THANK YOU FOR JOINING US FOR
DAY TWO OF OUR NIH HEALTH
DISPARITIES AND OSTEOARTHRITIS
WORKSHOP.
YESTERDAY WENT REALLY WELL AND
WE'RE EXCITED ABOUT DAY TWO,
WE'RE GOING TO CONTINUE MOVING
ALONG IN OUR AGENDA AND I'LL
TURN THIS OVER TO NIMHD.
>> THANK YOU, KRISTY.
GOOD MORNING, EVERYONE.
I'M A PROGRAM OFFICIAL AT THE
NATIONAL INSTITUTE ON MINORITY
HEALTH AND HEALTH DISPARITIES.
I'D LIKE TO INTRODUCE THE
DIRECTOR OF THE INSTITUTE,
DR. ELISEO PEREZ-STABLE.
DR. PEREZ-STABLE EARNED HIS BA
IN CHEMISTRY IN 1974 AND HIS
M.D. IN 1978 FROM THE UNIVERSITY
OF MIAMI.
HE THEN COMPLETED HIS PRIMARY
CARE INTERNAL MEDICINE RESIDENCY
AND A RESEARCH FELLOWSHIP IN
GENERAL INTERNAL MEDICINE AT THE
UNIVERSITY OF CALIFORNIA
SAN FRANCISCO, UCSF.
BEFORE JOINING THE FACULTY AS
ASSISTANT PROFESSOR IN 1983.
DR. PEREZ-STABLE PRACTICED
PRIMARY CARE INTERNAL MEDICINE
FOR 37 YEARS AT UCSF, FOLLOWING
A PANEL OF ABOUT 200 PATIENTS,
AND HE SUPERVISED AND TAUGHT
STUDENTS AND RESIDENTS IN THE
AMBULATORY CARE AND HOSPITAL
SETTINGS.
DR. PEREZ-STABLE' RESEARCH
INTERESTS HAVE CENTERED ON
IMPROVING THE HEALTH OF RACIAL
AND ETHNIC MINORITIES THROUGH
EFFECTIVE PREVENTION
INTERVENTIONS, UNDERSTANDING
UNDERLYING CAUSES OF HEALTH
DISPARITIES AND ADVANCING
PATIENT-CENTERED CARE FOR
UNDERSERVED POPULATIONS.
RECOGNIZED AS A LEADER IN LATINO
HEALTHCARE AND DISPARITIES
RESEARCH, DR. PEREZ-STABLE SPENT
32 YEARS LEADING RESEARCH ON
SMOKING CESSATION AND TOBACCO
CONTROL IN LATINO POPULATIONS IN
THE UNITED STATES AND LATIN
AMERICA, ADDRESSING CLINICAL AND
PREVENTION ISSUES IN CANCER
CONTROL RESEARCH, SUPPORTING
EARLY CAREER SCIENTISTS IN
RESEARCH ON MINORITY AGING AND
CLINICAL AND COMMUNITY SETTINGS,
AND ADDRESSING RESEARCH
QUESTIONS IN CONDITIONS SUCH AS
HYPERTENSION, ASTHMA, DIABETES
AND DEMENTIA.
HE'S PUBLISHED MORE THAN 300
PEER REVIEWED PAPERS AND WAS
CONTINUOUSLY FUNDED BY NIH
GRANTS FOR 30 YEARS PRIOR TO
BECOMING NIMHD DIRECTOR.
DR. PEREZ-STABLE WAS ELECTED TO
THE NATIONAL ACADEMY OF
MEDICINE, OF THE NATIONAL
ACADEMY OF SCIENCE IN 2001, AND
THE AMERICAN SOCIETY OF CLINICAL
INVESTIGATION IN 1996.
SO ELISEO, THE FLOOR IS YOURS.
>> THANK YOU VERY MUCH, RICK,
FOR THAT INTRODUCTION AND I
GUESS I'M NOT GOING TO SHARE
SCREEN, IT'S GOING TO COME FROM
CENTRAL.
I WANT TO FIRST OF ALL JUST
WELCOME EVERYONE TO THIS DAY
TWO.
I MISSED THE VERY BEGINNING
YESTERDAY, BUT I POPPED IN AND
OUT, LISTENED TO SOME TERRIFIC
TALKS, AND I REALLY WANT TO
THANK LINDSAY AND NIAMS FOR
HELPING LEAD THIS EFFORT.
THE IDEA, THINK, WAS DEVELOPED
WITH BOB CARTER AND I SOME TIME
AGO AS A COMMON CONDITION THAT
WE DON'T PAY ENOUGH ATTENTION TO
ON A VARIETY OF FRONTS, AND I
THINK WE HAVE A LOT OF COMMON
INTERESTS ALSO WITH NATIONAL
INSTITUTE ON AGING, WHICH
IS HELPING ALSO WITH THIS
CONFERENCE.
AND I WANT TO ESPECIALLY THANK
THE CO-CHAIRS, ARLEEN BROWN, SO
I'M GOING TO SAY A FEW THINGS
ABOUT OSTEOARTHRITIS IN THE
CONTEXT OF NIMHD, SO GO AHEAD
AND PUT ON THE NEXT SLIDE.
I'LL START WITH THINGS THAT I
THINK MOST OF YOU ARE FAMILIAR
WITH, BUT JUST TO MAKE SURE
WE'RE ON THE SAME PAGE, THESE
ARE THE POPULATIONS WITH HEALTH
DISPARITIES AS DEFINED BY NIH.
THE FIRST THREE BULLETS ON THIS
SLIDE WERE ACTUALLY INCLUDED IN
OUR ORIGINAL LEGISLATION FROM
THE YEAR 2000, WHEN WE WERE
ESTABLISHED AS A CENTER, SO ALL
RACIAL AND ETHNIC MINORITY
GROUPS AS DEFINED BY THE CENSUS,
AND THAT COULD EVOLVE, ALL POOR
PEOPLE OF ANY COLOR, WE USE THE
TERM LESS PRIVILEGED
SOCIOECONOMIC STATUS,
UNDERSERVED RURAL RESIDENTS,
PRIMARILY FOCUSED ON THOSE WHO
HAVE ACCESS ISSUES THAT ARE ALSO
OFTEN OF LESS PRIVILEGED
SOCIOECONOMIC STATUS, AND IN
2016, AFTER A PROCESS INITIATED
BEFORE I ARRIVED AT NIH, SEXUAL
AND GENDER MINORITIES WERE
DECLARED A POPULATION WITH
HEALTH DISPARITIES.
ALL OF THESE MARKERS ARE
IDENTITY OR DEMOGRAPHIC
SOCIOECONOMIC MARKERS AND NOT
DISEASE OR CONDITION-BASED, JUST
TO MAKE A NOTE OF THAT.
WE DO EMBRACE THIS NOTION THAT
ALL OF THESE POPULATIONS HAVE A
CERTAIN SOCIAL DISADVANTAGE
THAT, IN PART, COMES FROM HAVING
BEEN SUBJECT TO DISCRIMINATION
OR RACISM, AND BEING UNDERSERVED
IN HEALTHCARE.
I KNOW YESTERDAY THERE WAS A
DISCUSSION ON RACISM IN ONE OF
THE TALKS, AND I'M NOT GOING TO
DWELL ON THAT MORE TODAY BUT
THIS IS A VERY IMPORTANT
CROSS-CUTTING ISSUE FOR OUR
INSTITUTE.
SO A HEALTH OUTCOME THAT IS
WORSE IN THESE POPULATIONS
EITHER COMPARED TO A REFERENCE
GROUP OR PERHAPS TO A STANDARD
NATIONAL QUALITY METRIC THAT WE
CAN AGREE ON DEFINES A HEALTH
DISPARITY.
DO I ADVANCE?
HERE WE GO.
THESE ARE A GLOBAL POINT THAT I
WOULD LIKE TO RE-EMPHASIZE IN MY
ROLE HERE AT NIH OVER THE LAST
SEVEN YEARS.
RACE AND ETHNICITY ARE
SELF-IDENTIFIED SOCIAL
CONSTRUCTS.
THERE'S NO DISCUSSION ABOUT THAT
AMONGST MY COLLEAGUES.
PRIMARILY FOCUSED ON NHGRI, THE
GENOME INSTITUTE.
WE AGREE ON THIS.
THERE ARE OTHER COMPONENTS THAT
WE CAN DISCUSS, BUT SO THIS SELF
IDENTIFIED SOCIAL CONSTRUCT AND
SOCIAL CLASS OR SOCIOECONOMIC
STATUS, ARE VERY POWERFUL
PREDICTORS OF LOTS OF IMPORTANT
OUTCOMES THAT WE DON'T FULLY
UNDERSTAND.
SO I WOULD SAY THAT IN ANY HUMAN
STUDY, THEY NEED TO BE MEASURED
IN A STANDARDIZED WAY AND
CONSIDERED AS POSSIBLE
EXPLANATORY OR ASSOCIATED
FACTORS.
IN THE OUTCOMES.
THERE'S LOTS OF DATA ABOUT LIFE
EXPECTANCY AND MORTALITY,
INCLUDING RELATED TO COVID AND
OTHER CONDITIONS.
WE KNOW THAT, FOR EXAMPLE,
AFRICAN AMERICANS IN THE REGARDS
COHORT STUDY HAVE TWICE AS MANY
STROKES FOR THE EXACT SAME LEVEL
OF SYSTOLIC BLOOD PRESSURE AS
THEIR WHITE COUNTERPARTS, IN A
PROSPECTIVE LONGITUDINAL STUDY.
MOST CHRONIC DISEASES ARE MORE
COMMON IN POOR PEOPLE AND THIS
IS NOT RELATED TO POOR BEHAVIOR
ONLY.
IT RELATES TO LOTS OF STRUCTURAL
FACTORS AND OTHER CONDITIONS.
TWICE AS MUCH HEART DISEASE END
STAGE RENAL DISEASE AS THEIR
COUNTERPARTS.
SO WHAT CAN SCIENCE DO TO REDUCE
INEQUITIES?
I THINK THESE WI ARE GENERALIZAE
PRINCIPLES THAT I WILL
RECOMMEND.
WE REALLY NEED TO GET OUR ACT
TOGETHER AND USE STANDARDIZED
MEASUREMENT OF THESE FACTORS
THAT AFFECT HEALTH.
THIS IS A CHALLENGE THAT IS
HARDER THAN I WOULD HAVE
PREDICTED A COUPLE YEARS AGO,
WHEN WE STARTED WORKING ON THIS.
SO I'LL LEAVE IT AT THAT.
WE NEED TO FACILITATE DISCOVERY
SCIENCE IN THIS KIND OF RESEARCH
WITH BIG DATA, AND WE NEED TO
BECOME MORE ADEPT AT DATA
SCIENCE AND BEING ABLE TO WORK
WITH THINGS LIKE ELECTRONIC
HEALTH RECORDS AND POPULATION
DATA AND LINKED DATA.
OUR FIELD NEEDS TO BE AN ENGINE
FOR PROMOTING DIE VEERS IT OF DE
SCIENTIFIC AND CLINICAL
WORKFORCE.
WE'RE IN A CRISIS MODE.
14% OF NEWLY MINTED PH.D.s IN
THE STEM FIELDS, 14% OF NEW
M.D.s ARE FROM
UNDERREPRESENTED RACIAL AND
ETHNIC GROUPS, AND YET WE'RE
ABOUT 33% OF THE POPULATION.
THIS KIND OF A GAP IS NOT
SUSTAINABLE, AND WILL LEAD TO A
CRISIS IN THE PROFESSION OVER
TIME.
WE NEED TO REALLY CONTINUE TO
CULTIVATE COMMUNITY ENGAGEMENT
IN A COMPLETELY TRANSPARENT AND
HONEST WAY, AND MAINTAIN THIS
FOR SUSTAINABLE, TRUSTWORTHY
RELATIONSHIPS.
THIS TAKES RESOURCES, TIME, AND
EFFORT ON THE PART OF THE
SCIENTISTS AS WELL AS THE
ORGANIZATIONS.
AND THEN WE NEED TO IMPLEMENT
WHAT WE KNOW WORKS TO PROMOTE
EQUITY.
THE GAPS ARE BLATANT IN THINGS
THAT WE KNOW HOW TO DO BEST, AND
THE PEOPLE WHO HAVE THE WORST
OUTCOMES ARE OFTEN THOSE WITH
THE WORST -- THE LOWEST RATE OF
CONTROL OF THESE FACTORS.
NIMHD HAS REFERRED TO OUR
RESEARCH FRAMEWORK AS A
REFERENCE POINT FOR ALL OUR
APPLICANTS.
IT WAS DEVELOPED OUT OF AN
EFFORT THAT WE HAD DONE AT NIA
AS WELL AS USING BUILDING ON
HISTORICAL SOCIOECONOMIC MODELS.
I WOULD EMPHASIZE HERE FOR THIS
PURPOSE, THE HEALTHCARE SYSTEM
AND NOT JUST THE INDIVIDUAL
FACTORS AND THE INTERPERSONAL
ONES BUT ALSO ALL OF THE ISSUES
RELATED TO COMMUNITY AND
SOCIETAL.
AS OSTEOARTHRITIS ON THE
SCIENTIFIC SIDE, THERE MAY BE
MANY QUESTIONS LEFT TO BE
ADDRESSED, BUT I THINK IN MANY
OF THE THINGS THAT WE'RE GOING
TO FOCUS ON HERE, FROM OUR
PERSPECTIVE AT NIMHD, THEY'RE
GOING TO BE FOCUSED ON THE
HEALTHCARE SYSTEM.
A COUPLE OF HIGHLIGHTS THAT YOU
ALREADY PROBABLY DISCUSSED
YESTERDAY, OSTEOARTHRITIS IS
HIGHLY PREVALENT.
IT'S INCREASING, THERE'S NO CURE
AS MANY CHRONIC CONDITIONS HAVE
NO CURE.
AS RICK OUTLINED, I PRACTICED
MEDICINE FOR 37 YEARS, AND THIS
WAS A VERY COMMON CONDITION I
SAW.
THIS IS NOT A CONDITION THAT IS
MOST OFTEN SEEN BY THE
SPECIALISTS, NOT UNTIL AN
INTERVENTION IS NEEDED.
AND THIS IS, I THINK, ONE OF THE
FACTORS THAT NEEDS TO BE
EMPHASIZED.
THIS IS A PRIMARY CARE
CONDITION.
IT HAS A SIGNIFICANT IMPACT ON
QUALITY YEARS OF LIFE LOST DUE
TO DISABILITY.
SO YOU MAY NOT DIE FROM THIS
MOST OF THE TIME, BUT WE ALL
KNOW THAT IT AFFECTS QUALITY OF
LIFE IN MANY WAYS, WHETHER IT BE
MOBILITY OR PAIN.
AND ON OTHER THINGS.
MAJOR CO-MORBIDITY WHEN PEOPLE
ALSO HAVE DIABETES, HEART
DISEASE, ASTHMA, COPD, THEN THIS
EXACERBATES THINGS.
THERE ARE MAJOR FINANCIAL
IMPACTS ON INDIVIDUALS, BOTH
FROM OUT OF POCKET COSTS FOR
HEALTHCARE AS WELL AS INABILITY
TO CONTINUE WORK IN SOME
CONDITIONS.
TOTAL KNEE REPLACEMENT IS
ACTUALLY THE SECOND MOST COMMON
SURGICAL PROCEDURE DONE IN THE
UNITED STATES TODAY, I BELIEVE
THAT'S CORRECT.
IT IS SECOND ONLY TO C-SECTION
AND OSTEOAR THRI OSTEOARTHRITISE
COST ITEM FOR CMS, THE CENTERS
FOR MEDICARE AND MEDICAID
SERVICES, PRIMARILY RELATED TO
THE SURGICAL PROCEDURES, BOTH
KNEE AND HIP BEING THE BIGGEST
ONES BUT ALSO BACK ISSUES.
DRUG THERAPIES HAVE SMALL
TREATMENT EFFECT.
THEY MAY HAVE SIGNIFICANT
ADVERSE EFFECTS, CHRONIC
NONSTEROIDALS CERTAINLY HAVE LED
TO A CERTAIN RATE OF
GASTROINTESTINAL HEMORRHAGE AND
OTHER THINGS SUCH AS RENAL
CONDITIONS, SO THESE ARE NOT TO
BE TAKEN LIGHTLY.
AND THEN THINGS LIKE PHYSICAL
THERAPY, STRENGTHENING EXERCISES
THAT REALLY MAY BE LESS TOXIC,
DO REQUIRE BEHAVIORAL CHANGE AND
WE HAVE NOT BEEN GREAT AT
IMPLEMENTING AND SUSTAINING
THESE CHANGES IN OUR PATIENTS.
ALMOST DONE HERE.
SO QUICKLY, NIMHD HAS HAD A SORT
OF A FOOTPRINT IN THIS FOR SOME
TIME.
YOU HEARD FROM SAID YESTERDAY,
HE WAS FUNDED BY US, FORMERLY ON
OUR COUNCIL, THAT TIME AS THE VA
REPRESENTATIVE.
WE'VE HAD A NUMBER OF
APPLICATIONS OVER A FEW YEARS.
10 HAVE BEEN FUNDED.
THESE HAVE BEEN OF DIFFERENT
FLAVORS, R01s AS WELL AS K
AWARDS, ONE SMALL BUSINESS AND
ONE LOAN REPAYMENT PROGRAM.
MOST HAVE FOCUSED ON THE
DISPARITIES IN SURGERY FOR JOINT
REPLACEMENT, AS WAS DISCUSSED
YESTERDAY, INCLUDING ACCESS AND
OUTCOMES, AND ALL OTHER ISSUES
AROUND PAIN MANAGEMENT.
THEN I WANT TO LEAVE YOU WITH
JUST TWO MESSAGES ABOUT NIMHD
PROGRAMS THAT MADE THIS
INVESTIGATOR POOL AWARE.
WE HAVE A PROGRAM THAT IS FUNDED
THAT IS A SETASIDE FROM
CONGRESSIONAL MANDATE, WE FUND
21 INSTITUTIONS WITH SIGNIFICANT
GRANTS VARYING FROM 1 1/2 TO
3 1/2 MILLION DOLLARS PER YEAR
IN DIRECT COSTS.
13 OF THESE ARE HBCUs, AT
LEAST EIGHT HAVE ATTACHED
MEDICAL SCHOOLS, PROBABLY MORE
HAVE AFFILIATIONS, SO DREW,
UCLA, MEHARRY, MOREHOUSE, U
PUERTO RICO, FIU, AND I THINK
THAT'S PROBABLY IT, MAYBE
UNIVERSITY OF HOUSTON IS CLOSE
ENOUGH TO UT HOUSTON TO BE
CONNECTED.
AND SO THEY HAVE AN OPPORTUNITY
FOR BOTH ACCESSING
UNDERREPRESENTED POPULATIONS AND
INVESTIGATORS, AND AS WELL AS
LESS RESOURCE INSTITUTIONS AND
COLLABORATION AND PARTNERSHIPS
ARE ENCOURAGED.
AND MY LAST SLIDE IS JUST ALSO
TO LET YOU KNOW ABOUT THE
MULTIPLE CHRONIC DISEASE
RESEARCH CENTERS.
THIS WAS A PROGRAM AGAIN THAT WE
RECEIVED A CONGRESSIONAL
ALLOCATION OF $45 MILLION IN
FISCAL YEAR '21.
THESE WERE FUNDED AT THE VERY
END OF THE FISCAL YEAR.
THEY'RE $3 MILLION CENTERS.
WE WERE TOLD TO MAKE SURE THAT
CARDIOVASCULAR DISEASE, CANCER,
OBESITY, DIABETES, CHRONIC
KIDNEY DISEASE, STROKE AND
CHRONIC LIVER DISEASE WERE
INCLUDED, AND WE ADDED
OSTEOARTHRITIS AND GOT INPUT
FROM NIGH AMS AS WELL AS THE
OTHER INSTITUTES LISTED HERE.
NONE OF THE FUNDED CENTERS
ACTUALLY FOCUSED ON
OSTEOARTHRITIS TO OUR
DISAPPOINTMENT.
BUT I'M HOPEFUL THAT THROUGH
OTHER MECHANISMS, WE CAN GET ONE
OF THEM INTERESTED, MAYBE A
COUPLE OF YOU ARE INVOLVED WITH
THESE CENTERS.
THESE ARE THE FUNDED CENTERS,
THE CHILDREN'S HOSPITAL IS
EXCLUSIVELY ON CHILDREN, OF
COURSE AT COLUMBIA HOPKINS,
RUTGERS, ARKANSAS, ALABAMA,
UCLA, UNIVERSITY OF CHICAGO,
MINNESOTA, VANDERBILT, WAYNE
STATE, AND THEN THE COORDINATING
CENTER IS AT UCSF.
SO THANK YOU AGAIN FOR YOUR
ATTENTION.
LAST SLIDE IS JUST OUR CONTACT
INFORMATION.
I APPRECIATE ALL THE EFFORT THAT
WENT INTO GETTING THIS WORKSHOP
GOING, AND I PLAN TO LISTEN TO
AS MUCH AS I CAN TODAY.
>> THANK YOU, DR. PEREZ-STABLE.
OUR FIRST SESSION THIS MORNING
WILL ALLOW US TO HEAR FROM
IMPORTANT STAKEHOLDERS WHO ARE
AFFECTED BY THESE ISSUES IN
OSTEOARTHRITIS DAILY.
OUR PATIENTS ARE PROVIDERS AND
THOSE WHO WORK TO ADDRESS THESE
ISSUES.
IT WILL BE MODERATED BY OUR
WORKSHOP CO-CHAIR, DR. ARLEEN
BROWN AT THE UNIVERSITY OF
CALIFORNIA LOS ANGELES.
DR. BROWN, THE FLOOR IS YOURS.
>> THANK YOU FOR THAT
INTRODUCTION, KRISTY.
I WANT TO THANK NIAMS AND ALL
THE INSTITUTES INVOLVED IN
PLANNING IN CONFERENCE AND FOR
FOCUSING ON THIS IMPORTANT
TOPICS.
THANK YOU TO DR. PEREZ-STABLE
FOR HIS INTRODUCTORY REMARKS.
SO IN THIS SESSION, WE WANT TO
BRING IN A RANGE OF COMMUNITY
VOICES TO OBTAIN A BROADER
PERSPECTIVE ON AND DIVERSE
INSIGHTS INTO DISPARITIES IN
OSTEOARTHRITIS AND STRATEGIES TO
PROMOTE EQUITY FOR THOSE AT RISK
FOR AND AFFECTED BY THE
CONDITION.
OUR FIRST SPEAKER IS MISS VAL
OVERTON.
AS YOU'LL HEAR, SHE'S A FORMER
EMPLOYEE OF THE HEALTH
DEPARTMENT IN THE CITY OF
DETROIT AND THE STATE OF
MICHIGAN.
SHE'S ALSO A PATIENT WITH
OSTEOARTHRITIS, WHO WILL TALK TO
US ABOUT THE PROFOUND IMPACT OF
THE DISEASE ON HER LIFE, AND
SHARE WITH US HER EXPERIENCES
BOTH WITHIN AND OUTSIDE THE
HEALTHCARE SYSTEM.
SO I'M GOING TO TURN THE MIC
OVER TO MISS OVERTON.
>> THANK YOU.
HI, MY NAME IS VAL OVERTON.
I LIVE IN MICHIGAN IN THE CITY
OF DETROIT.
I AM A MOTHER OF TWO, A
MOTHER-IN-LAW OF TWO, AND A
GRANDMOTHER OF SIX.
I CALL MYSELF RETIRED BY
PHYSICIAN ORDER, SIMPLY BECAUSE
A PHYSICIAN WOULD NOT ALLOW ME
TO RETURN TO WORK DUE TO MY
DISABILITIES.
PRIOR TO THAT, I SERVED AS A
DIRECTOR WITH OVER 21 YEARS --
20-PLUS YEARS IN HUMAN RESOURCES
FOR A NON-PROFIT PUBLIC HEALTH
CONSORTIUM.
THAT CONSORTIUM WORKED WITH THE
CITY OF DETROIT'S HEALTH
DEPARTMENT, HEALTH DEPARTMENTS
IN SEVEN DIFFERENT COUNTIES
WITHIN THE STATE OF MICHIGAN,
AND THE STATE OF MICHIGAN PUBLIC
HEALTH DEPARTMENT.
I HAVE NO DISCLOSURES.
MY HEALTH ISSUES INCLUDE BUT
AREN'T LIMITED TO AS YOE
ARTHOSTEOARTHRITISIN BOTH HANDSR
SURGERY AND REMOVAL OF A CYST
AND A MOLE, ONE CANCEROUS CYST
REMOVAL FROM MY STOMACH,
ARTHRITIS IN BOTH KNEES AND
ANKLES, AND SPINAL DISK
DEGENERATION.
I'VE HAD FOUR HERNIATED DISK
SURGERIES, ONE NEUROSTIMULATOR
IMPLANT, AN IMPLANT OF A
BATTERY, AND I HAVE A REMOTE
CONTROL TO REGULATE THAT.
MY PHYSICAL AND MENTAL JOURNEY
HAS BEEN THROUGH TWO HEALTHCARE
SYSTEMS.
