1 00:00:05,400 --> 00:00:09,120 >>MY NAME IS TANIA STROUT, I'M 2 00:00:09,120 --> 00:00:11,960 HAPPY TO BE HERE AGAIN TODAY ON 3 00:00:11,960 --> 00:00:14,920 BEHALF OF THE EMERGENCY NURSES 4 00:00:14,920 --> 00:00:15,920 ASSOCIATION. 5 00:00:15,920 --> 00:00:18,680 AND THE ANA RESEARCH ADVISORY 6 00:00:18,680 --> 00:00:18,920 COUNCIL. 7 00:00:18,920 --> 00:00:23,920 WE HAD A WONDERFUL OPENING 8 00:00:23,920 --> 00:00:26,880 SESSION YESTERDAY, WHERE DR. 9 00:00:26,880 --> 00:00:29,160 RENEE HSIA GET US STARTED ON 10 00:00:29,160 --> 00:00:30,520 STRUCTURAL INEQUITIES WITHIN OUR 11 00:00:30,520 --> 00:00:31,480 EMERGENCY CARE SYSTEM. 12 00:00:31,480 --> 00:00:33,520 WE HAVE A FANTASTIC SERIES OF 13 00:00:33,520 --> 00:00:36,600 SPEAKERS WHO WILL CONTINUE TO 14 00:00:36,600 --> 00:00:37,160 EXPLORE THE IMPACT OF SOCIAL 15 00:00:37,160 --> 00:00:38,520 DETERMINANTS OF HEALTH AND HOW 16 00:00:38,520 --> 00:00:41,160 WE MIGHT BETTER ADDRESS THOSE 17 00:00:41,160 --> 00:00:43,880 SOCIAL DETERMINANTS IN OUR 18 00:00:43,880 --> 00:00:44,600 NATION'S EMERGENCY DEPARTMENTS. 19 00:00:44,600 --> 00:00:45,960 THANK YOU VERY MUCH FOR JOINING 20 00:00:45,960 --> 00:00:46,960 US AGAIN TODAY. 21 00:00:46,960 --> 00:00:48,920 AS WE BEGIN I'D LOVE TO 22 00:00:48,920 --> 00:00:50,520 ACKNOWLEDGE THAT THE TERRITORY 23 00:00:50,520 --> 00:00:52,600 THAT I'M SITUATED ON TODAY IS 24 00:00:52,600 --> 00:00:55,440 THE TRADITIONAL AND MODERN HOME 25 00:00:55,440 --> 00:00:57,240 OF THE WABANAKI PEOPLE. 26 00:00:57,240 --> 00:00:58,960 AS WE WORK TOGETHER ON 27 00:00:58,960 --> 00:00:59,920 ADDRESSING SOCIAL DETERMINANTS 28 00:00:59,920 --> 00:01:02,760 AND THEIR CONNECTION TO HEALTH 29 00:01:02,760 --> 00:01:05,800 WE ACKNOWLEDGE AND SUPPORT 30 00:01:05,800 --> 00:01:07,440 WABANAKI EFFORTS AND ALL 31 00:01:07,440 --> 00:01:10,600 INDIGENOUS PEOPLES TOWARD LAND 32 00:01:10,600 --> 00:01:12,120 PROTECTION, CULTURAL HEARING, 33 00:01:12,120 --> 00:01:12,520 RECONCILIATION. 34 00:01:12,520 --> 00:01:13,440 I ENCOURAGE EVERYONE TO CONSIDER 35 00:01:13,440 --> 00:01:16,680 THE LAND YOU'RE SITUATED ON 36 00:01:16,680 --> 00:01:19,000 TODAY AND THE INDIGENOUS PEOPLES 37 00:01:19,000 --> 00:01:20,000 WHO INHABITED THAT SPACE BEFORE 38 00:01:20,000 --> 00:01:21,200 YOU AND TODAY. 39 00:01:21,200 --> 00:01:27,400 AS WE BEGIN, I'D LOVE TO INVINE 40 00:01:27,400 --> 00:01:29,200 DR. SHANNON ZENK TO SHARE 41 00:01:29,200 --> 00:01:30,280 COMMENTS AND UPDATES WITH THE 42 00:01:30,280 --> 00:01:31,800 GROUP. 43 00:01:31,800 --> 00:01:32,080 DR. ZENK? 44 00:01:32,080 --> 00:01:34,040 >> THANK YOU, DR. STROUT. 45 00:01:34,040 --> 00:01:35,200 AND WELCOME 46 00:01:35,200 --> 00:01:41,480 TO THE DAY 2 OF THE 2022 47 00:01:41,480 --> 00:01:42,360 NATIONAL NURSING RESEARCH 48 00:01:42,360 --> 00:01:42,800 ROUNDTABLE. 49 00:01:42,800 --> 00:01:44,640 SO TODAY THIS MORNING I'LL SHARE 50 00:01:44,640 --> 00:01:48,480 WITH YOU A BRIEF UPDATE ON NINR 51 00:01:48,480 --> 00:01:51,520 ACTIVITY INCLUDING OVERVIEW OF 52 00:01:51,520 --> 00:01:53,000 OUR STRATEGIC DIRECTION, SOME OF 53 00:01:53,000 --> 00:01:53,880 THE PARTNERSHIPS AND 54 00:01:53,880 --> 00:01:56,560 COLLABORATIONS WE'RE PART OF AND 55 00:01:56,560 --> 00:01:57,360 NEWS FROM NINR. 56 00:01:57,360 --> 00:01:59,200 SO LET'S START WITH A BIT ABOUT 57 00:01:59,200 --> 00:02:02,320 OUR SOON TO BE RELEASED 58 00:02:02,320 --> 00:02:04,120 STRATEGIC PLAN THAT WILL PROVIDE 59 00:02:04,120 --> 00:02:06,120 A BIG PICTURE VIEW OF THE 60 00:02:06,120 --> 00:02:08,480 DIRECTIONS WE'LL BE HEADING 61 00:02:08,480 --> 00:02:08,760 NEXT. 62 00:02:08,760 --> 00:02:11,280 THOUGH THE PLAN HASN'T BEEN 63 00:02:11,280 --> 00:02:16,040 RELEASED YET I CAN SHARE SOME 64 00:02:16,040 --> 00:02:17,880 INFORMATION ON FRAMEWORK. 65 00:02:17,880 --> 00:02:19,680 THREADED THROUGHOUT THE GUIDING 66 00:02:19,680 --> 00:02:20,560 PRINCIPLES FOR RESEARCH AND 67 00:02:20,560 --> 00:02:22,680 STRATEGIC PLAN FRAMEWORK IS A 68 00:02:22,680 --> 00:02:26,120 FOCUS ON HEALTH EQUITY. 69 00:02:26,120 --> 00:02:29,040 WE BELIEVE THIS IS NECESSARY TO 70 00:02:29,040 --> 00:02:32,000 RIGHT SYSTEMIC WRONGS THAT LED 71 00:02:32,000 --> 00:02:34,000 TO UNEQUAL ACCESS TO RESOURCES 72 00:02:34,000 --> 00:02:36,400 NEEDED FOR EACH PERSON TO LIVE 73 00:02:36,400 --> 00:02:38,400 THEIR HEALTHIEST LIFE AND ALSO 74 00:02:38,400 --> 00:02:42,800 BECAUSE IT'S THE ROOT OF MANY 75 00:02:42,800 --> 00:02:43,440 OUR NATION'S MOST PRESSING 76 00:02:43,440 --> 00:02:44,960 HEALTH CHALLENGES. 77 00:02:44,960 --> 00:02:47,680 BEFORE I GO INTO A BIT MORE 78 00:02:47,680 --> 00:02:48,920 DETAIL ON THE STRATEGIC PLAN'S 79 00:02:48,920 --> 00:02:50,000 FRAMEWORK I WANT TO SHARE SOME 80 00:02:50,000 --> 00:02:53,560 OF THE WAYS THAT WE ENGAGED OUR 81 00:02:53,560 --> 00:02:54,840 RESEARCH COMMUNITY AS WE 82 00:02:54,840 --> 00:02:58,720 DEVELOPED AND REFINED THE 83 00:02:58,720 --> 00:02:59,000 FRAMEWORK. 84 00:02:59,000 --> 00:03:00,880 20 EXTERNAL EXPERTS PARTICIPATED 85 00:03:00,880 --> 00:03:03,840 IN A WORKING GROUP THAT PROVIDED 86 00:03:03,840 --> 00:03:04,440 RECOMMENDATIONS THROUGH THE 87 00:03:04,440 --> 00:03:09,000 NATIONAL ADVISORY COUNCIL FOR 88 00:03:09,000 --> 00:03:09,520 NURSING RESEARCH. 89 00:03:09,520 --> 00:03:11,720 WE RECEIVED 385 ONLINE RESPONSES 90 00:03:11,720 --> 00:03:14,640 TO OUR TELL US WHAT NURSING 91 00:03:14,640 --> 00:03:17,360 RESEARCH MEANS TO YOU CAMPAIGN. 92 00:03:17,360 --> 00:03:19,280 WE RECEIVED OVER 100 E-MAILS IN 93 00:03:19,280 --> 00:03:21,800 RESPONSE TO AN OPEN CALL FOR 94 00:03:21,800 --> 00:03:23,440 INPUT ON THE DEVELOPMENT OF THE 95 00:03:23,440 --> 00:03:25,960 STRATEGIC PLAN. 96 00:03:25,960 --> 00:03:28,040 I PERSONALLY PARTICIPATED IN 80 97 00:03:28,040 --> 00:03:30,360 MEETINGS AND PRESENTATIONS WITH 98 00:03:30,360 --> 00:03:32,720 EXTERNAL GROUPS, AND OUR REQUEST 99 00:03:32,720 --> 00:03:36,840 FOR INFORMATION ON THE DRAFT 100 00:03:36,840 --> 00:03:38,200 STRATEGIC PLAN RESEARCH 101 00:03:38,200 --> 00:03:39,600 FRAMEWORK GENERATED OVER 130 102 00:03:39,600 --> 00:03:41,040 PUBLIC COMMENTS. 103 00:03:41,040 --> 00:03:42,640 WE CAREFULLY STUDIED THE INPUT 104 00:03:42,640 --> 00:03:45,360 AND THE FEEDBACK WE RECEIVED. 105 00:03:45,360 --> 00:03:46,920 THE MAJORITY OF RESPONDENTS TO 106 00:03:46,920 --> 00:03:49,920 OUR CALL FOR INPUT ON THE 107 00:03:49,920 --> 00:03:52,240 DEVELOPMENT OF THE STRATEGIC 108 00:03:52,240 --> 00:03:54,240 PLAN EXPLICITLY SUPPORTED A 109 00:03:54,240 --> 00:03:56,600 STRATEGIC DIRECTION AND RESEARCH 110 00:03:56,600 --> 00:03:57,480 TOPICS ALIGNED WITH SOCIAL 111 00:03:57,480 --> 00:03:58,960 DETERMINANTS OF HEALTH, HEALTH 112 00:03:58,960 --> 00:04:00,720 EQUITY, AND COMMUNITY AND 113 00:04:00,720 --> 00:04:01,920 POPULATION HEALTH. 114 00:04:01,920 --> 00:04:03,040 REGARDING OUR REQUEST FOR 115 00:04:03,040 --> 00:04:06,160 INFORMATION ON THE DRAFT 116 00:04:06,160 --> 00:04:09,200 FRAMEWORK, OVERALL NEARLY 2/3 OF 117 00:04:09,200 --> 00:04:13,240 RESPONDENTS SUPPORTED THE 118 00:04:13,240 --> 00:04:14,040 STRATEGIC PLAN FRAMEWORK. 119 00:04:14,040 --> 00:04:15,920 AS PART OF THE STRATEGIC PLAN 120 00:04:15,920 --> 00:04:18,520 EFFORT WE RECENTLY UPDATED THE 121 00:04:18,520 --> 00:04:19,320 INSTITUTE'S MISSION STATEMENT. 122 00:04:19,320 --> 00:04:21,440 AS YOU CAN SEE HERE WE'RE 123 00:04:21,440 --> 00:04:23,960 COMMITTED TO SOLVING PRESSING 124 00:04:23,960 --> 00:04:25,040 HEALTH CHALLENGES AND INFORMING 125 00:04:25,040 --> 00:04:27,200 PRACTICE AND POLICY TO OPTIMIZE 126 00:04:27,200 --> 00:04:28,480 HEALTH AND ADVANCE HEALTH 127 00:04:28,480 --> 00:04:29,000 EQUITY. 128 00:04:29,000 --> 00:04:31,920 A BIG PART OF ACHIEVING THIS 129 00:04:31,920 --> 00:04:32,920 MISSION WILL INVOLVE ADDRESSING 130 00:04:32,920 --> 00:04:34,400 THE IMPACT OF SOCIAL 131 00:04:34,400 --> 00:04:36,240 DETERMINANTS OF HEALTH. 132 00:04:36,240 --> 00:04:37,040 OUR STRATEGIC PLAN FRAMEWORK 133 00:04:37,040 --> 00:04:39,680 INCLUDES A SET OF GUIDING 134 00:04:39,680 --> 00:04:41,600 PRINCIPLES THAT WE BELIEVE 135 00:04:41,600 --> 00:04:45,000 SHOULD DRIVE ALL AREAS OF 136 00:04:45,000 --> 00:04:46,840 NINR-SUPPORTED SCIENCE, AND FIVE 137 00:04:46,840 --> 00:04:48,680 RESEARCH LENSES THAT DESCRIBE 138 00:04:48,680 --> 00:04:51,040 BROAD PERSPECTIVES BY WHICH TO 139 00:04:51,040 --> 00:04:52,440 EXAMINE HEALTH CHALLENGES. 140 00:04:52,440 --> 00:04:54,240 AFTER THE PLAN IS IMPLEMENTED 141 00:04:54,240 --> 00:04:57,240 WE'LL ALSO DESCRIBE OUR 142 00:04:57,240 --> 00:04:58,640 INTENTION TO DEVELOP STRATEGIC 143 00:04:58,640 --> 00:05:00,480 IMPERATIVES AS NEW HEALTH 144 00:05:00,480 --> 00:05:03,280 CHALLENGES AND NEW OPPORTUNITIES 145 00:05:03,280 --> 00:05:04,480 ARE IDENTIFIED. 146 00:05:04,480 --> 00:05:06,760 SO FIRST I'LL DESCRIBE OUR 147 00:05:06,760 --> 00:05:08,440 GUIDING PRINCIPLES. 148 00:05:08,440 --> 00:05:12,840 NINR'S GUIDING PRINCIPLES 149 00:05:12,840 --> 00:05:15,760 DESCRIBE IMPORTANT POLICIES WE 150 00:05:15,760 --> 00:05:18,440 SHOULD HAVE AS WE MOVE TO THE 151 00:05:18,440 --> 00:05:18,880 TOWARD. 152 00:05:18,880 --> 00:05:22,240 IN CONSIDERING AWARDS, EXTENT TO 153 00:05:22,240 --> 00:05:23,360 WHICH STUDIES REFLECT THESE 154 00:05:23,360 --> 00:05:24,600 PRINCIPLES WILL BE A FACTOR. 155 00:05:24,600 --> 00:05:27,200 WE NEED TO SUPPORT RESEARCH 156 00:05:27,200 --> 00:05:29,040 THAT'S INNOVATIVE, APPLIES 157 00:05:29,040 --> 00:05:30,760 RIGOROUS RESEARCH METHODS, HAS 158 00:05:30,760 --> 00:05:31,720 THE POTENTIAL FOR SIGNIFICANT 159 00:05:31,720 --> 00:05:34,920 IMPACT ON HEALTH AND WELLNESS, 160 00:05:34,920 --> 00:05:42,880 WELL BEYOND THE STUDY STUDY 161 00:05:42,880 --> 00:05:45,760 SAMPLE, ADDRESSES TODAY'S 162 00:05:45,760 --> 00:05:46,840 CHALLENGES AND PROVIDES 163 00:05:46,840 --> 00:05:48,880 SOLUTIONS TO OPTIMIZE HEALTH 164 00:05:48,880 --> 00:05:51,560 ACROSS CLINICAL, COMMUNITY, AND 165 00:05:51,560 --> 00:05:51,960 POLICY SETTINGS. 166 00:05:51,960 --> 00:05:54,240 NOW LET ME EXPLAIN WHAT WE MEAN 167 00:05:54,240 --> 00:05:55,160 BY A RESEARCH LENS. 168 00:05:55,160 --> 00:05:58,240 SIMPLY PUT, WHAT WE'RE CALLING A 169 00:05:58,240 --> 00:06:00,240 RESEARCH LENS IS PERSPECTIVE BY 170 00:06:00,240 --> 00:06:01,120 WHICH TO EXAMINE IDENTIFIED 171 00:06:01,120 --> 00:06:01,840 HEALTH CHALLENGE. 172 00:06:01,840 --> 00:06:03,840 AS WE KNOW THE FIELD OF NURSING 173 00:06:03,840 --> 00:06:08,840 SCIENCE IS COMPRISED OF MANY, 174 00:06:08,840 --> 00:06:10,720 MANY DIFFERENT PERSPECTIVES ON 175 00:06:10,720 --> 00:06:12,880 TOPIC AND HOW TO DO SO. 176 00:06:12,880 --> 00:06:14,720 IN DEVELOPING THE STRATEGIC 177 00:06:14,720 --> 00:06:16,280 PLAN, NINR IDENTIFIED FIVE 178 00:06:16,280 --> 00:06:18,040 LENSES THAT WE THINK BEST LEVER 179 00:06:18,040 --> 00:06:21,080 YANG THE STRENGTHS OF NURSING 180 00:06:21,080 --> 00:06:23,240 SCIENCE AND POSITION THE FIELD 181 00:06:23,240 --> 00:06:25,520 TO INNOVATE AND THINK EVEN 182 00:06:25,520 --> 00:06:27,120 BIGGER THAN WE HAVE IN THE PAST, 183 00:06:27,120 --> 00:06:28,640 TO INCREASE OUR IMPACT, SO LET'S 184 00:06:28,640 --> 00:06:33,360 TAKE A CLOSER LOOK AT EACH OF 185 00:06:33,360 --> 00:06:34,240 THESE LENSES. 186 00:06:34,240 --> 00:06:36,080 HEALTH EQUITY INCLUDES STUDIES 187 00:06:36,080 --> 00:06:38,520 AIMED AT PRODUCING EVIDENCE 188 00:06:38,520 --> 00:06:41,880 NEEDED TO REDUCE AND ULTIMATELY 189 00:06:41,880 --> 00:06:45,640 ELIMINATE SYSTEMIC AND 190 00:06:45,640 --> 00:06:46,520 STRUCTURAL INEQUALITIES THAT 191 00:06:46,520 --> 00:06:52,000 PLACE POPULATION GROUPS AT A 192 00:06:52,000 --> 00:06:52,320 DISADVANTAGE. 193 00:06:52,320 --> 00:06:53,240 SOCIAL DETERMINANTS OF HEALTH 194 00:06:53,240 --> 00:06:55,040 ARE THE CONDITIONS PEOPLE ARE 195 00:06:55,040 --> 00:06:57,600 BORN, LIVE, LEARN, WORK, PLAY, 196 00:06:57,600 --> 00:06:58,040 AGE. 197 00:06:58,040 --> 00:06:58,640 BECAUSE THESE DETERMINANTS 198 00:06:58,640 --> 00:07:00,680 IMPACT SO MANY FACETS OF OUR 199 00:07:00,680 --> 00:07:02,640 HEALTH AND WELL-BEING WE BELIEVE 200 00:07:02,640 --> 00:07:05,040 IT'S VITAL TO SUPPORT RESEARCH 201 00:07:05,040 --> 00:07:07,280 THAT WILL EXAMINE THEM AND 202 00:07:07,280 --> 00:07:08,840 IDENTIFY EFFECTIVE APPROACHES TO 203 00:07:08,840 --> 00:07:10,760 ADDRESS SOCIAL FACTORS, POSITIVE 204 00:07:10,760 --> 00:07:14,800 AND NEGATIVE, AND SOCIAL NEEDS 205 00:07:14,800 --> 00:07:16,560 TO IMPROVE HEALTH OUTCOMES. 206 00:07:16,560 --> 00:07:17,640 POPULATION AND COMMUNITY HEALTH 207 00:07:17,640 --> 00:07:19,840 INCLUDE STUDIES THAT ADDRESS 208 00:07:19,840 --> 00:07:21,240 CRITICAL HEALTH CHALLENGES AT 209 00:07:21,240 --> 00:07:23,800 THE MACRO LEVEL, BY FOCUSING ON 210 00:07:23,800 --> 00:07:24,840 INTERVENTIONS THAT AFFECT GROUPS 211 00:07:24,840 --> 00:07:26,680 OF PEOPLE WITH SHARED 212 00:07:26,680 --> 00:07:28,960 CHARACTERISTICS, OR WHO LIVE 213 00:07:28,960 --> 00:07:31,280 WITHIN A SHARED AREA. 214 00:07:31,280 --> 00:07:32,480 PREVENTION AND HEALTH PROMOTION 215 00:07:32,480 --> 00:07:34,280 INCLUDE PROJECTS STUDYING HOW TO 216 00:07:34,280 --> 00:07:36,160 PREVENT DISEASE AND PROMOTE 217 00:07:36,160 --> 00:07:40,120 HEALTH THROUGH THE CONTINUUM OF 218 00:07:40,120 --> 00:07:40,440 PREVENTION. 219 00:07:40,440 --> 00:07:42,040 FROM PRIMORDIAL PREVENTION THAT 220 00:07:42,040 --> 00:07:43,520 TARGETS UNDERLYING FACTORS THAT 221 00:07:43,520 --> 00:07:48,040 INCREASE RISK OF ILLNESS TO 222 00:07:48,040 --> 00:07:50,880 TERTIARY PREVENTION TO REDUCE 223 00:07:50,880 --> 00:07:54,160 SYMPTOMS, PROGRESSION, WITH 224 00:07:54,160 --> 00:08:02,240 EMPHASIS ON ELIMINATING HEALTH 225 00:08:02,240 --> 00:08:02,760 DISPARITIES. 226 00:08:02,760 --> 00:08:04,400 SYSTEMS ADDRESS ORGANIZATIONAL 227 00:08:04,400 --> 00:08:07,680 AND POLICY CHALLENGES THROUGH 228 00:08:07,680 --> 00:08:08,600 DEVELOPMENT, DISSEMINATION AND 229 00:08:08,600 --> 00:08:11,000 IMPLEMENTATION OF SYSTEMS OF 230 00:08:11,000 --> 00:08:12,440 CARE BRIDGING COMMUNITY CARE 231 00:08:12,440 --> 00:08:14,240 WITH SOCIAL FACTORS AND 232 00:08:14,240 --> 00:08:14,600 ASSOCIATE NEEDS. 233 00:08:14,600 --> 00:08:17,000 HERE'S WHAT YOU CAN EXPECT OVER 234 00:08:17,000 --> 00:08:17,560 THE NEXT FEW MONTHS. 235 00:08:17,560 --> 00:08:19,600 THE STRATEGIC PLAN WILL BE 236 00:08:19,600 --> 00:08:20,840 FINALIZED AND PUBLISHED ON OUR 237 00:08:20,840 --> 00:08:21,200 WEBSITE. 238 00:08:21,200 --> 00:08:23,640 WE'LL BEGIN THE HARD WORK OF 239 00:08:23,640 --> 00:08:26,160 IMPLEMENTING THE NEW PLAN. 240 00:08:26,160 --> 00:08:27,240 AND RESEARCH WE FUND AND CONDUCT 241 00:08:27,240 --> 00:08:30,720 AND IN THE WAY WE MANAGE OUR 242 00:08:30,720 --> 00:08:31,160 INSTITUTE. 243 00:08:31,160 --> 00:08:32,000 WE'RE CONSIDERING HOSTING 244 00:08:32,000 --> 00:08:34,400 SEMINARS AND OTHER EVENTS THAT 245 00:08:34,400 --> 00:08:35,840 WILL HIGHLIGHT IMPORTANT 246 00:08:35,840 --> 00:08:38,840 RESEARCH IN THESE NEW AREAS OF 247 00:08:38,840 --> 00:08:39,440 EMPHASIS. 248 00:08:39,440 --> 00:08:41,400 THE BOTTOM LINE IS PLEASE STAY 249 00:08:41,400 --> 00:08:43,200 TUNED TO OUR WEBSITE, TWITTER 250 00:08:43,200 --> 00:08:47,240 FEED, NEWS NEED FOR THE VERY 251 00:08:47,240 --> 00:08:47,640 LATEST. 252 00:08:47,640 --> 00:08:50,040 AS YOU ALL KNOW THE PERSPECTIVE 253 00:08:50,040 --> 00:08:51,880 THAT NURSING BRINGS TO RESEARCH 254 00:08:51,880 --> 00:08:54,360 IS UNIQUE IN THAT WE APPROACH 255 00:08:54,360 --> 00:08:57,160 PREVENTION, TREATMENT, AND CARE 256 00:08:57,160 --> 00:08:58,440 HOLISTICALLY AND IN CONTEXT. 257 00:08:58,440 --> 00:09:00,800 AND THE SCOPE OF OUR PRACTICE 258 00:09:00,800 --> 00:09:02,440 AND DISCIPLINE EXTENDS FROM 259 00:09:02,440 --> 00:09:03,400 IMPROVING THE HEALTH OF 260 00:09:03,400 --> 00:09:06,720 INDIVIDUALS TO THAT OF ENTIRE 261 00:09:06,720 --> 00:09:07,040 POPULATIONS. 262 00:09:07,040 --> 00:09:09,400 WHAT SETS NINR APART FROM THE 263 00:09:09,400 --> 00:09:12,440 OTHER NIH INSTITUTES IS THAT OUR 264 00:09:12,440 --> 00:09:13,840 RESEARCH IS FOCUSED ON PEOPLE IN 265 00:09:13,840 --> 00:09:16,840 THE CONTEXT OF THEIR LIVES AND 266 00:09:16,840 --> 00:09:17,960 LIVING CONDITIONS. 267 00:09:17,960 --> 00:09:20,160 IT'S OUR UNIQUE PERSPECTIVE THAT 268 00:09:20,160 --> 00:09:22,120 MAKES OUR SCIENTIFIC DISCIPLINE 269 00:09:22,120 --> 00:09:23,040 SO WELL-POSITIONED TO LEAD 270 00:09:23,040 --> 00:09:24,400 RESEARCH FOCUSED ON THE WHOLE 271 00:09:24,400 --> 00:09:26,560 PICTURE OF HEALTH, FROM THE 272 00:09:26,560 --> 00:09:29,440 BIOLOGY OF A PERSON'S CELLS AND 273 00:09:29,440 --> 00:09:31,720 GENES TO THEIR WHOLE SELF, 274 00:09:31,720 --> 00:09:32,440 FAMILY AND RESOURCES, THE 275 00:09:32,440 --> 00:09:34,720 COMMUNITY AND SOCIETY IN WHICH 276 00:09:34,720 --> 00:09:35,360 THEY LIVE. 277 00:09:35,360 --> 00:09:38,440 IT'S VITAL THAT WE BRING THAT 278 00:09:38,440 --> 00:09:39,800 PERSPECTIVE TO THE TABLE 279 00:09:39,800 --> 00:09:41,440 WHEREVER DECISIONS ARE MADE THAT 280 00:09:41,440 --> 00:09:43,920 IMPACT HUMAN HEALTH AND WE'RE 281 00:09:43,920 --> 00:09:45,040 DOING JUST THAT. 282 00:09:45,040 --> 00:09:46,920 SO I'M EXCITED TO SHARE THAT 283 00:09:46,920 --> 00:09:50,040 NINR IS EXPANDING OUR 284 00:09:50,040 --> 00:09:51,120 INVOLVEMENT IN NIH-WIDE 285 00:09:51,120 --> 00:09:51,840 INITIATIVES. 286 00:09:51,840 --> 00:09:54,280 I'M EXCITED TO HIGHLIGHT NINR'S 287 00:09:54,280 --> 00:09:57,120 PARTICIPATION IN SOME OF THESE 288 00:09:57,120 --> 00:09:59,160 PARTNERSHIPS AND COLLABORATIONS, 289 00:09:59,160 --> 00:10:01,600 INCLUDING THE MATERNAL MORTALITY 290 00:10:01,600 --> 00:10:03,440 TASK FORCE ADVISORY CABINET. 291 00:10:03,440 --> 00:10:06,720 THE NIH CMS JOINT COUNCIL, THE 292 00:10:06,720 --> 00:10:09,280 "ALL OF US" BRAIN TRUST AND 293 00:10:09,280 --> 00:10:11,120 EXECUTIVE COMMITTEE FOR 294 00:10:11,120 --> 00:10:12,760 ADVANCING NIH-WIDE BASIC 295 00:10:12,760 --> 00:10:13,480 BEHAVIORAL AND SOCIAL SCIENCES 296 00:10:13,480 --> 00:10:14,160 RESEARCH. 297 00:10:14,160 --> 00:10:16,040 AND AS YOU KNOW WE'VE BEEN 298 00:10:16,040 --> 00:10:17,040 INVITED TO SERVE ON LEADERSHIP 299 00:10:17,040 --> 00:10:20,080 ROLES IN THE CLIMATE CHANGE AND 300 00:10:20,080 --> 00:10:22,320 HEALTH INITIATIVE, COVID SOCIAL 301 00:10:22,320 --> 00:10:24,800 BEHAVIORAL AND ECONOMIC HEALTH 302 00:10:24,800 --> 00:10:25,880 IMPACTS INITIATIVE, AND 303 00:10:25,880 --> 00:10:30,320 EXECUTIVE COMMITTEE OF HELPING 304 00:10:30,320 --> 00:10:40,520 TO END ADDICTION LONG TERM, OR 305 00:10:40,520 --> 00:10:41,960 HEAL INITIATIVE, AND SPEARHEADED 306 00:10:41,960 --> 00:10:43,240 NIH-WIDE SOCIAL DETERMINANTS OF 307 00:10:43,240 --> 00:10:43,840 HEALTH RESEARCH COORDINATING 308 00:10:43,840 --> 00:10:46,240 COMMITTEE WITH SEVERAL OTHER 309 00:10:46,240 --> 00:10:47,640 INSTITUTES AND CENTERS. 310 00:10:47,640 --> 00:10:49,720 AS WELL AS OFFICES. 311 00:10:49,720 --> 00:10:51,000 GIVEN OUR NATION'S PRESSING 312 00:10:51,000 --> 00:10:52,040 HEALTH CHALLENGES, THE 313 00:10:52,040 --> 00:10:53,560 IMPORTANCE OF STRUCTURAL AND 314 00:10:53,560 --> 00:10:56,880 SOCIAL FACTORS FOR HEALTH AND 315 00:10:56,880 --> 00:11:00,000 HEALTH DISPARITIES AND THEIR 316 00:11:00,000 --> 00:11:00,640 PRIORITIZATION IN THE NIH-WIDE 317 00:11:00,640 --> 00:11:02,760 STRATEGIC PLAN, THE GOAL OF THE 318 00:11:02,760 --> 00:11:05,440 RESEARCH COORDINATING COMMITTEE 319 00:11:05,440 --> 00:11:06,320 IS TO ACCELERATE SOCIAL 320 00:11:06,320 --> 00:11:07,840 DETERMINANTS OF HEALTH RESEARCH 321 00:11:07,840 --> 00:11:09,280 ACROSS NIH. 322 00:11:09,280 --> 00:11:12,560 TOWARDS THIS GOAL, THE RESEARCH 323 00:11:12,560 --> 00:11:14,760 COORDINATING COMMITTEE WILL SEEK 324 00:11:14,760 --> 00:11:16,240 TO FACILITATE INFORMATION 325 00:11:16,240 --> 00:11:17,120 SHARING ABOUT SOCIAL 326 00:11:17,120 --> 00:11:18,640 DETERMINANTS OF HEALTH RESEARCH 327 00:11:18,640 --> 00:11:22,120 ACROSS NIH AND WITH FEDERAL 328 00:11:22,120 --> 00:11:24,040 PARTNERS, DEVELOP SOCIAL 329 00:11:24,040 --> 00:11:24,840 DETERMINANTS OF HEALTH 330 00:11:24,840 --> 00:11:26,440 EXPERTISE, CAPACITY AND A 331 00:11:26,440 --> 00:11:30,400 LEARNING SYSTEM IN THIS 332 00:11:30,400 --> 00:11:32,680 SCIENTIFIC FIELD, BUILD 333 00:11:32,680 --> 00:11:33,280 COMMUNITY AND COLLABORATION IN 334 00:11:33,280 --> 00:11:34,400 SOCIAL DETERMINANTS OF HEALTH 335 00:11:34,400 --> 00:11:37,040 RESEARCH ACROSS NIH AND WITH 336 00:11:37,040 --> 00:11:39,520 FEDERAL PARTNERS, AND IDENTIFY 337 00:11:39,520 --> 00:11:42,200 GAPS AND PROMISING RESEARCH 338 00:11:42,200 --> 00:11:43,440 DIRECTIONS IN THIS FIELD. 339 00:11:43,440 --> 00:11:44,720 THE RESEARCH COORDINATING 340 00:11:44,720 --> 00:11:46,120 COMMITTEE WAS APPROVED JUST A 341 00:11:46,120 --> 00:11:50,440 WEEK AGO, AND WE LOOK FORWARD TO 342 00:11:50,440 --> 00:11:51,680 SHARING MORE INFORMATION AS THE 343 00:11:51,680 --> 00:11:54,160 COMMITTEE IS ESTABLISHED AND 344 00:11:54,160 --> 00:11:54,720 MOVES FORWARD. 345 00:11:54,720 --> 00:11:57,800 WE THINK OUR LEADERSHIP AND 346 00:11:57,800 --> 00:11:58,720 PARTICIPATION IN THESE 347 00:11:58,720 --> 00:12:00,120 ACTIVITIES MAKE CLEAR THAT 348 00:12:00,120 --> 00:12:02,720 NURSING RESEARCH IS BEING 349 00:12:02,720 --> 00:12:06,320 RECOGNIZED FOR ITS VITAL ROLE IN 350 00:12:06,320 --> 00:12:07,440 THE BIOMEDICAL RESEARCH 351 00:12:07,440 --> 00:12:07,840 ENTERPRISE. 352 00:12:07,840 --> 00:12:10,280 AT NIH I'M ALSO EXCITED TO SHARE 353 00:12:10,280 --> 00:12:13,760 THAT NINR IS HELPING TO LEAD TWO 354 00:12:13,760 --> 00:12:18,240 COMMON FUND PROGRAMS TO ADVANCE 355 00:12:18,240 --> 00:12:19,880 HEALTH EQUITY, AS BACKGROUND THE 356 00:12:19,880 --> 00:12:21,520 THEY ADDRESS EMERGING 357 00:12:21,520 --> 00:12:22,520 OPPORTUNITIES AND PRESSING 358 00:12:22,520 --> 00:12:24,040 HEALTH CHALLENGES IN BIOMEDICAL 359 00:12:24,040 --> 00:12:26,040 RESEARCH, BUT NO SINGLE NIH 360 00:12:26,040 --> 00:12:28,080 INSTITUTE OR CENTER CAN ADDRESS 361 00:12:28,080 --> 00:12:29,040 ON ITS OWN. 362 00:12:29,040 --> 00:12:32,080 BUT ARE OF HIGH PRIORITY FOR NIH 363 00:12:32,080 --> 00:12:32,400 AS A WHOLE. 364 00:12:32,400 --> 00:12:35,920 THE COMMON FUND IS A UNIQUE 365 00:12:35,920 --> 00:12:38,200 RESOURCE AT NIH, HIGH RISK 366 00:12:38,200 --> 00:12:40,280 INNOVATIVE ENDEAVORS WITH THE 367 00:12:40,280 --> 00:12:42,040 POTENTIAL FOR EXTRAORDINARY 368 00:12:42,040 --> 00:12:44,440 IMPACT ARE SUPPORTED. 369 00:12:44,440 --> 00:12:46,280 LAUNCHED IN 2021, THE FIRST 370 00:12:46,280 --> 00:12:48,240 PROGRAM WAS THE TRANSFORMATIVE 371 00:12:48,240 --> 00:12:49,560 RESEARCH TO ADDRESS HEALTH 372 00:12:49,560 --> 00:12:53,200 DISPARITIES AND ADVANCE HEALTH 373 00:12:53,200 --> 00:12:55,520 EQUITY COMMON FUND PROGRAM, 374 00:12:55,520 --> 00:12:56,200 SUPPORTING INNOVATIVE 375 00:12:56,200 --> 00:12:57,680 TRANSLATIONAL RESEARCH PROJECTS 376 00:12:57,680 --> 00:12:59,840 TO PREVENT, REDUCE, OR ELIMINATE 377 00:12:59,840 --> 00:13:02,240 HEALTH DISPARITIES AND ADVANCE 378 00:13:02,240 --> 00:13:02,720 HEALTH EQUITY. 379 00:13:02,720 --> 00:13:04,320 SO FAR, 11 GRANTS HAVE BEEN 380 00:13:04,320 --> 00:13:07,840 FUNDED THROUGH THIS PROGRAM, 381 00:13:07,840 --> 00:13:10,160 WITH ADDITIONAL GRANTS 382 00:13:10,160 --> 00:13:10,720 CONSIDERED. 383 00:13:10,720 --> 00:13:14,200 TWO FUNDING ANNOUNCEMENTS 384 00:13:14,200 --> 00:13:16,360 RELEASED IN 2021 ULTIMATELY 385 00:13:16,360 --> 00:13:18,920 PROVIDED $58 MILLION OVER THE 386 00:13:18,920 --> 00:13:19,800 NEXT FIVE YEARS. 387 00:13:19,800 --> 00:13:22,200 SO YOU CAN LEARN MORE ABOUT THAT 388 00:13:22,200 --> 00:13:24,640 PROGRAM AND FUNDED GRANTS AT THE 389 00:13:24,640 --> 00:13:26,240 WEB ADDRESS SHOWN ON THE SLIDE. 390 00:13:26,240 --> 00:13:30,640 AND I WANT TO POINT OUT THAT THE 391 00:13:30,640 --> 00:13:33,480 RFA FOR MINORITY-SERVING 392 00:13:33,480 --> 00:13:34,160 INSTITUTIONS WAS RECENTLY 393 00:13:34,160 --> 00:13:37,240 REISSUED FOR THE PROGRAM WITH A 394 00:13:37,240 --> 00:13:39,040 MAY 23 DUE DATE. 395 00:13:39,040 --> 00:13:41,240 I'M ALSO EXCITED TO SHARE OUR 396 00:13:41,240 --> 00:13:45,960 INVOLVEMENT IN A SECOND OR NEW 397 00:13:45,960 --> 00:13:46,880 COMMON FUND PROGRAM RECOGNIZING 398 00:13:46,880 --> 00:13:53,640 URGENCY OF HEALTH EQUITY 399 00:13:53,640 --> 00:13:56,000 RESEARCH, NINNR WITH COLLEAGUES 400 00:13:56,000 --> 00:14:02,320 IS CO-CHAIRING A SECOND NEW 401 00:14:02,320 --> 00:14:05,400 10-YEAR $397 MILLION NIH COMMON 402 00:14:05,400 --> 00:14:06,840 FUND PROGRAM, COMPASS, IT WILL 403 00:14:06,840 --> 00:14:08,680 BE TRANSFORMATIVE AND HELP MAKE 404 00:14:08,680 --> 00:14:10,520 REAL PROGRESS IN ELIMINATING 405 00:14:10,520 --> 00:14:11,680 HEALTH INEQUITIES AND ACHIEVING 406 00:14:11,680 --> 00:14:13,400 HEALTH EQUITY. 407 00:14:13,400 --> 00:14:15,040 BY LOOKING UPSTREAM AT THE 408 00:14:15,040 --> 00:14:18,720 SYSTEMS AND STRUCTURES THAT ARE 409 00:14:18,720 --> 00:14:20,360 CAUSING SOCIALLY AND 410 00:14:20,360 --> 00:14:20,880 ECONOMICALLY DISADVANTAGED 411 00:14:20,880 --> 00:14:22,840 POPULATIONS TO BECOME SICK IN 412 00:14:22,840 --> 00:14:25,200 THE FIRST PLACE. 413 00:14:25,200 --> 00:14:28,000 COMPASS HAS TWO OVERARCHING 414 00:14:28,000 --> 00:14:28,240 GOALS. 415 00:14:28,240 --> 00:14:30,400 FIRST THE PROGRAM WILL 416 00:14:30,400 --> 00:14:33,120 FACILITATE AND IMPLEMENT A 417 00:14:33,120 --> 00:14:34,400 CROSS-I.C. FRAMEWORK FOR 418 00:14:34,400 --> 00:14:36,040 RESEARCH. 419 00:14:36,040 --> 00:14:38,760 SECOND, IT WILL DEPLOY AND 420 00:14:38,760 --> 00:14:39,840 EVALUATE COMMUNITY-DRIVEN 421 00:14:39,840 --> 00:14:43,760 STRUCTURAL HEALTH EQUITY 422 00:14:43,760 --> 00:14:45,640 INTERVENTIONS THAT LEVERAGE 423 00:14:45,640 --> 00:14:46,200 INTERSECTORIAL PARTNERSHIPS, 424 00:14:46,200 --> 00:14:48,480 GENERATING NEW EVIDENCE ON WHAT 425 00:14:48,480 --> 00:14:49,560 STRUCTURAL INTERVENTIONS ARE 426 00:14:49,560 --> 00:14:51,240 EFFECTIVE IN ADVANCING HEALTH 427 00:14:51,240 --> 00:14:51,480 EQUITY. 428 00:14:51,480 --> 00:14:54,000 AND IT WILL SHED LIGHT ON THE 429 00:14:54,000 --> 00:14:57,080 MECHANISMS BY WHICH THESE 430 00:14:57,080 --> 00:14:59,280 INTERVENTIONS WORK. 431 00:14:59,280 --> 00:15:00,240 432 00:15:00,240 --> 00:15:02,760 IN ADDITION IT WILL INCREASE 433 00:15:02,760 --> 00:15:05,040 RESEARCH CAPACITY AMONG ALL 434 00:15:05,040 --> 00:15:06,880 PARTNERS IN HEALTH EQUITY 435 00:15:06,880 --> 00:15:09,360 INTERVENTION RESEARCH, AND 436 00:15:09,360 --> 00:15:11,520 INCREASE COMPETITIVENESS FOR 437 00:15:11,520 --> 00:15:12,720 INSTITUTE AND CENTER FUNDING, 438 00:15:12,720 --> 00:15:16,040 CONTRIBUTING TO GREATER 439 00:15:16,040 --> 00:15:18,000 DIVERSITY AND INCLUSION OF 440 00:15:18,000 --> 00:15:19,200 INVESTIGATORS AND PARTICIPANTS 441 00:15:19,200 --> 00:15:20,680 ACROSS THE NIH. 442 00:15:20,680 --> 00:15:22,640 IT WILL RESULT IN COMMON DATA 443 00:15:22,640 --> 00:15:25,240 AND TOOLS, SHARED FRAMEWORK FOR 444 00:15:25,240 --> 00:15:29,520 RESEARCH ACROSS PARTNERS, AND 445 00:15:29,520 --> 00:15:32,840 EXCITINGLY A DISEASE AGNOSTIC 446 00:15:32,840 --> 00:15:36,040 NETWORK AT THE NATIONAL LEVEL AS 447 00:15:36,040 --> 00:15:37,680 WELL AS AT-RISK COMMUNITIES. 448 00:15:37,680 --> 00:15:40,880 IT WILL PROVIDE REPOSITORIES OF 449 00:15:40,880 --> 00:15:41,840 EVIDENCE-BASED HEALTH EQUITY 450 00:15:41,840 --> 00:15:43,440 INTERVENTIONS, YIELD CAPACITY 451 00:15:43,440 --> 00:15:45,360 BUILDING AND TRAINING CURRICULA, 452 00:15:45,360 --> 00:15:46,640 AND INFORM HEALTH EQUITY 453 00:15:46,640 --> 00:15:48,600 ENHANCING POLICIES AND PROGRAMS. 454 00:15:48,600 --> 00:15:53,800 SO I CERTAINLY LOOK FORWARD TO 455 00:15:53,800 --> 00:15:54,800 NURSING SCIENCE'S CONTINUED 456 00:15:54,800 --> 00:15:56,600 INVOLVEMENT IN THIS IMPORTANT 457 00:15:56,600 --> 00:15:57,440 PROGRAM. 458 00:15:57,440 --> 00:15:58,960 IN ADDITION TO NINR 459 00:15:58,960 --> 00:16:01,480 PARTICIPATION IN THESE IMPORTANT 460 00:16:01,480 --> 00:16:04,840 NIH-WIDE PROGRAMS WE'RE ALSO 461 00:16:04,840 --> 00:16:06,440 PARTICIPATING IN SEVERAL 462 00:16:06,440 --> 00:16:08,600 INTERAGENCY AND HHS-WIDE 463 00:16:08,600 --> 00:16:08,880 INITIATIVES. 464 00:16:08,880 --> 00:16:10,000 THESE INCLUDE SOCIAL 465 00:16:10,000 --> 00:16:12,080 DETERMINANTS OF HEALTH 466 00:16:12,080 --> 00:16:12,960 INTERAGENCY POLICY COMMITTEE, 467 00:16:12,960 --> 00:16:15,240 THE INTERAGENCY WORKING GROUP 468 00:16:15,240 --> 00:16:17,120 FOR THE NATIONAL HEALTHCARE 469 00:16:17,120 --> 00:16:19,800 QUALITY AND DISPARITIES REPORT, 470 00:16:19,800 --> 00:16:22,320 THE HHS INTERDEPARTMENTAL HEALTH 471 00:16:22,320 --> 00:16:22,920 EQUITY COLLABORATIVE, THE HHS 472 00:16:22,920 --> 00:16:26,200 SOCIAL DETERMINANTS OF HEALTH 473 00:16:26,200 --> 00:16:29,120 WORKGROUP, AND THE HHS 474 00:16:29,120 --> 00:16:30,240 INITIATIVE TO STRENGTHEN PRIMARY 475 00:16:30,240 --> 00:16:31,440 HEALTH CARE, AND WE'RE 476 00:16:31,440 --> 00:16:33,560 REPRESENTED ON THE CLIMATE 477 00:16:33,560 --> 00:16:35,160 CHANGE FOOD SYSTEMS AND 478 00:16:35,160 --> 00:16:35,800 NUTRITION SECURITY WORKING GROUP 479 00:16:35,800 --> 00:16:38,440 OF THE U.S. GLOBAL CHANGE 480 00:16:38,440 --> 00:16:38,840 RESEARCH PROGRAM. 481 00:16:38,840 --> 00:16:43,520 I AM REALLY EXCITED TO HAVE 482 00:16:43,520 --> 00:16:45,000 NURSING SCIENCE'S PERSPECTIVE ON 483 00:16:45,000 --> 00:16:47,800 THESE, ACROSS ALL THESE 484 00:16:47,800 --> 00:16:48,600 IMPORTANT COMMITTEES. 485 00:16:48,600 --> 00:16:52,880 SO NOW LET ME SHARE A LITTLE BIT 486 00:16:52,880 --> 00:16:54,640 MORE NEWS FROM NINR. 487 00:16:54,640 --> 00:16:57,760 AT NINR WE ACKNOWLEDGE THAT OUR 488 00:16:57,760 --> 00:16:58,760 EFFORTS TOWARDS ACHIEVING HEALTH 489 00:16:58,760 --> 00:17:01,480 EQUITY DEPEND AT LEAST IN PART 490 00:17:01,480 --> 00:17:03,240 ON OUR EFFORTS TOWARDS 491 00:17:03,240 --> 00:17:03,560 DIVERSITY. 492 00:17:03,560 --> 00:17:04,880 QUITE SIMPLY, GREATER DIVERSITY 493 00:17:04,880 --> 00:17:08,840 AND INCLUSION IN OUR SCIENCE 494 00:17:08,840 --> 00:17:09,760 GREATLY IMPACTS, ENHANCES 495 00:17:09,760 --> 00:17:12,960 QUALITY AND IMPACT OF OUR 496 00:17:12,960 --> 00:17:13,400 SCIENCE. 497 00:17:13,400 --> 00:17:15,720 WE'RE ADDRESSING THE ISSUE OF 498 00:17:15,720 --> 00:17:18,480 DIVERSITY AND NURSING SCIENCE 499 00:17:18,480 --> 00:17:20,040 WORKFORCE BY PARTICIPATING IN 500 00:17:20,040 --> 00:17:21,160 TWO IMPORTANT NIH INITIATIVES 501 00:17:21,160 --> 00:17:24,560 THAT AIM TO BUILD DIVERSITY 502 00:17:24,560 --> 00:17:26,080 AMONG EARLY CAREER SCIENTISTS, 503 00:17:26,080 --> 00:17:28,280 THE FIRST IS THE FIRST 504 00:17:28,280 --> 00:17:32,880 INITIATIVE, THE SECOND, THE 505 00:17:32,880 --> 00:17:33,440 MOSAIC POSTDOCTORAL CAREER 506 00:17:33,440 --> 00:17:35,400 TRANSITION AWARD TO PROMOTE 507 00:17:35,400 --> 00:17:35,960 DIVERSITY. 508 00:17:35,960 --> 00:17:38,040 THROUGH FIRST, NIH AIMS TO 509 00:17:38,040 --> 00:17:40,440 FACILITATE INSTITUTIONS AND 510 00:17:40,440 --> 00:17:41,600 BUILDING A SELF-REINFORCING 511 00:17:41,600 --> 00:17:43,000 COMMUNITY OF SCIENTISTS, THROUGH 512 00:17:43,000 --> 00:17:44,920 RECRUITMENT OF A CRITICAL MASS 513 00:17:44,920 --> 00:17:48,800 OF EARLY CAREER FACULTY WITH 514 00:17:48,800 --> 00:17:50,240 DEMONSTRATED COMMITMENT TO 515 00:17:50,240 --> 00:17:50,720 INCLUSIVE EXCELLENCE. 516 00:17:50,720 --> 00:17:52,840 THE FIRST PROGRAM WILL SOON 517 00:17:52,840 --> 00:17:55,840 BEGIN ACCEPTING APPLICATIONS FOR 518 00:17:55,840 --> 00:17:58,760 NEW COHORT SO PLEASE SHARE THIS 519 00:17:58,760 --> 00:18:02,680 OPPORTUNITY BROADLY ACROSS YOUR 520 00:18:02,680 --> 00:18:02,960 NETWORKS. 521 00:18:02,960 --> 00:18:06,040 MOSAIC AIMS TO SUPPORT A COHORT 522 00:18:06,040 --> 00:18:08,440 OF EARLY CAREER INDEPENDENT 523 00:18:08,440 --> 00:18:08,960 INVESTIGATORS FROM DIVERSE 524 00:18:08,960 --> 00:18:11,040 BACKGROUNDS WITH A LONG-TERM 525 00:18:11,040 --> 00:18:13,640 GOAL OF ENHANCING DIVERSITY IN 526 00:18:13,640 --> 00:18:14,600 THE BIOMEDICAL RESEARCH 527 00:18:14,600 --> 00:18:16,440 WORKFORCE, AGAIN PLEASE SHARE 528 00:18:16,440 --> 00:18:18,560 ACROSS YOUR NETWORKS, FOR MORE 529 00:18:18,560 --> 00:18:21,520 INFORMATION THOUGH ON ALL 530 00:18:21,520 --> 00:18:22,160 TRAINING OPPORTUNITIES AVAILABLE 531 00:18:22,160 --> 00:18:24,160 THROUGH NINR PLEASE CHECK OUR 532 00:18:24,160 --> 00:18:24,400 WEBSITE. 533 00:18:24,400 --> 00:18:25,960 OF COURSE, ALWAYS FEEL FREE TO 534 00:18:25,960 --> 00:18:29,440 REACH OUT TO OUR PROGRAM STAFF. 535 00:18:29,440 --> 00:18:31,440 AND WE ENCOURAGE ALL 536 00:18:31,440 --> 00:18:33,280 INVESTIGATORS WITH AN ELIGIBLE 537 00:18:33,280 --> 00:18:36,920 GRANT SUCH AS R01 TO SUBMIT A 538 00:18:36,920 --> 00:18:38,600 DIVERSITY SUPPLEMENT AND HELP 539 00:18:38,600 --> 00:18:41,600 ENSURE OUR WORK IS INCLUSIVE OF 540 00:18:41,600 --> 00:18:41,880 EVERYONE. 541 00:18:41,880 --> 00:18:44,760 DIVERSITY SUPPLEMENTS HAVE BEEN 542 00:18:44,760 --> 00:18:46,840 SHOWN TO LAUNCH SUCCESSFUL AND 543 00:18:46,840 --> 00:18:48,960 PROTECTIVE RESEARCH CAREERS OF 544 00:18:48,960 --> 00:18:50,800 SCIENTISTS OF DIVERSITY 545 00:18:50,800 --> 00:18:51,080 BACKGROUNDS. 546 00:18:51,080 --> 00:18:52,160 NINR SUPPORTS DIVERSITY 547 00:18:52,160 --> 00:18:54,800 SUPPLEMENTS TO ENHANCE THE 548 00:18:54,800 --> 00:18:57,040 DIVERSITY OF THE RESEARCH, AND 549 00:18:57,040 --> 00:18:59,400 ENTREPRENEURIAL WORK FORCE BY 550 00:18:59,400 --> 00:19:01,840 RECRUITING AND SUPPORTING 551 00:19:01,840 --> 00:19:03,800 STUDENTS, POSTDOCTORAL FELLOWS, 552 00:19:03,800 --> 00:19:05,120 AND ELIGIBLE INVESTIGATORS FROM 553 00:19:05,120 --> 00:19:06,040 DIVERSE BACKGROUNDS. 554 00:19:06,040 --> 00:19:06,960 THIS INCLUDES THOSE FROM GROUPS 555 00:19:06,960 --> 00:19:10,800 THAT HAVE BEEN SHOWN TO BE 556 00:19:10,800 --> 00:19:11,560 UNDERREPRESENTED IN 557 00:19:11,560 --> 00:19:13,400 HEALTH-RELATED RESEARCH, OR IN 558 00:19:13,400 --> 00:19:16,680 THE SMALL BUSINESS PROGRAMS. 559 00:19:16,680 --> 00:19:17,440 AN INTERESTING OPPORTUNITY TOYED 560 00:19:17,440 --> 00:19:22,040 LIKE TO DRAW -- I'D LIKE TO DRAW 561 00:19:22,040 --> 00:19:24,640 YOUR ATTENTION TO, SUPPLEMENTS 562 00:19:24,640 --> 00:19:30,600 TO RECOGNIZE EXCELLENCE IN 563 00:19:30,600 --> 00:19:31,880 MENTORSHIP RECOGNIZING THE 564 00:19:31,880 --> 00:19:33,360 CRUCIAL ROLE GREAT MENTORS PLAY 565 00:19:33,360 --> 00:19:36,000 IN DEVELOPMENT OF FUTURE LEADERS 566 00:19:36,000 --> 00:19:37,520 IN THE SCIENTIFIC RESEARCH 567 00:19:37,520 --> 00:19:37,840 ENTERPRISE. 568 00:19:37,840 --> 00:19:39,920 THIS IS FOR SCIENTIST WHO IS ARE 569 00:19:39,920 --> 00:19:44,080 OUTSTANDING MENTORS AND WHO HAVE 570 00:19:44,080 --> 00:19:44,600 DEMONSTRATED COMPELLING 571 00:19:44,600 --> 00:19:48,000 COMMITMENT AND CONTRIBUTIONS TO 572 00:19:48,000 --> 00:19:50,560 ENHANCING DIVERSITY, EQUITY, 573 00:19:50,560 --> 00:19:53,160 INCLUSION, AND ACCESSIBILITY IN 574 00:19:53,160 --> 00:19:55,320 THE BIOMEDICAL SCIENCES. 575 00:19:55,320 --> 00:19:59,120 NOW, PART OF INCREASING 576 00:19:59,120 --> 00:20:00,000 DIVERSITY AMONG NINR-SUPPORTED 577 00:20:00,000 --> 00:20:02,320 SCIENTISTS INCLUDING ENSURING 578 00:20:02,320 --> 00:20:03,040 OPPORTUNITIES ARE AVAILABLE TO 579 00:20:03,040 --> 00:20:05,040 SCIENTISTS AN STUDENTS AT A 580 00:20:05,040 --> 00:20:06,760 RANGE OF INSTITUTIONS. 581 00:20:06,760 --> 00:20:10,720 AS SUCH WE'RE PARTICIPATING IN 582 00:20:10,720 --> 00:20:12,160 THE NIH SEARCH ENHANCEMENT AWARD 583 00:20:12,160 --> 00:20:14,240 PROGRAM DESIGNED TO STIMULATE 584 00:20:14,240 --> 00:20:18,440 BASIC AND CLINICAL RESEARCH IN 585 00:20:18,440 --> 00:20:21,000 EDUCATIONAL INSTITUTIONS THAT 586 00:20:21,000 --> 00:20:21,920 PROVIDE BACCALAUREATE OR 587 00:20:21,920 --> 00:20:22,760 ADVANCED DEGREES, FOR 588 00:20:22,760 --> 00:20:25,680 SIGNIFICANT NUMBER OF THE 589 00:20:25,680 --> 00:20:26,960 NATION'S RESEARCH SCIENTISTS, 590 00:20:26,960 --> 00:20:29,400 BUT THAT HAVE NOT BEEN MAJOR 591 00:20:29,400 --> 00:20:31,160 RECIPIENTS OF NIH SUPPORT. 592 00:20:31,160 --> 00:20:32,960 IT'S HOPED THIS PROGRAM WILL 593 00:20:32,960 --> 00:20:36,440 EXPOSE STUDENTS IN THESE 594 00:20:36,440 --> 00:20:38,680 ENVIRONMENTS TO MERITORIOUS 595 00:20:38,680 --> 00:20:39,440 RESEARCH. 596 00:20:39,440 --> 00:20:42,760 ELIGIBLE INSTITUTIONS MUST AWARD 597 00:20:42,760 --> 00:20:44,280 NIH-RELEVANT BACCALAUREATE OR 598 00:20:44,280 --> 00:20:48,200 ADVANCED DEGREES IN HEALTH 599 00:20:48,200 --> 00:20:49,760 PROFESSIONS AND HAVE RECEIVED 600 00:20:49,760 --> 00:20:52,000 LESS THAN $6 MILLION A YEAR IN 601 00:20:52,000 --> 00:20:53,400 NIH SUPPORT, MA GEORGE OF THE 602 00:20:53,400 --> 00:20:55,440 LAST SEVEN PHYSICAL EQUAL YEARS. 603 00:20:55,440 --> 00:20:57,960 A LOT TO REMEMBER, CHECK OUT THE 604 00:20:57,960 --> 00:20:58,760 WEBSITE. 605 00:20:58,760 --> 00:21:01,840 I ENCOURAGE YOU TO CONSIDER 606 00:21:01,840 --> 00:21:02,880 APPLYING FOR THIS AND, YOU KNOW, 607 00:21:02,880 --> 00:21:06,720 HOPE THAT YOU'LL SHARE THIS 608 00:21:06,720 --> 00:21:09,280 INFORMATION AGAIN IN YOUR 609 00:21:09,280 --> 00:21:09,560 NETWORKS. 610 00:21:09,560 --> 00:21:11,240 AND WE'RE EAGER TO LEARN MORE 611 00:21:11,240 --> 00:21:14,680 ABOUT WHAT WE CAN DO TO 612 00:21:14,680 --> 00:21:15,640 SIGNIFICANTLY STRENGTHEN 613 00:21:15,640 --> 00:21:16,640 DIVERSITY AND INCLUSION. 614 00:21:16,640 --> 00:21:18,400 TOWARDS THAT END, TWO NEW 615 00:21:18,400 --> 00:21:21,840 WORKING GROUPS OF THE NINR 616 00:21:21,840 --> 00:21:22,880 ADVISORY COUNCIL RECENTLY 617 00:21:22,880 --> 00:21:24,480 LAUNCHED THEIR FIRST MEETINGS, 618 00:21:24,480 --> 00:21:27,040 THESE WORKING GROUPS ARE 619 00:21:27,040 --> 00:21:27,920 ADDRESSING DIVERSITY AND 620 00:21:27,920 --> 00:21:29,400 INCLUSION IN OUR RESEARCH 621 00:21:29,400 --> 00:21:31,400 WORKFORCE AND IN THE WORK WE 622 00:21:31,400 --> 00:21:32,320 SUPPORT. 623 00:21:32,320 --> 00:21:34,360 I LOOK FORWARD TO HEARING FROM 624 00:21:34,360 --> 00:21:37,640 THESE GROUPS AS THEY EXAMINE 625 00:21:37,640 --> 00:21:38,680 THESE ISSUES. 626 00:21:38,680 --> 00:21:41,120 WE HAVE SEVERAL ACTIVE FUNDING 627 00:21:41,120 --> 00:21:44,360 OPPORTUNITIES THAT I'D LIKE TO 628 00:21:44,360 --> 00:21:44,720 HIGHLIGHT. 629 00:21:44,720 --> 00:21:47,120 NINR RELEASED AN RFA TO EVALUATE 630 00:21:47,120 --> 00:21:48,640 THE IMPACT OF PANDEMIC-RELATED 631 00:21:48,640 --> 00:21:51,640 FOOD AND HOUSING POLICIES AND 632 00:21:51,640 --> 00:21:57,680 PROGRAMS ON HEALTH OUTCOMES AND 633 00:21:57,680 --> 00:21:58,840 HEALTH DISPARITY POPULATIONS. 634 00:21:58,840 --> 00:22:00,240 OUR PROGRAM OFFICE, FOR THOSE 635 00:22:00,240 --> 00:22:02,720 INTERESTED IN APPLYING FOR THIS 636 00:22:02,720 --> 00:22:04,680 RFA, YOU CAN FIND MORE 637 00:22:04,680 --> 00:22:08,440 INFORMATIONING ON OUR WEBSITE AS 638 00:22:08,440 --> 00:22:11,640 WELL AS OTHER DETAILS ABOUT THIS 639 00:22:11,640 --> 00:22:14,040 OPPORTUNITY ON NIH'S GRANT 640 00:22:14,040 --> 00:22:14,800 WEBSITE. 641 00:22:14,800 --> 00:22:17,480 APPLICATIONS FOR THIS RFA ARE 642 00:22:17,480 --> 00:22:18,760 DUE APRIL 7. 643 00:22:18,760 --> 00:22:23,240 WE ALSO RECENTLY POSTED AN R01 644 00:22:23,240 --> 00:22:24,840 AND R21 FOR ADVANCING INTEGRATED 645 00:22:24,840 --> 00:22:27,640 MODELS OF CARE TO IMPROVE 646 00:22:27,640 --> 00:22:29,840 MATERNAL HEALTH OUTCOMES AMONG 647 00:22:29,840 --> 00:22:30,440 DISPROPORTIONATELY IMPACTED 648 00:22:30,440 --> 00:22:33,840 POPULATIONS, AND, AGAIN, THE DUE 649 00:22:33,840 --> 00:22:35,040 DATE IS APRIL 7. 650 00:22:35,040 --> 00:22:38,840 WE ARE ALSO SIGNED ON TO MANY 651 00:22:38,840 --> 00:22:41,040 ADDITIONAL FUNDING OPPORTUNITY 652 00:22:41,040 --> 00:22:41,360 ANNOUNCEMENTS. 653 00:22:41,360 --> 00:22:42,640 SOME EXAMPLES ARE SHOWN HERE. 654 00:22:42,640 --> 00:22:45,440 I ENCOURAGE YOU TO LEARN MORE 655 00:22:45,440 --> 00:22:48,960 ABOUT THESE AT THE ADDRESSES 656 00:22:48,960 --> 00:22:50,760 SHOWN HERE. 657 00:22:50,760 --> 00:22:53,800 OF COURSE, WE WELCOME 658 00:22:53,800 --> 00:22:54,240 INVESTIGATOR-INITIATED 659 00:22:54,240 --> 00:22:57,040 APPLICATION SO IT DOESN'T JUST 660 00:22:57,040 --> 00:22:58,760 TO -- YOU DON'T JUST HAVE TO 661 00:22:58,760 --> 00:23:01,520 APPLY THROUGH ONE OF THESE 662 00:23:01,520 --> 00:23:01,840 MECHANISMS. 663 00:23:01,840 --> 00:23:04,280 CLOSER TO HOME, WE ARE LOOKING 664 00:23:04,280 --> 00:23:05,720 FOR NURSING SCIENTISTS TO JOIN 665 00:23:05,720 --> 00:23:07,240 OUR TEAM. 666 00:23:07,240 --> 00:23:09,040 ONE EXCITING OPPORTUNITY IS TO 667 00:23:09,040 --> 00:23:10,440 JOIN AS A PROGRAM OFFICER. 668 00:23:10,440 --> 00:23:12,920 IN THIS ROLE YOU'LL HAVE THE 669 00:23:12,920 --> 00:23:15,680 OPPORTUNITY TO HELP SHAPE THE 670 00:23:15,680 --> 00:23:17,400 NINR RESEARCH PORTFOLIO TO 671 00:23:17,400 --> 00:23:18,880 SUPPORT STRONGEST HIGHEST IMPACT 672 00:23:18,880 --> 00:23:19,880 SCIENCE WITH THE GREATEST 673 00:23:19,880 --> 00:23:23,240 POTENTIAL TO SOLVE THE NATION'S 674 00:23:23,240 --> 00:23:24,240 MOST PRESSING HEALTH CHALLENGES. 675 00:23:24,240 --> 00:23:26,960 THIS IS AN EXCITING TIME TO JOIN 676 00:23:26,960 --> 00:23:30,080 AND CONTRIBUTE TO OUR NEW VISION 677 00:23:30,080 --> 00:23:33,640 AND STRATEGIC DIRECTION. 678 00:23:33,640 --> 00:23:35,080 PROGRAM OFFICERS INITIATE, 679 00:23:35,080 --> 00:23:37,240 DEVELOP, MANAGE, AND PROVIDE 680 00:23:37,240 --> 00:23:40,000 INSIGHT FOR THE INSTITUTE'S 681 00:23:40,000 --> 00:23:41,600 EXTRAMURAL RESEARCH PORTFOLIO. 682 00:23:41,600 --> 00:23:43,560 WE'RE SPECIFICALLY INTERESTED IN 683 00:23:43,560 --> 00:23:45,160 EXPERTISE ALIGNED WITH RESEARCH 684 00:23:45,160 --> 00:23:47,680 LENSES, IDENTIFIED IN THE DRAFT 685 00:23:47,680 --> 00:23:47,960 FRAMEWORK. 686 00:23:47,960 --> 00:23:50,120 AGAIN, THOSE ARE SOCIAL 687 00:23:50,120 --> 00:23:51,800 DETERMINANTS OF HEALTH, HEALTH 688 00:23:51,800 --> 00:23:53,480 EQUITY, COMMUNITY AND POPULATION 689 00:23:53,480 --> 00:23:54,640 HEALTH, PREVENTION AND HEALTH 690 00:23:54,640 --> 00:23:56,480 PROMOTION, AND SYSTEMS AND 691 00:23:56,480 --> 00:23:58,040 MODELS OF CARE. 692 00:23:58,040 --> 00:24:01,160 THESE POSITIONS ARE FILLED VIA 693 00:24:01,160 --> 00:24:02,800 NIH'S GLOBAL HEALTH SCIENCE 694 00:24:02,800 --> 00:24:04,760 ADMINISTRATOR, IT'S A LONG TERM, 695 00:24:04,760 --> 00:24:05,960 JOB ANNOUNCEMENT, A NEW 696 00:24:05,960 --> 00:24:09,320 ANNOUNCEMENT WILL BE POSTED ON 697 00:24:09,320 --> 00:24:10,840 MARCH 14 WITH APPLICATIONS DUE 698 00:24:10,840 --> 00:24:12,920 BY MARCH 18. 699 00:24:12,920 --> 00:24:16,120 SO YOU CAN FIND THE 700 00:24:16,120 --> 00:24:17,240 ANNOUNCEMENTS ON USA JOBS, AND 701 00:24:17,240 --> 00:24:19,040 CAN ALSO WATCH FOR ANNOUNCEMENT 702 00:24:19,040 --> 00:24:19,960 ON OUR WEBSITE. 703 00:24:19,960 --> 00:24:25,120 PLEASE FEEL FREE TO REACH OUT TO 704 00:24:25,120 --> 00:24:27,840 OUR ACTING EXTRAMURAL DIRECTOR, 705 00:24:27,840 --> 00:24:30,480 DR. REBEKAH RASOOLY, WITH ANY 706 00:24:30,480 --> 00:24:30,760 QUESTIONS. 707 00:24:30,760 --> 00:24:32,880 FINALLY, ONE MORE UPDATE FROM 708 00:24:32,880 --> 00:24:35,120 NINR, I AM VERY THANKFUL TO DR. 709 00:24:35,120 --> 00:24:38,280 JOHN GRAYSON FOR AGREEING TO 710 00:24:38,280 --> 00:24:39,960 SERVE AS NINR ACTING DEPUTY 711 00:24:39,960 --> 00:24:41,440 DIRECTOR WHILE WE CONTINUE OUR 712 00:24:41,440 --> 00:24:46,480 SEARCH FOR OUR NEXT PERMANENT 713 00:24:46,480 --> 00:24:46,720 DEPUTY. 714 00:24:46,720 --> 00:24:49,400 DR. GRASON SERVED IN OFFICE OF 715 00:24:49,400 --> 00:24:50,800 SCIENCE POLICY AND LEGISLATION 716 00:24:50,800 --> 00:24:53,160 FOR MORE THAN 15 YEARS, RECENTLY 717 00:24:53,160 --> 00:24:55,880 AS ACTING DIRECTOR OF THE 718 00:24:55,880 --> 00:24:56,600 DIVISION. 719 00:24:56,600 --> 00:24:59,040 HE BEGAN HIS NIH CAREER AS AN 720 00:24:59,040 --> 00:25:01,400 AMERICAN ASSOCIATION FOR THE 721 00:25:01,400 --> 00:25:02,760 ADVANCEMENT OF SCIENCE FELLOW, 722 00:25:02,760 --> 00:25:05,840 HE WAS ALSO AN HHS EMERGING 723 00:25:05,840 --> 00:25:08,520 LEADER FELLOW, HAS A Ph.D. IN 724 00:25:08,520 --> 00:25:09,760 BIOCHEMISTRY FROM UNIVERSITY OF 725 00:25:09,760 --> 00:25:12,640 MARYLAND, AND HE HAS BEEN 726 00:25:12,640 --> 00:25:14,680 INSTRUMENTAL IN NINR STRATEGIC 727 00:25:14,680 --> 00:25:16,800 PLANNING PROCESS AS WELL AS A 728 00:25:16,800 --> 00:25:18,800 SOURCE OF COUNSEL FOR ME AND 729 00:25:18,800 --> 00:25:20,840 LEADERS ACROSS THE INSTITUTE. 730 00:25:20,840 --> 00:25:24,560 I'M SO THRILLED TO HAVE DR. 731 00:25:24,560 --> 00:25:26,440 GRASON IN THIS IMPORTANT ROLE AS 732 00:25:26,440 --> 00:25:29,000 WE MOVE NINR INTO THE FUTURE. 733 00:25:29,000 --> 00:25:30,560 SO TURNING TO THE REASON WE'RE 734 00:25:30,560 --> 00:25:33,560 ALL HERE TODAY, THE NATIONAL 735 00:25:33,560 --> 00:25:34,320 NURSING RESEARCH ROUNDTABLE, 736 00:25:34,320 --> 00:25:36,040 THIS YEAR'S THEME AS YOU ALL 737 00:25:36,040 --> 00:25:39,040 KNOW IS FROM CONTEXT TO CARE, 738 00:25:39,040 --> 00:25:41,240 UNDERSTANDING THE CONVERGENCE OF 739 00:25:41,240 --> 00:25:42,840 SOCIAL FACTORS AND EMERGENCY 740 00:25:42,840 --> 00:25:44,040 DEPARTMENT CARE. 741 00:25:44,040 --> 00:25:46,600 AND WE CERTAINLY UNDERSTAND THE 742 00:25:46,600 --> 00:25:47,040 IMPORTANCE OF SOCIAL 743 00:25:47,040 --> 00:25:47,560 DETERMINANTS OF HEALTH. 744 00:25:47,560 --> 00:25:50,520 MANY OF THE INITIATIVES AND 745 00:25:50,520 --> 00:25:52,080 FUNDING OPPORTUNITIES I SHARED 746 00:25:52,080 --> 00:25:54,520 EARLIER FOCUS ON OR INCLUDE 747 00:25:54,520 --> 00:25:56,400 SOCIAL DETERMINANTS. 748 00:25:56,400 --> 00:25:58,160 AS EXPERTS IN EMERGENCY 749 00:25:58,160 --> 00:25:59,880 MEDICINE, OUR ENA COLLEAGUES SEE 750 00:25:59,880 --> 00:26:02,440 EVERY DAY THE IMPACT OF UPSTREAM 751 00:26:02,440 --> 00:26:04,000 FACTORS THAT LEAD TO HEALTH 752 00:26:04,000 --> 00:26:05,880 INEQUITIES BASED ON SOCIAL 753 00:26:05,880 --> 00:26:06,400 NEEDS. 754 00:26:06,400 --> 00:26:07,920 AND OUR COLLEAGUES ACROSS THE 755 00:26:07,920 --> 00:26:10,240 MANY FIELDS THAT ARE REPRESENTED 756 00:26:10,240 --> 00:26:12,680 HERE TODAY ARE CERTAINLY WELL 757 00:26:12,680 --> 00:26:14,680 VERSED IN THESE ISSUES. 758 00:26:14,680 --> 00:26:15,360 I MENTIONED EARLIER THAT AS 759 00:26:15,360 --> 00:26:19,640 NURSES WE HAVE A UNIQUE 760 00:26:19,640 --> 00:26:21,280 PERSPECTIVE THAT VIEWS THE 761 00:26:21,280 --> 00:26:21,920 INDIVIDUAL HOLISTICALLY AND IN 762 00:26:21,920 --> 00:26:22,280 CONTEXT. 763 00:26:22,280 --> 00:26:25,000 WE KNOW THERE ARE FACTORS THAT 764 00:26:25,000 --> 00:26:26,760 INFLUENCE PEOPLE'S HEALTH AND 765 00:26:26,760 --> 00:26:28,800 THAT OF THEIR COMMUNITIES, LONG 766 00:26:28,800 --> 00:26:30,320 BEFORE WE PROVIDE CARE. 767 00:26:30,320 --> 00:26:32,920 AND WE KNOW THAT FOR SOME PEOPLE 768 00:26:32,920 --> 00:26:36,760 WE CARE FOR HAVE MANY IF NOT ALL 769 00:26:36,760 --> 00:26:40,600 THE RESOURCES, SOME PEOPLE 770 00:26:40,600 --> 00:26:41,360 DON'T, NEEDED TO MAINTAIN 771 00:26:41,360 --> 00:26:44,200 THROUGH NO FAULT OF OUR THINK 772 00:26:44,200 --> 00:26:45,440 BUT IT'S OUR RESPONSIBILITY AS 773 00:26:45,440 --> 00:26:46,440 CLINICIANS AND RESEARCHERS TO 774 00:26:46,440 --> 00:26:48,920 ENSURE WE DO EVERYTHING AND IN 775 00:26:48,920 --> 00:26:50,760 OUR POWER TO HELP BRIDGE THAT 776 00:26:50,760 --> 00:26:51,080 DIVIDE. 777 00:26:51,080 --> 00:26:54,440 I'M SO EXCITED THAT WE'RE HERE 778 00:26:54,440 --> 00:26:55,480 AT THIS ROUNDTABLE TO SHARE 779 00:26:55,480 --> 00:26:58,000 EXPERIENCE AND KNOWLEDGE ON 780 00:26:58,000 --> 00:27:00,360 TOPICS FROM INEQUITY IN THE 781 00:27:00,360 --> 00:27:01,920 EMERGENCY CARE SYSTEM TO 782 00:27:01,920 --> 00:27:02,760 ADDRESSING SOCIAL DETERMINANTS 783 00:27:02,760 --> 00:27:04,120 OF HEALTH IN EMERGENCY 784 00:27:04,120 --> 00:27:06,800 DEPARTMENTS TO THE ROLE OF 785 00:27:06,800 --> 00:27:08,160 HOUSING IN PATIENTS' HEALTH AND 786 00:27:08,160 --> 00:27:09,440 SO MUCH MORE. 787 00:27:09,440 --> 00:27:12,320 I HOPE THAT BY BRINGING SO MANY 788 00:27:12,320 --> 00:27:14,160 EXPERTS AND SO MANY FIELDS 789 00:27:14,160 --> 00:27:15,240 TOGETHER IN THIS ROUNDTABLE, 790 00:27:15,240 --> 00:27:16,800 MANY OF YOU WILL MAKE 791 00:27:16,800 --> 00:27:20,040 CONNECTIONS WITH OTHERS WHO ARE 792 00:27:20,040 --> 00:27:21,560 PASSIONATE ABOUT THESE ISSUES 793 00:27:21,560 --> 00:27:23,640 AND I'M CONFIDENT THOSE 794 00:27:23,640 --> 00:27:24,320 CONNECTIONS WILL LEAD TO 795 00:27:24,320 --> 00:27:26,440 RESEARCH THAT WILL INFORM 796 00:27:26,440 --> 00:27:30,160 POLICIES AND SYSTEMS TO ADDRESS 797 00:27:30,160 --> 00:27:30,760 THE INEQUITIES AND INJUSTICES 798 00:27:30,760 --> 00:27:33,200 THAT PREVENT SO MANY FROM 799 00:27:33,200 --> 00:27:34,720 ACHIEVING AND REACHING THEIR 800 00:27:34,720 --> 00:27:36,960 HEALTHIEST LIVES. 801 00:27:36,960 --> 00:27:37,800 WE HAVE A PACKED AGENDA. 802 00:27:37,800 --> 00:27:39,960 BEFORE I TURN THE MEETING OVER 803 00:27:39,960 --> 00:27:42,640 TO DR. STROUT I WANT TO MAKE A 804 00:27:42,640 --> 00:27:44,040 MOMENT TO THANK ENA COLLEAGUES 805 00:27:44,040 --> 00:27:46,840 AGAIN FOR PARTNERING WITH US ON 806 00:27:46,840 --> 00:27:47,200 THE ROUNDTABLE. 807 00:27:47,200 --> 00:27:51,520 I THINK EVERYONE WHO HELPED -- I 808 00:27:51,520 --> 00:27:53,080 THANK EVERYONE WHO BROUGHT THIS 809 00:27:53,080 --> 00:27:53,360 TOGETHER. 810 00:27:53,360 --> 00:27:59,440 EVERYONE WHO HAS JOINED US FORT 811 00:27:59,440 --> 00:28:00,480 MEET -- FOR THE MEETING, 812 00:28:00,480 --> 00:28:01,440 LEARNING HOW WE IMPLEMENT THE 813 00:28:01,440 --> 00:28:03,640 LESSONS WE TAKE AWAY FROM OUR 814 00:28:03,640 --> 00:28:03,960 DISCUSSION. 815 00:28:03,960 --> 00:28:09,280 AND NOW BACK TO YOU, DR. STROUT. 816 00:28:09,280 --> 00:28:10,480 >> THANK YOU SO VERY MUCH. 817 00:28:10,480 --> 00:28:12,640 IT'S FANTASTIC TO HEAR ABOUT 818 00:28:12,640 --> 00:28:13,760 THESE IMPORTANT UPDATES AND I'M 819 00:28:13,760 --> 00:28:17,160 SO PLEASED TO HEAR ABOUT THE 820 00:28:17,160 --> 00:28:18,600 INCORPORATION OF DIVERSITY, 821 00:28:18,600 --> 00:28:19,040 HEALTH EQUITY, SOCIAL 822 00:28:19,040 --> 00:28:20,320 DETERMINANTS INTO THE WORK OF 823 00:28:20,320 --> 00:28:23,640 THE INSTITUTE GOING FORWARD. 824 00:28:23,640 --> 00:28:24,920 FABULOUS STUFF AND GREAT 825 00:28:24,920 --> 00:28:25,760 OPPORTUNITIES. 826 00:28:25,760 --> 00:28:27,560 LOOK FORWARD TO READING THE 827 00:28:27,560 --> 00:28:28,800 WHOLE STRATEGIC PLAN. 828 00:28:28,800 --> 00:28:34,640 NOW I WOULD LIKE TO INTRODUCE 829 00:28:34,640 --> 00:28:36,360 DR. SARAH YOON, PLANNING 830 00:28:36,360 --> 00:28:38,480 COMMITTEE MEMBER AND NINR 831 00:28:38,480 --> 00:28:39,840 PROGRAM DIRECTOR OVERSEEING 832 00:28:39,840 --> 00:28:40,920 PORTFOLIO FOCUSED ON WOMEN'S 833 00:28:40,920 --> 00:28:42,400 HEALTH AND DATA SCIENCE, AND SHE 834 00:28:42,400 --> 00:28:44,600 WILL BE INTRODUCING THE NEXT 835 00:28:44,600 --> 00:28:44,840 SPEAKER. 836 00:28:44,840 --> 00:28:46,760 IN THE INTEREST OF TIME I'D LIKE 837 00:28:46,760 --> 00:28:49,840 TO SHARE THE BIOS WILL BE SHORT. 838 00:28:49,840 --> 00:28:53,400 I'LL REMIND YOU THAT THE FULL 839 00:28:53,400 --> 00:28:55,000 BIOS CAN BE FOUND IN THE 840 00:28:55,000 --> 00:28:56,040 ELECTRONIC PROGRAM. 841 00:28:56,040 --> 00:28:57,560 I'LL PLACE THAT IN THE CHAT IN 842 00:28:57,560 --> 00:29:00,160 CASE YOU HAVEN'T HAD A CHANCE TO 843 00:29:00,160 --> 00:29:01,520 DOWNLOAD THAT YET. 844 00:29:01,520 --> 00:29:03,840 I'LL REMIND YOU THERE IS A 845 00:29:03,840 --> 00:29:05,680 SUGGESTED READING LIST FOR MANY 846 00:29:05,680 --> 00:29:07,920 SPEAKERS THAT WAS ATTACHED TO 847 00:29:07,920 --> 00:29:08,920 YOUR INVITATION, I'LL INVITE YOU 848 00:29:08,920 --> 00:29:10,360 TO PERUSER THAT AND TAKE 849 00:29:10,360 --> 00:29:12,640 ADVANTAGE OF THOSE RESOURCES TO 850 00:29:12,640 --> 00:29:14,840 CONTINUE OUR LEARNING TOGETHER. 851 00:29:14,840 --> 00:29:16,840 DR. YOON, I'LL TURN IT OVER TO 852 00:29:16,840 --> 00:29:20,400 YOU AT THIS POINT. 853 00:29:20,400 --> 00:29:22,440 >> THANK YOU, DR. STROUT. 854 00:29:22,440 --> 00:29:25,920 GOOD MORNING, EVERYONE. 855 00:29:25,920 --> 00:29:28,720 TODAY WE'LL START WITH THE 856 00:29:28,720 --> 00:29:32,080 SESSION OVERVIEW OF EMERGENCY 857 00:29:32,080 --> 00:29:32,760 DEPARTMENT VISITS AND THE 858 00:29:32,760 --> 00:29:39,400 SPEAKER WILL BE DR. CAROL 859 00:29:39,400 --> 00:29:49,040 DEFRANCES, CURRENTLY THE ACTING 860 00:29:49,040 --> 00:29:55,200 DIRECTOR AT CDC CENTER FOR HELD 861 00:29:55,200 --> 00:30:04,840 STATISTICIAN, MODERNIZING TO 862 00:30:04,840 --> 00:30:09,040 ELECTRONIC DATA CHECK, WAS DHCS 863 00:30:09,040 --> 00:30:11,840 DEPUTY DIRECTOR AND DHCS CHIEF 864 00:30:11,840 --> 00:30:15,360 OF AMBULATORY AND HOSPITAL CARE 865 00:30:15,360 --> 00:30:17,680 STATISTIC BRANCH. 866 00:30:17,680 --> 00:30:20,200 PLEASE JOIN ME IN WELCOMING DR. 867 00:30:20,200 --> 00:30:22,960 DEFRANCES WHO WILL SPEAK FOR 15 868 00:30:22,960 --> 00:30:24,960 MINUTES AND JUST PLEASE NOTE 869 00:30:24,960 --> 00:30:26,720 WE'RE REQUESTING THAT YOU HOLD 870 00:30:26,720 --> 00:30:30,320 YOUR QUESTIONS FOR THE PANEL 871 00:30:30,320 --> 00:30:30,640 DISCUSSION. 872 00:30:30,640 --> 00:30:33,200 HOWEVER, PLEASE USE THE CHAT 873 00:30:33,200 --> 00:30:34,320 FUNCTION TO BEGIN SUBMITTING 874 00:30:34,320 --> 00:30:36,720 YOUR QUESTIONS AT ANY TIME 875 00:30:36,720 --> 00:30:38,360 DURING THE PRESENTATION, SO 876 00:30:38,360 --> 00:30:40,000 DURING THE BREAK WE WILL BEGIN 877 00:30:40,000 --> 00:30:43,880 TO CURATE YOUR QUESTIONS FOR THE 878 00:30:43,880 --> 00:30:45,640 PANEL MODERATOR. 879 00:30:45,640 --> 00:30:53,200 DR. FRANCES, PLEASE SHARE YOUR 880 00:30:53,200 --> 00:30:54,760 PRESENTATION. 881 00:30:54,760 --> 00:30:55,920 >> THANK YOU. 882 00:30:55,920 --> 00:30:57,120 THANK YOU, DR. YOON, GOOD 883 00:30:57,120 --> 00:30:57,400 MORNING. 884 00:30:57,400 --> 00:30:59,480 I'M TRULY PLEASED TO BE HERE 885 00:30:59,480 --> 00:31:02,440 TODAY AND TO ACTUALLY START OFF 886 00:31:02,440 --> 00:31:05,920 THIS ROUND OF PRESENTATIONS FOR 887 00:31:05,920 --> 00:31:06,440 TODAY. 888 00:31:06,440 --> 00:31:09,040 THE GOAL OF MY PRESENTATION 889 00:31:09,040 --> 00:31:10,680 TODAY IS TWO-FOLD. 890 00:31:10,680 --> 00:31:13,240 I WILL PROVIDE OVERVIEW OF 891 00:31:13,240 --> 00:31:14,040 EMERGENCY DEPARTMENT OR E.D. 892 00:31:14,040 --> 00:31:15,720 VISITS IN THE UNITED STATES 893 00:31:15,720 --> 00:31:18,640 USING DATA FROM NATIONAL 894 00:31:18,640 --> 00:31:23,760 HOSPITAL AMBULATORY MEDICAL CARE 895 00:31:23,760 --> 00:31:26,640 SURVEY, AND DISCUSS NCHS EFFORTS 896 00:31:26,640 --> 00:31:29,720 TO ENHANCE COLLECTION OF DATA 897 00:31:29,720 --> 00:31:33,640 THROUGH NATIONAL HOSPITAL CARE 898 00:31:33,640 --> 00:31:36,120 SURVEY WITH AN CREASED DATA THAT 899 00:31:36,120 --> 00:31:36,920 HAMCS DOES NOT. 900 00:31:36,920 --> 00:31:39,120 I'M GOING TO BE PRESENTING DATA 901 00:31:39,120 --> 00:31:41,360 FROM HAMCS TODAY BUT I WANT TO 902 00:31:41,360 --> 00:31:42,840 POINT OUT THERE ARE OTHER E.D. 903 00:31:42,840 --> 00:31:44,400 DATASETS OUT THERE. 904 00:31:44,400 --> 00:31:46,760 THE AGENCY FOR HEALTH CARE 905 00:31:46,760 --> 00:31:49,960 QUALITY AND RESEARCH, AMERICAN 906 00:31:49,960 --> 00:31:51,480 HOSPITAL ASSOCIATION, CONSUMER 907 00:31:51,480 --> 00:31:52,440 PRICE SAFETY COMMISSION HAVE 908 00:31:52,440 --> 00:31:53,440 DATASETS. 909 00:31:53,440 --> 00:31:54,880 AND THERE ARE OTHERS. 910 00:31:54,880 --> 00:31:57,840 NEEDLESS TO SAY, ALL OF THESE 911 00:31:57,840 --> 00:32:03,640 DATASETS INCLUDING HAMCS HAVE 912 00:32:03,640 --> 00:32:04,840 ADVANTAGES AND DISADVANTAGES TO 913 00:32:04,840 --> 00:32:06,120 KEEP IN MIND WHEN WE EXAMINE 914 00:32:06,120 --> 00:32:09,520 PATTERNS OF E.D. CARE. 915 00:32:09,520 --> 00:32:14,000 WHAT DOES HAMCS HAVE TO TELL US? 916 00:32:14,000 --> 00:32:18,960 VISIT RATES IN E.D.s REMAINED 917 00:32:18,960 --> 00:32:22,600 STABLE OVER THE DECADE FROM 2007 918 00:32:22,600 --> 00:32:22,920 THROUGH 2018. 