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>>THANK YOU,

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FOR JOINING US FOR NIH HEALTH

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DISPARITIES AND OSTEOARTHRITIS

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WORKSHOP. I'M CHRISTY NIX. BONE

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BIOLOGY, METABOLIC BONE

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DISORDERS AND OSTEOPOROSIS

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PROGRAM DIRECTOR AT NIAMS. WE

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PLANNED THE NEXT TWO DAYS AN

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INTERESTING AND INFORMATIVE

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AGENDA. VISIT THE WORKSHOP

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WEBSITE TO FIND RELEVANT

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INFORMATION INCLUDING THE

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PARTICIPANT LIST AND SPEAKER

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BIOGRAPHIES. IN ORDER TO STAY ON

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TIME IN OUR BUSY AGENDA WE WILL

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GET STARTED. I WOULD LIKE TO

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TURN THINGS OVER TO OUR DIRECTOR

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OF THE NATIONAL INSTITUTE OF

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ARTHRITIS, MUSCULOSKELETAL AND

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SKIN DISEASE, DR. LINDS SHY

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CRISWELL TO OPEN THE WORKSHOP.

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SHE BECAME THE NIAMS DIRECTOR

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FEBRUARY OF 2021. DR. CRISWELL,

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FLOOR IS YOURS. 

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>> THANK YOU, CHRISTY.
GOOD

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MORNING, EVERYBODY IT IS A

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PLEASURE TO WELCOME YOU TO THIS

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TWO DAY NIH WORKSHOP ON HEALTH

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DISPARITIES IN OSTEOARTHRITIS. I

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WOULD LIKE TO BEGIN BY THANKING

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THE CO-CHAIRS DR.S ARLENE BROWN,

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LEIGH CALLAHAN, KENT KWOH

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ANDERNIST MOY FOR LEADING THE

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WORKSHOP HELPING TO IDENTIFY

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SPEAKERS AND THEIR CONTRIBUTIONS

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TO OUR AGENDA. WE KNOW THAT YOU

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ALL WORKED VERY HARD ON THIS

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MEETING AND WE APPRECIATE YOUR

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PARTICIPATION IN OUR TEAMS

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MONTHLY CONFERENCE CALLS.  NEXT

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SLIDE. YOU SEE THE NIAMS MISSION

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IS SUPPORT AND CONDUCT RESEARCH

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INTO THE AWE CAUSES TREATMENT

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AND PREVENTION OF ARTHRITIS, AND

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MUSCULOSKELETAL AND SKIN

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DISEASES, TO TRAIN THE NEXT

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GENERATION OF SCIENTISTS TO

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CARRY OUT THIS RESEARCH, AND

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PROVIDE INFORMATION TO THE

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PUBLIC ABOUT RESEARCH PROGRESS

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IN OUR MISSION AREAS AND HOW IT

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CAN BE APPLIED TO IMPROVE

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HEALTH. CONSIDERING THE

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OSTEOARTHRITIS IS BOTH THE MOST

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COMMON FORM OF ARTHRITIS AND

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LEADING CAUSE OF DISABILITY

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ADDRESSING DISPARITIES IN

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OSTEOARTHRITIS IS A CRITICAL

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COMPONENT OF EFFORTS TO FULFILL

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THE NIAMS MISSION AND IMPROVE

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THE PUBLIC HEALTH. DOCUMENTED

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HEALTH DISPARITIES IN OA INCLUDE

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THOSE IN OUTCOMES AS WELL AS IN

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ACCESS TO QUALITY CARE. FOR

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EXAMPLE, AFRICAN AMERICAN OA

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PATIENTS WHO UNDERGO TOTAL KNEE

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REPLACEMENT ARE TWO AND A HALF

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TO FIVE TIMES MORE LIKELY THAN

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WHITE PATIENTS TO BE DISCHARGED

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TO AN INPATIENT REHABILITATION

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OR SKILLED NURSING FACILITY

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RATHER THAN TO HOME HEALTHCARE

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OR SELF CARE. ONE POSSIBLE

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EXPLANATION FOR THESE

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DIFFERENCES IS THAT AFRICAN

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AMERICAN PATIENTS ARE MORE

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LIKELY THAN WHITE PATIENTS TO

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DELAY THEIR TOTAL KNEE

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REPLACEMENT AND THUS EXPERIENCE

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MORE SEVERE DISEASE. SO BETTER

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UNDERSTANDING THESE DISPARITIES

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AND THE ROLES SOCIAL

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DETERMINANTS OF HEALTH PLAY IS

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VITAL TO ADDRESSING THIS OFTEN

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DEBILITATING CONDITION AND THIS

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WAS THE PRIMARY GOAL IN

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DEVELOPING THIS WORKSHOP. THE

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NEXT SLIDE HIGHLIGHTS OUR

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PARTNERSHIP WITH THE NATIONAL

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INSTITUTE ON AGING, AND THE

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NATIONAL INSTITUTE ON MINORITY

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HEALTH AND HEALTH DISPARITIES TO

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EXPLORE WAYS THAT BEHAVIORAL AND

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BIOMEDICAL SCIENCES TOGETHER CAN

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BE LEVERAGED TO REDUCE

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DISPARITIES IN MORBIDITY

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OUTCOMES AND OTHER FACTORS

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INFLUENCING QUALITY OF LIFE

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AMONG OA PATIENTS. I WANT TO

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ACKNOWLEDGE DR. CHRISTY NIX AND

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MS. JANNA ISENSTEIN OF NIAMS,

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DR. LYNDON JOHNSON AND PATRICIA

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JONES ON NATIONAL INSTITUTE ON

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AGING, AND DR.S RADHA AND RICK

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BURSON NATIONAL INSTITUTE ON

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MINORITY HEALTH AND HEALTH

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DISPARITIES FOR LEADING THE

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DEVELOPMENT OF THIS WORKSHOP ON

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BEHALF OF THE NIH. AND ALL THOSE

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THREE NIH COMPONENTS FOCUS

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SPECIFICALLY ON OA WE HOPE THE

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WORKSHOP SERVES AS A MOLD FOR

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OTHER NIH ENTITIES AND FEDERAL

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AGENCIES COMMITTED TO REDUCING

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DISPARITIES IN AND THE OVERALL

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IMPACT OF DISEASES ACROSS THE

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NIH MISSION.  N MISSION.  ON TH,

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THE NIH IS WIDELY RECOGNIZED AS

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THE LEADING GOVERNMENT AGENCY

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THAT SUPPORTS BIOMEDICAL

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RESEARCH. THUS WE MUST CONTINUE

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TO LOOK HOLISTICALLY AT THE

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OPPORTUNITIES TO WORK ACROSS THE

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MANY FIELDS OF SCIENCE IN ORDER

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TO EQUITABLY REDUCE IMPACT OF

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DISEASE CAUSED BY

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OSTEOARTHRITIS. WHILE THE

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FEDERAL GOVERNMENT SHOULD BE A

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PART OF ANY NATIONAL ENDEAVOR TO

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IMPROVE AMERICAN JOINT HEALTH,

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THE GOVERNMENT CANNOT AND

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SHOULDN'T DO IT ALONE.

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LEADERSHIP MUST BE SHARED AMONG

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THE MANY PUBLIC PRIVATE

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NON-PROFIT ACADEMIC AND

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SCIENTIFIC STAKEHOLDERS. 

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THEREFORE I'M PARTICULARLY

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LOOKING FORWARD TO THE SESSIONS

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TOMORROW WHERE WE HEAR THE

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PATIENT CLINICIAN AND SOCIETAL

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VOICES FOR THEIR INSIGHTS IN TO

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THE PRESSING ISSUE OF HEALTH

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DISPARITIES IN OSTEOARTHRITIS.  

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I'M ALSO LOOKING FORWARD TO

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TODAY'S SESSIONS THAT FOCUS ON

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INTERACTIONS THAT SHAPE

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DISPARITIES IN OSTEOARTHRITIS AS

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WELL AS THE SOCIAL DETERMINANTS

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OF THE HEALTH THAT SYSTEMATIZE

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THESE DISPARITIES. LASTLY, THIS

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WORKSHOP IS BEING VIDEOCAST AND

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WE WILL POST A SUMMARY ON THE

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NIAMS WEBSITE.  AND WE WILL LET

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ALL OF YOU WHO REGISTERED FOR

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THE MEETING KNOW WHEN THAT

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SUMMARY IS AVAILABLE.  NOW I

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WANT TO TURN THE MEETING BACK TO

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DR. NIX FOR THE FIRST SESSION.

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>> THANK YOU, DR.
CRISWELL, WE

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WILL MOVE TO INTRODUCTION TO

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OSTEOARTHRITIS TO SET THE STAGE

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FOR DISCUSSION TODAY. SESSION

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ONE IS MODERATED BY WORKSHOP

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CO-CHAIR DR. KENT KWOH,

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UNIVERSITY OF ARIZONA. DR. KWOH

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IS FIRST SPEAKER OF THE SESSION

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WHERE HE WILL DISCUSS THE

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CLINICAL MANIFESTATIONS AND

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EPIDEMIOLOGY OF OSTEOARTHRITIS.

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I WILL TURN THE SESSION TO YOU

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DR. KWOH.

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>> THANK YOU. I WOULD LIKE
TO

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THANK THE NIH FOR THE HONOR AND

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PRIVILEGE TO PARTICIPATE IN THIS

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WORKSHOP. O OSTEOARTHRITIS IS

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THE MOST COMMON FORM INVOLVING

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CHRONIC INFLAMMATION BREAK DOWN

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AND STRUCTURAL ALTERATION OF

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WHOLE JOINTS. IMPORTANT TO

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REALIZE OSTEOARTHRITIS IS A

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DISEASE THAT IS CHANGES IN JOINT

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STRUCTURE AND ILLNESS AND THAT

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IS A PERSON EXPERIENCE OF OA

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PAIN IS THE REASON PATIENTS SEEK

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CARE FOR OA. THERE IS A TYPO ON

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FORMATTING ON THIS SLIDE. THE

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SYMPTOMS SHOULD BE ON THE LEFT

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AND THE SIGN SHOULD BE ON RIGHT.

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SYMPTOMS OF OSTEOARTHRITIS IS

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USEFUL RELATED PAIN OR

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STIFFNESS, WORST WITH ACTIVITY

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BETTER WITH REST AND LATE STAGE

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PATIENTS EXPERIENCE PAIN AT

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NIGHT.  THEY MAY HAVE STIFFNESS

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OR JELLING AFTER ACTIVITY

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JELLING WOULD BE AFTER YOU SAT

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HERE AND LISTEND TO THE WORKSHOP

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FOR A FEW HOURS AND HAVE A

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LITTLE BIT OF DIFFICULTY GETTING

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OUT OF YOUR CHAIR, THAT'S THE

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SENSATION OF JELLING. MORNING

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STIFFNESS IS USUALLY LESS THAN

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30 MINUTES WHEREAS INFLAMMATORY

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ARTHRITIS IS OVER AN HOUR. 

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PATIENTS ALSO EXPERIENCE LOSS OF

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MOBILITY DIFFICULTY WITH CERTAIN

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TASKS SUCH AS WALKING, CLIMBING

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STAIRS. PATIENTS MAY ALSO HAVE

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FEELINGS OF INSECURITY OF

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INSTABILITY DUE TO LACKSTY

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AROUND THEIR JOINTS. THERE IS

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FUNCTIONAL LIMITATION AND

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HANDICAP FOR DAILY ACTIVITIES

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SUCH AS ADL OR INSTRUMENTAL

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DAILY ACTIVITIES. IN TERMS OF

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SIGNS OF OSTEOARTHRITIS, THEY

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MAY HAVE TENDER SPOTS AROUND

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JOINT MARGIN, FIRM OR SWELLING

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ON THE JOINT MARGIN, CRACKING OR

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LOCKING RICE CRISPY SEN STATION

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THAT CAN BE PALPABLE OR AUDIBLE

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WHEN PATIENTS MOVE THEIR JOINTS.

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THERE MAYBE SIGNS OF MILD

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INFLAMMATION THAT IS THAT THE

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FUSION OR SWELLING IS COOL

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COMPARED TO RED HOT SWOLLEN

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JOINTS ONE SEES IN INFLAMMATORY

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TYPES OF ARTHRITIS SUCH AS

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RHEUMATOID ARTHRITIS. PATIENTS

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HAVE RESTRICTED RANGE OF MOTION

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AND MAYBE HURTS AT THE EXTREMES

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IN MOTION. AND INSTABILITY THAT

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WE TALKED ABOUT BEFORE WHEN

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THERE IS OBVIOUS SEVERE WON'T OR

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JOINT DESTRUCTION. 

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OSTEOARTHRITIS IS NOW RECOGNIZED

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AS JOINT FAILURE. A DISEASE

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PROCESS INVOLVING THE ENTIRE

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JOINT. USED TO BE MORE CARBON

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CENTRIC AND CENTRIC IN TERMS OF

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BONE IN TERMS OF OSTEOPHYTE BUT

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WE KNOW THERE IS BONE REMODELING

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SCLEROSIS, CARTILAGE BREAK DOWN,

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SYNOVIAL HYPERTROPHY, IMPORTANT

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THERE IS MILD INFLAMMATION

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OCCURRING WITHIN THE JOINTS.

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LIGAMENTS CAN BE -- THERE IS

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DYSFUNCTION AND LOSS OF

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STRUCTURSTRUCTURSTRUCTURAL. ALSE

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IMPORTANT COMPONENT OF

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OSTEOARTHRITIS AND OSTEOPHYTES

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USED TO DEFINE OSTEOARTHRITIS

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RADIOGRAPHICALLY. THE COMMON

254
00:09:21,160 --> 00:09:22,560
SITES INCLUDE JOINTS CLOSE TO

255
00:09:22,560 --> 00:09:26,280
YOUR NAIL OR DIP. AND THEN THE

256
00:09:26,280 --> 00:09:30,320
JOINTS NEXT TO THOSE IN TERMS O

257
00:09:30,320 --> 00:09:30,920
PROXIMAL INTERPHALANGEAL JOINTS,

258
00:09:30,920 --> 00:09:34,880
HIPS KNEES AND FIRST MTP AT THE

259
00:09:34,880 --> 00:09:36,560
BASE OF YOUR GREAT TOE ARE ALSO

260
00:09:36,560 --> 00:09:39,880
COMMONLY INVOLVED. ALSO IN TERMS

261
00:09:39,880 --> 00:09:42,560
OF C SPINE CERVICAL SPINE OR

262
00:09:42,560 --> 00:09:43,200
LUMBAR SACRAL SPINE MAYBE

263
00:09:43,200 --> 00:09:45,120
INVOLVED. LESS COMMONLY YOU CAN

264
00:09:45,120 --> 00:09:49,880
HAVE THE KNUCKLES OF THE HAND OR

265
00:09:49,880 --> 00:09:50,600
META CARPAL FLAN JOEL JOINTS OR

266
00:09:50,600 --> 00:09:54,320
JOINTS IN SHOULDERS OR THE

267
00:09:54,320 --> 00:09:54,880
FOLLICULAR JOINTS MAYBE

268
00:09:54,880 --> 00:10:02,160
INVOLVED. NEXT. SO YOU MAY

269
00:10:02,160 --> 00:10:03,520
WONDER IS OSTEOARTHRITIS A

270
00:10:03,520 --> 00:10:05,320
SERIOUS DISEASE? IT HAS BEEN BY

271
00:10:05,320 --> 00:10:07,360
THE FDA AND WHY THIS IS BECAUSE

272
00:10:07,360 --> 00:10:10,000
OA IS COMMON AND GROWING,

273
00:10:10,000 --> 00:10:11,760
AFFECTS 240 MILLION PEOPLE

274
00:10:11,760 --> 00:10:12,960
WORLDWIDE WITH WOMEN EFFECTED

275
00:10:12,960 --> 00:10:14,680
MORE -- TWO TIME MORRIS LIKELY

276
00:10:14,680 --> 00:10:18,200
THAN MEN. OA ALSO LIMITS LIFE,

277
00:10:18,200 --> 00:10:19,760
25% OF INDIVIDUALS CAN'T DONOR

278
00:10:19,760 --> 00:10:21,280
MALL ACTIVITIES SUCH AS WALKING

279
00:10:21,280 --> 00:10:22,680
OR CLIMBING STAIRS.  THEY MAY

280
00:10:22,680 --> 00:10:24,560
HAVE LIMITED MOBILITY. AND WE

281
00:10:24,560 --> 00:10:25,800
ALSO KNOW NOW THAT THERE IS

282
00:10:25,800 --> 00:10:27,600
INCREASE RISK OF CARDIOVASCULAR

283
00:10:27,600 --> 00:10:29,600
DISEASE, DIABETES, HYPERTENSION,

284
00:10:29,600 --> 00:10:32,280
EVEN PREMATURE MORTALITY RELATED

285
00:10:32,280 --> 00:10:33,800
TO OSTEOARTHRITIS. IT IS

286
00:10:33,800 --> 00:10:35,800
IMPORTANT TO REALIZE THAT

287
00:10:35,800 --> 00:10:37,400
OSTEOARTHRITIS IS NO KNOWN CURE.

288
00:10:37,400 --> 00:10:39,240
WHILE TREATMENTS CAN REDUCE PAIN

289
00:10:39,240 --> 00:10:41,000
AND WE KNOW THERE IS CERTAINLY

290
00:10:41,000 --> 00:10:46,600
SIDE EFFECTS TO NON-STEROIDAL

291
00:10:46,600 --> 00:10:47,560
ANTI-INFLAMMATORY DRUGS, I DON'T

292
00:10:47,560 --> 00:10:48,880
NEED TO TELL YOU ABOUT THE

293
00:10:48,880 --> 00:10:50,680
OPIATE EPIDEMIC. WE DON'T HAVE

294
00:10:50,680 --> 00:10:52,360
GOOD DRUGS FOR OSTEOARTHRITIS.

295
00:10:52,360 --> 00:10:54,800
THERE ARE NO APPROVED DRUGS TO

296
00:10:54,800 --> 00:10:56,800
PREVENT OA OR SLOWER HEALTH

297
00:10:56,800 --> 00:10:58,480
PROGRESSION OF OA. SURGERY CAN

298
00:10:58,480 --> 00:11:05,160
REPLACE BUT NOTTER RES NOT RESTL

299
00:11:05,160 --> 00:11:06,480
JOINTS H. EVERYONE SHOULD

300
00:11:06,480 --> 00:11:08,920
RECEIVE EDUCATION BE ACTIVE

301
00:11:08,920 --> 00:11:10,560
EXERCISE TO MAG, SOME BENEFIT

302
00:11:10,560 --> 00:11:12,480
FROM DRUGS OR INJECTIONS AND A

303
00:11:12,480 --> 00:11:14,040
FEW MAY NEED SURGERY. THIS WAS

304
00:11:14,040 --> 00:11:17,520
AN INFO GRAPHIC DEVELOPED BY THE

305
00:11:17,520 --> 00:11:18,840
OSTEOARTHRITIS RESEARCH SOCIETY

306
00:11:18,840 --> 00:11:21,400
INTERNATIONAL AND ONE GETS MORE

307
00:11:21,400 --> 00:11:22,840
INFORMATION ON IN IN THE

308
00:11:22,840 --> 00:11:24,000
OSTEOARTHRITIS SERIOUS WHITE

309
00:11:24,000 --> 00:11:25,840
PAPER IS AVAILABLE AND HAS BEEN

310
00:11:25,840 --> 00:11:31,360
DISTRIBUTED. SO THIS SLIDE SHOWS

311
00:11:31,360 --> 00:11:34,120
OLDER DATA THAT IS LIMITED DATA

312
00:11:34,120 --> 00:11:35,840
ON AGE AND SEX SPECIFIC

313
00:11:35,840 --> 00:11:38,280
INCIDENCE OF SYMPTOMATIC

314
00:11:38,280 --> 00:11:40,880
OSTEOARTHRITIS.  YOU CAN SEE

315
00:11:40,880 --> 00:11:43,600
THAT LOWER AGES STARTING AT AGE

316
00:11:43,600 --> 00:11:46,120
20 WHEN THEY DEVELOP

317
00:11:46,120 --> 00:11:46,760
OSTEOARTHRITIS, IT IS THE

318
00:11:46,760 --> 00:11:48,480
INCIDENCE IS LOWEST IN THE HAND,

319
00:11:48,480 --> 00:11:49,760
NEXT IS THE HIP AND THEN THE

320
00:11:49,760 --> 00:11:53,920
KNEE. AND AFTER AGE 50 WE CAN

321
00:11:53,920 --> 00:11:56,360
SEE INCREASE IN THE INCIDENCE OF

322
00:11:56,360 --> 00:11:59,320
OSTEOARTHRITIS IN ALL THESE

323
00:11:59,320 --> 00:12:00,800
JOINTS AND IN PARTICULAR AFTER

324
00:12:00,800 --> 00:12:02,560
AGE 50 FOR WOMEN, AND WE CAN SEE

325
00:12:02,560 --> 00:12:08,240
A DRAMATIC RISE IN INCIDENCE OF

326
00:12:08,240 --> 00:12:10,280
HAND HIP AND KNEE OSTEOARTHRITIS

327
00:12:10,280 --> 00:12:12,320
MUCH HIGHER THAN IN MEN

328
00:12:12,320 --> 00:12:15,920
PARTICULARLY AFTER AGE 50. THIS

329
00:12:15,920 --> 00:12:18,480
SLIDE SUMMARIZES AGE AND SEX

330
00:12:18,480 --> 00:12:20,320
SPECIFIC PREVALENCE OF OA FROM

331
00:12:20,320 --> 00:12:24,360
2005 TO 2006 TO 2017 AND 2018

332
00:12:24,360 --> 00:12:27,800
USING N HAYNES DATA YOU CAN SEE

333
00:12:27,800 --> 00:12:30,080
THAT REGARDLESS OF RACE OR

334
00:12:30,080 --> 00:12:32,560
ETHNICITY, THAT FOR THE HISPANIC

335
00:12:32,560 --> 00:12:34,600
POPULATION, NON-HISPANIC

336
00:12:34,600 --> 00:12:36,960
CAUCASIANS, NON-HISPANIC AFRICAN

337
00:12:36,960 --> 00:12:38,760
AMERICANS AN NON-HISPANIC OTHER

338
00:12:38,760 --> 00:12:41,760
WE HAVE RISES IN THE PREVALENCE

339
00:12:41,760 --> 00:12:45,400
OVER THESE YEARS. BOTH IN MEN

340
00:12:45,400 --> 00:12:51,120
AND WOMEN IMPORTANTLY, THIS

341
00:12:51,120 --> 00:12:53,760
SLIDE SUMMARIZES IN TERMS OF THE

342
00:12:53,760 --> 00:12:55,760
ACTUAL NUMBERS AND PREVALENCE

343
00:12:55,760 --> 00:12:57,360
RATES OF SELF-REPORTED ARTHRITIS

344
00:12:57,360 --> 00:13:03,400
WHICH IS MAINLY OSTEOARTHRI OST.

345
00:13:03,400 --> 00:13:05,120
AMONG NON-HISPANIC WHITES,

346
00:13:05,120 --> 00:13:06,880
AFRICAN AMERICAN AND AMERICAN

347
00:13:06,880 --> 00:13:08,000
INDIAN THE PROBLEMS ARE NOT THAT

348
00:13:08,000 --> 00:13:10,160
DIFFERENT AND LOWER IN PACIFIC

349
00:13:10,160 --> 00:13:12,320
ISLANDERS BUT WHEN LOOKING AT

350
00:13:12,320 --> 00:13:13,120
SELF-REPORTED ACTIVITY

351
00:13:13,120 --> 00:13:15,560
LIMITATIONS IT IS HIGHER AMONG

352
00:13:15,560 --> 00:13:17,120
MINORITY GROUPS SUCH AS AFRICAN

353
00:13:17,120 --> 00:13:19,040
AMERICANS AND AMERICAN INDIANS

354
00:13:19,040 --> 00:13:21,000
COMPARED TO WHITES. THEN LOOK AT

355
00:13:21,000 --> 00:13:22,920
PROPORTION WITH ARTHRITIS WITH

356
00:13:22,920 --> 00:13:24,040
ACTIVITY LIMITATION ATTRIBUTABLE

357
00:13:24,040 --> 00:13:27,920
TO ARTHRITIS, HERE WE CAN SEE

358
00:13:27,920 --> 00:13:30,320
THE DRAMATIC EFFECT ON ARTHRITIS

359
00:13:30,320 --> 00:13:32,560
ON PEOPLE'S LIFE PARTICULARLY

360
00:13:32,560 --> 00:13:34,160
MINORITY POPULATIONS WHEREAS

361
00:13:34,160 --> 00:13:34,960
PROPORTION WITH ACTIVITY

362
00:13:34,960 --> 00:13:36,400
LIMITATION ATTRIBUTABLE TO

363
00:13:36,400 --> 00:13:38,840
ARTHRITIS IS ACTUALLY HIGHER IN

364
00:13:38,840 --> 00:13:40,560
AFRICAN AMERICANS AND AMERICAN

365
00:13:40,560 --> 00:13:44,080
INDIANS COMPARED TO NON-HISPANIC

366
00:13:44,080 --> 00:13:47,480
WHITES. IF WE LOOK BY ETHNICITY,

367
00:13:47,480 --> 00:13:49,440
SELF-REPORTED ARTHRITIS ACTUALLY

368
00:13:49,440 --> 00:13:52,200
IS HIGHER AMONG NON-HISPANIC

369
00:13:52,200 --> 00:13:53,960
WHITES AND NON-HISPANIC BLACKS

370
00:13:53,960 --> 00:13:57,680
COMPARED TO HISPANICS BUT

371
00:13:57,680 --> 00:13:58,320
SELF-REPORTED ACTIVITY

372
00:13:58,320 --> 00:13:59,480
LIMITATION IS SIMILAR BUT LOOK

373
00:13:59,480 --> 00:14:01,600
AT PROPORTION AGAIN ON FAR

374
00:14:01,600 --> 00:14:05,680
RIGHT, WHERE ARTHRITIS IS

375
00:14:05,680 --> 00:14:06,920
ATTRIBUTABLE ACTIVITY LIMITATION

376
00:14:06,920 --> 00:14:08,880
TO ARTHRITIS WE CAN SEE

377
00:14:08,880 --> 00:14:10,400
HISPANICS AND NON-HISPANIC

378
00:14:10,400 --> 00:14:12,080
BLACKS HAVE HIGHER ACTIVITY

379
00:14:12,080 --> 00:14:14,320
LIMITATION ATTRIBUTABLE TO

380
00:14:14,320 --> 00:14:15,360
ARTHRITIS THAN NON-HISPANIC

381
00:14:15,360 --> 00:14:22,080
WHITES.  WHEN LOOKING AT

382
00:14:22,080 --> 00:14:24,160
PREVALENCE OF RADIOGRAPHIC

383
00:14:24,160 --> 00:14:26,480
OSTEOARTHRITIS, DEFINED BY A

384
00:14:26,480 --> 00:14:27,280
DEFINITE OSTEOPHYTE AS GROWTH OF

385
00:14:27,280 --> 00:14:32,120
THE BONE ON X-RAY THIS IS IN THE

386
00:14:32,120 --> 00:14:34,560
LAUREN SCALE DATING BACK TO 1957

387
00:14:34,560 --> 00:14:36,160
USED IN CLINICAL EPIDEMIOLOGIC

388
00:14:36,160 --> 00:14:38,800
STUDIES WE CAN SEE THAT FOR

389
00:14:38,800 --> 00:14:39,960
AFRICAN AMERICANS THEY MAY HAVE

390
00:14:39,960 --> 00:14:41,440
DECREASE PREVALENCE OF

391
00:14:41,440 --> 00:14:44,200
RADIOGRAPHIC OA BUT WE KNOW

392
00:14:44,200 --> 00:14:46,800
THEIR FEATURES ON RADIOGRAPHIC

393
00:14:46,800 --> 00:14:48,640
OA AND PATTERNS ARE ACTUALLY

394
00:14:48,640 --> 00:14:51,000
DIFFERENT COMPARED TO WHITES.  

395
00:14:51,000 --> 00:14:53,840
AND IN TERMS OF AFRICAN

396
00:14:53,840 --> 00:14:54,880
AMERICANS HAVE HIGHER PREVALENCE

397
00:14:54,880 --> 00:14:57,560
OF NEOA ALSO MORE SEVERE AND

398
00:14:57,560 --> 00:15:01,480
LIKELY BILATERAL. THOUGH

399
00:15:01,480 --> 00:15:03,360
DECREASED PREVALENCE OF

400
00:15:03,360 --> 00:15:05,360
RADIOGRAPHIC HIP OA BUT WE SEE

401
00:15:05,360 --> 00:15:07,720
THE PATTERN OF OA IN THESE

402
00:15:07,720 --> 00:15:08,680
INDIVIDUALS IS DIFFERENT AND

403
00:15:08,680 --> 00:15:09,600
FEATURES ARE DIFFERENT COMPARED

404
00:15:09,600 --> 00:15:12,440
TO WHITES.  THERE IS LIMITED

405
00:15:12,440 --> 00:15:14,720
DATA ON HIS FA NIX SUGGEST THAT

406
00:15:14,720 --> 00:15:17,160
IN TERMS OF -- HISPANICS SUGGEST

407
00:15:17,160 --> 00:15:20,280
THAT THERE IS NOT A DIFFERENCE

408
00:15:20,280 --> 00:15:22,040
IN HISPANICS AND NON-HISPANIC

409
00:15:22,040 --> 00:15:23,720
WHITES. THERE'S LIMITED DATA ON

410
00:15:23,720 --> 00:15:25,480
ASIANS BUT THERE WAS ONE STUDY

411
00:15:25,480 --> 00:15:27,400
IN TERMS OF COMPARING WHITES IN

412
00:15:27,400 --> 00:15:30,600
THE U.S. AND FRAMINGHAM TO THE

413
00:15:30,600 --> 00:15:33,320
BEIJING OA STUDY SUGGESTING

414
00:15:33,320 --> 00:15:35,960
RADIOGRAPHCAL OA IS DECREASE

415
00:15:35,960 --> 00:15:39,440
PREVALENCE IN CHINESE IN BEIJING

416
00:15:39,440 --> 00:15:42,200
COMPARED TO WHITES IN THE U.S.

417
00:15:42,200 --> 00:15:44,040
BUT THEIR KNEE OA PARTICULARLY

418
00:15:44,040 --> 00:15:45,720
IN WOMEN IS INCREASED AND WILL

419
00:15:45,720 --> 00:15:49,000
IS ALSO DIFFERENCES IN

420
00:15:49,000 --> 00:15:50,600
MORPHOLOGY IN WELCOME PAIR IN

421
00:15:50,600 --> 00:15:52,000
CHINESE WELCOME PAIRED TO WHITE

422
00:15:52,000 --> 00:15:54,000
WOMEN AND MORE OFTEN BILATERAL.

423
00:15:54,000 --> 00:15:55,400
THESE DIFFERENCES WERE NOT

424
00:15:55,400 --> 00:15:58,320
NECESSARILY SEEN IN WHITE MEN. 

425
00:15:58,320 --> 00:16:01,240
IN HIP OA WE SEE THERE MAYBE

426
00:16:01,240 --> 00:16:03,520
DIFFERENT DECREASES IN

427
00:16:03,520 --> 00:16:05,400
PREVALENCE IN CHINESE AND

428
00:16:05,400 --> 00:16:06,560
BEIJING COMPARED TO WHITES BUT

429
00:16:06,560 --> 00:16:08,120
AGAIN WE SEE THERE'S DIFFERENCES

430
00:16:08,120 --> 00:16:09,840
IN MORPHOLOGY IN THE HIP IN

431
00:16:09,840 --> 00:16:16,360
CHINESE COMPARED TO WHITES.  

432
00:16:16,360 --> 00:16:20,240
WHEN WE LOOK AT PREVALENCE OF

433
00:16:20,240 --> 00:16:20,960
SYMPTOMATIC OSTEOARTHRITIS,

434
00:16:20,960 --> 00:16:23,000
SYMPTOMATIC OA DEFINED DEPENDING

435
00:16:23,000 --> 00:16:25,440
USUALLY ON N HAYNES DEFINITION

436
00:16:25,440 --> 00:16:27,680
ON PAIN ON BOTH DAYS OF AT LEAST

437
00:16:27,680 --> 00:16:30,840
ONE MONTH THE PAST 12 MONTHS

438
00:16:30,840 --> 00:16:32,840
WHICH IS SOMETIMES AN AWKWARD

439
00:16:32,840 --> 00:16:34,160
DEFINITION BUT MOST

440
00:16:34,160 --> 00:16:35,520
EPIDEMIOLOGIC STUDIES WE LOOK AT

441
00:16:35,520 --> 00:16:38,080
PAIN ON MOST DAYS THE PAST 30

442
00:16:38,080 --> 00:16:40,480
DAYS AS DEFINING SYMPTOMATIC OA

443
00:16:40,480 --> 00:16:42,040
WHEN RADIOGRAPHIC OA IS ALSO

444
00:16:42,040 --> 00:16:46,640
PRESENT. YOU CAN SEE IN AFRICAN

445
00:16:46,640 --> 00:16:48,400
AMERICANS THE PREVALENCE OF

446
00:16:48,400 --> 00:16:50,080
SYMPTOMATIC HAND OA IS DECREASED

447
00:16:50,080 --> 00:16:53,120
COMPARED TO WHITES, BUT KNEE OA

448
00:16:53,120 --> 00:16:54,240
IN AFRICAN AMERICANS IS

449
00:16:54,240 --> 00:16:55,800
INCREASED IN TERMS OF PREVALENCE

450
00:16:55,800 --> 00:16:57,760
AND MORE SEVERE IN TERMS OF

451
00:16:57,760 --> 00:16:59,600
SYMPTOMATIC OA COMPARED TO

452
00:16:59,600 --> 00:17:01,920
WHITES. HIP OA IS DECREASED IN

453
00:17:01,920 --> 00:17:04,000
AFRICAN AMERICANS IN TERMS OF

454
00:17:04,000 --> 00:17:05,240
SYMPTOMATIC OA COMPARED TO

455
00:17:05,240 --> 00:17:08,160
WHITES. FOR HISPANICS WE HAVE

456
00:17:08,160 --> 00:17:10,160
INCREASE IN SYMPTOMATIC HAND OA

457
00:17:10,160 --> 00:17:13,080
AND INCREASE IN SYMPTOMATIC KNEE

458
00:17:13,080 --> 00:17:17,000
OA COMPARED TO WHITES. DATA FROM

459
00:17:17,000 --> 00:17:19,920
THE BEIJING OSTEOARTHRITIS STUDY

460
00:17:19,920 --> 00:17:22,120
PREVALENCE OF SYMPTOMATIC HAND

461
00:17:22,120 --> 00:17:25,120
OA DECREASED IN CHINESE AND

462
00:17:25,120 --> 00:17:27,240
DECREASED IN HIP OA COMPARED TO

463
00:17:27,240 --> 00:17:30,400
WHITES BUT KNEE OA IS INCREASED

464
00:17:30,400 --> 00:17:32,600
IN CHINESE PARTICULARLY IN WOMEN

465
00:17:32,600 --> 00:17:39,760
BUT NOT MEN. THIS WAS VERY

466
00:17:39,760 --> 00:17:40,880
INTERESTING DATA FROM THE

467
00:17:40,880 --> 00:17:42,680
JOHNSTON COUNTY OSTEOARTHRITIS

468
00:17:42,680 --> 00:17:45,720
PROJECT. IT SHOWS THE PA TERM OF

469
00:17:45,720 --> 00:17:47,720
ENVIRONMENTAL OA WHETHER HAND

470
00:17:47,720 --> 00:17:50,000
HIP KNEE, LS, SPINE, IS

471
00:17:50,000 --> 00:17:52,000
DIFFERENT IN AFRICAN AMERICANS

472
00:17:52,000 --> 00:17:53,600
COMPARED TO WHITES IN THAT

473
00:17:53,600 --> 00:17:55,280
THERE'S CERTAIN PATTERNS OF

474
00:17:55,280 --> 00:17:57,040
JOINT INVOLVEMENT THAT ARE LEAST

475
00:17:57,040 --> 00:17:58,480
LIKELY IN AFRICAN AMERICANS AND

476
00:17:58,480 --> 00:18:00,160
YOU CAN SEE AS WE MOVE FROM LEFT

477
00:18:00,160 --> 00:18:02,320
TO RIGHT THAT THERE ARE OTHER

478
00:18:02,320 --> 00:18:03,400
PATTERNS OF JOINT INVOLVEMENT

479
00:18:03,400 --> 00:18:05,360
ARE MOST LIKELY IN AFRICAN

480
00:18:05,360 --> 00:18:07,080
AMERICANS. THIS IS IMPORTANT TO

481
00:18:07,080 --> 00:18:10,320
SHOW THAT WE NOW KNOW THERE ARE

482
00:18:10,320 --> 00:18:12,440
DIFFERENT PHENOTYPES OF KNEE

483
00:18:12,440 --> 00:18:13,840
OSTEOARTHRITIS AND THAT THIS MAY

484
00:18:13,840 --> 00:18:15,840
BE RELATED TO JOINT INVOLVEMENT

485
00:18:15,840 --> 00:18:22,720
ALSO IN TERMS OF WHETHER

486
00:18:22,720 --> 00:18:23,720
PATIENTS HAVE DIFFERENT

487
00:18:23,720 --> 00:18:25,200
UNDERLYING PATHOPHYSIOLOGY IN

488
00:18:25,200 --> 00:18:26,920
TERMS OF THEIR ARTHRITIS AND

489
00:18:26,920 --> 00:18:28,920
THIS IS IMPORTANT TO CONSIDER

490
00:18:28,920 --> 00:18:31,840
WHEN THINKING ABOUT ETHNIC AND

491
00:18:31,840 --> 00:18:38,040
RACIAL DISPARITIES IN OA. THIS

492
00:18:38,040 --> 00:18:41,000
IS DATA THAT FROM THE

493
00:18:41,000 --> 00:18:42,240
OSTEOARTHRITIS INITIATIVE THAT

494
00:18:42,240 --> 00:18:45,160
OUR GROUP DID USING DATA FROM

495
00:18:45,160 --> 00:18:47,240
THE FIX FLEX KNEE X-RAYS USED TO

496
00:18:47,240 --> 00:18:51,040
MEASURE JOINT SPACE WITH BETWEEN

497
00:18:51,040 --> 00:18:52,680
FEMUR AND TIBIA, BONES IN YOUR

498
00:18:52,680 --> 00:18:55,560
LEGS AS SURROGATE OF CARTILAGE

499
00:18:55,560 --> 00:18:56,920
THICKNESS AND WHAT YOU CAN SEE

500
00:18:56,920 --> 00:18:59,600
HERE IS IN TERMS OF PROGRESSION

501
00:18:59,600 --> 00:19:02,080
OF KNEE OSTEOARTHRITIS THAT ODD

502
00:19:02,080 --> 00:19:05,160
AVERAGE AT BASELINE AFRICAN

503
00:19:05,160 --> 00:19:07,760
AMERICAN MEN AND WHITE MEN HAVE

504
00:19:07,760 --> 00:19:09,920
MORE JOINT SPACE, THAT IS

505
00:19:09,920 --> 00:19:12,320
PRESUMABLY MORE CARTILAGE THAN

506
00:19:12,320 --> 00:19:14,000
WHITE FEMALES OR AFRICAN

507
00:19:14,000 --> 00:19:15,120
AMERICAN FEMALES.  OVER FOUR

508
00:19:15,120 --> 00:19:18,800
YEARS OF ANIMAL FOLLOW-UP OF

509
00:19:18,800 --> 00:19:20,800
KNEE X-RAYS THERE IS LOSS OF

510
00:19:20,800 --> 00:19:22,800
JOINT SPACE WITH PROGRESSION OF

511
00:19:22,800 --> 00:19:25,280
THEIR KNEE OSTEOARTHRITIS AND

512
00:19:25,280 --> 00:19:29,920
THE RATES OF LOSS IN WHITE MEN,

513
00:19:29,920 --> 00:19:32,560
WHITE WHEN AND AFRICAN AMERICAN

514
00:19:32,560 --> 00:19:35,720
WOMEN ARE SIMILAR BUT THERE IS A

515
00:19:35,720 --> 00:19:37,800
SUGGESTION OF GREATER LOSS IN

516
00:19:37,800 --> 00:19:39,480
AFRICAN AMERICAN MEN COMPARED TO

517
00:19:39,480 --> 00:19:41,440
THE OTHER GROUPS. I WILL CAUTION

518
00:19:41,440 --> 00:19:43,120
THAT THIS IS DUE TO A SMALLER

519
00:19:43,120 --> 00:19:44,800
NUMBER OF AFRICAN AMERICAN MEN

520
00:19:44,800 --> 00:19:46,480
THAT IS AVAILABLE BUT WE ARE

521
00:19:46,480 --> 00:19:48,200
DOING OTHER STUDIES TO TRY TO

522
00:19:48,200 --> 00:19:49,440
BETTER UNDERSTAND IF THERE ARE

523
00:19:49,440 --> 00:19:52,640
RACIAL AND ETHNIC DIFFERENCES IN

524
00:19:52,640 --> 00:19:55,200
TERMS OF PROGRESSION OF

525
00:19:55,200 --> 00:19:56,320
OSTEOARTHRITIS.  IT IS IMPORTANT

526
00:19:56,320 --> 00:20:00,200
TO NOTE AFTER FOUR YEARS WITH

527
00:20:00,200 --> 00:20:02,680
THE LOSS THAT MEN ON AVERAGE,

528
00:20:02,680 --> 00:20:04,520
WHITES AND AFRICAN AMERICANS

529
00:20:04,520 --> 00:20:06,080
HAVE LARGER JOINT SPACE COMPARED

530
00:20:06,080 --> 00:20:09,280
TO WOMEN. THIS MAY BE IN PART

531
00:20:09,280 --> 00:20:11,880
WHY THERE IS DISPARITY OF WOMEN

532
00:20:11,880 --> 00:20:13,920
HAVING HIGHER INCIDENCE AND

533
00:20:13,920 --> 00:20:16,000
PREVALENCE OF OSTEOARTHRITIS

534
00:20:16,000 --> 00:20:23,440
COMPARED TO MEN. THIS IS A META

535
00:20:23,440 --> 00:20:24,640
ANALYSIS OF RACIAL ETHNIC

536
00:20:24,640 --> 00:20:26,640
DIFFERENCES MANY PAIN AND

537
00:20:26,640 --> 00:20:28,440
DISABILITY AND YOU CAN SEE HERE

538
00:20:28,440 --> 00:20:30,000
THAT AFRICAN AMERICANS COMPARED

539
00:20:30,000 --> 00:20:32,480
TO WHITES HAVE HIGHER REPORTS

540
00:20:32,480 --> 00:20:36,560
AND MORE SEVERE PAIN. WESTERN

541
00:20:36,560 --> 00:20:40,200
ONTARIO MCMASTER OUTCOME

542
00:20:40,200 --> 00:20:42,120
MEASURES THAT GENERALLY USED IN

543
00:20:42,120 --> 00:20:43,200
EPIDEMIOLOGIC AND CLINICAL

544
00:20:43,200 --> 00:20:46,920
STUDIES TO MEASURE PAIN,

545
00:20:46,920 --> 00:20:48,360
STIFFNESS AND DISABILITY RELATED

546
00:20:48,360 --> 00:20:50,400
TO LOWER EXTREMITY

547
00:20:50,400 --> 00:21:00,440
OSTEOARTHRITIS.  WE WILL FOCUS

548
00:21:00,440 --> 00:21:02,080
NON-MODIFIABLE RISK FACTORS. YOU

549
00:21:02,080 --> 00:21:05,200
HAVE SEEN AGING IS A POTENT

550
00:21:05,200 --> 00:21:06,600
NON-MODIFIABLE RISK FACTOR FOR

551
00:21:06,600 --> 00:21:07,880
THE DEVELOPMENT OF

552
00:21:07,880 --> 00:21:15,080
OSTEOARTHRITIS.  THAT FEMALE SEX

553
00:21:15,080 --> 00:21:16,320
AROUND MENOPAUSE PERI AND MOST

554
00:21:16,320 --> 00:21:17,640
MENOPAUSAL PERIOD IS IMPORTANT

555
00:21:17,640 --> 00:21:19,760
RISK FACTOR. GENETICS AND JOINT

556
00:21:19,760 --> 00:21:21,320
SHAPE. WE KNOW PARTICULARLY IN

557
00:21:21,320 --> 00:21:23,080
HIP AND KNEE POTENT

558
00:21:23,080 --> 00:21:25,080
NON-MODIFIABLE RISK FACTORS.

559
00:21:25,080 --> 00:21:26,600
RETURNING TO THE RIGHT SIDE IN

560
00:21:26,600 --> 00:21:28,440
TERMS OF MODIFIABLE RISK

561
00:21:28,440 --> 00:21:31,800
FACTORS, OBESITY IS IMPORTANT

562
00:21:31,800 --> 00:21:33,560
PARTICULARLY IN KNEES BUT ALSO

563
00:21:33,560 --> 00:21:35,640
IN OTHER JOINTS SUCH AS HINT AND

564
00:21:35,640 --> 00:21:36,880
HANDS THOUGH LESS SO THAN FOR

565
00:21:36,880 --> 00:21:39,560
THE KNEES. UNFORTUNATELY JOINT

566
00:21:39,560 --> 00:21:42,680
INJURY IS A VERY POTENT RISK

567
00:21:42,680 --> 00:21:45,360
FACTOR SO JOINT PROTECTION IS A

568
00:21:45,360 --> 00:21:47,320
VERY IMPORTANT PREVENTATIVE

569
00:21:47,320 --> 00:21:49,600
STRATEGY FOR OSTEOARTHRITIS. 

570
00:21:49,600 --> 00:21:51,160
REPETITIVE STRESS DUE TO CERTAIN

571
00:21:51,160 --> 00:21:52,400
OCCUPATIONING YOU CAN SEE HERE

572
00:21:52,400 --> 00:21:56,160
WITH REPETITIVE SQUATTING OR

573
00:21:56,160 --> 00:21:58,120
KNEELING PUTS STRESS ON KNEES

574
00:21:58,120 --> 00:21:59,720
AND HIPS AND THIS CAN BE

575
00:21:59,720 --> 00:22:02,400
IMPORTANT MODIFIABLE RISK FACTOR

576
00:22:02,400 --> 00:22:04,200
FOR OSTEOARTHRITIS AND MAL

577
00:22:04,200 --> 00:22:06,880
ALIGNMENT OF JOINTS, IF YOU ARE

578
00:22:06,880 --> 00:22:07,560
KNOCK KNEED OR BOWLEGGED THAT

579
00:22:07,560 --> 00:22:10,080
ALSO INCREASES YOUR RISK OF

580
00:22:10,080 --> 00:22:16,240
OSTEOARTHRITIS.  SO IN TERMS OF

581
00:22:16,240 --> 00:22:21,120
SUMMARY AND RESEARCH GAPS MUCH

582
00:22:21,120 --> 00:22:22,120
EPIDEMIOLOGY IS FOCUSED ON THE

583
00:22:22,120 --> 00:22:23,600
KNEE WITH LIMITED INFORMATION ON

584
00:22:23,600 --> 00:22:24,840
OA AND OTHER JOINTS. THERE'S

585
00:22:24,840 --> 00:22:28,840
LIMITED DATA ON EPIDEMIOLOGY IN

586
00:22:28,840 --> 00:22:31,600
AFRICAN AMERICANS ESPECIALLY

587
00:22:31,600 --> 00:22:33,000
AFRICAN AMERICAN MEN. LACK OF

588
00:22:33,000 --> 00:22:34,600
INCIDENCE AND PREVALENCE ON KNEE

589
00:22:34,600 --> 00:22:37,400
HIP AND HAND OA AND FOOT AND

590
00:22:37,400 --> 00:22:40,240
OTHER RACIAL ETHNIC GROUPS SUCH

591
00:22:40,240 --> 00:22:42,400
AS LATINO AFRICAN AMERICAN AND

592
00:22:42,400 --> 00:22:43,400
INDIGENOUS POPULATION AND LACK

593
00:22:43,400 --> 00:22:45,520
OF DATA AND RISK FACTORS FOR

594
00:22:45,520 --> 00:22:47,400
KNEE HIP HAND AND FOOT OA OTHER

595
00:22:47,400 --> 00:22:49,520
RACIAL ETHNIC GROUPS SUCH AS

596
00:22:49,520 --> 00:22:52,480
HISPANICS LATINOS, ASIAN

597
00:22:52,480 --> 00:22:53,680
AMERICANS AND INDIGENOUS

598
00:22:53,680 --> 00:22:57,600
POPULATIONS.  THESE ARE THE

599
00:22:57,600 --> 00:23:00,640
REFERENCES THAT MAY BE HELPFUL

600
00:23:00,640 --> 00:23:11,240
FOR LATER DISCUSSION. THANK YOU 

601
00:23:15,520 --> 00:23:16,680
WE CAN MOVE TO THE NEXT TALK

602
00:23:16,680 --> 00:23:21,560
THEN. I'M PLEASED DO INTRODUCE

603
00:23:21,560 --> 00:23:23,600
DR. AMANDA NELSON, ASSOCIATE

604
00:23:23,600 --> 00:23:26,160
PROFESSOR DIVISION OF

605
00:23:26,160 --> 00:23:28,040
RHEUMATOLOGY ALLELE ANY

606
00:23:28,040 --> 00:23:29,280
RHEUMNOLOGY AT THURSTON

607
00:23:29,280 --> 00:23:30,240
ARTHRITIS CENTER UNIVERSITY OF

608
00:23:30,240 --> 00:23:32,000
NORTH CAROLINA CHAPEL HILL.

609
00:23:32,000 --> 00:23:33,520
I'M CHARGED TO TALK

610
00:23:33,520 --> 00:23:40,520
ABOUT HEALTHY  

611
00:23:40,520 --> 00:23:41,440
PEOPLE OSTEOARTHRITIS

612
00:23:41,440 --> 00:23:43,240
2030. WE KNOW OA IS A COMMON

613
00:23:43,240 --> 00:23:44,800
SERIOUS DISEASE AND HEALTHY

614
00:23:44,800 --> 00:23:46,480
PEOPLE 2030 FOCUSES ON COMMON

615
00:23:46,480 --> 00:23:48,960
SERIOUS DISEASES IN GENERAL.  IT

616
00:23:48,960 --> 00:23:50,200
INCLUDES GOALS FOR ARTHRITIS

617
00:23:50,200 --> 00:23:52,120
AROUND REDUCING JOINT PAIN,

618
00:23:52,120 --> 00:23:53,760
REDUCING WORK LIMITATION AND

619
00:23:53,760 --> 00:23:56,480
INCREASING PHYSICAL ACTIVITY.

620
00:23:56,480 --> 00:24:00,600
THERE ARE SIMILAR GOALS FOR

621
00:24:00,600 --> 00:24:02,080
CHRONIC PAIN, THERE IS CHRONIC

622
00:24:02,080 --> 00:24:04,000
PAIN MANAGEMENT MODULE ALSO,

623
00:24:04,000 --> 00:24:08,040
VERY SIMILAR TO ARTHRITIS. THE

624
00:24:08,040 --> 00:24:09,880
PLAN INCLUDES FOCUS ON SOCIAL

625
00:24:09,880 --> 00:24:15,840
DETERMINANTS OF HEALTH. THESE

626
00:24:15,840 --> 00:24:16,640
INCLUDENATE ENVIRONMENT SOCIAL

627
00:24:16,640 --> 00:24:17,880
CONTEXT, ECONOMIC STABILITY,

628
00:24:17,880 --> 00:24:20,080
EDUCATION AND HEALTHCARE ACCESS 

629
00:24:20,080 --> 00:24:25,560
THERE IS A NEXT ANIMATION. THAT

630
00:24:25,560 --> 00:24:27,200
IS THE SOCIAL DETERMINANTS OF

631
00:24:27,200 --> 00:24:31,000
HEALTH FROM HEALTHY PEOPLE 2030.

632
00:24:31,000 --> 00:24:33,320
WE SEE MAPS FROM THE CDC THAT

633
00:24:33,320 --> 00:24:36,000
HIGHLIGHT AREAS WHERE PEOPLE ARE

634
00:24:36,000 --> 00:24:37,640
FROM THE TOP. LIVING IN POVERTY

635
00:24:37,640 --> 00:24:39,640
IN THE CENTER, THOSE WITHOUT

636
00:24:39,640 --> 00:24:41,920
HIGH SCHOOL EDUCATION, AND

637
00:24:41,920 --> 00:24:43,840
BOTTOM THOSE UNDER 65 AND DON'T

638
00:24:43,840 --> 00:24:44,720
HAVE INSURANCE MEANING NOT

639
00:24:44,720 --> 00:24:46,640
COVERED BY MEDICARE. THESE

640
00:24:46,640 --> 00:24:48,440
BARRIERS TO HEALTHY AGING

641
00:24:48,440 --> 00:24:50,560
DIRECTLY IMPACT RISK AND

642
00:24:50,560 --> 00:24:52,240
PROGNOSIS OF OSTEOARTHRITIS AND

643
00:24:52,240 --> 00:24:53,800
OTHER CHRONIC DISEASES. THE

644
00:24:53,800 --> 00:24:54,360
IMPORTANCE OF SOCIAL

645
00:24:54,360 --> 00:24:55,600
DETERMINANTS OF HEALTH AND OA

646
00:24:55,600 --> 00:24:57,280
AND OTHER COMMONLY CO-MORBID

647
00:24:57,280 --> 00:24:58,480
DISEASE HIGHLIGHTED IN THE NEXT

648
00:24:58,480 --> 00:25:04,080
THREE SLIDES.  SO NEXT. TWO

649
00:25:04,080 --> 00:25:09,480
MORE. SO HERE ARE SEVERAL MAPS

650
00:25:09,480 --> 00:25:12,360
FROM THE CDC WEBSITE. ON THE TOP

651
00:25:12,360 --> 00:25:16,560
IF YOU CAN CLICK NEXT.  THERE IS

652
00:25:16,560 --> 00:25:17,720
THE PREVALENCE OF DIABETES OVER

653
00:25:17,720 --> 00:25:19,480
THE LAST TWO DECADES. YOU CAN

654
00:25:19,480 --> 00:25:24,760
SEE FROM 2004 TO 2019 THERE IS

655
00:25:24,760 --> 00:25:27,280
AN OBVIOUS CONCENTRATION IN THE

656
00:25:27,280 --> 00:25:31,880
SOUTHEAST AND WE SEE SIMILAR

657
00:25:31,880 --> 00:25:34,440
PATTERNS FOR STROKE IN PURPLE,

658
00:25:34,440 --> 00:25:40,080
HART DISEASE IN RED, AND EVEN

659
00:25:40,080 --> 00:25:41,760
PHORIA THEY AT THIS. DOCTOR

660
00:25:41,760 --> 00:25:42,400
DIAGNOSED ARTHRITIS IN BROWN.