ONE WAS EMPLOYER-PROVIDED HEALTH
INSURANCE, AND THAT TIME FRAME
WAS ACTUALLY FROM WHEN MY MOTHER
COVERED ME AS A TEEN UNTIL THE
AGE OF 61.
THE STEPS THAT I WENT THROUGH IN
THAT HEALTH SYSTEM INCLUDED
GOING TO A PRIMARY CARE
PHYSICIAN, WHO THEN GAVE ME A
REFERRAL TO STEPS TWO AND THREE,
WHICH INCLUDED THE PAIN CLINIC,
SURGERY ON MY BACK WITH THE
IMPLANTS, AND THEN THE THIRD
STEP WAS WITH DERMATOLOGY,
SURPRISINGLY ENOUGH, WHERE I HAD
SURGERY ON MY HAND AND STOMACH.
MY MENTAL REACTION IS THIS.
MY JOURNEY CONTINUED IN THE
HEALTH SYSTEM WITH HEALTH SYSTEM
NUMBER TWO, WHICH INCLUDED
HEALTH INSURANCE THROUGH COBRA.
COBRA IS CONSOLIDATED OMBUDSMEN
RECONCILIATION ACT, AND COBRA IS
A FEDERAL LAW, NOT A COMPANY,
AND THE LAW GIVES WORKERS THE
RIGHT TO CONTINUE COVERAGE UNDER
THE EMPLOYER WHEN THEY ARE
QUALIFIED, WHEN THERE'S A
QUALIFYING EVENT SUCH AS
RETIREMENT OR LOSS OF
EMPLOYMENT.
NOW, AFTER MY COBRA RAN OUT
BECAUSE IT ONLY GOES SO LONG, I
HAD MEDICARE ADVANTAGE INSURANCE
WITH A MAJOR INSURANCE COMPANY.
THE TIME FRAME FOR THAT WAS AGED
61 TO CURRENTLY, WHICH IS NOW
68.
AGAIN MY STEPS WERE, I WENT TO A
PRIMARY CARE PHYSICIAN WHO
REFERRED ME TO STEP TWO, WHICH
WAS A PAIN CLINIC.
AND AGAIN, MY MENTAL REACTION
IS -- LIVING WITH PAIN.
AT LAST, SOMEONE ADDRESSED MY
HAND PAIN.
EVEN THOUGH THERE REMAINS THE
FINANCIAL IMPACT, MULTIPLE
DOCTOR VISITS, PRESCRIPTIONS,
TRAVEL, TRANSPORTATION COSTS
SUCH AS GASOLINE AND CAR UPKEEP,
ET CETERA, I HAVE SOCIAL
ISOLATION, AND MY SOCIAL
INTERACTIONS HAVE BEEN REDUCED
DRAMATICALLY DUE TO THE
DISCOMFORT.
I HAVE BROKEN SLEEP.
AN EXAMPLE OF THAT, IT'S
3:00 A.M. ON MY SON'S 42ND
BIRTHDAY.
I TEXTED A HAPPY BIRTHDAY
MESSAGE TO HIM.
MY SON IMMEDIATELY TEXTED BACK,
MOM, WHAT ARE YOU DOING UP SO
EARLY?
MY RESPONSE?
I ACTUALLY LAUGHED OUT LOUD.
MY HAND PAIN WOKE ME UP!
NOTICE, I DIDN'T ASK HIM WHAT HE
WAS DOING UP THAT EARLY.
LAUGHING OUT LOUD.
MY JOURNEY I I CONTINUED THROUGE
HEALTH SYSTEMS, AND THAT WAS
HEALTH SYSTEM ONE AND TWO.
THE GOOD ABOUT THAT IS THE
HEALTH INSURANCE PROVIDED ME
WITH A VOLUNTARY PAIN MANAGEMENT
COURSE WHERE I WAS GIVEN THE
OPPORTUNITY TO TRY AND MAKE
LIVING WITH PAIN BETTER.
A NURSE PRACTITIONER ACTUALLY
COMMENTED, AND I HADN'T HAD
ANYONE ADDRESS MY HAND PAIN
PRIOR TO THAT.
THE PAIN CONTINUES.
NO PHYSICIAN ADDRESSES MY HAND
PAIN.
MY KNEE PAIN.
WITH A VIABLE RESOLUTION.
THE UGLY?
I'M STILL HAVING BROKEN SLEEP,
I'M IRRITABLE, AND THERE'S A
SECRETNESS OF NOT TELLING
EVERYBODY WHAT'S GOING ON WITH
ME.
THE ACTUAL?
I APPLY OINTMENT, I PUT ON
COPPER-LINED GLOVES, AND I TUCK
MY HAND UNDER MY BODY PARTS TO
KEEP WARM.
THANK YOU.
THANK YOU FOR ALLOWING ME TO SAY
MY LITTLE PIECE.
>> THANK YOU SO MUCH, VAL.
THAT WAS INCREDIBLY, I THINK --
I THINK HUMBLING FOR ME AS A
PRIMARY CARE PROVIDER, AND I
REALLY APPRECIATE YOUR TAKING
THE TIME TO SHARE WITH US THAT
PERSPECTIVE.
I THINK WE'RE GOING TO PLAN TO
MOVE ON TO THE NEXT SPEAKER AND
WE'LL HAVE QUESTIONS AT THE END,
BUT CERTAINLY FOLKS SHOULD PUT
YOUR QUESTIONS INTO THE CHAT.
SO OUR NEXT SPEAKER IS
DR. TUHINA NEOGI, PROFESSOR OF
MEDICINE AND EPIDEMIOLOGY AT
BOSTON UNIVERSITY SCHOOLS OF
MEDICINE AND PUBLIC HEALTH AND
ALAN COHEN PROFESSOR OF REUM
TOOLING AS WELL AS CHIEF OF
RHEUMATOLOGY AT BOSTON MEDICAL
CENTER.
SHE CONDUCTS RESEARCH WITH AN
EMPHASIS ON PAIN MECHANISMS AND
SHE WILL FOCUS ON THE PHYSICIAN
VOICE IN THE CARE OF PATIENTS
WITH OSTEOARTHRITIS.
THANK YOU, DR. NEOGI.
>> THANK YOU VERY MUCH.
THANK YOU TO NIH FOR THIS KIND
INVITATION, AND THANK YOU, MISS
OVERTON, FOR SHARING YOUR STORY,
AND I THINK A LOT OF WHAT YOU'VE
SAID IS TOUCHING UPON MANY
IMPORTANT THINGS THAT WE IN THE
HEALTHCARE SYSTEM NEED TO DO A
BETTER JOB ADDRESSING.
SO I'M TRYING TO USE THE
CONTROLS ON MY SCREEN -- THERE
WE GO.
OKAY.
SO THE FIRST PERSPECTIVE FROM
THE PHYSICIAN'S PERSPECTIVE IS
WHAT WE THINK ABOUT WHEN WE TALK
ABOUT OSTEOARTHRITIS, AND OFTEN
FOR MANY PHYSICIANS AND ALSO
RESEARCHERS, WE THINK OF
OSTEOARTHRITIS AS THE DISEASE,
AND THIS IS FRAMED AS THE TISSUE
STRUCTURE, PATHOLOGY, SO FOR A
BASIC SCIENTIST, THEY MIGHT BE
THINKING ABOUT ALL OF THESE
DIFFERENT PATHWAYS, WHAT IT
LOOKS LIKE ON HISTOPATHOLOGY, ON
IMAGING, MRI AND X-RAYS, PERHAPS
GROSS PATHOLOGY, AND THESE ARE
THE AREAS OF TREATMENT TARGETS
THAT ARE UNDER RESEARCH.
BUT FOR A PATIENT, IT'S THE PAIN
THAT BRINGS THEM TO SEEK CARE.
AND SO AS WAS SUMMARIZED
YESTERDAY, WE NEED TO THINK
ABOUT OSTEOARTHRITIS AS THE
ILLNESS, THE HUMAN EXPERIENCE IN
RESPONSE TO DISEASE, SO THAT
PATHOLOGY CONTRIBUTES TO
SYMPTOMS, WHICH THEN AFFECTS
FUNCTION YOING, BUT BEYOND WHATE
MIGHT THINK OF AS DIFFICULTY
WITH STAIR CLIMBING OR WITH
WALKING, ET CETERA, THERE CAN BE
ADVANCED STAGES, DIFFICULTY WITH
DAILY FUNCTIONING SUCH AS
BATHING, DRESSING, ET CETERA.
THERE CAN BE ASSOCIATED
WIDESPREAD PAIN, SO A SINGLE
JOINT WITH OA IS NOT SO COMAN,
MULTIPLE JOINTS CAN BE AFFECTED,
AND BEYOND HAVING
OSTEOARTHRITIS, THERE CAN BE
OTHER MUSCULOSKELETAL
CONDITIONS.
AS MISS OVERTON NICELY SHARED,
THE EXPERIENCE CAN ALSO IMPACT
YOUR MOOD.
THE PAIN FROM OSTEOARTHRITIS AND
ANY CONDITION CAN AFFECT
COGNITION, AND AS MISS OVERTON
ALSO SHARED, AFFECTS SLEEP,
DISRUPTED SLEEP.
AND AS DR. PEREZ-STABLE ALREADY
SHARED BRIEFLY, I JUST WANTED TO
HIGHLIGHT THE IMPACT OF
OSTEOARTHRITIS ON THE HEALTHCARE
SYSTEM, BECAUSE I FIND THAT MANY
INDIVIDUALS IN THE PUBLIC AND
PHYSICIANS AND HEALTHCARE -- AND
OTHER MEMBERS OF THE HEALTHCARE
SYSTEM ARE UNAWARE OF HOW BIG AN
IMPACT MUSCULOSKELETAL
CONDITIONS HAVE ON CHRONIC PAIN.
SO CURRENTLY ABOUT 100 MILLION
ADULTS IN THE U.S. HAVE CHRONIC
PAIN, AND OF THAT 100 MILLION,
ABOUT 30% ARE DUE TO
OSTEOARTHRITIS, BUT ALSO A
NUMBER OF OTHER MUSCULOSKELETAL
CONDITIONS.
AND THIS REFLECTS ITSELF IN THE
FACT THAT BASED ON THE NATIONAL
AMBULATORY MEDICAL CARE SURVEY,
JOINT PAIN AND A ARTHROPATHIES E
THE NUMBER ONE REASON FOR
OUTPATIENT BLAM TRI CARE VISITS
FOR WHICH OSTEOARTHRITIS IS A
MAJOR CONTRIBUTOR.
MUSCULOSKELETAL CONDITIONS FOR
WHICH OSTEOARTHRITIS IS A MAJOR
CONTRIBUTOR IS A SECOND LEADING
CAUSE OF YEARS LIVED WITH
DISABILITY, AND WHAT WAS MOST
SURPRISING TO ME WHEN I LOOKED
THIS UP IS THAT OSTEOARTHRITIS
IS THE THIRD LEADING HOSPITAL
DISCHARGE DIAGNOSIS IN THE U.S.
AND THIS IS THIRD AFTER NUMBER
ONE BEING CHILDBIRTH-RELATED
HOSPITALIZATIONS, AND NUMBER TWO
BEING SEPSIS-RELATED
HOSPITALIZATIONS.
AND THIS WAS SURPRISING TO ME
THAT OA IS A THIRD LEADING
HOSPITAL DISCHARGE DIAGNOSIS
BECAUSE IN TRAINING, I ALWAYS
THOUGHT IT WOULD BE RELATED TO
CARDIAC DISEASE, HEART ATTACKS,
CONGESTIVE HEART FAILURE, ET
CETERA, BUT OBVIOUSLY
OSTEOARTHRITIS IS HERE AS NUMBER
THREE BECAUSE OF JOINT
REPLACEMENT SURGERY.
OBVIOUSLY WE CAN'T OPERATE OUR
WAY THROUGH THIS MASSIVE PUBLIC
HEALTH BURDEN OF OSTEOARTHRITIS.
WE HAVE TO FIND ADDITIONAL
MANAGEMENT OPTIONS TO REDUCE THE
BURDEN OF THIS DISEASE.
WE ARE KNOW THERE ARE MULTIPLE
CONTRIBUTORS TO PAIN AND WHILE
IN OSTEOARTHRITIS RESEARCH
ARENAS, THE PREDOMINANT FOCUS IS
ON JOINT PATHOLOGY, WE
UNDERSTAND THERE ARE A WHOLE
HOST OF INFLUENCES AND FOR THOSE
OF US THAT ARE CLINICIANS, WE
KNOW FOR EXAMPLE THAT WE DO NEED
TO ADDRESS SLEEP AND MOOD AND
COPING SKILLS BECAUSE NO MATTER
WHAT WE MIGHT DO TO ADDRESS
JOINT PATHOLOGY, IF WE DON'T
ADDRESS THOSE FACTORS, WE'RE NOT
GOING TO HAVE THE OPTIMAL PAIN
MANAGEMENT STRATEGY IN PLACE.
AND THEN UNDERSTANDING AND
MANAGING PAIN IS COMPLICATED
ENOUGH BECAUSE OF ALL THOSE
MULTIPLE CONTRIBUTORS TO THE
PAIN EXPERIENCE, BUT THERE ARE
ALSO LOTS OF DISPARITIES, AND
WE'VE ALREADY HEARD A LOT OF
THIS YESTERDAY SO I'M NOT GOING
TO GO INTO DETAILS, BUT THERE'S
A MUM NUM NUMBER OF STUDIES ANDO
ANECDOTAL EXPERIENCE OF
DISPARITIES IN AFFIRMATION OF
THE PAIN EXPERIENCE THAT SOMEONE
IS EXPRESSING.
PEOPLE FROM DIFFERENT
COMMUNITIES USE DIFFERENT
LANGUAGE, DIFFERENT WORDS TO
EXPRESS THE SYMPTOMS THEY'RE
EXPERIENCING, AND UNFORTUNATELY
THERE ARE SOME GROUPS WHOSE PAIN
IS DISCOUNTED, AND ESPECIALLY
WHEN THERE'S INTERSECTIONALITY
OF DIFFERENT IDENTITIES TOGETHER
IN AN INDIVIDUAL.
WE ALSO HEARD YESTERDAY ABOUT
DISPARITIES IN PA PAIN MANAGEMET
OFFERED.
A NUMBER OF STUDIES SHOWING
PEOPLE OF CERTAIN MINORITY
GROUPS HAVE LESS PAIN MANAGEMENT
OPTIONS OFFERED TO THEM, AND
WILL HAVE LESS OPIOIDS OFFERED
TO THEM.
NOW OBVIOUSLY OPIOIDS ARE NOT
APPROPRIATE IN MANY INSTANCES,
BUT IN INSTANCES WHERE THEY
SHOULD BE OFFERED, THEY OFTEN
ARE NOT.
AND LEST YOU THINK THAT, WELL,
ACADEMICIANS WHO CAN ADVOCATE
FOR THEMSELVES MAY BE LESS PRONE
TO THIS, THAT IS NOT THE CASE.
THERE ARE STILL PHYSICIANS
THEMSELVES WHO ARE OF -- WOMEN
AND PEOPLE OF COLOR WHO HAVE
BEEN DENIED ADEQUATE PAIN
CONTROL DESPITE BEING STRONG
ADVOCATES FOR THEMSELVES AND
FROM BEING WITHIN THE MEDICAL
COMMUNITY.
WE ALSO HEARD YESTERDAY ABOUT
DISPARITIES IN REFERRAL FOR
JOINT REPLACEMENT, EDUCATION
AROUND THE PROCEDURE.
ONE CITY I WANTED TO HIGHLIGHT
THAT WE DIDN'T HEAR ABOUT
YESTERDAY IS THE GENDER BIAS
ALSO IN REFERRAL FOR JOINT
REPLACEMENT.
A WONDERFUL STUDY YEARS AGO THAT
WAS LED IN PART BY DR. JILLIAN
HAWKER FROM UNIVERSITY OF
TORONTO, HAD ACTORS USING A
SCRIPT WITH THE SAME X-RAY.
ONE WAS A MAN, ONE WAS A WOMAN.
THEY WENT TO VARIOUS PRIMARY
CARE PHYSICIANS' OFFICES WITH
THE SAME SCRIPT AND SAME X-RAY,
AND THE WOMAN PATIENT WAS
OFFERED REFERRAL FOR JOINT
REPLACEMENT LESS FREQUENTLY.
LEST YOU THINK THAT, WELL, MAYBE
FEMALE, WOMEN PHYSICIANS ARE
BETTER AT THIS, NO, THERE WAS --
WOMEN PHYSICIANS WERE EQUALLY
BIASED IN REFERRING THE WOMAN
PATIENT FOR JOINT REPLACEMENT.
SO WE AS PHYSICIANS HAVE A LOT
OF UNCONSCIOUS BIAS OR SOMETIMES
OVERT BIAS THAT WE NEED TO CHECK
AND ADDRESS, AND I KNOW THAT
MANY OF US ATTENDED YESTERDAY'S
SESSION ON RACISM IN MED
SIRNTION AND MEDICINEAND THIS IT
FACTOR IN PATIENTS NOT RECEIVING
THE CARE THAT THEY NEED.
AND THEN IN TERMS OF PATIENT
EDUCATION, I JUST WANTED TO
SPEND A MOMENT TALKING ABOUT
LANGUAGE.
SO LANGUAGE MATTERS.
UNFORTUNATELY IN OSTEOARTHRITIS,
THERE'S A LOT OF PHRASES LIKE
WLIKEWEAR AND TEAR WHICH MAKES S
SOUND LIKE AN INEVITABLE DEMISE
IN THIS DISEASE COURSE.
AND ALSO THE TREATMENTS THAT ARE
OFFERED, THE LANGUAGE THERE ALSO
MATTERS, BECAUSE
NON-PHARMACOLOGIC TO SOME SOUNDS
LIKE NON-TREATMENT, OR THAT IT'S
THE SECOND BEST.
PHARMACOLOGIC MUST BE THE BEST
CHOICE, SINCE NON-PHARMACOLOGIC
IS BEING COMPARED TO THAT.
SO WE REALLY NEED TO BE CAREFUL
WITH THE LANGUAGE THAT WE USE,
AND AVOID THESE TYPES OF TERMS,
AND USE MUCH MORE ACTIVE
LANGUAGE AND THERE'S A CONCEPT
OF PARTICIPATORY LANGUAGE.
SO WE NEED TO BE ABLE TO EGGS
PLEXPLAINWHAT OSTEOARTHRITIS IS
UNDERSTANDABLY BUT NOT MAKE IT
SEEM LIKE AN INEVITABLE DECLINE,
AND ENCOURAGE AND SUPPORT PEOPLE
IN BEING ABLE TO ENGAGE IN THEIR
OWN CARE.
AND THN FINA THEN FINALLY I THIE
REALLY ALSO NEED TO SET THE
NOTION IN PLACE THAT THERE'S NO
SINGLE MAGIC BULLET, THAT WE
HAVE TO USE MULTIMODAL
APPROACHES.
THERE IS NOT GOING TO BE A MAGIC
PILL.
SO WE HAVE TO FIND THE RIGHT
PUZZLE PIECES THAT ARE
APPROPRIATE FOR THAT INDIVIDUAL
AT THAT MOMENT IN TIME, AND THAT
THESE PUZZLE PIECES MIGHT CHANGE
AS THE DISEASE COURSE EVOLVES
OVER TIME.
IMPORTANTLY, WE HAVE TO ENGAGE
OUR PARTNERS, IMPORTANT PARTNERS
ARE PHYSICAL THERAPISTS, AND IN
PREPARING FOR THE SESSION WHEN
WE HAD OUR SORT OF
PRE-CONFERENCE MEETING, I
HIGHLIGHTED THE FACT THAT ONE OF
THE IMPORTANT VOICES HERE IS VIZ
ISPHYSICAL THERAPY, AMONG THE
FIRST LINE RECOMMENDED
TREATMENTS IN A LOT OF WHAT
PATIENTS NEED TO ENGAGE IN
REQUIRES THE SUPPORT, GUIDANCE
AND SUPERVISION OF PHYSICAL
THERAPISTS.
AS AN EXAMPLE OF HOW POORLY WE
ENGAGE IN FIRST LINE THERAPIES,
THIS STUDY FROM ABOUT TWO YEARS
AGO NOW TOOK DATA FROM THE
NATIONAL AMBULATORY CARE --
MEDICAL CARE SURVEY I BRIEFLY
MENTIONED A FEW SLIDES AGO.
YOU CAN SEE OVER THREE TIME
PERIODS, REFERRAL TO PHYSICAL
THERAPY REMAINED LOW, COUNSELING
ABOUT LIFESTYLE DID NOT INCREASE
OVER TIME DESPITE TREATMENT
GUIDELINES COMING OUT IN THIS
PERIOD, YET PRESCRIPTIONS FOR
NSAIDS AND NARCOTICS CONTINUED
TO RISE.
IN THE INTEREST OF TIME, I
DIDN'T SHARE ANOTHER STUDY HERE
BUT I WILL JUST RAISE THIS
BECAUSE I THINK IT'S IMPORTANT
FOR US TO REALIZE THAT LACK OF
ADEQUATE OPTIONS FOR PAIN
MANAGEMENT HAS UNINTENDED
CONSEQUENCES.
SO WE LOOKED AT ENHANCED DATA IN
LOOKING AT PRESCRIPTION
MEDICATION USE OR PRESCRIPTIONS
FOR PEOPLE WHO HAVE ARTHRITIS,
PREDOMINANTLY OSTEOARTHRITIS,
AND WE FOUND THAT OVER TIME, IN
THE LATE 1990s AND EARLY
2000s, NSAIDS WERE PRESCRIBED
FAIRLY STEADILY AND OPIOIDS WERE
FAIRLY LOW, BUT THEN BETWEEN
2003 AND 2005, NSAID
PRESCRIPTIONS DROPPED MARKEDLY
WHILE OPIOID PRESCRIPTIONS ROSE
MARKEDLY.
WHAT HAPPENED AT THAT TIME WAS
VIOXX CAME OFF THE MARKET, SO AS
THE CONSEQUENCES OF NSAIDs AND
COX-2 INHIBITORS BECAME
INCREASINGLY UNDERSTOOD, AND
AGAIN, DR. PEREZ-STABLE REVIEWED
THIS, THE GI BLEEDS, RENAL
INSUFFICIENCY, CARDIOVASCULAR
DISEASE, PHYSICIANS WERE MORE
RELUCTANT TO PRESCRIBE NSAIDs,
BUT PAIN IN OSTEOARTHRITIS DID
NOT GO AWAY SO WITHOUT OTHER
ADEQUATE OPTIONS, OPIOID
PRESCRIPTIONS ROSE.
WE NEED TO RECOGNIZE THESE
UNINTENDED CONSEQUENCES AND
GIVEN THE HIGH PREVALENCE OF
OSTEOARTHRITIS AND THE HIGH
PRESCRIPTIONS OF OPIOIDS, THIS
COULD BE ONE OF THE UNDERLYING
REASONS FOR PEOPLE GETTING
STARTED ON OPIOIDS AND
CONTRIBUTING TO AN OPIOID
EPIDEMIC.
SO IN TERMS OF PAIN MANAGEMENT
IN THE CLINIC FOR US AS
PHYSICIANS, WE NEED TO MEET
PATIENTS WHERE THEY ARE.
WE NEED TO UNDERSTAND THEIR
GOALS, WE NEED TO SET REALISTIC
EXPECTATIONS BECAUSE ZERO PAIN
IS NOT THE GOAL.
WE DO NOT HAVE THE TOOLS AT
PRESENT TO SAFELY TAKE PEOPLE TO
ZERO PAIN.
WHAT WE'RE TRYING TO DO IS
MANAGE PAIN TO IMPROVE FUNCTION
AND IMPROVE QUALITY OF LIFE, SO
THAT PEOPLE CAN PARTICIPATE AND
ENGAGE IN ACTIVITIES THAT THEY
WANT TO ENGAGE IN.
AND WE NEED TO HELP OUR PATIENTS
DEVELOP ACTION PLANS.
WE CAN'T SIMPLY TELL THEM TO GO
DO SOMETHING WITHOUT HELPING
THEM DEVELOP A STEP BY STEP
PLAN.
SO AS ONE EXAMPLE, AS EXERCISE
AND WEIGHT LOSS ARE FIRST LINE
MANAGEMENT OPTIONS, WE NEED TO
TREAT IT AS A PRESCRIPTION JUST
LIKE WE WOULD ANY OTHER
MEDICATIONS.
SO FIRST START WITH WHERE ARE
THEY STARTING?
THERE'S NO POINT IN TELLING
SOMEONE TO GO AND WALK 20 TO 30
MINUTES PER DAY IF THEY ARE
FULLY SEDENTARY.
WE NEED TO START WITH GIVING
THEM CONCRETE WAYS TO GAUGE
THEIR PROGRESS AND TO PUT LIMITS
SO THAT THEY DON'T OVERDO IT BY
USING CERTAIN MINUTES PER DAY
FOR WALKING ACTIVITIES OR A
PEDOMETER, AND HELPING THEM
THINK THROUGH HOW THEY CAN DO
THAT IN A COMFORTABLE WAY.
MANY PATIENTS FEEL ANXIOUS THEY
MIGHT WALK TOO FAR AND THEN HAVE
DIFFICULTY MAKING IT BACK HOME.
SO WHAT'S IN THEIR
NEIGHBORHOODS?
