1 00:00:05,320 --> 00:00:07,600 THANK YOU FOR JOINING US FOR 2 00:00:07,600 --> 00:00:09,800 DAY TWO OF OUR NIH HEALTH 3 00:00:09,800 --> 00:00:11,680 DISPARITIES AND OSTEOARTHRITIS 4 00:00:11,680 --> 00:00:12,120 WORKSHOP. 5 00:00:12,120 --> 00:00:13,200 YESTERDAY WENT REALLY WELL AND 6 00:00:13,200 --> 00:00:15,040 WE'RE EXCITED ABOUT DAY TWO, 7 00:00:15,040 --> 00:00:16,400 WE'RE GOING TO CONTINUE MOVING 8 00:00:16,400 --> 00:00:18,880 ALONG IN OUR AGENDA AND I'LL 9 00:00:18,880 --> 00:00:22,640 TURN THIS OVER TO NIMHD. 10 00:00:22,640 --> 00:00:24,800 >> THANK YOU, KRISTY. 11 00:00:24,800 --> 00:00:26,080 GOOD MORNING, EVERYONE. 12 00:00:26,080 --> 00:00:28,080 I'M A PROGRAM OFFICIAL AT THE 13 00:00:28,080 --> 00:00:29,400 NATIONAL INSTITUTE ON MINORITY 14 00:00:29,400 --> 00:00:32,680 HEALTH AND HEALTH DISPARITIES. 15 00:00:32,680 --> 00:00:34,720 I'D LIKE TO INTRODUCE THE 16 00:00:34,720 --> 00:00:36,960 DIRECTOR OF THE INSTITUTE, 17 00:00:36,960 --> 00:00:40,440 DR. ELISEO PEREZ-STABLE. 18 00:00:40,440 --> 00:00:41,320 DR. PEREZ-STABLE EARNED HIS BA 19 00:00:41,320 --> 00:00:44,920 IN CHEMISTRY IN 1974 AND HIS 20 00:00:44,920 --> 00:00:45,880 M.D. IN 1978 FROM THE UNIVERSITY 21 00:00:45,880 --> 00:00:47,200 OF MIAMI. 22 00:00:47,200 --> 00:00:49,200 HE THEN COMPLETED HIS PRIMARY 23 00:00:49,200 --> 00:00:53,040 CARE INTERNAL MEDICINE RESIDENCY 24 00:00:53,040 --> 00:00:54,640 AND A RESEARCH FELLOWSHIP IN 25 00:00:54,640 --> 00:00:56,280 GENERAL INTERNAL MEDICINE AT THE 26 00:00:56,280 --> 00:00:58,920 UNIVERSITY OF CALIFORNIA 27 00:00:58,920 --> 00:00:59,800 SAN FRANCISCO, UCSF. 28 00:00:59,800 --> 00:01:01,320 BEFORE JOINING THE FACULTY AS 29 00:01:01,320 --> 00:01:04,600 ASSISTANT PROFESSOR IN 1983. 30 00:01:04,600 --> 00:01:05,600 DR. PEREZ-STABLE PRACTICED 31 00:01:05,600 --> 00:01:08,000 PRIMARY CARE INTERNAL MEDICINE 32 00:01:08,000 --> 00:01:10,840 FOR 37 YEARS AT UCSF, FOLLOWING 33 00:01:10,840 --> 00:01:12,600 A PANEL OF ABOUT 200 PATIENTS, 34 00:01:12,600 --> 00:01:14,800 AND HE SUPERVISED AND TAUGHT 35 00:01:14,800 --> 00:01:16,320 STUDENTS AND RESIDENTS IN THE 36 00:01:16,320 --> 00:01:19,040 AMBULATORY CARE AND HOSPITAL 37 00:01:19,040 --> 00:01:20,240 SETTINGS. 38 00:01:20,240 --> 00:01:21,000 DR. PEREZ-STABLE' RESEARCH 39 00:01:21,000 --> 00:01:22,440 INTERESTS HAVE CENTERED ON 40 00:01:22,440 --> 00:01:23,640 IMPROVING THE HEALTH OF RACIAL 41 00:01:23,640 --> 00:01:25,720 AND ETHNIC MINORITIES THROUGH 42 00:01:25,720 --> 00:01:29,240 EFFECTIVE PREVENTION 43 00:01:29,240 --> 00:01:30,080 INTERVENTIONS, UNDERSTANDING 44 00:01:30,080 --> 00:01:31,280 UNDERLYING CAUSES OF HEALTH 45 00:01:31,280 --> 00:01:32,720 DISPARITIES AND ADVANCING 46 00:01:32,720 --> 00:01:33,680 PATIENT-CENTERED CARE FOR 47 00:01:33,680 --> 00:01:37,200 UNDERSERVED POPULATIONS. 48 00:01:37,200 --> 00:01:38,840 RECOGNIZED AS A LEADER IN LATINO 49 00:01:38,840 --> 00:01:40,120 HEALTHCARE AND DISPARITIES 50 00:01:40,120 --> 00:01:43,560 RESEARCH, DR. PEREZ-STABLE SPENT 51 00:01:43,560 --> 00:01:44,880 32 YEARS LEADING RESEARCH ON 52 00:01:44,880 --> 00:01:47,800 SMOKING CESSATION AND TOBACCO 53 00:01:47,800 --> 00:01:49,600 CONTROL IN LATINO POPULATIONS IN 54 00:01:49,600 --> 00:01:52,400 THE UNITED STATES AND LATIN 55 00:01:52,400 --> 00:01:53,800 AMERICA, ADDRESSING CLINICAL AND 56 00:01:53,800 --> 00:01:56,040 PREVENTION ISSUES IN CANCER 57 00:01:56,040 --> 00:01:57,440 CONTROL RESEARCH, SUPPORTING 58 00:01:57,440 --> 00:01:58,760 EARLY CAREER SCIENTISTS IN 59 00:01:58,760 --> 00:02:01,600 RESEARCH ON MINORITY AGING AND 60 00:02:01,600 --> 00:02:03,000 CLINICAL AND COMMUNITY SETTINGS, 61 00:02:03,000 --> 00:02:05,760 AND ADDRESSING RESEARCH 62 00:02:05,760 --> 00:02:08,040 QUESTIONS IN CONDITIONS SUCH AS 63 00:02:08,040 --> 00:02:09,280 HYPERTENSION, ASTHMA, DIABETES 64 00:02:09,280 --> 00:02:11,680 AND DEMENTIA. 65 00:02:11,680 --> 00:02:13,440 HE'S PUBLISHED MORE THAN 300 66 00:02:13,440 --> 00:02:14,720 PEER REVIEWED PAPERS AND WAS 67 00:02:14,720 --> 00:02:17,360 CONTINUOUSLY FUNDED BY NIH 68 00:02:17,360 --> 00:02:20,760 GRANTS FOR 30 YEARS PRIOR TO 69 00:02:20,760 --> 00:02:24,200 BECOMING NIMHD DIRECTOR. 70 00:02:24,200 --> 00:02:25,880 DR. PEREZ-STABLE WAS ELECTED TO 71 00:02:25,880 --> 00:02:29,400 THE NATIONAL ACADEMY OF 72 00:02:29,400 --> 00:02:30,640 MEDICINE, OF THE NATIONAL 73 00:02:30,640 --> 00:02:34,280 ACADEMY OF SCIENCE IN 2001, AND 74 00:02:34,280 --> 00:02:36,280 THE AMERICAN SOCIETY OF CLINICAL 75 00:02:36,280 --> 00:02:40,080 INVESTIGATION IN 1996. 76 00:02:40,080 --> 00:02:41,960 SO ELISEO, THE FLOOR IS YOURS. 77 00:02:41,960 --> 00:02:43,600 >> THANK YOU VERY MUCH, RICK, 78 00:02:43,600 --> 00:02:45,760 FOR THAT INTRODUCTION AND I 79 00:02:45,760 --> 00:02:47,440 GUESS I'M NOT GOING TO SHARE 80 00:02:47,440 --> 00:02:50,360 SCREEN, IT'S GOING TO COME FROM 81 00:02:50,360 --> 00:02:50,600 CENTRAL. 82 00:02:50,600 --> 00:02:53,200 I WANT TO FIRST OF ALL JUST 83 00:02:53,200 --> 00:02:56,200 WELCOME EVERYONE TO THIS DAY 84 00:02:56,200 --> 00:02:56,360 TWO. 85 00:02:56,360 --> 00:02:57,720 I MISSED THE VERY BEGINNING 86 00:02:57,720 --> 00:02:59,240 YESTERDAY, BUT I POPPED IN AND 87 00:02:59,240 --> 00:03:02,520 OUT, LISTENED TO SOME TERRIFIC 88 00:03:02,520 --> 00:03:06,360 TALKS, AND I REALLY WANT TO 89 00:03:06,360 --> 00:03:08,760 THANK LINDSAY AND NIAMS FOR 90 00:03:08,760 --> 00:03:09,880 HELPING LEAD THIS EFFORT. 91 00:03:09,880 --> 00:03:12,360 THE IDEA, THINK, WAS DEVELOPED 92 00:03:12,360 --> 00:03:14,240 WITH BOB CARTER AND I SOME TIME 93 00:03:14,240 --> 00:03:17,600 AGO AS A COMMON CONDITION THAT 94 00:03:17,600 --> 00:03:18,840 WE DON'T PAY ENOUGH ATTENTION TO 95 00:03:18,840 --> 00:03:20,440 ON A VARIETY OF FRONTS, AND I 96 00:03:20,440 --> 00:03:22,320 THINK WE HAVE A LOT OF COMMON 97 00:03:22,320 --> 00:03:23,400 INTERESTS ALSO WITH NATIONAL 98 00:03:23,400 --> 00:03:27,360 INSTITUTE ON AGING, WHICH 99 00:03:27,360 --> 00:03:28,240 IS HELPING ALSO WITH THIS 100 00:03:28,240 --> 00:03:28,760 CONFERENCE. 101 00:03:28,760 --> 00:03:30,080 AND I WANT TO ESPECIALLY THANK 102 00:03:30,080 --> 00:03:40,640 THE CO-CHAIRS, ARLEEN BROWN, SO 103 00:03:43,680 --> 00:03:45,920 I'M GOING TO SAY A FEW THINGS 104 00:03:45,920 --> 00:03:47,120 ABOUT OSTEOARTHRITIS IN THE 105 00:03:47,120 --> 00:03:50,440 CONTEXT OF NIMHD, SO GO AHEAD 106 00:03:50,440 --> 00:03:52,400 AND PUT ON THE NEXT SLIDE. 107 00:03:52,400 --> 00:03:53,600 I'LL START WITH THINGS THAT I 108 00:03:53,600 --> 00:03:55,360 THINK MOST OF YOU ARE FAMILIAR 109 00:03:55,360 --> 00:03:56,440 WITH, BUT JUST TO MAKE SURE 110 00:03:56,440 --> 00:03:58,760 WE'RE ON THE SAME PAGE, THESE 111 00:03:58,760 --> 00:04:00,480 ARE THE POPULATIONS WITH HEALTH 112 00:04:00,480 --> 00:04:03,880 DISPARITIES AS DEFINED BY NIH. 113 00:04:03,880 --> 00:04:05,400 THE FIRST THREE BULLETS ON THIS 114 00:04:05,400 --> 00:04:06,960 SLIDE WERE ACTUALLY INCLUDED IN 115 00:04:06,960 --> 00:04:08,800 OUR ORIGINAL LEGISLATION FROM 116 00:04:08,800 --> 00:04:11,080 THE YEAR 2000, WHEN WE WERE 117 00:04:11,080 --> 00:04:12,280 ESTABLISHED AS A CENTER, SO ALL 118 00:04:12,280 --> 00:04:13,720 RACIAL AND ETHNIC MINORITY 119 00:04:13,720 --> 00:04:16,880 GROUPS AS DEFINED BY THE CENSUS, 120 00:04:16,880 --> 00:04:18,320 AND THAT COULD EVOLVE, ALL POOR 121 00:04:18,320 --> 00:04:21,840 PEOPLE OF ANY COLOR, WE USE THE 122 00:04:21,840 --> 00:04:24,240 TERM LESS PRIVILEGED 123 00:04:24,240 --> 00:04:25,320 SOCIOECONOMIC STATUS, 124 00:04:25,320 --> 00:04:26,720 UNDERSERVED RURAL RESIDENTS, 125 00:04:26,720 --> 00:04:27,720 PRIMARILY FOCUSED ON THOSE WHO 126 00:04:27,720 --> 00:04:31,000 HAVE ACCESS ISSUES THAT ARE ALSO 127 00:04:31,000 --> 00:04:32,880 OFTEN OF LESS PRIVILEGED 128 00:04:32,880 --> 00:04:34,600 SOCIOECONOMIC STATUS, AND IN 129 00:04:34,600 --> 00:04:37,000 2016, AFTER A PROCESS INITIATED 130 00:04:37,000 --> 00:04:39,680 BEFORE I ARRIVED AT NIH, SEXUAL 131 00:04:39,680 --> 00:04:41,280 AND GENDER MINORITIES WERE 132 00:04:41,280 --> 00:04:42,920 DECLARED A POPULATION WITH 133 00:04:42,920 --> 00:04:43,600 HEALTH DISPARITIES. 134 00:04:43,600 --> 00:04:47,960 ALL OF THESE MARKERS ARE 135 00:04:47,960 --> 00:04:50,240 IDENTITY OR DEMOGRAPHIC 136 00:04:50,240 --> 00:04:52,240 SOCIOECONOMIC MARKERS AND NOT 137 00:04:52,240 --> 00:04:53,880 DISEASE OR CONDITION-BASED, JUST 138 00:04:53,880 --> 00:04:56,800 TO MAKE A NOTE OF THAT. 139 00:04:56,800 --> 00:04:58,000 WE DO EMBRACE THIS NOTION THAT 140 00:04:58,000 --> 00:05:00,120 ALL OF THESE POPULATIONS HAVE A 141 00:05:00,120 --> 00:05:02,520 CERTAIN SOCIAL DISADVANTAGE 142 00:05:02,520 --> 00:05:03,840 THAT, IN PART, COMES FROM HAVING 143 00:05:03,840 --> 00:05:05,160 BEEN SUBJECT TO DISCRIMINATION 144 00:05:05,160 --> 00:05:07,760 OR RACISM, AND BEING UNDERSERVED 145 00:05:07,760 --> 00:05:11,160 IN HEALTHCARE. 146 00:05:11,160 --> 00:05:12,240 I KNOW YESTERDAY THERE WAS A 147 00:05:12,240 --> 00:05:14,920 DISCUSSION ON RACISM IN ONE OF 148 00:05:14,920 --> 00:05:16,400 THE TALKS, AND I'M NOT GOING TO 149 00:05:16,400 --> 00:05:20,000 DWELL ON THAT MORE TODAY BUT 150 00:05:20,000 --> 00:05:21,440 THIS IS A VERY IMPORTANT 151 00:05:21,440 --> 00:05:24,080 CROSS-CUTTING ISSUE FOR OUR 152 00:05:24,080 --> 00:05:24,600 INSTITUTE. 153 00:05:24,600 --> 00:05:25,800 SO A HEALTH OUTCOME THAT IS 154 00:05:25,800 --> 00:05:26,880 WORSE IN THESE POPULATIONS 155 00:05:26,880 --> 00:05:27,920 EITHER COMPARED TO A REFERENCE 156 00:05:27,920 --> 00:05:32,360 GROUP OR PERHAPS TO A STANDARD 157 00:05:32,360 --> 00:05:33,120 NATIONAL QUALITY METRIC THAT WE 158 00:05:33,120 --> 00:05:36,960 CAN AGREE ON DEFINES A HEALTH 159 00:05:36,960 --> 00:05:41,000 DISPARITY. 160 00:05:41,000 --> 00:05:42,440 DO I ADVANCE? 161 00:05:42,440 --> 00:05:44,800 HERE WE GO. 162 00:05:44,800 --> 00:05:47,800 THESE ARE A GLOBAL POINT THAT I 163 00:05:47,800 --> 00:05:50,000 WOULD LIKE TO RE-EMPHASIZE IN MY 164 00:05:50,000 --> 00:05:51,720 ROLE HERE AT NIH OVER THE LAST 165 00:05:51,720 --> 00:05:52,480 SEVEN YEARS. 166 00:05:52,480 --> 00:05:56,200 RACE AND ETHNICITY ARE 167 00:05:56,200 --> 00:05:56,960 SELF-IDENTIFIED SOCIAL 168 00:05:56,960 --> 00:05:57,280 CONSTRUCTS. 169 00:05:57,280 --> 00:06:01,240 THERE'S NO DISCUSSION ABOUT THAT 170 00:06:01,240 --> 00:06:06,280 AMONGST MY COLLEAGUES. 171 00:06:06,280 --> 00:06:08,920 PRIMARILY FOCUSED ON NHGRI, THE 172 00:06:08,920 --> 00:06:09,680 GENOME INSTITUTE. 173 00:06:09,680 --> 00:06:10,440 WE AGREE ON THIS. 174 00:06:10,440 --> 00:06:11,400 THERE ARE OTHER COMPONENTS THAT 175 00:06:11,400 --> 00:06:14,800 WE CAN DISCUSS, BUT SO THIS SELF 176 00:06:14,800 --> 00:06:16,640 IDENTIFIED SOCIAL CONSTRUCT AND 177 00:06:16,640 --> 00:06:20,160 SOCIAL CLASS OR SOCIOECONOMIC 178 00:06:20,160 --> 00:06:22,680 STATUS, ARE VERY POWERFUL 179 00:06:22,680 --> 00:06:23,880 PREDICTORS OF LOTS OF IMPORTANT 180 00:06:23,880 --> 00:06:25,000 OUTCOMES THAT WE DON'T FULLY 181 00:06:25,000 --> 00:06:25,280 UNDERSTAND. 182 00:06:25,280 --> 00:06:26,960 SO I WOULD SAY THAT IN ANY HUMAN 183 00:06:26,960 --> 00:06:28,960 STUDY, THEY NEED TO BE MEASURED 184 00:06:28,960 --> 00:06:30,880 IN A STANDARDIZED WAY AND 185 00:06:30,880 --> 00:06:32,720 CONSIDERED AS POSSIBLE 186 00:06:32,720 --> 00:06:33,400 EXPLANATORY OR ASSOCIATED 187 00:06:33,400 --> 00:06:34,480 FACTORS. 188 00:06:34,480 --> 00:06:35,720 IN THE OUTCOMES. 189 00:06:35,720 --> 00:06:37,440 THERE'S LOTS OF DATA ABOUT LIFE 190 00:06:37,440 --> 00:06:40,720 EXPECTANCY AND MORTALITY, 191 00:06:40,720 --> 00:06:41,600 INCLUDING RELATED TO COVID AND 192 00:06:41,600 --> 00:06:42,280 OTHER CONDITIONS. 193 00:06:42,280 --> 00:06:45,960 WE KNOW THAT, FOR EXAMPLE, 194 00:06:45,960 --> 00:06:47,840 AFRICAN AMERICANS IN THE REGARDS 195 00:06:47,840 --> 00:06:50,440 COHORT STUDY HAVE TWICE AS MANY 196 00:06:50,440 --> 00:06:52,120 STROKES FOR THE EXACT SAME LEVEL 197 00:06:52,120 --> 00:06:53,520 OF SYSTOLIC BLOOD PRESSURE AS 198 00:06:53,520 --> 00:06:56,600 THEIR WHITE COUNTERPARTS, IN A 199 00:06:56,600 --> 00:06:58,240 PROSPECTIVE LONGITUDINAL STUDY. 200 00:06:58,240 --> 00:06:59,120 MOST CHRONIC DISEASES ARE MORE 201 00:06:59,120 --> 00:07:00,440 COMMON IN POOR PEOPLE AND THIS 202 00:07:00,440 --> 00:07:02,680 IS NOT RELATED TO POOR BEHAVIOR 203 00:07:02,680 --> 00:07:03,120 ONLY. 204 00:07:03,120 --> 00:07:08,720 IT RELATES TO LOTS OF STRUCTURAL 205 00:07:08,720 --> 00:07:17,040 FACTORS AND OTHER CONDITIONS. 206 00:07:17,040 --> 00:07:18,920 TWICE AS MUCH HEART DISEASE END 207 00:07:18,920 --> 00:07:20,120 STAGE RENAL DISEASE AS THEIR 208 00:07:20,120 --> 00:07:24,400 COUNTERPARTS. 209 00:07:24,400 --> 00:07:26,560 SO WHAT CAN SCIENCE DO TO REDUCE 210 00:07:26,560 --> 00:07:27,000 INEQUITIES? 211 00:07:27,000 --> 00:07:30,600 I THINK THESE WI ARE GENERALIZAE 212 00:07:30,600 --> 00:07:33,760 PRINCIPLES THAT I WILL 213 00:07:33,760 --> 00:07:34,200 RECOMMEND. 214 00:07:34,200 --> 00:07:35,640 WE REALLY NEED TO GET OUR ACT 215 00:07:35,640 --> 00:07:37,080 TOGETHER AND USE STANDARDIZED 216 00:07:37,080 --> 00:07:38,480 MEASUREMENT OF THESE FACTORS 217 00:07:38,480 --> 00:07:39,800 THAT AFFECT HEALTH. 218 00:07:39,800 --> 00:07:41,000 THIS IS A CHALLENGE THAT IS 219 00:07:41,000 --> 00:07:42,280 HARDER THAN I WOULD HAVE 220 00:07:42,280 --> 00:07:43,520 PREDICTED A COUPLE YEARS AGO, 221 00:07:43,520 --> 00:07:44,920 WHEN WE STARTED WORKING ON THIS. 222 00:07:44,920 --> 00:07:48,000 SO I'LL LEAVE IT AT THAT. 223 00:07:48,000 --> 00:07:50,000 WE NEED TO FACILITATE DISCOVERY 224 00:07:50,000 --> 00:07:51,480 SCIENCE IN THIS KIND OF RESEARCH 225 00:07:51,480 --> 00:07:53,440 WITH BIG DATA, AND WE NEED TO 226 00:07:53,440 --> 00:07:56,400 BECOME MORE ADEPT AT DATA 227 00:07:56,400 --> 00:07:58,600 SCIENCE AND BEING ABLE TO WORK 228 00:07:58,600 --> 00:07:59,800 WITH THINGS LIKE ELECTRONIC 229 00:07:59,800 --> 00:08:01,200 HEALTH RECORDS AND POPULATION 230 00:08:01,200 --> 00:08:04,720 DATA AND LINKED DATA. 231 00:08:04,720 --> 00:08:06,480 OUR FIELD NEEDS TO BE AN ENGINE 232 00:08:06,480 --> 00:08:10,080 FOR PROMOTING DIE VEERS IT OF DE 233 00:08:10,080 --> 00:08:10,840 SCIENTIFIC AND CLINICAL 234 00:08:10,840 --> 00:08:11,160 WORKFORCE. 235 00:08:11,160 --> 00:08:13,480 WE'RE IN A CRISIS MODE. 236 00:08:13,480 --> 00:08:17,640 14% OF NEWLY MINTED PH.D.s IN 237 00:08:17,640 --> 00:08:21,880 THE STEM FIELDS, 14% OF NEW 238 00:08:21,880 --> 00:08:23,320 M.D.s ARE FROM 239 00:08:23,320 --> 00:08:26,360 UNDERREPRESENTED RACIAL AND 240 00:08:26,360 --> 00:08:28,000 ETHNIC GROUPS, AND YET WE'RE 241 00:08:28,000 --> 00:08:29,200 ABOUT 33% OF THE POPULATION. 242 00:08:29,200 --> 00:08:32,400 THIS KIND OF A GAP IS NOT 243 00:08:32,400 --> 00:08:33,800 SUSTAINABLE, AND WILL LEAD TO A 244 00:08:33,800 --> 00:08:36,840 CRISIS IN THE PROFESSION OVER 245 00:08:36,840 --> 00:08:37,960 TIME. 246 00:08:37,960 --> 00:08:40,800 WE NEED TO REALLY CONTINUE TO 247 00:08:40,800 --> 00:08:42,240 CULTIVATE COMMUNITY ENGAGEMENT 248 00:08:42,240 --> 00:08:44,720 IN A COMPLETELY TRANSPARENT AND 249 00:08:44,720 --> 00:08:46,160 HONEST WAY, AND MAINTAIN THIS 250 00:08:46,160 --> 00:08:49,480 FOR SUSTAINABLE, TRUSTWORTHY 251 00:08:49,480 --> 00:08:50,000 RELATIONSHIPS. 252 00:08:50,000 --> 00:08:52,080 THIS TAKES RESOURCES, TIME, AND 253 00:08:52,080 --> 00:08:53,600 EFFORT ON THE PART OF THE 254 00:08:53,600 --> 00:08:56,240 SCIENTISTS AS WELL AS THE 255 00:08:56,240 --> 00:08:56,920 ORGANIZATIONS. 256 00:08:56,920 --> 00:08:58,080 AND THEN WE NEED TO IMPLEMENT 257 00:08:58,080 --> 00:08:59,840 WHAT WE KNOW WORKS TO PROMOTE 258 00:08:59,840 --> 00:09:00,520 EQUITY. 259 00:09:00,520 --> 00:09:03,880 THE GAPS ARE BLATANT IN THINGS 260 00:09:03,880 --> 00:09:05,200 THAT WE KNOW HOW TO DO BEST, AND 261 00:09:05,200 --> 00:09:06,600 THE PEOPLE WHO HAVE THE WORST 262 00:09:06,600 --> 00:09:08,680 OUTCOMES ARE OFTEN THOSE WITH 263 00:09:08,680 --> 00:09:10,640 THE WORST -- THE LOWEST RATE OF 264 00:09:10,640 --> 00:09:17,680 CONTROL OF THESE FACTORS. 265 00:09:17,680 --> 00:09:18,880 NIMHD HAS REFERRED TO OUR 266 00:09:18,880 --> 00:09:20,640 RESEARCH FRAMEWORK AS A 267 00:09:20,640 --> 00:09:24,000 REFERENCE POINT FOR ALL OUR 268 00:09:24,000 --> 00:09:24,320 APPLICANTS. 269 00:09:24,320 --> 00:09:25,520 IT WAS DEVELOPED OUT OF AN 270 00:09:25,520 --> 00:09:27,480 EFFORT THAT WE HAD DONE AT NIA 271 00:09:27,480 --> 00:09:33,520 AS WELL AS USING BUILDING ON 272 00:09:33,520 --> 00:09:34,760 HISTORICAL SOCIOECONOMIC MODELS. 273 00:09:34,760 --> 00:09:37,680 I WOULD EMPHASIZE HERE FOR THIS 274 00:09:37,680 --> 00:09:38,360 PURPOSE, THE HEALTHCARE SYSTEM 275 00:09:38,360 --> 00:09:39,400 AND NOT JUST THE INDIVIDUAL 276 00:09:39,400 --> 00:09:40,760 FACTORS AND THE INTERPERSONAL 277 00:09:40,760 --> 00:09:42,200 ONES BUT ALSO ALL OF THE ISSUES 278 00:09:42,200 --> 00:09:45,240 RELATED TO COMMUNITY AND 279 00:09:45,240 --> 00:09:46,320 SOCIETAL. 280 00:09:46,320 --> 00:09:47,440 AS OSTEOARTHRITIS ON THE 281 00:09:47,440 --> 00:09:48,440 SCIENTIFIC SIDE, THERE MAY BE 282 00:09:48,440 --> 00:09:49,600 MANY QUESTIONS LEFT TO BE 283 00:09:49,600 --> 00:09:50,600 ADDRESSED, BUT I THINK IN MANY 284 00:09:50,600 --> 00:09:51,480 OF THE THINGS THAT WE'RE GOING 285 00:09:51,480 --> 00:09:53,520 TO FOCUS ON HERE, FROM OUR 286 00:09:53,520 --> 00:09:54,880 PERSPECTIVE AT NIMHD, THEY'RE 287 00:09:54,880 --> 00:09:56,280 GOING TO BE FOCUSED ON THE 288 00:09:56,280 --> 00:09:58,960 HEALTHCARE SYSTEM. 289 00:09:58,960 --> 00:10:01,320 A COUPLE OF HIGHLIGHTS THAT YOU 290 00:10:01,320 --> 00:10:04,720 ALREADY PROBABLY DISCUSSED 291 00:10:04,720 --> 00:10:06,880 YESTERDAY, OSTEOARTHRITIS IS 292 00:10:06,880 --> 00:10:08,760 HIGHLY PREVALENT. 293 00:10:08,760 --> 00:10:10,200 IT'S INCREASING, THERE'S NO CURE 294 00:10:10,200 --> 00:10:13,360 AS MANY CHRONIC CONDITIONS HAVE 295 00:10:13,360 --> 00:10:14,760 NO CURE. 296 00:10:14,760 --> 00:10:16,640 AS RICK OUTLINED, I PRACTICED 297 00:10:16,640 --> 00:10:20,120 MEDICINE FOR 37 YEARS, AND THIS 298 00:10:20,120 --> 00:10:20,720 WAS A VERY COMMON CONDITION I 299 00:10:20,720 --> 00:10:21,000 SAW. 300 00:10:21,000 --> 00:10:23,200 THIS IS NOT A CONDITION THAT IS 301 00:10:23,200 --> 00:10:26,240 MOST OFTEN SEEN BY THE 302 00:10:26,240 --> 00:10:27,320 SPECIALISTS, NOT UNTIL AN 303 00:10:27,320 --> 00:10:29,960 INTERVENTION IS NEEDED. 304 00:10:29,960 --> 00:10:31,600 AND THIS IS, I THINK, ONE OF THE 305 00:10:31,600 --> 00:10:32,720 FACTORS THAT NEEDS TO BE 306 00:10:32,720 --> 00:10:33,320 EMPHASIZED. 307 00:10:33,320 --> 00:10:34,760 THIS IS A PRIMARY CARE 308 00:10:34,760 --> 00:10:35,320 CONDITION. 309 00:10:35,320 --> 00:10:37,080 IT HAS A SIGNIFICANT IMPACT ON 310 00:10:37,080 --> 00:10:40,920 QUALITY YEARS OF LIFE LOST DUE 311 00:10:40,920 --> 00:10:41,360 TO DISABILITY. 312 00:10:41,360 --> 00:10:42,320 SO YOU MAY NOT DIE FROM THIS 313 00:10:42,320 --> 00:10:43,400 MOST OF THE TIME, BUT WE ALL 314 00:10:43,400 --> 00:10:45,920 KNOW THAT IT AFFECTS QUALITY OF 315 00:10:45,920 --> 00:10:48,560 LIFE IN MANY WAYS, WHETHER IT BE 316 00:10:48,560 --> 00:10:52,040 MOBILITY OR PAIN. 317 00:10:52,040 --> 00:10:54,240 AND ON OTHER THINGS. 318 00:10:54,240 --> 00:10:55,640 MAJOR CO-MORBIDITY WHEN PEOPLE 319 00:10:55,640 --> 00:10:57,440 ALSO HAVE DIABETES, HEART 320 00:10:57,440 --> 00:11:00,280 DISEASE, ASTHMA, COPD, THEN THIS 321 00:11:00,280 --> 00:11:00,680 EXACERBATES THINGS. 322 00:11:00,680 --> 00:11:02,000 THERE ARE MAJOR FINANCIAL 323 00:11:02,000 --> 00:11:03,240 IMPACTS ON INDIVIDUALS, BOTH 324 00:11:03,240 --> 00:11:06,520 FROM OUT OF POCKET COSTS FOR 325 00:11:06,520 --> 00:11:08,360 HEALTHCARE AS WELL AS INABILITY 326 00:11:08,360 --> 00:11:11,080 TO CONTINUE WORK IN SOME 327 00:11:11,080 --> 00:11:11,960 CONDITIONS. 328 00:11:11,960 --> 00:11:13,520 TOTAL KNEE REPLACEMENT IS 329 00:11:13,520 --> 00:11:15,360 ACTUALLY THE SECOND MOST COMMON 330 00:11:15,360 --> 00:11:16,800 SURGICAL PROCEDURE DONE IN THE 331 00:11:16,800 --> 00:11:19,960 UNITED STATES TODAY, I BELIEVE 332 00:11:19,960 --> 00:11:20,320 THAT'S CORRECT. 333 00:11:20,320 --> 00:11:25,080 IT IS SECOND ONLY TO C-SECTION 334 00:11:25,080 --> 00:11:29,480 AND OSTEOAR THRI OSTEOARTHRITISE 335 00:11:29,480 --> 00:11:32,000 COST ITEM FOR CMS, THE CENTERS 336 00:11:32,000 --> 00:11:33,080 FOR MEDICARE AND MEDICAID 337 00:11:33,080 --> 00:11:34,400 SERVICES, PRIMARILY RELATED TO 338 00:11:34,400 --> 00:11:36,040 THE SURGICAL PROCEDURES, BOTH 339 00:11:36,040 --> 00:11:37,560 KNEE AND HIP BEING THE BIGGEST 340 00:11:37,560 --> 00:11:42,360 ONES BUT ALSO BACK ISSUES. 341 00:11:42,360 --> 00:11:43,680 DRUG THERAPIES HAVE SMALL 342 00:11:43,680 --> 00:11:44,280 TREATMENT EFFECT. 343 00:11:44,280 --> 00:11:46,200 THEY MAY HAVE SIGNIFICANT 344 00:11:46,200 --> 00:11:50,880 ADVERSE EFFECTS, CHRONIC 345 00:11:50,880 --> 00:11:51,680 NONSTEROIDALS CERTAINLY HAVE LED 346 00:11:51,680 --> 00:11:54,280 TO A CERTAIN RATE OF 347 00:11:54,280 --> 00:11:55,040 GASTROINTESTINAL HEMORRHAGE AND 348 00:11:55,040 --> 00:11:56,680 OTHER THINGS SUCH AS RENAL 349 00:11:56,680 --> 00:11:58,040 CONDITIONS, SO THESE ARE NOT TO 350 00:11:58,040 --> 00:11:59,320 BE TAKEN LIGHTLY. 351 00:11:59,320 --> 00:12:01,960 AND THEN THINGS LIKE PHYSICAL 352 00:12:01,960 --> 00:12:04,080 THERAPY, STRENGTHENING EXERCISES 353 00:12:04,080 --> 00:12:07,520 THAT REALLY MAY BE LESS TOXIC, 354 00:12:07,520 --> 00:12:09,080 DO REQUIRE BEHAVIORAL CHANGE AND 355 00:12:09,080 --> 00:12:11,120 WE HAVE NOT BEEN GREAT AT 356 00:12:11,120 --> 00:12:13,440 IMPLEMENTING AND SUSTAINING 357 00:12:13,440 --> 00:12:16,280 THESE CHANGES IN OUR PATIENTS. 358 00:12:16,280 --> 00:12:17,160 ALMOST DONE HERE. 359 00:12:17,160 --> 00:12:20,760 SO QUICKLY, NIMHD HAS HAD A SORT 360 00:12:20,760 --> 00:12:22,520 OF A FOOTPRINT IN THIS FOR SOME 361 00:12:22,520 --> 00:12:22,960 TIME. 362 00:12:22,960 --> 00:12:28,760 YOU HEARD FROM SAID YESTERDAY, 363 00:12:28,760 --> 00:12:31,040 HE WAS FUNDED BY US, FORMERLY ON 364 00:12:31,040 --> 00:12:33,440 OUR COUNCIL, THAT TIME AS THE VA 365 00:12:33,440 --> 00:12:33,840 REPRESENTATIVE. 366 00:12:33,840 --> 00:12:35,440 WE'VE HAD A NUMBER OF 367 00:12:35,440 --> 00:12:37,600 APPLICATIONS OVER A FEW YEARS. 368 00:12:37,600 --> 00:12:38,600 10 HAVE BEEN FUNDED. 369 00:12:38,600 --> 00:12:42,720 THESE HAVE BEEN OF DIFFERENT 370 00:12:42,720 --> 00:12:44,920 FLAVORS, R01s AS WELL AS K 371 00:12:44,920 --> 00:12:45,720 AWARDS, ONE SMALL BUSINESS AND 372 00:12:45,720 --> 00:12:47,760 ONE LOAN REPAYMENT PROGRAM. 373 00:12:47,760 --> 00:12:49,120 MOST HAVE FOCUSED ON THE 374 00:12:49,120 --> 00:12:51,600 DISPARITIES IN SURGERY FOR JOINT 375 00:12:51,600 --> 00:12:52,560 REPLACEMENT, AS WAS DISCUSSED 376 00:12:52,560 --> 00:12:54,760 YESTERDAY, INCLUDING ACCESS AND 377 00:12:54,760 --> 00:12:55,760 OUTCOMES, AND ALL OTHER ISSUES 378 00:12:55,760 --> 00:12:57,080 AROUND PAIN MANAGEMENT. 379 00:12:57,080 --> 00:12:58,400 THEN I WANT TO LEAVE YOU WITH 380 00:12:58,400 --> 00:13:02,120 JUST TWO MESSAGES ABOUT NIMHD 381 00:13:02,120 --> 00:13:04,080 PROGRAMS THAT MADE THIS 382 00:13:04,080 --> 00:13:06,160 INVESTIGATOR POOL AWARE. 383 00:13:06,160 --> 00:13:09,680 WE HAVE A PROGRAM THAT IS FUNDED 384 00:13:09,680 --> 00:13:12,840 THAT IS A SETASIDE FROM 385 00:13:12,840 --> 00:13:15,480 CONGRESSIONAL MANDATE, WE FUND 386 00:13:15,480 --> 00:13:16,520 21 INSTITUTIONS WITH SIGNIFICANT 387 00:13:16,520 --> 00:13:19,720 GRANTS VARYING FROM 1 1/2 TO 388 00:13:19,720 --> 00:13:21,680 3 1/2 MILLION DOLLARS PER YEAR 389 00:13:21,680 --> 00:13:23,000 IN DIRECT COSTS. 390 00:13:23,000 --> 00:13:26,160 13 OF THESE ARE HBCUs, AT 391 00:13:26,160 --> 00:13:27,320 LEAST EIGHT HAVE ATTACHED 392 00:13:27,320 --> 00:13:29,560 MEDICAL SCHOOLS, PROBABLY MORE 393 00:13:29,560 --> 00:13:37,320 HAVE AFFILIATIONS, SO DREW, 394 00:13:37,320 --> 00:13:44,760 UCLA, MEHARRY, MOREHOUSE, U 395 00:13:44,760 --> 00:13:45,960 PUERTO RICO, FIU, AND I THINK 396 00:13:45,960 --> 00:13:47,480 THAT'S PROBABLY IT, MAYBE 397 00:13:47,480 --> 00:13:48,920 UNIVERSITY OF HOUSTON IS CLOSE 398 00:13:48,920 --> 00:13:50,680 ENOUGH TO UT HOUSTON TO BE 399 00:13:50,680 --> 00:13:51,040 CONNECTED. 400 00:13:51,040 --> 00:13:53,920 AND SO THEY HAVE AN OPPORTUNITY 401 00:13:53,920 --> 00:13:55,920 FOR BOTH ACCESSING 402 00:13:55,920 --> 00:13:59,880 UNDERREPRESENTED POPULATIONS AND 403 00:13:59,880 --> 00:14:00,840 INVESTIGATORS, AND AS WELL AS 404 00:14:00,840 --> 00:14:02,160 LESS RESOURCE INSTITUTIONS AND 405 00:14:02,160 --> 00:14:03,240 COLLABORATION AND PARTNERSHIPS 406 00:14:03,240 --> 00:14:03,920 ARE ENCOURAGED. 407 00:14:03,920 --> 00:14:05,880 AND MY LAST SLIDE IS JUST ALSO 408 00:14:05,880 --> 00:14:07,520 TO LET YOU KNOW ABOUT THE 409 00:14:07,520 --> 00:14:08,600 MULTIPLE CHRONIC DISEASE 410 00:14:08,600 --> 00:14:09,160 RESEARCH CENTERS. 411 00:14:09,160 --> 00:14:13,000 THIS WAS A PROGRAM AGAIN THAT WE 412 00:14:13,000 --> 00:14:14,080 RECEIVED A CONGRESSIONAL 413 00:14:14,080 --> 00:14:15,840 ALLOCATION OF $45 MILLION IN 414 00:14:15,840 --> 00:14:18,080 FISCAL YEAR '21. 415 00:14:18,080 --> 00:14:18,880 THESE WERE FUNDED AT THE VERY 416 00:14:18,880 --> 00:14:21,640 END OF THE FISCAL YEAR. 417 00:14:21,640 --> 00:14:23,360 THEY'RE $3 MILLION CENTERS. 418 00:14:23,360 --> 00:14:25,920 WE WERE TOLD TO MAKE SURE THAT 419 00:14:25,920 --> 00:14:27,320 CARDIOVASCULAR DISEASE, CANCER, 420 00:14:27,320 --> 00:14:28,640 OBESITY, DIABETES, CHRONIC 421 00:14:28,640 --> 00:14:30,280 KIDNEY DISEASE, STROKE AND 422 00:14:30,280 --> 00:14:31,480 CHRONIC LIVER DISEASE WERE 423 00:14:31,480 --> 00:14:34,960 INCLUDED, AND WE ADDED 424 00:14:34,960 --> 00:14:35,960 OSTEOARTHRITIS AND GOT INPUT 425 00:14:35,960 --> 00:14:37,480 FROM NIGH AMS AS WELL AS THE 426 00:14:37,480 --> 00:14:40,120 OTHER INSTITUTES LISTED HERE. 427 00:14:40,120 --> 00:14:41,400 NONE OF THE FUNDED CENTERS 428 00:14:41,400 --> 00:14:42,600 ACTUALLY FOCUSED ON 429 00:14:42,600 --> 00:14:43,640 OSTEOARTHRITIS TO OUR 430 00:14:43,640 --> 00:14:44,680 DISAPPOINTMENT. 431 00:14:44,680 --> 00:14:47,240 BUT I'M HOPEFUL THAT THROUGH 432 00:14:47,240 --> 00:14:49,840 OTHER MECHANISMS, WE CAN GET ONE 433 00:14:49,840 --> 00:14:51,160 OF THEM INTERESTED, MAYBE A 434 00:14:51,160 --> 00:14:52,680 COUPLE OF YOU ARE INVOLVED WITH 435 00:14:52,680 --> 00:14:53,360 THESE CENTERS. 436 00:14:53,360 --> 00:14:57,920 THESE ARE THE FUNDED CENTERS, 437 00:14:57,920 --> 00:14:58,960 THE CHILDREN'S HOSPITAL IS 438 00:14:58,960 --> 00:15:00,080 EXCLUSIVELY ON CHILDREN, OF 439 00:15:00,080 --> 00:15:04,000 COURSE AT COLUMBIA HOPKINS, 440 00:15:04,000 --> 00:15:08,160 RUTGERS, ARKANSAS, ALABAMA, 441 00:15:08,160 --> 00:15:09,080 UCLA, UNIVERSITY OF CHICAGO, 442 00:15:09,080 --> 00:15:10,840 MINNESOTA, VANDERBILT, WAYNE 443 00:15:10,840 --> 00:15:12,280 STATE, AND THEN THE COORDINATING 444 00:15:12,280 --> 00:15:14,240 CENTER IS AT UCSF. 445 00:15:14,240 --> 00:15:15,120 SO THANK YOU AGAIN FOR YOUR 446 00:15:15,120 --> 00:15:15,920 ATTENTION. 447 00:15:15,920 --> 00:15:17,000 LAST SLIDE IS JUST OUR CONTACT 448 00:15:17,000 --> 00:15:18,400 INFORMATION. 449 00:15:18,400 --> 00:15:19,400 I APPRECIATE ALL THE EFFORT THAT 450 00:15:19,400 --> 00:15:21,040 WENT INTO GETTING THIS WORKSHOP 451 00:15:21,040 --> 00:15:24,760 GOING, AND I PLAN TO LISTEN TO 452 00:15:24,760 --> 00:15:26,960 AS MUCH AS I CAN TODAY. 453 00:15:26,960 --> 00:15:29,240 >> THANK YOU, DR. PEREZ-STABLE. 454 00:15:29,240 --> 00:15:30,120 OUR FIRST SESSION THIS MORNING 455 00:15:30,120 --> 00:15:32,320 WILL ALLOW US TO HEAR FROM 456 00:15:32,320 --> 00:15:33,400 IMPORTANT STAKEHOLDERS WHO ARE 457 00:15:33,400 --> 00:15:35,120 AFFECTED BY THESE ISSUES IN 458 00:15:35,120 --> 00:15:36,240 OSTEOARTHRITIS DAILY. 459 00:15:36,240 --> 00:15:37,240 OUR PATIENTS ARE PROVIDERS AND 460 00:15:37,240 --> 00:15:38,880 THOSE WHO WORK TO ADDRESS THESE 461 00:15:38,880 --> 00:15:39,200 ISSUES. 462 00:15:39,200 --> 00:15:40,960 IT WILL BE MODERATED BY OUR 463 00:15:40,960 --> 00:15:42,560 WORKSHOP CO-CHAIR, DR. ARLEEN 464 00:15:42,560 --> 00:15:43,920 BROWN AT THE UNIVERSITY OF 465 00:15:43,920 --> 00:15:45,560 CALIFORNIA LOS ANGELES. 466 00:15:45,560 --> 00:15:49,600 DR. BROWN, THE FLOOR IS YOURS. 467 00:15:49,600 --> 00:15:50,880 >> THANK YOU FOR THAT 468 00:15:50,880 --> 00:15:52,000 INTRODUCTION, KRISTY. 469 00:15:52,000 --> 00:15:53,640 I WANT TO THANK NIAMS AND ALL 470 00:15:53,640 --> 00:15:55,840 THE INSTITUTES INVOLVED IN 471 00:15:55,840 --> 00:15:58,000 PLANNING IN CONFERENCE AND FOR 472 00:15:58,000 --> 00:15:59,640 FOCUSING ON THIS IMPORTANT 473 00:15:59,640 --> 00:15:59,880 TOPICS. 474 00:15:59,880 --> 00:16:01,280 THANK YOU TO DR. PEREZ-STABLE 475 00:16:01,280 --> 00:16:02,360 FOR HIS INTRODUCTORY REMARKS. 476 00:16:02,360 --> 00:16:03,480 SO IN THIS SESSION, WE WANT TO 477 00:16:03,480 --> 00:16:04,920 BRING IN A RANGE OF COMMUNITY 478 00:16:04,920 --> 00:16:07,080 VOICES TO OBTAIN A BROADER 479 00:16:07,080 --> 00:16:08,840 PERSPECTIVE ON AND DIVERSE 480 00:16:08,840 --> 00:16:10,800 INSIGHTS INTO DISPARITIES IN 481 00:16:10,800 --> 00:16:12,200 OSTEOARTHRITIS AND STRATEGIES TO 482 00:16:12,200 --> 00:16:13,640 PROMOTE EQUITY FOR THOSE AT RISK 483 00:16:13,640 --> 00:16:15,600 FOR AND AFFECTED BY THE 484 00:16:15,600 --> 00:16:17,000 CONDITION. 485 00:16:17,000 --> 00:16:20,200 OUR FIRST SPEAKER IS MISS VAL 486 00:16:20,200 --> 00:16:21,200 OVERTON. 487 00:16:21,200 --> 00:16:22,800 AS YOU'LL HEAR, SHE'S A FORMER 488 00:16:22,800 --> 00:16:23,480 EMPLOYEE OF THE HEALTH 489 00:16:23,480 --> 00:16:24,240 DEPARTMENT IN THE CITY OF 490 00:16:24,240 --> 00:16:25,240 DETROIT AND THE STATE OF 491 00:16:25,240 --> 00:16:25,720 MICHIGAN. 492 00:16:25,720 --> 00:16:28,200 SHE'S ALSO A PATIENT WITH 493 00:16:28,200 --> 00:16:29,280 OSTEOARTHRITIS, WHO WILL TALK TO 494 00:16:29,280 --> 00:16:30,960 US ABOUT THE PROFOUND IMPACT OF 495 00:16:30,960 --> 00:16:32,920 THE DISEASE ON HER LIFE, AND 496 00:16:32,920 --> 00:16:34,320 SHARE WITH US HER EXPERIENCES 497 00:16:34,320 --> 00:16:35,720 BOTH WITHIN AND OUTSIDE THE 498 00:16:35,720 --> 00:16:36,520 HEALTHCARE SYSTEM. 499 00:16:36,520 --> 00:16:39,320 SO I'M GOING TO TURN THE MIC 500 00:16:39,320 --> 00:16:48,360 OVER TO MISS OVERTON. 501 00:16:48,360 --> 00:16:49,080 >> THANK YOU. 502 00:16:49,080 --> 00:16:50,720 HI, MY NAME IS VAL OVERTON. 503 00:16:50,720 --> 00:16:51,800 I LIVE IN MICHIGAN IN THE CITY 504 00:16:51,800 --> 00:16:52,400 OF DETROIT. 505 00:16:52,400 --> 00:16:54,800 I AM A MOTHER OF TWO, A 506 00:16:54,800 --> 00:16:56,760 MOTHER-IN-LAW OF TWO, AND A 507 00:16:56,760 --> 00:17:00,120 GRANDMOTHER OF SIX. 508 00:17:00,120 --> 00:17:02,440 I CALL MYSELF RETIRED BY 509 00:17:02,440 --> 00:17:03,760 PHYSICIAN ORDER, SIMPLY BECAUSE 510 00:17:03,760 --> 00:17:05,160 A PHYSICIAN WOULD NOT ALLOW ME 511 00:17:05,160 --> 00:17:07,560 TO RETURN TO WORK DUE TO MY 512 00:17:07,560 --> 00:17:08,320 DISABILITIES. 513 00:17:08,320 --> 00:17:12,320 PRIOR TO THAT, I SERVED AS A 514 00:17:12,320 --> 00:17:17,200 DIRECTOR WITH OVER 21 YEARS -- 515 00:17:17,200 --> 00:17:19,800 20-PLUS YEARS IN HUMAN RESOURCES 516 00:17:19,800 --> 00:17:24,200 FOR A NON-PROFIT PUBLIC HEALTH 517 00:17:24,200 --> 00:17:24,840 CONSORTIUM. 518 00:17:24,840 --> 00:17:26,320 THAT CONSORTIUM WORKED WITH THE 519 00:17:26,320 --> 00:17:28,360 CITY OF DETROIT'S HEALTH 520 00:17:28,360 --> 00:17:29,880 DEPARTMENT, HEALTH DEPARTMENTS 521 00:17:29,880 --> 00:17:30,880 IN SEVEN DIFFERENT COUNTIES 522 00:17:30,880 --> 00:17:34,960 WITHIN THE STATE OF MICHIGAN, 523 00:17:34,960 --> 00:17:36,600 AND THE STATE OF MICHIGAN PUBLIC 524 00:17:36,600 --> 00:17:41,880 HEALTH DEPARTMENT. 525 00:17:41,880 --> 00:17:46,400 I HAVE NO DISCLOSURES. 526 00:17:46,400 --> 00:17:50,120 MY HEALTH ISSUES INCLUDE BUT 527 00:17:50,120 --> 00:17:51,400 AREN'T LIMITED TO AS YOE 528 00:17:51,400 --> 00:17:55,920 ARTHOSTEOARTHRITISIN BOTH HANDSR 529 00:17:55,920 --> 00:17:59,520 SURGERY AND REMOVAL OF A CYST 530 00:17:59,520 --> 00:18:02,040 AND A MOLE, ONE CANCEROUS CYST 531 00:18:02,040 --> 00:18:03,800 REMOVAL FROM MY STOMACH, 532 00:18:03,800 --> 00:18:06,200 ARTHRITIS IN BOTH KNEES AND 533 00:18:06,200 --> 00:18:08,840 ANKLES, AND SPINAL DISK 534 00:18:08,840 --> 00:18:09,240 DEGENERATION. 535 00:18:09,240 --> 00:18:12,680 I'VE HAD FOUR HERNIATED DISK 536 00:18:12,680 --> 00:18:15,680 SURGERIES, ONE NEUROSTIMULATOR 537 00:18:15,680 --> 00:18:16,880 IMPLANT, AN IMPLANT OF A 538 00:18:16,880 --> 00:18:19,000 BATTERY, AND I HAVE A REMOTE 539 00:18:19,000 --> 00:18:25,560 CONTROL TO REGULATE THAT. 540 00:18:25,560 --> 00:18:27,000 MY PHYSICAL AND MENTAL JOURNEY 541 00:18:27,000 --> 00:18:31,360 HAS BEEN THROUGH TWO HEALTHCARE 542 00:18:31,360 --> 00:18:32,680 SYSTEMS. 543 00:18:32,680 --> 00:18:35,520 ONE WAS EMPLOYER-PROVIDED HEALTH 544 00:18:35,520 --> 00:18:36,720 INSURANCE, AND THAT TIME FRAME 545 00:18:36,720 --> 00:18:39,440 WAS ACTUALLY FROM WHEN MY MOTHER 546 00:18:39,440 --> 00:18:41,200 COVERED ME AS A TEEN UNTIL THE 547 00:18:41,200 --> 00:18:43,400 AGE OF 61. 