661
00:25:42,400 --> 00:25:44,320
YOU CAN SEE THESE MAPS OVERLAP

662
00:25:44,320 --> 00:25:46,000
WITH HIGHEST RISK IN THE SAME

663
00:25:46,000 --> 00:25:52,520
AREAS.  AGAIN FROM THE CDC WE

664
00:25:52,520 --> 00:25:54,880
SEE MAPS DEMONSTRATING OBESITY

665
00:25:54,880 --> 00:25:57,680
OVERALL IN THE TOP LEFT. OBESITY

666
00:25:57,680 --> 00:26:02,360
AMONG NON-HISPANIC BLACKS ON THE

667
00:26:02,360 --> 00:26:06,120
TOP RIGHT, PHYSICAL INACTIVITY

668
00:26:06,120 --> 00:26:08,560
OPT BOTTOM, INVERSE WALKING AS

669
00:26:08,560 --> 00:26:10,440
THE MAIN SOURCE OF PHYSICAL

670
00:26:10,440 --> 00:26:13,440
ACTIVITY ON THE BOTTOM RIGHT.

671
00:26:13,440 --> 00:26:16,760
YOU CAN SEE THIS PREPONDERANCE

672
00:26:16,760 --> 00:26:19,000
SOCIAL DETERMINANTS OF HEALTH

673
00:26:19,000 --> 00:26:21,600
BARRIERS OVERLAPPING MOSTLY

674
00:26:21,600 --> 00:26:22,600
SOUGHT EAST BUT SEVERAL OTHER

675
00:26:22,600 --> 00:26:24,320
STATES A WITH LARGE UNDERSERVED

676
00:26:24,320 --> 00:26:30,160
MINORITY POPULATIONS.  

677
00:26:30,160 --> 00:26:30,760
HIGHLIGHTED SOME OF THE

678
00:26:30,760 --> 00:26:31,920
DIFFERENCES PREVALENCE AND

679
00:26:31,920 --> 00:26:34,160
INCIDENCE OF OSTEOARTHRITIS A

680
00:26:34,160 --> 00:26:35,920
PAIN AND FUNCTION BY RACE AND

681
00:26:35,920 --> 00:26:37,600
ETHNICITY. WOMEN AND BLACK

682
00:26:37,600 --> 00:26:39,720
PATIENTS WITH OA REPORT MORE

683
00:26:39,720 --> 00:26:41,000
PAIN AND POORER FUNCTION BY

684
00:26:41,000 --> 00:26:42,400
VARIOUS MEASURES.  THESE ARE

685
00:26:42,400 --> 00:26:44,040
SHOWN ON THE RIGHT WHERE THE

686
00:26:44,040 --> 00:26:48,240
BLUE LINE REPRESENTS BLACK

687
00:26:48,240 --> 00:26:50,040
INDIVIDUALS, PAIN ON THE TOP,

688
00:26:50,040 --> 00:26:52,320
VAS PAIN THE LAST 30 DAYS, PAIN

689
00:26:52,320 --> 00:26:55,600
MOST DAYS THE LAST 30 DAYS AND

690
00:26:55,600 --> 00:26:56,480
WOMAC FUNCTION ON THEWOMAN SO

691
00:26:56,480 --> 00:27:02,520
ON THE BOTTOM, SOBLACK INDIVIDUN

692
00:27:02,520 --> 00:27:04,320
AND FUNCTION IN ALL THESE

693
00:27:04,320 --> 00:27:05,200
CATEGORIES OVER TIME.

694
00:27:05,200 --> 00:27:06,760
PERFORMANCE BASED FUNCTION IS

695
00:27:06,760 --> 00:27:08,680
ALSO CORE IN BLACK COMPARED TO

696
00:27:08,680 --> 00:27:09,600
WHITE PARTICIPANTS IN MOST

697
00:27:09,600 --> 00:27:13,640
STUDIES THOUGH THIS IS AT LEAST

698
00:27:13,640 --> 00:27:14,120
PARTIALLY EXPLAINED BY

699
00:27:14,120 --> 00:27:16,080
SOCIOECONOMIC STATUS AND OTHER

700
00:27:16,080 --> 00:27:17,240
HEALTH VARIABLES. THESE ARE

701
00:27:17,240 --> 00:27:22,480
LISTED HERE. OTHER FACTORS

702
00:27:22,480 --> 00:27:24,400
ASSOCIATE -- HIGHER AMONG BLACK

703
00:27:24,400 --> 00:27:27,120
PARTICIPANTS IN THESE STUDIES

704
00:27:27,120 --> 00:27:29,800
INCLUDE PAIN CATASTROPHIZING AND

705
00:27:29,800 --> 00:27:32,480
RESILIENCE REDUCED. SO DIFFERENT

706
00:27:32,480 --> 00:27:33,680
ASPECTS CONTRIBUTE TO DISPARITY

707
00:27:33,680 --> 00:27:38,960
WE SEE IN PAIN AND FUNCTION JUST

708
00:27:38,960 --> 00:27:41,960
BEGINNING TO BE UNDERSTOOD.

709
00:27:41,960 --> 00:27:42,840
OSTEOARTHRITIS HAS DIFFERENT

710
00:27:42,840 --> 00:27:44,720
EFFECTS ACROSS LIFE COURSE.

711
00:27:44,720 --> 00:27:46,400
WORKPLACE MODIFICATIONS CAN

712
00:27:46,400 --> 00:27:48,000
MITIGATE SOME OF THE IMPACT OF

713
00:27:48,000 --> 00:27:50,280
DISABILITY FROM OA BUT THESE ARE

714
00:27:50,280 --> 00:27:53,760
OFTEN NOT AVAILABLE OR NOT FULLY

715
00:27:53,760 --> 00:27:54,480
UTILIZED, PARTICULARLY AMONG

716
00:27:54,480 --> 00:27:57,080
INDIVIDUALS WITH LOWER CON LOGIC

717
00:27:57,080 --> 00:27:59,960
AGE OR LOWER ORGANIZATIONAL AGE

718
00:27:59,960 --> 00:28:00,880
WHICH MEANS THEY HAVE BEEN IN

719
00:28:00,880 --> 00:28:02,120
COMPANY OR SETTING A SHORTER

720
00:28:02,120 --> 00:28:03,920
TIME AND DON'T HAVE ACCESS OR

721
00:28:03,920 --> 00:28:06,320
DON'T WANT TO TAKE ADVANTAGE OF

722
00:28:06,320 --> 00:28:09,160
ADDITIONAL MODIFICATIONS.  OA

723
00:28:09,160 --> 00:28:11,240
AFFECT ROLES OUTSIDE OF WORK

724
00:28:11,240 --> 00:28:12,160
PARTICULARLY DIFFICULT IN

725
00:28:12,160 --> 00:28:14,240
YOUNGER ADULTS WHO MAY BE

726
00:28:14,240 --> 00:28:16,200
RAISING FAMILY AND CARING FOR

727
00:28:16,200 --> 00:28:19,400
OLDER RELATIVES WHILE WORKING SO

728
00:28:19,400 --> 00:28:21,520
WE THINK AGE IS A STROBING RISK

729
00:28:21,520 --> 00:28:24,360
FACTOR FOR OA BUT ALSO AFFECTS

730
00:28:24,360 --> 00:28:25,360
YOUNGER INDIVIDUALS IN DIFFERENT

731
00:28:25,360 --> 00:28:31,280
WAYS OVER THE LIFE COURSE.  

732
00:28:31,280 --> 00:28:32,480
BUILT ENVIRONMENT CAN BE A

733
00:28:32,480 --> 00:28:34,200
BARRIER OR FACILITATOR FOR

734
00:28:34,200 --> 00:28:37,880
THESE. IF THERE IS AN ACCESSIBLE

735
00:28:37,880 --> 00:28:39,680
WALKABLE SAFE ENVIRONMENT THAT

736
00:28:39,680 --> 00:28:41,800
COMPENSATES FOR DISEASE RELATED

737
00:28:41,800 --> 00:28:43,560
-- THOSE LOSSES CAN BE SIMILAR

738
00:28:43,560 --> 00:28:45,760
TO EXACERBATED BY LACK OF THESE

739
00:28:45,760 --> 00:28:48,240
BENEFICIAL FEATURES SO THIS

740
00:28:48,240 --> 00:28:51,000
PAPER BY JILLIAN BOWDEN ET AL

741
00:28:51,000 --> 00:28:52,760
TALKS ABOUT THE VARIOUS ASPECTS

742
00:28:52,760 --> 00:28:53,800
OF THE BUILT ENVIRONMENT AND HOW

743
00:28:53,800 --> 00:28:57,440
THEY CAN EITHER HINDER OR

744
00:28:57,440 --> 00:28:58,440
BENEFIT THOSE WITH

745
00:28:58,440 --> 00:29:00,080
OSTEOARTHRITIS. YOU CAN SEE THE

746
00:29:00,080 --> 00:29:04,080
IMPACT THAT MIGHT VARY BY LIFE

747
00:29:04,080 --> 00:29:10,560
STAGE. ACCOUNTING FOR SOCIAL

748
00:29:10,560 --> 00:29:13,000
DETERMINANTS OF HEALTH ACROSS

749
00:29:13,000 --> 00:29:15,480
THE CARE PATHWAY CAN BENEFIT IN

750
00:29:15,480 --> 00:29:17,520
OA AS WELL AS OTHER CONDITIONS.

751
00:29:17,520 --> 00:29:19,880
FROM THE ARTICLE THIS FIGURE

752
00:29:19,880 --> 00:29:21,120
DEMONSTRATES PREVENTION EFFORTS

753
00:29:21,120 --> 00:29:22,360
TARGETED TO THOSE ENGAGED IN

754
00:29:22,360 --> 00:29:24,320
HIGH RISK JOBS OR SPORTS WE

755
00:29:24,320 --> 00:29:26,440
TALKED ABOUT REPEATED SQUATTING

756
00:29:26,440 --> 00:29:27,440
OR OTHER OCCUPATIONS THAT MIGHT

757
00:29:27,440 --> 00:29:30,240
BE HIGHER RISK.  LIFESTYLE

758
00:29:30,240 --> 00:29:30,880
INTERVENTIONS INCLUDE SUPPORT IN

759
00:29:30,880 --> 00:29:32,040
THE WORKPLACE FOR THE

760
00:29:32,040 --> 00:29:34,640
NEIGHBORHOOD AND SHOULD ALSO

761
00:29:34,640 --> 00:29:36,120
ACCOUNT FOR SOCIAL CULTURAL

762
00:29:36,120 --> 00:29:38,040
CONSIDERATIONS. THE ARTICLE HAS

763
00:29:38,040 --> 00:29:39,160
OBVIOUSLY SUBSTANTIALLY MORE

764
00:29:39,160 --> 00:29:41,040
DETAIL IN THESE NICE FIGURES TO

765
00:29:41,040 --> 00:29:48,840
HIGHLIGHT THESE ISSUES.  OA

766
00:29:48,840 --> 00:29:49,920
INTERVENTIONS ARE OFTEN NOT

767
00:29:49,920 --> 00:29:54,360
STUDIED IN DIVERSE POPULATIONS. 

768
00:29:54,360 --> 00:29:56,840
EXCELLENT REVIEW DESCRIBE LACK

769
00:29:56,840 --> 00:29:58,360
OF DATA IN GENERAL BUT

770
00:29:58,360 --> 00:29:59,720
HIGHLIGHTED REDUCE ACCESS IN

771
00:29:59,720 --> 00:30:01,320
GREATER BARRIERS FOR DIVERSE

772
00:30:01,320 --> 00:30:03,840
POPULATIONS. AND DR. IBRAHIM

773
00:30:03,840 --> 00:30:06,320
WILL TALK ABOUT ARTHROPLASTY IN

774
00:30:06,320 --> 00:30:08,560
THE NEXT TALK BUT THIS KEY

775
00:30:08,560 --> 00:30:10,680
REFERENCES TALKS ABOUT LOWER

776
00:30:10,680 --> 00:30:12,800
SES, HAVING -- GET LESS

777
00:30:12,800 --> 00:30:14,480
EDUCATION ABOUT OA AND REDUCE

778
00:30:14,480 --> 00:30:15,720
PARTICIPATION AND SELF

779
00:30:15,720 --> 00:30:17,520
MANAGEMENT PROGRAMS, BLACK

780
00:30:17,520 --> 00:30:19,080
HISPANIC INDIVIDUALS WITH OA

781
00:30:19,080 --> 00:30:20,520
MIGHT HAVE LESS ACCESS OR LESS

782
00:30:20,520 --> 00:30:23,720
ABILITY TO USE PT, LESS

783
00:30:23,720 --> 00:30:25,920
PHYSICALLY ACTIVE AND EXPERIENCE

784
00:30:25,920 --> 00:30:30,240
ADDITIONAL BARRIERS.  ONE WAY TO

785
00:30:30,240 --> 00:30:31,680
COMBAT LACK OF DATA AROUND OA

786
00:30:31,680 --> 00:30:33,360
MANAGEMENT IN DIVERSE

787
00:30:33,360 --> 00:30:35,720
POPULATIONS IS THROUGH COMMUNITY

788
00:30:35,720 --> 00:30:37,040
BASED PARTICIPATORY RESEARCH.

789
00:30:37,040 --> 00:30:38,720
THIS IMPROVES VALUE OF STUDIES

790
00:30:38,720 --> 00:30:41,680
FOR RESEARCHERS AND COMMUNIT CO.

791
00:30:41,680 --> 00:30:43,960
HERE EXEMPLIFIED BY STAFF IN

792
00:30:43,960 --> 00:30:44,960
JOHNSTON COUNTY YOU HEARD

793
00:30:44,960 --> 00:30:49,360
EARLIER, THIS IS THE HOME OF THE

794
00:30:49,360 --> 00:30:50,960
JOHNSTON COUNTY PROJECT AND

795
00:30:50,960 --> 00:30:52,680
STUDY, WE HAVE LOCAL STAFF AND

796
00:30:52,680 --> 00:30:53,880
BUILT A LOT OF INFRASTRUCTURE

797
00:30:53,880 --> 00:30:55,560
WITHIN THE COMMUNITY TO

798
00:30:55,560 --> 00:31:01,720
FACILITATE THIS TYPE OF WORK. 

799
00:31:01,720 --> 00:31:03,360
INTERVENTIONS CAN BE TAILORED

800
00:31:03,360 --> 00:31:05,640
FOR SPECIFIC POPULATIONS. THE

801
00:31:05,640 --> 00:31:08,840
START STUDY STAART LED BY DR.

802
00:31:08,840 --> 00:31:10,640
ALAN WHO IS ON THE CALL I PUT

803
00:31:10,640 --> 00:31:12,520
HER PICTURE THERE, SURE SHE IS

804
00:31:12,520 --> 00:31:14,320
THRILLED WAS FOCUSED ON ENGAGING

805
00:31:14,320 --> 00:31:15,840
BLACK INDIVIDUALS WITH OA AND

806
00:31:15,840 --> 00:31:17,560
PAIN COPING PROGRAM. THE STUDY

807
00:31:17,560 --> 00:31:19,920
FOUND THIS PROGRAM IS FEASIBLE

808
00:31:19,920 --> 00:31:21,880
AND ACCEPTABLE, IMPROVED PAIN

809
00:31:21,880 --> 00:31:27,360
COPING SKILLS, SELF-EFFICACY AND

810
00:31:27,360 --> 00:31:30,560
PAIN CATASTROPHIZING IN THIS AT

811
00:31:30,560 --> 00:31:32,680
RISK POPULATION.  IN TAILORING

812
00:31:32,680 --> 00:31:36,040
WE CAN ADAPT EXISTING TO MEET

813
00:31:36,040 --> 00:31:38,520
CURL CHURL NEEDS. WALK WITH EASE

814
00:31:38,520 --> 00:31:42,640
IS STUDIED BY A CO-CHAIR DR.

815
00:31:42,640 --> 00:31:43,840
CALLAHAN, MY COLLEAGUE HAS BEEN

816
00:31:43,840 --> 00:31:45,280
STUDIED SPECIFICALLY IN BLACK

817
00:31:45,280 --> 00:31:47,840
INDIVIDUALS SO A SUB SAMPLE OF

818
00:31:47,840 --> 00:31:49,960
THE ORIGINAL TRIAL ON BLACK

819
00:31:49,960 --> 00:31:50,880
PARTICIPANTS AND SPECIFICALLY

820
00:31:50,880 --> 00:31:52,760
ADAPTED TO MEET THE NEEDS OF

821
00:31:52,760 --> 00:31:58,080
HISPANIC INDIVIDUALS WITH

822
00:31:58,080 --> 00:32:00,160
OSTEOARTHRITIS THROUGH CAMINE

823
00:32:00,160 --> 00:32:03,360
CON GUSTO TO BETTER FACILITATE

824
00:32:03,360 --> 00:32:07,280
UPTAKE OF THAT INTERVENTION.

825
00:32:07,280 --> 00:32:08,800
MANY GAPS REMAIN. THERE IS LACK

826
00:32:08,800 --> 00:32:10,400
OF RESEARCH IN THIS AREA, THERE

827
00:32:10,400 --> 00:32:12,760
ARE FEW AVAILABLE DIVERSE

828
00:32:12,760 --> 00:32:14,560
COHORT. DIFFERENCES BY BASIC

829
00:32:14,560 --> 00:32:16,800
FEATURES SUCH AS AGE AND SEX

830
00:32:16,800 --> 00:32:18,080
REMAIN UNDER APPRECIATED THOUGH

831
00:32:18,080 --> 00:32:19,800
GETTING BETTER. INTERVENTIONS

832
00:32:19,800 --> 00:32:22,360
WILL NEED TO BE STUDIED AND

833
00:32:22,360 --> 00:32:23,120
APPROPRIATE POPULATIONS IN ORDER

834
00:32:23,120 --> 00:32:24,880
TO ALLOW THEM TO BE TAILORED TO

835
00:32:24,880 --> 00:32:26,600
MEET THE NEEDS OF THOSE

836
00:32:26,600 --> 00:32:29,480
POPULATIONS.  FURTHER APPROVED

837
00:32:29,480 --> 00:32:32,760
FOCUS ON UNDERLYING ISSUES THAT

838
00:32:32,760 --> 00:32:35,160
ARE QUOTE RACE AS NEEDED.  AND

839
00:32:35,160 --> 00:32:36,200
OBVIOUSLY I MENTION AD FEW

840
00:32:36,200 --> 00:32:37,400
STUDIES THAT FOUND ATTENUATION

841
00:32:37,400 --> 00:32:39,520
OF THAT VARIABLE BY SES,

842
00:32:39,520 --> 00:32:41,080
PSYCHOSOCIAL VARIABLES AND

843
00:32:41,080 --> 00:32:42,160
OTHERS BUT MUCH MORE WORK IN

844
00:32:42,160 --> 00:32:48,600
THAT AREA IS NEEDED.  THOSE ARE

845
00:32:48,600 --> 00:32:52,240
THE REFERENCES THAT I MENTIONED.

846
00:32:52,240 --> 00:32:57,920
THANK YOU VERY MUCH.

847
00:32:57,920 --> 00:33:00,520
>> THANK YOU, DR. NELSON.
THE

848
00:33:00,520 --> 00:33:04,480
NEXT TALK IS BY DR. SAID

849
00:33:04,480 --> 00:33:05,440
IBRAHIM, SENIOR VICE PRESIDENT

850
00:33:05,440 --> 00:33:10,960
FOR MEDICINE SERVICE LINE AT

851
00:33:10,960 --> 00:33:13,160
NORTH WELL HEALTH. AND THE DAVID

852
00:33:13,160 --> 00:33:15,720
GREEN PROFESSOR DONALD BARBARA

853
00:33:15,720 --> 00:33:17,040
ZUCKER SCHOOL OF MEDICINE AND

854
00:33:17,040 --> 00:33:19,280
DR. IBRAHIM WILL DISCUSS

855
00:33:19,280 --> 00:33:21,760
INTERVENTIONS DISSEMINATION AND

856
00:33:21,760 --> 00:33:25,240
IMPLEMENTATION. DR. IBRAHIM.

857
00:33:25,240 --> 00:33:27,160
>> HELLO, EVERYONE, GOOD

858
00:33:27,160 --> 00:33:30,160
MORNING. IT IS GREAT TO SEE YOU

859
00:33:30,160 --> 00:33:34,640
ALL. MANY FAMILIAR FACES. THANKS

860
00:33:34,640 --> 00:33:40,360
AGAIN FOR NIAMS AND NIA AND THE

861
00:33:40,360 --> 00:33:46,480
NICNIMHD FOR SPONSORING THIS

862
00:33:46,480 --> 00:33:48,480
WORKSHOP, THIS REALLY A NEEDED

863
00:33:48,480 --> 00:33:51,240
THING. SO THANK YOU. I'M GOING

864
00:33:51,240 --> 00:33:53,720
TO, I THINK DR. NELSON AND DR.

865
00:33:53,720 --> 00:33:55,800
KWOH PROVIDED AN EXCELLENT

866
00:33:55,800 --> 00:33:57,720
INTRODUCTION TO OA AND

867
00:33:57,720 --> 00:33:59,960
DISPARITIES AS MANY OF YOU KNOW,

868
00:33:59,960 --> 00:34:04,520
OA IS SORT OF ALMOST LIFE LONG

869
00:34:04,520 --> 00:34:07,080
AMBITION. THE SPECTRUM OF

870
00:34:07,080 --> 00:34:09,680
DISPARITIES OR VARIATIONS IN

871
00:34:09,680 --> 00:34:16,000
BOTH EPIDEMIOLOGY AND TREATMENT

872
00:34:16,000 --> 00:34:19,160
AND MANAGEMENT FROM SELF CARE TO

873
00:34:19,160 --> 00:34:20,520
EXTREME END JOINT REPLACEMENT SO

874
00:34:20,520 --> 00:34:23,960
I WILL TAKE YOU TO THAT EXTREME

875
00:34:23,960 --> 00:34:28,440
END. I WILL TALK ABOUT THAT

876
00:34:28,440 --> 00:34:30,200
PARTICULAR DISPARITY IN

877
00:34:30,200 --> 00:34:31,560
MANAGEMENT OF END STAGE KNEE OR

878
00:34:31,560 --> 00:34:36,640
HIP OA. SO I'M GOING TO QUICKLY

879
00:34:36,640 --> 00:34:38,120
SUMMARIZE WORK THAT'S ONGOING

880
00:34:38,120 --> 00:34:43,760
AND MOSTLY FUNDED BY NIAMS

881
00:34:43,760 --> 00:34:45,000
CONDUCTED BY TEAM OF US

882
00:34:45,000 --> 00:34:48,600
INCLUDING DR. KWOH. BUT I THINK

883
00:34:48,600 --> 00:34:52,560
OUR FRAMEWORK FOR APPROACHING

884
00:34:52,560 --> 00:34:54,000
RACIAL DISPARITIES IN THE USE OF

885
00:34:54,000 --> 00:34:55,960
KNEE AND HIP REPLACEMENT HAS

886
00:34:55,960 --> 00:35:00,320
SORT OF USED THIS APPROACH WHERE

887
00:35:00,320 --> 00:35:03,120
WE FIRST TRIED TO LOOK AT FIRST

888
00:35:03,120 --> 00:35:06,320
GENERATION STUDIES, WE DECIDE TO

889
00:35:06,320 --> 00:35:09,440
REALLY LOOK AT THE EXISTENCE OF

890
00:35:09,440 --> 00:35:10,880
DISPARITY ITSELF TO MAKE SURE

891
00:35:10,880 --> 00:35:14,680
THAT WE ARE NOT CONFUSING

892
00:35:14,680 --> 00:35:18,320
DIFFERENCES WITH REALLY SERIOUS

893
00:35:18,320 --> 00:35:19,720
DISPARITIES. SECOND STUDIES

894
00:35:19,720 --> 00:35:20,720
STRIVE TO IDENTIFY SOMETHING WE

895
00:35:20,720 --> 00:35:23,960
CAN DO SOMETHING ABOUT. IDENTIFY

896
00:35:23,960 --> 00:35:25,840
POTENTIAL MITIGATING FACTORS. 

897
00:35:25,840 --> 00:35:27,760
AND THE THIRD GENERATION STUDIES

898
00:35:27,760 --> 00:35:29,680
ARE STUDIES THAT TEST

899
00:35:29,680 --> 00:35:30,600
INTERVENTIONS AND I WILL PROVIDE

900
00:35:30,600 --> 00:35:32,960
AN EXAMPLE OF SOME OF THE

901
00:35:32,960 --> 00:35:33,680
INTERVENTIONS THERE THAT WE HAVE

902
00:35:33,680 --> 00:35:37,240
TESTED.  LASTLY OF COURSE IS THE

903
00:35:37,240 --> 00:35:40,000
FOURTH GENERATION, IN A WAY THE

904
00:35:40,000 --> 00:35:43,200
HORIZON, THAT IS DISSEMINATION

905
00:35:43,200 --> 00:35:48,080
AND IMPLEMENTATION. NEXT. SO

906
00:35:48,080 --> 00:35:50,800
JUST QUICKLY, THE FIRST QUESTION

907
00:35:50,800 --> 00:35:55,240
ONE HAS TO ASK IS JOINT

908
00:35:55,240 --> 00:35:56,560
REPLACEMENT EFFECTIVE? IT IS

909
00:35:56,560 --> 00:35:58,840
TRUE WHEN ALL ELSE FAILS OA IS

910
00:35:58,840 --> 00:36:02,160
NOT A CURABLE DISEASE OR

911
00:36:02,160 --> 00:36:03,800
CONSERVATIVE MANAGEMENT FAILS,

912
00:36:03,800 --> 00:36:05,360
PATIENTS EVENTUALLY SORT OF

913
00:36:05,360 --> 00:36:08,000
REQUIRE MORE INVASIVE TREATMENT

914
00:36:08,000 --> 00:36:10,120
AND TOTAL REPLACEMENT IS THERE. 

915
00:36:10,120 --> 00:36:13,840
FOR THAT PURPOSE. BUT HAS IT

916
00:36:13,840 --> 00:36:16,760
BEEN EFFECTIVE? MANY OF YOU ON

917
00:36:16,760 --> 00:36:18,920
THE WORKSHOP KNOW BETTER THAN I,

918
00:36:18,920 --> 00:36:21,480
THIS HAS BEEN A SUBJECT OF

919
00:36:21,480 --> 00:36:22,160
NUMEROUS NIH CONSENSUS

920
00:36:22,160 --> 00:36:23,480
STATEMENTS AND SYSTEMIC REVIEWS

921
00:36:23,480 --> 00:36:27,320
BY AHRQQ. IT IS EFFECTIVE FOR TE

922
00:36:27,320 --> 00:36:28,120
RIGHT PATIENT AT THE RIGHT TIME

923
00:36:28,120 --> 00:36:30,320
IN THE THE RIGHT HANDS, AT THE

924
00:36:30,320 --> 00:36:32,720
RIGHT HEALTHCARE. I SHOULD SAY

925
00:36:32,720 --> 00:36:35,600
OR HOSPITAL, IT IS VERY

926
00:36:35,600 --> 00:36:36,960
EFFECTIVE TREATMENT, VERY COST

927
00:36:36,960 --> 00:36:39,360
EFFECTIVE WITH LESS THAN 10-K

928
00:36:39,360 --> 00:36:41,040
PER QUALITY ADJUSTED LIFE YEAR.

929
00:36:41,040 --> 00:36:42,320
THE VAST MAJORITY OF PATIENTS

930
00:36:42,320 --> 00:36:47,480
WHO UNDERGO THIS TREATMENT AND

931
00:36:47,480 --> 00:36:49,480
DO WELL THROUGH THE OPERATIVE

932
00:36:49,480 --> 00:36:51,480
PERIOD REPORT IMPROVEMENT IN

933
00:36:51,480 --> 00:36:52,720
PAIN OR FUNCTION. IT IS

934
00:36:52,720 --> 00:36:54,840
CONSIDERED ONE OF THE MOST --

935
00:36:54,840 --> 00:36:56,520
SAFEST ELECTIVE SURGICAL

936
00:36:56,520 --> 00:36:58,200
PROCEDURES IN HISTORY OF SURGERY

937
00:36:58,200 --> 00:37:01,520
WITH LESS THAN 1% RISK OF

938
00:37:01,520 --> 00:37:03,640
MORTALITY. WITH ADVANCEMENT OF

939
00:37:03,640 --> 00:37:07,320
TECHNOLOGIES AND MAKING

940
00:37:07,320 --> 00:37:09,880
PROSTHETICS, THE NUMBER OF YEARS

941
00:37:09,880 --> 00:37:13,400
THESE PROSTHETICS LAST IS ON THE

942
00:37:13,400 --> 00:37:18,680
INCREASE.  THAT IS REALLY

943
00:37:18,680 --> 00:37:21,120
REFLECTIVE BY THE UTILIZATION OF

944
00:37:21,120 --> 00:37:23,800
KNEE AND HIP REPLACEMENT. THIS

945
00:37:23,800 --> 00:37:28,920
SLIDE SHOWS THE PROJECTED LIVES

946
00:37:28,920 --> 00:37:32,240
IN USE OF KNEE AND HIP

947
00:37:32,240 --> 00:37:32,800
ARTHEROBLAST IN THE UNITED

948
00:37:32,800 --> 00:37:34,120
STATES ALONE LET ALONE THE REST

949
00:37:34,120 --> 00:37:36,200
OF THE WORLD. WHAT IS REMARKABLE

950
00:37:36,200 --> 00:37:37,800
IS JOINT REPLACEMENT ELECTIVE

951
00:37:37,800 --> 00:37:40,840
KNEE AND HIP REPLACEMENT IS BY

952
00:37:40,840 --> 00:37:44,400
FAR THE MOST COMMON AND THE

953
00:37:44,400 --> 00:37:47,560
FASTEST GROWING ELECTIVE JOINT

954
00:37:47,560 --> 00:37:48,120
REPLACEMENT IN THE UNITED

955
00:37:48,120 --> 00:37:54,520
STATES.  THERE HAS BEEN NUMEROUS

956
00:37:54,520 --> 00:37:58,800
STUDIES THAT HAVE DOCUMENTED

957
00:37:58,800 --> 00:38:00,080
BEAUTIFULLY DISPARITIES IN USE

958
00:38:00,080 --> 00:38:03,920
OF KNEE AND HIP REPLACEMENT BACK

959
00:38:03,920 --> 00:38:06,480
TO 1993. THIS IS START WITH THE

960
00:38:06,480 --> 00:38:09,040
WORK BY JOSE WHO IS NOW AT RAND

961
00:38:09,040 --> 00:38:11,920
I THINK AND SANDY SHORTS WHO

962
00:38:11,920 --> 00:38:15,040
PUBLISHED IN 1993 FIRST STUDIES

963
00:38:15,040 --> 00:38:17,280
USING MEDICAL DATABASES TO

964
00:38:17,280 --> 00:38:18,440
DOCUMENT BLACK AND WHITE

965
00:38:18,440 --> 00:38:19,880
DIFFERENCES IN THE USE OF KNEE

966
00:38:19,880 --> 00:38:24,280
AND HIP REPLACEMENT. SINCE THEN

967
00:38:24,280 --> 00:38:26,200
NUMEROUS OTHER AUTHORS LOOKED AT

968
00:38:26,200 --> 00:38:29,480
THIS ISSUE, USING MOSTLY LARGE

969
00:38:29,480 --> 00:38:32,320
ADMINISTRATIVE DATABASES TO SHOW

970
00:38:32,320 --> 00:38:36,800
THIS IS SIGNIFICANT DISPARITY.

971
00:38:36,800 --> 00:38:43,880
NEXT SLIDE. THIS IS A WORK BY

972
00:38:43,880 --> 00:38:46,000
JHA, OR COVID CZAR AT WHITE

973
00:38:46,000 --> 00:38:47,640
HOUSE BUT BEFORE EXPERT ON COVID

974
00:38:47,640 --> 00:38:50,120
HE WAS EXPERT ON KNEE AND HIP

975
00:38:50,120 --> 00:38:51,400
REPLACEMENT DISPARITIES.  THIS

976
00:38:51,400 --> 00:38:53,560
IS HIS WORK LOOKING AT THE BLACK

977
00:38:53,560 --> 00:38:54,760
WHITE DIFFERENCES IN AGE

978
00:38:54,760 --> 00:38:56,080
ADJUSTED NATIONAL RATES OF TOTAL

979
00:38:56,080 --> 00:39:00,240
HIP REPLACEMENT SHOWING

980
00:39:00,240 --> 00:39:01,960
DIFFERENCES BY RACE AND BY

981
00:39:01,960 --> 00:39:06,440
GENDER. NEXT SLIDE. THIS IS WORK

982
00:39:06,440 --> 00:39:10,320
FROM THE CDC, BEFORE CDC WAS

983
00:39:10,320 --> 00:39:16,040
DECREDITTED BY THE COVID WALL,

984
00:39:16,040 --> 00:39:19,360
GO BACK ONE. THIS IS WORK

985
00:39:19,360 --> 00:39:23,680
PUBLISHED IN 2009 SHOWING BLACK

986
00:39:23,680 --> 00:39:26,400
WHITE DIFFERENCES IN AGE

987
00:39:26,400 --> 00:39:28,400
ADJUSTED TOTAL KNEE REPLACEMENT,

988
00:39:28,400 --> 00:39:30,240
YOU CAN SEE MINORITY PATIENTS

989
00:39:30,240 --> 00:39:31,640
PARTICULARLY AFRICAN AMERICAN

990
00:39:31,640 --> 00:39:34,160
MEN ARE ALMOST 40% LESS LIKELY

991
00:39:34,160 --> 00:39:35,840
TO UNDERGO KNEE REPLACEMENT

992
00:39:35,840 --> 00:39:38,520
THOUGH WE ALL KNOW, BACK TO DR.

993
00:39:38,520 --> 00:39:40,440
KWOH BEAUTIFULLY ARTICULATED THE

994
00:39:40,440 --> 00:39:44,360
PREVALENCE OF KNEE OA IS

995
00:39:44,360 --> 00:39:47,280
BENEFITING SLIGHTLY HIGHER AMONG

996
00:39:47,280 --> 00:39:50,560
AFRICAN AMERICAN MEN. JUST IN

997
00:39:50,560 --> 00:39:52,160
CASE YOU WORRY THIS IS OLD DATA

998
00:39:52,160 --> 00:39:55,360
THIS IS MORE RECENT DATA THAT

999
00:39:55,360 --> 00:39:57,560
WORK FUNDED BY NATIONAL

1000
00:39:57,560 --> 00:39:59,000
INSTITUTE FOR MINORITY HEALTH

1001
00:39:59,000 --> 00:40:00,400
AND HEALTH DISPARITIES SHOW WHEN

1002
00:40:00,400 --> 00:40:02,400
WE WERE STUDYING ASSOCIATION OF

1003
00:40:02,400 --> 00:40:07,800
MEDICARE BUNDLED LIKELIHOOD OF

1004
00:40:07,800 --> 00:40:09,960
UNDERGOING ELECTED KNEE AND HIP

1005
00:40:09,960 --> 00:40:11,240
REPLACEMENT BY RACE AND

1006
00:40:11,240 --> 00:40:16,520
ETHNICITY, WE FOUND DISPARITY IS

1007
00:40:16,520 --> 00:40:19,080
PERSISTENT, GETTING WIDER. THIS

1008
00:40:19,080 --> 00:40:21,160
IS NOT AN OLD STORY, THIS IS A

1009
00:40:21,160 --> 00:40:23,800
MARKED DISPARITY, IN FACT MANY

1010
00:40:23,800 --> 00:40:25,720
PEOPLE CONSIDER IT THE LARGEST

1011
00:40:25,720 --> 00:40:26,960
SURGICAL DISPARITY, HISTORY OF

1012
00:40:26,960 --> 00:40:32,160
MEDICINE. ONE OF THE PROBLEMS IN

1013
00:40:32,160 --> 00:40:35,920
IN STUDYING DISPARITIES USING

1014
00:40:35,920 --> 00:40:38,920
DATABASES IS IT IS NOT ALWAYS

1015
00:40:38,920 --> 00:40:40,600
EASY TO LEVEL PLAYING FIELD IN

1016
00:40:40,600 --> 00:40:42,920
TERMS OF THE SEVERITY OF DISEASE

1017
00:40:42,920 --> 00:40:45,280
AND THE -- PEOPLE FOR WHOM THE

1018
00:40:45,280 --> 00:40:47,480
TREATMENT IS INDICATED. SO ONE

1019
00:40:47,480 --> 00:40:49,320
OF THE NICE STUDIES UNBY JEFF

1020
00:40:49,320 --> 00:40:53,720
KATZ AND HIS TEAM AT DONE BY

1021
00:40:53,720 --> 00:40:54,920
JEFF KATZ AND HIS TEAM IS

1022
00:40:54,920 --> 00:40:56,120
LOOKING AT COHORT OF PATIENTS

1023
00:40:56,120 --> 00:41:00,560
WITH KNOWN SEVERE KNEE OA THE

1024
00:41:00,560 --> 00:41:02,240
LIKELIHOOD OF UNDERGOING KNEE

1025
00:41:02,240 --> 00:41:03,720
REPLACEMENT OVER TIME AND WHAT

1026
00:41:03,720 --> 00:41:06,600
THEY HAVE SHOWN IS THE REALLY

1027
00:41:06,600 --> 00:41:10,000
SORT OF DIVERGENCE THAT ALMOST

1028
00:41:10,000 --> 00:41:11,320
MIRRORS WHO WHAT THE LARGE

1029
00:41:11,320 --> 00:41:13,360
DATABASES HAVE SHOWN US. THIS IS

1030
00:41:13,360 --> 00:41:16,240
A GOOD WAY TO METHOD LOGICALLY

1031
00:41:16,240 --> 00:41:18,560
CONFIRM THIS DISPARITY IS NOT

1032
00:41:18,560 --> 00:41:21,200
JUST CONFOUNDED BY DISEASE

1033
00:41:21,200 --> 00:41:27,000
SEVERITY AT TIME OF TREATMENT

1034
00:41:27,000 --> 00:41:31,840
CONSIDERATION. SO THE QUESTION

1035
00:41:31,840 --> 00:41:32,760
THEN BECOMES IF YOU ACCEPT WHAT

1036
00:41:32,760 --> 00:41:34,960
I SAID, THIS IS IS LARGE

1037
00:41:34,960 --> 00:41:36,520
DISPARITY, IT IS LONG LASTING,

1038
00:41:36,520 --> 00:41:38,080
IT HAS BEEN AROUND FOR A WHILE.

1039
00:41:38,080 --> 00:41:39,880
THE QUESTION IS WHAT -- FIRST

1040
00:41:39,880 --> 00:41:41,760
QUESTION IS WHAT ARE THE REASONS

1041
00:41:41,760 --> 00:41:44,080
FOR THIS? BEFORE WE THINK ABOUT

1042
00:41:44,080 --> 00:41:44,680
WHAT INTERVENTIONS SHOULD WE

1043
00:41:44,680 --> 00:41:48,200
CONSIDER. SO WE HAVE DONE OVER

1044
00:41:48,200 --> 00:41:49,440
THE YEARS NUMEROUS STUDIES

1045
00:41:49,440 --> 00:41:51,080
LOOKING AT PATIENT LEVEL FACTORS

1046
00:41:51,080 --> 00:41:53,080
THAT SHAPE THIS ISSUE, SOME

1047
00:41:53,080 --> 00:41:57,320
INSURANCE ISSUES THAT MAY SHAPE

1048
00:41:57,320 --> 00:41:58,960
DISPARITY, SOME STUDIES LOOKING

1049
00:41:58,960 --> 00:42:02,360
AT DOCTOR PATIENT COMMUNICATION

1050
00:42:02,360 --> 00:42:04,040
MITIGATION FACTORS THAT SHAPE

1051
00:42:04,040 --> 00:42:05,400
DISPARITY. FIRST I WANT TO SHOW

1052
00:42:05,400 --> 00:42:07,600
YOU WITH IS THAT THERE IS A

1053
00:42:07,600 --> 00:42:09,800
MARKED DIFFERENCES BY RACE IN

1054
00:42:09,800 --> 00:42:12,600
PATIENTS PERCEPTIONS ABOUT

1055
00:42:12,600 --> 00:42:15,680
USEFULNESS OF VARIOUS TREATMENTS

1056
00:42:15,680 --> 00:42:19,040
FOR KNEE OA. IF YOU THINK ABOUT

1057
00:42:19,040 --> 00:42:21,960
FROM PHYSICAL THERAPY TO

1058
00:42:21,960 --> 00:42:23,280
CHIROPRACTIC TO HERBAL MEDICINE

1059
00:42:23,280 --> 00:42:24,960
TO MASSAGE, PRAYER, AND SOME

1060
00:42:24,960 --> 00:42:27,880
SORT OF TRADITIONAL TREATMENT

1061
00:42:27,880 --> 00:42:31,400
FOR ARTHRITIS, AFRICAN AMERICANS

1062
00:42:31,400 --> 00:42:32,640
PATIENTS HOLD MORE FAVORABLE

1063
00:42:32,640 --> 00:42:34,600
VIEWS OF THOSE TREATMENTS. IF

1064
00:42:34,600 --> 00:42:37,080
YOU GO TO THE LAST YOU REALIZE

1065
00:42:37,080 --> 00:42:39,080
WHEN IT COMES TO SURGERY,

1066
00:42:39,080 --> 00:42:41,160
EVERYTHING IS DIFFERENT. AFRICAN

1067
00:42:41,160 --> 00:42:44,880
AMERICAN PATIENTS IN GENERAL DO

1068
00:42:44,880 --> 00:42:45,880
NOT CONSIDER TOTAL REPLACEMENT

1069
00:42:45,880 --> 00:42:48,680
AS A USEFUL TREATMENT OPTION FOR

1070
00:42:48,680 --> 00:42:50,040
ENDS STAGE KNEE OA COMPARED TO

1071
00:42:50,040 --> 00:42:55,000
WHITES.  SO YOU MIGHT SAY WHY IS

1072
00:42:55,000 --> 00:42:56,640
THAT? MULTIPLE FACTORS, SOME HAS

1073
00:42:56,640 --> 00:42:58,760
TO DO WITH PATIENT EXPECTATIONS,

1074
00:42:58,760 --> 00:43:00,560
REGARDING SURGICAL OUTCOMES.

1075
00:43:00,560 --> 00:43:04,960
SOME OF IT HAS TO DO WITH

1076
00:43:04,960 --> 00:43:08,640
PATIENTS FAMILIARITY AND KNOWING

1077
00:43:08,640 --> 00:43:09,560
RELATIVES OF COMMUNITY MEMBERS

1078
00:43:09,560 --> 00:43:12,760
WHO HAD THE TREATMENT AND THIS

1079
00:43:12,760 --> 00:43:16,760
SLIDE SHOWS A STUDY WE DID IN

1080
00:43:16,760 --> 00:43:18,600
CLEVELAND, WHAT WE FOUND WAS

1081
00:43:18,600 --> 00:43:19,960
AFRICAN AMERICAN PATIENTS WERE

1082
00:43:19,960 --> 00:43:21,640
MORE LIKELY TO HAVE CONCERNS

1083
00:43:21,640 --> 00:43:26,240
ABOUT WALKING AFTER THE

1084
00:43:26,240 --> 00:43:27,720
PROCEDURE. MORE CONSENSUS ABOUT

1085
00:43:27,720 --> 00:43:29,240
PAIN POST PROCEDURE. THEY

1086
00:43:29,240 --> 00:43:31,280
THOUGHT RECOVERY TIME WOULD TAKE

1087
00:43:31,280 --> 00:43:33,680
MORE THAN SIX MONTHS COMPARED TO

1088
00:43:33,680 --> 00:43:36,120
WHITES. MORE WORRIED ABOUT LONG

1089
00:43:36,120 --> 00:43:38,800
HOSPITAL COURSE, MORE THAN TWO

1090
00:43:38,800 --> 00:43:40,440
WEEKS, WE WILL COME BACK TO THIS

1091
00:43:40,440 --> 00:43:42,720
ISSUE BECAUSE IT MAY BE RELATED

1092
00:43:42,720 --> 00:43:44,120
TO SOMETHING THAT DR. CRISWELL

1093
00:43:44,120 --> 00:43:46,000
SAID WHICH IS MINORITY PATIENTS

1094
00:43:46,000 --> 00:43:48,360
ARE MORE LIKELY TO BE DISCHARGED

1095
00:43:48,360 --> 00:43:51,000
TO AN INSTITUTION AFTER

1096
00:43:51,000 --> 00:43:52,600
UNDERGOING KNEE OR HIP

1097
00:43:52,600 --> 00:43:54,000
REPLACEMENT WHICH MAY SHAPE THE

1098
00:43:54,000 --> 00:43:55,320
THOUGHTS ABOUT HOW LONG IT TAKES

1099
00:43:55,320 --> 00:43:57,880
TO BE IN A HOSPITAL. AFTER ALL

1100
00:43:57,880 --> 00:43:59,840
ACUTE HOSPITAL IS NO DIFFERENT

1101
00:43:59,840 --> 00:44:00,920
THAN A SNIFF IN THE MINDS OF

1102
00:44:00,920 --> 00:44:06,280
MANY OF THE PATIENTS. NEXT

1103
00:44:06,280 --> 00:44:10,640
SLIDE. IN SOME OF THOSE STUDIES

1104
00:44:10,640 --> 00:44:12,200
ONE OF THE THINGS WE ASK IN

1105
00:44:12,200 --> 00:44:17,440
COHORT OF PATIENTS WITH KNEE OA

1106
00:44:17,440 --> 00:44:18,680
OR HIP OA CANDIDATES FOR

1107
00:44:18,680 --> 00:44:22,560
TREATMENT, WE WANT TO KNOW WHAT

1108
00:44:22,560 --> 00:44:24,440
PATIENTS WOULD DO OR LIKE TO DO

1109
00:44:24,440 --> 00:44:28,080
IF DOCTOR RECOMMEND THE

1110
00:44:28,080 --> 00:44:30,480
TREATMENT. ONE OF THE THINGS YOU

1111
00:44:30,480 --> 00:44:35,120
REALIZE IS THAT AFRICAN AMERICAN

1112
00:44:35,120 --> 00:44:36,640
PATIENTS WERE ABOUT ALMOST 50%

1113
00:44:36,640 --> 00:44:38,880
LESS LIKELY TO BE WILLING TO

1114
00:44:38,880 --> 00:44:39,880
CONSIDER TOTAL REPLACEMENT EVEN

1115
00:44:39,880 --> 00:44:41,320
IF DOCTOR RECOMMENDED IT.  WHEN

1116
00:44:41,320 --> 00:44:45,960
WE ADJUSTED FOR FACTORS SUCH AS

1117
00:44:45,960 --> 00:44:47,200
EDUCATIONAL LEVEL AGE ANNUAL

1118
00:44:47,200 --> 00:44:50,440
HOUSEHOLD INCOME AND RADIOLOGY

1119
00:44:50,440 --> 00:44:52,920
AND GERIATRIC SCORE AND

1120
00:44:52,920 --> 00:44:54,760
FAMILIARITY IT DOESN'T MAKE A

1121
00:44:54,760 --> 00:44:56,560
LOT OF DIFFERENT BUT WHEN WE

1122
00:44:56,560 --> 00:45:00,600
INCLUDE INTO THE MODEL PATIENT

1123
00:45:00,600 --> 00:45:01,560
CONCERNS ABOUT SURGICAL

1124
00:45:01,560 --> 00:45:03,520
OUTCOMES, EXPECTATION ABOUT

1125
00:45:03,520 --> 00:45:05,320
SURGERY THE ODD RATIO MOVED

1126
00:45:05,320 --> 00:45:07,440
CLOSER TO ONE THAT WAS NO LONGER

1127
00:45:07,440 --> 00:45:09,040
STATISTICALLY SIGNIFICANT

1128
00:45:09,040 --> 00:45:12,440
SUGGESTING THAT PART OF PATIENT

1129
00:45:12,440 --> 00:45:15,080
CONCERNS ABOUT SURGERY HAS TO DO

1130
00:45:15,080 --> 00:45:19,520
WITH CONCERNS ABOUT OUTCOMES. 

1131
00:45:19,520 --> 00:45:22,720
WHAT ABOUT ORTHOPEDIC SURGERY IN

1132
00:45:22,720 --> 00:45:24,400
PATIENTS, THIS STUDY FUNDED BY

1133
00:45:24,400 --> 00:45:26,440
ROBERT WOOD JOHNSON FOUNDATION

1134
00:45:26,440 --> 00:45:29,080
WE INTERCEPTED PATIENTS AFRICAN

1135
00:45:29,080 --> 00:45:30,320
AMERICAN AND NON-AFRICAN

1136
00:45:30,320 --> 00:45:33,120
AMERICAN PATIENTS WHO REFERRED

1137
00:45:33,120 --> 00:45:35,560
TO ORTHOPEDIC SURGERY AND WANTED

1138
00:45:35,560 --> 00:45:38,360
TO KNOW HOW DID THEY COMMUNICATE

1139
00:45:38,360 --> 00:45:41,240
TO THE DOCTORS AND WHAT WAS THE

1140
00:45:41,240 --> 00:45:43,160
RECOMMENDATIONS AFTERWARDS. WE

1141
00:45:43,160 --> 00:45:46,400
AUDIOTAPED THE CONVERSATIONS ONE

1142
00:45:46,400 --> 00:45:48,960
THING WE FOUND IS THAT MINORITY

1143
00:45:48,960 --> 00:45:50,760
PATIENTS WERE SIGNIFICANTLY LESS

1144
00:45:50,760 --> 00:45:52,880
LIKELY TO BE RECOMMENDED FOR THE

1145
00:45:52,880 --> 00:45:57,360
JOINT REPLACEMENT, BUT THAT IS

1146
00:45:57,360 --> 00:45:59,120
ALMOST ALL ENTIRELY DUE TO THE

1147
00:45:59,120 --> 00:46:02,160
FACT THAT THAT BASELINE

1148
00:46:02,160 --> 00:46:03,840
PREFERENCE FOR THE TREATMENT WAS

1149
00:46:03,840 --> 00:46:05,800
VERY LOW TO BEGIN WITH. SO IN

1150
00:46:05,800 --> 00:46:08,440
OTHER WORDS, PHYSICIANS

1151
00:46:08,440 --> 00:46:09,480
ORTHOPEDIC SURGEONS ARE

1152
00:46:09,480 --> 00:46:11,240
CALIBRATING THE RECOMMENDATIONS

1153
00:46:11,240 --> 00:46:15,760
BASED ON WHERE PATIENTS ARE. AND

1154
00:46:15,760 --> 00:46:18,640
AFRICAN MESH PATIENTS LISTED

1155
00:46:18,640 --> 00:46:19,760
WHAT ARE DIFFERENT PLACES

1156
00:46:19,760 --> 00:46:23,240
COMPARED TO WHITE PATIENTS. SO

1157
00:46:23,240 --> 00:46:25,880
THE QUESTION THEN BECOMES YES,

1158
00:46:25,880 --> 00:46:29,360
IT LOOKS LIKE PATIENTS PLAY A

1159
00:46:29,360 --> 00:46:30,320
SIGNIFICANT ROLE, INSURANCE IS

1160
00:46:30,320 --> 00:46:31,640
NOT A DISPARITY, AFTERALL

1161
00:46:31,640 --> 00:46:33,640
STUDIES WE HAVE DONE IN THE VA

1162
00:46:33,640 --> 00:46:35,080
HEALTHCARE SYSTEM WHICH CLOSEST

1163
00:46:35,080 --> 00:46:36,960
WE HAVE IN THE UNITED STATES FOR

1164
00:46:36,960 --> 00:46:38,400
EQUAL ACCESS HEALTHCARE SYSTEM,

1165
00:46:38,400 --> 00:46:39,920
WE FOUND THAT DISPARITIES IN

1166
00:46:39,920 --> 00:46:42,520
JOINT REPLACEMENT USED TO BE

1167
00:46:42,520 --> 00:46:44,000
EXACTLY IDENTICAL WHAT WE FOUND

1168
00:46:44,000 --> 00:46:47,440
IN THE MEDICARE DATABASES. MORE

1169
00:46:47,440 --> 00:46:49,120
IMPORTANTLY SIGNIFICANT ALMOST

1170
00:46:49,120 --> 00:46:50,920
60% JOINT REPLACEMENT IN UNITED

1171
00:46:50,920 --> 00:46:54,920
STATES ARE PAID FOR BY MEDICARE

1172
00:46:54,920 --> 00:46:57,400
SO WE DON'T THINK ACCESS IS A

1173
00:46:57,400 --> 00:46:59,040
HUGE OR INSURANCE IS A HUGE

1174
00:46:59,040 --> 00:47:01,960
FACTOR IN DISPARITY, IT'S LITTLE

1175
00:47:01,960 --> 00:47:06,240
IF SOME. SO WHAT IS CLEAR TO US

1176
00:47:06,240 --> 00:47:07,800
FROM THIS STUDY IS PATIENT AND

1177
00:47:07,800 --> 00:47:09,280
THEIR PERCEPTION AND THEIR PLACE

1178
00:47:09,280 --> 00:47:14,040
IN TERMS OF THEIR THINKING, IS

1179
00:47:14,040 --> 00:47:16,200
IMPORTANT SOURCE OF SOURCE FOR

1180
00:47:16,200 --> 00:47:17,080
POTENTIAL TARGET FOR

1181
00:47:17,080 --> 00:47:19,440
INTERVENTION. SO IN A RANDOMIZE

1182
00:47:19,440 --> 00:47:21,840
CONTROL STUDY WE IDENTIFY

1183
00:47:21,840 --> 00:47:23,320
PATIENTS WHO ARE CANDIDATES FOR

1184
00:47:23,320 --> 00:47:25,440
JOINT REPLACEMENT AT THE PRIMARY

1185
00:47:25,440 --> 00:47:29,280
CARE LEVEL AND WE RANDOMIZE INTO

1186
00:47:29,280 --> 00:47:31,280
TWO POTENTIAL WAYS OF EDUCATING

1187
00:47:31,280 --> 00:47:32,680
THEM ABOUT THE RISKS AND THE

1188
00:47:32,680 --> 00:47:34,360
BENEFITS OF THE TREATMENT, WE

1189
00:47:34,360 --> 00:47:37,120
USE THE DECISION MADE THAT

1190
00:47:37,120 --> 00:47:38,440
REALLY WELL DEVELOPED OUT OF

1191
00:47:38,440 --> 00:47:41,960
BOSTON. AND WE USE MOTIVATIONAL

1192
00:47:41,960 --> 00:47:43,960
INTERVIEW, ANOTHER WAY OF

1193
00:47:43,960 --> 00:47:46,560
BEHAVIOR HELPING PATIENTS REALLY

1194
00:47:46,560 --> 00:47:50,200
FRAME THEIR OWN CHOICES. WE ALSO

1195
00:47:50,200 --> 00:47:51,800
WE HAVE DONE ASSESSED

1196
00:47:51,800 --> 00:47:54,960
WILLINGNESS AFTER UNDERGOING

1197
00:47:54,960 --> 00:47:56,160
THESE INTERVENTIONS AND THEIR

1198
00:47:56,160 --> 00:47:58,880
LACK OF RECEIVING DISCUSSING

1199
00:47:58,880 --> 00:48:01,280
THEIR PROBLEM WITH PRIMARY CARE

1200
00:48:01,280 --> 00:48:02,680
DOCTOR, PARTICULARLY WILLINGNESS

1201
00:48:02,680 --> 00:48:06,120
TO UNDERGO JOINT REPLACEMENT.

