

146
00:04:52,520 --> 00:04:53,640
SCHOOL OF MEDICINE IN ATLANTA,

147
00:04:53,640 --> 00:04:53,920
GEORGIA.

148
00:04:53,920 --> 00:04:55,440
NOW I'D LIKE TO PRESENT TO YOU

149
00:04:55,440 --> 00:04:55,760
DR. DAVID SATCHER.

150
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>> GOOD MORNING.

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00:04:58,080 --> 00:05:00,840
I'M DAVID SATCHER, FORMER U.S.

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00:05:00,840 --> 00:05:03,400
SURGEON GENERAL AND FORMER

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00:05:03,400 --> 00:05:04,440
DIRECTOR OF THE CDC.

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00:05:04,440 --> 00:05:06,040
I'M DELIGHTED TO BE ABLE TO JOIN

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00:05:06,040 --> 00:05:09,040
YOU TODAY AND I'M ALSO VERY

156
00:05:09,040 --> 00:05:11,440
PLEASED THAT YOU HAVE DECIDED TO

157
00:05:11,440 --> 00:05:14,440
TAKE ON THIS VERY IMPORTANT AND

158
00:05:14,440 --> 00:05:16,400
SOMETIMES DIFFICULT TOPIC.

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00:05:16,400 --> 00:05:19,120
AND I JUST HOPE THAT WE CAN ADD

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00:05:19,120 --> 00:05:21,400
SOMETHING TO OUR DISCUSSION THAT

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00:05:21,400 --> 00:05:23,400
WILL BE WORTHWHILE FOR YOU

162
00:05:23,400 --> 00:05:23,960
TODAY.

163
00:05:23,960 --> 00:05:26,720
BUT WE CERTAINLY APPRECIATE YOUR

164
00:05:26,720 --> 00:05:31,040
GIVING US THE OPPORTUNITY TO

165
00:05:31,040 --> 00:05:31,560
PARTICIPATE.

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00:05:31,560 --> 00:05:33,600
SO I'M GOING TO GO THROUGH A

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SERIES OF SLIDES WITH BRIEF

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00:05:39,200 --> 00:05:41,400
DISCUSSIONS, BECAUSE AS YOU

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00:05:41,400 --> 00:05:42,480
KNOW, WE ONLY HAVE ABOUT 30

170
00:05:42,480 --> 00:05:47,040
MINUTES.

171
00:05:47,040 --> 00:05:49,040
IT'S TRUE, THE SATCHER

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00:05:49,040 --> 00:05:50,760
LEADERSHIP INSTITUTE HAS A

173
00:05:50,760 --> 00:05:52,760
SAYING, AND IT IS, TODAY THE

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00:05:52,760 --> 00:05:54,040
NEED FOR LEADERS IS TOO GREAT TO

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00:05:54,040 --> 00:05:57,960
LEAVE THEIR EMERGENCE TO CHANCE

176
00:05:57,960 --> 00:05:58,960
ALONE.

177
00:05:58,960 --> 00:06:00,400
THE SATCHER LEADERSHIP INSTITUTE

178
00:06:00,400 --> 00:06:01,680
WAS ACTUALLY BUILT AROUND THIS

179
00:06:01,680 --> 00:06:03,440
CONCEPT THAT WE NEED TO BE

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PROACTIVE IN HELPING PEOPLE TO

181
00:06:05,280 --> 00:06:10,280
DEVELOP THEIR LEADERSHIP SKILLS.

182
00:06:10,280 --> 00:06:14,320
SO THE NEXT SLIDE BEGINS TO MOVE

183
00:06:14,320 --> 00:06:19,160
FORWARD IN TERMS OF THIS

184
00:06:19,160 --> 00:06:25,560
DISCUSSION OF BRAIN ATTACK

185
00:06:25,560 --> 00:06:25,840
COALITIONS.

186
00:06:25,840 --> 00:06:27,240
THE FIRST QUESTION THAT WE DEAL

187
00:06:27,240 --> 00:06:30,000
WITH IS, WHAT IS HEALTH EQUITY?

188
00:06:30,000 --> 00:06:31,760
BECAUSE I KNOW THAT THAT'S AT

189
00:06:31,760 --> 00:06:33,440
THE CENTER OF YOUR CONCERN AND

190
00:06:33,440 --> 00:06:35,960
YOUR DISCUSSION.

191
00:06:35,960 --> 00:06:38,320
NOW HEALTH EQUITY HAS BEEN

192
00:06:38,320 --> 00:06:40,240
DEFINED BY DIFFERENT GROUPS AT

193
00:06:40,240 --> 00:06:42,760
DIFFERENT TIMES.

194
00:06:42,760 --> 00:06:44,520
AND HEALTHY PEOPLE 2010, WHICH

195
00:06:44,520 --> 00:06:47,160
AS YOU KNOW, EVERY 10 YEARS, WE

196
00:06:47,160 --> 00:06:48,600
DEVELOP A PLAN FOR THE NEXT 10

197
00:06:48,600 --> 00:06:50,840
YEARS.

198
00:06:50,840 --> 00:06:53,840
SO IN HEALTHY PEOPLE 2010, WE

199
00:06:53,840 --> 00:06:54,880
DEFINE HEALTH EQUITY AS THE

200
00:06:54,880 --> 00:06:56,520
ATTAINMENT OF THE HIGHEST LEVEL

201
00:06:56,520 --> 00:07:01,880
OF HEALTH FOR ALL PEOPLE.

202
00:07:01,880 --> 00:07:02,480
THE WORLD HEALTH ORGANIZATION

203
00:07:02,480 --> 00:07:06,680
HAS DEFINED HEALTH EQUITY AS THE

204
00:07:06,680 --> 00:07:09,080
ABSENCE OF AFFORDABLE OR

205
00:07:09,080 --> 00:07:10,840
REMEDIABLE DIFFERENCES AMONG

206
00:07:10,840 --> 00:07:14,120
GROUPS OF PEOPLE, WHETHER THESE

207
00:07:14,120 --> 00:07:20,000
GROUPS ARE DEFINED SOCIALLY,

208
00:07:20,000 --> 00:07:21,400
ECONOMICALLY, DEMOGRAPHICALLY OR

209
00:07:21,400 --> 00:07:25,960
GEOGRAPHICALLY.

210
00:07:25,960 --> 00:07:28,720
THE CDC HAS ALSO DEFINED HEALTH

211
00:07:28,720 --> 00:07:28,960
EQUITY.

212
00:07:28,960 --> 00:07:31,760
THAT DEFINITION IS A LITTLE

213
00:07:31,760 --> 00:07:34,280
DIFFERENT FROM WHO.

214
00:07:34,280 --> 00:07:35,720
CDC SAYS WHEN EVERYONE HAS THE

215
00:07:35,720 --> 00:07:39,720
OPPORTUNITY TO ATTAIN THEIR FULL

216
00:07:39,720 --> 00:07:41,280
HEALTH POTENTIAL, AND NO ONE IS

217
00:07:41,280 --> 00:07:43,720
DISADVANTAGED FROM ACHIEVING

218
00:07:43,720 --> 00:07:46,360
THIS POTENTIAL BECAUSE OF THEIR

219
00:07:46,360 --> 00:07:48,160
SOCIAL POSITION OR OTHER

220
00:07:48,160 --> 00:07:50,520
SOCIALLY DETERMINED

221
00:07:50,520 --> 00:07:51,360
CIRCUMSTANCES.

222
00:07:51,360 --> 00:07:52,600
THAT IS HEALTH EQUITY.

223
00:07:52,600 --> 00:07:55,160
SO AS YOU CAN SEE, THE WHOLE

224
00:07:55,160 --> 00:07:56,600
ISSUE OF HEALTH HAS BROUGHT US

225
00:07:56,600 --> 00:07:59,160
TO THE POINT OF TRYING TO FIGURE

226
00:07:59,160 --> 00:08:02,000
OUT HOW WE CAN DO AWAY WITH SOME

227
00:08:02,000 --> 00:08:03,920
OF THE DIFFERENCES THAT

228
00:08:03,920 --> 00:08:06,880
INTERFERE WITH HEALTHCARE,

229
00:08:06,880 --> 00:08:08,000
INCLUDING DIAGNOSIS AND

230
00:08:08,000 --> 00:08:16,600
TREATMENT OF THE BRAIN.

231
00:08:16,600 --> 00:08:18,120
THE NEXT SLIDE GOES A LITTLE

232
00:08:18,120 --> 00:08:19,880
FURTHER IN TERMS OF TRYING TO

233
00:08:19,880 --> 00:08:20,880
ILLUSTRATE THE DIFFERENCE

234
00:08:20,880 --> 00:08:24,080
BETWEEN EQUALITY AND HEALTH

235
00:08:24,080 --> 00:08:24,600
EQUITY.

236
00:08:24,600 --> 00:08:26,760
SOME PEOPLE THINK THAT HEALTH

237
00:08:26,760 --> 00:08:28,520
EQUITY IS JUST ANOTHER WORD FOR

238
00:08:28,520 --> 00:08:35,000
EQUALITY, BUT IT'S NOT.

239
00:08:35,000 --> 00:08:36,200
EVEN THOUGH THIS IS NOT A

240
00:08:36,200 --> 00:08:37,840
PERFECT SLIDE, I HOPE IT HELPS

241
00:08:37,840 --> 00:08:40,960
TO SEE WHAT IS A CLEAR

242
00:08:40,960 --> 00:08:47,840
DIFFERENCE BETWEEN EQUALITY AND

243
00:08:47,840 --> 00:08:48,200
EQUITY.

244
00:08:48,200 --> 00:08:52,320
AS YOU CAN SEE, WHEN IT COMES TO

245
00:08:52,320 --> 00:08:54,960
EQUALITY, THE MEN ON THIS SLIDE

246
00:08:54,960 --> 00:08:58,760
HAVE DIFFERENT OPPORTUNITIES,

247
00:08:58,760 --> 00:09:02,840
THEY HAVE DIFFERENT HEIGHTS, AND

248
00:09:02,840 --> 00:09:06,080
HOWEVER, THEY'RE STANDING ON THE

249
00:09:06,080 --> 00:09:07,480
SAME HEIGHT SUPPORT.

250
00:09:07,480 --> 00:09:09,960
IN OTHER WORDS, THE BOXES ARE

251
00:09:09,960 --> 00:09:11,600
EQUAL IN HEIGHT.

252
00:09:11,600 --> 00:09:13,480
AND, THEREFORE, THERE IS

253
00:09:13,480 --> 00:09:14,960
EQUALITY.

254
00:09:14,960 --> 00:09:18,560
THERE'S NOT EQUITY, BECAUSE,

255
00:09:18,560 --> 00:09:19,840
BECAUSE OF THEIR DIFFERENT

256
00:09:19,840 --> 00:09:21,680
HEIGHTS, THEY NEED DIFFERENT

257
00:09:21,680 --> 00:09:29,680
HEIGHTS OF BOXES TO STAND UPON.

258
00:09:29,680 --> 00:09:30,760
AND THAT'S WHAT EQUITY DOES.

259
00:09:30,760 --> 00:09:32,000
IT GIVES THEM WHAT THEY NEED

260
00:09:32,000 --> 00:09:32,880
WHEN THEY NEED IT IN ORDER TO

261
00:09:32,880 --> 00:09:35,560
GET THE JOB DONE.

262
00:09:35,560 --> 00:09:36,560
THAT'S HEALTH EQUITY.

263
00:09:36,560 --> 00:09:38,480
WHAT DO YOU NEED TO DO WHAT

264
00:09:38,480 --> 00:09:40,480
NEEDS TO BE DONE.

265
00:09:40,480 --> 00:09:43,840
IF YOU HAVE THAT, THEN WE'VE

266
00:09:43,840 --> 00:09:45,920
DEFINED THAT AS EQUITY.

267
00:09:45,920 --> 00:09:47,800
WHATEVER IT TAKES TO DO WHAT YOU

268
00:09:47,800 --> 00:09:50,920
NEED TO GET DONE.

269
00:09:50,920 --> 00:09:53,360
THAT'S EQUITY.

270
00:09:53,360 --> 00:09:55,760
SO THAT'S OUR ATTEMPT TO DEFINE

271
00:09:55,760 --> 00:09:57,080
EQUALITY VERSUS EQUITY.

272
00:09:57,080 --> 00:09:58,920
AND I DON'T MEAN TO IMPLY THAT I

273
00:09:58,920 --> 00:10:00,760
THINK THAT'S EASY.

274
00:10:00,760 --> 00:10:05,720
NEXT SLIDE.

275
00:10:05,720 --> 00:10:07,640
WHAT ARE HEALTH DISPARITIES?

276
00:10:07,640 --> 00:10:11,760
AS SURGEON GENERAL, I HAD THE

277
00:10:11,760 --> 00:10:13,560
OPPORTUNITY TO RELEASE THE FIRST

278
00:10:13,560 --> 00:10:15,080
EVER SURGEON GENERAL'S REPORT ON

279
00:10:15,080 --> 00:10:18,800
HEALTH DISPARITIES, AND IT WAS

280
00:10:18,800 --> 00:10:24,360
REALLY A MAJOR GOAL OF HEALTHY

281
00:10:24,360 --> 00:10:28,760
PEOPLE 2010, AND IT GOE THE GOAL
WAS TO

282
00:10:28,760 --> 00:10:30,160
ELIMINATE DISPARITIES IN HEALTH.

283
00:10:30,160 --> 00:10:31,360
I REMEMBER AS IF IT WERE

284
00:10:31,360 --> 00:10:33,000
YESTERDAY, WHEN WE RELEASED

285
00:10:33,000 --> 00:10:36,560
HEALTHY PEOPLE 2010, AS USUAL, I

286
00:10:36,560 --> 00:10:38,040
HAD GOTTEN UP TO WALK THAT

287
00:10:38,040 --> 00:10:41,960
MORNING ON THE CAMPUS OF NIH,

288
00:10:41,960 --> 00:10:44,960
AND THERE WAS SNOW ON THE

289
00:10:44,960 --> 00:10:46,240
GROUND.

290
00:10:46,240 --> 00:10:47,760
AN UNUSUAL AMOUNT OF SNOW FOR

291
00:10:47,760 --> 00:10:51,560
WASHINGTON, D.C. AREA.

292
00:10:51,560 --> 00:10:52,800
6 INCHES OF SNOW.

293
00:10:52,800 --> 00:10:55,320
AND THERE WERE 2,000 PEOPLE IN

294
00:10:55,320 --> 00:10:57,320
HOTELS IN WASHINGTON, WAITING

295
00:10:57,320 --> 00:10:59,560
FOR THE SURGEON GENERAL'S

296
00:10:59,560 --> 00:11:02,080
RELEASE OF HEALTHY PEOPLE 2010.

297
00:11:02,080 --> 00:11:03,400
SO THAT'S THE BACKGROUND FOR

298
00:11:03,400 --> 00:11:06,360
THIS.

299
00:11:06,360 --> 00:11:09,160
HEALTHY PEOPLE 2010 CAME OUT IN

300
00:11:09,160 --> 00:11:10,520
THE YEAR 2000, WHEN I WAS

301
00:11:10,520 --> 00:11:14,560
SURGEON GENERAL.

302
00:11:14,560 --> 00:11:18,480
HEALTHY PEOPLE 2020 CAME OUT IN

303
00:11:18,480 --> 00:11:24,800
2010.

304
00:11:24,800 --> 00:11:27,560
SO WHAT IS HEALTHY PEOPLE 2020?

305
00:11:27,560 --> 00:11:30,040
SO A PARTICULAR TYPE OF HEALTH

306
00:11:30,040 --> 00:11:31,080
DIFFERENCE THAT IS CLOSELY

307
00:11:31,080 --> 00:11:37,160
LINKED WITH SOCIAL, ECONOMIC,

308
00:11:37,160 --> 00:11:37,960
AND/OR ENVIRONMENTAL

309
00:11:37,960 --> 00:11:39,480
DISADVANTAGES.

310
00:11:39,480 --> 00:11:41,080
SO EVEN THOUGH IT WAS VERY

311
00:11:41,080 --> 00:11:42,560
DIFFICULT, WE MANAGE TO COME

312
00:11:42,560 --> 00:11:44,360
TOGETHER EVERY 10 YEARS AND

313
00:11:44,360 --> 00:11:45,760
AGREE ON WHAT OUR GOALS SHOULD

314
00:11:45,760 --> 00:11:48,960
BE FOR THE NEXT 10 YEARS WHEN IT

315
00:11:48,960 --> 00:11:50,160
COMES TO THE HEALTH OF THE

316
00:11:50,160 --> 00:11:51,560
PEOPLE OF THIS COUNTRY.

317
00:11:51,560 --> 00:11:54,360
AND TO A CERTAIN EXTENT, PEOPLE

318
00:11:54,360 --> 00:12:01,560
IN OTHER PARTS OF THE WORLD.

319
00:12:01,560 --> 00:12:04,760
SO HEALTH DISPARITIES WAS

320
00:12:04,760 --> 00:12:08,880
DEFINED IN HEALTHY PEOPLE 2010,

321
00:12:08,880 --> 00:12:12,960
2020, AND NIH HAS DEFINED IT AS

322
00:12:12,960 --> 00:12:14,960
DIFFERENCES IN THE INCIDENCE,

323
00:12:14,960 --> 00:12:16,360
PREVALENCE, MORTALITY, AND

324
00:12:16,360 --> 00:12:19,040
BURDEN OF DISEASE, AND OTHER

325
00:12:19,040 --> 00:12:21,360
ADVERSE HEALTH CONDITIONS THAT

326
00:12:21,360 --> 00:12:24,320
EXIST AMONG SPECIFIC POPULATION

327
00:12:24,320 --> 00:12:26,840
GROUPS.

328
00:12:26,840 --> 00:12:27,880
THAT'S NIH.

329
00:12:27,880 --> 00:12:31,760
THE CDC DEFINES HEALTH

330
00:12:31,760 --> 00:12:33,320
DISPARITIES AS PREVENTABLE

331
00:12:33,320 --> 00:12:37,040
DIFFERENCES IN THE BURDEN OF

332
00:12:37,040 --> 00:12:38,160
DISEASE, IN THE BURDEN OF INJURY

333
00:12:38,160 --> 00:12:40,960
AND VIOLENCE OR OPPORTUNITIES TO

334
00:12:40,960 --> 00:12:42,800
ACHIEVE OPTIMAL HEALTH THAT ARE

335
00:12:42,800 --> 00:12:45,360
EXPERIENCED BY SOCIALLY

336
00:12:45,360 --> 00:12:51,400
DISADVANTAGED POPULATIONS.

337
00:12:51,400 --> 00:12:54,120
SO THAT'S PART OF WHERE HEALTH

338
00:12:54,120 --> 00:12:54,880
DISPARITIES ORIGINATE.

339
00:12:54,880 --> 00:12:59,320
THEY ORIGINATE IN THE FACT THAT

340
00:12:59,320 --> 00:13:01,480
PEOPLE HAVE DIFFERENT HISTORIES,

341
00:13:01,480 --> 00:13:02,880
DIFFERENT BACKGROUNDS, DIFFERENT

342
00:13:02,880 --> 00:13:05,720
TALENTS, AND, THEREFORE, THEY

343
00:13:05,720 --> 00:13:07,560
START OFF SOMETIMES WITH

344
00:13:07,560 --> 00:13:08,920
DISADVANTAGES THAT HAVE TO BE

345
00:13:08,920 --> 00:13:12,360
OVERCOME.

346
00:13:12,360 --> 00:13:13,440
THE NEXT SLIDE GOES A LITTLE

347
00:13:13,440 --> 00:13:15,560
FURTHER.

348
00:13:15,560 --> 00:13:17,760
AND ASKS THE QUESTION, WHAT ARE

349
00:13:17,760 --> 00:13:20,040
THE SOCIAL DETERMINANTS OF

350
00:13:20,040 --> 00:13:21,160
HEALTH?

351
00:13:21,160 --> 00:13:23,320
NOW I HAVE TO TELL YOU A LITTLE

352
00:13:23,320 --> 00:13:24,760
BIT ABOUT MY OWN PERSONAL

353
00:13:24,760 --> 00:13:30,840
BACKGROUND WITH THIS.

354
00:13:30,840 --> 00:13:35,000
WHEN I BECAME SURGEON GENERAL, I

355
00:13:35,000 --> 00:13:36,320
HAD REPRESENTED THE UNITED

356
00:13:36,320 --> 00:13:40,960
STATES AS A DELEGATE TO THE

357
00:13:40,960 --> 00:13:44,040
WORLD HEALTH ORGANIZATION FOR

358
00:13:44,040 --> 00:13:49,560
ALMOST EIGHT YEARS.

359
00:13:49,560 --> 00:13:52,080
SO IT WAS REALLY AN OPPORTUNITY

360
00:13:52,080 --> 00:13:56,160
FOR ME TO CONTINUE TO PURSUE

361
00:13:56,160 --> 00:13:56,680
THIS WORK.

362
00:13:56,680 --> 00:13:58,640
AND SO THE WHOLE ISSUE OF SOCIAL

363
00:13:58,640 --> 00:14:01,560
DETERMINANTS OF HEALTH CAME

364
00:14:01,560 --> 00:14:03,560
ABOUT AT EXACTLY THE TIME THAT I

365
00:14:03,560 --> 00:14:08,880
WAS MAKING THE TRANSITION IN

366
00:14:08,880 --> 00:14:11,800
GOVERNMENT.

367
00:14:11,800 --> 00:14:13,160
WE DEFINED SOCIAL DETERMINANTS

368
00:14:13,160 --> 00:14:14,600
OF HEALTH AS THE CONDITIONS IN

369
00:14:14,600 --> 00:14:17,440
WHICH PEOPLE ARE BORN, GROW,

370
00:14:17,440 --> 00:14:19,960
LIVE, WORK, AND AGE.

371
00:14:19,960 --> 00:14:21,720
CONDITIONS.

372
00:14:21,720 --> 00:14:25,640
THAT DETERMINES OUR SOCIAL

373
00:14:25,640 --> 00:14:29,040
SITUATION, BUT ALSO OUR SOCIAL

374
00:14:29,040 --> 00:14:33,840
SITUATION IMPACTS OUR HEALTH.

375
00:14:33,840 --> 00:14:37,880
AND SO THAT'S PART OF THE REAL

376
00:14:37,880 --> 00:14:40,560
ISSUE HERE, IS THAT PEOPLE

377
00:14:40,560 --> 00:14:44,800
STRUGGLE WITH THEIR HEALTH, THAT

378
00:14:44,800 --> 00:14:46,440
STRUGGLE IS IMPACTED BY HOW MUCH

379
00:14:46,440 --> 00:14:48,040
MONEY THEY HAVE, HOW MUCH

380
00:14:48,040 --> 00:14:52,000
EDUCATION THEY HAVE, WHERE THEY

381
00:14:52,000 --> 00:14:56,760
WERE BORN, WHO THEY KNOW, AND SO

382
00:14:56,760 --> 00:14:58,160
SOCIAL DETERMINANTS OF HEALTH

383
00:14:58,160 --> 00:15:00,120
ARE MAJOR FACTORS WHEN IT COMES

384
00:15:00,120 --> 00:15:02,240
TO TRYING TO IMPROVE THE HEALTH

385
00:15:02,240 --> 00:15:07,280
OF ALL PEOPLE AND TRYING TO

386
00:15:07,280 --> 00:15:08,480
ACHIEVE EQUITY WHEN IT COMES TO

387
00:15:08,480 --> 00:15:14,560
HEALTH AND HEALTHCARE.

388
00:15:14,560 --> 00:15:16,520
THE CONDITIONS IN WHICH PEOPLE

389
00:15:16,520 --> 00:15:19,160
ARE BORN, GROW, LIVE, WORK AND

390
00:15:19,160 --> 00:15:22,160
AGE ARE THE SOCIAL DETERMINANTS

391
00:15:22,160 --> 00:15:22,880
OF HEALTH.

392
00:15:22,880 --> 00:15:23,920
THEY'RE SHAPED BY THE

393
00:15:23,920 --> 00:15:25,880
DISTRIBUTION OF MONEY, POWER,

394
00:15:25,880 --> 00:15:27,760
AND RESOURCES AT THE GLOBAL,

395
00:15:27,760 --> 00:15:29,520
NATIONAL, AND AT THE LOCAL

396
00:15:29,520 --> 00:15:29,720
LEVEL.

397
00:15:29,720 --> 00:15:30,560
CHANGES IN THE SOCIAL

398
00:15:30,560 --> 00:15:32,840
DETERMINANTS OF HEALTH OFTEN

399
00:15:32,840 --> 00:15:37,960
REQUIRE THAT WE CHANGE POLICIES.

400
00:15:37,960 --> 00:15:39,080
I MEAN, THAT'S -- YOU KNOW, A

401
00:15:39,080 --> 00:15:41,160
LOT OF WHAT CONGRESS DOES

402
00:15:41,160 --> 00:15:43,600
RELATIVE TO HEALTH IS

403
00:15:43,600 --> 00:15:44,720
RE-EXAMINING POLICIES.

404
00:15:44,720 --> 00:15:47,080
AND I'LL SPEAK A LITTLE BIT

405
00:15:47,080 --> 00:15:51,760
LATER ABOUT OBAMACARE AND HOW

406
00:15:51,760 --> 00:15:54,040
THAT REPRESENTED AN ATTEMPT TO

407
00:15:54,040 --> 00:15:58,640
GET IN PLACE POLICIES THAT

408
00:15:58,640 --> 00:16:05,080
REALLY SUPPORTED HEALTH EQUITY.

409
00:16:05,080 --> 00:16:06,200
SOCIAL DETERMINANTS OF HEALTH

410
00:16:06,200 --> 00:16:09,160
ARE SHAPED BY HOW WE DISTRIBUTE

411
00:16:09,160 --> 00:16:13,200
MONEY, POWER, AND RESOURCES AT

412
00:16:13,200 --> 00:16:16,520
THE GLOBAL, NATIONAL AND LOCAL

413
00:16:16,520 --> 00:16:16,760
LEVELS.

414
00:16:16,760 --> 00:16:17,560
AND CHANGES IN THE SOCIAL

415
00:16:17,560 --> 00:16:20,000
DETERMINANTS OF HEALTH OFTEN

416
00:16:20,000 --> 00:16:21,920
REQUIRE POLICY CHANGES.

417
00:16:21,920 --> 00:16:24,240
SO A LOT OF WORK GOES ON IN

418
00:16:24,240 --> 00:16:30,200
CONGRESS AS IT RELATES TO

419
00:16:30,200 --> 00:16:32,160
HEALTH, REPRESENT ATTEMPTS TO

420
00:16:32,160 --> 00:16:35,040
MAKE POLICY CONSISTENT WITH OUR

421
00:16:35,040 --> 00:16:37,280
GOALS AS A NATION.

422
00:16:37,280 --> 00:16:38,760
SOMETIMES THOSE POLICIES HAVE TO

423
00:16:38,760 --> 00:16:42,440
BE DRAMATICALLY CHANGED WHEN WE

424
00:16:42,440 --> 00:16:43,760
REALIZE THAT THEY'RE NOT

425
00:16:43,760 --> 00:16:45,960
CONSISTENT WITH EQUITY IN

426
00:16:45,960 --> 00:16:46,520
HEALTHCARE.

427
00:16:46,520 --> 00:16:47,720
WE SAY WE ALL AGREE THAT WE

428
00:16:47,720 --> 00:16:53,080
SHOULD HAVE EQUITY IN HEALTH AND

429
00:16:53,080 --> 00:16:53,600
HEALTHCARE.

430
00:16:53,600 --> 00:16:54,720
THEN IF WE FIND THAT WE HAVE

431
00:16:54,720 --> 00:16:56,160
POLICIES THAT ARE NOT CONSISTENT

432
00:16:56,160 --> 00:16:58,160
WITH THAT, THEN WE HAVE TO BE

433
00:16:58,160 --> 00:16:59,360
WILLING TO RE-EXAMINE THEM AND,

434
00:16:59,360 --> 00:17:01,000
IN FACT, IN MANY CASES, TO

435
00:17:01,000 --> 00:17:03,080
CHANGE THEM.

436
00:17:03,080 --> 00:17:06,560
AND AS WE SAID BEFORE, THE

437
00:17:06,560 --> 00:17:09,480
SOCIAL DETERMINANTS OF HEALTH

438
00:17:09,480 --> 00:17:11,080
ARE THE CONDITIONS IN WHICH

439
00:17:11,080 --> 00:17:12,360
PEOPLE ARE BORN, GROW, LIVE,

440
00:17:12,360 --> 00:17:16,000
WORK AND AGE.

441
00:17:16,000 --> 00:17:18,160
SO THAT'S HOW MUCH MONEY DO YOU

442
00:17:18,160 --> 00:17:20,080
HAVE, HOW MUCH MONEY DO YOU

443
00:17:20,080 --> 00:17:21,400
BRING TO THE TABLE WHEN IT COMES

444
00:17:21,400 --> 00:17:22,840
TO GETTING QUALITY HEALTHCARE.

445
00:17:22,840 --> 00:17:25,680
HOW MUCH SHOULD YOU BE REQUIRED?

446
00:17:25,680 --> 00:17:27,760
THAT'S AN ONGOING DEBATE IN THIS

447
00:17:27,760 --> 00:17:28,280
COUNTRY.

448
00:17:28,280 --> 00:17:30,240
WHEN WE ALLOW MONEY TO BE A

449
00:17:30,240 --> 00:17:32,000
BARRIER TO GOOD HEALTH AND GOOD

450
00:17:32,000 --> 00:17:35,400
HEALTHCARE.

451
00:17:35,400 --> 00:17:36,560
BUT THAT'S THE FACT OF THE

452
00:17:36,560 --> 00:17:38,440
MATTER THAT IT IS.

453
00:17:38,440 --> 00:17:45,760
THE NEXT SLIDE BRINGS US CLOSER

454
00:17:45,760 --> 00:17:47,440
TO YOUR TOPIC.

455
00:17:47,440 --> 00:17:52,320
AND THAT IS, THE BRAIN.

456
00:17:52,320 --> 00:17:57,160
THE BRAIN IS, WITHOUT QUESTION,

457
00:17:57,160 --> 00:17:59,600
THE MOST IMPORTANT ORGAN IN THE

458
00:17:59,600 --> 00:18:03,560
BODY IN MANY WAYS.

459
00:18:03,560 --> 00:18:05,360
AND WE DEFINE WORK OF THE BRAIN

460
00:18:05,360 --> 00:18:08,640
AS MENTAL HEALTH.

461
00:18:08,640 --> 00:18:10,160
SO WHAT IS MENTAL HEALTH?

462
00:18:10,160 --> 00:18:13,560
MENTAL HEALTH IS THE SUCCESSFUL

463
00:18:13,560 --> 00:18:14,440
PERFORMANCE OF MENTAL FUNCTION,

464
00:18:14,440 --> 00:18:19,640
RESULTING IN PRODUCTIVE

465
00:18:19,640 --> 00:18:20,320
ACTIVITY.

466
00:18:20,320 --> 00:18:22,440
S.

467
00:18:22,440 --> 00:18:23,360
FULFILLING RELATIONSHIPS WITH

468
00:18:23,360 --> 00:18:26,280
OTHERS, AND THE ABILITY TO ADAPT

469
00:18:26,280 --> 00:18:27,960
TO CHANGE AND SUCCESSFULLY COPE

470
00:18:27,960 --> 00:18:29,960
WITH ADVERSITY.

471
00:18:29,960 --> 00:18:33,720
THAT'S MENTAL HEALTH.

472
00:18:33,720 --> 00:18:36,440
MENTAL HEALTH IS A STRUGGLE.

473
00:18:36,440 --> 00:18:38,760
THERE ARE OBVIOUSLY -- NOT

474
00:18:38,760 --> 00:18:41,000
EVERYBODY IS MENTALLY HEALTHY.

475
00:18:41,000 --> 00:18:42,560
OBVIOUSLY NOT ALL OF OUR

476
00:18:42,560 --> 00:18:44,840
ENDEAVORS SUPPORT MENTAL HEALTH.

477
00:18:44,840 --> 00:18:48,320
AND SO IT'S AN ONGOING STRUGGLE

478
00:18:48,320 --> 00:18:50,320
TO ACHIEVE MENTAL HEALTH OF

479
00:18:50,320 --> 00:18:53,360
INDIVIDUALS, FAMILIES AND

480
00:18:53,360 --> 00:18:53,640
COMMUNITIES.

481
00:18:53,640 --> 00:18:57,840
THE NEXT SLIDE TAKES THAT A

482
00:18:57,840 --> 00:19:02,360
LITTLE FURTHER, AND THERE WERE

483
00:19:02,360 --> 00:19:05,800
THREE MAJOR REPORTS THAT I

484
00:19:05,800 --> 00:19:06,800
RELEASED AS SURGEON GENERAL

485
00:19:06,800 --> 00:19:08,160
DEALING WITH MENTAL HEALTH.

486
00:19:08,160 --> 00:19:10,600
AND THE FIRST REPORT WAS THE

487
00:19:10,600 --> 00:19:14,360
REPORT ON MENTAL HEALTH:  A

488
00:19:14,360 --> 00:19:15,440
REPORT OF THE SURGEON GENERAL,

489
00:19:15,440 --> 00:19:16,920
WHICH WAS RELEASED IN DECEMBER

490
00:19:16,920 --> 00:19:20,920
OF 1999.

491
00:19:20,920 --> 00:19:22,480
AND THAT WAS IMPORTANT BECAUSE

492
00:19:22,480 --> 00:19:29,280
THEY HAD NEVETHERE ARE NEVER
BEFORE BEEN A

493
00:19:29,280 --> 00:19:29,960
SURGEON GENERAL'S REPORT ON

494
00:19:29,960 --> 00:19:30,480
MENTAL HEALTH.

495
00:19:30,480 --> 00:19:31,240
SO THIS WAS A FIRST.

496
00:19:31,240 --> 00:19:33,400
IT CAME OUT IN DECEMBER OF 1999.

497
00:19:33,400 --> 00:19:35,160
NOW THAT WASN'T THE END.

498
00:19:35,160 --> 00:19:37,160
THAT WAS SORT OF THE BEGINNING.

499
00:19:37,160 --> 00:19:39,320
THERE WAS SO MUCH INTEREST IN

500
00:19:39,320 --> 00:19:42,560
THE REPORT ON MENTAL HEALTH

501
00:19:42,560 --> 00:19:44,160
UNTIL WE HAD TO PRODUCE

502
00:19:44,160 --> 00:19:47,160
SUPPLEMENTS, WE HAD TO DO ONE ON

503
00:19:47,160 --> 00:19:47,720
CHILDREN'S MENTAL HEALTH.

504
00:19:47,720 --> 00:19:49,560
CHILDREN HAVE SPECIAL NEEDS, I'M

505
00:19:49,560 --> 00:19:52,120
SURE YOU KNOW THAT.

506
00:19:52,120 --> 00:19:55,240
AND WE ALSO FOUND, OF COURSE,

507
00:19:55,240 --> 00:19:57,480
THAT MENTAL HEALTH IS CLOSELY

508
00:19:57,480 --> 00:19:59,640
RELATED TO YOUR CULTURAL

509
00:19:59,640 --> 00:20:00,960
BACKGROUND, TO YOUR RACE,

510
00:20:00,960 --> 00:20:04,200
ETHNICITY.

511
00:20:04,200 --> 00:20:06,720
AND THERE IS SUCH A THING AS

512
00:20:06,720 --> 00:20:08,000
MENTAL RETARDATION THAT WE HAVE

513
00:20:08,000 --> 00:20:10,160
TO DEAL WITH IN DEALING WITH

514
00:20:10,160 --> 00:20:12,280
CHILDREN ESPECIALLY.

515
00:20:12,280 --> 00:20:15,720
SO THE SURGEON GENERAL'S MENTAL

516
00:20:15,720 --> 00:20:16,560
HEALTH REPORT WAS SORT OF THE

517
00:20:16,560 --> 00:20:20,080
BEGINNING OF A MUCH MORE CLOSELY

518
00:20:20,080 --> 00:20:23,840
WATCHED FOCUS ON MENTAL HEALTH.

519
00:20:23,840 --> 00:20:31,360
AND WE CONTINUED, NEXT SLIDE, WE

520
00:20:31,360 --> 00:20:32,880
TRIED TO PULL TOGETHER THESE

521
00:20:32,880 --> 00:20:38,280
MAJOR FACTORS IN A MATRIX.

522
00:20:38,280 --> 00:20:42,200
AND IN THIS MATRIX, WE INCLUDED,

523
00:20:42,200 --> 00:20:45,320
IN TRYING TO DEFINE MENTAL

524
00:20:45,320 --> 00:20:47,160
HEALTH AS PRODUCTIVE ACTIVITIES.

525
00:20:47,160 --> 00:20:50,000
IN OTHER WORDS, HOW DO YOU

526
00:20:50,000 --> 00:20:51,320
FUNCTION IF YOU'RE MENTALLY

527
00:20:51,320 --> 00:20:53,400
HEALTHY?

528
00:20:53,400 --> 00:20:56,560
TO WHAT EXTENT ARE YOU ABLE TO

529
00:20:56,560 --> 00:20:58,760
ADAPT TO CHANGE?

530
00:20:58,760 --> 00:21:01,040
CAN YOU SUCCESSFULLY COPE WITH

531
00:21:01,040 --> 00:21:02,800
ADVERSITY?

532
00:21:02,800 --> 00:21:06,360
CAN YOU DEVELOP AND MAINTAIN

533
00:21:06,360 --> 00:21:07,360
FULFILLING RELATIONSHIPS WITH

534
00:21:07,360 --> 00:21:10,160
OTHER PEOPLE?

535
00:21:10,160 --> 00:21:12,480
THAT'S WHEN MENTAL HEALTH IS

536
00:21:12,480 --> 00:21:13,560
FUNCTIONING FOR YOU AND FOR

537
00:21:13,560 --> 00:21:16,760
THOSE AROUND YOU.

538
00:21:16,760 --> 00:21:20,680
AND AS YOU KNOW, IT'S NOT ALWAYS

539
00:21:20,680 --> 00:21:21,960
FUNCTIONING WELL, FOR FAMILIES

540
00:21:21,960 --> 00:21:25,800
SOMETIMES, FOR COUPLES, FOR

541
00:21:25,800 --> 00:21:27,960
TEAMS.

542
00:21:27,960 --> 00:21:29,200
MENTAL HEALTH IS CRITICAL, BUT

543
00:21:29,200 --> 00:21:30,320
IT DOESN'T ALWAYS FUNCTION THE

544
00:21:30,320 --> 00:21:34,520
WAY IT NEEDS TO FUNCTION.

545
00:21:34,520 --> 00:21:35,880
SO MENTAL HEALTH FUNCTION IS AN

546
00:21:35,880 --> 00:21:39,760
ONGOING CHALLENGE.

547
00:21:39,760 --> 00:21:41,760
AND AS WE TRIED TO POINT OUT IN

548
00:21:41,760 --> 00:21:44,960
THIS MATRIX, WE LOOK AT THE

549
00:21:44,960 --> 00:21:48,120
ACTIVITIES THAT TAKE PLACE, WE

550
00:21:48,120 --> 00:21:50,800
LOOK AT ONE'S ABILITY TO ADAPT

551
00:21:50,800 --> 00:21:54,120
TO CHANGES IN THE ENVIRONMENT.

552
00:21:54,120 --> 00:21:55,640
AND THERE ARE A LOT OF THINGS

553
00:21:55,640 --> 00:21:59,400
THAT CAN IMPACT OUR ABILITY TO

554
00:21:59,400 --> 00:22:06,440
ADAPT TO OUR ENVIRONMENT.

555
00:22:06,440 --> 00:22:08,160
OUR ABILITY TO COPE WITH

556
00:22:08,160 --> 00:22:11,000
ADVERSITY.

557
00:22:11,000 --> 00:22:13,080
WE SURE HAVE OUR SHARE OF

558
00:22:13,080 --> 00:22:13,960
ADVERSITY TO COPE WITH.

559
00:22:13,960 --> 00:22:15,320
OUR ABILITY TO DEVELOP AND

560
00:22:15,320 --> 00:22:16,480
MAINTAIN FULFILLING

561
00:22:16,480 --> 00:22:17,440
RELATIONSHIPS WITH OTHER PEOPLE.

562
00:22:17,440 --> 00:22:19,560
THOSE ARE ALL THINGS THAT AFFECT

563
00:22:19,560 --> 00:22:22,960
OUR MENTAL HEALTH.

564
00:22:22,960 --> 00:22:23,920
THE NEXT SLIDE GOES A LITTLE

565
00:22:23,920 --> 00:22:26,160
FURTHER WITH THIS DISCUSSION,

566
00:22:26,160 --> 00:22:30,560
EVEN THOUGH WE COULD GO MUCH

567
00:22:30,560 --> 00:22:33,360
FURTHER.

568
00:22:33,360 --> 00:22:35,120
WE ASKED THE QUESTION, WHAT IS

569
00:22:35,120 --> 00:22:38,040
THE ROLE OF PRIMARY CARE AS IT

570
00:22:38,040 --> 00:22:39,480
RELATES TO MENTAL ILLNESS?

571
00:22:39,480 --> 00:22:41,480
AND LET ME JUST SAY AT THE

572
00:22:41,480 --> 00:22:44,960
OUTSET, THIS IS A MAJOR CONCERN.

573
00:22:44,960 --> 00:22:47,400
BECAUSE THIS IS ONE OF THE MOST

574
00:22:47,400 --> 00:22:49,320
UNDERSERVED AREAS OF HEALTHCARE

575
00:22:49,320 --> 00:22:52,960
THAT WE DEAL WITH EVERY DAY.

576
00:22:52,960 --> 00:22:55,880
THE FACT THAT WHEN IT COMES TO

577
00:22:55,880 --> 00:22:59,760
MENTAL HEALTH, AND THE ROLE OF

578
00:22:59,760 --> 00:23:01,360
PRIMARY CARE, IT TENDS TO BE

579
00:23:01,360 --> 00:23:03,840
OFTEN IGNORED.

580
00:23:03,840 --> 00:23:11,960
AND IGNORED BECAUSE, NUMBER ONE,

581
00:23:11,960 --> 00:23:13,080
PARENTS DON'T ALWAYS COOPERATE

582
00:23:13,080 --> 00:23:15,120
WHEN IT COMES TO MENTAL HEALTH.

583
00:23:15,120 --> 00:23:16,400
SOME PARENTS ARE EMBARRASSED IF

584
00:23:16,400 --> 00:23:17,680
THEIR CHILDREN HAVE MENTAL

585
00:23:17,680 --> 00:23:18,840
HEALTH NEEDS, AND, THEREFORE,

586
00:23:18,840 --> 00:23:21,920
THEY DON'T GET THE SUPPORT THEY

587
00:23:21,920 --> 00:23:23,680
NEED FROM THE HEALTHCARE SYSTEM.

588
00:23:23,680 --> 00:23:25,280
AND THEN, THERE ARE SOME PEOPLE

589
00:23:25,280 --> 00:23:27,800
IN THE HEALTHCARE SYSTEM WHO

590
00:23:27,800 --> 00:23:29,080
DON'T DO THE JOB THAT WE SHOULD

591
00:23:29,080 --> 00:23:29,920
BE DOING.

592
00:23:29,920 --> 00:23:32,680
WE DON'T ASK THE RIGHT

593
00:23:32,680 --> 00:23:33,720
QUESTIONS, AND WHEN WE DO ASK

594
00:23:33,720 --> 00:23:36,520
THE RIGHT QUESTIONS, WE DON'T

595
00:23:36,520 --> 00:23:37,320
FOLLOW THROUGH.

596
00:23:37,320 --> 00:23:38,280
AND WE CREATE AN ENVIRONMENT IN

597
00:23:38,280 --> 00:23:43,640
WHICH PEOPLE ARE NOT COMFORTABLE

598
00:23:43,640 --> 00:23:44,560
DISCUSSING THEIR MENTAL HEALTH.

599
00:23:44,560 --> 00:23:46,120
THESE ARE ALL THINGS THAT WE

600
00:23:46,120 --> 00:23:48,240
HAVE TO CHANGE IF WE'RE GOING TO

601
00:23:48,240 --> 00:23:50,040
DEAL WITH THE BRAIN AND ITS

602
00:23:50,040 --> 00:23:54,760
NEEDS AND ITS PARTICULAR

603
00:23:54,760 --> 00:23:55,960
FUNCTION.

604
00:23:55,960 --> 00:23:57,680
THAT INVOLVES SCREENING, EARLY

605
00:23:57,680 --> 00:24:00,360
DIAGNOSIS, IT INVOLVES TREATMENT

606
00:24:00,360 --> 00:24:04,920
WHEN APPROPRIATE, REFERRAL WHEN

607
00:24:04,920 --> 00:24:05,880
APPROPRIATE, AND CERTAINLY

608
00:24:05,880 --> 00:24:06,680
FOLLOW-THROUGH.

609
00:24:06,680 --> 00:24:09,600
SO MENTAL ILLNESS IS IMPORTANT

610
00:24:09,600 --> 00:24:12,000
AND PRIMARY CARE HAS A MAJOR

611
00:24:12,000 --> 00:24:18,560
ROLE, AND I'M SURE THAT YOUR

612
00:24:18,560 --> 00:24:19,400
PEDIATRICIAN, INTERNIST,

613
00:24:19,400 --> 00:24:20,760
NEUROLOGIST, WHAT HAVE YOU, WHAT

614
00:24:20,760 --> 00:24:21,920
HAPPENS IN PRIMARY CARE IS

615
00:24:21,920 --> 00:24:25,640
CRITICAL IN TERMS OF HOW WE DEAL

616
00:24:25,640 --> 00:24:27,560
WITH MENTAL ILLNESS AS OF

617
00:24:27,560 --> 00:24:30,440
SOCIETY, BUT ALSO AS FAMILIES

618
00:24:30,440 --> 00:24:31,840
AND ORGANIZATIONS AND WHAT HAVE

619
00:24:31,840 --> 00:24:32,960
YOU.

620
00:24:32,960 --> 00:24:36,800
WE'RE HEARING MORE ABOUT THAT

621
00:24:36,800 --> 00:24:37,960
LATELY.

622
00:24:37,960 --> 00:24:41,840
WE'RE HEARING MORE ABOUT

623
00:24:41,840 --> 00:24:43,520
ATHLETES WHO ARE NOT PERFORMING

624
00:24:43,520 --> 00:24:44,320
WELL, EVEN THOUGH THEY'RE

625
00:24:44,320 --> 00:24:45,360
MEMBERS OF THE TEAM, THEY'RE NOT

626
00:24:45,360 --> 00:24:47,720
ABLE TO PERFORM WELL BECAUSE OF

627
00:24:47,720 --> 00:24:49,160
MENTAL DISORDERS.

628
00:24:49,160 --> 00:24:51,960
BUT IT'S ONLY BEEN VERY RECENT

629
00:24:51,960 --> 00:24:54,840
THAT WE HAVE BEEN WILLING TO

630
00:24:54,840 --> 00:24:56,880
OPENLY DISCUSS THE ROLE THAT

631
00:24:56,880 --> 00:25:03,720
MENTAL HEALTH PLAYS IN TERMS OF

632
00:25:03,720 --> 00:25:04,960
PRIMARY CARE, AND, THEREFORE, IN

633
00:25:04,960 --> 00:25:10,520
TERMS OF HOW WE FUNCTION AS

634
00:25:10,520 --> 00:25:13,480
FAMILIES, AS MEMBERS OF TEAMS,

635
00:25:13,480 --> 00:25:14,040
ET CETERA.

636
00:25:14,040 --> 00:25:15,480
THE NEXT SLIDE TAKES THIS A

637
00:25:15,480 --> 00:25:16,120
LITTLE FURTHER.

638
00:25:16,120 --> 00:25:23,080
IT SAYS THAT MENTAL HEALTH IS

639
00:25:23,080 --> 00:25:25,400
FUNDAMENTAL TO OVERALL HEALTH

640
00:25:25,400 --> 00:25:25,840
AND WELL-BEING.

641
00:25:25,840 --> 00:25:29,760
MENTAL DISORDERS ARE REAL.

642
00:25:29,760 --> 00:25:31,920
YOU CAN'T BE HEALTHY WITHOUT

643
00:25:31,920 --> 00:25:32,360
YOUR MENTAL HEALTH.

644
00:25:32,360 --> 00:25:35,080
LET ME JUST SAY THAT AGAIN.

645
00:25:35,080 --> 00:25:36,960
YOU CAN'T BE HEALTHY WITHOUT

646
00:25:36,960 --> 00:25:40,200
YOUR MENTAL HEALTH.

647
00:25:40,200 --> 00:25:42,000
AND, THEREFORE, THE BRAIN AND

648
00:25:42,000 --> 00:25:46,280
HOW WE DEAL WITH THE BRAIN,

649
00:25:46,280 --> 00:25:47,560
INCLUDING WHEN THERE ARE MAJOR

650
00:25:47,560 --> 00:25:48,960
ISSUES AND PROBLEMS OF THE KIND

651
00:25:48,960 --> 00:25:52,000
YOU'RE GOING TO BE DISCUSSING,

652
00:25:52,000 --> 00:25:54,160
THE ROLE OF THE BRAIN AND HOW WE

653
00:25:54,160 --> 00:25:57,640
DEAL WITH IT IS CRITICAL.

654
00:25:57,640 --> 00:25:59,080
WE CAN MAKE A GREAT

655
00:25:59,080 --> 00:26:00,080
CONTRIBUTION, BUT WE HAVE TO

656
00:26:00,080 --> 00:26:03,520
WORK TOGETHER.

657
00:26:03,520 --> 00:26:07,160
PRIMARY CARE POSITIONS AND

658
00:26:07,160 --> 00:26:08,480
OTHERS HAVE TO WORK TOGETHER

659
00:26:08,480 --> 00:26:09,840
WITH NEUROLOGISTS AND

660
00:26:09,840 --> 00:26:11,440
NEUROSURGEONS AND OTHERS, THAT

661
00:26:11,440 --> 00:26:13,400
WE'RE GOING TO GIVE THE KIND OF

662
00:26:13,400 --> 00:26:16,720
CARE THAT PEOPLE NEED.

663
00:26:16,720 --> 00:26:22,240
THE NEXT SLIDE IS VERY

664
00:26:22,240 --> 00:26:22,560
IMPORTANT.

665
00:26:22,560 --> 00:26:26,920
I'VE SPENT MORE TIME DISCUSSING

666
00:26:26,920 --> 00:26:27,840
THIS SLIDE PROBABLY THAN

667
00:26:27,840 --> 00:26:29,000
ANYTHING ELSE IN THE AREA OF

668
00:26:29,000 --> 00:26:30,480
MENTAL HEALTH.

669
00:26:30,480 --> 00:26:33,800
AND YOU MAY RECOGNIZE THIS

670
00:26:33,800 --> 00:26:37,960
BECAUSE IT CAME OUT OF THE OBAMA

671
00:26:37,960 --> 00:26:38,560
ADMINISTRATION.

672
00:26:38,560 --> 00:26:40,200
AND IT SAYS -- WHAT WE TRIED TO

673
00:26:40,200 --> 00:26:43,040
DO WAS TO PIN DOWN, WHAT WERE

674
00:26:43,040 --> 00:26:44,400
THE THREE WAYS THAT THE

675
00:26:44,400 --> 00:26:45,400
AFFORDABLE CARE ACT, WHICH CAME

676
00:26:45,400 --> 00:26:48,560
OUT OF THE OBAMA ADMINISTRATION,

677
00:26:48,560 --> 00:26:50,840
HOW IS THE AFFORDABLE CARE ACT

678
00:26:50,840 --> 00:26:52,760
INCREASING ACCESS TO MENTAL

679
00:26:52,760 --> 00:26:54,520
HEALTH AND SUBSTANCE USE

680
00:26:54,520 --> 00:26:55,720
DISORDER SERVICES.

681
00:26:55,720 --> 00:26:57,880
AND WE BOILED IT DOWN TO THREE

682
00:26:57,880 --> 00:27:02,680
WAYS.

683
00:27:02,680 --> 00:27:03,960
ONE, THE AFFORDABLE CARE ACT

684
00:27:03,960 --> 00:27:05,360
WILL EXPAND MENTAL HEALTH AND

685
00:27:05,360 --> 00:27:09,320
SUBSTANCE USE DISORDER BENEFITS

686
00:27:09,320 --> 00:27:11,160
AND PARITY.

687
00:27:11,160 --> 00:27:13,480
NOW, A GOOD FRIEND OF MINE,

688
00:27:13,480 --> 00:27:15,960
PATRICK KENNEDY, AND AS SOME OF

689
00:27:15,960 --> 00:27:18,160
YOU KNOW, PATRICK AND HIS FAMILY

690
00:27:18,160 --> 00:27:23,000
HAVE FUNDED THE SATCHER HEALTH

691
00:27:23,000 --> 00:27:26,000
LEADERSHIP INSTITUTE'S PROGRAM,

692
00:27:26,000 --> 00:27:28,760
IN THE AREA OF MENTAL HEALTH.

693
00:27:28,760 --> 00:27:32,040
SO IT'S CALLED THE

694
00:27:32,040 --> 00:27:32,640
KENNEDY-SATCHER MENTAL HEALTH

695
00:27:32,640 --> 00:27:34,960
PROGRAM.

696
00:27:34,960 --> 00:27:37,840
I'M A PERSON WHO FEELS VERY

697
00:27:37,840 --> 00:27:40,360
INDEBTED TO THE KENNEDYS,

698
00:27:40,360 --> 00:27:47,160
ESPECIALLY PATRICK.

699
00:27:47,160 --> 00:27:48,400
BECAUSE IN SO MANY WAYS, I HAVE

700
00:27:48,400 --> 00:27:49,560
SEEN THEM IN ACTION.

701
00:27:49,560 --> 00:27:51,160
WHEN I WAS A STUDENT AT THE

702
00:27:51,160 --> 00:27:53,600
MOREHOUSE COLLEGE, ON ONE

703
00:27:53,600 --> 00:27:57,640
OCCASION BACK IN THAT TIME, WHEN

704
00:27:57,640 --> 00:27:58,920
MANY OF US WERE GOING TO JAIL

705
00:27:58,920 --> 00:28:00,520
BECAUSE WE DISAGREED WITH THE

706
00:28:00,520 --> 00:28:01,880
DISCRIMINATION THAT WAS TAKING

707
00:28:01,880 --> 00:28:04,280
PLACE, I BELIEVE AT ONE TIME,

708
00:28:04,280 --> 00:28:06,280
THERE WERE ONLY ONE OR TWO

709
00:28:06,280 --> 00:28:07,200
RESTAURANTS IN ATLANTA THAT

710
00:28:07,200 --> 00:28:08,400
WOULD SERVE BLACKS.

711
00:28:08,400 --> 00:28:11,160
BUT ANYWAY, WE WERE ARRESTED,

712
00:28:11,160 --> 00:28:13,120
AND I REMEMBER THE ROLE THAT THE

713
00:28:13,120 --> 00:28:15,080
KENNEDY FAMILY PLAYED, BECAUSE

714
00:28:15,080 --> 00:28:22,080
JOHN KENNEDY WAS RUNNING FOR

715
00:28:22,080 --> 00:28:24,160
PRESIDENT, AND DR. KING WAS

716
00:28:24,160 --> 00:28:26,840
ARRESTED, MRS. KING WAS VERY

717
00:28:26,840 --> 00:28:30,600
CONCERNED, AND SO SHE CALLED THE

718
00:28:30,600 --> 00:28:32,560
KENNEDY CAMPAIGN AND ASKED THEM

719
00:28:32,560 --> 00:28:34,160
FOR HELP, BECAUSE SHE WAS

720
00:28:34,160 --> 00:28:34,840
WORRIED ABOUT WHAT WAS GOING TO

721
00:28:34,840 --> 00:28:38,280
HAPPEN TO HER HUSBAND IN JAIL

722
00:28:38,280 --> 00:28:39,920
AND IN PRISON.

723
00:28:39,920 --> 00:28:43,120
AND THERE WERE SIX OF US,

724
00:28:43,120 --> 00:28:45,480
MOREHOUSE AND OTHER PEOPLE WHO

725
00:28:45,480 --> 00:28:47,840
WERE ALSO IN JAIL, BUT ANYWAY,

726
00:28:47,840 --> 00:28:49,480
BECAUSE OF THE WORK OF THE

727
00:28:49,480 --> 00:28:52,200
KENNEDY CAMPAIGN, WE WERE ALL

728
00:28:52,200 --> 00:28:52,640
RELEASED.

729
00:28:52,640 --> 00:28:55,040
AND THAT'S JUST ONE EXAMPLE OF

730
00:28:55,040 --> 00:28:57,640
THE COURAGE THAT THE KENNEDY

731
00:28:57,640 --> 00:29:00,560
FAMILY SHOWED IN HELPING TO MAKE

732
00:29:00,560 --> 00:29:08,160
SURE THAT WE GOT JUSTICE.

733
00:29:08,160 --> 00:29:13,680
WELL, MOST HEALTH PLANS BU PLAN
SERVICES

734
00:29:13,680 --> 00:29:16,760
MUST NOWP COVER SERVICES LIKE

735
00:29:16,760 --> 00:29:18,520
DEPRESSION SCREENING FOR ADULTS

736
00:29:18,520 --> 00:29:19,600
AND BEHAVIORAL ASSESSMENTS FOR

737
00:29:19,600 --> 00:29:20,600
CHILDREN AT NO COST.

738
00:29:20,600 --> 00:29:21,680
YOU MIGHT WANT TO THINK ABOUT

739
00:29:21,680 --> 00:29:23,400
THAT, BECAUSE I KNOW YOU'RE

740
00:29:23,400 --> 00:29:25,160
CONCERNED ABOUT BEING ABLE TO

741
00:29:25,160 --> 00:29:27,880
RESPOND TO THE NEEDS OF THE

742
00:29:27,880 --> 00:29:31,960
BRAIN IN CHILDREN AND IN ADULTS,

743
00:29:31,960 --> 00:29:36,440
BUT THERE ARE PREVENTIVE

744
00:29:36,440 --> 00:29:38,000
SERVICES LIKE DEPRESSION

745
00:29:38,000 --> 00:29:39,640
SCREENING FOR ADULTS, BEHAVIORAL

746
00:29:39,640 --> 00:29:41,760
ASSESSMENTS FOR CHILDREN, AT NO

747
00:29:41,760 --> 00:29:41,960
COST.

748
00:29:41,960 --> 00:29:45,040
THAT CAME OUT OF THE AFFORDABLE

749
00:29:45,040 --> 00:29:47,280
CARE ACT.

750
00:29:47,280 --> 00:29:48,760
THOSE THINGS WERE TO BE

751
00:29:48,760 --> 00:29:51,760
GUARANTEED.

752
00:29:51,760 --> 00:29:55,760
SCREENING, DIAGNOSING

753
00:29:55,760 --> 00:29:56,040
DEPRESSION.

754
00:29:56,040 --> 00:29:58,240
NOW DEPRESSION IS ONE OF THE

755
00:29:58,240 --> 00:30:00,120
MAJOR PROBLEMS THAT WE SEE IN

756
00:30:00,120 --> 00:30:03,800
MENTAL HEALTH.

757
00:30:03,800 --> 00:30:05,360
PEOPLE, WHEN THEY ARE DEPRESSED,

758
00:30:05,360 --> 00:30:08,840
ARE NOT ABLE TO FUNCTION

759
00:30:08,840 --> 00:30:12,200
OPTIMALLY, AND, THEREFORE, IT'S

760
00:30:12,200 --> 00:30:13,440
OF GREAT CONCERN.

761
00:30:13,440 --> 00:30:17,240
STARTING IN 2014, IT WAS STATED,

762
00:30:17,240 --> 00:30:18,640
BECAUSE OF THE WORK AGAIN OF

763
00:30:18,640 --> 00:30:21,960
PATRICK KENNEDY PRIMARILY,

764
00:30:21,960 --> 00:30:24,560
STARTING IN 2014, THE PLANS

765
00:30:24,560 --> 00:30:26,240
WOULD NOT BE ABLE TO DENY

766
00:30:26,240 --> 00:30:28,160
COVERAGE OR CHARGE MORE DUE TO

767
00:30:28,160 --> 00:30:30,360
PRE-EXISTING HEALTH CONDITIONS,

768
00:30:30,360 --> 00:30:32,960
INCLUDING MENTAL ILLNESS.

769
00:30:32,960 --> 00:30:36,200
SO THIS AFFORDABLE CARE ACT WAS

770
00:30:36,200 --> 00:30:36,960
VERY IMPORTANT AND IS SOMETHING

771
00:30:36,960 --> 00:30:38,320
WE NEED TO CONTINUE TO KEEP OUR

772
00:30:38,320 --> 00:30:39,640
EYES ON.

773
00:30:39,640 --> 00:30:44,920
NEXT SLIDE.

774
00:30:44,920 --> 00:30:46,960
WELL, I DON'T WANT YOU TO THINK

775
00:30:46,960 --> 00:30:48,960
ALL OF THE NEWS IS BAD.

776
00:30:48,960 --> 00:30:50,760
THERE'S GOOD NEWS BECAUSE MANY

777
00:30:50,760 --> 00:30:55,160
OF THESE THINGS HAVE BEEN

778
00:30:55,160 --> 00:30:56,360
IMPLEMENTED, WE FOLLOWED

779
00:30:56,360 --> 00:30:56,760
THROUGH.

780
00:30:56,760 --> 00:30:58,080
RESEARCH HAS IMPROVED OUR

781
00:30:58,080 --> 00:30:59,560
ABILITY TO RECOGNIZE, DIAGNOSE

782
00:30:59,560 --> 00:31:03,480
AND TREAT CONDITIONS

783
00:31:03,480 --> 00:31:04,600
EFFECTIVELY.

784
00:31:04,600 --> 00:31:05,960
80 TO 90% OF MENTAL DISORDERS

785
00:31:05,960 --> 00:31:08,200
ARE TREATABLE, USING MEDICATION

786
00:31:08,200 --> 00:31:09,760
AND OTHER THERAPIES.

787
00:31:09,760 --> 00:31:15,160
SO WE'RE MAKING PROGRESS.

788
00:31:15,160 --> 00:31:16,480
THE NEXT SLIDE, AND I'M COMING

789
00:31:16,480 --> 00:31:19,360
TO THE END SLIDES, THE BAD NEWS,

790
00:31:19,360 --> 00:31:21,760
OF COURSE, IS THAT OF THOSE WITH

791
00:31:21,760 --> 00:31:24,960
A DIAGNOSABLE MENTAL DISORDER,

792
00:31:24,960 --> 00:31:26,600
FEWER THAN HALF OF ADULTS

793
00:31:26,600 --> 00:31:28,000
ACTUALLY GET THE HELP THEY NEED,

794
00:31:28,000 --> 00:31:29,520
AND ONLY ONE-THIRD OF CHILDREN

795
00:31:29,520 --> 00:31:31,400
GET THE HELP THEY NEED WHEN

796
00:31:31,400 --> 00:31:33,280
DEALING WITH THE MENTAL

797
00:31:33,280 --> 00:31:33,880
DISORDER.

798
00:31:33,880 --> 00:31:36,120
SO KEEP THAT IN MIND AS YOU

799
00:31:36,120 --> 00:31:41,160
TACKLE THE CHALLENGES OF THE

800
00:31:41,160 --> 00:31:41,640
BRAIN.

801
00:31:41,640 --> 00:31:42,760
THERE'S A TREMENDOUS NEED OUT

802
00:31:42,760 --> 00:31:44,640
THERE, AND IT'S NOT BEING MET

803
00:31:44,640 --> 00:31:54,800
FOR MANY REASONS.

804
00:31:54,800 --> 00:31:56,120
IF YOU SAY ONLY ONE-THIRD OF

805
00:31:56,120 --> 00:31:57,160
CHILDREN ARE GETTING THE HELP

806
00:31:57,160 --> 00:31:58,960
THEY NEED, THEN THAT TELLS YOU A

807
00:31:58,960 --> 00:31:59,920
LOT ABOUT THE FACT THAT THERE

808
00:31:59,920 --> 00:32:01,240
ARE A LOT OF CHILDREN OUT THERE

809
00:32:01,240 --> 00:32:02,560
WHO NEED HELP AND ARE NOT

810
00:32:02,560 --> 00:32:07,800
GETTING IT.

811
00:32:07,800 --> 00:32:10,400
INDIVIDUALS SUFFER WITH STIGMA.

812
00:32:10,400 --> 00:32:11,840
PART OF THE REAL PROBLEM IN

813
00:32:11,840 --> 00:32:13,360
MENTAL HEALTH IS THERE'S SO MUCH

814
00:32:13,360 --> 00:32:14,360
STIGMA THAT A LOT OF PARENTS

815
00:32:14,360 --> 00:32:17,200
DON'T EVEN WANT TO TAKE THEIR

816
00:32:17,200 --> 00:32:18,960
CHILDREN TO THE DOCTOR AND ADMIT

817
00:32:18,960 --> 00:32:22,240
THAT THEIR CHILDREN HAVE MENTAL

818
00:32:22,240 --> 00:32:23,640
HEALTH PROBLEMS.

819
00:32:23,640 --> 00:32:26,040
AND OF COURSE, AGAIN, IN

820
00:32:26,040 --> 00:32:26,680
PROFESSIONAL SPORTS, WE'RE JUST

821
00:32:26,680 --> 00:32:30,440
BEGINNING TO SEE PEOPLE COME OUT

822
00:32:30,440 --> 00:32:31,520
AND ADMIT THEY NEED HELP IN THIS

823
00:32:31,520 --> 00:32:31,760
AREA.

824
00:32:31,760 --> 00:32:32,960
SO YOU CAN IMAGINE THE MILLIONS

825
00:32:32,960 --> 00:32:35,360
OF DOLLARS THAT HAVE BEEN WASTED

826
00:32:35,360 --> 00:32:36,840
BECAUSE WE HAVE NOT STOPPED TO

827
00:32:36,840 --> 00:32:37,960
DEAL WITH MENTAL HEALTH

828
00:32:37,960 --> 00:32:41,120
PROBLEMS.

829
00:32:41,120 --> 00:32:43,400
INDIVIDUALS WITH MENTAL HEALTH

830
00:32:43,400 --> 00:32:45,800
PROBLEMS AND EXPERIENCING

831
00:32:45,800 --> 00:32:48,280
PROBLEMS PREVENTS THEM FROM

832
00:32:48,280 --> 00:32:49,280
ACKNOWLEDGING THE PROBLEM, KEEPS

833
00:32:49,280 --> 00:32:51,160
THEM FROM RECOMMENDING HELP OR

834
00:32:51,160 --> 00:32:52,040
ACKNOWLEDGING PROBLEMS FOR

835
00:32:52,040 --> 00:32:56,040
FAMILY AND FRIENDS, AND IN THE

836
00:32:56,040 --> 00:32:58,600
POLICY ARENA, WE NEED MORE

837
00:32:58,600 --> 00:33:00,760
PEOPLE ON THE FRONT LINE, LIKE

838
00:33:00,760 --> 00:33:02,160
PATRICK KENNEDY WAS WHEN HE WAS

839
00:33:02,160 --> 00:33:03,840
THERE, TO KEEP GOVERNMENT AND

840
00:33:03,840 --> 00:33:06,440
PRIVATE SECTOR FROM ADDRESSING

841
00:33:06,440 --> 00:33:07,040
PROBLEMS.

842
00:33:07,040 --> 00:33:07,800
I APPRECIATE THE FACT THAT

843
00:33:07,800 --> 00:33:10,160
YOU'RE TAKING THE TIME TO BEGIN

844
00:33:10,160 --> 00:33:12,560
TO EXAMINE THIS PROBLEM MORE

845
00:33:12,560 --> 00:33:13,640
DEEPLY, AND LOOK FORWARD TO

846
00:33:13,640 --> 00:33:19,960
WORKING WITH YOU.

847
00:33:19,960 --> 00:33:22,160
NEXT SLIDE, PLEASE.

848
00:33:22,160 --> 00:33:24,440
CULTURE IS AN ISSUE HERE.

849
00:33:24,440 --> 00:33:30,520
MAKE NO MISTAKE ABOUT IT.

850
00:33:30,520 --> 00:33:33,160
WITH PATIENTS, CULTURE IMPACTS

851
00:33:33,160 --> 00:33:34,800
HOW THEY MANIFEST AND DESCRIBE

852
00:33:34,800 --> 00:33:36,160
ILLNESSES, HOW THEY COPE WITH

853
00:33:36,160 --> 00:33:37,160
ILLNESSES, THE TYPES OF STRESSES

854
00:33:37,160 --> 00:33:38,480
THEY EXPERIENCE, AND WHETHER

855
00:33:38,480 --> 00:33:39,200
THEY'RE WILLING TO SEEK

856
00:33:39,200 --> 00:33:39,680
TREATMENT.

857
00:33:39,680 --> 00:33:42,080
THERE ARE A LOT OF PEOPLE

858
00:33:42,080 --> 00:33:45,760
SUFFERING SILENTLY WITH MENTAL

859
00:33:45,760 --> 00:33:46,520
DISORDERS.

860
00:33:46,520 --> 00:33:48,200
SOMETIMES THEIR SILENCE PERSISTS

861
00:33:48,200 --> 00:33:54,480
THROUGH VIOLENCE, IT PERSISTS

862
00:33:54,480 --> 00:33:57,480
THROUGH ILLNESS AND MURDER,

863
00:33:57,480 --> 00:33:58,840
WITHOUT EVER SAYING, I NEED

864
00:33:58,840 --> 00:33:59,760
HELP.

865
00:33:59,760 --> 00:34:03,160
AND SO WE TOGETHER GOING TO HAVE

866
00:34:03,160 --> 00:34:05,480
TO TAKE ON THIS, AND I'M REALLY,

867
00:34:05,480 --> 00:34:08,320
AGAIN, HAPPY THAT YOU ARE TAKING

868
00:34:08,320 --> 00:34:12,960
THE LEADERSHIP YOU'RE TAKING.

869
00:34:12,960 --> 00:34:17,560
WITH HEALTH PROFESSIONALS,

870
00:34:17,560 --> 00:34:18,880
CULTURE IMPACTS THE WAY PATIENTS

871
00:34:18,880 --> 00:34:20,200
ARE DIAGNOSED, THE KIND OF

872
00:34:20,200 --> 00:34:21,400
TREATMENTS OFFERED TO PATIENTS,

873
00:34:21,400 --> 00:34:22,960
AND HOW SERVICES ARE ORGANIZED

874
00:34:22,960 --> 00:34:26,960
AND FINANCED.

875
00:34:26,960 --> 00:34:31,400
MENTAL HEALTH, CULTURE, RACE AND

876
00:34:31,400 --> 00:34:32,720
ETHNICITY.

877
00:34:32,720 --> 00:34:34,480
NEXT SLIDE.

878
00:34:34,480 --> 00:34:36,360
ASK THE QUESTION, WHAT IF WE HAD

879
00:34:36,360 --> 00:34:37,360
ELIMINATED DISPARITIES IN THE

880
00:34:37,360 --> 00:34:37,760
LAST CENTURY?

881
00:34:37,760 --> 00:34:38,720
I DON'T KNOW IF YOU YOU HAVE

882
00:34:38,720 --> 00:34:40,280
EVER ASKED YOURSELF THAT

883
00:34:40,280 --> 00:34:41,480
QUESTION, BUT I WANT TO TAKE A

884
00:34:41,480 --> 00:34:44,760
MINUTE AS WE COME TO A CLOSE.

885
00:34:44,760 --> 00:34:48,240
AND SHOW YOU HOW WE RESPONDED.

886
00:34:48,240 --> 00:34:51,080
GEORGE RUSS, WHO WAS HERE AT

887
00:34:51,080 --> 00:34:51,760
MOREHOUSE AT THE TIME WHEN I

888
00:34:51,760 --> 00:34:55,000
CAME BACK FROM WASHINGTON, AND

889
00:34:55,000 --> 00:34:59,000
WE ASKED THE QUESTION, WHAT DID

890
00:34:59,000 --> 00:35:00,160
WE ELIMINATE?

891
00:35:00,160 --> 00:35:01,720
WHAT WE WERE ABLE TO SHOW IS,

892
00:35:01,720 --> 00:35:04,560
THERE WOULD HAVE BEEN 83,500

893
00:35:04,560 --> 00:35:06,720
FEWER BLACK DEATHS IN THE YEAR

894
00:35:06,720 --> 00:35:08,520
2000 IF WE HAD ELIMINATED

895
00:35:08,520 --> 00:35:12,080
DISPARITIES IN THE LAST CENTURY.

896
00:35:12,080 --> 00:35:14,480
24,000 FEWER HEART DISEASE

897
00:35:14,480 --> 00:35:15,800
CASES.

898
00:35:15,800 --> 00:35:19,960
7,000 FROM HIV/AIDS, FEWER

899
00:35:19,960 --> 00:35:21,480
DEATHS.

900
00:35:21,480 --> 00:35:23,520
ALMOST 5,000 FEWER INFANT

901
00:35:23,520 --> 00:35:25,600
DEATHS.

902
00:35:25,600 --> 00:35:28,080
22,000 FROM DIABETES.

903
00:35:28,080 --> 00:35:31,400
AND OVER 2,000 BLACK WOMEN WHO

904
00:35:31,400 --> 00:35:32,600
DIED FROM BREAST CANCER WOULD

905
00:35:32,600 --> 00:35:35,560
NOT HAVE DIED.

906
00:35:35,560 --> 00:35:36,240
MORE HEALTH INSURANCE COVERAGE

907
00:35:36,240 --> 00:35:39,360
WOULD HAVE BEEN AVAILABLE.

908
00:35:39,360 --> 00:35:42,360
2.5 MILLION BLACKS, INCLUDING

909
00:35:42,360 --> 00:35:44,480
620,000 CHILDREN WOULD HAVE BEEN

910
00:35:44,480 --> 00:35:46,320
COVERED WHO WERE NOT COVERED.

911
00:35:46,320 --> 00:35:48,400
AND PROBABLY ARE NOT COVERED.

912
00:35:48,400 --> 00:35:53,600
NEXT SLIDE.