ARE THERE BENCHES, ARE THERE
PLACES THEY CAN REST?
SOMEONE TALKED ABOUT THIS
YESTERDAY, ABOUT THE LIVED
ENVIRONMENT IN WHICH INDIVIDUALS
ARE LIVING IN.
SLOW AND STEADY WINS THE RACE.
THEY DON'T NEED TO BE TRYING TO
LOSE 20 POUNDS IN A MONTH.
SLOW, CONSISTENT WEIGHT LOSS IS
LIKELY TO BE MORE EFFECTIVE AND
PERSISTENT OVER TIME, AND
IMPORTANTLY, WE NEED TO
CELEBRATE THEIR SUCCESSES NO
MATTER HOW SMALL.
IN TERMS OF EXERCISE, THERE'S NO
ONE TYPE OF EXERCISE THAT IS
BETTER FOR OSTEOARTHRITIS THAN
OTHERS, SO AGAIN LOOKING FOR
WHERE THERE MIGHT BE FUNCTIONAL
LIMITATIONS, WHERE THERE -- WHAT
THEIR INTERESTS ARE, WHAT
THEY'RE ABLE TO ENGAGE IN,
THINKING ABOUT SOCIOECONOMIC
STATUS, WHAT'S AFFORDABLE, ALL
OF THESE THINGS CAN BE
BENEFICIAL FOR OSTEOARTHRITIS,
AND THEN NOT THINKING ABOUT JUST
PURE EXERCISE, BUT PHYSICAL
ACTIVITY INCLUDES ALL ACTIVITIES
OF DAILY LIVING.
THEN IN TERMS OF GOALS FOR THOSE
THAT ARE INTERESTED IN STEP
GOALS, 10,000 STEPS PER DAY IS
KIND OF A MADE UP MARKETING
TACTIC BY AN ORIGINAL
MANUFACTURER OF A PEDOMETER, NOT
BASED ON ANY BIOLOGY.
YEARS AGO, WE FOUND THAT 6,000
STEPS PER DAY REDUCED RISK OF
INCIDENT FUNCTIONAL LIMITATIONS
IN OSTEOARTHRITIS, AND THIS
THRESHOLD ALSO HAS BEEN SHOWN IN
STUDIES TO HELP REDUCE RISK OF
MORTALITY, ET CETERA.
SO I MIGHT START SOMEONE AT 500
OR A THOUSAND STEPS PER DAY IF
THEY'RE COMPLETELY SEDENTARY,
SLOWLY INCREASE THEM TO 3,000
STEPS PER DAY, EVENTUALLY GET
THEM TO 6,000 STEPS PER DAY.
CERTAINLY SOME PEOPLE MAY BE
ABLE TO DO MORE THAN THAT.
AS AN EXAMPLE, I HAD SOMEONE WHO
WAS COMPLETELY SEDENTARY AND
THEN OVER TIME, SLOWLY, SLOWLY,
SLOWLY INCREASED HER DAILY
WALKING.
SHE LOST 60 POUNDS, WAS ABLE TO
COME OFF ALL HER PAIN
MEDICATIONS, WAS ABLE TO COME
OFF HER ANTIDEPRESSANTS AND
CONSISTENTLY WALKS 3 MILES PER
DAY.
THAT'S NOT GOING TO HAPPEN WITH
EVERYONE.
EXERCISE/PHYSICAL ACTIVITY IS
LARGELY BEHAVIORALLY MEDIATED,
BUT WE CAN HELP OUR PATIENTS SO
THAT THEY'RE NOT THINKING THAT
THEY HAVE TO GO JOGGING, THAT
THEY HAVE TO DO TWEP MIN 20 MINR
DAY RIGHT AWAY, THIS IS
SOMETHING THEY CAN BUILD TO.
AND REMIND THEM THAT THERE ARE
OTHER WAYS TO GET PHYSICAL
ACTIVITY, GARDENING, ALL THEIR
HOUSEHOLD CHORES, ET CETERA.
AND THEN -- OH, SORRY.
FINALLY, I JUST WANTED TO END ON
THIS CONCEPT OF MINIMALLY
DISRUPTIVE MEDICINE.
I THINK THIS IS REALLY AN
IMPORTANT THING FOR US TO BEAR
IN MIND AS HEALTHCARE PROVIDERS.
AND MISS OVERTON NICELY
HIGHLIGHTED MANY OF THESE
CONCEPTS.
SO AN INDIVIDUAL WITH
OSTEOARTHRITIS OR WITH ANY
MEDICAL CONDITION HAS TO ACCESS
CARE, USE CARE AND ENACT
SELF-CARE.
BUT THEIR CAPACITY TO ENGAGE MAY
BE LIMITED BY RESOURCES.
THEIR FINANCES, THEIR SOCIAL
SUPPORT.
SO MISS OVERTON TALKED ABOUT
TRANSPORTATION, ET CETERA.
AND THEN THERE ARE LIFE DEMANDS
THAT THEY HAVE TO GO TO WORK,
AND IN THE U.S., THERE'S A LOT
OF JOBS WHERE THERE'S NO UNPAID
LEAVE.
THEY MIGHT HAVE CAREGIVING
RESPONSIBILITIES.
AND SO AS THE BURDEN OF
TREATMENT INCREASES DUE TO
ATTENDING APPOINTMENTS, TESTS,
TAKING MEDICATIONS, THAT ADDS TO
THEIR WORKLOAD, AND IF THEY HAVE
LIMITED CAPACITY, THEY MAY NOT
BE ABLE TO ENGAGE, AND WHEN THEY
CAN'T ENGAGE IN THEIR OWN CARE,
THAT INCREASES THE BURDEN OF
ILLNESS, DECREASES OUR CAPACITY,
AND THEN THERE'S A VICIOUS
CYCLE.
SO OFTEN WHEN PATIENTS ARE
UNABLE TO ATTEND APPOINTMENTS ON
A ROUTINE BASIS, UNABLE TO TAKE
THEIR MEDICATIONS, UNABLE TO
ENGAGE IN PHYSICAL THERAPY, WE
NEED TO REALLY THINK MORE
BROADLY ABOUT MANY OF THESE
OTHER ISSUES.
RESOURCE SCARCITY AND WORKLOAD
ISSUES DISPROPORTIONATELY AFFECT
COMMUNITIES OF COLOR, PEOPLE OF
LOWER SOCIOECONOMIC STATUS.
THESE ARE REAL IMPORTANT ISSUES
THAT WE ARE ILL-EQUIPPED IN MOST
HEALTHCARE SYSTEMS TO ADEQUATELY
ADDRESS.
WHEN YOU THINK ABOUT TREATING
OSTEOARTHRITIS, MANY RESEARCHES
THINK ABOUT TARGETING MOLECULES
AND PATHWAYS BUT WE REALLY NEED
TO THINK ABOUT THE WHOLE PERSON.
WE WANT TO ADDRESS THEIR PAIN,
FUNCTION.
PEOPLE WITH OA HAVE NUMEROUS
COMORBIDITIES, SO
MULTI-MORBIDITY IS A BIG ISSUE
IN OSTEOARTHRITIS.
IDEALLY ADDRESS RISK FACTORS,
OTHER SYMPTOMS, MOOD, SLEEP, ET
CETERA, HELP ADDRESS QUALITY OF
LIFE.
SO ADDRESSING PATHOLOGY IS ONLY
ONE SMALL PART OF THIS BIG
PICTURE OF MANAGING AP AN
INDIVIDUAL'S OSTEOARTHRITIS.
SO IN SUMMARY, WE WANT TO MANAGE
DISEASE AND ILLNESS, LANGUAGE
MATTERS, DON'T USE FATALISTIC
LANGUAGE, USE PARTICIPATORY
LANGUAGE.
MEET PATIENTS WHERE THEY ARE,
BEWARE OF OUR OWN UNCONSCIOUS
BIAS, AND REFLECT ON WAYS IN
WHICH WE CAN TRY TO ENGAGE IN
MINIMALLY DISRUPTIVE MEDICINE.
THANK YOU.
>> THANK YOU SO MUCH, DR. NEOGI,
TO THAT REALLY THOUGHT PROVOKING
AND INFORMATIVE PRESENTATION.
WE'RE GOING TO LEVERAGE SOME OF
WHAT YOU DESCRIBED IN TERMS OF
THE TOPIC FOR OUR FINAL SPEAKER.
THIS SPEAKER IS JENNIFER
RAYMOND, WHO'S A JB AND MBA,
CHIEF STRIKE THAT YEE OFFICER
FOR AGESPAN, WHICH IS AN AREA
AGENCY ON AGING THAT SERVES
COMMUNITIES IN MASSACHUSETTS.
MISS RAYMOND ABOUT BE DISCUSSING
OSTEOARTHRITIS DISPARITIES FROM
THE PERSPECTIVE OF A LARGE
COMMUNITY-BASED ORGANIZATION
THAT'S REALLY FOCUSED ON WHOLE
PERSON CARE FOR OLDER ADULTS.
MISS RAYMOND, THANK YOU SO MUCH.
>> THANK YOU, ARLEEN, AND THANK
YOU, EVERYONE, FOR INVITING ME,
AND INCLUDING AND ACKNOWLEDGING
THE ROLE OF COMMUNITY IN
SUPPORTING INDIVIDUALS WHO HAVE
ARTHRITIS.
AS ARLEEN REFERENCED, WE ARE AN
AREA AGENCY ON AGING HERE IN
NORTHEAST MASSACHUSETTS, SO IF
YOU THINK NORTH OF BOSTON AND
SOUTH OF NEW HAMPSHIRE, YOU'LL
BE THINKING OF US.
THERE ARE THESE AREA AGENCIES ON
AGING THROUGHOUT THE COUNTRY.
I THINK THERE ARE ONLY ABOUT
FIVE STATES THAT DON'T HAVE AREA
AGENCIES ON AGING.
THESE AAA AS WELL AS OTHER
COMMUNCOMMUNITY-BASED ORGANIZATS
REALLY WANT TO BE PARTNERS WITH
PEOPLE WHO HAVE ARTHRITIS AS
WELL AS THEIR HEALTHCARE
PROVIDERS AND THEIR HEALTHCARE
SYSTEMS TO REALLY CREATE THAT,
THAT WHOLE-PERSON APPROACH
FOCUSING ON THE PERSON-CENTERED
NEEDS.
SO I WOULD ENCOURAGE ANYONE IF
YOU DON'T HAVE A RELATIONSHIP
WITH YOUR LOCAL AREA AGENCY ON
AGING, PLEASE REACH OUT AND
WE'RE HAPPY TO MAKE THOSE
CONNECTIONS.
THOSE ARE VERY VALUABLE.
WE SERVE AROUND 45,000
INDIVIDUALS PER YEAR.
USED TO BE JUST OLDER ADULTS,
NOW WE'RE SERVING FAMILY
CAREGIVERS AS WELL AS YOUNGER
PEOPLE WITH MULTIPLE CHRONIC
CONDITIONS.
WNOT ONLY DO WE WORK DIRECTLY
WITH INDIVIDUALS IN NEED OF
SERVICES, BUT WE ALSO PARTNER
WITH AND CONTRACT WITH A WIDE
VARIETY OF DIFFERENT HEALTHCARE
SYSTEMS SO THAT AS WE JUST
HEARD, IF YOU'RE A PROVIDER
WHO'S GOING TO BE COUNSELING
YOUR PATIENT TO WALK 500 STEPS,
A THOUSAND STEPS, 2,000 STEPS A
DAY, WE WANT TO BE A PARTNER
THAT HAS RESOURCES AVAILABLE TO
HELP THEM WHEN THEY'RE OUTSIDE
OF THE CLINICAL OFFICE TO
ACHIEVE THOSE GOALS.
SO WE DO PARTNER AND CONTRACT
WITH A WIDE VARIETY OF
HEALTHCARE ORGANIZATIONS AND
SYSTEMS TO DO THAT, AND WE ARE A
CDC-FUNDED STATE-WIDE APPROACHES
TO AIF DRESTO ADDRESSING ARTHRIE
AND WE'LL TALK A LITTLE BIT
ABOUT WHAT THAT MEANS.
AT THE COMMUNITY BASE LEVEL, WE
DO WANT TO TAKE THAT WHOLE
PERSON APPROACH AND I'M REALLY
CAREFUL TO USE THE WORD
"PERSON."
MANY OF THE INDIVIDUALS THAT WE
WORK WITH ARE USED TO BEING
LOOKED AT THROUGH THE PATIENT
LENS, THROUGH THE MEMBER LENS,
THROUGH THE RESIDENT LENS,
THROUGH WHATEVER TITLE IS
IMPORTANT FOR THE INDIVIDUAL
THAT'S PROVIDING SERVICES, BUT
AT THE END OF THE DAY, IT IS
THAT WHOLE PERSON, AND AS
MS. OVERTON SPOKE SO ELOQUENTLY
ABOUT, THERE'S A LOT OF THINGS
THAT ARE GOING ON IN THE LIVES
OF PEOPLE THAT HAVE ARTHRITIS
BESIDES THE FACT THAT THEY HAVE
ARTHRITIS.
SO WHEN WE TAKE A REFERRAL FROM
A MANAGED CARE ORGANIZATION OR
FROM A FAMILY HEALTH CENTER, WE
START FRESH WITH THE PERSON TO
SORT OF TALK ABOUT WHAT'S
IMPORTANT TO YOU, AND A LOT OF
TIMES WE HEAR THINGS LIKE I HAVE
A NEWBORN GRANDCHILD, I WANT TO
BE ABLE TO GET DOWN ON THE FLOOR
AND PLAY WITH THEM AND GET UP
AND NOT FEEL DEBILITATING PAIN
FOR THE NEXT 48 HOURS.
SO THAT WILL BE THE FOCUS, HOW
CAN WE HELP YOU BE MORE ENGAGED
WITH YOUR NEW GRANDCHILD WITHOUT
FEELING THAT PAIN.
AND THAT'S VERY DIFFERENT.
THAT'S VERY MUCH NOT THE WHAT'S
THE MATTER WITH ME BUT THE WHAT
MATTERS TO ME APPROACH, WHICH IS
THE APPROACH WE TAKE AS
COMMUNITY-BASED ORGANIZATIONS.
OFTENTIMES WE FIND THE GOALS OF
THE PROVIDER MIGHT BE REALLY
DIFFERENT THAN THE GOALS OF THE
PERSON, SO AGAIN, HOW DO WE SORT
OF THINK ABOUT WHAT'S IMPORTANT
TO THE PERSON.
OFTENTIMES WE'LL RECEIVE A
REFERRAL AND THE REFERRAL WILL
SAY ALL OF THESE THINGS ARE
TRUE, THIS PERSON LAS
OSTEOARTHRITIS, THEY WILL
BENEFIT FROM ADDITIONAL PHYSICAL
ACTIVITY, THEY WILL BENEFIT FROM
WEIGHT LOSS, THEY WILL BENEFIT
FROM BETTER MEDICATION
MANAGEMENT AND THEN WE TALK WITH
THE CONSUMER AND SORT OF GET
WHAT MATTERS TO THEM, I WANT TO
BE ABLE TO PLAY WITH MY
GRANDCHILD.
SO HOW DO WE CREATE THE RIGHT
SYNERGY AND BALANCES AMONG THOSE
GOALS, WHICH ARE CERTAINLY
ALIGNED BUT JUST MESSAGED AND
LANGUAGED IN VERY DIFFERENT
WAYS.
AND THEN SORT OF REALLY TALKING
WITH THE INDIVIDUAL WITH
ARTHRITIS ABOUT WHAT DOES
MEASURES OF SUCCESS LOOK LIKE TO
THEM.
IS IT ONLY HAVING PAIN THAT
REGISTERS A 3 AS OPPOSED TO A 9,
IS IT BEING ABLE TO PLAY WITH MY
GRANDCHILD, IS IT BEING MORE
PHYSICALLY ACTIVE, IS IT RELYING
LESS ON MEDICATION.
SO WHAT'S GOING TO BE THE
MEASURE OF SUCCESS FOR THE
INDIVIDUAL THAT WE'RE WORKING
WITH.
THAT'S SORT OF THE WHOLE PERSON
APPROACH THAT WE TAKE ON THIS, A
PART OF THE WHOLE PERSON
APPROACH, I'M SORRY, THAT WE
TAKE ON THE COMMUNITY-BASED
ORGANIZATION SIDE.
THE OTHER PIECE OF IT, AND I
THINK MISS OVERTON TALKED ABOUT
THIS VERY WELL, WHEN SOMEONE IS
DIAGNOSED WITH ARTHRITIS,
CHANCES ARE IT'S NOT UNUSUAL FOR
THEM TO HAVE OTHER VERY COMPLEX
PHYSICAL NEEDS, AND IT'S ALMOST
NOT UNHEARD OF FOR THEM TO HAVE
VERY COMPLEX SOCIAL NEEDS.
SO IF A PERSON THAT WE'RE
WORKING WITH HAS A GOAL OF
INCREASING PHYSICAL ACTIVITY SO
THEY CAN PLAY WITH THEIR
GRANDCHILD, WHAT IS GOING TO GET
IN THE WAY OF THEM ACHIEVING
THAT GOAL?
AND OFTENTIMES THE THINGS THAT
YOU SEE ON THE SCREEN HERE ARE
AT THE TOP OF THE LIST.
IF YOU'RE FINANCIALLY INSECURE
AND THE THREAT OF HOMELESSNESS
OR HOUSING SECURITY IS THERE,
THAT CERTAINLY GETS IN THE WAY
OF PRIORITIZING PHYSICAL
ACTIVITY.
IF YOU'RE FOOD-INSECURE, THAT
CERTAINLY GETS IN THE WAY OF
PRIORITIZING PHYSICAL ACTIVITY.
SOCIAL ISOLATION AND LONELINESS
CAN BE VERY DEMOTE VAITING
VERY DE MOTIVATINGFEELINGS TO GD
MOVING, AND MANY FOLKS SUFFER
FROM DEPRESSION, ANXIETY,
STRESS, OTHER KINDS OF
BEHAVIORAL HEALTH THINGS.
SO WHEN WE ARE REFERRED AN
INDIVIDUAL WHO HAS ARTHRITIS,
ONE OF THE VERY FIRST STEPS IS
TO DO THIS BROADER SOCIAL
DETERMINANT OF HEALTH
ASSESSMENT, THIS SDOH
ASSESSMENT, WHAT ELSE IS GOING
TO GET IN THE WAY?
ONCE WE IDENTIFY THOSE THINGS
THAT ARE GOING TO GET IN THE WAY
OF SOMEONE MANAGING THEIR
ARTHRITIS BETTER, THE NEXT STEP
IS TO LOOK AT WHAT ARE THE OTHER
RESOURCES THAT WE AS A
COMMUNITY-BASED ORGANIZATION CAN
CONNECT SOMEONE TO, TO HELP THEM
OVERCOME THOSE BARRIERS.
SO CAN WE GET MEALS DELIVERED TO
THEM ON A DAILY BASIS, CAN WE
CONNECT THEM WITH A LOCAL FOOD
BANK, CAN WE GET THEM REGISTERED
FOR SNAP BENEFIT OR HOUSING
BENEFITS OR OTHER KINDS OF
BENEFITS?
CAN WE GET THEM TRANSPORTATION
TO THEIR NON-EMERGENCY MEDICAL
APPOINTMENTS?
WHAT ARE THE OTHER THINGS THAT
THEY NEED THAT EXIST IN THE
COMMUNITY THAT WE WANT TO
CONNECT THEM WITH SO THEY CAN BE
SUCCESSFUL AND LET ME FIND THAT
FOAS WHO HAVE THOSE KINDS OF
SUPPORTS, THEN HAVE THE CAPACITY
TO PARTICIPATE MORE IN THE
MANAGEMENT OF THEIR DISEASE.
AND EVERY OLDER ADULT ENGAGED IN
SERVICES SHOULD HAVE A CBO.
WE KNOW WHERE THE RESOURCES ARE
SO WE'RE NOT GOING TO RELY ON A
WEBSITE TO GOOGLE AND SAY
WHERE'S THE NEAREST FOOD BANK.
WE'RE GOING TO BE ABLE TO SAY
THERE'S A FOOD MARKET THAT
HAPPENS ON MONDAY, WEDNESDAY AND
FRIDAY.
MAKE SURE YOU GET THERE BUT
10:15 BECAUSE THE GOOD STUFF IS
GONE BY 11:00.
AND IF YOU NEED TRANSPORTATION,
WE'RE THERE.
IF YOU NEED SOMEONE TO GO PICK
UP THE FOOD AND DELIVER TO YOUR
HOME, WE'RE THERE.
AND WE DO THIS WORK THROUGH THE
USE OF COMMUNITY HEALTH WORKERS
OR COMMUNITY OUTREACH WORKERS
WHO REPRESENT THE COMMUNITIES
THAT WE SERVE IN TERMS OF
LANGUAGE, CULTURE, DIVERSITY, SO
THAT WE DEVELOP THOSE
RELATIONSHIPS OF TRUST.
SO IT'S NOT JUST SORT OF WHAT
CAN I DO TO HELP YOU MANAGE YOUR
ARTHRITIS, BUT WHAT CAN I DO TO
HELP YOU OVERCOME ALL OF THE
BARRIERS THAT ARE GOING TO FIGHT
AGAINST YOU BETTER MANAGING YOUR
ARTHRITIS.
ONE OF THE RESOURCES AVAILABLE
TO MANY STATES INCLUDING
MASSACHUSETTS TO HELP WITH THESE
KINDS OF THINGS ARE GRANTS, AND
WE ARE THE FORTUNATE RECIPIENTS
OF A FIVE-YEAR GRANT FROM CDC
CALLED THE STATEWIDE APPROACHES
TO ADDRESSING ARTHRITIS.
UNDER THIS GRANT, THERE ARE FOUR
MAIN STRATEGIES.
THE FIRST IS THE DISSEMINATION
OF ARTHRITIS-APPROPRIATE
EVIDENCE-BASED INTERVENTIONS.
SO EVIDENCE-BASED PROGRAMS LIKE
THE CHRONIC DISEASE
SELF-MANAGEMENT PROGRAM OR THE
CHRONIC PAIN SELF-MANAGEMENT
PROGRAM, AND PERHAPS THIS IS NOT
UNLIKE THE PAIN MANAGEMENT
PROGRAM THAT MISS OVERTON SPOKE
OF THAT IS GOING TO TALK WITH
INDIVIDUALS IN A GROUP SETTING
ABOUT DIFFERENT TOOLS OR
RESOURCES TO HELP MANAGE PAIN,
WHETHER IT'S BETTER MEDICATION
MANAGEMENT, WHETHER IT'S PACING
ACTIVITY SO THAT YOU'RE DOING
THEM, YOU KNOW, MAYBE IN STEPPED
APPROACHES AS OPPOSED TO ALL AT
ONCE, WHETHER IT'S REACHING OUT
AND IMPROVING COMMUNICATION WITH
YOUR HEALTHCARE PROVIDER,
WHETHER IT'S CONNECTING WITH A
COMMUNITY-BASED ORGANIZATION TO
LEARNING ABOUT OTHER RESOURCES,
BUT THESE INTERVENTIONS THAT
HAVE BEEN PROVEN TO DECREASE
THINGS LIKE UNNECESSARY HOSPITAL
UTILIZATION, INCREASING
CONFIDENCE IN MANAGING PAIN, A
WIDE VARIETY OF OUTCOMES.
SECOND STRATEGY IS TO COUNSEL
AND REFER PATIENTS TO INCREASED
PHYSICAL ACTIVITY, INCLUDING THE
EVIDENCE-BASED PROGRAMS.
SO UNDER THIS STRATEGY, WE
PARTNER WITH FAMILY HEALTH
CENTERS, PRIMARY CARE PRACTICES,
AND OTHER HEALTH ENTITIES TO
ACCEPT REFERRALS FROM THEM FOR
PEOPLE WHO HAVE ARTHRITIS.
AND THEN WE PUT THEM THROUGH THE
MANY DIFFERENT SERVICES THAT
I'VE TALKED ABOUT UP TO THIS
POINT.
PROMOTING WALKING, SO IF THE
PHYSICIAN HAS SAID I WOULD LIKE
FOR YOU TO WORK TOWARDS 2,000
STEPS A DAY AND THEY LEAVE THAT
30 MINUTES IN THE PHYSICIAN'S
OFFICE, THEY SORT OF NEED SOME
SUPPORT FOR THE OTHER, YOU KNOW,
23 1/2 HOURS A DAY AROUND HOW
THEY'RE EXACTLY GOING TO BEGIN
THAT JOURNEY.
SO PROMOTING AND CONNECTING WITH
WALKING GROUPS, OTHER
EVIDENCE-BASED PROGRAMS AS A
PART OF THIS FUNDING, AND THEN
FINALLY RAISING JUST BROADLY
MORE PUBLIC AWARENESS AROUND
ARTHRITIS, THE ARTHRITIS BURDEN,
AND MANAGEMENT OF THAT BURDEN.
I KNOW THAT WE'RE TIGHT ON TIME
SO I WILL JUST QUICKLY PUT THIS
OUT THERE, IT IS IN THE SLIDES.
