1 00:00:05,880 --> 00:00:07,800 >>WELCOME EVERYONE. 2 00:00:07,800 --> 00:00:09,240 THANK YOU SO MUCH FOR JOINING US 3 00:00:09,240 --> 00:00:13,040 THIS AFTERNOON FOR OUR ANNUAL 4 00:00:13,040 --> 00:00:20,320 WORKSHOP FOR THE NIH PRAGMATIC 5 00:00:20,320 --> 00:00:24,640 TRIALS COLLABRATORY. 6 00:00:24,640 --> 00:00:28,000 WE'VE DONE VIDEO CAST OUT TO THE 7 00:00:28,000 --> 00:00:28,880 BROADER AUDIENCE AND IN THE LAST 8 00:00:28,880 --> 00:00:32,560 TWO YEARS, WE'VE DONE OUR 9 00:00:32,560 --> 00:00:35,640 WORKSHOPS WITH A SERIES OF GRAND 10 00:00:35,640 --> 00:00:36,880 ROUNDS OVER A SERIES OF 11 00:00:36,880 --> 00:00:39,640 DIFFERENT MONTHS WITH A TOTAL OF 12 00:00:39,640 --> 00:00:43,680 FOUR OR FIVE AND THIS MONTH 13 00:00:43,680 --> 00:00:45,720 WE'RE TRYING SOMETHING NEW SO WE 14 00:00:45,720 --> 00:00:47,280 CAN ACCOMMODATE BOTH OUR WEST 15 00:00:47,280 --> 00:00:49,600 COAST AND EAST COAST COLLEAGUES 16 00:00:49,600 --> 00:00:51,080 HERE IN THE U.S. AND ANY 17 00:00:51,080 --> 00:00:53,840 INTERNATIONAL COLLEAGUES WE HAVE 18 00:00:53,840 --> 00:00:55,200 AROUND THE WORLD WHO ARE 19 00:00:55,200 --> 00:00:55,680 PARTICIPATING TODAY. 20 00:00:55,680 --> 00:00:59,040 SO WELCOME TO EVERYONE. 21 00:00:59,040 --> 00:01:02,320 THIS YEAR, WE'RE SECELEBRATING E 22 00:01:02,320 --> 00:01:06,520 FIRST DECADES OF THE HEALTH 23 00:01:06,520 --> 00:01:08,040 SYSTEMS COLLABORATORY WHICH 24 00:01:08,040 --> 00:01:09,920 WE'VE REBRANDED. 25 00:01:09,920 --> 00:01:12,200 AND IN PREPARING FOR THIS YEAR'S 26 00:01:12,200 --> 00:01:13,400 WORKSHOP, WE THOUGHT WE'D TALK 27 00:01:13,400 --> 00:01:15,520 TO A LOT OF OUR INVESTIGATORS TO 28 00:01:15,520 --> 00:01:19,800 ASK THEM WHAT WOULD THEY DO 29 00:01:19,800 --> 00:01:20,120 DIFFERENTLY? 30 00:01:20,120 --> 00:01:21,760 WHAT WOULD THEY LEARN DOING 31 00:01:21,760 --> 00:01:27,040 THESE PRAGMATIC TRIALS EMBEDDED 32 00:01:27,040 --> 00:01:28,400 IN THE HEALTH ANTERIOR SYSTEMS, 33 00:01:28,400 --> 00:01:29,920 WHAT WOULD THEY SHARE IN DOING 34 00:01:29,920 --> 00:01:31,640 THIS RESEARCH? 35 00:01:31,640 --> 00:01:32,920 AND OUR CORE LEADERSHIP FOUND A 36 00:01:32,920 --> 00:01:33,880 FEW THINGS. 37 00:01:33,880 --> 00:01:35,960 ONE OF THEM WAS THE FACT THAT 38 00:01:35,960 --> 00:01:38,520 EVERYBODY'S USING ELECTRONIC 39 00:01:38,520 --> 00:01:41,200 HEALTH RECORDS AND A LOT HAS 40 00:01:41,200 --> 00:01:41,760 CHANGED IN THE LAST DECADE. 41 00:01:41,760 --> 00:01:43,840 SO WE'RE GOING TO HAVE A SESSION 42 00:01:43,840 --> 00:01:45,040 TODAY ABOUT ELECTRONIC HEALTH 43 00:01:45,040 --> 00:01:47,040 RECORD DATA AND HOW WE MIGHT BE 44 00:01:47,040 --> 00:01:48,320 ABLE TO USE IT AND MAYBE EVEN 45 00:01:48,320 --> 00:01:56,600 USE IT BETTER IN THE FUTURE. 46 00:01:56,600 --> 00:01:58,280 WE'VE LEARNED A LOT ABOUT 47 00:01:58,280 --> 00:01:59,400 DIFFERENT STUDY DESIGNS AND HOW 48 00:01:59,400 --> 00:02:00,920 YOU SELECT THE RIGHT STUDY 49 00:02:00,920 --> 00:02:02,640 DESIGN AND ANSWER THE RESEARCH 50 00:02:02,640 --> 00:02:05,000 QUESTION THAT YOU HAVE. 51 00:02:05,000 --> 00:02:05,640 AND MANY OF OUR INVESTIGATORS, 52 00:02:05,640 --> 00:02:06,520 WE'VE ASKED THEM THE QUESTION 53 00:02:06,520 --> 00:02:08,920 WOULD YOU DO IT THE SAME WAY 54 00:02:08,920 --> 00:02:10,600 THAT YOU'VE ENDED UP DOING IT? 55 00:02:10,600 --> 00:02:12,920 AND SO I'M LOOKING FORWARD TO 56 00:02:12,920 --> 00:02:14,520 THEIR DISCUSSION AND THOUGHTS 57 00:02:14,520 --> 00:02:17,960 ABOUT WHAT THEY DO THE TRIAL THE 58 00:02:17,960 --> 00:02:19,640 SAME WAY AND HAVE THEY LEARNED 59 00:02:19,640 --> 00:02:21,760 SOME THINGS OR MAYBE WOULD HAVE 60 00:02:21,760 --> 00:02:25,240 ANSWERED THEIR QUESTIONS A 61 00:02:25,240 --> 00:02:28,120 LITTLE BIT DIFFERENT HAD THEY 62 00:02:28,120 --> 00:02:29,800 DONE THE STUDY DESIGN. 63 00:02:29,800 --> 00:02:30,480 ONE OF THE THINGS THAT'S UNIQUE 64 00:02:30,480 --> 00:02:33,000 ABOUT THE PRAGMATIC TRIALS 65 00:02:33,000 --> 00:02:38,520 COLLABORATORY IS WE'VE LAUNCHED 66 00:02:38,520 --> 00:02:39,600 22 TRIALS ACROSS THE COUNTRY AND 67 00:02:39,600 --> 00:02:44,600 THEY'VE UTE ILLIZED A 1,000 AT 68 00:02:44,600 --> 00:02:45,040 THAT TIME. 69 00:02:45,040 --> 00:02:47,200 SOME OF OUR INVESTIGATORS ARE 70 00:02:47,200 --> 00:02:48,840 GOING TO TELL US ABOUT WHAT WAS 71 00:02:48,840 --> 00:02:53,560 USEFUL AND HELPFUL IN THAT 72 00:02:53,560 --> 00:02:54,160 PLANNING PERIOD AND WHAT WAS 73 00:02:54,160 --> 00:02:54,720 REALLY MAYBE SOMETHING THEY 74 00:02:54,720 --> 00:02:55,680 WISHED THINKING BACK THAT WOULD 75 00:02:55,680 --> 00:02:57,240 HAVE BEEN HELPFUL IF THEY HAD 76 00:02:57,240 --> 00:02:59,800 DONE AND SO WE'RE GOING TO HAVE 77 00:02:59,800 --> 00:03:00,440 A NICE DISCUSSION AROUND THAT. 78 00:03:00,440 --> 00:03:06,520 AND OUR LAST PANEL IS ONE THAT 79 00:03:06,520 --> 00:03:09,080 HAS BECOME MORE AND MORE OF AN 80 00:03:09,080 --> 00:03:12,520 ISSUE OVER TIME IS THE HUGE 81 00:03:12,520 --> 00:03:13,600 IMPLEMENTATION AND DELIVERING 82 00:03:13,600 --> 00:03:16,280 THESE IN THE HEALTH CARE CENTER 83 00:03:16,280 --> 00:03:20,440 AND WORKING WITH OUR COLLEAGUES 84 00:03:20,440 --> 00:03:23,040 DOING IMPLEMENTATION SCIENCE 85 00:03:23,040 --> 00:03:25,240 AROUND WHAT CAN WE LEARN FROM 86 00:03:25,240 --> 00:03:27,920 THEIR METHODS DOING PRAGMATIC 87 00:03:27,920 --> 00:03:29,520 TRIALS IN THOSE HEALTH CARE 88 00:03:29,520 --> 00:03:30,880 SYSTEMS SO WE CAN TEST WHETHER 89 00:03:30,880 --> 00:03:32,080 INTERVENTION WORKS AND THE 90 00:03:32,080 --> 00:03:34,800 BIGGEST THING IS LOGISTICS. 91 00:03:34,800 --> 00:03:39,000 LOTS OF LOGISTICS TO OVERCOME. 92 00:03:39,000 --> 00:03:39,560 SO I'M LOOKING FORWARD TO 93 00:03:39,560 --> 00:03:40,040 HEARING FROM ALL OF OUR 94 00:03:40,040 --> 00:03:45,080 INVESTIGATORS ABOUT WHAT THEY'VE 95 00:03:45,080 --> 00:03:46,640 LEARNED ABOUT SOME OF THE 96 00:03:46,640 --> 00:03:48,280 IMPLEMENTATION TRIALS. 97 00:03:48,280 --> 00:03:50,680 BECAUSE THE HEALTH KERR SYSTEMS 98 00:03:50,680 --> 00:03:52,760 REALLY VARY. 99 00:03:52,760 --> 00:03:53,440 EVERYTHING FROM YOUR ACADEMIC 100 00:03:53,440 --> 00:03:55,240 HEALTH CARE SETTING TO MANAGED 101 00:03:55,240 --> 00:03:57,040 CARE TYPESETTING AND EVEN 102 00:03:57,040 --> 00:03:58,240 COMMUNITY BASED CLINICS. 103 00:03:58,240 --> 00:04:00,400 SO WE HAVE A BIG RANGE OF 104 00:04:00,400 --> 00:04:03,000 DIFFERENT LESSONS ACROSS THESE 105 00:04:03,000 --> 00:04:06,920 DIFFERENT HEALTH CARE SETTINGS. 106 00:04:06,920 --> 00:04:07,760 SO WE KNOW WE HAVE A BROAD 107 00:04:07,760 --> 00:04:10,480 AUDIENCE HERE ON OUR VIDEO CAST. 108 00:04:10,480 --> 00:04:12,160 WE CERTAINLY KNOW WE HAVE OTHER 109 00:04:12,160 --> 00:04:14,200 RESEARCH FUNDERS THAT ARE HERE 110 00:04:14,200 --> 00:04:16,760 AND WE HOPE YOU CAN LEARN THINGS 111 00:04:16,760 --> 00:04:18,760 ABOUT HOW TO DO THESE TYPE OF 112 00:04:18,760 --> 00:04:20,240 RESEARCH AND ANSWER QUESTIONS 113 00:04:20,240 --> 00:04:21,520 ABOUT DO INTERVENTIONS WORK WHEN 114 00:04:21,520 --> 00:04:24,000 THEY'RE ACTUALLY IN THE HEALTH 115 00:04:24,000 --> 00:04:25,480 CARE SETTING AS WELL AS 116 00:04:25,480 --> 00:04:26,760 IMPLEMENTATION QUESTIONS SUCH AS 117 00:04:26,760 --> 00:04:27,840 HOW DO YOU GET INTERVENTIONS 118 00:04:27,840 --> 00:04:29,080 INTO THE HEALTH CARE SETTING AND 119 00:04:29,080 --> 00:04:30,720 WHAT'S THE BEST WAY TO DO THAT. 120 00:04:30,720 --> 00:04:32,560 CERTAINLY, WE KNOW WE HAVE MANY 121 00:04:32,560 --> 00:04:33,880 INVESTIGATORS AND RESEARCHERS ON 122 00:04:33,880 --> 00:04:35,480 THIS MEETING AND WE HOPE THAT 123 00:04:35,480 --> 00:04:38,520 YOU CAN BENEFIT FROM THE 124 00:04:38,520 --> 00:04:39,680 EXPERIENCE OF THE INVESTIGATORS 125 00:04:39,680 --> 00:04:41,560 YOU'RE GOING TO HEAR FROM TODAY 126 00:04:41,560 --> 00:04:42,720 AND TOMORROW ABOUT THEIR 127 00:04:42,720 --> 00:04:43,560 EXPERIENCE CONDUCTING THESE 128 00:04:43,560 --> 00:04:46,160 TRIALS AND HEALTH CARE SYSTEMS. 129 00:04:46,160 --> 00:04:47,800 WE ALSO KNOW THAT YOU BRING A 130 00:04:47,800 --> 00:04:49,560 LOT OF YOUR OWN EXPERIENCE TO 131 00:04:49,560 --> 00:04:51,080 THIS DISCUSSION AND TO THIS 132 00:04:51,080 --> 00:04:54,000 VIDEO CAST AND TO THIS WORKSHOP 133 00:04:54,000 --> 00:04:55,840 OVER THE NEXT TWO DAYS. 134 00:04:55,840 --> 00:04:58,000 AND SO WE CERTAINLY WELCOME 135 00:04:58,000 --> 00:04:59,680 OPPORTUNITIES FOR YOU TO ASK 136 00:04:59,680 --> 00:05:00,840 QUESTIONS AS WELL AS TO GIVE 137 00:05:00,840 --> 00:05:03,120 YOUR INPUT AND THOUGHTS AND 138 00:05:03,120 --> 00:05:04,120 IDEAS AS WELL. 139 00:05:04,120 --> 00:05:06,880 AND THEN, FINALLY, WE KNOW WE 140 00:05:06,880 --> 00:05:09,360 HAVE MANY STAKEHOLDERS WHO'VE 141 00:05:09,360 --> 00:05:10,680 PARTICIPATED IN THESE WORKSHOPS 142 00:05:10,680 --> 00:05:12,400 AND WANT TO KNOW ABOUT WHAT 143 00:05:12,400 --> 00:05:16,440 WE'RE DOING HERE AT NIH WHETHER 144 00:05:16,440 --> 00:05:17,320 YOU'RE ON THE PATIENT'S SIDE, 145 00:05:17,320 --> 00:05:21,000 THE PROVIDER'S SIDE, HOW TO DO 146 00:05:21,000 --> 00:05:21,560 RESEARCH THAT INFORMS YOUR 147 00:05:21,560 --> 00:05:23,760 DECISIONS ABOUT WHAT CARE IS 148 00:05:23,760 --> 00:05:24,480 RIGHT FOR YOU, WHAT CARE IS BEST 149 00:05:24,480 --> 00:05:26,520 FOR YOUR PATIENTS, OR WHAT CARE 150 00:05:26,520 --> 00:05:29,920 IS BEST FOR YOUR BENEFICIARIES. 151 00:05:29,920 --> 00:05:30,560 SO WE'RE LOOKING FORWARD TO ALL 152 00:05:30,560 --> 00:05:31,640 OF YOUR PERSPECTIVES AS WELL. 153 00:05:31,640 --> 00:05:34,120 IF YOU CAN GO TO THE NEXT SLIDE 154 00:05:34,120 --> 00:05:35,120 FOR ME, MARY JOE. 155 00:05:35,120 --> 00:05:37,720 I HAVE JUST ARE A COUPLE OF 156 00:05:37,720 --> 00:05:39,400 MINOR LITTLE HOUSEKEEPING NOTES. 157 00:05:39,400 --> 00:05:41,320 ONE IS AS I MENTIONED, WE HAVE 158 00:05:41,320 --> 00:05:43,320 AN ACTIVE E-MAIL THAT YOU CAN 159 00:05:43,320 --> 00:05:44,920 SUBMIT QUESTIONS TO AND WE WILL 160 00:05:44,920 --> 00:05:48,480 BE MONITORING THAT E-MAIL BOX 161 00:05:48,480 --> 00:05:50,200 THROUGHOUT THE WORKSHOP TODAY 162 00:05:50,200 --> 00:05:51,360 AND TOMORROW. 163 00:05:51,360 --> 00:05:52,560 SO PLEASE DO SEND YOUR QUESTIONS 164 00:05:52,560 --> 00:05:55,320 IN AS YOU THINK OF THEM AND WE 165 00:05:55,320 --> 00:05:57,960 WILL TRY OUR BEST TO GET TO AS 166 00:05:57,960 --> 00:05:59,840 MANY OF THEM AS POSSIBLE. 167 00:05:59,840 --> 00:06:04,200 WE DO HAVE A ZOOM PLATFORM FOR 168 00:06:04,200 --> 00:06:04,800 OUR SPEAKERS AND SO FOR THE 169 00:06:04,800 --> 00:06:05,840 SPEAKERS, WE ARE ASKING YOU TO 170 00:06:05,840 --> 00:06:07,960 KEEP YOUR CAMERAS OFF UNLESS 171 00:06:07,960 --> 00:06:09,440 YOU'RE ACTUALLY SPEAKING, 172 00:06:09,440 --> 00:06:10,560 OTHERWISE YOU'RE GOING TO SHOW 173 00:06:10,560 --> 00:06:13,280 UP IN THE LIVE VIDEO CAST FEED 174 00:06:13,280 --> 00:06:14,520 AS YOUR CAMERA IS ON. 175 00:06:14,520 --> 00:06:15,960 WE ALSO DO HAVE THE CHAT 176 00:06:15,960 --> 00:06:18,520 AVAILABLE TO US, BUT PLEASE DO 177 00:06:18,520 --> 00:06:19,880 REMEMBER ONCE WE GET TO THE 178 00:06:19,880 --> 00:06:21,400 DISCUSSION, I ENCOURAGE YOU TO 179 00:06:21,400 --> 00:06:22,920 RAISE YOUR HAND OR TURN YOUR 180 00:06:22,920 --> 00:06:24,760 CAMERA ON IF YOU WANT TO 181 00:06:24,760 --> 00:06:25,680 PARTICIPATE IN THE DISCUSSION SO 182 00:06:25,680 --> 00:06:29,200 WE CAN GET TO YOUR QUESTIONS. 183 00:06:29,200 --> 00:06:29,960 OUR AUDIENCE, MOST OF OUR 184 00:06:29,960 --> 00:06:31,760 AUDIENCE IS HERE VIA VIDEO CAST 185 00:06:31,760 --> 00:06:35,400 AND THEY CANNOT SEE THE ZOOM 186 00:06:35,400 --> 00:06:35,720 DISCUSSION. 187 00:06:35,720 --> 00:06:37,400 SO WE'LL DEFINITELY WANT TO 188 00:06:37,400 --> 00:06:39,120 BRING THOSE QUESTIONS UP IN THE 189 00:06:39,120 --> 00:06:40,200 LIVE DISCUSSION AND WE SHOULD 190 00:06:40,200 --> 00:06:41,640 HAVE PLENTY OF TIME FOR IN ALL 191 00:06:41,640 --> 00:06:42,440 OF OUR SESSIONS. 192 00:06:42,440 --> 00:06:43,760 WE'RE LOOKING FORWARD TO A 193 00:06:43,760 --> 00:06:45,040 SERIES OF MODERATED DISCUSSIONS 194 00:06:45,040 --> 00:06:47,600 AS I MENTIONED ON THOSE FOUR 195 00:06:47,600 --> 00:06:50,320 DIFFERENT TOPICS, BUT BEFORE WE 196 00:06:50,320 --> 00:06:53,320 LAUNCH INTO THAT, I'M VERY 197 00:06:53,320 --> 00:07:01,520 EXCITED TO INTRODUCE DR. ELAN 198 00:07:01,520 --> 00:07:01,760 LONGEVAN. 199 00:07:01,760 --> 00:07:10,560 AND SHE IS ALSO THE CO-CHAIR OF 200 00:07:10,560 --> 00:07:16,400 THE COLLABORATORY PROGRAM AND 201 00:07:16,400 --> 00:07:18,200 SHE IS HERE AND WE'VE BEEN LUCKY 202 00:07:18,200 --> 00:07:19,640 IN DOING THIS AMAZING PROGRAM 203 00:07:19,640 --> 00:07:23,680 WITH AN AMAZING SET OF PEOPLE AT 204 00:07:23,680 --> 00:07:24,560 OUR COORDINATING CENTER AT DUKE 205 00:07:24,560 --> 00:07:25,680 AS WELL AS ALL OF OUR 206 00:07:25,680 --> 00:07:27,760 INVESTIGATORS AND ALL OF OUR 207 00:07:27,760 --> 00:07:29,920 COLLABORATORS IN THE COORDINATED 208 00:07:29,920 --> 00:07:32,400 CENTER ACROSS MANY INSTITUTIONS 209 00:07:32,400 --> 00:07:34,520 ACROSS THE COUNTRY. 210 00:07:34,520 --> 00:07:37,320 SO DR. LANGEVIN I'M GOING TO 211 00:07:37,320 --> 00:07:40,200 INTRODUCE YOU TO OUR KEYNOTE 212 00:07:40,200 --> 00:07:44,680 WHICH WE'RE EXCITED TO HAVE 213 00:07:44,680 --> 00:07:47,360 DR. SHANNON ZENK AS WELL. 214 00:07:47,360 --> 00:07:48,960 >> IT'S REALLY MY GREAT PLEASURE 215 00:07:48,960 --> 00:07:53,280 TO INTRODUCE OUR KEYNOTE SPEAKER 216 00:07:53,280 --> 00:07:56,880 DR. SHANNON ZENK WHO IS THE 217 00:07:56,880 --> 00:07:58,880 DIRECTOR OF NATIONAL INSTITUTE 218 00:07:58,880 --> 00:08:00,720 NURSING RESEARCH. 219 00:08:00,720 --> 00:08:09,160 DR. ZENK JOINED NNR IN 2020. 220 00:08:09,160 --> 00:08:12,120 HER LEADERSHIP IN NINR'S LEADING 221 00:08:12,120 --> 00:08:13,720 NURSING RESEARCH TO SOLVE 222 00:08:13,720 --> 00:08:15,000 CRITICAL HEALTH CHALLENGES, 223 00:08:15,000 --> 00:08:18,200 INFORMING PRACTICE AND POLICY 224 00:08:18,200 --> 00:08:21,120 AND ADVANCING HEALTH. 225 00:08:21,120 --> 00:08:26,520 BEFORE LEAVING NINR, DR. ZENK 226 00:08:26,520 --> 00:08:28,640 WAS THE LEADING PROFESSOR IN THE 227 00:08:28,640 --> 00:08:30,000 HEALTH SCIENCES AT THE 228 00:08:30,000 --> 00:08:31,320 UNIVERSITY OF CHICAGO COLLEGE OF 229 00:08:31,320 --> 00:08:31,680 NURSING. 230 00:08:31,680 --> 00:08:35,760 AND, A FELLOW IN THE UIC 231 00:08:35,760 --> 00:08:38,120 INSTITUTE FOR HEALTH RESEARCH 232 00:08:38,120 --> 00:08:38,400 AND POLICY. 233 00:08:38,400 --> 00:08:41,600 SHE EARNED A BACHELOR'S IN 234 00:08:41,600 --> 00:08:45,360 NURSING FROM ILLINOIS WESLEY 235 00:08:45,360 --> 00:08:45,640 UNIVERSITY. 236 00:08:45,640 --> 00:08:47,000 MASTERS IN NURSING AND HEALTH 237 00:08:47,000 --> 00:08:48,640 FROM THE UNIVERSITY OF ILLINOIS. 238 00:08:48,640 --> 00:08:51,160 AND A DOCTORATE IN HEALTH 239 00:08:51,160 --> 00:08:52,240 BEHAVIOR AND HEALTH EDUCATION 240 00:08:52,240 --> 00:08:57,160 FROM THE UNIVERSITY OF MICHIGAN. 241 00:08:57,160 --> 00:08:58,480 DR. ZENK WAS ELECTED AS A FELLOW 242 00:08:58,480 --> 00:09:00,080 OF THE AMERICAN ACADEMY OF 243 00:09:00,080 --> 00:09:01,200 NURSING IN 2013. 244 00:09:01,200 --> 00:09:02,520 RECEIVED AWARDS FROM THE 245 00:09:02,520 --> 00:09:04,200 NATIONAL INSTITUTE OF NURSING 246 00:09:04,200 --> 00:09:04,920 RESEARCH IN 2018. 247 00:09:04,920 --> 00:09:06,840 WAS INDUCTED INTO THE 248 00:09:06,840 --> 00:09:08,320 INTERNATIONAL NURSE'S 249 00:09:08,320 --> 00:09:10,560 RESEARCHER'S HALL OF FAME IN 250 00:09:10,560 --> 00:09:11,480 2019, AND, ELECTED AS A MEMBER 251 00:09:11,480 --> 00:09:13,200 OF THE NATIONAL ACADEMY OF 252 00:09:13,200 --> 00:09:15,960 MEDICINE IN 2021. 253 00:09:15,960 --> 00:09:18,720 HER RESEARCH FOCUSES ON SOCIAL 254 00:09:18,720 --> 00:09:20,560 INEQUITIES AND HEALTH WITH A 255 00:09:20,560 --> 00:09:23,800 GOAL OF IDENTIFYING EFFECTIVE 256 00:09:23,800 --> 00:09:25,600 MULTI-LEVEL APPROACHES TO 257 00:09:25,600 --> 00:09:28,080 IMPROVE HEALTH AND ELIMINATE 258 00:09:28,080 --> 00:09:28,960 RACIAL AND ETHNIC AND SOCIAL 259 00:09:28,960 --> 00:09:30,960 ECONOMIC HEALTH DISPARITIES. 260 00:09:30,960 --> 00:09:32,840 HER RESEARCH PORTFOLIO HAS 261 00:09:32,840 --> 00:09:34,800 INCLUDED NIH SUPPORTED WORK IN 262 00:09:34,800 --> 00:09:36,280 URBAN FOOD ENVIRONMENTS, 263 00:09:36,280 --> 00:09:39,480 COMMUNITY HEALTH SOLUTIONS, AND 264 00:09:39,480 --> 00:09:40,800 VETERANS' HEALTH THROUGH 265 00:09:40,800 --> 00:09:42,400 PIONEERING RESEARCH ON THE BUILT 266 00:09:42,400 --> 00:09:45,160 ENVIRONMENT AND FOOD DESERTS, 267 00:09:45,160 --> 00:09:47,560 DR. ZENK AND HER COLLEAGUES 268 00:09:47,560 --> 00:09:48,840 INCREASED NATIONAL ATTENTION TO 269 00:09:48,840 --> 00:09:50,600 THE PROBLEM OF INADEQUATE ACCESS 270 00:09:50,600 --> 00:09:54,520 TO FOOD IN LOW-INCOME AND BLACK 271 00:09:54,520 --> 00:09:54,840 NEIGHBORHOODS. 272 00:09:54,840 --> 00:09:57,240 DR. ZENK AND HER COLLEAGUES HAVE 273 00:09:57,240 --> 00:10:00,120 STUDIED YOU ENVIRONMENTAL AND 274 00:10:00,120 --> 00:10:01,280 PERSONAL FACTORS INTERACT TO 275 00:10:01,280 --> 00:10:05,440 AFFECT HEALTH AS WELL AS THE 276 00:10:05,440 --> 00:10:06,440 EFFECTIVENESS OF BEHAVIORAL CAN 277 00:10:06,440 --> 00:10:08,640 VARY IN ENVIRONMENTAL CONTEXT. 278 00:10:08,640 --> 00:10:10,560 HER WORK HAS LEVERAGED A VARIETY 279 00:10:10,560 --> 00:10:11,880 OF TECHNOLOGIES AND EMERGING 280 00:10:11,880 --> 00:10:16,120 DATA RESEARCH SUCH AS ELECTRONIC 281 00:10:16,120 --> 00:10:16,720 HEALTH RECORDS. 282 00:10:16,720 --> 00:10:20,640 FIRST OFF, SHE WAS AN EARLY 283 00:10:20,640 --> 00:10:22,200 ADOPTER OF GPS TRACKING TO STUDY 284 00:10:22,200 --> 00:10:23,280 ENVIRONMENTS IN RELATION TO 285 00:10:23,280 --> 00:10:24,040 HEALTH BEHAVIORS. 286 00:10:24,040 --> 00:10:25,560 SHE RECOGNIZED THAT PEOPLE NOT 287 00:10:25,560 --> 00:10:28,280 ONLY SPEND TIME IN THE 288 00:10:28,280 --> 00:10:29,520 COMMUNITIES WHERE THEY LIVE BUT 289 00:10:29,520 --> 00:10:31,200 ALSO IN MANY OTHER PLACES WHICH 290 00:10:31,200 --> 00:10:32,560 IS CRUCIAL WHEN IMPLEMENTING 291 00:10:32,560 --> 00:10:34,440 INTERVENTIONS IN THE CONTEXT OF 292 00:10:34,440 --> 00:10:35,400 HEALTH DISPARITIES. 293 00:10:35,400 --> 00:10:37,160 I HOPE YOU CAN AGREE WITH ME 294 00:10:37,160 --> 00:10:40,520 THAT MANY OF THESE TOPICS ARE 295 00:10:40,520 --> 00:10:41,080 RELEVANT NOT ONLY TO THIS 296 00:10:41,080 --> 00:10:45,120 WORKSHOP BUT ALSO TO THE 297 00:10:45,120 --> 00:10:47,840 PRAGMATIC TRIALS GOAL. 298 00:10:47,840 --> 00:10:50,520 WE ALL LOOK FORWARD TO YOUR 299 00:10:50,520 --> 00:10:50,880 PRESENTATION. 300 00:10:50,880 --> 00:10:55,920 WELCOME, SHANNON. 301 00:10:55,920 --> 00:10:58,280 >> THANK YOU, HELENE. 302 00:10:58,280 --> 00:11:00,520 I'M LOOKING FORWARD TO OUR 303 00:11:00,520 --> 00:11:01,840 CONVERSATION TODAY. 304 00:11:01,840 --> 00:11:12,360 I'M GOING TO SHARE MY SCREEN. 305 00:11:12,800 --> 00:11:13,760 ALL RIGHT. 306 00:11:13,760 --> 00:11:14,880 SO, AGAIN, GOOD AFTERNOON 307 00:11:14,880 --> 00:11:15,120 EVERYONE. 308 00:11:15,120 --> 00:11:17,120 THANK YOU FOR INVITING ME TO 309 00:11:17,120 --> 00:11:17,880 TODAY'S WORKSHOP MARKING THE 310 00:11:17,880 --> 00:11:20,640 FIRST TEN YEARS OF THE PRAGMATIC 311 00:11:20,640 --> 00:11:24,160 CLINICAL TRIALS COLLABORATORY AT 312 00:11:24,160 --> 00:11:24,320 NIH. 313 00:11:24,320 --> 00:11:25,880 CONGRATULATIONS TO ALL. 314 00:11:25,880 --> 00:11:31,040 AND, I DO WANT TO THANK MY 315 00:11:31,040 --> 00:11:35,600 COLLEAGUE DR. HELENE LANGEVIN 316 00:11:35,600 --> 00:11:37,640 FOR RECOMMENDING ME TO JOIN YOU 317 00:11:37,640 --> 00:11:37,840 TODAY. 318 00:11:37,840 --> 00:11:43,280 SO I'M EXCITED TO TELL YOU ABOUT 319 00:11:43,280 --> 00:11:44,800 N 320 00:11:44,800 --> 00:11:45,080 N 321 00:11:45,080 --> 00:11:46,520 NINR, NURSING SCIENCE, AND 322 00:11:46,520 --> 00:11:51,840 IMPLEMENT OF PRAGMATIC CLINICAL 323 00:11:51,840 --> 00:11:52,080 TRIALS. 324 00:11:52,080 --> 00:11:54,440 SO I'LL START BY SHARING SOME 325 00:11:54,440 --> 00:11:57,880 BACKGROUND ON NINR AND OUR NEW 326 00:11:57,880 --> 00:11:58,960 STRATEGIC PLAN INCLUDING 327 00:11:58,960 --> 00:12:01,320 THOUGHTS ON OUR MOST PRESSING 328 00:12:01,320 --> 00:12:02,120 HEALTH CHALLENGES. 329 00:12:02,120 --> 00:12:04,600 CHIEF AMONG THEM HEALTH 330 00:12:04,600 --> 00:12:04,920 INEQUITIES. 331 00:12:04,920 --> 00:12:07,400 AND THE MANY WAYS THAT NURSING 332 00:12:07,400 --> 00:12:08,680 AND NURSING SCIENCE CAN 333 00:12:08,680 --> 00:12:11,120 CONTRIBUTE TO PRAGMATIC CLINICAL 334 00:12:11,120 --> 00:12:12,480 TRIALS AND I'M CERTAINLY LOOKING 335 00:12:12,480 --> 00:12:14,200 FORWARD TO DISCUSSION ON HOW WE 336 00:12:14,200 --> 00:12:16,360 CAN BETTER WORK TOGETHER IN 337 00:12:16,360 --> 00:12:18,440 THESE AREAS. 338 00:12:18,440 --> 00:12:20,280 NOW, BEFORE I BEGIN THOUGH, I DO 339 00:12:20,280 --> 00:12:21,680 WANT TO TELL YOU A LITTLE BIT 340 00:12:21,680 --> 00:12:24,040 ABOUT NINR AND THE IMPORTANCE OF 341 00:12:24,040 --> 00:12:26,360 NURSING SCIENCE TO HEALTH AND 342 00:12:26,360 --> 00:12:26,720 WELL-BEING. 343 00:12:26,720 --> 00:12:29,360 NINR WAS FOUNDED AS AN NIH 344 00:12:29,360 --> 00:12:32,600 CENTER IN 1985 AND BECAME AN 345 00:12:32,600 --> 00:12:33,720 INSTITUTE IN 1993. 346 00:12:33,720 --> 00:12:37,040 SINCE ITS FOUNDING, NINR HAS 347 00:12:37,040 --> 00:12:38,280 SUPPORTED RESEARCH THAT DEVELOPS 348 00:12:38,280 --> 00:12:40,560 THE SCIENTIFIC BASIS FOR 349 00:12:40,560 --> 00:12:42,120 CLINICAL PRACTICE AS WELL AS 350 00:12:42,120 --> 00:12:42,520 POLICY. 351 00:12:42,520 --> 00:12:46,160 ECHOING THE PRAGMATIC TRIAL'S 352 00:12:46,160 --> 00:12:48,240 COLLABORATORY VISION OF 353 00:12:48,240 --> 00:12:48,880 GENERATING RELIABLE EVIDENCE 354 00:12:48,880 --> 00:12:51,160 WITH REAL WORLD DATA. 355 00:12:51,160 --> 00:12:55,200 NOW, WE THINK WHAT SETS NINR 356 00:12:55,200 --> 00:12:56,920 APART FROM OTHER NIH INSTITUTES 357 00:12:56,920 --> 00:12:59,240 IS THAT OUR RESEARCH WITH 358 00:12:59,240 --> 00:13:01,840 NURSING'S % AT ITS CORE IS 359 00:13:01,840 --> 00:13:03,160 FOCUSED ON HEALTH SOLUTIONS FOR 360 00:13:03,160 --> 00:13:05,240 PEOPLE IN THE CONTEXT OF THEIR 361 00:13:05,240 --> 00:13:10,360 LIVES AND LIVING CONDITIONS. 362 00:13:10,360 --> 00:13:11,960 NURSES ARE EVERYWHERE. 363 00:13:11,960 --> 00:13:13,200 CERTAINLY, WE THINK ABOUT 364 00:13:13,200 --> 00:13:15,000 HOSPITALS AND CLINICS, BUT 365 00:13:15,000 --> 00:13:16,640 NURSES ARE ALSO IN OUR SCHOOLS, 366 00:13:16,640 --> 00:13:19,400 IN OUR WORK PLACES, IN HOMES AND 367 00:13:19,400 --> 00:13:23,920 LONG-TERM CARE FACILITIES, IN 368 00:13:23,920 --> 00:13:25,240 JUSTICE SETTINGS AND REALLY 369 00:13:25,240 --> 00:13:26,760 THROUGHOUT OUR COMMUNITIES. 370 00:13:26,760 --> 00:13:27,920 WE APPROACH PREVENTION, 371 00:13:27,920 --> 00:13:30,760 TREATMENT, AND CARE HOLISTICALLY 372 00:13:30,760 --> 00:13:32,080 AND IN CONTEXT. 373 00:13:32,080 --> 00:13:34,800 AND THE SCOPE OF OUR PRACTICE 374 00:13:34,800 --> 00:13:36,280 AND DISCIPLINE AND THE BREATH OF 375 00:13:36,280 --> 00:13:38,840 OUR KNOWLEDGE SPANS THE LIFE 376 00:13:38,840 --> 00:13:40,640 COURSE, CROSSES DISEASES AND 377 00:13:40,640 --> 00:13:42,360 CONDITIONS, AND EXTENDS FROM 378 00:13:42,360 --> 00:13:44,080 IMPROVING THE HEALTH OF 379 00:13:44,080 --> 00:13:47,320 INDIVIDUALS TO THAT OF ENTIRE 380 00:13:47,320 --> 00:13:47,600 POPULATIONS. 381 00:13:47,600 --> 00:13:49,760 IT'S THIS UNIQUE PERSPECTIVE AND 382 00:13:49,760 --> 00:13:52,200 POSITIONING THAT MAKES NURSING 383 00:13:52,200 --> 00:13:54,880 SCIENCE SO WELL-SITUATED TO LEAD 384 00:13:54,880 --> 00:13:57,200 RESEARCH ON THE WHOLE PICTURE OF 385 00:13:57,200 --> 00:13:59,520 HEALTH FROM THE BIOLOGY OF A 386 00:13:59,520 --> 00:14:02,400 PERSON'S CELLS AND GENES TO 387 00:14:02,400 --> 00:14:03,560 THEIR WHOLE SELF, THEIR FAMILY 388 00:14:03,560 --> 00:14:05,480 AND RESOURCES, AND THE COMMUNITY 389 00:14:05,480 --> 00:14:08,120 AND SOCIETY IN WHICH THEY LIVE. 390 00:14:08,120 --> 00:14:09,960 SO, WITH THAT, NURSING AND 391 00:14:09,960 --> 00:14:11,880 NURSING SCIENCE CONTEXT IN MIND, 392 00:14:11,880 --> 00:14:15,200 LET ME TELL YOU ABOUT NINR'S 393 00:14:15,200 --> 00:14:15,960 STRATEGIC PLAN. 394 00:14:15,960 --> 00:14:23,320 WE LAUNCHED A 20222026 STRATEGIC 395 00:14:23,320 --> 00:14:25,160 PLAN LAST NO AND I THINK YOU'LL 396 00:14:25,160 --> 00:14:27,040 SEE A NUMBER OF PARALLELS 397 00:14:27,040 --> 00:14:28,240 BETWEEN OUR STRATEGIC DIRECTION 398 00:14:28,240 --> 00:14:29,840 AND THAT OF THE COLLABORATORY. 399 00:14:29,840 --> 00:14:34,120 AT NINR AS DR. LANGEVIN 400 00:14:34,120 --> 00:14:35,680 MENTIONED, WE ARE COMMITTED TO 401 00:14:35,680 --> 00:14:39,200 LEADING NURSING SCIENCE TO SOLVE 402 00:14:39,200 --> 00:14:41,840 PRESSING HEALTH CHALLENGES AND 403 00:14:41,840 --> 00:14:43,320 PRACTICING POLICY. 404 00:14:43,320 --> 00:14:44,800 OPTIMIZING HEALTH AND ADVANCING 405 00:14:44,800 --> 00:14:46,520 HEALTH EQUITY INTO THE FUTURE. 406 00:14:46,520 --> 00:14:48,200 OUR MISSION STATEMENT REFLECTS 407 00:14:48,200 --> 00:14:49,360 OUR BELIEF THAT NURSING RESEARCH 408 00:14:49,360 --> 00:14:52,160 IS THE KEY TO UNLOCKING THE 409 00:14:52,160 --> 00:14:54,640 POWER AND POTENTIAL OF NURSING. 410 00:14:54,640 --> 00:14:58,360 IN OUR STRATEGIC PLAN DESCRIBES 411 00:14:58,360 --> 00:15:00,120 HOW WE WANT TO LEVERAGE THE 412 00:15:00,120 --> 00:15:02,200 STRENGTHS AND UNIQUE KNOWLEDGE 413 00:15:02,200 --> 00:15:06,520 AND PERSPECTIVES INHERENT TO THE 414 00:15:06,520 --> 00:15:09,960 DISCIPLINE TO THE BENEFIT OF ALL 415 00:15:09,960 --> 00:15:10,200 PEOPLE. 416 00:15:10,200 --> 00:15:11,400 THE STRATEGIC PLAN INCLUDES 417 00:15:11,400 --> 00:15:14,440 GUIDEN PRINCIPLES THAT IMPORTANT 418 00:15:14,440 --> 00:15:16,520 QUALITIES THAT NINR SUPPORTIVE 419 00:15:16,520 --> 00:15:18,320 WORK SHOULD HAVE GOING FORWARD. 420 00:15:18,320 --> 00:15:18,880 IN CONSIDERING GRANT 421 00:15:18,880 --> 00:15:21,200 APPLICATIONS FOR FUNDING, THE 422 00:15:21,200 --> 00:15:22,720 EXTENT TO WHICH REFLECT THESE 423 00:15:22,720 --> 00:15:23,640 PRINCIPLES WILL BE A FACTOR IN 424 00:15:23,640 --> 00:15:24,840 OUR DECISIONS. 425 00:15:24,840 --> 00:15:27,200 WE NEED TO SUPPORT RESEARCH THAT 426 00:15:27,200 --> 00:15:28,720 ADDRESSES TODAY'S CHALLENGES AND 427 00:15:28,720 --> 00:15:32,600 HELPS US BE BETTER PREPARED FOR 428 00:15:32,600 --> 00:15:33,000 THE FUTURE. 429 00:15:33,000 --> 00:15:36,200 DISCOVER SOLUTIONS TO OPTIMIZE 430 00:15:36,200 --> 00:15:37,440 HEALTH ACROSS CLINICAL, 431 00:15:37,440 --> 00:15:42,160 COMMUNITY, AND POLICY SETTINGS. 432 00:15:42,160 --> 00:15:43,560 ADVANCES EQUITY, DIVERSITY, 433 00:15:43,560 --> 00:15:45,480 INCLUSION, AND ACCESSIBILITY AND 434 00:15:45,480 --> 00:15:48,120 IS INNOVATIVE DEVELOPS OR 435 00:15:48,120 --> 00:15:49,840 APPLIES RESEARCH METHODS AND HAS 436 00:15:49,840 --> 00:15:51,920 THE POTENTIAL FOR SIGNIFICANT 437 00:15:51,920 --> 00:15:53,400 IMPACT ON HEALTH AND WELL-BEING. 438 00:15:53,400 --> 00:15:55,680 SO I ENCOURAGE ALL INVESTIGATORS 439 00:15:55,680 --> 00:15:58,520 TO THINK ABOUT IMPLEMENTATION 440 00:15:58,520 --> 00:16:00,160 FROM THE START. 441 00:16:00,160 --> 00:16:02,800 ANOTHER COMMONALITY WITH THE 442 00:16:02,800 --> 00:16:03,120 COLLABORATORY. 443 00:16:03,120 --> 00:16:04,920 THE PLAN ALSO INCLUDES FIVE 444 00:16:04,920 --> 00:16:06,440 RESEARCH LENSES. 445 00:16:06,440 --> 00:16:08,560 AGAIN, I THINK YOU'LL SEE 446 00:16:08,560 --> 00:16:10,080 PARALLELS IN HOW THESE LENSES 447 00:16:10,080 --> 00:16:11,480 CAN BE APPLIED TO PRAGMATIC 448 00:16:11,480 --> 00:16:13,840 CLINICAL TRIALS. 449 00:16:13,840 --> 00:16:17,080 SO WHEN WE SAY "LENS" WE ARE 450 00:16:17,080 --> 00:16:18,080 DESCRIBING A PERSPECTIVE THROUGH 451 00:16:18,080 --> 00:16:19,320 WHICH TO EXAMINE A HEALTH 452 00:16:19,320 --> 00:16:20,240 CHALLENGE. 453 00:16:20,240 --> 00:16:22,000 IN DEVELOPING OUR SCIENTIFIC 454 00:16:22,000 --> 00:16:24,240 STRATEGY, NINR IDENTIFIED FIVE 455 00:16:24,240 --> 00:16:25,760 LENSES THAT WE THINK BEST 456 00:16:25,760 --> 00:16:27,480 LEVERAGE THE STRENGTHS INHERENT 457 00:16:27,480 --> 00:16:29,760 TO OUR DISCIPLINE AND PUSHED 458 00:16:29,760 --> 00:16:31,680 NURSING SCIENCE TO INNOVATE, 459 00:16:31,680 --> 00:16:33,160 THINK BIGGER, AND GREATLY 460 00:16:33,160 --> 00:16:33,920 INCREASE OUR IMPACT. 461 00:16:33,920 --> 00:16:36,120 THE LENSES IN THE STRATEGIC PLAN 462 00:16:36,120 --> 00:16:43,640 ARE HEALTH EQUITY, SOCIAL 463 00:16:43,640 --> 00:16:44,440 DETERMINENCE OF HEALTH, SYSTEMS 464 00:16:44,440 --> 00:16:45,920 AND MODELS OF CARE. 465 00:16:45,920 --> 00:16:48,080 LET ME GIVE YOU A CLOSER LOOK AT 466 00:16:48,080 --> 00:16:51,520 EACH OF THESE LENSES. 467 00:16:51,520 --> 00:16:54,240 OUR HEALTH EQUITY LENS AIMS TO 468 00:16:54,240 --> 00:16:55,920 REDUCE AND ULTIMATELY ELIMINATE 469 00:16:55,920 --> 00:16:58,520 THE SYSTEMIC AND STRUCTURAL 470 00:16:58,520 --> 00:16:59,480 INEQUITIES THAT PLACE SOME 471 00:16:59,480 --> 00:17:02,960 POPULATION GROUPS AT AN UNFAIR, 472 00:17:02,960 --> 00:17:04,560 UNJUST, AND AVOIDABLE 473 00:17:04,560 --> 00:17:07,280 DISADVANTAGE AND ATTAINING THEIR 474 00:17:07,280 --> 00:17:07,880 FULL HEALTH POTENTIAL. 475 00:17:07,880 --> 00:17:11,360 FROM NINR'S PERSPECTIVE, HEALTH 476 00:17:11,360 --> 00:17:12,520 INEQUITIES ARE ROOTED IN 477 00:17:12,520 --> 00:17:14,840 SYSTEMIC AND STRUCTURAL FACTORS 478 00:17:14,840 --> 00:17:17,080 THAT LIMIT ACCESS TO POWER, 479 00:17:17,080 --> 00:17:21,200 OPPORTUNITIES, AND RESOURCES. 480 00:17:21,200 --> 00:17:22,520 THESE FACTORS INCLUDE STRUCTURAL 481 00:17:22,520 --> 00:17:25,320 RACISM AND CREATE BARRIERS TO 482 00:17:25,320 --> 00:17:28,000 HEALTH AND CAN LEAD TO 483 00:17:28,000 --> 00:17:29,880 PERSISTENT HEALTH INEQUITIES. 484 00:17:29,880 --> 00:17:31,640 WE ARE INTERESTED IN SUPPORTING 485 00:17:31,640 --> 00:17:33,760 NURSING RESEARCH THAT IMPROVES 486 00:17:33,760 --> 00:17:35,760 HEALTH AND WELL-BEING FOR ALL 487 00:17:35,760 --> 00:17:37,480 THROUGH STRUCTURAL INTERVENTIONS 488 00:17:37,480 --> 00:17:39,760 THAT REMOVE OBSTACLES TO HEALTH, 489 00:17:39,760 --> 00:17:41,280 INCREASE AVAILABILITY AND 490 00:17:41,280 --> 00:17:45,200 ACCESSIBILITY OF RESOURCES AND 491 00:17:45,200 --> 00:17:47,480 ALTER ARE SOCIAL AND 492 00:17:47,480 --> 00:17:49,800 INSTITUTIONAL NORMS. 493 00:17:49,800 --> 00:18:00,320 OUR SOCIAL DETERMINANTS AS WELL 494 00:18:11,240 --> 00:18:12,760 AS INDIVIDUAL AND FAMILY SOCIAL 495 00:18:12,760 --> 00:18:15,880 AND ECONOMIC CIRCUMSTANCES. 496 00:18:15,880 --> 00:18:17,240 SO WE'RE INTERESTED IN 497 00:18:17,240 --> 00:18:19,960 SUPPORTING NURSING RESEARCH THAT 498 00:18:19,960 --> 00:18:21,200 IDENTIFIES AND SUPPORTS 499 00:18:21,200 --> 00:18:22,040 INTERVENTIONS DELIVERED AT THE 500 00:18:22,040 --> 00:18:23,840 RIGHT PLACE AND THE RIGHT TIME 501 00:18:23,840 --> 00:18:27,800 TO TARGET THESE SOCIAL FACTORS. 502 00:18:27,800 --> 00:18:30,520 WE WANT OUR INVESTIGATORS TO 503 00:18:30,520 --> 00:18:32,320 DISCOVER CREATIVE SOLUTIONS TO 504 00:18:32,320 --> 00:18:36,160 ADDRESS UPSTREAM AND MIDSTREAM 505 00:18:36,160 --> 00:18:38,160 CAUSES OF HEALTH OUTCOMES. 506 00:18:38,160 --> 00:18:40,360 IDENTIFY ON HOW TO LIMIT 507 00:18:40,360 --> 00:18:42,520 EXPOSURES TO ADVERSE AND 508 00:18:42,520 --> 00:18:43,160 ECONOMIC CONDITIONS. 509 00:18:43,160 --> 00:18:45,680 AND CONSIDER HOW TO LIMIT 510 00:18:45,680 --> 00:18:48,720 SUSCEPTIBILITY TO BIOLOGICAL 511 00:18:48,720 --> 00:18:50,160 EMBEDDING OF DETERMINANTS OVER 512 00:18:50,160 --> 00:18:51,960 THE LIFE COURSE AND ACROSS 513 00:18:51,960 --> 00:18:52,280 GENERATIONS. 514 00:18:52,280 --> 00:18:54,280 OUR POPULATION AND COMMUNITY 515 00:18:54,280 --> 00:18:56,200 HEALTH LENS AIMS TO ADDRESS 516 00:18:56,200 --> 00:18:59,680 CRITICAL HEALTH CHALLENGES AT A 517 00:18:59,680 --> 00:19:01,080 MACRO LEVEL THAT PERSISTENTLY 518 00:19:01,080 --> 00:19:02,720 AFFECTS GROUPS OF PEOPLE WITH 519 00:19:02,720 --> 00:19:04,840 SHARED CHARACTERISTICS. 520 00:19:04,840 --> 00:19:05,920 WE'RE INTERESTED IN SUPPORTING 521 00:19:05,920 --> 00:19:16,480 NURSING RESEARCH THAT USES ETIO 522 00:19:18,560 --> 00:19:18,680 LOGIC. 523 00:19:18,680 --> 00:19:21,240 TESTS AND EVALUATES PLANNED AS 524 00:19:21,240 --> 00:19:24,240 WELL AS NATURAL EXPERIMENTS OF 525 00:19:24,240 --> 00:19:26,200 MACRO-LEVEL INTERVENTIONS AND 526 00:19:26,200 --> 00:19:27,560 USES COMMUNITY ACTION AND 527 00:19:27,560 --> 00:19:28,760 PARTNERSHIPS IN THE MANY 528 00:19:28,760 --> 00:19:33,200 SETTINGS IN WHICH NURSES WORK. 529 00:19:33,200 --> 00:19:37,120 THE NEXT LENS AIMS TO PREVENT 530 00:19:37,120 --> 00:19:39,160 DISEASE AND PROMOTE HEALTH 531 00:19:39,160 --> 00:19:40,840 THROUGH THE CONTINUUM OF 532 00:19:40,840 --> 00:19:41,120 PREVENTION. 533 00:19:41,120 --> 00:19:45,160 THROUGH THE NINR'S PERSPECTIVE, 534 00:19:45,160 --> 00:19:48,000 PREVENTION ACT OF RISK OF 535 00:19:48,000 --> 00:19:49,720 DISEASE, DISABILITY OR INJURY 536 00:19:49,720 --> 00:19:52,720 ALONG WITH THE CONTINUUM THAT 537 00:19:52,720 --> 00:20:00,880 BEGINS WITH PRIMORTIAL AND 538 00:20:00,880 --> 00:20:02,440 CONTINUES TO TERTIARY 539 00:20:02,440 --> 00:20:02,760 PREVENTION. 540 00:20:02,760 --> 00:20:03,720 HEALTH PROMOTION INCLUDES 541 00:20:03,720 --> 00:20:06,520 EFFORTS TO FACILITATE HEALTHY 542 00:20:06,520 --> 00:20:08,480 BEHAVIORS THAT REDUCE RISK, 543 00:20:08,480 --> 00:20:10,280 IMPROVE HEALTH, MANAGE DISEASE, 544 00:20:10,280 --> 00:20:12,040 AND ENHANCE WELL-BEING. 545 00:20:12,040 --> 00:20:15,880 WE ARE INTERESTED IN SUPPORTING 546 00:20:15,880 --> 00:20:17,440 NURSE RESEARCH THAT TESTS 547 00:20:17,440 --> 00:20:19,480 INTERVENTIONS AND IDENTIFIES THE 548 00:20:19,480 --> 00:20:20,440 MECHANISMS THROUGH WHICH 549 00:20:20,440 --> 00:20:23,520 INTERVENTIONS WORK. 550 00:20:23,520 --> 00:20:25,400 MORE OVER, PREVENTION AND HEALTH 551 00:20:25,400 --> 00:20:27,240 PROMOTION EFFORTS MUST AIM TO 552 00:20:27,240 --> 00:20:28,680 ELIMINATE HEALTH INEQUITIES BY 553 00:20:28,680 --> 00:20:30,400 ACCOUNTING FOR THE MYRIAD OF 554 00:20:30,400 --> 00:20:32,640 INFLUENCES ON RISK FROM 555 00:20:32,640 --> 00:20:35,080 BIOLOGICAL TO SOCIETAL. 556 00:20:35,080 --> 00:20:37,160 AND OUR LAST LENS AIMS TO 557 00:20:37,160 --> 00:20:38,440 ADDRESS CLINICAL, 558 00:20:38,440 --> 00:20:40,160 ORGANIZATIONAL, AND POLICY 559 00:20:40,160 --> 00:20:42,280 CHALLENGES THROUGH NEW SYSTEMS 560 00:20:42,280 --> 00:20:44,200 AND MODELS OF CARE. 561 00:20:44,200 --> 00:20:46,280 WE DO NEED INNOVATIVE SYSTEMS 562 00:20:46,280 --> 00:20:50,600 AND MODELS OF CARE MADE UP OF 563 00:20:50,600 --> 00:20:52,800 COALITIONS AND PARTNERSHIPS THAT 564 00:20:52,800 --> 00:20:54,560 SPAN CLINICAL AND COMMUNITY 565 00:20:54,560 --> 00:20:56,040 SETTINGS AND ADDRESS SOCIAL 566 00:20:56,040 --> 00:20:57,200 FACTORS AND NEEDS FOR 567 00:20:57,200 --> 00:20:59,960 POPULATIONS AND INDIVIDUALS. 568 00:20:59,960 --> 00:21:01,480 WE ENCOURAGE NURSE-LED SYSTEMS 569 00:21:01,480 --> 00:21:04,200 AND MODELS OF CARE THAT CONSIDER 570 00:21:04,200 --> 00:21:05,720 HOW TO LEVERAGE THE PUBLIC'S 571 00:21:05,720 --> 00:21:08,440 TRUST IN AND THE EXPERTISE OF 572 00:21:08,440 --> 00:21:12,360 THE NURSING WORK FORCE TO EMPLOY 573 00:21:12,360 --> 00:21:14,800 SOLUTIONS INFORMED BY NURSES' 574 00:21:14,800 --> 00:21:16,280 PERSPECTIVE AND EXPERIENCES AND 575 00:21:16,280 --> 00:21:18,480 TO FOCUS ON HEALTH PROMOTING 576 00:21:18,480 --> 00:21:19,960 CARE THAT ENCOMPASSES THE WHOLE 577 00:21:19,960 --> 00:21:21,960 PERSON IN THE CONTEXT OF THEIR 578 00:21:21,960 --> 00:21:23,520 LIVES AND LIVING CONDITIONS. 579 00:21:23,520 --> 00:21:24,720 SO WE ARE INTERESTED IN 580 00:21:24,720 --> 00:21:26,440 SUPPORTING NURSING RESEARCH THAT 581 00:21:26,440 --> 00:21:28,960 INFORMS THE DEVELOPMENT, 582 00:21:28,960 --> 00:21:29,920 DESEMINATION, AND IMPLEMENTATION 583 00:21:29,920 --> 00:21:33,160 OF SYSTEMS AND MODELS OF CARE 584 00:21:33,160 --> 00:21:35,000 AND GRAPPLES WITH CHALLENGES 585 00:21:35,000 --> 00:21:37,360 SUCH AS COORDINATING CARE AND 586 00:21:37,360 --> 00:21:39,200 INTEGRATING DATA ACROSS CLINICAL 587 00:21:39,200 --> 00:21:41,520 AND COMMUNITY SETTINGS. 588 00:21:41,520 --> 00:21:45,000 TESTING MODELS OF CONTEXTUALIZED 589 00:21:45,000 --> 00:21:46,800 CARE AND UNDERSTANDING THE 590 00:21:46,800 --> 00:21:48,080 IMPACTS OF ORGANIZATIONAL 591 00:21:48,080 --> 00:21:49,880 PRACTICES AND POLICY ON QUALITY 592 00:21:49,880 --> 00:21:53,120 OF CARE AND ITS OUTCOMES. 593 00:21:53,120 --> 00:21:56,400 NOW, YOU'VE PROBABLY NOTICED 594 00:21:56,400 --> 00:21:57,880 THESE LENSES ARE COMPLEMENTARY. 595 00:21:57,880 --> 00:21:59,280 SO IN ADDITION TO LEVERAGING THE 596 00:21:59,280 --> 00:22:00,680 STRENGTHS OF NURSING RESEARCH, 597 00:22:00,680 --> 00:22:05,200 THE LENSES PROMOTE MULTI-LEVEL 598 00:22:05,200 --> 00:22:08,360 APPROACHES, CROSS-DISCIPLINARY, 599 00:22:08,360 --> 00:22:10,600 AND CROSS SEC. TOIRL 600 00:22:10,600 --> 00:22:12,120 COLLABORATION AND COMMUNITY 601 00:22:12,120 --> 00:22:13,120 ENGAGEMENT AND RESEARCH. 602 00:22:13,120 --> 00:22:16,720 AND NINR SUPPORT INVESTIGATORS 603 00:22:16,720 --> 00:22:18,640 TO HAVE THE FLEXIBILITY TO APPLY 604 00:22:18,640 --> 00:22:21,200 A SINGLE LENS OR A COMBINATION 605 00:22:21,200 --> 00:22:22,640 OF LENSES IN THEIR STUDY DESIGNS 606 00:22:22,640 --> 00:22:24,280 AND TRAINING PROGRAMS. 607 00:22:24,280 --> 00:22:26,200 WE ENCOURAGE RESEARCHERS TO VIEW 608 00:22:26,200 --> 00:22:28,040 THE HEALTH EQUITY AND SOCIAL 609 00:22:28,040 --> 00:22:32,480 DETERMINANTS OF HEALTH LENSES AS 610 00:22:32,480 --> 00:22:34,880 PRIMARY TO SIDE TO CONSIDER THE 611 00:22:34,880 --> 00:22:36,160 OTHER THREE LENSES. 612 00:22:36,160 --> 00:22:36,960 THIS IS BECAUSE WE STRONGLY 613 00:22:36,960 --> 00:22:38,480 BELIEVE THAT NURSES NEED TO BE 614 00:22:38,480 --> 00:22:40,760 AT THE TABLE AND THAT NURSING 615 00:22:40,760 --> 00:22:42,800 SCIENCE NEEDS TO BE IT AT THE 616 00:22:42,800 --> 00:22:43,840 FOREFRONT IN DISCOVERING 617 00:22:43,840 --> 00:22:45,360 SOLUTIONS TO ADDRESS OUR 618 00:22:45,360 --> 00:22:47,480 NATION'S DEEPLY ROOTED SYSTEMIC 619 00:22:47,480 --> 00:22:51,200 AND STRUCTURAL INEQUITIES AND TO 620 00:22:51,200 --> 00:22:54,400 ULTIMATELY ACHIEVE HEALTH 621 00:22:54,400 --> 00:22:54,640 EQUITY. 622 00:22:54,640 --> 00:22:56,120 NINR'S RESEARCH LENSES WILL 623 00:22:56,120 --> 00:22:57,560 ALLOW INVESTIGATORS TO CONSIDER 624 00:22:57,560 --> 00:23:00,280 A FULL SPECTRUM OF NURSING 625 00:23:00,280 --> 00:23:01,960 RESEARCH TOPICS THAT ENCOMPASSED 626 00:23:01,960 --> 00:23:03,360 HEALTH AND ILLNESS WITHIN THE 627 00:23:03,360 --> 00:23:06,120 CONTEXT OF PEOPLES' LIVED 628 00:23:06,120 --> 00:23:06,440 EXPERIENCES. 