548 00:18:43,400 --> 00:18:45,040 THE STEPS THAT I WENT THROUGH IN 549 00:18:45,040 --> 00:18:46,880 THAT HEALTH SYSTEM INCLUDED 550 00:18:46,880 --> 00:18:49,400 GOING TO A PRIMARY CARE 551 00:18:49,400 --> 00:18:52,040 PHYSICIAN, WHO THEN GAVE ME A 552 00:18:52,040 --> 00:18:53,680 REFERRAL TO STEPS TWO AND THREE, 553 00:18:53,680 --> 00:18:56,600 WHICH INCLUDED THE PAIN CLINIC, 554 00:18:56,600 --> 00:18:58,720 SURGERY ON MY BACK WITH THE 555 00:18:58,720 --> 00:19:00,640 IMPLANTS, AND THEN THE THIRD 556 00:19:00,640 --> 00:19:04,160 STEP WAS WITH DERMATOLOGY, 557 00:19:04,160 --> 00:19:05,160 SURPRISINGLY ENOUGH, WHERE I HAD 558 00:19:05,160 --> 00:19:08,080 SURGERY ON MY HAND AND STOMACH. 559 00:19:08,080 --> 00:19:18,280 MY MENTAL REACTION IS THIS. 560 00:19:18,280 --> 00:19:19,600 MY JOURNEY CONTINUED IN THE 561 00:19:19,600 --> 00:19:21,320 HEALTH SYSTEM WITH HEALTH SYSTEM 562 00:19:21,320 --> 00:19:23,040 NUMBER TWO, WHICH INCLUDED 563 00:19:23,040 --> 00:19:25,840 HEALTH INSURANCE THROUGH COBRA. 564 00:19:25,840 --> 00:19:29,960 COBRA IS CONSOLIDATED OMBUDSMEN 565 00:19:29,960 --> 00:19:31,560 RECONCILIATION ACT, AND COBRA IS 566 00:19:31,560 --> 00:19:33,240 A FEDERAL LAW, NOT A COMPANY, 567 00:19:33,240 --> 00:19:36,200 AND THE LAW GIVES WORKERS THE 568 00:19:36,200 --> 00:19:37,760 RIGHT TO CONTINUE COVERAGE UNDER 569 00:19:37,760 --> 00:19:42,360 THE EMPLOYER WHEN THEY ARE 570 00:19:42,360 --> 00:19:43,440 QUALIFIED, WHEN THERE'S A 571 00:19:43,440 --> 00:19:44,280 QUALIFYING EVENT SUCH AS 572 00:19:44,280 --> 00:19:44,960 RETIREMENT OR LOSS OF 573 00:19:44,960 --> 00:19:45,640 EMPLOYMENT. 574 00:19:45,640 --> 00:19:47,360 NOW, AFTER MY COBRA RAN OUT 575 00:19:47,360 --> 00:19:52,280 BECAUSE IT ONLY GOES SO LONG, I 576 00:19:52,280 --> 00:19:52,960 HAD MEDICARE ADVANTAGE INSURANCE 577 00:19:52,960 --> 00:19:54,480 WITH A MAJOR INSURANCE COMPANY. 578 00:19:54,480 --> 00:19:58,120 THE TIME FRAME FOR THAT WAS AGED 579 00:19:58,120 --> 00:20:02,880 61 TO CURRENTLY, WHICH IS NOW 580 00:20:02,880 --> 00:20:03,240 68. 581 00:20:03,240 --> 00:20:05,200 AGAIN MY STEPS WERE, I WENT TO A 582 00:20:05,200 --> 00:20:05,960 PRIMARY CARE PHYSICIAN WHO 583 00:20:05,960 --> 00:20:07,040 REFERRED ME TO STEP TWO, WHICH 584 00:20:07,040 --> 00:20:09,920 WAS A PAIN CLINIC. 585 00:20:09,920 --> 00:20:15,600 AND AGAIN, MY MENTAL REACTION 586 00:20:15,600 --> 00:20:21,640 IS -- LIVING WITH PAIN. 587 00:20:21,640 --> 00:20:22,960 AT LAST, SOMEONE ADDRESSED MY 588 00:20:22,960 --> 00:20:27,320 HAND PAIN. 589 00:20:27,320 --> 00:20:28,800 EVEN THOUGH THERE REMAINS THE 590 00:20:28,800 --> 00:20:30,080 FINANCIAL IMPACT, MULTIPLE 591 00:20:30,080 --> 00:20:36,600 DOCTOR VISITS, PRESCRIPTIONS, 592 00:20:36,600 --> 00:20:37,280 TRAVEL, TRANSPORTATION COSTS 593 00:20:37,280 --> 00:20:39,720 SUCH AS GASOLINE AND CAR UPKEEP, 594 00:20:39,720 --> 00:20:42,600 ET CETERA, I HAVE SOCIAL 595 00:20:42,600 --> 00:20:43,960 ISOLATION, AND MY SOCIAL 596 00:20:43,960 --> 00:20:48,000 INTERACTIONS HAVE BEEN REDUCED 597 00:20:48,000 --> 00:20:49,000 DRAMATICALLY DUE TO THE 598 00:20:49,000 --> 00:20:49,320 DISCOMFORT. 599 00:20:49,320 --> 00:20:55,440 I HAVE BROKEN SLEEP. 600 00:20:55,440 --> 00:20:56,640 AN EXAMPLE OF THAT, IT'S 601 00:20:56,640 --> 00:20:59,160 3:00 A.M. ON MY SON'S 42ND 602 00:20:59,160 --> 00:20:59,480 BIRTHDAY. 603 00:20:59,480 --> 00:21:01,680 I TEXTED A HAPPY BIRTHDAY 604 00:21:01,680 --> 00:21:02,320 MESSAGE TO HIM. 605 00:21:02,320 --> 00:21:05,080 MY SON IMMEDIATELY TEXTED BACK, 606 00:21:05,080 --> 00:21:06,480 MOM, WHAT ARE YOU DOING UP SO 607 00:21:06,480 --> 00:21:08,320 EARLY? 608 00:21:08,320 --> 00:21:08,680 MY RESPONSE? 609 00:21:08,680 --> 00:21:11,600 I ACTUALLY LAUGHED OUT LOUD. 610 00:21:11,600 --> 00:21:14,760 MY HAND PAIN WOKE ME UP! 611 00:21:14,760 --> 00:21:16,000 NOTICE, I DIDN'T ASK HIM WHAT HE 612 00:21:16,000 --> 00:21:19,160 WAS DOING UP THAT EARLY. 613 00:21:19,160 --> 00:21:25,840 LAUGHING OUT LOUD. 614 00:21:25,840 --> 00:21:28,120 MY JOURNEY I I CONTINUED THROUGE 615 00:21:28,120 --> 00:21:29,640 HEALTH SYSTEMS, AND THAT WAS 616 00:21:29,640 --> 00:21:30,440 HEALTH SYSTEM ONE AND TWO. 617 00:21:30,440 --> 00:21:31,600 THE GOOD ABOUT THAT IS THE 618 00:21:31,600 --> 00:21:33,160 HEALTH INSURANCE PROVIDED ME 619 00:21:33,160 --> 00:21:38,080 WITH A VOLUNTARY PAIN MANAGEMENT 620 00:21:38,080 --> 00:21:39,320 COURSE WHERE I WAS GIVEN THE 621 00:21:39,320 --> 00:21:40,400 OPPORTUNITY TO TRY AND MAKE 622 00:21:40,400 --> 00:21:43,680 LIVING WITH PAIN BETTER. 623 00:21:43,680 --> 00:21:45,320 A NURSE PRACTITIONER ACTUALLY 624 00:21:45,320 --> 00:21:46,960 COMMENTED, AND I HADN'T HAD 625 00:21:46,960 --> 00:21:48,160 ANYONE ADDRESS MY HAND PAIN 626 00:21:48,160 --> 00:21:50,920 PRIOR TO THAT. 627 00:21:50,920 --> 00:21:53,200 THE PAIN CONTINUES. 628 00:21:53,200 --> 00:21:54,600 NO PHYSICIAN ADDRESSES MY HAND 629 00:21:54,600 --> 00:21:55,680 PAIN. 630 00:21:55,680 --> 00:21:57,800 MY KNEE PAIN. 631 00:21:57,800 --> 00:22:03,040 WITH A VIABLE RESOLUTION. 632 00:22:03,040 --> 00:22:03,560 THE UGLY? 633 00:22:03,560 --> 00:22:05,880 I'M STILL HAVING BROKEN SLEEP, 634 00:22:05,880 --> 00:22:08,280 I'M IRRITABLE, AND THERE'S A 635 00:22:08,280 --> 00:22:09,600 SECRETNESS OF NOT TELLING 636 00:22:09,600 --> 00:22:10,360 EVERYBODY WHAT'S GOING ON WITH 637 00:22:10,360 --> 00:22:13,720 ME. 638 00:22:13,720 --> 00:22:14,840 THE ACTUAL? 639 00:22:14,840 --> 00:22:18,000 I APPLY OINTMENT, I PUT ON 640 00:22:18,000 --> 00:22:19,320 COPPER-LINED GLOVES, AND I TUCK 641 00:22:19,320 --> 00:22:21,080 MY HAND UNDER MY BODY PARTS TO 642 00:22:21,080 --> 00:22:26,320 KEEP WARM. 643 00:22:26,320 --> 00:22:26,640 THANK YOU. 644 00:22:26,640 --> 00:22:28,200 THANK YOU FOR ALLOWING ME TO SAY 645 00:22:28,200 --> 00:22:32,160 MY LITTLE PIECE. 646 00:22:32,160 --> 00:22:34,640 >> THANK YOU SO MUCH, VAL. 647 00:22:34,640 --> 00:22:37,600 THAT WAS INCREDIBLY, I THINK -- 648 00:22:37,600 --> 00:22:39,480 I THINK HUMBLING FOR ME AS A 649 00:22:39,480 --> 00:22:43,400 PRIMARY CARE PROVIDER, AND I 650 00:22:43,400 --> 00:22:45,600 REALLY APPRECIATE YOUR TAKING 651 00:22:45,600 --> 00:22:46,920 THE TIME TO SHARE WITH US THAT 652 00:22:46,920 --> 00:22:47,200 PERSPECTIVE. 653 00:22:47,200 --> 00:22:49,040 I THINK WE'RE GOING TO PLAN TO 654 00:22:49,040 --> 00:22:50,600 MOVE ON TO THE NEXT SPEAKER AND 655 00:22:50,600 --> 00:22:52,040 WE'LL HAVE QUESTIONS AT THE END, 656 00:22:52,040 --> 00:22:54,000 BUT CERTAINLY FOLKS SHOULD PUT 657 00:22:54,000 --> 00:23:04,520 YOUR QUESTIONS INTO THE CHAT. 658 00:23:05,880 --> 00:23:09,640 SO OUR NEXT SPEAKER IS 659 00:23:09,640 --> 00:23:12,480 DR. TUHINA NEOGI, PROFESSOR OF 660 00:23:12,480 --> 00:23:15,560 MEDICINE AND EPIDEMIOLOGY AT 661 00:23:15,560 --> 00:23:16,560 BOSTON UNIVERSITY SCHOOLS OF 662 00:23:16,560 --> 00:23:19,720 MEDICINE AND PUBLIC HEALTH AND 663 00:23:19,720 --> 00:23:21,040 ALAN COHEN PROFESSOR OF REUM 664 00:23:21,040 --> 00:23:22,320 TOOLING AS WELL AS CHIEF OF 665 00:23:22,320 --> 00:23:23,880 RHEUMATOLOGY AT BOSTON MEDICAL 666 00:23:23,880 --> 00:23:24,560 CENTER. 667 00:23:24,560 --> 00:23:27,560 SHE CONDUCTS RESEARCH WITH AN 668 00:23:27,560 --> 00:23:29,000 EMPHASIS ON PAIN MECHANISMS AND 669 00:23:29,000 --> 00:23:30,960 SHE WILL FOCUS ON THE PHYSICIAN 670 00:23:30,960 --> 00:23:32,280 VOICE IN THE CARE OF PATIENTS 671 00:23:32,280 --> 00:23:33,000 WITH OSTEOARTHRITIS. 672 00:23:33,000 --> 00:23:35,320 THANK YOU, DR. NEOGI. 673 00:23:35,320 --> 00:23:36,120 >> THANK YOU VERY MUCH. 674 00:23:36,120 --> 00:23:39,960 THANK YOU TO NIH FOR THIS KIND 675 00:23:39,960 --> 00:23:41,680 INVITATION, AND THANK YOU, MISS 676 00:23:41,680 --> 00:23:44,600 OVERTON, FOR SHARING YOUR STORY, 677 00:23:44,600 --> 00:23:48,240 AND I THINK A LOT OF WHAT YOU'VE 678 00:23:48,240 --> 00:23:50,000 SAID IS TOUCHING UPON MANY 679 00:23:50,000 --> 00:23:51,960 IMPORTANT THINGS THAT WE IN THE 680 00:23:51,960 --> 00:23:53,600 HEALTHCARE SYSTEM NEED TO DO A 681 00:23:53,600 --> 00:23:58,960 BETTER JOB ADDRESSING. 682 00:23:58,960 --> 00:24:00,160 SO I'M TRYING TO USE THE 683 00:24:00,160 --> 00:24:01,040 CONTROLS ON MY SCREEN -- THERE 684 00:24:01,040 --> 00:24:01,720 WE GO. 685 00:24:01,720 --> 00:24:04,120 OKAY. 686 00:24:04,120 --> 00:24:06,520 SO THE FIRST PERSPECTIVE FROM 687 00:24:06,520 --> 00:24:08,920 THE PHYSICIAN'S PERSPECTIVE IS 688 00:24:08,920 --> 00:24:11,000 WHAT WE THINK ABOUT WHEN WE TALK 689 00:24:11,000 --> 00:24:14,480 ABOUT OSTEOARTHRITIS, AND OFTEN 690 00:24:14,480 --> 00:24:17,240 FOR MANY PHYSICIANS AND ALSO 691 00:24:17,240 --> 00:24:19,200 RESEARCHERS, WE THINK OF 692 00:24:19,200 --> 00:24:21,840 OSTEOARTHRITIS AS THE DISEASE, 693 00:24:21,840 --> 00:24:25,000 AND THIS IS FRAMED AS THE TISSUE 694 00:24:25,000 --> 00:24:27,400 STRUCTURE, PATHOLOGY, SO FOR A 695 00:24:27,400 --> 00:24:28,600 BASIC SCIENTIST, THEY MIGHT BE 696 00:24:28,600 --> 00:24:29,720 THINKING ABOUT ALL OF THESE 697 00:24:29,720 --> 00:24:30,800 DIFFERENT PATHWAYS, WHAT IT 698 00:24:30,800 --> 00:24:36,160 LOOKS LIKE ON HISTOPATHOLOGY, ON 699 00:24:36,160 --> 00:24:38,120 IMAGING, MRI AND X-RAYS, PERHAPS 700 00:24:38,120 --> 00:24:39,440 GROSS PATHOLOGY, AND THESE ARE 701 00:24:39,440 --> 00:24:43,840 THE AREAS OF TREATMENT TARGETS 702 00:24:43,840 --> 00:24:46,120 THAT ARE UNDER RESEARCH. 703 00:24:46,120 --> 00:24:48,280 BUT FOR A PATIENT, IT'S THE PAIN 704 00:24:48,280 --> 00:24:52,040 THAT BRINGS THEM TO SEEK CARE. 705 00:24:52,040 --> 00:24:54,720 AND SO AS WAS SUMMARIZED 706 00:24:54,720 --> 00:24:56,600 YESTERDAY, WE NEED TO THINK 707 00:24:56,600 --> 00:24:58,720 ABOUT OSTEOARTHRITIS AS THE 708 00:24:58,720 --> 00:24:59,680 ILLNESS, THE HUMAN EXPERIENCE IN 709 00:24:59,680 --> 00:25:02,160 RESPONSE TO DISEASE, SO THAT 710 00:25:02,160 --> 00:25:05,160 PATHOLOGY CONTRIBUTES TO 711 00:25:05,160 --> 00:25:07,000 SYMPTOMS, WHICH THEN AFFECTS 712 00:25:07,000 --> 00:25:09,160 FUNCTION YOING, BUT BEYOND WHATE 713 00:25:09,160 --> 00:25:11,800 MIGHT THINK OF AS DIFFICULTY 714 00:25:11,800 --> 00:25:13,360 WITH STAIR CLIMBING OR WITH 715 00:25:13,360 --> 00:25:18,600 WALKING, ET CETERA, THERE CAN BE 716 00:25:18,600 --> 00:25:19,920 ADVANCED STAGES, DIFFICULTY WITH 717 00:25:19,920 --> 00:25:23,200 DAILY FUNCTIONING SUCH AS 718 00:25:23,200 --> 00:25:24,880 BATHING, DRESSING, ET CETERA. 719 00:25:24,880 --> 00:25:27,040 THERE CAN BE ASSOCIATED 720 00:25:27,040 --> 00:25:32,160 WIDESPREAD PAIN, SO A SINGLE 721 00:25:32,160 --> 00:25:34,560 JOINT WITH OA IS NOT SO COMAN, 722 00:25:34,560 --> 00:25:35,760 MULTIPLE JOINTS CAN BE AFFECTED, 723 00:25:35,760 --> 00:25:37,320 AND BEYOND HAVING 724 00:25:37,320 --> 00:25:40,280 OSTEOARTHRITIS, THERE CAN BE 725 00:25:40,280 --> 00:25:40,960 OTHER MUSCULOSKELETAL 726 00:25:40,960 --> 00:25:42,160 CONDITIONS. 727 00:25:42,160 --> 00:25:45,720 AS MISS OVERTON NICELY SHARED, 728 00:25:45,720 --> 00:25:47,160 THE EXPERIENCE CAN ALSO IMPACT 729 00:25:47,160 --> 00:25:49,640 YOUR MOOD. 730 00:25:49,640 --> 00:25:53,480 THE PAIN FROM OSTEOARTHRITIS AND 731 00:25:53,480 --> 00:25:54,920 ANY CONDITION CAN AFFECT 732 00:25:54,920 --> 00:25:57,240 COGNITION, AND AS MISS OVERTON 733 00:25:57,240 --> 00:25:58,320 ALSO SHARED, AFFECTS SLEEP, 734 00:25:58,320 --> 00:26:02,480 DISRUPTED SLEEP. 735 00:26:02,480 --> 00:26:04,440 AND AS DR. PEREZ-STABLE ALREADY 736 00:26:04,440 --> 00:26:07,320 SHARED BRIEFLY, I JUST WANTED TO 737 00:26:07,320 --> 00:26:09,040 HIGHLIGHT THE IMPACT OF 738 00:26:09,040 --> 00:26:10,000 OSTEOARTHRITIS ON THE HEALTHCARE 739 00:26:10,000 --> 00:26:14,720 SYSTEM, BECAUSE I FIND THAT MANY 740 00:26:14,720 --> 00:26:16,360 INDIVIDUALS IN THE PUBLIC AND 741 00:26:16,360 --> 00:26:17,680 PHYSICIANS AND HEALTHCARE -- AND 742 00:26:17,680 --> 00:26:19,640 OTHER MEMBERS OF THE HEALTHCARE 743 00:26:19,640 --> 00:26:23,600 SYSTEM ARE UNAWARE OF HOW BIG AN 744 00:26:23,600 --> 00:26:24,880 IMPACT MUSCULOSKELETAL 745 00:26:24,880 --> 00:26:28,280 CONDITIONS HAVE ON CHRONIC PAIN. 746 00:26:28,280 --> 00:26:30,000 SO CURRENTLY ABOUT 100 MILLION 747 00:26:30,000 --> 00:26:31,800 ADULTS IN THE U.S. HAVE CHRONIC 748 00:26:31,800 --> 00:26:36,160 PAIN, AND OF THAT 100 MILLION, 749 00:26:36,160 --> 00:26:39,680 ABOUT 30% ARE DUE TO 750 00:26:39,680 --> 00:26:40,520 OSTEOARTHRITIS, BUT ALSO A 751 00:26:40,520 --> 00:26:42,880 NUMBER OF OTHER MUSCULOSKELETAL 752 00:26:42,880 --> 00:26:46,000 CONDITIONS. 753 00:26:46,000 --> 00:26:47,640 AND THIS REFLECTS ITSELF IN THE 754 00:26:47,640 --> 00:26:50,800 FACT THAT BASED ON THE NATIONAL 755 00:26:50,800 --> 00:26:52,880 AMBULATORY MEDICAL CARE SURVEY, 756 00:26:52,880 --> 00:26:54,840 JOINT PAIN AND A ARTHROPATHIES E 757 00:26:54,840 --> 00:26:57,040 THE NUMBER ONE REASON FOR 758 00:26:57,040 --> 00:26:58,480 OUTPATIENT BLAM TRI CARE VISITS 759 00:26:58,480 --> 00:27:00,560 FOR WHICH OSTEOARTHRITIS IS A 760 00:27:00,560 --> 00:27:04,480 MAJOR CONTRIBUTOR. 761 00:27:04,480 --> 00:27:06,360 MUSCULOSKELETAL CONDITIONS FOR 762 00:27:06,360 --> 00:27:08,000 WHICH OSTEOARTHRITIS IS A MAJOR 763 00:27:08,000 --> 00:27:09,920 CONTRIBUTOR IS A SECOND LEADING 764 00:27:09,920 --> 00:27:13,680 CAUSE OF YEARS LIVED WITH 765 00:27:13,680 --> 00:27:15,000 DISABILITY, AND WHAT WAS MOST 766 00:27:15,000 --> 00:27:15,960 SURPRISING TO ME WHEN I LOOKED 767 00:27:15,960 --> 00:27:17,200 THIS UP IS THAT OSTEOARTHRITIS 768 00:27:17,200 --> 00:27:19,240 IS THE THIRD LEADING HOSPITAL 769 00:27:19,240 --> 00:27:20,880 DISCHARGE DIAGNOSIS IN THE U.S. 770 00:27:20,880 --> 00:27:23,600 AND THIS IS THIRD AFTER NUMBER 771 00:27:23,600 --> 00:27:26,600 ONE BEING CHILDBIRTH-RELATED 772 00:27:26,600 --> 00:27:28,200 HOSPITALIZATIONS, AND NUMBER TWO 773 00:27:28,200 --> 00:27:29,680 BEING SEPSIS-RELATED 774 00:27:29,680 --> 00:27:31,200 HOSPITALIZATIONS. 775 00:27:31,200 --> 00:27:33,080 AND THIS WAS SURPRISING TO ME 776 00:27:33,080 --> 00:27:35,640 THAT OA IS A THIRD LEADING 777 00:27:35,640 --> 00:27:36,440 HOSPITAL DISCHARGE DIAGNOSIS 778 00:27:36,440 --> 00:27:37,520 BECAUSE IN TRAINING, I ALWAYS 779 00:27:37,520 --> 00:27:39,400 THOUGHT IT WOULD BE RELATED TO 780 00:27:39,400 --> 00:27:41,240 CARDIAC DISEASE, HEART ATTACKS, 781 00:27:41,240 --> 00:27:42,720 CONGESTIVE HEART FAILURE, ET 782 00:27:42,720 --> 00:27:43,760 CETERA, BUT OBVIOUSLY 783 00:27:43,760 --> 00:27:44,880 OSTEOARTHRITIS IS HERE AS NUMBER 784 00:27:44,880 --> 00:27:46,040 THREE BECAUSE OF JOINT 785 00:27:46,040 --> 00:27:49,520 REPLACEMENT SURGERY. 786 00:27:49,520 --> 00:27:51,400 OBVIOUSLY WE CAN'T OPERATE OUR 787 00:27:51,400 --> 00:27:54,760 WAY THROUGH THIS MASSIVE PUBLIC 788 00:27:54,760 --> 00:27:55,800 HEALTH BURDEN OF OSTEOARTHRITIS. 789 00:27:55,800 --> 00:27:59,200 WE HAVE TO FIND ADDITIONAL 790 00:27:59,200 --> 00:28:00,160 MANAGEMENT OPTIONS TO REDUCE THE 791 00:28:00,160 --> 00:28:04,800 BURDEN OF THIS DISEASE. 792 00:28:04,800 --> 00:28:07,440 WE ARE KNOW THERE ARE MULTIPLE 793 00:28:07,440 --> 00:28:08,920 CONTRIBUTORS TO PAIN AND WHILE 794 00:28:08,920 --> 00:28:10,560 IN OSTEOARTHRITIS RESEARCH 795 00:28:10,560 --> 00:28:13,200 ARENAS, THE PREDOMINANT FOCUS IS 796 00:28:13,200 --> 00:28:14,720 ON JOINT PATHOLOGY, WE 797 00:28:14,720 --> 00:28:16,120 UNDERSTAND THERE ARE A WHOLE 798 00:28:16,120 --> 00:28:17,280 HOST OF INFLUENCES AND FOR THOSE 799 00:28:17,280 --> 00:28:19,240 OF US THAT ARE CLINICIANS, WE 800 00:28:19,240 --> 00:28:21,640 KNOW FOR EXAMPLE THAT WE DO NEED 801 00:28:21,640 --> 00:28:24,040 TO ADDRESS SLEEP AND MOOD AND 802 00:28:24,040 --> 00:28:25,040 COPING SKILLS BECAUSE NO MATTER 803 00:28:25,040 --> 00:28:26,560 WHAT WE MIGHT DO TO ADDRESS 804 00:28:26,560 --> 00:28:27,960 JOINT PATHOLOGY, IF WE DON'T 805 00:28:27,960 --> 00:28:29,160 ADDRESS THOSE FACTORS, WE'RE NOT 806 00:28:29,160 --> 00:28:33,640 GOING TO HAVE THE OPTIMAL PAIN 807 00:28:33,640 --> 00:28:40,880 MANAGEMENT STRATEGY IN PLACE. 808 00:28:40,880 --> 00:28:45,400 AND THEN UNDERSTANDING AND 809 00:28:45,400 --> 00:28:46,880 MANAGING PAIN IS COMPLICATED 810 00:28:46,880 --> 00:28:48,120 ENOUGH BECAUSE OF ALL THOSE 811 00:28:48,120 --> 00:28:49,320 MULTIPLE CONTRIBUTORS TO THE 812 00:28:49,320 --> 00:28:52,520 PAIN EXPERIENCE, BUT THERE ARE 813 00:28:52,520 --> 00:28:56,000 ALSO LOTS OF DISPARITIES, AND 814 00:28:56,000 --> 00:28:57,440 WE'VE ALREADY HEARD A LOT OF 815 00:28:57,440 --> 00:28:58,520 THIS YESTERDAY SO I'M NOT GOING 816 00:28:58,520 --> 00:29:00,080 TO GO INTO DETAILS, BUT THERE'S 817 00:29:00,080 --> 00:29:04,760 A MUM NUM NUMBER OF STUDIES ANDO 818 00:29:04,760 --> 00:29:06,720 ANECDOTAL EXPERIENCE OF 819 00:29:06,720 --> 00:29:08,080 DISPARITIES IN AFFIRMATION OF 820 00:29:08,080 --> 00:29:09,240 THE PAIN EXPERIENCE THAT SOMEONE 821 00:29:09,240 --> 00:29:14,120 IS EXPRESSING. 822 00:29:14,120 --> 00:29:15,640 PEOPLE FROM DIFFERENT 823 00:29:15,640 --> 00:29:17,280 COMMUNITIES USE DIFFERENT 824 00:29:17,280 --> 00:29:19,040 LANGUAGE, DIFFERENT WORDS TO 825 00:29:19,040 --> 00:29:20,480 EXPRESS THE SYMPTOMS THEY'RE 826 00:29:20,480 --> 00:29:21,320 EXPERIENCING, AND UNFORTUNATELY 827 00:29:21,320 --> 00:29:22,960 THERE ARE SOME GROUPS WHOSE PAIN 828 00:29:22,960 --> 00:29:26,280 IS DISCOUNTED, AND ESPECIALLY 829 00:29:26,280 --> 00:29:29,120 WHEN THERE'S INTERSECTIONALITY 830 00:29:29,120 --> 00:29:31,080 OF DIFFERENT IDENTITIES TOGETHER 831 00:29:31,080 --> 00:29:35,960 IN AN INDIVIDUAL. 832 00:29:35,960 --> 00:29:37,640 WE ALSO HEARD YESTERDAY ABOUT 833 00:29:37,640 --> 00:29:42,120 DISPARITIES IN PA PAIN MANAGEMET 834 00:29:42,120 --> 00:29:42,600 OFFERED. 835 00:29:42,600 --> 00:29:43,760 A NUMBER OF STUDIES SHOWING 836 00:29:43,760 --> 00:29:44,840 PEOPLE OF CERTAIN MINORITY 837 00:29:44,840 --> 00:29:47,480 GROUPS HAVE LESS PAIN MANAGEMENT 838 00:29:47,480 --> 00:29:51,200 OPTIONS OFFERED TO THEM, AND 839 00:29:51,200 --> 00:29:52,520 WILL HAVE LESS OPIOIDS OFFERED 840 00:29:52,520 --> 00:29:53,080 TO THEM. 841 00:29:53,080 --> 00:29:54,360 NOW OBVIOUSLY OPIOIDS ARE NOT 842 00:29:54,360 --> 00:29:55,960 APPROPRIATE IN MANY INSTANCES, 843 00:29:55,960 --> 00:29:58,400 BUT IN INSTANCES WHERE THEY 844 00:29:58,400 --> 00:30:00,720 SHOULD BE OFFERED, THEY OFTEN 845 00:30:00,720 --> 00:30:03,520 ARE NOT. 846 00:30:03,520 --> 00:30:06,280 AND LEST YOU THINK THAT, WELL, 847 00:30:06,280 --> 00:30:07,480 ACADEMICIANS WHO CAN ADVOCATE 848 00:30:07,480 --> 00:30:09,000 FOR THEMSELVES MAY BE LESS PRONE 849 00:30:09,000 --> 00:30:12,640 TO THIS, THAT IS NOT THE CASE. 850 00:30:12,640 --> 00:30:15,800 THERE ARE STILL PHYSICIANS 851 00:30:15,800 --> 00:30:18,640 THEMSELVES WHO ARE OF -- WOMEN 852 00:30:18,640 --> 00:30:20,960 AND PEOPLE OF COLOR WHO HAVE 853 00:30:20,960 --> 00:30:22,800 BEEN DENIED ADEQUATE PAIN 854 00:30:22,800 --> 00:30:25,320 CONTROL DESPITE BEING STRONG 855 00:30:25,320 --> 00:30:27,600 ADVOCATES FOR THEMSELVES AND 856 00:30:27,600 --> 00:30:28,600 FROM BEING WITHIN THE MEDICAL 857 00:30:28,600 --> 00:30:29,240 COMMUNITY. 858 00:30:29,240 --> 00:30:31,520 WE ALSO HEARD YESTERDAY ABOUT 859 00:30:31,520 --> 00:30:32,760 DISPARITIES IN REFERRAL FOR 860 00:30:32,760 --> 00:30:34,520 JOINT REPLACEMENT, EDUCATION 861 00:30:34,520 --> 00:30:36,920 AROUND THE PROCEDURE. 862 00:30:36,920 --> 00:30:38,240 ONE CITY I WANTED TO HIGHLIGHT 863 00:30:38,240 --> 00:30:38,960 THAT WE DIDN'T HEAR ABOUT 864 00:30:38,960 --> 00:30:40,640 YESTERDAY IS THE GENDER BIAS 865 00:30:40,640 --> 00:30:42,920 ALSO IN REFERRAL FOR JOINT 866 00:30:42,920 --> 00:30:43,360 REPLACEMENT. 867 00:30:43,360 --> 00:30:48,080 A WONDERFUL STUDY YEARS AGO THAT 868 00:30:48,080 --> 00:30:50,240 WAS LED IN PART BY DR. JILLIAN 869 00:30:50,240 --> 00:30:54,200 HAWKER FROM UNIVERSITY OF 870 00:30:54,200 --> 00:30:57,800 TORONTO, HAD ACTORS USING A 871 00:30:57,800 --> 00:31:02,720 SCRIPT WITH THE SAME X-RAY. 872 00:31:02,720 --> 00:31:04,160 ONE WAS A MAN, ONE WAS A WOMAN. 873 00:31:04,160 --> 00:31:06,680 THEY WENT TO VARIOUS PRIMARY 874 00:31:06,680 --> 00:31:07,640 CARE PHYSICIANS' OFFICES WITH 875 00:31:07,640 --> 00:31:10,760 THE SAME SCRIPT AND SAME X-RAY, 876 00:31:10,760 --> 00:31:12,760 AND THE WOMAN PATIENT WAS 877 00:31:12,760 --> 00:31:13,960 OFFERED REFERRAL FOR JOINT 878 00:31:13,960 --> 00:31:18,160 REPLACEMENT LESS FREQUENTLY. 879 00:31:18,160 --> 00:31:20,880 LEST YOU THINK THAT, WELL, MAYBE 880 00:31:20,880 --> 00:31:21,640 FEMALE, WOMEN PHYSICIANS ARE 881 00:31:21,640 --> 00:31:25,600 BETTER AT THIS, NO, THERE WAS -- 882 00:31:25,600 --> 00:31:28,840 WOMEN PHYSICIANS WERE EQUALLY 883 00:31:28,840 --> 00:31:34,000 BIASED IN REFERRING THE WOMAN 884 00:31:34,000 --> 00:31:35,000 PATIENT FOR JOINT REPLACEMENT. 885 00:31:35,000 --> 00:31:39,720 SO WE AS PHYSICIANS HAVE A LOT 886 00:31:39,720 --> 00:31:41,440 OF UNCONSCIOUS BIAS OR SOMETIMES 887 00:31:41,440 --> 00:31:43,320 OVERT BIAS THAT WE NEED TO CHECK 888 00:31:43,320 --> 00:31:48,360 AND ADDRESS, AND I KNOW THAT 889 00:31:48,360 --> 00:31:52,280 MANY OF US ATTENDED YESTERDAY'S 890 00:31:52,280 --> 00:31:53,160 SESSION ON RACISM IN MED 891 00:31:53,160 --> 00:31:57,840 SIRNTION AND MEDICINEAND THIS IT 892 00:31:57,840 --> 00:31:58,920 FACTOR IN PATIENTS NOT RECEIVING 893 00:31:58,920 --> 00:32:00,480 THE CARE THAT THEY NEED. 894 00:32:00,480 --> 00:32:02,160 AND THEN IN TERMS OF PATIENT 895 00:32:02,160 --> 00:32:03,160 EDUCATION, I JUST WANTED TO 896 00:32:03,160 --> 00:32:04,880 SPEND A MOMENT TALKING ABOUT 897 00:32:04,880 --> 00:32:05,480 LANGUAGE. 898 00:32:05,480 --> 00:32:10,800 SO LANGUAGE MATTERS. 899 00:32:10,800 --> 00:32:11,600 UNFORTUNATELY IN OSTEOARTHRITIS, 900 00:32:11,600 --> 00:32:12,760 THERE'S A LOT OF PHRASES LIKE 901 00:32:12,760 --> 00:32:17,720 WLIKEWEAR AND TEAR WHICH MAKES S 902 00:32:17,720 --> 00:32:20,320 SOUND LIKE AN INEVITABLE DEMISE 903 00:32:20,320 --> 00:32:21,080 IN THIS DISEASE COURSE. 904 00:32:21,080 --> 00:32:23,800 AND ALSO THE TREATMENTS THAT ARE 905 00:32:23,800 --> 00:32:25,800 OFFERED, THE LANGUAGE THERE ALSO 906 00:32:25,800 --> 00:32:27,000 MATTERS, BECAUSE 907 00:32:27,000 --> 00:32:28,400 NON-PHARMACOLOGIC TO SOME SOUNDS 908 00:32:28,400 --> 00:32:32,240 LIKE NON-TREATMENT, OR THAT IT'S 909 00:32:32,240 --> 00:32:33,800 THE SECOND BEST. 910 00:32:33,800 --> 00:32:35,640 PHARMACOLOGIC MUST BE THE BEST 911 00:32:35,640 --> 00:32:37,680 CHOICE, SINCE NON-PHARMACOLOGIC 912 00:32:37,680 --> 00:32:41,320 IS BEING COMPARED TO THAT. 913 00:32:41,320 --> 00:32:42,880 SO WE REALLY NEED TO BE CAREFUL 914 00:32:42,880 --> 00:32:44,520 WITH THE LANGUAGE THAT WE USE, 915 00:32:44,520 --> 00:32:48,440 AND AVOID THESE TYPES OF TERMS, 916 00:32:48,440 --> 00:32:52,280 AND USE MUCH MORE ACTIVE 917 00:32:52,280 --> 00:32:53,680 LANGUAGE AND THERE'S A CONCEPT 918 00:32:53,680 --> 00:32:54,960 OF PARTICIPATORY LANGUAGE. 919 00:32:54,960 --> 00:32:56,520 SO WE NEED TO BE ABLE TO EGGS 920 00:32:56,520 --> 00:33:00,880 PLEXPLAINWHAT OSTEOARTHRITIS IS 921 00:33:00,880 --> 00:33:02,120 UNDERSTANDABLY BUT NOT MAKE IT 922 00:33:02,120 --> 00:33:05,000 SEEM LIKE AN INEVITABLE DECLINE, 923 00:33:05,000 --> 00:33:08,560 AND ENCOURAGE AND SUPPORT PEOPLE 924 00:33:08,560 --> 00:33:09,880 IN BEING ABLE TO ENGAGE IN THEIR 925 00:33:09,880 --> 00:33:11,400 OWN CARE. 926 00:33:11,400 --> 00:33:15,440 AND THN FINA THEN FINALLY I THIE 927 00:33:15,440 --> 00:33:17,280 REALLY ALSO NEED TO SET THE 928 00:33:17,280 --> 00:33:18,600 NOTION IN PLACE THAT THERE'S NO 929 00:33:18,600 --> 00:33:20,480 SINGLE MAGIC BULLET, THAT WE 930 00:33:20,480 --> 00:33:21,760 HAVE TO USE MULTIMODAL 931 00:33:21,760 --> 00:33:22,080 APPROACHES. 932 00:33:22,080 --> 00:33:26,040 THERE IS NOT GOING TO BE A MAGIC 933 00:33:26,040 --> 00:33:26,240 PILL. 934 00:33:26,240 --> 00:33:28,800 SO WE HAVE TO FIND THE RIGHT 935 00:33:28,800 --> 00:33:29,480 PUZZLE PIECES THAT ARE 936 00:33:29,480 --> 00:33:30,800 APPROPRIATE FOR THAT INDIVIDUAL 937 00:33:30,800 --> 00:33:32,960 AT THAT MOMENT IN TIME, AND THAT 938 00:33:32,960 --> 00:33:35,000 THESE PUZZLE PIECES MIGHT CHANGE 939 00:33:35,000 --> 00:33:38,760 AS THE DISEASE COURSE EVOLVES 940 00:33:38,760 --> 00:33:39,280 OVER TIME. 941 00:33:39,280 --> 00:33:41,920 IMPORTANTLY, WE HAVE TO ENGAGE 942 00:33:41,920 --> 00:33:43,240 OUR PARTNERS, IMPORTANT PARTNERS 943 00:33:43,240 --> 00:33:44,680 ARE PHYSICAL THERAPISTS, AND IN 944 00:33:44,680 --> 00:33:45,880 PREPARING FOR THE SESSION WHEN 945 00:33:45,880 --> 00:33:47,080 WE HAD OUR SORT OF 946 00:33:47,080 --> 00:33:48,480 PRE-CONFERENCE MEETING, I 947 00:33:48,480 --> 00:33:49,960 HIGHLIGHTED THE FACT THAT ONE OF 948 00:33:49,960 --> 00:33:52,200 THE IMPORTANT VOICES HERE IS VIZ 949 00:33:52,200 --> 00:33:57,760 ISPHYSICAL THERAPY, AMONG THE 950 00:33:57,760 --> 00:33:59,400 FIRST LINE RECOMMENDED 951 00:33:59,400 --> 00:34:01,080 TREATMENTS IN A LOT OF WHAT 952 00:34:01,080 --> 00:34:03,160 PATIENTS NEED TO ENGAGE IN 953 00:34:03,160 --> 00:34:04,400 REQUIRES THE SUPPORT, GUIDANCE 954 00:34:04,400 --> 00:34:06,320 AND SUPERVISION OF PHYSICAL 955 00:34:06,320 --> 00:34:10,600 THERAPISTS. 956 00:34:10,600 --> 00:34:13,240 AS AN EXAMPLE OF HOW POORLY WE 957 00:34:13,240 --> 00:34:14,720 ENGAGE IN FIRST LINE THERAPIES, 958 00:34:14,720 --> 00:34:17,600 THIS STUDY FROM ABOUT TWO YEARS 959 00:34:17,600 --> 00:34:19,120 AGO NOW TOOK DATA FROM THE 960 00:34:19,120 --> 00:34:22,720 NATIONAL AMBULATORY CARE -- 961 00:34:22,720 --> 00:34:24,360 MEDICAL CARE SURVEY I BRIEFLY 962 00:34:24,360 --> 00:34:25,680 MENTIONED A FEW SLIDES AGO. 963 00:34:25,680 --> 00:34:27,960 YOU CAN SEE OVER THREE TIME 964 00:34:27,960 --> 00:34:28,960 PERIODS, REFERRAL TO PHYSICAL 965 00:34:28,960 --> 00:34:31,040 THERAPY REMAINED LOW, COUNSELING 966 00:34:31,040 --> 00:34:32,960 ABOUT LIFESTYLE DID NOT INCREASE 967 00:34:32,960 --> 00:34:34,560 OVER TIME DESPITE TREATMENT 968 00:34:34,560 --> 00:34:38,880 GUIDELINES COMING OUT IN THIS 969 00:34:38,880 --> 00:34:42,000 PERIOD, YET PRESCRIPTIONS FOR 970 00:34:42,000 --> 00:34:43,200 NSAIDS AND NARCOTICS CONTINUED 971 00:34:43,200 --> 00:34:43,520 TO RISE. 972 00:34:43,520 --> 00:34:45,680 IN THE INTEREST OF TIME, I 973 00:34:45,680 --> 00:34:46,800 DIDN'T SHARE ANOTHER STUDY HERE 974 00:34:46,800 --> 00:34:47,840 BUT I WILL JUST RAISE THIS 975 00:34:47,840 --> 00:34:48,600 BECAUSE I THINK IT'S IMPORTANT 976 00:34:48,600 --> 00:34:51,240 FOR US TO REALIZE THAT LACK OF 977 00:34:51,240 --> 00:34:52,680 ADEQUATE OPTIONS FOR PAIN 978 00:34:52,680 --> 00:34:56,760 MANAGEMENT HAS UNINTENDED 979 00:34:56,760 --> 00:34:57,680 CONSEQUENCES. 980 00:34:57,680 --> 00:34:59,720 SO WE LOOKED AT ENHANCED DATA IN 981 00:34:59,720 --> 00:35:01,680 LOOKING AT PRESCRIPTION 982 00:35:01,680 --> 00:35:02,680 MEDICATION USE OR PRESCRIPTIONS 983 00:35:02,680 --> 00:35:04,960 FOR PEOPLE WHO HAVE ARTHRITIS, 984 00:35:04,960 --> 00:35:05,880 PREDOMINANTLY OSTEOARTHRITIS, 985 00:35:05,880 --> 00:35:09,840 AND WE FOUND THAT OVER TIME, IN 986 00:35:09,840 --> 00:35:11,400 THE LATE 1990s AND EARLY 987 00:35:11,400 --> 00:35:13,600 2000s, NSAIDS WERE PRESCRIBED 988 00:35:13,600 --> 00:35:15,360 FAIRLY STEADILY AND OPIOIDS WERE 989 00:35:15,360 --> 00:35:18,640 FAIRLY LOW, BUT THEN BETWEEN 990 00:35:18,640 --> 00:35:20,360 2003 AND 2005, NSAID 991 00:35:20,360 --> 00:35:23,440 PRESCRIPTIONS DROPPED MARKEDLY 992 00:35:23,440 --> 00:35:27,680 WHILE OPIOID PRESCRIPTIONS ROSE 993 00:35:27,680 --> 00:35:28,000 MARKEDLY. 994 00:35:28,000 --> 00:35:29,760 WHAT HAPPENED AT THAT TIME WAS 995 00:35:29,760 --> 00:35:31,200 VIOXX CAME OFF THE MARKET, SO AS 996 00:35:31,200 --> 00:35:33,280 THE CONSEQUENCES OF NSAIDs AND 997 00:35:33,280 --> 00:35:35,560 COX-2 INHIBITORS BECAME 998 00:35:35,560 --> 00:35:36,120 INCREASINGLY UNDERSTOOD, AND 999 00:35:36,120 --> 00:35:38,960 AGAIN, DR. PEREZ-STABLE REVIEWED 1000 00:35:38,960 --> 00:35:41,480 THIS, THE GI BLEEDS, RENAL 1001 00:35:41,480 --> 00:35:43,440 INSUFFICIENCY, CARDIOVASCULAR 1002 00:35:43,440 --> 00:35:44,800 DISEASE, PHYSICIANS WERE MORE 1003 00:35:44,800 --> 00:35:48,680 RELUCTANT TO PRESCRIBE NSAIDs, 1004 00:35:48,680 --> 00:35:49,800 BUT PAIN IN OSTEOARTHRITIS DID 1005 00:35:49,800 --> 00:35:51,440 NOT GO AWAY SO WITHOUT OTHER 1006 00:35:51,440 --> 00:35:54,640 ADEQUATE OPTIONS, OPIOID 1007 00:35:54,640 --> 00:35:55,160 PRESCRIPTIONS ROSE. 1008 00:35:55,160 --> 00:35:58,000 WE NEED TO RECOGNIZE THESE 1009 00:35:58,000 --> 00:35:58,680 UNINTENDED CONSEQUENCES AND 1010 00:35:58,680 --> 00:36:00,200 GIVEN THE HIGH PREVALENCE OF 1011 00:36:00,200 --> 00:36:01,280 OSTEOARTHRITIS AND THE HIGH 1012 00:36:01,280 --> 00:36:02,120 PRESCRIPTIONS OF OPIOIDS, THIS 1013 00:36:02,120 --> 00:36:06,960 COULD BE ONE OF THE UNDERLYING 1014 00:36:06,960 --> 00:36:08,160 REASONS FOR PEOPLE GETTING 1015 00:36:08,160 --> 00:36:09,480 STARTED ON OPIOIDS AND 1016 00:36:09,480 --> 00:36:11,240 CONTRIBUTING TO AN OPIOID 1017 00:36:11,240 --> 00:36:14,960 EPIDEMIC. 1018 00:36:14,960 --> 00:36:17,000 SO IN TERMS OF PAIN MANAGEMENT 1019 00:36:17,000 --> 00:36:20,200 IN THE CLINIC FOR US AS 1020 00:36:20,200 --> 00:36:21,520 PHYSICIANS, WE NEED TO MEET 1021 00:36:21,520 --> 00:36:22,280 PATIENTS WHERE THEY ARE. 1022 00:36:22,280 --> 00:36:23,480 WE NEED TO UNDERSTAND THEIR 1023 00:36:23,480 --> 00:36:26,000 GOALS, WE NEED TO SET REALISTIC 1024 00:36:26,000 --> 00:36:26,920 EXPECTATIONS BECAUSE ZERO PAIN 1025 00:36:26,920 --> 00:36:28,040 IS NOT THE GOAL. 1026 00:36:28,040 --> 00:36:31,560 WE DO NOT HAVE THE TOOLS AT 1027 00:36:31,560 --> 00:36:33,120 PRESENT TO SAFELY TAKE PEOPLE TO 1028 00:36:33,120 --> 00:36:33,440 ZERO PAIN. 1029 00:36:33,440 --> 00:36:35,720 WHAT WE'RE TRYING TO DO IS 1030 00:36:35,720 --> 00:36:37,720 MANAGE PAIN TO IMPROVE FUNCTION 1031 00:36:37,720 --> 00:36:39,240 AND IMPROVE QUALITY OF LIFE, SO 1032 00:36:39,240 --> 00:36:41,520 THAT PEOPLE CAN PARTICIPATE AND 1033 00:36:41,520 --> 00:36:44,280 ENGAGE IN ACTIVITIES THAT THEY 1034 00:36:44,280 --> 00:36:46,880 WANT TO ENGAGE IN. 1035 00:36:46,880 --> 00:36:48,520 AND WE NEED TO HELP OUR PATIENTS 1036 00:36:48,520 --> 00:36:49,280 DEVELOP ACTION PLANS. 1037 00:36:49,280 --> 00:36:51,680 WE CAN'T SIMPLY TELL THEM TO GO 1038 00:36:51,680 --> 00:36:52,960 DO SOMETHING WITHOUT HELPING 1039 00:36:52,960 --> 00:36:56,760 THEM DEVELOP A STEP BY STEP 1040 00:36:56,760 --> 00:36:59,880 PLAN. 1041 00:36:59,880 --> 00:37:01,760 SO AS ONE EXAMPLE, AS EXERCISE 1042 00:37:01,760 --> 00:37:03,280 AND WEIGHT LOSS ARE FIRST LINE 1043 00:37:03,280 --> 00:37:04,400 MANAGEMENT OPTIONS, WE NEED TO 1044 00:37:04,400 --> 00:37:05,680 TREAT IT AS A PRESCRIPTION JUST 1045 00:37:05,680 --> 00:37:08,680 LIKE WE WOULD ANY OTHER 1046 00:37:08,680 --> 00:37:09,480 MEDICATIONS. 1047 00:37:09,480 --> 00:37:10,200 SO FIRST START WITH WHERE ARE 1048 00:37:10,200 --> 00:37:10,840 THEY STARTING? 1049 00:37:10,840 --> 00:37:11,840 THERE'S NO POINT IN TELLING 1050 00:37:11,840 --> 00:37:13,720 SOMEONE TO GO AND WALK 20 TO 30 1051 00:37:13,720 --> 00:37:17,400 MINUTES PER DAY IF THEY ARE 1052 00:37:17,400 --> 00:37:18,680 FULLY SEDENTARY. 1053 00:37:18,680 --> 00:37:20,680 WE NEED TO START WITH GIVING 1054 00:37:20,680 --> 00:37:23,120 THEM CONCRETE WAYS TO GAUGE 1055 00:37:23,120 --> 00:37:24,840 THEIR PROGRESS AND TO PUT LIMITS 1056 00:37:24,840 --> 00:37:28,680 SO THAT THEY DON'T OVERDO IT BY 1057 00:37:28,680 --> 00:37:30,840 USING CERTAIN MINUTES PER DAY 1058 00:37:30,840 --> 00:37:34,880 FOR WALKING ACTIVITIES OR A 1059 00:37:34,880 --> 00:37:36,000 PEDOMETER, AND HELPING THEM 1060 00:37:36,000 --> 00:37:38,080 THINK THROUGH HOW THEY CAN DO 1061 00:37:38,080 --> 00:37:42,000 THAT IN A COMFORTABLE WAY. 1062 00:37:42,000 --> 00:37:43,320 MANY PATIENTS FEEL ANXIOUS THEY 1063 00:37:43,320 --> 00:37:45,320 MIGHT WALK TOO FAR AND THEN HAVE 1064 00:37:45,320 --> 00:37:46,720 DIFFICULTY MAKING IT BACK HOME. 1065 00:37:46,720 --> 00:37:47,520 SO WHAT'S IN THEIR 1066 00:37:47,520 --> 00:37:48,360 NEIGHBORHOODS? 1067 00:37:48,360 --> 00:37:50,120 ARE THERE BENCHES, ARE THERE 1068 00:37:50,120 --> 00:37:51,080 PLACES THEY CAN REST? 1069 00:37:51,080 --> 00:37:52,520 SOMEONE TALKED ABOUT THIS 1070 00:37:52,520 --> 00:37:53,280 YESTERDAY, ABOUT THE LIVED 1071 00:37:53,280 --> 00:37:55,000 ENVIRONMENT IN WHICH INDIVIDUALS 1072 00:37:55,000 --> 00:37:58,400 ARE LIVING IN. 1073 00:37:58,400 --> 00:38:00,040 SLOW AND STEADY WINS THE RACE. 1074 00:38:00,040 --> 00:38:03,680 THEY DON'T NEED TO BE TRYING TO 1075 00:38:03,680 --> 00:38:05,320 LOSE 20 POUNDS IN A MONTH. 1076 00:38:05,320 --> 00:38:06,520 SLOW, CONSISTENT WEIGHT LOSS IS 1077 00:38:06,520 --> 00:38:10,640 LIKELY TO BE MORE EFFECTIVE AND 1078 00:38:10,640 --> 00:38:11,760 PERSISTENT OVER TIME, AND 1079 00:38:11,760 --> 00:38:12,760 IMPORTANTLY, WE NEED TO 1080 00:38:12,760 --> 00:38:14,160 CELEBRATE THEIR SUCCESSES NO 1081 00:38:14,160 --> 00:38:18,240 MATTER HOW SMALL. 