1202
00:48:06,120 --> 00:48:11,680
ONE OF THE THINGS WE FOUND THE

1203
00:48:11,680 --> 00:48:14,040
DECISION MADE WHICH ACTUALLY A

1204
00:48:14,040 --> 00:48:17,480
45 MINUTE LONG VIDEO TA TALKS

1205
00:48:17,480 --> 00:48:18,680
BEAUTIFULLY ABOUT DIFFERENT

1206
00:48:18,680 --> 00:48:20,240
OPTIONS AND TREATMENT OPTIONS

1207
00:48:20,240 --> 00:48:24,200
FOR KNEE OA, SIGNIFICANTLY

1208
00:48:24,200 --> 00:48:28,160
CHANGED.  INITIALLY PATIENTS

1209
00:48:28,160 --> 00:48:29,520
WILLINGNESS AFRICAN AMERICAN

1210
00:48:29,520 --> 00:48:30,600
PATIENTS TO CONSIDER KNEE

1211
00:48:30,600 --> 00:48:34,320
REPLACEMENT IF OFFERED. AS YOU

1212
00:48:34,320 --> 00:48:36,760
CAN SEE BY ONE MONTH AND BY

1213
00:48:36,760 --> 00:48:38,320
THREE MONTHS HIGH. BUT OF COURSE

1214
00:48:38,320 --> 00:48:42,360
THIS WAS A ONE TIME INTERVENTION

1215
00:48:42,360 --> 00:48:46,680
SO THINGS WILL TAPERING OFF. SO

1216
00:48:46,680 --> 00:48:49,120
CLEARLY USING EDUCATIONAL TOOLS

1217
00:48:49,120 --> 00:48:51,600
PARTICULARLY EVIDENCE BASED DEAD

1218
00:48:51,600 --> 00:48:56,400
SESSION AIDS, COULD BE ACTUALLY

1219
00:48:56,400 --> 00:48:58,080
AN INTERVENTION FOR ELECTIVE

1220
00:48:58,080 --> 00:48:59,240
TREATMENT OR PREFERENCE

1221
00:48:59,240 --> 00:49:00,640
SENSITIVE TREATMENTS LIKE KNEE

1222
00:49:00,640 --> 00:49:02,280
AND HIP REPLACEMENT IN OUR

1223
00:49:02,280 --> 00:49:03,840
OPINION. BUT THE QUESTION THAT

1224
00:49:03,840 --> 00:49:05,960
WAS RAISED AFTER WE SUBMITTED

1225
00:49:05,960 --> 00:49:08,280
THIS PUBLISHED THIS STUDY WAS IT

1226
00:49:08,280 --> 00:49:14,320
IS ONE THING TO CHANGE A

1227
00:49:14,320 --> 00:49:17,280
PERSON'S THINKING ABOUT

1228
00:49:17,280 --> 00:49:18,880
TREATMENT, IT IS ALL TOGETHER IF

1229
00:49:18,880 --> 00:49:20,120
THEY UNDERGO THE TREATMENT. SO

1230
00:49:20,120 --> 00:49:22,920
WE ARE FUNDED BY NIAMS TO DO A

1231
00:49:22,920 --> 00:49:24,480
RANDOMIZE CONTROL STUDY. LOOKING

1232
00:49:24,480 --> 00:49:28,200
AT THE WHETHER THE DECISION MADE

1233
00:49:28,200 --> 00:49:29,480
WOULD CHANGE LIKELIHOOD OF

1234
00:49:29,480 --> 00:49:32,440
UNDERGOING KNEE OR HIP

1235
00:49:32,440 --> 00:49:33,960
REPLACEMENT. FOR COHORT OF

1236
00:49:33,960 --> 00:49:36,960
AFRICAN AMERICAN PATIENTS WHO

1237
00:49:36,960 --> 00:49:39,840
REFERRED TO ORTHOPEDIC SURGEON

1238
00:49:39,840 --> 00:49:44,560
IN PHILADELPHIA. AND TREMBLE

1239
00:49:44,560 --> 00:49:46,360
UNIVERSITY. WHAT WE FOUND IS CUT

1240
00:49:46,360 --> 00:49:52,120
TO THE CHASE IS THAT MINORITY

1241
00:49:52,120 --> 00:49:53,480
PATIENTS WHO VIEWED DECISION

1242
00:49:53,480 --> 00:49:56,160
MADE BEFORE SEEING ORTHOPEDIC

1243
00:49:56,160 --> 00:49:57,400
SURGEON WERE MORE LIKELY TO

1244
00:49:57,400 --> 00:49:58,840
UNDERGO KNEE REPLACEMENT AT 12

1245
00:49:58,840 --> 00:50:04,440
MONTHS. THAT WAS THROUGH

1246
00:50:04,440 --> 00:50:06,080
ANALYSIS PROTOCOL OR WHETHER WE

1247
00:50:06,080 --> 00:50:08,440
DID ANALYSIS OF INTENTION TO

1248
00:50:08,440 --> 00:50:12,480
TREAT ANALYSIS. SO THIS WAS A

1249
00:50:12,480 --> 00:50:14,280
UNEXPECTED ACTUALLY FINDING ON

1250
00:50:14,280 --> 00:50:18,240
OUR PART. NEXT SLIDE.  SO THAT

1251
00:50:18,240 --> 00:50:21,400
IS REALLY ONE POSSIBLE

1252
00:50:21,400 --> 00:50:24,040
INTERVENTION IN OUR OPINION

1253
00:50:24,040 --> 00:50:26,320
READY FOR POTENTIALLY

1254
00:50:26,320 --> 00:50:30,240
IMPLEMENTATION AND DISSEMINATION

1255
00:50:30,240 --> 00:50:33,280
EDUCATIONAL TOOL, MANY OF YOU

1256
00:50:33,280 --> 00:50:35,000
KNOW HEALTH SYSTEMS ARE ADOPTED

1257
00:50:35,000 --> 00:50:36,240
SOME EDUCATIONAL TOOLS OR

1258
00:50:36,240 --> 00:50:41,160
PATIENTS NOT NECESSARILY AFRICAN

1259
00:50:41,160 --> 00:50:42,440
AMERICAN PATIENTS BUT ANYONE

1260
00:50:42,440 --> 00:50:43,680
CONSIDERING SURGERY BUT NOT

1261
00:50:43,680 --> 00:50:45,360
WIDELY USED AND IT IS NOT

1262
00:50:45,360 --> 00:50:51,440
SOMETHING PATIENTS APPLIES TO

1263
00:50:51,440 --> 00:50:53,960
PROCEED. ANOTHER POSSIBLE

1264
00:50:53,960 --> 00:50:56,640
INTERVENTION IDEA DOWN THE ROAD,

1265
00:50:56,640 --> 00:50:59,320
IS SORT OF EXPANDING ON A WORK

1266
00:50:59,320 --> 00:51:00,920
STARTED BY THIS GROUP OF PEOPLE

1267
00:51:00,920 --> 00:51:10,800
LED BY EMMA PEERSON WHO USE AI

1268
00:51:10,800 --> 00:51:13,840
TECHNOLOGY APPROACH TO

1269
00:51:13,840 --> 00:51:15,280
ASSESSMENT OF KNEE PAIN, AFTER

1270
00:51:15,280 --> 00:51:17,480
ALL PAIN IS AN IMPORTANT FACTOR

1271
00:51:17,480 --> 00:51:20,880
FOR QUALITY OF LIFE, WHICH IS A

1272
00:51:20,880 --> 00:51:22,720
KEY INDICATION FOR JOINT

1273
00:51:22,720 --> 00:51:23,280
REPLACEMENT. THERE ARE

1274
00:51:23,280 --> 00:51:28,480
DIFFERENCES IN DISPARITIES IN

1275
00:51:28,480 --> 00:51:32,360
PAIN ASSESSMENT MINORITY AND

1276
00:51:32,360 --> 00:51:33,520
NON-MINORITY PATIENTS IT IS

1277
00:51:33,520 --> 00:51:34,520
POSSIBLE THAT COULD HAVE

1278
00:51:34,520 --> 00:51:35,960
IMPLICATIONS TO WHO UNDERGOES

1279
00:51:35,960 --> 00:51:41,040
KNEE OR HIP REPLACEMENT. THEY

1280
00:51:41,040 --> 00:51:42,840
COMPARED ALGORITHM THEY

1281
00:51:42,840 --> 00:51:50,080
DEVELOPED USING AI MEEK NICHE

1282
00:51:50,080 --> 00:51:52,280
MANY WAYS TO ASSESSING OA

1283
00:51:52,280 --> 00:51:54,480
SEVERITY, IT IS A VALIDATED

1284
00:51:54,480 --> 00:51:56,480
SCALE THAT HAS BEEN DEVELOPED

1285
00:51:56,480 --> 00:51:58,320
OVER 30 YEARS AGO IN NORTHERN

1286
00:51:58,320 --> 00:51:59,920
ENGLAND. SO WITH VERY DIFFERENT

1287
00:51:59,920 --> 00:52:03,280
SAMPLE SO THEY USED THE SORT OF

1288
00:52:03,280 --> 00:52:06,920
SAMPLE TO RECALIBRATE AND CREATE

1289
00:52:06,920 --> 00:52:09,000
A DEVELOPED ALGORITHM AND THEY

1290
00:52:09,000 --> 00:52:12,600
FOUND REALLY ABLE TO POTENTIALLY

1291
00:52:12,600 --> 00:52:14,680
NARROW ASSESSMENT OF PAIN WITH

1292
00:52:14,680 --> 00:52:16,920
BLACKS AND AFRICAN AMERICANS AND

1293
00:52:16,920 --> 00:52:19,440
FIRST PART OF THIS SLIDE WE SEE

1294
00:52:19,440 --> 00:52:24,720
KNEE ELIGIBLE FOR SURGERY BY

1295
00:52:24,720 --> 00:52:31,080
RACE IS ON THIS CHANGED MARKEDLY

1296
00:52:31,080 --> 00:52:33,320
USE ALG VERSUS THE ALGORITHM

1297
00:52:33,320 --> 00:52:35,120
THEY DEVELOPED.  THEY LOOKED

1298
00:52:35,120 --> 00:52:36,600
ALSO HOW NOT JUST RACE BUT LOW

1299
00:52:36,600 --> 00:52:39,840
INCOME AND LOW EDUCATION IMPACTS

1300
00:52:39,840 --> 00:52:45,400
THESE VARIATIONS.  IN A

1301
00:52:45,400 --> 00:52:49,640
FOLLOW-UP I WAS ASKED TO WRITE

1302
00:52:49,640 --> 00:52:51,840
EDITORIAL TO ACCOMPANY THIS

1303
00:52:51,840 --> 00:52:53,640
PUBLICATION AND I APPLAUDED THE

1304
00:52:53,640 --> 00:52:57,000
TEAM FOR REALLY USING EMERGING

1305
00:52:57,000 --> 00:52:59,440
TECHNOLOGY TO HELP COME UP WITH

1306
00:52:59,440 --> 00:53:01,080
POTENTIAL WAYS TO INTERVENE,S

1307
00:53:01,080 --> 00:53:03,040
THAT IS NOT NECESSARILY FOCUSED

1308
00:53:03,040 --> 00:53:05,960
ON THE PATIENT BUT ALSO ON THE

1309
00:53:05,960 --> 00:53:07,600
HEALTH SYSTEM AND HOW WE ARE

1310
00:53:07,600 --> 00:53:09,120
ASSESSING PAIN. INDICATION FOR

1311
00:53:09,120 --> 00:53:14,360
TREATMENT. I DID IN THIS

1312
00:53:14,360 --> 00:53:18,240
EDITORIAL POINTED OUT THAT WE

1313
00:53:18,240 --> 00:53:21,400
SORT OF NEED TO UNDERSTAND PAIN

1314
00:53:21,400 --> 00:53:24,360
IS NOT THE ONLY INDICATION FOR

1315
00:53:24,360 --> 00:53:28,240
KNEE OR HIP REPLACEMENT BUT

1316
00:53:28,240 --> 00:53:30,480
OTHER PA FACTORS SUCH AS OTHER

1317
00:53:30,480 --> 00:53:32,520
THINGS THAT NEED TO BE LOOKED

1318
00:53:32,520 --> 00:53:35,080
INTO. EVERYBODY ALSO KNOWS HOW

1319
00:53:35,080 --> 00:53:38,520
PATIENTS EXPRESS PAIN FIRST BY

1320
00:53:38,520 --> 00:53:43,120
RACE ETHNICITY AND CORRELATION

1321
00:53:43,120 --> 00:53:47,280
PAIN AND PATIENTS RADIO LOGIC

1322
00:53:47,280 --> 00:53:48,800
EVIDENCE OF KNEE OA IS NOT VERY

1323
00:53:48,800 --> 00:53:55,400
GOOD. NEXT SLIDE. THIS IS A

1324
00:53:55,400 --> 00:53:58,360
PIECE THAT I BROUGHT WHICH I

1325
00:53:58,360 --> 00:54:02,920
MAKE THE CASE BY EDUCATING

1326
00:54:02,920 --> 00:54:05,480
PATIENTS, ABOUT THESE ELECTIVE

1327
00:54:05,480 --> 00:54:06,920
TREATMENTS WE MAY REDUCE

1328
00:54:06,920 --> 00:54:11,240
DISPARITIES. I WANT TO END BY

1329
00:54:11,240 --> 00:54:16,040
TAKING US WHERE WE THINK THIS

1330
00:54:16,040 --> 00:54:18,440
WORK NEEDS TO GO. THAT IS -- WE

1331
00:54:18,440 --> 00:54:22,360
NEED TO BE ABLE TO IMPLEMENT

1332
00:54:22,360 --> 00:54:24,320
WHAT WE FIND EVEN IF IMPACT IS

1333
00:54:24,320 --> 00:54:29,800
SMALL. THAT IS REALLY THE

1334
00:54:29,800 --> 00:54:30,360
FRONTIER OF THE FILL. I HAVE

1335
00:54:30,360 --> 00:54:31,760
BEEN TRYING TO GET MY HEALTH

1336
00:54:31,760 --> 00:54:35,000
SYSTEM TO ADOPT SOME OF THESE

1337
00:54:35,000 --> 00:54:39,760
HIGHLY VALIDATED EVIDENCE BASED

1338
00:54:39,760 --> 00:54:40,640
EDUCATIONAL TOOLS FOR SHARED

1339
00:54:40,640 --> 00:54:41,640
DECISION MAKING FOR PATIENTS

1340
00:54:41,640 --> 00:54:44,320
WITH KNEE OA. THAT IS THE WORK

1341
00:54:44,320 --> 00:54:48,600
WE NEED TO DO MORE. IN MY

1342
00:54:48,600 --> 00:54:50,720
OPINION. THANK YOU. I WILL STOP

1343
00:54:50,720 --> 00:54:52,560
HERE AND HAPPY TO TAKE QUESTIONS

1344
00:54:52,560 --> 00:54:56,080
LATER ON. I SEE THERE ARE SOME

1345
00:54:56,080 --> 00:54:57,880
QUESTIONS IN THE CHAT ALREADY

1346
00:54:57,880 --> 00:54:59,760
BUT BACK TO DR. KWOH.

1347
00:54:59,760 --> 00:55:03,200
>> IT IS TIME FOR THE
PANEL

1348
00:55:03,200 --> 00:55:06,680
DISCUSSION. THANK YOU, DR.

1349
00:55:06,680 --> 00:55:10,320
NELSON AND DR. IBRAHIM. WE ARE A

1350
00:55:10,320 --> 00:55:12,880
LITTLE OVER TIME SO WE WOULD ASK

1351
00:55:12,880 --> 00:55:18,280
FOR SHORT QUESTIONS AND SHORT

1352
00:55:18,280 --> 00:55:22,640
ANSWERS. FROM DR. MARY ANN HAHN

1353
00:55:22,640 --> 00:55:23,720
NON, DISCONNECT BETWEEN

1354
00:55:23,720 --> 00:55:25,480
TREATMENT PROVIDERS, ARE

1355
00:55:25,480 --> 00:55:27,160
PHYSICAL THERAPISTS BETTER ABLE

1356
00:55:27,160 --> 00:55:29,240
TO COMMUNICATE OUTCOMES TO

1357
00:55:29,240 --> 00:55:31,640
PATIENTS? I DON'T RECALL IF WE

1358
00:55:31,640 --> 00:55:34,440
HAVE STUDIES LOOKING AT

1359
00:55:34,440 --> 00:55:36,200
COMMUNICATION BETWEEN PHYSICAL

1360
00:55:36,200 --> 00:55:41,640
THERAPISTS AND DIFFERENCES BY

1361
00:55:41,640 --> 00:55:44,040
RACE. SAID, DO YOU RECALL THOSE

1362
00:55:44,040 --> 00:55:44,400
STUDIES?

1363
00:55:44,400 --> 00:55:46,080
>> EXCELLENT QUESTION. IT
IS ONE

1364
00:55:46,080 --> 00:55:50,080
OF THOSE AREAS THAT NEED MORE

1365
00:55:50,080 --> 00:55:52,240
RESEARCH. I AM NOT FAMILIAR WITH

1366
00:55:52,240 --> 00:55:55,880
THAT RESEARCH AT THE MOMENT.

1367
00:55:55,880 --> 00:55:57,840
>> ANOTHER PLACE TO
INTERVENE IN

1368
00:55:57,840 --> 00:55:59,160
TERMS OF HEALTH DISPARITIES, A

1369
00:55:59,160 --> 00:56:02,560
GOOD POINT. QUESTION IN TERMS OF

1370
00:56:02,560 --> 00:56:04,440
LOW BONE DENSITY AFFECT DECISION

1371
00:56:04,440 --> 00:56:06,320
O HAVE JOINT REPLACEMENT, I

1372
00:56:06,320 --> 00:56:07,720
DON'T THINK THAT'S THE CASE.

1373
00:56:07,720 --> 00:56:09,080
AMANDA, DO YOU KNOW OF ANYTHING?

1374
00:56:09,080 --> 00:56:10,640
TERMS OF BONE DENSITY AND

1375
00:56:10,640 --> 00:56:13,440
DECISIONS OF JOINT REPLACEMENT? 

1376
00:56:13,440 --> 00:56:17,400
>> I DON'T. CERTAINLY
THERE IS

1377
00:56:17,400 --> 00:56:18,520
ASSOCIATION BETWEEN BONE DENSITY

1378
00:56:18,520 --> 00:56:19,800
AND OA. BUT I DON'T THINK IT

1379
00:56:19,800 --> 00:56:21,320
AFFECTS THE DECISION. 

1380
00:56:21,320 --> 00:56:26,640
>> I DON'T THINK SO.
DECISION

1381
00:56:26,640 --> 00:56:27,880
ITS IMPLEMENTATION, SAID YOU

1382
00:56:27,880 --> 00:56:30,520
TALKED ABOUT THIS, TOUCHED UPON

1383
00:56:30,520 --> 00:56:32,920
IT. ARE YOU ABLE TO MENTION IN

1384
00:56:32,920 --> 00:56:35,760
TERMS OF LITTLE BIT MORE HEALTH

1385
00:56:35,760 --> 00:56:40,440
SYSTEMS AND HOW IT'S SUCCESSFUL?

1386
00:56:40,440 --> 00:56:44,160
PARTICULARLY SAY ARE THESE

1387
00:56:44,160 --> 00:56:46,120
DISSEMINATION EFFORTS COST

1388
00:56:46,120 --> 00:56:47,480
EFFECTIVE FOR HEALTH SYSTEM?

1389
00:56:47,480 --> 00:56:49,920
>> THAT IS REALLY A GOOD

1390
00:56:49,920 --> 00:56:51,160
QUESTION. FIRST I THINK MANY OF

1391
00:56:51,160 --> 00:56:54,480
YOU PROBABLY KNOW CMS HAS BEEN

1392
00:56:54,480 --> 00:56:56,920
ENCOURAGING HEALTH SYSTEMS TO

1393
00:56:56,920 --> 00:56:58,440
ADOPT SHARED DECISION MAKING

1394
00:56:58,440 --> 00:57:00,760
TOOLS IN GENERAL. IN FACT

1395
00:57:00,760 --> 00:57:04,160
ACTUALLY OA MANAGEMENT SPECIFIC

1396
00:57:04,160 --> 00:57:11,720
ONE IS TMS HAS IDENTIFIED AS A

1397
00:57:11,720 --> 00:57:13,160
SCRIBE FOR SHARED DECISION

1398
00:57:13,160 --> 00:57:14,280
MAKING. THERE ARE DIFFERENT WAYS

1399
00:57:14,280 --> 00:57:16,480
OF DOING IT. DECISION AIDS IN MY

1400
00:57:16,480 --> 00:57:17,600
OPINION ARE JUST ONE WAY TO DO

1401
00:57:17,600 --> 00:57:20,760
IT.  IN OUR STUDIES, WE USE THE

1402
00:57:20,760 --> 00:57:23,720
DECISION AID AS A SORT OF

1403
00:57:23,720 --> 00:57:25,840
VEHICLE FOR EVIDENCE BASED

1404
00:57:25,840 --> 00:57:28,040
INFORMATION. WE DIDN'T REALLY

1405
00:57:28,040 --> 00:57:29,840
USE AS A SHARED DECISION MAKING

1406
00:57:29,840 --> 00:57:33,360
TOOL. WE JUST WANTED TO EDUCATE

1407
00:57:33,360 --> 00:57:39,720
OUR PATIENTS USING A VALID

1408
00:57:39,720 --> 00:57:41,280
APPROACH ABOUT RISKS AND

1409
00:57:41,280 --> 00:57:42,560
BENEFITS AND WHO SHOULD AND WHO

1410
00:57:42,560 --> 00:57:44,200
SHOULDN'T. BUT IT IS REALLY --

1411
00:57:44,200 --> 00:57:45,880
THE OTHER CHALLENGE THAT I FIND

1412
00:57:45,880 --> 00:57:47,200
ABOUT THE IMPLEMENTATION OF

1413
00:57:47,200 --> 00:57:49,000
DECISION AIDS AS A FORM OF

1414
00:57:49,000 --> 00:57:53,000
SHARED DECISION MAKING, TOOL,

1415
00:57:53,000 --> 00:57:55,280
THERE'S SO MANY OF THEM. SOME

1416
00:57:55,280 --> 00:57:57,800
ARE BETTER THAN OTHERS. THE ONE

1417
00:57:57,800 --> 00:58:00,600
WE USE, COCHRAN APPROVED

1418
00:58:00,600 --> 00:58:02,960
DECISION AID WHICH BY THE WAY IS

1419
00:58:02,960 --> 00:58:04,560
NO LONGER AVAILABLE OR

1420
00:58:04,560 --> 00:58:05,880
ACCESSIBLE BECAUSE IT BECAME A

1421
00:58:05,880 --> 00:58:09,160
BILLION DOLLAR THING AND IT WAS

1422
00:58:09,160 --> 00:58:12,120
BOUGHT BY WALGREEN'S NOW SO IT

1423
00:58:12,120 --> 00:58:16,720
IS GONE. IT WEPT TO WALL STREET 

1424
00:58:16,720 --> 00:58:19,440
SO WE CAN ACTUALLY USE THAT, IT

1425
00:58:19,440 --> 00:58:21,560
IS VERY TOO EXPENSIVE BUT OUR

1426
00:58:21,560 --> 00:58:24,960
OTHERS THAT ARE OUT THERE, THAT

1427
00:58:24,960 --> 00:58:28,120
COULD BE USEFUL, QUESTION IS HOW

1428
00:58:28,120 --> 00:58:33,280
EVIDENCE BASED ARE THEY AND HOW

1429
00:58:33,280 --> 00:58:36,600
RELIABLE ARE THEY. SO NOT UNLESS

1430
00:58:36,600 --> 00:58:37,560
I THINK -- NONETHELESS IT IS

1431
00:58:37,560 --> 00:58:39,160
REALLY IMPORTANT WE PROVIDE SOME

1432
00:58:39,160 --> 00:58:41,280
SORT OF EDUCATION AT A SYSTEM

1433
00:58:41,280 --> 00:58:43,920
LEVEL POPULATION LEVEL FOR IN

1434
00:58:43,920 --> 00:58:47,440
ORDER FOR US TO MAKE DIFFERENCE

1435
00:58:47,440 --> 00:58:49,440
IN THIS DISPARITY.

1436
00:58:49,440 --> 00:58:54,080
>> INTERESTING QUESTION,
COMMENT

1437
00:58:54,080 --> 00:58:56,040
FROM JEFF KATZ, DECISION AIDS

1438
00:58:56,040 --> 00:58:59,640
ARE OFTEN USED TO DECREASE

1439
00:58:59,640 --> 00:59:01,400
UTILIZATION, WHEREAS IN TERMS OF

1440
00:59:01,400 --> 00:59:02,840
HEALTH DISPARITIES IT INCREASED

1441
00:59:02,840 --> 00:59:05,840
UTILIZATION.  I DON'T KNOW IF

1442
00:59:05,840 --> 00:59:07,280
YOU WANT TO COMMENT.

1443
00:59:07,280 --> 00:59:08,960
>> THAT WAS -- THAT IS A

1444
00:59:08,960 --> 00:59:10,520
BEAUTIFUL QUESTION, JEFF,

1445
00:59:10,520 --> 00:59:11,680
BECAUSE THAT WAS ONE OF THE

1446
00:59:11,680 --> 00:59:13,520
REASONS WE PICKED THE DECISION

1447
00:59:13,520 --> 00:59:16,640
AID WE PICKED.  IT WAS DECIDED

1448
00:59:16,640 --> 00:59:18,320
THROUGH USE UTILIZATION BUT NOT

1449
00:59:18,320 --> 00:59:19,440
NECESSARILY AFRICAN AMERICANS,

1450
00:59:19,440 --> 00:59:22,640
FOR EVERYBODY. THAT WAS CRITICAL

1451
00:59:22,640 --> 00:59:24,760
IN OUR DECISION MAKING AS TO

1452
00:59:24,760 --> 00:59:26,440
WHETHER TO USE IT OR NOT BECAUSE

1453
00:59:26,440 --> 00:59:28,240
WE DIDN'T WANT TO BE PERCEIVED

1454
00:59:28,240 --> 00:59:34,920
AS OVERSELLING THE TREATMENT. SO

1455
00:59:34,920 --> 00:59:36,160
WE KNEW IT WAS CONSERVATIVE WAY

1456
00:59:36,160 --> 00:59:38,040
OF COMMUNICATING. SO YES WE WERE

1457
00:59:38,040 --> 00:59:39,480
AWARE OF THAT. IN FACT ONE OF

1458
00:59:39,480 --> 00:59:43,640
THE THINGS THAT WE ALSO DID IS

1459
00:59:43,640 --> 00:59:47,640
THAT THE SYSTEM AID WE USED HAD

1460
00:59:47,640 --> 00:59:50,400
FIVE PATIENTS TWO DECLINED THREE

1461
00:59:50,400 --> 00:59:52,600
SAID YES TO KNEE REPLACE. , THEY

1462
00:59:52,600 --> 00:59:54,680
TALKED ABOUT THEIR EXPERIENCE,

1463
00:59:54,680 --> 00:59:57,320
THEY WERE ALL INTERVIEWED BY

1464
00:59:57,320 --> 01:00:00,720
MINORITY ORTHOPEDIC SURGEON. SO

1465
01:00:00,720 --> 01:00:02,760
WE ASKED THEM TO EXPAND NUMBER

1466
01:00:02,760 --> 01:00:06,600
OF PEOPLE, FOR MORE AFRICAN

1467
01:00:06,600 --> 01:00:08,440
AMERICANS SO WE CAN SEE A MORE

1468
01:00:08,440 --> 01:00:10,080
BALANCED DIVERSE GROUP. THEY DID

1469
01:00:10,080 --> 01:00:12,640
THAT. THEY RECREATED THE

1470
01:00:12,640 --> 01:00:14,880
DECISION AID, ADDED AFRICAN

1471
01:00:14,880 --> 01:00:16,480
AMERICAN PATIENT WHO REFUSED TO

1472
01:00:16,480 --> 01:00:17,960
HAVE THE TREATMENT AFTER KNOWING

1473
01:00:17,960 --> 01:00:20,520
ALL THE THINGS THEY NEED TO

1474
01:00:20,520 --> 01:00:23,160
KNOW. SO THAT IS A WELL DONE,

1475
01:00:23,160 --> 01:00:24,720
TOO BAD IT IS NOT ACCESSIBLE AND

1476
01:00:24,720 --> 01:00:30,360
TOO EXPENSIVE TO USE BUT IT IS A

1477
01:00:30,360 --> 01:00:31,120
GOOD STRATEGY FOR EDUCATING

1478
01:00:31,120 --> 01:00:31,480
PATIENTS.

1479
01:00:31,480 --> 01:00:34,280
>> THAT IS ALSO IMPORTANT
POINT,

1480
01:00:34,280 --> 01:00:35,600
SAID, THAT WHEN WE TALK ABOUT

1481
01:00:35,600 --> 01:00:39,800
DECISION AIDS, LOOKING AT THERE

1482
01:00:39,800 --> 01:00:41,440
IS A LOFT THEM BUT ALSO NEED TO

1483
01:00:41,440 --> 01:00:43,640
BE CULTURALLY APPROPRIATE. YOU

1484
01:00:43,640 --> 01:00:48,960
AND I HAVE TALKED, IT WASN'T

1485
01:00:48,960 --> 01:00:49,960
BALANCED BEFORE SO SOMETHING TO

1486
01:00:49,960 --> 01:00:51,840
THINK ABOUT AS WE DO

1487
01:00:51,840 --> 01:00:52,160
DISSEMINATION.

1488
01:00:52,160 --> 01:00:54,640
>> ABSOLUTELY. THAT IS A
KEY I

1489
01:00:54,640 --> 01:00:58,760
DIDN'T MEAN THE INTERRUPT, BUT I

1490
01:00:58,760 --> 01:01:00,560
DO RECALL BACK IN PITTSBURGH

1491
01:01:00,560 --> 01:01:01,960
USING THIS DECISION AID WE WERE

1492
01:01:01,960 --> 01:01:05,600
FUNDED BY NIA IN A SMALL GRANT

1493
01:01:05,600 --> 01:01:07,600
TO DO A FOCUS GROUP MAKE SURE

1494
01:01:07,600 --> 01:01:08,840
DECISION AID WAS ACCEPTABLE TO

1495
01:01:08,840 --> 01:01:11,600
MINORITY PATIENTS. AND THAT IT

1496
01:01:11,600 --> 01:01:13,120
IS CULTURALLY REASONABLE TO

1497
01:01:13,120 --> 01:01:16,720
THEM. SO WE RECRUITED MINORITY

1498
01:01:16,720 --> 01:01:18,600
PATIENTS AND DID FOCUS GROUPS,

1499
01:01:18,600 --> 01:01:20,680
SHOWED THEM DECISION AID AND

1500
01:01:20,680 --> 01:01:22,360
MADE SURE IT WAS ACCESSIBLE AND

1501
01:01:22,360 --> 01:01:23,880
FEASIBLE TO USE.

1502
01:01:23,880 --> 01:01:28,720
>> KEY POINT. THERE IS A

1503
01:01:28,720 --> 01:01:30,960
QUESTION IN TERMS OF BIOLOGICAL

1504
01:01:30,960 --> 01:01:32,320
MECHANISMS AND WORSE PAIN IN

1505
01:01:32,320 --> 01:01:35,600
RACIAL ETHNIC MINORITIES. AMANDA

1506
01:01:35,600 --> 01:01:37,480
YOU WERE ANSWERING THAT

1507
01:01:37,480 --> 01:01:38,000
QUESTION?

1508
01:01:38,000 --> 01:01:39,800
>> IONSED IN THE CHALET
BECAUSE

1509
01:01:39,800 --> 01:01:42,240
TIME IS RUNNING SHORT. I DID

1510
01:01:42,240 --> 01:01:45,440
MENTION THERE ARE SOME FEATURES

1511
01:01:45,440 --> 01:01:46,760
MINORITY INDIVIDUALS TEND TO

1512
01:01:46,760 --> 01:01:51,520
HAVE MORE PAIN QUAS THAT STRAY

1513
01:01:51,520 --> 01:01:54,160
FIES, MORE CATASTROPHIZING.

1514
01:01:54,160 --> 01:01:55,720
REASONS TO REPORT GREATER PAIN

1515
01:01:55,720 --> 01:01:58,480
BUT THERE'S UNEXPLAINED

1516
01:01:58,480 --> 01:01:59,640
CONFOUNDERS IN THESE ANALYSES WE

1517
01:01:59,640 --> 01:02:04,520
HAVE NOT ASSESSED WELL.

1518
01:02:04,520 --> 01:02:07,800
>> I THINK WE PROBABLY
SHOULD

1519
01:02:07,800 --> 01:02:10,040
PAUSE HERE. WE HAVE PEOPLE TIME

1520
01:02:10,040 --> 01:02:11,600
FOR BIO BREAK BEFORE WE MOVE TO

1521
01:02:11,600 --> 01:02:14,000
THE NEXT SESSION. I WOULD LIKE

1522
01:02:14,000 --> 01:02:17,440
TO THANK DR. IBRAHIM, DR. NELSON

1523
01:02:17,440 --> 01:02:19,640
AND ALL THE OTHER PARTICIPANTS

1524
01:02:19,640 --> 01:02:20,640
FOR GREAT DISCUSSION.  THANK

1525
01:02:20,640 --> 01:02:21,240
YOU.

1526
01:02:21,240 --> 01:02:24,760
>> THANK YOU.

1527
01:02:24,760 --> 01:02:26,800
>> THANK YOU, EVERYONE FOR
OUR

1528
01:02:26,800 --> 01:02:28,600
SESSION 1 DISCUSSIONS AND THE

1529
01:02:28,600 --> 01:02:32,240
ROBUST DISCUSSION WE HAD. I KNOW

1530
01:02:32,240 --> 01:02:33,360
WE DIDN'T HAVE TIME FOR ALL THE

1531
01:02:33,360 --> 01:02:35,320
QUESTIONS SO IF THE SPEAKERS ARE

1532
01:02:35,320 --> 01:02:36,960
WILLING AND YOU HAVE MORE

1533
01:02:36,960 --> 01:02:38,640
QUESTIONS TO PUT IN THE CHAT

1534
01:02:38,640 --> 01:02:41,360
MAYBE THEY WILL FOLLOW-UP WITH

1535
01:02:41,360 --> 01:02:43,360
YOU DURING THE BREAK AND WE WILL

1536
01:02:43,360 --> 01:02:47,040
STOP HERE AND RESUME AT 12:15.  

1537
01:02:47,040 --> 01:02:49,840
>>WELCOME BACK,
EVERYBODY. WE

1538
01:02:49,840 --> 01:02:57,120
WILL GET STARTED WITH SESSION 2 

1539
01:02:57,120 --> 01:02:58,200
WE WILL HEAR FROM A DIVERSE

1540
01:02:58,200 --> 01:02:59,320
GROUP OF SPEAKERS ON FACTORS

1541
01:02:59,320 --> 01:03:00,600
THAT IMPACT DISPARITIES IN

1542
01:03:00,600 --> 01:03:03,160
OSTEOARTHRITIS. SESSION 2 WILL

1543
01:03:03,160 --> 01:03:06,560
BE MODERATED BY CO-CHAIR DR.

1544
01:03:06,560 --> 01:03:07,400
LEIGH CALLAHAN, UNIVERSITY OF

1545
01:03:07,400 --> 01:03:10,400
NORTH CAROLINA. DR. CALLAHAN, I

1546
01:03:10,400 --> 01:03:13,880
WILL TURN IT OVER TO YOU.

1547
01:03:13,880 --> 01:03:15,720
>> THANK YOU VERY MUCH,
CHRISTY.

1548
01:03:15,720 --> 01:03:17,040
WELCOME BACK, EVERYONE. I WANT

1549
01:03:17,040 --> 01:03:19,240
TO OFFER MY THANKS TO THE

1550
01:03:19,240 --> 01:03:20,640
OUTSTANDING SPEAKERS WE HAD IN

1551
01:03:20,640 --> 01:03:26,040
SESSION ONE. SESSION 2 WE WILL

1552
01:03:26,040 --> 01:03:27,920
FOCUS ON PERSONAL INTERPERSONAL

1553
01:03:27,920 --> 01:03:29,920
INFLUENCES ON OA CARE AND WE

1554
01:03:29,920 --> 01:03:30,920
HAVE THREE WONDERFUL SPEAKERS

1555
01:03:30,920 --> 01:03:36,640
FOR THIS SESSION AS WELL. THEIR

1556
01:03:36,640 --> 01:03:39,160
COMPLETE BIO EGG ARE IN YOUR

1557
01:03:39,160 --> 01:03:40,640
MEETING MATERIALS AND I WILL

1558
01:03:40,640 --> 01:03:42,800
GIVE A BRIEF OVERVIEW OF THE

1559
01:03:42,800 --> 01:03:44,000
SPEAKER BEFORE THEY SPEAK. THE

1560
01:03:44,000 --> 01:03:46,640
FIRST SPEAKER IS DR. JEFF KATZ,

1561
01:03:46,640 --> 01:03:48,840
PROFESSOR MEDICINE ORTHOPEDIC

1562
01:03:48,840 --> 01:03:50,640
SURGERY AT HARVARD MEDICAL

1563
01:03:50,640 --> 01:03:52,360
SCHOOL AND PROFESSOR

1564
01:03:52,360 --> 01:03:53,240
EPIDEMIOLOGY HARVARD SCHOOL OF

1565
01:03:53,240 --> 01:03:59,280
PUBLIC HEALTH. HE HOLDS A CLINIC

1566
01:03:59,280 --> 01:04:00,040
SLEDGE DISTINGUISHED CHAIR IN

1567
01:04:00,040 --> 01:04:01,360
ORTHOPEDIC SURGERY AT BRIGHAM

1568
01:04:01,360 --> 01:04:03,520
AND WOMEN'S HOSPITAL. DR. KATZ

1569
01:04:03,520 --> 01:04:09,920
IS GOING TO GIVE AN OVERVIEW OF

1570
01:04:09,920 --> 01:04:10,960
SOCIOECONOMIC STATUS AND

1571
01:04:10,960 --> 01:04:14,480
DISPARITIES. JEFF.

1572
01:04:14,480 --> 01:04:18,640
>> THANK YOU, LISA. I WILL
WAIT

1573
01:04:18,640 --> 01:04:23,200
TO SEE MY FIRST SLIDE. THANK

1574
01:04:23,200 --> 01:04:25,440
YOU. SO SUBTITLE HOW

1575
01:04:25,440 --> 01:04:28,560
SOCIOECONOMIC FACTORS IMPACT

1576
01:04:28,560 --> 01:04:30,160
DISPARITIES WHICH I THOUGHT WAS

1577
01:04:30,160 --> 01:04:31,280
A VERY CHALLENGING QUESTION

1578
01:04:31,280 --> 01:04:32,600
WHICH I WILL COME BACK TO IN THE

1579
01:04:32,600 --> 01:04:34,320
END, IT IS A FAIRLY SUBTLE

1580
01:04:34,320 --> 01:04:38,320
QUESTION. NOT SURE I HAVE THE

1581
01:04:38,320 --> 01:04:39,920
ANSWER BUT IF WE GO QUICKLY TO

1582
01:04:39,920 --> 01:04:47,360
THE NEXT SLIDE O FOR DISCLOSURES

1583
01:04:47,360 --> 01:04:50,200
FUNDED BY NIAMS. SO WHAT I WILL

1584
01:04:50,200 --> 01:04:52,920
DO AS DR. CALLAHAN SAID IS TO

1585
01:04:52,920 --> 01:04:54,560
DELINEATE SOCIAL DETERMINANTS OF

1586
01:04:54,560 --> 01:04:58,120
HEALTH THAT MAY INFLUENCE RISK

1587
01:04:58,120 --> 01:05:00,600
OF OA ONSET AND OUTCOMES TO TALK

1588
01:05:00,600 --> 01:05:03,280
A LITTLE BIT ABOUT MEASUREMENT

1589
01:05:03,280 --> 01:05:05,880
AND DATA SOURCES. TO GIVE COUPLE

1590
01:05:05,880 --> 01:05:07,840
OF EXAMPLES WE HAVE SEEN MANY

1591
01:05:07,840 --> 01:05:10,800
ALREADY SO THIS WILL BE LIGHT OF

1592
01:05:10,800 --> 01:05:11,800
ASSOCIATIONS OF SOCIAL

1593
01:05:11,800 --> 01:05:14,600
DETERMINANTS WITH OA ONSET OR

1594
01:05:14,600 --> 01:05:17,240
OUTCOMES AND THEN TO DELVE INTO

1595
01:05:17,240 --> 01:05:19,160
THIS QUESTION OF WHETHER SOCIAL

1596
01:05:19,160 --> 01:05:22,480
DETERMINANTS INFLUENCE

1597
01:05:22,480 --> 01:05:24,720
DISPARITIES IN OUTCOME SAND I

1598
01:05:24,720 --> 01:05:27,120
WILL MAKE COUPLE OF METHOD LOGIC

1599
01:05:27,120 --> 01:05:30,000
POINTS WITH RESPECT TO THAT

1600
01:05:30,000 --> 01:05:31,640
ISSUE IN THE END. SO WE WILL GO

1601
01:05:31,640 --> 01:05:37,480
TO THE NEXT SLIDE PLEASE. DR.

1602
01:05:37,480 --> 01:05:39,280
NELSON PRESENTED THIS ALREADY

1603
01:05:39,280 --> 01:05:42,920
JUST TO GET US STARTED, THE

1604
01:05:42,920 --> 01:05:46,680
HEALTHY PEOPLE 2030

1605
01:05:46,680 --> 01:05:47,520
CONCEPTUALIZATION OF SOCIAL

1606
01:05:47,520 --> 01:05:49,160
DETERMINANTS OF HEALTH ARE THE

1607
01:05:49,160 --> 01:05:51,280
CONDITIONS IN THE ENVIRONMENT.

1608
01:05:51,280 --> 01:05:54,920
ENVIRONMENTS WHERE PEOPLE ARE

1609
01:05:54,920 --> 01:05:57,360
BORN LIVE LEARN WORK PLAY

1610
01:05:57,360 --> 01:05:58,960
WORSHIP AND AGE THAT AFFECT WIDE

1611
01:05:58,960 --> 01:06:00,720
RANGE OF HEALTH FUNCTIONING AND

1612
01:06:00,720 --> 01:06:03,600
QUALITY OF LIFE OUTCOMES AND

1613
01:06:03,600 --> 01:06:09,080
RISKS AND THEY CREATED THE FIVE

1614
01:06:09,080 --> 01:06:12,160
DOMAINS THAT AMANDA POINTED OUT

1615
01:06:12,160 --> 01:06:16,120
ALREADY. HOW ARE SOCIAL

1616
01:06:16,120 --> 01:06:17,480
DETERMINANTS MEASURED? DEPENDS

1617
01:06:17,480 --> 01:06:20,840
ON THE DATA SOURCE. WE CAN AT

1618
01:06:20,840 --> 01:06:23,920
THE INDIVIDUAL LEVEL LEVEL OF

1619
01:06:23,920 --> 01:06:27,160
INDIVIDUAL RESEARCH SUBJECT OR

1620
01:06:27,160 --> 01:06:28,920
PATIENT LOOK AT INSURANCE STATUS

1621
01:06:28,920 --> 01:06:30,800
INCOME EDUCATIONAL ATTAINMENT

1622
01:06:30,800 --> 01:06:32,240
USING SOURCES THAT PROVIDE DATA

1623
01:06:32,240 --> 01:06:34,200
AT THE INDIVIDUAL LEVEL SUCH AS

1624
01:06:34,200 --> 01:06:35,760
MEDICAL RECORDS, INSURANCE

1625
01:06:35,760 --> 01:06:37,440
CLAIMS, HOSPITAL DISCHARGE

1626
01:06:37,440 --> 01:06:40,440
ABSTRACTS OR SURVEYS THAT ARE

1627
01:06:40,440 --> 01:06:42,760
ADMINISTERED ROUTINELY OR AS

1628
01:06:42,760 --> 01:06:44,240
PART OF RESEARCH. THERE IS A

1629
01:06:44,240 --> 01:06:46,720
GROWING TRADITION AS WELL OF

1630
01:06:46,720 --> 01:06:47,800
MEASURING SOCIAL DETERMINANTS AT

1631
01:06:47,800 --> 01:06:51,520
HE CAN LOGIC LEVEL OFTEN THE

1632
01:06:51,520 --> 01:06:53,560
NEIGHBORHOOD USING CENSUS DATA

1633
01:06:53,560 --> 01:06:56,520
OR SEVERE STATE OR NATIONAL

1634
01:06:56,520 --> 01:06:58,440
DATABASES, AND HERE ONE CAN LOOK

1635
01:06:58,440 --> 01:07:00,800
AT NOT INDIVIDUAL LEVEL BUT AREA

1636
01:07:00,800 --> 01:07:03,520
LEVEL VARIABLES SUCH AS INCOME

1637
01:07:03,520 --> 01:07:08,160
HOUSING EDUCATION SEGREGATION.

1638
01:07:08,160 --> 01:07:10,080
TO MAKE IT MORE CONCRETE ON THE

1639
01:07:10,080 --> 01:07:12,400
LEFT WE HAVE A FEW OF MANY

1640
01:07:12,400 --> 01:07:14,280
EXAMPLES OF INDIVIDUAL LEVEL

1641
01:07:14,280 --> 01:07:16,040
SOCIAL DETERMINANTS THAT CAN BE

1642
01:07:16,040 --> 01:07:17,600
OBTAINED FROM QUESTIONNAIRES OR

1643
01:07:17,600 --> 01:07:20,680
CLAIMS OR MEDICAL RECORDS

1644
01:07:20,680 --> 01:07:21,600
EMPLOYMENT STATUS INCOME OR

1645
01:07:21,600 --> 01:07:24,320
INCOME CATEGORY EDUCATIONAL

1646
01:07:24,320 --> 01:07:26,680
ATTAINMENT INSURANCE STATUS AND

1647
01:07:26,680 --> 01:07:30,160
THEN DATA CAN BE OBTAINED AT THE

1648
01:07:30,160 --> 01:07:32,400
ECOLOGICAL OR AGGREGATE LEVEL

1649
01:07:32,400 --> 01:07:35,720
PERCENT PLOYED MEANING THE

1650
01:07:35,720 --> 01:07:39,320
SUBJECT OR PATIENT LIVES IN AN

1651
01:07:39,320 --> 01:07:40,800
AREA WHERE THE PERSON EMPLOYED

1652
01:07:40,800 --> 01:07:42,680
EXCEED A CERTAIN NUMBER OR WHERE

1653
01:07:42,680 --> 01:07:44,600
THE PROPORTION OF PEOPLE WITH

1654
01:07:44,600 --> 01:07:48,440
INCOME GREATER THAN THE POVERTY

1655
01:07:48,440 --> 01:07:51,960
LEVEL EXCEED CERTAIN PERCENTAGE,

1656
01:07:51,960 --> 01:07:53,880
ET CETERA, AND THEN OTHER

1657
01:07:53,880 --> 01:07:57,000
DATABASES BEYOND CENSUS GATHER

1658
01:07:57,000 --> 01:08:00,520
ECOLOGICAL DATA SUCH AS LEAD

1659
01:08:00,520 --> 01:08:02,080
LEVELS IN WATER HOMICIDE PER

1660
01:08:02,080 --> 01:08:08,560
CAPITA AND OTHER EXAMPLES.  I

1661
01:08:08,560 --> 01:08:11,040
THINK THAT SOME RESEARCHERS WILL

1662
01:08:11,040 --> 01:08:15,360
TURN TO AREA LEVEL INDICATORS AS

1663
01:08:15,360 --> 01:08:18,240
PROXIES FOR INDIVIDUAL LEVEL

1664
01:08:18,240 --> 01:08:20,160
INDICATORS BECAUSE INDIVIDUAL

1665
01:08:20,160 --> 01:08:21,920
LEVEL INDICATORS ARE UNAVAILABLE

1666
01:08:21,920 --> 01:08:24,920
IN MANY DATABASES BUT THAT IS

1667
01:08:24,920 --> 01:08:28,160
CERTAINLY NOT THE ONLY OR I

1668
01:08:28,160 --> 01:08:30,120
WOULD SAY PREFERRED USE OF AREA

1669
01:08:30,120 --> 01:08:33,040
LEVEL INDICATORS, THERE IS A

1670
01:08:33,040 --> 01:08:35,520
RICH SOCIAL SCIENCE THEORY THAT

1671
01:08:35,520 --> 01:08:39,000
EMPHASIZES ROLE OF INDIVIDUAL

1672
01:08:39,000 --> 01:08:39,640
NEIGHBORHOOD IN THEIR

1673
01:08:39,640 --> 01:08:40,160
ENVIRONMENT IN AFFECTING

1674
01:08:40,160 --> 01:08:41,760
INDIVIDUAL BEHAVIOR AND HEALTH

1675
01:08:41,760 --> 01:08:46,040
INCLUDING HOUSING EMPLOYMENT,

1676
01:08:46,040 --> 01:08:48,440
EDUCATIONAL OPPORTUNITIES THAT

1677
01:08:48,440 --> 01:08:53,280
SURROUND THEN, ENVIRONMENTAL

1678
01:08:53,280 --> 01:08:57,400
TOXINS OR GLUTIN, CULTURAL

1679
01:08:57,400 --> 01:08:58,920
FACTORS OBSERVED IN THEIR

1680
01:08:58,920 --> 01:09:01,920
NEIGHBORS AND I HAVE GIVEN PA

1681
01:09:01,920 --> 01:09:03,120
GRAPHIC FROM THAT PAPER IS ON

1682
01:09:03,120 --> 01:09:07,560
THE RIGHT OF THE SLIDE, THAT

1683
01:09:07,560 --> 01:09:12,400
GIVES A SENSE HOW FACTORS CAN BE

1684
01:09:12,400 --> 01:09:13,160
MEASURED AT INDIVIDUAL

1685
01:09:13,160 --> 01:09:14,720
ORGANIZATIONAL A AND COMMUNITY

1686
01:09:14,720 --> 01:09:19,280
LEVEL AND THESE DIFFERENT LEVELS

1687
01:09:19,280 --> 01:09:22,200
OF INFORMATION INFORM EACH OTHER

1688
01:09:22,200 --> 01:09:26,880
TO CREATE VECTORS OF USED IN

1689
01:09:26,880 --> 01:09:27,680
MEASUREMENT

1690
01:09:27,680 --> 01:09:29,920
A. CXFC I WON'T DELVE INTO THAT

1691
01:09:29,920 --> 01:09:32,160
HERE BUT DO RECOMMEND THIS PAPER

1692
01:09:32,160 --> 01:09:40,000
TO YOU.  ONE FAIRLY FREQUENTLY

1693
01:09:40,000 --> 01:09:43,000
USED WAY OF AGGREGATING AREA

1694
01:09:43,000 --> 01:09:44,920
LEVEL DATA IS SOCIAL

1695
01:09:44,920 --> 01:09:48,720
VULNERABILITY INDEX THE CDC HAS

1696
01:09:48,720 --> 01:09:54,280
PUT TOGETHER THAT USES CENSUS

1697
01:09:54,280 --> 01:09:55,280
DATA, 15 VARIABLES ARE SHOWN ON

1698
01:09:55,280 --> 01:09:59,040
THE RIGHT RIGHT.  MOST PART OF S

1699
01:09:59,040 --> 01:10:01,360
SLIDE THAT AGGREGATE TO FOUR

1700
01:10:01,360 --> 01:10:02,840
DOMAINS WHICH IS MIDDLE PART OF

1701
01:10:02,840 --> 01:10:04,600
THE SLIDE WHICH ARE FURTHER

1702
01:10:04,600 --> 01:10:07,760
AGGRAVATED INTO OVERALL

1703
01:10:07,760 --> 01:10:09,160
VULNERABILITY AND INVESTIGATORS

1704
01:10:09,160 --> 01:10:14,400
USED DOMAIN LEVEL AS WELL AS

1705
01:10:14,400 --> 01:10:19,520
OVERALL LEVEL VULNERABILITY

1706
01:10:19,520 --> 01:10:21,800
INSIGHTS TO GAIN INSIGHT TO

1707
01:10:21,800 --> 01:10:24,680
SOCIAL DETERMINANTS. A VALIDITY

1708
01:10:24,680 --> 01:10:26,600
CHECK FOR KNOW BOSTON A BIT,

1709
01:10:26,600 --> 01:10:31,680
DARK BLUE AREAS ARE THE AREAS OF

1710
01:10:31,680 --> 01:10:33,080
GREATEST SOCIAL VULNERABILITY

1711
01:10:33,080 --> 01:10:35,960
AND TRACKED VERY WELL WITH SOME

1712
01:10:35,960 --> 01:10:38,280
OF OUR MOST VULNERABLE

1713
01:10:38,280 --> 01:10:39,480
NEIGHBORHOODS FROM SOUTH TO

1714
01:10:39,480 --> 01:10:42,200
NORTH, NOR CHESTER ROCKS BURY

1715
01:10:42,200 --> 01:10:43,040
WHICH HE IS SEE AN WINTHROP SO

1716
01:10:43,040 --> 01:10:44,440
THIS FOR PEOPLE WHO KNOW THE

1717
01:10:44,440 --> 01:10:47,200
AREA IS REALLY NICE VALIDITY

1718
01:10:47,200 --> 01:10:57,680
CONFIRMATION.  THERE IS RICH

1719
01:11:00,040 --> 01:11:03,120
LITERATURE THAT LINKS, WE

1720
01:11:03,120 --> 01:11:04,960
PRESENTED EARLIER NICE EXAMPLES

1721
01:11:04,960 --> 01:11:08,280
AS DID DR. IBRAHIM SO HERE IS

1722
01:11:08,280 --> 01:11:12,480
ONE MORE FROM NORTH CAROLINA

1723
01:11:12,480 --> 01:11:15,920
GROUP, BECK KY CLEVELAND'S PAPER

1724
01:11:15,920 --> 01:11:17,600
WHICH I LIKE BECAUSE OF THE

1725
01:11:17,600 --> 01:11:20,120
INFERENCES WE CAN MAKE SO THIS

1726
01:11:20,120 --> 01:11:24,520
IS A TABLE SHOWING ASSOCIATION

1727
01:11:24,520 --> 01:11:26,960
DIFFERENT SOCIAL DETERMINANTS OF

1728
01:11:26,960 --> 01:11:29,120
HEALTH WITH TOTAL WOMAC SCORE

1729
01:11:29,120 --> 01:11:30,520
AMONG PERSONS WITH SYMPTOMATIC

1730
01:11:30,520 --> 01:11:32,640
RAID YES GRAPHIC OA IN JOHNSTON

1731
01:11:32,640 --> 01:11:36,640
COUNTY OA PROJECT. THE SCORE

1732
01:11:36,640 --> 01:11:42,120
RANKS FROM 0 TO 96 POINTS WITH

1733
01:11:42,120 --> 01:11:45,440
96 BEING WORSE AND MEAN 34,

1734
01:11:45,440 --> 01:11:47,400
STANDARD DEVIATION WITH THIS

1735
01:11:47,400 --> 01:11:48,720
COHORT. FIRST YOU CAN SEE WHAT

1736
01:11:48,720 --> 01:11:52,240
WE ARE LOOKING AT ARE COUPLE OF

1737
01:11:52,240 --> 01:11:55,120
INDIVIDUAL LEVEL INDICATORS,

1738
01:11:55,120 --> 01:11:57,560
EDUCATIONAL ATTAINMENT AND

1739
01:11:57,560 --> 01:11:58,840
OCCUPATION AND AGGREGATE LEVEL

1740
01:11:58,840 --> 01:12:02,360
INDICATORS IN TERMS OF POVERTY

1741
01:12:02,360 --> 01:12:06,520
RATE EACH CONTRIBUTES TO HIGHER

1742
01:12:06,520 --> 01:12:09,000
OR WORSE WOMAC SCORE COMPARED TO

1743
01:12:09,000 --> 01:12:10,920
PERSONS WHO DON'T HAVE THE

1744
01:12:10,920 --> 01:12:13,080
INDICATOR WHO HAVE GREATER THAN

1745
01:12:13,080 --> 01:12:16,680
12 YEARS EDUCATION, ALSO NOTABLE

1746
01:12:16,680 --> 01:12:18,600
THESE DIFFERENCES FROM SMALL.