629 00:23:06,440 --> 00:23:08,600 THUS, THESE LENSES WILL ALLOW 630 00:23:08,600 --> 00:23:10,080 NURSE INVESTIGATORS AND OTHERS 631 00:23:10,080 --> 00:23:13,280 TO EXAMINE NEW TOPICS WHILE ALSO 632 00:23:13,280 --> 00:23:14,520 ALLOWING THOSE WITH LONG 633 00:23:14,520 --> 00:23:16,040 STANDING PROGRAMS OF RESEARCH TO 634 00:23:16,040 --> 00:23:20,840 TAKE A DIFFERENT LOOK AT THEIR 635 00:23:20,840 --> 00:23:29,840 AREAS OF INTEREST. 636 00:23:29,840 --> 00:23:32,280 FOR EXAMPLE, 43% OF NINR'S 637 00:23:32,280 --> 00:23:35,160 BUDGET FOCUSES ON LENS RESEARCH. 638 00:23:35,160 --> 00:23:36,360 30% FOCUSES ON RESEARCH. 639 00:23:36,360 --> 00:23:39,920 AND 26% OF OUR BUDGET FOCUSES 640 00:23:39,920 --> 00:23:49,360 ALREADY ON SOCIAL DETERMINANTS 641 00:23:49,360 --> 00:23:50,840 OF HEALTH. 642 00:23:50,840 --> 00:23:52,800 SO YOU CAN FIND THE FULL 643 00:23:52,800 --> 00:23:54,840 STRATEGIC PLAN ON OUR WEBSITE. 644 00:23:54,840 --> 00:23:58,080 THAT ALLOWS US TO MERGE. 645 00:23:58,080 --> 00:24:01,240 AS A RESULT, WE'RE GOING TO KEEP 646 00:24:01,240 --> 00:24:01,840 IT ON OUR WEBSITE AND YOU CAN 647 00:24:01,840 --> 00:24:04,720 ALWAYS FIND THE LATEST THERE. 648 00:24:04,720 --> 00:24:05,960 SO LET ME TRANSITION. 649 00:24:05,960 --> 00:24:09,240 WHAT DO WE MEAN WHEN WE AT NINR 650 00:24:09,240 --> 00:24:12,800 SAY WE WANT TO ADDRESS PRESSING 651 00:24:12,800 --> 00:24:14,360 HEALTH CHALLENGES? 652 00:24:14,360 --> 00:24:21,600 NOW, WE MEAN THAT PRESSING THAT 653 00:24:21,600 --> 00:24:24,080 UNDER LINE HEALTH INEQUITIES. 654 00:24:24,080 --> 00:24:26,920 SO I'LL SHARE A FEW EXAMPLES TO 655 00:24:26,920 --> 00:24:28,280 ILLUSTRATE SOME OF THE 656 00:24:28,280 --> 00:24:30,040 CHALLENGES THAT REQUIRE URGENT 657 00:24:30,040 --> 00:24:31,120 SOLUTIONS AND THAT I THINK ARE 658 00:24:31,120 --> 00:24:34,520 RELEVANT TO THOSE INVOLVED IN 659 00:24:34,520 --> 00:24:39,680 PRAGMATIC CLINICAL TRIALS. 660 00:24:39,680 --> 00:24:46,040 PEOPLE WHO ARE HISPANIC, BLACK, 661 00:24:46,040 --> 00:24:53,440 AND AMERICAN INDIAN ARE MORE 662 00:24:53,440 --> 00:24:54,080 LIKELY TO DIE FROM COVID-19 AS 663 00:24:54,080 --> 00:24:54,680 THAN PEOPLE WHO ARE WHITE. 664 00:24:54,680 --> 00:24:57,200 WITH NEARLY THREE QUARTERS OF 665 00:24:57,200 --> 00:25:00,320 THOSE REPORTING MORE THAN ONE 666 00:25:00,320 --> 00:25:00,640 EXPERIENCE. 667 00:25:00,640 --> 00:25:03,680 BLACK INDIVIDUALS ARE 22% LESS 668 00:25:03,680 --> 00:25:07,440 LIKELY THAN WHITE INDIVIDUALS TO 669 00:25:07,440 --> 00:25:09,760 RECEIVE ANY PAIN MEDICATION FOR 670 00:25:09,760 --> 00:25:11,720 SIMILAR PAINFUL CONDITIONS. 671 00:25:11,720 --> 00:25:13,560 IN THE UNITED STATES, SIX IN 672 00:25:13,560 --> 00:25:15,680 SEVEN ADULTS HAVE A CHRONIC 673 00:25:15,680 --> 00:25:19,320 DISEASE AND FOUR IN TEN HAVE TWO 674 00:25:19,320 --> 00:25:24,960 OR MORE LEADING DRIVERS OF THE 675 00:25:24,960 --> 00:25:29,120 NATION'S $3.8 TRILLION ANNUAL 676 00:25:29,120 --> 00:25:34,080 HEALTH CARE COST. 677 00:25:34,080 --> 00:25:36,200 SO SPEAKING OF CHRONIC DISEASE, 678 00:25:36,200 --> 00:25:39,600 PEOPLE OF COLOR ARE SUFFERING 679 00:25:39,600 --> 00:25:42,080 FROM DISEASE MORE THAN PEOPLE 680 00:25:42,080 --> 00:25:42,880 WHO ARE WHITE. 681 00:25:42,880 --> 00:25:44,560 U.S. ADULTS DIAGNOSED WITH 682 00:25:44,560 --> 00:25:46,040 DIABETES IS MUCH HIGHER FOR 683 00:25:46,040 --> 00:25:47,680 PEOPLE WHO ARE AMERICAN INDIAN 684 00:25:47,680 --> 00:25:52,360 OR CAN NATIVE, BLACK, OR 685 00:25:52,360 --> 00:25:53,840 HISPANIC AND LATINO THAN OF 686 00:25:53,840 --> 00:25:54,920 THOSE WHO ARE WHITE. 687 00:25:54,920 --> 00:25:56,600 THESE ARE JUST A FEW EXAMPLES OF 688 00:25:56,600 --> 00:25:58,720 THE ALARMING AND TRAGIC HEALTH 689 00:25:58,720 --> 00:26:01,000 INEQUITIES THAT OUR NATION 690 00:26:01,000 --> 00:26:01,600 FACES. 691 00:26:01,600 --> 00:26:05,160 SO, HOW CAN NURSES AND NURSING 692 00:26:05,160 --> 00:26:10,560 SCIENCE CONTRIBUTE TO PRAGMATIC 693 00:26:10,560 --> 00:26:12,040 CLINICAL TRIALS. 694 00:26:12,040 --> 00:26:14,240 THREE KEY ATTRIBUTES ARE 695 00:26:14,240 --> 00:26:17,520 SUMMARIZED IN THE COMMON SENSE 696 00:26:17,520 --> 00:26:17,880 DEFINITION HERE. 697 00:26:17,880 --> 00:26:22,000 IN DETAIL, THESE ATTRIBUTES 698 00:26:22,000 --> 00:26:23,320 INCLUDE INFORM DECISION MAKERS 699 00:26:23,320 --> 00:26:25,320 INSTEAD OF EXPLAINING A 700 00:26:25,320 --> 00:26:26,840 BIOLOGICAL OR SOCIAL MECHANISM. 701 00:26:26,840 --> 00:26:28,560 AN INTENT TO ENROLL A 702 00:26:28,560 --> 00:26:29,440 REPRESENTATIVE POPULATION IN 703 00:26:29,440 --> 00:26:31,800 RELEVANT SETTINGS, AND, AN 704 00:26:31,800 --> 00:26:33,640 INTENT TO EITHER STREAMLINE 705 00:26:33,640 --> 00:26:35,480 PROCEDURES AND DATA COLLECTION 706 00:26:35,480 --> 00:26:45,960 OR MEASURE A BROAD RANGE OF 707 00:26:46,600 --> 00:26:46,800 OUTCOMES. 708 00:26:46,800 --> 00:26:50,520 IN OUR GUIDING PRINCIPLES 709 00:26:50,520 --> 00:26:55,880 INCLUDE DISCOVERING SOLUTIONS TO 710 00:26:55,880 --> 00:26:56,640 OPTIMIZE HEALTH. 711 00:26:56,640 --> 00:26:58,520 ADVANCING EQUITY, DIVERSION, AND 712 00:26:58,520 --> 00:27:02,720 INCLUSION AND ACCESSIBILITY, AND 713 00:27:02,720 --> 00:27:04,000 SIGNIFICANTLY IMPACTING ON 714 00:27:04,000 --> 00:27:05,160 HEALTH AND WELL BEING. 715 00:27:05,160 --> 00:27:08,040 IN USING THE GRAPHIC FROM THE 716 00:27:08,040 --> 00:27:09,880 COLLABORATORY'S LIVING TEXTBOOK, 717 00:27:09,880 --> 00:27:12,080 IT'S EASY TO SEE WHERE NURSING 718 00:27:12,080 --> 00:27:13,960 AND NURSING RESEARCH CAN FIT 719 00:27:13,960 --> 00:27:16,040 WITH AN EMBEDDED PRAGMATIC 720 00:27:16,040 --> 00:27:16,480 CLINICAL TRIALS. 721 00:27:16,480 --> 00:27:18,040 NURSES MAKE UP THE LARGEST 722 00:27:18,040 --> 00:27:20,760 SEGMENT OF THE HEALTH CARE WORK 723 00:27:20,760 --> 00:27:23,040 FORCE AND ARE ALREADY IN EVERY 724 00:27:23,040 --> 00:27:25,040 SETTING WHERE PEOPLE RECEIVE 725 00:27:25,040 --> 00:27:25,240 CARE. 726 00:27:25,240 --> 00:27:26,520 IMPORTANTLY, AS THE 727 00:27:26,520 --> 00:27:28,320 COLLABORATORY INTENSIFIES ITS 728 00:27:28,320 --> 00:27:31,080 EFFORTS TO ADDRESS HEALTH 729 00:27:31,080 --> 00:27:35,440 INEQUITIES, NURSES ARE IN A WIDE 730 00:27:35,440 --> 00:27:37,400 RANGE OF NOT ONLY CLINICAL 731 00:27:37,400 --> 00:27:39,120 SETTINGS, BUT ALSO IN COMMUNITY 732 00:27:39,120 --> 00:27:39,720 SETTINGS PROVIDING CARE. 733 00:27:39,720 --> 00:27:41,640 THESE COMMUNITY SETTINGS ARE 734 00:27:41,640 --> 00:27:44,960 CRITICAL FOR REACHING 735 00:27:44,960 --> 00:27:46,520 POPULATIONS AND WHO ARE 736 00:27:46,520 --> 00:27:47,480 DISCONNECTED FROM TRADITIONAL 737 00:27:47,480 --> 00:27:48,480 HEALTH CARE SETTINGS. 738 00:27:48,480 --> 00:27:52,080 MORE OVER, NURSES KNOW THAT 739 00:27:52,080 --> 00:27:53,280 PATIENTS IN THE CONTEXT OF THEIR 740 00:27:53,280 --> 00:27:55,280 WHOLE LIVES AND CAN USE THAT 741 00:27:55,280 --> 00:27:57,000 KNOWLEDGE TO DEVELOP SOLUTIONS 742 00:27:57,000 --> 00:27:59,480 AND IDENTIFY BARRIERS TO 743 00:27:59,480 --> 00:28:03,200 PARTICIPATION AND STUDIES. 744 00:28:03,200 --> 00:28:04,280 NURSES ALSO ARE INTIMATELY 745 00:28:04,280 --> 00:28:06,400 FAMILIAR WITH THE NUANCES OF 746 00:28:06,400 --> 00:28:07,960 ELECTRONIC HEALTH RECORDS, A 747 00:28:07,960 --> 00:28:09,800 VITAL SOURCE OF DATA FOR 748 00:28:09,800 --> 00:28:12,120 PRAGMATIC TRIALS AND OUR EXPERT 749 00:28:12,120 --> 00:28:12,520 USERS. 750 00:28:12,520 --> 00:28:14,600 AND NURSES ARE DECISION-MAKERS 751 00:28:14,600 --> 00:28:17,240 IN THEIR OWN RIGHT AND ALSO 752 00:28:17,240 --> 00:28:20,200 SERVE AS A VITAL LINK BETWEEN 753 00:28:20,200 --> 00:28:24,120 OTHER DECISION MAKER, PATIENTS, 754 00:28:24,120 --> 00:28:25,920 AND HEALTH CARE PROVIDERS TO 755 00:28:25,920 --> 00:28:29,480 NAME JUST A FEW. 756 00:28:29,480 --> 00:28:33,760 AND I AM PROUD THAT NINR IS 757 00:28:33,760 --> 00:28:35,920 SHARING ITS EXPERTISE WITH 758 00:28:35,920 --> 00:28:37,640 COLLABORATORY PROJECTS. 759 00:28:37,640 --> 00:28:39,640 DR. KAREN KALE SERVES AS THE 760 00:28:39,640 --> 00:28:41,320 NINR REPRESENTATIVE TO THE 761 00:28:41,320 --> 00:28:42,240 COLLABORATORY STEERING COMMITTEE 762 00:28:42,240 --> 00:28:45,160 AND I THANK HER FOR REPRESENTING 763 00:28:45,160 --> 00:28:47,400 NINR'S PERSPECTIVE. 764 00:28:47,400 --> 00:28:49,160 ADDITIONALLY, DR. KALE SERVES AS 765 00:28:49,160 --> 00:28:53,200 THE PROGRAM OFFICIAL FOR THE 766 00:28:53,200 --> 00:28:54,360 COLLABORATORY'S BEAT PAYING UTAH 767 00:28:54,360 --> 00:28:58,520 PROJECT FOR WHICH NINR PROVIDES 768 00:28:58,520 --> 00:28:59,440 OVERSIGHT. 769 00:28:59,440 --> 00:29:01,560 AND, DR. LYNN ADAMS AND 770 00:29:01,560 --> 00:29:04,480 DR. JERRY MILLER HAVE ALSO 771 00:29:04,480 --> 00:29:06,040 SERVED AS PROJECT SCIENTISTS FOR 772 00:29:06,040 --> 00:29:09,360 SEVERAL ONGOING AND COMPLETED 773 00:29:09,360 --> 00:29:11,680 PRAGMATIC CLINICAL TRIAL 774 00:29:11,680 --> 00:29:12,280 DEMONSTRATION PROJECTS. 775 00:29:12,280 --> 00:29:16,360 SO AS PARTS OF THE NIH HEAL 776 00:29:16,360 --> 00:29:17,520 INITIATIVE TO SPEED SCIENTIFIC 777 00:29:17,520 --> 00:29:20,040 SOLUTIONS FOR THE NATIONAL 778 00:29:20,040 --> 00:29:21,920 OPIOID PUBLIC HEALTH CRISIS, 779 00:29:21,920 --> 00:29:24,120 NINR PARTICIPATED IN THE PRISM 780 00:29:24,120 --> 00:29:24,400 PROJECT. 781 00:29:24,400 --> 00:29:26,000 PRISM AS YOU MAY KNOW STANDS FOR 782 00:29:26,000 --> 00:29:27,920 THE PRAGMATIC AND IMPLEMENTATION 783 00:29:27,920 --> 00:29:29,840 STUDIES FOR THE MANAGEMENT OF 784 00:29:29,840 --> 00:29:32,480 PAIN TO REDUCE OPIOID 785 00:29:32,480 --> 00:29:33,080 PRESCRIBING. 786 00:29:33,080 --> 00:29:34,480 IN FACT, JUST LAST MONTH 787 00:29:34,480 --> 00:29:43,160 DR. KALE PRESENTED A CONCEPT TO 788 00:29:43,160 --> 00:29:45,920 NINR'S OF CHRONIC PAIN IN RURAL 789 00:29:45,920 --> 00:29:46,240 POPULATIONS. 790 00:29:46,240 --> 00:29:49,560 THIS CONCEPT WHICH IS SPONSORED 791 00:29:49,560 --> 00:29:51,960 BY NCCIH WOULD BE INCLUDED IN 792 00:29:51,960 --> 00:29:53,760 PRISM AND WOULD AIM TO 793 00:29:53,760 --> 00:29:58,360 ACCELERATE IMPLEMENTATION OF 794 00:29:58,360 --> 00:29:59,920 EVIDENCE-BASED, NONOPIOID PAIN 795 00:29:59,920 --> 00:30:02,280 CARE IN RURAL POPULATIONS TO 796 00:30:02,280 --> 00:30:03,800 OPTIMIZE HEALTH, ADDRESS 797 00:30:03,800 --> 00:30:05,440 DISPARITIES AND ADVANCE HEALTH 798 00:30:05,440 --> 00:30:05,640 EQUITY. 799 00:30:05,640 --> 00:30:07,920 AS DR. KALE EXPLAINED IN HER 800 00:30:07,920 --> 00:30:10,080 PRESENTATION TO NINR'S COUNCIL, 801 00:30:10,080 --> 00:30:12,640 IN RURAL AND REMOTE SETTINGS, 802 00:30:12,640 --> 00:30:14,520 PRIMARY CARE PROVIDERS INCLUDING 803 00:30:14,520 --> 00:30:16,120 NURSE PRACTICIONERS, CLINICAL 804 00:30:16,120 --> 00:30:18,520 NURSE SPECIALISTS, AND CERTIFIED 805 00:30:18,520 --> 00:30:21,200 NURSE MID WIVES ARE RESPONSIBLE 806 00:30:21,200 --> 00:30:23,160 FOR MANAGING CHRONIC PAIN AND 807 00:30:23,160 --> 00:30:26,520 FOR ADHERING TO GUIDELINES TO 808 00:30:26,520 --> 00:30:28,080 REDUCE OPIOID USE OFTEN WITH 809 00:30:28,080 --> 00:30:29,600 LIMITED RESOURCES. 810 00:30:29,600 --> 00:30:32,240 WHILE THERE ARE EFFECTIVE 811 00:30:32,240 --> 00:30:33,840 EVIDENCE-BASED NONOPIOID 812 00:30:33,840 --> 00:30:35,040 INTERVENTIONS FOR CHRONIC PAIN, 813 00:30:35,040 --> 00:30:36,640 THEY HAVE NOT BEEN WIDELY 814 00:30:36,640 --> 00:30:38,720 IMPLEMENTED IN RURAL AND REMOTE 815 00:30:38,720 --> 00:30:38,920 AREAS. 816 00:30:38,920 --> 00:30:42,520 THE CONCEPT FOCUSES ON 817 00:30:42,520 --> 00:30:43,720 IMPLEMENTATION IN COMMUNITY 818 00:30:43,720 --> 00:30:44,960 SETTINGS AND BUILDING 819 00:30:44,960 --> 00:30:46,440 PARTNERSHIPS BETWEEN 820 00:30:46,440 --> 00:30:50,200 INVESTIGATORS, LOCAL PROVIDERS 821 00:30:50,200 --> 00:30:51,120 AND COMMUNITY ORGANIZATIONS. 822 00:30:51,120 --> 00:30:52,960 NOW, AS YOU KNOW, CONCEPTS MAY 823 00:30:52,960 --> 00:30:54,800 OR MAY NOT TURN INTO FUNDING 824 00:30:54,800 --> 00:30:57,200 OPPORTUNITY ANNOUNCEMENTS 825 00:30:57,200 --> 00:30:59,560 DEPENDING ON A WIDE VARIETY OF 826 00:30:59,560 --> 00:31:00,160 FACTORS. 827 00:31:00,160 --> 00:31:03,080 I DO WANT TO THANK DR. KALE, 828 00:31:03,080 --> 00:31:04,400 NCCIH AND THE MANY OTHER 829 00:31:04,400 --> 00:31:06,000 INSTITUTE CENTERS AND OFFICES 830 00:31:06,000 --> 00:31:09,200 WHO HAVE EXPRESSED INTEREST IN 831 00:31:09,200 --> 00:31:12,200 COLLABORATING ON THIS PROJECT. 832 00:31:12,200 --> 00:31:14,200 BEFORE I WRAP UP, I'D LIKE TO 833 00:31:14,200 --> 00:31:16,080 SHARE MY THOUGHTS ON TWO 834 00:31:16,080 --> 00:31:17,680 STRENGTHS THAT NURSES AND 835 00:31:17,680 --> 00:31:20,120 NURSING RESEARCH CAN BRING TO 836 00:31:20,120 --> 00:31:23,640 COLLABORATORY EFFORTS. 837 00:31:23,640 --> 00:31:25,600 FIRST IS OUR KNOWLEDGE OF SOCIAL 838 00:31:25,600 --> 00:31:26,920 DETERMINANTS OF HEALTH WITH THE 839 00:31:26,920 --> 00:31:28,240 CONDITIONS IN WHICH PEOPLE ARE 840 00:31:28,240 --> 00:31:30,360 BORN, LIVE, LEARN, WORK, PLAY, 841 00:31:30,360 --> 00:31:32,320 AND AGE. 842 00:31:32,320 --> 00:31:35,120 NURSING'S EARLIEST PIONEERS 843 00:31:35,120 --> 00:31:36,400 RECOGNIZE THAT HEALTH MUST BE 844 00:31:36,400 --> 00:31:38,480 CONSIDERED WITHIN THE CONTEXT OF 845 00:31:38,480 --> 00:31:40,600 PEOPLES' LIVES AND LIVING 846 00:31:40,600 --> 00:31:41,040 CONDITIONS. 847 00:31:41,040 --> 00:31:42,440 IN OTHER WORDS, THEY WERE AMONG 848 00:31:42,440 --> 00:31:44,840 THE EARLIEST TO INCORPORATE 849 00:31:44,840 --> 00:31:46,920 SOCIAL DETERMINANTS INTO THEIR 850 00:31:46,920 --> 00:31:48,320 SOLUTIONS TO HEALTH PROBLEMS. 851 00:31:48,320 --> 00:31:51,560 AND THE TASK OF ELIMINATING 852 00:31:51,560 --> 00:31:54,320 INEQUITIES CAUSED BY SOCIAL 853 00:31:54,320 --> 00:31:55,480 DETERMINANTS IS NOTHING NEW TO 854 00:31:55,480 --> 00:31:55,840 NURSES. 855 00:31:55,840 --> 00:31:58,880 AT NINR, WE CONTINUE TO BUILD ON 856 00:31:58,880 --> 00:32:02,560 THIS RICH HISTORY THROUGH 857 00:32:02,560 --> 00:32:05,440 NURSE-LED EFFORTS TO ADDRESS 858 00:32:05,440 --> 00:32:06,520 INEQUITIES AND SOCIAL 859 00:32:06,520 --> 00:32:07,720 DETERMINANTS OF HEALTH. 860 00:32:07,720 --> 00:32:09,040 IN FACT, A RECENT FUTURE OF 861 00:32:09,040 --> 00:32:10,800 NURSING REPORT MAKES A 862 00:32:10,800 --> 00:32:12,320 COMPELLING CASE FOR NEW 863 00:32:12,320 --> 00:32:14,520 NURSE-LED MODELS TO ADDRESS 864 00:32:14,520 --> 00:32:16,280 SOCIAL DETERMINANTS OF HEALTH 865 00:32:16,280 --> 00:32:17,720 AND SOCIAL NEEDS ALL WITH THE 866 00:32:17,720 --> 00:32:21,040 GOAL OF ACHIEVING HEALTH EQUITY. 867 00:32:21,040 --> 00:32:23,880 WE CAN'T UNDERESTIMATE THE 868 00:32:23,880 --> 00:32:26,080 IMPACT OF SOCIAL DETERMINANTS 869 00:32:26,080 --> 00:32:29,080 AND INDIVIDUALS' ABILITY AND 870 00:32:29,080 --> 00:32:30,760 INTEREST IN PARTICIPATING IN 871 00:32:30,760 --> 00:32:31,040 RESEARCH. 872 00:32:31,040 --> 00:32:34,120 EVEN A PRAGMATIC CLINICAL TRIAL 873 00:32:34,120 --> 00:32:35,560 THAT'S DESIGNED TO BE AS 874 00:32:35,560 --> 00:32:36,480 INCLUSIVE AS POSSIBLE. 875 00:32:36,480 --> 00:32:38,640 MORE OVER, I WOULD ARGUE THAT 876 00:32:38,640 --> 00:32:40,600 PRAGMATIC TRIALS IN HEALTH CARE 877 00:32:40,600 --> 00:32:41,800 SETTINGS THAT SEEK TO ADDRESS 878 00:32:41,800 --> 00:32:43,960 HEALTH INEQUITIES ARE MORE 879 00:32:43,960 --> 00:32:46,560 LIKELY TO BE SUCCESSFUL IF THEY 880 00:32:46,560 --> 00:32:47,840 INCORPORATE AND ADDRESS SOCIAL 881 00:32:47,840 --> 00:32:51,440 NEEDS AND SOCIAL DETERMINANTS OF 882 00:32:51,440 --> 00:32:51,800 HEALTH. 883 00:32:51,800 --> 00:32:54,000 AND, OF COURSE, WE HAVE TO 884 00:32:54,000 --> 00:32:55,920 CONSIDER COMMUNITY ENGAGEMENT 885 00:32:55,920 --> 00:32:58,920 WHICH IS CRUCIAL FOR DESIGNING, 886 00:32:58,920 --> 00:33:00,720 IMPLEMENTING, AND SUSTAINING 887 00:33:00,720 --> 00:33:03,080 INTERVENTIONS. 888 00:33:03,080 --> 00:33:03,720 WHEN COMMUNITY MEMBERS ARE 889 00:33:03,720 --> 00:33:06,520 INCLUDED EQUITABLY FROM THE 890 00:33:06,520 --> 00:33:08,440 OUTSET, WE CAN BETTER UNDERSTAND 891 00:33:08,440 --> 00:33:11,040 WHAT PEOPLE NEED AND WHAT THEY 892 00:33:11,040 --> 00:33:11,240 WANT. 893 00:33:11,240 --> 00:33:16,000 AND WE CAN CO-CREATE AND 894 00:33:16,000 --> 00:33:17,440 CO-EVALUATE INTERVENTIONS THAT 895 00:33:17,440 --> 00:33:18,880 TRULY RESPOND TO THE ISSUES AND 896 00:33:18,880 --> 00:33:19,960 IMPORTANT TO THE COMMUNITY AND 897 00:33:19,960 --> 00:33:21,240 ARE MORE LIKELY TO WORK. 898 00:33:21,240 --> 00:33:24,040 MORE OVER, BUILDING THIS TRUST 899 00:33:24,040 --> 00:33:26,520 AND ENSURING COMMUNITY BUY-IN 900 00:33:26,520 --> 00:33:28,080 HELPS TO SUSTAIN EFFORTS LONG 901 00:33:28,080 --> 00:33:30,760 AFTER GRANT FUNDING HAS ENDED. 902 00:33:30,760 --> 00:33:33,200 AND NURSES MAKE UP NOT ONLY THE 903 00:33:33,200 --> 00:33:34,400 LARGEST SEGMENT OF THE HEALTH 904 00:33:34,400 --> 00:33:36,280 CARE WORK FORCE, BUT ALSO ARE 905 00:33:36,280 --> 00:33:37,720 THE MOST TRUSTED. 906 00:33:37,720 --> 00:33:39,720 SO I ENCOURAGE YOU ALL TO 907 00:33:39,720 --> 00:33:42,400 CONSIDER HOW YOU CAN INCLUDE 908 00:33:42,400 --> 00:33:43,280 NURSES THROUGHOUT THE PROCESS OF 909 00:33:43,280 --> 00:33:45,480 TRIAL DESIGN AND IMPLEMENTATION 910 00:33:45,480 --> 00:33:49,440 TO CAPITALIZE ON THIS TRUST AND 911 00:33:49,440 --> 00:33:50,600 TRULY ENGAGE COMMUNITY PARTNERS 912 00:33:50,600 --> 00:33:52,080 AT ALL LEVELS. 913 00:33:52,080 --> 00:33:53,960 NOW, I MUST POINT OUT THOUGH 914 00:33:53,960 --> 00:33:55,360 THAT COMMUNITY ENGAGEMENT IS 915 00:33:55,360 --> 00:33:57,880 ONLY ONE PART OF THE EQUATION. 916 00:33:57,880 --> 00:34:06,040 WE AS RESEARCHERS MUST BE AND 917 00:34:06,040 --> 00:34:06,440 STAY ENGAGED TOO. 918 00:34:06,440 --> 00:34:07,040 NO HOARDING OF RESEARCH 919 00:34:07,040 --> 00:34:09,360 RESOURCES POWER OR CONTROL, NO 920 00:34:09,360 --> 00:34:11,560 PARACHUTE OR HELICOPTER RESEARCH 921 00:34:11,560 --> 00:34:13,520 AND NO RESEARCH TOURISM. 922 00:34:13,520 --> 00:34:15,880 WE MUST HAVE A COMMITMENT TO 923 00:34:15,880 --> 00:34:17,680 BUILDING MUTUALLY BENEFICIAL 924 00:34:17,680 --> 00:34:19,160 RELATIONSHIPS, BENEFITTING 925 00:34:19,160 --> 00:34:22,800 COMMUNITIES, AND SUSTAINING 926 00:34:22,800 --> 00:34:24,520 EVIDENCE-BASED SOLUTIONS. 927 00:34:24,520 --> 00:34:25,920 SO, THANK YOU AGAIN FOR INVITING 928 00:34:25,920 --> 00:34:28,360 ME TO JOIN YOU TODAY. 929 00:34:28,360 --> 00:34:30,760 I WISH YOU MUCH CONTINUED 930 00:34:30,760 --> 00:34:33,200 SUCCESS IN THE COLLABORATORY'S 931 00:34:33,200 --> 00:34:35,680 NEXT TEN YEARS INCLUDING THROUGH 932 00:34:35,680 --> 00:34:39,400 AN EVEN KEENER FOCUS ON HOW THE 933 00:34:39,400 --> 00:34:40,680 COLLABORATORY CAN IDENTIFY 934 00:34:40,680 --> 00:34:42,360 SOLUTIONS TO ELIMINATE HEALTH 935 00:34:42,360 --> 00:34:44,080 DISPARITIES AND ADVANCE HEALTH 936 00:34:44,080 --> 00:34:44,320 EQUITY. 937 00:34:44,320 --> 00:34:47,760 I LOOK FORWARD TO YOUR 938 00:34:47,760 --> 00:34:48,000 QUESTIONS. 939 00:34:48,000 --> 00:34:49,760 I'D LOVE TO HEAR YOUR THOUGHTS 940 00:34:49,760 --> 00:34:51,560 ON HOW NURSES AND NURSING 941 00:34:51,560 --> 00:34:53,160 RESEARCH CAN ENHANCE PRAGMATIC 942 00:34:53,160 --> 00:34:55,040 CLINICAL TRIALS AT NIH AND 943 00:34:55,040 --> 00:34:57,520 THROUGHOUT THE BIO MEDICAL 944 00:34:57,520 --> 00:34:57,960 ENTERPRISE. 945 00:34:57,960 --> 00:34:59,400 PLEASE DO NOTE THE E-MAIL 946 00:34:59,400 --> 00:35:00,560 ADDRESS HERE, IF THERE'S 947 00:35:00,560 --> 00:35:03,800 ANYTHING WE DON'T GET TO DISCUSS 948 00:35:03,800 --> 00:35:05,320 TODAY OR ANY PROGRAM YOU'D LIKE 949 00:35:05,320 --> 00:35:06,400 MORE INFORMATION ON PLEASE FEEL 950 00:35:06,400 --> 00:35:08,280 FREE TO REACH OUT TO US AND 951 00:35:08,280 --> 00:35:09,480 WE'LL GET YOU THE INFORMATION 952 00:35:09,480 --> 00:35:13,000 YOU NEED. 953 00:35:13,000 --> 00:35:15,920 SO THANK YOU AGAIN. 954 00:35:15,920 --> 00:35:18,520 >> WOW, DR. ZENK, THAT WAS 955 00:35:18,520 --> 00:35:18,760 AMAZING. 956 00:35:18,760 --> 00:35:19,920 THANK YOU SO MUCH FOR THAT 957 00:35:19,920 --> 00:35:22,120 WONDERFUL KEYNOTE AND IT'S SO 958 00:35:22,120 --> 00:35:24,360 GREAT TO SEE HOW YOUR NEW 959 00:35:24,360 --> 00:35:26,520 PRIORITIES AND YOUR NEW 960 00:35:26,520 --> 00:35:28,080 STRATEGIC PLAN REALLY SORT OF 961 00:35:28,080 --> 00:35:30,720 OVERLAP AND, YOU KNOW, SO WELL 962 00:35:30,720 --> 00:35:33,680 FIT WITH WHAT WE'RE DOING HERE 963 00:35:33,680 --> 00:35:35,840 IN THE COLLABORATORY PROGRAM. 964 00:35:35,840 --> 00:35:37,000 I'LL ENCOURAGE EVERYONE IN THE 965 00:35:37,000 --> 00:35:39,360 AUDIENCE, IF YOU HAVE QUESTIONS, 966 00:35:39,360 --> 00:35:41,880 YOU CAN SEND THEM TO THE E-MAIL 967 00:35:41,880 --> 00:35:46,280 THAT YOU SEE POPPING UP ON YOUR 968 00:35:46,280 --> 00:35:48,680 SCREEN NOW. 969 00:35:48,680 --> 00:35:49,840 MARY JOE, IF YOU CAN SWITCH THE 970 00:35:49,840 --> 00:35:51,240 DISPLAY IT WILL BE A LITTLE BIT 971 00:35:51,240 --> 00:35:53,720 BIGGER SO YOU CAN SEE IT AND ALL 972 00:35:53,720 --> 00:35:54,720 OF OUR PANELISTS THAT ARE PART 973 00:35:54,720 --> 00:35:56,400 OF THE ZOOM, YOU CAN PUT THEM 974 00:35:56,400 --> 00:35:58,200 INTO THE CHAT OR JUST RAISE YOUR 975 00:35:58,200 --> 00:35:59,960 HAND IF YOU'D LIKE TO ASK A 976 00:35:59,960 --> 00:36:00,680 QUESTION. 977 00:36:00,680 --> 00:36:02,080 I'LL START OFF, WE CERTAINLY 978 00:36:02,080 --> 00:36:04,760 HAVE HAD MANY TRIALS ACROSS THE 979 00:36:04,760 --> 00:36:06,520 COLLABORATORY THAT HAVE INCLUDED 980 00:36:06,520 --> 00:36:08,840 NURSES IN ONE WAY OR ANOTHER 981 00:36:08,840 --> 00:36:10,960 WHETHER IT'S, YOU KNOW, I'M 982 00:36:10,960 --> 00:36:13,040 THINKING OF THE ABATE TRIAL 983 00:36:13,040 --> 00:36:15,720 WHERE THE NURSES WERE THE ONES 984 00:36:15,720 --> 00:36:17,480 DELIVERING AND DOING THE BATHING 985 00:36:17,480 --> 00:36:18,240 PROCEDURES IN THE HOSPITAL 986 00:36:18,240 --> 00:36:19,480 SETTINGS AND IT WAS PART OF 987 00:36:19,480 --> 00:36:25,640 THEIR CHECKLIST AS TO WHETHER 988 00:36:25,640 --> 00:36:26,240 THEY WERE DOING THE BATHING 989 00:36:26,240 --> 00:36:26,920 PROCEDURES TO REDUCE SUBSEQUENT 990 00:36:26,920 --> 00:36:28,600 INFECTIONS AND A WHOLE RANGE OF 991 00:36:28,600 --> 00:36:29,840 OTHER THINGS AND ONE OF THE 992 00:36:29,840 --> 00:36:31,720 THINGS THAT OUR INVESTIGATORS 993 00:36:31,720 --> 00:36:32,960 HAVE STRUGGLED WITH IS THE 994 00:36:32,960 --> 00:36:35,600 RESEARCH BURDEN THAT'S PUT ON 995 00:36:35,600 --> 00:36:36,640 PROVIDERS, WHATEVER THE PROVIDER 996 00:36:36,640 --> 00:36:38,400 IS, THEY HAVE SO MUCH ALREADY 997 00:36:38,400 --> 00:36:41,840 GOING ON IN THE CLINICAL CARE 998 00:36:41,840 --> 00:36:42,520 SETTING. 999 00:36:42,520 --> 00:36:46,480 ANY ADVICE YOU HAVE ON HOW TO 1000 00:36:46,480 --> 00:36:49,280 MAYBE ENGAGE THE NURSING 1001 00:36:49,280 --> 00:36:50,440 COMMUNITY POTENTIALLY AS 1002 00:36:50,440 --> 00:36:52,680 STAKEHOLDERS OR HOW DO WE WORK 1003 00:36:52,680 --> 00:36:54,040 TOGETHER BECAUSE IT'S OFTEN THE 1004 00:36:54,040 --> 00:36:55,520 IMPLEMENTATION OF THESE 1005 00:36:55,520 --> 00:36:56,760 INTERVENTIONS INTO THE HEALTH 1006 00:36:56,760 --> 00:36:58,520 CARE SETTING IS OFTEN A REALLY 1007 00:36:58,520 --> 00:36:59,240 BIG CHALLENGE. 1008 00:36:59,240 --> 00:37:02,160 SO ANY ADVICE THAT YOU HAVE 1009 00:37:02,160 --> 00:37:02,360 THERE? 1010 00:37:02,360 --> 00:37:02,760 >> YEAH. 1011 00:37:02,760 --> 00:37:04,320 I THINK THAT'S A REALLY 1012 00:37:04,320 --> 00:37:05,240 IMPORTANT ISSUE AND YOU POINT 1013 00:37:05,240 --> 00:37:08,960 OUT THE HEALTH CARE WORKFORCE 1014 00:37:08,960 --> 00:37:09,840 INCLUDING NURSES ARE VERY 1015 00:37:09,840 --> 00:37:11,200 STRETCHED AND SO TRYING TO COME 1016 00:37:11,200 --> 00:37:14,480 UP WITH SOLUTIONS THAT ARE 1017 00:37:14,480 --> 00:37:16,640 FEASIBLE AND IMPLEMENTABLE IS 1018 00:37:16,640 --> 00:37:16,840 KEY. 1019 00:37:16,840 --> 00:37:19,440 SO I THINK, YOU KNOW, IT'S THE 1020 00:37:19,440 --> 00:37:21,600 SAME AS ENGAGING THE COMMUNITY 1021 00:37:21,600 --> 00:37:23,520 TO REALLY UNDERSTAND AND ENGAGE 1022 00:37:23,520 --> 00:37:25,080 NURSES RIGHT FROM THE START. 1023 00:37:25,080 --> 00:37:28,960 THEY KNOW WHAT WORKS, WHAT IS, 1024 00:37:28,960 --> 00:37:30,920 YOU KNOW, MORE CHALLENGING AND 1025 00:37:30,920 --> 00:37:34,200 SO I'M GLAD TO HEAR THAT NURSES 1026 00:37:34,200 --> 00:37:36,320 HAVE BEEN INCLUDED AND I THINK 1027 00:37:36,320 --> 00:37:38,040 THERE ARE MANY MORE 1028 00:37:38,040 --> 00:37:38,960 OPPORTUNITIES TO EXPAND THEIR 1029 00:37:38,960 --> 00:37:39,880 INCLUSION AND THEIR LEADERSHIP 1030 00:37:39,880 --> 00:37:41,960 OF THIS TYPE OF RESEARCH. 1031 00:37:41,960 --> 00:37:43,040 AND SO WE'RE CERTAINLY 1032 00:37:43,040 --> 00:37:44,800 INTERESTED IN AT NINR. 1033 00:37:44,800 --> 00:37:46,840 I THINK THERE ARE SO MANY 1034 00:37:46,840 --> 00:37:47,840 CHALLENGES OUR HEALTH CARE 1035 00:37:47,840 --> 00:37:49,920 SYSTEM BASES IN CLINICAL 1036 00:37:49,920 --> 00:37:50,600 SETTINGS AND COMMUNITY SETTINGS 1037 00:37:50,600 --> 00:37:53,680 AND THE BRIDGING OF THE TWO THAT 1038 00:37:53,680 --> 00:37:56,640 I CERTAINLY HOPE NURSES 1039 00:37:56,640 --> 00:37:57,840 INCREASINGLY BECOME MORE ENGAGED 1040 00:37:57,840 --> 00:38:00,280 IN THIS AREA OF RESEARCH. 1041 00:38:00,280 --> 00:38:01,600 >> THAT'S WONDERFUL. 1042 00:38:01,600 --> 00:38:01,800 YEAH. 1043 00:38:01,800 --> 00:38:03,600 I KNOW THAT WE REALLY ENJOYED 1044 00:38:03,600 --> 00:38:06,120 WORKING WITH KAREN ON THIS NEW 1045 00:38:06,120 --> 00:38:09,000 IDEA AROUND HOW TO WE ADDRESS 1046 00:38:09,000 --> 00:38:10,320 PAIN MANAGEMENT IN THIS RURAL 1047 00:38:10,320 --> 00:38:12,280 AND REMOTE SETTING AND CERTAINLY 1048 00:38:12,280 --> 00:38:14,040 MANY OF THE PROVIDERS THAT ARE 1049 00:38:14,040 --> 00:38:16,160 SEEN ARE NURSES AND SO HOW DO WE 1050 00:38:16,160 --> 00:38:18,520 ENGAGE THEM IN LEADING RESEARCH 1051 00:38:18,520 --> 00:38:21,720 IN THAT AREA I THINK IS A REALLY 1052 00:38:21,720 --> 00:38:23,000 IMPORTANT ISSUE. 1053 00:38:23,000 --> 00:38:25,640 I WILL ENCOURAGE ONCE AGAIN 1054 00:38:25,640 --> 00:38:26,440 ANYBODY WHO'S GOT A QUESTION TO 1055 00:38:26,440 --> 00:38:28,080 GO AHEAD AND RAISE YOUR HAND OR 1056 00:38:28,080 --> 00:38:29,040 OTHERWISE I'M JUST GOING TO TAKE 1057 00:38:29,040 --> 00:38:33,080 THE MODERATOR'S PREROGATIVE AND 1058 00:38:33,080 --> 00:38:36,520 ASK MY NEXT QUESTION. 1059 00:38:36,520 --> 00:38:38,520 SO, I LOVE YOUR NEW LENS LOOKING 1060 00:38:38,520 --> 00:38:40,560 AT HEALTH EQUITIES AND THAT IS 1061 00:38:40,560 --> 00:38:42,040 AN AREA THAT WE'RE REALLY 1062 00:38:42,040 --> 00:38:43,880 ENCOURAGING INVESTIGATORS TO GO 1063 00:38:43,880 --> 00:38:46,040 WITH THE NEXT ROUND OF PROJECTS. 1064 00:38:46,040 --> 00:38:48,960 DO YOU SEE ANY SORT OF REALLY 1065 00:38:48,960 --> 00:38:49,800 GREAT OPPORTUNITIES MAYBE THAT 1066 00:38:49,800 --> 00:38:52,600 YOU CAN THINK OF FROM THE 1067 00:38:52,600 --> 00:38:54,520 NURSING SCIENCE AREA OF WHERE 1068 00:38:54,520 --> 00:38:56,240 THERE WOULD BE OPPORTUNITIES TO 1069 00:38:56,240 --> 00:38:58,040 ADDRESS HEALTH INEQUITIES AND 1070 00:38:58,040 --> 00:38:59,000 SORT OF THESE HEALTH CARE 1071 00:38:59,000 --> 00:39:00,840 SETTINGS THAT ARE JUST, YOU 1072 00:39:00,840 --> 00:39:02,880 KNOW, GREAT OPPORTUNITIES THAT 1073 00:39:02,880 --> 00:39:05,480 EXIST RIGHT NOW? 1074 00:39:05,480 --> 00:39:08,120 >> I MEAN, THE NEEDS AS WE 1075 00:39:08,120 --> 00:39:10,320 POINTED OUT IN THE TALK ARE 1076 00:39:10,320 --> 00:39:11,600 TREMENDOUS. 1077 00:39:11,600 --> 00:39:13,200 THE INEQUITIES WE SEE REALLY ARE 1078 00:39:13,200 --> 00:39:14,760 ALARMING, THEY'RE TRAGIC AND 1079 00:39:14,760 --> 00:39:16,800 PERSISTENT AND WE URGENTLY NEED 1080 00:39:16,800 --> 00:39:18,200 SOLUTIONS AND FROM OUR 1081 00:39:18,200 --> 00:39:19,400 PERSPECTIVE, I THINK HOSPITALS 1082 00:39:19,400 --> 00:39:23,480 AND CLINICS AND INTERVENTIONS 1083 00:39:23,480 --> 00:39:24,800 AND THOSE SETTINGS REMAIN VITAL, 1084 00:39:24,800 --> 00:39:26,520 BUT I THINK WE ALSO NEED TO GET 1085 00:39:26,520 --> 00:39:28,960 OUT OF THOSE SETTINGS INTO THE 1086 00:39:28,960 --> 00:39:30,520 COMMUNITY WHERE PEOPLE LIVE 1087 00:39:30,520 --> 00:39:32,720 THEIR LIVES AND WHERE MANY RELY 1088 00:39:32,720 --> 00:39:36,080 ON THOSE SETTINGS FOR THEIR CARE 1089 00:39:36,080 --> 00:39:38,920 AND TO DISCOVER SOLUTIONS THAT 1090 00:39:38,920 --> 00:39:39,960 NOT ONLY ADDRESS IMMEDIATE 1091 00:39:39,960 --> 00:39:42,320 HEALTH NEEDS, BUT THAT REALLY 1092 00:39:42,320 --> 00:39:46,040 ALSO LOOK UPSTREAM AND INTEGRATE 1093 00:39:46,040 --> 00:39:49,080 THOSE FUNDAMENTAL CAUSES OF 1094 00:39:49,080 --> 00:39:50,840 HEALTH INEQUITIES. 1095 00:39:50,840 --> 00:39:53,000 SO I THINK WE NEED TO BLEND THE 1096 00:39:53,000 --> 00:39:55,440 IMMEDIATE NEEDS WITH THE LONGER 1097 00:39:55,440 --> 00:39:57,240 TERM, BIGGER PICTURE ISSUES THAT 1098 00:39:57,240 --> 00:40:02,040 NEED TO BE TACKLED TO REALLY 1099 00:40:02,040 --> 00:40:04,400 MAKE SIZABLE AND MEANINGFUL 1100 00:40:04,400 --> 00:40:06,280 DIFFERENCES IN HEALTH 1101 00:40:06,280 --> 00:40:06,600 INEQUITIES. 1102 00:40:06,600 --> 00:40:10,880 >> WONDERFUL. 1103 00:40:10,880 --> 00:40:12,120 I SEE DR. LANGEVIN, DO YOU HAVE 1104 00:40:12,120 --> 00:40:12,840 A QUESTION? 1105 00:40:12,840 --> 00:40:14,040 >> I DO. 1106 00:40:14,040 --> 00:40:17,080 THANK YOU SO MUCH FOR SUCH A 1107 00:40:17,080 --> 00:40:17,880 GREAT, WONDERFUL TALK. 1108 00:40:17,880 --> 00:40:19,400 ANOTHER THE BEGINNING OF THE 1109 00:40:19,400 --> 00:40:20,440 TALK YOU SAID SOMETHING THAT 1110 00:40:20,440 --> 00:40:22,520 STUCK WITH ME, YOU SAID NURSES 1111 00:40:22,520 --> 00:40:23,520 ARE EVERYWHERE. 1112 00:40:23,520 --> 00:40:24,760 IT'S JUST A VERY CENTRAL 1113 00:40:24,760 --> 00:40:24,960 CONCEPT. 1114 00:40:24,960 --> 00:40:27,000 YOU KNOW, YOU MENTIONED SCHOOLS, 1115 00:40:27,000 --> 00:40:30,520 WORK PLACES, YOU MENTIONED 1116 00:40:30,520 --> 00:40:31,200 OBVIOUSLY HOSPITALS, CLINICS, 1117 00:40:31,200 --> 00:40:33,160 BUT ALSO LONG-TERM CARE 1118 00:40:33,160 --> 00:40:37,400 FACILITIES AND A LOT OF THESE 1119 00:40:37,400 --> 00:40:39,240 DIFFERENT PLACES WHERE NURSES 1120 00:40:39,240 --> 00:40:40,600 ARE ARE NOT NECESSARILY 1121 00:40:40,600 --> 00:40:43,880 CONNECTED FROM THE POINT OF VIEW 1122 00:40:43,880 --> 00:40:46,120 OF HEALTH RECORDS AND THIS IS A 1123 00:40:46,120 --> 00:40:49,600 BIG CHALLENGE BECAUSE WE HAVE 1124 00:40:49,600 --> 00:40:52,920 ALL THESE DISCONNECTED SOURCES 1125 00:40:52,920 --> 00:40:54,960 OF DATA AND I WAS WONDERING IF 1126 00:40:54,960 --> 00:40:56,160 NURSES COULD FUNCTION A LITTLE 1127 00:40:56,160 --> 00:40:58,640 BIT IN A SORT OF A GLUE TO 1128 00:40:58,640 --> 00:40:59,520 CONNECT ALL THESE. 1129 00:40:59,520 --> 00:41:03,240 THIS IS A BIG NEED THAT WE HAVE. 1130 00:41:03,240 --> 00:41:06,280 COULD NURSES BE A SOLUTION TO 1131 00:41:06,280 --> 00:41:06,520 THIS? 1132 00:41:06,520 --> 00:41:07,800 >> I WOULD THINK SO. 1133 00:41:07,800 --> 00:41:10,120 THEY ARE A COMMONALITY ACROSS 1134 00:41:10,120 --> 00:41:13,640 THOSE SETTINGS AND SPEND SO MUCH 1135 00:41:13,640 --> 00:41:13,840 TIME. 1136 00:41:13,840 --> 00:41:14,040 I AGREE. 1137 00:41:14,040 --> 00:41:18,280 I THINK, HELENE WE'VE TALKED 1138 00:41:18,280 --> 00:41:20,360 ABOUT THIS AND THAT WE REALLY 1139 00:41:20,360 --> 00:41:22,520 NEED TO BRING DATA TOGETHER 1140 00:41:22,520 --> 00:41:24,120 ACROSS THOSE CLINICAL AND 1141 00:41:24,120 --> 00:41:26,520 COMMUNITY SETTINGS AND I THINK 1142 00:41:26,520 --> 00:41:29,960 IT MAKES SENSE THAT NURSES CAN 1143 00:41:29,960 --> 00:41:31,160 PLAY AN IMPORTANT ROLE IN THAT 1144 00:41:31,160 --> 00:41:32,840 SENSE AND I'D LOVE TO SEE MORE 1145 00:41:32,840 --> 00:41:33,920 DISCUSSION ABOUT THAT. 1146 00:41:33,920 --> 00:41:36,040 >> IT'D BE CHALLENGING FOR SURE, 1147 00:41:36,040 --> 00:41:38,640 BUT I THINK SO IMPORTANT. 1148 00:41:38,640 --> 00:41:41,320 >> TO BE SURE, I THINK THE 1149 00:41:41,320 --> 00:41:42,360 REMOTE AND RURAL PAIN CONCEPT 1150 00:41:42,360 --> 00:41:44,360 THAT WE'VE BEEN TALKING ABOUT 1151 00:41:44,360 --> 00:41:46,160 TOGETHER I THINK ILLUSTRATES THE 1152 00:41:46,160 --> 00:41:47,480 NEED FOR THAT KIND OF DATA TO 1153 00:41:47,480 --> 00:41:50,120 REALLY MAKE A DIFFERENCE THERE 1154 00:41:50,120 --> 00:41:50,880 AS WELL. 1155 00:41:50,880 --> 00:41:53,040 >> YES. 1156 00:41:53,040 --> 00:41:53,320 ABSOLUTELY. 1157 00:41:53,320 --> 00:41:54,400 THANK YOU. 1158 00:41:54,400 --> 00:41:55,880 PERHAPS THIS COULD BE A GOOD 1159 00:41:55,880 --> 00:41:58,480 TOPIC FOR SOME OF THE 1160 00:41:58,480 --> 00:41:59,480 DISCUSSIONS TODAY. 1161 00:41:59,480 --> 00:42:01,800 >> YEAH. 1162 00:42:01,800 --> 00:42:02,120 ABSOLUTELY. 1163 00:42:02,120 --> 00:42:04,440 >> GREAT. 1164 00:42:04,440 --> 00:42:05,080 >> WELL, THANK YOU SO MUCH FOR 1165 00:42:05,080 --> 00:42:05,480 STARTING US OFF. 1166 00:42:05,480 --> 00:42:07,160 WE'RE THRILLED THAT YOU WERE 1167 00:42:07,160 --> 00:42:09,720 ABLE TO JOIN US TODAY FOR THE 1168 00:42:09,720 --> 00:42:11,000 KEYNOTE LECTURE AND HOPE YOU'LL 1169 00:42:11,000 --> 00:42:12,640 BE ABLE TO STAY A LITTLE BIT. 1170 00:42:12,640 --> 00:42:15,440 AS ALWAYS, WE ARCHIVE THIS, SO 1171 00:42:15,440 --> 00:42:17,520 IT'S AVAILABLE FOR ANYONE TO 1172 00:42:17,520 --> 00:42:18,760 TUNE IN IF THEY'VE MISSED 1173 00:42:18,760 --> 00:42:19,400 DIFFERENT ELEMENTS. 1174 00:42:19,400 --> 00:42:21,360 SO THANK YOU SO MUCH FOR KICKING 1175 00:42:21,360 --> 00:42:23,120 US OFF THIS AFTERNOON. 1176 00:42:23,120 --> 00:42:26,280 I'M NOW GOING TO TURN THINGS 1177 00:42:26,280 --> 00:42:30,160 OVER TO MY COLLEAGUE DR. KEITH 1178 00:42:30,160 --> 00:42:31,440 MARSOLO WHO'S GOING TO KICK OFF 1179 00:42:31,440 --> 00:42:33,440 OUR FIRST MODERATED DISCUSSION. 1180 00:42:33,440 --> 00:42:35,120 KEITH, I'LL TURN THINGS OVER TO 1181 00:42:35,120 --> 00:42:35,280 YOU. 1182 00:42:35,280 --> 00:42:36,160 >> GREAT. 1183 00:42:36,160 --> 00:42:39,200 THANK YOU SO MUCH, WENDY. 1184 00:42:39,200 --> 00:42:42,680 SO, THE FIRST PANEL THAT WE'RE 1185 00:42:42,680 --> 00:42:44,000 GOING TO TALK ABOUT TODAY THAT 1186 00:42:44,000 --> 00:42:48,840 WENDY TEED UP IN HER INTRO 1187 00:42:48,840 --> 00:42:50,040 CONVERSATION WAS REALLY AROUND 1188 00:42:50,040 --> 00:42:52,400 SQUEEZING MORE VALUE OUT OF THE 1189 00:42:52,400 --> 00:42:53,120 ELECTRONIC HEALTH RECORDS. 1190 00:42:53,120 --> 00:42:54,760 SO IF WE GO TO THE NEXT 1191 00:42:54,760 --> 00:42:56,880 SLIDEMENT JUST AS A WAY OF 1192 00:42:56,880 --> 00:42:57,720 BACKGROUND, YOU KNOW, WE'RE 1193 00:42:57,720 --> 00:42:59,880 TALKING SORT OF ABOUT THE LAST 1194 00:42:59,880 --> 00:43:02,400 TEN YEARS OF SUCCESS WITHIN THE 1195 00:43:02,400 --> 00:43:03,160 PRAGMATIC TRIALS COLLABORATORY 1196 00:43:03,160 --> 00:43:05,120 AND ACTUALLY OVER THAT SAME 1197 00:43:05,120 --> 00:43:07,000 TIME, WE'VE SEEN KIND OF A 1198 00:43:07,000 --> 00:43:08,760 SIMILAR CONSISTENT EVOLUTION 1199 00:43:08,760 --> 00:43:11,560 WITHIN THE EHR TO BETTER SUPPORT 1200 00:43:11,560 --> 00:43:13,360 RESEARCH PROCESSES AND THOSE ARE 1201 00:43:13,360 --> 00:43:16,040 RELATED, YOU KNOW, TO COHORT 1202 00:43:16,040 --> 00:43:17,960 IDENTIFICATION, RECRUITMENT, 1203 00:43:17,960 --> 00:43:19,800 DELIVERY OF INTERVENTIONS, 1204 00:43:19,800 --> 00:43:22,520 MONITORING OF OUTCOMES, 1205 00:43:22,520 --> 00:43:24,560 MONITORING INTERVENTIONS AND 1206 00:43:24,560 --> 00:43:26,640 SORT OF THE WHOLE GAMUT OF 1207 00:43:26,640 --> 00:43:28,520 PROCESSES THAT YOU NEED TO 1208 00:43:28,520 --> 00:43:28,960 SUPPORT TRIALS. 1209 00:43:28,960 --> 00:43:30,880 THERE'S BEEN, YOU KNOW, 1210 00:43:30,880 --> 00:43:32,680 CONSISTENT PROGRESS. 1211 00:43:32,680 --> 00:43:34,920 NOW, THE CAPABILITIES, THEY DO 1212 00:43:34,920 --> 00:43:36,520 VARY ACROSS THE VENDOR AND THEY 1213 00:43:36,520 --> 00:43:39,240 VARY WITH SORT OF WITHIN A 1214 00:43:39,240 --> 00:43:40,800 VENDOR'S CUSTOMER BASE, SO IT'S 1215 00:43:40,800 --> 00:43:44,320 KIND OF THE OLD JOKE THEY USED 1216 00:43:44,320 --> 00:43:45,720 TO MAKE ABOUT ACADEMIC MEDICAL 1217 00:43:45,720 --> 00:43:47,960 CENTERS WHERE IF YOU'VE SEEN ONE 1218 00:43:47,960 --> 00:43:50,880 IT'S KIND OF THE SAME THING 1219 00:43:50,880 --> 00:43:52,120 AROUND HEALTH RECORDS 1220 00:43:52,120 --> 00:43:52,800 IMPLEMENTATION. 1221 00:43:52,800 --> 00:43:54,080 IF YOU'VE SEEN ONE YOU'VE SEEN 1222 00:43:54,080 --> 00:43:54,520 ONE. 1223 00:43:54,520 --> 00:43:58,640 WE ARE CONSISTENTLY RAISING THE 1224 00:43:58,640 --> 00:44:01,960 BAR OR THE BASE OF THAT EVEN IF 1225 00:44:01,960 --> 00:44:04,080 THERE'S SORT OF VARYING 1226 00:44:04,080 --> 00:44:05,960 CAPABILITY IN SORT OF WHAT WE 1227 00:44:05,960 --> 00:44:07,920 CAN DO NOW IS STILL MUCH BETTER 1228 00:44:07,920 --> 00:44:10,240 THAN WHAT WE COULD HAVE DONE TEN 1229 00:44:10,240 --> 00:44:12,240 YEARS AGO. 1230 00:44:12,240 --> 00:44:15,400 SO, EVEN SO, THERE ARE SORT OF 1231 00:44:15,400 --> 00:44:17,280 CHALLENGES THAT DO REMAIN. 1232 00:44:17,280 --> 00:44:19,640 I THINK THIS IS IN PARTICULAR 1233 00:44:19,640 --> 00:44:22,600 SORT OF MODIFYING THE EHR SO 1234 00:44:22,600 --> 00:44:24,040 IT'S FIT FOR PURPOSE FOR EVERY 1235 00:44:24,040 --> 00:44:25,960 TRIAL OR FOR ANY TRIAL. 1236 00:44:25,960 --> 00:44:27,920 SO IT MIGHT WORK FOR MANY, BUT 1237 00:44:27,920 --> 00:44:29,800 IT DOESN'T NECESSARILY DO 1238 00:44:29,800 --> 00:44:30,840 EVERYTHING FOR EVERYBODY. 1239 00:44:30,840 --> 00:44:32,640 YOU KNOW, CHALLENGES REMAIN 1240 00:44:32,640 --> 00:44:36,680 AROUND SORT OF COLLECTION AND 1241 00:44:36,680 --> 00:44:37,360 SCALE FOR NEW DATA ELEMENTS SUCH 1242 00:44:37,360 --> 00:44:39,880 AS SOCIAL DETERMINANTS OF HEALTH 1243 00:44:39,880 --> 00:44:42,720 AND, YOU KNOW, AGGREGATING DATA 1244 00:44:42,720 --> 00:44:44,760 ACROSS SITES. 1245 00:44:44,760 --> 00:44:46,320 THESE ARE AGE-OLD PROBLEMS AND 1246 00:44:46,320 --> 00:44:48,360 THINGS GET BETTER, BUT WE SORT 1247 00:44:48,360 --> 00:44:50,520 OF COME UP WITH NEW MORE COMPLEX 1248 00:44:50,520 --> 00:44:52,360 TRIALS OR PROJECTS THAT WE WANT 1249 00:44:52,360 --> 00:44:54,360 TO EXECUTE AND SO WE'VE GOT NEW 1250 00:44:54,360 --> 00:44:55,600 PROBLEMS THAT WE NEED TO DEAL 1251 00:44:55,600 --> 00:44:55,800 WITH. 1252 00:44:55,800 --> 00:44:59,600 IF WE GO TO THE NEXT SLIDE. 1253 00:44:59,600 --> 00:45:01,520 SO, YOU KNOW, WHAT WE WANTED TO 1254 00:45:01,520 --> 00:45:03,520 REALLY TRY AND DO WITHIN THE 1255 00:45:03,520 --> 00:45:05,760 PANEL TODAY IS TOUCH ON A FEW 1256 00:45:05,760 --> 00:45:09,240 KEY QUESTIONS THAT WE'RE GOING 1257 00:45:09,240 --> 00:45:10,280 TO DIG INTO. 1258 00:45:10,280 --> 00:45:12,280 SO, YOU KNOW, GIVEN THE VARIOUS 1259 00:45:12,280 --> 00:45:14,200 ACTIVITIES THAT EHR CAN SUPPORT 1260 00:45:14,200 --> 00:45:15,320 WITHIN A TRIAL AND I MENTIONED 1261 00:45:15,320 --> 00:45:17,120 SOME OF THESE IN THE PREVIOUS 1262 00:45:17,120 --> 00:45:20,520 SLIDE, YOU KNOW, IDENTIFYING OR 1263 00:45:20,520 --> 00:45:20,960 RECRUITING PATIENTS. 