919 00:32:22,920 --> 00:32:26,080 VARIATIONS EXIST IN E.D. VISITS 920 00:32:26,080 --> 00:32:26,520 BY VARIOUS PATIENT 921 00:32:26,520 --> 00:32:28,640 CHARACTERISTICS, AND MEASUREMENT 922 00:32:28,640 --> 00:32:29,880 OF THESE VARIATIONS IS POSSIBLE 923 00:32:29,880 --> 00:32:31,640 IF DATA ON CHARACTERISTICS OF 924 00:32:31,640 --> 00:32:34,080 INTEREST HAVE BEEN COLLECTED IN 925 00:32:34,080 --> 00:32:36,400 THE MEDICAL RECORD. 926 00:32:36,400 --> 00:32:37,240 SEVERAL PATIENT CHARACTERISTICS 927 00:32:37,240 --> 00:32:38,840 ARE ROUTINELY COLLECTED, SOME 928 00:32:38,840 --> 00:32:42,680 ARE RELATED TO SOCIAL 929 00:32:42,680 --> 00:32:44,240 DETERMINANTS OF HEALTH MAY AT 930 00:32:44,240 --> 00:32:45,880 TIMES BE MISSING FROM MEDICAL 931 00:32:45,880 --> 00:32:46,120 RECORDS. 932 00:32:46,120 --> 00:32:48,960 BEFORE I BEGIN AND SHOW DATA I 933 00:32:48,960 --> 00:32:52,280 WANT TO TALK BRIEFLY ABOUT 934 00:32:52,280 --> 00:32:52,680 HAMCS. 935 00:32:52,680 --> 00:32:54,160 IT WAS DESIGNED TO COLLECT DATA 936 00:32:54,160 --> 00:32:56,800 ON THE PROVISION AND ALLS OF 937 00:32:56,800 --> 00:32:59,920 AMBULATORY CARE SERVICES IN 938 00:32:59,920 --> 00:33:01,240 HOSPITAL EDs, OUTPATIENT 939 00:33:01,240 --> 00:33:02,840 DEPARTMENTS, AND AMBULATORY 940 00:33:02,840 --> 00:33:04,800 SURGERY LOCATIONS. 941 00:33:04,800 --> 00:33:08,320 SINCE 2018 WE'VE COLLECTED ONLY 942 00:33:08,320 --> 00:33:11,360 E.D. DATA A, 400 HOSPITALS, WE 943 00:33:11,360 --> 00:33:13,800 COLLECTED SAMPLE OF E.D. VISITS. 944 00:33:13,800 --> 00:33:18,240 THE DATA ARE COLLECTED ANNUALLY, 945 00:33:18,240 --> 00:33:21,000 NHMCS IN THE FIELD SINCE 1992. 946 00:33:21,000 --> 00:33:22,320 PRE-COVID, THE DATA WERE 947 00:33:22,320 --> 00:33:26,720 COLLECTED WITH IN-PERSON 948 00:33:26,720 --> 00:33:28,520 INDUCTION INTERVIEWS, ON-SITE, 949 00:33:28,520 --> 00:33:31,120 CONDUCTED BY U.S. BUREAU OF 950 00:33:31,120 --> 00:33:36,480 CENSUS FIELD REPRESENTATIVES. 951 00:33:36,480 --> 00:33:37,760 PARTICIPATION IN NHMCS IS 952 00:33:37,760 --> 00:33:38,360 VOLUNTARY. 953 00:33:38,360 --> 00:33:40,000 AS YOU CAN IMAGINE WITH COVID-19 954 00:33:40,000 --> 00:33:42,040 PANDEMIC, IT'S BEEN VERY HARD TO 955 00:33:42,040 --> 00:33:44,440 COLLECT THESE DATA. 956 00:33:44,440 --> 00:33:45,680 HOSPITALS HAVE BEEN SERIOUSLY 957 00:33:45,680 --> 00:33:47,120 BURDENED WITH THE PANDEMIC, AND 958 00:33:47,120 --> 00:33:49,240 IT'S BEEN VERY DIFFICULT FOR US 959 00:33:49,240 --> 00:33:50,760 TO GET ON SITE. 960 00:33:50,760 --> 00:33:54,400 SO WE'VE HAD TO SWITCH TO 961 00:33:54,400 --> 00:33:55,160 ADMINISTRATION OF HOSPITAL 962 00:33:55,160 --> 00:33:56,480 INDUCTION INTERVIEW TO 963 00:33:56,480 --> 00:33:57,520 TELEPHONE. 964 00:33:57,520 --> 00:33:58,960 WE SWITCHED FROM IN-PERSON 965 00:33:58,960 --> 00:33:59,680 ABSTRACTION TO REMOTE 966 00:33:59,680 --> 00:34:01,040 ABSTRACTION FOR HOSPITALS THAT 967 00:34:01,040 --> 00:34:05,080 WERE ABLE TO DO SO, AND WE ALSO 968 00:34:05,080 --> 00:34:06,720 DELAYED THE DATA COLLECTION AND 969 00:34:06,720 --> 00:34:10,720 LOOKING AT HOT SPOTS IN 2021. 970 00:34:10,720 --> 00:34:12,840 CONSEQUENTLY, OUR DATA ARE 971 00:34:12,840 --> 00:34:14,080 DELAYED FOR 2020 AND 2021, SO 972 00:34:14,080 --> 00:34:17,200 I'LL ONLY BE ABLE TO PRESENT 973 00:34:17,200 --> 00:34:18,120 DATA THROUGH 2019 TODAY. 974 00:34:18,120 --> 00:34:21,000 SO LET'S LOOK AT SOME DATA. 975 00:34:21,000 --> 00:34:22,320 AND, AGAIN, I SHOULD POINT OUT 976 00:34:22,320 --> 00:34:24,120 IN THE NEXT SERIES OF SLIDES I'M 977 00:34:24,120 --> 00:34:27,800 ONLY GOING TO BE HIGHLIGHTING 978 00:34:27,800 --> 00:34:28,560 STATISTICALLY SIGNIFICANT 979 00:34:28,560 --> 00:34:29,040 RESULTS. 980 00:34:29,040 --> 00:34:32,360 IN FIGURE 1 HERE WE HAVE E.D. 981 00:34:32,360 --> 00:34:33,640 VISITS PER THOUSAND PERSONS BY 982 00:34:33,640 --> 00:34:35,560 PATIENT AGE. 983 00:34:35,560 --> 00:34:38,040 IN 2016 AND 2017, ENCOUNTERS OF 984 00:34:38,040 --> 00:34:40,160 PATIENTS WHO WERE 18-44 HAD 985 00:34:40,160 --> 00:34:44,400 SIGNIFICANT HIGHER E.D. RATES 986 00:34:44,400 --> 00:34:45,840 THAN THOSE AGE 45-64. 987 00:34:45,840 --> 00:34:48,560 2018 AND 19 ENCOUNTERS FOR THOSE 988 00:34:48,560 --> 00:34:50,480 65 AND OVER WERE SIGNIFICANTLY 989 00:34:50,480 --> 00:34:55,360 HIGHER THAN RATES FOR THOSE 990 00:34:55,360 --> 00:34:55,720 45-64. 991 00:34:55,720 --> 00:34:59,920 HERE IN FIGURE 2 WE SHOW E.D. 992 00:34:59,920 --> 00:35:02,560 RATES PER THOUSAND BY PATIENT 993 00:35:02,560 --> 00:35:10,240 RACE AND ETHNICITY. 994 00:35:10,240 --> 00:35:12,200 DURING 2016 AND 2019, ENCOUNTERS 995 00:35:12,200 --> 00:35:13,320 OF NON-HISPANIC OTHER PERSONS 996 00:35:13,320 --> 00:35:19,400 HAD THE LOWEST E.D. RATES DURING 997 00:35:19,400 --> 00:35:21,080 THESE FOUR YEARS. 998 00:35:21,080 --> 00:35:24,920 IN FIGURE 3 WE SHOW E.D. VISIT 999 00:35:24,920 --> 00:35:27,800 RATES PER THOUSAND BY SOURCE OF 1000 00:35:27,800 --> 00:35:28,240 PAYMENT. 1001 00:35:28,240 --> 00:35:29,560 ENCOUNTERS WITH MEDICAID HAD 1002 00:35:29,560 --> 00:35:33,240 HIGHEST RATE OF E.D. VISITS FROM 1003 00:35:33,240 --> 00:35:34,040 2016 TO 2019. 1004 00:35:34,040 --> 00:35:36,920 THE LOWEST RATE OF E.D. VISITS 1005 00:35:36,920 --> 00:35:42,040 WAS CONSISTENTLY OBSERVED FOR 1006 00:35:42,040 --> 00:35:43,840 PATIENTS WITH PRIVATE INSURANCE. 1007 00:35:43,840 --> 00:35:46,880 FIGURE 4 DEPICTS E.D. RATES PER 1008 00:35:46,880 --> 00:35:48,640 THOUSAND BY METROPOLITAN 1009 00:35:48,640 --> 00:35:51,840 STATISTICAL AREA OR MSA, NO 1010 00:35:51,840 --> 00:35:53,440 SIGNIFICANT DIFFERENCES OBSERVED 1011 00:35:53,440 --> 00:35:56,720 BY MSA STATUS FOR E.D. 1012 00:35:56,720 --> 00:36:02,280 ENCOUNTERS IN ANY YEAR 1013 00:36:02,280 --> 00:36:02,880 2016-2019. 1014 00:36:02,880 --> 00:36:05,640 THE NEXT FOUR BAR GRAPHS DEPICT 1015 00:36:05,640 --> 00:36:06,920 RATES PER THOUSAND PERSONS BY 1016 00:36:06,920 --> 00:36:10,000 FIVE MOST COMMON REASONS FOR 1017 00:36:10,000 --> 00:36:13,040 VISIT FOR PRIMARY DIAGNOSIS FOR 1018 00:36:13,040 --> 00:36:13,360 ONLY 2019. 1019 00:36:13,360 --> 00:36:16,800 HERE IN FIGURE 5 ENCOUNTERS FOR 1020 00:36:16,800 --> 00:36:22,240 E D VISITS FOR THE FIVE MOST 1021 00:36:22,240 --> 00:36:23,320 COMMON ARE SHOWN. 1022 00:36:23,320 --> 00:36:24,280 OVERALL, THE FIVE MOST COMMON 1023 00:36:24,280 --> 00:36:27,480 REASONS FOR E.D. VISITS INCLUDE 1024 00:36:27,480 --> 00:36:29,440 STOMACH AND ABDOMINAL PAIN, 1025 00:36:29,440 --> 00:36:32,120 CRAMP, AND SPASMS; CHEST PAIN 1026 00:36:32,120 --> 00:36:34,280 AND RELATED SYMPTOMS, FEVER, 1027 00:36:34,280 --> 00:36:36,800 COUGH, SHORTNESS OF BREATH. 1028 00:36:36,800 --> 00:36:38,960 FOR STOMACH PAIN, CHEST PAIN AND 1029 00:36:38,960 --> 00:36:40,240 COUGH, NON-HISPANIC BLACKS HAD 1030 00:36:40,240 --> 00:36:43,040 THE HIGHEST RATES OF E.D. 1031 00:36:43,040 --> 00:36:43,520 VISITS. 1032 00:36:43,520 --> 00:36:45,800 FOR SHORTNESS OF BREATH, 1033 00:36:45,800 --> 00:36:46,800 NON-HISPANIC WHITES AND 1034 00:36:46,800 --> 00:36:48,040 NON-HISPANIC BLACKS HAD HIGHER 1035 00:36:48,040 --> 00:36:54,760 VISIT RATES THAN COMPARED TO 1036 00:36:54,760 --> 00:36:55,040 HISPANICS. 1037 00:36:55,040 --> 00:36:57,520 FIGURE 6 HERE SHOWS E.D. RATES 1038 00:36:57,520 --> 00:36:59,240 PER THOUSAND PERSONS FOR FIVE 1039 00:36:59,240 --> 00:37:01,880 MOST COMMON REASONS FOR VISIT BY 1040 00:37:01,880 --> 00:37:03,960 PRIMARY EXPECTED SOURCE OF 1041 00:37:03,960 --> 00:37:04,480 PAYMENT. 1042 00:37:04,480 --> 00:37:06,560 FOR STOMACH PAIN, FEVER AND 1043 00:37:06,560 --> 00:37:07,560 COUGH, ENCOUNTERS OF PATIENTS 1044 00:37:07,560 --> 00:37:09,960 WITH MEDICAID HAD THE HIGHEST 1045 00:37:09,960 --> 00:37:12,600 E.D. VISIT RATES. 1046 00:37:12,600 --> 00:37:14,160 CHEST PAIN, RATES OF ENCOUNTER 1047 00:37:14,160 --> 00:37:15,800 WITH MEDICAID AND MEDICARE WERE 1048 00:37:15,800 --> 00:37:18,720 SIGNIFICANTLY HIGHER THAN RATES 1049 00:37:18,720 --> 00:37:21,440 FOR PRIVATE INSURANCE AND 1050 00:37:21,440 --> 00:37:21,800 UNINSURED. 1051 00:37:21,800 --> 00:37:27,840 SHORTNESS OF BREATH MEDICARE HAD 1052 00:37:27,840 --> 00:37:29,560 HIGHEST VISIT RATES. 1053 00:37:29,560 --> 00:37:31,640 HERE IN FIGURE 7 WE ILLUSTRATE 1054 00:37:31,640 --> 00:37:33,400 E.D. RATES PER THOUSAND PERSONS 1055 00:37:33,400 --> 00:37:36,560 FOR THE FIVE MOST COMMON PRIMARY 1056 00:37:36,560 --> 00:37:40,600 DIAGNOSIS BY RACE AND ETHNICITY 1057 00:37:40,600 --> 00:37:41,200 FOR 2019. 1058 00:37:41,200 --> 00:37:42,840 FIVE MOST COMMON DIAGNOSES 1059 00:37:42,840 --> 00:37:45,480 REPORTED IN 2019 WERE SYMPTOMS, 1060 00:37:45,480 --> 00:37:51,400 SIGNS, ABNORMAL CLINICAL LAB 1061 00:37:51,400 --> 00:37:52,840 FINDINGS, INJURY POISONING, 1062 00:37:52,840 --> 00:37:54,800 DISEASES OF THE RESPIRATORY 1063 00:37:54,800 --> 00:37:57,400 SYSTEM, DISEASES OF THE 1064 00:37:57,400 --> 00:37:58,000 MUSCULOSKELETAL SYSTEM, 1065 00:37:58,000 --> 00:38:00,920 CONNECTIVE TISSUE, DISEASES OF 1066 00:38:00,920 --> 00:38:01,320 DIGESTIVE SYSTEM. 1067 00:38:01,320 --> 00:38:04,520 FOR ENCOUNTERS FOR ALL FIVE OF 1068 00:38:04,520 --> 00:38:05,480 THESE PRIMARY DIAGNOSES, 1069 00:38:05,480 --> 00:38:06,240 NON-HISPANIC BLACKS HAD THE 1070 00:38:06,240 --> 00:38:09,840 HIGHEST RATE OF E.D. VISITS, 1071 00:38:09,840 --> 00:38:11,400 NON-HISPANIC OTHER PERSONS HAD 1072 00:38:11,400 --> 00:38:16,640 LOWEST RATE OF E.D. VISITS. 1073 00:38:16,640 --> 00:38:18,760 FIGURE 8 SHOWS E.D. RATES PER 1074 00:38:18,760 --> 00:38:21,760 THOUSAND PERSONS FOR FIVE MOST 1075 00:38:21,760 --> 00:38:22,280 COMMON PRIMARY DIAGNOSES, 1076 00:38:22,280 --> 00:38:23,880 PRIMARY EXPECTED SOURCE OF 1077 00:38:23,880 --> 00:38:26,040 PAYMENT FOR 2019. 1078 00:38:26,040 --> 00:38:30,720 FOR SYMPTOMS AND SIGNS, INJURY 1079 00:38:30,720 --> 00:38:36,840 AND POISONINGS, MEDICAID HAD 1080 00:38:36,840 --> 00:38:38,440 HIGHEST, PRIVATE INSURANCE HAD 1081 00:38:38,440 --> 00:38:39,120 LOWEST. 1082 00:38:39,120 --> 00:38:40,560 DISEASES OF THE MUSCULOSKELETAL 1083 00:38:40,560 --> 00:38:42,320 SYSTEM, PATIENTS WITH MEDICARE 1084 00:38:42,320 --> 00:38:45,200 AND MEDICAID HAD HIGHER E.D. 1085 00:38:45,200 --> 00:38:46,840 VISIT RATES THAN UNINSURED, 1086 00:38:46,840 --> 00:38:49,040 AGAIN THOSE WITH PRIVATE 1087 00:38:49,040 --> 00:38:52,040 INSURANCE HAD THE LOWEST E.D. 1088 00:38:52,040 --> 00:38:53,320 VISIT RATES. 1089 00:38:53,320 --> 00:38:54,880 SINCE THE THEME OF OUR 1090 00:38:54,880 --> 00:38:57,240 ROUNDTABLE TODAY IS LOOKING AT 1091 00:38:57,240 --> 00:38:58,040 SOCIAL FACTORS, SOCIAL 1092 00:38:58,040 --> 00:39:00,280 DETERMINANTS OF HEALTH, I ALSO 1093 00:39:00,280 --> 00:39:03,200 WANTED TO INCLUDE A SLIDE ON THE 1094 00:39:03,200 --> 00:39:03,720 HOMELESS. 1095 00:39:03,720 --> 00:39:06,320 HERE IN FIGURE 9 WE SHOW E.D. 1096 00:39:06,320 --> 00:39:08,640 RATES HER 100 PERSONS AMONG 1097 00:39:08,640 --> 00:39:12,800 HOMELESS PERSONS BY PATIENT SEX, 1098 00:39:12,800 --> 00:39:13,440 FOR FOUR-YEAR PERIOD 2016 1099 00:39:13,440 --> 00:39:14,560 THROUGH 2019. 1100 00:39:14,560 --> 00:39:15,600 ONLY SIGNIFICANT DIFFERENCE, 1101 00:39:15,600 --> 00:39:28,840 HIGHER RATE OF E.D. VISITS AMONG 1102 00:39:28,840 --> 00:39:31,160 HOMELESS MALES VERSUS FEMALES. 1103 00:39:31,160 --> 00:39:32,840 OUR ESTIMATES OF E.D. VISITS BY 1104 00:39:32,840 --> 00:39:34,440 HOMELESS PERSONS ARE LOWER THAN 1105 00:39:34,440 --> 00:39:35,560 OTHER DATA SOURCES. 1106 00:39:35,560 --> 00:39:42,720 THIS IS A LIMITATION OR 1107 00:39:42,720 --> 00:39:43,280 DISADVANTAGE OF NHMCS. 1108 00:39:43,280 --> 00:39:45,960 THEY ARE HARDER FOR US TO SELECT 1109 00:39:45,960 --> 00:39:48,320 GIVEN OUR CURRENT SAMPLING 1110 00:39:48,320 --> 00:39:50,040 METHODS. 1111 00:39:50,040 --> 00:39:52,240 ALSO NHMCS DAD DATA RELY ON 1112 00:39:52,240 --> 00:39:53,360 WHAT'S REPORTED IN MEDICAL 1113 00:39:53,360 --> 00:39:54,760 RECORD FOR RESIDENCE AND 1114 00:39:54,760 --> 00:39:56,440 SOMETIMES DIFFICULT, WE DON'T 1115 00:39:56,440 --> 00:39:58,720 KNOW WHERE THAT DATA COME FROM, 1116 00:39:58,720 --> 00:40:00,960 AND BECAUSE THERE ARE MANY 1117 00:40:00,960 --> 00:40:02,560 PLACES WHERE IT COULD BE STORED 1118 00:40:02,560 --> 00:40:06,400 AND PLACED IN THE RECORD. 1119 00:40:06,400 --> 00:40:08,280 ALSO SOME PATIENTS MAY 1120 00:40:08,280 --> 00:40:10,960 UNDERREPORT HOMELESSNESS DUE TO 1121 00:40:10,960 --> 00:40:11,840 SOCIAL DESIRABILITY BIAS. 1122 00:40:11,840 --> 00:40:14,120 AND THIS IS A GOOD SEGUE TO TALK 1123 00:40:14,120 --> 00:40:17,160 ABOUT SOME EFFORTS WE'RE DOING 1124 00:40:17,160 --> 00:40:19,840 AT NCHS TO ENHANCE OUR E.D. DATA 1125 00:40:19,840 --> 00:40:22,680 THROUGH THE NATIONAL HOSPITAL 1126 00:40:22,680 --> 00:40:23,160 CARE SURVEY. 1127 00:40:23,160 --> 00:40:25,640 AND QUICKLY LET ME JUST TELL YOU 1128 00:40:25,640 --> 00:40:27,520 ABOUT HOSPITAL CARE. 1129 00:40:27,520 --> 00:40:28,680 HOSPITAL CARE PROVIDES RELIABLE 1130 00:40:28,680 --> 00:40:30,440 AND TIMELY HEALTH CARE 1131 00:40:30,440 --> 00:40:34,520 UTILIZATION DATA FOR ENCOUNTERS 1132 00:40:34,520 --> 00:40:35,440 IN HOSPITAL-BASED SETTINGS, 1133 00:40:35,440 --> 00:40:37,560 UNLIKE NHMCS THE HOSPITAL CARE 1134 00:40:37,560 --> 00:40:39,440 IS ALL ELECTRONIC DATA 1135 00:40:39,440 --> 00:40:40,400 COLLECTION, ADMINISTRATIVE 1136 00:40:40,400 --> 00:40:45,600 CLAIMS DATA AND ELECTRONIC 1137 00:40:45,600 --> 00:40:48,600 HEALTH RECORD DATA TRANSMITTED 1138 00:40:48,600 --> 00:40:49,240 ELECTRONICALLY. 1139 00:40:49,240 --> 00:40:53,440 THE DATA COLLECTION IS ANNUAL. 1140 00:40:53,440 --> 00:40:56,520 THE SAMPLE SIZE IS ABOUT 608 1141 00:40:56,520 --> 00:40:57,480 NATIONALLY REPRESENTED 1142 00:40:57,480 --> 00:40:57,760 HOSPITALS. 1143 00:40:57,760 --> 00:41:00,240 WE ASK THESE HOSPITALS TO SEND 1144 00:41:00,240 --> 00:41:04,080 US ALL THEIR INPATIENT AND E.D. 1145 00:41:04,080 --> 00:41:04,400 ENCOUNTERS. 1146 00:41:04,400 --> 00:41:06,880 THE SURVEY AGAIN IS ALL 1147 00:41:06,880 --> 00:41:07,440 VOLUNTARY. 1148 00:41:07,440 --> 00:41:10,560 A KEY FEATURE IS THAT PERSONALLY 1149 00:41:10,560 --> 00:41:11,320 IDENTIFIABLE INFORMATION IS 1150 00:41:11,320 --> 00:41:12,680 COLLECTED IN HOSPITAL CARE. 1151 00:41:12,680 --> 00:41:15,400 AND THIS ALLOWS US TO LINK 1152 00:41:15,400 --> 00:41:16,720 ACROSS HOSPITAL SETTINGS, SO IF 1153 00:41:16,720 --> 00:41:18,680 SOMEONE COMES INTO THE EMERGENCY 1154 00:41:18,680 --> 00:41:20,520 DEPARTMENT AND IS ADMITTED AS 1155 00:41:20,520 --> 00:41:21,520 INPATIENT WE CAN TRACE THAT 1156 00:41:21,520 --> 00:41:21,840 CARE. 1157 00:41:21,840 --> 00:41:25,360 WE CAN ALSO LOOK AT REPEAT 1158 00:41:25,360 --> 00:41:25,680 VISITS. 1159 00:41:25,680 --> 00:41:28,200 FINALLY WE CAN ALSO LINK TO 1160 00:41:28,200 --> 00:41:30,240 EXTERNAL DATA SOURCES SUCH AS 1161 00:41:30,240 --> 00:41:32,360 NATIONAL DEATH INDEX, HOUSED IN 1162 00:41:32,360 --> 00:41:36,920 NCHS, AND CMS AND HUD DATA. 1163 00:41:36,920 --> 00:41:40,080 WHY MOVE TO ELECTRONIC DATA 1164 00:41:40,080 --> 00:41:40,400 COLLECTION? 1165 00:41:40,400 --> 00:41:45,680 RELYING ON IN-PERSON AND MANUAL 1166 00:41:45,680 --> 00:41:46,720 RECORD ABSTRACTIIN HAS CHANCE, 1167 00:41:46,720 --> 00:41:48,240 THERE ARE CHALLENGES, 1168 00:41:48,240 --> 00:41:49,040 HIGHLIGHTED DURING THE COVID-19 1169 00:41:49,040 --> 00:41:49,320 PANDEMIC. 1170 00:41:49,320 --> 00:41:51,240 IT WAS VERY HARD FOR US TO GET 1171 00:41:51,240 --> 00:41:52,960 ON SITE, ALSO WE HAD TO BE 1172 00:41:52,960 --> 00:41:54,440 REALLY CONCERNED ABOUT THE 1173 00:41:54,440 --> 00:41:58,480 SAFETY OF THE HOSPITAL STAFF AS 1174 00:41:58,480 --> 00:42:01,000 WELL AS OUR CENSUS FRs. 1175 00:42:01,000 --> 00:42:02,240 ELECTRONIC DATA COLLECTION 1176 00:42:02,240 --> 00:42:03,480 ALLOWS FOR MORE TIMELY RELEASE. 1177 00:42:03,480 --> 00:42:06,760 WE CAN OBTAIN LARGER VOLUME OF 1178 00:42:06,760 --> 00:42:09,440 VISITS WITH MORE CLINICAL DEATH 1179 00:42:09,440 --> 00:42:12,440 WHEN COLLECTING DATA. 1180 00:42:12,440 --> 00:42:13,240 I'LL HIGHLIGHT THREE EXAMPLES 1181 00:42:13,240 --> 00:42:15,480 HOW THIS HAS INCLUSIVE CREASED 1182 00:42:15,480 --> 00:42:18,480 UTILITY OF OUR E.D. DATA THROUGH 1183 00:42:18,480 --> 00:42:21,080 PRELIMINARY RELEASE OF DATA, 1184 00:42:21,080 --> 00:42:25,800 DATA LINKAGE, USE OF 1185 00:42:25,800 --> 00:42:28,000 UNSTRUCTURED DATA. 1186 00:42:28,000 --> 00:42:30,680 THE COLLECTION OF ELECTRONIC 1187 00:42:30,680 --> 00:42:31,520 HEALTH DATA HAS ALLOWED FOR 1188 00:42:31,520 --> 00:42:33,600 RELEASE OF PRELIMINARY DATA FOR 1189 00:42:33,600 --> 00:42:37,040 50 HOSPITALS, ON IMPACT OF 1190 00:42:37,040 --> 00:42:38,760 COVID-19, INPATIENT AND E.D. 1191 00:42:38,760 --> 00:42:39,040 SETTINGS. 1192 00:42:39,040 --> 00:42:41,440 THESE DATA ARE NOT NATIONALLY 1193 00:42:41,440 --> 00:42:42,440 REPRESENTATIVE, THEY PROVIDE 1194 00:42:42,440 --> 00:42:44,200 IMPORTANT INSIGHT INTO WHAT IS 1195 00:42:44,200 --> 00:42:46,680 HAPPENING WITH COVID-19 IN SOME 1196 00:42:46,680 --> 00:42:48,360 HOSPITALS ACROSS THE COUNTRY. 1197 00:42:48,360 --> 00:42:51,440 THIS SHOWS TYPE OF DATA THAT WE 1198 00:42:51,440 --> 00:42:54,480 HAVE AVAILABLE BY WEEK FROM 1199 00:42:54,480 --> 00:42:55,440 MARCH 2020 THROUGH SEPTEMBER 1200 00:42:55,440 --> 00:42:56,240 2021. 1201 00:42:56,240 --> 00:43:02,240 AGAIN, THIS IS SOMETHING THAT WE 1202 00:43:02,240 --> 00:43:05,240 CAN'T DO WITH NHMCS. 1203 00:43:05,240 --> 00:43:08,600 ON THIS SLIDE THE PRELIMINARY 1204 00:43:08,600 --> 00:43:09,760 HOSPITAL AVAILABLE, THIS SLIDE 1205 00:43:09,760 --> 00:43:12,320 SHOWS PERCENTAGE OF E.D. 1206 00:43:12,320 --> 00:43:12,960 ENCOUNTERS WITH CONFIRMED 1207 00:43:12,960 --> 00:43:15,840 COVID-19 STAT FROM US COLLECTED 1208 00:43:15,840 --> 00:43:16,800 HOSPITALS BY HOSPITAL URBAN 1209 00:43:16,800 --> 00:43:19,840 RURAL LOCATION AND WEEK. 1210 00:43:19,840 --> 00:43:22,280 THESE DATA FROM MARCH 2020 1211 00:43:22,280 --> 00:43:28,920 THROUGH SEPTEMBER 2021, THE DATA 1212 00:43:28,920 --> 00:43:32,360 ARE AVAILABLE FOR DOWNLOAD. 1213 00:43:32,360 --> 00:43:33,480 UNLIKE NHMCS DATA, THE HOSPITAL 1214 00:43:33,480 --> 00:43:35,440 CARE DATA HAVE BEEN LINKED TO 1215 00:43:35,440 --> 00:43:36,520 EXTERNAL SOURCES. 1216 00:43:36,520 --> 00:43:39,480 WE'VE LINK LTD TO THE NATIONAL 1217 00:43:39,480 --> 00:43:40,760 DEATH INDEX, CENTERS FOR 1218 00:43:40,760 --> 00:43:43,720 MEDICARE AND MEDICAID DATASETS, 1219 00:43:43,720 --> 00:43:44,800 HOUSING AND URBAN DEVELOPMENT 1220 00:43:44,800 --> 00:43:50,240 DATA. 1221 00:43:50,240 --> 00:43:52,240 WE'RE LINKING TO MEDICARE AND 1222 00:43:52,240 --> 00:43:54,280 VETERANS AFFAIRS DATA. 1223 00:43:54,280 --> 00:43:56,240 THIS SHOULD HELP WITH SOCIAL 1224 00:43:56,240 --> 00:43:57,720 DETERMINANTS OF HEALTH RESEARCH, 1225 00:43:57,720 --> 00:44:00,640 INPATIENT AND E.D. HOSPITAL USE 1226 00:44:00,640 --> 00:44:05,480 BY INCREASING NUMBER OF RELEVANT 1227 00:44:05,480 --> 00:44:09,840 VARIABLES AVAILABLE TO PROVIDE 1228 00:44:09,840 --> 00:44:10,520 CONTEXT. 1229 00:44:10,520 --> 00:44:11,400 ALSO, FOR HOSPITALS SUBMITTING 1230 00:44:11,400 --> 00:44:18,040 EHR DATA TO THE SURVEY THEY HAVE 1231 00:44:18,040 --> 00:44:18,920 INCLUDED UNSTRUCTURED DATA, 1232 00:44:18,920 --> 00:44:24,920 THESE HAVE BEEN USED TO ENHANCE 1233 00:44:24,920 --> 00:44:25,520 ELEMENTS PROVIDING ADDITIONAL 1234 00:44:25,520 --> 00:44:25,840 INFORMATION. 1235 00:44:25,840 --> 00:44:33,240 USE OF NATURAL LANGUAGE 1236 00:44:33,240 --> 00:44:35,000 PROCESSING HELPS IN DEVELOPMENT 1237 00:44:35,000 --> 00:44:37,840 OF ALGORITHMS IN OPIOID AND 1238 00:44:37,840 --> 00:44:38,560 CO-OCCURRING DISORDERS, HOPING 1239 00:44:38,560 --> 00:44:41,240 SIMILAR APPROACHES MAY BE USED 1240 00:44:41,240 --> 00:44:43,960 TO CAPTURE SOCIAL DETERMINANTS 1241 00:44:43,960 --> 00:44:49,320 OF HEALTH ELEMENTS WITHIN THESE 1242 00:44:49,320 --> 00:44:51,800 STRUCTURED DATA. 1243 00:44:51,800 --> 00:44:56,720 I PROVIDED LINKS FOR MORE 1244 00:44:56,720 --> 00:44:57,760 INFORMATION ON NHAMCS, AND MORE 1245 00:44:57,760 --> 00:45:01,560 ABOUT THE DATA THROUGH THE NCHS 1246 00:45:01,560 --> 00:45:02,320 RESEARCH DATA CENTER. 1247 00:45:02,320 --> 00:45:13,320 THANK UP FOR YOUR TIME TODAY. 1248 00:45:13,320 --> 00:45:19,360 >> THANK YOU. 1249 00:45:19,360 --> 00:45:21,160 THERE'S A LOT OF INFORMATION AND 1250 00:45:21,160 --> 00:45:22,200 DATA AND NUMBERS. 1251 00:45:22,200 --> 00:45:22,560 FASCINATING. 1252 00:45:22,560 --> 00:45:24,960 THANK YOU. 1253 00:45:24,960 --> 00:45:34,720 NOW I WOULD LIKE TO INTRODUCE 1254 00:45:34,720 --> 00:45:36,640 CORYCNE PERHATS WORKING TO 1255 00:45:36,640 --> 00:45:37,800 ADVANCE PROFESSION THROUGH 1256 00:45:37,800 --> 00:45:42,040 RESEARCH AND EVIDENCE-BASED 1257 00:45:42,040 --> 00:45:42,880 POLICIES AND PRACTICE. 1258 00:45:42,880 --> 00:45:46,760 SHE WILL INTRODUCE THE NEXT TWO 1259 00:45:46,760 --> 00:45:47,040 SPEAKERS. 1260 00:45:47,040 --> 00:45:48,280 THANK YOU. 1261 00:45:48,280 --> 00:45:50,640 >> THANK YOU, DR. YOON. 1262 00:45:50,640 --> 00:45:52,040 GOOD MORNING, EVERYONE. 1263 00:45:52,040 --> 00:45:55,120 THIS SECTION IS GOING TO HAVE 1264 00:45:55,120 --> 00:45:56,640 SPEAKERS ADDRESSING SPECIFIC 1265 00:45:56,640 --> 00:45:59,760 SOCIAL NEEDS TO PROVIDE 1266 00:45:59,760 --> 00:46:01,040 CONTEXTUALIZED, PERSON-FOCUSED 1267 00:46:01,040 --> 00:46:04,240 CARE IN THE EMERGENCY 1268 00:46:04,240 --> 00:46:04,680 DEPARTMENT. 1269 00:46:04,680 --> 00:46:06,040 DR. ANDREA WALLACE IS ASSOCIATE 1270 00:46:06,040 --> 00:46:08,640 PROFESSOR AND ASSOCIATE DEAN FOR 1271 00:46:08,640 --> 00:46:10,720 RESEARCH AT UNIVERSITY OF UTAH 1272 00:46:10,720 --> 00:46:13,040 COLLEGE OF NURSING. 1273 00:46:13,040 --> 00:46:16,200 A PRIMARY OBJECTIVE OF DR. 1274 00:46:16,200 --> 00:46:19,520 WALLACE'S RESEARCH IS DESIGNED 1275 00:46:19,520 --> 00:46:20,640 HIGH-QUALITY CHRONIC HEALTH CARE 1276 00:46:20,640 --> 00:46:22,840 SERVICE INTERVENTIONS AIMED AT 1277 00:46:22,840 --> 00:46:25,680 NARROWS GAPS IN CLINICAL 1278 00:46:25,680 --> 00:46:27,240 OUTCOMES WITH EMPHASIS ON 1279 00:46:27,240 --> 00:46:29,080 UNDERSTANDING HOW THESE 1280 00:46:29,080 --> 00:46:31,960 INTERVENTIONS CAN BE FEASIBLY 1281 00:46:31,960 --> 00:46:34,440 ADMINISTERED DURING ROUTINE 1282 00:46:34,440 --> 00:46:37,000 SERVICE DELIVERY. 1283 00:46:37,000 --> 00:46:39,400 MOST RECENTLY, AHRQ AND 1284 00:46:39,400 --> 00:46:40,680 NIH-FUNDED RESEARCH PROGRAM HAS 1285 00:46:40,680 --> 00:46:43,720 FOCUSED ON HOW TO BEST COUNT FOR 1286 00:46:43,720 --> 00:46:45,720 PATIENT SOCIAL DETERMINANTS OF 1287 00:46:45,720 --> 00:46:47,080 HEALTH DURING INPATIENT AND E.D. 1288 00:46:47,080 --> 00:46:48,000 DISCHARGE PLANNING. 1289 00:46:48,000 --> 00:46:52,640 AS WELL AS PART OF COVID-19 1290 00:46:52,640 --> 00:46:52,880 TESTING. 1291 00:46:52,880 --> 00:46:55,440 DR. EMELIA DE MARCHIS IS A 1292 00:46:55,440 --> 00:46:59,720 FAMILY PHYSICIAN, HEALTH 1293 00:46:59,720 --> 00:47:00,360 SERVICES RESEARCHER, UNIVERSITY 1294 00:47:00,360 --> 00:47:02,640 OF CALIFORNIA, SAN FRANCISCO. 1295 00:47:02,640 --> 00:47:05,480 HER RESEARCH IS BASED OUT OF THE 1296 00:47:05,480 --> 00:47:07,000 UCSF SOCIAL INTERVENTION 1297 00:47:07,000 --> 00:47:09,440 RESEARCH AND EVALUATION NETWORK, 1298 00:47:09,440 --> 00:47:11,520 ALSO KNOWN AS SIREN, SHE WORKS 1299 00:47:11,520 --> 00:47:13,440 TO ASSESS AND IMPROVE HOW WE 1300 00:47:13,440 --> 00:47:15,960 SCREEN FOR AND ADDRESS SOCIAL 1301 00:47:15,960 --> 00:47:19,000 RISK FACTORS WITHIN HEALTH CARE 1302 00:47:19,000 --> 00:47:25,040 SETTINGS. 1303 00:47:25,040 --> 00:47:31,000 SHE USES IMPLEMENTATION SCIENCE 1304 00:47:31,000 --> 00:47:32,240 METHODS, INTO ACTIVITIES IN REAL 1305 00:47:32,240 --> 00:47:33,480 WORLD SETTINGS. 1306 00:47:33,480 --> 00:47:34,440 THROUGH HER RESEARCH AND 1307 00:47:34,440 --> 00:47:36,040 CLINICAL PRACTICE SHE HOPES TO 1308 00:47:36,040 --> 00:47:40,160 ADVANCE THE HEALTH CARE SYSTEM'S 1309 00:47:40,160 --> 00:47:41,600 INTEGRATION OF PATIENT SOCIAL 1310 00:47:41,600 --> 00:47:45,040 RISK DATA TO PROVIDE HIGH 1311 00:47:45,040 --> 00:47:45,640 QUALITY PATIENT CENTERED 1312 00:47:45,640 --> 00:47:48,400 PREVENTIVE HEALTH CARE TO REDUCE 1313 00:47:48,400 --> 00:47:50,480 HEALTH DISPARITIES. 1314 00:47:50,480 --> 00:47:53,360 DR. CRAIG POLLACK IS KATY AYRES 1315 00:47:53,360 --> 00:47:55,640 ENDOWED PROFESSOR, DEPARTMENT OF 1316 00:47:55,640 --> 00:47:56,680 HEALTH POLICY AND MANAGEMENT, 1317 00:47:56,680 --> 00:47:58,240 JOHNS HOPKINS BLOOMBERG SCHOOL 1318 00:47:58,240 --> 00:47:59,840 OF PUBLIC HEALTH AND SCHOOL OF 1319 00:47:59,840 --> 00:48:01,000 NURSING. 1320 00:48:01,000 --> 00:48:05,880 HE IS A PRACTICING PRIMARY CARE 1321 00:48:05,880 --> 00:48:06,480 PHYSICIAN, RESEARCH FOCUSES ON 1322 00:48:06,480 --> 00:48:08,320 SOCIAL DETERMINANTS OF HEALTH 1323 00:48:08,320 --> 00:48:10,600 WITH EMPHASIS ON HOUSING POLICY. 1324 00:48:10,600 --> 00:48:13,200 IN A CURRENT NIH-FUNDED RESEARCH 1325 00:48:13,200 --> 00:48:16,640 STUDY HE'S INVESTIGATING THE 1326 00:48:16,640 --> 00:48:17,560 HEALTH EFFECTS OF HOUSING 1327 00:48:17,560 --> 00:48:20,840 MOBILITY PROGRAMS THAT HELP 1328 00:48:20,840 --> 00:48:27,680 FAMILY MOVE TO RESOURCED 1329 00:48:27,680 --> 00:48:28,440 RESOURCED NEIGHBORHOODS, 1330 00:48:28,440 --> 00:48:29,920 PART-TIME SENIOR RESEARCH 1331 00:48:29,920 --> 00:48:31,840 ADVISER IN OFFICE OF POLICY 1332 00:48:31,840 --> 00:48:34,240 DEVELOPMENT AND RESEARCH AT THE 1333 00:48:34,240 --> 00:48:35,360 U.S. DEPARTMENT OF HOUSING AND 1334 00:48:35,360 --> 00:48:36,160 URBAN DEVELOPMENT. 1335 00:48:36,160 --> 00:48:39,840 PLEASE JOIN ME IN WELCOMING 1336 00:48:39,840 --> 00:48:41,840 DOCTORS WALLACE, DE MARCHIS AND 1337 00:48:41,840 --> 00:48:43,840 POLLACK, WHO WILL SPEAK EACH FOR 1338 00:48:43,840 --> 00:48:46,000 15 MINUTES AND AGAIN WE'RE 1339 00:48:46,000 --> 00:48:47,840 REQUESTING THAT YOU HOLD 1340 00:48:47,840 --> 00:48:49,120 QUESTIONS FOR THE PANEL 1341 00:48:49,120 --> 00:48:49,440 DISCUSSION. 1342 00:48:49,440 --> 00:48:54,520 PLEASE ENTER THEM IN THE CHAT. 1343 00:48:54,520 --> 00:48:57,160 DURING THE BREAK WE'LL MAKE THE 1344 00:48:57,160 --> 00:48:59,120 QUESTIONS AVAILABLE FOR THE 1345 00:48:59,120 --> 00:49:00,040 PANEL MODERATOR. 1346 00:49:00,040 --> 00:49:07,560 DR. WALLACE, WELCOME. 1347 00:49:07,560 --> 00:49:08,320 PLEASE BEGIN YOUR PRESENTATION. 1348 00:49:08,320 --> 00:49:09,400 >> ALL RIGHT. 1349 00:49:09,400 --> 00:49:14,760 HOPEFULLY YOU CAN SEE WHAT I 1350 00:49:14,760 --> 00:49:16,440 SEE. 1351 00:49:16,440 --> 00:49:21,800 IT'S AN HONOR TO PRESENT THIS 1352 00:49:21,800 --> 00:49:24,040 WORK. 1353 00:49:24,040 --> 00:49:26,760 1354 00:49:26,760 --> 00:49:29,640 NOTHING I PRESENT TODAY IS DONE 1355 00:49:29,640 --> 00:49:33,360 WITHOUT HELP FROM COLLABORATORS, 1356 00:49:33,360 --> 00:49:34,160 COMMUNITY PARTNERS AT UTAH 211 1357 00:49:34,160 --> 00:49:36,080 AND STAFF. 1358 00:49:36,080 --> 00:49:38,800 THIS WORK WAS FUNDED BY AHRQ AND 1359 00:49:38,800 --> 00:49:39,880 BY NINR. 1360 00:49:39,880 --> 00:49:45,000 I HAVE NO CONFLICTS TO DISCLOSE. 1361 00:49:45,000 --> 00:49:48,160 I SHOW THIS MAP, WHAT INSPIRES 1362 00:49:48,160 --> 00:49:49,320 OUR WORK RELATED TO SOCIAL 1363 00:49:49,320 --> 00:49:50,120 DETERMINANTS AT A LOCAL AND 1364 00:49:50,120 --> 00:49:50,560 PERSONAL LEVEL. 1365 00:49:50,560 --> 00:49:52,240 THIS IS A MAP OF NEIGHBORHOODS 1366 00:49:52,240 --> 00:49:54,080 IN URBAN SALT LAKE CITY, UTAH, 1367 00:49:54,080 --> 00:49:55,640 WHERE UNIVERSITY OF UTAH IS 1368 00:49:55,640 --> 00:49:56,360 LOCATED. 1369 00:49:56,360 --> 00:50:03,000 LIFE EXPECTANCY BASED WHERE A 1370 00:50:03,000 --> 00:50:04,320 PATIENT RESIDES, MORE HOMOGENOUS 1371 00:50:04,320 --> 00:50:05,720 AVENUES HAS A LIFE EXPECTANCY 1372 00:50:05,720 --> 00:50:07,640 TEN YEARS LONGER THAN THOSE 1373 00:50:07,640 --> 00:50:09,440 LIVING ONLY A FEW BLOCKS 1374 00:50:09,440 --> 00:50:12,640 DOWNHILL IN CENTRAL DOWNTOWN 1375 00:50:12,640 --> 00:50:14,680 WHERE RESIDENTS EXPERIENCE 1376 00:50:14,680 --> 00:50:26,680 HOUSING INSTABILITY AND FOOD 1377 00:50:26,680 --> 00:50:27,000 INSECURITY. 1378 00:50:27,000 --> 00:50:28,360 WE'VE LONG KNOWN THIS AFFECTS 1379 00:50:28,360 --> 00:50:29,600 HEALTH AND WELL BEING. 1380 00:50:29,600 --> 00:50:31,040 HOWEVER, THE IDEA THAT SOCIAL 1381 00:50:31,040 --> 00:50:34,680 DETERMINANTS CAN AND SHOULD BE 1382 00:50:34,680 --> 00:50:35,520 ADDRESSED BY HEALTH SYSTEMS 1383 00:50:35,520 --> 00:50:37,480 CAUGHT NATIONAL ATTENTION WITH 1384 00:50:37,480 --> 00:50:38,480 AWARENESS OF CAMDEN COALITION 1385 00:50:38,480 --> 00:50:41,760 EXPLAINED HERE IN THIS FAMOUS 1386 00:50:41,760 --> 00:50:42,640 2011 NEW YORKER PIECE. 1387 00:50:42,640 --> 00:50:45,440 THE IDEA WAS THAT BY HOT 1388 00:50:45,440 --> 00:50:48,160 SPOTTING HEALTH SERVICE SUPER 1389 00:50:48,160 --> 00:50:50,000 UTILIZERS SOME HAD UP TO 100 1390 00:50:50,000 --> 00:50:50,760 E.D. VISITS ANNUALLY, ADDRESSING 1391 00:50:50,760 --> 00:50:53,480 SOCIAL NEEDS, WE CAN DECREASE 1392 00:50:53,480 --> 00:50:54,680 UNNECESSARY HEALTH CARE RESOURCE 1393 00:50:54,680 --> 00:50:58,160 USE, REDUCE COST, IMPROVE 1394 00:50:58,160 --> 00:50:58,520 OUTCOMES. 1395 00:50:58,520 --> 00:51:01,400 IT TOOK A DECADE TO TEST THIS 1396 00:51:01,400 --> 00:51:03,720 IDEA WITH RCT, SOCIAL SERVICE 1397 00:51:03,720 --> 00:51:05,480 SOLUTIONS WERE OFFERED TO THOSE 1398 00:51:05,480 --> 00:51:10,720 IDENTIFIED AS HEALTH CARE 1399 00:51:10,720 --> 00:51:13,080 SUPER-UTILIZERS, UNFORTUNATELY 1400 00:51:13,080 --> 00:51:14,680 RESULTS WERE DISCOURAGING, 1401 00:51:14,680 --> 00:51:18,520 OFFERING SERVICES DID NOT RESULT 1402 00:51:18,520 --> 00:51:21,040 IN SIGNIFICANT COST SAVINGS. 1403 00:51:21,040 --> 00:51:25,360 SO WHERE DOES THAT LEAVE US? 1404 00:51:25,360 --> 00:51:29,680 SHOULD WE ABANDON? 1405 00:51:29,680 --> 00:51:30,640 WE SHOULDN'T. 1406 00:51:30,640 --> 00:51:33,240 THERE ARE MANY IDEAS WERE IT 1407 00:51:33,240 --> 00:51:34,840 CONFLICTED WITH CONVENTIONAL 1408 00:51:34,840 --> 00:51:37,000 WISDOM HOW SOCIAL DETERMINANTS 1409 00:51:37,000 --> 00:51:37,240 WORK. 1410 00:51:37,240 --> 00:51:41,960 I WANT TO USE THESE TO POINT OUT 1411 00:51:41,960 --> 00:51:45,040 HOW THIS DISTINGUISHES OUR 1412 00:51:45,040 --> 00:51:45,400 WORK. 1413 00:51:45,400 --> 00:51:46,400 A KEY REALIZATION IS ALL 1414 00:51:46,400 --> 00:51:47,880 PATIENTS COME IN TO HEALTH CARE 1415 00:51:47,880 --> 00:51:51,280 SETTINGS WITH SOCIAL FACTORS 1416 00:51:51,280 --> 00:51:55,840 IMPACTING HEALTH AND THEY CHANGE 1417 00:51:55,840 --> 00:51:57,520 OVER TIME. 1418 00:51:57,520 --> 00:51:59,320 ISOLATION CAN AFFECT POPULATIONS 1419 00:51:59,320 --> 00:52:00,280 REGARDLESS OF HOW MUCH THEY HAVE 1420 00:52:00,280 --> 00:52:02,080 USED SERVICES. 1421 00:52:02,080 --> 00:52:04,360 AS WE KNOW SOCIAL NEEDS POSE 1422 00:52:04,360 --> 00:52:05,440 BARRIERS TO ACCESSING SERVICES 1423 00:52:05,440 --> 00:52:07,000 SO FOCUSING ONLY ON THOSE USING 1424 00:52:07,000 --> 00:52:09,160 SERVICES DOESN'T ALLOW US TO 1425 00:52:09,160 --> 00:52:10,840 FULLY UNDERSTAND OR ADDRESS 1426 00:52:10,840 --> 00:52:13,840 SOCIAL NEEDS AND MAY REINFORCE 1427 00:52:13,840 --> 00:52:14,760 INEQUITIES. 1428 00:52:14,760 --> 00:52:15,440 AND DEMONSTRATING CLINICAL 1429 00:52:15,440 --> 00:52:17,120 EFFECTIVENESS AND COST SAVINGS 1430 00:52:17,120 --> 00:52:18,200 IS EXTREMELY DIFFICULT TO DO BY 1431 00:52:18,200 --> 00:52:20,960 FOCUSING ONLY ON THOSE LABELED 1432 00:52:20,960 --> 00:52:22,000 AS HIGH SERVICE UTILIZERS. 1433 00:52:22,000 --> 00:52:24,880 AS SUCH WE HAVE FOCUSED ON IDEA 1434 00:52:24,880 --> 00:52:28,240 OF UNIVERSALLY SCREENING FOR 1435 00:52:28,240 --> 00:52:30,280 SOCIAL NIGHTS, TRANSPORTATION, 1436 00:52:30,280 --> 00:52:31,000 HOUSING, FOOD, CHILD CARE, 1437 00:52:31,000 --> 00:52:33,960 VERSUS ONLY ON THOSE WHO USE 1438 00:52:33,960 --> 00:52:34,680 MANY SERVICES. 1439 00:52:34,680 --> 00:52:36,720 SECOND DRIVER FOR US IS WE SEE 1440 00:52:36,720 --> 00:52:38,760 THAT OUR HEALTH SYSTEMS ARE IN A 1441 00:52:38,760 --> 00:52:39,280 CRITICAL JUNCTURE. 1442 00:52:39,280 --> 00:52:41,880 WE HAVE AN OPPORTUNITY IN THIS 1443 00:52:41,880 --> 00:52:45,240 WORK, HEALTH SYSTEMS ARE RAPIDLY 1444 00:52:45,240 --> 00:52:49,720 ADOPTING PRACTICES AND WE LITTLE 1445 00:52:49,720 --> 00:52:50,760 EVIDENCE. 1446 00:52:50,760 --> 00:52:53,040 WE'RE PASSIONATE ABOUT BUILDING 1447 00:52:53,040 --> 00:52:53,320 EVIDENCE. 1448 00:52:53,320 --> 00:52:57,280 A KEY CHALLENGE IS HOW DO WE DO 1449 00:52:57,280 --> 00:52:57,480 THIS? 1450 00:52:57,480 --> 00:52:58,880 CAROL TALKED EARLIER, IT REALLY 1451 00:52:58,880 --> 00:53:02,040 IS DIFFICULT DATA TO COLLECT. 1452 00:53:02,040 --> 00:53:04,000 IN ROUTINE CARE WE RELY ON 1453 00:53:04,000 --> 00:53:05,480 ELECTRONIC HEALTH RECORDS, WE 1454 00:53:05,480 --> 00:53:07,600 KNOW LITTLE ABOUT PATIENT SOCIAL 1455 00:53:07,600 --> 00:53:08,760 CIRCUMSTANCES. 1456 00:53:08,760 --> 00:53:11,440 WE'RE OFTEN LEFT WITH HAPHAZARD 1457 00:53:11,440 --> 00:53:13,840 PROXY SUCH AS INSURANCE STATUS, 1458 00:53:13,840 --> 00:53:16,080 RESIDENTIAL ZIP CODE, 1459 00:53:16,080 --> 00:53:17,880 AVAILABILITY OF EMERGENCY 1460 00:53:17,880 --> 00:53:18,440 CONTACTS. 1461 00:53:18,440 --> 00:53:19,640 WE'VE BEEN LEFT WITHOUT 1462 00:53:19,640 --> 00:53:20,240 UNDERSTANDING HOW TO ADDRESS 1463 00:53:20,240 --> 00:53:22,640 SOCIAL NEEDS AND DON'T HAVE A 1464 00:53:22,640 --> 00:53:23,280 FIRM UNDERSTANDING OF THE 1465 00:53:23,280 --> 00:53:26,680 MECHANISMS BY WHICH NEEDS AND 1466 00:53:26,680 --> 00:53:27,800 SERVICES AFFECT HEALTH OUTCOMES. 1467 00:53:27,800 --> 00:53:30,240 OVER THE PAST SEVERAL YEARS THE 1468 00:53:30,240 --> 00:53:31,000 CHALLENGE OF UNDERSTANDING 1469 00:53:31,000 --> 00:53:32,920 SOCIAL NEEDS STARTED A NATIONAL 1470 00:53:32,920 --> 00:53:35,720 CONVERSATION OF HOW TO INTEGRATE 1471 00:53:35,720 --> 00:53:36,600 SOCIAL INFORMATION IN E HRs, 1472 00:53:36,600 --> 00:53:44,280 ALMOST DAILY WE HAVE NEW MODULES 1473 00:53:44,280 --> 00:53:44,560 AVAILABLE. 1474 00:53:44,560 --> 00:53:47,520 THOUGHT LEADERS AS IN THIS 1475 00:53:47,520 --> 00:53:49,120 PUBLICATION IN 2016 CAUTIONED US 1476 00:53:49,120 --> 00:53:54,480 SOCIAL NEEDS SCREENING MAY COME 1477 00:53:54,480 --> 00:53:56,400 WITH STIGMA AND COULD REINFORCE 1478 00:53:56,400 --> 00:53:58,720 HEALTH INEQUITIES IF 1479 00:53:58,720 --> 00:54:01,120 IDENTIFICATION ISN'T ACCOMPANIED 1480 00:54:01,120 --> 00:54:02,760 BY INTERVENTION. 1481 00:54:02,760 --> 00:54:04,960 SO, WITH THIS, OUR RESEARCH 1482 00:54:04,960 --> 00:54:12,200 RECOGNIZES THAT THIS REQUIRES 1483 00:54:12,200 --> 00:54:14,680 SCREENING APPROACHES IN CLINICAL 1484 00:54:14,680 --> 00:54:15,080 WORK FLOW. 1485 00:54:15,080 --> 00:54:17,040 SECOND, REQUIRES MEANS OF 1486 00:54:17,040 --> 00:54:17,680 COMMUNICATING INFORMATION TO 1487 00:54:17,680 --> 00:54:19,440 CLINICAL TEAMS IN A WAY THAT 1488 00:54:19,440 --> 00:54:21,840 INFORMS CLINICAL DECISION 1489 00:54:21,840 --> 00:54:22,600 MAKING. 1490 00:54:22,600 --> 00:54:23,600 THIRD, REQUIRES LINKING PATIENTS 1491 00:54:23,600 --> 00:54:24,880 WITH RESOURCES THAT CAN MEET 1492 00:54:24,880 --> 00:54:25,880 NEEDS AT HOME. 1493 00:54:25,880 --> 00:54:29,520 WE NEED TO RECOGNIZE WE CAN 1494 00:54:29,520 --> 00:54:30,920 START THE PROCESS, ADDRESSING 1495 00:54:30,920 --> 00:54:33,000 THOSE NEEDS REQUIRES COMMITMENT 1496 00:54:33,000 --> 00:54:35,120 AND CONNECTIONS FAR BEYOND 1497 00:54:35,120 --> 00:54:36,680 SCREENING AND CLINICAL 1498 00:54:36,680 --> 00:54:37,680 ENCOUNTER. 1499 00:54:37,680 --> 00:54:41,040 SO WITH THAT, OUR PURPOSE 1500 00:54:41,040 --> 00:54:43,880 STARTED IN 2017, TO DEVELOP 1501 00:54:43,880 --> 00:54:44,840 MEANS OF IDENTIFYING SOCIAL 1502 00:54:44,840 --> 00:54:46,600 NEEDS THAT CAN BE USED IN 1503 00:54:46,600 --> 00:54:47,360 ROUTINE CARE. 1504 00:54:47,360 --> 00:54:48,840 WHEN THE WORK ISN'T NECESSARILY 1505 00:54:48,840 --> 00:54:51,600 SUPPORTED BY DEDICATED RESEARCH 1506 00:54:51,600 --> 00:54:54,640 STAFF, TO FACILITATE ACCESS TO 1507 00:54:54,640 --> 00:54:58,200 RESOURCES AND INTEGRATE DATA, TO 1508 00:54:58,200 --> 00:54:59,280 DATE WE'VE SCREENED 10,000 E.D. 1509 00:54:59,280 --> 00:54:59,560 PATIENTS. 1510 00:54:59,560 --> 00:55:01,760 OUR WORK IS GROUNDED IN A 1511 00:55:01,760 --> 00:55:03,360 PARTNERSHIP WITH UTAH 211, PART 1512 00:55:03,360 --> 00:55:06,720 OF A NATIONAL NETWORK OF 1513 00:55:06,720 --> 00:55:07,920 COMMUNITY SERVICE REFERRAL 1514 00:55:07,920 --> 00:55:09,440 CENTERS THAT OFFER CONNECTIONS 1515 00:55:09,440 --> 00:55:11,320 AND LOW COST ASSISTANCE PROGRAMS 1516 00:55:11,320 --> 00:55:13,640 FOR FOOD AND HOUSING, AND TO ALL 1517 00:55:13,640 --> 00:55:15,040 THOSE WHO CALL. 1518 00:55:15,040 --> 00:55:18,880 OR VIA INTERNET OR TEXT. 1519 00:55:18,880 --> 00:55:20,920 OVERVIEW OF HOW WE'VE DONE THIS 1520 00:55:20,920 --> 00:55:22,240 IS QUITE SIMPLE. 1521 00:55:22,240 --> 00:55:24,920 USING LOW COST READILY AVAILABLE 1522 00:55:24,920 --> 00:55:26,760 HIPAA COMPLIANT TOOLS, REDCap 1523 00:55:26,760 --> 00:55:31,160 IN THIS CASE, E.D. REGISTRATION 1524 00:55:31,160 --> 00:55:34,400 STEMS USE THE VALIDATED TEN ITEM 1525 00:55:34,400 --> 00:55:35,440 SCREENER, THE CITATION IS 1526 00:55:35,440 --> 00:55:36,880 INCLUDED HERE TO THE RIGHT. 1527 00:55:36,880 --> 00:55:39,200 WE REFER THOSE WHO HAVE NEEDS 1528 00:55:39,200 --> 00:55:41,760 AND WANT OUTREACH TO 211 1529 00:55:41,760 --> 00:55:43,600 SPECIALISTS WHO CONTACT VIA 1530 00:55:43,600 --> 00:55:45,440 PHONE, TEXT, E-MAIL WITHIN 48 1531 00:55:45,440 --> 00:55:46,840 HOURS OF DISCHARGE AND COMPILE 1532 00:55:46,840 --> 00:55:48,120 DATA FROM INSIDE AND OUTSIDE 1533 00:55:48,120 --> 00:55:50,480 HEALTH SYSTEM TO UNDERSTAND 1534 00:55:50,480 --> 00:55:52,760 NEEDS AND COMMUNITY OUTREACH 1535 00:55:52,760 --> 00:55:53,000 PROCESS. 1536 00:55:53,000 --> 00:55:54,680 PARTNERSHIP WITH 211 WHICH HAS 1537 00:55:54,680 --> 00:55:56,440 ROBUST ENCOUNTER AND RESOURCE 1538 00:55:56,440 --> 00:56:00,520 DATABASES ALLOWED US TO DO THIS. 1539 00:56:00,520 --> 00:56:01,960 OF COURSE, THIS IS DISPLAYED 1540 00:56:01,960 --> 00:56:03,480 DIFFERENTLY ON TOUCH PADS BUT 1541 00:56:03,480 --> 00:56:06,280 THIS IS A VISUAL OF WHAT IS 1542 00:56:06,280 --> 00:56:06,640 ADMINISTERED. 1543 00:56:06,640 --> 00:56:09,240 ON THE LEFT ARE QUESTIONS FROM 1544 00:56:09,240 --> 00:56:10,480 THE SCREENER, ON THE RIGHT 1545 00:56:10,480 --> 00:56:11,160 INFORMATION GATHERED FROM THOSE 1546 00:56:11,160 --> 00:56:13,760 WHO WOULD LIKE TO BE CONTACTED 1547 00:56:13,760 --> 00:56:17,840 BY 211 FOR SERVICE CONNECTIONS. 1548 00:56:17,840 --> 00:56:19,480 AND WE'VE GATHERED A LOT OF DAFT 1549 00:56:19,480 --> 00:56:22,040 ALONG THE WAY AND CONTINUE TO 1550 00:56:22,040 --> 00:56:22,640 GATHER DATA. 1551 00:56:22,640 --> 00:56:24,680 QUANTITATIVE AND QUALITATIVE 1552 00:56:24,680 --> 00:56:25,240 INFORMATION FROM PATIENTS, 1553 00:56:25,240 --> 00:56:26,760 STAFF, 211 SPECIALISTS TO 1554 00:56:26,760 --> 00:56:28,640 UNDERSTAND THE CHALLENGES AND 1555 00:56:28,640 --> 00:56:29,560 IMPLICATIONS OF INTEGRATING 1556 00:56:29,560 --> 00:56:34,320 SOCIAL NEEDS SCREENING INTO 1557 00:56:34,320 --> 00:56:35,240 CLINICAL SYSTEMS. 1558 00:56:35,240 --> 00:56:36,760 SO, LET'S TALK ABOUT NUMBERS OF 1559 00:56:36,760 --> 00:56:41,320 WHAT WE'VE SEEN FROM THIS WORK. 1560 00:56:41,320 --> 00:56:43,400 IN A STUDY FUNDED BY AHRQ WE 1561 00:56:43,400 --> 00:56:44,840 SCREENED PATIENTS FOR SOCIAL 1562 00:56:44,840 --> 00:56:47,640 NEEDS OVER 15 MONTHS AND FOCUSED 1563 00:56:47,640 --> 00:56:49,200 ON EVALUATING EFFORTS USING 1564 00:56:49,200 --> 00:56:50,320 IMPLEMENTATION SCIENCE APPROACH. 1565 00:56:50,320 --> 00:56:53,040 WE FOLLOWED THE NUMBER OF 1566 00:56:53,040 --> 00:56:54,760 PATIENTS APPROACHED, COMPLETED 1567 00:56:54,760 --> 00:56:57,800 SCREENINGS, POSITIVE SCREENINGS 1568 00:56:57,800 --> 00:57:00,640 AND REFERRALS TO UNDERSTAND THE 1569 00:57:00,640 --> 00:57:01,040 IMPACT. 1570 00:57:01,040 --> 00:57:06,600 AND HERE WE SHOW WHAT MIGHT 1571 00:57:06,600 --> 00:57:08,680 EXPECTING WITHOUT DEDICATED 1572 00:57:08,680 --> 00:57:08,880 STAFF. 1573 00:57:08,880 --> 00:57:10,240 ABOUT 10% OF POTENTIAL 1574 00:57:10,240 --> 00:57:11,360 DISCHARGES ARE APPROACHED FOR 1575 00:57:11,360 --> 00:57:12,160 SCREENING BY STAFF. 1576 00:57:12,160 --> 00:57:14,080 THE GOOD NEWS IS THAT THE 1577 00:57:14,080 --> 00:57:15,680 SCREENING IS EASY TO COMPLETE, 1578 00:57:15,680 --> 00:57:16,840 IT TOOK ONE MINUTE, MOST 1579 00:57:16,840 --> 00:57:19,440 FINISHED THE QUESTIONS, WE HAD 1580 00:57:19,440 --> 00:57:20,760 FEW TECHNICAL DIFFICULTIES. 1581 00:57:20,760 --> 00:57:22,680 NOW FOR THE OTHER NEWS. 1582 00:57:22,680 --> 00:57:24,160 WE SAW AND CONTINUE TO SEE OVER 1583 00:57:24,160 --> 00:57:26,360 40% OF PATIENTS SCREENED IN OUR 1584 00:57:26,360 --> 00:57:29,280 EFFORT E.D. HAVE MORE THAN ONE 1585 00:57:29,280 --> 00:57:29,520 NEED. 1586 00:57:29,520 --> 00:57:31,160 BUT LESS THAN HALF WANT 1587 00:57:31,160 --> 00:57:31,440 OUTREACH. 1588 00:57:31,440 --> 00:57:34,760 OF THOSE WHO WANT OUTREACH, ONLY 1589 00:57:34,760 --> 00:57:36,800 30% CONNECT WITH 211 FOR HELP. 1590 00:57:36,800 --> 00:57:38,800 IN THE END ABOUT 10% OF THOSE 1591 00:57:38,800 --> 00:57:42,000 WHO STATED THEY HAVE SOCIAL 1592 00:57:42,000 --> 00:57:44,560 NEEDS ENGAGED WITH 211 TO GET 1593 00:57:44,560 --> 00:57:44,760 HELP. 1594 00:57:44,760 --> 00:57:46,360 AND HERE WE SEE THE BREAKDOWN OF 1595 00:57:46,360 --> 00:57:48,040 STATED NEEDS FROM THE MOST TO 1596 00:57:48,040 --> 00:57:49,200 LEAST COMMON. 1597 00:57:49,200 --> 00:57:55,440 KNOW THESE AREN'T MUTUALLY 1598 00:57:55,440 --> 00:57:55,680 EXCLUSIVE. 1599 00:57:55,680 --> 00:57:58,400 IN OUR ANALYSIS IT'S IMPORTANT 1600 00:57:58,400 --> 00:58:01,200 TO NOTE THE NEEDS AT THE TOP, 1601 00:58:01,200 --> 00:58:05,240 UTILITIES, MORTGAGE OR 1602 00:58:05,240 --> 00:58:09,440 REPRESENTATIVE, HOUSEHOLD ITEMS 1603 00:58:09,440 --> 00:58:15,640 OR FOOD DROVE DESIRE FOR 1604 00:58:15,640 --> 00:58:15,920 OUTREACH. 1605 00:58:15,920 --> 00:58:18,760 EVEN AFTER THE RESEARCH STUDY 1606 00:58:18,760 --> 00:58:23,440 STOPPED, STAFF MAINTAINED 1607 00:58:23,440 --> 00:58:25,000 SCREENING AND SAW AVAILABLE 1608 00:58:25,000 --> 00:58:29,240 SERVICES AVAILABLE WITH A GREAT 1609 00:58:29,240 --> 00:58:30,080 DEGREE OF VARIABILITY. 1610 00:58:30,080 --> 00:58:31,280 THIS IS WHY WE CONTINUE DOING 1611 00:58:31,280 --> 00:58:32,920 THIS WORK. 1612 00:58:32,920 --> 00:58:35,240 HERE'S ONE EXAMPLE OF NOTES 1613 00:58:35,240 --> 00:58:37,120 SUMMARIZED FROM THE SPECIALIST. 1614 00:58:37,120 --> 00:58:39,520 IN HER INITIAL CALL SHE WROTE, I 1615 00:58:39,520 --> 00:58:40,720 SPOKE WITH PATIENT'S DAUGHTER 1616 00:58:40,720 --> 00:58:42,080 WHO MENTIONED MOTHER NEEDS HELP 1617 00:58:42,080 --> 00:58:43,240 WITH MEALS AND TRANSPORTATION TO 1618 00:58:43,240 --> 00:58:44,360 APPOINTMENTS WHEN SHE'S NOT 1619 00:58:44,360 --> 00:58:44,640 AVAILABLE. 1620 00:58:44,640 --> 00:58:47,320 I PROVIDED A LITS OF RESOURCES 1621 00:58:47,320 --> 00:58:48,840 AND WILL FOLLOW UP. 1622 00:58:48,840 --> 00:58:49,920 TWO WEEKS LATER, I SPOKE WITH 1623 00:58:49,920 --> 00:58:52,000 THE PATIENT. 1624 00:58:52,000 --> 00:58:57,280 SHE MENTIONED SHE NOR HER 1625 00:58:57,280 --> 00:59:00,840 HUSBAND SPEAK ENGLISH, 83 YEARS 1626 00:59:00,840 --> 00:59:02,520 OLD, HER HUSBAND IS 92, DAUGHTER 1627 00:59:02,520 --> 00:59:03,880 HELPS BUT IS BUSY JUGGLING 1628 00:59:03,880 --> 00:59:05,120 SCHOOL AND WORK BUT BECAUSE OF 1629 00:59:05,120 --> 00:59:06,920 THE BUSY SCHEDULE HER DAUGHTER 1630 00:59:06,920 --> 00:59:08,240 WAS UNABLE TO CONTACT RESOURCES. 1631 00:59:08,240 --> 00:59:10,800 I WAS ABLE TO CONNECT THE 1632 00:59:10,800 --> 00:59:13,120 PATIENT WITH AGING AND ADULT 1633 00:59:13,120 --> 00:59:16,080 SERVICES, AND HELPED COMPLETE 1634 00:59:16,080 --> 00:59:18,760 THE PHONE APPLICATION FOR 1635 00:59:18,760 --> 00:59:19,680 PROGRAMS, STARTING NEXT WEEK 1636 00:59:19,680 --> 00:59:23,240 THEY WILL RECEIVE MEALS AND 1637 00:59:23,240 --> 00:59:23,640 TRANSPORTATION. 1638 00:59:23,640 --> 00:59:27,840 THIS IS WHY WE DO THIS WORK. 1639 00:59:27,840 --> 00:59:29,240 SO, FROM THE NUMBERS, WE CAN 1640 00:59:29,240 --> 00:59:31,640 SCREEN AND MAKE CONNECTIONS IN A 1641 00:59:31,640 --> 00:59:38,720 QUICK AND COST EFFECT ITCHIVE 1642 00:59:38,720 --> 00:59:40,360 BUT IN ROUTINE CARE HAD DROPS 1643 00:59:40,360 --> 00:59:45,080 BETWEEN THOSE WITH NEEDS AND WHO 1644 00:59:45,080 --> 00:59:46,040 GET HELP ULTIMATELY. 1645 00:59:46,040 --> 00:59:48,240 NOW WHAT DID ALL THE QUALITATIVE 1646 00:59:48,240 --> 00:59:50,280 DATA TELL US ABOUT WHERE TO GO 1647 00:59:50,280 --> 00:59:51,600 WITH THIS IF WE WANT SOCIAL 1648 00:59:51,600 --> 00:59:55,040 NEEDS SCREENING TO BE EFFECTIVE 1649 00:59:55,040 --> 00:59:58,640 IN OUR HEALTH SYSTEM. 1650 00:59:58,640 --> 00:59:59,920 DESPITE SCRIPTING AND TRAINING, 1651 00:59:59,920 --> 01:00:01,680 WE FOUND A LOT OF DISCOMFORT 1652 01:00:01,680 --> 01:00:04,920 FROM STAFF ABOUT ASKING WHAT 1653 01:00:04,920 --> 01:00:06,640 THEY DO TO STIGMATIZING 1654 01:00:06,640 --> 01:00:07,920 QUESTIONS AND PROFILE, DETERMINE 1655 01:00:07,920 --> 01:00:16,280 WHO TO SCREEN BAILED ON CLOTHING 1656 01:00:16,280 --> 01:00:17,840 OR EMPLOYMENT, THE STAFF WHO SAW 1657 01:00:17,840 --> 01:00:19,760 THIS AS A TOOL FOR ENGAGING AND 1658 01:00:19,760 --> 01:00:22,160 FELT THEY HAD AN IMPORTANT ROLE 1659 01:00:22,160 --> 01:00:23,400 IN THE LARGER CLINICAL TEAM WERE 1660 01:00:23,400 --> 01:00:30,240 MORE INCLINED TO SCREEN PATIENTS 1661 01:00:30,240 --> 01:00:32,160 FOR SOCIAL NEEDS. 1662 01:00:32,160 --> 01:00:32,640 PATIENT FOCUSED GROUPS 1663 01:00:32,640 --> 01:00:33,440 UNDERSTAND HEALTH CARE PROVIDER 1664 01:00:33,440 --> 01:00:35,360 MAY NOT ADDRESS ALL THEIR NEEDS 1665 01:00:35,360 --> 01:00:36,360 AND PREFER NURSES TO DO 1666 01:00:36,360 --> 01:00:37,880 SCREENING THEY ARE HOPE TO 1667 01:00:37,880 --> 01:00:38,600 SCREENING BY OTHER TEAM MEMBERS 1668 01:00:38,600 --> 01:00:41,240 AS LONG AS IT'S DONE WITH 1669 01:00:41,240 --> 01:00:42,120 SINCERITY AND UNIVERSALLY. 1670 01:00:42,120 --> 01:00:43,680 THEY DON'T WANT TO BE SINGLED 1671 01:00:43,680 --> 01:00:45,840 OUT AND ASKED QUESTIONS. 1672 01:00:45,840 --> 01:00:46,880 THEY RECOMMEND QUESTIONS BE 1673 01:00:46,880 --> 01:00:47,360 ACCOMPANIED WITH CLEAR 1674 01:00:47,360 --> 01:00:49,040 EXPLANATION OF WHY THEY ARE 1675 01:00:49,040 --> 01:00:50,760 BEING ASKED. 1676 01:00:50,760 --> 01:00:52,360 SOMETHING WE DIDN'T FULLY 1677 01:00:52,360 --> 01:00:53,000 EXPECT, PATIENTS COMMUNICATED 1678 01:00:53,000 --> 01:00:54,560 THEY DID NOT WANT THIS 1679 01:00:54,560 --> 01:00:57,840 INFORMATION TO BE IN THEIR EHR 1680 01:00:57,840 --> 01:01:00,480 FOR FEAR OF BEING LABELED AND 1681 01:01:00,480 --> 01:01:01,520 TREATED DIFFERENTLY AND VOICED 1682 01:01:01,520 --> 01:01:02,680 CONCERNS ABOUT PRIVACY. 1683 01:01:02,680 --> 01:01:03,560 AS WE CONTINUE EXPLORING ALL 1684 01:01:03,560 --> 01:01:05,920 THESE TOOLS TO MAKE IT EASY TO 1685 01:01:05,920 --> 01:01:07,640 DOCUMENT CLINTON CAT SETTINGS WE 1686 01:01:07,640 --> 01:01:10,720 NEED TO BETTER UNDERSTAND HOW TO 1687 01:01:10,720 --> 01:01:13,120 MAKE EFFORTS PATIENT CENTERED 1688 01:01:13,120 --> 01:01:14,760 AND REDUCING HEALTH INEQUITIES. 1689 01:01:14,760 --> 01:01:18,280 AND WE CONTINUE TO DO MORE WORK. 1690 01:01:18,280 --> 01:01:20,080 THESE AREAS ARE ALSO IN REVIEW 1691 01:01:20,080 --> 01:01:22,120 BUT DATA SHOWS IT'S AS IMPORTANT 1692 01:01:22,120 --> 01:01:24,880 TO FOCUS ON MULTIPLE NEEDS VERSE 1693 01:01:24,880 --> 01:01:27,840 U. -- VERSUS ONE AREA. 1694 01:01:27,840 --> 01:01:30,560 IF THERE'S ONE QUESTION TO ASK, 1695 01:01:30,560 --> 01:01:32,840 MAYBE TO ASK WHAT WHETHER 1696 01:01:32,840 --> 01:01:34,240 PATIENT HAS ACCESS TO STABLE 1697 01:01:34,240 --> 01:01:36,480 TELEPHONE NUMBER. 1698 01:01:36,480 --> 01:01:40,720 MORE ON THAT SOON. 1699 01:01:40,720 --> 01:01:42,320 AND FROM WHAT WE'RE SEEING, 1700 01:01:42,320 --> 01:01:44,200 EXAMINING ENGAGEMENT IN PATIENT 1701 01:01:44,200 --> 01:01:45,520 OUTCOMES, SCREENING LOCATION AND 1702 01:01:45,520 --> 01:01:46,240 METHODS MATTER. 1703 01:01:46,240 --> 01:01:47,880 HOW WE DO THE SCREENING RESULTS 1704 01:01:47,880 --> 01:01:50,760 IN DIFFERENCES IN DESIRE FOR 1705 01:01:50,760 --> 01:01:54,040 OUTREACH, THOSE WHO INTERACT VIA 1706 01:01:54,040 --> 01:01:54,840 MY CHART WITH DIFFERENT THAN 1707 01:01:54,840 --> 01:01:57,080 THOSE WHO SCREEN WELL IN THE 1708 01:01:57,080 --> 01:01:57,240 E.D. 1709 01:01:57,240 --> 01:02:01,640 WE NEED TO CONSIDER HOW AND 1710 01:02:01,640 --> 01:02:02,720 WHERE WE SCREEN. 1711 01:02:02,720 --> 01:02:08,800 SO WHERE TO NEXT WITH ALL THIS? 1712 01:02:08,800 --> 01:02:09,400 WE'RE FOCUSING ON EXPANDING 1713 01:02:09,400 --> 01:02:11,960 REFERRALS TO UNDERSTAND HOW TO 1714 01:02:11,960 --> 01:02:15,720 REACH THOSE IMPACTED BY COVID-19 1715 01:02:15,720 --> 01:02:18,520 AND 19, TESTING METHODS CENTERED 1716 01:02:18,520 --> 01:02:22,600 ON PATIENT PROBLEM SOLVING, 1717 01:02:22,600 --> 01:02:25,080 MEASURING PATIENT CENTERED 1718 01:02:25,080 --> 01:02:29,200 OUTCOMES AND TARGETING 1719 01:02:29,200 --> 01:02:31,360 MOTIVATION OF STAFF ENGAGED IN 1720 01:02:31,360 --> 01:02:31,840 SCREENING. 1721 01:02:31,840 --> 01:02:34,680 I KNOW THIS IS A LOT TO TAKE IN. 1722 01:02:34,680 --> 01:02:36,520 THIS WORK HAS MANY COMPONENTS, 1723 01:02:36,520 --> 01:02:43,160 BUT THE KEY TAKEAWAYS WE HAVE 1724 01:02:43,160 --> 01:02:44,640 AVAILABLE TOOLS, OUR APPROACH OF 1725 01:02:44,640 --> 01:02:45,640 WORKING WITH E.D. REGISTRATION 1726 01:02:45,640 --> 01:02:47,360 STAFF IS ONE OF MANY APPROACHES 1727 01:02:47,360 --> 01:02:50,760 THAT COULD BE USED. 1728 01:02:50,760 --> 01:02:59,040 OUR RESEARCH FINDINGS UNCOVER 1729 01:02:59,040 --> 01:03:02,720 CAVEATS IF IT IS TO BE A 1730 01:03:02,720 --> 01:03:04,760 SOLUTION FOR ADDRESSING HEALTH 1731 01:03:04,760 --> 01:03:05,400 INEQUITIES. 1732 01:03:05,400 --> 01:03:10,240 THANK YOU VERY MUCH FOR YOUR 1733 01:03:10,240 --> 01:03:13,160 TIME TODAY. 1734 01:03:13,160 --> 01:03:13,280 1735 01:03:13,280 --> 01:03:15,920 >> THANK YOU, DR. WALLACE. 1736 01:03:15,920 --> 01:03:20,640 DR. DE MARCHIS, WE'RE READY FOR 1737 01:03:20,640 --> 01:03:25,440 YOU. 1738 01:03:25,440 --> 01:03:27,720 >> THANK YOU SO MUCH. 1739 01:03:27,720 --> 01:03:29,200 CAN EVERYONE SEE MY SCREEN? 1740 01:03:29,200 --> 01:03:33,280 THANK YOU FOR THAT INTRODUCTION. 1741 01:03:33,280 --> 01:03:35,120 THANK YOU, DR. WALLACE, FOR YOUR 1742 01:03:35,120 --> 01:03:35,400 TALK. 1743 01:03:35,400 --> 01:03:36,840 IT HAS A LOT OF OVERLAP WITH A 1744 01:03:36,840 --> 01:03:38,560 LOT OF WORK WE'RE DOING. 1745 01:03:38,560 --> 01:03:40,760 IT WAS EXCITING TO SEE THE WORK 1746 01:03:40,760 --> 01:03:44,240 FROM UNIVERSITY OF UTAH. 1747 01:03:44,240 --> 01:03:48,480 PSOAS HAS BEEN MENTIONED I'M 1748 01:03:48,480 --> 01:03:49,040 ASSISTANT PROFESSOR AT THE 1749 01:03:49,040 --> 01:03:50,640 UNIVERSITY OF CALIFORNIA, SAN 1750 01:03:50,640 --> 01:03:50,880 FRANCISCO. 1751 01:03:50,880 --> 01:03:53,640 AND OVER THE PAST DAY, DAY AND A 1752 01:03:53,640 --> 01:03:55,160 HALF WE'VE BEEN HEARING GREAT 1753 01:03:55,160 --> 01:03:57,440 TALKS ON INTEGRATION OF SOCIAL 1754 01:03:57,440 --> 01:03:58,280 CARE AND IT'S BEEN AMAZING TO 1755 01:03:58,280 --> 01:04:01,800 SEE AND LEARN MORE ABOUT EFFORTS 1756 01:04:01,800 --> 01:04:03,040 TO REDUCE INEQUITIES. 1757 01:04:03,040 --> 01:04:06,280 I'M GOING TO TALK IN THIS 1758 01:04:06,280 --> 01:04:08,440 SESSION ABOUT BACKGROUND AND 1759 01:04:08,440 --> 01:04:09,840 LITERATURE ON PATIENT INTEREST 1760 01:04:09,840 --> 01:04:12,080 AND ASSISTANCE AND WORK AT 1761 01:04:12,080 --> 01:04:12,920 SIREN, SOCIAL INTERVENTIONS 1762 01:04:12,920 --> 01:04:18,560 RESEARCH AND EVALUATION NETWORK, 1763 01:04:18,560 --> 01:04:20,240 ON THIS TOPIC. 1764 01:04:20,240 --> 01:04:20,640 NO DISCLOSURES. 1765 01:04:20,640 --> 01:04:26,000 I'D LIKE TO ACKNOWLEDGE THE 1766 01:04:26,000 --> 01:04:27,200 PRIMARY FUNDER, THE COMMONWEALTH 1767 01:04:27,200 --> 01:04:28,960 FUND, AND SIREN, SOME RESEARCH I 1768 01:04:28,960 --> 01:04:32,680 DID HAD BEEN DURING UCSF PRIMARY 1769 01:04:32,680 --> 01:04:33,440 CARE RESEARCH FELLOWSHIP. 1770 01:04:33,440 --> 01:04:35,200 SO WE'VE HEARD THERE'S BEEN 1771 01:04:35,200 --> 01:04:36,320 MOUNTING EVIDENCE OF THE IMPACT 1772 01:04:36,320 --> 01:04:38,480 OF SOCIAL RISK FACTORS TO HEALTH 1773 01:04:38,480 --> 01:04:39,240 AND EMERGENCY CARE. 1774 01:04:39,240 --> 01:04:43,160 THERE'S BEEN A POLICY PUSH TO 1775 01:04:43,160 --> 01:04:45,640 INTEGRATE SOCIAL RISK SCREENING, 1776 01:04:45,640 --> 01:04:48,360 THIS IS SOME ORGANIZATION THAT 1777 01:04:48,360 --> 01:04:52,800 HAVE SUPPORTED INTERNAL CARE 1778 01:04:52,800 --> 01:04:53,080 INTEGRATION. 1779 01:04:53,080 --> 01:04:55,160 IN THE 2019 NASEM REPORT 1780 01:04:55,160 --> 01:05:00,520 PROVIDED A FRAMEWORK TO 1781 01:05:00,520 --> 01:05:02,880 INTEGRATE SOCIAL AND MEDICAL 1782 01:05:02,880 --> 01:05:04,520 CARE, 5A FRAMEWORK, INCLUDING 1783 01:05:04,520 --> 01:05:09,640 AWARENESS OF THE SCREENING FOR 1784 01:05:09,640 --> 01:05:11,440 SOCIAL RISK, ACCOMMODATING IN 1785 01:05:11,440 --> 01:05:14,640 CARE WE DELIVER, ASSISTANCE, THE 1786 01:05:14,640 --> 01:05:16,200 PROVISION, AND COMMUNITY FOCUSED 1787 01:05:16,200 --> 01:05:19,080 STRATEGIES OF ADVOCACY AND 1788 01:05:19,080 --> 01:05:19,640 ALIGNMENT. 1789 01:05:19,640 --> 01:05:20,600 THE ENTHUSIASM FOR INTEGRATING 1790 01:05:20,600 --> 01:05:22,520 SOCIAL MEDICAL CARE IS BASED ON 1791 01:05:22,520 --> 01:05:27,920 THE GROWING EVIDENCE BASE 1792 01:05:27,920 --> 01:05:30,320 SUGGESTING AWARENESS AND EFFORTS 1793 01:05:30,320 --> 01:05:32,120 TO ADDRESS THEM CAN IMPROVE 1794 01:05:32,120 --> 01:05:34,000 HEALTH AND WELLNESS. 1795 01:05:34,000 --> 01:05:35,400 AND FROM THAT AWARENESS ONE OF 1796 01:05:35,400 --> 01:05:37,760 THE AVENUES FOR INTERVENTION IS 1797 01:05:37,760 --> 01:05:39,400 FOCUSED ON THE SYSTEM, THE 1798 01:05:39,400 --> 01:05:40,680 ACTUAL INTERVENTION TO ASSIST 1799 01:05:40,680 --> 01:05:42,720 WITH SOCIAL RISK FACTORS. 1800 01:05:42,720 --> 01:05:44,160 THERE'S GROWING EVIDENCE THAT 1801 01:05:44,160 --> 01:05:45,640 STRATEGIES TO ASSIST PATIENTS 1802 01:05:45,640 --> 01:05:47,440 WITH SOCIAL RISKS CAN IMPROVE 1803 01:05:47,440 --> 01:05:51,520 THEIR HEALTH AND WELLNESS AND 1804 01:05:51,520 --> 01:05:52,200 DECREASE UTILIZATION, BUT IMPACT 1805 01:05:52,200 --> 01:05:54,040 AS WE'VE BEEN HEARING AS WELL AS 1806 01:05:54,040 --> 01:05:55,440 BEST PRACTICESES FOR THEIR 1807 01:05:55,440 --> 01:05:58,360 IMPLEMENTATION ARE STILL 1808 01:05:58,360 --> 01:05:59,520 ACTIVELY BEING STUDIED. 1809 01:05:59,520 --> 01:06:00,560 WE KNOW SCREENING FOR SOCIAL 1810 01:06:00,560 --> 01:06:03,400 RISKS IS ONE STEP IN THE PROCESS 1811 01:06:03,400 --> 01:06:04,040 TOWARDS ASSISTING PATIENTS WITH 1812 01:06:04,040 --> 01:06:04,840 SOCIAL RISKS. 1813 01:06:04,840 --> 01:06:06,720 THERE HAVE BEEN DIFFERENT WAYS 1814 01:06:06,720 --> 01:06:07,960 RESEARCHERS DESCRIBED CASCADE OF 1815 01:06:07,960 --> 01:06:10,760 EVENTS THAT NEED TO OCCUR FROM 1816 01:06:10,760 --> 01:06:12,880 AWARENESS TO ACTUAL REDUCTION IN 1817 01:06:12,880 --> 01:06:14,720 RISK RESOLUTION, AS DR. WALLACE 1818 01:06:14,720 --> 01:06:16,440 MENTIONED REFERRED TO AS VOLTAGE 1819 01:06:16,440 --> 01:06:17,160 DROP. 1820 01:06:17,160 --> 01:06:18,120 THIS FIGURE IS MEANT TO 1821 01:06:18,120 --> 01:06:19,880 REPRESENT STEPS FROM A PATIENT 1822 01:06:19,880 --> 01:06:21,840 BEING IDENTIFIED AS HAVING A 1823 01:06:21,840 --> 01:06:22,840 SOCIAL RISK FACTOR TO WHETHER 1824 01:06:22,840 --> 01:06:28,040 THEY HAVE HAD THAT RISK RESOLVED 1825 01:06:28,040 --> 01:06:30,720 OR IMPROVED UPON BAILED ON THE 1826 01:06:30,720 --> 01:06:32,120 HIV CASCADE, NOT INTENDED TO 1827 01:06:32,120 --> 01:06:33,760 REPRESENT NUMBERS OR LEVELS 1828 01:06:33,760 --> 01:06:35,920 WITHIN EACH OF THESE BOXES. 