1747
01:12:18,600 --> 01:12:21,120
THREE OR FOUR POINTS WHICH IS

1748
01:12:21,120 --> 01:12:22,760
ABOUT A FIFTH STANDARD

1749
01:12:22,760 --> 01:12:24,440
DEVIATION. IN ANALYSES IT JUST

1750
01:12:24,440 --> 01:12:27,160
AS YOU CAN SEE THE BOTTOM OF THE

1751
01:12:27,160 --> 01:12:30,520
SLIDE FOR VARIETY OF FACTORS,

1752
01:12:30,520 --> 01:12:33,960
SOCIAL DETERMINANTS INFLUENCE

1753
01:12:33,960 --> 01:12:38,560
REPORT OF PAIN AND FUNCTION BUT

1754
01:12:38,560 --> 01:12:40,640
MILDLY SO. AT THE BOTTOM HALF OF

1755
01:12:40,640 --> 01:12:42,040
THE TABLE EACH INDICATOR ADJUST

1756
01:12:42,040 --> 01:12:44,000
FOR ONE ANOTHER YOU CAN SEE

1757
01:12:44,000 --> 01:12:47,360
EFFECTS ARE ATTENUATED

1758
01:12:47,360 --> 01:12:51,280
SUGGESTING NO SURPRISE

1759
01:12:51,280 --> 01:12:54,720
INDICATORS ARE CORRELATED WITH

1760
01:12:54,720 --> 01:12:59,200
ONE ANOTHER, THAT HAS LED TO

1761
01:12:59,200 --> 01:13:04,200
CREATE ADDITIVE INDICES TO AVOID

1762
01:13:04,200 --> 01:13:05,600
THE PROBLEM OF INTERCORRELATION.

1763
01:13:05,600 --> 01:13:06,560
SO THESE ARE INDIVIDUAL LEVEL

1764
01:13:06,560 --> 01:13:09,800
DATA FROM CDC BEHAVIORAL RISK

1765
01:13:09,800 --> 01:13:20,000
SURVEILLANCE SURVEY, AND WHAT WE

1766
01:13:20,000 --> 01:13:25,240
HAVE IN 36,000 INDIVIDUALS 26%

1767
01:13:25,240 --> 01:13:26,120
REPORT ARTHRITIS AND PREVALENCE

1768
01:13:26,120 --> 01:13:27,840
OF SELF-REPORTED ARTHRITIS

1769
01:13:27,840 --> 01:13:30,520
INCREASES FROM 12% AMONG THOSE

1770
01:13:30,520 --> 01:13:32,520
WITH 0 OF THESE SOCIAL

1771
01:13:32,520 --> 01:13:34,320
DETERMINANTS TO ABOUT TWICE THAT

1772
01:13:34,320 --> 01:13:38,040
AMONG THOSE WITH FOUR WITH DOSE

1773
01:13:38,040 --> 01:13:43,880
RESPONSE. SO THIS IS A NICE WAY

1774
01:13:43,880 --> 01:13:45,200
TO HANDLE THE DATA AND FROM THE

1775
01:13:45,200 --> 01:13:49,080
SAME STUDY, IN THE TABLE THE

1776
01:13:49,080 --> 01:13:51,600
FOUR COLUMNS SHOW ADDITIONAL

1777
01:13:51,600 --> 01:13:53,320
OUTCOMES THE AUTHORS LOOKED AT,

1778
01:13:53,320 --> 01:13:56,280
LIMITED ACTIVITIES, LIMITED

1779
01:13:56,280 --> 01:13:57,760
WORK, ET CETERA AND IN EACH SEE

1780
01:13:57,760 --> 01:13:59,280
THE SAME PATTERN PEOPLE WITH

1781
01:13:59,280 --> 01:14:05,040
FOUR OR FIVE SOCIAL DETERMINANTS

1782
01:14:05,040 --> 01:14:07,120
OF HEALTH HAVE TWO OR THREE

1783
01:14:07,120 --> 01:14:08,840
TIMES THE LIKELIHOOD OR RISK OF

1784
01:14:08,840 --> 01:14:12,280
HAVING THESE ADVERSE OUTCOMES,

1785
01:14:12,280 --> 01:14:14,720
DISPOSED WITH ZERO. TO THE NEXT

1786
01:14:14,720 --> 01:14:18,920
SLIDE. HERE IS THE CONUNDRUM I

1787
01:14:18,920 --> 01:14:20,640
DISCUSS AT THE OUTSET.  I WAS

1788
01:14:20,640 --> 01:14:24,440
LOOKING CAREFULLY FOR DATA THAT

1789
01:14:24,440 --> 01:14:26,600
ILLUSTRATE THE AFFECT OF SOCIAL

1790
01:14:26,600 --> 01:14:28,680
DETERMINANTS OF HEALTH ON

1791
01:14:28,680 --> 01:14:30,000
DISPARITIES RACIAL ETHNIC

1792
01:14:30,000 --> 01:14:33,480
DISPARITIES AND OUTCOME. I

1793
01:14:33,480 --> 01:14:35,120
BELIEVE THE LITERATURE IS SPARSE

1794
01:14:35,120 --> 01:14:36,200
AND INTERESTED IN OTHERS ARE

1795
01:14:36,200 --> 01:14:38,160
AWARE OF EXAMPLES IN OUR FIELD,

1796
01:14:38,160 --> 01:14:41,840
I FOUND A NICE EXAMPLE FROM THAT

1797
01:14:41,840 --> 01:14:43,600
RELATES TO COMPLICATIONS OF

1798
01:14:43,600 --> 01:14:47,480
CORONARY ARTERY BYPASS GRAFT OR

1799
01:14:47,480 --> 01:14:49,080
CABBAGE OWN SURGERY SO ON THE Y

1800
01:14:49,080 --> 01:14:50,760
ACCESS WE SEE RISK OR THE

1801
01:14:50,760 --> 01:14:53,200
PREVALENCE OF SERIOUS

1802
01:14:53,200 --> 01:14:54,680
COMPLICATIONS OF BYPASS SURGERY,

1803
01:14:54,680 --> 01:14:57,600
ON THE X AXIS WE SEE THE SOCIAL

1804
01:14:57,600 --> 01:15:02,960
VULNERABILITY INDEX FROM 0 TO

1805
01:15:02,960 --> 01:15:04,920
100, 100 BEING MOST VULNERABLE.

1806
01:15:04,920 --> 01:15:07,520
THE DARK LINE ARE NON-WHITES AND

1807
01:15:07,520 --> 01:15:09,040
WHITE LINE THE DASHED LINES ARE

1808
01:15:09,040 --> 01:15:10,400
WHITES. SO COUPLE OF

1809
01:15:10,400 --> 01:15:12,000
OBSERVATIONS THE DARK LINE IS

1810
01:15:12,000 --> 01:15:15,320
SITUATED ABOVE THE DASH LINE. SO

1811
01:15:15,320 --> 01:15:20,160
THIS IS ANOTHER DISPARITY WHERE

1812
01:15:20,160 --> 01:15:21,200
NON-WHITES HAVE MORE

1813
01:15:21,200 --> 01:15:22,400
COMPLICATIONS THAN WHITES.

1814
01:15:22,400 --> 01:15:25,840
ANOTHER OBSERVATION IS THAT BOTH

1815
01:15:25,840 --> 01:15:27,960
LINE VERSUS A POSITIVE SLOPE

1816
01:15:27,960 --> 01:15:30,240
MEANING THERE ARE GREATER

1817
01:15:30,240 --> 01:15:31,320
COMPLICATIONCATIONS FOR THOSE

1818
01:15:31,320 --> 01:15:33,440
WHO ARE MORE VULNERABLE THAN

1819
01:15:33,440 --> 01:15:35,840
THOSE WITH LESS VULNERABILITY

1820
01:15:35,840 --> 01:15:38,080
AND A THIRD OBSERVATION IS THAT

1821
01:15:38,080 --> 01:15:41,200
THE LINES ARE NOT PARALLEL SO IF

1822
01:15:41,200 --> 01:15:44,160
YOU LOOK AT THE DISPARITY THE

1823
01:15:44,160 --> 01:15:46,640
RISK IN NON-WHITES COMPARED TO

1824
01:15:46,640 --> 01:15:50,960
WHITES AT HIGHEST END OF SBI

1825
01:15:50,960 --> 01:15:54,000
ABOUT 1.24, AT LOWEST 1.1 SO

1826
01:15:54,000 --> 01:15:56,600
THERE IS A DIFFERENCE, TO ME

1827
01:15:56,600 --> 01:15:59,920
THOUGH WE DON'T SEE HERE THESE

1828
01:15:59,920 --> 01:16:03,880
STATISTICAL SIGNIFICANCE OF THIS

1829
01:16:03,880 --> 01:16:06,440
DIFFERENCE BUT JUST ON THE

1830
01:16:06,440 --> 01:16:08,640
SURFACE IN TERMS OF MAGNITUDE OF

1831
01:16:08,640 --> 01:16:10,840
EFFECT IS IT DOES APPEAR

1832
01:16:10,840 --> 01:16:13,040
INFLUENCE OF SOCIAL DETERMINANT

1833
01:16:13,040 --> 01:16:15,520
OF HEALTH SBI ON THE

1834
01:16:15,520 --> 01:16:17,640
DISPARITIES.  I WILL CLOSE WITH

1835
01:16:17,640 --> 01:16:21,080
A COUPLE OF METHOD LOGIC POINTS,

1836
01:16:21,080 --> 01:16:25,760
I WOULD LIKE MOTIVATE THESE BY

1837
01:16:25,760 --> 01:16:27,080
PRESENTING/I MADE THIS UP A

1838
01:16:27,080 --> 01:16:30,520
COHORT OF A THOUSAND INDIVIDUALS

1839
01:16:30,520 --> 01:16:33,920
WHO DO OR DO NOT DEVELOP

1840
01:16:33,920 --> 01:16:36,600
INCIDENCE OA, 23% IN THIS

1841
01:16:36,600 --> 01:16:40,080
EXAMPLE DO DEVELOP IT. ABOUT 150

1842
01:16:40,080 --> 01:16:43,480
OR 15% COHORT ARE BLACK. THE

1843
01:16:43,480 --> 01:16:46,880
OTHERS NON-BLACK. AS I DEVELOPED

1844
01:16:46,880 --> 01:16:49,320
THIS 40% OF THE BLACKS DEVELOP

1845
01:16:49,320 --> 01:16:52,280
OA, 20% NON-BLACKS SO RISK RATIO

1846
01:16:52,280 --> 01:16:56,600
IS 2.0. SO IF WE GO TO THE NEXT

1847
01:16:56,600 --> 01:16:58,760
SLIDE, ONE ANALYSES THAT IS

1848
01:16:58,760 --> 01:17:04,360
OFTEN HELPFUL TO DO IN TRYING TO

1849
01:17:04,360 --> 01:17:09,040
DISENTANGLE THE ROLE OF RACE OR

1850
01:17:09,040 --> 01:17:10,440
ETHNICITY, OUTCOME OF INTEREST

1851
01:17:10,440 --> 01:17:12,520
IS TO DO ADJUSTMENT FOR IN THIS

1852
01:17:12,520 --> 01:17:14,040
CASE SIMPLE STRATIFICATION. 

1853
01:17:14,040 --> 01:17:17,200
THIS IS A MADE UP EXAMPLE, I

1854
01:17:17,200 --> 01:17:19,760
STRATIFIED BY INCOME AND FIND

1855
01:17:19,760 --> 01:17:23,000
THE RISK RATIOS ARE CLOSE TO 1.

1856
01:17:23,000 --> 01:17:25,400
FOR BOTH HIGH INCOME AND LOW

1857
01:17:25,400 --> 01:17:26,640
INCOME GROUPS. SO THERE IS

1858
01:17:26,640 --> 01:17:28,120
WITHIN THE HIGH INCOME GROUP NOT

1859
01:17:28,120 --> 01:17:32,560
A RACIAL DISPARITY OR NOR LOW

1860
01:17:32,560 --> 01:17:34,360
INCOME GROUP SO WHAT WE CAN

1861
01:17:34,360 --> 01:17:37,440
CONCLUDE IS INCOME IS RELATED TO

1862
01:17:37,440 --> 01:17:39,200
INCIDENCE OF IA LOW INCOME

1863
01:17:39,200 --> 01:17:41,440
RELATED TO INCIDENCE OA BLACKS

1864
01:17:41,440 --> 01:17:43,640
ARE MORE LIKELY TO HAVE LOW

1865
01:17:43,640 --> 01:17:46,840
INCOME AND THIS NEED TO BE

1866
01:17:46,840 --> 01:17:48,800
ASSESSED FORMALLY AND CONFIRMED

1867
01:17:48,800 --> 01:17:50,200
WITH ANALYSIS BUT WHAT WE LEARN

1868
01:17:50,200 --> 01:17:54,880
FROM THIS ANALYSIS, IS A PATHWAY

1869
01:17:54,880 --> 01:17:58,720
WHERE DISPARITY IN RACE CAN BE

1870
01:17:58,720 --> 01:18:00,520
EXPLAINED IN THIS EXAMPLE BY

1871
01:18:00,520 --> 01:18:02,360
INCOME. I WILL CONTRAST THAT

1872
01:18:02,360 --> 01:18:07,800
WITH THE NEXT SLIDE WHERE WE DO

1873
01:18:07,800 --> 01:18:09,360
SIMILAR EXERCISE BUT DIFFERENT

1874
01:18:09,360 --> 01:18:13,400
FINDINGS. SO HERE THIS IS WHERE

1875
01:18:13,400 --> 01:18:15,200
REMINISCENT OF CABBAGE EXAMPLE I

1876
01:18:15,200 --> 01:18:19,280
SHOWED YOU A MOMENT AGO. HERE

1877
01:18:19,280 --> 01:18:21,040
STRATEGY PHID BY SOCIAL

1878
01:18:21,040 --> 01:18:22,520
DETERMINANT OF HEALTH, YOU HAVE

1879
01:18:22,520 --> 01:18:25,520
HIGH INCOME GROUP RELATIVE RISK

1880
01:18:25,520 --> 01:18:27,240
IS .9 BUT IN THE LOW INCOME

1881
01:18:27,240 --> 01:18:29,840
GROUP THE BLACKS ARE 2.3 TIMES

1882
01:18:29,840 --> 01:18:33,080
MORE LIKELY THAN WHITE PERSONS

1883
01:18:33,080 --> 01:18:35,080
TO HAVE OSTEOARTHRITIS, SO WE

1884
01:18:35,080 --> 01:18:38,160
SEE A MARKED DISPARITY. SO THIS

1885
01:18:38,160 --> 01:18:41,920
IS AN EXAMPLE WHERE WE

1886
01:18:41,920 --> 01:18:43,600
ESSENTIALLY PERFORM ANALYSIS

1887
01:18:43,600 --> 01:18:46,000
LOOKING FOR INTERACTION AND UPON

1888
01:18:46,000 --> 01:18:49,760
FINDING IT COULD INDEED CONCLUDE

1889
01:18:49,760 --> 01:18:52,840
THAT SOCIAL DETERMINANT INCOME

1890
01:18:52,840 --> 01:18:56,040
DOES INFLUENCE DISPARITY IN OA

1891
01:18:56,040 --> 01:18:59,480
BY INCIDENCE BY RACE.  IF I CAN

1892
01:18:59,480 --> 01:19:03,880
CONCLUDE ON THE FINAL SLIDE

1893
01:19:03,880 --> 01:19:05,520
SOCIAL DETERMINANTS IS ADJUSTED

1894
01:19:05,520 --> 01:19:06,920
CAN BE MEASURED AT THE

1895
01:19:06,920 --> 01:19:08,440
INDIVIDUAL HE CAN LOGIC OR AREA

1896
01:19:08,440 --> 01:19:09,880
LEVEL AND THAT WHILE THE HE CAN

1897
01:19:09,880 --> 01:19:13,240
LOGIC MEASURES ARE OFTEN

1898
01:19:13,240 --> 01:19:15,600
PROXIES, INDIVIDUAL BEHAVIOR

1899
01:19:15,600 --> 01:19:17,480
DOES IN RARE INSTANCES MIRROR

1900
01:19:17,480 --> 01:19:18,480
THOSE OF NEIGHBORS AND

1901
01:19:18,480 --> 01:19:20,320
INFLUENCED BY HE CAN LOGIC

1902
01:19:20,320 --> 01:19:23,040
FACTORS HOUSING, ET CETERA, AS I

1903
01:19:23,040 --> 01:19:27,720
HAVE SHOWN AMANDA SHOWED. SOCIAL

1904
01:19:27,720 --> 01:19:29,080
DETERMINANTS ARE INTERCORRELATED

1905
01:19:29,080 --> 01:19:32,280
SO USING ADDITIVE INDICES CAN BE

1906
01:19:32,280 --> 01:19:34,040
HELPFUL WAY TO APPRECIATE THE

1907
01:19:34,040 --> 01:19:38,920
CUMULATIVE IMPACT. THERE ARE

1908
01:19:38,920 --> 01:19:40,320
NUMEROUS EXAMPLE SOCIAL

1909
01:19:40,320 --> 01:19:41,880
DETERMINANTS INFLUENCE OA

1910
01:19:41,880 --> 01:19:45,000
INCIDENCE AN OUTCOMES AND THERE

1911
01:19:45,000 --> 01:19:47,520
ARE EXAMPLES AND I SHOWED YOU A

1912
01:19:47,520 --> 01:19:48,560
FICTITIOUS ONE BUT THERE ARE

1913
01:19:48,560 --> 01:19:51,800
MANY EXAMPLES SOCIAL

1914
01:19:51,800 --> 01:19:54,040
DETERMINANTS MEDIATE RACE AND

1915
01:19:54,040 --> 01:19:58,440
ETHNICITY. I THINK IT IS UNUSUAL

1916
01:19:58,440 --> 01:20:01,680
TO FIND PUBLISHED EXAMPLES WHERE

1917
01:20:01,680 --> 01:20:04,520
SOCIAL DETERMINANTS INFLUENCE

1918
01:20:04,520 --> 01:20:07,680
DISPARITIES MEANING THAT THE

1919
01:20:07,680 --> 01:20:09,840
RESEARCHERS HAVE DONE

1920
01:20:09,840 --> 01:20:11,200
STATISTICAL INTERACTIONS TO

1921
01:20:11,200 --> 01:20:12,960
DESCRIBE THESE DISPARATE RISK

1922
01:20:12,960 --> 01:20:15,120
RATIOS DEPENDING ON THE LEVEL OF

1923
01:20:15,120 --> 01:20:17,960
SOCIAL DETERMINANT. SO THE FIRST

1924
01:20:17,960 --> 01:20:20,720
GAP I WOULD POINT TO IS TO TRY

1925
01:20:20,720 --> 01:20:22,480
TO UNDERSTAND WHETHER THERE IS

1926
01:20:22,480 --> 01:20:25,240
RESEARCH OR TO SUGGEST RESEARCH

1927
01:20:25,240 --> 01:20:27,400
THAT EXAMINES WHETHER SOCIAL

1928
01:20:27,400 --> 01:20:28,440
DETERMINANTS INFLUENCE

1929
01:20:28,440 --> 01:20:30,040
DISPARITIES AND INCIDENCE OR

1930
01:20:30,040 --> 01:20:31,480
OUTCOME. THAT HAS REALLY

1931
01:20:31,480 --> 01:20:34,400
IMPORTANT IMPLICATIONS FOR HOW

1932
01:20:34,400 --> 01:20:38,440
WE AND WHERE WE WOULD TARGET

1933
01:20:38,440 --> 01:20:39,840
INTERVENTIONS. I THINK IT IS

1934
01:20:39,840 --> 01:20:42,200
ALSO USEFUL TO DISTINGUISH AMONG

1935
01:20:42,200 --> 01:20:44,160
THOSE OUTCOMES THAT APPEAR

1936
01:20:44,160 --> 01:20:46,720
INFLUENCED PRIMARILY BY

1937
01:20:46,720 --> 01:20:48,320
INDIVIDUAL LEVEL IN PARTICULAR

1938
01:20:48,320 --> 01:20:50,560
THOSE THAT APPEAR INFLUENCED

1939
01:20:50,560 --> 01:20:52,760
PRIMARILY BY HE CAN LOGIC OR

1940
01:20:52,760 --> 01:20:55,520
AREA LEVEL SOCIAL DETERMINANTS

1941
01:20:55,520 --> 01:20:56,200
BECAUSE THAT WOULD HAVE SOME

1942
01:20:56,200 --> 01:20:59,520
IMPORTANT IMPLICATIONS FOR

1943
01:20:59,520 --> 01:21:01,640
INTERVENTION. FINALLY THE THIRD

1944
01:21:01,640 --> 01:21:03,840
GAP, THIS WILL FOLLOW DR.

1945
01:21:03,840 --> 01:21:06,640
IBRAHIM'S COMMENTS, IS WE HAVE

1946
01:21:06,640 --> 01:21:11,160
REACHED THE STAGE IN THIS ARENA

1947
01:21:11,160 --> 01:21:13,200
WHERE WOULD BE EXTREMELY USEFUL

1948
01:21:13,200 --> 01:21:16,000
TO FIELD INTERVENTIONS, BOTH THE

1949
01:21:16,000 --> 01:21:17,520
INDIVIDUAL AND WHERE APPROPRIATE

1950
01:21:17,520 --> 01:21:19,720
AREA LEVEL TO TRY TO ADDRESS

1951
01:21:19,720 --> 01:21:22,040
SOME OF THE RACIAL ETHNIC

1952
01:21:22,040 --> 01:21:30,200
DISPARITIES SO WELL DOCUMENTED. 

1953
01:21:30,200 --> 01:21:31,800
>> THANK YOU VERY MUCH,
JEFF,

1954
01:21:31,800 --> 01:21:34,320
THAT WAS AS USUAL VERY THOUGHT

1955
01:21:34,320 --> 01:21:36,200
PROVOKING TALK. OUR NEXT WE WILL

1956
01:21:36,200 --> 01:21:38,080
MOVE TO THE NEXT SPEAKER, IN

1957
01:21:38,080 --> 01:21:41,640
THIS SESSION, AND THAT IS DR.

1958
01:21:41,640 --> 01:21:43,440
SANDRA SOTO, UNIVERSITY OF NORTH

1959
01:21:43,440 --> 01:21:47,760
CAROLINA CHAPEL HILL H. SHE IS

1960
01:21:47,760 --> 01:21:49,760
ASSISTANT PROFESSOR IN SCHOOL OF

1961
01:21:49,760 --> 01:21:52,880
NURSING AND ALSO MEMBER OF THE

1962
01:21:52,880 --> 01:21:54,720
FIRST ARTHRITIS RESEARCH CENTER

1963
01:21:54,720 --> 01:21:56,360
AND SHE WILL FOCUS ON PATIENT

1964
01:21:56,360 --> 01:21:57,160
PROVIDER RELATIONSHIP

1965
01:21:57,160 --> 01:22:01,120
COMMUNICATION. 

1966
01:22:01,120 --> 01:22:03,560
>> THANK YOU. I HAVE NO

1967
01:22:03,560 --> 01:22:06,560
CONFLICTS OF INTEREST TO

1968
01:22:06,560 --> 01:22:08,640
DISCLOSE. FIRST I WILL BRIEFLY

1969
01:22:08,640 --> 01:22:10,480
COVER SOME OVERARCHING PATIENT

1970
01:22:10,480 --> 01:22:12,840
PROVIDER COMMUNICATION ISSUES

1971
01:22:12,840 --> 01:22:15,080
AND CARE OCCUR ACROSS PATIENTS

1972
01:22:15,080 --> 01:22:17,080
NOT SPECIFIC TO HEALTH DIVISION

1973
01:22:17,080 --> 01:22:18,680
PARITIES YET. SO IN THIS

1974
01:22:18,680 --> 01:22:19,640
COMMUNICATION HAPPENS BETWEEN

1975
01:22:19,640 --> 01:22:21,720
PATIENTS WITH OA AND PROVIDERS

1976
01:22:21,720 --> 01:22:23,720
DUE THE MISALIGNED EXPECTATIONS

1977
01:22:23,720 --> 01:22:27,560
AROUND PRESCRIPTION MEDICATIONS

1978
01:22:27,560 --> 01:22:29,920
AND REFERRALS. WE SEE THIS BREAK

1979
01:22:29,920 --> 01:22:31,280
DOWN LEADS TO DECLINES AND

1980
01:22:31,280 --> 01:22:33,160
TREATMENT ADHERENCE. HOWEVER

1981
01:22:33,160 --> 01:22:35,920
BREAK DOWNS IN COMMUNICATION GO

1982
01:22:35,920 --> 01:22:37,480
BEYOND DISAGREEMENT ABOUT

1983
01:22:37,480 --> 01:22:39,200
TREATMENT OPTIONS THEY INCLUDE

1984
01:22:39,200 --> 01:22:41,040
INCONSISTENT EDUCATION AND

1985
01:22:41,040 --> 01:22:43,040
DISCUSSION AROUND OA MANAGEMENT.

1986
01:22:43,040 --> 01:22:45,040
IN A META ANALYSIS OF STUDIES

1987
01:22:45,040 --> 01:22:47,080
ASSESS THE CARE PROVIDED TO

1988
01:22:47,080 --> 01:22:49,280
PATIENTS WITH OA THE AUTHORS

1989
01:22:49,280 --> 01:22:51,360
PAYMENT PROVIDER ADHERENCE TO

1990
01:22:51,360 --> 01:22:52,760
SIX QUALITY INDICATORS IN OA

1991
01:22:52,760 --> 01:22:56,640
CARE. THE TWO QUALITY INDICATORS

1992
01:22:56,640 --> 01:22:58,360
WITH LOWEST ADHERENCE WERE

1993
01:22:58,360 --> 01:23:00,520
OFFERED EDUCATION AND/OR SELF

1994
01:23:00,520 --> 01:23:02,880
MANAGEMENT WITH ADHERENCE RATE

1995
01:23:02,880 --> 01:23:06,560
OF 35%. INFORMED ABOUT POTENTIAL

1996
01:23:06,560 --> 01:23:08,600
RISKS IF N SAID PRESCRIBED WITH

1997
01:23:08,600 --> 01:23:10,720
ADHERENCE RATE OF ONLY 34%. THIS

1998
01:23:10,720 --> 01:23:12,800
META ANALYSIS AND OTHER RESEARCH

1999
01:23:12,800 --> 01:23:14,080
LED TO DEVELOPMENT OF CORE

2000
01:23:14,080 --> 01:23:15,800
CAPABILITY FRAMEWORK FOR

2001
01:23:15,800 --> 01:23:17,360
PROVIDERS CARING FOR PATIENTS

2002
01:23:17,360 --> 01:23:19,040
WITH, OA WHICH IS WHERE THIS

2003
01:23:19,040 --> 01:23:20,120
INFO GRAPHIC ON THE RIGHT COMES

2004
01:23:20,120 --> 01:23:23,680
FROM. THE FRAMEWORK HIGHLIGHTS

2005
01:23:23,680 --> 01:23:25,160
13 BROAD SKILLS AREAS THAT

2006
01:23:25,160 --> 01:23:26,280
PROVIDERS SHOULD DEVELOP TO

2007
01:23:26,280 --> 01:23:27,520
PROVIDE QUALITY CARE TO THEIR

2008
01:23:27,520 --> 01:23:29,400
PATIENTS. NOTE THAT

2009
01:23:29,400 --> 01:23:31,400
COMMUNICATION IS LISTED FIRST

2010
01:23:31,400 --> 01:23:32,840
AND NO THIS IS NOT BECAUSE THE

2011
01:23:32,840 --> 01:23:34,960
LIST IS ALPHABETICAL ORDER.

2012
01:23:34,960 --> 01:23:36,200
COMMUNICATION WAS LIKELY PUT AT

2013
01:23:36,200 --> 01:23:38,640
THE TOP OF THE LIST TO EMPHASIZE

2014
01:23:38,640 --> 01:23:41,000
IMPORTANCE OF SKILL HAS ON

2015
01:23:41,000 --> 01:23:42,160
QUALITY OA CARE AND HOW IT

2016
01:23:42,160 --> 01:23:43,440
RELATES TO OTHER SKILLS ON THE

2017
01:23:43,440 --> 01:23:50,040
LIST. NOW WE WILL FOCUS IN ON

2018
01:23:50,040 --> 01:23:51,040
HOW DIFFERENT PATIENT

2019
01:23:51,040 --> 01:23:52,160
CHARACTERISTICS PLAY A ROLE IN

2020
01:23:52,160 --> 01:23:55,560
PATIENT PROVIDER COMMUNICATION.

2021
01:23:55,560 --> 01:23:56,920
HERE ARE EXAMPLES, I WILL

2022
01:23:56,920 --> 01:23:59,720
HIGHLIGHT A FEW. LIMITED HEALTH

2023
01:23:59,720 --> 01:24:01,120
LITERACY COMES INTO PLAY BECAUSE

2024
01:24:01,120 --> 01:24:03,280
IT COMPLY CASE COMMUNICATION

2025
01:24:03,280 --> 01:24:05,120
ESPECIALLY REGARDING OA AND

2026
01:24:05,120 --> 01:24:06,240
OTHER CHRONIC DISEASE MANAGEMENT

2027
01:24:06,240 --> 01:24:08,600
THAT REQUIRE ONGOING CARE.  

2028
01:24:08,600 --> 01:24:11,000
RACIAL ETHNIC MINORITIES

2029
01:24:11,000 --> 01:24:12,560
EXPERIENCE COMMUNICATION

2030
01:24:12,560 --> 01:24:13,880
DISPARITIES EVEN WHEN THERE ARE

2031
01:24:13,880 --> 01:24:15,880
NO HEALTH LITERACY OR LINGUISTIC

2032
01:24:15,880 --> 01:24:17,800
BARRIERS. RESEARCH SHOWS THAT

2033
01:24:17,800 --> 01:24:21,240
AFRICAN AMERICAN PATIENTS

2034
01:24:21,240 --> 01:24:22,280
EXPERIENCE LOWER QUALITY

2035
01:24:22,280 --> 01:24:23,320
COMMUNICATION WITH PROVIDERS

2036
01:24:23,320 --> 01:24:25,880
THAN WHITE PATIENTS.  AFRICAN

2037
01:24:25,880 --> 01:24:28,320
AMERICAN, LATINOS AND OTHER

2038
01:24:28,320 --> 01:24:30,480
MINORITIES HAVE INDIVIDUALLY AND

2039
01:24:30,480 --> 01:24:32,400
HISTORICALLY EXPERIENCED

2040
01:24:32,400 --> 01:24:33,520
INFERIOR QUALITY OF CARE

2041
01:24:33,520 --> 01:24:34,960
RESULTING IN DISTRUST AND

2042
01:24:34,960 --> 01:24:36,440
MISTRUST OF HEALTHCARE PROVIDERS

2043
01:24:36,440 --> 01:24:40,080
AND THE HEALTHCARE SYSTEM. WE

2044
01:24:40,080 --> 01:24:43,760
KNOW LESS ACULTUREATED LATINOS

2045
01:24:43,760 --> 01:24:45,560
ARE SKEPTICAL OF PHARMACEUTICALS

2046
01:24:45,560 --> 01:24:46,560
AND PREFER ALTERNATIVE

2047
01:24:46,560 --> 01:24:48,920
TREATMENTS. CRITICAL OR PROVIDER

2048
01:24:48,920 --> 01:24:50,600
RELATIONSHIP WITH PHARMACEUTICAL

2049
01:24:50,600 --> 01:24:51,960
INDUSTRY AND THEY HAVE LESS

2050
01:24:51,960 --> 01:24:53,800
PREFERENCE FOR SURGICAL

2051
01:24:53,800 --> 01:24:56,480
TREATMENT. AS DO AFRICAN

2052
01:24:56,480 --> 01:24:58,160
AMERICANS. SO I WANT TO NOTE

2053
01:24:58,160 --> 01:25:00,120
THAT I HAVE NOT LISTED HERE

2054
01:25:00,120 --> 01:25:01,800
PROVIDERS SPECIFIC FACTORS SUCH

2055
01:25:01,800 --> 01:25:05,320
AS RACIAL ETHNIC STEREOTYPES AND

2056
01:25:05,320 --> 01:25:06,680
PROVIDER DISCRIMINATION BECAUSE

2057
01:25:06,680 --> 01:25:09,160
THIS WILL BE COVERED IN SESSION

2058
01:25:09,160 --> 01:25:14,520
3. SO I MENTION THIS A FEW TIMES

2059
01:25:14,520 --> 01:25:16,320
BUT I WANT TO PROVIDE A

2060
01:25:16,320 --> 01:25:17,400
DEPICTION OF WHY PATIENT

2061
01:25:17,400 --> 01:25:18,320
PROVIDER COMMUNICATION IS SO

2062
01:25:18,320 --> 01:25:20,800
IMPORTANT. FROM THIS PHI YOUR WE

2063
01:25:20,800 --> 01:25:22,400
SEE POOR COMMUNICATION CAN

2064
01:25:22,400 --> 01:25:24,640
RESULT IN POOR PATIENT

2065
01:25:24,640 --> 01:25:26,240
SATISFACTION WHICH LEADS TO LOW

2066
01:25:26,240 --> 01:25:29,440
TREATMENT ADHERENCE AND THUS

2067
01:25:29,440 --> 01:25:33,440
POOR HEALTH OUTCOMES THIS TABLE

2068
01:25:33,440 --> 01:25:35,840
COMES FROM A STUDY THAT IDENTIFY

2069
01:25:35,840 --> 01:25:37,640
HIGH PRIORITY RESEARCH QUESTIONS

2070
01:25:37,640 --> 01:25:40,840
FOR OA SYSTEMATIC REVIEWS,

2071
01:25:40,840 --> 01:25:42,200
WITHIN SCOPE OVERLET EQUITY AND

2072
01:25:42,200 --> 01:25:44,320
SOCIAL DETERMINANTS OF HEALTH. 

2073
01:25:44,320 --> 01:25:46,880
ONE ASPECT WAS TO SURVEY

2074
01:25:46,880 --> 01:25:48,080
PATIENTS AND ASK THEM TO RANK

2075
01:25:48,080 --> 01:25:50,240
TOP TEN RESEARCH QUESTIONS AND

2076
01:25:50,240 --> 01:25:52,240
HERE YOU SEE THE TOP RANKED

2077
01:25:52,240 --> 01:25:53,960
PRIORITY BASED ON IMPORTANCE AND

2078
01:25:53,960 --> 01:25:57,520
POTENTIAL IMPACT ON EQUITY WAS

2079
01:25:57,520 --> 01:25:59,080
COMMUNICATION INTERVENTION TO

2080
01:25:59,080 --> 01:26:00,880
APPROVE QUALITY AND LEVEL OF

2081
01:26:00,880 --> 01:26:02,480
COMMUNICATION BETWEEN OA

2082
01:26:02,480 --> 01:26:05,080
PATIENTS AND THEIR HEALTHCARE

2083
01:26:05,080 --> 01:26:09,280
PROVIDERS. SO WHERE ARE

2084
01:26:09,280 --> 01:26:10,320
OPPORTUNITIES FOR INTERVENTION

2085
01:26:10,320 --> 01:26:13,880
WHERE COMMUNICATION CAN BE

2086
01:26:13,880 --> 01:26:16,520
ENHANCED? MANY HERE MAY ALREADY

2087
01:26:16,520 --> 01:26:17,720
THINK ABOUT THE OPPORTUNITIES

2088
01:26:17,720 --> 01:26:19,840
HIGHLIGHTED IN THE RED BOX WHERE

2089
01:26:19,840 --> 01:26:21,400
PATIENTS PROVIDERS AND PATIENT

2090
01:26:21,400 --> 01:26:24,080
PROVIDER DYADS ARE TARGETED TO

2091
01:26:24,080 --> 01:26:25,560
IMPROVE COMMUNICATION. AND YES,

2092
01:26:25,560 --> 01:26:26,960
THERE ARE INDEED INDIVIDUAL

2093
01:26:26,960 --> 01:26:29,320
PATIENT PROVIDER DIATIC

2094
01:26:29,320 --> 01:26:30,600
INTERVENTIONS THAT HAVE SHOWN

2095
01:26:30,600 --> 01:26:34,200
SUCCESS.  HOWEVER I WANT TO

2096
01:26:34,200 --> 01:26:36,920
FOCUS ON OTHER DIATIC CLINIC AND

2097
01:26:36,920 --> 01:26:37,560
COMMUNITY LEVEL OPPORTUNITIES

2098
01:26:37,560 --> 01:26:39,400
BECAUSE WHEN WE TALK ABOUT

2099
01:26:39,400 --> 01:26:41,400
HEALTH DISPARITIES, NOT ONLY

2100
01:26:41,400 --> 01:26:42,680
TALKING ABOUT INDIVIDUAL LEVEL

2101
01:26:42,680 --> 01:26:45,480
BARRIERS TO COMMUNICATION. WE

2102
01:26:45,480 --> 01:26:47,520
ARE ALSO TALKING SYSTEMATIC

2103
01:26:47,520 --> 01:26:48,920
INSTITUTIONAL AND COMMUNITY

2104
01:26:48,920 --> 01:26:50,240
LEVEL BARRIERS THAT NEED TO BE

2105
01:26:50,240 --> 01:26:54,160
ADDRESSED.  SO LET'S STAY AT

2106
01:26:54,160 --> 01:26:56,840
THIS TOP LEVEL OF POTENTIAL

2107
01:26:56,840 --> 01:26:58,800
INTERVENTION TO WORK. DIRECT

2108
01:26:58,800 --> 01:27:00,360
SERVICES MEANS PROVISION OF

2109
01:27:00,360 --> 01:27:01,720
VERBAL WRITTEN PATIENT

2110
01:27:01,720 --> 01:27:04,160
COMMUNICATION DESIGNED TO MEET

2111
01:27:04,160 --> 01:27:06,840
DISPARATE LANGUAGE NEEDS.

2112
01:27:06,840 --> 01:27:08,160
INTERPRETERS, AND HEALTH

2113
01:27:08,160 --> 01:27:09,480
EDUCATION MATERIALS THAT

2114
01:27:09,480 --> 01:27:11,240
TRANSLATED PROFESSIONALLY OR AT

2115
01:27:11,240 --> 01:27:13,200
LEAST NATIVE SPEAKER SO NOT

2116
01:27:13,200 --> 01:27:15,440
GOOGLE, OR SOMEONE WHO HAD BASIC

2117
01:27:15,440 --> 01:27:19,360
LANGUAGE SKILLS AND DEVELOPED AT

2118
01:27:19,360 --> 01:27:20,640
A SIXTH GRADE READING LEVEL OR

2119
01:27:20,640 --> 01:27:23,760
BELOW. THESE SOUND OFTEN AND

2120
01:27:23,760 --> 01:27:25,000
WELL HANGING FRUIT BUT CAN BE

2121
01:27:25,000 --> 01:27:26,000
DONE LAST MINUTE WITHOUT

2122
01:27:26,000 --> 01:27:27,000
ATTENTION THAT THEY NEED TO BE

2123
01:27:27,000 --> 01:27:33,920
EFFECTIVE. INCORPORATING

2124
01:27:33,920 --> 01:27:36,360
CULTURAL HOMOPHYLY CREATING

2125
01:27:36,360 --> 01:27:37,680
CULTURE OF PATIENTS WE ARE

2126
01:27:37,680 --> 01:27:39,640
TRYING TO REACH. DOING SO CAN

2127
01:27:39,640 --> 01:27:41,240
IMPROVE COMMUNICATION BY HELPING

2128
01:27:41,240 --> 01:27:43,800
PATIENTS FEEL UNDERSTOOD, SEEN

2129
01:27:43,800 --> 01:27:45,160
AND HEARD AND THEREFORE BUILT

2130
01:27:45,160 --> 01:27:46,040
TRUST BETWEEN PATIENTS AND

2131
01:27:46,040 --> 01:27:47,520
PROVIDERS THAT LEAD TO IMPROVED

2132
01:27:47,520 --> 01:27:49,880
COMMUNICATION. THIS INSLIDES

2133
01:27:49,880 --> 01:27:52,400
HIRING PROVIDERS AND STAFF WHO

2134
01:27:52,400 --> 01:27:54,160
SHARE CULTURAL BACKGROUND OF

2135
01:27:54,160 --> 01:27:55,640
THESE PATIENTS, ANOTHER EXAMPLE

2136
01:27:55,640 --> 01:27:57,520
IS CREATING ENVIRONMENT THAT

2137
01:27:57,520 --> 01:27:58,720
PROMOTES INCLUSION OF FAMILY,

2138
01:27:58,720 --> 01:28:01,480
SINCE MANY MINORITY CULTURES

2139
01:28:01,480 --> 01:28:04,280
PLACE MYVALUE ROLE OF FAMILY IN

2140
01:28:04,280 --> 01:28:04,960
HEALTH AND MAILLOT HEALTH

2141
01:28:04,960 --> 01:28:06,360
BEHAVIORS INCLUDING MEDICATION

2142
01:28:06,360 --> 01:28:08,000
ADHERENCE. SO THIS MAY LOOK LIKE

2143
01:28:08,000 --> 01:28:09,600
MAKING EFFORT TO INCLUDE FAMILY

2144
01:28:09,600 --> 01:28:11,200
MEMBERS AND CLINIC VISITS IN

2145
01:28:11,200 --> 01:28:14,560
PERSON, VIA VIDEO OR BY PHONE. 

2146
01:28:14,560 --> 01:28:16,880
NEXT INCLUDING ALTERNATIVE

2147
01:28:16,880 --> 01:28:18,200
TREATMENTS DOESN'T MEAN

2148
01:28:18,200 --> 01:28:19,000
PROMOTING QUESTIONABLE

2149
01:28:19,000 --> 01:28:20,000
TREATMENTS THAT LACK EVIDENCE

2150
01:28:20,000 --> 01:28:22,680
BUT DOES MEAN BEING AWARE OF THE

2151
01:28:22,680 --> 01:28:24,040
OTHER TREATMENT OPTIONS PATIENTS

2152
01:28:24,040 --> 01:28:25,280
ARE INTERESTED IN, SUCH AS

2153
01:28:25,280 --> 01:28:27,400
DIETARY SUPPLEMENTS AND CHANGES,

2154
01:28:27,400 --> 01:28:29,080
AND HAVING RESOURCES AND

2155
01:28:29,080 --> 01:28:30,080
INFORMATION ON THIS TREATMENT

2156
01:28:30,080 --> 01:28:32,720
AVAILABLE FOR THESE PATIENTS.  

2157
01:28:32,720 --> 01:28:34,560
FINALLY, IN INCLUDING COMMUNITY

2158
01:28:34,560 --> 01:28:36,400
HEALTH WORKERS IN CLINIC

2159
01:28:36,400 --> 01:28:39,640
SETTINGS MAY INCREASE CULTURAL

2160
01:28:39,640 --> 01:28:41,360
HOMOPHYLY NEEDED TO IMPROVE

2161
01:28:41,360 --> 01:28:44,000
COMMUNICATION. COMMUNITY HEALTH

2162
01:28:44,000 --> 01:28:44,800
WORKERS HAVE A DEEP

2163
01:28:44,800 --> 01:28:45,920
UNDERSTANDING OF COMMUNITY THEY

2164
01:28:45,920 --> 01:28:47,480
SERVE BECAUSE THEY ARE MEMBERS

2165
01:28:47,480 --> 01:28:50,720
OF THAT COMMUNITY TOO. 

2166
01:28:50,720 --> 01:28:51,320
LOGISTICALLY COMMUNITY HEALTH

2167
01:28:51,320 --> 01:28:52,480
WORKERS PROVIDE PATIENT

2168
01:28:52,480 --> 01:28:53,640
EDUCATION LANGUAGE ASSISTANCE

2169
01:28:53,640 --> 01:28:55,640
AND INFORMAL COUNSELING AND

2170
01:28:55,640 --> 01:28:56,920
IMPROVED CONTINUITY AND

2171
01:28:56,920 --> 01:28:59,040
COORDINATION OF CARE. THEY

2172
01:28:59,040 --> 01:28:59,680
LITERALLY SPEAK THE SAME

2173
01:28:59,680 --> 01:29:02,560
LANGUAGE. AND UNDERSTAND

2174
01:29:02,560 --> 01:29:04,480
CULTURAL NUANCES AN RATIONALE

2175
01:29:04,480 --> 01:29:06,080
BEHIND PATIENT VALUES BELIEFS

2176
01:29:06,080 --> 01:29:07,840
AND BEHAVIORS.  THIS IS WHY THEY

2177
01:29:07,840 --> 01:29:09,400
MAKE SUCH GREAT LIAISONS BETWEEN

2178
01:29:09,400 --> 01:29:12,160
PATIENTS AND PROVIDERS. THIS IS

2179
01:29:12,160 --> 01:29:12,960
AN IMPORTANT POINT BECAUSE

2180
01:29:12,960 --> 01:29:14,720
COMMUNITY HEALTH WORKERS ARE NOT

2181
01:29:14,720 --> 01:29:16,400
ONLY VALUABLE TRANSLATORS AND

2182
01:29:16,400 --> 01:29:18,000
EFFECTIVE MESSENGERS OF

2183
01:29:18,000 --> 01:29:20,040
EDUCATION BUT PROVIDER WANTS TO

2184
01:29:20,040 --> 01:29:22,320
RELATE TO THE PATIENT BUT MORE

2185
01:29:22,320 --> 01:29:24,320
IMPORTANTLY THEY ARE ABLE

2186
01:29:24,320 --> 01:29:25,320
TEENING KATE PROVIDERS ABOUT

2187
01:29:25,320 --> 01:29:26,680
COMMUNITY NEEDS AND THE CULTURE

2188
01:29:26,680 --> 01:29:29,280
OF THE COMMUNITY SO THAT THE

2189
01:29:29,280 --> 01:29:30,720
PROVIDER CAN DEVELOP GREATER

2190
01:29:30,720 --> 01:29:32,480
UNDERSTANDING OF THEIR PATIENT

2191
01:29:32,480 --> 01:29:34,480
NEEDS. FINALLY COMMUNITY HEALTH

2192
01:29:34,480 --> 01:29:37,360
WORKERS HELP INCREASE USE OF

2193
01:29:37,360 --> 01:29:38,080
COMMUNITY RESOURCES WHICH WE

2194
01:29:38,080 --> 01:29:42,600
WILL DISCUSS NEXT. INSTITUTIONAL

2195
01:29:42,600 --> 01:29:44,720
ACCOMMODATIONS TO IMPROVE

2196
01:29:44,720 --> 01:29:45,840
COMMUNICATION GO BEYOND STAFFING

2197
01:29:45,840 --> 01:29:47,640
DECISIONS AND TYPES OF RESOURCES

2198
01:29:47,640 --> 01:29:50,200
MADE AVAILABLE TO PATIENTSS. THS

2199
01:29:50,200 --> 01:29:52,200
INCLUDES LOCATION OF CLINICS AN

2200
01:29:52,200 --> 01:29:53,640
SERVICES PROVIDED BY THE CLINIC.

2201
01:29:53,640 --> 01:29:56,680
MOBILE CLINICS.  THE HOURS OF

2202
01:29:56,680 --> 01:29:58,200
OPERATION WITH THE PHYSICAL

2203
01:29:58,200 --> 01:29:59,640
ENVIRONMENT LOOKS AND FEELS LIKE

2204
01:29:59,640 --> 01:30:02,200
AND INCREASING CULTURAL HUMILITY

2205
01:30:02,200 --> 01:30:04,640
OF ALL PROVIDERS AND STAFF WHO

2206
01:30:04,640 --> 01:30:06,120
INTERACT WITH PATIENTS IN A

2207
01:30:06,120 --> 01:30:07,320
CONCERTED EFFORT THAT GOES

2208
01:30:07,320 --> 01:30:09,320
BEYOND HIRING PEOPLE WITH THE

2209
01:30:09,320 --> 01:30:10,240
SAME BACK GROWN AS THEIR

2210
01:30:10,240 --> 01:30:12,320
PATIENTS.  SOME OF THESE ARE

2211
01:30:12,320 --> 01:30:14,200
OBVIOUS AND EASIER TO MODIFY

2212
01:30:14,200 --> 01:30:15,960
THAN OTHERS. I WANT TO SPEND

2213
01:30:15,960 --> 01:30:17,720
TIME ON THE LAST EXAMPLE.

2214
01:30:17,720 --> 01:30:21,920
COMMUNITY PARTNERSHIPS. CLINIC

2215
01:30:21,920 --> 01:30:23,960
COMMUNITY PARTNERSHIPS ARE

2216
01:30:23,960 --> 01:30:25,120
IMPORTANT BECAUSE WHILE AN

2217
01:30:25,120 --> 01:30:27,000
INDIVIDUAL PROVIDER LACKS SKILLS

2218
01:30:27,000 --> 01:30:28,400
AN RESOURCES TO ADDRESS TRUST

2219
01:30:28,400 --> 01:30:30,520
ISSUES THAT MAY IMPEDE

2220
01:30:30,520 --> 01:30:31,560
COMMUNICATION WITH PATIENT, THEY

2221
01:30:31,560 --> 01:30:33,000
CAN PARTNER WITH ORGANIZATIONS

2222
01:30:33,000 --> 01:30:35,520
THAT ALREADY HAVE THAT TRUST. 

2223
01:30:35,520 --> 01:30:37,200
EXAMPLES INCLUDE PARTICIPATING

2224
01:30:37,200 --> 01:30:38,800
IN HEALTH FAIRS MOBILE CLINICS

2225
01:30:38,800 --> 01:30:40,240
AND EDUCATING THE PUBLIC IN

2226
01:30:40,240 --> 01:30:41,880
PLACES LIKE RELIGIOUS

2227
01:30:41,880 --> 01:30:44,120
INSTITUTIONS LOCAL GROCERY

2228
01:30:44,120 --> 01:30:46,120
STORES BARBERSHOP AN COMMUNITY

2229
01:30:46,120 --> 01:30:48,080
CENTERS. THESE PARTNERSHIPS

2230
01:30:48,080 --> 01:30:51,320
INCREASE PATIENT HEALTH

2231
01:30:51,320 --> 01:30:51,920
KNOWLEDGE, IMPROVER COMMUNITY

2232
01:30:51,920 --> 01:30:53,360
IMAGE OF CLINIC AND ENHANCE

2233
01:30:53,360 --> 01:30:54,160
PROVIDERS AND STAFF MEMBERS

2234
01:30:54,160 --> 01:30:56,040
UNDERSTANDING OF CULTURE THAT I

2235
01:30:56,040 --> 01:31:02,000
SHALLS COME FROM. TO END I WILL

2236
01:31:02,000 --> 01:31:04,840
REVIEW A FEW GAPS AND POTENTIAL

2237
01:31:04,840 --> 01:31:06,640
RESEARCH FUTURE RESEARCH THAT

2238
01:31:06,640 --> 01:31:10,040
CAN ADDRESS THESE GAPS. FIRST

2239
01:31:10,040 --> 01:31:11,120
MULTI-LEVEL INTERVENTIONS THAT

2240
01:31:11,120 --> 01:31:14,880
TARGET VARIOUS LEVELS OF

2241
01:31:14,880 --> 01:31:15,800
INFLUENCE INFLUENCE PATIENT

2242
01:31:15,800 --> 01:31:17,200
PROVIDER COMMUNICATION. THERE'S

2243
01:31:17,200 --> 01:31:18,560
HEALTH LITERACY INTERVENTION

2244
01:31:18,560 --> 01:31:20,880
THAT TARGETS PATIENTS AND THEIR

2245
01:31:20,880 --> 01:31:22,880
FAMILIES WHICH HELP PROMOTE

2246
01:31:22,880 --> 01:31:24,040
TREATMENT ADHERENCE IN PATIENTS

2247
01:31:24,040 --> 01:31:27,080
WHO CULTURE PLACES HIGH VALUE ON

2248
01:31:27,080 --> 01:31:29,800
FACILITATE OA MANAGEMENT. 