I WANTED TO SHARE JUST ONE
EXAMPLE, A CASE STUDY, AND I
INTENTIONALLY CHOSE SOMEONE WHO
WAS YOUNGER, WHICH WE SOMETIMES
DON'T ALWAYS THINK OF PEOPLE
WITH OSTEOARTHRITIS AS BEING
YOUNGER, BUT JOHANNA IS A
32-YEAR-OLD HISPANIC FEMALE
LIVING IN MASSACHUSETTS.
SHE DIDN'T FINISH HIGH SCHOOL,
SHE'S EMPLOYED PART-TIME.
SHE HAS A NUMBER OF DIFFERENT
HEALTH NEED-BASED CRITERIA,
INCLUDING BOTH PHYSICAL AND
BEHAVIORAL HEALTH CHALLENGES.
ONE OF THOSE BEING ARTHRITIS AND
PAIN MANAGEMENT, BUT ALSO HAVING
DEPRESSION, ANXIETY, AND IN HER
CASE BIPOLAR DISORDER, AND
AGAIN, SOCIAL DETERMINANTS OF
HEALTH, LOOKING AT THE WHOLE
PERSON, WHILE THOSE THINGS,
THOSE BEHAVIORAL AND BEHAVIORAL
AND PHYSICAL HEALTH CHALLENGES
ARE HUGE AND DAUNTING, JOANNA
WAS ALSO A PERSON WHO HAD THIS
OVERWHELMING STRESSOR OF HAVING
A DOMESTIC RELATIONS CHALLENGE
AROUND MAINTAINING CUSTODY OF
HER CHILDREN.
SO SHE WAS AT RISK FOR
HOMELESSNESS, SHE WAS ALSO AT
RISK FOR NUTRITION DEFICIENCY,
AND THE PAIN REALLY PROHIBITED
HER FROM MOVING FORWARD.
SHE BECAME INVOLVED IN ONE OF
THE CHRONIC PAIN SELF MANAGEMENT
PROGRAMS.
WE PROVIDED TRANSPORTATION TO
THAT PROGRAM AS WELL AS
TRANSPORTATION TO THE FOOD
MARKET, WE PROVIDED GIFT CARDS
FOR HER, WE PROVIDED A
REGISTERED DIETITIAN THAT GO TO
THE GROCERY STORE WITH HER AND
HELP HER LEARN HOW TO NAVIGATE
AND MAKE HEALTHY CHOICES.
WE HELPED HER GET ALL OF HER
PAPERWORK TOGETHER AND WE GOT
HER CONNECTED WITH A BEHAVIORAL
HEALTH CLINICIAN.
SO ALL OF THAT COMING IN FROM A
REFERRAL WHERE WE THOUGHT THE
PRIMARY CONCERN WAS MANAGING
ARTHRITIS, THAT WAS A VERY
ESSENTIAL AND VERY IMPORTANT
CONCERN, BUT BEFORE SHE COULD
FOCUS ON ALL OF THAT, WE REALLY
HAD TO LOOK AT ALL OF THE OTHER
SOCIETAL CHALLENGES AND PROVIDE
RESOURCES TO SUPPORT THAT.
SO I'M CERTAINLY AVAILABLE TO
TALK, ANSWER QUESTIONS TODAY OR
TALK OFFLINE.
I ENCOURAGE FOLKS TO REACH OUT
TO MYSELF OR YOUR LOCAL
COMMUNITY-BASED ORGANIZATION,
WE'RE HERE TO HELP.
THANK YOU
>> THANK YOU SO MUCH.
THAT WAS REALLY A WONDERFUL
PRESENTATION.
AND I WANT TO THANK ALL OF OUR
PANELISTS FOR REALLY THOUGHTFUL
PRESENTATIONS THAT I THINK SHONE
A LIGHT ON AREAS THAT ARE OFTEN
BELIEUNDERSTUDIED AND UNDERADDRD
IN THE RESEARCH THAT WE DO.
SO WE'D LOVE TO -- THERE HAVE
BEEN SOME GREAT RESOURCES PLACED
IN THE CHAT, BUT WE'D LOVE TO
KNOW IF THERE ARE ANY QUESTIONS.
WE ONLY HAVE TIME FOR ONE OR TWO
QUESTIONS FROM THE AUDIENCE.
AND WE'D LIKE TO MAKE SURE THAT
THOSE QUESTIONS GET ASKED.
AND I ACTUALLY HAVE A QUESTION
FOR THE PANELISTS.
I'M WONDERING IF -- AND THIS IS
INFORMED BY A QUESTION THAT WAS
SENT, BOTH YESTERDAY AND TODAY
IS, IF THERE'S RESEARCH THAT
SHOULD BE DONE, WHAT DO YOU
THINK ARE THE PRIORITY RESEARCH
AREAS THAT WOULD HELP YOU AS A
PATIENT, MISS OVERTON, YOU AS A
PROVIDER, TUHINA, OR YOU AS A
COMMUNITY AGENCY, JENNIFER?
AS A REPRESENTATIVE OF A
COMMUNITY AGENCY?
LOVE TO GET YOUR THOUGHTS ON
THAT.
>> FOR MYSELF, I'LL JUMP IN REAL
QUICK.
IT WOULD BE ADVANTAGEOUS TO ME
TO HAVE MY INTERNAL MEDICINE
DOCTOR, THE FIRST DOCTOR I GO TO
SEE, THE ONE THAT I GET MY
YEARLY UPDATES TO REACH OUT TO
THE PAIN CLINIC TO SAY, WELL,
SHE DOESN'T HAVE JUST THIS ONE
THING, WE'RE DEALING WITH ALL
THESE OTHER THINGS.
: BLOOD
PRESSURE, PRE-DIABETES.
WHAT DO YOU SUGGEST I GIVE TO
HER AND THAT WOULD BE COMING
FROM THE ONE THAT I HAD THE
CLOSEST RELATIONSHIP WITH, WHICH
IS MY INTERNAL MEDICINE DOCTOR.
BUT I JUST KIND OF FEEL LIKE I'M
SCOOTED AWAY, AS SOON AS I SAY
"PAIN," I'M THROWN TO THE PAIN
CLINIC AND THEY ARE VERY
DETAILED IN WHETHER THEY'RE
GOING TO DO AN OPERATION, WHICH
I CAN'T HAVE ANY MORE OF, OR
THERE ISN'T AN OPERATION FOR MY
HANDS, TO GIVE ME EXERCISE,
DIET, I DON'T KNOW.
AS I UNDERSTAND THAT THERE ISN'T
ANYTHING AT THIS POINT, BUT
SOMETHING TO RELIEVE MY FEELING
THAT NOBODY CARES.
>> SO TO HAVE BETTER
COORDINATION AND FOCUS ON THE
PATIENT.
>> YES, FOR ME.
>> THANK YOU.
>> I WOULD AGREE WITH WHAT MISS
OVERTON HAS SHARED, AND I WOULD
ADD TO THAT, YOU KNOW, WE ARE
SEEING EMERGING MORE RESEARCH ON
THE ROLE OF NON-CLINICAL
INTERVENTIONS, AND PARTICULARLY
THE ROLE OF COMMUNITY HEALTH
WORKERS, COMMUNITY OUTREACH
WORKERS, AND I'D LOVE TO SEE A
BIT MORE AROUND THAT,
PARTICULARLY IN BIPOC
COMMUNITIES, WE CAN CERTAINLY
TALK ABOUT FROM A TESTIMONIAL
STANDPOINT WHAT WE SEE IN TERMS
OF THE ROLE THAT NON-CLINICAL
INTERVENTIONS AND COMMUNITY
HEALTH WORKERS, COMMUNITY
OUTREACH WORKERS CAN PROVIDE IN
HELPING TO MANAGE PAIN, BUT I'D
LOVE TO SEE MORE RESEARCH.
>> I KNOW WE'RE OUT OF TIME SO
I'LL MAKE TWO SMALL COMMENTS.
ONE IS, MISS OVERTON'S
PERSPECTIVE IS ABSOLUTELY
SPOT-ON.
WE DO NOT DO A GOOD JOB AS
CLINICIANS OF MANAGING PAIN.
IT STARTS ALL THE WAY FROM
MEDICAL SCHOOL TRAINING.
NO ONE REALLY OWNS IT.
IN MEDICINE, WE KIND OF TREAT IT
BASED ON THE ANATOMY, LOCATION
OF PAIN, AS OPPOSED TO THINKING
ABOUT MANAGING PAIN
COMPREHENSIVELY.
AND FROM THE RESEARCH
PERSPECTIVE, I THINK WE HAVE A
LOT OF GOOD STUDIES AND VARIOUS
MANAGEMENT OPTIONS IN
OSTEOARTHRITIS.
THE ISSUE IS IMPLEMENTATION.
ONE OF THE AREAS OF RESEARCH
THAT WE NEED IS IMPROVING
IMPLEMENTATION.
PATIENT EDUCATION, THEY'RE GOING
TO VARIOUS SOURCES FOR
INFORMATION, NOT ALL OF WHICH IS
TRUSTWORTHY, SO THERE ARE MANY
AREAS THAT WE CAN IMPROVE.
I WANT TO ALSO ECHO AND PUT IN A
PLUG FOR THE ARTHRITIS
FOUNDATION'S WALK WITH EASE
PROGRAM.
THAT'S SOMETHING THAT CAN BE
READILY ACCESSED BY INDIVIDUALS.
AND AGAIN, PHYSICAL ACTIVITY,
JUST DAILY WALKING IS AMONG THE
CHEAPEST AND EASIEST THINGS TO
DO.
OBVIOUSLY THERE'S ISSUES OF THE
LIVED ENVIRONMENT AND SAFETY OF
THE ENVIRONMENT, BUT DOING
SOMETHING IS BETTER THAN DOING
NOTHING, AND SOMEONE PUT THAT IN
THE CHAT AND I MEANT TO SAY THAT
IN MY TALK AS WELL.
YOU DON'T NEED TO GO FOR 10,000
STEPS.
3,000 STEPS IS BETTER THAN ZERO
STEPS.
>> THANK YOU ALL SO MUCH.
THIS HAS BEEN FABULOUS.
I'M GOING TO TURN IT BACK OVER
TO KRISTY, I THINK WHO'S
BRINGING US TO BREAK.
>> YES, THANK YOU, DR. BROWN,
AND AGAIN, THANK YOU TO ALL OF
OUR SPEAKERS IN THIS WONDERFUL
SESSION.
WE REALLY APPRECIATE YOUR TIME.
SO WE ARE GOING TO TAKE A SHORT
BREAK BEFORE WE MOVE TO THE
BREAKOUT SESSIONS.
IF YOU HAD QUESTIONS YOU WEREN'T
ABLE TO GET ASKED BECAUSE OF OUR
SHORT LIMIT OF TIME, PLEASE TAKE
THEM TO YOUR BREAKOUT SESSIONS.
HOPEFULLY THEY CAN HELP INFORM
OUR DISCUSSIONS TODAY.
WE WILL BREAK UNTIL 12:10.
PLEASE STAY LOGGED ON IF YOU CAN
SO THAT WE CAN GET YOU PUT IN
YOUR BREAKOUT ROOMS, AND WHEN
YOU COME BACK, YOU WILL COME
BACK INTO YOUR BREAKOUT ROOMS.
SO THAT WILL BE AT 12:10.
THANK YOU.
WELCOME BACK TO THE AFTERNOON
SESSIONS.
WE'RE GOING TO GO AHEAD AND GET
STARTED, IT'S RIGHT AT 2:30, AND
WE'RE GOING TO START WITH
SESSION V, WHICH IS OUR REPORT
OUT FROM OUR BREAKOUT SESSIONS.
WE WANTED TO GIVE EVERYBODY THE
OPPORTUNITY TO HEAR THE
DISCUSSIONS FOR THE BREAKOUTS
THAT THEY WEREN'T ABLE TO ATTEND
BECAUSE OF THE VIRTUAL FORMAT,
WE WERE VERY LIMITED IN TIME.
SO WHAT WE'LL DO IS GET STARTED
WITH DR. LEIGH CALLAHAN, WHO
WILL PRESENT THE INFORMATION ON
THE PATIENT-LEVEL FACTORS.
DR. CALLAHAN, THE FLOOR IS
YOURS.
>> GREAT.
THANK YOU, KRISTY.
SO I'M GOING TO REPORT OUT FROM
OUR TWO DIFFERENT SESSIONS.
WE HAD A WONDERFUL, ROBUST
GROUP, LIVELY DISCUSSIONS, AND
IT WAS NICE, BOTH SESSIONS
INCLUDED INDIVIDUALS FROM
DIFFERENT CLINICAL DISCIPLINES
AS WELL AS RESEARCHERS AND NIH
STAFF.
SO FIRST I'M GOING TO TALK ABOUT
THE GAPS THAT WE DISCUSSED, AND
I THINK WE REALLY FOCUSED ON
PATIENT-LEVEL VARIABLES, BUT
THERE WERE A FEW THINGS THAT
CAME UP IN OUR DISCUSSIONS JUST
THAT WE'LL REPORT ON TANGENTIAL
RELATIONSHIPS.
INITIALLY, THERE WAS A LOT OF
DISCUSSION ABOUT THE MEASURES
THAT ARE USED CURRENTLY IN
STUDIES OR MEASURES THAT ARE
COLLECTED IN LARGE
ADMINISTRATIVE DATASETS AND
THINGS LIKE CMS OR INSURANCE
COMPANIES AS WELL AS THE ITEMS
THAT ARE COLLECTED IN CLINICAL
TRIALS.
SO IN TERMS OF GAPS, WE NOTED
THERE WERE A LACK OF CONSISTENT
AND STANDARDIZED MEASURES
UTILIZED IN LARGE ADMINISTRATIVE
DATASETS.
AND THEN WE HAD A LOT OF -- FROM
THAT, WE WERE REFERRING TO
ALTHOUGH THERE ARE SOME MEASURES
THAT HAVE BEEN LOOKED AT
ROUTINELY IN A NUMBER OF THE
STUDIES AND TRIALS AND THINGS
THAT WERE PRESENTED BY DR. KATZ
IN HIS LECTURE, THOSE THINGS
LIKE EDUCATION, INCOME, THAT
TYPE OF THING, THEY STILL AREN'T
CONSISTENTLY COLLECTED, AND THEN
IN ADDITION, THERE ARE MANY
MEASURES THAT WOULD GET AT THE
COMPLEXITIES AND THE NUANCES
THAT ADDRESS SOME OF THESE GAPS
IN DISPARITIES.
SO THESE ME SO MEASURES THAT ART
COLLECTED ROUTINELY INCLUDE
MEASURES OF THINGS LIKE CULTURAL
DIFFERENCES, PATIENT
WILLINGNESS, NON-TRADITIONAL
DOMAINS SUCH AS KA T CATASTROPHG
OR SELF-EFFICACY, AND MEASURES
IMPORTANT TO PEOPLE IN ANOTHER
WAY.
MEASUREMENT FOR PROTECTIVE AND
VULNERABLE TRAITS, PEOPLE THAT
ARE CATASTROPHIZING AND THINGS
LIKE THAT.
A LACK OF FOCUS ON THE LIFE
COURSE AND THE LIVED EXPERIENCE
OF THE INDIVIDUAL.
MEASUREMENT OF COMFORT WITH THE
USE OF TECHNOLOGY AS WELL AS
MEASUREMENT OF ACCESS TO
TECHNOLOGY USE.
AND THIS WAS NOTED PARTICULARLY
IN REFERENCE TO WHAT WE'VE
EXPERIENCED WITH THE COVID
PANDEMIC AND WHERE PEOPLE MOVE
TO TELEHEALTH AND TRYING TO
MEASURE BOTH OF THOSE.
ASSESSMENT OF PATIENT FACTORS
FROM A MOLECULAR AND GENETIC
LEVEL, ASSESSMENT OF LEARNING
STYLE AND LEARNING PREFERENCES
AS WELL AS THE HEALTH LITERACY
OF THE PATIENT, ASSESSMENT OF
COMPREHENSION OF INFORMATION
RECEIVED FROM PROVIDERS AND
OTHER SOURCES, AND THEN
ASSESSMENT OF CO-MORBID
CONDITIONS THAT THE PARTICIPANT
MIGHT HAVE IN ADDITION TO THEIR
OA.
SO ALL OF THESE WERE PUT ON THE
TABLE AS THINGS THAT COULD BE
CONSIDERED FOR MORE ROBUST AND
OBVIOUSLY EVERYTHING WOULD NOT
BE ABLE TO BE MEASURED AT ALL
TIMES, BUT THESE WERE NOTED AS
THINGS THAT FREQUENTLY ARE NOT
MEASURED AND THAT COULD
CONTRIBUTE.
IN ADDITION TO THESE MEASUREMENT
ISSUES AND ITEMS THAT AREN'T
COLLECTED, OTHER THINGS WERE
NOTED INCLUDING THE NEED FOR
ENHANCING THE CROSSTALK AMONG
PATIENTS, PROVIDERS, COMMUNITY
AND HEALTH SYSTEMS.
AND ALTHOUGH THIS ISN'T LIKE A
PATIENT LEVEL FACTOR, IT WAS
FELT THAT IF THERE'S MORE
CROSSTALK WITH PATIENTS
INVOLVED, THAT THAT COULD
ENHANCE MANY OF THE PATIENT
LEVEL FACTORS.
THERE'S A GAP IN TERMS OF
MINORITY AND UNDERREPRESENTED
POPULATIONS BEING REFLECTED IN
LARGE DATASETS, AND THERE WAS A
FAIR AMOUNT OF DISCUSSION ABOUT
THE FACT THAT YOU MIGHT HAVE
PEOPLE WHO ARE ANALYZING
MINORITY POPULATIONS, FOR
EXAMPLE, IN SOMETHING LIKE THE
OAI, BUT THAT ONLY HAS 17%
MINORITY POPULATION.
SO IF OUR DATASETS HAVE A SMALL
GROUP, AND MAYBE THAT GROUP IS
NOT REFLECTIVE OF THE WHOLE
NON-MINORITY POPULATION, DOING
THESE COMPARISONS LEADS TO
INADEQUATE REFLECTION OF WHAT
THE OUTCOMES ARE.
ALSO THERE WAS DISCUSSION THAT
THERE'S NO CONSENSUS ABOUT ONE
SPECIFIC SOCIAL DETERMINANTS OF
HEALTH FRAMEWORK.
THREE FRA FRAMEWORKS WERE BROUGP
WITHIN THE MEETING.
THE NIMHD, NIA AND ALSO THE
HEALTHY PEOPLE 2030.
AND THERE WAS DISCUSSION THAT
PEOPLE -- PATIENT LEVEL FACTORS
WERE IN ALL OF THOSE FRAME
WORKS, IF YOU'RE APPLYING FOR
DIFFERENT GRANTS OR TRYING TO
USE -- PICK A FRAMEWORK, HOW TO
PICK THAT FRAMEWORK AND WHAT ARE
THE STRENGTHS AND WEAKNESSES OF
THE FRAME WORKS.
AND THEN LASTLY, A GAP WAS THAT
THERE'S A NEED FOR A WORKFORCE
THAT REFLECTS DIVERSE
POPULATIONS.
AND BY HAVING A MORE REFLECTIVE
WORKFORCE, IT MIGHT BE EASIER TO
RECRUIT INDIVIDUALS INTO STUDIES
IF THE INDIVIDUALS WHO ARE
CARING FOR THEM OR CONDUCTING
STUT STUDIES REFLECT THE POPULA.
WE'VE SORT OF LOOKED AT
OPPORTUNITIES IN TERMS OF SHORT
TERM, IP INTERMEDIATE AND LONG
TERM.
AND FROM THE SHORT TERM AS I
NOTED, THERE HAVE BEEN
SUBSTANTIAL WORK IDENTIFYING
MANY PATIENT LEVEL FACTORS THAT
CONTRIBUTE TO SOCIAL
DETERMINANTS OF HEALTH.
AND WE FELT LIKE THOSE COULD
IMMEDIATELY BE RECOMMENDED FOR
INCLUSION IN LARGE
ADMINISTRATIVE DATASETS OR
PROPOSED TRIALS.
AND THEN MORE GRANULAR WORK
COULD BE DONE TO IDENTIFY THE
INCLUSION AND THE MEASURES OF
ALL OF THE GAPS THAT WERE LISTED
ON THE PREVIOUS SLIDE BUT IN THE
SHORT TERM, THE ONES WHERE THE
SUBSTANTIAL WORK HAS BEEN DONE
COULD BE RECOMMENDED THAT THEY
SHOULD ALWAYS BE INCLUDED.
ANOTHER SHORT TERM OPPORTUNITY
IS THAT INDIVIDUALS FROM A RANGE
OF DISCIPLINES AND FIELDS ARE
INTERESTED IN HEALTH DISPARITIES
AND THAT WAS REFLECTED BY THE
PARTICIPATION IN THIS
CONFERENCE, AND THERE WAS A
RECOMMENDATION THAT WE COULD
HAVE MORE COLLABORATIVE
DISCUSSIONS BETWEEN THESE GROUPS
AND THESE DISCUSSIONS WOULDN'T
NEED TO BE TWO-DAY CONFERENCES
BUT THEY COULD BE SHORTER ONE OR
TWO-HOUR INTERCHANGES WHERE
PEOPLE COULD BE TALKING ABOUT A
LOT OF THE IDEAS THAT WILL BE
IDENTIFIED AS NOT ONLY PATIENT
LEVEL FACTORS BUT OTHER GROUPS
TODAY AND THIS COULD BE
FACILITATED BY THE NIH.
ANOTHER SHORT TERM IS TO HAVE
SUPPLEMENTS TO EXISTING LARGE
RESEARCH STUDIES AROUND OBESITY,
PAIN AND OA FOR ENHANCING
MINORITY AND UNDERREPRESENTED
PARTICIPANTS.
AND THEN BACK TO THE FRAMEWORKS,
PERHAPS THERE COULD BE
REPRESENTATIVES FROM EACH
FRAMEWORK, NIMHD, NIA AND
HEALTHY PEOPLE 2030, HAVE THEM
GET TOGETHER TO DEVELOP A
POSITION PAPER TO GUIDE
RESEARCHERS OR AT LEAST SOME
PEOPLE COULD REFER TO SORT OF A
COALESCING FROM THESE GROUPS.
AND OUR LAST SHORT TERM
OPPORTUNITY WAS TO RECOMMEND
TRIANGULATION OF OTHER
PROFESSIONAL AND RESEARCH GROUPS
IN THE OA DISEASE AREA THAT ARE
FOCUSING ON DISPARITIES SUCH AS
ORS, OAAA, ACR, AAOS, AND
OTHERS.
FOR OUR IMMEDIATE OPPORTUNITIES,
WE RECOMMENDED DEVELOPMENT OF A
MORE ROBUST CORSET OF MEASURES
FOR PATIENT-LEVEL FACTORS TO
ADDRESS THE MULTITUDE OF ITEMS
THAT WERE NOTED IN THE GAPS.
TO ENSURE PATIENT PROVIDERS
UNDERSTAND THE PREVALENCE,
IMPACT AND EPIDEMIOLOGY OF THE
DISEASE IN VARIOUS POPULATIONS,
AND THAT THEIR COMMUNICATION IS
APPROPRIATE.
AND THIS WAS INDICATING THAT IF
THEIR COMMUNICATION IS
APPROPRIATE WITH THEIR PATIENTS,
THERE MAY BE MORE PARTICIPANTS
WILLING TO PARTICIPATE IN
STUDIES IF THEY'RE SENDING A
MESSAGE ABOUT THE IMPACT OF THE
DISEASE.
AND LASTLY ANOTHER INTERMEDIATE
OPPORTUNITY WOULD BE TO EDUCATE
PARENTS, YOUTH ORGANIZATIONS,
COACHES, ATHLETIC TRAINERS AND
OTHERS ABOUT THE EARLY RISK
FACTORS FOR OA: OBESITY,
INJURY, LACK OF PHYSICAL
ACTIVITY, AND THESE ARE PATIENT
LEVEL RISK FACTORS THAT CAN
OCCUR EARLY IN LIFE, AND WE NEED
TO BE INTERVENING SO THAT
INDIVIDUALS UNDERSTAND THE
IMPORTANCE OF ADDRESSING THESE
RISK FACTORS EARLY.
LASTLY, OUR OPPORTUNITIES THAT
WE THINK WILL TAKE A LONGER --
MUCH LONGER TIME, THESE INCLUDE
CHANGING THE ATTITUDES OF
PARTICIPANTS ABOUT STUDIES, SO
THAT MINORITY PARTICIPANTS DO
NOT FEEL LIKE GUINEA PIGS AND
ARE MORE WILLING TO BE PART OF
RESEARCH, DISPELLING THE
PERCEPTION THAT STUDIES LIKE
TUSKEGEE ARE STILL AROUND.
ONE OF OUR INDIVIDUALS IN OUR
GROUP NOTED THAT IN SOME FOCUS
GREUNS WHEN THEY WERE TALKING TO
GROUPS, THE WORD GUINEA PIG CAME
UP REPEATEDLY AND EVEN YOUNG
INDIVIDUALS MENTION TUSKEGEE
EVEN IF THEY DON'T KNOW THE
SPECIFICS OF THE STUDY.
WE THINK THAT PUBLIC HEALTH
COULD HAVE A VERY STRONG ROLE IN
THIS ONE.