1829 01:06:35,920 --> 01:06:37,640 IT SERVES AS VISUAL OF THE 1830 01:06:37,640 --> 01:06:38,840 MULTIPLE STEPS WHICH PATIENTS 1831 01:06:38,840 --> 01:06:42,000 MAY BE LOST TO FOLLOW-UP, MAYBE 1832 01:06:42,000 --> 01:06:43,640 DISINTERESTED IN ASSISTANCE, 1833 01:06:43,640 --> 01:06:45,880 UNABLE TO ACCESS SERVICES, NOT 1834 01:06:45,880 --> 01:06:48,520 ALL OF THESE STEPS MAY BE 1835 01:06:48,520 --> 01:06:49,280 REQUIRED OR REPRESENTED, 1836 01:06:49,280 --> 01:06:52,960 DEPENDING ON TYPE OF ASSISTANCE 1837 01:06:52,960 --> 01:06:58,840 BEING OFFERED OR ACCESSED AND 1838 01:06:58,840 --> 01:07:00,520 STEPS MAY OCCUR IN DIFFERENT 1839 01:07:00,520 --> 01:07:00,760 ORDERS. 1840 01:07:00,760 --> 01:07:04,480 I'M GOING TO FOCUS ON THIS RED 1841 01:07:04,480 --> 01:07:07,440 BOX THAT PATIENTS ACCEPTING AN 1842 01:07:07,440 --> 01:07:09,840 OFFER OF ASSISTANCE OR BEING 1843 01:07:09,840 --> 01:07:10,680 INTERESTED THROUGH THE HEALTH 1844 01:07:10,680 --> 01:07:11,800 CARE TEAM. 1845 01:07:11,800 --> 01:07:13,840 THERE'S BEEN INCREASE IN 1846 01:07:13,840 --> 01:07:15,920 RESEARCH REPORTING ON PATIENTS 1847 01:07:15,920 --> 01:07:16,560 SOCIAL RISK SCREENING, COMMON 1848 01:07:16,560 --> 01:07:20,040 FIND BE HAS BEEN AS DR. WALLACE 1849 01:07:20,040 --> 01:07:22,480 NOTED LOWER THAN ANTICIPATED 1850 01:07:22,480 --> 01:07:23,400 PATIENT INTEREST IN THE 1851 01:07:23,400 --> 01:07:25,200 ASSISTANCE WITH SOCIAL RISK 1852 01:07:25,200 --> 01:07:25,720 FACTORS. 1853 01:07:25,720 --> 01:07:29,160 THIS RANGE IN INTEREST IN 1854 01:07:29,160 --> 01:07:30,480 ASSISTANCE IN THOSE WHO SCREEN 1855 01:07:30,480 --> 01:07:33,080 POSITIVE AS LOW AS 0% TO 100% 1856 01:07:33,080 --> 01:07:34,760 DEPENDING ON THE CONTEXT AND 1857 01:07:34,760 --> 01:07:35,200 RISK FACTOR. 1858 01:07:35,200 --> 01:07:36,600 SO A BIG CHALLENGE FOR THIS WORK 1859 01:07:36,600 --> 01:07:38,840 IS WE'RE NOT ALL REPORTING THE 1860 01:07:38,840 --> 01:07:41,200 SAME DENOMINATORS AND THE LEVEL 1861 01:07:41,200 --> 01:07:42,840 OF INFORMATION TO COMPARE ACROSS 1862 01:07:42,840 --> 01:07:44,400 THE STUDIES. 1863 01:07:44,400 --> 01:07:45,120 AND STUDIES AREN'T ALL MEASURING 1864 01:07:45,120 --> 01:07:49,240 THE SAME THING. 1865 01:07:49,240 --> 01:07:52,680 IT'S HARD TO EXTRAPOLATE. 1866 01:07:52,680 --> 01:07:55,080 SOME MIGHT REPORT ON WHETHER 1867 01:07:55,080 --> 01:07:57,280 PATIENTS REQUEST OR WHETHER THEY 1868 01:07:57,280 --> 01:07:58,280 ACCEPT AFTER ASSISTANCE IS 1869 01:07:58,280 --> 01:07:58,520 OFFERED. 1870 01:07:58,520 --> 01:08:00,280 AND ONCE A PATIENT KNOWS MORE 1871 01:08:00,280 --> 01:08:01,680 ABOUT THE RESOURCE BEING OFFERED 1872 01:08:01,680 --> 01:08:03,440 THEY MAY BE MORE OR LEST APT TO 1873 01:08:03,440 --> 01:08:06,960 BE INTERESTED BASED ON PRIOR 1874 01:08:06,960 --> 01:08:07,640 EXPERIENCES AND COMPETING 1875 01:08:07,640 --> 01:08:09,560 DEMANDS AND INTERESTS, WHICH IS 1876 01:08:09,560 --> 01:08:11,200 ALSO INFLUENCED BY WHETHER 1877 01:08:11,200 --> 01:08:11,840 ASSISTANCE BEING OFFERED IS 1878 01:08:11,840 --> 01:08:14,800 INFORMATIONAL SUCH AS HAND 1879 01:08:14,800 --> 01:08:17,040 THROUGHOUT OR LIST OF RESOURCES 1880 01:08:17,040 --> 01:08:19,840 VERSUS ACTIVE NAVIGATION SUPPORT 1881 01:08:19,840 --> 01:08:23,240 OR RESOURCES OFFERED BY THE 1882 01:08:23,240 --> 01:08:25,160 HEALTH SYSTEM. 1883 01:08:25,160 --> 01:08:26,760 OF 22 ARTICLES WE'VE REVIEWED, 1884 01:08:26,760 --> 01:08:29,720 MORE IN A SCOPING REVIEW, THE 1885 01:08:29,720 --> 01:08:32,160 BULK DO COME FROM PRIMARY CARE, 1886 01:08:32,160 --> 01:08:35,080 ALSO EMERGENCY DEPARTMENTS. 1887 01:08:35,080 --> 01:08:37,160 16 STUDIES REPORTED WHETHER 1888 01:08:37,160 --> 01:08:39,360 PATIENTS ACCEPTED AN OFFER, 1889 01:08:39,360 --> 01:08:41,240 EIGHT WENT TO DISCUSS WHETHER OR 1890 01:08:41,240 --> 01:08:43,160 NOT THE PATIENTS CONTACTED OR 1891 01:08:43,160 --> 01:08:45,200 CONNECTED, WHETHER A PATIENT 1892 01:08:45,200 --> 01:08:46,680 ENROLLED, ONLY ONE WHETHER 1893 01:08:46,680 --> 01:08:48,280 PATIENT SOCIAL NEEDS IMPROVED 1894 01:08:48,280 --> 01:08:51,040 THROUGH THE PROCESS. 1895 01:08:51,040 --> 01:08:52,040 AND THERE'S ALSO CONSIDERABLE 1896 01:08:52,040 --> 01:08:54,760 VARIATION IN WHO IS OFFERED 1897 01:08:54,760 --> 01:08:55,680 ASSISTANCE, WHETHER ALL-COMERS 1898 01:08:55,680 --> 01:08:58,600 VERSUS ONLY THOSE WHO SCREEN 1899 01:08:58,600 --> 01:08:59,960 POSITIVE FOR SOCIAL RISK FACTOR, 1900 01:08:59,960 --> 01:09:02,640 ONLY THOSE OR ANYONE WHO DID THE 1901 01:09:02,640 --> 01:09:06,040 SCREENING TOOL, COMPLETED THE 1902 01:09:06,040 --> 01:09:06,440 SCREENING TOOL. 1903 01:09:06,440 --> 01:09:11,640 SO IT'S OVERLAPPING AREA THAT'S 1904 01:09:11,640 --> 01:09:12,520 PRESENTED CONFUSION FOR 1905 01:09:12,520 --> 01:09:13,080 RESEARCHES, RAISING CONCERN 1906 01:09:13,080 --> 01:09:14,720 WHETHER THERE'S POTENTIAL TO 1907 01:09:14,720 --> 01:09:16,720 WORSEN DISPARITIES IF THERE'S 1908 01:09:16,720 --> 01:09:18,360 SPECIFIC PATIENT CHARACTERISTICS 1909 01:09:18,360 --> 01:09:20,320 DRIVING INTEREST IN ASSISTANCE 1910 01:09:20,320 --> 01:09:26,720 AND ACCEPTANCE OF THE 1911 01:09:26,720 --> 01:09:30,360 ASSISTANCE. 1912 01:09:30,360 --> 01:09:32,120 SHIFTINGGEARS, YOU MAY BE AWARE 1913 01:09:32,120 --> 01:09:36,840 IN 2017 THE CENTER FOR MEDICARE 1914 01:09:36,840 --> 01:09:38,760 MEDICAID PUBLISHED A SCREENING 1915 01:09:38,760 --> 01:09:39,320 TOOL. 1916 01:09:39,320 --> 01:09:42,400 THE PROGRAM REQUIRES SCREENING 1917 01:09:42,400 --> 01:09:45,440 FOR FIVE SOCIOECONOMIC DOMAINS, 1918 01:09:45,440 --> 01:09:48,080 HOUSING, STABILITY AND QUALITY, 1919 01:09:48,080 --> 01:09:48,560 TRANSPORTATION ACCESS, 1920 01:09:48,560 --> 01:09:51,680 UTILITIES, FOOD SECURITY, AND 1921 01:09:51,680 --> 01:09:52,280 PERSONAL SAFETY. 1922 01:09:52,280 --> 01:09:54,720 SO PART OF A LARGE STUDY FOCUSED 1923 01:09:54,720 --> 01:09:55,960 ON PATIENT ACCEPTABILITY OF 1924 01:09:55,960 --> 01:09:57,040 SCREENING WE ALSO ASK PATIENTS 1925 01:09:57,040 --> 01:09:58,520 IF THEY WOULD BE INTERESTED IN 1926 01:09:58,520 --> 01:10:00,960 ASSISTANCE WITH ANY OF THE FIVE 1927 01:10:00,960 --> 01:10:02,440 SOCIAL RISK DOMAINS REGARDLESS 1928 01:10:02,440 --> 01:10:05,120 OF SCREENING RESULTS. 1929 01:10:05,120 --> 01:10:06,160 RESPONSE OPTIONS INCLUDED 1930 01:10:06,160 --> 01:10:08,880 ASSISTANCE WITH HOUSING, FOOD 1931 01:10:08,880 --> 01:10:10,240 ACCESS, MEDICAL OR NON-MEDICAL 1932 01:10:10,240 --> 01:10:11,520 TRANSPORTATION, ELECTRIC GAS OIL 1933 01:10:11,520 --> 01:10:12,520 OR WATER UTILITY SERVICES OR 1934 01:10:12,520 --> 01:10:14,720 SAFETY OR VIOLENCE IN THE 1935 01:10:14,720 --> 01:10:16,720 HOUSEHOLD OR NONE OF THESE. 1936 01:10:16,720 --> 01:10:20,720 AS A SECONDARY ANALYSIS, AS 1937 01:10:20,720 --> 01:10:22,760 RELATED TO RESPONSE TO SOCIAL 1938 01:10:22,760 --> 01:10:23,840 RISK SCREENING TOOL. 1939 01:10:23,840 --> 01:10:25,480 THE GOAL TO UNDERSTAND THE 1940 01:10:25,480 --> 01:10:26,680 CONTRIBUTORS TO INTEREST IN 1941 01:10:26,680 --> 01:10:33,680 ASSIST ASSISTANCE IN 1942 01:10:33,680 --> 01:10:34,000 CAREGIVERS. 1943 01:10:34,000 --> 01:10:36,520 DATA FROM 11 CLINICAL SITES, 1944 01:10:36,520 --> 01:10:38,080 INCLUDING FOUR FAMILY MEDICINE, 1945 01:10:38,080 --> 01:10:39,360 THREE INTERNAL MEDICINE, TWO 1946 01:10:39,360 --> 01:10:42,000 GENERAL EMERGENCY DEPARTMENTS, 1947 01:10:42,000 --> 01:10:44,960 TWO PEDIATRIC FOCUSED EMERGENCY 1948 01:10:44,960 --> 01:10:45,240 DEPARTMENTS. 1949 01:10:45,240 --> 01:10:46,720 BLUE ARE CMMI HEALTH COMMUNITY 1950 01:10:46,720 --> 01:10:48,720 SITES, STARS INDICATE OUR SITES, 1951 01:10:48,720 --> 01:10:50,760 NONE WERE TAKING PART BY DESIGN 1952 01:10:50,760 --> 01:10:54,400 IN THE ACTUAL DEMONSTRATION 1953 01:10:54,400 --> 01:10:54,840 PROJECT. 1954 01:10:54,840 --> 01:10:59,720 EACH RECRUITED 100 ENGLISH OR 1955 01:10:59,720 --> 01:11:06,480 SPANISH SPEAKING PATIENTS OR 1956 01:11:06,480 --> 01:11:07,120 CAREGIVERS. 1957 01:11:07,120 --> 01:11:09,760 WE HYPOTHESIZE INTEREST WOULD 1958 01:11:09,760 --> 01:11:11,600 VARY BASED ON SEVERAL PATIENT 1959 01:11:11,600 --> 01:11:12,640 CHARACTERISTICS INCLUDING BURDEN 1960 01:11:12,640 --> 01:11:14,560 OF SOCIAL RISKS, PRIOR EXPOSURE 1961 01:11:14,560 --> 01:11:17,360 TO SOCIAL RISK SCREENING, TRUST 1962 01:11:17,360 --> 01:11:19,120 IN CLINICIAN, BEING SURVEYED IN 1963 01:11:19,120 --> 01:11:21,160 A SAFETY NET SETTING, EXPERIENCE 1964 01:11:21,160 --> 01:11:23,040 OF DISCRIMINATION WITHIN A 1965 01:11:23,040 --> 01:11:26,720 HEALTH CARE SETTING. 1966 01:11:26,720 --> 01:11:28,960 THIS TABLE OUTLINES PARTICIPANT 1967 01:11:28,960 --> 01:11:30,240 DEMOGRAPHICS, PREDOMINANTLY 1968 01:11:30,240 --> 01:11:34,680 FEMALE AND ADULT PATIENT 1969 01:11:34,680 --> 01:11:35,240 RESPONDENTS. 1970 01:11:35,240 --> 01:11:37,080 PRIMARILY ENGLISH SPEAKERS. 1971 01:11:37,080 --> 01:11:39,760 AND THIS IS THE RESPONSE TO THE 1972 01:11:39,760 --> 01:11:43,760 SOCIAL RISK SCREENING QUESTIONS. 1973 01:11:43,760 --> 01:11:47,240 WE HAD ABOUT 5 2% SCREENING 1974 01:11:47,240 --> 01:11:54,720 POSITIVE FOR HOUSING, 40% FOOD 1975 01:11:54,720 --> 01:11:56,240 INSECURITY, 20% TRANSPORTATION, 1976 01:11:56,240 --> 01:11:57,400 13% UTILITIES, 2% PERSONAL 1977 01:11:57,400 --> 01:11:57,680 SAFETY. 1978 01:11:57,680 --> 01:11:59,040 AND BOTTOM NUMBER OF SOCIAL 1979 01:11:59,040 --> 01:12:00,880 RISKS, 35% WITH NO IDENTIFIED 1980 01:12:00,880 --> 01:12:05,880 RISK VERSE U.S. 17% HAVING THREE 1981 01:12:05,880 --> 01:12:06,120 OR MORE. 1982 01:12:06,120 --> 01:12:07,840 THIS GRAPH SHOWS RATES OF 1983 01:12:07,840 --> 01:12:09,840 INTEREST IN ANY ASSISTANCE WITH 1984 01:12:09,840 --> 01:12:11,840 ONE OR MORE SOCIAL RISK DOMAINS 1985 01:12:11,840 --> 01:12:14,280 BASED ON NUMBER OF DOMAINS 1986 01:12:14,280 --> 01:12:15,240 SCREENING POSITIVE FOR. 1987 01:12:15,240 --> 01:12:16,440 I WANT TO HIGHLIGHT TWO 1988 01:12:16,440 --> 01:12:17,080 FINDINGS. 1989 01:12:17,080 --> 01:12:19,120 ONE, WE DO SEE INCREASE IN 1990 01:12:19,120 --> 01:12:21,560 INTEREST IN ASSISTANCE AS NUMBER 1991 01:12:21,560 --> 01:12:24,240 OF POSITIVE RISK DOMAINS 1992 01:12:24,240 --> 01:12:24,600 INCREASES. 1993 01:12:24,600 --> 01:12:25,560 AMONG THOSE WHO SCREENED 1994 01:12:25,560 --> 01:12:26,560 NEGATIVE FOR ALL FIVE INTEREST 1995 01:12:26,560 --> 01:12:30,360 WAS LOW BUT THERE WAS STILL 1996 01:12:30,360 --> 01:12:32,240 ALMOST 10% REPORTING INTEREST IN 1997 01:12:32,240 --> 01:12:32,960 THE ASSISTANCE. 1998 01:12:32,960 --> 01:12:34,120 OVERALL THOSE SCREENING POSITIVE 1999 01:12:34,120 --> 01:12:37,080 FOR ONE OR MORE RISK FACTORS, 2000 01:12:37,080 --> 01:12:38,640 53% INTERESTED IN THE 2001 01:12:38,640 --> 01:12:41,280 ASSISTANCE, ONE OR MORE OF 2002 01:12:41,280 --> 01:12:42,800 SOCIAL RISK DOMAINS. 2003 01:12:42,800 --> 01:12:45,560 THIS NEXT GRAPH SHOWS DOMAIN 2004 01:12:45,560 --> 01:12:48,280 SPECIFIC INTEREST IN ASSISTANCE, 2005 01:12:48,280 --> 01:12:49,400 STRATIFIED BY WHETHER THEY 2006 01:12:49,400 --> 01:12:51,320 SCREENED POSITIVE OR NEGATIVE 2007 01:12:51,320 --> 01:12:53,640 WITH BLUE BEING PERCENTAGES WHO 2008 01:12:53,640 --> 01:12:54,480 REPORTED INTEREST FROM HEALTH 2009 01:12:54,480 --> 01:12:56,920 CARE TEAM AND SCREENED POSITIVE 2010 01:12:56,920 --> 01:12:59,320 IN THOSE DOMAINS AND GREEN IS 2011 01:12:59,320 --> 01:13:00,960 INTEREST AND ASSISTANCE AMONG 2012 01:13:00,960 --> 01:13:03,520 THOSE WHO SCREENED NEGATIVE IN 2013 01:13:03,520 --> 01:13:04,040 THOSE DOMAINS. 2014 01:13:04,040 --> 01:13:05,040 DRAWING YOUR ATTENTION TO WHO 2015 01:13:05,040 --> 01:13:07,800 FINDINGS ON THIS GRAPH. 2016 01:13:07,800 --> 01:13:09,640 FIRST ON INDIVIDUAL DOMAIN, 2017 01:13:09,640 --> 01:13:12,280 CONSISTENCY AMONG HOUSING, FOOD, 2018 01:13:12,280 --> 01:13:12,880 UTILITIES AND TRANSPORTATION, 2019 01:13:12,880 --> 01:13:15,960 WITH 35 TO 40% OF PARTICIPANTS 2020 01:13:15,960 --> 01:13:16,840 INTERESTED IN DOMAIN-SPECIFIC 2021 01:13:16,840 --> 01:13:17,760 ASSISTANCE IF THEY SCREENED 2022 01:13:17,760 --> 01:13:19,400 POSITIVE IN THAT DOMAIN BUT 2023 01:13:19,400 --> 01:13:21,240 PERSONAL SAFETY STANDS OUT WITH 2024 01:13:21,240 --> 01:13:28,040 MUCH LOWER INTEREST IN 2025 01:13:28,040 --> 01:13:28,960 ASSISTANCE, AND THERE'S STILL A 2026 01:13:28,960 --> 01:13:33,880 PERCENTAGE OF PEOPLE WHO WANTED 2027 01:13:33,880 --> 01:13:34,640 ASSISTANCE. 2028 01:13:34,640 --> 01:13:36,200 FINALLY WE EXPLORED WHAT FACTORS 2029 01:13:36,200 --> 01:13:38,040 WERE ASSOCIATED WITH INTEREST IN 2030 01:13:38,040 --> 01:13:40,120 THE ASSISTANCE, RESULTS FROM 2031 01:13:40,120 --> 01:13:41,320 MULTI-VARIABLE MODEL SHOWING 2032 01:13:41,320 --> 01:13:43,560 ADJUSTED ODDS RATIOS. 2033 01:13:43,560 --> 01:13:46,440 THE STARS IN BOLDING INDICATE 2034 01:13:46,440 --> 01:13:47,160 STATISTICALLY SIGNIFICANT 2035 01:13:47,160 --> 01:13:47,400 RESULT. 2036 01:13:47,400 --> 01:13:49,920 ON THE LEFT IS THE RESULT OF THE 2037 01:13:49,920 --> 01:13:52,240 MODEL FOR THOSE WHO DID REPORT 2038 01:13:52,240 --> 01:13:54,440 OR SCREEN POSITIVE FOR ONE OR 2039 01:13:54,440 --> 01:13:55,600 MORE SOCIAL RISK FACTORS, ON THE 2040 01:13:55,600 --> 01:13:57,680 RIGHT ARE RESULTS OF THE MODEL 2041 01:13:57,680 --> 01:14:01,200 FOR THOSE WITH NO SOCIAL RISK 2042 01:14:01,200 --> 01:14:01,760 FACTORS REPORTED. 2043 01:14:01,760 --> 01:14:05,360 AND SO AMONG THOSE WHO SCREENED 2044 01:14:05,360 --> 01:14:06,760 POSITIVE, CENTER COLUMN, THE 2045 01:14:06,760 --> 01:14:08,680 NUMBER OF SOCIAL RISKS 2046 01:14:08,680 --> 01:14:14,240 INCREASED, AND PARTICIPANTS WHO 2047 01:14:14,240 --> 01:14:15,840 SELF-IDENTIFIED AS NON-HISPANIC 2048 01:14:15,840 --> 01:14:20,120 OR LOW VERSUS HIGH, INCREASED 2049 01:14:20,120 --> 01:14:21,240 ODDS OF INTEREST, PARTICIPANTS 2050 01:14:21,240 --> 01:14:23,640 WITH LOWER ODDS OF INTEREST IF 2051 01:14:23,640 --> 01:14:24,240 THEY REPORTED EXPERIENCING 2052 01:14:24,240 --> 01:14:25,320 DISCRIMINATION WITHIN HEALTH 2053 01:14:25,320 --> 01:14:27,440 CARE IN THE PAST, THOUGH THIS 2054 01:14:27,440 --> 01:14:28,840 WAS NOT STATISTICALLY 2055 01:14:28,840 --> 01:14:29,400 SIGNIFICANT. 2056 01:14:29,400 --> 01:14:31,840 AND AMONG THOSE WHO SCREENED 2057 01:14:31,840 --> 01:14:33,640 NEGATIVE FOR ALL RISKS, INTEREST 2058 01:14:33,640 --> 01:14:36,320 IN ASSISTANCE FOR 9% OF THIS 2059 01:14:36,320 --> 01:14:40,560 POPULATION, LOWER INCOME BUT 2060 01:14:40,560 --> 01:14:52,240 ALSO SELF-REPORTED WERE 2061 01:14:52,240 --> 01:14:53,360 ASSOCIATE FAIR/POOR HEALTH. 2062 01:14:53,360 --> 01:14:57,200 I THINK I MENTIONED THIS BUT WE 2063 01:14:57,200 --> 01:14:58,720 FLIPPED THE ORDER OF THE 2064 01:14:58,720 --> 01:15:00,040 QUESTIONS FOR ASSISTANCE, IF 2065 01:15:00,040 --> 01:15:01,880 PATIENTS ANSWERED IF THEY WERE 2066 01:15:01,880 --> 01:15:02,640 INTERESTED IN ASSISTANCE BEFORE 2067 01:15:02,640 --> 01:15:04,240 ACTUALLY BEING SCREENED FOR 2068 01:15:04,240 --> 01:15:05,840 SOCIAL RISKS, THEY HAD HIGHER 2069 01:15:05,840 --> 01:15:09,920 ODDS OF BEING INTERESTED IN THE 2070 01:15:09,920 --> 01:15:10,440 ASSISTANCE. 2071 01:15:10,440 --> 01:15:12,360 AND SO THERE ARE SOME 2072 01:15:12,360 --> 01:15:12,640 LIMITATIONS. 2073 01:15:12,640 --> 01:15:14,360 I LIKE TO IDENTIFY, IT WAS 2074 01:15:14,360 --> 01:15:16,040 CROSS-SECTIONAL SURVEY, HE WE 2075 01:15:16,040 --> 01:15:17,440 EXCLUDED PATIENTS WHO DID NOT 2076 01:15:17,440 --> 01:15:22,160 SPEAK OR READ ENGLISH OR 2077 01:15:22,160 --> 01:15:23,720 SPANISH, NOT REPRESENTATIVE OF 2078 01:15:23,720 --> 01:15:26,040 ALL HEALTH CARE SETTINGS, AND 2079 01:15:26,040 --> 01:15:28,440 INTEREST IN ASSISTANCE WAS ASKED 2080 01:15:28,440 --> 01:15:29,160 THEORETICALLY AS PART OF 2081 01:15:29,160 --> 01:15:30,440 RESEARCH SURVEY, THERE MAY BE 2082 01:15:30,440 --> 01:15:32,680 OTHER FACTORS THAT INFLUENCE 2083 01:15:32,680 --> 01:15:34,120 INTEREST BUT OUR STUDY WASN'T 2084 01:15:34,120 --> 01:15:36,080 DESIGNED TO TEST FOR DIFFERENT 2085 01:15:36,080 --> 01:15:38,840 WAYS INTEREST IN ASSISTANCE IS 2086 01:15:38,840 --> 01:15:39,320 ASKED. 2087 01:15:39,320 --> 01:15:40,640 IN CONCLUSION THERE HAVE BEEN 2088 01:15:40,640 --> 01:15:42,720 CONCERNS RAISED ABOUT HOW 2089 01:15:42,720 --> 01:15:43,680 PATIENTS WILL REACT TO SCREENING 2090 01:15:43,680 --> 01:15:46,800 AND WHETHER THEY COULD WORSEN 2091 01:15:46,800 --> 01:15:47,240 INEQUITIES. 2092 01:15:47,240 --> 01:15:49,240 FROM THIS WE SEE PEOPLE WHO MAY 2093 01:15:49,240 --> 01:15:52,600 BE THE MOST AT RISK OR MOST 2094 01:15:52,600 --> 01:15:53,800 MARGINALIZED ARE MOST INTERESTED 2095 01:15:53,800 --> 01:15:55,520 IN ASSISTANCE, AND WHETHER WE 2096 01:15:55,520 --> 01:15:56,400 ASK ABOUT INTEREST AND 2097 01:15:56,400 --> 01:15:58,160 ASSISTANCE FIRST OR SCREEN FOR 2098 01:15:58,160 --> 01:16:00,000 SOCIAL RISK FACTORS FIRST SEEMS 2099 01:16:00,000 --> 01:16:01,640 TO INFLUENCE WHETHER OR NOT 2100 01:16:01,640 --> 01:16:02,400 PEOPLE MIGHT WANT ASSISTANCE SO 2101 01:16:02,400 --> 01:16:04,480 WE NEED TO THINK ABOUT HOW 2102 01:16:04,480 --> 01:16:05,680 ASSISTANCE IS OFFERED AND BETTER 2103 01:16:05,680 --> 01:16:10,760 UNDERSTAND PATIENT PER 2104 01:16:10,760 --> 01:16:12,880 PERSPECTIVES TO ENSURE 2105 01:16:12,880 --> 01:16:13,400 SUCCESSFUL IMPLEMENTATION. 2106 01:16:13,400 --> 01:16:17,920 THERE'S THE POSITION -- 2107 01:16:17,920 --> 01:16:19,240 POSSIBILITY WE SHOULD OFFER ALL, 2108 01:16:19,240 --> 01:16:20,520 UNCLEAR IF THAT MAKES 2109 01:16:20,520 --> 01:16:22,080 INTERVENTION MORE OR LESS 2110 01:16:22,080 --> 01:16:22,880 FEASIBLE FOR HEALTH CARE 2111 01:16:22,880 --> 01:16:23,360 SETTINGS. 2112 01:16:23,360 --> 01:16:25,200 PUTTING THESE RESULTS INTO THE 2113 01:16:25,200 --> 01:16:25,840 CONTEXT OF OTHER LITERATURE, 2114 01:16:25,840 --> 01:16:29,120 OVERALL THERE'S A NEED TO BETTER 2115 01:16:29,120 --> 01:16:32,080 URNS PSYCHOMETRIC PROPERTIES OF 2116 01:16:32,080 --> 01:16:33,040 SCREENING TOOLS ESPECIALLY IF 2117 01:16:33,040 --> 01:16:33,880 ASSISTANCE IS TIED. 2118 01:16:33,880 --> 01:16:35,600 WE NEED TO KNOW WHAT TOOLS ARE 2119 01:16:35,600 --> 01:16:37,160 MEASURING, HOW TO INTERPRET 2120 01:16:37,160 --> 01:16:39,040 RESULTS, AND ARE THERE 2121 01:16:39,040 --> 01:16:41,200 LINGUISTICALLY AND CULTURALLY 2122 01:16:41,200 --> 01:16:42,600 ACCEPTABLE TO PATIENTS WHO HAVE 2123 01:16:42,600 --> 01:16:44,640 BEEN FACED CURRENT AND PRIOR 2124 01:16:44,640 --> 01:16:45,760 RACISM AND DISCRIMINATION WITHIN 2125 01:16:45,760 --> 01:16:46,760 AND OUTSIDE THE HEALTH CARE 2126 01:16:46,760 --> 01:16:47,160 SYSTEM. 2127 01:16:47,160 --> 01:16:50,160 WE ALSO NEED TO BETTER 2128 01:16:50,160 --> 01:16:50,760 UNDERSTAND PATIENT PREFERENCE 2129 01:16:50,760 --> 01:16:51,560 AND PRIORITIES AROUND THE WAY 2130 01:16:51,560 --> 01:16:53,080 THEY WANT THE HEALTH CARE TEAM 2131 01:16:53,080 --> 01:16:54,760 TO INTEGRATE SOCIAL CARE INTO 2132 01:16:54,760 --> 01:16:57,280 THE HEALTH CARE SYSTEM AND EARLY 2133 01:16:57,280 --> 01:16:58,560 IMPLEMENTATION EFFORTS SUGGEST 2134 01:16:58,560 --> 01:17:00,680 THERE ARE BENEFITS TO ALIGNING 2135 01:17:00,680 --> 01:17:02,880 EFFORTS ACROSS HEALTH CARE 2136 01:17:02,880 --> 01:17:05,040 SETTINGS, E.D.s AND PRIMARY 2137 01:17:05,040 --> 01:17:06,840 HEALTH BUT COMMUNITY 2138 01:17:06,840 --> 01:17:09,120 ORGANIZATIONS AND HEALTH CARE AS 2139 01:17:09,120 --> 01:17:10,760 DUPLICATION CAN BE RESOURCE 2140 01:17:10,760 --> 01:17:14,240 INTENSIVE AND CONTRIBUTE TO 2141 01:17:14,240 --> 01:17:15,200 PATIENT SURVEY FATIGUE AND 2142 01:17:15,200 --> 01:17:17,080 DISINTEREST IF THEY ARE GETTING 2143 01:17:17,080 --> 01:17:18,320 REPEAT OFFERS OF SAME 2144 01:17:18,320 --> 01:17:18,760 ASSISTANCE. 2145 01:17:18,760 --> 01:17:19,680 FINALLY PERHAPS MOST IMPORTANTLY 2146 01:17:19,680 --> 01:17:22,640 WE NEED TO MAKE SURE THAT WE'RE 2147 01:17:22,640 --> 01:17:23,160 EVALUATING SOCIAL CARE 2148 01:17:23,160 --> 01:17:24,080 INTERVENTION WAS EQUITY LENS. 2149 01:17:24,080 --> 01:17:25,920 WE NEED TO BE STUDYING WHO IS 2150 01:17:25,920 --> 01:17:27,640 GETTING OR NOT GETTING SCREENED, 2151 01:17:27,640 --> 01:17:30,080 WHO IS GETTING OFFERED OR NOT 2152 01:17:30,080 --> 01:17:31,400 OFFERED ASSISTANCE, WHO IS 2153 01:17:31,400 --> 01:17:33,880 ACCEPTING OR NOT ACCEPTING AND 2154 01:17:33,880 --> 01:17:34,040 WHY. 2155 01:17:34,040 --> 01:17:36,040 THESE ALL HAVE IMPLICATIONS FOR 2156 01:17:36,040 --> 01:17:37,640 WHO WILL AND WON'T BENEFIT FROM 2157 01:17:37,640 --> 01:17:38,800 INTEGRATION EFFORTS. 2158 01:17:38,800 --> 01:17:41,760 IF ONE GOAL IS TO REDUCE 2159 01:17:41,760 --> 01:17:44,040 INEQUITIES, WE NEED TO MINDFULLY 2160 01:17:44,040 --> 01:17:46,000 MONITOR HOW WE'RE IMPACTING 2161 01:17:46,000 --> 01:17:48,600 EQUITY ALONG THE WAY. 2162 01:17:48,600 --> 01:17:49,800 UNDERSTANDING EFFORTS AND 2163 01:17:49,800 --> 01:17:51,640 FACTORS CONTRIBUTING TO INTEREST 2164 01:17:51,640 --> 01:17:53,240 IN ASSISTANCE WILL INFORM 2165 01:17:53,240 --> 01:17:54,040 INTERVENTION SUCCESS AND 2166 01:17:54,040 --> 01:17:56,040 EQUITABLE IMPLEMENTATION. 2167 01:17:56,040 --> 01:17:57,960 I WANT TO HIGHLY, STAY TUNED. 2168 01:17:57,960 --> 01:17:59,680 SIREN FUNDED A NUMBER OF STUDIES 2169 01:17:59,680 --> 01:18:01,640 TO BETTER UNDERSTAND WHAT TYPES 2170 01:18:01,640 --> 01:18:02,400 OF INTERVENTIONS WILL MAKE 2171 01:18:02,400 --> 01:18:05,920 PEOPLE MORE OR LESS LIKELY TO 2172 01:18:05,920 --> 01:18:06,320 ACCEPT ASSISTANCE. 2173 01:18:06,320 --> 01:18:08,840 AND IN OCTOBER 2022 THERE WILL 2174 01:18:08,840 --> 01:18:11,080 BE A SPECIAL ISSUE REPORTING ON 2175 01:18:11,080 --> 01:18:13,840 THESE RESULTS, IN ADDITION THE 2176 01:18:13,840 --> 01:18:16,480 EVALUATION FOR THE CMMI, HEALTH 2177 01:18:16,480 --> 01:18:18,640 COMMUNITIES MODEL, WILL 2178 01:18:18,640 --> 01:18:20,400 HOPEFULLY ADD TO KNOWLEDGE BASE 2179 01:18:20,400 --> 01:18:21,240 OF NAVIGATION SUPPORT AND 2180 01:18:21,240 --> 01:18:23,240 DEMONSTRATION PROJECT COMING TO 2181 01:18:23,240 --> 01:18:24,280 A CLOSE AT MAYBE SITES. 2182 01:18:24,280 --> 01:18:28,040 MUCH OF THE WORK WAS AT 2183 01:18:28,040 --> 01:18:28,680 EMERGENCY DEPARTMENTS. 2184 01:18:28,680 --> 01:18:30,640 AND I WANT TO CLOSE BY THANKING 2185 01:18:30,640 --> 01:18:32,640 THE RESEARCH TEAM FOR THE STUDY, 2186 01:18:32,640 --> 01:18:35,760 AS WELL AS RESEARCH SITES AND 2187 01:18:35,760 --> 01:18:37,960 PATIENTS WHO PARTICIPATED AND 2188 01:18:37,960 --> 01:18:39,320 HAPPY TO ANSWER QUESTIONS DURING 2189 01:18:39,320 --> 01:18:40,720 THE PANEL OR AT ANOTHER TIME AS 2190 01:18:40,720 --> 01:18:40,960 WELL. 2191 01:18:40,960 --> 01:18:46,280 THANK YOU SO MUCH FOR HAVING ME. 2192 01:18:46,280 --> 01:18:48,360 >> THANK YOU, DR. DE MARCHIS. 2193 01:18:48,360 --> 01:18:50,840 WE'RE READY FOR YOU, DR. 2194 01:18:50,840 --> 01:18:54,760 POLLACK. 2195 01:18:54,760 --> 01:18:58,160 2196 01:18:58,160 --> 01:19:03,160 >> ARE YOU ABLE TO SEE THE 2197 01:19:03,160 --> 01:19:04,240 SLIDES? 2198 01:19:04,240 --> 01:19:05,480 >> YES. 2199 01:19:05,480 --> 01:19:05,800 >> GREAT. 2200 01:19:05,800 --> 01:19:06,000 OKAY. 2201 01:19:06,000 --> 01:19:07,120 I WANT TO THANK YOU FOR THE 2202 01:19:07,120 --> 01:19:09,240 CHANCE TO TALK ABOUT THE 2203 01:19:09,240 --> 01:19:10,800 CONNECTION BETWEEN SOCIAL 2204 01:19:10,800 --> 01:19:14,040 FACTORS AND HEALTH. 2205 01:19:14,040 --> 01:19:15,440 IMPORTANTLY I APPRECIATE NINR'S 2206 01:19:15,440 --> 01:19:17,880 LEADERSHIP IN RAISING AWARENESS 2207 01:19:17,880 --> 01:19:18,560 ABOUT UPSTREAM DETERMINANTS OF 2208 01:19:18,560 --> 01:19:20,600 HEALTH WITHIN NIH AND BEYOND, 2209 01:19:20,600 --> 01:19:21,960 ALSO THANK THE EMERGENCY NURSES 2210 01:19:21,960 --> 01:19:24,680 ASSOCIATION FOR THEIR 2211 01:19:24,680 --> 01:19:28,040 PARTNERSHIP AND MAKING TODAY 2212 01:19:28,040 --> 01:19:28,320 POSSIBLE. 2213 01:19:28,320 --> 01:19:28,760 WITH MANY WONDERFUL 2214 01:19:28,760 --> 01:19:29,480 PRESENTATIONS, TALKING ABOUT 2215 01:19:29,480 --> 01:19:30,640 SCREENING AND CONNECTING PEOPLE 2216 01:19:30,640 --> 01:19:31,720 TO SOCIAL NEEDS, HERE I WANT TO 2217 01:19:31,720 --> 01:19:34,080 TAKE A STEP BACK. 2218 01:19:34,080 --> 01:19:37,560 I'LL DESCRIBE THE PROBLEM OF 2219 01:19:37,560 --> 01:19:39,680 UNAFFORDABLE HOUSING BEFORE 2220 01:19:39,680 --> 01:19:41,520 TURNING TO TWO SECTIONS. 2221 01:19:41,520 --> 01:19:43,360 FIRST WILL BE ABOUT WHAT WE CAN 2222 01:19:43,360 --> 01:19:44,240 LEARN FROM COVID-19 AND SECOND 2223 01:19:44,240 --> 01:19:47,880 PART WILL TALK ABOUT HOUSING AND 2224 01:19:47,880 --> 01:19:50,200 ITS NEIGHBORHOOD LOCATION AND 2225 01:19:50,200 --> 01:19:53,720 RELATE BOTH TO EMERGENCY FUND 2226 01:19:53,720 --> 01:19:54,200 USE. 2227 01:19:54,200 --> 01:19:57,000 AS A BRIEF DISCLAIMER I WORK ON 2228 01:19:57,000 --> 01:19:59,960 A PART-TIME BASIS OF HUD'S 2229 01:19:59,960 --> 01:20:02,680 OFFICE OF POLICY ON RESEARCH, MY 2230 01:20:02,680 --> 01:20:04,600 VIEWS DO NOT NECESSARILY REFLECT 2231 01:20:04,600 --> 01:20:06,200 THOSE OF HUD. 2232 01:20:06,200 --> 01:20:08,040 AS WE'RE ALL AWARE WE'VE REACHED 2233 01:20:08,040 --> 01:20:09,000 A HOUSING AFFORDABLE CRISIS IN 2234 01:20:09,000 --> 01:20:10,680 THE UNITED STATES WITH WAGES 2235 01:20:10,680 --> 01:20:12,280 INEFFICIENT TO MATCH HOUSING 2236 01:20:12,280 --> 01:20:12,480 COSTS. 2237 01:20:12,480 --> 01:20:14,440 THIS IS A SLIDE FROM THE 2238 01:20:14,440 --> 01:20:16,920 NATIONAL LOW INCOME HOUSING 2239 01:20:16,920 --> 01:20:18,200 COALITION THAT MAPS HOW MUCH OF 2240 01:20:18,200 --> 01:20:21,680 THE MINIMUM WAGE WOULD NEED TO 2241 01:20:21,680 --> 01:20:22,800 BE FOR INDIVIDUAL WORKING 40 2242 01:20:22,800 --> 01:20:27,240 HOURS A WEEK, 52 WEEKS A YEAR TO 2243 01:20:27,240 --> 01:20:29,840 AFFORD A TWO BEDROOM APARTMENT. 2244 01:20:29,840 --> 01:20:31,400 IN NONE OF THE 50 STATES IS THE 2245 01:20:31,400 --> 01:20:34,640 MINIMUM WAGE HIGH ENOUGH TO MAKE 2246 01:20:34,640 --> 01:20:35,160 HOUSING AFFORDABLE. 2247 01:20:35,160 --> 01:20:38,080 IN MARYLAND, THE MINIMUM HOUSING 2248 01:20:38,080 --> 01:20:40,280 WAGE IS $28 PER HOUR, ACTUAL 2249 01:20:40,280 --> 01:20:43,880 MINIMUM WAGE WAS INCREASED ON 2250 01:20:43,880 --> 01:20:46,760 JANUARY 1 TO $12.50. 2251 01:20:46,760 --> 01:20:49,120 2252 01:20:49,120 --> 01:20:50,560 AND PAYING HIGH HOUSING COSTS 2253 01:20:50,560 --> 01:20:53,640 MATTERS IN WAYS WE'RE BEGINNING 2254 01:20:53,640 --> 01:20:54,320 TO UNPACK. 2255 01:20:54,320 --> 01:20:56,760 AS MATTHEW DESMOND HAS WRITTEN 2256 01:20:56,760 --> 01:20:59,880 IN HIS BOOK, THE RENT EATS 2257 01:20:59,880 --> 01:21:00,080 FIRST. 2258 01:21:00,080 --> 01:21:01,240 THIS FIGURE FROM HARVARD MAKES 2259 01:21:01,240 --> 01:21:02,480 THAT CASE. 2260 01:21:02,480 --> 01:21:05,040 YOU CAN SEE WHAT HAPPENS TO LOW 2261 01:21:05,040 --> 01:21:06,560 INCOME HOUSEHOLDS AS THEY SPENT 2262 01:21:06,560 --> 01:21:08,120 MORE OF THEIR HOUSEHOLD INCOME 2263 01:21:08,120 --> 01:21:09,760 ON RENT AND UTILITIES. 2264 01:21:09,760 --> 01:21:11,040 THE FIRST BAR REPRESENTS THOSE 2265 01:21:11,040 --> 01:21:12,600 PAYING 30% OR LESS THAN 30% OF 2266 01:21:12,600 --> 01:21:15,560 INCOME ON RENT AND UTILITIES. 2267 01:21:15,560 --> 01:21:18,080 SECOND THOSE PAYING 30 TO 50%, 2268 01:21:18,080 --> 01:21:19,800 AND THAT FINAL BAR SHOWING THOSE 2269 01:21:19,800 --> 01:21:21,320 THAT PAY MORE THAN 50%. 2270 01:21:21,320 --> 01:21:22,800 AND YOU CAN SEE THOSE WHO SPEND 2271 01:21:22,800 --> 01:21:24,400 MORE ON THEIR RENT HAVE LESS 2272 01:21:24,400 --> 01:21:28,360 MONEY LEFT OVER TO PAY FOR FOOD, 2273 01:21:28,360 --> 01:21:29,160 TRANSPORTATION, RETIREMENT, 2274 01:21:29,160 --> 01:21:30,120 HEALTH CARE. 2275 01:21:30,120 --> 01:21:31,840 IMPORTANTLY THESE HOUSEHOLDS ARE 2276 01:21:31,840 --> 01:21:34,240 NOT LESS HUNGRY, THEY JUST HAVE 2277 01:21:34,240 --> 01:21:37,520 LESS LEFT OVER AFTER THE RENT 2278 01:21:37,520 --> 01:21:40,920 EATS. 2279 01:21:40,920 --> 01:21:42,920 AS MANY OF US KNOW FROM TRYING 2280 01:21:42,920 --> 01:21:45,520 TO REFER PATIENTS TO SUBSIDIZED 2281 01:21:45,520 --> 01:21:46,240 HOUSING, THE WAITLISTS ARE LONG 2282 01:21:46,240 --> 01:21:47,360 AND CLOSED. 2283 01:21:47,360 --> 01:21:49,000 THIS IS A SCREEN SHOT FROM THE 2284 01:21:49,000 --> 01:21:50,120 BALTIMORE SUN, WHAT HAPPENED 2285 01:21:50,120 --> 01:21:52,640 LAST TIME HOUSING AUTHORITY OF 2286 01:21:52,640 --> 01:21:54,640 BALTIMORE CITY OPENED ITS 2287 01:21:54,640 --> 01:21:55,480 WAITLIST. 2288 01:21:55,480 --> 01:21:57,040 YOU CAN SEE OVER 58,000 PEOPLE 2289 01:21:57,040 --> 01:22:00,080 SIGNED UP IN A WEEK TO TRY TO 2290 01:22:00,080 --> 01:22:08,320 GET A SLOT ON THAT, TO RECEIVE A 2291 01:22:08,320 --> 01:22:09,000 HOUSING VOUCHER. 2292 01:22:09,000 --> 01:22:11,200 FEDERAL ASSISTANCE IS NOT AN 2293 01:22:11,200 --> 01:22:12,720 ENTITLEMENT PROGRAM. 2294 01:22:12,720 --> 01:22:14,640 ONLY A QUARTER OF PEOPLE 2295 01:22:14,640 --> 01:22:16,920 ELIGIBLE RECEIVE IT. 2296 01:22:16,920 --> 01:22:20,040 LEADING TO CRUSHING BURDENS OF 2297 01:22:20,040 --> 01:22:20,600 UNAFFORDABLE HOUSING AND 2298 01:22:20,600 --> 01:22:22,800 CONTRIBUTING TO THAT FEELING OF 2299 01:22:22,800 --> 01:22:25,440 HELPLESS NESS WHEN FACED WITH 2300 01:22:25,440 --> 01:22:26,720 PATIENTS WITH UNMET NEEDS AND I 2301 01:22:26,720 --> 01:22:29,200 THINK THE DATA THAT DR. WALLACE 2302 01:22:29,200 --> 01:22:30,920 AND DR. DE MARCHIS PRESENTED ON 2303 01:22:30,920 --> 01:22:32,520 EXTENT TO WHICH HOUSING NEEDS 2304 01:22:32,520 --> 01:22:37,680 RISE TO TOP OF THE LIST MAKES 2305 01:22:37,680 --> 01:22:39,760 THIS CASE POWERFULLY. 2306 01:22:39,760 --> 01:22:41,840 SO HERE I WANT TO SHIFT TO TALK 2307 01:22:41,840 --> 01:22:42,920 ABOUT WHAT THE COVID-19 PANDEMIC 2308 01:22:42,920 --> 01:22:45,000 CAN BEGIN TO TEACH US ABOUT THE 2309 01:22:45,000 --> 01:22:46,560 RELATIONSHIP BETWEEN HOUSING AND 2310 01:22:46,560 --> 01:22:46,840 HEALTH. 2311 01:22:46,840 --> 01:22:49,160 IMPORTANTLY, HOW WE CAN BEGIN TO 2312 01:22:49,160 --> 01:22:50,160 ADDRESS IT. 2313 01:22:50,160 --> 01:22:52,480 BACK IN MARCH OF 2021, AT THE 2314 01:22:52,480 --> 01:22:53,400 ONE-YEAR ANNIVERSARY OF THE 2315 01:22:53,400 --> 01:22:55,280 COVID PANDEMIC, I READ AN 2316 01:22:55,280 --> 01:22:56,840 ARTICLE IN THE "NEW YORK TIMES" 2317 01:22:56,840 --> 01:23:00,040 THAT WAS REFLECTING ON THE 2318 01:23:00,040 --> 01:23:01,560 PANDEMIC, "WE LEARNED WHAT WAS 2319 01:23:01,560 --> 01:23:03,200 POSSIBLE" AND RACHEL COHEN 2320 01:23:03,200 --> 01:23:04,200 WRITES THE PANDEMIC OFFERED 2321 01:23:04,200 --> 01:23:06,040 GLIMPSES OF WHAT IS POSSIBLE. 2322 01:23:06,040 --> 01:23:08,440 BUT WILL ALL THIS BECOME A BLIP 2323 01:23:08,440 --> 01:23:08,760 IN HISTORY? 2324 01:23:08,760 --> 01:23:11,120 OR WILL IT PROVIDE IMPETUS FOR 2325 01:23:11,120 --> 01:23:11,520 LONG-TERM CHANGE? 2326 01:23:11,520 --> 01:23:13,920 SHE GOES ON TO WRITE, THROUGH 2327 01:23:13,920 --> 01:23:15,040 NATIONWIDE PUBLIC HEALTH ORDERS 2328 01:23:15,040 --> 01:23:17,880 TO STAY AT HOME TO CONTAIN THE 2329 01:23:17,880 --> 01:23:19,120 VIRUS, THE PANDEMIC FORCED 2330 01:23:19,120 --> 01:23:20,240 LAWMAKERS TO STRIKE BETTER 2331 01:23:20,240 --> 01:23:21,400 BALANCES BETWEEN THE PROPERTY 2332 01:23:21,400 --> 01:23:24,960 RIGHTS OF LANDLORDS AND SAVED OF 2333 01:23:24,960 --> 01:23:29,960 THEIR TENANTS. 2334 01:23:29,960 --> 01:23:33,400 WITH LOOPHOLES, NEVER BEFORE HAS 2335 01:23:33,400 --> 01:23:34,720 CONGRESS THROWN ITS WEIGHT 2336 01:23:34,720 --> 01:23:37,120 BEHIND PROTECTING FROM THREAT OF 2337 01:23:37,120 --> 01:23:38,800 ADDICTION. 2338 01:23:38,800 --> 01:23:40,240 2339 01:23:40,240 --> 01:23:40,480 EVICTION. 2340 01:23:40,480 --> 01:23:41,880 WE'VE BEEN LOOKING AT HOW 2341 01:23:41,880 --> 01:23:43,160 HOUSING RELATES TO HEALTH AND 2342 01:23:43,160 --> 01:23:46,040 WHAT WE CAN DO TO SUPPORT 2343 01:23:46,040 --> 01:23:46,360 PEOPLE. 2344 01:23:46,360 --> 01:23:49,400 IN ONE OF THE STUDIES I'M GOING 2345 01:23:49,400 --> 01:23:52,200 TO TALK ABOUT TODAY, WE TRY TO 2346 01:23:52,200 --> 01:23:53,680 UNPACK THE EVICTION PROCESS. 2347 01:23:53,680 --> 01:23:56,240 TYPICALLY WHEN A HOUSEHOLD GETS 2348 01:23:56,240 --> 01:23:57,720 EVICTED IT OCCURS OVER FIVE 2349 01:23:57,720 --> 01:24:00,720 STAGES, BEGINNING WITH NOTICE TO 2350 01:24:00,720 --> 01:24:02,240 THE TENANT, ULTIMATELY 2351 01:24:02,240 --> 01:24:03,720 PROGRESSING THROUGH ENFORCEMENT 2352 01:24:03,720 --> 01:24:06,160 OF THE JUDGMENT. 2353 01:24:06,160 --> 01:24:09,360 DIFFERENT STATES DURING THE 2354 01:24:09,360 --> 01:24:13,120 COVID PANDEMIC BLOCKED STAGES, 2355 01:24:13,120 --> 01:24:14,400 SOME BLOCKING LATER PHASES, 2356 01:24:14,400 --> 01:24:17,200 OTHERS BLOCKING THE EARLIER 2357 01:24:17,200 --> 01:24:19,440 PHASES AS WELL, NOTICE AND 2358 01:24:19,440 --> 01:24:22,880 FILING OR STRONGER TYPES OF 2359 01:24:22,880 --> 01:24:24,680 MORATORIUMS. 2360 01:24:24,680 --> 01:24:25,240 THESE DIFFERENCES MAY HAVE 2361 01:24:25,240 --> 01:24:39,800 IMPORTANT RAM RAMIFICATION FOR 2362 01:24:39,800 --> 01:24:41,800 HEALTH OUTCOMES, AND USING 2363 01:24:41,800 --> 01:24:42,440 LONGITUDINAL DATA SHOWED EXACTLY 2364 01:24:42,440 --> 01:24:44,920 THAT LOW INCOME RENTERS LIVING 2365 01:24:44,920 --> 01:24:46,640 IN STATES WITH STRONG 2366 01:24:46,640 --> 01:24:48,440 MORATORIUMS, THAT BLOCKED EARLY 2367 01:24:48,440 --> 01:24:50,640 STAGES OF GIVING NOTICE TO 2368 01:24:50,640 --> 01:24:52,520 TENANTS ARE LOWER RATES OF 2369 01:24:52,520 --> 01:24:54,360 MENTAL DISTRESS COMPARED TO 2370 01:24:54,360 --> 01:24:57,840 STATES THAT DIDN'T HAVE EVICTION 2371 01:24:57,840 --> 01:24:58,120 MORATORIUMS. 2372 01:24:58,120 --> 01:25:00,600 WE SEE THIS -- THESE LOWER RATES 2373 01:25:00,600 --> 01:25:03,280 WERE NOT FOUND IN STATES WITH 2374 01:25:03,280 --> 01:25:04,200 WEAK MORATORIUMS THAT BLOCKED 2375 01:25:04,200 --> 01:25:05,720 THE LATER PHASES. 2376 01:25:05,720 --> 01:25:07,200 THE EFFECT SIZE HERE IS MODEST 2377 01:25:07,200 --> 01:25:09,880 BUT THIS IS AT THE POPULATION 2378 01:25:09,880 --> 01:25:11,840 LEVEL AND SUGGESTS AS A 2379 01:25:11,840 --> 01:25:13,400 POPULATION LEVEL THESE EFFECT 2380 01:25:13,400 --> 01:25:15,360 SIZES MAY BE MEANINGFUL. 2381 01:25:15,360 --> 01:25:19,000 WE THINK THIS TYPE OF STUDY 2382 01:25:19,000 --> 01:25:22,680 UNDERSCORES HOW SOCIAL POLICIES 2383 01:25:22,680 --> 01:25:24,520 ARE STRUCTURED HAVE IMPLICATION 2384 01:25:24,520 --> 01:25:26,200 IN WELL BEING AND FUTURE EFFORTS 2385 01:25:26,200 --> 01:25:35,920 THAT HELP KEEP PEOPLE IN HOUSE 2386 01:25:35,920 --> 01:25:36,440 BY LIMITING EVICTIONS. 2387 01:25:36,440 --> 01:25:39,960 KNOW -- NOW I WANT TO TALK 2388 01:25:39,960 --> 01:25:43,840 ABOUT THE NEIGHBORHOOD CONTEXT, 2389 01:25:43,840 --> 01:25:44,120 LOCATION. 2390 01:25:44,120 --> 01:25:45,360 I'D LIKE TO FRAME THIS WITH A 2391 01:25:45,360 --> 01:25:47,640 PICTURE THAT MANY OF ARE YOU 2392 01:25:47,640 --> 01:25:50,920 FAMILIAR WITH SHOWING RED MAP 2393 01:25:50,920 --> 01:25:53,880 FROM HOMEOWNERS CORPORATION IN 2394 01:25:53,880 --> 01:25:54,520 BALTIMORE, CERTAIN NEIGHBORHOODS 2395 01:25:54,520 --> 01:25:55,920 PARTICULARLY WITH FOREIGN BORN 2396 01:25:55,920 --> 01:25:57,280 RESIDENTS AND BLACK RESIDENCE 2397 01:25:57,280 --> 01:26:00,040 WERE MARKED IN RED INDICATING 2398 01:26:00,040 --> 01:26:01,200 THESE NEIGHBORS PRESENTED 2399 01:26:01,200 --> 01:26:03,040 HAZARDOUS RISKS FOR LENDERS, 2400 01:26:03,040 --> 01:26:04,080 DENYING NEIGHBORHOODS CAPITAL 2401 01:26:04,080 --> 01:26:08,240 FOR INVESTMENT AND HELPED 2402 01:26:08,240 --> 01:26:10,720 CONTRIBUTE TO WHAT AMOUNTED TO A 2403 01:26:10,720 --> 01:26:12,320 STATE SPONSORED SYSTEM OF 2404 01:26:12,320 --> 01:26:12,640 SEGREGATION. 2405 01:26:12,640 --> 01:26:16,120 THIS IS THE MOST EASILY VISIBLE 2406 01:26:16,120 --> 01:26:16,840 EXAMPLE OF NEIGHBORHOOD 2407 01:26:16,840 --> 01:26:18,160 SEGREGATION AND POLICIES THAT 2408 01:26:18,160 --> 01:26:20,280 PROMOTED BUT IT'S NOT THE ONLY 2409 01:26:20,280 --> 01:26:20,440 ONE. 2410 01:26:20,440 --> 01:26:22,680 THERE ARE MANY EXAMPLES OF 2411 01:26:22,680 --> 01:26:24,720 SYSTEMIC RACISM THAT PERVADE 2412 01:26:24,720 --> 01:26:26,720 HOUSING POLICIES AROUND LOCAL 2413 01:26:26,720 --> 01:26:28,360 ZONING LAWS THAT HAVE CRITICAL 2414 01:26:28,360 --> 01:26:30,760 REVERBERATIONS FOR WHERE AND HOW 2415 01:26:30,760 --> 01:26:32,080 PEOPLE LIVE TODAY. 2416 01:26:32,080 --> 01:26:33,160 AND SO WORKING WITH COLLEAGUES 2417 01:26:33,160 --> 01:26:34,720 I'VE BEEN ATTEMPTING TO MEASURE 2418 01:26:34,720 --> 01:26:35,480 IMPACT OF NEIGHBORHOOD CONTEXT 2419 01:26:35,480 --> 01:26:38,560 ON HEALTH AND HEALTH CARE, 2420 01:26:38,560 --> 01:26:40,120 ESPECIALLY FOR PEOPLE WHO 2421 01:26:40,120 --> 01:26:40,840 RECEIVE HOUSING ASSISTANCE AND 2422 01:26:40,840 --> 01:26:42,560 WE'VE BEEN TRYING TO ANSWER THE 2423 01:26:42,560 --> 01:26:43,360 QUESTION, WHAT WOULD IT LOOK 2424 01:26:43,360 --> 01:26:45,360 LIKE IF WE WANTED TO MAXIMIZE 2425 01:26:45,360 --> 01:26:57,240 HEALTH IMPACT OF HOUSING 2426 01:26:57,240 --> 01:26:57,920 ASSISTANCE? 2427 01:26:57,920 --> 01:26:59,880 WE'VE BEEN EXPLORING IN 2428 01:26:59,880 --> 01:27:01,160 CHILDHOOD ASTHMA RATES. 2429 01:27:01,160 --> 01:27:04,760 RATES ARE HIGH WITH A QUARTER OF 2430 01:27:04,760 --> 01:27:06,240 KIDS REPORTING ASTHMA, ONE OF 2431 01:27:06,240 --> 01:27:08,680 THE TOP CAUSES OF EMERGENCY 2432 01:27:08,680 --> 01:27:12,120 DEPARTMENT VISITS AND WE KNOW IN 2433 01:27:12,120 --> 01:27:22,360 BALTIMORE CITY MOUSE ALLERGYEN 2434 01:27:22,360 --> 01:27:29,040 IS A DRIVER. 2435 01:27:29,040 --> 01:27:30,560 ATTEMPTS AT REMEDIATION HAD 2436 01:27:30,560 --> 01:27:32,240 MIXED RESULTS, DIFFICULT TO 2437 01:27:32,240 --> 01:27:37,120 ELIMINATE MOUSE AND COCKROACH 2438 01:27:37,120 --> 01:27:40,040 INFESTATIONS WHERE IT'S ENDEMIC, 2439 01:27:40,040 --> 01:27:44,000 WHEN THAT NEIGHBORING ROWHOUSE 2440 01:27:44,000 --> 01:27:46,840 MAY BE VACANT, IT'S HARD TO PLUG 2441 01:27:46,840 --> 01:27:48,320 THE HOLES. 2442 01:27:48,320 --> 01:27:50,760 TO BEGIN TO UNDERSTAND A 2443 01:27:50,760 --> 01:27:51,640 DIFFERENT APPROACH TO 2444 01:27:51,640 --> 01:27:53,400 UNDERSTANDING CHILDHOOD ASTHMA 2445 01:27:53,400 --> 01:27:54,800 AMONG UNDERRESOURCED NEIGHBORS 2446 01:27:54,800 --> 01:27:58,240 WE STARTED THE MOBILITY ASTHMA 2447 01:27:58,240 --> 01:27:58,480 PROJECT. 2448 01:27:58,480 --> 01:28:01,160 THIS REPRESENTS PARTNERSHIP WITH 2449 01:28:01,160 --> 01:28:03,240 THE BALTIMORE REGIONAL HOUSING 2450 01:28:03,240 --> 01:28:07,960 PARTNERSHIP, GROWING OUT OF THE 2451 01:28:07,960 --> 01:28:09,240 TOM ONLAWSUIT ACLU SUED SAYING 2452 01:28:09,240 --> 01:28:11,160 ITS LOCATION OF PUBLIC HOUSING 2453 01:28:11,160 --> 01:28:12,480 INCREASED SEGREGATION AND 2454 01:28:12,480 --> 01:28:14,120 VIOLATED FAIR HOUSING LAWS, WERE 2455 01:28:14,120 --> 01:28:15,240 SUCCESSFUL IN THE LAWSUIT, PART 2456 01:28:15,240 --> 01:28:18,400 OF THE REMEDY FOR THAT LAWSUIT 2457 01:28:18,400 --> 01:28:19,000 CREATED HOUSING VOUCHERS FOR 2458 01:28:19,000 --> 01:28:21,240 HOUSEHOLDS THAT HAD TO BE USED 2459 01:28:21,240 --> 01:28:22,840 IN NON-POOR NEIGHBORHOODS, 2460 01:28:22,840 --> 01:28:24,400 BALTIMORE REGIONAL HOUSING 2461 01:28:24,400 --> 01:28:25,840 PARTNERSHIP HELPS HOUSEHOLDS USE 2462 01:28:25,840 --> 01:28:34,480 THESE VOUCHERS TO PROVIDE 2463 01:28:34,480 --> 01:28:35,720 SUPPORT, COUNSELING ON CREDIT 2464 01:28:35,720 --> 01:28:37,080 SCORES, HELP WITH SECURITY 2465 01:28:37,080 --> 01:28:39,400 PAYMENT FOR RENTAL HOUSES, 2466 01:28:39,400 --> 01:28:42,840 WORKING WITH LANDLORDS TO FIND 2467 01:28:42,840 --> 01:28:44,640 AVAILABLE UNITS, AND THE LIKE, 2468 01:28:44,640 --> 01:28:45,880 AND THEY HAVE BEEN INCREDIBLY 2469 01:28:45,880 --> 01:28:49,240 SUCCESSFUL OVER THE MANY YEARS. 2470 01:28:49,240 --> 01:28:51,520 WE STARTED A RECRUITMENT OF 2471 01:28:51,520 --> 01:28:52,600 CHILDREN WITH ASTHMA, WHOSE 2472 01:28:52,600 --> 01:28:58,760 FAMILIES WERE ENROLLING IN THE 2473 01:28:58,760 --> 01:28:59,320 PROGRAM. 2474 01:28:59,320 --> 01:29:02,760 RECRUITED 140 KIDS IN 2016, 126 2475 01:29:02,760 --> 01:29:05,160 OF THOSE FAMILIES RECEIVED A 2476 01:29:05,160 --> 01:29:07,280 VOUCHER, 121 MOVED, AMONG THOSE 2477 01:29:07,280 --> 01:29:10,200 FAMILIES THAT HAVE RECEIVED 2478 01:29:10,200 --> 01:29:10,800 VOUCHERS WE'VE SEEN DRAMATIC 2479 01:29:10,800 --> 01:29:12,000 CHANGES IN THE NEIGHBORHOODS 2480 01:29:12,000 --> 01:29:14,920 THAT THEY LIVE IN. 2481 01:29:14,920 --> 01:29:16,720 AWAY THEY MOVED FROM POVERTY 2482 01:29:16,720 --> 01:29:22,200 RATE OF 25% TO A AVERAGE POVERTY 2483 01:29:22,200 --> 01:29:23,440 RATE OF 6.7%. 2484 01:29:23,440 --> 01:29:31,400 AND THE RESULTS ARE 2485 01:29:31,400 --> 01:29:32,800 UNPUBLISHED, WITH SIGNIFICANT 2486 01:29:32,800 --> 01:29:34,720 REDUCTIONS IN SYMPTOMS WHEN 2487 01:29:34,720 --> 01:29:35,880 RUNNING, USING RELIEVER 2488 01:29:35,880 --> 01:29:37,200 MEDICINE, OR IN NIGHTTIME 2489 01:29:37,200 --> 01:29:37,840 SYMPTOMS. 2490 01:29:37,840 --> 01:29:40,080 YOU CAN SEE HERE AVERAGES OUT TO 2491 01:29:40,080 --> 01:29:42,600 A MONTH FEWER OF NIGHTTIME 2492 01:29:42,600 --> 01:29:43,320 SYMPTOMS, PARALLEL WE'VE 2493 01:29:43,320 --> 01:29:45,520 OBSERVED LARGE REDUCTION IN 2494 01:29:45,520 --> 01:29:49,680 ASTHMA TRIGGERS INCLUDING MOUSE 2495 01:29:49,680 --> 01:29:52,040 AND COCKROACH ALLERGENS AND 2496 01:29:52,040 --> 01:29:53,000 CHANGES IN LUNG FUNCTION 2497 01:29:53,000 --> 01:29:57,640 INCLUDING FEV1 THAT GOES UP 2498 01:29:57,640 --> 01:30:00,160 EARLY ADULTHOOD AND STARTS 2499 01:30:00,160 --> 01:30:02,720 DECLINING AND THE RATE OF FEV 1 2500 01:30:02,720 --> 01:30:04,880 IS ALSO ASSOCIATED WITH 2501 01:30:04,880 --> 01:30:06,960 LONG-TERM OUTCOMES FOR ADULTS, 2502 01:30:06,960 --> 01:30:09,840 WE THINK THIS UNDERSTANDING THE 2503 01:30:09,840 --> 01:30:10,720 NEIGHBORHOOD CONTEXT CAN DRIVE 2504 01:30:10,720 --> 01:30:13,080 OVERALL KIND OF LIFE COURSE 2505 01:30:13,080 --> 01:30:16,360 TRAJECTORY FOR PULMONARY HEALTH 2506 01:30:16,360 --> 01:30:17,120 AND OVERALL WELL-BEING IS 2507 01:30:17,120 --> 01:30:17,400 CRITICAL. 2508 01:30:17,400 --> 01:30:22,440 SO AGAIN THESE ARE UNPUBLISHED, 2509 01:30:22,440 --> 01:30:25,880 WE'RE STILL DOING SOME OTHER -- 2510 01:30:25,880 --> 01:30:30,160 ADDITIONAL ANALYSES COMPARING TO 2511 01:30:30,160 --> 01:30:33,600 MAKE SURE OUR RESULTS HOLD UP. 2512 01:30:33,600 --> 01:30:35,640 THE REGIONAL HOUSING PARTNERSHIP 2513 01:30:35,640 --> 01:30:37,520 IN CONJUNCTION ARE HOUSING 2514 01:30:37,520 --> 01:30:38,720 AUTHORITY OF BALTIMORE CITY 2515 01:30:38,720 --> 01:30:41,200 LAUNCHED THE HEALTHY HOUSING 2516 01:30:41,200 --> 01:30:42,760 VOUCHERS, TO TEST WHETHER TRYING 2517 01:30:42,760 --> 01:30:44,880 TO RECRUIT CHILDREN WITH 2518 01:30:44,880 --> 01:30:47,440 VOUCHERS WHO ARE CURRENTLY 2519 01:30:47,440 --> 01:30:49,120 RESIDING IN UNDERRESOURCED 2520 01:30:49,120 --> 01:30:51,480 NEIGHBORS MAY WANT HELP MOVING 2521 01:30:51,480 --> 01:30:52,800 TO MORE RESOURCED NEIGHBORHOODS, 2522 01:30:52,800 --> 01:30:54,960 MAY WANTS TO PARTICIPATE IN 2523 01:30:54,960 --> 01:30:55,640 BALTIMORE REGIONAL HOUSING 2524 01:30:55,640 --> 01:31:01,160 PROGRAM AND RECEIVE SERVICES. 2525 01:31:01,160 --> 01:31:04,600 THIS IS AN EXCITING EXAMPLE 2526 01:31:04,600 --> 01:31:07,080 RECRUITING KIDS MOST VULNERABLE 2527 01:31:07,080 --> 01:31:07,880 FROM EMERGENCY DEPARTMENT 2528 01:31:07,880 --> 01:31:09,240 WORKING POTENTIALLY WITH THE 2529 01:31:09,240 --> 01:31:10,840 CITY PUBLIC HEALTH AGENCY, THESE 2530 01:31:10,840 --> 01:31:13,640 PARTNERSHIPS ARE BEING DEVELOPED 2531 01:31:13,640 --> 01:31:15,080 WORKING WITH THE PEDIATRIC 2532 01:31:15,080 --> 01:31:17,960 CLINIC TO TRY TO IDENTIFY THOSE 2533 01:31:17,960 --> 01:31:20,440 KIDS WHO MAY BE -- MAY BENEFIT 2534 01:31:20,440 --> 01:31:22,120 IN MOVING TO SEE WHETHER THAT 2535 01:31:22,120 --> 01:31:24,760 INCREMENTAL COST OF PAYING FOR 2536 01:31:24,760 --> 01:31:25,440 MOBILITY SERVICES MAY BENEFIT 2537 01:31:25,440 --> 01:31:29,160 AND MAY PROVIDE A NOVEL PATHWAY 2538 01:31:29,160 --> 01:31:31,520 FOR THESE PATIENTS. 2539 01:31:31,520 --> 01:31:32,440 2540 01:31:32,440 --> 01:31:34,560 SO I WANT TO END BY COMING BACK 2541 01:31:34,560 --> 01:31:36,400 TO THE IDEA, WE HAVE A GLIMPSE 2542 01:31:36,400 --> 01:31:39,160 OF WHAT MIGHT BE POSSIBLE IF WE 2543 01:31:39,160 --> 01:31:40,960 START VIEWING HOUSING AS A 2544 01:31:40,960 --> 01:31:41,760 CRITICAL FACTOR IN HEALTH AND 2545 01:31:41,760 --> 01:31:42,480 HEALTH EQUITY. 2546 01:31:42,480 --> 01:31:45,040 THIS IS NOT A NEW INSIGHT. 2547 01:31:45,040 --> 01:31:48,360 BUT GOES BACK TO THE ROOTS OF 2548 01:31:48,360 --> 01:31:49,200 EPIDEMIOLOGY, ROOTS OF NURSING, 2549 01:31:49,200 --> 01:31:50,640 REMINDING US CONNECTION IS 2550 01:31:50,640 --> 01:31:50,920 PARAMOUNT. 2551 01:31:50,920 --> 01:31:53,120 WE HAVE TO WORK WITH OUR 2552 01:31:53,120 --> 01:31:54,760 EMERGENCY DEPARTMENT COLLEAGUES 2553 01:31:54,760 --> 01:31:57,440 TOED ADVOCATE FOR CHANGES THAT 2554 01:31:57,440 --> 01:31:58,720 MAKE HOUSING IN RESOURCED 2555 01:31:58,720 --> 01:32:01,000 NEIGHBORHOODS AFFORDABLE AND 2556 01:32:01,000 --> 01:32:01,240 AVAILABLE. 2557 01:32:01,240 --> 01:32:05,440 WITH THAT I WANT TO THANK MY 2558 01:32:05,440 --> 01:32:07,000 WONDERFUL COLLABORATORS ON 2559 01:32:07,000 --> 01:32:09,880 STUDIES AS WELL AS FUNDING FROM 2560 01:32:09,880 --> 01:32:11,440 NIH AND OTHER RESOURCES. 2561 01:32:11,440 --> 01:32:14,720 THANK YOU. 2562 01:32:14,720 --> 01:32:17,360 2563 01:32:17,360 --> 01:32:20,800 >> THANK YOU, DR. WALLACE, DE 2564 01:32:20,800 --> 01:32:24,080 MARCHIS AND POLLACK. 2565 01:32:24,080 --> 01:32:25,640 THESE CONVERSATIONS ARE 2566 01:32:25,640 --> 01:32:26,440 CRITICALLY IMPORTANT AND WE 2567 01:32:26,440 --> 01:32:28,680 REALLY APPRECIATE AND VALUE YOUR 2568 01:32:28,680 --> 01:32:30,720 INSIGHTS AND SHARING ALL OF 2569 01:32:30,720 --> 01:32:32,200 THOSE FASCINATING RESULTS FROM 2570 01:32:32,200 --> 01:32:32,600 YOUR RESEARCH. 2571 01:32:32,600 --> 01:32:37,280 WE DO HAVE TIME FOR A COUPLE OF 2572 01:32:37,280 --> 01:32:40,440 QUESTIONS, IF THERE ARE ANY FOR 2573 01:32:40,440 --> 01:32:43,240 THIS ROUND OF SPEAKERS. 2574 01:32:43,240 --> 01:32:48,640 2575 01:32:48,640 --> 01:32:52,000 IF NOT WE CAN WAIT TILL THE 2576 01:32:52,000 --> 01:32:52,960 PANEL. 2577 01:32:52,960 --> 01:32:54,720 AND TAKE A BREAK. 2578 01:32:54,720 --> 01:32:57,360 WE HAVE A BREAK SCHEDULED. 2579 01:32:57,360 --> 01:33:01,040 AND WE CAN RECONVENE AT ONE P.M. 2580 01:33:01,040 --> 01:33:02,520 2581 01:33:02,520 --> 01:33:04,400 WHY DON'T WE DO THAT. 2582 01:33:04,400 --> 01:33:07,640 AND WE WILL SEE ALL OF YOU IN 2583 01:33:07,640 --> 01:33:14,040 ABOUT 25 MINUTES. 2584 01:33:14,040 --> 01:33:15,320 >>WE WILL CONTINUE WITH THREE 2585 01:33:15,320 --> 01:33:22,480 OUTSTANDING SPEAKERS WITH SOCIAL 2586 01:33:22,480 --> 01:33:23,280 DETERMINANTS OF HEALTH AND 2587 01:33:23,280 --> 01:33:26,280 EMERGENCY DEPARTMENT 2588 01:33:26,280 --> 01:33:27,640 UTILIZATION. 2589 01:33:27,640 --> 01:33:28,920 I'M ACTING DIRECTOR FOR THE 2590 01:33:28,920 --> 01:33:32,720 DIVISION OF EXTRAMURAL SCIENCE 2591 01:33:32,720 --> 01:33:40,760 PROGRAMS AT THE NINR. 2592 01:33:40,760 --> 01:33:41,560 LET ME REMIND YOU WE HOPE TO 2593 01:33:41,560 --> 01:33:43,160 HAVE ALL THE QUESTIONS DURING 2594 01:33:43,160 --> 01:33:47,040 THE PANEL DISCUSSION AFTER TALKS 2595 01:33:47,040 --> 01:33:47,800 ARE CONCLUDED. 2596 01:33:47,800 --> 01:33:56,640 HERE IS THE LINE UP. DR. JOSH 2597 01:33:56,640 --> 01:34:01,120 VEST, THE FIRST SPEAKER IS A 2598 01:34:01,120 --> 01:34:03,000 HEALTH SERVICES RESEARCHER WHO 2599 01:34:03,000 --> 01:34:04,440 HAS EFFECTIVENESS IN HEALTH 2600 01:34:04,440 --> 01:34:06,800 INFORMATION TECHNOLOGY AND 2601 01:34:06,800 --> 01:34:08,680 SYSTEMSMENT DR. VEST'S WORK HAS 2602 01:34:08,680 --> 01:34:12,200 EMPLOYED A VARIETY OF RESEARCH 2603 01:34:12,200 --> 01:34:13,280 TECHNIQUES FROM LARGE SCALE 2604 01:34:13,280 --> 01:34:16,120 DATABASE ANALYSES TO 2605 01:34:16,120 --> 01:34:16,920 GEOGRAPHICAL INFORMATION SYSTEM 2606 01:34:16,920 --> 01:34:20,120 MAPPING TO SURVEY RESEARCH TO 2607 01:34:20,120 --> 01:34:22,080 QUALITATIVE FOCUS GROUP AND 2608 01:34:22,080 --> 01:34:22,400 INTERVIEWS. 2609 01:34:22,400 --> 01:34:23,480 DR. VEST HAS A PARTICULAR 2610 01:34:23,480 --> 01:34:25,000 INTEREST IN THE MEASUREMENT AND 2611 01:34:25,000 --> 01:34:30,880 USAGE OF SOCIAL DETERMINANTS 2612 01:34:30,880 --> 01:34:32,200 INFORMATION HE IS PROFESSOR 2613 01:34:32,200 --> 01:34:36,840 HEALTH POLICY AND MANAGEMENT 2614 01:34:36,840 --> 01:34:38,240 INDIANA UNIVERSITY RICHARD FAIR 2615 01:34:38,240 --> 01:34:39,400 BANKS SCHOOL OF PUBLIC HEALTH 2616 01:34:39,400 --> 01:34:40,600 AND THE RESEARCH INSTITUTES. 2617 01:34:40,600 --> 01:34:42,520 HE WILL BE FOLLOWED BY DR. 2618 01:34:42,520 --> 01:34:43,400 MELISSA MCCARTHY. 2619 01:34:43,400 --> 01:34:45,200 WHO IS A PROFESSOR OF THE 2620 01:34:45,200 --> 01:34:47,440 DEPARTMENT OF HEALTH POLICY AND 2621 01:34:47,440 --> 01:34:49,320 MANAGEMENT AT THE GEORGE 2622 01:34:49,320 --> 01:34:51,360 WASHINGTON UNIVERSITY MILKEN 2623 01:34:51,360 --> 01:34:54,000 INSTITUTE SCHOOL OF PUBLIC 2624 01:34:54,000 --> 01:34:55,440 HEALTH. 2625 01:34:55,440 --> 01:34:57,600 HAS A JOINTS APPOINTMENT IN THE 2626 01:34:57,600 --> 01:34:58,840 GEORGE WASHINGTON UNIVERSITY 2627 01:34:58,840 --> 01:34:59,600 SCHOOL OF MEDICINE IN DEPARTMENT 2628 01:34:59,600 --> 01:35:01,640 OF EMERGENCY MEDICINE. 2629 01:35:01,640 --> 01:35:02,880 DR. MCCARTHY, HAS A MASTERS 2630 01:35:02,880 --> 01:35:05,400 DEGREE IN EPIDEMIOLOGY AND 2631 01:35:05,400 --> 01:35:06,840 ADOCTORAL DEGREE IN HEALTH 2632 01:35:06,840 --> 01:35:09,160 SERVICES RESEARCH, PRESENT 2633 01:35:09,160 --> 01:35:11,360 RESEARCH FOCUSES ON IDENTIFYING 2634 01:35:11,360 --> 01:35:14,200 STRATEGIES AT THE MICROAND MACRO 2635 01:35:14,200 --> 01:35:15,720 LEVELS TO ADDRESS SOCIAL 2636 01:35:15,720 --> 01:35:17,080 DETERMINANTS OF HEALTH IN THE 2637 01:35:17,080 --> 01:35:18,880 MEDICAID POPULATION. 2638 01:35:18,880 --> 01:35:22,920 AND FINALLY, THE LAST SPEAKER IN 2639 01:35:22,920 --> 01:35:24,640 THIS SESSION DR. ANN ELIZABETH 2640 01:35:24,640 --> 01:35:27,280 MONTGOMERY IS ASSOCIATE 2641 01:35:27,280 --> 01:35:28,440 PROFESSOR SCHOOL OF PUBLIC 2642 01:35:28,440 --> 01:35:29,720 HEALTH UNIVERSITY OF ALABAMA 2643 01:35:29,720 --> 01:35:30,160 BIRMINGHAM. 2644 01:35:30,160 --> 01:35:32,040 SHE HAS EXTENSIVE EXPERIENCE 2645 01:35:32,040 --> 01:35:34,680 USING VETERANS ADMINISTRATION 2646 01:35:34,680 --> 01:35:36,000 ADMINISTRATIVE DATA SOURCES TO 2647 01:35:36,000 --> 01:35:38,240 ADDRESS HER PRIMARY RESEARCH 2648 01:35:38,240 --> 01:35:42,800 INTERESTS, WHICH ARE IDENTIFYING 2649 01:35:42,800 --> 01:35:44,480 HOLISTIC RISKS AMONG VETERANS 2650 01:35:44,480 --> 01:35:46,400 SEEKING HEALTHCARE AND ASSESSING 2651 01:35:46,400 --> 01:35:47,080 INTERVENTIONS INTENDED TO 2652 01:35:47,080 --> 01:35:50,120 MITIGATE THIS RISK IN STUDYING 2653 01:35:50,120 --> 01:35:51,800 VULNERABLE POPULATIONS AND 2654 01:35:51,800 --> 01:35:52,800 RELATED HEALTH DISPARITIES. 2655 01:35:52,800 --> 01:35:54,760 HER WORK FOCUSES LARGELY ON 2656 01:35:54,760 --> 01:35:57,440 ADDRESSING SOCIAL DETERMINANTS 2657 01:35:57,440 --> 01:35:58,760 OF HEALTH INCLUDING HOUSING 2658 01:35:58,760 --> 01:36:02,240 INSTABILITY, GENDER, VIOLENCE, 2659 01:36:02,240 --> 01:36:03,800 MORALITY, EMPLOYMENT, AND 2660 01:36:03,800 --> 01:36:04,840 JUSTICE INVOLVEMENT TO IMPROVE 2661 01:36:04,840 --> 01:36:06,840 THE HEALTH OF VETERANS. 2662 01:36:06,840 --> 01:36:10,120 SO PLEASE JOIN ME IN WELCOMING 2663 01:36:10,120 --> 01:36:12,000 DR.S VEST, MCCARTHY AND 2664 01:36:12,000 --> 01:36:13,480 MONTGOMERY WHO WILL EACH SPEAK 2665 01:36:13,480 --> 01:36:15,400 FOR 15 MINUTES AFTER WHICH TIME 2666 01:36:15,400 --> 01:36:16,640 THERE WILL BE A PANEL DISCUSSION 2667 01:36:16,640 --> 01:36:18,160 AND WE HOPE THAT YOU WILL 2668 01:36:18,160 --> 01:36:18,920 PARTICIPATE. 2669 01:36:18,920 --> 01:36:21,760 PLEASE USE THE CHAT FUNCTION 2670 01:36:21,760 --> 01:36:22,920 WHENEVER YOU FEEL LIKE IT TO 2671 01:36:22,920 --> 01:36:25,680 BEGIN SUBMITTING YOUR QUESTIONS 2672 01:36:25,680 --> 01:36:26,920 DURING THE PRESENTATIONS AND 2673 01:36:26,920 --> 01:36:29,040 DURING THE BREAK WE WILL CURATE 2674 01:36:29,040 --> 01:36:30,880 THE QUESTIONS FOR THE PANEL 2675 01:36:30,880 --> 01:36:35,200 MODERATOR. 2676 01:36:35,200 --> 01:36:39,160 DR. VEST. 2677 01:36:39,160 --> 01:36:41,360 >> THANK YOU SO MUCH, APPRECIATE 2678 01:36:41,360 --> 01:36:42,880 THIS OPPORTUNITY TO TALK TO 2679 01:36:42,880 --> 01:36:44,000 Y'ALL. 2680 01:36:44,000 --> 01:36:46,160 AND I'M GOING TO BE MEASURING 2681 01:36:46,160 --> 01:36:47,880 PATIENT SOCIAL RISK FACTORS, 2682 01:36:47,880 --> 01:36:49,200 TALK ABOUT THE CONSIDERATIONS 2683 01:36:49,200 --> 01:36:50,840 AND SOME OF THE STUFF WE ARE 2684 01:36:50,840 --> 01:36:53,600 SEEING HERE IN INDIANA, THE 2685 01:36:53,600 --> 01:36:55,800 PRESENTATIONS HAVE BEEN 2686 01:36:55,800 --> 01:36:58,920 PHENOMENAL SO FAR AND I THINK 2687 01:36:58,920 --> 01:37:00,800 WILL DOVE TAIL NICELY WITH 2688 01:37:00,800 --> 01:37:01,520 EARLIER SPEAKERS. 2689 01:37:01,520 --> 01:37:05,760 SO AS MENTIONED, I'M INTERESTED 2690 01:37:05,760 --> 01:37:08,200 IN HOW WE MEASURE CONSTRUCTS AND 2691 01:37:08,200 --> 01:37:10,840 APPLY THEM TO HEALTHCARE AND 2692 01:37:10,840 --> 01:37:13,040 HEALTH POPULATION IMPROVEMENT SO 2693 01:37:13,040 --> 01:37:15,440 THERE'S REALLY THREE MAIN WAYS 2694 01:37:15,440 --> 01:37:18,960 WE COLLECT SOCIAL RISK FACTORS, 2695 01:37:18,960 --> 01:37:20,760 SOCIAL FACTOR INFORMATION. 2696 01:37:20,760 --> 01:37:22,800 THEY ALL HAVE STRENGTHS AND 2697 01:37:22,800 --> 01:37:23,080 LIMITATIONS. 2698 01:37:23,080 --> 01:37:26,280 ONE IS SURVEYS, WE HAVE HEARD 2699 01:37:26,280 --> 01:37:27,200 THAT ALREADY, THEY ARE WIDELY 2700 01:37:27,200 --> 01:37:28,800 USED, MANY POPULAR SURVEYS ARE 2701 01:37:28,800 --> 01:37:30,040 BUILT IN THE EHR SO THEY ARE 2702 01:37:30,040 --> 01:37:33,280 ABLE TO CAPTURE STRUCTURED DATA. 2703 01:37:33,280 --> 01:37:35,400 PHENOMENAL ADVANTAGE OF A LOT OF 2704 01:37:35,400 --> 01:37:37,280 SURVEYS THEY ARE IN MULTIPLE 2705 01:37:37,280 --> 01:37:39,240 LANGUAGES AND TRANSLATED ALREADY 2706 01:37:39,240 --> 01:37:40,600 SO THERE FOR EVERYBODY TO USE, 2707 01:37:40,600 --> 01:37:42,200 EASY OFF THE SHELF SET OF STUFF 2708 01:37:42,200 --> 01:37:46,600 THAT IS VERY GOOD. 2709 01:37:46,600 --> 01:37:48,520 HOWEVER THEY DO HAVE LIMITATION 2710 01:37:48,520 --> 01:37:51,640 USES, THEY ARE NOT PSYCHO 2711 01:37:51,640 --> 01:37:53,000 METRICALLY EVALUATED. 2712 01:37:53,000 --> 01:37:56,200 AS A RESULTS PULL AND CHOOSE 2713 01:37:56,200 --> 01:37:56,800 INSTRUMENTS FROM PSYCHO 2714 01:37:56,800 --> 01:37:58,720 METRICALLY EVALUATED TOOLS, A 2715 01:37:58,720 --> 01:38:00,040 GOOD COMMON WAY OF BUILDING BUT 2716 01:38:00,040 --> 01:38:02,000 DOESN'T MEAN THE TOOLS ARE 2717 01:38:02,000 --> 01:38:02,800 PSYCHOMETRICALLY EVALUATED. 2718 01:38:02,800 --> 01:38:04,400 IF YOU LOOK AT THE QUESTION 2719 01:38:04,400 --> 01:38:06,440 FLAIRS YOU WILL SEE NUANCES IN 2720 01:38:06,440 --> 01:38:08,080 QUESTIONS WHICH POSSIBLY DO HAVE 2721 01:38:08,080 --> 01:38:10,880 SOME IMPLICATIONS FOR WHAT WE 2722 01:38:10,880 --> 01:38:12,640 ARE MEASURING AS A CONSTRUCT OF 2723 01:38:12,640 --> 01:38:13,080 SOCIAL FACTOR. 2724 01:38:13,080 --> 01:38:15,000 AS MENTIONED EARLIER, THERE'S 2725 01:38:15,000 --> 01:38:18,400 WORK FLOW ISSUES AND BURDENS 2726 01:38:18,400 --> 01:38:19,880 SURVEYS DO REQUIRE SOMEBODY TO 2727 01:38:19,880 --> 01:38:21,200 ANSWER THEM AND ADMINISTRATION. 