2249
01:31:29,800 --> 01:31:32,240
ANOTHER EXAMPLE IS OA

2250
01:31:32,240 --> 01:31:33,000
SELF-MANAGEMENT INTERVENTION

2251
01:31:33,000 --> 01:31:34,600
DELIVERED VIA PARTNERSHIP

2252
01:31:34,600 --> 01:31:35,640
BETWEEN EMPLOYER COMMITTEEOR

2253
01:31:35,640 --> 01:31:37,480
CLINIC AND COMMUNITY CENTER.

2254
01:31:37,480 --> 01:31:39,280
SUCH INTERVENTION TARGET SELF

2255
01:31:39,280 --> 01:31:41,280
MANAGEMENT BEHAVIORS AND WORK

2256
01:31:41,280 --> 01:31:43,480
ENVIRONMENT BY PROMOTING

2257
01:31:43,480 --> 01:31:45,080
OCCUPATIONAL ACCOMMODATIONS, BY

2258
01:31:45,080 --> 01:31:47,800
ENHANCING PATIENT PROVIDER

2259
01:31:47,800 --> 01:31:48,760
COMMUNICATION SKILLS, AND IN

2260
01:31:48,760 --> 01:31:50,080
COMMUNITY CENTER BY OFFERING

2261
01:31:50,080 --> 01:31:52,400
EVIDENCE BASED PROGRAM. ANOTHER

2262
01:31:52,400 --> 01:31:53,640
AREA OF INTEREST MAY INCLUDES

2263
01:31:53,640 --> 01:31:55,400
HOW TO MEASURE SUCCESS AT EACH

2264
01:31:55,400 --> 01:31:58,360
OF THESE LEVELS.  HOW MUCH WE

2265
01:31:58,360 --> 01:32:00,160
EXPECT HIGHER LEVEL OF

2266
01:32:00,160 --> 01:32:01,320
MULTI-LEVEL INTERVENTION TO

2267
01:32:01,320 --> 01:32:03,400
IMPACT PATIENT OUTCOME SUCH AS

2268
01:32:03,400 --> 01:32:06,840
PAIN AN FUNCTION. HOW LONG DO WE

2269
01:32:06,840 --> 01:32:08,760
EXPECT UPSTREAM VARIABLES LIKE

2270
01:32:08,760 --> 01:32:10,320
TRUST WILL TAKE TO MAKE AN

2271
01:32:10,320 --> 01:32:11,440
IMPACT ON INDIVIDUAL MEASURES

2272
01:32:11,440 --> 01:32:14,560
LIKE MEDICATION ADHERENCE.

2273
01:32:14,560 --> 01:32:15,960
FINALLY, CROSS CULTURAL

2274
01:32:15,960 --> 01:32:17,160
EDUCATION FOR STUDENTS SUCH AS

2275
01:32:17,160 --> 01:32:19,040
MEDICAL AND NURSING STUDENTS CAN

2276
01:32:19,040 --> 01:32:20,400
GO BEYOND ACTIVE LISTENING

2277
01:32:20,400 --> 01:32:22,600
SKILLS TO BUILD AN AWARENESS OF

2278
01:32:22,600 --> 01:32:24,520
BIASES AND STEREOTYPES AN

2279
01:32:24,520 --> 01:32:26,120
INCREASING CULTURAL HUMILITY TO

2280
01:32:26,120 --> 01:32:27,120
ENHANCE PATIENT PROVIDER

2281
01:32:27,120 --> 01:32:31,800
COMMUNICATION.  THANK YOU.

2282
01:32:31,800 --> 01:32:33,960
>> THANK YOU, SANDRA. NOW
WE

2283
01:32:33,960 --> 01:32:36,400
MOVE RIGHT INTO OUR THIRD TALK

2284
01:32:36,400 --> 01:32:38,400
IN THIS AREA, SOCIAL

2285
01:32:38,400 --> 01:32:40,080
DETERMINANTS OF HEALTH QUALITY

2286
01:32:40,080 --> 01:32:44,400
AND ACCESS AND THIS IS PRESENTED

2287
01:32:44,400 --> 01:32:46,400
BY DR. CATHERINE MACLEAN, CHIEF

2288
01:32:46,400 --> 01:32:48,960
MEDICAL OFFICER AND SENIOR VICE

2289
01:32:48,960 --> 01:32:49,680
PRESIDENT AT HOSPITAL TO HAVE

2290
01:32:49,680 --> 01:32:50,960
SURGERY AND PROFESSOR MEDICINE

2291
01:32:50,960 --> 01:32:51,880
AT WEILL CORNELL MEDICAL

2292
01:32:51,880 --> 01:32:54,480
COLLEGE. 

2293
01:32:54,480 --> 01:32:56,120
>> GOOD MORNING OR
AFTERNOON,

2294
01:32:56,120 --> 01:32:57,240
EVERYBODY, DEPENDING WHERE YOU

2295
01:32:57,240 --> 01:32:59,680
ARE, PLEASURE TO HAVE THE

2296
01:32:59,680 --> 01:33:03,720
OPPORTUNITY TO SPEAK WITH YOU

2297
01:33:03,720 --> 01:33:05,040
SOME HEALTHCARE QUALITY ISSUES

2298
01:33:05,040 --> 01:33:07,760
AS RELATED TO SOCIAL

2299
01:33:07,760 --> 01:33:09,040
DETERMINANTS. MY HAT IS OFF TO

2300
01:33:09,040 --> 01:33:11,280
THE ORGANIZERS, THIS IS A GREAT

2301
01:33:11,280 --> 01:33:12,400
SESSION SO FAR. I CERTAINLY

2302
01:33:12,400 --> 01:33:18,680
LEARNED A LOT AND HOPE TO DEPLOY

2303
01:33:18,680 --> 01:33:21,920
IN OUR HEALTH ORGANIZATION.  

2304
01:33:21,920 --> 01:33:25,800
NOTHING TO DISCLOSE.  SO I WANT

2305
01:33:25,800 --> 01:33:28,120
TO START WITH FIRST PRINCIPLES,

2306
01:33:28,120 --> 01:33:29,720
ONE IS QUALITY OSTEOARTHRITIS

2307
01:33:29,720 --> 01:33:32,200
WHAT IS QUALITY AND ONE IS

2308
01:33:32,200 --> 01:33:34,360
VALUE. THIS IS THE CLASSIC MODEL

2309
01:33:34,360 --> 01:33:35,560
OF HEALTHCARE QUALITY FROM BACK

2310
01:33:35,560 --> 01:33:38,040
IN THE '80s, HASN'T CHANGED.

2311
01:33:38,040 --> 01:33:40,120
WHEN WE THINK OF QUALITY OF

2312
01:33:40,120 --> 01:33:43,560
HEALTHCARE, IT IS WHAT WE DO TO

2313
01:33:43,560 --> 01:33:45,840
PATIENTS WITHIN OUR HEALTHCARE

2314
01:33:45,840 --> 01:33:46,960
SYSTEM THAT AFFECT HEALTH

2315
01:33:46,960 --> 01:33:48,840
OUTCOMES SO WE HAVE HAD A LOT OF

2316
01:33:48,840 --> 01:33:51,640
DISCUSSION TODAY ABOUT THE

2317
01:33:51,640 --> 01:33:52,720
IMPACT, SOCIAL DETERMINANTS OF

2318
01:33:52,720 --> 01:33:54,200
HEALTH OUTCOMES SO I THINK WE

2319
01:33:54,200 --> 01:33:57,280
KNOW THAT THAT IS A GIVEN.

2320
01:33:57,280 --> 01:33:59,840
HEALTHCARE QUALITY, HEALTHCARE

2321
01:33:59,840 --> 01:34:01,760
QUALITY IS ABOUT WHAT WE DO AND

2322
01:34:01,760 --> 01:34:03,280
HOW THAT AFFECTS THE HEALTH

2323
01:34:03,280 --> 01:34:05,840
OUTCOMES. SO WE CON SIP

2324
01:34:05,840 --> 01:34:06,800
ACTUALIZE QUALITY MEASURE IN

2325
01:34:06,800 --> 01:34:08,480
STRUCTURE PROCESS AND OUTCOME

2326
01:34:08,480 --> 01:34:10,520
MEASURES. THAT'S ARE THINGS LIKE

2327
01:34:10,520 --> 01:34:12,160
COMPLICATION RATES, REVISION

2328
01:34:12,160 --> 01:34:13,800
RATES, MORTALITY RATES

2329
01:34:13,800 --> 01:34:14,760
READMISSION RATES ET CETERA,

2330
01:34:14,760 --> 01:34:17,360
STRUCTURAL MEASURES ARE THINGS

2331
01:34:17,360 --> 01:34:21,000
THAT GET INTO PHYSICAL

2332
01:34:21,000 --> 01:34:21,800
STRUCTURE, ORGANIZATIONAL

2333
01:34:21,800 --> 01:34:25,120
STRUCTURE, SO THE PROPORTION OF

2334
01:34:25,120 --> 01:34:26,440
PHYSICIANS FACILITY THAT ARE

2335
01:34:26,440 --> 01:34:29,160
BOARD CERTIFIED. WHETHER A

2336
01:34:29,160 --> 01:34:32,400
HOSPITAL HAS A STROKE UNIT.

2337
01:34:32,400 --> 01:34:33,600
STROKE UNITS ASSOCIATED WITH

2338
01:34:33,600 --> 01:34:34,920
BETTER OUTCOMES. STRUCTURE

2339
01:34:34,920 --> 01:34:37,040
MEASURES AN PROCESS MEASURES ARE

2340
01:34:37,040 --> 01:34:39,560
THE MOST COMMON TYPES OF QUALITY

2341
01:34:39,560 --> 01:34:41,000
MEASURES, THOSE MEASURE WHAT WE

2342
01:34:41,000 --> 01:34:43,720
DO TO PATIENTS PROPORTION OF

2343
01:34:43,720 --> 01:34:45,720
PATIENTS WHO ARE ELIGIBLE FOR A

2344
01:34:45,720 --> 01:34:47,960
MAMMOGRAM THAT GOT THAT

2345
01:34:47,960 --> 01:34:49,200
MAMMOGRAM. PROPORTION OF

2346
01:34:49,200 --> 01:34:50,840
PATIENTS UNDERGOING SURGERY WHO

2347
01:34:50,840 --> 01:34:52,880
GOT THE PROPHYLACTIC ANTIBIOTICS

2348
01:34:52,880 --> 01:34:54,080
THEY WERE SUPPOSED TO HAVE

2349
01:34:54,080 --> 01:34:55,720
GOTTEN. SO THESE ARE WHAT

2350
01:34:55,720 --> 01:34:58,960
QUALITY MEASURES ARE. WE THINK

2351
01:34:58,960 --> 01:35:00,480
ABOUT VALUE, REPORTER HAS A NICE

2352
01:35:00,480 --> 01:35:02,680
MODEL WHICH IS REALLY JUST

2353
01:35:02,680 --> 01:35:04,360
TALKING ABOUT HEALTH OUTCOMES

2354
01:35:04,360 --> 01:35:07,240
WHICH ARE INTEGRAL TO QUALITY

2355
01:35:07,240 --> 01:35:08,760
AND RELATIONSHIP TO COST. SO

2356
01:35:08,760 --> 01:35:10,760
VALUE WE THINK ABOUT VALUE, WE

2357
01:35:10,760 --> 01:35:13,400
MAKE VALUE JUDGMENTS EVERY DAY

2358
01:35:13,400 --> 01:35:15,640
AS CONSUMERS AND THAT OUTCOME

2359
01:35:15,640 --> 01:35:17,880
WHAT YOU WILL GET OUT OF IT OVER

2360
01:35:17,880 --> 01:35:22,040
THE COST OF CARE. NEXT SLIDE.  

2361
01:35:22,040 --> 01:35:25,280
WHY MEASURE QUALITY? WHY BOTHER?

2362
01:35:25,280 --> 01:35:27,920
THERE IS THREE MAIN REASONS TO

2363
01:35:27,920 --> 01:35:29,920
DO IT WE MEASURE TO DIRECT

2364
01:35:29,920 --> 01:35:31,920
QUALITY IMPROVEMENT ACTIVITIES,

2365
01:35:31,920 --> 01:35:33,600
MEASURE QUALITY FOR PURPOSES OF

2366
01:35:33,600 --> 01:35:35,000
PUBLIC REPORTING AND

2367
01:35:35,000 --> 01:35:36,600
ACCOUNTABILITY. AND LASTLY MORE

2368
01:35:36,600 --> 01:35:38,480
RECENTLY TO ENABLE VALUE BASED

2369
01:35:38,480 --> 01:35:40,360
PURCHASING PROGRAM. I WANT TO

2370
01:35:40,360 --> 01:35:42,120
EMPHASIZE, AT THE BOTTOM HERE

2371
01:35:42,120 --> 01:35:44,320
THE REASON WE DO ANY OF THIS

2372
01:35:44,320 --> 01:35:45,720
STUFF, IS IMPROVE HEALTH OF

2373
01:35:45,720 --> 01:35:47,880
INDIVIDUALS AND POPULATIONS. WE

2374
01:35:47,880 --> 01:35:49,360
CANNOT LOSE SIGHT OF THAT. THAT

2375
01:35:49,360 --> 01:35:51,760
IS THE PURPOSE OF QUALITY

2376
01:35:51,760 --> 01:35:53,360
MEASUREMENT AND REALLY THE

2377
01:35:53,360 --> 01:35:57,960
PURPOSE OF VALUE BASED

2378
01:35:57,960 --> 01:35:58,840
PURCHASING. RISK ADJUSTMENT OF

2379
01:35:58,840 --> 01:36:00,000
QUALITY MEASURES. WHY DO WE DO

2380
01:36:00,000 --> 01:36:04,440
THAT? IN GENERAL REASON WE RISK

2381
01:36:04,440 --> 01:36:06,480
ADJUST IS FACILITATE FAIR

2382
01:36:06,480 --> 01:36:09,280
COMPARISONS ACROSS PROVIDERS. WE

2383
01:36:09,280 --> 01:36:11,080
WANT TO ENSURE THE MAIN

2384
01:36:11,080 --> 01:36:13,080
DIFFERENCES WE ARE LOOK AT FOR

2385
01:36:13,080 --> 01:36:16,720
QUALITY MEASUREMENT ARE RELATED

2386
01:36:16,720 --> 01:36:17,840
TO DIFFERENCES IN PERFORMANCE.

2387
01:36:17,840 --> 01:36:19,360
DIFFERENCES IN THE WAY

2388
01:36:19,360 --> 01:36:21,600
HEALTHCARE IS DELIVERED. THEY

2389
01:36:21,600 --> 01:36:24,040
ARE NOT RELATED TO PATIENT

2390
01:36:24,040 --> 01:36:26,560
FACTORS OVER WRITE PROVIDERS

2391
01:36:26,560 --> 01:36:29,680
DON'T HAVE MUCH CONTROL OR DON'T

2392
01:36:29,680 --> 01:36:31,400
HAVE ANY CONTROL. MOST CURRENT

2393
01:36:31,400 --> 01:36:33,280
RISK ADJUSTMENTS FOCUS ON

2394
01:36:33,280 --> 01:36:34,360
PHYSICAL CHARACTERISTICS IN

2395
01:36:34,360 --> 01:36:36,760
PATIENTS AND IMPACT OF HEALTH

2396
01:36:36,760 --> 01:36:39,240
OUTCOMES. DISEASE SEVERITY. AGE,

2397
01:36:39,240 --> 01:36:41,960
GENDER, WE KNOW THOSE THINGS

2398
01:36:41,960 --> 01:36:43,200
AFFECT HEALTH OUTCOMES AND IN

2399
01:36:43,200 --> 01:36:45,200
THE CONTEXT OF LOOKING AT

2400
01:36:45,200 --> 01:36:46,760
QUALITY MEASURE, WE WANT TO MAKE

2401
01:36:46,760 --> 01:36:48,800
SURE WE ADJUST FOR THOSE THINGS

2402
01:36:48,800 --> 01:36:50,800
TO MAKE SURE WE ARE DOING A FAIR

2403
01:36:50,800 --> 01:36:52,680
COMPARISON ACROSS DIFFERENT

2404
01:36:52,680 --> 01:36:53,880
PROVIDERS. WHAT ARE SOCIAL

2405
01:36:53,880 --> 01:36:55,120
DETERMINANTS? WE HAD A WHOLE

2406
01:36:55,120 --> 01:36:56,480
DISCUSSION THIS MORNING, I DON'T

2407
01:36:56,480 --> 01:36:58,320
THINK I NEED TO PROVE THE POINT

2408
01:36:58,320 --> 01:37:00,000
SOCIAL DETERMINANTS CERTAINLY

2409
01:37:00,000 --> 01:37:01,840
AFFECT HEALTH OUTCOMES AND THE

2410
01:37:01,840 --> 01:37:04,520
PROS FOR ADJUSTING FOR SOCIAL

2411
01:37:04,520 --> 01:37:07,360
DETERMINANTS IN THE CONTEXT OF

2412
01:37:07,360 --> 01:37:10,160
QUALITY MEASUREMENT IS THAT

2413
01:37:10,160 --> 01:37:11,240
MEASURE PERFORMANCE TIDE TO

2414
01:37:11,240 --> 01:37:12,920
SOCIAL DETERMINANTS IN WAYS

2415
01:37:12,920 --> 01:37:14,840
BEYOND PROVIDER CONTROL. FOR

2416
01:37:14,840 --> 01:37:17,440
EXAMPLE, WE KNOW DUAL

2417
01:37:17,440 --> 01:37:20,720
ELIGIBILITY IS TIGHTLY

2418
01:37:20,720 --> 01:37:22,600
CORRELATED WITH OUTCOMES AND

2419
01:37:22,600 --> 01:37:26,960
WITH QUALITY. ANOTHER PROSE TO

2420
01:37:26,960 --> 01:37:29,280
LEVEL PLAYING FIELD VALUE BASED

2421
01:37:29,280 --> 01:37:31,960
PURCHASING CONS OF ACTUALLY RISK

2422
01:37:31,960 --> 01:37:33,160
ADJUSTING FOR SOCIAL

2423
01:37:33,160 --> 01:37:35,320
DETERMINANTS WITHIN QUALITY

2424
01:37:35,320 --> 01:37:36,720
MEASURES IS TO MASSK DISPARITIES

2425
01:37:36,720 --> 01:37:38,280
AN LIMIT ABILITY TO IDENTIFY

2426
01:37:38,280 --> 01:37:41,240
PROBLEMS AND IMPROVE IT.  THEY

2427
01:37:41,240 --> 01:37:46,000
MAY ON ON FEW SKATE POOR

2428
01:37:46,000 --> 01:37:47,680
PERFORMANCE, BIAS OR

2429
01:37:47,680 --> 01:37:49,560
DISCRIMINATION. WE WANT TO

2430
01:37:49,560 --> 01:37:50,720
UNDERSTAND IF THEY ARE INSURANCE

2431
01:37:50,720 --> 01:37:52,280
COMPANIES DOING THAT THAT FALL

2432
01:37:52,280 --> 01:37:54,520
INTO THAT BUCKET. ANOTHER CON IS

2433
01:37:54,520 --> 01:37:56,120
THAT THE SAME CON IS ONE OF THE

2434
01:37:56,120 --> 01:37:58,560
PROS, COULD REDUCE INCENTIVES TO

2435
01:37:58,560 --> 01:37:59,800
PARTICIPATE VALUE BASED

2436
01:37:59,800 --> 01:38:03,400
PURCHASING DEPENDING WHERE YOUR

2437
01:38:03,400 --> 01:38:04,720
ORGANIZATION SITS ON SPECTRUM IN

2438
01:38:04,720 --> 01:38:05,800
TERMS OF DELIVERING CARE WITH

2439
01:38:05,800 --> 01:38:09,720
THE PROPORTION OF POPULATION. OF

2440
01:38:09,720 --> 01:38:15,000
PATIENTS WHO ARE DISADVANTAGED.

2441
01:38:15,000 --> 01:38:16,440
SO WILL IS A LOT OF THOUGHT

2442
01:38:16,440 --> 01:38:19,640
ABOUT THIS, I THINK CMS HAS BEEN

2443
01:38:19,640 --> 01:38:23,320
A REALLY NICE THOUGHTFUL JOB IN

2444
01:38:23,320 --> 01:38:26,280
THINKING ABOUT HOW SOCIAL

2445
01:38:26,280 --> 01:38:28,280
DETERMINANTS OUGHT TO BE THOUGHT

2446
01:38:28,280 --> 01:38:29,840
ABOUT IN TERMS OF VALUE BASED

2447
01:38:29,840 --> 01:38:33,120
PURCHASING PROGRAM, UNDER THE

2448
01:38:33,120 --> 01:38:37,960
IMPACT ACT, ASPE WAS TASKED WITH

2449
01:38:37,960 --> 01:38:39,080
RELATIONSHIP BETWEEN SOCIAL

2450
01:38:39,080 --> 01:38:41,560
DETERMINANTS AND MEDICARE VALUE

2451
01:38:41,560 --> 01:38:42,680
BASED PURCHASING PROGRAMS. IN

2452
01:38:42,680 --> 01:38:46,120
THE CENTER I LAID OUT MEDICARE

2453
01:38:46,120 --> 01:38:47,960
VALUE BASED PURCHASING PROGRAMS

2454
01:38:47,960 --> 01:38:50,160
SO THERE ARE A LOOT.  SOME FOCUS

2455
01:38:50,160 --> 01:38:52,240
ON -- A LOT.  SOME FOCUS ON CARE

2456
01:38:52,240 --> 01:38:53,800
DELIVERY SYSTEM, SOME INSURANCE

2457
01:38:53,800 --> 01:38:54,920
COMPANIES SO HOSPITAL

2458
01:38:54,920 --> 01:38:56,880
READMISSION REDUCTION PROGRAM,

2459
01:38:56,880 --> 01:38:58,440
HOSPITAL PURCHASING PROGRAM TO

2460
01:38:58,440 --> 01:39:03,160
THE BIGS, THE HOSPITAL ACQUIRED

2461
01:39:03,160 --> 01:39:05,120
CONDITIONS REDUCTION PROGRAM,

2462
01:39:05,120 --> 01:39:07,160
ANOTHER BIG ONE, MEDICARE

2463
01:39:07,160 --> 01:39:09,760
ADVANTAGE STAR PROGRAM. SO THERE

2464
01:39:09,760 --> 01:39:14,400
IS A LOT OF MONEY TIED TO

2465
01:39:14,400 --> 01:39:16,160
QUALITY PERFORMANCE ON MEDICARE

2466
01:39:16,160 --> 01:39:17,720
ADVANTAGE STAR PROGRAM AND SOME

2467
01:39:17,720 --> 01:39:19,440
INSURANCE COMPANIES THE MONEY IS

2468
01:39:19,440 --> 01:39:22,000
IN THE BILLIONS. WITH A B OF

2469
01:39:22,000 --> 01:39:27,040
DOLLARS IN TERMS OF QUALITY. SO

2470
01:39:27,040 --> 01:39:27,840
THESE ARE SOME OF THE -- VALUE

2471
01:39:27,840 --> 01:39:29,440
BASED PROGRAMS. A COUPLE OF

2472
01:39:29,440 --> 01:39:30,960
STUDIES WERE DONE, THE FIRST

2473
01:39:30,960 --> 01:39:33,120
RELEASED IN 2016, SECOND WAS

2474
01:39:33,120 --> 01:39:36,000
RELEASED IN 2020. THE KEY

2475
01:39:36,000 --> 01:39:37,560
FINDINGS FROM THESE STUDIES FROM

2476
01:39:37,560 --> 01:39:40,520
THE FIRST STUDY WAS THAT

2477
01:39:40,520 --> 01:39:41,720
BENEFICIARIES WITH SOCIAL RISK

2478
01:39:41,720 --> 01:39:44,160
FACTORS HAD WORSE OUTCOMES. AND

2479
01:39:44,160 --> 01:39:45,760
INEQUALITY MEASURES. THAT DOES

2480
01:39:45,760 --> 01:39:49,640
NOT A SURPRISING FINDING. AND

2481
01:39:49,640 --> 01:39:51,400
THE DUAL ELIGIBILITY WAS REALLY

2482
01:39:51,400 --> 01:39:55,600
HIGHLY CORRELATED WITH THAT POOR

2483
01:39:55,600 --> 01:39:57,560
PERFORMANCE. ADDITIONALLY

2484
01:39:57,560 --> 01:40:00,520
PROVIDERS WHO DISPROPORTIONATELY

2485
01:40:00,520 --> 01:40:02,440
BENEFICIARIES WITH SOCIAL RISK

2486
01:40:02,440 --> 01:40:04,520
FACTORS TENDED TO HAVE WORSE

2487
01:40:04,520 --> 01:40:05,880
PERFORMANCE ON THESE QUALITY

2488
01:40:05,880 --> 01:40:09,320
MEASURES EVEN AFTER ADJUSTING

2489
01:40:09,320 --> 01:40:10,320
FOR BENEFICIARY BUT NOT ALL THE

2490
01:40:10,320 --> 01:40:11,760
TIME, I WILL GO THROUGH A COUPLE

2491
01:40:11,760 --> 01:40:13,480
OF SLIDES ON THAT. FINDINGS FROM

2492
01:40:13,480 --> 01:40:16,960
THE MORE RECENT STUDY INCLUDE

2493
01:40:16,960 --> 01:40:19,200
THAT BENEFICIARY SOCIAL RISK FOR

2494
01:40:19,200 --> 01:40:21,560
INFORMATION, IS NOT ROUTINELY

2495
01:40:21,560 --> 01:40:23,040
SYSTEMATICALLY COLLECTED. SO IT

2496
01:40:23,040 --> 01:40:24,480
IS HARD TO EVEN UNDERSTAND WHAT

2497
01:40:24,480 --> 01:40:27,800
IS GOING ON. AGAIN AFTER

2498
01:40:27,800 --> 01:40:29,280
ACCOUNTING FOR LOTS OF DIFFERENT

2499
01:40:29,280 --> 01:40:33,200
RISK FACTORS OR PATIENT

2500
01:40:33,200 --> 01:40:34,480
CHARACTERISTICS THIS DUAL

2501
01:40:34,480 --> 01:40:37,680
ELIGIBILITY RISES TO THE SURFACE

2502
01:40:37,680 --> 01:40:42,560
AS BEING A KEY FACTOR THAT IS

2503
01:40:42,560 --> 01:40:43,840
ASSOCIATED WITH POOR QUALITY

2504
01:40:43,840 --> 01:40:45,320
PERFORMANCE, IN SOME CASES

2505
01:40:45,320 --> 01:40:47,800
FUNCTIONAL STATUS MATTER AS

2506
01:40:47,800 --> 01:40:50,840
WELL. AND THAT ALTHOUGH LOTS OF

2507
01:40:50,840 --> 01:40:52,440
ORGANIZATIONS ARE WORKING ON

2508
01:40:52,440 --> 01:40:54,200
THIS IN DIFFERENT WAYS THERE IS

2509
01:40:54,200 --> 01:40:58,600
NOT A COMMON WAY WE HAVEN'T

2510
01:40:58,600 --> 01:41:00,080
DETERMINED WHAT IS REPUTABLE IN

2511
01:41:00,080 --> 01:41:04,040
TERMS OF REDUCING THESE SOURCE

2512
01:41:04,040 --> 01:41:08,520
OF DISPARITIES. I WANTED TO PULL

2513
01:41:08,520 --> 01:41:10,200
OUT STUDIES OUT OF THE ASPE

2514
01:41:10,200 --> 01:41:14,200
WORK. THE REPORT IS REFERENCED

2515
01:41:14,200 --> 01:41:18,840
AT BOTTOM AND REALLY BIG BODY OF

2516
01:41:18,840 --> 01:41:21,080
REALLY ELEGANT VARIABLE DONE

2517
01:41:21,080 --> 01:41:23,200
RESEARCH LOOK AT SOCIAL

2518
01:41:23,200 --> 01:41:25,960
DETERMINANTS, BUT TO ME TWO OF

2519
01:41:25,960 --> 01:41:28,400
THE KEY FINDINGS OR THE TWO KEY

2520
01:41:28,400 --> 01:41:32,280
FINDINGS KEY STUDIES ARE IN THE

2521
01:41:32,280 --> 01:41:34,400
NEXT SLIDE. THEY LOOK AT

2522
01:41:34,400 --> 01:41:35,800
RELATIONSHIP BETWEEN

2523
01:41:35,800 --> 01:41:37,880
DISPROPORTIONATE SHARE HOSPITAL

2524
01:41:37,880 --> 01:41:39,920
INDEX AND HOSPITAL BABIES

2525
01:41:39,920 --> 01:41:40,760
PURCHASING TOTAL PERFORMANCE

2526
01:41:40,760 --> 01:41:43,200
SCORES. ON THE LEFT IS

2527
01:41:43,200 --> 01:41:46,080
PERFORMANCE SCORES, QUALITY

2528
01:41:46,080 --> 01:41:49,960
SCORE AND ON THE X AXIS WE SEE

2529
01:41:49,960 --> 01:41:53,520
THE DISPROPORTIONAL SHARE

2530
01:41:53,520 --> 01:41:56,720
HOSPITAL INDEX. SAFETY NET

2531
01:41:56,720 --> 01:41:58,280
HOSPITALS IN RED, NON-ARE IN

2532
01:41:58,280 --> 01:42:00,040
BLUE. THERE IS A CLEAR

2533
01:42:00,040 --> 01:42:01,520
CORRELATION WEAN THE PROPORTION

2534
01:42:01,520 --> 01:42:04,800
OF PATIENTS WHO ARE

2535
01:42:04,800 --> 01:42:05,720
DISADVANTAGED, IN THESE

2536
01:42:05,720 --> 01:42:07,200
HOSPITALS AND THE QUALITY

2537
01:42:07,200 --> 01:42:11,280
SCORES. NEXT SLIDE. THIS TO ME

2538
01:42:11,280 --> 01:42:15,120
WAS THE MOST FASCINATING RESULT

2539
01:42:15,120 --> 01:42:17,640
OF ALL RESEARCH THEY DID, THIS

2540
01:42:17,640 --> 01:42:20,400
WAS FOR MEDICARE ADVANTAGE IN

2541
01:42:20,400 --> 01:42:21,720
THIS STUDY THEY LOOK AT

2542
01:42:21,720 --> 01:42:23,440
RELATIONSHIP BETWEEN THE

2543
01:42:23,440 --> 01:42:27,240
PROPORTION OF DUALLY ELIGIBLE

2544
01:42:27,240 --> 01:42:28,760
ENROLLED SLASH LOW INCOME

2545
01:42:28,760 --> 01:42:31,960
SUBSIDY STATUS AND MEDICARE

2546
01:42:31,960 --> 01:42:33,240
ADVANTAGE QUALITY STAR RATING.

2547
01:42:33,240 --> 01:42:35,000
THIS MEDICARE ADVANTAGE QUALITY

2548
01:42:35,000 --> 01:42:38,320
STAR RATING IS WORTH A LOT OF

2549
01:42:38,320 --> 01:42:41,200
MONEY HEALTH PLANS. ON THE Y

2550
01:42:41,200 --> 01:42:46,160
AXIS WE SEE UNROUNDED OVERALL

2551
01:42:46,160 --> 01:42:50,480
MEDICARE STAR, SCORE, 0 TO 5.

2552
01:42:50,480 --> 01:42:53,120
AND ON THE X AXIS WHICH SEE

2553
01:42:53,120 --> 01:42:56,040
PROPORTION OF DISADVANTAGED --

2554
01:42:56,040 --> 01:42:57,080
PEOPLE IN THE POPULATION. THERE

2555
01:42:57,080 --> 01:43:04,240
IS A BIMODAL OUTCOME HERE. SO

2556
01:43:04,240 --> 01:43:06,360
FAR LEFT PART OF THE SLIDE TOP

2557
01:43:06,360 --> 01:43:11,400
PART WE SEE THAT PLANS WHO HAVE

2558
01:43:11,400 --> 01:43:12,800
FEW DISADVANTAGE PATIENTS IN

2559
01:43:12,800 --> 01:43:15,160
THEIR POPULATION HAVE MUCH --

2560
01:43:15,160 --> 01:43:17,520
PRETTY HIGH SCORES. FOR MEDICARE

2561
01:43:17,520 --> 01:43:19,560
ADVANTAGE. BUT WE SEE THAT ON

2562
01:43:19,560 --> 01:43:23,320
THE RIGHT HAND SIDE THERE ARE

2563
01:43:23,320 --> 01:43:25,280
NUMBER OF PLANS WHERE THERE IS A

2564
01:43:25,280 --> 01:43:28,200
HIGH PROPORTION OF PATIENTS WHO

2565
01:43:28,200 --> 01:43:31,480
ARE DISADVANTAGED AND DOING

2566
01:43:31,480 --> 01:43:34,320
WHITE WELL. THESE ARE PROBABLY

2567
01:43:34,320 --> 01:43:35,760
SPECIAL NEEDS PLANS AND WHAT

2568
01:43:35,760 --> 01:43:39,160
THIS SAYS IS HEALTH PLANS WHO

2569
01:43:39,160 --> 01:43:40,880
FOCUS ON THOSE PATIENTS, THESE

2570
01:43:40,880 --> 01:43:42,440
ARE MEDICARE ADVANTAGE PLANS

2571
01:43:42,440 --> 01:43:44,800
HAVE SOME THAT HAVE DONE A VERY

2572
01:43:44,800 --> 01:43:45,960
GOOD JOB IN DELIVERING HIGH

2573
01:43:45,960 --> 01:43:48,040
QUALITY CARE. IT IS NOT

2574
01:43:48,040 --> 01:43:49,400
IMPOSSIBPOSSIBLE. THIS IS SOMETG

2575
01:43:49,400 --> 01:43:55,800
THAT CAN BE DONE. BASED ON ALL

2576
01:43:55,800 --> 01:43:59,480
THE STUDIES DONE AS PART OF THE

2577
01:43:59,480 --> 01:44:03,000
EVALUATION ASPE MADE

2578
01:44:03,000 --> 01:44:04,800
RECOMMENDATIONS ON WHEN WE

2579
01:44:04,800 --> 01:44:08,240
SHOULD OR SHOULDN'T ADJUST FOR

2580
01:44:08,240 --> 01:44:11,760
SOCIAL DETERMINANTS IN TERMS OF

2581
01:44:11,760 --> 01:44:14,080
QUALITY MEASUREMENT. THE TOP

2582
01:44:14,080 --> 01:44:15,760
GRAPHIC IS SCHEMATIC IS

2583
01:44:15,760 --> 01:44:17,600
STRUCTURE PROCESS MEASURES,

2584
01:44:17,600 --> 01:44:19,440
PROBABLY NOT ADJUSTING THOSE BUT

2585
01:44:19,440 --> 01:44:22,600
RESOURCE USE MEASURES AN PATIENT

2586
01:44:22,600 --> 01:44:23,520
EXPERIENCE MEASURES MAKES MORE

2587
01:44:23,520 --> 01:44:27,200
SENSE SO ON THE BOTTOM RIGHT ARE

2588
01:44:27,200 --> 01:44:29,400
THE RECOMMENDATIONS ON WHETHER

2589
01:44:29,400 --> 01:44:30,360
TO ADJUST FOR SOCIAL RISK

2590
01:44:30,360 --> 01:44:31,840
FACTORS IN TERMS OF QUALITY

2591
01:44:31,840 --> 01:44:33,200
REPORTING, AND ALSO IN TERMS OF

2592
01:44:33,200 --> 01:44:35,000
VALUE BASED PROGRAMS. SO WHEN WE

2593
01:44:35,000 --> 01:44:39,440
ARE PAYING OUT. PROCESS MEASURES

2594
01:44:39,440 --> 01:44:42,080
NO, OUTCOME MEASURES NO, PATIENT

2595
01:44:42,080 --> 01:44:43,520
EXPERIENCE MEASURES YES, IN

2596
01:44:43,520 --> 01:44:44,960
SCENARIOS, RESOURCE USE

2597
01:44:44,960 --> 01:44:47,480
MEASURES, YES, WHEN PAYING OUT

2598
01:44:47,480 --> 01:44:48,600
AND PROGRAM PERFORMANCE SCORES

2599
01:44:48,600 --> 01:44:52,000
IN EITHER SITUATION. NEXT SLIDE 

2600
01:44:52,000 --> 01:44:54,640
THIS JUST THE FRAMEWORK HERE FOR

2601
01:44:54,640 --> 01:44:56,200
YOUR REFERENCE BUT THE CONCEPT

2602
01:44:56,200 --> 01:44:57,960
IS WE OUGHT TO ACCOUNT FOR

2603
01:44:57,960 --> 01:45:00,280
SOCIAL RISK IN MEDICARE

2604
01:45:00,280 --> 01:45:02,520
PURCHASING PROGRAMS AND DO BY

2605
01:45:02,520 --> 01:45:03,760
MEASURING AND REPORTING QUALITY

2606
01:45:03,760 --> 01:45:05,280
FOR BENEFICIARIES WITH SOCIAL

2607
01:45:05,280 --> 01:45:07,200
RISK FACTORS SENDING HIGH FAIR

2608
01:45:07,200 --> 01:45:09,520
QUALITY STANDARDS FOR EVERYONE

2609
01:45:09,520 --> 01:45:11,000
IS NOT OKAY TO HAVE A LOWER

2610
01:45:11,000 --> 01:45:11,920
STANDARD FOR DISADVANTAGED

2611
01:45:11,920 --> 01:45:15,120
PEOPLE. AND THEN LASTLY TO

2612
01:45:15,120 --> 01:45:17,800
REWARD AND SUPPORT BETTER

2613
01:45:17,800 --> 01:45:23,000
OUTCOMES. GO QUICKLY THROUGH

2614
01:45:23,000 --> 01:45:28,680
SOME STUDIES DONE REALLY THROUGH

2615
01:45:28,680 --> 01:45:30,040
THE LANDS INSTITUTE AND U.S.

2616
01:45:30,040 --> 01:45:32,240
NEWS REPORT THAT LOOK AT

2617
01:45:32,240 --> 01:45:35,040
RELATIONSHIP BETWEEN ACCESS TO

2618
01:45:35,040 --> 01:45:39,080
HOSPITALS AND THE TYPE OF CARE,

2619
01:45:39,080 --> 01:45:40,200
DELIVERED TO PATIENTS BASED ON

2620
01:45:40,200 --> 01:45:45,720
RACE.  SO THE U.S. NEWS WORLD

2621
01:45:45,720 --> 01:45:47,160
REPORT BUILDING ON SOME OF THE

2622
01:45:47,160 --> 01:45:50,360
WORK THE LANSETT INSTITUTE HAD

2623
01:45:50,360 --> 01:45:51,720
DONE, PUT TOGETHER THIS

2624
01:45:51,720 --> 01:45:54,240
INTERESTING METRIC THAT LOOKS AT

2625
01:45:54,240 --> 01:45:56,920
THE RELATIONSHIP BETWEEN

2626
01:45:56,920 --> 01:45:59,040
PATIENTS THIS IS ALL BASED ON

2627
01:45:59,040 --> 01:46:02,440
MEDICARE PATIENTS PATIENTS IN A

2628
01:46:02,440 --> 01:46:04,640
HOSPITAL HOW THEIR RACE REFLECTS

2629
01:46:04,640 --> 01:46:06,640
THE RACE IN THE CATCHMENT AREA

2630
01:46:06,640 --> 01:46:08,440
AROUND THAT HOSPITAL OR IN THAT

2631
01:46:08,440 --> 01:46:11,040
COMMUNITY. WHAT WE SEE,

2632
01:46:11,040 --> 01:46:12,400
VARIATION HERE YOU CAN SEE ON

2633
01:46:12,400 --> 01:46:14,400
THE GRAPH ON THE TOP LEFT BUT

2634
01:46:14,400 --> 01:46:15,520
BOTTOM RIGHT LOOKING AT

2635
01:46:15,520 --> 01:46:19,720
DIFFERENT TYPES OF HOSPITALS WE

2636
01:46:19,720 --> 01:46:23,480
SEE HOSPITALS OVERALL THEY ARE

2637
01:46:23,480 --> 01:46:26,960
NOT -- THEY DON'T REPRESENT

2638
01:46:26,960 --> 01:46:28,600
COMMUNITIES THAT ARE SURROUNDING

2639
01:46:28,600 --> 01:46:30,360
THEM. WHEN WE LOOK DOWN ON THE

2640
01:46:30,360 --> 01:46:33,680
BOTTOM WE SEE THAT IT IS NOT FOR

2641
01:46:33,680 --> 01:46:36,400
PROFIT, IT IS LOWER STATE OWNED

2642
01:46:36,400 --> 01:46:40,040
HOSPITALS AND END UP HAVING

2643
01:46:40,040 --> 01:46:45,040
REPRESENT MORE PATIENTS MINORITY

2644
01:46:45,040 --> 01:46:49,520
POPULATIONS THAN DO OTHER

2645
01:46:49,520 --> 01:46:53,000
HOSPITALS. WE DID ANOTHER

2646
01:46:53,000 --> 01:46:57,560
ANALYSIS AND LOOKED AT RACE AS

2647
01:46:57,560 --> 01:47:00,920
INDEX AT THE LANDS INDEX --

2648
01:47:00,920 --> 01:47:02,160
INSTITUTE PUT TOGETHER ON RACE

2649
01:47:02,160 --> 01:47:06,000
INCLUSIVITY AND LOOKED AT IT IN

2650
01:47:06,000 --> 01:47:07,400
RELATIONSHIP TO U.S. NEWS WORLD

2651
01:47:07,400 --> 01:47:09,640
REPORT TOP 20 HOSPITALS I FOCUS

2652
01:47:09,640 --> 01:47:12,520
ON ORTHOPEDIC HOSPITAL AND

2653
01:47:12,520 --> 01:47:13,440
TALKING OSTEOARTHRITIS. WHAT YOU

2654
01:47:13,440 --> 01:47:15,280
SEE HERE IS AMONG THESE TOP 20

2655
01:47:15,280 --> 01:47:17,160
HOSPITAL THERE IS IS A

2656
01:47:17,160 --> 01:47:20,880
DIVERGENCE, THERE ARE NUMBER OF

2657
01:47:20,880 --> 01:47:24,800
HOSPITALS WHO HAVE HIGH

2658
01:47:24,800 --> 01:47:26,760
INCLUSIVITY INDEX, NOT RACIALLY

2659
01:47:26,760 --> 01:47:28,920
INCLUSIVE, AS THE ONES ON TOP

2660
01:47:28,920 --> 01:47:31,680
BUT THERE ARE SOME SHINING STARS

2661
01:47:31,680 --> 01:47:33,360
AMONG THAT TOP 20 LILLED DOWN AT

2662
01:47:33,360 --> 01:47:38,400
THE BOTTOM. CALL OUT FOR MASS

2663
01:47:38,400 --> 01:47:40,640
GENERAL UCSF. JUST WANTS TO CALL

2664
01:47:40,640 --> 01:47:43,440
OUT THAT THE U.S. NEWS REPORT

2665
01:47:43,440 --> 01:47:46,560
NUMBER 1 AND 10 AND 11 RATED

2666
01:47:46,560 --> 01:47:48,800
HOSPITALS, ARE NOT INCLUDED

2667
01:47:48,800 --> 01:47:51,000
HERE, SPECIALTY HOSPITALS, THAT

2668
01:47:51,000 --> 01:47:56,920
WAS NOT CALCULATED BY THE INDEX 

2669
01:47:56,920 --> 01:48:00,720
THIS IS REALLY THE FINAL SLIDE,

2670
01:48:00,720 --> 01:48:02,240
THIS GRAPHIC BACKGROUND IS

2671
01:48:02,240 --> 01:48:04,360
TAKING FROM -- TAKEN FROM

2672
01:48:04,360 --> 01:48:07,040
HOSPITAL COMPARE AND CMS LOOKS

2673
01:48:07,040 --> 01:48:09,920
AT HIP AND KNEE REPLACEMENT THE

2674
01:48:09,920 --> 01:48:11,560
RELATIONSHIP BETWEEN TOTAL HIP

2675
01:48:11,560 --> 01:48:13,680
KNEE REPLACEMENT 90 DAY

2676
01:48:13,680 --> 01:48:15,240
COMPLICATION RATES ON THE X AXIS

2677
01:48:15,240 --> 01:48:18,800
AND THE 90 DAY PAYMENT ON THE Y

2678
01:48:18,800 --> 01:48:21,320
AXIS. SO YOU WANT TO BE IN THE

2679
01:48:21,320 --> 01:48:23,480
BOTTOM LEFT AND SO AGAIN I HAVE

2680
01:48:23,480 --> 01:48:26,120
TAKEN THE TOP 20 U.S. NEWS

2681
01:48:26,120 --> 01:48:27,480
REPORT HOSPITALS AND PLOTTED

2682
01:48:27,480 --> 01:48:29,440
THEM ON THIS AND YOU CAN SEE

2683
01:48:29,440 --> 01:48:31,920
WHERE THEY PAN OUT. AGAIN THERE

2684
01:48:31,920 --> 01:48:33,080
ARE FOUR HOSPITALS ON HERE,

2685
01:48:33,080 --> 01:48:35,880
THREE THAT I MENTION PREVIOUSLY,

2686
01:48:35,880 --> 01:48:37,680
HHS, SCRIP, THEY ARE SPECIALTY

2687
01:48:37,680 --> 01:48:39,520
HOSPITALS THEY HAVEN'T GOTTEN

2688
01:48:39,520 --> 01:48:42,680
THIS RATING IN TERMS OF RACIAL

2689
01:48:42,680 --> 01:48:44,360
INCLUSIVITY. MAYO CLINIC WASN'T

2690
01:48:44,360 --> 01:48:47,680
RATED BECAUSE COMMUNITY IN WHICH

2691
01:48:47,680 --> 01:48:50,960
MAYO CLINIC IS LOCATED IS NOT

2692
01:48:50,960 --> 01:48:54,560
VERY HETEROGENOUS POPULATION IN

2693
01:48:54,560 --> 01:48:58,200
TERMS OF RACE. SO YOU CAN SEE

2694
01:48:58,200 --> 01:48:59,200
HERE IN THE GREEN THESE ARE

2695
01:48:59,200 --> 01:49:01,320
INSTITUTIONS THAT ARE IN THE --

2696
01:49:01,320 --> 01:49:04,040
AT THE FAVORABLE 50% OF THE

2697
01:49:04,040 --> 01:49:05,120
LANDS RACIAL INCLUSIVITY INDEX

2698
01:49:05,120 --> 01:49:09,640
AND THE RED ARE ONES IN THE

2699
01:49:09,640 --> 01:49:11,720
LOWER LEAST FAVORABLE PROPORTION

2700
01:49:11,720 --> 01:49:14,280
AT THE RACIAL INCLUSIVITY INDEX.

2701
01:49:14,280 --> 01:49:18,280
SO THERE IS A MIX HERE. SIMILAR

2702
01:49:18,280 --> 01:49:22,240
TO THAT SLIDE EARLIER IT IS

2703
01:49:22,240 --> 01:49:23,280
POSSIBLE TO DELIVER HIGHER

2704
01:49:23,280 --> 01:49:24,840
QUALITY CARE AND DO IT

2705
01:49:24,840 --> 01:49:28,080
EFFICIENTLY REGARDLESS OF THAT

2706
01:49:28,080 --> 01:49:33,160
INDEX. NOT GOING TO SPEND A LOT

2707
01:49:33,160 --> 01:49:35,720
OF TIME ON THIS, LOTS OF QUALITY

2708
01:49:35,720 --> 01:49:37,520
MEASURES FOR OA, SELECTIVE ONES

2709
01:49:37,520 --> 01:49:39,520
AND I WANT TO POINT OUT MOST ARE

2710
01:49:39,520 --> 01:49:42,760
NOT ADJUSTED FOR SOCIAL

2711
01:49:42,760 --> 01:49:44,000
DETERMINANTS OF HEALTH. THERE IS

2712
01:49:44,000 --> 01:49:46,440
A NEW MEASURE SOON COMING MANY

2713
01:49:46,440 --> 01:49:49,160
IN THE NEXT SEVERAL YEARS, BASED

2714
01:49:49,160 --> 01:49:50,760
ON PATIENT REPORTED OUTCOMES.

2715
01:49:50,760 --> 01:49:52,320
THERE WILL BE A ADJUSTMENT FOR

2716
01:49:52,320 --> 01:49:54,360
HEALTH LITERACY THAT PARTICULAR

2717
01:49:54,360 --> 01:49:57,080
MEASURE. AND THE NOT ON THE

2718
01:49:57,080 --> 01:50:00,840
SLIDE BUT IN RECENT NEWS CMS IS

2719
01:50:00,840 --> 01:50:04,480
STARTING NEXT YEAR GOING TO BE

2720
01:50:04,480 --> 01:50:07,080
COLLECTING OR PUTTING INTO PLACE

2721
01:50:07,080 --> 01:50:11,400
MEASURES ON COLLECTION OF

2722
01:50:11,400 --> 01:50:13,880
INFORMATION ON SOCIAL

2723
01:50:13,880 --> 01:50:15,920
DETERMINANTS OF HEALTH AT LARGE

2724
01:50:15,920 --> 01:50:16,840
NOT SPECIFIC TO OSTEOARTHRITIS.

2725
01:50:16,840 --> 01:50:21,040
WRAPPING UP SUMMARY POINTS,

2726
01:50:21,040 --> 01:50:21,920
THERE IS EVIDENCE SOCIAL RISK

2727
01:50:21,920 --> 01:50:23,400
FACTORS ARE ASSOCIATED WITH POOR

2728
01:50:23,400 --> 01:50:27,320
OUTCOMES.  QUALITY SCORES

2729
01:50:27,320 --> 01:50:28,400
PROVIDERS DISPROPORTIONATE

2730
01:50:28,400 --> 01:50:29,440
SHARES OF PATIENTS WITH SOCIAL

2731
01:50:29,440 --> 01:50:31,800
RISK FACTORS ARE LOWER FOR MOST

2732
01:50:31,800 --> 01:50:33,840
BUT NOT ALL. VARIATION IN THE

2733
01:50:33,840 --> 01:50:35,800
RACIAL INCOME AND EDUCATIONAL

2734
01:50:35,800 --> 01:50:36,600
INCLUSIVITY OF HOSPITAL SUGGEST

2735
01:50:36,600 --> 01:50:38,720
THAT ACCESS TO SOME TOP QUALITY

2736
01:50:38,720 --> 01:50:41,480
HOSPITALS IS LIMITED. BY SOLE

2737
01:50:41,480 --> 01:50:44,240
DETERMINANTS AND POLICY MEMBERS

2738
01:50:44,240 --> 01:50:45,160
ADJUST FOR QUALITY MEASURES OF

2739
01:50:45,160 --> 01:50:47,120
THE SOCIAL DETERMINANTS OF

2740
01:50:47,120 --> 01:50:48,320
HEALTH. OPEN QUESTION AND

2741
01:50:48,320 --> 01:50:50,360
RESEARCH IDEAS AND WILL THE

2742
01:50:50,360 --> 01:50:52,640
QUALITY INEFFICIENCY REPORTING

2743
01:50:52,640 --> 01:50:56,200
STRATIFIED SOCIAL DETERMINANTS

2744
01:50:56,200 --> 01:50:57,920
CHANGES IN SCORES WHAT QUALITY

2745
01:50:57,920 --> 01:50:58,800
IMPROVE INTERVENTIONS ARE

2746
01:50:58,800 --> 01:51:01,360
EFFECTIVE IN IMPROVING

2747
01:51:01,360 --> 01:51:02,600
HEALTHCARE QUALITY AMONG

2748
01:51:02,600 --> 01:51:04,280
DISADVANTAGED POPULATION AND DO

2749
01:51:04,280 --> 01:51:06,840
MEASUREMENT METHODS INTRODUCE

2750
01:51:06,840 --> 01:51:08,440
BIAS IN RESULTS AS A CONSEQUENCE

2751
01:51:08,440 --> 01:51:10,040
OF SOCIAL DETERMINANTS. THAT

2752
01:51:10,040 --> 01:51:11,200
LAST ONE IS REALLY QUITE

2753
01:51:11,200 --> 01:51:14,680
IMPORTANT. THAT IS IT. HAND IT

2754
01:51:14,680 --> 01:51:16,720
BACK OVER TO THE CHAIR.

2755
01:51:16,720 --> 01:51:19,320
>> THANK YOU, VERY MUCH.
THANKS

2756
01:51:19,320 --> 01:51:21,520
TO ALL OUR SPEAKERS.  WE HAVE

2757
01:51:21,520 --> 01:51:23,640
RUN UP UNTIL LUNCHTIME SO WE ARE

2758
01:51:23,640 --> 01:51:25,200
GOING TO JUST TAKE A COUPLE OF

2759
01:51:25,200 --> 01:51:30,080
QUESTIONS NOW. THEN WE WILL

2760
01:51:30,080 --> 01:51:32,800
SUGGEST THAT IN THE ATTENDEES

2761
01:51:32,800 --> 01:51:33,920
HAVE SPECIFIC QUESTIONS IF THEY

2762
01:51:33,920 --> 01:51:35,400
JUST PUT THEM IN THE CHAT AND

2763
01:51:35,400 --> 01:51:36,520
THE SPEAKERS CAN ANSWER

2764
01:51:36,520 --> 01:51:42,840
DIRECTLY. ONE COMMENT CAME IN,

2765
01:51:42,840 --> 01:51:44,200
NOTES WE WANT PEOPLE TO LOOK AT

2766
01:51:44,200 --> 01:51:46,200
POSTERS AT THE END OF THE DAY

2767
01:51:46,200 --> 01:51:47,520
BECAUSE THEY WILL BE BUILDING ON

2768
01:51:47,520 --> 01:51:51,520
FIND,. HERE WAS A QUESTION

2769
01:51:51,520 --> 01:51:53,640
SPECIFICALLY FOR NEWS. HOW DO WE

2770
01:51:53,640 --> 01:51:57,560
BALANCE INCLUSION OF FAMILY FOR

2771
01:51:57,560 --> 01:51:59,040
CULTURAL HOMOPHYLY WHEN PATIENT

2772
01:51:59,040 --> 01:52:01,160
PRIVACY AND ANY RESERVATIONS

2773
01:52:01,160 --> 01:52:01,880
PATIENTS THEMSELVES MAY HAVE

2774
01:52:01,880 --> 01:52:03,800
WITH DISCUSSING MORE SENSITIVE

2775
01:52:03,800 --> 01:52:05,280
BUT RELEVANT INFORMATION IN THE

2776
01:52:05,280 --> 01:52:07,400
PRESENCE OF THE FAMILY?