1082 00:38:18,240 --> 00:38:20,320 IN TERMS OF EXERCISE, THERE'S NO 1083 00:38:20,320 --> 00:38:22,160 ONE TYPE OF EXERCISE THAT IS 1084 00:38:22,160 --> 00:38:23,920 BETTER FOR OSTEOARTHRITIS THAN 1085 00:38:23,920 --> 00:38:25,120 OTHERS, SO AGAIN LOOKING FOR 1086 00:38:25,120 --> 00:38:27,320 WHERE THERE MIGHT BE FUNCTIONAL 1087 00:38:27,320 --> 00:38:29,280 LIMITATIONS, WHERE THERE -- WHAT 1088 00:38:29,280 --> 00:38:30,560 THEIR INTERESTS ARE, WHAT 1089 00:38:30,560 --> 00:38:32,440 THEY'RE ABLE TO ENGAGE IN, 1090 00:38:32,440 --> 00:38:33,320 THINKING ABOUT SOCIOECONOMIC 1091 00:38:33,320 --> 00:38:35,040 STATUS, WHAT'S AFFORDABLE, ALL 1092 00:38:35,040 --> 00:38:36,800 OF THESE THINGS CAN BE 1093 00:38:36,800 --> 00:38:38,280 BENEFICIAL FOR OSTEOARTHRITIS, 1094 00:38:38,280 --> 00:38:43,040 AND THEN NOT THINKING ABOUT JUST 1095 00:38:43,040 --> 00:38:44,360 PURE EXERCISE, BUT PHYSICAL 1096 00:38:44,360 --> 00:38:48,520 ACTIVITY INCLUDES ALL ACTIVITIES 1097 00:38:48,520 --> 00:38:49,400 OF DAILY LIVING. 1098 00:38:49,400 --> 00:38:50,800 THEN IN TERMS OF GOALS FOR THOSE 1099 00:38:50,800 --> 00:38:54,000 THAT ARE INTERESTED IN STEP 1100 00:38:54,000 --> 00:38:54,720 GOALS, 10,000 STEPS PER DAY IS 1101 00:38:54,720 --> 00:38:57,480 KIND OF A MADE UP MARKETING 1102 00:38:57,480 --> 00:39:00,120 TACTIC BY AN ORIGINAL 1103 00:39:00,120 --> 00:39:02,760 MANUFACTURER OF A PEDOMETER, NOT 1104 00:39:02,760 --> 00:39:05,800 BASED ON ANY BIOLOGY. 1105 00:39:05,800 --> 00:39:07,440 YEARS AGO, WE FOUND THAT 6,000 1106 00:39:07,440 --> 00:39:09,720 STEPS PER DAY REDUCED RISK OF 1107 00:39:09,720 --> 00:39:11,240 INCIDENT FUNCTIONAL LIMITATIONS 1108 00:39:11,240 --> 00:39:13,680 IN OSTEOARTHRITIS, AND THIS 1109 00:39:13,680 --> 00:39:17,040 THRESHOLD ALSO HAS BEEN SHOWN IN 1110 00:39:17,040 --> 00:39:18,680 STUDIES TO HELP REDUCE RISK OF 1111 00:39:18,680 --> 00:39:19,160 MORTALITY, ET CETERA. 1112 00:39:19,160 --> 00:39:21,600 SO I MIGHT START SOMEONE AT 500 1113 00:39:21,600 --> 00:39:23,280 OR A THOUSAND STEPS PER DAY IF 1114 00:39:23,280 --> 00:39:26,720 THEY'RE COMPLETELY SEDENTARY, 1115 00:39:26,720 --> 00:39:28,320 SLOWLY INCREASE THEM TO 3,000 1116 00:39:28,320 --> 00:39:29,560 STEPS PER DAY, EVENTUALLY GET 1117 00:39:29,560 --> 00:39:31,280 THEM TO 6,000 STEPS PER DAY. 1118 00:39:31,280 --> 00:39:32,280 CERTAINLY SOME PEOPLE MAY BE 1119 00:39:32,280 --> 00:39:33,360 ABLE TO DO MORE THAN THAT. 1120 00:39:33,360 --> 00:39:38,600 AS AN EXAMPLE, I HAD SOMEONE WHO 1121 00:39:38,600 --> 00:39:39,800 WAS COMPLETELY SEDENTARY AND 1122 00:39:39,800 --> 00:39:42,120 THEN OVER TIME, SLOWLY, SLOWLY, 1123 00:39:42,120 --> 00:39:43,200 SLOWLY INCREASED HER DAILY 1124 00:39:43,200 --> 00:39:44,000 WALKING. 1125 00:39:44,000 --> 00:39:45,640 SHE LOST 60 POUNDS, WAS ABLE TO 1126 00:39:45,640 --> 00:39:47,440 COME OFF ALL HER PAIN 1127 00:39:47,440 --> 00:39:48,440 MEDICATIONS, WAS ABLE TO COME 1128 00:39:48,440 --> 00:39:50,760 OFF HER ANTIDEPRESSANTS AND 1129 00:39:50,760 --> 00:39:52,080 CONSISTENTLY WALKS 3 MILES PER 1130 00:39:52,080 --> 00:39:52,400 DAY. 1131 00:39:52,400 --> 00:39:53,480 THAT'S NOT GOING TO HAPPEN WITH 1132 00:39:53,480 --> 00:39:55,120 EVERYONE. 1133 00:39:55,120 --> 00:39:56,440 EXERCISE/PHYSICAL ACTIVITY IS 1134 00:39:56,440 --> 00:39:57,640 LARGELY BEHAVIORALLY MEDIATED, 1135 00:39:57,640 --> 00:40:00,360 BUT WE CAN HELP OUR PATIENTS SO 1136 00:40:00,360 --> 00:40:01,480 THAT THEY'RE NOT THINKING THAT 1137 00:40:01,480 --> 00:40:03,120 THEY HAVE TO GO JOGGING, THAT 1138 00:40:03,120 --> 00:40:06,800 THEY HAVE TO DO TWEP MIN 20 MINR 1139 00:40:06,800 --> 00:40:07,720 DAY RIGHT AWAY, THIS IS 1140 00:40:07,720 --> 00:40:08,800 SOMETHING THEY CAN BUILD TO. 1141 00:40:08,800 --> 00:40:09,880 AND REMIND THEM THAT THERE ARE 1142 00:40:09,880 --> 00:40:12,280 OTHER WAYS TO GET PHYSICAL 1143 00:40:12,280 --> 00:40:13,840 ACTIVITY, GARDENING, ALL THEIR 1144 00:40:13,840 --> 00:40:15,920 HOUSEHOLD CHORES, ET CETERA. 1145 00:40:15,920 --> 00:40:19,280 AND THEN -- OH, SORRY. 1146 00:40:19,280 --> 00:40:21,480 FINALLY, I JUST WANTED TO END ON 1147 00:40:21,480 --> 00:40:23,440 THIS CONCEPT OF MINIMALLY 1148 00:40:23,440 --> 00:40:24,000 DISRUPTIVE MEDICINE. 1149 00:40:24,000 --> 00:40:27,480 I THINK THIS IS REALLY AN 1150 00:40:27,480 --> 00:40:29,360 IMPORTANT THING FOR US TO BEAR 1151 00:40:29,360 --> 00:40:31,760 IN MIND AS HEALTHCARE PROVIDERS. 1152 00:40:31,760 --> 00:40:33,160 AND MISS OVERTON NICELY 1153 00:40:33,160 --> 00:40:33,960 HIGHLIGHTED MANY OF THESE 1154 00:40:33,960 --> 00:40:34,400 CONCEPTS. 1155 00:40:34,400 --> 00:40:35,600 SO AN INDIVIDUAL WITH 1156 00:40:35,600 --> 00:40:36,560 OSTEOARTHRITIS OR WITH ANY 1157 00:40:36,560 --> 00:40:38,000 MEDICAL CONDITION HAS TO ACCESS 1158 00:40:38,000 --> 00:40:39,880 CARE, USE CARE AND ENACT 1159 00:40:39,880 --> 00:40:42,480 SELF-CARE. 1160 00:40:42,480 --> 00:40:46,000 BUT THEIR CAPACITY TO ENGAGE MAY 1161 00:40:46,000 --> 00:40:48,800 BE LIMITED BY RESOURCES. 1162 00:40:48,800 --> 00:40:50,680 THEIR FINANCES, THEIR SOCIAL 1163 00:40:50,680 --> 00:40:51,120 SUPPORT. 1164 00:40:51,120 --> 00:40:53,520 SO MISS OVERTON TALKED ABOUT 1165 00:40:53,520 --> 00:40:54,200 TRANSPORTATION, ET CETERA. 1166 00:40:54,200 --> 00:40:56,160 AND THEN THERE ARE LIFE DEMANDS 1167 00:40:56,160 --> 00:40:57,360 THAT THEY HAVE TO GO TO WORK, 1168 00:40:57,360 --> 00:40:58,800 AND IN THE U.S., THERE'S A LOT 1169 00:40:58,800 --> 00:41:00,200 OF JOBS WHERE THERE'S NO UNPAID 1170 00:41:00,200 --> 00:41:00,680 LEAVE. 1171 00:41:00,680 --> 00:41:02,720 THEY MIGHT HAVE CAREGIVING 1172 00:41:02,720 --> 00:41:03,360 RESPONSIBILITIES. 1173 00:41:03,360 --> 00:41:05,920 AND SO AS THE BURDEN OF 1174 00:41:05,920 --> 00:41:07,960 TREATMENT INCREASES DUE TO 1175 00:41:07,960 --> 00:41:10,280 ATTENDING APPOINTMENTS, TESTS, 1176 00:41:10,280 --> 00:41:11,560 TAKING MEDICATIONS, THAT ADDS TO 1177 00:41:11,560 --> 00:41:13,120 THEIR WORKLOAD, AND IF THEY HAVE 1178 00:41:13,120 --> 00:41:15,760 LIMITED CAPACITY, THEY MAY NOT 1179 00:41:15,760 --> 00:41:17,480 BE ABLE TO ENGAGE, AND WHEN THEY 1180 00:41:17,480 --> 00:41:18,880 CAN'T ENGAGE IN THEIR OWN CARE, 1181 00:41:18,880 --> 00:41:20,120 THAT INCREASES THE BURDEN OF 1182 00:41:20,120 --> 00:41:21,640 ILLNESS, DECREASES OUR CAPACITY, 1183 00:41:21,640 --> 00:41:23,960 AND THEN THERE'S A VICIOUS 1184 00:41:23,960 --> 00:41:24,480 CYCLE. 1185 00:41:24,480 --> 00:41:27,560 SO OFTEN WHEN PATIENTS ARE 1186 00:41:27,560 --> 00:41:29,280 UNABLE TO ATTEND APPOINTMENTS ON 1187 00:41:29,280 --> 00:41:30,840 A ROUTINE BASIS, UNABLE TO TAKE 1188 00:41:30,840 --> 00:41:32,600 THEIR MEDICATIONS, UNABLE TO 1189 00:41:32,600 --> 00:41:35,440 ENGAGE IN PHYSICAL THERAPY, WE 1190 00:41:35,440 --> 00:41:36,920 NEED TO REALLY THINK MORE 1191 00:41:36,920 --> 00:41:37,840 BROADLY ABOUT MANY OF THESE 1192 00:41:37,840 --> 00:41:39,360 OTHER ISSUES. 1193 00:41:39,360 --> 00:41:44,400 RESOURCE SCARCITY AND WORKLOAD 1194 00:41:44,400 --> 00:41:45,600 ISSUES DISPROPORTIONATELY AFFECT 1195 00:41:45,600 --> 00:41:47,560 COMMUNITIES OF COLOR, PEOPLE OF 1196 00:41:47,560 --> 00:41:48,360 LOWER SOCIOECONOMIC STATUS. 1197 00:41:48,360 --> 00:41:50,160 THESE ARE REAL IMPORTANT ISSUES 1198 00:41:50,160 --> 00:41:53,160 THAT WE ARE ILL-EQUIPPED IN MOST 1199 00:41:53,160 --> 00:41:54,120 HEALTHCARE SYSTEMS TO ADEQUATELY 1200 00:41:54,120 --> 00:41:59,600 ADDRESS. 1201 00:41:59,600 --> 00:42:01,680 WHEN YOU THINK ABOUT TREATING 1202 00:42:01,680 --> 00:42:03,240 OSTEOARTHRITIS, MANY RESEARCHES 1203 00:42:03,240 --> 00:42:04,760 THINK ABOUT TARGETING MOLECULES 1204 00:42:04,760 --> 00:42:06,600 AND PATHWAYS BUT WE REALLY NEED 1205 00:42:06,600 --> 00:42:07,560 TO THINK ABOUT THE WHOLE PERSON. 1206 00:42:07,560 --> 00:42:09,760 WE WANT TO ADDRESS THEIR PAIN, 1207 00:42:09,760 --> 00:42:10,440 FUNCTION. 1208 00:42:10,440 --> 00:42:13,360 PEOPLE WITH OA HAVE NUMEROUS 1209 00:42:13,360 --> 00:42:14,480 COMORBIDITIES, SO 1210 00:42:14,480 --> 00:42:15,680 MULTI-MORBIDITY IS A BIG ISSUE 1211 00:42:15,680 --> 00:42:17,000 IN OSTEOARTHRITIS. 1212 00:42:17,000 --> 00:42:19,840 IDEALLY ADDRESS RISK FACTORS, 1213 00:42:19,840 --> 00:42:22,160 OTHER SYMPTOMS, MOOD, SLEEP, ET 1214 00:42:22,160 --> 00:42:23,240 CETERA, HELP ADDRESS QUALITY OF 1215 00:42:23,240 --> 00:42:23,880 LIFE. 1216 00:42:23,880 --> 00:42:26,840 SO ADDRESSING PATHOLOGY IS ONLY 1217 00:42:26,840 --> 00:42:27,720 ONE SMALL PART OF THIS BIG 1218 00:42:27,720 --> 00:42:31,520 PICTURE OF MANAGING AP AN 1219 00:42:31,520 --> 00:42:32,640 INDIVIDUAL'S OSTEOARTHRITIS. 1220 00:42:32,640 --> 00:42:34,880 SO IN SUMMARY, WE WANT TO MANAGE 1221 00:42:34,880 --> 00:42:37,560 DISEASE AND ILLNESS, LANGUAGE 1222 00:42:37,560 --> 00:42:40,280 MATTERS, DON'T USE FATALISTIC 1223 00:42:40,280 --> 00:42:42,120 LANGUAGE, USE PARTICIPATORY 1224 00:42:42,120 --> 00:42:42,560 LANGUAGE. 1225 00:42:42,560 --> 00:42:44,000 MEET PATIENTS WHERE THEY ARE, 1226 00:42:44,000 --> 00:42:45,880 BEWARE OF OUR OWN UNCONSCIOUS 1227 00:42:45,880 --> 00:42:47,840 BIAS, AND REFLECT ON WAYS IN 1228 00:42:47,840 --> 00:42:50,240 WHICH WE CAN TRY TO ENGAGE IN 1229 00:42:50,240 --> 00:42:51,240 MINIMALLY DISRUPTIVE MEDICINE. 1230 00:42:51,240 --> 00:42:55,960 THANK YOU. 1231 00:42:55,960 --> 00:42:58,000 >> THANK YOU SO MUCH, DR. NEOGI, 1232 00:42:58,000 --> 00:43:00,240 TO THAT REALLY THOUGHT PROVOKING 1233 00:43:00,240 --> 00:43:01,200 AND INFORMATIVE PRESENTATION. 1234 00:43:01,200 --> 00:43:02,160 WE'RE GOING TO LEVERAGE SOME OF 1235 00:43:02,160 --> 00:43:04,640 WHAT YOU DESCRIBED IN TERMS OF 1236 00:43:04,640 --> 00:43:07,760 THE TOPIC FOR OUR FINAL SPEAKER. 1237 00:43:07,760 --> 00:43:09,040 THIS SPEAKER IS JENNIFER 1238 00:43:09,040 --> 00:43:12,320 RAYMOND, WHO'S A JB AND MBA, 1239 00:43:12,320 --> 00:43:13,200 CHIEF STRIKE THAT YEE OFFICER 1240 00:43:13,200 --> 00:43:17,360 FOR AGESPAN, WHICH IS AN AREA 1241 00:43:17,360 --> 00:43:18,560 AGENCY ON AGING THAT SERVES 1242 00:43:18,560 --> 00:43:20,720 COMMUNITIES IN MASSACHUSETTS. 1243 00:43:20,720 --> 00:43:22,520 MISS RAYMOND ABOUT BE DISCUSSING 1244 00:43:22,520 --> 00:43:23,240 OSTEOARTHRITIS DISPARITIES FROM 1245 00:43:23,240 --> 00:43:25,800 THE PERSPECTIVE OF A LARGE 1246 00:43:25,800 --> 00:43:26,480 COMMUNITY-BASED ORGANIZATION 1247 00:43:26,480 --> 00:43:27,560 THAT'S REALLY FOCUSED ON WHOLE 1248 00:43:27,560 --> 00:43:31,800 PERSON CARE FOR OLDER ADULTS. 1249 00:43:31,800 --> 00:43:32,800 MISS RAYMOND, THANK YOU SO MUCH. 1250 00:43:32,800 --> 00:43:34,200 >> THANK YOU, ARLEEN, AND THANK 1251 00:43:34,200 --> 00:43:37,160 YOU, EVERYONE, FOR INVITING ME, 1252 00:43:37,160 --> 00:43:39,040 AND INCLUDING AND ACKNOWLEDGING 1253 00:43:39,040 --> 00:43:43,440 THE ROLE OF COMMUNITY IN 1254 00:43:43,440 --> 00:43:44,400 SUPPORTING INDIVIDUALS WHO HAVE 1255 00:43:44,400 --> 00:43:49,320 ARTHRITIS. 1256 00:43:49,320 --> 00:43:52,160 AS ARLEEN REFERENCED, WE ARE AN 1257 00:43:52,160 --> 00:43:55,680 AREA AGENCY ON AGING HERE IN 1258 00:43:55,680 --> 00:43:56,960 NORTHEAST MASSACHUSETTS, SO IF 1259 00:43:56,960 --> 00:43:58,960 YOU THINK NORTH OF BOSTON AND 1260 00:43:58,960 --> 00:44:00,280 SOUTH OF NEW HAMPSHIRE, YOU'LL 1261 00:44:00,280 --> 00:44:01,240 BE THINKING OF US. 1262 00:44:01,240 --> 00:44:03,440 THERE ARE THESE AREA AGENCIES ON 1263 00:44:03,440 --> 00:44:05,400 AGING THROUGHOUT THE COUNTRY. 1264 00:44:05,400 --> 00:44:06,880 I THINK THERE ARE ONLY ABOUT 1265 00:44:06,880 --> 00:44:09,440 FIVE STATES THAT DON'T HAVE AREA 1266 00:44:09,440 --> 00:44:12,720 AGENCIES ON AGING. 1267 00:44:12,720 --> 00:44:14,880 THESE AAA AS WELL AS OTHER 1268 00:44:14,880 --> 00:44:16,120 COMMUNCOMMUNITY-BASED ORGANIZATS 1269 00:44:16,120 --> 00:44:18,200 REALLY WANT TO BE PARTNERS WITH 1270 00:44:18,200 --> 00:44:20,240 PEOPLE WHO HAVE ARTHRITIS AS 1271 00:44:20,240 --> 00:44:21,480 WELL AS THEIR HEALTHCARE 1272 00:44:21,480 --> 00:44:23,560 PROVIDERS AND THEIR HEALTHCARE 1273 00:44:23,560 --> 00:44:25,720 SYSTEMS TO REALLY CREATE THAT, 1274 00:44:25,720 --> 00:44:28,920 THAT WHOLE-PERSON APPROACH 1275 00:44:28,920 --> 00:44:31,680 FOCUSING ON THE PERSON-CENTERED 1276 00:44:31,680 --> 00:44:31,880 NEEDS. 1277 00:44:31,880 --> 00:44:34,360 SO I WOULD ENCOURAGE ANYONE IF 1278 00:44:34,360 --> 00:44:35,480 YOU DON'T HAVE A RELATIONSHIP 1279 00:44:35,480 --> 00:44:38,200 WITH YOUR LOCAL AREA AGENCY ON 1280 00:44:38,200 --> 00:44:39,200 AGING, PLEASE REACH OUT AND 1281 00:44:39,200 --> 00:44:40,600 WE'RE HAPPY TO MAKE THOSE 1282 00:44:40,600 --> 00:44:41,040 CONNECTIONS. 1283 00:44:41,040 --> 00:44:43,680 THOSE ARE VERY VALUABLE. 1284 00:44:43,680 --> 00:44:46,120 WE SERVE AROUND 45,000 1285 00:44:46,120 --> 00:44:47,040 INDIVIDUALS PER YEAR. 1286 00:44:47,040 --> 00:44:48,840 USED TO BE JUST OLDER ADULTS, 1287 00:44:48,840 --> 00:44:51,120 NOW WE'RE SERVING FAMILY 1288 00:44:51,120 --> 00:44:51,800 CAREGIVERS AS WELL AS YOUNGER 1289 00:44:51,800 --> 00:44:53,080 PEOPLE WITH MULTIPLE CHRONIC 1290 00:44:53,080 --> 00:44:56,800 CONDITIONS. 1291 00:44:56,800 --> 00:45:00,080 WNOT ONLY DO WE WORK DIRECTLY 1292 00:45:00,080 --> 00:45:01,840 WITH INDIVIDUALS IN NEED OF 1293 00:45:01,840 --> 00:45:06,120 SERVICES, BUT WE ALSO PARTNER 1294 00:45:06,120 --> 00:45:07,560 WITH AND CONTRACT WITH A WIDE 1295 00:45:07,560 --> 00:45:09,360 VARIETY OF DIFFERENT HEALTHCARE 1296 00:45:09,360 --> 00:45:11,440 SYSTEMS SO THAT AS WE JUST 1297 00:45:11,440 --> 00:45:12,800 HEARD, IF YOU'RE A PROVIDER 1298 00:45:12,800 --> 00:45:17,480 WHO'S GOING TO BE COUNSELING 1299 00:45:17,480 --> 00:45:19,440 YOUR PATIENT TO WALK 500 STEPS, 1300 00:45:19,440 --> 00:45:22,520 A THOUSAND STEPS, 2,000 STEPS A 1301 00:45:22,520 --> 00:45:25,240 DAY, WE WANT TO BE A PARTNER 1302 00:45:25,240 --> 00:45:28,080 THAT HAS RESOURCES AVAILABLE TO 1303 00:45:28,080 --> 00:45:30,280 HELP THEM WHEN THEY'RE OUTSIDE 1304 00:45:30,280 --> 00:45:31,360 OF THE CLINICAL OFFICE TO 1305 00:45:31,360 --> 00:45:31,920 ACHIEVE THOSE GOALS. 1306 00:45:31,920 --> 00:45:33,760 SO WE DO PARTNER AND CONTRACT 1307 00:45:33,760 --> 00:45:35,720 WITH A WIDE VARIETY OF 1308 00:45:35,720 --> 00:45:38,480 HEALTHCARE ORGANIZATIONS AND 1309 00:45:38,480 --> 00:45:42,320 SYSTEMS TO DO THAT, AND WE ARE A 1310 00:45:42,320 --> 00:45:44,160 CDC-FUNDED STATE-WIDE APPROACHES 1311 00:45:44,160 --> 00:45:48,560 TO AIF DRESTO ADDRESSING ARTHRIE 1312 00:45:48,560 --> 00:45:50,280 AND WE'LL TALK A LITTLE BIT 1313 00:45:50,280 --> 00:45:57,840 ABOUT WHAT THAT MEANS. 1314 00:45:57,840 --> 00:45:58,960 AT THE COMMUNITY BASE LEVEL, WE 1315 00:45:58,960 --> 00:46:00,680 DO WANT TO TAKE THAT WHOLE 1316 00:46:00,680 --> 00:46:02,680 PERSON APPROACH AND I'M REALLY 1317 00:46:02,680 --> 00:46:04,960 CAREFUL TO USE THE WORD 1318 00:46:04,960 --> 00:46:06,280 "PERSON." 1319 00:46:06,280 --> 00:46:07,120 MANY OF THE INDIVIDUALS THAT WE 1320 00:46:07,120 --> 00:46:10,960 WORK WITH ARE USED TO BEING 1321 00:46:10,960 --> 00:46:12,960 LOOKED AT THROUGH THE PATIENT 1322 00:46:12,960 --> 00:46:14,040 LENS, THROUGH THE MEMBER LENS, 1323 00:46:14,040 --> 00:46:15,440 THROUGH THE RESIDENT LENS, 1324 00:46:15,440 --> 00:46:17,320 THROUGH WHATEVER TITLE IS 1325 00:46:17,320 --> 00:46:18,720 IMPORTANT FOR THE INDIVIDUAL 1326 00:46:18,720 --> 00:46:20,080 THAT'S PROVIDING SERVICES, BUT 1327 00:46:20,080 --> 00:46:24,000 AT THE END OF THE DAY, IT IS 1328 00:46:24,000 --> 00:46:27,040 THAT WHOLE PERSON, AND AS 1329 00:46:27,040 --> 00:46:28,240 MS. OVERTON SPOKE SO ELOQUENTLY 1330 00:46:28,240 --> 00:46:29,240 ABOUT, THERE'S A LOT OF THINGS 1331 00:46:29,240 --> 00:46:30,440 THAT ARE GOING ON IN THE LIVES 1332 00:46:30,440 --> 00:46:32,640 OF PEOPLE THAT HAVE ARTHRITIS 1333 00:46:32,640 --> 00:46:35,040 BESIDES THE FACT THAT THEY HAVE 1334 00:46:35,040 --> 00:46:35,680 ARTHRITIS. 1335 00:46:35,680 --> 00:46:38,880 SO WHEN WE TAKE A REFERRAL FROM 1336 00:46:38,880 --> 00:46:41,480 A MANAGED CARE ORGANIZATION OR 1337 00:46:41,480 --> 00:46:45,080 FROM A FAMILY HEALTH CENTER, WE 1338 00:46:45,080 --> 00:46:46,760 START FRESH WITH THE PERSON TO 1339 00:46:46,760 --> 00:46:48,800 SORT OF TALK ABOUT WHAT'S 1340 00:46:48,800 --> 00:46:51,880 IMPORTANT TO YOU, AND A LOT OF 1341 00:46:51,880 --> 00:46:54,480 TIMES WE HEAR THINGS LIKE I HAVE 1342 00:46:54,480 --> 00:46:56,120 A NEWBORN GRANDCHILD, I WANT TO 1343 00:46:56,120 --> 00:46:57,800 BE ABLE TO GET DOWN ON THE FLOOR 1344 00:46:57,800 --> 00:46:59,600 AND PLAY WITH THEM AND GET UP 1345 00:46:59,600 --> 00:47:02,680 AND NOT FEEL DEBILITATING PAIN 1346 00:47:02,680 --> 00:47:04,880 FOR THE NEXT 48 HOURS. 1347 00:47:04,880 --> 00:47:07,720 SO THAT WILL BE THE FOCUS, HOW 1348 00:47:07,720 --> 00:47:09,600 CAN WE HELP YOU BE MORE ENGAGED 1349 00:47:09,600 --> 00:47:11,880 WITH YOUR NEW GRANDCHILD WITHOUT 1350 00:47:11,880 --> 00:47:14,080 FEELING THAT PAIN. 1351 00:47:14,080 --> 00:47:15,160 AND THAT'S VERY DIFFERENT. 1352 00:47:15,160 --> 00:47:16,920 THAT'S VERY MUCH NOT THE WHAT'S 1353 00:47:16,920 --> 00:47:18,760 THE MATTER WITH ME BUT THE WHAT 1354 00:47:18,760 --> 00:47:22,200 MATTERS TO ME APPROACH, WHICH IS 1355 00:47:22,200 --> 00:47:24,360 THE APPROACH WE TAKE AS 1356 00:47:24,360 --> 00:47:26,120 COMMUNITY-BASED ORGANIZATIONS. 1357 00:47:26,120 --> 00:47:29,040 OFTENTIMES WE FIND THE GOALS OF 1358 00:47:29,040 --> 00:47:30,280 THE PROVIDER MIGHT BE REALLY 1359 00:47:30,280 --> 00:47:32,640 DIFFERENT THAN THE GOALS OF THE 1360 00:47:32,640 --> 00:47:34,200 PERSON, SO AGAIN, HOW DO WE SORT 1361 00:47:34,200 --> 00:47:38,280 OF THINK ABOUT WHAT'S IMPORTANT 1362 00:47:38,280 --> 00:47:40,440 TO THE PERSON. 1363 00:47:40,440 --> 00:47:41,440 OFTENTIMES WE'LL RECEIVE A 1364 00:47:41,440 --> 00:47:42,480 REFERRAL AND THE REFERRAL WILL 1365 00:47:42,480 --> 00:47:43,640 SAY ALL OF THESE THINGS ARE 1366 00:47:43,640 --> 00:47:47,000 TRUE, THIS PERSON LAS 1367 00:47:47,000 --> 00:47:47,960 OSTEOARTHRITIS, THEY WILL 1368 00:47:47,960 --> 00:47:49,520 BENEFIT FROM ADDITIONAL PHYSICAL 1369 00:47:49,520 --> 00:47:51,360 ACTIVITY, THEY WILL BENEFIT FROM 1370 00:47:51,360 --> 00:47:52,560 WEIGHT LOSS, THEY WILL BENEFIT 1371 00:47:52,560 --> 00:47:54,960 FROM BETTER MEDICATION 1372 00:47:54,960 --> 00:47:58,400 MANAGEMENT AND THEN WE TALK WITH 1373 00:47:58,400 --> 00:48:00,120 THE CONSUMER AND SORT OF GET 1374 00:48:00,120 --> 00:48:01,640 WHAT MATTERS TO THEM, I WANT TO 1375 00:48:01,640 --> 00:48:03,200 BE ABLE TO PLAY WITH MY 1376 00:48:03,200 --> 00:48:03,520 GRANDCHILD. 1377 00:48:03,520 --> 00:48:05,680 SO HOW DO WE CREATE THE RIGHT 1378 00:48:05,680 --> 00:48:07,120 SYNERGY AND BALANCES AMONG THOSE 1379 00:48:07,120 --> 00:48:08,320 GOALS, WHICH ARE CERTAINLY 1380 00:48:08,320 --> 00:48:10,400 ALIGNED BUT JUST MESSAGED AND 1381 00:48:10,400 --> 00:48:11,600 LANGUAGED IN VERY DIFFERENT 1382 00:48:11,600 --> 00:48:13,800 WAYS. 1383 00:48:13,800 --> 00:48:16,040 AND THEN SORT OF REALLY TALKING 1384 00:48:16,040 --> 00:48:18,080 WITH THE INDIVIDUAL WITH 1385 00:48:18,080 --> 00:48:19,360 ARTHRITIS ABOUT WHAT DOES 1386 00:48:19,360 --> 00:48:22,960 MEASURES OF SUCCESS LOOK LIKE TO 1387 00:48:22,960 --> 00:48:23,520 THEM. 1388 00:48:23,520 --> 00:48:26,720 IS IT ONLY HAVING PAIN THAT 1389 00:48:26,720 --> 00:48:30,080 REGISTERS A 3 AS OPPOSED TO A 9, 1390 00:48:30,080 --> 00:48:32,040 IS IT BEING ABLE TO PLAY WITH MY 1391 00:48:32,040 --> 00:48:33,400 GRANDCHILD, IS IT BEING MORE 1392 00:48:33,400 --> 00:48:34,720 PHYSICALLY ACTIVE, IS IT RELYING 1393 00:48:34,720 --> 00:48:36,560 LESS ON MEDICATION. 1394 00:48:36,560 --> 00:48:37,520 SO WHAT'S GOING TO BE THE 1395 00:48:37,520 --> 00:48:39,840 MEASURE OF SUCCESS FOR THE 1396 00:48:39,840 --> 00:48:42,240 INDIVIDUAL THAT WE'RE WORKING 1397 00:48:42,240 --> 00:48:42,560 WITH. 1398 00:48:42,560 --> 00:48:43,840 THAT'S SORT OF THE WHOLE PERSON 1399 00:48:43,840 --> 00:48:46,840 APPROACH THAT WE TAKE ON THIS, A 1400 00:48:46,840 --> 00:48:47,800 PART OF THE WHOLE PERSON 1401 00:48:47,800 --> 00:48:50,000 APPROACH, I'M SORRY, THAT WE 1402 00:48:50,000 --> 00:48:51,800 TAKE ON THE COMMUNITY-BASED 1403 00:48:51,800 --> 00:48:53,840 ORGANIZATION SIDE. 1404 00:48:53,840 --> 00:48:55,680 THE OTHER PIECE OF IT, AND I 1405 00:48:55,680 --> 00:48:57,760 THINK MISS OVERTON TALKED ABOUT 1406 00:48:57,760 --> 00:49:05,320 THIS VERY WELL, WHEN SOMEONE IS 1407 00:49:05,320 --> 00:49:06,280 DIAGNOSED WITH ARTHRITIS, 1408 00:49:06,280 --> 00:49:07,600 CHANCES ARE IT'S NOT UNUSUAL FOR 1409 00:49:07,600 --> 00:49:12,840 THEM TO HAVE OTHER VERY COMPLEX 1410 00:49:12,840 --> 00:49:16,360 PHYSICAL NEEDS, AND IT'S ALMOST 1411 00:49:16,360 --> 00:49:17,920 NOT UNHEARD OF FOR THEM TO HAVE 1412 00:49:17,920 --> 00:49:21,080 VERY COMPLEX SOCIAL NEEDS. 1413 00:49:21,080 --> 00:49:22,800 SO IF A PERSON THAT WE'RE 1414 00:49:22,800 --> 00:49:24,040 WORKING WITH HAS A GOAL OF 1415 00:49:24,040 --> 00:49:25,440 INCREASING PHYSICAL ACTIVITY SO 1416 00:49:25,440 --> 00:49:27,080 THEY CAN PLAY WITH THEIR 1417 00:49:27,080 --> 00:49:30,240 GRANDCHILD, WHAT IS GOING TO GET 1418 00:49:30,240 --> 00:49:32,560 IN THE WAY OF THEM ACHIEVING 1419 00:49:32,560 --> 00:49:33,320 THAT GOAL? 1420 00:49:33,320 --> 00:49:34,840 AND OFTENTIMES THE THINGS THAT 1421 00:49:34,840 --> 00:49:35,880 YOU SEE ON THE SCREEN HERE ARE 1422 00:49:35,880 --> 00:49:39,200 AT THE TOP OF THE LIST. 1423 00:49:39,200 --> 00:49:40,840 IF YOU'RE FINANCIALLY INSECURE 1424 00:49:40,840 --> 00:49:44,120 AND THE THREAT OF HOMELESSNESS 1425 00:49:44,120 --> 00:49:46,880 OR HOUSING SECURITY IS THERE, 1426 00:49:46,880 --> 00:49:48,080 THAT CERTAINLY GETS IN THE WAY 1427 00:49:48,080 --> 00:49:50,920 OF PRIORITIZING PHYSICAL 1428 00:49:50,920 --> 00:49:52,800 ACTIVITY. 1429 00:49:52,800 --> 00:49:54,760 IF YOU'RE FOOD-INSECURE, THAT 1430 00:49:54,760 --> 00:49:56,160 CERTAINLY GETS IN THE WAY OF 1431 00:49:56,160 --> 00:49:58,720 PRIORITIZING PHYSICAL ACTIVITY. 1432 00:49:58,720 --> 00:50:02,640 SOCIAL ISOLATION AND LONELINESS 1433 00:50:02,640 --> 00:50:04,720 CAN BE VERY DEMOTE VAITING 1434 00:50:04,720 --> 00:50:09,600 VERY DE MOTIVATINGFEELINGS TO GD 1435 00:50:09,600 --> 00:50:10,880 MOVING, AND MANY FOLKS SUFFER 1436 00:50:10,880 --> 00:50:13,520 FROM DEPRESSION, ANXIETY, 1437 00:50:13,520 --> 00:50:15,400 STRESS, OTHER KINDS OF 1438 00:50:15,400 --> 00:50:15,920 BEHAVIORAL HEALTH THINGS. 1439 00:50:15,920 --> 00:50:19,760 SO WHEN WE ARE REFERRED AN 1440 00:50:19,760 --> 00:50:21,360 INDIVIDUAL WHO HAS ARTHRITIS, 1441 00:50:21,360 --> 00:50:24,360 ONE OF THE VERY FIRST STEPS IS 1442 00:50:24,360 --> 00:50:26,960 TO DO THIS BROADER SOCIAL 1443 00:50:26,960 --> 00:50:28,720 DETERMINANT OF HEALTH 1444 00:50:28,720 --> 00:50:32,000 ASSESSMENT, THIS SDOH 1445 00:50:32,000 --> 00:50:32,880 ASSESSMENT, WHAT ELSE IS GOING 1446 00:50:32,880 --> 00:50:33,760 TO GET IN THE WAY? 1447 00:50:33,760 --> 00:50:34,760 ONCE WE IDENTIFY THOSE THINGS 1448 00:50:34,760 --> 00:50:35,920 THAT ARE GOING TO GET IN THE WAY 1449 00:50:35,920 --> 00:50:37,480 OF SOMEONE MANAGING THEIR 1450 00:50:37,480 --> 00:50:38,920 ARTHRITIS BETTER, THE NEXT STEP 1451 00:50:38,920 --> 00:50:42,840 IS TO LOOK AT WHAT ARE THE OTHER 1452 00:50:42,840 --> 00:50:46,000 RESOURCES THAT WE AS A 1453 00:50:46,000 --> 00:50:47,320 COMMUNITY-BASED ORGANIZATION CAN 1454 00:50:47,320 --> 00:50:49,920 CONNECT SOMEONE TO, TO HELP THEM 1455 00:50:49,920 --> 00:50:53,640 OVERCOME THOSE BARRIERS. 1456 00:50:53,640 --> 00:50:55,080 SO CAN WE GET MEALS DELIVERED TO 1457 00:50:55,080 --> 00:50:56,840 THEM ON A DAILY BASIS, CAN WE 1458 00:50:56,840 --> 00:50:58,120 CONNECT THEM WITH A LOCAL FOOD 1459 00:50:58,120 --> 00:51:00,680 BANK, CAN WE GET THEM REGISTERED 1460 00:51:00,680 --> 00:51:02,720 FOR SNAP BENEFIT OR HOUSING 1461 00:51:02,720 --> 00:51:04,360 BENEFITS OR OTHER KINDS OF 1462 00:51:04,360 --> 00:51:04,680 BENEFITS? 1463 00:51:04,680 --> 00:51:08,760 CAN WE GET THEM TRANSPORTATION 1464 00:51:08,760 --> 00:51:11,160 TO THEIR NON-EMERGENCY MEDICAL 1465 00:51:11,160 --> 00:51:11,920 APPOINTMENTS? 1466 00:51:11,920 --> 00:51:15,560 WHAT ARE THE OTHER THINGS THAT 1467 00:51:15,560 --> 00:51:16,760 THEY NEED THAT EXIST IN THE 1468 00:51:16,760 --> 00:51:17,960 COMMUNITY THAT WE WANT TO 1469 00:51:17,960 --> 00:51:20,600 CONNECT THEM WITH SO THEY CAN BE 1470 00:51:20,600 --> 00:51:22,080 SUCCESSFUL AND LET ME FIND THAT 1471 00:51:22,080 --> 00:51:27,800 FOAS WHO HAVE THOSE KINDS OF 1472 00:51:27,800 --> 00:51:29,000 SUPPORTS, THEN HAVE THE CAPACITY 1473 00:51:29,000 --> 00:51:30,960 TO PARTICIPATE MORE IN THE 1474 00:51:30,960 --> 00:51:38,520 MANAGEMENT OF THEIR DISEASE. 1475 00:51:38,520 --> 00:51:40,480 AND EVERY OLDER ADULT ENGAGED IN 1476 00:51:40,480 --> 00:51:51,000 SERVICES SHOULD HAVE A CBO. 1477 00:51:51,520 --> 00:51:52,760 WE KNOW WHERE THE RESOURCES ARE 1478 00:51:52,760 --> 00:51:54,720 SO WE'RE NOT GOING TO RELY ON A 1479 00:51:54,720 --> 00:51:56,160 WEBSITE TO GOOGLE AND SAY 1480 00:51:56,160 --> 00:51:57,440 WHERE'S THE NEAREST FOOD BANK. 1481 00:51:57,440 --> 00:51:58,640 WE'RE GOING TO BE ABLE TO SAY 1482 00:51:58,640 --> 00:52:00,280 THERE'S A FOOD MARKET THAT 1483 00:52:00,280 --> 00:52:01,840 HAPPENS ON MONDAY, WEDNESDAY AND 1484 00:52:01,840 --> 00:52:02,320 FRIDAY. 1485 00:52:02,320 --> 00:52:04,440 MAKE SURE YOU GET THERE BUT 1486 00:52:04,440 --> 00:52:05,760 10:15 BECAUSE THE GOOD STUFF IS 1487 00:52:05,760 --> 00:52:08,520 GONE BY 11:00. 1488 00:52:08,520 --> 00:52:10,640 AND IF YOU NEED TRANSPORTATION, 1489 00:52:10,640 --> 00:52:10,920 WE'RE THERE. 1490 00:52:10,920 --> 00:52:12,880 IF YOU NEED SOMEONE TO GO PICK 1491 00:52:12,880 --> 00:52:14,320 UP THE FOOD AND DELIVER TO YOUR 1492 00:52:14,320 --> 00:52:16,280 HOME, WE'RE THERE. 1493 00:52:16,280 --> 00:52:18,240 AND WE DO THIS WORK THROUGH THE 1494 00:52:18,240 --> 00:52:20,560 USE OF COMMUNITY HEALTH WORKERS 1495 00:52:20,560 --> 00:52:22,960 OR COMMUNITY OUTREACH WORKERS 1496 00:52:22,960 --> 00:52:25,880 WHO REPRESENT THE COMMUNITIES 1497 00:52:25,880 --> 00:52:27,320 THAT WE SERVE IN TERMS OF 1498 00:52:27,320 --> 00:52:28,760 LANGUAGE, CULTURE, DIVERSITY, SO 1499 00:52:28,760 --> 00:52:31,240 THAT WE DEVELOP THOSE 1500 00:52:31,240 --> 00:52:32,360 RELATIONSHIPS OF TRUST. 1501 00:52:32,360 --> 00:52:34,040 SO IT'S NOT JUST SORT OF WHAT 1502 00:52:34,040 --> 00:52:35,920 CAN I DO TO HELP YOU MANAGE YOUR 1503 00:52:35,920 --> 00:52:36,840 ARTHRITIS, BUT WHAT CAN I DO TO 1504 00:52:36,840 --> 00:52:39,120 HELP YOU OVERCOME ALL OF THE 1505 00:52:39,120 --> 00:52:41,000 BARRIERS THAT ARE GOING TO FIGHT 1506 00:52:41,000 --> 00:52:42,640 AGAINST YOU BETTER MANAGING YOUR 1507 00:52:42,640 --> 00:52:48,960 ARTHRITIS. 1508 00:52:48,960 --> 00:52:50,080 ONE OF THE RESOURCES AVAILABLE 1509 00:52:50,080 --> 00:52:51,960 TO MANY STATES INCLUDING 1510 00:52:51,960 --> 00:52:53,240 MASSACHUSETTS TO HELP WITH THESE 1511 00:52:53,240 --> 00:52:57,520 KINDS OF THINGS ARE GRANTS, AND 1512 00:52:57,520 --> 00:52:59,920 WE ARE THE FORTUNATE RECIPIENTS 1513 00:52:59,920 --> 00:53:03,280 OF A FIVE-YEAR GRANT FROM CDC 1514 00:53:03,280 --> 00:53:05,040 CALLED THE STATEWIDE APPROACHES 1515 00:53:05,040 --> 00:53:06,040 TO ADDRESSING ARTHRITIS. 1516 00:53:06,040 --> 00:53:08,960 UNDER THIS GRANT, THERE ARE FOUR 1517 00:53:08,960 --> 00:53:09,840 MAIN STRATEGIES. 1518 00:53:09,840 --> 00:53:11,640 THE FIRST IS THE DISSEMINATION 1519 00:53:11,640 --> 00:53:14,120 OF ARTHRITIS-APPROPRIATE 1520 00:53:14,120 --> 00:53:16,080 EVIDENCE-BASED INTERVENTIONS. 1521 00:53:16,080 --> 00:53:18,800 SO EVIDENCE-BASED PROGRAMS LIKE 1522 00:53:18,800 --> 00:53:21,120 THE CHRONIC DISEASE 1523 00:53:21,120 --> 00:53:22,440 SELF-MANAGEMENT PROGRAM OR THE 1524 00:53:22,440 --> 00:53:24,920 CHRONIC PAIN SELF-MANAGEMENT 1525 00:53:24,920 --> 00:53:28,160 PROGRAM, AND PERHAPS THIS IS NOT 1526 00:53:28,160 --> 00:53:29,440 UNLIKE THE PAIN MANAGEMENT 1527 00:53:29,440 --> 00:53:32,200 PROGRAM THAT MISS OVERTON SPOKE 1528 00:53:32,200 --> 00:53:35,360 OF THAT IS GOING TO TALK WITH 1529 00:53:35,360 --> 00:53:37,640 INDIVIDUALS IN A GROUP SETTING 1530 00:53:37,640 --> 00:53:39,200 ABOUT DIFFERENT TOOLS OR 1531 00:53:39,200 --> 00:53:41,800 RESOURCES TO HELP MANAGE PAIN, 1532 00:53:41,800 --> 00:53:44,200 WHETHER IT'S BETTER MEDICATION 1533 00:53:44,200 --> 00:53:46,480 MANAGEMENT, WHETHER IT'S PACING 1534 00:53:46,480 --> 00:53:48,040 ACTIVITY SO THAT YOU'RE DOING 1535 00:53:48,040 --> 00:53:50,680 THEM, YOU KNOW, MAYBE IN STEPPED 1536 00:53:50,680 --> 00:53:52,640 APPROACHES AS OPPOSED TO ALL AT 1537 00:53:52,640 --> 00:53:54,280 ONCE, WHETHER IT'S REACHING OUT 1538 00:53:54,280 --> 00:53:56,000 AND IMPROVING COMMUNICATION WITH 1539 00:53:56,000 --> 00:53:57,200 YOUR HEALTHCARE PROVIDER, 1540 00:53:57,200 --> 00:53:59,520 WHETHER IT'S CONNECTING WITH A 1541 00:53:59,520 --> 00:54:00,360 COMMUNITY-BASED ORGANIZATION TO 1542 00:54:00,360 --> 00:54:02,560 LEARNING ABOUT OTHER RESOURCES, 1543 00:54:02,560 --> 00:54:05,000 BUT THESE INTERVENTIONS THAT 1544 00:54:05,000 --> 00:54:08,280 HAVE BEEN PROVEN TO DECREASE 1545 00:54:08,280 --> 00:54:11,560 THINGS LIKE UNNECESSARY HOSPITAL 1546 00:54:11,560 --> 00:54:12,320 UTILIZATION, INCREASING 1547 00:54:12,320 --> 00:54:14,280 CONFIDENCE IN MANAGING PAIN, A 1548 00:54:14,280 --> 00:54:17,600 WIDE VARIETY OF OUTCOMES. 1549 00:54:17,600 --> 00:54:21,720 SECOND STRATEGY IS TO COUNSEL 1550 00:54:21,720 --> 00:54:23,280 AND REFER PATIENTS TO INCREASED 1551 00:54:23,280 --> 00:54:25,080 PHYSICAL ACTIVITY, INCLUDING THE 1552 00:54:25,080 --> 00:54:25,840 EVIDENCE-BASED PROGRAMS. 1553 00:54:25,840 --> 00:54:27,200 SO UNDER THIS STRATEGY, WE 1554 00:54:27,200 --> 00:54:28,840 PARTNER WITH FAMILY HEALTH 1555 00:54:28,840 --> 00:54:32,360 CENTERS, PRIMARY CARE PRACTICES, 1556 00:54:32,360 --> 00:54:34,040 AND OTHER HEALTH ENTITIES TO 1557 00:54:34,040 --> 00:54:35,280 ACCEPT REFERRALS FROM THEM FOR 1558 00:54:35,280 --> 00:54:36,960 PEOPLE WHO HAVE ARTHRITIS. 1559 00:54:36,960 --> 00:54:39,000 AND THEN WE PUT THEM THROUGH THE 1560 00:54:39,000 --> 00:54:39,640 MANY DIFFERENT SERVICES THAT 1561 00:54:39,640 --> 00:54:43,800 I'VE TALKED ABOUT UP TO THIS 1562 00:54:43,800 --> 00:54:44,000 POINT. 1563 00:54:44,000 --> 00:54:48,360 PROMOTING WALKING, SO IF THE 1564 00:54:48,360 --> 00:54:49,520 PHYSICIAN HAS SAID I WOULD LIKE 1565 00:54:49,520 --> 00:54:52,800 FOR YOU TO WORK TOWARDS 2,000 1566 00:54:52,800 --> 00:54:54,680 STEPS A DAY AND THEY LEAVE THAT 1567 00:54:54,680 --> 00:54:56,080 30 MINUTES IN THE PHYSICIAN'S 1568 00:54:56,080 --> 00:54:57,920 OFFICE, THEY SORT OF NEED SOME 1569 00:54:57,920 --> 00:55:01,320 SUPPORT FOR THE OTHER, YOU KNOW, 1570 00:55:01,320 --> 00:55:02,880 23 1/2 HOURS A DAY AROUND HOW 1571 00:55:02,880 --> 00:55:05,040 THEY'RE EXACTLY GOING TO BEGIN 1572 00:55:05,040 --> 00:55:07,880 THAT JOURNEY. 1573 00:55:07,880 --> 00:55:10,160 SO PROMOTING AND CONNECTING WITH 1574 00:55:10,160 --> 00:55:11,480 WALKING GROUPS, OTHER 1575 00:55:11,480 --> 00:55:12,400 EVIDENCE-BASED PROGRAMS AS A 1576 00:55:12,400 --> 00:55:14,800 PART OF THIS FUNDING, AND THEN 1577 00:55:14,800 --> 00:55:18,600 FINALLY RAISING JUST BROADLY 1578 00:55:18,600 --> 00:55:20,360 MORE PUBLIC AWARENESS AROUND 1579 00:55:20,360 --> 00:55:23,960 ARTHRITIS, THE ARTHRITIS BURDEN, 1580 00:55:23,960 --> 00:55:25,160 AND MANAGEMENT OF THAT BURDEN. 1581 00:55:25,160 --> 00:55:27,040 I KNOW THAT WE'RE TIGHT ON TIME 1582 00:55:27,040 --> 00:55:29,080 SO I WILL JUST QUICKLY PUT THIS 1583 00:55:29,080 --> 00:55:30,520 OUT THERE, IT IS IN THE SLIDES. 1584 00:55:30,520 --> 00:55:34,240 I WANTED TO SHARE JUST ONE 1585 00:55:34,240 --> 00:55:36,960 EXAMPLE, A CASE STUDY, AND I 1586 00:55:36,960 --> 00:55:37,840 INTENTIONALLY CHOSE SOMEONE WHO 1587 00:55:37,840 --> 00:55:40,040 WAS YOUNGER, WHICH WE SOMETIMES 1588 00:55:40,040 --> 00:55:41,920 DON'T ALWAYS THINK OF PEOPLE 1589 00:55:41,920 --> 00:55:45,840 WITH OSTEOARTHRITIS AS BEING 1590 00:55:45,840 --> 00:55:49,560 YOUNGER, BUT JOHANNA IS A 1591 00:55:49,560 --> 00:55:51,400 32-YEAR-OLD HISPANIC FEMALE 1592 00:55:51,400 --> 00:55:52,080 LIVING IN MASSACHUSETTS. 1593 00:55:52,080 --> 00:55:53,280 SHE DIDN'T FINISH HIGH SCHOOL, 1594 00:55:53,280 --> 00:55:54,480 SHE'S EMPLOYED PART-TIME. 1595 00:55:54,480 --> 00:55:57,640 SHE HAS A NUMBER OF DIFFERENT 1596 00:55:57,640 --> 00:55:59,520 HEALTH NEED-BASED CRITERIA, 1597 00:55:59,520 --> 00:56:01,080 INCLUDING BOTH PHYSICAL AND 1598 00:56:01,080 --> 00:56:03,120 BEHAVIORAL HEALTH CHALLENGES. 1599 00:56:03,120 --> 00:56:05,520 ONE OF THOSE BEING ARTHRITIS AND 1600 00:56:05,520 --> 00:56:07,920 PAIN MANAGEMENT, BUT ALSO HAVING 1601 00:56:07,920 --> 00:56:10,080 DEPRESSION, ANXIETY, AND IN HER 1602 00:56:10,080 --> 00:56:13,280 CASE BIPOLAR DISORDER, AND 1603 00:56:13,280 --> 00:56:15,720 AGAIN, SOCIAL DETERMINANTS OF 1604 00:56:15,720 --> 00:56:17,200 HEALTH, LOOKING AT THE WHOLE 1605 00:56:17,200 --> 00:56:19,000 PERSON, WHILE THOSE THINGS, 1606 00:56:19,000 --> 00:56:22,040 THOSE BEHAVIORAL AND BEHAVIORAL 1607 00:56:22,040 --> 00:56:23,360 AND PHYSICAL HEALTH CHALLENGES 1608 00:56:23,360 --> 00:56:25,120 ARE HUGE AND DAUNTING, JOANNA 1609 00:56:25,120 --> 00:56:27,640 WAS ALSO A PERSON WHO HAD THIS 1610 00:56:27,640 --> 00:56:30,640 OVERWHELMING STRESSOR OF HAVING 1611 00:56:30,640 --> 00:56:32,880 A DOMESTIC RELATIONS CHALLENGE 1612 00:56:32,880 --> 00:56:35,080 AROUND MAINTAINING CUSTODY OF 1613 00:56:35,080 --> 00:56:35,680 HER CHILDREN. 