913
00:35:53,600 --> 00:35:55,040
I WON'T TRY TO GET YOU TO

914
00:35:55,040 --> 00:35:58,880
ANALYZE THIS SLIDE, BUT THIS IS

915
00:35:58,880 --> 00:36:00,360
WHAT WE DID HERE, WAS TO TRY TO

916
00:36:00,360 --> 00:36:03,720
PUT IN GRAPHIC FORM WHAT

917
00:36:03,720 --> 00:36:07,120
HAPPENED FROM 1960 TO 2000, AND

918
00:36:07,120 --> 00:36:12,560
WHAT YOU SEE IS THINGS CHANGE IN

919
00:36:12,560 --> 00:36:18,040
TERMS OF MALE/FEMALE

920
00:36:18,040 --> 00:36:22,200
INTERACTION, MORTALITY RATES FOR

921
00:36:22,200 --> 00:36:25,040
FEMALES WERE GREATER IN 1960

922
00:36:25,040 --> 00:36:28,160
THAN THEY WERE COMPARED TO MALES

923
00:36:28,160 --> 00:36:30,640
THAN THEY WERE IN 1990.

924
00:36:30,640 --> 00:36:33,000
AND SINCE 1980, REALLY, THERE'S

925
00:36:33,000 --> 00:36:37,160
BEEN AN INCREASE, RELATIVELY

926
00:36:37,160 --> 00:36:39,200
SPEAKING, IN MORTALITY AMONG

927
00:36:39,200 --> 00:36:40,200
MALES, ESPECIALLY AFRICAN

928
00:36:40,200 --> 00:36:43,800
AMERICAN MALES.

929
00:36:43,800 --> 00:36:45,120
THERE ARE MANY REASONS WE CAN

930
00:36:45,120 --> 00:36:47,600
POINT TO, TO EXPLAIN THIS

931
00:36:47,600 --> 00:36:49,360
DISPARITY, AND WE'RE ALSO --

932
00:36:49,360 --> 00:36:50,840
WE'VE SEEN SIMILAR DISPARITY IN

933
00:36:50,840 --> 00:36:55,320
TERMS OF RACE CONTINUE.

934
00:36:55,320 --> 00:36:56,760
SO KEEP THAT SLIDE IN MIND AS

935
00:36:56,760 --> 00:37:00,960
YOU GO ABOUT YOUR WORK THAT IS

936
00:37:00,960 --> 00:37:02,160
SO GREATLY NEEDED.

937
00:37:02,160 --> 00:37:05,400
NEXT SLIDE.

938
00:37:05,400 --> 00:37:07,960
WELL, I THINK THAT ENDS THIS

939
00:37:07,960 --> 00:37:10,280
DISCUSSION, AND I DON'T KNOW

940
00:37:10,280 --> 00:37:11,400
WHETHER WE WILL HAVE TIME NOW

941
00:37:11,400 --> 00:37:13,800
FOR QUESTIONS, BUT WHENEVER WE

942
00:37:13,800 --> 00:37:18,560
DO, I LOOK FORWARD TO

943
00:37:18,560 --> 00:37:21,560
INTERACTING WITH YOU AND

944
00:37:21,560 --> 00:37:23,480
DISCUSSING FURTHER THIS ISSUE OF

945
00:37:23,480 --> 00:37:25,680
HOW DO WE OVERCOME THE BARRIERS

946
00:37:25,680 --> 00:37:29,600
THAT PREVENT US FROM ATTACKING

947
00:37:29,600 --> 00:37:31,000
BRAIN PROBLEMS AS OPPOSED TO

948
00:37:31,000 --> 00:37:37,560
HAVING THEM ATTACK US.

949
00:37:37,560 --> 00:37:38,400
THAT'S A VERY IMPORTANT

950
00:37:38,400 --> 00:37:38,760
QUESTION.

951
00:37:38,760 --> 00:37:39,920
I LOOK FORWARD TO BEING ABLE TO

952
00:37:39,920 --> 00:37:40,360
DISCUSS IT WITH YOU.

953
00:37:40,360 --> 00:37:45,120
THANK YOU.

954
00:37:45,120 --> 00:37:47,800
>>

955
00:37:47,800 --> 00:37:50,120
[SPEAKER ON MUTE]

956
00:37:50,120 --> 00:38:01,840
>> RICHARD, YOU'RE MUTED.

957
00:38:01,840 --> 00:38:02,600
>> OKAY, GREAT.

958
00:38:02,600 --> 00:38:05,360
I HAD DIFFICULTY UNMUTING

959
00:38:05,360 --> 00:38:05,600
MYSELF.

960
00:38:05,600 --> 00:38:06,840
THANK YOU, THANK YOU,

961
00:38:06,840 --> 00:38:10,600
DR. SATCHER, FOR THAT EXCELLENT

962
00:38:10,600 --> 00:38:11,160
PRESENTATION.

963
00:38:11,160 --> 00:38:13,880
AGAIN, IT WAS TRULY AN HONOR AND

964
00:38:13,880 --> 00:38:16,080
A PRIVILEGE FOR YOU TO SPEAK TO

965
00:38:16,080 --> 00:38:17,240
US TODAY.

966
00:38:17,240 --> 00:38:19,040
I KNOW WHEN I SPOKE WITH YOU

967
00:38:19,040 --> 00:38:21,960
SEVERAL WEEKS AGO, YOU SAID THAT

968
00:38:21,960 --> 00:38:23,080
YOU -- YOU KNOW, YOU AREN'T

969
00:38:23,080 --> 00:38:25,600
TAKING AS MANY SPEAKING

970
00:38:25,600 --> 00:38:27,560
INVITATIONS, BUT WE'RE SO HAPPY

971
00:38:27,560 --> 00:38:29,400
AND GRATEFUL THAT YOU DID CHOOSE

972
00:38:29,400 --> 00:38:31,400
TO PRESENT TO US TODAY.

973
00:38:31,400 --> 00:38:33,560
I'M GOING TO OPEN THE FLOOR FOR

974
00:38:33,560 --> 00:38:36,120
QUESTIONS, BUT I WANT TO START

975
00:38:36,120 --> 00:38:38,840
US OUT WITH A QUESTION, I HAVE

976
00:38:38,840 --> 00:38:39,480
SEVERAL QUESTIONS BUT I'M GOING

977
00:38:39,480 --> 00:38:41,360
TO START WITH ONE QUESTION AS

978
00:38:41,360 --> 00:38:43,400
OTHERS TYPE IN THE CHAT.

979
00:38:43,400 --> 00:38:47,360
I WAS REALLY STRUCK BY YOUR

980
00:38:47,360 --> 00:38:49,480
HISTORICAL PERSPECTIVE OF WHEN

981
00:38:49,480 --> 00:38:50,840
YOU WERE IN UNDERGRADUATE SCHOOL

982
00:38:50,840 --> 00:38:53,120
AT MOREHOUSE IN ATLANTA AND YOU

983
00:38:53,120 --> 00:38:54,960
TALKED ABOUT, AT THAT TIME,

984
00:38:54,960 --> 00:38:58,680
BEING ARRESTED WITH OTHERS, AND

985
00:38:58,680 --> 00:39:00,840
THE TIME WITH DR. KING.

986
00:39:00,840 --> 00:39:02,640
COULD YOU TALK A LITTLE BIT

987
00:39:02,640 --> 00:39:06,200
ABOUT THE IMPACT OF RACISM AND

988
00:39:06,200 --> 00:39:09,520
HOW THAT IMPACTS HEALTH, AS WELL

989
00:39:09,520 --> 00:39:11,560
AS YOU TALKED ABOUT THE SOCIAL

990
00:39:11,560 --> 00:39:13,680
DETERMINANTS OF HEALTH.

991
00:39:13,680 --> 00:39:15,720
I THINK -- I MENTIONED AT THE

992
00:39:15,720 --> 00:39:18,920
START THE COVID PANDEMIC AND HOW

993
00:39:18,920 --> 00:39:20,120
THAT HAS SHOWN THE DISPARITIES

994
00:39:20,120 --> 00:39:23,480
THAT WE HAVE DUE TO CO-MORBID

995
00:39:23,480 --> 00:39:26,200
CONDITIONS BUT ALSO THE IMPACT

996
00:39:26,200 --> 00:39:29,760
OF RACISM WITH THE MURDER OF

997
00:39:29,760 --> 00:39:31,560
GEORGE FLOYD, BREONNA TAYLOR AND

998
00:39:31,560 --> 00:39:31,920
OTHERS.

999
00:39:31,920 --> 00:39:35,040
SO SORT OF DUELING PANDEMICS AND

1000
00:39:35,040 --> 00:39:35,880
THE IMPACT OF HEALTH.

1001
00:39:35,880 --> 00:39:37,520
IF YOU DON'T MIND COMMENTING ON

1002
00:39:37,520 --> 00:39:38,960
THAT.

1003
00:39:38,960 --> 00:39:41,360
>> WELL, AS YOU KNOW, RICHARD,

1004
00:39:41,360 --> 00:39:43,320
IT WAS A LONG TIME AGO WHEN I

1005
00:39:43,320 --> 00:39:46,560
WAS A STUDENT.

1006
00:39:46,560 --> 00:39:47,560
AT MOREHOUSE COLLEGE.

1007
00:39:47,560 --> 00:39:49,720
BUT I REMEMBER THAT TIME PERIOD

1008
00:39:49,720 --> 00:39:52,440
VERY WELL BECAUSE IT SORT OF

1009
00:39:52,440 --> 00:39:54,960
HELPED TO SHAPE US INTO WHO WE

1010
00:39:54,960 --> 00:39:55,120
ARE.

1011
00:39:55,120 --> 00:39:57,840
IT WASN'T ALWAYS PLEASANT.

1012
00:39:57,840 --> 00:39:59,560
BUT THE STUDENTS DURING THAT

1013
00:39:59,560 --> 00:40:01,520
PERIOD OF TIME, YOU MIGHT SAY,

1014
00:40:01,520 --> 00:40:02,960
ROSE UP AND DECIDED THAT WE'RE

1015
00:40:02,960 --> 00:40:04,080
JUST NOT GOING TO TAKE IT

1016
00:40:04,080 --> 00:40:05,560
ANYMORE.

1017
00:40:05,560 --> 00:40:07,560
AND WE ORGANIZED -- THERE WERE

1018
00:40:07,560 --> 00:40:12,120
STUDENTS FROM MOREHOUSE, SPELL

1019
00:40:12,120 --> 00:40:14,400
SPELLMAN, BROWN, CLARKE, AND WE

1020
00:40:14,400 --> 00:40:17,160
ORGANIZED AND WE WOULD GO

1021
00:40:17,160 --> 00:40:19,960
DOWNTOWN AND WE WOULD GO IN

1022
00:40:19,960 --> 00:40:21,120
RESTAURANTS TO BE SERVED,

1023
00:40:21,120 --> 00:40:22,320
KNOWING THAT WE WOULD BE

1024
00:40:22,320 --> 00:40:23,560
ARRESTED AS OPPOSED TO BEING

1025
00:40:23,560 --> 00:40:25,080
SERVED.

1026
00:40:25,080 --> 00:40:27,800
THAT WENT ON FOR AT LEAST TWO

1027
00:40:27,800 --> 00:40:29,760
YEARS.

1028
00:40:29,760 --> 00:40:31,840
AND DR. KING, OF COURSE, AT THE

1029
00:40:31,840 --> 00:40:41,000
TIME WAS CO-PASTORING EBONEZER

1030
00:40:41,000 --> 00:40:41,560
WITH HIS FATHER.

1031
00:40:41,560 --> 00:40:42,600
HE BECAME INVOLVED WITH THE

1032
00:40:42,600 --> 00:40:42,920
STUDENTS.

1033
00:40:42,920 --> 00:40:44,280
HE WAS QUITE A MOTIVATIONAL

1034
00:40:44,280 --> 00:40:45,760
LEADER WITH US.

1035
00:40:45,760 --> 00:40:47,640
SO WAS A.D. KING, HIS BROTHER.

1036
00:40:47,640 --> 00:40:51,400
IN FACT, A.D. WAS ONE OF THE SIX

1037
00:40:51,400 --> 00:40:53,040
STUDENTS, SIX OF US WHO WERE

1038
00:40:53,040 --> 00:40:56,640
PLAYING LEADERSHIP ROLES HAD

1039
00:40:56,640 --> 00:40:59,560
SAID THAT WE'RE GOING TO ASK THE

1040
00:40:59,560 --> 00:41:03,160
STUDENTS TO FILL THE JAILS IN

1041
00:41:03,160 --> 00:41:05,840
ATLANTA, SO THAT THERE WOULD BE

1042
00:41:05,840 --> 00:41:07,320
NO MORE PLACE FOR STUDENTS TO BE

1043
00:41:07,320 --> 00:41:09,640
SENT TO JAIL.

1044
00:41:09,640 --> 00:41:10,640
WE SUCCEEDED.

1045
00:41:10,640 --> 00:41:13,080
THE STUDENTS REALLY TURNED OUT.

1046
00:41:13,080 --> 00:41:16,160
THEN THERE WERE SIX OF US

1047
00:41:16,160 --> 00:41:19,760
LEADERS WHO WERE LEFT, AND THEY

1048
00:41:19,760 --> 00:41:20,880
HAD NO MORE SPACE IN THE JAIL

1049
00:41:20,880 --> 00:41:22,560
FOR US, SO THEY SENT US TO

1050
00:41:22,560 --> 00:41:23,600
PRISON.

1051
00:41:23,600 --> 00:41:25,440
SO IT'S THE ONE TIME IN MY LIFE

1052
00:41:25,440 --> 00:41:27,960
THAT I'VE BEEN TO PRISON AND THE

1053
00:41:27,960 --> 00:41:30,480
ONLY TIME I WOULD WANT TO BE.

1054
00:41:30,480 --> 00:41:32,240
BUT IT WAS -- WE LEARNED A LOT

1055
00:41:32,240 --> 00:41:34,280
ABOUT WHAT GOES ON IN PRISON,

1056
00:41:34,280 --> 00:41:38,240
AND WE WERE IN PRISON WHEN

1057
00:41:38,240 --> 00:41:41,840
DR. KING, YOU KNOW -- MRS. KING

1058
00:41:41,840 --> 00:41:43,480
CALLED THE KENNEDY CAMPAIGN TO

1059
00:41:43,480 --> 00:41:46,200
ASK THEM TO HELP IN GETTING

1060
00:41:46,200 --> 00:41:48,720
DR. KING OUT OF JAIL, AND HER

1061
00:41:48,720 --> 00:41:52,160
CONCERN WAS, IF YOU REMEMBER,

1062
00:41:52,160 --> 00:41:53,320
THAT DR. KING AND OTHERS HAD

1063
00:41:53,320 --> 00:41:57,440
BEEN SO MISTREATED IN JAILS, AND

1064
00:41:57,440 --> 00:41:58,800
THEY WERE TALKING ABOUT TAKING

1065
00:41:58,800 --> 00:42:00,960
DR. KING OUT OF ATLANTA AND

1066
00:42:00,960 --> 00:42:02,800
SENDING HIM TO ATHENS OR

1067
00:42:02,800 --> 00:42:03,200
SAVANNAH.

1068
00:42:03,200 --> 00:42:05,480
THAT WAS OF GREAT CONCERN TO

1069
00:42:05,480 --> 00:42:08,920
MRS. KING.

1070
00:42:08,920 --> 00:42:10,560
AND IT WAS OUT OF THAT CALL THAT

1071
00:42:10,560 --> 00:42:15,800
WE ENDED UP INTERACTING WITH

1072
00:42:15,800 --> 00:42:18,600
PRESIDENT KENNEDY, AND OTHERS IN

1073
00:42:18,600 --> 00:42:22,640
THE KENNEDY FAMILY, E ESPECIALLY

1074
00:42:22,640 --> 00:42:23,840
BOBBY KENNEDY, WHO REALLY MADE

1075
00:42:23,840 --> 00:42:25,960
THE CALL TO THE MAYOR OF ATLANTA

1076
00:42:25,960 --> 00:42:29,640
SO ASTO ASK THAT DR. KING BE

1077
00:42:29,640 --> 00:42:30,840
RELEASED.

1078
00:42:30,840 --> 00:42:33,600
>> THANK YOU, DR. SATCHER.

1079
00:42:33,600 --> 00:42:36,760
THERE ARE SEVERAL QUESTIONS IN

1080
00:42:36,760 --> 00:42:41,280
THE CHAT THAT RELATE TO STROKE

1081
00:42:41,280 --> 00:42:42,440
DISPARITIES, ONE, IN NATIVE

1082
00:42:42,440 --> 00:42:42,760
POPULATIONS.

1083
00:42:42,760 --> 00:42:43,960
I THINK WE'LL TALK ABOUT THAT

1084
00:42:43,960 --> 00:42:44,880
MORE OVER THE COURSE OF THE DAY.

1085
00:42:44,880 --> 00:42:48,440
WE HAVE PANELS OF EXPERTS THAT

1086
00:42:48,440 --> 00:42:49,560
HAVE BEEN STUDYING THOSE TYPES

1087
00:42:49,560 --> 00:42:50,560
OF DISPARITIES.

1088
00:42:50,560 --> 00:42:52,320
BUT ONE OF THE QUESTIONS I WANT

1089
00:42:52,320 --> 00:42:55,240
TO ASK YOU ABOUT, IT'S RELATED

1090
00:42:55,240 --> 00:42:56,720
TO THE IMPACT OF MENTAL HEALTH.

1091
00:42:56,720 --> 00:42:59,360
THE QUESTION IS RELATED TO

1092
00:42:59,360 --> 00:43:00,800
MENTAL HEALTH DISORDERS AND ITS

1093
00:43:00,800 --> 00:43:04,760
IMPACT ON STROKE.

1094
00:43:04,760 --> 00:43:08,320
IN GENERAL, JUST THE IMPACT OF

1095
00:43:08,320 --> 00:43:10,160
MENTAL HEALTH AND DISEASE IN

1096
00:43:10,160 --> 00:43:10,560
GENERAL.

1097
00:43:10,560 --> 00:43:14,080
I KNOW THAT THAT IMPACTS

1098
00:43:14,080 --> 00:43:15,560
COMPLIANCE WITH MEDICAL REGIMES.

1099
00:43:15,560 --> 00:43:17,680
IT ALSO PROBABLY IMPACTS

1100
00:43:17,680 --> 00:43:19,000
SOCIOECONOMIC STATUS AND OTHER

1101
00:43:19,000 --> 00:43:20,920
THINGS, BUT JUST WANT TO -- AND

1102
00:43:20,920 --> 00:43:23,640
ITS IMPACT ON BEING ABLE TO SEE

1103
00:43:23,640 --> 00:43:25,360
GOOD MEDICAL PROVIDERS, SO ANY

1104
00:43:25,360 --> 00:43:27,800
COMMENTS ON THAT?

1105
00:43:27,800 --> 00:43:32,040
 QUESTION?

1106
00:43:32,040 --> 00:43:34,520
>> REPEAT THE QUESTION.

1107
00:43:34,520 --> 00:43:37,720
>> THE IMPACT OF MENTAL HEALTH

1108
00:43:37,720 --> 00:43:38,720
DISORDERS ON SPECIFIC DISEASES.

1109
00:43:38,720 --> 00:43:41,120
THE QUESTION WAS ABOUT STROKE,

1110
00:43:41,120 --> 00:43:43,680
BUT I WANT TO EXPAND TO OTHER

1111
00:43:43,680 --> 00:43:45,600
DISEASES AS WELL SO YOU DON'T

1112
00:43:45,600 --> 00:43:48,480
HAVE TO FEEL THAT YOU NEED TO

1113
00:43:48,480 --> 00:43:51,080
RESPOND SPECIFICALLY TO STROKE,

1114
00:43:51,080 --> 00:43:52,360
BUT ANY COMMENTS YOU HAVE.

1115
00:43:52,360 --> 00:43:55,400
>> WELL, STROKE IS SUCH A MAJOR

1116
00:43:55,400 --> 00:44:04,240
PROBLEM, ESPECIALLY IN OUR

1117
00:44:04,240 --> 00:44:04,600
POPULATION.

1118
00:44:04,600 --> 00:44:07,160
BECAUSE OF HYPERTENSION

1119
00:44:07,160 --> 00:44:08,280
ESPECIALLY AMONG AFRICAN

1120
00:44:08,280 --> 00:44:11,280
AMERICANS, AND BECAUSE OF

1121
00:44:11,280 --> 00:44:15,600
DIABETES AMONG NATIV NATIVE
AMERICANS

1122
00:44:15,600 --> 00:44:17,000
AND OTHERS, STROKE IS A VERY

1123
00:44:17,000 --> 00:44:18,640
SERIOUS PROBLEM, AND IT IS

1124
00:44:18,640 --> 00:44:27,960
RELATE THED TORERELATED TO, AS
YOU SORTRER
ELATED TO AS YOU PUT IT

1125
00:44:27,960 --> 00:44:28,920
EARLIER THOSE DISPARITIES IN

1126
00:44:28,920 --> 00:44:32,440
HEALTH LEAD TO DISPARITIES IN

1127
00:44:32,440 --> 00:44:35,280
OUTCOMES SUCH AS STROKE.

1128
00:44:35,280 --> 00:44:38,680
NOW TODAY, YOU COULD SAY, THOUGH

1129
00:44:38,680 --> 00:44:43,680
DISPARITIES IN HEALTH LEAD TO

1130
00:44:43,680 --> 00:44:48,400
DISPARITIES IN COVID-19, AND IN

1131
00:44:48,400 --> 00:44:49,840
NORMAL PEOPLE WHO GET IT, NORMAL

1132
00:44:49,840 --> 00:44:51,120
PEOPLE WHO ARE HOSPITALIZED AND

1133
00:44:51,120 --> 00:44:52,640
ALL THE THINGS THAT GO ALONG

1134
00:44:52,640 --> 00:44:54,960
WITH IT, SOME OF THEM, WE DON'T

1135
00:44:54,960 --> 00:44:56,760
KNOW YET BECAUSE WE HAVEN'T

1136
00:44:56,760 --> 00:44:59,040
STUDIED LONG ENOUGH, WE HAVEN'T

1137
00:44:59,040 --> 00:45:01,160
STUDIED COVID-19 TO KNOW WHAT

1138
00:45:01,160 --> 00:45:02,360
SOME OF THE LONG-TERM EFFECTS

1139
00:45:02,360 --> 00:45:03,400
ARE.

1140
00:45:03,400 --> 00:45:06,480
BUT THESE ARE ALL RELATED, AND I

1141
00:45:06,480 --> 00:45:09,920
THINK RIGHT NOW, CONCERN SHOULD

1142
00:45:09,920 --> 00:45:11,160
BE, ALMOST A MILLION PEOPLE IN

1143
00:45:11,160 --> 00:45:14,440
THIS COUNTRY HAVE DIED FROM

1144
00:45:14,440 --> 00:45:17,760
COVID-19.

1145
00:45:17,760 --> 00:45:20,480
SO HOW MANY OF PEOPLE WHO HAVE

1146
00:45:20,480 --> 00:45:23,680
NOT DIED ARE GOING TO CONTINUE

1147
00:45:23,680 --> 00:45:26,280
TO SUFFER OTHER DISPARITIES.

1148
00:45:26,280 --> 00:45:27,360
SO THAT'S WHAT WE'RE DEALING

1149
00:45:27,360 --> 00:45:28,680
WITH, AND WE SHOULD BE VERY

1150
00:45:28,680 --> 00:45:31,080
CLEAR ABOUT THAT.

1151
00:45:31,080 --> 00:45:35,760
THAT THE PANDEMIC WILL NOT END,

1152
00:45:35,760 --> 00:45:44,880
OR EVEN WHEN EVERYBODY IS

1153
00:45:44,880 --> 00:45:47,000
DECEASED OR DIED -- WHO ARE

1154
00:45:47,000 --> 00:45:49,560
DECEASED, INCAPACITATED FROM THE

1155
00:45:49,560 --> 00:45:50,040
DISEASE/INFECTION.

1156
00:45:50,040 --> 00:45:52,560
WE REALLY NEED TO GET SERIOUS

1157
00:45:52,560 --> 00:45:55,640
ABOUT VACCINATION, BECAUSE IT'S

1158
00:45:55,640 --> 00:45:59,240
THE BEST HOPE WE HAVE NOT JUST

1159
00:45:59,240 --> 00:46:03,600
FOR PREVENTING COVID-19, BUT

1160
00:46:03,600 --> 00:46:04,800
PREVENTING A LOT OF THE THINGS

1161
00:46:04,800 --> 00:46:07,160
THAT WE'RE GOING TO SEE LATER,

1162
00:46:07,160 --> 00:46:08,960
IN TERMS OF THE AFTERMATH OF

1163
00:46:08,960 --> 00:46:10,360
COVID-19.

1164
00:46:10,360 --> 00:46:12,560
>> THANK YOU FOR THAT ANSWER.

1165
00:46:12,560 --> 00:46:15,120
THE OTHER THING THAT WE KNOW IS

1166
00:46:15,120 --> 00:46:17,080
THAT IN ADDITION TO THE RACIAL

1167
00:46:17,080 --> 00:46:18,040
DISPARITIES WHEN WE LOOK

1168
00:46:18,040 --> 00:46:18,960
SPECIFICALLY AT STROKE, WE KNOW

1169
00:46:18,960 --> 00:46:20,640
THAT THERE ARE GEOGRAPHIC

1170
00:46:20,640 --> 00:46:21,440
DISPARITIES AS WELL.

1171
00:46:21,440 --> 00:46:23,360
WE HAVE THE STROKE BELT AND THE

1172
00:46:23,360 --> 00:46:24,960
STROKE BUCKLE.

1173
00:46:24,960 --> 00:46:27,280
I KNOW THAT YOU OFTEN TALK ABOUT

1174
00:46:27,280 --> 00:46:30,640
GROWING UP IN RURAL ALABAMA, AND

1175
00:46:30,640 --> 00:46:32,400
SORT OF THE IMPACT ON HEALTH.

1176
00:46:32,400 --> 00:46:34,160
SO DO YOU HAVE ANY COMMENTS IN

1177
00:46:34,160 --> 00:46:37,960
TERMS OF GEOGRAPHIC DISPARITIES?

1178
00:46:37,960 --> 00:46:40,760
AGAIN, YOU DON'T HAVE TO FEEL --

1179
00:46:40,760 --> 00:46:42,560
TO SPEAK SPECIFICALLY TO STROKE,

1180
00:46:42,560 --> 00:46:47,680
BUT IN GENERAL, HEALTHCARE GEE
GEE

1181
00:46:47,680 --> 00:46:48,960
GRAPHICS AND HOW THAT IMPACTS

1182
00:46:48,960 --> 00:46:49,480
HEALTHCARE.

1183
00:46:49,480 --> 00:46:51,760
>> YOU COULD ARGUE THAT I GREW

1184
00:46:51,760 --> 00:46:53,760
UP IN THE STROKE BELT, THAT PART

1185
00:46:53,760 --> 00:46:55,080
OF THE COUNTRY, ALONG SEVERAL

1186
00:46:55,080 --> 00:46:57,840
STATES, NOT JUST ALABAMA, WHERE

1187
00:46:57,840 --> 00:46:59,480
PEOPLE ARE MORE LIKELY TO SUFFER

1188
00:46:59,480 --> 00:47:04,400
AND DIE OF STROKE.

1189
00:47:04,400 --> 00:47:05,760
AFRICAN AMERICANS ESPECIALLY SO.

1190
00:47:05,760 --> 00:47:08,360
WE REALLY NEED TO FOCUS ON THIS

1191
00:47:08,360 --> 00:47:10,560
ISSUE.

1192
00:47:10,560 --> 00:47:13,280
WHEN I WAS DIRECTOR OF THE CDC,

1193
00:47:13,280 --> 00:47:16,120
WE TRIED TO ILLUSTRATE WHAT

1194
00:47:16,120 --> 00:47:23,200
COULD HAPPEN WHEN YOU FOCUS.

1195
00:47:23,200 --> 00:47:25,160
WE DID IT LOOKING AT NATIVE

1196
00:47:25,160 --> 00:47:29,720
AMERICANS, AMERICAN INDIANS.

1197
00:47:29,720 --> 00:47:35,760
NEWT GINGRICH WAS A --

1198
00:47:35,760 --> 00:47:38,080
[SPEAKER FROZE]

1199
00:47:38,080 --> 00:47:40,760
 -- TO GET $200 MILLION, I

1200
00:47:40,760 --> 00:47:42,160
BELIEVE, DIABETES, AMERICAN

1201
00:47:42,160 --> 00:47:43,320
INDIANS HAVE THE HIGHEST RATE OF

1202
00:47:43,320 --> 00:47:44,880
DIABETES IN THIS COUNTRY, AND WE

1203
00:47:44,880 --> 00:47:47,760
WERE ABLE TO IMPLEMENT PROGRAMS,

1204
00:47:47,760 --> 00:47:50,000
THESE WERE NOT JUST MEDICAL

1205
00:47:50,000 --> 00:47:54,760
PROGRAMS BUT THEY WERE LIFESTYLE

1206
00:47:54,760 --> 00:47:56,760
PROGRAMS AND WHAT WE SAW WAS A

1207
00:47:56,760 --> 00:47:58,840
DRAMATIC DECREASE IN RENAL

1208
00:47:58,840 --> 00:48:01,840
DISEASE AMONG NATIVE AMERICANS

1209
00:48:01,840 --> 00:48:03,160
AND SEVERAL OTHERS.

1210
00:48:03,160 --> 00:48:06,040
IT'S THE RESULTS OF THAT STUDY

1211
00:48:06,040 --> 00:48:07,160
UNFORTUNATELY DIDN'T COME OUT

1212
00:48:07,160 --> 00:48:10,120
UNTIL I HAD LEFT THE CDC AND I

1213
00:48:10,120 --> 00:48:12,000
WAS IN WASHINGTON AS SURGEON

1214
00:48:12,000 --> 00:48:13,000
GENERAL.

1215
00:48:13,000 --> 00:48:16,120
BUT I THINK WE ALL NEED TO STOP

1216
00:48:16,120 --> 00:48:18,800
AND LOOK BACK AT THAT STUDY AND

1217
00:48:18,800 --> 00:48:25,120
WHAT IT REALLY TOLD US ABOUT OUR

1218
00:48:25,120 --> 00:48:26,160
ABILITY, BECAUSE WE OFTEN THINK

1219
00:48:26,160 --> 00:48:27,080
WE CAN'T DO ANYTHING ABOUT IT,

1220
00:48:27,080 --> 00:48:29,800
OUR ABILITY TO IMPACT SOMETHING

1221
00:48:29,800 --> 00:48:33,360
LIKE DIABETES IN A POPULATION

1222
00:48:33,360 --> 00:48:34,760
LIKE AMERICAN INDIANS AND NATIVE

1223
00:48:34,760 --> 00:48:39,880
AMERICANS.

1224
00:48:39,880 --> 00:48:41,360
>> THANK YOU, DR. SATCHER.

1225
00:48:41,360 --> 00:48:43,720
I THINK THIS HAS BEEN A

1226
00:48:43,720 --> 00:48:44,440
WONDERFUL SESSION.

1227
00:48:44,440 --> 00:48:46,680
YOU'VE GIVEN US GREAT INSIGHT

1228
00:48:46,680 --> 00:48:50,760
FROM YOUR EXPERIENCE, YOUR VAST

1229
00:48:50,760 --> 00:48:54,440
EXPERIENCE FROM GOVERNMENT, AS

1230
00:48:54,440 --> 00:48:56,320
SURGEON GENERAL AS WELL AS YOUR

1231
00:48:56,320 --> 00:48:57,160
OTHER EXPERIENCE BEING AT THE

1232
00:48:57,160 --> 00:48:59,960
HIGHEST LEVELS OF ACADEMIC

1233
00:48:59,960 --> 00:49:00,320
INSTITUTIONS.

1234
00:49:00,320 --> 00:49:00,920
WE THANK YOU.

1235
00:49:00,920 --> 00:49:03,320
ANY LAST REMARKS IN TERMS OF

1236
00:49:03,320 --> 00:49:04,840
YOUR VISION FOR THE FUTURE IN

1237
00:49:04,840 --> 00:49:06,760
TERMS OF HEALTH EQUITY WORK?

1238
00:49:06,760 --> 00:49:12,960
>> WELL, YOU KNOW, I'M NOW

1239
00:49:12,960 --> 00:49:14,400
COMMITTED TO CONTINUING TO PLAY

1240
00:49:14,400 --> 00:49:16,520
A MAJOR ROLE IN LEADERSHIP

1241
00:49:16,520 --> 00:49:18,560
DEVELOPMENT, BECAUSE I JUST

1242
00:49:18,560 --> 00:49:20,040
BELIEVE THAT AMONG OUR PEOPLE

1243
00:49:20,040 --> 00:49:22,440
ESPECIALLY, WE NEED MORE

1244
00:49:22,440 --> 00:49:24,480
LEADERS, BECAUSE WE'RE BEING

1245
00:49:24,480 --> 00:49:26,160
CONTINUALLY CHALLENGED.

1246
00:49:26,160 --> 00:49:29,960
IN EVERY WAY, NOT JUST BY

1247
00:49:29,960 --> 00:49:30,200
RACISM.

1248
00:49:30,200 --> 00:49:36,400
BUT WE HAVE THIS SAYING AT THE

1249
00:49:36,400 --> 00:49:38,040
SATCHER LEADERSHIP INSTITUTE AND

1250
00:49:38,040 --> 00:49:39,960
THE MOREHOUSE SCHOOL OF

1251
00:49:39,960 --> 00:49:41,000
MEDICINE, IN ORDER TO ELIMINATE

1252
00:49:41,000 --> 00:49:43,080
DISPARITIES IN HEALTH, WE NEED

1253
00:49:43,080 --> 00:49:43,360
LEADERS.

1254
00:49:43,360 --> 00:49:46,080
WE NEED LEADERS WHO CARE ENOUGH,

1255
00:49:46,080 --> 00:49:48,520
WE NEED LEADERS WHO KNOW ENOUGH,

1256
00:49:48,520 --> 00:49:52,360
LEADERS WHO WILL DO ENOUGH, AND

1257
00:49:52,360 --> 00:49:54,120
LEADERS WHO WILL PERSEVERE UNTIL

1258
00:49:54,120 --> 00:49:55,760
THE JOB IS DONE.

1259
00:49:55,760 --> 00:49:57,480
THAT'S WHAT WE NEED.

1260
00:49:57,480 --> 00:49:58,880
AND WE'VE GOT TO KEEP WORKING

1261
00:49:58,880 --> 00:50:01,480
FOR THAT DAY.

1262
00:50:01,480 --> 00:50:02,080
>> THANK YOU.

1263
00:50:02,080 --> 00:50:03,240
THANK YOU, DR. SATCHER.

1264
00:50:03,240 --> 00:50:05,560
THAT'S A GREAT WAY TO END THIS

1265
00:50:05,560 --> 00:50:05,800
SESSION.

1266
00:50:05,800 --> 00:50:06,560
AGAIN, WE THANK YOU FOR YOUR

1267
00:50:06,560 --> 00:50:07,160
TIME.

1268
00:50:07,160 --> 00:50:09,240
I KNOW YOU'RE VERY BUSY.

1269
00:50:09,240 --> 00:50:11,080
WE THANK YOU FOR PRESENTING TO

1270
00:50:11,080 --> 00:50:12,760
US TODAY.

1271
00:50:12,760 --> 00:50:14,960
>> DELIGHTED, RICHARD.

1272
00:50:14,960 --> 00:50:16,440
>> THANK YOU, DR. SATCHER.

1273
00:50:16,440 --> 00:50:17,360
VERY MUCH APPRECIATE YOUR WORDS

1274
00:50:17,360 --> 00:50:18,920
OF WISDOM.

1275
00:50:18,920 --> 00:50:24,160
>> THANK YOU.

1276
00:50:24,160 --> 00:50:26,600
>> AND BACK OVER TO YOU,

1277
00:50:26,600 --> 00:50:27,960
DR. ALBERTS.

1278
00:50:27,960 --> 00:50:31,440
>> THANK YOU, RICHARD, FOR

1279
00:50:31,440 --> 00:50:33,200
MODERATING DR. SATCHER AND

1280
00:50:33,200 --> 00:50:34,600
SHARING HIS WORDS OF WISDOM.

1281
00:50:34,600 --> 00:50:37,400
SO TO FRAME THINGS AS WE GET

1282
00:50:37,400 --> 00:50:39,000
INTO OUR REPORTS, I WANTED TO

1283
00:50:39,000 --> 00:50:40,360
JUST TAKE A FEW MINUTES TO

1284
00:50:40,360 --> 00:50:42,760
EXPLAIN TO MANY OF THE

1285
00:50:42,760 --> 00:50:44,160
PARTICIPANTS HOW WE ENDED UP

1286
00:50:44,160 --> 00:50:46,360
HERE IN TERMS OF THE ADVISORY

1287
00:50:46,360 --> 00:50:47,840
COUNCIL TO THE BAC AND THE

1288
00:50:47,840 --> 00:50:49,800
RETREATS THAT WE HAD THAT REALLY

1289
00:50:49,800 --> 00:50:51,160
IDENTIFIED THIS ISSUE OF THE

1290
00:50:51,160 --> 00:50:53,880
INEQUITY AND DISPARITY IN STROKE

1291
00:50:53,880 --> 00:50:54,320
CARE.

1292
00:50:54,320 --> 00:50:55,920
IT'S SUCH A HUGE TOPIC, AND

1293
00:50:55,920 --> 00:50:58,080
STROKE IS SUCH A BIG MEDICAL

1294
00:50:58,080 --> 00:50:58,520
PROBLEM.

1295
00:50:58,520 --> 00:51:01,680
WHAT WE DECIDED AFTER EXTENSIVE

1296
00:51:01,680 --> 00:51:02,960
DISCUSSION AND DELIBERATION IS

1297
00:51:02,960 --> 00:51:04,840
THAT IT MADE MORE SENSE TO LOOK

1298
00:51:04,840 --> 00:51:09,560
AT IT AMONG DIFFERENT ACCESSES.

1299
00:51:09,560 --> 00:51:13,160
AND ONE ACCESS, AND DR. SATCHER

1300
00:51:13,160 --> 00:51:15,800
TOUCHED ON THIS IN HIS COMMENTS

1301
00:51:15,800 --> 00:51:17,320
OF A FEW MINUTES AGO, WAS TO

1302
00:51:17,320 --> 00:51:18,840
BREAK IT DOWN INTO SORT OF MAJOR

1303
00:51:18,840 --> 00:51:20,680
REALMS THAT WE COULD HAVE AN

1304
00:51:20,680 --> 00:51:23,120
INFLUENCE ON OR THAT WE NEEDED

1305
00:51:23,120 --> 00:51:25,360
TO ANALYZE AND DIGEST.

1306
00:51:25,360 --> 00:51:27,800
AND AGAIN, DR. SATCHER SAID IT

1307
00:51:27,800 --> 00:51:29,760
VERY ELOQUENTLY A FEW MINUTES

1308
00:51:29,760 --> 00:51:31,040
AGO, BUT THERE'S BASICALLY FOUR

1309
00:51:31,040 --> 00:51:31,760
OF THEM.

1310
00:51:31,760 --> 00:51:34,160
NUMBER ONE HAS TO DO WITH

1311
00:51:34,160 --> 00:51:35,560
DEMOGRAPHICS, PATIENT

1312
00:51:35,560 --> 00:51:36,200
DEMOGRAPHICS, RISK FACTORS,

1313
00:51:36,200 --> 00:51:38,160
THINGS LIKE THAT.

1314
00:51:38,160 --> 00:51:40,960
NUMBER TWO HAD TO DO WITH

1315
00:51:40,960 --> 00:51:41,880
RESOURCES AND ECONOMICS, WHICH

1316
00:51:41,880 --> 00:51:45,040
SORT OF PARTIALLY -- HE TOUCHED

1317
00:51:45,040 --> 00:51:49,880
ON A LOT IN TERMS OF FINANCIAL

1318
00:51:49,880 --> 00:51:51,080
RESOURCES, THINGS LIKE THAT.

1319
00:51:51,080 --> 00:51:52,560
A THIRD AREA WHICH HE TOUCHED ON

1320
00:51:52,560 --> 00:51:56,440
UNDER THE NAME OF POWER, BUT WE

1321
00:51:56,440 --> 00:51:58,560
REFRAMED THAT OR WE RENAMED IT

1322
00:51:58,560 --> 00:51:59,480
IN TERMS OF POLICY AND

1323
00:51:59,480 --> 00:52:00,440
LEGISLATION.

1324
00:52:00,440 --> 00:52:01,760
SINCE THAT -- IF YOU HAVE THE

1325
00:52:01,760 --> 00:52:04,760
RIGHT POLICIES AND THE

1326
00:52:04,760 --> 00:52:08,200
LEGISLATION WHERE THE LAWS

1327
00:52:08,200 --> 00:52:09,440
BEHIND IT CAN REALLY DICTATE

1328
00:52:09,440 --> 00:52:10,760
WHAT YOU CAN DO, WHEN YOU CAN DO

1329
00:52:10,760 --> 00:52:12,480
IT AND HOW YOU CAN DO IT, AND

1330
00:52:12,480 --> 00:52:14,160
THEN LAST BUT NOT LEAST, WHICH

1331
00:52:14,160 --> 00:52:15,720
AGAIN DR. SATCHER VERY

1332
00:52:15,720 --> 00:52:17,520
ELOQUENTLY TOUCHED UPON WAS

1333
00:52:17,520 --> 00:52:17,760
GEOGRAPHY.

1334
00:52:17,760 --> 00:52:19,600
WHERE IS THE PATIENT, WHERE DO

1335
00:52:19,600 --> 00:52:23,080
THEY LIVE, WHAT'S THE POLITICS

1336
00:52:23,080 --> 00:52:25,160
OF THAT AREA, WHAT ARE THE

1337
00:52:25,160 --> 00:52:25,880
LIMITATIONS OF LIVING IN THE

1338
00:52:25,880 --> 00:52:27,280
NORTH VERSUS THE SOUTH AND

1339
00:52:27,280 --> 00:52:28,160
THINGS LIKE THAT.

1340
00:52:28,160 --> 00:52:32,040
AND AGAIN, THIS I HAS REALLY

1341
00:52:32,040 --> 00:52:33,440
HELPED FRAME THE DIFFERENT

1342
00:52:33,440 --> 00:52:36,120
BUCKETS WE PUT THESE BREAKOUT

1343
00:52:36,120 --> 00:52:43,160
GRAWPBREAKOUTGROUPS INTO ON ONE
AXIS.

1344
00:52:43,160 --> 00:52:45,760
THE OTHER AXIS WE'VE IMPOSED IS

1345
00:52:45,760 --> 00:52:48,560
THE DIFFERENT TIME -- OF STROKE.

1346
00:52:48,560 --> 00:52:49,600
THE REASON WHY THAT'S IMPORTANT

1347
00:52:49,600 --> 00:52:50,600
WHICH I'M SURE THE MEDICAL

1348
00:52:50,600 --> 00:52:52,200
PEOPLE ON THE CALL UNDERSTAND

1349
00:52:52,200 --> 00:52:54,600
BUT THE NON-MEDICINE PEOPLE MAY

1350
00:52:54,600 --> 00:52:57,160
NOT FULLY APPRECIATE IS THAT OUR

1351
00:52:57,160 --> 00:52:59,560
CARE PARADIGMS AND THE PEOPLE

1352
00:52:59,560 --> 00:53:01,680
WHO DELIVER THE CARE AND THEIR

1353
00:53:01,680 --> 00:53:03,480
FOCUS IS VASTLY DIFFERENT IN

1354
00:53:03,480 --> 00:53:07,920
THESE DIFFERENT TIME EPOCHS.

1355
00:53:07,920 --> 00:53:09,360
FOR EXAMPLE, THE EMS, WHAT

1356
00:53:09,360 --> 00:53:10,280
HAPPENS BEFORE THE PATIENT GETS

1357
00:53:10,280 --> 00:53:11,320
TO THE HOSPITAL OR IN THE

1358
00:53:11,320 --> 00:53:12,720
AMBULANCE ON THEIR WAY THERE?

1359
00:53:12,720 --> 00:53:15,200
THAT CARE IS DELIVERED REALLY BY

1360
00:53:15,200 --> 00:53:17,960
DIFFERENT PEOPLE IN DIFFERENT

1361
00:53:17,960 --> 00:53:19,520
WAYS THAN THE HYPERACUTE CARE,

1362
00:53:19,520 --> 00:53:20,680
WHICH IS WHAT WOULD HAPPEN IN

1363
00:53:20,680 --> 00:53:22,120
THE EMERGENCY DEPARTMENT ONCE

1364
00:53:22,120 --> 00:53:25,000
YOU GET TO THE HOSPITAL, AND

1365
00:53:25,000 --> 00:53:26,320
THEN THAT ALSO IS A LITTLE BIT

1366
00:53:26,320 --> 00:53:27,080
DIFFERENT ABOUT WHAT HAPPENS

1367
00:53:27,080 --> 00:53:28,360
ONCE A PATIENT IS ACTUALLY

1368
00:53:28,360 --> 00:53:29,920
ADMITTED TO THE HOSPITAL, THEY

1369
00:53:29,920 --> 00:53:31,680
GO UP TO THE FLOOR AND THEY HAVE

1370
00:53:31,680 --> 00:53:33,160
ONGOING CARE.

1371
00:53:33,160 --> 00:53:36,160
SO AGAIN, STROKE IS SO HUGE AND

1372
00:53:36,160 --> 00:53:38,360
SO MULTIDIMENSIONAL WITH

1373
00:53:38,360 --> 00:53:39,320
DIFFERENT FACTORS, DIFFERENT

1374
00:53:39,320 --> 00:53:41,280
PEOPLE, DIFFERENT CARE

1375
00:53:41,280 --> 00:53:42,560
PARADIGMS, THAT'S WHY WE DECIDED

1376
00:53:42,560 --> 00:53:47,920
TO BREAK IT UP IN SORT OF THIS

1377
00:53:47,920 --> 00:53:48,920
DUAL ACCESSES IN THE MAJOR

1378
00:53:48,920 --> 00:53:50,440
POLICY ISSUES AND THE CARE

1379
00:53:50,440 --> 00:53:53,200
PARADIGMS AS WELL AS THE TIME

1380
00:53:53,200 --> 00:53:54,440
EPOCHS.

1381
00:53:54,440 --> 00:53:56,160
HYPERACUTE BY EMS, IN THE E.D.,

1382
00:53:56,160 --> 00:53:58,160
AND THEN ONCE THE PATIENT WAS

1383
00:53:58,160 --> 00:54:00,680
ADMITTED INTO THE HOSPITAL.

1384
00:54:00,680 --> 00:54:02,960
BUT I THINK ALSO AN OVERLYING

1385
00:54:02,960 --> 00:54:04,720
THEME, WHEN WE TALK ABOUT

1386
00:54:04,720 --> 00:54:07,320
ADDRESSING DISPARITIES AND LACK

1387
00:54:07,320 --> 00:54:09,640
OF EQUITY, IS THAT THERE SHOULD

1388
00:54:09,640 --> 00:54:14,240
BE ONE STANDARD OF CARE.

1389
00:54:14,240 --> 00:54:15,040
ONE STANDARD OF CARE.

1390
00:54:15,040 --> 00:54:16,760
THE CHALLENGE IS HOW DO WE MEET

1391
00:54:16,760 --> 00:54:17,600
THESE DIFFERENT STANDARDS OF

1392
00:54:17,600 --> 00:54:18,480
CARE WITH THE LIMITATIONS OF

1393
00:54:18,480 --> 00:54:19,800
LACK OF EQUITY?

1394
00:54:19,800 --> 00:54:22,320
WITH THE LIMITATIONS OF LACK OF

1395
00:54:22,320 --> 00:54:23,240
RESOURCES?

1396
00:54:23,240 --> 00:54:25,560
WITH THE DIFFERENT GEOGRAPHIC

1397
00:54:25,560 --> 00:54:27,560
BURDENS, WITH THE DIFFERENT CARE

1398
00:54:27,560 --> 00:54:27,880
PARADIGMS?

1399
00:54:27,880 --> 00:54:30,880
HOW CAN WE IDENTIFY THE ISSUES

1400
00:54:30,880 --> 00:54:34,200
AND COME UP WITH SOLUTIONS,

1401
00:54:34,200 --> 00:54:36,400
TESTABLE HYPOTHESES TO OVERCOME

1402
00:54:36,400 --> 00:54:38,080
SOME OF THESE ISSUES THAT MAKE

1403
00:54:38,080 --> 00:54:40,360
IT VERY CHALLENGING FOR SOME

1404
00:54:40,360 --> 00:54:42,480
PATIENTS TO RECEIVE THE STANDARD

1405
00:54:42,480 --> 00:54:44,920
OF CARE IN VARIOUS PARTS OF THE

1406
00:54:44,920 --> 00:54:47,040
COUNTRY, VARIOUS CARE PARADIGMS,

1407
00:54:47,040 --> 00:54:48,640
DIFFERENT VENUES.

1408
00:54:48,640 --> 00:54:50,800
SO I THINK THOSE CONSTRUCTS HAVE

1409
00:54:50,800 --> 00:54:52,520
HELPED SHAPE SOME OF THE REPORT

1410
00:54:52,520 --> 00:54:53,720
THAT YOU WILL HEAR FROM THE

1411
00:54:53,720 --> 00:54:56,200
VARIOUS TASK FORCES, AND WE HOPE

1412
00:54:56,200 --> 00:54:58,040
THEY WILL HELP SHAPE THE ONGOING

1413
00:54:58,040 --> 00:55:01,160
DISCUSSIONS AS WE GO BEYOND

1414
00:55:01,160 --> 00:55:03,000
DESCRIPTIVE DATA, BUT AS WE TRY

1415
00:55:03,000 --> 00:55:05,800
TO DEVELOP ASSOCIATIONS AND

1416
00:55:05,800 --> 00:55:07,960
DEVELOP TESTABLE HYPOTHESES FOR

1417
00:55:07,960 --> 00:55:09,920
HOW WE CAN ADDRESS SOME OF THESE

1418
00:55:09,920 --> 00:55:12,240
ISSUES ABOVE AND BEYOND JUST THE

1419
00:55:12,240 --> 00:55:14,200
DESCRIPTIVE LEVEL THAT WE'RE AT

1420
00:55:14,200 --> 00:55:15,920
FOR I THINK MANY OF THESE

1421
00:55:15,920 --> 00:55:16,200
CHALLENGES.

1422
00:55:16,200 --> 00:55:18,800
SO I JUST WANTED TO HELP FRAME

1423
00:55:18,800 --> 00:55:20,200
THIS, ESPECIALLY IN THE SETTING

1424
00:55:20,200 --> 00:55:22,800
OF THE EXCELLENT KICKOFF THAT

1425
00:55:22,800 --> 00:55:24,440
DR. SATCHER HAS GIVEN US.

1426
00:55:24,440 --> 00:55:25,400
RICHARD, DO YOU HAVE ANYTHING TO

1427
00:55:25,400 --> 00:55:28,120
ADD TO THAT?

1428
00:55:28,120 --> 00:55:29,040
>> NO, THANK YOU, MARK.

1429
00:55:29,040 --> 00:55:30,560
I THINK THAT WAS AN EXCELLENT

1430
00:55:30,560 --> 00:55:31,160
OVERVIEW.

1431
00:55:31,160 --> 00:55:32,320
I'M EXCITED TO HEAR THE

1432
00:55:32,320 --> 00:55:34,560
PRESENTATIONS.

1433
00:55:34,560 --> 00:55:35,160
>> OKAY.

1434
00:55:35,160 --> 00:55:37,520
THANK YOU VERY MUCH.

1435
00:55:37,520 --> 00:55:38,840
I'M GOING TO TURN IT BACK OVER

1436
00:55:38,840 --> 00:55:41,040
TO YOU, GREG, AND WE'LL GET INTO

1437
00:55:41,040 --> 00:55:43,960
THE REPORTOUTS.

1438
00:55:43,960 --> 00:55:44,320
>> ALL RIGHT.

1439
00:55:44,320 --> 00:55:45,240
THANK YOU SO MUCH.

1440
00:55:45,240 --> 00:55:47,360
WE ARE NOW GOING TO START OUR

1441
00:55:47,360 --> 00:56:06,880
PRE-HOSPITAL REPORTOUT SECTION.

1442
00:56:06,880 --> 00:56:08,960
>> WELCOME TO THE BRAIN ATTACK

1443
00:56:08,960 --> 00:56:10,560
COALITION SYMPOSIUM ON

1444
00:56:10,560 --> 00:56:11,880
INEQUITIES IN ACCESS AND

1445
00:56:11,880 --> 00:56:16,600
DELIVERY OF ACUTE STROKE CARE.

1446
00:56:16,600 --> 00:56:18,480
I'M COMMANDER ERICA ODOM.

1447
00:56:18,480 --> 00:56:20,760
AS A CDC EMPLOYEE, I NEED TO

1448
00:56:20,760 --> 00:56:22,280
PROVIDE THE DISCLAIMER THAT THE

1449
00:56:22,280 --> 00:56:23,920
INFORMATION PROVIDED TODAY DOES

1450
00:56:23,920 --> 00:56:26,240
NOT REPRESENT CDC'S OFFICIAL

1451
00:56:26,240 --> 00:56:30,160
POSITION OR RECOMMENDATIONS.

1452
00:56:30,160 --> 00:56:31,960
DR. TODD CROCCO AND I REPRESENT

1453
00:56:31,960 --> 00:56:34,000
A TASK FORCE OF CENTRAL ENTED

1454
00:56:34,000 --> 00:56:35,960
AND DEDICATED RESEARCHERS AND

1455
00:56:35,960 --> 00:56:39,160
PHYSICIANS WHO HAVE COME

1456
00:56:39,160 --> 00:56:41,440
TOGETHER FOR AREAS THAT ALREADY

1457
00:56:41,440 --> 00:56:42,960
MAY, THROUGH SYSTEMATIC ACTION,

1458
00:56:42,960 --> 00:56:44,920
BEGIN TO DISMANTLE SOME

1459
00:56:44,920 --> 00:56:46,720
INEQUITIES AND PRE-HOSPITAL

1460
00:56:46,720 --> 00:56:47,760
STROKE CARE.

1461
00:56:47,760 --> 00:56:49,480
THE PRIORITY AREAS WERE

1462
00:56:49,480 --> 00:56:50,960
DEVELOPED THROUGH SUBJECT MATTER

1463
00:56:50,960 --> 00:56:52,880
EXPERTISE AND CRITICAL

1464
00:56:52,880 --> 00:56:54,560
ASSESSMENT OF THE LITERATURE.

1465
00:56:54,560 --> 00:56:55,760
POTENTIAL INEQUITIES AND

1466
00:56:55,760 --> 00:56:57,160
DISPARITIES WERE ASSESSED IN

1467
00:56:57,160 --> 00:57:00,360
FOUR DOMAINS:  GEOGRAPHY,

1468
00:57:00,360 --> 00:57:03,520
POLICIES AND REGULATIONS,

1469
00:57:03,520 --> 00:57:04,720
ECONOMICS IN HEALTHCARE

1470
00:57:04,720 --> 00:57:07,120
RESOURCES AND DEMOGRAPHICS.

1471
00:57:07,120 --> 00:57:09,040
IN THIS RECORDING, WE WILL

1472
00:57:09,040 --> 00:57:10,360
HIGHLIGHT A LIST OF PRIORITIES

1473
00:57:10,360 --> 00:57:12,080
WITHIN EACH DOMAIN THAT FALL

1474
00:57:12,080 --> 00:57:14,000
INTO THREE BROAD CATEGORIES.

1475
00:57:14,000 --> 00:57:17,960
EDUCATION AND TRAINING, SYSTEM

1476
00:57:17,960 --> 00:57:21,160
STRUCTURES AND GOVERNMENT OR

1477
00:57:21,160 --> 00:57:22,360
REGULATIONS.

1478
00:57:22,360 --> 00:57:23,600
THIS CATEGORIZATION MAY BE

1479
00:57:23,600 --> 00:57:25,600
HELPFUL FOR FUTURE EFFORTS AIMED

1480
00:57:25,600 --> 00:57:27,000
AT IDENTIFYING SOLUTIONS TO

1481
00:57:27,000 --> 00:57:29,160
ADDRESS INEQUITIES IN

1482
00:57:29,160 --> 00:57:30,160
PRE-HOSPITAL STROKE CARE, BUT

1483
00:57:30,160 --> 00:57:32,360
THIS IS NOT A COMPREHENSIVE

1484
00:57:32,360 --> 00:57:32,840
LIST.

1485
00:57:32,840 --> 00:57:34,120
WE, THEREFORE, INVITE YOU TO

1486
00:57:34,120 --> 00:57:35,760
REFLECT AND CONSIDER SOME GAPS

1487
00:57:35,760 --> 00:57:37,560
THAT REMAIN TO BE ADDRESSED AND

1488
00:57:37,560 --> 00:57:41,480
BRING YOUR THOUGHTS FOR

1489
00:57:41,480 --> 00:57:42,960
DISCUSSION TO OUR SESSION.

1490
00:57:42,960 --> 00:57:43,880
IT IS WELL-KNOWN THAT STROKE IS

1491
00:57:43,880 --> 00:57:47,040
A LEADING CAUSE OF DEATH IN LONG

1492
00:57:47,040 --> 00:57:48,440
TERM DISABILITY IN THE UNITED

1493
00:57:48,440 --> 00:57:51,480
STATES, IMPACTING ABOUT 795,000

1494
00:57:51,480 --> 00:57:53,560
PERSONS ANNUALLY.

1495
00:57:53,560 --> 00:57:54,960
TIME IS A CRITICAL FACTOR

1496
00:57:54,960 --> 00:57:59,160
FOLLOWING A STROKE, WITH EACH

1497
00:57:59,160 --> 00:57:59,840
PASSING MINUTE RESULTING IN THE

1498
00:57:59,840 --> 00:58:02,840
LOSS OF MILLIONS OF NEURONS.

1499
00:58:02,840 --> 00:58:04,200
THUS, TIME-SENSITIVE HIGH

1500
00:58:04,200 --> 00:58:05,640
QUALITY CARE IS NEEDED TO

1501
00:58:05,640 --> 00:58:07,960
SUPPORT PATIENTS AT THE EARLIEST

1502
00:58:07,960 --> 00:58:09,120
SIGNS OF STROKE.

1503
00:58:09,120 --> 00:58:10,400
FOR MOST PATIENTS, STROKES OCCUR

1504
00:58:10,400 --> 00:58:13,200
IN THE COMMUNITY SETTING.

1505
00:58:13,200 --> 00:58:14,880
DURING A PERIOD WE WILL DEFINE

1506
00:58:14,880 --> 00:58:16,680
AS THE PRE-HOSPITAL SETTING.

1507
00:58:16,680 --> 00:58:18,320
THE PRE-HOSPITAL STROKE SETTING

1508
00:58:18,320 --> 00:58:20,560
IS DYNAMIC, DIVERSE, AND

1509
00:58:20,560 --> 00:58:22,240
INCLUDES A BROAD RANGE OF

1510
00:58:22,240 --> 00:58:23,960
PEOPLE, PLACES AND ENVIRONMENTS.

1511
00:58:23,960 --> 00:58:26,160
THESE MAY INCLUDE FAMILY, AND

1512
00:58:26,160 --> 00:58:28,920
COMMUNITY MEMBERS, EMERGENCY

1513
00:58:28,920 --> 00:58:32,160
MEDICAL SERVICES OR EMS

1514
00:58:32,160 --> 00:58:34,360
PROFESSIONALS, AS WELL AS THE

1515
00:58:34,360 --> 00:58:35,560
SYSTEMS, STRUCTURES AND POLICIES

1516
00:58:35,560 --> 00:58:38,400
THAT SHAPE THE STROKE CARE

1517
00:58:38,400 --> 00:58:38,720
ENVIRONMENT.

1518
00:58:38,720 --> 00:58:39,840
AND THE COMMUNITY, AFTER IT IS

1519
00:58:39,840 --> 00:58:41,160
RECOGNIZED THAT A PERSON MAY BE

1520
00:58:41,160 --> 00:58:43,440
HAVING A STROKE, 911 SHOULD BE

1521
00:58:43,440 --> 00:58:45,680
CALLED IMMEDIATELY.

1522
00:58:45,680 --> 00:58:47,280
EMS PLAYS A SIGNIFICANT ROLE IN

1523
00:58:47,280 --> 00:58:49,840
THE STROKE CHAIN OF SURVIVAL.

1524
00:58:49,840 --> 00:58:52,160
COMMONLY BEING THE FIRST MEDICAL

1525
00:58:52,160 --> 00:58:53,360
PERSONNEL ON SCENE, THEY'RE ABLE

1526
00:58:53,360 --> 00:58:54,960
TO STABILIZE THE PATIENT AND

1527
00:58:54,960 --> 00:58:56,560
QUICKLY TRY TO DETERMINE IF THE

1528
00:58:56,560 --> 00:59:01,840
PERSON IS HAVING A STROKE,

1529
00:59:01,840 --> 00:59:03,480
GATHER INFORMATION ABOUT THE

1530
00:59:03,480 --> 00:59:04,200
PATIENT, WHEN THEY WERE LAST

1531
00:59:04,200 --> 00:59:05,560
KNOWN TO BE WELL, TRANSPORT THE

1532
00:59:05,560 --> 00:59:06,560
PATIENT TO THE HOSPITAL WITH THE

1533
00:59:06,560 --> 00:59:08,040
BEST LEVEL OF CARE FOR STROKE

1534
00:59:08,040 --> 00:59:10,400
SEVERITY AND TIMING, AND

1535
00:59:10,400 --> 00:59:11,840
PRE-NOTIFY HOSPITAL TEAMS OF

1536
00:59:11,840 --> 00:59:14,840
STROKE ARRIVAL.

1537
00:59:14,840 --> 00:59:15,960
PRE-NOTIFICATION TRIGGERS STROKE

1538
00:59:15,960 --> 00:59:18,800
TEAMS TO BE ACTIVATED IN THE

1539
00:59:18,800 --> 00:59:20,880
EMERGENCY DEPARTMENT AND

1540
00:59:20,880 --> 00:59:21,760
NEUROIMAGING MACHINES TO BE

1541
00:59:21,760 --> 00:59:23,880
CLEAR, AVOIDING TRIAGE DELAYS

1542
00:59:23,880 --> 00:59:26,000
AND DECREASING WAIT TIME.

1543
00:59:26,000 --> 00:59:29,160
WHILE MANY BEST PRACTICES ARE

1544
00:59:29,160 --> 00:59:30,600
WELL-KNOWN AND LIFE SAVING

1545
00:59:30,600 --> 00:59:34,960
INTERVENTIONS ARE AVAILABLE,

1546
00:59:34,960 --> 00:59:37,160
BARRIERS CONTINUE TO EXIST IN

1547
00:59:37,160 --> 00:59:38,760
EFFECTIVELY DELIVERING CARE.

1548
00:59:38,760 --> 00:59:40,960
WHILE MANY BEST PRACTICES ARE

1549
00:59:40,960 --> 00:59:42,720
WELL-KNOWN AND LIFE-SAVING

1550
00:59:42,720 --> 00:59:45,400
INTERVENTIONS ARE AVAILABLE,

1551
00:59:45,400 --> 00:59:46,960
BARRIERS CONTINUE TO EXIST IN

1552
00:59:46,960 --> 00:59:49,160
EFFECTIVELY DELIVERING CARE.

1553
00:59:49,160 --> 00:59:53,160
FOR EXAMPLE, MANY PATIENTS CAN

1554
00:59:53,160 --> 00:59:54,640
RAPIDLY ACCESS STROKE CENTERS,

1555
00:59:54,640 --> 00:59:56,760
YET ONLY 50 TO 60% OF STROKE

1556
00:59:56,760 --> 00:59:59,120
PATIENTS ARRIVE TO THE HOSPITAL

1557
00:59:59,120 --> 00:59:59,840
BY AMBULANCE.

1558
00:59:59,840 --> 01:00:03,440
IN ADDITION, ONLY 25 TO 30% OF

1559
01:00:03,440 --> 01:00:05,960
STROKE PATIENTS ARRIVE WITHIN

1560
01:00:05,960 --> 01:00:09,560
RECOMMENDED TREATMENT WINDOWS TO

1561
01:00:09,560 --> 01:00:10,960
RECEIVE ENDO VASCULAR TREATMENT

1562
01:00:10,960 --> 01:00:14,600
OR I.V.

1563
01:00:14,600 --> 01:00:15,360
>> HELLO, EVERYONE.

1564
01:00:15,360 --> 01:00:18,840
MY NAME IS TODD CROCCO,

1565
01:00:18,840 --> 01:00:20,760
PROFESSOR OF EMERGENCY MEDICINE

1566
01:00:20,760 --> 01:00:22,280
AT THE UNIVERSITY OF MARYLAND

1567
01:00:22,280 --> 01:00:22,840
SCHOOL OF MEDICINE AND VICE

1568
01:00:22,840 --> 01:00:23,880
PRESIDENT FOR TELEHEALTH AT THE

1569
01:00:23,880 --> 01:00:25,320
UNIVERSITY OF MARYLAND MEDICAL

1570
01:00:25,320 --> 01:00:27,560
SYSTEM.

1571
01:00:27,560 --> 01:00:30,880
THE PRE-HOSPITAL TASK FORCE

1572
01:00:30,880 --> 01:00:32,360
BROKE INTO SEVERAL DIFFERENT

1573
01:00:32,360 --> 01:00:34,720
SUBGROUPS AND IDENTIFIED

1574
01:00:34,720 --> 01:00:35,840
OPPORTUNITIES ACROSS THE

1575
01:00:35,840 --> 01:00:37,640
DIFFERENT CROSS-CUTTING THEMES.

1576
01:00:37,640 --> 01:00:39,880
I'M GOING TO START BY COVERING

1577
01:00:39,880 --> 01:00:43,120
THE THEME OF GEOGRAPHY.

1578
01:00:43,120 --> 01:00:45,520
NOW GEOGRAPHIC DISPARITIES EXIST

1579
01:00:45,520 --> 01:00:47,560
REGARDING VARIABILITY IN

1580
01:00:47,560 --> 01:00:50,840
QUALITY, ACCESS, EMS

1581
01:00:50,840 --> 01:00:51,800
INFRASTRUCTURE, PROVIDER

1582
01:00:51,800 --> 01:00:53,120
TRAINING AND EXPERIENCE, AND

1583
01:00:53,120 --> 01:00:54,840
OTHER AREAS.

1584
01:00:54,840 --> 01:00:56,760
THE DISPARITIES ARE HEIGHTENED

1585
01:00:56,760 --> 01:01:00,200
IN RURAL AREAS, BUT ALSO EXIST

1586
01:01:00,200 --> 01:01:06,040
IN URBAN AND SUBURBAN AREAS.

1587
01:01:06,040 --> 01:01:08,160
IN FACT, ENDOVASCULAR STROKE

1588
01:01:08,160 --> 01:01:09,200
THERAPY HAS HIGHLIGHTED SOME OF

1589
01:01:09,200 --> 01:01:11,080
THESE DISPARITIES DUE TO THE

1590
01:01:11,080 --> 01:01:13,320
LIMITED LOCATIONS WHERE

1591
01:01:13,320 --> 01:01:14,200
ENDOVASCULAR STROKE THERAPY CAN

1592
01:01:14,200 --> 01:01:17,960
BE PERFORMED.

1593
01:01:17,960 --> 01:01:19,160
ADDITIONALLY, GEOGRAPHIC

1594
01:01:19,160 --> 01:01:20,920
VARIATIONS INTRODUCE CULTURAL

1595
01:01:20,920 --> 01:01:22,960
DIFFERENCES IN EMS PROVIDER

1596
01:01:22,960 --> 01:01:25,080
GROUPS AND PATIENT POPULATIONS.

1597
01:01:25,080 --> 01:01:28,480
SO WITH THAT AS THE BACKDROP,

1598
01:01:28,480 --> 01:01:30,800
THE GEOGRAPHY SUBGROUP

1599
01:01:30,800 --> 01:01:32,120
IDENTIFIED THREE DIFFERENT

1600
01:01:32,120 --> 01:01:34,360
PRIORITY AREAS.

1601
01:01:34,360 --> 01:01:36,120
THE FIRST PRIORITY AREA

1602
01:01:36,120 --> 01:01:39,520
IDENTIFIED WAS TO TAKE A

1603
01:01:39,520 --> 01:01:40,760
MULTIFACETED PRE-HOSPITAL STROKE

1604
01:01:40,760 --> 01:01:44,800
SYSTEM OF CARE TO SUPPORT

1605
01:01:44,800 --> 01:01:45,800
GEOGRAPHIC NETWORKS,

1606
01:01:45,800 --> 01:01:47,200
DIFFERENTIATING BETWEEN RURAL,

1607
01:01:47,200 --> 01:01:50,480
URBAN, AND SUBURBAN SETTINGS.

1608
01:01:50,480 --> 01:01:51,840
GEOGRAPHIC STROKE SYSTEMS OF

1609
01:01:51,840 --> 01:01:54,320
CARE NEED TO CONSIDER QUANTITY

1610
01:01:54,320 --> 01:01:56,360
AND DISTANCE AND AVAILABILITY OF

1611
01:01:56,360 --> 01:02:03,200
AMBULANCE AGENCIES, AIR MEDICAL

1612
01:02:03,200 --> 01:02:05,240
TRAPT, FACILITY TRANSPORT, TO

1613
01:02:05,240 --> 01:02:07,360
HAVE A TRULY SYSTEM-BASED

1614
01:02:07,360 --> 01:02:08,440
APPROACH WILL REQUIRE

1615
01:02:08,440 --> 01:02:09,680
COLLABORATION BETWEEN STATE AND

1616
01:02:09,680 --> 01:02:10,560
LOCAL GOVERNMENT POLICY MAKERS

1617
01:02:10,560 --> 01:02:12,360
AND REGIONAL HEALTH SYSTEMS,

1618
01:02:12,360 --> 01:02:14,600
LOCAL HOSPITALS, AND AMBULANCE

1619
01:02:14,600 --> 01:02:16,840
AGENCIES.

1620
01:02:16,840 --> 01:02:18,440
IT ALSO REQUIRES COLLABORATION

1621
01:02:18,440 --> 01:02:20,880
WITHIN REGIONALIZED STROKENET

1622
01:02:20,880 --> 01:02:23,120
WORKS TO OVERCOME MARKET

1623
01:02:23,120 --> 01:02:23,480
COMPETITIVENESS.

1624
01:02:23,480 --> 01:02:26,160
AND INSTEAD, FOCUS ON THE

1625
01:02:26,160 --> 01:02:27,560
STANDARDIZATION OF PRE-HOSPITAL

1626
01:02:27,560 --> 01:02:30,240
STROKE SCREENING AND ROUTING

1627
01:02:30,240 --> 01:02:32,880
PROTOCOLS, EMS TRAINING AND

1628
01:02:32,880 --> 01:02:33,240
EDUCATION.

1629
01:02:33,240 --> 01:02:35,960
THE GOAL IS TO BUILD IN A

1630
01:02:35,960 --> 01:02:37,600
GEOGRAPHICALLY MINDFUL WAY A

1631
01:02:37,600 --> 01:02:41,000
SYSTEM OF CARE THAT FACILITATE

1632
01:02:41,000 --> 01:02:42,560
COLLABORATION RATHER THAN

1633
01:02:42,560 --> 01:02:44,000
COMPETITION PERTAINING TO STROKE

1634
01:02:44,000 --> 01:02:45,960
TRIAGE.

1635
01:02:45,960 --> 01:02:47,080
THE SECOND PRIORITY AREA THAT

1636
01:02:47,080 --> 01:02:50,240
THE SUBGROUP IDENTIFIED WAS TO

1637
01:02:50,240 --> 01:02:51,560
SUPPORT EDUCATION AND CULTURAL

1638
01:02:51,560 --> 01:02:54,800
AWARENESS OF PREHOSPITAL STROKE

1639
01:02:54,800 --> 01:02:55,960
RECOGNITION AND PREVENTION

1640
01:02:55,960 --> 01:02:57,440
THROUGH ENHANCED COMMUNITY

1641
01:02:57,440 --> 01:02:58,520
ENGAGEMENT.

1642
01:02:58,520 --> 01:03:00,360
THIS PRIORITY SUPPORTS ENHANCED

1643
01:03:00,360 --> 01:03:03,560
TRAINING FOR UNDERSERVED AREAS,

1644
01:03:03,560 --> 01:03:05,320
FOR ACCURATE IDENTIFICATION OF

1645
01:03:05,320 --> 01:03:06,120
STROKE BY FIRST RESPONDERS

1646
01:03:06,120 --> 01:03:08,040
ACROSS THE PRE-HOSPITAL

1647
01:03:08,040 --> 01:03:08,320
CONTINUUM.

1648
01:03:08,320 --> 01:03:12,160
AND THAT INCLUDES DISPATCH, EMS,

1649
01:03:12,160 --> 01:03:15,680
FIRE, RESCUE, AND POLICE.

1650
01:03:15,680 --> 01:03:17,120
UNDERSERVED AREAS INCLUDE

1651
01:03:17,120 --> 01:03:19,880
FACTORS LIKE SOCIOECONOMIC

1652
01:03:19,880 --> 01:03:21,360
STATUS, CULTURAL DIFFERENCES,

1653
01:03:21,360 --> 01:03:23,960
AND LOCAL GOVERNANCE AND

1654
01:03:23,960 --> 01:03:25,320
POLICIES, AND AFFECT THE MAKEUP

1655
01:03:25,320 --> 01:03:27,160
OF PRE-HOSPITAL PROVIDER

1656
01:03:27,160 --> 01:03:28,800
POPULATIONS AND STROKE AWARENESS

1657
01:03:28,800 --> 01:03:31,520
IN THE LOCAL COMMUNITY.

1658
01:03:31,520 --> 01:03:33,160
LEADERS MUST WORK WITH STATE AND

1659
01:03:33,160 --> 01:03:35,400
LOCAL REGULATORS TO IMPROVE

1660
01:03:35,400 --> 01:03:37,320
EDUCATION AND RESOURCES FOR

1661
01:03:37,320 --> 01:03:40,600
STROKE EDUCATION AND TRAINING

1662
01:03:40,600 --> 01:03:42,760
AMONG PREHOSPITAL PROVIDERS.