2777
01:52:07,400 --> 01:52:10,120
OPERATOR:  THAT IS A GREAT

2778
01:52:10,120 --> 01:52:12,080
QUESTION. I THINK I WILL BEGIN

2779
01:52:12,080 --> 01:52:16,120
SAYING OUR NORMS ARE US-BASED

2780
01:52:16,120 --> 01:52:17,080
CULTURAL NORMS, MIGHT BE VERY

2781
01:52:17,080 --> 01:52:19,400
DIFFERENT IN THIS ASPECT FROM

2782
01:52:19,400 --> 01:52:21,480
OTHER CULTURES. I RUN INTO THIS

2783
01:52:21,480 --> 01:52:23,520
WHEN IT COMES TO OUR IRB

2784
01:52:23,520 --> 01:52:26,720
PROTOCOLS AND DOING CONSENT

2785
01:52:26,720 --> 01:52:27,440
ESPECIALLY NOW DURING THE

2786
01:52:27,440 --> 01:52:30,160
PANDEMIC WHERE WE ARE EXPECTED

2787
01:52:30,160 --> 01:52:31,640
TO TELL PARTICIPANTS MAKE SURE

2788
01:52:31,640 --> 01:52:34,800
YOU ARE IN A PRIVATE LOCATION,

2789
01:52:34,800 --> 01:52:36,040
AND WE SEE IF THEY ARE ON THE

2790
01:52:36,040 --> 01:52:37,800
SCREEN WE SEE THE WHOLE FAMILY,

2791
01:52:37,800 --> 01:52:39,800
WE HEAR THE WHOLE FAMILY AROUND

2792
01:52:39,800 --> 01:52:41,800
SO THEY HAVE A VERY DIFFERENT

2793
01:52:41,800 --> 01:52:45,040
SENSE OF WHAT IS PRIVATE AND

2794
01:52:45,040 --> 01:52:46,600
WHAT REQUIRES PRIVACY, I THINK

2795
01:52:46,600 --> 01:52:50,120
WE DO IN OUR OUR CULTURE

2796
01:52:50,120 --> 01:52:54,200
US-BASED CULTURE, SO THAT IS MY

2797
01:52:54,200 --> 01:52:55,520
MAJOR POINT, OUR UNDERSTANDING

2798
01:52:55,520 --> 01:52:56,760
OF WHAT SHOULD BE THE NORM OF

2799
01:52:56,760 --> 01:52:58,560
WHAT IS THE NORM COULD LOOK

2800
01:52:58,560 --> 01:52:59,800
DIFFERENT AND THEN OF COURSE

2801
01:52:59,800 --> 01:53:01,480
HAVING PROVIDERS EXPLAIN UP

2802
01:53:01,480 --> 01:53:02,800
FRONT IF THERE IS ANOTHER PERSON

2803
01:53:02,800 --> 01:53:04,560
IN THE ROOM OR VIRTUALLY ON THE

2804
01:53:04,560 --> 01:53:06,160
PHONE TO SAY ABOUT ANY POINT IF

2805
01:53:06,160 --> 01:53:07,600
THE PATIENT WANTS TO HAVE SOME

2806
01:53:07,600 --> 01:53:11,120
PRIVACY THAT THE EXPECTATION I

2807
01:53:11,120 --> 01:53:12,240
AM LATINA AND I HAVE BEEN

2808
01:53:12,240 --> 01:53:15,000
INVOLVED IN MANY, MANY VISITS

2809
01:53:15,000 --> 01:53:17,120
WITH MY PARENTS SEPARATELY AND I

2810
01:53:17,120 --> 01:53:19,520
HAVE BEEN KICKED OUT OF THE

2811
01:53:19,520 --> 01:53:22,880
ROOM. AND IT WAS EASY. SO I

2812
01:53:22,880 --> 01:53:24,080
THINK THE MORE IT BECOME IT IS

2813
01:53:24,080 --> 01:53:26,080
NORM TO HAVE PATIENT FAMILIES IN

2814
01:53:26,080 --> 01:53:27,760
THERE EASIER IT WILL BE TO FOR

2815
01:53:27,760 --> 01:53:29,960
PATIENTS TO BE DELINEATE THIS

2816
01:53:29,960 --> 01:53:33,240
PART IS PRIVATE. I WANT PRIVACY

2817
01:53:33,240 --> 01:53:33,960
HERE.

2818
01:53:33,960 --> 01:53:39,240
>> THANK YOU. I DON'T SEE
ANY

2819
01:53:39,240 --> 01:53:40,360
OTHER QUESTIONS. MAYBE PEOPLE

2820
01:53:40,360 --> 01:53:41,880
ARE GETTING HUNGRY ON THE EAST

2821
01:53:41,880 --> 01:53:46,960
COAST. SO CHRISTY, DO YOU HAVE A

2822
01:53:46,960 --> 01:53:50,840
CHARGE FOR PEOPLE? WE START BACK

2823
01:53:50,840 --> 01:53:52,440
AT 1:30. WE WILL STAY ON

2824
01:53:52,440 --> 01:53:57,760
SCHEDULE. I THINK THAT'S --

2825
01:53:57,760 --> 01:54:00,920
>> SORRY I WAS TRYING TO
UNMUTE

2826
01:54:00,920 --> 01:54:03,840
MYSELF. WE WILL RETURN AT 1:30,

2827
01:54:03,840 --> 01:54:05,480
THANKS TO EVERYONE FOR

2828
01:54:05,480 --> 01:54:07,120
DISCUSSION IN SESSION 2 AND IF

2829
01:54:07,120 --> 01:54:09,880
YOU DO HAVE QUESTIONS THESE ARE

2830
01:54:09,880 --> 01:54:11,360
ALSO TOPICS WE ARE HOPING TO

2831
01:54:11,360 --> 01:54:12,360
DISCUSS DURING THE BREAK OUT

2832
01:54:12,360 --> 01:54:14,800
SESSION SO PLEASE FEEL FREE TO

2833
01:54:14,800 --> 01:54:16,360
HOLD ON TO THEM AND TALK WITH

2834
01:54:16,360 --> 01:54:17,400
YOUR BREAK OUT SESSIONS ABOUT

2835
01:54:17,400 --> 01:54:19,600
THESE TOPICS AS WELL. SO WE WILL

2836
01:54:19,600 --> 01:54:21,160
SEE EVERYONE BACK AT 1:30 FOR

2837
01:54:21,160 --> 01:54:22,800
THE START OF SESSION 3.  

2838
01:54:22,800 --> 01:54:24,280
>>WELCOME BACK,
EVERYBODY. WE

2839
01:54:24,280 --> 01:54:27,120
ARE GOING TO GET STARTED WITH

2840
01:54:27,120 --> 01:54:28,760
SESSION 3 WHERE WE WILL CONTINUE

2841
01:54:28,760 --> 01:54:30,200
OUR DISCUSSIONS RELATED TO

2842
01:54:30,200 --> 01:54:31,960
FACTORS THAT IMPACT DISPARITIES

2843
01:54:31,960 --> 01:54:33,520
IN OSTEOARTHRITIS FOCUSING HERE

2844
01:54:33,520 --> 01:54:35,680
ON THE MANY SOCIAL DETERMINANTS

2845
01:54:35,680 --> 01:54:37,560
OF HEALTH. SESSION 3 WILL BE

2846
01:54:37,560 --> 01:54:39,520
MODERATED BY ONE OF OUR WORKSHOP

2847
01:54:39,520 --> 01:54:45,320
CO-CHAIRS DR. ERNES MOY,

2848
01:54:45,320 --> 01:54:46,640
EXECUTIVE DIRECTOR VA OFFICE OF

2849
01:54:46,640 --> 01:54:48,520
HEALTH EQUITY. DR. MOY, OVER TO

2850
01:54:48,520 --> 01:54:49,840
YOU.

2851
01:54:49,840 --> 01:54:51,760
>> THANK YOU SO MUCH, IT
IS A

2852
01:54:51,760 --> 01:54:53,120
PLEASURE TO BE HERE AND I'M

2853
01:54:53,120 --> 01:54:55,960
LEARNING SO MUCH. WE HAVE A VERY

2854
01:54:55,960 --> 01:54:59,440
PACKED AGENDA SO I WILL TURN IT

2855
01:54:59,440 --> 01:55:01,160
OVER TO TALK MULTIPLE

2856
01:55:01,160 --> 01:55:02,000
DETERMINANT OF HEALTH RELATING

2857
01:55:02,000 --> 01:55:04,600
TO OSTEOARTHRITIS. OUR FIRST

2858
01:55:04,600 --> 01:55:06,960
SPEAKER IS DR. MESSIER,

2859
01:55:06,960 --> 01:55:09,840
PROFESSOR DIRECTOR J B

2860
01:55:09,840 --> 01:55:11,680
BIOMECHANICS LABORATORY WAKE

2861
01:55:11,680 --> 01:55:13,920
FOREST, PRINCIPAL INVESTIGATOR

2862
01:55:13,920 --> 01:55:16,200
OF WEIGHT LOSS AND EXERCISE

2863
01:55:16,200 --> 01:55:16,960
COMMUNITIES IN EARTHIEST AT THIS

2864
01:55:16,960 --> 01:55:18,600
NORTH CAROLINA CHILD AND THE

2865
01:55:18,600 --> 01:55:19,600
OSTEOARTHRITIS PREVENTION TRIAL.

2866
01:55:19,600 --> 01:55:22,160
WE WILL PRESENT ON EXAMINING HOW

2867
01:55:22,160 --> 01:55:24,080
RURAL AND URBAN POPULATIONS WITH

2868
01:55:24,080 --> 01:55:25,080
OSTEOARTHRITIS RESPOND TO

2869
01:55:25,080 --> 01:55:27,000
LIFESTYLE INTERVENTIONS. DR.

2870
01:55:27,000 --> 01:55:28,280
MESSIER.

2871
01:55:28,280 --> 01:55:31,280
>> THANK YOU, APPRECIATE
IT.  SO

2872
01:55:31,280 --> 01:55:34,040
AS DR. MOY SAID I'M GOING TO

2873
01:55:34,040 --> 01:55:42,280
DISCUSS PART OF OUR TRIAL ON

2874
01:55:42,280 --> 01:55:43,960
RURAL AND YOU CAN URBAN

2875
01:55:43,960 --> 01:55:45,440
POPULATIONS AND HOW THEY RELATE

2876
01:55:45,440 --> 01:55:46,800
TO LIFESTYLE INTERVENTIONS OF

2877
01:55:46,800 --> 01:55:54,480
DIET AND EXERCISE.  HEALTH

2878
01:55:54,480 --> 01:55:57,240
BEHAVIOR DIFFERENCES BETWEEN

2879
01:55:57,240 --> 01:56:00,240
RURAL AND URBAN COMMUNITIES

2880
01:56:00,240 --> 01:56:02,760
INCLUDE ACCESS TO PROPER

2881
01:56:02,760 --> 01:56:05,040
NUTRITION, ABILITY TO EXERCISE,

2882
01:56:05,040 --> 01:56:06,440
AND ACCESS TO SPECIALIZED

2883
01:56:06,440 --> 01:56:09,320
HEALTHCARE. HEALTH DISPARITIES

2884
01:56:09,320 --> 01:56:11,320
BETWEEN THESE COMMUNITIES

2885
01:56:11,320 --> 01:56:13,800
INCLUDE MEDICAL INSURANCE

2886
01:56:13,800 --> 01:56:14,960
ACCESSIBILITY, INCREASE

2887
01:56:14,960 --> 01:56:20,360
PREVALENCE OF OBESITY, AND OTHER

2888
01:56:20,360 --> 01:56:23,760
CO-MORBIDITIES. THE PURPOSE OF

2889
01:56:23,760 --> 01:56:25,720
THE STUDY WAS TO DETERMINE THE

2890
01:56:25,720 --> 01:56:29,080
EFFECT OF GEOGRAPHY WHETHER YOU

2891
01:56:29,080 --> 01:56:32,320
RESIDE IN RURAL OR URBAN

2892
01:56:32,320 --> 01:56:33,560
COMMUNITIES, ON CLINICAL

2893
01:56:33,560 --> 01:56:37,040
OUTCOMES IN A PRAGMATIC

2894
01:56:37,040 --> 01:56:38,000
RANDOMIZE CLINICAL TRIAL OF DIET

2895
01:56:38,000 --> 01:56:43,520
AND EXERCISE. THE WEIGHT LOSS

2896
01:56:43,520 --> 01:56:44,320
EXERCISE COMMUNITIES WITH

2897
01:56:44,320 --> 01:56:48,320
ARTHRITIS IN NORTH CAROLINA WAS

2898
01:56:48,320 --> 01:56:51,160
PHASE 3 PRAGMATIC ASSESSMENT

2899
01:56:51,160 --> 01:56:53,760
BLINDED RANDOMIZE CONTROL TRIAL.

2900
01:56:53,760 --> 01:56:57,680
THAT COMPARED 18 MONTHS DIET AND

2901
01:56:57,680 --> 01:57:00,160
EXERCISE TO CONTROL AND OLDER

2902
01:57:00,160 --> 01:57:02,520
ADULTS WITH NEO'S SKYLAR

2903
01:57:02,520 --> 01:57:03,480
ARTHRITIS, OVERWEIGHT AND

2904
01:57:03,480 --> 01:57:12,440
OBESITY.  WE RANDOMIZE 823

2905
01:57:12,440 --> 01:57:14,240
PARTICIPANTS THAT WERE RECRUITED

2906
01:57:14,240 --> 01:57:16,920
FROM THREE NORTH CAROLINA

2907
01:57:16,920 --> 01:57:20,560
COUNTICOUNTIES. FORCYTE COUNTY 0

2908
01:57:20,560 --> 01:57:22,040
PEOPLE PER SQUARE MILE,

2909
01:57:22,040 --> 01:57:25,080
CLASSIFIED AS URBAN, THEY WOOD

2910
01:57:25,080 --> 01:57:26,920
COUNTY HAS 100 PEOPLE FOR SQUARE

2911
01:57:26,920 --> 01:57:28,800
MILE, CLASSIFIED RURAL. AND

2912
01:57:28,800 --> 01:57:30,800
JOHNSTON COUNTY HAS 200 PEOPLE

2913
01:57:30,800 --> 01:57:32,520
PER SQUARE MILE, IT WAS ALSO

2914
01:57:32,520 --> 01:57:37,600
CLASSIFIED RURAL.  413

2915
01:57:37,600 --> 01:57:40,560
PARTICIPANTS WERE RECRUITED FROM

2916
01:57:40,560 --> 01:57:43,280
FORSYTHE COUNTY AND COMBINED 410

2917
01:57:43,280 --> 01:57:45,040
PARTICIPANTS RECRUITED FROM

2918
01:57:45,040 --> 01:57:51,280
THEYWOOD AND JOHNSTON COUNTIES. 

2919
01:57:51,280 --> 01:57:53,600
SO THIS NEXT PAIR OF SLIDES

2920
01:57:53,600 --> 01:57:56,160
REPEATED FOR EACH OF THE

2921
01:57:56,160 --> 01:57:59,600
OUTCOMES I'M GOING TO DISCUSS.  

2922
01:57:59,600 --> 01:58:01,760
AT BASELINE RURAL GROUP SHOWN IN

2923
01:58:01,760 --> 01:58:05,480
THE DARKER BOXES SIGNIFICANTLY

2924
01:58:05,480 --> 01:58:13,520
MORE PAIN THAN URBAN GROUP. THIS

2925
01:58:13,520 --> 01:58:14,560
FIGURE SHOUGHS THE DIFFERENCE

2926
01:58:14,560 --> 01:58:16,960
BETWEEN THE DIET AND EXERCISE

2927
01:58:16,960 --> 01:58:18,760
AND CONTROL GROUP IN PAIN FOR

2928
01:58:18,760 --> 01:58:19,760
BOTH URBAN AND RURAL

2929
01:58:19,760 --> 01:58:23,880
COMMUNITIES.  A POSITIVE

2930
01:58:23,880 --> 01:58:24,960
DIFFERENCE CONTROL HAD LESS

2931
01:58:24,960 --> 01:58:27,520
PAIN. NEGATIVE DIFFERENCE MEANT

2932
01:58:27,520 --> 01:58:30,800
DIET AND EXERCISE HAD LESS PAIN 

2933
01:58:30,800 --> 01:58:32,920
WHAT YOU CAN SEE HERE IS THAT

2934
01:58:32,920 --> 01:58:36,200
DIET AND EXERCISE HAD THE SAME

2935
01:58:36,200 --> 01:58:37,720
POSITIVE EFFECT ON BOTH URBAN

2936
01:58:37,720 --> 01:58:40,000
AND RURAL GROUPS OVER 18 MONTHS

2937
01:58:40,000 --> 01:58:41,560
WITH NO SIGNIFICANT DIFFERENCE

2938
01:58:41,560 --> 01:58:49,160
BETWEEN THE TWO. AT BASELINE THE

2939
01:58:49,160 --> 01:58:53,400
RURAL GROUP HAD SIGNIFICANTLY

2940
01:58:53,400 --> 01:58:59,360
WORSE FUNCTION THAN URBAN GROUP.

2941
01:58:59,360 --> 01:59:00,560
THIS SHOWS DIFFERENCE BETWEEN

2942
01:59:00,560 --> 01:59:02,680
DIET AND EXERCISE AND CONTROL

2943
01:59:02,680 --> 01:59:05,240
AND FUNCTION FOR BOTH URBAN AND

2944
01:59:05,240 --> 01:59:07,360
RURAL GROUPS. POSITIVE

2945
01:59:07,360 --> 01:59:09,560
DIFFERENCE MEANT THAT CONTROL

2946
01:59:09,560 --> 01:59:11,880
HAD BETTER FUNCTION. NEGATIVE

2947
01:59:11,880 --> 01:59:12,800
DIFFERENCE MEANT DIET AND

2948
01:59:12,800 --> 01:59:14,520
EXERCISE HAD BETTER FUNCTION. 

2949
01:59:14,520 --> 01:59:16,840
YOU CAN SEE DIET AND EXERCISE

2950
01:59:16,840 --> 01:59:18,600
HAS THE SAME POSITIVE EFFECT ON

2951
01:59:18,600 --> 01:59:22,400
BOTH URBAN AND RURAL GROUPS. 

2952
01:59:22,400 --> 01:59:23,600
WITH A TREND THAT TENDED TO

2953
01:59:23,600 --> 01:59:30,920
FAVOR THE RURAL GROUP. AT

2954
01:59:30,920 --> 01:59:32,080
BASELINE THE RURAL GROUP

2955
01:59:32,080 --> 01:59:34,920
SIGNIFICANTLY WORSE MOBILITY

2956
01:59:34,920 --> 01:59:36,080
QUANTIFYD BY SIX MINUTE WALK

2957
01:59:36,080 --> 01:59:38,160
DISTANCE.  COMPARED TO URBAN

2958
01:59:38,160 --> 01:59:45,160
GROUP. THIS IS THE DIFFERENCE

2959
01:59:45,160 --> 01:59:46,800
BETWEEN DIET AND EXERCISE

2960
01:59:46,800 --> 01:59:48,600
CONTROL AND SIX MINUTE WALK FOR

2961
01:59:48,600 --> 01:59:50,840
BOTH URBAN AND RURAL GROUPS.

2962
01:59:50,840 --> 01:59:51,680
POSITIVE DIFFERENCE MEANT THAT

2963
01:59:51,680 --> 01:59:56,320
DIET AND EXERCISE HAD BETTER

2964
01:59:56,320 --> 01:59:57,560
MOBILITY, NEGATIVE DIFFERENCE

2965
01:59:57,560 --> 02:00:00,120
MEANT CONTROL HAD BETTER

2966
02:00:00,120 --> 02:00:00,840
MOBILITY. YOU CAN SEW DIET AND

2967
02:00:00,840 --> 02:00:02,800
EXERCISE ARE THE SAME POSITIVE

2968
02:00:02,800 --> 02:00:05,520
EFFECT ON BOTH RURAL AND URBAN

2969
02:00:05,520 --> 02:00:06,400
GROUPS WITH NO SIGNIFICANT

2970
02:00:06,400 --> 02:00:10,160
DIFFERENCE BETWEEN THE TWO.  

2971
02:00:10,160 --> 02:00:16,040
NEXT PLEASE.  AT BASELINE THE

2972
02:00:16,040 --> 02:00:18,840
RURAL GROUP SIGNIFICANTLY WORSE

2973
02:00:18,840 --> 02:00:20,080
PHYSICAL HEALTH RELATED QUALITY

2974
02:00:20,080 --> 02:00:21,840
OF LIFE. THAT WAS MEASURED BY

2975
02:00:21,840 --> 02:00:24,160
THE SF 36. COMPARED TO THE

2976
02:00:24,160 --> 02:00:30,480
URBAN. THE DIFFERENCE BETWEEN

2977
02:00:30,480 --> 02:00:33,120
DIET AND EXERCISE AND CONTROL

2978
02:00:33,120 --> 02:00:36,720
AND SF 36 BETWEEN URBAN AND

2979
02:00:36,720 --> 02:00:40,320
RURAL COMMUNITIES SHOW DIET AND

2980
02:00:40,320 --> 02:00:42,960
EXERCISE HAD THE SAME POSITIVE

2981
02:00:42,960 --> 02:00:45,840
EFFECT ON BOTH RURAL AND URBAN

2982
02:00:45,840 --> 02:00:49,400
GROUPS, NO SIGNIFICANT

2983
02:00:49,400 --> 02:00:55,400
DIFFERENCE BETWEEN. FINALLY THE

2984
02:00:55,400 --> 02:00:58,560
RURAL GROUP AT BASELINE RURAL

2985
02:00:58,560 --> 02:00:59,360
BROWN HAD SIGNIFICANTLY MORE

2986
02:00:59,360 --> 02:01:01,440
DEPRESSIVE SYMPTOMS COMPARED TO

2987
02:01:01,440 --> 02:01:03,280
THE URBAN GROUP AS MEASURED BY

2988
02:01:03,280 --> 02:01:09,040
THE CESD. THIS SHOWS THE

2989
02:01:09,040 --> 02:01:10,720
DIFFERENCE BETWEEN DIET AND

2990
02:01:10,720 --> 02:01:13,080
EXERCISE AND CONTROL IN CESD FOR

2991
02:01:13,080 --> 02:01:16,800
URBAN AND RURAL COMMUNITY. 

2992
02:01:16,800 --> 02:01:18,720
POSITIVE NUMBER OR POSITIVE

2993
02:01:18,720 --> 02:01:20,360
DIFFERENCE MEANT CONTROL HAD

2994
02:01:20,360 --> 02:01:22,960
FEWER DEPRESSIVE SYMPTOMS.

2995
02:01:22,960 --> 02:01:23,880
NEGATIVE DIFFERENCE MEANT DIET

2996
02:01:23,880 --> 02:01:25,680
AND EXERCISE HAD FEWER

2997
02:01:25,680 --> 02:01:28,120
DEPRESSIVE SYMPTOMS AND ONCE

2998
02:01:28,120 --> 02:01:29,480
AGAIN YOU CAN SEE DIET AND

2999
02:01:29,480 --> 02:01:30,800
EXERCISE HAVE THE SAME POSITIVE

3000
02:01:30,800 --> 02:01:32,880
EFFECT ON URBAN AND RURAL GROUPS

3001
02:01:32,880 --> 02:01:34,320
WITH NO SIGNIFICANT DIFFERENCE

3002
02:01:34,320 --> 02:01:43,880
BETWEEN. AT SUMMARY AT BASELINE

3003
02:01:43,880 --> 02:01:46,760
RURAL RESIDENTS HAD MORE PAIN,

3004
02:01:46,760 --> 02:01:49,760
POORER FUNCTION, WORSE MOBILITY,

3005
02:01:49,760 --> 02:01:51,360
POOR PHYSICAL HEALTH RELATED

3006
02:01:51,360 --> 02:01:54,040
QUALITY OF LIFE, AND MORE

3007
02:01:54,040 --> 02:01:56,280
DEPRESSIVE SYMPTOMS THAN THE

3008
02:01:56,280 --> 02:02:01,160
URBAN RESIDENTS. HOWEVER BOTH

3009
02:02:01,160 --> 02:02:03,920
RURAL AND URBAN GROUPS RESPONDED

3010
02:02:03,920 --> 02:02:06,920
IN A SIMILAR FASHION TO THE DIET

3011
02:02:06,920 --> 02:02:09,120
AND EXERCISE AND CONTROL

3012
02:02:09,120 --> 02:02:11,080
INTERVENTIONS. THOUGH YOU CAN

3013
02:02:11,080 --> 02:02:12,440
ARGUE THERE WAS A DEFINITE TREND

3014
02:02:12,440 --> 02:02:19,760
THAT FAVORED THE RURAL GROUP. SO

3015
02:02:19,760 --> 02:02:21,920
THIS BRINGS US BACK TO OUR

3016
02:02:21,920 --> 02:02:23,080
ORIGINAL QUESTION. DOES

3017
02:02:23,080 --> 02:02:26,160
GEOGRAPHY MATTER? IS IT

3018
02:02:26,160 --> 02:02:27,960
IMPORTANT TO HAVE BOTH RURAL AND

3019
02:02:27,960 --> 02:02:31,840
URBAN RESIDENTS IN YOUR CLINICAL

3020
02:02:31,840 --> 02:02:34,520
TRIALS? PERHAPS WE CAN DISCUSS

3021
02:02:34,520 --> 02:02:35,320
THIS AT OUR BREAK OUT SESSION.

3022
02:02:35,320 --> 02:02:43,640
THANK YOU. 

3023
02:02:43,640 --> 02:02:44,080
>> THANK YOU

3024
02:02:44,080 --> 02:02:46,720
>> DR. MESSIER. I WILL NOW
MOVE

3025
02:02:46,720 --> 02:02:49,080
TO DR. KIM. DR. KIM IS A HEALTH

3026
02:02:49,080 --> 02:02:50,400
ECONOMIST CENTER FOR HEALTH

3027
02:02:50,400 --> 02:02:52,600
SYSTEM EFFECTIVENESS AT OREGON

3028
02:02:52,600 --> 02:02:54,040
HEALTH AND SCIENCE UNIVERSITY.

3029
02:02:54,040 --> 02:02:56,560
HER RESEARCH INTERESTS INCLUDE

3030
02:02:56,560 --> 02:02:58,760
RACIAL ETHNIC DISPARITIES IN

3031
02:02:58,760 --> 02:03:00,080
HEALTHCARE AND MEDICARE MEDICAID

3032
02:03:00,080 --> 02:03:01,600
PAID REFORM, AND DR. KIM WILL

3033
02:03:01,600 --> 02:03:02,960
PRESENT ON MOVEMENT OF JOINT

3034
02:03:02,960 --> 02:03:04,280
REPLACEMENT SURGERIES FROM

3035
02:03:04,280 --> 02:03:05,960
INPATIENT TO OUTPATIENT SETTINGS

3036
02:03:05,960 --> 02:03:07,600
AND IMPLICATIONS OF THE MOVEMENT

3037
02:03:07,600 --> 02:03:09,720
FOR DISPARITIES. DR. KIM.

3038
02:03:09,720 --> 02:03:14,600
>> HI, EVERYONE. I WILL
TALK

3039
02:03:14,600 --> 02:03:16,360
ABOUT HUGE CHANGE IN SURGICAL

3040
02:03:16,360 --> 02:03:19,200
SETTING FOR JOINT REPLACEMENT

3041
02:03:19,200 --> 02:03:20,920
SURGERIES AND WHAT IT MEANS IN

3042
02:03:20,920 --> 02:03:27,440
TERMS OF DISPARITIES. SO THERE

3043
02:03:27,440 --> 02:03:32,800
ARE THREE REPLACEMENTS, HIP AND

3044
02:03:32,800 --> 02:03:35,000
KNEE. PRIMARILY THEY RECEIVE IN

3045
02:03:35,000 --> 02:03:37,160
HOSPITAL AT PATIENT SETTING, BUT

3046
02:03:37,160 --> 02:03:38,120
INCREASINGLY PEOPLE ARE

3047
02:03:38,120 --> 02:03:41,040
RECEIVING SURGERY AT HOSPITAL

3048
02:03:41,040 --> 02:03:42,880
OUTPATIENT DEPARTMENT, OR

3049
02:03:42,880 --> 02:03:47,400
AMBULATORY SURGICAL CENTER ASC.

3050
02:03:47,400 --> 02:03:49,080
SO HOSPITAL OUTPATIENT

3051
02:03:49,080 --> 02:03:52,280
DEPARTMENT IS STILL AFFILIATED

3052
02:03:52,280 --> 02:03:54,720
HOSPITAL, PEOPLE STAY THERE LESS

3053
02:03:54,720 --> 02:03:56,120
THAN 24 HOURS AFTER SURGERY,

3054
02:03:56,120 --> 02:03:58,840
THEY GO BACK HOME AS SOON AS

3055
02:03:58,840 --> 02:04:01,160
POSSIBLE. IN SAME AM BRATORY

3056
02:04:01,160 --> 02:04:03,240
SURGICAL CENTER MAY OR MAY NOT

3057
02:04:03,240 --> 02:04:05,920
BE AFFILIATED TO HOSPITAL,

3058
02:04:05,920 --> 02:04:08,240
PEOPLE STAY LESS THAN 24 HOURS

3059
02:04:08,240 --> 02:04:09,120
AND GO BACK HOME AFTER THE

3060
02:04:09,120 --> 02:04:15,240
SURGERY.  SO SURGICAL SETTINGS

3061
02:04:15,240 --> 02:04:20,920
CHANGING SO THIS SPEAKER SHOWING

3062
02:04:20,920 --> 02:04:25,080
THE SURGICAL SETTING CHANGE MORE

3063
02:04:25,080 --> 02:04:26,520
MEDICARE FEE FOR SERVICE JOINT

3064
02:04:26,520 --> 02:04:31,840
REPLACEMENT PATIENTS.  THERE IS

3065
02:04:31,840 --> 02:04:34,320
NO OUTPATIENT WHATSOEVER UNTIL

3066
02:04:34,320 --> 02:04:35,840
2017 AND OUTPATIENT SURGERIES

3067
02:04:35,840 --> 02:04:39,880
ARE STARTING TO SHOW UP FROM

3068
02:04:39,880 --> 02:04:42,880
2018 BECAUSE MAINLY BECAUSE

3069
02:04:42,880 --> 02:04:45,800
MEDICARE SORRY TO PAY -- STARTED

3070
02:04:45,800 --> 02:04:49,640
TO PI FOR OUTPATIENT KNEE

3071
02:04:49,640 --> 02:04:55,680
REPLACEMENT FROM 2018. SO WE NOW

3072
02:04:55,680 --> 02:04:58,240
KNOW WHY OUTPATIENT REPLACEMENT

3073
02:04:58,240 --> 02:05:00,320
SHOWED UP AMONG MEDICARE FEE FOR

3074
02:05:00,320 --> 02:05:01,880
SERVICE POPULATION BUT THERE ARE

3075
02:05:01,880 --> 02:05:04,840
-- THE MORE INTERESTING FINDING

3076
02:05:04,840 --> 02:05:07,040
IS THERE WAS A STRONG FACT FROM

3077
02:05:07,040 --> 02:05:09,360
MED CAROL POPULATION TO PRIVATE

3078
02:05:09,360 --> 02:05:10,920
-- MEDICARE POPULATION TO

3079
02:05:10,920 --> 02:05:12,040
PRIVATE INSURED POPULATION. SO

3080
02:05:12,040 --> 02:05:15,440
THIS FIGURE SHOWING THE JOINT

3081
02:05:15,440 --> 02:05:17,160
REPLACEMENT IN STATE OF FLORIDA.

3082
02:05:17,160 --> 02:05:20,360
LET'S LOOK AT THE SOLID LINE

3083
02:05:20,360 --> 02:05:24,760
FIRST. TWO SOLID LINES AND FIRST

3084
02:05:24,760 --> 02:05:26,840
DARKER BLUE IS MEDICARE FEE FOR

3085
02:05:26,840 --> 02:05:29,680
SERVICE POPULATION AND IN

3086
02:05:29,680 --> 02:05:34,120
PATIENT REPLACEMENT VOLUME. THE

3087
02:05:34,120 --> 02:05:37,000
LIGHTER ONE IS SAME BUT FOR

3088
02:05:37,000 --> 02:05:38,160
PRIVATE INSURANCE POPULATION. AS

3089
02:05:38,160 --> 02:05:40,800
YOU CAN SEE THE NUMBER HAS BEEN

3090
02:05:40,800 --> 02:05:43,120
GRADUALLY INCREASING NOTE THAT

3091
02:05:43,120 --> 02:05:44,480
INTERESTING BUT IF YOU LOOK AT

3092
02:05:44,480 --> 02:05:47,160
THE BAR GRAPH DOWN THERE, THAT

3093
02:05:47,160 --> 02:05:49,680
SHOWS THE CHANGE IN VOLUME

3094
02:05:49,680 --> 02:05:55,720
YEAR-TO-YEAR. SO LOOK AT 2014.

3095
02:05:55,720 --> 02:06:00,680
DARKER BLUE IS FEE FOR SERVICE.

3096
02:06:00,680 --> 02:06:01,840
INPATIENT KNEE REPLACEMENT

3097
02:06:01,840 --> 02:06:03,880
INCREASE BY 1% AMONG MEDICARE

3098
02:06:03,880 --> 02:06:08,040
FEE FOR SERVICE POPULATION. BUT

3099
02:06:08,040 --> 02:06:09,320
9% AMONG PRIVATE POPULATION BUT

3100
02:06:09,320 --> 02:06:12,720
IF YOU MOVE TO 2017 AND 18 AS

3101
02:06:12,720 --> 02:06:17,040
YOU CAN SEE THERE IS A HUGE DROP

3102
02:06:17,040 --> 02:06:19,160
IN IN PATIENT MEDICARE

3103
02:06:19,160 --> 02:06:19,960
POPULATION AN PRIVATE INSURANCE

3104
02:06:19,960 --> 02:06:23,880
POPULATION. I REALLY WISH I

3105
02:06:23,880 --> 02:06:26,600
COULD SHARE THE GRAPH MY TEAM

3106
02:06:26,600 --> 02:06:27,440
PRODUCED, I COULDN'T DO IT

3107
02:06:27,440 --> 02:06:29,840
BECAUSE WE GETTING PERMISSION

3108
02:06:29,840 --> 02:06:35,640
FROM DATA VENDOR BUT WE LOOK AT

3109
02:06:35,640 --> 02:06:36,080
HOW THING CHANGE AMONG

3110
02:06:36,080 --> 02:06:38,160
COMMERCIAL POPULATION FROM 18 TO

3111
02:06:38,160 --> 02:06:39,440
26 YEARS OLD POPULATION. THERE

3112
02:06:39,440 --> 02:06:44,280
IS A HUGE INCREASE IN HOSPITAL

3113
02:06:44,280 --> 02:06:47,240
DEPARTMENT OPERATION JOINT

3114
02:06:47,240 --> 02:06:50,560
REPLACEMENT SURGERY FROM 2017

3115
02:06:50,560 --> 02:06:52,320
AND 2020. BY 2020 DURING COVID

3116
02:06:52,320 --> 02:06:53,920
TIME THE PROPORTION OF INPATIENT

3117
02:06:53,920 --> 02:06:55,160
JOINT REPLACEMENT SURGERY WAS

3118
02:06:55,160 --> 02:06:56,840
LESS THAN HALF. SO THERE IS A

3119
02:06:56,840 --> 02:06:59,640
HUGE CHANGE.

3120
02:06:59,640 --> 02:07:03,440
NEXT SLIDE.  AGAIN I BELIEVE

3121
02:07:03,440 --> 02:07:05,240
THIS HUGE CHANGE WAS DRIVEN BY

3122
02:07:05,240 --> 02:07:07,080
MEDICARE PAYMENT POLICY, AS I

3123
02:07:07,080 --> 02:07:10,360
SAID BEFORE, MEDICARE STARTED TO

3124
02:07:10,360 --> 02:07:12,360
PAY FOR HOSPITAL OUTPATIENT

3125
02:07:12,360 --> 02:07:15,320
DEPARTMENT KNEE REPLACEMENT FROM

3126
02:07:15,320 --> 02:07:21,560
18 HIP REPLACEMENT FROM 2020.

3127
02:07:21,560 --> 02:07:23,360
ALSO IT IS NOT PROVEN

3128
02:07:23,360 --> 02:07:25,680
SCIENTIFICALLY BUT IN COVID-19

3129
02:07:25,680 --> 02:07:29,800
MAYBE PLAY A ROLE. IN 2020 WE

3130
02:07:29,800 --> 02:07:32,480
FOUND LESS THAN 50% JOINT

3131
02:07:32,480 --> 02:07:35,000
REPLACEMENT SURGERY IN PATIENT,

3132
02:07:35,000 --> 02:07:36,240
WE THOUGHT MAYBE PATIENT DON'T

3133
02:07:36,240 --> 02:07:38,560
WANT TO STAY IN HOSPITAL, SO

3134
02:07:38,560 --> 02:07:40,480
THEY WANT TO GO BACK AS SOON AS

3135
02:07:40,480 --> 02:07:42,120
POSSIBLE AND THAT IS WHY WE SEE

3136
02:07:42,120 --> 02:07:43,560
HIGH PROPORTION OF OUTPATIENT

3137
02:07:43,560 --> 02:07:49,440
SURGERIES IN 2020. JUST COMPARE

3138
02:07:49,440 --> 02:07:50,760
OUTPATIENT INPATIENT

3139
02:07:50,760 --> 02:07:53,720
REPLACEMENT, NOT SURPRISING

3140
02:07:53,720 --> 02:07:55,600
OUTPATIENT SURGERY ARE CHEAPER

3141
02:07:55,600 --> 02:07:59,680
BY 50 TO 70% BUT WE FOUND

3142
02:07:59,680 --> 02:08:01,640
PATIENTS OUT OF POCKET COST 70%

3143
02:08:01,640 --> 02:08:08,320
HIGHER IN ASC. SCHOOL SETTING IN

3144
02:08:08,320 --> 02:08:10,680
PATIENT. WE DON'T HAVE ANY

3145
02:08:10,680 --> 02:08:12,120
ROBUST EVIDENCE SURGICAL

3146
02:08:12,120 --> 02:08:13,360
OUTCOMES BETWEEN OUTPATIENT AND

3147
02:08:13,360 --> 02:08:15,520
IN PATIENT SURGERY YET.  NEXT

3148
02:08:15,520 --> 02:08:22,360
SLIDE.  SO WHAT THIS MEANS IN

3149
02:08:22,360 --> 02:08:23,640
TERMS OF DISPARITIES? THERE IS

3150
02:08:23,640 --> 02:08:27,480
LIMITED DATA BUT THERE IS

3151
02:08:27,480 --> 02:08:28,640
EMERGING EVIDENCE THAT PATIENTS

3152
02:08:28,640 --> 02:08:30,000
LESS LIKELY TO RECEIVE

3153
02:08:30,000 --> 02:08:31,480
OUTPATIENT KNEE REPLACEMENT

3154
02:08:31,480 --> 02:08:33,560
SURGERY THAN WHITE PATIENTS.  

3155
02:08:33,560 --> 02:08:36,640
THIS FIGURE IS LOOKING AT

3156
02:08:36,640 --> 02:08:38,880
NATIONWIDE DATA INCLUDE MEDICARE

3157
02:08:38,880 --> 02:08:42,120
AND COMMERCIAL INSURANCE AND

3158
02:08:42,120 --> 02:08:48,640
EVERYONE, LOOK AT 2019 ABOUT 6%

3159
02:08:48,640 --> 02:08:52,880
OF PATIENTS, PATIENT REPLACEMENT

3160
02:08:52,880 --> 02:08:58,480
SURGERY HAPPEN AT OUTPATIENT AND

3161
02:08:58,480 --> 02:09:00,720
FOR WHITE WAS HIGHER AROUND 8%.

3162
02:09:00,720 --> 02:09:03,360
YOU SEE EMERGING TREND BETWEEN

3163
02:09:03,360 --> 02:09:07,080
WHITE AND BLACK. WE SEE THE SAME

3164
02:09:07,080 --> 02:09:10,840
TREND IN HIP REPLACEMENT, SOL WE

3165
02:09:10,840 --> 02:09:12,880
DON'T -- THIS IS EMERGING

3166
02:09:12,880 --> 02:09:13,800
EVIDENCE WE DON'T KNOW WHY THIS

3167
02:09:13,800 --> 02:09:17,000
IS HAPPENING. MAYBE IT IS

3168
02:09:17,000 --> 02:09:19,800
BECAUSE STRUCTURAL RACISM OR

3169
02:09:19,800 --> 02:09:21,440
MAYBE BECAUSE THERE IS DIFFERENT

3170
02:09:21,440 --> 02:09:24,080
IN ACCESSIBILITY TO OUTPATIENT

3171
02:09:24,080 --> 02:09:27,440
SURGERIES WE HEARD IN RURAL AR 

3172
02:09:27,440 --> 02:09:29,480
AREA, HARD TO RECEIVE OUTPATIENT

3173
02:09:29,480 --> 02:09:32,480
SURGERY, MAYBE THAT IS WHY. WE

3174
02:09:32,480 --> 02:09:35,760
NEED MORE EVIDENCE WITH THAT. I

3175
02:09:35,760 --> 02:09:41,040
WILL SKIP THIS ONE. NEXT SLIDE. 

3176
02:09:41,040 --> 02:09:42,600
I LISTED WHAT EVIDENCE WE NEED

3177
02:09:42,600 --> 02:09:44,200
SO WE WANT TO UNDERSTAND

3178
02:09:44,200 --> 02:09:46,280
DISPARITIES IN THE ACCESS TO

3179
02:09:46,280 --> 02:09:48,400
OUTPATIENT JOINT REPLACEMENT. WE

3180
02:09:48,400 --> 02:09:49,360
WANT TO KNOW WHY THAT IS THE

3181
02:09:49,360 --> 02:09:53,040
CASE. AND THIRD WE DEFINITELY

3182
02:09:53,040 --> 02:09:55,440
NEED MORE EVIDENCE FOR

3183
02:09:55,440 --> 02:09:57,280
DISPARITIESES IN POST SURGICAL

3184
02:09:57,280 --> 02:10:03,520
OUTCOME FOR OUTPATIENT JOINT

3185
02:10:03,520 --> 02:10:05,920
REPLACEMENT PATIENT REPLACEMENT.

3186
02:10:05,920 --> 02:10:08,440
THE BUNDLE PAYMENT PROGRAMS LIKE

3187
02:10:08,440 --> 02:10:09,960
COMPLETE JOINT REPLACEMENT

3188
02:10:09,960 --> 02:10:12,600
MODEL, IT STARTED TO INCLUDE

3189
02:10:12,600 --> 02:10:14,680
OUTPATIENT JOINT REPLACEMENT IN

3190
02:10:14,680 --> 02:10:16,280
ITS BUNDS L. SO WE WANT TO

3191
02:10:16,280 --> 02:10:18,480
UNDERSTAND WHAT IT MEANS ON THE

3192
02:10:18,480 --> 02:10:20,400
CARE QUALITY OF CARE, WHAT IT

3193
02:10:20,400 --> 02:10:21,640
MEANS IN TERMS OF DISPARITIES OF

3194
02:10:21,640 --> 02:10:29,280
CARE. THANK YOU.

3195
02:10:29,280 --> 02:10:33,680
>> THANK YOU, DR. KIM. I'M
GOING

3196
02:10:33,680 --> 02:10:36,520
TO PUSH ON TO OUR THIRD SPEAKER.

3197
02:10:36,520 --> 02:10:40,520
DR. ENDSLEY, A CLINICAL

3198
02:10:40,520 --> 02:10:41,400
PSYCHOLOGIST AND DIVERSITY

3199
02:10:41,400 --> 02:10:42,960
EQUITY INCLUSION PROGRAM MANAGER

3200
02:10:42,960 --> 02:10:44,680
AT THE VA NORTHERN CALIFORNIA

3201
02:10:44,680 --> 02:10:47,760
HEALTHCARE SYSTEM. HE IS CO-LEAD

3202
02:10:47,760 --> 02:10:49,880
FOR VA YOU KNOWVATION SUPPORTED

3203
02:10:49,880 --> 02:10:51,520
PROJECT TO SPREAD RISK-BASED

3204
02:10:51,520 --> 02:10:53,960
STRESS AND TRAUMA BASED

3205
02:10:53,960 --> 02:10:55,120
INTERVENTION TO SUPPORT VETERANS

3206
02:10:55,120 --> 02:10:56,800
OF THE COLOR. HE WILL PRESENT ON

3207
02:10:56,800 --> 02:10:58,360
RACIAL DISCRIMINATION AND

3208
02:10:58,360 --> 02:11:00,760
PATIENT PROVIDER COMMUNICATION. 

3209
02:11:00,760 --> 02:11:09,440
DR. ENDSLEY.  THANK YOU. TODAY I

3210
02:11:09,440 --> 02:11:11,320
WANT TO TALK ABOUT WHAT ARE WAYS

3211
02:11:11,320 --> 02:11:16,480
AS MEDICAL PROFESSIONALS WE CAN

3212
02:11:16,480 --> 02:11:18,360
COMMUNICATE BETTER WITH PATIENTS

3213
02:11:18,360 --> 02:11:21,320
EXPERIENCE RACIAL DISCRIMINATION

3214
02:11:21,320 --> 02:11:23,160
MAYBE LEADING TO INCREASE

3215
02:11:23,160 --> 02:11:24,400
HEALTHCARE DISPARITIES FOR THEM,

3216
02:11:24,400 --> 02:11:25,520
ALSO TALK ABOUT WHAT ARE

3217
02:11:25,520 --> 02:11:27,000
CONSIDERATIONS WHEN THINKING

3218
02:11:27,000 --> 02:11:28,520
ABOUT DOING SHARED DECISION

3219
02:11:28,520 --> 02:11:30,400
MAKING, IN ADDITION IF YOU

3220
02:11:30,400 --> 02:11:32,000
NOTICE THERE'S SOMETHING CHANGED

3221
02:11:32,000 --> 02:11:34,440
IN THE ROOM MAYBE YOU ACCIDENTLY

3222
02:11:34,440 --> 02:11:35,920
COMMITTED A MICROAGGRESSION,

3223
02:11:35,920 --> 02:11:39,520
WHAT ARE SOME STEPS YOU CAN

3224
02:11:39,520 --> 02:11:44,720
RECOVER. AND MAYBE IMPROVE THE

3225
02:11:44,720 --> 02:11:48,560
RELATIONSHIP. MANY OTHER

3226
02:11:48,560 --> 02:11:50,760
FANTASTIC SPEAKERS SO FAR

3227
02:11:50,760 --> 02:11:51,720
INDICATED THERE ARE SOME

3228
02:11:51,720 --> 02:11:53,480
HEALTHCARE DISPARITIES, I ALWAYS

3229
02:11:53,480 --> 02:12:00,920
GO BACK TO THIS INSTITUTE OF

3230
02:12:00,920 --> 02:12:02,160
MEDICINE QUOTE. THAT TALKS ABOUT

3231
02:12:02,160 --> 02:12:03,880
WHEN YOU CONTROL FOR CONFOUNDING

3232
02:12:03,880 --> 02:12:05,200
FACTORS THERE'S RACIAL

3233
02:12:05,200 --> 02:12:06,280
DIFFERENCES IN VARIOUS AREAS OF

3234
02:12:06,280 --> 02:12:11,280
CARE. DISEASE SEVERITY AND SITE

3235
02:12:11,280 --> 02:12:16,120
OF CARE. IN OA WE SEE THAT LOT

3236
02:12:16,120 --> 02:12:18,920
OF PATIENTS EX-- BLACK PATIENTS

3237
02:12:18,920 --> 02:12:20,520
TALK ABOUT HAVING LOWER

3238
02:12:20,520 --> 02:12:23,040
SATISFACTION WITH COMMUNICATION.

3239
02:12:23,040 --> 02:12:26,360
THEY ALSO MAY REPORT DIFFERENT

3240
02:12:26,360 --> 02:12:28,560
DESCRIPTIONS OF THEIR QUALITY OF

3241
02:12:28,560 --> 02:12:32,600
KNEE OR HIP PAIN IN ADDITION

3242
02:12:32,600 --> 02:12:37,520
THERE'S OTHER COPING TOOLS THAT

3243
02:12:37,520 --> 02:12:39,160
BLACK AND INDIGENOUS PEOPLE MAY

3244
02:12:39,160 --> 02:12:41,400
USE WHEN IT COMES TO MANAGING

3245
02:12:41,400 --> 02:12:42,960
PAIN, OTHERS IN ENVIRONMENT

3246
02:12:42,960 --> 02:12:44,640
FRIENDS FAMILY FOR ADVICE IN

3247
02:12:44,640 --> 02:12:47,080
DIFFERENT WAYS THAN OTHER GROUPS

3248
02:12:47,080 --> 02:12:48,680
SO IT IS IMPORTANT TO HIGHLIGHT

3249
02:12:48,680 --> 02:12:54,600
THOSE BRIEFLY. SO THIS IS A

3250
02:12:54,600 --> 02:12:56,160
MODEL OF HOW DISCRIMINATION CAN

3251
02:12:56,160 --> 02:13:01,360
HAVE VARIOUS IMPACT ACROSS

3252
02:13:01,360 --> 02:13:02,400
RELATIONSHIP WITH THE PATIENT

3253
02:13:02,400 --> 02:13:04,560
AND THE PROVIDER AND THEIR

3254
02:13:04,560 --> 02:13:06,920
ENGAGEMENT WITH CARE.

3255
02:13:06,920 --> 02:13:08,640
DISCRIMINATION HAS IMPACT, OFTEN

3256
02:13:08,640 --> 02:13:10,680
TIMES LEADING TO MEDICAL

3257
02:13:10,680 --> 02:13:15,560
MISTRUST WHICH CAN LEAD TO CARE

3258
02:13:15,560 --> 02:13:16,680
NON-ADHERENCE DUE TO NOT

3259
02:13:16,680 --> 02:13:20,320
TRUSTING PROVIDERS, INCREASE

3260
02:13:20,320 --> 02:13:21,520
SATISFACTION. SOMEWHERE WE SEE

3261
02:13:21,520 --> 02:13:23,520
HERE DISCRIMINATION ALSO IMPACTS

3262
02:13:23,520 --> 02:13:27,360
THE PROVIDER COMMUNICATION WITH

3263
02:13:27,360 --> 02:13:29,960
THE PATIENT. WHICH ALSO GOES

3264
02:13:29,960 --> 02:13:32,760
INTO INFLUENCE ONGOING MEDICAL

3265
02:13:32,760 --> 02:13:33,880
MISTRUST, OFTEN TIMES I WORK

3266
02:13:33,880 --> 02:13:35,560
WITH VETERANS WHO ARE STUCK IN

3267
02:13:35,560 --> 02:13:37,720
CYCLE OF THEY HAVE HAD HISTORY

3268
02:13:37,720 --> 02:13:40,560
OF DISCRIMINATION SO THEY GET

3269
02:13:40,560 --> 02:13:41,600
STUCK AND MAY HAVE DIFFICULTY

3270
02:13:41,600 --> 02:13:45,120
TRYING TO OVERCOME SOME OF THOSE

3271
02:13:45,120 --> 02:13:46,040
BARRIERS OR MAYBE HAVE

3272
02:13:46,040 --> 02:13:49,080
EXPERIENCE A LOT OF

3273
02:13:49,080 --> 02:13:49,720
DISCRIMINATION HEALTHCARE SO

3274
02:13:49,720 --> 02:13:51,280
THEY NOTICE SIMILAR THINGS

3275
02:13:51,280 --> 02:13:52,560
HAPPENING FOR THEM AND HARDER TO

3276
02:13:52,560 --> 02:13:53,960
ENGAGE IN CARE. SO PART OF WHAT

3277
02:13:53,960 --> 02:13:55,880
I WANT TO TALK ABOUT TODAY IS

3278
02:13:55,880 --> 02:13:57,560
HOW DO WE HELP INTERRUPT THAT

3279
02:13:57,560 --> 02:14:00,200
CYCLE FROM HAPPENING. NEXT SLIDE

3280
02:14:00,200 --> 02:14:04,720
PLEASE. SO I THINK WHEN YOU ARE

3281
02:14:04,720 --> 02:14:06,160
CONSIDERING PATIENT PROVIDER

3282
02:14:06,160 --> 02:14:08,800
COMMUNICATION, I THINK IT IS

3283
02:14:08,800 --> 02:14:10,960
IMPORTANT TO ADAPT IT AND THINK

3284
02:14:10,960 --> 02:14:12,680
THROUGH WHAT IS SHARE DECISION

3285
02:14:12,680 --> 02:14:14,200
MAKING, MEAN FOR THAT PATIENT.

3286
02:14:14,200 --> 02:14:19,640
IT IS IMPORTANT TO ASK THEM.