1614 00:56:35,680 --> 00:56:37,480 SO SHE WAS AT RISK FOR 1615 00:56:37,480 --> 00:56:39,720 HOMELESSNESS, SHE WAS ALSO AT 1616 00:56:39,720 --> 00:56:43,040 RISK FOR NUTRITION DEFICIENCY, 1617 00:56:43,040 --> 00:56:44,560 AND THE PAIN REALLY PROHIBITED 1618 00:56:44,560 --> 00:56:46,440 HER FROM MOVING FORWARD. 1619 00:56:46,440 --> 00:56:49,760 SHE BECAME INVOLVED IN ONE OF 1620 00:56:49,760 --> 00:56:52,120 THE CHRONIC PAIN SELF MANAGEMENT 1621 00:56:52,120 --> 00:56:52,600 PROGRAMS. 1622 00:56:52,600 --> 00:56:54,880 WE PROVIDED TRANSPORTATION TO 1623 00:56:54,880 --> 00:56:58,160 THAT PROGRAM AS WELL AS 1624 00:56:58,160 --> 00:56:59,320 TRANSPORTATION TO THE FOOD 1625 00:56:59,320 --> 00:57:01,440 MARKET, WE PROVIDED GIFT CARDS 1626 00:57:01,440 --> 00:57:03,840 FOR HER, WE PROVIDED A 1627 00:57:03,840 --> 00:57:04,920 REGISTERED DIETITIAN THAT GO TO 1628 00:57:04,920 --> 00:57:06,240 THE GROCERY STORE WITH HER AND 1629 00:57:06,240 --> 00:57:07,880 HELP HER LEARN HOW TO NAVIGATE 1630 00:57:07,880 --> 00:57:10,600 AND MAKE HEALTHY CHOICES. 1631 00:57:10,600 --> 00:57:12,240 WE HELPED HER GET ALL OF HER 1632 00:57:12,240 --> 00:57:13,320 PAPERWORK TOGETHER AND WE GOT 1633 00:57:13,320 --> 00:57:15,080 HER CONNECTED WITH A BEHAVIORAL 1634 00:57:15,080 --> 00:57:17,720 HEALTH CLINICIAN. 1635 00:57:17,720 --> 00:57:19,560 SO ALL OF THAT COMING IN FROM A 1636 00:57:19,560 --> 00:57:20,560 REFERRAL WHERE WE THOUGHT THE 1637 00:57:20,560 --> 00:57:23,600 PRIMARY CONCERN WAS MANAGING 1638 00:57:23,600 --> 00:57:25,480 ARTHRITIS, THAT WAS A VERY 1639 00:57:25,480 --> 00:57:26,360 ESSENTIAL AND VERY IMPORTANT 1640 00:57:26,360 --> 00:57:27,440 CONCERN, BUT BEFORE SHE COULD 1641 00:57:27,440 --> 00:57:30,600 FOCUS ON ALL OF THAT, WE REALLY 1642 00:57:30,600 --> 00:57:32,680 HAD TO LOOK AT ALL OF THE OTHER 1643 00:57:32,680 --> 00:57:34,880 SOCIETAL CHALLENGES AND PROVIDE 1644 00:57:34,880 --> 00:57:35,560 RESOURCES TO SUPPORT THAT. 1645 00:57:35,560 --> 00:57:38,240 SO I'M CERTAINLY AVAILABLE TO 1646 00:57:38,240 --> 00:57:40,040 TALK, ANSWER QUESTIONS TODAY OR 1647 00:57:40,040 --> 00:57:41,120 TALK OFFLINE. 1648 00:57:41,120 --> 00:57:43,520 I ENCOURAGE FOLKS TO REACH OUT 1649 00:57:43,520 --> 00:57:46,080 TO MYSELF OR YOUR LOCAL 1650 00:57:46,080 --> 00:57:46,720 COMMUNITY-BASED ORGANIZATION, 1651 00:57:46,720 --> 00:57:49,520 WE'RE HERE TO HELP. 1652 00:57:49,520 --> 00:57:49,920 THANK YOU 1653 00:57:49,920 --> 00:57:50,840 >> THANK YOU SO MUCH. 1654 00:57:50,840 --> 00:57:52,280 THAT WAS REALLY A WONDERFUL 1655 00:57:52,280 --> 00:57:52,760 PRESENTATION. 1656 00:57:52,760 --> 00:57:54,160 AND I WANT TO THANK ALL OF OUR 1657 00:57:54,160 --> 00:57:56,120 PANELISTS FOR REALLY THOUGHTFUL 1658 00:57:56,120 --> 00:57:59,920 PRESENTATIONS THAT I THINK SHONE 1659 00:57:59,920 --> 00:58:02,200 A LIGHT ON AREAS THAT ARE OFTEN 1660 00:58:02,200 --> 00:58:06,840 BELIEUNDERSTUDIED AND UNDERADDRD 1661 00:58:06,840 --> 00:58:07,840 IN THE RESEARCH THAT WE DO. 1662 00:58:07,840 --> 00:58:09,240 SO WE'D LOVE TO -- THERE HAVE 1663 00:58:09,240 --> 00:58:11,320 BEEN SOME GREAT RESOURCES PLACED 1664 00:58:11,320 --> 00:58:13,840 IN THE CHAT, BUT WE'D LOVE TO 1665 00:58:13,840 --> 00:58:15,120 KNOW IF THERE ARE ANY QUESTIONS. 1666 00:58:15,120 --> 00:58:16,920 WE ONLY HAVE TIME FOR ONE OR TWO 1667 00:58:16,920 --> 00:58:18,200 QUESTIONS FROM THE AUDIENCE. 1668 00:58:18,200 --> 00:58:20,720 AND WE'D LIKE TO MAKE SURE THAT 1669 00:58:20,720 --> 00:58:31,160 THOSE QUESTIONS GET ASKED. 1670 00:58:37,080 --> 00:58:38,200 AND I ACTUALLY HAVE A QUESTION 1671 00:58:38,200 --> 00:58:39,440 FOR THE PANELISTS. 1672 00:58:39,440 --> 00:58:41,480 I'M WONDERING IF -- AND THIS IS 1673 00:58:41,480 --> 00:58:47,200 INFORMED BY A QUESTION THAT WAS 1674 00:58:47,200 --> 00:58:51,120 SENT, BOTH YESTERDAY AND TODAY 1675 00:58:51,120 --> 00:58:52,200 IS, IF THERE'S RESEARCH THAT 1676 00:58:52,200 --> 00:58:53,640 SHOULD BE DONE, WHAT DO YOU 1677 00:58:53,640 --> 00:58:56,480 THINK ARE THE PRIORITY RESEARCH 1678 00:58:56,480 --> 00:58:59,200 AREAS THAT WOULD HELP YOU AS A 1679 00:58:59,200 --> 00:59:04,360 PATIENT, MISS OVERTON, YOU AS A 1680 00:59:04,360 --> 00:59:10,920 PROVIDER, TUHINA, OR YOU AS A 1681 00:59:10,920 --> 00:59:14,000 COMMUNITY AGENCY, JENNIFER? 1682 00:59:14,000 --> 00:59:15,960 AS A REPRESENTATIVE OF A 1683 00:59:15,960 --> 00:59:16,920 COMMUNITY AGENCY? 1684 00:59:16,920 --> 00:59:17,920 LOVE TO GET YOUR THOUGHTS ON 1685 00:59:17,920 --> 00:59:19,680 THAT. 1686 00:59:19,680 --> 00:59:23,600 >> FOR MYSELF, I'LL JUMP IN REAL 1687 00:59:23,600 --> 00:59:23,960 QUICK. 1688 00:59:23,960 --> 00:59:29,080 IT WOULD BE ADVANTAGEOUS TO ME 1689 00:59:29,080 --> 00:59:32,760 TO HAVE MY INTERNAL MEDICINE 1690 00:59:32,760 --> 00:59:34,000 DOCTOR, THE FIRST DOCTOR I GO TO 1691 00:59:34,000 --> 00:59:38,880 SEE, THE ONE THAT I GET MY 1692 00:59:38,880 --> 00:59:41,120 YEARLY UPDATES TO REACH OUT TO 1693 00:59:41,120 --> 00:59:45,040 THE PAIN CLINIC TO SAY, WELL, 1694 00:59:45,040 --> 00:59:47,400 SHE DOESN'T HAVE JUST THIS ONE 1695 00:59:47,400 --> 00:59:48,440 THING, WE'RE DEALING WITH ALL 1696 00:59:48,440 --> 00:59:52,920 THESE OTHER THINGS. 1697 00:59:52,920 --> 00:59:54,440 : BLOOD 1698 00:59:54,440 --> 00:59:55,440 PRESSURE, PRE-DIABETES. 1699 00:59:55,440 --> 00:59:58,600 WHAT DO YOU SUGGEST I GIVE TO 1700 00:59:58,600 --> 01:00:00,480 HER AND THAT WOULD BE COMING 1701 01:00:00,480 --> 01:00:02,960 FROM THE ONE THAT I HAD THE 1702 01:00:02,960 --> 01:00:04,520 CLOSEST RELATIONSHIP WITH, WHICH 1703 01:00:04,520 --> 01:00:07,920 IS MY INTERNAL MEDICINE DOCTOR. 1704 01:00:07,920 --> 01:00:09,880 BUT I JUST KIND OF FEEL LIKE I'M 1705 01:00:09,880 --> 01:00:11,960 SCOOTED AWAY, AS SOON AS I SAY 1706 01:00:11,960 --> 01:00:14,360 "PAIN," I'M THROWN TO THE PAIN 1707 01:00:14,360 --> 01:00:16,000 CLINIC AND THEY ARE VERY 1708 01:00:16,000 --> 01:00:17,200 DETAILED IN WHETHER THEY'RE 1709 01:00:17,200 --> 01:00:18,720 GOING TO DO AN OPERATION, WHICH 1710 01:00:18,720 --> 01:00:21,160 I CAN'T HAVE ANY MORE OF, OR 1711 01:00:21,160 --> 01:00:24,280 THERE ISN'T AN OPERATION FOR MY 1712 01:00:24,280 --> 01:00:28,120 HANDS, TO GIVE ME EXERCISE, 1713 01:00:28,120 --> 01:00:30,000 DIET, I DON'T KNOW. 1714 01:00:30,000 --> 01:00:31,840 AS I UNDERSTAND THAT THERE ISN'T 1715 01:00:31,840 --> 01:00:34,040 ANYTHING AT THIS POINT, BUT 1716 01:00:34,040 --> 01:00:37,320 SOMETHING TO RELIEVE MY FEELING 1717 01:00:37,320 --> 01:00:42,360 THAT NOBODY CARES. 1718 01:00:42,360 --> 01:00:44,880 >> SO TO HAVE BETTER 1719 01:00:44,880 --> 01:00:46,000 COORDINATION AND FOCUS ON THE 1720 01:00:46,000 --> 01:00:46,200 PATIENT. 1721 01:00:46,200 --> 01:00:47,720 >> YES, FOR ME. 1722 01:00:47,720 --> 01:00:49,040 >> THANK YOU. 1723 01:00:49,040 --> 01:00:51,800 >> I WOULD AGREE WITH WHAT MISS 1724 01:00:51,800 --> 01:00:53,280 OVERTON HAS SHARED, AND I WOULD 1725 01:00:53,280 --> 01:00:57,440 ADD TO THAT, YOU KNOW, WE ARE 1726 01:00:57,440 --> 01:00:58,560 SEEING EMERGING MORE RESEARCH ON 1727 01:00:58,560 --> 01:01:01,720 THE ROLE OF NON-CLINICAL 1728 01:01:01,720 --> 01:01:02,880 INTERVENTIONS, AND PARTICULARLY 1729 01:01:02,880 --> 01:01:04,680 THE ROLE OF COMMUNITY HEALTH 1730 01:01:04,680 --> 01:01:06,640 WORKERS, COMMUNITY OUTREACH 1731 01:01:06,640 --> 01:01:08,280 WORKERS, AND I'D LOVE TO SEE A 1732 01:01:08,280 --> 01:01:11,000 BIT MORE AROUND THAT, 1733 01:01:11,000 --> 01:01:12,640 PARTICULARLY IN BIPOC 1734 01:01:12,640 --> 01:01:15,960 COMMUNITIES, WE CAN CERTAINLY 1735 01:01:15,960 --> 01:01:17,560 TALK ABOUT FROM A TESTIMONIAL 1736 01:01:17,560 --> 01:01:21,400 STANDPOINT WHAT WE SEE IN TERMS 1737 01:01:21,400 --> 01:01:23,920 OF THE ROLE THAT NON-CLINICAL 1738 01:01:23,920 --> 01:01:24,960 INTERVENTIONS AND COMMUNITY 1739 01:01:24,960 --> 01:01:26,760 HEALTH WORKERS, COMMUNITY 1740 01:01:26,760 --> 01:01:28,080 OUTREACH WORKERS CAN PROVIDE IN 1741 01:01:28,080 --> 01:01:30,400 HELPING TO MANAGE PAIN, BUT I'D 1742 01:01:30,400 --> 01:01:33,560 LOVE TO SEE MORE RESEARCH. 1743 01:01:33,560 --> 01:01:35,200 >> I KNOW WE'RE OUT OF TIME SO 1744 01:01:35,200 --> 01:01:36,280 I'LL MAKE TWO SMALL COMMENTS. 1745 01:01:36,280 --> 01:01:39,480 ONE IS, MISS OVERTON'S 1746 01:01:39,480 --> 01:01:41,720 PERSPECTIVE IS ABSOLUTELY 1747 01:01:41,720 --> 01:01:41,960 SPOT-ON. 1748 01:01:41,960 --> 01:01:44,040 WE DO NOT DO A GOOD JOB AS 1749 01:01:44,040 --> 01:01:45,320 CLINICIANS OF MANAGING PAIN. 1750 01:01:45,320 --> 01:01:46,440 IT STARTS ALL THE WAY FROM 1751 01:01:46,440 --> 01:01:49,160 MEDICAL SCHOOL TRAINING. 1752 01:01:49,160 --> 01:01:50,520 NO ONE REALLY OWNS IT. 1753 01:01:50,520 --> 01:01:52,160 IN MEDICINE, WE KIND OF TREAT IT 1754 01:01:52,160 --> 01:01:54,560 BASED ON THE ANATOMY, LOCATION 1755 01:01:54,560 --> 01:01:58,800 OF PAIN, AS OPPOSED TO THINKING 1756 01:01:58,800 --> 01:02:00,800 ABOUT MANAGING PAIN 1757 01:02:00,800 --> 01:02:01,440 COMPREHENSIVELY. 1758 01:02:01,440 --> 01:02:02,440 AND FROM THE RESEARCH 1759 01:02:02,440 --> 01:02:06,760 PERSPECTIVE, I THINK WE HAVE A 1760 01:02:06,760 --> 01:02:09,480 LOT OF GOOD STUDIES AND VARIOUS 1761 01:02:09,480 --> 01:02:10,680 MANAGEMENT OPTIONS IN 1762 01:02:10,680 --> 01:02:11,320 OSTEOARTHRITIS. 1763 01:02:11,320 --> 01:02:12,560 THE ISSUE IS IMPLEMENTATION. 1764 01:02:12,560 --> 01:02:13,640 ONE OF THE AREAS OF RESEARCH 1765 01:02:13,640 --> 01:02:16,560 THAT WE NEED IS IMPROVING 1766 01:02:16,560 --> 01:02:18,960 IMPLEMENTATION. 1767 01:02:18,960 --> 01:02:19,640 PATIENT EDUCATION, THEY'RE GOING 1768 01:02:19,640 --> 01:02:21,520 TO VARIOUS SOURCES FOR 1769 01:02:21,520 --> 01:02:27,200 INFORMATION, NOT ALL OF WHICH IS 1770 01:02:27,200 --> 01:02:28,200 TRUSTWORTHY, SO THERE ARE MANY 1771 01:02:28,200 --> 01:02:29,160 AREAS THAT WE CAN IMPROVE. 1772 01:02:29,160 --> 01:02:30,800 I WANT TO ALSO ECHO AND PUT IN A 1773 01:02:30,800 --> 01:02:32,640 PLUG FOR THE ARTHRITIS 1774 01:02:32,640 --> 01:02:33,760 FOUNDATION'S WALK WITH EASE 1775 01:02:33,760 --> 01:02:34,080 PROGRAM. 1776 01:02:34,080 --> 01:02:37,600 THAT'S SOMETHING THAT CAN BE 1777 01:02:37,600 --> 01:02:39,880 READILY ACCESSED BY INDIVIDUALS. 1778 01:02:39,880 --> 01:02:42,280 AND AGAIN, PHYSICAL ACTIVITY, 1779 01:02:42,280 --> 01:02:44,120 JUST DAILY WALKING IS AMONG THE 1780 01:02:44,120 --> 01:02:45,400 CHEAPEST AND EASIEST THINGS TO 1781 01:02:45,400 --> 01:02:45,880 DO. 1782 01:02:45,880 --> 01:02:47,440 OBVIOUSLY THERE'S ISSUES OF THE 1783 01:02:47,440 --> 01:02:49,320 LIVED ENVIRONMENT AND SAFETY OF 1784 01:02:49,320 --> 01:02:54,120 THE ENVIRONMENT, BUT DOING 1785 01:02:54,120 --> 01:02:55,560 SOMETHING IS BETTER THAN DOING 1786 01:02:55,560 --> 01:02:56,520 NOTHING, AND SOMEONE PUT THAT IN 1787 01:02:56,520 --> 01:02:57,760 THE CHAT AND I MEANT TO SAY THAT 1788 01:02:57,760 --> 01:02:59,000 IN MY TALK AS WELL. 1789 01:02:59,000 --> 01:03:00,560 YOU DON'T NEED TO GO FOR 10,000 1790 01:03:00,560 --> 01:03:01,200 STEPS. 1791 01:03:01,200 --> 01:03:02,800 3,000 STEPS IS BETTER THAN ZERO 1792 01:03:02,800 --> 01:03:03,000 STEPS. 1793 01:03:03,000 --> 01:03:04,040 >> THANK YOU ALL SO MUCH. 1794 01:03:04,040 --> 01:03:05,240 THIS HAS BEEN FABULOUS. 1795 01:03:05,240 --> 01:03:06,680 I'M GOING TO TURN IT BACK OVER 1796 01:03:06,680 --> 01:03:08,440 TO KRISTY, I THINK WHO'S 1797 01:03:08,440 --> 01:03:09,240 BRINGING US TO BREAK. 1798 01:03:09,240 --> 01:03:10,480 >> YES, THANK YOU, DR. BROWN, 1799 01:03:10,480 --> 01:03:11,920 AND AGAIN, THANK YOU TO ALL OF 1800 01:03:11,920 --> 01:03:13,280 OUR SPEAKERS IN THIS WONDERFUL 1801 01:03:13,280 --> 01:03:13,600 SESSION. 1802 01:03:13,600 --> 01:03:15,200 WE REALLY APPRECIATE YOUR TIME. 1803 01:03:15,200 --> 01:03:16,640 SO WE ARE GOING TO TAKE A SHORT 1804 01:03:16,640 --> 01:03:18,280 BREAK BEFORE WE MOVE TO THE 1805 01:03:18,280 --> 01:03:18,760 BREAKOUT SESSIONS. 1806 01:03:18,760 --> 01:03:20,920 IF YOU HAD QUESTIONS YOU WEREN'T 1807 01:03:20,920 --> 01:03:22,960 ABLE TO GET ASKED BECAUSE OF OUR 1808 01:03:22,960 --> 01:03:24,520 SHORT LIMIT OF TIME, PLEASE TAKE 1809 01:03:24,520 --> 01:03:26,240 THEM TO YOUR BREAKOUT SESSIONS. 1810 01:03:26,240 --> 01:03:27,240 HOPEFULLY THEY CAN HELP INFORM 1811 01:03:27,240 --> 01:03:28,640 OUR DISCUSSIONS TODAY. 1812 01:03:28,640 --> 01:03:31,040 WE WILL BREAK UNTIL 12:10. 1813 01:03:31,040 --> 01:03:32,480 PLEASE STAY LOGGED ON IF YOU CAN 1814 01:03:32,480 --> 01:03:34,000 SO THAT WE CAN GET YOU PUT IN 1815 01:03:34,000 --> 01:03:35,200 YOUR BREAKOUT ROOMS, AND WHEN 1816 01:03:35,200 --> 01:03:36,320 YOU COME BACK, YOU WILL COME 1817 01:03:36,320 --> 01:03:37,720 BACK INTO YOUR BREAKOUT ROOMS. 1818 01:03:37,720 --> 01:03:40,040 SO THAT WILL BE AT 12:10. 1819 01:03:40,040 --> 01:03:42,160 THANK YOU. 1820 01:03:42,160 --> 01:03:43,720 WELCOME BACK TO THE AFTERNOON 1821 01:03:43,720 --> 01:03:43,960 SESSIONS. 1822 01:03:43,960 --> 01:03:45,920 WE'RE GOING TO GO AHEAD AND GET 1823 01:03:45,920 --> 01:03:47,760 STARTED, IT'S RIGHT AT 2:30, AND 1824 01:03:47,760 --> 01:03:49,960 WE'RE GOING TO START WITH 1825 01:03:49,960 --> 01:03:52,360 SESSION V, WHICH IS OUR REPORT 1826 01:03:52,360 --> 01:03:54,200 OUT FROM OUR BREAKOUT SESSIONS. 1827 01:03:54,200 --> 01:03:56,760 WE WANTED TO GIVE EVERYBODY THE 1828 01:03:56,760 --> 01:03:58,800 OPPORTUNITY TO HEAR THE 1829 01:03:58,800 --> 01:03:59,920 DISCUSSIONS FOR THE BREAKOUTS 1830 01:03:59,920 --> 01:04:01,080 THAT THEY WEREN'T ABLE TO ATTEND 1831 01:04:01,080 --> 01:04:02,840 BECAUSE OF THE VIRTUAL FORMAT, 1832 01:04:02,840 --> 01:04:04,040 WE WERE VERY LIMITED IN TIME. 1833 01:04:04,040 --> 01:04:05,480 SO WHAT WE'LL DO IS GET STARTED 1834 01:04:05,480 --> 01:04:08,440 WITH DR. LEIGH CALLAHAN, WHO 1835 01:04:08,440 --> 01:04:11,160 WILL PRESENT THE INFORMATION ON 1836 01:04:11,160 --> 01:04:13,360 THE PATIENT-LEVEL FACTORS. 1837 01:04:13,360 --> 01:04:14,120 DR. CALLAHAN, THE FLOOR IS 1838 01:04:14,120 --> 01:04:17,960 YOURS. 1839 01:04:17,960 --> 01:04:18,520 >> GREAT. 1840 01:04:18,520 --> 01:04:20,120 THANK YOU, KRISTY. 1841 01:04:20,120 --> 01:04:22,880 SO I'M GOING TO REPORT OUT FROM 1842 01:04:22,880 --> 01:04:23,960 OUR TWO DIFFERENT SESSIONS. 1843 01:04:23,960 --> 01:04:27,480 WE HAD A WONDERFUL, ROBUST 1844 01:04:27,480 --> 01:04:29,160 GROUP, LIVELY DISCUSSIONS, AND 1845 01:04:29,160 --> 01:04:32,800 IT WAS NICE, BOTH SESSIONS 1846 01:04:32,800 --> 01:04:36,000 INCLUDED INDIVIDUALS FROM 1847 01:04:36,000 --> 01:04:36,960 DIFFERENT CLINICAL DISCIPLINES 1848 01:04:36,960 --> 01:04:41,080 AS WELL AS RESEARCHERS AND NIH 1849 01:04:41,080 --> 01:04:47,160 STAFF. 1850 01:04:47,160 --> 01:04:48,120 SO FIRST I'M GOING TO TALK ABOUT 1851 01:04:48,120 --> 01:04:51,000 THE GAPS THAT WE DISCUSSED, AND 1852 01:04:51,000 --> 01:04:54,800 I THINK WE REALLY FOCUSED ON 1853 01:04:54,800 --> 01:04:56,000 PATIENT-LEVEL VARIABLES, BUT 1854 01:04:56,000 --> 01:04:57,120 THERE WERE A FEW THINGS THAT 1855 01:04:57,120 --> 01:05:01,040 CAME UP IN OUR DISCUSSIONS JUST 1856 01:05:01,040 --> 01:05:03,800 THAT WE'LL REPORT ON TANGENTIAL 1857 01:05:03,800 --> 01:05:04,880 RELATIONSHIPS. 1858 01:05:04,880 --> 01:05:07,400 INITIALLY, THERE WAS A LOT OF 1859 01:05:07,400 --> 01:05:08,160 DISCUSSION ABOUT THE MEASURES 1860 01:05:08,160 --> 01:05:10,640 THAT ARE USED CURRENTLY IN 1861 01:05:10,640 --> 01:05:14,480 STUDIES OR MEASURES THAT ARE 1862 01:05:14,480 --> 01:05:15,840 COLLECTED IN LARGE 1863 01:05:15,840 --> 01:05:18,120 ADMINISTRATIVE DATASETS AND 1864 01:05:18,120 --> 01:05:23,560 THINGS LIKE CMS OR INSURANCE 1865 01:05:23,560 --> 01:05:24,760 COMPANIES AS WELL AS THE ITEMS 1866 01:05:24,760 --> 01:05:28,360 THAT ARE COLLECTED IN CLINICAL 1867 01:05:28,360 --> 01:05:31,000 TRIALS. 1868 01:05:31,000 --> 01:05:34,160 SO IN TERMS OF GAPS, WE NOTED 1869 01:05:34,160 --> 01:05:36,480 THERE WERE A LACK OF CONSISTENT 1870 01:05:36,480 --> 01:05:37,920 AND STANDARDIZED MEASURES 1871 01:05:37,920 --> 01:05:39,640 UTILIZED IN LARGE ADMINISTRATIVE 1872 01:05:39,640 --> 01:05:40,080 DATASETS. 1873 01:05:40,080 --> 01:05:44,680 AND THEN WE HAD A LOT OF -- FROM 1874 01:05:44,680 --> 01:05:45,760 THAT, WE WERE REFERRING TO 1875 01:05:45,760 --> 01:05:46,760 ALTHOUGH THERE ARE SOME MEASURES 1876 01:05:46,760 --> 01:05:48,280 THAT HAVE BEEN LOOKED AT 1877 01:05:48,280 --> 01:05:51,040 ROUTINELY IN A NUMBER OF THE 1878 01:05:51,040 --> 01:05:52,240 STUDIES AND TRIALS AND THINGS 1879 01:05:52,240 --> 01:05:56,160 THAT WERE PRESENTED BY DR. KATZ 1880 01:05:56,160 --> 01:05:59,320 IN HIS LECTURE, THOSE THINGS 1881 01:05:59,320 --> 01:06:00,640 LIKE EDUCATION, INCOME, THAT 1882 01:06:00,640 --> 01:06:04,720 TYPE OF THING, THEY STILL AREN'T 1883 01:06:04,720 --> 01:06:06,000 CONSISTENTLY COLLECTED, AND THEN 1884 01:06:06,000 --> 01:06:07,640 IN ADDITION, THERE ARE MANY 1885 01:06:07,640 --> 01:06:12,880 MEASURES THAT WOULD GET AT THE 1886 01:06:12,880 --> 01:06:15,520 COMPLEXITIES AND THE NUANCES 1887 01:06:15,520 --> 01:06:18,400 THAT ADDRESS SOME OF THESE GAPS 1888 01:06:18,400 --> 01:06:20,040 IN DISPARITIES. 1889 01:06:20,040 --> 01:06:24,080 SO THESE ME SO MEASURES THAT ART 1890 01:06:24,080 --> 01:06:25,800 COLLECTED ROUTINELY INCLUDE 1891 01:06:25,800 --> 01:06:27,560 MEASURES OF THINGS LIKE CULTURAL 1892 01:06:27,560 --> 01:06:28,880 DIFFERENCES, PATIENT 1893 01:06:28,880 --> 01:06:30,640 WILLINGNESS, NON-TRADITIONAL 1894 01:06:30,640 --> 01:06:36,760 DOMAINS SUCH AS KA T CATASTROPHG 1895 01:06:36,760 --> 01:06:38,960 OR SELF-EFFICACY, AND MEASURES 1896 01:06:38,960 --> 01:06:43,000 IMPORTANT TO PEOPLE IN ANOTHER 1897 01:06:43,000 --> 01:06:46,720 WAY. 1898 01:06:46,720 --> 01:06:49,040 MEASUREMENT FOR PROTECTIVE AND 1899 01:06:49,040 --> 01:06:51,960 VULNERABLE TRAITS, PEOPLE THAT 1900 01:06:51,960 --> 01:06:52,960 ARE CATASTROPHIZING AND THINGS 1901 01:06:52,960 --> 01:06:53,920 LIKE THAT. 1902 01:06:53,920 --> 01:06:55,240 A LACK OF FOCUS ON THE LIFE 1903 01:06:55,240 --> 01:06:57,440 COURSE AND THE LIVED EXPERIENCE 1904 01:06:57,440 --> 01:06:58,520 OF THE INDIVIDUAL. 1905 01:06:58,520 --> 01:06:59,920 MEASUREMENT OF COMFORT WITH THE 1906 01:06:59,920 --> 01:07:02,480 USE OF TECHNOLOGY AS WELL AS 1907 01:07:02,480 --> 01:07:04,000 MEASUREMENT OF ACCESS TO 1908 01:07:04,000 --> 01:07:06,600 TECHNOLOGY USE. 1909 01:07:06,600 --> 01:07:09,240 AND THIS WAS NOTED PARTICULARLY 1910 01:07:09,240 --> 01:07:10,360 IN REFERENCE TO WHAT WE'VE 1911 01:07:10,360 --> 01:07:13,160 EXPERIENCED WITH THE COVID 1912 01:07:13,160 --> 01:07:15,040 PANDEMIC AND WHERE PEOPLE MOVE 1913 01:07:15,040 --> 01:07:18,320 TO TELEHEALTH AND TRYING TO 1914 01:07:18,320 --> 01:07:19,840 MEASURE BOTH OF THOSE. 1915 01:07:19,840 --> 01:07:20,960 ASSESSMENT OF PATIENT FACTORS 1916 01:07:20,960 --> 01:07:24,040 FROM A MOLECULAR AND GENETIC 1917 01:07:24,040 --> 01:07:27,720 LEVEL, ASSESSMENT OF LEARNING 1918 01:07:27,720 --> 01:07:30,320 STYLE AND LEARNING PREFERENCES 1919 01:07:30,320 --> 01:07:31,680 AS WELL AS THE HEALTH LITERACY 1920 01:07:31,680 --> 01:07:34,680 OF THE PATIENT, ASSESSMENT OF 1921 01:07:34,680 --> 01:07:35,800 COMPREHENSION OF INFORMATION 1922 01:07:35,800 --> 01:07:36,480 RECEIVED FROM PROVIDERS AND 1923 01:07:36,480 --> 01:07:38,120 OTHER SOURCES, AND THEN 1924 01:07:38,120 --> 01:07:40,160 ASSESSMENT OF CO-MORBID 1925 01:07:40,160 --> 01:07:41,840 CONDITIONS THAT THE PARTICIPANT 1926 01:07:41,840 --> 01:07:45,640 MIGHT HAVE IN ADDITION TO THEIR 1927 01:07:45,640 --> 01:07:47,760 OA. 1928 01:07:47,760 --> 01:07:49,160 SO ALL OF THESE WERE PUT ON THE 1929 01:07:49,160 --> 01:07:52,000 TABLE AS THINGS THAT COULD BE 1930 01:07:52,000 --> 01:07:56,480 CONSIDERED FOR MORE ROBUST AND 1931 01:07:56,480 --> 01:07:57,120 OBVIOUSLY EVERYTHING WOULD NOT 1932 01:07:57,120 --> 01:07:59,000 BE ABLE TO BE MEASURED AT ALL 1933 01:07:59,000 --> 01:08:00,840 TIMES, BUT THESE WERE NOTED AS 1934 01:08:00,840 --> 01:08:03,080 THINGS THAT FREQUENTLY ARE NOT 1935 01:08:03,080 --> 01:08:04,120 MEASURED AND THAT COULD 1936 01:08:04,120 --> 01:08:05,680 CONTRIBUTE. 1937 01:08:05,680 --> 01:08:07,880 IN ADDITION TO THESE MEASUREMENT 1938 01:08:07,880 --> 01:08:13,440 ISSUES AND ITEMS THAT AREN'T 1939 01:08:13,440 --> 01:08:14,640 COLLECTED, OTHER THINGS WERE 1940 01:08:14,640 --> 01:08:16,360 NOTED INCLUDING THE NEED FOR 1941 01:08:16,360 --> 01:08:17,920 ENHANCING THE CROSSTALK AMONG 1942 01:08:17,920 --> 01:08:20,120 PATIENTS, PROVIDERS, COMMUNITY 1943 01:08:20,120 --> 01:08:22,000 AND HEALTH SYSTEMS. 1944 01:08:22,000 --> 01:08:24,040 AND ALTHOUGH THIS ISN'T LIKE A 1945 01:08:24,040 --> 01:08:25,000 PATIENT LEVEL FACTOR, IT WAS 1946 01:08:25,000 --> 01:08:27,000 FELT THAT IF THERE'S MORE 1947 01:08:27,000 --> 01:08:28,400 CROSSTALK WITH PATIENTS 1948 01:08:28,400 --> 01:08:30,040 INVOLVED, THAT THAT COULD 1949 01:08:30,040 --> 01:08:31,160 ENHANCE MANY OF THE PATIENT 1950 01:08:31,160 --> 01:08:33,800 LEVEL FACTORS. 1951 01:08:33,800 --> 01:08:36,080 THERE'S A GAP IN TERMS OF 1952 01:08:36,080 --> 01:08:38,480 MINORITY AND UNDERREPRESENTED 1953 01:08:38,480 --> 01:08:40,680 POPULATIONS BEING REFLECTED IN 1954 01:08:40,680 --> 01:08:44,080 LARGE DATASETS, AND THERE WAS A 1955 01:08:44,080 --> 01:08:45,680 FAIR AMOUNT OF DISCUSSION ABOUT 1956 01:08:45,680 --> 01:08:48,320 THE FACT THAT YOU MIGHT HAVE 1957 01:08:48,320 --> 01:08:50,160 PEOPLE WHO ARE ANALYZING 1958 01:08:50,160 --> 01:08:51,360 MINORITY POPULATIONS, FOR 1959 01:08:51,360 --> 01:08:55,400 EXAMPLE, IN SOMETHING LIKE THE 1960 01:08:55,400 --> 01:08:59,400 OAI, BUT THAT ONLY HAS 17% 1961 01:08:59,400 --> 01:09:00,240 MINORITY POPULATION. 1962 01:09:00,240 --> 01:09:05,400 SO IF OUR DATASETS HAVE A SMALL 1963 01:09:05,400 --> 01:09:06,840 GROUP, AND MAYBE THAT GROUP IS 1964 01:09:06,840 --> 01:09:09,120 NOT REFLECTIVE OF THE WHOLE 1965 01:09:09,120 --> 01:09:10,680 NON-MINORITY POPULATION, DOING 1966 01:09:10,680 --> 01:09:15,040 THESE COMPARISONS LEADS TO 1967 01:09:15,040 --> 01:09:17,640 INADEQUATE REFLECTION OF WHAT 1968 01:09:17,640 --> 01:09:20,800 THE OUTCOMES ARE. 1969 01:09:20,800 --> 01:09:22,240 ALSO THERE WAS DISCUSSION THAT 1970 01:09:22,240 --> 01:09:26,560 THERE'S NO CONSENSUS ABOUT ONE 1971 01:09:26,560 --> 01:09:27,560 SPECIFIC SOCIAL DETERMINANTS OF 1972 01:09:27,560 --> 01:09:31,200 HEALTH FRAMEWORK. 1973 01:09:31,200 --> 01:09:34,480 THREE FRA FRAMEWORKS WERE BROUGP 1974 01:09:34,480 --> 01:09:36,440 WITHIN THE MEETING. 1975 01:09:36,440 --> 01:09:40,280 THE NIMHD, NIA AND ALSO THE 1976 01:09:40,280 --> 01:09:42,280 HEALTHY PEOPLE 2030. 1977 01:09:42,280 --> 01:09:45,000 AND THERE WAS DISCUSSION THAT 1978 01:09:45,000 --> 01:09:46,880 PEOPLE -- PATIENT LEVEL FACTORS 1979 01:09:46,880 --> 01:09:50,920 WERE IN ALL OF THOSE FRAME 1980 01:09:50,920 --> 01:09:52,640 WORKS, IF YOU'RE APPLYING FOR 1981 01:09:52,640 --> 01:09:56,360 DIFFERENT GRANTS OR TRYING TO 1982 01:09:56,360 --> 01:09:57,880 USE -- PICK A FRAMEWORK, HOW TO 1983 01:09:57,880 --> 01:10:00,760 PICK THAT FRAMEWORK AND WHAT ARE 1984 01:10:00,760 --> 01:10:02,200 THE STRENGTHS AND WEAKNESSES OF 1985 01:10:02,200 --> 01:10:03,400 THE FRAME WORKS. 1986 01:10:03,400 --> 01:10:06,560 AND THEN LASTLY, A GAP WAS THAT 1987 01:10:06,560 --> 01:10:08,200 THERE'S A NEED FOR A WORKFORCE 1988 01:10:08,200 --> 01:10:09,480 THAT REFLECTS DIVERSE 1989 01:10:09,480 --> 01:10:11,360 POPULATIONS. 1990 01:10:11,360 --> 01:10:14,720 AND BY HAVING A MORE REFLECTIVE 1991 01:10:14,720 --> 01:10:18,240 WORKFORCE, IT MIGHT BE EASIER TO 1992 01:10:18,240 --> 01:10:21,200 RECRUIT INDIVIDUALS INTO STUDIES 1993 01:10:21,200 --> 01:10:23,600 IF THE INDIVIDUALS WHO ARE 1994 01:10:23,600 --> 01:10:25,680 CARING FOR THEM OR CONDUCTING 1995 01:10:25,680 --> 01:10:30,280 STUT STUDIES REFLECT THE POPULA. 1996 01:10:30,280 --> 01:10:33,560 WE'VE SORT OF LOOKED AT 1997 01:10:33,560 --> 01:10:34,880 OPPORTUNITIES IN TERMS OF SHORT 1998 01:10:34,880 --> 01:10:37,800 TERM, IP INTERMEDIATE AND LONG 1999 01:10:37,800 --> 01:10:38,240 TERM. 2000 01:10:38,240 --> 01:10:42,840 AND FROM THE SHORT TERM AS I 2001 01:10:42,840 --> 01:10:44,840 NOTED, THERE HAVE BEEN 2002 01:10:44,840 --> 01:10:46,440 SUBSTANTIAL WORK IDENTIFYING 2003 01:10:46,440 --> 01:10:48,520 MANY PATIENT LEVEL FACTORS THAT 2004 01:10:48,520 --> 01:10:49,280 CONTRIBUTE TO SOCIAL 2005 01:10:49,280 --> 01:10:50,080 DETERMINANTS OF HEALTH. 2006 01:10:50,080 --> 01:10:52,480 AND WE FELT LIKE THOSE COULD 2007 01:10:52,480 --> 01:10:54,320 IMMEDIATELY BE RECOMMENDED FOR 2008 01:10:54,320 --> 01:10:55,640 INCLUSION IN LARGE 2009 01:10:55,640 --> 01:10:58,040 ADMINISTRATIVE DATASETS OR 2010 01:10:58,040 --> 01:10:59,480 PROPOSED TRIALS. 2011 01:10:59,480 --> 01:11:01,000 AND THEN MORE GRANULAR WORK 2012 01:11:01,000 --> 01:11:04,360 COULD BE DONE TO IDENTIFY THE 2013 01:11:04,360 --> 01:11:06,560 INCLUSION AND THE MEASURES OF 2014 01:11:06,560 --> 01:11:08,360 ALL OF THE GAPS THAT WERE LISTED 2015 01:11:08,360 --> 01:11:10,200 ON THE PREVIOUS SLIDE BUT IN THE 2016 01:11:10,200 --> 01:11:12,160 SHORT TERM, THE ONES WHERE THE 2017 01:11:12,160 --> 01:11:13,240 SUBSTANTIAL WORK HAS BEEN DONE 2018 01:11:13,240 --> 01:11:14,800 COULD BE RECOMMENDED THAT THEY 2019 01:11:14,800 --> 01:11:19,600 SHOULD ALWAYS BE INCLUDED. 2020 01:11:19,600 --> 01:11:20,920 ANOTHER SHORT TERM OPPORTUNITY 2021 01:11:20,920 --> 01:11:22,320 IS THAT INDIVIDUALS FROM A RANGE 2022 01:11:22,320 --> 01:11:23,880 OF DISCIPLINES AND FIELDS ARE 2023 01:11:23,880 --> 01:11:28,560 INTERESTED IN HEALTH DISPARITIES 2024 01:11:28,560 --> 01:11:30,000 AND THAT WAS REFLECTED BY THE 2025 01:11:30,000 --> 01:11:32,920 PARTICIPATION IN THIS 2026 01:11:32,920 --> 01:11:33,800 CONFERENCE, AND THERE WAS A 2027 01:11:33,800 --> 01:11:34,520 RECOMMENDATION THAT WE COULD 2028 01:11:34,520 --> 01:11:35,480 HAVE MORE COLLABORATIVE 2029 01:11:35,480 --> 01:11:36,880 DISCUSSIONS BETWEEN THESE GROUPS 2030 01:11:36,880 --> 01:11:39,680 AND THESE DISCUSSIONS WOULDN'T 2031 01:11:39,680 --> 01:11:40,920 NEED TO BE TWO-DAY CONFERENCES 2032 01:11:40,920 --> 01:11:43,880 BUT THEY COULD BE SHORTER ONE OR 2033 01:11:43,880 --> 01:11:45,040 TWO-HOUR INTERCHANGES WHERE 2034 01:11:45,040 --> 01:11:47,520 PEOPLE COULD BE TALKING ABOUT A 2035 01:11:47,520 --> 01:11:51,080 LOT OF THE IDEAS THAT WILL BE 2036 01:11:51,080 --> 01:11:52,640 IDENTIFIED AS NOT ONLY PATIENT 2037 01:11:52,640 --> 01:11:53,840 LEVEL FACTORS BUT OTHER GROUPS 2038 01:11:53,840 --> 01:11:55,240 TODAY AND THIS COULD BE 2039 01:11:55,240 --> 01:11:58,640 FACILITATED BY THE NIH. 2040 01:11:58,640 --> 01:11:59,960 ANOTHER SHORT TERM IS TO HAVE 2041 01:11:59,960 --> 01:12:01,600 SUPPLEMENTS TO EXISTING LARGE 2042 01:12:01,600 --> 01:12:06,040 RESEARCH STUDIES AROUND OBESITY, 2043 01:12:06,040 --> 01:12:08,720 PAIN AND OA FOR ENHANCING 2044 01:12:08,720 --> 01:12:10,760 MINORITY AND UNDERREPRESENTED 2045 01:12:10,760 --> 01:12:11,120 PARTICIPANTS. 2046 01:12:11,120 --> 01:12:13,080 AND THEN BACK TO THE FRAMEWORKS, 2047 01:12:13,080 --> 01:12:15,040 PERHAPS THERE COULD BE 2048 01:12:15,040 --> 01:12:18,200 REPRESENTATIVES FROM EACH 2049 01:12:18,200 --> 01:12:20,400 FRAMEWORK, NIMHD, NIA AND 2050 01:12:20,400 --> 01:12:23,240 HEALTHY PEOPLE 2030, HAVE THEM 2051 01:12:23,240 --> 01:12:25,440 GET TOGETHER TO DEVELOP A 2052 01:12:25,440 --> 01:12:27,200 POSITION PAPER TO GUIDE 2053 01:12:27,200 --> 01:12:28,840 RESEARCHERS OR AT LEAST SOME 2054 01:12:28,840 --> 01:12:33,760 PEOPLE COULD REFER TO SORT OF A 2055 01:12:33,760 --> 01:12:35,160 COALESCING FROM THESE GROUPS. 2056 01:12:35,160 --> 01:12:37,040 AND OUR LAST SHORT TERM 2057 01:12:37,040 --> 01:12:43,280 OPPORTUNITY WAS TO RECOMMEND 2058 01:12:43,280 --> 01:12:44,360 TRIANGULATION OF OTHER 2059 01:12:44,360 --> 01:12:46,040 PROFESSIONAL AND RESEARCH GROUPS 2060 01:12:46,040 --> 01:12:48,840 IN THE OA DISEASE AREA THAT ARE 2061 01:12:48,840 --> 01:12:53,440 FOCUSING ON DISPARITIES SUCH AS 2062 01:12:53,440 --> 01:13:01,240 ORS, OAAA, ACR, AAOS, AND 2063 01:13:01,240 --> 01:13:01,800 OTHERS. 2064 01:13:01,800 --> 01:13:02,880 FOR OUR IMMEDIATE OPPORTUNITIES, 2065 01:13:02,880 --> 01:13:06,920 WE RECOMMENDED DEVELOPMENT OF A 2066 01:13:06,920 --> 01:13:08,320 MORE ROBUST CORSET OF MEASURES 2067 01:13:08,320 --> 01:13:09,720 FOR PATIENT-LEVEL FACTORS TO 2068 01:13:09,720 --> 01:13:11,080 ADDRESS THE MULTITUDE OF ITEMS 2069 01:13:11,080 --> 01:13:14,880 THAT WERE NOTED IN THE GAPS. 2070 01:13:14,880 --> 01:13:18,160 TO ENSURE PATIENT PROVIDERS 2071 01:13:18,160 --> 01:13:19,920 UNDERSTAND THE PREVALENCE, 2072 01:13:19,920 --> 01:13:21,880 IMPACT AND EPIDEMIOLOGY OF THE 2073 01:13:21,880 --> 01:13:23,960 DISEASE IN VARIOUS POPULATIONS, 2074 01:13:23,960 --> 01:13:26,480 AND THAT THEIR COMMUNICATION IS 2075 01:13:26,480 --> 01:13:27,480 APPROPRIATE. 2076 01:13:27,480 --> 01:13:33,680 AND THIS WAS INDICATING THAT IF 2077 01:13:33,680 --> 01:13:35,880 THEIR COMMUNICATION IS 2078 01:13:35,880 --> 01:13:37,360 APPROPRIATE WITH THEIR PATIENTS, 2079 01:13:37,360 --> 01:13:38,960 THERE MAY BE MORE PARTICIPANTS 2080 01:13:38,960 --> 01:13:40,360 WILLING TO PARTICIPATE IN 2081 01:13:40,360 --> 01:13:41,680 STUDIES IF THEY'RE SENDING A 2082 01:13:41,680 --> 01:13:43,000 MESSAGE ABOUT THE IMPACT OF THE 2083 01:13:43,000 --> 01:13:45,080 DISEASE. 2084 01:13:45,080 --> 01:13:48,040 AND LASTLY ANOTHER INTERMEDIATE 2085 01:13:48,040 --> 01:13:50,440 OPPORTUNITY WOULD BE TO EDUCATE 2086 01:13:50,440 --> 01:13:52,520 PARENTS, YOUTH ORGANIZATIONS, 2087 01:13:52,520 --> 01:13:55,560 COACHES, ATHLETIC TRAINERS AND 2088 01:13:55,560 --> 01:13:57,200 OTHERS ABOUT THE EARLY RISK 2089 01:13:57,200 --> 01:14:00,680 FACTORS FOR OA: OBESITY, 2090 01:14:00,680 --> 01:14:01,720 INJURY, LACK OF PHYSICAL 2091 01:14:01,720 --> 01:14:05,080 ACTIVITY, AND THESE ARE PATIENT 2092 01:14:05,080 --> 01:14:06,960 LEVEL RISK FACTORS THAT CAN 2093 01:14:06,960 --> 01:14:08,920 OCCUR EARLY IN LIFE, AND WE NEED 2094 01:14:08,920 --> 01:14:12,080 TO BE INTERVENING SO THAT 2095 01:14:12,080 --> 01:14:14,840 INDIVIDUALS UNDERSTAND THE 2096 01:14:14,840 --> 01:14:16,280 IMPORTANCE OF ADDRESSING THESE 2097 01:14:16,280 --> 01:14:20,920 RISK FACTORS EARLY. 2098 01:14:20,920 --> 01:14:22,120 LASTLY, OUR OPPORTUNITIES THAT 2099 01:14:22,120 --> 01:14:24,280 WE THINK WILL TAKE A LONGER -- 2100 01:14:24,280 --> 01:14:27,320 MUCH LONGER TIME, THESE INCLUDE 2101 01:14:27,320 --> 01:14:28,360 CHANGING THE ATTITUDES OF 2102 01:14:28,360 --> 01:14:31,120 PARTICIPANTS ABOUT STUDIES, SO 2103 01:14:31,120 --> 01:14:32,600 THAT MINORITY PARTICIPANTS DO 2104 01:14:32,600 --> 01:14:35,200 NOT FEEL LIKE GUINEA PIGS AND 2105 01:14:35,200 --> 01:14:37,120 ARE MORE WILLING TO BE PART OF 2106 01:14:37,120 --> 01:14:38,120 RESEARCH, DISPELLING THE 2107 01:14:38,120 --> 01:14:40,000 PERCEPTION THAT STUDIES LIKE 2108 01:14:40,000 --> 01:14:45,880 TUSKEGEE ARE STILL AROUND. 2109 01:14:45,880 --> 01:14:47,080 ONE OF OUR INDIVIDUALS IN OUR 2110 01:14:47,080 --> 01:14:50,920 GROUP NOTED THAT IN SOME FOCUS 2111 01:14:50,920 --> 01:14:56,120 GREUNS WHEN THEY WERE TALKING TO 2112 01:14:56,120 --> 01:14:58,480 GROUPS, THE WORD GUINEA PIG CAME 2113 01:14:58,480 --> 01:15:01,080 UP REPEATEDLY AND EVEN YOUNG 2114 01:15:01,080 --> 01:15:01,680 INDIVIDUALS MENTION TUSKEGEE 2115 01:15:01,680 --> 01:15:02,960 EVEN IF THEY DON'T KNOW THE 2116 01:15:02,960 --> 01:15:04,720 SPECIFICS OF THE STUDY. 2117 01:15:04,720 --> 01:15:06,000 WE THINK THAT PUBLIC HEALTH 2118 01:15:06,000 --> 01:15:11,040 COULD HAVE A VERY STRONG ROLE IN 2119 01:15:11,040 --> 01:15:15,640 THIS ONE. 2120 01:15:15,640 --> 01:15:17,080 NEXT, LONG TERM IS SUPPORTING 2121 01:15:17,080 --> 01:15:18,920 LARGE ONGOING DATASETS THAT 2122 01:15:18,920 --> 01:15:20,880 COLLECT DATA EXCLUSIVELY WITHIN 2123 01:15:20,880 --> 01:15:23,520 MINORITY AND UNDERREPRESENTED 2124 01:15:23,520 --> 01:15:25,120 POPULATIONS TO HAVE -- WHERE YOU 2125 01:15:25,120 --> 01:15:27,680 CAN REALLY HAVE THE PATIENT 2126 01:15:27,680 --> 01:15:31,080 LEVEL OF ALL OF THIS. 2127 01:15:31,080 --> 01:15:32,240 AND LAST LONG TERM IS THE 2128 01:15:32,240 --> 01:15:33,920 DEVELOPMENT OF A WORKFORCE THAT 2129 01:15:33,920 --> 01:15:36,400 REFLECTS THE DIVERSITY OF THE 2130 01:15:36,400 --> 01:15:37,280 POPULATION IT SERVES AND 2131 01:15:37,280 --> 01:15:39,920 CONDUCTS RESEARCH. 2132 01:15:39,920 --> 01:15:45,400 THANK YOU. 2133 01:15:45,400 --> 01:15:46,680 >> THANK YOU, DR. CALLAHAN. 