2728 01:38:21,200 --> 01:38:24,520 WE ALSO HAVE THE CHALLENGE OF 2729 01:38:24,520 --> 01:38:28,520 RESPONSE BIAS IF WE ARE NOT 2730 01:38:28,520 --> 01:38:30,120 DOING UNIVERSAL SCREENING WE RUN 2731 01:38:30,120 --> 01:38:33,320 INTO CHALLENGES ON RISK SAL 2732 01:38:33,320 --> 01:38:34,400 STRATIFICATION, ADVANCED 2733 01:38:34,400 --> 01:38:36,600 ANALYTICS MAKE INFERENCES ABOUT 2734 01:38:36,600 --> 01:38:37,800 THE POPULATION AND RESPONSE CAN 2735 01:38:37,800 --> 01:38:40,440 COME FROM TWO WAYSES, THE 2736 01:38:40,440 --> 01:38:41,800 HEALTHCARE ORGANIZATION DOES NOT 2737 01:38:41,800 --> 01:38:43,320 UNIVERSALLY SCREEN PATIENTS OUT 2738 01:38:43,320 --> 01:38:45,480 OF EITHER WORK FLOW DEMANDS OR 2739 01:38:45,480 --> 01:38:47,720 SOME SORT OF MISGUIDED THOUGHT 2740 01:38:47,720 --> 01:38:48,840 ABOUT WHO SHOULD AND SHOULDN'T 2741 01:38:48,840 --> 01:38:53,120 BE SCREENED OR ALTERNATIVELY WE 2742 01:38:53,120 --> 01:38:54,240 KNOW SOMETIMES PATIENTS DON'T 2743 01:38:54,240 --> 01:38:55,200 WANT TO RESPOND TO 2744 01:38:55,200 --> 01:38:55,600 QUESTIONNAIRES. 2745 01:38:55,600 --> 01:38:58,000 WE ARE USED TO HEALTHCARE AND 2746 01:38:58,000 --> 01:39:02,320 USED TO FAIRLY SENSITIVE HEALTH 2747 01:39:02,320 --> 01:39:04,040 QUESTIONS BE SOCIAL FACTOR 2748 01:39:04,040 --> 01:39:06,080 QUESTIONS ARE JUST AS SENSITIVE 2749 01:39:06,080 --> 01:39:08,120 FOR PEOPLE TO RESPOND TO IF THEY 2750 01:39:08,120 --> 01:39:08,960 HAD NEGATIVE EXPERIENCES WITH 2751 01:39:08,960 --> 01:39:09,520 THE HEALTHCARE SYSTEM IN THE 2752 01:39:09,520 --> 01:39:12,040 PAST. 2753 01:39:12,040 --> 01:39:14,640 WE CAN TURN TO NLP NATURAL 2754 01:39:14,640 --> 01:39:16,200 LANGUAGE PROCESSING AND TEXT 2755 01:39:16,200 --> 01:39:16,440 MINING. 2756 01:39:16,440 --> 01:39:19,400 THAT HAS ADVANTAGES. 2757 01:39:19,400 --> 01:39:20,440 OFTEN SOCIAL DETERMINANTS OR 2758 01:39:20,440 --> 01:39:22,120 RISKS ARE DOCUMENTED IN CLINICAL 2759 01:39:22,120 --> 01:39:22,600 NOTES. 2760 01:39:22,600 --> 01:39:24,800 THE MEDICAL RECORD HAS A LONG 2761 01:39:24,800 --> 01:39:30,600 TRADITION OF HAVING A WHERE 2762 01:39:30,600 --> 01:39:31,520 THESE POP UP. 2763 01:39:31,520 --> 01:39:33,920 WE CAN AUTOMATE THIS INTO BACK 2764 01:39:33,920 --> 01:39:34,960 END PROCESSES SO WE CAN BE 2765 01:39:34,960 --> 01:39:37,000 MINING CONTINUOUSLY SRI WITH 2766 01:39:37,000 --> 01:39:38,600 USEFUL AND HAS POTENTIAL FOR'S 2767 01:39:38,600 --> 01:39:39,600 OF USE. 2768 01:39:39,600 --> 01:39:40,760 HOWEVER THERE ARE LIMITATIONS 2769 01:39:40,760 --> 01:39:45,480 WITHIN NLP, IT IS FAIRLY CUTTING 2770 01:39:45,480 --> 01:39:46,960 EDGE IT IS LEARNING TO MEASURE 2771 01:39:46,960 --> 01:39:49,400 THESE THINGS IS A CHALLENGE AND 2772 01:39:49,400 --> 01:39:50,080 PARTICULARLY WITH SOME OF THE 2773 01:39:50,080 --> 01:39:52,200 TEMPORALTY ISSUES GIVEN HOW 2774 01:39:52,200 --> 01:39:54,600 FREQUENTLY SOCIAL RISKS AND FANG 2775 01:39:54,600 --> 01:39:55,680 TORRS CHANGE OVER TIME. 2776 01:39:55,680 --> 01:39:56,800 MEASURING IS A CHALLENGE. 2777 01:39:56,800 --> 01:39:59,200 WE HAVE A SELECTION BIAS WITH 2778 01:39:59,200 --> 01:39:59,680 NLP. 2779 01:39:59,680 --> 01:40:02,760 WHEN WE DO NLP TO EXTRACT SOCIAL 2780 01:40:02,760 --> 01:40:04,800 RISK OUT OF NOTES WE ARE NOT 2781 01:40:04,800 --> 01:40:06,000 ASKING PATIENTS AND MEASURING 2782 01:40:06,000 --> 01:40:07,720 THE PATIENT LEVEL, WE ARE 2783 01:40:07,720 --> 01:40:08,960 MEASURING WHAT'S FILTERED 2784 01:40:08,960 --> 01:40:10,920 THROUGH THAT PROVIDER PATIENT 2785 01:40:10,920 --> 01:40:13,200 INTERACTION. 2786 01:40:13,200 --> 01:40:14,960 SO BECAUSE A PATIENT HAS ASOCIAL 2787 01:40:14,960 --> 01:40:17,400 RISK DOESN'T MEAN THAT IS ASKED 2788 01:40:17,400 --> 01:40:19,040 ABOUT AND EVEN IF ASKED ABOUT IT 2789 01:40:19,040 --> 01:40:20,640 DOESN'T MEAN IT IS ANSWERED AND 2790 01:40:20,640 --> 01:40:23,000 EVEN IF ANSWERED DOESN'T MEAN 2791 01:40:23,000 --> 01:40:24,920 IT'S DOCUMENTED SO IT IS THROUGH 2792 01:40:24,920 --> 01:40:26,920 THAT FILTER OF WHAT IS 2793 01:40:26,920 --> 01:40:27,840 DOCUMENTED SO THAT WILL 2794 01:40:27,840 --> 01:40:30,680 UNDERCOUNT SOME PEOPLE AS WELL. 2795 01:40:30,680 --> 01:40:31,880 JUST TRUTHFULLY NOT ALL HEALTH 2796 01:40:31,880 --> 01:40:35,000 SYSTEMS ARE ABLE TO RUN NLP AT 2797 01:40:35,000 --> 01:40:36,400 SUCH LARGE SCALE. 2798 01:40:36,400 --> 01:40:36,800 ROUTINE BASIS. 2799 01:40:36,800 --> 01:40:38,400 THE OTHER THING WE CAN TURN TO 2800 01:40:38,400 --> 01:40:40,080 IS STRUCTURE DATA. 2801 01:40:40,080 --> 01:40:43,000 STRUCTURE DATA IS VERY USEFUL 2802 01:40:43,000 --> 01:40:45,400 PARTICULARLY ICDZ CODES, THESE 2803 01:40:45,400 --> 01:40:47,200 ICD 10 Z CODES ARE BUILT INTO 2804 01:40:47,200 --> 01:40:48,600 EHR SO IT IS EASY TO DOCUMENT 2805 01:40:48,600 --> 01:40:50,120 AND WORK THAT WAY. 2806 01:40:50,120 --> 01:40:52,000 THAT IS REALLY USEFUL. 2807 01:40:52,000 --> 01:40:54,000 HOWEVER, ALL OF THE RESEARCH 2808 01:40:54,000 --> 01:40:56,200 INDICATES OUT THERE THEY ARE 2809 01:40:56,200 --> 01:40:56,680 DRAMATICALLY UNDERUSED. 2810 01:40:56,680 --> 01:40:59,960 IT IS NOT EVEN LIKE A LITTLE 2811 01:40:59,960 --> 01:41:01,720 UNDERUSED, IT IS BY MILES ACROSS 2812 01:41:01,720 --> 01:41:02,800 THE ENTIRE U.S. HEALTHCARE 2813 01:41:02,800 --> 01:41:05,240 SYSTEM THESE THINGS ARE JUST NOT 2814 01:41:05,240 --> 01:41:06,280 USED SUFFICIENTLY ENOUGH TO GET 2815 01:41:06,280 --> 01:41:10,920 A GOOD HANDLE ON WHAT IS GOING 2816 01:41:10,920 --> 01:41:11,080 ON. 2817 01:41:11,080 --> 01:41:12,600 WHAT IS OUR SITUATION AND AND 2818 01:41:12,600 --> 01:41:14,000 WHERE DOES IT LEAD US TO? 2819 01:41:14,000 --> 01:41:15,600 WE THINK ON THIS CALL SOCIAL 2820 01:41:15,600 --> 01:41:17,800 RISKS ARE REALLY AN IMPORTANT 2821 01:41:17,800 --> 01:41:18,600 QUOTE UNQUOTE CONDITION THAT 2822 01:41:18,600 --> 01:41:19,600 SHOULD BE MEASURED. 2823 01:41:19,600 --> 01:41:21,880 WE SEE FROM OUR EXISTING 2824 01:41:21,880 --> 01:41:22,680 APPROACHES THEY HAVE STRENGTH 2825 01:41:22,680 --> 01:41:24,600 BUT IN MANY WAYS WE GET 2826 01:41:24,600 --> 01:41:25,320 INCOMPLETE PICTURE OF THE 2827 01:41:25,320 --> 01:41:28,160 PATIENT FROM EACH ONE. 2828 01:41:28,160 --> 01:41:29,040 THAT IS A CHALLENGE. 2829 01:41:29,040 --> 01:41:30,680 WE KNOW THE DATA ARE NOT ALWAYS 2830 01:41:30,680 --> 01:41:32,600 COLLECTED AT EVERY ENCOUNTER. 2831 01:41:32,600 --> 01:41:34,640 WE ALSO KNOW THAT THE 2832 01:41:34,640 --> 01:41:36,320 DEFINITIONS ARE NOT CONSISTENT 2833 01:41:36,320 --> 01:41:39,000 ACROSS SYSTEMS AND ACROSS 2834 01:41:39,000 --> 01:41:41,600 INSTITUTIONS. 2835 01:41:41,600 --> 01:41:43,000 TRUTH TRUTHFULLY, A LOT OF EHR 2836 01:41:43,000 --> 01:41:45,160 DATA WE HAVE ACCESS TO ARE ABOUT 2837 01:41:45,160 --> 01:41:46,720 DEMOGRAPHICS AND INSURANCE, 2838 01:41:46,720 --> 01:41:47,880 PAYMENT INFORMATION SOCIAL 2839 01:41:47,880 --> 01:41:49,000 RELATIONSHIPS, ALL ABOUT 2840 01:41:49,000 --> 01:41:50,800 LANGUAGE, THAT MIGHT BE REALLY 2841 01:41:50,800 --> 01:41:53,080 USEFUL STUFF THAT WE COULD BE 2842 01:41:53,080 --> 01:41:55,400 CONSIDERING OUTSIDE OF PURE 2843 01:41:55,400 --> 01:41:56,360 STRUCTURE DATA FOR SOCIAL 2844 01:41:56,360 --> 01:41:58,200 DETERMINANTS AND RISKS. 2845 01:41:58,200 --> 01:42:00,200 I APOLOGIZE, I DO KNOW SOCIAL 2846 01:42:00,200 --> 01:42:01,440 DETERMINANTS AND SOCIAL FACTORS 2847 01:42:01,440 --> 01:42:03,360 ARE NOT THE SAME THING BUT I 2848 01:42:03,360 --> 01:42:04,120 WILL PROBABLY SLIP IN BETWEEN 2849 01:42:04,120 --> 01:42:06,680 THEM ROUTINELY SO BRINGING THAT 2850 01:42:06,680 --> 01:42:07,640 TOGETHER WHAT ABOUT IF WE 2851 01:42:07,640 --> 01:42:09,680 THOUGHT ABOUT COMPUTABLE SOCIAL 2852 01:42:09,680 --> 01:42:10,960 RISK FACTOR PHENOTYPES? 2853 01:42:10,960 --> 01:42:12,400 AND THINKING ABOUT SOCIAL FACTOR 2854 01:42:12,400 --> 01:42:14,880 MEASUREMENT THAT WAY. 2855 01:42:14,880 --> 01:42:17,200 JUST SO WE ARE ALL ON THE SAME 2856 01:42:17,200 --> 01:42:20,400 PAGE ABOUT DEFINITION, A 2857 01:42:20,400 --> 01:42:21,600 PHENOTYPE OF PARTICULAR 2858 01:42:21,600 --> 01:42:22,800 PHENOTYPE IS REPRESENTATION OF 2859 01:42:22,800 --> 01:42:24,000 PATIENT CONDITIONS OR 2860 01:42:24,000 --> 01:42:25,320 CHARACTERISTICS ATTAINED FROM 2861 01:42:25,320 --> 01:42:27,000 EHR DATA BY COMBINING A SET OF 2862 01:42:27,000 --> 01:42:29,440 DEFINED VARIABLES AND LOGICAL 2863 01:42:29,440 --> 01:42:29,760 EXPRESSIONS. 2864 01:42:29,760 --> 01:42:31,040 THE BEST EXAMPLE THAT I THINK 2865 01:42:31,040 --> 01:42:33,760 PEOPLE CAN RESONATE MOST WITH IS 2866 01:42:33,760 --> 01:42:34,000 DIABETES. 2867 01:42:34,000 --> 01:42:35,600 SOMEBODY WHO IS -- HAS BEEN 2868 01:42:35,600 --> 01:42:37,600 DIAGNOSED WITH DIABETES IS ONLY 2869 01:42:37,600 --> 01:42:39,080 ONE FRACTION OF THE ENTIRE 2870 01:42:39,080 --> 01:42:39,800 POPULATION WITH DIABETES. 2871 01:42:39,800 --> 01:42:43,000 WE KNOW SOME PEOPLE DON'T HAVE 2872 01:42:43,000 --> 01:42:45,600 THAT ICD 10 CODE MAY STILL HAVE 2873 01:42:45,600 --> 01:42:47,240 AN A 1C OUT OF RANGE OR MAYBE ON 2874 01:42:47,240 --> 01:42:48,440 MEDICATIONS THAT ARE INDICATIVE 2875 01:42:48,440 --> 01:42:50,360 OF DIABETES. 2876 01:42:50,360 --> 01:42:53,760 SO WE CAN USE THOSE OTHER 2877 01:42:53,760 --> 01:42:54,360 INFORMATION; MEDICATIONS, LAB 2878 01:42:54,360 --> 01:42:56,760 VALUES, PROCEDURES, THAT WOULD 2879 01:42:56,760 --> 01:42:58,000 HELP ROUND OUT AND GET THAT 2880 01:42:58,000 --> 01:43:01,240 COMPLETE PICTURE OF WHO'S 2881 01:43:01,240 --> 01:43:02,320 ACTUALLY SUFFERING FROM A 2882 01:43:02,320 --> 01:43:02,680 CONDITION. 2883 01:43:02,680 --> 01:43:04,320 AND WE PLAN TO USE THAT FOR 2884 01:43:04,320 --> 01:43:06,160 SOCIAL RISK FACTORS. 2885 01:43:06,160 --> 01:43:08,120 SO HOW CAN WE BEST MEASURE 2886 01:43:08,120 --> 01:43:09,640 SOCIAL RISK FACTORS? 2887 01:43:09,640 --> 01:43:11,200 THAT IS WHAT WE ARE BUILDING ON 2888 01:43:11,200 --> 01:43:11,360 NOW. 2889 01:43:11,360 --> 01:43:14,520 WE HAVE SURVEYS ICD 10 CODES AND 2890 01:43:14,520 --> 01:43:16,200 OUR GROUP IS PROPOSING A 2891 01:43:16,200 --> 01:43:17,000 COMPUTABLE PHENOTYPE APPROACH. 2892 01:43:17,000 --> 01:43:18,200 THAT'S WHAT WE ARE WORKING ON 2893 01:43:18,200 --> 01:43:19,720 RIGHT NOW. 2894 01:43:19,720 --> 01:43:21,120 HERE IN INDIANA. 2895 01:43:21,120 --> 01:43:24,000 WE ARE IN PROCESS FOR DATA -- A 2896 01:43:24,000 --> 01:43:25,600 LITTLE BIT OF RESULTS. 2897 01:43:25,600 --> 01:43:27,480 WE ARE COLLECTING 1500 SURVEYS 2898 01:43:27,480 --> 01:43:29,360 OF ED PATIENTS IN INDIANA. 2899 01:43:29,360 --> 01:43:33,560 WE ARE WORKING WITH OUR HEALTH 2900 01:43:33,560 --> 01:43:37,600 PARTNERS, A 330 BED SAFETY NET 2901 01:43:37,600 --> 01:43:39,720 HOSPITAL WITH 10 FQAC SITES, 2902 01:43:39,720 --> 01:43:41,800 ADULTS ONLY FOR THIS STUDY. 2903 01:43:41,800 --> 01:43:43,800 ALSO COLLECTING 3,000 STUDIES OF 2904 01:43:43,800 --> 01:43:44,800 PRIMARY CARE PATIENTS HERE IN 2905 01:43:44,800 --> 01:43:46,920 INDIANA AND AT THE UNIVERSITY OF 2906 01:43:46,920 --> 01:43:50,280 FLORIDA. 2907 01:43:50,280 --> 01:43:51,720 WE HAD BEEN LOOKING AT THE 2908 01:43:51,720 --> 01:43:52,680 PREVALENCE OF PATIENTS WITH 2909 01:43:52,680 --> 01:43:54,320 SOCIAL FACTORS AND USING THESE 2910 01:43:54,320 --> 01:43:57,640 GOLD STANDARD -- CAN'T CALL THEM 2911 01:43:57,640 --> 01:43:59,000 GOLD STANDARD, INDEPENDENTLY 2912 01:43:59,000 --> 01:44:00,480 ASSESSED SURVEY INSTRUMENTS TO 2913 01:44:00,480 --> 01:44:02,400 BE OUR STANDARD FOR REFERENCE 2914 01:44:02,400 --> 01:44:02,720 GOING FORWARD. 2915 01:44:02,720 --> 01:44:04,720 SO WHAT ARE WE LOOKING AT WHEN 2916 01:44:04,720 --> 01:44:06,880 WE SEE OUT INTO OUR COMMUNITY? 2917 01:44:06,880 --> 01:44:09,600 WHAT CHALLENGES ARE COMING 2918 01:44:09,600 --> 01:44:12,840 ACROSS IN THE ED SIDE A COUPLE 2919 01:44:12,840 --> 01:44:13,800 OF HIGHLIGHTS. 2920 01:44:13,800 --> 01:44:15,960 THERE IS A SIMPLE QUESTION, IN 2921 01:44:15,960 --> 01:44:18,080 12 MONTHS ARE YOU WORRIED YOUR 2922 01:44:18,080 --> 01:44:19,480 FOOD WOULD RUN OUT BEFORE YOU 2923 01:44:19,480 --> 01:44:21,160 GOT MONEY TO BUY MORE. 2924 01:44:21,160 --> 01:44:22,320 FOOD INSECURITY, THE TWO COLUMNS 2925 01:44:22,320 --> 01:44:24,000 IN RED IN CONTRAST TO BLUE ARE 2926 01:44:24,000 --> 01:44:26,000 INDICATIONS OF BEING AT RISK FOR 2927 01:44:26,000 --> 01:44:27,400 FOOT INSECURITY BY THIS 2928 01:44:27,400 --> 01:44:28,800 QUESTION. 2929 01:44:28,800 --> 01:44:30,120 YOU CAN SEE IN ED WE HAVE GOT 2930 01:44:30,120 --> 01:44:33,280 NEARLY HALF OF OUR PATIENTS ARE 2931 01:44:33,280 --> 01:44:34,840 ADULT PATIENTS ARE REPORTING 2932 01:44:34,840 --> 01:44:35,040 THIS. 2933 01:44:35,040 --> 01:44:37,280 THIS IS GOING ON SINCE LAST JULY 2934 01:44:37,280 --> 01:44:38,920 SO WE ARE STILL IN THE PANDEMIC 2935 01:44:38,920 --> 01:44:40,680 PERIOD ON SOME OF THIS DATA 2936 01:44:40,680 --> 01:44:41,000 COLLECTION. 2937 01:44:41,000 --> 01:44:42,040 WHEN WE ASK ABOUT A TIME WHEN 2938 01:44:42,040 --> 01:44:44,240 THEY WERE NOT ABLE TO PAY THE 2939 01:44:44,240 --> 01:44:46,120 MORTGAGE OR RENT ON TIME, 2940 01:44:46,120 --> 01:44:48,080 INDICATER ONE INDICATOR HOUSING 2941 01:44:48,080 --> 01:44:50,240 INSTABILITY, IT WAS A THIRD OF 2942 01:44:50,240 --> 01:44:51,360 THE POPULATION. 2943 01:44:51,360 --> 01:44:54,480 WHEN WE GO FORWARD LOOKING AT 2944 01:44:54,480 --> 01:44:56,120 JUST GENERAL FINANCE QUESTIONS 2945 01:44:56,120 --> 01:44:59,000 LIKE OVERALL FINANCIAL WELL 2946 01:44:59,000 --> 01:45:04,760 BEING, WE SEE THAT 16% OF ADULTS 2947 01:45:04,760 --> 01:45:05,800 ARE REPORTING CHALLENGES PAYING 2948 01:45:05,800 --> 01:45:07,920 FOR FOOD HOUSING MEDICAL CARE, 2949 01:45:07,920 --> 01:45:12,440 HEATING, REALLY BASIC STUFF. 2950 01:45:12,440 --> 01:45:15,720 WE SEE A LACK OF TRANSPORTATION 2951 01:45:15,720 --> 01:45:16,360 AND TRANSPORTATION BARRIER ABOUT 2952 01:45:16,360 --> 01:45:17,240 A QUARTER OF ADULT PATIENTS IN 2953 01:45:17,240 --> 01:45:18,920 THE ED ARE REPORTING THIS AS 2954 01:45:18,920 --> 01:45:22,160 WELL. 2955 01:45:22,160 --> 01:45:24,920 AND WE ALSO REPORT QUITE A BIT 2956 01:45:24,920 --> 01:45:30,080 OF HISTORY WITH LEGAL ISSUES. 2957 01:45:30,080 --> 01:45:32,320 THIS IS NOT CIVIL ISSUES BUT 2958 01:45:32,320 --> 01:45:34,440 CRIMINAL ISSUES, 10% OF THE 2959 01:45:34,440 --> 01:45:35,680 POPULATION IS REPORTING THIS IN 2960 01:45:35,680 --> 01:45:37,520 A VOLUNTARY BASED SURVEY. 2961 01:45:37,520 --> 01:45:40,280 SO WHAT ARE WE DOING WITH THESE 2962 01:45:40,280 --> 01:45:41,200 THINGS WE ARE COLLECTING 2963 01:45:41,200 --> 01:45:42,800 VALIDATED SURVEYS, COLLECTING 2964 01:45:42,800 --> 01:45:44,520 THEM IN THE ED SETTING AND IN 2965 01:45:44,520 --> 01:45:46,120 PRIMARY CARE. 2966 01:45:46,120 --> 01:45:49,320 AND THEY WILL BE OUR INDEPENDENT 2967 01:45:49,320 --> 01:45:49,880 CRITERIA. 2968 01:45:49,880 --> 01:45:52,440 WE HAVE IN PARALLEL SET UP THE 2969 01:45:52,440 --> 01:45:53,880 IDENTIFICATION AND ASSESSMENT OF 2970 01:45:53,880 --> 01:45:56,000 POTENTIAL DATA ELEMENTS TO USE 2971 01:45:56,000 --> 01:45:56,800 IN OUR PHENOTYPE CONSTRUCTION, 2972 01:45:56,800 --> 01:45:59,000 WE HAD AN EXTRA PANEL TOGETHER 2973 01:45:59,000 --> 01:46:02,000 OF PEOPLE WITH EXPERTISE IN 2974 01:46:02,000 --> 01:46:04,000 SOCIAL DETERMINANTS, IN HEALTH 2975 01:46:04,000 --> 01:46:05,880 INFORMATION EXCHANGE, EHR DATA, 2976 01:46:05,880 --> 01:46:08,400 TO TALK ABOUT WHAT DATA ELEMENTS 2977 01:46:08,400 --> 01:46:12,120 COULD BE INFORMATIVE TO SOCIAL 2978 01:46:12,120 --> 01:46:13,800 DETERMINANT MEASUREMENT. 2979 01:46:13,800 --> 01:46:14,440 THEY IDENTIFIED 89 STRUCTURAL 2980 01:46:14,440 --> 01:46:16,920 DATA ELEMENTS THAT ARE ALREADY 2981 01:46:16,920 --> 01:46:18,960 COLLECTED HER, COULD BE USED IN 2982 01:46:18,960 --> 01:46:22,200 VARIOUS WAYS, TO ESTABLISH SOME 2983 01:46:22,200 --> 01:46:24,800 MEASURES OF SOCIAL RISK. 2984 01:46:24,800 --> 01:46:25,960 THAT STUDY IS JUST BEEN 2985 01:46:25,960 --> 01:46:27,280 PUBLISHED IN THE AMERICAN 2986 01:46:27,280 --> 01:46:28,800 JOURNAL OF MANAGED CARE. 2987 01:46:28,800 --> 01:46:30,800 WE HAVE BEEN WORKING ON THE NLP 2988 01:46:30,800 --> 01:46:33,000 SIDE, WE HAVE BEEN DOING NLP 2989 01:46:33,000 --> 01:46:34,640 DEVELOPMENT FOR HOUSING 2990 01:46:34,640 --> 01:46:35,800 FINANCIAL UNEMPLOYMENT AND 2991 01:46:35,800 --> 01:46:37,360 INCARCERATION HISTORY AND FOOD 2992 01:46:37,360 --> 01:46:38,320 INSECURITY. 2993 01:46:38,320 --> 01:46:39,440 WE VALIDATE THESE THROUGH CHART 2994 01:46:39,440 --> 01:46:42,640 REVIEW AND PRESENTED THIS AT THE 2995 01:46:42,640 --> 01:46:44,280 AMERICAN MEDICAL INFORMATICS 2996 01:46:44,280 --> 01:46:45,760 ASSOCIATION ANNUAL SYMPOSIUM. 2997 01:46:45,760 --> 01:46:47,680 SO ACROSS THE BOARD WHAT DO WE 2998 01:46:47,680 --> 01:46:47,840 GOT? 2999 01:46:47,840 --> 01:46:51,240 A LARGE SET OF SURVEYS, WE ARE 3000 01:46:51,240 --> 01:46:51,800 COLLECTING BOTH SUFFICIENT 3001 01:46:51,800 --> 01:46:56,320 SURVEYS IN THE EHR AND IN 3002 01:46:56,320 --> 01:46:57,440 INDEPENDENT SURVEY INSTRUMENT 3003 01:46:57,440 --> 01:47:00,160 STAND AS ITS OWN INDEPENDENT 3004 01:47:00,160 --> 01:47:02,240 ASSESSMENT OF SOCIAL FACTOR 3005 01:47:02,240 --> 01:47:02,520 STANDING. 3006 01:47:02,520 --> 01:47:04,400 WE HAVE OUR DATA ELEMENTS FOR 3007 01:47:04,400 --> 01:47:05,240 COMPUTABLE PHENOTYPES AND WE 3008 01:47:05,240 --> 01:47:08,240 HAVE AN NLP ENGINE AND WE CAN 3009 01:47:08,240 --> 01:47:09,400 IMPLY TO EXTRACT OUT OF NOTES. 3010 01:47:09,400 --> 01:47:11,200 SO THESE ARE PLANNED ANALYSIS. 3011 01:47:11,200 --> 01:47:15,000 T WE ARE DOING THE HEAD TO HEAD 3012 01:47:15,000 --> 01:47:16,080 BATTLE ROYALE. 3013 01:47:16,080 --> 01:47:18,840 WE ARE TAKING EHR BASED SOCIAL 3014 01:47:18,840 --> 01:47:22,080 RISK FACTORS SURVEYS, NLP 3015 01:47:22,080 --> 01:47:24,000 DEVELOP PHENOTYPES AND COMPARING 3016 01:47:24,000 --> 01:47:24,520 PSYCHOMETRIC PROPERTIESES. 3017 01:47:24,520 --> 01:47:27,360 WE WILL COMPARE THEIR PREDICTIVE 3018 01:47:27,360 --> 01:47:28,920 ABILITY, ASSESS THE BIAS THAT 3019 01:47:28,920 --> 01:47:31,000 MAY BE IN PRESENT IN ANY OF 3020 01:47:31,000 --> 01:47:33,320 THESE MEASURES USING MACHINE 3021 01:47:33,320 --> 01:47:34,880 LEARNING AND AI TECHNIQUES. 3022 01:47:34,880 --> 01:47:37,160 WE ARE ALSO DEVELOPING 3023 01:47:37,160 --> 01:47:38,360 PREDICTIVE MODELS FOR SOCIAL 3024 01:47:38,360 --> 01:47:40,000 RISK FACTORS IN THE ED 3025 01:47:40,000 --> 01:47:40,960 UNDERSTANDING HOW WE CAN 3026 01:47:40,960 --> 01:47:44,320 LEVERAGE THIS DATA TO PREDICT 3027 01:47:44,320 --> 01:47:46,440 WHO NEEDS RISK FACTOR 3028 01:47:46,440 --> 01:47:47,760 INTERVENTIONS, KIND OF A TWO 3029 01:47:47,760 --> 01:47:48,880 STAGE SCREENING APPROACH TO MOVE 3030 01:47:48,880 --> 01:47:49,720 FORWARD IN THAT WAY. 3031 01:47:49,720 --> 01:47:52,480 WE ARE LOOKING BOTH AT PATIENT 3032 01:47:52,480 --> 01:47:53,080 PROVIDER ACCEPTABILITY BECAUSE 3033 01:47:53,080 --> 01:47:54,880 IT IS A VERY DIFFERENT TYPE OF 3034 01:47:54,880 --> 01:47:56,200 SCREENING APPROACH, ALGORITHMIC. 3035 01:47:56,200 --> 01:47:58,120 WE ARE LOOKING FOR PERFORMANCE 3036 01:47:58,120 --> 01:48:01,720 AND ALSO BE ASSESSING BIAS IN 3037 01:48:01,720 --> 01:48:03,400 THAT WAY AS WELL. 3038 01:48:03,400 --> 01:48:05,760 I DIDN'T START WITH THIS BUT 3039 01:48:05,760 --> 01:48:07,400 THIS IS THE EFFORTS OF A LOT OF 3040 01:48:07,400 --> 01:48:08,320 DIFFERENT PEOPLE, I WANT TO 3041 01:48:08,320 --> 01:48:10,600 THANK MY CO-AUTHORS HELPING ME 3042 01:48:10,600 --> 01:48:13,680 ON THIS PROJECT, OUR WORK HAS 3043 01:48:13,680 --> 01:48:17,280 BEEN SUPPORTED BOTH BY OUR CTSI 3044 01:48:17,280 --> 01:48:19,400 WHICH IS FUNDED BY NIH HERE ON 3045 01:48:19,400 --> 01:48:21,960 CAMPUS AS WELL BY COUPLE OF 3046 01:48:21,960 --> 01:48:23,920 GRANTS FROM AHRQ. 3047 01:48:23,920 --> 01:48:26,000 SO AS I SAID WE ARE THINKING 3048 01:48:26,000 --> 01:48:27,600 ABOUT ALL THESE THINGS IN 3049 01:48:27,600 --> 01:48:28,800 PRELIMINARY STEPS AROUND LARGER 3050 01:48:28,800 --> 01:48:30,400 STUDIES AROUND SURVEYS THINKING 3051 01:48:30,400 --> 01:48:32,920 ABOUT ROLE OF NLP AND TEXT, 3052 01:48:32,920 --> 01:48:36,880 STRUCTURED DATA AND POTENTIAL OF 3053 01:48:36,880 --> 01:48:37,640 COMPUTABLE PHENOTYPES. 3054 01:48:37,640 --> 01:48:38,920 IN LOOKING AT BETTER APPROACHES 3055 01:48:38,920 --> 01:48:48,040 TO ME MEASUREMENT OF SOCIAL RISK 3056 01:48:48,040 --> 01:48:48,520 FACTOR INFORMATION. 3057 01:48:48,520 --> 01:48:54,120 THANK YOU ALL. 3058 01:48:54,120 --> 01:48:56,360 >> ALL RIGHT. 3059 01:48:56,360 --> 01:48:58,720 THANK YOU SO MUCH. 3060 01:48:58,720 --> 01:49:00,720 I'M JUST NOW GOING TO TURN THIS 3061 01:49:00,720 --> 01:49:06,680 OVER TO OUR NEXT SPEAKER. 3062 01:49:06,680 --> 01:49:08,000 DR. MCCARTHY, CAN YOU SEE THE 3063 01:49:08,000 --> 01:49:08,320 SLIDES? 3064 01:49:08,320 --> 01:49:09,400 >> I CAN, THANK YOU. 3065 01:49:09,400 --> 01:49:12,520 >> GREAT. 3066 01:49:12,520 --> 01:49:13,400 >> THANK YOU VERY MUCH. 3067 01:49:13,400 --> 01:49:15,640 THANK YOU FOR THE INVITATION TO 3068 01:49:15,640 --> 01:49:17,840 BE PART OF THIS ROUND TABLE. 3069 01:49:17,840 --> 01:49:20,520 AS DR. VEST NICELY SAID IT IS 3070 01:49:20,520 --> 01:49:22,880 INTERESTING AND INFORMATIVE, 3071 01:49:22,880 --> 01:49:23,720 REALLY ENJOYING IT. 3072 01:49:23,720 --> 01:49:25,920 TODAY I'M GOING TO DESCRIBE A 3073 01:49:25,920 --> 01:49:28,000 STUDY THAT WE CONDUCTED THAT WAS 3074 01:49:28,000 --> 01:49:29,800 FUNDED BY THE NATIONAL INSTITUTE 3075 01:49:29,800 --> 01:49:32,400 OF MINORITY HEALTH AND HEALTH 3076 01:49:32,400 --> 01:49:36,800 DISPARITIES. 3077 01:49:36,800 --> 01:49:41,400 FIRST I WOULD LIKE TO 3078 01:49:41,400 --> 01:49:44,320 ACKNOWLEDGE MY STUDY TEAM 3079 01:49:44,320 --> 01:49:47,680 MEMBERS AND ALSO JUST START OUT 3080 01:49:47,680 --> 01:49:50,320 BY DESCRIBING THE FRAMEWORK THAT 3081 01:49:50,320 --> 01:49:52,280 GUIDES OUR RESEARCH. 3082 01:49:52,280 --> 01:49:54,960 I'M HOPING THIS SLIDE IS 3083 01:49:54,960 --> 01:49:58,400 FAMILIAR TO EVERYONE AND IT IS 3084 01:49:58,400 --> 01:50:00,400 THE WHO MODEL CONCEPTUAL MODEL 3085 01:50:00,400 --> 01:50:02,560 OF SOCIAL DETERMINANTS OF 3086 01:50:02,560 --> 01:50:03,040 HEALTH. 3087 01:50:03,040 --> 01:50:06,680 I THINK WHAT I LIKE MOST ABOUT 3088 01:50:06,680 --> 01:50:09,000 IT IS IT KIND OF SEPARATES 3089 01:50:09,000 --> 01:50:09,560 STRUCTURAL DETERMINANTS OF 3090 01:50:09,560 --> 01:50:10,480 HEALTH FROM INTERMEDIARY 3091 01:50:10,480 --> 01:50:14,400 DETERMINANTS OF HEALTH. 3092 01:50:14,400 --> 01:50:15,920 THE MOST UPSTREAM DETERMINANTS 3093 01:50:15,920 --> 01:50:18,920 OF HEALTH ARE THESE STRUCTURAL 3094 01:50:18,920 --> 01:50:20,160 DETERMINANTS, THAT ARE PUBLIC 3095 01:50:20,160 --> 01:50:22,960 POLICIES AND VALUES AND 3096 01:50:22,960 --> 01:50:23,720 PROGRAMS. 3097 01:50:23,720 --> 01:50:26,280 THEY KIND OF DRIVE OUR -- WHERE 3098 01:50:26,280 --> 01:50:28,920 WE -- OUR SOCIOECONOMIC POSITION 3099 01:50:28,920 --> 01:50:29,600 IN SOCIETY. 3100 01:50:29,600 --> 01:50:32,440 THEN OUR OCCUPATION OR 3101 01:50:32,440 --> 01:50:33,440 EDUCATION. 3102 01:50:33,440 --> 01:50:36,400 THEN DETERMINANTS ARE 3103 01:50:36,400 --> 01:50:38,000 INTERMEDIATE DETERMINANTS OF 3104 01:50:38,000 --> 01:50:38,640 HEALTH, MATERIAL CIRCUMSTANCES 3105 01:50:38,640 --> 01:50:41,560 LIKE HOUSING AND FOOD 3106 01:50:41,560 --> 01:50:44,400 INSECURITY, HEALTH BEHAVIORS, 3107 01:50:44,400 --> 01:50:45,960 SOCIAL SUPPORTS. 3108 01:50:45,960 --> 01:50:48,920 THOSE ARE THE MORE PROXIMAL 3109 01:50:48,920 --> 01:50:49,760 INTERMEDIARY DETERMINANTS OF 3110 01:50:49,760 --> 01:50:51,200 WHAT DRIVE HEALTH DISPARITIES WE 3111 01:50:51,200 --> 01:50:54,600 SEEK IN THE CLINICAL SETTING. 3112 01:50:54,600 --> 01:50:59,000 SO I THINK ONE OF THE THINGS I 3113 01:50:59,000 --> 01:51:00,720 LOVE MOST ABOUT THE MODEL IS A 3114 01:51:00,720 --> 01:51:03,520 LOT OF US ARE TRYING TO ADDRESS 3115 01:51:03,520 --> 01:51:05,640 INTERMEDIARY DETERMINANTS OF 3116 01:51:05,640 --> 01:51:08,800 HEALTH LIKE HOUSING INSTABILITY 3117 01:51:08,800 --> 01:51:09,920 AND FOOD INSECURITY. 3118 01:51:09,920 --> 01:51:11,840 WE HAVE TO ALWAYS KEEP IN MIND 3119 01:51:11,840 --> 01:51:14,400 THAT WE WANT TO MOVE EVEN 3120 01:51:14,400 --> 01:51:19,000 FURTHER UPSTREAM, IT IS JUST AS 3121 01:51:19,000 --> 01:51:20,400 IMPORTANT TO ADDRESS THE 3122 01:51:20,400 --> 01:51:22,000 UPSTREAM FACTORS THAT DETERMINE 3123 01:51:22,000 --> 01:51:25,360 NOSE INTERMEDIARY DETERMINANTS. 3124 01:51:25,360 --> 01:51:26,800 FINALLY IN THIS SYSTEM YOU CAN 3125 01:51:26,800 --> 01:51:28,680 SEE THE HEALTHCARE SYSTEM WHERE 3126 01:51:28,680 --> 01:51:29,880 -- WHICH IS WHAT WE ARE TALKING 3127 01:51:29,880 --> 01:51:33,360 ABOUT TODAY HOW DOES THAT 3128 01:51:33,360 --> 01:51:34,840 INFLUENCE THE RELATIONSHIP 3129 01:51:34,840 --> 01:51:36,320 BETWEEN SOCIAL DETERMINANTS AND 3130 01:51:36,320 --> 01:51:37,680 HEALTH AND IT IS REALLY SEEN AS 3131 01:51:37,680 --> 01:51:40,960 A MODERATOR, TO ADDRESS MORE SO 3132 01:51:40,960 --> 01:51:42,920 THE INTERMEDIARY DETERMINANTS OF 3133 01:51:42,920 --> 01:51:43,600 HEALTH. 3134 01:51:43,600 --> 01:51:45,160 -- ON HEALTH. 3135 01:51:45,160 --> 01:51:48,440 SO WITH THIS FOUNDATION IN MIND, 3136 01:51:48,440 --> 01:51:52,880 LET ME DESCRIBE THE STUDY WE 3137 01:51:52,880 --> 01:51:54,480 CONDUCTED. 3138 01:51:54,480 --> 01:51:56,400 OVER ABOUT 15 MONTH PERIOD 3139 01:51:56,400 --> 01:52:00,560 STARTING IN SEPTEMBER OF 2017 WE 3140 01:52:00,560 --> 01:52:04,040 CONDUCTED A PROSPECTIVE COHORT 3141 01:52:04,040 --> 01:52:06,520 STUDY WHERE WE ENROLLED ALMOST 9 3142 01:52:06,520 --> 01:52:10,680 HOW ADULT MEDICAID PATIENTS. 3143 01:52:10,680 --> 01:52:12,240 WHEN THEY PRESENTED AT A 3144 01:52:12,240 --> 01:52:14,240 HEALTHCARE SETTING EITHER AT 3145 01:52:14,240 --> 01:52:16,800 COUPLE OF EMERGENCY DEPARTMENTS, 3146 01:52:16,800 --> 01:52:22,800 PRIMARY CARE CLINIC, OBGYN 3147 01:52:22,800 --> 01:52:23,000 SETTING. 3148 01:52:23,000 --> 01:52:23,240 CLINIC. 3149 01:52:23,240 --> 01:52:26,920 ALL THEY HAD TO BE WAS INSURED 3150 01:52:26,920 --> 01:52:28,560 BY DEPARTMENT OF DISTRICT OF 3151 01:52:28,560 --> 01:52:31,000 COLUMBIA MEDICAID PROGRAM AT THE 3152 01:52:31,000 --> 01:52:31,200 TIME. 3153 01:52:31,200 --> 01:52:32,480 WHEN THEY CONSENTED THEY WERE 3154 01:52:32,480 --> 01:52:34,160 INTERVIEWED BY A RESEARCH 3155 01:52:34,160 --> 01:52:35,480 ASSISTANT, ESSENTIALLY DID A 3156 01:52:35,480 --> 01:52:37,400 SOCIAL DETERMINANT OF HEALTH 3157 01:52:37,400 --> 01:52:40,840 ASSESSMENT AND THEY ALSO AGREED 3158 01:52:40,840 --> 01:52:42,520 TO TWO FOLLOW-UP INTERVIEWS 6 3159 01:52:42,520 --> 01:52:43,440 AND 12 MONTHS LATER. 3160 01:52:43,440 --> 01:52:48,800 THEY ALLOWED US TO OBTAIN A COPY 3161 01:52:48,800 --> 01:52:52,040 OF MEDICAID CLAIMS DATA, IT IS 3162 01:52:52,040 --> 01:52:54,200 ENCOMPASSINGK HEALTHCARE VISITS, 3163 01:52:54,200 --> 01:52:55,800 COSTS PRESCRIPTION DRUGS NURSING 3164 01:52:55,800 --> 01:52:57,640 HOME, WHATEVER RELATED 3165 01:52:57,640 --> 01:52:58,320 HEALTHCARE INCLUDING EMERGENCY 3166 01:52:58,320 --> 01:52:59,680 DEPARTMENTSMENT AND WE GOT THE 3167 01:52:59,680 --> 01:53:01,440 CLAIMS DATA FOR FOUR YEAR 3168 01:53:01,440 --> 01:53:03,480 PERIOD, TWO YEARS PRIOR AND TWO 3169 01:53:03,480 --> 01:53:04,640 YEARS POST WHEN THEY ENROLLED IN 3170 01:53:04,640 --> 01:53:08,280 STUDY. 3171 01:53:08,280 --> 01:53:09,360 SO ESSENTIALLY WHAT I WILL SHOW 3172 01:53:09,360 --> 01:53:10,800 YOU TODAY IS A COMBINATION OF 3173 01:53:10,800 --> 01:53:12,920 THE INTERVIEW DATA AND THE 3174 01:53:12,920 --> 01:53:14,360 CLAIMS DATA. 3175 01:53:14,360 --> 01:53:18,640 YOU CAN SEE FROM THIS SLIDE, 3176 01:53:18,640 --> 01:53:22,640 THAT WE ASK PARTICIPANTS ABOUT 3177 01:53:22,640 --> 01:53:25,880 NUMBER OF STRUCTURAL AND 3178 01:53:25,880 --> 01:53:27,000 INTERMEDIARY DETERMINANTS OF 3179 01:53:27,000 --> 01:53:27,600 HEALTH. 3180 01:53:27,600 --> 01:53:29,600 DID THEY WORK, HOW MUCH 3181 01:53:29,600 --> 01:53:32,360 EDUCATION HAVE THEY OBTAINED. 3182 01:53:32,360 --> 01:53:34,880 LOT OF QUESTIONS ABOUT HOUSING, 3183 01:53:34,880 --> 01:53:38,360 FOOD INSECURITY, TROUBLE PAYING 3184 01:53:38,360 --> 01:53:41,480 DIFFERENT KINDS OF BILLS, HEALTH 3185 01:53:41,480 --> 01:53:42,800 BEHAVIORS, VARIOUS PSYCHOSOCIAL 3186 01:53:42,800 --> 01:53:46,560 SUPPORTS AND WE ASKED ABOUT 3187 01:53:46,560 --> 01:53:48,360 SOCIAL SERVICE USE LIKE THEY 3188 01:53:48,360 --> 01:53:51,400 RECEIVE FOOD STAMPS HOUSING 3189 01:53:51,400 --> 01:53:53,200 SUBSIDIES, THE CLAIMS DATA GAVE 3190 01:53:53,200 --> 01:53:57,680 US A LOT OF INSIGHT INTO 3191 01:53:57,680 --> 01:53:58,960 HEALTHCARE UTILIZATION AND 3192 01:53:58,960 --> 01:54:06,360 COSTS. 3193 01:54:06,360 --> 01:54:08,320 JUST TO DESCRIBE THE SAMPLE 3194 01:54:08,320 --> 01:54:10,400 BEFORE YOU, 76% OF MEDICAID 3195 01:54:10,400 --> 01:54:12,080 PARTICIPANTS WERE ENROLLED IN A 3196 01:54:12,080 --> 01:54:13,880 MEDICAID MANAGED CARE PLAN 3197 01:54:13,880 --> 01:54:16,840 VERSUS A FEE FOR SERVICE. 3198 01:54:16,840 --> 01:54:18,920 AND 82% HAD BEEN CONTINUOUSLY 3199 01:54:18,920 --> 01:54:21,400 ENROLLED IN MEDICAID FOR THE TWO 3200 01:54:21,400 --> 01:54:23,400 YEARS PRIOR TO DAY OF STUDY 3201 01:54:23,400 --> 01:54:24,800 ENROLLMENT BECAUSE WE HAD ALL 3202 01:54:24,800 --> 01:54:27,160 THE CLAIMS AND ELIGIBILITY 3203 01:54:27,160 --> 01:54:28,760 FILES. 3204 01:54:28,760 --> 01:54:31,440 TWO-THIRDS WERE FEMALE, 90% WERE 3205 01:54:31,440 --> 01:54:32,440 BLACK. 3206 01:54:32,440 --> 01:54:35,960 51% REPORTED WORKING AT THE TIME 3207 01:54:35,960 --> 01:54:38,600 OF ENROLLMENT, AND LESS THAN 20% 3208 01:54:38,600 --> 01:54:42,280 HAD NOT YET COMPLETED HIGH 3209 01:54:42,280 --> 01:54:42,520 SCHOOL. 3210 01:54:42,520 --> 01:54:46,920 41% SMOKED. 3211 01:54:46,920 --> 01:54:48,480 AND REPORTED THEY HAD BEEN IN A 3212 01:54:48,480 --> 01:54:49,760 RELATIONSHIP WITH SOMEONE WHO 3213 01:54:49,760 --> 01:54:52,040 HAD THREATEN THEM OR PHYSICALLY 3214 01:54:52,040 --> 01:54:52,320 HURT THEM. 3215 01:54:52,320 --> 01:54:54,400 WE HAD A HIGH PREVALENCE OF FOOD 3216 01:54:54,400 --> 01:54:56,320 INSECURITY IN THE SAMPLE, 3217 01:54:56,320 --> 01:55:01,320 TROUBLE PAYING AT LEAST ONE BILL 3218 01:55:01,320 --> 01:55:02,320 WE EWE THE QUESTION FROM VA 3219 01:55:02,320 --> 01:55:04,040 ABOUT ARE YOU CONCERNED IN THE 3220 01:55:04,040 --> 01:55:08,000 NEXT TWO MONTHS YOU MAY NOT HAVE 3221 01:55:08,000 --> 01:55:11,480 HOUSING IN 22% SAID YES. 3222 01:55:11,480 --> 01:55:13,000 YOU CAN SEE 48% REPORTED 3223 01:55:13,000 --> 01:55:16,760 RECEIVING FOOD STAMPS AND 30% 3224 01:55:16,760 --> 01:55:22,920 REPORTED HOUSING ASSISTANCE. 3225 01:55:22,920 --> 01:55:25,800 SO WE MEASURED A VARIETY OF 3226 01:55:25,800 --> 01:55:27,000 SOCIAL DETERMINANTS OF HEALTH. 3227 01:55:27,000 --> 01:55:30,320 ONE OF THE ISSUES PREVIOUS 3228 01:55:30,320 --> 01:55:31,560 SPEAKERS ALLUDED TO WAS THAT A 3229 01:55:31,560 --> 01:55:33,920 LOT OF SOCIAL DETERMINANTS ARE 3230 01:55:33,920 --> 01:55:35,480 CORRELATED WITH EACH OTHER, WITH 3231 01:55:35,480 --> 01:55:38,040 THE SUBJECT, A PERSON A PATIENT 3232 01:55:38,040 --> 01:55:39,240 REPORTS, HAVING HOUSING 3233 01:55:39,240 --> 01:55:40,960 INSTABILITY, ALSO GOING TO TELL 3234 01:55:40,960 --> 01:55:43,600 YOU THEY HAVE TROUBLE PAYING 3235 01:55:43,600 --> 01:55:46,200 RENT OR THEIR PHONE OR WHATEVER. 3236 01:55:46,200 --> 01:55:48,520 SO WE WERE TRYING TO DECIDE 3237 01:55:48,520 --> 01:55:50,920 WELL, IF YOU KIND OF LOOK AT ALL 3238 01:55:50,920 --> 01:55:53,200 THESE DETERMINANTS SEPARATELY, 3239 01:55:53,200 --> 01:55:57,000 YOU MIGHT MASK RELATIONSHIPS 3240 01:55:57,000 --> 01:55:58,440 THAT YOU WANT TO KNOW ABOUT, 3241 01:55:58,440 --> 01:56:00,960 WANT TO UNDERSTAND BETTER. 3242 01:56:00,960 --> 01:56:02,920 THIS SLIDE IS LIKE A HEAT MAP OF 3243 01:56:02,920 --> 01:56:06,640 CORRELATION AMONG THE DIFFERENT 3244 01:56:06,640 --> 01:56:08,320 SOCIAL DETERMINANTS MEASURED. 3245 01:56:08,320 --> 01:56:10,880 SO FOR EXAMPLE, IF SOMEONE 3246 01:56:10,880 --> 01:56:14,920 REPORTED TO US, THAT THEY USED 3247 01:56:14,920 --> 01:56:16,000 ELICIT DRUGS AND VERY MUCH 3248 01:56:16,000 --> 01:56:18,760 LIKELY TO TELL US THEY HAD A 3249 01:56:18,760 --> 01:56:22,600 HISTORY OF OF BEING IN JAIL OR 3250 01:56:22,600 --> 01:56:25,720 PRISON, THEY SMOKED. 3251 01:56:25,720 --> 01:56:26,120 THIS KEEFE THING. 3252 01:56:26,120 --> 01:56:28,800 WHAT WE DECIDED TO DO, IS USE 3253 01:56:28,800 --> 01:56:34,440 LATENT CLASS ANALYSIS. 3254 01:56:34,440 --> 01:56:35,680 WHICH GAVE ABILITY TO WHAT IT 3255 01:56:35,680 --> 01:56:38,880 DOES IS LOOK AT THE PATTERN OF 3256 01:56:38,880 --> 01:56:40,360 RESPONSES THE PARTICIPANTS HAVE 3257 01:56:40,360 --> 01:56:41,000 TO EACH QUESTION. 3258 01:56:41,000 --> 01:56:43,960 IT GROUPS PEOPLE THAT HAVE 3259 01:56:43,960 --> 01:56:45,400 SIMILAR RESPONSE PATTERNS AMONG 3260 01:56:45,400 --> 01:56:49,000 ALL THE QUESTIONS. 3261 01:56:49,000 --> 01:56:51,640 THAT YOU WANT TO GIVE THEM THIS 3262 01:56:51,640 --> 01:56:53,280 NEXT SLIDES SHOWS YOU THE USE 3263 01:56:53,280 --> 01:56:54,960 COME OF THAT. 3264 01:56:54,960 --> 01:56:57,280 WAS THE LATENT CLASS ANALYSIS, 3265 01:56:57,280 --> 01:57:01,120 IN OUR SAMPLE, IDENTIFIED FOUR 3266 01:57:01,120 --> 01:57:05,600 DISTINCT SOCIAL RISK CLASSES. 3267 01:57:05,600 --> 01:57:09,000 ALONG THIS X AXIS IS ALL THE 3268 01:57:09,000 --> 01:57:10,440 DIFFERENT SOCIAL DETERMINANTS 3269 01:57:10,440 --> 01:57:12,800 MEASURED AND ALONG THE Y AXIS IS 3270 01:57:12,800 --> 01:57:17,240 THE PREVALENCE OF THESE PROBLEMS 3271 01:57:17,240 --> 01:57:18,400 WITHIN EACH OF THE FOUR SOCIAL 3272 01:57:18,400 --> 01:57:22,240 RISK CLASSES. 3273 01:57:22,240 --> 01:57:24,240 FOR EXAMPLE AT THE TOP OF THE 3274 01:57:24,240 --> 01:57:29,120 BOX HERE I CALL THIS THE SOCIAL 3275 01:57:29,120 --> 01:57:30,960 RISK CLASS ONE, IS THE LABEL IS 3276 01:57:30,960 --> 01:57:32,640 THEY ARE EMPLOYED AND THEY HAVE 3277 01:57:32,640 --> 01:57:35,840 THE FEWEST SOCIAL RISKS IN 3278 01:57:35,840 --> 01:57:40,640 SAMPLE REPRESENTING 44% 3279 01:57:40,640 --> 01:57:41,000 PARTICIPANTS. 3280 01:57:41,000 --> 01:57:44,760 WHAT THEY ARE HIGHEST IN IS THEY 3281 01:57:44,760 --> 01:57:49,000 ARE NOT MARRIED NOR LIVING WITH 3282 01:57:49,000 --> 01:57:49,720 CHILDREN. 3283 01:57:49,720 --> 01:57:52,560 BUT THEIR UNEMPLOYMENT RATE IS 3284 01:57:52,560 --> 01:57:54,640 RELATIVELY LOW. 3285 01:57:54,640 --> 01:57:55,800 ONLY 26%. 3286 01:57:55,800 --> 01:57:58,000 YOU CAN SEE OTHER PEAKS THEY 3287 01:57:58,000 --> 01:58:01,480 HAVE FEW OTHER SOCIAL RISKS. 3288 01:58:01,480 --> 01:58:03,800 THE NEXT GROUP IS ALMOST SAME 3289 01:58:03,800 --> 01:58:04,000 LEVEL. 3290 01:58:04,000 --> 01:58:06,560 HIGHER LEVEL UNEMPLOYMENT BUT 3291 01:58:06,560 --> 01:58:10,880 STILL MORE THAN 50% EMPLOYED IN 3292 01:58:10,880 --> 01:58:11,960 THIS GROUP. 3293 01:58:11,960 --> 01:58:14,480 THEY ARE REPORTING A LOT OF 3294 01:58:14,480 --> 01:58:16,800 FINANCIAL STRAIN TROUBLE PAYING 3295 01:58:16,800 --> 01:58:20,720 PHONE, UTILITIES THEIR RENT. 3296 01:58:20,720 --> 01:58:22,200 THEY REPRESENT 20% OF OUR SYSTEM 3297 01:58:22,200 --> 01:58:25,800 BILL. 3298 01:58:25,800 --> 01:58:30,920 THE NEXT GROUP UNEMPLOYED AND -- 3299 01:58:30,920 --> 01:58:32,400 HAVE HIGHER UNEMPLOYMENT RATE, 3300 01:58:32,400 --> 01:58:36,840 UP TO 75, 76% UNEMPLOYED. 3301 01:58:36,840 --> 01:58:38,840 THEY ALSO HAVE HIGH SMOKING 3302 01:58:38,840 --> 01:58:41,320 RATE, 61%, THEY HAVE LIMITED 3303 01:58:41,320 --> 01:58:44,680 ACCESS TO THE INTERNET. 3304 01:58:44,680 --> 01:58:46,200 THIS GROUP REPORTED RECEIVING 3305 01:58:46,200 --> 01:58:48,720 THE MOST HOUSING ASSISTANCE, AND 3306 01:58:48,720 --> 01:58:51,920 FOOD STAMPS. 3307 01:58:51,920 --> 01:58:57,560 AND REPPED 27% OF OUR SAMPLE. 3308 01:58:57,560 --> 01:58:59,000 THE FINAL THE POOREST SOCIAL 3309 01:58:59,000 --> 01:59:01,680 RISK CLASS OR HIGHEST SOCIAL 3310 01:59:01,680 --> 01:59:04,040 RISK CLASS IS THIS LAST GROUP, 3311 01:59:04,040 --> 01:59:06,240 IT IS 9% OF OUR SAMPLE, THEY ARE 3312 01:59:06,240 --> 01:59:08,320 ALSO VERY HIGH RATE OF 3313 01:59:08,320 --> 01:59:09,760 UNEMPLOYMENT AND ALSO JUST HIGH 3314 01:59:09,760 --> 01:59:11,560 RATES OF A LOT OF OTHER SOCIAL 3315 01:59:11,560 --> 01:59:15,920 RISK FACTORS. 3316 01:59:15,920 --> 01:59:18,400 JUST TO GIVE YOU WHEN YOU DO 3317 01:59:18,400 --> 01:59:19,960 THIS ANALYSIS YOU JUST LOOKING 3318 01:59:19,960 --> 01:59:21,600 AT THE -- IT IS NOT AGAINST ANY 3319 01:59:21,600 --> 01:59:23,920 OUTCOMES YOU ARE LOOK AT THE 3320 01:59:23,920 --> 01:59:26,400 SOCIAL RISK PROFILES BASED ON 3321 01:59:26,400 --> 01:59:27,080 THE QUESTIONS. 3322 01:59:27,080 --> 01:59:30,280 IF YOU THEN LIKE -- HOW DOES 3323 01:59:30,280 --> 01:59:33,680 THIS CORRELATE TO FOR EXAMPLE 3324 01:59:33,680 --> 01:59:34,200 HEALTH CONDITIONS. 3325 01:59:34,200 --> 01:59:36,400 WE TOOK THE -- WE HAVE THE TWO 3326 01:59:36,400 --> 01:59:38,400 YEARS OF CLAIMS DATA PRIOR TO 3327 01:59:38,400 --> 01:59:39,920 STUDY ENROLLMENT SO WE TOOK ALL 3328 01:59:39,920 --> 01:59:44,200 OF THOSE ICD 10 CODES IN THE 3329 01:59:44,200 --> 01:59:45,800 CLAIMS, AND ABLE TO SAY 3330 01:59:45,800 --> 01:59:46,960 PREVALENCE OF DIFFERENT PEOPLE 3331 01:59:46,960 --> 01:59:48,040 DID THEY HAVE SOME KIND OF 3332 01:59:48,040 --> 01:59:49,840 MENTAL HEALTH CONDITION, DO THEY 3333 01:59:49,840 --> 01:59:51,720 HAVE A MUSCULOSKELETAL 3334 01:59:51,720 --> 01:59:52,000 CONDITION. 3335 01:59:52,000 --> 01:59:56,800 THESE ARE TOP THREE CATEGORIES. 3336 01:59:56,800 --> 01:59:58,600 YOU CAN SEE BY SOCIAL RISK 3337 01:59:58,600 --> 02:00:02,840 CLASS, AS A SOCIAL RISK BECOME 3338 02:00:02,840 --> 02:00:04,440 MORE OF THEM, IF YOU MOVE FROM 3339 02:00:04,440 --> 02:00:06,040 SOCIAL RISK CLASS ONE WITH 3340 02:00:06,040 --> 02:00:07,760 FEWEST TO SOCIAL RISK CLASS 3341 02:00:07,760 --> 02:00:11,080 FOUR, YOU SEE INCREASE IN THE 3342 02:00:11,080 --> 02:00:13,560 NUMBER OF MEDICAL CONDITIONS AND 3343 02:00:13,560 --> 02:00:17,000 ILLNESS SEVERITY THEY HAVE. 3344 02:00:17,000 --> 02:00:20,480 SIMILARLY,D IF YOU DO THE SAME 3345 02:00:20,480 --> 02:00:24,880 WITH COST, THIS IS TOTAL COST 3346 02:00:24,880 --> 02:00:25,160 PER MONTH. 3347 02:00:25,160 --> 02:00:27,880 AND WE TOOK -- WE AGGRAVATED 3348 02:00:27,880 --> 02:00:29,400 EVERYONE'S -- AGGREGATED COSTS 3349 02:00:29,400 --> 02:00:31,200 OVER TWO YEAR PERIOD AND DIVIDED 3350 02:00:31,200 --> 02:00:33,040 THEM INTO QUARTILES. 3351 02:00:33,040 --> 02:00:34,960 SO THIS IS THE PEOPLE IN THE 3352 02:00:34,960 --> 02:00:36,200 LOWEST QUARTILE ONE OR PEOPLE 3353 02:00:36,200 --> 02:00:41,360 WITH THE LOWEST COST PER MONTH. 3354 02:00:41,360 --> 02:00:43,560 TO THE MEDICAID PROGRAM AND 3355 02:00:43,560 --> 02:00:44,760 QUARTILE 4 REPRESENTS HIGHEST. 3356 02:00:44,760 --> 02:00:46,960 IF YOU LOOK AT THIS BY SOCIAL 3357 02:00:46,960 --> 02:00:52,200 RISK CLASS, FOR EXAMPLE, CLASS 3358 02:00:52,200 --> 02:00:53,320 1, SOCIAL RISK CLASS ONE IS MORE 3359 02:00:53,320 --> 02:00:54,560 LIKELY TO BE IN THE QUARTILE ONE 3360 02:00:54,560 --> 02:00:58,800 WHICH IS THE LOWEST MEDICAID 3361 02:00:58,800 --> 02:00:59,000 COST. 3362 02:00:59,000 --> 02:01:01,920 PEOPLE SOCIAL RISK CLASS 4 ARE 3363 02:01:01,920 --> 02:01:06,960 MORE LIKELY TO BE IN THE HIGHEST 3364 02:01:06,960 --> 02:01:09,640 MEDICAID SPENDING CATEGORY. 3365 02:01:09,640 --> 02:01:11,760 SO GOING FORWARD WHAT WE DECIDED 3366 02:01:11,760 --> 02:01:13,640 TO DO IS RATHER THAN LOOK AT 3367 02:01:13,640 --> 02:01:15,760 WHAT IS THE RELATIONSHIP BETWEEN 3368 02:01:15,760 --> 02:01:17,560 INDIVIDUAL SOCIAL DETERMINANTS 3369 02:01:17,560 --> 02:01:20,440 OF HEALTH ON ED VISITS, WE LOOK 3370 02:01:20,440 --> 02:01:23,320 AT HOW DO FOUR SOCIAL RISK CLASS 3371 02:01:23,320 --> 02:01:29,000 DO THEY INFLUENCE THE ED SR VISIT 3372 02:01:29,000 --> 02:01:29,440 RATE. 3373 02:01:29,440 --> 02:01:31,760 WHAT WE THEN DID WAS TOOK 3374 02:01:31,760 --> 02:01:33,080 EVERYONE'S CLAIM, EACH PERSON'S 3375 02:01:33,080 --> 02:01:34,720 CLAIMS FOR THE TWO YEARS PRIOR 3376 02:01:34,720 --> 02:01:37,440 TO STUDY ENROLLMENT AND 3377 02:01:37,440 --> 02:01:38,200 IDENTIFIED EVERY EMERGENCY 3378 02:01:38,200 --> 02:01:43,000 DEPARTMENT VISIT IF THEY HAVE 3379 02:01:43,000 --> 02:01:43,160 ONE. 3380 02:01:43,160 --> 02:01:44,880 BOTH ADMITTED TO HOSPITAL AS 3381 02:01:44,880 --> 02:01:48,800 WELL AS TREAT AND RELEASE. 3382 02:01:48,800 --> 02:01:50,400 WE USE THE MINNESOTA ALGORITHM 3383 02:01:50,400 --> 02:01:53,320 TO CATEGORIZE THE E ED VISITS 3384 02:01:53,320 --> 02:01:54,800 ACCORDING TO WHERE THEY WERE 3385 02:01:54,800 --> 02:01:58,400 PRIMARY CARE TREATABLE VERSUS ED 3386 02:01:58,400 --> 02:02:01,000 CARE NEEDED. 3387 02:02:01,000 --> 02:02:07,440 SO THESE ARE BOX PLOTS OF THE 3388 02:02:07,440 --> 02:02:08,200 DISTRIBUTION OF THE DIFFERENT 3389 02:02:08,200 --> 02:02:10,960 KINDS OF ED VISITS BY THEIR 3390 02:02:10,960 --> 02:02:12,400 SOCIAL RISK GROUP. 3391 02:02:12,400 --> 02:02:15,000 SO FOR EXAMPLE THE PRIMARY CARE 3392 02:02:15,000 --> 02:02:19,040 TREATABLE VISITS, 50% OF SOCIAL 3393 02:02:19,040 --> 02:02:22,160 RISK CLASS 1, THIS IS 25TH AND 3394 02:02:22,160 --> 02:02:25,400 75TH PERCENTILE WITHIN 0 TO 2 3395 02:02:25,400 --> 02:02:26,800 VISITS, MAYBE ONE VISIT. 3396 02:02:26,800 --> 02:02:27,800 THESE DIAMONDS REPRESENT THE 3397 02:02:27,800 --> 02:02:29,960 MEAN NUMBER OF VISITS IN THIS 3398 02:02:29,960 --> 02:02:32,120 SOCIAL RISK CLASS. 3399 02:02:32,120 --> 02:02:34,480 YOU CAN SEE THAT AS YOU GO UP 3400 02:02:34,480 --> 02:02:35,600 THE SOCIAL RISK CLASS AS SOCIAL 3401 02:02:35,600 --> 02:02:37,960 RISK CLASS BECOMES MORE SEVERE, 3402 02:02:37,960 --> 02:02:41,120 THE MEAN NUMBER OF PRIMARY CARE 3403 02:02:41,120 --> 02:02:42,000 TREATABLE VISITS RISE. 3404 02:02:42,000 --> 02:02:43,520 AND IT IS EVEN MORE PRONOUNCED 3405 02:02:43,520 --> 02:02:50,800 AMONG THE ED CARE NEEDED VISITS. 3406 02:02:50,800 --> 02:02:54,800 AND ALSO WE WERE THINKING ABOUT 3407 02:02:54,800 --> 02:02:55,680 SOCIAL RISK CLASS AND 3408 02:02:55,680 --> 02:02:58,560 RELATIONSHIP TO ED VISITS, IT IS 3409 02:02:58,560 --> 02:03:01,200 IMPORTANT TO ALSO REMEMBER, WELL 3410 02:03:01,200 --> 02:03:02,240 HOW DOES ILLNESS SEVERITY PLAY 3411 02:03:02,240 --> 02:03:04,600 AT THIS BECAUSE OBVIOUSLY PEOPLE 3412 02:03:04,600 --> 02:03:08,400 WHO ARE SICKER VISIT THE 3413 02:03:08,400 --> 02:03:11,360 EMERGENCY DEPARTMENT MORE. 3414 02:03:11,360 --> 02:03:14,080 AND SO THIS JUST SHOWS YOU ALSO 3415 02:03:14,080 --> 02:03:17,080 WHEN YOU -- WE USE THE CHRONIC 3416 02:03:17,080 --> 02:03:18,600 DISABILITY PAYMENT SYSTEM, THIS 3417 02:03:18,600 --> 02:03:21,280 IS A RISK ADJUSTED MEASURE OR 3418 02:03:21,280 --> 02:03:22,680 ILLNESS SEVERITY MEASURE, IT WAS 3419 02:03:22,680 --> 02:03:25,800 DEVELOPED SPECIFICALLY FOR THE 3420 02:03:25,800 --> 02:03:26,360 MEDICAID POPULATION. 3421 02:03:26,360 --> 02:03:29,080 WE USE OTHER RISK AS JUSTMENT 3422 02:03:29,080 --> 02:03:30,920 MEASURES AND YOU WILL FIND THE 3423 02:03:30,920 --> 02:03:32,360 SAME PATTERN. 3424 02:03:32,360 --> 02:03:34,200 BUT WHAT THEY DOO IS TAKE ALL 3425 02:03:34,200 --> 02:03:36,800 THE DIAGNOSIS -- WHAT THEY DO IS 3426 02:03:36,800 --> 02:03:38,880 TAKE ALL DIAGNOSIS DOCUMENTED IN 3427 02:03:38,880 --> 02:03:42,040 THE CLAIMS DATA, AND THEN THEY 3428 02:03:42,040 --> 02:03:44,200 ASSIGN ILLNESS SEVERITY SCORE 3429 02:03:44,200 --> 02:03:46,000 DEPENDING HOW SEVERE THE 3430 02:03:46,000 --> 02:03:48,200 CONDITION IS, AND IT IS USUALLY 3431 02:03:48,200 --> 02:03:50,920 RELATIONSHIP TO HEALTHCARE 3432 02:03:50,920 --> 02:03:56,320 COSTS. 3433 02:03:56,320 --> 02:03:57,560 WE CATEGORIZED PATIENTS 3434 02:03:57,560 --> 02:03:58,160 ACCORDING TO ILLNESS SEVERITY 3435 02:03:58,160 --> 02:03:59,680 USING THE SCORE AND CATEGORIZED 3436 02:03:59,680 --> 02:04:02,200 THEM BY THE LOWEST QUARTILE, THE 3437 02:04:02,200 --> 02:04:03,560 LEAST SICK TO THE HIGHEST 3438 02:04:03,560 --> 02:04:06,880 QUARTILE TO THE MOST SICK. 3439 02:04:06,880 --> 02:04:09,800 AND AGAIN, YOU SEE THE PRIMARY 3440 02:04:09,800 --> 02:04:14,400 CARE TREATABLE AND ED CARE 3441 02:04:14,400 --> 02:04:18,960 VISITS ON AVERAGE RISE THE 3442 02:04:18,960 --> 02:04:19,320 SICKER YOU ARE. 3443 02:04:19,320 --> 02:04:22,320 FROMS SO WHEN WE HAD THAT 3444 02:04:22,320 --> 02:04:25,280 ESTABLISHED, HEN WE MODEL THESE 3445 02:04:25,280 --> 02:04:25,600 RELATIONSHIPS. 3446 02:04:25,600 --> 02:04:26,960 AND WHAT WE ARE MOST INTERESTED 3447 02:04:26,960 --> 02:04:30,960 IN WAS THE RELATIONSHIP OF 3448 02:04:30,960 --> 02:04:37,120 SOCIAL RISK CLASS. 3449 02:04:37,120 --> 02:04:39,000 WHAT WE SHOW THE RESULTS OF 3450 02:04:39,000 --> 02:04:40,680 MODELS FIRST NOT CONTROLLING FOR 3451 02:04:40,680 --> 02:04:42,040 ILLNESS, HOW DOES SOCIAL RISK 3452 02:04:42,040 --> 02:04:44,360 CLASS ADJUSTED FOR AGE AND 3453 02:04:44,360 --> 02:04:46,920 GENDER INFLUENCE THE ED VISIT 3454 02:04:46,920 --> 02:04:47,200 RATE? 3455 02:04:47,200 --> 02:04:50,240 THE NUMBERS IN RED HERE ARE THE 3456 02:04:50,240 --> 02:04:52,280 STATISTICALLY SIGNIFICANT. 3457 02:04:52,280 --> 02:04:54,600 AND SO WHAT IT IS SHOWING IS IF 3458 02:04:54,600 --> 02:04:56,920 THE PARTICIPANT WAS IN SOCIAL 3459 02:04:56,920 --> 02:04:58,720 RISK CLASS 2 COMPARED TO THE 3460 02:04:58,720 --> 02:05:00,600 MOST FAVORABLE LOWER SOCIAL RISK 3461 02:05:00,600 --> 02:05:03,200 CLASS THE ED VISIT RATE ON 3462 02:05:03,200 --> 02:05:07,760 AVERAGE IS 13% HIGHER. 3463 02:05:07,760 --> 02:05:10,880 37% HIGHER IF SOCIAL RISK CLASS 3464 02:05:10,880 --> 02:05:14,120 3 VERSUS 4 AND 59% HIGHER IF THE 3465 02:05:14,120 --> 02:05:15,560 WORST SOCIAL RISK CLASS COMPARED 3466 02:05:15,560 --> 02:05:16,600 TO THE BEST ONE. 3467 02:05:16,600 --> 02:05:17,920 THAT'S FOR PRIMARY CARE 3468 02:05:17,920 --> 02:05:19,480 TREATABLE VISITS. 3469 02:05:19,480 --> 02:05:22,480 THE SAME PATTERN EMERGES FOR THE 3470 02:05:22,480 --> 02:05:25,600 ED CARE NEEDED. 3471 02:05:25,600 --> 02:05:29,360 WHEN YOU CONTROL FOR ILLNESS 3472 02:05:29,360 --> 02:05:31,000 SEVERITY, YOU SEE THAT THE 3473 02:05:31,000 --> 02:05:34,920 EFFECT, IMPACT IS ATTENUATED BUT 3474 02:05:34,920 --> 02:05:36,320 STILL SIGNIFICANT. 3475 02:05:36,320 --> 02:05:38,360 SO THESE ARE -- EVEN WHEN YOU 3476 02:05:38,360 --> 02:05:41,200 CONTROL FOR HOW SICK A PERSON 3477 02:05:41,200 --> 02:05:42,480 IS, THE SOCIAL RISK HOW OFTEN 3478 02:05:42,480 --> 02:05:44,880 THEY VISIT THE ED FOR PRIMARY 3479 02:05:44,880 --> 02:05:46,560 CARE TREATABLE OR ED CARE NEEDED 3480 02:05:46,560 --> 02:05:48,440 VISITS IS GOING TO VARY BY YOUR 3481 02:05:48,440 --> 02:05:54,320 SOCIAL RISK CLASS. 3482 02:05:54,320 --> 02:05:56,360 WE THEN TESTED WHETHER THERE WAS 3483 02:05:56,360 --> 02:05:56,840 INTERACTION AFFECT. 3484 02:05:56,840 --> 02:05:58,320 DOES IT MATTER HOW SICK YOU ARE 3485 02:05:58,320 --> 02:05:59,000 AND WHAT SOCIAL RISK CLASS YOU 3486 02:05:59,000 --> 02:06:01,360 ARE. 3487 02:06:01,360 --> 02:06:04,000 ON ED VISIT RATE, WE FOUND 3488 02:06:04,000 --> 02:06:06,840 SIGNIFICANT INTERACTION. 3489 02:06:06,840 --> 02:06:10,080 SO WHAT THE PATTERN IS, IT IS 3490 02:06:10,080 --> 02:06:11,360 REALLY IN THE SICKER PATIENTS 3491 02:06:11,360 --> 02:06:14,400 THAT THE SOCIAL RISK CLASS IS 3492 02:06:14,400 --> 02:06:17,800 REALLY INFLUENCING THE ED VISIT 3493 02:06:17,800 --> 02:06:18,720 RATE. 3494 02:06:18,720 --> 02:06:21,360 IN OTHER WORDS WHEN YOUR ILLNESS 3495 02:06:21,360 --> 02:06:22,800 SEVERITY, CDPS IS RELATIVERY 3496 02:06:22,800 --> 02:06:24,640 LOW, WE ARE NOT SEEING A BIG 3497 02:06:24,640 --> 02:06:26,360 DIFFERENCE IN THE ED VISIT RATE 3498 02:06:26,360 --> 02:06:27,200 AMONG THE DIFFERENT SOCIAL RISK 3499 02:06:27,200 --> 02:06:30,560 CLASS. 3500 02:06:30,560 --> 02:06:34,960 ONCE YOU GET TO THE TWO HIGHER 3501 02:06:34,960 --> 02:06:37,160 ILLNESS SEVERITY SCORES, THEN 3502 02:06:37,160 --> 02:06:38,520 THE SOCIAL RISK CLASS IS MAKING 3503 02:06:38,520 --> 02:06:41,000 A BIG DIFFERENCE IN YOUR ED 3504 02:06:41,000 --> 02:06:42,560 VISIT RATE FOR PRIMARY CARE 3505 02:06:42,560 --> 02:06:46,920 TREATABLE AND ED CARE NEEDED. 3506 02:06:46,920 --> 02:06:49,360 THIS PATTERN, THIS INTERACTION 3507 02:06:49,360 --> 02:06:51,240 EFFECT IS OBSERVABLE REGARDLESS 3508 02:06:51,240 --> 02:06:54,000 OF IF PEOPLE HAVE DIABETES, 3509 02:06:54,000 --> 02:06:54,920 CARDIOVASCULAR, WE LOOK AT 3510 02:06:54,920 --> 02:06:56,760 VARIETY OF CONDITIONS THAT 3511 02:06:56,760 --> 02:06:58,120 PARTICIPANTS HAD. 3512 02:06:58,120 --> 02:07:06,200 AND WE STILL FIND THIS EFFECT. 3513 02:07:06,200 --> 02:07:08,200 SO IN CONCLUSION I DON'T THINK 3514 02:07:08,200 --> 02:07:13,840 IT IS SURPRISING THAT THE MORE 3515 02:07:13,840 --> 02:07:15,040 SOCIAL ADVERSITIES A PARTICIPANT 3516 02:07:15,040 --> 02:07:18,200 HAS THE MORE ED VISITS THEY HAVE 3517 02:07:18,200 --> 02:07:21,520 PRIMARY CARE TREATABLE AND ED 3518 02:07:21,520 --> 02:07:22,560 CARE NEEDED. 3519 02:07:22,560 --> 02:07:26,560 SOME OF THIS SOCIAL DETERMINANTS 3520 02:07:26,560 --> 02:07:30,640 EFFECT IS INDIRECT BECAUSE 3521 02:07:30,640 --> 02:07:32,280 SOCIAL DETERMINANTS MAKE A 3522 02:07:32,280 --> 02:07:34,400 PERSON I WILL, WE SEE HIGHER 3523 02:07:34,400 --> 02:07:36,360 MEDICAL CONDITIONS AMONG PEOPLE 3524 02:07:36,360 --> 02:07:38,960 WHO ARE -- HAVE MORE SOCIAL RISK 3525 02:07:38,960 --> 02:07:40,840 SO INDIRECT EFFECT THROUGH 3526 02:07:40,840 --> 02:07:42,800 MEDICAL CONDITIONS, ILLNESS 3527 02:07:42,800 --> 02:07:43,040 SEVERITY. 3528 02:07:43,040 --> 02:07:45,200 AND WILL IS A SEPARATE DIRECT 3529 02:07:45,200 --> 02:07:47,000 EFFECT OF SOCIAL DETERMINANTS OF 3530 02:07:47,000 --> 02:07:54,000 ED VISITS. THIS IS LARGELY 3531 02:07:54,000 --> 02:07:56,200 SEEING MORE OF EFFECT OF SOCIAL 3532 02:07:56,200 --> 02:07:58,040 DETERMINANTS AMONG SICKER 3533 02:07:58,040 --> 02:07:58,360 PATIENTS. 3534 02:07:58,360 --> 02:08:03,400 AND THEN FINALLY, I WOULD PUT A 3535 02:08:03,400 --> 02:08:06,960 PLUG, AS THAT TO ADDRESS THESE 3536 02:08:06,960 --> 02:08:13,680 SOCIAL DETERMINANTS WE NEED 3537 02:08:13,680 --> 02:08:16,000 MULTI-LEVEL INTERSECT TORR 3538 02:08:16,000 --> 02:08:16,920 INTERVENTIONS, THE EXAMPLE GAVE 3539 02:08:16,920 --> 02:08:19,920 OF HOUSING AND TRYING TO 3540 02:08:19,920 --> 02:08:20,960 INFLUENCE ASTHMA RATES WAS GREAT 3541 02:08:20,960 --> 02:08:22,200 SO HEALTHCARE PROVIDER CAN'T DO 3542 02:08:22,200 --> 02:08:25,880 IT ALONE, HEALTHCARE SYSTEMS 3543 02:08:25,880 --> 02:08:27,960 CAN'T DO IT BUT WE NEED STRONGER 3544 02:08:27,960 --> 02:08:29,960 PUBLIC POLICIES TO ADDRESS 3545 02:08:29,960 --> 02:08:32,280 INEQUITIES AND THAT CAUSED 3546 02:08:32,280 --> 02:08:34,920 HEALTH DISPARITIES THAT WE 3547 02:08:34,920 --> 02:08:37,400 SERVE. 3548 02:08:37,400 --> 02:08:46,480 THANK YOU. 3549 02:08:46,480 --> 02:08:48,120 >> THANK YOU VERY MUCH. 3550 02:08:48,120 --> 02:08:50,840 FINALLY FOR OUR LAST SPEAKER IN 3551 02:08:50,840 --> 02:09:06,000 THIS SESSION DR. MONTGOMERY. 3552 02:09:06,000 --> 02:09:08,000 >> ARE Y'ALL ABLE TO SEE THE 3553 02:09:08,000 --> 02:09:08,400 SLIDES? 3554 02:09:08,400 --> 02:09:09,160 >> YES, PERFECT. 3555 02:09:09,160 --> 02:09:10,240 THANK YOU. 3556 02:09:10,240 --> 02:09:11,800 >> GREAT, THANK YOU. 3557 02:09:11,800 --> 02:09:14,400 SO MY NAME IS ANN ELIZABETH 3558 02:09:14,400 --> 02:09:15,000 MONTGOMERY. 3559 02:09:15,000 --> 02:09:18,000 I'M A RESEARCHER WITH THE U.S. 3560 02:09:18,000 --> 02:09:20,200 DEPARTMENT OF VETERANS AFFAIRS. 3561 02:09:20,200 --> 02:09:24,200 SO I'M GOING TO TALK ABOUT HOW 3562 02:09:24,200 --> 02:09:26,400 ONCE WE IDENTIFY SOCIAL 3563 02:09:26,400 --> 02:09:29,400 DETERMINANTS OF HEALTH, AND THEN 3564 02:09:29,400 --> 02:09:34,360 PROVIDE SERVICES TO PATIENTS, TO 3565 02:09:34,360 --> 02:09:36,400 ADDRESS THOSE NEEDS, WHAT IMPACT 3566 02:09:36,400 --> 02:09:39,000 DOES THAT HAVE ON OUTCOMES, ON 3567 02:09:39,000 --> 02:09:42,280 NUMBER OF OUTCOMES BUT ALSO LOOK 3568 02:09:42,280 --> 02:09:42,960 SPECIFICALLY SHARE SOME 3569 02:09:42,960 --> 02:09:44,440 EXPLORATORY ANALYSES WE HAVE 3570 02:09:44,440 --> 02:09:45,480 DONE LOOKING AT EMERGENCY 3571 02:09:45,480 --> 02:09:50,400 DEPARTMENT USE. 3572 02:09:50,400 --> 02:09:53,000 JUST A LITTLE BACKGROUND. 3573 02:09:53,000 --> 02:09:54,800 THE U.S. DEPARTMENT OF VETERANS 3574 02:09:54,800 --> 02:09:56,680 AFFAIRS IS FOCUSED A LOT OF 3575 02:09:56,680 --> 02:09:59,200 ENERGY AND RESOURCES ON 3576 02:09:59,200 --> 02:10:02,920 PREVENTING AND ENDING 3577 02:10:02,920 --> 02:10:04,280 HOMELESSNESS AMONG VETERANS 3578 02:10:04,280 --> 02:10:04,600 SINCE 2009. 3579 02:10:04,600 --> 02:10:06,120 SINCE THAT TIME THERE'S BEEN 3580 02:10:06,120 --> 02:10:08,360 ABOUT A 50% REDUCTION IN THE 3581 02:10:08,360 --> 02:10:13,160 NUMBER OF VETERANS EXPERIENCING 3582 02:10:13,160 --> 02:10:13,680 HOMELESSNESS. 3583 02:10:13,680 --> 02:10:22,160 THE VA HAS DEPLOYED A 3584 02:10:22,160 --> 02:10:23,800 MULTI-TIERED STRATEGY TO PREVENT 3585 02:10:23,800 --> 02:10:25,000 AND END HOMELESSNESS ROUGHLY 3586 02:10:25,000 --> 02:10:28,800 ALONG THE THREE LEVELS OF PUBLIC 3587 02:10:28,800 --> 02:10:29,200 HEALTH PREVENTION. 3588 02:10:29,200 --> 02:10:31,920 THE PRIMARY LEVEL THERE IS 3589 02:10:31,920 --> 02:10:33,920 UNIVERSAL SCREENING FOR HOUSING 3590 02:10:33,920 --> 02:10:36,040 INSTABILITY AMONG ALL VETERAN 3591 02:10:36,040 --> 02:10:36,680 OUTPATIENTS. 3592 02:10:36,680 --> 02:10:38,440 THIS DOESN'T HAPPEN IN THE 3593 02:10:38,440 --> 02:10:40,400 EMERGENCY DEPARTMENT OR IN 3594 02:10:40,400 --> 02:10:41,960 PATIENT SETTINGS BUT VETERANS 3595 02:10:41,960 --> 02:10:45,520 PRESENT FOR OUTPATIENT CARE AT 3596 02:10:45,520 --> 02:10:47,920 ANY VA FACILITY IS ASKED 3597 02:10:47,920 --> 02:10:49,000 QUESTIONS ABOUT HOUSING 3598 02:10:49,000 --> 02:10:50,400 INSTABILITY, SAME QUESTIONS THAT 3599 02:10:50,400 --> 02:10:54,960 DR. MCCARTHY MENTIONED IN HER 3600 02:10:54,960 --> 02:10:57,760 TALK. 3601 02:10:57,760 --> 02:10:59,120 SECONDARY PREVENTION IS PROVIDED 3602 02:10:59,120 --> 02:11:02,400 THROUGH NUMBER OF TYPES OF 3603 02:11:02,400 --> 02:11:06,880 PROGRAMS SO PROVIDING RAPID 3604 02:11:06,880 --> 02:11:08,800 REHOUSING THROUGH SUPPORTIVE 3605 02:11:08,800 --> 02:11:10,920 SERVICES FOR VETERAN FAMILIES 3606 02:11:10,920 --> 02:11:14,400 FUNDS THAT VA SENDS TO COMMUNITY 3607 02:11:14,400 --> 02:11:18,400 BASE ORGANIZATIONS TO HELP 3608 02:11:18,400 --> 02:11:19,720 VETERANS TO PREVENT BECOMING 3609 02:11:19,720 --> 02:11:22,680 HOMELESS OR PUT THEM BACK INTO 3610 02:11:22,680 --> 02:11:24,320 HOUSING P THEY HAVE EXPERIENCED 3611 02:11:24,320 --> 02:11:26,000 HOUSING INSTABILITY. 3612 02:11:26,000 --> 02:11:28,560 THERE IS A NUMBER OF EMPLOYMENT 3613 02:11:28,560 --> 02:11:29,840 ASSISTANCE PROGRAMS, PROGRAMS 3614 02:11:29,840 --> 02:11:32,440 FOR VETERANS WHO ARE INVOLVED IN 3615 02:11:32,440 --> 02:11:34,080 CRIMINAL JUSTICE PROGRAM, 3616 02:11:34,080 --> 02:11:37,920 SYSTEM, AND THEN AT THE TERTIARY 3617 02:11:37,920 --> 02:11:40,040 LEVEL THERE IS PERMANENT 3618 02:11:40,040 --> 02:11:42,120 SUPPORTIVE HOUSING FOR VETERANS 3619 02:11:42,120 --> 02:11:44,200 WHO EXPERIENCED LONG TERM 3620 02:11:44,200 --> 02:11:45,760 CHRONIC HOMELESSNESS AND MAY 3621 02:11:45,760 --> 02:11:47,000 HAVE OTHER DISABLING CONDITIONS. 3622 02:11:47,000 --> 02:11:50,200 THIS IS PROVIDED THROUGH WHAT IS 3623 02:11:50,200 --> 02:11:51,080 COMMONLY KNOWN AS SECTION 8 3624 02:11:51,080 --> 02:11:54,720 VOUCHER OR HOUSING CHOICE 3625 02:11:54,720 --> 02:11:54,960 VOUCHER. 3626 02:11:54,960 --> 02:11:56,400 SO VETERANS RECEIVE A DEEP 3627 02:11:56,400 --> 02:11:58,600 SUBSIDY TO HELP PAY FOR THEIR 3628 02:11:58,600 --> 02:11:58,920 HOUSING. 