3287
02:14:19,640 --> 02:14:21,000
SOMETIMES WHEN I WORK WITH

3288
02:14:21,000 --> 02:14:22,520
VETERANS THEY HAVE NOT

3289
02:14:22,520 --> 02:14:23,760
EXPERIENCED THAT, THEY FEEL LIKE

3290
02:14:23,760 --> 02:14:26,280
THEY ARE NOT BEING HEARD IN THE

3291
02:14:26,280 --> 02:14:29,440
ROOM SO THOSE DISCUSSION CAN BE

3292
02:14:29,440 --> 02:14:32,200
HOPEFUL. I LIKE THIS QUOTE

3293
02:14:32,200 --> 02:14:35,200
ENCOUNTERED THE EXPERIENCE

3294
02:14:35,200 --> 02:14:37,120
SHARED IT MUST OCCUR IN TRUSTING

3295
02:14:37,120 --> 02:14:39,240
PATTERN. SO THERE NEEDS TO BE

3296
02:14:39,240 --> 02:14:41,040
WORK OFTEN TIMES AT LEAST

3297
02:14:41,040 --> 02:14:42,720
MANUFACTURE THAT I EXPERIENCE A

3298
02:14:42,720 --> 02:14:45,480
LOT OF RACIAL DISCRIMINATION TO

3299
02:14:45,480 --> 02:14:47,560
OVERCOME AND MAYBE LESS LIKELY

3300
02:14:47,560 --> 02:14:50,200
TO SHARE INFORMATION, THEY CAN

3301
02:14:50,200 --> 02:14:52,000
FEELING, MAYBE PROBING FOR MORE

3302
02:14:52,000 --> 02:14:54,320
INFORMATION FROM YOU TO GET TO

3303
02:14:54,320 --> 02:14:56,080
KNOW YOU AND CREATE THAT FEELING

3304
02:14:56,080 --> 02:14:59,320
OF SAFETY AND TRUST WITHIN THE

3305
02:14:59,320 --> 02:15:02,000
CLINICAL ENCOUNTER. OFTENTIMES

3306
02:15:02,000 --> 02:15:05,120
MANY PATIENTS MAYBE PERCEIVED AS

3307
02:15:05,120 --> 02:15:07,920
INAPPROPRIATE OR ASKING

3308
02:15:07,920 --> 02:15:08,920
UNCOMFORTABLE QUESTIONS, ACTING

3309
02:15:08,920 --> 02:15:12,760
IN WAYS THAT SEEN AS NEGATIVE BY

3310
02:15:12,760 --> 02:15:15,800
PROVIDERS. SO IT IS A IMPORTANT

3311
02:15:15,800 --> 02:15:16,960
TO UNDERSTAND RACIAL TRAUMA AND

3312
02:15:16,960 --> 02:15:18,320
DISCRIMINATION MAYBE INFLUENCING

3313
02:15:18,320 --> 02:15:20,400
THAT BEHAVIOR AND NOT OTHER

3314
02:15:20,400 --> 02:15:25,040
PERSONALITY FACTORS. IN

3315
02:15:25,040 --> 02:15:27,480
ADDITION, THE PATIENT TELL,

3316
02:15:27,480 --> 02:15:28,560
SHARING INFORMATION BETWEEN BOTH

3317
02:15:28,560 --> 02:15:30,360
PATIENT AND MEDICAL

3318
02:15:30,360 --> 02:15:32,600
PROFESSIONAL, OFTENTIMES EVEN IN

3319
02:15:32,600 --> 02:15:34,720
MY PROFESSION AS CLINICAL

3320
02:15:34,720 --> 02:15:35,400
PSYCHOLOGIST CAN BE -- I WAS

3321
02:15:35,400 --> 02:15:37,200
TRAINED VERY MUCH WE DON'T SHARE

3322
02:15:37,200 --> 02:15:39,880
MUCH ABOUT OURSELVES. I LEARNED

3323
02:15:39,880 --> 02:15:41,320
WITH VETERANS I WORK WITH, WE

3324
02:15:41,320 --> 02:15:42,800
EXPERIENCE A LOT OF RACIAL

3325
02:15:42,800 --> 02:15:44,000
DISCRIMINATION IT IS HELPFUL FOR

3326
02:15:44,000 --> 02:15:46,720
ME TO BE A LITTLE OPEN ABOUT WHO

3327
02:15:46,720 --> 02:15:48,880
I AM, HELP THEM FEEL SAFER IN

3328
02:15:48,880 --> 02:15:50,760
THE ROOM AND OFTEN TIMES MAY

3329
02:15:50,760 --> 02:15:52,000
DISCLOSE THINGS THEY HAVE NOT

3330
02:15:52,000 --> 02:15:53,680
DISCLOSED OF OR HEALTHCARE

3331
02:15:53,680 --> 02:15:55,720
PROVIDERS. SO I THINK BEING

3332
02:15:55,720 --> 02:15:58,200
MINDFUL OF THAT RELATIONSHIP AND

3333
02:15:58,200 --> 02:16:00,400
BEING COMFORTABLE SOMETIMES

3334
02:16:00,400 --> 02:16:02,040
TALKING ABOUT YOURSELF A LITTLE

3335
02:16:02,040 --> 02:16:03,760
BIT MORE CAN BE HELPFUL FOR

3336
02:16:03,760 --> 02:16:07,880
FOLKS WHO EXPERIENCE RACIAL

3337
02:16:07,880 --> 02:16:09,000
DISCRIMINATION. ALSO TEACH FOLKS

3338
02:16:09,000 --> 02:16:10,640
HOW TO ADVOCATE FOR THEMSELVES

3339
02:16:10,640 --> 02:16:13,920
AND MAYBE NECESSARY TO STEP IN.

3340
02:16:13,920 --> 02:16:16,640
AND ADVOCATE FOR THAT PATIENT --

3341
02:16:16,640 --> 02:16:18,840
IF SOMEONE IS NOT HEARING THE

3342
02:16:18,840 --> 02:16:19,760
PATIENT CONCERNS, HAVING

3343
02:16:19,760 --> 02:16:21,760
CHALLENGES WITH OTHER HEALTHCARE

3344
02:16:21,760 --> 02:16:23,120
PROVIDERS AND HAVE A GOOD

3345
02:16:23,120 --> 02:16:24,400
TRUSTING RELATIONSHIP WITH YOU

3346
02:16:24,400 --> 02:16:26,120
THAT'S ANOTHER PLAY TO CONTINUE

3347
02:16:26,120 --> 02:16:28,680
TO BOND WITH THAT PATIENT AND

3348
02:16:28,680 --> 02:16:30,280
HAS PROFOUND IMPACT ON THEIR

3349
02:16:30,280 --> 02:16:34,920
ENGAGEMENT. I THINK WHILE SHARE

3350
02:16:34,920 --> 02:16:37,160
DECISION MAKING IS REALLY

3351
02:16:37,160 --> 02:16:39,200
IMPORTANT, MAY NOT BE WITH THE

3352
02:16:39,200 --> 02:16:40,440
PREFERENCE IS FOR EVERY PATIENT.

3353
02:16:40,440 --> 02:16:42,880
IT DOSE BACK TO MAKING SURE THAT

3354
02:16:42,880 --> 02:16:44,360
WE ARE ASKING ABOUT WHAT ARE

3355
02:16:44,360 --> 02:16:46,040
THEY LOOKING FOR, HOW TO ENGAGE

3356
02:16:46,040 --> 02:16:48,920
IN THEIR CARE, THIS COMES FROM

3357
02:16:48,920 --> 02:16:52,360
DATA THAT LOOK AT MOTIVATIONAL

3358
02:16:52,360 --> 02:16:54,040
INTERVIEWING AND FOUND THAT

3359
02:16:54,040 --> 02:16:55,960
MOTIVATIONAL INTERVIEWING IS

3360
02:16:55,960 --> 02:16:58,840
SOMETHING WE USE IN HEALTHCARE

3361
02:16:58,840 --> 02:17:01,080
TO HELP PATIENTS OR VETERANS

3362
02:17:01,080 --> 02:17:04,040
ENGAGE IN CARE, ENGAGE IN

3363
02:17:04,040 --> 02:17:06,400
BEHAVIORS, IT SHOWS THAT THERE

3364
02:17:06,400 --> 02:17:09,880
ARE CHALLENGES WHEN IT COMES TO

3365
02:17:09,880 --> 02:17:11,280
USING MOTIVATION WITHOUT

3366
02:17:11,280 --> 02:17:13,440
ADAPTING AND SOME PATIENTS MAY

3367
02:17:13,440 --> 02:17:15,240
PREFER MORE DIRECTIVE APPROACH. 

3368
02:17:15,240 --> 02:17:18,320
SO THE OTHER PIECE THAT SOME OF

3369
02:17:18,320 --> 02:17:23,200
THE DATA SHOWED FOR SOME GROUPS,

3370
02:17:23,200 --> 02:17:24,720
REALLY IMPORTANT GOALS VALUES AN

3371
02:17:24,720 --> 02:17:26,240
PREFERENCES ARE DISCUSSED. AND

3372
02:17:26,240 --> 02:17:28,000
INCLUDE MISDEMEANOR THE

3373
02:17:28,000 --> 02:17:31,800
TREATMENT DECISION. NEXT SLIDE.

3374
02:17:31,800 --> 02:17:33,160
SO THESE ARE SOME QUESTIONS THAT

3375
02:17:33,160 --> 02:17:34,400
MIGHT BE IMPORTANT TO ASK ABOUT

3376
02:17:34,400 --> 02:17:36,320
THE PATIENT. HOW DOES A PATIENT

3377
02:17:36,320 --> 02:17:37,520
UNDERSTAND AND VIEW THEIR OWN

3378
02:17:37,520 --> 02:17:39,600
EXPERIENCE?

3379
02:17:39,600 --> 02:17:42,360
HOW DO OTHER IMPORTANT PEOPLE IN

3380
02:17:42,360 --> 02:17:43,880
THEIR LIVES ALSO RECEIVE THIS

3381
02:17:43,880 --> 02:17:47,080
PROBLEM AS WE SAW EARLIER ONE

3382
02:17:47,080 --> 02:17:50,480
STUDY NOTED THAT BLACK AFRICAN

3383
02:17:50,480 --> 02:17:51,920
AMERICAN PATIENTS MAYBE MORE

3384
02:17:51,920 --> 02:17:54,000
LIKELY TO ENGAGE FAMILY MEMBERS

3385
02:17:54,000 --> 02:17:57,000
AN FRIENDS AND ASK FOR ADVICE.

3386
02:17:57,000 --> 02:17:59,680
SOMETIMES IT CAN BE HELPFUL TO

3387
02:17:59,680 --> 02:18:01,160
ASK, WHO WOULD YOU FIND HELPFUL

3388
02:18:01,160 --> 02:18:04,880
IN THAT ADVICE. SO THEY LEARN

3389
02:18:04,880 --> 02:18:06,320
MORE ABOUT THAT PATIENT

3390
02:18:06,320 --> 02:18:08,160
ENGAGEMENT A LITTLE BIT MORE

3391
02:18:08,160 --> 02:18:10,240
ABOUT THE WORLD AROUND THEM,

3392
02:18:10,240 --> 02:18:12,120
WHAT STRUCTURAL BARRIERS ARE

3393
02:18:12,120 --> 02:18:13,920
IMPACTED. SO IT CAN BE IMPORTANT

3394
02:18:13,920 --> 02:18:16,880
TO ASK ABOUT THESE THINGS TO

3395
02:18:16,880 --> 02:18:19,000
HELP DEVELOP RELATIONSHIP,

3396
02:18:19,000 --> 02:18:21,880
RACISM AND DISCRIMINATION OFTEN

3397
02:18:21,880 --> 02:18:25,320
TIMES SOMETHING THAT THERE MAYBE

3398
02:18:25,320 --> 02:18:26,680
A NEED MORE QUESTIONING AROUND

3399
02:18:26,680 --> 02:18:30,160
TO GET FOLKS TO ENGAGE WITH THAT

3400
02:18:30,160 --> 02:18:33,000
AND SHARE MORE HOW HISTORIC PAL

3401
02:18:33,000 --> 02:18:36,800
DISCRIMINATION IMPACTED THE WAY

3402
02:18:36,800 --> 02:18:38,600
THEY RECEIVE. SO WHAT CAN YOU

3403
02:18:38,600 --> 02:18:40,320
DO? ONE OF THE IMPORTANT PIECES

3404
02:18:40,320 --> 02:18:41,680
IS THINKING WHAT CAN YOU DO IF

3405
02:18:41,680 --> 02:18:43,560
YOU MAKE A MISTAKE OR NOTICE

3406
02:18:43,560 --> 02:18:44,960
THAT SOMETHING IS CHANGED IN THE

3407
02:18:44,960 --> 02:18:46,840
RELATIONSHIP OR THE WAY THAT A

3408
02:18:46,840 --> 02:18:49,760
PATIENT INTERACTS WITH YOU, AND

3409
02:18:49,760 --> 02:18:50,600
RECOGNIZE THIS MAYBE INEVITABLE

3410
02:18:50,600 --> 02:18:52,800
IN SOME POINT AND SOMETIME YOU

3411
02:18:52,800 --> 02:18:56,040
WILL ENGAGE IN A MICROAGGRESSION

3412
02:18:56,040 --> 02:18:57,520
AND THERE ARE WAYS TO RECOVER

3413
02:18:57,520 --> 02:19:00,920
FROM THAT. THE RESEARCH SHOWS AT

3414
02:19:00,920 --> 02:19:04,240
LEAST THERAPY ENCOUNTERS AND TO

3415
02:19:04,240 --> 02:19:06,360
MAKE A ENCOUNTER THERAPEUTIC BY

3416
02:19:06,360 --> 02:19:07,480
ADDRESSING THE MICROAGGRESSION

3417
02:19:07,480 --> 02:19:10,320
AN RECOVERING FROM IT CAN UNDO

3418
02:19:10,320 --> 02:19:13,520
THE HARM CAUSED BY THAT

3419
02:19:13,520 --> 02:19:15,320
MICROAGGRESSION. SO THIS COMES

3420
02:19:15,320 --> 02:19:17,640
FROM DR. MONICA WILLIAMS,

3421
02:19:17,640 --> 02:19:19,640
SHARING STEPS YOU CAN DO THAT SO

3422
02:19:19,640 --> 02:19:22,240
THAT WILL INCLUDE ONE, NOTICE AT

3423
02:19:22,240 --> 02:19:24,040
WORK IF THE PATIENT BRINGS UP

3424
02:19:24,040 --> 02:19:26,360
SOMETHING AND SAYS HEY YOUR

3425
02:19:26,360 --> 02:19:27,640
STEREOTYPING ME, YOU ARE

3426
02:19:27,640 --> 02:19:29,880
ENGAGING IN A MICROAGGRESSION OR

3427
02:19:29,880 --> 02:19:31,280
YOU ARE NOT -- I'M FEELING LIKE

3428
02:19:31,280 --> 02:19:32,920
THERE IS A MISMATCH HERE WHEN IT

3429
02:19:32,920 --> 02:19:36,240
COMES TO RACE, SOMETIMES MAYBE

3430
02:19:36,240 --> 02:19:37,960
CLUES AS TO -- THERE'S SOMETHING

3431
02:19:37,960 --> 02:19:40,560
GOING ON MAYBE A MICROAGGRESSION

3432
02:19:40,560 --> 02:19:44,360
OCCURRED IN THE ENCOUNTER. SO I

3433
02:19:44,360 --> 02:19:45,360
THINK IT WOULD BE REALLY

3434
02:19:45,360 --> 02:19:47,200
IMPORTANT, FIRST TO ACKNOWLEDGE

3435
02:19:47,200 --> 02:19:49,880
SOMETHING HAPPENED. AND BE

3436
02:19:49,880 --> 02:19:51,800
CAREFUL ABOUT BECOMING DEFENSIVE

3437
02:19:51,800 --> 02:19:54,760
ABOUT IT OR BLAMING THE PATIENT

3438
02:19:54,760 --> 02:19:57,320
FOR WHAT HAPPENED OR MINIMIZING

3439
02:19:57,320 --> 02:19:59,160
THE IMPACT OF WHAT WAS SAID. 

3440
02:19:59,160 --> 02:20:02,040
TRY TO AVOID EXPLAIN AWAY, WE

3441
02:20:02,040 --> 02:20:05,280
ARE SPENDING TIME TALKING ABOUT

3442
02:20:05,280 --> 02:20:07,120
YOURSELF IN THAT SITUATION.

3443
02:20:07,120 --> 02:20:09,600
INSTEAD FOCUS ON HOW IT IMPACT

3444
02:20:09,600 --> 02:20:11,560
LIMITATIONS. WHAT WAS IT LIKE

3445
02:20:11,560 --> 02:20:14,160
FOR THEM WHEN THAT HAPPENED? 

3446
02:20:14,160 --> 02:20:20,080
NEXT SLIDE PLEASE.  APOLOGIZE.

3447
02:20:20,080 --> 02:20:22,560
AND GENUINELY, IT IS IMPORTANT

3448
02:20:22,560 --> 02:20:24,320
TO APOLOGIZE AND RECOGNIZE THAT

3449
02:20:24,320 --> 02:20:27,160
BEHAVIOR HAD AN IMPACT. AND THEN

3450
02:20:27,160 --> 02:20:30,880
GGO AHEAD AND HIGHLIGHT WAYS THT

3451
02:20:30,880 --> 02:20:32,840
YOU ARE CONCERNED ABOUT WHAT

3452
02:20:32,840 --> 02:20:35,280
JUST HAPPENED. MAYBE IMPORTANT

3453
02:20:35,280 --> 02:20:38,280
TO DISCUSS WAYS TO PLAN TO

3454
02:20:38,280 --> 02:20:40,960
REMEDY THAT, AND SUCH AS GETTING

3455
02:20:40,960 --> 02:20:42,400
MORE EDUCATION OR TRYING TO GROW

3456
02:20:42,400 --> 02:20:43,680
AND LEARN TO PREVENT FROM

3457
02:20:43,680 --> 02:20:48,920
HAPPENING AGAIN. REMIND THEM YOU

3458
02:20:48,920 --> 02:20:51,600
ARE OPEN TO FEEDBACK. BE GENUINE

3459
02:20:51,600 --> 02:20:53,480
ABOUT THAT. ASK WAYS WHICH THEY

3460
02:20:53,480 --> 02:20:54,920
WOULD LIKE TO BE REMEDIED, ONE

3461
02:20:54,920 --> 02:20:59,160
WAY TO DO THAT, RECOMMIT TO THAT

3462
02:20:59,160 --> 02:21:02,120
HOPE FEEDBACK AND LISTEN TO

3463
02:21:02,120 --> 02:21:04,560
RESPONSE AND TRY NOT TO

3464
02:21:04,560 --> 02:21:05,680
INTERRUPT TOO MUCH AND TRY TO

3465
02:21:05,680 --> 02:21:07,640
FOCUS ON THEM, I KNOW THAT'S

3466
02:21:07,640 --> 02:21:09,880
HARD IN SHORT ENCOUNTERS BUT

3467
02:21:09,880 --> 02:21:13,120
EVEN THIS CAN TAKE A FEW SECONDS

3468
02:21:13,120 --> 02:21:14,360
TO REALLY WORK THROUGH SOME OF

3469
02:21:14,360 --> 02:21:20,200
THESE. RAIL DATION FOR THE

3470
02:21:20,200 --> 02:21:21,960
IMPACT, IT IS UNDERSTANDABLE,

3471
02:21:21,960 --> 02:21:23,920
ANGER AND FRUSTRATED WHEN THEY

3472
02:21:23,920 --> 02:21:27,760
EXPERIENCE A MICROAGGRESSION AND

3473
02:21:27,760 --> 02:21:30,800
RECOGNIZE THOSE EMOTIONS ARE

3474
02:21:30,800 --> 02:21:34,120
REAL RELEVANT. REMAIN OPEN TO

3475
02:21:34,120 --> 02:21:38,320
THEM ALERTING YOU TO MICROAGREG

3476
02:21:38,320 --> 02:21:41,120
IN THE FUTURE H. COMMIT TO

3477
02:21:41,120 --> 02:21:42,920
LEARNING AND CONTINUE TO LEAR L.

3478
02:21:42,920 --> 02:21:46,320
THOSE ARE WAYS TO SALVAGE THOSE

3479
02:21:46,320 --> 02:21:48,000
ENCOUNTERS, MANY VETERANS I WORK

3480
02:21:48,000 --> 02:21:49,360
WITH AROUND RACIAL DISCELL

3481
02:21:49,360 --> 02:21:51,560
NATION AND HOW IT IMPACTS

3482
02:21:51,560 --> 02:21:53,360
ABILITY TO ENGAGE IN CARE FOUND

3483
02:21:53,360 --> 02:21:54,720
WHEN THERE ARE PROVIDERS WHO

3484
02:21:54,720 --> 02:21:57,600
MADE MISTAKES OR MADE

3485
02:21:57,600 --> 02:21:58,120
MICROAGGRESSION THESE

3486
02:21:58,120 --> 02:21:59,600
CONVERSATIONS ARE REALLY HELPFUL

3487
02:21:59,600 --> 02:22:02,920
FOR THEM TO FEEL THEY CAN TRUST

3488
02:22:02,920 --> 02:22:06,800
THOSE HEALTHCARE PROVIDERS. SO

3489
02:22:06,800 --> 02:22:10,160
SOME EXTRA STEPS YOU CAN DO IS

3490
02:22:10,160 --> 02:22:13,120
CONTINUE TO LEARN MORE AND

3491
02:22:13,120 --> 02:22:14,960
ACCEPT THE UNFORTUNATE HISTORY

3492
02:22:14,960 --> 02:22:16,840
OF RACISM AND THE RACIAL

3493
02:22:16,840 --> 02:22:18,720
DISCRIMINATION AND EFFECT IT HAS

3494
02:22:18,720 --> 02:22:19,960
ON RACIAL DISPARITIES.

3495
02:22:19,960 --> 02:22:21,600
UNDERSTAND HOW RACISM SHAPES

3496
02:22:21,600 --> 02:22:22,720
DISPARITIESES NOT JUST RACE BUT

3497
02:22:22,720 --> 02:22:25,640
RACISM IS PLAYING A ROLE CAUSING

3498
02:22:25,640 --> 02:22:28,760
DISPARITIES. DEFINE AND NAME

3499
02:22:28,760 --> 02:22:30,200
RACISM, WHEN YOU SEE IT CALL IT

3500
02:22:30,200 --> 02:22:32,280
OUT. BE HONEST. IF THERE'S

3501
02:22:32,280 --> 02:22:33,480
SOMETHING GOING ON IT IS

3502
02:22:33,480 --> 02:22:35,240
IMPORTANT TO ENGAGE OTHER

3503
02:22:35,240 --> 02:22:37,800
HEALTHCARE PROVIDERS. YOU NOTICE

3504
02:22:37,800 --> 02:22:38,760
STEREOTYPING OTHER TYPES OF

3505
02:22:38,760 --> 02:22:42,040
ISSUES GOING ON WITH THE

3506
02:22:42,040 --> 02:22:45,520
PATIENT. IT IS IMPORTANT TO --

3507
02:22:45,520 --> 02:22:47,000
LOOK AT THE EXPERIENCE OF THOSE

3508
02:22:47,000 --> 02:22:50,520
WHO OFTEN TIMES WERE NOT THOSE

3509
02:22:50,520 --> 02:22:53,680
WE SEE AS THE NORM. WHO

3510
02:22:53,680 --> 02:22:55,320
OFTENTIMES MAYBE LARGER GROUP OF

3511
02:22:55,320 --> 02:22:57,920
FOLKS STUDIED IN OTHER GROUPS

3512
02:22:57,920 --> 02:22:59,160
MARGINALIZED OFTENTIMES ARE NOT

3513
02:22:59,160 --> 02:23:01,120
ENGAGED IN THAT CONVERSATION AND

3514
02:23:01,120 --> 02:23:04,080
RESEARCH OR ENGAGED IN THEIR OWN

3515
02:23:04,080 --> 02:23:06,600
CULTURAL VALUES AND HOW THAT

3516
02:23:06,600 --> 02:23:09,120
SHAPES THEIR HEALTHCARE RULES.

3517
02:23:09,120 --> 02:23:12,440
SO I THINK IT IS LEARNING IS

3518
02:23:12,440 --> 02:23:14,120
SOMETHING THAT HAS TO KEEP

3519
02:23:14,120 --> 02:23:15,600
GOING. SOMETIMES MIGHT ASK

3520
02:23:15,600 --> 02:23:16,920
YOURSELF WHAT WAYS ARE YOU

3521
02:23:16,920 --> 02:23:18,280
SUSTAINING THAT SYSTEM WHERE DO

3522
02:23:18,280 --> 02:23:20,280
YOU FIT IN THAT SYSTEM. ARE YOU

3523
02:23:20,280 --> 02:23:22,240
ADVOCATING AND HOW CAN YOU

3524
02:23:22,240 --> 02:23:23,760
ADVOCATE IF YOU NOTICE HEALTH

3525
02:23:23,760 --> 02:23:26,120
DISPARITIES GOING ON. AND IF YOU

3526
02:23:26,120 --> 02:23:29,040
ARE CURIOUS ABOUT HOW TO LEARN

3527
02:23:29,040 --> 02:23:30,960
MORE OF POEMS STORIES BOOKS ON

3528
02:23:30,960 --> 02:23:34,720
THIS TOPIC, OR EVEN DIGEST ASK

3529
02:23:34,720 --> 02:23:37,920
YOURSELF WHAT ARE YOUR

3530
02:23:37,920 --> 02:23:40,640
REACTIONS. THROUGHOUT THIS TALK

3531
02:23:40,640 --> 02:23:42,000
AND CONTINUE CONTINUE TO HAVE

3532
02:23:42,000 --> 02:23:43,280
THE CONVERSATION GOING, CONTINUE

3533
02:23:43,280 --> 02:23:45,120
TO TALK WITH COLLEAGUES AND

3534
02:23:45,120 --> 02:23:50,680
EDUCATE OTHERS.

3535
02:23:50,680 --> 02:23:53,240
>> THANK YOU, DR. ENDSLEY.
NOW I

3536
02:23:53,240 --> 02:23:57,520
WILL TURN TO OUR LAST SPEAKER,

3537
02:23:57,520 --> 02:23:58,960
DR. THIRUKUMARAN. SHE IS HEALTH

3538
02:23:58,960 --> 02:24:00,600
SERVICES RESEARCHER ASSISTANT

3539
02:24:00,600 --> 02:24:02,360
PROFESSOR IN ORTHOPEDICS PUBLIC

3540
02:24:02,360 --> 02:24:04,600
HEALTH SCIENCES AT CENTER FOR

3541
02:24:04,600 --> 02:24:05,320
MUSCULOSKELETAL RESEARCH

3542
02:24:05,320 --> 02:24:07,160
UNIVERSITY OF ROCHESTER MEDICAL

3543
02:24:07,160 --> 02:24:09,800
CENTER. HER RESEARCH INTERESTS

3544
02:24:09,800 --> 02:24:13,480
ARE SECTION OF HEALTH POLICY OR

3545
02:24:13,480 --> 02:24:14,160
COMES DISPARITIESES IN

3546
02:24:14,160 --> 02:24:15,600
ORTHOPEDIC OUTCOMES AND SHE WILL

3547
02:24:15,600 --> 02:24:17,240
PRESENT RESEARCH EXAMINING

3548
02:24:17,240 --> 02:24:19,720
ASSOCIATION BETWEEN MEDICARE

3549
02:24:19,720 --> 02:24:20,560
BUNDLE PAYMENT PERFORM

3550
02:24:20,560 --> 02:24:22,640
COMPREHENSIVE CARE FOR DRUG

3551
02:24:22,640 --> 02:24:23,680
REPLACEMENT WITH DISPARITIES USE

3552
02:24:23,680 --> 02:24:26,680
OF ALKALINES WITH JOINT

3553
02:24:26,680 --> 02:24:29,880
REPLACEMENT SURGERIES.  DR.

3554
02:24:29,880 --> 02:24:31,120
THIRUKUMARAN.

3555
02:24:31,120 --> 02:24:32,440
>> THANK YOU.

3556
02:24:32,440 --> 02:24:36,280
>> MANY THANKS TO THE DONE
TO

3557
02:24:36,280 --> 02:24:37,320
PRESENT MY IMPORTANT WORK IN

3558
02:24:37,320 --> 02:24:39,280
THIS IMPORTANT SYMPOSIUM. I WILL

3559
02:24:39,280 --> 02:24:42,880
COVER ASSOCIATION OF FORMS WITH

3560
02:24:42,880 --> 02:24:44,200
DISPARITIES IN USE OF JOINT

3561
02:24:44,200 --> 02:24:45,880
REPLACEMENT AND THE OVERARCHING

3562
02:24:45,880 --> 02:24:49,600
TOPIC IS REALLY HOW SYSTEM LEVEL

3563
02:24:49,600 --> 02:24:51,440
MEDICARE POLICIES CAN BE

3564
02:24:51,440 --> 02:24:52,960
DETERMINANTS OF HEALTH

3565
02:24:52,960 --> 02:24:54,480
DISPARITIES IN TOTAL JOINT

3566
02:24:54,480 --> 02:24:58,480
REPLACEMENT FOR ARTHRITIS.  I'M

3567
02:24:58,480 --> 02:25:01,280
GRATEFUL FOR THE FUNDING

3568
02:25:01,280 --> 02:25:04,360
RECEIVED FROM THE NIMHD AND NIA 

3569
02:25:04,360 --> 02:25:06,840
AS MOST OF US HERE KNOW TOTAL

3570
02:25:06,840 --> 02:25:08,920
JOINT REPLACEMENT ARE HIGHLY

3571
02:25:08,920 --> 02:25:09,920
EFFECTIVE TREATMENT FOR END

3572
02:25:09,920 --> 02:25:12,160
STAGE ARTHRITIS. THEY ARE MOST

3573
02:25:12,160 --> 02:25:14,280
COMMONLY PERFORMED IN IN PATIENT

3574
02:25:14,280 --> 02:25:16,200
SETTING BUT AS DR. KIM MENTIONED

3575
02:25:16,200 --> 02:25:17,800
EARLIER NOW INCREASINGLY

3576
02:25:17,800 --> 02:25:19,560
CONSIDER IN THE OUTPATIENT

3577
02:25:19,560 --> 02:25:21,520
SETTING OFTEN REMOVAL OF THESE

3578
02:25:21,520 --> 02:25:24,680
SURGERIES FOR THE INPATIENT

3579
02:25:24,680 --> 02:25:26,560
PRIMARY CARE. DESPITE LARGELY

3580
02:25:26,560 --> 02:25:28,320
STANDARDIZED NATURE OF SURGERIES

3581
02:25:28,320 --> 02:25:29,080
THERE IS CONSIDERABLE

3582
02:25:29,080 --> 02:25:30,760
VARIABILITY IN THE USE OF

3583
02:25:30,760 --> 02:25:33,080
OUTCOMES AND SPENDING WITH JOINT

3584
02:25:33,080 --> 02:25:36,840
REPLACEMENT NOTABLY OUR

3585
02:25:36,840 --> 02:25:38,960
DISPARITIES IN USE OF OUTCOMES

3586
02:25:38,960 --> 02:25:41,080
OF THESE SURGERY AND

3587
02:25:41,080 --> 02:25:42,120
DISPARITIESES HAVE PERSISTED FOR

3588
02:25:42,120 --> 02:25:46,760
DECADES.  THIS MAP SHOW AGE AND

3589
02:25:46,760 --> 02:25:49,400
SEX STANDARDIZE RATE OF HIP E

3590
02:25:49,400 --> 02:25:50,920
REPLACEMENT IN BLUE AND HIP

3591
02:25:50,920 --> 02:25:52,440
REPLACEMENT IN GREEN AS RECENT

3592
02:25:52,440 --> 02:25:55,200
AS 2017, THIS WAS A STUDY WE DID

3593
02:25:55,200 --> 02:25:57,560
RESPONDING FROM THE NIMHD. ON

3594
02:25:57,560 --> 02:26:00,880
THE LEFT SIDE ARE THE MAPS FOR

3595
02:26:00,880 --> 02:26:05,000
THE WHITE MEDICARE BENEFICIARIES

3596
02:26:05,000 --> 02:26:08,280
AND LEFT SIDE THE BLACK. ON THE

3597
02:26:08,280 --> 02:26:10,240
TOP RIGHT HAND SIDE THOSE WHO

3598
02:26:10,240 --> 02:26:11,720
ARE INTERESTED IN MORE DETAILS

3599
02:26:11,720 --> 02:26:14,200
ABOUT METHODOLOGY OF THE PAPER.

3600
02:26:14,200 --> 02:26:15,920
THE STARK CONTRAST BETWEEN THE

3601
02:26:15,920 --> 02:26:17,280
MAPS LEFT AND RIGHT SIDE

3602
02:26:17,280 --> 02:26:18,360
HIGHLIGHT THE PROFOUND

3603
02:26:18,360 --> 02:26:20,000
DISPARITIES IN JOINT REPLACEMENT

3604
02:26:20,000 --> 02:26:22,840
USE THAT EXIST IN 2017 USE OF

3605
02:26:22,840 --> 02:26:26,280
THESE SURGERIES WAS 38 TO 40%

3606
02:26:26,280 --> 02:26:28,320
FOR BLACK BENEFICIARIES COMPARED

3607
02:26:28,320 --> 02:26:30,640
TO WHITE BENEFICIARIES AND I

3608
02:26:30,640 --> 02:26:33,240
THINK DR. BRANNON MENTIONED

3609
02:26:33,240 --> 02:26:36,960
EARLIER FROM THE STUDIES JUST AS

3610
02:26:36,960 --> 02:26:38,480
MUCH IN THE FIRST DECADE AS

3611
02:26:38,480 --> 02:26:39,880
WELL. WHAT WOULD BE

3612
02:26:39,880 --> 02:26:41,280
INTERESTINGLY FOUND IS WHETHER

3613
02:26:41,280 --> 02:26:45,160
IT WAS A WHITE GROUP OR BLACK

3614
02:26:45,160 --> 02:26:48,120
GROUP USE OF SURGERY WAS NOWHERE

3615
02:26:48,120 --> 02:26:49,600
POORER FOR THOSE DULY ELIGIBLE

3616
02:26:49,600 --> 02:26:50,960
FOR MEDICARE AND MEDICAID

3617
02:26:50,960 --> 02:26:54,840
COMPARED TO THE ORIGINAL

3618
02:26:54,840 --> 02:26:56,960
BENEFICIARIES HIGHLIGHTS THE

3619
02:26:56,960 --> 02:26:59,600
DUAL ROLE IN ELIGIBILITY IN USE

3620
02:26:59,600 --> 02:27:02,600
OF THESE SURGERIES.  GIVEN

3621
02:27:02,600 --> 02:27:05,080
IMPORTANCE OF JOINT REPLACEMENT

3622
02:27:05,080 --> 02:27:06,480
MEDICARE IMPLEMENTED SEPARATELY

3623
02:27:06,480 --> 02:27:08,400
DELIVERY OF FORMS OF PAST DECADE

3624
02:27:08,400 --> 02:27:11,280
TO INCREASE THE VALUE OF THESE

3625
02:27:11,280 --> 02:27:13,080
SURGERIES. SOME EXAMPLES INCLUDE

3626
02:27:13,080 --> 02:27:14,680
HOSPITAL READMISSION REDUCTION

3627
02:27:14,680 --> 02:27:15,960
PROGRAM THAT TARGETED

3628
02:27:15,960 --> 02:27:18,120
READMISSION IN JOINT REPLACEMENT

3629
02:27:18,120 --> 02:27:20,120
AND OTHER CONDITIONS IN

3630
02:27:20,120 --> 02:27:21,320
SURGERIES, AND COMPREHENSIVE

3631
02:27:21,320 --> 02:27:23,840
CARE JOINT REPLACEMENT MODEL

3632
02:27:23,840 --> 02:27:26,040
WHICH IS FOCUS OF MY RESEARCH

3633
02:27:26,040 --> 02:27:29,400
AND DR. KIM'S RESEARCH AS WELL,

3634
02:27:29,400 --> 02:27:31,480
AND IT IS A (INAUDIBLE) FOCUSED

3635
02:27:31,480 --> 02:27:36,200
EXCLUSIVELY ON JOINT

3636
02:27:36,200 --> 02:27:37,360
REPLACEMENT. ONE PAYMENT

3637
02:27:37,360 --> 02:27:39,000
RESPONSE SUGGESTS COMPREHENSIVE

3638
02:27:39,000 --> 02:27:41,160
CARE FOR JOINT REPLACEMENT OR

3639
02:27:41,160 --> 02:27:42,720
CGR ARE UNIQUE IN THE SENSE THAT

3640
02:27:42,720 --> 02:27:45,480
THE SPENDING ACUTE AND POST

3641
02:27:45,480 --> 02:27:48,560
ACUTE ARE EPISODES OF BUNDLED

3642
02:27:48,560 --> 02:27:51,960
TOGETHER. HOSPITALS OR OTHER

3643
02:27:51,960 --> 02:27:53,960
ENTITIES SUGGEST FACILITIES

3644
02:27:53,960 --> 02:27:55,040
MAYBE HEALTH ACCOUNTABLE FOR

3645
02:27:55,040 --> 02:27:56,800
QUALITY AND SPENDING DURING THE

3646
02:27:56,800 --> 02:28:00,000
EPISODE.  THESE ENTITIES MAYBE

3647
02:28:00,000 --> 02:28:03,200
ASSESSED PENALTIES, DEPENDING ON

3648
02:28:03,200 --> 02:28:06,040
PERFORMANCE ON QUALITY AND

3649
02:28:06,040 --> 02:28:09,280
SPENDING METRICS. THESE REFORM

3650
02:28:09,280 --> 02:28:11,400
ARE NOT AIMED AT DISPARITIES

3651
02:28:11,400 --> 02:28:13,200
REDUCTION AND MAY

3652
02:28:13,200 --> 02:28:15,120
UNINTENTIONALLY WORSEN

3653
02:28:15,120 --> 02:28:16,240
PRE-EXISTING DISPARITIESES THIS

3654
02:28:16,240 --> 02:28:18,480
MAY OCCUR BECAUSE REFORMS DON'T

3655
02:28:18,480 --> 02:28:22,240
ADJUST SOCIAL RISK AND WE IN

3656
02:28:22,240 --> 02:28:24,880
PREVIOUS SESSION TODAY. WHY DOES

3657
02:28:24,880 --> 02:28:27,200
THIS HAPPEN? WELL ESTABLISHED

3658
02:28:27,200 --> 02:28:28,920
MINORITY INDIVIDUALS AND LOW

3659
02:28:28,920 --> 02:28:30,280
INCOME INDIVIDUALS ARE AT HIGHER

3660
02:28:30,280 --> 02:28:32,560
RISK OF ADVERSE EVENTS AND

3661
02:28:32,560 --> 02:28:33,680
SPENDING ON ACCOUNT OF THE

3662
02:28:33,680 --> 02:28:36,040
HEALTH AND OTHER SOCIAL RISK

3663
02:28:36,040 --> 02:28:37,440
FACTORS. HOWEVER PROVIDERS

3664
02:28:37,440 --> 02:28:39,920
TREATING THESE PATIENTS ARE NOT

3665
02:28:39,920 --> 02:28:41,600
CREDITED FOR HIGHEST SPENDING OR

3666
02:28:41,600 --> 02:28:43,840
EFFORT FOR THESE PATIENTS. HENCE

3667
02:28:43,840 --> 02:28:46,840
PROVIDERS ARE LIKELY TO EXCEED

3668
02:28:46,840 --> 02:28:48,840
SPENDING BENCHMARKS AND BE

3669
02:28:48,840 --> 02:28:50,840
PENALIZED. T THIS LEADS TO BEING

3670
02:28:50,840 --> 02:28:53,880
MORE CAUTIOUS IN SELECTING

3671
02:28:53,880 --> 02:28:54,880
MARGINALIZED OR DISADVANTAGED

3672
02:28:54,880 --> 02:28:56,760
PATIENTS FOR SURGERY, REDUCING

3673
02:28:56,760 --> 02:28:58,600
ACCESS TO SURGERY AND WORSENING

3674
02:28:58,600 --> 02:29:03,000
DISPARITIES. REPORTS FROM

3675
02:29:03,000 --> 02:29:05,440
SEVERAL AGENCIES INCLUDE

3676
02:29:05,440 --> 02:29:07,000
ASSISTANT -- INCLUDING ASSISTANT

3677
02:29:07,000 --> 02:29:08,400
SEC FOR PLANNING AND EVALUATION

3678
02:29:08,400 --> 02:29:10,600
AND NATIONAL ACADEMIES OF

3679
02:29:10,600 --> 02:29:12,680
SCIENCE ENGINEERING AND MEDICINE

3680
02:29:12,680 --> 02:29:14,200
RECOMMENDED THE ADJUSTMENT OF

3681
02:29:14,200 --> 02:29:15,600
SOCIAL RISK ADJUSTMENT OF

3682
02:29:15,600 --> 02:29:17,640
PAYMENT OR ADJUSTMENT OF THE

3683
02:29:17,640 --> 02:29:19,320
PERFORMANCE METRICS IN VALUE

3684
02:29:19,320 --> 02:29:21,720
BASED FOR CHOOSING PROGRAMS SUCH

3685
02:29:21,720 --> 02:29:24,880
AS CGR. THEY RECOMMEND IN AS A

3686
02:29:24,880 --> 02:29:26,640
WAY TO LEVEL PLAYING FIELD FOR

3687
02:29:26,640 --> 02:29:30,040
PROVIDERS WHO CARE FOR

3688
02:29:30,040 --> 02:29:31,720
MARGINALIZED PATIENTS. HOW CAN

3689
02:29:31,720 --> 02:29:33,320
THESE RECOMMENDATIONS BE APPLIED

3690
02:29:33,320 --> 02:29:34,760
IN THE CONTEXT OF TOTAL JOINT

3691
02:29:34,760 --> 02:29:39,080
REPLACEMENT? CGR WAS ABUNDANT

3692
02:29:39,080 --> 02:29:42,080
PAYMENT RESPONSE IMPLEMENTED IN

3693
02:29:42,080 --> 02:29:44,600
2016 IMPROVING QUALITY AND

3694
02:29:44,600 --> 02:29:46,040
REDUCING SPENDING FOR JOINT

3695
02:29:46,040 --> 02:29:47,520
REPLACEMENT, IT WAS MANDATED FOR

3696
02:29:47,520 --> 02:29:49,880
MOST HOSPITALS IN 67

3697
02:29:49,880 --> 02:29:52,040
METROPOLITAN AREAS AND HOSPITALS

3698
02:29:52,040 --> 02:29:53,200
ON PENALTIES OR WOULD BE

3699
02:29:53,200 --> 02:29:55,960
ASSESSED PENALTIES OR THEY WOULD

3700
02:29:55,960 --> 02:29:57,480
BUNDLE DEPENDING ON PERFORMANCE

3701
02:29:57,480 --> 02:30:00,240
IN THE PROGRAM. THE CGR WAS

3702
02:30:00,240 --> 02:30:02,880
REDESIGNED IN 2018, THEN IN

3703
02:30:02,880 --> 02:30:06,880
2021, WITH 2021 REDESIGN

3704
02:30:06,880 --> 02:30:08,080
INTRODUCING KEY DISPARITIES AND

3705
02:30:08,080 --> 02:30:13,360
CHANGES. SEVEN STUDIES HAVE BEEN

3706
02:30:13,360 --> 02:30:16,520
EXAMINE THE IMPACT OF CGR ON

3707
02:30:16,520 --> 02:30:17,720
DISPARITIES AND ALSO BE SPECIFIC

3708
02:30:17,720 --> 02:30:19,600
FOCUS ON SAFETY NET HOSPITALS

3709
02:30:19,600 --> 02:30:21,000
AND CARE THEY DELIVER IN THE

3710
02:30:21,000 --> 02:30:22,800
INTEREST OF TIME I WON'T GO

3711
02:30:22,800 --> 02:30:24,480
THROUGH THE DETAILS OF THIS TYPE

3712
02:30:24,480 --> 02:30:30,240
OF THESE STUDIES BUT HAPPY TO

3713
02:30:30,240 --> 02:30:31,800
SEND OUT REFERENCES AND ALSO

3714
02:30:31,800 --> 02:30:34,800
WANT TO ACKNOWLEDGE FANTASTIC

3715
02:30:34,800 --> 02:30:36,840
DISPARITIES FOCUSED CJR WHICH

3716
02:30:36,840 --> 02:30:38,400
DR. KIM AND COLLEAGUES ALSO

3717
02:30:38,400 --> 02:30:40,120
CONDUCTED AND SOME OF THOSE

3718
02:30:40,120 --> 02:30:44,760
CITATIONS ARE MENTIONED HERE.  

3719
02:30:44,760 --> 02:30:46,720
FOCUS ON OUR WORK DUCTED IN 2021

3720
02:30:46,720 --> 02:30:49,760
WHICH WAS PUBLISHED IN THE JAMA

3721
02:30:49,760 --> 02:30:51,200
NETWORK QR CODE ON THE RIGHT

3722
02:30:51,200 --> 02:30:54,040
HAND SIDE FOR THOSE WHO MAYBE

3723
02:30:54,040 --> 02:30:55,480
INTERESTED. WHERE WE INVESTIGATE

3724
02:30:55,480 --> 02:31:00,040
IMPACT OF CGR DISPARITIES IN THE

3725
02:31:00,040 --> 02:31:03,200
NEWS TOTAL JOINT REPLACEMENT. 

3726
02:31:03,200 --> 02:31:04,680
THIS IS A ONE SLIDE SUMMARY OF

3727
02:31:04,680 --> 02:31:08,520
THE LAST STUDY THAT -- DATA FOR

3728
02:31:08,520 --> 02:31:13,040
MILLIONS OF BENEFICIARIES FROM

3729
02:31:13,040 --> 02:31:17,600
2013 TO 2017. ON THE TOP LEFT

3730
02:31:17,600 --> 02:31:18,920
PANEL 8 IS THE PANEL FOR TOTAL

3731
02:31:18,920 --> 02:31:23,240
HIP REPLACEMENT AND CJR WAS NOT

3732
02:31:23,240 --> 02:31:26,240
ASSOCIATED WITH WORSENING OR

3733
02:31:26,240 --> 02:31:27,480
PREEXISTING DISPARITIES IN USE

3734
02:31:27,480 --> 02:31:28,920
OF TOTAL HIP REPLACEMENT.

3735
02:31:28,920 --> 02:31:32,760
HOWEVER IT DID WORSEN TO A MANY

3736
02:31:32,760 --> 02:31:34,840
DECEMBER EXTENT DISPARITIES IN

3737
02:31:34,840 --> 02:31:37,400
USE OF KNEE REPLACEMENT PANEL

3738
02:31:37,400 --> 02:31:38,840
BOTTOM RIGHT HAND SIDE AND

3739
02:31:38,840 --> 02:31:41,960
ENCLOSED IN RED BOX. NOTE IN

3740
02:31:41,960 --> 02:31:47,240
PANEL B THE FIRST BAR SHOWED CGR

3741
02:31:47,240 --> 02:31:50,440
IMPLEMENTATION KNEE REPLACEMENT

3742
02:31:50,440 --> 02:31:54,760
USED INCREASE WHITE RICH AND

3743
02:31:54,760 --> 02:31:56,800
WHITE POOR, DECREASED FOR BLACK

3744
02:31:56,800 --> 02:32:00,320
RICH AND BLACK POOR NOTED BY THE

3745
02:32:00,320 --> 02:32:02,240
TWO DOWNWARD FACING BARS AND

3746
02:32:02,240 --> 02:32:05,000
KNEE REPLACEMENT INCREASED WOULD

3747
02:32:05,000 --> 02:32:06,560
NOT SIGNIFICANTLY FOR HISPANIC

3748
02:32:06,560 --> 02:32:09,240
BENEFICIARIES. THE LIGHT GREEN

3749
02:32:09,240 --> 02:32:15,080
OR THE TEAL BAR SHOW HOW CHANGE

3750
02:32:15,080 --> 02:32:15,600
FOREFEET INCOME BASE GROUP

3751
02:32:15,600 --> 02:32:19,120
COMPARED TO THE WHITE, A KEY

3752
02:32:19,120 --> 02:32:20,720
REFERENCE POINT. AS YOU NOTE

3753
02:32:20,720 --> 02:32:23,640
FROM THE TWO DOWNWARD LIGHT

3754
02:32:23,640 --> 02:32:25,320
GREEN BARS THAT YOU HAVE

3755
02:32:25,320 --> 02:32:28,080
SUBSTANTIAL MAGNITUDE, CGR WAS

3756
02:32:28,080 --> 02:32:33,080
ASSOCIATED WITH DEEP LINE IN

3757
02:32:33,080 --> 02:32:35,240
KNEE REPLACEMENT FOR BLACK RICH

3758
02:32:35,240 --> 02:32:38,440
AND BLACK POOR BENEFICIARIES

3759
02:32:38,440 --> 02:32:39,720
COMPARED TO POOR WHITE

3760
02:32:39,720 --> 02:32:41,400
BENEFICIARYINGS THIS IS A

3761
02:32:41,400 --> 02:32:42,640
WIDENING IN THE GAP OF THE

3762
02:32:42,640 --> 02:32:44,120
SURGERIES AND CONSEQUENTLY THE

3763
02:32:44,120 --> 02:32:45,480
WORSENING OF DISPARITIES WITH

3764
02:32:45,480 --> 02:32:51,320
THE IMPLEMENTATION OF THE CJR. 

3765
02:32:51,320 --> 02:32:53,120
OVERALL CJR WAS ASSOCIATED WITH

3766
02:32:53,120 --> 02:32:55,280
17 TO 19% FEW ERNIE REPLACEMENT

3767
02:32:55,280 --> 02:32:56,800
FOR BLACK RICH AND BLACK POOR

3768
02:32:56,800 --> 02:32:58,400
INDIVIDUALS COMPARED TO WHITE

3769
02:32:58,400 --> 02:33:01,520
RICH INDIVIDUALS. 

3770
02:33:01,520 --> 02:33:03,840
THESE ARE STUDIES PROVIDE

3771
02:33:03,840 --> 02:33:09,160
EVIDENCE FOR THE CONSENT ABOUT

3772
02:33:09,160 --> 02:33:09,800
PATIENT SELECTION STEMMING FROM

3773
02:33:09,800 --> 02:33:12,560
PAIN IN CGR. THE WORSENING OF

3774
02:33:12,560 --> 02:33:14,440
KNEE REPLACEMENT DISPARITIES AND

3775
02:33:14,440 --> 02:33:18,520
NOT HIP REPLACEMENT DISPARITIES

3776
02:33:18,520 --> 02:33:21,400
-- PRIOR ADVERSE EVENTS AFTER

3777
02:33:21,400 --> 02:33:24,720
LONGER RECOVERY THERE BY

3778
02:33:24,720 --> 02:33:25,560
RESULTING IN PROVIDE EFFORT NOT

3779
02:33:25,560 --> 02:33:27,440
SELECTING IN KNEE REPLACEMENT.

3780
02:33:27,440 --> 02:33:28,760
SIMILAR EFFECTS MANNED OTHER

3781
02:33:28,760 --> 02:33:29,720
PAYMENT RESPONSE THAT DON'T

3782
02:33:29,720 --> 02:33:32,680
ACCOUNT FOR SOCIAL RISK MAY

3783
02:33:32,680 --> 02:33:34,000
CUMULATIVELY WORSEN STATE OF

3784
02:33:34,000 --> 02:33:35,600
PRE-EXISTING JOINT REPLACEMENT

3785
02:33:35,600 --> 02:33:37,520
DISPARITIES. THUS THERE IS A

3786
02:33:37,520 --> 02:33:40,280
NEED FOR RESPONSE TO RISK ADJUST

3787
02:33:40,280 --> 02:33:41,640
AND OTHER APPROACHES THAT

3788
02:33:41,640 --> 02:33:45,800
MITIGATE THE UNINTENDED

3789
02:33:45,800 --> 02:33:48,440
CONSEQUENCES OF (INAUDIBLE) THE

3790
02:33:48,440 --> 02:33:50,480
2021 CJR INTRODUCE ADJUSTMENT

3791
02:33:50,480 --> 02:33:51,520
FOR SOCIAL CLINICAL RISK WHICH

3792
02:33:51,520 --> 02:33:53,480
IS A STEP TOWARDS PROBABLY

3793
02:33:53,480 --> 02:33:55,520
TRANSFORRING THE CJR TO

3794
02:33:55,520 --> 02:33:56,440
DISPARITY REDUCTION AND

3795
02:33:56,440 --> 02:34:03,680
DIMENSION. ' IN 2021 JAMA

3796
02:34:03,680 --> 02:34:07,720
PROPOSED THE IDEA OF -- TO CJR

3797
02:34:07,720 --> 02:34:08,920
EXISTING N QUALITY AND SPENDING.

3798
02:34:08,920 --> 02:34:10,800
WE PROPOSE ADDING DISPARITIES

3799
02:34:10,800 --> 02:34:14,040
REDUCTION AS EXPLICIT -- MAKING

3800
02:34:14,040 --> 02:34:17,520
THE TRIPLE AIM OF KEEPING UNDER

3801
02:34:17,520 --> 02:34:20,760
CONCEPT OF TRIPLE AIM COULD

3802
02:34:20,760 --> 02:34:22,160
TRANSFORM CJR TO NATIONAL

3803
02:34:22,160 --> 02:34:23,440
DISPARITIES REDUCTION

3804
02:34:23,440 --> 02:34:27,280
INTERVENTION. WE SUGGESTED THIS

3805
02:34:27,280 --> 02:34:30,280
BECAUSE DISPARITIES DESPITE

3806
02:34:30,280 --> 02:34:31,360
IMPLEMENTATION OF SEVERAL WELL

3807
02:34:31,360 --> 02:34:33,760
INTENTIONED HIGHLY EFFECTIVE

3808
02:34:33,760 --> 02:34:35,440
LOCAL RESPONSE HIGHLIGHTING THE

3809
02:34:35,440 --> 02:34:38,320
NEED FOR NATIONAL INTERVENTION

3810
02:34:38,320 --> 02:34:41,040
WITH SCOPE, DESIGN DISPARITIES

3811
02:34:41,040 --> 02:34:42,920
REDUCTION INTERVENTION NATIONAL

3812
02:34:42,920 --> 02:34:44,880
INTERVENTION FROM SCRATCH

3813
02:34:44,880 --> 02:34:46,240
REQUIRE CONSENSUS BUILDING AND

3814
02:34:46,240 --> 02:34:49,280
POLITICAL WILL FOR THE

3815
02:34:49,280 --> 02:34:50,720
POSTPONING GOAL OF ACHIEVING

3816
02:34:50,720 --> 02:34:53,720
EQUITY IN CJR CARE. MODIFYING OR

3817
02:34:53,720 --> 02:34:55,920
REFINING EXISTING RESPONSE TO

3818
02:34:55,920 --> 02:34:58,600
CJR TO TARGET DISPARITIES MAYBE

3819
02:34:58,600 --> 02:35:01,320
FAIRLY ACHIEVABLE GOAL. MOREOVER

3820
02:35:01,320 --> 02:35:04,520
IT IS CURRENTLY HOE 400

3821
02:35:04,520 --> 02:35:07,040
HOSPITALS MAKING IT A GREAT TO

3822
02:35:07,040 --> 02:35:09,320
TEST MODIFICATIONS IN CJR BEFORE

3823
02:35:09,320 --> 02:35:13,800
SCALING TO A NATIONAL LEVEL. THE

3824
02:35:13,800 --> 02:35:16,800
2021 CJR UPDATE ADJUSTMENT FOR

3825
02:35:16,800 --> 02:35:18,160
SOCIAL RISK BUT JUST WHAT HAS

3826
02:35:18,160 --> 02:35:21,000
BEEN RECOMMENDED BY LEADING

3827
02:35:21,000 --> 02:35:27,960
NATIONAL AGENCIES.  FINALLY WHAT

3828
02:35:27,960 --> 02:35:31,920
DOES RISK ADJUSTMENT DO?