1663
01:03:42,760 --> 01:03:43,960
LASTLY, STATE-WIDE EFFORTS

1664
01:03:43,960 --> 01:03:46,160
SHOULD BE INCORPORATED TO

1665
01:03:46,160 --> 01:03:49,200
STANDARDIZE TRAINING AND

1666
01:03:49,200 --> 01:03:50,160
APPLICATION OF PREHOSPITAL

1667
01:03:50,160 --> 01:03:51,160
STROKE SKILLS.

1668
01:03:51,160 --> 01:03:52,560
THE THIRD AND FINAL PRIORITY

1669
01:03:52,560 --> 01:03:55,160
AREA IDENTIFIED BY THE SUBGROUP

1670
01:03:55,160 --> 01:03:56,880
WAS TO ADVOCATE FOR SUSTAINED

1671
01:03:56,880 --> 01:03:59,360
ACCESS AND SUSTAINABILITY OF

1672
01:03:59,360 --> 01:04:04,160
TELESTROKE SYSTEMS OF CARE THAT

1673
01:04:04,160 --> 01:04:05,720
SUPPORT HUB AND SPOKE MODELS OF

1674
01:04:05,720 --> 01:04:06,680
PREHOSPITAL AND INTERFACILITY

1675
01:04:06,680 --> 01:04:07,960
STROKE CARE, INCLUDING EXPANSION

1676
01:04:07,960 --> 01:04:12,200
INTO THE PREHOSPITAL SETTING.

1677
01:04:12,200 --> 01:04:13,320
WHILE TELESTROKE SYSTEMS ARE

1678
01:04:13,320 --> 01:04:15,520
DESIGNED TO ADDRESS GEOGRAPHIC

1679
01:04:15,520 --> 01:04:17,600
DISPARITIES IN HOSPITAL-BASED

1680
01:04:17,600 --> 01:04:20,200
ACUTE STROKE CARE, THEY'RE ALSO

1681
01:04:20,200 --> 01:04:23,960
RELEVANT TO PREHOSPITAL STROKE

1682
01:04:23,960 --> 01:04:26,560
CARE.

1683
01:04:26,560 --> 01:04:28,000
THIS MEANS WE NEED TO WORK WITH

1684
01:04:28,000 --> 01:04:34,400
POLICY MAKERS, PAYORS, INCLUDING

1685
01:04:34,400 --> 01:04:37,560
REIMBURSEMENT, AVAILABILITY OF

1686
01:04:37,560 --> 01:04:38,560
BROADBAND AND WIRELESS

1687
01:04:38,560 --> 01:04:38,960
INFRASTRUCTURE.

1688
01:04:38,960 --> 01:04:44,920
>> THE CHALLENGES AROUND TROLL

1689
01:04:44,920 --> 01:04:46,200
OF EMS IN THE U.S. ARE EXPLORED.

1690
01:04:46,200 --> 01:04:48,440
THIS AREA CAN BE COMPLEX AND

1691
01:04:48,440 --> 01:04:50,840
SOMETIMES CONFUSING, YET HAS THE

1692
01:04:50,840 --> 01:04:53,480
POTENTIAL TO RESULT IN LONG TERM

1693
01:04:53,480 --> 01:04:55,360
SUSTAINABLE INTERVENTIONS.

1694
01:04:55,360 --> 01:04:58,240
ALTHOUGH EMS PRACTITIONERS AND

1695
01:04:58,240 --> 01:04:59,880
AGENCY CERTIFICATIONS ARE

1696
01:04:59,880 --> 01:05:02,640
LARGELY REGULATED BY THE STATE,

1697
01:05:02,640 --> 01:05:04,160
MEDICAL PROTOCOLS ARE DETERMINED

1698
01:05:04,160 --> 01:05:06,560
AT THE LOCAL LEVEL.

1699
01:05:06,560 --> 01:05:09,280
FEDERAL ENTITIES SUCH AS THE

1700
01:05:09,280 --> 01:05:10,960
NATIONAL HIGHWAY AND

1701
01:05:10,960 --> 01:05:12,560
TRANSPORTATION SAFETY

1702
01:05:12,560 --> 01:05:14,200
ADMINISTRATION, THE FEDERAL

1703
01:05:14,200 --> 01:05:16,960
INTERAGENCY COMMITTEE ON EMS AND

1704
01:05:16,960 --> 01:05:19,760
THE NATIONAL EMS ADVISORY

1705
01:05:19,760 --> 01:05:21,560
COUNCIL ALSO PROVIDE GUIDANCE

1706
01:05:21,560 --> 01:05:24,280
AND COORDINATION AMONG REGIONAL

1707
01:05:24,280 --> 01:05:25,520
ENTITIES.

1708
01:05:25,520 --> 01:05:27,600
FEDERAL ENTITIES SUCH AS THE

1709
01:05:27,600 --> 01:05:28,760
NATIONAL HIGHWAY AND

1710
01:05:28,760 --> 01:05:30,560
TRANSPORTATION SAFETY

1711
01:05:30,560 --> 01:05:32,080
ADMINISTRATION, THE FEDERAL

1712
01:05:32,080 --> 01:05:34,640
INTERAGENCY COMMITTEE ON EMS,

1713
01:05:34,640 --> 01:05:37,160
AND THE NATIONAL EMS ADVISORY

1714
01:05:37,160 --> 01:05:38,720
COUNCIL ALSO PROVIDE GUIDANCE

1715
01:05:38,720 --> 01:05:40,760
AND COORDINATION AMONG REGIONAL

1716
01:05:40,760 --> 01:05:41,880
ENTITIES.

1717
01:05:41,880 --> 01:05:43,320
AS A RESULT OF THIS TIERED

1718
01:05:43,320 --> 01:05:47,080
SYSTEM OF REGULATION,

1719
01:05:47,080 --> 01:05:49,760
COORDINATION OF POLICY IS

1720
01:05:49,760 --> 01:05:51,320
VARIABLE AND FRAGMENTATION CAN

1721
01:05:51,320 --> 01:05:56,480
OCCUR EVEN WITHIN STATES.

1722
01:05:56,480 --> 01:05:58,040
WITHIN THE FIRST PRIORITY AREA,

1723
01:05:58,040 --> 01:05:59,440
MODIFICATION OF REIMBURSEMENT

1724
01:05:59,440 --> 01:06:01,440
MODELS, WE EXPLORE FEE SCHEDULES

1725
01:06:01,440 --> 01:06:03,200
FOR REIMBURSEMENT OF

1726
01:06:03,200 --> 01:06:04,160
PRE-HOSPITAL STROKE CARE AS A

1727
01:06:04,160 --> 01:06:06,360
FUNCTION OF PATIENT DECISION TO

1728
01:06:06,360 --> 01:06:08,400
ALLOW TRANSPORT, MILEAGE AND

1729
01:06:08,400 --> 01:06:09,360
COMPLEXITY OF CARE.

1730
01:06:09,360 --> 01:06:11,160
THE LITERATURE SUGGESTS THAT

1731
01:06:11,160 --> 01:06:13,360
CARE PROVIDED BY EMS FOR STROKE

1732
01:06:13,360 --> 01:06:15,600
MAY NOT REQUIRE NUMEROUS

1733
01:06:15,600 --> 01:06:17,280
CLINICAL PROCEDURES.

1734
01:06:17,280 --> 01:06:19,960
HOWEVER, EMS DECISION-MAKING FOR

1735
01:06:19,960 --> 01:06:21,480
STROKE PATIENTS CAN BE COMPLEX

1736
01:06:21,480 --> 01:06:24,600
AND MAY NOT BE FULLY ACCOUNTED

1737
01:06:24,600 --> 01:06:27,680
FOR IN CURRENT EMS REIMBURSEMENT

1738
01:06:27,680 --> 01:06:27,880
MODEL.

1739
01:06:27,880 --> 01:06:30,760
WITHIN THE SECOND PRIORITY AREA,

1740
01:06:30,760 --> 01:06:32,760
ALIGNMENT FOR REIMBURSEMENT AND

1741
01:06:32,760 --> 01:06:37,360
COMPLEXITY OF CARE, WE EX-PLR
EXPLORE

1742
01:06:37,360 --> 01:06:38,760
THE EVIDENCE REGARDING

1743
01:06:38,760 --> 01:06:39,960
PATIENT-CENTERED CARE MODELS,

1744
01:06:39,960 --> 01:06:43,400
LIKE CMS'S EMERGENCY TRIAGE,

1745
01:06:43,400 --> 01:06:44,600
TREAT AND TRANSPORT PROGRAM, AND

1746
01:06:44,600 --> 01:06:47,680
THE NATIONAL EMS QUALITY

1747
01:06:47,680 --> 01:06:48,560
ALLIANCE -- [INAUDIBLE].

1748
01:06:48,560 --> 01:06:50,400
WE CONSIDER THESE AS PREHOSPITAL

1749
01:06:50,400 --> 01:06:53,280
STROKE CARE MODELS FOR

1750
01:06:53,280 --> 01:06:54,360
DETERMINING REIMBURSEMENT RATHER

1751
01:06:54,360 --> 01:06:58,600
THAN RELIANCE ON PROCEDURE BASIS

1752
01:06:58,600 --> 01:07:00,120
AND TRANSPORT [INAUDIBLE].

1753
01:07:00,120 --> 01:07:01,800
IN OUR THIRD PRIORITY AREA, WE

1754
01:07:01,800 --> 01:07:02,760
EXPLORE EVIDENCE ON THE

1755
01:07:02,760 --> 01:07:04,240
INTEGRATION OF PREHOSPITAL

1756
01:07:04,240 --> 01:07:08,360
STROKE CARE DATA TO THE HOSPITAL

1757
01:07:08,360 --> 01:07:09,800
AND DISCHARGE OUTCOME.

1758
01:07:09,800 --> 01:07:11,400
INITIATIVES BY FEDERAL ENTITIES

1759
01:07:11,400 --> 01:07:16,360
LIKE THE CDC'S NATIONAL STROKE

1760
01:07:16,360 --> 01:07:18,440
PROGRAM, PRIVATE ORGANIZATIONS

1761
01:07:18,440 --> 01:07:19,800
AND INDIVIDUAL INVESTIGATORS

1762
01:07:19,800 --> 01:07:22,040
HAVE MADE STRIDES TO IMPROVE

1763
01:07:22,040 --> 01:07:23,640
DATA LANGUAGE.

1764
01:07:23,640 --> 01:07:24,920
HOWEVER, UNIVERSAL DATA

1765
01:07:24,920 --> 01:07:26,120
INTEGRATION HAS NOT BEEN

1766
01:07:26,120 --> 01:07:28,720
ACHIEVED TO DATE.

1767
01:07:28,720 --> 01:07:31,320
FRAGMENTATION IN PREHOSPITAL

1768
01:07:31,320 --> 01:07:32,160
REGULATION, REIMBURSEMENT AND

1769
01:07:32,160 --> 01:07:34,200
LINKAGE OF DATA CAN RESULT IN

1770
01:07:34,200 --> 01:07:35,600
DIFFERENTIAL ACCESS TO HIGH

1771
01:07:35,600 --> 01:07:38,680
QUALITY EMS CARE FOR PATIENTS.

1772
01:07:38,680 --> 01:07:40,880
THUS, SYSTEMATIC IMPLEMENTATION

1773
01:07:40,880 --> 01:07:42,760
OF PREHOSPITAL STROKE CARE

1774
01:07:42,760 --> 01:07:44,840
POLICIES AND REGULATIONS COULD

1775
01:07:44,840 --> 01:07:47,880
HELP DRIVE MORE EQUITABLE STROKE

1776
01:07:47,880 --> 01:07:48,080
CARE.

1777
01:07:48,080 --> 01:07:51,560
>> I'M NOW GOING TO TALK ABOUT

1778
01:07:51,560 --> 01:07:53,360
THE NEXT CROSS-CUTTING THEME,

1779
01:07:53,360 --> 01:07:55,760
AND THAT IS, ECONOMICS AND

1780
01:07:55,760 --> 01:07:59,960
HEALTHCARE RESOURCES.

1781
01:07:59,960 --> 01:08:01,560
SO BY WAY OF BACKGROUND, THIS IS

1782
01:08:01,560 --> 01:08:03,240
A COMPLEX TOPIC.

1783
01:08:03,240 --> 01:08:04,640
EMS REGULATION TAKES PLACE AT

1784
01:08:04,640 --> 01:08:07,720
THE STATE, TERRITORY OR LOCAL

1785
01:08:07,720 --> 01:08:09,920
LEVEL, STANDARDS ARE CREATED

1786
01:08:09,920 --> 01:08:12,160
PRIMARILY BY PROFESSIONAL

1787
01:08:12,160 --> 01:08:13,160
ORGANIZATIONS, PAYMENTS ARE

1788
01:08:13,160 --> 01:08:15,600
DRIVEN BY THE STATE, FEDERAL,

1789
01:08:15,600 --> 01:08:19,280
AND PRIVATE SOURCES.

1790
01:08:19,280 --> 01:08:21,000
ADDITIONALLY, PREHOSPITAL SAIR

1791
01:08:21,000 --> 01:08:23,960
SYSTEMS ARE INTERDEPENDENT WITH

1792
01:08:23,960 --> 01:08:26,960
HOSPITAL-BASED STROKE CARE.

1793
01:08:26,960 --> 01:08:29,360
VERY IMPORTANTLY, VARIABILITY IN

1794
01:08:29,360 --> 01:08:30,760
REGIONAL RESOURCE AVAILABILITY

1795
01:08:30,760 --> 01:08:32,840
IS ASSOCIATED WITH DISPARITIES

1796
01:08:32,840 --> 01:08:34,920
IN HEALTH OUTCOMES.

1797
01:08:34,920 --> 01:08:38,240
THESE DISPARITIES IMPACT RACIAL

1798
01:08:38,240 --> 01:08:39,640
AND ETHNIC MINORITY GROUPS,

1799
01:08:39,640 --> 01:08:42,760
RURAL AREAS, AND THE MOST

1800
01:08:42,760 --> 01:08:45,080
ECONOMICALLY DISADVANTAGED.

1801
01:08:45,080 --> 01:08:47,800
THIS SUBGROUP ALSO IDENTIFIED

1802
01:08:47,800 --> 01:08:50,640
THREE PRIORITY AREAS.

1803
01:08:50,640 --> 01:08:52,160
THE FIRST PRIORITY AREA

1804
01:08:52,160 --> 01:08:54,400
IDENTIFIED WAS TO ALIGN

1805
01:08:54,400 --> 01:08:56,480
PREHOSPITAL AND HOSPITAL BASED

1806
01:08:56,480 --> 01:08:58,400
STROKE CARE WITH THE BROADER

1807
01:08:58,400 --> 01:09:00,360
OBJECTIVE OF ENHANCING EMERGENCY

1808
01:09:00,360 --> 01:09:02,760
CRITICAL CARE SYSTEMS.

1809
01:09:02,760 --> 01:09:05,600
SIMPLY STATED, PREHOSPITAL CARE

1810
01:09:05,600 --> 01:09:07,960
IS A CENTRAL TOUCH POINT BETWEEN

1811
01:09:07,960 --> 01:09:09,160
THE COMMUNITY AND THE HEALTHCARE

1812
01:09:09,160 --> 01:09:10,360
SYSTEM.

1813
01:09:10,360 --> 01:09:12,000
DEVELOPING A MODEL THAT ALLOWS

1814
01:09:12,000 --> 01:09:13,880
FOR SHARED ACCOUNTABILITY FOR

1815
01:09:13,880 --> 01:09:16,880
HEALTH OUTCOMES AT THE COMMUNITY

1816
01:09:16,880 --> 01:09:19,000
LEVEL WOULD ALIGN INCENTIVES

1817
01:09:19,000 --> 01:09:20,360
AMONG KEY STAKEHOLDERS TO WORK

1818
01:09:20,360 --> 01:09:22,560
TOGETHER TO IMPROVE ACCESS TO

1819
01:09:22,560 --> 01:09:26,160
CARE AND OPTIMIZE OUTCOMES.

1820
01:09:26,160 --> 01:09:28,080
ADDITIONALLY, NEW REGULATORY,

1821
01:09:28,080 --> 01:09:30,560
PAYMENT AND WORKFORCE SOLUTIONS

1822
01:09:30,560 --> 01:09:31,800
TARGETING HEALTHCARE

1823
01:09:31,800 --> 01:09:33,560
PROFESSIONALS THAT COMMIT TO

1824
01:09:33,560 --> 01:09:35,240
TREATING PATIENTS IN UNDERSERVED

1825
01:09:35,240 --> 01:09:38,840
AREAS WOULD BE BENEFICIAL.

1826
01:09:38,840 --> 01:09:40,760
THE SECOND PRIORITY THIS

1827
01:09:40,760 --> 01:09:42,560
SUBGROUP IDENTIFIED WAS TO

1828
01:09:42,560 --> 01:09:44,240
DEVELOP NATIONAL AND LOCAL

1829
01:09:44,240 --> 01:09:46,120
LEGISLATION ENSURING

1830
01:09:46,120 --> 01:09:47,560
POPULATION-BASED PLANNING

1831
01:09:47,560 --> 01:09:49,080
SOLUTIONS THAT ARE DESIGNED TO

1832
01:09:49,080 --> 01:09:51,880
MEET THE STROKE NEEDS OF

1833
01:09:51,880 --> 01:09:52,600
COMMUNITIES INDEPENDENT OF THE

1834
01:09:52,600 --> 01:09:54,160
ECONOMICS.

1835
01:09:54,160 --> 01:09:57,880
AS THE SUBGROUP NOTES, WHILE

1836
01:09:57,880 --> 01:09:59,600
MOST PREHOSPITAL CARE IS

1837
01:09:59,600 --> 01:10:00,480
ORGANIZED AT THE COMMUNITY

1838
01:10:00,480 --> 01:10:02,280
LEVEL, HEALTHCARE IS PRIMARILY

1839
01:10:02,280 --> 01:10:03,160
FOCUSED ON THE INDIVIDUAL

1840
01:10:03,160 --> 01:10:04,560
PATIENT CARE LEVEL.

1841
01:10:04,560 --> 01:10:06,400
THE TASK FORCE BELIEVES THAT

1842
01:10:06,400 --> 01:10:07,480
NATIONAL LEGISLATION COULD

1843
01:10:07,480 --> 01:10:09,360
CREATE A PATHWAY FROM

1844
01:10:09,360 --> 01:10:10,880
MEASUREMENT TO IMPLEMENTATION OF

1845
01:10:10,880 --> 01:10:13,480
BEST PRACTICES, AS WELL AS

1846
01:10:13,480 --> 01:10:16,000
MANDATE PUBLIC REPORTING OF THE

1847
01:10:16,000 --> 01:10:17,080
VARIABILITY IN REGIONAL

1848
01:10:17,080 --> 01:10:18,640
RESOURCES.

1849
01:10:18,640 --> 01:10:20,200
THIS COULD IMPROVE OUR

1850
01:10:20,200 --> 01:10:22,000
UNDERSTANDING OF HOW THE

1851
01:10:22,000 --> 01:10:23,360
UNDERLYING ECONOMIC DRIVERS OF

1852
01:10:23,360 --> 01:10:25,960
HEALTHCARE RESOURCE ALLOCATION

1853
01:10:25,960 --> 01:10:26,880
IMPACTS THE DISPARITIES IN

1854
01:10:26,880 --> 01:10:32,440
HEALTH OUTCOMES.

1855
01:10:32,440 --> 01:10:33,520
THE THIRD AND FINAL PRIORITY

1856
01:10:33,520 --> 01:10:35,080
AREA DEVELOPED BY THIS SUBGROUP

1857
01:10:35,080 --> 01:10:37,400
WAS TO DEVELOP A NATIONAL STROKE

1858
01:10:37,400 --> 01:10:42,160
REGISTRY IN ORDER TO BETTER

1859
01:10:42,160 --> 01:10:43,440
UNDERSTAND THE ROLE OF

1860
01:10:43,440 --> 01:10:45,760
COMMUNITY, ECONOMIC, AND HEALTH

1861
01:10:45,760 --> 01:10:47,520
SYSTEMS FACTORS DRIVING STROKE

1862
01:10:47,520 --> 01:10:49,680
OUTCOMES.

1863
01:10:49,680 --> 01:10:51,320
THE STROKE REGISTRY ENSURES THAT

1864
01:10:51,320 --> 01:10:52,760
ECONOMIC BIAS IS INTRODUCED INTO

1865
01:10:52,760 --> 01:10:54,560
STROKE CARE BECAUSE RESOURCE

1866
01:10:54,560 --> 01:10:57,960
CENTERS ARE MORE INCLINED TO

1867
01:10:57,960 --> 01:10:59,520
PARTICIPATE IN VOLUNTARY

1868
01:10:59,520 --> 01:11:00,840
REGISTRIES.

1869
01:11:00,840 --> 01:11:02,960
HEALTHCARE RESOURCES ARE

1870
01:11:02,960 --> 01:11:04,280
PARTICULARLY SHORT IN MINORITY

1871
01:11:04,280 --> 01:11:04,800
POPULATIONS.

1872
01:11:04,800 --> 01:11:06,880
THE LACK OF REPRESENTATIVE DATA

1873
01:11:06,880 --> 01:11:09,760
FROM UNDERRESOURCED AREAS LIMIT

1874
01:11:09,760 --> 01:11:11,160
THE ABILITY TO DEVELOP

1875
01:11:11,160 --> 01:11:12,880
MEANINGFUL METRICS TO INFORM

1876
01:11:12,880 --> 01:11:16,600
NATIONAL POLICIES.

1877
01:11:16,600 --> 01:11:18,360
AND STANDARDS AROUND VALUE BASED

1878
01:11:18,360 --> 01:11:19,320
REIMBURSEMENT.

1879
01:11:19,320 --> 01:11:21,080
AND EMS PROTOCOLS AND TELESTROKE

1880
01:11:21,080 --> 01:11:22,800
UTILIZATION AND OTHER AREAS.

1881
01:11:22,800 --> 01:11:24,560
THE ESTABLISHMENT OF A NATIONAL

1882
01:11:24,560 --> 01:11:28,240
STROKE REGISTRY WOULD PROVIDE

1883
01:11:28,240 --> 01:11:29,360
REALTIME DATA ON THE CARE

1884
01:11:29,360 --> 01:11:31,720
RENDERED TO STROKE PATIENTS.

1885
01:11:31,720 --> 01:11:33,520
>> IN THE FOURTH CROSS-CUTTING

1886
01:11:33,520 --> 01:11:38,000
THEME, DEMOGRAPHICS, WE IDENTIFY

1887
01:11:38,000 --> 01:11:39,120
COMMUNITY INCREASED HOSPITAL

1888
01:11:39,120 --> 01:11:40,840
RELATED FACTORS ASSOCIATED WITH

1889
01:11:40,840 --> 01:11:44,280
SEX AND GENDER, RACE AND

1890
01:11:44,280 --> 01:11:46,640
ETHNICITY, SOCIOECONOMIC STATUS

1891
01:11:46,640 --> 01:11:48,640
AND INSURANCE STATUS DISPARITIES

1892
01:11:48,640 --> 01:11:51,920
SEEN IN STROKE TREATMENT.

1893
01:11:51,920 --> 01:11:54,440
IN THE FIRST PRIORITY AREA, WE

1894
01:11:54,440 --> 01:11:56,960
EXPLORE THE LITERATURE ON

1895
01:11:56,960 --> 01:11:58,920
SYSTEMATIC, HIGH QUALITY DATA

1896
01:11:58,920 --> 01:12:00,080
COLLECTION.

1897
01:12:00,080 --> 01:12:03,080
DATA ARE ESSENTIAL TO EVALUATE

1898
01:12:03,080 --> 01:12:04,800
EMS PERFORMANCE, IDENTIFY AREAS

1899
01:12:04,800 --> 01:12:08,040
OF IMPROVEMENT, AND TO EXAMINE

1900
01:12:08,040 --> 01:12:09,280
THE EFFECTS OF CONTINUOUS

1901
01:12:09,280 --> 01:12:10,840
QUALITY IMPROVEMENT.

1902
01:12:10,840 --> 01:12:13,360
DATA MAY ALSO LEAD TO THE

1903
01:12:13,360 --> 01:12:14,840
IDENTIFICATION OF DEMOGRAPHIC

1904
01:12:14,840 --> 01:12:17,280
DISPARITIES AT THE LOCAL LEVEL,

1905
01:12:17,280 --> 01:12:18,720
PROVIDING OPPORTUNITIES FOR

1906
01:12:18,720 --> 01:12:21,280
INTERVENTIONS AIMED AT

1907
01:12:21,280 --> 01:12:22,400
STANDARDIZING STROKE CARE

1908
01:12:22,400 --> 01:12:23,840
OUTCOMES FOR ALL.

1909
01:12:23,840 --> 01:12:28,440
IN THE SECOND PRIORITY AREA,

1910
01:12:28,440 --> 01:12:29,760
PROGRAMS AND PRACTICES THAT

1911
01:12:29,760 --> 01:12:31,160
EDUCATE THE PUBLIC ABOUT STROKE

1912
01:12:31,160 --> 01:12:32,240
CARE ARE REVIEWED.

1913
01:12:32,240 --> 01:12:35,360
PUBLIC AWARENESS AND EDUCATIONAL

1914
01:12:35,360 --> 01:12:37,480
ACTIVITIES HAVE BEEN REGARDED AS

1915
01:12:37,480 --> 01:12:39,240
INTEGRAL FOR THE EARLY

1916
01:12:39,240 --> 01:12:40,880
IDENTIFICATION OF STROKE AND

1917
01:12:40,880 --> 01:12:43,440
EARLY ACTIVATION OF THE

1918
01:12:43,440 --> 01:12:44,880
PREHOSPITAL STROKE SYSTEM.

1919
01:12:44,880 --> 01:12:46,920
WHILE SUCH INTERVENTIONS MAY

1920
01:12:46,920 --> 01:12:48,840
INCREASE STROKE KNOWLEDGE,

1921
01:12:48,840 --> 01:12:50,920
LIMITATIONS MAY EXIST IN THE

1922
01:12:50,920 --> 01:12:52,960
LINKAGE TO BEHAVIOR CHANGE IN

1923
01:12:52,960 --> 01:12:54,160
MEDICALLY UNDERSERVED

1924
01:12:54,160 --> 01:12:55,760
POPULATIONS.

1925
01:12:55,760 --> 01:12:57,560
FURTHER, TAILORED INTERVENTIONS

1926
01:12:57,560 --> 01:13:02,040
MAY BE NECESSARY TO INCREASE

1927
01:13:02,040 --> 01:13:02,880
UNDERSERVED COMMUNITIES'

1928
01:13:02,880 --> 01:13:06,760
UNDERSTANDING AND TRUST OF

1929
01:13:06,760 --> 01:13:08,000
PREHOSPITAL STROKE SYSTEMS.

1930
01:13:08,000 --> 01:13:09,000
FURTHER, TAILORED INTERVENTIONS

1931
01:13:09,000 --> 01:13:12,520
MAY BE NECESSARY TO INCREASE

1932
01:13:12,520 --> 01:13:13,280
UNDERSERVED COMMUNITIES'

1933
01:13:13,280 --> 01:13:14,920
UNDERSTANDING AND TRUST OF

1934
01:13:14,920 --> 01:13:16,360
PREHOSPITAL STROKE SYSTEMS.

1935
01:13:16,360 --> 01:13:19,360
IN THE THIRD PRIORITY AREA FOR

1936
01:13:19,360 --> 01:13:22,960
THE DEMOGRAPHIC THEME, EMS

1937
01:13:22,960 --> 01:13:23,800
WORKFORCE DIVERSITY AND HEALTH

1938
01:13:23,800 --> 01:13:26,040
EQUITY TRAINING ARE REVIEWED.

1939
01:13:26,040 --> 01:13:28,440
HAVING A DIVERSE WORKFORCE CAN

1940
01:13:28,440 --> 01:13:30,000
BE ASSOCIATED WITH IMPROVED

1941
01:13:30,000 --> 01:13:33,920
ACCESS TO MEDICAL CARE FOR THOSE

1942
01:13:33,920 --> 01:13:35,920
IN RACIAL AND ETHNIC MINORITY

1943
01:13:35,920 --> 01:13:37,160
COMMUNITIES.

1944
01:13:37,160 --> 01:13:40,120
GREATER PATIENT CHOICE AND

1945
01:13:40,120 --> 01:13:41,160
SATISFACTION, IMPROVEMENT IN THE

1946
01:13:41,160 --> 01:13:43,480
REPORTED QUALITY OF CARE AND

1947
01:13:43,480 --> 01:13:44,760
INCREASED INTEREST IN THE SYSTEM

1948
01:13:44,760 --> 01:13:47,880
OF CARE.

1949
01:13:47,880 --> 01:13:50,560
PUBLIC EDUCATION CAMPAIGNS AND

1950
01:13:50,560 --> 01:13:51,520
INITIATIVES THAT SUPPORT

1951
01:13:51,520 --> 01:13:52,320
BEHAVIOR CHANGE IN COMMUNITIES

1952
01:13:52,320 --> 01:13:55,000
CAN BE INFORMED BY ACCESSING AND

1953
01:13:55,000 --> 01:13:58,080
INTERPRETING HIGH QUALITY DATA.

1954
01:13:58,080 --> 01:14:01,160
SYSTEMATIC COLLECTION OF

1955
01:14:01,160 --> 01:14:04,280
PREHOSPITAL DATA STARTS WITH A

1956
01:14:04,280 --> 01:14:07,280
DIVERSE, WELL TRAINED EMS

1957
01:14:07,280 --> 01:14:08,400
WORKFORCE THAT MAY SERVE AS THE

1958
01:14:08,400 --> 01:14:09,760
INITIAL ENTRY POINT INTO THE

1959
01:14:09,760 --> 01:14:11,360
HEALTHCARE SYSTEM, AND A

1960
01:14:11,360 --> 01:14:13,120
COMMUNITY RESOURCE PROVIDING

1961
01:14:13,120 --> 01:14:14,200
EQUITABLE ACCESS TO HIGH QUALITY

1962
01:14:14,200 --> 01:14:16,880
CARE.

1963
01:14:16,880 --> 01:14:18,160
>> HAVING GONE THROUGH THE

1964
01:14:18,160 --> 01:14:20,480
DIFFERENT CROSS-CUTTING THEMES

1965
01:14:20,480 --> 01:14:21,760
WITHIN THE PREHOSPITAL TASK

1966
01:14:21,760 --> 01:14:23,360
FORCE, I'D LIKE TO NOW PROVIDE

1967
01:14:23,360 --> 01:14:24,840
YOU WITH A SUMMARY OF THE KEY

1968
01:14:24,840 --> 01:14:26,760
FINDINGS.

1969
01:14:26,760 --> 01:14:28,840
THE PREHOSPITAL TASK FORCE

1970
01:14:28,840 --> 01:14:29,560
IDENTIFIED 10 SEPARATE KEY

1971
01:14:29,560 --> 01:14:32,880
FINDINGS.

1972
01:14:32,880 --> 01:14:34,480
FIRST, SPECIFIC STROKE SYSTEMS

1973
01:14:34,480 --> 01:14:37,320
OF CARE NEED TO BE OPTIMALLY

1974
01:14:37,320 --> 01:14:40,000
DESIGNED FOR SPECIFIC RURAL,

1975
01:14:40,000 --> 01:14:42,960
URBAN, AND SUBURBAN REGIONS.

1976
01:14:42,960 --> 01:14:45,000
SECOND, WE NEED TO ASSESS STROKE

1977
01:14:45,000 --> 01:14:46,960
EDUCATION AND TRAINING NEEDS

1978
01:14:46,960 --> 01:14:48,880
AMONG PREHOSPITAL CARE PROVIDERS

1979
01:14:48,880 --> 01:14:50,040
TO STANDARDIZE CARE IN A

1980
01:14:50,040 --> 01:14:53,360
SPECIFIC REGION.

1981
01:14:53,360 --> 01:14:54,560
THIRD, TELESTROKE SYSTEMS OF

1982
01:14:54,560 --> 01:14:56,640
CARE SHOULD EXPAND INTO THE

1983
01:14:56,640 --> 01:14:59,480
PREHOSPITAL SETTING.

1984
01:14:59,480 --> 01:15:01,480
FOURTH, EMS REIMBURSEMENT MODELS

1985
01:15:01,480 --> 01:15:04,160
NEED TO BE MODIFIED TO

1986
01:15:04,160 --> 01:15:05,880
APPROPRIATELY REFLECT AND ALIGN

1987
01:15:05,880 --> 01:15:07,960
WITH THE COMPLEX DECISION-MAKING

1988
01:15:07,960 --> 01:15:09,440
THAT OCCURS WITH POTENTIAL

1989
01:15:09,440 --> 01:15:10,440
STROKE PATIENTS IN THE

1990
01:15:10,440 --> 01:15:13,800
PREHOSPITAL SETTING.

1991
01:15:13,800 --> 01:15:16,120
FIFTH, PREHOSPITAL PATIENT CARE

1992
01:15:16,120 --> 01:15:18,280
REPORTS NEED TO BE LINKED AND

1993
01:15:18,280 --> 01:15:20,080
INTEGRATED WITH HOSPITAL PATIENT

1994
01:15:20,080 --> 01:15:23,760
CARE REPORTS AND OUTCOMES.

1995
01:15:23,760 --> 01:15:25,280
SIXTH, WE NEED TO ESTABLISH A

1996
01:15:25,280 --> 01:15:29,440
NATIONAL STROKE REGISTRY.

1997
01:15:29,440 --> 01:15:30,960
SEVENTH, ESTABLISH NATIONAL

1998
01:15:30,960 --> 01:15:32,680
STROKE STANDARDS FOR PREHOSPITAL

1999
01:15:32,680 --> 01:15:35,040
CARE.

2000
01:15:35,040 --> 01:15:37,640
EIGHTH, WE NEED TO ENHANCE

2001
01:15:37,640 --> 01:15:39,040
REGISTRY DATA AT THE STATE AND

2002
01:15:39,040 --> 01:15:42,920
LOCAL LEVELS.

2003
01:15:42,920 --> 01:15:45,800
NINTH, WE NEED TO EXPAND AND

2004
01:15:45,800 --> 01:15:47,280
ENHANCE CULTURALLY SENSITIVE,

2005
01:15:47,280 --> 01:15:49,400
SUSTAINABLE STROKE MESSAGING TO

2006
01:15:49,400 --> 01:15:49,840
THE PUBLIC.

2007
01:15:49,840 --> 01:15:53,080
AND LASTLY, WE NEED TO PROMOTE

2008
01:15:53,080 --> 01:15:59,960
EMS WORKFORCE DIVERSITY.

2009
01:15:59,960 --> 01:16:01,360
HAVING GONE THROUGH THE SUMMARY

2010
01:16:01,360 --> 01:16:02,760
ITEMS PUT FORTH BY THE

2011
01:16:02,760 --> 01:16:04,640
PREHOSPITAL TASK FORCE, WE'RE

2012
01:16:04,640 --> 01:16:05,840
LEFT WITH SOME ACTIONS,

2013
01:16:05,840 --> 01:16:06,240
OPPORTUNITIES AND

2014
01:16:06,240 --> 01:16:09,040
RECOMMENDATIONS.

2015
01:16:09,040 --> 01:16:10,480
THE PREHOSPITAL TASK FORCE BROKE

2016
01:16:10,480 --> 01:16:11,760
THESE RECOMMENDATIONS DOWN VERY

2017
01:16:11,760 --> 01:16:15,800
BROADLY INTO THREE CATEGORIES.

2018
01:16:15,800 --> 01:16:17,760
EDUCATION/TRAINING, SYSTEMS AND

2019
01:16:17,760 --> 01:16:18,760
STRUCTURE, AND GOVERNMENT AND

2020
01:16:18,760 --> 01:16:22,800
REG WILL TRI OPPORTUNITIES.

2021
01:16:22,800 --> 01:16:23,360
REGULATORY OPPORTUNITIES.

2022
01:16:23,360 --> 01:16:24,440
LET ME HIT A FEW OF THE

2023
01:16:24,440 --> 01:16:24,840
HIGHLIGHTS.

2024
01:16:24,840 --> 01:16:26,160
I'LL START WITH EDUCATION AND

2025
01:16:26,160 --> 01:16:26,760
TRAINING.

2026
01:16:26,760 --> 01:16:28,880
WE NEED TO ENLANCE TRAINING FOR

2027
01:16:28,880 --> 01:16:31,080
UNDERSERVED AREAS.

2028
01:16:31,080 --> 01:16:33,320
AS NATIONALLY VALIDATED

2029
01:16:33,320 --> 01:16:35,160
PREHOSPITAL STROKE SCALES

2030
01:16:35,160 --> 01:16:37,160
EVOLVE, THERE NEEDS TO BE

2031
01:16:37,160 --> 01:16:39,480
IMPLEMENTATION OF STATEWIDE

2032
01:16:39,480 --> 01:16:40,760
POLICIES PROMULGATING THE USE OF

2033
01:16:40,760 --> 01:16:44,360
SUCH SCALES.

2034
01:16:44,360 --> 01:16:46,000
WITHIN THE SYSTEMS AND STRUCTURE

2035
01:16:46,000 --> 01:16:47,520
CATEGORY, WE NEED TO ENCOURAGE

2036
01:16:47,520 --> 01:16:51,000
RESEARCH THAT FURTHER OPTIMIZES

2037
01:16:51,000 --> 01:16:52,800
REALTIME ADAPTIVE PREHOSPITAL

2038
01:16:52,800 --> 01:16:55,520
ROUTING ALGORITHMS.

2039
01:16:55,520 --> 01:16:58,320
WE NEED TO ENHANCE ACCESS TO

2040
01:16:58,320 --> 01:17:01,240
PRESTROKE HOSPITAL RESEARCH AND

2041
01:17:01,240 --> 01:17:01,920
PROMOTE GEOGRAPHIC SPECIFIC

2042
01:17:01,920 --> 01:17:02,760
HOSPITAL TRIAGE PROGRAMS.

2043
01:17:02,760 --> 01:17:05,200
WE NEED TO STANDARDIZE

2044
01:17:05,200 --> 01:17:05,840
PREHOSPITAL COMMUNICATIONS

2045
01:17:05,840 --> 01:17:08,560
WITHIN STROKE SYSTEMS OF CARE,

2046
01:17:08,560 --> 01:17:11,200
AND INCORPORATE COMMUNITY

2047
01:17:11,200 --> 01:17:12,360
PARAMEDICINE AND LOCAL

2048
01:17:12,360 --> 01:17:13,920
PARTNERSHIPS INTO THOSE STROKE

2049
01:17:13,920 --> 01:17:14,360
SYSTEMS OF CARE.

2050
01:17:14,360 --> 01:17:18,520
AND LASTLY, WE NEED TO ESTABLISH

2051
01:17:18,520 --> 01:17:20,200
LINKAGES BETWEEN PREHOSPITAL AND

2052
01:17:20,200 --> 01:17:22,640
HOSPITAL PATIENT CARE RECORDS.

2053
01:17:22,640 --> 01:17:24,760
THEN IN THE GOVERNMENT AND

2054
01:17:24,760 --> 01:17:26,560
REGULATORY CATEGORY, WE NEED

2055
01:17:26,560 --> 01:17:28,440
LEGISLATION TO PROMOTE

2056
01:17:28,440 --> 01:17:31,080
STANDARDIZED EMS PROTOCOLS AND

2057
01:17:31,080 --> 01:17:34,200
REGIONALIZATION OF PREHOSPITAL

2058
01:17:34,200 --> 01:17:34,720
STROKE CARE.

2059
01:17:34,720 --> 01:17:37,600
THE TASK FORCE ADVOCATES FOR

2060
01:17:37,600 --> 01:17:39,520
POLICIES, LEGISLATION, AND

2061
01:17:39,520 --> 01:17:41,080
RESOURCES TO SUPPORT THE

2062
01:17:41,080 --> 01:17:43,120
CREATION OF STATE OR COMMUNITY

2063
01:17:43,120 --> 01:17:46,000
LEVEL STROKE REGISTRIES, TO LINK

2064
01:17:46,000 --> 01:17:47,240
PREHOSPITAL DATA METRICS TO

2065
01:17:47,240 --> 01:17:49,360
HEALTH SYSTEM OUTCOMES, AND TO

2066
01:17:49,360 --> 01:17:51,960
SERVE AS A BASIS FOR POLICY

2067
01:17:51,960 --> 01:17:53,160
DEVELOPMENT AND CONTINUING

2068
01:17:53,160 --> 01:17:55,760
QUALITY IMPROVEMENT INITIATIVES.

2069
01:17:55,760 --> 01:17:58,360
WE NEED TO PROVIDE GUIDANCE TO

2070
01:17:58,360 --> 01:17:59,400
STATES REGARDING MINIMUM

2071
01:17:59,400 --> 01:18:00,760
ELEMENTS REQUIRED FOR

2072
01:18:00,760 --> 01:18:02,400
PREHOSPITAL STROKE SYSTEMS OF

2073
01:18:02,400 --> 01:18:06,120
CARE, AND FINALLY, WE NEED TO

2074
01:18:06,120 --> 01:18:07,920
SUPPORT EVOLUTION OF CMS

2075
01:18:07,920 --> 01:18:09,320
REIMBURSEMENT GUIDELINES THAT

2076
01:18:09,320 --> 01:18:11,600
PROMOTE REIMBURSEMENT FOR

2077
01:18:11,600 --> 01:18:13,160
PREHOSPITAL CARE COMMENSURATE

2078
01:18:13,160 --> 01:18:16,080
WITH THE LEVEL OF CARE PROVIDED.

2079
01:18:16,080 --> 01:18:18,440
THAT'S IT FROM THE PREHOSPITAL

2080
01:18:18,440 --> 01:18:19,160
TASK FORCE.

2081
01:18:19,160 --> 01:18:21,120
WE HOPE YOU FOUND THIS VALUABLE

2082
01:18:21,120 --> 01:18:23,760
AND WE GREATLY APPRECIATE YOUR

2083
01:18:23,760 --> 01:18:31,760
PARTICIPATION IN OUR SYMPOSIUM.

2084
01:18:31,760 --> 01:18:34,000
>> THANK YOU SO

2085
01:18:34,000 --> 01:18:39,000
MUCH FOR JOINING THIS

2086
01:18:39,000 --> 01:18:39,680
PREHOSPITAL SECTION.

2087
01:18:39,680 --> 01:18:42,000
I GUESS SO NOW WE'LL BEGIN THE Q

2088
01:18:42,000 --> 01:18:44,600
& A SESSION.

2089
01:18:44,600 --> 01:18:49,760
I HAVE A CO-HOST JOINING TODAY,

2090
01:18:49,760 --> 01:18:50,720
CHARLES, IF YOU'RE ON THE LINE,

2091
01:18:50,720 --> 01:18:56,600
YOU CAN ALSO JOIN.

2092
01:18:56,600 --> 01:18:58,200
AND WE CAN GO AHEAD AND GET

2093
01:18:58,200 --> 01:18:59,840
STARTED WITH SOME Q & As

2094
01:18:59,840 --> 01:19:02,800
BEFORE WE GO TO OUR BREAKOUT

2095
01:19:02,800 --> 01:19:07,520
SESSION.

2096
01:19:07,520 --> 01:19:12,200
>> DR. ODOM OR COLONEL ODOM, IS

2097
01:19:12,200 --> 01:19:12,360
IT?

2098
01:19:12,360 --> 01:19:12,800
>> IT'S COMMANDER.

2099
01:19:12,800 --> 01:19:14,400
THANK YOU SO MUCH.

2100
01:19:14,400 --> 01:19:18,960
>> IT'S MARK ALBERT.

2101
01:19:18,960 --> 01:19:20,400
THANK YOU AND TODD AND YOUR

2102
01:19:20,400 --> 01:19:21,480
COLLEAGUES FOR PUTTING TOGETHER

2103
01:19:21,480 --> 01:19:23,640
THIS REALLY SPECTACULAR

2104
01:19:23,640 --> 01:19:24,160
PRESENTATION.

2105
01:19:24,160 --> 01:19:26,040
I MEAN, I AGREE WITH SO MUCH OF

2106
01:19:26,040 --> 01:19:31,680
WHAT YOU SAID SAID HAVING TO

2107
01:19:31,680 --> 01:19:33,000
DEAL WITH THIS IN THE VARIOUS

2108
01:19:33,000 --> 01:19:34,800
STATES I'VE LIVED AND WORKED IN.

2109
01:19:34,800 --> 01:19:35,720
JUST A COUPLE QUESTIONS OR

2110
01:19:35,720 --> 01:19:39,800
COMMENTS.

2111
01:19:39,800 --> 01:19:41,680
I DIDN'T HEAR MUCH, AND AGAIN, I

2112
01:19:41,680 --> 01:19:43,080
MIGHT HAVE MISSED IT, AUDIO

2113
01:19:43,080 --> 01:19:44,400
FADES IN AND OUT, I DIDN'T HEAR

2114
01:19:44,400 --> 01:19:46,200
MUCH ABOUT MOBILE STROKE UNITS.

2115
01:19:46,200 --> 01:19:47,520
DID YOU TOUCH ON THAT?

2116
01:19:47,520 --> 01:19:48,560
DID I MISS IT?

2117
01:19:48,560 --> 01:19:51,040
DO YOU NOT SEE THAT AS IMPORTANT

2118
01:19:51,040 --> 01:19:53,640
IN THE CARE PARADIGMS?

2119
01:19:53,640 --> 01:19:55,680
WHAT'S YOUR PERCEPTION OF THE

2120
01:19:55,680 --> 01:19:58,000
PLACE OF THAT MOBILE STROKE

2121
01:19:58,000 --> 01:20:00,000
UNITS COULD OR WOULD OR

2122
01:20:00,000 --> 01:20:01,240
SHOULDN'T PLAY IN THIS WHOLE

2123
01:20:01,240 --> 01:20:07,120
CARE PARADIGM?

2124
01:20:07,120 --> 01:20:08,320
>> HI, MARK.

2125
01:20:08,320 --> 01:20:10,960
THAT'S A GREAT QUESTION.

2126
01:20:10,960 --> 01:20:12,200
ERIKA, UNLESS YOU WANT TO

2127
01:20:12,200 --> 01:20:13,240
RESPOND FIRST, I'M HAPPY TO

2128
01:20:13,240 --> 01:20:16,000
OFFER AN INITIAL RESPONSE.

2129
01:20:16,000 --> 01:20:19,080
I THINK, YOU KNOW, THERE IS

2130
01:20:19,080 --> 01:20:21,760
GREAT POTENTIAL AND IMPORTANCE

2131
01:20:21,760 --> 01:20:22,880
PERSONALLY FOR MOBILE STROKE

2132
01:20:22,880 --> 01:20:24,600
UNITS BEING INCORPORATED INTO

2133
01:20:24,600 --> 01:20:27,000
THESE SCHEMES.

2134
01:20:27,000 --> 01:20:29,360
AS WAS TALKED ABOUT AND AS

2135
01:20:29,360 --> 01:20:32,160
RECENT PUBLICATIONS HAVE

2136
01:20:32,160 --> 01:20:33,040
ADDRESSED, PATIENTS IN RURAL

2137
01:20:33,040 --> 01:20:35,200
AREAS HAVE THE LONGEST DISTANCES

2138
01:20:35,200 --> 01:20:37,640
TO TRAVEL TO RECEIVE ACCESS TO

2139
01:20:37,640 --> 01:20:38,040
STROKE CARE.

2140
01:20:38,040 --> 01:20:41,400
AND THE QUESTION IN THE CHAT

2141
01:20:41,400 --> 01:20:42,520
BOXY SAW THAT SOMEONE HAD A

2142
01:20:42,520 --> 01:20:43,800
QUESTION ABOUT NATIVE AMERICAN

2143
01:20:43,800 --> 01:20:45,000
POPULATIONS AS WELL.

2144
01:20:45,000 --> 01:20:50,600
AND SIMILARLY, IN THIS RECENT

2145
01:20:50,600 --> 01:20:51,800
STUDY, NATIVE AMERICANS LIKEWISE

2146
01:20:51,800 --> 01:20:54,600
HAD THE LONGEST TRAVEL TIME TO

2147
01:20:54,600 --> 01:20:55,640
RECEIVING STROKE CARE.

2148
01:20:55,640 --> 01:20:59,000
SO POTENTIALLY, MOBILE STROKE

2149
01:20:59,000 --> 01:21:02,280
UNITS CAN BE FURTHER --

2150
01:21:02,280 --> 01:21:04,520
UTILIZATION CAN BE FURTHER

2151
01:21:04,520 --> 01:21:05,680
ENHANCED TO BRIDGE THESE

2152
01:21:05,680 --> 01:21:10,080
DISTANCE AND TRAVEL GAPS THAT

2153
01:21:10,080 --> 01:21:10,600
MAY EXIST.

2154
01:21:10,600 --> 01:21:12,840
THERE ARE SOME POTENTIAL NOVEL

2155
01:21:12,840 --> 01:21:15,400
THINGS THAT MAY BE COMING DOWN

2156
01:21:15,400 --> 01:21:16,600
THE PIKE.

2157
01:21:16,600 --> 01:21:17,960
THERE'S BEEN A VEN TOOR CAPITAL

2158
01:21:17,960 --> 01:21:19,480
COMPANY THAT AS RECENTLY AS LAST

2159
01:21:19,480 --> 01:21:23,000
NOVEMBER, I THINK, WAS TRIALING

2160
01:21:23,000 --> 01:21:26,080
A TELE-911 SYSTEM BY WHICH --

2161
01:21:26,080 --> 01:21:28,080
THERE WAS, FOR BACKGROUND

2162
01:21:28,080 --> 01:21:31,040
OBVIOUSLY IN TODD AND ERIKA'S

2163
01:21:31,040 --> 01:21:32,120
PRESENTATION AND THE WORK GROUP

2164
01:21:32,120 --> 01:21:33,360
REPORT DISCUSSION ABOUT

2165
01:21:33,360 --> 01:21:35,800
TELEMEDICINE BEING UTILIZED ON

2166
01:21:35,800 --> 01:21:36,520
AMBULANCES.

2167
01:21:36,520 --> 01:21:39,200
WHAT THIS COMPANY IS

2168
01:21:39,200 --> 01:21:40,200
INVESTIGATING IS WHETHER OR NOT

2169
01:21:40,200 --> 01:21:41,880
TELEMEDICINE COULD BE UTILIZED

2170
01:21:41,880 --> 01:21:45,600
BY DISPATCHERS BEFORE AMBULANCES

2171
01:21:45,600 --> 01:21:47,480
EVEN ARRIVE ON SITE.

2172
01:21:47,480 --> 01:21:49,240
THE ORIGINAL INTENTIONS ARE TO

2173
01:21:49,240 --> 01:21:51,400
SEE IF PATIENTS CAN BE TRIAGED

2174
01:21:51,400 --> 01:21:54,280
TO AN URGENT CARE CENTER OR

2175
01:21:54,280 --> 01:21:56,200
MANAGED AT HOME, BUT THERE IS

2176
01:21:56,200 --> 01:21:58,600
POTENTIAL GREAT UTILITY IF THIS

2177
01:21:58,600 --> 01:22:01,400
DOES TRANSLATE TO BECOME USED ON

2178
01:22:01,400 --> 01:22:03,920
A MORE WIDESPREAD BASIS FOR

2179
01:22:03,920 --> 01:22:07,440
USING TELE-911 TO ASSESS STROKE

2180
01:22:07,440 --> 01:22:08,360
PATIENTS.

2181
01:22:08,360 --> 01:22:09,840
AND THAT POTENTIALLY COULD THEN

2182
01:22:09,840 --> 01:22:15,920
LEAD TO DOWNSTREAM EFFECTS OF

2183
01:22:15,920 --> 01:22:17,840
DISPATCH DECISIONS FOR WHAT

2184
01:22:17,840 --> 01:22:20,920
LEVEL OF AMBULANCE OR MOBILE

2185
01:22:20,920 --> 01:22:23,800
STROKE UNIT IS DISPATCHED TO THE

2186
01:22:23,800 --> 01:22:25,800
XENOAND WHETHER OR NOT AS WAS

2187
01:22:25,800 --> 01:22:27,520
DISCUSSED BY THE WORK GROUP AS

2188
01:22:27,520 --> 01:22:29,200
WELL, WHETHER OR NOT DOWNSTREAM

2189
01:22:29,200 --> 01:22:34,040
ROUTING DECISIONS ARE THEN

2190
01:22:34,040 --> 01:22:36,320
IMPLEMENTED AS WELL BASED UPON

2191
01:22:36,320 --> 01:22:39,040
THE PREDICTABILITY OF A LARGE

2192
01:22:39,040 --> 01:22:39,840
VESSEL OCCLUSION.

2193
01:22:39,840 --> 01:22:41,840
AND JUST FOR BACKGROUND FOR THE

2194
01:22:41,840 --> 01:22:42,880
NON-CLINICAL PEOPLE WHO MAY BE

2195
01:22:42,880 --> 01:22:46,920
JOINING OUR CONFERENCE TODAY,

2196
01:22:46,920 --> 01:22:49,480
LVO, AS YOU MAY BE AWARE OF THE

2197
01:22:49,480 --> 01:22:51,080
TERM STANDS FOR LARGE VESSEL

2198
01:22:51,080 --> 01:22:53,240
OCCLUSION, AND THESE TYPES OF

2199
01:22:53,240 --> 01:22:56,240
STROKES HAVE BLOCKAGES VISIBLE

2200
01:22:56,240 --> 01:22:59,040
ON CT ANGIOGRAMS WHICH ARE CAT

2201
01:22:59,040 --> 01:23:01,320
SCANS LOOKING AT THE CEREBRAL

2202
01:23:01,320 --> 01:23:02,480
VASCULATURE, THE BLOOD VESSELS

2203
01:23:02,480 --> 01:23:04,000
GOING TO THE BRAIN, AND THESE

2204
01:23:04,000 --> 01:23:05,720
TYPES OF STROKES ARE AMENABLE TO

2205
01:23:05,720 --> 01:23:07,600
THE TREATMENT OF MECHANICAL

2206
01:23:07,600 --> 01:23:12,320
THROM BECKETTHROMBECTOMY BY
WHICH A CATHET
ER

2207
01:23:12,320 --> 01:23:14,120
IS PLACED TO THEN EXTRACT THE

2208
01:23:14,120 --> 01:23:14,320
CLOTS.

2209
01:23:14,320 --> 01:23:17,200
FOR THESE TYPES OF LVO STROKES

2210
01:23:17,200 --> 01:23:19,240
AND NON-LVO STROKES, WE STILL

2211
01:23:19,240 --> 01:23:21,760
HAVE GREAT BENEFIT FROM THE CLOT

2212
01:23:21,760 --> 01:23:26,320
BUSTER MEDICATION ALTOPLASE

2213
01:23:26,320 --> 01:23:27,600
WHICH WAS ALSO REFERRED TO.

2214
01:23:27,600 --> 01:23:29,600
SO MARK, I DON'T KNOW IF THAT

2215
01:23:29,600 --> 01:23:31,000
FULLY ANSWERS YOUR QUESTION, BUT

2216
01:23:31,000 --> 01:23:33,080
SOME INITIAL THOUGHTS.

2217
01:23:33,080 --> 01:23:36,000
>> THANK YOU.

2218
01:23:36,000 --> 01:23:36,840
COMMANDER ODOM, DO YOU HAVE ANY

2219
01:23:36,840 --> 01:23:39,400
THOUGHTS ON THAT?

2220
01:23:39,400 --> 01:23:41,360
>> I WOULD AGREE WITH EVERYTHING

2221
01:23:41,360 --> 01:23:44,120
THAT CHARLES MENTIONED,

2222
01:23:44,120 --> 01:23:46,880
ESPECIALLY IN THINKING ABOUT

2223
01:23:46,880 --> 01:23:51,000
MORE RURAL AREAS AND AREAS WHERE

2224
01:23:51,000 --> 01:23:54,840
NATIVE PERSONS LIVE, IN TERMS OF

2225
01:23:54,840 --> 01:23:56,840
HAVING ACCESS TO THAT CARE

2226
01:23:56,840 --> 01:23:59,440
RATHER QUICKLY, MOBILE STROKE

2227
01:23:59,440 --> 01:24:01,840
UNITS WOULD BE ESSENTIAL IN

2228
01:24:01,840 --> 01:24:03,520
PROVIDING SOME OF THAT INITIAL

2229
01:24:03,520 --> 01:24:06,720
CARE AND EVEN THINKING ABOUT

2230
01:24:06,720 --> 01:24:07,880
THAT SORT OF DISPATCH SITUATION

2231
01:24:07,880 --> 01:24:11,920
THAT YOU MENTIONED AND I HADN'T

2232
01:24:11,920 --> 01:24:13,800
EVEN -- I WASN'T FULLY AWARE OF

2233
01:24:13,800 --> 01:24:15,520
THE RESEARCH IN THAT AREA, SO

2234
01:24:15,520 --> 01:24:18,600
THANK YOU FOR SHARING THAT.

2235
01:24:18,600 --> 01:24:20,960
BUT YEAH, ABSOLUTELY, I AGREE

2236
01:24:20,960 --> 01:24:23,240
THAT THOSE ARE -- IT IS AN AREA

2237
01:24:23,240 --> 01:24:26,080
THAT, YOU KNOW, SHOULD BE

2238
01:24:26,080 --> 01:24:29,760
ADDRESSED IN TERMS OF PROVIDING

2239
01:24:29,760 --> 01:24:32,520
EQUITABLE CARE ACROSS GEOGRAPHIC

2240
01:24:32,520 --> 01:24:34,000
REGIONS AND SHOULD BE SOMETHING

2241
01:24:34,000 --> 01:24:37,000
THAT WE INCLUDE IN OUR

2242
01:24:37,000 --> 01:24:37,840
DISCUSSIONS.

2243
01:24:37,840 --> 01:24:39,720
I DO SEE THAT WE HAD A COUPLE OF

2244
01:24:39,720 --> 01:24:44,360
OTHER QUESTIONS IN THE CHAT, AND

2245
01:24:44,360 --> 01:24:45,800
I WANTED TO MAKE SURE WE BRING

2246
01:24:45,800 --> 01:24:50,320
THOSE FORWARD.

2247
01:24:50,320 --> 01:24:51,040
SO ONE IS REGARDING ANY

2248
01:24:51,040 --> 01:24:52,840
ESTIMATES ON A NATIONAL LINKED

2249
01:24:52,840 --> 01:24:55,600
SYSTEM THAT MIGHT BE AVAILABLE.

2250
01:24:55,600 --> 01:24:59,480
AND THIS QUESTION WAS FROM

2251
01:24:59,480 --> 01:25:00,280
ANDREA.

2252
01:25:00,280 --> 01:25:02,600
ANDREA, IF YOU WANT TO JUMP ON

2253
01:25:02,600 --> 01:25:03,760
AND SAY MORE.

2254
01:25:03,760 --> 01:25:09,600
IN TERMS OF SYSTEMS -- DATA

2255
01:25:09,600 --> 01:25:12,720
SYSTEMS IF YOU'RE SPEAKING

2256
01:25:12,720 --> 01:25:13,920
SPECIFICALLY TO NATIONAL

2257
01:25:13,920 --> 01:25:17,360
DATABASES THAT EXIST FOR STROKE

2258
01:25:17,360 --> 01:25:22,280
CARE, I'M SURE YOU ALL ARE AWARE

2259
01:25:22,280 --> 01:25:24,000
OF THE NATIONAL ACUTE STROKE

2260
01:25:24,000 --> 01:25:24,240
PROGRAM.

2261
01:25:24,240 --> 01:25:26,160
THAT IS NOT NATIONAL, IT'S BASED

2262
01:25:26,160 --> 01:25:30,120
ON FUNDING THAT'S AVAILABLE FROM

2263
01:25:30,120 --> 01:25:31,240
CONGRESS FROM THE DIFFERENT

2264
01:25:31,240 --> 01:25:33,240
CYCLES THAT EXIST AND THE MOST

2265
01:25:33,240 --> 01:25:35,880
RECENT CYCLE COVERED ABOUT 13

2266
01:25:35,880 --> 01:25:36,440
STATES.

2267
01:25:36,440 --> 01:25:39,680
SO THAT'S NOT NATIONALLY

2268
01:25:39,680 --> 01:25:41,280
REPRESENTATIVE, BUT THE GOAL

2269
01:25:41,280 --> 01:25:44,080
WITHIN THIS LAST NOFO WAS TO

2270
01:25:44,080 --> 01:25:47,080
MAKE SURE THAT WE ADDRESSED AND

2271
01:25:47,080 --> 01:25:52,240
INCLUDED STATES WITHIN REGIONS

2272
01:25:52,240 --> 01:25:55,520
WHERE STROKE HAS A HIGH

2273
01:25:55,520 --> 01:25:56,040
INCIDENCE.

2274
01:25:56,040 --> 01:25:59,200
SO THAT'S SOMETHING THAT WE

2275
01:25:59,200 --> 01:26:01,040
ENSURED THAT THE PEOPLE WHO

2276
01:26:01,040 --> 01:26:04,080
APPLIED FOR THE GRANTS WROTE

2277
01:26:04,080 --> 01:26:06,520
ABOUT AND SO OUR GOAL WAS TO

2278
01:26:06,520 --> 01:26:08,000
ADDRESS SOME OF THESE INEQUITIES

2279
01:26:08,000 --> 01:26:11,000
THAT WE SEE WITHIN STROKE WITHIN

2280
01:26:11,000 --> 01:26:13,600
THE PROGRAM PUSHING THAT TOPIC

2281
01:26:13,600 --> 01:26:17,240
FORWARD.

2282
01:26:17,240 --> 01:26:19,560
DID YOU HAVE ANYTHING ELSE TO

2283
01:26:19,560 --> 01:26:22,000
ADD IN TERMS OF YOUR QUESTION,

2284
01:26:22,000 --> 01:26:26,720
ANDREA?

2285
01:26:26,720 --> 01:26:29,000
IF NOT, I DID SEE A COUPLE OF

2286
01:26:29,000 --> 01:26:32,480
OTHER QUESTIONS.

2287
01:26:32,480 --> 01:26:38,520
ONE WAS RELATED SPECIFICALLY TO

2288
01:26:38,520 --> 01:26:40,360
ADDRESSING COMMUNITY EDUCATION

2289
01:26:40,360 --> 01:26:43,000
WITHIN THE HOSPITAL SETTING TO

2290
01:26:43,000 --> 01:26:44,920
INCREASE STROKE READINESS AND

2291
01:26:44,920 --> 01:26:45,640
KNOWLEDGE.

2292
01:26:45,640 --> 01:26:48,960
SO CHARLES, I'LL KICK IT BACK TO

2293
01:26:48,960 --> 01:26:52,680
YOU IF YOU WANT TO EY ADDRESS
THAT,

2294
01:26:52,680 --> 01:26:53,640
AND I CAN ADD ON.

2295
01:26:53,640 --> 01:26:54,920
>> SURE, HAPPY TO.

2296
01:26:54,920 --> 01:26:56,480
I DO THINK WE HAVE AT THE END OF

2297
01:26:56,480 --> 01:27:04,000
THE DAY AN ENTIRE TIME EPOCH

2298
01:27:04,000 --> 01:27:05,400
PERIOD OF IN-HOSPITAL CARE SO

2299
01:27:05,400 --> 01:27:07,760
THAT MAY ADDRESS THIS ISSUE, BUT

2300
01:27:07,760 --> 01:27:10,320
CERTAINLY AS MANY KNOW, STROKE

2301
01:27:10,320 --> 01:27:12,040
CAN STRIKE ANYWHERE, INCLUDING

2302
01:27:12,040 --> 01:27:13,480
AMONG INPATIENTS WHO ARE

2303
01:27:13,480 --> 01:27:16,120
ADMITTED WITHOUT STROKES.

2304
01:27:16,120 --> 01:27:20,680
AND SIMILARLY HAVING RAPID

2305
01:27:20,680 --> 01:27:22,840
IDENTIFICATION AND RAPID ACCESS

2306
01:27:22,840 --> 01:27:25,720
TO DIAGNOSTICS FOR THESE

2307
01:27:25,720 --> 01:27:27,280
PATIENTS ARE OF THE UTMOST

2308
01:27:27,280 --> 01:27:28,520
IMPORTANCE.

2309
01:27:28,520 --> 01:27:34,640
PER THE LITERATURE, THERE ARE

2310
01:27:34,640 --> 01:27:36,720
TIME LAGS AS MOBILIZATION OF THE

2311
01:27:36,720 --> 01:27:38,680
SYSTEM IN THE IN-HOUSE SETTING

2312
01:27:38,680 --> 01:27:40,560
IS SOMETIMES FRAUGHT WITH

2313
01:27:40,560 --> 01:27:42,000
CHALLENGES COMPARED TO THE

2314
01:27:42,000 --> 01:27:46,080
EMERGENCY DEPARTMENT SETTING.

2315
01:27:46,080 --> 01:27:47,400
SO THERE ARE FURTHER

2316
01:27:47,400 --> 01:27:48,400
OPPORTUNITIES FOR ENHANCEMENT

2317
01:27:48,400 --> 01:27:51,280
HERE AND CERTAINLY THERE'S A LOT

2318
01:27:51,280 --> 01:27:53,480
OF PEOPLE WHO ARE SHINING A

2319
01:27:53,480 --> 01:27:55,240
MAGNIFYING GLASS ON THIS AREA TO

2320
01:27:55,240 --> 01:27:57,040
TRY TO MAKE FURTHER

2321
01:27:57,040 --> 01:28:01,960
IMPROVEMENTS.

2322
01:28:01,960 --> 01:28:07,120
ANOTHER QUESTION I SEE, ERIKA,

2323
01:28:07,120 --> 01:28:08,960
IS FROM DR. BENSON.

2324
01:28:08,960 --> 01:28:11,720
ANY DISCUSSION OF PREHOSPITAL

2325
01:28:11,720 --> 01:28:17,360
SYSTEMS TAKING ON THE ROLE ROLE

2326
01:28:17,360 --> 01:28:18,600
OR ASSISTING WITH COMMUNITY

2327
01:28:18,600 --> 01:28:20,080
EDUCATION AND ENGAGEMENT TO

2328
01:28:20,080 --> 01:28:22,560
INCREASE STROKE READINESS

2329
01:28:22,560 --> 01:28:23,400
KNOWLEDGE?

2330
01:28:23,400 --> 01:28:28,560
I'M NOT AN EXPERT BUT I THINK

2331
01:28:28,560 --> 01:28:30,120
THIS IS A VERY IMPORTANT

2332
01:28:30,120 --> 01:28:30,880
QUESTION, IMPORTANT AREA TO

2333
01:28:30,880 --> 01:28:31,600
FOCUS ON.

2334
01:28:31,600 --> 01:28:35,240
HERE AT YALE, I HAVE A LITTLE

2335
01:28:35,240 --> 01:28:37,200
BIT OF EXPERIENCE BECAUSE ONE OF

2336
01:28:37,200 --> 01:28:39,320
MY COLLEAGUES HAD A DIFFERENT

2337
01:28:39,320 --> 01:28:44,200
PREHOSPITAL PROJECT THAT WAS

2338
01:28:44,200 --> 01:28:45,160
LOOKING AT COMMUNITY EDUCATION

2339
01:28:45,160 --> 01:28:48,720
THAT WAS CALLED THE PRAD STUDY,

2340
01:28:48,720 --> 01:28:50,200
IT WAS LOOKING AT A DIFFERENT

2341
01:28:50,200 --> 01:28:51,280
POPULATION OF ELDERLY PATIENTS

2342
01:28:51,280 --> 01:28:54,160
WITH FALLS, AND UTILIZE

2343
01:28:54,160 --> 01:28:58,600
PARAMEDIC FOLLOW-UP VISITS TO GO

2344
01:28:58,600 --> 01:29:00,840
OVER RISK FACTORS, FALL

2345
01:29:00,840 --> 01:29:02,240
ASSESSMENTS, REVIEW OF

2346
01:29:02,240 --> 01:29:06,280
MEDICATIONS, AND THEN REFERRING

2347
01:29:06,280 --> 01:29:07,040
PATIENTS TO APPROPRIATE

2348
01:29:07,040 --> 01:29:08,240
PROVIDERS IF NEEDED AND

2349
01:29:08,240 --> 01:29:08,840
NECESSARY.

2350
01:29:08,840 --> 01:29:11,280
AND I THINK -- I'M NOT AWARE

2351
01:29:11,280 --> 01:29:13,800
OFFHAND OF ANY LARGE SCALE

2352
01:29:13,800 --> 01:29:15,120
SIMILAR INTERVENTIONS BEING DONE

2353
01:29:15,120 --> 01:29:17,560
LIKE THIS IN THE PREHOSPITAL

2354
01:29:17,560 --> 01:29:19,800
SETTING FOR STROKE PRIMARY AND

2355
01:29:19,800 --> 01:29:22,480
SECONDARY PREVENTION OR

2356
01:29:22,480 --> 01:29:23,880
EDUCATION REGARDING THE

2357
01:29:23,880 --> 01:29:24,600
IDENTIFICATION OF STROKE.

2358
01:29:24,600 --> 01:29:29,120
BUT I THINK IT DOES REALLY LEND

2359
01:29:29,120 --> 01:29:30,920
ITSELF TO A GREAT OPPORTUNITY

2360
01:29:30,920 --> 01:29:33,680
OVER THE COURSE OF THE NEXT

2361
01:29:33,680 --> 01:29:37,120
DECADE, BUILDING UPON WHAT THE

2362
01:29:37,120 --> 01:29:38,480
PRAD GROUP AND WHAT OTHER GROUPS

2363
01:29:38,480 --> 01:29:39,880
HAVE IDENTIFIED FOR OTHER

2364
01:29:39,880 --> 01:29:42,400
PATIENT POPULATIONS.

2365
01:29:42,400 --> 01:29:43,920
DR. BENSON, I DON'T KNOW IF YOU

2366
01:29:43,920 --> 01:29:45,000
HAVE ANY FURTHER THOUGHTS ON

2367
01:29:45,000 --> 01:29:48,000
THERE, OR DR. ALBERT OR ERIKA AS

2368
01:29:48,000 --> 01:29:48,200
WELL.

2369
01:29:48,200 --> 01:29:48,520
>> THANK YOU.

2370
01:29:48,520 --> 01:29:54,200
THANK YOU, DR. WIRA, THAT WAS

2371
01:29:54,200 --> 01:29:54,480
SPOT-ON.

2372
01:29:54,480 --> 01:29:55,880
WE KNOW, AND IT WAS MENTIONED AT

2373
01:29:55,880 --> 01:29:57,000
THE OUTSET OF THE PRESENTATION

2374
01:29:57,000 --> 01:29:58,120
THAT IN GENERAL, PEOPLE PRESENT

2375
01:29:58,120 --> 01:30:01,400
TO THE HOSPITAL LATE, AND WHEN

2376
01:30:01,400 --> 01:30:02,440
WE THINK ABOUT DISPARITIES, WE

2377
01:30:02,440 --> 01:30:03,600
KNOW THAT THERE'S A LOT OF

2378
01:30:03,600 --> 01:30:06,280
MEDICAL MISTRUST.

2379
01:30:06,280 --> 01:30:07,680
WE'VE TALKED ABOUT THE NEED FOR

2380
01:30:07,680 --> 01:30:10,480
BETTER COMMUNITY ENGAGEMENT FOR

2381
01:30:10,480 --> 01:30:11,920
CLINICAL CARE, BUT ALSO FOR

2382
01:30:11,920 --> 01:30:13,160
ENROLLING IN CLINICAL TRIALS,

2383
01:30:13,160 --> 01:30:14,640
WHICH I THINK, YOU KNOW,

2384
01:30:14,640 --> 01:30:16,080
CLINICAL RESEARCH AND CLINICAL

2385
01:30:16,080 --> 01:30:18,000
CARE GO HAND IN HAND.

2386
01:30:18,000 --> 01:30:20,360
AND SO I SEE THIS AS AN

2387
01:30:20,360 --> 01:30:21,560
OPPORTUNITY, AND I REALLY LOVE

2388
01:30:21,560 --> 01:30:24,440
THE IDEA OF THIS PREHOSPITAL

2389
01:30:24,440 --> 01:30:26,920
STROKE SYSTEMS WORKING WITH THE

2390
01:30:26,920 --> 01:30:28,120
HOSPITALS AS WELL, AS A WAY TO

2391
01:30:28,120 --> 01:30:30,120
SORT OF ENGAGE THE COMMUNITY AND

2392
01:30:30,120 --> 01:30:33,040
CREATE THESE COMMUNITY NETWORKS.

2393
01:30:33,040 --> 01:30:35,360
AND SO I THINK IT'S DEFINITELY

2394
01:30:35,360 --> 01:30:37,320
AN OPPORTUNITY GAP AND SO THAT

2395
01:30:37,320 --> 01:30:38,560
WAS SORT OF WHERE I WAS

2396
01:30:38,560 --> 01:30:41,480
THINKING.

2397
01:30:41,480 --> 01:30:44,320
>> SO ONE OF THE UNIQUE THINGS

2398
01:30:44,320 --> 01:30:45,880
ABOUT THE COVERDALE PROGRAM IS

2399
01:30:45,880 --> 01:30:48,560
THAT INITIALLY WE WORK WITH THE

2400
01:30:48,560 --> 01:30:51,480
STATE HEALTH DEPARTMENT, AND WE

2401
01:30:51,480 --> 01:30:53,160
BUILD INTO THE PROGRAMS THAT

2402
01:30:53,160 --> 01:30:56,680
THERE IS GOING TO BE A

2403
01:30:56,680 --> 01:30:58,520
COMMUNICATION EFFORT WITH THE

2404
01:30:58,520 --> 01:31:00,920
COMMUNITY AROUND THESE ISSUES OF

2405
01:31:00,920 --> 01:31:03,560
HOW TO RECOGNIZE THE SIGNS AND

2406
01:31:03,560 --> 01:31:04,000
SYMPTOMS OF STROKE.