2134 01:15:46,680 --> 01:15:48,440 IT SEEMS YOU GUYS HAD A REALLY 2135 01:15:48,440 --> 01:15:50,280 ROBUST DISCUSSION, AS I'M SURE 2136 01:15:50,280 --> 01:15:51,640 ALL OF THE BREAKOUT SESSIONS 2137 01:15:51,640 --> 01:15:52,080 WERE. 2138 01:15:52,080 --> 01:15:54,040 WE'RE GOING TO PIVOT FROM THE 2139 01:15:54,040 --> 01:15:58,400 AGENDA AND HAVE DR. MOY GO NEXT, 2140 01:15:58,400 --> 01:15:59,600 TALKING ABOUT THE HEALTH SYSTEM 2141 01:15:59,600 --> 01:16:00,800 FACTORS. 2142 01:16:00,800 --> 01:16:01,560 DR. MOY? 2143 01:16:01,560 --> 01:16:03,440 >> OKAY. 2144 01:16:03,440 --> 01:16:03,760 THANKS. 2145 01:16:03,760 --> 01:16:05,520 IT'S A PLEASURE TO HAVE THIS 2146 01:16:05,520 --> 01:16:06,960 OPPORTUNITY TO PRESENT TO THE 2147 01:16:06,960 --> 01:16:07,560 GROUP. 2148 01:16:07,560 --> 01:16:09,160 OUR GROUP FOCUSED ON HEALTH 2149 01:16:09,160 --> 01:16:11,200 SYSTEM AND POLICY LEVEL ISSUES 2150 01:16:11,200 --> 01:16:13,720 AND SO WE THOUGHT ABOUT THINGS 2151 01:16:13,720 --> 01:16:15,600 LIKE FEDERAL POLICY, STATE 2152 01:16:15,600 --> 01:16:17,440 POLICY AND POLICIES THAT WOULD 2153 01:16:17,440 --> 01:16:20,600 CUT ACROSS MULTIPLE HEALTHCARE 2154 01:16:20,600 --> 01:16:22,120 FACILITIES, SO LARGE HEALTH 2155 01:16:22,120 --> 01:16:22,480 SYSTEM. 2156 01:16:22,480 --> 01:16:23,560 OF COURSE WE THANK ALL THE 2157 01:16:23,560 --> 01:16:24,800 MEMBERS OF THE GROUP, IT WAS A 2158 01:16:24,800 --> 01:16:27,160 VERY, VERY LIVELY DISCUSSION, 2159 01:16:27,160 --> 01:16:31,200 AND COLLEEN, WHO HELPED TAKE 2160 01:16:31,200 --> 01:16:34,280 NOTES AND CREATE THESE SLIDES. 2161 01:16:34,280 --> 01:16:36,680 SO WE ALSO TWEAKED WHAT WE 2162 01:16:36,680 --> 01:16:38,000 WANTED TO PRESENT A LITTLE BIT. 2163 01:16:38,000 --> 01:16:41,840 FIRST WE THOUGHT ABOUT THE 2164 01:16:41,840 --> 01:16:43,040 OPPORTUNITIES AS WELL AS SOME 2165 01:16:43,040 --> 01:16:44,120 EQUITY IMPLICATIONS OF SOME OF 2166 01:16:44,120 --> 01:16:44,680 THESE OPPORTUNITIES. 2167 01:16:44,680 --> 01:16:48,280 A LOT OF OUR CONVERSATIONS 2168 01:16:48,280 --> 01:16:50,680 FOCUSED ON THESE MAJOR THEMES 2169 01:16:50,680 --> 01:16:51,800 THAT EMERGED. 2170 01:16:51,800 --> 01:16:55,040 ONE THING WE THOUGHT WAS A 2171 01:16:55,040 --> 01:16:56,480 CURRENT OPPORTUNITY WERE 2172 01:16:56,480 --> 01:16:57,280 PATIENT-REPORTED OUTCOME 2173 01:16:57,280 --> 01:16:57,880 MEASURES. 2174 01:16:57,880 --> 01:17:04,800 WE HAD A FEELING THAT THE 2175 01:17:04,800 --> 01:17:06,640 SCIENCE BEHIND THE PROMS WERE 2176 01:17:06,640 --> 01:17:08,840 FAIRLY WELL DEVELOPED, THEY WERE 2177 01:17:08,840 --> 01:17:10,360 WELL POSITIONED, BEST PRACTICES 2178 01:17:10,360 --> 01:17:11,680 FOR PEOPLE TO ADOPT AND THAT 2179 01:17:11,680 --> 01:17:13,120 THIS INFORMATION WOULD REALLY 2180 01:17:13,120 --> 01:17:14,400 HELP GUIDE THE ASSESSMENT OF 2181 01:17:14,400 --> 01:17:16,960 PATIENTS AND TRACK THEIR 2182 01:17:16,960 --> 01:17:18,680 PROGRESS OVER TIME. 2183 01:17:18,680 --> 01:17:20,880 ALSO ANOTHER IMPORTANT ASPECT OF 2184 01:17:20,880 --> 01:17:22,000 PATIENT-REPORTED OUTCOME 2185 01:17:22,000 --> 01:17:24,160 MEASURES IS NOT ONLY GATHERING 2186 01:17:24,160 --> 01:17:25,040 INFORMATION BUT MAKING THIS 2187 01:17:25,040 --> 01:17:29,040 INFORMATION WIDELY AVAILABLE TO 2188 01:17:29,040 --> 01:17:31,040 BOTH PROVIDERS AS WELL AS 2189 01:17:31,040 --> 01:17:31,920 RESEARCHERS SO THAT THEY COULD 2190 01:17:31,920 --> 01:17:36,080 USE TO ASSESS BOTH THE, AGAIN, 2191 01:17:36,080 --> 01:17:37,720 IMPROVEMENTS OF INDIVIDUAL 2192 01:17:37,720 --> 01:17:38,920 PATIENTS AS WELL AS THEIR 2193 01:17:38,920 --> 01:17:42,520 HEALTHCARE SYSTEMS AS A WHOLE. 2194 01:17:42,520 --> 01:17:43,960 SOME EQUITY IMPLICATIONS OF THIS 2195 01:17:43,960 --> 01:17:45,360 MIGHT BE THAT DIFFERENT GROUPS 2196 01:17:45,360 --> 01:17:47,000 MIGHT HAVE DIFFICULTY DOING 2197 01:17:47,000 --> 01:17:49,320 THESE PARTICULAR KINDS OF DATA 2198 01:17:49,320 --> 01:17:52,920 COLLECTIONS, THEY MAY HAVE LESS 2199 01:17:52,920 --> 01:17:54,600 TRUST FOR SUPPLYING THIS KIND OF 2200 01:17:54,600 --> 01:17:55,320 INFORMATION, ESPECIALLY IF THEY 2201 01:17:55,320 --> 01:17:56,000 DON'T KNOW WHERE THIS 2202 01:17:56,000 --> 01:17:57,080 INFORMATION IS GOING TO AND HOW 2203 01:17:57,080 --> 01:17:58,040 IT'S GOING TO BE USED, SO 2204 01:17:58,040 --> 01:18:00,240 THERE'S A NEED FOR SOME 2205 01:18:00,240 --> 01:18:01,760 INFORMATION PROCESSES TO OCCUR 2206 01:18:01,760 --> 01:18:05,280 SO DIFFERENT GROUPS CAN FEEL 2207 01:18:05,280 --> 01:18:06,800 COMFORTABLE PROVIDING THIS KIND 2208 01:18:06,800 --> 01:18:07,560 OF INFORMATION. 2209 01:18:07,560 --> 01:18:08,560 ANOTHER AREA WE TALKED A LOT 2210 01:18:08,560 --> 01:18:10,320 ABOUT WAS PROMOTION OF DIET, 2211 01:18:10,320 --> 01:18:11,400 EXERCISE AND REHABILITATION FOR 2212 01:18:11,400 --> 01:18:13,800 THE TREATMENT OF OSTEOARTHRITIS, 2213 01:18:13,800 --> 01:18:14,720 ESPECIALLY EARLIER IN THE 2214 01:18:14,720 --> 01:18:20,040 DISEASE COURSE. 2215 01:18:20,040 --> 01:18:21,560 AGAIN THIS IS -- IT WAS FELT 2216 01:18:21,560 --> 01:18:23,560 THAT THE THINGS WE NEED TO DO 2217 01:18:23,560 --> 01:18:24,840 ARE FAIRLY WELL ESTABLISHED AND 2218 01:18:24,840 --> 01:18:26,200 IT'S MORE A MATTER OF GETTING IT 2219 01:18:26,200 --> 01:18:27,400 OUT AND INTO THE HANDS OF 2220 01:18:27,400 --> 01:18:28,600 PROVIDERS AND PATIENTS WHO CAN 2221 01:18:28,600 --> 01:18:30,440 THEN USE THIS INFORMATION. 2222 01:18:30,440 --> 01:18:31,960 SOME OF THE THINGS THAT CAME UP 2223 01:18:31,960 --> 01:18:33,760 FROM AN EQUITY PERSPECTIVE WAS 2224 01:18:33,760 --> 01:18:35,440 THAT DIFFERENT GROUPS MAY 2225 01:18:35,440 --> 01:18:37,240 BENEFIT FROM MORE CUSTOMIZED 2226 01:18:37,240 --> 01:18:40,280 INFORMATION PRODUCTS. 2227 01:18:40,280 --> 01:18:41,920 A GENERAL MANILA ENVELOPE KIND 2228 01:18:41,920 --> 01:18:45,520 OF PRODUCT, HANDOUT, GUIDANCE 2229 01:18:45,520 --> 01:18:46,840 MAY NOT RESONATE AS WELL WITH 2230 01:18:46,840 --> 01:18:48,920 DIFFERENT GROUPS, AND HAVING 2231 01:18:48,920 --> 01:18:50,120 MORE CUSTOMIZED INFORMATION 2232 01:18:50,120 --> 01:18:51,960 PRODUCTS MAY ENABLE MORE GROUPS 2233 01:18:51,960 --> 01:18:53,320 TO EMBRACE THE CHANGES THAT ARE 2234 01:18:53,320 --> 01:18:54,960 OFTEN NEEDED IN THEIR LIVES AND 2235 01:18:54,960 --> 01:18:56,680 TO BE MORE SUCCESSFUL COMPLYING 2236 01:18:56,680 --> 01:18:58,000 WITH THE DIFFERENT THINGS THAT 2237 01:18:58,000 --> 01:19:01,800 THEY NEED TO DO. 2238 01:19:01,800 --> 01:19:02,840 ANOTHER ONE WAS DIFFERENT GROUPS 2239 01:19:02,840 --> 01:19:03,680 THAT BENEFIT FROM DIFFERENT 2240 01:19:03,680 --> 01:19:05,320 KINDS OF OPTIONS IN TERMS OF 2241 01:19:05,320 --> 01:19:06,320 MODALITIES FOR RECEIVING THIS 2242 01:19:06,320 --> 01:19:08,400 KIND OF GUIDANCE AND 2243 01:19:08,400 --> 01:19:09,240 REHABILITATION, AND SO FOR 2244 01:19:09,240 --> 01:19:11,560 INSTANCE, THE EXAMPLE OF RURAL 2245 01:19:11,560 --> 01:19:15,480 AREAS NEEDING DIFFERENT KINDS OF 2246 01:19:15,480 --> 01:19:17,240 PRODUCTS AND DIFFERENT KINDS OF 2247 01:19:17,240 --> 01:19:19,120 INTERVENTIONS WAS RAISED, AND IN 2248 01:19:19,120 --> 01:19:21,080 PARTICULAR, THE SUPPLY OF 2249 01:19:21,080 --> 01:19:23,160 PHYSICAL THERAPISTS MAY BE LOW 2250 01:19:23,160 --> 01:19:25,680 IN CERTAIN RURAL AREAS AND AGAIN 2251 01:19:25,680 --> 01:19:27,560 SOME ADDED ADAPTATION OF 2252 01:19:27,560 --> 01:19:28,840 MODALITIES NEEDED, SUCH AS THE 2253 01:19:28,840 --> 01:19:31,600 USE OF TELEPHYSICAL THERAPY 2254 01:19:31,600 --> 01:19:35,720 KINDS OF INTERVENTIONS. 2255 01:19:35,720 --> 01:19:36,920 THERE WAS A CONVERSATION ABOUT 2256 01:19:36,920 --> 01:19:38,400 ACCESS TO JOINT REPLACEMENTS AS 2257 01:19:38,400 --> 01:19:40,440 WELL AS THE IMPORTANCE OF 2258 01:19:40,440 --> 01:19:40,960 FOLLOW-UP REHABILITATION 2259 01:19:40,960 --> 01:19:42,080 FOLLOWING A JOINT REPLACEMENT, 2260 01:19:42,080 --> 01:19:43,920 AND HERE WE KNOW THAT THERE ARE 2261 01:19:43,920 --> 01:19:45,800 MANY EQUITY ISSUES THAT RELATE, 2262 01:19:45,800 --> 01:19:49,200 DIFFERENT GROUPS HAVE DIFFERENT 2263 01:19:49,200 --> 01:19:52,680 BARRIERS TO CARE, THEY MAY HAVE 2264 01:19:52,680 --> 01:19:54,520 DIFFERENT PERCEPTIONS OF CARE SO 2265 01:19:54,520 --> 01:19:55,640 EQUALIZING THE ABILITIES OF 2266 01:19:55,640 --> 01:19:57,160 DIFFERENT GROUPS TO RECEIVE 2267 01:19:57,160 --> 01:19:58,800 JOINT REPLACEMENTS PROVIDING 2268 01:19:58,800 --> 01:20:00,160 SUPPORTS THAT ENABLE THEM TO 2269 01:20:00,160 --> 01:20:01,880 RECEIVE JOINT REPLACEMENTS WILL 2270 01:20:01,880 --> 01:20:02,760 BE IMPORTANT. 2271 01:20:02,760 --> 01:20:04,280 ALSO UNDERSTANDING THERE ARE 2272 01:20:04,280 --> 01:20:06,040 DIFFERENCES IN COSTS AND 2273 01:20:06,040 --> 01:20:08,000 BENEFITS FOR DIFFERENT GROUPS OF 2274 01:20:08,000 --> 01:20:09,640 JOINT REPLACEMENT WOULD BE 2275 01:20:09,640 --> 01:20:12,840 IMPORTANT TO UNDERSTAND. 2276 01:20:12,840 --> 01:20:13,920 CONVERSATION ABOUT PAYMENT, IT 2277 01:20:13,920 --> 01:20:15,520 SEEMS LIKE A LOT OF THE PAYMENT 2278 01:20:15,520 --> 01:20:17,280 ISSUE, THE PAYMENT METHODS CAN 2279 01:20:17,280 --> 01:20:22,680 INTRODUCE BIASES INTO THE SYSTEM 2280 01:20:22,680 --> 01:20:25,400 ATION IT RELATES TO DIFFERENT 2281 01:20:25,400 --> 01:20:27,360 GROUPS OF PATIENTS. 2282 01:20:27,360 --> 01:20:31,840 TOUCHED ON BOTH MOVEMENT FROM 2283 01:20:31,840 --> 01:20:33,360 THE INPATIENT SETTING TO 2284 01:20:33,360 --> 01:20:35,360 OUTPATIENT SETTING, MAKING 2285 01:20:35,360 --> 01:20:36,440 DISPARITIES LARGER AS WELL AS 2286 01:20:36,440 --> 01:20:39,960 THE USE OF BUNDLED PAYMENTS. 2287 01:20:39,960 --> 01:20:41,080 UNDERSTANDING HOW THESE PAYMENTS 2288 01:20:41,080 --> 01:20:42,000 RELATE TO DIFFERENT GROUPS IS 2289 01:20:42,000 --> 01:20:45,200 VERY IMPORTANT. 2290 01:20:45,200 --> 01:20:49,560 OTHER ISSUES, FEE FOR SERVICE, 2291 01:20:49,560 --> 01:20:55,800 LESS INVASIVE TREATMENTS, SO 2292 01:20:55,800 --> 01:20:57,560 PATIENT -- THERE MAY BE 2293 01:20:57,560 --> 01:20:58,520 INCENTIVES FOR PATIENTS THAT 2294 01:20:58,520 --> 01:21:09,400 NEED TO HAVE -- ON VAIT -- OBSES 2295 01:21:09,400 --> 01:21:12,320 THAT MEDICAID PAYS FOR FEW JOINT 2296 01:21:12,320 --> 01:21:13,600 REPLACEMENTS, BUNDLED PAYMENTS 2297 01:21:13,600 --> 01:21:16,680 AND SHIFTS TO OUTPATIENT 2298 01:21:16,680 --> 01:21:21,040 SETTING, FEWER OF RECIPIENTS 2299 01:21:21,040 --> 01:21:23,360 RECEIVING JOINT REPLACEMENTS. 2300 01:21:23,360 --> 01:21:25,000 THIS MAY BE AN EXAMPLE OF 2301 01:21:25,000 --> 01:21:26,320 STRUCTURAL RACISM WHERE WE KNOW 2302 01:21:26,320 --> 01:21:28,280 THE POPULATION ISN'T EVENLY 2303 01:21:28,280 --> 01:21:32,000 DISTRIBUTED ACROSS MEDICAID 2304 01:21:32,000 --> 01:21:35,400 RECIPIENTS, SO THE BIASES THAT 2305 01:21:35,400 --> 01:21:37,680 EXIST TOWARD MEDICAID PATIENTS 2306 01:21:37,680 --> 01:21:38,680 EXTRAPOLATE TO OTHER GROUPS AS 2307 01:21:38,680 --> 01:21:40,960 WELL. 2308 01:21:40,960 --> 01:21:43,040 THE LAST ONE WAS, I THINK THERE 2309 01:21:43,040 --> 01:21:45,680 WAS A CONVERSATION THAT ENGAGED 2310 01:21:45,680 --> 01:21:46,800 WITH COMMUNITY PARTNERS, THIS IS 2311 01:21:46,800 --> 01:21:51,800 ALSO TEAM TE DEEMED TO BE AN IMT 2312 01:21:51,800 --> 01:21:52,360 ASPECT, MANY OF THE 2313 01:21:52,360 --> 01:21:53,240 ORGANIZATIONS THAT DEAL WITH 2314 01:21:53,240 --> 01:21:54,200 COMMUNITY PARTNERS HAVE LESS 2315 01:21:54,200 --> 01:21:55,080 EXPERIENCE WORKING WITH 2316 01:21:55,080 --> 01:21:58,480 COMMUNITY PARTNERS AND A,, 2317 01:21:58,480 --> 01:21:59,800 THEREFORE, THE COSTS AND WORK 2318 01:21:59,800 --> 01:22:01,760 INVOLVED TO ENGAGE NEW PARTNERS 2319 01:22:01,760 --> 01:22:02,720 THAT FOCUS ON SPECIFIC 2320 01:22:02,720 --> 01:22:03,840 POPULATIONS MAY BE HIGHER THAN 2321 01:22:03,840 --> 01:22:05,120 THAT FOR THE OTHER -- THE 2322 01:22:05,120 --> 01:22:06,680 COMMUNITY PARTNERS THAT THEY'RE 2323 01:22:06,680 --> 01:22:14,120 USED TO DEALING WITH. 2324 01:22:14,120 --> 01:22:15,320 THE NEXT THING WE TRIED TO DO 2325 01:22:15,320 --> 01:22:17,960 WAS TO DELVE INTO SOME OF THE 2326 01:22:17,960 --> 01:22:20,680 BARRIERS THAT EXIST IN ACHIEVING 2327 01:22:20,680 --> 01:22:21,600 THESE OPPORTUNITIES. 2328 01:22:21,600 --> 01:22:23,520 FOR INSTANCE IN TERMS OF 2329 01:22:23,520 --> 01:22:24,960 ADOPTION OF PATIENT-REPORTED 2330 01:22:24,960 --> 01:22:26,800 OUTCOME MEASURES MORE BROADLY, 2331 01:22:26,800 --> 01:22:28,760 THIS RAISED THE ISSUE OF SOME 2332 01:22:28,760 --> 01:22:31,720 STANDARDIZATION BUT NOT AS MUCH 2333 01:22:31,720 --> 01:22:34,760 STANDARDIZATION AS WOULD BE 2334 01:22:34,760 --> 01:22:36,320 DESIRED, THE LACK OF JUST 2335 01:22:36,320 --> 01:22:39,520 SWITCHING A BUTTON, BEING ABLE 2336 01:22:39,520 --> 01:22:41,240 TO INCORPORATE THIS THROUGH 2337 01:22:41,240 --> 01:22:42,320 ELECTRONIC HEALTH RECORDS EASILY 2338 01:22:42,320 --> 01:22:43,560 AND THE LIFT THAT'S REQUIRED FOR 2339 01:22:43,560 --> 01:22:44,960 BOTH GETTING THIS INFORMATION 2340 01:22:44,960 --> 01:22:45,840 INTO ELECTRONIC HEALTH RECORDS 2341 01:22:45,840 --> 01:22:48,160 AND THEN GETTING IT OUT OF 2342 01:22:48,160 --> 01:22:51,200 ELECTRONIC HEALTH RECORDS WAS 2343 01:22:51,200 --> 01:22:51,800 RAISED. 2344 01:22:51,800 --> 01:22:55,680 THE COSTS BOTH IN TERMS OF TIME 2345 01:22:55,680 --> 01:22:57,120 AND I.T. EFFORT WAS A POTENTIAL 2346 01:22:57,120 --> 01:23:01,240 BARRIER THAT COULD BE ADDRESSED. 2347 01:23:01,240 --> 01:23:02,240 AGAIN, ACCESS TO DATA 2348 01:23:02,240 --> 01:23:02,760 AFTERWARDS. 2349 01:23:02,760 --> 01:23:04,200 IT'S GREAT TO COLLECT THIS DATA 2350 01:23:04,200 --> 01:23:05,360 BUT PEOPLE ACTUALLY NEED TO BE 2351 01:23:05,360 --> 01:23:06,960 ABLE TO GET TO THOSE DATA EASILY 2352 01:23:06,960 --> 01:23:11,200 IN ORDER TO USE IT, OVERALL 2353 01:23:11,200 --> 01:23:14,400 HEALTH SYSTEM, AND THEN LASTLY, 2354 01:23:14,400 --> 01:23:16,240 THE DISPARITIES IN THESE 2355 01:23:16,240 --> 01:23:17,240 PATIENT-REPORTED OUTCOME 2356 01:23:17,240 --> 01:23:19,280 MEASURES WAS NOT DEEMED TO BE 2357 01:23:19,280 --> 01:23:22,360 WELL ESTABLISHED, SO WE DON'T 2358 01:23:22,360 --> 01:23:24,640 KNOW ARE THEY EQUALLY EFFECTIVE 2359 01:23:24,640 --> 01:23:26,640 ACROSS DIFFERENT POPULATIONS, 2360 01:23:26,640 --> 01:23:28,040 AREN'T DIFFERENT POPULATIONS 2361 01:23:28,040 --> 01:23:31,240 INTERPRETING THE QUESTIONS 2362 01:23:31,240 --> 01:23:33,720 DIFFERENTLY AS INFORMATION 2363 01:23:33,720 --> 01:23:34,640 COMPARABLE ACROSS DIFFERENT 2364 01:23:34,640 --> 01:23:35,480 GROUPS. 2365 01:23:35,480 --> 01:23:37,880 FOR THE PROMOTION OF DIET, 2366 01:23:37,880 --> 01:23:39,880 EXERCISE AND REHABILITATION, 2367 01:23:39,880 --> 01:23:42,920 THAT WAS IDENTIFIED AS A LACK OF 2368 01:23:42,920 --> 01:23:43,800 IMPLEMENTATION KNOWLEDGE WITH 2369 01:23:43,800 --> 01:23:44,240 DIVERSE GROUPS. 2370 01:23:44,240 --> 01:23:46,520 SO THIS WAS DEEMED TO BE VERY, 2371 01:23:46,520 --> 01:23:47,320 VERY IMPORTANT FEATURE THAT WE 2372 01:23:47,320 --> 01:23:48,360 NEED TO HAVE MORE INFORMATION 2373 01:23:48,360 --> 01:23:50,480 ABOUT HOW TO BEST IMPLEMENT 2374 01:23:50,480 --> 01:23:52,120 THESE KINDS OF INTERVENTIONS 2375 01:23:52,120 --> 01:23:53,360 WITH DIFFERENT GROUPS OF 2376 01:23:53,360 --> 01:23:54,960 PATIENTS. 2377 01:23:54,960 --> 01:23:56,280 DIFFERENT GROUPS NEED DIFFERENT 2378 01:23:56,280 --> 01:23:58,000 KINDS OF SUPPORTS IN ORDER TO 2379 01:23:58,000 --> 01:23:59,560 ACHIEVE THESE PARTICULAR KINDS 2380 01:23:59,560 --> 01:24:00,000 OF INTERVENTIONS. 2381 01:24:00,000 --> 01:24:01,080 THERE'S A NOTION THAT MANY 2382 01:24:01,080 --> 01:24:02,720 THINGS THAT ARE BEING SUPPORTED 2383 01:24:02,720 --> 01:24:04,600 FOR OSTEOARTHRITIS IN TERMS OF 2384 01:24:04,600 --> 01:24:05,800 DIET, EXERCISE AND 2385 01:24:05,800 --> 01:24:07,440 REHABILITATION ARE SIMILAR WITH 2386 01:24:07,440 --> 01:24:11,160 WHAT'S BEING PROMOTED FOR 2387 01:24:11,160 --> 01:24:13,120 INTEGRATION WITH OTHER CHRONIC 2388 01:24:13,120 --> 01:24:14,080 DISEASES, TO INTEGRATE WITH THEM 2389 01:24:14,080 --> 01:24:15,720 IN SOME WAY BUT SHOULD BE ABLE 2390 01:24:15,720 --> 01:24:17,520 TO OPTIMIZE THE EFFECTIVENESS OF 2391 01:24:17,520 --> 01:24:18,800 THESE DIFFERENT KINDS OF 2392 01:24:18,800 --> 01:24:21,120 INTERVENTIONS THAT WOULD BENEFIT 2393 01:24:21,120 --> 01:24:22,320 DIFFERENT DISEASES IN ADDITION 2394 01:24:22,320 --> 01:24:24,480 TO OSTEOARTHRITIS. 2395 01:24:24,480 --> 01:24:27,440 AND TO LEADING TO THE NOTION OF 2396 01:24:27,440 --> 01:24:29,960 TELESERVICES EARLIER, AS AN AREA 2397 01:24:29,960 --> 01:24:32,360 WHERE MORE -- THAT WAS AN 2398 01:24:32,360 --> 01:24:34,320 OPPORTUNITY, BEING ABLE TO 2399 01:24:34,320 --> 01:24:35,200 PROVIDE REHABILITATION TO MORE 2400 01:24:35,200 --> 01:24:36,600 GROUPS OF PATIENTS, BUT THEN THE 2401 01:24:36,600 --> 01:24:39,600 ISSUE OF PAYMENT CAME UP, ARE 2402 01:24:39,600 --> 01:24:40,800 THESE SERVICES BEING PAID FOR IN 2403 01:24:40,800 --> 01:24:42,080 A FAIR WAY, ARE THEY BEING PAID 2404 01:24:42,080 --> 01:24:43,720 FOR AT ALL FOR THAT MATTER. 2405 01:24:43,720 --> 01:24:45,800 AN ISSUE OF WHAT IS THE BEST 2406 01:24:45,800 --> 01:24:48,680 DIET, ASSUMING EXERCISE 2407 01:24:48,680 --> 01:24:51,640 PROTOCOLS ARE WELL-DEFINED BUT 2408 01:24:51,640 --> 01:24:53,480 DIET IS LESS CLEAR, WHAT IS THE 2409 01:24:53,480 --> 01:24:55,320 BEST DIET FOR A PATIENT WITH 2410 01:24:55,320 --> 01:24:55,880 OSTEOARTHRITIS. 2411 01:24:55,880 --> 01:24:57,640 IN TERMS OF ENSURING ACCESS TO 2412 01:24:57,640 --> 01:24:59,280 JOINT REPLACEMENT, I THINK SOME 2413 01:24:59,280 --> 01:25:02,880 ISSUES WERE DISCUSSED WERE 2414 01:25:02,880 --> 01:25:04,400 TIMING, WHEN DIFFERENT GROUPS 2415 01:25:04,400 --> 01:25:06,480 MAY -- HAVE ACCESS BUT RECEIVE 2416 01:25:06,480 --> 01:25:08,120 THEIR JOINT REPLACEMENTS AT 2417 01:25:08,120 --> 01:25:10,440 DIFFERENT TIMES, PARTICULARLY 2418 01:25:10,440 --> 01:25:11,320 DISADVANTAGED GROUPS BEING SEEN 2419 01:25:11,320 --> 01:25:12,840 LATER IN THE DISEASE COURSE WHEN 2420 01:25:12,840 --> 01:25:14,160 THEY'RE PERHAPS LESS EFFECTIVE. 2421 01:25:14,160 --> 01:25:19,400 THE WHOLE NOTION OF INFORMED 2422 01:25:19,400 --> 01:25:20,160 DECISION-MAKING WAS RAISED. 2423 01:25:20,160 --> 01:25:21,560 SOME OPINED THAT PEOPLE OFTEN 2424 01:25:21,560 --> 01:25:22,960 HAD JOINT REPLACEMENTS AND 2425 01:25:22,960 --> 01:25:23,680 REALLY DIDN'T KNOW WHAT THEY 2426 01:25:23,680 --> 01:25:25,080 WERE GETTING INTO, UNTIL THEY 2427 01:25:25,080 --> 01:25:27,280 GOT TO POST JOINT PREPLACEMENT 2428 01:25:27,280 --> 01:25:28,080 REHABILITATION AND THEY WERE 2429 01:25:28,080 --> 01:25:31,600 TOLD WHAT THEY NEED TO DO, WHAT 2430 01:25:31,600 --> 01:25:34,680 WAS THE SUBSEQUENT COURSE, SO 2431 01:25:34,680 --> 01:25:36,800 THIS WOULD SUGGEST THEY WEREN'T 2432 01:25:36,800 --> 01:25:38,000 OPTIMUM BEFORE THEY HAD THEIR 2433 01:25:38,000 --> 01:25:38,200 SURGERY. 2434 01:25:38,200 --> 01:25:46,880 THERE ARE BIASES ABOUT PROVIDERS 2435 01:25:46,880 --> 01:25:48,480 IN THE OFFERING OF JOINT 2436 01:25:48,480 --> 01:25:49,600 REPLACEMENT TO INDIVIDUALS AND 2437 01:25:49,600 --> 01:25:51,240 STRUCTURAL BIASES LEADING TO THE 2438 01:25:51,240 --> 01:25:53,080 MEDICAID ISSUE EARLIER BUT ALSO 2439 01:25:53,080 --> 01:25:54,280 STRUCTURAL BIASES THAT EXIST. 2440 01:25:54,280 --> 01:25:57,120 FOR INSTANCE, PATIENTS THAT ARE 2441 01:25:57,120 --> 01:26:00,520 DEEMED TO HAVE CERTAIN SKILLSETS 2442 01:26:00,520 --> 01:26:01,720 OR THE ABILITY TO CARE FOR 2443 01:26:01,720 --> 01:26:03,120 THEMSELVES IN DIFFERENT WAYS, 2444 01:26:03,120 --> 01:26:05,440 BECAUSE THAT MAY NOT BE EVENLY 2445 01:26:05,440 --> 01:26:06,200 DISTRIBUTED ACROSS THE 2446 01:26:06,200 --> 01:26:07,520 POPULATION, THAT COULD MEAN 2447 01:26:07,520 --> 01:26:08,960 CREATING A STRUCTURAL BARRIER 2448 01:26:08,960 --> 01:26:09,920 FOR DIFFERENT GROUPS TO GET 2449 01:26:09,920 --> 01:26:10,680 JOINT REPLACEMENTS. 2450 01:26:10,680 --> 01:26:14,200 IN TERMS OF REDUCING BIASES 2451 01:26:14,200 --> 01:26:18,040 RELATED TO PAYMENT, PAYMENT 2452 01:26:18,040 --> 01:26:20,120 RATES ARE OFTEN DIFFERENTIAL, 2453 01:26:20,120 --> 01:26:23,080 AND THEN THE GENERIC NEED FOR 2454 01:26:23,080 --> 01:26:24,880 HAVING -- REPORTING TRACKING OF 2455 01:26:24,880 --> 01:26:26,880 DATA THAT'S EITHER ADJUSTED OR 2456 01:26:26,880 --> 01:26:28,080 STRATIFIED FOR DIFFERENT PATIENT 2457 01:26:28,080 --> 01:26:29,600 CHARACTERISTICS AND/OR SOCIAL 2458 01:26:29,600 --> 01:26:32,240 DETERMINANTS OF HEALTH WAS 2459 01:26:32,240 --> 01:26:33,400 IMPORTANT. 2460 01:26:33,400 --> 01:26:35,080 LASTLY IN TERMS OF ENGAGING 2461 01:26:35,080 --> 01:26:37,080 COMMUNITY PARTNERS, I THINK A 2462 01:26:37,080 --> 01:26:38,560 BARRIER WAS THE INSUFFICIENCY, 2463 01:26:38,560 --> 01:26:39,880 PERHAPS, OF CUSTOMIZED 2464 01:26:39,880 --> 01:26:41,440 INFORMATION PRODUCTS FOR 2465 01:26:41,440 --> 01:26:43,960 DIFFERENT GROUPS OF PATIENTS, 2466 01:26:43,960 --> 01:26:45,920 AND THESE CUSTOMIZED PRODUCTS 2467 01:26:45,920 --> 01:26:48,000 WILL THEN ENABLE BETTER 2468 01:26:48,000 --> 01:26:49,400 PARTNERSHIPS WITH THE COMMUNITY, 2469 01:26:49,400 --> 01:26:50,840 SPECIFIC COMMUNITIES TO GET THIS 2470 01:26:50,840 --> 01:26:51,640 INFORMATION IN THE LANDS OF 2471 01:26:51,640 --> 01:26:58,160 PINTO THE HANDS OFPATIENTS WITHD 2472 01:26:58,160 --> 01:27:00,280 COSTS OF ENGAGING PARTNERS. 2473 01:27:00,280 --> 01:27:02,800 SO THIS IS SOMEWHAT SUBJECTIVE. 2474 01:27:02,800 --> 01:27:06,080 WE TRIED TO CONSIDER WHAT WERE 2475 01:27:06,080 --> 01:27:08,040 THE LOWER HANGING FRUIT, THE 2476 01:27:08,040 --> 01:27:10,760 MORE IMPORTANT THINGS TO ENGAGE 2477 01:27:10,760 --> 01:27:11,880 EARLIER, AND THIS IS KIND OF 2478 01:27:11,880 --> 01:27:13,960 THINGS WE CAME UP WITH VERY 2479 01:27:13,960 --> 01:27:14,280 GENERICALLY. 2480 01:27:14,280 --> 01:27:15,160 WE THOUGHT IT'S VERY IMPORTANT 2481 01:27:15,160 --> 01:27:17,920 TO COLLECT DATA, TO EXAMINE AND 2482 01:27:17,920 --> 01:27:19,400 ADDRESS DISPARITIES, AS WE ARE 2483 01:27:19,400 --> 01:27:21,200 IMPLEMENTING POLICY, AS WE ARE 2484 01:27:21,200 --> 01:27:23,240 PROMOTING CERTAIN BEST 2485 01:27:23,240 --> 01:27:23,760 PRACTICES. 2486 01:27:23,760 --> 01:27:26,120 THAT ALSO IS A NEED TO CONSIDER 2487 01:27:26,120 --> 01:27:28,400 A STRUCTURAL BIAS EXPLICITLY, 2488 01:27:28,400 --> 01:27:29,920 WHENEVER WE MAKE CHANGES INTO 2489 01:27:29,920 --> 01:27:33,480 POLICY AND RESEARCH, FOR 2490 01:27:33,480 --> 01:27:34,520 INSTANCE IT IS IMPORTANT TO 2491 01:27:34,520 --> 01:27:36,160 INCLUDE PEOPLE FROM DIFFERENT 2492 01:27:36,160 --> 01:27:38,600 GROUPS TO INFORM THAT NEW POLICY 2493 01:27:38,600 --> 01:27:40,640 AS WELL AS TO CONSIDER THE 2494 01:27:40,640 --> 01:27:42,240 STRUCTURAL BARRIERS THAT WOULD 2495 01:27:42,240 --> 01:27:44,360 BE CREATED AS WE MARK DOWN A NEW 2496 01:27:44,360 --> 01:27:45,960 POLICY PATHWAY. 2497 01:27:45,960 --> 01:27:47,320 THE LIST OF DIFFERENT THINGS WE 2498 01:27:47,320 --> 01:27:48,840 CONSIDERED, WE THOUGHT ADOPTION 2499 01:27:48,840 --> 01:27:50,400 OF PATIENT-REPORTED OUTCOME 2500 01:27:50,400 --> 01:27:53,280 MEASURES WAS A HIGH PRIORITY AND 2501 01:27:53,280 --> 01:27:57,160 THAT WAS FEASIBLE GIVEN THE 2502 01:27:57,160 --> 01:27:58,160 CURRENT SCIENCE. 2503 01:27:58,160 --> 01:27:59,360 GATHERING THOSE INFORMATION AND 2504 01:27:59,360 --> 01:28:01,120 MAKING THEM MORE EASILY 2505 01:28:01,120 --> 01:28:02,640 AVAILABLE IS DOABLE, AND THERE 2506 01:28:02,640 --> 01:28:05,040 ARE CERTAIN BEST PRACTICES BUT 2507 01:28:05,040 --> 01:28:06,880 WHAT WE NEED TO DO IS PROMOTE 2508 01:28:06,880 --> 01:28:10,080 MORE STANDARDIZATION OF THESE 2509 01:28:10,080 --> 01:28:11,520 PRACTICES, GREATER 2510 01:28:11,520 --> 01:28:15,640 INTEROPERABILITY, TRYING TO MAKE 2511 01:28:15,640 --> 01:28:16,560 THIS A STANDARD FEATURE, FOR 2512 01:28:16,560 --> 01:28:17,640 INSTANCE, ON ELECTRONIC HEALTH 2513 01:28:17,640 --> 01:28:19,800 RECORDS AS OPPOSED TO A 2514 01:28:19,800 --> 01:28:23,520 CUSTOMIZED HISTORY. 2515 01:28:23,520 --> 01:28:24,960 ANOTHER SHORT TERM LOWER HANGING 2516 01:28:24,960 --> 01:28:26,800 FRUIT GOAL THAT WAS IDENTIFIED 2517 01:28:26,800 --> 01:28:28,880 WAS PROMOTION OF DIET, EXERCISE 2518 01:28:28,880 --> 01:28:29,320 AND REHAB. 2519 01:28:29,320 --> 01:28:30,320 WE THOUGHT THAT WAS REALLY 2520 01:28:30,320 --> 01:28:33,800 IMPORTANT TO DO MORE STUDIES OF 2521 01:28:33,800 --> 01:28:34,800 IMPLEMENTATION IN DIFFERENT 2522 01:28:34,800 --> 01:28:35,560 GROUPS AND COMMUNITIES, BUT AT 2523 01:28:35,560 --> 01:28:36,640 THE SAME TIME, WE THOUGHT THERE 2524 01:28:36,640 --> 01:28:37,880 WAS ENOUGH KNOWLEDGE TO 2525 01:28:37,880 --> 01:28:38,640 GENERALLY RECOMMEND THESE KINDS 2526 01:28:38,640 --> 01:28:40,680 OF INTERVENTIONS ACROSS THE 2527 01:28:40,680 --> 01:28:44,000 SPECTRUM FOR OSTEOARTHRITIS 2528 01:28:44,000 --> 01:28:44,560 PATIENTS. 2529 01:28:44,560 --> 01:28:47,800 ALSO A NEED TO UNDERSTAND THE 2530 01:28:47,800 --> 01:28:51,080 SPREAD OF BEST PRACTICES MORE 2531 01:28:51,080 --> 01:28:52,080 BROADLY FOR BEHAVIORAL CHANGE. 2532 01:28:52,080 --> 01:28:53,720 ALL OF THIS IS IMPORTANT TO 2533 01:28:53,720 --> 01:28:54,800 ENSURE THAT IMPLEMENTATION AND 2534 01:28:54,800 --> 01:28:56,880 SPREAD WERE EQUITABLE ACROSS 2535 01:28:56,880 --> 01:28:57,920 DIFFERENT POPULATIONS AND 2536 01:28:57,920 --> 01:29:01,160 DIFFERENT COMMUNITIES. 2537 01:29:01,160 --> 01:29:03,000 IN TERMS OF LONGER TERM GOALS, I 2538 01:29:03,000 --> 01:29:04,320 THINK WHERE WE ULTIMATELY WANTED 2539 01:29:04,320 --> 01:29:08,920 TO GO WAS WE WANTED TO HAVE 2540 01:29:08,920 --> 01:29:10,240 CLEAR OSTEOARTHRITIS MANAGEMENT 2541 01:29:10,240 --> 01:29:11,440 GUIDELINES INFORMED BY 2542 01:29:11,440 --> 01:29:12,440 PATIENT-REPORTED OUTCOME 2543 01:29:12,440 --> 01:29:15,920 MEASURES ACROSS THE LIFECYCLE OF 2544 01:29:15,920 --> 01:29:16,360 DIFFERENT PATIENTS. 2545 01:29:16,360 --> 01:29:19,640 THERE'S A NOTION THAT SOME 2546 01:29:19,640 --> 01:29:20,720 COST-EFFECTIVE ANALYSES WOULD BE 2547 01:29:20,720 --> 01:29:22,040 HELPFUL TO SUPPORT 2548 01:29:22,040 --> 01:29:23,360 DECISION-MAKING AND TO SUPPORT 2549 01:29:23,360 --> 01:29:25,960 POLICY MAKERS SIGNING ON FOR 2550 01:29:25,960 --> 01:29:28,520 DIFFERENT KINDS OF INTERVENTIONS 2551 01:29:28,520 --> 01:29:29,920 FOR OSTEOARTHRITIS, THAT THERE 2552 01:29:29,920 --> 01:29:30,760 WAS SOME COST INFORMATION 2553 01:29:30,760 --> 01:29:33,960 AVAILABLE BUT REALLY 2554 01:29:33,960 --> 01:29:35,080 UNDERSTANDING THE BIG PICTURE 2555 01:29:35,080 --> 01:29:36,040 LONG TERM COSTS OF DIFFERENT 2556 01:29:36,040 --> 01:29:38,440 KINDS OF TREATMENT PATHWAYS WAS 2557 01:29:38,440 --> 01:29:40,080 NOT KNOWN AS WELL AS IT COULD 2558 01:29:40,080 --> 01:29:40,960 BE. 2559 01:29:40,960 --> 01:29:42,920 SIMILARLY, I THINK IT WAS RAISED 2560 01:29:42,920 --> 01:29:44,560 THAT THERE WERE NOT A LOT OF 2561 01:29:44,560 --> 01:29:46,160 LONGITUDINAL STUDIES TO LOOK AT 2562 01:29:46,160 --> 01:29:47,880 THE LONG TERM OUTCOMES OF 2563 01:29:47,880 --> 01:29:49,680 PATIENTS WITH OSTEOARTHRITIS 2564 01:29:49,680 --> 01:29:54,120 TREATMENT IN DIFFERENT WAYS, WE 2565 01:29:54,120 --> 01:29:55,400 STUDY SHORT TERM AS OPPOSED TO 2566 01:29:55,400 --> 01:29:57,920 CONSIDERING THE BENEFITS AND THE 2567 01:29:57,920 --> 01:29:59,960 HEALTH OF INDIVIDUALS 10 YEARS, 2568 01:29:59,960 --> 01:30:01,200 20 YEARS DOWN THE ROAD FROM 2569 01:30:01,200 --> 01:30:02,320 DIFFERENT KINDS OF 2570 01:30:02,320 --> 01:30:04,040 INTERVENTIONS. 2571 01:30:04,040 --> 01:30:06,720 I THINK PAYMENT AND TRACKING 2572 01:30:06,720 --> 01:30:08,520 NEEDS TO BE DEVELOPED TO SUPPORT 2573 01:30:08,520 --> 01:30:10,880 EQUITABLE OUTCOMES FOR ALL OF 2574 01:30:10,880 --> 01:30:12,680 THE OSTEOARTHRITIS PATIENTS THAT 2575 01:30:12,680 --> 01:30:15,440 ARE COMING FOR TREATMENT, AND 2576 01:30:15,440 --> 01:30:16,200 THERE WAS IMPORTANCE OF 2577 01:30:16,200 --> 01:30:17,600 COMMUNITY PARTNERSHIPS THAT 2578 01:30:17,600 --> 01:30:19,560 COULD SUPPORT LIFESTYLES AND 2579 01:30:19,560 --> 01:30:20,880 ADDRESS SOME SOCIAL DETERMINANTS 2580 01:30:20,880 --> 01:30:23,160 OF HEALTH, AGAIN, ACROSS THE 2581 01:30:23,160 --> 01:30:26,480 LIFETIMES OF INDIVIDUALS -- 2582 01:30:26,480 --> 01:30:27,440 INDIVIDUALS WITH OSTEOARTHRITIS. 2583 01:30:27,440 --> 01:30:29,000 SO I'M GOING TO ASK OUR GROUP TO 2584 01:30:29,000 --> 01:30:30,000 SEE IF THERE ARE OTHER THINGS 2585 01:30:30,000 --> 01:30:33,360 THAT THEY WANTED TO ADD TO THIS 2586 01:30:33,360 --> 01:30:34,440 PRESENTATION OF THE DISCUSSIONS 2587 01:30:34,440 --> 01:30:35,640 THAT WE HAD. 2588 01:30:35,640 --> 01:30:36,840 ANY OTHER MEMBERS OF OUR GROUP 2589 01:30:36,840 --> 01:30:38,640 WANT TO CHIME IN ABOUT THINGS I 2590 01:30:38,640 --> 01:30:47,840 MISSED? 2591 01:30:47,840 --> 01:30:49,240 >> I THOUGHT YOU COVERED IT ALL. 2592 01:30:49,240 --> 01:30:50,080 I CAN'T THINK OF ANY. 2593 01:30:50,080 --> 01:30:50,760 THANK YOU. 2594 01:30:50,760 --> 01:30:51,640 >> OKAY. 2595 01:30:51,640 --> 01:30:54,680 I'LL TURN IT BACK TO YOU. 2596 01:30:54,680 --> 01:30:58,080 >> THANK YOU, DR. MOY. 2597 01:30:58,080 --> 01:30:59,840 WE'RE GOING TO MOVE TO OUR NEXT 2598 01:30:59,840 --> 01:31:04,320 REPORT OUT FROM DR. KENT KWOH'S 2599 01:31:04,320 --> 01:31:05,760 GROUP, PATIENT AND PROVIDER 2600 01:31:05,760 --> 01:31:06,360 LEVEL FACTORS. 2601 01:31:06,360 --> 01:31:08,160 >> THANK YOU, KRISTY. 2602 01:31:08,160 --> 01:31:09,760 I WANT TO THANK STEPHANIE THAT 2603 01:31:09,760 --> 01:31:12,320 DID A TERRIFIC JOB IN TERMS OF 2604 01:31:12,320 --> 01:31:15,160 COLLECTING THE INFORMATION. 2605 01:31:15,160 --> 01:31:17,760 ALSO IN TERMS OF OUR GROUP, WE 2606 01:31:17,760 --> 01:31:22,560 HAD REALLY A ROBUST DISCUSSION 2607 01:31:22,560 --> 01:31:24,080 WITH VERY MANY DIFFERENT 2608 01:31:24,080 --> 01:31:29,880 PERSPECTIVES OVER THE TWO DAYS. 2609 01:31:29,880 --> 01:31:34,600 DO I HAVE CONTROL OF THE SLIDES? 2610 01:31:34,600 --> 01:31:35,720 SO WE TALKED ABOUT CURRENT 2611 01:31:35,720 --> 01:31:37,440 OPPORTUNITIES IN TERMS OF 2612 01:31:37,440 --> 01:31:40,320 RESOURCES THAT CERTAINLY 2613 01:31:40,320 --> 01:31:41,520 IMPROVED COMMUNICATION WOULD BE 2614 01:31:41,520 --> 01:31:43,360 IMPORTANT FOR PATIENTS AND 2615 01:31:43,360 --> 01:31:43,680 PROVIDERS. 2616 01:31:43,680 --> 01:31:46,640 USE OF DECISION AIDS, BUT IN 2617 01:31:46,640 --> 01:31:48,800 TERMS OF DISCUSSION OF DECISION 2618 01:31:48,800 --> 01:31:50,240 AIDS AS WAS BROUGHT UP, YOU WANT 2619 01:31:50,240 --> 01:31:52,000 TO MAKE SURE THOSE ARE 2620 01:31:52,000 --> 01:31:53,520 CULTURALLY APPROPRIATE FOR THE 2621 01:31:53,520 --> 01:31:56,480 POPULATION THAT WE'RE TARGETING. 2622 01:31:56,480 --> 01:31:57,680 THERE WAS A LOT OF DISCUSSION IN 2623 01:31:57,680 --> 01:31:59,880 TERMS OF UTILIZING OTHER 2624 01:31:59,880 --> 01:32:00,640 CLINICIANS. 2625 01:32:00,640 --> 01:32:01,640 CERTAINLY PRIMARY CARE PROVIDERS 2626 01:32:01,640 --> 01:32:03,520 ARE IMPORTANT AS THEY'RE ON THE 2627 01:32:03,520 --> 01:32:06,000 FRONT LINES, INTERNISTS, FAMILY 2628 01:32:06,000 --> 01:32:08,600 PHYSICIANS, NURSE PRACTITIONERS. 2629 01:32:08,600 --> 01:32:10,920 ALSO HAD A DISCUSSION THAT MAYBE 2630 01:32:10,920 --> 01:32:11,920 TALKING TO URGENT CARE CENTERS 2631 01:32:11,920 --> 01:32:14,120 IN TERMS OF WHERE SOME OF THAT 2632 01:32:14,120 --> 01:32:16,280 COMMUNICATION TAKES PLACE. 2633 01:32:16,280 --> 01:32:17,640 CERTAINLY RHEUMATOLOGISTS AND 2634 01:32:17,640 --> 01:32:20,000 ORTHOPEDIC SURGEONS ARE 2635 01:32:20,000 --> 01:32:22,000 IMPORTANT, WHAT WASN'T DISCUSSED 2636 01:32:22,000 --> 01:32:23,480 AS MUCH DURING THESE SESSIONS 2637 01:32:23,480 --> 01:32:25,680 AND WE HAVE A PHYSICAL THERAPIST 2638 01:32:25,680 --> 01:32:30,160 AS PART OF IT THAT THEY WOULD BE 2639 01:32:30,160 --> 01:32:31,080 IMPORTANT CLINICIANS TO PARTNER 2640 01:32:31,080 --> 01:32:34,320 WITH IN TERMS OF PROVIDING 2641 01:32:34,320 --> 01:32:36,080 BETTER PATIENT PROVIDER 2642 01:32:36,080 --> 01:32:36,880 COMMUNICATION. 2643 01:32:36,880 --> 01:32:39,120 ALSO PHARMACISTS ARE ANOTHER 2644 01:32:39,120 --> 01:32:40,680 CLINICIAN THAT MAY BE USEFUL IN 2645 01:32:40,680 --> 01:32:42,320 TERMS OF ENGAGING AND ALSO 2646 01:32:42,320 --> 01:32:43,520 SOCIAL WORKERS. 2647 01:32:43,520 --> 01:32:45,280 SO ALL THESE DIFFERENT 2648 01:32:45,280 --> 01:32:50,520 CLINICIANS CAN HELP TO IMPROVE 2649 01:32:50,520 --> 01:32:52,680 THE PATIENT-PROVIDER 2650 01:32:52,680 --> 01:32:53,200 COMMUNICATION ABOUT 2651 01:32:53,200 --> 01:32:53,560 OSTEOARTHRITIS. 2652 01:32:53,560 --> 01:32:54,400 THEN WE HAD A LONG DISCUSSION 2653 01:32:54,400 --> 01:32:56,000 ABOUT OTHER MEMBERS OF THE 2654 01:32:56,000 --> 01:32:57,960 HEALTHCARE TEAM. 2655 01:32:57,960 --> 01:33:00,240 COMMUNITY HEALTHCARE WORKERS, 2656 01:33:00,240 --> 01:33:02,040 INTERPRETERS, SOCIAL WORKERS, 2657 01:33:02,040 --> 01:33:03,960 PATIENT NAVIGATORS AND PATIENT 2658 01:33:03,960 --> 01:33:05,640 EDUCATORS WILL COME BACK AND 2659 01:33:05,640 --> 01:33:06,920 TALK ABOUT THE PATIENT 2660 01:33:06,920 --> 01:33:08,240 EDUCATORS, BUT THESE ARE 2661 01:33:08,240 --> 01:33:10,240 PROBABLY UNDERUTILIZED, AND THEY 2662 01:33:10,240 --> 01:33:11,920 CERTAINLY WOULD BE VERY HELPFUL 2663 01:33:11,920 --> 01:33:14,920 IN TERMS OF IMPROVING 2664 01:33:14,920 --> 01:33:17,760 COMMUNICATION ABOUT OA, AND THEN 2665 01:33:17,760 --> 01:33:19,080 BASED ON THE TALK THAT WE HAD 2666 01:33:19,080 --> 01:33:20,920 TODAY IN TERMS OF 2667 01:33:20,920 --> 01:33:22,160 COMMUNITY-BASED RESOURCES, 2668 01:33:22,160 --> 01:33:25,000 AGAIN, PROBABLY UNDERUTILIZED IN 2669 01:33:25,000 --> 01:33:28,600 TERMS OF THE AREA AGENCY ON 2670 01:33:28,600 --> 01:33:30,760 AGING, THAT CLINICIANS COULD 2671 01:33:30,760 --> 01:33:32,520 REACH OUT AND TO UTILIZE THAT AS 2672 01:33:32,520 --> 01:33:35,680 A RESOURCE. 