3829
02:35:31,920 --> 02:35:36,320
MEDICAID CATEGORIES AGE INCREASE

3830
02:35:36,320 --> 02:35:38,400
LIKELIHOOD OF REWARDS, WITH

3831
02:35:38,400 --> 02:35:41,280
JOINT REPLACEMENT FOR BONES BY

3832
02:35:41,280 --> 02:35:42,760
MARGIN FOR MARGINALIZED PATIENT.

3833
02:35:42,760 --> 02:35:45,960
THIS IS A STEP IN THE RIGHT

3834
02:35:45,960 --> 02:35:50,800
DIRECTION USING CJR AS DISPARITY

3835
02:35:50,800 --> 02:35:52,160
INTERVENTION. RISK ADJUSTMENT

3836
02:35:52,160 --> 02:35:56,680
ARE NOT SURPRISE AND CONSIDERED

3837
02:35:56,680 --> 02:35:59,000
MANY THE FUTURE. THESE COULD

3838
02:35:59,000 --> 02:36:02,960
INCLUDE INCLUSION OF DISPARITY

3839
02:36:02,960 --> 02:36:05,080
SENSITIVE METRICS PUBLICLY

3840
02:36:05,080 --> 02:36:07,440
CHANGING THE SIZE OF INCENTIVES

3841
02:36:07,440 --> 02:36:10,640
AND ADJUSTMENT FUNCTIONAL STATUS

3842
02:36:10,640 --> 02:36:12,400
ARE OLD INITIATIVES THAT

3843
02:36:12,400 --> 02:36:13,720
POSSIBLY NEED TO BE CONSIDERED

3844
02:36:13,720 --> 02:36:18,360
IN THE FUTURE. WITH THAT I WOULD

3845
02:36:18,360 --> 02:36:19,760
LIKE TO THANK THE AUDIENCE FOR

3846
02:36:19,760 --> 02:36:21,560
THE ATTENTION. I LOOK FORWARD TO

3847
02:36:21,560 --> 02:36:22,760
QUESTIONS AND COMMENTS AND

3848
02:36:22,760 --> 02:36:24,200
DISCUSSING THIS IN THE BREAK OUT

3849
02:36:24,200 --> 02:36:31,440
SESSIONS. THANK YOU.

3850
02:36:31,440 --> 02:36:35,640
>> THANK YOU, DR.
THIRUKUMARAN.

3851
02:36:35,640 --> 02:36:37,360
WE CAN TURN TO Q&A. I THINK
WE

3852
02:36:37,360 --> 02:36:38,680
HAVE PLENTY OF TIME. THERE IS A

3853
02:36:38,680 --> 02:36:40,080
NUMBER OF QUESTIONS IN THE CHAT

3854
02:36:40,080 --> 02:36:43,320
WHICH I'M GLAD TO READ OUT BUT I

3855
02:36:43,320 --> 02:36:45,960
WANT TO START AND TAKE ON

3856
02:36:45,960 --> 02:36:48,400
BROADER QUESTION, I ENJOYED ALL

3857
02:36:48,400 --> 02:36:51,400
THE PRESENTATIONS, THE LAST

3858
02:36:51,400 --> 02:36:52,200
PRESENTATION I WAS FASCINATING

3859
02:36:52,200 --> 02:36:53,960
ABOUT THE MOTIONEN COLLUDING

3860
02:36:53,960 --> 02:36:58,000
DISPARITIES REDUCTION IN THE

3861
02:36:58,000 --> 02:37:00,920
BUNDLE PAYMENT METHODOLOGY. TWO

3862
02:37:00,920 --> 02:37:04,320
THINGS STRUCK ME. ONE, AS

3863
02:37:04,320 --> 02:37:07,240
PREVIOUSLY DISCUSSED ADJUSTMENT

3864
02:37:07,240 --> 02:37:09,560
WE TEND TO FINDING EFFECTS OF

3865
02:37:09,560 --> 02:37:11,960
DIFFERENT POPULATIONS, SOCIAL

3866
02:37:11,960 --> 02:37:12,960
DETERMINANTS ENTERING INTO

3867
02:37:12,960 --> 02:37:15,440
EQUATION. SO STRATIFICATION

3868
02:37:15,440 --> 02:37:16,440
ISN'T A PRODUCT THAT ALLOWS US

3869
02:37:16,440 --> 02:37:20,720
TO SEE THAT, TO BE ABLE TO

3870
02:37:20,720 --> 02:37:23,680
ADDRESS IT. WONDERING IF CURRENT

3871
02:37:23,680 --> 02:37:24,920
BUNDLE SYSTEMS REPORT THOSE DATA

3872
02:37:24,920 --> 02:37:27,880
INTERNALLY OR PUBLICLY, STRATIFY

3873
02:37:27,880 --> 02:37:29,400
FOR DIFFERENT KINDS OF GROUPS

3874
02:37:29,400 --> 02:37:32,080
NOT QUITE AT THE RELATIONSHIP TO

3875
02:37:32,080 --> 02:37:35,720
PAYMENT YET BUT PUBLIC REPORTING

3876
02:37:35,720 --> 02:37:37,840
OFTEN SHAME PROVIDERS INTO BEING

3877
02:37:37,840 --> 02:37:40,000
MORE EQUITABLE. I DIDN'T KNOW IF

3878
02:37:40,000 --> 02:37:41,440
CURRENT SYSTEM HAS THAT CONCEPT

3879
02:37:41,440 --> 02:37:42,560
BUILT INTO IT.

3880
02:37:42,560 --> 02:37:48,200
>> GREAT QUESTION THEN.
THEY ARE

3881
02:37:48,200 --> 02:37:50,640
ABLE TO ACCOUNT FOR THIS. NOT

3882
02:37:50,640 --> 02:37:52,320
AWARE OF CURRENT PAYMENT

3883
02:37:52,320 --> 02:37:55,440
REFORMS, THAT STRATIFY AND

3884
02:37:55,440 --> 02:37:57,080
REPORT SOME OF THE METRICS WITH

3885
02:37:57,080 --> 02:38:00,360
DISPARITY FOCUS AND I THINK

3886
02:38:00,360 --> 02:38:02,040
PROBABLY MAYBE THE HOSPITAL

3887
02:38:02,040 --> 02:38:03,360
READMISSION REDUCTION PROGRAM, I

3888
02:38:03,360 --> 02:38:05,600
KNOW HAD SOME STRATIFICATION,

3889
02:38:05,600 --> 02:38:07,800
NOT TOO CLEAR AROUND THAT BUT

3890
02:38:07,800 --> 02:38:11,400
DEFINITELY CGR DOESN'T AS FAR AS

3891
02:38:11,400 --> 02:38:16,440
I CAN RECALL HAVE STRATIFICATION

3892
02:38:16,440 --> 02:38:17,720
MEEK NICHE PUBLICLY AVAILABLE

3893
02:38:17,720 --> 02:38:19,120
AND THAT SOMETHING WE THINK

3894
02:38:19,120 --> 02:38:22,120
WOULD BE QUITE AN IMPORTANT

3895
02:38:22,120 --> 02:38:24,720
INITIATIVE BUT THINGS CMS

3896
02:38:24,720 --> 02:38:26,040
RECOGNIZED AND INTRODUCE.  THERE

3897
02:38:26,040 --> 02:38:28,320
IS ADJUSTMENT AS FIRST STEP,

3898
02:38:28,320 --> 02:38:29,920
LOOKING FORWARD TO SEEING WHAT

3899
02:38:29,920 --> 02:38:34,880
MORE IT HAS IN COMMON.

3900
02:38:34,880 --> 02:38:38,640
>> ARE THERE QUESTIONS
FROM THE

3901
02:38:38,640 --> 02:38:40,120
AUDIENCE? AND WHILE YOU ARE

3902
02:38:40,120 --> 02:38:41,320
THINKING ABOUT THEM, I CAN READ

3903
02:38:41,320 --> 02:38:42,320
THE QUESTIONS THAT CAME THROUGH

3904
02:38:42,320 --> 02:38:46,200
ON THE CHAT. SO A QUESTION FOR

3905
02:38:46,200 --> 02:38:47,960
DR. MESSIER WAS ASKING ABOUT HOW

3906
02:38:47,960 --> 02:38:51,480
DO YOU ADJUST FOR SEX

3907
02:38:51,480 --> 02:38:53,160
DETERMINING PAIN MEASUREMENT

3908
02:38:53,160 --> 02:38:55,240
BETWEEN URBAN AND RURAL

3909
02:38:55,240 --> 02:38:56,080
COMMUNITIES FOR PATIENT

3910
02:38:56,080 --> 02:38:56,560
POPULATIONS.

3911
02:38:56,560 --> 02:39:00,560
>> WE ADJUST ANY
DISCREPANCY IN

3912
02:39:00,560 --> 02:39:03,440
NUMBER OF MALES AND FEMALES

3913
02:39:03,440 --> 02:39:06,200
BETWEEN GROUPS AT BASELINE SO

3914
02:39:06,200 --> 02:39:08,040
ADJUSTING FOR THAT AT BASELINE.

3915
02:39:08,040 --> 02:39:15,800
WE DO THAT FOR OUR ANALYSIS. 

3916
02:39:15,800 --> 02:39:16,480
>> QUESTIONS.

3917
02:39:16,480 --> 02:39:18,840
>> I HAD A QUESTION ABOUT
HER

3918
02:39:18,840 --> 02:39:20,720
STUDY WHICH I THOUGHT WAS

3919
02:39:20,720 --> 02:39:22,640
INTERESTING. SIMPLY WHAT HAPPENS

3920
02:39:22,640 --> 02:39:27,600
WHEN PATIENTS AFTER THEY LEFT

3921
02:39:27,600 --> 02:39:29,480
YOUR TRIAL URBAN RURAL PATIENTS

3922
02:39:29,480 --> 02:39:31,040
MIGHT HAVE ACCESS TO DIFFERENT

3923
02:39:31,040 --> 02:39:35,200
KINDS OF EXERCISE CAPABILITIES

3924
02:39:35,200 --> 02:39:38,160
AND DIET OUTSIDE OF YOUR TRIAL

3925
02:39:38,160 --> 02:39:39,600
AND CURIOUS WAS THAT PART OF

3926
02:39:39,600 --> 02:39:42,360
WHAT YOU LOOKED AT LONGER TERM

3927
02:39:42,360 --> 02:39:47,120
AFTER NO LONGER RECEIVING?

3928
02:39:47,120 --> 02:39:50,560
>> THE TRIAL HAS JUST BEEN

3929
02:39:50,560 --> 02:39:52,720
FINISHED, IN FACT THE OUTCOME

3930
02:39:52,720 --> 02:39:56,240
PAPER IS UNDER REVIEW RIGHT NOW.

3931
02:39:56,240 --> 02:40:00,080
IT IS FRESH OFF THE PRESS. AS I

3932
02:40:00,080 --> 02:40:02,360
SPEAK. SO WE WOULD LIKE TO DO

3933
02:40:02,360 --> 02:40:03,600
THAT WITH 820 SOMETHING PEOPLE

3934
02:40:03,600 --> 02:40:07,240
IN THE STUDY, IT WOULD BE

3935
02:40:07,240 --> 02:40:09,000
POSSIBLE I THINK TO FOLLOW A

3936
02:40:09,000 --> 02:40:11,360
GOOD NUMBER OF THEM AFTERWARDS

3937
02:40:11,360 --> 02:40:12,120
AND THAT WOULD BE INTERESTING.

3938
02:40:12,120 --> 02:40:14,640
WE HAVE DONE THAT SMALLER SCALE

3939
02:40:14,640 --> 02:40:18,080
PREVIOUS STUDY THAT WECAN WAS

3940
02:40:18,080 --> 02:40:20,200
BASED ON, THE IDEA TRIAL WHICH

3941
02:40:20,200 --> 02:40:23,840
WAS MORE AN EFFICACY TRIAL. AND

3942
02:40:23,840 --> 02:40:26,640
WE GOT AFTER THREE AND A HALF

3943
02:40:26,640 --> 02:40:31,480
YEARS PEOPLE COMING BACK, WE GOT

3944
02:40:31,480 --> 02:40:33,760
ABOUT ONE QUARTER OF THEM BACK. 

3945
02:40:33,760 --> 02:40:35,240
THERE WERE 400 SOMETHING IN THE

3946
02:40:35,240 --> 02:40:37,720
STUDY. WE GOT ABOUT A HUNDRED

3947
02:40:37,720 --> 02:40:40,080
BACK. SO IT IS TWICE AS MANY

3948
02:40:40,080 --> 02:40:41,640
HERE, HOPEFULLY WE CAN GET MORE

3949
02:40:41,640 --> 02:40:44,440
PEOPLE COMING BACK AFTER THREE

3950
02:40:44,440 --> 02:40:46,720
OR FOUR OR FIVE YEARS.

3951
02:40:46,720 --> 02:40:48,760
>> WONDERING IF THERE WAS

3952
02:40:48,760 --> 02:40:49,640
TARGETED COUNSELING OF THE THE

3953
02:40:49,640 --> 02:40:52,280
DIFFERENT GROUPS ABOUT THE

3954
02:40:52,280 --> 02:40:54,720
EXERCISE, WE SHOULD ENGAGE IN,

3955
02:40:54,720 --> 02:40:56,760
IMAGINE AGAIN WHAT THEY COULD DO

3956
02:40:56,760 --> 02:41:00,840
MIGHT DIFFER DEPENDING ON THE

3957
02:41:00,840 --> 02:41:01,160
TWO STUDIES.

3958
02:41:01,160 --> 02:41:03,120
>> WE USE SOCIAL COGNITIVE

3959
02:41:03,120 --> 02:41:04,840
THEORY, WE TRAIN OUR

3960
02:41:04,840 --> 02:41:05,600
INTERVENTIONISTS AND SOCIAL

3961
02:41:05,600 --> 02:41:09,480
COGNITIVE THEORY. SO BECAUSE THE

3962
02:41:09,480 --> 02:41:11,520
STUDY WAS REALLY LOOKING AT THE

3963
02:41:11,520 --> 02:41:16,640
EFFECT OF DIET AND EXERCISE,

3964
02:41:16,640 --> 02:41:19,560
VERSUS CONTROL IT JUST HAPPENED

3965
02:41:19,560 --> 02:41:21,960
OUR COMMUNITIES DIVIDED EVENLY

3966
02:41:21,960 --> 02:41:23,960
BETWEEN RURAL AND URBAN. IT

3967
02:41:23,960 --> 02:41:34,520
MAKES FOR NICE ANCILLARY STUDY. 

3968
02:41:35,440 --> 02:41:37,600
>> DID SOMEONE HAVE A
QUESTION

3969
02:41:37,600 --> 02:41:37,720
IN

3970
02:41:37,720 --> 02:41:39,000
>> THERE WAS COUPLE OF
QUESTIONS

3971
02:41:39,000 --> 02:41:40,680
FOR DR. KIM IN THE CHAT.

3972
02:41:40,680 --> 02:41:42,880
>> IS THIS -- I SEE ONE,
ANY

3973
02:41:42,880 --> 02:41:45,200
THOUGHTS ON ANALYZING ACCESS TO

3974
02:41:45,200 --> 02:41:47,080
REHAB, PHYSICAL THERAPY IN A

3975
02:41:47,080 --> 02:41:49,520
SIMILAR WAY TO JOINT

3976
02:41:49,520 --> 02:41:49,840
REPLACEMENT?

3977
02:41:49,840 --> 02:41:53,400
>> FOR ONE UNDER REVIEW WE
DID

3978
02:41:53,400 --> 02:41:59,160
THAT AND WE FOUND FOR IN PATIENT

3979
02:41:59,160 --> 02:42:01,160
PATIENTS, THEY ARE SICKER, THEY

3980
02:42:01,160 --> 02:42:04,000
WERE MORE LIKELY TO USING USUAL

3981
02:42:04,000 --> 02:42:05,240
POST ACUTE CARE COMPARED TO

3982
02:42:05,240 --> 02:42:11,080
PEOPLE WHO RECEIVED OUTPATIENTS

3983
02:42:11,080 --> 02:42:15,200
OR (INAUDIBLE).

3984
02:42:15,200 --> 02:42:16,880
>> LOST IN THE CHAT,
ANOTHER ONE

3985
02:42:16,880 --> 02:42:19,760
FOR DR. KIM?

3986
02:42:19,760 --> 02:42:22,640
>> IT IS HERE THE
OUTPATIENT OP

3987
02:42:22,640 --> 02:42:24,400
ARE CHEAPER THAN IN PATIENT AND

3988
02:42:24,400 --> 02:42:26,240
THOSE MINORITIES RECEIVE MORE

3989
02:42:26,240 --> 02:42:27,160
OUTPATIENT. WOULDN'T THAT

3990
02:42:27,160 --> 02:42:28,840
INDICATE MORE ACCESSIBILITY

3991
02:42:28,840 --> 02:42:30,160
BECAUSE IT IS CHEAPER?

3992
02:42:30,160 --> 02:42:35,680
>> WHAT WE FOUND IS WHEN
WE LOOK

3993
02:42:35,680 --> 02:42:38,960
AT OUT OF POCKET COSTS,

3994
02:42:38,960 --> 02:42:40,960
OUTPATIENT WERE MORE EXPENSIVE

3995
02:42:40,960 --> 02:42:43,040
THAN IN PATIENT BUT IF YOU LOOK

3996
02:42:43,040 --> 02:42:45,000
AT THE TOTAL PAYMENT THAT

3997
02:42:45,000 --> 02:42:47,480
INCLUDES OUTPATIENT OUTOF POCKET

3998
02:42:47,480 --> 02:42:52,600
COST AND THEN PAYMENT FROM -- TO

3999
02:42:52,600 --> 02:42:54,640
PROVIDER INPATIENT IS A LOT MORE

4000
02:42:54,640 --> 02:42:55,720
EXPENSIVE THAN OUTPATIENT BUT

4001
02:42:55,720 --> 02:43:01,040
LOOK AT THE PATIENT BURDEN

4002
02:43:01,040 --> 02:43:02,760
SURPRISINGLY OUTPATIENT WERE

4003
02:43:02,760 --> 02:43:11,360
MORE SEX PENS EXPENSIVE.

4004
02:43:11,360 --> 02:43:15,720
>> HERE IS A QUESTION FOR
DR.

4005
02:43:15,720 --> 02:43:18,440
THIRUKUMARAN. IF YOU DEVISE A

4006
02:43:18,440 --> 02:43:20,760
PROGRAM TO TRIPLE BENEFITS,

4007
02:43:20,760 --> 02:43:22,280
OUTCOSTS VERSUS DISPARITIES,

4008
02:43:22,280 --> 02:43:23,800
WHAT WOULD YOU USE TO INCLUDE

4009
02:43:23,800 --> 02:43:25,000
DISPARITIES? WOULD YOU THINK

4010
02:43:25,000 --> 02:43:27,240
DATA SYSTEMS ARE ADEQUATE TO

4011
02:43:27,240 --> 02:43:28,040
SUPPORT INTERVENTION?

4012
02:43:28,040 --> 02:43:31,680
>> THANK YOU DR. KATZ FOR
THAT

4013
02:43:31,680 --> 02:43:34,440
QUESTION. I HAVE -- SOME OF IT

4014
02:43:34,440 --> 02:43:36,760
COVERED IN -- SOME COVERED IN

4015
02:43:36,760 --> 02:43:38,640
TRIPLE E PIECE BUT YOU RAISE A

4016
02:43:38,640 --> 02:43:40,800
VERY IMPORTANT POINT ABOUT

4017
02:43:40,800 --> 02:43:43,520
WHETHER WE ARE GEARED TO BE ABLE

4018
02:43:43,520 --> 02:43:45,440
TO INCLUDE WHAT WE WANT TO

4019
02:43:45,440 --> 02:43:48,640
INCLUDE AND THIS IS IN

4020
02:43:48,640 --> 02:43:50,360
INTERVENTIONS AND THE DATA

4021
02:43:50,360 --> 02:43:52,120
SYSTEMS ARE SOMEWHERE WHERE WE

4022
02:43:52,120 --> 02:43:55,120
NEED A LOT MORE WORK TO BE DONE.

4023
02:43:55,120 --> 02:43:58,520
THAT IS GOING TO BE WORK IN

4024
02:43:58,520 --> 02:44:00,960
PROGRESS. BEING THE OPTIMIST I

4025
02:44:00,960 --> 02:44:03,200
AM, I WOULD LIKE START WITH WHAT

4026
02:44:03,200 --> 02:44:05,320
WE HAVE AND ADMINISTRATIVE DATA

4027
02:44:05,320 --> 02:44:06,760
WHICH WE HAVE ACCESS WHICH IS

4028
02:44:06,760 --> 02:44:09,080
FOUND TO GENERATE FAIRLY

4029
02:44:09,080 --> 02:44:10,640
SENSITIVE STANDARDIZED

4030
02:44:10,640 --> 02:44:15,160
COMPLICATION RATES, I THINK DR.

4031
02:44:15,160 --> 02:44:16,240
(INAUDIBLE) WORK HAVE SHOWN

4032
02:44:16,240 --> 02:44:17,640
SENSITIVITY OF IDENTIFYING

4033
02:44:17,640 --> 02:44:19,480
COMPLICATIONS THROUGH

4034
02:44:19,480 --> 02:44:21,960
ADMINISTRATIVE DATA ARE ABOUT

4035
02:44:21,960 --> 02:44:24,560
99% WHEN COMPARED TO MEDICAL

4036
02:44:24,560 --> 02:44:26,280
RECORD DATA AND AGAIN I THINK MY

4037
02:44:26,280 --> 02:44:28,200
OPINION THAT'S A GREAT PLACE TO

4038
02:44:28,200 --> 02:44:29,840
START OFF WITH WHAT WE HAVE.

4039
02:44:29,840 --> 02:44:32,600
THAT IS CERTAINLY NOT SUFFICIENT

4040
02:44:32,600 --> 02:44:36,360
AND GETTING GRANULAR CLINICAL

4041
02:44:36,360 --> 02:44:39,360
DATA PLACE TO GO. CJR HAS A

4042
02:44:39,360 --> 02:44:41,840
OPTION TO DO THAT, WE TALK ABOUT

4043
02:44:41,840 --> 02:44:45,560
THAT IN THAT PERSPECTIVE. CJR

4044
02:44:45,560 --> 02:44:48,080
HAS VOLUNTARY OPTION, TWO

4045
02:44:48,080 --> 02:44:50,080
ADDITIONAL POINTS FOR REPORTING

4046
02:44:50,080 --> 02:44:51,840
ON CERTAIN PATIENT REPORTED

4047
02:44:51,840 --> 02:44:54,200
OUTCOME METRICS. CJR DOESN'T

4048
02:44:54,200 --> 02:44:56,520
PUBLICLY -- IT PUBLICLY REPORTS

4049
02:44:56,520 --> 02:44:58,280
ON WHETHER OR NOT A HOSPITAL

4050
02:44:58,280 --> 02:45:00,720
SUBMITTED PROs AND WHAT THE

4051
02:45:00,720 --> 02:45:03,920
VALUE OF THOSE PRO. SO LOW

4052
02:45:03,920 --> 02:45:06,400
HANGING FRUIT TO BE ABLE TO MAKE

4053
02:45:06,400 --> 02:45:08,440
THAT DATA PUBLICLY VAILND AND

4054
02:45:08,440 --> 02:45:11,760
SURE THERE IS BIAS IN THAT

4055
02:45:11,760 --> 02:45:12,960
BECAUSE RESOURCE HOSPITALS ARE

4056
02:45:12,960 --> 02:45:14,920
MORE LIKELY TO BE ABLE TO

4057
02:45:14,920 --> 02:45:19,280
PREVENT -- PRESENT THAT DATA

4058
02:45:19,280 --> 02:45:21,280
THAN HOSPITAL DO NOT HAVE

4059
02:45:21,280 --> 02:45:24,200
RESOURCE TO REPORT ON THAT. THAT

4060
02:45:24,200 --> 02:45:25,480
POTENTIALLY IS THE NEXT SECOND

4061
02:45:25,480 --> 02:45:27,680
LOW HANGING FRUIT TO REPORT ON

4062
02:45:27,680 --> 02:45:29,400
USING WITHIN THE FRAMEWORK THAT

4063
02:45:29,400 --> 02:45:32,320
EXISTS IN THE CJR. BECAUSE WE

4064
02:45:32,320 --> 02:45:35,960
MOVE AHEAD METRICS FUNCTIONAL

4065
02:45:35,960 --> 02:45:37,320
VISIBILITY KEY IN RISK

4066
02:45:37,320 --> 02:45:40,160
ADJUSTMENT PIECE ON SOME

4067
02:45:40,160 --> 02:45:41,720
MEASURES SUCH AS CLINICAL USE,

4068
02:45:41,720 --> 02:45:43,920
GETTING REUSE ADMINISTRATIVE

4069
02:45:43,920 --> 02:45:46,040
DATA, WE ONLY ACCOUNT FOR

4070
02:45:46,040 --> 02:45:47,160
METRICS WHETHER OR NOT A PATIENT

4071
02:45:47,160 --> 02:45:50,160
HAD OA BUT NOT SEVERITY OF OA.

4072
02:45:50,160 --> 02:45:54,360
SO I'M HOPING THAT WITH YOUR

4073
02:45:54,360 --> 02:45:55,560
INSIGHTS THAT MAYBE A GREAT

4074
02:45:55,560 --> 02:45:58,000
PLACE TO MOVE AHEAD, GREAT PATH

4075
02:45:58,000 --> 02:46:00,640
TO TAKE TOWARDS GETTING MORE

4076
02:46:00,640 --> 02:46:02,480
GRANULAR CLINICAL DATA MADE

4077
02:46:02,480 --> 02:46:08,080
AVAILABLE BUT THERE ARE SOME

4078
02:46:08,080 --> 02:46:10,480
POTENTIALLY LEVERAGED TO HAVE

4079
02:46:10,480 --> 02:46:12,040
STRATIFIED REPORTING OTHER

4080
02:46:12,040 --> 02:46:15,040
DISPARITIES SENSITIVE METRICS,

4081
02:46:15,040 --> 02:46:19,160
WITHIN CJR POTENTIALLY COULD BE

4082
02:46:19,160 --> 02:46:22,360
TEMPLATE OF THAT REFORMS AS

4083
02:46:22,360 --> 02:46:22,720
WELL.

4084
02:46:22,720 --> 02:46:25,360
>> DR. MOY I HAD A
QUESTION FOR

4085
02:46:25,360 --> 02:46:28,640
DR. ENDSLEY, THIS IS DAN, DR.

4086
02:46:28,640 --> 02:46:31,960
ENDSLEY I APPRECIATED YOUR TALK

4087
02:46:31,960 --> 02:46:34,680
TODAY BECAUSE WE HEARD A GOOD

4088
02:46:34,680 --> 02:46:36,560
BIT ABOUT DECISION AIDS WHICH

4089
02:46:36,560 --> 02:46:38,800
OBVIOUSLY PLACES BURDEN ON

4090
02:46:38,800 --> 02:46:41,280
PATIENTS TO LEARN MORE BEFORE

4091
02:46:41,280 --> 02:46:43,560
THEY SEE THEIR PROVIDER. WHAT

4092
02:46:43,560 --> 02:46:47,520
YOU TALKED ABOUT I THOUGHT

4093
02:46:47,520 --> 02:46:49,160
SOUNDED COULD BE SHAPED INTO AN

4094
02:46:49,160 --> 02:46:50,880
INTERVENTION FOR PROVIDER. SEEMS

4095
02:46:50,880 --> 02:46:54,080
LIKE WE ARE MISSING AN

4096
02:46:54,080 --> 02:46:54,960
OPPORTUNITY FOR THIS SHARE

4097
02:46:54,960 --> 02:46:56,440
DECISION MAKING APPROACH IF WE

4098
02:46:56,440 --> 02:46:59,000
ARE NOT PROVIDING AN

4099
02:46:59,000 --> 02:47:00,560
INTERVENTION FOR PROVIDERS AN

4100
02:47:00,560 --> 02:47:01,800
EXPECTING PATIENTS TO CARRY THE

4101
02:47:01,800 --> 02:47:04,960
BURDEN.  WONDERING IF YOU MIGHT

4102
02:47:04,960 --> 02:47:07,640
COMMENT ON THAT. IN OTHER

4103
02:47:07,640 --> 02:47:09,400
MEDICAL -- MEDICALLY TREATED

4104
02:47:09,400 --> 02:47:12,080
DISORDERS DIABETES AND SO FORTH,

4105
02:47:12,080 --> 02:47:13,800
THE INTERVENTIONIST IS THE ONE

4106
02:47:13,800 --> 02:47:15,080
THAT'S THE TARGET FOR THE

4107
02:47:15,080 --> 02:47:16,880
INTERVENTION, NOT NECESSARILY

4108
02:47:16,880 --> 02:47:18,640
THE PATIENT. SO BONDING ARE IF

4109
02:47:18,640 --> 02:47:20,360
YOU MIGHT COMMENT ON THAT.

4110
02:47:20,360 --> 02:47:24,160
>> I THINK THAT OFTEN
TIMES

4111
02:47:24,160 --> 02:47:26,280
UNFORTUNATELY MY WORK WITH

4112
02:47:26,280 --> 02:47:28,040
VETERANS OF COLOR IN PARTICULAR,

4113
02:47:28,040 --> 02:47:30,280
OFTEN TIMES FEEL LIKE A LOT OF

4114
02:47:30,280 --> 02:47:32,600
ONUS IS PLACED ON THEM, THAT CAN

4115
02:47:32,600 --> 02:47:34,520
BE CHALLENGING AS THEY MANAGE SO

4116
02:47:34,520 --> 02:47:37,360
MANY DIFFERENT THINGS, SO MANY

4117
02:47:37,360 --> 02:47:38,360
DIFFERENT HEALTH CONDITIONS. IN

4118
02:47:38,360 --> 02:47:43,080
A LOT OF WAYS WE HAVE -- WE HAVE

4119
02:47:43,080 --> 02:47:45,480
SORT OF INSTITUTIONAL POWER AND

4120
02:47:45,480 --> 02:47:47,200
WE HAVE THE KNOWLEDGE AND THE

4121
02:47:47,200 --> 02:47:49,320
OTHER THINGS TO BE ABLE TO DO --

4122
02:47:49,320 --> 02:47:52,480
TO MAKE THOSE CHANGES BROADLY.

4123
02:47:52,480 --> 02:47:56,520
SO I WOULD AGREE, SOMETIMES

4124
02:47:56,520 --> 02:47:58,320
USING TOOLS TO CHANGE PROVIDER

4125
02:47:58,320 --> 02:48:01,560
BEHAVIOR HAS SIGNIFICANT IMPACT

4126
02:48:01,560 --> 02:48:03,640
ON VETERAN ENGAGEMENT AND

4127
02:48:03,640 --> 02:48:07,360
HEALTHCARE FOLLOWING THROUGH ON

4128
02:48:07,360 --> 02:48:09,520
RECOMMENDATIONS, CLIENTS THERE

4129
02:48:09,520 --> 02:48:11,240
BUT I DO THINK THOSE CAN BE

4130
02:48:11,240 --> 02:48:12,120
REALLY IMPORTANT, SOMETIMES

4131
02:48:12,120 --> 02:48:14,840
THAT'S LEFT OUT OF THE

4132
02:48:14,840 --> 02:48:16,320
CONVERSATION. AND MANY VETERANS

4133
02:48:16,320 --> 02:48:19,720
FEEL LIKE THEY GET BLAMED FOR

4134
02:48:19,720 --> 02:48:20,600
THEIR HEALTHCARE CONDITIONS

4135
02:48:20,600 --> 02:48:22,080
VERSUS GET SUPPORT AND HELP THEY

4136
02:48:22,080 --> 02:48:23,880
ARE LOOKING FOR AT TIMES SO ONE

4137
02:48:23,880 --> 02:48:28,240
WAY IS TO TRY TO REVERSE THAT.

4138
02:48:28,240 --> 02:48:30,520
SOMETIMES ACTION ISN'T ABOUT

4139
02:48:30,520 --> 02:48:32,160
PATIENT, SOMETIMES INTERACTIONS

4140
02:48:32,160 --> 02:48:33,840
IS BECAUSE OF HISTORY OF RACISM

4141
02:48:33,840 --> 02:48:37,600
AND DISCRIMINATION AND HOW THEY

4142
02:48:37,600 --> 02:48:40,040
ARE PRESENTING MAKE MORE DUE TO

4143
02:48:40,040 --> 02:48:40,720
THAT THAN INDIVIDUAL

4144
02:48:40,720 --> 02:48:41,520
CHARACTERISTICS OR THINGS LIKE

4145
02:48:41,520 --> 02:48:44,840
THAT BUT THEY GET BLAMED FOR

4146
02:48:44,840 --> 02:48:46,920
REALISTIC CONCERNS WHEN IT COMES

4147
02:48:46,920 --> 02:48:50,800
TO HISTORY WITH RACISM AND

4148
02:48:50,800 --> 02:48:52,360
DISCRIMINATION. ON THE PROVIDER

4149
02:48:52,360 --> 02:48:53,160
SIDE IT IS IMPORTANT TO

4150
02:48:53,160 --> 02:48:54,480
RECOGNIZE THAT, I KNOW THAT

4151
02:48:54,480 --> 02:49:00,040
THAT'S CHANGED THE RELATIONSHIP

4152
02:49:00,040 --> 02:49:01,800
IN THERAPY MANY TIMES WHEN I

4153
02:49:01,800 --> 02:49:03,480
RECOGNIZE THOSE BEHAVIORS, TALK

4154
02:49:03,480 --> 02:49:04,920
THROUGH IT, IT COMES FROM A

4155
02:49:04,920 --> 02:49:06,240
PLACE OF HEY I HAVE HAD THESE

4156
02:49:06,240 --> 02:49:10,560
AWFUL EXPERIENCES IN HEALTHCARE.

4157
02:49:10,560 --> 02:49:14,840
LESS PROVIDERS ASKING ABOUT

4158
02:49:14,840 --> 02:49:18,880
THOSE THINGS IN THE SESSION IT

4159
02:49:18,880 --> 02:49:23,120
IS BEST. THERE IS A PLACE FOR IN

4160
02:49:23,120 --> 02:49:25,080
SOME WAYS BOTH, THERE IS A PLACE

4161
02:49:25,080 --> 02:49:28,240
FOR PATIENTS TO LEARN MORE BUT

4162
02:49:28,240 --> 02:49:29,640
THEY FEEL MOST COMFORTABLE

4163
02:49:29,640 --> 02:49:30,840
LEARNING FROM A TRUSTED

4164
02:49:30,840 --> 02:49:36,880
PROVIDER. JUST FOCUS ON THE

4165
02:49:36,880 --> 02:49:39,200
PATIENT WE LOSE A HUGE PART OF

4166
02:49:39,200 --> 02:49:42,280
THAT RELATIONSHIP WHICH IS

4167
02:49:42,280 --> 02:49:43,400
HEALTHCARE PROFESSIONAL WORKING

4168
02:49:43,400 --> 02:49:48,160
WITH VENDORS. 

4169
02:49:48,160 --> 02:49:51,440
>> I APPRECIATE THAT, IN
MY AREA

4170
02:49:51,440 --> 02:49:53,880
OF ARTHROPLASTY RESEARCH WE

4171
02:49:53,880 --> 02:49:56,040
THINK OF THE ORTHOPEDIC SURGEON

4172
02:49:56,040 --> 02:50:01,160
BEING TOO BUSY TO LEARN HOW BEST

4173
02:50:01,160 --> 02:50:02,480
TO CONVEY INFORMATION TO

4174
02:50:02,480 --> 02:50:04,280
PATIENTS ABOUT OPTIONS. IT IS A

4175
02:50:04,280 --> 02:50:05,720
LOST OPPORTUNITY. THANK YOU FOR

4176
02:50:05,720 --> 02:50:11,400
YOUR ANSWER.

4177
02:50:11,400 --> 02:50:15,480
>> THANKS FOR A NICE TALK.

4178
02:50:15,480 --> 02:50:16,920
QUESTION WHETHER URBAN RURAL

4179
02:50:16,920 --> 02:50:20,200
STUDY WHETHER YOU ARE ABLE TO

4180
02:50:20,200 --> 02:50:23,280
LOOK AT WIDER AFRICAN AMERICAN

4181
02:50:23,280 --> 02:50:25,080
-- WHITE AND AFRICAN AMERICAN IN

4182
02:50:25,080 --> 02:50:26,120
RESPONSE IF YOU HAD SIGNIFICANT

4183
02:50:26,120 --> 02:50:27,120
NUMBERS OF PATIENTS TO DO THAT.

4184
02:50:27,120 --> 02:50:33,840
>> WE DO. WE HAD A 48%
AFRICAN

4185
02:50:33,840 --> 02:50:38,360
AMERICAN OUT OF 823. WHAT WE

4186
02:50:38,360 --> 02:50:42,440
DIDN'T DO WAS COLLECT ALL THE

4187
02:50:42,440 --> 02:50:43,800
SOCIAL DETERMINANTS THAT YOU

4188
02:50:43,800 --> 02:50:48,080
REALLY NEED TO BE ABLE TO

4189
02:50:48,080 --> 02:50:49,520
COMPARE BLACK VERSUS WHITE. SO

4190
02:50:49,520 --> 02:50:53,560
I'M HESITANT TO SHOW THOSE DATA

4191
02:50:53,560 --> 02:51:00,840
WITHOUT SOCIAL DETERMINANTS. 

4192
02:51:00,840 --> 02:51:07,680
THAT'S HONEST ANSWER.

4193
02:51:07,680 --> 02:51:09,720
>> I WAS THINKING
HARMONIZATION

4194
02:51:09,720 --> 02:51:13,920
ABOUT DR. KIM STUDY, IN DR.

4195
02:51:13,920 --> 02:51:15,600
KIM'S STUDY FOUND THAT AFRICAN

4196
02:51:15,600 --> 02:51:16,840
AMERICAN PATIENTS WERE LESS

4197
02:51:16,840 --> 02:51:19,240
LIKELY TO GET OUTPATIENT JOINT

4198
02:51:19,240 --> 02:51:21,000
REPLACEMENT AND MAY JUMP TO THE

4199
02:51:21,000 --> 02:51:23,760
CONCLUSION ACCESS ISSUE BUT ALSO

4200
02:51:23,760 --> 02:51:25,680
A TRUST ISSUE, VERY OFTEN FIND

4201
02:51:25,680 --> 02:51:30,280
THAT NEW TECHNOLOGIES ARE --

4202
02:51:30,280 --> 02:51:32,280
MAKE PEOPLE NERVOUS, UNLESS YOU

4203
02:51:32,280 --> 02:51:34,320
TRUST THE PERSON ADVOCATING THIS

4204
02:51:34,320 --> 02:51:36,240
NEW TECHNOLOGY MAYBE HESITANT TO

4205
02:51:36,240 --> 02:51:40,280
DO IT, JUST GIVE YOU THE OLD

4206
02:51:40,280 --> 02:51:41,680
FASHIONED I WANT TO DO IT

4207
02:51:41,680 --> 02:51:42,880
OUTPATIENT WAY AND ASK THE TWO

4208
02:51:42,880 --> 02:51:44,040
OF YOU, IF THAT MIGHT BE

4209
02:51:44,040 --> 02:51:45,520
HAPPENING OR IF THERE MIGHT BE

4210
02:51:45,520 --> 02:51:47,280
WAYS TO COMMUNICATE MORE

4211
02:51:47,280 --> 02:51:50,120
EFFECTIVELY FOR THE PATIENTS TO

4212
02:51:50,120 --> 02:51:53,000
MAKE TRUE INFORMED DECISION THAT

4213
02:51:53,000 --> 02:51:55,360
INCORPORATES PROS AND CONS OF

4214
02:51:55,360 --> 02:52:00,840
TECHNOLOGY. 

4215
02:52:00,840 --> 02:52:02,800
>> WE NEED RESEARCH IN
THIS

4216
02:52:02,800 --> 02:52:04,120
AREA, IT IS EMERGING EVIDENCE

4217
02:52:04,120 --> 02:52:05,640
AND WE NEED TO STUDY WHY THIS IS

4218
02:52:05,640 --> 02:52:11,760
HAPPENING. TRUST ISSUE I THINK

4219
02:52:11,760 --> 02:52:13,200
THAT MAYBE ONE PART DEFINITELY

4220
02:52:13,200 --> 02:52:14,760
BUT WE NEED EVIDENCE.  THANK

4221
02:52:14,760 --> 02:52:22,320
YOU.

4222
02:52:22,320 --> 02:52:25,320
>> ARE THERE WAYS TO
MEASURE

4223
02:52:25,320 --> 02:52:26,760
THIS, MEASURE THE TRAUMA,

4224
02:52:26,760 --> 02:52:30,760
HISTORY OF TRAUMA, LACK OF

4225
02:52:30,760 --> 02:52:33,000
TRUST, WHAT EXTENT BUILD THESE

4226
02:52:33,000 --> 02:52:34,560
INTO TRIALS IF THIS IS ANOTHER

4227
02:52:34,560 --> 02:52:35,880
SOCIAL DETERMINANTS OF HEALTH

4228
02:52:35,880 --> 02:52:37,160
ADJUSTOR PERHAPS TO UNDERSTAND

4229
02:52:37,160 --> 02:52:38,840
HOW THESE ARE CONTRIBUTING TO

4230
02:52:38,840 --> 02:52:41,320
OUTCOMES.

4231
02:52:41,320 --> 02:52:47,720
>> DEFINITELY.

4232
02:52:47,720 --> 02:52:51,000
>> WE HAVE TWO MINUTES
LEFT IN

4233
02:52:51,000 --> 02:52:52,520
THE SESSION. WE DIP GET AN

4234
02:52:52,520 --> 02:52:53,640
OPPORTUNITY TO ASK QUESTIONS OF

4235
02:52:53,640 --> 02:53:01,760
ALL THE OTHER SPEAKERS. YOU CAN

4236
02:53:01,760 --> 02:53:03,240
PUT THEM IN THE CHAT. IF THEY

4237
02:53:03,240 --> 02:53:05,040
ARE STILL AROUND, IF THEY WOULD

4238
02:53:05,040 --> 02:53:06,160
BE SO KIND TO ANSWER THOSE

4239
02:53:06,160 --> 02:53:08,400
QUESTIONS AGAIN, WE ARE COMING

4240
02:53:08,400 --> 02:53:10,400
INTO THE -- WHAT WE THINK THE

4241
02:53:10,400 --> 02:53:11,880
MOST IMPORTANT PART OF THIS

4242
02:53:11,880 --> 02:53:12,600
CONVERSATION WHERE WE CAN HAVE

4243
02:53:12,600 --> 02:53:14,080
OUR DISCUSSION IN OUR BREAK OUT

4244
02:53:14,080 --> 02:53:16,760
SESSION SO YOU ARE MORE THAN

4245
02:53:16,760 --> 02:53:18,560
WELCOME TO BRING THOSE ISSUES UP

4246
02:53:18,560 --> 02:53:20,760
DURING THAT DISCUSSION.  IT IS

4247
02:53:20,760 --> 02:53:22,560
ABOUT A MINUTE BEFORE WE WERE

4248
02:53:22,560 --> 02:53:25,000
SUPPOSED TO BREAK SO I WILL JUST

4249
02:53:25,000 --> 02:53:27,200
THANK DR. MOY AND ALL HIS

4250
02:53:27,200 --> 02:53:29,680
SPEAKERS FOR THIS WONDERFUL

4251
02:53:29,680 --> 02:53:32,880
SESSION AND WE WILL BREAK UNTIL

4252
02:53:32,880 --> 02:53:34,760
2:40 AND COME BACK AND GET OUR

4253
02:53:34,760 --> 02:53:36,240
CHARGE FOR THE BREAK OUT SESSION

4254
02:53:36,240 --> 02:53:38,200
AND HAVE VERY ROBUST DISCUSSIONS

4255
02:53:38,200 --> 02:53:39,800
DURING THE BREAK OUT SESSION.  

4256
02:53:39,800 --> 02:53:42,000
THANKS, EVERYBODY EVERYBODY

4257
02:53:42,000 --> 02:53:43,240
>>WELCOME BACK, EVERYBODY
TO

4258
02:53:43,240 --> 02:53:44,920
OUR BREAK OUT SESSIONS THAT WE

4259
02:53:44,920 --> 02:53:47,960
WILL HAVE THIS AFTERNOON. WE

4260
02:53:47,960 --> 02:53:49,240
HOPE THEY WILL BE VERY

4261
02:53:49,240 --> 02:53:51,080
INFORMATIVE FOR YOU AND ALLOW

4262
02:53:51,080 --> 02:53:52,840
FOR ROBUST DISCUSSION AND

4263
02:53:52,840 --> 02:53:54,600
EXCHANGING OF IDEAS. BEFORE WE

4264
02:53:54,600 --> 02:53:57,920
MOVE TO THE SPECIFIC SESSIONS,

4265
02:53:57,920 --> 02:54:00,120
DR. GAYLE LESTER, DIMES DIRECTOR

4266
02:54:00,120 --> 02:54:01,360
OF DIVISION OF EXTRAMURAL

4267
02:54:01,360 --> 02:54:02,520
RESEARCH WILL PROVIDE YOU WITH

4268
02:54:02,520 --> 02:54:04,160
THE CHARGE FOR THE SESSION. DR.

4269
02:54:04,160 --> 02:54:09,000
LESTER, TURN IT OVER TO YOU.

4270
02:54:09,000 --> 02:54:11,120
>> OKAY. CHRISTY, CAN YOU
HEAR

4271
02:54:11,120 --> 02:54:12,600
ME?

4272
02:54:12,600 --> 02:54:13,680
>> YES, MA'AM.

4273
02:54:13,680 --> 02:54:16,000
>> GOOD. HELLO, EVERYBODY.
I

4274
02:54:16,000 --> 02:54:19,200
THINK WE HAVE ALL ENJOYED A VERY

4275
02:54:19,200 --> 02:54:21,120
STIMULATING AND INFORMATIVE DAY.

4276
02:54:21,120 --> 02:54:23,360
NOW WE HAVE THE BREAK OUT

4277
02:54:23,360 --> 02:54:24,800
SESSION. WE ENVISIONED THIS

4278
02:54:24,800 --> 02:54:26,160
MEETING WOULD BE IN PERSON WHEN

4279
02:54:26,160 --> 02:54:28,520
WE FIRST STARTED PLANNING,

4280
02:54:28,520 --> 02:54:30,160
HOWEVER THAT WASN'T GOING TO BE

4281
02:54:30,160 --> 02:54:31,840
POSSIBLE FOR US AT THIS

4282
02:54:31,840 --> 02:54:33,520
PARTICULAR POINT IN TIME. SO

4283
02:54:33,520 --> 02:54:36,280
THESE BREAK OUT SESSIONS WHILE

4284
02:54:36,280 --> 02:54:38,960
VIRTUAL, ARE HOPEFULLY GOING TO

4285
02:54:38,960 --> 02:54:40,840
STIMULATE SOME OF THE TYPES OF

4286
02:54:40,840 --> 02:54:43,520
DISCUSSION AND INTERACTIONS

4287
02:54:43,520 --> 02:54:44,800
BETWEEN INDIVIDUALS IN THE

4288
02:54:44,800 --> 02:54:46,000
GROUPS THAT WE HOPED TO HAVE IN

4289
02:54:46,000 --> 02:54:50,840
PERSON.  OUR GOAL IS WE STATED

4290
02:54:50,840 --> 02:54:52,600
IN THE DESCRIPTION PROVIDED TO

4291
02:54:52,600 --> 02:54:54,680
YOU IS TO PROVIDE PARTICIPANTS

4292
02:54:54,680 --> 02:54:58,680
IN THE WORKSHOP WITH DIVERSE --

4293
02:54:58,680 --> 02:55:00,640
WHO HAVE DIVERSE AREAS OF

4294
02:55:00,640 --> 02:55:01,760
EXPERTISE WITH OPPORTUNITIES TO

4295
02:55:01,760 --> 02:55:03,680
GET TOGETHER AND EXCHANGE IDEAS

4296
02:55:03,680 --> 02:55:05,720
ON HOW TO ADDRESS AND IMPROVE

4297
02:55:05,720 --> 02:55:07,120
ISSUES RELATED TO HEALTH

4298
02:55:07,120 --> 02:55:09,240
DISPARITIES IN OSTEOARTHRITIS. I

4299
02:55:09,240 --> 02:55:11,080
THINK WE HAVE HAD A TERRIFIC

4300
02:55:11,080 --> 02:55:13,600
START SO FAR. AND NOW WE ARE

4301
02:55:13,600 --> 02:55:16,200
GOING IN TO OUR FIVE DIFFERENT

4302
02:55:16,200 --> 02:55:17,800
GROUPS WHICHEVER ONE YOU SIGNED

4303
02:55:17,800 --> 02:55:19,560
UP FOR. HOWEVER, I DO THINK

4304
02:55:19,560 --> 02:55:22,760
THERE ARE OPTIONS TO MOVE

4305
02:55:22,760 --> 02:55:25,080
AROUND. THE QUESTIONS WE WOULD

4306
02:55:25,080 --> 02:55:28,640
LIKE TO WORK ON HERE ARE HOW

4307
02:55:28,640 --> 02:55:30,400
WEAKNESSES IN DISCUSSED FACTORS

4308
02:55:30,400 --> 02:55:33,240
AND DETERMINANTS INFLUENCE

4309
02:55:33,240 --> 02:55:37,120
HEALTH DISPARIT DISPARITIES. HAT

4310
02:55:37,120 --> 02:55:38,880
ON SOME THAT YOU ARE AWARE OF

4311
02:55:38,880 --> 02:55:39,920
THAT COULD BE INFORMATIVE. HOW

4312
02:55:39,920 --> 02:55:43,640
THESE FACTORS AND PROCESSES BE

4313
02:55:43,640 --> 02:55:48,160
MODIFIED TO ADDRESS DEFICIENCIES

4314
02:55:48,160 --> 02:55:53,280
THAT ARE OBVIOUS IN THE WAY

4315
02:55:53,280 --> 02:55:55,520
OSTEOARTHRITIS IS TREATED IN

4316
02:55:55,520 --> 02:55:58,240
UNDERSERVED OR UNDER-REPRESENTED

4317
02:55:58,240 --> 02:56:02,320
POPULATIONS. SO HERE ARE THE

4318
02:56:02,320 --> 02:56:03,640
TITLES OF THE BREAK OUT

4319
02:56:03,640 --> 02:56:05,800
SESSIONS. AND LIKE I SAID, YOU

4320
02:56:05,800 --> 02:56:07,720
HAVE ALREADY SIGNED UP FOR ONE,

4321
02:56:07,720 --> 02:56:12,320
AND DAVE IS GOING TO VERY

4322
02:56:12,320 --> 02:56:13,720
ADEPTLY PUT INTO DIFFERENT BREAK

4323
02:56:13,720 --> 02:56:16,280
OUT ROOMS IN THE BREAK OUT ROOMS

4324
02:56:16,280 --> 02:56:19,280
THERE ARE LEADS POINTED OUT

4325
02:56:19,280 --> 02:56:21,720
HERHERE. ALSO THERE WILL BE NOTE

4326
02:56:21,720 --> 02:56:26,560
TAKERS AND WE HOPE THERE WILL BE

4327
02:56:26,560 --> 02:56:28,160
SOME GENERAL CONSENSUS THAT COME

4328
02:56:28,160 --> 02:56:29,920
OUT OF THESE GROUPS RELATED TO

4329
02:56:29,920 --> 02:56:31,760
ISSUES THAT THE GROUP DECIDES

4330
02:56:31,760 --> 02:56:35,520
ARE THE MOST IMPORTANT TO BE

4331
02:56:35,520 --> 02:56:36,600
DISCUSSED FURTHER. IS THERE ANY

4332
02:56:36,600 --> 02:56:38,480
-- THAT'S THE LAST SLIDE WE HAD.

4333
02:56:38,480 --> 02:56:43,720
RIGHT? OH, ONE MORE. SO HERE ARE

4334
02:56:43,720 --> 02:56:44,760
SOME OF THE QUESTIONS JUST TO

4335
02:56:44,760 --> 02:56:48,640
GET YOU STARTED AND WE SHARED

4336
02:56:48,640 --> 02:56:51,160
THESE WITH THE BREAK OUT SESSION

4337
02:56:51,160 --> 02:56:52,840
LEADS JUST TO GET DISCUSSION

4338
02:56:52,840 --> 02:56:54,960
GOING BUT WE HOPE ONCE IT GETS

4339
02:56:54,960 --> 02:56:56,680
STARTED THAT THE CONVERSATION

4340
02:56:56,680 --> 02:56:59,160
WILL BE RATHER ORGANIC AND

4341
02:56:59,160 --> 02:57:02,800
CONTINUE IN THE DIRECTIONS THAT

4342
02:57:02,800 --> 02:57:05,840
ARE MOST APPROPRIATE FOR THE

4343
02:57:05,840 --> 02:57:07,280
GROUP. EVERYONE ENJOY THE TIME

4344
02:57:07,280 --> 02:57:09,600
AND AT THE END DON'T FORGET

4345
02:57:09,600 --> 02:57:13,480
THERE IS A SMALL POSTER SESSION

4346
02:57:13,480 --> 02:57:18,640
AND MEET AND GREET. PLEASE JOIN

4347
02:57:18,640 --> 02:57:20,960
YOUR GROUP AND THEN STAY ON FOR

4348
02:57:20,960 --> 02:57:31,520
THE POSTERS AND THE NETWORKING.