1264 00:45:20,960 --> 00:45:24,200 DELIVERING INTERVENTIONS, 1265 00:45:24,200 --> 00:45:25,160 MONITORING INTERVENTIONS AND 1266 00:45:25,160 --> 00:45:27,200 OUTCOMES. 1267 00:45:27,200 --> 00:45:27,800 WHAT WE REALLY WANT TO TRY TO 1268 00:45:27,800 --> 00:45:33,000 DIVE INTO IS THE EHR FIT FOR 1269 00:45:33,000 --> 00:45:36,000 MORE TASKS HTHAN OTHERS. 1270 00:45:36,000 --> 00:45:37,520 THEY'RE A PIECE OF CAKE OR 1271 00:45:37,520 --> 00:45:39,040 THINGS THAT ARE JUST KIND OF 1272 00:45:39,040 --> 00:45:40,080 GOING TO BE A CHALLENGE KIND OF 1273 00:45:40,080 --> 00:45:42,080 NO MATTER WHAT YOU'RE TRYING TO 1274 00:45:42,080 --> 00:45:44,800 DO, NO MATTER WHAT YOU'RE 1275 00:45:44,800 --> 00:45:45,600 STUDYING WITHIN YOUR TRIAL AND 1276 00:45:45,600 --> 00:45:47,880 THEN THE STRATEGIES FOR HEALTH 1277 00:45:47,880 --> 00:45:49,280 SYSTEMS TO COLLECT NEW DATA 1278 00:45:49,280 --> 00:45:50,760 ELEMENTS AND THEN I THINK, YOU 1279 00:45:50,760 --> 00:45:52,600 KNOW, WHAT WE'VE SEEN OVER THE 1280 00:45:52,600 --> 00:45:54,320 PAST TEN YEARS SORT OF WHAT'S ON 1281 00:45:54,320 --> 00:45:55,800 OUR WISH LIST AND WHAT DO WE 1282 00:45:55,800 --> 00:45:57,280 PROJECT WE WOULD LIKE IT TO SEE 1283 00:45:57,280 --> 00:45:59,560 OVER THE NEXT TEN YEARS SO WE 1284 00:45:59,560 --> 00:46:01,440 CAN CONTINUE TO MAKE PROGRESS. 1285 00:46:01,440 --> 00:46:04,800 SO IF WE GO TO THE NEXT SLIDE. 1286 00:46:04,800 --> 00:46:10,760 SO I'M JOINED TODAY BY FOUR 1287 00:46:10,760 --> 00:46:11,360 PANELI 1288 00:46:11,360 --> 00:46:13,240 PANELISTS FOUR SORT OF ALL STARS 1289 00:46:13,240 --> 00:46:18,960 FROM THE COLLABORATORY. 1290 00:46:18,960 --> 00:46:20,880 MIG 1291 00:46:20,880 --> 00:46:29,080 MIGUEL VAZQUEZ, ANDREA CHEVILLE, 1292 00:46:29,080 --> 00:46:32,880 JEFFY JARVIK AND GREG SIMON. 1293 00:46:32,880 --> 00:46:35,520 EACH OF OUR PANELIST IS GOING TO 1294 00:46:35,520 --> 00:46:38,800 BRIEFLY DESCRIBE SORT OF THEIR 1295 00:46:38,800 --> 00:46:41,600 TRIAL AND THEIR SORT OF USE OF 1296 00:46:41,600 --> 00:46:43,920 THE EHR AND WE'RE REALLY GOING 1297 00:46:43,920 --> 00:46:45,040 TO DIVE INTO THOSE QUESTIONS 1298 00:46:45,040 --> 00:46:47,200 THAT I HAD ON THE PREVIOUS 1299 00:46:47,200 --> 00:46:47,600 SLIDE. 1300 00:46:47,600 --> 00:46:49,520 RATHER THAN SPEND THE BULK OF 1301 00:46:49,520 --> 00:46:51,480 THE TIME EACH PANELIST SPENDING 1302 00:46:51,480 --> 00:46:52,200 TIME TALKING ABOUT THEIR TRIAL, 1303 00:46:52,200 --> 00:46:53,880 WE'RE GOING TO MIX IT UP A 1304 00:46:53,880 --> 00:46:57,120 LITTLE BIT AND DO A DEEPER DIVE 1305 00:46:57,120 --> 00:46:58,400 INTO EACH OF THOSE TASKS, SO 1306 00:46:58,400 --> 00:46:59,720 IDENTIFYING AND RECRUITING 1307 00:46:59,720 --> 00:47:01,120 PATIENTS AND DRILL DOWN INTO 1308 00:47:01,120 --> 00:47:02,800 THAT AND HAVE EACH PANELIST 1309 00:47:02,800 --> 00:47:03,760 RESPOND WITH THEIR PERSPECTIVE 1310 00:47:03,760 --> 00:47:07,120 SO THAT WAY WE CAN REALLY FOCUS 1311 00:47:07,120 --> 00:47:09,640 ON SORT OF THE SPECIFIC TASKS AS 1312 00:47:09,640 --> 00:47:11,840 OPPOSED TO SORT OF TAKING IT AS 1313 00:47:11,840 --> 00:47:14,680 A SORT OF TRIAL BY TRIAL. 1314 00:47:14,680 --> 00:47:17,000 SO WE'LL SEE HOW THIS GOES. 1315 00:47:17,000 --> 00:47:18,320 IT WORKED WELL IN SOME OF THE 1316 00:47:18,320 --> 00:47:19,760 PREVIOUS PANELS IN THE 1317 00:47:19,760 --> 00:47:20,600 COLLABORATORY STEERING 1318 00:47:20,600 --> 00:47:23,040 COMMITTEE, AND SO WE'LL SEE IF 1319 00:47:23,040 --> 00:47:24,160 WE CAN CONTINUE THAT RECORD OF 1320 00:47:24,160 --> 00:47:24,400 SUCCESS. 1321 00:47:24,400 --> 00:47:30,720 SO I THINK IF WE GO TO THE NEXT 1322 00:47:30,720 --> 00:47:32,040 SLIDE, I BELIEVE WE'VE GOT THE 1323 00:47:32,040 --> 00:47:34,840 SPOT TRIALS SO I'LL TURN IT OVER 1324 00:47:34,840 --> 00:47:36,560 TO GREG FOR HIS INTRODUCTION. 1325 00:47:36,560 --> 00:47:36,760 >> SURE. 1326 00:47:36,760 --> 00:47:37,120 THANKS. 1327 00:47:37,120 --> 00:47:38,600 AS MANY REMEMBER, THIS TRIAL WAS 1328 00:47:38,600 --> 00:47:40,800 A PATIENT LEVEL RANDOMIZED 1329 00:47:40,800 --> 00:47:41,560 PRAGMATIC TRIAL. 1330 00:47:41,560 --> 00:47:45,000 WE WERE EVALUATING TWO OUTREACH 1331 00:47:45,000 --> 00:47:45,880 INTERVENTIONS VERSUS USUAL CARE 1332 00:47:45,880 --> 00:47:47,600 FOR PREVENTION OF SELF-HARM 1333 00:47:47,600 --> 00:47:51,080 EVENTS OR SUICIDE ATTEMPTS AMONG 1334 00:47:51,080 --> 00:47:55,000 OUTPATIENTS WHO REPORTED 1335 00:47:55,000 --> 00:47:56,840 FREQUENT SUICIDE. 1336 00:47:56,840 --> 00:47:58,880 IT WAS FOUR INTEGRATION SYSTEMS. 1337 00:47:58,880 --> 00:48:00,880 BUT NOT THE SAME VERSION. 1338 00:48:00,880 --> 00:48:02,360 RELEVANT TO THIS PANEL, WITHIN 1339 00:48:02,360 --> 00:48:04,120 THIS TRIAL, THE ELECTRONIC 1340 00:48:04,120 --> 00:48:05,320 HEALTH RECORD DATA WERE USED FOR 1341 00:48:05,320 --> 00:48:07,600 A VARIETY OF PURPOSES. 1342 00:48:07,600 --> 00:48:09,760 FIRST, EHR DATA WERE USED TO 1343 00:48:09,760 --> 00:48:10,680 IDENTIFY PEOPLE WHO WERE 1344 00:48:10,680 --> 00:48:12,080 ELIGIBLE FOR THE TRIAL. 1345 00:48:12,080 --> 00:48:13,960 EACH WEEK IDENTIFYING PEOPLE WHO 1346 00:48:13,960 --> 00:48:17,520 HAD MADE AN OUTPATIENT VISIT, 1347 00:48:17,520 --> 00:48:21,800 HAD COMPLETED A PHQ 9 DEPRESSION 1348 00:48:21,800 --> 00:48:23,880 QUESTIONNAIRE AND ON THAT ITEM 1349 00:48:23,880 --> 00:48:26,360 THOUGHTS OF SETH OR SELF-HARM 1350 00:48:26,360 --> 00:48:28,240 HAD THOSE THOUGHTS MOST DAYS OR 1351 00:48:28,240 --> 00:48:29,040 NEARLY EVERY DAY. 1352 00:48:29,040 --> 00:48:32,280 SAME WERE APPLIED TO VARIOUS 1353 00:48:32,280 --> 00:48:33,920 OTHER EXCLUSION CRITERIA THAT 1354 00:48:33,920 --> 00:48:36,080 PEOPLE DID NOT HAVE DEVELOPMENT 1355 00:48:36,080 --> 00:48:37,640 DELAY BECAUSE THE INTERVENTIONS 1356 00:48:37,640 --> 00:48:38,920 WOULD NOT BE APPROPRIATE 1357 00:48:38,920 --> 00:48:39,800 LIMITING TO PEOPLE WHO WERE AT 1358 00:48:39,800 --> 00:48:43,320 LEAST REGISTERED FOR USE OF THE 1359 00:48:43,320 --> 00:48:43,920 PATIENT PORTAL BECAUSE THAT'S 1360 00:48:43,920 --> 00:48:45,160 HOW INTERVENTIONS WERE LARGELY 1361 00:48:45,160 --> 00:48:47,360 DELIVERED LIMITING TO PEOPLE WHO 1362 00:48:47,360 --> 00:48:49,760 WERE ENROYALED IN THE 1363 00:48:49,760 --> 00:48:50,400 PARTICIPATING HEALTH INSURANCE 1364 00:48:50,400 --> 00:48:52,960 PLAN TO MAKE SURE WE WERE ABLE 1365 00:48:52,960 --> 00:48:54,000 TO ASCERTAIN OUTCOMES. 1366 00:48:54,000 --> 00:48:56,200 SO THAT PROCESS WAS RUN EVERY 1367 00:48:56,200 --> 00:48:57,840 WEEK TO IDENTIFY AND 1368 00:48:57,840 --> 00:48:59,320 AUTOMATICALLY RANDOMIZE PEOPLE 1369 00:48:59,320 --> 00:49:01,520 WHO WERE NEWLY ELIGIBLE. 1370 00:49:01,520 --> 00:49:03,560 THE INTERVENTIONS DEPENDING A 1371 00:49:03,560 --> 00:49:05,440 LOT ON MESSAGING CAPABILITIES 1372 00:49:05,440 --> 00:49:06,800 THROUGH THE PORTAL FOR OUTREACH 1373 00:49:06,800 --> 00:49:07,880 AND ONGOING CONTACT. 1374 00:49:07,880 --> 00:49:10,680 AND THEN, DATA THAT CAME FROM 1375 00:49:10,680 --> 00:49:13,240 THE EHR, BUT ALSO FROM EXTERNAL 1376 00:49:13,240 --> 00:49:15,360 INSURANCE CLAIMS CPS FROM STATE 1377 00:49:15,360 --> 00:49:17,400 MORTALITY DATA, WE'RE USED TO 1378 00:49:17,400 --> 00:49:19,720 IDENTIFY THE PRIMARY OUTCOME, 1379 00:49:19,720 --> 00:49:21,200 THAT IS, SELF-HARM EVENTS OR 1380 00:49:21,200 --> 00:49:23,440 SUICIDE ATTEMPTS WHICH COULD BE 1381 00:49:23,440 --> 00:49:25,120 NONFATAL SELF-HARM EVENTS 1382 00:49:25,120 --> 00:49:27,000 PRESENTED FOR HEALTH CARE OR 1383 00:49:27,000 --> 00:49:31,040 FATAL EVENTS FROM STATE 1384 00:49:31,040 --> 00:49:31,400 MORTALITY DATA. 1385 00:49:31,400 --> 00:49:35,480 SO IN THIS, THE EHR DATA WERE 1386 00:49:35,480 --> 00:49:36,840 USED AT EVERY STEP IN THE TRIAL 1387 00:49:36,840 --> 00:49:38,400 AND WE'LL TALK ABOUT SOME OF 1388 00:49:38,400 --> 00:49:41,200 THOSE STEPS. 1389 00:49:41,200 --> 00:49:41,440 THANKS. 1390 00:49:41,440 --> 00:49:43,000 >> GREAT. 1391 00:49:43,000 --> 00:49:43,680 THANKS, GREG. 1392 00:49:43,680 --> 00:49:47,920 AND NOW I THINK NEXT IS IF WE GO 1393 00:49:47,920 --> 00:49:53,120 TO THE NEXT SLIDE. 1394 00:49:53,120 --> 00:49:53,320 JERRY. 1395 00:49:53,320 --> 00:49:54,040 >> THANKS, KEITH. 1396 00:49:54,040 --> 00:49:54,560 AND GOOD MORNING EVERYONE. 1397 00:49:54,560 --> 00:49:56,600 OR GOOD AFTERNOON FROM THE EAST 1398 00:49:56,600 --> 00:49:57,040 COAST. 1399 00:49:57,040 --> 00:49:58,320 HARD TO BELIEVE IT'S BEEN TEN 1400 00:49:58,320 --> 00:50:01,240 YEARS SINCE WE STARTED THINKING 1401 00:50:01,240 --> 00:50:03,120 ABOUT THE LEER TRIAL. 1402 00:50:03,120 --> 00:50:08,040 SO OURS WAS A CLUSTER RANDOMIZED 1403 00:50:08,040 --> 00:50:13,680 TRIAL WHERE WE WERE COMPARING 1404 00:50:13,680 --> 00:50:15,120 THE INSERTION OF BENCHMARK 1405 00:50:15,120 --> 00:50:18,040 PREVALENCE DATA INTO ROUTINE 1406 00:50:18,040 --> 00:50:20,600 RADIOLOGY REPORTS OF PEOPLE WHO 1407 00:50:20,600 --> 00:50:22,040 HAVE GOTTEN LUMBAR SPINE 1408 00:50:22,040 --> 00:50:22,360 IMAGING. 1409 00:50:22,360 --> 00:50:25,240 WE CONDUCTED THIS AT FOUR 1410 00:50:25,240 --> 00:50:26,960 INTEGRATED HEALTH SYSTEMS. 1411 00:50:26,960 --> 00:50:28,440 ALL OF WHOM WERE EVENTUALLY 1412 00:50:28,440 --> 00:50:30,400 USING EPIC, BUT THAT'S ONE OF 1413 00:50:30,400 --> 00:50:32,760 THE PROBLEMS THAT WE FACED ALONG 1414 00:50:32,760 --> 00:50:35,120 THE WAY WHICH WE CAN TALK ABOUT 1415 00:50:35,120 --> 00:50:35,360 LATER. 1416 00:50:35,360 --> 00:50:39,720 THE HEALTH SYSTEMS EHRs AND 1417 00:50:39,720 --> 00:50:41,040 OTHER INFORMATION SYSTEMS 1418 00:50:41,040 --> 00:50:42,640 ACTUALLY IMPORTANTLY WERE USED 1419 00:50:42,640 --> 00:50:45,720 FOR A VARIETY OF PURPOSES AND 1420 00:50:45,720 --> 00:50:47,080 INCLUDING IDENTIFYING THE 1421 00:50:47,080 --> 00:50:49,640 PRIMARY CARE CLINICIANS IN THEIR 1422 00:50:49,640 --> 00:50:52,520 CLINICS SINCE IT WAS A CLUSTER 1423 00:50:52,520 --> 00:50:55,960 RANDOMIZED TRIAL WITH THE UNIT 1424 00:50:55,960 --> 00:50:58,200 OF RANDOMIZATION BEING THE 1425 00:50:58,200 --> 00:50:58,440 CLINICS. 1426 00:50:58,440 --> 00:51:02,160 WE ALSO USED THE ELECTRONIC 1427 00:51:02,160 --> 00:51:02,760 INFORMATION SYSTEMS TO INSERT 1428 00:51:02,760 --> 00:51:04,560 THE INTERVENTION TEXT INTO THE 1429 00:51:04,560 --> 00:51:06,440 RADIOLOGY REPORTS AND THIS WAS 1430 00:51:06,440 --> 00:51:09,640 EITHER DIRECTLY THROUGH THE EHR 1431 00:51:09,640 --> 00:51:11,680 OR COULD HAVE ALSO BEEN THROUGH 1432 00:51:11,680 --> 00:51:16,880 THE REPORTING SYSTEMS FOR 1433 00:51:16,880 --> 00:51:18,400 RADIOLOGY TAILORING THE 1434 00:51:18,400 --> 00:51:19,760 INTERVENTION BY MODALITY AND 1435 00:51:19,760 --> 00:51:20,800 PATIENT AGE. 1436 00:51:20,800 --> 00:51:23,400 SO WE HAD DIFFERENT FLAVORS OF 1437 00:51:23,400 --> 00:51:25,720 THE INTERVENTION TEXT DEPENDING 1438 00:51:25,720 --> 00:51:27,520 ON EXACTLY WHAT IMAGING TEST 1439 00:51:27,520 --> 00:51:29,720 PEOPLE GOT AND HOW THE PATIENT 1440 00:51:29,720 --> 00:51:30,160 WAS. 1441 00:51:30,160 --> 00:51:32,160 VERIFICATION OF THE INTERVENTION 1442 00:51:32,160 --> 00:51:32,560 IMPLEMENTATION. 1443 00:51:32,560 --> 00:51:36,920 SO WE DID THIS AT REGULAR 1444 00:51:36,920 --> 00:51:43,560 INTERVALS AFTER IT WAS TURNED ON 1445 00:51:43,560 --> 00:51:44,840 AND WORKING AND FINALLY THE 1446 00:51:44,840 --> 00:51:46,640 ASSESSMENT OF THE OUTCOMES 1447 00:51:46,640 --> 00:51:49,520 INCLUDING OUR PRIMARY OUTCOMES 1448 00:51:49,520 --> 00:51:54,240 WHICH WERE SPINE-RELATED AND 1449 00:51:54,240 --> 00:51:57,120 OPIOID PRESCRIPTIONS 1450 00:51:57,120 --> 00:51:59,440 CROSS-SECTIONAL IMAGING, SPINAL 1451 00:51:59,440 --> 00:52:01,760 INJECTIONS AND SURGERIES. 1452 00:52:01,760 --> 00:52:02,000 THANKS. 1453 00:52:02,000 --> 00:52:02,600 >> GREAT. 1454 00:52:02,600 --> 00:52:05,720 IF WE GO ON TO THE NEXT SLIDE 1455 00:52:05,720 --> 00:52:08,640 WE'VE GOT "NO HARM" WITH ANDREA. 1456 00:52:08,640 --> 00:52:10,040 >> THANKS, KEITH. 1457 00:52:10,040 --> 00:52:12,000 IT'S A REAL PLEASURE TO BE ON 1458 00:52:12,000 --> 00:52:13,680 THE PANEL AND TO JOIN EVERYBODY. 1459 00:52:13,680 --> 00:52:16,320 NO HARM STANDS FROM NONCOLLAGIC 1460 00:52:16,320 --> 00:52:17,600 OPTIONS AND POST HOSPITAL BASED 1461 00:52:17,600 --> 00:52:20,800 AND REHABILITATION PAIN 1462 00:52:20,800 --> 00:52:21,080 MANAGEMENT. 1463 00:52:21,080 --> 00:52:22,200 HENCE THE NEED FOR AN ACRONYM. 1464 00:52:22,200 --> 00:52:25,280 IT IS A CLUSTER RANDOMIZED WEDGE 1465 00:52:25,280 --> 00:52:34,360 AND OUR GOAL IS TO MAKE ROBUSTLY 1466 00:52:34,360 --> 00:52:36,240 VALIDATED NONPHARMACOLOGIC PAIN 1467 00:52:36,240 --> 00:52:38,960 CARE EVALUATING PATIENTS 1468 00:52:38,960 --> 00:52:39,600 UNDERGOING SURGERIES IN THE HOPE 1469 00:52:39,600 --> 00:52:42,400 OF IMPROVING PAIN AND FUNCTION 1470 00:52:42,400 --> 00:52:44,640 WHILE ATTENUATING INAPPROPRIATE 1471 00:52:44,640 --> 00:52:47,200 AND PROLONGED OPIOID USE. 1472 00:52:47,200 --> 00:52:51,280 THE INTERVENTION IS CONDUCTED 1473 00:52:51,280 --> 00:52:53,200 THROUGHOUT SIX FACILITIES OR 1474 00:52:53,200 --> 00:52:55,240 SITES WITHIN THE LARGER MAYO 1475 00:52:55,240 --> 00:52:55,960 ENTERPRISE AND WE HAVE THE 1476 00:52:55,960 --> 00:52:58,560 ADVANTAGE OF USING A SINGULAR 1477 00:52:58,560 --> 00:52:59,600 EPIC EHR. 1478 00:52:59,600 --> 00:53:03,520 SO WE HAVE A CENTRALIZED EHR, 1479 00:53:03,520 --> 00:53:06,000 ANY CHANGES MADE AFFECT ALL THE 1480 00:53:06,000 --> 00:53:09,160 SITES AND OVERSIGHT AND 1481 00:53:09,160 --> 00:53:11,280 GOVERNANCE OF THE EHR WAS COMMON 1482 00:53:11,280 --> 00:53:14,320 ACROSS OUR SITES AND THAT WAS A 1483 00:53:14,320 --> 00:53:16,040 TREMENDOUS BOOM. 1484 00:53:16,040 --> 00:53:18,920 I MENTIONED IT'S CLUSTER 1485 00:53:18,920 --> 00:53:19,320 RANDOMIZED. 1486 00:53:19,320 --> 00:53:23,240 WE USED THE EHR RELIED ON IT 1487 00:53:23,240 --> 00:53:25,840 VERY HEAVILY FOR INTERVENTION 1488 00:53:25,840 --> 00:53:26,360 DELIVERY. 1489 00:53:26,360 --> 00:53:27,840 THERE ARE THREE COMPONENTS TO 1490 00:53:27,840 --> 00:53:31,160 THE NO-HARM INTERVENTION. 1491 00:53:31,160 --> 00:53:34,080 ONE IS A CONVERSATION GUIDE WE 1492 00:53:34,080 --> 00:53:35,880 CALL IT THAT'S AUTOMATICALLY 1493 00:53:35,880 --> 00:53:38,360 SENT TO PATIENTS PORTAL AND THAT 1494 00:53:38,360 --> 00:53:42,800 HAS AN EDUCATION COMPONENT THAT 1495 00:53:42,800 --> 00:53:46,440 APPRISES PATIENTS OF THE RISK OF 1496 00:53:46,440 --> 00:53:50,280 OPIOIDS, IT NORMS PAIN AND 1497 00:53:50,280 --> 00:53:51,520 POST-OPERATIVE PAIN SO PATIENTS 1498 00:53:51,520 --> 00:53:54,400 HAVE REALISTIC EXPECTATIONS. 1499 00:53:54,400 --> 00:53:57,960 IT ALSO INTRODUCES 1500 00:53:57,960 --> 00:53:58,600 NONPHARMALOGICAL IN MANY OF 1501 00:53:58,600 --> 00:54:02,400 THESE MODALITIES ARE HIGHLY 1502 00:54:02,400 --> 00:54:04,000 EFFECTIVE, EVIDENCE-BASED AND 1503 00:54:04,000 --> 00:54:06,080 HAVE BENEFICIAL EFFECTS ON OTHER 1504 00:54:06,080 --> 00:54:08,320 PROBLEMATIC SYMPTOMS, ANXIETY, 1505 00:54:08,320 --> 00:54:11,920 SLEEP DISTURBANCE AFTER SURGERY. 1506 00:54:11,920 --> 00:54:15,760 THE GUIDE THEN EDUCATES PATIENTS 1507 00:54:15,760 --> 00:54:18,360 ON THE 13 MODALITIES THAT ARE 1508 00:54:18,360 --> 00:54:26,640 SUPPORTED BY THE NO-HARM AND 1509 00:54:26,640 --> 00:54:28,880 THEN ENABLES THEM TO SELECT 1510 00:54:28,880 --> 00:54:30,160 MODALITIES AND WE ENCOURAGE THEM 1511 00:54:30,160 --> 00:54:31,320 TO SELECT THREE. 1512 00:54:31,320 --> 00:54:34,040 BUT THAT INFORMATION AND THOSE 1513 00:54:34,040 --> 00:54:35,280 PREFERENCES BECOME INTEGRAL 1514 00:54:35,280 --> 00:54:39,680 PARTS OF THE EPIC EHR AND ARE 1515 00:54:39,680 --> 00:54:40,280 AVAILABLE TO DRIVE CLINICAL 1516 00:54:40,280 --> 00:54:41,240 PHYSICIAN SUPPORT. 1517 00:54:41,240 --> 00:54:43,800 SO THE CONVERSATION GUIDE IS ONE 1518 00:54:43,800 --> 00:54:44,120 ELEMENT. 1519 00:54:44,120 --> 00:54:47,560 THE SECOND IS A COLLECTION OF 1520 00:54:47,560 --> 00:54:50,800 CLINICAL DECISION SUPPORT THAT 1521 00:54:50,800 --> 00:54:52,840 PROMPTS CLINICIANS TO INTRODUCE, 1522 00:54:52,840 --> 00:54:54,960 NORMALIZE, VALIDATE, AND SUPPORT 1523 00:54:54,960 --> 00:54:56,560 THE USE OF THESE MODALITIES AT 1524 00:54:56,560 --> 00:55:02,800 ALL POINTS ALONG THE COMPLEX 1525 00:55:02,800 --> 00:55:04,920 TRAJECTORIES, OPERATIVE CARE 1526 00:55:04,920 --> 00:55:06,160 TRAJECTORIES AND THE LAST 1527 00:55:06,160 --> 00:55:09,040 COMPONENT IS A SWEET OF 1528 00:55:09,040 --> 00:55:10,240 SELF-MANAGEMENT TOOLS TO SUPPORT 1529 00:55:10,240 --> 00:55:13,640 UPTAKE, PRACTICE, AND USE AND 1530 00:55:13,640 --> 00:55:16,720 ADAPTATION OF ALL OF THE 1531 00:55:16,720 --> 00:55:17,440 MODALITIES. 1532 00:55:17,440 --> 00:55:20,840 SO WE LIKE OTHERS USE THE EHR 1533 00:55:20,840 --> 00:55:24,280 FOR TIMELY IDENTIFICATION AND 1534 00:55:24,280 --> 00:55:24,560 ENROLLMENT. 1535 00:55:24,560 --> 00:55:26,360 SO WE WANTED TO IDENTIFY THEM 1536 00:55:26,360 --> 00:55:27,680 IMMEDIATELY ONCE IT WAS DECIDED 1537 00:55:27,680 --> 00:55:30,160 THEY WERE GOING TO RECEIVE A 1538 00:55:30,160 --> 00:55:30,800 QUALIFYING SURGERY. 1539 00:55:30,800 --> 00:55:38,400 WE ALSO USED THE EHR TO ALTHOUGH 1540 00:55:38,400 --> 00:55:40,640 IT WAS CLUSTER RANDOMIZED TO 1541 00:55:40,640 --> 00:55:42,000 SUPPORT TRANSITIONS FROM CONTROL 1542 00:55:42,000 --> 00:55:46,960 TO ACTIVE STATE AS A DIFFERENT 1543 00:55:46,960 --> 00:55:49,480 CLUSTERS WENT LIVE. 1544 00:55:49,480 --> 00:55:51,200 THE INTERVENTION, THE GROUP 1545 00:55:51,200 --> 00:55:54,280 ASSIGNMENT I MENTIONED WAS BASED 1546 00:55:54,280 --> 00:55:55,920 ON SITE DATA AND SURGICAL 1547 00:55:55,920 --> 00:55:56,400 PROCEDURES. 1548 00:55:56,400 --> 00:55:59,280 SO ONCE A PATIENT WAS PLACED ON 1549 00:55:59,280 --> 00:56:03,360 AN EPIC INDUSTRY, THEIR GROUP 1550 00:56:03,360 --> 00:56:06,240 STATUS WAS DETERMINED THE 1551 00:56:06,240 --> 00:56:07,280 CONVERSATION GUIDE WAS 1552 00:56:07,280 --> 00:56:09,560 AUTOMATICALLY DELIVERED TO THEIR 1553 00:56:09,560 --> 00:56:11,640 PORTAL AND APPROPRIATE PROM 1554 00:56:11,640 --> 00:56:12,920 ASSIGNMENTS WERE INITIATED. 1555 00:56:12,920 --> 00:56:17,400 THE EPIC EHO IS CENTRAL TO OUR 1556 00:56:17,400 --> 00:56:18,480 BUNDLED INTERVENTION DELIVERY. 1557 00:56:18,480 --> 00:56:20,720 AS I MENTIONED, THE CONVERSATION 1558 00:56:20,720 --> 00:56:21,920 GUIDE WAS DELIVERED TO THE 1559 00:56:21,920 --> 00:56:26,120 PATIENT'S PORTAL, BUT SO WERE 1560 00:56:26,120 --> 00:56:28,840 TAILORED MESSAGES THAT MATCHED 1561 00:56:28,840 --> 00:56:30,400 PATIENT-SPECIFIC PREFERENCES, 1562 00:56:30,400 --> 00:56:32,040 THEIR EXPRESSED LEVEL OF 1563 00:56:32,040 --> 00:56:34,600 CONFIDENCE AND SELF-EFFICACY TO 1564 00:56:34,600 --> 00:56:35,960 UTILIZE THE INTERVENTION. 1565 00:56:35,960 --> 00:56:38,680 THE EHR WAS USED TO PROMPT 1566 00:56:38,680 --> 00:56:40,640 CLINICIANS ACROSS THE FULL 1567 00:56:40,640 --> 00:56:41,600 TRAJECTORY SO THAT THOSE 1568 00:56:41,600 --> 00:56:44,920 INCLUDED PATIENTS IN THE 1569 00:56:44,920 --> 00:56:46,200 PRE-OPERATIVE OUTPATIENT 1570 00:56:46,200 --> 00:56:48,080 CLINICS, HOSPITAL-BASED NURSES, 1571 00:56:48,080 --> 00:56:50,920 PHYSICAL AND OCCUPATIONAL 1572 00:56:50,920 --> 00:56:51,920 THERAPISTS AS WELL AS THE CARE 1573 00:56:51,920 --> 00:56:52,680 TEAMS. 1574 00:56:52,680 --> 00:56:55,000 I MENTIONED INTERVENTION 1575 00:56:55,000 --> 00:56:55,280 TAILORING. 1576 00:56:55,280 --> 00:56:58,360 WE MONITORED INTERVENTION 1577 00:56:58,360 --> 00:56:59,640 FIDELITY ACROSS OUR CLUSTERS AND 1578 00:56:59,640 --> 00:57:04,040 WE CAN USE THE EHR TO COLLECT 1579 00:57:04,040 --> 00:57:05,600 OUR OUTCOMES AND I'LL STOP 1580 00:57:05,600 --> 00:57:05,840 THERE. 1581 00:57:05,840 --> 00:57:06,080 THANKS. 1582 00:57:06,080 --> 00:57:09,400 >> THANKS, ANDREA. 1583 00:57:09,400 --> 00:57:10,880 FINALLY, MIGUEL. 1584 00:57:10,880 --> 00:57:12,960 >> THANK YOU, KEITH. 1585 00:57:12,960 --> 00:57:14,400 GOOD AFTERNOON EVERYONE. 1586 00:57:14,400 --> 00:57:21,160 ICD PIECES IS A CLUSTER, A 1587 00:57:21,160 --> 00:57:22,560 RANDOMIZED PRAGMATIC TRIAL. 1588 00:57:22,560 --> 00:57:26,520 IT COMPARES A MODEL AND INVOLVED 1589 00:57:26,520 --> 00:57:28,600 INFORMATION TECHNOLOGY AND 1590 00:57:28,600 --> 00:57:32,120 SOFTWARE PLATFORM AND IDENTIFIED 1591 00:57:32,120 --> 00:57:35,040 PATIENTS AND ASSIGNED 1592 00:57:35,040 --> 00:57:36,600 FACILITATORS TO HELP PRIMARY 1593 00:57:36,600 --> 00:57:36,920 PROVIDERS. 1594 00:57:36,920 --> 00:57:38,360 THIS WAS TO IMPROVE CARE OF 1595 00:57:38,360 --> 00:57:40,960 PATIENT WHO IS HAD A CO-EXISTENT 1596 00:57:40,960 --> 00:57:45,440 TRIAL OF CHRONIC KIDNEY DISEASE, 1597 00:57:45,440 --> 00:57:46,960 DIABETES. 1598 00:57:46,960 --> 00:57:50,400 PATIENTS HAD TO MEET THE 1599 00:57:50,400 --> 00:57:54,560 CRITERIA WITH THE THREE 1600 00:57:54,560 --> 00:57:54,840 DIAGNOSISES. 1601 00:57:54,840 --> 00:57:59,680 IN THIS MODEL OF CARE WAS 1602 00:57:59,680 --> 00:58:03,120 COMPARED TOES. 1603 00:58:03,120 --> 00:58:03,680 IN THIS MODEL OF CARE WAS 1604 00:58:03,680 --> 00:58:06,360 COMPARED TO STANDARD CARE AND 1605 00:58:06,360 --> 00:58:08,520 THE MAIN OUTCOME OF THE STUDY 1606 00:58:08,520 --> 00:58:12,760 WAS HOSPITALIZATIONS AND THERE 1607 00:58:12,760 --> 00:58:13,840 WERE SOME OTHER SECONDARY 1608 00:58:13,840 --> 00:58:14,920 OUTCOMES INCLUDING EMERGENCY 1609 00:58:14,920 --> 00:58:21,280 VISITS, CARDIOVASCULAR EVENTS -- 1610 00:58:21,280 --> 00:58:25,000 AS FAR AS THE PARTICIPATING 1611 00:58:25,000 --> 00:58:26,040 HEALTH SYSTEMS, THERE WERE FOUR 1612 00:58:26,040 --> 00:58:28,240 LARGE HEALTH SYSTEMS WITH VERY 1613 00:58:28,240 --> 00:58:30,400 DIFFERENT LEVELS OF INTEGRATION. 1614 00:58:30,400 --> 00:58:33,840 ONE OF THEM WAS THE COUNTY 1615 00:58:33,840 --> 00:58:35,280 HOSPITAL HEALTH SYSTEM VERY 1616 00:58:35,280 --> 00:58:36,520 INTEGRATED FROM THE OUTSIDE 1617 00:58:36,520 --> 00:58:39,120 CLINICS ALL THE WAY TO THE MAIN 1618 00:58:39,120 --> 00:58:43,800 HOSPITAL WHEN PATIENTS REQUIRED 1619 00:58:43,800 --> 00:58:44,120 ADMISSIONS. 1620 00:58:44,120 --> 00:58:48,840 AND ALSO THE VA SYSTEM WAS A 1621 00:58:48,840 --> 00:58:49,880 PARTICIPANT AND THEN THERE WERE 1622 00:58:49,880 --> 00:58:52,840 TWO HEALTH SYSTEMS, ONE 1623 00:58:52,840 --> 00:58:55,800 NONPROFIT IN NORTH TEXAS WAS 1624 00:58:55,800 --> 00:58:59,080 ONE, ACO -- MUCH LOWER LEVELS OF 1625 00:58:59,080 --> 00:59:00,360 INTEGRATION. 1626 00:59:00,360 --> 00:59:03,760 SO THERE WAS QUITE A 1627 00:59:03,760 --> 00:59:05,000 HETEROGENEITY IN TERMS OF 1628 00:59:05,000 --> 00:59:05,400 CHARGE. 1629 00:59:05,400 --> 00:59:08,920 TWO OF THE HEALTH SYSTEMS USED 1630 00:59:08,920 --> 00:59:10,280 EPIC WITH VARIATIONS. 1631 00:59:10,280 --> 00:59:12,240 ONE HEALTH SYSTEM USED ALL THE 1632 00:59:12,240 --> 00:59:13,720 SCRIPTS AND ONE HEALTH SYSTEM 1633 00:59:13,720 --> 00:59:16,760 USED CPRS. 1634 00:59:16,760 --> 00:59:20,880 HEALTH SYSTEM EHRs WERE USED FOR 1635 00:59:20,880 --> 00:59:21,560 VARIOUS TASKS. 1636 00:59:21,560 --> 00:59:26,400 THE MOST CRITICAL ONE FOR US WAS 1637 00:59:26,400 --> 00:59:28,320 TO IDENTIFY POSSIBLE CANDIDATES 1638 00:59:28,320 --> 00:59:30,440 AND KNOW WHAT PATIENTS TO 1639 00:59:30,440 --> 00:59:33,640 RECRUIT FOR THE STUDY. 1640 00:59:33,640 --> 00:59:36,200 THERE WAS ALSO SOME ASSISTANCE 1641 00:59:36,200 --> 00:59:37,760 IN TERMS OF THE INTERVENTIONS IN 1642 00:59:37,760 --> 00:59:43,480 THE CAPTURE OF SOME OF THE 1643 00:59:43,480 --> 00:59:43,720 OUTCOMES. 1644 00:59:43,720 --> 00:59:46,360 AND THE MAIN PRIMARY OUTCOME WAS 1645 00:59:46,360 --> 00:59:48,840 DATA CLAIMSES, BUT ALSO THERE 1646 00:59:48,840 --> 00:59:49,520 WAS SOME CONTRIBUTION FROM THE 1647 00:59:49,520 --> 00:59:54,200 -- 1648 00:59:54,200 --> 00:59:54,960 >> GREAT. 1649 00:59:54,960 --> 00:59:55,680 THANK YOU. 1650 00:59:55,680 --> 00:59:57,000 YOU BROKE UP BRIEFLY AT LEAST 1651 00:59:57,000 --> 01:00:01,960 FOR ME AT THE END OF THAT, 1652 01:00:01,960 --> 01:00:02,200 MIGUEL. 1653 01:00:02,200 --> 01:00:04,080 BUT I THINK WE HEARD UP UNTIL 1654 01:00:04,080 --> 01:00:05,240 THE LAST SENTENCE OR TWO. 1655 01:00:05,240 --> 01:00:06,280 SO THANK YOU. 1656 01:00:06,280 --> 01:00:06,480 OKAY. 1657 01:00:06,480 --> 01:00:07,240 SO THAT'S GREAT. 1658 01:00:07,240 --> 01:00:09,680 SORT OF A GREAT SUMMARY FROM OUR 1659 01:00:09,680 --> 01:00:10,000 PANELISTS. 1660 01:00:10,000 --> 01:00:12,240 I ACTUALLY THINK IT'S KIND OF 1661 01:00:12,240 --> 01:00:14,360 NICE EVERYBODY HAS A SORT OF 1662 01:00:14,360 --> 01:00:15,880 CLIFF HANGER FROM THEIR STUDY 1663 01:00:15,880 --> 01:00:18,920 THAT WE'LL GET INTO IN THESE 1664 01:00:18,920 --> 01:00:19,920 NEXT SET OF SLIDES. 1665 01:00:19,920 --> 01:00:21,680 AND SO, THE WAY THAT WE'RE GOING 1666 01:00:21,680 --> 01:00:23,400 TO DO THIS IS EACH OF OUR 1667 01:00:23,400 --> 01:00:25,320 PANELIST IS GOING TO TAKE POINT 1668 01:00:25,320 --> 01:00:27,160 ON THE DIFFERENT TASKS THAT WE 1669 01:00:27,160 --> 01:00:30,920 SORT OF HIGHLIGHTED FROM THE 1670 01:00:30,920 --> 01:00:31,600 EHR. 1671 01:00:31,600 --> 01:00:33,080 AND, REALLY SORT OF PROVIDE AN 1672 01:00:33,080 --> 01:00:36,320 OVERVIEW OF WHAT KIND OF WHAT 1673 01:00:36,320 --> 01:00:39,000 WORKED WELL AND WHAT WERE THE 1674 01:00:39,000 --> 01:00:40,640 UNPLEASANT SURPRISES AND OTHER 1675 01:00:40,640 --> 01:00:41,800 LESSONS LEARNED JUST TO KEY UP 1676 01:00:41,800 --> 01:00:42,840 THE DISCUSSION AND WE'LL HAVE 1677 01:00:42,840 --> 01:00:45,280 THE REST OF OUR PANELISTS WEIGH 1678 01:00:45,280 --> 01:00:48,120 IN ON EACH TOPIC AS WELL. 1679 01:00:48,120 --> 01:00:51,720 SO FIRST UP IS USING THE EHR TO 1680 01:00:51,720 --> 01:00:52,320 IDENTIFY OR RECRUIT PATIENTS AND 1681 01:00:52,320 --> 01:00:54,680 I THINK, MIGUEL, AS YOU TALKED 1682 01:00:54,680 --> 01:00:56,480 ABOUT WITH ICD PIECES THAT WAS 1683 01:00:56,480 --> 01:00:59,120 CRUCIAL FOR YOUR STUDY AND SO 1684 01:00:59,120 --> 01:01:01,160 WE'LL LEAVE THIS ONE TO YOU TO 1685 01:01:01,160 --> 01:01:02,960 GET US STARTED. 1686 01:01:02,960 --> 01:01:03,320 >> THANK YOU. 1687 01:01:03,320 --> 01:01:06,760 SO AS I MENTIONED IN ICD PIECES, 1688 01:01:06,760 --> 01:01:09,640 WE DEPENDED ON THE EHR TO 1689 01:01:09,640 --> 01:01:11,000 IDENTIFY POSSIBLE CANDIDATES IF 1690 01:01:11,000 --> 01:01:14,160 FOR THE STUDY AND THEN RECRUITED 1691 01:01:14,160 --> 01:01:17,600 THOSE AS PARTICIPANTS IN ICD 1692 01:01:17,600 --> 01:01:17,840 PIECES. 1693 01:01:17,840 --> 01:01:20,920 SO PIECES IS ACTUALLY A SOFTWARE 1694 01:01:20,920 --> 01:01:24,320 THAT WAS DEVELOPED BY ONE OF OUR 1695 01:01:24,320 --> 01:01:26,360 INVESTIGATORS AND WITH THAT WE 1696 01:01:26,360 --> 01:01:30,160 COULD SURVEY THE EHR AND KNOW 1697 01:01:30,160 --> 01:01:32,120 WHAT PATIENTS MET CRITERIA AS 1698 01:01:32,120 --> 01:01:32,400 CANDIDATES. 1699 01:01:32,400 --> 01:01:37,440 OUR STUDIES I MENTIONED THE 1700 01:01:37,440 --> 01:01:41,160 TRIAL WAS CHRONIC DIABETES AND 1701 01:01:41,160 --> 01:01:41,480 HYPERTENSION. 1702 01:01:41,480 --> 01:01:45,160 WE HAD LIKE A PHENO TYPE THEY 1703 01:01:45,160 --> 01:01:48,080 NEEDED TO HAVE CHRONIC KIDNEY 1704 01:01:48,080 --> 01:01:50,400 DISEASE AND THAT WAS DEFINED ON 1705 01:01:50,400 --> 01:01:53,160 OBJECTIVE LABORATORY CRITERIA 1706 01:01:53,160 --> 01:01:59,720 DATA AND SO GFRs SO THESE WERE 1707 01:01:59,720 --> 01:02:01,280 LABORATORIES FOR DIABETES. 1708 01:02:01,280 --> 01:02:03,160 ITS CRITERIA WAS BASED ON 1709 01:02:03,160 --> 01:02:10,680 GLUCOSE LEVELS OR THE USE OF 1710 01:02:10,680 --> 01:02:14,320 HYPOGLYCEMIC AGENTS OR BLOOD 1711 01:02:14,320 --> 01:02:15,240 PRESSURE READINGS OR 1712 01:02:15,240 --> 01:02:17,360 HYPERTENSION LIST OR PROBLEM 1713 01:02:17,360 --> 01:02:18,120 WITH HYPERTENSION. 1714 01:02:18,120 --> 01:02:20,040 SO AN OBJECTIVE CRITERIA TO 1715 01:02:20,040 --> 01:02:20,560 CREATE THIS. 1716 01:02:20,560 --> 01:02:25,560 SO THE EHR WAS VERY HELPFUL IN 1717 01:02:25,560 --> 01:02:26,360 PIECES. 1718 01:02:26,360 --> 01:02:27,400 IT WAS ABLE FROM THE CLOUD 1719 01:02:27,400 --> 01:02:29,320 INFORMATION FROM THE HEALTH 1720 01:02:29,320 --> 01:02:31,080 SYSTEMS WOULD BE THERE AND THEN 1721 01:02:31,080 --> 01:02:34,680 IDENTIFY POTENTIAL CANDIDATES. 1722 01:02:34,680 --> 01:02:38,160 THEN, A LIST WAS DELIVERED EVERY 1723 01:02:38,160 --> 01:02:42,040 WEEK, ONCE A WEEK TO EACH 1724 01:02:42,040 --> 01:02:43,960 PARTICIPANT ON SITE TO -- 1725 01:02:43,960 --> 01:02:44,880 PRACTICES ABOUT POTENTIAL 1726 01:02:44,880 --> 01:02:45,800 CANDIDATES FROM THEIR PATIENTS 1727 01:02:45,800 --> 01:02:48,240 THAT WERE COMING OFF THAT WEEK. 1728 01:02:48,240 --> 01:02:53,960 THEN THAT LIST WOULD BE REVIEWED 1729 01:02:53,960 --> 01:02:57,080 AND PATIENTS WOULD BE THEN IN A 1730 01:02:57,080 --> 01:02:57,880 DEBT POINT. 1731 01:02:57,880 --> 01:03:01,280 THAT PROVIDER OR CLINIC PERSONAL 1732 01:03:01,280 --> 01:03:03,600 WOULD THEN INVOLVE THE PATIENT 1733 01:03:03,600 --> 01:03:06,160 ACTIVELY INTO THE STUDY. 1734 01:03:06,160 --> 01:03:08,920 IT WAS POSSIBLE TO FIND A LARGE 1735 01:03:08,920 --> 01:03:10,640 NUMBER OF PATIENTS. 1736 01:03:10,640 --> 01:03:14,120 WE INVOLVED 11,000 PATIENTS IN 1737 01:03:14,120 --> 01:03:19,320 THE STUDY FOLLOWING THESE 1738 01:03:19,320 --> 01:03:19,800 PROTOCOLS. 1739 01:03:19,800 --> 01:03:27,520 SO IT WORKED VERY WELL FOLLOWING 1740 01:03:27,520 --> 01:03:28,120 PATIENTS. 1741 01:03:28,120 --> 01:03:30,920 WHEN WE WERE MAKING PROGRESS TO 1742 01:03:30,920 --> 01:03:33,520 GET READY TO LAUNCH THE STUDY, 1743 01:03:33,520 --> 01:03:35,520 WE LEARNED THAT TWO OF THE 1744 01:03:35,520 --> 01:03:39,160 HEALTH SYSTEMS WOULD NOT ALLOW 1745 01:03:39,160 --> 01:03:44,720 THEIR DATA TO COME OUT TO THE 1746 01:03:44,720 --> 01:03:46,000 CLOUD SO THIS ALGORITHM COULD 1747 01:03:46,000 --> 01:03:47,920 IDENTIFY THE PATIENTS. 1748 01:03:47,920 --> 01:03:49,280 SO OUR EEUCHLT T COLLABORATORS 1749 01:03:49,280 --> 01:03:51,040 HAD TO GO BACK TO FIND A WAY AND 1750 01:03:51,040 --> 01:03:53,280 THEN TO RECREATE THE ALGORITHM 1751 01:03:53,280 --> 01:03:56,040 INSIDE THE FIREWALL FOR THESE 1752 01:03:56,040 --> 01:03:56,640 TWO SYSTEMS. 1753 01:03:56,640 --> 01:03:58,160 SO THAT'S SOMETHING THAT WE HAD 1754 01:03:58,160 --> 01:03:59,880 NOT PLANNED AND CAUSED SOME 1755 01:03:59,880 --> 01:04:01,520 DELAYS, BUT EVENTUALLY, THERE 1756 01:04:01,520 --> 01:04:05,640 WAS A SOLUTION TO BYPASS THAT 1757 01:04:05,640 --> 01:04:05,880 OBSTACLE. 1758 01:04:05,880 --> 01:04:08,960 ANOTHER SURPRISE WAS THAT WE 1759 01:04:08,960 --> 01:04:09,960 NEEDED TO HAVE MORE THAN ONE 1760 01:04:09,960 --> 01:04:12,560 LABORATORY FOR SOME OF THE 1761 01:04:12,560 --> 01:04:16,360 CRITERIA, FOR EXAMPLE, FOR 1762 01:04:16,360 --> 01:04:19,760 CHRONIC OBESITY, WE NEEDED TO 1763 01:04:19,760 --> 01:04:21,360 HAVE TWO RATIOS SEPARATED BY AT 1764 01:04:21,360 --> 01:04:22,560 LEAST THREE MONTHS. 1765 01:04:22,560 --> 01:04:24,240 THEN IT WOULD ALLOW US TO KNOW 1766 01:04:24,240 --> 01:04:26,640 WHAT PATIENTS WERE POSSIBLE 1767 01:04:26,640 --> 01:04:27,160 CANDIDATES. 1768 01:04:27,160 --> 01:04:30,560 THE PLAN OF ENROLLMENT, THESE 1769 01:04:30,560 --> 01:04:31,680 LABORATORIES HAD TO BE UPDATED 1770 01:04:31,680 --> 01:04:34,400 TO MAKE SURE THE PATIENT STILL 1771 01:04:34,400 --> 01:04:37,000 MET CRITERIA AND WAS AN ELIGIBLE 1772 01:04:37,000 --> 01:04:37,440 CANDIDATE. 1773 01:04:37,440 --> 01:04:39,400 WELL, SOMETIMES THE LABORATORIES 1774 01:04:39,400 --> 01:04:42,880 WERE NOT UPDATED INTO THE 1775 01:04:42,880 --> 01:04:47,520 ALGORITHM IN PATIENTS COULD NOT 1776 01:04:47,520 --> 01:04:49,360 BE IDENTIFIED, POTENTIAL 1777 01:04:49,360 --> 01:04:49,680 CANDIDATES. 1778 01:04:49,680 --> 01:04:50,960 THAT'S SOMETHING WE LEARNED IN 1779 01:04:50,960 --> 01:04:52,880 THE FIRST FEW MONTHS OF THIS 1780 01:04:52,880 --> 01:04:54,880 STUDY EVEN THOUGH THE SYSTEM WAS 1781 01:04:54,880 --> 01:04:56,760 VERY EFFICIENT TO THE PATIENTS, 1782 01:04:56,760 --> 01:04:58,800 THEY NEEDED TO BE THERE. 1783 01:04:58,800 --> 01:04:59,720 SOME PATIENTS COULD BE MISSED. 1784 01:04:59,720 --> 01:05:02,880 SO WE HAD TO HAVE A SECOND, A 1785 01:05:02,880 --> 01:05:05,520 CHECK WITH A MANUAL REVIEW OF 1786 01:05:05,520 --> 01:05:07,160 PATIENTS COMING TO THAT 1787 01:05:07,160 --> 01:05:08,040 PARTICULAR CLAIM. 1788 01:05:08,040 --> 01:05:09,240 SO THAT WAS SOMETHING THAT WE 1789 01:05:09,240 --> 01:05:11,120 WERE NOT EXPECTING, BUT, AGAIN, 1790 01:05:11,120 --> 01:05:15,440 WE WERE ABLE TO GET AROUND IT 1791 01:05:15,440 --> 01:05:15,880 WITH HELP. 1792 01:05:15,880 --> 01:05:19,120 AND COLLABORATORS. 1793 01:05:19,120 --> 01:05:21,600 WHAT LESSONS HAVE WE LEARNED 1794 01:05:21,600 --> 01:05:22,880 BESIDES THOSE FROM THE 1795 01:05:22,880 --> 01:05:24,360 SURPRISES, WELL, THE TECHNOLOGY 1796 01:05:24,360 --> 01:05:27,160 AND THE EEUCHLT T ARE GREAT, BUT 1797 01:05:27,160 --> 01:05:28,960 NOT ENOUGH. 1798 01:05:28,960 --> 01:05:30,520 I MENTIONED THE ALGORITHM COULD 1799 01:05:30,520 --> 01:05:31,760 WORK VERY WELL. 1800 01:05:31,760 --> 01:05:34,600 WE COULD IDENTIFY THE PATIENTS, 1801 01:05:34,600 --> 01:05:37,040 WE COULD HAVE A MANUAL REVIEW 1802 01:05:37,040 --> 01:05:39,000 WHERE THOSE PATIENTS WERE COMING 1803 01:05:39,000 --> 01:05:40,880 UP IN THEIR INDUSTRY OR LIST 1804 01:05:40,880 --> 01:05:42,000 THAT WAS PROVIDED EVERY WEEK. 1805 01:05:42,000 --> 01:05:43,960 BUT IN THE END, WE REQUIRED 1806 01:05:43,960 --> 01:05:45,880 SOMEONE IN THE CLINIC, IDEALLY 1807 01:05:45,880 --> 01:05:49,400 THE PROVIDER OR IN SOME CASES, 1808 01:05:49,400 --> 01:05:53,680 SOME CLINIC PERSON ASSIGNED TO 1809 01:05:53,680 --> 01:05:56,440 THIS TASK TO ACTUALLY MANUALLY 1810 01:05:56,440 --> 01:05:57,160 OR ACTIVELY ENROLL THE PATIENT 1811 01:05:57,160 --> 01:06:01,040 SO THAT ALL INTERVENTIONS WOULD 1812 01:06:01,040 --> 01:06:03,160 THEN BECOME RELEVANT FOR THE 1813 01:06:03,160 --> 01:06:03,400 PATIENT. 1814 01:06:03,400 --> 01:06:05,120 BUT THAT LAST STEP WAS NOT 1815 01:06:05,120 --> 01:06:06,200 HAPPENING, THEN THE PATIENTS 1816 01:06:06,200 --> 01:06:08,000 WOULD COME THROUGH CLINIC AND 1817 01:06:08,000 --> 01:06:11,440 WOULD BE MISSED EVEN -- THOUGH 1818 01:06:11,440 --> 01:06:16,040 THERE WAS A LESSON ALSO THAT WE 1819 01:06:16,040 --> 01:06:16,960 LEARNED. 1820 01:06:16,960 --> 01:06:19,120 WE WERE ABLE TO ADDRESS TO SOME 1821 01:06:19,120 --> 01:06:21,880 DEGREE BUT NEVER OVERCOME 100% 1822 01:06:21,880 --> 01:06:25,280 THAT PARTICULAR LIMITATION THAT 1823 01:06:25,280 --> 01:06:25,880 SOME PATIENTS, THEY WERE NOT 1824 01:06:25,880 --> 01:06:27,520 BEING ACTIVATED BY THE CLINIC. 1825 01:06:27,520 --> 01:06:29,760 BUT IN GENERAL TERMS, WE WERE 1826 01:06:29,760 --> 01:06:33,760 VERY HAPPY ABOUT HOW EHR WORKED 1827 01:06:33,760 --> 01:06:35,360 TO ALLOW US TO IDENTIFY 1828 01:06:35,360 --> 01:06:37,120 CANDIDATES AND TO RECRUIT 1829 01:06:37,120 --> 01:06:37,680 PATIENTS. 1830 01:06:37,680 --> 01:06:42,600 SO I WILL STOP AT THIS POINT. 1831 01:06:42,600 --> 01:06:42,840 >> GREAT. 1832 01:06:42,840 --> 01:06:44,480 THAT'S A REALLY FANTASTIC 1833 01:06:44,480 --> 01:06:46,880 SUMMARY I THINK OF SORT OF WHAT 1834 01:06:46,880 --> 01:06:49,640 MANY OF THE PROJECTS GO THROUGH. 1835 01:06:49,640 --> 01:06:51,440 ARE THERE ANY PANELISTS THAT 1836 01:06:51,440 --> 01:06:53,880 WANT TO WAVE SORT OF TO SPEAK 1837 01:06:53,880 --> 01:06:54,080 NEXT? 1838 01:06:54,080 --> 01:06:56,240 OTHERWISE I CAN JUST CALL ON 1839 01:06:56,240 --> 01:06:56,440 FOLKS. 1840 01:06:56,440 --> 01:06:57,960 JERRY'S GOT HIS HAND UP. 1841 01:06:57,960 --> 01:07:02,560 JERRY, WOULD YOU LIKE TO ADD ON 1842 01:07:02,560 --> 01:07:03,160 THERE? 1843 01:07:03,160 --> 01:07:04,000 >> SURE. 1844 01:07:04,000 --> 01:07:06,360 KEITH, JUST TO CONTINUE WITH AN 1845 01:07:06,360 --> 01:07:08,600 ISSUE THAT MIGUEL RAISED ABOUT 1846 01:07:08,600 --> 01:07:10,400 NEEDING TO UPDATE CERTAIN 1847 01:07:10,400 --> 01:07:11,400 ASPECTS OF INFORMATION AS YOU 1848 01:07:11,400 --> 01:07:14,560 WENT ALONG, ONE OF THE, YOU 1849 01:07:14,560 --> 01:07:17,960 KNOW, I THINK PREVALENT THEMES 1850 01:07:17,960 --> 01:07:19,760 WE FACE AS FAR AS SURPRISES OR 1851 01:07:19,760 --> 01:07:21,640 LESSONS LEARNED IS THAT THE 1852 01:07:21,640 --> 01:07:24,600 SYSTEMS WEREN'T AS STATIC AS WE 1853 01:07:24,600 --> 01:07:26,480 ASSUMED AT FIRST AND THAT WE 1854 01:07:26,480 --> 01:07:30,120 WERE CONSTANTLY NEEDING TO 1855 01:07:30,120 --> 01:07:32,920 ADJUST TO A VARIETY OF CHANGES 1856 01:07:32,920 --> 01:07:34,160 AS WE WENT ALONG. 1857 01:07:34,160 --> 01:07:39,240 YOU KNOW, I THINK ONE EXAMPLE OF 1858 01:07:39,240 --> 01:07:49,800 THAT FOR US SO WE COULD DEFINE 1859 01:08:17,200 --> 01:08:20,200 WHO OUR CLINICS WERE BECAUSE 1860 01:08:20,200 --> 01:08:21,760 THEY WERE OUR UNIT OF 1861 01:08:21,760 --> 01:08:22,120 RANDOMIZATION. 1862 01:08:22,120 --> 01:08:23,640 AND THAT'S JUST ONE EXAMPLE OF A 1863 01:08:23,640 --> 01:08:26,160 VARIETY OF THINGS THAT WE NEEDED 1864 01:08:26,160 --> 01:08:33,480 TO MONITOR AND UPDATE AS WE WENT 1865 01:08:33,480 --> 01:08:35,080 FORWARD WITH THE TRIAL. 1866 01:08:35,080 --> 01:08:36,160 >> YEAH. 1867 01:08:36,160 --> 01:08:38,080 THAT'S A GREAT POINT. 1868 01:08:38,080 --> 01:08:40,880 GREG, ARE YOU RAISING YOUR HAND 1869 01:08:40,880 --> 01:08:41,080 THERE. 1870 01:08:41,080 --> 01:08:41,440 >> YEAH. 1871 01:08:41,440 --> 01:08:43,560 IN TERMS OF THINGS THAT WENT 1872 01:08:43,560 --> 01:08:51,640 WELL AND SORT OF AVOIDED 1873 01:08:51,640 --> 01:08:53,680 SURPRISES MOST OF THE SURPRISES 1874 01:08:53,680 --> 01:08:56,720 ARE NOT PLEASANT SURPRISES. 1875 01:08:56,720 --> 01:08:58,360 FORTUNATELY, WE WERE ABLE TO 1876 01:08:58,360 --> 01:09:00,560 LOOK VERY CAREFULLY BEFORE THE 1877 01:09:00,560 --> 01:09:03,480 TRIAL STARTED ACTUALLY ALL THE 1878 01:09:03,480 --> 01:09:05,160 POTENTIAL PARTICIPATING SITES IN 1879 01:09:05,160 --> 01:09:08,960 TERMS OF HOW CONSISTENT WERE THE 1880 01:09:08,960 --> 01:09:10,320 PHQ 9 MEASURES BEING USED. 1881 01:09:10,320 --> 01:09:12,760 WHAT WAS THE VOLUME. 1882 01:09:12,760 --> 01:09:14,520 WHAT PROPORTION OF THEM WERE 1883 01:09:14,520 --> 01:09:16,080 REPORTING SUICIDAL THOUGHTS AND 1884 01:09:16,080 --> 01:09:17,680 THAT WAS A KEY POINT IN 1885 01:09:17,680 --> 01:09:18,920 SELECTING SITES. 