NEXT, LONG TERM IS SUPPORTING
LARGE ONGOING DATASETS THAT
COLLECT DATA EXCLUSIVELY WITHIN
MINORITY AND UNDERREPRESENTED
POPULATIONS TO HAVE -- WHERE YOU
CAN REALLY HAVE THE PATIENT
LEVEL OF ALL OF THIS.
AND LAST LONG TERM IS THE
DEVELOPMENT OF A WORKFORCE THAT
REFLECTS THE DIVERSITY OF THE
POPULATION IT SERVES AND
CONDUCTS RESEARCH.
THANK YOU.
>> THANK YOU, DR. CALLAHAN.
IT SEEMS YOU GUYS HAD A REALLY
ROBUST DISCUSSION, AS I'M SURE
ALL OF THE BREAKOUT SESSIONS
WERE.
WE'RE GOING TO PIVOT FROM THE
AGENDA AND HAVE DR. MOY GO NEXT,
TALKING ABOUT THE HEALTH SYSTEM
FACTORS.
DR. MOY?
>> OKAY.
THANKS.
IT'S A PLEASURE TO HAVE THIS
OPPORTUNITY TO PRESENT TO THE
GROUP.
OUR GROUP FOCUSED ON HEALTH
SYSTEM AND POLICY LEVEL ISSUES
AND SO WE THOUGHT ABOUT THINGS
LIKE FEDERAL POLICY, STATE
POLICY AND POLICIES THAT WOULD
CUT ACROSS MULTIPLE HEALTHCARE
FACILITIES, SO LARGE HEALTH
SYSTEM.
OF COURSE WE THANK ALL THE
MEMBERS OF THE GROUP, IT WAS A
VERY, VERY LIVELY DISCUSSION,
AND COLLEEN, WHO HELPED TAKE
NOTES AND CREATE THESE SLIDES.
SO WE ALSO TWEAKED WHAT WE
WANTED TO PRESENT A LITTLE BIT.
FIRST WE THOUGHT ABOUT THE
OPPORTUNITIES AS WELL AS SOME
EQUITY IMPLICATIONS OF SOME OF
THESE OPPORTUNITIES.
A LOT OF OUR CONVERSATIONS
FOCUSED ON THESE MAJOR THEMES
THAT EMERGED.
ONE THING WE THOUGHT WAS A
CURRENT OPPORTUNITY WERE
PATIENT-REPORTED OUTCOME
MEASURES.
WE HAD A FEELING THAT THE
SCIENCE BEHIND THE PROMS WERE
FAIRLY WELL DEVELOPED, THEY WERE
WELL POSITIONED, BEST PRACTICES
FOR PEOPLE TO ADOPT AND THAT
THIS INFORMATION WOULD REALLY
HELP GUIDE THE ASSESSMENT OF
PATIENTS AND TRACK THEIR
PROGRESS OVER TIME.
ALSO ANOTHER IMPORTANT ASPECT OF
PATIENT-REPORTED OUTCOME
MEASURES IS NOT ONLY GATHERING
INFORMATION BUT MAKING THIS
INFORMATION WIDELY AVAILABLE TO
BOTH PROVIDERS AS WELL AS
RESEARCHERS SO THAT THEY COULD
USE TO ASSESS BOTH THE, AGAIN,
IMPROVEMENTS OF INDIVIDUAL
PATIENTS AS WELL AS THEIR
HEALTHCARE SYSTEMS AS A WHOLE.
SOME EQUITY IMPLICATIONS OF THIS
MIGHT BE THAT DIFFERENT GROUPS
MIGHT HAVE DIFFICULTY DOING
THESE PARTICULAR KINDS OF DATA
COLLECTIONS, THEY MAY HAVE LESS
TRUST FOR SUPPLYING THIS KIND OF
INFORMATION, ESPECIALLY IF THEY
DON'T KNOW WHERE THIS
INFORMATION IS GOING TO AND HOW
IT'S GOING TO BE USED, SO
THERE'S A NEED FOR SOME
INFORMATION PROCESSES TO OCCUR
SO DIFFERENT GROUPS CAN FEEL
COMFORTABLE PROVIDING THIS KIND
OF INFORMATION.
ANOTHER AREA WE TALKED A LOT
ABOUT WAS PROMOTION OF DIET,
EXERCISE AND REHABILITATION FOR
THE TREATMENT OF OSTEOARTHRITIS,
ESPECIALLY EARLIER IN THE
DISEASE COURSE.
AGAIN THIS IS -- IT WAS FELT
THAT THE THINGS WE NEED TO DO
ARE FAIRLY WELL ESTABLISHED AND
IT'S MORE A MATTER OF GETTING IT
OUT AND INTO THE HANDS OF
PROVIDERS AND PATIENTS WHO CAN
THEN USE THIS INFORMATION.
SOME OF THE THINGS THAT CAME UP
FROM AN EQUITY PERSPECTIVE WAS
THAT DIFFERENT GROUPS MAY
BENEFIT FROM MORE CUSTOMIZED
INFORMATION PRODUCTS.
A GENERAL MANILA ENVELOPE KIND
OF PRODUCT, HANDOUT, GUIDANCE
MAY NOT RESONATE AS WELL WITH
DIFFERENT GROUPS, AND HAVING
MORE CUSTOMIZED INFORMATION
PRODUCTS MAY ENABLE MORE GROUPS
TO EMBRACE THE CHANGES THAT ARE
OFTEN NEEDED IN THEIR LIVES AND
TO BE MORE SUCCESSFUL COMPLYING
WITH THE DIFFERENT THINGS THAT
THEY NEED TO DO.
ANOTHER ONE WAS DIFFERENT GROUPS
THAT BENEFIT FROM DIFFERENT
KINDS OF OPTIONS IN TERMS OF
MODALITIES FOR RECEIVING THIS
KIND OF GUIDANCE AND
REHABILITATION, AND SO FOR
INSTANCE, THE EXAMPLE OF RURAL
AREAS NEEDING DIFFERENT KINDS OF
PRODUCTS AND DIFFERENT KINDS OF
INTERVENTIONS WAS RAISED, AND IN
PARTICULAR, THE SUPPLY OF
PHYSICAL THERAPISTS MAY BE LOW
IN CERTAIN RURAL AREAS AND AGAIN
SOME ADDED ADAPTATION OF
MODALITIES NEEDED, SUCH AS THE
USE OF TELEPHYSICAL THERAPY
KINDS OF INTERVENTIONS.
THERE WAS A CONVERSATION ABOUT
ACCESS TO JOINT REPLACEMENTS AS
WELL AS THE IMPORTANCE OF
FOLLOW-UP REHABILITATION
FOLLOWING A JOINT REPLACEMENT,
AND HERE WE KNOW THAT THERE ARE
MANY EQUITY ISSUES THAT RELATE,
DIFFERENT GROUPS HAVE DIFFERENT
BARRIERS TO CARE, THEY MAY HAVE
DIFFERENT PERCEPTIONS OF CARE SO
EQUALIZING THE ABILITIES OF
DIFFERENT GROUPS TO RECEIVE
JOINT REPLACEMENTS PROVIDING
SUPPORTS THAT ENABLE THEM TO
RECEIVE JOINT REPLACEMENTS WILL
BE IMPORTANT.
ALSO UNDERSTANDING THERE ARE
DIFFERENCES IN COSTS AND
BENEFITS FOR DIFFERENT GROUPS OF
JOINT REPLACEMENT WOULD BE
IMPORTANT TO UNDERSTAND.
CONVERSATION ABOUT PAYMENT, IT
SEEMS LIKE A LOT OF THE PAYMENT
ISSUE, THE PAYMENT METHODS CAN
INTRODUCE BIASES INTO THE SYSTEM
ATION IT RELATES TO DIFFERENT
GROUPS OF PATIENTS.
TOUCHED ON BOTH MOVEMENT FROM
THE INPATIENT SETTING TO
OUTPATIENT SETTING, MAKING
DISPARITIES LARGER AS WELL AS
THE USE OF BUNDLED PAYMENTS.
UNDERSTANDING HOW THESE PAYMENTS
RELATE TO DIFFERENT GROUPS IS
VERY IMPORTANT.
OTHER ISSUES, FEE FOR SERVICE,
LESS INVASIVE TREATMENTS, SO
PATIENT -- THERE MAY BE
INCENTIVES FOR PATIENTS THAT
NEED TO HAVE -- ON VAIT -- OBSES
THAT MEDICAID PAYS FOR FEW JOINT
REPLACEMENTS, BUNDLED PAYMENTS
AND SHIFTS TO OUTPATIENT
SETTING, FEWER OF RECIPIENTS
RECEIVING JOINT REPLACEMENTS.
THIS MAY BE AN EXAMPLE OF
STRUCTURAL RACISM WHERE WE KNOW
THE POPULATION ISN'T EVENLY
DISTRIBUTED ACROSS MEDICAID
RECIPIENTS, SO THE BIASES THAT
EXIST TOWARD MEDICAID PATIENTS
EXTRAPOLATE TO OTHER GROUPS AS
WELL.
THE LAST ONE WAS, I THINK THERE
WAS A CONVERSATION THAT ENGAGED
WITH COMMUNITY PARTNERS, THIS IS
ALSO TEAM TE DEEMED TO BE AN IMT
ASPECT, MANY OF THE
ORGANIZATIONS THAT DEAL WITH
COMMUNITY PARTNERS HAVE LESS
EXPERIENCE WORKING WITH
COMMUNITY PARTNERS AND A,,
THEREFORE, THE COSTS AND WORK
INVOLVED TO ENGAGE NEW PARTNERS
THAT FOCUS ON SPECIFIC
POPULATIONS MAY BE HIGHER THAN
THAT FOR THE OTHER -- THE
COMMUNITY PARTNERS THAT THEY'RE
USED TO DEALING WITH.
THE NEXT THING WE TRIED TO DO
WAS TO DELVE INTO SOME OF THE
BARRIERS THAT EXIST IN ACHIEVING
THESE OPPORTUNITIES.
FOR INSTANCE IN TERMS OF
ADOPTION OF PATIENT-REPORTED
OUTCOME MEASURES MORE BROADLY,
THIS RAISED THE ISSUE OF SOME
STANDARDIZATION BUT NOT AS MUCH
STANDARDIZATION AS WOULD BE
DESIRED, THE LACK OF JUST
SWITCHING A BUTTON, BEING ABLE
TO INCORPORATE THIS THROUGH
ELECTRONIC HEALTH RECORDS EASILY
AND THE LIFT THAT'S REQUIRED FOR
BOTH GETTING THIS INFORMATION
INTO ELECTRONIC HEALTH RECORDS
AND THEN GETTING IT OUT OF
ELECTRONIC HEALTH RECORDS WAS
RAISED.
THE COSTS BOTH IN TERMS OF TIME
AND I.T. EFFORT WAS A POTENTIAL
BARRIER THAT COULD BE ADDRESSED.
AGAIN, ACCESS TO DATA
AFTERWARDS.
IT'S GREAT TO COLLECT THIS DATA
BUT PEOPLE ACTUALLY NEED TO BE
ABLE TO GET TO THOSE DATA EASILY
IN ORDER TO USE IT, OVERALL
HEALTH SYSTEM, AND THEN LASTLY,
THE DISPARITIES IN THESE
PATIENT-REPORTED OUTCOME
MEASURES WAS NOT DEEMED TO BE
WELL ESTABLISHED, SO WE DON'T
KNOW ARE THEY EQUALLY EFFECTIVE
ACROSS DIFFERENT POPULATIONS,
AREN'T DIFFERENT POPULATIONS
INTERPRETING THE QUESTIONS
DIFFERENTLY AS INFORMATION
COMPARABLE ACROSS DIFFERENT
GROUPS.
FOR THE PROMOTION OF DIET,
EXERCISE AND REHABILITATION,
THAT WAS IDENTIFIED AS A LACK OF
IMPLEMENTATION KNOWLEDGE WITH
DIVERSE GROUPS.
SO THIS WAS DEEMED TO BE VERY,
VERY IMPORTANT FEATURE THAT WE
NEED TO HAVE MORE INFORMATION
ABOUT HOW TO BEST IMPLEMENT
THESE KINDS OF INTERVENTIONS
WITH DIFFERENT GROUPS OF
PATIENTS.
DIFFERENT GROUPS NEED DIFFERENT
KINDS OF SUPPORTS IN ORDER TO
ACHIEVE THESE PARTICULAR KINDS
OF INTERVENTIONS.
THERE'S A NOTION THAT MANY
THINGS THAT ARE BEING SUPPORTED
FOR OSTEOARTHRITIS IN TERMS OF
DIET, EXERCISE AND
REHABILITATION ARE SIMILAR WITH
WHAT'S BEING PROMOTED FOR
INTEGRATION WITH OTHER CHRONIC
DISEASES, TO INTEGRATE WITH THEM
IN SOME WAY BUT SHOULD BE ABLE
TO OPTIMIZE THE EFFECTIVENESS OF
THESE DIFFERENT KINDS OF
INTERVENTIONS THAT WOULD BENEFIT
DIFFERENT DISEASES IN ADDITION
TO OSTEOARTHRITIS.
AND TO LEADING TO THE NOTION OF
TELESERVICES EARLIER, AS AN AREA
WHERE MORE -- THAT WAS AN
OPPORTUNITY, BEING ABLE TO
PROVIDE REHABILITATION TO MORE
GROUPS OF PATIENTS, BUT THEN THE
ISSUE OF PAYMENT CAME UP, ARE
THESE SERVICES BEING PAID FOR IN
A FAIR WAY, ARE THEY BEING PAID
FOR AT ALL FOR THAT MATTER.
AN ISSUE OF WHAT IS THE BEST
DIET, ASSUMING EXERCISE
PROTOCOLS ARE WELL-DEFINED BUT
DIET IS LESS CLEAR, WHAT IS THE
BEST DIET FOR A PATIENT WITH
OSTEOARTHRITIS.
IN TERMS OF ENSURING ACCESS TO
JOINT REPLACEMENT, I THINK SOME
ISSUES WERE DISCUSSED WERE
TIMING, WHEN DIFFERENT GROUPS
MAY -- HAVE ACCESS BUT RECEIVE
THEIR JOINT REPLACEMENTS AT
DIFFERENT TIMES, PARTICULARLY
DISADVANTAGED GROUPS BEING SEEN
LATER IN THE DISEASE COURSE WHEN
THEY'RE PERHAPS LESS EFFECTIVE.
THE WHOLE NOTION OF INFORMED
DECISION-MAKING WAS RAISED.
SOME OPINED THAT PEOPLE OFTEN
HAD JOINT REPLACEMENTS AND
REALLY DIDN'T KNOW WHAT THEY
WERE GETTING INTO, UNTIL THEY
GOT TO POST JOINT PREPLACEMENT
REHABILITATION AND THEY WERE
TOLD WHAT THEY NEED TO DO, WHAT
WAS THE SUBSEQUENT COURSE, SO
THIS WOULD SUGGEST THEY WEREN'T
OPTIMUM BEFORE THEY HAD THEIR
SURGERY.
THERE ARE BIASES ABOUT PROVIDERS
IN THE OFFERING OF JOINT
REPLACEMENT TO INDIVIDUALS AND
STRUCTURAL BIASES LEADING TO THE
MEDICAID ISSUE EARLIER BUT ALSO
STRUCTURAL BIASES THAT EXIST.
FOR INSTANCE, PATIENTS THAT ARE
DEEMED TO HAVE CERTAIN SKILLSETS
OR THE ABILITY TO CARE FOR
THEMSELVES IN DIFFERENT WAYS,
BECAUSE THAT MAY NOT BE EVENLY
DISTRIBUTED ACROSS THE
POPULATION, THAT COULD MEAN
CREATING A STRUCTURAL BARRIER
FOR DIFFERENT GROUPS TO GET
JOINT REPLACEMENTS.
IN TERMS OF REDUCING BIASES
RELATED TO PAYMENT, PAYMENT
RATES ARE OFTEN DIFFERENTIAL,
AND THEN THE GENERIC NEED FOR
HAVING -- REPORTING TRACKING OF
DATA THAT'S EITHER ADJUSTED OR
STRATIFIED FOR DIFFERENT PATIENT
CHARACTERISTICS AND/OR SOCIAL
DETERMINANTS OF HEALTH WAS
IMPORTANT.
LASTLY IN TERMS OF ENGAGING
COMMUNITY PARTNERS, I THINK A
BARRIER WAS THE INSUFFICIENCY,
PERHAPS, OF CUSTOMIZED
INFORMATION PRODUCTS FOR
DIFFERENT GROUPS OF PATIENTS,
AND THESE CUSTOMIZED PRODUCTS
WILL THEN ENABLE BETTER
PARTNERSHIPS WITH THE COMMUNITY,
SPECIFIC COMMUNITIES TO GET THIS
INFORMATION IN THE LANDS OF
PINTO THE HANDS OFPATIENTS WITHD
COSTS OF ENGAGING PARTNERS.
SO THIS IS SOMEWHAT SUBJECTIVE.
WE TRIED TO CONSIDER WHAT WERE
THE LOWER HANGING FRUIT, THE
MORE IMPORTANT THINGS TO ENGAGE
EARLIER, AND THIS IS KIND OF
THINGS WE CAME UP WITH VERY
GENERICALLY.
WE THOUGHT IT'S VERY IMPORTANT
TO COLLECT DATA, TO EXAMINE AND
ADDRESS DISPARITIES, AS WE ARE
IMPLEMENTING POLICY, AS WE ARE
PROMOTING CERTAIN BEST
PRACTICES.
THAT ALSO IS A NEED TO CONSIDER
A STRUCTURAL BIAS EXPLICITLY,
WHENEVER WE MAKE CHANGES INTO
POLICY AND RESEARCH, FOR
INSTANCE IT IS IMPORTANT TO
INCLUDE PEOPLE FROM DIFFERENT
GROUPS TO INFORM THAT NEW POLICY
AS WELL AS TO CONSIDER THE
STRUCTURAL BARRIERS THAT WOULD
BE CREATED AS WE MARK DOWN A NEW
POLICY PATHWAY.
THE LIST OF DIFFERENT THINGS WE
CONSIDERED, WE THOUGHT ADOPTION
OF PATIENT-REPORTED OUTCOME
MEASURES WAS A HIGH PRIORITY AND
THAT WAS FEASIBLE GIVEN THE
CURRENT SCIENCE.
GATHERING THOSE INFORMATION AND
MAKING THEM MORE EASILY
AVAILABLE IS DOABLE, AND THERE
ARE CERTAIN BEST PRACTICES BUT
WHAT WE NEED TO DO IS PROMOTE
MORE STANDARDIZATION OF THESE
PRACTICES, GREATER
INTEROPERABILITY, TRYING TO MAKE
THIS A STANDARD FEATURE, FOR
INSTANCE, ON ELECTRONIC HEALTH
RECORDS AS OPPOSED TO A
CUSTOMIZED HISTORY.
ANOTHER SHORT TERM LOWER HANGING
FRUIT GOAL THAT WAS IDENTIFIED
WAS PROMOTION OF DIET, EXERCISE
AND REHAB.
WE THOUGHT THAT WAS REALLY
IMPORTANT TO DO MORE STUDIES OF
IMPLEMENTATION IN DIFFERENT
GROUPS AND COMMUNITIES, BUT AT
THE SAME TIME, WE THOUGHT THERE
WAS ENOUGH KNOWLEDGE TO
GENERALLY RECOMMEND THESE KINDS
OF INTERVENTIONS ACROSS THE
SPECTRUM FOR OSTEOARTHRITIS
PATIENTS.
ALSO A NEED TO UNDERSTAND THE
SPREAD OF BEST PRACTICES MORE
BROADLY FOR BEHAVIORAL CHANGE.
ALL OF THIS IS IMPORTANT TO
ENSURE THAT IMPLEMENTATION AND
SPREAD WERE EQUITABLE ACROSS
DIFFERENT POPULATIONS AND
DIFFERENT COMMUNITIES.
IN TERMS OF LONGER TERM GOALS, I
THINK WHERE WE ULTIMATELY WANTED
TO GO WAS WE WANTED TO HAVE
CLEAR OSTEOARTHRITIS MANAGEMENT
GUIDELINES INFORMED BY
PATIENT-REPORTED OUTCOME
MEASURES ACROSS THE LIFECYCLE OF
DIFFERENT PATIENTS.
THERE'S A NOTION THAT SOME
COST-EFFECTIVE ANALYSES WOULD BE
HELPFUL TO SUPPORT
DECISION-MAKING AND TO SUPPORT
POLICY MAKERS SIGNING ON FOR
DIFFERENT KINDS OF INTERVENTIONS
FOR OSTEOARTHRITIS, THAT THERE
WAS SOME COST INFORMATION
AVAILABLE BUT REALLY
UNDERSTANDING THE BIG PICTURE
LONG TERM COSTS OF DIFFERENT
KINDS OF TREATMENT PATHWAYS WAS
NOT KNOWN AS WELL AS IT COULD
BE.
SIMILARLY, I THINK IT WAS RAISED
THAT THERE WERE NOT A LOT OF
LONGITUDINAL STUDIES TO LOOK AT
THE LONG TERM OUTCOMES OF
PATIENTS WITH OSTEOARTHRITIS
TREATMENT IN DIFFERENT WAYS, WE
STUDY SHORT TERM AS OPPOSED TO
CONSIDERING THE BENEFITS AND THE
HEALTH OF INDIVIDUALS 10 YEARS,
20 YEARS DOWN THE ROAD FROM
DIFFERENT KINDS OF
INTERVENTIONS.
I THINK PAYMENT AND TRACKING
NEEDS TO BE DEVELOPED TO SUPPORT
EQUITABLE OUTCOMES FOR ALL OF
THE OSTEOARTHRITIS PATIENTS THAT
ARE COMING FOR TREATMENT, AND
THERE WAS IMPORTANCE OF
COMMUNITY PARTNERSHIPS THAT
COULD SUPPORT LIFESTYLES AND
ADDRESS SOME SOCIAL DETERMINANTS
OF HEALTH, AGAIN, ACROSS THE
LIFETIMES OF INDIVIDUALS --
INDIVIDUALS WITH OSTEOARTHRITIS.
SO I'M GOING TO ASK OUR GROUP TO
SEE IF THERE ARE OTHER THINGS
THAT THEY WANTED TO ADD TO THIS
PRESENTATION OF THE DISCUSSIONS
THAT WE HAD.
ANY OTHER MEMBERS OF OUR GROUP
WANT TO CHIME IN ABOUT THINGS I
MISSED?
>> I THOUGHT YOU COVERED IT ALL.
I CAN'T THINK OF ANY.
THANK YOU.
>> OKAY.
I'LL TURN IT BACK TO YOU.
>> THANK YOU, DR. MOY.
WE'RE GOING TO MOVE TO OUR NEXT
REPORT OUT FROM DR. KENT KWOH'S
GROUP, PATIENT AND PROVIDER
LEVEL FACTORS.
>> THANK YOU, KRISTY.
I WANT TO THANK STEPHANIE THAT
DID A TERRIFIC JOB IN TERMS OF
COLLECTING THE INFORMATION.
ALSO IN TERMS OF OUR GROUP, WE
HAD REALLY A ROBUST DISCUSSION
WITH VERY MANY DIFFERENT
PERSPECTIVES OVER THE TWO DAYS.
DO I HAVE CONTROL OF THE SLIDES?
SO WE TALKED ABOUT CURRENT
OPPORTUNITIES IN TERMS OF
RESOURCES THAT CERTAINLY
IMPROVED COMMUNICATION WOULD BE
IMPORTANT FOR PATIENTS AND
PROVIDERS.
USE OF DECISION AIDS, BUT IN
TERMS OF DISCUSSION OF DECISION
AIDS AS WAS BROUGHT UP, YOU WANT
TO MAKE SURE THOSE ARE
CULTURALLY APPROPRIATE FOR THE
POPULATION THAT WE'RE TARGETING.
THERE WAS A LOT OF DISCUSSION IN
TERMS OF UTILIZING OTHER
CLINICIANS.
CERTAINLY PRIMARY CARE PROVIDERS
ARE IMPORTANT AS THEY'RE ON THE
FRONT LINES, INTERNISTS, FAMILY
PHYSICIANS, NURSE PRACTITIONERS.
ALSO HAD A DISCUSSION THAT MAYBE
TALKING TO URGENT CARE CENTERS
IN TERMS OF WHERE SOME OF THAT
COMMUNICATION TAKES PLACE.
CERTAINLY RHEUMATOLOGISTS AND
ORTHOPEDIC SURGEONS ARE
IMPORTANT, WHAT WASN'T DISCUSSED
AS MUCH DURING THESE SESSIONS
AND WE HAVE A PHYSICAL THERAPIST
AS PART OF IT THAT THEY WOULD BE
IMPORTANT CLINICIANS TO PARTNER
WITH IN TERMS OF PROVIDING
BETTER PATIENT PROVIDER
COMMUNICATION.
ALSO PHARMACISTS ARE ANOTHER
CLINICIAN THAT MAY BE USEFUL IN
TERMS OF ENGAGING AND ALSO
SOCIAL WORKERS.
SO ALL THESE DIFFERENT
CLINICIANS CAN HELP TO IMPROVE
THE PATIENT-PROVIDER
COMMUNICATION ABOUT
OSTEOARTHRITIS.
THEN WE HAD A LONG DISCUSSION
ABOUT OTHER MEMBERS OF THE
HEALTHCARE TEAM.