2673 01:33:35,680 --> 01:33:37,240 WE TALKED ABOUT THE NEED OF 2674 01:33:37,240 --> 01:33:38,880 STANDARDIZED MEASURES OF PAIN 2675 01:33:38,880 --> 01:33:40,400 AND PHYSICAL FUNCTION, ALSO 2676 01:33:40,400 --> 01:33:42,160 PERFORMANCE MEASURES, PROMISE. 2677 01:33:42,160 --> 01:33:43,920 WE DID HAVE A DISCUSSION, 2678 01:33:43,920 --> 01:33:47,520 THOUGH, IN TERMS OF WHETHER 2679 01:33:47,520 --> 01:33:51,440 DIFFERENT GROUPS INTERPRET AND 2680 01:33:51,440 --> 01:33:52,640 COMMUNICATE THE SAME IN TERMS OF 2681 01:33:52,640 --> 01:33:57,440 THESE MEASURES, IN TERMS OF PAIN 2682 01:33:57,440 --> 01:33:58,640 INCENTIVE AND DISABILITY 2683 01:33:58,640 --> 01:33:59,280 COMMUNICATION, THAT'S IMPORTANT 2684 01:33:59,280 --> 01:34:00,600 IN TERMS OF THINKING ABOUT MORE 2685 01:34:00,600 --> 01:34:05,120 RESEARCH IN THAT AREA. 2686 01:34:05,120 --> 01:34:06,200 TED BROUGHT UP THERE'S A FUNDING 2687 01:34:06,200 --> 01:34:06,840 OPPORTUNITY THAT EVERYBODY 2688 01:34:06,840 --> 01:34:09,240 SHOULD BE AWARE OF IN TERMS OF 2689 01:34:09,240 --> 01:34:09,880 PATIENT-CLINICIAN RELATIONSHIPS 2690 01:34:09,880 --> 01:34:11,560 IN TERMS OF IMPROVING HEALTH 2691 01:34:11,560 --> 01:34:12,880 OUTCOMES OF PATIENTS THAT 2692 01:34:12,880 --> 01:34:13,840 EXPERIENCE HEALTH DISPARITIES 2693 01:34:13,840 --> 01:34:14,800 AND WE THOUGHT IT WAS IMPORTANT 2694 01:34:14,800 --> 01:34:16,680 TO INCLUDE THAT HERE. 2695 01:34:16,680 --> 01:34:22,600 AND WE WERE FORTUNATE TO HAVE 2696 01:34:22,600 --> 01:34:23,600 MS. OVERTON, A PATIENT TO HAVE 2697 01:34:23,600 --> 01:34:25,160 AS PART OF OUR GROUP, AND REALLY 2698 01:34:25,160 --> 01:34:26,680 TWO THINGS THAT CAME OUT OF THAT 2699 01:34:26,680 --> 01:34:28,320 WAS REALLY ENGAGING THE PATIENT 2700 01:34:28,320 --> 01:34:30,160 AS A WHOLE PERSON AND NOT JUST 2701 01:34:30,160 --> 01:34:32,680 LOOKING AT THEM AS ONE DISEASE 2702 01:34:32,680 --> 01:34:35,280 OR EVEN A SUBDISEASE IN TERMS OF 2703 01:34:35,280 --> 01:34:36,800 JUST A JOINT, YOU KNOW, THAT 2704 01:34:36,800 --> 01:34:41,640 THEY HAVE A KNEE OR A HAND THAT 2705 01:34:41,640 --> 01:34:42,960 REALLY -- IT'S IMPORTANT IN 2706 01:34:42,960 --> 01:34:44,680 TERMS OF THE PATIENT CLINICIAN 2707 01:34:44,680 --> 01:34:47,000 COMMUNICATION TO THINK ABOUT THE 2708 01:34:47,000 --> 01:34:48,200 PATIENT AS A WHOLE PERSON IN 2709 01:34:48,200 --> 01:34:51,840 TERMS OF ALL THE PIECES THAT 2710 01:34:51,840 --> 01:34:53,760 COMPRISED THE VARIOUS PROBLEMS 2711 01:34:53,760 --> 01:34:56,400 THAT THEY MAY BE FACING, AND NOT 2712 01:34:56,400 --> 01:34:59,240 JUST FOCUS ON ONE AREA. 2713 01:34:59,240 --> 01:35:01,120 AND ALSO RELATED TO THAT, SHE 2714 01:35:01,120 --> 01:35:02,640 BROUGHT UP THE IMPORTANCE THAT 2715 01:35:02,640 --> 01:35:05,600 WE TALK ABOUT IN TERMS OF CARE 2716 01:35:05,600 --> 01:35:09,520 COORDINATION, AND THIS IS WHERE 2717 01:35:09,520 --> 01:35:11,480 THE WHY WOULD WAS THAT WE REALLY 2718 01:35:11,480 --> 01:35:15,640 NEED TO WORK ACROSS DIFFERENT 2719 01:35:15,640 --> 01:35:17,200 CLINICIANS, AND SHE TALKED ABOUT 2720 01:35:17,200 --> 01:35:18,600 HOW HER CARE WAS FRAGMENTED, 2721 01:35:18,600 --> 01:35:20,880 BEFORE HAVING A PCP THAT REALLY 2722 01:35:20,880 --> 01:35:22,240 OVERALL MANAGED HER CARE, BUT 2723 01:35:22,240 --> 01:35:24,200 HAVING THE PAIN CLINIC VERSUS 2724 01:35:24,200 --> 01:35:26,280 THE ORTHOPEDIC SURGEON VERSUS 2725 01:35:26,280 --> 01:35:29,320 YOUR DERMATOLOGIST, SO THAT 2726 01:35:29,320 --> 01:35:31,880 CERTAINLY BETTER CARE 2727 01:35:31,880 --> 01:35:36,760 COORDINATION WAS EMPHASIZED THAT 2728 01:35:36,760 --> 01:35:38,760 THAT'S IMPORTANT EMPHASIS OF THE 2729 01:35:38,760 --> 01:35:40,480 NIA IN TERMS OF CARE 2730 01:35:40,480 --> 01:35:41,480 COORDINATION FOR OLDER FOLKS, 2731 01:35:41,480 --> 01:35:43,200 BUT CERTAINLY FOR PATIENTS WITH 2732 01:35:43,200 --> 01:35:44,320 OA. 2733 01:35:44,320 --> 01:35:47,040 WE HAD QUITE A BIT OF DISCUSSION 2734 01:35:47,040 --> 01:35:49,640 UNDERSTANDING WHAT WORKS IS 2735 01:35:49,640 --> 01:35:53,480 CHALLENGING, AND SO TRYING TO -- 2736 01:35:53,480 --> 01:35:56,120 MORE EVIDENCE IS NEEDED FOR THE 2737 01:35:56,120 --> 01:35:57,680 EXISTING RESOURCES AND HOW 2738 01:35:57,680 --> 01:36:00,720 EFFECTIVE THEY ARE, NEED TO 2739 01:36:00,720 --> 01:36:01,760 STANDARDIZE EXISTING MEASURES 2740 01:36:01,760 --> 01:36:03,240 AND PROTOCOLS IN RESEARCH AND 2741 01:36:03,240 --> 01:36:06,560 CLINICAL CARE TO BETTER 2742 01:36:06,560 --> 01:36:07,160 UNDERSTAND HEALTH DISPARITIES 2743 01:36:07,160 --> 01:36:08,600 AND PATIENT-PROVIDER 2744 01:36:08,600 --> 01:36:09,360 COMMUNICATION. 2745 01:36:09,360 --> 01:36:12,320 AND BETTER PAIN COMMUNICATION 2746 01:36:12,320 --> 01:36:12,640 TOOLS. 2747 01:36:12,640 --> 01:36:14,080 WE NEED TO TEST THESE MEASURES 2748 01:36:14,080 --> 01:36:16,040 IN DIVERSE POPULATIONS AS I 2749 01:36:16,040 --> 01:36:19,320 MENTIONED AND THAT LACK OF 2750 01:36:19,320 --> 01:36:20,760 EVIDENCE IS A BARRIER TO 2751 01:36:20,760 --> 01:36:23,800 REIMBURSEMENT FOR RESOURCES, FOR 2752 01:36:23,800 --> 01:36:25,240 EXAMPLE, DIABETES, PATIENT 2753 01:36:25,240 --> 01:36:27,960 EDUCATORS ARE REIMBURSED AND FOR 2754 01:36:27,960 --> 01:36:31,080 RHEUMATOLOGY OR OSTEOARTHRITIS, 2755 01:36:31,080 --> 01:36:32,240 THAT ISN'T THE CASE, SO IF WE 2756 01:36:32,240 --> 01:36:35,600 HAD MORE STUDIES TO SHOW THAT 2757 01:36:35,600 --> 01:36:36,760 THE BENEFIT OF PATIENT EDUCATION 2758 01:36:36,760 --> 01:36:40,880 THAT PERHAPS, THEN, WE COULD GET 2759 01:36:40,880 --> 01:36:41,840 REIMBURSEMENT FOR THESE 2760 01:36:41,840 --> 01:36:44,040 RESOURCES IN OUR CLINICS THAT 2761 01:36:44,040 --> 01:36:46,120 WOULD BENEFIT OUR PATIENTS. 2762 01:36:46,120 --> 01:36:49,400 THEN WE TALKED A LOT OF 2763 01:36:49,400 --> 01:36:53,040 MODIFYING DISEASE PROCESSES. 2764 01:36:53,040 --> 01:36:53,880 DEFINING COMMUNICATION TAKING 2765 01:36:53,880 --> 01:36:55,200 INTO CONSIDERATION THE PATIENT'S 2766 01:36:55,200 --> 01:37:01,080 EXPERIENCES AND RESOURCES, NOT 2767 01:37:01,080 --> 01:37:02,520 JUST FOCUSING ON THE DISEASE BUT 2768 01:37:02,520 --> 01:37:03,840 WHAT THE PATIENT'S SYMPTOMS ARE, 2769 01:37:03,840 --> 01:37:05,720 HOW IT IMPACTS THEIR LIFE, AND 2770 01:37:05,720 --> 01:37:08,000 WHAT RESOURCES THEY HAVE TO 2771 01:37:08,000 --> 01:37:12,360 ADDRESS THESE AND 2772 01:37:12,360 --> 01:37:14,200 RECOMMENDATIONS OF TAKING INTO 2773 01:37:14,200 --> 01:37:15,440 ACCOUNT THESE RESOURCES. 2774 01:37:15,440 --> 01:37:16,400 AND RECOGNIZING THE 2775 01:37:16,400 --> 01:37:17,720 COMMUNICATION IS NOT JUST 2776 01:37:17,720 --> 01:37:18,800 NECESSARILY WITH THE ONE 2777 01:37:18,800 --> 01:37:19,480 PATIENT, WE'VE HEARD ABOUT THAT 2778 01:37:19,480 --> 01:37:22,000 DURING THE WORKSHOP IN TERMS OF 2779 01:37:22,000 --> 01:37:24,840 CULTURALLY DIFFERENT GROUPS THAT 2780 01:37:24,840 --> 01:37:28,240 FAMILY MEMBERS PLAY A VERY 2781 01:37:28,240 --> 01:37:29,640 IMPORTANT ROLE, AND WE'VE 2782 01:37:29,640 --> 01:37:30,440 ALREADY DISCUSSED IN TERMS OF 2783 01:37:30,440 --> 01:37:31,400 DIFFERENT PROVIDERS INVOLVED IN 2784 01:37:31,400 --> 01:37:32,400 THAT CARE AND THE IMPORTANCE IN 2785 01:37:32,400 --> 01:37:34,680 TERMS OF COMMUNICATION AND CARE 2786 01:37:34,680 --> 01:37:37,520 COORDINATION AMONG THESE GROUPS. 2787 01:37:37,520 --> 01:37:39,520 AND REALLY LOOK FOR 2788 01:37:39,520 --> 01:37:42,240 OPPORTUNITIES FOR SHARED 2789 01:37:42,240 --> 01:37:43,880 DECISION-MAKING, REALLIAGE NOT 2790 01:37:43,880 --> 01:37:47,480 JUST PATIENTS AND PRIMARY CARE 2791 01:37:47,480 --> 01:37:48,560 PRACTITIONERS, BUT AGAIN ACROSS 2792 01:37:48,560 --> 01:37:50,400 THESE VARIOUS PROVIDERS THAT 2793 01:37:50,400 --> 01:37:51,600 WILL BE INTERACTING WITH THE 2794 01:37:51,600 --> 01:37:54,160 PATIENT BASED ON THEIR 2795 01:37:54,160 --> 01:37:56,000 OSTEOARTHRITIS. 2796 01:37:56,000 --> 01:37:57,760 AND WE THOUGHT THAT PATIENT 2797 01:37:57,760 --> 01:37:58,320 PREFERENCES ARE IMPORTANT. 2798 01:37:58,320 --> 01:38:00,600 I KNOW THAT THE OTHER GROUP 2799 01:38:00,600 --> 01:38:05,440 TALKED ABOUT ASSESSING PATIENT 2800 01:38:05,440 --> 01:38:06,640 PREFERENCES REALIZING THAT 2801 01:38:06,640 --> 01:38:08,800 PHYSICIANS MAY INTERPRET PATIENT 2802 01:38:08,800 --> 01:38:09,880 PREFERENCES DIFFERENTLY AND 2803 01:38:09,880 --> 01:38:10,880 PATIENTS HAVE THEIR OWN 2804 01:38:10,880 --> 01:38:11,680 PREFERENCES AND IT'S IMPORTANT 2805 01:38:11,680 --> 01:38:13,640 THEN TO RECONCILE THESE 2806 01:38:13,640 --> 01:38:14,920 POTENTIAL DIFFERENCES IN TERMS 2807 01:38:14,920 --> 01:38:18,120 OF PATIENT PREFERENCES AND 2808 01:38:18,120 --> 01:38:19,640 PHYSICIAN PREFERENCES, ALSO 2809 01:38:19,640 --> 01:38:20,560 PHYSICIAN INTERPRETATIONS OF 2810 01:38:20,560 --> 01:38:26,840 PATIENT PREFERENCES. 2811 01:38:26,840 --> 01:38:28,600 WE TALKED ABOUT HOW DO WE BETTER 2812 01:38:28,600 --> 01:38:30,840 TRANSLATE AND IMPLEMENT RESEARCH 2813 01:38:30,840 --> 01:38:35,640 RESULTS INTO THE COMMUNITY, 2814 01:38:35,640 --> 01:38:39,320 MIGHT BE SOMETHING MORE IN TERMS 2815 01:38:39,320 --> 01:38:42,840 OF AHRQ AND PCORI IN TERMS OF 2816 01:38:42,840 --> 01:38:43,680 COMMUNICATING TO PATIENTS IN 2817 01:38:43,680 --> 01:38:47,960 TERMS OF THE RESEARCH RESULTS 2818 01:38:47,960 --> 01:38:52,760 THAT MAY BENEFIT THEM, ALSO IN 2819 01:38:52,760 --> 01:38:56,520 TERMS OF IMPLEMENTING THEM INTO 2820 01:38:56,520 --> 01:38:57,160 CLINICAL PRACTICE IN THE 2821 01:38:57,160 --> 01:38:57,400 COMMUNITY. 2822 01:38:57,400 --> 01:39:00,640 SO WE TALKED ABOUT GAPS, 2823 01:39:00,640 --> 01:39:05,440 PATIENTS, PROVIDERS CAN CONSULT 2824 01:39:05,440 --> 01:39:06,640 IN GENERAL INFORMATION ABOUT OA, 2825 01:39:06,640 --> 01:39:08,440 BUT THERE WERE DEFINITELY SOME 2826 01:39:08,440 --> 01:39:11,800 GAPS THERE. 2827 01:39:11,800 --> 01:39:12,800 RESOURCES ARE AVAILABLE FOR 2828 01:39:12,800 --> 01:39:13,880 PROVIDERS ABOUT MANAGEMENT 2829 01:39:13,880 --> 01:39:16,280 OPTIONS AND FOR OA, BUT THESE 2830 01:39:16,280 --> 01:39:18,280 NEED TO BE CURATED AND EASY TO 2831 01:39:18,280 --> 01:39:20,760 FIND EVIDENCE-BASED INFORMATION 2832 01:39:20,760 --> 01:39:21,760 CERTAINLY PATIENTS SEARCHING THE 2833 01:39:21,760 --> 01:39:24,600 WEB AND IT'S NOT ALWAYS EASY TO 2834 01:39:24,600 --> 01:39:25,040 FIND INFORMATION. 2835 01:39:25,040 --> 01:39:27,360 MUCH OF IT MAY BE PROMOTED BY 2836 01:39:27,360 --> 01:39:29,520 DRUG COMPANIES AND THEIR 2837 01:39:29,520 --> 01:39:38,600 PARTICULAR PRODUCTS. 2838 01:39:38,600 --> 01:39:41,240 OA TENDS TO BE IN GENERAL THAT 2839 01:39:41,240 --> 01:39:45,400 MUCH OF THE DISCUSSION IS ON 2840 01:39:45,400 --> 01:39:47,880 KNEE OA, CERTAINLY THE NIH HAS 2841 01:39:47,880 --> 01:39:50,440 GOOD HEALTH INFORMATION 2842 01:39:50,440 --> 01:39:51,520 RESOURCES AS DOES AMERICAN 2843 01:39:51,520 --> 01:39:53,280 COLLEGE OF RHEUMATOLOGY, AND WE 2844 01:39:53,280 --> 01:39:55,880 TALKED ABOUT MAYBE INCORPORATING 2845 01:39:55,880 --> 01:39:57,560 MORE GRAPHICS INTO THESE PATIENT 2846 01:39:57,560 --> 01:39:59,600 EDUCATION RESOURCES TO MAKE 2847 01:39:59,600 --> 01:40:01,040 COMMUNICATION EASIER FOR OUR 2848 01:40:01,040 --> 01:40:04,440 VISUAL YOU'LL LEARNER LEARNERS. 2849 01:40:04,440 --> 01:40:05,720 WE HAD A LONG DISCUSSION IN 2850 01:40:05,720 --> 01:40:07,040 TERMS OF THE NEED FOR TRAINING 2851 01:40:07,040 --> 01:40:10,200 AND EDUCATION SUPPORT PROVIDERS 2852 01:40:10,200 --> 01:40:13,480 TO IMPROVE PATIENT INTERACTIONS 2853 01:40:13,480 --> 01:40:14,920 AND SUPPORT BY THE HEALTH 2854 01:40:14,920 --> 01:40:16,920 SYSTEM, BETTER COMMUNICATION, 2855 01:40:16,920 --> 01:40:18,760 ALSO IN TERMS OF RISK 2856 01:40:18,760 --> 01:40:21,800 COMMUNICATION TRAIBING FOR TRAIR 2857 01:40:21,800 --> 01:40:23,920 CLINICIANS SO THEY CAN BETTER 2858 01:40:23,920 --> 01:40:25,000 COMMUNICATE RISKS AND BENEFITS 2859 01:40:25,000 --> 01:40:27,520 OF VARIOUS TREATMENTS AND 2860 01:40:27,520 --> 01:40:31,880 INTERVENTIONS TO PATIENTS. 2861 01:40:31,880 --> 01:40:34,880 AS WE TALKED ABOUT, OA RESEARCH 2862 01:40:34,880 --> 01:40:36,680 TENDS TO BE FOCUSED ON THE KNEE, 2863 01:40:36,680 --> 01:40:38,560 AND THAT AGENCIES SHOULD REALLY 2864 01:40:38,560 --> 01:40:40,960 TALK ABOUT MORE RESEARCH IN 2865 01:40:40,960 --> 01:40:44,560 OTHER AREAS BESIDES THE KNEE IN 2866 01:40:44,560 --> 01:40:45,560 TERMS OF SPECIFIC JOINTS SUCH AS 2867 01:40:45,560 --> 01:40:47,200 HAND OR FOOT AND ANKLE OR 2868 01:40:47,200 --> 01:40:49,920 SHOULDER. 2869 01:40:49,920 --> 01:40:51,320 THESE ARE -- SPINE, THAT COULD 2870 01:40:51,320 --> 01:40:52,560 BE IMPORTANT FOR PATIENTS AND WE 2871 01:40:52,560 --> 01:40:56,920 NEED TO HAVE BETTER EVIDENCE IN 2872 01:40:56,920 --> 01:40:59,960 THIS AREA TO COMMUNICATE PATIENT 2873 01:40:59,960 --> 01:41:00,280 INFORMATION. 2874 01:41:00,280 --> 01:41:02,520 WE TALKED ABOUT TO REALLY 2875 01:41:02,520 --> 01:41:05,360 IMPROVE PATIENT CLINICIAN 2876 01:41:05,360 --> 01:41:06,000 COMMUNICATION, WE NEED 2877 01:41:06,000 --> 01:41:07,640 MEASUREMENTS TO ASSESS THIS AND 2878 01:41:07,640 --> 01:41:10,800 STANDARDIZED MEASUREMENTS, AND 2879 01:41:10,800 --> 01:41:12,120 WE'LL TALK ABOUT THAT MORE, THAT 2880 01:41:12,120 --> 01:41:16,080 A LOT OF THE WORK HAN HAS BEEN 2881 01:41:16,080 --> 01:41:17,600 QUALITATIVE, THERE HAVE BEEN A 2882 01:41:17,600 --> 01:41:20,760 FEW STANDARDIZED MEASURES, BUT 2883 01:41:20,760 --> 01:41:21,720 PATIENT INFORMATION, THAT NEEDS 2884 01:41:21,720 --> 01:41:23,040 TO BE CULTURALLY APPROPRIATE IN 2885 01:41:23,040 --> 01:41:24,840 TERMS OF THIS PATIENT CLINICIAN 2886 01:41:24,840 --> 01:41:26,560 COMMUNICATION. 2887 01:41:26,560 --> 01:41:27,520 THERE ARE A VARIETY OF 2888 01:41:27,520 --> 01:41:31,800 OPPORTUNITIES THAT WE 2889 01:41:31,800 --> 01:41:34,640 IDENTIFIED, AND SO MULTIMODAL 2890 01:41:34,640 --> 01:41:36,840 STUDIES OF DIET INTERVENTION, 2891 01:41:36,840 --> 01:41:37,480 EXERCISE INTERVENTIONS IN TERMS 2892 01:41:37,480 --> 01:41:41,120 OF THINKING ABOUT HOW TO 2893 01:41:41,120 --> 01:41:42,560 COMMUNICATE THE BENEFITS OF 2894 01:41:42,560 --> 01:41:44,200 THESE TO PATIENTS, PARTNERING 2895 01:41:44,200 --> 01:41:49,840 WITH OTHER NIH INSTITUTES, ON 2896 01:41:49,840 --> 01:41:52,400 OA, COMORBIDITIES, YOU HEARD A 2897 01:41:52,400 --> 01:41:55,160 LOT ABOUT THAT OVER THESE TWO 2898 01:41:55,160 --> 01:41:55,960 DAYS, THERE'S OPPORTUNITIES IN 2899 01:41:55,960 --> 01:41:57,280 TERMS OF HEALTHY DIET AND 2900 01:41:57,280 --> 01:41:58,480 EXERCISE FOR A VARIETY OF 2901 01:41:58,480 --> 01:42:04,280 CHRONIC DISEASES, AND HOW DO WE 2902 01:42:04,280 --> 01:42:07,120 TAILOR THESE RECOMMENDS THAT ARE 2903 01:42:07,120 --> 01:42:08,240 CULTURALLY SENSITIVE FOR 2904 01:42:08,240 --> 01:42:09,760 ACCESSING HEALTHY FOODS, 2905 01:42:09,760 --> 01:42:10,200 PROVIDING REALISTIC 2906 01:42:10,200 --> 01:42:12,280 RECOMMENDATIONS ABOUT 2907 01:42:12,280 --> 01:42:13,560 EXERCISING, CONSIDERING 2908 01:42:13,560 --> 01:42:14,680 PATIENTS' RESOURCES AND 2909 01:42:14,680 --> 01:42:16,440 ENVIRONMENT, WE'VE HEARD ABOUT 2910 01:42:16,440 --> 01:42:19,280 THE FIT ENVIRONMENT AND WHERE 2911 01:42:19,280 --> 01:42:20,800 PATIENTS MAY OR MAY NOT HAVE THE 2912 01:42:20,800 --> 01:42:24,760 ABILITY TO EXERCISE BASED ON THE 2913 01:42:24,760 --> 01:42:25,800 ENVIRONMENT, BUT ALSO IMPORTANT 2914 01:42:25,800 --> 01:42:26,960 IN TERMS OF FITNESS LEVEL. 2915 01:42:26,960 --> 01:42:28,600 WE ALSO HEARD ABOUT THAT DURING 2916 01:42:28,600 --> 01:42:31,760 THE SESSIONS HERE, THAT 2917 01:42:31,760 --> 01:42:32,960 REALISTIC EXPECTATIONS OF WHAT 2918 01:42:32,960 --> 01:42:36,480 PATIENTS CAN EXERCISE, NOT 2919 01:42:36,480 --> 01:42:38,640 NECESSARILY 10,000 STEPS A DAY, 2920 01:42:38,640 --> 01:42:40,120 CERTAINLY LOWER LEVELS, 6,000 2921 01:42:40,120 --> 01:42:42,360 STEPS A DAY BUT IF SOMEBODY IS 2922 01:42:42,360 --> 01:42:44,880 SEDENTARY, EVEN 500 STEPS IS 2923 01:42:44,880 --> 01:42:45,160 REASONABLE. 2924 01:42:45,160 --> 01:42:47,960 MORE IS BETTER THAN LESS, AND 2925 01:42:47,960 --> 01:42:50,800 THAT GRADUALLY INCREASING THOSE 2926 01:42:50,800 --> 01:42:53,760 TARGETS ARE IMPORTANT WHEN 2927 01:42:53,760 --> 01:42:54,280 COMMUNICATING THESE 2928 01:42:54,280 --> 01:42:59,760 RECOMMENDATIONS TO PATIENTS. 2929 01:42:59,760 --> 01:43:01,040 AND SO THAT RELATES TO 2930 01:43:01,040 --> 01:43:01,920 RECOMMENDATIONS AND GOALS TO 2931 01:43:01,920 --> 01:43:03,120 PATIENTS ABOUT TYPE, FREQUENCY 2932 01:43:03,120 --> 01:43:04,800 AND DURATION OF EXERCISE. 2933 01:43:04,800 --> 01:43:06,080 AGAIN, HAVING REALISTIC GOALS 2934 01:43:06,080 --> 01:43:08,160 AND REALLY A GRADED EXERCISE 2935 01:43:08,160 --> 01:43:10,120 PROGRAM, THAT THEY ARE ABLE TO 2936 01:43:10,120 --> 01:43:14,040 ATTAIN AND HAVE SUCCESS AND THEN 2937 01:43:14,040 --> 01:43:14,600 MOVE ON. 2938 01:43:14,600 --> 01:43:17,040 SO PART OF THAT ALSO IS MANAGING 2939 01:43:17,040 --> 01:43:18,120 PATIENTS' EXPECTATIONS ABOUT THE 2940 01:43:18,120 --> 01:43:21,520 OUTCOMES OF EXERCISE, THAT THEY 2941 01:43:21,520 --> 01:43:22,800 AREN'T GOING TO SEE THE BENEFITS 2942 01:43:22,800 --> 01:43:24,040 RIGHT AWAY BUT IT'S REALLY LONG 2943 01:43:24,040 --> 01:43:27,880 TERM IN TERMS OF HOW THE IMPACT 2944 01:43:27,880 --> 01:43:30,680 OF THE EXERCISE WILL BE ON THEIR 2945 01:43:30,680 --> 01:43:37,680 PAIN AND THEIR JOINTS. 2946 01:43:37,680 --> 01:43:41,200 IN TERMS OF IMMEDIATE SHORT TERM 2947 01:43:41,200 --> 01:43:42,200 GOALS, WE NEED TO REALLY 2948 01:43:42,200 --> 01:43:43,280 UNDERSTAND HOW TO BETTER 2949 01:43:43,280 --> 01:43:44,120 COMMUNICATE THE EVIDENCE BASE 2950 01:43:44,120 --> 01:43:48,760 FOR THE EFFICACY OF EXISTING 2951 01:43:48,760 --> 01:43:52,560 INTERVENTIONS, IN TERMS OF 2952 01:43:52,560 --> 01:43:54,560 HEALTHY WEIGHT, COMMUNITY HEALTH 2953 01:43:54,560 --> 01:43:56,320 WORKERS, AND TO BE ABLE TO 2954 01:43:56,320 --> 01:43:57,720 BETTER PROMOTE THE TOOLS THROUGH 2955 01:43:57,720 --> 01:43:59,120 THE OA ACTION ALLIANCE. 2956 01:43:59,120 --> 01:44:01,120 THIS IS AT UNC PARTNERING WITH 2957 01:44:01,120 --> 01:44:04,720 CDC AND WITH ARTHRITIS 2958 01:44:04,720 --> 01:44:07,120 FOUNDATION, THAT THEY'VE CURATED 2959 01:44:07,120 --> 01:44:08,440 A DATA BANK OF TOOLS FOR 2960 01:44:08,440 --> 01:44:12,280 EDUCATION, BUT ALSO MEASURES AND 2961 01:44:12,280 --> 01:44:16,880 WE TALKED ABOUT DECISION AIDS, 2962 01:44:16,880 --> 01:44:18,720 MAYBE INCORPORATING THOSE IN 2963 01:44:18,720 --> 01:44:20,280 THERE IF THEY AREN'T IN THERE. 2964 01:44:20,280 --> 01:44:21,560 THERE ARE THE ABILITY OF THESE 2965 01:44:21,560 --> 01:44:27,800 EVIDENCE-BASE PROG-BASED PROGRAE 2966 01:44:27,800 --> 01:44:32,000 EXERCISE PROGRAM FOR HISPANICS 2967 01:44:32,000 --> 01:44:35,000 HAS BEEN TRANSLATED, SO WE WANT 2968 01:44:35,000 --> 01:44:37,000 TO MAKE SURE PEOPLE ARE AWARE OF 2969 01:44:37,000 --> 01:44:39,840 THAT RESOURCE AND UTILIZE IT 2970 01:44:39,840 --> 01:44:40,480 MORE. 2971 01:44:40,480 --> 01:44:42,880 AND REALLY IN TERMS OF THINKING 2972 01:44:42,880 --> 01:44:45,720 ABOUT PATIENT CLINICIAN 2973 01:44:45,720 --> 01:44:46,600 COMMUNICATION, NEED TO DEVELOP 2974 01:44:46,600 --> 01:44:48,800 TOOLS AND OUT COME MEASURES TO 2975 01:44:48,800 --> 01:44:53,600 ASSESS THE QUALITY OF 2976 01:44:53,600 --> 01:44:55,680 INTERACTIONS, POTENTIALLY IF 2977 01:44:55,680 --> 01:44:57,960 POSSIBLE TO HAVE -- ENCOURAGE 2978 01:44:57,960 --> 01:45:01,280 COMMON MEASURES OF THESE 2979 01:45:01,280 --> 01:45:03,760 ASSESSMENTS OF THE QUALITY OF 2980 01:45:03,760 --> 01:45:04,560 PATIENT-CLINICIAN INTERACTIONS 2981 01:45:04,560 --> 01:45:06,520 SO THAT THEY CAN BE IMPLEMENTED 2982 01:45:06,520 --> 01:45:09,240 ACROSS MULTIPLE STUDIES OF OA 2983 01:45:09,240 --> 01:45:11,120 BUT ALSO IMPLEMENTED ACROSS 2984 01:45:11,120 --> 01:45:12,640 DIFFERENT HEALTH SYSTEMS SUCH AS 2985 01:45:12,640 --> 01:45:15,400 PROBLEMS ARE BEING IMPLEMENTED 2986 01:45:15,400 --> 01:45:16,680 ACROSS THESE HEALTH SYSTEMS. 2987 01:45:16,680 --> 01:45:18,560 AND ALSO ENGAGE IN OTHER 2988 01:45:18,560 --> 01:45:25,120 DISCIPLINES IN TERMS OF 2989 01:45:25,120 --> 01:45:26,000 COMMUNICATION TRIALS, WE 2990 01:45:26,000 --> 01:45:27,720 DISCUSSED CERTAINLY PCPs ARE 2991 01:45:27,720 --> 01:45:29,160 IMPORTANT BUT MANY OTHER 2992 01:45:29,160 --> 01:45:30,680 CLINICIANS ARE INVOLVED IN THE 2993 01:45:30,680 --> 01:45:32,120 MANAGEMENT OF PATIENTS WITH 2994 01:45:32,120 --> 01:45:34,080 OSTEOARTHRITIS AND WE TALK ABOUT 2995 01:45:34,080 --> 01:45:37,480 OA COMMUNICATION THAT WE SHOULD 2996 01:45:37,480 --> 01:45:39,320 UTILIZE THE PERSPECTIVES OF THE 2997 01:45:39,320 --> 01:45:40,560 OTHER DISCIPLINES TO SEE HOW WE 2998 01:45:40,560 --> 01:45:43,920 CAN BETTER IMPROVE OA 2999 01:45:43,920 --> 01:45:44,240 COMMUNICATION. 3000 01:45:44,240 --> 01:45:47,320 AND STUDY HOW PROVIDERS MAY BE 3001 01:45:47,320 --> 01:45:50,040 USING CURRENT MEASURES SUCH AS 3002 01:45:50,040 --> 01:45:56,920 OCHT A CARE OA CARE TOOLS, WHETE 3003 01:45:56,920 --> 01:45:58,360 PATIENT-REPORTED OUTCOME 3004 01:45:58,360 --> 01:45:59,760 MEASURES, PERFORMANCE MEASURES, 3005 01:45:59,760 --> 01:46:00,960 AND WE DISCUSSED THAT THERE WAS 3006 01:46:00,960 --> 01:46:03,320 A NEED FOR MORE MULTIMODAL 3007 01:46:03,320 --> 01:46:06,000 STUDIES ON PATIENT CLINICIAN 3008 01:46:06,000 --> 01:46:07,120 COMMUNICATION, BOTH QUALITATIVE 3009 01:46:07,120 --> 01:46:09,960 AND QUANTITATIVE, AND ALSO IN 3010 01:46:09,960 --> 01:46:14,120 DIFFERENT SETTINGS, THAT MAY BE 3011 01:46:14,120 --> 01:46:15,200 DURING THE OFFICE, MAYBE IN THE 3012 01:46:15,200 --> 01:46:17,720 COMMUNITY, HOW TO PROVIDE 3013 01:46:17,720 --> 01:46:19,080 PATIENT EDUCATION RESOURCES, HOW 3014 01:46:19,080 --> 01:46:20,120 TO TAILOR THAT AND HOW TO 3015 01:46:20,120 --> 01:46:21,120 COMMUNICATE WITH THE REST OF THE 3016 01:46:21,120 --> 01:46:25,080 CARE TEAM. 3017 01:46:25,080 --> 01:46:26,920 ONE OF THE RECOMMENDATIONS WE'D 3018 01:46:26,920 --> 01:46:28,240 COME UP WITH, THERE NEEDS TO BE 3019 01:46:28,240 --> 01:46:32,600 MORE TRAINING ON PATIENT 3020 01:46:32,600 --> 01:46:33,720 COMMUNICATION INTO CLINICIAN 3021 01:46:33,720 --> 01:46:34,920 TRAINING REQUIREMENTS, TRAINING 3022 01:46:34,920 --> 01:46:37,320 REQUIREMENTS FOR NIH K AND F 3023 01:46:37,320 --> 01:46:40,240 AWARDS. 3024 01:46:40,240 --> 01:46:42,000 CERTAINLY THIS STARTING AT AN 3025 01:46:42,000 --> 01:46:43,320 EARLY STAGE, IMPORTANCE OF 3026 01:46:43,320 --> 01:46:43,880 PATIENT COMMUNICATION AND 3027 01:46:43,880 --> 01:46:45,600 REALLY, AGAIN, TALKING ABOUT 3028 01:46:45,600 --> 01:46:47,480 THIS IN TERMS OF MEDICAL STOOL 3029 01:46:47,480 --> 01:46:48,880 AND STAFF TRAINING AS WELL, IN 3030 01:46:48,880 --> 01:46:50,760 TERMS OF HOW TO COMMUNICATE WITH 3031 01:46:50,760 --> 01:46:52,520 DIVERSE POPULATIONS IN A 3032 01:46:52,520 --> 01:46:53,680 CULTURALLY APPROPRIATE WAY. 3033 01:46:53,680 --> 01:46:56,440 CERTAINLY WE'VE MADE STRIDES IN 3034 01:46:56,440 --> 01:46:58,520 THIS AREA, BUT I THINK THERE'S 3035 01:46:58,520 --> 01:47:02,040 MANY MORE STRIDES THAT COULD BE 3036 01:47:02,040 --> 01:47:03,680 DONE IN TERMS OF IMPROVING HOW 3037 01:47:03,680 --> 01:47:04,440 WE'RE DOING THIS. 3038 01:47:04,440 --> 01:47:06,840 I TALKED ABOUT DEVELOPING 3039 01:47:06,840 --> 01:47:09,600 EDUCATION RESOURCES FOR SPECIFIC 3040 01:47:09,600 --> 01:47:11,200 JOINTS AND MAKING THEM MORE 3041 01:47:11,200 --> 01:47:13,520 ACCESSIBLE TO PATIENTS AND 3042 01:47:13,520 --> 01:47:15,560 PROVIDERS. 3043 01:47:15,560 --> 01:47:17,120 ALSO HOW WE FACILITATE EARLY 3044 01:47:17,120 --> 01:47:18,320 DIAGNOSIS AND PREVENTION, THIS 3045 01:47:18,320 --> 01:47:22,160 IS CERTAINLY A CHALLENGE IN 3046 01:47:22,160 --> 01:47:23,240 TERMS OF IDENTIFYING PATIENTS 3047 01:47:23,240 --> 01:47:25,240 WITH OA EARLY IN THE DISEASE 3048 01:47:25,240 --> 01:47:28,240 COURSE, IN TERMS OF 3049 01:47:28,240 --> 01:47:29,160 COMMUNICATING THE EVIDENCE 3050 01:47:29,160 --> 01:47:31,320 MEASURES THAT WE HAVE IN TERMS 3051 01:47:31,320 --> 01:47:36,120 OF ADDRESSING OA IN TERMS OF 3052 01:47:36,120 --> 01:47:40,720 EXERCISE AND HEALTHY DIETS. 3053 01:47:40,720 --> 01:47:43,120 LONG TERM GOALS, WE NEED MORE 3054 01:47:43,120 --> 01:47:46,960 STUDIES ON THE EFFICACY OF NOVEL 3055 01:47:46,960 --> 01:47:47,760 INTERVENTIONS TO TREAT OR 3056 01:47:47,760 --> 01:47:48,520 PREVENT OA. 3057 01:47:48,520 --> 01:47:50,080 MORE STUDIES OF IMPLEMENTATION 3058 01:47:50,080 --> 01:47:51,360 OF EVIDENCE-BASED INTERVENTIONS 3059 01:47:51,360 --> 01:47:53,080 TO IMPROVE PATIENT-CLINICIAN 3060 01:47:53,080 --> 01:47:55,520 COMMUNICATION, AND WE TALKED 3061 01:47:55,520 --> 01:47:57,360 ABOUT REALLY INCORPORATING 3062 01:47:57,360 --> 01:47:59,320 TRAINING ON PATIENT 3063 01:47:59,320 --> 01:48:00,320 COMMUNICATION, ALL LEVELS OF 3064 01:48:00,320 --> 01:48:04,480 CLINICIAN TRAINING REQUIREMENTS 3065 01:48:04,480 --> 01:48:06,560 IN TERMS OF RESEARCH AND ALSO IN 3066 01:48:06,560 --> 01:48:08,720 TERMS OF MEDICAL SCHOOL AND 3067 01:48:08,720 --> 01:48:09,480 HOUSE STAFF TRAINING. 3068 01:48:09,480 --> 01:48:10,480 ONE OF THE THINGS I WOULD ADD 3069 01:48:10,480 --> 01:48:14,640 THAT WE DIDN'T TOUCH ON THAT ARE 3070 01:48:14,640 --> 01:48:15,640 CLEARLY VERY IMPORTANT IS WE 3071 01:48:15,640 --> 01:48:17,280 NEED A DIVERSE WORKFORCE IN 3072 01:48:17,280 --> 01:48:21,560 TERMS OF IMPROVING 3073 01:48:21,560 --> 01:48:22,520 PATIENT-PROVIDER COMMUNICATION 3074 01:48:22,520 --> 01:48:26,120 FOR DIVERSE POPULATIONS. 3075 01:48:26,120 --> 01:48:28,200 ALSO THEN IF THERE'S ANYONE IN 3076 01:48:28,200 --> 01:48:30,280 THE GROUP THAT WANTS TO MAKE 3077 01:48:30,280 --> 01:48:34,240 COMMENTS TO ADDRESS THIS, IS 3078 01:48:34,240 --> 01:48:35,640 THERE ANYTHING WE LEFT OUT HERE? 3079 01:48:35,640 --> 01:48:37,400 >> NO, THIS IS A VERY GOOD 3080 01:48:37,400 --> 01:48:40,040 SUMMARY. 3081 01:48:40,040 --> 01:48:41,040 >> I THINK SO TOO. 3082 01:48:41,040 --> 01:48:42,240 THANKS FOR INCLUDING MY 3083 01:48:42,240 --> 01:48:42,480 THOUGHTS. 3084 01:48:42,480 --> 01:48:43,640 >> GREAT. 3085 01:48:43,640 --> 01:48:45,720 WELL, THANK YOU FOR CONTRIBUTING 3086 01:48:45,720 --> 01:48:48,520 VERY IMPORTANT POINTS, 3087 01:48:48,520 --> 01:48:48,920 MS. OVERTON. 3088 01:48:48,920 --> 01:48:49,200 ALL RIGHT. 3089 01:48:49,200 --> 01:48:54,000 THANK YOU, BACK TO YOU, KRISTY. 3090 01:48:54,000 --> 01:48:55,560 >> THANKS, DR. KWOH. 3091 01:48:55,560 --> 01:48:56,960 WE'LL MOVE NEXT TO DR. BROWN WHO 3092 01:48:56,960 --> 01:48:59,040 WILL TALK ABOUT THE SOCIETAL AND 3093 01:48:59,040 --> 01:49:00,160 SOCIAL DETERMINANTS OF HEALTH 3094 01:49:00,160 --> 01:49:05,320 BREAKOUT SESSION. 3095 01:49:05,320 --> 01:49:06,480 >> THANK YOU SO MUCH. 3096 01:49:06,480 --> 01:49:09,680 CAN YOU GUYS HEAR ME? 3097 01:49:09,680 --> 01:49:10,560 >> YES. 3098 01:49:10,560 --> 01:49:11,280 >> ALL RIGHT. 3099 01:49:11,280 --> 01:49:13,600 SO I WANT TO THANK THOMAS FOR 3100 01:49:13,600 --> 01:49:17,520 HIS HARD WORK ON THIS. 3101 01:49:17,520 --> 01:49:18,960 IF YOU GO TO THE NEXT SLIDE, 3102 01:49:18,960 --> 01:49:23,440 PLEASE. 3103 01:49:23,440 --> 01:49:26,520 SO I'LL TRY TO NOT BE TOO 3104 01:49:26,520 --> 01:49:27,200 REDUNDANT, THOUGH OBVIOUSLY 3105 01:49:27,200 --> 01:49:28,560 THERE'S GOING TO BE SOME OVERLAP 3106 01:49:28,560 --> 01:49:30,880 WITH THE PRIOR PRESENTATIONS. 3107 01:49:30,880 --> 01:49:32,080 SO IN THINKING ABOUT 3108 01:49:32,080 --> 01:49:33,520 OPPORTUNITIES, WE WERE TRYING TO 3109 01:49:33,520 --> 01:49:35,040 FOCUS FIRST ON, YOU KNOW, WHAT 3110 01:49:35,040 --> 01:49:37,560 RESOURCES AND SYSTEMS ARE IN 3111 01:49:37,560 --> 01:49:39,000 PLACE THAT CAN BE LEVERAGED. 3112 01:49:39,000 --> 01:49:41,600 THERE'S A LOT OF DISCUSSION ON 3113 01:49:41,600 --> 01:49:42,920 AVAILABLE RESOURCES AROUND 3114 01:49:42,920 --> 01:49:47,520 SOCIAL DETERMINANTS OF HEALTH, 3115 01:49:47,520 --> 01:49:53,720 THE AHRQ, PHENX TOOLKIT, THE 3116 01:49:53,720 --> 01:49:55,160 RAND REPORT ON WORK AND 3117 01:49:55,160 --> 01:49:55,720 OCCUPATIONS. 3118 01:49:55,720 --> 01:49:58,960 THERE'S GAPS IN LINKAGE TO OA 3119 01:49:58,960 --> 01:50:02,280 CLINICAL AND EPIDEMIOLOGIC DATA, 3120 01:50:02,280 --> 01:50:03,920 SOME HIGH RISK INDIVIDUALS, 3121 01:50:03,920 --> 01:50:06,000 UNDOCUMENTED, PART-TIME WORKERS, 3122 01:50:06,000 --> 01:50:07,520 ET CETERA, ARE NOT REPRESENTED 3123 01:50:07,520 --> 01:50:10,600 OR UNDERREPRESENTED IN THESE 3124 01:50:10,600 --> 01:50:11,880 DATASETS. 3125 01:50:11,880 --> 01:50:12,520 THE SECOND IMPORTANT OPPORTUNITY 3126 01:50:12,520 --> 01:50:13,520 SITS WITH THE ELECTRONIC HEALTH 3127 01:50:13,520 --> 01:50:14,000 RECORD. 3128 01:50:14,000 --> 01:50:15,920 SO AGAIN, THERE'S INCREASED 3129 01:50:15,920 --> 01:50:17,480 EMPHASIS ON INCORPORATING SOCIAL 3130 01:50:17,480 --> 01:50:19,080 AND GENDER IDENTITY VARIABLES 3131 01:50:19,080 --> 01:50:20,680 INTO THE EHR AND THEN 3132 01:50:20,680 --> 01:50:21,640 POTENTIALLY LINKING THESE TO 3133 01:50:21,640 --> 01:50:23,920 CLINICAL AND COMMUNITY 3134 01:50:23,920 --> 01:50:24,920 RESOURCES. 3135 01:50:24,920 --> 01:50:26,240 A HUGE GAP IS THAT MANY OF THESE 3136 01:50:26,240 --> 01:50:27,720 FIELDS ARE NOT FILLED OUT, NO 3137 01:50:27,720 --> 01:50:30,520 ONE REVIEWS THEM WHEN THEY ARE 3138 01:50:30,520 --> 01:50:31,080 AVAILABLE. 3139 01:50:31,080 --> 01:50:32,800 AND IN THINKING ABOUT -- WE WERE 3140 01:50:32,800 --> 01:50:35,600 TRYING TO IDENTIFY SOME OF THE 3141 01:50:35,600 --> 01:50:39,360 THINGS THAT WORK, THEY DESCRIBED 3142 01:50:39,360 --> 01:50:40,000 A UNIVERSITY OF MISSOURI PROGRAM 3143 01:50:40,000 --> 01:50:41,880 THAT REALLY INCORPORATES THE 3144 01:50:41,880 --> 01:50:43,800 PATIENT VOICE IN RESEARCH DESIGN 3145 01:50:43,800 --> 01:50:45,920 BUT ALSO IN CLINICAL CARE. 3146 01:50:45,920 --> 01:50:47,640 AND TO TRY TO REALLY GET INPUT 3147 01:50:47,640 --> 01:50:49,760 AND BUY-IN BASED ON THE PATIENT 3148 01:50:49,760 --> 01:50:50,400 PERSPECTIVE. 3149 01:50:50,400 --> 01:50:51,600 AND THEY DESCRIBED ALSO A JOINT 3150 01:50:51,600 --> 01:50:54,560 HEALTH PROGRAM THAT IMPROVED THE 3151 01:50:54,560 --> 01:50:55,640 COMMUNICATION BETWEEN PATIENT 3152 01:50:55,640 --> 01:50:56,880 AND PROVIDER, AND COMMUNICATION 3153 01:50:56,880 --> 01:50:58,280 COMES UP A LOT IN A LOT OF THE 3154 01:50:58,280 --> 01:51:00,440 DISCUSSION THAT WE HAD. 3155 01:51:00,440 --> 01:51:04,960 SO THE IDEA HERE IS IT REDUCES 3156 01:51:04,960 --> 01:51:06,920 PATIENT FRUSTRATION AND REALLY 3157 01:51:06,920 --> 01:51:08,280 BRINGS OUTPATIENT PERSPECTIVE TO 3158 01:51:08,280 --> 01:51:10,960 THE TABLE, BUT ALSO INCLUDES A 3159 01:51:10,960 --> 01:51:14,840 BEHAVISTBEHAVIORIST WHO ALSO ADS 3160 01:51:14,840 --> 01:51:16,000 SOME OF THE MENTAL HEALTH 3161 01:51:16,000 --> 01:51:17,400 CONCERNS, AGAIN TAKING THAT 3162 01:51:17,400 --> 01:51:19,400 WHOLE HEALTH PERSPECTIVE. 3163 01:51:19,400 --> 01:51:20,920 ANOTHER IMPORTANT POTENTIAL 3164 01:51:20,920 --> 01:51:23,240 OPPORTUNITY IS AN EMPHASIS ON 3165 01:51:23,240 --> 01:51:24,400 PATIENT-CENTERED CARE IN 3166 01:51:24,400 --> 01:51:25,640 COMMUNITY SETTINGS, NOT JUST IN 3167 01:51:25,640 --> 01:51:26,480 HEALTHCARE SETTINGS. 3168 01:51:26,480 --> 01:51:30,760 AND DESCRIBING THE ROLE OF 3169 01:51:30,760 --> 01:51:32,320 PLACES LIKE LIBRARIES THAT CAN 3170 01:51:32,320 --> 01:51:33,600 CONNECT PEOPLE TO RENTABLE 3171 01:51:33,600 --> 01:51:36,520 EQUIPMENT FOR EXERCISE OR OTHER 3172 01:51:36,520 --> 01:51:38,080 TYPES OF RESOURCES THAT MAY BE 3173 01:51:38,080 --> 01:51:38,960 AVAILABLE IN THE COMMUNITY THAT 3174 01:51:38,960 --> 01:51:40,080 SHOULD BE MORE WIDELY SHARED AND 3175 01:51:40,080 --> 01:51:45,000 THAT SHOULD BE LINGED WITH CLINH 3176 01:51:45,000 --> 01:51:46,200 CLINICAL AND HEALTH SYSTEMS. 3177 01:51:46,200 --> 01:51:47,400 WE'LL TALK A LITTLE MORE ABOUT 3178 01:51:47,400 --> 01:51:48,960 SOME OF THE EXISTING PROGRAMS 3179 01:51:48,960 --> 01:51:51,080 BUT THERE ARE MANY PROGRAMS THAT 3180 01:51:51,080 --> 01:51:52,440 CAN BE LEVERAGED THAT HAVE BEEN 3181 01:51:52,440 --> 01:51:53,280 SHOWN TO WORK AND WORK IN A 3182 01:51:53,280 --> 01:51:56,560 RANGE OF COMMUNITY SETTINGS. 3183 01:51:56,560 --> 01:51:58,080 WHERE THERE MAY BE GAPS, IF THEY 3184 01:51:58,080 --> 01:51:59,200 HAVEN'T BEEN TESTED IN SOME 3185 01:51:59,200 --> 01:52:00,200 COMMUNITIES, REALLY MAKING SURE 3186 01:52:00,200 --> 01:52:03,040 THAT THAT INFORMATION IS 3187 01:52:03,040 --> 01:52:03,880 AVAILABLE, THAT THE TESTING IS 3188 01:52:03,880 --> 01:52:05,760 DONE IN A RIGOROUS MANNER. 