1886 01:09:18,920 --> 01:09:21,360 THERE WERE SOME SITES WHERE THE 1887 01:09:21,360 --> 01:09:23,040 QUESTIONNAIRES WERE NOT BEING 1888 01:09:23,040 --> 01:09:24,200 USED CONSISTENTLY AND THE VOLUME 1889 01:09:24,200 --> 01:09:25,760 WAS JUST TOO LOW. 1890 01:09:25,760 --> 01:09:27,920 AND THEN THE OTHER IN TERMS OF 1891 01:09:27,920 --> 01:09:29,840 DEALING WITH SURPRISES, YOU 1892 01:09:29,840 --> 01:09:31,440 KNOW, THE ROUTINE THAT WAS SET 1893 01:09:31,440 --> 01:09:41,000 UP WHICH ACTUALLY FOR 1894 01:09:41,000 --> 01:09:44,240 CONFIDENTIALITY CONDITION THE AT 1895 01:09:44,240 --> 01:09:45,840 EACH SITE. 1896 01:09:45,840 --> 01:09:48,280 FOLKS AT KP WASHINGTON WOULD 1897 01:09:48,280 --> 01:09:51,240 GENERATE WHAT MOST PEOPLE WOULD 1898 01:09:51,240 --> 01:09:53,120 CALL A WATERFALL DIAGRAM. 1899 01:09:53,120 --> 01:09:56,560 THIS WAS A PROPORTION FILLED OUT 1900 01:09:56,560 --> 01:09:59,000 A PHQ 9. 1901 01:09:59,000 --> 01:10:01,120 THIS WAS THE PROPORTION WHO HAD 1902 01:10:01,120 --> 01:10:02,800 ALREADY BEEN ENROLLED IN THE 1903 01:10:02,800 --> 01:10:06,360 TRIAL AND ALL THE EXCLUSION 1904 01:10:06,360 --> 01:10:06,640 CRITERIA. 1905 01:10:06,640 --> 01:10:09,480 AND THEN THE SORT OF LOG OF THAT 1906 01:10:09,480 --> 01:10:10,600 PROCESS WAS THEN JUST 1907 01:10:10,600 --> 01:10:12,680 AUTOMATICALLY E-MAILED TO THE 1908 01:10:12,680 --> 01:10:14,040 CENTRAL SITE EVERY WEEK AND 1909 01:10:14,040 --> 01:10:15,200 THERE WERE A FEW SURPRISES ALONG 1910 01:10:15,200 --> 01:10:16,760 THE WAY IN TERMS OF SOMETHING 1911 01:10:16,760 --> 01:10:19,040 JUST NOT LOOKING RIGHT, BUT 1912 01:10:19,040 --> 01:10:20,480 GENERATING THAT LOG FILE AND 1913 01:10:20,480 --> 01:10:22,160 LOOKING AT THE WATERFALL EVERY 1914 01:10:22,160 --> 01:10:24,600 WEEK ALLOWED YOU TO QUICKLY 1915 01:10:24,600 --> 01:10:26,760 PINPOINT HERE'S WHAT IT IS. 1916 01:10:26,760 --> 01:10:28,280 SOMETHING IS BROKEN ABOUT THE 1917 01:10:28,280 --> 01:10:30,400 PATIENT REPORTED OUTCOME DATA 1918 01:10:30,400 --> 01:10:32,120 GETTING LOADED INTO THE DATA 1919 01:10:32,120 --> 01:10:33,800 WAREHOUSE THIS WEEK OR SOMETHING 1920 01:10:33,800 --> 01:10:35,200 IS BROKEN ABOUT FAR TOO MANY 1921 01:10:35,200 --> 01:10:36,920 PEOPLE OR FAR TOO FEW PEOPLE 1922 01:10:36,920 --> 01:10:38,840 BEING EXCLUDED FOR THIS REASON, 1923 01:10:38,840 --> 01:10:40,280 LET'S TRACK THAT DOWN. 1924 01:10:40,280 --> 01:10:41,960 SO THOSE THINGS CERTAINLY DID 1925 01:10:41,960 --> 01:10:42,200 HAPPEN. 1926 01:10:42,200 --> 01:10:43,920 THESE INEVITABLE THOSE THINGS 1927 01:10:43,920 --> 01:10:46,800 HAPPENED, BUT HAVING A PROCESS 1928 01:10:46,800 --> 01:10:48,280 IN PLACE THAT ALLOWS YOU TO 1929 01:10:48,280 --> 01:10:49,160 QUICKLY PINPOINT WHERE DID IT 1930 01:10:49,160 --> 01:10:50,520 HAPPEN AND THEN TRACK THAT DOWN 1931 01:10:50,520 --> 01:10:55,800 AND FIX IT, THAT WORKED PRETTY 1932 01:10:55,800 --> 01:10:56,000 WELL. 1933 01:10:56,000 --> 01:10:56,280 >> YEAH. 1934 01:10:56,280 --> 01:11:00,600 GREAT POINT PLANNING FOR SOME 1935 01:11:00,600 --> 01:11:01,200 RESILIENCY THERE BECAUSE THE 1936 01:11:01,200 --> 01:11:02,240 SYSTEM WILL BREAK AT SOME POINT. 1937 01:11:02,240 --> 01:11:05,360 ANYTHING TO ADD OVER WHAT'S BEEN 1938 01:11:05,360 --> 01:11:05,560 SAID? 1939 01:11:05,560 --> 01:11:05,800 >> YEAH. 1940 01:11:05,800 --> 01:11:07,080 JUST A COUPLE OF POINTS. 1941 01:11:07,080 --> 01:11:12,000 I THINK IN OUR STUDY, ENROLLMENT 1942 01:11:12,000 --> 01:11:12,920 WAS TIME SENSITIVE BECAUSE MANY 1943 01:11:12,920 --> 01:11:16,440 OF THE PATIENTS, THE INTERVAL 1944 01:11:16,440 --> 01:11:17,880 BETWEEN ORDERING THE SURGERY AND 1945 01:11:17,880 --> 01:11:19,280 THE SURGERY OCCURRING, IT COULD 1946 01:11:19,280 --> 01:11:20,520 BE DAYS. 1947 01:11:20,520 --> 01:11:23,160 AND SO THIS IS WHERE THE H R 1948 01:11:23,160 --> 01:11:25,320 SERVED US INCREDIBLY WELL. 1949 01:11:25,320 --> 01:11:28,520 WE WERE ABLE TO VERY PRECISELY 1950 01:11:28,520 --> 01:11:30,720 PINPOINT THE TIME AT WHICH A 1951 01:11:30,720 --> 01:11:32,640 PATIENT BECAME ELIGIBLE AND, FOR 1952 01:11:32,640 --> 01:11:34,360 US, THAT ELECTRONIC EVENT WAS 1953 01:11:34,360 --> 01:11:35,920 THE ENTRY OF AN ORDER, THE 1954 01:11:35,920 --> 01:11:38,000 SURGICAL ORDER INTO THE SYSTEM. 1955 01:11:38,000 --> 01:11:40,200 LITERALLY, WE HAVE A PRECISE 1956 01:11:40,200 --> 01:11:44,000 TIME STAMP AND WE WERE ABLE TO 1957 01:11:44,000 --> 01:11:46,920 DEVELOP FAIRLY NOT OVERLY 1958 01:11:46,920 --> 01:11:57,640 CONVOLUTED, BUT NOT SIMPLE LOGIC 1959 01:11:57,640 --> 01:11:58,120 THAT 1960 01:11:58,120 --> 01:11:59,920 TRIANGULATE TO IDENTIFY THOSE 1961 01:11:59,920 --> 01:12:01,080 PATIENTS WHO SHOULD BE CONTROL 1962 01:12:01,080 --> 01:12:02,160 VERSUS INTERVENTION. 1963 01:12:02,160 --> 01:12:05,800 AND SO BY TWEAKING THAT LOGIC 1964 01:12:05,800 --> 01:12:08,200 THROUGHOUT A VERY GEOGRAPHICALLY 1965 01:12:08,200 --> 01:12:09,440 DISBURSED HEALTH SYSTEM, WE WERE 1966 01:12:09,440 --> 01:12:13,440 ABLE TO SHIFT ON A DIME. 1967 01:12:13,440 --> 01:12:19,000 PATIENTS EXPOSURE TO CERTAIN 1968 01:12:19,000 --> 01:12:19,680 INTERVENTION ELEMENTS. 1969 01:12:19,680 --> 01:12:23,000 SO THAT WORKED WELL. 1970 01:12:23,000 --> 01:12:26,360 ONE SOURCE OF FILIBUSTER 1971 01:12:26,360 --> 01:12:30,400 REGISTRATION, WE USED A INDUSTRY 1972 01:12:30,400 --> 01:12:34,600 FOR DRIVING A LOT OF ELEMENTS 1973 01:12:34,600 --> 01:12:34,760 OUT. 1974 01:12:34,760 --> 01:12:36,040 THAT WAS NOT UPDATED UNTIL AFTER 1975 01:12:36,040 --> 01:12:36,960 24 HOURS. 1976 01:12:36,960 --> 01:12:38,680 THE LIGHTS DIM AND THE AIR 1977 01:12:38,680 --> 01:12:39,880 CONDITIONER. 1978 01:12:39,880 --> 01:12:41,960 IT TAKES SO MUCH POWER THAT IT'S 1979 01:12:41,960 --> 01:12:44,240 NOT COMPATIBLE TO UPDATE 1980 01:12:44,240 --> 01:12:45,600 INDUSTRIES DURING BUSINESS 1981 01:12:45,600 --> 01:12:46,000 HOURS. 1982 01:12:46,000 --> 01:12:49,000 SO THE KNOWLEDGE THAT A PATIENT 1983 01:12:49,000 --> 01:12:51,080 OR EVEN THE EHR'S AWARENESS THAT 1984 01:12:51,080 --> 01:12:53,760 A PATIENT WAS ASSIGNED TO THE 1985 01:12:53,760 --> 01:12:54,880 INTERVENTION DID NOT OCCUR UNTIL 1986 01:12:54,880 --> 01:12:58,360 MIDNIGHT AND THAT HAD SOME 1987 01:12:58,360 --> 01:13:01,840 SUBTLE REPERCUSSIONS. 1988 01:13:01,840 --> 01:13:04,320 UNMREZN'T SURPRISES AND THESE 1989 01:13:04,320 --> 01:13:07,320 WEREN'T REALLY EHR SURPRISES. 1990 01:13:07,320 --> 01:13:10,400 WHAT WE DISCOVERED WAS 1991 01:13:10,400 --> 01:13:11,720 HETEROGENEITY OF WORK FLOWS. 1992 01:13:11,720 --> 01:13:14,360 WE FOUND THAT THE OBSTETRICIANS 1993 01:13:14,360 --> 01:13:15,920 INCLUDING C-SECTIONS IN THE 1994 01:13:15,920 --> 01:13:19,200 TRIAL THE OBSTETRICIANS IN 1995 01:13:19,200 --> 01:13:21,200 ROCHESTER KEEP A PAPER LOG. 1996 01:13:21,200 --> 01:13:24,240 IT'S LITERALLY ALMOST A 1997 01:13:24,240 --> 01:13:25,560 PARCHMENT BOOK WHERE THEY LOG 1998 01:13:25,560 --> 01:13:26,960 PLANNED C-SECTIONS. 1999 01:13:26,960 --> 01:13:28,840 THEY DON'T SCHEDULE THEM USING 2000 01:13:28,840 --> 01:13:31,480 THE EHR, SO THAT WAS A 2001 01:13:31,480 --> 01:13:31,760 DISCOVERY. 2002 01:13:31,760 --> 01:13:34,720 WE ALSO DISCOVERED THAT SOME 2003 01:13:34,720 --> 01:13:39,160 GROUPS EVEN THOUGH A PATIENT 2004 01:13:39,160 --> 01:13:39,800 DOESN'T REALIZE THEY'RE HAVING 2005 01:13:39,800 --> 01:13:41,720 THE SURGERY, THEY PLACED THE 2006 01:13:41,720 --> 01:13:42,200 ORDER. 2007 01:13:42,200 --> 01:13:44,160 SO THE UNCOMFORTABLE TENSION 2008 01:13:44,160 --> 01:13:45,600 AROSE WHEN PATIENTS WERE GETTING 2009 01:13:45,600 --> 01:13:48,000 OUR MATERIAL AND THEY DIDN'T YET 2010 01:13:48,000 --> 01:13:49,520 KNOW HE WERE GOING TO HAVE 2011 01:13:49,520 --> 01:13:50,400 SURGERY. 2012 01:13:50,400 --> 01:14:00,920 I THINK OTHER THE HAVE HOW MUCH 2013 01:14:08,920 --> 01:14:11,920 GOOD WILL WE GAINED BY INCLUDING 2014 01:14:11,920 --> 01:14:14,960 PROCEDURES THAT WE HAD NOT 2015 01:14:14,960 --> 01:14:17,440 ALREADY DECIDED ON BUT 2016 01:14:17,440 --> 01:14:19,080 CLINICIANS FELT STRONGLY ABOUT 2017 01:14:19,080 --> 01:14:19,680 INCLUDING. 2018 01:14:19,680 --> 01:14:21,880 SOME OF THEM WE WILL INCLUDE IN 2019 01:14:21,880 --> 01:14:23,880 THE ANALYSIS, BUT IT WAS VERY 2020 01:14:23,880 --> 01:14:25,320 IMPORTANT TO THE CLINICIANS AND 2021 01:14:25,320 --> 01:14:29,000 IT WAS EASY TO DO AND A LOT OF 2022 01:14:29,000 --> 01:14:30,400 ENTHUSIASM AND THAT'S ALL I'VE 2023 01:14:30,400 --> 01:14:32,440 GOT. 2024 01:14:32,440 --> 01:14:32,560 . 2025 01:14:32,560 --> 01:14:33,760 >> GREAT. 2026 01:14:33,760 --> 01:14:33,960 OKAY. 2027 01:14:33,960 --> 01:14:36,800 SO LET'S GO AHEAD AND MOVE ON TO 2028 01:14:36,800 --> 01:14:38,680 THE NEXT SORT OF TASK. 2029 01:14:38,680 --> 01:14:40,000 SO SAME QUESTIONS. 2030 01:14:40,000 --> 01:14:43,200 NOW WE'RE MOVING ON.' 2031 01:14:43,200 --> 01:14:45,120 WE'VE IDENTIFIED PATIENTS. 2032 01:14:45,120 --> 01:14:47,160 WE'VE RECRUITED PATIENTS AND NOW 2033 01:14:47,160 --> 01:14:48,560 WE'RE DELIVERING INTERVENTIONS 2034 01:14:48,560 --> 01:14:50,280 TO THE PATIENTS THEMSELVES. 2035 01:14:50,280 --> 01:14:53,840 JERRY HAD VOLUNTEERED TO GET US 2036 01:14:53,840 --> 01:14:54,760 STARTED WITH THIS ONE. 2037 01:14:54,760 --> 01:14:56,920 >> SO THIS IS SOMETHING THAT 2038 01:14:56,920 --> 01:15:00,760 ACTUALLY WORKED QUITE WELL WITH 2039 01:15:00,760 --> 01:15:02,880 OUR INTERVENTION. 2040 01:15:02,880 --> 01:15:05,240 REMEMBER, OUR INTERVENTION WAS 2041 01:15:05,240 --> 01:15:06,800 ESSENTIALLY A CLINICAL DECISION 2042 01:15:06,800 --> 01:15:09,120 SUPPORT TYPE OF INTERVENTION 2043 01:15:09,120 --> 01:15:11,040 WHERE WE WERE PUTTING PREVALENCE 2044 01:15:11,040 --> 01:15:14,120 INFORMATION DIRECTLY INTO THE 2045 01:15:14,120 --> 01:15:21,120 CLINICAL RADIOLOGY REPORT AND WE 2046 01:15:21,120 --> 01:15:22,880 NEEDED THIS TO BE AUTOMATED AND 2047 01:15:22,880 --> 01:15:24,920 CUSTOMIZED TO THE AGE OF THE 2048 01:15:24,920 --> 01:15:32,600 PATIENT AND WORKING WITH 2049 01:15:32,600 --> 01:15:35,640 PROGRAMMERS AT EACH OF THE SITES 2050 01:15:35,640 --> 01:15:46,200 WHO WERE FAMILIAR WITH THE EHR 2051 01:15:53,800 --> 01:15:57,680 AND REALLY ALLOWED US TO HAVE A 2052 01:15:57,680 --> 01:15:59,160 LIGHT TOUCH INTERVENTION AND PUT 2053 01:15:59,160 --> 01:16:01,480 US ON THE FAR END OF THE 2054 01:16:01,480 --> 01:16:01,760 SPECTRUM. 2055 01:16:01,760 --> 01:16:06,080 YOU KNOW, ONE OF THE, YOU AGAIN, 2056 01:16:06,080 --> 01:16:08,200 I WOULDN'T NECESSARILY CALL IT 2057 01:16:08,200 --> 01:16:09,680 AN UNPLEASANT SURPRISE, BUT IT 2058 01:16:09,680 --> 01:16:11,160 WAS SOMETHING THAT WE HAD TO 2059 01:16:11,160 --> 01:16:21,680 DEAL WITH WAS THE FACT THAT NOT 2060 01:16:27,080 --> 01:16:31,040 ALL THE SO THE WAY WE DESIGNED 2061 01:16:31,040 --> 01:16:32,680 THE TRIAL THEN GOING FROM THE 2062 01:16:32,680 --> 01:16:36,760 REPORTING SYSTEM TO THE EHR AND 2063 01:16:36,760 --> 01:16:39,040 THEN THE INTERVENTION TEXT BEING 2064 01:16:39,040 --> 01:16:40,200 INSERTED THERE. 2065 01:16:40,200 --> 01:16:41,920 ONE OF OUR HEALTH SYSTEMS DIDN'T 2066 01:16:41,920 --> 01:16:42,760 WANT TO DO IT THAT WAY. 2067 01:16:42,760 --> 01:16:45,560 THEY WANTED TO INSERT THE 2068 01:16:45,560 --> 01:16:48,280 INTERVENTION AS POP-UPS AS THESE 2069 01:16:48,280 --> 01:16:50,320 POP-UP ALERTS THAT CLINICIANS 2070 01:16:50,320 --> 01:16:52,960 GET AND SO IT WASN'T PERMANENTLY 2071 01:16:52,960 --> 01:16:56,080 ATTACHED TO THE REPORT, BUT IT 2072 01:16:56,080 --> 01:16:58,600 APPEARED WHEN THE REPORT WAS 2073 01:16:58,600 --> 01:17:01,280 OPENED AND THIS PRESENTED SOME 2074 01:17:01,280 --> 01:17:04,200 CHALLENGES BECAUSE DEPENDING ON 2075 01:17:04,200 --> 01:17:04,800 WHO OPENED THE REPORT, THEY 2076 01:17:04,800 --> 01:17:07,160 MIGHT OR MIGHT NOT SEE THE 2077 01:17:07,160 --> 01:17:09,160 POP-UP AND, YOU KNOW, SO THERE 2078 01:17:09,160 --> 01:17:12,120 WERE ADDITIONAL SORT OF THINGS 2079 01:17:12,120 --> 01:17:13,320 TO WORK THROUGH JUST BECAUSE 2080 01:17:13,320 --> 01:17:16,440 THEIR APPROACH WAS SLIGHTLY 2081 01:17:16,440 --> 01:17:16,720 DIFFERENT. 2082 01:17:16,720 --> 01:17:18,040 THEN, AS I MENTIONED BEFORE, 2083 01:17:18,040 --> 01:17:20,520 SOME OF THE SITES INSERTED THE 2084 01:17:20,520 --> 01:17:23,640 INTERVENTION AT THE LEVEL OF THE 2085 01:17:23,640 --> 01:17:26,080 RADIOLOGY REPORTING SYSTEM AND 2086 01:17:26,080 --> 01:17:27,880 WHILE YOU MIGHT NOT THINK THAT 2087 01:17:27,880 --> 01:17:33,000 WOULD MAKE A BIG DIFFERENCE, IT 2088 01:17:33,000 --> 01:17:34,120 DID ALLOW THE RADIOLOGIST WHO 2089 01:17:34,120 --> 01:17:37,320 WAS DICTATING TO SEE THE 2090 01:17:37,320 --> 01:17:38,800 INTERVENTION TEXT AND TO REMOVE 2091 01:17:38,800 --> 01:17:42,280 IT IF THEY WANTED TO AND WHILE 2092 01:17:42,280 --> 01:17:44,480 NOT A LOT OF THEM DID, SOME OF 2093 01:17:44,480 --> 01:17:48,480 THEM DID AND SOME OF THEM DID 2094 01:17:48,480 --> 01:17:50,440 CONSISTENTLY AND SO THAT 2095 01:17:50,440 --> 01:17:52,640 PRESENTED CHALLENGES WHERE WE 2096 01:17:52,640 --> 01:17:56,160 WOULD HAVE TO WORK WITH OUR SITE 2097 01:17:56,160 --> 01:17:57,240 DIRECTORS FOR EXAMPLE TO GO AND 2098 01:17:57,240 --> 01:17:58,880 TO TALK TO THOSE INDIVIDUALS AND 2099 01:17:58,880 --> 01:18:01,280 SEE WHY THEY WERE DOING WHAT 2100 01:18:01,280 --> 01:18:03,040 THEY WERE DOING AND SORT OF 2101 01:18:03,040 --> 01:18:04,640 RE-EXPLAIN THE STUDY TO THEM 2102 01:18:04,640 --> 01:18:06,560 AND, AGAIN, IT TOOK SORT OF TIME 2103 01:18:06,560 --> 01:18:07,600 AND EFFORT. 2104 01:18:07,600 --> 01:18:10,800 ONCE WE HAD THOSE SORT OF KINKS 2105 01:18:10,800 --> 01:18:12,800 WORKED OUT, THINGS WERE, YOU 2106 01:18:12,800 --> 01:18:15,720 KNOW, I WOULD SAY VERY WELL AND 2107 01:18:15,720 --> 01:18:18,360 THE INTERVENTION WAS INSERTED AS 2108 01:18:18,360 --> 01:18:22,720 WE HAD THOUGHT IT SHOULD BE 2109 01:18:22,720 --> 01:18:24,360 INSERTED AND STAYED THERE 2110 01:18:24,360 --> 01:18:24,680 APPROPRIATELY. 2111 01:18:24,680 --> 01:18:26,280 SO, YOU KNOW, I THINK SORT OF 2112 01:18:26,280 --> 01:18:30,480 THE LESSONS LEARNED AS ANDREA 2113 01:18:30,480 --> 01:18:31,240 AND OTHERS HAVE ALLUDED TO IS 2114 01:18:31,240 --> 01:18:34,680 THAT THERE'S A LOT OF 2115 01:18:34,680 --> 01:18:35,760 HETEROGENEITY TO THE ACTUAL 2116 01:18:35,760 --> 01:18:38,120 IMPLEMENTATION AND YOU JUST NEED 2117 01:18:38,120 --> 01:18:40,480 TO BE ABLE TO BE AGILE AND 2118 01:18:40,480 --> 01:18:46,320 ADJUST AND ADAPT TO THAT. 2119 01:18:46,320 --> 01:18:47,120 >> GREAT. 2120 01:18:47,120 --> 01:18:50,600 ANYONE WANT TO GO -- WANT TO 2121 01:18:50,600 --> 01:18:53,200 VOLUNTEER TO GO NEXT? 2122 01:18:53,200 --> 01:18:54,920 ANY HANDS AT ALL? 2123 01:18:54,920 --> 01:18:56,400 MIGUEL, WOULD YOU LIKE TO GO? 2124 01:18:56,400 --> 01:18:59,440 >> I'LL BE HAPPY TO MAKE SOME 2125 01:18:59,440 --> 01:18:59,720 COMMENTS. 2126 01:18:59,720 --> 01:19:01,520 FOR US, AS FAR AS DELIVERING 2127 01:19:01,520 --> 01:19:02,720 INTERVENTIONS, SOME THINGS 2128 01:19:02,720 --> 01:19:04,960 WORKED WELL. 2129 01:19:04,960 --> 01:19:07,160 WE HAD A SMART SET AVAILABLE SO 2130 01:19:07,160 --> 01:19:08,560 SOME PROVIDERS WERE HAPPY WITH 2131 01:19:08,560 --> 01:19:09,840 THE SMART SETS. 2132 01:19:09,840 --> 01:19:11,360 HOWEVER, MOST OF THEM PREFERRED 2133 01:19:11,360 --> 01:19:18,240 TO STILL MAKE ADJUSTMENTS TO 2134 01:19:18,240 --> 01:19:18,960 FOLLOW -- RATHER THAN USING THE 2135 01:19:18,960 --> 01:19:20,360 SMART SETS THAT WERE PROVIDED. 2136 01:19:20,360 --> 01:19:23,160 ONE OF THE THINGS THAT ALSO 2137 01:19:23,160 --> 01:19:26,160 BECAME, YOU KNOW, VERY CLEAR TO 2138 01:19:26,160 --> 01:19:28,320 US WE HAD ANTICIPATED THAT SOME 2139 01:19:28,320 --> 01:19:30,240 OF THEM WOULD PREPARE LIKE A 2140 01:19:30,240 --> 01:19:32,200 MORE STRUCTURED TYPE OF TOOL 2141 01:19:32,200 --> 01:19:33,960 SUCH AS THERAPY PLAN OR 2142 01:19:33,960 --> 01:19:36,360 SOMETHING MORE COMPREHENSIVE IN 2143 01:19:36,360 --> 01:19:39,160 THE PROVIDERS TOLD US VERY 2144 01:19:39,160 --> 01:19:42,320 CLEARLY THAT THAT WAS NOT WHAT 2145 01:19:42,320 --> 01:19:43,200 THEY WANTED. 2146 01:19:43,200 --> 01:19:44,320 THERE WAS SOME RESISTANCE TO 2147 01:19:44,320 --> 01:19:47,840 THAT SO WE WENT WITH A SOFTER 2148 01:19:47,840 --> 01:19:49,120 TOUCH THAN WAS HAVING THE 2149 01:19:49,120 --> 01:19:51,680 PROTOCOLS, THE OPTIONS, EVEN THE 2150 01:19:51,680 --> 01:19:53,840 SMART SET, BUT NOT REQUIRING TO 2151 01:19:53,840 --> 01:19:55,240 GO THROUGH A THERAPY PLAN OR 2152 01:19:55,240 --> 01:19:57,440 THROUGH A MORE STRUCTURED TYPE 2153 01:19:57,440 --> 01:19:58,360 OF TOOL. 2154 01:19:58,360 --> 01:20:02,000 OTHER THINGS THAT WE LEARNED WAS 2155 01:20:02,000 --> 01:20:04,520 HOW THE CHANGES TO THE STUDY 2156 01:20:04,520 --> 01:20:06,680 AFFECTED OUR INTERVENTIONS AND 2157 01:20:06,680 --> 01:20:08,960 THAT HAPPENED AT THE LEVEL OF 2158 01:20:08,960 --> 01:20:09,840 THE OVERALL STRUCTURE AND THE 2159 01:20:09,840 --> 01:20:13,280 LEVEL OF INTERVENTIONS. 2160 01:20:13,280 --> 01:20:16,320 SO, FOR EXAMPLE, WE WANTED TO 2161 01:20:16,320 --> 01:20:17,400 DELIVER INTERVENTIONS BASED UPON 2162 01:20:17,400 --> 01:20:19,120 THE ASSIGNMENT AND, OF COURSE, 2163 01:20:19,120 --> 01:20:21,080 IT WAS AN INTENTION TO TREAT 2164 01:20:21,080 --> 01:20:22,320 STUDY, BUT SOME OF THE 2165 01:20:22,320 --> 01:20:22,880 PRACTICIONERS LEFT. 2166 01:20:22,880 --> 01:20:25,600 SOME RETIRED. 2167 01:20:25,600 --> 01:20:28,600 SOME UNEXPECTED CHANGES. 2168 01:20:28,600 --> 01:20:30,480 US, AS FAR AS SPECIFIC 2169 01:20:30,480 --> 01:20:32,080 INTERVENTIONS WERE MANY CHANGES 2170 01:20:32,080 --> 01:20:37,080 IN THE PRACTICE OF CARE FOR 2171 01:20:37,080 --> 01:20:39,280 PATIENTS WITH THIS TRIAL. 2172 01:20:39,280 --> 01:20:45,800 FOR EXAMPLE, MANY CHANGES WE 2173 01:20:45,800 --> 01:20:49,280 APPROACHED ESPECIALLY WITH THE 2174 01:20:49,280 --> 01:20:53,120 COMBINATION WE MENTIONED, THERE 2175 01:20:53,120 --> 01:20:55,160 WERE NEW HYPERTENSION GUIDELINES 2176 01:20:55,160 --> 01:20:58,080 WITH THE STUD, WITH OUR DATA 2177 01:20:58,080 --> 01:20:59,960 SAFETY MONITORING BOARD IN TERMS 2178 01:20:59,960 --> 01:21:02,200 OF HOW THEY WOULD AFFECT OUR 2179 01:21:02,200 --> 01:21:02,720 STUDYING PROGRESS. 2180 01:21:02,720 --> 01:21:05,560 IN THE AREA OF DIABETES, THERE 2181 01:21:05,560 --> 01:21:09,880 WAS AN EXPLOSION OF NEW 2182 01:21:09,880 --> 01:21:12,000 TREATMENTS, NEW MEDICATIONS TO 2183 01:21:12,000 --> 01:21:14,440 TREAT DIABETES THAT WERE NOT 2184 01:21:14,440 --> 01:21:16,000 PRESENT WHEN THE STUDY FIRST 2185 01:21:16,000 --> 01:21:18,160 STARTED. 2186 01:21:18,160 --> 01:21:19,880 SO, AGAIN, THERE WERE SURPRISES. 2187 01:21:19,880 --> 01:21:22,280 I WOULDN'T SAY THEY WERE 2188 01:21:22,280 --> 01:21:23,960 UNPLEASANT, BUT CERTAINLY 2189 01:21:23,960 --> 01:21:25,240 SURPRISES AND IT WOULD REQUIRE 2190 01:21:25,240 --> 01:21:27,800 FOR US TO ADJUST AND LEARN HOW 2191 01:21:27,800 --> 01:21:34,280 TO BE FLEXIBLE THROUGHOUT THE 2192 01:21:34,280 --> 01:21:34,480 STUDY. 2193 01:21:34,480 --> 01:21:34,760 >> GREAT. 2194 01:21:34,760 --> 01:21:35,960 GREG, I THOUGHT YOU HAD YOUR 2195 01:21:35,960 --> 01:21:36,960 HAND UP ALSO. 2196 01:21:36,960 --> 01:21:38,640 DO YOU WANT TO GO NEXT? 2197 01:21:38,640 --> 01:21:39,600 >> YEAH. 2198 01:21:39,600 --> 01:21:39,800 SURE. 2199 01:21:39,800 --> 01:21:44,200 SO WE WERE IT TESTING TWO 2200 01:21:44,200 --> 01:21:44,840 DIFFERENT OUTREACH INTERVENTIONS 2201 01:21:44,840 --> 01:21:45,800 AND ONE OF THEM WORKED REALLY 2202 01:21:45,800 --> 01:21:47,680 WELL SORT OF WITHIN THE 2203 01:21:47,680 --> 01:21:49,280 CONTAINER OF STANDARD PATIENT 2204 01:21:49,280 --> 01:21:49,520 PORTAL. 2205 01:21:49,520 --> 01:21:50,560 THAT WAS A SORT OF CARE 2206 01:21:50,560 --> 01:21:51,760 MANAGEMENT INTERVENTION WHERE 2207 01:21:51,760 --> 01:21:54,120 THE PRIMARY ACTIVITIES WERE 2208 01:21:54,120 --> 01:21:57,120 SYSTEMATICALLY REACHING OUT TO 2209 01:21:57,120 --> 01:22:00,520 PEOPLE VIA MESSAGING SENDING 2210 01:22:00,520 --> 01:22:02,080 THEM QUESTIONNAIRES TO COMPLETE, 2211 01:22:02,080 --> 01:22:05,000 INTERACTING WITH THEM BACK AND 2212 01:22:05,000 --> 01:22:07,960 FORTH VIA MESSAGING 2213 01:22:07,960 --> 01:22:09,520 COMMUNICATING WITH THEIR USUAL 2214 01:22:09,520 --> 01:22:11,120 OUTPATIENT PROVIDERS AND HAVING 2215 01:22:11,120 --> 01:22:12,560 ALL OF THIS BEING VISIBLE TO THE 2216 01:22:12,560 --> 01:22:14,360 CARE TEAM, THAT WORKED REALLY 2217 01:22:14,360 --> 01:22:17,440 WELL AND THAT'S SORT OF WHAT 2218 01:22:17,440 --> 01:22:18,720 PATIENT PORTAL COMMUNICATION IS 2219 01:22:18,720 --> 01:22:19,640 BUILT FOR. 2220 01:22:19,640 --> 01:22:20,960 THE OTHER INTERVENTION INVOLVES 2221 01:22:20,960 --> 01:22:23,320 SORT OF BOTH THAT KIND OF TEXT 2222 01:22:23,320 --> 01:22:25,280 BASED COMMUNICATION, BUT ALSO 2223 01:22:25,280 --> 01:22:27,120 DELIVERY OF MORE SORT OF 2224 01:22:27,120 --> 01:22:29,680 INTERACTIVE KIND OF EDUCATION ON 2225 01:22:29,680 --> 01:22:31,360 SELF-MANAGEMENT MATERIAL, 2226 01:22:31,360 --> 01:22:33,120 WATCHING VIDEOS, DOING HOMEWORK, 2227 01:22:33,120 --> 01:22:35,320 THINGS WHICH ARE CLEARLY OUTSIDE 2228 01:22:35,320 --> 01:22:37,320 SORT OF THE STANDARD KIND OF 2229 01:22:37,320 --> 01:22:38,600 PATIENT PORTAL COMMUNICATION. 2230 01:22:38,600 --> 01:22:41,560 SO THE CHALLENGE THERE IS IT 2231 01:22:41,560 --> 01:22:43,000 REQUIRES SORT OF I DON'T KNOW 2232 01:22:43,000 --> 01:22:45,480 WHAT TO SAY EXCEPT A 2233 01:22:45,480 --> 01:22:47,000 DISCONTINUITY BETWEEN THESE WAYS 2234 01:22:47,000 --> 01:22:48,400 YOU'RE INTERACTING WITH PEOPLE 2235 01:22:48,400 --> 01:22:50,680 AND THE CLUNKINESS OF SHIFTING 2236 01:22:50,680 --> 01:22:52,040 FROM ONE MODE TO THE OTHER. 2237 01:22:52,040 --> 01:22:54,320 WE TRIED TO HANDLE THAT BY USING 2238 01:22:54,320 --> 01:22:56,560 THE PORTAL TO SEND MESSAGES THAT 2239 01:22:56,560 --> 01:22:57,800 WOULD INCLUDE UNDER THE COVERS 2240 01:22:57,800 --> 01:23:00,880 LENGTH THAT WOULD TAKE PEOPLE 2241 01:23:00,880 --> 01:23:01,480 STRAIGHT TO THE CONTENT WE WERE 2242 01:23:01,480 --> 01:23:03,000 TRYING TO REFER THEM TOO, BUT IT 2243 01:23:03,000 --> 01:23:03,920 WAS A BIT CLUNKY. 2244 01:23:03,920 --> 01:23:06,600 YOU KNOW, I THINK THIS IS A SORT 2245 01:23:06,600 --> 01:23:08,320 OF GENERAL ISSUE ABOUT, YOU 2246 01:23:08,320 --> 01:23:10,760 KNOW, HOW WE DELIVER RICHER, 2247 01:23:10,760 --> 01:23:11,680 MORE INTERACTIVE CONTENT TO 2248 01:23:11,680 --> 01:23:13,560 PEOPLE SORT OF WHAT THE 2249 01:23:13,560 --> 01:23:15,000 BOUNDARIES OF PATIENT PORTAL 2250 01:23:15,000 --> 01:23:16,160 COMMUNICATION ARE AND THEN WHEN 2251 01:23:16,160 --> 01:23:17,960 YOU SORT OF MOVE OVER TO SOME 2252 01:23:17,960 --> 01:23:21,200 OTHER SORT OF SEPARATE WEBSITE 2253 01:23:21,200 --> 01:23:23,320 OR APP-BASED COMMUNICATION AND 2254 01:23:23,320 --> 01:23:25,120 HOW THOSE TWO THINGS INTERACT 2255 01:23:25,120 --> 01:23:26,360 WITH EACH OTHER. 2256 01:23:26,360 --> 01:23:27,640 HOW THEY CONNECT OR SOMETIMES 2257 01:23:27,640 --> 01:23:31,360 DON'T CONNECT WELL WITH EACH 2258 01:23:31,360 --> 01:23:31,560 OTHER. 2259 01:23:31,560 --> 01:23:32,760 >> GREAT POINT. 2260 01:23:32,760 --> 01:23:34,360 ANDREA, ANYTHING TO ADD? 2261 01:23:34,360 --> 01:23:35,400 >> YEAH. 2262 01:23:35,400 --> 01:23:40,240 ACTUALLY FOLLOWING UP PRECISELY 2263 01:23:40,240 --> 01:23:44,120 ON THAT ISSUE ONE OF THE THINGS 2264 01:23:44,120 --> 01:23:46,160 THAT WORKED VERY NICELY WAS THIS 2265 01:23:46,160 --> 01:23:51,520 HIGH FIDELITY OF DELIVERY TO 2266 01:23:51,520 --> 01:23:52,720 CONVERSATION GUIDE WE 2267 01:23:52,720 --> 01:23:56,880 EXPERIMENTED WITH LOT OFFICER 2268 01:23:56,880 --> 01:24:07,400 OPTIONS REALIZING OUR GOAL OF 2269 01:24:09,000 --> 01:24:12,480 AND ULTIMATELY, WE WOUND UP 2270 01:24:12,480 --> 01:24:19,680 GOING WITH EPIC QUESTIONNAIRE 2271 01:24:19,680 --> 01:24:20,320 FUNCTIONALITY AND WE WERE 2272 01:24:20,320 --> 01:24:22,920 PLEASANTLY SURPRISED OF THE 2273 01:24:22,920 --> 01:24:25,720 ABILITY TO EMBED HTML. 2274 01:24:25,720 --> 01:24:27,480 WE DID OUR BEST TO NOT MAKE IT 2275 01:24:27,480 --> 01:24:28,640 LOOK LIKE A QUESTIONNAIRE 2276 01:24:28,640 --> 01:24:30,160 BECAUSE PATIENTS DON'T HAVE WARM 2277 01:24:30,160 --> 01:24:33,440 AND FUZZY ASSOCIATIONS WITH 2278 01:24:33,440 --> 01:24:33,640 THOSE. 2279 01:24:33,640 --> 01:24:36,080 WE HAD WEB DESIGNERS WORK WITH 2280 01:24:36,080 --> 01:24:36,440 US. 2281 01:24:36,440 --> 01:24:39,960 SO THE END PRODUCT LOOKS VERY 2282 01:24:39,960 --> 01:24:40,280 PROFESSIONAL. 2283 01:24:40,280 --> 01:24:42,400 IT DOESN'T LOOK LIKE A 2284 01:24:42,400 --> 01:24:42,720 QUESTIONNAIRE. 2285 01:24:42,720 --> 01:24:45,160 THERE ARE BEAUTIFUL IMAGES. 2286 01:24:45,160 --> 01:24:46,800 HTML EMBEDDED IN THE 2287 01:24:46,800 --> 01:24:47,800 CONVERSATION GUIDE THE PATIENTS 2288 01:24:47,800 --> 01:24:49,200 CAN WORK WITH. 2289 01:24:49,200 --> 01:24:52,280 THAT WAS A GREAT DISCOVERY AND 2290 01:24:52,280 --> 01:24:55,080 EPIC WAS VERY HELPFUL THERE. 2291 01:24:55,080 --> 01:24:57,440 WHAT WAS A LITTLE BIT 2292 01:24:57,440 --> 01:24:59,080 FRUSTRATING IS ANY INTERACTION 2293 01:24:59,080 --> 01:25:02,120 WITH THE HTML, WE CAN TELL IF 2294 01:25:02,120 --> 01:25:03,200 PATIENTS ARE INTERACTING WITH IT 2295 01:25:03,200 --> 01:25:07,040 AND WE CAN TELL FOR HOW LONG, 2296 01:25:07,040 --> 01:25:09,560 BUT NONE OF THE DATA THAT 2297 01:25:09,560 --> 01:25:11,120 RESULTS FROM THAT INTERACTION 2298 01:25:11,120 --> 01:25:11,880 BEING COLLECTED. 2299 01:25:11,880 --> 01:25:12,720 WE HAVE TO USE. 2300 01:25:12,720 --> 01:25:14,240 SO IF YOU THINK OF THE 2301 01:25:14,240 --> 01:25:16,280 CONTAINER, THE EPIC 2302 01:25:16,280 --> 01:25:18,600 QUESTIONNAIRE AS A CONTAINER 2303 01:25:18,600 --> 01:25:19,720 ONLY LANGUAGE AND SELECTION 2304 01:25:19,720 --> 01:25:21,520 OPTIONS IN THE CONTAINER HAVE 2305 01:25:21,520 --> 01:25:23,840 THE CAPABILITY TO BE STORED 2306 01:25:23,840 --> 01:25:25,560 PERMANENTLY IN THE EPIC EHR. 2307 01:25:25,560 --> 01:25:27,440 SO A LITTLE BIT OF FANCY 2308 01:25:27,440 --> 01:25:29,920 FOOTWORK WAS REQUIRED TO MAKE 2309 01:25:29,920 --> 01:25:33,560 THAT HTML SINK NICELY WITH THE 2310 01:25:33,560 --> 01:25:34,000 QUESTIONNAIRE BUILD. 2311 01:25:34,000 --> 01:25:35,840 THE OTHER UNPLEASANT DISCOVERY 2312 01:25:35,840 --> 01:25:38,000 WE HAD WAS WE WERE LOCKED IN TO 2313 01:25:38,000 --> 01:25:41,440 SOME EPIC QUESTIONNAIRE TITLE 2314 01:25:41,440 --> 01:25:41,680 FORMAT. 2315 01:25:41,680 --> 01:25:43,840 IF WE CHANGED IT FOR OUR 2316 01:25:43,840 --> 01:25:45,040 QUESTIONNAIRE, WE WOULD OF HAD 2317 01:25:45,040 --> 01:25:46,880 TO CHANGE IT FOR ALL 2318 01:25:46,880 --> 01:25:48,240 QUESTIONNAIRES THROUGHOUT THE 2319 01:25:48,240 --> 01:25:48,680 ENTERPRISE. 2320 01:25:48,680 --> 01:25:55,120 AND THAT SEEMS SO SILLY BUT IT 2321 01:25:55,120 --> 01:25:56,080 WAS ACTUALLY QUITE AN 2322 01:25:56,080 --> 01:25:56,520 IMPEDIMENT. 2323 01:25:56,520 --> 01:25:59,680 SO THE ABILITY TO CREATE 2324 01:25:59,680 --> 01:26:01,360 APPROPRIATELY TAILORED 2325 01:26:01,360 --> 01:26:03,200 EXPERIENCES USING QUESTIONNAIRE 2326 01:26:03,200 --> 01:26:05,520 FUNCTIONALITY ARE LIMITED. 2327 01:26:05,520 --> 01:26:08,360 ANOTHER NICE THING THAT WORKED 2328 01:26:08,360 --> 01:26:09,200 WELL WAS TAILORING INTERVENTION 2329 01:26:09,200 --> 01:26:10,520 DELIVERY AND I'VE ALLUDED TO 2330 01:26:10,520 --> 01:26:13,080 THIS A LITTLE BIT EARLIER. 2331 01:26:13,080 --> 01:26:14,640 WE IN THE CONVERSATION GUIDE, WE 2332 01:26:14,640 --> 01:26:16,680 HAD A HEALTH COACH WORK WITH US 2333 01:26:16,680 --> 01:26:17,840 AND WE WERE ABLE TO SOLICIT 2334 01:26:17,840 --> 01:26:19,480 WHETHER PATIENTS HAD LOW 2335 01:26:19,480 --> 01:26:20,480 CONFIDENCE THAT THEY WERE GOING 2336 01:26:20,480 --> 01:26:22,360 TO BE ABLE TO USE THE 2337 01:26:22,360 --> 01:26:24,040 INTERVENTION MODALITIES, LEARN 2338 01:26:24,040 --> 01:26:26,680 HOW TO USE THEM, SO IF THEY 2339 01:26:26,680 --> 01:26:33,160 SELECTED YES, I ACTUALLY THINK 2340 01:26:33,160 --> 01:26:34,880 IT WAS A ORDINAL RESPONSE 2341 01:26:34,880 --> 01:26:36,120 OPTION, IF THEY SELECTED THEY 2342 01:26:36,120 --> 01:26:38,360 HAD ISSUES, WE TAILORED THE 2343 01:26:38,360 --> 01:26:38,960 SUBSEQUENT MESSAGING AND 2344 01:26:38,960 --> 01:26:40,760 SUBSEQUENT CONTENT WE DELIVERED 2345 01:26:40,760 --> 01:26:43,680 TO THEM TO ADDRESS LOW 2346 01:26:43,680 --> 01:26:44,000 CONFIDENCE. 2347 01:26:44,000 --> 01:26:47,160 FOR FOLKS THAT REQUESTED POST 2348 01:26:47,160 --> 01:26:48,280 DISMISSAL HOSPITAL OPIOID 2349 01:26:48,280 --> 01:26:50,360 DISCHARGE REFILLS, WE WERE ABLE 2350 01:26:50,360 --> 01:26:52,960 TO SEND VERY TAILORED MESSAGING, 2351 01:26:52,960 --> 01:26:54,680 SUPPORTIVE MESSAGING TO THEIR 2352 01:26:54,680 --> 01:26:57,160 PORTAL REDIRECTING THEM TO THE 2353 01:26:57,160 --> 01:26:58,160 MODALITIES. 2354 01:26:58,160 --> 01:27:00,840 AND WE WERE ABLE CONTINGENT ON 2355 01:27:00,840 --> 01:27:03,360 HOSPITAL DISCHARGE LOCATION 2356 01:27:03,360 --> 01:27:04,760 DEPENDING ON WHICH PACK THAT 2357 01:27:04,760 --> 01:27:07,040 POST ACUTE CARE SETTING THEY 2358 01:27:07,040 --> 01:27:08,120 MIGHT BE GOING TO, WE WERE ABLE 2359 01:27:08,120 --> 01:27:11,120 TO USE LOGIC TO PRECISELY TAILOR 2360 01:27:11,120 --> 01:27:14,200 THE INFORMATION, THE MODALITY 2361 01:27:14,200 --> 01:27:15,560 SPECIFIC INFORMATION PROVIDED AT 2362 01:27:15,560 --> 01:27:18,200 DISCHARGE TO THEIR SETTING AND 2363 01:27:18,200 --> 01:27:21,120 WE EVEN USED ZIP CODE BASED 2364 01:27:21,120 --> 01:27:25,040 LOGIC TO LINK THEM TO LOCAL 2365 01:27:25,040 --> 01:27:26,200 RESOURCES. 2366 01:27:26,200 --> 01:27:27,800 UNPLEASANT SURPRISES, THESE 2367 01:27:27,800 --> 01:27:30,640 AGAIN WERE NOT SO MUCH EHR. 2368 01:27:30,640 --> 01:27:32,160 THERE WAS A MARKET SHIFT AWAY 2369 01:27:32,160 --> 01:27:36,600 FROM OVERNIGHT STAYS TO SAME-DAY 2370 01:27:36,600 --> 01:27:39,160 SURGERIES DURING THE TRIAL -- IT 2371 01:27:39,160 --> 01:27:43,560 WAS DURING OUR UG 3 YEAR SO THAT 2372 01:27:43,560 --> 01:27:47,040 NECESSITATED A VERY AGILE SHIFT 2373 01:27:47,040 --> 01:27:49,120 AND LEVERAGING, DEVELOPING BUILT 2374 01:27:49,120 --> 01:27:51,040 SPECIFIC TO PACK DISMISSALS, 2375 01:27:51,040 --> 01:27:53,240 POST ACUTE CARE AND THAT WORKED 2376 01:27:53,240 --> 01:27:54,960 QUITE WELL. 2377 01:27:54,960 --> 01:27:56,800 AND A NOT SO PLEASANT DISCOVERY 2378 01:27:56,800 --> 01:27:58,560 WAS A FREQUENCY OF CANCELLATIONS 2379 01:27:58,560 --> 01:27:59,880 AND RESCHEDULING. 2380 01:27:59,880 --> 01:28:02,080 AND THAT NECESSITATED THE BUILD 2381 01:28:02,080 --> 01:28:03,880 OF SURVEILLANCE ALGORITHMS TO 2382 01:28:03,880 --> 01:28:09,520 IDENTIFY THESE EVENTS AND HANDLE 2383 01:28:09,520 --> 01:28:09,920 THEM. 2384 01:28:09,920 --> 01:28:14,480 AND THAT'S -- THOSE WERE OUR 2385 01:28:14,480 --> 01:28:15,360 MAJOR OBSERVATIONS. 2386 01:28:15,360 --> 01:28:15,760 >> ALL RIGHT. 2387 01:28:15,760 --> 01:28:19,640 SO I THINK WE'LL NOW MOVE ON TO 2388 01:28:19,640 --> 01:28:20,760 MONITORING THE INTERVENTION 2389 01:28:20,760 --> 01:28:22,720 DELIVERY AND I THINK ANDREA, 2390 01:28:22,720 --> 01:28:24,840 WE'RE GOING TO GO BACK TO YOU TO 2391 01:28:24,840 --> 01:28:29,640 KICK US OFF ON THIS ONE. 2392 01:28:29,640 --> 01:28:31,480 >> SURE. 2393 01:28:31,480 --> 01:28:36,480 MANY THINGS WORKED WELL HERE. 2394 01:28:36,480 --> 01:28:47,040 WE WERE ABLE TO THE ACTIVITIES 2395 01:28:50,760 --> 01:28:53,320 OF MULTIPLE GROUPS. 2396 01:28:53,320 --> 01:28:55,320 FOR PATIENTS, WE WERE ABLE TO 2397 01:28:55,320 --> 01:28:57,320 CERTAINLY MONITOR, WAS THE 2398 01:28:57,320 --> 01:28:59,440 CONVERSATION GUIDE DELIVERED, 2399 01:28:59,440 --> 01:29:00,920 WAS IT OPENED? 2400 01:29:00,920 --> 01:29:02,320 FOR HOW LONG WAS IT OPENED? 2401 01:29:02,320 --> 01:29:04,320 WHICH ELEMENTS OF THE 2402 01:29:04,320 --> 01:29:05,720 CONVERSATION GUIDE DID PATIENTS 2403 01:29:05,720 --> 01:29:08,280 INTERACT WITH AND FOR HOW LONG 2404 01:29:08,280 --> 01:29:11,600 WHICH WE PLAN TO CAPITALIZE ON A 2405 01:29:11,600 --> 01:29:13,040 MEDIATOR ANALYSES AND TRY TO 2406 01:29:13,040 --> 01:29:16,600 UNDERSTAND WHAT WORKED AND WHAT 2407 01:29:16,600 --> 01:29:16,960 WORKED FOR WHOM. 2408 01:29:16,960 --> 01:29:18,600 WE WERE ABLE TO ASK -- THE 2409 01:29:18,600 --> 01:29:20,720 VISION INITIALLY WAS FOR THE 2410 01:29:20,720 --> 01:29:22,480 CONVERSATION GUIDE TO SERVE AS 2411 01:29:22,480 --> 01:29:24,000 AN EVER PRESENT RESOURCE FOR THE 2412 01:29:24,000 --> 01:29:27,000 PATIENT SO THAT THEY COULD 2413 01:29:27,000 --> 01:29:29,080 RETURN TO THAT REPEATEDLY 2414 01:29:29,080 --> 01:29:31,640 THROUGHOUT THEIR JOURNEY TO 2415 01:29:31,640 --> 01:29:32,200 TROUBLESHOOT, LEARN ABOUT 2416 01:29:32,200 --> 01:29:34,200 DIFFERENT MODALITIES IF THEIR 2417 01:29:34,200 --> 01:29:35,120 INITIAL SELECTIONS DIDN'T WORK. 2418 01:29:35,120 --> 01:29:36,840 SO WE WERE ABLE TO MONITOR 2419 01:29:36,840 --> 01:29:38,240 PATTERNS OF USE WITH THE 2420 01:29:38,240 --> 01:29:39,160 CONVERSATION GUIDE. 2421 01:29:39,160 --> 01:29:43,080 DID THEY RETURN, DID THEY CHANGE 2422 01:29:43,080 --> 01:29:45,440 THEIR SELECTIONS. 2423 01:29:45,440 --> 01:29:50,840 WE WERE ALSO ABLE TO ASCERTAIN 2424 01:29:50,840 --> 01:30:00,840 WHETHER THEY RECEIVED PPC 2425 01:30:00,840 --> 01:30:02,600 NONPHARMACOLOGIC PAIN CARE 2426 01:30:02,600 --> 01:30:04,240 WHETHER THEY RECEIVED IT 2427 01:30:04,240 --> 01:30:06,000 SPECIFIC TO THE MODALITIES THEY 2428 01:30:06,000 --> 01:30:06,560 SELECTED. 2429 01:30:06,560 --> 01:30:15,840 EPIC HAS A FAIRLY MATURE SYSTEM. 2430 01:30:15,840 --> 01:30:20,400 SO ON THE PART OF NURSES, WE 2431 01:30:20,400 --> 01:30:23,160 WERE ABLE TO CAPTURE HOW THEY 2432 01:30:23,160 --> 01:30:23,440 RESPONDED. 2433 01:30:23,440 --> 01:30:25,400 WE USED ALERTS TO LET PATIENTS 2434 01:30:25,400 --> 01:30:27,160 KNOW THIS IS A PATIENT WHO'S 2435 01:30:27,160 --> 01:30:28,120 HAVING PAIN. 2436 01:30:28,120 --> 01:30:30,440 THESE ARE THEIR PREFERENCES AND 2437 01:30:30,440 --> 01:30:33,120 WE COULD VERY PRECISELY 2438 01:30:33,120 --> 01:30:34,000 DETERMINE HOW A GIVEN NURSE 2439 01:30:34,000 --> 01:30:35,160 RESPONDED TO THAT. 2440 01:30:35,160 --> 01:30:37,560 DID SHE TELL IT TO GO AWAY. 2441 01:30:37,560 --> 01:30:38,880 DID SHE SAY YES? 2442 01:30:38,880 --> 01:30:41,880 I'LL CHANGE THE ORDERS OR I'M 2443 01:30:41,880 --> 01:30:45,920 DOING IT RIGHT NOW. 2444 01:30:45,920 --> 01:30:50,920 WE WERE BY VIRTUE COLLECTING 2445 01:30:50,920 --> 01:30:54,440 FLOW SHEETS. 2446 01:30:54,440 --> 01:30:57,440 AND ALSO THE EXTENT VERY 2447 01:30:57,440 --> 01:30:58,800 PRECISELY WHAT EDUCATION NURSES 2448 01:30:58,800 --> 01:31:01,200 DELIVERED TO PATIENTS ABOUT THE 2449 01:31:01,200 --> 01:31:01,520 MODALITIES. 2450 01:31:01,520 --> 01:31:04,040 AND THE SAME APPLIES TO PHYSICAL 2451 01:31:04,040 --> 01:31:07,320 AND OCCUPATIONAL THERAPISTS. 2452 01:31:07,320 --> 01:31:09,200 WE CAN DETERMINE WHETHER 2453 01:31:09,200 --> 01:31:11,000 MODALITY EDUCATION WAS DELIVERED 2454 01:31:11,000 --> 01:31:13,160 IN PRE-OPERATIVE CLASSES WHICH 2455 01:31:13,160 --> 01:31:16,040 IS NOW THE NORM IN MANY PLACES 2456 01:31:16,040 --> 01:31:21,200 PRIOR TO HIP AND KNEE. 2457 01:31:21,200 --> 01:31:23,240 WHETHER THERAPISTS INTEGRATED 2458 01:31:23,240 --> 01:31:25,000 MODALITIES INTO THEIR 2459 01:31:25,000 --> 01:31:27,240 HOSPITAL-BASED CARE. 2460 01:31:27,240 --> 01:31:27,640 THAT WAS RECORDED. 2461 01:31:27,640 --> 01:31:28,520 SO MANY OF THESE KEY ELEMENTS OF 2462 01:31:28,520 --> 01:31:30,720 THE INTERVENTION WE WILL BE ABLE 2463 01:31:30,720 --> 01:31:33,760 TO DETERMINE WHETHER THEY WERE 2464 01:31:33,760 --> 01:31:34,360 DELIVERED, WHO DELIVERED THEM 2465 01:31:34,360 --> 01:31:37,640 AND IN WHAT WAY. 2466 01:31:37,640 --> 01:31:38,520 ONE OTHER THING THAT WAS NICE IN 2467 01:31:38,520 --> 01:31:41,160 TERMS OF THE ALERTS, WE WERE 2468 01:31:41,160 --> 01:31:45,240 ABLE TO CON FIGURE THE ALERTS SO 2469 01:31:45,240 --> 01:31:47,600 IT WAS SPECIFIC TO WHAT STAGE A 2470 01:31:47,600 --> 01:31:51,000 PATIENT WAS, WHERE THEY WERE IN 2471 01:31:51,000 --> 01:31:52,120 THIS INTERVENTION CONTINUUM AND 2472 01:31:52,120 --> 01:31:53,040 I'LL DESCRIBE THAT. 2473 01:31:53,040 --> 01:31:54,560 SOME PATIENTS ARRIVED AT THE 2474 01:31:54,560 --> 01:31:56,640 HOSPITAL NOT HAVING SELECTED ANY 2475 01:31:56,640 --> 01:31:57,440 MODALITIES AND WHEN A PATIENT 2476 01:31:57,440 --> 01:31:59,960 HAD PAIN, WE WOULD LET THE NURSE 2477 01:31:59,960 --> 01:32:01,720 KNOW, THIS PATIENT NEEDS 2478 01:32:01,720 --> 01:32:02,040 SELECTIONS. 2479 01:32:02,040 --> 01:32:04,600 SOME PATIENTS HAD SELECTED 2480 01:32:04,600 --> 01:32:06,560 MODALITIES, BUT NOT RECEIVED ANY 2481 01:32:06,560 --> 01:32:06,840 EDUCATION. 2482 01:32:06,840 --> 01:32:08,560 WE LET THE NURSE KNOW YOU NEED 2483 01:32:08,560 --> 01:32:09,520 TO EDUCATE. 2484 01:32:09,520 --> 01:32:12,800 SO WE WERE ABLE TO TARGET 2485 01:32:12,800 --> 01:32:14,960 NURSES' ACTIVITIES IN A 2486 01:32:14,960 --> 01:32:16,400 PATIENT-SPECIFIC WAY BASED ON 2487 01:32:16,400 --> 01:32:19,240 WHERE THEY WERE IN THIS 2488 01:32:19,240 --> 01:32:22,960 CONTINUUM OF THE INTERVENTION. 2489 01:32:22,960 --> 01:32:23,920 UNPLEASANT SURPRISES. 2490 01:32:23,920 --> 01:32:25,880 ONE THING WE WOULD HAVE LOVED TO 2491 01:32:25,880 --> 01:32:28,400 BE ABLE TO DO IS TO DETERMINE 2492 01:32:28,400 --> 01:32:30,280 THE DEGREE TO WHICH PHYSICIANS, 2493 01:32:30,280 --> 01:32:34,600 APPs AND ALLIED HEALTH WERE 2494 01:32:34,600 --> 01:32:41,160 USING THE NO-HARM INTERFACES, 2495 01:32:41,160 --> 01:32:43,920 THAT WE CREATED TO HELP THEM 2496 01:32:43,920 --> 01:32:46,920 UNDERSTAND THE INTERVENTION. 2497 01:32:46,920 --> 01:32:53,320 A DATA SET THAT CAPTURES USERS 2498 01:32:53,320 --> 01:32:54,640 ENGAGEMENT WITH CERTAIN 2499 01:32:54,640 --> 01:32:58,080 FUNCTIONALITY BUT IT'S NOT AS 2500 01:32:58,080 --> 01:33:00,480 GRANULAR AS SOMEONE WOULD LIKE. 2501 01:33:00,480 --> 01:33:02,920 WE WOULD HAVE LIMITED POSSIBLY 2502 01:33:02,920 --> 01:33:06,400 TO DETERMINE THAT USAGE AND I 2503 01:33:06,400 --> 01:33:06,800 WILL PASS THE MIC. 2504 01:33:06,800 --> 01:33:16,960 >> GREAT. 2505 01:33:18,600 --> 01:33:18,920 THANKS. 2506 01:33:18,920 --> 01:33:21,600 ANYBODY WANT TO GO NEXT FROM OUR 2507 01:33:21,600 --> 01:33:22,400 PANELISTS? 2508 01:33:22,400 --> 01:33:22,600 GREG. 2509 01:33:22,600 --> 01:33:22,760 >>. 2510 01:33:22,760 --> 01:33:25,360 >> IN SOME WAYS SIMILAR TO WHAT 2511 01:33:25,360 --> 01:33:26,480 ANDREA WAS TALKING ABOUT BUT 2512 01:33:26,480 --> 01:33:28,360 SIMILAR TO OUR TRIAL. 2513 01:33:28,360 --> 01:33:30,160 ONE OF THE KEY QUESTIONS WE WERE 2514 01:33:30,160 --> 01:33:31,440 INTERESTED IN DOING THIS WAS 2515 01:33:31,440 --> 01:33:33,120 ABOUT THE VALUE OR EFFECTIVENESS 2516 01:33:33,120 --> 01:33:35,360 OF OUTREACH TO PEOPLE WHO WERE 2517 01:33:35,360 --> 01:33:37,000 NOT NECESSARILY SEEKING ANY SORT 2518 01:33:37,000 --> 01:33:38,640 OF MENTAL HEALTH CARE AND 2519 01:33:38,640 --> 01:33:40,360 CERTAINLY NOT SEEKING CARE 2520 01:33:40,360 --> 01:33:43,000 RELATED TO SUICIDE PREVENTION. 