2407
01:31:04,000 --> 01:31:05,360
SO A NUMBER OF OUR PROGRAMS

2408
01:31:05,360 --> 01:31:08,360
WITHIN THE COVERDALE PROGRAM PUT

2409
01:31:08,360 --> 01:31:09,040
TOGETHER COMMUNICATION EFFORTS,

2410
01:31:09,040 --> 01:31:12,200
WHETHER IT BE BY RADIO OR

2411
01:31:12,200 --> 01:31:14,040
ADVERTISEMENTS ON SIDE OF BUSES,

2412
01:31:14,040 --> 01:31:17,640
OR EVEN WITH THIS IDEA AROUND

2413
01:31:17,640 --> 01:31:18,640
COMMUNITY PARAMEDICINE AND

2414
01:31:18,640 --> 01:31:20,600
GETTING THE EMS PROVIDERS WHEN

2415
01:31:20,600 --> 01:31:22,520
THEY GO IN FOR FALLS AND

2416
01:31:22,520 --> 01:31:24,360
DIFFERENT THINGS LIKE THAT, THEY

2417
01:31:24,360 --> 01:31:26,360
WOULD HAVE MAGNETS REGARDING THE

2418
01:31:26,360 --> 01:31:27,280
SIGNS AND SYMPTOMS OF STROKE

2419
01:31:27,280 --> 01:31:28,960
THAT THEY JUST SLAP ON THE

2420
01:31:28,960 --> 01:31:30,080
REFRIGERATOR OR SOMETHING, YOU

2421
01:31:30,080 --> 01:31:33,440
KNOW, MAGNETIC.

2422
01:31:33,440 --> 01:31:35,120
AND TALK TO FAMILY MEMBERS AND

2423
01:31:35,120 --> 01:31:37,040
DIFFERENT THINGS ABOUT THE SIGNS

2424
01:31:37,040 --> 01:31:38,480
AND SYMPTOMS OF STROKE IF YOU

2425
01:31:38,480 --> 01:31:42,200
HAVE ELDERLY FOLKS AT RISK FOR A

2426
01:31:42,200 --> 01:31:42,440
STROKE.

2427
01:31:42,440 --> 01:31:44,840
THERE ARE ALSO PROGRAMS THAT

2428
01:31:44,840 --> 01:31:51,040
HOSPITALS HAVE BUILT AROUND

2429
01:31:51,040 --> 01:31:52,640
EDUCATING NOT ONLY EMS PROVIDERS

2430
01:31:52,640 --> 01:31:53,960
ABOUT EDUCATING IN THE

2431
01:31:53,960 --> 01:31:55,520
COMMUNITY, BUT ALSO PROVIDING

2432
01:31:55,520 --> 01:31:58,040
EDUCATION PROGRAMS WITHIN SCHOOL

2433
01:31:58,040 --> 01:32:01,360
SYSTEMS BECAUSE YOU'RE ABLE TO

2434
01:32:01,360 --> 01:32:03,840
CONNECT THESE YOUNG CHILDREN

2435
01:32:03,840 --> 01:32:05,800
WITH THEIR OLDER FAMILY MEMBERS

2436
01:32:05,800 --> 01:32:07,360
AND RECOGNIZING THOSE SIGNS AND

2437
01:32:07,360 --> 01:32:09,560
SYMPTOMS OF STROKE.

2438
01:32:09,560 --> 01:32:11,520
SO THERE'S THINGS LIKE HIP-HOP

2439
01:32:11,520 --> 01:32:18,520
STROKE AND, AN EDUCATIONAL
PROGRAM

2440
01:32:18,520 --> 01:32:20,400
TARGETING SCHOOL AGED FOLKS SO

2441
01:32:20,400 --> 01:32:22,400
THEY CAN RECOGNIZE THE SIGNS AND

2442
01:32:22,400 --> 01:32:24,800
SYMPTOMS OF STROKE SO THEY'RE

2443
01:32:24,800 --> 01:32:25,920
ABLE TO RECOGNIZE THAT WITHIN

2444
01:32:25,920 --> 01:32:27,000
THEIR FAMILY MEMBERS.

2445
01:32:27,000 --> 01:32:28,200
SO I THINK THERE ARE MANY SORT

2446
01:32:28,200 --> 01:32:30,600
OF AVENUES TO GET THOSE MESSAGES

2447
01:32:30,600 --> 01:32:32,840
OUT TO THE COMMUNITY, BUT

2448
01:32:32,840 --> 01:32:36,800
THINKING SPECIFICALLY ABOUT HOW

2449
01:32:36,800 --> 01:32:37,920
PREHOSPITAL AND EMS PROVIDERS

2450
01:32:37,920 --> 01:32:39,680
CAN PLAY A ROLE IN THAT IS ONE

2451
01:32:39,680 --> 01:32:42,000
THAT CONTINUES TO BE AN AREA

2452
01:32:42,000 --> 01:32:49,040
THAT CONTINUES TO BE BUILT OUT.

2453
01:32:49,040 --> 01:32:50,920
>> JUST TO BUILD ON THE

2454
01:32:50,920 --> 01:32:52,200
EXCELLENT COMMENTS THAT

2455
01:32:52,200 --> 01:32:53,920
COMMANDER ODOM JUST SAID, WE

2456
01:32:53,920 --> 01:32:55,280
KNOW FROM DECADES OF RESEARCH

2457
01:32:55,280 --> 01:32:57,720
RELATED TO TPA AND HYPERACUTE

2458
01:32:57,720 --> 01:32:59,000
THERAPIES THAT THE MESSAGE NEEDS

2459
01:32:59,000 --> 01:33:00,640
TO BE REPETITIVE.

2460
01:33:00,640 --> 01:33:02,360
YOU CAN'T JUST THINK YOU CAN DO

2461
01:33:02,360 --> 01:33:03,360
IT ONE AND DONE.

2462
01:33:03,360 --> 01:33:04,640
BECAUSE REALLY WHAT WE'RE TRYING

2463
01:33:04,640 --> 01:33:05,680
TO DO WITH STROKE EDUCATION,

2464
01:33:05,680 --> 01:33:07,720
WE'RE TRYING TO TRAIN PEOPLE TO

2465
01:33:07,720 --> 01:33:09,520
REACT TO AN EVENT, TO A

2466
01:33:09,520 --> 01:33:12,600
CIRCUMSTANCE, TO A SET OF

2467
01:33:12,600 --> 01:33:13,960
SYMPTOMS, THAT THEY MAY ONLY

2468
01:33:13,960 --> 01:33:14,840
EXPERIENCE ONCE IN THEIR

2469
01:33:14,840 --> 01:33:15,240
LIFETIME.

2470
01:33:15,240 --> 01:33:18,520
SO IT'S NOT LIKE WHERE THE

2471
01:33:18,520 --> 01:33:19,640
PUBLIC EDUCATION CAMPAIGNS HAVE

2472
01:33:19,640 --> 01:33:21,840
BEEN SUCCESSFUL, LIKE USING YOUR

2473
01:33:21,840 --> 01:33:24,000
SEAT BELTS, WHICH PEOPLE DO

2474
01:33:24,000 --> 01:33:25,720
MULTIPLE TIMES A DAY, THAT'S

2475
01:33:25,720 --> 01:33:27,360
VERY SUCCESSFUL BECAUSE, AGAIN,

2476
01:33:27,360 --> 01:33:29,240
IT'S A FREQUENT BEHAVIOR.

2477
01:33:29,240 --> 01:33:31,280
WHEREAS CALLING 911 BECAUSE

2478
01:33:31,280 --> 01:33:32,800
SOMEONE HAS WEAKNESS OR NUMBNESS

2479
01:33:32,800 --> 01:33:34,400
IS A VERY INFREQUENT BEHAVIOR,

2480
01:33:34,400 --> 01:33:36,280
AND TO THE EXTENT AS DR. BENSON

2481
01:33:36,280 --> 01:33:39,960
SAID A FEW MINUTES AGO, THAT

2482
01:33:39,960 --> 01:33:45,320
THERE'S DISTRUST IN LACK OF

2483
01:33:45,320 --> 01:33:46,240
UNDERSTANDING BETWEEN

2484
01:33:46,240 --> 01:33:47,800
DISAFFECTED GROUPS AND THE

2485
01:33:47,800 --> 01:33:49,320
MEDICAL SYSTEM THAT MAKES THE

2486
01:33:49,320 --> 01:33:51,440
BARRIER, THE HURDLE OF THIS EVEN

2487
01:33:51,440 --> 01:33:58,000
MORE CHALLENGING.

2488
01:33:58,000 --> 01:33:59,000
>> AND I THINK JUST IN GENERAL,

2489
01:33:59,000 --> 01:34:00,880
WE HAVE TO THINK ABOUT

2490
01:34:00,880 --> 01:34:02,400
COMMUNITIES, DIFFERENT

2491
01:34:02,400 --> 01:34:05,520
COMMUNITIES AND THEIR

2492
01:34:05,520 --> 01:34:07,240
WILLINGNESS TO CALL A SYSTEM

2493
01:34:07,240 --> 01:34:09,000
LIKE 911 AND EXPECTING

2494
01:34:09,000 --> 01:34:09,560
RESPONSIVENESS, SO THINKING

2495
01:34:09,560 --> 01:34:11,040
ABOUT THOSE ISSUES TOO, IN TERMS

2496
01:34:11,040 --> 01:34:14,200
OF THAT TRUST OR MISTRUST ON THE

2497
01:34:14,200 --> 01:34:17,120
MEDICAL COMMUNITY.

2498
01:34:17,120 --> 01:34:19,360
>> TOTALLLY AGREE.

2499
01:34:19,360 --> 01:34:20,480
THE OTHER ASPECT -- WELL,

2500
01:34:20,480 --> 01:34:23,800
THERE'S MANY ASPECTS THAT ARE

2501
01:34:23,800 --> 01:34:25,360
IMPORTANT, BUT SEVERAL OF THE

2502
01:34:25,360 --> 01:34:26,360
FOLKS WERE TALKING ABOUT

2503
01:34:26,360 --> 01:34:30,200
BREAKING DOWN BARRIERS, AND YOU

2504
01:34:30,200 --> 01:34:32,400
KNOW, I THINK REMOVING

2505
01:34:32,400 --> 01:34:38,120
ARTIFICIAL BARRIERS IS A HUGE

2506
01:34:38,120 --> 01:34:38,680
OPPORTUNITY, BECAUSE THERE

2507
01:34:38,680 --> 01:34:41,200
SHOULDN'T BE A BARRIER, I MEAN,

2508
01:34:41,200 --> 01:34:42,200
THERE'S NO BRICK WALL, THERE'S

2509
01:34:42,200 --> 01:34:43,720
NO IRON CURTAIN BETWEEN

2510
01:34:43,720 --> 01:34:44,240
ADJOINING STATES.

2511
01:34:44,240 --> 01:34:45,880
AND TO THE BEST OF MY KNOWLEDGE,

2512
01:34:45,880 --> 01:34:48,200
IF YOU'RE HAVING A MEDICAL

2513
01:34:48,200 --> 01:34:50,360
EMERGENCY SUCH AS AN ACUTE

2514
01:34:50,360 --> 01:34:52,400
STROKE OR ACUTE CORONARY

2515
01:34:52,400 --> 01:34:56,560
SYNDROME, THERE ARE NO INSURANCE

2516
01:34:56,560 --> 01:34:57,480
BARRIERS THAT SHOULD BLOCK

2517
01:34:57,480 --> 01:34:59,400
PATIENT TRANSFER OR

2518
01:34:59,400 --> 01:35:00,440
REIMBURSEMENT AS OPPOSED TO

2519
01:35:00,440 --> 01:35:01,560
GOING TO THE NEAREST FACILITY,

2520
01:35:01,560 --> 01:35:03,560
WHICH WE ALL KNOW TIME IS BRAIN.

2521
01:35:03,560 --> 01:35:05,480
SO I THINK THAT'S AN OPPORTUNITY

2522
01:35:05,480 --> 01:35:08,640
TO REMOVE ARTIFICIAL BARRIERS OF

2523
01:35:08,640 --> 01:35:09,800
SAYING THIS AMBULANCE COULD NOT

2524
01:35:09,800 --> 01:35:11,480
CROSS STATE LINES, OR COULD NOT

2525
01:35:11,480 --> 01:35:12,960
GO INTO A DIFFERENT COUNTY.

2526
01:35:12,960 --> 01:35:14,480
TO THE BEST OF MY KNOWLEDGE, IF

2527
01:35:14,480 --> 01:35:16,680
IT'S A MEDICAL EMERGENCY, MAJOR

2528
01:35:16,680 --> 01:35:19,120
TRAUMA, MVA, WHATEVER, YOU ARE

2529
01:35:19,120 --> 01:35:20,320
ALLOWED TO DO THAT TO PROVIDE

2530
01:35:20,320 --> 01:35:24,520
EMERGENCY CARE.

2531
01:35:24,520 --> 01:35:25,400
>> AGREE.

2532
01:35:25,400 --> 01:35:29,560
IF I CAN ALSO ADD IN TOO, I

2533
01:35:29,560 --> 01:35:32,800
THINK WHEN YOU THINK ABOUT

2534
01:35:32,800 --> 01:35:33,480
ENGAGING COMMUNITIES THAT ARE

2535
01:35:33,480 --> 01:35:35,160
MORE DIFFICULT TO ENGAGE, IT'S

2536
01:35:35,160 --> 01:35:36,000
IMPORTANT -- WE TALK ABOUT THIS

2537
01:35:36,000 --> 01:35:37,640
IN RESEARCH BUT MAYBE ALSO WE

2538
01:35:37,640 --> 01:35:40,200
SHOULD CONSIDER THIS IN THE SORT

2539
01:35:40,200 --> 01:35:42,160
OF PREHOSPITAL ENGAGEMENT

2540
01:35:42,160 --> 01:35:43,280
SETTINGS, MAKING SURE THAT THERE

2541
01:35:43,280 --> 01:35:46,240
ARE PEOPLE WHO REPRESENT THE

2542
01:35:46,240 --> 01:35:47,360
COMMUNITY IN TERMS OF CULTURE

2543
01:35:47,360 --> 01:35:51,200
AND HOW THEY LOOK, EMPLOYED TO

2544
01:35:51,200 --> 01:35:55,520
WORK WITH THEM TO HELP GIVE

2545
01:35:55,520 --> 01:35:56,720
MESSAGES THAT ARE UNDERSTANDABLE

2546
01:35:56,720 --> 01:35:57,560
AND DEAL WITH SOME OF THE GAPS

2547
01:35:57,560 --> 01:35:58,160
THAT ARE THERE.

2548
01:35:58,160 --> 01:36:00,200
AND I LIKE THE TERM THAT MARK

2549
01:36:00,200 --> 01:36:01,840
MENTIONED IN TERMS OF THESE

2550
01:36:01,840 --> 01:36:03,000
BARRIERS, ARTIFICIAL BARRIERS, A

2551
01:36:03,000 --> 01:36:07,000
LOT OF THEM, I THINK THROUGH

2552
01:36:07,000 --> 01:36:09,280
HAVING THEM MESSAGED CORRECTLY,

2553
01:36:09,280 --> 01:36:11,240
SOME OF THEM COULD BE ADDRESSED.

2554
01:36:11,240 --> 01:36:14,400
AND AGAIN, TYING THAT TO

2555
01:36:14,400 --> 01:36:17,920
ENGAGEMENT ENROLLMENT AND

2556
01:36:17,920 --> 01:36:18,960
CLINICAL TRIALS AS WELL AS

2557
01:36:18,960 --> 01:36:19,760
UNDERSTANDING MEDICAL BEHAVIORS

2558
01:36:19,760 --> 01:36:22,200
IN ALL OF THAT.

2559
01:36:22,200 --> 01:36:23,920
BUT -- AND ALSO DEALING WITH THE

2560
01:36:23,920 --> 01:36:25,000
MEDICAL MISTRUST, I THINK

2561
01:36:25,000 --> 01:36:29,560
COMMUNITIES ARE PRETTY SAVVY, SO

2562
01:36:29,560 --> 01:36:30,200
THIS BIDIRECTIONAL COMMUNICATION

2563
01:36:30,200 --> 01:36:30,520
IS IMPORTANT.

2564
01:36:30,520 --> 01:36:31,800
THERE ARE PEOPLE THAT ARE EXPERT

2565
01:36:31,800 --> 01:36:33,320
AND TRAINED IN COMMUNITY

2566
01:36:33,320 --> 01:36:35,400
ENGAGEMENT, SO MAYBE HAVING

2567
01:36:35,400 --> 01:36:36,880
PEOPLE AT THE HOSPITAL OR THE

2568
01:36:36,880 --> 01:36:40,080
PREHOSPITAL SETTING WHO HAS

2569
01:36:40,080 --> 01:36:43,720
TRAINING IN ENGAGING TIE VERSE
DIVERSE

2570
01:36:43,720 --> 01:36:44,200
COMMUNITIES, WORKING WITH THE

2571
01:36:44,200 --> 01:36:45,720
TEAM AS WELL IS IMPORTANT IS A

2572
01:36:45,720 --> 01:36:46,520
BARRIER THAT CAN BE BROUGHT DOWN

2573
01:36:46,520 --> 01:36:47,960
AS WELL.

2574
01:36:47,960 --> 01:36:49,240
CHERYL WROTE IN OUR EFFORTS TO

2575
01:36:49,240 --> 01:36:51,760
EDUCATE, WHY DO WE NOT DO A GOOD

2576
01:36:51,760 --> 01:36:52,720
JOB EXPLAINING WHY IT'S CRITICAL

2577
01:36:52,720 --> 01:36:54,360
TO CALL 911?

2578
01:36:54,360 --> 01:36:55,520
THIS KIND OF DOVETAILS WHY WE

2579
01:36:55,520 --> 01:36:56,520
ARE TALKING.

2580
01:36:56,520 --> 01:37:00,560
WHY SHOULD WE UNDERSTAND TO

2581
01:37:00,560 --> 01:37:08,600
EXPECT SOMEONE TO -- WHEN WE

2582
01:37:08,600 --> 01:37:11,320
SPEND UP TO AN HOUR EXPLAINING

2583
01:37:11,320 --> 01:37:14,200
THE PENUMBRA TO STUDENTS AND

2584
01:37:14,200 --> 01:37:14,480
RESIDENTS?

2585
01:37:14,480 --> 01:37:15,800
WE NEED A STRATEGIC CONSISTENT

2586
01:37:15,800 --> 01:37:17,120
MESSAGE TO THIS EFFECT.

2587
01:37:17,120 --> 01:37:19,680
THAT'S PART OF THE CHALLENGE, NO

2588
01:37:19,680 --> 01:37:20,520
TWO STROKES ARE THE SAME IN

2589
01:37:20,520 --> 01:37:26,120
TERMS OF THEIR PRESENTATION.

2590
01:37:26,120 --> 01:37:27,560
ONE PERSON MAY PRESENT WITH SORT

2591
01:37:27,560 --> 01:37:28,600
OF THE CLASSIC PARALYSIS ON ONE

2592
01:37:28,600 --> 01:37:30,680
SIDE OF THEIR BODY, ANOTHER

2593
01:37:30,680 --> 01:37:33,960
PERSON MAY JUST HAVE DIZZINESS

2594
01:37:33,960 --> 01:37:37,920
AND VOMITING, SO THERE CAN

2595
01:37:37,920 --> 01:37:38,800
SOMETIMES BE CHALLENGES.

2596
01:37:38,800 --> 01:37:43,280
IT'S HARD JUST FOR OUR RESIDENTS

2597
01:37:43,280 --> 01:37:48,400
JUST TO CONVEY THE MESSAGE ACUTE

2598
01:37:48,400 --> 01:37:50,520
SYMPTOM IS VASCULAR OR STROKE

2599
01:37:50,520 --> 01:37:52,280
UNTIL PROVEN OTHERWISE.

2600
01:37:52,280 --> 01:37:53,240
THAT'S HARD ENOUGH TO EDUCATE

2601
01:37:53,240 --> 01:37:54,720
OUR STAFF IN THE HOSPITAL LET

2602
01:37:54,720 --> 01:37:56,000
ALONE AT THE COMMUNITY LEVEL,

2603
01:37:56,000 --> 01:37:58,640
LET ALONE ALL OF THE OTHER

2604
01:37:58,640 --> 01:38:02,320
BARRIERS THAT EXIST IN TERMS OF

2605
01:38:02,320 --> 01:38:04,320
TRANSLATING THE EDUCATION TO

2606
01:38:04,320 --> 01:38:05,560
DIFFERENT GEOGRAPHICAL AREAS AND

2607
01:38:05,560 --> 01:38:09,800
DIFFERENT POPULATIONS, AND IT

2608
01:38:09,800 --> 01:38:12,920
CERTAINLY IS AN ONGOING CHAL

2609
01:38:12,920 --> 01:38:13,560
CHALLENGE BUT ALSO OPPORTUNITY

2610
01:38:13,560 --> 01:38:18,160
TO WORK ON FURTHER.

2611
01:38:18,160 --> 01:38:19,920
>> I AGREE.

2612
01:38:19,920 --> 01:38:23,040
AS YOU KNOW, FOR THE NON-MEDICAL

2613
01:38:23,040 --> 01:38:24,240
PEOPLE ON THE CALL, EVEN

2614
01:38:24,240 --> 01:38:25,200
PATIENTS IN THE HOSPITAL OR IN

2615
01:38:25,200 --> 01:38:26,800
THE EMERGENCY DEPARTMENT WHO WE

2616
01:38:26,800 --> 01:38:28,440
THINK ARE HAVING A STROKE AND

2617
01:38:28,440 --> 01:38:32,720
WHO WE CALL A STROKE CODE ON,

2618
01:38:32,720 --> 01:38:34,400
WE'RE WRONG 50 -- THAT'S 5-0,

2619
01:38:34,400 --> 01:38:35,680
WE'RE WRONG 50% OF THE TIME.

2620
01:38:35,680 --> 01:38:36,880
AND THAT'S TRAINED MEDICAL

2621
01:38:36,880 --> 01:38:37,120
PEOPLE.

2622
01:38:37,120 --> 01:38:39,040
IN THE COMMUNITY, THEY'RE GOING

2623
01:38:39,040 --> 01:38:41,000
TO BE WRONG AS OFTEN IF NOT MORE

2624
01:38:41,000 --> 01:38:42,440
OFTEN THAN WE ARE, AND THAT'S

2625
01:38:42,440 --> 01:38:44,120
PART OF THE CHALLENGES AND THEN

2626
01:38:44,120 --> 01:38:47,720
YOU HAVE THE ISSUES OF LACK OF

2627
01:38:47,720 --> 01:38:51,120
COMMUNICATION WITH THE MEDICAL

2628
01:38:51,120 --> 01:38:53,160
SYSTEM, MISTRUST, I SAW ONE OF

2629
01:38:53,160 --> 01:38:55,800
THE COMMENTS, OR RELUCTANCE TO

2630
01:38:55,800 --> 01:38:57,640
CALL 911 THAT IT'S INTIMIDATING.

2631
01:38:57,640 --> 01:38:58,360
TOTALLY GET THAT.

2632
01:38:58,360 --> 01:38:59,840
THE FLIP SIDE IS THAT PATIENTS

2633
01:38:59,840 --> 01:39:00,800
STAY HOME FOR HOURS AND THEN

2634
01:39:00,800 --> 01:39:01,960
THEY'RE OUT OF THE TIME WINDOW

2635
01:39:01,960 --> 01:39:03,880
WHERE THEY CAN BENEFIT FROM A

2636
01:39:03,880 --> 01:39:04,880
THERAPY.

2637
01:39:04,880 --> 01:39:09,600
SO IT IS A VERY VEXING PROBLEM.

2638
01:39:09,600 --> 01:39:11,080
THE OTHER THING I WAS THINKING

2639
01:39:11,080 --> 01:39:12,040
ABOUT AND I KNOW WE'RE ALMOST

2640
01:39:12,040 --> 01:39:12,920
OUT OF TIME HERE IS THAT IN

2641
01:39:12,920 --> 01:39:14,320
TERMS OF SETTING ONE STANDARD OF

2642
01:39:14,320 --> 01:39:16,080
CARE, WE'RE TALKING ABOUT FANCY

2643
01:39:16,080 --> 01:39:17,520
TELEHEALTH SYSTEMS AND MOBILE

2644
01:39:17,520 --> 01:39:20,200
STROKE UNITS WHICH ARE GREAT.

2645
01:39:20,200 --> 01:39:22,640
BUT WHEN PUSH COMES TO SHOVE, WE

2646
01:39:22,640 --> 01:39:24,680
ALL HAVE ONE OF THESE.

2647
01:39:24,680 --> 01:39:26,320
[HOLDING UP PHONE]

2648
01:39:26,320 --> 01:39:28,160
THREE OR FOUR MINUTES WITH AN

2649
01:39:28,160 --> 01:39:30,160
IPHONE VIDEO CHAT WHICH MY KIDS

2650
01:39:30,160 --> 01:39:33,880
DO CONTINUALLY, WITH THE TRAINED

2651
01:39:33,880 --> 01:39:35,280
OBSERVER ON THE OTHER END.

2652
01:39:35,280 --> 01:39:36,760
I THINK WE COULD DO A GOOD JOB

2653
01:39:36,760 --> 01:39:39,800
AT LEAST PICKING OUT THE MAJOR

2654
01:39:39,800 --> 01:39:42,440
LVOs OR THE MAJOR MEDICAL

2655
01:39:42,440 --> 01:39:43,960
THINGS, SO DON'T LET THE PERFECT

2656
01:39:43,960 --> 01:39:44,920
BE THE ENEMY OF THE GOOD,

2657
01:39:44,920 --> 01:39:46,640
SOMETIMES THIS IS ALL THAT WE

2658
01:39:46,640 --> 01:39:48,520
HAVE AVAILABLE FOR TRIAGE IN A

2659
01:39:48,520 --> 01:39:51,440
REMOTE LOCATION, AND IF IT'S

2660
01:39:51,440 --> 01:39:54,720
GOING TO SPUR OR ACCELERATE

2661
01:39:54,720 --> 01:39:56,040
MEDICAL CARE, I THINK THIS IS A

2662
01:39:56,040 --> 01:40:00,400
VIABLE OPTION IN SOME CASES.

2663
01:40:00,400 --> 01:40:01,720
>> SOMEONE ELSE WROTE IN THE

2664
01:40:01,720 --> 01:40:03,600
CHAT, ACCORDING TO YOU, MANY

2665
01:40:03,600 --> 01:40:07,240
RURAL RESIDENTS HAVE HAD A BAD

2666
01:40:07,240 --> 01:40:09,000
EXPERIENCE OF DELAYED

2667
01:40:09,000 --> 01:40:10,480
911 RESPONSE DUE TO COVID.

2668
01:40:10,480 --> 01:40:13,000
SUCH AS THE STAFFING CRISIS

2669
01:40:13,000 --> 01:40:14,760
AVAILABILITY.

2670
01:40:14,760 --> 01:40:15,680
THEY'D JUST RATHER DRIVE

2671
01:40:15,680 --> 01:40:18,360
THEMSELVES TO THE E.D. AND THIS

2672
01:40:18,360 --> 01:40:24,040
IS CERTAINLY -- AGAIN, AS

2673
01:40:24,040 --> 01:40:25,400
DR. BENSON KIND OF HIGHLIGHTED,

2674
01:40:25,400 --> 01:40:26,040
OVER THE COURSE OF THE PAST

2675
01:40:26,040 --> 01:40:28,040
THREE YEARS WITH COVID BUT THEN

2676
01:40:28,040 --> 01:40:29,040
ALSO WITH THE NATIONAL SENTINEL

2677
01:40:29,040 --> 01:40:31,040
EVENT OF THE GEORGE FLOYD,

2678
01:40:31,040 --> 01:40:37,120
BREONNA TAYLOR AND AHMAUD AUBREY

2679
01:40:37,120 --> 01:40:38,440
MURDERS, THE SPOTLIGHT HAS

2680
01:40:38,440 --> 01:40:41,280
REALLY BEEN SHINED ON THE

2681
01:40:41,280 --> 01:40:42,480
INEQUITIES, AND THEN WE ALSO

2682
01:40:42,480 --> 01:40:43,920
HAVE SOME OF THESE OTHER THINGS

2683
01:40:43,920 --> 01:40:45,640
LIKE THE STAFFING CRISIS THAT'S

2684
01:40:45,640 --> 01:40:50,000
BEEN ALLUDED THAT ALSO HAS AN

2685
01:40:50,000 --> 01:40:53,880
IMPACT ON SOME OF OUR PATIENTS'

2686
01:40:53,880 --> 01:40:55,360
DESIRE TO ACCESS THE SYSTEM AND

2687
01:40:55,360 --> 01:40:59,160
TO RECEIVE HELP.

2688
01:40:59,160 --> 01:41:01,000
SO IT'S A GOOD POINT THAT

2689
01:41:01,000 --> 01:41:02,240
THERE'S MULTIFACTORIAL REASONS

2690
01:41:02,240 --> 01:41:06,840
OF WHY 911 MAY NOT BE UTILIZED

2691
01:41:06,840 --> 01:41:09,440
BUT HOPEFULLY AS WE MOVE

2692
01:41:09,440 --> 01:41:10,960
FORWARD, TAKE THAT SPOTLIGHT

2693
01:41:10,960 --> 01:41:14,160
THAT I ALLUDE TO, AND SHINE IT

2694
01:41:14,160 --> 01:41:16,360
TODAY ON THE DIFFERENT FOUR

2695
01:41:16,360 --> 01:41:19,760
CATEGORY AREAS OF STROKE CARE,

2696
01:41:19,760 --> 01:41:23,000
WE CAN HOPEFULLY WORK TO

2697
01:41:23,000 --> 01:41:24,080
IDENTIFY NEW OPPORTUNITIES, THE

2698
01:41:24,080 --> 01:41:29,040
CURRENT GAPS TO FILL THE VOID OF

2699
01:41:29,040 --> 01:41:31,120
AND ALSO RESEARCH PRIORITIES FOR

2700
01:41:31,120 --> 01:41:36,600
FUTURE UTILIZATION BY THE NIH.

2701
01:41:36,600 --> 01:41:39,160
>> SO THANK YOU ALL FOR THIS

2702
01:41:39,160 --> 01:41:40,480
GREAT DISCUSSION AND

2703
01:41:40,480 --> 01:41:41,000
CONTRIBUTIONS.

2704
01:41:41,000 --> 01:41:42,440
ON THE EAST COAST HERE, IT

2705
01:41:42,440 --> 01:41:42,720
NOONTIME.

2706
01:41:42,720 --> 01:41:44,080
SO I THINK WE'RE DUE TO GO TO

2707
01:41:44,080 --> 01:41:48,640
OUR BREAKOUT SESSIONS.

2708
01:41:48,640 --> 01:41:50,200
I'M GOING TO GO AHEAD AND

2709
01:41:50,200 --> 01:41:52,240
INTRODUCE THE NEXT SESSION AND

2710
01:41:52,240 --> 01:41:53,920
WE WILL PLAY YOUR PRE-RECORDED

2711
01:41:53,920 --> 01:41:58,360
SUMMARY, SO WE ARE ABOUT TO HEAR

2712
01:41:58,360 --> 01:41:59,880
THE REPORT-OUT SUMMARY FROM OUR

2713
01:41:59,880 --> 01:42:06,240
TASK FORCE, LED BY AMIR AND LEE,

2714
01:42:06,240 --> 01:42:08,760
FOCUSING ON HEALTH INEQUITIES IN

2715
01:42:08,760 --> 01:42:10,840
THE HYPER/ACUTE CARE TIME EPOCH

2716
01:42:10,840 --> 01:42:12,440
OF STROKE CARE.

2717
01:42:12,440 --> 01:42:14,560
WE WILL HAVE AS BEFORE A VIDEO

2718
01:42:14,560 --> 01:42:16,640
THAT WILL PLAY, WITH ALL OF

2719
01:42:16,640 --> 01:42:17,240
THEIR FINDINGS.

2720
01:42:17,240 --> 01:42:19,280
THEN WE WILL MOVE INTO A

2721
01:42:19,280 --> 01:42:20,120
DISCUSSION SESSION, AND I THINK

2722
01:42:20,120 --> 01:42:22,000
THAT THEY HAVE A COUPLE

2723
01:42:22,000 --> 01:42:23,480
DISCUSSANTS WHO ARE GOING TO

2724
01:42:23,480 --> 01:42:23,800
PARTICIPATE.

2725
01:42:23,800 --> 01:42:25,360
THAT WOULD BE A GREAT

2726
01:42:25,360 --> 01:42:27,920
OPPORTUNITY FOR YOU ALL TO BEGIN

2727
01:42:27,920 --> 01:42:29,560
PUTTING QUESTIONS IN THE CHAT AS

2728
01:42:29,560 --> 01:42:30,640
THE VIDEO IS PLAYING.

2729
01:42:30,640 --> 01:42:31,840
WHEN THEY MOVE INTO LIVE

2730
01:42:31,840 --> 01:42:32,120
DISCUSSION.

2731
01:42:32,120 --> 01:42:37,960
AND THIN AFTER -- THEN WE'LL GO 

2732
01:42:37,960 --> 01:42:41,240
BACK INTO BREAKOUTS BY

2733
01:42:41,240 --> 01:42:42,080
CROSS-CUTTING AREAS, HAVE

2734
01:42:42,080 --> 01:42:44,400
CAMERAS ON, HAVE AN ORGANIC

2735
01:42:44,400 --> 01:42:45,160
DISCUSSION ABOUT CROSS-CUTTING

2736
01:42:45,160 --> 01:42:48,240
TOPICS IN THE BREAKOUT SESSIONS.

2737
01:42:48,240 --> 01:42:50,280
I THINK OUR CONTRACTORS ARE

2738
01:42:50,280 --> 01:42:52,000
GOING TO PLAY THE VIDEO, WITHOUT

2739
01:42:52,000 --> 01:42:54,640
FURTHER ADO.

2740
01:42:54,640 --> 01:43:02,720
 

2741
01:43:02,720 --> 01:43:06,960
 

2742
01:43:06,960 --> 01:43:08,640
 

2743
01:43:08,640 --> 01:43:13,080
>> HELLO, I'M AMEER HASSAN,

2744
01:43:13,080 --> 01:43:17,440
TODAY I WILL BE CO-CHAIRING THE

2745
01:43:17,440 --> 01:43:19,320
HYPERACUTE CARE SECTION OF THE

2746
01:43:19,320 --> 01:43:22,040
INEQUITIES AND DELIVERY OF ACUTE

2747
01:43:22,040 --> 01:43:25,360
STROKE CARE WITH MARY LEE

2748
01:43:25,360 --> 01:43:25,600
JENSON.

2749
01:43:25,600 --> 01:43:27,520
A QUICK OVERVIEW, HYPER AND

2750
01:43:27,520 --> 01:43:30,600
ACUTE CARE TASK FORCE IS

2751
01:43:30,600 --> 01:43:32,440
FOCUSING ON IDENTIFYING DRIVERS

2752
01:43:32,440 --> 01:43:34,560
OF DISPARITY IN ACUTE STROKE

2753
01:43:34,560 --> 01:43:35,200
CARE THAT AFFECT EQUITABLE

2754
01:43:35,200 --> 01:43:36,960
ACCESS IN THE U.S. AND

2755
01:43:36,960 --> 01:43:37,240
TERRITORIES.

2756
01:43:37,240 --> 01:43:39,440
PRIMARY FOCUS WILL BE DELIVERY

2757
01:43:39,440 --> 01:43:41,000
OF CARE IN TRADITIONAL EMERGENCY

2758
01:43:41,000 --> 01:43:41,440
DEPARTMENTS.

2759
01:43:41,440 --> 01:43:42,640
OTHER IMPORTANT AREAS OF FOCUS

2760
01:43:42,640 --> 01:43:44,840
ARE THE SPOKES IN THE HUB AND

2761
01:43:44,840 --> 01:43:48,440
SPOKE MODEL, ESPECIALLY IN RURAL

2762
01:43:48,440 --> 01:43:49,000
AREAS.

2763
01:43:49,000 --> 01:43:51,040
ME BEING IN TEXAS, IT'S NOT

2764
01:43:51,040 --> 01:43:53,400
REALLY RURAL BUT IT'S A

2765
01:43:53,400 --> 01:43:54,440
POPULATION OF ABOUT 70,000, I

2766
01:43:54,440 --> 01:43:56,320
KNOW WHAT IT'S LIKE TO FEEL

2767
01:43:56,320 --> 01:43:57,640
DISCONNECTED, TRYING TO BUILD A

2768
01:43:57,640 --> 01:44:00,560
PROGRAM OUTSIDE OF A MAJOR CITY.

2769
01:44:00,560 --> 01:44:01,440
EMERGENCY CARE ENTRY POINTS

2770
01:44:01,440 --> 01:44:08,840
WHERE CARE IS DELIVERED IN

2771
01:44:08,840 --> 01:44:09,640
NON-TRADITIONAL EMERGENCY

2772
01:44:09,640 --> 01:44:13,440
DEPARTMENTS AND CLINICS

2773
01:44:13,440 --> 01:44:14,760
UTILIZATION OF TELEMEDICINE TO

2774
01:44:14,760 --> 01:44:16,040
MEET NEEDS OF UNDERSERVED

2775
01:44:16,040 --> 01:44:17,800
POPULATIONS AND/OR LOCATIONS,

2776
01:44:17,800 --> 01:44:20,440
ACCESS TO BROADBAND AND OTHER

2777
01:44:20,440 --> 01:44:25,040
TELL MEDICINE EQUIPMENT AND

2778
01:44:25,040 --> 01:44:26,440
STAFFING, EDUCATION, ALIGNMENT

2779
01:44:26,440 --> 01:44:28,840
OF REGULATION, POLICY, LOCAL,

2780
01:44:28,840 --> 01:44:30,080
STATE, NATIONAL LEVELS.

2781
01:44:30,080 --> 01:44:34,920
SO, I'M GOING TO DISCUSS TODAY

2782
01:44:34,920 --> 01:44:35,880
DEMOGRAPHICS AND ECONOMIC

2783
01:44:35,880 --> 01:44:36,200
SUBGROUPS.

2784
01:44:36,200 --> 01:44:38,840
AND THEN LEE WILL BE PRESENTING

2785
01:44:38,840 --> 01:44:40,720
GEOGRAPHY AND POLICY.

2786
01:44:40,720 --> 01:44:41,320
FOR DEMOGRAPHIC SUBGROUP

2787
01:44:41,320 --> 01:44:42,600
PRIORITY NUMBER ONE IS DIVERSITY

2788
01:44:42,600 --> 01:44:46,600
IN THE WORK FORCE, SHOWN TO

2789
01:44:46,600 --> 01:44:47,960
IMPROVE THE LEARNING EXPERIENCE

2790
01:44:47,960 --> 01:44:50,120
OF DIVERSE STUDENTS AND MEDICAL

2791
01:44:50,120 --> 01:44:52,080
TRAINEES, IMPROVE PATIENT CARE

2792
01:44:52,080 --> 01:44:53,520
AND HEALTH OUTCOMES, IMPROVE

2793
01:44:53,520 --> 01:44:58,320
QUALITY OF HEALTH CARE RESEARCH.

2794
01:44:58,320 --> 01:45:00,640
SO, FOR PRIORITY 1,

2795
01:45:00,640 --> 01:45:01,880
UNFORTUNATELY THE CURRENT RACIAL

2796
01:45:01,880 --> 01:45:04,280
AND ETHNIC DIVERSITY AMONG

2797
01:45:04,280 --> 01:45:05,760
STROKE, EVEN OVERALL NEUROLOGY

2798
01:45:05,760 --> 01:45:07,320
AND NEUROSURGERY WORKFORCE DOES

2799
01:45:07,320 --> 01:45:09,560
NOT REFLECT DIVERSITY OF THE

2800
01:45:09,560 --> 01:45:10,640
UNITED STATES POPULATION.

2801
01:45:10,640 --> 01:45:13,640
ANOTHER IS LACK OF GENDER

2802
01:45:13,640 --> 01:45:15,440
DIVERSE IN ACADEMIC STROKE

2803
01:45:15,440 --> 01:45:17,080
MEDICINE, ESPECIALLY IN

2804
01:45:17,080 --> 01:45:17,760
LEADERSHIP POSITIONS.

2805
01:45:17,760 --> 01:45:24,240
AND VERY PROUD OF WORKING WITH

2806
01:45:24,240 --> 01:45:24,680
LUIS MCCULLOUGH, WE'VE

2807
01:45:24,680 --> 01:45:26,440
COLLABORATED ON A NUMBER OF

2808
01:45:26,440 --> 01:45:26,720
THINGS.

2809
01:45:26,720 --> 01:45:28,640
LACK OF DIVERSITY EXISTS IN

2810
01:45:28,640 --> 01:45:30,400
FACULTY WORKFORCE AND LACK OF

2811
01:45:30,400 --> 01:45:34,240
RACIAL AND ETHNIC WORKFORCE IN

2812
01:45:34,240 --> 01:45:34,640
TRAINEES.

2813
01:45:34,640 --> 01:45:35,600
INCLUDING VASCULAR NEUROLOGY.

2814
01:45:35,600 --> 01:45:37,440
IN ADDITION HAVING A LOW

2815
01:45:37,440 --> 01:45:40,200
PROPORTION OF FACULTY AND

2816
01:45:40,200 --> 01:45:40,960
TRAINEES FOR MINORITY GROUPS

2817
01:45:40,960 --> 01:45:43,040
INDIVIDUALS ARE A PART OF THE

2818
01:45:43,040 --> 01:45:45,320
WORKFORCE AND FACE CHALLENGES IN

2819
01:45:45,320 --> 01:45:46,760
ADVANCING WITHIN ACADEMIC

2820
01:45:46,760 --> 01:45:47,040
MEDICINE.

2821
01:45:47,040 --> 01:45:51,560
THESE INCLUDE AS YOU CAN SEE

2822
01:45:51,560 --> 01:45:54,240
LISTED THE MINORITY TAX, LOYALTY

2823
01:45:54,240 --> 01:45:55,560
TAX, DISTANCE TRAVELED, POWER

2824
01:45:55,560 --> 01:45:57,080
DISTANCE, INCREASE THE IMPOSTOR

2825
01:45:57,080 --> 01:45:57,360
SYNDROME.

2826
01:45:57,360 --> 01:45:59,640
PRIORITY 2 IS NEED FOR STROKE

2827
01:45:59,640 --> 01:46:01,240
OUTREACH TO UNDERSERVED

2828
01:46:01,240 --> 01:46:02,600
POPULATION AND AT-RISK

2829
01:46:02,600 --> 01:46:02,880
POPULATIONS.

2830
01:46:02,880 --> 01:46:04,880
FOR ME THIS HITS HOME.

2831
01:46:04,880 --> 01:46:08,160
85% OF MY POPULATION IS MEXICAN

2832
01:46:08,160 --> 01:46:10,800
AMERICAN, 15 MINUTES FROM THE

2833
01:46:10,800 --> 01:46:15,600
BORDER, SO I SEE THIS A LOT.

2834
01:46:15,600 --> 01:46:16,680
ANOTHER PRIORITY IS CRITICAL --

2835
01:46:16,680 --> 01:46:19,440
THAT IS CRITICAL TO REDUCTION OF

2836
01:46:19,440 --> 01:46:22,920
DISPARITIES IS NEED FOR IMPROVED

2837
01:46:22,920 --> 01:46:23,480
OUTREACH TO UNDERSERVED

2838
01:46:23,480 --> 01:46:32,840
COMMUNITIES AND INDIVIDUALS AT 

2839
01:46:32,840 --> 01:46:33,760
RISK IN OUTCOMES.

2840
01:46:33,760 --> 01:46:35,600
SOCIAL DETERMINANTS OF HEALTH

2841
01:46:35,600 --> 01:46:38,440
IMPACT ACCESS TO ACUTE STROKE

2842
01:46:38,440 --> 01:46:39,760
CARE.

2843
01:46:39,760 --> 01:46:40,720
ESPECIALLY THROMBOLYSIS AND

2844
01:46:40,720 --> 01:46:41,840
MECHANICAL THROMBECTOMY.

2845
01:46:41,840 --> 01:46:44,680
WE DID RESEARCH SEVERAL YEARS

2846
01:46:44,680 --> 01:46:48,480
AGO SHOWING SIGNIFICANTLY

2847
01:46:48,480 --> 01:46:55,000
DECREASED IVTP UTILIZE ATION

2848
01:46:55,000 --> 01:47:01,360
LEADING TO INCREASED MORTALITY.

2849
01:47:01,360 --> 01:47:02,360
BLACKS, HISPANICS, SPANISH

2850
01:47:02,360 --> 01:47:03,560
SPEAKING, LOWER INCOME, LOW

2851
01:47:03,560 --> 01:47:05,640
EDUCATION, THOSE LIVING IN RURAL

2852
01:47:05,640 --> 01:47:05,920
AREAS.

2853
01:47:05,920 --> 01:47:08,680
AND THEN OF COURSE ADD INTO THIS

2854
01:47:08,680 --> 01:47:09,640
THAT THE EDUCATIONAL PNEUMONICS

2855
01:47:09,640 --> 01:47:12,480
LIKE FAST AND B FAST FOR STROKE

2856
01:47:12,480 --> 01:47:15,040
SIGNS AND SYMPTOMS ARE PRIMARILY

2857
01:47:15,040 --> 01:47:18,480
IN ENGLISH, NEW TOOLS OF SPANISH

2858
01:47:18,480 --> 01:47:19,640
LANGUAGE TOOLS ARE BEING

2859
01:47:19,640 --> 01:47:22,320
DEVELOPED, AND WE'RE WORKING

2860
01:47:22,320 --> 01:47:24,520
WITH TO GET WITH GUIDELINES

2861
01:47:24,520 --> 01:47:30,520
PARTNERS ON THIS.

2862
01:47:30,520 --> 01:47:33,160
LEE SHWAM IS HEADING THIS.

2863
01:47:33,160 --> 01:47:36,040
PRIORITY 3, THERE HAVE BEEN

2864
01:47:36,040 --> 01:47:36,840
DISPARITIES IN HOSPITAL

2865
01:47:36,840 --> 01:47:38,040
RESOURCES ACROSS THE BOARD

2866
01:47:38,040 --> 01:47:39,040
ESPECIALLY IN MINORITY GROUPS,

2867
01:47:39,040 --> 01:47:41,600
IN HOSPITALS IN U.S. TERRITORIES

2868
01:47:41,600 --> 01:47:42,200
ARE NO EXCEPTION.

2869
01:47:42,200 --> 01:47:44,200
ONE OF THE CHALLENGES THE

2870
01:47:44,200 --> 01:47:47,520
TERRITORIES FACE IS DISTANCE

2871
01:47:47,520 --> 01:47:50,560
FROM CONTINENTAL U.S. AND

2872
01:47:50,560 --> 01:47:52,000
POTENTIAL TRANSFER CENTERS.

2873
01:47:52,000 --> 01:47:53,400
DISTANCE CREATES URGENCY TO

2874
01:47:53,400 --> 01:47:55,360
IMPROVE SYSTEMS OF CARE AND

2875
01:47:55,360 --> 01:47:57,000
HOUSEHOLD RESOURCES SPECIFICALLY

2876
01:47:57,000 --> 01:48:02,960
AT THOSE TERRITORIES.

2877
01:48:02,960 --> 01:48:09,320
INCREASED UTILIZATION OF

2878
01:48:09,320 --> 01:48:11,400
TELEMEDICINE COULD HELP.

2879
01:48:11,400 --> 01:48:15,000
RAFI WILL BE PART OF THE

2880
01:48:15,000 --> 01:48:15,280
DISCUSSION.

2881
01:48:15,280 --> 01:48:19,240
SDIM, MT 2220 AND SILK ARE TWO

2882
01:48:19,240 --> 01:48:22,440
SUBCOMMITTEES WORKING ON

2883
01:48:22,440 --> 01:48:23,840
CREATING TRAINING PATHWAYS FOR

2884
01:48:23,840 --> 01:48:25,400
LOW-INCOME COUNTRIES ACROSS THE

2885
01:48:25,400 --> 01:48:26,560
WORLD, ESPECIALLY U.S.

2886
01:48:26,560 --> 01:48:31,480
TERRITORIES THAT WOULD BE A

2887
01:48:31,480 --> 01:48:32,400
PRIORITY.

2888
01:48:32,400 --> 01:48:35,320
INCREASED UTILIZATION OF

2889
01:48:35,320 --> 01:48:37,640
TELEMEDICINE AND MEDICAL

2890
01:48:37,640 --> 01:48:39,160
PROFESSIONALS IN THE TERRITORIES

2891
01:48:39,160 --> 01:48:40,440
COULD HELP AND MENTORING AND

2892
01:48:40,440 --> 01:48:41,240
EDUCATION ARE ESSENTIAL TO

2893
01:48:41,240 --> 01:48:42,320
IMPROVE THE CARE OF STROKE

2894
01:48:42,320 --> 01:48:44,840
PATIENTS LIVING IN U.S.

2895
01:48:44,840 --> 01:48:45,360
TERRITORIES.

2896
01:48:45,360 --> 01:48:50,000
POTENTIAL SOLUTIONS TO LACK OF

2897
01:48:50,000 --> 01:48:52,640
DIVERSITY IN STROKE WORK FORCE

2898
01:48:52,640 --> 01:48:53,960
TRACK AND MEASURE USING

2899
01:48:53,960 --> 01:48:56,120
DIVERSITY INDEX, DEVELOP ROLE OF

2900
01:48:56,120 --> 01:48:59,920
DIVERSITY OFFICERS, D.E.I. OR

2901
01:48:59,920 --> 01:49:01,320
DIE COMMITTEES IN ACADEMIC

2902
01:49:01,320 --> 01:49:02,320
NEUROLOGY DEPARTMENTS,

2903
01:49:02,320 --> 01:49:04,520
PARTICULARLY WITH REGARD TO

2904
01:49:04,520 --> 01:49:06,800
RESIDENCY, FELLOWSHIP, AND

2905
01:49:06,800 --> 01:49:07,680
FACULTY RECRUITMENT.

2906
01:49:07,680 --> 01:49:09,440
FORMALIZED TRAINING THROUGH USE

2907
01:49:09,440 --> 01:49:10,560
OF CERTIFICATION PROGRAMS, MAKE

2908
01:49:10,560 --> 01:49:13,880
USE OF SOCIAL MEDIA TO INCREASE

2909
01:49:13,880 --> 01:49:14,680
NETWORKING AND MEMBERSHIP

2910
01:49:14,680 --> 01:49:16,800
OPPORTUNITIES FOR DIVERSITY AND

2911
01:49:16,800 --> 01:49:19,600
TRAINEES AND JUNIOR FACULTY.

2912
01:49:19,600 --> 01:49:21,320
OF COURSE, CREATE MULTI-PRONGED

2913
01:49:21,320 --> 01:49:22,760
AND CONTINUOUS PIPELINE, THIS

2914
01:49:22,760 --> 01:49:24,720
HELPS RECRUIT AND RETAIN

2915
01:49:24,720 --> 01:49:26,640
TRAINEES IN OUR FIELD,

2916
01:49:26,640 --> 01:49:28,120
ESPECIALLY VASCULAR NEUROLOGY.

2917
01:49:28,120 --> 01:49:29,640
LOOK TO OTHER SPECIALTIES FOR

2918
01:49:29,640 --> 01:49:31,600
EXAMPLES OF SIMILAR PROGRAMS

2919
01:49:31,600 --> 01:49:33,640
SUCH AS EMERGENCY MEDICINE,

2920
01:49:33,640 --> 01:49:34,760
RADIOLOGY, GENERAL

2921
01:49:34,760 --> 01:49:38,200
MULTI-SPECIALTY AND G.I.

2922
01:49:38,200 --> 01:49:41,840
INCREASE DIVERSITY AND TRAINING

2923
01:49:41,840 --> 01:49:42,880
THROUGH TARGETED FUNDING

2924
01:49:42,880 --> 01:49:43,240
OPPORTUNITIES.

2925
01:49:43,240 --> 01:49:44,640
NOW WE'LL SWITCH GEARS TO

2926
01:49:44,640 --> 01:49:46,840
ECONOMIC AND HEALTH CARE

2927
01:49:46,840 --> 01:49:49,400
RESOURCE SUBGROUP, CROSS-CUTTING

2928
01:49:49,400 --> 01:49:50,320
THEME IS TELEMEDICINE.

2929
01:49:50,320 --> 01:49:51,000
WHAT IS KNOWN?

2930
01:49:51,000 --> 01:49:54,600
TELEMEDICINE AS YOU KNOW IS USE

2931
01:49:54,600 --> 01:49:56,240
OF REALTIME AV

2932
01:49:56,240 --> 01:50:00,560
TELECOMMUNICATIONS TO PROVIDE

2933
01:50:00,560 --> 01:50:02,000
STROKE EXPERTISE AND DECISION IN

2934
01:50:02,000 --> 01:50:04,040
ACUTE STROKE SETTING.

2935
01:50:04,040 --> 01:50:05,120
WE KNOW TELESTROKE,

2936
01:50:05,120 --> 01:50:05,720
TELERADIOLOGY EVALUATIONS OF

2937
01:50:05,720 --> 01:50:10,400
STROKE PATIENTS CAN BE EFFECTIVE

2938
01:50:10,400 --> 01:50:11,040
FOR CORRECT THROMBOLYSIS

2939
01:50:11,040 --> 01:50:13,360
ELIGIBILITY DECISION MAKING AND

2940
01:50:13,360 --> 01:50:17,720
TELESTROKE SERVICES IS MORE

2941
01:50:17,720 --> 01:50:19,360
ACCURATE IN DETERMINING FOR

2942
01:50:19,360 --> 01:50:20,240
PATIENTS PRESENTING WITH

2943
01:50:20,240 --> 01:50:21,760
SYMPTOMS IN THEE R.

2944
01:50:21,760 --> 01:50:24,400
WHEN IMPLEMENTED WITHIN A

2945
01:50:24,400 --> 01:50:24,920
TELESTROKE NETWORK,

2946
01:50:24,920 --> 01:50:26,440
TELERADIOLOGY SYSTEMS ARE

2947
01:50:26,440 --> 01:50:29,520
EFFECTIVE IN SUPPORTING RAPID

2948
01:50:29,520 --> 01:50:32,160
IMAGE INTERPRETATION, END TIME

2949
01:50:32,160 --> 01:50:33,040
FOR THROMBO LYTIC ADMINISTRATION

2950
01:50:33,040 --> 01:50:34,640
DISTINCTION MAKING.

2951
01:50:34,640 --> 01:50:36,520
NETWORKS MAY BE REASONABLE FOR

2952
01:50:36,520 --> 01:50:37,160
TRIAGING PATIENTS WITH ACUTE

2953
01:50:37,160 --> 01:50:40,800
STROKE CARE WHO MAY BE ELIGIBLE

2954
01:50:40,800 --> 01:50:43,760
FOR INTERFACILITY TRANSFER FOR

2955
01:50:43,760 --> 01:50:45,760
MECHANICAL THROMBECTOMY AND USE

2956
01:50:45,760 --> 01:50:46,920
OF SERVICES AND RESOURCES AND

2957
01:50:46,920 --> 01:50:49,440
SYSTEMS SHOULD BE SUPPORTED BY

2958
01:50:49,440 --> 01:50:51,080
HEALTH CARE INSTITUTIONS,

2959
01:50:51,080 --> 01:50:51,720
GOVERNMENTS, PAYERS AND VENDORS

2960
01:50:51,720 --> 01:50:54,160
AS A METHOD TO ENSURE ADEQUATE

2961
01:50:54,160 --> 01:50:56,760
24/7 COVERAGE IN A VARIETY OF

2962
01:50:56,760 --> 01:50:58,040
SETTINGS.

2963
01:50:58,040 --> 01:51:02,520
SO WHAT ARE THE GAPS IN

2964
01:51:02,520 --> 01:51:03,000
OPPORTUNITIES?

2965
01:51:03,000 --> 01:51:06,360
SMALL RURAL HOSPITALS LESS

2966
01:51:06,360 --> 01:51:08,280
LIKELY TO HAVE TELESTROKE

2967
01:51:08,280 --> 01:51:10,000
SYSTEMS COMPARED TO URBAN

2968
01:51:10,000 --> 01:51:10,520
HOSPITALS AND FACILITIES,

2969
01:51:10,520 --> 01:51:13,280
STUDIED IN THE UNITED STATES, WE

2970
01:51:13,280 --> 01:51:21,320
HAVE DATA ON THIS. 

2971
01:51:21,320 --> 01:51:23,240
NEUROLOGIST DENSITY HAS

2972
01:51:23,240 --> 01:51:24,720
INCREASED IN RURAL SETTINGS.

2973
01:51:24,720 --> 01:51:27,640
IN 2020 THEY LOOKED AT 2017

2974
01:51:27,640 --> 01:51:31,200
CAPACITY, AND LOOKING AT THE

2975
01:51:31,200 --> 01:51:35,240
HIGHEST QUARTILE YOU HAD 33% OF

2976
01:51:35,240 --> 01:51:37,640
LARGER HOSPITALS HAVING

2977
01:51:37,640 --> 01:51:39,520
TELESTROKE SERVICES, ONLY 14.8

2978
01:51:39,520 --> 01:51:41,080
IN LOWEST QUARTILE, SMALLER

2979
01:51:41,080 --> 01:51:42,840
HOSPITALS ARE NOT GETTING THIS.

2980
01:51:42,840 --> 01:51:44,440
YOU SEE IT MOSTLY BASED ON SIZE

2981
01:51:44,440 --> 01:51:46,480
BUT ALSO SEE IT BASED ON

2982
01:51:46,480 --> 01:51:47,240
LOCATION.

2983
01:51:47,240 --> 01:51:49,360
30% OF URBAN HOSPITALS HAD

2984
01:51:49,360 --> 01:51:52,080
TELESTROKE SERVICES, ONLY 23% IN

2985
01:51:52,080 --> 01:51:52,760
RURAL.

2986
01:51:52,760 --> 01:51:55,600
FOR SHORT-TERM ACUTE CARE

2987
01:51:55,600 --> 01:51:59,880
HOSPITALS 31%, CRITICAL ACCESS

2988
01:51:59,880 --> 01:52:00,720
17%.

2989
01:52:00,720 --> 01:52:04,400
2018 DATA LOOKED AT UNITS IN 51,

2990
01:52:04,400 --> 01:52:08,640
37, 18% BREAKING UP LARGE

2991
01:52:08,640 --> 01:52:09,560
METROPOLITAN, MEDIUM, SMALL,

2992
01:52:09,560 --> 01:52:13,120
METRO COUNTIES, FOUR OUT OF FIVE

2993
01:52:13,120 --> 01:52:19,800
RURAL COUNTIES DO NOT HAVE A

2994
01:52:19,800 --> 01:52:20,520
TELESTROKE UNIT.

2995
01:52:20,520 --> 01:52:26,360
BARRIERS IS COST.

2996
01:52:26,360 --> 01:52:27,320
CAPACITY.

2997
01:52:27,320 --> 01:52:28,640
CAPACITY, LIMITATIONS, AVAILABLE

2998
01:52:28,640 --> 01:52:30,280
OF RURAL BROADBAND AND

2999
01:52:30,280 --> 01:52:32,360
TELESTROKE PROVIDERS.

3000
01:52:32,360 --> 01:52:34,000
LACK OF PERSPECTIVE COMPARATIVE

3001
01:52:34,000 --> 01:52:35,080
RESEARCH TO CONFIRM

3002
01:52:35,080 --> 01:52:37,040
EFFECTIVENESS OF TELESTROKE AND

3003
01:52:37,040 --> 01:52:42,320
TELESTROKE SYSTEMS IN THE ACUTE 

3004
01:52:42,320 --> 01:52:43,840
STROKE TREATMENT AND TRIAGE.

3005
01:52:43,840 --> 01:52:46,680
HOW DO WE MAKE IMPROVEMENTS TO

3006
01:52:46,680 --> 01:52:49,280
DISSOLVE DISPARITIES?

3007
01:52:49,280 --> 01:52:50,840
EXPAND LICENSURE, EXPAND

3008
01:52:50,840 --> 01:52:53,040
LICENSURE TO PERFORM TELESTROKE

3009
01:52:53,040 --> 01:52:55,000
SERVICES ACROSS STRAIGHT LINES.

3010
01:52:55,000 --> 01:52:56,840
ALLOW UNIVERSAL PARITY BETWEEN

3011
01:52:56,840 --> 01:52:58,640
STROKE CARE PERFORMED VIA

3012
01:52:58,640 --> 01:53:00,400
TELEMEDICINE AND IN-PERSON

3013
01:53:00,400 --> 01:53:00,960
SERVICES.

3014
01:53:00,960 --> 01:53:02,360
MAINTAIN ELIMINATION OF

3015
01:53:02,360 --> 01:53:04,640
ORIGINATING SITE RESTRICTIONS

3016
01:53:04,640 --> 01:53:06,760
FOR TELESTROKE SERVICES.

3017
01:53:06,760 --> 01:53:08,440
2019 FAST ACT LEGISLATION

3018
01:53:08,440 --> 01:53:10,680
REQUIRES CMS TO REIMBURSE FOR

3019
01:53:10,680 --> 01:53:11,560
TELESTROKE SERVICES REGARDLESS

3020
01:53:11,560 --> 01:53:12,640
OF WHERE A PATIENT RECEIVES

3021
01:53:12,640 --> 01:53:13,000
TREATMENT.

3022
01:53:13,000 --> 01:53:14,760
IN SITUATION WHERE IS

3023
01:53:14,760 --> 01:53:18,360
VIDEO-BASED CONSULTATION IS NOT 

3024
01:53:18,360 --> 01:53:19,320
AVAILABLE ALLOW EMERGENCY

3025
01:53:19,320 --> 01:53:21,080
TELEPHONE CONSULTATION TO BE

3026
01:53:21,080 --> 01:53:24,160
REIMBURSABLE AS A LIMITED

3027
01:53:24,160 --> 01:53:26,200
TELEPHONE-ONLY ENCOUNTER.

3028
01:53:26,200 --> 01:53:27,560
CONTINUE POLICIES ENACTED THE

3029
01:53:27,560 --> 01:53:29,320
WITH THE COVID-19 ENERGY

3030
01:53:29,320 --> 01:53:30,480
AUTHORIZATION ACT THAT

3031
01:53:30,480 --> 01:53:32,680
INCENTIVIZE ADOPTION OF

3032
01:53:32,680 --> 01:53:35,760
TELESTROKE SERVICES ACROSS ALL

3033
01:53:35,760 --> 01:53:36,840
GEOGRAPHIES.

3034
01:53:36,840 --> 01:53:38,640
WORK WITH LEGISLATURE,

3035
01:53:38,640 --> 01:53:39,400
POLICYMAKERS, REGULATORY

3036
01:53:39,400 --> 01:53:40,360
AGENCIES AND COMMERCIAL

3037
01:53:40,360 --> 01:53:43,440
PROVIDERS TO ENSURE ACCESS TO

3038
01:53:43,440 --> 01:53:44,960
HIGH QUALITY BROADBAND FOR RURAL

3039
01:53:44,960 --> 01:53:45,920
SETTINGS.

3040
01:53:45,920 --> 01:53:47,800
TO CONTINUE ON THIS, EMPOWER

3041
01:53:47,800 --> 01:53:49,520
STATE DEPARTMENTS OF HEALTH,

3042
01:53:49,520 --> 01:53:51,200
GHOSTAL AGENCIES AND REGIONAL

3043
01:53:51,200 --> 01:53:52,920
HEALTH SYSTEMS TO PARTNER IN

3044
01:53:52,920 --> 01:53:54,880
PROVISION OF TELESTROKE SERVICES

3045
01:53:54,880 --> 01:53:56,000
FOR CRITICAL ACCESS HOSPITALS

3046
01:53:56,000 --> 01:53:57,640
WITHIN STROKE SYSTEMS OF CARE.

3047
01:53:57,640 --> 01:54:00,000
CREATE MORE FEDERAL GRANT

3048
01:54:00,000 --> 01:54:01,520
FUNDING OPPORTUNITIES FOR

3049
01:54:01,520 --> 01:54:02,920
ADOPTION OF TELEASTROS PROGRAMS

3050
01:54:02,920 --> 01:54:05,440
AND NETWORKS FOR RURAL AND

3051
01:54:05,440 --> 01:54:08,080
CRITICAL ACCESS HOSPITALS.

3052
01:54:08,080 --> 01:54:09,120
FOR EXAMPLE, HRSA.

3053
01:54:09,120 --> 01:54:11,040
AND NIH, OF COURSE.

3054
01:54:11,040 --> 01:54:12,320
DEVELOP LOAN REPAYMENT PROGRAMS

3055
01:54:12,320 --> 01:54:13,840
FOR TELESTROKE PROVIDERS WHO

3056
01:54:13,840 --> 01:54:14,960
PROVIDE CARE FOR RURAL-BASED

3057
01:54:14,960 --> 01:54:17,360
HOSPITALS WITH GOAL OF GROWING

3058
01:54:17,360 --> 01:54:20,560
AND INCENTIVIZING THE TELESTROKE

3059
01:54:20,560 --> 01:54:20,960
WORKFORCE.

3060
01:54:20,960 --> 01:54:23,280
WORK WITH ACGME AND SPECIALTY

3061
01:54:23,280 --> 01:54:24,800
BOARDS TO INSTILL EDUCATIONAL

3062
01:54:24,800 --> 01:54:27,040
AND TRAINING REQUIREMENTS IN

3063
01:54:27,040 --> 01:54:32,240
TELEMEDICINE COMPETENCY, STEM 

3064
01:54:32,240 --> 01:54:34,200
PROMOTE SKILLS TRAINING AND

3065
01:54:34,200 --> 01:54:35,640
CERTIFICATION FOR EMERGENCY

3066
01:54:35,640 --> 01:54:37,960
PROVIDERS, NURSES AND SUPPORT

3067
01:54:37,960 --> 01:54:41,000
STAFF, IN TELESTROKE COMPETENCY.

3068
01:54:41,000 --> 01:54:42,960
EXPAND RESEARCH BY INTEGRATING

3069
01:54:42,960 --> 01:54:44,840
WITH CLINICAL TRIALS,

3070
01:54:44,840 --> 01:54:45,800
EPIDEMIOLOGICAL STUDIES,

3071
01:54:45,800 --> 01:54:46,800
DEVELOPING MULTI-CENTER

3072
01:54:46,800 --> 01:54:47,600
TELESTROKE RESEARCH NETWORKS.

3073
01:54:47,600 --> 01:54:48,640
>> GOOD AFTERNOON.

3074
01:54:48,640 --> 01:54:53,440
THANK YOU FOR PARTICIPATING IN

3075
01:54:53,440 --> 01:54:57,040
THIS EXCITING SYMPOSIUM.

3076
01:54:57,040 --> 01:54:58,040
DR. HASSAN DISCUSSED

3077
01:54:58,040 --> 01:54:59,880
DEMOGRAPHICS AND ADDRESSED OUR

3078
01:54:59,880 --> 01:55:00,640
MOST IMPORTANT TELEMEDICINE

3079
01:55:00,640 --> 01:55:01,040
CONCERNS.

3080
01:55:01,040 --> 01:55:04,320
I WILL BE TOUCHING ON SOME MAJOR

3081
01:55:04,320 --> 01:55:05,680
GEOGRAPHIC AND POLICY ISSUES

3082
01:55:05,680 --> 01:55:07,760
INVOLVING STROKE CARE AT THE

3083
01:55:07,760 --> 01:55:09,480
ACUTE LEVEL.

3084
01:55:09,480 --> 01:55:10,680
KEY CONTRIBUTING FACTORS FOR

3085
01:55:10,680 --> 01:55:12,000
GEOGRAPHIC INTHE QUESTIONS AND

3086
01:55:12,000 --> 01:55:14,520
ACCESS AND DELIVERY OF ACUTE

3087
01:55:14,520 --> 01:55:16,040
STROKE CARE INCLUDE MAL

3088
01:55:16,040 --> 01:55:18,320
DISTRIBUTION OF HIGHER LEVEL

3089
01:55:18,320 --> 01:55:22,360
STROKE HOSPITALS, SUCH AS

3090
01:55:22,360 --> 01:55:24,360
PSCs, TSCs, CSCs, STROKE

3091
01:55:24,360 --> 01:55:25,440
EXPERTISE, LACK OF CONTINUING

3092
01:55:25,440 --> 01:55:26,520
EDUCATION AND RESEARCH

3093
01:55:26,520 --> 01:55:28,920
PARTICIPATION FOR PROVIDERS AND

3094
01:55:28,920 --> 01:55:30,880
PATIENTS, AND NON-UNIFORM ACCESS

3095
01:55:30,880 --> 01:55:31,800
TO TELEMEDICINE.

3096
01:55:31,800 --> 01:55:33,520
OUR FIRST PRIORITY IS IMPROVING

3097
01:55:33,520 --> 01:55:37,440
ACCESS TO STROKE LEVEL

3098
01:55:37,440 --> 01:55:38,040
HOSPITALS.

3099
01:55:38,040 --> 01:55:39,320
SEVERAL MANUSCRIPTS HAVE BEEN

3100
01:55:39,320 --> 01:55:41,720
PUBLISHED OVER YEARS MAPPING

3101
01:55:41,720 --> 01:55:44,240
DISTRIBUTION OF PSCS AND CSCs.

3102
01:55:44,240 --> 01:55:45,320
TECHNOLOGY IS AVAILABLE TO

3103
01:55:45,320 --> 01:55:46,320
FACILITATE DETERMINATION OF

3104
01:55:46,320 --> 01:55:48,360
DISTANCE AND TIME BETWEEN WHERE

3105
01:55:48,360 --> 01:55:50,040
POPULATIONS LIVE AND CLOSEST

3106
01:55:50,040 --> 01:55:51,120
APPROPRIATE HOSPITAL.

3107
01:55:51,120 --> 01:55:52,080
THE CHALLENGE WITH MAINTAINING

3108
01:55:52,080 --> 01:55:54,960
SUCH A MAP OF STROKE RESOURCES

3109
01:55:54,960 --> 01:55:57,440
IS A CONTINUOUS EVOLUTION OF

3110
01:55:57,440 --> 01:55:57,960
HOSPITAL CERTIFICATION,

3111
01:55:57,960 --> 01:56:00,760
THEREFORE THIS ISSUE NEEDS TO BE

3112
01:56:00,760 --> 01:56:02,720
REVISITED WITH FREQUENCY AND

3113
01:56:02,720 --> 01:56:05,360
CHANGES IN HOSPITAL STATUS

3114
01:56:05,360 --> 01:56:05,640
IDENTIFIED.

3115
01:56:05,640 --> 01:56:07,280
THE LARGER CHALLENGE IS IN

3116
01:56:07,280 --> 01:56:08,480
DETERMINING THE MOST EFFECTIVE

3117
01:56:08,480 --> 01:56:13,080
WAY TO FILL THE GAPS IN ACCESS

3118
01:56:13,080 --> 01:56:14,720
TO QUALITY PSCs, TSCs,

3119
01:56:14,720 --> 01:56:17,800
CSCs FOR DEFINITIVE CARE AND

3120
01:56:17,800 --> 01:56:18,560
REDUCE GEOGRAPHICAL DISPARITY.

3121
01:56:18,560 --> 01:56:20,960
IT IS IMPORTANT TO GET PATIENTS

3122
01:56:20,960 --> 01:56:21,640
WITH SUSPECTED STROKE TO THE

3123
01:56:21,640 --> 01:56:23,520
RIGHT PLACE AT THE RIGHT TIME

3124
01:56:23,520 --> 01:56:25,240
FOR THE RIGHT CARE.

3125
01:56:25,240 --> 01:56:27,960
ROUTING PROTOCOLS SUCH AS

3126
01:56:27,960 --> 01:56:28,480
AUTOMATICALLY BYPASSING

3127
01:56:28,480 --> 01:56:38,000
APPROPRIATE HOSPITALS TO A

3128
01:56:38,000 --> 01:56:39,000
DEFAULT HOSPITAL, IF THE CENTER

3129
01:56:39,000 --> 01:56:41,640
DOESN'T GET THE PATIENTS THE

3130
01:56:41,640 --> 01:56:43,800
CENTER CANNOT DEMONSTRATE

3131
01:56:43,800 --> 01:56:44,040
MASTERY.

3132
01:56:44,040 --> 01:56:44,880
THE SIGNIFICANT FINANCIAL

3133
01:56:44,880 --> 01:56:46,200
RESOURCES NECESSARY TO ADVANCE

3134
01:56:46,200 --> 01:56:47,960
FROM ONE LEVEL OF CERTIFICATION

3135
01:56:47,960 --> 01:56:51,640
TO ANOTHER MAY NOT BE

3136
01:56:51,640 --> 01:56:52,040
FORTHCOMING.

3137
01:56:52,040 --> 01:56:55,080
OUR SECOND PRIORITY INVOLVES

3138
01:56:55,080 --> 01:56:57,800
IMPROVING ACCESS TO EXPERTISE.

3139
01:56:57,800 --> 01:56:59,640
98% OF AMERICANS LIVE WITHIN 60

3140
01:56:59,640 --> 01:57:01,040
MINUTES OF EMERGENCY DEPARTMENT,

3141
01:57:01,040 --> 01:57:02,440
ACCESS TO CERTIFIED STROKE

3142
01:57:02,440 --> 01:57:04,240
CENTERS IS A MOVING TARGET

3143
01:57:04,240 --> 01:57:05,640
PARTICULARLY IN RURAL AREAS.

3144
01:57:05,640 --> 01:57:08,040
THIS IS PARTIALLY DUE TO

3145
01:57:08,040 --> 01:57:10,320
EVOLUTION OF HOSPITALS THROUGH

3146
01:57:10,320 --> 01:57:12,200
ESCALATING CERTIFICATION

3147
01:57:12,200 --> 01:57:12,520
PROGRAMS.

3148
01:57:12,520 --> 01:57:13,680
HOSPITALS WITHOUT CERTIFICATION

3149
01:57:13,680 --> 01:57:16,320
HAVE LESS ACCESS TO ACUTE STROKE

3150
01:57:16,320 --> 01:57:20,440
PATIENTS AND HAVE LESS

3151
01:57:20,440 --> 01:57:22,040
OPPORTUNITY TO ESTABLISH

3152
01:57:22,040 --> 01:57:22,320
PROFICIENCY.