3189 01:52:05,760 --> 01:52:07,400 I THINK THE OTHER THING THAT 3190 01:52:07,400 --> 01:52:08,800 CAME UP A LOT WAS PROGRAMS IN 3191 01:52:08,800 --> 01:52:11,000 OTHER DISCIPLINES. 3192 01:52:11,000 --> 01:52:12,760 SO IN GERIATRICS, WE TALKED 3193 01:52:12,760 --> 01:52:14,960 ABOUT PROGRAMS IN MENTAL HEALTH, 3194 01:52:14,960 --> 01:52:17,680 PROGRAMS FOR PATIENTS WITH 3195 01:52:17,680 --> 01:52:20,200 ALZHEIMER'S, AND THOSE TYPES OF 3196 01:52:20,200 --> 01:52:21,520 PROGRAMS SHOULD AND CAN BE 3197 01:52:21,520 --> 01:52:29,920 LEVERAGED FOR PATIENTS WITH OA. 3198 01:52:29,920 --> 01:52:32,240 SO A SECOND ISSUE IS REALLY I 3199 01:52:32,240 --> 01:52:33,320 WOULD SAY ALMOST EVERYTHING ON 3200 01:52:33,320 --> 01:52:34,960 THIS SLIDE IS REALLY ABOUT 3201 01:52:34,960 --> 01:52:35,720 COMMUNICATION. 3202 01:52:35,720 --> 01:52:37,600 SO REALLY TAKING A PUBLIC HEALTH 3203 01:52:37,600 --> 01:52:40,000 APPROACH TO SHARING EVIDENCE, 3204 01:52:40,000 --> 01:52:41,720 USING APPROACHES THAT ARE 3205 01:52:41,720 --> 01:52:42,920 RELEVANT ON THE BASIS OF 3206 01:52:42,920 --> 01:52:45,360 LANGUAGE AND CULTURE, REALLY 3207 01:52:45,360 --> 01:52:46,840 THINKING ABOUT THE AUDIENCE, AND 3208 01:52:46,840 --> 01:52:49,400 ONE EXAMPLE THAT WAS GIVEN IS 3209 01:52:49,400 --> 01:52:50,600 THAT WHEN YOU'RE TALKING TO 3210 01:52:50,600 --> 01:52:52,240 TEEN, YOU DON'T TALK ABOUT 3211 01:52:52,240 --> 01:52:54,000 OSTEOARTHRITIS BUT RATHER ABOUT 3212 01:52:54,000 --> 01:52:55,000 INJURY PREVENTION, SO REALLY 3213 01:52:55,000 --> 01:52:58,160 TAILORING THE MESSAGES TO THE 3214 01:52:58,160 --> 01:53:00,800 AUDIENCE ACROSS A NUMBER OF 3215 01:53:00,800 --> 01:53:03,640 DEMOGRAPHIC CHARACTERISTICS. 3216 01:53:03,640 --> 01:53:05,280 ANOTHER CRITICAL COMPONENT WAS 3217 01:53:05,280 --> 01:53:06,560 HAVING TRUSTWORTHY MESSENGERS 3218 01:53:06,560 --> 01:53:10,960 AND INSTITUTIONS, IN ORDER TO 3219 01:53:10,960 --> 01:53:12,360 REALLY ENHANCE THE EFFECTIVENESS 3220 01:53:12,360 --> 01:53:14,920 OF COMMUNICATION WITH PATIENT 3221 01:53:14,920 --> 01:53:15,960 POPULATIONS WHO ARE OFTEN 3222 01:53:15,960 --> 01:53:16,960 UNDERSERVED. 3223 01:53:16,960 --> 01:53:19,960 AND FIGURING OUT WAYS TO REALLY 3224 01:53:19,960 --> 01:53:22,440 ENGAGE PROVIDERS AND 3225 01:53:22,440 --> 01:53:24,720 INSTITUTIONS, AND LINKING THEM 3226 01:53:24,720 --> 01:53:26,240 TO THE COMMUNITIES IN A MORE 3227 01:53:26,240 --> 01:53:27,440 SYSTEMATIC WAY. 3228 01:53:27,440 --> 01:53:30,120 WE ALSO DISCUSSED IDENTIFYING 3229 01:53:30,120 --> 01:53:32,160 COMMUNITY-BASED STRATEGIES THAT 3230 01:53:32,160 --> 01:53:35,360 FOR BOTH PREVENTION AND 3231 01:53:35,360 --> 01:53:36,840 TREATMENT, EXAMPLES THAT CAME UP 3232 01:53:36,840 --> 01:53:38,840 WERE THINGS LIKE THE MILITARY, 3233 01:53:38,840 --> 01:53:40,360 POLICE, FIRE DEPARTMENTS AND 3234 01:53:40,360 --> 01:53:41,720 EVEN WORKPLACE AND DELIVERY 3235 01:53:41,720 --> 01:53:44,320 SERVICES HAVE PHYSICAL 3236 01:53:44,320 --> 01:53:46,160 THERAPISTS IN PLACE, AND ON SITE 3237 01:53:46,160 --> 01:53:50,200 WHO CAN HELP TO PREVENT INJURY 3238 01:53:50,200 --> 01:53:52,160 AND ALSO TO HELP WITH 3239 01:53:52,160 --> 01:53:53,400 RECUPERATION FROM INJURY. 3240 01:53:53,400 --> 01:53:55,560 SO REALLY THINKING ABOUT MOVING 3241 01:53:55,560 --> 01:54:00,200 SOME OF OUR CLINICAL RESOURCES 3242 01:54:00,200 --> 01:54:01,280 FROM THE WALLS OF OUR 3243 01:54:01,280 --> 01:54:02,160 INSTITUTIONS AND OUT INTO THE 3244 01:54:02,160 --> 01:54:03,800 COMMUNITIES IN MORE MEANINGFUL 3245 01:54:03,800 --> 01:54:05,080 WAYS. 3246 01:54:05,080 --> 01:54:08,840 AND THEN FINALLY, THICKING ABOUT 3247 01:54:08,840 --> 01:54:10,840 STRATEGIES TO ADDRESS SYSTEMIC 3248 01:54:10,840 --> 01:54:11,960 RACISM AND DISCRIMINATION THAT 3249 01:54:11,960 --> 01:54:13,120 PATIENTS MAY FACE, RECOGNIZING 3250 01:54:13,120 --> 01:54:14,200 THIS IS AN IMPORTANT PROBLEM, 3251 01:54:14,200 --> 01:54:17,080 AND ALSO UNDERSTANDING THAT 3252 01:54:17,080 --> 01:54:19,080 THERE ARE SOME EVIDENCE-BASED 3253 01:54:19,080 --> 01:54:19,800 INTERVENTIONS THAT HAVE BEEN 3254 01:54:19,800 --> 01:54:21,480 SHOWN TO WORK, BUT WE NEED TO 3255 01:54:21,480 --> 01:54:22,760 FIGURE OUT WAYS THAT WE CAN 3256 01:54:22,760 --> 01:54:25,080 DEVELOP MORE EFFECTIVE 3257 01:54:25,080 --> 01:54:25,640 EVIDENCE-BASED INTERVENTIONS 3258 01:54:25,640 --> 01:54:28,160 THAT ARE SPECIFIC TO PATIENTS 3259 01:54:28,160 --> 01:54:30,760 WITH OSTEOARTHRITIS AND THEIR 3260 01:54:30,760 --> 01:54:37,760 CO-MORBID CONDITIONS. 3261 01:54:37,760 --> 01:54:39,400 THE NEXT I THINK WAS MODIFYING 3262 01:54:39,400 --> 01:54:41,240 AND ADAPTING THOSE THINGS THAT 3263 01:54:41,240 --> 01:54:42,360 MAY BE WORKING WELL AND OTHER 3264 01:54:42,360 --> 01:54:43,680 THINGS THAT MAY NOT BE WORKING 3265 01:54:43,680 --> 01:54:45,640 SO WELL. 3266 01:54:45,640 --> 01:54:48,280 I THINK REALLY IDENTIFYING 3267 01:54:48,280 --> 01:54:49,880 STRATEGIES TO BUILD RAPPORT AND 3268 01:54:49,880 --> 01:54:51,520 TRUST AMONG PATIENTS AND 3269 01:54:51,520 --> 01:54:53,320 PROVIDERS SO THAT WE CAN GET 3270 01:54:53,320 --> 01:54:55,280 MORE ACCURATE AND INCLUSIVE AND 3271 01:54:55,280 --> 01:54:56,920 REPRESENTATIVE DATA, AND COLLECT 3272 01:54:56,920 --> 01:54:58,880 THAT DATA, BRING IT INTO OUR 3273 01:54:58,880 --> 01:55:00,080 HEALTH SYSTEMS B YOU ALSO MAKE 3274 01:55:00,080 --> 01:55:02,160 SURE THAT WE UNDERSTAND WHAT THE 3275 01:55:02,160 --> 01:55:03,800 COMMUNITY LOOKS LIKE, WHAT THE 3276 01:55:03,800 --> 01:55:06,560 COMMUNITY RESOURCES ARE. 3277 01:55:06,560 --> 01:55:08,400 IF PROVIDERS DON'T ASK, IF 3278 01:55:08,400 --> 01:55:09,280 RESEARCHERS DON'T ASK THE 3279 01:55:09,280 --> 01:55:10,720 PATIENTS AND THE STUDY 3280 01:55:10,720 --> 01:55:11,320 PARTICIPANTS AROUND GOING TO 3281 01:55:11,320 --> 01:55:14,040 TELL US. 3282 01:55:14,040 --> 01:55:15,320 SO IT GOING TO BE REALLY 3283 01:55:15,320 --> 01:55:16,720 CRITICAL TO MAKE SURE WE DO THAT 3284 01:55:16,720 --> 01:55:21,760 OUTREACH IN A SYSTEMATIC WAY. 3285 01:55:21,760 --> 01:55:23,560 ANOTHER BIG DISCUSSION POINT WAS 3286 01:55:23,560 --> 01:55:25,400 THE IMPORTANCE OF INDIVIDUALIZED 3287 01:55:25,400 --> 01:55:26,120 PATIENT RECOMMENDATIONS FOR 3288 01:55:26,120 --> 01:55:27,680 PHYSICAL ACTIVITY, FOR OTHER 3289 01:55:27,680 --> 01:55:29,440 HELPFUL AND PREVENTIVE MEASURES 3290 01:55:29,440 --> 01:55:31,400 TO PREVENT OBESITY, FOR EXAMPLE. 3291 01:55:31,400 --> 01:55:34,440 SO REALLY UNDERSTANDING HOW WE 3292 01:55:34,440 --> 01:55:35,320 CAN TAIL. 3293 01:55:35,320 --> 01:55:42,960 OHOR RECOMMENDATIONS ANDTAILOR O 3294 01:55:42,960 --> 01:55:44,440 ENHANCE UP TAKE. 3295 01:55:44,440 --> 01:55:47,760 WHAT CAME UP TIME AND AGAIN WERE 3296 01:55:47,760 --> 01:55:48,960 FINDING LESS TIME-CONSUMING 3297 01:55:48,960 --> 01:55:50,000 METHODS OF PHYSICAL ACTIVITY 3298 01:55:50,000 --> 01:55:51,160 THAT WORK FOR PEOPLE WHO HAVE 3299 01:55:51,160 --> 01:55:52,320 LESS ACCESS TO RESOURCES AND 3300 01:55:52,320 --> 01:55:54,960 JUST LESS TIME TO DO THIS. 3301 01:55:54,960 --> 01:55:56,720 WE ALSO DISCUSSED BETTER 3302 01:55:56,720 --> 01:55:58,480 INTEGRATION OF PHYSICAL 3303 01:55:58,480 --> 01:56:01,640 THERAPISTS INTO CONVERSATIONS. 3304 01:56:01,640 --> 01:56:03,600 WE HAD -- IN BOTH OF OUR 3305 01:56:03,600 --> 01:56:04,920 SESSIONS, WE HAD PHYSICAL 3306 01:56:04,920 --> 01:56:06,000 THERAPISTS WHO TALKED ABOUT THE 3307 01:56:06,000 --> 01:56:08,560 FACT THEY OFTEN ARE PIVOTAL TO 3308 01:56:08,560 --> 01:56:10,600 IMPROVEMENT FOR PATIENTS WITH OA 3309 01:56:10,600 --> 01:56:12,680 BUT OFTEN ARE LEFT OUT OF THE 3310 01:56:12,680 --> 01:56:14,880 DISCUSSION. 3311 01:56:14,880 --> 01:56:16,080 AND NEEDING TO FIGURE OUT WAYS 3312 01:56:16,080 --> 01:56:17,800 TO LINK PHYSICAL THERAPISTS WITH 3313 01:56:17,800 --> 01:56:19,160 CARE PROVIDERS FOR MORE 3314 01:56:19,160 --> 01:56:22,440 INTEGRATED AND CONTINUOUS CARE. 3315 01:56:22,440 --> 01:56:24,160 AND THAT CARE NEEDS TO EXTEND, 3316 01:56:24,160 --> 01:56:26,480 AGAIN, BEYOND THE INSTITUTION 3317 01:56:26,480 --> 01:56:28,760 AND INTO THE COMMUNITY. 3318 01:56:28,760 --> 01:56:30,840 GIVING PATIENTS TAKE-HOME 3319 01:56:30,840 --> 01:56:31,960 INFORMATION IN A FORMAT, WHETHER 3320 01:56:31,960 --> 01:56:35,240 IT BE VIDEO, AUDIO, PAPER-BASED, 3321 01:56:35,240 --> 01:56:38,960 SO THAT THEY CAN USE THIS 3322 01:56:38,960 --> 01:56:39,920 INFORMATION AT HOME, IN THEIR 3323 01:56:39,920 --> 01:56:41,000 HOME ENVIRONMENTS, AND THAT 3324 01:56:41,000 --> 01:56:42,960 INFORMATION REALLY NEEDS TO TAKE 3325 01:56:42,960 --> 01:56:44,320 INTO CONSIDERATION THEIR BUILT 3326 01:56:44,320 --> 01:56:46,000 ENVIRONMENT, THEIR COMMUNITY 3327 01:56:46,000 --> 01:56:48,360 CONTEXT. 3328 01:56:48,360 --> 01:56:49,440 ONE PROGRAM THAT WAS DESCRIBED 3329 01:56:49,440 --> 01:56:52,400 ACTUALLY LOOKED AT THIS IN THE 3330 01:56:52,400 --> 01:56:53,480 CONTEXT OF HOSPITAL DISCHARGE. 3331 01:56:53,480 --> 01:56:55,040 SO IT WAS A SENSITIVE MOMENT 3332 01:56:55,040 --> 01:56:56,000 WHEN PEOPLE WERE LEAVING THE 3333 01:56:56,000 --> 01:56:57,640 HOSPITAL AND PROVIDING THEM WITH 3334 01:56:57,640 --> 01:56:58,640 THIS INFORMATION COULD MAKE A 3335 01:56:58,640 --> 01:56:59,600 WORLD OF DIFFERENCE. 3336 01:56:59,600 --> 01:57:00,680 SO THINKING ABOUT STRATEGIES 3337 01:57:00,680 --> 01:57:03,680 LIKE THAT, THAT REALLY TAKE 3338 01:57:03,680 --> 01:57:05,400 ADVANTAGE OF OPPORTUNITIES TO 3339 01:57:05,400 --> 01:57:06,280 GIVE PEOPLE INFORMATION THAT 3340 01:57:06,280 --> 01:57:09,000 THEY CAN THEN USE AND ACT ON, 3341 01:57:09,000 --> 01:57:11,640 BUT ALSO IN A FORMAT THAT IS 3342 01:57:11,640 --> 01:57:18,320 EASY FOR THEM TO TAKE UP. 3343 01:57:18,320 --> 01:57:20,720 THINKING ABOUT GAPS IN 3344 01:57:20,720 --> 01:57:21,920 OPPORTUNITIES, A LOT OF OUR 3345 01:57:21,920 --> 01:57:24,560 DISCUSSION AS IN MANY OTHER 3346 01:57:24,560 --> 01:57:25,840 GROUPS, IT SOUNDS LIKE, FOCUSED 3347 01:57:25,840 --> 01:57:28,360 ON REALLY ENGAGING A MORE 3348 01:57:28,360 --> 01:57:31,880 DIVERSE WORKFORCE, AND THAT 3349 01:57:31,880 --> 01:57:33,840 DIVERSITY SHOULD BE ON A RANGE 3350 01:57:33,840 --> 01:57:34,160 OF FACTORS. 3351 01:57:34,160 --> 01:57:36,560 SO LANGUAGE, CULTURE, RACE AND 3352 01:57:36,560 --> 01:57:39,440 ETHNICITY, ET CETERA. 3353 01:57:39,440 --> 01:57:41,280 AND THAT THE WORKFORCE SHOULDN'T 3354 01:57:41,280 --> 01:57:42,520 JUST BE FOR DOCTORS AND NEWERS 3355 01:57:42,520 --> 01:57:51,680 BUT RNURSES,BUT CAN WE HAVE A ME 3356 01:57:51,680 --> 01:57:52,640 GROUP AND THINKING ABOUT THIS IN 3357 01:57:52,640 --> 01:57:54,520 RURAL AND URBAN SETTINGS. 3358 01:57:54,520 --> 01:57:56,800 COMMUNITY MEMBERS REALLY NEED TO 3359 01:57:56,800 --> 01:58:00,520 UNDERSTAND THE IMPORTANCE OF 3360 01:58:00,520 --> 01:58:01,960 THESE OPPORTUNITIES FOR 3361 01:58:01,960 --> 01:58:03,040 PREVENTION AND MANAGEMENT OF 3362 01:58:03,040 --> 01:58:07,720 THEIR OA, AND WE ALSO NEED TO 3363 01:58:07,720 --> 01:58:08,640 EMPOWER COMMUNITY MEMBERS WHO 3364 01:58:08,640 --> 01:58:10,400 HAVE SUCCESSFULLY NEGOTIATED 3365 01:58:10,400 --> 01:58:11,680 THESE PROCESSES, TO TALK ABOUT 3366 01:58:11,680 --> 01:58:14,120 THE UPS AND DOWNS IN THE 3367 01:58:14,120 --> 01:58:15,160 CHALLENGES THAT THEY FACE, TO 3368 01:58:15,160 --> 01:58:16,080 TALK ABOUT THE IMPORTANCE OF 3369 01:58:16,080 --> 01:58:19,360 SERVICES LIKE PHYSICAL THERAPY. 3370 01:58:19,360 --> 01:58:22,400 SO WE NEED TO USE COMMUNITY 3371 01:58:22,400 --> 01:58:24,040 ENGAGEMENT, COMMUNITY-BASED 3372 01:58:24,040 --> 01:58:26,800 PARTICIPATORY STRATEGIES TO DO 3373 01:58:26,800 --> 01:58:28,320 THIS. 3374 01:58:28,320 --> 01:58:30,200 I THINK ANOTHER OBVIOUS ISSUE IS 3375 01:58:30,200 --> 01:58:31,600 MAKING SURE THAT WE HAVE A 3376 01:58:31,600 --> 01:58:33,440 DIVERSE WORKFORCE WHO CAN TRULY 3377 01:58:33,440 --> 01:58:34,440 COMMUNICATE IN A NUMBER OF 3378 01:58:34,440 --> 01:58:36,400 DIFFERENT WAYS WITH THE PATIENTS 3379 01:58:36,400 --> 01:58:37,720 THEY SEE. 3380 01:58:37,720 --> 01:58:41,080 AND THE OTHER THING WE DESCRIBED 3381 01:58:41,080 --> 01:58:46,040 AND DISCUSSED AT LENGTH WAS THE 3382 01:58:46,040 --> 01:58:48,880 PLACES WHERE PATIENTS AND 3383 01:58:48,880 --> 01:58:51,640 INDIVIDUALS CAN ENGAGE WITH 3384 01:58:51,640 --> 01:58:53,160 PREVENTION AND MANAGEMENT. 3385 01:58:53,160 --> 01:58:54,440 AND YOU KNOW, REALLY THINKING 3386 01:58:54,440 --> 01:58:58,600 ABOUT BRINGING THE FAMILY TO THE 3387 01:58:58,600 --> 01:58:59,240 TABLE. 3388 01:58:59,240 --> 01:59:02,800 PLACES OF WORSHIP, SCHOOLS, ONE 3389 01:59:02,800 --> 01:59:04,720 PARTICIPANT DESCRIBED LIMITED 3390 01:59:04,720 --> 01:59:08,360 ACCESS IN LATINO COMMUNITIES, 3391 01:59:08,360 --> 01:59:09,880 BUT THAT MANY LATINO FAMILIES 3392 01:59:09,880 --> 01:59:13,080 AND COMMUNITIES WOULD RALLY 3393 01:59:13,080 --> 01:59:14,040 AROUND KIDS' SPORTS, SO HOW DO 3394 01:59:14,040 --> 01:59:18,080 YOU BRING THAT TYPE OF -- YOU 3395 01:59:18,080 --> 01:59:19,080 CAN BRING THIS INFORMATION TO 3396 01:59:19,080 --> 01:59:22,520 THAT VEB E VENUE AND ACTUALLY ME 3397 01:59:22,520 --> 01:59:24,960 HAVE A REALLY POWERFUL IMPACT BY 3398 01:59:24,960 --> 01:59:26,520 FOCUSING NOT JUST ON THE STUDENT 3399 01:59:26,520 --> 01:59:29,560 ATHLETE, BUT ALSO THE PARENT WHO 3400 01:59:29,560 --> 01:59:30,880 MAY HAVE -- OR THE GRANDPARENT 3401 01:59:30,880 --> 01:59:32,400 WHO MAY HAVE A DISABILITY AS A 3402 01:59:32,400 --> 01:59:36,560 RESULT OF OSTEOARTHRITIS. 3403 01:59:36,560 --> 01:59:38,440 ANOTHER BIG ISSUE THAT ACTUALLY 3404 01:59:38,440 --> 01:59:43,800 HAS A LARGE SOCIETAL IMPACT IS 3405 01:59:43,800 --> 01:59:45,640 LIMITED DATA THAT CAN BE SHARED 3406 01:59:45,640 --> 01:59:46,080 ACROSS INSTITUTIONS. 3407 01:59:46,080 --> 01:59:51,680 SO TOO OFTEN, ONE INSTITUTION OR 3408 01:59:51,680 --> 01:59:52,280 ONE HEALTH SYSTEM RECORD CAN 3409 01:59:52,280 --> 01:59:54,000 ONLY GIVE YOU INFORMATION ON 3410 01:59:54,000 --> 01:59:55,360 THAT SYSTEM, BUT HOW DO WE 3411 01:59:55,360 --> 01:59:57,920 REALLY LEVERAGE THAT, HOW CAN WE 3412 01:59:57,920 --> 01:59:59,000 ENHANCE INTEROPERABILITY, SO 3413 01:59:59,000 --> 02:00:01,800 THAT YOU CAN ACTUALLY SHARE 3414 02:00:01,800 --> 02:00:02,720 INFORMATION FROM DIFFERENT 3415 02:00:02,720 --> 02:00:06,000 SETTINGS. 3416 02:00:06,000 --> 02:00:07,960 WE TALKED A COMMUNICATION, AND 3417 02:00:07,960 --> 02:00:10,920 ALSO THE PROGRAMS THAT WORK. 3418 02:00:10,920 --> 02:00:15,280 I THINK ANOTHER ISSUE THAT CAME 3419 02:00:15,280 --> 02:00:18,440 UP IS REALLY AROUND ASSUMPTIONS 3420 02:00:18,440 --> 02:00:24,800 THAT PROVIDERS MAKE ABOUT 3421 02:00:24,800 --> 02:00:26,120 PATIENTS AND THE IDEA THAT 3422 02:00:26,120 --> 02:00:32,480 PATIENTS WHO MAY BE CONSIDERED 3423 02:00:32,480 --> 02:00:34,120 AS CATASTROPHIZING THEIR 3424 02:00:34,120 --> 02:00:36,520 EXPERIENCES, FROM THOSE 3425 02:00:36,520 --> 02:00:37,600 PATIENTS' PERSPECTIVES, THEY MAY 3426 02:00:37,600 --> 02:00:38,680 FEEL THAT THEIR PAIN OR THEIR 3427 02:00:38,680 --> 02:00:41,080 EXPERIENCE IS BEING IGNORED OR 3428 02:00:41,080 --> 02:00:46,440 MISUNDERSTOOD OR DISCOUNTED. 3429 02:00:46,440 --> 02:00:48,080 SO THIS AGAIN RELATES IN PART TO 3430 02:00:48,080 --> 02:00:50,720 COMMUNICATION BUT ALSO TO 3431 02:00:50,720 --> 02:00:53,800 LANGUAGE AND OPPORTUNITIES TO 3432 02:00:53,800 --> 02:00:55,200 REALLY ENGAGE PATIENTS ABOUT 3433 02:00:55,200 --> 02:00:57,720 THEIR OWN EXPERIENCES. 3434 02:00:57,720 --> 02:00:59,760 AND NOT PUT THEM UNDER ONE 3435 02:00:59,760 --> 02:01:01,160 BUCKET. 3436 02:01:01,160 --> 02:01:04,520 AND RECOGNIZE THAT WHAT THEY'RE 3437 02:01:04,520 --> 02:01:06,560 EXPERIENCING AND WHAT THEY'RE 3438 02:01:06,560 --> 02:01:08,000 FEELING, FOR THEM THAT BEHAVIOR 3439 02:01:08,000 --> 02:01:09,440 MAY BE ENTIRELY APPROPRIATE, 3440 02:01:09,440 --> 02:01:11,360 BECAUSE THIS IS AFFECTING EVERY 3441 02:01:11,360 --> 02:01:16,000 ASPECT OF THEIR LIVES. 3442 02:01:16,000 --> 02:01:18,520 IN TERMS OF IMMEDIATE OR 3443 02:01:18,520 --> 02:01:19,920 INTERMEDIATE GOALS, A BIG FOCUS 3444 02:01:19,920 --> 02:01:22,880 WAS ON EDUCATION. 3445 02:01:22,880 --> 02:01:28,480 PARTICULARLY EDUCATION THAT 3446 02:01:28,480 --> 02:01:30,200 COULD ON STRATEGIES FOR MORE 3447 02:01:30,200 --> 02:01:31,640 EFFECTIVE COMMUNITY PARTNERED 3448 02:01:31,640 --> 02:01:33,360 RESEARCH, THINKING ABOUT WAYS TO 3449 02:01:33,360 --> 02:01:36,440 GATHER DEMOGRAPHIC INFORMATION 3450 02:01:36,440 --> 02:01:42,360 FROM PEOPLE IN A SYSTEMATIC WAY, 3451 02:01:42,360 --> 02:01:43,120 GETTING -- GIVING PEOPLE 3452 02:01:43,120 --> 02:01:44,200 INFORMATION IN A FORMAT AGAIN 3453 02:01:44,200 --> 02:01:48,920 AND IN A MANNER N THAT THEY 3454 02:01:48,920 --> 02:01:49,520 UNDERSTOOD, BECAUSE THERE'S A 3455 02:01:49,520 --> 02:01:52,280 LOT OF EVIDENCE-BASED MATERIALS 3456 02:01:52,280 --> 02:01:53,400 ALREADY OUT THERE. 3457 02:01:53,400 --> 02:01:55,800 ANOTHER BIG, I THINK ANOTHER BIG 3458 02:01:55,800 --> 02:01:59,960 GOAL IS REALLY THINKING ABOUT -- 3459 02:01:59,960 --> 02:02:01,280 AND THIS CAME UP IN SEVERAL 3460 02:02:01,280 --> 02:02:02,680 SESSIONS YESTERDAY, IS THINKING 3461 02:02:02,680 --> 02:02:05,640 ABOUT PRIMARY, SECONDARY AND 3462 02:02:05,640 --> 02:02:09,920 TERTIARY PREVENTION. 3463 02:02:09,920 --> 02:02:11,320 AND REALLY MAKING SURE WE'RE 3464 02:02:11,320 --> 02:02:12,640 OPERATING AT ALL THOSE LEVELS, 3465 02:02:12,640 --> 02:02:13,960 AND RECOGNIZING THAT WE MIGHT IN 3466 02:02:13,960 --> 02:02:15,720 SOME INSTANCES, AS IN THE CASE 3467 02:02:15,720 --> 02:02:17,920 OF WORKING IN SCHOOLS OR 3468 02:02:17,920 --> 02:02:20,080 CHURCHES OR OTHER COMMUNITY 3469 02:02:20,080 --> 02:02:23,160 VENUES, BE ABLE TO ADDRESS MORE 3470 02:02:23,160 --> 02:02:26,000 THAN ONE FORM OF PREVENTION WITH 3471 02:02:26,000 --> 02:02:28,640 THE SAME STRATEGY, WITH SIMILAR 3472 02:02:28,640 --> 02:02:30,120 INTERVENTIONS. 3473 02:02:30,120 --> 02:02:31,880 AND REALLY THINKING ABOUT THESE 3474 02:02:31,880 --> 02:02:34,720 AS SORT OF GATEWAYS INTO GETTING 3475 02:02:34,720 --> 02:02:36,360 THE WHOLE FAMILY INTO THE 3476 02:02:36,360 --> 02:02:37,280 HEALTHCARE SYSTEM, INCLUDING 3477 02:02:37,280 --> 02:02:40,880 THOSE PEOPLE IN THE FAMILY WHO 3478 02:02:40,880 --> 02:02:42,400 MAY HAVE ALREADY SUFFERED AN 3479 02:02:42,400 --> 02:02:43,720 INJURY BUT DON'T VIEW THEMSELVES 3480 02:02:43,720 --> 02:02:49,080 AS ILL OR YET HAVE ARTHRITIS. 3481 02:02:49,080 --> 02:02:50,560 ANOTHER ISSUE WAS ADDRESSING 3482 02:02:50,560 --> 02:02:52,480 UPSTREAM FACTORS, LOOKING NOW AT 3483 02:02:52,480 --> 02:02:55,760 PREVENTIVE M MEASURES AND FACTOS 3484 02:02:55,760 --> 02:02:58,400 THAT LEAD TO OA IN THE FUTURE 3485 02:02:58,400 --> 02:02:59,920 AND USING STRATEGIES THAT WORKED 3486 02:02:59,920 --> 02:03:00,880 IN THE PAST. 3487 02:03:00,880 --> 02:03:03,480 SO AS AN EXAMPLE IN THE VA, 3488 02:03:03,480 --> 02:03:05,600 USING BIG DATA APPROACHES TO 3489 02:03:05,600 --> 02:03:07,880 GETTING -- TO INCREASING 3490 02:03:07,880 --> 02:03:08,760 INFORMATION ABOUT THE PATIENT 3491 02:03:08,760 --> 02:03:12,920 BUT ALSO ABOUT THEIR COMMUNITY. 3492 02:03:12,920 --> 02:03:14,120 TO GET A MORE COMPLETE PICTURE 3493 02:03:14,120 --> 02:03:15,520 OF THE MULTILEVEL FACTORS THAT 3494 02:03:15,520 --> 02:03:16,920 MAY PLAY A ROLE IN THE 3495 02:03:16,920 --> 02:03:21,000 DISPARITIES THAT WE SEE. 3496 02:03:21,000 --> 02:03:24,520 THEN ANOTHER THING IS USING 3497 02:03:24,520 --> 02:03:27,680 RESEARCH STRATEGIES THAT HAVE 3498 02:03:27,680 --> 02:03:28,880 BEEN SHOWN TO BE EFFECTIVE IN 3499 02:03:28,880 --> 02:03:31,800 OTHER DOMAINS, LIKE FINANCIAL OR 3500 02:03:31,800 --> 02:03:34,040 NON-FINANCIAL INCENTIVES SUCH AS 3501 02:03:34,040 --> 02:03:35,240 PEER RECOGNITION, AND USING 3502 02:03:35,240 --> 02:03:41,480 THOSE TYPES OF STRATEGIES TO 3503 02:03:41,480 --> 02:03:42,680 PROMOTE THE BEHAVIORS AT THE 3504 02:03:42,680 --> 02:03:44,440 PATIENT LEVEL, AT THE PROVIDER 3505 02:03:44,440 --> 02:03:46,600 LEVEL, THAT MAY HELP PREVENT 3506 02:03:46,600 --> 02:03:49,560 ARTHRITIS OR MAY HELP WITH 3507 02:03:49,560 --> 02:03:53,960 BETTER MANAGEMENT OF 3508 02:03:53,960 --> 02:03:56,800 OSTEOARTHRITIS. 3509 02:03:56,800 --> 02:04:00,200 ALSO REALLY THINKING ABOUT USING 3510 02:04:00,200 --> 02:04:01,840 THE TYPES OF SYSTEMS THAT HAVE 3511 02:04:01,840 --> 02:04:02,960 WORKED IN OTHER SETTINGS LIKE 3512 02:04:02,960 --> 02:04:05,120 THE STUDY BUDDY DESIGN THAT WE 3513 02:04:05,120 --> 02:04:12,720 DESCRIBED BEFORE, IMPROVING 3514 02:04:12,720 --> 02:04:14,080 ACCESS TO INFORMATION OUTSIDE OF 3515 02:04:14,080 --> 02:04:19,120 HEALTHCARE SETTINGS AND USING 3516 02:04:19,120 --> 02:04:22,320 EVIDENCE FROM SOME OF THE SOCIAL 3517 02:04:22,320 --> 02:04:26,800 DETERMINANTS WORK THAT'S REALLY 3518 02:04:26,800 --> 02:04:27,600 EMERGING, AND THAT HAS BEEN 3519 02:04:27,600 --> 02:04:28,960 SHOWN TO PLAY A DIFFERENCE IN 3520 02:04:28,960 --> 02:04:34,120 CHRONIC DISEASE MANAGEMENT. 3521 02:04:34,120 --> 02:04:35,400 WHETHER IT BE THINKING ABOUT 3522 02:04:35,400 --> 02:04:36,760 FOOD INSECURITY FOR DIABETES OR 3523 02:04:36,760 --> 02:04:41,560 HOUSING AND THE IMPACT OF 3524 02:04:41,560 --> 02:04:42,440 ENHANCING HOUSING STABILITY OR 3525 02:04:42,440 --> 02:04:44,720 PROVIDING HOMES FOR THE 3526 02:04:44,720 --> 02:04:46,040 HOMELESS, AND LOOKING AT THE 3527 02:04:46,040 --> 02:04:47,360 LONG TERM CONSEQUENCES OF THAT. 3528 02:04:47,360 --> 02:04:48,680 AND THOSE CONSEQUENCES INCLUDE 3529 02:04:48,680 --> 02:04:53,360 THINGS LIKE PREVENTING 3530 02:04:53,360 --> 02:04:56,800 READMISSION, AND SO HOW CAN WE 3531 02:04:56,800 --> 02:04:59,600 USE THE -- SORT OF THE SOCIAL -- 3532 02:04:59,600 --> 02:05:03,200 RIGOROUS SOCIAL SCIENCE TO 3533 02:05:03,200 --> 02:05:05,160 REALLY INTERVENE BOTH AT THE 3534 02:05:05,160 --> 02:05:06,600 INDIVIDUAL LEVEL BUT AT THE 3535 02:05:06,600 --> 02:05:07,360 HEALTH SYSTEM LEVEL AND THE 3536 02:05:07,360 --> 02:05:10,200 COMMUNITY LEVEL TO MAKE A 3537 02:05:10,200 --> 02:05:10,840 DIFFERENCE. 3538 02:05:10,840 --> 02:05:14,840 AND RELATED TO THIS IS USING 3539 02:05:14,840 --> 02:05:16,560 WHAT WE'RE LEARNING FROM 3540 02:05:16,560 --> 02:05:19,200 STRATEGIES TO IDENTIFY AND 3541 02:05:19,200 --> 02:05:22,800 INTERVENE ON IMPLICIT BIAS, TO 3542 02:05:22,800 --> 02:05:24,680 BOTH CHANGE THE WAY OUR HEALTH 3543 02:05:24,680 --> 02:05:27,600 SYSTEMS OPERATE, BUT ALSO CHANGE 3544 02:05:27,600 --> 02:05:28,720 THE PATIENT'S EXPERIENCE OF CARE 3545 02:05:28,720 --> 02:05:30,680 WITHIN OUR HEALTH SYSTEMS. 3546 02:05:30,680 --> 02:05:32,400 AND RECOGNIZING THAT -- SO A LOT 3547 02:05:32,400 --> 02:05:33,960 OF THIS IS COMPLETELY OUTSIDE OF 3548 02:05:33,960 --> 02:05:35,720 OUR HEALTH SYSTEM, BUT IT'S 3549 02:05:35,720 --> 02:05:38,880 REALLY IMPORTANT TO START 3550 02:05:38,880 --> 02:05:40,280 WITH -- WE CAN START AT THE 3551 02:05:40,280 --> 02:05:42,680 HEALTH SYSTEM LEVEL AND MAKE OUR 3552 02:05:42,680 --> 02:05:43,760 SYSTEMS, AGAIN, MORE TRUSTWORTHY 3553 02:05:43,760 --> 02:05:45,000 AND MORE ENGAGING FOR OUR 3554 02:05:45,000 --> 02:05:49,040 PATIENTS. 3555 02:05:49,040 --> 02:05:51,640 THINKING ABOUT LONG TERM GOALS, 3556 02:05:51,640 --> 02:05:55,280 EXPANDING AND IMPROVING HEALTH 3557 02:05:55,280 --> 02:05:59,960 EDUCATION, FACILITATING BET ARER 3558 02:05:59,960 --> 02:06:01,160 CONTINUITY OF CARE THROUGH 3559 02:06:01,160 --> 02:06:01,920 ELECTRONIC HEALTH RECORDS AND 3560 02:06:01,920 --> 02:06:03,600 ALSO BETTER INTEROPERABILITY SO 3561 02:06:03,600 --> 02:06:05,120 THAT PATIENTS WHO ARE MOVING 3562 02:06:05,120 --> 02:06:06,760 BETWEEN HEALTH SYSTEMS ACTUALLY 3563 02:06:06,760 --> 02:06:10,360 CAN GET CONSISTENT CARE AND THEN 3564 02:06:10,360 --> 02:06:15,960 LINKING THAT TO COMMUNITY 3565 02:06:15,960 --> 02:06:16,920 RESOURCES, MAKING SURE THE 3566 02:06:16,920 --> 02:06:17,720 COMMUNITY RESOURCES THAT ARE 3567 02:06:17,720 --> 02:06:22,520 AVAILABLE CAN BE SHARED WIDELY, 3568 02:06:22,520 --> 02:06:24,240 ALSO RECOGNIZING WE MAY HAVE TO 3569 02:06:24,240 --> 02:06:29,080 HAVE A BALANCE BETWEEN HEALTH 3570 02:06:29,080 --> 02:06:31,360 I.T. AND SORT OF THESE LOW TOUCH 3571 02:06:31,360 --> 02:06:32,920 APPROACHES AND HIGHER TOUCH 3572 02:06:32,920 --> 02:06:34,880 APPROACHES. 3573 02:06:34,880 --> 02:06:39,760 WE ALSO DISCUSSED ENHANCING DATA 3574 02:06:39,760 --> 02:06:42,320 COLLECTION AND AVAILABILITY OF 3575 02:06:42,320 --> 02:06:43,520 INFORMATION ABOUT WHAT DOES AND 3576 02:06:43,520 --> 02:06:45,920 DOES NOT WORK, PARTICULARLY FOR 3577 02:06:45,920 --> 02:06:46,920 UNDERSERVED COMMUNITIES. 3578 02:06:46,920 --> 02:06:48,440 SO REALLY LEVERAGING SOME OF THE 3579 02:06:48,440 --> 02:06:49,840 SYSTEMS THAT ARE OUT THERE THAT 3580 02:06:49,840 --> 02:06:52,560 ARE DESCRIBING THE STRATEGIES 3581 02:06:52,560 --> 02:06:54,120 THAT WORK AND AS OTHERS HAVE 3582 02:06:54,120 --> 02:06:55,840 DESCRIBED, REALLY MAKING SURE 3583 02:06:55,840 --> 02:06:57,520 THAT WE PROVIDE ENOUGH DETAIL SO 3584 02:06:57,520 --> 02:06:59,160 THAT FOLKS CAN UNDERSTAND, HEY, 3585 02:06:59,160 --> 02:07:02,520 DID THIS WORK IN MY COMMUNITY. 3586 02:07:02,520 --> 02:07:04,400 CENTERING THE PATIENT IN 3587 02:07:04,400 --> 02:07:07,040 COMMUNICATIONS AND 3588 02:07:07,040 --> 02:07:11,400 RECOMMENDATIONS, USING SOCIAL 3589 02:07:11,400 --> 02:07:15,000 NEEDS SCREENERS TO CAPTURE OTHER 3590 02:07:15,000 --> 02:07:17,200 DETERMINANTS. 3591 02:07:17,200 --> 02:07:18,440 AND PROVIDING INFRASTRUCTURE, 3592 02:07:18,440 --> 02:07:19,800 COMMUNITY PROGRAMS THAT CAN BE 3593 02:07:19,800 --> 02:07:21,600 TAPPED INTO, BOTH FROM WITHIN A 3594 02:07:21,600 --> 02:07:23,200 HEALTHCARE SYSTEM AND FOR PEOPLE 3595 02:07:23,200 --> 02:07:24,600 WITHIN THE -- IN THE BROADER 3596 02:07:24,600 --> 02:07:26,640 COMMUNITY. 3597 02:07:26,640 --> 02:07:28,120 AND THEN ANOTHER I THINK 3598 02:07:28,120 --> 02:07:31,960 IMPORTANT STRATEGY IS REALLY 3599 02:07:31,960 --> 02:07:36,320 ACQUIRING LONGITUDINAL DATA, SO 3600 02:07:36,320 --> 02:07:37,760 BOTH LONGITUDINAL OBSERVATIONAL 3601 02:07:37,760 --> 02:07:40,280 DATA THAT INCLUDES ENOUGH 3602 02:07:40,280 --> 02:07:44,320 DIVERSITY SO THAT WE CAN 3603 02:07:44,320 --> 02:07:45,240 ACTUALLY SAY SOMETHING ABOUT A 3604 02:07:45,240 --> 02:07:46,400 LOT OF DIFFERENT COMMUNITIES, 3605 02:07:46,400 --> 02:07:49,480 BOTH URBAN AND RURAL, BUT ALSO 3606 02:07:49,480 --> 02:07:51,120 THINKING ABOUT BUILDING OUT 3607 02:07:51,120 --> 02:07:52,320 MULTI-SITE AND MULTILEVEL 3608 02:07:52,320 --> 02:07:53,200 INTERVENTIONS THAT INCORPORATE 3609 02:07:53,200 --> 02:07:56,920 THE SOCIAL DETERMINANTS, MAKING 3610 02:07:56,920 --> 02:07:59,320 SURE THAT THESE INTERVENTIONS 3611 02:07:59,320 --> 02:08:00,800 INCLUDE DIVERSITY -- A DIVERSITY 3612 02:08:00,800 --> 02:08:02,680 OF COMMUNITIES. 3613 02:08:02,680 --> 02:08:04,200 SO REALLY TAKING AN APPROACH 3614 02:08:04,200 --> 02:08:05,240 LIKE THE DIABETES PREVENTION 3615 02:08:05,240 --> 02:08:10,120 PROGRAM, WHERE THERE WAS A 3616 02:08:10,120 --> 02:08:12,760 REQUIREMENT TO BRING TO THE 3617 02:08:12,760 --> 02:08:13,440 TABLE SPECIFIC COMMUNITIES TO 3618 02:08:13,440 --> 02:08:14,720 MAKE SURE THAT WE COULD, AT THE 3619 02:08:14,720 --> 02:08:20,400 END OF THE STUDY, SAY SOMETHING 3620 02:08:20,400 --> 02:08:24,560 ABOUT -- HAVE A PRESPECIFIED 3621 02:08:24,560 --> 02:08:25,680 DATA ON A NUMBER OF DIFFERENT 3622 02:08:25,680 --> 02:08:26,560 GROUPS. 3623 02:08:26,560 --> 02:08:28,960 I THINK THOSE WERE OUR MAIN 3624 02:08:28,960 --> 02:08:29,400 TAKE-HOME POINT. 3625 02:08:29,400 --> 02:08:30,680 PLEASE IF ANYONE ELSE HAS STUFF 3626 02:08:30,680 --> 02:08:41,080 TO ADD, PLEASE DO SO. 3627 02:08:41,920 --> 02:08:45,240 >> THE BIASES IN ACCESS OF 3628 02:08:45,240 --> 02:08:46,240 COMMUNICATION, DID YOU COVER 3629 02:08:46,240 --> 02:08:46,520 THAT ONE? 3630 02:08:46,520 --> 02:08:48,200 >> I'M SORRY, SAY THAT AGAIN? 3631 02:08:48,200 --> 02:08:50,800 >> THE ONE ON BIASES. 3632 02:08:50,800 --> 02:08:52,360 >> YES, WE DID, WE TALKED ABOUT 3633 02:08:52,360 --> 02:08:52,920 IMPLICIT BIAS. 3634 02:08:52,920 --> 02:08:57,520 >> THANK YOU. 3635 02:08:57,520 --> 02:08:58,160 >> OKAY. 3636 02:08:58,160 --> 02:09:02,200 THANK YOU, DR. BROWN. 3637 02:09:02,200 --> 02:09:03,720 IT SEEMS LIKE WE'VE HAD A LOT OF 3638 02:09:03,720 --> 02:09:04,360 INTERESTING DISCUSSIONS IN ALL 3639 02:09:04,360 --> 02:09:05,840 OF THE BREAKOUT SESSIONS, SO FOR 3640 02:09:05,840 --> 02:09:07,000 OUR LAST REPORT OUT, WE'LL HEAR 3641 02:09:07,000 --> 02:09:08,240 ABOUT THE COMMUNITY LEVEL 3642 02:09:08,240 --> 02:09:10,080 FACTORS DISCUSSION FROM DR. PA 3643 02:09:10,080 --> 02:09:10,640 TRI THAT JONES. 3644 02:09:10,640 --> 02:09:15,440 DR. PATRICIA JONES, THE NATIONAL 3645 02:09:15,440 --> 02:09:17,000 INSTITUTE ON AGING OFFICE OF 3646 02:09:17,000 --> 02:09:18,400 SPECIAL POPULATIONS AND LEADS 3647 02:09:18,400 --> 02:09:21,240 THEIR EFFORTS IN STIMULATING 3648 02:09:21,240 --> 02:09:22,880 RESEARCH RELATING TO AGING. 3649 02:09:22,880 --> 02:09:23,760 DR. JONES, THE FLOOR IS YOURS. 3650 02:09:23,760 --> 02:09:26,120 >> THANK YOU, KRISTY. 3651 02:09:26,120 --> 02:09:27,240 NEXT SLIDE, PLEASE. 3652 02:09:27,240 --> 02:09:30,400 I JUST WANT TO ACKNOWLEDGE THE 3653 02:09:30,400 --> 02:09:32,600 TREMENDOUS SUPPORT PROVIDED BY 3654 02:09:32,600 --> 02:09:37,840 DAPHNE ROBINSON AND ELISA 3655 02:09:37,840 --> 02:09:39,280 MICHALEK. 3656 02:09:39,280 --> 02:09:40,160 APPRECIATE THEIR EFFORTS IN 3657 02:09:40,160 --> 02:09:41,160 PULLING THESE SLIDES TOGETHER. 3658 02:09:41,160 --> 02:09:43,120 WE HAD A REALLY ENGAGING 3659 02:09:43,120 --> 02:09:43,880 CONVERSATION YESTERDAY AND TODAY 3660 02:09:43,880 --> 02:09:45,080 IN OUR BREAKOUT SESSIONS. 3661 02:09:45,080 --> 02:09:46,480 SOME OF THE POINTS MAY SOUND 3662 02:09:46,480 --> 02:09:47,280 FAMILIAR AS THEY WERE TOUCHED 3663 02:09:47,280 --> 02:09:49,040 UPON, BUT I WILL DO MY BEST NOT 3664 02:09:49,040 --> 02:09:49,880 TO BE REDUNDANT. 3665 02:09:49,880 --> 02:09:53,120 I WILL SAY THAT ACROSS THE TWO 3666 02:09:53,120 --> 02:09:55,720 DAYS, ONE OF THE THINGS THAT 3667 02:09:55,720 --> 02:09:57,880 CAME THROUGH VERY PRONOUNCEDLY 3668 02:09:57,880 --> 02:10:00,960 WAS THE IMPORTANCE OF COLLECTING 3669 02:10:00,960 --> 02:10:02,240 DATA RELATED TO SOCIAL 3670 02:10:02,240 --> 02:10:04,440 DETERMINANTS OF HEALTH IN 3671 02:10:04,440 --> 02:10:06,320 EXISTING STUDIES WITH SUFFICIENT 3672 02:10:06,320 --> 02:10:07,400 DIVERSE POPULATIONS. 3673 02:10:07,400 --> 02:10:09,160 MANY OF OUR PARTICIPANTS 3674 02:10:09,160 --> 02:10:12,000 REPRESENTED NOT ONLY INDIVIDUALS 3675 02:10:12,000 --> 02:10:14,280 WITH LIVED EXPERIENCES WITH 3676 02:10:14,280 --> 02:10:15,680 OSTEOARTHRITIS BUT OTHERS WHO 3677 02:10:15,680 --> 02:10:18,040 WERE ESTABLISHING CAREERS AS 3678 02:10:18,040 --> 02:10:19,320 EARLY CAREER SCIENTISTS AS WELL 3679 02:10:19,320 --> 02:10:22,480 AS VERY EXPERIENCED 3680 02:10:22,480 --> 02:10:23,040 INVESTIGATORS AND PHYSICIAN 3681 02:10:23,040 --> 02:10:24,400 SCIENTISTS WHO WERE IN CLINICAL 3682 02:10:24,400 --> 02:10:26,080 PRACTICE SEEING PATIENTS, AND 3683 02:10:26,080 --> 02:10:30,560 EACH OF THESE INDIVIDUAL 3684 02:10:30,560 --> 02:10:31,480 PERSPECTIVES HAD A SHARED 3685 02:10:31,480 --> 02:10:32,680 AGREEMENT THAT THE IMPORTANCE OF 3686 02:10:32,680 --> 02:10:36,840 HAVING DATA COLLECT OND SOCIAL L 3687 02:10:36,840 --> 02:10:38,000 DETERMINANTS OF HEALTH FROM 3688 02:10:38,000 --> 02:10:42,920 EXISTING STUDIES WAS AN 3689 02:10:42,920 --> 02:10:43,680 IMPORTANT FACTOR IN ADDITION TO 3690 02:10:43,680 --> 02:10:44,200 LEVERAGE. 3691 02:10:44,200 --> 02:10:53,440 BUILDING UPON THE -- MANY OF OUR 3692 02:10:53,440 --> 02:10:54,720 PARTICIPANTS ARE ENGAGED IN A 3693 02:10:54,720 --> 02:10:56,280 NUMBER OF DIFFERENT STUDIES AND 3694 02:10:56,280 --> 02:10:58,120 TRIALS AND TO BE MINDFUL THAT 3695 02:10:58,120 --> 02:10:59,320 WHILE WE HAVE AN OPPORTUNITY TO 3696 02:10:59,320 --> 02:11:00,640 ENGAGE THEM, THAT WE ARE 3697 02:11:00,640 --> 02:11:02,320 THOUGHTFUL AND ORGANIZED AND 3698 02:11:02,320 --> 02:11:04,120 MINDFUL OF THINGS THAT WE MAY 3699 02:11:04,120 --> 02:11:06,000 ASK UP FRONT AND NOT HAVE TO 3700 02:11:06,000 --> 02:11:07,400 BURDEN THEM WITH ADDITIONAL 3701 02:11:07,400 --> 02:11:09,720 REQUESTS FOR INFORMATION LATER 3702 02:11:09,720 --> 02:11:14,320 ON IN A PROJECT OR ACTIVITY. 3703 02:11:14,320 --> 02:11:16,520 IT WAS ALSO DISCUSS AND NOTED 3704 02:11:16,520 --> 02:11:19,240 THAT ONE OF THE OPPORTUNITIES IS 3705 02:11:19,240 --> 02:11:20,640 TO CONSIDER THE COMPOUNDING 3706 02:11:20,640 --> 02:11:21,960 FACTORS THAT MAY BE TOUCHING THE 3707 02:11:21,960 --> 02:11:25,360 LIVES OF OUR PARTICIPANTS AND 3708 02:11:25,360 --> 02:11:26,880 BEING THOUGHTFUL ABOUT HOW WE GO 3709 02:11:26,880 --> 02:11:29,640 ABOUT ORGANIZING PROJECTS AND 3710 02:11:29,640 --> 02:11:32,160 INTERVENTIONS THAT ARE 3711 02:11:32,160 --> 02:11:34,200 REFLECTIVE OF FINDINGS IN DATA 3712 02:11:34,200 --> 02:11:34,720 COLLECTED. 