3629 02:11:58,920 --> 02:12:00,840 BUT ALSO RECEIVE WRAP AROUND 3630 02:12:00,840 --> 02:12:01,960 SERVICES TO ADDRESS MENTAL 3631 02:12:01,960 --> 02:12:04,920 HEALTH ISSUES, MEDICAL ISSUES, 3632 02:12:04,920 --> 02:12:08,480 PROVIDED THROUGH THE VA. 3633 02:12:08,480 --> 02:12:11,600 THE VA HAS AN OBLIGATION TO 3634 02:12:11,600 --> 02:12:14,400 VETERANS TO NOT ONLY SERVE THEIR 3635 02:12:14,400 --> 02:12:18,760 MEDICAL NEEDS BUT SOCIAL NEEDS. 3636 02:12:18,760 --> 02:12:23,600 SO IT IS A UNIQUE PLACE TO STUDY 3637 02:12:23,600 --> 02:12:24,960 SOCIAL DETERMINANTS OF HEALTH 3638 02:12:24,960 --> 02:12:29,200 AND IMPACT ON OTHER OUTCOMES. 3639 02:12:29,200 --> 02:12:31,160 BECAUSE WE HAVE A NATIONAL 3640 02:12:31,160 --> 02:12:35,000 ELECTRONIC HEALTH RECORD SYSTEM 3641 02:12:35,000 --> 02:12:36,760 AND ACCESS TO NOT ONLY 3642 02:12:36,760 --> 02:12:37,920 INFORMATION ABOUT VETERAN 3643 02:12:37,920 --> 02:12:38,480 CHARACTERISTICS AND SOCIAL 3644 02:12:38,480 --> 02:12:40,000 DETERMINANTS OF HEALTH, THAT WE 3645 02:12:40,000 --> 02:12:42,400 CHECK THROUGH NUMBER OF WAYS AS 3646 02:12:42,400 --> 02:12:45,120 DR. VEST DESCRIBED FOR EXAMPLE, 3647 02:12:45,120 --> 02:12:46,400 THROUGH CLINICAL REMINDERS WHICH 3648 02:12:46,400 --> 02:12:49,280 IS LIKE SURVEY DATA, THROUGH 3649 02:12:49,280 --> 02:12:52,600 TEXT, AND NATIONAL -- NATURAL 3650 02:12:52,600 --> 02:12:54,400 LANGUAGE PROCESSING AND ALSO 3651 02:12:54,400 --> 02:12:55,400 THROUGH ICD CODES. 3652 02:12:55,400 --> 02:12:56,920 WE ALSO CAN LOOK AT THEIR OTHER 3653 02:12:56,920 --> 02:13:01,720 SERVICE ISSUES. 3654 02:13:01,720 --> 02:13:04,440 SO I WANT TO -- AND WITH THOSE 3655 02:13:04,440 --> 02:13:06,320 DATA, WE CAN LOOK AT LOTS OF 3656 02:13:06,320 --> 02:13:07,120 DIFFERENT OUTCOMES. 3657 02:13:07,120 --> 02:13:08,400 WE HAVE LOOKED AT LOTS OF 3658 02:13:08,400 --> 02:13:10,960 OUTCOMES INCLUDING DYNAMICS OF 3659 02:13:10,960 --> 02:13:12,600 HOUSING INSTABILITY, HEALTH AND 3660 02:13:12,600 --> 02:13:15,560 HOMELESS SERVICES USED, 3661 02:13:15,560 --> 02:13:17,920 DISPARITIES, MORTALITY AND 3662 02:13:17,920 --> 02:13:18,280 SUICIDE. 3663 02:13:18,280 --> 02:13:21,120 HEALTH AND HOMELESS SERVICES USE 3664 02:13:21,120 --> 02:13:22,080 HAS BEEN THE WORK THAT I HAVE 3665 02:13:22,080 --> 02:13:29,680 BEEN INVOLVED IN HAS BEEN AROUND 3666 02:13:29,680 --> 02:13:30,880 WHO GETS INTO SERVICE, WHO IS 3667 02:13:30,880 --> 02:13:34,920 REFERRED FOR PARTICULAR 3668 02:13:34,920 --> 02:13:36,200 SERVICES, AND AGAIN, EMERGENCY 3669 02:13:36,200 --> 02:13:37,400 DEPARTMENT SERVICES USE THAT I'M 3670 02:13:37,400 --> 02:13:39,600 GOING TO DESCRIBE, IS 3671 02:13:39,600 --> 02:13:40,560 EXPLORATORY BUT SHOWS 3672 02:13:40,560 --> 02:13:44,200 INTERESTING FINDINGS. 3673 02:13:44,200 --> 02:13:46,640 SO WHICH HAD A STUDY WHERE WE 3674 02:13:46,640 --> 02:13:50,160 LOOKED AT A COHORT OF VETERANS 3675 02:13:50,160 --> 02:13:51,520 WHO WE IDENTIFIED AS 3676 02:13:51,520 --> 02:13:55,880 EXPERIENCING HOUSING 3677 02:13:55,880 --> 02:13:58,960 INSTABILITY, USING DATA FROM 3678 02:13:58,960 --> 02:14:01,480 THEIR ELECTRONIC HEALTH RECORDS. 3679 02:14:01,480 --> 02:14:02,800 THEN WHETHER THEY RECEIVED 3680 02:14:02,800 --> 02:14:05,000 HOMELESS SERVICES AND WHAT 3681 02:14:05,000 --> 02:14:07,280 IMPACT THAT HAS ON THEIR ALL 3682 02:14:07,280 --> 02:14:12,600 CAUSE AND SUICIDE MORTALITY. 3683 02:14:12,600 --> 02:14:17,200 SO WE KNOW THERE IS A TEMPORAL 3684 02:14:17,200 --> 02:14:18,640 ASSOCIATION BETWEEN EXPERIENCE 3685 02:14:18,640 --> 02:14:22,200 OF HOMELESSNESS AND SUICIDALITY. 3686 02:14:22,200 --> 02:14:23,800 WE FOUND THAT AS THE SORT OF 3687 02:14:23,800 --> 02:14:29,680 DATE APPROACHES WHEN A VETERAN 3688 02:14:29,680 --> 02:14:31,680 IS IDENTIFIED AS EXPERIENCING 3689 02:14:31,680 --> 02:14:33,440 HOMELESSNESS OR REACHES OUT FOR 3690 02:14:33,440 --> 02:14:35,400 SERVICES IT COIN SIDES WITH A 3691 02:14:35,400 --> 02:14:37,000 PEAK IN -- COINCIDES WITH THE 3692 02:14:37,000 --> 02:14:38,360 RATE OF SUICIDE AMONG THAT 3693 02:14:38,360 --> 02:14:45,320 POPULATION. 3694 02:14:45,320 --> 02:14:46,600 VETTED RAINS WHO REPORT 3695 02:14:46,600 --> 02:14:49,360 SUICIDALITY HAVE RATES OF 3696 02:14:49,360 --> 02:14:50,640 SUICIDAL IDEATION HIGHER THAN 3697 02:14:50,640 --> 02:14:51,680 THOSE HOUSED. 3698 02:14:51,680 --> 02:14:54,160 SO WITH THIS STUDY WE WANTED TO 3699 02:14:54,160 --> 02:14:56,000 ASSESS USING NATIONAL SAMPLE OF 3700 02:14:56,000 --> 02:14:57,720 VETERANS WITH SELF-REPORTED 3701 02:14:57,720 --> 02:14:58,680 HOUSING INSTABILITY, WHETHER 3702 02:14:58,680 --> 02:14:59,920 PARTICIPATION IN HOMELESS 3703 02:14:59,920 --> 02:15:02,280 PROGRAMS THROUGH THE VA REDUCE 3704 02:15:02,280 --> 02:15:08,320 THEIR RISK OF MORTALITY. 3705 02:15:08,320 --> 02:15:11,600 SO AS I MENTIONED IN DIFFERENT 3706 02:15:11,600 --> 02:15:14,480 STUDIES WE USE DIFFERENT 3707 02:15:14,480 --> 02:15:17,760 CRITERIA FOR IDAPIING VETERANS 3708 02:15:17,760 --> 02:15:18,640 EXPERIENCING SOCIAL DETERMINANTS 3709 02:15:18,640 --> 02:15:20,000 OF HEALTH FOR THIS PARTICULAR 3710 02:15:20,000 --> 02:15:24,840 STUDY WE ONLY USED THE DATA FROM 3711 02:15:24,840 --> 02:15:26,240 THE UNIVERSAL SCREENING HOUSING 3712 02:15:26,240 --> 02:15:27,600 INSTABILITY IN THE VA. 3713 02:15:27,600 --> 02:15:31,280 SO OUR SAMPLE WAS 169,000 3714 02:15:31,280 --> 02:15:33,600 VETERANS WHO BETWEEN 2012 AND 3715 02:15:33,600 --> 02:15:35,080 2016 PRESENTED FOR OUTPATIENT 3716 02:15:35,080 --> 02:15:38,320 CARE AT A VA ACROSS THE COUNTRY 3717 02:15:38,320 --> 02:15:40,400 AND REPORTED THEY WERE CONCERNED 3718 02:15:40,400 --> 02:15:41,880 ABOUT THEIR HOUSING IN THE NEXT 3719 02:15:41,880 --> 02:15:44,200 TWO MONTHS OR HAD EXPERIENCED 3720 02:15:44,200 --> 02:15:45,960 HOUSING INSTABILITY IN THE 3721 02:15:45,960 --> 02:15:46,480 PREVIOUS TWO MONTHS. 3722 02:15:46,480 --> 02:15:50,320 A LITTLE MORE THAN HALF OF THOSE 3723 02:15:50,320 --> 02:15:53,040 LATER ACCESSED VA HOMELESS 3724 02:15:53,040 --> 02:15:53,800 PROGRAM. 3725 02:15:53,800 --> 02:15:55,520 THE OUTCOMES WE WERE INTERESTED 3726 02:15:55,520 --> 02:15:57,760 IN WAS ALL CAUSE MORTALITY AND 3727 02:15:57,760 --> 02:15:58,960 THEN SPECIFICALLY SUICIDE 3728 02:15:58,960 --> 02:16:01,680 MORTALITY. 3729 02:16:01,680 --> 02:16:04,040 REALLY OUR PRIMARY INDEPENDENT 3730 02:16:04,040 --> 02:16:06,760 VARIABLE WAS ACCESSING VHA 3731 02:16:06,760 --> 02:16:08,320 HOMELESS PROGRAMS, SO WE WANTED 3732 02:16:08,320 --> 02:16:13,480 TO LOOK SPECIFICALLY AMONG 3733 02:16:13,480 --> 02:16:15,640 VETERANS EXPERIENCING HOUSING 3734 02:16:15,640 --> 02:16:17,800 INSTABILITY, IF THEY GOT THAT, 3735 02:16:17,800 --> 02:16:22,960 WHAT IMPACT DID IT HAVE ON THEIR 3736 02:16:22,960 --> 02:16:23,400 MORTALITY. 3737 02:16:23,400 --> 02:16:25,160 WE RAN THREE DIFFERENT COX 3738 02:16:25,160 --> 02:16:26,400 REGRESSION MODELS FOR EACH OF 3739 02:16:26,400 --> 02:16:28,200 THE TWO OUTCOMES OF YOU WILL ALL 3740 02:16:28,200 --> 02:16:30,240 CAUSE AND SUICIDE MORTALITY. 3741 02:16:30,240 --> 02:16:32,400 WHICH OBVIOUSLY CONTROLLED FOR 3742 02:16:32,400 --> 02:16:34,280 VHA HOMELESS PROGRAM USE AND 3743 02:16:34,280 --> 02:16:36,000 ALSO VARIETY OF SOCIO 3744 02:16:36,000 --> 02:16:37,600 DEMOGRAPHICS, MILITARY SEXUAL 3745 02:16:37,600 --> 02:16:42,920 TRAUMA, DIKE NOSE SEIZE AND -- 3746 02:16:42,920 --> 02:16:44,400 DIAGNOSES AND EVIDENCE OF 3747 02:16:44,400 --> 02:16:45,080 SUICIDAL IDEATION OR ATTEMPT IN 3748 02:16:45,080 --> 02:16:48,080 THE MEDICAL REPORT. 3749 02:16:48,080 --> 02:16:49,640 REPORT -- RECORD. 3750 02:16:49,640 --> 02:16:53,560 SO THIS POPULATION OF VETERANS 3751 02:16:53,560 --> 02:16:55,160 WHO SELF-REPORTED HOUSING 3752 02:16:55,160 --> 02:16:56,360 INSTABILITY AND DID OR DID NOT 3753 02:16:56,360 --> 02:17:00,480 ACCESS A VHA HOMELESS PROGRAM WE 3754 02:17:00,480 --> 02:17:02,400 SEE THAT THIS CHART BASICALLY 3755 02:17:02,400 --> 02:17:05,800 COME PARIS THE RATE OF SUICIDE 3756 02:17:05,800 --> 02:17:07,920 IDEATION, SUICIDE ATTEMPT, ALL 3757 02:17:07,920 --> 02:17:09,800 CAUSE DEATH AND SUICIDE DEATH 3758 02:17:09,800 --> 02:17:12,400 GATHERED FROM THE ELECTRONIC 3759 02:17:12,400 --> 02:17:15,480 HEALTH RECORD DATA. 3760 02:17:15,480 --> 02:17:17,920 THE DEATH DATA ARE A DEATH 3761 02:17:17,920 --> 02:17:20,560 HAPPENED OR DIDN'T AND METHOD, 3762 02:17:20,560 --> 02:17:23,800 EXCUSE ME THE CAUSE OF DEATH, 3763 02:17:23,800 --> 02:17:25,600 THERE COULD BE ISSUES AROUND 3764 02:17:25,600 --> 02:17:26,960 THERE. 3765 02:17:26,960 --> 02:17:28,840 THE SUICIDE IDEATION AND ATTEMPT 3766 02:17:28,840 --> 02:17:32,000 IS LIKELY UNDERREPORTED, BECAUSE 3767 02:17:32,000 --> 02:17:34,200 A VETERAN HAD THE SEEK CARE AND 3768 02:17:34,200 --> 02:17:36,200 HAD THAT AS A DIAGNOSIS IN THEIR 3769 02:17:36,200 --> 02:17:37,400 MEDICAL RECORD FOR US TO BE ABLE 3770 02:17:37,400 --> 02:17:42,800 TO ACCESS THOSE DATA. 3771 02:17:42,800 --> 02:17:45,560 BUT YOU CAN SEE THAT RATES OF -- 3772 02:17:45,560 --> 02:17:47,000 THE PROPORTION OF VETERANS 3773 02:17:47,000 --> 02:17:49,320 EXPERIENCING HOUSING INSTABILITY 3774 02:17:49,320 --> 02:17:51,000 WHO DIED DURING THE OBSERVATION 3775 02:17:51,000 --> 02:17:53,280 PERIOD WAS HIGHER AMONG THOSE 3776 02:17:53,280 --> 02:17:56,760 WHO DID NOT ACCESS VHA HOMELESS 3777 02:17:56,760 --> 02:17:57,640 PROGRAM. 3778 02:17:57,640 --> 02:18:01,520 WE SEE THE RATES OF SUICIDE 3779 02:18:01,520 --> 02:18:02,480 MORBIDITY ARE HIGHER AMONG THOSE 3780 02:18:02,480 --> 02:18:05,920 WHO DID ACCESS VHA HOMELESS 3781 02:18:05,920 --> 02:18:07,680 PROGRAM,S AND AGAIN I THINK SOME 3782 02:18:07,680 --> 02:18:11,760 OF THAT IS BACK TO RELATED TO 3783 02:18:11,760 --> 02:18:14,960 BIAS AROUND WE KNOW MORE 3784 02:18:14,960 --> 02:18:16,240 INFORMATION ABOUT VETERANS OR 3785 02:18:16,240 --> 02:18:19,400 PATIENTS WHO ENGAGE WITH THE 3786 02:18:19,400 --> 02:18:21,080 SYSTEM MORE. 3787 02:18:21,080 --> 02:18:22,920 IN TERMS OF SUICIDE DEATH WE 3788 02:18:22,920 --> 02:18:27,320 DIDN'T SEE AT THIS LEVEL A 3789 02:18:27,320 --> 02:18:29,360 DIFFERENCE BETWEEN PROPORTION OF 3790 02:18:29,360 --> 02:18:32,360 VETERANS EXPERIENCING HOUSING 3791 02:18:32,360 --> 02:18:33,760 INSTABILITY WHO DID AND DID NOT 3792 02:18:33,760 --> 02:18:35,960 ACCESS HOMELESS PROGRAMS. 3793 02:18:35,960 --> 02:18:41,320 SO WHAT WE DID AGAIN, WE RAN 3794 02:18:41,320 --> 02:18:42,880 THREE DIFFERENT MODELS FOR EACH 3795 02:18:42,880 --> 02:18:48,000 OF OUTCOMES, SO WE SEE 3796 02:18:48,000 --> 02:18:50,560 CONSISTENTLY WHEN THE OUTCOME IS 3797 02:18:50,560 --> 02:18:53,600 ALL CAUSE MORTALITY, ACCESSING A 3798 02:18:53,600 --> 02:18:54,920 VHA HOMELESS PROGRAM YES OR NO, 3799 02:18:54,920 --> 02:18:58,000 THEY ACCESS ANY PROGRAM DURING 3800 02:18:58,000 --> 02:19:00,200 OBSERVATION PERIOD, MORTALITY IS 3801 02:19:00,200 --> 02:19:01,720 REDUCED. 3802 02:19:01,720 --> 02:19:03,240 THE NUMBER OF DIFFERENT PROGRAMS 3803 02:19:03,240 --> 02:19:05,800 MEASURE BOTH AS CONTINUOUS AND 3804 02:19:05,800 --> 02:19:09,480 ORDINAL MEASURE, FOR THE MOST 3805 02:19:09,480 --> 02:19:14,400 PART SIGNIFICANTLY REDUCED THEIR 3806 02:19:14,400 --> 02:19:18,000 RISK OF ALL CAUSE MORTALITY. 3807 02:19:18,000 --> 02:19:18,960 SUICIDE MORTALITY WE HAVE SOME 3808 02:19:18,960 --> 02:19:22,240 DIFFERENT SLIGHTLY DIFFERENT 3809 02:19:22,240 --> 02:19:24,640 OUTCOMES, WE DID FIND THIS SORT 3810 02:19:24,640 --> 02:19:26,960 OF MEASURE OF SERVICE USE, 3811 02:19:26,960 --> 02:19:29,720 WASN'T SIGNIFICANT BUT WE FOUND 3812 02:19:29,720 --> 02:19:31,600 THE MORE PROGRAMS, MORE 3813 02:19:31,600 --> 02:19:35,240 INTERACTION THAT A VETERAN WITH 3814 02:19:35,240 --> 02:19:37,600 SELF-REPORTED HOUSING 3815 02:19:37,600 --> 02:19:41,280 INSTABILITY HAD WITH VHA 3816 02:19:41,280 --> 02:19:43,920 HOMELESS PROGRAMS, THE MORE 3817 02:19:43,920 --> 02:19:48,520 ENGAGEMENT THEIR RISK OF SUICIDE 3818 02:19:48,520 --> 02:19:49,680 MORTALITY REDUCED OVER TIME. 3819 02:19:49,680 --> 02:19:50,720 SO WE WANTED TO FOLLOW-UP AND 3820 02:19:50,720 --> 02:19:54,800 LEARN MORE ABOUT THIS 3821 02:19:54,800 --> 02:19:55,800 RELATIONSHIP, WE HAVE A RECENT 3822 02:19:55,800 --> 02:19:58,200 WILL I FUNDED STUDY, THIS TITLE 3823 02:19:58,200 --> 02:20:00,480 SERVICES TO ADDRESS VETERANS 3824 02:20:00,480 --> 02:20:02,080 SOCIAL DETERMINANTS OF HEALTH 3825 02:20:02,080 --> 02:20:02,960 REDUCE SUICIDE RISK. 3826 02:20:02,960 --> 02:20:06,680 MANY THIS STUDY WE ARE LOOKING 3827 02:20:06,680 --> 02:20:09,080 AT THREE DIFFERENT ADVERSE 3828 02:20:09,080 --> 02:20:10,000 SOCIAL DETERMINANTS OF HEALTH, 3829 02:20:10,000 --> 02:20:11,400 HOUSING INSTABILITY, 3830 02:20:11,400 --> 02:20:12,600 UNEMPLOYMENT AND JUSTICE 3831 02:20:12,600 --> 02:20:20,400 INVOLVEMENT SO THIS ANALYSIS WE 3832 02:20:20,400 --> 02:20:26,800 MODELED WHETHER WHETHER ACCESS 3833 02:20:26,800 --> 02:20:30,000 TO SERVICES TAILORED TO ADVERSE 3834 02:20:30,000 --> 02:20:32,280 SOCIAL DETERMINANTS OF HEALTH 3835 02:20:32,280 --> 02:20:34,400 REDUCES THE ODDS OF HIGH 3836 02:20:34,400 --> 02:20:36,080 EMERGENCY DEPARTMENT USE WHICH 3837 02:20:36,080 --> 02:20:38,240 IS -- WE CONSIDER FOR THIS 3838 02:20:38,240 --> 02:20:40,680 ANALYSIS FOUR OR MORE ED VISITS 3839 02:20:40,680 --> 02:20:45,280 THE PAST 12 MONTHS. 3840 02:20:45,280 --> 02:20:48,840 THIS IS ON A COHORT OF 937,000 3841 02:20:48,840 --> 02:20:55,680 VETERANS WHO HAD ICD CODE, OR 3842 02:20:55,680 --> 02:20:56,720 SOME OTHER EVIDENCE IN MEDICAL 3843 02:20:56,720 --> 02:20:58,320 RECORD FOR ADVERSE SOCIAL 3844 02:20:58,320 --> 02:21:00,000 DETERMINANTS OF HEALTH. 3845 02:21:00,000 --> 02:21:03,320 AND WE FIND DIFFERENT RESULTS 3846 02:21:03,320 --> 02:21:04,640 FOR THE DIFFERENT SOCIAL 3847 02:21:04,640 --> 02:21:08,360 DETERMINANTS OF HEALTH WE LOOKED 3848 02:21:08,360 --> 02:21:09,920 AT. 3849 02:21:09,920 --> 02:21:12,160 WE SEE VETERANS FOR EXAMPLE WHO 3850 02:21:12,160 --> 02:21:16,680 HAVE INDICATOR OF UNEMPLOYMENT, 3851 02:21:16,680 --> 02:21:19,000 THOSE WHO AT LEAST HAD SOME 3852 02:21:19,000 --> 02:21:21,400 INTERACTION WITH EMPLOYMENT 3853 02:21:21,400 --> 02:21:24,840 SERVICES, WERE LESS LIKELY TO BE 3854 02:21:24,840 --> 02:21:26,480 HIGH ED USERS. 3855 02:21:26,480 --> 02:21:30,400 COMPARED TO THOSE WHO HAD NONE. 3856 02:21:30,400 --> 02:21:36,120 THOSE WHO HAD SORT OF MEDIUM 3857 02:21:36,120 --> 02:21:37,120 ENGAGEMENT WITH EMPLOYMENT 3858 02:21:37,120 --> 02:21:38,920 SERVICES IS PROTECTIVE AGAINST 3859 02:21:38,920 --> 02:21:40,440 HIGH ED USER, WE SEE THE 3860 02:21:40,440 --> 02:21:45,000 OPPOSITE WITH HOUSING 3861 02:21:45,000 --> 02:21:45,680 INSTABILITY SOMETHING WE ARE -- 3862 02:21:45,680 --> 02:21:47,400 THIS IS THE BEGINNING OF THE 3863 02:21:47,400 --> 02:21:50,160 EXPLORATION BECAUSE WE NEED TO 3864 02:21:50,160 --> 02:21:53,280 PULL OUT DIFFERENT TYPES OF 3865 02:21:53,280 --> 02:21:54,280 HOUSING SERVICES THAT WERE 3866 02:21:54,280 --> 02:21:54,800 CONTROLLING FOR THERE. 3867 02:21:54,800 --> 02:21:58,600 THERE IS A VERY BIG DIFFERENCE 3868 02:21:58,600 --> 02:22:00,560 IN SERVICE LIKE PERMANENT 3869 02:22:00,560 --> 02:22:01,800 SUPPORTIVE HOUSING WHERE SOMEONE 3870 02:22:01,800 --> 02:22:03,320 IS IN PERMANENT HOUSING WITH 3871 02:22:03,320 --> 02:22:05,440 WRAP AROUND SUPPORT SERVICES AND 3872 02:22:05,440 --> 02:22:08,120 SOMEONE IN EMERGENCY SHELTER AND 3873 02:22:08,120 --> 02:22:09,680 DOESN'T HAVE A HOME. 3874 02:22:09,680 --> 02:22:12,800 SO I THINK THAT SOME OF -- WHILE 3875 02:22:12,800 --> 02:22:16,320 THE SERVICES DON'T APPEAR 3876 02:22:16,320 --> 02:22:18,160 PROTECTIVE FOR HIGH ED USE FOR 3877 02:22:18,160 --> 02:22:20,440 HOUSING INSTABILITY COHORT, IT 3878 02:22:20,440 --> 02:22:22,320 IS LIKELY THERE ARE DIFFERENCES 3879 02:22:22,320 --> 02:22:25,120 BY PROGRAMS. 3880 02:22:25,120 --> 02:22:28,560 SO JUST TO SUMMARIZE, AGAIN, VA 3881 02:22:28,560 --> 02:22:30,600 IS OBLIGATED TO ADDRESS MEDICAL 3882 02:22:30,600 --> 02:22:33,600 ISSUES AND NON-MEDICAL 3883 02:22:33,600 --> 02:22:36,080 DETERMINANTS OF HEALTH AMONG 3884 02:22:36,080 --> 02:22:36,680 VETERANS. 3885 02:22:36,680 --> 02:22:40,520 WE ARE ABLE TO USE VERY RICH 3886 02:22:40,520 --> 02:22:42,840 ADMINISTRATIVE DATA THE VA HAS 3887 02:22:42,840 --> 02:22:46,920 TO NOT ONLY IDENTIFY PATIENTS 3888 02:22:46,920 --> 02:22:49,920 WHO ARE EXPERIENCING WIDE 3889 02:22:49,920 --> 02:22:51,200 VARIETY OF SOCIAL DETERMINANTS 3890 02:22:51,200 --> 02:22:54,400 OF HEALTH BUT HOW SOCIAL 3891 02:22:54,400 --> 02:22:55,720 DETERMINANTS OF HEALTH AND 3892 02:22:55,720 --> 02:23:00,600 ACCESS TO SERVICES TO ADDRESS 3893 02:23:00,600 --> 02:23:08,400 THEM MAY MITIGATE POOR OUTCOMES. 3894 02:23:08,400 --> 02:23:10,400 AGAIN, WE HAVE FOUND IN OUR 3895 02:23:10,400 --> 02:23:14,400 PRELIMINARY ANALYSES, THE USE OF 3896 02:23:14,400 --> 02:23:17,040 VHA HOMELESS PROGRAMS AMONG 3897 02:23:17,040 --> 02:23:19,600 UNSTABLY HOUSED VETERANS IS 3898 02:23:19,600 --> 02:23:21,400 PROTECTIVE FOR MORTALITY. 3899 02:23:21,400 --> 02:23:22,600 AND PRELIMINARY RESULTS RELATED 3900 02:23:22,600 --> 02:23:28,600 TO ED USE IS THAT THERE IS SOME 3901 02:23:28,600 --> 02:23:29,200 PROMISING ASSOCIATION THERE AT 3902 02:23:29,200 --> 02:23:30,920 LEAST FOR UNEMPLOYMENT AND 3903 02:23:30,920 --> 02:23:34,000 JUSTICE INVOLVEMENT AND MORE 3904 02:23:34,000 --> 02:23:36,520 WORK NEEDS TO BE DONE TO TEASE 3905 02:23:36,520 --> 02:23:40,000 OUT THOSE AFFECTS FOR HOMELESS 3906 02:23:40,000 --> 02:23:40,280 PROGRAMS. 3907 02:23:40,280 --> 02:23:41,680 COUPLE OF REFERENCES IF YOU ARE 3908 02:23:41,680 --> 02:23:43,400 INTERESTED IN LEARNING MORE, 3909 02:23:43,400 --> 02:23:46,920 ABOUT THIS, AND HUE FOR YOUR 3910 02:23:46,920 --> 02:23:49,280 TIME. 3911 02:23:49,280 --> 02:23:50,880 >> THANK YOU SO MUCH. 3912 02:23:50,880 --> 02:23:54,880 ONCE AGAIN WE SEE THE ENORMOUS 3913 02:23:54,880 --> 02:23:59,640 POWER OF VA EHR SYSTEM AND HUE 3914 02:23:59,640 --> 02:24:01,000 FOR FOR THIS INSIGHT. 3915 02:24:01,000 --> 02:24:02,880 I WANT TO THANK DR. VEST AND 3916 02:24:02,880 --> 02:24:04,800 MCCARTHY AS WELL AS DR. 3917 02:24:04,800 --> 02:24:10,080 MONTGOMERY FOR REALLY TERRIFIC 3918 02:24:10,080 --> 02:24:11,560 PRESENTATIONS AND THEN I'M GOING 3919 02:24:11,560 --> 02:24:14,360 TO TAKE TIME TO INTRODUCE AGAIN 3920 02:24:14,360 --> 02:24:16,800 MY COLLEAGUES SARA HUNE WHO WILL 3921 02:24:16,800 --> 02:24:22,680 BE THE MODERATOR FOR THE NEXT 3922 02:24:22,680 --> 02:24:22,920 SESSION. 3923 02:24:22,920 --> 02:24:23,640 SARA. 3924 02:24:23,640 --> 02:24:24,920 >> THANK YOU, DOCTOR. 3925 02:24:24,920 --> 02:24:28,400 WELCOME TO THIS SESSION ON 3926 02:24:28,400 --> 02:24:30,640 HOLISTIC CARE PLANNING. 3927 02:24:30,640 --> 02:24:31,360 ACCESS OF EMERGENCY DEPARTMENT 3928 02:24:31,360 --> 02:24:36,200 AND COMMUNITY RESOURCES IN 3929 02:24:36,200 --> 02:24:37,200 TRANSLATE -- TRANSLATIONAL CARE. 3930 02:24:37,200 --> 02:24:39,920 I WOULD LIKE TO INTRODUCE ALL 3931 02:24:39,920 --> 02:24:42,920 THE THREE SPEAKERS FOR THIS 3932 02:24:42,920 --> 02:24:44,360 SESSION. 3933 02:24:44,360 --> 02:24:47,800 AND FIRST SPEAKER WOULD BE DR. 3934 02:24:47,800 --> 02:24:48,640 LAUREN TAYLOR. 3935 02:24:48,640 --> 02:24:49,880 DR. TAYLOR IS ASSISTANT 3936 02:24:49,880 --> 02:24:52,240 PROFESSOR IN THE DEPARTMENT OF 3937 02:24:52,240 --> 02:24:57,240 POPULATION HEALTH IN NYU 3938 02:24:57,240 --> 02:24:57,800 GROSSMAN SCHOOL OF MEDICINE. 3939 02:24:57,800 --> 02:25:00,480 HER RESEARCH EXPLORES THE 3940 02:25:00,480 --> 02:25:02,720 ETHICAL CHALLENGES THAT ARISE IN 3941 02:25:02,720 --> 02:25:05,560 MANAGING HEALTHCARE 3942 02:25:05,560 --> 02:25:06,080 ORGANIZATIONS. 3943 02:25:06,080 --> 02:25:09,040 TO DATE SHE HAS TAKEN UP 3944 02:25:09,040 --> 02:25:12,440 QUESTIONS ABOUT HOW TO 3945 02:25:12,440 --> 02:25:16,800 APPROPRIATELY DIVIDE THE LABOR 3946 02:25:16,800 --> 02:25:17,600 ADDRESSING SOCIAL DETERMINE 3947 02:25:17,600 --> 02:25:18,960 FANTASTIC, WHETHER HOSPITALS 3948 02:25:18,960 --> 02:25:21,800 HAVE RESPONSIBILITIES BEYOND 3949 02:25:21,800 --> 02:25:24,360 DELIVERY OF HEALTHCARE, HOW TO 3950 02:25:24,360 --> 02:25:26,800 EFFECTIVELY BUILD TRUST IN 3951 02:25:26,800 --> 02:25:30,960 CLINICIANS AND INSTITUTIONS AND 3952 02:25:30,960 --> 02:25:32,320 WHAT TECHNOLOGY PLATFORM SHOULD 3953 02:25:32,320 --> 02:25:34,760 PLAY IN MEDIATING COMMUNITY 3954 02:25:34,760 --> 02:25:38,960 CLINICAL RELATIONSHIPS. 3955 02:25:38,960 --> 02:25:42,720 OUR SECOND SPEAKER, DR. ALYCIA 3956 02:25:42,720 --> 02:25:43,360 BRISTOL. 3957 02:25:43,360 --> 02:25:45,600 DR. BRISTOL IS ASSISTANT 3958 02:25:45,600 --> 02:25:47,120 PROFESSOR AT THE UNIVERSITY OF 3959 02:25:47,120 --> 02:25:51,440 UTAH COLLEGE OF NURSING. 3960 02:25:51,440 --> 02:25:52,520 DR. BRISTOL'S RESEARCH BROADLY 3961 02:25:52,520 --> 02:25:57,600 SEEKS TO ADDRESS THE CARE NEEDS 3962 02:25:57,600 --> 02:26:01,480 OF -- AND FAMILY CAREGIVERS, 3963 02:26:01,480 --> 02:26:06,960 PARTICULARLY DURING THE 3964 02:26:06,960 --> 02:26:08,320 HOSPITALIZATIONS, AND CARE 3965 02:26:08,320 --> 02:26:09,600 TRANSLATION, HER RESEARCH 3966 02:26:09,600 --> 02:26:11,440 BACKGROUND INCLUDED EXPLORING 3967 02:26:11,440 --> 02:26:12,840 EXPERIENCE AND INVOLVEMENT OF 3968 02:26:12,840 --> 02:26:18,280 FAMILY CAREGIVERS DID YOU 3969 02:26:18,280 --> 02:26:18,800 RECOLLECT INTRAHOSPITAL 3970 02:26:18,800 --> 02:26:19,920 TRANSMISSIONS OR PATIENT 3971 02:26:19,920 --> 02:26:26,400 MOVEMENT DURING HOSPITALIZATION 3972 02:26:26,400 --> 02:26:31,800 HOSPITALIZATIONS, DR. BRISTOL IS 3973 02:26:31,800 --> 02:26:34,440 CURRENTLY EXAMINING THE 3974 02:26:34,440 --> 02:26:39,120 INFLUENCE OF INTRAHOSPITAL ON 3975 02:26:39,120 --> 02:26:42,360 DISCHARGE PLANNING AND OLDER AS 3976 02:26:42,360 --> 02:26:43,360 I ADULT AND CAREGIVER FOR THIS 3977 02:26:43,360 --> 02:26:46,800 CHARGE. 3978 02:26:46,800 --> 02:26:49,960 FINALLY, OUR THIRD SPEAKER WOULD 3979 02:26:49,960 --> 02:27:05,600 BE DR. MARGARET MARGARET KALOW, 3980 02:27:05,600 --> 02:27:08,360 PATRICIA J MALI M.D. ENDOWED 3981 02:27:08,360 --> 02:27:10,840 SCHOLAR IN PEDIATRIC EMERGENCY 3982 02:27:10,840 --> 02:27:11,480 MEDICINE RESEARCH. 3983 02:27:11,480 --> 02:27:13,680 ATTENDING PHYSICIAN IN BOTH, 3984 02:27:13,680 --> 02:27:16,680 EMERGENCY MEDICINE AND PEDIATRIC 3985 02:27:16,680 --> 02:27:17,480 EMERGENCY MEDICINE AT MASS 3986 02:27:17,480 --> 02:27:19,920 GENERAL HOSPITAL. 3987 02:27:19,920 --> 02:27:22,920 HER WORK FOCUSES ON DEVELOPING 3988 02:27:22,920 --> 02:27:25,200 INTERVENTIONS TO REDUCE 3989 02:27:25,200 --> 02:27:28,480 DISPARITIES IN EMERGENCY CARE, 3990 02:27:28,480 --> 02:27:31,560 AND DESIGNING STRATEGIES TO USE 3991 02:27:31,560 --> 02:27:33,400 EMERGENCY DEPARTMENT VISIT TO 3992 02:27:33,400 --> 02:27:34,600 ADDRESS ADVERSE SOCIAL 3993 02:27:34,600 --> 02:27:54,320 DETERMINANTS OF HEALTH. 3994 02:27:54,320 --> 02:27:56,360 PLEASE HOLD YOUR QUESTIONS FOR 3995 02:27:56,360 --> 02:28:00,920 THE PANEL DISCUSSION AND 3996 02:28:00,920 --> 02:28:02,040 SUBMITTING YOUR QUESTIONS AT ANY 3997 02:28:02,040 --> 02:28:04,880 TIME DURING THE PRESENTATIONS. 3998 02:28:04,880 --> 02:28:06,160 DURING THE BREAK WE WILL CURATE 3999 02:28:06,160 --> 02:28:10,920 THE QUESTIONS FOR THE MODERATOR. 4000 02:28:10,920 --> 02:28:15,240 THANK YOU. 4001 02:28:15,240 --> 02:28:17,480 I WILL TURN IT TO DR. TAYLOR. 4002 02:28:17,480 --> 02:28:18,000 >> WONDERFUL. 4003 02:28:18,000 --> 02:28:19,920 THANK YOU VERY MUCH I APPRECIATE 4004 02:28:19,920 --> 02:28:20,240 IT. 4005 02:28:20,240 --> 02:28:22,400 LET ME BE SURE Y'ALL CAN HEAR 4006 02:28:22,400 --> 02:28:22,720 ME, CORRECT? 4007 02:28:22,720 --> 02:28:23,280 >> YES. 4008 02:28:23,280 --> 02:28:24,200 >> WONDERFUL. 4009 02:28:24,200 --> 02:28:32,200 YOU CAN SEE MY SLIDES. 4010 02:28:32,200 --> 02:28:34,680 I SEE MICHAEL SETTING THE TABLE 4011 02:28:34,680 --> 02:28:35,800 FOR CONCRETE DATA ON 4012 02:28:35,800 --> 02:28:39,400 INTERVENTIONS AND WAYS FORWARD. 4013 02:28:39,400 --> 02:28:41,960 MY GOAL IS TO SET THE TABLE FOR 4014 02:28:41,960 --> 02:28:44,360 WHERE THE STATE OF PLAY IS 4015 02:28:44,360 --> 02:28:47,200 AROUND CREATING HEALTHCARE 4016 02:28:47,200 --> 02:28:49,520 COMMUNITY OR CLINICAL COMMUNITY 4017 02:28:49,520 --> 02:28:50,160 RELATIONSHIPS. 4018 02:28:50,160 --> 02:28:52,160 AND PARTICULARLY FOCUSED ON 4019 02:28:52,160 --> 02:28:55,440 TRYING TO CREATE REFERRAL 4020 02:28:55,440 --> 02:28:56,680 PATHWAYS FROM EMERGENCY 4021 02:28:56,680 --> 02:28:58,080 DEPARTMENTS TO SOCIAL SERVICE 4022 02:28:58,080 --> 02:28:59,560 ORGANIZATIONS OR COMMUNITY BASED 4023 02:28:59,560 --> 02:28:59,800 ORGANIZES. 4024 02:28:59,800 --> 02:29:02,360 I USE THOSE TWO TERMS VIRTUALLY 4025 02:29:02,360 --> 02:29:05,400 INTERCHANGEABLY. 4026 02:29:05,400 --> 02:29:06,640 WHAT I WOULD LIKE TO TRY TO 4027 02:29:06,640 --> 02:29:07,760 LEAVE YOU WITH AT THE END OF TEN 4028 02:29:07,760 --> 02:29:10,800 MIGHT BEES WHICH IS GOING TO GO 4029 02:29:10,800 --> 02:29:13,080 INCREDIBLY QUICKLY, IS THAT 4030 02:29:13,080 --> 02:29:14,200 NON-MEDICAL CRISES OFTEN LAND 4031 02:29:14,200 --> 02:29:15,000 PATIENTS IN EMERGENCY DEPARTMENT 4032 02:29:15,000 --> 02:29:16,560 AND I THINK FOR THOSE WHO WORK 4033 02:29:16,560 --> 02:29:19,800 IN THE EMERGENCY NURSING THIS IS 4034 02:29:19,800 --> 02:29:21,360 ALMOST SELF-EVIDENT, LET'S START 4035 02:29:21,360 --> 02:29:21,600 THERE. 4036 02:29:21,600 --> 02:29:26,400 WHEN THIS HAPPENS FRONT LINE 4037 02:29:26,400 --> 02:29:27,320 CLINICIANS AND NUR NURSES AND 4038 02:29:27,320 --> 02:29:32,400 MANAGERS WILL BE SERVED 4039 02:29:32,400 --> 02:29:33,880 PARTICULAR EXPERTISE SOCIAL 4040 02:29:33,880 --> 02:29:36,840 DETERMINANTS OF HEALTH, THAT LIE 4041 02:29:36,840 --> 02:29:37,840 OUTSIDE THE STANDARDS HEALTHCARE 4042 02:29:37,840 --> 02:29:38,360 DELIVERY SYSTEM. 4043 02:29:38,360 --> 02:29:39,960 THE GOAL FOR ME TODAY IS TO 4044 02:29:39,960 --> 02:29:41,000 ADDRESS THE QUESTION THOUGH I 4045 02:29:41,000 --> 02:29:44,360 WON'T FULLY ADDRESS IT, WHY HAVE 4046 02:29:44,360 --> 02:29:46,960 SUCH REFERRAL PATHWAYS BEEN 4047 02:29:46,960 --> 02:29:48,080 DIFFICULT TO ESTABLISH WHY CAN'T 4048 02:29:48,080 --> 02:29:50,600 IT BE A NURSE MANAGER CAN FIND 4049 02:29:50,600 --> 02:29:51,600 THE EMERGENCY DEPARTMENT REALIZE 4050 02:29:51,600 --> 02:29:53,240 WHAT THEY SEEK IS HOUSING OR 4051 02:29:53,240 --> 02:29:54,960 THEIR HEALTHCARE CONDITION IS 4052 02:29:54,960 --> 02:29:57,000 BEING SUBSTANTIALLY EXACERBATED 4053 02:29:57,000 --> 02:29:58,240 BY HOUSING INSTABILITY. 4054 02:29:58,240 --> 02:30:03,880 AND REALLY BE ABLE TO KIND OF IN 4055 02:30:03,880 --> 02:30:05,320 A WARM HAND OFF WITH PEOPLE WITH 4056 02:30:05,320 --> 02:30:08,520 HOUSING EXPERTISE. THE WAY THAT 4057 02:30:08,520 --> 02:30:11,840 I THINK ABOUT THIS WHOLE FIELD 4058 02:30:11,840 --> 02:30:13,720 OF PLAY, HOW HEALTHCARE AND 4059 02:30:13,720 --> 02:30:15,520 COMMUNITY BASED ORGANIZATIONS 4060 02:30:15,520 --> 02:30:16,840 WORK TOGETHER OR HEALTHCARE 4061 02:30:16,840 --> 02:30:18,960 PURSUES DELIVERY OF HOLISTIC 4062 02:30:18,960 --> 02:30:20,600 CARE, TITLE OUR SESSION, THERE 4063 02:30:20,600 --> 02:30:23,160 IS FOUR CHALLENGES OR FOUR 4064 02:30:23,160 --> 02:30:24,320 STRATEGIC ISSUES THAT A 4065 02:30:24,320 --> 02:30:24,920 HEALTHCARE MANAGER HAS TO 4066 02:30:24,920 --> 02:30:28,120 CONFRONTS. EN ONE WE HEARD ABOUT 4067 02:30:28,120 --> 02:30:30,520 TODAY IS HOW DO I SCREEN AND 4068 02:30:30,520 --> 02:30:32,400 IDENTIFY HIGH RISK PATIENTS OR 4069 02:30:32,400 --> 02:30:34,680 HOW SCREEN IDENTIFY MAYBE EVEN 4070 02:30:34,680 --> 02:30:36,720 NOT HIGH RISK BUT PATIENTS WITH 4071 02:30:36,720 --> 02:30:39,560 PARTICULAR SOCIAL NEEDS. 4072 02:30:39,560 --> 02:30:42,320 THE SECOND IS NOW I HAVE 4073 02:30:42,320 --> 02:30:43,440 IDENTIFIED PEOPLE WHO HAVE NEEDS 4074 02:30:43,440 --> 02:30:46,080 THAT LIE OUTSIDE MY EXPERTISE. 4075 02:30:46,080 --> 02:30:47,640 NOW HOW DO I THINK ABOUT MEETING 4076 02:30:47,640 --> 02:30:52,360 THOSE NEEDS. 4077 02:30:52,360 --> 02:30:54,920 THAT IS SOMETIMES CALLED A MAKE 4078 02:30:54,920 --> 02:30:56,240 BY DECISION, A DECISION DO I TRY 4079 02:30:56,240 --> 02:30:58,400 TO CULTIVATE NEW CAPACITIES 4080 02:30:58,400 --> 02:31:01,040 WITHIN THE HEALTHCARE SYSTEM OR 4081 02:31:01,040 --> 02:31:01,800 WITHIN MY CLINIC? 4082 02:31:01,800 --> 02:31:04,200 OR IS IT GOING TO BE A BY 4083 02:31:04,200 --> 02:31:05,560 STRATEGY WHICH MEANS I'M GOING 4084 02:31:05,560 --> 02:31:08,120 TO REFER THEM ELSEWHERE IN THE 4085 02:31:08,120 --> 02:31:10,680 BUY INFERS YOU WILL PAY SOME 4086 02:31:10,680 --> 02:31:11,600 PARTNER ORGANIZATION FOR THEIR 4087 02:31:11,600 --> 02:31:19,400 TIME STAFFING SERVICES. LET'S 4088 02:31:19,400 --> 02:31:22,320 GO WITH BY PREFERRED STRATEGY 4089 02:31:22,320 --> 02:31:23,000 POLICY MAKERS THEN HEALTHCARE 4090 02:31:23,000 --> 02:31:25,560 MANAGER IS HOW TO VET POTENTIAL 4091 02:31:25,560 --> 02:31:27,000 PARTNER ORGANIZATIONS, I DID A 4092 02:31:27,000 --> 02:31:30,200 LOT OF MY RESEARCH IN BOSTON, 4093 02:31:30,200 --> 02:31:32,400 AND I ONCE COUNTED SOMETHING 4094 02:31:32,400 --> 02:31:34,920 LIKE 50 PLUS FOOD PANTRIES IN A 4095 02:31:34,920 --> 02:31:36,360 TWO SQUARE MILE RADIUS. 4096 02:31:36,360 --> 02:31:37,880 IF YOU WERE BOSTON MEDICAL 4097 02:31:37,880 --> 02:31:39,360 CENTER YOU LOOK AT YOUR BACKYARD 4098 02:31:39,360 --> 02:31:41,400 AND YOU THOUGHT GREAT I NEED A 4099 02:31:41,400 --> 02:31:44,000 FOOD PANTRY PARTNER, NUTRITION 4100 02:31:44,000 --> 02:31:44,800 SOLUTION PARTNER, HOW DO YOU 4101 02:31:44,800 --> 02:31:46,240 BEGIN TO SORT THROUGH. 4102 02:31:46,240 --> 02:31:47,000 HOW DO YOU BEGIN TO ASSESS 4103 02:31:47,000 --> 02:31:50,080 QUALITY. 4104 02:31:50,080 --> 02:31:51,400 FINALLY SAY YOU IDENTIFY A 4105 02:31:51,400 --> 02:31:54,280 PARTNER AND SAY GREAT, WE ARE IN 4106 02:31:54,280 --> 02:31:55,920 AN OPERATIONAL RELATIONSHIP, 4107 02:31:55,920 --> 02:31:57,120 MONEY CHANGING HANDS IN RETURN 4108 02:31:57,120 --> 02:31:59,000 FOR SERVICES HOW DO WE GO ABOUT 4109 02:31:59,000 --> 02:32:00,880 DAY TO DAY SHARING INFORMATION 4110 02:32:00,880 --> 02:32:02,400 ABOUT PATIENTS. 4111 02:32:02,400 --> 02:32:03,680 TALKING TO ONE ANOTHER TO MAKE 4112 02:32:03,680 --> 02:32:04,600 SURE THAT THE HEALTHCARE 4113 02:32:04,600 --> 02:32:07,360 DELIVERY THAT I'M DOING AND THE 4114 02:32:07,360 --> 02:32:08,080 SOCIAL SERVICE DELIVERY THEY ARE 4115 02:32:08,080 --> 02:32:10,640 DOING IS WORKING IN CONCERT. 4116 02:32:10,640 --> 02:32:12,720 I WOULD SAY I THINK THE TOP TWO 4117 02:32:12,720 --> 02:32:14,440 HAVE BEEN ADDRESSED MORE FULLY 4118 02:32:14,440 --> 02:32:17,040 BY SOME OF MY PREDECESSORS HERE, 4119 02:32:17,040 --> 02:32:19,400 AND MY FOCUS TENDS TO BE ON 4120 02:32:19,400 --> 02:32:21,000 THESE BOTTOM TWO, THE VETTING OR 4121 02:32:21,000 --> 02:32:23,000 IDENTIFICATION OF PARTNERS, 4122 02:32:23,000 --> 02:32:24,200 CBOs AND THE OPERATIONAL 4123 02:32:24,200 --> 02:32:27,400 CHALLENGES OF WORKING WITH THEM. 4124 02:32:27,400 --> 02:32:29,600 SO I WOULD JUST SAY IT'S 4125 02:32:29,600 --> 02:32:31,800 IMPORTANT NOT TO BE AHISTORICAL 4126 02:32:31,800 --> 02:32:32,920 WHEN TALK ABOUT WOULDN'T IT BE 4127 02:32:32,920 --> 02:32:35,280 NICE TO HAVE STRONGER 4128 02:32:35,280 --> 02:32:36,000 COMMUNALLITY LINKAGES. 4129 02:32:36,000 --> 02:32:37,320 I THINK TO TAKE A LOOK AT 4130 02:32:37,320 --> 02:32:39,360 HISTORY TO REALIZE JUST HOW 4131 02:32:39,360 --> 02:32:41,200 DIFFERENTLY HEALTHCARE SERVICES 4132 02:32:41,200 --> 02:32:42,160 AND SOCIAL SERVICES HAVE BEEN 4133 02:32:42,160 --> 02:32:45,720 TREATED IN THIS COUNTRY FOR AT 4134 02:32:45,720 --> 02:32:46,320 LEAST 150 YEARS. 4135 02:32:46,320 --> 02:32:48,400 THIS HISTORY SOMETHING THAT MY 4136 02:32:48,400 --> 02:32:49,760 COLLEAGUE BETSY BRADLEY AND I 4137 02:32:49,760 --> 02:32:51,360 SPENT TIME ON IN THE AMERICAN 4138 02:32:51,360 --> 02:32:52,800 HEALTHCARE PARADOX, THE WHOLE OF 4139 02:32:52,800 --> 02:32:54,560 CHAPTER TWO WAS ABOUT TRYING TO 4140 02:32:54,560 --> 02:32:58,880 CHART THESE INCREDIBLY DISTINCT 4141 02:32:58,880 --> 02:33:00,440 PATHS EVEN AS WE RECOGNIZE 4142 02:33:00,440 --> 02:33:01,280 SOCIAL DETERMINANTS OF HEALTH 4143 02:33:01,280 --> 02:33:03,200 ARE INTEGRAL TO HEALTH, WE WANT 4144 02:33:03,200 --> 02:33:05,200 TO AND ASPIRE TO DELIVER 4145 02:33:05,200 --> 02:33:06,840 HOLISTIC CARE, THE OPERATIONAL 4146 02:33:06,840 --> 02:33:10,120 DEVELOPMENT OF THESE TWO SECTORS 4147 02:33:10,120 --> 02:33:11,200 HAS BEEN QUITE DISTINCT. 4148 02:33:11,200 --> 02:33:13,960 WHILE I WON'T GO INTO HISTORY 4149 02:33:13,960 --> 02:33:15,120 MUCH THE RESULTS ARE DISTINCT 4150 02:33:15,120 --> 02:33:17,640 ORGANIZATIONAL LANDS SCAPES WITH 4151 02:33:17,640 --> 02:33:19,240 OFTEN HUGE ORGANIZATIONS IN THE 4152 02:33:19,240 --> 02:33:20,960 HEALTHCARE SIDE COMPARED TO THE 4153 02:33:20,960 --> 02:33:23,480 SIZE OF SOCIAL SERVICE 4154 02:33:23,480 --> 02:33:23,800 ORGANIZATIONS. 4155 02:33:23,800 --> 02:33:25,120 THAT HUGENESS COMES THROUGH IN 4156 02:33:25,120 --> 02:33:29,080 NUMBER OF EMPLOYEES ANNUAL 4157 02:33:29,080 --> 02:33:30,920 REVENUE, PHYSICAL PLANT, JUST 4158 02:33:30,920 --> 02:33:34,600 TENDS TO REALLY BE STORY OF 4159 02:33:34,600 --> 02:33:35,000 DAVID AND GOLIATH. 4160 02:33:35,000 --> 02:33:37,720 AS I SAY IN JUST A MOMENT THE 4161 02:33:37,720 --> 02:33:41,840 CBOs FEEL THAT SHARPLY. 4162 02:33:41,840 --> 02:33:44,080 YOU HAVE PRIVATE INSURANCE, 4163 02:33:44,080 --> 02:33:47,320 REALLY PROPELLING HEALTHCARE 4164 02:33:47,320 --> 02:33:49,280 DEVELOPMENT, AND HEALTHCARE 4165 02:33:49,280 --> 02:33:49,640 DELIVERY. 4166 02:33:49,640 --> 02:33:52,960 SOCIAL SERVICE DELIVERY HAS BEEN 4167 02:33:52,960 --> 02:33:54,880 LARGELY MANDATE OF THE STATE, 4168 02:33:54,880 --> 02:33:57,480 GOVERNMENT FINANCING, ALTHOUGH 4169 02:33:57,480 --> 02:33:58,840 INCREASINGLY OVER THE 20TH 4170 02:33:58,840 --> 02:34:00,040 CENTURY, 21ST CENTURY, IT IS 4171 02:34:00,040 --> 02:34:02,360 AUGMENTED BY THE QUOTE UNQUOTE 4172 02:34:02,360 --> 02:34:03,880 THIRD SECTOR INDEPENDENT 4173 02:34:03,880 --> 02:34:06,240 NON-PROFITS ON CHARITABLE 4174 02:34:06,240 --> 02:34:06,600 CONTRIBUTIONS. 4175 02:34:06,600 --> 02:34:08,480 VERY DIFFERENT STAFFING MODELS, 4176 02:34:08,480 --> 02:34:10,000 DISTINCT REGULATORY AND PRIVACY 4177 02:34:10,000 --> 02:34:12,280 REGULATIONS WHICH REALLY COMES 4178 02:34:12,280 --> 02:34:14,400 IN TO FULL VIEW WHEN YOU 4179 02:34:14,400 --> 02:34:16,120 CONFRONT HIPAA CHALLENGES WITH 4180 02:34:16,120 --> 02:34:17,480 SHARING INFORMATION BETWEEN 4181 02:34:17,480 --> 02:34:18,600 HEALTHCARE AND SOCIAL SERVICES 4182 02:34:18,600 --> 02:34:20,040 AND THEN THIS IS THE ONE THAT I 4183 02:34:20,040 --> 02:34:22,960 WANTED TO TAKE 30 SECONDS ON. 4184 02:34:22,960 --> 02:34:25,400 DISTINCT CONCEPTIONS WHAT GOOD 4185 02:34:25,400 --> 02:34:26,200 QUALITY OR MANAGEMENT LOOKS 4186 02:34:26,200 --> 02:34:27,720 LIKE. 4187 02:34:27,720 --> 02:34:29,680 A LOT OF THIS IS COMING NOT ONLY 4188 02:34:29,680 --> 02:34:32,280 OUT OF STUDIES OF HISTORY BUT 4189 02:34:32,280 --> 02:34:35,320 NOW PROBABLY UPWARDS OF 150 4190 02:34:35,320 --> 02:34:36,040 CONVERSATIONS WITH HEALTHCARE 4191 02:34:36,040 --> 02:34:38,360 AND SOCIAL SERVICES FOLKS ABOUT 4192 02:34:38,360 --> 02:34:43,280 RELATIONSHIP TO ONE ANOTHER. 4193 02:34:43,280 --> 02:34:45,800 WHEN I TALK TO HEALTHCARE FOLKS 4194 02:34:45,800 --> 02:34:48,120 AND SAY WHAT DOES GOOD QUALITY 4195 02:34:48,120 --> 02:34:49,440 CARE LIKE, OFTEN WHAT PEEP POINT 4196 02:34:49,440 --> 02:34:51,880 TO IS TO SAY GOOD QUALITY CARE 4197 02:34:51,880 --> 02:34:54,440 IS DELIVERING THE SAME SERVICE 4198 02:34:54,440 --> 02:34:57,880 TO THE SAME CASE PRESENTATION 4199 02:34:57,880 --> 02:34:58,160 EACH TIME. 4200 02:34:58,160 --> 02:35:00,640 SO WHATEVER THE PERSON SHOWS UP 4201 02:35:00,640 --> 02:35:02,600 WITH I MAKE AN IDENTIFICATION OF 4202 02:35:02,600 --> 02:35:04,000 WHAT I THINK THE DIFFERENTIAL IS 4203 02:35:04,000 --> 02:35:06,240 OR WHAT THEY NEED AND REGARDLESS 4204 02:35:06,240 --> 02:35:09,200 OF RACE GENDER AGE, I'M FLYING 4205 02:35:09,200 --> 02:35:10,840 TO -- CONFINED TO THOSE 4206 02:35:10,840 --> 02:35:11,560 CHALLENGES UNLESS MEDICALLY 4207 02:35:11,560 --> 02:35:13,000 RELEVANT AND I HIT THE MARK WITH 4208 02:35:13,000 --> 02:35:16,200 LIKE A PRETTY PROTOCOLIZED 4209 02:35:16,200 --> 02:35:18,960 APPROACH TO PROBLEM SOLVING. 4210 02:35:18,960 --> 02:35:20,400 SO THERE'S SOMETHING ABOUT 4211 02:35:20,400 --> 02:35:24,120 SAMENESS ROUTINENESS, PROTOCOLS, 4212 02:35:24,120 --> 02:35:25,160 THAT REALLY STANDS OUT AS A 4213 02:35:25,160 --> 02:35:28,800 HALLMARK OF GOOD CARE. 4214 02:35:28,800 --> 02:35:29,720 MY MOM JUST WENT INTO THE 4215 02:35:29,720 --> 02:35:30,920 HOSPITAL A COUPLE OF WEEKS AGO 4216 02:35:30,920 --> 02:35:33,600 AND SHE GOT PUT ON A SEPSIS 4217 02:35:33,600 --> 02:35:38,080 PROTOCOL THAT WE ARE SURE SAVE 4218 02:35:38,080 --> 02:35:40,920 HER LIFE, THAT IS GOOD IN 4219 02:35:40,920 --> 02:35:41,200 HEALTHCARE. 4220 02:35:41,200 --> 02:35:42,200 WHEN I TALK ABOUT WHAT GOOD LOOK 4221 02:35:42,200 --> 02:35:46,800 LIKE IN A CBO OR SOCIAL SERVICE 4222 02:35:46,800 --> 02:35:48,200 WORLD THE WORDS THAT PROTOTO TOP 4223 02:35:48,200 --> 02:35:48,800 ARE INCREDIBLY DIFFERENT. 4224 02:35:48,800 --> 02:35:53,040 WHEN I SAY WHAT IS THAT LOOK 4225 02:35:53,040 --> 02:35:54,280 LIKE THEY SAY IT LOOKS LIKE 4226 02:35:54,280 --> 02:35:55,760 TAILORING SERVICES TO THE 4227 02:35:55,760 --> 02:35:59,120 INDIVIDUAL IN FRONT OF ME. 4228 02:35:59,120 --> 02:36:01,120 NO TWO PEOPLE RECEIVE THE SAME 4229 02:36:01,120 --> 02:36:04,520 THING BUT INSTEAD WE HAVE 4230 02:36:04,520 --> 02:36:06,200 CURATED OR ADAPTED WHAT WE ARE 4231 02:36:06,200 --> 02:36:10,200 ABLE TO PROVIDE FOR THAT PERSON 4232 02:36:10,200 --> 02:36:13,480 OR FAMILY CIRCUMSTANCES. 4233 02:36:13,480 --> 02:36:15,600 I P NOT SAYING THE TRUTH DOESN'T 4234 02:36:15,600 --> 02:36:17,880 LIE IN BETWEEN OR BOTH 4235 02:36:17,880 --> 02:36:18,920 HEALTHCARE AND SERVICES NEED 4236 02:36:18,920 --> 02:36:22,800 BOTH APPROACHES BUT THERE ARE, 4237 02:36:22,800 --> 02:36:26,000 DIFFERENT EMPHASES ON 4238 02:36:26,000 --> 02:36:27,200 STANDARDIZATION VERSUS 4239 02:36:27,200 --> 02:36:28,760 CUSTOMIZATION AND THAT WILL MAKE 4240 02:36:28,760 --> 02:36:30,560 IT DIFFICULT FOR TWO SECTORS TO 4241 02:36:30,560 --> 02:36:34,880 COME UP WITH UNIFIED PLAN OF 4242 02:36:34,880 --> 02:36:37,240 ACTION, A CONCEPTION OF WHAT 4243 02:36:37,240 --> 02:36:43,000 CERTAIN SERVICES ARE WORTH, AND 4244 02:36:43,000 --> 02:36:47,520 WHAT SHOULD BE PAID FOR THEM. 4245 02:36:47,520 --> 02:36:48,440 HEALTHCARE SERVICE 4246 02:36:48,440 --> 02:36:49,440 RELATIONSHIPS, WITH PUBLISHED 4247 02:36:49,440 --> 02:36:50,440 QUARTERLY BACK IN DECEMBER OF 4248 02:36:50,440 --> 02:36:53,680 2020. 4249 02:36:53,680 --> 02:36:59,000 THE HIGH TAKE AWAY POINTS HERE, 4250 02:36:59,000 --> 02:37:00,480 QUALITATIVE STUDY OF COMMUNITY 4251 02:37:00,480 --> 02:37:02,640 BASED ORGANIZATIONS IN 4252 02:37:02,640 --> 02:37:03,080 MASSACHUSETTS. 4253 02:37:03,080 --> 02:37:06,920 IT WAS INCLUSIVE OF HOUSING 4254 02:37:06,920 --> 02:37:07,840 TRANSPORTATION NUTRITION, LOTS 4255 02:37:07,840 --> 02:37:12,200 OF COMMUNITY CENTERS, SOME JOB 4256 02:37:12,200 --> 02:37:13,400 TRAINING AND EDUCATION. 4257 02:37:13,400 --> 02:37:15,920 QUITE A DIVERSE SET. 4258 02:37:15,920 --> 02:37:17,920 CERTAINLY FUTURE WORK IN THIS 4259 02:37:17,920 --> 02:37:19,240 AREA SHOULD START QUICKLY 4260 02:37:19,240 --> 02:37:19,880 DRILLING DOWN BECAUSE THOSE ARE 4261 02:37:19,880 --> 02:37:23,840 NOT ALL THE SAME, WE NEED MORE 4262 02:37:23,840 --> 02:37:25,520 SPECIFIC UNDERSTANDING WHAT IS 4263 02:37:25,520 --> 02:37:26,400 PARTICULAR TO HOUSING DIFFERENT 4264 02:37:26,400 --> 02:37:27,320 FROM NUTRITION. 4265 02:37:27,320 --> 02:37:29,720 FOR THIS STUDY DATA COLLECTING 4266 02:37:29,720 --> 02:37:32,440 2018, PAINT WITH BROAD BRUSH AND 4267 02:37:32,440 --> 02:37:34,400 I WOULD SAY ONE THING WE HEARD 4268 02:37:34,400 --> 02:37:36,920 AGAIN AND AGAIN IS THEY ARE 4269 02:37:36,920 --> 02:37:40,800 FINANCIALLY PRECARIOUS. 4270 02:37:40,800 --> 02:37:45,360 YOU CAN SEE THAT IN QUOTE. 4271 02:37:45,360 --> 02:37:45,840 THAT STRATEGIC INTEREST 4272 02:37:45,840 --> 02:37:48,640 PARTNERING WITH HEALTHCARE. 4273 02:37:48,640 --> 02:37:52,400 WHAT THAT SOUNDED LIKE IN CBOs 4274 02:37:52,400 --> 02:37:55,280 WERE THINGS LIKE A CBO LEADER 4275 02:37:55,280 --> 02:37:57,000 MORE DELIBERATE EFFORT TO MARKET 4276 02:37:57,000 --> 02:37:58,720 AND TRY TO DEVELOP RELATIONSHIPS 4277 02:37:58,720 --> 02:38:00,680 FOR REFERRALS SPECIFICALLY FOR 4278 02:38:00,680 --> 02:38:03,440 THE HEALTHCARE PROVIDERS. 4279 02:38:03,440 --> 02:38:04,840 I THINK ANYTHING WE CAN TRY TO 4280 02:38:04,840 --> 02:38:06,560 DO TO GET SERVICE PROVIDERS 4281 02:38:06,560 --> 02:38:07,680 PARTICULARLY HOSPITALS WHO HAVE 4282 02:38:07,680 --> 02:38:10,440 PRETTY SIGNIFICANT RESOURCES AT 4283 02:38:10,440 --> 02:38:12,320 HAND TO CONNECT WITH COMMUNITY 4284 02:38:12,320 --> 02:38:14,560 ORGANIZATIONS, IS A GOOD THING. 4285 02:38:14,560 --> 02:38:18,280 SO LOOK AT THIS SLIDE, YOU SET 4286 02:38:18,280 --> 02:38:19,920 UP HOLISTIC CARES PARTNERSHIP 4287 02:38:19,920 --> 02:38:20,800 BETWEEN HEALTHCARE AND SOCIAL 4288 02:38:20,800 --> 02:38:23,320 SERVICES AND HERE YOU ARE 4289 02:38:23,320 --> 02:38:25,160 TELLING US SERVICES ARE GAME AND 4290 02:38:25,160 --> 02:38:26,480 WANT TO PARTNER. 4291 02:38:26,480 --> 02:38:28,840 SO WHAT IS THE CHALLENGE HERE. 4292 02:38:28,840 --> 02:38:33,480 THE CHALLENGE IS REALLY IN THE 4293 02:38:33,480 --> 02:38:35,360 SPECIFICS AND DETAILS OF HOW 4294 02:38:35,360 --> 02:38:38,600 THESE CONNECTIONS CAN BE FORGED. 4295 02:38:38,600 --> 02:38:40,760 AGAIN AND AGAIN THOUGH CBO SAID 4296 02:38:40,760 --> 02:38:43,400 TO ME YEAH, CONCEPTUALLY I VERY 4297 02:38:43,400 --> 02:38:44,640 MUCH WANT TO A RELATIONSHIP WITH 4298 02:38:44,640 --> 02:38:45,960 HEALTHCARE. 4299 02:38:45,960 --> 02:38:49,680 THEY ALSO REPORTED BUT WE HAVE 4300 02:38:49,680 --> 02:38:50,720 TROUBLE FINDING OUR WAY AND 4301 02:38:50,720 --> 02:38:53,400 GETTING IN THE SAME ROOM AND 4302 02:38:53,400 --> 02:38:56,000 AGREEING ON WHAT WE SHOULD BE 4303 02:38:56,000 --> 02:38:56,360 DOING. 4304 02:38:56,360 --> 02:38:59,000 THIS IS EMBLEMATIC QUOTE, WHAT 4305 02:38:59,000 --> 02:39:00,200 WE LEARNED FROM MEETING A COUPLE 4306 02:39:00,200 --> 02:39:04,400 OF MONTHS AGO, WE SPEAK ENTIRELY 4307 02:39:04,400 --> 02:39:05,960 DIFFERENT LANGUAGE. 4308 02:39:05,960 --> 02:39:07,080 SITTING HOSPITAL PEOPLE HAVING 4309 02:39:07,080 --> 02:39:08,240 LUNCH AND WE WERE TALKING FOR 4310 02:39:08,240 --> 02:39:11,800 TEN MINUTES, ACTUALLY WE HAVE NO 4311 02:39:11,800 --> 02:39:13,960 IDEA WHAT YOU SAID. 4312 02:39:13,960 --> 02:39:15,880 THIS COMES UP AGAIN AND AGAIN. 4313 02:39:15,880 --> 02:39:17,720 ONE FAVORITE STORY ABOUT HOW 4314 02:39:17,720 --> 02:39:19,600 HEALTHCARE AND SOCIAL SERVICES 4315 02:39:19,600 --> 02:39:23,000 CAN BE TWO PLANES IN THE NIGHT 4316 02:39:23,000 --> 02:39:26,960 -- OR SHIPS IN THE NIGHT IS CBO 4317 02:39:26,960 --> 02:39:29,120 SAYING TO ME THIS WAS SOMEONE 4318 02:39:29,120 --> 02:39:29,800 WHO RAN HOUSING ORGANIZATION AND 4319 02:39:29,800 --> 02:39:32,720 HAD A DIRECT LINE TO THE TENANT 4320 02:39:32,720 --> 02:39:36,480 ORGANIZATION. 4321 02:39:36,480 --> 02:39:38,400 SO SOMEONE IN THE HOSPITAL AND 4322 02:39:38,400 --> 02:39:41,040 RURAL COMMUNITY CALL AND SAID 4323 02:39:41,040 --> 02:39:42,160 CAN YOU ROUND UP TENANTS AND 4324 02:39:42,160 --> 02:39:43,280 MAKE IT TO THIS MEETING NEXT 4325 02:39:43,280 --> 02:39:43,680 WEEK. 4326 02:39:43,680 --> 02:39:46,200 SO THE HOUSING PROVIDERS SAID 4327 02:39:46,200 --> 02:39:47,640 SURE, THAT SOUNDS LIKE A GOOD 4328 02:39:47,640 --> 02:39:48,120 OPPORTUNITY. 4329 02:39:48,120 --> 02:39:49,680 SO GOT A FEW TOGETHER, THEY ALL 4330 02:39:49,680 --> 02:39:53,880 WENT TO THE HOSPITAL, THESE TEND 4331 02:39:53,880 --> 02:39:55,840 TO HAPPEN ON HEALTHCARE 4332 02:39:55,840 --> 02:39:56,120 TERRITORY. 4333 02:39:56,120 --> 02:39:56,920 BUT THEY WENT TO HOSPITAL AND 4334 02:39:56,920 --> 02:39:57,800 HAD THE MEETING. 4335 02:39:57,800 --> 02:39:59,520 AND THE HOUSING LEADER SAID TO 4336 02:39:59,520 --> 02:40:01,880 ME IT WAS JUST SO DEEPLY 4337 02:40:01,880 --> 02:40:03,440 UNCOMFORTABLE BECAUSE WE GOT 4338 02:40:03,440 --> 02:40:04,800 THERE AND THERE THEY HAD BROUGHT 4339 02:40:04,800 --> 02:40:07,280 FIVE OR SIX PEOPLE FROM THE 4340 02:40:07,280 --> 02:40:08,120 HEALTHCARE ORGANIZATION ALL WHOM 4341 02:40:08,120 --> 02:40:10,000 ARE DRESSED TO THE NINES. 4342 02:40:10,000 --> 02:40:12,200 IN VERY, VERY FANCY CLOTHES. 4343 02:40:12,200 --> 02:40:13,600 ALL THE HEALTHCARE PEOPLE SAT ON 4344 02:40:13,600 --> 02:40:15,480 ONE SIDE OF THE TABLE AND WE 4345 02:40:15,480 --> 02:40:18,200 WOUND UP ON THE OTHER SIDE OF 4346 02:40:18,200 --> 02:40:19,720 THE TABLE. 4347 02:40:19,720 --> 02:40:20,840 THEY DIDN'T HAVE AN AGENDA. 4348 02:40:20,840 --> 02:40:21,920 THE HEALTHCARE PEOPLE SAT THERE 4349 02:40:21,920 --> 02:40:24,240 AND SAID WE WANT YOU TO TELL US 4350 02:40:24,240 --> 02:40:25,640 WHAT IT IS LIKE LIVERING IN SUCH 4351 02:40:25,640 --> 02:40:30,160 AND SUCH PUBLIC HOUSING 4352 02:40:30,160 --> 02:40:30,440 DEVELOPMENT. 4353 02:40:30,440 --> 02:40:31,880 I THINK IT IS AN INTERESTING 4354 02:40:31,880 --> 02:40:35,680 STORY BECAUSE I COULD FEEL 4355 02:40:35,680 --> 02:40:37,280 CLEARLY THIS HOUSING PERSON FELT 4356 02:40:37,280 --> 02:40:40,840 A LITTLE LIKE INSULTED, MAYBE 4357 02:40:40,840 --> 02:40:42,960 MOVING TOWARDS OFFENDED BY THE 4358 02:40:42,960 --> 02:40:46,160 MEETING YET I COULD ALSO 4359 02:40:46,160 --> 02:40:47,360 INTERNALIZE OH, THESE FOLKS GOT 4360 02:40:47,360 --> 02:40:48,320 DRESSED TO THE NINES FOR THE 4361 02:40:48,320 --> 02:40:48,760 MEETING. 4362 02:40:48,760 --> 02:40:50,160 IN SOME WAY THAT IS A SIGN OF 4363 02:40:50,160 --> 02:40:50,760 RESPECT. 4364 02:40:50,760 --> 02:40:52,400 THAT'S HEALTHCARE TRYING TO SHOW 4365 02:40:52,400 --> 02:40:55,600 UP AND SAY WE TAKE YOU VERY 4366 02:40:55,600 --> 02:40:56,880 SERIOUSLY. 4367 02:40:56,880 --> 02:40:58,000 WE WANT TO LISTEN CLOSE TO WHAT 4368 02:40:58,000 --> 02:40:59,520 YOU HAVE TO SAY. 4369 02:40:59,520 --> 02:41:02,280 THE NO AGENDA, MAN IT MUST HAVE 4370 02:41:02,280 --> 02:41:03,960 TAKEN RESTRAINT OR DO YOU HAVE 4371 02:41:03,960 --> 02:41:04,960 TAKEN RESTRAINT FOR THESE 4372 02:41:04,960 --> 02:41:06,880 HEALTHCARE FOLKS TO GO IN AND 4373 02:41:06,880 --> 02:41:08,360 SAY THE FLOOR IS YOURS, TELL US 4374 02:41:08,360 --> 02:41:11,560 ABOUT YOUR LIVED EXPERIENCE. 4375 02:41:11,560 --> 02:41:13,200 AND NOT DRILL DOWN TO HERE IS 4376 02:41:13,200 --> 02:41:15,680 AGENDA A THROUGH E AND WE ARE 4377 02:41:15,680 --> 02:41:20,000 OPERATIONAL RIGHT NOW. 4378 02:41:20,000 --> 02:41:21,600 SO AGAIN NICE STORY NOT BECAUSE 4379 02:41:21,600 --> 02:41:24,200 IT PAINTS HEALTHCARE AS 100% OF 4380 02:41:24,200 --> 02:41:27,720 THE LENS BUT SHOWS HOW THE SAME 4381 02:41:27,720 --> 02:41:28,880 ACTION CAN MEAN VERY DIFFERENT 4382 02:41:28,880 --> 02:41:31,000 THINGS TO HEALTHCARE AND SOCIAL 4383 02:41:31,000 --> 02:41:32,400 SERVICES. 4384 02:41:32,400 --> 02:41:35,200 I WANT TO END BY SAYING I THINK 4385 02:41:35,200 --> 02:41:39,200 CHANGES IS A FOOT AND CHANGE IS 4386 02:41:39,200 --> 02:41:40,880 AFOOT FOR HEALTHCARE COMMUNITY 4387 02:41:40,880 --> 02:41:42,200 ORGANIZATIONS AND RELATIONSHIPS 4388 02:41:42,200 --> 02:41:43,720 BECAUSE OF ARRIVAL OF NEW 4389 02:41:43,720 --> 02:41:44,400 TECHNOLOGY PLATFORMS AN BUSINESS 4390 02:41:44,400 --> 02:41:45,200 MODELS. 4391 02:41:45,200 --> 02:41:46,920 SO I WANT TO CLOSE BY SUGGESTING 4392 02:41:46,920 --> 02:41:48,840 THAT THE ARRIVAL OF THESE 4393 02:41:48,840 --> 02:41:50,960 TECHNOLOGY PLATFORMS AND YOU 4394 02:41:50,960 --> 02:41:54,440 MIGHT KNOW SOME OF THE NAMES 4395 02:41:54,440 --> 02:41:57,880 LIKE UNITE US, THEY STAND TO 4396 02:41:57,880 --> 02:41:59,000 RESHAPE THE HEALTHCARE CBO 4397 02:41:59,000 --> 02:42:01,400 RELATIONSHIPS BY THREE, ONE 4398 02:42:01,400 --> 02:42:02,360 FACILITATING ELECTRONIC 4399 02:42:02,360 --> 02:42:04,520 REFERRAL, TWO, ALLOWING A MODE 4400 02:42:04,520 --> 02:42:06,960 FOR CONSISTENT PAYMENT, TO 4401 02:42:06,960 --> 02:42:08,400 CBOs FROM HEALTHCARE. 4402 02:42:08,400 --> 02:42:13,440 THREE, BRINGING IN A NEW -- I HE 4403 02:42:13,440 --> 02:42:17,760 HESITATE TO SAY AGE BUT NEW 4404 02:42:17,760 --> 02:42:20,200 GUISTE AROUND QUALITY 4405 02:42:20,200 --> 02:42:20,920 MEASUREMENT IN THE SOCIAL 4406 02:42:20,920 --> 02:42:21,680 SERVICES DELIVERY SECTOR. 4407 02:42:21,680 --> 02:42:24,200 THESE ARE THE BIG NAMES IN THE 4408 02:42:24,200 --> 02:42:27,440 INNOVATION PLATFORM SPACE, 4409 02:42:27,440 --> 02:42:30,160 SHOULD BE ON HERE, THERE IS A 4410 02:42:30,160 --> 02:42:33,560 LOTTED LINE BETWEEN UNITE US AND 4411 02:42:33,560 --> 02:42:36,000 NOW POW BECAUSE IT ACQUIRED NOW 4412 02:42:36,000 --> 02:42:36,400 POW NOT LONG AGO. 4413 02:42:36,400 --> 02:42:38,320 AS I SEE IT, THERE IS ONGOING 4414 02:42:38,320 --> 02:42:39,320 FOOT RACE BETWEEN PLATFORM 4415 02:42:39,320 --> 02:42:41,520 COMPANIES WHO ARE TRYING TO GET 4416 02:42:41,520 --> 02:42:44,040 IN WITH HEALTHCARE CLIENTS 4417 02:42:44,040 --> 02:42:48,000 HEALTHCARE IS PAYER FOR YOUR 4418 02:42:48,000 --> 02:42:50,200 SERVICES STATE BY STATE THESE 4419 02:42:50,200 --> 02:42:52,480 COMPANIES ARE DUKING IT OUT. 4420 02:42:52,480 --> 02:42:53,280 MARKET BY MARKET. 4421 02:42:53,280 --> 02:42:54,960 TO TRY AND GET THOSE HEALTHCARE 4422 02:42:54,960 --> 02:42:56,160 ORGANIZATIONS SIGNED UP BECAUSE 4423 02:42:56,160 --> 02:42:59,480 ONCE THEY ARE SIGNED UP YOU CAN 4424 02:42:59,480 --> 02:43:00,600 ONLY BE A PLAYER WITH ONE OF 4425 02:43:00,600 --> 02:43:01,120 THESE. 4426 02:43:01,120 --> 02:43:02,920 YOU SIGN ON GENERALLY TO ONE 4427 02:43:02,920 --> 02:43:03,800 NETWORK OR THE OTHER. 4428 02:43:03,800 --> 02:43:05,160 SO I'M WORKING ON A PIECE NOW 4429 02:43:05,160 --> 02:43:08,400 AND I WILL CLOSE WITH THIS 4430 02:43:08,400 --> 02:43:10,040 SLIDE. 4431 02:43:10,040 --> 02:43:13,360 TRYING TO SUGGEST THESE STOH 4432 02:43:13,360 --> 02:43:14,400 PLATFORMS OR TECHNOLOGY 4433 02:43:14,400 --> 02:43:16,040 COMPANIES REALLY STAND TO BE 4434 02:43:16,040 --> 02:43:17,160 MARKET MAKERS. 4435 02:43:17,160 --> 02:43:19,440 THAT IS A LITTLE BIT OF 4436 02:43:19,440 --> 02:43:20,360 CONTROVERSIAL IDEA, BUT I THINK 4437 02:43:20,360 --> 02:43:22,200 THEY DO STAND TO BE MARKET 4438 02:43:22,200 --> 02:43:24,600 MAKERS IN TERMS OF CONNECTING 4439 02:43:24,600 --> 02:43:25,880 HEALTHCARE SOCIAL SERVICE 4440 02:43:25,880 --> 02:43:26,680 ORGANIZATIONS AND POSITIONING 4441 02:43:26,680 --> 02:43:30,160 HEALTHCARE AS POTENTIAL BUYER OF 4442 02:43:30,160 --> 02:43:33,200 SOCIAL SERVICE. 4443 02:43:33,200 --> 02:43:38,400 THIS IS FACILITATED BY STATE 4444 02:43:38,400 --> 02:43:39,800 POLICIES EMPHASIZING HEALTHCARE 4445 02:43:39,800 --> 02:43:41,280 TO HAVE PAID CONTRACTS WITH 4446 02:43:41,280 --> 02:43:42,040 COMMUNITY BASED ORGANIZATIONS. 4447 02:43:42,040 --> 02:43:45,200 THIS IS CERTAINLY THE CASE, 4448 02:43:45,200 --> 02:43:46,280 CURRENTLY BASED AND CERTAINLY 4449 02:43:46,280 --> 02:43:47,800 THE CASE IN MAZAMA WHERE WHERE I 4450 02:43:47,800 --> 02:43:49,240 WAS FOR Ph.D.. 4451 02:43:49,240 --> 02:43:51,640 THE TWO THINGS THAT I THINK ARE 4452 02:43:51,640 --> 02:43:53,400 HAPPENING QUICKLY AS A RESULT OF 4453 02:43:53,400 --> 02:43:56,160 THESE PLATFORMS IS THEY ARE 4454 02:43:56,160 --> 02:43:56,680 FACILITATING BIDIRECTIONAL 4455 02:43:56,680 --> 02:43:59,160 REFERRALS, BY LIMITING 4456 02:43:59,160 --> 02:44:00,600 ADMINISTRATIVE HASSLE, NO LONGER 4457 02:44:00,600 --> 02:44:03,400 IF YOU ARE REALLY IN MESH ON 4458 02:44:03,400 --> 02:44:05,120 THESE TECHNOLOGY PLATFORMS DO 4459 02:44:05,120 --> 02:44:08,040 YOU HAVE TO GO TO PEN AND PAPER, 4460 02:44:08,040 --> 02:44:09,400 PICK UP THE PHONE THE MAKE A 4461 02:44:09,400 --> 02:44:10,800 PARTICULAR CALL, GET THE 4462 02:44:10,800 --> 02:44:11,800 PARTICULAR PERSON YOU NIGHT KNOW 4463 02:44:11,800 --> 02:44:14,400 AT SHELTER INSTEAD IT CAN BE 4464 02:44:14,400 --> 02:44:16,320 FAIRLY AUTOMATED AND KIND OF ONE 4465 02:44:16,320 --> 02:44:16,520 CLICK. 4466 02:44:16,520 --> 02:44:18,880 THEN THEY ALSO LOWER SEARCH 4467 02:44:18,880 --> 02:44:19,400 COSTS. 4468 02:44:19,400 --> 02:44:21,760 BY WHICH I MEAN THE TIME NEEDS 4469 02:44:21,760 --> 02:44:25,280 TO SPEND -- USED TO TAKE TO SAY 4470 02:44:25,280 --> 02:44:26,920 PATIENT WHAT IS YOUR HOME ZIP 4471 02:44:26,920 --> 02:44:27,840 CODE, SHOULD I FIND SOMETHING 4472 02:44:27,840 --> 02:44:30,600 CLOSE TO ZIP CODE, CLOSE TO BUS 4473 02:44:30,600 --> 02:44:32,400 ROUTE, HOW SHOULD I START THESE. 4474 02:44:32,400 --> 02:44:34,640 ALL THAT LITERAL SEARCHING FOR 4475 02:44:34,640 --> 02:44:36,440 WHICH CBO MIGHT BE MOST 4476 02:44:36,440 --> 02:44:37,600 APPROPRIATE FOR PATIENT CAN BE 4477 02:44:37,600 --> 02:44:39,080 DONE QUITE QUICKLY. 4478 02:44:39,080 --> 02:44:42,480 THAT REDUCTION IN SEARCH COSTS 4479 02:44:42,480 --> 02:44:42,920 ARE MEANINGFUL. 4480 02:44:42,920 --> 02:44:45,280 SO I THINK IN SOME WAYS IF YOU 4481 02:44:45,280 --> 02:44:48,080 ARE ENTHUSIAST FOR HOLISTIC CARE 4482 02:44:48,080 --> 02:44:49,680 AND HEALTHCARE SOCIAL SERVICE 4483 02:44:49,680 --> 02:44:51,640 RELATIONSHIPS THESE TECHNOLOGY 4484 02:44:51,640 --> 02:44:53,920 PLATFORMS ARE IN MANY RESPECTS 4485 02:44:53,920 --> 02:44:54,920 GOOD NEWS. 4486 02:44:54,920 --> 02:44:56,240 ONE THING I WOULD SAY WE SHOULD 4487 02:44:56,240 --> 02:44:59,640 ALL KEEP OUR EYES OPEN TO, IS 4488 02:44:59,640 --> 02:45:05,080 THE RISK OF HAVING A HUGE AMOUNT 4489 02:45:05,080 --> 02:45:06,880 OF DATA COLLECTED IN WHAT IS 4490 02:45:06,880 --> 02:45:10,800 LIKELY TO ONE DAY BE 4491 02:45:10,800 --> 02:45:11,640 MONOPOLISTIC PROVIDER. 4492 02:45:11,640 --> 02:45:14,400 I SAY PRIVATE BECAUSE THIS LAST 4493 02:45:14,400 --> 02:45:18,160 POINTS IS JUST THAT IS 4494 02:45:18,160 --> 02:45:19,800 INTERESTING FROM POLITICAL 4495 02:45:19,800 --> 02:45:20,840 ECONOMY PERSPECTIVE TO THINK 4496 02:45:20,840 --> 02:45:25,120 ABOUT WHAT IT MEANS TO HAVE 4497 02:45:25,120 --> 02:45:27,960 LARGELY VENTURE CAPITAL BACKED 4498 02:45:27,960 --> 02:45:29,840 PRIVATE COMPANIES MEDIATING 4499 02:45:29,840 --> 02:45:30,400 LARGELY NON-PROFIT 4500 02:45:30,400 --> 02:45:30,800 RELATIONSHIPS. 4501 02:45:30,800 --> 02:45:34,560 SO IF YOU THINK ABOUT PULL 4502 02:45:34,560 --> 02:45:36,040 TECHNOLOGY COMPANIES OUT FOR A 4503 02:45:36,040 --> 02:45:37,920 MOMENT, WE HAVE MOSTLY 4504 02:45:37,920 --> 02:45:38,520 NON-PROFIT HEALTHCARE DELIVERY 4505 02:45:38,520 --> 02:45:38,920 SYSTEMS. 4506 02:45:38,920 --> 02:45:41,880 NOT EXCLUSIVELY BUT MOSTLY. 4507 02:45:41,880 --> 02:45:43,000 AND MOSTLY NOT PROFIT SOCIAL 4508 02:45:43,000 --> 02:45:45,920 SERVICE PROVIDERS. 4509 02:45:45,920 --> 02:45:46,880 THEN IF YOU THINK THESE 4510 02:45:46,880 --> 02:45:51,360 RELATIONSHIPS ARE GOING TO BE 4511 02:45:51,360 --> 02:45:54,160 MEDIATED BY AND MADE MORE COMMON 4512 02:45:54,160 --> 02:45:58,360 AS A RESULT OF UNITE US OR OTHER 4513 02:45:58,360 --> 02:45:59,760 LOOK ALIKES YOU SUDDENLY HAVE A 4514 02:45:59,760 --> 02:46:01,960 LITTLE BIT OF A DIFFERENT 4515 02:46:01,960 --> 02:46:02,920 LANDSCAPE TO THINK ABOUT WHAT IS 4516 02:46:02,920 --> 02:46:04,880 IN THE PUBLIC INTEREST AND IS 4517 02:46:04,880 --> 02:46:06,920 THERE A RISK THAT AS HE IS 4518 02:46:06,920 --> 02:46:09,000 PLATFORMS GROW LARGER AND LARGER 4519 02:46:09,000 --> 02:46:09,640 AND LARGER. 4520 02:46:09,640 --> 02:46:11,200 AS I SAID IT IS A FOOT RACE, I 4521 02:46:11,200 --> 02:46:13,040 DON'T THINK MANY WILL WIN, I 4522 02:46:13,040 --> 02:46:16,040 THINK WE WILL HAVE BASICALLY ONE 4523 02:46:16,040 --> 02:46:17,440 WINNER PER MARKET. 