3153
01:57:22,320 --> 01:57:25,960
BED SIZE, RURAL OR UNDERSERVED

3154
01:57:25,960 --> 01:57:27,440
DESIGNATION, LOW POPULATION

3155
01:57:27,440 --> 01:57:28,920
DENSITY ARE SIGNIFICANTLY

3156
01:57:28,920 --> 01:57:31,280
ASSOCIATED WITH LOW tPA

3157
01:57:31,280 --> 01:57:33,040
TREATMENT RATES.

3158
01:57:33,040 --> 01:57:34,440
EMERGENCY MEDICINE RESIDENCY

3159
01:57:34,440 --> 01:57:35,480
PROGRAMS LACK STANDARDIZATION

3160
01:57:35,480 --> 01:57:37,760
FOR STROKE MANAGEMENT TRAINING.

3161
01:57:37,760 --> 01:57:43,120
THERE ARE NO STROKE-SPECIFIC

3162
01:57:43,120 --> 01:57:43,960
ONGOING REQUIREMENTS FOR

3163
01:57:43,960 --> 01:57:47,240
EMERGENCY MEDICINE PHYSICIANS.

3164
01:57:47,240 --> 01:57:49,440
ACCESS TO EXPERTS IS LIMITED.

3165
01:57:49,440 --> 01:57:52,840
THERE ARE ALSO GAPS IN ACCESS TO

3166
01:57:52,840 --> 01:57:54,680
ADVANCED NEUROIMAGING RESULTING

3167
01:57:54,680 --> 01:57:58,280
IN REROUTING PATIENTS TO OUT OF

3168
01:57:58,280 --> 01:58:01,120
AREA TSC OR CSC RATHER THAN

3169
01:58:01,120 --> 01:58:02,520
CLOSER PSC WHEN APPROPRIATE.

3170
01:58:02,520 --> 01:58:06,640
IF WE'RE TO RESOLVE THE

3171
01:58:06,640 --> 01:58:07,880
GEOGRAPHIC DISPARITIES, THE

3172
01:58:07,880 --> 01:58:11,040
NUMBER OF VASCULAR NEUROLOGISTS

3173
01:58:11,040 --> 01:58:12,880
AND INTERVENTIONALLISTS NEEDS TO

3174
01:58:12,880 --> 01:58:14,520
BE INCENTIVIZED TO WORK IN AREAS

3175
01:58:14,520 --> 01:58:16,640
OF SHORTAGE.

3176
01:58:16,640 --> 01:58:18,600
TRAINING AND POST GRADUATE

3177
01:58:18,600 --> 01:58:19,400
EDUCATION CAN IMPROVE

3178
01:58:19,400 --> 01:58:22,160
PROFICIENCY WITH IDENTIFYING AND

3179
01:58:22,160 --> 01:58:24,200
TREATING CANDIDATES FOR

3180
01:58:24,200 --> 01:58:24,840
THERAPIES.

3181
01:58:24,840 --> 01:58:29,240
ACCESS TO NEURAL RADIOLOGISTS 

3182
01:58:29,240 --> 01:58:30,720
AND ADVANCED IMAGING CAN IMPROVE

3183
01:58:30,720 --> 01:58:32,160
INTERPRETATION TIMES FOR

3184
01:58:32,160 --> 01:58:35,000
IDENTIFICATION OF LARGE VESSEL

3185
01:58:35,000 --> 01:58:35,640
OCCLUSIONS RESULTING IN

3186
01:58:35,640 --> 01:58:43,360
EFFICIENT  TRANSFER OF

3187
01:58:43,360 --> 01:58:44,680
THROMBECTOMY CANDIDATES.

3188
01:58:44,680 --> 01:58:46,560
KNOWLEDGE OF STROKE SIGNS AND

3189
01:58:46,560 --> 01:58:48,960
SYMPTOMS IS LOWER IN RURAL

3190
01:58:48,960 --> 01:58:52,440
AREAS, PREFERENCE OF

3191
01:58:52,440 --> 01:58:53,200
HYPERTENSION DIABETES AND

3192
01:58:53,200 --> 01:58:55,760
TOBACCO USE IS HIGHER.

3193
01:58:55,760 --> 01:58:57,480
LOWER EDUCATION, POVERTY,

3194
01:58:57,480 --> 01:59:02,480
MACROLEVEL INEQUITIES LIKELY 

3195
01:59:02,480 --> 01:59:04,640
CONTRIBUTE TO PARTICIPATION,

3196
01:59:04,640 --> 01:59:05,440
COMPREHENSION FOR PATIENTS.

3197
01:59:05,440 --> 01:59:08,080
U.S. CLINICAL TRIAL SITES ARE

3198
01:59:08,080 --> 01:59:14,960
CLUSTERED AROUND URBAN AREAS, A

3199
01:59:14,960 --> 01:59:16,600
PERCEPTION SMALLER HOSPITALS ARE

3200
01:59:16,600 --> 01:59:18,120
LESS LIKELY TO BE INVOLVED IN

3201
01:59:18,120 --> 01:59:21,640
RESEARCH AND LESS LIKELY TO

3202
01:59:21,640 --> 01:59:24,360
PARTICIPATE IN RESEARCH STUDIES.

3203
01:59:24,360 --> 01:59:27,080
INVESTMENT IN RURAL COMMUNITIES

3204
01:59:27,080 --> 01:59:32,000
POTENTIALLY REDUCED INTEREST IN 

3205
01:59:32,000 --> 01:59:36,040
TRIAL PARTICIPATION IS A

3206
01:59:36,040 --> 01:59:36,480
BARRIER.

3207
01:59:36,480 --> 01:59:38,040
RURAL HOSPITALS MAY BE LESS

3208
01:59:38,040 --> 01:59:40,960
LIKELY TO FUND OR SUPPORT TIME

3209
01:59:40,960 --> 01:59:43,160
FOR CLINICIANS TO ATTEND

3210
01:59:43,160 --> 01:59:46,040
CONFERENCES WHERE PRACTICE

3211
01:59:46,040 --> 01:59:48,400
CHANGING TRIALS ARE PRESENTED.

3212
01:59:48,400 --> 01:59:50,240
POTENTIAL STRATEGIES TO ADDRESS

3213
01:59:50,240 --> 01:59:52,640
THESE ISSUES INCLUDE PATIENT

3214
01:59:52,640 --> 01:59:53,760
ROUTING BY STATE-FUNDED

3215
01:59:53,760 --> 01:59:55,920
COMMUNICATION CENTERS TO

3216
01:59:55,920 --> 01:59:56,840
IDENTIFY CLOSEST APPROPRIATE

3217
01:59:56,840 --> 02:00:00,960
HOSPITAL BASED ON PATIENT

3218
02:00:00,960 --> 02:00:06,520
LOCATION, CLINICAL SYMPTOMS, 

3219
02:00:06,520 --> 02:00:07,400
INITIAL DESTINATION PROTOCOL

3220
02:00:07,400 --> 02:00:10,440
SHOULD BE IN PLACE, REALTIME

3221
02:00:10,440 --> 02:00:11,440
RECOMMENDATIONS FOR CLOSEST

3222
02:00:11,440 --> 02:00:12,400
APPROPRIATE HOSPITAL, MECHANISM

3223
02:00:12,400 --> 02:00:14,480
FOR CROSSING STATE LINES IN

3224
02:00:14,480 --> 02:00:18,760
ORDER TO ACCESS CLOSER EMERGENCY

3225
02:00:18,760 --> 02:00:20,400
CARE IN TIME SENSITIVE TREATMENT

3226
02:00:20,400 --> 02:00:21,720
SHOULD BE PROVIDED.

3227
02:00:21,720 --> 02:00:25,000
IMPROVED TRAINING IN STROKE CARE

3228
02:00:25,000 --> 02:00:26,280
FOR EMERGENCY MEDICINE RESIDENTS

3229
02:00:26,280 --> 02:00:28,040
AND PHYSICIANS WILL IMPROVE

3230
02:00:28,040 --> 02:00:29,800
COMFORT LEVEL WITH PATIENTS

3231
02:00:29,800 --> 02:00:33,840
DEMONSTRATING STROKE SYMPTOMS.

3232
02:00:33,840 --> 02:00:34,720
OTHER IDEAS INCLUDE

3233
02:00:34,720 --> 02:00:38,000
INVESTIGATING IDEA OF A MOBILE

3234
02:00:38,000 --> 02:00:39,320
INTERVENTIONAL STROKE TEAM MODEL

3235
02:00:39,320 --> 02:00:42,680
THAT COULD IMPROVE REGIONAL

3236
02:00:42,680 --> 02:00:44,000
ACCESS TO THROMBECTOMY AND

3237
02:00:44,000 --> 02:00:45,680
REDUCE EXTENDED TRANSFER.

3238
02:00:45,680 --> 02:00:48,160
MIST TEAMS COULD CONCERT MANY

3239
02:00:48,160 --> 02:00:51,600
PSCs WITH FUNCTIONAL CATH LABS

3240
02:00:51,600 --> 02:00:52,840
INTO THROMBECTOMY CAPABLE

3241
02:00:52,840 --> 02:00:53,240
HOSPITALS.

3242
02:00:53,240 --> 02:00:56,040
ANOTHER IDEA IS STUDENT LOAN

3243
02:00:56,040 --> 02:00:58,080
REPAYMENT PROGRAM TO STROKE

3244
02:00:58,080 --> 02:01:00,240
NEUROLOGISTS TO CLOSE THE GAP ON

3245
02:01:00,240 --> 02:01:02,800
ACCESS TO STROKE EXPERTISE AND

3246
02:01:02,800 --> 02:01:03,840
POTENTIAL HOSPITAL

3247
02:01:03,840 --> 02:01:04,200
CERTIFICATION.

3248
02:01:04,200 --> 02:01:06,040
STATES AND TERRITORIES SHOULD

3249
02:01:06,040 --> 02:01:08,120
WORK TO IDENTIFY CENTERS CAN

3250
02:01:08,120 --> 02:01:10,520
GREATEST POTENTIAL IMPACT ON

3251
02:01:10,520 --> 02:01:11,480
REDUCING DISTANCE NECESSARY TO

3252
02:01:11,480 --> 02:01:12,720
ACCESS THROMBECTOMY.

3253
02:01:12,720 --> 02:01:14,800
IN GENERAL, PROVIDERS WOULD BE

3254
02:01:14,800 --> 02:01:16,640
RECRUITED TO PRACTICE IN

3255
02:01:16,640 --> 02:01:17,920
DESIGNATED HEALTH PROFESSIONAL

3256
02:01:17,920 --> 02:01:19,480
SHORTAGE AREAS AS DETERMINED BY

3257
02:01:19,480 --> 02:01:21,880
MAPS OF ACCESS TO STROKE CENTERS

3258
02:01:21,880 --> 02:01:23,760
OFFERING THROMBECTOMY.

3259
02:01:23,760 --> 02:01:25,280
PRIOR STUDIES DEMONSTRATED

3260
02:01:25,280 --> 02:01:26,000
PHYSICIAN RETENTION AND

3261
02:01:26,000 --> 02:01:28,840
SATISFACTION WITH SOME OF THESE

3262
02:01:28,840 --> 02:01:29,120
PROGRAMS.

3263
02:01:29,120 --> 02:01:32,000
RESEARCH OPPORTUNITIES ABOUND.

3264
02:01:32,000 --> 02:01:33,400
SOME EXAMPLES INCLUDE SURVEYING

3265
02:01:33,400 --> 02:01:34,640
VASCULAR NEUROLOGY FELLOWS AND

3266
02:01:34,640 --> 02:01:39,120
INTERVENTIONAL  FELLOWS TO GAUGE

3267
02:01:39,120 --> 02:01:40,000
INTEREST IN LOAN FORGIVENESS

3268
02:01:40,000 --> 02:01:41,720
PROGRAMS IN EXCHANGE FOR THREE

3269
02:01:41,720 --> 02:01:43,240
YEARS OF SERVICE IN A HIGH NEED

3270
02:01:43,240 --> 02:01:43,480
AREA.

3271
02:01:43,480 --> 02:01:48,080
DEVELOPMENT OF A MAP OF 

3272
02:01:48,080 --> 02:01:50,040
HOSPITALS WITH CATH LABS, AND

3273
02:01:50,040 --> 02:01:51,840
VALIDATION OF THE SAFETY

3274
02:01:51,840 --> 02:01:53,440
EFFICACY AND EFFICIENCY OF A

3275
02:01:53,440 --> 02:01:59,440
MIST MODEL COMPARED TO THE 

3276
02:01:59,440 --> 02:02:00,400
TRADITIONAL MOTHER SHIP

3277
02:02:00,400 --> 02:02:00,640
APPROACH.

3278
02:02:00,640 --> 02:02:06,040
POLICY AND REGULATION SUBGROUP

3279
02:02:06,040 --> 02:02:08,040
IDENTIFIED ISSUES WITH RESPECT

3280
02:02:08,040 --> 02:02:11,760
TO HUB AND SPOKE MODEL OF CARE,

3281
02:02:11,760 --> 02:02:14,400
TRANSPORT AND TRANSFER, AND

3282
02:02:14,400 --> 02:02:15,920
INTERSTATE VARIABILITY IN

3283
02:02:15,920 --> 02:02:21,160
POLICIES AND REGULATIONS.

3284
02:02:21,160 --> 02:02:23,680
FIRST PRIORITY ISSUES, HUB AND

3285
02:02:23,680 --> 02:02:25,000
SPOKE, MAY DEVELOP FORMAL

3286
02:02:25,000 --> 02:02:25,840
TRANSFER PROTOCOLS TO OFFLOAD

3287
02:02:25,840 --> 02:02:27,480
PATIENTS BY TRANSFERRING THEM TO

3288
02:02:27,480 --> 02:02:29,680
A MORE ESTABLISHED STROKE

3289
02:02:29,680 --> 02:02:30,520
CENTER.

3290
02:02:30,520 --> 02:02:32,400
THIS HUB AND SPOKE MODEL HAS

3291
02:02:32,400 --> 02:02:37,600
BROKEN AS TELEMEDICINE CAN NOW

3292
02:02:37,600 --> 02:02:41,240
PROVIDE REALTIME SUPPORT.

3293
02:02:41,240 --> 02:02:43,400
RADIUS BETWEEN HUBS AND SPOKES

3294
02:02:43,400 --> 02:02:44,920
HAS GROWN CREATING OVERLAPPING

3295
02:02:44,920 --> 02:02:46,160
SYSTEMS IN STATES, LEADING TO

3296
02:02:46,160 --> 02:02:47,680
PATIENTS GOING DIRECTLY TO THE

3297
02:02:47,680 --> 02:02:49,760
MOTHER SHIP AND BYPASSING CLOSER

3298
02:02:49,760 --> 02:02:54,120
FACILITIES THAT COULD PROVIDE

3299
02:02:54,120 --> 02:02:56,640
NEEDED CARE, LEADING TO DELAY.

3300
02:02:56,640 --> 02:02:58,600
IN ADDITION PHYSICAL SEPARATION

3301
02:02:58,600 --> 02:03:00,000
IMPEDES FAMILY AND CAREGIVERS

3302
02:03:00,000 --> 02:03:03,960
FROM BEING PRESENT DURING 

3303
02:03:03,960 --> 02:03:04,600
HOSPITALIZATION AND REHAB

3304
02:03:04,600 --> 02:03:06,680
LEADING TO BURDEN AND STRESS FOR

3305
02:03:06,680 --> 02:03:10,480
FAMILY MEMBERS AND PATIENT.

3306
02:03:10,480 --> 02:03:12,920
SECOND PRIORITY DEALS WITH

3307
02:03:12,920 --> 02:03:19,680
INTERFACILITY TRANSPORT AND 

3308
02:03:19,680 --> 02:03:20,280
TRANSFER.

3309
02:03:20,280 --> 02:03:21,400
THE HUB HOSPITAL RESPONDS WHEN

3310
02:03:21,400 --> 02:03:23,200
NOTIFIED OF CLINICAL CHANGE.

3311
02:03:23,200 --> 02:03:24,920
DURING TRANSFER WHO OWNS THE

3312
02:03:24,920 --> 02:03:26,400
RESPONSIBILITY FOR MANAGING THE

3313
02:03:26,400 --> 02:03:28,640
PATIENT IS MORE AMBIGUOUS.

3314
02:03:28,640 --> 02:03:29,760
JOINT COMMISSION CONSIDERS IT TO

3315
02:03:29,760 --> 02:03:31,720
OF RESPONSIBILITY OF THE

3316
02:03:31,720 --> 02:03:35,120
CERTIFIED CENTER TO ESTABLISH

3317
02:03:35,120 --> 02:03:36,120
EXPECTATIONS FOR MONITORING

3318
02:03:36,120 --> 02:03:38,520
PATIENT BEFORE AND DURING

3319
02:03:38,520 --> 02:03:39,680
TRANSFER, YET LEGAL

3320
02:03:39,680 --> 02:03:43,240
RESPONSIBILITY MAY FALL TO THE

3321
02:03:43,240 --> 02:03:45,080
SENDING PHYSICIAN OR TO MED

3322
02:03:45,080 --> 02:03:47,040
CONTROL UNDER UMBRELLA OF EMS

3323
02:03:47,040 --> 02:03:48,720
AGENCY, THIS SITUATION IS

3324
02:03:48,720 --> 02:03:50,800
DANGEROUS FOR PATIENT AND MAY

3325
02:03:50,800 --> 02:03:55,080
PLACE HEALTH CARE PROVIDERS AND 

3326
02:03:55,080 --> 02:03:56,840
SYSTEMS AT RISK LEGALLY.

3327
02:03:56,840 --> 02:03:59,400
THIRD PRIORITY IS ADDRESSING

3328
02:03:59,400 --> 02:04:00,520
INTERSTATE VARIABILITY IN STROKE

3329
02:04:00,520 --> 02:04:02,240
CARE POLICY AND REGULATION.

3330
02:04:02,240 --> 02:04:04,000
SURVEY OF STATES STROKE CARE

3331
02:04:04,000 --> 02:04:07,480
POLICIES AND REGULATIONS HAS

3332
02:04:07,480 --> 02:04:13,160
DEMONSTRATED WIDE VARIABILITY IN

3333
02:04:13,160 --> 02:04:13,480
 RIGOR.

3334
02:04:13,480 --> 02:04:18,320
REGISTRIES ARE NEEDED TO TRACK

3335
02:04:18,320 --> 02:04:20,760
COMES BUT LINKING HAS LOGISTICAL

3336
02:04:20,760 --> 02:04:21,920
CHALLENGES.

3337
02:04:21,920 --> 02:04:24,240
SMALLER HOSPITALS WITH LIMITED

3338
02:04:24,240 --> 02:04:26,960
RESOURCES MAY FIND THIS A BURDEN

3339
02:04:26,960 --> 02:04:30,360
YET INCLUDE OF DATA IS NECESSARY

3340
02:04:30,360 --> 02:04:32,320
TO AVOID BIAS.

3341
02:04:32,320 --> 02:04:40,520
SOME STATES  CERTIFY STROKE

3342
02:04:40,520 --> 02:04:43,680
PROGRAMS, SOME RECOGNIZE AN

3343
02:04:43,680 --> 02:04:44,600
ENTITY.

3344
02:04:44,600 --> 02:04:46,320
TASK FORCE HAS IDENTIFIED THE

3345
02:04:46,320 --> 02:04:49,040
FOLLOWING HIGH PRIORITY ACTION

3346
02:04:49,040 --> 02:04:49,480
ITEMS.

3347
02:04:49,480 --> 02:04:51,360
NUMBER ONE, POLICY AND

3348
02:04:51,360 --> 02:04:52,640
LEGISLATION IS NEEDED TO SUPPORT

3349
02:04:52,640 --> 02:04:55,280
SMALLER HOSPITALS TO GAIN ACCESS

3350
02:04:55,280 --> 02:04:57,240
TO CLOSEST APPROPRIATE HOSPITAL

3351
02:04:57,240 --> 02:04:58,120
POTENTIALLY UTILIZING NEUROLOGY

3352
02:04:58,120 --> 02:05:01,040
EXPERT FROM A DIFFERENT HOSPITAL

3353
02:05:01,040 --> 02:05:01,440
SYSTEM.

3354
02:05:01,440 --> 02:05:02,120
CENTRALIZED STROKE COMMAND

3355
02:05:02,120 --> 02:05:03,600
CENTER COULD BE USED AT THE

3356
02:05:03,600 --> 02:05:05,520
LOCAL LEVEL TO HELP TRIAGE

3357
02:05:05,520 --> 02:05:07,480
PATIENTS TO THE CLOSEST

3358
02:05:07,480 --> 02:05:08,800
APPROPRIATE FACILITY AND

3359
02:05:08,800 --> 02:05:11,000
DETERMINE MODE OF SECONDARY

3360
02:05:11,000 --> 02:05:11,240
TRANSFER.

3361
02:05:11,240 --> 02:05:14,920
NUMBER 2, UNIFORMITY OF

3362
02:05:14,920 --> 02:05:16,040
LICENSING RULES, STANDARDIZED

3363
02:05:16,040 --> 02:05:16,640
EDUCATIONAL REQUIREMENTS FOR

3364
02:05:16,640 --> 02:05:17,880
TELEMEDICINE ACROSS STATES IS

3365
02:05:17,880 --> 02:05:20,320
NEEDED TO ALLOW FOR APPROPRIATE

3366
02:05:20,320 --> 02:05:22,160
CARE REGARDLESS OF TREATING

3367
02:05:22,160 --> 02:05:23,960
NEUROLOGIST PHYSICAL LOCATION.

3368
02:05:23,960 --> 02:05:27,760
NUMBER 3, POLICIES ARE NEEDED TO

3369
02:05:27,760 --> 02:05:28,840
ACCOMMODATE INTERHOSPITAL TO

3370
02:05:28,840 --> 02:05:30,680
FACILITY TRANSFER TO ENSURE ALL

3371
02:05:30,680 --> 02:05:33,120
PATIENTS CONTINUE TO RECEIVE

3372
02:05:33,120 --> 02:05:35,520
QUALITY STROKE CARE DURING

3373
02:05:35,520 --> 02:05:35,880
TRANSPORTATION.

3374
02:05:35,880 --> 02:05:38,440
NOBLE 4, EDUCATION AND MATERIALS

3375
02:05:38,440 --> 02:05:39,600
FOR MANAGEMENT AND DOCUMENTATION

3376
02:05:39,600 --> 02:05:41,840
DURING SECONDARY TRANSFER COULD

3377
02:05:41,840 --> 02:05:42,960
BE STANDARDIZED TO PROMOTE

3378
02:05:42,960 --> 02:05:44,920
PATIENT SAFETY DURING PERIODS

3379
02:05:44,920 --> 02:05:46,600
FOR THE STROKE SPECIALIST

3380
02:05:46,600 --> 02:05:48,040
DISCONNECTED FROM THE PATIENT.

3381
02:05:48,040 --> 02:05:48,840
QUALITY IMPROVEMENT EFFORTS

3382
02:05:48,840 --> 02:05:51,960
SHOULD BE IN PLACE TO

3383
02:05:51,960 --> 02:05:53,240
TROUBLESHOOT AVOIDABLE ADVERSE

3384
02:05:53,240 --> 02:05:53,560
OUTCOMES.

3385
02:05:53,560 --> 02:05:57,040
AND NUMBER 5, LOCAL GUIDELINES

3386
02:05:57,040 --> 02:05:58,480
SHOULD BE CONSISTENT, NATIONAL

3387
02:05:58,480 --> 02:05:59,440
GUIDELINES, FOR PARTNERSHIP

3388
02:05:59,440 --> 02:06:01,080
BETWEEN REFERRING AND ACCEPTING

3389
02:06:01,080 --> 02:06:05,280
TEAMS AND LOCAL AMBULANCE

3390
02:06:05,280 --> 02:06:07,920
SERVICES INCLUDING TRANSFER FROM

3391
02:06:07,920 --> 02:06:09,200
SPOKE TO HUB PHYSICIAN.

3392
02:06:09,200 --> 02:06:10,960
IN SHORT I'D LIKE TO THANK THE

3393
02:06:10,960 --> 02:06:12,920
MEMBERS OF OUR TASK FORCE, MY

3394
02:06:12,920 --> 02:06:15,440
CO-CHAIR FOR ALL OF THEIR HARD

3395
02:06:15,440 --> 02:06:17,920
WORK, I LOOK FORWARD TO THE

3396
02:06:17,920 --> 02:06:45,640
OUTSTANDING DISCUSSIONS TO COME.

3397
02:06:45,640 --> 02:06:48,400
THANK YOU AGAIN.

3398
02:06:48,400 --> 02:06:49,440
>> GREAT TALKS, YOU TOUCHED ON

3399
02:06:49,440 --> 02:06:50,000
GREAT POINTS.

3400
02:06:50,000 --> 02:06:52,440
THANK YOU ALL.

3401
02:06:52,440 --> 02:06:56,800
 

3402
02:06:56,800 --> 02:06:58,240
IF YOU'RE TALKING, I'M NOT

3403
02:06:58,240 --> 02:06:59,120
HEARING YOU, LEE.

3404
02:06:59,120 --> 02:07:01,800
I THINK YOU'RE MUTED.

3405
02:07:01,800 --> 02:07:02,880
>> YEAH, YOU'RE MUTED.

3406
02:07:02,880 --> 02:07:03,160
>> OKAY.

3407
02:07:03,160 --> 02:07:05,440
DO WE HAVE ANY QUESTIONS? 

3408
02:07:05,440 --> 02:07:11,760
I'M LOOKING AT THE -- SHERYL

3409
02:07:11,760 --> 02:07:16,680
MARTIN, WOULD YOU LIKE TO JOIN

3410
02:07:16,680 --> 02:07:23,200
US TOO? 

3411
02:07:23,200 --> 02:07:27,320
THANKS FOR JOINING US.

3412
02:07:27,320 --> 02:07:28,720
WE'RE GOING TO OPEN THE FLOOR

3413
02:07:28,720 --> 02:07:34,640
FOR QUESTIONS. 

3414
02:07:34,640 --> 02:07:35,240
DOES ANYBODY HAVE QUESTIONS?

3415
02:07:35,240 --> 02:07:37,720
>> I HAVE A QUESTION.

3416
02:07:37,720 --> 02:07:40,440
THIS IS RICHARD BENSON.

3417
02:07:40,440 --> 02:07:41,720
WE KNOW THAT EXCELLENT

3418
02:07:41,720 --> 02:07:43,360
PRESENTATION AND GREAT WORK,

3419
02:07:43,360 --> 02:07:46,560
LOOK FORWARD TO BREAKOUT

3420
02:07:46,560 --> 02:07:47,640
SESSIONS AND DISCUSSION.

3421
02:07:47,640 --> 02:07:50,520
ANY DISCUSSION AMONG THE GROUP

3422
02:07:50,520 --> 02:07:58,400
IN TERMS OF WHY WE HAVE

3423
02:07:58,400 --> 02:08:03,680
DISPARITIES IN tPA AND

3424
02:08:03,680 --> 02:08:05,240
EMBOLECTOMY?

3425
02:08:05,240 --> 02:08:07,080
WE KNOW IT'S DIFFICULT TO GET TO

3426
02:08:07,080 --> 02:08:08,200
FACILITIES IN ENOUGH TIME BUT

3427
02:08:08,200 --> 02:08:10,160
FOR THOSE WHO DO WE STILL KNOW

3428
02:08:10,160 --> 02:08:12,600
THERE ARE DISPARITIES IN

3429
02:08:12,600 --> 02:08:13,440
UTILIZATION OF THOSE

3430
02:08:13,440 --> 02:08:14,000
INTERVENTIONS.

3431
02:08:14,000 --> 02:08:16,040
ANY COMMENTS ABOUT THAT IN TERMS

3432
02:08:16,040 --> 02:08:17,920
OF ANYTHING WE CAN DO TO

3433
02:08:17,920 --> 02:08:24,680
INTERVENE ON THOSE AS WELL?

3434
02:08:24,680 --> 02:08:28,920
>> IT IS A PROBLEM EVEN IN URBAN

3435
02:08:28,920 --> 02:08:31,560
AREAS, PREVIOUSLY EXAMINED NEW

3436
02:08:31,560 --> 02:08:33,320
ORLEANS AREA, COMPREHENSIVE

3437
02:08:33,320 --> 02:08:34,880
CENTERS, AND PATIENTS, MINORITY

3438
02:08:34,880 --> 02:08:36,640
BACKGROUND, WERE LESS LIKELY TO

3439
02:08:36,640 --> 02:08:38,040
ARRIVE TO THE HOSPITAL WITHIN

3440
02:08:38,040 --> 02:08:40,520
THE WINDOW OF OPPORTUNITY.

3441
02:08:40,520 --> 02:08:43,360
LESS LIKELY TO UTILIZE EMS.

3442
02:08:43,360 --> 02:08:45,880
AND THOSE ARE PRETTY SIGNIFICANT

3443
02:08:45,880 --> 02:08:47,520
BARRIERS TO BEING ELIGIBLE FOR

3444
02:08:47,520 --> 02:08:50,240
TIME-SENSITIVE TREATMENT.

3445
02:08:50,240 --> 02:08:52,640
WHAT WE DON'T KNOW IS WHY THEY

3446
02:08:52,640 --> 02:08:54,760
ARE LESS LIKELY, ONE GROUP IS

3447
02:08:54,760 --> 02:08:57,840
LESS LIKELY TO UTILIZE EMS THAN

3448
02:08:57,840 --> 02:08:58,160
ANOTHER.

3449
02:08:58,160 --> 02:09:02,400
THAT REMAINS TO BE DETERMINED.

3450
02:09:02,400 --> 02:09:04,160
>> SO, WE HAD A PUBLICATION ON

3451
02:09:04,160 --> 02:09:10,680
THIS YEARS AGO AND LOOKED IN

3452
02:09:10,680 --> 02:09:11,720
HARLINGEN TEXAS, 20 MINUTES FROM

3453
02:09:11,720 --> 02:09:14,120
THE BORDER OF MEXICO.

3454
02:09:14,120 --> 02:09:17,240
THE RIO GRANDE VALLEY, SOUTH

3455
02:09:17,240 --> 02:09:20,240
TEXAS, AS LOW UTILIZATION OF

3456
02:09:20,240 --> 02:09:27,840
911, EMS, AND OUR MECHANICAL

3457
02:09:27,840 --> 02:09:28,840
THROMBECTOMY DOUBLED, IT'S A

3458
02:09:28,840 --> 02:09:29,840
SIGNIFICANT ISSUE OF THEM COMING

3459
02:09:29,840 --> 02:09:31,880
IN ON TIME AND THEM USING

3460
02:09:31,880 --> 02:09:32,840
RESOURCES THAT ARE AVAILABLE,

3461
02:09:32,840 --> 02:09:36,440
YET  THEY DON'T WANT TO.

3462
02:09:36,440 --> 02:09:38,840
IT'S AN EDUCATION THING.

3463
02:09:38,840 --> 02:09:44,080
WE SPENT TIME WORKING ON FAST

3464
02:09:44,080 --> 02:09:46,840
FOR EXAMPLE IN SPANISH AND NOW

3465
02:09:46,840 --> 02:09:48,480
AHORA, GETTING THEM TO

3466
02:09:48,480 --> 02:09:51,000
UNDERSTAND THAT NOBODY'S GOING

3467
02:09:51,000 --> 02:09:52,440
TO CALL ANYBODY, IT'S HEALTH

3468
02:09:52,440 --> 02:09:52,640
CARE.

3469
02:09:52,640 --> 02:09:54,000
IT'S NOT POLITICS.

3470
02:09:54,000 --> 02:09:55,280
IT'S NOT IMMIGRATION SERVICES.

3471
02:09:55,280 --> 02:09:56,040
IT'S HEALTH CARE.

3472
02:09:56,040 --> 02:09:57,040
WE'RE GOING TO PICK YOU UP AND

3473
02:09:57,040 --> 02:09:58,600
TAKE YOU TO THE RIGHT FACILITY

3474
02:09:58,600 --> 02:10:01,640
AND TREAT YOU IN THE APPROPRIATE

3475
02:10:01,640 --> 02:10:01,840
TIME.

3476
02:10:01,840 --> 02:10:05,960
I THINK THAT EDUCATION PIECE IS 

3477
02:10:05,960 --> 02:10:06,920
MISSING, ESPECIALLY IN THE

3478
02:10:06,920 --> 02:10:09,400
POPULATION HERE IN SOUTH TEXAS

3479
02:10:09,400 --> 02:10:14,120
WHICH IS 85% MEXICAN AMERICAN.

3480
02:10:14,120 --> 02:10:17,520
 

3481
02:10:17,520 --> 02:10:20,600
>> I SEE THAT DR. HERRERA PUT

3482
02:10:20,600 --> 02:10:22,560
IN -- SORRY, SOMEONE PUT IN THE

3483
02:10:22,560 --> 02:10:23,320
CHAT ABOUT TRUST.

3484
02:10:23,320 --> 02:10:25,440
I THINK IT COMES BACK TO THE

3485
02:10:25,440 --> 02:10:26,160
PREVIOUS CONVERSATION AS WELL.

3486
02:10:26,160 --> 02:10:28,360
I THINK THIS IS AN OVERARCHING

3487
02:10:28,360 --> 02:10:32,320
THEME IN TERMS OF MEDICAL

3488
02:10:32,320 --> 02:10:34,920
FACILITIES DOING OUTREACH TO THE

3489
02:10:34,920 --> 02:10:37,640
COMMUNITY, HOWEVER THAT LOOKS

3490
02:10:37,640 --> 02:10:42,360
THROUGH COMMUNITY CHAMPIONS OR

3491
02:10:42,360 --> 02:10:43,040
FEDERALLY QUALIFIED HEALTH

3492
02:10:43,040 --> 02:10:44,320
CENTERS, BUT NOT SORT OF STAYING

3493
02:10:44,320 --> 02:10:46,200
THERE, SORT OF THAT INSTITUTION

3494
02:10:46,200 --> 02:10:49,280
AND NOT DOING OUTREACH TO THE 

3495
02:10:49,280 --> 02:10:53,120
COMMUNITY BECAUSE THAT DOESN'T 

3496
02:10:53,120 --> 02:10:54,240
PROMOTE TRUST WE NEED.

3497
02:10:54,240 --> 02:10:57,600
GREAT POINT.

3498
02:10:57,600 --> 02:11:00,400
>> THIS ALSO CAME UP IN THE

3499
02:11:00,400 --> 02:11:04,960
MORNING SESSION ON EMS, AND

3500
02:11:04,960 --> 02:11:07,040
CALLING 911, AND DR. BENSON

3501
02:11:07,040 --> 02:11:10,520
BROUGHT UP THE EXCELLENT POINT

3502
02:11:10,520 --> 02:11:13,160
ABOUT CERTAIN GROUPS NOT WANTING

3503
02:11:13,160 --> 02:11:18,080
TO CALL 911 BECAUSE OF RECENT

3504
02:11:18,080 --> 02:11:18,640
WELL-PUBLICIZED VERY

3505
02:11:18,640 --> 02:11:20,720
CATASTROPHIC INTERACTIONS WITH

3506
02:11:20,720 --> 02:11:23,440
POLICE AND OTHER EMS PEOPLE THAT

3507
02:11:23,440 --> 02:11:26,200
COULD LEAD TO AN OVERFLOW

3508
02:11:26,200 --> 02:11:29,120
REACTION, I DON'T WANT TO SAY

3509
02:11:29,120 --> 02:11:30,720
OVERREACTION BECAUSE THE

3510
02:11:30,720 --> 02:11:32,960
REACTION -- THE ACTION MAY BE

3511
02:11:32,960 --> 02:11:34,240
ENTIRELY APPROPRIATE, NOT

3512
02:11:34,240 --> 02:11:37,080
WANTING TO GET INTO THAT EMS 911

3513
02:11:37,080 --> 02:11:39,320
REALM AND HAVING THE POLICE COME

3514
02:11:39,320 --> 02:11:40,520
KNOCKING ON YOUR DOOR.

3515
02:11:40,520 --> 02:11:42,160
RICHARD, I DON'T KNOW IF YOU

3516
02:11:42,160 --> 02:11:43,440
WANT TO ELABORATE ON THAT BUT I

3517
02:11:43,440 --> 02:11:46,000
THOUGHT THAT WAS AN EXCELLENT

3518
02:11:46,000 --> 02:11:47,640
POINT YOU BROUGHT UP IN THE

3519
02:11:47,640 --> 02:11:48,480
MORNING SESSION.

3520
02:11:48,480 --> 02:11:50,600
>> YEAH, NO, IT'S A GREAT POINT.

3521
02:11:50,600 --> 02:11:52,560
YEAH, IT'S BEEN -- YEAH, SEVERAL

3522
02:11:52,560 --> 02:11:54,400
PUBLICATIONS ABOUT THAT IN TERMS

3523
02:11:54,400 --> 02:11:56,080
OF CERTAIN COMMUNITIES NOT

3524
02:11:56,080 --> 02:11:57,440
WANTING TO CALL 911 BECAUSE OF

3525
02:11:57,440 --> 02:12:00,720
THAT FEAR, BUT ALSO NOT WANTING

3526
02:12:00,720 --> 02:12:03,800
TO LET THE NEIGHBORS KNOW WHAT'S

3527
02:12:03,800 --> 02:12:05,000
GOING ON, QUOTE/UNQUOTE, THEIR

3528
02:12:05,000 --> 02:12:08,040
BUSINESS, IN THE INDIVIDUAL

3529
02:12:08,040 --> 02:12:10,560
HOME, FEARS ABOUT -- IF IT'S

3530
02:12:10,560 --> 02:12:14,040
FEARS WITH PEOPLE WHO ARE

3531
02:12:14,040 --> 02:12:16,360
CITIZENS OR CITIZENSHIP, AS WELL

3532
02:12:16,360 --> 02:12:19,200
AS FEARS WITH AN EXTRA BILL TO

3533
02:12:19,200 --> 02:12:19,360
PAY.

3534
02:12:19,360 --> 02:12:20,840
THERE ARE A LOT OF REASONS

3535
02:12:20,840 --> 02:12:24,320
PEOPLE CHOOSE NOT TO CALL 911.

3536
02:12:24,320 --> 02:12:25,960
AGAIN, I LIKE HOW MARK MENTIONED

3537
02:12:25,960 --> 02:12:27,280
THIS EARLIER IN TERMS OF

3538
02:12:27,280 --> 02:12:29,040
BARRIERS, I THINK IT'S IMPORTANT

3539
02:12:29,040 --> 02:12:30,440
TO SEE FIRST OF ALL WE HAVE TO

3540
02:12:30,440 --> 02:12:32,000
DO THE RESEARCH TO KNOW WHAT ALL

3541
02:12:32,000 --> 02:12:33,640
OF THE CONCERNS ARE THAT PEOPLE

3542
02:12:33,640 --> 02:12:33,960
HAVE.

3543
02:12:33,960 --> 02:12:36,440
BUT THEN FINDING WAYS TO ADDRESS

3544
02:12:36,440 --> 02:12:38,200
THOSE CONCERNS THAT PEOPLE HAVE.

3545
02:12:38,200 --> 02:12:40,440
BUT THERE IS A MAJOR CONCERN,

3546
02:12:40,440 --> 02:12:43,640
MAJOR CONCERNS, I MENTIONED SOME

3547
02:12:43,640 --> 02:12:46,440
IN TERMS OF CALLING 911.

3548
02:12:46,440 --> 02:12:47,280
 

3549
02:12:47,280 --> 02:12:51,040
>> I THINK SOME OF THE OTHER

3550
02:12:51,040 --> 02:12:53,280
ISSUES THAT WE DISCUSSED, WE

3551
02:12:53,280 --> 02:12:55,360
NEED TO HIGHLIGHT ALSO, WHICH IS

3552
02:12:55,360 --> 02:12:59,080
NOT SO MUCH NOT CALLING EMS BUT

3553
02:12:59,080 --> 02:13:00,760
CALLING EMS AND GETTING TO THE

3554
02:13:00,760 --> 02:13:02,320
HOSPITAL, AND THEN AT THE

3555
02:13:02,320 --> 02:13:04,760
HOSPITAL THE STROKE NOT BEING

3556
02:13:04,760 --> 02:13:08,120
RECOGNIZED BY EMERGENCY MEDICINE

3557
02:13:08,120 --> 02:13:08,440
PERSONNEL.

3558
02:13:08,440 --> 02:13:13,360
YOU KNOW, IF EVERYBODY CAME IN

3559
02:13:13,360 --> 02:13:14,720
THE SAME IT WOULD BE

3560
02:13:14,720 --> 02:13:15,360
STRAIGHTFORWARD, BUT THAT'S NOT

3561
02:13:15,360 --> 02:13:17,560
THE WAY IT IS.

3562
02:13:17,560 --> 02:13:20,840
WE NOTED IN OUR INVESTIGATION,

3563
02:13:20,840 --> 02:13:24,440
THERE'S NO STANDARD AMOUNT OF

3564
02:13:24,440 --> 02:13:25,160
NEUROLOGICAL OR TRAINING

3565
02:13:25,160 --> 02:13:27,080
EMERGENCY MEDICINE PHYSICIANS

3566
02:13:27,080 --> 02:13:27,400
NEED.

3567
02:13:27,400 --> 02:13:29,680
MY ONLY PERSONAL EXPERIENCE SOME

3568
02:13:29,680 --> 02:13:30,880
PEOPLE ARE EXTREMELY COMFORTABLE

3569
02:13:30,880 --> 02:13:34,160
WITH EVALUATING A PATIENT

3570
02:13:34,160 --> 02:13:37,920
NEUROLOGICALLY, OTHERS LESS SO.

3571
02:13:37,920 --> 02:13:40,320
SOMETIMES THAT RELUCTANCE TO

3572
02:13:40,320 --> 02:13:41,640
ACTUALLY STATE THE PATIENT

3573
02:13:41,640 --> 02:13:43,200
HAVING A STROKE THEN LEADS TO

3574
02:13:43,200 --> 02:13:46,160
THEM NOT GETTING THE APPROPRIATE

3575
02:13:46,160 --> 02:13:47,640
IMAGING OR CONSULTATION.

3576
02:13:47,640 --> 02:13:50,720
SO I THINK THAT WE NEED TO ALSO

3577
02:13:50,720 --> 02:13:57,240
FOCUS ON THE TRAINING OF OUR

3578
02:13:57,240 --> 02:13:58,920
IN-HOSPITAL OR E.D. FIRST

3579
02:13:58,920 --> 02:13:59,600
RESPONDERS IDENTIFYING STROKES

3580
02:13:59,600 --> 02:14:01,000
AND GETTING THEM INTO THE

3581
02:14:01,000 --> 02:14:04,120
PATHWAY FASTER.

3582
02:14:04,120 --> 02:14:05,200
>> EXCELLENT QUESTIONS IN THE

3583
02:14:05,200 --> 02:14:09,880
CHAT AS WELL.

3584
02:14:09,880 --> 02:14:12,440
ONE QUESTION IS, IS DOES ANYONE

3585
02:14:12,440 --> 02:14:21,400
KNOW ABOUT DIFFERENCES IN

3586
02:14:21,400 --> 02:14:23,240
CONSENT TO ALTEPLASE OR

3587
02:14:23,240 --> 02:14:24,120
THROMBECTOMY ACROSS GROUPS?

3588
02:14:24,120 --> 02:14:26,840
>> I BELIEVE THERE WERE SEVERAL

3589
02:14:26,840 --> 02:14:29,640
STUDIES LOOKING AT AT LEAST USE

3590
02:14:29,640 --> 02:14:30,160
OF ALTEPLASE.

3591
02:14:30,160 --> 02:14:31,440
I DON'T KNOW IF IT WAS RELATED

3592
02:14:31,440 --> 02:14:32,000
TO CONSENT.

3593
02:14:32,000 --> 02:14:33,880
WE HAVE TO BE CAREFUL ABOUT

3594
02:14:33,880 --> 02:14:34,840
ASSOCIATION VERSUS CAUSATION.

3595
02:14:34,840 --> 02:14:37,920
BUT IN A GROUP OF PATIENTS, IN

3596
02:14:37,920 --> 02:14:42,080
GROUPS OF PATIENTS WHO MET ALL

3597
02:14:42,080 --> 02:14:42,640
QUALIFICATIONS FOR ALTEPLASE

3598
02:14:42,640 --> 02:14:44,480
WITHIN I THINK THREE HOURS BACK

3599
02:14:44,480 --> 02:14:47,880
THEN, IT WAS STILL A DISPARITY

3600
02:14:47,880 --> 02:14:51,520
IN USE OF ALTEPLASE BETWEEN

3601
02:14:51,520 --> 02:14:52,360
MINORITY GROUPS AND CAUCASIANS.

3602
02:14:52,360 --> 02:14:55,000
SOMEBODY ELSE ON THE CALL MAY

3603
02:14:55,000 --> 02:14:56,200
HAVE MORE SPECIFIC INFORMATION

3604
02:14:56,200 --> 02:14:58,720
BUT I RECALL THAT THAT WAS THE

3605
02:14:58,720 --> 02:14:58,920
CASE.

3606
02:14:58,920 --> 02:15:00,520
AGAIN, CONTROLLING FOR ALL OF

3607
02:15:00,520 --> 02:15:01,920
THOSE MEDICAL FACTORS AND BEING

3608
02:15:01,920 --> 02:15:06,640
WITHIN THE TIME WINDOW, THINGS

3609
02:15:06,640 --> 02:15:07,080
LIKE THAT.

3610
02:15:07,080 --> 02:15:09,600
>> S 

3611
02:15:09,600 --> 02:15:12,240
>> THAT'S WHAT I REMEMBER AS

3612
02:15:12,240 --> 02:15:12,520
WELL.

3613
02:15:12,520 --> 02:15:13,080
I'M SORRY, ANDY.

3614
02:15:13,080 --> 02:15:14,960
>> I WAS GOING TO SUPPORT WHAT

3615
02:15:14,960 --> 02:15:16,440
YOU, RICHARD AND MARK HAD

3616
02:15:16,440 --> 02:15:16,920
ALREADY SAID.

3617
02:15:16,920 --> 02:15:18,320
THERE WAS A LARGE STUDY

3618
02:15:18,320 --> 02:15:21,960
PUBLISHED IN NEURALGIA COUPLE

3619
02:15:21,960 --> 02:15:28,480
YEARS AGO, LOOKING AT tPA

3620
02:15:28,480 --> 02:15:31,240
UTILIZATION RATES THAT VERIFIED

3621
02:15:31,240 --> 02:15:38,920
SIGNIFICANT DISPARITY AND 

3622
02:15:38,920 --> 02:15:40,320
RECEIVING IVTPA AND ENDOVASCULAR

3623
02:15:40,320 --> 02:15:41,440
THERAPY COMPARED TO NON-HISPANIC

3624
02:15:41,440 --> 02:15:44,360
WHITE, ET CETERA.

3625
02:15:44,360 --> 02:15:45,160
KNOWS LARGE EPIDEMIOLOGY STUDIES

3626
02:15:45,160 --> 02:15:48,200
IT'S HARD TO GET AT UNDERLYING

3627
02:15:48,200 --> 02:15:50,680
REASONS OF COURSE BUT I THINK

3628
02:15:50,680 --> 02:15:51,440
THERE'S GUIDELINES DATA.

3629
02:15:51,440 --> 02:15:55,400
I THINK CHRIS PUT IT IN THE

3630
02:15:55,400 --> 02:16:04,600
CHAT, THAT LOOKS AT DECLINATION

3631
02:16:04,600 --> 02:16:07,320
RATES AS WELL.

3632
02:16:07,320 --> 02:16:11,240
THAT LEVEL, IS THERE STRUCTURAL

3633
02:16:11,240 --> 02:16:12,480
RACISM, UNCONSCIOUS BIAS ON

3634
02:16:12,480 --> 02:16:14,840
PROVIDERS OR TEAM, IS IT ISSUES

3635
02:16:14,840 --> 02:16:16,640
RELATED TO SOCIOECONOMIC

3636
02:16:16,640 --> 02:16:18,640
DISPARITIES, ARRIVAL TIME?

3637
02:16:18,640 --> 02:16:20,200
AND INSURANCE AND ASPECTS,

3638
02:16:20,200 --> 02:16:22,400
HOSPITALIZATION THAT MAY CREATE

3639
02:16:22,400 --> 02:16:22,640
BARRIERS?

3640
02:16:22,640 --> 02:16:24,080
AND THEN THERE'S SOMEONE ALREADY

3641
02:16:24,080 --> 02:16:26,520
SAID RIGHTLY I THINK THERE'S A

3642
02:16:26,520 --> 02:16:28,840
TRUST EDUCATION ISSUE WE FACE,

3643
02:16:28,840 --> 02:16:30,600
LACK OF DIVERSIFICATION IN

3644
02:16:30,600 --> 02:16:31,080
STROKE WORKFORCE.

3645
02:16:31,080 --> 02:16:33,760
YOU KNOW, OF THE PERSON THAT'S

3646
02:16:33,760 --> 02:16:34,440
DOING THE DISCUSSION, CONSENTING

3647
02:16:34,440 --> 02:16:35,840
ON THE RISKS AND BENEFITS.

3648
02:16:35,840 --> 02:16:37,800
I THINK WE HAVE MULTIPLE LEVELS

3649
02:16:37,800 --> 02:16:40,320
AT WHICH A GROUP LIKE THIS CAN

3650
02:16:40,320 --> 02:16:45,360
ADDRESS AND TAKE IT HEAD ON.

3651
02:16:45,360 --> 02:16:48,280
CHAZ HAS A HAND RAISED.

3652
02:16:48,280 --> 02:16:49,840
>> YEAH, THANKS, ANDY.

3653
02:16:49,840 --> 02:16:52,440
REVISITING THE POINT BROUGHT UP

3654
02:16:52,440 --> 02:16:57,560
BY DR. JENSON FOR RESIDENCY

3655
02:16:57,560 --> 02:16:59,040
EDUCATION, THE COALITION WITH

3656
02:16:59,040 --> 02:17:00,360
ALL THE COLLABORATIVE EXPERTISE

3657
02:17:00,360 --> 02:17:02,960
THAT IT HAS I THINK HAS THE

3658
02:17:02,960 --> 02:17:06,200
OPPORTUNITY TO POTENTIALLY MAKE

3659
02:17:06,200 --> 02:17:09,160
SOME STATEMENTS THAT COULD

3660
02:17:09,160 --> 02:17:11,040
CHANGE OTHER ORGANIZATIONS,

3661
02:17:11,040 --> 02:17:12,520
INCLUDING THOSE WITH OVERSIGHT

3662
02:17:12,520 --> 02:17:14,440
FOR RESIDENCY TRAINING.

3663
02:17:14,440 --> 02:17:16,360
AND THAT COULD POTENTIALLY

3664
02:17:16,360 --> 02:17:18,280
COMPLEMENT OTHER EFFORTS FROM

3665
02:17:18,280 --> 02:17:20,000
OTHER ORGANIZATIONS AS WELL.

3666
02:17:20,000 --> 02:17:21,480
AS WAS ALLUDED TO IN EMERGENCY

3667
02:17:21,480 --> 02:17:26,880
MEDICINE WE DID A PAST SURVEY 

3668
02:17:26,880 --> 02:17:30,920
AND ONLY 50% OF E.M. RESIDENCY

3669
02:17:30,920 --> 02:17:35,840
PROGRAM ARE STROKE OR NEUROLOGY

3670
02:17:35,840 --> 02:17:38,680
ROTATIONS FOR RESIDENTS.

3671
02:17:38,680 --> 02:17:42,720
SO, QUESTION NUMBER 1, SHOULD

3672
02:17:42,720 --> 02:17:50,200
THE STATEMENT THAT WE KIND OF ON

3673
02:17:50,200 --> 02:17:53,040
 BEHALF OF BRAIN ATTACK

3674
02:17:53,040 --> 02:17:55,040
COALITION, SHOULD IT MIMIC WHAT

3675
02:17:55,040 --> 02:17:56,080
TRAUMA CENTERS DO?

3676
02:17:56,080 --> 02:17:57,280
QUESTION NUMBER 2 THAT CAME OUT

3677
02:17:57,280 --> 02:18:01,200
OF THE SMALL GROUP IN TERMS OF

3678
02:18:01,200 --> 02:18:04,360
-- THE MORNING SESSION,

3679
02:18:04,360 --> 02:18:06,840
BRAINSTORMING WITH DR. BENSON,

3680
02:18:06,840 --> 02:18:09,080
SHOULD MEDICAL SCHOOLS OR

3681
02:18:09,080 --> 02:18:10,400
RESIDENCIES OF DIFFERENT

3682
02:18:10,400 --> 02:18:13,360
DISCIPLINES ALSO HAVE COMMUNITY

3683
02:18:13,360 --> 02:18:16,040
ENGAGEMENT REQUIREMENTS LIKE A

3684
02:18:16,040 --> 02:18:17,480
TWO-WEEK TIME PERIOD WHERE

3685
02:18:17,480 --> 02:18:20,240
RESIDENTS GO INTO THE COMMUNITY

3686
02:18:20,240 --> 02:18:23,720
PERFORMING EDUCATION, E.M.,

3687
02:18:23,720 --> 02:18:24,600
NEUROLOGY, INTERNAL MEDICINE,

3688
02:18:24,600 --> 02:18:26,040
THERE'S MANY PLUSES THAT COULD

3689
02:18:26,040 --> 02:18:32,800
COME FROM THAT IN TERMS OF

3690
02:18:32,800 --> 02:18:34,440
BREAKING DOWN BARRIERS AND

3691
02:18:34,440 --> 02:18:36,640
BUILDING UP OTHER ASPECTS THAT

3692
02:18:36,640 --> 02:18:38,240
STRENGTHEN THE SYSTEM.

3693
02:18:38,240 --> 02:18:41,120
AND I DO THINK FOR MYSELF BEING

3694
02:18:41,120 --> 02:18:45,640
E.M. AND I.M. TRAINED, A MONTH 

3695
02:18:45,640 --> 02:18:50,560
IN THE FIELD IN DETROIT AS PART

3696
02:18:50,560 --> 02:18:51,960
OF HOSPICE ROTATION, GREAT VALUE

3697
02:18:51,960 --> 02:18:54,880
SEEING ENVIRONMENTS OUR PATIENTS

3698
02:18:54,880 --> 02:18:55,760
LIVED IN.

3699
02:18:55,760 --> 02:18:58,680
CURIOUS FOR WHAT THE GROUP

3700
02:18:58,680 --> 02:19:00,320
THINKS ABOUT ADVOCATING AT THE

3701
02:19:00,320 --> 02:19:01,720
MEDICAL STUDENT LEVEL, WE COULD

3702
02:19:01,720 --> 02:19:05,120
EXTEND TO THE P.A. EDUCATION,

3703
02:19:05,120 --> 02:19:07,240
NURSE PRACTITIONER EDUCATION,

3704
02:19:07,240 --> 02:19:10,840
ALSO RESIDENCY LEVEL TOO.

3705
02:19:10,840 --> 02:19:14,440
>> WE HAD DISCUSSED THAT IN OUR

3706
02:19:14,440 --> 02:19:16,080
MORNING SESSION ALSO, TAPPING

3707
02:19:16,080 --> 02:19:18,000
INDIVIDUALS SUCH AS PHARMACISTS

3708
02:19:18,000 --> 02:19:20,120
AND NURSES, NOT NECESSARILY JUST

3709
02:19:20,120 --> 02:19:21,280
NURSE PRACTITIONERS, JUST OTHER

3710
02:19:21,280 --> 02:19:22,840
GROUPS THAT HAVE HEALTH CARE

3711
02:19:22,840 --> 02:19:24,920
EDUCATION THAT COULD REACH OUT

3712
02:19:24,920 --> 02:19:26,240
TO THE COMMUNITY, AND THAT WOULD

3713
02:19:26,240 --> 02:19:29,760
BUILD TRUST.

3714
02:19:29,760 --> 02:19:31,960
>> WE ALSO DISCUSSED ABOUT THAT.

3715
02:19:31,960 --> 02:19:36,360
IT'S VERY IMPORTANT TO INCLUDE

3716
02:19:36,360 --> 02:19:37,720
ESPECIALLY EMERGENCY PHYSICIANS,

3717
02:19:37,720 --> 02:19:38,840
TO HELP EXPOSURE IN VASCULAR

3718
02:19:38,840 --> 02:19:41,120
NEUROLOGY.

3719
02:19:41,120 --> 02:19:43,440
 

3720
02:19:43,440 --> 02:19:45,560
>> I ALSO WANTED TO MENTION --

3721
02:19:45,560 --> 02:19:48,640
>> WHAT I HEARD FROM PROGRAM

3722
02:19:48,640 --> 02:19:50,080
DIRECTOR HERE MORE MEDICAL

3723
02:19:50,080 --> 02:19:51,960
SCHOOLS ARE MANDATING ROTATIONS

3724
02:19:51,960 --> 02:19:53,800
IN NEUROLOGY FOR INTERNAL

3725
02:19:53,800 --> 02:19:54,800
MEDICINE RESIDENTS AND FAMILY

3726
02:19:54,800 --> 02:19:56,240
MEDICINE RESIDENTS WHICH CAN

3727
02:19:56,240 --> 02:20:00,040
ONLY BE BENEFICIAL IN TERMS OF

3728
02:20:00,040 --> 02:20:01,400
TRAINING UP THESE PEOPLE.

3729
02:20:01,400 --> 02:20:03,240
ANOTHER THING I WANTED TO BRING

3730
02:20:03,240 --> 02:20:06,760
UP, I HOPE THE NINDS PEOPLE ARE

3731
02:20:06,760 --> 02:20:08,400
ON OR LISTENING, ONE OF THE

3732
02:20:08,400 --> 02:20:11,280
PURPOSES OF THIS SYMPOSIUM IS TO

3733
02:20:11,280 --> 02:20:14,960
GENERATE SOME HYPOTHESES, TO DO

3734
02:20:14,960 --> 02:20:16,080
HIGH LEVEL RESEARCH, BECAUSE

3735
02:20:16,080 --> 02:20:20,640
AGAIN EVENTUALLY WE WANT TO MOVE

3736
02:20:20,640 --> 02:20:23,600
BEYOND ASSOCIATION AND GIVE IN

3737
02:20:23,600 --> 02:20:25,040
TO CAUSATION AND

3738
02:20:25,040 --> 02:20:26,000
HYPOTHESIS-DRIVEN TYPES OF

3739
02:20:26,000 --> 02:20:29,440
RESEARCH, I WAS INTRIGUED BY THE

3740
02:20:29,440 --> 02:20:32,120
DISCUSSION ABOUT ALTEPLASE, I.V.

3741
02:20:32,120 --> 02:20:34,960
ALTEPLASE UTILIZATION OR LACK

3742
02:20:34,960 --> 02:20:36,600
THEREOF AMONG CERTAIN

3743
02:20:36,600 --> 02:20:37,800
UNDERSERVED POPULATIONS.

3744
02:20:37,800 --> 02:20:39,560
AND PERHAPS OUR PRECONCEIVED

3745
02:20:39,560 --> 02:20:44,800
NOTION IS THAT IT IS LACK OF

3746
02:20:44,800 --> 02:20:47,080
EDUCATION, OR BACKGROUND, RACIAL

3747
02:20:47,080 --> 02:20:49,600
OR ETHNICITY BACKGROUND, OR LACK

3748
02:20:49,600 --> 02:20:51,360
OF TRUST, BUT WE DON'T KNOW THAT

3749
02:20:51,360 --> 02:20:54,640
THAT'S THE CASE.

3750
02:20:54,640 --> 02:20:57,000
STRIKES ME THAT'S A TESTABLE

3751
02:20:57,000 --> 02:20:57,360
HYPOTHESIS.

3752
02:20:57,360 --> 02:20:59,040
MAYBE, FOR EXAMPLE, THE REASON

3753
02:20:59,040 --> 02:21:00,760
WHY CERTAIN GROUPS MAY REFUSE TO

3754
02:21:00,760 --> 02:21:02,240
GET IT IS THAT MAYBE THEY ARE

3755
02:21:02,240 --> 02:21:03,040
UNDER THE MISTAKEN BELIEF THEY

3756
02:21:03,040 --> 02:21:05,320
ARE GOING TO HAVE TO PAY FOR IT.

3757
02:21:05,320 --> 02:21:08,240
AND THEY THINK IT'S A NEW AND

3758
02:21:08,240 --> 02:21:09,760
BRAND NEW AND EXPENSIVE

3759
02:21:09,760 --> 02:21:10,040
MEDICATION.

3760
02:21:10,040 --> 02:21:11,000
OR THEY THINK BECAUSE THEY HAVE

3761
02:21:11,000 --> 02:21:12,840
NEVER HEARD OF IT BEFORE, THAT

3762
02:21:12,840 --> 02:21:16,600
IT'S IN SOME WAYS AN

3763
02:21:16,600 --> 02:21:17,440
EXPERIMENTAL MEDICATION.

3764
02:21:17,440 --> 02:21:20,760
SO, I THINK GRANTED ALSO A NICHE

3765
02:21:20,760 --> 02:21:23,440
THING BUT IT'S VERY IMPACTFUL

3766
02:21:23,440 --> 02:21:25,560
FROM PUBLIC HEALTH POINT OF VIEW

3767
02:21:25,560 --> 02:21:26,760
STILL THE EASIEST ACUTE

3768
02:21:26,760 --> 02:21:29,720
MEDICATION FOR STROKE AND

3769
02:21:29,720 --> 02:21:31,880
REQUIRES VERY LITTLE

3770
02:21:31,880 --> 02:21:33,080
INFRASTRUCTURE AND MODEST AMOUNT

3771
02:21:33,080 --> 02:21:34,520
OF MEDICAL EXPERTISE.

3772
02:21:34,520 --> 02:21:37,160
I THINK THAT'S AN INTRIGUING

3773
02:21:37,160 --> 02:21:40,560
POINT THAT COULD BE VERY

3774
02:21:40,560 --> 02:21:41,200
FUNDABLE HYPOTHESIS-DRIVEN TYPE

3775
02:21:41,200 --> 02:21:43,840
OF RESEARCH AND COULD BE VERY

3776
02:21:43,840 --> 02:21:44,640
IMPACTFUL FOR UNDERSERVED AND

3777
02:21:44,640 --> 02:21:48,640
OTHER COMMUNITIES.

3778
02:21:48,640 --> 02:21:53,000
>> YOU COULD TEST BEFORE AND

3779
02:21:53,000 --> 02:21:56,520
AFTER INITIATING A STANDARDIZED

3780
02:21:56,520 --> 02:21:58,600
SCRIPT THAT IS CONCISE,

3781
02:21:58,600 --> 02:21:59,240
EVIDENCE-BASED, UNDERSTANDABLE

3782
02:21:59,240 --> 02:22:01,280
AND AT EVEN 6th GRADE LEVEL OF

3783
02:22:01,280 --> 02:22:01,720
EDUCATION.

3784
02:22:01,720 --> 02:22:03,600
IF YOU IMPLEMENT THAT ACROSS A

3785
02:22:03,600 --> 02:22:05,240
REGION OR STATE, YOU MIGHT FIND

3786
02:22:05,240 --> 02:22:06,360
THAT THERE ARE DIFFERENT --

3787
02:22:06,360 --> 02:22:08,200
THERE'S A CHANGE IN THE TREND

3788
02:22:08,200 --> 02:22:09,640
WITH PROPORTION OF PATIENTS NOT

3789
02:22:09,640 --> 02:22:11,840
GETTING TREATED WHO ARE WITHIN

3790
02:22:11,840 --> 02:22:14,120
THE WINDOW, CITING THAT THE

3791
02:22:14,120 --> 02:22:16,040
PATIENT REFUSED.

3792
02:22:16,040 --> 02:22:16,840
>> I LOVE THAT.

3793
02:22:16,840 --> 02:22:19,440
I THINK THAT'S A GREAT IDEA.

3794
02:22:19,440 --> 02:22:20,800
IT COULD BE STANDARDIZED,

3795
02:22:20,800 --> 02:22:22,640
OBJECTIVE, YOU COULD MEASURE IT,

3796
02:22:22,640 --> 02:22:25,640
MEASURE HAVE A MULTI-LINGUAL

3797
02:22:25,640 --> 02:22:27,160
SCRIPT, THINGS LIKE THAT.

3798
02:22:27,160 --> 02:22:29,280
>> I CAN SHARE MINE.

3799
02:22:29,280 --> 02:22:29,640
>> OKAY.

3800
02:22:29,640 --> 02:22:29,920
ALL RIGHT.

3801
02:22:29,920 --> 02:22:31,480
PUT THAT ON THE LIST OF THINGS

3802
02:22:31,480 --> 02:22:34,040
WE COULD ASK FOR FUNDING ABOUT.

3803
02:22:34,040 --> 02:22:36,080
>> I THINK ONE OF THE THINGS

3804
02:22:36,080 --> 02:22:38,400
THAT WAS MENTIONED ALSO IN THE

3805
02:22:38,400 --> 02:22:41,000
HOSPITAL GROUP IS THAT ALTHOUGH,

3806
02:22:41,000 --> 02:22:43,400
YOU KNOW, WE CAN MAKE TESTABLE

3807
02:22:43,400 --> 02:22:46,040
HYPOTHESES IN TERMS OF EDUCATION

3808
02:22:46,040 --> 02:22:47,440
AT THE COMMUNITY LEVEL, IT HAS

3809
02:22:47,440 --> 02:22:51,160
TO BE A MESSAGE THAT IS SEND OUT

3810
02:22:51,160 --> 02:22:52,480
OVER AND OVER AGAIN BECAUSE

3811
02:22:52,480 --> 02:22:54,320
STROKES ARE SO RARE AND PEOPLE

3812
02:22:54,320 --> 02:22:56,280
DON'T SEE IT OFTEN IN THEIR DAY

3813
02:22:56,280 --> 02:22:58,400
TO DAY.

3814
02:22:58,400 --> 02:23:00,960
SO EXAMPLE WAS GIVEN OF, YOU

3815
02:23:00,960 --> 02:23:01,840
KNOW, EARLY MESSAGING AROUND

3816
02:23:01,840 --> 02:23:04,240
WEARING A SEAT BELT.

3817
02:23:04,240 --> 02:23:05,360
IT JUST BECAME AN EVERYDAY

3818
02:23:05,360 --> 02:23:06,800
THING, THAT YOU WEAR YOUR SEAT

3819
02:23:06,800 --> 02:23:11,360
BELT, AND IT'S REQUIRED BY LAW.

3820
02:23:11,360 --> 02:23:12,560
BUT IT'S A MORE DIFFICULT, YOU

3821
02:23:12,560 --> 02:23:17,200
KNOW, SORT OF MESSAGE THAT YOU

3822
02:23:17,200 --> 02:23:19,560
WOULD HAVE TO REITERATE IN TERMS

3823
02:23:19,560 --> 02:23:20,320
OF COMMUNITY MEMBERS RECOGNIZING

3824
02:23:20,320 --> 02:23:24,160
THE SIGNS AND SYMPTOMS OF

3825
02:23:24,160 --> 02:23:26,120
STROKE, ALSO KNOWING THAT

3826
02:23:26,120 --> 02:23:28,320
GETTING EMS AND TAKING EMS,

3827
02:23:28,320 --> 02:23:32,640
CALLING 911 IS VERY CRITICAL, 

3828
02:23:32,640 --> 02:23:34,000
AND WHY IT'S IMPORTANT.

3829
02:23:34,000 --> 02:23:36,000
>> I THINK THESE ARE REALLY

3830
02:23:36,000 --> 02:23:37,920
GREAT SUGGESTIONS.

3831
02:23:37,920 --> 02:23:44,240
I THINK THAT THOSE TIMES OF 

3832
02:23:44,240 --> 02:23:45,320
INTERVENTIONS, I LIKE HOW DR.

3833
02:23:45,320 --> 02:23:46,880
MARTIN PUT IT IN THE CONTEXT OF

3834
02:23:46,880 --> 02:23:48,480
THAT TYPE OF STUDY, THAT WOULD

3835
02:23:48,480 --> 02:23:50,640
BE A GREAT IDEA, MAY FIT INTO

3836
02:23:50,640 --> 02:23:52,120
SOME OF OUR CURRENT MECHANISMS.

3837
02:23:52,120 --> 02:23:54,560
THE OTHER POINT THAT I WANTED TO

3838
02:23:54,560 --> 02:23:59,760
MENTION, DR. JENSON MADE A

3839
02:23:59,760 --> 02:24:02,240
REALLY GREAT POINT ABOUT NOT

3840
02:24:02,240 --> 02:24:04,040
HAVING ENOUGH MEDICAL PERSONNEL

3841
02:24:04,040 --> 02:24:07,840
IN CERTAIN RURAL AREAS.

3842
02:24:07,840 --> 02:24:10,040
AND INCENTIVIZING PEOPLE.

3843
02:24:10,040 --> 02:24:14,080
CREATING AS A SUGGESTION, WE

3844
02:24:14,080 --> 02:24:17,240
HAVE PAYBACK PROGRAMS OF LOAN,

3845
02:24:17,240 --> 02:24:18,560
TUITION PAYBACK PROGRAMS FOR

3846
02:24:18,560 --> 02:24:19,880
PROVIDERS TO WORK IN CERTAIN

3847
02:24:19,880 --> 02:24:21,000
AREAS, SOMETHING AVAILABLE THAT

3848
02:24:21,000 --> 02:24:22,640
WE CAN LOOK AT AS A

3849
02:24:22,640 --> 02:24:23,080
RECOMMENDATION.

3850
02:24:23,080 --> 02:24:25,680
I LIKE THE THOUGHT AS WELL IN

3851
02:24:25,680 --> 02:24:26,800
TERMS OF INCENTIVIZING PEOPLE IN

3852
02:24:26,800 --> 02:24:28,720
OTHER WAYS TO WORK IN THOSE

3853
02:24:28,720 --> 02:24:28,960
AREAS.

3854
02:24:28,960 --> 02:24:31,840
I THINK CLINT IS ON.

3855
02:24:31,840 --> 02:24:33,560
>> YEAH, HI, EVERYBODY.

3856
02:24:33,560 --> 02:24:35,280
GREAT TALKS.

3857
02:24:35,280 --> 02:24:38,240
JUST IN TERMS OF DR. ALBERT'S

3858
02:24:38,240 --> 02:24:41,000
CALL FOR RESEARCH, I WANTED TO

3859
02:24:41,000 --> 02:24:45,800
MENTION THAT WE'VE MOVED TOWARDS

3860
02:24:45,800 --> 02:24:46,880
THE DISSEMINATION IMPLEMENTATION

3861
02:24:46,880 --> 02:24:48,040
SCIENCE FUNDING OPPORTUNITIES,

3862
02:24:48,040 --> 02:24:49,120
THERE'S A BUNCH IN DIFFERENT

3863
02:24:49,120 --> 02:24:49,320
AREAS.

3864
02:24:49,320 --> 02:24:51,240
THOSE ARE THE ONES THAT YOU

3865
02:24:51,240 --> 02:24:52,680
WOULD RESPOND TO WHEN TRYING TO

3866
02:24:52,680 --> 02:24:54,320
DO THIS TYPE OF RESEARCH AND

3867
02:24:54,320 --> 02:24:57,160
WE'RE TRYING TO BE BETTER AT

3868
02:24:57,160 --> 02:24:58,680
SUPPORTING THAT TYPE OF

3869
02:24:58,680 --> 02:24:59,920
RESEARCH.

3870
02:24:59,920 --> 02:25:01,600
YOU KNOW, IN THE PAST IT HASN'T

3871
02:25:01,600 --> 02:25:04,240
ALWAYS DONE VERY WELL IN REVIEW.

3872
02:25:04,240 --> 02:25:08,640
AND ONE OF THE THINGS AT NINDS

3873
02:25:08,640 --> 02:25:09,680
WE'VE BEEN TRYING TO EMPHASIZE

3874
02:25:09,680 --> 02:25:11,560
IS NOW THAT WE'VE ACCUMULATED

3875
02:25:11,560 --> 02:25:13,440
ALL OF THIS WONDERFUL

3876
02:25:13,440 --> 02:25:15,640
OBSERVATIONAL DATA, OVER SEVERAL

3877
02:25:15,640 --> 02:25:18,240
DECADES, IT'S TIME TO DO MORE OF

3878
02:25:18,240 --> 02:25:20,640
THE IMPLEMENTATION WORK TO

3879
02:25:20,640 --> 02:25:22,640
REALLY UNDERSTAND HOW WE ADDRESS

3880
02:25:22,640 --> 02:25:23,400
SOME OF THESE BARRIERS AND

3881
02:25:23,400 --> 02:25:25,680
ISSUES THAT YOU ALL HAVE BEEN

3882
02:25:25,680 --> 02:25:26,600
TALKING ABOUT TODAY.

3883
02:25:26,600 --> 02:25:28,960
SO I JUST WANTED TO MENTION THAT

3884
02:25:28,960 --> 02:25:30,960
BECAUSE THERE ARE THOSE

3885
02:25:30,960 --> 02:25:32,120
OPPORTUNITIES OUT THERE OUTSIDE

3886
02:25:32,120 --> 02:25:33,840
OF TARGETED STUFF THAT MIGHT

3887
02:25:33,840 --> 02:25:34,760
HAPPEN.

3888
02:25:34,760 --> 02:25:37,440
OVER.

3889
02:25:37,440 --> 02:25:39,160
>> THANKS SO MUCH, CLINT.

3890
02:25:39,160 --> 02:25:39,640
THAT'S VERY VALUABLE.

3891
02:25:39,640 --> 02:25:42,440
THANK YOU.

3892
02:25:42,440 --> 02:25:43,520
WELCOME BACK.

3893
02:25:43,520 --> 02:25:44,960
SO, ACTUALLY WITHOUT FURTHER ADO

3894
02:25:44,960 --> 02:25:47,240
WE'RE GOING TO SEGUE RIGHT INTO

3895
02:25:47,240 --> 02:25:50,560
OUR LAST SESSION FOR OUR LAST

3896
02:25:50,560 --> 02:25:54,000
TIME POINT, SO I WANT TO MAKE

3897
02:25:54,000 --> 02:25:57,840
SURE THAT WE HAVE OUR CO-LEADS

3898
02:25:57,840 --> 02:26:01,160
FOR THE INPATIENT TASK FORCE AT

3899
02:26:01,160 --> 02:26:02,800
HAND, AND I'M JUST SCROLLING

3900
02:26:02,800 --> 02:26:09,320
THROUGH ... LOOKING FOR KAREN

3901
02:26:09,320 --> 02:26:14,440
FURY AND LAWRENCE FLESHLER.