2521 01:33:43,000 --> 01:33:44,640 MUCH OF THE PREVIOUS RESEARCH 2522 01:33:44,640 --> 01:33:47,640 ABOUT THE EFFECTIVENESS OF 2523 01:33:47,640 --> 01:33:49,560 INTERVENTIONS VOLUNTEERED TO 2524 01:33:49,560 --> 01:33:50,320 RECEIVE A PREVENTION 2525 01:33:50,320 --> 01:33:51,720 INTERVENTION WHICH AS YOU MIGHT 2526 01:33:51,720 --> 01:33:53,080 IMAGINE PROBABLY NOT THE 2527 01:33:53,080 --> 01:33:53,920 QUESTION WE SHOULD BE ASKING 2528 01:33:53,920 --> 01:33:55,720 BECAUSE THE PEOPLE WHO VOLUNTEER 2529 01:33:55,720 --> 01:33:57,120 TO RECEIVE A SUICIDE PREVENTION 2530 01:33:57,120 --> 01:33:59,240 PROGRAM ARE PROBABLY PEOPLE WHO 2531 01:33:59,240 --> 01:34:01,000 MAY HAVE LOWER RISK. 2532 01:34:01,000 --> 01:34:03,000 WHAT THAT MEANT WAS THE DESIGN 2533 01:34:03,000 --> 01:34:04,840 WE CHOSE DID NOT ACTUALLY ASK 2534 01:34:04,840 --> 01:34:07,560 PEOPLE UPFRONT AT ALL WHETHER 2535 01:34:07,560 --> 01:34:08,240 THEY WERE AT ALL INTERESTED IN 2536 01:34:08,240 --> 01:34:09,800 ANY OF THESE PROGRAMS. 2537 01:34:09,800 --> 01:34:11,120 PEOPLE WERE ASSIGNED TO BE 2538 01:34:11,120 --> 01:34:12,400 OFFERED THE PROGRAM OR NOT AND 2539 01:34:12,400 --> 01:34:14,360 THE OFFER WAS DELIVERED 2540 01:34:14,360 --> 01:34:17,880 INITIALLY, YOU KNOW, VIA PATIENT 2541 01:34:17,880 --> 01:34:18,920 PORTAL MESSAGING. 2542 01:34:18,920 --> 01:34:20,440 AND, IT WAS INTERESTING THE 2543 01:34:20,440 --> 01:34:21,680 EXPERIENCE OF OUR FRONT LINE 2544 01:34:21,680 --> 01:34:24,640 CLINICIANS IN TERMS OF TRYING TO 2545 01:34:24,640 --> 01:34:27,280 REACH OUT TO PEOPLE IN THIS WAY 2546 01:34:27,280 --> 01:34:29,000 AND WHEN THERE WAS SILENCE, 2547 01:34:29,000 --> 01:34:31,120 KNOWING THAT THAT COULD MEAN 2548 01:34:31,120 --> 01:34:35,240 VERY DIFFERENT THINGS, YOU KNOW, 2549 01:34:35,240 --> 01:34:35,880 THAT THE FAVOR TO RESPOND COULD 2550 01:34:35,880 --> 01:34:36,920 MEAN THAT PEOPLE WELCOMED AN 2551 01:34:36,920 --> 01:34:38,800 EXPRESSION OF CARING OR IT COULD 2552 01:34:38,800 --> 01:34:40,080 MEAN WE WERE IRRITATING PEOPLE 2553 01:34:40,080 --> 01:34:41,880 AND MAKING THINGS WORSE. 2554 01:34:41,880 --> 01:34:43,880 AND WE SUSPECTED BOTH THINGS 2555 01:34:43,880 --> 01:34:44,520 MIGHT HAVE BEEN HAPPENING. 2556 01:34:44,520 --> 01:34:46,360 THE CHALLENGE WAS KNOWING WHEN 2557 01:34:46,360 --> 01:34:47,960 IT WAS ONE AND WHEN IT WAS THE 2558 01:34:47,960 --> 01:34:50,720 OTHER AND HOW YOU MIGHT RESPOND 2559 01:34:50,720 --> 01:34:51,280 TO THAT. 2560 01:34:51,280 --> 01:34:52,920 WE EVEN DID THINGS FOR INSTANCE 2561 01:34:52,920 --> 01:34:56,240 WHEN WE WOULD TALK TO OUR 2562 01:34:56,240 --> 01:34:56,840 INTERVENTION STAFF ABOUT WHAT 2563 01:34:56,840 --> 01:34:58,000 ARE ARE THE HINTS. 2564 01:34:58,000 --> 01:34:59,240 FOR INSTANCE, IT'S POSSIBLE TO 2565 01:34:59,240 --> 01:35:01,200 KNOW WHEN YOU SEND SOMEONE A 2566 01:35:01,200 --> 01:35:01,400 MESSAGE. 2567 01:35:01,400 --> 01:35:03,040 HAVE THEY READ IT OR NOT. 2568 01:35:03,040 --> 01:35:04,160 HAVE THEY DELETED IT. 2569 01:35:04,160 --> 01:35:07,080 WE SORT OF JOKINGLY TALKED ABOUT 2570 01:35:07,080 --> 01:35:09,240 WE WISHED IT WERE POSSIBLE TO 2571 01:35:09,240 --> 01:35:11,040 MESSAGE THE VIGOR WITH WHICH 2572 01:35:11,040 --> 01:35:14,520 THEY HIT THE DELETE KEY, YOU 2573 01:35:14,520 --> 01:35:15,080 KNOW. 2574 01:35:15,080 --> 01:35:16,400 IS SOMEONE'S RESPONSE TO THIS 2575 01:35:16,400 --> 01:35:18,360 SORT OF, YOU KNOW, LINGERING FOR 2576 01:35:18,360 --> 01:35:19,960 A LONG TIME OVER THAT SAYING 2577 01:35:19,960 --> 01:35:22,040 THAT'S NICE, MAYBE I SHOULD GET 2578 01:35:22,040 --> 01:35:24,840 BACK TO THAT NICE PERSON, VERSUS 2579 01:35:24,840 --> 01:35:27,240 WILL THEY LEAVE ME ALONE PLEASE. 2580 01:35:27,240 --> 01:35:30,000 AND SINCE WE ACTUALLY DID 2581 01:35:30,000 --> 01:35:30,640 OBSERVE EVIDENCE POSSIBLY THAT 2582 01:35:30,640 --> 01:35:32,800 ONE OF THE INTERVENTIONS MAY 2583 01:35:32,800 --> 01:35:34,680 HAVE HAD NEGATIVE EFFECTS OR 2584 01:35:34,680 --> 01:35:36,320 BEEN HARMFUL IN SOME PEOPLE, 2585 01:35:36,320 --> 01:35:37,040 THAT WAS AN IMPORTANT QUESTION 2586 01:35:37,040 --> 01:35:39,120 WE WERE NOT ABLE TO ANSWER. 2587 01:35:39,120 --> 01:35:42,600 I'M NOT SURE THERE IS ANY ANSWER 2588 01:35:42,600 --> 01:35:43,280 TO THAT QUESTION. 2589 01:35:43,280 --> 01:35:45,840 I THINK IT'S AN INEVITABLE 2590 01:35:45,840 --> 01:35:48,720 CHALLENGE OF TRYING TO DELIVER 2591 01:35:48,720 --> 01:35:49,920 INTERVENTIONS IN THIS WAY WHEN 2592 01:35:49,920 --> 01:35:51,640 NOT ONLY DO YOU HAVE THE 2593 01:35:51,640 --> 01:35:55,680 NONVERBAL CUES, YOU DON'T EVEN 2594 01:35:55,680 --> 01:35:57,280 HAVE TONE OF VOICE IN TERMS OF 2595 01:35:57,280 --> 01:35:59,400 HOW IT THIS COMING ACROSS. 2596 01:35:59,400 --> 01:36:01,040 >> THAT'S REALLY FASCINATING. 2597 01:36:01,040 --> 01:36:02,520 I'M SORT OF THINKING TO LIKE 2598 01:36:02,520 --> 01:36:03,880 SOME OF THE SOCIAL MEDIA 2599 01:36:03,880 --> 01:36:06,600 COMPANIES THAT ARE OUT THERE 2600 01:36:06,600 --> 01:36:09,440 THAT CAN TELL HOW LONG YOU HOVER 2601 01:36:09,440 --> 01:36:11,640 OVER AN IMAGE ON YOUR SCREEN WE 2602 01:36:11,640 --> 01:36:13,120 PROBABLY FOR BETTER, WE DON'T 2603 01:36:13,120 --> 01:36:14,800 NECESSARILY HAVE THAT WITH THE 2604 01:36:14,800 --> 01:36:16,560 EHR, BUT CERTAINLY THAT COULD 2605 01:36:16,560 --> 01:36:18,680 COME IN HANDY WITH SOME OF THESE 2606 01:36:18,680 --> 01:36:18,880 THINGS. 2607 01:36:18,880 --> 01:36:20,360 IT'S REALLY FASCINATING. 2608 01:36:20,360 --> 01:36:21,880 >> IT'S POSSIBLE SOME OF THOSE 2609 01:36:21,880 --> 01:36:22,880 THINGS ARE KNOWABLE. 2610 01:36:22,880 --> 01:36:24,960 AND, YOU'RE RIGHT, IT IS AN 2611 01:36:24,960 --> 01:36:25,600 INTERESTING QUESTION. 2612 01:36:25,600 --> 01:36:27,920 CERTAINLY THIS VERGES INTO 2613 01:36:27,920 --> 01:36:30,360 REALMS THAT MANY PEOPLE WOULD 2614 01:36:30,360 --> 01:36:35,560 CONSIDER CREEPY, BUT, YOU KNOW, 2615 01:36:35,560 --> 01:36:37,280 I WOULD LIKE TO SAY OUR MOTIVES 2616 01:36:37,280 --> 01:36:38,360 ARE NOT CREEPY. 2617 01:36:38,360 --> 01:36:40,920 WE WOULD LIKE TO KNOW WHEN THE 2618 01:36:40,920 --> 01:36:42,720 THINGS WE'RE DOING ARE HELPFUL 2619 01:36:42,720 --> 01:36:44,440 AND SUPPORTED AND WHEN THEY'RE 2620 01:36:44,440 --> 01:36:45,880 BEING PERCEIVED ADDS IRRITATING 2621 01:36:45,880 --> 01:36:50,960 AND UNCARING AND HOW ARE WE TO 2622 01:36:50,960 --> 01:36:51,160 KNOW? 2623 01:36:51,160 --> 01:36:52,480 >> THAT'S A GREAT POINT. 2624 01:36:52,480 --> 01:36:54,520 JERRY OR MIGUEL, ANYTHING TO ADD 2625 01:36:54,520 --> 01:36:56,040 ON THIS TOPIC? 2626 01:36:56,040 --> 01:37:01,600 >> I HAVE SOME MORE MUNDANE 2627 01:37:01,600 --> 01:37:02,520 EXAMPLES. 2628 01:37:02,520 --> 01:37:06,120 WE DID REGULAR DATA POLLS AFTER 2629 01:37:06,120 --> 01:37:09,160 EACH WAVE JUST TO ASSURE THAT 2630 01:37:09,160 --> 01:37:10,880 THE TEXT WAS BEING APPROPRIATELY 2631 01:37:10,880 --> 01:37:12,800 INSERTED INTO THE RADIOLOGY 2632 01:37:12,800 --> 01:37:14,680 REPORT AND THEN WE ASSUMED 2633 01:37:14,680 --> 01:37:16,320 EVERYTHING STAYED THE SAME UNTIL 2634 01:37:16,320 --> 01:37:19,720 THE NEXT WAVE WHEN WE WOULD DO 2635 01:37:19,720 --> 01:37:21,040 ANOTHER DATA POLL. 2636 01:37:21,040 --> 01:37:23,760 WE ACTUALLY FOUND OUT THROUGH 2637 01:37:23,760 --> 01:37:30,360 THIS SORT OF MONITORING THAT ONE 2638 01:37:30,360 --> 01:37:32,080 OF THE SITES HAD AN UPGRADE TO 2639 01:37:32,080 --> 01:37:34,760 THEIR SOFTWARE, A DICTATION 2640 01:37:34,760 --> 01:37:37,200 SOFTWARE WHICH BROKE THE LINK 2641 01:37:37,200 --> 01:37:38,560 THAT INSERTED THE INTERVENTION 2642 01:37:38,560 --> 01:37:40,320 TEXT AND WE DIDN'T FIND OUT 2643 01:37:40,320 --> 01:37:41,960 ABOUT THAT UNTIL OUR NEXT 2644 01:37:41,960 --> 01:37:43,560 ROUTINE DATA POLL FROM THE SITE. 2645 01:37:43,560 --> 01:37:46,400 SO THAT WAS AN UNPLEASANT 2646 01:37:46,400 --> 01:37:48,040 SURPRISE SINCE WE ESSENTIALLY 2647 01:37:48,040 --> 01:37:50,320 HAD UNINTENTIONAL CROSS-OVER FOR 2648 01:37:50,320 --> 01:37:52,320 SEVERAL WEEKS AND, YOU KNOW, IF 2649 01:37:52,320 --> 01:37:53,880 THERE'S A LESSON LEARNED FROM 2650 01:37:53,880 --> 01:37:55,440 THAT, IT WOULD BE TO INCREASE 2651 01:37:55,440 --> 01:37:58,360 THE FREQUENCY THAT WE MONITORED 2652 01:37:58,360 --> 01:38:01,440 THE FIDELITY OF THE INTERVENTION 2653 01:38:01,440 --> 01:38:04,920 SO THAT WE DIDN'T GO WEEKS WITH 2654 01:38:04,920 --> 01:38:10,320 THIS UNKNOWN CROSS-OVER. 2655 01:38:10,320 --> 01:38:10,920 >> YEAH. 2656 01:38:10,920 --> 01:38:13,560 I THINK I IMAGINE SORT OF I CAN 2657 01:38:13,560 --> 01:38:18,840 SPEAK FOR ALL THE PANELISTS WHEN 2658 01:38:18,840 --> 01:38:21,040 SYSTEM UPGRADES ARE THE BANE OF 2659 01:38:21,040 --> 01:38:21,560 EVERYONE'S EXISTENCE. 2660 01:38:21,560 --> 01:38:23,200 THEY CAUSE ALL SORTS OF 2661 01:38:23,200 --> 01:38:23,520 PROBLEMS. 2662 01:38:23,520 --> 01:38:26,720 >> JUST TO BRING IT BACK, THAT 2663 01:38:26,720 --> 01:38:28,040 FITS WITH THIS THEME THAT 2664 01:38:28,040 --> 01:38:29,240 SYSTEMSES DON'T REMAIN STATIC 2665 01:38:29,240 --> 01:38:31,840 OVER TIME AND YOU HAVE TO BE 2666 01:38:31,840 --> 01:38:38,360 VIGILANT ABOUT CHANGES. 2667 01:38:38,360 --> 01:38:42,360 >> ABSOLUTELY. 2668 01:38:42,360 --> 01:38:42,600 MIGUEL. 2669 01:38:42,600 --> 01:38:44,960 >> YES. 2670 01:38:44,960 --> 01:38:49,560 FROM OUR PERSPECTIVE FOR US IT 2671 01:38:49,560 --> 01:38:53,480 WAS MANAGEMENT OF THE CONDITIONS 2672 01:38:53,480 --> 01:38:54,600 -- BUT AT THE SAME TIME SINCE WE 2673 01:38:54,600 --> 01:38:57,520 WERE A PRAGMATIC TRIAL, 2674 01:38:57,520 --> 01:39:00,080 SPECIFIED CLINIC VISITS OR QUOTE 2675 01:39:00,080 --> 01:39:02,560 UNQUOTE A STUDY INTERVENTION. 2676 01:39:02,560 --> 01:39:04,440 SO WE CAPTURED WHAT WAS 2677 01:39:04,440 --> 01:39:06,280 AVAILABLE IN THE EHR AND WE 2678 01:39:06,280 --> 01:39:09,160 LEARNED SOME OF THE METRICS THAT 2679 01:39:09,160 --> 01:39:10,640 WERE HELPFUL AS FAR AS 2680 01:39:10,640 --> 01:39:12,400 INTERVENTION DELIVERY WOULD NOT 2681 01:39:12,400 --> 01:39:14,160 BE MADE AVAILABLE BECAUSE 2682 01:39:14,160 --> 01:39:15,640 PATIENTS MIGHT NOT HAVE A GIVEN 2683 01:39:15,640 --> 01:39:17,320 TEST WHEN THEY SAY WHAT HAD BEEN 2684 01:39:17,320 --> 01:39:19,280 REQUIRED AS PART OF THE STUDY. 2685 01:39:19,280 --> 01:39:23,800 ANOTHER THING IS THAT ONE OF THE 2686 01:39:23,800 --> 01:39:29,720 LIMITATIONS WE HAD, WE WERE NOT 2687 01:39:29,720 --> 01:39:35,080 ABLE TO ALTERNATE WHEN THE TOOLS 2688 01:39:35,080 --> 01:39:37,160 WERE USED. 2689 01:39:37,160 --> 01:39:40,120 SO WE DID HANDWRITING REVIEWS 2690 01:39:40,120 --> 01:39:43,760 AND ONE OF THE THINGS IS IT 2691 01:39:43,760 --> 01:39:45,920 WOULD BE IMPORTANT TO USE MANUAL 2692 01:39:45,920 --> 01:39:49,080 REVIEWS WITH THE STUDY WHEN THE 2693 01:39:49,080 --> 01:39:50,600 STUDY HAS BEEN ONGOING. 2694 01:39:50,600 --> 01:39:53,520 BUT THESE ARE THINGS WE HAD NOT 2695 01:39:53,520 --> 01:39:56,640 ANTICIPATED AND WE LEARNED AS WE 2696 01:39:56,640 --> 01:39:58,720 WENT ALONG. 2697 01:39:58,720 --> 01:39:59,400 >> GREAT. 2698 01:39:59,400 --> 01:39:59,600 OKAY. 2699 01:39:59,600 --> 01:40:02,080 ALL RIGHT. 2700 01:40:02,080 --> 01:40:04,840 SO THE LAST -- MOVING ON TO THE 2701 01:40:04,840 --> 01:40:05,480 LAST. 2702 01:40:05,480 --> 01:40:07,880 NOW, WE'RE MONITORING OUR 2703 01:40:07,880 --> 01:40:09,240 INTERVENTION AND NOW WE'RE 2704 01:40:09,240 --> 01:40:10,360 ASSESSING OUTCOMES. 2705 01:40:10,360 --> 01:40:11,440 GREG, I THINK YOU WERE GOING TO 2706 01:40:11,440 --> 01:40:13,080 LEAD THE WAY ON THIS ONE. 2707 01:40:13,080 --> 01:40:14,680 >> SURE. 2708 01:40:14,680 --> 01:40:17,120 SO IN OUR TRIAL, THE PRIMARY 2709 01:40:17,120 --> 01:40:18,800 OUTCOME WAS A SELF-HARM EVENT, 2710 01:40:18,800 --> 01:40:20,880 ARE THE SUICIDE ATTEMPT WHICH 2711 01:40:20,880 --> 01:40:23,440 WOULD INCLUDE NONFATAL SELF-HARM 2712 01:40:23,440 --> 01:40:26,240 EVENTS AND FATAL SELF-HARM 2713 01:40:26,240 --> 01:40:26,480 EVENTS. 2714 01:40:26,480 --> 01:40:29,760 WE ASCERTAINED FROM ENCOUNTER 2715 01:40:29,760 --> 01:40:30,960 DIAGNOSIS IN THE ELECTRONIC 2716 01:40:30,960 --> 01:40:32,680 HEALTH RECORDS AND IN SOME CASES 2717 01:40:32,680 --> 01:40:34,080 INSURANCE CLAIMS WHEN PEOPLE 2718 01:40:34,080 --> 01:40:36,800 WERE RECEIVING CARE FROM SOME 2719 01:40:36,800 --> 01:40:39,000 OUTSIDE FACILITY. 2720 01:40:39,000 --> 01:40:39,960 PROBABLY WORTH MENTIONING WHY WE 2721 01:40:39,960 --> 01:40:42,800 CHOSE, WHY WE WENT THIS ROUTE AS 2722 01:40:42,800 --> 01:40:44,760 OPPOSED IT WOULD NOT HAVE BEEN 2723 01:40:44,760 --> 01:40:46,800 POSSIBLE TO SAY SURVEY PEOPLE OR 2724 01:40:46,800 --> 01:40:48,160 SEND THEM A QUESTIONNAIRE ABOUT 2725 01:40:48,160 --> 01:40:48,800 THAT. 2726 01:40:48,800 --> 01:40:49,800 BUT EVEN THOUGH THAT'S SOMETHING 2727 01:40:49,800 --> 01:40:52,240 THAT'S OFTEN DONE IN TRIALS OF 2728 01:40:52,240 --> 01:40:55,440 SUICIDE PREVENTION PROGRAMS, I 2729 01:40:55,440 --> 01:40:57,720 THINK IT'S PROBLEMATIC FOR TWO 2730 01:40:57,720 --> 01:40:57,960 REASONS. 2731 01:40:57,960 --> 01:41:01,560 IN OUR POPULATION, THIS IS A 2732 01:41:01,560 --> 01:41:02,920 RELATIVELY FORTUNATELY LOW 2733 01:41:02,920 --> 01:41:03,440 FREQUENCY EVENT. 2734 01:41:03,440 --> 01:41:05,920 WE WERE EXPECTING A RATE OF 4% 2735 01:41:05,920 --> 01:41:07,200 TO 5% OF SUICIDE ATTEMPTS. 2736 01:41:07,200 --> 01:41:10,280 IF THE OUTCOME IS OCCURRING 4% 2737 01:41:10,280 --> 01:41:13,520 TO 5% OF THE TIME IF EVEN IF YOU 2738 01:41:13,520 --> 01:41:15,800 HAVE 90% RESPOND TO A SURVEY, 2739 01:41:15,800 --> 01:41:17,040 THAT'S NOT GOOD ENOUGH, YOU 2740 01:41:17,040 --> 01:41:18,400 DON'T KNOW WHAT YOU'RE MISSING. 2741 01:41:18,400 --> 01:41:19,680 AND WE WOULD CERTAINLY NOT 2742 01:41:19,680 --> 01:41:22,480 EXPECT THAT WILLINGNESS TO 2743 01:41:22,480 --> 01:41:24,760 PARTICIPATE IN A SURVEY ABOUT 2744 01:41:24,760 --> 01:41:26,520 SUICIDAL BEHAVIOR IS UNRELATED 2745 01:41:26,520 --> 01:41:30,880 TO THE EXISTENCE OF SUICIDAL 2746 01:41:30,880 --> 01:41:32,200 BEHAVIOR. 2747 01:41:32,200 --> 01:41:34,800 JUST A COUPLE OF NONRESPONSE, WE 2748 01:41:34,800 --> 01:41:36,360 COULD NOT ASSUME THAT 2749 01:41:36,360 --> 01:41:37,880 NONRESPONSE WAS RANDOM. 2750 01:41:37,880 --> 01:41:38,960 SO IT WAS REALLY NECESSARY TO 2751 01:41:38,960 --> 01:41:39,640 USE RECORDS DATA. 2752 01:41:39,640 --> 01:41:41,800 OF THIS WAS NOT A CASE OF LETS 2753 01:41:41,800 --> 01:41:45,200 USE RECORDS DATA BECAUSE IT'S 2754 01:41:45,200 --> 01:41:45,800 CHEAPER OR LET'S USE RECORDS 2755 01:41:45,800 --> 01:41:48,360 DATA BECAUSE IT'S EASY. 2756 01:41:48,360 --> 01:41:49,000 IT WAS LET'S USE IT BECAUSE WE 2757 01:41:49,000 --> 01:41:50,400 THINK IT'S THE ONLY RIGHT AND 2758 01:41:50,400 --> 01:41:51,320 FAIR WAY TO DO IT. 2759 01:41:51,320 --> 01:41:54,400 TWO ISSUES WE HAD TO DEAL WITH. 2760 01:41:54,400 --> 01:41:57,400 ONE WAS AS YOU MAY REMEMBER 2761 01:41:57,400 --> 01:41:58,800 THERE WAS A TRANSITION RIGHT 2762 01:41:58,800 --> 01:42:00,720 BEFORE OUR TRIAL WENT INTO THE 2763 01:42:00,720 --> 01:42:00,920 FIELD. 2764 01:42:00,920 --> 01:42:03,720 AND WE'D ACTUALLY DONE FOR OTHER 2765 01:42:03,720 --> 01:42:06,080 REASONS BECAUSE WE'VE BEEN DOING 2766 01:42:06,080 --> 01:42:07,880 RESEARCH IN THIS AREA FOR A 2767 01:42:07,880 --> 01:42:08,440 WHILE. 2768 01:42:08,440 --> 01:42:09,320 WE'VE DONE SOME WORK AND WHEN 2769 01:42:09,320 --> 01:42:12,000 YOU LOOKED AT THE CLINICAL TEXT, 2770 01:42:12,000 --> 01:42:13,800 HOW OFTEN COULD YOU TRUST OR 2771 01:42:13,800 --> 01:42:19,000 WHEN COULD YOU TRUST RECORDED 2772 01:42:19,000 --> 01:42:19,520 DIAGNOSES OF SELF-HARM. 2773 01:42:19,520 --> 01:42:20,720 ONE OF THE BIG QUESTIONS WAS THE 2774 01:42:20,720 --> 01:42:24,400 CATEGORY OF THINGS WHERE THINGS 2775 01:42:24,400 --> 01:42:26,360 WERE SAID TO HAVE UNDETERMINED 2776 01:42:26,360 --> 01:42:29,080 INTENT AND DO YOU COUNT THOSE OR 2777 01:42:29,080 --> 01:42:32,480 NOT COUNT THOSE AS SELF-HARM 2778 01:42:32,480 --> 01:42:32,680 EVENT. 2779 01:42:32,680 --> 01:42:34,360 THERE WAS A MAJOR CHANGE IN THE 2780 01:42:34,360 --> 01:42:36,080 CODING, SO WE HAD SORT OF SOME 2781 01:42:36,080 --> 01:42:38,640 IDEAS ABOUT HOW THINGS WOULD 2782 01:42:38,640 --> 01:42:40,640 CROSS OVER, BUT IT WAS NECESSARY 2783 01:42:40,640 --> 01:42:43,400 IN THE TRIAL ACTUALLY TO DO SOME 2784 01:42:43,400 --> 01:42:45,240 SORT OF NEW VALIDATION WORK AND 2785 01:42:45,240 --> 01:42:48,920 WE REALLY FOCUSED ON SELF-HARM 2786 01:42:48,920 --> 01:42:50,400 EVENTS THAT MIGHT BE MISSED. 2787 01:42:50,400 --> 01:42:52,520 THOSE INCLUDED INJURIES AND 2788 01:42:52,520 --> 01:42:54,280 POISONINGS THAT WERE SAID TO 2789 01:42:54,280 --> 01:42:56,320 HAVE UNDETERMINED INTENT. 2790 01:42:56,320 --> 01:43:00,040 THEY INCLUDED CERTAIN CATEGORIES 2791 01:43:00,040 --> 01:43:01,520 OF EVENTS THAT INCLUDED CERTAIN 2792 01:43:01,520 --> 01:43:03,240 ACCIDENTS, BUT BASED ON OUR 2793 01:43:03,240 --> 01:43:06,200 JUDGMENT, WE NEEDED TO LOOK 2794 01:43:06,200 --> 01:43:10,200 THERE, FOR INSTANCE IN PEOPLE IN 2795 01:43:10,200 --> 01:43:11,720 SELF-HARM, WE MIGHT SAY WE 2796 01:43:11,720 --> 01:43:13,560 SHOULD CHECK THAT OUT. 2797 01:43:13,560 --> 01:43:16,560 OR THERE STILL ARE IN ICD SOME 2798 01:43:16,560 --> 01:43:24,560 KIND OF CODING INTENT THAT'S NOT 2799 01:43:24,560 --> 01:43:25,280 REQUIRED. 2800 01:43:25,280 --> 01:43:26,520 SO THERE WERE INJURIES. 2801 01:43:26,520 --> 01:43:29,160 SO WE HAD TO DO SOME CHART WORK. 2802 01:43:29,160 --> 01:43:31,040 AND WE SET UP A ROBUST PROCESS 2803 01:43:31,040 --> 01:43:34,440 FOR DOING THAT AND WHAT WE DID 2804 01:43:34,440 --> 01:43:35,320 FIND WAS THERE WERE SOME EVENTS 2805 01:43:35,320 --> 01:43:37,400 WHICH WERE NOT CODED TO 2806 01:43:37,400 --> 01:43:39,000 SELF-HARM THAT ADDED TO THE 2807 01:43:39,000 --> 01:43:41,400 TOTAL NUMBER OF OUTCOMES OF ONLY 2808 01:43:41,400 --> 01:43:42,720 ABLE 10%. 2809 01:43:42,720 --> 01:43:43,760 SO IT WOULD NOT HAVE 2810 01:43:43,760 --> 01:43:44,520 SUBSTANTIALLY CHANGED THE 2811 01:43:44,520 --> 01:43:47,160 RESULTS OF THE TRIAL TO INCLUDE 2812 01:43:47,160 --> 01:43:48,240 OR EXCLUDE THOSE. 2813 01:43:48,240 --> 01:43:50,040 SO WE THOUGHT WE CAME UP WITH 2814 01:43:50,040 --> 01:43:53,360 SOME EXTRA WORK, BUT A SORT OF 2815 01:43:53,360 --> 01:43:54,800 REASONABLE SOLUTION TO THAT. 2816 01:43:54,800 --> 01:43:57,200 THE THING WE STILL, THERE IS NO 2817 01:43:57,200 --> 01:43:59,520 GOOD WAY TO ADDRESS IS THE IDEA 2818 01:43:59,520 --> 01:44:03,280 THAT CERTAINLY ASCERTAINMENT OF 2819 01:44:03,280 --> 01:44:07,120 SELF-HARM EVENTS USING RECORDS 2820 01:44:07,120 --> 01:44:08,080 MEANS WE. 2821 01:44:08,080 --> 01:44:12,640 SO, WE DO NOT KNOW ABOUT 2822 01:44:12,640 --> 01:44:13,800 SELF-HARM EVENTS WHERE PEOPLE 2823 01:44:13,800 --> 01:44:15,160 NEVER WENT TO THE EMERGENCY 2824 01:44:15,160 --> 01:44:16,880 DEPARTMENT OR EVER TOLD A DOCTOR 2825 01:44:16,880 --> 01:44:17,640 ABOUT IT. 2826 01:44:17,640 --> 01:44:20,320 IT CERTAINLY IS PLAUSIBLE THAT 2827 01:44:20,320 --> 01:44:21,680 PARTICIPATING IN INTERVENTION 2828 01:44:21,680 --> 01:44:24,640 THAT'S INTENDED TO PREVENT OR 2829 01:44:24,640 --> 01:44:25,800 REDUCE SELF-HARM MIGHT INFLUENCE 2830 01:44:25,800 --> 01:44:28,040 THE LIKELIHOOD THAT PEOPLE WOULD 2831 01:44:28,040 --> 01:44:35,360 SEEK CARE FOR SELF-HARM. 2832 01:44:35,360 --> 01:44:45,760 WE LOOKED AT THAT THAT. 2833 01:44:46,920 --> 01:44:49,720 THE IDEA OR LIKELIHOOD THAT THE 2834 01:44:49,720 --> 01:44:50,680 INTERVENTION WOULD BE LESS. 2835 01:44:50,680 --> 01:44:52,880 WHEN YOU SAY THE EVENT WAS SORT 2836 01:44:52,880 --> 01:44:55,120 OF LESS DISCRETIONARY OR MORE 2837 01:44:55,120 --> 01:44:56,560 SEVERE AND ALTHOUGH THERE WERE A 2838 01:44:56,560 --> 01:44:58,560 SMALLER NUMBER OF EVENTS IN THAT 2839 01:44:58,560 --> 01:45:02,360 CATEGORY, SO STATISTICAL POWER 2840 01:45:02,360 --> 01:45:04,160 WAS LOWER, THE PATTERN OF 2841 01:45:04,160 --> 01:45:05,840 RESULTS WAS THE SAME. 2842 01:45:05,840 --> 01:45:08,040 THAT WAS STILL A BIG CAVEAT IN 2843 01:45:08,040 --> 01:45:09,240 INTERPRETING THE RESULTS OF THE 2844 01:45:09,240 --> 01:45:11,360 TRIAL AND SAYING WE CANNOT BE 2845 01:45:11,360 --> 01:45:12,600 SURE THAT THE INTERVENTION MIGHT 2846 01:45:12,600 --> 01:45:22,360 HAVE CHANGED THE PROCESS OF 2847 01:45:22,360 --> 01:45:22,720 ASCERTAINMENT. 2848 01:45:22,720 --> 01:45:25,760 >> GREAT. 2849 01:45:25,760 --> 01:45:27,440 REALLY FASCINATING CHALLENGES TO 2850 01:45:27,440 --> 01:45:28,160 WORK THROUGH. 2851 01:45:28,160 --> 01:45:32,360 ANY OTHER PANELISTS WANT TO ADD 2852 01:45:32,360 --> 01:45:32,520 ON? 2853 01:45:32,520 --> 01:45:34,760 IF YOU WANT TO RAISE A HAND. 2854 01:45:34,760 --> 01:45:35,000 ANDREA. 2855 01:45:35,000 --> 01:45:39,040 >> I'LL JUST ADD A FEW QUICK 2856 01:45:39,040 --> 01:45:39,280 POINTS. 2857 01:45:39,280 --> 01:45:40,560 ONE, WE TALKED A LITTLE BIT 2858 01:45:40,560 --> 01:45:44,120 ABOUT IN THE LOVELY PRESENTATION 2859 01:45:44,120 --> 01:45:50,080 ABOUT THE CHALLENGES OF 2860 01:45:50,080 --> 01:45:51,920 ACCESSING RURAL POPULATIONS. 2861 01:45:51,920 --> 01:45:55,160 WE'RE ABLE TO VERY ACCURATELY 2862 01:45:55,160 --> 01:45:56,920 DETERMINE PATIENTS PORTAL 2863 01:45:56,920 --> 01:45:57,320 STATUS. 2864 01:45:57,320 --> 01:45:59,040 DO THEY HAVE AN ACCOUNT, ARE 2865 01:45:59,040 --> 01:46:01,160 THEY USING THEIR PORTAL AND IF 2866 01:46:01,160 --> 01:46:02,960 NOT, WE'RE ABLE TO DETERMINE 2867 01:46:02,960 --> 01:46:06,120 WHETHER THEY'RE IN A BROAD BAND, 2868 01:46:06,120 --> 01:46:10,120 INACCESSIBLE ZIP CODE. 2869 01:46:10,120 --> 01:46:11,800 WE SEND THEM PAPER AND I DON'T 2870 01:46:11,800 --> 01:46:13,440 KNOW IF THIS IS UNIQUE TO MAIL, 2871 01:46:13,440 --> 01:46:18,160 BUT WE'VE DEVELOPED A WAY BY 2872 01:46:18,160 --> 01:46:20,280 WHICH WE AUTOMATICALLY SEND THEM 2873 01:46:20,280 --> 01:46:26,040 A PRINTED MAILED PROM IN LIEU OF 2874 01:46:26,040 --> 01:46:28,320 ADMINISTERING IT VIA THE PORTAL. 2875 01:46:28,320 --> 01:46:30,680 WE'VE ALLEGATION BEEN ABLE TO 2876 01:46:30,680 --> 01:46:32,240 CONTINGENT ON RESPONSE RATES, WE 2877 01:46:32,240 --> 01:46:34,680 WERE ABLE TO ADD PEOPLE 2878 01:46:34,680 --> 01:46:39,040 AUTOMATICALLY TO PRINT LISTS SO 2879 01:46:39,040 --> 01:46:41,200 THAT THEY'RE SENT PRINT VERSIONS 2880 01:46:41,200 --> 01:46:46,040 AND WE FOUND THAT INCREASE OUR 2881 01:46:46,040 --> 01:46:49,160 RESPONSE RATES AMONG RURAL 2882 01:46:49,160 --> 01:46:52,720 SITUATED PATIENTS. 2883 01:46:52,720 --> 01:46:55,720 WE HAD A VERY HEART STOPPING 2884 01:46:55,720 --> 01:46:55,920 EVENT. 2885 01:46:55,920 --> 01:46:57,920 WE BLATANTLY DISCOVERED HOW 2886 01:46:57,920 --> 01:46:59,680 VULNERABLE SOME OF THIS LOGIC IS 2887 01:46:59,680 --> 01:47:01,920 TO SYSTEM UPGRADES AND TWICE NOW 2888 01:47:01,920 --> 01:47:06,720 HAVE HAD EVENTS WHERE PROMS WERE 2889 01:47:06,720 --> 01:47:09,160 NOT BEING SENT OUT ALTHOUGH THE 2890 01:47:09,160 --> 01:47:10,000 PROXY MEASURES THAT WE WERE 2891 01:47:10,000 --> 01:47:11,680 USING TO MONITOR FIDELITY 2892 01:47:11,680 --> 01:47:12,320 SUGGESTED THEY WERE. 2893 01:47:12,320 --> 01:47:15,200 SO WE HAD GAPS IN DATA 2894 01:47:15,200 --> 01:47:16,480 COLLECTION AND SIMILAR TO 2895 01:47:16,480 --> 01:47:20,480 JERRY'S EXPERIENCE, IT TAUGHT US 2896 01:47:20,480 --> 01:47:22,120 VALIDATE, MONITOR CLOSELY AND 2897 01:47:22,120 --> 01:47:26,360 UNTIL YOU LOOK AT THE ACTUAL 2898 01:47:26,360 --> 01:47:28,440 DATA, DON'T BELIEVE ANYTHING. 2899 01:47:28,440 --> 01:47:31,280 AND, ACTUALLY, THAT EXPERIENCE 2900 01:47:31,280 --> 01:47:34,600 LED US TO TWO I THINK TWO 2901 01:47:34,600 --> 01:47:37,640 DISCOVERIES, ONE, BECAUSE THE 2902 01:47:37,640 --> 01:47:38,920 PROMISE MEASURES ARE BEING 2903 01:47:38,920 --> 01:47:41,160 ENCOURAGED THROUGHOUT THE MAYO 2904 01:47:41,160 --> 01:47:42,760 ENTERPRISE, A LOT OF OTHER 2905 01:47:42,760 --> 01:47:44,040 RESEARCH AND CLINICAL 2906 01:47:44,040 --> 01:47:48,680 INITIATIVES WERE COLLECTING 2907 01:47:48,680 --> 01:47:50,440 PROMISE DATA. 2908 01:47:50,440 --> 01:47:51,000 SO WE WERE ABLE TO SCAVENGE 2909 01:47:51,000 --> 01:47:51,680 THEIR RESULTS AND THAT PROVED 2910 01:47:51,680 --> 01:47:52,840 VERY EFFECTIVE. 2911 01:47:52,840 --> 01:47:54,680 THE OTHER THING IS THAT WE 2912 01:47:54,680 --> 01:47:56,400 BROADENED OUR CLINIC BASED 2913 01:47:56,400 --> 01:47:58,120 ASSIGNMENT OF PROMS TO ANY 2914 01:47:58,120 --> 01:48:00,640 HEALTH CARE ENCOUNTER TO MAKE 2915 01:48:00,640 --> 01:48:02,880 SURE THAT IF RURALLY PORTAL 2916 01:48:02,880 --> 01:48:04,720 NONUSERS CAME DURING THE 2917 01:48:04,720 --> 01:48:08,120 FOLLOWUP INTERVAL FOR CARE AT A 2918 01:48:08,120 --> 01:48:10,040 BRICKS AND MORTAR ENCOUNTER, 2919 01:48:10,040 --> 01:48:11,920 THEY WERE VERY LIKELY TO BE 2920 01:48:11,920 --> 01:48:17,160 ADMINISTERED OUR STUDY PROMS. 2921 01:48:17,160 --> 01:48:17,400 >> GREAT. 2922 01:48:17,400 --> 01:48:17,600 OKAY. 2923 01:48:17,600 --> 01:48:20,560 JERRY OR MIGUEL, ANYTHING TO 2924 01:48:20,560 --> 01:48:21,000 ADD? 2925 01:48:21,000 --> 01:48:23,360 OTHERWISE WE CAN MOVE ON TO THE 2926 01:48:23,360 --> 01:48:24,800 NEXT QUESTION. 2927 01:48:24,800 --> 01:48:25,000 JERRY. 2928 01:48:25,000 --> 01:48:25,760 >> YEAH. 2929 01:48:25,760 --> 01:48:28,040 I HAVE JUST A COUPLE OF QUICK 2930 01:48:28,040 --> 01:48:28,280 POINTS. 2931 01:48:28,280 --> 01:48:32,080 YOU KNOW, ARE AS A REMINDER, WE 2932 01:48:32,080 --> 01:48:36,760 RELIED ON CPT AND ICD CODES TO 2933 01:48:36,760 --> 01:48:39,640 ASSESS OUR OUTCOMES AND, YOU 2934 01:48:39,640 --> 01:48:41,720 KNOW, WE ALSO HAD THE JOY AND 2935 01:48:41,720 --> 01:48:44,720 PRIVILEGE OF LIVING THROUGH THE 2936 01:48:44,720 --> 01:48:46,560 ICD 9 TO ICD 10 TRANSITION WHICH 2937 01:48:46,560 --> 01:48:49,560 I GUESS UNLIKE GREG'S TRIAL 2938 01:48:49,560 --> 01:48:51,520 WHICH WAS RIGHT AT THE BEGINNING 2939 01:48:51,520 --> 01:48:53,400 OF HIS DATA COLLECTION, FOR US, 2940 01:48:53,400 --> 01:48:54,680 IT WAS RIGHT IN THE MIDDLE. 2941 01:48:54,680 --> 01:49:00,400 AND SO WE HAD TO GO THROUGH A 2942 01:49:00,400 --> 01:49:01,720 VARIETY OF TRANSLATION 2943 01:49:01,720 --> 01:49:03,720 GYMNASTICS IN ORDER TO COME UP 2944 01:49:03,720 --> 01:49:05,000 AND ASSESS OUR FINAL OUTCOMES 2945 01:49:05,000 --> 01:49:05,720 BECAUSE OF THIS. 2946 01:49:05,720 --> 01:49:07,880 SO I GUESS ONE LESSON LEARNED IS 2947 01:49:07,880 --> 01:49:12,240 IF YOU CAN ANTICIPATE THE NEXT 2948 01:49:12,240 --> 01:49:13,520 ICD ITERATION, AVOID DOING YOUR 2949 01:49:13,520 --> 01:49:16,920 TRIAL IN THE MIDDLE OF IT. 2950 01:49:16,920 --> 01:49:20,920 BUT EVEN IF THE CODES ARE THE 2951 01:49:20,920 --> 01:49:23,720 SAME FROM DIFFERENT SITES, 2952 01:49:23,720 --> 01:49:27,080 BEWARE THAT THEY MAY BE USED 2953 01:49:27,080 --> 01:49:29,600 DIFFERENTLY AND THAT CODING 2954 01:49:29,600 --> 01:49:32,600 PRACTICES ARE NOT IDENTICAL AND 2955 01:49:32,600 --> 01:49:35,000 SO EVEN THOUGH YOU THINK YOU'RE 2956 01:49:35,000 --> 01:49:37,960 GETTING THE SAME DATA FROM SITE 2957 01:49:37,960 --> 01:49:41,320 A AND SITE B, IN FACT, YOU MAY 2958 01:49:41,320 --> 01:49:42,720 BE GETTING DIFFERENT INFORMATION 2959 01:49:42,720 --> 01:49:46,960 AND SO IT TAKES SOME 2960 01:49:46,960 --> 01:49:48,320 INVESTIGATIVE WORK TO MAKE SURE 2961 01:49:48,320 --> 01:49:51,320 THAT SITES ARE CODING THE SAME 2962 01:49:51,320 --> 01:49:54,560 PROCESSES AND THE SAME DISEASES 2963 01:49:54,560 --> 01:49:54,800 SIMILARLY. 2964 01:49:54,800 --> 01:49:58,040 AND THEN, OF COURSE, THERE, WE 2965 01:49:58,040 --> 01:50:01,280 CAME ACROSS ONE SITE WHICH 2966 01:50:01,280 --> 01:50:01,880 DIDN'T USE THE SAME CODE, SO 2967 01:50:01,880 --> 01:50:03,920 THEY HAD THEIR OWN PROPRIETARY 2968 01:50:03,920 --> 01:50:06,560 SET OF CODES THAT THEY USED AND 2969 01:50:06,560 --> 01:50:13,800 SO THAT REQUIRED YET ANOTHER 2970 01:50:13,800 --> 01:50:14,880 TRANSLATION EFFORT. 2971 01:50:14,880 --> 01:50:20,000 AND SO CODES ARE NOT WHAT THEY 2972 01:50:20,000 --> 01:50:26,000 SEEM TO BE ALWAYS. 2973 01:50:26,000 --> 01:50:29,680 >> ALSO THE CAPTURE OF OUTCOMES 2974 01:50:29,680 --> 01:50:33,640 FROM THE EHR WORKED WELL FOR ALL 2975 01:50:33,640 --> 01:50:38,400 OF THE SITES. 2976 01:50:38,400 --> 01:50:40,280 IT WAS VERY CLEAR WHAT WE NEE 2977 01:50:40,280 --> 01:50:41,720 ALSO STRAIGHT FORWARD. 2978 01:50:41,720 --> 01:50:45,240 IN THE OTHER ONE -- BUT THE 2979 01:50:45,240 --> 01:50:46,000 ORIGINAL INTERMEDIARY THAT WAS 2980 01:50:46,000 --> 01:50:49,280 GOING TO SUPPLY THE DATA WAS 2981 01:50:49,280 --> 01:50:55,120 CHANGED IN THE MIDDLE OF THE 2982 01:50:55,120 --> 01:50:58,200 PROCESS APPROVED THE SHARING OF 2983 01:50:58,200 --> 01:50:58,400 DATA. 2984 01:50:58,400 --> 01:51:00,360 THE AGREEMENT HAD BEEN INITIALLY 2985 01:51:00,360 --> 01:51:02,160 FOR THE DATE. 2986 01:51:02,160 --> 01:51:04,000 IT WAS FOR CARING FOR DATA OF 2987 01:51:04,000 --> 01:51:06,040 CLINICAL OPERATIONS, BUT NOT FOR 2988 01:51:06,040 --> 01:51:06,320 RESEARCH. 2989 01:51:06,320 --> 01:51:09,080 SO WE HAD TO GO BACK TO NUMEROUS 2990 01:51:09,080 --> 01:51:12,960 PRIVACY OFFICERS INTO THE HEALTH 2991 01:51:12,960 --> 01:51:14,400 SYSTEM UNTIL FINALLY THERE WAS A 2992 01:51:14,400 --> 01:51:20,120 WAY TO ALLOW FOR THE SHARING OF 2993 01:51:20,120 --> 01:51:23,800 DATA FOR RESEARCH PURPOSES. 2994 01:51:23,800 --> 01:51:26,960 SO THERE WAS A DELAY IN ALLOWING 2995 01:51:26,960 --> 01:51:29,240 THAT TO BE SHARED WITH US FOR 2996 01:51:29,240 --> 01:51:33,440 THE PURPOSES OF RESEARCH SO IT 2997 01:51:33,440 --> 01:51:39,640 WAS AN UNPLEASANT SURPRISE, BUT 2998 01:51:39,640 --> 01:51:43,680 CERTAINLY BROUGHT SOME DELAYS. 2999 01:51:43,680 --> 01:51:47,400 >> GREAT. 3000 01:51:47,400 --> 01:51:57,840 I THINK WE HAVE A COUPLE 3001 01:52:01,960 --> 01:52:05,600 QUESTIONS LEFT. 3002 01:52:05,600 --> 01:52:08,560 I KNOW GREG AND ANDREA, BOTH OF 3003 01:52:08,560 --> 01:52:11,520 YOU HAVE SOME NICE ANECDOTES OF 3004 01:52:11,520 --> 01:52:13,560 WHAT CAN GO WRONG OR NOT GO 3005 01:52:13,560 --> 01:52:14,520 WRONG WITH THIS. 3006 01:52:14,520 --> 01:52:17,440 WOULD ANY OF YOU LIKE TO START? 3007 01:52:17,440 --> 01:52:18,000 >> SURE. 3008 01:52:18,000 --> 01:52:19,560 AT LEAST IN TERMS OF WHAT'S 3009 01:52:19,560 --> 01:52:20,960 HAPPENING WITH THE HEALTH 3010 01:52:20,960 --> 01:52:23,280 SYSTEMS I KNOW BEST KAISER, 3011 01:52:23,280 --> 01:52:24,520 WASHINGTON, BUT ALSO THE OTHER 3012 01:52:24,520 --> 01:52:27,160 HEALTH SYSTEMS IN OUR NETWORK, I 3013 01:52:27,160 --> 01:52:30,520 THINK, YOU KNOW IN TERMS OF 3014 01:52:30,520 --> 01:52:33,640 COLLECTING AND RECORDING 3015 01:52:33,640 --> 01:52:34,320 INFORMATION ABOUT GENDER 3016 01:52:34,320 --> 01:52:36,120 IDENTITY, WE'RE SAYING WE THINK 3017 01:52:36,120 --> 01:52:38,520 WE KNOW HOW TO DO THIS. 3018 01:52:38,520 --> 01:52:41,600 WE'VE CREATED THE RIGHT 3019 01:52:41,600 --> 01:52:42,440 INFRASTRUCTURE TO DO THIS AND 3020 01:52:42,440 --> 01:52:46,400 GETTING UP TO SPEED ON 3021 01:52:46,400 --> 01:52:48,000 SYSTEMATICALLY DOING IT. 3022 01:52:48,000 --> 01:52:49,800 AT THIS POINT, WE'RE STILL ON 3023 01:52:49,800 --> 01:52:51,640 HOW WELL IS THAT. 3024 01:52:51,640 --> 01:52:53,480 WE'RE STILL PROBABLY IN THE 3025 01:52:53,480 --> 01:52:55,240 SINGLE DIGITS OF PERCENTAGES AND 3026 01:52:55,240 --> 01:52:58,440 I THINK THE HEALTH SYSTEMS ARE 3027 01:52:58,440 --> 01:52:59,280 PROCEEDING A LITTLE BIT 3028 01:52:59,280 --> 01:53:00,880 CAUTIOUSLY AND I CAN TELL YOU IN 3029 01:53:00,880 --> 01:53:02,680 TERMS OF ASKING THESE QUESTIONS 3030 01:53:02,680 --> 01:53:04,080 ESPECIALLY TO OUR YOUNGER 3031 01:53:04,080 --> 01:53:05,520 MEMBERS, THERE HAS BEEN A LITTLE 3032 01:53:05,520 --> 01:53:07,960 BIT OF PUSHBACK ABOUT THAT, SO 3033 01:53:07,960 --> 01:53:10,000 WE HAVE TO TREAD CAREFULLY. 3034 01:53:10,000 --> 01:53:12,120 ALTHOUGH I'LL SAY AT KAISER 3035 01:53:12,120 --> 01:53:13,440 WASHINGTON, WE'VE BEEN ASKING 3036 01:53:13,440 --> 01:53:15,160 PEOPLE NOW FOR WELL OVER A 3037 01:53:15,160 --> 01:53:16,160 DECADE WHETHER THEY HAVE ACCESS 3038 01:53:16,160 --> 01:53:16,920 TO FIREARMS. 3039 01:53:16,920 --> 01:53:19,000 YOU KNOW, WE'RE NOT UNACCUSTOMED 3040 01:53:19,000 --> 01:53:21,600 TO TRYING TO TREAD INTO SOMEWHAT 3041 01:53:21,600 --> 01:53:23,160 CHALLENGING TERRITORY. 3042 01:53:23,160 --> 01:53:25,160 SO I THINK THAT IS MOVING ALONG 3043 01:53:25,160 --> 01:53:26,040 NOW. 3044 01:53:26,040 --> 01:53:27,600 TO BE CLEAR, I SHOULD HAVE SAID 3045 01:53:27,600 --> 01:53:30,120 AT THE BEGINNING, THIS IS 3046 01:53:30,120 --> 01:53:31,640 CLEARLY A CASE WHERE HEALTH 3047 01:53:31,640 --> 01:53:33,000 SYSTEMS MAKE THE DECISIONS ABOUT 3048 01:53:33,000 --> 01:53:34,640 WHETHER THEY WANT TO DO THIS IN 3049 01:53:34,640 --> 01:53:36,120 TERMS OF DELIVERING BETTER 3050 01:53:36,120 --> 01:53:36,880 HEALTH CARE. 3051 01:53:36,880 --> 01:53:39,680 DOING IT FOR RESEARCH, NO ONE IS 3052 01:53:39,680 --> 01:53:41,080 EVER GOING TO DO THIS FOR THE 3053 01:53:41,080 --> 01:53:45,360 PURPOSES OF MAKING RESEARCH 3054 01:53:45,360 --> 01:53:45,880 EASIER. 3055 01:53:45,880 --> 01:53:46,960 THIS IS ABOUT DELIVERING HEALTH 3056 01:53:46,960 --> 01:53:47,640 CARE. 3057 01:53:47,640 --> 01:53:49,880 IF YOU'RE IN A MEETING IN THE 3058 01:53:49,880 --> 01:53:51,960 HEALTH SYSTEM TALKING ABOUT 3059 01:53:51,960 --> 01:53:53,000 THIS, DIFFERENT PEOPLE MEAN 3060 01:53:53,000 --> 01:53:54,720 REALLY DIFFERENT THINGS WHEN 3061 01:53:54,720 --> 01:54:00,400 THEY SAY THAT AND YOU WOULD ASK 3062 01:54:00,400 --> 01:54:03,800 ABOUT DIFFERENT THINGS DEPENDING 3063 01:54:03,800 --> 01:54:06,360 ON YOUR PURPOSE AND THERE I 3064 01:54:06,360 --> 01:54:07,520 THINK IT'S AN INTERESTING 3065 01:54:07,520 --> 01:54:08,400 CHALLENGE BECAUSE I'M NOT SURE 3066 01:54:08,400 --> 01:54:10,880 WE'RE AT THE PLACE WHERE WE HAVE 3067 01:54:10,880 --> 01:54:14,240 A CLEAR ENOUGH CONSENSUS ABOUT 3068 01:54:14,240 --> 01:54:15,200 WHAT QUESTIONS SHOULD BE ASKED 3069 01:54:15,200 --> 01:54:17,360 OF WHOM AND WHEN TO BE ABLE TO 3070 01:54:17,360 --> 01:54:20,640 SAY IT'S TIME TO GO ON THAT. 3071 01:54:20,640 --> 01:54:23,520 AND I THINK, YOU KNOW, WHEN I AS 3072 01:54:23,520 --> 01:54:25,760 A RESEARCHER HAVE THE PRIVILEGE, 3073 01:54:25,760 --> 01:54:27,240 YOU KNOW, BECAUSE IT IS A 3074 01:54:27,240 --> 01:54:28,640 PRIVILEGE OF BEING IN ON THOSE 3075 01:54:28,640 --> 01:54:30,160 MEETINGS AND BEING ABLE TO 3076 01:54:30,160 --> 01:54:31,920 APINE, YOU KNOW, MY ROLE IS MORE 3077 01:54:31,920 --> 01:54:37,840 ALONG THE LINES OF, OKAY, ARE WE 3078 01:54:37,840 --> 01:54:39,800 CLEAR WHAT QUESTION WE'RE ASKING 3079 01:54:39,800 --> 01:54:43,640 HERE AND TO TEAR OUT MY THREE 3080 01:54:43,640 --> 01:54:46,360 REMAINING HAIRS WHEN ANYBODY 3081 01:54:46,360 --> 01:54:50,480 SUGGESTIONS WE RECORD SOMETHING 3082 01:54:50,480 --> 01:54:52,280 AS FREE TEXT. 3083 01:54:52,280 --> 01:54:56,000 >> ANYONE WANT TO ADD? 3084 01:54:56,000 --> 01:54:56,240 ANDREA. 3085 01:54:56,240 --> 01:54:58,920 >> I COULDN'T AGREE WITH GREG 3086 01:54:58,920 --> 01:54:59,760 MORE ABOUT FREE TEXT. 3087 01:54:59,760 --> 01:55:02,520 WE WANT YOUR HAIRS TO SURVIVE. 3088 01:55:02,520 --> 01:55:06,560 ONE ANECDOTE ABOUT THE SOGI 3089 01:55:06,560 --> 01:55:09,920 QUESTIONS, MAYO TURNED THOSE ON 3090 01:55:09,920 --> 01:55:13,960 ABOUT 18 MONTHS AGO AND I THINK 3091 01:55:13,960 --> 01:55:16,960 OUR EXPERIENCE HIGHLIGHTS AN 3092 01:55:16,960 --> 01:55:17,760 IMPORTANT CHALLENGE. 3093 01:55:17,760 --> 01:55:19,480 THEY DECIDED TO MAKE THE 3094 01:55:19,480 --> 01:55:22,360 QUESTIONS PERMANENTLY AVAILABLE 3095 01:55:22,360 --> 01:55:24,720 TO PATIENTS SHOULD THEY DECIDE 3096 01:55:24,720 --> 01:55:28,280 TO CHANGE THEM, THEIR RESPONSES. 3097 01:55:28,280 --> 01:55:29,560 THIS CREATED A FATHERER BECAUSE 3098 01:55:29,560 --> 01:55:32,520 THEY NEVER WENT AWAY AND 3099 01:55:32,520 --> 01:55:34,040 PATIENTS ASSUMED THEY HAD TO 3100 01:55:34,040 --> 01:55:39,960 KEEP REPORTING THAT MAYO IN A 3101 01:55:39,960 --> 01:55:44,040 VERY BENEGATIVE SIT WAY WAS 3102 01:55:44,040 --> 01:55:45,800 CHECKING ON THEIR GENDER 3103 01:55:45,800 --> 01:55:47,000 IDENTITY AND SEXUAL ORIENTATION. 3104 01:55:47,000 --> 01:55:49,040 WE WENT THROUGH THIS ISSUE TOO 3105 01:55:49,040 --> 01:55:51,360 WITH OUR CONVERSATION GUIDE. 3106 01:55:51,360 --> 01:55:54,920 WE WANT IT TO BE PERMANENTLY 3107 01:55:54,920 --> 01:55:57,360 AVAILABLE, BUT PATIENTS 3108 01:55:57,360 --> 01:55:59,080 MISINTERPRETED THAT AS WE WANTED 3109 01:55:59,080 --> 01:56:01,200 TO COMPLETE AND REAFFIRM THEIR 3110 01:56:01,200 --> 01:56:03,360 MODALITY SELECTIONS AND THERE 3111 01:56:03,360 --> 01:56:05,840 REALLY ISN'T ANY NICE WAY OF -- 3112 01:56:05,840 --> 01:56:07,000 WE ULTIMATELY CREATED TWO 3113 01:56:07,000 --> 01:56:07,640 CONVERSATION GUIDES. 3114 01:56:07,640 --> 01:56:10,240 ONE IS THE INITIAL AND ONE AS 3115 01:56:10,240 --> 01:56:10,760 THE FOLLOWUP. 3116 01:56:10,760 --> 01:56:12,840 IT WAS JUST EASY TO COPY AND 3117 01:56:12,840 --> 01:56:13,640 CREATE ANOTHER VERSION. 3118 01:56:13,640 --> 01:56:16,440 BUT EPIC CURRENTLY DOESN'T HAVE 3119 01:56:16,440 --> 01:56:19,080 ANY NICE WAY TO HAVE SENSITIVE 3120 01:56:19,080 --> 01:56:20,400 QUESTIONNAIRES LIKE THAT THAT 3121 01:56:20,400 --> 01:56:25,800 YOU'D LIKE IT TO BE OPEN ENDED. 3122 01:56:25,800 --> 01:56:28,200 SO INTIMATE PARTNER VIOLENCE OR 3123 01:56:28,200 --> 01:56:29,720 ANY INSTANT SITUATION THAT MIGHT 3124 01:56:29,720 --> 01:56:31,360 SOMEONE MIGHT LIKE TO USE THIS 3125 01:56:31,360 --> 01:56:33,560 TYPE OF REPORTING TO CALL TO THE 3126 01:56:33,560 --> 01:56:36,680 HEALTH CARE SYSTEM'S ATTENTION: 3127 01:56:36,680 --> 01:56:39,840 THERE'S NO EASY WAY TO MAKE 3128 01:56:39,840 --> 01:56:42,040 THOSE ITEMS AVAILABLE IN A 3129 01:56:42,040 --> 01:56:43,960 SUBTLE AND ONGOING BASIS. 3130 01:56:43,960 --> 01:56:45,920 THE OTHER THING I'D LIKE TO 3131 01:56:45,920 --> 01:56:47,920 POINT OUT, IT'S NOW BEEN ABOUT 3132 01:56:47,920 --> 01:56:50,360 TWO AND A HALF YEARS SINCE WE'VE 3133 01:56:50,360 --> 01:56:53,640 BEEN COLLECTING EPIC'S SOCIAL 3134 01:56:53,640 --> 01:56:55,360 DETERMINANTS OF HEALTH DATA ON 3135 01:56:55,360 --> 01:56:56,880 AN ENTERPRISE WIDE BASIS. 3136 01:56:56,880 --> 01:56:59,080 THIS IS FROM A POLL AT THE END 3137 01:56:59,080 --> 01:57:02,120 OF MARCH. 3138 01:57:02,120 --> 01:57:04,200 WE'VE HAD ROUGHLY BUT ONLY A 3139 01:57:04,200 --> 01:57:06,760 MILLION RESPONSES. 