4524 02:46:17,440 --> 02:46:18,720 THEN ARE THERE THINGS WE SHOULD 4525 02:46:18,720 --> 02:46:19,480 JUST BE THINKING DIFFERENTLY 4526 02:46:19,480 --> 02:46:19,920 ABOUT. 4527 02:46:19,920 --> 02:46:21,520 IN TERMS OF THE REGULATION OF 4528 02:46:21,520 --> 02:46:22,800 THESE PLATFORMS TO MAKE SURE 4529 02:46:22,800 --> 02:46:24,160 THAT THEY CONTINUE TO SERVE 4530 02:46:24,160 --> 02:46:25,120 PUBLIC INTEREST AND MOST 4531 02:46:25,120 --> 02:46:27,320 IMPORTANTLY PATIENT INTEREST. 4532 02:46:27,320 --> 02:46:29,200 I HOPE I WET THE PALATE A BIT. 4533 02:46:29,200 --> 02:46:32,480 I WILL PAUSE THERE AND TAKE ANY 4534 02:46:32,480 --> 02:46:33,600 QUESTIONS ON ANYTHING COMMUNITY 4535 02:46:33,600 --> 02:46:35,960 CLINICAL RELATIONSHIPS, TRUST 4536 02:46:35,960 --> 02:46:38,000 WHICH I DIDN'T TALK ABOUT A TON 4537 02:46:38,000 --> 02:46:39,320 HERE OR THESE TECHNOLOGY 4538 02:46:39,320 --> 02:46:40,440 PLATFORMS ON BACKSIDE. 4539 02:46:40,440 --> 02:46:48,400 THANKS VERY MUCH. 4540 02:46:48,400 --> 02:46:50,120 >> THANK YOU, DR. TAYLOR. 4541 02:46:50,120 --> 02:46:53,720 I AGREE, A LOT OF THINGS YOU 4542 02:46:53,720 --> 02:46:56,400 SHARED WITH US. 4543 02:46:56,400 --> 02:46:58,920 NEXT SPEAKER WILL BE DR. 4544 02:46:58,920 --> 02:47:22,960 BRISTOL. 4545 02:47:22,960 --> 02:47:26,240 >> HELLO, WELCOME. 4546 02:47:26,240 --> 02:47:27,400 CAN YOU SEE MY SLIDES? 4547 02:47:27,400 --> 02:47:30,960 THEY ARE IN PRESENTER VIEW. 4548 02:47:30,960 --> 02:47:32,400 PERFECT. 4549 02:47:32,400 --> 02:47:36,000 OKAY. 4550 02:47:36,000 --> 02:47:37,920 IT IS AN HONOR TO BE HERE TODAY 4551 02:47:37,920 --> 02:47:40,840 PRESENTING AND I WANT TO THANK 4552 02:47:40,840 --> 02:47:42,680 ALL PREVIOUS SPEAKERS FOR THEIR 4553 02:47:42,680 --> 02:47:45,480 PRESENTATIONS, I TRULY ENJOYED 4554 02:47:45,480 --> 02:47:47,200 EACH AND EVERY ONE. 4555 02:47:47,200 --> 02:47:50,120 TODAY I WILL BE TALKING ABOUT 4556 02:47:50,120 --> 02:47:51,680 HIGHLIGHTING CARE TRANSITION IN 4557 02:47:51,680 --> 02:47:54,800 EMERGENCY DEPARTMENT AND REALLY 4558 02:47:54,800 --> 02:47:56,400 THINKING ABOUT HOW IMPORTANT 4559 02:47:56,400 --> 02:47:58,400 ASSESSMENT OF SOCIAL LEADS ARE 4560 02:47:58,400 --> 02:48:00,800 DURING TRANSITION AND ROLE OF 4561 02:48:00,800 --> 02:48:01,080 CAREGIVERS. 4562 02:48:01,080 --> 02:48:04,320 I HAVE NO NO DISCLOSURE AND I 4563 02:48:04,320 --> 02:48:06,680 WANTED TO ACKNOWLEDGE FUNDING 4564 02:48:06,680 --> 02:48:09,400 WAS SUPPORTED THROUGH A PILOT 4565 02:48:09,400 --> 02:48:11,160 GRANT FROM THE M ETHEL JONES 4566 02:48:11,160 --> 02:48:12,440 NURSING RESEARCH CENTER AT THE 4567 02:48:12,440 --> 02:48:16,280 UNIVERSITY OF UTAH. 4568 02:48:16,280 --> 02:48:18,280 WHEN WE THINK ABOUT CARE 4569 02:48:18,280 --> 02:48:20,520 TRANSITIONS IN THE EMERGENCY 4570 02:48:20,520 --> 02:48:23,000 DEPARTMENT, WE OFTEN MIGHT HEAR 4571 02:48:23,000 --> 02:48:25,200 THE THOUGHT ABOUT REVOLVING 4572 02:48:25,200 --> 02:48:25,400 DOOR. 4573 02:48:25,400 --> 02:48:28,520 PATIENTS ARE FREQUENTLY ENTERING 4574 02:48:28,520 --> 02:48:32,400 LEAVING AND REENTERING THE 4575 02:48:32,400 --> 02:48:33,000 EMERGENCY DEPARTMENT. 4576 02:48:33,000 --> 02:48:34,120 IT IS IMPORTANT WHEN WE THINK 4577 02:48:34,120 --> 02:48:37,040 ABOUT THESE TRANSITIONS AND 4578 02:48:37,040 --> 02:48:38,920 PATIENTS WE ALSO THINK ABOUT WHO 4579 02:48:38,920 --> 02:48:41,920 IS ACCOMPANYING PATIENTS. 4580 02:48:41,920 --> 02:48:43,840 FREQUENTLY WHEN WE THINK ABOUT 4581 02:48:43,840 --> 02:48:46,280 OLDER ADULT PATIENTS, WE KNOW 4582 02:48:46,280 --> 02:48:49,680 THAT THEY RELY ON CAREGIVERS OR 4583 02:48:49,680 --> 02:48:51,520 FAMILY AND FRIENDS WHO STEP INTO 4584 02:48:51,520 --> 02:48:53,120 CARE GIVING ROLE TO HELP SUPPORT 4585 02:48:53,120 --> 02:48:54,560 THEM AS THEY NAVIGATE THE 4586 02:48:54,560 --> 02:48:56,120 HEALTHCARE SYSTEM AND AS THEY 4587 02:48:56,120 --> 02:48:57,600 ARE DEALING WITH CHANGES IN 4588 02:48:57,600 --> 02:49:00,920 THEIR HEALTH STATUS. 4589 02:49:00,920 --> 02:49:02,400 AND FREQUENTLY DURING THE THE 4590 02:49:02,400 --> 02:49:04,200 ENTRY INTO THE EMERGENCY 4591 02:49:04,200 --> 02:49:06,720 DEPARTMENT CAREGIVERS MAY BE 4592 02:49:06,720 --> 02:49:07,000 OVERLOOKED. 4593 02:49:07,000 --> 02:49:09,480 THERE IS A LOT OF EMPHASIS 4594 02:49:09,480 --> 02:49:11,800 PLACED ON PATIENTS AND 4595 02:49:11,800 --> 02:49:13,440 ADDRESSING PATIENT NEEDS WHICH 4596 02:49:13,440 --> 02:49:16,480 IS OF COURSE IMPORTANT BUT 4597 02:49:16,480 --> 02:49:18,160 CAREGIVERS REPRESENT KEY SOURCES 4598 02:49:18,160 --> 02:49:20,400 OF INFORMATION FOR HEALTHCARE 4599 02:49:20,400 --> 02:49:21,040 PROFESSIONALS, ESPECIALLY WHEN 4600 02:49:21,040 --> 02:49:22,920 WORKING WITH OLDER ADULTS WHO 4601 02:49:22,920 --> 02:49:24,640 HAVE COGNITIVE IMPAIRMENT OR 4602 02:49:24,640 --> 02:49:26,600 OTHER CHALLENGES. 4603 02:49:26,600 --> 02:49:29,000 SO IT IS IMPORTANT TO THINK 4604 02:49:29,000 --> 02:49:32,400 ABOUT HOW WE ALSO CAN ASSESS AND 4605 02:49:32,400 --> 02:49:33,200 INCLUDE CAREGIVER SOCIAL NEEDS 4606 02:49:33,200 --> 02:49:38,400 WHEN WE ARE LOOKING AT CARE 4607 02:49:38,400 --> 02:49:38,880 TRANSITION. 4608 02:49:38,880 --> 02:49:40,080 THERE ARE DIFFERENT CARE 4609 02:49:40,080 --> 02:49:42,160 TRANSITIONS THAT OCCUR MANY THE 4610 02:49:42,160 --> 02:49:42,960 EMERGENCY DEPARTMENT. 4611 02:49:42,960 --> 02:49:46,080 OF COURSE THERE ARE COMMUNITY TO 4612 02:49:46,080 --> 02:49:47,840 ED TRANSITIONS, SUCH AS COMING 4613 02:49:47,840 --> 02:49:50,400 FROM A HOME STUDY LONG TERM CARE 4614 02:49:50,400 --> 02:49:52,840 OR OTHER FACILITY INTO THE 4615 02:49:52,840 --> 02:49:53,400 EMERGENCY DEPARTMENT. 4616 02:49:53,400 --> 02:49:56,400 WE HAVE OUR ED BACK TO COMMUNITY 4617 02:49:56,400 --> 02:49:57,520 TRANSITIONS THAT ARE ALSO 4618 02:49:57,520 --> 02:49:59,680 REFERRED TO AS ED DISCHARGE. 4619 02:49:59,680 --> 02:50:03,680 THEN WE HAVE OUR ED TO INPATIENT 4620 02:50:03,680 --> 02:50:04,000 TRANSITION. 4621 02:50:04,000 --> 02:50:06,880 THESE ARE REFERRED TO AS 4622 02:50:06,880 --> 02:50:07,800 INTERHOSPITAL TRANSITIONS WHICH 4623 02:50:07,800 --> 02:50:11,400 REPRESENT THE MOVEMENT OF A 4624 02:50:11,400 --> 02:50:12,600 INDIVIDUAL FROM EMERGENCY 4625 02:50:12,600 --> 02:50:14,440 DEPARTMENT TO A CRITICAL CARE 4626 02:50:14,440 --> 02:50:18,040 UNIT OR MEDICAL SURGICAL UNIT. 4627 02:50:18,040 --> 02:50:19,800 AS WELL AS MOVEMENTS THAT MIGHT 4628 02:50:19,800 --> 02:50:22,040 OCCUR WITHIN THE SAME UNIT. 4629 02:50:22,040 --> 02:50:24,920 SO AN INDIVIDUAL MIGHT BE MOVED 4630 02:50:24,920 --> 02:50:26,400 WITHIN THE EMERGENCY DEPARTMENT 4631 02:50:26,400 --> 02:50:30,360 FROM ROOM -- ONE ROOM TO 4632 02:50:30,360 --> 02:50:30,600 ANOTHER. 4633 02:50:30,600 --> 02:50:32,400 IT IS IMPORTANT WE CONSIDER 4634 02:50:32,400 --> 02:50:35,400 THESE DIFFERENT TRANSITIONS 4635 02:50:35,400 --> 02:50:38,800 BECAUSE THEY ARE THEY CAN BE 4636 02:50:38,800 --> 02:50:39,840 INFLUENCED BY THE ENVIRONMENT OF 4637 02:50:39,840 --> 02:50:41,880 THE HEALTHCARE SYSTEM. 4638 02:50:41,880 --> 02:50:43,760 IN CARE TRANSITIONS, THERE IS A 4639 02:50:43,760 --> 02:50:46,520 LOT OF EMPHASIS PLACED ON 4640 02:50:46,520 --> 02:50:50,000 PROMOTING WELL COORDINATED 4641 02:50:50,000 --> 02:50:50,920 MOVEMENTS, INVOLVING PATIENT 4642 02:50:50,920 --> 02:50:54,880 CAREGIVER VOICES, HOWEVER, DUE 4643 02:50:54,880 --> 02:50:58,240 TO ENVIRONMENTAL ISSUES, SUCH AS 4644 02:50:58,240 --> 02:50:59,680 OVERCROWDING, STAFF SHORTAGES, 4645 02:50:59,680 --> 02:51:01,440 ALL THOSE CAN CHALLENGE THE 4646 02:51:01,440 --> 02:51:02,920 ABILITY OF HEALTHCARE 4647 02:51:02,920 --> 02:51:05,800 PROFESSIONALS TO MAINTAIN A HIGH 4648 02:51:05,800 --> 02:51:11,120 LEVEL OF CARE COORDINATION. 4649 02:51:11,120 --> 02:51:16,640 ONE WAY TO ENSURE PATIENTS NEEDS 4650 02:51:16,640 --> 02:51:18,320 ARE INCLUDED IN OUR -- AND ARE 4651 02:51:18,320 --> 02:51:21,480 CONSIDERED WHEN PLANNING TO MOVE 4652 02:51:21,480 --> 02:51:23,000 PATIENTS OR TRANSFER THEM 4653 02:51:23,000 --> 02:51:24,240 BETWEEN DIFFERENT CARE SETTINGS 4654 02:51:24,240 --> 02:51:26,440 IS TO INCLUDE SOCIAL NEEDS 4655 02:51:26,440 --> 02:51:28,400 ASSESSMENT AS HAS BEEN 4656 02:51:28,400 --> 02:51:29,320 HIGHLIGHTED IN MANY 4657 02:51:29,320 --> 02:51:31,240 PRESENTATIONS HERE TODAY. 4658 02:51:31,240 --> 02:51:34,400 AND WHEN WE ARE LOOKING AT 4659 02:51:34,400 --> 02:51:36,600 CAREGIVERS SOCIAL NEEDS 4660 02:51:36,600 --> 02:51:40,040 ASSESSMENT HELP PROMOTE AND 4661 02:51:40,040 --> 02:51:41,880 RECOGNIZE PRIORITIES THAT 4662 02:51:41,880 --> 02:51:44,000 CAREGIVERS MIGHT BE WORRIED 4663 02:51:44,000 --> 02:51:45,160 ABOUT, MIGHT BE CONCERNED ABOUT 4664 02:51:45,160 --> 02:51:49,040 AS THEY ARE ASSUMING NEW CARE 4665 02:51:49,040 --> 02:51:50,720 DUTIES OR AS THEY MIGHT BE 4666 02:51:50,720 --> 02:51:52,400 THINKING ABOUT CARE THAT THEY 4667 02:51:52,400 --> 02:51:59,000 MUST DELIVER POST DISCHARGE, AND 4668 02:51:59,000 --> 02:52:01,760 SO WHEN WE LOOK AT CAREGIVERS 4669 02:52:01,760 --> 02:52:04,480 ARE WE ADDRESSING SOCIAL NEEDS 4670 02:52:04,480 --> 02:52:06,720 EARLY DURING THESE TRANSITIONS 4671 02:52:06,720 --> 02:52:10,080 RATHER THAN WAITING FOR DISOF 4672 02:52:10,080 --> 02:52:11,920 DISCHARGE WHEN THINGS ARE 4673 02:52:11,920 --> 02:52:14,760 RUSHED, CHAOTIC AND WE MIGHT BE 4674 02:52:14,760 --> 02:52:17,680 MISSING KEY SOCIAL NEEDS THAT 4675 02:52:17,680 --> 02:52:20,440 WOULD IMPACT POST DISCHARGE CARE 4676 02:52:20,440 --> 02:52:22,800 AND THAT MIGHT INFLUENCE RETURN 4677 02:52:22,800 --> 02:52:26,400 VISIT BACK TO THE EMERGENCY 4678 02:52:26,400 --> 02:52:27,720 DEPARTMENT. 4679 02:52:27,720 --> 02:52:30,800 TO BETTER UNDERSTAND HOW SOCIAL 4680 02:52:30,800 --> 02:52:31,960 NEEDS CURRENTLY ADDRESS DURING 4681 02:52:31,960 --> 02:52:34,320 CARE TRANSITIONS IN THE 4682 02:52:34,320 --> 02:52:35,000 EMERGENCY DEPARTMENT, AS MEMBER 4683 02:52:35,000 --> 02:52:38,440 OF THE CARE TRANSITIONS GROUP, 4684 02:52:38,440 --> 02:52:39,760 THE GERIATRIC EMERGENCY CARE 4685 02:52:39,760 --> 02:52:41,160 APPLIED RESEARCH NETWORK, WE 4686 02:52:41,160 --> 02:52:44,440 CONDUCTED A SCOPING REVIEW TO 4687 02:52:44,440 --> 02:52:45,600 SEE WHAT INTERVENTIONS WERE IN 4688 02:52:45,600 --> 02:52:47,520 USE AND HOW THEY WERE ADDRESSING 4689 02:52:47,520 --> 02:52:49,600 SOCIAL NEEDS. 4690 02:52:49,600 --> 02:52:52,600 WE FOUND OUT OF 248 ARTICLES, 17 4691 02:52:52,600 --> 02:52:55,640 MET INCLUSION CRITERIA, THAT WAS 4692 02:52:55,640 --> 02:52:58,080 LOOKING AT THE DISCHARGE OF 4693 02:52:58,080 --> 02:52:59,680 PATIENTS FROM THE EMERGENCY ROOM 4694 02:52:59,680 --> 02:53:01,040 TO COMMUNITIES SETTINGS SUCH AS 4695 02:53:01,040 --> 02:53:03,320 HOME, LONG TERM CARE, ASSISTED 4696 02:53:03,320 --> 02:53:03,560 LIVING. 4697 02:53:03,560 --> 02:53:05,960 THEN OUR OUTCOME OF INTEREST 4698 02:53:05,960 --> 02:53:07,920 LOOKING AT HEALTHCARE 4699 02:53:07,920 --> 02:53:10,040 UTILIZATION OR RETURN VISITS TO 4700 02:53:10,040 --> 02:53:12,400 THE EMERGENCY DEPARTMENT AS WELL 4701 02:53:12,400 --> 02:53:14,400 AS FOLLOW-UP APPOINTMENTS AND 4702 02:53:14,400 --> 02:53:18,920 OTHER PATIENT REPORTED OUTCOMES. 4703 02:53:18,920 --> 02:53:20,560 WE DID FIND MAJORITY OF THESE 4704 02:53:20,560 --> 02:53:22,880 CARE TRANSITION INTERVENTIONS 4705 02:53:22,880 --> 02:53:26,160 ADDRESS AT LEAST ONE SOCIAL NEED 4706 02:53:26,160 --> 02:53:28,160 AND WE SAW A VARIETY OF FACTORS 4707 02:53:28,160 --> 02:53:31,440 LOOKING AT ACCESS TO FOOD ACCESS 4708 02:53:31,440 --> 02:53:34,040 TO HEALTHCARE SERVICES, AND 4709 02:53:34,040 --> 02:53:36,200 ACCESS TO MEDICATIONS. 4710 02:53:36,200 --> 02:53:38,920 OR SOME COMBINATION OF THOSE 4711 02:53:38,920 --> 02:53:40,960 FACTORS. 4712 02:53:40,960 --> 02:53:43,320 VERY FEW CONSIDERED 4713 02:53:43,320 --> 02:53:46,320 TRANSPORTATION OR INTERVENTION 4714 02:53:46,320 --> 02:53:49,680 TARGETING HOUSING OR FINANCIAL 4715 02:53:49,680 --> 02:53:50,280 CONCERNS. 4716 02:53:50,280 --> 02:53:52,280 NO CARE TRANSITION INTERVENTION 4717 02:53:52,280 --> 02:53:54,840 CONSISTENTLY REDUCE SUBSEQUENT 4718 02:53:54,840 --> 02:53:56,440 HEALTHCARE UTILIZATION OR OTHER 4719 02:53:56,440 --> 02:53:58,200 PATIENT CENTERED OUTCOMES SUCH 4720 02:53:58,200 --> 02:54:02,320 AS QUALITY OF LIFE OR FUNCTIONAL 4721 02:54:02,320 --> 02:54:04,400 STATUS. 4722 02:54:04,400 --> 02:54:07,520 THE OTHER KEY ASPECT TO THAT WAS 4723 02:54:07,520 --> 02:54:08,560 MISSING FROM INTERVENTIONS WAS 4724 02:54:08,560 --> 02:54:12,600 THERE WAS A LACK OF CONSISTENT 4725 02:54:12,600 --> 02:54:13,400 CONSIDERATION OF CAREGIVER 4726 02:54:13,400 --> 02:54:16,000 SOCIAL NEEDS AS WE KNOW WITH 4727 02:54:16,000 --> 02:54:20,400 OLDER ADULTS RELY ON CAREGIVERS 4728 02:54:20,400 --> 02:54:22,240 OFTEN FOR TRANSPORTATION FOR 4729 02:54:22,240 --> 02:54:26,200 HELP WITH FOOD PREPARATION, WITH 4730 02:54:26,200 --> 02:54:29,000 HELP WITH GOING TO DIFFERENCE 4731 02:54:29,000 --> 02:54:30,920 HEALTHCARE APPOINTMENTS AND SO H 4732 02:54:30,920 --> 02:54:35,480 IS A CRITICAL GAP THAT CAN 4733 02:54:35,480 --> 02:54:38,360 REALLY BE INFLUENCING THE 4734 02:54:38,360 --> 02:54:39,480 POTENTIAL REASONS FOR WHY 4735 02:54:39,480 --> 02:54:42,480 PATIENTS ARE RETURNING TO THE 4736 02:54:42,480 --> 02:54:46,000 EMERGENCY DEPARTMENT OR SEEKING 4737 02:54:46,000 --> 02:54:47,800 OUT FURTHER AID AS WE ARE 4738 02:54:47,800 --> 02:54:50,080 OVERLOOKING HOW CAREGIVERS WHAT 4739 02:54:50,080 --> 02:54:52,720 THEIR NEEDS ARE, AND HOW WE -- 4740 02:54:52,720 --> 02:54:55,040 HOW THEY ARE CRITICAL TO 4741 02:54:55,040 --> 02:55:00,960 SUPPORTING THE PATIENT OUTCOMES. 4742 02:55:00,960 --> 02:55:03,280 WHILE WE HAVE LOOKED IN THE 4743 02:55:03,280 --> 02:55:05,440 LITERATURE THE TRANSITION FROM 4744 02:55:05,440 --> 02:55:07,240 THE EMERGENCY DEPARTMENT TO 4745 02:55:07,240 --> 02:55:10,280 COMMUNITY OR COMMUNITY TO THE 4746 02:55:10,280 --> 02:55:11,800 EMERGENCY DEPARTMENT, WHICH IS 4747 02:55:11,800 --> 02:55:13,800 HIGHLIGHTED CHALLENGES RELATED 4748 02:55:13,800 --> 02:55:17,960 TO COMMUNICATION, AND 4749 02:55:17,960 --> 02:55:20,120 COMMUNICATING THE HEALTH STATUS 4750 02:55:20,120 --> 02:55:22,400 OF PATIENTS, VERY LITTLE IS 4751 02:55:22,400 --> 02:55:24,440 KNOWN ABOUT THE TRANSITIONS THAT 4752 02:55:24,440 --> 02:55:26,000 OCCUR WITHIN THE HOSPITAL AND 4753 02:55:26,000 --> 02:55:29,840 HOW THAT INFLUENCES CAREGIVER 4754 02:55:29,840 --> 02:55:30,920 ABILITY TO SUPPORT INDIVIDUALS 4755 02:55:30,920 --> 02:55:33,120 IN THE COMMUNITY OR POST 4756 02:55:33,120 --> 02:55:34,680 DISCHARGE AND HOW THAT MIGHT 4757 02:55:34,680 --> 02:55:38,360 RELATE THEN TO THE READMISSION 4758 02:55:38,360 --> 02:55:42,920 TO HOSPITAL OR RETURN VISIT TO 4759 02:55:42,920 --> 02:55:45,480 THE EMERGENCY DEPARTMENT. 4760 02:55:45,480 --> 02:55:46,920 TO BEGIN TO DEVELOP THIS 4761 02:55:46,920 --> 02:55:49,040 UNDERSTANDING WE ARE CURRENTLY 4762 02:55:49,040 --> 02:55:52,200 CONDUCTING A PILOT STUDY THAT IS 4763 02:55:52,200 --> 02:55:55,360 LOOKING AT PATIENT AND CAREGIVER 4764 02:55:55,360 --> 02:55:57,080 REPORTED DISCHARGE READINESS 4765 02:55:57,080 --> 02:55:59,840 SCORES WITH PATIENT FACTORS AND 4766 02:55:59,840 --> 02:56:01,920 THE NUMBER OF TRANSITION OF 4767 02:56:01,920 --> 02:56:03,480 PATIENT EXPERIENCE DURING 4768 02:56:03,480 --> 02:56:03,840 HOSPITALIZATION. 4769 02:56:03,840 --> 02:56:05,920 WE HAVE ALSO CONDUCTED 4770 02:56:05,920 --> 02:56:11,400 INTERVIEWS WITH CAREGIVERS. 4771 02:56:11,400 --> 02:56:14,000 WE HAVE FOUND THROUGH LOOKING AT 4772 02:56:14,000 --> 02:56:16,440 THESE IN PATIENT TRANSFERS AN 4773 02:56:16,440 --> 02:56:18,600 CAREGIVER DISCHARGE READINESS, 4774 02:56:18,600 --> 02:56:22,160 THAT WHEN WE SEE FEWER 4775 02:56:22,160 --> 02:56:24,640 TRANSITIONS, WE DO SEE HIGHER 4776 02:56:24,640 --> 02:56:26,000 REPORTED CAREGIVER READINESS, 4777 02:56:26,000 --> 02:56:28,120 THIS IS OUR PRELIMINARY RESULTS 4778 02:56:28,120 --> 02:56:29,600 THAT HAVE NOT BEEN PUBLISHED. 4779 02:56:29,600 --> 02:56:31,560 BUT WE DO SEE THIS ASSOCIATION 4780 02:56:31,560 --> 02:56:34,120 AND WHEN WE HAVE RUN OUR 4781 02:56:34,120 --> 02:56:36,200 LOGISTIC REGRESSION WE SEE THAT 4782 02:56:36,200 --> 02:56:38,400 THIS IS SIGNIFICANT FOR 4783 02:56:38,400 --> 02:56:40,960 CAREGIVERS BUT IT IS NOT 4784 02:56:40,960 --> 02:56:43,600 SIGNIFICANT FOR PATIENTS. 4785 02:56:43,600 --> 02:56:47,600 SO WILL IS A LIKELIHOOD WHEN 4786 02:56:47,600 --> 02:56:49,840 PATIENTS ARE EXPERIENCING 4787 02:56:49,840 --> 02:56:50,600 NUMEROUS TRANSITIONS WITHIN THE 4788 02:56:50,600 --> 02:56:53,160 HOSPITAL SETTING, THAT THE 4789 02:56:53,160 --> 02:56:54,880 CAREGIVERS MAY FEEL LESS 4790 02:56:54,880 --> 02:57:02,400 PREPARED FOR POST DISCHARGE 4791 02:57:02,400 --> 02:57:02,600 CARE. 4792 02:57:02,600 --> 02:57:03,240 ADDITIONALLY WE HAVE FOUND THERE 4793 02:57:03,240 --> 02:57:05,800 IS A RELATIONSHIP, THE 4794 02:57:05,800 --> 02:57:07,400 RELATIONSHIP BETWEEN CAREGIVER 4795 02:57:07,400 --> 02:57:09,400 AND PATIENT IS INFLUENCING 4796 02:57:09,400 --> 02:57:12,800 CAREGIVER DISCHARGE READINESS 4797 02:57:12,800 --> 02:57:13,040 SCORES. 4798 02:57:13,040 --> 02:57:14,600 WE FOUND THAT WHEN THE CAREGIVER 4799 02:57:14,600 --> 02:57:16,520 HAS A SPOUSAL OR PARTNER 4800 02:57:16,520 --> 02:57:19,440 RELATIONSHIP WITH THE PATIENT 4801 02:57:19,440 --> 02:57:22,960 THEY ARE 121% MORE LIKELY TO 4802 02:57:22,960 --> 02:57:25,760 FEEL READY FOR DISCHARGE VERSUS 4803 02:57:25,760 --> 02:57:28,640 CAREGIVERS WHO DON'T -- WHO HAVE 4804 02:57:28,640 --> 02:57:33,400 A NON-SPOUSE RELATIONSHIP. 4805 02:57:33,400 --> 02:57:34,960 THIS IS ECHOED IN OUR 4806 02:57:34,960 --> 02:57:36,320 QUALITATIVE FINDINGS. 4807 02:57:36,320 --> 02:57:38,800 WHEN WE INTERVIEWED CAREGIVERS 4808 02:57:38,800 --> 02:57:42,400 WE FOUND THAT WHILE CAREGIVERS 4809 02:57:42,400 --> 02:57:43,400 ACKNOWLEDGED THAT THEY WERE IN 4810 02:57:43,400 --> 02:57:46,920 -- THEY RECEIVE DISCHARGE 4811 02:57:46,920 --> 02:57:48,040 EDUCATION, DISCHARGE INSTRUCTION 4812 02:57:48,040 --> 02:57:50,920 THEY REPORTED THAT IT WAS A VERY 4813 02:57:50,920 --> 02:57:54,760 PASSIVE EVENT, THEY WERE HANDED 4814 02:57:54,760 --> 02:57:56,880 INFORMATION THAT WAS PRINTED OUT 4815 02:57:56,880 --> 02:57:59,040 THAT WAS NOT ALWAYS TAILORED TO 4816 02:57:59,040 --> 02:58:02,280 THEIR SPECIFIC POST DISCHARGE 4817 02:58:02,280 --> 02:58:02,480 CARE. 4818 02:58:02,480 --> 02:58:04,760 BUT THEY DID REPORT THEY 4819 02:58:04,760 --> 02:58:06,640 RECEIVED IT AND THEY WERE -- 4820 02:58:06,640 --> 02:58:07,600 THEY APPRECIATED THOSE HAND 4821 02:58:07,600 --> 02:58:09,320 OUTS. 4822 02:58:09,320 --> 02:58:12,760 HOWEVER, WE SEE INSTANCES WHERE 4823 02:58:12,760 --> 02:58:15,800 CAREGIVERS RECOGNIZE THEY STILL 4824 02:58:15,800 --> 02:58:19,720 WERE NOT TRULY PREPARED FOR THE 4825 02:58:19,720 --> 02:58:22,960 BURDEN OF CARE THEY MIGHT FACE 4826 02:58:22,960 --> 02:58:24,600 AFTER LEAVING THE HOSPITAL 4827 02:58:24,600 --> 02:58:24,880 SETTING. 4828 02:58:24,880 --> 02:58:27,440 THIS CAREGIVER SHARED HOW SHE 4829 02:58:27,440 --> 02:58:28,760 RECEIVED TECHNICAL INFORMATION 4830 02:58:28,760 --> 02:58:32,440 ABOUT USING THE OXYGEN TANK BUT 4831 02:58:32,440 --> 02:58:34,960 THERE WAS STILL A LOT OF WORRY 4832 02:58:34,960 --> 02:58:36,480 SHE EXPERIENCED BECAUSE THE 4833 02:58:36,480 --> 02:58:38,400 PATIENT SHE FELT WAS STILL VERY 4834 02:58:38,400 --> 02:58:40,800 ILL. 4835 02:58:40,800 --> 02:58:43,360 WE SEE THIS ECHOED IN PREVIOUS 4836 02:58:43,360 --> 02:58:46,320 WORK WHEN LOOKING AT CAREGIVERS 4837 02:58:46,320 --> 02:58:48,800 AND THEIR REPORTED BURDEN. 4838 02:58:48,800 --> 02:58:53,080 WE KNOW WHEN CAREGIVERS FEEL 4839 02:58:53,080 --> 02:58:55,760 UNPREPARED FOR POST DISCHARGE 4840 02:58:55,760 --> 02:58:58,400 CARE, THEY ARE MORE LIKELY TO 4841 02:58:58,400 --> 02:58:59,640 SEEK OUT RETURN VISIT TO 4842 02:58:59,640 --> 02:59:00,600 EMERGENCY DEPARTMENT. 4843 02:59:00,600 --> 02:59:03,200 OR TO SEEK PLACEMENT OF THE 4844 02:59:03,200 --> 02:59:04,400 INDIVIDUAL IN SOME KIND OF LONG 4845 02:59:04,400 --> 02:59:06,280 TERM CARE SERVICE. 4846 02:59:06,280 --> 02:59:09,000 ASSISTED LIVING FACILITY, OR 4847 02:59:09,000 --> 02:59:13,120 SOMETHING SIMILAR. 4848 02:59:13,120 --> 02:59:14,680 ADDITIONALLY THIS CAREGIVER 4849 02:59:14,680 --> 02:59:16,720 SHARED HOW THEY RECEIVED 4850 02:59:16,720 --> 02:59:18,160 INFORMATION ABOUT MEDICATION AND 4851 02:59:18,160 --> 02:59:22,320 RECEIVED INFORMATION ABOUT WHO 4852 02:59:22,320 --> 02:59:23,760 TO CONTACT IF SOMETHING WERE TO 4853 02:59:23,760 --> 02:59:24,960 HAPPEN BUT MENTAL HEALTH OF THE 4854 02:59:24,960 --> 02:59:26,960 PATIENT WAS LARGELY OVERLOOKED. 4855 02:59:26,960 --> 02:59:29,280 AND THE CAREGIVER WAS EXTREMELY 4856 02:59:29,280 --> 02:59:32,400 WORRIED ABOUT HOW TO ADDRESS 4857 02:59:32,400 --> 02:59:35,000 MENTAL HEALTH NEEDS OF THE 4858 02:59:35,000 --> 02:59:35,720 INDIVIDUAL, HOW TO SUPPORT THIS 4859 02:59:35,720 --> 02:59:40,640 INDIVIDUAL. 4860 02:59:40,640 --> 02:59:44,000 FINALLY WE HAVE THIS FROM A 4861 02:59:44,000 --> 02:59:46,320 NON-CAREGIVER WHO SHARED THEIR 4862 02:59:46,320 --> 02:59:49,360 EXPERIENCES WITH DISCHARGE AND 4863 02:59:49,360 --> 02:59:52,120 HIGHLIGHTED HOW NON-TRADITIONAL 4864 02:59:52,120 --> 02:59:53,400 RELATIONSHIPS BETWEEN CAREGIVER 4865 02:59:53,400 --> 02:59:55,040 AND PATIENTS PLACES ADDITIONAL 4866 02:59:55,040 --> 02:59:58,360 BURDENS AND BARRIERS TO BEING 4867 02:59:58,360 --> 03:00:00,440 INCLUDED DURING CARE TRANSITIONS 4868 03:00:00,440 --> 03:00:02,400 AND DISCHARGE PLANNING. 4869 03:00:02,400 --> 03:00:04,120 THIS CAREGIVER WAS NOT NOTIFIED 4870 03:00:04,120 --> 03:00:06,520 UNTIL THE DAY AFTER DISCHARGE 4871 03:00:06,520 --> 03:00:09,360 THE PERSON HAD BEEN DISCHARGED. 4872 03:00:09,360 --> 03:00:11,400 THIS WAS A EXTREMELY DIFFICULT 4873 03:00:11,400 --> 03:00:13,200 AS THE PATIENT WAS HOMELESS AND 4874 03:00:13,200 --> 03:00:15,000 CAREGIVER HAD MADE PLANS FOR THE 4875 03:00:15,000 --> 03:00:17,440 INDIVIDUAL TO COME AND LIVE WITH 4876 03:00:17,440 --> 03:00:17,600 HER. 4877 03:00:17,600 --> 03:00:20,400 WE SEE THIS ECHOED IN PREVIOUS 4878 03:00:20,400 --> 03:00:24,000 WORK LOOKING AT INTERHOSPITAL 4879 03:00:24,000 --> 03:00:24,800 TRANSITIONS. 4880 03:00:24,800 --> 03:00:28,440 WHEN CAREGIVERS FEEL LEFT OUT OF 4881 03:00:28,440 --> 03:00:30,960 TRANSITIONS, THEY TEND TO HAVE 4882 03:00:30,960 --> 03:00:32,400 NEGATIVE VIEWS OF THE HEALTHCARE 4883 03:00:32,400 --> 03:00:34,960 SYSTEM, THEY LOSE TRUST AND THEN 4884 03:00:34,960 --> 03:00:40,160 THERE IS WORRY ABOUT ADHERENCE 4885 03:00:40,160 --> 03:00:42,960 TO FOLLOWING INSTRUCTIONS OR 4886 03:00:42,960 --> 03:00:44,400 LOOKING AT THE ACTS OF 4887 03:00:44,400 --> 03:00:46,440 HEALTHCARE PROFESSIONALS IN A 4888 03:00:46,440 --> 03:00:49,000 POSITIVE MANNER. 4889 03:00:49,000 --> 03:00:51,200 SO OUR FUTURE DIRECTIONS THEN 4890 03:00:51,200 --> 03:00:56,160 WOULD INCLUDE THINKING ABOUT 4891 03:00:56,160 --> 03:00:58,200 DEVELOPING THE SPECIFIC 4892 03:00:58,200 --> 03:00:59,680 INTERVENTIONS AND TOOLS THAT 4893 03:00:59,680 --> 03:01:01,600 WOULD PROMOTE INVOLVEMENT OF 4894 03:01:01,600 --> 03:01:03,640 CAREGIVERS DURING THESE 4895 03:01:03,640 --> 03:01:05,480 TRANSITIONS IN PARTICULAR HOW WE 4896 03:01:05,480 --> 03:01:08,000 CAN INCLUDE ASSESSMENT OF 4897 03:01:08,000 --> 03:01:08,880 CAREGIVER SOCIAL NEEDS DURING 4898 03:01:08,880 --> 03:01:11,840 THESE CARE TRANSITIONS. 4899 03:01:11,840 --> 03:01:14,120 IT IS OFTEN DIFFICULT FOR 4900 03:01:14,120 --> 03:01:16,160 INDIVIDUALS TO BE RECOGNIZED AS 4901 03:01:16,160 --> 03:01:16,960 CAREGIVERS, WHILE THE PATIENT IS 4902 03:01:16,960 --> 03:01:21,520 IN THE HOSPITAL AND TO BE 4903 03:01:21,520 --> 03:01:24,280 ACTIVELY INVOLVED WHEN DECISIONS 4904 03:01:24,280 --> 03:01:25,840 ARE MADE, WHEN TEAMS, HEALTHCARE 4905 03:01:25,840 --> 03:01:27,200 TEAMS GET TOGETHER AND 4906 03:01:27,200 --> 03:01:29,200 COMMUNICATE ABOUT PATIENT 4907 03:01:29,200 --> 03:01:31,000 STATUS, CAREGIVERS ARE OFTEN 4908 03:01:31,000 --> 03:01:32,000 LEFT OUT OF THE CONVERSATIONS. 4909 03:01:32,000 --> 03:01:33,600 SO IN IN SUMMARY IT WOULD BE 4910 03:01:33,600 --> 03:01:36,280 VERY IMPORTANT FOR US TO THINK 4911 03:01:36,280 --> 03:01:38,960 ABOUT ALSO INVOLVING CAREGIVERS 4912 03:01:38,960 --> 03:01:44,080 IN OUR SOCIAL NEEDS ASSESSMENT. 4913 03:01:44,080 --> 03:01:46,440 I WANT TO ACKNOWLEDGE THESE 4914 03:01:46,440 --> 03:01:47,040 INDIVIDUALS FOR THEIR SUPPORT 4915 03:01:47,040 --> 03:01:49,240 AND INVOLVEMENT IN THE RESEARCH. 4916 03:01:49,240 --> 03:01:54,040 THANK YOU. 4917 03:01:54,040 --> 03:01:59,000 >> THANK YOU, DR. BRISTOL. 4918 03:01:59,000 --> 03:02:03,680 OUR NEXT SPEAKER WILL BE DR. 4919 03:02:03,680 --> 03:02:04,000 KALOW. 4920 03:02:04,000 --> 03:02:05,400 >> CAN YOU SEE MY SLIDES? 4921 03:02:05,400 --> 03:02:08,400 >> YES. 4922 03:02:08,400 --> 03:02:09,000 >> THANK YOU. 4923 03:02:09,000 --> 03:02:10,920 WE HAVE SPOKEN A LOT ABOUT 4924 03:02:10,920 --> 03:02:12,640 STRATEGIES FOR DOING SOCIAL 4925 03:02:12,640 --> 03:02:13,800 DETERMINANTS OF HEALTH SCREENING 4926 03:02:13,800 --> 03:02:15,520 IN THE EMERGENCY DEPARTMENT, AND 4927 03:02:15,520 --> 03:02:17,320 I THINK IT IS WORTH GOING BACK 4928 03:02:17,320 --> 03:02:20,440 TO EARLY DATA FROM 2015 JUST TO 4929 03:02:20,440 --> 03:02:21,360 EMPHASIZE THIS IS SOMETHING ED 4930 03:02:21,360 --> 03:02:23,800 PROVIDERS WANT TO DO AND FEEL 4931 03:02:23,800 --> 03:02:26,320 LIKE IS INCLUDED WITHIN THEIR 4932 03:02:26,320 --> 03:02:26,720 RESPONSIBILITIES. 4933 03:02:26,720 --> 03:02:28,000 BUT PEEL LIKE THEY CAN'T DO 4934 03:02:28,000 --> 03:02:28,280 WELL. 4935 03:02:28,280 --> 03:02:29,920 BECAUSE THEY DON'T HAVE ENOUGH 4936 03:02:29,920 --> 03:02:31,360 TIME, NOT ENOUGH KNOWLEDGE, 4937 03:02:31,360 --> 03:02:33,000 DON'T HAVE ABILITY TO ACT, DON'T 4938 03:02:33,000 --> 03:02:34,040 HAVE THOSE CONNECTIONS DR. 4939 03:02:34,040 --> 03:02:37,040 TAYLOR WAS EMPHASIZING WITH THE 4940 03:02:37,040 --> 03:02:38,120 COMMUNITY BASED ORGANIZATIONS. 4941 03:02:38,120 --> 03:02:39,320 OR STRATEGIES CONNECTING PEOPLE 4942 03:02:39,320 --> 03:02:47,840 TO THOSE RESOURCES. QUALITATIVE 4943 03:02:47,840 --> 03:02:50,280 RESEARCH FROM MY COLLEAGUES 4944 03:02:50,280 --> 03:02:52,800 EMPHASIZES THIS, WITH QUOTE I 4945 03:02:52,800 --> 03:02:53,840 THINK HOUSING SCREENING IS A 4946 03:02:53,840 --> 03:02:55,160 GREAT IDEA BECAUSE PEOPLE HAVE 4947 03:02:55,160 --> 03:02:56,600 TOO MUCH PRIDE ON THEIR OWN, IT 4948 03:02:56,600 --> 03:02:57,800 IS GOOD INFORMATION BECAUSE YOU 4949 03:02:57,800 --> 03:02:59,600 DON'T KNOW WHO IS HOMELESS OF 4950 03:02:59,600 --> 03:03:01,440 NOT, LOOK AT ME, I DON'T LOOK 4951 03:03:01,440 --> 03:03:02,960 LIKE HOMELESS, NEVER CAN TELL, 4952 03:03:02,960 --> 03:03:04,720 IF YOU DON'T ASK ME YOU DON'T 4953 03:03:04,720 --> 03:03:04,920 KNOW. 4954 03:03:04,920 --> 03:03:06,080 SIMILAR TO WHAT WE HAVE HEARD 4955 03:03:06,080 --> 03:03:06,920 THROUGHOUT THE DAY, IT IS 4956 03:03:06,920 --> 03:03:08,400 IMPORTANT TO DO THIS CAREFULLY, 4957 03:03:08,400 --> 03:03:10,360 PEOPLE ARE FEARFUL YOU WILL 4958 03:03:10,360 --> 03:03:11,800 REPORT TO DHS OR THERE WILL BE 4959 03:03:11,800 --> 03:03:16,520 JUDGMENT OR YOU NEED A HANDOUT. 4960 03:03:16,520 --> 03:03:17,600 WE ASK QUESTIONS IN THE 4961 03:03:17,600 --> 03:03:18,200 EMERGENCY DEPARTMENT SENSITIVE 4962 03:03:18,200 --> 03:03:19,160 AND ASKED CAREFULLY ALL THE 4963 03:03:19,160 --> 03:03:20,240 TIME. 4964 03:03:20,240 --> 03:03:21,040 THIS IS RESEARCH FROM MY TEAM 4965 03:03:21,040 --> 03:03:23,360 LOOKING AT SCREENING ACROSS NEW 4966 03:03:23,360 --> 03:03:24,200 ENGLAND EMERGENCY DEPARTMENT AND 4967 03:03:24,200 --> 03:03:26,400 YOU CAN SEE THAT WE ASK ABOUT 4968 03:03:26,400 --> 03:03:27,680 INTIMATE PARTNER VIOLENCE 4969 03:03:27,680 --> 03:03:30,920 SUBSTANCE USE AN MENTAL HEALTH 4970 03:03:30,920 --> 03:03:32,800 BETWEENMENT AND 95% OF THE TIME 4971 03:03:32,800 --> 03:03:33,560 AT TRIAGE. 4972 03:03:33,560 --> 03:03:35,320 WHEN IT COMES TO ASKING SOCIAL 4973 03:03:35,320 --> 03:03:37,840 DETERMINANTS OF HEALTH LIKE 4974 03:03:37,840 --> 03:03:39,400 HOUSING INSTABILITY, FOOD 4975 03:03:39,400 --> 03:03:39,920 INSECURITY, TRANSPORTATION 4976 03:03:39,920 --> 03:03:41,680 UTILITIES WE DO MUCH WORSE 4977 03:03:41,680 --> 03:03:43,760 ASKING ABOUT IT ONLY 33% FOR 4978 03:03:43,760 --> 03:03:46,920 HOUSING INSTABILITY TO 6% 4979 03:03:46,920 --> 03:03:49,160 UTILITIES. THESE ARE KINDS OF 4980 03:03:49,160 --> 03:03:49,920 QUESTIONS WE COULD ASK. 4981 03:03:49,920 --> 03:03:51,880 IT IS A REAL MISSED OPPORTUNITY 4982 03:03:51,880 --> 03:03:53,680 BECAUSE AS YOU HEARD OVER AND 4983 03:03:53,680 --> 03:03:54,840 OVER THE HIGHEST RISK PATIENTS 4984 03:03:54,840 --> 03:03:56,840 ARE IN THE EMERGENCY DEPARTMENT 4985 03:03:56,840 --> 03:03:58,240 AND YET EXISTING POLICY 4986 03:03:58,240 --> 03:04:00,400 INITIATIVES FOCUS PRIMARILY ON 4987 03:04:00,400 --> 03:04:01,680 PCP SCREENING. 4988 03:04:01,680 --> 03:04:04,160 SO HERE IN MASSACHUSETTS WHERE I 4989 03:04:04,160 --> 03:04:05,680 AM FROM OUR ACCOUNTABLE CARE 4990 03:04:05,680 --> 03:04:08,040 ORGANIZATION EMPHASIZED OVER AND 4991 03:04:08,040 --> 03:04:09,680 OVER SCREENING FOR SOCIAL 4992 03:04:09,680 --> 03:04:10,880 DETERMINANTS OF HEALTH IN THE 4993 03:04:10,880 --> 03:04:12,000 PRIMARY CARE OFFICE. 4994 03:04:12,000 --> 03:04:13,560 THAT MEANS YOU ARE ONLY 4995 03:04:13,560 --> 03:04:14,600 SCREENING PEOPLE WHO HAVE 4996 03:04:14,600 --> 03:04:16,600 WHEREWITHAL TO GET THERE, SO 4997 03:04:16,600 --> 03:04:17,640 THOSE ARE PEOPLE WHO ALREADY 4998 03:04:17,640 --> 03:04:18,400 HAVE ACCESS TO TRANSPORTATION 4999 03:04:18,400 --> 03:04:20,000 AND SOME LEVEL OF ACCESS TO CARE 5000 03:04:20,000 --> 03:04:21,640 AND WE RISK POTENTIALLY 5001 03:04:21,640 --> 03:04:22,920 EXACERBATING THIS DISPARITIES IF 5002 03:04:22,920 --> 03:04:24,600 THOSE ARE THE ONLY PEOPLE WE ARE 5003 03:04:24,600 --> 03:04:29,840 CONNECTING TO RESOURCES. SO I 5004 03:04:29,840 --> 03:04:31,280 WANT TO TALK ABOUT NEW STRATEGY 5005 03:04:31,280 --> 03:04:32,400 AROUND THREE ISSUES OF 5006 03:04:32,400 --> 03:04:33,400 IDENTIFICATION, CONNECTIONS AND 5007 03:04:33,400 --> 03:04:36,520 LINKAGE AND OUTCOME MEASUREMENT. 5008 03:04:36,520 --> 03:04:38,400 IN PARTICULAR, IF WE THINK ABOUT 5009 03:04:38,400 --> 03:04:39,400 IDENTIFICATION WE ARE GOING TO 5010 03:04:39,400 --> 03:04:41,000 TALK ABOUT CONTENT, THEN TALK 5011 03:04:41,000 --> 03:04:43,160 ABOUT FEASIBILITY. 5012 03:04:43,160 --> 03:04:45,840 WE TALKED ABOUT DISTINCTIONS 5013 03:04:45,840 --> 03:04:47,200 BETWEEN SOCIAL RISK AND SOCIAL 5014 03:04:47,200 --> 03:04:48,880 NEED ABOUT WHETHER WE THINK 5015 03:04:48,880 --> 03:04:50,080 ABOUT USING QUESTIONNAIRES OR 5016 03:04:50,080 --> 03:04:51,880 THINK ABOUT USING INFORMATION 5017 03:04:51,880 --> 03:04:54,880 WHERE PATIENT DESCRIBES FOR US 5018 03:04:54,880 --> 03:04:56,120 DIRECTLY WHEN THOSE THEY WANT OR 5019 03:04:56,120 --> 03:04:56,800 NEED FROM THE HEALTHCARE SYSTEM. 5020 03:04:56,800 --> 03:04:59,800 THIS IS DATA FROM ED WHERE WE 5021 03:04:59,800 --> 03:05:01,400 TRIED TO COMPARE ANSWERS IN THE 5022 03:05:01,400 --> 03:05:02,720 SAME POPULATION OF PATIENTS IN 5023 03:05:02,720 --> 03:05:03,520 OUR ED. 5024 03:05:03,520 --> 03:05:05,200 WE FOUND THAT ABOUT A THIRD OF 5025 03:05:05,200 --> 03:05:09,720 PATIENTS HAD SOCIAL RISK, A 5026 03:05:09,720 --> 03:05:11,520 THIRD HAD NEED AND INCOMPLETE 5027 03:05:11,520 --> 03:05:11,760 OVERLAP. 5028 03:05:11,760 --> 03:05:13,920 SIMILAR TO DATA THAT WAS 5029 03:05:13,920 --> 03:05:14,920 PRESENTED EARLIER, WE FOUND 5030 03:05:14,920 --> 03:05:16,600 SPANISH SPEAKERS AND 5031 03:05:16,600 --> 03:05:18,400 NON-HISPANIC BLACK PATIENTS WERE 5032 03:05:18,400 --> 03:05:20,400 MORE LIKELY TO REPORT SOCIAL 5033 03:05:20,400 --> 03:05:20,800 NEED. 5034 03:05:20,800 --> 03:05:22,760 WE THEN DID A SIMILAR ANALYSIS 5035 03:05:22,760 --> 03:05:24,280 LOOKING AT OUR ACO. 5036 03:05:24,280 --> 03:05:26,600 SO ALL THE MEDICAID PATIENTS WHO 5037 03:05:26,600 --> 03:05:28,400 WERE TAKEN CARE OF IN THE 5038 03:05:28,400 --> 03:05:29,840 HEALTHCARE SYSTEM SCREENED IN 5039 03:05:29,840 --> 03:05:30,920 PRIMARY KARAK AT THISES. 5040 03:05:30,920 --> 03:05:34,880 NOW WE HAVE 27,000 PEOPLE WHO 5041 03:05:34,880 --> 03:05:35,480 COMPLETED 30,000 SCREENS. 5042 03:05:35,480 --> 03:05:38,400 45% WERE POSITIVE FOR ONE SOCIAL 5043 03:05:38,400 --> 03:05:38,880 RISK. 5044 03:05:38,880 --> 03:05:41,680 19% WERE POSITIVE FOR SOCIAL 5045 03:05:41,680 --> 03:05:44,000 NEED AND 35% WERE POSITIVE FOR 5046 03:05:44,000 --> 03:05:44,200 BOTH. 5047 03:05:44,200 --> 03:05:46,200 6% WERE NEGATIVE FOR SOCIAL RISK 5048 03:05:46,200 --> 03:05:47,560 BUT POSITIVE FOR SOCIAL NEED. 5049 03:05:47,560 --> 03:05:50,400 SO THEY SCREENED NEGATIVE ON 5050 03:05:50,400 --> 03:05:51,000 YOUR TEST SCREENER, BUT STILL 5051 03:05:51,000 --> 03:05:54,440 WOULD HAVE REQUESTED ASSISTANCE. 5052 03:05:54,440 --> 03:05:56,400 WHO WERE THOSE PEOPLE? 5053 03:05:56,400 --> 03:05:57,320 PATIENTS NON-WHITE, THOSE WHO 5054 03:05:57,320 --> 03:05:58,520 COME FROM PRACTICES WITH A 5055 03:05:58,520 --> 03:06:00,400 HIGHER PROPORTION OF LIMITED 5056 03:06:00,400 --> 03:06:02,000 ENGLISH PROFICIENCY OR MEDICAID 5057 03:06:02,000 --> 03:06:03,800 PATIENTS THOSE ARE ONES MOST 5058 03:06:03,800 --> 03:06:05,120 LIKELY TO REPORT SOCIAL NEED 5059 03:06:05,120 --> 03:06:06,600 WITH OR WITHOUT SOCIAL RISK. 5060 03:06:06,600 --> 03:06:08,400 AMONG THE PEOPLE WHO REPORT 5061 03:06:08,400 --> 03:06:10,640 SOCIAL RISK THE PATIENTS BLACK 5062 03:06:10,640 --> 03:06:12,240 WHO PREFER NON-ENGLISH LANGUAGE 5063 03:06:12,240 --> 03:06:14,920 OR WHO WERE IN PRACTICE TO CARE 5064 03:06:14,920 --> 03:06:17,160 OF PEOPLE WITH LIMITED 5065 03:06:17,160 --> 03:06:18,680 PROFICIENCY OR MEDICAID NEEDS, 5066 03:06:18,680 --> 03:06:21,440 HAD HIGHER ODDS OF REPORTING 5067 03:06:21,440 --> 03:06:22,840 SOCIAL NEED IN DIFFERENT DOMAIN 5068 03:06:22,840 --> 03:06:23,480 THAN SOCIAL RISK. 5069 03:06:23,480 --> 03:06:24,800 WHAT THIS SUGGESTS TO ME IN OUR 5070 03:06:24,800 --> 03:06:27,600 SETTING IS RISK SCREENING ALONE 5071 03:06:27,600 --> 03:06:29,360 IS INSUFFICIENT AND INEQUITABLE. 5072 03:06:29,360 --> 03:06:31,000 SO IT IS SUPER IMPORTANT THAT 5073 03:06:31,000 --> 03:06:33,120 WHATEVER TOOL WE PICK NOT ONLY 5074 03:06:33,120 --> 03:06:36,400 SCREENS FOR SOCIAL RISK BUT ALSO 5075 03:06:36,400 --> 03:06:38,000 SCREENS FOR SOCIAL NEED. 5076 03:06:38,000 --> 03:06:39,600 THAT IS SUPER CHALLENGING TO 5077 03:06:39,600 --> 03:06:40,560 IMPLEMENT IN THE EMERGENCY 5078 03:06:40,560 --> 03:06:41,280 DEPARTMENT BECAUSE MOST EXISTING 5079 03:06:41,280 --> 03:06:42,800 TOOLS ARE REALLY LONG. 5080 03:06:42,800 --> 03:06:44,200 I HAVE INCLUDED ON THIS SLIDE 5081 03:06:44,200 --> 03:06:46,520 THE TOOL THAT IS USED IN OUR 5082 03:06:46,520 --> 03:06:46,800 INSTITUTION. 5083 03:06:46,800 --> 03:06:49,520 AND YOU CAN SEE THE TOP IS 5084 03:06:49,520 --> 03:06:51,560 FOCUSED O ON SOCIAL RISK AND AT 5085 03:06:51,560 --> 03:06:52,920 THE BOTTOM WE GET TO SEMBLANCE 5086 03:06:52,920 --> 03:06:54,720 OF ASKING WHAT IT IS THAT THEY 5087 03:06:54,720 --> 03:06:54,920 WANT. 5088 03:06:54,920 --> 03:06:58,080 THE PRIMARY FOCUS IS REALLY ON 5089 03:06:58,080 --> 03:06:58,360 REST. 5090 03:06:58,360 --> 03:06:59,800 IT IS ALSO OF COURSE SUPER 5091 03:06:59,800 --> 03:07:01,200 IMPORTANT TO MAKE SURE THE TOOLS 5092 03:07:01,200 --> 03:07:01,840 ARE AVAILABLE. 5093 03:07:01,840 --> 03:07:05,320 IN MULTIPLE LANGUAGES. 5094 03:07:05,320 --> 03:07:06,480 WE ATTEMPTED TO BUILD A TOOL 5095 03:07:06,480 --> 03:07:09,280 THAT WOULD BE USEFUL IN THE 5096 03:07:09,280 --> 03:07:11,160 EMERGENCY DEPARTMENT AND QUICK 5097 03:07:11,160 --> 03:07:12,280 EASY TO UNDERSTAND. 5098 03:07:12,280 --> 03:07:14,120 WE STARTED WITH INITIAL TOOL 5099 03:07:14,120 --> 03:07:16,760 DOMAINS TO MATCH ACCOUNTABLE 5100 03:07:16,760 --> 03:07:18,080 HEALTH COMMUNITIES THE FOOD 5101 03:07:18,080 --> 03:07:18,880 HOUSING TRANSPORTATION UTILITIES 5102 03:07:18,880 --> 03:07:20,760 AND SAFETY AND IMPORTANTLY WE 5103 03:07:20,760 --> 03:07:21,920 PICKED QUESTIONS IN THE PUBLIC 5104 03:07:21,920 --> 03:07:24,200 DOMAIN BECAUSE WE WANTED TO BE 5105 03:07:24,200 --> 03:07:26,000 SOMETHING WE BOTH USE FOR FREE 5106 03:07:26,000 --> 03:07:28,040 AND CONDUCTED COGNITIVE 5107 03:07:28,040 --> 03:07:28,600 INTERVIEWS IN ENGLISH AND 5108 03:07:28,600 --> 03:07:29,040 SPANISH. 5109 03:07:29,040 --> 03:07:30,800 WE FOUND THAT PEOPLE STRUGGLED 5110 03:07:30,800 --> 03:07:31,480 TO UNDERSTAND A LOT OF THESE 5111 03:07:31,480 --> 03:07:32,360 QUESTIONS. 5112 03:07:32,360 --> 03:07:34,920 THEY WERE INTERPRETING THEM 5113 03:07:34,920 --> 03:07:36,600 DIFFERENTLY, ACROSS DIFFERENT 5114 03:07:36,600 --> 03:07:38,200 INDIVIDUALS AND ALSO DIFFERENTLY 5115 03:07:38,200 --> 03:07:38,960 THAN WE THOUGHT THEY WERE GOING 5116 03:07:38,960 --> 03:07:41,400 TO BE. 5117 03:07:41,400 --> 03:07:43,360 THOSE THINK ALOUD APPROACHES ARE 5118 03:07:43,360 --> 03:07:44,720 REALLY IMPORTANT TO MAKING SURE 5119 03:07:44,720 --> 03:07:46,280 PEOPLE ARE UNDERSTANDING THE 5120 03:07:46,280 --> 03:07:47,440 QUESTIONS THE WAY YOU WANT THEM 5121 03:07:47,440 --> 03:07:50,400 TO BE INTERPRETED. 5122 03:07:50,400 --> 03:07:51,760 ULTIMATELY WE END UNDERSTOOD 5123 03:07:51,760 --> 03:07:52,840 REMOVING DOMAIN OF SAFETY FROM 5124 03:07:52,840 --> 03:07:54,920 OUR SCREENER BECAUSE THERE WAS 5125 03:07:54,920 --> 03:07:57,680 REALLY ENORMOUS INCONSISTENCY 5126 03:07:57,680 --> 03:07:58,360 HOW IT WAS INTERPRETED ACROSS 5127 03:07:58,360 --> 03:07:59,800 PATIENT POPULATION, RANGING FROM 5128 03:07:59,800 --> 03:08:01,120 PEOPLE THINKING ABOUT IT IN 5129 03:08:01,120 --> 03:08:06,680 TERMS OF DOMESTIC VIOLENCE TO 5130 03:08:06,680 --> 03:08:07,720 NEIGHBORHOOD SAFETY AND DIDN'T 5131 03:08:07,720 --> 03:08:09,000 MATCH TO A BODY OF RESOURCES IN 5132 03:08:09,000 --> 03:08:09,800 THE COMMUNITY. 5133 03:08:09,800 --> 03:08:13,680 WHAT THIS BROUGHT UP IS TENSION 5134 03:08:13,680 --> 03:08:14,960 BETWEEN COMPLETENESS, SPEEDS 5135 03:08:14,960 --> 03:08:16,160 COMPREHENSIVENESS WITHIN THE 5136 03:08:16,160 --> 03:08:16,360 TOOL. 5137 03:08:16,360 --> 03:08:18,120 AND THE FACT THE TOOL THAT IS 5138 03:08:18,120 --> 03:08:19,720 APPROPRIATE FOR SCREENING IN THE 5139 03:08:19,720 --> 03:08:20,400 EMERGENCY DEPARTMENT MAY NOT BE 5140 03:08:20,400 --> 03:08:21,960 THE SAME AS THE TOOL APPROPRIATE 5141 03:08:21,960 --> 03:08:24,560 IN THE PRIMARY CARE SETTING OR 5142 03:08:24,560 --> 03:08:25,200 OBGYN CLINIC OR SOMEWHERE YOU 5143 03:08:25,200 --> 03:08:26,920 HAVE A LONGER LONGITUDINAL 5144 03:08:26,920 --> 03:08:27,400 RELATIONSHIP. 5145 03:08:27,400 --> 03:08:30,000 WITH THE PATIENT, AND THEN A 5146 03:08:30,000 --> 03:08:34,200 BRIEFER SCREENER FOCUSED ON MORE 5147 03:08:34,200 --> 03:08:34,720 IMMEDIATE RECOGNIZE MAYBE 5148 03:08:34,720 --> 03:08:35,320 SOMETHING MORE APPROPRIATE FOR 5149 03:08:35,320 --> 03:08:37,440 USE IN THE EMERGENCY DEPARTMENT: 5150 03:08:37,440 --> 03:08:39,240 ONCE YOU HAVE IDENTIFIED SOCIAL 5151 03:08:39,240 --> 03:08:41,480 RISK AND NEEDS HOW DO WE THINK 5152 03:08:41,480 --> 03:08:42,960 ABOUT CREATING A TRUE CONNECTION 5153 03:08:42,960 --> 03:08:44,440 BETWEEN THE PATIENT AND THE 5154 03:08:44,440 --> 03:08:47,640 RESOURCES. 5155 03:08:47,640 --> 03:08:49,840 SO WE SIMILAR TO WORK DR. TAYLOR 5156 03:08:49,840 --> 03:08:51,640 DID EARLIER QUALITATIVE 5157 03:08:51,640 --> 03:08:53,440 INTERVIEWS WITH ED PATIENTS AND 5158 03:08:53,440 --> 03:08:55,600 ALSO WITH COMMUNITY ORGANIZATION 5159 03:08:55,600 --> 03:08:57,480 LEADERS ENGLISH AND SPANISH 5160 03:08:57,480 --> 03:08:59,000 FOCUS ON COMMUNITY ORGANIZATIONS 5161 03:08:59,000 --> 03:09:00,320 THAT WE ANTICIPATED WOULD BE 5162 03:09:00,320 --> 03:09:01,840 RECEIVING THE REFERRALS OF 5163 03:09:01,840 --> 03:09:02,880 PATIENTS FROM EMERGENCY 5164 03:09:02,880 --> 03:09:03,280 DEPARTMENT. 5165 03:09:03,280 --> 03:09:04,800 SO FOOD PANTRIES HOMELESS 5166 03:09:04,800 --> 03:09:06,880 SHELTERS IN OUR NEIGHBORHOOD. 5167 03:09:06,880 --> 03:09:08,400 TRYING TO UNDERSTAND WHAT IT IS 5168 03:09:08,400 --> 03:09:10,440 THEY WANTED FROM THIS 5169 03:09:10,440 --> 03:09:11,520 BIDIRECTIONAL RELATIONSHIP IN 5170 03:09:11,520 --> 03:09:13,200 THE EMERGENCY DEPARTMENT AS WE 5171 03:09:13,200 --> 03:09:14,640 WERE CREATING A REFERRAL 5172 03:09:14,640 --> 03:09:15,000 PATHWAY. 5173 03:09:15,000 --> 03:09:16,400 THERE ARE THREE CATEGORIES OF 5174 03:09:16,400 --> 03:09:18,960 THESE THAT I WANT TO TALK TO YOU 5175 03:09:18,960 --> 03:09:20,480 ABOUT TODAY. 5176 03:09:20,480 --> 03:09:23,600 THE FIRST NO SURPRISE TO THIS 5177 03:09:23,600 --> 03:09:25,240 AUDIENCE IS IMPORTANCE OF ED 5178 03:09:25,240 --> 03:09:26,400 UTILIZATION AND SCREENING WITH 5179 03:09:26,400 --> 03:09:27,680 EMERGENCY DEPARTMENT, 5180 03:09:27,680 --> 03:09:28,840 CONSISTENTLY OUR PATIENTS 5181 03:09:28,840 --> 03:09:30,360 DESCRIBE CHALLENGES ACCESSING 5182 03:09:30,360 --> 03:09:31,840 PCP AND INCONSISTENT SCREENING 5183 03:09:31,840 --> 03:09:32,840 AT THEIR PCP. 5184 03:09:32,840 --> 03:09:35,960 THIS IS JUST ONE QUOTE, HOURS 5185 03:09:35,960 --> 03:09:37,960 CLOSE AT 3 I GET OUT OF WORK AT 5186 03:09:37,960 --> 03:09:40,240 3 THEY GET OUT OF SCHOOL AT 3, 5187 03:09:40,240 --> 03:09:41,400 DURING WEEK SICK BABIES ON THE 5188 03:09:41,400 --> 03:09:42,920 WEEKEND SO IN ORDER TO GO WITH 5189 03:09:42,920 --> 03:09:44,240 THESE KIDS FOR ANYTHING I HAD TO 5190 03:09:44,240 --> 03:09:46,040 TAKE DAY OFF WORK, TAKE TIME OFF 5191 03:09:46,040 --> 03:09:47,400 OF SCHOOL WHICH IS NOT RIGHT. 5192 03:09:47,400 --> 03:09:49,840 SO THESE PATIENTS ARE IN THE ED, 5193 03:09:49,840 --> 03:09:54,720 THE ONES WITH HIGHEST NEEDS. 5194 03:09:54,720 --> 03:09:57,440 A LOT OF CHALLENGES AROUND 5195 03:09:57,440 --> 03:09:59,560 SCREENING AND COMMUNITY 5196 03:09:59,560 --> 03:10:00,200 RESOURCES. 5197 03:10:00,200 --> 03:10:02,800 THE FIRST WE NEED TO MAKE SURE 5198 03:10:02,800 --> 03:10:04,320 SYSTEMS ADDRESS HEAD ON IS FEAR 5199 03:10:04,320 --> 03:10:04,880 AN MISTRUST. 5200 03:10:04,880 --> 03:10:06,640 WE TALKED ABOUT THIS AT VARIOUS 5201 03:10:06,640 --> 03:10:08,000 POINTS HOW DATA IS RECORDED, 5202 03:10:08,000 --> 03:10:11,000 WHERE IT'S STORED AND WE NEED TO 5203 03:10:11,000 --> 03:10:13,960 BE REALLY EXPLICIT HOW WE 5204 03:10:13,960 --> 03:10:15,800 ADDRESS THIS BUILDING OUTS THE 5205 03:10:15,800 --> 03:10:16,040 SYSTEMS. 5206 03:10:16,040 --> 03:10:17,560 WE HEARD THIS A LOT PARTICULARLY 5207 03:10:17,560 --> 03:10:19,200 IN OUR SPANISH LANGUAGE 5208 03:10:19,200 --> 03:10:20,600 INTERVIEW BUS ALSO ENGLISH 5209 03:10:20,600 --> 03:10:22,560 LANGUAGE INTERVIEWS FEAR OF 5210 03:10:22,560 --> 03:10:24,440 RECEIVING ANY HELP FROM ANYBODY 5211 03:10:24,440 --> 03:10:25,200 IF YOU ARE UNDOCUMENTED. 5212 03:10:25,200 --> 03:10:26,520 NOT JUST FEAR WHAT IT IS AND HOW 5213 03:10:26,520 --> 03:10:30,160 MUCH INFORMATION DO I HAVE TO 5214 03:10:30,160 --> 03:10:30,640 PROVIDE, IMMIGRATION AND 5215 03:10:30,640 --> 03:10:32,520 DEPORTATION FEAR, MOVING PEOPLE 5216 03:10:32,520 --> 03:10:33,880 DONGMENTED WILL SAY NO, THANK 5217 03:10:33,880 --> 03:10:36,000 YOU BECAUSE THE FEAR THE PUBLIC 5218 03:10:36,000 --> 03:10:36,880 CHARGE CLAUSE APPLY. 5219 03:10:36,880 --> 03:10:40,840 THEN THE QUESTIONS AROUND 5220 03:10:40,840 --> 03:10:41,720 COLLECTION MAINTENANCE AND 5221 03:10:41,720 --> 03:10:42,560 TRANSMISSION OF ACCURATE 5222 03:10:42,560 --> 03:10:42,880 INFORMATION. 5223 03:10:42,880 --> 03:10:43,600 THIS IS KEY. 5224 03:10:43,600 --> 03:10:44,880 HOW DO YOU MAKE SURE IN A WORLD 5225 03:10:44,880 --> 03:10:49,600 OF CHANGING RESOURCE, IF YOU 5226 03:10:49,600 --> 03:10:51,600 HAVE SMALL CBOs, THE HOURS ARE 5227 03:10:51,600 --> 03:10:53,200 CHANGING OVER TIME, FOOD 5228 03:10:53,200 --> 03:10:55,360 PANTRIES MOVING HOW DO YOU MAKE 5229 03:10:55,360 --> 03:10:56,480 SURE GOOD INFORMATION HANDING 5230 03:10:56,480 --> 03:10:58,240 OUT REMAINS ACCURATE, OR IF YOU 5231 03:10:58,240 --> 03:11:00,960 ARE CONTRACTING TO RESOURCE 5232 03:11:00,960 --> 03:11:02,000 PROVIDER, LIKE -- HOW DO YOU 5233 03:11:02,000 --> 03:11:03,840 MAKE SURE THEIR INFORMATION IS 5234 03:11:03,840 --> 03:11:05,040 ACCURATE. 5235 03:11:05,040 --> 03:11:06,800 WE HAVE DONE SOME CHECKS ON THAT 5236 03:11:06,800 --> 03:11:08,040 DATA IT IS NOT PERFECT EITHER 5237 03:11:08,040 --> 03:11:09,400 AND YOU REALLY DON'T WANT TO BE 5238 03:11:09,400 --> 03:11:13,240 IN THE POSITION OF STANDING OUT 5239 03:11:13,240 --> 03:11:14,600 INACCURATE INFORMATION TO FOLKS 5240 03:11:14,600 --> 03:11:15,760 AND FINALLY MAKING SURE THE 5241 03:11:15,760 --> 03:11:17,400 INFORMATION YOU ARE HANDING OUT 5242 03:11:17,400 --> 03:11:18,480 TO PEOPLE ADDRESSES TIME AND 5243 03:11:18,480 --> 03:11:19,360 RESOURCE CONSTRAINTS. 5244 03:11:19,360 --> 03:11:20,840 THIS WAS A QUOTE THAT WE THOUGHT 5245 03:11:20,840 --> 03:11:22,040 WAS REALLY ILLUMINATING. 5246 03:11:22,040 --> 03:11:26,160 A PATIENT DESCRIBING RECEIVING 5247 03:11:26,160 --> 03:11:30,160 INFORMATION IN THE HOSPITAL THE 5248 03:11:30,160 --> 03:11:31,360 STUFF IS THERE BUT UNLESS 5249 03:11:31,360 --> 03:11:32,280 WRITING IT DOWN OR TAKE A 5250 03:11:32,280 --> 03:11:34,600 PICTURE WITH YOUR PHONE, MIGHT 5251 03:11:34,600 --> 03:11:36,440 SEE IT AND GO WOW, I WOULD LIKE 5252 03:11:36,440 --> 03:11:38,520 TO DO THAT BUT REMEMBER TO TAKE 5253 03:11:38,520 --> 03:11:40,000 A PICTURE, REMEMBER TO GRAB THE 5254 03:11:40,000 --> 03:11:41,000 INFORMATION COULD BE HARD SO HOW 5255 03:11:41,000 --> 03:11:43,600 DO WE MAKE SURE THE INFORMATION 5256 03:11:43,600 --> 03:11:45,920 LEADS WITH PATIENT. 5257 03:11:45,920 --> 03:11:48,600 WE HAVE A LOT OF SUGGESTIONS FOR 5258 03:11:48,600 --> 03:11:49,440 IMPROVEMENT AND PROGRAM 5259 03:11:49,440 --> 03:11:50,480 DEVELOPMENT. 5260 03:11:50,480 --> 03:11:52,360 MIXED PREFERENCES WHETHER PEOPLE 5261 03:11:52,360 --> 03:11:54,960 WANTED IT TO BE VERBAL OR 5262 03:11:54,960 --> 03:11:56,280 ELECTRONICALLY DELIVERED, AND 5263 03:11:56,280 --> 03:11:58,200 WHEN WE STUDY THAT IN RANDOMIZED 5264 03:11:58,200 --> 03:11:59,880 CONTROL TRIAL IT IS MIXED, NOT A 5265 03:11:59,880 --> 03:12:01,600 CLEAR WINNER BETWEEN VERBAL OR 5266 03:12:01,600 --> 03:12:02,480 ELECTRONIC DELIVERY OF 5267 03:12:02,480 --> 03:12:04,360 RESOURCES. 5268 03:12:04,360 --> 03:12:07,440 BUT EVERYBODY WANTS CENTRALIZED 5269 03:12:07,440 --> 03:12:07,960 RESOURCE INFORMATION 5270 03:12:07,960 --> 03:12:08,280 COORDINATION. 5271 03:12:08,280 --> 03:12:08,880 IS WILL SOME WAY FOR THE 5272 03:12:08,880 --> 03:12:09,880 HOSPITAL OR ORGANIZATION IN THE 5273 03:12:09,880 --> 03:12:11,600 HOSPITAL WORKING WITH TO HOLD 5274 03:12:11,600 --> 03:12:12,360 THE KNOWLEDGE OF ORGANIZATION TO 5275 03:12:12,360 --> 03:12:14,400 BE ABLE THE SHARE THAT. 5276 03:12:14,400 --> 03:12:16,520 UPDATE ON WHAT PLACES, BEDS AND 5277 03:12:16,520 --> 03:12:18,960 HOURS ARE, AND HOW THEIR HOURS 5278 03:12:18,960 --> 03:12:21,280 CHANGE. 5279 03:12:21,280 --> 03:12:22,720 THERE WAS INTEREST IN THE IDEA 5280 03:12:22,720 --> 03:12:24,120 OF ON DEMAND INFORMATION 5281 03:12:24,120 --> 03:12:24,400 NAVIGATION. 5282 03:12:24,400 --> 03:12:25,800 IS THERE A WAY TO TEXT AND BE 5283 03:12:25,800 --> 03:12:28,120 LIKE WHERE CAN I GO NOW TO GET 5284 03:12:28,120 --> 03:12:28,320 FOOD. 5285 03:12:28,320 --> 03:12:29,320 WHAT IF THERE WAS AUTOMATIC 5286 03:12:29,320 --> 03:12:32,360 RESPONSE, WHERE DO I GET FOOD 5287 03:12:32,360 --> 03:12:34,600 02116 OR WHATEVER, THAT'S COOL. 5288 03:12:34,600 --> 03:12:35,680 IS THERE SOMETHING COMPUTER 5289 03:12:35,680 --> 03:12:37,440 SYSTEM THAT COULD GENERATE 5290 03:12:37,440 --> 03:12:38,320 RESPONSES TO QUESTIONS AND 5291 03:12:38,320 --> 03:12:39,880 PATIENTS COULD BE EDUCATED HOW 5292 03:12:39,880 --> 03:12:41,800 THAT WORKS BEFORE THEY LEAVE ED 5293 03:12:41,800 --> 03:12:43,560 AND HAVE THAT INFORMATION ON 5294 03:12:43,560 --> 03:12:44,000 HAND. 5295 03:12:44,000 --> 03:12:46,200 SO WE DECIDED TO BUILD IT. 5296 03:12:46,200 --> 03:12:49,080 WE BUILT A SYSTEM THAT WOULD 5297 03:12:49,080 --> 03:12:49,720 TEXT PATIENTS QUESTIONS ABOUT 5298 03:12:49,720 --> 03:12:52,440 SOCIAL RISK AND NEEDS AND IF 5299 03:12:52,440 --> 03:12:54,360 THEY SCREEN POSITIVE THEY WOULD 5300 03:12:54,360 --> 03:12:56,520 GET TEXTED BACK GEOGRAPHICALLY 5301 03:12:56,520 --> 03:12:57,480 PROXIMATE RESOURCE AND WE PLAN 5302 03:12:57,480 --> 03:12:59,360 TO DO A RANDOMIZE CONTROL TRIAL 5303 03:12:59,360 --> 03:13:04,800 OF THAT SYSTEM VERSUS OUR 5304 03:13:04,800 --> 03:13:05,920 STANDARD VERBAL SCREENING AND 5305 03:13:05,920 --> 03:13:06,440 HAND OUT. 5306 03:13:06,440 --> 03:13:08,480 THE IDEA IS STUDY HOW MANY 5307 03:13:08,480 --> 03:13:09,600 PEOPLE ABLE TO LIG TO RESOURCES 5308 03:13:09,600 --> 03:13:11,120 AN MIXED METHOD EVALUATION TO 5309 03:13:11,120 --> 03:13:12,400 INTERVIEW EVERYONE WHO FAILED TO 5310 03:13:12,400 --> 03:13:13,360 LEAD TO RESOURCE AND TRYING TO 5311 03:13:13,360 --> 03:13:14,440 UNDERSTAND WHAT THE BARRIERS 5312 03:13:14,440 --> 03:13:18,360 WERE. 5313 03:13:18,360 --> 03:13:19,960 WE GOT REALLY IMPORTANT AND 5314 03:13:19,960 --> 03:13:22,920 INTERESTING EARLY DATA AROUND 5315 03:13:22,920 --> 03:13:24,000 IMPORTANCE OF THIS KIND OF 5316 03:13:24,000 --> 03:13:25,800 ASSISTANCE, PEOPLE CHALLENGED BY 5317 03:13:25,800 --> 03:13:27,160 THE PAPER VERSION AND SEEMED TO 5318 03:13:27,160 --> 03:13:30,320 LIKE THE TEXT MESSAGE BETTER. 5319 03:13:30,320 --> 03:13:31,680 THERE WERE CONSISTENT BARRIERS 5320 03:13:31,680 --> 03:13:33,800 BEYOND RESOURCE IDENTIFICATION. 5321 03:13:33,800 --> 03:13:35,600 THERE WAS SMALL SUBSET OF PEOPLE 5322 03:13:35,600 --> 03:13:37,000 KNOWING THE FOOD PANTRY WAS 5323 03:13:37,000 --> 03:13:38,320 ENOUGH AND MORE PEOPLE WHO 5324 03:13:38,320 --> 03:13:41,520 NEEDED MORE HAND HOLDING AND 5325 03:13:41,520 --> 03:13:42,520 HELP TO GET THERE. 5326 03:13:42,520 --> 03:13:44,360 AND WOULD HAVE REALLY BENEFITED 5327 03:13:44,360 --> 03:13:45,320 FROM MORE IN PERSON ASSISTANCE. 5328 03:13:45,320 --> 03:13:46,640 THEN COVID HAPPENED. 5329 03:13:46,640 --> 03:13:49,200 ALL THE FOOD PANTRIES AND 5330 03:13:49,200 --> 03:13:50,680 HOMELESS SHELTERS SHALT DOWN AND 5331 03:13:50,680 --> 03:13:52,200 EVERY SINGLE RESOURCE CHANGED 5332 03:13:52,200 --> 03:13:54,280 THEIR LOCATION, THEIR 5333 03:13:54,280 --> 03:13:55,840 ELIGIBILITY CRITERIA AND HOW YOU 5334 03:13:55,840 --> 03:13:57,800 ACCESS THEM. 5335 03:13:57,800 --> 03:13:59,800 AND IT WAS TOO HARD TO UPDATE 5336 03:13:59,800 --> 03:14:01,000 THE TEXT MESSAGE SYSTEM FAST 5337 03:14:01,000 --> 03:14:02,440 ENOUGH TO MAKE IT RESPONSIVE TO 5338 03:14:02,440 --> 03:14:04,200 THE CHANGES IN DATA IN REAL 5339 03:14:04,200 --> 03:14:04,400 TIME. 5340 03:14:04,400 --> 03:14:06,000 SO WE WENT BACK TO PAPER HAND 5341 03:14:06,000 --> 03:14:07,480 OUTS BECAUSE THAT WAS THE ONLY 5342 03:14:07,480 --> 03:14:08,200 THING YOU COULD MOVE FAST ENOUGH 5343 03:14:08,200 --> 03:14:10,200 ON TO MAKE SURE WE WERE 5344 03:14:10,200 --> 03:14:13,160 PROVIDING ACCURATE INFORMATION. 5345 03:14:13,160 --> 03:14:14,960 SO WE ARE TRYING AGAIN. 5346 03:14:14,960 --> 03:14:17,480 WE RECEIVED A POSITIVE SCORE ON 5347 03:14:17,480 --> 03:14:20,000 A GRANT TO DO SIMILAR TEXT 5348 03:14:20,000 --> 03:14:21,400 MESSAGING INTERVENTION IN TIME 5349 03:14:21,400 --> 03:14:22,600 HOPEFULLY LESS CHAOTIC AND 5350 03:14:22,600 --> 03:14:24,360 INTERESTING TO SEE IF IT WORKS. 5351 03:14:24,360 --> 03:14:25,320 WITH A LOT THAT WE HAVE LEARNED 5352 03:14:25,320 --> 03:14:26,920 FROM THIS PILOT. 5353 03:14:26,920 --> 03:14:29,720 AND IT WILL HAVE AND IN PERSON 5354 03:14:29,720 --> 03:14:30,760 NAVIGATIONAL ASSISTANCE ARM AS 5355 03:14:30,760 --> 03:14:32,040 WELL AS TEXT MESSAGING ARM. 5356 03:14:32,040 --> 03:14:34,920 I THINK WE LEARNED FROM THIS 5357 03:14:34,920 --> 03:14:38,120 PILOT THAT INFORMATION ALONE IS 5358 03:14:38,120 --> 03:14:38,440 INSUFFICIENT. 5359 03:14:38,440 --> 03:14:40,240 ONCE YOU HAVE SUCCESSFULLY 5360 03:14:40,240 --> 03:14:41,600 CONNECTED PEOPLE TO RESOURCES, 5361 03:14:41,600 --> 03:14:45,520 THE NEXT QUESTION IS, HOW DO WE 5362 03:14:45,520 --> 03:14:46,800 MEASURE WHETHER OR NOT WE HAVE 5363 03:14:46,800 --> 03:14:49,000 MADE A DIFFERENCE FOR FOLKS. 5364 03:14:49,000 --> 03:14:51,720 THERE WAS A REALLY EXCELLENT 5365 03:14:51,720 --> 03:14:53,360 SYSTEMATIC REVIEW TAXONOMY THAT 5366 03:14:53,360 --> 03:14:54,880 CAME OUT THAT STARTS TO THINK 5367 03:14:54,880 --> 03:14:56,960 WHETHER THE RIGHT OUTCOMES FOR 5368 03:14:56,960 --> 03:14:58,600 MEASURING THIS WORK, SO WE HAVE 5369 03:14:58,600 --> 03:15:02,360 OFTEN MEASURED DID THEY CONTACT 5370 03:15:02,360 --> 03:15:04,600 THE SERVICE OR ORGANIZATION, DID 5371 03:15:04,600 --> 03:15:06,240 THEY CALL 211, CALL THE FOOD 5372 03:15:06,240 --> 03:15:07,320 PANTRY, SOME MEASURED WHETHER 5373 03:15:07,320 --> 03:15:09,360 THEY ENROLLED OR RECEIVED A NEW 5374 03:15:09,360 --> 03:15:10,200 SERVICE, WHETHER SOCIAL NEEDS 5375 03:15:10,200 --> 03:15:12,040 WERE ADDRESSED WHETHER THE 5376 03:15:12,040 --> 03:15:13,920 PARTICIPANT RATING OF EXPERIENCE 5377 03:15:13,920 --> 03:15:15,160 WERE THEY SATISFIED. 5378 03:15:15,160 --> 03:15:17,000 THERE IS ROOM FOR MORE WORK TO 5379 03:15:17,000 --> 03:15:18,560 BE DONE HERE ON OTHER 5380 03:15:18,560 --> 03:15:19,880 PARTICIPANT REPORTED OUTCOMES. 5381 03:15:19,880 --> 03:15:22,960 AND ALSO ON UTILIZATION AND COST 5382 03:15:22,960 --> 03:15:24,040 OUTCOMES. 5383 03:15:24,040 --> 03:15:26,480 FOLLOWING THIS KIND OF SERVICE 5384 03:15:26,480 --> 03:15:27,760 INTERVENTION. 5385 03:15:27,760 --> 03:15:29,800 ULTIMATELY WHAT I WOULD LIKE TO 5386 03:15:29,800 --> 03:15:31,680 SEE IS HOW TO EWE EMERGENCY 5387 03:15:31,680 --> 03:15:33,280 DEPARTMENT AS SAFETY NET. 5388 03:15:33,280 --> 03:15:34,760 WE THINK ABOUT WHETHER THE UNMET 5389 03:15:34,760 --> 03:15:36,840 ACCESS NEEDS, WHAT ARE THE UNMET 5390 03:15:36,840 --> 03:15:37,800 INFORMATIONAL NEEDS, UNMET 5391 03:15:37,800 --> 03:15:39,840 SOCIAL NEEDS AND THINK ABOUT ED 5392 03:15:39,840 --> 03:15:41,160 INTERVENTIONS THAT CAN ADDRESS 5393 03:15:41,160 --> 03:15:42,880 ALL OF THEM AND MEASURE THOSE 5394 03:15:42,880 --> 03:15:44,680 OUTCOMES. 5395 03:15:44,680 --> 03:15:45,320 RIGOROUSLY. 5396 03:15:45,320 --> 03:15:48,280 AS WE THINK ABOUT THOSE FEATURE 5397 03:15:48,280 --> 03:15:50,440 DIRECTIONS AROUND IDENTIFICATION 5398 03:15:50,440 --> 03:15:55,800 INTERVENTIONS AND OUTCOME, FOR 5399 03:15:55,800 --> 03:15:57,000 IDENTIFICATION IT NEEDS TO BE 5400 03:15:57,000 --> 03:15:58,280 ELECTRONIC SCALABLE AND BASED ON 5401 03:15:58,280 --> 03:15:59,760 PATIENT NEED, WE WANT TO 5402 03:15:59,760 --> 03:16:02,480 IDENTIFY PATIENTS WHO NEED 5403 03:16:02,480 --> 03:16:04,160 INPATIENT, WE WANT TO BE CAREFUL 5404 03:16:04,160 --> 03:16:05,600 ABOUT STIGMA AND ADVERSE 5405 03:16:05,600 --> 03:16:06,800 CONSEQUENCES, AS WE THINK ABOUT 5406 03:16:06,800 --> 03:16:07,920 INTERVENTIONS, WE WANTS THE MAKE 5407 03:16:07,920 --> 03:16:10,160 SURE WE HAVE UPDATED CENTRALIZED 5408 03:16:10,160 --> 03:16:10,960 INFORMATION SYSTEMS AND TRUE 5409 03:16:10,960 --> 03:16:12,120 CONNECTIONS TO RESOURCES NOT 5410 03:16:12,120 --> 03:16:14,120 JUST HAHN OUTS. 5411 03:16:14,120 --> 03:16:15,800 OUR OUTCOMES NEED TO BE USE AND 5412 03:16:15,800 --> 03:16:18,200 CHANGE BASED TO MAKE A REAL 5413 03:16:18,200 --> 03:16:19,880 DIFFERENCE DO WE GET ELECTRICITY 5414 03:16:19,880 --> 03:16:21,600 TURNED ON NOT JUST CALL THE 5415 03:16:21,600 --> 03:16:21,800 HOTLINE. 5416 03:16:21,800 --> 03:16:23,920 AND MAKING SURE WE ARE MEASURING 5417 03:16:23,920 --> 03:16:26,440 TRUE PATIENT CENTERED REPORTED 5418 03:16:26,440 --> 03:16:27,960 OUTCOMES. 