3902
02:26:14,440 --> 02:26:15,360
>> THIS IS KAREN, I'M HERE.

3903
02:26:15,360 --> 02:26:17,560
>> I'M HERE AS WELL.

3904
02:26:17,560 --> 02:26:20,000
>> AS BEFORE, WE'RE ABOUT TO

3905
02:26:20,000 --> 02:26:23,440
HEAR A SUMMARY OF THE REPORT-OUT

3906
02:26:23,440 --> 02:26:29,320
FROM THE TASK FORCE, SUMMARY

3907
02:26:29,320 --> 02:26:31,440
PRE-RECORDED, THEN WE WILL SHIFT

3908
02:26:31,440 --> 02:26:32,160
INTO A LIVE DISCUSSION, QUESTION

3909
02:26:32,160 --> 02:26:33,680
AND ANSWER PERIOD.

3910
02:26:33,680 --> 02:26:34,840
I WANT TO ENCOURAGE EVERYONE TO

3911
02:26:34,840 --> 02:26:37,440
POST QUESTIONS IN THE CHAT AS

3912
02:26:37,440 --> 02:26:39,160
YOU LISTEN TO SUMMARY AND

3913
02:26:39,160 --> 02:26:39,760
DISCUSSION, FOLLOWING THAT

3914
02:26:39,760 --> 02:26:40,720
QUESTION AND ANSWER PERIOD WE'LL

3915
02:26:40,720 --> 02:26:43,680
SHIFT BACK INTO THE BREAKOUT

3916
02:26:43,680 --> 02:26:45,360
ROOMS BY CROSS-CUTTING THEME

3917
02:26:45,360 --> 02:26:46,240
AND, AGAIN, I ENCOURAGE EVERYONE

3918
02:26:46,240 --> 02:26:48,480
IN THE BREAKOUT TO TURN ON YOUR

3919
02:26:48,480 --> 02:26:50,440
VIDEO AND HAVE MUCH MORE OF AN

3920
02:26:50,440 --> 02:26:52,120
ORGANIC DISCUSSION, IF YOU'RE

3921
02:26:52,120 --> 02:26:52,320
ABLE.

3922
02:26:52,320 --> 02:26:53,640
WITHOUT FURTHER ADO, I'M GOING

3923
02:26:53,640 --> 02:26:54,840
TO ASK OUR CONTRACTORS TO START

3924
02:26:54,840 --> 02:26:57,560
PLAYING THE VIDEO.

3925
02:26:57,560 --> 02:27:01,720
 

3926
02:27:01,720 --> 02:27:03,040
>> I APPRECIATE THE OPPORTUNITY

3927
02:27:03,040 --> 02:27:05,560
TO PRESENT ON BEHALF OF THE

3928
02:27:05,560 --> 02:27:07,200
INPATIENT CARE GROUP EXPLORING

3929
02:27:07,200 --> 02:27:13,080
INTHE  INEQUITIES.

3930
02:27:13,080 --> 02:27:16,160
THE TASK FORCE IDENTIFIED THE

3931
02:27:16,160 --> 02:27:17,240
FOLLOWING SUBCATEGORIES,

3932
02:27:17,240 --> 02:27:18,440
DIAGNOSTICS, PROCEDURES,

3933
02:27:18,440 --> 02:27:19,480
SECONDARY STROKE MEDICATIONS,

3934
02:27:19,480 --> 02:27:25,040
ACCESS TO POST STROKE CARE, AND

3935
02:27:25,040 --> 02:27:25,640
READMISSIONS.

3936
02:27:25,640 --> 02:27:27,800
OUR WRITING GROUP PERFORMED

3937
02:27:27,800 --> 02:27:29,320
LITERATURE SEARCHES IN EACH OF

3938
02:27:29,320 --> 02:27:31,280
THE CATEGORIES, FOR EACH

3939
02:27:31,280 --> 02:27:34,560
SUBCATEGORY WE IDENTIFIED ISSUES

3940
02:27:34,560 --> 02:27:37,000
RELATED TO DEMOGRAPHICS,

3941
02:27:37,000 --> 02:27:38,240
GEOGRAPHY, POLICY AND

3942
02:27:38,240 --> 02:27:42,560
REGULATIONS, ECONOMICS, AND

3943
02:27:42,560 --> 02:27:44,280
HEALTH CARE RESOURCES.

3944
02:27:44,280 --> 02:27:49,800
WE'LL START WITH WEEING  --

3945
02:27:49,800 --> 02:27:51,840
GEOGRAPHY, LINKED TO STRENGTH OF

3946
02:27:51,840 --> 02:27:58,520
ECONOMY AND RESOURCES, WE KNOW

3947
02:27:58,520 --> 02:28:01,000
THIS INVOLVING LITERATURE WITH

3948
02:28:01,000 --> 02:28:02,320
LOW AND MIDDLE INCOME NATIONS

3949
02:28:02,320 --> 02:28:02,600
GLOBALLY.

3950
02:28:02,600 --> 02:28:07,360
IN IT'S UNITED STATES THERE ARE

3951
02:28:07,360 --> 02:28:10,080
INEQUITIES IN RURAL AREAS, LESS

3952
02:28:10,080 --> 02:28:10,960
EXPERTISE FOR COMPLICATED

3953
02:28:10,960 --> 02:28:12,960
CONDITIONS, LESS ACCESS TO

3954
02:28:12,960 --> 02:28:14,160
SPECIALIZED SUPPORT SERVICES,

3955
02:28:14,160 --> 02:28:17,520
LESS COORDINATION OF CARE THAT

3956
02:28:17,520 --> 02:28:19,320
RESULTS IN MORE HANDOFFS,

3957
02:28:19,320 --> 02:28:21,960
INCREASED RISK OF SECONDARY

3958
02:28:21,960 --> 02:28:26,160
COMPLICATIONS IN STROKE, AND 

3959
02:28:26,160 --> 02:28:28,920
INCREASED RISKS OF READMISSION.

3960
02:28:28,920 --> 02:28:31,920
WE IDENTIFIED NUMEROUS GAPS WITH

3961
02:28:31,920 --> 02:28:32,680
REGARD TO GEOGRAPHY.

3962
02:28:32,680 --> 02:28:35,320
THERE WERE VERY FEW STUDIES

3963
02:28:35,320 --> 02:28:36,960
COMPARING INPATIENT CARE

3964
02:28:36,960 --> 02:28:43,720
DELIVERY IN RURAL AND URBAN CARE

3965
02:28:43,720 --> 02:28:44,040
FACILITIES.

3966
02:28:44,040 --> 02:28:45,160
GEOGRAPHIC DIFFERENCES DO NOT

3967
02:28:45,160 --> 02:28:46,240
EXIST IN ISOLATION.

3968
02:28:46,240 --> 02:28:49,200
WE NEED TO BETTER UNDERSTAND

3969
02:28:49,200 --> 02:28:50,520
STRUCTURAL AND SOCIOECONOMIC

3970
02:28:50,520 --> 02:28:51,920
CHARACTERISTICS OF REGIONS AND

3971
02:28:51,920 --> 02:28:52,800
NEIGHBORHOODS, TO UNDERSTAND

3972
02:28:52,800 --> 02:28:56,960
THEIR IMPACT ON ACUTE STROKE

3973
02:28:56,960 --> 02:28:57,360
CARE.

3974
02:28:57,360 --> 02:29:02,960
MORE INFORMATION IS NEEDED ON 

3975
02:29:02,960 --> 02:29:09,000
IMPACT OF TELE AND HOME SERVICES

3976
02:29:09,000 --> 02:29:10,240
WITH COORDINATION OF BROADBAND

3977
02:29:10,240 --> 02:29:11,480
ACCESS AND DEVICE SKILLS.

3978
02:29:11,480 --> 02:29:15,360
NEXT WE CONSIDERED POLICIES AND

3979
02:29:15,360 --> 02:29:17,000
REGULATIONS.

3980
02:29:17,000 --> 02:29:19,200
SEVERAL KEY ISSUES EMERGED.

3981
02:29:19,200 --> 02:29:21,280
TECHNOLOGY CAN HELP WITH

3982
02:29:21,280 --> 02:29:23,720
STANDARDIZING BEST PRACTICES,

3983
02:29:23,720 --> 02:29:25,760
AND IMPLEMENTING GUIDELINES.

3984
02:29:25,760 --> 02:29:27,440
PROTOCOLS AND PATHWAYS SHOULD BE

3985
02:29:27,440 --> 02:29:31,000
DEVELOPED LOCALLY TO MATCH THE

3986
02:29:31,000 --> 02:29:32,640
RESOURCES WITH NEEDS.

3987
02:29:32,640 --> 02:29:36,240
AGAIN, WITH REGARD TO POLICY, WE

3988
02:29:36,240 --> 02:29:38,360
IDENTIFIED SEVERAL GAPS.

3989
02:29:38,360 --> 02:29:44,040
THERE'S LACK OF DATA ON IMPACT,

3990
02:29:44,040 --> 02:29:47,440
ON DIAGNOSTICS, PROCEDURES,

3991
02:29:47,440 --> 02:29:48,840
THERAPEUTICS, POST-ACUTE CARE.

3992
02:29:48,840 --> 02:29:51,720
THERE ARE SOME SUGGESTIONS THAT

3993
02:29:51,720 --> 02:29:54,560
COST AFFECTS POST-ACUTE CARE AND

3994
02:29:54,560 --> 02:29:55,320
MEDICATION USE.

3995
02:29:55,320 --> 02:29:58,680
BUT THESE ISSUES ARE VERY POORLY

3996
02:29:58,680 --> 02:29:59,360
UNDERSTOOD.

3997
02:29:59,360 --> 02:30:01,680
LITTLE IS KNOWN ABOUT HOSPITAL

3998
02:30:01,680 --> 02:30:05,480
POLICIES REGARDING INEQUITIES IN

3999
02:30:05,480 --> 02:30:08,560
DELIVERY OF CARE.

4000
02:30:08,560 --> 02:30:12,000
OVERALL WE FOUND MANY AREAS THAT

4001
02:30:12,000 --> 02:30:13,520
REQUIRE ADDITIONAL RESEARCH.

4002
02:30:13,520 --> 02:30:20,360
AND NOW I'LL PASS THIS OFF TO MY

4003
02:30:20,360 --> 02:30:23,520
PARTNER, DR. LARRY WECHSLER.

4004
02:30:23,520 --> 02:30:24,800
>> THANK YOU, KAREN.

4005
02:30:24,800 --> 02:30:27,080
THE THIRD CROSS-CUTTING THEME IS

4006
02:30:27,080 --> 02:30:29,400
ECONOMICS AND HEALTH CARE

4007
02:30:29,400 --> 02:30:30,960
RESOURCES.

4008
02:30:30,960 --> 02:30:32,320
AND THE INPATIENT WORK GROUP

4009
02:30:32,320 --> 02:30:34,960
IDENTIFIED SEVERAL KEY ISSUES IN

4010
02:30:34,960 --> 02:30:37,800
THIS AREA.

4011
02:30:37,800 --> 02:30:40,760
FIRST WAS THAT IN NEIGHBORHOODS

4012
02:30:40,760 --> 02:30:42,840
WITH LOWER SOCIOECONOMIC STATUS,

4013
02:30:42,840 --> 02:30:46,640
THIS WAS ASSOCIATED WITH POOR

4014
02:30:46,640 --> 02:30:48,840
OUTCOMES WITH LITERATURE TO

4015
02:30:48,840 --> 02:30:51,640
SUPPORT THAT.

4016
02:30:51,640 --> 02:30:54,280
SECONDARY STROKE PREVENTION

4017
02:30:54,280 --> 02:30:56,120
MEASURES WERE LESS UTILIZED IN

4018
02:30:56,120 --> 02:31:00,240
LOW INCOME SETTINGS.

4019
02:31:00,240 --> 02:31:01,480
THAT INCLUDES ANTI-COAGULATION,

4020
02:31:01,480 --> 02:31:05,920
AND REDUCED USE OF STATINS AND

4021
02:31:05,920 --> 02:31:06,360
ANTIPLATELET AGENTS,

4022
02:31:06,360 --> 02:31:11,160
PARTICULARLY IN LOW INCOME

4023
02:31:11,160 --> 02:31:11,800
PATIENTS.

4024
02:31:11,800 --> 02:31:14,320
THE GROUP FOUND THAT INCOME ALSO

4025
02:31:14,320 --> 02:31:18,040
AFFECTS THE USE OF

4026
02:31:18,040 --> 02:31:18,720
POST-DISCHARGE FACILITIES,

4027
02:31:18,720 --> 02:31:21,200
WHETHER THAT BE INPATIENT REHAB

4028
02:31:21,200 --> 02:31:24,800
FACILITIES, THE USE OF HOME

4029
02:31:24,800 --> 02:31:27,000
HEALTH SERVICES, AND SKILLED

4030
02:31:27,000 --> 02:31:28,760
NURSING FACILITIES, ALL OF THOSE

4031
02:31:28,760 --> 02:31:31,360
THINGS VARIED ACCORDING TO

4032
02:31:31,360 --> 02:31:31,880
INCOME.

4033
02:31:31,880 --> 02:31:35,520
WE ALSO FOUND THAT THE COST OF

4034
02:31:35,520 --> 02:31:37,840
TECHNOLOGY WAS A LIMITATION, AND

4035
02:31:37,840 --> 02:31:39,680
CONTRIBUTED TO INEQUITIES.

4036
02:31:39,680 --> 02:31:43,840
PARTICULARLY WITH THE USE OF

4037
02:31:43,840 --> 02:31:45,200
ADVANCED DIAGNOSTIC PROCEDURES,

4038
02:31:45,200 --> 02:31:49,480
AND TELEHEALTH SERVICES IN THE

4039
02:31:49,480 --> 02:31:50,640
POST-DISCHARGE PHASE.

4040
02:31:50,640 --> 02:31:52,600
THE WORK GROUP IDENTIFIED GAPS

4041
02:31:52,600 --> 02:31:55,000
IN THIS AREA THAT WE WANTED TO

4042
02:31:55,000 --> 02:31:56,760
POINT OUT.

4043
02:31:56,760 --> 02:32:02,320
FIRST IS THE FACT THAT THERE IS

4044
02:32:02,320 --> 02:32:02,960
NON-STANDARDIZATION OF

4045
02:32:02,960 --> 02:32:04,640
DEFINITIONS ACROSS ARTICLES IN

4046
02:32:04,640 --> 02:32:06,160
LITERATURE, A RECURRING THEME

4047
02:32:06,160 --> 02:32:08,120
THAT WE FEEL IS VERY IMPORTANT

4048
02:32:08,120 --> 02:32:12,400
TO ADDRESS BECAUSE IT MAKES IT

4049
02:32:12,400 --> 02:32:14,600
DIFFICULT TO COMPARE ACROSS

4050
02:32:14,600 --> 02:32:18,400
STUDIES AND ACROSS ARTICLES IN

4051
02:32:18,400 --> 02:32:20,840
THE LITERATURE.

4052
02:32:20,840 --> 02:32:23,840
ANOTHER GAP IS THAT VERY FEW OF

4053
02:32:23,840 --> 02:32:27,760
THESE ISSUES STAND ALONE.

4054
02:32:27,760 --> 02:32:32,360
AND THE EFFECT OF UNUTILIZATION

4055
02:32:32,360 --> 02:32:35,200
OF RESOURCES, PROTOCOLS,

4056
02:32:35,200 --> 02:32:37,600
ECONOMICS, PATIENT FACTORS, HOW

4057
02:32:37,600 --> 02:32:39,800
THEY ALL INTERACT IS NOT VERY

4058
02:32:39,800 --> 02:32:42,960
WELL UNDERSTOOD AND REPRESENTS A

4059
02:32:42,960 --> 02:32:43,640
SIGNIFICANT GAP.

4060
02:32:43,640 --> 02:32:44,920
FINALLY, THERE'S NOT A GREAT

4061
02:32:44,920 --> 02:32:48,760
DEAL OF DATA IN THE LITERATURE

4062
02:32:48,760 --> 02:32:53,360
ON EQUITY IN THINGS LIKE DOSING

4063
02:32:53,360 --> 02:32:54,640
OF MEDICATIONS, AND COMPLIANCE

4064
02:32:54,640 --> 02:33:00,800
AS WELL AS THE APPLICATION OF

4065
02:33:00,800 --> 02:33:03,440
INPATIENT DIAGNOSTIC PROCEDURES,

4066
02:33:03,440 --> 02:33:09,520
AND THERAPEUTIC PROCEDURES, SUCH

4067
02:33:09,520 --> 02:33:12,480
AS ENDARTERECTOMY, USE OF

4068
02:33:12,480 --> 02:33:14,240
IMPLANTABLE CARDIAC MONITORS.

4069
02:33:14,240 --> 02:33:16,840
WITH REGARD TO DEMOGRAPHICS, THE

4070
02:33:16,840 --> 02:33:20,000
NEXT CROSS-CUTTING TEAM, KEY

4071
02:33:20,000 --> 02:33:25,840
ISSUES THE INPATIENT WORK GROUP 

4072
02:33:25,840 --> 02:33:28,400
IDENTIFIED WERE THE FOLLOWING.

4073
02:33:28,400 --> 02:33:33,000
POST-ACUTE SERVICES SEEM TO VARY

4074
02:33:33,000 --> 02:33:34,840
ACCORDING TO SEX, RACE, AGE,

4075
02:33:34,840 --> 02:33:37,400
INCLUDING APPLICATION OF

4076
02:33:37,400 --> 02:33:39,360
INPATIENT REHAB, HOME HEALTH

4077
02:33:39,360 --> 02:33:43,840
SERVICES, AND SKILLED NURSING

4078
02:33:43,840 --> 02:33:44,120
FACILITIES.

4079
02:33:44,120 --> 02:33:45,440
IT WAS ALSO FOUND THAT OLDER

4080
02:33:45,440 --> 02:33:47,760
PATIENTS, THAT IS THOSE OLDER

4081
02:33:47,760 --> 02:33:51,040
THAN 65, WERE LESS LIKELY TO

4082
02:33:51,040 --> 02:33:52,920
RECEIVE SECONDARY STROKE

4083
02:33:52,920 --> 02:33:53,680
PREVENTION THERAPIES, BOTH EARLY

4084
02:33:53,680 --> 02:33:56,680
ON WITHIN THE FIRST COUPLE OF

4085
02:33:56,680 --> 02:33:59,360
DAYS, AND AT DISCHARGE.

4086
02:33:59,360 --> 02:34:03,360
THIS INCLUDES ANTI-PLATE LIT

4087
02:34:03,360 --> 02:34:04,520
AGENTS, ANTICOAGULANTS AND

4088
02:34:04,520 --> 02:34:04,840
STATINS.

4089
02:34:04,840 --> 02:34:06,920
BLACKS AND HISPANICS WERE FOUND

4090
02:34:06,920 --> 02:34:09,600
TO BE LESS LIKELY TO RECEIVE

4091
02:34:09,600 --> 02:34:13,440
THESE SAME OPTIMAL MEDICAL

4092
02:34:13,440 --> 02:34:16,600
THERAPIES, AND WERE LESS LIKELY

4093
02:34:16,600 --> 02:34:19,840
TO RECEIVE VARIOUS POST-ACUTE

4094
02:34:19,840 --> 02:34:22,560
CARE MEASURES SUCH AS HOME

4095
02:34:22,560 --> 02:34:24,520
HEALTH SERVICES, FOR EXAMPLE.

4096
02:34:24,520 --> 02:34:27,160
FINALLY, WOMEN WERE ALSO LESS

4097
02:34:27,160 --> 02:34:28,760
LIKELY TO RECEIVE APPROPRIATE

4098
02:34:28,760 --> 02:34:32,880
ANTI-THROMBOTIC THERAPY.

4099
02:34:32,880 --> 02:34:39,680
FOR EXAMPLE, THE USE OF 

4100
02:34:39,680 --> 02:34:44,080
ANTIPLATELET AGENTS FOLLOWING

4101
02:34:44,080 --> 02:34:46,040
CAROTID ENDARTERETCOMY, WOMEN

4102
02:34:46,040 --> 02:34:49,240
REST LIKELY TO RECEIVE

4103
02:34:49,240 --> 02:34:49,840
TREATMENTS.

4104
02:34:49,840 --> 02:34:56,440
FOR THE INPATIENT WORK GROUP,

4105
02:34:56,440 --> 02:34:58,080
SIMILAR TO PREVIOUS ONES

4106
02:34:58,080 --> 02:34:58,360
MENTIONED.

4107
02:34:58,360 --> 02:35:01,600
FIRST OF ALL THERE'S VERY LITTLE

4108
02:35:01,600 --> 02:35:03,080
STANDARDIZATION OF REPORTING

4109
02:35:03,080 --> 02:35:06,280
ACROSS STUDIES WITHIN THE

4110
02:35:06,280 --> 02:35:06,840
LITERATURE.

4111
02:35:06,840 --> 02:35:08,440
SECOND, DISENTANGLING THE

4112
02:35:08,440 --> 02:35:11,760
FEATURES OF DEMOGRAPHICS FROM

4113
02:35:11,760 --> 02:35:14,360
OTHER FACTORS SUCH AS

4114
02:35:14,360 --> 02:35:15,240
SOCIOECONOMIC STATUS AND

4115
02:35:15,240 --> 02:35:16,800
GEOGRAPHY A DIFFICULT AND COULD

4116
02:35:16,800 --> 02:35:17,640
USE FURTHER WORK.

4117
02:35:17,640 --> 02:35:20,640
WHAT ARE OPPORTUNITIES FOR

4118
02:35:20,640 --> 02:35:20,840
ACTION?

4119
02:35:20,840 --> 02:35:22,600
THE INPATIENT WORK GROUP

4120
02:35:22,600 --> 02:35:24,000
IDENTIFIED SEVERAL OF THESE,

4121
02:35:24,000 --> 02:35:27,600
FIVE OF THESE, LISTED HERE.

4122
02:35:27,600 --> 02:35:29,680
NUMBER ONE IS STANDARDIZATION OF

4123
02:35:29,680 --> 02:35:31,000
TERMS AND CATEGORIES, AND I'VE

4124
02:35:31,000 --> 02:35:33,840
ALREADY MENTIONED THIS.

4125
02:35:33,840 --> 02:35:37,560
BUT THE GROUP WAS THOUGHT THIS

4126
02:35:37,560 --> 02:35:38,880
WAS A VERY IMPORTANT FACTOR, NOT

4127
02:35:38,880 --> 02:35:41,480
ONLY IN TRYING TO UNDERSTAND THE

4128
02:35:41,480 --> 02:35:44,360
EXISTING LITERATURE BUT

4129
02:35:44,360 --> 02:35:48,000
HOPEFULLY TO BETTER UNDERSTAND

4130
02:35:48,000 --> 02:35:49,840
NEW LITERATURE GOING FORWARD.

4131
02:35:49,840 --> 02:35:51,880
THERE WAS LITTLE KNOWN ABOUT

4132
02:35:51,880 --> 02:35:53,200
INEQUITIES IN DIAGNOSTIC STUDIES

4133
02:35:53,200 --> 02:35:58,440
AND PROCEDURES SUCH AS CAROTID

4134
02:35:58,440 --> 02:36:01,080
VASCULARIZE ACE, PFO CLOSURE

4135
02:36:01,080 --> 02:36:02,480
DURING THE HOSPITAL STAY, SINCE

4136
02:36:02,480 --> 02:36:05,600
THESE COULD EASILY RESULT IN

4137
02:36:05,600 --> 02:36:11,320
DIFFERENCES IN OUTCOME DOWN THE

4138
02:36:11,320 --> 02:36:12,080
LINE.

4139
02:36:12,080 --> 02:36:14,400
THIRDLY, A NUMBER OF FACTORS,

4140
02:36:14,400 --> 02:36:19,240
PATIENT AND PROVIDER AND 

4141
02:36:19,240 --> 02:36:20,600
SOCIETAL FACTORS NEED TO BE

4142
02:36:20,600 --> 02:36:21,960
BETTER DEFINED.

4143
02:36:21,960 --> 02:36:23,760
PATIENT FACTORS SUCH AS

4144
02:36:23,760 --> 02:36:30,760
NON-ADHERENCE, PROVIDER FACT 

4145
02:36:30,760 --> 02:36:35,360
ORS, AND THERAPEUTIC INHERITTA 

4146
02:36:35,360 --> 02:36:37,880
AND SOCIETAL FACTORS, DRUG COST,

4147
02:36:37,880 --> 02:36:38,960
REFERRAL PATTERNS, THOSE THINGS

4148
02:36:38,960 --> 02:36:45,000
NEED TO BE BETTER DEFINED TO

4149
02:36:45,000 --> 02:36:46,080
UNDERSTAND INEQUITIES.

4150
02:36:46,080 --> 02:36:52,280
WE NEED MORE RESEARCH ON THE

4151
02:36:52,280 --> 02:36:53,400
FACILITATION OF TRANSITIONING

4152
02:36:53,400 --> 02:36:56,000
INDIVIDUALS BACK TO THEIR

4153
02:36:56,000 --> 02:36:59,000
COMMUNITIES, PARTICULARLY IN LOW

4154
02:36:59,000 --> 02:37:02,040
RESOURCED RURAL COMMUNITIES.

4155
02:37:02,040 --> 02:37:02,920
AND FINALLY, ADDITIONAL RESEARCH

4156
02:37:02,920 --> 02:37:07,720
WAS FELT TO BE NEEDED TO BETTER

4157
02:37:07,720 --> 02:37:11,640
CHARACTERIZE THE FEATURES OF

4158
02:37:11,640 --> 02:37:15,040
RURALITY MOST IMPORTANT FOR THE

4159
02:37:15,040 --> 02:37:16,120
INPATIENT AND POST-STROKE CARE

4160
02:37:16,120 --> 02:37:16,480
EXPERIENCE.

4161
02:37:16,480 --> 02:37:18,440
I'D LIKE TO TAKE THIS

4162
02:37:18,440 --> 02:37:21,000
OPPORTUNITY TO GREATLY THANK THE

4163
02:37:21,000 --> 02:37:24,640
MANY TASK FORCE MEMBERS THAT

4164
02:37:24,640 --> 02:37:28,800
WORKED VERY HARD ON THIS TOPIC.

4165
02:37:28,800 --> 02:37:29,880
EVERYONE CONTRIBUTED A GREAT

4166
02:37:29,880 --> 02:37:30,080
DEAL.

4167
02:37:30,080 --> 02:37:32,720
AND SEVERAL OF THEM WILL BE PART

4168
02:37:32,720 --> 02:37:35,000
OF OUR PANEL THAT FOLLOWS THIS

4169
02:37:35,000 --> 02:37:36,760
PRESENTATION.

4170
02:37:36,760 --> 02:37:39,040
I'D LIKE TO PARTICULARLY THANK

4171
02:37:39,040 --> 02:37:40,800
KAREN FURIE, MY CO-LEAD FOR THIS

4172
02:37:40,800 --> 02:37:43,760
TASK FORCE, FOR ALL THE GREAT

4173
02:37:43,760 --> 02:37:45,680
CONTRIBUTIONS THAT SHE MADE TO

4174
02:37:45,680 --> 02:37:46,400
THIS EFFORT.

4175
02:37:46,400 --> 02:37:47,280
THANK YOU.

4176
02:37:47,280 --> 02:37:50,200
HERE ARE SOME KEY REFERENCES

4177
02:37:50,200 --> 02:37:53,040
IDENTIFIED BY THE TASK FORCE. 

4178
02:37:53,040 --> 02:37:54,000
>> THANK YOU, LARRY.

4179
02:37:54,000 --> 02:37:57,720
THANK YOU, KAREN, FOR THAT

4180
02:37:57,720 --> 02:37:58,160
REPORT-OUT.

4181
02:37:58,160 --> 02:37:58,840
VERY COMPREHENSIVE.

4182
02:37:58,840 --> 02:38:01,880
CERTAINLY LAID OUT SOME GREAT

4183
02:38:01,880 --> 02:38:03,040
OPPORTUNITIES FOR FURTHER

4184
02:38:03,040 --> 02:38:04,080
RESEARCH AND STUDY.

4185
02:38:04,080 --> 02:38:07,680
WE'RE GOING TO MOVE NOW TO THE

4186
02:38:07,680 --> 02:38:09,480
QUESTION AND ANSWER PERIOD.

4187
02:38:09,480 --> 02:38:11,800
EITHER OF YOU, YOU PRESENTED A

4188
02:38:11,800 --> 02:38:15,240
LOT OF VERY INTRIGUING DATA AND

4189
02:38:15,240 --> 02:38:15,640
OPPORTUNITIES.

4190
02:38:15,640 --> 02:38:16,960
IN TERMS OF RESEARCH, THIS CAME

4191
02:38:16,960 --> 02:38:19,080
UP IN A DIFFERENT BREAKOUT

4192
02:38:19,080 --> 02:38:20,560
SESSION ON A DIFFERENT TOPIC,

4193
02:38:20,560 --> 02:38:24,160
BUT I THINK IT'S STILL RELEVANT.

4194
02:38:24,160 --> 02:38:26,680
IN TERMS OF DOING HIGH LEVEL

4195
02:38:26,680 --> 02:38:28,760
RESEARCH, ONE OF THE HOPES WILL

4196
02:38:28,760 --> 02:38:31,360
BE A RESULT OF THIS, WILL BE TO

4197
02:38:31,360 --> 02:38:36,760
GO BEYOND DESCRIPTIVE STUDIES

4198
02:38:36,760 --> 02:38:40,040
AND ASSOCIATION STUDIES INTO

4199
02:38:40,040 --> 02:38:40,600
HYPOTHESIS-DRIVEN RESEARCH,

4200
02:38:40,600 --> 02:38:41,760
CAUSATIVE MECHANISMS, AND THINGS

4201
02:38:41,760 --> 02:38:43,600
LIKE THAT.

4202
02:38:43,600 --> 02:38:46,040
FOR EXAMPLE, IT MAY OR MAY NOT

4203
02:38:46,040 --> 02:38:48,680
BE TRUE THAT PEOPLE FROM

4204
02:38:48,680 --> 02:38:49,480
DIFFERENT SOCIOECONOMIC GROUPS

4205
02:38:49,480 --> 02:38:52,280
DO OR DO NOT HAVE ACCESS TO

4206
02:38:52,280 --> 02:38:54,760
REHAB OR MAY OR MAY NOT BE

4207
02:38:54,760 --> 02:38:57,960
TAKING MEDICATIONS BECAUSE OF

4208
02:38:57,960 --> 02:39:01,000
FINANCIAL ISSUES OR RACIAL

4209
02:39:01,000 --> 02:39:02,160
ISSUES OR ETHNIC ISSUES.

4210
02:39:02,160 --> 02:39:03,240
I THINK WE'RE LOOKING FOR

4211
02:39:03,240 --> 02:39:05,560
OPPORTUNITIES TO TAKE IT TO THE

4212
02:39:05,560 --> 02:39:08,400
NEXT STEP BEYOND THIS GROUP

4213
02:39:08,400 --> 02:39:10,600
DOESN'T GET THIS TYPE OF

4214
02:39:10,600 --> 02:39:12,240
MEDICATION, WHICH IS ASSOCIATION

4215
02:39:12,240 --> 02:39:13,240
INTO CAUSATIVE FACTORS.

4216
02:39:13,240 --> 02:39:15,720
SO I WONDER IF YOU HAD ANY

4217
02:39:15,720 --> 02:39:18,040
THOUGHTS ON THAT, FROM YOUR

4218
02:39:18,040 --> 02:39:19,240
REVIEW OF THE LITERATURE IF

4219
02:39:19,240 --> 02:39:21,080
THERE WAS ANYTHING PUBLISHED ON

4220
02:39:21,080 --> 02:39:22,400
THAT IN THE LITERATURE?

4221
02:39:22,400 --> 02:39:24,040
>> THAT'S A GREAT QUESTION,

4222
02:39:24,040 --> 02:39:24,360
MARK.

4223
02:39:24,360 --> 02:39:26,880
AND, YOU KNOW, WHAT EXISTS IS

4224
02:39:26,880 --> 02:39:29,240
PRETTY SUPERFICIAL.

4225
02:39:29,240 --> 02:39:32,120
IT MAINLY IS OBSERVATIONAL.

4226
02:39:32,120 --> 02:39:36,080
AND IT'S NOT CLEAR THAT PEOPLE

4227
02:39:36,080 --> 02:39:43,080
EITHER RECEIVE OR DO NOT RECEIVE

4228
02:39:43,080 --> 02:39:44,320
TESTS, INTERVENTIONS, OR

4229
02:39:44,320 --> 02:39:45,600
MEDICATIONS BASED ON

4230
02:39:45,600 --> 02:39:45,880
ELIGIBILITY.

4231
02:39:45,880 --> 02:39:49,720
IN OTHER WORDS, IF THERE ARE

4232
02:39:49,720 --> 02:39:51,920
DISPARITIES, IS IT BECAUSE THEY

4233
02:39:51,920 --> 02:39:54,120
ARE NOT BEING OFFERED, WHATEVER

4234
02:39:54,120 --> 02:39:55,680
IT IS?

4235
02:39:55,680 --> 02:39:57,280
THE INTERVENTION?

4236
02:39:57,280 --> 02:40:00,640
OR IS IT THAT THEY DON'T MEET

4237
02:40:00,640 --> 02:40:03,040
THE CRITERIA TO ACTUALLY BE

4238
02:40:03,040 --> 02:40:05,120
ELIGIBLE FOR THAT TEST OR

4239
02:40:05,120 --> 02:40:05,680
PROCEDURE?

4240
02:40:05,680 --> 02:40:07,480
AND THERE'S REALLY NOTHING THAT

4241
02:40:07,480 --> 02:40:09,240
HELPS TEASE THAT OUT.

4242
02:40:09,240 --> 02:40:11,080
AND OUR GROUP, YOU KNOW, WAS

4243
02:40:11,080 --> 02:40:12,480
REALLY INTERESTED IN THIS.

4244
02:40:12,480 --> 02:40:15,080
AND ACTUALLY ONE OF OUR GROUP

4245
02:40:15,080 --> 02:40:19,240
MEMBERS WENT AND DIPPED INTO ONE

4246
02:40:19,240 --> 02:40:20,240
OF THE INSURANCE DATABASES, TO

4247
02:40:20,240 --> 02:40:23,320
TRY AND GET AT THIS INFORMATION.

4248
02:40:23,320 --> 02:40:25,080
BUT IT REALLY DOESN'T -- AGAIN,

4249
02:40:25,080 --> 02:40:28,680
YOU CAN LOOK AT THE DEMOGRAPHICS

4250
02:40:28,680 --> 02:40:30,320
OR THE GEOGRAPHY, AND IDENTIFY

4251
02:40:30,320 --> 02:40:32,720
THAT THERE MAY BE REGIONAL

4252
02:40:32,720 --> 02:40:33,920
DIFFERENCES, BUT IT'S REALLY

4253
02:40:33,920 --> 02:40:35,720
HARD FROM WHAT EXISTS CURRENTLY

4254
02:40:35,720 --> 02:40:38,200
TO SAY, YEP, THE FOLKS WHO ARE

4255
02:40:38,200 --> 02:40:40,080
BEING -- NOT BEING TREATED OR

4256
02:40:40,080 --> 02:40:41,200
NOT BEING STUDIED REALLY OUGHT

4257
02:40:41,200 --> 02:40:42,480
TO BE.

4258
02:40:42,480 --> 02:40:46,320
AND THAT'S WHERE STANDARDIZING

4259
02:40:46,320 --> 02:40:48,200
PROTOCOLS WITHIN THE HOSPITAL

4260
02:40:48,200 --> 02:40:50,600
MAY HELP ELIMINATE THIS, THAT

4261
02:40:50,600 --> 02:40:53,120
WHETHER, YOU KNOW, REGARDLESS OF

4262
02:40:53,120 --> 02:40:53,840
DEMOGRAPHICS, WHERE ARE YOU IN

4263
02:40:53,840 --> 02:40:55,520
THE UNITED STATES, YOUR CARE IS

4264
02:40:55,520 --> 02:40:56,960
GOING TO FOLLOW THAT PRESCRIBED

4265
02:40:56,960 --> 02:40:57,320
ALGORITHM.

4266
02:40:57,320 --> 02:40:59,680
AND YOU WILL NOT BE DENIED

4267
02:40:59,680 --> 02:41:03,040
EVIDENCE-BASED CARE.

4268
02:41:03,040 --> 02:41:04,480
>> SO, I WOULD JUST COMMENT

4269
02:41:04,480 --> 02:41:05,720
ADDITIONALLY, FIRST OF ALL, I

4270
02:41:05,720 --> 02:41:06,440
AGREE COMPLETELY, KAREN.

4271
02:41:06,440 --> 02:41:08,640
I AGREE WITH YOU, MARK, THAT'S

4272
02:41:08,640 --> 02:41:10,360
REALLY WHAT WE NEED TO GET TO,

4273
02:41:10,360 --> 02:41:12,240
IN ADDITION TO THE FACT THAT

4274
02:41:12,240 --> 02:41:16,080
THERE ARE DISPARITIES, WHAT THE

4275
02:41:16,080 --> 02:41:18,160
CAUSE OF THE DISPARITIES IS.

4276
02:41:18,160 --> 02:41:20,880
I WAS SURPRISED THAT WE DIDN'T

4277
02:41:20,880 --> 02:41:24,840
FIND MORE INFORMATION ABOUT

4278
02:41:24,840 --> 02:41:25,480
IN-HOSPITAL DISPARITIES, BECAUSE

4279
02:41:25,480 --> 02:41:26,880
OF ALL THE THREE AREAS WE'RE

4280
02:41:26,880 --> 02:41:29,640
TALKING ABOUT THAT'S THE AREA

4281
02:41:29,640 --> 02:41:30,640
WHERE THE MOST INFORMATION

4282
02:41:30,640 --> 02:41:32,240
SHOULD BE AVAILABLE.

4283
02:41:32,240 --> 02:41:34,880
YOU KNOW, EMRs ARE EVERYWHERE.

4284
02:41:34,880 --> 02:41:37,640
AND THEY HAVE VERY RICH

4285
02:41:37,640 --> 02:41:39,040
INFORMATION BASE IN THEM THAT

4286
02:41:39,040 --> 02:41:41,240
SHOULD ALLOW US TO KIND OF DIG

4287
02:41:41,240 --> 02:41:42,240
INTO THIS.

4288
02:41:42,240 --> 02:41:45,080
NOW, EXACTLY HOW TO PUT THAT

4289
02:41:45,080 --> 02:41:46,400
TOGETHER IS A DIFFICULT RESEARCH

4290
02:41:46,400 --> 02:41:47,360
QUESTION I THINK, BUT THERE

4291
02:41:47,360 --> 02:41:49,960
SHOULD BE QUITE A BIT OF BASIC

4292
02:41:49,960 --> 02:41:51,200
INFORMATION THAT WOULD ALLOW US

4293
02:41:51,200 --> 02:41:52,040
TO STUDY THIS.

4294
02:41:52,040 --> 02:41:54,480
NOW, OF COURSE THERE ARE

4295
02:41:54,480 --> 02:41:57,400
BARRIERS BECAUSE EVERYONE'S GOT

4296
02:41:57,400 --> 02:41:59,880
DIFFERENT EMRs, EMRs DON'T

4297
02:41:59,880 --> 02:42:01,080
TALK TO EACH OTHER, HIPAA

4298
02:42:01,080 --> 02:42:03,280
ISSUES, THAT SORT OF THING, BUT

4299
02:42:03,280 --> 02:42:06,120
I BET THERE'S INFORMATION

4300
02:42:06,120 --> 02:42:07,880
AVAILABLE OUT THERE GIVEN THE

4301
02:42:07,880 --> 02:42:08,960
PREVALENCE OF EMRs THAT WOULD

4302
02:42:08,960 --> 02:42:10,280
ALLOW US TO ADDRESS THIS IF WE

4303
02:42:10,280 --> 02:42:11,560
COULD FIGURE OUT A WAY TO MINE

4304
02:42:11,560 --> 02:42:15,400
IT.

4305
02:42:15,400 --> 02:42:17,280
>> WELL, I THINK THE GUIDELINES

4306
02:42:17,280 --> 02:42:25,560
DATABASE HAS EVERYBODY KNOW HAS

4307
02:42:25,560 --> 02:42:26,800
BAZILLIONS OF DATA POINTS, THAT

4308
02:42:26,800 --> 02:42:36,920
CAPTURES AT LEAST A PICTURE OF

4309
02:42:36,920 --> 02:42:38,400
IN-HOSPITAL CARE.

4310
02:42:38,400 --> 02:42:40,600
>> I DON'T ABOUT SOCIOECONOMIC

4311
02:42:40,600 --> 02:42:42,560
STATUS, ZIP CODES, WHERE PEOPLE

4312
02:42:42,560 --> 02:42:43,960
LIVE AND THE KIND OF STUFF THAT

4313
02:42:43,960 --> 02:42:48,240
YOU MIGHT NEED TO GET TO THIS.

4314
02:42:48,240 --> 02:42:49,680
I THINK THAT, GETTING WITH THE

4315
02:42:49,680 --> 02:42:52,080
GUIDELINES MIGHT BE A GOOD START

4316
02:42:52,080 --> 02:42:55,680
BUT THE EMR WOULD HAVE SUCH A

4317
02:42:55,680 --> 02:42:56,240
RICH DEPTH OF INFORMATION TO

4318
02:42:56,240 --> 02:42:58,800
HELP US IF WE COULD GET TO THAT

4319
02:42:58,800 --> 02:43:01,080
INFORMATION SOMEHOW.

4320
02:43:01,080 --> 02:43:05,080
>> I WANT TO SHARE THAT THE

4321
02:43:05,080 --> 02:43:08,320
REFERRALS WE DO, FOR EXAMPLE,

4322
02:43:08,320 --> 02:43:12,360
THE REHAB, THERE IS CLEAR

4323
02:43:12,360 --> 02:43:14,920
DISPARITIES THERE WHERE, YOU

4324
02:43:14,920 --> 02:43:18,840
KNOW, FEMALE, OLDER, AFRICAN

4325
02:43:18,840 --> 02:43:20,480
AMERICAN, UNINSURED PEOPLE ARE

4326
02:43:20,480 --> 02:43:24,080
LESS LIKELY TO GO TO ACUTE

4327
02:43:24,080 --> 02:43:24,480
REHAB.

4328
02:43:24,480 --> 02:43:30,200
THEY ARE MOST LIKELY UTILIZE

4329
02:43:30,200 --> 02:43:31,960
SKILLED FACILITIES, AND ALSO

4330
02:43:31,960 --> 02:43:33,800
PEOPLE WHO ARE LIVING NEXT --

4331
02:43:33,800 --> 02:43:37,400
CLOSE TO THE REHAB FACILITIES,

4332
02:43:37,400 --> 02:43:39,080
ACUTE REHAB, MALES AND

4333
02:43:39,080 --> 02:43:40,680
CAUCASIANS, THEY ARE MORE LIKELY

4334
02:43:40,680 --> 02:43:42,880
TO GET TO THE ACUTE REHAB AFTER

4335
02:43:42,880 --> 02:43:44,200
THE STROKE.

4336
02:43:44,200 --> 02:43:45,800
I WANT TO SHARE THAT PIECE OF

4337
02:43:45,800 --> 02:43:51,480
INFORMATION THAT IS THERE.

4338
02:43:51,480 --> 02:43:52,280
 

4339
02:43:52,280 --> 02:43:54,480
>> THANK YOU.

4340
02:43:54,480 --> 02:43:55,480
>> GO AHEAD, RICHARD.

4341
02:43:55,480 --> 02:43:56,240
>> THAT'S A GREAT POINT.

4342
02:43:56,240 --> 02:43:59,080
SORT OF ONE OF THE QUESTIONS I

4343
02:43:59,080 --> 02:43:59,400
HAD.

4344
02:43:59,400 --> 02:44:00,560
KAREN MAY HAVE ANSWERED IT AS

4345
02:44:00,560 --> 02:44:05,200
WELL IN TERMS OF THE REFERRALS

4346
02:44:05,200 --> 02:44:07,600
TO THE SKILLED NURSING

4347
02:44:07,600 --> 02:44:10,080
FACILITIES VERSUS REHAB, WAS IT

4348
02:44:10,080 --> 02:44:13,440
RELATED TO INSURANCE STATUS.

4349
02:44:13,440 --> 02:44:15,520
ONE POINT TO WHAT YOU WERE

4350
02:44:15,520 --> 02:44:18,760
SAYING, LARRY, IN TERMS OF THE

4351
02:44:18,760 --> 02:44:22,200
EHR, I WORKED ON WITH THE

4352
02:44:22,200 --> 02:44:22,840
REGISTRIES COMMITTEE THROUGH THE

4353
02:44:22,840 --> 02:44:26,200
AMERICAN ACADEMY OF NEUROLOGY,

4354
02:44:26,200 --> 02:44:28,880
THEY HAVE THE AXON REGISTRY, WE

4355
02:44:28,880 --> 02:44:30,640
WERE LOOKING THROUGH THAT

4356
02:44:30,640 --> 02:44:33,360
DATABASE TO SEE IF WE COULD FIND

4357
02:44:33,360 --> 02:44:34,880
DISPARITIES IN CARE.

4358
02:44:34,880 --> 02:44:36,880
YOU KNOW, THAT'S PURELY

4359
02:44:36,880 --> 02:44:37,960
OUTPATIENT SO DOESN'T INCLUDE

4360
02:44:37,960 --> 02:44:39,360
STROKE.

4361
02:44:39,360 --> 02:44:42,560
WHAT THEY FOUND WAS THAT THE

4362
02:44:42,560 --> 02:44:45,360
RACE AND ETHNIC DATA, A LOT OF

4363
02:44:45,360 --> 02:44:47,480
EHRs WAS INCORRECT, WASN'T

4364
02:44:47,480 --> 02:44:48,080
OBTAINED CORRECTLY.

4365
02:44:48,080 --> 02:44:49,960
SO THIS IS AN ISSUE, THIS IS

4366
02:44:49,960 --> 02:44:51,280
SOMETHING THAT WE'RE GOING TO

4367
02:44:51,280 --> 02:44:56,760
SORT OF TALK ABOUT AT THE 

4368
02:44:56,760 --> 02:44:58,320
UPCOMING AAN MEETING BUT A LOT

4369
02:44:58,320 --> 02:45:00,520
OF INFORMATION IS NOT COLLECTED

4370
02:45:00,520 --> 02:45:01,280
CORRECTLY.

4371
02:45:01,280 --> 02:45:04,240
EHR SHOULD BE A RICH SOURCE BUT

4372
02:45:04,240 --> 02:45:06,120
WE HAVE TO DO TRAINING WHY IT'S

4373
02:45:06,120 --> 02:45:07,320
IMPORTANT TO COLLECT THIS

4374
02:45:07,320 --> 02:45:08,000
INFORMATION.

4375
02:45:08,000 --> 02:45:10,960
THERE IS A MISTRUST WE KNOW WITH

4376
02:45:10,960 --> 02:45:12,160
CERTAIN GROUPS CONCERNED ABOUT

4377
02:45:12,160 --> 02:45:13,240
CITIZENSHIP STATUS AND HOW THAT

4378
02:45:13,240 --> 02:45:15,080
INFORMATION IS GOING TO BE USED

4379
02:45:15,080 --> 02:45:19,080
IN TERMS OF GIVING RACE AND

4380
02:45:19,080 --> 02:45:20,240
ETHNIC DATA.

4381
02:45:20,240 --> 02:45:21,240
THERE ARE CHALLENGES IN

4382
02:45:21,240 --> 02:45:23,320
COLLECTING THAT BUT THAT CREATES

4383
02:45:23,320 --> 02:45:24,600
UNFORTUNATELY A BARRIER TO USING

4384
02:45:24,600 --> 02:45:25,720
THAT TYPE OF RESOURCE RIGHT NOW

4385
02:45:25,720 --> 02:45:29,240
TO GET SOME OF THAT INFORMATION.

4386
02:45:29,240 --> 02:45:34,320
THE OTHER THING I WANTED TO

4387
02:45:34,320 --> 02:45:37,160
MENTION, THIS THEME OF

4388
02:45:37,160 --> 02:45:38,680
TRANSITION OF CARE, PRE-HOSPITAL

4389
02:45:38,680 --> 02:45:41,480
STROKE SYSTEM, IT WOULD BE GREAT

4390
02:45:41,480 --> 02:45:44,440
IF, YOU KNOW,

4391
02:45:44,440 --> 02:45:45,080
POST-HOSPITALIZATION, POST-ACUTE

4392
02:45:45,080 --> 02:45:45,880
HOSPITALIZATION, IF THERE WAS

4393
02:45:45,880 --> 02:45:47,920
ANOTHER WAY FOR THAT TRANSITION

4394
02:45:47,920 --> 02:45:48,120
PIECE.

4395
02:45:48,120 --> 02:45:50,760
WE KNOW TRANSITIONS OF CARE ARE

4396
02:45:50,760 --> 02:45:51,800
ALSO DIFFICULT, BUT SORT OF

4397
02:45:51,800 --> 02:45:52,840
FOLLOWING UP ON PEOPLE.

4398
02:45:52,840 --> 02:45:55,800
THIS COULD BE DONE THROUGH THE

4399
02:45:55,800 --> 02:45:56,760
MEDICAL CENTER, FOLLOWING THEM

4400
02:45:56,760 --> 02:46:01,040
UP IN TERMS OF GOING TO AN ACUTE

4401
02:46:01,040 --> 02:46:04,120
CARE, SUBACUTE OR SKILLED

4402
02:46:04,120 --> 02:46:05,160
NURSING FACILITY, OR HOME.

4403
02:46:05,160 --> 02:46:06,880
SORT OF CLOSING THAT LOOP AND

4404
02:46:06,880 --> 02:46:09,200
TYING THAT BACK INTO THIS SORT

4405
02:46:09,200 --> 02:46:12,280
OF PRE-HOSPITAL STROKE SYSTEM WE

4406
02:46:12,280 --> 02:46:14,680
TALKED ABOUT BUT I THINK, AGAIN,

4407
02:46:14,680 --> 02:46:16,200
IT'S THE CONCEPT OF TYING THE

4408
02:46:16,200 --> 02:46:17,240
HOSPITAL TO THE COMMUNITY IN

4409
02:46:17,240 --> 02:46:19,480
SOME KIND OF WAY, THAT MAY BE

4410
02:46:19,480 --> 02:46:21,760
HELPFUL FOR THAT TRANSITION OF

4411
02:46:21,760 --> 02:46:22,280
CARE, PRE-HOSPITAL, EVEN

4412
02:46:22,280 --> 02:46:26,920
POST-HOSPITAL.

4413
02:46:26,920 --> 02:46:27,080
 

4414
02:46:27,080 --> 02:46:31,320
>> THOSE POINTS, RICHARD, I KNOW

4415
02:46:31,320 --> 02:46:33,200
THERE'S A PCORI PCRI PATIENT

4416
02:46:33,200 --> 02:46:35,880
CENTERED OUTSOME RESEARCH, THERE

4417
02:46:35,880 --> 02:46:44,800
ARE NUMBER OF GRANTS WHERE

4418
02:46:44,800 --> 02:46:45,680
PARTICIPATING CENTERS GET

4419
02:46:45,680 --> 02:46:46,680
RANDOMIZED WITH NURSES AND

4420
02:46:46,680 --> 02:46:48,840
PEOPLE VISITING THE HOME, JUST

4421
02:46:48,840 --> 02:46:51,240
TO SEE IF PATIENTS' RISK FACTORS

4422
02:46:51,240 --> 02:46:54,640
ARE ADDRESSED, THE CONTROL GROUP

4423
02:46:54,640 --> 02:46:56,240
IS -- THEY DO WHATEVER THEY

4424
02:46:56,240 --> 02:46:58,520
WOULD NORMALLY DO, THAT'S BEING

4425
02:46:58,520 --> 02:46:59,640
FOLLOWED, ONE-YEAR FOLLOW-UP,

4426
02:46:59,640 --> 02:47:01,160
MAY BE EXTENDED, BUT THAT'S A

4427
02:47:01,160 --> 02:47:01,960
GREAT IDEA.

4428
02:47:01,960 --> 02:47:04,040
THE OTHER THING IS MORE AND MORE

4429
02:47:04,040 --> 02:47:08,160
MEDICAL CENTERS ARE USING 

4430
02:47:08,160 --> 02:47:11,000
PROVIDERS THAT WE CALL NURSE

4431
02:47:11,000 --> 02:47:12,960
NAVIGATORS TO NAVIGATE BETWEEN

4432
02:47:12,960 --> 02:47:13,880
INPATIENT, GOING TO OUTPATIENT

4433
02:47:13,880 --> 02:47:16,480
ARENA TO MAKE SURE MEDS GET

4434
02:47:16,480 --> 02:47:17,800
FOLLOWED UP, OUTPATIENT

4435
02:47:17,800 --> 02:47:21,520
FOLLOW-UP OR IMAGING STUDIES, 

4436
02:47:21,520 --> 02:47:23,920
WHATEVER NEED GETS DONE, AS PART

4437
02:47:23,920 --> 02:47:27,560
OF ROUTINE CARE, NOT PART OF A

4438
02:47:27,560 --> 02:47:28,880
STUDY.

4439
02:47:28,880 --> 02:47:32,240
WE TAKE ALL COMERS, ELIGIBLE TO

4440
02:47:32,240 --> 02:47:34,760
MAKE USE OF NURSE NAVIGATOR, GET

4441
02:47:34,760 --> 02:47:35,960
CONTACTED AND GET FOLLOW-UP

4442
02:47:35,960 --> 02:47:39,240
PHONE CALLS, ALL GREAT IDEAS TO

4443
02:47:39,240 --> 02:47:43,400
EXTEND IN-HOSPITAL CARE INTO THE

4444
02:47:43,400 --> 02:47:44,280
OUTPATIENT ARENA.

4445
02:47:44,280 --> 02:47:46,400
>> I THINK TO SOME AGREE YOU

4446
02:47:46,400 --> 02:47:47,480
MAKE GOOD POINTS, RICHARD.

4447
02:47:47,480 --> 02:47:49,440
THEY ARE VERY IMPORTANT POINTS

4448
02:47:49,440 --> 02:47:51,080
IN TERMS OF PATIENT CARE.

4449
02:47:51,080 --> 02:47:53,640
AND TO SOME DEGREE IT'S AN

4450
02:47:53,640 --> 02:47:57,960
ARTIFACT OF THE WAY OUR MEDICAL

4451
02:47:57,960 --> 02:48:03,880
ECONOMICS IN COUNTRY IS SET UP.

4452
02:48:03,880 --> 02:48:04,840
THE HOSPITALS, FINANCES FOR THE

4453
02:48:04,840 --> 02:48:05,920
MOST PART ARE NOT DEPENDENT ON

4454
02:48:05,920 --> 02:48:07,120
WHAT HAPPENS TO THE PATIENT

4455
02:48:07,120 --> 02:48:10,240
AFTER THEY LEAVE THE HOSPITAL

4456
02:48:10,240 --> 02:48:11,880
EXCEPT THAT NOW CMS IS TRYING TO

4457
02:48:11,880 --> 02:48:14,680
CHANGE THAT BY LOOKING AT THINGS

4458
02:48:14,680 --> 02:48:15,480
LIKE 30-DAY READMISSIONS, AS

4459
02:48:15,480 --> 02:48:18,680
THEY DO THAT MORE HOSPITALS ARE 

4460
02:48:18,680 --> 02:48:22,160
GETTING INTO THE BUSINESS OF

4461
02:48:22,160 --> 02:48:22,840
DOING APPROPRIATE POST-DISCHARGE

4462
02:48:22,840 --> 02:48:24,480
FOLLOW-UP TO MAKE SURE THAT

4463
02:48:24,480 --> 02:48:24,960
PEOPLE UNDERSTAND WHAT

4464
02:48:24,960 --> 02:48:25,960
MEDICATIONS THEY ARE SUPPOSED TO

4465
02:48:25,960 --> 02:48:27,920
BE ON AND WHAT TESTS THEY ARE

4466
02:48:27,920 --> 02:48:28,840
SUPPOSED TO GET, AND THE FACT

4467
02:48:28,840 --> 02:48:31,080
THAT THEY ARE SUPPOSED TO GET

4468
02:48:31,080 --> 02:48:34,880
FOLLOW-UP APPOINTMENTS AND SEE

4469
02:48:34,880 --> 02:48:36,040
THEIR DOCTOR.

4470
02:48:36,040 --> 02:48:37,560
I HATE TO BE CYNICAL BUT IT HAS

4471
02:48:37,560 --> 02:48:40,960
TO DO WITH THE FACT THEY GET

4472
02:48:40,960 --> 02:48:41,440
PENALIZED FOR 30-DAY

4473
02:48:41,440 --> 02:48:42,720
READMISSIONS SO THEY ARE TRYING

4474
02:48:42,720 --> 02:48:44,000
TO KEEP PEOPLE FROM COMING BACK

4475
02:48:44,000 --> 02:48:45,560
TO THE HOSPITAL.

4476
02:48:45,560 --> 02:48:46,240
UNFORTUNATELY, THAT FORCES

4477
02:48:46,240 --> 02:48:48,600
PEOPLE TO DO THE RIGHT THING.

4478
02:48:48,600 --> 02:48:50,800
BUT I THINK WE COULD DO A WHOLE

4479
02:48:50,800 --> 02:48:54,520
LOT MORE IN THAT REGARD, I THINK

4480
02:48:54,520 --> 02:48:55,200
WHEN PATIENTS ARE DISCHARGED

4481
02:48:55,200 --> 02:48:58,080
FROM THE HOSPITAL IT'S A

4482
02:48:58,080 --> 02:48:58,680
CONFUSING SITUATION.

4483
02:48:58,680 --> 02:49:00,640
MOST JUST WANT TO GET OUT AND

4484
02:49:00,640 --> 02:49:02,600
DON'T LISTEN WHEN PEOPLE REVIEW

4485
02:49:02,600 --> 02:49:03,480
MEDICATIONS AND APPOINTMENTS AND

4486
02:49:03,480 --> 02:49:06,880
THAT SORT OF THING.

4487
02:49:06,880 --> 02:49:09,200
AND SO ALL OF THESE, TO TRY TO

4488
02:49:09,200 --> 02:49:14,240
PULL THE SYSTEM TOGETHER IN THE 

4489
02:49:14,240 --> 02:49:16,080
WAYS YOU'RE TALKING ABOUT, PRE

4490
02:49:16,080 --> 02:49:18,680
AND POST HOSPITAL, ACUTE

4491
02:49:18,680 --> 02:49:20,160
HOSPITAL EVENT, THAT IS THE WAY

4492
02:49:20,160 --> 02:49:23,880
TO GO IN TERMS OF POPULATION

4493
02:49:23,880 --> 02:49:25,720
HEALTH AND I THINK INSURANCE

4494
02:49:25,720 --> 02:49:27,240
COMPANIES ARE INTERESTED IN

4495
02:49:27,240 --> 02:49:28,240
THAT, HOPEFULLY HOSPITALS WILL

4496
02:49:28,240 --> 02:49:31,160
BECOME MORE INTERESTED AS WELL.

4497
02:49:31,160 --> 02:49:33,600
 

4498
02:49:33,600 --> 02:49:36,640
>> YEAH, IT'S NOT EVEN CLEAR

4499
02:49:36,640 --> 02:49:38,480
WHAT HOSPITALIZATION LOOKS LIKE

4500
02:49:38,480 --> 02:49:40,480
FOR DIFFERENT GROUPS.

4501
02:49:40,480 --> 02:49:42,280
ARE THESE 36-HOUR ADMISSIONS

4502
02:49:42,280 --> 02:49:45,520
WITH A LOT OF THE FOLLOW-UP

4503
02:49:45,520 --> 02:49:48,200
INTENDED TO BE DONE ON AN

4504
02:49:48,200 --> 02:49:49,680
OUTPATIENT BASIS AND MAY OR MAY

4505
02:49:49,680 --> 02:49:52,640
NOT GET DONE, OR ARE THERE

4506
02:49:52,640 --> 02:49:53,920
INDIVIDUALS OR AREAS WHERE

4507
02:49:53,920 --> 02:49:55,680
PATIENTS STAY IN THE HOSPITAL

4508
02:49:55,680 --> 02:49:58,720
FOR THREE OR FOUR DAYS BUT HAVE

4509
02:49:58,720 --> 02:50:01,480
MORE OF THE DIAGNOSTICS AND

4510
02:50:01,480 --> 02:50:03,280
POTENTIALLY EVEN INTERVENTION

4511
02:50:03,280 --> 02:50:04,920
PERFORMED DURING THAT INDEX

4512
02:50:04,920 --> 02:50:05,280
HOSPITALIZATION.

4513
02:50:05,280 --> 02:50:08,000
AND WE DIDN'T FIND ANYTHING IN

4514
02:50:08,000 --> 02:50:10,720
THE LITERATURE THAT HELPED

4515
02:50:10,720 --> 02:50:13,880
CATEGORIZE HOW THAT MIGHT VARY

4516
02:50:13,880 --> 02:50:15,680
BY THE DIFFERENT CROSS-CUTTING

4517
02:50:15,680 --> 02:50:17,000
PARAMETERS OR HOW IT WOULD

4518
02:50:17,000 --> 02:50:22,960
IMPACT OUTCOME.

4519
02:50:22,960 --> 02:50:23,640
 

4520
02:50:23,640 --> 02:50:26,240
>> SOMETIMES -- THESE ARE GREAT

4521
02:50:26,240 --> 02:50:26,680
POINTS.

4522
02:50:26,680 --> 02:50:28,320
SOMETIMES UNDER THE RUBRIC OF

4523
02:50:28,320 --> 02:50:29,440
UNINTENDED CONSEQUENCES, MANY OF

4524
02:50:29,440 --> 02:50:31,240
YOU KNOW THIS, IN CASE SOME

4525
02:50:31,240 --> 02:50:32,840
DON'T, WHILE WE THINK ADMITTING

4526
02:50:32,840 --> 02:50:34,440
THE PATIENT TO THE OBSERVATION

4527
02:50:34,440 --> 02:50:37,200
UNIT BECAUSE IT'S GOING TO BE A

4528
02:50:37,200 --> 02:50:38,400
47-HOUR STAY, THIS IS A GOOD

4529
02:50:38,400 --> 02:50:40,280
THING AND GOOD FOR THE HOSPITAL.

4530
02:50:40,280 --> 02:50:42,600
IT MAY BE GOOD FOR THE HOSPITAL.

4531
02:50:42,600 --> 02:50:44,760
BUT IN MANY CASES IT MAY BE BAD

4532
02:50:44,760 --> 02:50:46,280
FOR THE PATIENT BECAUSE THEY ARE

4533
02:50:46,280 --> 02:50:48,040
NEVER ADMITTED, THEY ARE NOT

4534
02:50:48,040 --> 02:50:50,120
UNDER THAT HOSPITAL DRG AND GET

4535
02:50:50,120 --> 02:50:52,720
STUCK WITH A HUGE BILL FOR ALL

4536
02:50:52,720 --> 02:50:54,760
OF THESE OUTPATIENT IMAGING AND

4537
02:50:54,760 --> 02:50:59,160
ECHOES AND BLOOD WORK.

4538
02:50:59,160 --> 02:51:01,120
SO THAT SOMETIMES WORKS AT

4539
02:51:01,120 --> 02:51:03,080
CROSS-PURPOSES, WHAT'S GOOD FOR

4540
02:51:03,080 --> 02:51:04,160
THE HOSPITAL, THE PATIENTS GET

4541
02:51:04,160 --> 02:51:07,480
SOCKED WITH A HUGE BILL, THAT

4542
02:51:07,480 --> 02:51:09,520
MAY DISINCENTIVIZE THEM TO GET

4543
02:51:09,520 --> 02:51:10,520
FURTHER CARE.

4544
02:51:10,520 --> 02:51:14,680
IF CERTAIN GROUPS ARE IMPACTED 

4545
02:51:14,680 --> 02:51:15,760
MORE, FINANCIALLY DISADVANTAGED,

4546
02:51:15,760 --> 02:51:18,280
MAY FURTHER REINFORCE THE NOTION

4547
02:51:18,280 --> 02:51:19,480
I'M NOT DOING THIS AGAIN BECAUSE

4548
02:51:19,480 --> 02:51:21,480
I GOT SOCKED WITH A $30,000 BILL

4549
02:51:21,480 --> 02:51:24,640
FOR A SCAN AND BLOOD TESTS.

4550
02:51:24,640 --> 02:51:25,480
THAT'S ANOTHER IMPORTANT

4551
02:51:25,480 --> 02:51:29,440
CROSS-CUTTING THING IN TERMS OF

4552
02:51:29,440 --> 02:51:30,440
ECONOMICS AND RESOURCES.

4553
02:51:30,440 --> 02:51:34,400
>> THERE ARE A COUPLE OF 

4554
02:51:34,400 --> 02:51:38,400
COMMENTS IN THE CHAT.

4555
02:51:38,400 --> 02:51:42,240
STEPHANIE ASKS A QUESTION, DR.

4556
02:51:42,240 --> 02:51:45,920
DENNY RESPONDS, ARE HOSPITAL

4557
02:51:45,920 --> 02:51:46,600
CONDUCTING SOCIAL NEEDS

4558
02:51:46,600 --> 02:51:52,840
ASSESSMENTS AND IF NOT HOW COULD

4559
02:51:52,840 --> 02:51:55,880
WE INCENTIVIZE.

4560
02:51:55,880 --> 02:51:56,880
DR. DENNY, IF YOU WANT TO

4561
02:51:56,880 --> 02:51:59,880
RESPOND.

4562
02:51:59,880 --> 02:52:06,800
 

4563
02:52:06,800 --> 02:52:09,200
IT'S MENTIONED IN THE CHAT AT

4564
02:52:09,200 --> 02:52:10,840
MEDSTAR THEY DO HAVE THE SOCIAL

4565
02:52:10,840 --> 02:52:13,680
WORKERS THAT DO THE NEEDS

4566
02:52:13,680 --> 02:52:14,680
ASSESSMENT PRIOR TO PATIENT

4567
02:52:14,680 --> 02:52:17,520
DISCHARGE, BUT I THINK IT'S A

4568
02:52:17,520 --> 02:52:18,680
VERY IMPORTANT POINT.

4569
02:52:18,680 --> 02:52:20,960
AND THIS GOES BACK IN TERMS OF

4570
02:52:20,960 --> 02:52:23,080
TYING THE HOSPITAL TO THE

4571
02:52:23,080 --> 02:52:24,480
COMMUNITY, AND COMPLIANCE.

4572
02:52:24,480 --> 02:52:25,840
WE KNOW SOCIAL DETERMINANTS OF

4573
02:52:25,840 --> 02:52:27,040
HEALTH ARE SO IMPORTANT AND SO

4574
02:52:27,040 --> 02:52:29,520
PEOPLE HAVE ALL KIND OF

4575
02:52:29,520 --> 02:52:30,680
COMPETING NEEDS, AND IF YOU'RE

4576
02:52:30,680 --> 02:52:33,680
DEALING WITH HOUSING AND FOOD

4577
02:52:33,680 --> 02:52:35,080
INSECURITY, THEN TAKING YOUR

4578
02:52:35,080 --> 02:52:36,440
ANTIPLATELET AGENT AND STATIN

4579
02:52:36,440 --> 02:52:43,200
AGENT IS PROBLEM  -- PROBABLY AT

4580
02:52:43,200 --> 02:52:44,600
THE BOTTOM OF YOUR PRIORITY

4581
02:52:44,600 --> 02:52:44,840
LIST.

4582
02:52:44,840 --> 02:52:46,160
IT MAY BE IMPORTANT TO ASSESS

4583
02:52:46,160 --> 02:52:48,560
NEEDS PEOPLE HAVE BEFORE THEY

4584
02:52:48,560 --> 02:52:51,400
LEAVE THE HOSPITAL AND

4585
02:52:51,400 --> 02:52:52,240
INCORPORATING THIS INTO THE CARE

4586
02:52:52,240 --> 02:52:54,680
PLAN.

4587
02:52:54,680 --> 02:53:00,160
 

4588
02:53:00,160 --> 02:53:01,360
>> KAREN AND LARRY, A COMMON

4589
02:53:01,360 --> 02:53:04,080
THEME I HEARD, WE'VE HEARD IT

4590
02:53:04,080 --> 02:53:06,600
BEFORE, THAT ACCESS TO INPATIENT

4591
02:53:06,600 --> 02:53:08,680
REHAB AFTER STROKE IS VERY

4592
02:53:08,680 --> 02:53:12,080
PROBLEMATIC BECAUSE IT'S VERY

4593
02:53:12,080 --> 02:53:13,480
EXPENSIVE AND RESOURCE INTENSE

4594
02:53:13,480 --> 02:53:14,800
AND SOME PLACES DON'T OFFER IT.

4595
02:53:14,800 --> 02:53:17,880
AS WE KNOW THIS CAN BE UP TO

4596
02:53:17,880 --> 02:53:20,840
THREE WEEKS AND CAN COST TENS OF

4597
02:53:20,840 --> 02:53:23,120
THOUSANDS OF DOLLARS, AND YOU

4598
02:53:23,120 --> 02:53:25,000
HAVE TO HAVE PRETTY GOOD

4599
02:53:25,000 --> 02:53:27,240
INSURANCE FOR THIS.

4600
02:53:27,240 --> 02:53:28,600
IN TERMS OF TESTABLE HYPOTHESIS,

4601
02:53:28,600 --> 02:53:31,240
WOULD IT BE CLOSE TO EQUALLY AS

4602
02:53:31,240 --> 02:53:32,520
BENEFICIAL UNDER THE RUBRIC OF

4603
02:53:32,520 --> 02:53:35,080
LET'S NOT LET THE PERFECT BE THE

4604
02:53:35,080 --> 02:53:36,560
ENEMY OF THE GOOD, MAYBE THE

4605
02:53:36,560 --> 02:53:38,200
RESOURCES ARE NOT THERE TO OFFER

4606
02:53:38,200 --> 02:53:40,720
EVERYBODY THREE WEEKS OF

4607
02:53:40,720 --> 02:53:42,280
INTENSIVE INPATIENT REHAB, BUT

4608
02:53:42,280 --> 02:53:45,760
MAYBE FIVE DAYS OF INPATIENT

4609
02:53:45,760 --> 02:53:48,480
REHAB WOULD GENERATE ENOUGH

4610
02:53:48,480 --> 02:53:50,160
INCREMENTAL BENEFIT AT A

4611
02:53:50,160 --> 02:53:53,640
REASONABLE POINT THAT PEOPLE WHO

4612
02:53:53,640 --> 02:53:54,440
ARE FINANCIALLY DISADVANTAGED,

4613
02:53:54,440 --> 02:53:57,360
IT WOULDN'T EXCLUDE THEM FROM

4614
02:53:57,360 --> 02:53:59,320
THAT OR ANOTHER PAYER COULD PICK

4615
02:53:59,320 --> 02:54:01,160
UP THAT COST BECAUSE THE

4616
02:54:01,160 --> 02:54:02,520
DOWNSTREAM BENEFIT IN TERMS OF

4617
02:54:02,520 --> 02:54:04,120
GETTING THE PATIENTS BACK TO

4618
02:54:04,120 --> 02:54:06,880
WORK SOONER OR PREVENTING THEM

4619
02:54:06,880 --> 02:54:08,640
FROM GOING INTO A SNIFF, MAYBE

4620
02:54:08,640 --> 02:54:11,560
WAS JUST FIVE DAYS INSTEAD OF

4621
02:54:11,560 --> 02:54:13,080
THREE WEEKS, COULD PROVE EQUALLY

4622
02:54:13,080 --> 02:54:13,360
BENEFICIAL.

4623
02:54:13,360 --> 02:54:16,120
I JUST PUT THAT OUT THERE FOR

4624
02:54:16,120 --> 02:54:17,240
THE GROUP TO CONSIDER AND

4625
02:54:17,240 --> 02:54:19,360
DISCUSS AND SEE IF THIS COULD BE

4626
02:54:19,360 --> 02:54:27,640
THE GENESIS OF A TESTABLE

4627
02:54:27,640 --> 02:54:28,280
HYPOTHESIS.

4628
02:54:28,280 --> 02:54:31,560
>> OR ONE COULD PROPOSE A TRIAL

4629
02:54:31,560 --> 02:54:34,960
OF COMMUNITY-BASED AUGMENTED

4630
02:54:34,960 --> 02:54:36,240
REHAB EXPERIENCE AT HOME.

4631
02:54:36,240 --> 02:54:38,280
IF YOU COULDN'T PAY FOR THE

4632
02:54:38,280 --> 02:54:41,800
FACILITY, IS THERE A WAY TO USE

4633
02:54:41,800 --> 02:54:43,680
EITHER TELEHEALTH BUT PERHAPS

4634
02:54:43,680 --> 02:54:46,520
COMMUNITY HEALTH WORKERS AS WELL

4635
02:54:46,520 --> 02:54:49,800
TO HAVE THE PATIENT PARTICIPATE

4636
02:54:49,800 --> 02:54:52,760
IN A REHABILITATION THERAPY

4637
02:54:52,760 --> 02:54:53,720
WHILE SIMULTANEOUSLY GETTING

4638
02:54:53,720 --> 02:54:54,800
REINFORCEMENT OF THE SECONDARY

4639
02:54:54,800 --> 02:54:57,240
STROKE PREVENTION MEASURES.

4640
02:54:57,240 --> 02:55:02,120
SO THERE MAY BE DIFFERENT WAYS 

4641
02:55:02,120 --> 02:55:07,920
TO ACCOMPLISH THE GOAL OF 

4642
02:55:07,920 --> 02:55:09,240
OPTIMIZING OUTCOME, ENSURING

4643
02:55:09,240 --> 02:55:09,880
COMPLIANCE, REDUCING

4644
02:55:09,880 --> 02:55:10,160
READMISSION.

4645
02:55:10,160 --> 02:55:10,880
>> GREAT POINTS, KAREN.

4646
02:55:10,880 --> 02:55:12,520
THANK YOU FOR SHARING WITH THE

4647
02:55:12,520 --> 02:55:12,800
GROUP.