3140 01:57:06,760 --> 01:57:12,560 AND IT SEEMS IN A DEMOGRAPHIC 3141 01:57:12,560 --> 01:57:14,840 ASSESSMENT THE FOLKS THAT YOU 3142 01:57:14,840 --> 01:57:17,000 MOST WANT TO LEARN ABOUT ARE NOT 3143 01:57:17,000 --> 01:57:20,160 THE ONES THAT ARE ANSWERING THE 3144 01:57:20,160 --> 01:57:20,680 QUESTION. 3145 01:57:20,680 --> 01:57:25,080 AND I THINK TO GREG'S POINT, 3146 01:57:25,080 --> 01:57:27,280 WHAT ITEMS WE USE, THE 3147 01:57:27,280 --> 01:57:32,800 CONSTRUCTS THAT WE THINK ARE 3148 01:57:32,800 --> 01:57:34,160 CLINICALLY ACTIONABLE, WHICH 3149 01:57:34,160 --> 01:57:38,000 ONES WE SELECT AND THE ITEMS WE 3150 01:57:38,000 --> 01:57:39,440 SELECT TO QUERY THOSE, SOME OF 3151 01:57:39,440 --> 01:57:43,640 THE SDOH DOE MAINS IN EPIC HAVE 3152 01:57:43,640 --> 01:57:44,760 FIVE OR SIX ITEMS. 3153 01:57:44,760 --> 01:57:50,720 SO IT BECOMES A FAIRLY PREDIJOUS 3154 01:57:50,720 --> 01:57:51,600 QUESTIONNAIRE, A LONG ONE WHEN 3155 01:57:51,600 --> 01:57:53,960 ALL OF THOSE ARE ADDED UP. 3156 01:57:53,960 --> 01:57:57,240 SO I THINK THERE ARE SOME VERY 3157 01:57:57,240 --> 01:58:00,320 IMPORTANT ONGOING CHALLENGES. 3158 01:58:00,320 --> 01:58:01,800 >> ALL RIGHT. 3159 01:58:01,800 --> 01:58:03,920 SO I THINK A REALLY FANTASTIC 3160 01:58:03,920 --> 01:58:04,200 RESPONSE. 3161 01:58:04,200 --> 01:58:06,000 IN THE INTEREST OF TIME, I THINK 3162 01:58:06,000 --> 01:58:09,840 WE'LL JUST MOVE ON TO THE FINAL 3163 01:58:09,840 --> 01:58:10,200 QUESTION. 3164 01:58:10,200 --> 01:58:11,560 REAL QUICK LIGHTNING ROUND PART 3165 01:58:11,560 --> 01:58:13,600 TWO, WHAT'S ON YOUR WISH LIST 3166 01:58:13,600 --> 01:58:16,760 FOR THE NEXT TEN YEARS? 3167 01:58:16,760 --> 01:58:18,520 ANDREA, SINCE YOU SPOKE LAST, 3168 01:58:18,520 --> 01:58:22,040 I'LL GO TO YOU NEXT IF YOU WANT 3169 01:58:22,040 --> 01:58:24,200 TO RUN DOWN YOUR LIST. 3170 01:58:24,200 --> 01:58:27,600 >> I WANT PARAMETERIZABLE 3171 01:58:27,600 --> 01:58:31,840 QUESTIONNAIRES SO IT'S NOT A 3172 01:58:31,840 --> 01:58:34,280 ONE-SIZE-FITS-ALL FOR THE 3173 01:58:34,280 --> 01:58:34,640 INTERINTERVAL. 3174 01:58:34,640 --> 01:58:37,080 AUTO MATED TOOLS. 3175 01:58:37,080 --> 01:58:38,760 IT TOOK A HUGE AMOUNT OF BUILD 3176 01:58:38,760 --> 01:58:41,240 TO BE ABLE TO AUTOMATICALLY 3177 01:58:41,240 --> 01:58:42,360 RESPOND TO PATIENTS 3178 01:58:42,360 --> 01:58:43,720 QUESTIONNAIRE CHOICES IN THE 3179 01:58:43,720 --> 01:58:45,840 CONVERSATION GUIDE AND THAT'S A 3180 01:58:45,840 --> 01:58:46,080 BARRIER. 3181 01:58:46,080 --> 01:58:49,680 THE COST OF THIS BUILD IS 3182 01:58:49,680 --> 01:58:49,960 PROHIBITIVE. 3183 01:58:49,960 --> 01:58:53,240 SO IF THEY HAD SOME SIMPLE 3184 01:58:53,240 --> 01:58:55,840 FOUNDATION SYSTEM TOOLS FOR 3185 01:58:55,840 --> 01:58:57,160 RESPONDING TO PATIENT 3186 01:58:57,160 --> 01:59:01,200 INFORMATION, NOT NAMELY PROM 3187 01:59:01,200 --> 01:59:03,800 RESPONSES, ALSO, MORE EASILY 3188 01:59:03,800 --> 01:59:06,720 PROGRAMTIZABLE TOOLS FOR THE 3189 01:59:06,720 --> 01:59:12,760 TYPE OF CO-HOHORT IDENTIFICATIO 3190 01:59:12,760 --> 01:59:15,840 AND FUNDING WITH A LESSER TRIAL. 3191 01:59:15,840 --> 01:59:18,720 SO THOSE WOULD BE MYS AND. 3192 01:59:18,720 --> 01:59:19,480 >> GREG. 3193 01:59:19,480 --> 01:59:20,560 YOU'RE NEXT ON MY LIST. 3194 01:59:20,560 --> 01:59:21,840 I'LL GO TO YOU. 3195 01:59:21,840 --> 01:59:23,200 >> YEAH. 3196 01:59:23,200 --> 01:59:24,360 THIS IS MAYBE A LITTLE NEARBY 3197 01:59:24,360 --> 01:59:26,120 FOR HOW WE SPECIALIZE, BUT I'M 3198 01:59:26,120 --> 01:59:28,680 INTERESTED IN TRYING TO 3199 01:59:28,680 --> 01:59:32,160 UNDERSTAND MORE ABOUT PEOPLES' 3200 01:59:32,160 --> 01:59:33,240 NEGATIVE EXPERIENCES WITH 3201 01:59:33,240 --> 01:59:34,280 MEDICATIONS AND WE JUST DON'T 3202 01:59:34,280 --> 01:59:39,320 HAVE 3203 01:59:39,320 --> 01:59:41,200 >> AS A CLINICIAN YOU CERTAINLY 3204 01:59:41,200 --> 01:59:43,400 LEARN YOU WOULD NEVER EVER 3205 01:59:43,400 --> 01:59:45,080 REPORT THE REASON SOMEBODY 3206 01:59:45,080 --> 01:59:47,560 STOPPED MAKING A MEDICINE IS 3207 01:59:47,560 --> 01:59:51,680 BECAUSE OF AN ADVERSE EFFECT 3208 01:59:51,680 --> 01:59:54,640 WHEN YOU SUBSEQUENTLY PRESCRIPT 3209 01:59:54,640 --> 01:59:56,960 ANOTHER YOU'D HAVE TO CLICK 3210 01:59:56,960 --> 01:59:59,320 THROUGH THREE WARNINGS ON A 3211 01:59:59,320 --> 02:00:00,920 SUPPOSED CLASS INTOLERANCE. 3212 02:00:00,920 --> 02:00:02,960 I'M GETTING ON A SOAPBOX. 3213 02:00:02,960 --> 02:00:05,640 THE CURRENT PROCESS FOR 3214 02:00:05,640 --> 02:00:07,480 RECORDING THAT DISCOURAGES 3215 02:00:07,480 --> 02:00:08,840 RECORDING ANY USEFUL 3216 02:00:08,840 --> 02:00:09,160 INFORMATION. 3217 02:00:09,160 --> 02:00:10,440 THAT'S SOMETHING I'D LIKE TO SEE 3218 02:00:10,440 --> 02:00:19,800 US DO BETTER. 3219 02:00:19,800 --> 02:00:21,280 >> MIGUEL. 3220 02:00:25,560 --> 02:00:28,000 >> A WAY OF INTERVENTIONS 3221 02:00:28,000 --> 02:00:32,600 WITHOUT AN EXPENSIVE BILL AND TO 3222 02:00:32,600 --> 02:00:33,720 CAPTURE THIS ACROSS MULTIPLE 3223 02:00:33,720 --> 02:00:38,640 HEALTH SYSTEMS. 3224 02:00:38,640 --> 02:00:42,840 I THINK WE REALIZE MANY PATIENTS 3225 02:00:42,840 --> 02:00:45,920 GO THROUGH MANY PLACES AND WE'RE 3226 02:00:45,920 --> 02:00:47,080 MISSING IMPORTANT DATA WHEN WE 3227 02:00:47,080 --> 02:00:48,960 JUST LOOK AT THE E.H.R. OF THE 3228 02:00:48,960 --> 02:00:49,640 HEALTH SYSTEM. 3229 02:00:49,640 --> 02:00:51,920 SOME TOOLS ALLOW FOR SHARING BUT 3230 02:00:51,920 --> 02:00:53,120 THERE'S STILL INCOMPLETE AND 3231 02:00:53,120 --> 02:00:55,440 REQUIRE LEVELS OF ACTIVATION AND 3232 02:00:55,440 --> 02:01:01,040 DO NOT WORK ACROSS ALL SITES. 3233 02:01:01,040 --> 02:01:06,600 THAT HAS TO BE NEEDS TO BE 3234 02:01:06,600 --> 02:01:06,800 FIXED. 3235 02:01:06,800 --> 02:01:11,600 >> LAST BUT NOT LEAST, TERRY. 3236 02:01:11,600 --> 02:01:15,040 >> I'M WITH MIGUEL AND ANDREA 3237 02:01:15,040 --> 02:01:20,280 AND MAKING IT EASY TO 3238 02:01:20,280 --> 02:01:27,320 INCORPORATE STANDARDIZED PRONGS 3239 02:01:27,320 --> 02:01:32,320 AND CUSTOMIZABLE FOR THE PURPOSE 3240 02:01:32,320 --> 02:01:35,320 OF CARE AND ADMINISTER THEM NOT 3241 02:01:35,320 --> 02:01:38,560 ONLY AT SCHEDULED VISITS BUT AT 3242 02:01:38,560 --> 02:01:42,680 REGULAR FOLLOW-UP INTERVALS 3243 02:01:42,680 --> 02:01:46,400 APART FROM PATIENT CARE 3244 02:01:46,400 --> 02:01:46,760 ENCOUNTERS. 3245 02:01:46,760 --> 02:01:49,240 THE ISSUE OF CAPTURING CARE 3246 02:01:49,240 --> 02:01:52,680 OUTSIDE YOUR OWN HEALTH STUCK IS 3247 02:01:52,680 --> 02:01:57,280 CRITICALLY IMPORTANT FOR CLINIC 3248 02:01:57,280 --> 02:02:03,720 CARE AS WELL AS RESEARCH. 3249 02:02:03,720 --> 02:02:04,960 >> THANK YOU ALL. 3250 02:02:04,960 --> 02:02:06,960 THAT WAS OUR PREPARED LIST. 3251 02:02:06,960 --> 02:02:09,840 NOW WE HAVE TIME FOR QUESTIONS. 3252 02:02:09,840 --> 02:02:12,960 I DON'T KNOW THERE'S ANYTHING 3253 02:02:12,960 --> 02:02:13,680 FROM THE GROUP. 3254 02:02:13,680 --> 02:02:16,600 I DO HAVE BASED ON WHAT JERRY 3255 02:02:16,600 --> 02:02:21,880 JUST MENTIONED I HAVE A 3256 02:02:21,880 --> 02:02:24,520 FOLLOW-UP QUESTION MAYBE I'LL 3257 02:02:24,520 --> 02:02:27,840 POSE IT BECAUSE I DON'T SEE 3258 02:02:27,840 --> 02:02:28,560 ANYTHING IMMEDIATELY. 3259 02:02:28,560 --> 02:02:33,840 THE QUESTION OF CARE OUTSIDE THE 3260 02:02:33,840 --> 02:02:35,120 HEALTH CARE SYSTEM AND ONE WAY 3261 02:02:35,120 --> 02:02:38,200 TO GET AT THAT WITH THE 3262 02:02:38,200 --> 02:02:39,240 LIMITATIONS AND E.H.R. HAS 3263 02:02:39,240 --> 02:02:44,280 CAPABILITIES WHERE YOU CAN START 3264 02:02:44,280 --> 02:02:50,280 TO PULL IN INFORMATION FROM CARE 3265 02:02:50,280 --> 02:02:53,720 AND THE RULES OF THE ROAD ARE 3266 02:02:53,720 --> 02:02:58,920 SUCH YOU CAN'T LEVERAGE THE DATA 3267 02:02:58,920 --> 02:03:02,240 FOR RESEARCH. 3268 02:03:02,240 --> 02:03:04,600 IT'S COME UP IN SEVERAL TRIALS 3269 02:03:04,600 --> 02:03:06,320 CAN WE QUERY THEM AND ABSTRACT 3270 02:03:06,320 --> 02:03:10,720 THEM FROM THE CHART. 3271 02:03:10,720 --> 02:03:11,440 THERE'S DIFFERENT THOUGHTS HOW 3272 02:03:11,440 --> 02:03:12,320 THAT GOES OR MIGHT GO. 3273 02:03:12,320 --> 02:03:17,800 I DON'T KNOW IF THE PANELISTS 3274 02:03:17,800 --> 02:03:19,640 HAVE ANY THOUGHTS AROUND WHETHER 3275 02:03:19,640 --> 02:03:24,720 WE CAN PIGGY BACK ON THE 3276 02:03:24,720 --> 02:03:25,280 INTEROPERABILITY, HEALTH 3277 02:03:25,280 --> 02:03:26,640 EXCHANGE MECHANISMS THAT MAY BE 3278 02:03:26,640 --> 02:03:29,480 IN PLACE. 3279 02:03:29,480 --> 02:03:31,600 >> THIS MAY ANSWER YOUR 3280 02:03:31,600 --> 02:03:33,560 QUESTION, TECHNICALLY HOW THAT'S 3281 02:03:33,560 --> 02:03:35,320 WORKED OUT AT MY HEALTH SYSTEM 3282 02:03:35,320 --> 02:03:36,880 AND THE HEALTH SYSTEMS WE WORK 3283 02:03:36,880 --> 02:03:38,800 ON WITH THE POLICIES ABOUT USING 3284 02:03:38,800 --> 02:03:40,040 THAT INFORMATION IS THAT 3285 02:03:40,040 --> 02:03:41,920 INFORMATION THAT WE WOULD ACCESS 3286 02:03:41,920 --> 02:03:45,200 VIA CARE EVERYONE OR WHATEVER 3287 02:03:45,200 --> 02:03:49,360 THE BRAND NAME OF SUCH ANOTHER 3288 02:03:49,360 --> 02:03:51,960 SYSTEM IS TO USE THOSE IDENTIFY 3289 02:03:51,960 --> 02:03:52,640 RESEARCH PARTICIPANTS OR 3290 02:03:52,640 --> 02:03:54,400 SOMETHING ELSE LIKE THAT IS 3291 02:03:54,400 --> 02:03:56,000 CONSIDERED OUT OF BOUNDS. 3292 02:03:56,000 --> 02:03:59,360 BUT ONCE EVEN IN THE CONTEXT OF 3293 02:03:59,360 --> 02:04:00,640 A RESEARCH PROJECT, ONCE ONE 3294 02:04:00,640 --> 02:04:02,640 CROSSES OVER THE BOUNDARY TO 3295 02:04:02,640 --> 02:04:04,080 BECOME A CARE PROVIDER YOU'RE 3296 02:04:04,080 --> 02:04:08,080 NOW A PROVIDER OF CARE AND THIS 3297 02:04:08,080 --> 02:04:09,640 IS PART OF THE PERSON'S CARE AND 3298 02:04:09,640 --> 02:04:12,480 YOU SHOULD OFFER THE BEST CARE 3299 02:04:12,480 --> 02:04:13,960 AVAILABLE AND THAT'S USING THE 3300 02:04:13,960 --> 02:04:15,320 RECORDS AND THAT'S THE BOUNDARY 3301 02:04:15,320 --> 02:04:15,640 ESTABLISHED. 3302 02:04:15,640 --> 02:04:18,840 THIS CAME UP SPECIFICALLY IN OUR 3303 02:04:18,840 --> 02:04:21,280 TRIAL IT WAS NOT OKAY TO USE 3304 02:04:21,280 --> 02:04:24,640 THOSE DATA OR TRY TO USE THE 3305 02:04:24,640 --> 02:04:27,480 DATA TO IDENTIFY POTENTIAL 3306 02:04:27,480 --> 02:04:29,400 PARTICIPANTS OR ASCERTAIN 3307 02:04:29,400 --> 02:04:32,160 OUTCOMES BUT WHEN A CARE MANAGER 3308 02:04:32,160 --> 02:04:33,240 WAS TRYING TO PROVIDER CARE 3309 02:04:33,240 --> 02:04:36,640 MANAGEMENT AND MAKE SURE PEOPLE 3310 02:04:36,640 --> 02:04:38,560 WERE GET APPROPRIATE MEDICAL 3311 02:04:38,560 --> 02:04:40,200 HEALTH CARE FOR SUICIDE ATTEMPTS 3312 02:04:40,200 --> 02:04:42,680 THAT WAS CONSIDERED INBOUNDS FOR 3313 02:04:42,680 --> 02:04:43,400 THAT. 3314 02:04:43,400 --> 02:04:45,480 >> THAT'S A REALLY IMPORTANT 3315 02:04:45,480 --> 02:04:48,600 NUANCE ON HOW THAT MIGHT GO. 3316 02:04:48,600 --> 02:04:50,800 WE DO HAVE A QUESTION FROM 3317 02:04:50,800 --> 02:04:51,000 WENDY. 3318 02:04:51,000 --> 02:04:53,520 SO HAS ANYTHING EXCHANGED IN THE 3319 02:04:53,520 --> 02:04:54,320 E.H.R. SYSTEM AT YOUR 3320 02:04:54,320 --> 02:04:56,160 INSTITUTIONS SINCE YOU STARTED 3321 02:04:56,160 --> 02:04:57,160 YOUR TRIALS THAT WOULD HAVE MADE 3322 02:04:57,160 --> 02:04:58,600 IT EASIER DO COLLECT THE DATA 3323 02:04:58,600 --> 02:05:08,880 THAT YOU NEEDED? 3324 02:05:09,240 --> 02:05:09,560 ANYONE? 3325 02:05:09,560 --> 02:05:11,560 >> I'M CONCERNED HOW QUICKLY THE 3326 02:05:11,560 --> 02:05:13,640 SYSTEMS ARE EVOLVING AND IF 3327 02:05:13,640 --> 02:05:15,640 THERE'S THINGS THAT ALREADY 3328 02:05:15,640 --> 02:05:18,760 CHANGED NOW THAT ESPECIALLY LIKE 3329 02:05:18,760 --> 02:05:21,960 JERRY AND GREG YOU STARTED YOUR 3330 02:05:21,960 --> 02:05:23,320 TRIALS A WHILE AGO AND HAD TO 3331 02:05:23,320 --> 02:05:24,880 USE THE SYSTEM YOU USED THAT THE 3332 02:05:24,880 --> 02:05:25,240 POINTS. 3333 02:05:25,240 --> 02:05:26,840 HAVE THINGS IMPROVED. 3334 02:05:26,840 --> 02:05:29,320 IS IT EASIER TO LAUNCH YOUR 3335 02:05:29,320 --> 02:05:30,360 TRIAL THAN WHEN YOU ACTUALLY 3336 02:05:30,360 --> 02:05:34,800 LAUNCHED? 3337 02:05:34,800 --> 02:05:37,280 ANDREA TALKED ABOUT SOME WAYS WE 3338 02:05:37,280 --> 02:05:38,840 WERE DELIVERING INTERVENTIONS 3339 02:05:38,840 --> 02:05:42,200 VIA THE PORTAL WERE PRETTY 3340 02:05:42,200 --> 02:05:43,680 CLUNKY AT THE BEGINNING, GOT 3341 02:05:43,680 --> 02:05:45,840 BETTER IN TERMS OF WHAT YOU 3342 02:05:45,840 --> 02:05:49,640 COULD EMBED IN MESSAGES AND NOW 3343 02:05:49,640 --> 02:05:50,880 ARE EVEN BETTER. 3344 02:05:50,880 --> 02:05:53,960 ANDREA MENTIONED THE BETTER 3345 02:05:53,960 --> 02:05:58,240 CAPABLEABILITIY -- CAPABILITIES 3346 02:05:58,240 --> 02:05:59,400 THAT CAME THROUGH AND THAT COULD 3347 02:05:59,400 --> 02:06:09,880 IMPROVE AND DO BETTER THERE. 3348 02:06:10,600 --> 02:06:13,000 AND IT'S BEEN AS I SAID OVER A 3349 02:06:13,000 --> 02:06:14,600 DECADE SINCE WE STARTED THINKING 3350 02:06:14,600 --> 02:06:17,560 ABOUT OUT SO OUR SYSTEMS HAVE 3351 02:06:17,560 --> 02:06:22,160 NOT EVOLVED QUICKLY BUT THEY'RE 3352 02:06:22,160 --> 02:06:24,080 EVOLVING NONETHELESS AND WE'RE 3353 02:06:24,080 --> 02:06:26,360 ABOUT TO HOPEFULLY IMPLEMENT 3354 02:06:26,360 --> 02:06:28,880 UNIFORM COLLECTION OF THE 3355 02:06:28,880 --> 02:06:30,360 PROMISED PAIN MEASURES FOR 3356 02:06:30,360 --> 02:06:32,200 EXAMPLE IN CERTAIN CLINICS AND 3357 02:06:32,200 --> 02:06:35,160 THAT IDEALLY WOULD BE HELPFUL IN 3358 02:06:35,160 --> 02:06:36,880 GETTING SOME INFORMATION THAT WE 3359 02:06:36,880 --> 02:06:38,360 WERE NOT ABLE TO GET THAT WE 3360 02:06:38,360 --> 02:06:41,160 WANTED TO GET AS PART OF OUR 3361 02:06:41,160 --> 02:06:41,600 TRIAL. 3362 02:06:41,600 --> 02:06:46,720 SO I THINK WE'RE MAYBE AT THE 3363 02:06:46,720 --> 02:06:52,120 CUSP OF A SLOW EVOLUTION THAT 3364 02:06:52,120 --> 02:06:58,720 WILL HELP. 3365 02:06:58,720 --> 02:07:01,720 >> TWO INNOVATIONS. 3366 02:07:01,720 --> 02:07:04,520 EPIC HAS RECEIVED PRESSURE TO 3367 02:07:04,520 --> 02:07:06,400 IMPROVE CAPABILITY TO PRESENT 3368 02:07:06,400 --> 02:07:07,520 PATIENTS WITH THEIR OWN PROM 3369 02:07:07,520 --> 02:07:10,120 SCORES AND MEANS OF TRACKING 3370 02:07:10,120 --> 02:07:13,800 THEM AND LINKING INTERVENTION TO 3371 02:07:13,800 --> 02:07:14,680 THEIR PROMPT SCORES. 3372 02:07:14,680 --> 02:07:18,360 THAT OPENS A HUGE OPPORTUNITY 3373 02:07:18,360 --> 02:07:20,760 FOR US TO EMBED MATERIAL. 3374 02:07:20,760 --> 02:07:28,280 IT'S EASIER IF SOMETHING IS A 3375 02:07:28,280 --> 02:07:29,840 FUNCTIONALITY IN THE FOUNDATION 3376 02:07:29,840 --> 02:07:31,760 SYSTEM WE JUST NEED TO TWEAK 3377 02:07:31,760 --> 02:07:32,560 PARAMETERS. 3378 02:07:32,560 --> 02:07:36,120 I'M VERY EXCITED AND OPTIMISTIC 3379 02:07:36,120 --> 02:07:39,280 ABOUT THIS CAPABILITY TO CUSTOM 3380 02:07:39,280 --> 02:07:40,760 I'M PATIENT INDIVIDUAL LEVEL 3381 02:07:40,760 --> 02:07:42,360 PRESENTATION OF PRONG DATA TO 3382 02:07:42,360 --> 02:07:42,600 PATIENTS. 3383 02:07:42,600 --> 02:07:47,480 I THINK THAT'S REALLY GOING TO 3384 02:07:47,480 --> 02:07:54,360 BE EXCITING THE SECOND IS A 3385 02:07:54,360 --> 02:08:02,680 FUNCTIONALITY CALLED COMPASS 3386 02:08:02,680 --> 02:08:06,760 ROSE ONE FOR ACTIVE CARE AND 3387 02:08:06,760 --> 02:08:11,600 COPD BUT COMMONLY TROD PATHWAYS 3388 02:08:11,600 --> 02:08:12,600 APPRECIATES WITH FAIRLY 3389 02:08:12,600 --> 02:08:15,520 CONSISTENT MILESTONES OR STAGES 3390 02:08:15,520 --> 02:08:19,880 AND THEY ARE AN AGGREGATE OF 3391 02:08:19,880 --> 02:08:22,640 PROMS, VIDEOS, PATIENT EDUCATION 3392 02:08:22,640 --> 02:08:24,600 MATERIALS AND THERE'S ONE FOR 3393 02:08:24,600 --> 02:08:25,880 SLEEP DISTURBANCE. 3394 02:08:25,880 --> 02:08:27,960 THEY'RE NOT TRIVIAL TO BUILD BUT 3395 02:08:27,960 --> 02:08:30,920 I DON'T THINK THEY'RE NEARLY THE 3396 02:08:30,920 --> 02:08:34,360 HEAVY LIFT WE WENT THROUGH AT 3397 02:08:34,360 --> 02:08:36,200 THE BEGINNING OF NO HARM. 3398 02:08:36,200 --> 02:08:38,080 THESE ARE EMERGENT CAPABILITIES 3399 02:08:38,080 --> 02:08:43,120 WE CAN LOOK FORWARD TO IN THE 3400 02:08:43,120 --> 02:08:53,520 NOT TOO DISTANT FUTURE. 3401 02:08:57,480 --> 02:08:59,880 >> IN CONVERSATIONS SEVEN YEARS 3402 02:08:59,880 --> 02:09:02,040 AGO IT WOULD HAVE BEEN SHORT AND 3403 02:09:02,040 --> 02:09:04,120 THE RESEARCH IS PROBABLY NOT 3404 02:09:04,120 --> 02:09:06,360 GOING TO BE POSSIBLE AND NOW 3405 02:09:06,360 --> 02:09:10,160 THERE'S MUCH MORE WILLINGNESS TO 3406 02:09:10,160 --> 02:09:12,560 DO A BUILD AND HIGHER COMFORT 3407 02:09:12,560 --> 02:09:14,680 LEVEL TO SAY YES, WE CAN MAKE 3408 02:09:14,680 --> 02:09:16,720 THEM WORK IN THE SYSTEM IT'S 3409 02:09:16,720 --> 02:09:22,560 GOING TO TAKE EXTRA WORK AND 3410 02:09:22,560 --> 02:09:22,920 RESOURCES. 3411 02:09:22,920 --> 02:09:33,200 WE CAN WORK AND 3412 02:09:42,840 --> 02:09:46,720 >> E.H.R.'S WERE NOT DEVELOPED 3413 02:09:46,720 --> 02:09:47,200 FOR RESEARCH 3414 02:09:47,200 --> 02:09:49,480 THEY WERE DESIGNED TO SUPPORT 3415 02:09:49,480 --> 02:09:49,720 BILLING. 3416 02:09:49,720 --> 02:09:50,800 WHAT WE HAVE DONE IS LEVERAGED 3417 02:09:50,800 --> 02:09:55,840 THE TOOLS FOR OUR PURPOSES AND 3418 02:09:55,840 --> 02:10:02,120 RECONFIGURE THEM BECAUSE THERE'S 3419 02:10:02,120 --> 02:10:07,040 REVENUE CYCLE FOLKS AND CODES 3420 02:10:07,040 --> 02:10:10,160 AND WITH HOSPITALIZATIONS 3421 02:10:10,160 --> 02:10:14,360 WHETHER IMPORTANT CLINICAL 3422 02:10:14,360 --> 02:10:16,640 EVENTS OCCURRED THAT ARE NOT 3423 02:10:16,640 --> 02:10:23,600 ALWAYS ABLE TO QUERY. 3424 02:10:23,600 --> 02:10:27,520 >> THE LAST POINT IS E.H.R.s FOR 3425 02:10:27,520 --> 02:10:32,640 THE MOST PART UPGRADE CYCLE IS 3426 02:10:32,640 --> 02:10:33,000 GETTING FASTER. 3427 02:10:33,000 --> 02:10:36,640 AND EVERY THREE AND FIVE AND 10 3428 02:10:36,640 --> 02:10:38,560 YEARS BEFORE PEOPLE WOULD 3429 02:10:38,560 --> 02:10:40,640 UPGRADE AND NOW THEY'RE PUSHING 3430 02:10:40,640 --> 02:10:45,640 IT ON A CYCLE. 3431 02:10:45,640 --> 02:10:54,720 THAT GETS EVERYBODY AND FOR 3432 02:10:54,720 --> 02:11:01,920 SMALLER UPGRADES PUT IT'S A MORE 3433 02:11:01,920 --> 02:11:05,280 OF THINGS TO BREAK BUT NOT 3434 02:11:05,280 --> 02:11:06,720 NECESSARILY WAITING FOR THE NEXT 3435 02:11:06,720 --> 02:11:07,920 PIECE OF FUNCTIONALITY. 3436 02:11:07,920 --> 02:11:10,360 IT COULD BE DELIVERED MORE 3437 02:11:10,360 --> 02:11:11,000 FREQUENTLY THAN YOU MIGHT HAVE 3438 02:11:11,000 --> 02:11:21,320 OTHERWISE HAVE SEEN. 3439 02:11:23,720 --> 02:11:25,040 >> THINK WE'RE AT TIME AND THANK 3440 02:11:25,040 --> 02:11:26,480 YOU FOR RESPONDING TO THE 3441 02:11:26,480 --> 02:11:26,720 QUESTIONS. 3442 02:11:26,720 --> 02:11:31,600 I FOUND THIS VERY ENLIGHTENING. 3443 02:11:31,600 --> 02:11:33,280 AM I TURNING THIS BACK OVER TO 3444 02:11:33,280 --> 02:11:34,360 YOU? 3445 02:11:34,360 --> 02:11:37,960 >> YES. 3446 02:11:37,960 --> 02:11:39,280 WE ARE GOING TO TAKE BRIEF 3447 02:11:39,280 --> 02:11:39,880 BREAK. 3448 02:11:39,880 --> 02:11:41,720 WE ARE PLANNING TO COME BACK AT 3449 02:11:41,720 --> 02:11:45,920 3:20 SO PLEASE GET UP AND 3450 02:11:45,920 --> 02:11:48,400 STRETCH AND WE'LL SEE YOU BACK 3451 02:11:48,400 --> 02:11:51,000 IN 10 MINUTES TO START OUR NEXT 3452 02:11:51,000 --> 02:11:52,040 PANEL ABOUT TALKING ABOUT 3453 02:11:52,040 --> 02:11:53,200 DIFFERENT STUDY DESIGNS. 3454 02:11:53,200 --> 02:12:00,720 WE'LL SEE YOU ALL BACK SHORTLY. 3455 02:12:00,720 --> 02:14:50,280 >>GREETINGS 3456 02:14:50,280 --> 02:14:52,600 >>SHOWS UP IN THE SIGNS AND 3457 02:14:52,600 --> 02:14:57,560 LOTS OF RANDOMIZED DESIGNS. 3458 02:14:57,560 --> 02:14:58,600 IT'S PRAGMATIC WHICH WE CAN LOOK 3459 02:14:58,600 --> 02:15:00,920 UP THE DEFINITION BUT IN MY 3460 02:15:00,920 --> 02:15:06,960 SIMPLE THINKING, PRAGMATIC MEANS 3461 02:15:06,960 --> 02:15:14,000 THERE'S GOING TO BE VARIATION 3462 02:15:14,000 --> 02:15:17,480 IT'S FLEXIBLE IN ELIGIBILITY FOR 3463 02:15:17,480 --> 02:15:22,600 SUBJECTS AND FLEXIBLE IN 3464 02:15:22,600 --> 02:15:24,920 INTERVENTION AND MAYBE SOMETIMES 3465 02:15:24,920 --> 02:15:26,880 TOO FLEXIBILITY IN STUDY 3466 02:15:26,880 --> 02:15:27,280 CONDUCT. 3467 02:15:27,280 --> 02:15:29,480 AT THE DESIGN STAGE HOW DO YOU 3468 02:15:29,480 --> 02:15:36,000 ADDRESS AND THINK ABOUT AND 3469 02:15:36,000 --> 02:15:41,760 IDENTIFY THOSE IMPORTANT DESIGN 3470 02:15:41,760 --> 02:15:46,600 AND ANALYSIS AND AS WE'LL SEE IN 3471 02:15:46,600 --> 02:15:48,800 THE PRESENTATIONS THAT FOLLOW, 3472 02:15:48,800 --> 02:15:53,800 THESE SOURCES OF VARIATION ARE 3473 02:15:53,800 --> 02:15:56,840 SOMETIMES NOT JUST HARMLESS OR 3474 02:15:56,840 --> 02:15:59,080 IMPACTFUL BUT CAN LEAD TO BIAS 3475 02:15:59,080 --> 02:16:04,800 AND NEED TO ADDRESS REMOVAL OF 3476 02:16:04,800 --> 02:16:10,800 BIAS. 3477 02:16:10,800 --> 02:16:13,880 ANOTHER WE DISCUSSED IS THE 3478 02:16:13,880 --> 02:16:15,880 CRITICAL ELEMENT OF TIME AND THE 3479 02:16:15,880 --> 02:16:16,800 EARLIER PANEL TALKED ABOUT ALL 3480 02:16:16,800 --> 02:16:22,600 THE CHANGES THAT CAN HAPPEN OVER 3481 02:16:22,600 --> 02:16:25,240 TIME. 3482 02:16:25,240 --> 02:16:27,400 THAT'S A PROMINENT FEATURE AND 3483 02:16:27,400 --> 02:16:32,840 MANY ASPECT TO THINK ABOUT TO 3484 02:16:32,840 --> 02:16:41,360 HELP STRUCTURE AND WE SAW THAT 3485 02:16:41,360 --> 02:16:44,000 IN COVID AND CHANGES IN STANDARD 3486 02:16:44,000 --> 02:16:46,600 OF CARE AND THE CATCH-ALL BUCKET 3487 02:16:46,600 --> 02:16:51,640 OF WHAT I PICKED UP FROM A 3488 02:16:51,640 --> 02:16:56,720 GUIDANCE DOCUMENT INTERCURRENT 3489 02:16:56,720 --> 02:17:06,880 FORCES. 3490 02:17:07,480 --> 02:17:08,960 MAYBE THEY'RE INTRINSIC CHANGES 3491 02:17:08,960 --> 02:17:10,160 IN TERMS OF NATIONAL POLICIES 3492 02:17:10,160 --> 02:17:15,680 AND CODING ISSUES. 3493 02:17:15,680 --> 02:17:21,480 WE WANTED TO HIGHLIGHT FOUR 3494 02:17:21,480 --> 02:17:25,760 SPECIFIC TRIALS WE WANTED A 3495 02:17:25,760 --> 02:17:26,920 STRUCTURED FRAMEWORK FOR 3496 02:17:26,920 --> 02:17:31,840 THINKING ABOUT THOSE AND DRAW 3497 02:17:31,840 --> 02:17:36,640 OUT THESE THREE ELEMENTS IT'S 3498 02:17:36,640 --> 02:17:40,000 PRAGMATIC AND LONGITUDINAL 3499 02:17:40,000 --> 02:17:44,000 ELEMENTS AND IF WERE HELPING 3500 02:17:44,000 --> 02:17:48,520 FOLKS I WOULD FIRST SAY, I 3501 02:17:48,520 --> 02:17:50,120 SYSTEMATIC WAY IS TO THINK ABOUT 3502 02:17:50,120 --> 02:17:54,320 THE CLINICAL RESEARCH QUESTION 3503 02:17:54,320 --> 02:17:59,160 AND THERE'S SCAFFOLDING FRAME 3504 02:17:59,160 --> 02:18:04,320 WORKS THAT HELP AND THE 3505 02:18:04,320 --> 02:18:10,040 COMPARISON AND OUTCOMES TIMING 3506 02:18:10,040 --> 02:18:12,040 AND THE HEALTH CARE DELIVERY AND 3507 02:18:12,040 --> 02:18:13,080 CONTEXT SETTING. 3508 02:18:13,080 --> 02:18:18,920 WE ALSO RECOGNIZED THAT THIS 3509 02:18:18,920 --> 02:18:20,000 STRUCTURED THINKING HAS NAME 3510 02:18:20,000 --> 02:18:21,840 THAT'S BEEN PICKED UP IN 3511 02:18:21,840 --> 02:18:23,400 REGULATORY GUIDANCE DOCUMENTS. 3512 02:18:23,400 --> 02:18:25,640 I'LL SHOW A GLIMPSE OF THAT AND 3513 02:18:25,640 --> 02:18:28,000 CLEAR THINKING ABOUT THE 3514 02:18:28,000 --> 02:18:29,200 ESTIMATE. 3515 02:18:29,200 --> 02:18:36,000 THEN I WANT TO GIVE A SHOUT OUT 3516 02:18:36,000 --> 02:18:37,960 TO THE DESIGN PROCESS. 3517 02:18:37,960 --> 02:18:39,920 WE CAN TALK ABOUT THE DESIGN. 3518 02:18:39,920 --> 02:18:46,000 HOW ARE YOU ON YOUR OWN OR WHAT 3519 02:18:46,000 --> 02:18:50,280 THE PEERS YOU CAN TAP INTO OR 3520 02:18:50,280 --> 02:18:54,840 EXPERTISE OR EXPERTISES YOU CAN 3521 02:18:54,840 --> 02:18:58,800 TAP INTO TO AND THE 3522 02:18:58,800 --> 02:19:00,560 COLLABORATORY WAS UNIQUE IN 3523 02:19:00,560 --> 02:19:01,880 TAPPING INTO PEERS AND EXPERTS 3524 02:19:01,880 --> 02:19:04,000 AND THEY'VE BEEN INCREDIBLY 3525 02:19:04,000 --> 02:19:09,600 VALUABLE AND INFECTIOUS TO OTHER 3526 02:19:09,600 --> 02:19:10,600 NETWORKS THAT WE HAVE 3527 02:19:10,600 --> 02:19:13,440 REPRESENTED LEADERSHIP IN OUR 3528 02:19:13,440 --> 02:19:14,840 PANELISTS. 3529 02:19:14,840 --> 02:19:18,680 THE NIH IMPACT COLLABORATORY IS 3530 02:19:18,680 --> 02:19:19,360 ONE. 3531 02:19:19,360 --> 02:19:24,680 I'VE INVOLVED IN THE NHLBI 3532 02:19:24,680 --> 02:19:26,760 DECIPHER AND THE DOD PAIN 3533 02:19:26,760 --> 02:19:27,200 MANAGEMENT. 3534 02:19:27,200 --> 02:19:30,000 THESE ARE ALL OTHER GROUPS THAT 3535 02:19:30,000 --> 02:19:32,120 HAVE RECOGNIZED A GOOD THING 3536 02:19:32,120 --> 02:19:34,040 FROM THE COLLABORATORY THE 3537 02:19:34,040 --> 02:19:36,000 PROCESS FOR DESIGNING A NEW 3538 02:19:36,000 --> 02:19:38,320 TRIAL AND SHEPHERDING THAT 3539 02:19:38,320 --> 02:19:38,560 FORWARD. 3540 02:19:38,560 --> 02:19:48,040 I DO WANT TO CALL THAT OUT NOW. 3541 02:19:48,040 --> 02:19:51,720 THE NEXT IS STRUCTURE OF THIS 3542 02:19:51,720 --> 02:19:53,120 AND WE'LL TOUCH OR LEAN ON THESE 3543 02:19:53,120 --> 02:19:56,040 IN THE SUBSEQUENT TALKS. 3544 02:19:56,040 --> 02:20:00,640 WE HAVE THIS CONCEPT THAT 3545 02:20:00,640 --> 02:20:01,680 CRITICALLY GUIDES I THINK 3546 02:20:01,680 --> 02:20:02,640 CLARIFYING A RESEARCH QUESTION 3547 02:20:02,640 --> 02:20:07,120 AND THE RESEARCH QUESTION THEN 3548 02:20:07,120 --> 02:20:08,080 LEADS TO DESIGN CONSIDERATION. 3549 02:20:08,080 --> 02:20:09,400 DESIGN CONSIDERATION AND 3550 02:20:09,400 --> 02:20:10,080 FIDELITY TO THE QUESTION AND 3551 02:20:10,080 --> 02:20:10,640 THEN ADDRESSING SOURCES OF 3552 02:20:10,640 --> 02:20:18,880 VARIATION. 3553 02:20:18,880 --> 02:20:26,960 THIS IS CODIFIED IN THE R01 3554 02:20:26,960 --> 02:20:29,400 DOCUMENT THEY SAY TREATMENT AND 3555 02:20:29,400 --> 02:20:30,320 ALTERNATIVE. 3556 02:20:30,320 --> 02:20:30,920 IT'S BASICALLY TREATMENT AND 3557 02:20:30,920 --> 02:20:35,000 COMPARATOR ESSENTIALLY. 3558 02:20:35,000 --> 02:20:36,000 THEY TALK ABOUT POPULATION. 3559 02:20:36,000 --> 02:20:38,360 I WANT TO CALL OUT THE CONCEPT 3560 02:20:38,360 --> 02:20:44,000 OF POPULATION FOR EMBEDDED 3561 02:20:44,000 --> 02:20:48,400 TRIALS TAKES ADDITIONAL 3562 02:20:48,400 --> 02:20:51,080 DIMENSIONS AND WE THINK OF IT AS 3563 02:20:51,080 --> 02:20:53,040 POPULATION AS GUIDANCE DOCUMENT 3564 02:20:53,040 --> 02:20:55,360 HERE BUT WE'RE OFTEN THINKING 3565 02:20:55,360 --> 02:21:03,080 WHEN EVALUATING IMPLEMENTATION 3566 02:21:03,080 --> 02:21:04,080 OPTIONS MAYBE IT'S THE HEALTH 3567 02:21:04,080 --> 02:21:06,400 CARE DELIVERY AGENTS. 3568 02:21:06,400 --> 02:21:08,920 THAT'S WHERE WE WANT TO 3569 02:21:08,920 --> 02:21:10,840 CHARACTERIZE WHAT WHAT'S 3570 02:21:10,840 --> 02:21:11,520 HAPPENING THERE. 3571 02:21:11,520 --> 02:21:13,760 WE MAKE INFERENCE ON STRATEGY TO 3572 02:21:13,760 --> 02:21:17,840 IMPACT THAT PATIENT POPULATION. 3573 02:21:17,840 --> 02:21:19,800 SORRY, THAT TARGET POPULATION 3574 02:21:19,800 --> 02:21:21,200 THE POPULATION OF FOCUS FOR THE 3575 02:21:21,200 --> 02:21:22,840 RESEARCH QUESTION AT HAND. 3576 02:21:22,840 --> 02:21:26,280 VERY CLEARLY ONCE IT'S EMBEDDED, 3577 02:21:26,280 --> 02:21:28,040 POPULATION CAN TAKE NEW MEANING 3578 02:21:28,040 --> 02:21:32,680 IN TERMS OF PATIENTS, PROVIDERS, 3579 02:21:32,680 --> 02:21:34,600 CLINICS, OTHER HEALTH CARE 3580 02:21:34,600 --> 02:21:42,440 DELIVERY STRUCTURES OR PEOPLE. 3581 02:21:42,440 --> 02:21:44,680 THIS GETS IN THE SPECIFIC 3582 02:21:44,680 --> 02:21:46,000 INTERCURRENT EVENT ISSUES AS 3583 02:21:46,000 --> 02:21:47,160 WELL AND THE NEXT SLIDE ROUNDS 3584 02:21:47,160 --> 02:21:49,840 THAT OUT TO SAY THE OUTCOME OR 3585 02:21:49,840 --> 02:21:52,000 IN THIS PARLANCE THE VARIABLE OF 3586 02:21:52,000 --> 02:21:55,600 INTEREST. 3587 02:21:55,600 --> 02:21:58,200 CLARITY ON WHAT IS THAT VARIABLE 3588 02:21:58,200 --> 02:22:00,360 AND SEE ON THE EMBEDDED 3589 02:22:00,360 --> 02:22:03,800 PRAGMATIC TRIALS CONTEXT WHAT 3590 02:22:03,800 --> 02:22:06,320 ARE FACTORS ASSOCIATED WITH 3591 02:22:06,320 --> 02:22:07,520 VARIABILITY. 3592 02:22:07,520 --> 02:22:08,080 THE EARLIER SESSION WAS 3593 02:22:08,080 --> 02:22:09,560 WONDERFUL AT HIGHLIGHTING 3594 02:22:09,560 --> 02:22:10,680 CHANGES OVER TIME IN HOW 3595 02:22:10,680 --> 02:22:16,000 VARIABLES ARE CAPTURED OR 3596 02:22:16,000 --> 02:22:23,560 CHANGES OVER SETTING AN CAPTURED 3597 02:22:23,560 --> 02:22:28,000 AND WHAT'S THE DESIGN ANALYSIS 3598 02:22:28,000 --> 02:22:29,400 IN THE PRAGMATIC TRIALS AND 3599 02:22:29,400 --> 02:22:32,640 THERE'S A SUMMARY THAT'S A 3600 02:22:32,640 --> 02:22:33,320 CONCEPTUAL THOUGHT HOW WOULD YOU 3601 02:22:33,320 --> 02:22:35,840 AVERAGE THE OUTCOME. 3602 02:22:35,840 --> 02:22:39,600 HOW WOULD YOU COMPARE IT ACROSS 3603 02:22:39,600 --> 02:22:41,280 THE TWO GROUPS WHAT IS THAT 3604 02:22:41,280 --> 02:22:43,800 SPECIFIC AND FINAL ANALYTICAL 3605 02:22:43,800 --> 02:22:46,240 SUMMARY THAT WOULD ADDRESS THE 3606 02:22:46,240 --> 02:22:46,880 PRIMARY AND SECONDARY RESEARCH 3607 02:22:46,880 --> 02:22:53,880 QUESTIONS. 3608 02:22:53,880 --> 02:22:57,720 I THINK WE'RE GOING TRY AND 3609 02:22:57,720 --> 02:23:01,080 TOUCH ON IN FOUR SEQUENTIAL 3610 02:23:01,080 --> 02:23:03,600 STUDY SPECIFIC PRESENTATIONS 3611 02:23:03,600 --> 02:23:05,200 WHAT WAS GOING ON INITIALLY, 3612 02:23:05,200 --> 02:23:07,640 WHAT ARE THE CONSIDERATIONS THAT 3613 02:23:07,640 --> 02:23:11,000 MOTIVATED THE STUDY DESIGN. 3614 02:23:11,000 --> 02:23:13,080 NOW THAT YOU'RE SO MUCH SMARTER, 3615 02:23:13,080 --> 02:23:16,000 IN HINDSIGHT WHAT MIGHT YOU DO 3616 02:23:16,000 --> 02:23:17,480 DIFFERENTLY OR WHAT MIGHT YOU 3617 02:23:17,480 --> 02:23:18,480 ADVISE SOMEONE ELSE TO THINK 3618 02:23:18,480 --> 02:23:20,800 ABOUT AS THEY EMBARK ON A 3619 02:23:20,800 --> 02:23:24,920 SIMILAR ENDEAVOR AND THEN ARE 3620 02:23:24,920 --> 02:23:25,920 THERE ALTERNATIVE DESIGNS FROM 3621 02:23:25,920 --> 02:23:28,480 THE ONE YOU STARTED WITH THAT 3622 02:23:28,480 --> 02:23:31,520 YOU MIGHT CONSIDER FOR A FUTURE 3623 02:23:31,520 --> 02:23:31,960 TRIAL. 3624 02:23:31,960 --> 02:23:35,320 IN FACT I KNOW AT LEAST TWO OF 3625 02:23:35,320 --> 02:23:38,080 THE TRIALS WE'LL TALK ABOUT 3626 02:23:38,080 --> 02:23:40,400 CHANGE THEIR DESIGN EITHER EARLY 3627 02:23:40,400 --> 02:23:41,120 OR LATER IN THE PROCESS OF DOING 3628 02:23:41,120 --> 02:23:45,880 THE RESEARCH. 3629 02:23:45,880 --> 02:23:48,120 THE NEXT SLIDE SHOWS THE FOUR 3630 02:23:48,120 --> 02:23:50,480 STELLAR PEOPLE THAT ARE GOING TO 3631 02:23:50,480 --> 02:23:54,560 GIVE THEIR INSIGHTS INTERN AND 3632 02:23:54,560 --> 02:23:56,000 THEN WE'LL WRAP UP AND LEAVE I 3633 02:23:56,000 --> 02:23:58,600 THINK PLENTY OF TIME FOR 3634 02:23:58,600 --> 02:23:58,880 QUESTIONS. 3635 02:23:58,880 --> 02:24:03,200 SO IF YOU HAVE QUESTIONS AS THE 3636 02:24:03,200 --> 02:24:04,480 TALKS GO, PLEASE JUST PUT THEM 3637 02:24:04,480 --> 02:24:06,040 IN THE CHAT AND I'LL TRACK THEM 3638 02:24:06,040 --> 02:24:07,640 AND COME BACK TO THEM. 3639 02:24:07,640 --> 02:24:12,360 BUT I THINK WE'LL LET THE FOUR 3640 02:24:12,360 --> 02:24:13,880 PROJECTS SUMMARIZE THEIR STUDIES 3641 02:24:13,880 --> 02:24:16,040 AND LEARNINGS AND ADVICE AND 3642 02:24:16,040 --> 02:24:21,920 THEN WE'LL RETURN TO AN OPEN 3643 02:24:21,920 --> 02:24:25,640 TIME FOR QUESTIONS. 3644 02:24:25,640 --> 02:24:29,920 WITH THAT I'LL TURN IT OVER TO 3645 02:24:29,920 --> 02:24:32,000 DOUG ZATZICK. 3646 02:24:32,000 --> 02:24:41,640 >> THANK YOU. 3647 02:24:41,640 --> 02:24:43,680 I'LL GIVE A BRIEF OVERVIEW AND 3648 02:24:43,680 --> 02:24:46,640 WHAT CAME OUT IN THE ROLLOUT OF 3649 02:24:46,640 --> 02:24:50,720 THE TRIAL THAT CAME UP AND 3650 02:24:50,720 --> 02:24:52,600 BRIEFLY GO OVER DESIGN 3651 02:24:52,600 --> 02:24:53,240 CONSIDERATIONS HOPEFULLY GETTING 3652 02:24:53,240 --> 02:24:54,880 TO A RICH DISCUSSION ON THE 3653 02:24:54,880 --> 02:24:56,880 PANEL AND WITH OTHERS. 3654 02:24:56,880 --> 02:25:02,920 BASICALLY THE RESEARCH QUESTION 3655 02:25:02,920 --> 02:25:09,240 WAS WILL THE INTERVENTION SHOW 3656 02:25:09,240 --> 02:25:13,640 REDUCTIONS OF POST-TRAUMATIC 3657 02:25:13,640 --> 02:25:16,000 STRESS DISORDER COMPARED TO THE 3658 02:25:16,000 --> 02:25:18,560 USUAL INTERVENTION. 3659 02:25:18,560 --> 02:25:22,600 WITH THE POPULATION OF SURVIVORS 3660 02:25:22,600 --> 02:25:31,200 OF INTENTIONAL AND UNINTENTIONAL 3661 02:25:31,200 --> 02:25:33,160 HAD PHARMACOLOGY AND ELEMENTS 3662 02:25:33,160 --> 02:25:37,480 AND PTSD SYSTEMS WERE ASSESSED 3663 02:25:37,480 --> 02:25:39,480 AT TRAUMA CENTER SETTINGS OR 3664 02:25:39,480 --> 02:25:45,560 DEPARTMENTS AND NEW OF INTEREST 3665 02:25:45,560 --> 02:25:51,440 TO US, AFTER THE INJURY AS 3666 02:25:51,440 --> 02:25:52,120 ASSESSED AND POSTSTATE OF 3667 02:25:52,120 --> 02:25:57,760 EMERGENCY AND THE TRAUMA CENTER 3668 02:25:57,760 --> 02:26:08,240 SITES WHICH WAS THE CLUSTER. 3669 02:26:10,040 --> 02:26:15,760 THIS IS A COMPLEX SLIDE AND WE 3670 02:26:15,760 --> 02:26:18,880 BASICALLY HAVE UNEXPOSED IS THE 3671 02:26:18,880 --> 02:26:21,000 DOTTED LINE OR CONTROL GROUP TO 3672 02:26:21,000 --> 02:26:22,600 START RECRUITMENT AND WE HAVE 3673 02:26:22,600 --> 02:26:25,080 THE INTERVENTION GROUP YOU 3674 02:26:25,080 --> 02:26:26,680 SWITCH ON IN THE STEP WEDGE 3675 02:26:26,680 --> 02:26:30,320 DESIGN OF THE INTERVENTION GROUP 3676 02:26:30,320 --> 02:26:30,640 RECRUITMENT. 3677 02:26:30,640 --> 02:26:33,640 EACH OF THE SITES RANDOMIZED TO 3678 02:26:33,640 --> 02:26:36,720 ONE OF FOUR WAVES. 3679 02:26:36,720 --> 02:26:38,400 THERE'S FIVE PERIODS, STEP 3680 02:26:38,400 --> 02:26:39,120 WEDGE, CLUSTER RANDOMIZED 3681 02:26:39,120 --> 02:26:49,280 DESIGN. 3682 02:26:52,080 --> 02:26:55,040 THERE WERE A LOT OF EVENTS AT 3683 02:26:55,040 --> 02:26:58,520 TSOS AND THE OTHER EVENTS CAN 3684 02:26:58,520 --> 02:27:01,440 OCCUR FREQUENTLY AND MAKE YOU 3685 02:27:01,440 --> 02:27:03,400 THINK ABOUT YOUR ORIGINAL DESIGN 3686 02:27:03,400 --> 02:27:04,280 AND PERHAPS SIMPLICITY. 3687 02:27:04,280 --> 02:27:06,800 WE HAD A REGULATORY PAUSE IN OUR 3688 02:27:06,800 --> 02:27:09,280 FINAL PERIOD WHEN WE WERE ONLY 3689 02:27:09,280 --> 02:27:10,680 RECRUITING INTERVENTION 3690 02:27:10,680 --> 02:27:11,280 SUBJECTS. 3691 02:27:11,280 --> 02:27:12,840 AND IT TURNS OUT IN THE STEP 3692 02:27:12,840 --> 02:27:14,600 WEDGE DESIGN IT'S HARD TO 3693 02:27:14,600 --> 02:27:16,120 OVERCOME SOMETHING LIKE THIS FOR 3694 02:27:16,120 --> 02:27:20,680 A VARIETY OF REASONS. 3695 02:27:20,680 --> 02:27:23,000 AND OTHERS THINK MAYBE WE SHOULD 3696 02:27:23,000 --> 02:27:25,720 HAVE GONE WITH OR STUCK WITH A 3697 02:27:25,720 --> 02:27:27,360 PARALLEL GROUP RANDOMIZED DESIGN 3698 02:27:27,360 --> 02:27:32,000 BASED ON THE ONE SORT OF EVENT 3699 02:27:32,000 --> 02:27:40,600 THAT OCCURRED DURING THE TRIAL. 3700 02:27:40,600 --> 02:27:41,920 IN THE TSOS THE CONTROL PATIENTS 3701 02:27:41,920 --> 02:27:43,760 WERE INTERVENTED FIRST AND THE 3702 02:27:43,760 --> 02:27:49,480 STEP WEDGE WAS TURNED ON. 3703 02:27:49,480 --> 02:27:51,320 AT EACH SITE ACROSS THE SITES 3704 02:27:51,320 --> 02:27:54,960 THERE WAS A STATISTICALLY AND 3705 02:27:54,960 --> 02:27:57,120 CLINICALLY SIGNIFICANT INCREASE 3706 02:27:57,120 --> 02:27:59,280 IN PTSD SYMPTOMS IN INTERVENTION 3707 02:27:59,280 --> 02:28:00,560 SYSTEMS WHO RECRUITED LATER THAN 3708 02:28:00,560 --> 02:28:10,600 CONTROL PATIENTS. 3709 02:28:10,600 --> 02:28:12,040 MAYBE ANOTHER DESIGN WOULD HAVE 3710 02:28:12,040 --> 02:28:20,920 BEEN BETTER THAN THE STEP WEDGE. 3711 02:28:20,920 --> 02:28:23,320 WE ALSO SAW TREMENDOUS SITE 3712 02:28:23,320 --> 02:28:24,920 HETEROGENEITY AND AT BASELINE WE 3713 02:28:24,920 --> 02:28:28,920 KNEW SOME OF OUR CENTERS HAD 3714 02:28:28,920 --> 02:28:30,480 HIGHER RATES OF INJURY LIKE 3715 02:28:30,480 --> 02:28:31,360 FIREARM THAN OTHERS AND 3716 02:28:31,360 --> 02:28:33,280 ADMISSION VOLUME WAS DIFFERENT. 3717 02:28:33,280 --> 02:28:40,040 A SLEW OF VARIABLES BETWEEN THE 3718 02:28:40,040 --> 02:28:41,600 SITES. 3719 02:28:41,600 --> 02:28:44,040 EACH SITE CONTRIBUTES TO THE 3720 02:28:44,040 --> 02:28:53,720 CONTROL AND INTERVENTION GROUP. 3721 02:28:53,720 --> 02:28:55,720 THERE'S A METHODS LIKE EXTREME 3722 02:28:55,720 --> 02:28:57,720 RANDOMIZATION AND OTHERS CAN 3723 02:28:57,720 --> 02:29:03,560 OFFSET BUT WHAT'S CHALLENGING IS 3724 02:29:03,560 --> 02:29:04,600 THE NOTION OF DIFFERENTIAL 3725 02:29:04,600 --> 02:29:05,640 HETEROGENEITY OVER TIME. 3726 02:29:05,640 --> 02:29:06,840 WE SAW A TREMENDOUS AMOUNT IN 3727 02:29:06,840 --> 02:29:09,480 TERMS OF RECRUITMENT RATES, 3728 02:29:09,480 --> 02:29:10,680 REGULATORY LAPSES, LEADERSHIP 3729 02:29:10,680 --> 02:29:12,680 TURNOVER AND THE FUNDAMENTAL 3730 02:29:12,680 --> 02:29:15,480 QUALITY OF THE INTERVENTION OF 3731 02:29:15,480 --> 02:29:17,440 DELIVERY AND TREMENDOUS 3732 02:29:17,440 --> 02:29:20,440 VARIABILITY ACROSS THE SITES. 3733 02:29:20,440 --> 02:29:23,080 IT TURNS OUT THAT THIS 3734 02:29:23,080 --> 02:29:24,000 DIFFERENTIAL SITE VARIABILITY 3735 02:29:24,000 --> 02:29:29,520 OVER TIME WAS A KEY FACTOR 3736 02:29:29,520 --> 02:29:30,520 INFLUENCING ENROLLMENT. 3737 02:29:30,520 --> 02:29:34,560 WITH THE PATIENTS THERE'S A 3738 02:29:34,560 --> 02:29:36,000 BASELINE SIGNIFICANT INCREASE IN 3739 02:29:36,000 --> 02:29:37,880 PTSD SYSTEMS AND THE 3740 02:29:37,880 --> 02:29:38,480 INTERVENTION CONTROL. 3741 02:29:38,480 --> 02:29:40,040 WHEN YOU TAKE INTO ACCOUNT THE 3742 02:29:40,040 --> 02:29:42,600 SITES THAT RECRUITED FEWER 3743 02:29:42,600 --> 02:29:44,760 PATIENTS THAT HAD MORE 3744 02:29:44,760 --> 02:29:45,520 REGULATORY LAPSES AND GREATER 3745 02:29:45,520 --> 02:29:52,040 LEADERSHIP TURNOVER AND DIDN'T 3746 02:29:52,040 --> 02:29:56,000 DO AS GOOD AN A JOB INTERVENING 3747 02:29:56,000 --> 02:30:00,280 IT'S AMPLIFIED AND COHORT INTO 3748 02:30:00,280 --> 02:30:01,520 GROUPS. 3749 02:30:01,520 --> 02:30:03,920 POOR IMPLEMENTERS AND THE OTHERS 3750 02:30:03,920 --> 02:30:05,600 DON'T HAVE SIGNIFICANT 3751 02:30:05,600 --> 02:30:05,920 DIFFERENCES. 3752 02:30:05,920 --> 02:30:10,080 THE INTERVENTION STILL HAS 3753 02:30:10,080 --> 02:30:11,280 HIGHER PTSD SYMPTOMS BUT THE 3754 02:30:11,280 --> 02:30:13,200 DIFFERENCE NO LONGER 3755 02:30:13,200 --> 02:30:13,600 SIGNIFICANT. 3756 02:30:13,600 --> 02:30:15,440 I'LL BE PROVOCATIVE AND 3757 02:30:15,440 --> 02:30:16,520 HOPEFULLY THIS WILL INSPIRE 3758 02:30:16,520 --> 02:30:21,480 DISCUSSION AMONGST THE PANEL AND 3759 02:30:21,480 --> 02:30:28,000 EVERYONE ELSE BUT MAYBE THE TSOS 3760 02:30:28,000 --> 02:30:29,760 LESSON IS SITE VARIABILITY 3761 02:30:29,760 --> 02:30:30,760 CONSIDERATION BOTH AT BASELINE 3762 02:30:30,760 --> 02:30:33,960 AND LONGITUDINALLY 3763 02:30:33,960 --> 02:30:36,000 DIFFERENTIALLY OVER TIME FAVOR 3764 02:30:36,000 --> 02:30:36,560 RANDOMIZATION WHEN POSSIBLE. 