COMMUNITY HEALTHCARE WORKERS,
INTERPRETERS, SOCIAL WORKERS,
PATIENT NAVIGATORS AND PATIENT
EDUCATORS WILL COME BACK AND
TALK ABOUT THE PATIENT
EDUCATORS, BUT THESE ARE
PROBABLY UNDERUTILIZED, AND THEY
CERTAINLY WOULD BE VERY HELPFUL
IN TERMS OF IMPROVING
COMMUNICATION ABOUT OA, AND THEN
BASED ON THE TALK THAT WE HAD
TODAY IN TERMS OF
COMMUNITY-BASED RESOURCES,
AGAIN, PROBABLY UNDERUTILIZED IN
TERMS OF THE AREA AGENCY ON
AGING, THAT CLINICIANS COULD
REACH OUT AND TO UTILIZE THAT AS
A RESOURCE.
WE TALKED ABOUT THE NEED OF
STANDARDIZED MEASURES OF PAIN
AND PHYSICAL FUNCTION, ALSO
PERFORMANCE MEASURES, PROMISE.
WE DID HAVE A DISCUSSION,
THOUGH, IN TERMS OF WHETHER
DIFFERENT GROUPS INTERPRET AND
COMMUNICATE THE SAME IN TERMS OF
THESE MEASURES, IN TERMS OF PAIN
INCENTIVE AND DISABILITY
COMMUNICATION, THAT'S IMPORTANT
IN TERMS OF THINKING ABOUT MORE
RESEARCH IN THAT AREA.
TED BROUGHT UP THERE'S A FUNDING
OPPORTUNITY THAT EVERYBODY
SHOULD BE AWARE OF IN TERMS OF
PATIENT-CLINICIAN RELATIONSHIPS
IN TERMS OF IMPROVING HEALTH
OUTCOMES OF PATIENTS THAT
EXPERIENCE HEALTH DISPARITIES
AND WE THOUGHT IT WAS IMPORTANT
TO INCLUDE THAT HERE.
AND WE WERE FORTUNATE TO HAVE
MS. OVERTON, A PATIENT TO HAVE
AS PART OF OUR GROUP, AND REALLY
TWO THINGS THAT CAME OUT OF THAT
WAS REALLY ENGAGING THE PATIENT
AS A WHOLE PERSON AND NOT JUST
LOOKING AT THEM AS ONE DISEASE
OR EVEN A SUBDISEASE IN TERMS OF
JUST A JOINT, YOU KNOW, THAT
THEY HAVE A KNEE OR A HAND THAT
REALLY -- IT'S IMPORTANT IN
TERMS OF THE PATIENT CLINICIAN
COMMUNICATION TO THINK ABOUT THE
PATIENT AS A WHOLE PERSON IN
TERMS OF ALL THE PIECES THAT
COMPRISED THE VARIOUS PROBLEMS
THAT THEY MAY BE FACING, AND NOT
JUST FOCUS ON ONE AREA.
AND ALSO RELATED TO THAT, SHE
BROUGHT UP THE IMPORTANCE THAT
WE TALK ABOUT IN TERMS OF CARE
COORDINATION, AND THIS IS WHERE
THE WHY WOULD WAS THAT WE REALLY
NEED TO WORK ACROSS DIFFERENT
CLINICIANS, AND SHE TALKED ABOUT
HOW HER CARE WAS FRAGMENTED,
BEFORE HAVING A PCP THAT REALLY
OVERALL MANAGED HER CARE, BUT
HAVING THE PAIN CLINIC VERSUS
THE ORTHOPEDIC SURGEON VERSUS
YOUR DERMATOLOGIST, SO THAT
CERTAINLY BETTER CARE
COORDINATION WAS EMPHASIZED THAT
THAT'S IMPORTANT EMPHASIS OF THE
NIA IN TERMS OF CARE
COORDINATION FOR OLDER FOLKS,
BUT CERTAINLY FOR PATIENTS WITH
OA.
WE HAD QUITE A BIT OF DISCUSSION
UNDERSTANDING WHAT WORKS IS
CHALLENGING, AND SO TRYING TO --
MORE EVIDENCE IS NEEDED FOR THE
EXISTING RESOURCES AND HOW
EFFECTIVE THEY ARE, NEED TO
STANDARDIZE EXISTING MEASURES
AND PROTOCOLS IN RESEARCH AND
CLINICAL CARE TO BETTER
UNDERSTAND HEALTH DISPARITIES
AND PATIENT-PROVIDER
COMMUNICATION.
AND BETTER PAIN COMMUNICATION
TOOLS.
WE NEED TO TEST THESE MEASURES
IN DIVERSE POPULATIONS AS I
MENTIONED AND THAT LACK OF
EVIDENCE IS A BARRIER TO
REIMBURSEMENT FOR RESOURCES, FOR
EXAMPLE, DIABETES, PATIENT
EDUCATORS ARE REIMBURSED AND FOR
RHEUMATOLOGY OR OSTEOARTHRITIS,
THAT ISN'T THE CASE, SO IF WE
HAD MORE STUDIES TO SHOW THAT
THE BENEFIT OF PATIENT EDUCATION
THAT PERHAPS, THEN, WE COULD GET
REIMBURSEMENT FOR THESE
RESOURCES IN OUR CLINICS THAT
WOULD BENEFIT OUR PATIENTS.
THEN WE TALKED A LOT OF
MODIFYING DISEASE PROCESSES.
DEFINING COMMUNICATION TAKING
INTO CONSIDERATION THE PATIENT'S
EXPERIENCES AND RESOURCES, NOT
JUST FOCUSING ON THE DISEASE BUT
WHAT THE PATIENT'S SYMPTOMS ARE,
HOW IT IMPACTS THEIR LIFE, AND
WHAT RESOURCES THEY HAVE TO
ADDRESS THESE AND
RECOMMENDATIONS OF TAKING INTO
ACCOUNT THESE RESOURCES.
AND RECOGNIZING THE
COMMUNICATION IS NOT JUST
NECESSARILY WITH THE ONE
PATIENT, WE'VE HEARD ABOUT THAT
DURING THE WORKSHOP IN TERMS OF
CULTURALLY DIFFERENT GROUPS THAT
FAMILY MEMBERS PLAY A VERY
IMPORTANT ROLE, AND WE'VE
ALREADY DISCUSSED IN TERMS OF
DIFFERENT PROVIDERS INVOLVED IN
THAT CARE AND THE IMPORTANCE IN
TERMS OF COMMUNICATION AND CARE
COORDINATION AMONG THESE GROUPS.
AND REALLY LOOK FOR
OPPORTUNITIES FOR SHARED
DECISION-MAKING, REALLIAGE NOT
JUST PATIENTS AND PRIMARY CARE
PRACTITIONERS, BUT AGAIN ACROSS
THESE VARIOUS PROVIDERS THAT
WILL BE INTERACTING WITH THE
PATIENT BASED ON THEIR
OSTEOARTHRITIS.
AND WE THOUGHT THAT PATIENT
PREFERENCES ARE IMPORTANT.
I KNOW THAT THE OTHER GROUP
TALKED ABOUT ASSESSING PATIENT
PREFERENCES REALIZING THAT
PHYSICIANS MAY INTERPRET PATIENT
PREFERENCES DIFFERENTLY AND
PATIENTS HAVE THEIR OWN
PREFERENCES AND IT'S IMPORTANT
THEN TO RECONCILE THESE
POTENTIAL DIFFERENCES IN TERMS
OF PATIENT PREFERENCES AND
PHYSICIAN PREFERENCES, ALSO
PHYSICIAN INTERPRETATIONS OF
PATIENT PREFERENCES.
WE TALKED ABOUT HOW DO WE BETTER
TRANSLATE AND IMPLEMENT RESEARCH
RESULTS INTO THE COMMUNITY,
MIGHT BE SOMETHING MORE IN TERMS
OF AHRQ AND PCORI IN TERMS OF
COMMUNICATING TO PATIENTS IN
TERMS OF THE RESEARCH RESULTS
THAT MAY BENEFIT THEM, ALSO IN
TERMS OF IMPLEMENTING THEM INTO
CLINICAL PRACTICE IN THE
COMMUNITY.
SO WE TALKED ABOUT GAPS,
PATIENTS, PROVIDERS CAN CONSULT
IN GENERAL INFORMATION ABOUT OA,
BUT THERE WERE DEFINITELY SOME
GAPS THERE.
RESOURCES ARE AVAILABLE FOR
PROVIDERS ABOUT MANAGEMENT
OPTIONS AND FOR OA, BUT THESE
NEED TO BE CURATED AND EASY TO
FIND EVIDENCE-BASED INFORMATION
CERTAINLY PATIENTS SEARCHING THE
WEB AND IT'S NOT ALWAYS EASY TO
FIND INFORMATION.
MUCH OF IT MAY BE PROMOTED BY
DRUG COMPANIES AND THEIR
PARTICULAR PRODUCTS.
OA TENDS TO BE IN GENERAL THAT
MUCH OF THE DISCUSSION IS ON
KNEE OA, CERTAINLY THE NIH HAS
GOOD HEALTH INFORMATION
RESOURCES AS DOES AMERICAN
COLLEGE OF RHEUMATOLOGY, AND WE
TALKED ABOUT MAYBE INCORPORATING
MORE GRAPHICS INTO THESE PATIENT
EDUCATION RESOURCES TO MAKE
COMMUNICATION EASIER FOR OUR
VISUAL YOU'LL LEARNER LEARNERS.
WE HAD A LONG DISCUSSION IN
TERMS OF THE NEED FOR TRAINING
AND EDUCATION SUPPORT PROVIDERS
TO IMPROVE PATIENT INTERACTIONS
AND SUPPORT BY THE HEALTH
SYSTEM, BETTER COMMUNICATION,
ALSO IN TERMS OF RISK
COMMUNICATION TRAIBING FOR TRAIR
CLINICIANS SO THEY CAN BETTER
COMMUNICATE RISKS AND BENEFITS
OF VARIOUS TREATMENTS AND
INTERVENTIONS TO PATIENTS.
AS WE TALKED ABOUT, OA RESEARCH
TENDS TO BE FOCUSED ON THE KNEE,
AND THAT AGENCIES SHOULD REALLY
TALK ABOUT MORE RESEARCH IN
OTHER AREAS BESIDES THE KNEE IN
TERMS OF SPECIFIC JOINTS SUCH AS
HAND OR FOOT AND ANKLE OR
SHOULDER.
THESE ARE -- SPINE, THAT COULD
BE IMPORTANT FOR PATIENTS AND WE
NEED TO HAVE BETTER EVIDENCE IN
THIS AREA TO COMMUNICATE PATIENT
INFORMATION.
WE TALKED ABOUT TO REALLY
IMPROVE PATIENT CLINICIAN
COMMUNICATION, WE NEED
MEASUREMENTS TO ASSESS THIS AND
STANDARDIZED MEASUREMENTS, AND
WE'LL TALK ABOUT THAT MORE, THAT
A LOT OF THE WORK HAN HAS BEEN
QUALITATIVE, THERE HAVE BEEN A
FEW STANDARDIZED MEASURES, BUT
PATIENT INFORMATION, THAT NEEDS
TO BE CULTURALLY APPROPRIATE IN
TERMS OF THIS PATIENT CLINICIAN
COMMUNICATION.
THERE ARE A VARIETY OF
OPPORTUNITIES THAT WE
IDENTIFIED, AND SO MULTIMODAL
STUDIES OF DIET INTERVENTION,
EXERCISE INTERVENTIONS IN TERMS
OF THINKING ABOUT HOW TO
COMMUNICATE THE BENEFITS OF
THESE TO PATIENTS, PARTNERING
WITH OTHER NIH INSTITUTES, ON
OA, COMORBIDITIES, YOU HEARD A
LOT ABOUT THAT OVER THESE TWO
DAYS, THERE'S OPPORTUNITIES IN
TERMS OF HEALTHY DIET AND
EXERCISE FOR A VARIETY OF
CHRONIC DISEASES, AND HOW DO WE
TAILOR THESE RECOMMENDS THAT ARE
CULTURALLY SENSITIVE FOR
ACCESSING HEALTHY FOODS,
PROVIDING REALISTIC
RECOMMENDATIONS ABOUT
EXERCISING, CONSIDERING
PATIENTS' RESOURCES AND
ENVIRONMENT, WE'VE HEARD ABOUT
THE FIT ENVIRONMENT AND WHERE
PATIENTS MAY OR MAY NOT HAVE THE
ABILITY TO EXERCISE BASED ON THE
ENVIRONMENT, BUT ALSO IMPORTANT
IN TERMS OF FITNESS LEVEL.
WE ALSO HEARD ABOUT THAT DURING
THE SESSIONS HERE, THAT
REALISTIC EXPECTATIONS OF WHAT
PATIENTS CAN EXERCISE, NOT
NECESSARILY 10,000 STEPS A DAY,
CERTAINLY LOWER LEVELS, 6,000
STEPS A DAY BUT IF SOMEBODY IS
SEDENTARY, EVEN 500 STEPS IS
REASONABLE.
MORE IS BETTER THAN LESS, AND
THAT GRADUALLY INCREASING THOSE
TARGETS ARE IMPORTANT WHEN
COMMUNICATING THESE
RECOMMENDATIONS TO PATIENTS.
AND SO THAT RELATES TO
RECOMMENDATIONS AND GOALS TO
PATIENTS ABOUT TYPE, FREQUENCY
AND DURATION OF EXERCISE.
AGAIN, HAVING REALISTIC GOALS
AND REALLY A GRADED EXERCISE
PROGRAM, THAT THEY ARE ABLE TO
ATTAIN AND HAVE SUCCESS AND THEN
MOVE ON.
SO PART OF THAT ALSO IS MANAGING
PATIENTS' EXPECTATIONS ABOUT THE
OUTCOMES OF EXERCISE, THAT THEY
AREN'T GOING TO SEE THE BENEFITS
RIGHT AWAY BUT IT'S REALLY LONG
TERM IN TERMS OF HOW THE IMPACT
OF THE EXERCISE WILL BE ON THEIR
PAIN AND THEIR JOINTS.
IN TERMS OF IMMEDIATE SHORT TERM
GOALS, WE NEED TO REALLY
UNDERSTAND HOW TO BETTER
COMMUNICATE THE EVIDENCE BASE
FOR THE EFFICACY OF EXISTING
INTERVENTIONS, IN TERMS OF
HEALTHY WEIGHT, COMMUNITY HEALTH
WORKERS, AND TO BE ABLE TO
BETTER PROMOTE THE TOOLS THROUGH
THE OA ACTION ALLIANCE.
THIS IS AT UNC PARTNERING WITH
CDC AND WITH ARTHRITIS
FOUNDATION, THAT THEY'VE CURATED
A DATA BANK OF TOOLS FOR
EDUCATION, BUT ALSO MEASURES AND
WE TALKED ABOUT DECISION AIDS,
MAYBE INCORPORATING THOSE IN
THERE IF THEY AREN'T IN THERE.
THERE ARE THE ABILITY OF THESE
EVIDENCE-BASE PROG-BASED PROGRAE
EXERCISE PROGRAM FOR HISPANICS
HAS BEEN TRANSLATED, SO WE WANT
TO MAKE SURE PEOPLE ARE AWARE OF
THAT RESOURCE AND UTILIZE IT
MORE.
AND REALLY IN TERMS OF THINKING
ABOUT PATIENT CLINICIAN
COMMUNICATION, NEED TO DEVELOP
TOOLS AND OUT COME MEASURES TO
ASSESS THE QUALITY OF
INTERACTIONS, POTENTIALLY IF
POSSIBLE TO HAVE -- ENCOURAGE
COMMON MEASURES OF THESE
ASSESSMENTS OF THE QUALITY OF
PATIENT-CLINICIAN INTERACTIONS
SO THAT THEY CAN BE IMPLEMENTED
ACROSS MULTIPLE STUDIES OF OA
BUT ALSO IMPLEMENTED ACROSS
DIFFERENT HEALTH SYSTEMS SUCH AS
PROBLEMS ARE BEING IMPLEMENTED
ACROSS THESE HEALTH SYSTEMS.
AND ALSO ENGAGE IN OTHER
DISCIPLINES IN TERMS OF
COMMUNICATION TRIALS, WE
DISCUSSED CERTAINLY PCPs ARE
IMPORTANT BUT MANY OTHER
CLINICIANS ARE INVOLVED IN THE
MANAGEMENT OF PATIENTS WITH
OSTEOARTHRITIS AND WE TALK ABOUT
OA COMMUNICATION THAT WE SHOULD
UTILIZE THE PERSPECTIVES OF THE
OTHER DISCIPLINES TO SEE HOW WE
CAN BETTER IMPROVE OA
COMMUNICATION.
AND STUDY HOW PROVIDERS MAY BE
USING CURRENT MEASURES SUCH AS
OCHT A CARE OA CARE TOOLS, WHETE
PATIENT-REPORTED OUTCOME
MEASURES, PERFORMANCE MEASURES,
AND WE DISCUSSED THAT THERE WAS
A NEED FOR MORE MULTIMODAL
STUDIES ON PATIENT CLINICIAN
COMMUNICATION, BOTH QUALITATIVE
AND QUANTITATIVE, AND ALSO IN
DIFFERENT SETTINGS, THAT MAY BE
DURING THE OFFICE, MAYBE IN THE
COMMUNITY, HOW TO PROVIDE
PATIENT EDUCATION RESOURCES, HOW
TO TAILOR THAT AND HOW TO
COMMUNICATE WITH THE REST OF THE
CARE TEAM.
ONE OF THE RECOMMENDATIONS WE'D
COME UP WITH, THERE NEEDS TO BE
MORE TRAINING ON PATIENT
COMMUNICATION INTO CLINICIAN
TRAINING REQUIREMENTS, TRAINING
REQUIREMENTS FOR NIH K AND F
AWARDS.
CERTAINLY THIS STARTING AT AN
EARLY STAGE, IMPORTANCE OF
PATIENT COMMUNICATION AND
REALLY, AGAIN, TALKING ABOUT
THIS IN TERMS OF MEDICAL STOOL
AND STAFF TRAINING AS WELL, IN
TERMS OF HOW TO COMMUNICATE WITH
DIVERSE POPULATIONS IN A
CULTURALLY APPROPRIATE WAY.
CERTAINLY WE'VE MADE STRIDES IN
THIS AREA, BUT I THINK THERE'S
MANY MORE STRIDES THAT COULD BE
DONE IN TERMS OF IMPROVING HOW
WE'RE DOING THIS.
I TALKED ABOUT DEVELOPING
EDUCATION RESOURCES FOR SPECIFIC
JOINTS AND MAKING THEM MORE
ACCESSIBLE TO PATIENTS AND
PROVIDERS.
ALSO HOW WE FACILITATE EARLY
DIAGNOSIS AND PREVENTION, THIS
IS CERTAINLY A CHALLENGE IN
TERMS OF IDENTIFYING PATIENTS
WITH OA EARLY IN THE DISEASE
COURSE, IN TERMS OF
COMMUNICATING THE EVIDENCE
MEASURES THAT WE HAVE IN TERMS
OF ADDRESSING OA IN TERMS OF
EXERCISE AND HEALTHY DIETS.
LONG TERM GOALS, WE NEED MORE
STUDIES ON THE EFFICACY OF NOVEL
INTERVENTIONS TO TREAT OR
PREVENT OA.
MORE STUDIES OF IMPLEMENTATION
OF EVIDENCE-BASED INTERVENTIONS
TO IMPROVE PATIENT-CLINICIAN
COMMUNICATION, AND WE TALKED
ABOUT REALLY INCORPORATING
TRAINING ON PATIENT
COMMUNICATION, ALL LEVELS OF
CLINICIAN TRAINING REQUIREMENTS
IN TERMS OF RESEARCH AND ALSO IN
TERMS OF MEDICAL SCHOOL AND
HOUSE STAFF TRAINING.
ONE OF THE THINGS I WOULD ADD
THAT WE DIDN'T TOUCH ON THAT ARE
CLEARLY VERY IMPORTANT IS WE
NEED A DIVERSE WORKFORCE IN
TERMS OF IMPROVING
PATIENT-PROVIDER COMMUNICATION
FOR DIVERSE POPULATIONS.
ALSO THEN IF THERE'S ANYONE IN
THE GROUP THAT WANTS TO MAKE
COMMENTS TO ADDRESS THIS, IS
THERE ANYTHING WE LEFT OUT HERE?
>> NO, THIS IS A VERY GOOD
SUMMARY.
>> I THINK SO TOO.
THANKS FOR INCLUDING MY
THOUGHTS.
>> GREAT.
WELL, THANK YOU FOR CONTRIBUTING
VERY IMPORTANT POINTS,
MS. OVERTON.
ALL RIGHT.
THANK YOU, BACK TO YOU, KRISTY.
>> THANKS, DR. KWOH.
WE'LL MOVE NEXT TO DR. BROWN WHO
WILL TALK ABOUT THE SOCIETAL AND
SOCIAL DETERMINANTS OF HEALTH
BREAKOUT SESSION.
>> THANK YOU SO MUCH.
CAN YOU GUYS HEAR ME?
>> YES.
>> ALL RIGHT.
SO I WANT TO THANK THOMAS FOR
HIS HARD WORK ON THIS.
IF YOU GO TO THE NEXT SLIDE,
PLEASE.
SO I'LL TRY TO NOT BE TOO
REDUNDANT, THOUGH OBVIOUSLY
THERE'S GOING TO BE SOME OVERLAP
WITH THE PRIOR PRESENTATIONS.
SO IN THINKING ABOUT
OPPORTUNITIES, WE WERE TRYING TO
FOCUS FIRST ON, YOU KNOW, WHAT
RESOURCES AND SYSTEMS ARE IN
PLACE THAT CAN BE LEVERAGED.
THERE'S A LOT OF DISCUSSION ON
AVAILABLE RESOURCES AROUND
SOCIAL DETERMINANTS OF HEALTH,
THE AHRQ, PHENX TOOLKIT, THE
RAND REPORT ON WORK AND
OCCUPATIONS.
THERE'S GAPS IN LINKAGE TO OA
CLINICAL AND EPIDEMIOLOGIC DATA,
SOME HIGH RISK INDIVIDUALS,
UNDOCUMENTED, PART-TIME WORKERS,
ET CETERA, ARE NOT REPRESENTED
OR UNDERREPRESENTED IN THESE
DATASETS.
THE SECOND IMPORTANT OPPORTUNITY
SITS WITH THE ELECTRONIC HEALTH
RECORD.
SO AGAIN, THERE'S INCREASED
EMPHASIS ON INCORPORATING SOCIAL
AND GENDER IDENTITY VARIABLES
INTO THE EHR AND THEN
POTENTIALLY LINKING THESE TO
CLINICAL AND COMMUNITY
RESOURCES.
A HUGE GAP IS THAT MANY OF THESE
FIELDS ARE NOT FILLED OUT, NO
ONE REVIEWS THEM WHEN THEY ARE
AVAILABLE.
AND IN THINKING ABOUT -- WE WERE
TRYING TO IDENTIFY SOME OF THE
THINGS THAT WORK, THEY DESCRIBED
A UNIVERSITY OF MISSOURI PROGRAM
THAT REALLY INCORPORATES THE
PATIENT VOICE IN RESEARCH DESIGN
BUT ALSO IN CLINICAL CARE.
AND TO TRY TO REALLY GET INPUT
AND BUY-IN BASED ON THE PATIENT
PERSPECTIVE.
AND THEY DESCRIBED ALSO A JOINT
HEALTH PROGRAM THAT IMPROVED THE
COMMUNICATION BETWEEN PATIENT
AND PROVIDER, AND COMMUNICATION
COMES UP A LOT IN A LOT OF THE
DISCUSSION THAT WE HAD.
SO THE IDEA HERE IS IT REDUCES
PATIENT FRUSTRATION AND REALLY
BRINGS OUTPATIENT PERSPECTIVE TO
THE TABLE, BUT ALSO INCLUDES A
BEHAVISTBEHAVIORIST WHO ALSO ADS
SOME OF THE MENTAL HEALTH
CONCERNS, AGAIN TAKING THAT
WHOLE HEALTH PERSPECTIVE.
ANOTHER IMPORTANT POTENTIAL
OPPORTUNITY IS AN EMPHASIS ON
PATIENT-CENTERED CARE IN
COMMUNITY SETTINGS, NOT JUST IN
HEALTHCARE SETTINGS.
AND DESCRIBING THE ROLE OF
PLACES LIKE LIBRARIES THAT CAN
CONNECT PEOPLE TO RENTABLE
EQUIPMENT FOR EXERCISE OR OTHER
TYPES OF RESOURCES THAT MAY BE
AVAILABLE IN THE COMMUNITY THAT
SHOULD BE MORE WIDELY SHARED AND
THAT SHOULD BE LINGED WITH CLINH
CLINICAL AND HEALTH SYSTEMS.
WE'LL TALK A LITTLE MORE ABOUT
SOME OF THE EXISTING PROGRAMS
BUT THERE ARE MANY PROGRAMS THAT
CAN BE LEVERAGED THAT HAVE BEEN
SHOWN TO WORK AND WORK IN A
RANGE OF COMMUNITY SETTINGS.