5419 03:16:27,960 --> 03:16:29,200 THIS IS MY CONTACT INFORMATION 5420 03:16:29,200 --> 03:16:32,480 LOOK FORWARD TO TAKING YOUR 5421 03:16:32,480 --> 03:16:35,040 QUESTIONS DURING THE PANEL. 5422 03:16:35,040 --> 03:16:39,560 >> THANK YOU, THANK YOU ALL. 5423 03:16:39,560 --> 03:16:44,440 DR. TAYLOR AND DR. BRISTOL AND 5424 03:16:44,440 --> 03:16:46,920 DR. KALOW. 5425 03:16:46,920 --> 03:16:51,920 WE ARE GOING TO HAVE A BREAK 5426 03:16:51,920 --> 03:16:55,240 I WILL SEE YOU AT 3. 5427 03:16:55,240 --> 03:16:56,920 >> HELLO EVERYONE, WELCOME 5428 03:16:56,920 --> 03:17:01,160 BACK TO THIS AFTERNOON'S PANEL 5429 03:17:01,160 --> 03:17:01,680 DISCUSSION. 5430 03:17:01,680 --> 03:17:03,040 I'M SENIOR ASSOCIATE FOR 5431 03:17:03,040 --> 03:17:04,240 EMERGENCY NURSING RESEARCH AT 5432 03:17:04,240 --> 03:17:10,160 EMA AND ONE OF THE MEMBERS OF 5433 03:17:10,160 --> 03:17:14,280 THE PLANNING COMMITTEE FOR THE 5434 03:17:14,280 --> 03:17:14,480 EVENT. 5435 03:17:14,480 --> 03:17:16,920 DR. BILLY ROW IS A IS CO-CHIEF 5436 03:17:16,920 --> 03:17:18,720 RESEARCH FELLOW DEPARTMENT OF 5437 03:17:18,720 --> 03:17:20,440 PSYCHIATRY BEHAVIORAL SCIENCES 5438 03:17:20,440 --> 03:17:21,440 AT MEMORIAL SLOAN-KETTERING 5439 03:17:21,440 --> 03:17:21,800 CANCER CENTER. 5440 03:17:21,800 --> 03:17:23,960 AS A PREVIOUS ROBERT WOOD 5441 03:17:23,960 --> 03:17:24,800 JOHNSON FOUNDATION FUTURE OF 5442 03:17:24,800 --> 03:17:27,680 NURSING SCHOLAR AT UNIVERSITY OF 5443 03:17:27,680 --> 03:17:29,720 PENNSYLVANIA, HIS STREAMS OF 5444 03:17:29,720 --> 03:17:32,560 RESEARCH IS ON CANCER PAIN 5445 03:17:32,560 --> 03:17:36,240 DISPARITIES LGBTQ INCLUSIVE 5446 03:17:36,240 --> 03:17:37,600 PALLIATIVE CARE AND 5447 03:17:37,600 --> 03:17:38,640 PSYCHOASSISTED THERAPY IN 5448 03:17:38,640 --> 03:17:39,440 CONTEXT OF CANCER RELATED 5449 03:17:39,440 --> 03:17:39,960 STRESS. 5450 03:17:39,960 --> 03:17:43,360 DR. ROSA WAS LEAD RESEARCHER FOR 5451 03:17:43,360 --> 03:17:44,040 THE 2021 NURSES FOR HEALTH 5452 03:17:44,040 --> 03:17:46,920 EQUITY GUIDELINES FOR SOCIAL 5453 03:17:46,920 --> 03:17:48,440 DETERMINANTS OF HEALTH POLICY 5454 03:17:48,440 --> 03:17:50,800 REPORT ENDORSED BY WORLD HEALTH 5455 03:17:50,800 --> 03:17:53,200 ORGANIZATION AMONG OTHERS. 5456 03:17:53,200 --> 03:17:55,640 JOIN ME IN WELCOMING DR. ROSA. 5457 03:17:55,640 --> 03:17:56,800 >> THANK YOU SO MUCH, CAN YOU 5458 03:17:56,800 --> 03:17:57,760 HEAR ME OKAY? 5459 03:17:57,760 --> 03:17:59,040 >> YES. 5460 03:17:59,040 --> 03:18:00,240 >> WONDERFUL. 5461 03:18:00,240 --> 03:18:01,640 THANK YOU. 5462 03:18:01,640 --> 03:18:03,360 I'M REALLY HONORED TO BE HERE 5463 03:18:03,360 --> 03:18:04,720 TODAY TO MODERATE THIS 5464 03:18:04,720 --> 03:18:05,040 DISCUSSION. 5465 03:18:05,040 --> 03:18:08,080 I WANT TO START BY THANKING AND 5466 03:18:08,080 --> 03:18:11,840 ACKNOWLEDGING YVONNE BRYAN 5467 03:18:11,840 --> 03:18:14,280 ROBBIE DA AND TANYA STRAUGHT, 5468 03:18:14,280 --> 03:18:15,320 THE REST OF THE PLANNING 5469 03:18:15,320 --> 03:18:16,320 COMMITTEE TEAM WHO I DID NOT 5470 03:18:16,320 --> 03:18:18,400 MENTION BY NAME, JUST SUCH AN 5471 03:18:18,400 --> 03:18:19,800 INCREDIBLE AMOUNT OF WORK AND 5472 03:18:19,800 --> 03:18:21,240 PASSION THAT WENT ON BEHIND THE 5473 03:18:21,240 --> 03:18:22,640 SCIENCE OF THIS PROGRAM SO MY 5474 03:18:22,640 --> 03:18:26,560 HAT IS OFF TO YOU. 5475 03:18:26,560 --> 03:18:26,960 THANK YOU SO MUCH. 5476 03:18:26,960 --> 03:18:28,840 I'M SPYING TO YOU FROM THE 5477 03:18:28,840 --> 03:18:30,440 ANCESTRAL LANDS OF THE -- PEOPLE 5478 03:18:30,440 --> 03:18:32,440 MORE BROADLY KNOWN TODAY AS NEW 5479 03:18:32,440 --> 03:18:32,800 YORK CITY. 5480 03:18:32,800 --> 03:18:34,920 AND SO I WANT TO ACKNOWLEDGE AND 5481 03:18:34,920 --> 03:18:37,640 HONOR DIVERSE AND VIBRANT 5482 03:18:37,640 --> 03:18:39,320 INDIGENOUS PEOPLE'S AND 5483 03:18:39,320 --> 03:18:40,760 TRADITIONS THAT INHABIT THIS 5484 03:18:40,760 --> 03:18:41,040 LAND TODAY. 5485 03:18:41,040 --> 03:18:42,440 I ALSO THINK IT IS REALLY 5486 03:18:42,440 --> 03:18:44,240 IMPORTANT TO DISCLOSE MY OWN 5487 03:18:44,240 --> 03:18:45,640 SOCIAL LOCATION AS I COME TO YOU 5488 03:18:45,640 --> 03:18:47,520 TO MODERATE THIS DISCUSSION ON 5489 03:18:47,520 --> 03:18:50,240 THE SOCIAL DETERMINANTS OF 5490 03:18:50,240 --> 03:18:51,200 HEALTH AND HEALTH EQUITY. 5491 03:18:51,200 --> 03:18:53,240 SO I COME TO YOU AT THE 5492 03:18:53,240 --> 03:18:54,600 INTERSECTION OF MULTIPLE 5493 03:18:54,600 --> 03:18:56,520 IDENTITIES, OF HISTORICAL 5494 03:18:56,520 --> 03:18:59,280 PRIVILEGE, BEING WHITE, BEING A 5495 03:18:59,280 --> 03:19:01,520 CIS GENDERED MAN HIGHLY EDUCATED 5496 03:19:01,520 --> 03:19:02,600 HOUSING AND FOOD SECURE AND 5497 03:19:02,600 --> 03:19:05,080 SOMEBODY WHO IS PHYSICALLY WELL 5498 03:19:05,080 --> 03:19:05,440 ABLED. 5499 03:19:05,440 --> 03:19:07,760 AND ALSO SOME IDENTITIES OF 5500 03:19:07,760 --> 03:19:08,880 HISTORICAL EXCLUSION IDENTIFYING 5501 03:19:08,880 --> 03:19:11,240 AS A GAY PERSON, AS A FIRST 5502 03:19:11,240 --> 03:19:12,440 GENERATION COLLEGE STUDENT AND 5503 03:19:12,440 --> 03:19:16,920 AS THE DESCENDENT OF IMMIGRANT 5504 03:19:16,920 --> 03:19:17,400 ANCESTORS. 5505 03:19:17,400 --> 03:19:19,320 SO AGAIN AND AGAIN TODAY I HAVE 5506 03:19:19,320 --> 03:19:21,920 BEEN REMINDED OF DR. PAUL FARMER 5507 03:19:21,920 --> 03:19:23,320 MANY OF YOU PROBABLY KNOW WE 5508 03:19:23,320 --> 03:19:25,600 LOST A TREMENDOUS GIANT IN THE 5509 03:19:25,600 --> 03:19:27,160 GLOBAL HEALTH FIELD LAST WEEK, 5510 03:19:27,160 --> 03:19:28,640 DR. PAUL FARMER WHO FOUNDED 5511 03:19:28,640 --> 03:19:30,600 PARTNERS IN HELP AND HE WAS A 5512 03:19:30,600 --> 03:19:32,600 TREMENDOUS SOCIAL JUSTICE 5513 03:19:32,600 --> 03:19:33,640 ADVOCATE. 5514 03:19:33,640 --> 03:19:38,400 AND HE ASKED THIS QUESTION, IF 5515 03:19:38,400 --> 03:19:39,120 ACCESS TO HEALTHCARE IS 5516 03:19:39,120 --> 03:19:42,040 CONSIDERED A HUMAN RIGHT, WHO IS 5517 03:19:42,040 --> 03:19:44,560 CONSIDERED HUMAN ENOUGH TO HAVE 5518 03:19:44,560 --> 03:19:45,040 THAT RIGHT. 5519 03:19:45,040 --> 03:19:46,640 IF ACCESS TO HEALTHCARE IS 5520 03:19:46,640 --> 03:19:50,400 CONSIDERED A HUMAN RIGHT, WHO IS 5521 03:19:50,400 --> 03:19:51,280 CONSIDERED HUMAN ENOUGH TO HAVE 5522 03:19:51,280 --> 03:19:51,840 THAT RIGHT. 5523 03:19:51,840 --> 03:19:55,280 SO I HAVE BEEN SO MOVED TODAY BY 5524 03:19:55,280 --> 03:19:57,080 INNOVATIVE METHODS AND APPROACH 5525 03:19:57,080 --> 03:19:57,720 THAT HAVE BEEN EMPLOYEDD BY 5526 03:19:57,720 --> 03:20:00,120 THESE RESEARCHERS TO ADVANCE 5527 03:20:00,120 --> 03:20:02,040 EQUITY AND INCLUSION AND REALLY 5528 03:20:02,040 --> 03:20:03,960 TACKLE THE SOCIAL DETERMINANTS 5529 03:20:03,960 --> 03:20:05,800 OF HEALTH WITH SUCH RIGOR AND 5530 03:20:05,800 --> 03:20:07,600 FOR ME AS NURSE BY BACKGROUND 5531 03:20:07,600 --> 03:20:09,400 THIS SCIENCE REALLY SPOKE TO THE 5532 03:20:09,400 --> 03:20:11,920 WAYS THAT NURSES AND OTHER 5533 03:20:11,920 --> 03:20:14,280 HEALTH WORKERS CAN FULFILL THEIR 5534 03:20:14,280 --> 03:20:16,880 ETHICAL OBLIGATION TO ATTEND TO 5535 03:20:16,880 --> 03:20:17,840 THE HUMAN CONDITION AT 5536 03:20:17,840 --> 03:20:20,080 INDIVIDUAL, POPULATION, PUBLIC 5537 03:20:20,080 --> 03:20:22,080 HEALTH LEVELS IN A MORE HOLISTIC 5538 03:20:22,080 --> 03:20:24,120 AND SOCIALLY CONSCIOUS WAY. 5539 03:20:24,120 --> 03:20:25,760 SO I'M GRATEFUL. 5540 03:20:25,760 --> 03:20:27,360 I THOUGHT IT WOULD BE HELPFUL TO 5541 03:20:27,360 --> 03:20:29,240 START WITH A BRIEF OVERVIEW 5542 03:20:29,240 --> 03:20:31,920 WHERE WE HAVE BEEN DURING THIS 5543 03:20:31,920 --> 03:20:32,600 ROUND TABLE. 5544 03:20:32,600 --> 03:20:34,680 AS RESEARCHERS HAVE MAPPED OUT 5545 03:20:34,680 --> 03:20:37,720 THIS INCREDIBLE CARTOGRAPHY OF 5546 03:20:37,720 --> 03:20:38,920 SOCIAL DETERMINANTS IN CONTEXT 5547 03:20:38,920 --> 03:20:40,440 OF ED CARE. 5548 03:20:40,440 --> 03:20:42,400 SO YESTERDAY OF COURSE DR. RENEE 5549 03:20:42,400 --> 03:20:44,520 SHAW STARTED US OFF TALKING 5550 03:20:44,520 --> 03:20:46,040 ABOUT THE STRUCTURAL SICKNESS OF 5551 03:20:46,040 --> 03:20:51,240 INEQUITY IN OUR ED CARE SYSTEM. 5552 03:20:51,240 --> 03:20:52,040 REALLY POKING HOLES IN THE 5553 03:20:52,040 --> 03:20:53,360 NOTION ARISING TIDE LIFTS ALL 5554 03:20:53,360 --> 03:20:55,160 BOATS WHICH IS GREAT NEWS IF YOU 5555 03:20:55,160 --> 03:20:58,480 HAPPEN TO HAVE A BOAT. 5556 03:20:58,480 --> 03:21:00,120 DR. CAROL DEFRANCIS TODAY GAVE 5557 03:21:00,120 --> 03:21:02,040 AN OVERVIEW OF ED VISITS IN THE 5558 03:21:02,040 --> 03:21:03,680 U.S. STRATIFYING VISITS BY 5559 03:21:03,680 --> 03:21:07,360 NUMBER OF VARIABLES AGE, RACE 5560 03:21:07,360 --> 03:21:07,960 ETHNICITY GEOGRAPHY INSURANCE 5561 03:21:07,960 --> 03:21:08,800 TYPE AND SO ON. 5562 03:21:08,800 --> 03:21:11,680 WE HEARD FROM DR.S WALLACE, 5563 03:21:11,680 --> 03:21:14,160 DEMARCUS AND BILL LACK ABOUT 5564 03:21:14,160 --> 03:21:14,960 ADDRESSING SPECIFIC SOCIAL NEEDS 5565 03:21:14,960 --> 03:21:17,240 TO PROVIDE CONTEXTUALIZED PERSON 5566 03:21:17,240 --> 03:21:18,640 FOCUSED CARE IN ED. 5567 03:21:18,640 --> 03:21:20,800 DR. VEST MCCARTHY AND MONTGOMERY 5568 03:21:20,800 --> 03:21:22,040 TALKED SOCIAL DETERMINANTS OF 5569 03:21:22,040 --> 03:21:24,440 HEALTH AND ED UTILIZATION WITH 5570 03:21:24,440 --> 03:21:27,080 DISCUSSION OF SOCIAL RISK IN THE 5571 03:21:27,080 --> 03:21:27,240 ED. 5572 03:21:27,240 --> 03:21:30,400 AND THEN WE HEARD FROM DR.S 5573 03:21:30,400 --> 03:21:32,000 TAYLOR BRISTOL AND SAMUELS KALOW 5574 03:21:32,000 --> 03:21:33,440 ON THE INTERPLAY OF ED AND 5575 03:21:33,440 --> 03:21:35,320 COMMUNITY RESOURCES IN 5576 03:21:35,320 --> 03:21:36,440 TRANSITIONAL CARE. 5577 03:21:36,440 --> 03:21:42,640 OF COURSE DR. SHANNON ZINK SET 5578 03:21:42,640 --> 03:21:44,320 THIS INTO MOTION WITH THE ISSUES 5579 03:21:44,320 --> 03:21:46,320 AND SCIENCE TODAY DIRECTLY 5580 03:21:46,320 --> 03:21:48,160 ADVANCES THE STRATEGIC PLAN OF 5581 03:21:48,160 --> 03:21:50,640 NINR AND LARGER NIH COMMUNITY. 5582 03:21:50,640 --> 03:21:53,480 SO I'M GOING TO GO BACK AND 5583 03:21:53,480 --> 03:21:54,480 FORTH BETWEEN SOME GENERAL 5584 03:21:54,480 --> 03:21:57,720 QUESTIONS FOR OUR PANEL AND SOME 5585 03:21:57,720 --> 03:21:59,360 VERY SPECIFIC QUESTIONS FOR 5586 03:21:59,360 --> 03:22:00,400 INDIVIDUAL PRESENTERS. 5587 03:22:00,400 --> 03:22:02,640 THE FIRST QUESTION IS A LITTLE 5588 03:22:02,640 --> 03:22:03,240 MORE GENERAL. 5589 03:22:03,240 --> 03:22:05,840 I DO INVITE ANY PRESENTERS FROM 5590 03:22:05,840 --> 03:22:08,000 TODAY TO JUMP IN. 5591 03:22:08,000 --> 03:22:08,960 IT IS IN REFERENCE TO SOMETHING 5592 03:22:08,960 --> 03:22:10,000 DR. SHAW SAID YESTERDAY. 5593 03:22:10,000 --> 03:22:13,840 SHE NOTED THAT EVEN THE BEST 5594 03:22:13,840 --> 03:22:15,040 INTENTIONS TO HEAL SICK HEALTH 5595 03:22:15,040 --> 03:22:18,000 SYSTEM CAN WIDEN GAPS BETWEEN 5596 03:22:18,000 --> 03:22:21,480 ADVANTAGE AND DISADVANTAGED IN 5597 03:22:21,480 --> 03:22:21,800 OUR SOCIETY. 5598 03:22:21,800 --> 03:22:24,040 I WOULD LIKE TO HEAR FROM OUR 5599 03:22:24,040 --> 03:22:25,240 PRESENTERS SOME OF THE TANGIBLE 5600 03:22:25,240 --> 03:22:28,040 STEPS WE CAN TAKE AS RESEARCHERS 5601 03:22:28,040 --> 03:22:29,360 PARTICULARLY THOSE OF US 5602 03:22:29,360 --> 03:22:31,200 PARTNERING WITH COMMUNITY AND 5603 03:22:31,200 --> 03:22:31,680 CLINICIAN STAKEHOLDERS. 5604 03:22:31,680 --> 03:22:34,320 TO ENSURE THAT WE DON'T 5605 03:22:34,320 --> 03:22:50,600 CONTRIBUTE TO WIDENING THIS GAP. 5606 03:22:50,600 --> 03:22:53,160 I SEE ANDREA WALLACE, GO AHEAD. 5607 03:22:53,160 --> 03:22:54,120 DISBELIEFSN'T SURE IF I SHOULD 5608 03:22:54,120 --> 03:22:57,800 RAISE MY HAND. 5609 03:22:57,800 --> 03:23:00,040 I THINK FROM -- AS YOU HEARD 5610 03:23:00,040 --> 03:23:02,000 FROM OUR PRESENTATION I THINK IT 5611 03:23:02,000 --> 03:23:04,560 IS REALLY BEING SENSITIVE AND 5612 03:23:04,560 --> 03:23:07,960 AWARE OF HOW WE ARE APPROACHING 5613 03:23:07,960 --> 03:23:10,040 PATIENTS AND THAT WE JUST AREN'T 5614 03:23:10,040 --> 03:23:13,760 REINFORCING STEREOTYPES, THAT WE 5615 03:23:13,760 --> 03:23:17,000 ARE REINFORCING INEQUITIES. 5616 03:23:17,000 --> 03:23:19,240 I MEAN, THE PATIENTS WE TALK TO 5617 03:23:19,240 --> 03:23:21,240 ABOUT THIS, THEY ARE OPEN TO IT 5618 03:23:21,240 --> 03:23:24,480 BUT IT IS -- IT IS -- MET WITH 5619 03:23:24,480 --> 03:23:26,120 SUSPICIONS AND CONCERNS OF 5620 03:23:26,120 --> 03:23:27,360 PRIVACY, AND OF COURSE THAT'S 5621 03:23:27,360 --> 03:23:32,640 GOING TO JUST BE MAGNIFIED 5622 03:23:32,640 --> 03:23:33,960 DIFFERENT THAT HAVE HAD NEGATIVE 5623 03:23:33,960 --> 03:23:36,400 EXPERIENCES IN OUR HEALTHCARE 5624 03:23:36,400 --> 03:23:38,240 SYSTEM AND DISTRUST. 5625 03:23:38,240 --> 03:23:41,600 I THINK THAT THAT IS -- WITH 5626 03:23:41,600 --> 03:23:42,600 THAT AWARENESS AND ACCOUNTING 5627 03:23:42,600 --> 03:23:44,400 FOR DISTRUST, I'M REALLY 5628 03:23:44,400 --> 03:23:47,000 INSPIRED BY THE WORK OF THIS -- 5629 03:23:47,000 --> 03:23:48,160 OF EVERYONE I HEARD FROM TODAY 5630 03:23:48,160 --> 03:23:50,280 THAT REALLY EMPHASIZES THAT AND 5631 03:23:50,280 --> 03:23:51,680 UNDERSTAND THAT MORE DEEPLY AND 5632 03:23:51,680 --> 03:23:54,640 THE WORK THAT WE ARE DOING WITH 5633 03:23:54,640 --> 03:23:54,960 PATIENTS. 5634 03:23:54,960 --> 03:23:56,240 >> GREAT. 5635 03:23:56,240 --> 03:23:56,800 THANK YOU. 5636 03:23:56,800 --> 03:24:00,120 DR. DEMARCUS YOU MUST HAVE A 5637 03:24:00,120 --> 03:24:01,280 CRYSTAL BALL BECAUSE IT WAS -- I 5638 03:24:01,280 --> 03:24:02,640 WAS ABOUT TO ASK FOR YOUR 5639 03:24:02,640 --> 03:24:04,200 INSIGHTS ON THAT AS WELL. 5640 03:24:04,200 --> 03:24:05,800 >> THANK YOU FOR THE GREAT 5641 03:24:05,800 --> 03:24:08,480 QUESTION AND I AGREE WITH DR. 5642 03:24:08,480 --> 03:24:10,880 WALLACE, 100%. 5643 03:24:10,880 --> 03:24:13,680 I THINK ALSO HOW WE ANALYZE AND 5644 03:24:13,680 --> 03:24:16,280 COLLECT THE DATA WE ARE GAIN OF 5645 03:24:16,280 --> 03:24:17,800 RESEARCH -- THE DATA ON, WHAT WE 5646 03:24:17,800 --> 03:24:19,600 WERE DOING I THINK IS REALLY 5647 03:24:19,600 --> 03:24:20,000 IMPORTANT. 5648 03:24:20,000 --> 03:24:21,600 WE HAVE BEEN WORKING WITH SOME 5649 03:24:21,600 --> 03:24:24,560 PRIMARY CARE SETTINGS WHO HAVE 5650 03:24:24,560 --> 03:24:26,640 BEEN TELLING US WE SCREEN 5651 03:24:26,640 --> 03:24:29,200 EVERYONE THE SAME, RESOURCES THE 5652 03:24:29,200 --> 03:24:30,760 SAME BUT WE ARE LOOKING AT OTHER 5653 03:24:30,760 --> 03:24:32,040 DATA AND FINDING THERE ARE 5654 03:24:32,040 --> 03:24:33,760 ACTUALLY DIFFERENCES IN WHO IS 5655 03:24:33,760 --> 03:24:37,800 GETTING SCREENED RELATED TO 5656 03:24:37,800 --> 03:24:38,840 LANGUAGE RACE ETHNICITY AND SOME 5657 03:24:38,840 --> 03:24:40,160 PART RELATED TO PATIENTS WITH 5658 03:24:40,160 --> 03:24:41,200 INTEREST AND ENGAGEMENT WHICH 5659 03:24:41,200 --> 03:24:43,440 COULD BE RELATED TO WHAT DR. 5660 03:24:43,440 --> 03:24:45,160 WALLACE NOTED TOO, HISTORICAL 5661 03:24:45,160 --> 03:24:46,760 TRAUMA EXPERIENCES CURRENT 5662 03:24:46,760 --> 03:24:48,000 EXPERIENCES WITH THE HEALTHCARE 5663 03:24:48,000 --> 03:24:48,240 SYSTEMS. 5664 03:24:48,240 --> 03:24:49,480 BUT I THINK IT IS REALLY 5665 03:24:49,480 --> 03:24:51,000 IMPORTANT THAT WE ARE TRACKING 5666 03:24:51,000 --> 03:24:52,440 THAT DATA ACTUALLY LOOKING AT 5667 03:24:52,440 --> 03:24:53,920 THE IMPACT ON EQUITY. 5668 03:24:53,920 --> 03:24:56,040 WITH THE WORK THAT WE ARE DOING 5669 03:24:56,040 --> 03:24:57,240 SO WE CAN MAKE SURE WHICH ARE 5670 03:24:57,240 --> 03:24:59,120 NOT WIDENING DISPARITIES AND 5671 03:24:59,120 --> 03:25:00,440 IDEALLY CLOSING THE GAPS WE ARE 5672 03:25:00,440 --> 03:25:02,960 SEEKING TO DO WITH THIS WORK. 5673 03:25:02,960 --> 03:25:04,520 >> THANK YOU. 5674 03:25:04,520 --> 03:25:05,800 THAT LENDS ITSELF TO SPECIFIC 5675 03:25:05,800 --> 03:25:07,480 QUESTION I HAD FOR BOTH YOU AND 5676 03:25:07,480 --> 03:25:10,080 DR. WALLACE. 5677 03:25:10,080 --> 03:25:11,160 YOU BOTH GAVE REFERENCE IN THE 5678 03:25:11,160 --> 03:25:13,400 CHAT TO ASKING QUESTIONS ABOUT 5679 03:25:13,400 --> 03:25:15,040 PRIOR EXPERIENCES OF 5680 03:25:15,040 --> 03:25:17,120 DISCRIMINATION AND HEALTHCARE 5681 03:25:17,120 --> 03:25:17,400 SETTINGS. 5682 03:25:17,400 --> 03:25:18,720 DO YOU HAVE RECOMMENDATIONS TO 5683 03:25:18,720 --> 03:25:20,240 SUPPORT RESEARCHERS AND HAVING 5684 03:25:20,240 --> 03:25:22,640 THESE CONVERSATIONS WITH 5685 03:25:22,640 --> 03:25:23,240 RESEARCH PARTICIPANTS? 5686 03:25:23,240 --> 03:25:26,440 I'M PARTICULARLY CURIOUS BECAUSE 5687 03:25:26,440 --> 03:25:28,120 EXPERIENCE IS OF PRIOR 5688 03:25:28,120 --> 03:25:31,360 DISCRIMINATION ARE COUPLED WITH 5689 03:25:31,360 --> 03:25:34,960 TRAUMA OF REJECTION OR RACISM OR 5690 03:25:34,960 --> 03:25:35,400 DISENFRANCHISEMENT. 5691 03:25:35,400 --> 03:25:38,400 HOW DO WE ELICIT THAT 5692 03:25:38,400 --> 03:25:40,760 INFORMATION AND EMPATHETIC AND 5693 03:25:40,760 --> 03:25:42,000 SUPPORTIVE WAY THAT AVOIDS HARM 5694 03:25:42,000 --> 03:25:43,440 AND MAY ACTUALLY BE ENCOURAGING 5695 03:25:43,440 --> 03:25:49,840 AND HEALING FOR PARTICIPANTS? 5696 03:25:49,840 --> 03:25:53,080 >> I CAN JUMP IN, NOT SURE IF I 5697 03:25:53,080 --> 03:25:54,080 HAVE SPECIFIC RECOMMENDATIONS, 5698 03:25:54,080 --> 03:25:57,440 WE ARE TAKING -- WE ARE 5699 03:25:57,440 --> 03:25:58,960 CONSIDERING THAT IN OUR 5700 03:25:58,960 --> 03:26:00,040 LONGITUDINAL STUDY WHERE WE HAVE 5701 03:26:00,040 --> 03:26:01,680 PATIENTS ENGAGED WITH US. 5702 03:26:01,680 --> 03:26:04,440 SO I FEEL LIKE WE CAN ASK THOSE 5703 03:26:04,440 --> 03:26:05,760 QUESTIONS AND APPROACH THAT. 5704 03:26:05,760 --> 03:26:09,120 BUT IT IS AN AREA, INTERESTINGLY 5705 03:26:09,120 --> 03:26:10,560 ENOUGH IN OUR CURRENT STUDY WE 5706 03:26:10,560 --> 03:26:12,440 ARE SEEING A GREAT DEAL MORE 5707 03:26:12,440 --> 03:26:14,360 ENGAGEMENT OF PATIENTS WHO ARE 5708 03:26:14,360 --> 03:26:16,000 SPANISH SPEAKERS. 5709 03:26:16,000 --> 03:26:18,640 SO WE WANT TO DELVE INTO THAT 5710 03:26:18,640 --> 03:26:22,240 MORE IN TERMS OF DIFFERENCES IN 5711 03:26:22,240 --> 03:26:24,680 THE SCREENING, THE ANSWERS EARLY 5712 03:26:24,680 --> 03:26:26,240 ON IN THE STUDY BUT ONCE THEY 5713 03:26:26,240 --> 03:26:28,880 GET IN AND CONNECTED WITH US, WE 5714 03:26:28,880 --> 03:26:29,920 ARE ACTUALLY SEEING MORE 5715 03:26:29,920 --> 03:26:32,560 CONNECTION WITH THE COMMUNITY 5716 03:26:32,560 --> 03:26:33,960 BASED SERVICES. 5717 03:26:33,960 --> 03:26:35,160 I DON'T KNOW IF THAT IS 5718 03:26:35,160 --> 03:26:35,680 ANSWERING YOUR QUESTION. 5719 03:26:35,680 --> 03:26:38,880 BUT I THINK IT IS -- I WORK WITH 5720 03:26:38,880 --> 03:26:43,360 AMAZING QUALITATIVE 5721 03:26:43,360 --> 03:26:44,240 INVESTIGATORS WITH RE-ENGAGEMENT 5722 03:26:44,240 --> 03:26:45,600 FOLKS AND TRYING TO MAKE SURE 5723 03:26:45,600 --> 03:26:49,120 THAT OUR WORK IS GROUNDED IN 5724 03:26:49,120 --> 03:26:52,240 GOOD BEST PRACTICES. 5725 03:26:52,240 --> 03:26:52,800 WITH THAT. 5726 03:26:52,800 --> 03:26:54,160 I DON'T KNOW IF THAT ANSWERS 5727 03:26:54,160 --> 03:26:54,480 ANYTHING. 5728 03:26:54,480 --> 03:26:55,240 >> GREAT. 5729 03:26:55,240 --> 03:26:57,360 >> MAYBE MOLLY HAS SOMETHING 5730 03:26:57,360 --> 03:26:57,880 MORE. 5731 03:26:57,880 --> 03:26:59,920 >> TO ADD TO THAT I THINK THAT 5732 03:26:59,920 --> 03:27:01,640 THERE IS A LOT WE CAN LEARN FROM 5733 03:27:01,640 --> 03:27:05,040 TRAUMA INFORMED CARE APPROACHES 5734 03:27:05,040 --> 03:27:07,640 EMPATHETIC INQUIRY AND WE HAVE 5735 03:27:07,640 --> 03:27:09,200 SEEN IN RECENT VARIES WITH 5736 03:27:09,200 --> 03:27:11,280 PERMISSIONS THEY FIND THOSE 5737 03:27:11,280 --> 03:27:12,400 TRAININGS HELPFUL. 5738 03:27:12,400 --> 03:27:15,960 AND STAFF AS WELL CALLED WARRANT 5739 03:27:15,960 --> 03:27:17,600 COULD CULTURALLY APPROPRIATE 5740 03:27:17,600 --> 03:27:18,280 TRAINING SO EQUIPPING THE STAFF 5741 03:27:18,280 --> 03:27:20,280 WHO WILL BE DOING THIS WORK WITH 5742 03:27:20,280 --> 03:27:23,640 THE TOOLS THEY NEED TO TALK WITH 5743 03:27:23,640 --> 03:27:24,560 PATIENTS FEEL COMFORTABLE 5744 03:27:24,560 --> 03:27:26,040 TALKING WITH PATIENTS AND MAKING 5745 03:27:26,040 --> 03:27:28,800 SURE RESOURCES ARE AVAILABLE 5746 03:27:28,800 --> 03:27:30,320 DIFFERENTLY WHICH IS -- BECAUSE 5747 03:27:30,320 --> 03:27:32,240 WE -- IT SEEMS LIKE ONE THING 5748 03:27:32,240 --> 03:27:33,680 THAT IS CREATING BARRIERS IS 5749 03:27:33,680 --> 03:27:35,440 WHEN RESOURCES AND INTERPRETERS 5750 03:27:35,440 --> 03:27:37,080 AREN'T ALWAYS AVAILABLE SO 5751 03:27:37,080 --> 03:27:38,040 PATIENTS AREN'T GETTING 5752 03:27:38,040 --> 03:27:39,200 SCREENING AND ACTIVITY IT IS 5753 03:27:39,200 --> 03:27:41,320 SAME WAY THEY ENGLISH OR SPANISH 5754 03:27:41,320 --> 03:27:42,800 SPEAKING COUNTER PARTS MAY BE SO 5755 03:27:42,800 --> 03:27:44,600 THERE IS A LOT WE CAN PULL FROM 5756 03:27:44,600 --> 03:27:46,960 WORK DONE IN OTHER AREAS AND 5757 03:27:46,960 --> 03:27:48,040 THEN INTERPERSONAL VIOLENCE 5758 03:27:48,040 --> 03:27:50,560 REALM THAT HAS APPLICANT HERE AS 5759 03:27:50,560 --> 03:27:51,320 WELL. 5760 03:27:51,320 --> 03:27:52,240 >> WONTFUL. 5761 03:27:52,240 --> 03:27:55,640 THANK YOU SO MUCH P. ANOTHER 5762 03:27:55,640 --> 03:27:56,040 GENERAL QUESTION. 5763 03:27:56,040 --> 03:27:57,800 TO THE GROUP OF PRESENTERS 5764 03:27:57,800 --> 03:27:59,960 TODAY. 5765 03:27:59,960 --> 03:28:03,760 THIS IS FROM DR. YES, SIR IS A 5766 03:28:03,760 --> 03:28:05,800 HENESY, SORRY IF I MISPRONOUNCED 5767 03:28:05,800 --> 03:28:07,080 YOUR LAST NAME BUT BASED ON THE 5768 03:28:07,080 --> 03:28:08,640 DATA SHARED THROUGHOUT THE TALKS 5769 03:28:08,640 --> 03:28:10,720 AND LITERATURE WE KNOW 5770 03:28:10,720 --> 03:28:12,720 DISPARITIES IN ED POPULATIONS 5771 03:28:12,720 --> 03:28:13,800 ARE EVIDENT SO RECOGNIZING THERE 5772 03:28:13,800 --> 03:28:15,320 ARE UNDERLYING STRUCTURAL 5773 03:28:15,320 --> 03:28:18,320 INEQUITIES AND TOTAL REFORM IS 5774 03:28:18,320 --> 03:28:20,200 RECOMMENDED, AS DR. SHAW 5775 03:28:20,200 --> 03:28:22,360 RECOMMENDED, WHERE DOES ONE 5776 03:28:22,360 --> 03:28:22,840 START? 5777 03:28:22,840 --> 03:28:25,720 ARE MORE DESCRIPTIVE STUDIES 5778 03:28:25,720 --> 03:28:28,520 NEEDED AND/OR HOW DO WE MOVE 5779 03:28:28,520 --> 03:28:29,000 TOWARDS INTERVENTION. 5780 03:28:29,000 --> 03:28:31,640 WHAT CAN WE DO GIVEN HOW COMPLEX 5781 03:28:31,640 --> 03:28:33,440 EMBEDDED THE ISSUES ARE IN OUR 5782 03:28:33,440 --> 03:28:38,760 COMMUNITY AND IN OUR COUNTRY? 5783 03:28:38,760 --> 03:28:50,560 ANY OF THE SPEAKERS CAN JUMP IN. 5784 03:28:50,560 --> 03:28:55,440 DR. SAMUEL SAMUELS KALOW. 5785 03:28:55,440 --> 03:28:56,680 >> GREAT QUESTION. 5786 03:28:56,680 --> 03:28:58,680 I THINK YOU TOUCH ON A REALLY 5787 03:28:58,680 --> 03:29:01,400 IMPORTANT POINT WHICH IS THAT 5788 03:29:01,400 --> 03:29:02,880 WHILE DESCRIPTIVE WORK REMAINS 5789 03:29:02,880 --> 03:29:03,640 REALLY IMPORTANT YOU HAVE HEARD 5790 03:29:03,640 --> 03:29:06,040 A LOT OF US TALK ABOUT THIS 5791 03:29:06,040 --> 03:29:08,200 FEELING THAT WE NEED TO DO MORE. 5792 03:29:08,200 --> 03:29:13,040 THAT WE HAVE -- WE ARE AS NEAR 5793 03:29:13,040 --> 03:29:14,000 AS EPIDEMIOLOGY AROUND 5794 03:29:14,000 --> 03:29:15,360 DISPARITIES AND I THINK THE 5795 03:29:15,360 --> 03:29:17,440 QUESTION OF WHAT WE CAN DO IS 5796 03:29:17,440 --> 03:29:20,440 STARTING TO BE DEFINED. 5797 03:29:20,440 --> 03:29:23,800 YOU HAVE HEARD WORK FROM PEOPLE 5798 03:29:23,800 --> 03:29:26,560 TALKING ABOUT DIFFERENT 5799 03:29:26,560 --> 03:29:29,280 STRATEGIES, FOR STARTING TO 5800 03:29:29,280 --> 03:29:30,600 IDENTIFY EMERGENCY DEPARTMENT 5801 03:29:30,600 --> 03:29:32,280 SOCIAL NEEDS IN REALLY 5802 03:29:32,280 --> 03:29:34,680 SYSTEMATIC WAYS. 5803 03:29:34,680 --> 03:29:37,240 ENORMOUS VOLUMES OF FOLKS SCREEN 5804 03:29:37,240 --> 03:29:39,360 IN UTAH, FOLKS HAVE DONE AMAZING 5805 03:29:39,360 --> 03:29:41,200 MULTI-CENTER WORK, WE DEVELOPED 5806 03:29:41,200 --> 03:29:43,120 A SHORT FORM READER THAT IS EASY 5807 03:29:43,120 --> 03:29:44,760 IF YOU DON'T HAVE A TOP OF 5808 03:29:44,760 --> 03:29:45,800 RESOURCES TO PUT INTO IT SO 5809 03:29:45,800 --> 03:29:48,000 THERE'S WAYS TO THINK HOW THIS 5810 03:29:48,000 --> 03:29:49,080 CAN BE DONE DEPENDING ON 5811 03:29:49,080 --> 03:29:50,440 RESOURCES OF YOUR SETTING. 5812 03:29:50,440 --> 03:29:53,240 TO START TO THINK ABOUT WHAT 5813 03:29:53,240 --> 03:29:55,880 OPPORTUNITIES YOU HAVE IN YOUR 5814 03:29:55,880 --> 03:29:58,560 STUDY TO THINK ABOUT WHAT ARE 5815 03:29:58,560 --> 03:29:59,640 THE NEEDS YOUR PATIENT 5816 03:29:59,640 --> 03:30:01,320 POPULATION IS PRESENTING WITH, 5817 03:30:01,320 --> 03:30:03,240 AND WHAT ARE THE COMMUNITY 5818 03:30:03,240 --> 03:30:06,560 RESOURCES THAT YOU CAN START TO 5819 03:30:06,560 --> 03:30:07,640 MANAGE WITH THOSE NEEDS. 5820 03:30:07,640 --> 03:30:09,040 IT IS EASY TO START TO GET 5821 03:30:09,040 --> 03:30:10,560 OVERWHELMED BY THINKING ABOUT 5822 03:30:10,560 --> 03:30:12,400 THE NEEDS ARE OVERWHELMING AND 5823 03:30:12,400 --> 03:30:13,960 THERE ARE HUNDREDS OF THEM. 5824 03:30:13,960 --> 03:30:15,360 SO I WOULD ENCOURAGE YOU TO 5825 03:30:15,360 --> 03:30:16,240 THINK ABOUT MAYBE STARTING WITH 5826 03:30:16,240 --> 03:30:19,800 A RELATIVELY SMALLER SET OF 5827 03:30:19,800 --> 03:30:22,840 TRACTABLE ONES AND STARTING TO 5828 03:30:22,840 --> 03:30:24,440 BUILD FRAMEWORK FOR OH WE NOW 5829 03:30:24,440 --> 03:30:26,520 HAVE DONE A GOOD JOB WITH THIS 5830 03:30:26,520 --> 03:30:27,920 ONE NOW WE CAN MIX INTO ANOTHER 5831 03:30:27,920 --> 03:30:30,720 AND START TO GROW UPWARD FROM 5832 03:30:30,720 --> 03:30:31,320 THERE. 5833 03:30:31,320 --> 03:30:32,600 THIS IS A MOMENT WHERE STARTING 5834 03:30:32,600 --> 03:30:34,120 TO GIVE OUT ED BASED 5835 03:30:34,120 --> 03:30:38,600 INTERVENTIONS IS REALLY POSSIBLE 5836 03:30:38,600 --> 03:30:40,520 AND FEASIBLE. 5837 03:30:40,520 --> 03:30:41,960 >> WHILE I HAVE YOU HEAR THERE 5838 03:30:41,960 --> 03:30:43,400 WAS A SPECIFIC QUESTION FOR YOU 5839 03:30:43,400 --> 03:30:45,600 AND YOUR WORK. 5840 03:30:45,600 --> 03:30:46,880 NOT SURE WHO THIS CAME FROM BUT 5841 03:30:46,880 --> 03:30:49,240 THE QUESTION WAS HOW DO YOU 5842 03:30:49,240 --> 03:30:51,000 THOUGHT ABOUT SOME APP PATIENTS 5843 03:30:51,000 --> 03:30:52,240 WITH PHONES CAN DOWNLOAD THAT 5844 03:30:52,240 --> 03:30:54,720 CAN PROVIDE EDUCATION, 5845 03:30:54,720 --> 03:30:55,400 RESOURCES, ET CETERA TO PATIENTS 5846 03:30:55,400 --> 03:30:57,440 AT ANY TIME, THIS COULD BE 5847 03:30:57,440 --> 03:30:58,800 UPDATED RESOURCES COULD BE 5848 03:30:58,800 --> 03:30:59,680 ADDED, ET CETERA. 5849 03:30:59,680 --> 03:31:00,800 AND YOU CAN ALSO RECEIVE 5850 03:31:00,800 --> 03:31:03,360 FEEDBACK THROUGH BRIEF SURVEYS 5851 03:31:03,360 --> 03:31:04,800 TO EVALUATE AFFECT OF YOUR 5852 03:31:04,800 --> 03:31:05,280 INTERVENTIONS. 5853 03:31:05,280 --> 03:31:10,040 >> SO THAT IS A GREAT POINT. 5854 03:31:10,040 --> 03:31:12,440 MY COLLEAGUE ERIC AT BOSTON 5855 03:31:12,440 --> 03:31:14,200 CHILDREN'S HAS DEVELOPED AN APP 5856 03:31:14,200 --> 03:31:16,080 THAT SITS ON TOP OF THE TWO IN 5857 03:31:16,080 --> 03:31:19,800 ONE PLATFORM IN BOSTON. 5858 03:31:19,800 --> 03:31:21,440 ALLOWS PATIENTS OR PROVIDERS TO 5859 03:31:21,440 --> 03:31:22,920 BE ABLE TO ACCESS THAT 5860 03:31:22,920 --> 03:31:25,240 INFORMATION IN REAL TIME. 5861 03:31:25,240 --> 03:31:27,280 I THINK THERE ARE LOT OF 5862 03:31:27,280 --> 03:31:28,880 PATIENTS FOR WHOM THE APP WOULD 5863 03:31:28,880 --> 03:31:29,840 BE REALLY BENEFICIAL. 5864 03:31:29,840 --> 03:31:31,760 I THINK THERE ARE A LOT OF 5865 03:31:31,760 --> 03:31:34,040 CHALLENGES TO ASSUMING THAT 5866 03:31:34,040 --> 03:31:35,560 EVERYONE NEED THESE RESOURCES 5867 03:31:35,560 --> 03:31:37,160 HAS ACCESS TO A SMART PHONE AND 5868 03:31:37,160 --> 03:31:39,560 IN THE EARLY PILOT WORK MOST 5869 03:31:39,560 --> 03:31:42,000 PATIENTS HAD ACCESS TO A TEXT 5870 03:31:42,000 --> 03:31:43,400 MESSAGE CAPABLE PHONE BUT NOT 5871 03:31:43,400 --> 03:31:44,240 EVERYBODY HAD ACCESS TO A SMART 5872 03:31:44,240 --> 03:31:44,440 PHONE. 5873 03:31:44,440 --> 03:31:45,680 SO THAT WAS PART OF WHY WE FELT 5874 03:31:45,680 --> 03:31:47,600 LIKE IT WAS RELATIVELY IMPORTANT 5875 03:31:47,600 --> 03:31:49,720 TO STICK TO THE LOWER TEXT 5876 03:31:49,720 --> 03:31:50,960 MESSAGING VERSION OF THIS. 5877 03:31:50,960 --> 03:31:53,520 YOU CAN DO IT ON FLIP PHONE OR 5878 03:31:53,520 --> 03:31:54,200 BURNER PHONE. 5879 03:31:54,200 --> 03:31:56,200 SO THAT WAS HOW WE ENDED UP WITH 5880 03:31:56,200 --> 03:31:59,320 THAT STRATEGY RATHER THAN APP. 5881 03:31:59,320 --> 03:32:01,880 BUT MAYBE MULTIMULTILY THE 5882 03:32:01,880 --> 03:32:02,800 ANSWER IS MULTI-MODAL. 5883 03:32:02,800 --> 03:32:04,800 SOME OTHERS DO BETTER ON PAPER 5884 03:32:04,800 --> 03:32:06,960 AND SOME DO BETTER WITH TEST 5885 03:32:06,960 --> 03:32:07,840 MESSAGING AND SOME BETTER WITH 5886 03:32:07,840 --> 03:32:09,520 APP AND THE SOPHISTICATION OF 5887 03:32:09,520 --> 03:32:10,640 THIS WILL GROW AS WE START TO 5888 03:32:10,640 --> 03:32:12,800 UNDERSTAND THE BEST STRATEGIES 5889 03:32:12,800 --> 03:32:14,440 FOR MATCHING PEOPLE TO THE 5890 03:32:14,440 --> 03:32:15,280 INFORMATION AND COMMUNICATION 5891 03:32:15,280 --> 03:32:16,400 RESOURCES INVESTED FOR THAT AND 5892 03:32:16,400 --> 03:32:17,680 ALSO TO NAVIGATIONAL RESOURCES 5893 03:32:17,680 --> 03:32:20,760 THEY NEED. 5894 03:32:20,760 --> 03:32:22,440 SPEAKER5: EXCELLENT, THANK YOU 5895 03:32:22,440 --> 03:32:25,680 SO MUCH. 5896 03:32:25,680 --> 03:32:27,360 SO ANOTHER GENERAL QUESTION, 5897 03:32:27,360 --> 03:32:29,320 THIS GOES BACK TO DR. MCCARTHY 5898 03:32:29,320 --> 03:32:33,040 WHO IS REALLY ACKNOWLEDGING THE 5899 03:32:33,040 --> 03:32:35,520 SOCIAL DETERMINANTS MODEL THAT 5900 03:32:35,520 --> 03:32:38,600 INCLUDED STRUCTURAL RACISM AND 5901 03:32:38,600 --> 03:32:39,800 STRUCTURAL DETERMINANTS FURTHER 5902 03:32:39,800 --> 03:32:40,440 UPSTREAM FROM INDIVIDUAL 5903 03:32:40,440 --> 03:32:41,560 DETERMINANTS THAT MANY OF US 5904 03:32:41,560 --> 03:32:43,160 TEND TO FOCUS ON. 5905 03:32:43,160 --> 03:32:45,080 SO MORE BROADLY, OUTSIDE OF THE 5906 03:32:45,080 --> 03:32:46,520 ED CONTEXT THERE'S A SIGNIFICANT 5907 03:32:46,520 --> 03:32:47,960 AMOUNT OF SCHOLARLY DISCOURSE 5908 03:32:47,960 --> 03:32:50,440 ABOUT THE USE OF RACE AS A 5909 03:32:50,440 --> 03:32:52,560 VARIABLE IN RESEARCH. 5910 03:32:52,560 --> 03:32:54,640 RECOGNIZING THAT RACE IS A 5911 03:32:54,640 --> 03:32:57,720 SOCIAL CONSTRUCT BORN OUT OF 5912 03:32:57,720 --> 03:32:59,240 RACISM, SUGGESTIONS ON HOW DO WE 5913 03:32:59,240 --> 03:33:01,440 ADVANCE THE SCIENCE IN A WAY 5914 03:33:01,440 --> 03:33:03,840 THAT INTENTIONALLY AND 5915 03:33:03,840 --> 03:33:06,600 SUSTAINABLY DISENTANGLES RACE AS 5916 03:33:06,600 --> 03:33:07,880 A VARIABLE FROM STRUCTURAL 5917 03:33:07,880 --> 03:33:10,800 RACISM AS PREDICTOR AND 5918 03:33:10,800 --> 03:33:13,840 PERPETRATOR OF HEALTH INEQUITY. 5919 03:33:13,840 --> 03:33:23,400 ANY THOUGHTS FROM OUR PANEL? 5920 03:33:23,400 --> 03:33:27,200 ANY THOUGHTS DR. MCCARNEY? 5921 03:33:27,200 --> 03:33:33,880 BY ANY CHANCE? 5922 03:33:33,880 --> 03:33:38,360 >> YOU ASK TOUGH QUESTIONS. 5923 03:33:38,360 --> 03:33:39,240 BECAUSE IT IS INTERESTING, I 5924 03:33:39,240 --> 03:33:42,640 HAVE BEEN THINKING A LOT MORE 5925 03:33:42,640 --> 03:33:45,160 ABOUT LIKE EMPLOYMENT FOR 5926 03:33:45,160 --> 03:33:47,320 EXAMPLE, IF WE COULD HELP OUR 5927 03:33:47,320 --> 03:33:50,800 PATIENTS GET BETTER JOBS. 5928 03:33:50,800 --> 03:33:52,360 HOW THAT COULD EASE THE HOUSING 5929 03:33:52,360 --> 03:33:56,640 PROBLEMS AND THE FOOD 5930 03:33:56,640 --> 03:33:56,920 INSECURITY. 5931 03:33:56,920 --> 03:34:00,840 SO FOCUSING LESS ON RACISM AND 5932 03:34:00,840 --> 03:34:04,360 JUST MORE POSITIVE -- YOU KNOW. 5933 03:34:04,360 --> 03:34:06,120 I DON'T REALLY KNOW AND I 5934 03:34:06,120 --> 03:34:08,200 HAVEN'T MEASURED THAT IN THE 5935 03:34:08,200 --> 03:34:09,480 STUDIES THAT WE HAVE DONE, HOW 5936 03:34:09,480 --> 03:34:13,320 MUCH THAT IS AFFECTING THINGS. 5937 03:34:13,320 --> 03:34:14,560 I WILL SAY TOTALLY NOT RELATED 5938 03:34:14,560 --> 03:34:17,680 TO RACISM BUT AS I WAS LISTENING 5939 03:34:17,680 --> 03:34:21,280 TO A LOT OF THE PRESENTATIONS 5940 03:34:21,280 --> 03:34:23,360 TODAY, WE ARE SCREENING AND THEN 5941 03:34:23,360 --> 03:34:25,560 TRYING TO TO INTERVENE, WHEN WE 5942 03:34:25,560 --> 03:34:27,360 DID THAT, IT IS ALMOST LIKE A 5943 03:34:27,360 --> 03:34:30,400 LOT OF THESE SOCIAL DETERMINANTS 5944 03:34:30,400 --> 03:34:31,360 ARE CHRONIC CONDITION. 5945 03:34:31,360 --> 03:34:33,800 AND WHEN PEOPLE SAY THEY HAVE 5946 03:34:33,800 --> 03:34:36,160 FOOD INSECURITY OR THEY HAVE 5947 03:34:36,160 --> 03:34:38,640 HOUSING INSTABILITY THEY DON'T 5948 03:34:38,640 --> 03:34:40,200 FOLLOW-UP ON THE RECOMMENDATIONS 5949 03:34:40,200 --> 03:34:41,440 YOU GIVE THEM BECAUSE THEY HAVE 5950 03:34:41,440 --> 03:34:44,640 BEEN DEALING WITH THESE PROBLEMS 5951 03:34:44,640 --> 03:34:45,440 FOR YEARS. 5952 03:34:45,440 --> 03:34:47,240 LIKE LAUREN TAYLOR SAID SOCIAL 5953 03:34:47,240 --> 03:34:48,640 SERVICES ARE SO UNDERFUNDED 5954 03:34:48,640 --> 03:34:51,160 COMPARED TO THE MEDICAL CARE, 5955 03:34:51,160 --> 03:34:53,480 THAT WE DON'T HAVE THE RESOURCES 5956 03:34:53,480 --> 03:34:55,840 TO HELP ALL PEOPLE IN NEED. 5957 03:34:55,840 --> 03:34:59,400 YOU CAN'T GET LIKE DR. POLLACK 5958 03:34:59,400 --> 03:35:02,240 SAID, THAT SUBSIDIZES HOUSING 5959 03:35:02,240 --> 03:35:04,160 FOR PEOPLE TO GET A VOUCHER, IT 5960 03:35:04,160 --> 03:35:07,920 IS JUST SO BACKED UP. 5961 03:35:07,920 --> 03:35:11,120 SO WILL IS ALL THESE PROBLEMS. 5962 03:35:11,120 --> 03:35:13,600 ON TOP OF RACISM AND OTHER 5963 03:35:13,600 --> 03:35:13,920 STUFF. 5964 03:35:13,920 --> 03:35:17,440 SO I DON'T KNOW WHERE TO BEGIN. 5965 03:35:17,440 --> 03:35:20,160 WE HAVE LOTS OF ISSUES. 5966 03:35:20,160 --> 03:35:21,680 SO WHEN I SEE THINGS LIKE PEOPLE 5967 03:35:21,680 --> 03:35:25,160 TRYING TO PARTNER WITH HOUSING 5968 03:35:25,160 --> 03:35:26,120 AND OTHER PLACES I THINK WE 5969 03:35:26,120 --> 03:35:29,240 REALLY HAVE TO PUT THOSE IN 5970 03:35:29,240 --> 03:35:30,600 PLACE BECAUSE SCREENING TELLS US 5971 03:35:30,600 --> 03:35:32,680 WE HAVE A LOT OF NEED BUT WE 5972 03:35:32,680 --> 03:35:35,400 CAN'T -- HOW MUCH WE CAN REALLY 5973 03:35:35,400 --> 03:35:39,440 SOLVE THAT NEED. 5974 03:35:39,440 --> 03:35:41,840 I DON'T KNOW. 5975 03:35:41,840 --> 03:35:44,560 SORRY, THAT DIDN'T ANSWER YOUR 5976 03:35:44,560 --> 03:35:44,960 QUESTION. 5977 03:35:44,960 --> 03:35:47,320 >> I THINK IT IS A HARD QUESTION 5978 03:35:47,320 --> 03:35:49,000 BECAUSE I'M FOOLISH TO THINK 5979 03:35:49,000 --> 03:35:50,120 ANYBODY IS ABLE TO ANSWER IT 5980 03:35:50,120 --> 03:35:51,280 FULLY TODAY. 5981 03:35:51,280 --> 03:35:52,560 BUT CERTAINLY THE DISCOURSE IS 5982 03:35:52,560 --> 03:35:54,440 WELCOME. 5983 03:35:54,440 --> 03:35:56,400 ANY OTHER COMMENTS ON THAT 5984 03:35:56,400 --> 03:35:56,640 QUESTION? 5985 03:35:56,640 --> 03:35:58,880 RACE AN RACISM, RACE AS FEW DOES 5986 03:35:58,880 --> 03:36:03,520 VARIABLE? 5987 03:36:03,520 --> 03:36:07,760 >> I WILL SAY IN MY HOSPITAL OUR 5988 03:36:07,760 --> 03:36:10,200 IRB IS ON A JOURNEY TO BECOMING 5989 03:36:10,200 --> 03:36:11,840 AN ANTI-RACIST IRB AND THAT'S 5990 03:36:11,840 --> 03:36:13,120 ONE OF THE THINGS THAT WE ARE 5991 03:36:13,120 --> 03:36:14,920 NOW ASKING INVESTIGATORS TO 5992 03:36:14,920 --> 03:36:17,040 COMMENT ON IN THEIR IRB 5993 03:36:17,040 --> 03:36:17,360 APPLICATION. 5994 03:36:17,360 --> 03:36:19,320 WHEN THEY DO ASK TO USE RACE OR 5995 03:36:19,320 --> 03:36:24,280 ETHNICITY. 5996 03:36:24,280 --> 03:36:25,240 THESE VARIABLES, HOW EXACTLY ARE 5997 03:36:25,240 --> 03:36:26,240 YOU PLANNING TO USE THAT AND 5998 03:36:26,240 --> 03:36:29,800 HAVE YOU THOUGHT ABOUT ANY WAYS 5999 03:36:29,800 --> 03:36:31,280 IN WHICH FINDINGS OF YOUR 6000 03:36:31,280 --> 03:36:32,040 RESEARCH MIGHT HURT PARTICULAR 6001 03:36:32,040 --> 03:36:32,880 GROUPS? 6002 03:36:32,880 --> 03:36:35,600 SO MAKING SURE JUST THAT 6003 03:36:35,600 --> 03:36:37,160 RESEARCH TEAM NOT TO SAY YOU ARE 6004 03:36:37,160 --> 03:36:39,120 NOT ABLE TO USE THAT VARIABLE 6005 03:36:39,120 --> 03:36:40,640 BUT MAKING SURE IT IS IN THE 6006 03:36:40,640 --> 03:36:42,840 BACK OF THEIR MIND, SOMETIMES 6007 03:36:42,840 --> 03:36:45,240 OUR RESEARCH HAS UNINTENDED 6008 03:36:45,240 --> 03:36:48,800 CONSEQUENCES AND WE SHOULD BE 6009 03:36:48,800 --> 03:36:50,080 THINKING ABOUT THAT AS WE ARE 6010 03:36:50,080 --> 03:36:51,160 PLAN AND MOVING FORWARD. 6011 03:36:51,160 --> 03:36:52,680 THAT SORT OF THING MOVING 6012 03:36:52,680 --> 03:36:54,240 FORWARD THINKING ABOUT IT HAVING 6013 03:36:54,240 --> 03:36:55,880 CONVERSATIONS ON THEIR TEAMS, 6014 03:36:55,880 --> 03:36:58,240 CONSIDERING WHAT EXACTLY THEY 6015 03:36:58,240 --> 03:36:59,320 ARE GOING DO TO DO WITH THE 6016 03:36:59,320 --> 03:37:01,840 INFORMATION ASIDE FROM TABLE 6017 03:37:01,840 --> 03:37:02,040 ONE. 6018 03:37:02,040 --> 03:37:03,840 AND HOW IT CAN BE USEFUL AND 6019 03:37:03,840 --> 03:37:05,840 EMPOWERING FOR GROUPS THAT HAVE 6020 03:37:05,840 --> 03:37:07,800 BEEN MARGINALIZED IN THE PAST. 6021 03:37:07,800 --> 03:37:10,280 >> THAT IS REALLY GREAT. 6022 03:37:10,280 --> 03:37:10,800 SOUNDS LIKE IT IS REALLY 6023 03:37:10,800 --> 03:37:12,040 ENCOURAGING TEAM REFLECTION AND 6024 03:37:12,040 --> 03:37:16,720 SCIENTIFIC REFLECTION AND DESIGN 6025 03:37:16,720 --> 03:37:18,800 AND IMPLEMENTATION OF STUDIES. 6026 03:37:18,800 --> 03:37:20,600 THANK YOU FOR SHARING THAT. 6027 03:37:20,600 --> 03:37:22,040 QUESTION YOULY FOR DR. 6028 03:37:22,040 --> 03:37:23,560 DEFRANCIS. 6029 03:37:23,560 --> 03:37:26,640 CONSIDERING THE CURRENT STATE OF 6030 03:37:26,640 --> 03:37:28,720 MATERNAL INFANT MORBIDITY AND 6031 03:37:28,720 --> 03:37:29,560 MORTALITY, HEALTHCARE 6032 03:37:29,560 --> 03:37:31,240 DISPARITIES IN THIS POPULATION 6033 03:37:31,240 --> 03:37:32,040 SOCIAL DETERMINANTS OF HEALTH 6034 03:37:32,040 --> 03:37:35,800 AND INCREASE IN OB DESSERTS AND 6035 03:37:35,800 --> 03:37:38,600 MATERNITY UNIT CLOSURE, DOES 6036 03:37:38,600 --> 03:37:40,760 HMSIS CAPTURE DATA ON PREGNANCY 6037 03:37:40,760 --> 03:37:42,240 AND POSTPARTUM POST PREGNANCY 6038 03:37:42,240 --> 03:37:43,400 SCREENING AND OB EMERGENCY 6039 03:37:43,400 --> 03:37:43,720 SPECIFICALLY? 6040 03:37:43,720 --> 03:37:45,920 IF SO, WHAT IMPACT DID THEY HAVE 6041 03:37:45,920 --> 03:37:56,600 ON ED USAGE OF THIS POPULATION? 6042 03:37:56,600 --> 03:37:57,800 COMPLICATIONS IN PREGNANCY, 6043 03:37:57,800 --> 03:37:58,960 PROBLEMS WITH PREGNANCY, THIS IS 6044 03:37:58,960 --> 03:38:03,960 ALL CODED TO ICD 10 CM. 6045 03:38:03,960 --> 03:38:05,640 I SAW THE QUESTION IN THE CHAT 6046 03:38:05,640 --> 03:38:07,200 SO I SCURRIED BACK AND WE HAVE 6047 03:38:07,200 --> 03:38:09,240 SOME TABLES UP ON OUR WEBSITE 6048 03:38:09,240 --> 03:38:11,400 AND ACTUALLY I WENT TO LOOK AND 6049 03:38:11,400 --> 03:38:14,600 AGAIN, THIS IS JUST A CURSORY 6050 03:38:14,600 --> 03:38:18,640 LOOK AND FROM WHAT I COULD SEE, 6051 03:38:18,640 --> 03:38:20,560 IN OUR DATA THERE HASN'T BEEN 6052 03:38:20,560 --> 03:38:21,000 MUCH CHANGE. 6053 03:38:21,000 --> 03:38:21,720 IT IS STABLE. 6054 03:38:21,720 --> 03:38:23,880 THAT IS NOT TO SAY THERE HASN'T 6055 03:38:23,880 --> 03:38:27,120 BEEN CHANGE BUT AT LEAST IN THE 6056 03:38:27,120 --> 03:38:28,600 HAMSA DATA THERE IS NOT UPTICK 6057 03:38:28,600 --> 03:38:30,160 OR DECREASE, IT IS ROUGHLY ABOUT 6058 03:38:30,160 --> 03:38:31,320 THE SAME. 6059 03:38:31,320 --> 03:38:33,440 BUT I WANT TO POINT OUT A COUPLE 6060 03:38:33,440 --> 03:38:36,440 OF THINGS, I TALK ABOUT HOSPITAL 6061 03:38:36,440 --> 03:38:38,880 CARE SURVEY, WE PUT OUT A REPORT 6062 03:38:38,880 --> 03:38:40,200 A FEW MONTHS AGO LOOKING AT 6063 03:38:40,200 --> 03:38:41,720 WOMEN WHO DELIVERED IN THE 6064 03:38:41,720 --> 03:38:43,080 HOSPITAL AND THEN FOLLOWED TO 6065 03:38:43,080 --> 03:38:46,040 SEE IF THEY HAD A POSTPARTUM 6066 03:38:46,040 --> 03:38:48,520 EMERGENCY DEPARTMENT VISIT. 6067 03:38:48,520 --> 03:38:51,080 HOSPITAL CARE DATA IS NOT GNASH 6068 03:38:51,080 --> 03:38:52,160 NATIONALLY REPRESENTATIVE BUT 6069 03:38:52,160 --> 03:38:55,760 THIS PARTICULAR STUDY WAS BASED 6070 03:38:55,760 --> 03:38:58,200 ON 158 HOSPITALS AND AGAIN POINT 6071 03:38:58,200 --> 03:39:01,040 BEING THERE WAS 100,000 6072 03:39:01,040 --> 03:39:04,280 DELIVERIES IN THE DATA SET AND 6073 03:39:04,280 --> 03:39:07,040 ABOUT 6% OF THE WOMEN DID HAVE 6074 03:39:07,040 --> 03:39:08,880 POSTPARTUM ED VISIT. 6075 03:39:08,880 --> 03:39:11,560 I CAN DROP STUDY MANY THE CHAT. 6076 03:39:11,560 --> 03:39:14,080 SO AGAIN VERY IMPORTANT TOPIC. 6077 03:39:14,080 --> 03:39:16,440 WE ARE WELL AWARE OF, AND ALSO 6078 03:39:16,440 --> 03:39:17,640 ONE LAST THING I WANT TO SAY 6079 03:39:17,640 --> 03:39:20,040 AGAIN NOT DIRECTLY RELATED TO 6080 03:39:20,040 --> 03:39:22,840 HMSIS BUT WE COLLECT DATA AT 6081 03:39:22,840 --> 03:39:23,800 NCHS FROM FEDERALLY QUALIFIED 6082 03:39:23,800 --> 03:39:24,800 HEALTH CENTERS AND WE ARE 6083 03:39:24,800 --> 03:39:29,440 ACTUALLY MOVING THE COLLECTING 6084 03:39:29,440 --> 03:39:30,640 ON SITE ABSTRACTION AND REMOVING 6085 03:39:30,640 --> 03:39:32,640 NOW THE COLLECTION OF ELECTRONIC 6086 03:39:32,640 --> 03:39:35,240 HEALTH RECORD DATA AND IN THE 6087 03:39:35,240 --> 03:39:36,640 PROCESS OF RECRUITING A 6088 03:39:36,640 --> 03:39:38,600 NATIONALLY REPRESENTATIVE SAMPLE 6089 03:39:38,600 --> 03:39:40,560 AND ACTUALLY HAVE SOME PCOR 6090 03:39:40,560 --> 03:39:42,040 FUNDING TO LOOK AT MATERNAL 6091 03:39:42,040 --> 03:39:44,840 HEALTH MATERNAL MORBIDITY, WE 6092 03:39:44,840 --> 03:39:47,080 WILL BE LINKING TO THE NATIONAL 6093 03:39:47,080 --> 03:39:48,040 DEAF INDEX AND HUD DATA SO THAT 6094 03:39:48,040 --> 03:39:52,840 IS TO COME. 6095 03:39:52,840 --> 03:39:53,880 STAY TUNED BECAUSE WE ARE 6096 03:39:53,880 --> 03:39:56,400 IMPORTANT TOPIC ON MATERNAL 6097 03:39:56,400 --> 03:39:57,080 HEALTH MATERNAL MORBIDITY. 6098 03:39:57,080 --> 03:40:01,640 WE ARE TRYING TO DO SOME AGAIN 6099 03:40:01,640 --> 03:40:02,600 THINGS AT THE NATIONAL LEVEL TO 6100 03:40:02,600 --> 03:40:03,600 ADDRESS THAT ISSUE. 6101 03:40:03,600 --> 03:40:05,680 THANK YOU. 6102 03:40:05,680 --> 03:40:07,800 >> THANK YOU SO MUCH DR. 6103 03:40:07,800 --> 03:40:08,040 DEFRANCIS. 6104 03:40:08,040 --> 03:40:09,800 I WILL DRAW THE ATTENTION OF 6105 03:40:09,800 --> 03:40:11,040 ATTENDEES TO THE CHAT WHERE 6106 03:40:11,040 --> 03:40:12,760 THERE IS A VERY ACTIVE 6107 03:40:12,760 --> 03:40:14,120 CONVERSATION GOING ON AND 6108 03:40:14,120 --> 03:40:15,120 FOLLOWING UP ON SPECIFIC 6109 03:40:15,120 --> 03:40:16,440 QUESTIONS THAT HAVE BEEN ASKED. 6110 03:40:16,440 --> 03:40:21,640 FEEL FREE TO PARTICIPATE IN THAT 6111 03:40:21,640 --> 03:40:22,640 BECAUSE I CAN (INAUDIBLE) TO 6112 03:40:22,640 --> 03:40:25,000 LISTEN TO ME NECESSARILY. 6113 03:40:25,000 --> 03:40:27,240 SO SOME MORE SPECIFIC QUESTIONS 6114 03:40:27,240 --> 03:40:29,800 TO DR. TAYLOR. 6115 03:40:29,800 --> 03:40:32,040 SO FROM YOUR WORK WHAT 6116 03:40:32,040 --> 03:40:32,640 SUGGESTIONS DO YOU HAVE FOR 6117 03:40:32,640 --> 03:40:33,480 HEALTHCARE FOLKS WHO WOULD 6118 03:40:33,480 --> 03:40:35,320 REALLY LIKE TO PARTNER WITH 6119 03:40:35,320 --> 03:40:37,160 COMMUNITY ORGANIZATIONS TO HELP 6120 03:40:37,160 --> 03:40:38,600 NURTURE THOSE RELATIONSHIPS ON 6121 03:40:38,600 --> 03:40:40,000 TERMS THAT ARE COMFORTABLE FOR 6122 03:40:40,000 --> 03:40:41,800 THE PARTNERS VERSUS COMFORTABLE 6123 03:40:41,800 --> 03:40:44,640 FOR THE HEALTHCARE FOLKS. 6124 03:40:44,640 --> 03:40:48,320 >> THANKS SO MUCH, BILLY. 6125 03:40:48,320 --> 03:40:49,640 I DO HAVE A LITTLE ONE IN THE 6126 03:40:49,640 --> 03:40:53,640 BACK SO IF YOU HEAR A SLEEKY 6127 03:40:53,640 --> 03:40:54,760 WILL DO MY BEST. 6128 03:40:54,760 --> 03:40:56,360 I GOT THREE CONCRETE THINGS, 6129 03:40:56,360 --> 03:40:57,240 PEOPLE HAVE ASKED ME THIS 6130 03:40:57,240 --> 03:40:57,760 BEFORE. 6131 03:40:57,760 --> 03:41:00,400 ONE IS RESEARCH HAS SHOWN AGAIN 6132 03:41:00,400 --> 03:41:01,960 AND AGAIN THAT IF YOU CAN FOSTER 6133 03:41:01,960 --> 03:41:02,960 RELATIONSHIP BETWEEN HEALTHCARE 6134 03:41:02,960 --> 03:41:05,240 AND SOCIAL SERVICES, WITH PEOPLE 6135 03:41:05,240 --> 03:41:07,040 WHO ARE LIKE TRAINED AS THE 6136 03:41:07,040 --> 03:41:09,040 POINT PERSON ON BOTH SIDES, IT 6137 03:41:09,040 --> 03:41:10,360 GOES REALLY LONG WAY, THINK 6138 03:41:10,360 --> 03:41:13,800 ABOUT HAVING A SOCIAL WORKER IN 6139 03:41:13,800 --> 03:41:14,720 SOCIAL SERVICE ORGANIZATION RUN 6140 03:41:14,720 --> 03:41:16,120 POINT ON THE PARTNERSHIP 6141 03:41:16,120 --> 03:41:17,160 MANAGEMENT AND PUT SOMEONE WHO 6142 03:41:17,160 --> 03:41:18,640 IS ALSO A SOCIAL WORKER IN THE 6143 03:41:18,640 --> 03:41:19,520 HEALTHCARE SETTING ON THE OTHER 6144 03:41:19,520 --> 03:41:20,680 SIDE. 6145 03:41:20,680 --> 03:41:24,320 IT IS A REALLY NICE WAY TO TRY 6146 03:41:24,320 --> 03:41:25,160 AND BROKER AND CROSS THE CHASM 6147 03:41:25,160 --> 03:41:26,920 OF WHAT IS OTHERWISE A HUGE 6148 03:41:26,920 --> 03:41:28,280 CULTURAL DIFFERENCE BETWEEN THE 6149 03:41:28,280 --> 03:41:29,640 ORGANIZATIONS, IF YOU JUST HAVE 6150 03:41:29,640 --> 03:41:31,520 PEOPLE WHO SPEAK THE SAME 6151 03:41:31,520 --> 03:41:33,040 LANGUAGE IN ALMOST LIKE A 6152 03:41:33,040 --> 03:41:34,040 TRANSLATION ROLE. 6153 03:41:34,040 --> 03:41:35,120 THAT IS ONE. 6154 03:41:35,120 --> 03:41:37,520 A SECOND IS BACK TO STORY ABOUT 6155 03:41:37,520 --> 03:41:40,520 THE HOSPITAL MEETING THAT WENT 6156 03:41:40,520 --> 03:41:41,640 AWRY, JUST MAKES A HUGE 6157 03:41:41,640 --> 03:41:42,200 DIFFERENCE EARLY IN THE 6158 03:41:42,200 --> 03:41:43,000 ORGANIZATION IF HEALTHCARE FOLKS 6159 03:41:43,000 --> 03:41:45,840 ARE WILLING TO LEAVE THEIR OWN 6160 03:41:45,840 --> 03:41:46,120 PREMISES. 6161 03:41:46,120 --> 03:41:47,680 IF YOU ARE WILLING TO GO AND 6162 03:41:47,680 --> 03:41:49,360 HAVE MEETINGS, AT A SOCIAL 6163 03:41:49,360 --> 03:41:51,120 SERVICE ORGANIZATION OR EVEN AT 6164 03:41:51,120 --> 03:41:52,720 NEUTRAL POINT THERE IS REALLY 6165 03:41:52,720 --> 03:41:53,280 SOMETHING INTIMIDATING FOR 6166 03:41:53,280 --> 03:41:55,120 PEOPLE WALKING INTO A HEALTHCARE 6167 03:41:55,120 --> 03:41:57,040 SYSTEM OR INTO A HEALTHCARE 6168 03:41:57,040 --> 03:41:59,640 DELIVERY SITE AND FEELING LIKE 6169 03:41:59,640 --> 03:42:01,960 THIS IS A TOTAL INSTITUTION THAT 6170 03:42:01,960 --> 03:42:04,360 I AM NOT FAMILIAR WITH, THAN 6171 03:42:04,360 --> 03:42:06,480 JUST BEING WILLING TO TRAVEL 6172 03:42:06,480 --> 03:42:08,640 SPEND THE EXTRA 15, 20 MINUTES 6173 03:42:08,640 --> 03:42:10,640 HOWEVER IT TAKES TO BE THE ONE 6174 03:42:10,640 --> 03:42:11,920 WHO GOES AND NEEDS SOMEWHERE 6175 03:42:11,920 --> 03:42:17,120 ELSEWHERE IS BIG. 6176 03:42:17,120 --> 03:42:21,800 THREE, WHEN IT COMES TO 6177 03:42:21,800 --> 03:42:23,920 CONTRACTING IT COULD GOD A HUGE 6178 03:42:23,920 --> 03:42:25,480 WAY IF HEALTHCARE WAS WILLING TO 6179 03:42:25,480 --> 03:42:26,600 SAY DO YOU WANT TO PUT FORWARD 6180 03:42:26,600 --> 03:42:28,400 THE BOILERPLATE CONTRACT BECAUSE 6181 03:42:28,400 --> 03:42:32,320 HEALTHCARE BOILERPLATE CONTRACTS 6182 03:42:32,320 --> 03:42:34,920 ARE OVER THE TOP INTIMIDATING 6183 03:42:34,920 --> 03:42:36,400 AND SKEW DISCUSSION IN TERMS OF 6184 03:42:36,400 --> 03:42:38,640 WHAT HEALTHCARE WANTS TO MEASURE 6185 03:42:38,640 --> 03:42:41,640 AND THEIR POLICY RECOMMENDATIONS 6186 03:42:41,640 --> 03:42:42,120 ANDIA DA. 6187 03:42:42,120 --> 03:42:43,480 IF EVEN AT SOME POINT IN THE 6188 03:42:43,480 --> 03:42:45,640 CONTRACT NEGOTIATIONS YOU GIT 6189 03:42:45,640 --> 03:42:46,480 THERE, GIVING THE SOCIAL 6190 03:42:46,480 --> 03:42:48,040 SERVICES ADMINISTRATION AN 6191 03:42:48,040 --> 03:42:49,240 OPPORTUNITY TO PUT FORWARD THEIR 6192 03:42:49,240 --> 03:42:52,200 VERSION WHERE THEY WANT TO START 6193 03:42:52,200 --> 03:42:58,440 HELPS. 6194 03:42:58,440 --> 03:43:00,440 >> I THOUGHT I WAS A HERO BY 6195 03:43:00,440 --> 03:43:02,120 MODERATING THAT WITH A 60-POUND 6196 03:43:02,120 --> 03:43:04,040 LAB AT MY FEET BUT YOU WIN. 6197 03:43:04,040 --> 03:43:09,240 ALSO THERE WAS REQUEST IF YOU 6198 03:43:09,240 --> 03:43:10,880 KNOW HEALTH AND HUMAN SERVICES, 6199 03:43:10,880 --> 03:43:12,600 IF YOU CAN PUT THAT IN THE CHAT, 6200 03:43:12,600 --> 03:43:13,320 IF SOMEBODY MIGHT BE ABLE THE 6201 03:43:13,320 --> 03:43:14,040 ACCESS IS THAT. 6202 03:43:14,040 --> 03:43:14,800 >> ABSOLUTELY. 6203 03:43:14,800 --> 03:43:17,280 >> THANK YOU. 6204 03:43:17,280 --> 03:43:19,760 SO THERE IS GREAT QUESTION IN 6205 03:43:19,760 --> 03:43:22,640 THE CHAT, FROM KAREN JENNINGS 6206 03:43:22,640 --> 03:43:24,360 MATHIS HOW RESEARCHERS ARE 6207 03:43:24,360 --> 03:43:26,600 CONSIDERING AND/OR EVALUATING 6208 03:43:26,600 --> 03:43:28,800 IMPACT OF MENTAL HEALTH PROBLEMS 6209 03:43:28,800 --> 03:43:33,000 OR CHALLENGES IN THEIR RESEARCH. 6210 03:43:33,000 --> 03:43:34,920 ANY OF THE PANELISTS FEELING 6211 03:43:34,920 --> 03:43:38,640 STRONGLY ABOUT ANSWERING THAT 6212 03:43:38,640 --> 03:43:45,960 QUESTION? 6213 03:43:45,960 --> 03:43:48,760 HOW ARE RESEARCHERS CONSIDERING 6214 03:43:48,760 --> 03:43:50,080 AND EVALUATING HEALTH PROBLEMS 6215 03:43:50,080 --> 03:43:52,360 OR CHALLENGES IN THEIR RESEARCH? 6216 03:43:52,360 --> 03:43:53,200 >> I FEEL LIKE I HAVE BEEN 6217 03:43:53,200 --> 03:43:55,320 SPEAKING A LOT SO ANYONE 6218 03:43:55,320 --> 03:43:58,320 INTERRUPT ME AT ANY POINT. 6219 03:43:58,320 --> 03:43:59,680 BUT I CAN IN BRIEF SAY WE ARE 6220 03:43:59,680 --> 03:44:01,880 NOT STUDYING IT ENOUGH 6221 03:44:01,880 --> 03:44:02,600 ESPECIALLY EMERGENCY DEPARTMENT 6222 03:44:02,600 --> 03:44:03,600 SETTINGS AND OTHERS WE KNOW 6223 03:44:03,600 --> 03:44:05,160 MENTAL HEALTH IS INFLUENCING 6224 03:44:05,160 --> 03:44:08,560 PATIENTS ABILITY TO ACCESS 6225 03:44:08,560 --> 03:44:08,920 SERVICES. 6226 03:44:08,920 --> 03:44:10,040 I GAVE A TALK YESTERDAY TO ONE 6227 03:44:10,040 --> 03:44:12,560 OF THE NATIONAL COUNCILS ON 6228 03:44:12,560 --> 03:44:14,280 MENTAL HEALTH AND WELLNESS AND 6229 03:44:14,280 --> 03:44:16,800 THIS IS A FIELD INTEGRATION OF 6230 03:44:16,800 --> 03:44:18,640 SOCIAL CARE THEY ARE ACTIVELY 6231 03:44:18,640 --> 03:44:21,960 TRYING TO GET MORE INVOLVED 6232 03:44:21,960 --> 03:44:24,040 WITH. 6233 03:44:24,040 --> 03:44:26,000 SO WE SHOULD BE TAKING INTO 6234 03:44:26,000 --> 03:44:26,640 ACCOUNT AND THERE ARE STUDIES 6235 03:44:26,640 --> 03:44:29,440 OUT THERE TRYING TO LOOK AT 6236 03:44:29,440 --> 03:44:31,800 INFLUENCE CORRELATIONS BETWEEN 6237 03:44:31,800 --> 03:44:35,360 MENTAL HEALTH AND HAVING SOCIAL 6238 03:44:35,360 --> 03:44:38,480 RISK NEEDS AND THE FIELD OF 6239 03:44:38,480 --> 03:44:39,440 BEHAVIORAL HEALTH AND PSYCHIATRY 6240 03:44:39,440 --> 03:44:41,560 IS DOING A LOT OF SOCIAL CARE 6241 03:44:41,560 --> 03:44:43,400 THOUGH NOT SYSTEMATIC WAY OF 6242 03:44:43,400 --> 03:44:44,920 INTEGRATE SYSTEMATIC SCREENING 6243 03:44:44,920 --> 03:44:47,320 AND ASSISTANCE PROGRAMS. 6244 03:44:47,320 --> 03:44:48,480 BUT SOMEPLACE THEY ARE WORKING 6245 03:44:48,480 --> 03:44:50,640 TO GET MORE INVOLVED WITH AS 6246 03:44:50,640 --> 03:44:52,640 WELL. 6247 03:44:52,640 --> 03:44:56,040 >> ONE OTHER THOUGHT TOO IS THAT 6248 03:44:56,040 --> 03:44:58,240 I THINK MENTAL HEALTH, 6249 03:44:58,240 --> 03:45:00,600 ESPECIALLY A SCREENING IS MORE 6250 03:45:00,600 --> 03:45:05,200 SENSITIVE MEASURE FOR SOCIAL 6251 03:45:05,200 --> 03:45:05,520 DETERMINANTS. 6252 03:45:05,520 --> 03:45:06,800 IF SOMEBODY FACES HOUSING 6253 03:45:06,800 --> 03:45:10,080 INSTABILITY AND LOSES THEIR JOB 6254 03:45:10,080 --> 03:45:11,080 AND YOU HAVE A LONGITUDINAL 6255 03:45:11,080 --> 03:45:13,160 STUDY YOU WILL SEE THE OUTCOME, 6256 03:45:13,160 --> 03:45:14,720 THE HEALTH OUTCOME OF THAT MORE 6257 03:45:14,720 --> 03:45:16,280 QUICKLY IN THE MENTAL HEALTH 6258 03:45:16,280 --> 03:45:20,520 THAN YOU WILL LIKE WHEN DOES A 6259 03:45:20,520 --> 03:45:22,080 PERSON DEVELOP DIABETES OR 6260 03:45:22,080 --> 03:45:22,440 HYPERTENSION. 6261 03:45:22,440 --> 03:45:25,000 SO I THINK ACTUALLY MENTAL 6262 03:45:25,000 --> 03:45:29,240 HEALTH SCREENERS ARE GREAT FOR 6263 03:45:29,240 --> 03:45:32,040 CHANGES IN ADVERSE CHANGES IN 6264 03:45:32,040 --> 03:45:36,320 YOUR SOCIAL ECONOMIC 6265 03:45:36,320 --> 03:45:40,160 CIRCUMSTANCES. 6266 03:45:40,160 --> 03:45:42,200 >> ANYONE ELSE ON THAT NOTE? 6267 03:45:42,200 --> 03:45:44,040 >> I WILL ADD SOMEONE ELSE WHO 6268 03:45:44,040 --> 03:45:47,360 HAS SPOKEN TOO MUCH TODAY. 6269 03:45:47,360 --> 03:45:50,640 TO MOLLY'S POINT AND MELISSA, 6270 03:45:50,640 --> 03:45:52,440 THE LONGITUDINAL OUTCOMES IN 6271 03:45:52,440 --> 03:45:56,800 TERMS OF DISTRESS AND ANXIETY, 6272 03:45:56,800 --> 03:45:58,440 ABSOLUTELY THOSE ARE FANTASTIC 6273 03:45:58,440 --> 03:46:00,240 MEASURES TO TRACK. 6274 03:46:00,240 --> 03:46:02,240 BUT TO MOLLY'S POINT I THINK IS 6275 03:46:02,240 --> 03:46:03,840 THAT -- WHAT WE HAVE SEEN IN OUR 6276 03:46:03,840 --> 03:46:07,320 OWN ED IS THAT YES, BEHAVIOR, 6277 03:46:07,320 --> 03:46:11,400 MENTAL HEALTH CRISES ADDICTION, 6278 03:46:11,400 --> 03:46:13,720 THOSE ARE THE MOST UNDERSCREENED 6279 03:46:13,720 --> 03:46:14,480 PATIENTS IN OUR POPULATION. 6280 03:46:14,480 --> 03:46:20,240 IT IS THE FIRST DIAGNOSIS THAT 6281 03:46:20,240 --> 03:46:23,280 SENDS OUR STAFF INTO THE CORNER 6282 03:46:23,280 --> 03:46:26,600 AND SAYING THE PATIENT REFUSES 6283 03:46:26,600 --> 03:46:27,280 TO SCREEN. 6284 03:46:27,280 --> 03:46:29,880 SO WE HAVE WORK TO DO. 6285 03:46:29,880 --> 03:46:31,880 THAT IS WHAT WE KNOW AT LEAST 6286 03:46:31,880 --> 03:46:33,760 NUMBER OF PEOPLE AND HOW MUCH 6287 03:46:33,760 --> 03:46:35,080 WORK WE HAVE TO DO BUT THAT IS 6288 03:46:35,080 --> 03:46:39,240 ALL WE KNOW. 6289 03:46:39,240 --> 03:46:42,040 >> THERE HAD BEEN A QUESTION 6290 03:46:42,040 --> 03:46:45,360 ACTUALLY FOR DR. POLLACK NOT 6291 03:46:45,360 --> 03:46:47,280 SURE WAS HERE AT THE MOMENT BUT 6292 03:46:47,280 --> 03:46:49,960 LOOKING AT HOUSING INSECURITY 6293 03:46:49,960 --> 03:46:51,720 ALONGSIDE MENTAL HEALTH 6294 03:46:51,720 --> 03:46:53,640 CONDITIONS AND REALLY NOTICING 6295 03:46:53,640 --> 03:46:55,000 THAT PEOPLE DESTABILIZE WHEN 6296 03:46:55,000 --> 03:46:57,320 HOUSING SITUATION BECOMES MORE 6297 03:46:57,320 --> 03:46:58,880 TENUOUS AND BEING CURIOUS 6298 03:46:58,880 --> 03:47:00,040 WHETHER THERE HAVE BEEN 6299 03:47:00,040 --> 03:47:01,240 INTERVENTION STUDIES EXAMINING 6300 03:47:01,240 --> 03:47:03,000 THAT RELATIONSHIP CURIOUS IF 6301 03:47:03,000 --> 03:47:04,000 ANYBODY ELSE MIGHT BE ABLE TO 6302 03:47:04,000 --> 03:47:08,320 ANSWER THAT QUESTION. 6303 03:47:08,320 --> 03:47:10,040 EVEN PEOPLE WHO SAY THEY HAVE 6304 03:47:10,040 --> 03:47:10,840 SPOKEN A LOT FEEL FREE THE CHIME 6305 03:47:10,840 --> 03:47:17,680 IN. 6306 03:47:17,680 --> 03:47:21,200 >> I THINK THERE IS A GOOD BOOK. 6307 03:47:21,200 --> 03:47:24,000 IS IT JEFF -- HAS WRITTEN 6308 03:47:24,000 --> 03:47:25,760 EVICTION, HE'S DONE A LOT OF 6309 03:47:25,760 --> 03:47:27,320 WORK AROUND HOUSING INSTABILITY 6310 03:47:27,320 --> 03:47:31,280 EVICTION AND MENTAL HEALTH AND 6311 03:47:31,280 --> 03:47:34,480 SO HIS WORK IS FANTASTIC IF 6312 03:47:34,480 --> 03:47:36,160 ANYBODY IS NOT FAMILIAR WITH IT. 6313 03:47:36,160 --> 03:47:41,200 STRONG EVIDENCE OF THAT. 6314 03:47:41,200 --> 03:47:42,440 SOMETIMES IT IS FUNNY BECAUSE 6315 03:47:42,440 --> 03:47:44,520 LIKE WHEN WE ARE TALKING OPIOID 6316 03:47:44,520 --> 03:47:48,560 ADDICTION FOR EXAMPLE, EDs 6317 03:47:48,560 --> 03:47:49,800 HAVE BEEN RELUCTANT TO GET 6318 03:47:49,800 --> 03:47:50,720 INVOLVED IN THAT. 6319 03:47:50,720 --> 03:47:53,800 THAT IS -- GOES BACK TO RENEE'S 6320 03:47:53,800 --> 03:47:56,600 POINT YESTERDAY ABOUT SOME TIMES 6321 03:47:56,600 --> 03:47:57,880 STRUCTURAL INEQUITIES WHERE HERE 6322 03:47:57,880 --> 03:48:02,680 WE HAVE PEOPLE COMING IN IN DIRE 6323 03:48:02,680 --> 03:48:05,720 NEED OF TREATMENT AND WE HAVE 6324 03:48:05,720 --> 03:48:07,040 IGNORED THAT UNTIL RECENTLY 6325 03:48:07,040 --> 03:48:08,400 UNTIL THE YALE STUDY WAS DONE 6326 03:48:08,400 --> 03:48:11,160 AND SHOWED THAT, YOU KNOW, WE 6327 03:48:11,160 --> 03:48:12,920 START THE PROCESS IN THE ED WE 6328 03:48:12,920 --> 03:48:14,240 ARE MORE SUCCESSFUL AT MOVING 6329 03:48:14,240 --> 03:48:17,040 PEOPLE INTO LONGER TREATMENT. 