3765 02:30:36,560 --> 02:30:46,360 THANK YOU. 3766 02:30:46,360 --> 02:30:47,560 >> WE'LL COME BACK TO THAT. 3767 02:30:47,560 --> 02:30:50,240 IT'S A GREAT COMMENT TO LEAD 3768 02:30:50,240 --> 02:30:50,800 WITH. 3769 02:30:50,800 --> 02:30:52,400 THE FOLLOW-UP AS WELL WHAT IF 3770 02:30:52,400 --> 02:30:56,040 YOU CAN'T DO IT SO WE CAN GO 3771 02:30:56,040 --> 02:30:58,040 THERE LATER. 3772 02:30:58,040 --> 02:31:00,880 I'LL TRANSITION NOW TO MYLES 3773 02:31:00,880 --> 02:31:01,800 WOLF TALKING ABOUT HIGH LOW. 3774 02:31:01,800 --> 02:31:04,600 IT'S STILL IN PROCESS AND IN 3775 02:31:04,600 --> 02:31:05,200 PROGRESS. 3776 02:31:05,200 --> 02:31:08,080 IT'S A DIFFERENT STAGE AND THEN 3777 02:31:08,080 --> 02:31:11,600 ADDRESSING DIFFERENT ELEMENTS OF 3778 02:31:11,600 --> 02:31:12,360 DESIGN. 3779 02:31:12,360 --> 02:31:12,560 MYLES. 3780 02:31:12,560 --> 02:31:13,720 >> THANK YOU, PATRICK. 3781 02:31:13,720 --> 02:31:14,640 THANKS EVERYBODY FOR JOINING AND 3782 02:31:14,640 --> 02:31:17,440 FOR INVITING ME TO SPEAK ABOUT 3783 02:31:17,440 --> 02:31:17,680 THIS. 3784 02:31:17,680 --> 02:31:22,200 SO IT'S A DIALYSIS BASED TRIAL. 3785 02:31:22,200 --> 02:31:24,560 I'M A NEPHROLOGIST. 3786 02:31:24,560 --> 02:31:35,080 SO WE TAKE CARE OF PATIENTS WITH 3787 02:31:35,720 --> 02:31:37,680 RENAL AND END STAGE KIDNEY 3788 02:31:37,680 --> 02:31:40,000 DISEASE THAT REQUIRE DIALYSIS TO 3789 02:31:40,000 --> 02:31:40,520 STAY ALIVE. 3790 02:31:40,520 --> 02:31:45,600 WHEN YOU DON'T HAVE KIDNEY 3791 02:31:45,600 --> 02:31:46,600 FUNCTION YOU DEVELOP A 3792 02:31:46,600 --> 02:31:49,440 LIMITATION IN YOUR ABILITY TO 3793 02:31:49,440 --> 02:31:50,520 SECRETE PHOSPHORUS THAT COMES 3794 02:31:50,520 --> 02:31:54,280 INTO YOUR BODY FROM YOUR DIET 3795 02:31:54,280 --> 02:31:56,400 BUT MUST GET OUT THROUGH YOUR 3796 02:31:56,400 --> 02:31:56,640 KIDNEY. 3797 02:31:56,640 --> 02:31:57,840 SO PEOPLE WITHOUT KIDNEY 3798 02:31:57,840 --> 02:32:01,400 FUNCTION ACCUMULATE PHOSPHATE IN 3799 02:32:01,400 --> 02:32:04,560 THE BLOOD AND THE SERUM 3800 02:32:04,560 --> 02:32:05,600 PHOSPHATE RISES. 3801 02:32:05,600 --> 02:32:06,880 THE DIALYSIS CONTRIBUTE TO 3802 02:32:06,880 --> 02:32:10,600 REMOVING SOME OF IT BUT STILL 3803 02:32:10,600 --> 02:32:15,600 INSUFFICIENT SO WE HAVE AN 3804 02:32:15,600 --> 02:32:20,000 ARMAMENTARIAN OF DRUGS CALLED 3805 02:32:20,000 --> 02:32:24,000 DIETARY PHOSPHATE BINDERS BUT 3806 02:32:24,000 --> 02:32:27,160 HAVE NEVER BEEN PROVEN INFLUENCE 3807 02:32:27,160 --> 02:32:30,400 CLINICAL OUTCOMES IN PATIENTS 3808 02:32:30,400 --> 02:32:34,040 WITH KIDNEY DISEASE AND WE HAVE 3809 02:32:34,040 --> 02:32:36,040 EVIDENCE SUGGESTING THE HIGHER 3810 02:32:36,040 --> 02:32:39,000 THE SERUM PHOSPHATE THE WORSE 3811 02:32:39,000 --> 02:32:40,920 THE SURVIVAL IS IN DIALYSIS AND 3812 02:32:40,920 --> 02:32:44,000 THIS HAS TURNED INTO 3813 02:32:44,000 --> 02:32:44,520 OPINION-BASED GUIDELINES 3814 02:32:44,520 --> 02:32:45,160 RECOMMENDED GETTING THE 3815 02:32:45,160 --> 02:32:47,120 PHOSPHATE TO THE LEVEL OF LESS 3816 02:32:47,120 --> 02:32:48,400 THAN 5 1/2. 3817 02:32:48,400 --> 02:32:49,720 FOR PEOPLE WHO DON'T THINK IN 3818 02:32:49,720 --> 02:32:52,600 TERMS OF PHOSPHATE MUCH, THE 3819 02:32:52,600 --> 02:32:58,600 NORMAL RANGE IS MORE LIKE 4 OR 3 3820 02:32:58,600 --> 02:32:58,760 1/2. 3821 02:32:58,760 --> 02:33:02,960 GETTING 5 1/2 IS ACCEPTING SOME 3822 02:33:02,960 --> 02:33:04,000 DEGREE OF ELEVATION AND PATIENTS 3823 02:33:04,000 --> 02:33:08,040 CAN BE TREATED AT LEVELS OF 6, 3824 02:33:08,040 --> 02:33:11,560 7, 8, 9, 10. 3825 02:33:11,560 --> 02:33:13,640 SO THERE'S NO PROOF, NUMBER ONE, 3826 02:33:13,640 --> 02:33:14,880 THE PHOSPHATE BINDERS INFLUENCE 3827 02:33:14,880 --> 02:33:18,360 OUTCOMES AND THERE'S NO PROOF 3828 02:33:18,360 --> 02:33:20,000 THAT TAKING AN INDIVIDUAL 3829 02:33:20,000 --> 02:33:21,960 PATIENT'S SERUM PHOSPHATE THAT'S 3830 02:33:21,960 --> 02:33:24,000 HIGH AND LOWERING IT WILL 3831 02:33:24,000 --> 02:33:25,720 ACTUALLY IMPROVE THE OUTCOMES. 3832 02:33:25,720 --> 02:33:27,760 WE JUST HAVE OBSERVATIONAL DATA 3833 02:33:27,760 --> 02:33:30,760 THAT ASSOCIATED A HIGH PHOSPHATE 3834 02:33:30,760 --> 02:33:32,280 WITH WORSE OUTCOMES. 3835 02:33:32,280 --> 02:33:33,200 GETTING CLINICAL TRIAL GRADE 3836 02:33:33,200 --> 02:33:34,360 EVIDENCE IN THIS AREA ONE WAY OR 3837 02:33:34,360 --> 02:33:40,040 THE OTHER WAS OUR GOAL. 3838 02:33:40,040 --> 02:33:43,480 I SHOULD ALSO ADD THAT THE 3839 02:33:43,480 --> 02:33:46,600 PHOSPHATE BINDER MEDICINES HAVE 3840 02:33:46,600 --> 02:33:51,480 SIDE EFFECTS AND THEORETICAL 3841 02:33:51,480 --> 02:33:54,280 TOXICITIES THAT IN THE ABSENCE 3842 02:33:54,280 --> 02:33:55,560 OF CLINICAL TRIALS CREATE A 3843 02:33:55,560 --> 02:33:56,480 SITUATION WHERE WE THINK WE'RE 3844 02:33:56,480 --> 02:33:58,320 DOING GOOD TRYING TO LOWER 3845 02:33:58,320 --> 02:34:01,160 PEOPLE PHOSPHATE INTO THE 3846 02:34:01,160 --> 02:34:02,480 OPINION-BASED RANGE BUT FIT 3847 02:34:02,480 --> 02:34:04,000 REQUIRES USING A HOST OF 3848 02:34:04,000 --> 02:34:05,280 MEDICATIONS AND DIETARY 3849 02:34:05,280 --> 02:34:06,680 RESTRICTION THE ADVERSE EFFECTS 3850 02:34:06,680 --> 02:34:08,600 OF WHICH WE DON'T REALLY KNOW 3851 02:34:08,600 --> 02:34:10,400 FROM CLINICAL TRIALS WE DON'T 3852 02:34:10,400 --> 02:34:13,800 KNOW IF WE'RE ACTUALLY DOING 3853 02:34:13,800 --> 02:34:15,760 HARM, GOOD OR ARE COMPLETELY 3854 02:34:15,760 --> 02:34:17,880 NEUTRAL IN HAVING NO EFFECT IN 3855 02:34:17,880 --> 02:34:19,360 WHICH CASE PERHAPS WE SHOULD BE 3856 02:34:19,360 --> 02:34:21,280 USING OUR TIME AND ENERGY IN 3857 02:34:21,280 --> 02:34:23,520 OTHER ASPECTS OF DIALYSIS 3858 02:34:23,520 --> 02:34:26,880 MANAGEMENT OF WHICH THERE ARE 3859 02:34:26,880 --> 02:34:28,000 MANY. 3860 02:34:28,000 --> 02:34:31,800 SO ENTER THIS HILO TRIAL AS A 3861 02:34:31,800 --> 02:34:34,600 GOAL HAS TO COMPARE TWO 3862 02:34:34,600 --> 02:34:36,920 DIFFERENT PHOSPHATE TARGET 3863 02:34:36,920 --> 02:34:41,400 PATIENTS ON HEMODIALYSIS THE 3864 02:34:41,400 --> 02:34:43,280 MOST COMMONLY USED MODALITY OF 3865 02:34:43,280 --> 02:34:45,040 DIALYSIS IN THE UNITED STATES. 3866 02:34:45,040 --> 02:34:47,560 SO THE TWO THERAPEUTIC TARGETS 3867 02:34:47,560 --> 02:34:51,000 WE'RE AIMING FOR THE LOW ARM IS 3868 02:34:51,000 --> 02:34:55,880 THE STANDARD OF CARE EFFECTIVELY 3869 02:34:55,880 --> 02:35:00,480 THAT HAS NO EVIDENTIARY BASIS IT 3870 02:35:00,480 --> 02:35:03,120 HAS OBSERVATIONAL EVIDENCE. 3871 02:35:03,120 --> 02:35:05,200 AGAINST THAT WE'RE COMPARING 3872 02:35:05,200 --> 02:35:07,760 LESS STRICT PHOSPHATE CONTROL 3873 02:35:07,760 --> 02:35:13,160 ALLOWING THE SERUM PHOSPHATE TO 3874 02:35:13,160 --> 02:35:16,000 DRICHT TO ONE MILLIGRAM PER DES 3875 02:35:16,000 --> 02:35:19,200 LITER ACROSS THE TARGET RATE. 3876 02:35:19,200 --> 02:35:22,240 THERE'S A HIERARCHICAL COMPOSITE 3877 02:35:22,240 --> 02:35:25,240 OUTCOME AND I'LL TALK ABOUT IT 3878 02:35:25,240 --> 02:35:26,680 MORE. 3879 02:35:26,680 --> 02:35:28,000 ALL-CAUSE MORTALITY IS THE FIRST 3880 02:35:28,000 --> 02:35:29,520 IN THE HIERARCHY AND THE SECOND 3881 02:35:29,520 --> 02:35:31,680 IS ALL-CAUSE HOSPITALIZATION. 3882 02:35:31,680 --> 02:35:33,080 I THINK EVERYBODY WOULD 3883 02:35:33,080 --> 02:35:33,720 RECOGNIZE THESE ARE IMPORTANT 3884 02:35:33,720 --> 02:35:38,080 HEALTH OUTCOMES BUT AS WE'LL 3885 02:35:38,080 --> 02:35:40,000 DISCUSS THEY'RE EASY TO 3886 02:35:40,000 --> 02:35:45,080 ASCERTAIN FROM THE ELECTRONIC 3887 02:35:45,080 --> 02:35:46,080 HEALTH RECORD. 3888 02:35:46,080 --> 02:35:48,800 WHEN WE SET OUT TO DO THE TRIAL 3889 02:35:48,800 --> 02:35:50,880 FOR OPERATIONAL REASONS AND EASE 3890 02:35:50,880 --> 02:35:54,240 OF ADMINISTRATION IN THE 3891 02:35:54,240 --> 02:35:54,760 PARTICIPATING DIALYSIS 3892 02:35:54,760 --> 02:35:56,240 FACILITIES WE WERE STRONGLY 3893 02:35:56,240 --> 02:35:57,640 ENCOURAGED WITH OUR PARTNERS AND 3894 02:35:57,640 --> 02:36:00,520 AGGRADE TO DO THIS AS A CLUSTER 3895 02:36:00,520 --> 02:36:03,560 RANDOMIZED TRIAL. 3896 02:36:03,560 --> 02:36:08,920 THAT IS RANDOMIZED IN FACILITIES 3897 02:36:08,920 --> 02:36:12,040 AND EVERYBODY WHO PARTICIPATES 3898 02:36:12,040 --> 02:36:18,760 WOULD BE IN THE HIGH AR LOW. 3899 02:36:18,760 --> 02:36:27,680 AND THE CLINICAL TRIAL PART OF 3900 02:36:27,680 --> 02:36:30,480 PRAGMATIC TRIALS AND HAVE RISK 3901 02:36:30,480 --> 02:36:31,080 IN INTERVENTION. 3902 02:36:31,080 --> 02:36:36,360 THAT IS, WE'RE GOING AGAINST THE 3903 02:36:36,360 --> 02:36:36,960 GUIDELINES AND WE'RE ASKING 3904 02:36:36,960 --> 02:36:38,880 PEOPLE TO DO SO AND THERE'S A 3905 02:36:38,880 --> 02:36:41,400 POSSIBILITY I'LL BE SUPERIOR ON 3906 02:36:41,400 --> 02:36:42,600 MORTALITY OR LOW WILL BE 3907 02:36:42,600 --> 02:36:44,920 SUPERIOR ON MORTALITY. 3908 02:36:44,920 --> 02:36:46,960 CLEARLY THE OUTCOME IS A SERIOUS 3909 02:36:46,960 --> 02:36:50,720 HEALTH OUTCOME AND WE'RE 3910 02:36:50,720 --> 02:36:51,600 ANTICIPATING THIS INTERVENTION 3911 02:36:51,600 --> 02:36:52,640 WILL INFLUENCE THE OUTCOME ONE 3912 02:36:52,640 --> 02:36:54,040 WAY OR THE OTHER. 3913 02:36:54,040 --> 02:36:56,800 WE BELIEVE PATIENTS NEED TO 3914 02:36:56,800 --> 02:36:58,600 PROVIDE WRITTEN INFORMED CONSENT 3915 02:36:58,600 --> 02:37:04,600 TO PARTICIPATE IN THE STUDY 3916 02:37:04,600 --> 02:37:08,080 VERSUS, FOR EXAMPLE, VERSUS 3917 02:37:08,080 --> 02:37:09,480 ANOTHER IMPLEMENTATION. 3918 02:37:09,480 --> 02:37:12,840 THIS IS IN TWO BITES TRYING TO 3919 02:37:12,840 --> 02:37:15,360 ANSWER A SCIENTIFIC AND 3920 02:37:15,360 --> 02:37:16,600 IMPLEMENTATION QUESTION. 3921 02:37:16,600 --> 02:37:20,000 SO WE HAD THIS INFORMED CONSENT 3922 02:37:20,000 --> 02:37:21,800 BIT AND THAT REALLY COMPLICATES 3923 02:37:21,800 --> 02:37:23,560 OUR APPROACH AND AS PATRICK 3924 02:37:23,560 --> 02:37:25,880 ALLUDED TO IN HIS INTRODUCTORY 3925 02:37:25,880 --> 02:37:27,400 COMMENTS, WE'RE ONE OF THE 3926 02:37:27,400 --> 02:37:30,280 STUDIES THAT HAD TO MAKE SOME 3927 02:37:30,280 --> 02:37:33,080 CHANGES LATER ON I'LL WALK YOU 3928 02:37:33,080 --> 02:37:37,040 THROUGH HOW THE CLUSTER 3929 02:37:37,040 --> 02:37:37,600 RANDOMIZATION PLUS INFORMED 3930 02:37:37,600 --> 02:37:43,400 CONSENT IS A BIG CHALLENGE. 3931 02:37:43,400 --> 02:37:45,480 I TRIED TO ORGANIZATION THIS TO 3932 02:37:45,480 --> 02:37:46,080 TOUCH ON THE KEY POINTS. 3933 02:37:46,080 --> 02:37:49,760 I MENTIONED SOME FROM THE 3934 02:37:49,760 --> 02:37:52,000 FRAMEWORK AND THE POPULATION OF 3935 02:37:52,000 --> 02:37:54,200 END STAGE KIDNEY DISEASE IN 3936 02:37:54,200 --> 02:37:57,680 DIALYSIS AND FROM A PRAGMATIC 3937 02:37:57,680 --> 02:37:58,600 TRIAL PERSPECTIVE IT'S A DREAM 3938 02:37:58,600 --> 02:37:59,480 COME TRUE POPULATION. 3939 02:37:59,480 --> 02:38:01,800 THEY COME TO A FIXED PLACE. 3940 02:38:01,800 --> 02:38:02,480 THEY COME TO THE HEALTH CARE 3941 02:38:02,480 --> 02:38:08,920 SYSTEM THREE TIMES A WEEK AT A 3942 02:38:08,920 --> 02:38:10,440 KNOWN TIME ON SCHEDULE VERY 3943 02:38:10,440 --> 02:38:13,360 FREQUENT INTERACTIONS. 3944 02:38:13,360 --> 02:38:14,520 THERE'S ALSO GREAT DATA 3945 02:38:14,520 --> 02:38:16,600 COLLECTION IN THE ELECTRONIC 3946 02:38:16,600 --> 02:38:22,120 HEALTH RECORDS BECAUSE OF THE 3947 02:38:22,120 --> 02:38:22,760 MANDATES BY THE FEDERAL 3948 02:38:22,760 --> 02:38:24,840 GOVERNMENT WHICH AS YOU KNOW 3949 02:38:24,840 --> 02:38:27,960 PAYS FOR THE VAST MAJORITY OF 3950 02:38:27,960 --> 02:38:31,560 DIALYSIS AND THERE'S THE BURDEN 3951 02:38:31,560 --> 02:38:33,600 OF DOCUMENTATION WHICH BECOMES 3952 02:38:33,600 --> 02:38:36,000 USEFUL FOR CLINICAL TRIALS. 3953 02:38:36,000 --> 02:38:41,280 THE INTERVENTION TWO 3954 02:38:41,280 --> 02:38:42,520 THERAPEUTICS IN THIS CASE, AND 3955 02:38:42,520 --> 02:38:44,040 WHAT WE'RE ASKING PEOPLE TO DO 3956 02:38:44,040 --> 02:38:47,040 IS GET TO THE TARGET AND THEY 3957 02:38:47,040 --> 02:38:48,240 CAN USE WHATEVER WORKS IN THEIR 3958 02:38:48,240 --> 02:38:56,360 LOCAL SETTING. 3959 02:38:56,360 --> 02:38:58,120 THAT COULD BE BETWEEN THE 3960 02:38:58,120 --> 02:39:00,000 PATIENT AND HEALTH CARE FOLKS. 3961 02:39:00,000 --> 02:39:01,800 THE COMPARISON IS THE COMPARISON 3962 02:39:01,800 --> 02:39:04,600 BETWEEN THE TWO INTERVENTIONS ON 3963 02:39:04,600 --> 02:39:07,640 CLINICAL OUTCOMES AND THE 3964 02:39:07,640 --> 02:39:10,600 HIERARCHICAL OF ALL-CAUSE 3965 02:39:10,600 --> 02:39:15,040 MORTALITY AND HOSPITALIZATION. 3966 02:39:15,040 --> 02:39:18,280 IN THIS CASE, ALL CAUSE 3967 02:39:18,280 --> 02:39:21,400 MORTALITY IS TIME TO EVENT 3968 02:39:21,400 --> 02:39:24,000 MEASUREMENT AND ALL-CAUSE 3969 02:39:24,000 --> 02:39:25,920 HOSPITALIZATION IS COUNTS PER 3970 02:39:25,920 --> 02:39:29,920 UNIT TIME INCLUDING RECURRENT 3971 02:39:29,920 --> 02:39:30,160 EVENTS. 3972 02:39:30,160 --> 02:39:32,000 YOU CAN SEE IT'S TRYING TO ADD 3973 02:39:32,000 --> 02:39:33,640 TWO THINGS IN THE COMPOSITE 3974 02:39:33,640 --> 02:39:38,800 MEASURED AT DIFFERENT SCALES. 3975 02:39:38,800 --> 02:39:44,000 MAKING A TRADITIONAL TYPE OF 3976 02:39:44,000 --> 02:39:46,320 JOINT TIME TO FIRST DEATH OR 3977 02:39:46,320 --> 02:39:47,640 CARDIOVASCULAR EVENT WON'T WORK 3978 02:39:47,640 --> 02:39:49,720 IN THIS BECAUSE YOU HAVE GOT 3979 02:39:49,720 --> 02:39:51,560 THINGS MEASURED ON TWO SCALES 3980 02:39:51,560 --> 02:39:53,200 AND THAT'S WHERE THE 3981 02:39:53,200 --> 02:39:54,440 HIERARCHICAL OUTCOME AND 3982 02:39:54,440 --> 02:39:57,080 STATISTICS FOR THAT COME IN 3983 02:39:57,080 --> 02:39:57,280 HANDY. 3984 02:39:57,280 --> 02:39:58,480 I'LL SHOW IN A BIT. 3985 02:39:58,480 --> 02:40:03,160 THE TIMING, I THINK IF I 3986 02:40:03,160 --> 02:40:05,120 UNDERSTAND CORRECTLY THIS IS 3987 02:40:05,120 --> 02:40:06,240 PATIENTS PREVALENT TO DIALYSIS 3988 02:40:06,240 --> 02:40:07,720 AT LEAST THREE MONTHS ON AND 3989 02:40:07,720 --> 02:40:10,920 GOING TO BE FOLLOWED FOR UP TO 3990 02:40:10,920 --> 02:40:21,440 THREE TO FOUR YEARS AFTER WHICH 3991 02:40:31,520 --> 02:40:36,280 I MENTIONED DIALYSIS IS A 3992 02:40:36,280 --> 02:40:38,400 PRAGMATIC SETTING, FREQUENT 3993 02:40:38,400 --> 02:40:40,000 ENCOUNTERS THAT ARE PREDICTABLE 3994 02:40:40,000 --> 02:40:42,160 AND GRANULAR DATA COLLECTION, 3995 02:40:42,160 --> 02:40:45,720 LOTS OF LAB TESTING DONE ON A 3996 02:40:45,720 --> 02:40:46,040 MONTHLY BASIS. 3997 02:40:46,040 --> 02:40:50,840 THIS IS ALL MANDATED BY FEDERAL 3998 02:40:50,840 --> 02:40:51,240 REIMBURSEMENT. 3999 02:40:51,240 --> 02:40:56,040 A LOT OF THE VARIABILITY OTHER 4000 02:40:56,040 --> 02:41:06,480 STUDIES FACE IS MITIGATED IN 4001 02:41:06,480 --> 02:41:12,520 THIS POPULATION WE'RE WORKING 4002 02:41:12,520 --> 02:41:16,600 WITH OUR DIALYSIS PARTNER WHO 4003 02:41:16,600 --> 02:41:19,000 EMPLOYED DIETICIANS A MANDATE OF 4004 02:41:19,000 --> 02:41:19,680 THE FEDS. 4005 02:41:19,680 --> 02:41:24,120 THAT IS TO HAVE DIETICIANS WHO 4006 02:41:24,120 --> 02:41:27,680 ARE INTEGRALLY INVOLVED IN 4007 02:41:27,680 --> 02:41:29,920 MANAGING AND TRI TATING 4008 02:41:29,920 --> 02:41:31,120 PHOSPHATED THERAPIES WHETHER 4009 02:41:31,120 --> 02:41:35,720 THEY'RE ON THE TRIAL NOT. 4010 02:41:35,720 --> 02:41:40,000 THEY'RE A NATURE GROUP MOTIVATED 4011 02:41:40,000 --> 02:41:41,120 AND SCIENTIFICALLY INQUISITIVE 4012 02:41:41,120 --> 02:41:43,360 AND WANT TO SEE GOOD DATA FOR 4013 02:41:43,360 --> 02:41:45,320 BEST PRACTICE IN DIALYSIS AND 4014 02:41:45,320 --> 02:41:46,520 WORKED WITH DIETEDITIONS TO BE 4015 02:41:46,520 --> 02:41:51,960 ON THE GROUND IMPLEMENTATION OF 4016 02:41:51,960 --> 02:41:57,400 THE TRIAL PERSONNEL. 4017 02:41:57,400 --> 02:41:59,680 AND REHASHES AND THE RESEARCH 4018 02:41:59,680 --> 02:42:00,360 INVOLVED CLINIC RISK. 4019 02:42:00,360 --> 02:42:05,840 HOW DO WE GET CONSENT ON 4,000 4020 02:42:05,840 --> 02:42:11,160 PATIENTS WITH THE PERSONNEL ON 4021 02:42:11,160 --> 02:42:21,560 THE GROUND AND WE HAVE 4022 02:42:37,400 --> 02:42:39,240 STREAMLINED SOME OF THOSE LAST 4023 02:42:39,240 --> 02:42:40,880 MINE PAGES OF BOILER PLATE 4024 02:42:40,880 --> 02:42:43,880 INFORMATION ON TYPICAL INFORMED 4025 02:42:43,880 --> 02:42:46,360 CONSENT DOCUMENTS THAT ARE 4026 02:42:46,360 --> 02:42:48,520 REALLY CHALLENGES FOR EVERYBODY 4027 02:42:48,520 --> 02:42:49,280 INVOLVED IN THE PROCESS. 4028 02:42:49,280 --> 02:42:59,760 MOST IMPORTANTLY THE PATIENTS. 4029 02:43:09,960 --> 02:43:11,440 WE HAVE THE SERUM PHOSPHATE 4030 02:43:11,440 --> 02:43:13,120 THAT'S WHAT PEOPLE ARE BEING 4031 02:43:13,120 --> 02:43:21,000 ASKED TO TRITATE TO AND 4032 02:43:21,000 --> 02:43:22,560 INTERVENE IF PLACES ARE HAVING 4033 02:43:22,560 --> 02:43:23,800 STRUGGLES BY THE DATA BRIDGE 4034 02:43:23,800 --> 02:43:26,960 THAT WE HAVE WITH OUR PARTNERS 4035 02:43:26,960 --> 02:43:29,760 THAT SENDS US ON A MONTHLY BASIS 4036 02:43:29,760 --> 02:43:32,000 THE UPDATED LABORATORY RESULTS. 4037 02:43:32,000 --> 02:43:34,840 EVERY MONTH WE CAN SEE SERUM 4038 02:43:34,840 --> 02:43:35,920 PHOSPHATE AND CREATED A 4039 02:43:35,920 --> 02:43:38,600 DASHBOARD AT THE STUDY WIDE 4040 02:43:38,600 --> 02:43:40,120 LEVEL AND AT THE FACILITY LEVEL 4041 02:43:40,120 --> 02:43:43,800 WE FEEDBACK TO THE DIETICIANS 4042 02:43:43,800 --> 02:43:45,040 SHOWING THEM HOW WE'RE DOING 4043 02:43:45,040 --> 02:43:46,440 NATIONALLY AND WHICH PATIENTS 4044 02:43:46,440 --> 02:43:47,600 THEY MIGHT NEED TO FOCUS ON A 4045 02:43:47,600 --> 02:43:48,280 BIT MORE BECAUSE THEY'RE OUT OF 4046 02:43:48,280 --> 02:43:56,000 TARGET. 4047 02:43:56,000 --> 02:44:06,360 HERE'S THE OUTCOMES. 4048 02:44:09,200 --> 02:44:11,760 THE WAY THIS WORK AND I'LL GIVE 4049 02:44:11,760 --> 02:44:16,320 CREDIT TO FRANK AT THE BCRI THE 4050 02:44:16,320 --> 02:44:17,840 LEADER OF STATISTICS HERE WHERE 4051 02:44:17,840 --> 02:44:19,440 YOU HAVE THE SITUATION WHERE YOU 4052 02:44:19,440 --> 02:44:21,640 HAVE THINGS MEASURED ON TWO 4053 02:44:21,640 --> 02:44:26,480 DIFFERENT SCALES IN YOUR OUTCOME 4054 02:44:26,480 --> 02:44:28,040 YOU CAN'T JUST COMBINE THEM BY 4055 02:44:28,040 --> 02:44:29,160 ADDING THEM TOGETHER AND SAY 4056 02:44:29,160 --> 02:44:30,120 TIME TO FIRST. 4057 02:44:30,120 --> 02:44:32,800 THERE'S A THING CALLED 4058 02:44:32,800 --> 02:44:34,760 ESSENTIALLY THE WIN RATIO WHERE 4059 02:44:34,760 --> 02:44:38,760 YOU TRANSLATE BOTH SCALES ON TO 4060 02:44:38,760 --> 02:44:44,760 A NEW SCALE WHICH IS ONE PATIENT 4061 02:44:44,760 --> 02:44:47,160 IN BLUE IN THIS CASE VERSUS ONE 4062 02:44:47,160 --> 02:44:49,240 PATIENT IN RED. 4063 02:44:49,240 --> 02:44:51,080 WHAT I'M SHOWING HERE TAKE THE 4064 02:44:51,080 --> 02:44:55,880 FIRST EXAMPLE, THAT PATIENT IN 4065 02:44:55,880 --> 02:44:58,000 BLUE DIES RELATIVELY EARLY IN 4066 02:44:58,000 --> 02:44:59,040 FOLLOW-UP WHEREAS THE PATIENT IN 4067 02:44:59,040 --> 02:45:02,320 RED MAKES IT PRETTY FAR OUT. 4068 02:45:02,320 --> 02:45:03,760 THE EARLIER TIME TO DEATH MEANS 4069 02:45:03,760 --> 02:45:06,080 RED HAD A BETTER OUTCOME AND 4070 02:45:06,080 --> 02:45:08,080 PLUS ONE GOES IN THE RED COLUMN 4071 02:45:08,080 --> 02:45:09,880 AND MINUS ONE GOES IN THE BLUE 4072 02:45:09,880 --> 02:45:10,640 COLUMN. 4073 02:45:10,640 --> 02:45:14,600 THEN YOU CAN SEE ON THE 4074 02:45:14,600 --> 02:45:16,400 COMPARISON 2 IS A NICE EXAMPLE 4075 02:45:16,400 --> 02:45:19,200 WHERE THERE WERE TWO 4076 02:45:19,200 --> 02:45:20,000 HOSPITALIZATIONS THAT THE RED 4077 02:45:20,000 --> 02:45:22,640 COMPARATOR PATIENT IN THIS CASE 4078 02:45:22,640 --> 02:45:25,440 HAD BEFORE THE BLUE PATIENT DIED 4079 02:45:25,440 --> 02:45:28,040 BUT NEVERTHELESS SINCE WE HAVE 4080 02:45:28,040 --> 02:45:29,480 HIERARCHICALLY ASSIGNED THE 4081 02:45:29,480 --> 02:45:30,280 BIGGER PROFILE FOR BIGGER 4082 02:45:30,280 --> 02:45:32,080 PROFILE TO DEATH, YOU CAN SEE 4083 02:45:32,080 --> 02:45:36,000 SINCE THE RED PATIENT SURVIVED 4084 02:45:36,000 --> 02:45:37,920 LONGER THAN THE BLUE PATIENT 4085 02:45:37,920 --> 02:45:40,000 DID, THAT'S A WIN FOR RED THOUGH 4086 02:45:40,000 --> 02:45:42,480 THEY'RE EXPERIENCED MORE 4087 02:45:42,480 --> 02:45:42,880 HOSPITALIZATIONS. 4088 02:45:42,880 --> 02:45:44,000 YOU CAN TURN IT AROUND. 4089 02:45:44,000 --> 02:45:45,400 I WON'T GO THROUGH ALL OF THESE 4090 02:45:45,400 --> 02:45:47,600 BUT THE IDEA AND THE WAY THE 4091 02:45:47,600 --> 02:45:49,360 METHOD WORKS IS IT TAKES EVERY 4092 02:45:49,360 --> 02:45:51,520 PATIENT FROM THE BLUE ARM, THE 4093 02:45:51,520 --> 02:45:53,720 LOW ARM AND COMPARES IT TO EACH 4094 02:45:53,720 --> 02:45:56,440 POSSIBLE PATIENT IN THE RED ARM 4095 02:45:56,440 --> 02:45:57,400 AND RUNS THROUGH EVERY 4096 02:45:57,400 --> 02:45:58,640 PERMUTATION FROM THERE AND 4097 02:45:58,640 --> 02:46:01,840 GENERATES A SCORE AND YOU CAN 4098 02:46:01,840 --> 02:46:03,760 DERIVE A TEST STATISTIC FROM 4099 02:46:03,760 --> 02:46:05,400 THAT TO SAY WHICH GROUP HAD 4100 02:46:05,400 --> 02:46:08,520 BETTER OUTCOMES, ONE VERSUS THE 4101 02:46:08,520 --> 02:46:08,720 OTHER. 4102 02:46:08,720 --> 02:46:09,520 THE DOWN SIDE TO THE METHOD IS 4103 02:46:09,520 --> 02:46:11,360 THE SCORE IS HARD TO UNDERSTAND. 4104 02:46:11,360 --> 02:46:13,760 IT'S NOT LIKE A HAZARD RATIO 4105 02:46:13,760 --> 02:46:15,680 WHERE WE CAN QUANTIFY THE 4106 02:46:15,680 --> 02:46:19,160 MAGNITUDE OF EFFECT AND THE 4107 02:46:19,160 --> 02:46:21,080 SECONDARY ANALYSES IN OUR CASE 4108 02:46:21,080 --> 02:46:24,000 ARE THE COMPONENTS OF THE PRIME 4109 02:46:24,000 --> 02:46:27,600 PRIORY OUTCOME AND DO AN 4110 02:46:27,600 --> 02:46:29,600 ANALYSIS OF ADJUST TO DEATH AND 4111 02:46:29,600 --> 02:46:30,000 HOSPITALIZATIONS. 4112 02:46:30,000 --> 02:46:31,440 THE OVERALL PRIMARY OUTCOME WILL 4113 02:46:31,440 --> 02:46:38,880 BE DEFINED BY THE RATIO. 4114 02:46:38,880 --> 02:46:41,320 AND I'M SHOWING YOU A SNIPPET OF 4115 02:46:41,320 --> 02:46:44,000 WHAT TABLE 1 LOOKED LIKE BUT WE 4116 02:46:44,000 --> 02:46:45,760 HAD SOME IMBALANCES AND OTHER 4117 02:46:45,760 --> 02:46:47,960 THINGS THAT WERE BALANCED THAT 4118 02:46:47,960 --> 02:46:51,120 LED US TO THINK THERE WAS 4119 02:46:51,120 --> 02:46:52,680 SOMETHING FROM A CLINICAL TRIAL 4120 02:46:52,680 --> 02:46:54,440 PERSPECTIVE NOT GOING ON. 4121 02:46:54,440 --> 02:46:58,120 YOU CAN SEE FOR EXAMPLE THE 4122 02:46:58,120 --> 02:46:59,160 SERUM PHOSPHATE WAS ALREADY IN 4123 02:46:59,160 --> 02:47:01,880 RANGE GREATER THAN 6.5 AND THE 4124 02:47:01,880 --> 02:47:04,040 HIGH AT BASELINE AND CLOSE TO 4125 02:47:04,040 --> 02:47:14,400 RANGE IN THE LOW ARM. 4126 02:47:15,200 --> 02:47:16,920 AND THE WILLINGNESS TO 4127 02:47:16,920 --> 02:47:17,520 PARTICIPATE DELIVERED BETWEEN 4128 02:47:17,520 --> 02:47:18,520 THE TWO ARMS. 4129 02:47:18,520 --> 02:47:20,880 THE LOW ARM WE WERE ASKING 4130 02:47:20,880 --> 02:47:21,760 PEOPLE TO DO NOTHING DIFFERENT 4131 02:47:21,760 --> 02:47:27,880 JUST CONTINUE WIN -- WITH THE 4132 02:47:27,880 --> 02:47:30,120 STANDARD OF CARE AND IN THE HIGH 4133 02:47:30,120 --> 02:47:31,240 ARM GOOD CONSENT RATE BUT LOWER 4134 02:47:31,240 --> 02:47:36,080 THAN THE LOW ARM. 4135 02:47:36,080 --> 02:47:44,200 WE THINK AND SINCE THEY KNEW 4136 02:47:44,200 --> 02:47:45,960 WHAT THE HOUSING UNITS THEY WERE 4137 02:47:45,960 --> 02:47:49,360 IN WHAT THEY WERE RANDOMIZED TO 4138 02:47:49,360 --> 02:47:50,640 THAT PATIENTS WHO HISTORICALLY 4139 02:47:50,640 --> 02:47:54,360 HAD DIFFICULTY GETTING TO THEIR 4140 02:47:54,360 --> 02:47:55,560 PHOSPHATE TARGET WERE NOW 4141 02:47:55,560 --> 02:47:56,720 OFFERED THE OPPORTUNITY TO STOP 4142 02:47:56,720 --> 02:47:58,600 BEING BOTHERED BY EVERYBODY 4143 02:47:58,600 --> 02:48:00,000 THEY'RE PHOSPHATE'S TOO HIGH IF 4144 02:48:00,000 --> 02:48:02,240 THEY'RE DIALYSIS UNIT GOT 4145 02:48:02,240 --> 02:48:04,600 ASSIGNED TO THE HIGHER ARM AND 4146 02:48:04,600 --> 02:48:06,080 WERE PREFERENTIALLY AGREEING TO 4147 02:48:06,080 --> 02:48:07,560 PARTICIPATE IF THEY WERE ALREADY 4148 02:48:07,560 --> 02:48:09,480 HIGH AND VICE VERSA FOR THE LOW 4149 02:48:09,480 --> 02:48:10,480 ARM. 4150 02:48:10,480 --> 02:48:11,640 WE'RE WORRIED ABOUT BIASSED 4151 02:48:11,640 --> 02:48:13,480 ENROLLMENT AT THE OUTSET AND THE 4152 02:48:13,480 --> 02:48:20,000 NUMBERS AT THE BOTTOM SUPPORT 4153 02:48:20,000 --> 02:48:21,600 THAT. 4154 02:48:21,600 --> 02:48:32,160 WE MADE IT TO 500 PLUS PATIENTS 4155 02:48:44,560 --> 02:48:46,640 AND MADE THE REAL DRAMATIC 4156 02:48:46,640 --> 02:48:48,600 DECISION TO RE-WORK EVERYTHING 4157 02:48:48,600 --> 02:48:56,000 AND ESSENTIALLY START OVER 4158 02:48:56,000 --> 02:48:58,520 AGAIN. 4159 02:48:58,520 --> 02:49:01,520 AND THERE'S EXPERTISE AND 4160 02:49:01,520 --> 02:49:02,560 KNOW-HOW FROM HAVING DONE THIS 4161 02:49:02,560 --> 02:49:04,280 FIRST PART WITH THE CLUSTER. 4162 02:49:04,280 --> 02:49:06,320 I'D SAY FOR THIS GROUP AND FOR 4163 02:49:06,320 --> 02:49:07,440 TODAY'S SUBJECT MATTER THE MORAL 4164 02:49:07,440 --> 02:49:13,840 OF THE STORY FROM MY PERSPECTIVE 4165 02:49:13,840 --> 02:49:20,800 ARE TWO THINGS IF YOU YOU HAVE 4166 02:49:20,800 --> 02:49:26,000 DONE IT INTEREST A TRIAL IT 4167 02:49:26,000 --> 02:49:28,360 WOULD FROM THIS AND SUNK US IN 4168 02:49:28,360 --> 02:49:30,800 THIS CASE AND MORE ZOOMED OUT 4169 02:49:30,800 --> 02:49:32,920 FROM THAT 50,000 FOOT VIEW IN 4170 02:49:32,920 --> 02:49:37,160 FOCUSSING TRYING TO BE PRAGMATIC 4171 02:49:37,160 --> 02:49:44,560 WHEREVER FEASIBLE BUT NOT 4172 02:49:44,560 --> 02:49:46,200 NECESSARILY NOT BE A PRAGMATIC 4173 02:49:46,200 --> 02:49:48,840 ZEALOT AND THERE'S TIMES TO BE 4174 02:49:48,840 --> 02:49:50,240 PRAGMATIC AND SOMETIMES WHERE 4175 02:49:50,240 --> 02:49:52,040 BEING PRAGMATIC CAN CAUSE REAL 4176 02:49:52,040 --> 02:49:54,080 HARM TO INTERNAL VALIDITY AND 4177 02:49:54,080 --> 02:49:54,760 THOSE THINGS YOU SHOULD TRY TO 4178 02:49:54,760 --> 02:49:57,160 AVOID. 4179 02:49:57,160 --> 02:50:05,520 THANKS VERY MUCH. 4180 02:50:05,520 --> 02:50:06,920 >> WOULD YOU CHOOSE A DIFFERENT 4181 02:50:06,920 --> 02:50:09,520 DESIGN AND IT'S YES AND THE 4182 02:50:09,520 --> 02:50:14,720 SECOND ANSWER IS ALREADY HAVE 4183 02:50:14,720 --> 02:50:14,960 CHOSEN. 4184 02:50:14,960 --> 02:50:20,000 NOW WE TRANSITION TO PROVEN AND 4185 02:50:20,000 --> 02:50:21,360 VINCE MOR. 4186 02:50:21,360 --> 02:50:22,840 >> THANK YOU, IT'S FAS IN A 4187 02:50:22,840 --> 02:50:24,040 LOTTING. 4188 02:50:24,040 --> 02:50:33,560 OUR TRIAL HAS BEEN OVER FOR THE 4189 02:50:33,560 --> 02:50:34,640 VIDEO DID NOT MAKE A DIFFERENCE 4190 02:50:34,640 --> 02:50:38,680 IN OUR PRIMARY OUTCOME. 4191 02:50:38,680 --> 02:50:43,320 AND WORK WITH SUSAN MITCHELL AND 4192 02:50:43,320 --> 02:50:45,640 I'D LIKE TO BRIEFLY DISCUSS 4193 02:50:45,640 --> 02:50:46,680 CLUSTER RANDOMIZED TRIAL AND 4194 02:50:46,680 --> 02:50:50,680 SUMMARIZE THE MAIN FINDINGS AND 4195 02:50:50,680 --> 02:50:52,000 SPEND TIME TALKING ABOUT WOULD 4196 02:50:52,000 --> 02:50:53,240 DESIGN CHANGES HAVE MADE A 4197 02:50:53,240 --> 02:50:56,040 DIFFERENCE AND WHAT THE 4198 02:50:56,040 --> 02:51:06,520 IMPLICATIONS MIGHT HAVE BEEN. 4199 02:51:07,240 --> 02:51:09,960 YOU CAN GET VIDEO ASSISTED 4200 02:51:09,960 --> 02:51:12,960 ADVANCE CARE PLANNING AND DID IT 4201 02:51:12,960 --> 02:51:16,240 WITHIN TWO LARGE NURSING HOME 4202 02:51:16,240 --> 02:51:20,000 CHAINS. 4203 02:51:20,000 --> 02:51:21,960 AND THE RATIONALE IS THERE'S 1.5 4204 02:51:21,960 --> 02:51:23,800 MILLION PEOPLE AT THE TIME 4205 02:51:23,800 --> 02:51:26,320 LIVING IN NURSING HOMES OR 4206 02:51:26,320 --> 02:51:27,960 MOVING THROUGH NURSING HOMES 4207 02:51:27,960 --> 02:51:30,440 ABOUT 3 MILLION AND OFTEN 4208 02:51:30,440 --> 02:51:32,640 THEY'RE VERY SICK WITH ADVANCED 4209 02:51:32,640 --> 02:51:35,640 ILLNESS AND SUBJECTED TO 4210 02:51:35,640 --> 02:51:36,600 BURDENSOME INTERVENTIONS 4211 02:51:36,600 --> 02:51:39,480 PARTICULARLY HOSPITAL TRANSFERS 4212 02:51:39,480 --> 02:51:42,360 INCONSISTENT WITH PREFERENCES 4213 02:51:42,360 --> 02:51:46,640 AND OF LITTLE CLINICAL BENEFIT 4214 02:51:46,640 --> 02:51:52,000 IN TERMS OF EXTENDED LIFE. 4215 02:51:52,000 --> 02:51:59,280 IT'S PLANNING MAN DATES AND 4216 02:51:59,280 --> 02:51:59,920 OBSERVESAL STUDIES SUGGEST 4217 02:51:59,920 --> 02:52:02,080 PEOPLE WITH AN ADVANCED CARE 4218 02:52:02,080 --> 02:52:05,600 PLAN HAVE LESS LIKELY TO HAVE 4219 02:52:05,600 --> 02:52:06,520 HOSPITALIZATION AND TUBE FEEDING 4220 02:52:06,520 --> 02:52:10,320 OR GO TO AN ICU. 4221 02:52:10,320 --> 02:52:14,480 THOSE ARE OBSERVATIONAL. 4222 02:52:14,480 --> 02:52:17,960 THERE'S BEEN SOME SMALL PHASE 3 4223 02:52:17,960 --> 02:52:22,200 TRIALS TO SUGGEST ADVANCE CLAIR 4224 02:52:22,200 --> 02:52:27,280 PLANNING CAN LEAD TO PEOPLE 4225 02:52:27,280 --> 02:52:28,040 INCREASINGLY LIKELIHOOD ADVANCED 4226 02:52:28,040 --> 02:52:30,160 CARE PLAN AND HAVING LESS 4227 02:52:30,160 --> 02:52:34,640 INTENSIVE INTERVEGS -- 4228 02:52:34,640 --> 02:52:35,800 INTERVENTIONS THEY'RE HARD TO 4229 02:52:35,800 --> 02:52:38,520 SCALE UP WHERE THE AVERAGE SKILL 4230 02:52:38,520 --> 02:52:39,840 LEVEL OF THE STAFF IN THE 4231 02:52:39,840 --> 02:52:41,760 NURSING HOME WILL NOT BE AS 4232 02:52:41,760 --> 02:52:44,880 INTENSE IN HOSPITALS BUT EVEN IN 4233 02:52:44,880 --> 02:52:45,960 HOSPITALS THEY'RE DIFFICULT TO 4234 02:52:45,960 --> 02:52:48,000 SCALE UP. 4235 02:52:48,000 --> 02:52:50,960 THE VIDEO ASSISTED SUPPORT TOOL 4236 02:52:50,960 --> 02:52:51,640 WOULD STIMULATE THE CONVERSATION 4237 02:52:51,640 --> 02:52:55,440 AND THAT WAS THE IDEA BEHIND 4238 02:52:55,440 --> 02:52:55,640 THIS. 4239 02:52:55,640 --> 02:52:59,120 SO THE VIDEOS ARE FOCUSED ON 4240 02:52:59,120 --> 02:53:01,960 GOALS OF CARE AND PROLONGATIONS 4241 02:53:01,960 --> 02:53:03,600 AND SPECIFIC CONDITIONS AND AS 4242 02:53:03,600 --> 02:53:06,400 AN ADJUNCT TO OR LEAD-IN TO 4243 02:53:06,400 --> 02:53:09,160 COUNSELLING AND EACH OF THE 4244 02:53:09,160 --> 02:53:12,000 VIDEOS IS MAYBE FIVE TO EIGHT 4245 02:53:12,000 --> 02:53:13,600 MINUTES AT MAX. 4246 02:53:13,600 --> 02:53:15,360 WE DID A CLUSTER RANDOMIZED 4247 02:53:15,360 --> 02:53:17,680 TRIAL AND WORKED WITH TWO 4248 02:53:17,680 --> 02:53:21,360 SYSTEMS AND STARTED WITH 260 4249 02:53:21,360 --> 02:53:22,800 NURSING FACILITIES IN THE TWO 4250 02:53:22,800 --> 02:53:24,600 SYSTEMS AND SO WE FIRST 4251 02:53:24,600 --> 02:53:26,640 STRATIFIED BY HEALTH CARE SYSTEM 4252 02:53:26,640 --> 02:53:27,360 BECAUSE THEY'RE QUITE DIFFERENT, 4253 02:53:27,360 --> 02:53:29,000 DIFFERENT LOCATIONS IN THE 4254 02:53:29,000 --> 02:53:32,360 COUNTRY AND RANDOMLY ASSIGNED 4255 02:53:32,360 --> 02:53:34,640 THEM TO RANDOM CONTROL ARMS 4256 02:53:34,640 --> 02:53:41,400 WITHIN THAT. 4257 02:53:41,400 --> 02:53:42,600 THE PATIENT PARTICIPANT IS 4258 02:53:42,600 --> 02:53:42,840 IMPORTANT. 4259 02:53:42,840 --> 02:53:43,680 THEY'RE OF THEY'RE ALL 4260 02:53:43,680 --> 02:53:44,840 INDIVIDUALS IN THE NURSING 4261 02:53:44,840 --> 02:53:45,040 HOMES. 4262 02:53:45,040 --> 02:53:48,040 THIS WAS WAIVER OF CONSENT YOU, 4263 02:53:48,040 --> 02:53:52,040 CLUSTER RANDOM ASSIGNMENT, NO 4264 02:53:52,040 --> 02:53:53,360 CONSENT WHATSOEVER AND 4265 02:53:53,360 --> 02:53:54,120 FACILITIES IN THE INTERVENTION 4266 02:53:54,120 --> 02:53:55,280 GROUP THAT ADOPTED SOMETHING NEW 4267 02:53:55,280 --> 02:53:57,880 AND ACTUALLY WAS APPLIED TO ALL 4268 02:53:57,880 --> 02:53:59,120 NURSING HOME RESIDENTS DURING 4269 02:53:59,120 --> 02:54:02,600 THAT ENROLLMENT PERIOD. 4270 02:54:02,600 --> 02:54:04,840 HOWEVER, WE USED THE EMR IN THE 4271 02:54:04,840 --> 02:54:06,360 NURSING HOMES TO IDENTIFY THOSE 4272 02:54:06,360 --> 02:54:08,800 PEOPLE WHO ADVANCED ILLNESS WHO 4273 02:54:08,800 --> 02:54:10,200 WE THOUGHT HAD THE GREATEST 4274 02:54:10,200 --> 02:54:13,280 OPPORTUNITY TO BENEFIT FROM 4275 02:54:13,280 --> 02:54:15,920 ADVANCE D CARE PLANNING FOR 4276 02:54:15,920 --> 02:54:19,520 MEDICARE BENEFICIARIES 65 OR 4277 02:54:19,520 --> 02:54:21,480 OLDER WHO HAVE BEEN RESIDENTS 4278 02:54:21,480 --> 02:54:24,040 OVER 100 DAYS AND HAD EITHER 4279 02:54:24,040 --> 02:54:30,760 ADVANCED DEMENTIA OR COPD WITH 4280 02:54:30,760 --> 02:54:31,640 SIGNIFICANT COGNITIVE OR 4281 02:54:31,640 --> 02:54:34,440 PHYSICAL IMPAIRMENT AND BASED ON 4282 02:54:34,440 --> 02:54:35,480 HISTORICAL DATA THIS POPULATION 4283 02:54:35,480 --> 02:54:38,200 HAD A 50% PROBABILITY OF A 4284 02:54:38,200 --> 02:54:39,520 SIX-MONTH MORTALITY WITHIN SIX 4285 02:54:39,520 --> 02:54:41,320 MONTHS OF A GIVEN DATE AND THAT 4286 02:54:41,320 --> 02:54:50,120 WAS BASED ON MOLD -- MODEL AND 4287 02:54:50,120 --> 02:54:51,360 DATA AND THE POPULATION MORE 4288 02:54:51,360 --> 02:54:52,480 APPROPRIATE FOR. 4289 02:54:52,480 --> 02:54:55,280 WHILE EVERYONE WAS EXPOSED THIS 4290 02:54:55,280 --> 02:54:56,040 SUB GROUP OF THE POPULATION IS 4291 02:54:56,040 --> 02:54:58,640 WHERE IT TESTED THE PRIMARY 4292 02:54:58,640 --> 02:55:08,760 OUTCOME. 4293 02:55:25,200 --> 02:55:25,840 ING ON THE INTERVENTION SIDE 4294 02:55:25,840 --> 02:55:27,240 THERE WERE CHAMPIONS WHO TRIED 4295 02:55:27,240 --> 02:55:31,280 TO GET TWO PEOPLE TWO DO 4296 02:55:31,280 --> 02:55:31,800 TRAINING. 4297 02:55:31,800 --> 02:55:33,520 THERE WERE OFFERS OF VIDEOS AT 4298 02:55:33,520 --> 02:55:36,000 THE TIME OF ADMISSION AND IT WAS 4299 02:55:36,000 --> 02:55:37,520 INCORPORATED IN FOR NEW PATIENTS 4300 02:55:37,520 --> 02:55:40,840 INTO THE STANDARD ORIENTATIONS 4301 02:55:40,840 --> 02:55:44,440 IN THE FIRST 48-72 HOURS OF THE 4302 02:55:44,440 --> 02:55:45,200 ADMISSION TO THAT PATIENT 4303 02:55:45,200 --> 02:55:46,360 BECAUSE THERE'S LOTS OF DOWN 4304 02:55:46,360 --> 02:55:48,120 TIME IN THE NURSING HOME SETTING 4305 02:55:48,120 --> 02:55:51,720 AS THEY'RE SETTING YOU UP FOR 4306 02:55:51,720 --> 02:55:56,320 THE BEGINNING OF REHAB AND OTHER 4307 02:55:56,320 --> 02:55:57,480 POPULATIONS FOR THE LONG STAY 4308 02:55:57,480 --> 02:56:03,240 WAS EVERY SIX MONTHS OR AT THE 4309 02:56:03,240 --> 02:56:05,560 QUARTERLY CARE PLAN ADJUSTMENTS. 4310 02:56:05,560 --> 02:56:08,360 YOU CAN CHOOSE IN VIDEO OR 4311 02:56:08,360 --> 02:56:08,600 SPANISH. 4312 02:56:08,600 --> 02:56:11,200 WE HAD THEM EMBEDDED FOR THAT 4313 02:56:11,200 --> 02:56:13,560 AND THERE WERE PARTS OF THE 4314 02:56:13,560 --> 02:56:18,720 COUNTRY WHERE THERE WERE LOTS OF 4315 02:56:18,720 --> 02:56:27,520 SPANISH PATIENTS. 4316 02:56:27,520 --> 02:56:30,280 AND THIS MADE IT TOUGH TO CREATE 4317 02:56:30,280 --> 02:56:31,840 REPORTS ABOUT FIDELITY LARGELY 4318 02:56:31,840 --> 02:56:34,440 BASED ON THE PROPORTION OF 4319 02:56:34,440 --> 02:56:36,360 PEOPLE ENTERING TRYING TO GET A 4320 02:56:36,360 --> 02:56:37,640 HANDLE ON WHEN THESE WERE DONE 4321 02:56:37,640 --> 02:56:40,000 SO THERE WOULD BE SOME 4322 02:56:40,000 --> 02:56:44,920 REPORTING. 4323 02:56:44,920 --> 02:56:46,360 AND PEOPLE WERE OFFERED VIDEO. 4324 02:56:46,360 --> 02:56:51,760 EVERY TIME THERE WAS AN OFFERING 4325 02:56:51,760 --> 02:56:58,600 OF THE VIDEO AND THERE'S A VIDEO 4326 02:56:58,600 --> 02:56:59,600 IF THEY DID WANT IT THEY WERE 4327 02:56:59,600 --> 02:57:04,040 SHOWN. 4328 02:57:04,040 --> 02:57:06,800 THE PRIMARY OUTCOME I WAS 4329 02:57:06,800 --> 02:57:08,520 CHUCKLING WHEN MYLES WAS TALKING 4330 02:57:08,520 --> 02:57:10,240 ABOUT HIS COMPLEX AND COMPOSITE 4331 02:57:10,240 --> 02:57:11,600 OUTCOME WHICH WAS COMPLICATED 4332 02:57:11,600 --> 02:57:13,680 BECAUSE WE OF COURSE MORTALITY 4333 02:57:13,680 --> 02:57:15,560 IS MORTALITY AND MORTALITY WOULD 4334 02:57:15,560 --> 02:57:18,040 BE A SENSORING EVENT WHICH IS 4335 02:57:18,040 --> 02:57:18,880 COMPLICATED AND WE WERE 4336 02:57:18,880 --> 02:57:21,040 CONSCIOUS OF THAT GOING FORWARD. 4337 02:57:21,040 --> 02:57:26,520 WE HAD THE NUMBER OF HOSPITAL 4338 02:57:26,520 --> 02:57:31,880 TRANSFERS PER 1,000 PER 1,000 4339 02:57:31,880 --> 02:57:34,120 STAYS AMONG THE GROUP CALIBRATED 4340 02:57:34,120 --> 02:57:35,280 ON MEDICARE CLAIMS AND HAD 4341 02:57:35,280 --> 02:57:40,640 ACCESS TO THE DATA CENTER AT CMS 4342 02:57:40,640 --> 02:57:42,360 FOR THE DATA AND THEY'RE TWO OR 4343 02:57:42,360 --> 02:57:43,800 THREE MONTHS BEHIND. 4344 02:57:43,800 --> 02:57:46,920 WE WERE ABLE TO DO OUR FINAL 4345 02:57:46,920 --> 02:57:48,120 ANALYSES WITHIN THREE OR FOUR 4346 02:57:48,120 --> 02:57:51,480 MONTHS OF WHEN OUR LAST PATIENT 4347 02:57:51,480 --> 02:57:52,720 SORT OF MET THE 12-MONTH 4348 02:57:52,720 --> 02:58:03,000 FOLLOW-UP PERIOD. 4349 02:58:04,080 --> 02:58:04,920 HERE'S CHARACTERISTICS. 4350 02:58:04,920 --> 02:58:06,760 WITH RANDOM CLUSTER ASSIGNMENT 4351 02:58:06,760 --> 02:58:09,560 AT THE FACILITY LEVEL WE GOT 4352 02:58:09,560 --> 02:58:12,200 GOOD BALANCE ON MOST THINGS A 4353 02:58:12,200 --> 02:58:13,720 SLIGHT DIFFERENCE ON RESIDENTS 4354 02:58:13,720 --> 02:58:15,920 BECAUSE OF THE DISTRIBUTION OF 4355 02:58:15,920 --> 02:58:18,200 WHERE THE FACILITIES WERE ACROSS 4356 02:58:18,200 --> 02:58:18,760 THE COUNTRY. 4357 02:58:18,760 --> 02:58:21,040 WE DODGE THE BULLET. 4358 02:58:21,040 --> 02:58:22,280 THE MORTALITY RATE WAS SIMILAR 4359 02:58:22,280 --> 02:58:24,000 BETWEEN THE CONTROLS AND DAYS OF 4360 02:58:24,000 --> 02:58:26,320 FOLLOW-UP IN TERMS OF TOTAL 4361 02:58:26,320 --> 02:58:27,240 SURVIVAL TIME WERE LITERALLY 4362 02:58:27,240 --> 02:58:30,600 RIGHT ON THE MONEY. 4363 02:58:30,600 --> 02:58:33,560 DESPITE ALL THAT BALANCE WE 4364 02:58:33,560 --> 02:58:36,000 ACHIEVED NO DIFFERENCE IN THE 4365 02:58:36,000 --> 02:58:38,400 NUMBER OF HOSPITAL TRANSFERS PER 4366 02:58:38,400 --> 02:58:41,520 1,000 PERSON DAYS ALIVE, 3.7 4367 02:58:41,520 --> 02:58:44,560 VERSUS 3.9 AS WE LOOKED AT EACH 4368 02:58:44,560 --> 02:58:46,640 INDIVIDUAL ONES AND NONE OF 4369 02:58:46,640 --> 02:58:47,040 THOSE. 4370 02:58:47,040 --> 02:58:48,760 THERE WERE NO EFFECT IN THE 4371 02:58:48,760 --> 02:58:52,280 PRIMARY OUTCOME OR EVEN SOME OF 4372 02:58:52,280 --> 02:58:56,000 THE OTHER SUBANALYSIS SECONDARY 4373 02:58:56,000 --> 02:59:06,360 OUTCOMES WE LOOKED AT. 4374 02:59:07,800 --> 02:59:08,800 THERE'S DISTRIBUTION OF PERCENT 4375 02:59:08,800 --> 02:59:12,600 OF FACILITIES WHICH HAD WHAT 4376 02:59:12,600 --> 02:59:14,280 PERCENT OF RESIDENTS WITH 4377 02:59:14,280 --> 02:59:16,240 ILLNESS SHOWN ONE OF THE VIDEOS. 4378 02:59:16,240 --> 02:59:19,240 YOU CAN SEE THERE'S LOTS OF 4379 02:59:19,240 --> 02:59:20,560 VARIATION ACROSS THE 4380 02:59:20,560 --> 02:59:22,480 PARTICIPATING FACILITIES OR A 4381 02:59:22,480 --> 02:59:25,440 WHOLE BUNCH OF DIFFERENT REASONS 4382 02:59:25,440 --> 02:59:26,840 FROM TURNOVER IN THE STAFF TO 4383 02:59:26,840 --> 02:59:30,000 THIS IS ALL PRE-COVID SO WE 4384 02:59:30,000 --> 02:59:33,880 AGAIN DODGED THAT BULLET AS 4385 02:59:33,880 --> 02:59:34,120 WELL. 4386 02:59:34,120 --> 02:59:37,200 THERE WAS LOTS OF VARIATION FOR 4387 02:59:37,200 --> 02:59:38,560 MANY REASONS. 