WHERE THERE MAY BE GAPS, IF THEY
HAVEN'T BEEN TESTED IN SOME
COMMUNITIES, REALLY MAKING SURE
THAT THAT INFORMATION IS
AVAILABLE, THAT THE TESTING IS
DONE IN A RIGOROUS MANNER.
I THINK THE OTHER THING THAT
CAME UP A LOT WAS PROGRAMS IN
OTHER DISCIPLINES.
SO IN GERIATRICS, WE TALKED
ABOUT PROGRAMS IN MENTAL HEALTH,
PROGRAMS FOR PATIENTS WITH
ALZHEIMER'S, AND THOSE TYPES OF
PROGRAMS SHOULD AND CAN BE
LEVERAGED FOR PATIENTS WITH OA.
SO A SECOND ISSUE IS REALLY I
WOULD SAY ALMOST EVERYTHING ON
THIS SLIDE IS REALLY ABOUT
COMMUNICATION.
SO REALLY TAKING A PUBLIC HEALTH
APPROACH TO SHARING EVIDENCE,
USING APPROACHES THAT ARE
RELEVANT ON THE BASIS OF
LANGUAGE AND CULTURE, REALLY
THINKING ABOUT THE AUDIENCE, AND
ONE EXAMPLE THAT WAS GIVEN IS
THAT WHEN YOU'RE TALKING TO
TEEN, YOU DON'T TALK ABOUT
OSTEOARTHRITIS BUT RATHER ABOUT
INJURY PREVENTION, SO REALLY
TAILORING THE MESSAGES TO THE
AUDIENCE ACROSS A NUMBER OF
DEMOGRAPHIC CHARACTERISTICS.
ANOTHER CRITICAL COMPONENT WAS
HAVING TRUSTWORTHY MESSENGERS
AND INSTITUTIONS, IN ORDER TO
REALLY ENHANCE THE EFFECTIVENESS
OF COMMUNICATION WITH PATIENT
POPULATIONS WHO ARE OFTEN
UNDERSERVED.
AND FIGURING OUT WAYS TO REALLY
ENGAGE PROVIDERS AND
INSTITUTIONS, AND LINKING THEM
TO THE COMMUNITIES IN A MORE
SYSTEMATIC WAY.
WE ALSO DISCUSSED IDENTIFYING
COMMUNITY-BASED STRATEGIES THAT
FOR BOTH PREVENTION AND
TREATMENT, EXAMPLES THAT CAME UP
WERE THINGS LIKE THE MILITARY,
POLICE, FIRE DEPARTMENTS AND
EVEN WORKPLACE AND DELIVERY
SERVICES HAVE PHYSICAL
THERAPISTS IN PLACE, AND ON SITE
WHO CAN HELP TO PREVENT INJURY
AND ALSO TO HELP WITH
RECUPERATION FROM INJURY.
SO REALLY THINKING ABOUT MOVING
SOME OF OUR CLINICAL RESOURCES
FROM THE WALLS OF OUR
INSTITUTIONS AND OUT INTO THE
COMMUNITIES IN MORE MEANINGFUL
WAYS.
AND THEN FINALLY, THICKING ABOUT
STRATEGIES TO ADDRESS SYSTEMIC
RACISM AND DISCRIMINATION THAT
PATIENTS MAY FACE, RECOGNIZING
THIS IS AN IMPORTANT PROBLEM,
AND ALSO UNDERSTANDING THAT
THERE ARE SOME EVIDENCE-BASED
INTERVENTIONS THAT HAVE BEEN
SHOWN TO WORK, BUT WE NEED TO
FIGURE OUT WAYS THAT WE CAN
DEVELOP MORE EFFECTIVE
EVIDENCE-BASED INTERVENTIONS
THAT ARE SPECIFIC TO PATIENTS
WITH OSTEOARTHRITIS AND THEIR
CO-MORBID CONDITIONS.
THE NEXT I THINK WAS MODIFYING
AND ADAPTING THOSE THINGS THAT
MAY BE WORKING WELL AND OTHER
THINGS THAT MAY NOT BE WORKING
SO WELL.
I THINK REALLY IDENTIFYING
STRATEGIES TO BUILD RAPPORT AND
TRUST AMONG PATIENTS AND
PROVIDERS SO THAT WE CAN GET
MORE ACCURATE AND INCLUSIVE AND
REPRESENTATIVE DATA, AND COLLECT
THAT DATA, BRING IT INTO OUR
HEALTH SYSTEMS B YOU ALSO MAKE
SURE THAT WE UNDERSTAND WHAT THE
COMMUNITY LOOKS LIKE, WHAT THE
COMMUNITY RESOURCES ARE.
IF PROVIDERS DON'T ASK, IF
RESEARCHERS DON'T ASK THE
PATIENTS AND THE STUDY
PARTICIPANTS AROUND GOING TO
TELL US.
SO IT GOING TO BE REALLY
CRITICAL TO MAKE SURE WE DO THAT
OUTREACH IN A SYSTEMATIC WAY.
ANOTHER BIG DISCUSSION POINT WAS
THE IMPORTANCE OF INDIVIDUALIZED
PATIENT RECOMMENDATIONS FOR
PHYSICAL ACTIVITY, FOR OTHER
HELPFUL AND PREVENTIVE MEASURES
TO PREVENT OBESITY, FOR EXAMPLE.
SO REALLY UNDERSTANDING HOW WE
CAN TAIL.
OHOR RECOMMENDATIONS ANDTAILOR O
ENHANCE UP TAKE.
WHAT CAME UP TIME AND AGAIN WERE
FINDING LESS TIME-CONSUMING
METHODS OF PHYSICAL ACTIVITY
THAT WORK FOR PEOPLE WHO HAVE
LESS ACCESS TO RESOURCES AND
JUST LESS TIME TO DO THIS.
WE ALSO DISCUSSED BETTER
INTEGRATION OF PHYSICAL
THERAPISTS INTO CONVERSATIONS.
WE HAD -- IN BOTH OF OUR
SESSIONS, WE HAD PHYSICAL
THERAPISTS WHO TALKED ABOUT THE
FACT THEY OFTEN ARE PIVOTAL TO
IMPROVEMENT FOR PATIENTS WITH OA
BUT OFTEN ARE LEFT OUT OF THE
DISCUSSION.
AND NEEDING TO FIGURE OUT WAYS
TO LINK PHYSICAL THERAPISTS WITH
CARE PROVIDERS FOR MORE
INTEGRATED AND CONTINUOUS CARE.
AND THAT CARE NEEDS TO EXTEND,
AGAIN, BEYOND THE INSTITUTION
AND INTO THE COMMUNITY.
GIVING PATIENTS TAKE-HOME
INFORMATION IN A FORMAT, WHETHER
IT BE VIDEO, AUDIO, PAPER-BASED,
SO THAT THEY CAN USE THIS
INFORMATION AT HOME, IN THEIR
HOME ENVIRONMENTS, AND THAT
INFORMATION REALLY NEEDS TO TAKE
INTO CONSIDERATION THEIR BUILT
ENVIRONMENT, THEIR COMMUNITY
CONTEXT.
ONE PROGRAM THAT WAS DESCRIBED
ACTUALLY LOOKED AT THIS IN THE
CONTEXT OF HOSPITAL DISCHARGE.
SO IT WAS A SENSITIVE MOMENT
WHEN PEOPLE WERE LEAVING THE
HOSPITAL AND PROVIDING THEM WITH
THIS INFORMATION COULD MAKE A
WORLD OF DIFFERENCE.
SO THINKING ABOUT STRATEGIES
LIKE THAT, THAT REALLY TAKE
ADVANTAGE OF OPPORTUNITIES TO
GIVE PEOPLE INFORMATION THAT
THEY CAN THEN USE AND ACT ON,
BUT ALSO IN A FORMAT THAT IS
EASY FOR THEM TO TAKE UP.
THINKING ABOUT GAPS IN
OPPORTUNITIES, A LOT OF OUR
DISCUSSION AS IN MANY OTHER
GROUPS, IT SOUNDS LIKE, FOCUSED
ON REALLY ENGAGING A MORE
DIVERSE WORKFORCE, AND THAT
DIVERSITY SHOULD BE ON A RANGE
OF FACTORS.
SO LANGUAGE, CULTURE, RACE AND
ETHNICITY, ET CETERA.
AND THAT THE WORKFORCE SHOULDN'T
JUST BE FOR DOCTORS AND NEWERS
BUT RNURSES,BUT CAN WE HAVE A ME
GROUP AND THINKING ABOUT THIS IN
RURAL AND URBAN SETTINGS.
COMMUNITY MEMBERS REALLY NEED TO
UNDERSTAND THE IMPORTANCE OF
THESE OPPORTUNITIES FOR
PREVENTION AND MANAGEMENT OF
THEIR OA, AND WE ALSO NEED TO
EMPOWER COMMUNITY MEMBERS WHO
HAVE SUCCESSFULLY NEGOTIATED
THESE PROCESSES, TO TALK ABOUT
THE UPS AND DOWNS IN THE
CHALLENGES THAT THEY FACE, TO
TALK ABOUT THE IMPORTANCE OF
SERVICES LIKE PHYSICAL THERAPY.
SO WE NEED TO USE COMMUNITY
ENGAGEMENT, COMMUNITY-BASED
PARTICIPATORY STRATEGIES TO DO
THIS.
I THINK ANOTHER OBVIOUS ISSUE IS
MAKING SURE THAT WE HAVE A
DIVERSE WORKFORCE WHO CAN TRULY
COMMUNICATE IN A NUMBER OF
DIFFERENT WAYS WITH THE PATIENTS
THEY SEE.
AND THE OTHER THING WE DESCRIBED
AND DISCUSSED AT LENGTH WAS THE
PLACES WHERE PATIENTS AND
INDIVIDUALS CAN ENGAGE WITH
PREVENTION AND MANAGEMENT.
AND YOU KNOW, REALLY THINKING
ABOUT BRINGING THE FAMILY TO THE
TABLE.
PLACES OF WORSHIP, SCHOOLS, ONE
PARTICIPANT DESCRIBED LIMITED
ACCESS IN LATINO COMMUNITIES,
BUT THAT MANY LATINO FAMILIES
AND COMMUNITIES WOULD RALLY
AROUND KIDS' SPORTS, SO HOW DO
YOU BRING THAT TYPE OF -- YOU
CAN BRING THIS INFORMATION TO
THAT VEB E VENUE AND ACTUALLY ME
HAVE A REALLY POWERFUL IMPACT BY
FOCUSING NOT JUST ON THE STUDENT
ATHLETE, BUT ALSO THE PARENT WHO
MAY HAVE -- OR THE GRANDPARENT
WHO MAY HAVE A DISABILITY AS A
RESULT OF OSTEOARTHRITIS.
ANOTHER BIG ISSUE THAT ACTUALLY
HAS A LARGE SOCIETAL IMPACT IS
LIMITED DATA THAT CAN BE SHARED
ACROSS INSTITUTIONS.
SO TOO OFTEN, ONE INSTITUTION OR
ONE HEALTH SYSTEM RECORD CAN
ONLY GIVE YOU INFORMATION ON
THAT SYSTEM, BUT HOW DO WE
REALLY LEVERAGE THAT, HOW CAN WE
ENHANCE INTEROPERABILITY, SO
THAT YOU CAN ACTUALLY SHARE
INFORMATION FROM DIFFERENT
SETTINGS.
WE TALKED A COMMUNICATION, AND
ALSO THE PROGRAMS THAT WORK.
I THINK ANOTHER ISSUE THAT CAME
UP IS REALLY AROUND ASSUMPTIONS
THAT PROVIDERS MAKE ABOUT
PATIENTS AND THE IDEA THAT
PATIENTS WHO MAY BE CONSIDERED
AS CATASTROPHIZING THEIR
EXPERIENCES, FROM THOSE
PATIENTS' PERSPECTIVES, THEY MAY
FEEL THAT THEIR PAIN OR THEIR
EXPERIENCE IS BEING IGNORED OR
MISUNDERSTOOD OR DISCOUNTED.
SO THIS AGAIN RELATES IN PART TO
COMMUNICATION BUT ALSO TO
LANGUAGE AND OPPORTUNITIES TO
REALLY ENGAGE PATIENTS ABOUT
THEIR OWN EXPERIENCES.
AND NOT PUT THEM UNDER ONE
BUCKET.
AND RECOGNIZE THAT WHAT THEY'RE
EXPERIENCING AND WHAT THEY'RE
FEELING, FOR THEM THAT BEHAVIOR
MAY BE ENTIRELY APPROPRIATE,
BECAUSE THIS IS AFFECTING EVERY
ASPECT OF THEIR LIVES.
IN TERMS OF IMMEDIATE OR
INTERMEDIATE GOALS, A BIG FOCUS
WAS ON EDUCATION.
PARTICULARLY EDUCATION THAT
COULD ON STRATEGIES FOR MORE
EFFECTIVE COMMUNITY PARTNERED
RESEARCH, THINKING ABOUT WAYS TO
GATHER DEMOGRAPHIC INFORMATION
FROM PEOPLE IN A SYSTEMATIC WAY,
GETTING -- GIVING PEOPLE
INFORMATION IN A FORMAT AGAIN
AND IN A MANNER N THAT THEY
UNDERSTOOD, BECAUSE THERE'S A
LOT OF EVIDENCE-BASED MATERIALS
ALREADY OUT THERE.
ANOTHER BIG, I THINK ANOTHER BIG
GOAL IS REALLY THINKING ABOUT --
AND THIS CAME UP IN SEVERAL
SESSIONS YESTERDAY, IS THINKING
ABOUT PRIMARY, SECONDARY AND
TERTIARY PREVENTION.
AND REALLY MAKING SURE WE'RE
OPERATING AT ALL THOSE LEVELS,
AND RECOGNIZING THAT WE MIGHT IN
SOME INSTANCES, AS IN THE CASE
OF WORKING IN SCHOOLS OR
CHURCHES OR OTHER COMMUNITY
VENUES, BE ABLE TO ADDRESS MORE
THAN ONE FORM OF PREVENTION WITH
THE SAME STRATEGY, WITH SIMILAR
INTERVENTIONS.
AND REALLY THINKING ABOUT THESE
AS SORT OF GATEWAYS INTO GETTING
THE WHOLE FAMILY INTO THE
HEALTHCARE SYSTEM, INCLUDING
THOSE PEOPLE IN THE FAMILY WHO
MAY HAVE ALREADY SUFFERED AN
INJURY BUT DON'T VIEW THEMSELVES
AS ILL OR YET HAVE ARTHRITIS.
ANOTHER ISSUE WAS ADDRESSING
UPSTREAM FACTORS, LOOKING NOW AT
PREVENTIVE M MEASURES AND FACTOS
THAT LEAD TO OA IN THE FUTURE
AND USING STRATEGIES THAT WORKED
IN THE PAST.
SO AS AN EXAMPLE IN THE VA,
USING BIG DATA APPROACHES TO
GETTING -- TO INCREASING
INFORMATION ABOUT THE PATIENT
BUT ALSO ABOUT THEIR COMMUNITY.
TO GET A MORE COMPLETE PICTURE
OF THE MULTILEVEL FACTORS THAT
MAY PLAY A ROLE IN THE
DISPARITIES THAT WE SEE.
THEN ANOTHER THING IS USING
RESEARCH STRATEGIES THAT HAVE
BEEN SHOWN TO BE EFFECTIVE IN
OTHER DOMAINS, LIKE FINANCIAL OR
NON-FINANCIAL INCENTIVES SUCH AS
PEER RECOGNITION, AND USING
THOSE TYPES OF STRATEGIES TO
PROMOTE THE BEHAVIORS AT THE
PATIENT LEVEL, AT THE PROVIDER
LEVEL, THAT MAY HELP PREVENT
ARTHRITIS OR MAY HELP WITH
BETTER MANAGEMENT OF
OSTEOARTHRITIS.
ALSO REALLY THINKING ABOUT USING
THE TYPES OF SYSTEMS THAT HAVE
WORKED IN OTHER SETTINGS LIKE
THE STUDY BUDDY DESIGN THAT WE
DESCRIBED BEFORE, IMPROVING
ACCESS TO INFORMATION OUTSIDE OF
HEALTHCARE SETTINGS AND USING
EVIDENCE FROM SOME OF THE SOCIAL
DETERMINANTS WORK THAT'S REALLY
EMERGING, AND THAT HAS BEEN
SHOWN TO PLAY A DIFFERENCE IN
CHRONIC DISEASE MANAGEMENT.
WHETHER IT BE THINKING ABOUT
FOOD INSECURITY FOR DIABETES OR
HOUSING AND THE IMPACT OF
ENHANCING HOUSING STABILITY OR
PROVIDING HOMES FOR THE
HOMELESS, AND LOOKING AT THE
LONG TERM CONSEQUENCES OF THAT.
AND THOSE CONSEQUENCES INCLUDE
THINGS LIKE PREVENTING
READMISSION, AND SO HOW CAN WE
USE THE -- SORT OF THE SOCIAL --
RIGOROUS SOCIAL SCIENCE TO
REALLY INTERVENE BOTH AT THE
INDIVIDUAL LEVEL BUT AT THE
HEALTH SYSTEM LEVEL AND THE
COMMUNITY LEVEL TO MAKE A
DIFFERENCE.
AND RELATED TO THIS IS USING
WHAT WE'RE LEARNING FROM
STRATEGIES TO IDENTIFY AND
INTERVENE ON IMPLICIT BIAS, TO
BOTH CHANGE THE WAY OUR HEALTH
SYSTEMS OPERATE, BUT ALSO CHANGE
THE PATIENT'S EXPERIENCE OF CARE
WITHIN OUR HEALTH SYSTEMS.
AND RECOGNIZING THAT -- SO A LOT
OF THIS IS COMPLETELY OUTSIDE OF
OUR HEALTH SYSTEM, BUT IT'S
REALLY IMPORTANT TO START
WITH -- WE CAN START AT THE
HEALTH SYSTEM LEVEL AND MAKE OUR
SYSTEMS, AGAIN, MORE TRUSTWORTHY
AND MORE ENGAGING FOR OUR
PATIENTS.
THINKING ABOUT LONG TERM GOALS,
EXPANDING AND IMPROVING HEALTH
EDUCATION, FACILITATING BET ARER
CONTINUITY OF CARE THROUGH
ELECTRONIC HEALTH RECORDS AND
ALSO BETTER INTEROPERABILITY SO
THAT PATIENTS WHO ARE MOVING
BETWEEN HEALTH SYSTEMS ACTUALLY
CAN GET CONSISTENT CARE AND THEN
LINKING THAT TO COMMUNITY
RESOURCES, MAKING SURE THE
COMMUNITY RESOURCES THAT ARE
AVAILABLE CAN BE SHARED WIDELY,
ALSO RECOGNIZING WE MAY HAVE TO
HAVE A BALANCE BETWEEN HEALTH
I.T. AND SORT OF THESE LOW TOUCH
APPROACHES AND HIGHER TOUCH
APPROACHES.
WE ALSO DISCUSSED ENHANCING DATA
COLLECTION AND AVAILABILITY OF
INFORMATION ABOUT WHAT DOES AND
DOES NOT WORK, PARTICULARLY FOR
UNDERSERVED COMMUNITIES.
SO REALLY LEVERAGING SOME OF THE
SYSTEMS THAT ARE OUT THERE THAT
ARE DESCRIBING THE STRATEGIES
THAT WORK AND AS OTHERS HAVE
DESCRIBED, REALLY MAKING SURE
THAT WE PROVIDE ENOUGH DETAIL SO
THAT FOLKS CAN UNDERSTAND, HEY,
DID THIS WORK IN MY COMMUNITY.
CENTERING THE PATIENT IN
COMMUNICATIONS AND
RECOMMENDATIONS, USING SOCIAL
NEEDS SCREENERS TO CAPTURE OTHER
DETERMINANTS.
AND PROVIDING INFRASTRUCTURE,
COMMUNITY PROGRAMS THAT CAN BE
TAPPED INTO, BOTH FROM WITHIN A
HEALTHCARE SYSTEM AND FOR PEOPLE
WITHIN THE -- IN THE BROADER
COMMUNITY.
AND THEN ANOTHER I THINK
IMPORTANT STRATEGY IS REALLY
ACQUIRING LONGITUDINAL DATA, SO
BOTH LONGITUDINAL OBSERVATIONAL
DATA THAT INCLUDES ENOUGH
DIVERSITY SO THAT WE CAN
ACTUALLY SAY SOMETHING ABOUT A
LOT OF DIFFERENT COMMUNITIES,
BOTH URBAN AND RURAL, BUT ALSO
THINKING ABOUT BUILDING OUT
MULTI-SITE AND MULTILEVEL
INTERVENTIONS THAT INCORPORATE
THE SOCIAL DETERMINANTS, MAKING
SURE THAT THESE INTERVENTIONS
INCLUDE DIVERSITY -- A DIVERSITY
OF COMMUNITIES.
SO REALLY TAKING AN APPROACH
LIKE THE DIABETES PREVENTION
PROGRAM, WHERE THERE WAS A
REQUIREMENT TO BRING TO THE
TABLE SPECIFIC COMMUNITIES TO
MAKE SURE THAT WE COULD, AT THE
END OF THE STUDY, SAY SOMETHING
ABOUT -- HAVE A PRESPECIFIED
DATA ON A NUMBER OF DIFFERENT
GROUPS.
I THINK THOSE WERE OUR MAIN
TAKE-HOME POINT.
PLEASE IF ANYONE ELSE HAS STUFF
TO ADD, PLEASE DO SO.
>> THE BIASES IN ACCESS OF
COMMUNICATION, DID YOU COVER
THAT ONE?
>> I'M SORRY, SAY THAT AGAIN?
>> THE ONE ON BIASES.
>> YES, WE DID, WE TALKED ABOUT
IMPLICIT BIAS.
>> THANK YOU.
>> OKAY.
THANK YOU, DR. BROWN.
IT SEEMS LIKE WE'VE HAD A LOT OF
INTERESTING DISCUSSIONS IN ALL
OF THE BREAKOUT SESSIONS, SO FOR
OUR LAST REPORT OUT, WE'LL HEAR
ABOUT THE COMMUNITY LEVEL
FACTORS DISCUSSION FROM DR. PA
TRI THAT JONES.
DR. PATRICIA JONES, THE NATIONAL
INSTITUTE ON AGING OFFICE OF
SPECIAL POPULATIONS AND LEADS
THEIR EFFORTS IN STIMULATING
RESEARCH RELATING TO AGING.
DR. JONES, THE FLOOR IS YOURS.
>> THANK YOU, KRISTY.
NEXT SLIDE, PLEASE.
I JUST WANT TO ACKNOWLEDGE THE
TREMENDOUS SUPPORT PROVIDED BY
DAPHNE ROBINSON AND ELISA
MICHALEK.
APPRECIATE THEIR EFFORTS IN
PULLING THESE SLIDES TOGETHER.
WE HAD A REALLY ENGAGING
CONVERSATION YESTERDAY AND TODAY
IN OUR BREAKOUT SESSIONS.
SOME OF THE POINTS MAY SOUND
FAMILIAR AS THEY WERE TOUCHED
UPON, BUT I WILL DO MY BEST NOT
TO BE REDUNDANT.
I WILL SAY THAT ACROSS THE TWO
DAYS, ONE OF THE THINGS THAT
CAME THROUGH VERY PRONOUNCEDLY
WAS THE IMPORTANCE OF COLLECTING
DATA RELATED TO SOCIAL
DETERMINANTS OF HEALTH IN
EXISTING STUDIES WITH SUFFICIENT
DIVERSE POPULATIONS.
MANY OF OUR PARTICIPANTS
REPRESENTED NOT ONLY INDIVIDUALS
WITH LIVED EXPERIENCES WITH
OSTEOARTHRITIS BUT OTHERS WHO
WERE ESTABLISHING CAREERS AS
EARLY CAREER SCIENTISTS AS WELL
AS VERY EXPERIENCED
INVESTIGATORS AND PHYSICIAN
SCIENTISTS WHO WERE IN CLINICAL
PRACTICE SEEING PATIENTS, AND
EACH OF THESE INDIVIDUAL
PERSPECTIVES HAD A SHARED
AGREEMENT THAT THE IMPORTANCE OF
HAVING DATA COLLECT OND SOCIAL L
DETERMINANTS OF HEALTH FROM
EXISTING STUDIES WAS AN
IMPORTANT FACTOR IN ADDITION TO
LEVERAGE.
BUILDING UPON THE -- MANY OF OUR
PARTICIPANTS ARE ENGAGED IN A
NUMBER OF DIFFERENT STUDIES AND
TRIALS AND TO BE MINDFUL THAT
WHILE WE HAVE AN OPPORTUNITY TO
ENGAGE THEM, THAT WE ARE
THOUGHTFUL AND ORGANIZED AND
MINDFUL OF THINGS THAT WE MAY
ASK UP FRONT AND NOT HAVE TO
BURDEN THEM WITH ADDITIONAL
REQUESTS FOR INFORMATION LATER
ON IN A PROJECT OR ACTIVITY.
IT WAS ALSO DISCUSS AND NOTED
THAT ONE OF THE OPPORTUNITIES IS
TO CONSIDER THE COMPOUNDING
FACTORS THAT MAY BE TOUCHING THE
LIVES OF OUR PARTICIPANTS AND
BEING THOUGHTFUL ABOUT HOW WE GO
ABOUT ORGANIZING PROJECTS AND
INTERVENTIONS THAT ARE
REFLECTIVE OF FINDINGS IN DATA
COLLECTED.