3713 02:11:34,720 --> 02:11:37,080 WE DISCUSSED THE CONSIDERATION 3714 02:11:37,080 --> 02:11:44,520 OR USING SYNDEMICS AS A LENS OF 3715 02:11:44,520 --> 02:11:47,880 WHAT WE HAVE IN FRONT OF US. 3716 02:11:47,880 --> 02:11:49,760 THOSE THAT AREN'T FAMILIAR WITH 3717 02:11:49,760 --> 02:11:53,400 THE TERM SYNDEMICS, IT TALKS TO 3718 02:11:53,400 --> 02:11:55,120 A CLUSTER OF DISEASE IN A 3719 02:11:55,120 --> 02:11:55,680 POPULATION OF INDIVIDUALS. 3720 02:11:55,680 --> 02:11:57,400 TO BE MINDFUL OF THAT, I THINK 3721 02:11:57,400 --> 02:11:59,000 ONE OF OUR PRESENTERS FROM THE 3722 02:11:59,000 --> 02:12:00,480 FIRST DAY SHOWED A SERIES OF 3723 02:12:00,480 --> 02:12:02,880 MAPS HIGHLIGHTING THE IMPACT OF 3724 02:12:02,880 --> 02:12:06,920 DIFFERENT CONDITIONS ALL 3725 02:12:06,920 --> 02:12:08,240 CLUSTERED PRONOUNCEDLY IN THE 3726 02:12:08,240 --> 02:12:08,920 SOUTHEASTERN REGION OF THE 3727 02:12:08,920 --> 02:12:10,040 UNITED STATES, SO THAT WOULD BE 3728 02:12:10,040 --> 02:12:13,280 ONE EXAMPLE OF SYNDEMICS. 3729 02:12:13,280 --> 02:12:14,560 IT WAS ALSO DISCUSSED AS A 3730 02:12:14,560 --> 02:12:15,440 PARTICULAR OPPORTUNITY WITH THE 3731 02:12:15,440 --> 02:12:17,400 EXISTING RESOURCES AND SYSTEMS 3732 02:12:17,400 --> 02:12:20,040 THAT WE BE MINDFUL OF LEVERAGING 3733 02:12:20,040 --> 02:12:22,360 LESSONS LEARNED FROM OTHER 3734 02:12:22,360 --> 02:12:23,400 FIELDS. 3735 02:12:23,400 --> 02:12:25,200 I THINK SOME OF THE OTHER 3736 02:12:25,200 --> 02:12:26,320 REPORTS FROM THE BREAKOUT GROUPS 3737 02:12:26,320 --> 02:12:27,520 TALKED ABOUT NOT REINVENTING THE 3738 02:12:27,520 --> 02:12:27,960 WHEEL. 3739 02:12:27,960 --> 02:12:30,040 THAT WAS CERTAINLY A NOTION 3740 02:12:30,040 --> 02:12:31,240 DISCUSSED AS WELL IN OUR GROUPS, 3741 02:12:31,240 --> 02:12:32,360 THAT WE LEVERAGE THE INFORMATION 3742 02:12:32,360 --> 02:12:34,920 THAT'S BEEN PUBLISHED IN THE 3743 02:12:34,920 --> 02:12:36,480 SPACE OF HEALTH DISPARITIES 3744 02:12:36,480 --> 02:12:37,600 RESEARCH AND OTHER EVIDENCE 3745 02:12:37,600 --> 02:12:42,600 TESTED INTERVENTIONS THAT HAVE 3746 02:12:42,600 --> 02:12:44,720 BEEN DEVELOPED FOR HIV PAIN 3747 02:12:44,720 --> 02:12:46,440 RELATED INTERVENTIONS, CANCER, 3748 02:12:46,440 --> 02:12:50,840 CARDIOVASCULAR AND OTHER TOPICSY 3749 02:12:50,840 --> 02:12:52,480 OPPORTUNITIES TO SCAFFOLD UPON 3750 02:12:52,480 --> 02:12:53,360 KEY ATTRIBUTES OR 3751 02:12:53,360 --> 02:12:55,640 CHARACTERISTICS OF THOSE 3752 02:12:55,640 --> 02:12:57,600 INTERVENTIONS AS A LESSON TO 3753 02:12:57,600 --> 02:12:58,800 INFORM OSTEOARTHRITIS. 3754 02:12:58,800 --> 02:13:01,120 AND ALSO, WE DISCUSSED 3755 02:13:01,120 --> 02:13:02,840 BROADENING QUESTIONS. 3756 02:13:02,840 --> 02:13:04,160 SOME OF OUR INVESTIGATORS SHARED 3757 02:13:04,160 --> 02:13:07,800 THEIR LESSONS LEARNED IN 3758 02:13:07,800 --> 02:13:10,080 HINDSIGHT AS A CAUTIONARY TALE, 3759 02:13:10,080 --> 02:13:11,080 WHICH WAS VERY IMPORTANT AND 3760 02:13:11,080 --> 02:13:12,840 VERY HELPFUL, BUT THE TAKEAWAY 3761 02:13:12,840 --> 02:13:14,040 FROM THAT DISCUSSION WAS THE 3762 02:13:14,040 --> 02:13:15,520 IMPORTANCE OF BROADENING OUT OUR 3763 02:13:15,520 --> 02:13:17,080 QUESTIONS EARLY ON AS WE'RE 3764 02:13:17,080 --> 02:13:18,280 PLANNING STUDIES AND USING 3765 02:13:18,280 --> 02:13:21,360 DIFFERENT METHODS TO ANALYZE. 3766 02:13:21,360 --> 02:13:22,760 AND TO THAT POINT, ONE EXAMPLE 3767 02:13:22,760 --> 02:13:26,800 OF USING DIFFERENT METHODS TO 3768 02:13:26,800 --> 02:13:29,440 ANALYZE DATA, TRADITIONALLY 3769 02:13:29,440 --> 02:13:30,760 OFTENTIMES WE COMPARE NON-WHITE 3770 02:13:30,760 --> 02:13:32,600 TO WHITE POPULATIONS, BUT THERE 3771 02:13:32,600 --> 02:13:34,800 MAY BE DIFFERENT DETAILS 3772 02:13:34,800 --> 02:13:36,040 HIGHLIGHTED OR ILLUMINATED WHEN 3773 02:13:36,040 --> 02:13:38,000 OTHER METHODS SUCH AS WITHIN 3774 02:13:38,000 --> 02:13:40,280 GROUP ANALYSIS ARE ADOPTED OR 3775 02:13:40,280 --> 02:13:42,680 USED, AND WE MAY UNDERSTAND 3776 02:13:42,680 --> 02:13:43,880 OSTEOARTHRITIS AND DISPARITIES 3777 02:13:43,880 --> 02:13:45,080 FROM A DIFFERENT PERSPECTIVE IF 3778 02:13:45,080 --> 02:13:47,080 WE DO A DEEPER DIVE ANALYSIS 3779 02:13:47,080 --> 02:13:51,520 WITHIN A PARTICULAR GROUP. 3780 02:13:51,520 --> 02:13:54,160 IN ADDITION TO THOSE POINTS, 3781 02:13:54,160 --> 02:13:56,760 BETTER APPROACHES FOR 3782 02:13:56,760 --> 02:13:59,080 COMMUNICATION WERE IDENTIFIED AS 3783 02:13:59,080 --> 02:14:00,720 AN OPPORTUNITY AS FAR AS OUR 3784 02:14:00,720 --> 02:14:03,240 EXISTING RESOURCES IN TERMS OF 3785 02:14:03,240 --> 02:14:04,800 HIGHLIGHTING DIVERSITY OF 3786 02:14:04,800 --> 02:14:08,720 INDIVIDUALS FROM IMAGES THAT ARE 3787 02:14:08,720 --> 02:14:09,600 DISPLAYED ON DIFFERENT 3788 02:14:09,600 --> 02:14:11,320 MATERIALS, SOCIAL MEDIA MATT 3789 02:14:11,320 --> 02:14:14,640 FORMS, BROCHURES, TAILORING THE 3790 02:14:14,640 --> 02:14:16,600 INFORMATION IN A MANOR THAT 3791 02:14:16,600 --> 02:14:18,240 REFLECTS THE PREFERENCES AND 3792 02:14:18,240 --> 02:14:22,360 INTERESTS OF THE PARTICULAR 3793 02:14:22,360 --> 02:14:23,920 COMMUNITY THAT RESEARCHERS AND 3794 02:14:23,920 --> 02:14:24,680 OTHERS ARE COLLABORATING WITH, 3795 02:14:24,680 --> 02:14:25,560 AND HIGHLIGHTING THE 3796 02:14:25,560 --> 02:14:27,840 AVAILABILITY OF THE INFORMATION 3797 02:14:27,840 --> 02:14:30,160 IN DIFFERENT LANGUAGES IS 3798 02:14:30,160 --> 02:14:31,000 ABSOLUTELY ESSENTIAL, EVEN FOR 3799 02:14:31,000 --> 02:14:32,880 THOSE WHO MAY BE CONVERSANT AND 3800 02:14:32,880 --> 02:14:34,960 FLUENT IN SPEAKING ENGLISH, IT 3801 02:14:34,960 --> 02:14:38,360 WAS SHARED WITH US IN ONE OF OUR 3802 02:14:38,360 --> 02:14:39,560 GROUPS THE IMPORTANCE THAT 3803 02:14:39,560 --> 02:14:41,520 SOMETIMES THE UNSPOKEN MESSAGE 3804 02:14:41,520 --> 02:14:42,640 IS THAT THERE'S AN INTEREST FROM 3805 02:14:42,640 --> 02:14:46,680 THE RESEARCH PARTY THAT YOU TOOK 3806 02:14:46,680 --> 02:14:47,880 TIME AND MADE THE EFFORT TO 3807 02:14:47,880 --> 02:14:49,000 PRESENT INFORMATION IN MORE THAN 3808 02:14:49,000 --> 02:14:52,760 ONE LANGUAGE, EVEN IF THE 3809 02:14:52,760 --> 02:15:01,760 PARTICIPANTS WERE CON V CON CON 3810 02:15:01,760 --> 02:15:02,560 ENGLISH. 3811 02:15:02,560 --> 02:15:03,680 RECOGNIZING THAT ALL OF THESE 3812 02:15:03,680 --> 02:15:07,840 RESOURCES AND SERVICES THAT HELP 3813 02:15:07,840 --> 02:15:09,680 AID DOING A BETTER JOB AT 3814 02:15:09,680 --> 02:15:12,120 ENGAGEMENT ARE FEASIBLE, BUT 3815 02:15:12,120 --> 02:15:13,840 THEY MAY TAKE ADDITIONAL TIME 3816 02:15:13,840 --> 02:15:17,800 WHICH MAY EXTEND THE BUDGET 3817 02:15:17,800 --> 02:15:19,080 BEYOND PARAMETERS TRADITIONAL 3818 02:15:19,080 --> 02:15:21,280 FUNDERS ARE USED TO SEEING, WHAT 3819 02:15:21,280 --> 02:15:22,920 IS REQUIRED IN TERMS OF 3820 02:15:22,920 --> 02:15:30,120 TRANSLATION, TRANSPORTATION, 3821 02:15:30,120 --> 02:15:31,560 USING MOBILE CLINICS, OTHER 3822 02:15:31,560 --> 02:15:33,200 PLATFORMS AND DATA PLANS THAT 3823 02:15:33,200 --> 02:15:37,160 ONE MAY ASSUME INDIVIDUALS HAVE 3824 02:15:37,160 --> 02:15:40,440 ACCESS TO BUT MAY BE A COST 3825 02:15:40,440 --> 02:15:44,040 BURDEN FOR A PARTICIPANT IN THAT 3826 02:15:44,040 --> 02:15:47,320 REGARD. 3827 02:15:47,320 --> 02:15:48,640 JUST TO CLOSE OUT ON THIS 3828 02:15:48,640 --> 02:15:49,960 PARTICULAR TOPIC, WE ALSO 3829 02:15:49,960 --> 02:15:51,040 DISCUSSED THE IMPORTANCE OF 3830 02:15:51,040 --> 02:15:51,840 WORKING WITH COMMUNITY LEADERS 3831 02:15:51,840 --> 02:15:55,440 IN TERMS OF ENGAGEMENT. 3832 02:15:55,440 --> 02:15:57,080 WE'VE TOUCHED UPON DIFFERENT 3833 02:15:57,080 --> 02:15:59,480 EXAMPLES OF PARTICIPATORY ACTION 3834 02:15:59,480 --> 02:16:03,280 RESEARCH, ACTIVITIES THAT MAY BE 3835 02:16:03,280 --> 02:16:07,560 LESSEN GAUGLESS ENGAGING, OTHERY 3836 02:16:07,560 --> 02:16:09,520 BE MORE ENGAGING, INCLUDING 3837 02:16:09,520 --> 02:16:10,760 INDIVIDUALS FROM THE INTENDED 3838 02:16:10,760 --> 02:16:12,120 COMMUNITY AS A THOUGHT LEADER IN 3839 02:16:12,120 --> 02:16:16,000 THE DESIGN OF STUDIES, AND 3840 02:16:16,000 --> 02:16:16,760 STRATEGIES, IDENTIFYING 3841 02:16:16,760 --> 02:16:18,720 STRATEGIES FOR DISSEMINATING 3842 02:16:18,720 --> 02:16:19,840 INFORMATION ARE JUST A COUPLE OF 3843 02:16:19,840 --> 02:16:23,840 EXAMPLES OF MORE ENGAGED 3844 02:16:23,840 --> 02:16:24,960 STRATEGIES THAT COULD BE 3845 02:16:24,960 --> 02:16:25,920 ADOPTED, AND THERE ARE 3846 02:16:25,920 --> 02:16:27,280 OPPORTUNITIES TO DO THAT. 3847 02:16:27,280 --> 02:16:28,320 SAID DIFFERENTLY, WE ALSO 3848 02:16:28,320 --> 02:16:30,040 DISCUSSED THE IMPORTANCE OF 3849 02:16:30,040 --> 02:16:38,520 MOVING BEYOND THE PERFORMATORY 3850 02:16:38,520 --> 02:16:39,600 COMMUNITY BOARDS AND LOOKING AT 3851 02:16:39,600 --> 02:16:41,160 OTHER WAYS TO ENGAGE COMMUNITY 3852 02:16:41,160 --> 02:16:42,440 MEMBERS IN A MORE ACTIVE 3853 02:16:42,440 --> 02:16:42,680 FASHION. 3854 02:16:42,680 --> 02:16:44,400 IN ADDITION, IT WAS DISCUSSED, 3855 02:16:44,400 --> 02:16:46,400 THE IMPORTANCE OF INVESTING TIME 3856 02:16:46,400 --> 02:16:47,920 TO LEARN MORE ABOUT THE 3857 02:16:47,920 --> 02:16:49,120 COMMUNITY, THAT THESE ARE 3858 02:16:49,120 --> 02:16:50,640 ACTIVITIES AND EFFORTS THAT 3859 02:16:50,640 --> 02:16:52,800 SIMPLY JUST DO REQUIRE PATIENTS 3860 02:16:52,800 --> 02:16:56,440 PATIENCE,COMMITMENT AND DEDICAT. 3861 02:16:56,440 --> 02:16:59,280 WE TOUCHED A LITTLE BIT ON THE 3862 02:16:59,280 --> 02:17:01,480 PERCEPTION OF HEALTH DISPARITIES 3863 02:17:01,480 --> 02:17:03,880 RESEARCH TRUISM, COMMUNITY 3864 02:17:03,880 --> 02:17:05,400 ENGAGED RESEARCH TRUISM AND 3865 02:17:05,400 --> 02:17:07,080 IDEAS AND APPROACHES ON HOW TO 3866 02:17:07,080 --> 02:17:08,800 AVOID THAT, AND TAKING TIME TO 3867 02:17:08,800 --> 02:17:12,280 BUILD THE RAPPORT, IDENTIFYING 3868 02:17:12,280 --> 02:17:14,160 THINGS THAT ARE IMPORTANT TO THE 3869 02:17:14,160 --> 02:17:15,360 COMMUNITY MEMBER, LEVERAGING 3870 02:17:15,360 --> 02:17:18,040 PILOT STUDIES AS ONE APPROACH TO 3871 02:17:18,040 --> 02:17:19,960 DOING THAT COULD BE AN 3872 02:17:19,960 --> 02:17:22,680 INVESTMENT THAT PAYS QUITE 3873 02:17:22,680 --> 02:17:29,040 SIGNIFICANTLY DOWNSTREAM. 3874 02:17:29,040 --> 02:17:31,040 ONE OF OUR PARTICIPANTS SHARED 3875 02:17:31,040 --> 02:17:31,880 THAT EXPERIENCE IN TERMS OF 3876 02:17:31,880 --> 02:17:33,880 LEVERAGING THE PILOT STUDY WITH 3877 02:17:33,880 --> 02:17:34,640 A NATIVE AMERICAN COMMUNITY AND 3878 02:17:34,640 --> 02:17:38,600 THAT PROVED TO BE QUITE HELPFUL 3879 02:17:38,600 --> 02:17:40,520 LATER ON IN DEVELOPING A RAPPORT 3880 02:17:40,520 --> 02:17:43,160 WITHIN THAT PARTICULAR 3881 02:17:43,160 --> 02:17:45,920 COMMUNITY. 3882 02:17:45,920 --> 02:17:50,600 ALSO TOUCHING ONE AT THE LAST 3883 02:17:50,600 --> 02:17:54,200 BULLET POINT, TO UNDERSCORE THE 3884 02:17:54,200 --> 02:17:56,000 IMPORTANCE OF IDENTIFYING AND 3885 02:17:56,000 --> 02:17:56,960 ORGANIZATIONS THAT MIGHT BE 3886 02:17:56,960 --> 02:17:58,920 LEVERAGED EARLY ON AND AGAIN, 3887 02:17:58,920 --> 02:18:01,040 WITH THE EYE TOWARD BUILDING 3888 02:18:01,040 --> 02:18:04,640 RAPPORT AND BEING INCLUSIVE, 3889 02:18:04,640 --> 02:18:06,040 HAVING THAT RELATIONSHIP AND 3890 02:18:06,040 --> 02:18:07,040 EXTENDING THAT PARTNERSHIP EARLY 3891 02:18:07,040 --> 02:18:12,840 ON IS IMPORTANT. 3892 02:18:12,840 --> 02:18:14,240 SO WE ALSO TALKED ABOUT BIG 3893 02:18:14,240 --> 02:18:15,560 DATA, WE HAD A COUPLE OF 3894 02:18:15,560 --> 02:18:17,320 INDIVIDUALS WHO HAD EXPERTISE IN 3895 02:18:17,320 --> 02:18:21,920 USING DATA SCIENCE OR LARGE 3896 02:18:21,920 --> 02:18:22,760 DATASETS FOR ANALYSIS. 3897 02:18:22,760 --> 02:18:24,800 WE SPOKE ABOUT THE IMPORTANCE OF 3898 02:18:24,800 --> 02:18:27,360 COST SAVINGS THAT USING BIG DATA 3899 02:18:27,360 --> 02:18:29,000 MAY OFFER TO A RESEARCH TEAM. 3900 02:18:29,000 --> 02:18:32,280 IT'S A FAIRLY INEXPENSIVE WAY TO 3901 02:18:32,280 --> 02:18:34,640 CONDUCT RETROSPECTIVE STUDIES, 3902 02:18:34,640 --> 02:18:37,840 AND THE DATA -- BUT WE ALSO 3903 02:18:37,840 --> 02:18:38,440 DISCUSSED LIMITATIONS AND THE 3904 02:18:38,440 --> 02:18:40,600 IMPORTANCE OF DATA SCIENTISTS, 3905 02:18:40,600 --> 02:18:42,760 MACHINE LEARNING EXPERTS, AI 3906 02:18:42,760 --> 02:18:45,600 EXPERTS AND STATISTICIANS ALIKE 3907 02:18:45,600 --> 02:18:47,800 HAVING SHARED UNDERSTANDING AND 3908 02:18:47,800 --> 02:18:49,120 KNOWLEDGE BASE AROUND HEALTH 3909 02:18:49,120 --> 02:18:50,520 DISPARITIES, WHAT ARE HEALTH 3910 02:18:50,520 --> 02:18:53,760 DISPARITIES, WRECK NIEDZING THAT 3911 02:18:53,760 --> 02:18:56,080 EVERY TEAM MEMBER BENEFITS FROM 3912 02:18:56,080 --> 02:18:57,160 HAVING THAT BACKGROUND AND 3913 02:18:57,160 --> 02:18:59,800 HAVING THAT KNOWLEDGE BASE. 3914 02:18:59,800 --> 02:19:01,200 TO THAT END, WE TALKED ABOUT 3915 02:19:01,200 --> 02:19:02,640 BEING MINDFUL OF LEVERAGING 3916 02:19:02,640 --> 02:19:05,400 LARGE DATASETS SUCH THAT WE 3917 02:19:05,400 --> 02:19:06,680 DON'T PERPETUATE THE DISPARITIES 3918 02:19:06,680 --> 02:19:10,720 WE INTEND TO REDRESS OR 3919 02:19:10,720 --> 02:19:11,200 ELIMINATE. 3920 02:19:11,200 --> 02:19:14,760 WE ALSO TALKED ABOUT INCREASING 3921 02:19:14,760 --> 02:19:15,680 ONLINE COMMUNITIES. 3922 02:19:15,680 --> 02:19:16,880 SOME OF OUR PARTICIPANTS SHARED 3923 02:19:16,880 --> 02:19:19,480 THE LESSONS LEARNED FROM 3924 02:19:19,480 --> 02:19:20,920 COVID-19, AND USING ONLINE 3925 02:19:20,920 --> 02:19:22,760 PLATFORMS TO PROMOTE PHYSICAL 3926 02:19:22,760 --> 02:19:25,280 ACTIVITY TO ADDRESS 3927 02:19:25,280 --> 02:19:26,040 OSTEOARTHRITIS AND LEVERAGING 3928 02:19:26,040 --> 02:19:28,360 WHAT WE LEARNED FROM THE COVID 3929 02:19:28,360 --> 02:19:30,320 EXPERIENCE WITH GROUP SUPPORT 3930 02:19:30,320 --> 02:19:34,160 AND OTHER MEANS OF PROMOTING 3931 02:19:34,160 --> 02:19:39,160 PHYSICAL ENGAGEMENT. 3932 02:19:39,160 --> 02:19:40,240 IN TERMS OF GAPS AND 3933 02:19:40,240 --> 02:19:42,560 OPPORTUNITIES, OUR MEMBERS 3934 02:19:42,560 --> 02:19:44,640 IDENTIFIED CONCERNS, EXPRESSED 3935 02:19:44,640 --> 02:19:45,520 CONCERNS ABOUT BIAS AGAINST 3936 02:19:45,520 --> 02:19:47,600 FUNDING STUDIES IN CERTAIN 3937 02:19:47,600 --> 02:19:49,520 COMMUNITIES THAT MAY MISTAKENLY 3938 02:19:49,520 --> 02:19:51,200 BE THOUGHT OF AS SOMETHING 3939 02:19:51,200 --> 02:19:52,640 THAT'S NOT OF INTEREST. 3940 02:19:52,640 --> 02:19:56,560 WE ALSO TALKED ABOUT THE PROBLEM 3941 02:19:56,560 --> 02:19:57,520 WITH DISPROPORTIONATE FUNDING IN 3942 02:19:57,520 --> 02:19:58,960 TERMS OF FUNDERS THAT MAY BE 3943 02:19:58,960 --> 02:20:00,600 RELUCTANT TO PROVIDE ADDITIONAL 3944 02:20:00,600 --> 02:20:04,200 SUPPORT FOR CERTAIN THINGS SUCH 3945 02:20:04,200 --> 02:20:06,280 AS TRANSPORTATION OR GROUP 3946 02:20:06,280 --> 02:20:09,160 GATHERINGS AND BEING MINDFUL OF 3947 02:20:09,160 --> 02:20:10,240 PARADOXICALLY POOR PARTICIPANTS 3948 02:20:10,240 --> 02:20:14,640 WHO MAY ALSO HAVE ADDITIONAL 3949 02:20:14,640 --> 02:20:16,440 BURDEN OF PARTICIPATING AND 3950 02:20:16,440 --> 02:20:17,880 ENGAGING IN THESE TRIALS AND 3951 02:20:17,880 --> 02:20:19,520 STUDIES, OFTENTIMES ARE 3952 02:20:19,520 --> 02:20:23,880 REIMBURSED LESS FOR THEIR 3953 02:20:23,880 --> 02:20:24,880 CONTRIBUTION AS COMPARED TO 3954 02:20:24,880 --> 02:20:30,160 OTHER STUDIES CONDUCTED IN MORE 3955 02:20:30,160 --> 02:20:31,120 AFFLUENT PARTS OF DIFFERENT 3956 02:20:31,120 --> 02:20:32,000 COMMUNITIES. 3957 02:20:32,000 --> 02:20:33,120 OUR GROUP ALSO DISCUSSED THE 3958 02:20:33,120 --> 02:20:34,760 NEED TO ADDRESS SYSTEMIC ISSUES 3959 02:20:34,760 --> 02:20:36,680 SUCH AS MORE DISADVANTAGED 3960 02:20:36,680 --> 02:20:38,640 GROUPS NOT HAVING THE 3961 02:20:38,640 --> 02:20:40,800 OPPORTUNITY TO BE INVITED OR 3962 02:20:40,800 --> 02:20:45,040 REFERRED ON TO OTHER SECONDARY 3963 02:20:45,040 --> 02:20:47,200 SPECIALISTS FOR ADDITIONAL 3964 02:20:47,200 --> 02:20:48,960 CONSULTATION AS COMPARED TO 3965 02:20:48,960 --> 02:20:52,520 OTHER GROUPS, AND DE FACTO -- BY 3966 02:20:52,520 --> 02:20:54,120 DE FACTO BEING EXCLUDED FROM 3967 02:20:54,120 --> 02:20:55,400 BEING CONSIDERED FROM DIFFERENT 3968 02:20:55,400 --> 02:20:56,960 STUDIES, A LACK OF PHYSICAL 3969 02:20:56,960 --> 02:20:58,560 THERAPISTS AND OTHER RESOURCES 3970 02:20:58,560 --> 02:21:00,680 IN PARTICULAR AREAS. 3971 02:21:00,680 --> 02:21:02,560 WE TALKED ABOUT RESOURCE DESERTS 3972 02:21:02,560 --> 02:21:03,960 AS WELL AS OTHER TYPES OF 3973 02:21:03,960 --> 02:21:05,600 DESERTS, AND THE LACK OF ACCESS 3974 02:21:05,600 --> 02:21:07,360 OF PEOPLE IN TERMS OF SHARED 3975 02:21:07,360 --> 02:21:11,400 DISTANCE FROM ACADEMIC HEALTH 3976 02:21:11,400 --> 02:21:13,560 CENTERS -- SHEER DISTANCE FROM 3977 02:21:13,560 --> 02:21:16,440 ACADEMIC HEALTH CENTERS WHERE 3978 02:21:16,440 --> 02:21:17,280 EXPERTISE MAY BE READILY 3979 02:21:17,280 --> 02:21:18,840 AVAILABLE. 3980 02:21:18,840 --> 02:21:21,440 WE DISCUSSED THE IMPORTANCE OF 3981 02:21:21,440 --> 02:21:22,720 OPPORTUNITIES TO WORK WITH 3982 02:21:22,720 --> 02:21:29,000 COMMUNITY HEALTH WORKERS AND 3983 02:21:29,000 --> 02:21:31,960 PHYSICAL THERAPISTS, THOSE WHO 3984 02:21:31,960 --> 02:21:34,600 MAY HAVE A SPECIFIC ROLE IN 3985 02:21:34,600 --> 02:21:35,440 CONTRIBUTION IN THE RESEARCH 3986 02:21:35,440 --> 02:21:37,160 ARENA AND EXPAND THEIR RESEARCH 3987 02:21:37,160 --> 02:21:38,520 IN TERMS OF TASK SHIFTING WHERE 3988 02:21:38,520 --> 02:21:40,400 THEY MAY BE ABLE TO LEVERAGE 3989 02:21:40,400 --> 02:21:43,240 TECHNOLOGY AND OTHER TOOLS TO 3990 02:21:43,240 --> 02:21:47,080 INFORM OSTEOARTHRITIS RESEARCH. 3991 02:21:47,080 --> 02:21:48,680 WE ALSO ADDRESSED THE INITIAL 3992 02:21:48,680 --> 02:21:50,960 REACH BY TELEPHONE EMAIL AND 3993 02:21:50,960 --> 02:21:54,120 OTHER SOCIAL MEDIA PLATFORMS TO 3994 02:21:54,120 --> 02:21:55,680 SPECIFIC INDIVIDUALS OF LOCAL 3995 02:21:55,680 --> 02:21:57,960 GROUPS AND THE IMPORTANCE OF 3996 02:21:57,960 --> 02:22:00,520 EFFECTIVE AND BEING CREATIVE IN 3997 02:22:00,520 --> 02:22:02,440 LONG LASTING COLLABORATIONS AND 3998 02:22:02,440 --> 02:22:08,040 PARTNERSHIPS. 3999 02:22:08,040 --> 02:22:09,480 I'M SORRY, JUST ONE OTHER POINT. 4000 02:22:09,480 --> 02:22:11,000 IT WAS SHARED, THE IMPORTANCE OF 4001 02:22:11,000 --> 02:22:12,400 LEVERAGING EXISTING SYSTEMS SUCH 4002 02:22:12,400 --> 02:22:16,440 AS OUR LOCAL LIBRARIES. 4003 02:22:16,440 --> 02:22:17,560 SOME WERE SHARING THE IMPORTANCE 4004 02:22:17,560 --> 02:22:19,840 OF LOCAL LIBRARIES IN TERMS OF 4005 02:22:19,840 --> 02:22:21,480 FREE SPACE TO CONVENE MEETINGS 4006 02:22:21,480 --> 02:22:23,320 AND ALSO LEVERAGING THEIR 4007 02:22:23,320 --> 02:22:29,360 LISTSERVS, THEIR CONTEX CONTACTD 4008 02:22:29,360 --> 02:22:31,560 THEIR PLATFORMS THAT ALSO COULD 4009 02:22:31,560 --> 02:22:32,960 HELP FURTHER ENHANCE OUTREACH 4010 02:22:32,960 --> 02:22:35,800 AND MARKETING OF OSTEOARTHRITIS 4011 02:22:35,800 --> 02:22:36,560 RESEARCH-RELATED ACTIVITIES. 4012 02:22:36,560 --> 02:22:38,720 SO THIS WAS A VERY IMPORTANT 4013 02:22:38,720 --> 02:22:40,520 COMPONENT THAT WE DISCUSSED AS 4014 02:22:40,520 --> 02:22:45,000 WELL. 4015 02:22:45,000 --> 02:22:47,000 AS FAR AS FOCUSING ON MORE 4016 02:22:47,000 --> 02:22:50,480 IMMEDIATE GOALS TO BE IDENTIFIED 4017 02:22:50,480 --> 02:22:54,200 AT A MORE GRANULAR LEVEL, OUR 4018 02:22:54,200 --> 02:22:56,720 MEMBERS FELT IT WAS VERY 4019 02:22:56,720 --> 02:22:58,040 IMPORTANT TO JUST GET PEOPLE 4020 02:22:58,040 --> 02:22:58,560 MOVING. 4021 02:22:58,560 --> 02:22:59,920 ONE OF OUR PRESENTERS TODAY 4022 02:22:59,920 --> 02:23:01,200 SPOKE ON THIS VERY POINT AS 4023 02:23:01,200 --> 02:23:02,200 WELL, THAT SOME PHYSICAL 4024 02:23:02,200 --> 02:23:03,720 ACTIVITY IS BETTER THAN NOTHING 4025 02:23:03,720 --> 02:23:05,240 AT ALL, AND THAT WAS ECHOED IN 4026 02:23:05,240 --> 02:23:06,120 OUR CONVERSATIONS THAT IT WAS 4027 02:23:06,120 --> 02:23:07,760 IMPORTANT TO GET PEOPLE MOVING 4028 02:23:07,760 --> 02:23:11,280 AND TO REALLY ZERO IN ON OUR 4029 02:23:11,280 --> 02:23:13,880 LOCAL LEVEL EFFORTS TO PROMOTE A 4030 02:23:13,880 --> 02:23:16,400 MULTIPRONG APPROACH AND TO 4031 02:23:16,400 --> 02:23:17,600 LEVERAGE EXTENSION PROGRAMS THAT 4032 02:23:17,600 --> 02:23:20,040 MAY BE OFFERED THROUGH 4033 02:23:20,040 --> 02:23:24,160 UNIVERSITIES AND OTHER LARGE 4034 02:23:24,160 --> 02:23:25,360 SCALE INSTITUTIONS THAT MAY HELP 4035 02:23:25,360 --> 02:23:28,680 FILL THE GAP IN AREAS THAT DON'T 4036 02:23:28,680 --> 02:23:29,560 HAVE OTHER INFRASTRUCTURE 4037 02:23:29,560 --> 02:23:31,280 AVAILABLE TO PROMOTE PHYSICAL 4038 02:23:31,280 --> 02:23:39,040 ACTIVITY OR EXERCISE. 4039 02:23:39,040 --> 02:23:42,320 WE ALSO TALKED ABOUT TEACHING 4040 02:23:42,320 --> 02:23:43,640 RESEARCHERS AND CLINICIANS 4041 02:23:43,640 --> 02:23:45,720 CULTURAL HUMILITY AND DIFFERENT 4042 02:23:45,720 --> 02:23:47,600 MODELS FOR SHARED 4043 02:23:47,600 --> 02:23:48,680 DECISION-MAKING, AND NOT 4044 02:23:48,680 --> 02:23:50,520 ASSUMING EVERYONE WORKING IN A 4045 02:23:50,520 --> 02:23:51,840 SPACE WITH DIFFERENT 4046 02:23:51,840 --> 02:23:54,600 PARTICIPANTS OR PATIENTS HAVE A 4047 02:23:54,600 --> 02:23:56,040 COMMON UNDERSTANDING OF WHAT 4048 02:23:56,040 --> 02:23:58,280 CULTURAL HUMILITY OR SHARED 4049 02:23:58,280 --> 02:23:59,280 DECISION-MAKING IS OR WHAT THAT 4050 02:23:59,280 --> 02:24:00,680 MIGHT LOOK LIKE. 4051 02:24:00,680 --> 02:24:02,800 SO WE DID SPEAK ON THE 4052 02:24:02,800 --> 02:24:09,000 IMPORTANCE OF THAT EDUCATION. 4053 02:24:09,000 --> 02:24:10,520 AS FAR AS LONG TERM GOALS, WE 4054 02:24:10,520 --> 02:24:15,480 DISCUSSED THINKING MORE ABOUT 4055 02:24:15,480 --> 02:24:17,240 LONGITUDINAL ACTIVITIES, TAKING 4056 02:24:17,240 --> 02:24:20,280 THE TIME TO BUILD THE TRUST AND 4057 02:24:20,280 --> 02:24:22,800 CHANGE BEHAVIORS, BUT 4058 02:24:22,800 --> 02:24:24,400 TRADITIONAL PARAMETERS MAY BE 4059 02:24:24,400 --> 02:24:27,640 TOO BRIEF TO REALLY SERVE IN AN 4060 02:24:27,640 --> 02:24:29,160 EFFECTIVE WAY THE KIND OF 4061 02:24:29,160 --> 02:24:34,280 RESEARCH THAT MAY BE REQUIRED TO 4062 02:24:34,280 --> 02:24:36,240 INFORM OSTEOARTHRITIS AND 4063 02:24:36,240 --> 02:24:38,000 ADDRESS DISPARITIES AND 4064 02:24:38,000 --> 02:24:38,680 COMMUNITY INPUT. 4065 02:24:38,680 --> 02:24:40,640 WE ALSO TALKED ABOUT BUILDING ON 4066 02:24:40,640 --> 02:24:41,840 EXISTING ACTIVITIES THAT ARE 4067 02:24:41,840 --> 02:24:43,640 HAPPENING AT THE DEPARTMENT OF 4068 02:24:43,640 --> 02:24:44,320 HEALTH AND HUMAN SERVICES LEVEL, 4069 02:24:44,320 --> 02:24:47,320 SUCH AS THE MID COURSE REPORT, 4070 02:24:47,320 --> 02:24:48,960 AND OTHER GUIDELINES THAT ARE 4071 02:24:48,960 --> 02:24:49,800 BEING UPDATED. 4072 02:24:49,800 --> 02:24:52,120 THERE HAVE BEEN REQUESTS FOR 4073 02:24:52,120 --> 02:24:53,000 INFORMATION DISSEMINATED AND 4074 02:24:53,000 --> 02:24:55,400 THERE MAY BE OTHER OPPORTUNITIES 4075 02:24:55,400 --> 02:24:57,360 TO ENLIST PERSPECTIVES IN THE 4076 02:24:57,360 --> 02:25:02,080 NEAR FUTURE AS WELL. 4077 02:25:02,080 --> 02:25:03,920 AND I THINK THAT MAY BRING US TO 4078 02:25:03,920 --> 02:25:05,640 AN END. 4079 02:25:05,640 --> 02:25:07,280 >> THANK YOU, DR. JONES. 4080 02:25:07,280 --> 02:25:09,080 WE APPRECIATE ALL OF THE 4081 02:25:09,080 --> 02:25:10,560 BREAKOUT REPORTS FROM ALL OF OUR 4082 02:25:10,560 --> 02:25:11,680 CO-CHAIRS AND WE WANTED TO HAVE 4083 02:25:11,680 --> 02:25:13,320 TIME TO DISCUSS EVERYTHING WE'VE 4084 02:25:13,320 --> 02:25:15,160 HEARD OVER THE LAST FEW DAYS. 4085 02:25:15,160 --> 02:25:16,360 HOWEVER, BECAUSE YOU GUYS WERE 4086 02:25:16,360 --> 02:25:17,920 SO INVOLVED, WE HAD A LOT OF 4087 02:25:17,920 --> 02:25:19,440 INFORMATION TO SHARE, AND WE'VE 4088 02:25:19,440 --> 02:25:21,080 REACHED THE END OF OUR SCHEDULED 4089 02:25:21,080 --> 02:25:21,800 TIME. 4090 02:25:21,800 --> 02:25:25,560 SO TO BE AMENABLE TO YOUR 4091 02:25:25,560 --> 02:25:27,000 SCHEDULES, I JUST WANT TO REMIND 4092 02:25:27,000 --> 02:25:29,720 YOU THAT WE DO HAVE THE WORKSHOP 4093 02:25:29,720 --> 02:25:31,200 WEBSITE WHICH INCLUDES A LIST OF 4094 02:25:31,200 --> 02:25:33,000 THE PARTICIPANTS AND THEIR EMAIL 4095 02:25:33,000 --> 02:25:34,080 ADDRESSES, SO YOU SHOULD GO TO 4096 02:25:34,080 --> 02:25:36,400 THE WEBSITE, DOWNLOAD THAT, AND 4097 02:25:36,400 --> 02:25:37,600 CONTINUE THESE DISCUSSIONS VIA 4098 02:25:37,600 --> 02:25:39,040 EMAIL. 4099 02:25:39,040 --> 02:25:42,720 I ALSO WANTED TO SAY THANK YOU 4100 02:25:42,720 --> 02:25:43,920 TO ALL OF YOU FOR YOUR 4101 02:25:43,920 --> 02:25:44,360 PARTICIPATION. 4102 02:25:44,360 --> 02:25:46,920 THOSE THAT WERE ACTIVE 4103 02:25:46,920 --> 02:25:47,600 PARTICIPANTS AND THOSE WATCHING 4104 02:25:47,600 --> 02:25:48,640 ON THE VIDEOCAST. 4105 02:25:48,640 --> 02:25:49,840 YOU'VE PROVIDED US WITH A LOT OF 4106 02:25:49,840 --> 02:25:50,840 INFORMATION TO HELP MOVE THE 4107 02:25:50,840 --> 02:25:52,120 FIELD FORWARD IN ADDRESSING 4108 02:25:52,120 --> 02:25:54,880 HEALTH DISPARITIES IN OA. 4109 02:25:54,880 --> 02:25:56,080 THANK YOU AGAIN FOR TAKING TIME 4110 02:25:56,080 --> 02:25:57,520 OUT OF YOUR BUSY SCHEDULES, AND 4111 02:25:57,520 --> 02:25:59,040 THANKS TO THOSE INVOLVED IN 4112 02:25:59,040 --> 02:25:59,800 PLANNING THE WORKSHOP. 4113 02:25:59,800 --> 02:26:00,800 WE COULDN'T HAVE DONE IT WITHOUT 4114 02:26:00,800 --> 02:26:01,120 YOU. 4115 02:26:01,120 --> 02:26:02,640 SO NOW I WILL TURN THINGS OVER 4116 02:26:02,640 --> 02:26:04,400 TO DR. JOSEPH TO TAKE US INTO 4117 02:26:04,400 --> 02:26:07,440 OUR CLOSING REMARKS. 4118 02:26:07,440 --> 02:26:09,760 >> GOOD AFTERNOON, EVERYONE, AND 4119 02:26:09,760 --> 02:26:11,840 AS KRISTY SAID, THANK YOU GUYS 4120 02:26:11,840 --> 02:26:13,040 FOR BEING INVOLVED IN THIS 4121 02:26:13,040 --> 02:26:13,280 WORKSHOP. 4122 02:26:13,280 --> 02:26:15,000 IT IS MY GREAT PLEASURE TO 4123 02:26:15,000 --> 02:26:16,440 INTRODUCE TO YOU DR. RICHARD 4124 02:26:16,440 --> 02:26:17,800 HODES, WHO IS THE DIRECTOR OF 4125 02:26:17,800 --> 02:26:20,920 THE NATIONAL INSTITUTE ON AGING. 4126 02:26:20,920 --> 02:26:22,880 DR. HODES HAS BEEN LEADING NIA 4127 02:26:22,880 --> 02:26:25,720 SINCE 1993. 4128 02:26:25,720 --> 02:26:27,920 HE IS A GRADUATE OF YALE 4129 02:26:27,920 --> 02:26:29,000 UNIVERSITY AND HIS 4130 02:26:29,000 --> 02:26:31,320 MEDICAL DEGREE AT HARVARD EURT. 4131 02:26:31,320 --> 02:26:31,560 HARVARD 4132 02:26:31,560 --> 02:26:31,840 UNIVERSITY. 4133 02:26:31,840 --> 02:26:34,480 HE DID HIS FELLOWSHIP IN STOCK 4134 02:26:34,480 --> 02:26:36,640 STOCKHOLM AND HIS CLINICAL 4135 02:26:36,640 --> 02:26:40,680 IN ADDITION TO LEADING THE NIA 4136 02:26:40,680 --> 02:26:43,440 IN THE VAST RESEARCH FIELD, HE 4137 02:26:43,440 --> 02:26:45,080 IS THE -- HE DIRECTS THE FEDERAL 4138 02:26:45,080 --> 02:26:49,320 EFFORT TO FIND EFFECTIVE WAYS TO 4139 02:26:49,320 --> 02:26:50,240 TREAT AND PREVENT ALZHEIMER'S 4140 02:26:50,240 --> 02:26:52,200 DISEASE, WHICH IS A MISSION OF 4141 02:26:52,200 --> 02:26:54,160 THE NIA AND THAT IS A HUGE TASK. 4142 02:26:54,160 --> 02:26:55,720 HE ALSO WEARS VARIOUS HATS, ONE 4143 02:26:55,720 --> 02:26:57,280 OF THEM IS THAT HE'S STILL AN 4144 02:26:57,280 --> 02:26:59,320 ACTIVE RESEARCHER, AND HE IS 4145 02:26:59,320 --> 02:27:02,800 WELL-KNOWN IN THE FIELD OF 4146 02:27:02,800 --> 02:27:03,240 IMMUNOLOGY. 4147 02:27:03,240 --> 02:27:05,200 HE HAS HIS RESEARCH LAB AT THE 4148 02:27:05,200 --> 02:27:05,840 NATIONAL CANCER INSTITUTE. 4149 02:27:05,840 --> 02:27:08,720 HE'S THE HEAD OF THE IMMUNOLOGY 4150 02:27:08,720 --> 02:27:10,120 REGULATION -- THE IMMUNE 4151 02:27:10,120 --> 02:27:12,520 REGULATION SECTION, AND HE 4152 02:27:12,520 --> 02:27:14,400 FOCUSES ON THE CELLULAR AND 4153 02:27:14,400 --> 02:27:15,680 MOLECULAR MECHANISMS THAT 4154 02:27:15,680 --> 02:27:17,120 REGULATE THE IMMUNE SYSTEM. 4155 02:27:17,120 --> 02:27:19,200 DR. HODES IS A MEMBER OF THE 4156 02:27:19,200 --> 02:27:20,640 DANA ALLIANCE FOR BRAIN 4157 02:27:20,640 --> 02:27:21,480 INITIATIVE. 4158 02:27:21,480 --> 02:27:22,880 HE'S A FELLOW OF THE AMERICAN 4159 02:27:22,880 --> 02:27:24,320 ASSOCIATION FOR THE ADVANCEMENT 4160 02:27:24,320 --> 02:27:26,600 OF SCIENCE, AND HE'S A MEMBER OF 4161 02:27:26,600 --> 02:27:28,280 THE NATIONAL ACADEMY OF MEDICINE 4162 02:27:28,280 --> 02:27:30,680 AT THE NATIONAL ACADEMIES OF 4163 02:27:30,680 --> 02:27:31,440 SCIENCE, ENGINEERING AND 4164 02:27:31,440 --> 02:27:32,440 MEDICINE. 4165 02:27:32,440 --> 02:27:33,760 DR. HODES, THE FLOOR IS YOURS. 4166 02:27:33,760 --> 02:27:35,040 >> THANK YOU. 4167 02:27:35,040 --> 02:27:37,400 IT'S QUITE A TASK AND PRIVILEGE 4168 02:27:37,400 --> 02:27:39,360 TO WRAP UP THIS VERY RICH 4169 02:27:39,360 --> 02:27:39,800 MEETING. 4170 02:27:39,800 --> 02:27:43,160 I WANT TO BEGIN BY THANKING YOU 4171 02:27:43,160 --> 02:27:48,840 ALL FOR THE OPPORTUNITY FOR NIA, 4172 02:27:48,840 --> 02:27:50,160 NIMHD HAVE HAD TO WORK WITH YOU 4173 02:27:50,160 --> 02:27:51,680 ON THIS VERY IMPORTANT TOPIC. 4174 02:27:51,680 --> 02:27:53,320 OVER THE YEARS WITH OUR EMPHASIS 4175 02:27:53,320 --> 02:27:54,960 ON LIFE COURSE, NIA HAS BEEN 4176 02:27:54,960 --> 02:27:55,960 VERY MUCH INVOLVED WITH 4177 02:27:55,960 --> 02:27:56,920 OSTEOARTHRITIS AS AN IMPORTANT 4178 02:27:56,920 --> 02:27:59,560 CONDITION THAT CHALLENGES AND 4179 02:27:59,560 --> 02:28:00,760 COMPROMISES THE QUALITY OF LIFE. 4180 02:28:00,760 --> 02:28:02,080 MANY INDIVIDUALS THROUGH 4181 02:28:02,080 --> 02:28:03,840 LIFESPAN AS THEY AGE, THE 4182 02:28:03,840 --> 02:28:05,800 EMPHASIS HERE ON HEALTH 4183 02:28:05,800 --> 02:28:07,200 DISPARITIES HAS ADDED IN 4184 02:28:07,200 --> 02:28:08,320 RICHNESS TO THIS TOPIC. 4185 02:28:08,320 --> 02:28:09,520 THE MEETING HAS DEALT WITH 4186 02:28:09,520 --> 02:28:11,720 VARIABLES THAT RANGE FROM THE 4187 02:28:11,720 --> 02:28:12,680 BIOLOGIC BUT NOW AS WE 4188 02:28:12,680 --> 02:28:14,800 UNDERSTAND THE BIOLOGIC 4189 02:28:14,800 --> 02:28:16,760 INTERACTING WITH ENVIRONMENTAL 4190 02:28:16,760 --> 02:28:20,680 ASPECTS WHICH IN TURN ARE 4191 02:28:20,680 --> 02:28:22,200 CONDITIONED BY ASPECTS OF HEALTH 4192 02:28:22,200 --> 02:28:24,240 DISPARITIES, INFLUENCES THAT 4193 02:28:24,240 --> 02:28:25,240 AFFECT THE DIAGNOSIS OF THE 4194 02:28:25,240 --> 02:28:26,760 DISEASE, THE VULNERABILITY OF 4195 02:28:26,760 --> 02:28:28,240 THE DISEASE, ACCESS TO DIAGNOSIS 4196 02:28:28,240 --> 02:28:31,160 AND TREATMENT, AT ALL LEVELS. 4197 02:28:31,160 --> 02:28:32,800 WHAT THIS MEETING HAS DONE IN 4198 02:28:32,800 --> 02:28:35,120 THESE PAST TWO DAYS NOW SETS A 4199 02:28:35,120 --> 02:28:36,520 HIGHLIGHT OF THE CHALLENGES 4200 02:28:36,520 --> 02:28:38,720 BEFORE US TO BETTER UNDERSTAND 4201 02:28:38,720 --> 02:28:40,360 THE DISEASE, PROCESS, 4202 02:28:40,360 --> 02:28:41,680 DISPARITIES, AS A MEANS FOR 4203 02:28:41,680 --> 02:28:42,360 PROVIDING BETTER UNDERSTANDING 4204 02:28:42,360 --> 02:28:46,600 OF THE PROCESS WHICH PRECEDES, 4205 02:28:46,600 --> 02:28:47,680 UNDERLIES OSTEOARTHRITIS, TO 4206 02:28:47,680 --> 02:28:49,200 ADDRESS RISK FACTORS, MAKE SURE 4207 02:28:49,200 --> 02:28:51,080 WE DO SO IN AN EQUITABLE WAY 4208 02:28:51,080 --> 02:28:53,040 THAT DOESN'T FALL VICTIM TO 4209 02:28:53,040 --> 02:28:54,040 IGNORING RATHER THAN TAKES 4210 02:28:54,040 --> 02:28:55,120 ADVANTAGE OF WHAT WE CAN LEARN 4211 02:28:55,120 --> 02:28:56,320 ABOUT DISPARITIES AND THE 4212 02:28:56,320 --> 02:28:57,440 CHALLENGES, AGAIN, THE 4213 02:28:57,440 --> 02:28:58,520 DIAGNOSIS, THE TREATMENT AND THE 4214 02:28:58,520 --> 02:29:00,080 SERVICES PROVIDED. 4215 02:29:00,080 --> 02:29:02,240 SO I WOULD CONCLUDE JUST BY 4216 02:29:02,240 --> 02:29:04,440 CONTINUING THE COMMITMENT OF THE 4217 02:29:04,440 --> 02:29:08,920 NIA WITH OUR OTHER NIH AGENCIES, 4218 02:29:08,920 --> 02:29:11,200 NIAMS, NIMHD FOCUSED ON THIS 4219 02:29:11,200 --> 02:29:12,320 TOPIC, TO WORKING WITH ALL OF 4220 02:29:12,320 --> 02:29:13,960 YOU TO IDENTIFY THE GAPS, TO 4221 02:29:13,960 --> 02:29:15,360 IDENTIFY THE PRIORITIES THAT 4222 02:29:15,360 --> 02:29:17,960 WE'VE HEARD SUMMARIZED IN THESE 4223 02:29:17,960 --> 02:29:18,960 MEETINGS, AND LOOK FORWARD TO 4224 02:29:18,960 --> 02:29:23,120 FURTHER PROGRESS IN THE WORK. 4225 02:29:23,120 --> 02:29:25,840 SO IT'S A PRIVILEGE, I TURN IT 4226 02:29:25,840 --> 02:29:27,080 BACK WITH THANKS AND GRATITUDE 4227 02:29:27,080 --> 02:29:28,840 TO ALL OF YOU AND EXCITEMENT 4228 02:29:28,840 --> 02:29:32,760 LOOKING FORWARD TO THE FIELD OF 4229 02:29:32,760 --> 02:29:33,040 RESEARCH. 4230 02:29:33,040 --> 02:29:34,280 >> THANK YOU, DR. HODES. 4231 02:29:34,280 --> 02:29:36,480 THANK YOU ONCE AGAIN, EVERYBODY, 4232 02:29:36,480 --> 02:29:38,000 FOR PARTICIPATING. 4233 02:29:38,000 --> 02:29:39,760 VISIT THE WEBSITE AND KEEP AN 4234 02:29:39,760 --> 02:29:41,280 EYE ON YOUR EMAIL FOR 4235 02:29:41,280 --> 02:29:42,040 POST-MEETING MATERIALS. 4236 02:29:42,040 --> 00:00:00,000 THANK YOU.