6330 03:48:17,040 --> 03:48:18,520 WE WERE AFRAID TO TACKLE THAT 6331 03:48:18,520 --> 03:48:22,720 FOR A LONG TIME. 6332 03:48:22,720 --> 03:48:25,080 >> THEY THINK IT IS CONFUSING TO 6333 03:48:25,080 --> 03:48:26,640 PROVIDERS BECAUSE OPIOID MISUSE 6334 03:48:26,640 --> 03:48:30,040 DISORDER HAS REALLY BECOME 6335 03:48:30,040 --> 03:48:33,160 CONFLATED WITH NEED FORE PAIN 6336 03:48:33,160 --> 03:48:33,800 TREATMENT. 6337 03:48:33,800 --> 03:48:36,120 STUDIES HAVE SHOWN -- ONE BY DR. 6338 03:48:36,120 --> 03:48:39,920 ANDREA OUT OF DANA-FARBER THAT 6339 03:48:39,920 --> 03:48:43,440 LOOKED AT DATA BETWEEN 2007 AND 6340 03:48:43,440 --> 03:48:45,360 2017 OF CANCER INCIDENCE AND 6341 03:48:45,360 --> 03:48:47,280 SHOWED THIS MARKED INCREASE OF 6342 03:48:47,280 --> 03:48:50,600 ED HOSPITALIZATIONS RELATED TO 6343 03:48:50,600 --> 03:48:52,880 PAIN ADMISSION AND SUBSEQUENT 6344 03:48:52,880 --> 03:48:55,200 HOSPITALIZATION DUE TO PAIN 6345 03:48:55,200 --> 03:48:55,680 ALONGSIDE STATISTICALLY 6346 03:48:55,680 --> 03:48:59,440 SIGNIFICANT DECREASE IN OPIOID 6347 03:48:59,440 --> 03:49:00,960 PRESCRIBING. 6348 03:49:00,960 --> 03:49:02,400 SO THE LACK OF CLINICAL GUIDANCE 6349 03:49:02,400 --> 03:49:04,360 FOR A LOT OF CLINICS HOW TO 6350 03:49:04,360 --> 03:49:05,880 MANAGE OPIOID MISUSE DISORDER AS 6351 03:49:05,880 --> 03:49:08,640 A DISTINCT MEDICAL CONDITION 6352 03:49:08,640 --> 03:49:09,800 VERSUS ADEQUATELY ETHICALLY 6353 03:49:09,800 --> 03:49:12,840 TREATING PAIN AND DISTRESS. 6354 03:49:12,840 --> 03:49:14,680 LAUREN DID YOU WANT TO ADD 6355 03:49:14,680 --> 03:49:17,040 SOMETHING? 6356 03:49:17,040 --> 03:49:18,920 >> I WAS GOING TO VALIDATE THE 6357 03:49:18,920 --> 03:49:19,800 POINT THERE ARE NUMBER OF 6358 03:49:19,800 --> 03:49:21,800 HOUSING STUDIES THAT SHOW 6359 03:49:21,800 --> 03:49:23,080 IMPROVEMENT IN MENTAL HEALTH AND 6360 03:49:23,080 --> 03:49:24,440 I THINK IT UNDERSCORES HOW 6361 03:49:24,440 --> 03:49:26,280 IMPORTANT IT IS TO MEASURE 6362 03:49:26,280 --> 03:49:30,400 MENTAL HEALTH OUTCOMES IN 6363 03:49:30,400 --> 03:49:32,160 VARIETY OF INTERVENTION CONTEXT 6364 03:49:32,160 --> 03:49:33,160 BECAUSE REALITIES OF RESEARCH 6365 03:49:33,160 --> 03:49:35,320 MEAN WE ARE OFTEN NOT FOLLOWING 6366 03:49:35,320 --> 03:49:37,200 PEOPLE LONGITUDINALLY UNTIL THE 6367 03:49:37,200 --> 03:49:38,080 FIVE YEAR MARK OR SEVEN YEAR 6368 03:49:38,080 --> 03:49:40,240 MARK OR TEN YEAR MARK AN MENTAL 6369 03:49:40,240 --> 03:49:41,280 HEALTH CHANGES ARE THINGS THAT 6370 03:49:41,280 --> 03:49:42,120 OCCUR FIRST. 6371 03:49:42,120 --> 03:49:44,480 SO WHEN YOU ONLY HAVE FUNDING 6372 03:49:44,480 --> 03:49:46,440 FOR THREE YEAR STUDY OR FUN YEAR 6373 03:49:46,440 --> 03:49:48,720 STUDY YOU CATCH A CHANGE IN 6374 03:49:48,720 --> 03:49:49,840 MENTAL HEALTH OUTCOMES BEFORE 6375 03:49:49,840 --> 03:49:51,280 YOU WOULD HAVE POTENTIALLY 6376 03:49:51,280 --> 03:49:52,080 CAUGHT A CHANGE IN PHYSICAL 6377 03:49:52,080 --> 03:49:55,440 HEALTH OUTCOMES SO THAT HOUSING 6378 03:49:55,440 --> 03:49:57,120 REVIEW I DROPPED IN THE CHAT I 6379 03:49:57,120 --> 03:49:59,120 DID A FEW YEARS AGO BUT IN TERMS 6380 03:49:59,120 --> 03:50:00,160 OF CONNECTING HOUSING 6381 03:50:00,160 --> 03:50:02,600 IMPROVEMENT OF VARIOUS GUYSES, 6382 03:50:02,600 --> 03:50:04,760 TO HELP IMPROVEMENT, THE 6383 03:50:04,760 --> 03:50:05,880 STRONGEST CONNECTION IS BETWEEN 6384 03:50:05,880 --> 03:50:07,080 HOUSING IMPROVEMENT AND VARIOUS 6385 03:50:07,080 --> 03:50:10,720 KINDS OF MENTAL HEALTH. 6386 03:50:10,720 --> 03:50:11,720 >> THANKS LAUREN. 6387 03:50:11,720 --> 03:50:14,880 >> LAUREN'S POINT ALSO MAKES ME 6388 03:50:14,880 --> 03:50:15,440 THINK ABOUT SOMETHING ALSO 6389 03:50:15,440 --> 03:50:17,040 TRYING TO EXPLORE IN TERMS OF 6390 03:50:17,040 --> 03:50:20,440 LASH NATURAL FOR SCREENING AND 6391 03:50:20,440 --> 03:50:22,640 WE HAVE DONE A STUDY AND SOME 6392 03:50:22,640 --> 03:50:24,640 OTHER GROUPS HAVE FOUND PATIENTS 6393 03:50:24,640 --> 03:50:25,960 REPORT BENEFIT FROM JUST BEING 6394 03:50:25,960 --> 03:50:27,480 ASKED ABOUT SOCIAL RISK. 6395 03:50:27,480 --> 03:50:29,440 SO THAT BEING HELPING WITH 6396 03:50:29,440 --> 03:50:32,160 STRENGTHENING RELATIONSHIPS AND 6397 03:50:32,160 --> 03:50:33,400 RAPPORT, WE HAVEN'T SPECIFICALLY 6398 03:50:33,400 --> 03:50:34,480 LOOKED AT IT, I DON'T BELIEVE 6399 03:50:34,480 --> 03:50:35,920 OTHERS IN TERMS OF RELATIONSHIP 6400 03:50:35,920 --> 03:50:37,440 BETWEEN THAT AND THEN MENTAL 6401 03:50:37,440 --> 03:50:39,320 HEALTH DRAWING THAT LINK 6402 03:50:39,320 --> 03:50:40,120 EXPLICITLY BUT IT IS ANOTHER 6403 03:50:40,120 --> 03:50:43,160 INTERESTING AREA TO EXPLORE THAT 6404 03:50:43,160 --> 03:50:44,800 BEYOND THE ASSISTANCE OR LIKE 6405 03:50:44,800 --> 03:50:46,240 ADJUSTMENT TO MEDICAL CARE WE 6406 03:50:46,240 --> 03:50:47,680 PROVIDE, ARE THERE POTENTIAL 6407 03:50:47,680 --> 03:50:49,440 BENEFITS IN ADDITION TO 6408 03:50:49,440 --> 03:50:50,440 POTENTIAL INTENDED CONSEQUENCES 6409 03:50:50,440 --> 03:50:52,880 AND HARMS WE MIGHT BE DOING WITH 6410 03:50:52,880 --> 03:50:53,640 SCREENING THAT WOULD BE 6411 03:50:53,640 --> 03:50:57,960 INTERESTING TO FURTHER EXPLORE. 6412 03:50:57,960 --> 03:50:59,080 >> SO SHIFTING GEARS A LITTLE 6413 03:50:59,080 --> 03:51:01,840 BIT I HAVE A QUESTION FOR DR. 6414 03:51:01,840 --> 03:51:02,720 BRISTOL. 6415 03:51:02,720 --> 03:51:04,480 DR. BRISTOL CAN YOU SPEAK TO 6416 03:51:04,480 --> 03:51:06,880 IMPACT OF THE COVID PANDEMIC AND 6417 03:51:06,880 --> 03:51:08,280 VISITOR RESTRICTION POLICIES 6418 03:51:08,280 --> 03:51:10,040 HAVE HAD ON UNMET CAREGIVER 6419 03:51:10,040 --> 03:51:11,360 SOCIAL NEEDS AND DO YOU HAVE ANY 6420 03:51:11,360 --> 03:51:12,960 SUGGESTIONS ABOUT HOW WE MIGHT 6421 03:51:12,960 --> 03:51:16,640 ADDRESS THOSE NEEDS AS 6422 03:51:16,640 --> 03:51:17,160 RESTRICTIONS CONTINUE AND 6423 03:51:17,160 --> 03:51:18,920 SYSTEMS PREPARE FOR FUTURE COVID 6424 03:51:18,920 --> 03:51:20,120 SURGES. 6425 03:51:20,120 --> 03:51:23,320 >> GREAT QUESTION. 6426 03:51:23,320 --> 03:51:24,440 THANK YOU. 6427 03:51:24,440 --> 03:51:25,880 THIS -- WHEN WE WERE CONDUCTING 6428 03:51:25,880 --> 03:51:31,080 OUR INTERVIEWS WE ACTUALLY HAD 6429 03:51:31,080 --> 03:51:32,400 CAREGIVERS WHO WERE AT DIFFERENT 6430 03:51:32,400 --> 03:51:35,040 POINTS OF THE COVID PERIOD SO 6431 03:51:35,040 --> 03:51:36,600 THERE WAS SOME PERIODS WHERE 6432 03:51:36,600 --> 03:51:40,400 THEY HAD VERY LITTLE ACCESS TO 6433 03:51:40,400 --> 03:51:41,040 VISITATION. 6434 03:51:41,040 --> 03:51:43,040 SOME PERIODS WHERE VISITATION 6435 03:51:43,040 --> 03:51:44,880 POLICY WAS RELAXED BUT THERE IS 6436 03:51:44,880 --> 03:51:48,600 DEFINITELY A SIGNIFICANT OVERALL 6437 03:51:48,600 --> 03:51:53,040 IMPACT COVID HAD FOR CAREGIVERS, 6438 03:51:53,040 --> 03:51:54,320 ONE CAREGIVER JUST STORY JUST 6439 03:51:54,320 --> 03:51:58,880 STANDS OUT TO ME, SHARED HOW HER 6440 03:51:58,880 --> 03:52:02,080 HUSBAND WAS SCHEDULED FOR 6441 03:52:02,080 --> 03:52:03,320 SURGERY AND THOUGHT IT WAS AN 6442 03:52:03,320 --> 03:52:06,840 OUTPATIENT PROCEDURE, HE DROVE 6443 03:52:06,840 --> 03:52:08,720 HIMSELF, AND TOLD HIS WIFE I 6444 03:52:08,720 --> 03:52:10,280 WILL BE BACK LATER THIS 6445 03:52:10,280 --> 03:52:11,440 AFTERNOON, SHE WAS NOT ALLOWED 6446 03:52:11,440 --> 03:52:14,040 TO GO WITH HIM TO THE 6447 03:52:14,040 --> 03:52:16,240 PRE-SURGICAL VISIT SO SHE JUST 6448 03:52:16,240 --> 03:52:18,320 THOUGHT HE WAS TELLING THE 6449 03:52:18,320 --> 03:52:18,520 TRUTH. 6450 03:52:18,520 --> 03:52:21,000 HE SHOWED UP, IT WAS AN 6451 03:52:21,000 --> 03:52:22,120 INPATIENT HOSPITAL STAY, LONG 6452 03:52:22,120 --> 03:52:23,440 STORY SHORT HE WAS IN THE 6453 03:52:23,440 --> 03:52:26,000 HOSPITAL FOR FIVE DAYS, AND JUST 6454 03:52:26,000 --> 03:52:28,640 THE PANIC AND THE DIFFICULTY 6455 03:52:28,640 --> 03:52:31,320 THAT CAUSED FOR THEM OVER THAT 6456 03:52:31,320 --> 03:52:34,880 COMMUNICATION ISSUE, WAS VERY 6457 03:52:34,880 --> 03:52:36,480 SIGNIFICANT FOR THAT POST 6458 03:52:36,480 --> 03:52:38,640 DISCHARGE COPING AND THE 6459 03:52:38,640 --> 03:52:41,360 DIFFICULTY THEY HAD IN ADJUSTING 6460 03:52:41,360 --> 03:52:45,800 TO THIS UNEXPECTED TYPE SURGICAL 6461 03:52:45,800 --> 03:52:48,800 EVENT. 6462 03:52:48,800 --> 03:52:50,360 SO DEFINITELY FOR CAREGIVERS FOR 6463 03:52:50,360 --> 03:52:52,600 OLDER ADULTS THE PRESENCE OF THE 6464 03:52:52,600 --> 03:52:55,000 CAREGIVER AT BEDSIDE IS 6465 03:52:55,000 --> 03:52:57,640 CRITICAL, CAREGIVERS RECOGNIZE 6466 03:52:57,640 --> 03:53:00,040 IF THEY ARE NOT AT THE BEDSIDE 6467 03:53:00,040 --> 03:53:01,440 THE HEALTHCARE SYSTEM TENDS NOT 6468 03:53:01,440 --> 03:53:04,360 TO REACH OUT AND INCLUDE THEM 6469 03:53:04,360 --> 03:53:05,880 AND GIVE THEM UPDATES. 6470 03:53:05,880 --> 03:53:07,880 SO THERE IS A CHALLENGE IN 6471 03:53:07,880 --> 03:53:10,880 KNOWING WHAT IS GOING ON AND 6472 03:53:10,880 --> 03:53:14,040 THEN THE SCARY RESPONSIBILITY OF 6473 03:53:14,040 --> 03:53:16,680 I HAVE TO ASSUME ALL THESE NEW 6474 03:53:16,680 --> 03:53:17,640 THINGS BUT I DON'T KNOW WHAT I 6475 03:53:17,640 --> 03:53:20,280 NEED TO DO, I WASN'T THERE. 6476 03:53:20,280 --> 03:53:23,040 IT IS JUST CAN BE VERY 6477 03:53:23,040 --> 03:53:23,360 OVERWHELMING. 6478 03:53:23,360 --> 03:53:25,120 TO THE QUESTION EARLIER ABOUT 6479 03:53:25,120 --> 03:53:28,320 MENTAL HEALTH I WAS GOING TO ADD 6480 03:53:28,320 --> 03:53:29,760 THAT OFTEN WE FORGET THE MENTAL 6481 03:53:29,760 --> 03:53:31,680 HEALTH OF FAMILY MEMBERS OR 6482 03:53:31,680 --> 03:53:34,640 MENTAL HEALTH OF THE CAREGIVER 6483 03:53:34,640 --> 03:53:37,960 CAN DRAMATICALLY IMPACT THE 6484 03:53:37,960 --> 03:53:39,320 INDIVIDUAL PATIENT AND 6485 03:53:39,320 --> 03:53:42,680 DRAMATICALLY IMPACT THE WHOLE 6486 03:53:42,680 --> 03:53:44,640 WELL BEING OF THE RELATIONSHIP 6487 03:53:44,640 --> 03:53:47,320 OF THE FAMILY UNIT. 6488 03:53:47,320 --> 03:53:50,640 SO DEFINITELY WE UNDERSTAND WHY 6489 03:53:50,640 --> 03:53:53,080 THERE WAS VISITOR RESTRICTION 6490 03:53:53,080 --> 03:53:54,800 DURING COVID SO THE NEGATIVE 6491 03:53:54,800 --> 03:53:57,760 CONSEQUENCES OF THAT FOR OLDER 6492 03:53:57,760 --> 03:53:59,280 ADULTS IS VERY SIGNIFICANT. 6493 03:53:59,280 --> 03:54:01,560 >> THANK YOU SO MUCH. 6494 03:54:01,560 --> 03:54:05,000 I ALSO WANT TO HE CAN KNOW WHAT 6495 03:54:05,000 --> 03:54:05,680 TANYA STROUT HAS WRITTEN MANY 6496 03:54:05,680 --> 03:54:07,040 CHAT NOT HAVING FAMILIES AND 6497 03:54:07,040 --> 03:54:08,720 CAREGIVERS IN THE ED DURING THE 6498 03:54:08,720 --> 03:54:10,120 PANDEMIC WAS ONE OF THE WORST 6499 03:54:10,120 --> 03:54:12,040 THING, AS A PALLIATIVE 6500 03:54:12,040 --> 03:54:13,640 SPECIALIST MYSELF I'M PATHOSES 6501 03:54:13,640 --> 03:54:15,440 WITH THAT FOR PEOPLE NOT ABLE TO 6502 03:54:15,440 --> 03:54:16,840 BE WITH THEIR LOVED ONES AT THE 6503 03:54:16,840 --> 03:54:18,800 END OF LIFE AND OF COURSE THAT 6504 03:54:18,800 --> 03:54:20,600 IS GOING TO INFORM A WHOLE WAVE 6505 03:54:20,600 --> 03:54:23,640 OF COMPLICATED GRIEF AND MASS 6506 03:54:23,640 --> 03:54:24,560 BEREAVEMENT IN THAT SENSE. 6507 03:54:24,560 --> 03:54:27,440 I'M ALSO CURIOUS DR. BRISTOL 6508 03:54:27,440 --> 03:54:29,840 ABOUT CAREGIVERS FROM 6509 03:54:29,840 --> 03:54:30,520 HISTORICICALLY EXCLUDED GROUPS, 6510 03:54:30,520 --> 03:54:33,360 SOME OF MY WORK IS ABOUT LGBTQ 6511 03:54:33,360 --> 03:54:35,360 IDENTIFIED PATIENTS AND THEIR 6512 03:54:35,360 --> 03:54:37,360 CHOSEN FAMILIES. 6513 03:54:37,360 --> 03:54:41,200 SO WE HAVE JUST WORKED ON A 6514 03:54:41,200 --> 03:54:43,720 PROJECT AROUND REALLY HELPING TO 6515 03:54:43,720 --> 03:54:47,320 ENSURE THE CHOSEN FAMILIES OF 6516 03:54:47,320 --> 03:54:49,280 LGBTQ IDENTIFIED PATIENTS WHO 6517 03:54:49,280 --> 03:54:51,120 VERY OFTEN FORM SOCIAL SUPPORT 6518 03:54:51,120 --> 03:54:52,280 STRUCTURE FOR THESE PATIENTS AND 6519 03:54:52,280 --> 03:54:54,640 THE ILLNESS CONTEXT. 6520 03:54:54,640 --> 03:54:56,800 ARE SEEN AND VIEWED BY HEALTH 6521 03:54:56,800 --> 03:54:58,280 SYSTEMS AS CAREGIVERS OR 6522 03:54:58,280 --> 03:55:01,080 INCLUDED IN DECISION MAKING AND 6523 03:55:01,080 --> 03:55:01,920 CARE PLANNING PROCESSES OR 6524 03:55:01,920 --> 03:55:03,400 INTEGRATED TO SOCIAL 6525 03:55:03,400 --> 03:55:04,240 PRESCRIBING, ET CETERA. 6526 03:55:04,240 --> 03:55:05,400 CURIOUS IF YOU HAVE SEEN ANY OF 6527 03:55:05,400 --> 03:55:06,800 THAT IN YOUR WORK OR HAVE 6528 03:55:06,800 --> 03:55:08,080 ANYTHING TO ADD ABOUT HOW WE CAN 6529 03:55:08,080 --> 03:55:13,160 ACCOUNT FOR THAT. 6530 03:55:13,160 --> 03:55:14,680 >> YES, I HAVE UNFORTUNATELY 6531 03:55:14,680 --> 03:55:14,960 SEEN THAT. 6532 03:55:14,960 --> 03:55:18,720 AS I HIGHLIGHTED WHEN WE SEE THE 6533 03:55:18,720 --> 03:55:19,320 NON-TRADITIONAL RELATIONSHIPS 6534 03:55:19,320 --> 03:55:21,880 WHERE IT IS A FRIEND OR SOMEONE 6535 03:55:21,880 --> 03:55:25,560 MAYBE NOT RECOGNIZES AS SPOUSE 6536 03:55:25,560 --> 03:55:25,920 PARTNER. 6537 03:55:25,920 --> 03:55:27,400 THERE'S ADDITIONAL BARRIERS TO 6538 03:55:27,400 --> 03:55:30,560 BE INCLUDED OR TO BE RECOGNIZED 6539 03:55:30,560 --> 03:55:34,640 AS THE PERSON OF CONTACT. 6540 03:55:34,640 --> 03:55:38,840 OFTEN IF CAREGIVERS OFTEN 6541 03:55:38,840 --> 03:55:41,320 HEALTHCARE STAFF MAY AGAIN DUE 6542 03:55:41,320 --> 03:55:42,600 TO CHAOTIC ENVIRONMENT PROVIDING 6543 03:55:42,600 --> 03:55:45,520 CARE IT IS EASY TO OVERLOOK 6544 03:55:45,520 --> 03:55:47,320 FAMILIES NOT PRESENT AND DO I 6545 03:55:47,320 --> 03:55:49,080 NEED TO REACH OUT TO SOMEONE TO 6546 03:55:49,080 --> 03:55:51,600 INCLUDE THEM IN COMMUNICATION 6547 03:55:51,600 --> 03:55:52,520 ABOUT CARE PLANNING, DECISIONS 6548 03:55:52,520 --> 03:55:55,200 THAT NEED TO BE MADE, ET CETERA. 6549 03:55:55,200 --> 03:55:58,160 SO IF THE CAREGIVER IS NOT 6550 03:55:58,160 --> 03:56:01,760 SOMEONE WHO IS LISTED AS SPOUSE 6551 03:56:01,760 --> 03:56:06,160 THEN THEY FACE ADDITIONAL 6552 03:56:06,160 --> 03:56:07,640 BARRIERS ABOUT HIPAA CONCERNS, 6553 03:56:07,640 --> 03:56:08,680 CAN WE SHARE INFORMATION WITH 6554 03:56:08,680 --> 03:56:12,000 THIS PERSON, NOT MARRIED, WHAT 6555 03:56:12,000 --> 03:56:13,200 KIND OF STAFF MAY WORRY ABOUT 6556 03:56:13,200 --> 03:56:13,800 THAT. 6557 03:56:13,800 --> 03:56:17,120 SO DEFINITELY THERE ARE THOSE 6558 03:56:17,120 --> 03:56:21,320 BARRIERS AND SO WE REALLY IN THE 6559 03:56:21,320 --> 03:56:24,200 EHRs THERE ARE PLACES TO LIST 6560 03:56:24,200 --> 03:56:25,720 POINT OF CONTACT, THE PERSON TO 6561 03:56:25,720 --> 03:56:27,800 CONTACT BUT THERE IS NOT ALWAYS 6562 03:56:27,800 --> 03:56:30,560 A CLEAR PLACE TO LIST THIS 6563 03:56:30,560 --> 03:56:33,880 PERSON HAS THIS CAREGIVER PLEASE 6564 03:56:33,880 --> 03:56:36,040 ENSURE THAT YOU COMMUNICATE WITH 6565 03:56:36,040 --> 03:56:37,000 THIS INDIVIDUAL. 6566 03:56:37,000 --> 03:56:39,360 GOING FORWARD THAT IS A -- 6567 03:56:39,360 --> 03:56:42,040 SOMETHING THAT IS IMPORTANT TO 6568 03:56:42,040 --> 03:56:43,800 THINK ABOUT HOW DO WE BUILD THAT 6569 03:56:43,800 --> 03:56:47,280 IN, HOW DO WE WHEN PATIENTS ARE 6570 03:56:47,280 --> 03:56:48,360 TRANSITIONING BETWEEN UNITS DO 6571 03:56:48,360 --> 03:56:50,600 WE MAKE SURE THAT INFORMATION 6572 03:56:50,600 --> 03:56:51,800 GOES ALONG WITH THE PATIENT. 6573 03:56:51,800 --> 03:56:54,200 SO THEY DON'T HAVE TO ARRIVE AT 6574 03:56:54,200 --> 03:56:56,080 THE NEW LOCATION AND TELL 6575 03:56:56,080 --> 03:56:57,880 EVERYONE AGAIN I HAVE THIS 6576 03:56:57,880 --> 03:56:59,040 PERSON PLACE CONTACT THEM, 6577 03:56:59,040 --> 03:57:00,080 PLEASE MAKE SURE YOU INCLUDE 6578 03:57:00,080 --> 03:57:00,480 THEM. 6579 03:57:00,480 --> 03:57:03,320 SO REALLY THINKING HOW THAT IS 6580 03:57:03,320 --> 03:57:08,040 MORE SMOOTHLY INCORPORATED AND 6581 03:57:08,040 --> 03:57:09,880 SCHEMEATICALLY DONE FOR EVERY 6582 03:57:09,880 --> 03:57:12,880 PATIENT WITH A SIGNIFICANT 6583 03:57:12,880 --> 03:57:14,440 PARTNER OR CAREGIVER IS A REALLY 6584 03:57:14,440 --> 03:57:16,400 IMPORTANT THING TO THINK ABOUT. 6585 03:57:16,400 --> 03:57:19,080 >> THANK YOU SO MUCH, DR. 6586 03:57:19,080 --> 03:57:19,480 BRISTOL. 6587 03:57:19,480 --> 03:57:21,560 SO WE HAVE A FEW MINUTES LEFT, I 6588 03:57:21,560 --> 03:57:23,840 WILL ASK MY QUESTION, IF THAT IS 6589 03:57:23,840 --> 03:57:24,440 OKAY. 6590 03:57:24,440 --> 03:57:26,240 SO MY QUESTION IS ABOUT ACTUALLY 6591 03:57:26,240 --> 03:57:27,640 THE SOCIAL DETERMINANTS OF 6592 03:57:27,640 --> 03:57:28,080 HEALTHCARE WORKERS. 6593 03:57:28,080 --> 03:57:32,800 SO WE HAVE TALKED ABOUT PATIENTS 6594 03:57:32,800 --> 03:57:38,000 AND POPULATIONS, AND DIFFERENT 6595 03:57:38,000 --> 03:57:39,280 GROUPINGS WITHIN THE U.S. 6596 03:57:39,280 --> 03:57:40,840 POPULATION LARGELY. 6597 03:57:40,840 --> 03:57:42,840 BUT GIVEN THE COVID PANDEMIC AND 6598 03:57:42,840 --> 03:57:45,400 ALL REPORTS OF BURN OUT MORAL 6599 03:57:45,400 --> 03:57:47,280 SUFFERING AND TURN OVER, IN SOME 6600 03:57:47,280 --> 03:57:49,400 OF THE MORE GLOBAL REPORTS ON 6601 03:57:49,400 --> 03:57:50,640 THE SOCIAL DETERMINANTS OF 6602 03:57:50,640 --> 03:57:52,640 HEALTH DOCTORS FOR HEALTH EQUITY 6603 03:57:52,640 --> 03:57:55,040 REPORT, LED BY WHO NURSES FOR 6604 03:57:55,040 --> 03:57:56,240 HEALTH EQUITY REPORT, THERE HAVE 6605 03:57:56,240 --> 03:57:58,480 BEEN A LOT OF RECOMMENDATIONS 6606 03:57:58,480 --> 03:58:00,240 ABOUT HEALTH SYSTEMS AND THE 6607 03:58:00,240 --> 03:58:01,040 ROLES OF HEALTHCARE 6608 03:58:01,040 --> 03:58:02,400 ORGANIZATIONS AS EMPLOYERS AND 6609 03:58:02,400 --> 03:58:04,760 MANAGERS AND COMMISSIONERS WHO 6610 03:58:04,760 --> 03:58:05,800 ARE REALLY ACCOUNTABLE FOR 6611 03:58:05,800 --> 03:58:08,240 ENSURING THE WELFARE AND THE 6612 03:58:08,240 --> 03:58:09,800 WELL BEING AND DIVERSITY AND 6613 03:58:09,800 --> 03:58:11,000 INCLUSION OF HEALTHCARE WORKERS. 6614 03:58:11,000 --> 03:58:14,400 SO I'M CURIOUS UP FROM YOU AS 6615 03:58:14,400 --> 03:58:15,320 RESEARCHERS WHAT STEPS DO YOU 6616 03:58:15,320 --> 03:58:20,640 FOR SEE NEEDING TO TAKE FOR ED 6617 03:58:20,640 --> 03:58:23,120 HEALTH BEHAVIORS TO ENSURE THEIR 6618 03:58:23,120 --> 03:58:24,320 SOCIAL DETERMINANTS OF HEALTH 6619 03:58:24,320 --> 03:58:25,200 ARE ADDRESSED SO THAT WE CAN 6620 03:58:25,200 --> 03:58:38,640 REALLY SUSTAIN AND SUPPORT THEM? 6621 03:58:38,640 --> 03:58:39,240 GO AHEAD ANDREA JAY. 6622 03:58:39,240 --> 03:58:40,240 >> OUR HEALTH SYSTEM IS 6623 03:58:40,240 --> 03:58:42,360 INVESTIGATING A NUMBER OF 6624 03:58:42,360 --> 03:58:44,320 PROGRAMS TO TRY TO FIGURE OUT 6625 03:58:44,320 --> 03:58:46,400 HOW TO ADDRESS THIS. 6626 03:58:46,400 --> 03:58:47,880 ONE HAS BEEN A RELATIONAL 6627 03:58:47,880 --> 03:58:51,320 LEADERSHIP MODEL, I AM TRYING TO 6628 03:58:51,320 --> 03:58:54,640 FOSTER THIS IDEA OF 6629 03:58:54,640 --> 03:58:57,120 CONNECTEDNESS AND WITHOUT GOING 6630 03:58:57,120 --> 03:58:58,560 INTO DETAILS WHAT INVOLVED IN 6631 03:58:58,560 --> 03:58:59,160 THAT. 6632 03:58:59,160 --> 03:59:01,440 I DO KNOW THAT WE HAVE BEEN 6633 03:59:01,440 --> 03:59:04,560 TRYING TO FIGURE OUT WHAT IT IS 6634 03:59:04,560 --> 03:59:06,200 AGAIN I FEEL LIKE EVERY ANSWER I 6635 03:59:06,200 --> 03:59:07,560 GIVE I RAISE MORE QUESTIONS. 6636 03:59:07,560 --> 03:59:10,800 BUT I DO KNOW THAT IT HAS BEEN 6637 03:59:10,800 --> 03:59:12,280 AN ACTIVE PURSUIT BY HEALTHCARE 6638 03:59:12,280 --> 03:59:13,360 SYSTEMS OUT THERE BOTH OUR OWN 6639 03:59:13,360 --> 03:59:16,440 AS WELL AS OUR OTHERS, OTHER 6640 03:59:16,440 --> 03:59:19,800 SYSTEMS IN THE AREA. 6641 03:59:19,800 --> 03:59:22,680 THAT IS ONE MODEL, LEADERSHIP 6642 03:59:22,680 --> 03:59:23,040 MODEL. 6643 03:59:23,040 --> 03:59:24,480 >> EXCITING. 6644 03:59:24,480 --> 03:59:24,880 THANK YOU. 6645 03:59:24,880 --> 03:59:25,840 ANY OTHER THOUGHTS ON THAT 6646 03:59:25,840 --> 03:59:30,200 QUESTION? 6647 03:59:30,200 --> 03:59:30,840 ALL RIGHT. 6648 03:59:30,840 --> 03:59:32,240 ANY FINAL THOUGHTS OVERALL 6649 03:59:32,240 --> 03:59:36,960 BEFORE WE CLOSE? 6650 03:59:36,960 --> 03:59:40,360 SO AS WE PREPARE FOR THIS FINAL 6651 03:59:40,360 --> 03:59:42,440 KEYNOTE FROM DR. PHYLLIS SHARPS 6652 03:59:42,440 --> 03:59:45,320 I WANT TO CALL THE MEMORY OF DR. 6653 03:59:45,320 --> 03:59:47,000 PAUL FARMER AGAIN AND 6654 03:59:47,000 --> 03:59:48,080 FUNDAMENTAL TRUTH OF HEALTH AS A 6655 03:59:48,080 --> 03:59:49,200 HUMAN RIGHT AND LEAVE YOU WITH 6656 03:59:49,200 --> 03:59:50,000 THIS QUOTE. 6657 03:59:50,000 --> 03:59:52,240 HE SAID THAT HUMAN RIGHTS 6658 03:59:52,240 --> 03:59:54,120 VIOLATIONS ARE NOT ACCIDENTS. 6659 03:59:54,120 --> 03:59:56,400 THEY ARE NOT RANDOM IN 6660 03:59:56,400 --> 03:59:59,200 DISTRIBUTION OR EFFECT. 6661 03:59:59,200 --> 04:00:00,240 RIGHTS VIOLATIONS ARE RATHER 6662 04:00:00,240 --> 04:00:02,880 SYMPTOMS OF DEEPER PATHOLOGIES 6663 04:00:02,880 --> 04:00:04,880 OF POWER AND ARE LINKED 6664 04:00:04,880 --> 04:00:06,400 INTIMATELY TO THE SOCIAL 6665 04:00:06,400 --> 04:00:07,160 CONDITIONS THAT SO OFTEN 6666 04:00:07,160 --> 04:00:09,280 DETERMINE WHO WILL SUFFER ABUSE 6667 04:00:09,280 --> 04:00:11,400 AND WHO WILL BE SHIELDED FROM 6668 04:00:11,400 --> 04:00:11,880 HARM. 6669 04:00:11,880 --> 04:00:13,760 I'M VERY, VERY GRATEFUL TO HAVE 6670 04:00:13,760 --> 04:00:14,640 MODERATED THIS DISCUSSION AND 6671 04:00:14,640 --> 04:00:16,400 I'M SO GRATEFUL TO THE 6672 04:00:16,400 --> 04:00:17,840 RESEARCHERS FOR ALL THE WORK 6673 04:00:17,840 --> 04:00:18,160 THAT YOU DO. 6674 04:00:18,160 --> 04:00:27,400 THANK YOU SO MUCH. 6675 04:00:27,400 --> 04:00:33,720 >> YOU ARE MUTED. 6676 04:00:33,720 --> 04:00:36,400 >> OF COURSE I AM, WE ARE STILL 6677 04:00:36,400 --> 04:00:38,280 -- THANK YOU SO MUCH, DR. ROSA 6678 04:00:38,280 --> 04:00:41,960 FOR THE FINAL COMMENTARY AS WELL 6679 04:00:41,960 --> 04:00:43,600 AS ENGAGING THOUGHTFUL 6680 04:00:43,600 --> 04:00:44,720 DISCUSSION WITH PARTICIPANTS, WE 6681 04:00:44,720 --> 04:00:46,360 THANK YOU PANELISTS AND I WILL 6682 04:00:46,360 --> 04:00:48,880 TURN IT OVER TO YVONNE BRYAN. 6683 04:00:48,880 --> 04:00:50,040 >> THANK YOU SO MUCH. 6684 04:00:50,040 --> 04:00:55,320 SO I'M YVONNE BRYAN, SENIOR 6685 04:00:55,320 --> 04:00:57,640 ADVISOR IN THE NINR OFFICE OF 6686 04:00:57,640 --> 04:00:58,240 DIRECTOR. 6687 04:00:58,240 --> 04:01:02,680 IT IS MY GREAT HONOR TO PRESENT 6688 04:01:02,680 --> 04:01:05,240 TO YOU THE END NOTE SPEAKER DR. 6689 04:01:05,240 --> 04:01:06,400 PHYLLIS SHARPS. 6690 04:01:06,400 --> 04:01:08,880 DR. SHARPS IS PROFESSOR EMERITUS 6691 04:01:08,880 --> 04:01:12,520 AND FORMER LCM LAWLER ENDOWED 6692 04:01:12,520 --> 04:01:14,640 CHAIR OF ASSOCIATE DEAN FOR 6693 04:01:14,640 --> 04:01:16,640 COMMUNITY PROGRAMS AND 6694 04:01:16,640 --> 04:01:18,960 INITIATIVES AT THE JOHNS HOPKINS 6695 04:01:18,960 --> 04:01:20,640 SCHOOL OF NURSING. 6696 04:01:20,640 --> 04:01:23,560 DR. SHARPS WAS INAUGURAL 6697 04:01:23,560 --> 04:01:25,760 DIRECTOR FOR THE JOHNS HOPKINS 6698 04:01:25,760 --> 04:01:27,960 SCHOOL OF NURSING CENTER FOR 6699 04:01:27,960 --> 04:01:30,040 COMMUNITY INNOVATION AND 6700 04:01:30,040 --> 04:01:30,760 SCHOLARSHIP. 6701 04:01:30,760 --> 04:01:33,600 THE EAST BALTIMORE COMMUNITY 6702 04:01:33,600 --> 04:01:35,040 NURSE CENTERS THREE COMMUNITY 6703 04:01:35,040 --> 04:01:36,960 NURSE LED INITIATIVES OF THE 6704 04:01:36,960 --> 04:01:39,160 SCHOOL OF NURSING. 6705 04:01:39,160 --> 04:01:41,600 SHE ALSO ESTABLISHED THE HEALTH 6706 04:01:41,600 --> 04:01:44,640 AND WELLNESS PROGRAM AT THE 6707 04:01:44,640 --> 04:01:45,960 HENDERSON HOPKINS PARTNERSHIP 6708 04:01:45,960 --> 04:01:47,240 SCHOOL. 6709 04:01:47,240 --> 04:01:48,960 HER PRACTICE AND RESEARCH 6710 04:01:48,960 --> 04:01:52,440 EXAMINE CONSEQUENCES OF INTIMATE 6711 04:01:52,440 --> 04:01:53,920 PARTNER VIOLENCE AMONG PREGNANT 6712 04:01:53,920 --> 04:01:57,600 AND PARENTING WOMEN. 6713 04:01:57,600 --> 04:01:59,360 SPECIFICALLY THE EFFECTS OF 6714 04:01:59,360 --> 04:02:01,280 INTIMATE PARTNER VIOLENCE ON THE 6715 04:02:01,280 --> 04:02:04,440 PHYSICAL AND MENTAL HEALTH OF 6716 04:02:04,440 --> 04:02:07,360 PREGNANT WOMEN INFANTS AND VERY 6717 04:02:07,360 --> 04:02:08,000 YOUNG CHILDREN. 6718 04:02:08,000 --> 04:02:09,760 SHE HAS PUBLISHED NUMEROUS 6719 04:02:09,760 --> 04:02:13,440 ARTICLES AND BOOK CHAPTERS ON 6720 04:02:13,440 --> 04:02:14,040 IMPROVING REPRODUCTIVE HEALTH 6721 04:02:14,040 --> 04:02:17,760 AND REDUCING VIOLENCE AMONG 6722 04:02:17,760 --> 04:02:19,080 AFRICAN AMERICAN WOMEN. 6723 04:02:19,080 --> 04:02:24,760 PLEASE JOIN ME IN WELCOMING DR. 6724 04:02:24,760 --> 04:02:26,800 SHARPS. 6725 04:02:26,800 --> 04:02:31,800 >> GOOD AFTERNOON. 6726 04:02:31,800 --> 04:02:41,080 AND I -- I AM VERY PLEASED TO 6727 04:02:41,080 --> 04:02:42,280 HAVE THE OPPORTUNITY TO -- SEE 6728 04:02:42,280 --> 04:02:45,960 IF I CAN GET THIS TO WORK. 6729 04:02:45,960 --> 04:02:48,520 VERY PLEASED TO HAVE THIS 6730 04:02:48,520 --> 04:02:49,880 OPPORTUNITIES TO PRESENT THE 6731 04:02:49,880 --> 04:02:53,360 KEYNOTE -- THE ENDING 6732 04:02:53,360 --> 04:02:53,640 REFLECTIONS. 6733 04:02:53,640 --> 04:02:55,440 I WOULD FIRST LIKE TO 6734 04:02:55,440 --> 04:02:57,080 ACKNOWLEDGE I AM PRESENTING FROM 6735 04:02:57,080 --> 04:03:01,440 MY HOME IN MARYLAND. 6736 04:03:01,440 --> 04:03:05,040 THE (INAUDIBLE) TRIBE WHICH COME 6737 04:03:05,040 --> 04:03:07,920 PRIDES (INDISCERNIBLE) I WOULD 6738 04:03:07,920 --> 04:03:10,200 ALSO SAY THAT I HAVE NO 6739 04:03:10,200 --> 04:03:11,240 DISCLOSURES BUT I WOULD -- WHILE 6740 04:03:11,240 --> 04:03:16,640 THIS IS NOT A PRESENTATION ON 6741 04:03:16,640 --> 04:03:17,920 RESEARCH, MENTION FROM WORK I 6742 04:03:17,920 --> 04:03:23,320 HAVE DONE WHICH WAS FUNDED BY 6743 04:03:23,320 --> 04:03:23,880 NINR AND NICHD. 6744 04:03:23,880 --> 04:03:26,720 LIKE TO TAKE THIS OPPORTUNITY TO 6745 04:03:26,720 --> 04:03:30,120 THANK THE NATIONAL INSTITUTES OF 6746 04:03:30,120 --> 04:03:31,400 NURSING RESEARCH, EMERGENCY 6747 04:03:31,400 --> 04:03:33,600 NURSING ASSOCIATION, AND ALL THE 6748 04:03:33,600 --> 04:03:36,040 MEMBERS OF THE PLANNING 6749 04:03:36,040 --> 04:03:39,320 COMMITTEE THAT GAVE ME THIS 6750 04:03:39,320 --> 04:03:39,960 OPPORTUNITY TO PRESENT 6751 04:03:39,960 --> 04:03:40,560 REFLECTIONS. 6752 04:03:40,560 --> 04:03:42,920 I WILL PUT THIS DISCLAIMER, 6753 04:03:42,920 --> 04:03:46,080 THESE ARE MY REFLECTIONS AND 6754 04:03:46,080 --> 04:03:48,240 INTERPRETATION WHAT I HAVE HEARD 6755 04:03:48,240 --> 04:03:50,160 OVER THE PAST (INAUDIBLE) WE 6756 04:03:50,160 --> 04:03:54,960 HAVE SEEN AND HEARD AMAZING 6757 04:03:54,960 --> 04:03:57,680 SCIENCE THAT EXAMINED MANY 6758 04:03:57,680 --> 04:04:01,080 ASPECTS OF EMERGENCY CARE. 6759 04:04:01,080 --> 04:04:04,680 IN THE CONTEXT OF SOCIAL 6760 04:04:04,680 --> 04:04:05,680 DETERMINANTS OF HEALTH AND HOW 6761 04:04:05,680 --> 04:04:06,840 TO INTEGRATE THAT SCREENING. 6762 04:04:06,840 --> 04:04:10,000 WE HAVE HEARD THE (INAUDIBLE) 6763 04:04:10,000 --> 04:04:11,600 HAVING EXAMINE SYSTEMS PROVIDER 6764 04:04:11,600 --> 04:04:15,360 AND PATIENT PERSPECTIVES, AND 6765 04:04:15,360 --> 04:04:17,000 OPPORTUNITIES FOR IMPLEMENTING 6766 04:04:17,000 --> 04:04:19,400 SOCIAL DETERMINANTS OF HEALTH 6767 04:04:19,400 --> 04:04:21,680 SCREENING AND INTERVENTION IN 6768 04:04:21,680 --> 04:04:24,640 EMERGENCY DEPARTMENT SETTINGS. 6769 04:04:24,640 --> 04:04:29,240 I THINK THE PRESENTATIONS WE 6770 04:04:29,240 --> 04:04:33,360 HAVE HEARD BOTH (INAUDIBLE) MAY 6771 04:04:33,360 --> 04:04:36,520 INFORM OUR RESEARCH. 6772 04:04:36,520 --> 04:04:40,000 THE KEYNOTE SET THE CONTEXT OF 6773 04:04:40,000 --> 04:04:42,240 ALL OTHER PRESENTATIONS WE 6774 04:04:42,240 --> 04:04:43,160 HEARD. 6775 04:04:43,160 --> 04:04:46,680 OFTEN PEOPLE THINK OF ED IN HER 6776 04:04:46,680 --> 04:04:48,200 PRESENTATION SHE -- I THINK 6777 04:04:48,200 --> 04:04:49,880 STATED THAT OFTEN PEOPLE THINK 6778 04:04:49,880 --> 04:04:52,040 OF EMERGENCY DEPARTMENTS AS A 6779 04:04:52,040 --> 04:04:55,080 SAFETY NET MOST VULNERABLE. 6780 04:04:55,080 --> 04:05:01,400 SHE DID PRESENT DATA THAT HELPED 6781 04:05:01,400 --> 04:05:02,960 ON STRUCTURAL INEQUALITIES IN 6782 04:05:02,960 --> 04:05:07,400 THE DELIVERY OF ED CARE THAT 6783 04:05:07,400 --> 04:05:11,040 CONTRIBUTES TO HEALTH AND 6784 04:05:11,040 --> 04:05:12,560 PERSISTENT DISPARITIES AND THAT 6785 04:05:12,560 --> 04:05:17,640 SOME OFTEN ENSURED POPULATIONS 6786 04:05:17,640 --> 04:05:19,640 ACCESS TO QUALITY CARE BELIEVE 6787 04:05:19,640 --> 04:05:24,240 WE ARE NOT IMPACTED BY CARE BY 6788 04:05:24,240 --> 04:05:27,680 ED CARE OR THE LACK OF QUALITY 6789 04:05:27,680 --> 04:05:30,840 ED CARE AND CERTAINLY HER 6790 04:05:30,840 --> 04:05:33,800 GRAPHIC ON BOATS RISING I THINK 6791 04:05:33,800 --> 04:05:35,400 BROUGHT HOME THE POINT THAT HIGH 6792 04:05:35,400 --> 04:05:38,960 QUALITY ED CARE IMPROVES CARE 6793 04:05:38,960 --> 04:05:40,160 FOR (INAUDIBLE) AND VULNERABLE 6794 04:05:40,160 --> 04:05:43,400 POPULATIONS. 6795 04:05:43,400 --> 04:05:45,320 IT WAS-CONTEXT I WANT US TO 6796 04:05:45,320 --> 04:05:50,160 THINK ABOUT THAT WE NEED TO 6797 04:05:50,160 --> 04:05:59,320 DEVELOP (INAUDIBLE) ED CARE. 6798 04:05:59,320 --> 04:06:00,560 WHAT THEN FOLLOWED WAS A NUMBER 6799 04:06:00,560 --> 04:06:02,120 OF PRESENTATIONS ON MODELS FOR 6800 04:06:02,120 --> 04:06:07,800 ED CARE AND SOME WE HEARD DATA 6801 04:06:07,800 --> 04:06:10,040 THAT WAS PRESENTED ON THE 6802 04:06:10,040 --> 04:06:12,160 DEMOGRAPHICS AND PROFILES OF THE 6803 04:06:12,160 --> 04:06:16,760 ED INCLUDING POPULATION -- WE 6804 04:06:16,760 --> 04:06:19,280 LEARN THAT MANY PATIENTS PRESENT 6805 04:06:19,280 --> 04:06:24,480 TO ED WITH AT LEAST ONE UNMET 6806 04:06:24,480 --> 04:06:26,920 SOCIAL AND CHALLENGE IS HOW THAT 6807 04:06:26,920 --> 04:06:29,320 EDs ARE FACING PRESSURE TO 6808 04:06:29,320 --> 04:06:31,280 ADDRESS SOCIAL NEEDS AND TO DO 6809 04:06:31,280 --> 04:06:36,840 THIS RAPIDLY AND TO SCALE UP 6810 04:06:36,840 --> 04:06:37,440 DEVELOPING INTERVENTIONS THAT 6811 04:06:37,440 --> 04:06:39,520 WILL AND SCREENING THAT WILL 6812 04:06:39,520 --> 04:06:41,240 IDENTIFY SOCIAL NEEDS. 6813 04:06:41,240 --> 04:06:43,320 THE CHALLENGE IS HOW TO 6814 04:06:43,320 --> 04:06:44,360 IMPLEMENT SCREEN INTERVENTIONS 6815 04:06:44,360 --> 04:06:46,560 IN TRADITIONAL CONTEXT OF ED 6816 04:06:46,560 --> 04:06:52,400 CARE AS WE KNOW TODAY. 6817 04:06:52,400 --> 04:06:54,360 WE HAVE HEARD SOME THINGS 6818 04:06:54,360 --> 04:06:55,680 SUGGEST THERE ARE OPPORTUNITIES 6819 04:06:55,680 --> 04:06:59,440 AS WE CONTINUE TO RESEARCH AND 6820 04:06:59,440 --> 04:07:03,160 DEVELOP EXPERT IN ED. 6821 04:07:03,160 --> 04:07:05,040 ONE OPPORTUNITY IS I BELIEVE IS 6822 04:07:05,040 --> 04:07:08,040 THAT ED CARE FOR TOO LONG WE 6823 04:07:08,040 --> 04:07:11,080 PROBABLY THOUGHT OF THE ED 6824 04:07:11,080 --> 04:07:15,880 SYSTEM AS SEPARATE PART OF CARE 6825 04:07:15,880 --> 04:07:18,520 AND MORE TOWARDS COMPLEX 6826 04:07:18,520 --> 04:07:22,600 COMPREHENSIVE INTEGRATION OF ED 6827 04:07:22,600 --> 04:07:24,240 IN CARE FOR VULNERABLE 6828 04:07:24,240 --> 04:07:24,640 POPULATIONS. 6829 04:07:24,640 --> 04:07:27,280 WE NEED TO CERTAINLY PURSUE 6830 04:07:27,280 --> 04:07:29,080 RESEARCHERS FOR BEST PRACTICES 6831 04:07:29,080 --> 04:07:31,520 WITH DOCUMENTED EFFECTIVE 6832 04:07:31,520 --> 04:07:35,640 OUTCOMES AND CARE THAT HEALTH 6833 04:07:35,640 --> 04:07:37,600 INEQUITIES AND DISPARITIES. 6834 04:07:37,600 --> 04:07:39,160 OF COURSE THE CHALLENGE IS HOW 6835 04:07:39,160 --> 04:07:44,400 WE ADDRESS THAT GIVEN THE TIME 6836 04:07:44,400 --> 04:07:46,600 AND (INAUDIBLE) CARE. 6837 04:07:46,600 --> 04:07:52,120 SYSTEMS WE NEED CERTAINLY 6838 04:07:52,120 --> 04:07:55,120 INCREASE SYSTEM AND EFFECTIVE 6839 04:07:55,120 --> 04:07:56,520 SYSTEMS TO STORE AND (INAUDIBLE) 6840 04:07:56,520 --> 04:07:58,360 PATIENT SCREENING OUTCOMES AN 6841 04:07:58,360 --> 04:08:00,960 PROTOCOLS OR PROCEDURES FOREL 6842 04:08:00,960 --> 04:08:04,240 TIME INTERVENTIONS WE HEARD FROM 6843 04:08:04,240 --> 04:08:08,040 SEVERAL PATIENTS CERTAINLY NOT 6844 04:08:08,040 --> 04:08:09,560 ALL FOLLOW-UP PATIENT 6845 04:08:09,560 --> 04:08:12,760 (INAUDIBLE) TO ADDRESS THEIR 6846 04:08:12,760 --> 04:08:15,640 NEEDS WHEN IN REAL TIME THEY CAN 6847 04:08:15,640 --> 04:08:18,800 USE (INAUDIBLE) YOU HAVE HEARD 6848 04:08:18,800 --> 04:08:20,040 THAT HOW WE ARE ABLE TO 6849 04:08:20,040 --> 04:08:23,080 INTEGRATE DIGITAL RESOURCES TO 6850 04:08:23,080 --> 04:08:26,680 SUPPORT INNOVATION AND DIRECT 6851 04:08:26,680 --> 04:08:31,840 CARE. 6852 04:08:31,840 --> 04:08:33,160 OPPORTUNITY WAS WITH SOME OF THE 6853 04:08:33,160 --> 04:08:36,240 STUDIES THAT SHOW THAT PATIENTS 6854 04:08:36,240 --> 04:08:38,640 DO SOMEWHAT SCREENING AND SOME 6855 04:08:38,640 --> 04:08:41,720 ARE ACCEPTING AND WANT STUDIES 6856 04:08:41,720 --> 04:08:43,600 PARTICULARLY THE WALLACE STUDY 6857 04:08:43,600 --> 04:08:47,160 HAS SHOWN IT IS FEASIBLE AND WE 6858 04:08:47,160 --> 04:08:48,720 HEARD THE DIFFERENT ON NEEDS 6859 04:08:48,720 --> 04:08:52,440 VERSUS RISK AND THAT FOCUS MUCH 6860 04:08:52,440 --> 04:08:57,280 OF THE SCREENING IS BASED ON 6861 04:08:57,280 --> 04:08:59,080 RISK THOSE THAT HAVE NEEDS THAT 6862 04:08:59,080 --> 04:09:02,200 PERHAPS WE CAN DESIGN 6863 04:09:02,200 --> 04:09:02,520 INTERVENTIONS. 6864 04:09:02,520 --> 04:09:06,080 AND THEN SOME PATIENTS FOLLOW-UP 6865 04:09:06,080 --> 04:09:10,720 WORK GROUPS DO NOT. 6866 04:09:10,720 --> 04:09:14,640 AND CERTAINLY THERE ARE 6867 04:09:14,640 --> 04:09:15,840 VARIABLES FOR PATIENTS WHO DO 6868 04:09:15,840 --> 04:09:16,440 NOT ACCEPT HELP. 6869 04:09:16,440 --> 04:09:18,200 SOME OF THE CHALLENGES IN TRYING 6870 04:09:18,200 --> 04:09:22,440 TO IMPLEMENT SCREENING IN ED 6871 04:09:22,440 --> 04:09:26,640 SETTINGS ARE TIME CONSTRAINTS, 6872 04:09:26,640 --> 04:09:31,560 STAFF TRAINING, AND THIS IS ALSO 6873 04:09:31,560 --> 04:09:32,640 -- MOST SCREENERS HAVE BEEN 6874 04:09:32,640 --> 04:09:34,600 DEVELOPED FOR PRIMARY CARE 6875 04:09:34,600 --> 04:09:37,280 SETTINGS VERSUS ED SETTINGS, SO 6876 04:09:37,280 --> 04:09:40,600 THERE IS A QUESTION 6877 04:09:40,600 --> 04:09:42,120 ACCEPTABILITY OF THE 6878 04:09:42,120 --> 04:09:44,720 PSYCHOMETRIC CHARACTERISTICS OF 6879 04:09:44,720 --> 04:09:46,880 THIS, ARE WE SCREENING FOR 6880 04:09:46,880 --> 04:09:51,600 SOCIAL NEEDS OR SOCIAL RISK? 6881 04:09:51,600 --> 04:09:53,720 AND THEN HOW DO WE DO THAT AND 6882 04:09:53,720 --> 04:09:59,080 HOW DO WE STORE IT. 6883 04:09:59,080 --> 04:10:02,640 AND TECHNOLOGY TO IDENTIFY 6884 04:10:02,640 --> 04:10:05,280 RESOURCES TO FURTHER PARTNERSHIP 6885 04:10:05,280 --> 04:10:06,680 WITH CBOs AND THEN OF COURSE 6886 04:10:06,680 --> 04:10:08,040 FROM THE PATIENT PERSPECTIVES 6887 04:10:08,040 --> 04:10:14,280 THERE ARE CHALLENGES AROUND 6888 04:10:14,280 --> 04:10:17,000 GIVEN MANY WHO USE EMERGENCY 6889 04:10:17,000 --> 04:10:20,680 DEPARTMENTS HAVE HAD UNPLEASANT 6890 04:10:20,680 --> 04:10:24,160 ADVERSE NEGATIVE INTERACTIONS, 6891 04:10:24,160 --> 04:10:26,600 TO -- THEY CERTAINLY WISH TO BE 6892 04:10:26,600 --> 04:10:30,600 TREATED WITH DIGNITY, THERE ARE 6893 04:10:30,600 --> 04:10:34,200 PRIVACY AND WHAT HAPPENS TO THE 6894 04:10:34,200 --> 04:10:38,640 INFORMATION AND DO WE PURSUE 6895 04:10:38,640 --> 04:10:41,640 SCREENING FOR SOCIAL NEEDS OR 6896 04:10:41,640 --> 04:10:43,800 FOCUS SCREENING? 6897 04:10:43,800 --> 04:10:49,000 AND THEN (INAUDIBLE) ABILITY OF 6898 04:10:49,000 --> 04:10:50,640 THE -- ON OUR -- MIGHT HAVE 6899 04:10:50,640 --> 04:10:53,640 ENGLISH OR SPANISH BUT WE HAVE A 6900 04:10:53,640 --> 04:10:55,160 VERY DIVERSE (INAUDIBLE) IN OUR 6901 04:10:55,160 --> 04:10:56,640 COUNTRY AND CERTAINLY 6902 04:10:56,640 --> 04:10:58,240 INCREASING, SO THERE ARE MANY 6903 04:10:58,240 --> 04:11:01,280 LANGUAGES THAT WE NEED TO THINK 6904 04:11:01,280 --> 04:11:01,560 ABOUT. 6905 04:11:01,560 --> 04:11:05,560 IN MY OWN NIH FUNDED RESIRNLG 6906 04:11:05,560 --> 04:11:07,440 LOOK AT BEST WAYS TO SCREEN FOR 6907 04:11:07,440 --> 04:11:12,040 INTERNET PARTNER VIOLENCE. 6908 04:11:12,040 --> 04:11:13,000 COMPARE TECHNOLOGY DIGITAL 6909 04:11:13,000 --> 04:11:17,560 TABLET APPROACH TO SCREENING AND 6910 04:11:17,560 --> 04:11:18,400 INTERVENTION, PAPER AND PENCIL 6911 04:11:18,400 --> 04:11:23,360 AND WE FOUND THAT THERE WAS NO 6912 04:11:23,360 --> 04:11:28,520 (INAUDIBLE) WE DIDN'T 6913 04:11:28,520 --> 04:11:30,640 (INAUDIBLE) WE ALSO LEARNED IS 6914 04:11:30,640 --> 04:11:33,040 REGARDLESS OF THE METHOD USED, 6915 04:11:33,040 --> 04:11:35,560 TRAINING STAFF AND HOW TO ASK 6916 04:11:35,560 --> 04:11:37,640 QUESTIONS WHEN TO ASK QUESTIONS 6917 04:11:37,640 --> 04:11:38,920 HOW TO FRAME THEM ARE IMPORTANT. 6918 04:11:38,920 --> 04:11:41,840 I THINK THIS IS AN IMPORTANT 6919 04:11:41,840 --> 04:11:43,680 FINDING PERHAPS FOR HEALTH 6920 04:11:43,680 --> 04:11:46,040 DEPARTMENTS AND HOME VISIT 6921 04:11:46,040 --> 04:11:47,720 PROGRAMS WHO ARE OFTEN 6922 04:11:47,720 --> 04:11:49,440 STRUGGLING WITH HOW TO CONTINUE 6923 04:11:49,440 --> 04:11:53,840 TO SUPPORT THIS MECHANISM OF 6924 04:11:53,840 --> 04:11:56,640 CARE, THAT IF FOLKS -- IF STAFF 6925 04:11:56,640 --> 04:11:58,280 ARE TRAINED IN SUPPORT HOW TO 6926 04:11:58,280 --> 04:12:01,320 ASK QUESTIONS AND HOW TO 6927 04:12:01,320 --> 04:12:02,000 INTERVENE ABUSED WOMEN WILL 6928 04:12:02,000 --> 04:12:09,120 ACCEPT IT. 6929 04:12:09,120 --> 04:12:10,080 ANOTHER STUNT AROUND 6930 04:12:10,080 --> 04:12:11,040 INTERVENTIONS. 6931 04:12:11,040 --> 04:12:14,040 MANY DO DESIRE, WE HEARD FROM 6932 04:12:14,040 --> 04:12:15,560 DR. MONTGOMERY WITH VA 6933 04:12:15,560 --> 04:12:19,240 POPULATION PROMISING RESULTS TA 6934 04:12:19,240 --> 04:12:22,440 TAYLOR MIGHT MAKE A DIFFERENT 6935 04:12:22,440 --> 04:12:24,480 (INAUDIBLE) INTERVENTION REDUCE 6936 04:12:24,480 --> 04:12:26,640 ED USES. 6937 04:12:26,640 --> 04:12:30,760 WE ALSO REAL TIME RESOURCES 6938 04:12:30,760 --> 04:12:33,080 VERSUS -- PERHAPS FORMAL HAND 6939 04:12:33,080 --> 04:12:38,240 OFFS MAKE IN TERMS OF FOLLOW UP 6940 04:12:38,240 --> 04:12:42,600 HEALTH (INAUDIBLE) WE ALSO HEARD 6941 04:12:42,600 --> 04:12:43,440 THAT TRADITION CARE -- 6942 04:12:43,440 --> 04:12:49,120 TRANSITION CARE CERTAINLY -- 6943 04:12:49,120 --> 04:12:50,320 PATIENTS LEAVE THE EMERGENCY 6944 04:12:50,320 --> 04:12:51,800 DEPARTMENT IMMEDIATE TO INVOLVE 6945 04:12:51,800 --> 04:12:53,240 CAREGIVERS AND FAMILY MEMBERS 6946 04:12:53,240 --> 04:12:56,840 AND THAT IS IMPORTANT TO THE 6947 04:12:56,840 --> 04:12:59,240 SUCCESS OF. 6948 04:12:59,240 --> 04:13:01,160 SOME OF THE CHALLENGES AND 6949 04:13:01,160 --> 04:13:04,200 IMPLEMENT -- IN IMPLEMENTING ED 6950 04:13:04,200 --> 04:13:06,040 SETTINGS IS WE SUPPORT 6951 04:13:06,040 --> 04:13:07,800 CONTINUITY OF CARE. 6952 04:13:07,800 --> 04:13:09,760 WE RECOGNIZE SUCCESS AND DEVELOP 6953 04:13:09,760 --> 04:13:12,440 RESOURCES FOR CAREGIVERS TO 6954 04:13:12,440 --> 04:13:15,160 SUPPORT THE IDENTIFIED PATIENTS. 6955 04:13:15,160 --> 04:13:19,400 AND DEVELOPING PARTNERSHIPS WITH 6956 04:13:19,400 --> 04:13:22,840 CBOs ACCESS PRIVACY 6957 04:13:22,840 --> 04:13:27,240 INFORMATION SHARING IN MUCH OF 6958 04:13:27,240 --> 04:13:28,440 THE WORK COMMUNITY CENTERS 6959 04:13:28,440 --> 04:13:35,800 INVOLVE PARTNERING WITH, 6960 04:13:35,800 --> 04:13:39,320 SOMETIMES CARE PROVIDERS AND 6961 04:13:39,320 --> 04:13:42,360 (INAUDIBLE) PEOPLE WE NEED TO 6962 04:13:42,360 --> 04:13:44,600 LEARN DIFFERENT APPROACHES TO 6963 04:13:44,600 --> 04:13:46,080 WORKING WITH MEMBERS IN 6964 04:13:46,080 --> 04:13:47,160 COMMUNITY AND ALSO UNDERSTANDING 6965 04:13:47,160 --> 04:13:50,640 THAT OFTEN THE MEMBERS IN THE 6966 04:13:50,640 --> 04:13:51,200 STATE (INAUDIBLE) HAVE 6967 04:13:51,200 --> 04:13:52,880 SOLUTIONS. 6968 04:13:52,880 --> 04:13:56,640 STAFF TRAINING IS IMPORTANT, 6969 04:13:56,640 --> 04:13:57,880 RESOURCES, AND THEN WE HAVE 6970 04:13:57,880 --> 04:14:01,240 SEVERAL PAPERS ON HOW DO WE 6971 04:14:01,240 --> 04:14:03,080 EVALUATE EFFECTIVENESS OF 6972 04:14:03,080 --> 04:14:03,600 OUTCOMES. 6973 04:14:03,600 --> 04:14:05,800 WHAT DIFFERENCE DID IT MAKE, 6974 04:14:05,800 --> 04:14:07,560 WHAT WERE THE BARRIERS AND 6975 04:14:07,560 --> 04:14:10,960 FACILITATORS AND WHAT ARE THE 6976 04:14:10,960 --> 04:14:12,040 ACTUAL OUTCOMES WE SHOULD BE 6977 04:14:12,040 --> 04:14:17,920 LOOKING AT. 6978 04:14:17,920 --> 04:14:20,680 SO (INAUDIBLE) TALKED ABOUT ED 6979 04:14:20,680 --> 04:14:22,840 INTERVENTIONS AND COMMUNITY 6980 04:14:22,840 --> 04:14:23,400 CONNECTIONS. 6981 04:14:23,400 --> 04:14:26,920 TRANSITIONS THAT EXTEND ED 6982 04:14:26,920 --> 04:14:27,880 INTERVENTION TO COMMUNITY BASED 6983 04:14:27,880 --> 04:14:28,920 CARE. 6984 04:14:28,920 --> 04:14:30,080 SO THERE IS AN OPPORTUNITY THERE 6985 04:14:30,080 --> 04:14:34,080 FOR NEW MODELS OF CARE WE 6986 04:14:34,080 --> 04:14:36,840 CERTAIN WILL I HEARD DR. POLLACK 6987 04:14:36,840 --> 04:14:38,680 ABOUT THE IMPORTANCE OF 6988 04:14:38,680 --> 04:14:40,240 ADDRESSING HOUSING. 6989 04:14:40,240 --> 04:14:44,640 AND CHALLENGES THERE AND MODERN 6990 04:14:44,640 --> 04:14:46,960 DAY NURSING. 6991 04:14:46,960 --> 04:14:50,040 FLORENCE NIGHTINGGALE NOTED MORE 6992 04:14:50,040 --> 04:14:53,040 THAN A HUNDRED YEARS AGO 6993 04:14:53,040 --> 04:14:54,040 IMPORTANCE OF ADEQUATE HOUSING 6994 04:14:54,040 --> 04:14:57,360 IS CRITICAL TO GOOD HOUSING. 6995 04:14:57,360 --> 04:14:59,400 THE PILOT PROGRAM WE CALLED 6996 04:14:59,400 --> 04:15:03,400 HEALTH IN HOUSING, TO WHERE 6997 04:15:03,400 --> 04:15:05,280 PEOPLE LIVED AND WE IMPLEMENTED 6998 04:15:05,280 --> 04:15:08,680 HEALTH AND WELLNESS NURSE LED 6999 04:15:08,680 --> 04:15:10,920 CLINICS THIS IN SENIOR DEPENDENT 7000 04:15:10,920 --> 04:15:13,640 -- INDEPENDENT LIVING SHELTERS 7001 04:15:13,640 --> 04:15:14,720 THAT WOMEN AND TRANSITIONAL 7002 04:15:14,720 --> 04:15:18,680 HOUSING AND ONE OF THE IMPORTANT 7003 04:15:18,680 --> 04:15:20,120 OUTCOMES THAT DOCUMENT IN ALL 7004 04:15:20,120 --> 04:15:22,000 THOSE APPROACHES. 7005 04:15:22,000 --> 04:15:25,520 THESE WERE NURSE FACULTY 7006 04:15:25,520 --> 04:15:28,680 PRACTICE MODELS COMBINATION OF 7007 04:15:28,680 --> 04:15:31,360 FACULTY COMMUNITY FACULTY 7008 04:15:31,360 --> 04:15:32,640 (INAUDIBLE) UNDERGRADUATE AND 7009 04:15:32,640 --> 04:15:34,280 GRADUATE STUDENTS. 7010 04:15:34,280 --> 04:15:37,040 WE WERE ABLE TO MAKE CHANGES IN 7011 04:15:37,040 --> 04:15:40,320 HIGH USE OF EMERGENCY DEPARTMENT 7012 04:15:40,320 --> 04:15:44,640 FOR THOSE PATIENTS. 7013 04:15:44,640 --> 04:15:47,400 THOSE -- ANOTHER DR. ADLER AS 7014 04:15:47,400 --> 04:15:52,800 EARLY AS 2008 ONE OF THE FIRST 7015 04:15:52,800 --> 04:15:54,640 RESEARCH SETTING LOOK AT SOCIAL 7016 04:15:54,640 --> 04:15:58,040 EMERGENCY MEDICINE AND THERE WAS 7017 04:15:58,040 --> 04:15:59,160 RECOGNITION THAT IS THE SOCIAL 7018 04:15:59,160 --> 04:16:00,040 ENVIRONMENT WHICH WE HAD BEEN 7019 04:16:00,040 --> 04:16:03,320 TALKING EXTENSIVELY IMPACT 7020 04:16:03,320 --> 04:16:06,880 PARTICULARLY OF THOSE WHO WERE 7021 04:16:06,880 --> 04:16:08,640 USING ED CARE. 7022 04:16:08,640 --> 04:16:10,880 THAT WOULD BE ABLE TO DEVELOP 7023 04:16:10,880 --> 04:16:11,920 RESEARCH STRATEGIES AND METHODS 7024 04:16:11,920 --> 04:16:14,000 TO EXAMINE THOSE CHANGES AND 7025 04:16:14,000 --> 04:16:18,440 WHAT HAPPENS WHEN WE ADDRESS 7026 04:16:18,440 --> 04:16:18,640 NEEDS. 7027 04:16:18,640 --> 04:16:21,520 ONE OF HIS PROGRAMS HEALTH 7028 04:16:21,520 --> 04:16:23,680 ADVOCACY PROGRAM OR HELP DESKS 7029 04:16:23,680 --> 04:16:24,960 WERE SET UP IN EMERGENCY 7030 04:16:24,960 --> 04:16:26,640 DEPARTMENTS TO HELP PATIENTS 7031 04:16:26,640 --> 04:16:32,640 NAVIGATE SHOWED VERY FAVORABLE 7032 04:16:32,640 --> 04:16:35,280 OUTCOMES. 7033 04:16:35,280 --> 04:16:38,440 (INAUDIBLE) THERE IS A HEALTH 7034 04:16:38,440 --> 04:16:40,640 ADVOCATE PROGRAM WITHIN 7035 04:16:40,640 --> 04:16:43,360 ADDRESSES THINGS SUCH AS HOUSING 7036 04:16:43,360 --> 04:16:45,640 UTILITIES, TRANSPORTATION, AND 7037 04:16:45,640 --> 04:16:47,320 DOES MAKE A DIFFERENCE IN 7038 04:16:47,320 --> 04:16:53,520 PEDIATRIC HEALTHCARE. 7039 04:16:53,520 --> 04:16:56,280 (INAUDIBLE) WHICH PROVIDES SHORT 7040 04:16:56,280 --> 04:17:01,040 -- ANYONE THAT IS SEEN IN AN 7041 04:17:01,040 --> 04:17:02,480 EMERGENCY THERE IS (INAUDIBLE) 7042 04:17:02,480 --> 04:17:03,960 OPERATED BY INTERNAL MEDICINE 7043 04:17:03,960 --> 04:17:09,920 AND DOES PROVIDE THAT SUPPORT TO 7044 04:17:09,920 --> 04:17:12,880 GET FOLKS INTO MEDICAL HOMES, 7045 04:17:12,880 --> 04:17:16,440 AND IT IS INTERDISLYNARY 7046 04:17:16,440 --> 04:17:18,640 PHYSICIANS -- INTERDISCIPLINARY 7047 04:17:18,640 --> 04:17:20,240 AND WORK ON IDENTIFIED NEEDS AND 7048 04:17:20,240 --> 04:17:23,240 PROVIDE RESOURCES FOR 7049 04:17:23,240 --> 04:17:25,800 INDEPENDENT (INAUDIBLE). 7050 04:17:25,800 --> 04:17:29,960 ANOTHER EXAMPLE OF (INAUDIBLE) 7051 04:17:29,960 --> 04:17:38,640 PEOPLE BY COLLEAGUES DR. JOHN 7052 04:17:38,640 --> 04:17:40,240 (INAUDIBLE) UNIVERSITY INJURIES 7053 04:17:40,240 --> 04:17:42,760 DUE TO SHOOTING STABBINGS, 7054 04:17:42,760 --> 04:17:46,640 ASSAULTS AND SO FORTH. 7055 04:17:46,640 --> 04:17:50,600 AND IN HIS PROGRAM CARE IS 7056 04:17:50,600 --> 04:17:54,480 IMPLEMENTED TO ADDRESS PHYSICAL 7057 04:17:54,480 --> 04:17:57,760 AND EMOTIONAL WOUNDS AND PROGRAM 7058 04:17:57,760 --> 04:18:04,640 HAS BEEN IMPACT AND ALSO THE 7059 04:18:04,640 --> 04:18:05,440 STAFF (INAUDIBLE) WORK IN CITY 7060 04:18:05,440 --> 04:18:11,040 WIDE TO ADDRESS LONG-TERM 7061 04:18:11,040 --> 04:18:12,320 STRATEGIES TO VIOLENCE IN URBAN 7062 04:18:12,320 --> 04:18:14,360 SETTINGS. 7063 04:18:14,360 --> 04:18:16,040 SO I THINK IN ALL OF WHAT WE 7064 04:18:16,040 --> 04:18:17,760 HAVE HEARD, THERE ARE SOME 7065 04:18:17,760 --> 04:18:23,320 VALUABLE INSIGHTS FOR MOVING 7066 04:18:23,320 --> 04:18:27,320 RESEARCH FORWARD MODELS OF CARE 7067 04:18:27,320 --> 04:18:28,440 THAT INTEGRATE CONTINUITY OF 7068 04:18:28,440 --> 04:18:30,040 CARE ACROSS ED COMMUNITY 7069 04:18:30,040 --> 04:18:30,320 SETTINGS. 7070 04:18:30,320 --> 04:18:32,920 DATA AND SURVEILLANCE SYSTEMS 7071 04:18:32,920 --> 04:18:35,280 THAT CAPTURE INFORMATION NEEDED 7072 04:18:35,280 --> 04:18:40,200 TO EVALUATE CARE, OUTCOMES AND 7073 04:18:40,200 --> 04:18:41,640 WHAT WE NEED TO UNDERSTAND IF 7074 04:18:41,640 --> 04:18:42,280 IMPROVING OUTCOMES AND QUALITY 7075 04:18:42,280 --> 04:18:45,040 OF CARE. 7076 04:18:45,040 --> 04:18:46,760 SOCIAL NEEDS ASSESSMENT 7077 04:18:46,760 --> 04:18:49,240 SPECIFICALLY APPROPRIATE 7078 04:18:49,240 --> 04:18:50,360 EMERGENCY DEPARTMENT AND 7079 04:18:50,360 --> 04:18:50,640 POPULATIONS. 7080 04:18:50,640 --> 04:18:55,400 REAL TIME INTERVENTIONS THAT 7081 04:18:55,400 --> 04:18:56,440 (INAUDIBLE) INTEGRATION OF 7082 04:18:56,440 --> 04:18:58,000 TECHNOLOGY FOR ASSESSMENT 7083 04:18:58,000 --> 04:18:59,600 INTERVENTION AND FOR DOCUMENTING 7084 04:18:59,600 --> 04:19:06,480 OUTCOMES AND EFFECTIVENESS, 7085 04:19:06,480 --> 04:19:08,640 ACROSS SETTINGS. 7086 04:19:08,640 --> 04:19:11,840 PERHAPS MORE FAMILY FOCUS AND 7087 04:19:11,840 --> 04:19:12,400 INCORPORATING PATIENTS AND 7088 04:19:12,400 --> 04:19:16,840 CAREGIVERS. I WOULD LIKE TO 7089 04:19:16,840 --> 04:19:18,520 CONCLUDE MY REFLECTIONS BY 7090 04:19:18,520 --> 04:19:23,280 NOTING THE RESEARCH BASED 7091 04:19:23,280 --> 04:19:26,640 ASSESSMENT PREVENTION STRATEGIES 7092 04:19:26,640 --> 04:19:28,160 TO ADDRESS EQUALITY -- 7093 04:19:28,160 --> 04:19:30,040 INEQUALITY AND HEALTH 7094 04:19:30,040 --> 04:19:31,320 DISPARITIES AND SOCIAL 7095 04:19:31,320 --> 04:19:34,720 DETERMINANTS OF HEALTH SHOULD 7096 04:19:34,720 --> 04:19:36,720 ADOPT INTEMPERATE AND DEVELOP 7097 04:19:36,720 --> 04:19:37,800 RESEARCH METHODOLOGY THAT 7098 04:19:37,800 --> 04:19:40,240 ADDRESS JUSTICE PRINCIPLES. 7099 04:19:40,240 --> 04:19:44,640 TO DO THE WORK TO ADDRESS HEALTH 7100 04:19:44,640 --> 04:19:48,040 INEQUALITIES AND PERSISTENT 7101 04:19:48,040 --> 04:19:49,160 HEALTH DISPARITIES, PRINCIPLE -- 7102 04:19:49,160 --> 04:19:52,800 THE SOCIAL JUSTICE PRINCIPLES, 7103 04:19:52,800 --> 04:19:55,080 SUCH AS ANTS RACISM, 7104 04:19:55,080 --> 04:19:56,320 ANTI-VIOLENCEN, ANTI-(INAUDIBLE) 7105 04:19:56,320 --> 04:19:59,360 ANTI-OPPRESSION AN ANTI-POVERTY, 7106 04:19:59,360 --> 04:20:02,360 AS RESEARCHERS WE NEEDS TO BE 7107 04:20:02,360 --> 04:20:03,360 METHODOLOGIES THAT INCORPORATE 7108 04:20:03,360 --> 04:20:07,040 AND ADDRESS THESE ISSUES THAT 7109 04:20:07,040 --> 04:20:09,040 MANY PATIENTS (INAUDIBLE). 7110 04:20:09,040 --> 04:20:24,600 THANK YOU. 7111 04:20:24,600 --> 04:20:26,080 >> HAVING TROUBLE WITH MY 7112 04:20:26,080 --> 04:20:26,480 CAMERA. 7113 04:20:26,480 --> 04:20:30,240 NOT SURE WHAT IS GOING ON HERE. 7114 04:20:30,240 --> 04:20:36,040 IN ANY EVENT, I THINK MY VIDEO 7115 04:20:36,040 --> 04:20:41,280 WAS STOPPED BY SAM, SAM, CAN YOU 7116 04:20:41,280 --> 04:20:43,240 THANK YOU SO VERY MUCH, DR. 7117 04:20:43,240 --> 04:20:47,080 SHARPS FOR THAT THOUGHTFUL 7118 04:20:47,080 --> 04:20:50,040 SYNTHESIS REFLEXION. 7119 04:20:50,040 --> 04:20:51,280 REALLY HIGHLIGHTED THE CHALLENGE 7120 04:20:51,280 --> 04:20:53,680 AND OPPORTUNITIES. 7121 04:20:53,680 --> 04:20:56,400 WE ARE SO GRATEFUL TO YOU. 7122 04:20:56,400 --> 04:20:58,040 I WANT TO ECHO WHAT YOU SAID 7123 04:20:58,040 --> 04:21:00,920 ABOUT AN AMAZING DAY OF 7124 04:21:00,920 --> 04:21:03,880 INSIGHTFUL THOUGHT PROVOKING 7125 04:21:03,880 --> 04:21:04,360 STIMULATING SCIENCE. 7126 04:21:04,360 --> 04:21:10,240 SO BEFORE I TURN THIS OVER TO 7127 04:21:10,240 --> 04:21:13,640 DR. STROUT AND ZINK, I WANT TO 7128 04:21:13,640 --> 04:21:16,280 MAKE A LAST CLOSING COMMENTS. 7129 04:21:16,280 --> 04:21:19,360 WE ARE REALLY VERY EXCITED ABOUT 7130 04:21:19,360 --> 04:21:20,400 INCREASED INTEREST AND 7131 04:21:20,400 --> 04:21:24,200 PARTICIPATION IN THIS YEAR'S 7132 04:21:24,200 --> 04:21:25,120 VIRTUAL ROUND TABLE. 7133 04:21:25,120 --> 04:21:29,080 AS WE GET READY TO RELEASE OUR 7134 04:21:29,080 --> 04:21:31,240 NEXT STRATEGIC PLAN WE WILL BE 7135 04:21:31,240 --> 04:21:32,640 TAKING A LOOK HOW BEST TO USE 7136 04:21:32,640 --> 04:21:35,040 FUTURE EVENTS, SUCH AS TODAY'S 7137 04:21:35,040 --> 04:21:37,240 EVENTS. 7138 04:21:37,240 --> 04:21:38,680 TO REACH AS BROAD AN AUDIENCE AS 7139 04:21:38,680 --> 04:21:41,400 POSSIBLE. 7140 04:21:41,400 --> 04:21:43,440 TO PROMOTE NURSING SCIENCE. 7141 04:21:43,440 --> 04:21:45,320 IN THAT REGARD, PLEASE STAY 7142 04:21:45,320 --> 04:21:50,320 TUNED TO OUR WEBSITE AS WE 7143 04:21:50,320 --> 04:21:51,640 ANNOUNCE OUR UPCOMING PLANS. 7144 04:21:51,640 --> 04:21:53,760 SO I THANK YOU SO VERY MUCH. 7145 04:21:53,760 --> 04:21:55,200 AND NOW I WILL TURN IT OVER TO 7146 04:21:55,200 --> 04:21:56,640 DR. STROUT. 7147 04:21:56,640 --> 04:21:59,400 >> THANK YOU, DR. BRYAN AND DR. 7148 04:21:59,400 --> 04:22:02,440 SHARPS. 7149 04:22:02,440 --> 04:22:03,360 ON BEHALF OF THE EMERGENCY 7150 04:22:03,360 --> 04:22:05,840 NURSES ASSOCIATION AND THE ENA 7151 04:22:05,840 --> 04:22:08,720 EMERGENCY NURSING RESEARCH 7152 04:22:08,720 --> 04:22:10,720 ADVISORY COUNCIL, THANK YOU SO 7153 04:22:10,720 --> 04:22:12,880 MUCH TO SPEAKERS PANELIST 7154 04:22:12,880 --> 04:22:13,920 ATTENDEES, EVERYONE WHO WORKED 7155 04:22:13,920 --> 04:22:15,240 SO HARD AND PREPARING FOR THE 7156 04:22:15,240 --> 04:22:19,320 ROUND TABLE, THIS YEAR. 7157 04:22:19,320 --> 04:22:21,400 WE HAD VALUABLE LEARNINGS OVER 7158 04:22:21,400 --> 04:22:22,600 THE COURSE OF TIME TOGETHER THE 7159 04:22:22,600 --> 04:22:24,640 LAST FEW DAYS AND THIS WORK IS 7160 04:22:24,640 --> 04:22:25,080 CHALLENGING. 7161 04:22:25,080 --> 04:22:28,760 THE ISSUES WE FACE ARE COMPLEX 7162 04:22:28,760 --> 04:22:30,280 AND THERE ARE MANY I FEEL 7163 04:22:30,280 --> 04:22:31,360 HOPEFUL OUR COLLECTIVE EFFORTS 7164 04:22:31,360 --> 04:22:33,640 WILL ALLOW US TO INTEGRATE NEW 7165 04:22:33,640 --> 04:22:36,600 WAYS TO ADDRESS SOCIAL 7166 04:22:36,600 --> 04:22:37,760 DETERMINANTS INEQUITIES FOR THE 7167 04:22:37,760 --> 04:22:39,040 PATIENTS THAT WE SERVE AND 7168 04:22:39,040 --> 04:22:42,360 EMERGENCY SETTINGS AS WE WORK 7169 04:22:42,360 --> 04:22:43,840 FOR MORE EQUITABLE SYSTEMS AND 7170 04:22:43,840 --> 04:22:45,600 FIND WAYS TO NURTURE FLOURISHING 7171 04:22:45,600 --> 04:22:47,440 OF ALL PEOPLE. 7172 04:22:47,440 --> 04:22:49,880 DR. ZINC, TURN IT TO YOU TO 7173 04:22:49,880 --> 04:22:50,680 OFFER CLOSING THOUGHTS FOR THE 7174 04:22:50,680 --> 04:22:56,640 GROUP. 7175 04:22:56,640 --> 04:22:58,440 >> THANK YOU. 7176 04:22:58,440 --> 04:22:59,600 I AGREE, ECHO EVERYONE'S 7177 04:22:59,600 --> 04:23:02,440 COMMENTS, IT WAS A WONDERFUL 7178 04:23:02,440 --> 04:23:03,400 DAY, ENJOYED LAST EVENING AS 7179 04:23:03,400 --> 04:23:04,240 WELL. 7180 04:23:04,240 --> 04:23:07,880 SO THANK YOU SO MUCH FOR JOINING 7181 04:23:07,880 --> 04:23:09,280 NINR AND EMERGENCY NURSES 7182 04:23:09,280 --> 04:23:11,400 ASSOCIATION FOR THIS YEAR'S 7183 04:23:11,400 --> 04:23:11,840 ROUND TABLE. 7184 04:23:11,840 --> 04:23:14,680 FROM CONTEXT TO CARE 7185 04:23:14,680 --> 04:23:17,200 UNDERSTANDING THE CONVERGENCE OF 7186 04:23:17,200 --> 04:23:18,840 SOCIAL FACTORS AND EMERGENCY 7187 04:23:18,840 --> 04:23:19,360 DEPARTMENT CARE. 7188 04:23:19,360 --> 04:23:22,040 THANK YOU SO MUCH TO DR. SHARPS 7189 04:23:22,040 --> 04:23:25,320 FOR YOUR THOUGHTFUL REFLECTIONS. 7190 04:23:25,320 --> 04:23:27,400 I WANT TO EXTEND MY THANKS TO 7191 04:23:27,400 --> 04:23:29,880 THE EMERGENCY NURSES ASSOCIATION 7192 04:23:29,880 --> 04:23:32,000 FOR PARTNERING WITH US AT NINR 7193 04:23:32,000 --> 04:23:32,680 TO PRESENT THIS YEAR'S ROUND 7194 04:23:32,680 --> 04:23:34,600 TABLE. 7195 04:23:34,600 --> 04:23:37,440 I ALSO WISH TO THANK OUR KEYNOTE 7196 04:23:37,440 --> 04:23:39,680 SPEAKER, DR. RENEE SHAW, AND ALL 7197 04:23:39,680 --> 04:23:42,360 OF OUR DISTINGUISHED SPEAKERS 7198 04:23:42,360 --> 04:23:44,640 TODAY WHO PROVIDED REALLY 7199 04:23:44,640 --> 04:23:46,680 VALUABLE INSIGHT IN RESPONSE TO 7200 04:23:46,680 --> 04:23:50,040 PROGRAMS THEME. 7201 04:23:50,040 --> 04:23:52,440 I EXTEND A HUGE THANK YOU TO DR. 7202 04:23:52,440 --> 04:23:55,320 YVONNE BRYAN FOR ADMINISTERING 7203 04:23:55,320 --> 04:23:56,440 THE ROUND TABLE. 7204 04:23:56,440 --> 04:24:02,080 IT IS A PLEASURE TO HAVE YOU AT 7205 04:24:02,080 --> 04:24:02,320 NINR. 7206 04:24:02,320 --> 04:24:05,720 FINALLY, THANK YOU TO ALL OF OUR 7207 04:24:05,720 --> 04:24:06,640 ATTENDEES, CERTAINLY YOUR 7208 04:24:06,640 --> 04:24:07,920 COMMITMENT TO SOLVING THE 7209 04:24:07,920 --> 04:24:11,000 SYSTEMIC ISSUES, THAT LEAD TO 7210 04:24:11,000 --> 04:24:12,760 HEALTH INEQUITIES IS INVALUABLE. 7211 04:24:12,760 --> 04:24:14,680 WE LOOK FORWARD TO FUTURE 7212 04:24:14,680 --> 04:24:15,120 PARTNERSHIPS. 7213 04:24:15,120 --> 04:24:17,840 AGAIN, THANK YOU ALL SO MUCH. 7214 04:24:17,840 --> 04:29:44,320 AND GOOD NIGHT.