WE DISCUSSED THE CONSIDERATION
OR USING SYNDEMICS AS A LENS OF
WHAT WE HAVE IN FRONT OF US.
THOSE THAT AREN'T FAMILIAR WITH
THE TERM SYNDEMICS, IT TALKS TO
A CLUSTER OF DISEASE IN A
POPULATION OF INDIVIDUALS.
TO BE MINDFUL OF THAT, I THINK
ONE OF OUR PRESENTERS FROM THE
FIRST DAY SHOWED A SERIES OF
MAPS HIGHLIGHTING THE IMPACT OF
DIFFERENT CONDITIONS ALL
CLUSTERED PRONOUNCEDLY IN THE
SOUTHEASTERN REGION OF THE
UNITED STATES, SO THAT WOULD BE
ONE EXAMPLE OF SYNDEMICS.
IT WAS ALSO DISCUSSED AS A
PARTICULAR OPPORTUNITY WITH THE
EXISTING RESOURCES AND SYSTEMS
THAT WE BE MINDFUL OF LEVERAGING
LESSONS LEARNED FROM OTHER
FIELDS.
I THINK SOME OF THE OTHER
REPORTS FROM THE BREAKOUT GROUPS
TALKED ABOUT NOT REINVENTING THE
WHEEL.
THAT WAS CERTAINLY A NOTION
DISCUSSED AS WELL IN OUR GROUPS,
THAT WE LEVERAGE THE INFORMATION
THAT'S BEEN PUBLISHED IN THE
SPACE OF HEALTH DISPARITIES
RESEARCH AND OTHER EVIDENCE
TESTED INTERVENTIONS THAT HAVE
BEEN DEVELOPED FOR HIV PAIN
RELATED INTERVENTIONS, CANCER,
CARDIOVASCULAR AND OTHER TOPICSY
OPPORTUNITIES TO SCAFFOLD UPON
KEY ATTRIBUTES OR
CHARACTERISTICS OF THOSE
INTERVENTIONS AS A LESSON TO
INFORM OSTEOARTHRITIS.
AND ALSO, WE DISCUSSED
BROADENING QUESTIONS.
SOME OF OUR INVESTIGATORS SHARED
THEIR LESSONS LEARNED IN
HINDSIGHT AS A CAUTIONARY TALE,
WHICH WAS VERY IMPORTANT AND
VERY HELPFUL, BUT THE TAKEAWAY
FROM THAT DISCUSSION WAS THE
IMPORTANCE OF BROADENING OUT OUR
QUESTIONS EARLY ON AS WE'RE
PLANNING STUDIES AND USING
DIFFERENT METHODS TO ANALYZE.
AND TO THAT POINT, ONE EXAMPLE
OF USING DIFFERENT METHODS TO
ANALYZE DATA, TRADITIONALLY
OFTENTIMES WE COMPARE NON-WHITE
TO WHITE POPULATIONS, BUT THERE
MAY BE DIFFERENT DETAILS
HIGHLIGHTED OR ILLUMINATED WHEN
OTHER METHODS SUCH AS WITHIN
GROUP ANALYSIS ARE ADOPTED OR
USED, AND WE MAY UNDERSTAND
OSTEOARTHRITIS AND DISPARITIES
FROM A DIFFERENT PERSPECTIVE IF
WE DO A DEEPER DIVE ANALYSIS
WITHIN A PARTICULAR GROUP.
IN ADDITION TO THOSE POINTS,
BETTER APPROACHES FOR
COMMUNICATION WERE IDENTIFIED AS
AN OPPORTUNITY AS FAR AS OUR
EXISTING RESOURCES IN TERMS OF
HIGHLIGHTING DIVERSITY OF
INDIVIDUALS FROM IMAGES THAT ARE
DISPLAYED ON DIFFERENT
MATERIALS, SOCIAL MEDIA MATT
FORMS, BROCHURES, TAILORING THE
INFORMATION IN A MANOR THAT
REFLECTS THE PREFERENCES AND
INTERESTS OF THE PARTICULAR
COMMUNITY THAT RESEARCHERS AND
OTHERS ARE COLLABORATING WITH,
AND HIGHLIGHTING THE
AVAILABILITY OF THE INFORMATION
IN DIFFERENT LANGUAGES IS
ABSOLUTELY ESSENTIAL, EVEN FOR
THOSE WHO MAY BE CONVERSANT AND
FLUENT IN SPEAKING ENGLISH, IT
WAS SHARED WITH US IN ONE OF OUR
GROUPS THE IMPORTANCE THAT
SOMETIMES THE UNSPOKEN MESSAGE
IS THAT THERE'S AN INTEREST FROM
THE RESEARCH PARTY THAT YOU TOOK
TIME AND MADE THE EFFORT TO
PRESENT INFORMATION IN MORE THAN
ONE LANGUAGE, EVEN IF THE
PARTICIPANTS WERE CON V CON CON
ENGLISH.
RECOGNIZING THAT ALL OF THESE
RESOURCES AND SERVICES THAT HELP
AID DOING A BETTER JOB AT
ENGAGEMENT ARE FEASIBLE, BUT
THEY MAY TAKE ADDITIONAL TIME
WHICH MAY EXTEND THE BUDGET
BEYOND PARAMETERS TRADITIONAL
FUNDERS ARE USED TO SEEING, WHAT
IS REQUIRED IN TERMS OF
TRANSLATION, TRANSPORTATION,
USING MOBILE CLINICS, OTHER
PLATFORMS AND DATA PLANS THAT
ONE MAY ASSUME INDIVIDUALS HAVE
ACCESS TO BUT MAY BE A COST
BURDEN FOR A PARTICIPANT IN THAT
REGARD.
JUST TO CLOSE OUT ON THIS
PARTICULAR TOPIC, WE ALSO
DISCUSSED THE IMPORTANCE OF
WORKING WITH COMMUNITY LEADERS
IN TERMS OF ENGAGEMENT.
WE'VE TOUCHED UPON DIFFERENT
EXAMPLES OF PARTICIPATORY ACTION
RESEARCH, ACTIVITIES THAT MAY BE
LESSEN GAUGLESS ENGAGING, OTHERY
BE MORE ENGAGING, INCLUDING
INDIVIDUALS FROM THE INTENDED
COMMUNITY AS A THOUGHT LEADER IN
THE DESIGN OF STUDIES, AND
STRATEGIES, IDENTIFYING
STRATEGIES FOR DISSEMINATING
INFORMATION ARE JUST A COUPLE OF
EXAMPLES OF MORE ENGAGED
STRATEGIES THAT COULD BE
ADOPTED, AND THERE ARE
OPPORTUNITIES TO DO THAT.
SAID DIFFERENTLY, WE ALSO
DISCUSSED THE IMPORTANCE OF
MOVING BEYOND THE PERFORMATORY
COMMUNITY BOARDS AND LOOKING AT
OTHER WAYS TO ENGAGE COMMUNITY
MEMBERS IN A MORE ACTIVE
FASHION.
IN ADDITION, IT WAS DISCUSSED,
THE IMPORTANCE OF INVESTING TIME
TO LEARN MORE ABOUT THE
COMMUNITY, THAT THESE ARE
ACTIVITIES AND EFFORTS THAT
SIMPLY JUST DO REQUIRE PATIENTS
PATIENCE,COMMITMENT AND DEDICAT.
WE TOUCHED A LITTLE BIT ON THE
PERCEPTION OF HEALTH DISPARITIES
RESEARCH TRUISM, COMMUNITY
ENGAGED RESEARCH TRUISM AND
IDEAS AND APPROACHES ON HOW TO
AVOID THAT, AND TAKING TIME TO
BUILD THE RAPPORT, IDENTIFYING
THINGS THAT ARE IMPORTANT TO THE
COMMUNITY MEMBER, LEVERAGING
PILOT STUDIES AS ONE APPROACH TO
DOING THAT COULD BE AN
INVESTMENT THAT PAYS QUITE
SIGNIFICANTLY DOWNSTREAM.
ONE OF OUR PARTICIPANTS SHARED
THAT EXPERIENCE IN TERMS OF
LEVERAGING THE PILOT STUDY WITH
A NATIVE AMERICAN COMMUNITY AND
THAT PROVED TO BE QUITE HELPFUL
LATER ON IN DEVELOPING A RAPPORT
WITHIN THAT PARTICULAR
COMMUNITY.
ALSO TOUCHING ONE AT THE LAST
BULLET POINT, TO UNDERSCORE THE
IMPORTANCE OF IDENTIFYING AND
ORGANIZATIONS THAT MIGHT BE
LEVERAGED EARLY ON AND AGAIN,
WITH THE EYE TOWARD BUILDING
RAPPORT AND BEING INCLUSIVE,
HAVING THAT RELATIONSHIP AND
EXTENDING THAT PARTNERSHIP EARLY
ON IS IMPORTANT.
SO WE ALSO TALKED ABOUT BIG
DATA, WE HAD A COUPLE OF
INDIVIDUALS WHO HAD EXPERTISE IN
USING DATA SCIENCE OR LARGE
DATASETS FOR ANALYSIS.
WE SPOKE ABOUT THE IMPORTANCE OF
COST SAVINGS THAT USING BIG DATA
MAY OFFER TO A RESEARCH TEAM.
IT'S A FAIRLY INEXPENSIVE WAY TO
CONDUCT RETROSPECTIVE STUDIES,
AND THE DATA -- BUT WE ALSO
DISCUSSED LIMITATIONS AND THE
IMPORTANCE OF DATA SCIENTISTS,
MACHINE LEARNING EXPERTS, AI
EXPERTS AND STATISTICIANS ALIKE
HAVING SHARED UNDERSTANDING AND
KNOWLEDGE BASE AROUND HEALTH
DISPARITIES, WHAT ARE HEALTH
DISPARITIES, WRECK NIEDZING THAT
EVERY TEAM MEMBER BENEFITS FROM
HAVING THAT BACKGROUND AND
HAVING THAT KNOWLEDGE BASE.
TO THAT END, WE TALKED ABOUT
BEING MINDFUL OF LEVERAGING
LARGE DATASETS SUCH THAT WE
DON'T PERPETUATE THE DISPARITIES
WE INTEND TO REDRESS OR
ELIMINATE.
WE ALSO TALKED ABOUT INCREASING
ONLINE COMMUNITIES.
SOME OF OUR PARTICIPANTS SHARED
THE LESSONS LEARNED FROM
COVID-19, AND USING ONLINE
PLATFORMS TO PROMOTE PHYSICAL
ACTIVITY TO ADDRESS
OSTEOARTHRITIS AND LEVERAGING
WHAT WE LEARNED FROM THE COVID
EXPERIENCE WITH GROUP SUPPORT
AND OTHER MEANS OF PROMOTING
PHYSICAL ENGAGEMENT.
IN TERMS OF GAPS AND
OPPORTUNITIES, OUR MEMBERS
IDENTIFIED CONCERNS, EXPRESSED
CONCERNS ABOUT BIAS AGAINST
FUNDING STUDIES IN CERTAIN
COMMUNITIES THAT MAY MISTAKENLY
BE THOUGHT OF AS SOMETHING
THAT'S NOT OF INTEREST.
WE ALSO TALKED ABOUT THE PROBLEM
WITH DISPROPORTIONATE FUNDING IN
TERMS OF FUNDERS THAT MAY BE
RELUCTANT TO PROVIDE ADDITIONAL
SUPPORT FOR CERTAIN THINGS SUCH
AS TRANSPORTATION OR GROUP
GATHERINGS AND BEING MINDFUL OF
PARADOXICALLY POOR PARTICIPANTS
WHO MAY ALSO HAVE ADDITIONAL
BURDEN OF PARTICIPATING AND
ENGAGING IN THESE TRIALS AND
STUDIES, OFTENTIMES ARE
REIMBURSED LESS FOR THEIR
CONTRIBUTION AS COMPARED TO
OTHER STUDIES CONDUCTED IN MORE
AFFLUENT PARTS OF DIFFERENT
COMMUNITIES.
OUR GROUP ALSO DISCUSSED THE
NEED TO ADDRESS SYSTEMIC ISSUES
SUCH AS MORE DISADVANTAGED
GROUPS NOT HAVING THE
OPPORTUNITY TO BE INVITED OR
REFERRED ON TO OTHER SECONDARY
SPECIALISTS FOR ADDITIONAL
CONSULTATION AS COMPARED TO
OTHER GROUPS, AND DE FACTO -- BY
DE FACTO BEING EXCLUDED FROM
BEING CONSIDERED FROM DIFFERENT
STUDIES, A LACK OF PHYSICAL
THERAPISTS AND OTHER RESOURCES
IN PARTICULAR AREAS.
WE TALKED ABOUT RESOURCE DESERTS
AS WELL AS OTHER TYPES OF
DESERTS, AND THE LACK OF ACCESS
OF PEOPLE IN TERMS OF SHARED
DISTANCE FROM ACADEMIC HEALTH
CENTERS -- SHEER DISTANCE FROM
ACADEMIC HEALTH CENTERS WHERE
EXPERTISE MAY BE READILY
AVAILABLE.
WE DISCUSSED THE IMPORTANCE OF
OPPORTUNITIES TO WORK WITH
COMMUNITY HEALTH WORKERS AND
PHYSICAL THERAPISTS, THOSE WHO
MAY HAVE A SPECIFIC ROLE IN
CONTRIBUTION IN THE RESEARCH
ARENA AND EXPAND THEIR RESEARCH
IN TERMS OF TASK SHIFTING WHERE
THEY MAY BE ABLE TO LEVERAGE
TECHNOLOGY AND OTHER TOOLS TO
INFORM OSTEOARTHRITIS RESEARCH.
WE ALSO ADDRESSED THE INITIAL
REACH BY TELEPHONE EMAIL AND
OTHER SOCIAL MEDIA PLATFORMS TO
SPECIFIC INDIVIDUALS OF LOCAL
GROUPS AND THE IMPORTANCE OF
EFFECTIVE AND BEING CREATIVE IN
LONG LASTING COLLABORATIONS AND
PARTNERSHIPS.
I'M SORRY, JUST ONE OTHER POINT.
IT WAS SHARED, THE IMPORTANCE OF
LEVERAGING EXISTING SYSTEMS SUCH
AS OUR LOCAL LIBRARIES.
SOME WERE SHARING THE IMPORTANCE
OF LOCAL LIBRARIES IN TERMS OF
FREE SPACE TO CONVENE MEETINGS
AND ALSO LEVERAGING THEIR
LISTSERVS, THEIR CONTEX CONTACTD
THEIR PLATFORMS THAT ALSO COULD
HELP FURTHER ENHANCE OUTREACH
AND MARKETING OF OSTEOARTHRITIS
RESEARCH-RELATED ACTIVITIES.
SO THIS WAS A VERY IMPORTANT
COMPONENT THAT WE DISCUSSED AS
WELL.
AS FAR AS FOCUSING ON MORE
IMMEDIATE GOALS TO BE IDENTIFIED
AT A MORE GRANULAR LEVEL, OUR
MEMBERS FELT IT WAS VERY
IMPORTANT TO JUST GET PEOPLE
MOVING.
ONE OF OUR PRESENTERS TODAY
SPOKE ON THIS VERY POINT AS
WELL, THAT SOME PHYSICAL
ACTIVITY IS BETTER THAN NOTHING
AT ALL, AND THAT WAS ECHOED IN
OUR CONVERSATIONS THAT IT WAS
IMPORTANT TO GET PEOPLE MOVING
AND TO REALLY ZERO IN ON OUR
LOCAL LEVEL EFFORTS TO PROMOTE A
MULTIPRONG APPROACH AND TO
LEVERAGE EXTENSION PROGRAMS THAT
MAY BE OFFERED THROUGH
UNIVERSITIES AND OTHER LARGE
SCALE INSTITUTIONS THAT MAY HELP
FILL THE GAP IN AREAS THAT DON'T
HAVE OTHER INFRASTRUCTURE
AVAILABLE TO PROMOTE PHYSICAL
ACTIVITY OR EXERCISE.
WE ALSO TALKED ABOUT TEACHING
RESEARCHERS AND CLINICIANS
CULTURAL HUMILITY AND DIFFERENT
MODELS FOR SHARED
DECISION-MAKING, AND NOT
ASSUMING EVERYONE WORKING IN A
SPACE WITH DIFFERENT
PARTICIPANTS OR PATIENTS HAVE A
COMMON UNDERSTANDING OF WHAT
CULTURAL HUMILITY OR SHARED
DECISION-MAKING IS OR WHAT THAT
MIGHT LOOK LIKE.
SO WE DID SPEAK ON THE
IMPORTANCE OF THAT EDUCATION.
AS FAR AS LONG TERM GOALS, WE
DISCUSSED THINKING MORE ABOUT
LONGITUDINAL ACTIVITIES, TAKING
THE TIME TO BUILD THE TRUST AND
CHANGE BEHAVIORS, BUT
TRADITIONAL PARAMETERS MAY BE
TOO BRIEF TO REALLY SERVE IN AN
EFFECTIVE WAY THE KIND OF
RESEARCH THAT MAY BE REQUIRED TO
INFORM OSTEOARTHRITIS AND
ADDRESS DISPARITIES AND
COMMUNITY INPUT.
WE ALSO TALKED ABOUT BUILDING ON
EXISTING ACTIVITIES THAT ARE
HAPPENING AT THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES LEVEL,
SUCH AS THE MID COURSE REPORT,
AND OTHER GUIDELINES THAT ARE
BEING UPDATED.
THERE HAVE BEEN REQUESTS FOR
INFORMATION DISSEMINATED AND
THERE MAY BE OTHER OPPORTUNITIES
TO ENLIST PERSPECTIVES IN THE
NEAR FUTURE AS WELL.
AND I THINK THAT MAY BRING US TO
AN END.
>> THANK YOU, DR. JONES.
WE APPRECIATE ALL OF THE
BREAKOUT REPORTS FROM ALL OF OUR
CO-CHAIRS AND WE WANTED TO HAVE
TIME TO DISCUSS EVERYTHING WE'VE
HEARD OVER THE LAST FEW DAYS.
HOWEVER, BECAUSE YOU GUYS WERE
SO INVOLVED, WE HAD A LOT OF
INFORMATION TO SHARE, AND WE'VE
REACHED THE END OF OUR SCHEDULED
TIME.
SO TO BE AMENABLE TO YOUR
SCHEDULES, I JUST WANT TO REMIND
YOU THAT WE DO HAVE THE WORKSHOP
WEBSITE WHICH INCLUDES A LIST OF
THE PARTICIPANTS AND THEIR EMAIL
ADDRESSES, SO YOU SHOULD GO TO
THE WEBSITE, DOWNLOAD THAT, AND
CONTINUE THESE DISCUSSIONS VIA
EMAIL.
I ALSO WANTED TO SAY THANK YOU
TO ALL OF YOU FOR YOUR
PARTICIPATION.
THOSE THAT WERE ACTIVE
PARTICIPANTS AND THOSE WATCHING
ON THE VIDEOCAST.
YOU'VE PROVIDED US WITH A LOT OF
INFORMATION TO HELP MOVE THE
FIELD FORWARD IN ADDRESSING
HEALTH DISPARITIES IN OA.
THANK YOU AGAIN FOR TAKING TIME
OUT OF YOUR BUSY SCHEDULES, AND
THANKS TO THOSE INVOLVED IN
PLANNING THE WORKSHOP.
WE COULDN'T HAVE DONE IT WITHOUT
YOU.
SO NOW I WILL TURN THINGS OVER
TO DR. JOSEPH TO TAKE US INTO
OUR CLOSING REMARKS.
>> GOOD AFTERNOON, EVERYONE, AND
AS KRISTY SAID, THANK YOU GUYS
FOR BEING INVOLVED IN THIS
WORKSHOP.
IT IS MY GREAT PLEASURE TO
INTRODUCE TO YOU DR. RICHARD
HODES, WHO IS THE DIRECTOR OF
THE NATIONAL INSTITUTE ON AGING.
DR. HODES HAS BEEN LEADING NIA
SINCE 1993.
HE IS A GRADUATE OF YALE
UNIVERSITY AND HIS
MEDICAL DEGREE AT HARVARD EURT.
HARVARD
UNIVERSITY.
HE DID HIS FELLOWSHIP IN STOCK
STOCKHOLM AND HIS CLINICAL
IN ADDITION TO LEADING THE NIA
IN THE VAST RESEARCH FIELD, HE
IS THE -- HE DIRECTS THE FEDERAL
EFFORT TO FIND EFFECTIVE WAYS TO
TREAT AND PREVENT ALZHEIMER'S
DISEASE, WHICH IS A MISSION OF
THE NIA AND THAT IS A HUGE TASK.
HE ALSO WEARS VARIOUS HATS, ONE
OF THEM IS THAT HE'S STILL AN
ACTIVE RESEARCHER, AND HE IS
WELL-KNOWN IN THE FIELD OF
IMMUNOLOGY.
HE HAS HIS RESEARCH LAB AT THE
NATIONAL CANCER INSTITUTE.
HE'S THE HEAD OF THE IMMUNOLOGY
REGULATION -- THE IMMUNE
REGULATION SECTION, AND HE
FOCUSES ON THE CELLULAR AND
MOLECULAR MECHANISMS THAT
REGULATE THE IMMUNE SYSTEM.
DR. HODES IS A MEMBER OF THE
DANA ALLIANCE FOR BRAIN
INITIATIVE.
HE'S A FELLOW OF THE AMERICAN
ASSOCIATION FOR THE ADVANCEMENT
OF SCIENCE, AND HE'S A MEMBER OF
THE NATIONAL ACADEMY OF MEDICINE
AT THE NATIONAL ACADEMIES OF
SCIENCE, ENGINEERING AND
MEDICINE.
DR. HODES, THE FLOOR IS YOURS.
>> THANK YOU.
IT'S QUITE A TASK AND PRIVILEGE
TO WRAP UP THIS VERY RICH
MEETING.
I WANT TO BEGIN BY THANKING YOU
ALL FOR THE OPPORTUNITY FOR NIA,
NIMHD HAVE HAD TO WORK WITH YOU
ON THIS VERY IMPORTANT TOPIC.
OVER THE YEARS WITH OUR EMPHASIS
ON LIFE COURSE, NIA HAS BEEN
VERY MUCH INVOLVED WITH
OSTEOARTHRITIS AS AN IMPORTANT
CONDITION THAT CHALLENGES AND
COMPROMISES THE QUALITY OF LIFE.
MANY INDIVIDUALS THROUGH
LIFESPAN AS THEY AGE, THE
EMPHASIS HERE ON HEALTH
DISPARITIES HAS ADDED IN
RICHNESS TO THIS TOPIC.
THE MEETING HAS DEALT WITH
VARIABLES THAT RANGE FROM THE
BIOLOGIC BUT NOW AS WE
UNDERSTAND THE BIOLOGIC
INTERACTING WITH ENVIRONMENTAL
ASPECTS WHICH IN TURN ARE
CONDITIONED BY ASPECTS OF HEALTH
DISPARITIES, INFLUENCES THAT
AFFECT THE DIAGNOSIS OF THE
DISEASE, THE VULNERABILITY OF
THE DISEASE, ACCESS TO DIAGNOSIS
AND TREATMENT, AT ALL LEVELS.
WHAT THIS MEETING HAS DONE IN
THESE PAST TWO DAYS NOW SETS A
HIGHLIGHT OF THE CHALLENGES
BEFORE US TO BETTER UNDERSTAND
THE DISEASE, PROCESS,
DISPARITIES, AS A MEANS FOR
PROVIDING BETTER UNDERSTANDING
OF THE PROCESS WHICH PRECEDES,
UNDERLIES OSTEOARTHRITIS, TO
ADDRESS RISK FACTORS, MAKE SURE
WE DO SO IN AN EQUITABLE WAY
THAT DOESN'T FALL VICTIM TO
IGNORING RATHER THAN TAKES
ADVANTAGE OF WHAT WE CAN LEARN
ABOUT DISPARITIES AND THE
CHALLENGES, AGAIN, THE
DIAGNOSIS, THE TREATMENT AND THE
SERVICES PROVIDED.
SO I WOULD CONCLUDE JUST BY
CONTINUING THE COMMITMENT OF THE
NIA WITH OUR OTHER NIH AGENCIES,
NIAMS, NIMHD FOCUSED ON THIS
TOPIC, TO WORKING WITH ALL OF
YOU TO IDENTIFY THE GAPS, TO
IDENTIFY THE PRIORITIES THAT
WE'VE HEARD SUMMARIZED IN THESE
MEETINGS, AND LOOK FORWARD TO
FURTHER PROGRESS IN THE WORK.
SO IT'S A PRIVILEGE, I TURN IT
BACK WITH THANKS AND GRATITUDE
TO ALL OF YOU AND EXCITEMENT
LOOKING FORWARD TO THE FIELD OF
RESEARCH.
>> THANK YOU, DR. HODES.
THANK YOU ONCE AGAIN, EVERYBODY,
FOR PARTICIPATING.
VISIT THE WEBSITE AND KEEP AN
EYE ON YOUR EMAIL FOR
POST-MEETING MATERIALS.
THANK YOU.