4648
02:55:12,800 --> 02:55:19,400
YEAH, GREAT IDEAS.

4649
02:55:19,400 --> 02:55:21,200
>> I THINK, MARK, THAT, YOU

4650
02:55:21,200 --> 02:55:22,760
KNOW, THAT -- I DON'T KNOW

4651
02:55:22,760 --> 02:55:24,080
WHETHER FIVE DAYS, I THINK IT'S

4652
02:55:24,080 --> 02:55:25,520
A GOOD IDEA, MAYBE THAT WOULD

4653
02:55:25,520 --> 02:55:25,720
WORK.

4654
02:55:25,720 --> 02:55:29,560
I THINK WE WOULD HAVE TO LOOK AT

4655
02:55:29,560 --> 02:55:30,760
THE -- STILL, THE FINANCIAL

4656
02:55:30,760 --> 02:55:31,640
ISSUES SURROUNDING THAT.

4657
02:55:31,640 --> 02:55:33,720
BUT I KIND OF AGREE WITH KAREN

4658
02:55:33,720 --> 02:55:37,520
THAT MAYBE THE WAY TO GO IS TRY

4659
02:55:37,520 --> 02:55:42,040
TO ENHANCE THE HOME THERAPY

4660
02:55:42,040 --> 02:55:43,680
ROUTE RATHER THAN PUTTING

4661
02:55:43,680 --> 02:55:44,880
PEOPLE, MORE PATIENTS, MORE

4662
02:55:44,880 --> 02:55:47,800
PEOPLE IN  INPATIENT CARE IF WE

4663
02:55:47,800 --> 02:55:49,240
COULD ESTABLISH THAT WAS JUST AS

4664
02:55:49,240 --> 02:55:50,880
GOOD AND WOULD IMPROVE RECOVERY

4665
02:55:50,880 --> 02:55:51,960
TO THE SAME EXTENT.

4666
02:55:51,960 --> 02:55:53,760
I THINK FIRST OF ALL PATIENTS

4667
02:55:53,760 --> 02:55:54,920
WOULD LIKE IT BETTER.

4668
02:55:54,920 --> 02:55:56,680
AND IT MIGHT BE MORE COST

4669
02:55:56,680 --> 02:56:00,480
EFFECTIVE.

4670
02:56:00,480 --> 02:56:01,680
>> GOOD POINTS, LARRY.

4671
02:56:01,680 --> 02:56:04,240
AGAIN, JUST TRYING TO GENERATE

4672
02:56:04,240 --> 02:56:05,400
SOME TESTABLE HYPOTHESES, FOR US

4673
02:56:05,400 --> 02:56:08,360
TO GO FORWARD TO FIND SOLUTIONS

4674
02:56:08,360 --> 02:56:10,520
TO THESE, YOU KNOW, DISPARITIES

4675
02:56:10,520 --> 02:56:15,480
IN CARE AND ACCESS TO RESOURCES.

4676
02:56:15,480 --> 02:56:18,080
 

4677
02:56:18,080 --> 02:56:18,880
>> VERY IMPORTANT COMMENTS IN

4678
02:56:18,880 --> 02:56:28,480
THE CHAT. 

4679
02:56:28,480 --> 02:56:30,360
DR. JENSEN MENTIONED NOACs,

4680
02:56:30,360 --> 02:56:38,440
PEOPLE END UP ON COUMADIN WHICH

4681
02:56:38,440 --> 02:56:39,640
IMPACTS COMPLIANCE.

4682
02:56:39,640 --> 02:56:40,680
AND THEN COMMENTS ABOUT

4683
02:56:40,680 --> 02:56:42,080
TELEHEALTH, IF YOU WANT TO

4684
02:56:42,080 --> 02:56:47,480
EXPAND, DR. JENSEN.

4685
02:56:47,480 --> 02:56:49,120
 

4686
02:56:49,120 --> 02:56:52,520
>> YES, MY NURSE PRACTITIONERS,

4687
02:56:52,520 --> 02:56:55,480
WE WROTE A PAPER, EDUCATION FOR

4688
02:56:55,480 --> 02:56:56,680
RURAL ELDERLY VIRGINIANS, LOOKED

4689
02:56:56,680 --> 02:56:59,800
AT PATIENTS WHO HAD BEEN

4690
02:56:59,800 --> 02:57:02,440
HOSPITALIZED AT UVA FROM A VERY

4691
02:57:02,440 --> 02:57:03,760
RURAL AREA OF VIRGINIA AND SHE

4692
02:57:03,760 --> 02:57:04,840
WORKED IN THE CLINIC FOR A

4693
02:57:04,840 --> 02:57:06,080
PERIOD OF TIME DOING FOLLOW-UP

4694
02:57:06,080 --> 02:57:08,080
WITH THE STROKE PATIENTS AND

4695
02:57:08,080 --> 02:57:10,640
THEN SHE ALSO DID FOLLOW-UP WITH

4696
02:57:10,640 --> 02:57:12,280
TELEHEALTH AND FOUND THAT THEY

4697
02:57:12,280 --> 02:57:14,640
WERE EQUALLY AS EFFECTIVE IN

4698
02:57:14,640 --> 02:57:17,240
PROVIDING FOLLOW-UP STROKE CARE.

4699
02:57:17,240 --> 02:57:19,520
SO ABSOLUTELY THERE'S A PLACE

4700
02:57:19,520 --> 02:57:21,040
FOR TELEHEALTH.

4701
02:57:21,040 --> 02:57:24,760
IN STROKE FOLLOW-UP.

4702
02:57:24,760 --> 02:57:30,360
>> I ALSO WANT TO ADD THAT IN

4703
02:57:30,360 --> 02:57:35,840
OUR SYSTEM DURING COVID WE HAD A

4704
02:57:35,840 --> 02:57:37,480
HUNDRED PERSON STROKE FOLLOW-UP

4705
02:57:37,480 --> 02:57:39,160
PATIENTS TO TELEHEALTH AND IT'S

4706
02:57:39,160 --> 02:57:41,920
WORKING VERY WELL.

4707
02:57:41,920 --> 02:57:48,000
 

4708
02:57:48,000 --> 02:57:59,200
 

4709
02:57:59,200 --> 02:57:59,320
 

4710
02:57:59,320 --> 02:58:00,840
>> OTHER QUESTIONS OR COMMENTS?

4711
02:58:00,840 --> 02:58:04,960
I'M CHECKING THE CHAT  HERE TO

4712
02:58:04,960 --> 02:58:08,680
SEE IF THERE'S ANY OTHER THINGS.

4713
02:58:08,680 --> 02:58:15,160
 

4714
02:58:15,160 --> 02:58:19,600
>> MOST OF THE QUESTIONS IN THE 

4715
02:58:19,600 --> 02:58:23,320
CHAT WE HIT.

4716
02:58:23,320 --> 02:58:26,640
ANY OTHER COMMENTS?

4717
02:58:26,640 --> 02:58:30,120
>> YEAH, CAN YOU HEAR ME?

4718
02:58:30,120 --> 02:58:30,400
>> YES.

4719
02:58:30,400 --> 02:58:32,760
>> I'LL JUST ADD I DON'T THINK

4720
02:58:32,760 --> 02:58:33,640
ANYONE'S ADVOCATING FOR

4721
02:58:33,640 --> 02:58:35,160
ABANDONING IN-PERSON VISITS BUT

4722
02:58:35,160 --> 02:58:38,560
THERE'S A COHORT OF PATIENTS FOR

4723
02:58:38,560 --> 02:58:40,120
WHOM TELEHEALTH DOESN'T WORK, IN

4724
02:58:40,120 --> 02:58:42,160
MY SPECIAL PRACTICE, THEY ARE

4725
02:58:42,160 --> 02:58:43,240
SCHEDULED AND GET CANCELED

4726
02:58:43,240 --> 02:58:44,280
BECAUSE THEY CAN'T FIGURE OUT

4727
02:58:44,280 --> 02:58:45,880
HOW TO LOG ON AND OPERATE THE

4728
02:58:45,880 --> 02:58:47,280
SOFTWARE AND ALL THAT.

4729
02:58:47,280 --> 02:58:49,240
I DO THINK TELEHEALTH HAS OPENED

4730
02:58:49,240 --> 02:58:52,240
UP FOR A LOT OF PATIENTS BUT

4731
02:58:52,240 --> 02:58:53,920
OBVIOUSLY WE CAN'T ABANDON

4732
02:58:53,920 --> 02:58:57,560
TRADITIONAL IN-PERSON VISITS.

4733
02:58:57,560 --> 02:58:58,280
>> TOTALLY AGREE.

4734
02:58:58,280 --> 02:59:00,360
DURING COVID IT WAS EYE-OPENING

4735
02:59:00,360 --> 02:59:02,880
TO ME THE SIGNIFICANT NUMBER OF

4736
02:59:02,880 --> 02:59:04,280
OUR PATIENTS, AT LEAST MY

4737
02:59:04,280 --> 02:59:06,640
PATIENTS, WHO DON'T HAVE A

4738
02:59:06,640 --> 02:59:07,040
SMARTPHONE.

4739
02:59:07,040 --> 02:59:08,880
DON'T HAVE ACCESS TO EVEN THE

4740
02:59:08,880 --> 02:59:09,120
BASICS.

4741
02:59:09,120 --> 02:59:13,840
AND I THINK IN TERMS OF LOOKING

4742
02:59:13,840 --> 02:59:16,880
AT DISPARITY AND INEQUALITY, I'M

4743
02:59:16,880 --> 02:59:20,920
SURE, NOT SURE, I SUSPECT THAT

4744
02:59:20,920 --> 02:59:22,160
THEME CARRIES INTO MANY

4745
02:59:22,160 --> 02:59:23,880
DIFFERENT GROUPS AND SUBGROUPS

4746
02:59:23,880 --> 02:59:26,320
OF OUR PERHAPS MOST VULNERABLE

4747
02:59:26,320 --> 02:59:26,600
PATIENTS.

4748
02:59:26,600 --> 02:59:27,440
>> RIGHT, EXACTLY.

4749
02:59:27,440 --> 02:59:27,760
>> YEAH.

4750
02:59:27,760 --> 02:59:29,840
WE JUST CAN'T ASSUME EVERYBODY

4751
02:59:29,840 --> 02:59:33,240
HAS A HIGH END IPHONE.

4752
02:59:33,240 --> 02:59:33,520
>> RIGHT.

4753
02:59:33,520 --> 02:59:35,960
>> I WOULD JUST ADD EVEN WHEN

4754
02:59:35,960 --> 02:59:40,080
YOU DO HAVE THE CONNECTIVITY AND

4755
02:59:40,080 --> 02:59:41,960
THE EQUIPMENT, TELEHEALTH IS NOT

4756
02:59:41,960 --> 02:59:45,640
NECESSARILY THE BEST THING FOR 

4757
02:59:45,640 --> 02:59:47,520
EVERYBODY IN EVERY SITUATION.

4758
02:59:47,520 --> 02:59:49,520
PARTICULARLY AS NEUROLOGISTS,

4759
02:59:49,520 --> 02:59:50,400
THERE ARE SITUATIONS WHERE IT

4760
02:59:50,400 --> 02:59:52,600
WOULD BE NICE TO TAP ON THE

4761
02:59:52,600 --> 02:59:57,080
REFLEXES AND DO A SENSORY

4762
02:59:57,080 --> 02:59:58,080
EXAMINATION, SO ON.

4763
02:59:58,080 --> 02:59:59,720
SO DURING THE PANDEMIC WE DIDN'T

4764
02:59:59,720 --> 03:00:00,200
HAVE ANY CHOICE.

4765
03:00:00,200 --> 03:00:02,840
THAT WAS THE ONLY WAY WE COULD

4766
03:00:02,840 --> 03:00:04,200
SEE PATIENTS.

4767
03:00:04,200 --> 03:00:06,040
BUT NOT NECESSARILY THE RIGHT

4768
03:00:06,040 --> 03:00:07,880
THING FOR EVERY SITUATION,

4769
03:00:07,880 --> 03:00:08,320
EVERYONE.

4770
03:00:08,320 --> 03:00:09,240
JUST IT'S GOOD FOR A LOT OF

4771
03:00:09,240 --> 03:00:13,800
THINGS BUT NOT EVERYTHING.

4772
03:00:13,800 --> 03:00:15,640
>> AND AT TIMES FOR THAT, IT

4773
03:00:15,640 --> 03:00:17,080
GENERATES A SECOND VISIT BECAUSE

4774
03:00:17,080 --> 03:00:18,480
YOU DISCOVER SOMETHING ON

4775
03:00:18,480 --> 03:00:19,760
TELEHEALTH THAT I REALLY HAVE TO

4776
03:00:19,760 --> 03:00:22,000
SEE YOU, NOW THEY HAVE TO COME

4777
03:00:22,000 --> 03:00:24,080
FOR A SECOND VISIT, ARE GOING TO

4778
03:00:24,080 --> 03:00:26,480
GET BUILD FOR A SECOND VISIT.

4779
03:00:26,480 --> 03:00:28,240
FIGURING OUT WHO BENEFITS UNDER

4780
03:00:28,240 --> 03:00:30,720
WHAT SCENARIO IS IMPORTANT.

4781
03:00:30,720 --> 03:00:33,880
>> I WANTED TO MAKE ONE POINT

4782
03:00:33,880 --> 03:00:37,040
REGARDING ACCESS TO TECHNOLOGY

4783
03:00:37,040 --> 03:00:38,240
AND BROADBAND, THAT CERTAINLY IS

4784
03:00:38,240 --> 03:00:41,240
AN ISSUE IN SOME RURAL AREAS,

4785
03:00:41,240 --> 03:00:42,880
AND FOR THE UNDERSERVED.

4786
03:00:42,880 --> 03:00:45,160
ONE APPROACH FOR PEOPLE WITH

4787
03:00:45,160 --> 03:00:47,440
CHRONIC CONDITIONS AND THIS

4788
03:00:47,440 --> 03:00:50,600
COULD PERTAIN LET'S SAY

4789
03:00:50,600 --> 03:00:52,480
POST-STROKE, FOR FOLKS THAT HAVE

4790
03:00:52,480 --> 03:00:56,440
MOBILITY ISSUES OR RURAL AREAS,

4791
03:00:56,440 --> 03:01:00,240
WE, MEANING THE V.A., HAS LOANED

4792
03:01:00,240 --> 03:01:02,440
OR PROVIDED SOME SORT OF TABLET,

4793
03:01:02,440 --> 03:01:05,120
USUALLY AN IPAD, SOMETIMES WITH

4794
03:01:05,120 --> 03:01:06,520
A CELLULAR DATA PLAN, TO

4795
03:01:06,520 --> 03:01:08,040
VETERANS SO THEY CAN PARTICIPATE

4796
03:01:08,040 --> 03:01:12,440
IN TELEHEALTH TO THE HOME FOR

4797
03:01:12,440 --> 03:01:12,680
FOLLOW-UP.

4798
03:01:12,680 --> 03:01:15,160
AND WHILE THAT MAY SEEM VERY

4799
03:01:15,160 --> 03:01:19,560
EXPENSIVE, IT'S NOT IF YOU LOOK 

4800
03:01:19,560 --> 03:01:21,960
AT THE COST OF NOT GETTING CARE.

4801
03:01:21,960 --> 03:01:25,880
WE HAVE ATLAS CENTERS IN V.A.,

4802
03:01:25,880 --> 03:01:27,360
BASICALLY TELEHEALTH PODS, NOT

4803
03:01:27,360 --> 03:01:28,920
AT A V.A. CLINIC OR RESOURCE,

4804
03:01:28,920 --> 03:01:31,160
THEY MIGHT BE AT A WALMART OR

4805
03:01:31,160 --> 03:01:34,400
VET CENTER OR COMMUNITY CENTER,

4806
03:01:34,400 --> 03:01:38,320
BUT THESE ARE LIKE PODS.

4807
03:01:38,320 --> 03:01:40,600
I'LL DESCRIBE THEM, WITH SOME

4808
03:01:40,600 --> 03:01:42,160
MINIMAL TECH TO HELP PEOPLE

4809
03:01:42,160 --> 03:01:44,880
CHECK IN AND WORK ON PATIENT

4810
03:01:44,880 --> 03:01:48,120
FLOW, WHERE THE PATIENT CAN GET

4811
03:01:48,120 --> 03:01:48,880
EQUIVALENT OF OUTPATIENT

4812
03:01:48,880 --> 03:01:50,680
TELEHEALTH VISIT CLOSE TO HOME.

4813
03:01:50,680 --> 03:01:52,000
THESE ARE NOT AS CONVENIENT OR

4814
03:01:52,000 --> 03:01:54,640
NOT AS CHEAP AS JUST SENDING

4815
03:01:54,640 --> 03:01:56,640
SOMEONE AN IPAD BUT YOU CAN DO

4816
03:01:56,640 --> 03:01:57,440
IT AS A ONE-OFF.

4817
03:01:57,440 --> 03:01:59,640
THOSE ARE SOME OF THE APPROACHES

4818
03:01:59,640 --> 03:02:01,680
THAT V.A. IS TAKING TO BRING

4819
03:02:01,680 --> 03:02:02,680
TELEHEALTH TO RURAL AND

4820
03:02:02,680 --> 03:02:05,640
UNDERSERVED AREAS.

4821
03:02:05,640 --> 03:02:06,720
>> THANK YOU.

4822
03:02:06,720 --> 03:02:09,880
I APPRECIATE YOUR SPEAKING UP

4823
03:02:09,880 --> 03:02:13,760
AND IT BRINGS ME BACK TO LARRY'S

4824
03:02:13,760 --> 03:02:15,480
EARLIER COMMENT ABOUT EMRs.

4825
03:02:15,480 --> 03:02:16,880
I WAS SURPRISED WE DIDN'T FIND

4826
03:02:16,880 --> 03:02:19,320
ANYTHING FROM THE V.A. SYSTEM

4827
03:02:19,320 --> 03:02:24,440
WHERE THEY MIGHT BE BETTER ABLE

4828
03:02:24,440 --> 03:02:27,720
TO TRACK APPROPRIATE UTILIZATION

4829
03:02:27,720 --> 03:02:32,200
OF DIAGNOSTIC STUDIES AND

4830
03:02:32,200 --> 03:02:33,840
PROCEDURES THAN EVEN EPIC WHERE

4831
03:02:33,840 --> 03:02:36,320
THOSE THINGS MIGHT OCCUR IN

4832
03:02:36,320 --> 03:02:37,480
DIFFERENT CARE SETTINGS, PERHAPS

4833
03:02:37,480 --> 03:02:41,160
AT DIFFERENT HOSPITALS.

4834
03:02:41,160 --> 03:02:43,120
>> THERE HAVE BEEN SOME DATA

4835
03:02:43,120 --> 03:02:45,240
REALLY LOOKING AT DISPARITIES IN

4836
03:02:45,240 --> 03:02:46,640
STROKE CARE, VARIOUS SORTS.

4837
03:02:46,640 --> 03:02:48,000
AS I RECALL LARRY GOLDSTEIN WHEN

4838
03:02:48,000 --> 03:02:50,080
HE WORKED IN THE V.A. SYSTEM WAS

4839
03:02:50,080 --> 03:02:55,720
THE  CO-AUTHOR OF AT LEAST ONE.

4840
03:02:55,720 --> 03:02:57,680
FORTUNATELY IT DID NOT FIND OF

4841
03:02:57,680 --> 03:03:00,080
EVIDENCE OF ANY DISPARITY, AT

4842
03:03:00,080 --> 03:03:03,880
LEAST IN LOOKING AT RACE AND

4843
03:03:03,880 --> 03:03:04,160
GEOGRAPHY.

4844
03:03:04,160 --> 03:03:11,240
SO, THAT WAS A POSITIVE. 

4845
03:03:11,240 --> 03:03:13,280
BUT I'M RELUCTANT TO GENERALIZE

4846
03:03:13,280 --> 03:03:14,600
BROADLY FROM LIMITED DATA BUT

4847
03:03:14,600 --> 03:03:18,080
SOME DATA DO EXIST THAT DR.

4848
03:03:18,080 --> 03:03:20,720
FURIE, IN ANSWER TO YOUR

4849
03:03:20,720 --> 03:03:21,080
QUESTION.

4850
03:03:21,080 --> 03:03:21,480
>> THANK YOU.

4851
03:03:21,480 --> 03:03:22,880
>> WE'RE ALMOST OUT OF TIME HERE

4852
03:03:22,880 --> 03:03:24,560
BUT I DID WANT TO BRING UP

4853
03:03:24,560 --> 03:03:25,680
SOMETHING THAT EITHER KAREN OR

4854
03:03:25,680 --> 03:03:28,400
LARRY OR BOTH OF YOU MENTIONED

4855
03:03:28,400 --> 03:03:30,400
IN YOUR REPORT-OUT THAT I

4856
03:03:30,400 --> 03:03:31,480
THOUGHT WAS INTRIGUING AND

4857
03:03:31,480 --> 03:03:34,320
WONDER IF YOU COULD SHARE MORE

4858
03:03:34,320 --> 03:03:34,840
INFORMATION.

4859
03:03:34,840 --> 03:03:37,720
IT WAS SAID THAT IN TERMS OF

4860
03:03:37,720 --> 03:03:40,040
SECONDARY PREVENTION TREATMENTS,

4861
03:03:40,040 --> 03:03:42,000
THAT THE UTILIZATION WENT DOWN

4862
03:03:42,000 --> 03:03:42,720
WITH AGE.

4863
03:03:42,720 --> 03:03:44,080
AND YOU KNOW THE LITERATURE AS

4864
03:03:44,080 --> 03:03:46,040
WELL AS I DO.

4865
03:03:46,040 --> 03:03:48,520
THE RISK OF STROKE OR RECURRENT

4866
03:03:48,520 --> 03:03:49,440
STROKE, EVERYBODY BAD FOR THE

4867
03:03:49,440 --> 03:03:51,400
MOST PART GOES UP WITH AGE, NOT

4868
03:03:51,400 --> 03:03:52,600
DOWN.

4869
03:03:52,600 --> 03:03:54,240
SO I WAS WONDERING IF LARRY OR

4870
03:03:54,240 --> 03:03:57,520
KAREN OR SOMEBODY ELSE ON THE

4871
03:03:57,520 --> 03:03:59,480
CALL, YOU KNOW, HAD SOME

4872
03:03:59,480 --> 03:04:00,600
EXPLANATION FOR THAT OR

4873
03:04:00,600 --> 03:04:02,680
OBSERVATION ABOUT WHAT MAY BE

4874
03:04:02,680 --> 03:04:03,040
DRIVING THAT?

4875
03:04:03,040 --> 03:04:04,520
BECAUSE, YOU KNOW, WE DON'T WANT

4876
03:04:04,520 --> 03:04:09,560
AGE TO BE A DISCRIMINATOR BUT IT

4877
03:04:09,560 --> 03:04:11,560
OBVIOUSLY COULD, DOES DEFINE

4878
03:04:11,560 --> 03:04:13,200
ANOTHER ASPECT OF UNDERSERVED

4879
03:04:13,200 --> 03:04:13,520
POPULATION.

4880
03:04:13,520 --> 03:04:17,640
SO ANY THOUGHTS ON THAT?

4881
03:04:17,640 --> 03:04:19,480
>> JUST HYPOTHESES.

4882
03:04:19,480 --> 03:04:21,440
IT MAY BE COMORBIDITIES OR

4883
03:04:21,440 --> 03:04:23,480
INTERACTIONS WITH OTHER

4884
03:04:23,480 --> 03:04:25,440
MEDICATIONS MAKES IT DIFFICULT

4885
03:04:25,440 --> 03:04:27,080
TO PRESCRIBE WHATEVER THE

4886
03:04:27,080 --> 03:04:28,080
OPTIMAL MEDICAL THERAPY IS.

4887
03:04:28,080 --> 03:04:31,080
AGAIN, THIS IS AN AREA WHERE

4888
03:04:31,080 --> 03:04:32,840
SOCIOECONOMICS MAY OVERLAP WITH

4889
03:04:32,840 --> 03:04:34,480
DEMOGRAPHICS, MAYBE THE OLDER

4890
03:04:34,480 --> 03:04:35,920
PATIENT DOESN'T HAVE THE

4891
03:04:35,920 --> 03:04:38,480
RESOURCES, SOMEONE PUT IN THE

4892
03:04:38,480 --> 03:04:40,400
CHAT ABOUT THE DOACs, IT'S A

4893
03:04:40,400 --> 03:04:41,680
GREAT EXAMPLE, THEY ARE

4894
03:04:41,680 --> 03:04:42,960
EXPENSIVE AND NOT EVERYONE CAN

4895
03:04:42,960 --> 03:04:45,880
AFFORD THEM. 

4896
03:04:45,880 --> 03:04:48,360
THIS IS AN THAT I THINK IS

4897
03:04:48,360 --> 03:04:51,320
AMENABLE TO RESEARCH, WHY AREN'T

4898
03:04:51,320 --> 03:04:53,840
THOSE PATIENTS ON THE OPTIMUM

4899
03:04:53,840 --> 03:04:54,840
MEDICAL THERAPY?

4900
03:04:54,840 --> 03:04:57,440
RIGHT NOW IT'S ALL SPECULATIVE

4901
03:04:57,440 --> 03:04:59,560
BUT THERE MAY BE SOME REALLY

4902
03:04:59,560 --> 03:05:01,240
IMPORTANT ANSWERS THAT HELP US

4903
03:05:01,240 --> 03:05:04,560
BETTER MANAGE THE VERY ELDERLY.

4904
03:05:04,560 --> 03:05:06,080
>> I THINK THESE ISSUES ARE HARD

4905
03:05:06,080 --> 03:05:08,160
TO GET TO.

4906
03:05:08,160 --> 03:05:09,720
YOU CAN IMAGINE THAT AS WE ALL

4907
03:05:09,720 --> 03:05:13,280
KNOW, BECAUSE WE DO THIS ALL THE

4908
03:05:13,280 --> 03:05:18,520
TIME, THAT THESE DECISIONS ABOUT

4909
03:05:18,520 --> 03:05:20,560
THERAPY, SECONDARY STROKE

4910
03:05:20,560 --> 03:05:22,280
PREVENTION, INTERVENTIONS ARE

4911
03:05:22,280 --> 03:05:24,160
MULTI-FACTORIAL AND COMPLEX AND

4912
03:05:24,160 --> 03:05:25,800
INDIVIDUALIZED FOR EACH PATIENT,

4913
03:05:25,800 --> 03:05:27,320
SO, YEAH, THERE'S LOTS OF

4914
03:05:27,320 --> 03:05:28,960
FACTORS THAT WE'LL HAVE TO

4915
03:05:28,960 --> 03:05:31,720
ANALYZE IN ORDER TO GET TO THE

4916
03:05:31,720 --> 03:05:35,760
BOTTOM OF, YOU KNOW, WHY 

4917
03:05:35,760 --> 03:05:36,720
SOMETHING LIKE THAT OCCURS, AND

4918
03:05:36,720 --> 03:05:38,160
OTHER THAN WHAT KAREN HAS

4919
03:05:38,160 --> 03:05:41,200
ALREADY MENTIONED I THINK THOSE

4920
03:05:41,200 --> 03:05:44,680
ARE ALL GOOD POTENTIAL

4921
03:05:44,680 --> 03:05:45,240
HYPOTHESES TO TEST.

4922
03:05:45,240 --> 03:05:47,320
>> JUST TO MAKE LIFE MORE

4923
03:05:47,320 --> 03:05:50,200
COMPLICATED, WE MAY HAVE SOME

4924
03:05:50,200 --> 03:05:51,480
DATA ABOUT WHAT PATIENTS RUN

4925
03:05:51,480 --> 03:05:53,040
WHEN THEY LEAVE THE HOSPITAL

4926
03:05:53,040 --> 03:05:55,880
THAN AFTER 30 OR 60 DAYS MAY

4927
03:05:55,880 --> 03:05:57,480
ABANDON THAT THERAPY FOR VARIOUS

4928
03:05:57,480 --> 03:05:57,720
REASONS.

4929
03:05:57,720 --> 03:05:59,520
COULD BE COST, COULD BE

4930
03:05:59,520 --> 03:06:02,280
SOCIOECONOMIC, COULD BE SIDE

4931
03:06:02,280 --> 03:06:03,480
EFFECTS, COULD BE ACCESS, AND I

4932
03:06:03,480 --> 03:06:04,600
KNOW THERE ARE SOME GROUPS THAT

4933
03:06:04,600 --> 03:06:07,680
ARE LOOKING AT THIS ISSUE OF

4934
03:06:07,680 --> 03:06:11,640
MEDICATION  ABANDONMENT AFTER A

4935
03:06:11,640 --> 03:06:20,160
PERIOD OF TIME VERSUS

4936
03:06:20,160 --> 03:06:20,560
PERSISTENCE.

4937
03:06:20,560 --> 03:06:22,080
>> USEFUL IF WE LEARNED FOR

4938
03:06:22,080 --> 03:06:25,200
INSTANCE WHY PATIENT WITH ATRIAL

4939
03:06:25,200 --> 03:06:28,360
FIBRILLATION ARE NOT PRESCRIBED

4940
03:06:28,360 --> 03:06:29,680
ANTICOAGULANTS BECAUSE PROVIDERS

4941
03:06:29,680 --> 03:06:32,280
PERCEIVE A FALL RISK OR FRAILTY,

4942
03:06:32,280 --> 03:06:33,840
BY KNOWING THAT'S THE REASON

4943
03:06:33,840 --> 03:06:35,120
THAT'S THE BARRIER YOU CAN

4944
03:06:35,120 --> 03:06:40,400
ADDRESS IT HEAD ON SO BE  -- SO

4945
03:06:40,400 --> 03:06:44,080
THERE MAY BE LOTS OF EXAMPLES

4946
03:06:44,080 --> 03:06:44,520
LIKE THAT.

4947
03:06:44,520 --> 03:06:49,680
>> TOTALLY AGREE.

4948
03:06:49,680 --> 03:06:50,560
>> IS TELEREHAB CURRENTLY

4949
03:06:50,560 --> 03:06:51,880
REIMBURSABLE, SOMEONE ELSE SAYS

4950
03:06:51,880 --> 03:06:53,640
TELEHEALTH AND STROKE WOULD BE

4951
03:06:53,640 --> 03:06:54,520
GREAT OPPORTUNITY TO EDUCATE THE

4952
03:06:54,520 --> 03:06:58,680
COMMUNITY.

4953
03:06:58,680 --> 03:07:00,280
ANY COMMENTS ABOUT REIMBURSEMENT

4954
03:07:00,280 --> 03:07:01,840
FOR TELEREHAB?

4955
03:07:01,840 --> 03:07:04,840
>> SO, IT IS NOT, AS FAR AS I

4956
03:07:04,840 --> 03:07:07,800
KNOW, EVEN DURING THE PANDEMIC,

4957
03:07:07,800 --> 03:07:13,040
ALTHOUGH I GUESS UNLESS YOU BILL

4958
03:07:13,040 --> 03:07:15,320
AS (INDISCERNIBLE) VISIT.

4959
03:07:15,320 --> 03:07:20,200
THE OTHER COMMENT IS

4960
03:07:20,200 --> 03:07:20,840
INTERESTING, BRINGS UP THE ISSUE

4961
03:07:20,840 --> 03:07:22,760
THERE ARE THINGS WE CAN DO WITH

4962
03:07:22,760 --> 03:07:24,200
TELEMEDICINE BEYOND JUST SEEING

4963
03:07:24,200 --> 03:07:25,360
THE PATIENT.

4964
03:07:25,360 --> 03:07:27,240
THAT WE REALLY OUGHT TO, YOU

4965
03:07:27,240 --> 03:07:30,800
KNOW, BE LOOKING AT NOT JUST HOW

4966
03:07:30,800 --> 03:07:32,160
TELEMEDICINE CAN REPLACE AN

4967
03:07:32,160 --> 03:07:37,840
IN-PERSON  VISIT BUT WHAT CAN

4968
03:07:37,840 --> 03:07:39,240
MAKE OUR CARE BETTER THAN IN

4969
03:07:39,240 --> 03:07:41,760
PERSON IN THOSE SITUATIONS WHERE

4970
03:07:41,760 --> 03:07:43,080
IT'S APPROPRIATE, AND I THINK

4971
03:07:43,080 --> 03:07:44,680
TALKING DIRECTLY WITH FAMILY

4972
03:07:44,680 --> 03:07:47,720
MEMBERS WHO MAY BE SCATTERED

4973
03:07:47,720 --> 03:07:49,440
ACROSS THE COUNTRY, THEY MAY NOT

4974
03:07:49,440 --> 03:07:51,680
BE ALL IN THE HOUSE BUT THERE

4975
03:07:51,680 --> 03:07:54,240
COULD BE A DAUGHTER IN ARIZONA,

4976
03:07:54,240 --> 03:07:55,640
A SON IN MAINE, AND THEY CAN GET

4977
03:07:55,640 --> 03:07:58,800
ONLINE AND TALK AT THE SAME TIME

4978
03:07:58,800 --> 03:08:00,520
THROUGH TELEHEALTH, THEY CAN'T

4979
03:08:00,520 --> 03:08:02,720
COME INTO YOUR OFFICE AT THE

4980
03:08:02,720 --> 03:08:03,160
SAME TIME.

4981
03:08:03,160 --> 03:08:04,560
SO I THINK THOSE ARE GOOD

4982
03:08:04,560 --> 03:08:04,840
THOUGHTS.

4983
03:08:04,840 --> 03:08:06,880
I THINK THAT'S HOW WE OUGHT TO

4984
03:08:06,880 --> 03:08:08,680
BE THINKING ABOUT TELEHEALTH AS

4985
03:08:08,680 --> 03:08:09,880
ENHANCING OUR ABILITY TO DO

4986
03:08:09,880 --> 03:08:11,480
THINGS RATHER THAN JUST

4987
03:08:11,480 --> 03:08:13,320
REPLACING IN-PERSON VISITS.

4988
03:08:13,320 --> 03:08:15,880
>> AND I DID WANT TO MENTION

4989
03:08:15,880 --> 03:08:17,720
THAT THERE'S SOME USE, PROBABLY

4990
03:08:17,720 --> 03:08:20,240
COULD BE MORE, OF

4991
03:08:20,240 --> 03:08:21,760
TELEREHABILITATION AND IT DOES

4992
03:08:21,760 --> 03:08:25,800
BRING REHAB TO THE AREA OF THE

4993
03:08:25,800 --> 03:08:26,240
PATIENT.

4994
03:08:26,240 --> 03:08:27,040
IT CERTAINLY EXTENDS

4995
03:08:27,040 --> 03:08:29,240
GEOGRAPHICALLY AND ALSO HOURS

4996
03:08:29,240 --> 03:08:30,600
PER WEEK THE NUMBER OF HOURS

4997
03:08:30,600 --> 03:08:33,160
SOMEONE CAN DO A MIX OF

4998
03:08:33,160 --> 03:08:35,360
MONITORED UNSUPERVISED AND

4999
03:08:35,360 --> 03:08:36,320
SUPERVISED THERAPY.

5000
03:08:36,320 --> 03:08:37,960
I AM STRUCK AND I'LL MAKE

5001
03:08:37,960 --> 03:08:39,280
SOMETHING THAT I'M GOING GO OF

5002
03:08:39,280 --> 03:08:45,400
TO GO WAY OUT ON A LIMB.

5003
03:08:45,400 --> 03:08:47,840
I'M STRUCK AS I AM WHEN I DEAL

5004
03:08:47,840 --> 03:08:49,480
WITH THE PRIVATE VECTOR, 95% OF

5005
03:08:49,480 --> 03:08:52,080
MEDICAL CARE, HOW OFTEN

5006
03:08:52,080 --> 03:08:53,600
REIMBURSEMENT OR LACK THEREOF

5007
03:08:53,600 --> 03:08:55,800
ENTERS INTO THE DISCUSSION AS A

5008
03:08:55,800 --> 03:08:59,040
DRIVER OR ENHANCER OF

5009
03:08:59,040 --> 03:08:59,320
DISPARITIES.

5010
03:08:59,320 --> 03:09:02,960
AND I HAVE TO SAY THAT WORKING

5011
03:09:02,960 --> 03:09:04,080
IN THE SYSTEM WHERE THERE'S MUCH

5012
03:09:04,080 --> 03:09:08,080
BAD ABOUT IT WE GET A DIRECT 

5013
03:09:08,080 --> 03:09:08,880
APPROPRIATION FROM CONGRESS AND

5014
03:09:08,880 --> 03:09:12,800
HAVE CONTROL IN OUR BUDGETS

5015
03:09:12,800 --> 03:09:14,600
WITHIN STATUTORY RULES, DICTATES

5016
03:09:14,600 --> 03:09:15,640
OF CONGRESSIONAL COMMITTEES TO

5017
03:09:15,640 --> 03:09:17,160
LIKE TO FIND FAULT WITH WHAT WE

5018
03:09:17,160 --> 03:09:18,680
DO TO DECIDE WHAT WE VALUE, WHAT

5019
03:09:18,680 --> 03:09:21,240
WE WILL SUPPORT AND WHAT WE WILL

5020
03:09:21,240 --> 03:09:21,400
NOT.

5021
03:09:21,400 --> 03:09:27,560
AND I HAVE TO SAY THAT FROM A

5022
03:09:27,560 --> 03:09:28,120
SOCIETAL STANDPOINT, EQUITY

5023
03:09:28,120 --> 03:09:31,400
STANDPOINT, THERE ARE SOME GOOD

5024
03:09:31,400 --> 03:09:32,920
THINGS ABOUT THAT.

5025
03:09:32,920 --> 03:09:36,040
NOW, THAT'S AN EXTREMELY

5026
03:09:36,040 --> 03:09:37,280
CONTROVERSIAL STATEMENT BUT I

5027
03:09:37,280 --> 03:09:39,040
THINK TO SOME DEGREE WE'RE

5028
03:09:39,040 --> 03:09:40,240
DANCING AROUND THE ELEPHANT IN

5029
03:09:40,240 --> 03:09:41,320
THE ROOM.

5030
03:09:41,320 --> 03:09:46,400
SO I'M GOING TO LEAVE THAT

5031
03:09:46,400 --> 03:09:47,800
COMMENT AS SOMETHING THAT MAY

5032
03:09:47,800 --> 03:09:48,520
SPUR FURTHER DISCUSSION.

5033
03:09:48,520 --> 03:09:51,200
THANK YOU.

5034
03:09:51,200 --> 03:09:53,600
>> I WOULD ADD, GLENN, THERE ARE

5035
03:09:53,600 --> 03:09:55,360
INTERMEDIATE WAYS TO GO TOO.

5036
03:09:55,360 --> 03:09:56,080
>> OH, FOR SURE.

5037
03:09:56,080 --> 03:09:57,560
>> IT DOESN'T HAVE TO BE ALL ONE

5038
03:09:57,560 --> 03:09:59,040
WAY OR THE ANOTHER.

5039
03:09:59,040 --> 03:10:00,560
>> NOT AT ALL.

5040
03:10:00,560 --> 03:10:02,080
I'M NOT AN ADVOCATE PARTICULARLY

5041
03:10:02,080 --> 03:10:03,200
OF SINGLE PAYER SYSTEM.

5042
03:10:03,200 --> 03:10:04,400
I COULD SPEND AN HOUR TELLING

5043
03:10:04,400 --> 03:10:05,920
YOU GOOD THINGS ABOUT THE V.A.

5044
03:10:05,920 --> 03:10:07,640
AND SPEND THE NEXT HOUR TELLING

5045
03:10:07,640 --> 03:10:08,880
YOU THE BAD THINGS.

5046
03:10:08,880 --> 03:10:11,600
LIKE ALMOST ANY OTHER HUMAN

5047
03:10:11,600 --> 03:10:11,880
INSTITUTION.

5048
03:10:11,880 --> 03:10:18,160
SO I'M TRYING TO BE NUANCED.

5049
03:10:18,160 --> 03:10:19,880
BUT I DO THINK -- I'LL COME BACK

5050
03:10:19,880 --> 03:10:21,480
ON VIDEO FOR THIS ONE.

5051
03:10:21,480 --> 03:10:24,000
AS WE HAVE LAYERED MORE AND MORE

5052
03:10:24,000 --> 03:10:26,600
ON TOP OF AN ARCHAIC

5053
03:10:26,600 --> 03:10:27,480
REIMBURSEMENT AND SUPPORT MODEL

5054
03:10:27,480 --> 03:10:30,080
FOR HEALTH CARE IN THE UNITED

5055
03:10:30,080 --> 03:10:31,640
STATES, WE -- YOU KNOW, IT'S

5056
03:10:31,640 --> 03:10:35,480
HARDER AND HARDER TO MANAGE.

5057
03:10:35,480 --> 03:10:37,000
THE OLD CLICHÉ, WE SPEND MORE

5058
03:10:37,000 --> 03:10:38,440
THAN ANY OTHER COUNTRY, HAVE FAR

5059
03:10:38,440 --> 03:10:43,120
MORE PEOPLE THAT ARE NOT

5060
03:10:43,120 --> 03:10:47,160
TREATED, HEALTH OUTCOMES WITH 

5061
03:10:47,160 --> 03:10:49,800
LONGEVITY AND INFANT MORTALITY

5062
03:10:49,800 --> 03:10:50,880
ARE MEDIOCRE COMPARED TO

5063
03:10:50,880 --> 03:10:53,720
DEVELOPED WORLD. 

5064
03:10:53,720 --> 03:10:55,240
TO IGNORE THAT WE'RE DELUDING

5065
03:10:55,240 --> 03:10:57,880
OURSELVES IS WHAT I'M SAYING.

5066
03:10:57,880 --> 03:10:59,920
I'M HAPPY TO LISTEN TO THOSE WHO

5067
03:10:59,920 --> 03:11:03,600
I'M SURE MANY OF YOU WHO

5068
03:11:03,600 --> 03:11:04,880
VIOLENTLY DISAGREE WITH WHAT I

5069
03:11:04,880 --> 03:11:05,480
SAID BUT IT IS WORTHK.

5070
03:11:05,480 --> 03:11:08,680
I WANT TO WELCOME YOU BACK FROM

5071
03:11:08,680 --> 03:11:10,880
OUR 30-MINUTE BREAK.

5072
03:11:10,880 --> 03:11:12,680
SO, THIS NEXT BRIEF SESSION IS

5073
03:11:12,680 --> 03:11:14,560
GOING TO BE JUST AN INITIAL HIGH

5074
03:11:14,560 --> 03:11:18,400
LEVEL REPORTOUT OF ALL OF THE

5075
03:11:18,400 --> 03:11:22,040
BREAKOUT DISCUSSIONS THAT WE HAD

5076
03:11:22,040 --> 03:11:24,000
OVER THE COURSE OF TODAY, REALLY

5077
03:11:24,000 --> 03:11:25,680
MAJOR HIGHLIGHTS THAT I'M GOING

5078
03:11:25,680 --> 03:11:27,920
TO ASK OUR TASK FORCE LEADS TO

5079
03:11:27,920 --> 03:11:29,320
SHARE FROM ALL OF THE DIFFERENT

5080
03:11:29,320 --> 03:11:30,480
NOTES THAT THEY HAVE RECEIVED

5081
03:11:30,480 --> 03:11:33,960
FROM ALL OF OUR CONVERSATIONS.

5082
03:11:33,960 --> 03:11:35,760
AGAIN, TOMORROW THE FULL MEETING

5083
03:11:35,760 --> 03:11:37,680
RESUMES AT 11 A.M., AND THAT

5084
03:11:37,680 --> 03:11:40,960
WILL BE WHEN THEY DO PROVIDE A

5085
03:11:40,960 --> 03:11:43,320
MORE DETAILED REPORT-OUT AND

5086
03:11:43,320 --> 03:11:44,880
SUMMARY OF ANTICIPATED

5087
03:11:44,880 --> 03:11:45,760
DIRECTIONS THAT THEIR RESPECTIVE

5088
03:11:45,760 --> 03:11:48,400
REPORTS ARE GOING TO GO.

5089
03:11:48,400 --> 03:11:51,680
SO WITH THAT, I AM WATCHING MARK

5090
03:11:51,680 --> 03:11:54,560
GET RESET.

5091
03:11:54,560 --> 03:11:55,480
 

5092
03:11:55,480 --> 03:11:59,760
HE'S GOING TO PASS THE TORCH TO

5093
03:11:59,760 --> 03:12:00,720
FACILITATE THE NEXT 30 TO 40

5094
03:12:00,720 --> 03:12:03,280
MINUTES.

5095
03:12:03,280 --> 03:12:10,080
 

5096
03:12:10,080 --> 03:12:10,240
 

5097
03:12:10,240 --> 03:12:13,640
HE'S TRYING TO UNMUTE, I THINK.

5098
03:12:13,640 --> 03:12:19,360
 

5099
03:12:19,360 --> 03:12:20,440
>> TESTING 123, CAN YOU HEAR ME?

5100
03:12:20,440 --> 03:12:21,440
>> THERE YOU GO.

5101
03:12:21,440 --> 03:12:22,080
>> ALL RIGHT.

5102
03:12:22,080 --> 03:12:22,760
THANK YOU ALL.

5103
03:12:22,760 --> 03:12:25,120
I THINK WE HAD A GREAT SESSION

5104
03:12:25,120 --> 03:12:26,800
IN THE MORNING AND IN THE

5105
03:12:26,800 --> 03:12:27,080
AFTERNOON.

5106
03:12:27,080 --> 03:12:31,160
I HEARD A LOT OF UNIQUE

5107
03:12:31,160 --> 03:12:33,040
OPINIONS, UNIQUE PERSPECTIVES,

5108
03:12:33,040 --> 03:12:33,640
UNIQUE OPTIONS.

5109
03:12:33,640 --> 03:12:35,880
SO, THANK YOU ALL FOR YOUR HARD

5110
03:12:35,880 --> 03:12:38,600
WORK AND DILIGENCE AS WE ALL GET

5111
03:12:38,600 --> 03:12:39,680
BACK TOGETHER.

5112
03:12:39,680 --> 03:12:43,040
SO, WHAT WE WANTED TO DO IS JUST

5113
03:12:43,040 --> 03:12:45,040
HAVE A DISCUSSION FOR A LITTLE

5114
03:12:45,040 --> 03:12:48,400
WHILE ABOUT SOME OF THE TAKEHOME

5115
03:12:48,400 --> 03:12:50,560
POINTS THAT YOU ALL HAVE BROUGHT

5116
03:12:50,560 --> 03:12:52,680
OUT DURING THE BREAKOUT SESSIONS

5117
03:12:52,680 --> 03:12:58,360
THAT HAVE BEEN GOING ON ALL DAY.

5118
03:12:58,360 --> 03:13:00,160
SO, I'M GOING TO SEQUENCE IN THE

5119
03:13:00,160 --> 03:13:05,000
SAME ORDER THAT THE DAY EVOLVED

5120
03:13:05,000 --> 03:13:07,640
IN AND SAM AND HER COLLEAGUES

5121
03:13:07,640 --> 03:13:08,720
AND TRANSCRIBERS AND WRITERS AND

5122
03:13:08,720 --> 03:13:10,280
MYSELF ARE GOING TO TRY TO JOT

5123
03:13:10,280 --> 03:13:13,520
DOWN SOME OF THE KEY TAKEHOME

5124
03:13:13,520 --> 03:13:14,960
POINTS AND TAKEHOME MESSAGES,

5125
03:13:14,960 --> 03:13:17,560
AND SEE IF WE CAN SYNTHESIZE

5126
03:13:17,560 --> 03:13:20,680
SOME THINGS TOGETHER TO GET THE

5127
03:13:20,680 --> 03:13:23,840
MEETING KICKED OFF TOMORROW 

5128
03:13:23,840 --> 03:13:26,080
WHICH, AS SAM SAID, WILL BE AT

5129
03:13:26,080 --> 03:13:26,320
11:00.

5130
03:13:26,320 --> 03:13:30,680
WE'LL HAVE FINAL DISCUSSION AND

5131
03:13:30,680 --> 03:13:32,480
WRAP-UP AND THE PURPOSE, WHAT

5132
03:13:32,480 --> 03:13:34,760
WE'RE TRYING TO ACCOMPLISH, IS

5133
03:13:34,760 --> 03:13:38,160
TO FIND SOME COMMON THEMES, SOME

5134
03:13:38,160 --> 03:13:39,480
TAKEHOME POINTS, SOME PATHWAYS

5135
03:13:39,480 --> 03:13:44,240
FORWARD THAT WE CAN THEN USE TO

5136
03:13:44,240 --> 03:13:47,640
SYNTHESIZE THE FINAL WRITTEN

5137
03:13:47,640 --> 03:13:51,680
REPORT THAT WILL BE WRITTEN OVER

5138
03:13:51,680 --> 03:13:53,280
THE NEXT WEEKS AND A FEW MONTHS.

5139
03:13:53,280 --> 03:13:54,840
I HOPE THAT MAKES SENSE.

5140
03:13:54,840 --> 03:13:56,080
I'M GOING TO TURN MY CAMERA

5141
03:13:56,080 --> 03:13:59,280
AROUND AND SEE IF I CAN -- I

5142
03:13:59,280 --> 03:14:01,400
CAN'T REORIENT MYSELF, BUT IT'S

5143
03:14:01,400 --> 03:14:01,600
OKAY.

5144
03:14:01,600 --> 03:14:04,640
SO, HOPEFULLY CAN YOU HEAR ME.

5145
03:14:04,640 --> 03:14:06,120
IF NOT, SEE ME.

5146
03:14:06,120 --> 03:14:08,200
WE HAVE 41 PARTICIPANTS.

5147
03:14:08,200 --> 03:14:10,680
AGAIN, WE'LL START WITH THE

5148
03:14:10,680 --> 03:14:13,320
BREAKOUT LEADS FOR EACH OF THE

5149
03:14:13,320 --> 03:14:17,680
SESSIONS, AND THEN ANYBODY CAN

5150
03:14:17,680 --> 03:14:18,240
PARTICIPATE.

5151
03:14:18,240 --> 03:14:23,480
WE'RE GOING TO THE PRE-HOSPITAL

5152
03:14:23,480 --> 03:14:27,440
REPORT-OUT, THE FIRST BREAKOUT

5153
03:14:27,440 --> 03:14:32,400
LEAD WAS ACTUALLY GEOGRAPHIC.

5154
03:14:32,400 --> 03:14:34,040
SO, UNLESS ERIKA AND CHARLES

5155
03:14:34,040 --> 03:14:35,480
WANT TO GIVE A GENERAL OVERVIEW

5156
03:14:35,480 --> 03:14:37,520
OF THAT SESSION WE CAN GO TO THE

5157
03:14:37,520 --> 03:14:38,280
BREAKOUTS.

5158
03:14:38,280 --> 03:14:42,480
BUT I'LL OPEN UP FOR ERIKA,

5159
03:14:42,480 --> 03:14:43,280
SORRY, COMMANDER ODOM, AND

5160
03:14:43,280 --> 03:14:46,120
CHARLES TO SEE IF THEY WANT TO

5161
03:14:46,120 --> 03:14:48,080
PROVIDE SOME SUMMARY FROM THAT

5162
03:14:48,080 --> 03:14:49,720
SESSION AND THEN WE'LL ASK THE

5163
03:14:49,720 --> 03:14:51,880
BREAKOUT LEADS, SOME OF WHOM ARE

5164
03:14:51,880 --> 03:14:53,240
THE SAME PEOPLE.

5165
03:14:53,240 --> 03:14:57,680
SO COMMANDER ODOM, DO YOU WANT

5166
03:14:57,680 --> 03:14:58,480
TO BEGIN?

5167
03:14:58,480 --> 03:14:59,480
YOU MIGHT BE MUTED.

5168
03:14:59,480 --> 03:15:00,080
I CAN'T HEAR YOU.

5169
03:15:00,080 --> 03:15:01,680
I DON'T KNOW IF THAT'S MY FAULT

5170
03:15:01,680 --> 03:15:04,680
OR YOURS.

5171
03:15:04,680 --> 03:15:08,000
 

5172
03:15:08,000 --> 03:15:10,760
I AM NOT HEARING YOU.

5173
03:15:10,760 --> 03:15:13,080
>> MARK, I CAN HEAR YOU BUT I

5174
03:15:13,080 --> 03:15:13,960
CAN'T HEAR COMMANDER ODOM.

5175
03:15:13,960 --> 03:15:16,360
ARE YOU ABLE TO HEAR ME?

5176
03:15:16,360 --> 03:15:17,920
>> I CAN HEAR YOU, CHAZ.

5177
03:15:17,920 --> 03:15:18,560
>> YOU CAN?

5178
03:15:18,560 --> 03:15:23,880
OKAY.

5179
03:15:23,880 --> 03:15:25,040
>> SHE'S MAYBE HAVING A

5180
03:15:25,040 --> 03:15:25,760
MICROPHONE PROBLEM.

5181
03:15:25,760 --> 03:15:29,600
IF YOU WANT, I'M HAPPY TO --

5182
03:15:29,600 --> 03:15:32,080
JUST KIND OF LOOKING AT THE

5183
03:15:32,080 --> 03:15:34,400
NOTES FROM THE BREAKOUT SESSION

5184
03:15:34,400 --> 03:15:36,480
FOR GEOGRAPHY ONE THING THAT WAS

5185
03:15:36,480 --> 03:15:38,240
TALKED ABOUT, JUST A GENERAL

5186
03:15:38,240 --> 03:15:41,600
COMMENT, ALL OF THESE BREAKOUT

5187
03:15:41,600 --> 03:15:43,880
SESSIONS, YOU KNOW, ALL THE ONES

5188
03:15:43,880 --> 03:15:47,680
I WAS PARTAKING IN HAD GREAT

5189
03:15:47,680 --> 03:15:49,280
CONVERSATION, THE CLOCK RAN OUT

5190
03:15:49,280 --> 03:15:51,720
ON EACH OF THEM.

5191
03:15:51,720 --> 03:15:53,960
BUT FOR SOME OF THE HIGHLIGHTS

5192
03:15:53,960 --> 03:16:00,200
THAT I SAW IN A SCRIPT TEMPLATES

5193
03:16:00,200 --> 03:16:01,400
SENT TO ME DISCUSSING

5194
03:16:01,400 --> 03:16:03,280
EDUCATIONAL BARRIERS FOR

5195
03:16:03,280 --> 03:16:05,480
PROVIDERS AND PATIENTS AND

5196
03:16:05,480 --> 03:16:08,080
UNDERSERVED AREAS.

5197
03:16:08,080 --> 03:16:10,480
EDUCATION BARRIERS FOR

5198
03:16:10,480 --> 03:16:11,680
PROVIDERS, I IMAGINE

5199
03:16:11,680 --> 03:16:13,120
INCORPORATION ESPECIALLY FOR

5200
03:16:13,120 --> 03:16:15,440
RURAL SETTINGS JUST THE LOWER

5201
03:16:15,440 --> 03:16:16,840
FREQUENCY BY WHICH PRE-HOSPITAL

5202
03:16:16,840 --> 03:16:18,360
PROVIDERS MAY HAVE ACTUAL STROKE

5203
03:16:18,360 --> 03:16:23,960
ALERTS AND, YOU KNOW, CONTRASTED

5204
03:16:23,960 --> 03:16:25,480
TO AN URBAN SETTING.

5205
03:16:25,480 --> 03:16:28,440
FOR INSTANCE SOME RURAL

5206
03:16:28,440 --> 03:16:29,200
COMMUNITY SETTINGS WITH

5207
03:16:29,200 --> 03:16:31,680
VOLUNTEER EMS MAY SEE NO MORE

5208
03:16:31,680 --> 03:16:34,520
THAN FIVE STROKE ALERTS IN A

5209
03:16:34,520 --> 03:16:36,640
SIX-MONTH TIME PERIOD, IN A CITY

5210
03:16:36,640 --> 03:16:39,960
SETTING THERE MAY BE 3,000 

5211
03:16:39,960 --> 03:16:42,360
STROKE ALERTS PER YEAR.

5212
03:16:42,360 --> 03:16:46,640
EDUCATION AS WELL ON THE PART OF

5213
03:16:46,640 --> 03:16:48,160
PATIENTS IN THESE UNDERSERVED

5214
03:16:48,160 --> 03:16:50,800
AREAS CAN HAVE DIFFERENT AND

5215
03:16:50,800 --> 03:16:51,640
UNIQUE LOGISTICAL BARRIERS AND

5216
03:16:51,640 --> 03:16:58,080
CHALLENGES.

5217
03:16:58,080 --> 03:16:58,880
 

5218
03:16:58,880 --> 03:17:05,320
ANOTHER THING TO HIGHLIGHT FROM 

5219
03:17:05,320 --> 03:17:07,720
THE GROUP WAS INCENTIVES FOR EMS

5220
03:17:07,720 --> 03:17:08,880
TO SPECIALIZE IN STROKE IF

5221
03:17:08,880 --> 03:17:13,840
POSSIBLE AND CERTAINLY, YOU 

5222
03:17:13,840 --> 03:17:15,720
KNOW, TO GARNER   THE

5223
03:17:15,720 --> 03:17:19,680
APPROPRIATE CERTIFICATIONS AND

5224
03:17:19,680 --> 03:17:22,400
PERFORMANCE MODULES FOR

5225
03:17:22,400 --> 03:17:24,680
PRE-HOSPITAL SCALES THAT EXIST

5226
03:17:24,680 --> 03:17:25,680
FOR PRE-HOSPITAL PROVIDERS.

5227
03:17:25,680 --> 03:17:27,320
ANOTHER CHALLENGE AS WELL KIND

5228
03:17:27,320 --> 03:17:30,280
OF UNIQUE TO THE RURAL SETTING

5229
03:17:30,280 --> 03:17:33,560
IS WITH REGARDS TO

5230
03:17:33,560 --> 03:17:40,840
AMBULANCE-BASED  TELL MEDICINE.

5231
03:17:40,840 --> 03:17:44,520
THERE CAN BE IMPAIRED ACCESS TO

5232
03:17:44,520 --> 03:17:46,000
CELLULAR COVERAGE.

5233
03:17:46,000 --> 03:17:49,040
SO THAT'S ANOTHER BARRIER IN THE

5234
03:17:49,040 --> 03:17:51,680
RURAL SETTING THAT'S NOT PRESENT

5235
03:17:51,680 --> 03:17:53,800
IN URBAN SETTINGS REGARDING

5236
03:17:53,800 --> 03:17:56,920
CONNECTIVITY AND USING OTHER

5237
03:17:56,920 --> 03:17:59,560
THINGS TO ENABLE THE UTILIZATION

5238
03:17:59,560 --> 03:18:00,680
OF PRE-HOSPITAL TELEMEDICINE.

5239
03:18:00,680 --> 03:18:02,960
ANY OTHER PEOPLE WHO WERE IN

5240
03:18:02,960 --> 03:18:03,440
THAT BREAKOUT SESSION?

5241
03:18:03,440 --> 03:18:04,840
I DON'T KNOW IF THERE'S OTHER

5242
03:18:04,840 --> 03:18:07,520
POINTS TO ADD OR IF THERE WERE

5243
03:18:07,520 --> 03:18:09,040
THINGS I MISREPRESENTED, BUT

5244
03:18:09,040 --> 03:18:10,040
HAPPY TO HEAR ANYBODY ELSE'S

5245
03:18:10,040 --> 03:18:12,560
THOUGHTS.

5246
03:18:12,560 --> 03:18:17,400
 

5247
03:18:17,400 --> 03:18:18,920
>> CHAZ, IN THE GEOGRAPHY THING,

5248
03:18:18,920 --> 03:18:23,120
I HEARD A FEW COMMENTS ABOUT

5249
03:18:23,120 --> 03:18:24,160
REGIONALIZATION, LOOKING AT THE

5250
03:18:24,160 --> 03:18:27,000
EMS AND HEALTH CARE SYSTEM IN A

5251
03:18:27,000 --> 03:18:28,960
REGIONAL WAY, NOT NECESSARILY A

5252
03:18:28,960 --> 03:18:30,640
CITY OR A PARTICULAR STATE OR

5253
03:18:30,640 --> 03:18:31,520
SOMETHING LIKE THAT.

5254
03:18:31,520 --> 03:18:34,320
AND I THINK THAT HAS SOME

5255
03:18:34,320 --> 03:18:35,440
TRACTION BECAUSE I THINK WE NEED

5256
03:18:35,440 --> 03:18:39,280
TO LOOK AT OPPORTUNITIES TO

5257
03:18:39,280 --> 03:18:40,360
REMOVE ARTIFICIAL BARRIERS, AND

5258
03:18:40,360 --> 03:18:43,080
-- YOU KNOW, I USE STATE LINES

5259
03:18:43,080 --> 03:18:44,080
AS ARTIFICIAL BARRIERS.

5260
03:18:44,080 --> 03:18:47,200
I MEAN, THE STROKE DOESN'T CARE

5261
03:18:47,200 --> 03:18:48,480
WHETHER IT'S ON THIS OR THAT

5262
03:18:48,480 --> 03:18:49,280
SIDE OF THE STATE LINE.

5263
03:18:49,280 --> 03:18:51,680
WE NEED TO GET THE PATIENT TO

5264
03:18:51,680 --> 03:18:52,480
THE MOST APPROPRIATE CARE

5265
03:18:52,480 --> 03:18:53,680
FACILITY, WHETHER IT'S ON THIS

5266
03:18:53,680 --> 03:18:55,200
SIDE OR THAT SIDE OF THE STATE

5267
03:18:55,200 --> 03:18:58,480
LINE I THINK WE NEED TO DO A

5268
03:18:58,480 --> 03:19:01,560
BETTER JOB REGIONALIZING THESE

5269
03:19:01,560 --> 03:19:03,640
RESPONSE SYSTEMS, YOU KNOW, ALSO

5270
03:19:03,640 --> 03:19:05,600
SO THAT WE NEED TO, YOU KNOW,

5271
03:19:05,600 --> 03:19:07,680
OVERCOME ANY OF THESE

5272
03:19:07,680 --> 03:19:09,760
DISPARITIES BECAUSE LET'S BE

5273
03:19:09,760 --> 03:19:10,840
HONEST, SOMETIMES HAVE MORE

5274
03:19:10,840 --> 03:19:11,720
RESOURCES THAN OTHERS, AND I

5275
03:19:11,720 --> 03:19:15,000
VIEW THAT AS A DISPARITY.

5276
03:19:15,000 --> 03:19:17,360
BUT THAT SHOULDN'T BE A BARRIER

5277
03:19:17,360 --> 03:19:20,120
TO STATE-OF-THE-ART STROKE CARE.

5278
03:19:20,120 --> 03:19:28,080
 

5279
03:19:28,080 --> 03:19:30,440
ANY OTHER COMMENTS ABOUT

5280
03:19:30,440 --> 03:19:36,960
GEOGRAPHIC BARRIERS FOR EMS OR

5281
03:19:36,960 --> 03:19:41,480
OUT-OF-HOSPITAL CARE?

5282
03:19:41,480 --> 03:19:41,880
 

5283
03:19:41,880 --> 03:19:44,480
IF NOT, THE NEXT TOPIC I SEE IS,

5284
03:19:44,480 --> 03:19:49,000
AGAIN, THIS IS IN THE

5285
03:19:49,000 --> 03:19:50,240
PRE-HOSPITAL ARENA, SHERYL, IF

5286
03:19:50,240 --> 03:19:54,920
YOU WANT TO MAKE A FEW COMMENTS.

5287
03:19:54,920 --> 03:19:55,400
>> HELLO.

5288
03:19:55,400 --> 03:19:59,080
WE DIDN'T RECEIVE ANY

5289
03:19:59,080 --> 03:20:02,560
CORRECTIONS IN TERMS  OF A GAP

5290
03:20:02,560 --> 03:20:03,680
TO CONSIDER.

5291
03:20:03,680 --> 03:20:04,520
WE DISCUSSED MOBILE STROKE UNITS

5292
03:20:04,520 --> 03:20:06,720
IN TERMS OF WHAT THE FUNDING

5293
03:20:06,720 --> 03:20:08,880
SOURCE SHOULD BE, WHO WOULD HAVE

5294
03:20:08,880 --> 03:20:10,000
CONTROL, WHO PARTICIPATES, HOW

5295
03:20:10,000 --> 03:20:12,080
TO PREVENT IT FROM BEING USED TO

5296
03:20:12,080 --> 03:20:15,040
INCREASE MARKET SHARE, AND HOW

5297
03:20:15,040 --> 03:20:15,800
MANAGEMENT COULD BE

5298
03:20:15,800 --> 03:20:17,880
COLLABORATIVE, THE GROUP WAS IN

5299
03:20:17,880 --> 03:20:19,240
AGREEMENT THAT MSUs SHOULD NOT

5300
03:20:19,240 --> 03:20:23,120
BE USED AS A STRATEGY TO

5301
03:20:23,120 --> 03:20:24,560
INCREASE MARKET SHARE TAKING

5302
03:20:24,560 --> 03:20:27,000
PATIENTS AWAY FROM CLOSER

5303
03:20:27,000 --> 03:20:30,080
APPROPRIATE FACILITIES TO THE

5304
03:20:30,080 --> 03:20:33,560
MOTHER SHIP.

5305
03:20:33,560 --> 03:20:37,400
USING SUCH A THING AS LIKE A

5306
03:20:37,400 --> 03:20:39,880
COMMUNICATION CENTER, AND

5307
03:20:39,880 --> 03:20:41,280
EMPLOYING A PROTOCOL, AND ALL

5308
03:20:41,280 --> 03:20:43,200
STATES SHOULD HAVE PROTOCOLS FOR

5309
03:20:43,200 --> 03:20:44,800
INITIAL DESTINATION, WHICH CAN

5310
03:20:44,800 --> 03:20:46,720
BE REGIONALIZED WHEN IT'S

5311
03:20:46,720 --> 03:20:48,280
APPROPRIATE, DIRECTING PATIENTS

5312
03:20:48,280 --> 03:20:49,600
TO THE CLOSEST APPROPRIATE

5313
03:20:49,600 --> 03:20:53,520
FACILITY BASED ON THEIR SYMPTOM,

5314
03:20:53,520 --> 03:21:02,280
TIME OF SYMPTOM DETECTION AND

5315
03:21:02,280 --> 03:21:06,320
SCREENING, CAN WE AGREE TO 

5316
03:21:06,320 --> 03:21:07,840
STANDARDIZE EDUCATION FOR

5317
03:21:07,840 --> 03:21:08,480
PRE-HOSPITAL PROVIDERS AT

5318
03:21:08,480 --> 03:21:09,160
NATIONAL LEVEL.

5319
03:21:09,160 --> 03:21:11,560
IN ABSENCE OF THIS USING

5320
03:21:11,560 --> 03:21:13,120
TELESTROKE TO BRING A NEURALLIST

5321
03:21:13,120 --> 03:21:16,600
TO  -- NEUROLOGIST TO THE BACK

5322
03:21:16,600 --> 03:21:18,880
OF THE AMBULANCE CAN IMPROVE

5323
03:21:18,880 --> 03:21:20,520
ACCURACY OF SCREENING TOOLS, AT

5324
03:21:20,520 --> 03:21:22,400
LEAST A TARGET FOR A RESEARCH

5325
03:21:22,400 --> 03:21:26,080
PROJECT TO PROVE THAT USING

5326
03:21:26,080 --> 03:21:27,000
TELESTROKE CAN INCREASE ACCURACY

5327
03:21:27,000 --> 03:21:28,520
OF SCREENING TOOLS TO

5328
03:21:28,520 --> 03:21:33,560
DISTINGUISH THOSE WHO DON'T HAVE

5329
03:21:33,560 --> 03:21:36,280
A LARGE VASCULAR OCCLUSION FROM

5330
03:21:36,280 --> 03:21:38,160
THOSE WHO MAY.

5331
03:21:38,160 --> 03:21:38,680
WE DISCUSSED PRE-HOSPITAL

5332
03:21:38,680 --> 03:21:39,880
REIMBURSEMENT AND HOW TO TIE IT

5333
03:21:39,880 --> 03:21:45,960
TO THE COMPLEXITY OF THE CARE 

5334
03:21:45,960 --> 03:21:46,520
PROVIDED.

5335
03:21:46,520 --> 03:21:48,480
BY ADDING ADDITIONAL METRIC, WAS

5336
03:21:48,480 --> 03:21:50,920
GLUCOSE CHECKED, DID THE

5337
03:21:50,920 --> 03:21:51,480
PROTOCOL GET FOLLOWED, DID

5338
03:21:51,480 --> 03:21:55,080
PATIENT GO TO THE CLOSEST

5339
03:21:55,080 --> 03:21:56,080
APPROPRIATE FACILITY BASED ON

5340
03:21:56,080 --> 03:21:59,480
PROTOCOL, DID THEY REQUIRE A

5341
03:21:59,480 --> 03:22:01,200
SECONDARY TRANSFER, IF SO IS IT

5342
03:22:01,200 --> 03:22:04,240
POSSIBLE THAT SECONDARY TRANSFER

5343
03:22:04,240 --> 03:22:06,080
COULD HAVE BEEN AVOIDED?

5344
03:22:06,080 --> 03:22:08,720
WE DISCUSSED LINKAGE OF

5345
03:22:08,720 --> 03:22:10,680
PRE-HOSPITAL TO HOSPITAL DATA,

5346
03:22:10,680 --> 03:22:12,120
IT'S COMPLEX BECAUSE IF WE'RE

5347
03:22:12,120 --> 03:22:14,080
RELYING ON HOSPITALS TO SUBMIT

5348
03:22:14,080 --> 03:22:16,280
THAT DATA, THE HOSPITALS USUALLY

5349
03:22:16,280 --> 03:22:19,560
GO THROUGH A BAA TO GAIN ACCESS

5350
03:22:19,560 --> 03:22:21,720
TO THOSE PRE-HOSPITAL CARE

5351
03:22:21,720 --> 03:22:23,720
REPORTS FROM A SPECIFIC EMS

5352
03:22:23,720 --> 03:22:25,880
ENTITY AND MANY HOSPITALS

5353
03:22:25,880 --> 03:22:27,760
RECEIVE PATIENTS FROM MULTIPLE

5354
03:22:27,760 --> 03:22:29,280
EMS ENTITIES AND HOW MIGHT WE

5355
03:22:29,280 --> 03:22:31,880
MAKE IT SUCH THAT A LIMITED DATA

5356
03:22:31,880 --> 03:22:36,400
IS THE  -- DATASET WOULD BE ABLE

5357
03:22:36,400 --> 03:22:39,040
TO BE SHARED WITH ANOTHER ENTITY

5358
03:22:39,040 --> 03:22:40,880
WITH THE AGGREGATED DATA FOR

5359
03:22:40,880 --> 03:22:42,360
THAT REGION OR STATE.

5360
03:22:42,360 --> 03:22:48,480
WE DISCUSSED PRE-HOSPITAL

5361
03:22:48,480 --> 03:22:52,280
EDUCATION, IDEALLY A NATIONAL 

5362
03:22:52,280 --> 03:22:54,480
GROUP OF PEERS TO CREATE A

5363
03:22:54,480 --> 03:22:56,280
SYMPOSIUM POSTED ON A WEBSITE

5364
03:22:56,280 --> 03:22:57,440
SUCH THAT ANYONE AT ANY TIME IN

5365
03:22:57,440 --> 03:22:59,640
THE STATE WOULD BE ABLE TO GAIN

5366
03:22:59,640 --> 03:23:01,160
ACCESS TO THAT BUT THAT EACH

5367
03:23:01,160 --> 03:23:04,080
STATE OR REGION WOULD HAVE TO

5368
03:23:04,080 --> 03:23:07,160
HAVE LOCAL EDUCATORS FOR THE EMS

5369
03:23:07,160 --> 03:23:09,800
PRACTITIONERS SO THERE CAN BE

5370
03:23:09,800 --> 03:23:11,800
SOME INDIVIDUALIZATION IN THOSE

5371
03:23:11,800 --> 03:23:12,440
REGIONS.

5372
03:23:12,440 --> 03:23:17,880
WE COULD HAVE A COHESIVE

5373
03:23:17,880 --> 03:23:20,080
NATIONAL PLATFORM AND THEN HAVE

5374
03:23:20,080 --> 03:23:22,080
AN OPPORTUNITY AT THE END FOR

5375
03:23:22,080 --> 03:23:23,800
SOME INDIVIDUALIZATION TO BE

5376
03:23:23,800 --> 03:23:27,200
ADDED FOR THAT REGION OR STATE.

5377
03:23:27,200 --> 03:23:29,920
THAT'S THE GIST OF WHAT WE

5378
03:23:29,920 --> 03:23:30,320
DISCUSSED.

5379
03:23:30,320 --> 03:23:31,880
AND THEN WE RAN OUT OF TIME.

5380
03:23:31,880 --> 03:23:33,560
THE SESSION COULD HAVE GONE ON A

5381
03:23:33,560 --> 03:23:35,160
LOT LONGER BUT WE WERE OUT OF

5382
03:23:35,160 --> 03:23:37,280
TIME.

5383
03:23:37,280 --> 03:23:38,800
>> THANK YOU, SHERYL.

5384
03:23:38,800 --> 03:23:40,480
I ALSO RECALL YOU MAY HAVE

5385
03:23:40,480 --> 03:23:43,480
TOUCHED ON THIS BUT I THINK THIS

5386
03:23:43,480 --> 03:23:44,800
FITS UNDER PROBABLY POLICY,

5387
03:23:44,800 --> 03:23:47,080
MAYBE A LITTLE BIT ECONOMICS, IS

5388
03:23:47,080 --> 03:23:50,600
THAT THE NUMBER OF EMS PROVIDERS

5389
03:23:50,600 --> 03:23:51,880
HAS DECREASED SUBSTANTIALLY.

5390
03:23:51,880 --> 03:23:55,000
SO MAYBE THERE NEED TO BE SOME

5391
03:23:55,000 --> 03:23:56,080
POLICY CHANGES TO INCENTIVIZE

5392
03:23:56,080 --> 03:23:59,000
PEOPLE, MORE PEOPLE TO GO INTO

5393
03:23:59,000 --> 03:24:01,880
EMS, GET EMS TRAINING, NOT LEAVE

5394
03:24:01,880 --> 03:24:04,080
THE FIELD, I THINK THAT'S AN

5395
03:24:04,080 --> 03:24:05,120
OVERRIDING POLICY THING THAT I

5396
03:24:05,120 --> 03:24:06,240
HEARD IN SOME OF THE

5397
03:24:06,240 --> 03:24:06,640
DISCUSSIONS.

5398
03:24:06,640 --> 03:24:07,880
WOULD YOU AGREE WITH THAT?

5399
03:24:07,880 --> 03:24:09,080
>> I WOULD.

5400
03:24:09,080 --> 03:24:10,880
AND I'D SAY DURING THIS

5401
03:24:10,880 --> 03:24:13,560
EMERGENCY DECLARATION, AT LEAST

5402
03:24:13,560 --> 03:24:16,280
IN OUR STATE, BARRIERS WERE

5403
03:24:16,280 --> 03:24:18,680
MOVED AND ACTUALLY THE INSULT,

5404
03:24:18,680 --> 03:24:21,880
CALLING SOMEBODY AN AMBULANCE

5405
03:24:21,880 --> 03:24:33,200
DRIVER    ALLOWED PEOPLE TO

5406
03:24:33,200 --> 03:24:35,680
BECOME AMBULANCE DRIVERS WITHOUT

5407
03:24:35,680 --> 03:24:36,800
BEING PARAMEDIC OR EMT, LOOKING

5408
03:24:36,800 --> 03:24:38,680
AT QUALITY OF CARE WHEN DELIVERY

5409
03:24:38,680 --> 03:24:42,240
DRIVER IS NOT AS HIGHLY

5410
03:24:42,240 --> 03:24:44,520
QUALIFIED AS MEDIC OR EMT.

5411
03:24:44,520 --> 03:24:46,120
>> YEAH, DON'T LET THE PERFECT

5412
03:24:46,120 --> 03:24:49,440
BE THE MEN OF -- ENEMY OF THE

5413
03:24:49,440 --> 03:24:49,640
GOOD.

5414
03:24:49,640 --> 03:24:53,280
THANK YOU FOR THAT REPORT.

5415
03:24:53,280 --> 03:24:55,320
COMMANDER ODOM, ECONOMIC ISSUES?

5416
03:24:55,320 --> 03:24:57,080
>> YES, SURE.

5417
03:24:57,080 --> 03:24:58,600
SOME OF THE OUTSTANDING

5418
03:24:58,600 --> 03:25:01,240
QUESTIONS OR GAPS, AS YOU

5419
03:25:01,240 --> 03:25:03,400
MENTIONED, RELATED TO EMS

5420
03:25:03,400 --> 03:25:07,200
PROVIDERS AND MANY OF THEM BEING

5421
03:25:07,200 --> 03:25:10,040
VOLUNTEER STAFF AROUND THE

5422
03:25:10,040 --> 03:25:12,480
COUNTRY, PARTICULARLY IN THOSE

5423
03:25:12,480 --> 03:25:15,440
RURAL AREAS, UNDERSTANDING HOW

5424
03:25:15,440 --> 03:25:19,680
STANDARDIZATION OF REIMBURSEMENT

5425
03:25:19,680 --> 03:25:21,000
FOR PROCEDURES THEY DO WITHIN

5426
03:25:21,000 --> 03:25:29,440
AMBULANCE, HOW THEY COULD BE  

5427
03:25:29,440 --> 03:25:30,840
STANDARDIZED, THERE'S CURRENTLY

5428
03:25:30,840 --> 03:25:34,000
LITTLE TO NO REIMBURSEMENT 

5429
03:25:34,000 --> 03:25:35,600
AROUND ISSUES OF STROKE BECAUSE

5430
03:25:35,600 --> 03:25:36,640
WE'RE PROCEDURE BASED.

5431
03:25:36,640 --> 03:25:39,880
THE NEED FOR A NATIONAL STROKE

5432
03:25:39,880 --> 03:25:43,760
REGISTRY TO IDENTIFY CONSISTENT

5433
03:25:43,760 --> 03:25:49,480
DATA ON DISPARITIES 

5434
03:25:49,480 --> 03:25:50,080
S YSTEMATICICALLY, UNDERSTANDING

5435
03:25:50,080 --> 03:25:50,760
METRICS, IN TERMS OF COLLECTION

5436
03:25:50,760 --> 03:25:51,400
OF DATA.

5437
03:25:51,400 --> 03:25:56,680
AND THEN UNDERSTANDING 

5438
03:25:56,680 --> 03:26:00,600
UNDERSTANDING UTILITY OF

5439
03:26:00,600 --> 03:26:01,480
TELESTROKE AND TELEMEDICINE, AT

5440
03:26:01,480 --> 03:26:03,080
DISPATCH AS WELL AS DISCHARGE,

5441
03:26:03,080 --> 03:26:04,280
PROVIDING EDUCATION TO PATIENTS

5442
03:26:04,280 --> 03:26:05,840
AT THEIR HOME.

5443
03:26:05,840 --> 03:26:08,880
THOSE WERE SOME GAPS TO

5444
03:26:08,880 --> 03:26:09,280
CONSIDER.

5445
03:26:09,280 --> 03:26:13,680
AND THEN SOME NEW BEST PRACTICES

5446
03:26:13,680 --> 03:26:15,920
AND SOLUTIONS TO CONSIDER

5447
03:26:15,920 --> 03:26:16,880
INCLUDED CONSIDER SUPPORTING

5448
03:26:16,880 --> 03:26:21,280
COMMUNITY EDUCATION VIA OTHER

5449
03:26:21,280 --> 03:26:22,800
TRUSTED MEMBERS OUTSIDE OF

5450
03:26:22,800 --> 03:26:24,240
PHYSICIANS, SO OTHER TRUSTED

5451
03:26:24,240 --> 03:26:26,720
MEMBERS OF SOCIETY INCLUDING

5452
03:26:26,720 --> 03:26:30,040
NURSES, PHARMACISTS, COMMUNITY

5453
03:26:30,040 --> 03:26:32,080
HEALTH WORKERS.

5454
03:26:32,080 --> 03:26:33,080
TESTING IMPLEMENTATION OF

5455
03:26:33,080 --> 03:26:35,440
VARIOUS EDUCATIONAL TOOLS,

5456
03:26:35,440 --> 03:26:37,120
COMMUNITY EDUCATIONAL TOOLS

5457
03:26:37,120 --> 03:26:39,880
THROUGH VARIOUS METHODOLOGIES,

5458
03:26:39,880 --> 03:26:42,120
AND DISSEMINATING THAT THROUGH

5459
03:26:42,120 --> 03:26:42,560
RESEARCH.

5460
03:26:42,560 --> 03:26:46,080
IDENTIFYING BARRIERS TO USE OF

5461
03:26:46,080 --> 03:26:48,040
911 INCLUDING MISTRUST OF LOCAL

5462
03:26:48,040 --> 03:26:52,440
AUTHORITIES, IMPACT OF RACE AND 

5463
03:26:52,440 --> 03:26:54,800
RACIAL TENSIONS IN SOCIETY.

5464
03:26:54,800 --> 03:26:57,080
AND THAT IN CALLING EMS BEING A

5465
03:26:57,080 --> 03:26:58,200
PRIVATE ISSUE VERSUS WHAT YOUR

5466
03:26:58,200 --> 03:27:02,080
NEIGHBORS MAY KNOW.

5467
03:27:02,080 --> 03:27:05,960
AND THEN, AGAIN, THE ISSUE OF

5468
03:27:05,960 --> 03:27:08,320
INCENTIVIZING EVEN HIGH

5469
03:27:08,320 --> 03:27:12,280
SCHOOLERS TO GO INTO THE EMS

5470
03:27:12,280 --> 03:27:14,040
PROFESSION, HOW CAN WE ADD THAT

5471
03:27:14,040 --> 03:27:16,720
AS A SOLUTION TO INCREASED

5472
03:27:16,720 --> 03:27:19,360
DIVERSITY AMONG EMS.

5473
03:27:19,360 --> 03:27:23,680
  PROFESSION.

5474
03:27:23,680 --> 03:27:25,320
>> THANK YOU, COMMANDER ODOM.

5475
03:27:25,320 --> 03:27:28,280
I JOTTED DOWN SOMETHING THAT

5476
03:27:28,280 --> 03:27:29,800
HADN'T OCCURRED TO ME BUT HAS

5477
03:27:29,800 --> 03:27:31,680
OCCURRED TO OTHER PEOPLE, THE

5478
03:27:31,680 --> 03:27:34,680
FACT WHEN PATIENTS CALL EMS THEY

5479
03:27:34,680 --> 03:27:36,280
GET A BILL FOR PROBABLY

5480
03:27:36,280 --> 03:27:36,880
THOUSANDS OF DOLLARS.

5481
03:27:36,880 --> 03:27:41,920
AND THAT MAY BE A BARRIER OR A

5482
03:27:41,920 --> 03:27:43,000
DISINCENTIVE, ESPECIALLY IF

5483
03:27:43,000 --> 03:27:45,480
THESE ARE DISADVANTAGED FOLKS OR

5484
03:27:45,480 --> 03:27:46,920
POPULATIONS WHO FRANKLY CAN'T

5485
03:27:46,920 --> 03:27:47,800
AFFORD IT.

5486
03:27:47,800 --> 03:27:50,440
SO I THINK THAT'S SOMETHING THAT

5487
03:27:50,440 --> 03:27:52,600
WE ALSO NEED TO INCLUDE IN THE

5488
03:27:52,600 --> 03:27:55,440
FINAL DOCUMENT TO REMOVE THE

5489
03:27:55,440 --> 03:27:57,000
FINANCIAL BARRIERS TO CALLING

5490
03:27:57,000 --> 03:27:57,160
EMS.

5491
03:27:57,160 --> 03:27:58,720
EVEN THOUGH IT MAY COST A FEW

5492
03:27:58,720 --> 03:28:00,680
THOUSAND DOLLARS UP FRONT, IF

5493
03:28:00,680 --> 03:28:02,760
THEY CAN GET TREATED AND THE

5494
03:28:02,760 --> 03:28:04,080
TREATMENT IS EFFECTIVE AND GETS

5495
03:28:04,080 --> 03:28:06,840
THEM BACK TO THEIR NORMAL STATE,

5496
03:28:06,840 --> 03:28:08,480
LONG TERM, YOU GET A LOT OF BANG

5497
03:28:08,480 --> 03:28:10,080
FOR THE BUCK.

5498
03:28:10,080 --> 03:28:13,360
SHORT TERM PEOPLE SEE THAT AS

5499
03:28:13,360 --> 03:28:15,320
UNWANTED EXPENSE, ESPECIALLY IN

5500
03:28:15,320 --> 03:28:15,960
CHALLENGED POPULATIONS WITH

5501
03:28:15,960 --> 03:28:21,480
LIMITED FINANCES. 

5502
03:28:21,480 --> 03:28:22,120
OKAY.

5503
03:28:22,120 --> 03:28:23,080
THANK YOU.

5504
03:28:23,080 --> 03:28:25,280
NEXT IN TERMS OF DEMOGRAPHICS,

5505
03:28:25,280 --> 03:28:29,000
CHARLES, DO YOU WANT TO DO THAT?

5506
03:28:29,000 --> 03:28:29,480
>> SURE.

5507
03:28:29,480 --> 03:28:30,080
HAPPY TO.

5508
03:28:30,080 --> 03:28:31,440
AND THAT POINT THAT YOU RAISED

5509
03:28:31,440 --> 03:28:33,680
ABOUT JUST THE COST OF EMS,

5510
03:28:33,680 --> 03:28:35,480
YOU'RE ABSOLUTELY RIGHT.

5511
03:28:35,480 --> 03:28:36,880
I MEAN, IT'S FOUR DIGITS.

5512
03:28:36,880 --> 03:28:38,960
AND CERTAINLY SOMETHING TO

5513
03:28:38,960 --> 03:28:39,400
INCORPORATE.

5514
03:28:39,400 --> 03:28:40,480
FOR THE DEMOGRAPHIC JUST GOING

5515
03:28:40,480 --> 03:28:42,000
THROUGH THE HIGHLIGHTS OF THINGS

5516
03:28:42,000 --> 03:28:44,880
THAT WE DISCUSSED IN OUR

5517
03:28:44,880 --> 03:28:46,280
CONVERSATION, WE TALKED ABOUT

5518
03:28:46,280 --> 03:28:47,680
UTILIZING MULTIPLE COMPONENTS OF

5519
03:28:47,680 --> 03:28:50,320
THE STROKE SYSTEM TO PERFORM

5520
03:28:50,320 --> 03:28:53,280
COMMUNITY ENGAGEMENT AND

5521
03:28:53,280 --> 03:28:54,840
EDUCATION, HOSPITAL STAFF,

5522
03:28:54,840 --> 03:28:56,480
EMERGENCY PHYSICIANS, STROKE

5523
03:28:56,480 --> 03:28:58,640
TEAMS, EMS, RECOGNIZING THERE

5524
03:28:58,640 --> 03:29:04,560
ARE DIFFERENT BARRIERS AND 

5525
03:29:04,560 --> 03:29:06,200
STRAINS ON DISCIPLINES,

5526
03:29:06,200 --> 03:29:07,480
DIFFERENT SETTINGS.

5527
03:29:07,480 --> 03:29:08,880
SECOND CONSIDERING

5528
03:29:08,880 --> 03:29:09,720
IDENTIFICATION ANT UTILIZATION

5529
03:29:09,720 --> 03:29:15,360
OF COMMUNITY  CHAMPIONS TO WORK

5530
03:29:15,360 --> 03:29:18,080
WITH STROKE CENTERS, TO

5531
03:29:18,080 --> 03:29:20,200
COMPLEMENT AND ENHANCE STROKE

5532
03:29:20,200 --> 03:29:21,920
EDUCATION IN TERMS OF

5533
03:29:21,920 --> 03:29:27,880
IDENTIFICATION, PREVENTION, NINE

5534
03:29:27,880 --> 03:29:29,800
ONE ONE UTILIZATION, A BRIDGE

5535
03:29:29,800 --> 03:29:33,480
FOR THE BIDIRECTIONAL

5536
03:29:33,480 --> 03:29:34,680
COMMUNICATION THAT'S NECESSARY

5537
03:29:34,680 --> 03:29:36,120
TO ENGAGE COMMUNITIES.

5538
03:29:36,120 --> 03:29:39,760
NEXT WAS THE TRANSLATION OF KEY

5539
03:29:39,760 --> 03:29:41,600
STROKE EDUCATIONAL RESOURCES

5540
03:29:41,600 --> 03:29:43,680
INTO MOST PREVALENT LANGUAGES,

5541
03:29:43,680 --> 03:29:45,520
SPOKEN BY A PARTICULAR

5542
03:29:45,520 --> 03:29:46,480
COMMUNITY.

5543
03:29:46,480 --> 03:29:48,600
JUST AUGMENTATION OF STROKE

5544
03:29:48,600 --> 03:29:51,200
SYSTEM INTERACTION WITH

5545
03:29:51,200 --> 03:29:53,080
NON-ENGLISH SPEAKING

5546
03:29:53,080 --> 03:29:58,080
POPULATIONS, CORY GAVE THE

5547
03:29:58,080 --> 03:29:58,720
EXAMPLE OF CREATING

5548
03:29:58,720 --> 03:30:03,200
MULTI-LINGUAL STROKE RESOURCES

5549
03:30:03,200 --> 03:30:05,400
FOR DIFFERENT POPULATIONS.

5550
03:30:05,400 --> 03:30:06,480
NEXT WAS THE FURTHER

5551
03:30:06,480 --> 03:30:09,040
INCORPORATION OF CULTURAL AND

5552
03:30:09,040 --> 03:30:10,800
DEMOGRAPHIC COMPETENCY TRAINING,

5553
03:30:10,800 --> 03:30:17,000
AND ANNUAL ONGOING EMS EDUCATION

5554
03:30:17,000 --> 03:30:17,880
AND EMS PRE-CERTIFICATION

5555
03:30:17,880 --> 03:30:21,160
PROGRAMS FOR SEX, GENDER, RACE,

5556
03:30:21,160 --> 03:30:26,200
ECONOMIC DISPARITY SO THEY MAY 

5557
03:30:26,200 --> 03:30:27,600
BE EMPOWERED WITH KNOWLEDGE AND

5558
03:30:27,600 --> 03:30:29,160
THUS BE ABLE TO BETTER SERVE

5559
03:30:29,160 --> 03:30:33,160
WHATEVER COMMUNITY THEY END UP

5560
03:30:33,160 --> 03:30:33,640
WORKING IN.

5561
03:30:33,640 --> 03:30:36,160
AND THEN THERE WAS A LITTLE TALK

5562
03:30:36,160 --> 03:30:39,760
AS WELL ABOUT BUILDING FURTHER

5563
03:30:39,760 --> 03:30:41,800
UPON CURRENT NIH INITIATIVES

5564
03:30:41,800 --> 03:30:44,880
WITH SPECIFIC FOCUS ON STROKE,

5565
03:30:44,880 --> 03:30:46,400
PERFORMING RESEARCH INTO

5566
03:30:46,400 --> 03:30:48,240
DISPARITIES FOR EDUCATION,

5567
03:30:48,240 --> 03:30:49,560
ACCESS TO SYSTEM FOR LGBTQ

5568
03:30:49,560 --> 03:30:52,280
POPULATION WITH AIMS OF

5569
03:30:52,280 --> 03:30:53,920
UNDERSTANDS UNIQUE BARRIERS THAT

5570
03:30:53,920 --> 03:30:56,280
THEY EXPERIENCE AND CHALLENGES

5571
03:30:56,280 --> 03:30:57,640
FOR ACCESS AND TREATMENT.

5572
03:30:57,640 --> 03:30:59,160
IF ANYBODY ELSE IN OUR BREAKOUT

5573
03:30:59,160 --> 03:31:03,560
GROUP OF HAS ANY OTHER THINGS TO

5574
03:31:03,560 --> 03:31:04,200
ADD, CERTAINLY WELCOME AT THIS

5575
03:31:04,200 --> 03:31:06,600
TIME.

5576
03:31:06,600 --> 03:31:10,760
 

5577
03:31:10,760 --> 03:31:14,120
>> JUST LOOKING IN THE CHAT BOX

5578
03:31:14,120 --> 03:31:18,080
TO SEE IF THERE'S ANY COMMENTS.

5579
03:31:18,080 --> 03:31:25,440
 

5580
03:31:25,440 --> 03:31:26,080
OKAY.

5581
03:31:26,080 --> 03:31:28,880
I THINK WE'RE GOOD WITH THAT.

5582
03:31:28,880 --> 03:31:30,600
SO WE'RE GOING TO THANK YOU,

5583
03:31:30,600 --> 03:31:33,680
EVERYBODY, FOR THOSE REPORTS.

5584
03:31:33,680 --> 03:31:36,680
WE'RE GOING TO MOVE NOW TO THE

5585
03:31:36,680 --> 03:31:37,880
HYPER ACUTE AND ACUTE CARE,

5586
03:31:37,880 --> 03:31:39,440
WE'RE GOING TO GET COMMENTS,

5587
03:31:39,440 --> 03:31:41,560
FEEDBACK FROM THE TASK FORCE

5588
03:31:41,560 --> 03:31:41,760
LEADS.

5589
03:31:41,760 --> 03:31:43,440
I THINK THAT WOULD BE MORE

5590
03:31:43,440 --> 03:31:45,440
EFFICIENT THAN GOING FOR ALL THE

5591
03:31:45,440 --> 03:31:46,720
BREAKOUTS BUT, AGAIN, EVERYBODY

5592
03:31:46,720 --> 03:31:49,480
IN THE BREAKOUTS IS WELCOME TO

5593
03:31:49,480 --> 03:31:52,080
PROVIDE COMMENTS AND STUFF.

5594
03:31:52,080 --> 03:32:01,440
SO IN TERMS OF THE HYPER ACUTE

5595
03:32:01,440 --> 03:32:02,800
REPORTS, AMEER OR MARY.

5596
03:32:02,800 --> 03:32:04,120
>> I'LL START.

5597
03:32:04,120 --> 03:32:06,320
IN TERMS OF GEOGRAPHY ONE OF THE

5598
03:32:06,320 --> 03:32:08,160
THINGS WE DISCUSSED WAS THE IDEA

5599
03:32:08,160 --> 03:32:13,520
OF A MOBLING INTERVENTION --

5600
03:32:13,520 --> 03:32:15,080
MOBILE INTERVENTION TEAM TO

5601
03:32:15,080 --> 03:32:17,400
SUPPORT REGIONAL ACTRESS TO

5602
03:32:17,400 --> 03:32:18,040
THROMBECTOMY AND REDUCE

5603
03:32:18,040 --> 03:32:18,520
TRANSFERS.

5604
03:32:18,520 --> 03:32:20,640
OBVIOUSLY THIS IS GOING TO

5605
03:32:20,640 --> 03:32:23,160
REQUIRE TRAINING AND IS GOING TO

5606
03:32:23,160 --> 03:32:26,680
REQUIRE MAKING SURE THAT THE

5607
03:32:26,680 --> 03:32:28,880
HOSPITALS THAT HAVE CARDIAC CATH

5608
03:32:28,880 --> 03:32:31,720
SUITES HAVE THE ABILITY ALSO TO

5609
03:32:31,720 --> 03:32:33,880
STAFF THEM IN CASE YOU NEED

5610
03:32:33,880 --> 03:32:35,200
TO -- IN CASE YOU HAVE AN

5611
03:32:35,200 --> 03:32:37,160
OPERATOR GOING TO THE TEAM, YOU

5612
03:32:37,160 --> 03:32:39,160
NEED TO HAVE TECHNOLOGY STAFF

5613
03:32:39,160 --> 03:32:40,200
AND NURSING STAFF AVAILABLE,

5614
03:32:40,200 --> 03:32:41,640
WILLING TO DO IT.

5615
03:32:41,640 --> 03:32:43,280
WE ALSO TOUCHED ON THE

5616
03:32:43,280 --> 03:32:45,320
POSSIBILITY OF ULTIMATELY GOING

5617
03:32:45,320 --> 03:32:46,160
TO ROBOTIC INSTRUMENTATION LIKE

5618
03:32:46,160 --> 03:32:49,280
THEY ARE DOING IN SOME CORONARY

5619
03:32:49,280 --> 03:32:50,120
CASES WHERE THE OPERATOR DOESN'T

5620
03:32:50,120 --> 03:32:54,640
EVEN NEED TO BE AT THE HOSPITAL,

5621
03:32:54,640 --> 03:32:58,320
CAN ACTUALLY COME IN, USING

5622
03:32:58,320 --> 03:33:00,080
TELEMEDICINE AND PERFORM THE

5623
03:33:00,080 --> 03:33:00,680
PROCEDURE ROBOTICALLY.

5624
03:33:00,680 --> 03:33:03,680
THAT'S IN THE FUTURE.

5625
03:33:03,680 --> 03:33:05,880
BUT THERE ARE SOME CASES, BRAIN

5626
03:33:05,880 --> 03:33:10,120
CASES, THAT HAVE BEEN DONE,

5627
03:33:10,120 --> 03:33:12,880
ANEURYSM CASES, FROM A CARDIAC

5628
03:33:12,880 --> 03:33:13,200
STANDPOINT.

5629
03:33:13,200 --> 03:33:15,280
WE ALSO TOUCHED ON THE STUDENT

5630
03:33:15,280 --> 03:33:19,000
LOAN REPAYMENT PLAN, IN ORDER TO

5631
03:33:19,000 --> 03:33:20,520
EXTEND -- TRY AND GET MORE

5632
03:33:20,520 --> 03:33:23,800
STROKE NEUROLOGISTS TO GO INTO

5633
03:33:23,800 --> 03:33:26,800
AREAS THAT ARE HEALTH CARE, YOU

5634
03:33:26,800 --> 03:33:27,640
KNOW, DESERTS.

5635
03:33:27,640 --> 03:33:31,080
THAT WAS A GOOD IDEA AND

5636
03:33:31,080 --> 03:33:32,000
CERTAINLY WORTH PURSUING

5637
03:33:32,000 --> 03:33:32,240
FURTHER.

5638
03:33:32,240 --> 03:33:34,480
THE OTHER IDEA THAT CAME OUT OF

5639
03:33:34,480 --> 03:33:36,480
THAT TOO SINCE WE TOUCHED UPON

5640
03:33:36,480 --> 03:33:38,240
THE FACT THAT THERE'S ISSUES

5641
03:33:38,240 --> 03:33:42,320
WITH THE EMERGENCY MEDICINE

5642
03:33:42,320 --> 03:33:44,200
PHYSICIANS, PERHAPS NOT BEING

5643
03:33:44,200 --> 03:33:45,720
COMFORTABLE WITH STROKE WAS TO

5644
03:33:45,720 --> 03:33:47,280
ACTUALLY DEVELOP A GROUP OF

5645
03:33:47,280 --> 03:33:48,240
HEALTH CARE PROFESSIONALS SUCH

5646
03:33:48,240 --> 03:33:52,160
AS P.A.s OR NPS TRAINED IN

5647
03:33:52,160 --> 03:33:53,280
STROKE TO HELP SUPPORT THAT

5648
03:33:53,280 --> 03:33:56,040
MISSION IN THE E.D., TO IDENTIFY

5649
03:33:56,040 --> 03:33:59,520
AND TAKE CARE OF THOSE PATIENTS.

5650
03:33:59,520 --> 03:34:02,400
WE ALSO TALKED ABOUT THE FACT

5651
03:34:02,400 --> 03:34:05,360
THAT WE REALLY NEED RESEARCH IN

5652
03:34:05,360 --> 03:34:06,080
THIS AREA.

5653
03:34:06,080 --> 03:34:08,640
AND IT WAS INTERESTING YOUR

5654
03:34:08,640 --> 03:34:10,480
REMARK, MARK, THAT THE PROPOSALS

5655
03:34:10,480 --> 03:34:12,920
THAT ARE MADE TO STROKE NET

5656
03:34:12,920 --> 03:34:14,680
OFTEN GET VERY LOW SCORES SO

5657
03:34:14,680 --> 03:34:15,760
THEY DON'T GET FUNDED.

5658
03:34:15,760 --> 03:34:17,080
SO WE FEEL LIKE THERE NEEDS TO

5659
03:34:17,080 --> 03:34:21,080
BE A WAY TO GET THOSE SORT OF

5660
03:34:21,080 --> 03:34:24,280
STUDIES FUNDED SO WE CAN GET THE

5661
03:34:24,280 --> 03:34:25,600
RESEARCH THAT WE NEED AND MAYBE

5662
03:34:25,600 --> 03:34:29,320
THERE NEEDS TO BE A SEPARATE

5663
03:34:29,320 --> 03:34:32,160
GROUP OF FUNDING FOR THOSE SORT

5664
03:34:32,160 --> 03:34:36,760
OF PROPOSALS OUTSIDE OF SORT OF

5665
03:34:36,760 --> 03:34:43,160
THE OVERALL STROKENET FUNDING

5666
03:34:43,160 --> 03:34:43,840
THAT'S THERE.

5667
03:34:43,840 --> 03:34:46,760
I WAS IN THE GEOGRAPHY BREAKOUT

5668
03:34:46,760 --> 03:34:47,880
SESSION, WE TALKED ABOUT THOSE

5669
03:34:47,880 --> 03:34:49,640
THREE THINGS IN OUR HALF HOUR.

5670
03:34:49,640 --> 03:34:52,600
ONE THING WE TALKED ABOUT TOO

5671
03:34:52,600 --> 03:34:55,960
WAS ISSUES WITH THE STROKE --

5672
03:34:55,960 --> 03:34:59,280
HUB AND SPOKE MODEL, THE FACT

5673
03:34:59,280 --> 03:35:12,080
THAT PLACES WILL BE BYPASSED,

5674
03:35:12,080 --> 03:35:12,960
THE MOTHERSHIP PATHWAY, WE

5675
03:35:12,960 --> 03:35:14,480
NEEDED TO WORK ON BEING ABLE TO

5676
03:35:14,480 --> 03:35:16,560
SEND THE PATIENT TO THE

5677
03:35:16,560 --> 03:35:17,320
APPROPRIATE AND CLOSEST SITE

5678
03:35:17,320 --> 03:35:17,920
REGARDLESS OF WHETHER OR NOT

5679
03:35:17,920 --> 03:35:20,680
THEY ARE IN THE SAME HEALTH CARE

5680
03:35:20,680 --> 03:35:21,600
SYSTEM.

5681
03:35:21,600 --> 03:35:24,880
AND HOW DO YOU DO THAT WITH

5682
03:35:24,880 --> 03:35:25,880
REQUIRING THE COMMAND CENTER

5683
03:35:25,880 --> 03:35:27,960
THAT CAN ACTUALLY SEND THE

5684
03:35:27,960 --> 03:35:29,800
PATIENT TO THE APPROPRIATE

5685
03:35:29,800 --> 03:35:30,080
LOCATION.

5686
03:35:30,080 --> 03:35:31,800
SO THOSE WERE THE MAJOR THINGS

5687
03:35:31,800 --> 03:35:39,320
THAT I GOT OUT OF MY POLICY 

5688
03:35:39,320 --> 03:35:42,200
REGULATION AND GEOGRAPHY GROUP.

5689
03:35:42,200 --> 03:35:43,800
PERSONA, WHAT DID YOU TALK IN

5690
03:35:43,800 --> 03:35:47,960
YOUR GROUP WITH ECONOMICS AND

5691
03:35:47,960 --> 03:35:48,720
DEMOGRAPHICS?

5692
03:35:48,720 --> 03:35:51,040
>> YEAH, WE DISCUSSED ABOUT

5693
03:35:51,040 --> 03:35:54,120
THREE THINGS, MAINLY TELESTROKE

5694
03:35:54,120 --> 03:36:00,200
AND ADAPTATION.

5695
03:36:00,200 --> 03:36:04,680
THE TELESTROKE AND THE RURAL

5696
03:36:04,680 --> 03:36:07,680
COMMUNITIES, LIKE FINANCIAL AND

5697
03:36:07,680 --> 03:36:11,240
SO MANY HURDLES, WE WERE

5698
03:36:11,240 --> 03:36:13,760
DISCUSSING CHANGING THE POLICY,

5699
03:36:13,760 --> 03:36:14,960
REIMBURSEMENT, HOW WE CAN

5700
03:36:14,960 --> 03:36:16,680
REIMBURSE, THOSE ARE SOME OF THE

5701
03:36:16,680 --> 03:36:18,800
THINGS THAT WE DISCUSSED IN THE

5702
03:36:18,800 --> 03:36:19,560
TELESTROKE ADAPTATION.

5703
03:36:19,560 --> 03:36:22,960
AND THE SECOND THING WE

5704
03:36:22,960 --> 03:36:25,040
DISCUSSED, HOW WE CAN INCREASE

5705
03:36:25,040 --> 03:36:28,120
AVAILABILITY OF THE VASCULAR

5706
03:36:28,120 --> 03:36:29,520
NEUROLOGIST AND INTERVENTIONAL

5707
03:36:29,520 --> 03:36:29,920
NEUROLOGIST.

5708
03:36:29,920 --> 03:36:35,080
I THINK RAFAEL WAS THERE.

5709
03:36:35,080 --> 03:36:37,160
HE WAS DISCUSSING.

5710
03:36:37,160 --> 03:36:41,160
THERE ARE, YOU KNOW, TWO STROKE

5711
03:36:41,160 --> 03:36:43,720
NEUROLOGISTS FOR THE ENTIRE

5712
03:36:43,720 --> 03:36:44,480
TERRITORY.

5713
03:36:44,480 --> 03:36:46,880
SO SOME OF THE THINGS WE

5714
03:36:46,880 --> 03:36:49,080
MENTIONED IN OUR INVESTIGATION

5715
03:36:49,080 --> 03:36:54,640
IN THE REPORT THAT LOAN

5716
03:36:54,640 --> 03:36:57,640
REPAYMENT PROGRAM AND, YOU KNOW,

5717
03:36:57,640 --> 03:37:00,240
GREEN CARD, THAT WAY WE CAN

5718
03:37:00,240 --> 03:37:02,280
ATTRACT PEOPLE WHO ARE WILLING

5719
03:37:02,280 --> 03:37:04,480
TO COME TO THE UNDERSERVED AREAS

5720
03:37:04,480 --> 03:37:08,640
AND ARE WILLING TO SERVE THERE.

5721
03:37:08,640 --> 03:37:10,840
AND OTHER THING, THE THIRD

5722
03:37:10,840 --> 03:37:14,080
CROSS-CUTTING THEME WE DISCUSSED

5723
03:37:14,080 --> 03:37:14,520
PROVIDING EDUCATIONAL

5724
03:37:14,520 --> 03:37:22,520
OPPORTUNITIES, SO EVEN THOUGH WE

5725
03:37:22,520 --> 03:37:24,480
HAVE TELEMEDICINE, PEOPLE SHOULD

5726
03:37:24,480 --> 03:37:25,600
COME TO THE HOSPITAL.

5727
03:37:25,600 --> 03:37:28,880
SO HOW DO WE EDUCATE THEM?

5728
03:37:28,880 --> 03:37:31,800
AND ALSO EVEN IN SOME HOSPITALS,

5729
03:37:31,800 --> 03:37:35,680
WHERE THERE ARE NO NEUROLOGISTS

5730
03:37:35,680 --> 03:37:37,760
OR STROKE NEUROLOGISTS, HOW TO

5731
03:37:37,760 --> 03:37:43,720
EDUCATE THE E.R. PHYSICIANS AND 

5732
03:37:43,720 --> 03:37:46,120
WHAT IS THE VARIOUS TEAMS TO

5733
03:37:46,120 --> 03:37:46,800
EDUCATE AND FUND.

5734
03:37:46,800 --> 03:37:47,880
WE DISCUSSED ABOUT THAT.

5735
03:37:47,880 --> 03:37:52,560
SO THOSE ARE THE THREE THINGS WE

5736
03:37:52,560 --> 03:37:53,480
DISCUSSED.

5737
03:37:53,480 --> 03:37:53,920
THANK YOU.

5738
03:37:53,920 --> 03:37:55,200
AND SHERYL, DID YOU HAVE

5739
03:37:55,200 --> 03:37:58,240
SOMETHING YOU WANTED TO ADD TOO?

5740
03:37:58,240 --> 03:37:59,240
>> I JUST MENTIONED WE WERE

5741
03:37:59,240 --> 03:38:02,080
TALKING ABOUT TRYING TO BRING

5742
03:38:02,080 --> 03:38:03,880
RESEARCH TO COMMUNITIES, IF

5743
03:38:03,880 --> 03:38:06,000
THERE WAS A PROOF OF CONCEPT

5744
03:38:06,000 --> 03:38:07,080
FUNDING FOR RURAL COORDINATORS

5745
03:38:07,080 --> 03:38:11,680
THAT COULD GO INTO A DESIGNATED

5746
03:38:11,680 --> 03:38:15,520
AREA THAT PERHAPS HAS A COUPLE

5747
03:38:15,520 --> 03:38:17,560
PSCs, BUT MORE RURAL WITH

5748
03:38:17,560 --> 03:38:18,560
BENCHMARKS FOR WHAT WOULD BE

5749
03:38:18,560 --> 03:38:23,200
CONSIDERED SUCCESS IN TERMS OF 

5750
03:38:23,200 --> 03:38:25,040
ENROLLMENT AND CLINICAL TRIALS.

5751
03:38:25,040 --> 03:38:25,400
>> EXCELLENT.

5752
03:38:25,400 --> 03:38:26,680
THANK YOU ALL VERY MUCH.

5753
03:38:26,680 --> 03:38:27,880
WE'RE GOING MOVE ALONG NOW JUST

5754
03:38:27,880 --> 03:38:31,160
FOR THE SAKE OF TIME AND GET A

5755
03:38:31,160 --> 03:38:33,040
HARD STOP AT 4:53 FOR WALTER.

5756
03:38:33,040 --> 03:38:35,080
IN TERMS OF THE INPATIENT

5757
03:38:35,080 --> 03:38:36,600
REPORT-OUT I'M GOING TO ASK

5758
03:38:36,600 --> 03:38:38,480
KAREN AND LARRY TO GIVE A

5759
03:38:38,480 --> 03:38:39,560
SUMMARY AS THE LEADS AND WE'RE

5760
03:38:39,560 --> 03:38:42,480
NOT GOING TO DO THE INDIVIDUAL

5761
03:38:42,480 --> 03:38:44,080
BREAKOUTS BECAUSE I THINK WE

5762
03:38:44,080 --> 03:38:46,080
HAVE IDENTIFIED A FEW COMMON

5763
03:38:46,080 --> 03:38:46,640
THEMES.

5764
03:38:46,640 --> 03:38:47,720
BUT KAREN AND LARRY, YOU JUST

5765
03:38:47,720 --> 03:38:51,040
WANT TO GIVE A TOP LEVEL

5766
03:38:51,040 --> 03:38:52,600
REPORTOUT FROM YOUR IN-HOSPITAL

5767
03:38:52,600 --> 03:38:54,880
GROUP?

5768
03:38:54,880 --> 03:38:58,680
 

5769
03:38:58,680 --> 03:38:58,960
>> SURE.

5770
03:38:58,960 --> 03:38:59,400
>> YOU'RE MUTED.

5771
03:38:59,400 --> 03:39:01,240
>> I DON'T KNOW IF KAREN IS ON.

5772
03:39:01,240 --> 03:39:05,320
>> THANK YOU.

5773
03:39:05,320 --> 03:39:05,720
SORRY ABOUT THAT.

5774
03:39:05,720 --> 03:39:08,080
SO, THERE WERE A COUPLE AREAS

5775
03:39:08,080 --> 03:39:10,720
THAT OVERLAPPED ACROSS THE

5776
03:39:10,720 --> 03:39:13,480
VARIOUS BREAKOUTS.

5777
03:39:13,480 --> 03:39:15,080
ONE WAS TELEMEDICINE,

5778
03:39:15,080 --> 03:39:16,280
TELENEUROLOGY.

5779
03:39:16,280 --> 03:39:18,600
AND PARTICULARLY AROUND

5780
03:39:18,600 --> 03:39:19,560
TELEREHABILITATION AND THE

5781
03:39:19,560 --> 03:39:24,160
POST-ACUTE PHASE OF STROKE

5782
03:39:24,160 --> 03:39:24,760
RECOVERY.

5783
03:39:24,760 --> 03:39:26,480
THE OTHER AREA OF OVERLAP THAT I

5784
03:39:26,480 --> 03:39:28,720
SAW ACROSS ALL OF THE BREAKOUTS

5785
03:39:28,720 --> 03:39:36,560
HAD TO DO WITH COST AND HOW

5786
03:39:36,560 --> 03:39:38,680
INEQUITIES IN INSURANCE COVERAGE

5787
03:39:38,680 --> 03:39:41,480
DICTATED THE POST-ACUTE PHASE OF

5788
03:39:41,480 --> 03:39:41,800
RECOVERY.

5789
03:39:41,800 --> 03:39:44,680
AND SO THERE WAS WORK TO BE DONE

5790
03:39:44,680 --> 03:39:44,880
THERE.

5791
03:39:44,880 --> 03:39:54,720
WITH REGARD TO INTERACTION WITH

5792
03:39:54,720 --> 03:39:56,680
OTHER AREAS, THE DEFINITIONS OF

5793
03:39:56,680 --> 03:39:58,720
SOCIAL DETERMINANTS OF HEALTH

5794
03:39:58,720 --> 03:39:59,880
NEED TO BE STANDARDIZED.

5795
03:39:59,880 --> 03:40:04,280
AND IN ORDER TO MOVE FORWARD WE

5796
03:40:04,280 --> 03:40:07,160
NEED TO UNDERSTAND IN A

5797
03:40:07,160 --> 03:40:09,600
SYSTEMATIC WAY HOW PATIENTS

5798
03:40:09,600 --> 03:40:12,320
IDENTIFY THEMSELVES BY RACE, AND

5799
03:40:12,320 --> 03:40:14,080
SEX, AND ETHNICITY, SO WE CAN

5800
03:40:14,080 --> 03:40:18,160
MAKE ANY SENSE OF THE DATA

5801
03:40:18,160 --> 03:40:19,880
COMING FORWARD.

5802
03:40:19,880 --> 03:40:20,880
LARRY?

5803
03:40:20,880 --> 03:40:23,760
>> I'LL JUST ADD A COUPLE POINTS

5804
03:40:23,760 --> 03:40:29,480
THAT WERE PARTICULAR TO THE

5805
03:40:29,480 --> 03:40:31,120
POLICY AND REGULATIONS SUBGROUP.

5806
03:40:31,120 --> 03:40:33,600
I THINK THEY HAVE IMPLICATIONS

5807
03:40:33,600 --> 03:40:35,320
ACROSS ALL THESE BREAKOUTS.

5808
03:40:35,320 --> 03:40:37,720
SO, A COUPLE THINGS WE TALKED

5809
03:40:37,720 --> 03:40:39,480
ABOUT ARE THIS.

5810
03:40:39,480 --> 03:40:42,240
THAT FIRST OF ALL, WHAT WOULD BE

5811
03:40:42,240 --> 03:40:45,560
HELPFUL WOULD BE TO CREATE A 

5812
03:40:45,560 --> 03:40:49,520
STANDARD  OF CARE THAT COULD

5813
03:40:49,520 --> 03:40:50,280
CROSS HOSPITALS PARTICULARLY

5814
03:40:50,280 --> 03:40:52,080
WITH A SPOKE SYSTEM TO HUB

5815
03:40:52,080 --> 03:40:55,720
HOSPITALS TO SMALL RURAL AND

5816
03:40:55,720 --> 03:40:56,960
COMMUNITY HOSPITALS, TO -- AND

5817
03:40:56,960 --> 03:40:58,520
WE TALKED ABOUT WAYS THAT WE

5818
03:40:58,520 --> 03:41:01,600
COULD DO THAT.

5819
03:41:01,600 --> 03:41:06,080
FOR EXAMPLE, SHARING ORDER SETS

5820
03:41:06,080 --> 03:41:08,800
AND STROKE PATHWAYS FROM THE,

5821
03:41:08,800 --> 03:41:10,680
YOU KNOW, STROKE CENTERS TO THE

5822
03:41:10,680 --> 03:41:12,080
COMMUNITY HOSPITALS, THE RURAL

5823
03:41:12,080 --> 03:41:14,600
HOSPITALS, WHERE THEY DON'T HAVE

5824
03:41:14,600 --> 03:41:15,480
THE STROKE EXPERTISE, JUST

5825
03:41:15,480 --> 03:41:18,280
HAVING THOSE KINDS OF PATHWAYS

5826
03:41:18,280 --> 03:41:21,680
AND ORDER SETS TO PLACE THEIR

5827
03:41:21,680 --> 03:41:25,760
PATIENTS ON ONCE THEY GET INTO

5828
03:41:25,760 --> 03:41:27,680
THE HOSPITAL MIGHT HELP REDUCE

5829
03:41:27,680 --> 03:41:28,400
DISPARITIES.

5830
03:41:28,400 --> 03:41:30,080
OF COURSE AGAIN THERE'S A LOT OF

5831
03:41:30,080 --> 03:41:33,000
STUFFEDY  STUFFED -- STUDY TO

5832
03:41:33,000 --> 03:41:35,160
FIND WHAT THE DISPARITIES ARE,

5833
03:41:35,160 --> 03:41:36,800
AS WE POINTED OUT EARLIER, BUT

5834
03:41:36,800 --> 03:41:39,080
WE THOUGHT THAT WOULD BE ONE WAY

5835
03:41:39,080 --> 03:41:40,880
TO ADDRESS THIS.

5836
03:41:40,880 --> 03:41:42,480
AND THAT COULD BE SUPPLEMENTED

5837
03:41:42,480 --> 03:41:44,760
BY TELEHEALTH WHICH SEEMS TO

5838
03:41:44,760 --> 03:41:48,520
KEEP COMING UP, BUT TO HAVE THE

5839
03:41:48,520 --> 03:41:49,840
PEOPLE WITH STROKE EXPERTISE NOT

5840
03:41:49,840 --> 03:41:52,320
ONLY IN THE EMERGENCY ROOM

5841
03:41:52,320 --> 03:41:53,480
MAKING DECISIONS ABOUT

5842
03:41:53,480 --> 03:41:54,480
REPERFUSION THERAPY BUT ALSO

5843
03:41:54,480 --> 03:41:56,400
SEEING THE PATIENTS WHEN THEY

5844
03:41:56,400 --> 03:41:58,440
ARE IN THE HOSPITAL TO DECIDE ON

5845
03:41:58,440 --> 03:42:00,160
WORKUP AND LOOK AT THE RESULTS

5846
03:42:00,160 --> 03:42:04,840
OF THAT WORKUP AND DECIDE ON --

5847
03:42:04,840 --> 03:42:05,960
MAKE DECISIONS ABOUT SECONDARY

5848
03:42:05,960 --> 03:42:07,040
STROKE PREVENTION WOULD HELP

5849
03:42:07,040 --> 03:42:09,480
CREATE A STANDARD OF CARE THAT

5850
03:42:09,480 --> 03:42:11,720
WENT BEYOND THE ACUTE CARE

5851
03:42:11,720 --> 03:42:14,240
HOSPITAL OR THE HUB HOSPITAL,

5852
03:42:14,240 --> 03:42:15,360
AND PERHAPS WOULD PREVENT

5853
03:42:15,360 --> 03:42:16,760
PATIENTS FROM HAVING TO BE

5854
03:42:16,760 --> 03:42:17,960
TRANSFERRED IN TO A HUB

5855
03:42:17,960 --> 03:42:18,320
HOSPITAL.

5856
03:42:18,320 --> 03:42:20,120
THEY COULD STAY IN THEIR

5857
03:42:20,120 --> 03:42:21,160
COMMUNITY WHICH THEY MUCH PREFER

5858
03:42:21,160 --> 03:42:23,440
AND STILL GET THE SAME LEVEL OF

5859
03:42:23,440 --> 03:42:25,800
CARE FROM THE STROKE EXPERTS.

5860
03:42:25,800 --> 03:42:27,920
SO THAT WAS ONE SUGGESTION.

5861
03:42:27,920 --> 03:42:29,360
THE OTHER WAS I THOUGHT A VERY

5862
03:42:29,360 --> 03:42:32,200
GOOD ONE WHERE WE TALK ABOUT

5863
03:42:32,200 --> 03:42:33,640
REGULATIONS FROM THE STATE AND

5864
03:42:33,640 --> 03:42:37,240
FROM THE FEDERAL GOVERNMENT IN

5865
03:42:37,240 --> 03:42:39,840
TERMS OF CREATING -- REDUCING

5866
03:42:39,840 --> 03:42:40,600
DISPARITIES, CREATING STANDARD

5867
03:42:40,600 --> 03:42:41,480
OF CARE

5868
03:42:41,480 --> 03:42:43,280
WHAT ABOUT JACO?

5869
03:42:43,280 --> 03:42:47,680
ALL THE HOSPITALS ARE DEPENDENT

5870
03:42:47,680 --> 03:42:48,480
UPON JACO FOR OVERALL

5871
03:42:48,480 --> 03:42:53,680
CERTIFICATION AND STROKE 

5872
03:42:53,680 --> 03:42:54,800
CERTIFICATION AND TO WHAT EXTENT

5873
03:42:54,800 --> 03:42:57,960
DO THEY LOOK AT DISPARITIES AND

5874
03:42:57,960 --> 03:42:58,920
WHAT INFORMATION DOES JACO

5875
03:42:58,920 --> 03:43:00,480
REQUIRE HOSPITALS TO COLLECT

5876
03:43:00,480 --> 03:43:03,520
THAT COULD HELP US DECIDE ON

5877
03:43:03,520 --> 03:43:05,880
WHETHER DISPARITIES EXIST AND IF

5878
03:43:05,880 --> 03:43:08,320
SO HOW TO REDUCE THEM.

5879
03:43:08,320 --> 03:43:10,080
SO I THINK THAT WAS -- I THINK

5880
03:43:10,080 --> 03:43:11,720
THAT WAS QUITE A GOOD SUGGESTION

5881
03:43:11,720 --> 03:43:14,120
OF SOMETHING I HADN'T CONSIDERED

5882
03:43:14,120 --> 03:43:14,760
BEFORE.

5883
03:43:14,760 --> 03:43:17,040
AND THEN FINALLY LIKE KAREN

5884
03:43:17,040 --> 03:43:18,280
SUGGESTED, WE TALKED ABOUT COST

5885
03:43:18,280 --> 03:43:22,240
AND REIMBURSEMENT AND HOW THAT

5886
03:43:22,240 --> 03:43:24,080
AFFECTS IN-HOSPITAL CARE, AND

5887
03:43:24,080 --> 03:43:28,080
CERTAINLY THAT HAS A SIGNIFICANT

5888
03:43:28,080 --> 03:43:29,440
IMPLICATION FOR IN-HOSPITAL CARE

5889
03:43:29,440 --> 03:43:33,600
AS IT DOES ACROSS THE BOARD.

5890
03:43:33,600 --> 03:43:36,400
>> VERY GOOD.

5891
03:43:36,400 --> 03:43:37,960
THANK YOU, LARRY.

5892
03:43:37,960 --> 03:43:41,400
ANY OTHER COMMENTS FROM ANYBODY

5893
03:43:41,400 --> 03:43:43,840
ELSE ON THE CALL, PARTICIPANTS,

5894
03:43:43,840 --> 03:43:44,680
BREAKOUT LEADERS, ANY MAJOR

5895
03:43:44,680 --> 03:43:46,680
POINTS YOU FEEL WERE NOT

5896
03:43:46,680 --> 03:43:48,200
ADEQUATELY TOUCHED UPON?

5897
03:43:48,200 --> 03:43:50,920
AGAIN WE'RE GOING TO SYNTHESIZE

5898
03:43:50,920 --> 03:43:52,200
INTO A SUMMARY DOCUMENT AND

5899
03:43:52,200 --> 03:43:53,280
WRITTEN DOCUMENT OVER THE NEXT

5900
03:43:53,280 --> 03:43:57,280
FEW DAYS AND WEEKS.

5901
03:43:57,280 --> 03:44:03,600
>> I JUST WANT TO SHARE ANOTHER

5902
03:44:03,600 --> 03:44:05,120
SUBGROUP WE DISCUSSED ABOUT, YOU

5903
03:44:05,120 --> 03:44:08,240
KNOW, ONCE THE PATIENT IS IN THE

5904
03:44:08,240 --> 03:44:10,120
HYPER ACUTE PHASE AND COMES TO

5905
03:44:10,120 --> 03:44:12,480
THE HOSPITAL, AND FROM HOSPITAL,

5906
03:44:12,480 --> 03:44:13,680
ONCE THEY GET DISCHARGED, AND

5907
03:44:13,680 --> 03:44:16,080
SHERYL AND WE WERE ALL

5908
03:44:16,080 --> 03:44:18,600
DISCUSSING, YOU KNOW, IT'S A

5909
03:44:18,600 --> 03:44:19,240
BLACK BOX.

5910
03:44:19,240 --> 03:44:22,200
NOBODY, LIKE THE DATA AND

5911
03:44:22,200 --> 03:44:23,080
INFORMATION IS LIMITED, MAYBE

5912
03:44:23,080 --> 03:44:28,040
NEXT YEAR WE CAN INCLUDE

5913
03:44:28,040 --> 03:44:29,120
POST-HOSPITAL GROUP, THAT'S ONE

5914
03:44:29,120 --> 03:44:32,360
THING WE DISCUSSED.

5915
03:44:32,360 --> 03:44:35,160
>> YEAH, THAT'S AN EXCELLENT

5916
03:44:35,160 --> 03:44:35,480
POINT.

5917
03:44:35,480 --> 03:44:36,120
TRADITIONALLY THE BRAIN ATTACK

5918
03:44:36,120 --> 03:44:38,160
COALITION HAS BEEN FRONT LOADED

5919
03:44:38,160 --> 03:44:43,280
LOOKING AT THE HYPER ACUTE CARE

5920
03:44:43,280 --> 03:44:48,200
PARADIGMS, LESS SO FOR POST 

5921
03:44:48,200 --> 03:44:49,600
DISCHARGE CARE, A VERY IMPORTANT

5922
03:44:49,600 --> 03:44:51,240
PART OF THE CARE EPOCH.

5923
03:44:51,240 --> 03:44:53,520
WE DIDN'T HAVE THE BAND WIDTH TO

5924
03:44:53,520 --> 03:44:55,000
TAKE THIS ON FOR THIS INITIAL

5925
03:44:55,000 --> 03:44:56,320
MEETING BUT I AGREE.

5926
03:44:56,320 --> 03:44:58,360
WE CAN HOPEFULLY DO THIS AGAIN

5927
03:44:58,360 --> 03:45:01,200
NEXT YEAR AND INCLUDE THE

5928
03:45:01,200 --> 03:45:03,640
POST-ACUTE CARE LIKE REHAB, MORE

5929
03:45:03,640 --> 03:45:04,360
ABOUT COMMUNITY CARE, SECONDARY

5930
03:45:04,360 --> 03:45:04,680
PREVENTION.

5931
03:45:04,680 --> 03:45:08,160
THANK YOU ALL VERY MUCH.

5932
03:45:08,160 --> 03:45:09,680
ANY OTHER COMMENTS BEFORE WE GO

5933
03:45:09,680 --> 03:45:12,360
TO WALTER?

5934
03:45:12,360 --> 03:45:17,840
 

5935
03:45:17,840 --> 03:45:20,600
IF NOT, GREG, DO YOU WANT TO

5936
03:45:20,600 --> 03:45:21,680
SWITCH TO WALTER'S COMMENTS AT

5937
03:45:21,680 --> 03:45:22,480
THIS POINT?

5938
03:45:22,480 --> 03:45:25,600
CAN YOU DO THAT?

5939
03:45:25,600 --> 03:45:32,640
 

5940
03:45:32,640 --> 03:45:34,360
>> HELLO, I'M WALTER KOROSHETZ,

5941
03:45:34,360 --> 03:45:36,560
DIRECTOR OF THE NATIONAL

5942
03:45:36,560 --> 03:45:37,360
INSTITUTE OF NEUROLOGICAL

5943
03:45:37,360 --> 03:45:38,280
DISORDERS AND STROKE.

5944
03:45:38,280 --> 03:45:41,200
ON BEHALF OF THE INSTITUTES AND

5945
03:45:41,200 --> 03:45:43,240
THE 16 MEMBERS OF THE BRAIN

5946
03:45:43,240 --> 03:45:44,040
ATTACK COALITION I WANT TO

5947
03:45:44,040 --> 03:45:46,160
WELCOME EVERYONE AND THANK YOU

5948
03:45:46,160 --> 03:45:51,640
FOR YOUR WORK ON THIS REALLY

5949
03:45:51,640 --> 03:45:55,480
IMPORTANT SYMPOSIUM ON ACCESS TO

5950
03:45:55,480 --> 03:45:58,880
ACUTE STROKE CARE AND THIS IS

5951
03:45:58,880 --> 03:46:00,400
SOMETHING THAT A NUMBER OF US

5952
03:46:00,400 --> 03:46:04,680
HAVE BEEN WORKING ON FOR THE

5953
03:46:04,680 --> 03:46:07,480
PAST 30+ YEARS.

5954
03:46:07,480 --> 03:46:10,680
I REMEMBER IN THE BEGINNING A

5955
03:46:10,680 --> 03:46:14,680
GROUP GOT TOGETHER TO TRY TO

5956
03:46:14,680 --> 03:46:18,000
IMPROVE ACCESS TO EMERGENCY

5957
03:46:18,000 --> 03:46:22,120
NEUROSURGERY FOR PEOPLE WITH

5958
03:46:22,120 --> 03:46:23,680
INTERCEREBRAL HEMORRHAGE AND

5959
03:46:23,680 --> 03:46:25,280
SUBARACHNOID HEMORRHAGE, BUT

5960
03:46:25,280 --> 03:46:26,720
THINGS HAVE CHANGED DRAMATICALLY

5961
03:46:26,720 --> 03:46:31,000
OVER THE LAST 30 YEARS.

5962
03:46:31,000 --> 03:46:33,080
INITIALLY THERE WAS THE

5963
03:46:33,080 --> 03:46:34,920
DISCOVERY THAT ACUTE TREATMENT

5964
03:46:34,920 --> 03:46:40,640
WITHIN THREE HOURS WITH

5965
03:46:40,640 --> 03:46:41,440
INTRAVENOUS THROMBOLYSIS DRUGS

5966
03:46:41,440 --> 03:46:45,200
CAN IMPROVE YOUR CHANCE OF 

5967
03:46:45,200 --> 03:46:46,600
RECOVERY AFTER A STROKE.

5968
03:46:46,600 --> 03:46:49,440
THAT LAID ON TOP OF THE

5969
03:46:49,440 --> 03:46:53,480
IMPORTANCE OF HAVING ANEURYSMS

5970
03:46:53,480 --> 03:46:55,480
TREATED, SHOULD THEY HAVE HAVE

5971
03:46:55,480 --> 03:46:57,400
ONE, AND PATIENTS SURVIVE.

5972
03:46:57,400 --> 03:47:03,400
THE NEXT AMAZING RESULT OCCURRED

5973
03:47:03,400 --> 03:47:08,560
MORE RECENTLY AFTER NUMEROUS

5974
03:47:08,560 --> 03:47:11,080
INDUSTRY-SPONSORED TRIALS SHOWED

5975
03:47:11,080 --> 03:47:13,080
THAT REMOVING LOT WITH DEVICES

5976
03:47:13,080 --> 03:47:16,000
FROM LARGE ARTERIES IN THE

5977
03:47:16,000 --> 03:47:17,640
BRAIN, IF DONE BEFORE THE BRAIN

5978
03:47:17,640 --> 03:47:20,680
TISSUE HAD A CHANCE TO DIE,

5979
03:47:20,680 --> 03:47:22,920
COULD ALSO LEAD TO A DRAMATIC

5980
03:47:22,920 --> 03:47:28,560
EFFECT SIZE IN A PERSON'S CHANCE

5981
03:47:28,560 --> 03:47:29,800
OF RECOVERING FUNCTION AFTER

5982
03:47:29,800 --> 03:47:39,160
WHAT WOULD OTHERWISE BE A

5983
03:47:39,160 --> 03:47:40,240
DEVASTATING STROKE.

5984
03:47:40,240 --> 03:47:41,080
THROUGHOUT THE PROCESS THE STORY

5985
03:47:41,080 --> 03:47:42,920
IS THE SAME, WE IDENTIFY WAYS OF

5986
03:47:42,920 --> 03:47:46,680
TREATMENT AND THEN WE TRY TO

5987
03:47:46,680 --> 03:47:49,280
MAKE THOSE TREATMENTS ACCESSIBLE

5988
03:47:49,280 --> 03:47:51,360
THROUGHOUT THE COUNTRY.

5989
03:47:51,360 --> 03:47:54,120
AND THAT'S THE SITUATION THAT

5990
03:47:54,120 --> 03:47:56,840
WE'D LIKE TO DISCUSS TODAY,

5991
03:47:56,840 --> 03:48:00,280
BECAUSE DESPITE THE ADVANCES,

5992
03:48:00,280 --> 03:48:01,440
THERE ARE STILL TREMENDOUS

5993
03:48:01,440 --> 03:48:04,560
INEQUITIES, AND IT JUST SEEMS

5994
03:48:04,560 --> 03:48:07,760
UNFAIR THAT THE FATE OF YOUR

5995
03:48:07,760 --> 03:48:09,280
BRAIN WHEN YOU'RE HAVING A

5996
03:48:09,280 --> 03:48:13,480
STROKE DEPENDS UPON WHERE YOU

5997
03:48:13,480 --> 03:48:13,760
LIVE.

5998
03:48:13,760 --> 03:48:18,120
AND SO HOW TO MAKE THESE

5999
03:48:18,120 --> 03:48:21,080
TREATMENTS, WHICH ARE REALLY

6000
03:48:21,080 --> 03:48:23,720
DRAMATICALLY BRAIN SAVING IF NOT

6001
03:48:23,720 --> 03:48:24,840
LIFE SAVING, CERTAINLY SAVING

6002
03:48:24,840 --> 03:48:28,000
QUALITY OF LIFE, HOW TO MAKE

6003
03:48:28,000 --> 03:48:29,440
THEM ACCESSIBLE TO EVERYONE,

6004
03:48:29,440 --> 03:48:33,480
DESPITE WHERE THEY LIVE.

6005
03:48:33,480 --> 03:48:38,160
OF COURSE, NEEDLESS TO SAY, THE

6006
03:48:38,160 --> 03:48:40,960
ISSUE THAT'S RIGHT ON FRONT IS

6007
03:48:40,960 --> 03:48:42,240
THAT FOR THESE TREATMENTS TO

6008
03:48:42,240 --> 03:48:46,120
WORK THEY HAVE TO BE DELIVERED

6009
03:48:46,120 --> 03:48:48,680
VERY, VERY QUICKLY.

6010
03:48:48,680 --> 03:48:49,960
FOR SUBARACHNOID HEMORRHAGE

6011
03:48:49,960 --> 03:48:54,680
TREAT THE ANEURYSM BEFORE

6012
03:48:54,680 --> 03:48:57,200
THERE'S A REBLEED.

6013
03:48:57,200 --> 03:49:00,800
THROMBOLYSIS WE KNOW THE

6014
03:49:00,800 --> 03:49:02,080
TREATMENT EFFECT DISSIPATES

6015
03:49:02,080 --> 03:49:03,880
WITHIN MINUTES.

6016
03:49:03,880 --> 03:49:07,480
AND THEN STARTS TO DISSIPATE

6017
03:49:07,480 --> 03:49:08,080
WITHIN MINUTES, SEEMINGLY GONE

6018
03:49:08,080 --> 03:49:14,480
FOUR OR FIVE HOURS AFTERWARDS.

6019
03:49:14,480 --> 03:49:16,080
WITH INTRAARTERIALA THROMBOLYSIS

6020
03:49:16,080 --> 03:49:17,840
WE HAVE BETTER ABILITY USING

6021
03:49:17,840 --> 03:49:24,480
IMAGE TO IDENTIFY WHICH PATIENTS

6022
03:49:24,480 --> 03:49:28,480
CAN PROFIT BY THE TREATMENT OVER

6023
03:49:28,480 --> 03:49:30,000
MULTIPLE HOURS BUT STILL THE

6024
03:49:30,000 --> 03:49:32,280
MESSAGE IS ALWAYS THAT TO REDUCE

6025
03:49:32,280 --> 03:49:34,480
THE AMOUNT OF BRAIN DAMAGE, THE

6026
03:49:34,480 --> 03:49:35,760
EARLIER THE TREATMENT IS GIVEN,

6027
03:49:35,760 --> 03:49:40,280
THE BETTER THE RESULT IS GOING

6028
03:49:40,280 --> 03:49:43,600
TO BE.

6029
03:49:43,600 --> 03:49:48,920
SO THE REAL EMPHASIS IS ON

6030
03:49:48,920 --> 03:49:50,040
ACUTELY IDENTIFYING THESE

6031
03:49:50,040 --> 03:49:54,280
CONDITIONS, GETTING THE

6032
03:49:54,280 --> 03:49:55,440
EMERGENCY RESPONSE SYSTEMS

6033
03:49:55,440 --> 03:49:58,480
ALERTED AND GETTING TO THE 

6034
03:49:58,480 --> 03:50:00,080
PATIENT AS FAST AS POSSIBLE.

6035
03:50:00,080 --> 03:50:02,080
THERE WILL BE DISCUSSION ABOUT

6036
03:50:02,080 --> 03:50:06,120
THE PRE-HOSPITAL SYSTEMS AND HOW

6037
03:50:06,120 --> 03:50:09,280
THEY CAN BE IMPROVED TO MAKE

6038
03:50:09,280 --> 03:50:10,160
ACCESS MORE EQUITABLE.

6039
03:50:10,160 --> 03:50:13,320
AND IN SOME RURAL COUNTRIES THIS

6040
03:50:13,320 --> 03:50:14,520
REQUIRES HELICOPTERS, MOST

6041
03:50:14,520 --> 03:50:20,240
OTHERS IT REQUIRES AMBULANCE

6042
03:50:20,240 --> 03:50:21,000
SERVICES.

6043
03:50:21,000 --> 03:50:21,880
SOMETIMES IN A FOG OFF MARTHA'S

6044
03:50:21,880 --> 03:50:24,400
VINEYARD IT REQUIRES A FIXED

6045
03:50:24,400 --> 03:50:27,120
WING PLANE TO GET PATIENTS IN.

6046
03:50:27,120 --> 03:50:30,120
BUT THE IMPORTANCE OF SAVING

6047
03:50:30,120 --> 03:50:34,760
SOMEONE'S BRAIN FROM THESE

6048
03:50:34,760 --> 03:50:36,280
MASSIVE STROKES REALLY SHOULD

6049
03:50:36,280 --> 03:50:38,800
MOTIVATE EVERYONE TO DO WHATEVER

6050
03:50:38,800 --> 03:50:42,160
IT TAKES TO ENABLE ACCESS TO

6051
03:50:42,160 --> 03:50:43,680
THESE TREATMENTS.

6052
03:50:43,680 --> 03:50:45,240
AND IT'S CLEARLY NOT EASY

6053
03:50:45,240 --> 03:50:46,200
DEPENDING UPON THE ENVIRONMENT

6054
03:50:46,200 --> 03:50:49,000
IN WHICH YOU LIVE BUT THAT'S THE

6055
03:50:49,000 --> 03:50:53,000
GOAL, IS TO TRY TO GET THOSE

6056
03:50:53,000 --> 03:50:54,160
EMERGENCY RESPONSE FOLKS OUT, TO

6057
03:50:54,160 --> 03:50:55,840
GET THE PATIENTS TO THE

6058
03:50:55,840 --> 03:50:56,920
TREATMENT AS FAST AS POSSIBLE,

6059
03:50:56,920 --> 03:51:00,480
AND THEN TO GET THEM TO PLACES

6060
03:51:00,480 --> 03:51:02,920
WHERE THE TREATMENT IS

6061
03:51:02,920 --> 03:51:05,240
AVAILABLE, THE SKILLED

6062
03:51:05,240 --> 03:51:05,600
NEUROSURGEONS OR

6063
03:51:05,600 --> 03:51:06,200
NEUROINTERVENTIONALLISTS THAT

6064
03:51:06,200 --> 03:51:09,800
CAN TREAT THE PATIENT, AND THEN

6065
03:51:09,800 --> 03:51:10,800
FOLLOWING THAT WE'VE MADE

6066
03:51:10,800 --> 03:51:11,520
TREMENDOUS STRIDES IN CARE OF

6067
03:51:11,520 --> 03:51:14,120
THE STROKE PATIENT IN THE

6068
03:51:14,120 --> 03:51:16,600
HOSPITAL, THIS WAS DRIVEN

6069
03:51:16,600 --> 03:51:18,520
HEAVILY BY THE BENEFIT OF THE

6070
03:51:18,520 --> 03:51:22,160
ACUTE TREATMENTS BUT THAT HELPS

6071
03:51:22,160 --> 03:51:24,560
WHO HAS A STROKE WHETHER THEY

6072
03:51:24,560 --> 03:51:26,000
GET ACUTE TREATMENT OR NOT ARE

6073
03:51:26,000 --> 03:51:28,480
GUIDELINES FOR HOSPITAL CARE YOU

6074
03:51:28,480 --> 03:51:29,480
NO, THOSE ARE THE THREE MAIN

6075
03:51:29,480 --> 03:51:31,040
AIMS OF THE DISCUSSION TODAY.

6076
03:51:31,040 --> 03:51:34,440
I KNOW THERE ARE ALL WAYS WE CAN

6077
03:51:34,440 --> 03:51:35,000
DO BETTER.

6078
03:51:35,000 --> 03:51:37,600
WE NEED TO KEEP OUR EYE ON THE

6079
03:51:37,600 --> 03:51:39,240
GOAL AND NEVER BE SATISFIED

6080
03:51:39,240 --> 03:51:41,280
UNTIL WE REACH THAT GOAL, WHERE

6081
03:51:41,280 --> 03:51:45,440
WHAT HAPPENS TO YOU REALLY  DOES

6082
03:51:45,440 --> 03:51:46,800
NOT DEPEND ON WHERE YOU LIVE

6083
03:51:46,800 --> 03:51:47,040
ANYMORE.

6084
03:51:47,040 --> 03:51:47,920
THANKS VERY MUCH.

6085
03:51:47,920 --> 03:51:49,120
LOOK FORWARD TO HEARING ABOUT

6086
03:51:49,120 --> 03:51:54,160
THE SYMPOSIUM.

6087
03:51:54,160 --> 03:51:57,840
 

6088
03:51:57,840 --> 03:52:02,080
 

6089
03:52:02,080 --> 03:52:05,040
>> THANK YOU, DR. KOROSHETZ, FOR

6090
03:52:05,040 --> 03:52:06,000
YOUR GUIDANCE AND WISDOM AND

6091
03:52:06,000 --> 03:52:06,440
SUPPORT.

6092
03:52:06,440 --> 03:52:08,880
I'M SURE WE'LL BE TALKING AGAIN

6093
03:52:08,880 --> 03:52:14,120
IN THE FUTURE, WHEN PRODUCE THE

6094
03:52:14,120 --> 03:52:16,440
PROCEEDINGS AND HOPEFULLY CAN

6095
03:52:16,440 --> 03:52:17,520
GENERATE SOME STRONG

6096
03:52:17,520 --> 03:52:18,720
HYPOTHESIS-DRIVEN RESEARCH

6097
03:52:18,720 --> 03:52:22,200
PROJECTS THAT YOU AND NINDS AND

6098
03:52:22,200 --> 03:52:24,280
NIH ALMOST SUPPORT AND FIND IN

6099
03:52:24,280 --> 03:52:26,800
THE FUTURE TO HELP FURTHER

6100
03:52:26,800 --> 03:52:28,960
ADVANCE STROKE CARE.

6101
03:52:28,960 --> 03:52:30,400
WITH THAT, LOOKS LIKE WE'RE

6102
03:52:30,400 --> 03:52:31,640
RIGHT ON TIME.

6103
03:52:31,640 --> 03:52:35,000
AND JUST WANT TO TAKE THIS

6104
03:52:35,000 --> 03:52:37,240
OPPORTUNITY TO THANK DR. BENSON,

6105
03:52:37,240 --> 03:52:40,240
MY CO-CHAIR, SAM AND ANDREA FROM

6106
03:52:40,240 --> 03:52:42,600
NINDS, GREG FROM THE LOGISTICS

6107
03:52:42,600 --> 03:52:45,240
SERVICES, ESPECIALLY ALL OF YOU

6108
03:52:45,240 --> 03:52:49,080
FOR SHARING YOUR TIME, YOUR

6109
03:52:49,080 --> 03:52:51,240
WISDOM, YOUR EXPERTISE, AS WE

6110
03:52:51,240 --> 03:52:53,200
PUT TOGETHER THIS SYMPOSIUM AND

6111
03:52:53,200 --> 03:52:56,600
SYNTHESIZE IDEAS AND WE SHARE

6112
03:52:56,600 --> 03:52:59,200
YOUR CONTRIBUTIONS FOR THIS

6113
03:52:59,200 --> 03:53:01,080
PROJECT, FOR REDUCING LACK OF

6114
03:53:01,080 --> 03:53:02,920
EQUITY AND EQUALITY AND

6115
03:53:02,920 --> 03:53:03,840
ADDRESSING DISPARITIES AND

6116
03:53:03,840 --> 03:53:06,000
ACCESS TO ACUTE STROKE CARE AND

6117
03:53:06,000 --> 03:53:09,280
STROKE TREATMENTS.

6118
03:53:09,280 --> 03:53:13,240
YOUR INSIGHTS AND WISDOM AND

6119
03:53:13,240 --> 03:53:14,160
EXPERIENCE, EXPERIENCES, WE'RE

6120
03:53:14,160 --> 03:53:18,120
GRATEFUL FOR YOU SHARING THAT.

6121
03:53:18,120 --> 03:53:19,880
TOMORROW WE'LL BEGIN AT 11 A.M.

6122
03:53:19,880 --> 03:53:22,600
AND WE'RE GOING TO HAVE MORE

6123
03:53:22,600 --> 03:53:26,520
DISCUSSIONS ABOUT SOME COMMON

6124
03:53:26,520 --> 03:53:26,880
THEMES.

6125
03:53:26,880 --> 03:53:29,080
WE'LL WORK HARD TO ADDRESS THIS

6126
03:53:29,080 --> 03:53:31,040
AND HAVE THE ROBUST DISCUSSION

6127
03:53:31,040 --> 03:53:31,280
TOMORROW.

6128
03:53:31,280 --> 03:53:34,280
AND WE'LL USE THAT AS THE

6129
03:53:34,280 --> 03:53:37,280
LAUNCHING POINT FOR DOING EDITS

6130
03:53:37,280 --> 03:53:39,880
FOR THE FINAL SUMMARY DOCUMENT.

6131
03:53:39,880 --> 03:53:42,800
THIS IS OUR AGENDA FOR DAY 2.

6132
03:53:42,800 --> 03:53:47,160
AS YOU CAN SEE THERE, SYNTHESIS

6133
03:53:47,160 --> 03:53:48,840
OF THE DIALOGUE, CONFIRMATION,

6134
03:53:48,840 --> 03:53:50,240
CORRECTION, GENERATING NEW

6135
03:53:50,240 --> 03:53:51,080
IDEAS.

6136
03:53:51,080 --> 03:53:55,840
THEN FOLLOWED BY DISCUSSION AND

6137
03:53:55,840 --> 03:53:57,440
SYMPOSIUM WRAP-UP.

6138
03:53:57,440 --> 03:53:59,960
I PROMISE WE'LL ADJOURN AT 1

6139
03:53:59,960 --> 03:54:01,480
P.M. EASTERN TIME.

6140
03:54:01,480 --> 03:54:02,920
GREG OR SAM, OR DR. BENSON, DO

6141
03:54:02,920 --> 03:54:06,000
YOU WANT TO SAY ANYTHING ELSE IN

6142
03:54:06,000 --> 03:54:10,160
SUMMARY OR IN CONCLUSION? 

6143
03:54:10,160 --> 03:54:10,680
>> NO.

6144
03:54:10,680 --> 00:00:00,000
HAVE A GOOD EVENING, EVERYONE.