4388 02:59:38,560 --> 02:59:40,640 AFTER A WHILE SOME OF THE 4389 02:59:40,640 --> 02:59:42,320 ADMINISTRATORS FORGOT THEY WERE 4390 02:59:42,320 --> 02:59:44,000 EVEN INVOLVED BECAUSE OF CHANGES 4391 02:59:44,000 --> 02:59:54,560 IN ADMINISTRATION OR OTHERWISE. 4392 02:59:57,280 --> 02:59:58,640 SO WHAT COULD WE HAVE DONE 4393 02:59:58,640 --> 02:59:59,040 DIFFERENTLY? 4394 02:59:59,040 --> 03:00:01,880 WE THOUGHT WE COULD HAVE 4395 03:00:01,880 --> 03:00:04,640 STRATIFIED ON SOME MEASURE OF 4396 03:00:04,640 --> 03:00:05,360 FACILITY IMPLEMENTATION 4397 03:00:05,360 --> 03:00:05,640 CAPACITY. 4398 03:00:05,640 --> 03:00:07,760 NOW I COULD DO THAT AND COULD 4399 03:00:07,760 --> 03:00:10,360 COME UP WITH A SET OF RULES FOR 4400 03:00:10,360 --> 03:00:13,360 THAT BECAUSE YOU COULD ESTIMATE 4401 03:00:13,360 --> 03:00:15,600 THE EFFECT IN THE FACILITIES 4402 03:00:15,600 --> 03:00:16,160 THAT IMPLEMENTED. 4403 03:00:16,160 --> 03:00:18,800 WE CAN DO THAT PROSPECTIVELY 4404 03:00:18,800 --> 03:00:24,880 WITHOUT DOING POST HOC MASK YOU 4405 03:00:24,880 --> 03:00:27,280 COULD HAVE PEERS THAT WERE 4406 03:00:27,280 --> 03:00:28,800 ENGAGED A SHARING OF HOW THEY 4407 03:00:28,800 --> 03:00:30,840 SOLVED THE PROBLEM WHICH IS AN 4408 03:00:30,840 --> 03:00:32,000 IMPORTANT THING WHEN YOU DO 4409 03:00:32,000 --> 03:00:33,120 THESE EMBEDDED TRIALS. 4410 03:00:33,120 --> 03:00:35,160 YOU WANT TO GET ENGAGEMENT 4411 03:00:35,160 --> 03:00:36,200 ACROSS THE UNITS WHICH WERE 4412 03:00:36,200 --> 03:00:44,080 BEING DONE. 4413 03:00:44,080 --> 03:00:46,560 THE POST HOC ANALYSIS HAD MATCH 4414 03:00:46,560 --> 03:00:49,640 AND FACILITIES THAT WERE EXPOSED 4415 03:00:49,640 --> 03:00:52,000 WE DID SEE A DIFFERENCE BUT 4416 03:00:52,000 --> 03:00:54,200 THAT'S ONE OF THE REASONS WHY WE 4417 03:00:54,200 --> 03:00:55,560 THOUGHT IT WAS ABOUT 4418 03:00:55,560 --> 03:00:56,040 IMPLEMENTATION. 4419 03:00:56,040 --> 03:00:58,480 ON THE OTHER HAND WE COULD HAVE 4420 03:00:58,480 --> 03:01:00,000 BEEN UNDER POWERED BECAUSE WE 4421 03:01:00,000 --> 03:01:01,760 WOULD HAVE HAD FEWER FACILITIES 4422 03:01:01,760 --> 03:01:03,080 TO PICK. 4423 03:01:03,080 --> 03:01:08,080 THERE WAS A HIGHER ICC IN THE 4424 03:01:08,080 --> 03:01:10,400 OBSERVED INTERCLASS CORRELATION 4425 03:01:10,400 --> 03:01:11,880 IN THE DATA WE SAW RELATIVE TO 4426 03:01:11,880 --> 03:01:13,560 WHAT WE HAD PREDICTED AND 4427 03:01:13,560 --> 03:01:18,760 RELATIVE TO WHAT THE HISTORICAL 4428 03:01:18,760 --> 03:01:19,800 DATA SUGGESTS. 4429 03:01:19,800 --> 03:01:22,640 WE MAY NOT HAVE BEEN ABLE TO 4430 03:01:22,640 --> 03:01:25,320 PREDICT IMPLEMENTATION ALL THAT 4431 03:01:25,320 --> 03:01:25,520 WELL. 4432 03:01:25,520 --> 03:01:29,480 IT'S NOT ALL THAT GREAT AND HOW 4433 03:01:29,480 --> 03:01:31,240 PRAGMATIC IS IT YOU ONLY DEAL 4434 03:01:31,240 --> 03:01:34,400 WITH A QUARTER OF THE FACILITIES 4435 03:01:34,400 --> 03:01:35,080 AND COMPLICATES THE ANALYSIS AND 4436 03:01:35,080 --> 03:01:45,200 RESULTS. 4437 03:01:45,920 --> 03:01:48,000 PERHAPS WE CAN LOOK AT THIS 4438 03:01:48,000 --> 03:01:49,360 AMONGST THE SICK POSTACUTE 4439 03:01:49,360 --> 03:01:49,920 PATIENTS. 4440 03:01:49,920 --> 03:01:52,000 NOT THAT WE SAW AN EFFECT IN 4441 03:01:52,000 --> 03:01:58,200 THAT SUBGROUP BUT AGAIN WE WERE 4442 03:01:58,200 --> 03:01:58,800 UNDERPOWERED BECAUSE THERE 4443 03:01:58,800 --> 03:02:02,440 WEREN'T AS MANY OF THOSE PEOPLE. 4444 03:02:02,440 --> 03:02:03,880 THERE WERE HIGHER 4445 03:02:03,880 --> 03:02:05,200 HOSPITALIZATION RATES AND THE 4446 03:02:05,200 --> 03:02:08,080 VIDEO COULD HAVE BEEN INTRODUCED 4447 03:02:08,080 --> 03:02:10,640 AS PART OF THAT ADMISSION 4448 03:02:10,640 --> 03:02:12,560 ORIENTATION PROCESS AND THIS 4449 03:02:12,560 --> 03:02:16,000 WOULD HAVE BEEN SOMEBODY THAT 4450 03:02:16,000 --> 03:02:21,360 WAS SALIENT TO THE SKILLED 4451 03:02:21,360 --> 03:02:23,960 NURSING AND TO THE HOSPITAL THAT 4452 03:02:23,960 --> 03:02:24,680 WAS TRANSFERRING PEOPLE AND 4453 03:02:24,680 --> 03:02:26,160 COULD HAVE BEEN INVOLVED IN SOME 4454 03:02:26,160 --> 03:02:28,640 FORM OF INTERVENTION. 4455 03:02:28,640 --> 03:02:30,560 THE DISADVANTAGE IS A SMALLER 4456 03:02:30,560 --> 03:02:32,600 NUMBER OF PATIENTS AND VARIABLE 4457 03:02:32,600 --> 03:02:34,400 NUMBER OF POST-ACUTE PATIENTS 4458 03:02:34,400 --> 03:02:36,840 PER FACILITY BECAUSE WHEN YOU DO 4459 03:02:36,840 --> 03:02:40,000 FACILITY ANALYSIS AND PERHAPS WE 4460 03:02:40,000 --> 03:02:41,840 MIGHT HAVE DONE SOME 4461 03:02:41,840 --> 03:02:43,680 PATIENT-LEVEL RANDOM ASSIGNMENT 4462 03:02:43,680 --> 03:02:48,640 BUT THAT WOULD BE MORE DIFFICULT 4463 03:02:48,640 --> 03:02:50,720 TO DO BECAUSE OF THE BUILDING 4464 03:02:50,720 --> 03:02:53,360 OVER TIME AND OTHERWISE WE COULD 4465 03:02:53,360 --> 03:02:56,960 HAVE HAD THE PROBLEM MYLES HAD 4466 03:02:56,960 --> 03:02:59,320 WITH RECRUITMENT OF CLUSTER 4467 03:02:59,320 --> 03:03:00,160 RANDOM ASSIGNMENT. 4468 03:03:00,160 --> 03:03:04,640 IN THE END I THINK THERE WERE NO 4469 03:03:04,640 --> 03:03:08,600 WOULD HAVE BEEN NO CLEAR 4470 03:03:08,600 --> 03:03:09,880 ADVANTAGES DOING A DIFFERENT 4471 03:03:09,880 --> 03:03:10,640 KIND OF DESIGN IN THE OVERALL 4472 03:03:10,640 --> 03:03:20,760 STUDY. 4473 03:03:25,200 --> 03:03:27,440 AND YOU CAN GET DEMONSTRATION 4474 03:03:27,440 --> 03:03:29,360 PROJECTS IN NURSING SETTINGS IN 4475 03:03:29,360 --> 03:03:31,560 OLDER PEOPLE WITH DEMENTIA SO 4476 03:03:31,560 --> 03:03:33,560 THIS IS A VIBRANT ISSUE TO ME. 4477 03:03:33,560 --> 03:03:34,840 THANK YOU AND I LOOK FORWARD TO 4478 03:03:34,840 --> 03:03:45,040 QUESTIONS. 4479 03:03:59,320 --> 03:04:09,800 >> AND I THINK WE HAVE SUSAN 4480 03:04:12,320 --> 03:04:17,320 SHORTREED AS THE PRESENTER. 4481 03:04:17,320 --> 03:04:17,920 >> THANK YOU. 4482 03:04:17,920 --> 03:04:20,040 AS A BIO STATISTICIAN FOR THE 4483 03:04:20,040 --> 03:04:23,120 SUICIDE PREVENTION I'LL TRY NOT 4484 03:04:23,120 --> 03:04:29,840 TO DOUBLE UP ON INFORMATION. 4485 03:04:29,840 --> 03:04:31,320 I WANT TO ACKNOWLEDGE THIS IS 4486 03:04:31,320 --> 03:04:33,840 ANOTHER ONE OF THOSE HUGE TRIALS 4487 03:04:33,840 --> 03:04:35,560 IN THINKING ABOUT HEALTH SYSTEM 4488 03:04:35,560 --> 03:04:38,080 TRIALS AND PRAGMATIC TRIALS. 4489 03:04:38,080 --> 03:04:40,000 THERE'S A LOT OF NAMES THAT RNT 4490 03:04:40,000 --> 03:04:40,640 EVEN ON THIS INVOLVED IN 4491 03:04:40,640 --> 03:04:41,480 IMPLEMENTING THE TRIAL. 4492 03:04:41,480 --> 03:04:44,160 I WANT TO ACKNOWLEDGE ALL OF 4493 03:04:44,160 --> 03:04:50,640 THAT WORK. 4494 03:04:50,640 --> 03:04:52,440 AND THE GOAL OF THIS SUICIDE 4495 03:04:52,440 --> 03:04:54,760 PREVENTION OUTREACH TRIAL WAS TO 4496 03:04:54,760 --> 03:04:59,240 STUDY TWO LOW INTENSITY OUTREACH 4497 03:04:59,240 --> 03:05:00,400 INTERVENTIONS WHICH IS DIFFERENT 4498 03:05:00,400 --> 03:05:02,280 THAN SUICIDE PREVENTION RESEARCH 4499 03:05:02,280 --> 03:05:04,600 THAT HAS BEEN DONE WHICH FOCUSES 4500 03:05:04,600 --> 03:05:06,720 ON INDIVIDUALS WHO HAVE ALREADY 4501 03:05:06,720 --> 03:05:08,560 AGREED TO PARTICIPATE IN AN 4502 03:05:08,560 --> 03:05:09,800 INTERVENTION AND THE OUTCOME 4503 03:05:09,800 --> 03:05:12,680 WITH SELF-HARM OR SUICIDE 4504 03:05:12,680 --> 03:05:15,840 ATTEMPT INCLUDING FATAL SUICIDE 4505 03:05:15,840 --> 03:05:17,560 ATTEMPTS RESULTING IN SUICIDE. 4506 03:05:17,560 --> 03:05:19,360 NEITHER OF THE INTERVENTIONS 4507 03:05:19,360 --> 03:05:21,400 REDUCE RISK AND FOUND ONE OF THE 4508 03:05:21,400 --> 03:05:22,640 INTERVENTIONS MIGHT HAVE 4509 03:05:22,640 --> 03:05:25,480 INCREASED RISK. 4510 03:05:25,480 --> 03:05:26,920 IN LIGHT OF THIS DISAPPOINTING 4511 03:05:26,920 --> 03:05:28,640 RESULT IN THE EXTRA YEARS OF 4512 03:05:28,640 --> 03:05:30,160 EXPERIENCE I DON'T THINK THE 4513 03:05:30,160 --> 03:05:32,000 STUDY TEAM WOULD CHANGE THE 4514 03:05:32,000 --> 03:05:33,680 STUDY DESIGN. 4515 03:05:33,680 --> 03:05:35,800 WE WOULD OF COURSE HAVE 4516 03:05:35,800 --> 03:05:38,320 APPRECIATED AND HOPED THAT THESE 4517 03:05:38,320 --> 03:05:39,120 INTERVENTIONS WOULD PROVIDE US 4518 03:05:39,120 --> 03:05:42,320 SOME MORE PREVENTION STRATEGIES 4519 03:05:42,320 --> 03:05:47,160 IN OUR TOOLBOX BUT WE WEREN'T 4520 03:05:47,160 --> 03:05:47,760 CHANGE THINGS GOING BACK. 4521 03:05:47,760 --> 03:05:58,320 I WANTED TO PUT UP THE RESULTS. 4522 03:06:00,320 --> 03:06:01,240 AND THERE'S SKILLED TRAINING 4523 03:06:01,240 --> 03:06:02,680 WHICH I CAN TALK ABOUT LATER AND 4524 03:06:02,680 --> 03:06:07,320 THE TWO OVERLAPPING LINES THAT 4525 03:06:07,320 --> 03:06:09,520 ARE BLUE AND RED ARE CARE 4526 03:06:09,520 --> 03:06:10,680 MANAGER ANOTHER INTERVENTION AND 4527 03:06:10,680 --> 03:06:19,160 UNUSUAL CARE. 4528 03:06:19,160 --> 03:06:20,000 OUR STUDY QUESTION WAS AROUND 4529 03:06:20,000 --> 03:06:21,560 HEALTH QUESTIONS AND 4530 03:06:21,560 --> 03:06:22,960 IMPLEMENTING OUTREACH PROGRAMS 4531 03:06:22,960 --> 03:06:28,280 AND THE TWO INTERVENTIONS WERE 4532 03:06:28,280 --> 03:06:34,680 COACH WITH REDUCING SUICIDAL 4533 03:06:34,680 --> 03:06:39,280 BEHAVIOR WITH PATIENTS WHO 4534 03:06:39,280 --> 03:06:40,400 REPORTED SUICIDE IDEATION. 4535 03:06:40,400 --> 03:06:42,720 IN THINKING ABOUT THE POPULATION 4536 03:06:42,720 --> 03:06:46,680 IS SO WHO IS ENROLLED IN OUR 4537 03:06:46,680 --> 03:06:46,880 STUDY? 4538 03:06:46,880 --> 03:06:48,760 ALL INDIVIDUALS WERE ENROLLED IN 4539 03:06:48,760 --> 03:06:50,360 THE PARTICIPATING HEALTH 4540 03:06:50,360 --> 03:06:52,440 SYSTEMS, FOUR, WHO PRESIDENT 4541 03:06:52,440 --> 03:06:57,120 TRUMP OF RESPONDS WITH A PATIENT 4542 03:06:57,120 --> 03:06:58,880 QUESTIONNAIRE AND SUICIDE 4543 03:06:58,880 --> 03:07:02,520 IDEATION IS THE POPULATION WE 4544 03:07:02,520 --> 03:07:04,960 SAY ENDORSED SUICIDAL IDEATION. 4545 03:07:04,960 --> 03:07:10,040 THEY ALSO HAD TO USE MY CHART TO 4546 03:07:10,040 --> 03:07:12,000 BE RANDOMIZED BECAUSE IT WENT 4547 03:07:12,000 --> 03:07:16,000 THROUGH THE PATIENT PORTAL AND 4548 03:07:16,000 --> 03:07:26,360 SO THAT WAS IMPORTANT. 4549 03:07:44,080 --> 03:07:47,200 AND WE SEE AN INDIVIDUAL LEVEL 4550 03:07:47,200 --> 03:07:49,240 RANDOMIZATION IN THE 4551 03:07:49,240 --> 03:07:51,440 INTERVENTION IS DELIVERED 4552 03:07:51,440 --> 03:07:53,880 SEPARATELY FROM THE CLINICAL 4553 03:07:53,880 --> 03:07:56,000 STAFF AND CLINICAL CARE 4554 03:07:56,000 --> 03:07:56,840 CENTRALIZED LOCATION. 4555 03:07:56,840 --> 03:08:02,000 INDIVIDUAL LEVEL RANDOMIZATION 4556 03:08:02,000 --> 03:08:08,480 MADE THE MOST SENSE. 4557 03:08:08,480 --> 03:08:13,440 AND THERE'S A RESPONSE WITH 4558 03:08:13,440 --> 03:08:15,120 PARALLEL RANDOMIZATION EARLIER I 4559 03:08:15,120 --> 03:08:19,680 SAID ALL PARTICIPANTS IN FOUR 4560 03:08:19,680 --> 03:08:20,320 SITES. 4561 03:08:20,320 --> 03:08:21,720 ONE OF THE CHANGES WE BROUGHT ON 4562 03:08:21,720 --> 03:08:24,240 A SITE AND STARTED WITH THREE 4563 03:08:24,240 --> 03:08:25,520 SITES BUT WHEN YOU'RE ENROLLING 4564 03:08:25,520 --> 03:08:27,440 ALL INDIVIDUALS IF YOU'RE NOT 4565 03:08:27,440 --> 03:08:28,680 HITTING ENROLLMENT NUMBERS 4566 03:08:28,680 --> 03:08:31,200 THERE'S NOT A LOT YOU CAN DO 4567 03:08:31,200 --> 03:08:32,240 OTHER THAN WAIT LONGER OR BRING 4568 03:08:32,240 --> 03:08:34,680 ON ANOTHER SITE. 4569 03:08:34,680 --> 03:08:36,640 SO WE WERE ABLE TO BRING ON 4570 03:08:36,640 --> 03:08:37,280 ANOTHER SITE. 4571 03:08:37,280 --> 03:08:41,200 BECAUSE RANDOMIZATION WAS 4572 03:08:41,200 --> 03:08:42,760 PARALLEL, INDIVIDUAL LEVEL AND 4573 03:08:42,760 --> 03:08:44,240 STRATIFIED BY SITE IT WAS NOT 4574 03:08:44,240 --> 03:08:46,040 TOO MUCH OF A LIFT TO BRING IN 4575 03:08:46,040 --> 03:08:46,480 ANOTHER SITE. 4576 03:08:46,480 --> 03:08:48,040 WE CAN TALK ABOUT THE 4577 03:08:48,040 --> 03:08:49,240 OPERATIONAL CHALLENGES. 4578 03:08:49,240 --> 03:08:52,200 I DON'T WANT TO MINIMIZE THOSE. 4579 03:08:52,200 --> 03:08:55,720 AND I'LL SAY SPECIFICALLY 4580 03:08:55,720 --> 03:08:58,520 THINKING ABOUT SETTING AND 4581 03:08:58,520 --> 03:09:00,320 POPULATION IN SUICIDE PREVENTION 4582 03:09:00,320 --> 03:09:01,080 TRIALS AND RESEARCH, THIS 4583 03:09:01,080 --> 03:09:04,560 POPULATION IS ONE THAT HAS A 4584 03:09:04,560 --> 03:09:06,760 WIDER RANGE OF BASELINE RISK 4585 03:09:06,760 --> 03:09:07,840 THAN PREVIOUSLY STUDIED AND A 4586 03:09:07,840 --> 03:09:10,200 LOT OF SUICIDE PREVENTION 4587 03:09:10,200 --> 03:09:10,480 TRIALS. 4588 03:09:10,480 --> 03:09:13,400 SO THIS IS INCLUDING INDIVIDUALS 4589 03:09:13,400 --> 03:09:15,640 WHO HAVE NOT SOUGHT EMERGENCY 4590 03:09:15,640 --> 03:09:18,360 DEPARTMENT CARE FOR SELF HARM OR 4591 03:09:18,360 --> 03:09:21,040 PSYCHIATRIC CONDITIONS. 4592 03:09:21,040 --> 03:09:22,680 PEOPLE COULD BE SEEING THEIR 4593 03:09:22,680 --> 03:09:24,920 PRIMARY CARE PROVIDER, TALKING 4594 03:09:24,920 --> 03:09:27,960 ABOUT DEPRESSION AND WOULD BE 4595 03:09:27,960 --> 03:09:34,680 RANDOMIZED INTO THE TRIAL. 4596 03:09:34,680 --> 03:09:36,800 >> THERE'S TWO INTERVENTIONS 4597 03:09:36,800 --> 03:09:39,160 CALLED DBT SKILLS BY AN ONLINE 4598 03:09:39,160 --> 03:09:40,640 CARE AND RISK CARE MANAGEMENT. 4599 03:09:40,640 --> 03:09:42,200 I WANT TO HIGHLIGHT IN TERMS OF 4600 03:09:42,200 --> 03:09:45,200 THE RESULTS THAT BOTH 4601 03:09:45,200 --> 03:09:46,600 INTERVENTIONS ARE MUCH LOWER IN 4602 03:09:46,600 --> 03:09:51,160 INTENSITY THAN PREVIOUSLY 4603 03:09:51,160 --> 03:09:51,640 STUDIED. 4604 03:09:51,640 --> 03:09:53,320 THERE WAS NO COMPONENT WHICH CAN 4605 03:09:53,320 --> 03:09:56,880 OFTEN BE PART OF DBT SKILLS 4606 03:09:56,880 --> 03:09:57,080 THERAPY. 4607 03:09:57,080 --> 03:10:01,160 SO I WANTED TO CALL THAT OUT. 4608 03:10:01,160 --> 03:10:02,120 THE INVITATION PROCESS WAS 4609 03:10:02,120 --> 03:10:03,920 DELIVERED THROUGH THE ELECTRONIC 4610 03:10:03,920 --> 03:10:05,320 HEALTH RECORD. 4611 03:10:05,320 --> 03:10:09,960 IT DID NOT HAVE THE SAME 4612 03:10:09,960 --> 03:10:11,360 PERSONAL NOTE ATTACHED WE OFTEN 4613 03:10:11,360 --> 03:10:13,200 WOULD LIKE TO ATTACH TO MENTAL 4614 03:10:13,200 --> 03:10:13,840 HEALTH CARE. 4615 03:10:13,840 --> 03:10:16,680 I WOULD SAY THE INVITATION 4616 03:10:16,680 --> 03:10:18,360 PROCESS DID INVOLVE EXPRESSIONS 4617 03:10:18,360 --> 03:10:21,720 OF COMPARING AND CONCERN WHICH 4618 03:10:21,720 --> 03:10:23,600 THERE HAS BEEN SOME EVIDENCE 4619 03:10:23,600 --> 03:10:25,120 THAT IS EXPRESSING CARE, CARING 4620 03:10:25,120 --> 03:10:28,000 MESSAGES CAN BE A PREVENTION 4621 03:10:28,000 --> 03:10:32,040 STRATEGY FOR SUICIDE PREVENTION 4622 03:10:32,040 --> 03:10:34,080 MIXED RESULTS IN THAT AREA. 4623 03:10:34,080 --> 03:10:35,480 ONE THING THAT IS DIFFERENT 4624 03:10:35,480 --> 03:10:40,400 ABOUT OUR INVITATION PROCESS IS 4625 03:10:40,400 --> 03:10:42,160 WE'LL EXPRESS CONCERN THERE IS 4626 03:10:42,160 --> 03:10:43,960 ALSO AN ASK ABOUT WOULD YOU LIKE 4627 03:10:43,960 --> 03:10:47,560 TO PARTICIPATE IN THIS STUDY. 4628 03:10:47,560 --> 03:10:49,400 THE RESEARCH IS VOLUNTARY AND 4629 03:10:49,400 --> 03:10:52,960 YOU'RE FREE TO DECLINE. 4630 03:10:52,960 --> 03:10:54,800 THAT'S A VERY DIFFERENT 4631 03:10:54,800 --> 03:10:55,640 COMPONENT NOT IN TRADITIONAL 4632 03:10:55,640 --> 03:10:59,640 CARING MESSAGES AND THERE WAS A 4633 03:10:59,640 --> 03:11:00,720 REMINDER PROCESS AS WELL AS IS 4634 03:11:00,720 --> 03:11:04,080 STANDARD IN RESEARCH TO TRY TO 4635 03:11:04,080 --> 03:11:14,400 INCREASE INVOLVEMENT. 4636 03:11:14,400 --> 03:11:17,320 NOT ALL DBT SKILLS WERE COVERED 4637 03:11:17,320 --> 03:11:19,360 THIS WAS A COLLABORATION WITH 4638 03:11:19,360 --> 03:11:19,880 INDIVIDUALS WITH LIVED 4639 03:11:19,880 --> 03:11:24,840 EXPERIENCE AND INDIVIDUALS WHO 4640 03:11:24,840 --> 03:11:29,120 WORK WITH INDIVID INDIVIDUALS W 4641 03:11:29,120 --> 03:11:30,200 SUICIDAL THOUGHTS AND THE SKILLS 4642 03:11:30,200 --> 03:11:31,440 WERE USED. 4643 03:11:31,440 --> 03:11:33,800 THERE'S AN ONLINE COMPONENT AND 4644 03:11:33,800 --> 03:11:36,000 THE COACH SUPPORT HAD WITH 4645 03:11:36,000 --> 03:11:36,840 TAILORED REINFORCEMENT PERIODS 4646 03:11:36,840 --> 03:11:40,000 UP TO A 12-MONTH PERIOD. 4647 03:11:40,000 --> 03:11:43,160 CARE MANAGEMENT SIMILAR TO CARE 4648 03:11:43,160 --> 03:11:44,760 MANAGEMENT FOR DEPRESSION, SAME 4649 03:11:44,760 --> 03:11:45,120 OUTREACH. 4650 03:11:45,120 --> 03:11:48,000 IT WAS RISK-BASED AND IT COULD 4651 03:11:48,000 --> 03:11:53,640 OCCUR FOR UP TO 12 MONTHS AFTER 4652 03:11:53,640 --> 03:11:53,960 RANDOMIZATION. 4653 03:11:53,960 --> 03:11:56,000 LONG PERIODS OF POTENTIAL 4654 03:11:56,000 --> 03:11:58,600 INTERVENTION. 4655 03:11:58,600 --> 03:12:00,760 SO WITH EACH INTERVENTION IS 4656 03:12:00,760 --> 03:12:02,480 COMPARED TO USUAL CARE. 4657 03:12:02,480 --> 03:12:04,240 IN THE FIRST SLIDE I SAID ALL 4658 03:12:04,240 --> 03:12:06,240 INDIVIDUALS WERE RANDOMIZED AND 4659 03:12:06,240 --> 03:12:07,840 PEOPLE WERE BROUGHT FORTH AND 4660 03:12:07,840 --> 03:12:09,160 RANDOMIZED AND INTERVENTIONS 4661 03:12:09,160 --> 03:12:10,680 SENT AND EVERYONE WAS INCLUDED 4662 03:12:10,680 --> 03:12:15,080 IN THE COMPARISON WHETHER OR NOT 4663 03:12:15,080 --> 03:12:17,000 THEY TOOK UP THE INTERVENTION 4664 03:12:17,000 --> 03:12:22,720 AND THE LAST SPEAKER SHOWED A 4665 03:12:22,720 --> 03:12:33,120 VIDEO OF CARE PLANNING. 4666 03:12:34,760 --> 03:12:36,040 AND WE HAD OTHER INDIVIDUAL 4667 03:12:36,040 --> 03:12:40,680 WHO'S CRENGAGED IN THE 4668 03:12:40,680 --> 03:12:41,840 INTERVENTION AND OUTREACH WAS 4669 03:12:41,840 --> 03:12:44,560 WHO WOULD PARTICIPATE AND WHO 4670 03:12:44,560 --> 03:12:48,000 WOULDN'T AND WOULD THAT STILL BE 4671 03:12:48,000 --> 03:12:48,760 ABLE TO IMPACT SUICIDE ATTEMPT 4672 03:12:48,760 --> 03:12:58,880 RATES. 4673 03:13:02,520 --> 03:13:04,680 AND THE HYPOTHESIS ABOUT THE 4674 03:13:04,680 --> 03:13:07,520 POTENTIAL FOR INCREASED HARM IS 4675 03:13:07,520 --> 03:13:10,240 AROUND PERHAPS REPEATEDLY 4676 03:13:10,240 --> 03:13:11,920 REACHING OUT TO INDIVIDUALS WITH 4677 03:13:11,920 --> 03:13:13,080 SERVICES NOT INTERESTED. 4678 03:13:13,080 --> 03:13:16,040 THAT MAY NOT BE HELPFUL AND MAY 4679 03:13:16,040 --> 03:13:18,080 BE HARMFUL. 4680 03:13:18,080 --> 03:13:20,240 IT'S A POST HOC ANALYSIS AFTER 4681 03:13:20,240 --> 03:13:21,960 RANDOMIZATION AND A HYPOTHESES 4682 03:13:21,960 --> 03:13:22,720 FOR THE FUTURE BUT SOMETHING WE 4683 03:13:22,720 --> 03:13:28,720 WONDER ABOUT. 4684 03:13:28,720 --> 03:13:32,760 OUR OUTCOME WAS ALSO A COMPOSITE 4685 03:13:32,760 --> 03:13:35,200 OUTCOME BUT ABOUT 90% OF THE 4686 03:13:35,200 --> 03:13:38,120 OUTCOMES WERE NON-FATAL SUICIDE 4687 03:13:38,120 --> 03:13:43,640 ATTEMPTS AND 10% WERE SUICIDES. 4688 03:13:43,640 --> 03:13:47,440 AND WE HAD A CHART ADJUDICATION 4689 03:13:47,440 --> 03:13:49,320 SYSTEM DWREG -- 4690 03:13:52,480 --> 03:13:54,920 GREG TALKED ABOUT AND I 4691 03:13:54,920 --> 03:13:56,960 APPRECIATE THIS AS A 4692 03:13:56,960 --> 03:13:57,320 STATISTICIAN. 4693 03:13:57,320 --> 03:13:58,480 THERE WAS A LOT OF THOUGHT THAT 4694 03:13:58,480 --> 03:14:00,000 WENT INTO THIS TO HAVE A 4695 03:14:00,000 --> 03:14:03,160 RIGOROUS OUTCOME THAT WAS 4696 03:14:03,160 --> 03:14:05,280 COLLECTED ACROSS EVERYONE 4697 03:14:05,280 --> 03:14:09,400 UNIVERSALLY IN THE USUAL CARE AS 4698 03:14:09,400 --> 03:14:10,680 WELL AS THE INTERVENTION ARMS 4699 03:14:10,680 --> 03:14:12,000 AND ADDED TO THE RIGOR OF THE 4700 03:14:12,000 --> 03:14:15,240 STUDY. 4701 03:14:15,240 --> 03:14:18,240 SO WE DID LOOK AT 18 MONTHS 4702 03:14:18,240 --> 03:14:18,720 FOLLOWING RANDOMIZATION. 4703 03:14:18,720 --> 03:14:20,840 THE INTERVENTIONS COULD BE FOR 4704 03:14:20,840 --> 03:14:23,000 12 MONTHS OR SIX MONTHS 4705 03:14:23,000 --> 03:14:24,640 MAINTENANCE PERIOD BUT THINKING 4706 03:14:24,640 --> 03:14:27,800 ABOUT POTENTIAL CONTAMINATION 4707 03:14:27,800 --> 03:14:30,360 AND OTHER PROVIDERS WERE NOW 4708 03:14:30,360 --> 03:14:31,000 EXTENDING THAT TIME FOR WHICH 4709 03:14:31,000 --> 03:14:40,000 PEOPLE CAN DO THAT. 4710 03:14:40,000 --> 03:14:42,160 AND PERSONALLY IMPORTANT IN 4711 03:14:42,160 --> 03:14:43,720 OUTREACH TRIALS FOR SOME WHO 4712 03:14:43,720 --> 03:14:46,720 CONTINUE TO BE AT RISK FOR 4713 03:14:46,720 --> 03:14:49,040 SUICIDAL BEHAVIOR AND IS THAT 4714 03:14:49,040 --> 03:14:50,320 INTERVENTION -- IS THAT 4715 03:14:50,320 --> 03:14:52,000 SOMETHING WE NEED TO BE ONGOING 4716 03:14:52,000 --> 03:14:53,840 OR IS THAT MAINTAINED AT ANY 4717 03:14:53,840 --> 03:14:54,040 LEVEL? 4718 03:14:54,040 --> 03:14:55,880 I WANTED TO THROW OUT WE DID 4719 03:14:55,880 --> 03:15:05,120 HAVE TO CENSOR PEOPLE BECAUSE OF 4720 03:15:05,120 --> 03:15:06,080 AVAILABILITY OF INFORMATION 4721 03:15:06,080 --> 03:15:08,680 ABOUT SUICIDE ATTEMPTS. 4722 03:15:08,680 --> 03:15:12,000 THOSE NOT ENROLLED IN THE HEALTH 4723 03:15:12,000 --> 03:15:15,000 SYSTEM WE WERE NOT GUARANTEED TO 4724 03:15:15,000 --> 03:15:17,720 ASCERTAIN THAT OUTCOME. 4725 03:15:17,720 --> 03:15:20,360 I DO BELIEVE THIS WAS THE RIGHT 4726 03:15:20,360 --> 03:15:22,080 SETTING AND IS THIS SOMETHING 4727 03:15:22,080 --> 03:15:23,760 HEALTH SYSTEMS SHOULD WANT TO DO 4728 03:15:23,760 --> 03:15:25,320 TO REACH OUT TO PEOPLE WHO MAY 4729 03:15:25,320 --> 03:15:27,840 NOT SPECIFICALLY BE SEEKING CARE 4730 03:15:27,840 --> 03:15:33,120 FOR SUICIDAL IDEATION BUT MAY 4731 03:15:33,120 --> 03:15:34,840 HAVE INCREASED RISK AND DELIVER 4732 03:15:34,840 --> 03:15:39,000 ONE OF THE INTERVENTIONS? 4733 03:15:39,000 --> 03:15:39,680 I BELIEVE THAT WAS MY LAST 4734 03:15:39,680 --> 03:15:42,920 SLIDE -- NO, THIS IS AN 4735 03:15:42,920 --> 03:15:43,960 IMPORTANT SLIDE NOT RELATED 4736 03:15:43,960 --> 03:15:44,840 WHICH I FORGOT ABOUT. 4737 03:15:44,840 --> 03:15:49,240 I WANTED TO BRING IT UP IN A 4738 03:15:49,240 --> 03:15:51,120 GROUP OF INDIVIDUALS WHO ARE 4739 03:15:51,120 --> 03:15:56,640 PROBABLY DESIGNING OTHER STUDIES 4740 03:15:56,640 --> 03:16:03,880 IN THIS REALM. 4741 03:16:03,880 --> 03:16:05,280 IN THIS STUDY WE DIDN'T EXPECT 4742 03:16:05,280 --> 03:16:07,680 DO SEE AN INCREASED RISK OF 4743 03:16:07,680 --> 03:16:08,440 HARM. 4744 03:16:08,440 --> 03:16:10,680 THIS COULD EVEN HAPPEN IN 4745 03:16:10,680 --> 03:16:13,800 STUDIES WHERE WE DON'T THINK IT 4746 03:16:13,800 --> 03:16:13,960 CAN. 4747 03:16:13,960 --> 03:16:16,600 DATA SAFETY MONITORING BOARDS 4748 03:16:16,600 --> 03:16:21,320 ARE IMPORTANT EVEN FOR THOSE IN 4749 03:16:21,320 --> 03:16:22,720 PRAGMATIC TRIALS. 4750 03:16:22,720 --> 03:16:24,160 FOR THOSE STAFFING TRIALS WITH 4751 03:16:24,160 --> 03:16:25,600 SERIOUS OUTCOMES HAVING MORE 4752 03:16:25,600 --> 03:16:28,000 THAN ONE PERSON RESPONSIBLE FOR 4753 03:16:28,000 --> 03:16:29,280 THOSE REPORTS I JUST WANT TO 4754 03:16:29,280 --> 03:16:33,120 THROW THAT OUT THERE AS THERE'S 4755 03:16:33,120 --> 03:16:34,440 PEOPLE PLANNING STUDIES OR IN 4756 03:16:34,440 --> 03:16:38,120 THE FIELD IT'S IMPORTANT TO HAVE 4757 03:16:38,120 --> 03:16:40,280 MULTIPLE PEOPLE ON THE REPORT. 4758 03:16:40,280 --> 03:16:41,920 IN ANOTHER PIECE THAT'S BEEN 4759 03:16:41,920 --> 03:16:45,200 TOUCHED ON BY A FEW DIFFERENT 4760 03:16:45,200 --> 03:16:46,600 PEOPLE IS QUALITY ASSURANCE OF 4761 03:16:46,600 --> 03:16:48,440 THE DATA IS COMPLICATED IN 4762 03:16:48,440 --> 03:16:50,080 STUDIES THAT USE ADMINISTRATIVE 4763 03:16:50,080 --> 03:16:51,600 DATA AND ELECTRONIC HEALTH 4764 03:16:51,600 --> 03:16:54,080 RECORDS AND MANY STUDIES ARE 4765 03:16:54,080 --> 03:16:55,000 GOING OVER YEARS, THINGS CHANGE 4766 03:16:55,000 --> 03:16:56,680 OVER TIME AND BREAK OVER TIME. 4767 03:16:56,680 --> 03:16:58,480 I HEARD MULTIPLE STUDIES TALK 4768 03:16:58,480 --> 03:16:59,720 ABOUT THAT. 4769 03:16:59,720 --> 03:17:00,320 I PERSONALLY THINK THAT 4770 03:17:00,320 --> 03:17:03,040 SOMETHING THAT WOULD BE REALLY 4771 03:17:03,040 --> 03:17:05,760 IMPORTANT FOR DSMBs TO START 4772 03:17:05,760 --> 03:17:08,080 DOING IS TO INVOLVE THE REGULAR 4773 03:17:08,080 --> 03:17:13,280 QUALITY ASSURANCE AS PART OF THE 4774 03:17:13,280 --> 03:17:14,680 MONITORING OF THE TRIAL LIKE WE 4775 03:17:14,680 --> 03:17:15,680 MONITOR ENROLLMENT. 4776 03:17:15,680 --> 03:17:17,880 ARE WE GETTING THE DATA WE 4777 03:17:17,880 --> 03:17:18,920 EXPECT TO GET? 4778 03:17:18,920 --> 03:17:20,400 ARE WE GETTING IT EQUALLY ACROSS 4779 03:17:20,400 --> 03:17:20,960 THE GROUPS. 4780 03:17:20,960 --> 03:17:22,720 THESE ARE THINGS WE CAN PROBABLY 4781 03:17:22,720 --> 03:17:24,320 DO IN A BLINDED FASHION. 4782 03:17:24,320 --> 03:17:28,000 MAYBE NOT EVERYTHING BUT I THINK 4783 03:17:28,000 --> 03:17:29,560 IT'S ACTUALLY REALLY IMPORTANT 4784 03:17:29,560 --> 03:17:31,200 TO THE FIDELITY OF OUR RESEARCH 4785 03:17:31,200 --> 03:17:32,360 AND MAKING SURE WE'RE GETTING 4786 03:17:32,360 --> 03:17:34,680 THE ANSWER THAT WE SHOULD BE 4787 03:17:34,680 --> 03:17:36,000 GETTING. 4788 03:17:36,000 --> 03:17:40,200 AND I'M PRETTY SURE THAT'S MY 4789 03:17:40,200 --> 03:17:46,360 LAST SLIDE. 4790 03:17:46,360 --> 03:17:46,680 >> TERRIFIC. 4791 03:17:46,680 --> 03:17:47,360 MANY THANKS. 4792 03:17:47,360 --> 03:17:49,480 I WANT TO MAKE A QUICK SUMMARY 4793 03:17:49,480 --> 03:17:50,760 COMMENT AND THEN WE'LL OPEN IT 4794 03:17:50,760 --> 03:17:52,720 UP. 4795 03:17:52,720 --> 03:17:58,320 IT WOULD BE GREAT IF OUR 4796 03:17:58,320 --> 03:18:00,000 PANELI 4797 03:18:00,000 --> 03:18:03,080 PANELISTS AND REALLY, REALLY 4798 03:18:03,080 --> 03:18:03,720 INTERESTING. 4799 03:18:03,720 --> 03:18:04,720 THANK YOU FOR LAYING OUT THIS 4800 03:18:04,720 --> 03:18:05,960 POPULATION INTERVENTION 4801 03:18:05,960 --> 03:18:08,720 COMPARISON OUTCOMES, TIMING AND 4802 03:18:08,720 --> 03:18:11,680 SETTING AND I HAVE A QUESTION ON 4803 03:18:11,680 --> 03:18:14,200 EACH OF THOSE THAT I'D LOVE TO 4804 03:18:14,200 --> 03:18:18,320 ASK IF THERE'S TIME BUT I WANT 4805 03:18:18,320 --> 03:18:21,160 TO SAY YOU GUYS NICELY REMINDED 4806 03:18:21,160 --> 03:18:24,880 ME IT'S SOMETHING THAT WAS 4807 03:18:24,880 --> 03:18:26,880 TOUCHED ON AND THE CONSENT WAS 4808 03:18:26,880 --> 03:18:30,360 ALSO A FUNDAMENTAL PART OF THE 4809 03:18:30,360 --> 03:18:31,800 DESIGN OR EXECUTION OF THE 4810 03:18:31,800 --> 03:18:33,960 DESIGN AND THEN INTERVENTION 4811 03:18:33,960 --> 03:18:36,000 FIDELITY WAS REALLY IT SEEMED 4812 03:18:36,000 --> 03:18:38,400 LIKE A CRITICAL PART OF AT LEAST 4813 03:18:38,400 --> 03:18:42,920 THREE OF THE PRESENTATIONS. 4814 03:18:42,920 --> 03:18:45,080 SO MAYBE I'LL START THERE AND 4815 03:18:45,080 --> 03:18:46,240 INVITE OTHERS TO ASK QUESTIONS. 4816 03:18:46,240 --> 03:18:48,000 IN FACT, I DON'T WANT TO START 4817 03:18:48,000 --> 03:18:48,440 THERE. 4818 03:18:48,440 --> 03:18:50,080 I WANT TO SAY ARE THERE ANY 4819 03:18:50,080 --> 03:18:54,680 QUESTIONS FROM YOU PANELISTS OR 4820 03:18:54,680 --> 03:18:57,600 COMMENTS YOU WANT TO MAKE BASED 4821 03:18:57,600 --> 03:18:58,800 ON WHAT YOU HEARD FROM THE OTHER 4822 03:18:58,800 --> 03:19:05,240 PANELISTS. 4823 03:19:05,240 --> 03:19:07,960 >> THIS IS VINCE MOR. 4824 03:19:07,960 --> 03:19:08,880 MYLES I LOVED YOUR DESCRIPTION 4825 03:19:08,880 --> 03:19:15,080 OF THE DIAL -- DIALYSIS CENTER 4826 03:19:15,080 --> 03:19:16,680 IS THE PERFECT WAY AND I THINK 4827 03:19:16,680 --> 03:19:21,480 OF NURSING HOMES AND WAS VERY 4828 03:19:21,480 --> 03:19:25,480 AWARE OF THE WORK ON THE TIME AS 4829 03:19:25,480 --> 03:19:25,680 WELL. 4830 03:19:25,680 --> 03:19:28,360 IT'S GREAT STRUCTURE. 4831 03:19:28,360 --> 03:19:31,040 I THINK YOUR EXPERIENCE OF 4832 03:19:31,040 --> 03:19:35,800 BASICALLY FINDING YOU NEEDED TO 4833 03:19:35,800 --> 03:19:37,560 SWITCH TO PERSONAL RECRUITMENT 4834 03:19:37,560 --> 03:19:39,000 BECAUSE OF THE NATURE OF THE 4835 03:19:39,000 --> 03:19:41,760 OFFER UNDER THE CONSENT 4836 03:19:41,760 --> 03:19:42,640 CIRCUMSTANCE IS SUCH AN 4837 03:19:42,640 --> 03:19:46,720 INTERESTING AND COMPLICATED 4838 03:19:46,720 --> 03:19:47,920 CIRCUMSTANCE BECAUSE FOR MANY OF 4839 03:19:47,920 --> 03:19:55,560 THE CLUS FOR RANDOMIZED TRIALS 4840 03:19:55,560 --> 03:19:58,680 YOU'RE TRIAL IS THERE'S REALLY 4841 03:19:58,680 --> 03:20:00,800 NOT -- THEY SHOULD BE DOING WHAT 4842 03:20:00,800 --> 03:20:02,320 WE ARE PROPOSING FOR THEM TO DO 4843 03:20:02,320 --> 03:20:04,200 A LOT MORE OF ANYWAY. 4844 03:20:04,200 --> 03:20:05,200 SO WE'RE JUST TRYING TO GOOSE 4845 03:20:05,200 --> 03:20:07,920 THEM IN A QUALITY IMPROVEMENT 4846 03:20:07,920 --> 03:20:10,720 WAY BUT IN A RIGOROUS WAY. 4847 03:20:10,720 --> 03:20:16,480 TO DO A SHIFT IN WHAT THE 4848 03:20:16,480 --> 03:20:19,000 INTERVENTION IS ON THE CLINICAL 4849 03:20:19,000 --> 03:20:21,200 SIDE WITHOUT ASKING CONSENT IS A 4850 03:20:21,200 --> 03:20:22,160 COMPLICATED THING. 4851 03:20:22,160 --> 03:20:23,360 IT INTRODUCES A MORE COMPLICATED 4852 03:20:23,360 --> 03:20:25,320 WAY OF THINKING ABOUT WHAT'S THE 4853 03:20:25,320 --> 03:20:35,880 RIGHT UNIT OF RANDOM ASSIGNMENT. 4854 03:20:37,320 --> 03:20:38,640 >> I WOULD RESPOND SOME SMART 4855 03:20:38,640 --> 03:20:43,760 PEOPLE INVOLVED IN HEARING OUR 4856 03:20:43,760 --> 03:20:48,000 STUDY ALONG THE WAY AND I DON'T 4857 03:20:48,000 --> 03:20:53,120 THINK WE SHOULD TAKE CREDIT FOR 4858 03:20:53,120 --> 03:20:56,040 ANY GREAT CONTRIBUTION HERE TO 4859 03:20:56,040 --> 03:20:58,360 FIGURING THIS. 4860 03:20:58,360 --> 03:21:01,040 AT SOME LEVEL THE 4861 03:21:01,040 --> 03:21:02,960 POST-RANDOMIZATION CONSENT IS A 4862 03:21:02,960 --> 03:21:04,000 PREDICTABLE THING AND WE SAID 4863 03:21:04,000 --> 03:21:07,120 LET'S TRY TO OVERCOME IT. 4864 03:21:07,120 --> 03:21:08,080 WE WEREN'T SURE WHICH DIRECTION 4865 03:21:08,080 --> 03:21:09,920 IT WOULD GO. 4866 03:21:09,920 --> 03:21:12,000 WE THOUGHT FOR INSTANCE THERE 4867 03:21:12,000 --> 03:21:14,040 MIGHT BE ENOUGH PATIENTS WHO 4868 03:21:14,040 --> 03:21:15,760 WOULD SAY, GREAT, THIS MAKES MY 4869 03:21:15,760 --> 03:21:21,560 LIFE EASIER AND THAT THE HIGH 4870 03:21:21,560 --> 03:21:23,800 ARM WOULD HAVE HAD HIGHER 4871 03:21:23,800 --> 03:21:25,120 RECRUITMENT THAN ULTIMATE IT 4872 03:21:25,120 --> 03:21:26,000 PROVED TO BE. 4873 03:21:26,000 --> 03:21:31,040 I THINK WE PROVED SOMETHING 4874 03:21:31,040 --> 03:21:39,160 PEOPLE ALREADY KNEW. 4875 03:21:39,160 --> 03:21:41,400 >> I DIDN'T KNOW. 4876 03:21:41,400 --> 03:21:42,600 I'VE BEEN OFF THE COLLABORATORY 4877 03:21:42,600 --> 03:21:45,040 CALL FOR A WHILE BUT IT CAME UP 4878 03:21:45,040 --> 03:21:47,640 WITH THE COMMENT SUSAN WAS 4879 03:21:47,640 --> 03:21:49,840 SAYING ABOUT DSMBs. 4880 03:21:49,840 --> 03:21:51,360 YOU CAN SPEND SO MUCH TIME WITH 4881 03:21:51,360 --> 03:21:55,160 YOUR DSMB ON THINGS THAT ARE NOT 4882 03:21:55,160 --> 03:21:56,400 IMPORTANT AND YET THERE MAY BE 4883 03:21:56,400 --> 03:21:57,960 THINGS THAT ARE REALLY IMPORTANT 4884 03:21:57,960 --> 03:22:01,600 AND I THINK THE SOLUTION TO THAT 4885 03:22:01,600 --> 03:22:06,720 IS TAILORING DSMBs TO PRAGMATIC 4886 03:22:06,720 --> 03:22:06,960 TRIALS. 4887 03:22:06,960 --> 03:22:11,160 WE TALK ABOUT IT CAN'T HAVE IT'S 4888 03:22:11,160 --> 03:22:13,560 OWN PRAGMATIC TRIALS ACROSS 4889 03:22:13,560 --> 03:22:16,520 INSTITUTES BUT SAY WHAT YOU'VE 4890 03:22:16,520 --> 03:22:19,400 DONE TO TAILOR DSMBs TO TRIALS. 4891 03:22:19,400 --> 03:22:22,440 >> UNDER IMPACT WE'RE FUNDING 4892 03:22:22,440 --> 03:22:23,440 PILOTS AND DEMOS. 4893 03:22:23,440 --> 03:22:26,400 WE'VE NOW FUNDED LIKE 18 OF 4894 03:22:26,400 --> 03:22:27,240 THEM. 4895 03:22:27,240 --> 03:22:30,480 MOST THE PILOTS END UP WITH JUST 4896 03:22:30,480 --> 03:22:32,640 A SAFETY OFFICER AND WE HAVE A 4897 03:22:32,640 --> 03:22:34,040 SINGLE ONE WHO HAS A BROAD 4898 03:22:34,040 --> 03:22:34,680 PERSPECTIVE ON THIS. 4899 03:22:34,680 --> 03:22:39,160 SOMEBODY NOT INVOLVED IN TRIALS 4900 03:22:39,160 --> 03:22:41,840 BUT CLINICAL WORK AND KNOWS 4901 03:22:41,840 --> 03:22:44,680 GERIATRICS AND DEMENTIA BUT IT'S 4902 03:22:44,680 --> 03:22:46,120 APPLIED TO THREE OR FOUR OF THE 4903 03:22:46,120 --> 03:22:47,440 PILOTS IN THE DEMOS. 4904 03:22:47,440 --> 03:22:52,000 IT'S A STANDING DSMB OF SIX 4905 03:22:52,000 --> 03:22:56,760 PEOPLE. 4906 03:22:56,760 --> 03:22:58,200 THERE'S LARGE-SCALE TRIALS AND 4907 03:22:58,200 --> 03:23:04,000 THE STATISTICIANS PARTICULARLY 4908 03:23:04,000 --> 03:23:07,720 ARE. 4909 03:23:07,720 --> 03:23:13,280 IT'S NOT LIKE THE NIMH STANDING 4910 03:23:13,280 --> 03:23:15,040 DSMB MORE FAMILIAR WITH 4911 03:23:15,040 --> 03:23:16,000 INDIVIDUAL RANDOM ASSIGNMENT 4912 03:23:16,000 --> 03:23:16,680 DRUG TRIALS. 4913 03:23:16,680 --> 03:23:20,000 THESE PEOPLE KNOW ABOUT THE 4914 03:23:20,000 --> 03:23:24,160 VARIETIES HERE. 4915 03:23:24,160 --> 03:23:27,520 AS IT ALL ABOUT DEMENTIA AND 4916 03:23:27,520 --> 03:23:32,360 OLDER PEOPLE IN LOTS OF 4917 03:23:32,360 --> 03:23:32,600 SETTINGS. 4918 03:23:32,600 --> 03:23:34,720 THERE'S A COHERENCE TO THE 4919 03:23:34,720 --> 03:23:44,360 UNDERSTANDING OF THE POPULATION. 4920 03:23:44,360 --> 03:23:46,280 >> OTHER COMMENTS OR QUESTIONS 4921 03:23:46,280 --> 03:23:49,040 FROM OUR PANELISTS FIRST? 4922 03:23:49,040 --> 03:23:50,960 >> IT'S TANGENTIALLY RELATED TO 4923 03:23:50,960 --> 03:23:58,720 THE DSMBs KNOWLEDGE IN THIS 4924 03:23:58,720 --> 03:24:03,320 SPACE 4925 03:24:03,320 --> 03:24:05,240 >> WHAT SUNK US IN THE ATTEMPT 4926 03:24:05,240 --> 03:24:07,200 AT THE CLUSTER RANDOMIZATION WAS 4927 03:24:07,200 --> 03:24:12,800 A BIT OF A KNOWLEDGE GAP OR MORE 4928 03:24:12,800 --> 03:24:18,240 OF A BIT IN CLINICAL TRIALS AND 4929 03:24:18,240 --> 03:24:21,960 HOW THEY'RE DONE OF WHAT THEY'RE 4930 03:24:21,960 --> 03:24:25,360 TRYING TO EMBED THIS IN. 4931 03:24:25,360 --> 03:24:28,680 WE HAVE PEOPLE WILLING PARTNERS 4932 03:24:28,680 --> 03:24:34,720 WHICH IS AN ENORMOUS OBSTACLE TO 4933 03:24:34,720 --> 03:24:35,280 SURMOUNT. 4934 03:24:35,280 --> 03:24:36,560 THEY SOMETIMES HAVE SEE A 4935 03:24:36,560 --> 03:24:39,160 CLINICAL TRIAL THROUGH THE LENS 4936 03:24:39,160 --> 03:24:40,720 OF THEIR CLINICAL EXPERIENCE AND 4937 03:24:40,720 --> 03:24:44,720 THEIR BIASES OF WHAT THEY THINK 4938 03:24:44,720 --> 03:24:46,240 IS THE RIGHT ANSWER AND WHAT 4939 03:24:46,240 --> 03:24:51,480 THEY THINK WE WANT THEM TO DO 4940 03:24:51,480 --> 03:24:56,840 AND I THINK THAT HAD A BIG 4941 03:24:56,840 --> 03:24:58,680 INFLUENCE ON PEOPLE BEING COAXED 4942 03:24:58,680 --> 03:24:59,640 INTO A STUDY. 4943 03:24:59,640 --> 03:25:03,280 ONE OF THE BIG HURDLES TO THINK 4944 03:25:03,280 --> 03:25:04,680 ABOUT AND MAYBE OVER TIME AS THE 4945 03:25:04,680 --> 03:25:05,880 BUSINESS EXPANDS AND THERE'S 4946 03:25:05,880 --> 03:25:07,600 MORE AND MORE OF THE STUDIES IT 4947 03:25:07,600 --> 03:25:10,720 WILL START TO SEEP INTO MORE 4948 03:25:10,720 --> 03:25:12,000 PEOPLE'S CONSCIOUSNESS BUT 4949 03:25:12,000 --> 03:25:14,000 THERE'S A HUGE EDUCATIONAL GAP 4950 03:25:14,000 --> 03:25:16,680 FOR THE PEOPLE TO IMPLEMENT 4951 03:25:16,680 --> 03:25:20,040 STUDIES ON THE GROUND THAT NEEDS 4952 03:25:20,040 --> 03:25:22,680 TO BE THOUGHT ABOUT IN THE 4953 03:25:22,680 --> 03:25:30,280 DESIGN PHASE. 4954 03:25:30,280 --> 03:25:31,120 >> I AGREE. 4955 03:25:31,120 --> 03:25:33,560 HERE'S ONE FROM THE AUDIENCE. 4956 03:25:33,560 --> 03:25:34,680 ANY OTHER COMMENTS FROM 4957 03:25:34,680 --> 03:25:36,360 PANELISTS WHO WANT TO WEIGH IN? 4958 03:25:36,360 --> 03:25:38,720 LET'S HEAR FROM THE AUDIENCE. 4959 03:25:38,720 --> 03:25:40,720 WENDY, WHY DON'T YOU OPEN THE 4960 03:25:40,720 --> 03:25:47,240 MIC AND OFFER YOUR QUESTION. 4961 03:25:47,240 --> 03:25:50,720 >> GREAT PRESENTATIONS, 4962 03:25:50,720 --> 03:25:51,000 EVERYONE. 4963 03:25:51,000 --> 03:25:53,160 THE FIRST COMMENT FROM THE 4964 03:25:53,160 --> 03:25:55,040 AUDIENCE, FANTASTIC DISCUSSIONS 4965 03:25:55,040 --> 03:25:55,920 AND PRESENTATIONS. 4966 03:25:55,920 --> 03:25:58,760 THEY'D LOVE TO HEAR THE PROS AND 4967 03:25:58,760 --> 03:26:06,560 CONS OF INDIVIDUAL VERSUS THE 4968 03:26:06,560 --> 03:26:08,080 PROVIDER CLINIC LEVEL AND YOU 4969 03:26:08,080 --> 03:26:10,720 ALLUDED TO THIS IN A COMMENT AND 4970 03:26:10,720 --> 03:26:12,040 CURIOUS WHAT PEOPLE THINK ONE 4971 03:26:12,040 --> 03:26:18,920 VERSUS THE OTHER. 4972 03:26:18,920 --> 03:26:20,880 >> IT'S FUN AND IT'S A PRIVILEGE 4973 03:26:20,880 --> 03:26:22,720 TO BE ABLE TO SEE ACROSS SUCH A 4974 03:26:22,720 --> 03:26:25,320 WIDE RANGE OF TRIALS AS THEY 4975 03:26:25,320 --> 03:26:29,640 DEVELOP THROUGH THIS NETWORK AND 4976 03:26:29,640 --> 03:26:29,880 OTHERS. 4977 03:26:29,880 --> 03:26:33,120 WE HAVE LEARNED INDIVIDUALLY 4978 03:26:33,120 --> 03:26:35,360 RANDOMIZED IS PREFERRED TO 4979 03:26:35,360 --> 03:26:36,280 PARALLEL GROUP RANDOMIZED 4980 03:26:36,280 --> 03:26:41,280 PREFERRED TO STEP WEDGE. 4981 03:26:41,280 --> 03:26:43,120 IT'S HARD TO GENERALIZE BUT 4982 03:26:43,120 --> 03:26:48,880 THAT'S THE CASCADE OF THINKING 4983 03:26:48,880 --> 03:26:50,320 AND WHAT DOUG OR SUSAN COMMENTED 4984 03:26:50,320 --> 03:26:52,040 ON WHEN IT'S RANDOMIZED YOU CAN 4985 03:26:52,040 --> 03:26:55,280 BALANCE THINGS THAT CHANGE OVER 4986 03:26:55,280 --> 03:26:56,000 TIME. 4987 03:26:56,000 --> 03:26:57,880 STEP WEDGE PUTS LATER THINGS IN 4988 03:26:57,880 --> 03:26:58,440 THE INTERVENTION GROUP AND 4989 03:26:58,440 --> 03:27:04,040 DOESN'T BALANCE ON TIME. 4990 03:27:04,040 --> 03:27:05,840 PARALYZED RANDOMIZED TRIAL MAY 4991 03:27:05,840 --> 03:27:07,360 BUT THERE'S OTHER BALANCE OF 4992 03:27:07,360 --> 03:27:08,000 DRIFT TO CONSIDER IN THAT DESIGN 4993 03:27:08,000 --> 03:27:16,720 AS WELL. 4994 03:27:16,720 --> 03:27:18,120 THERE'S A 50,000 FOOT 4995 03:27:18,120 --> 03:27:19,320 GENERALIZIZATION AND MAYBE IT'S 4996 03:27:19,320 --> 03:27:21,720 THE ROBUSTNESS ISSUE THAT 4997 03:27:21,720 --> 03:27:23,000 CREATES THE HIERARCHY BUT HAS TO 4998 03:27:23,000 --> 03:27:24,120 MATCH THE QUESTION. 4999 03:27:24,120 --> 03:27:27,760 IF THE QUESTION'S ABOUT CHANGING 5000 03:27:27,760 --> 03:27:29,880 THE CLINIC STRUCTURE, YOU CHANGE 5001 03:27:29,880 --> 03:27:32,000 THE CLINIC STRUCTURE AND 5002 03:27:32,000 --> 03:27:33,360 RANDOMIZE CLINICS. 5003 03:27:33,360 --> 03:27:35,720 THE DESIGN HAS FIDELITY TO THE 5004 03:27:35,720 --> 03:27:36,000 QUESTION. 5005 03:27:36,000 --> 03:27:39,400 MAYBE WHAT WE'RE TALKING ABOUT 5006 03:27:39,400 --> 03:27:41,640 TODAY ARE ELEMENTS OF ROBUSTNESS 5007 03:27:41,640 --> 03:27:43,840 OF THAT DESIGN TO THE 5008 03:27:43,840 --> 03:27:46,480 INTERCURRENT FORCES IN THE WORLD 5009 03:27:46,480 --> 03:27:48,240 AS WE LISTED IN THE ONE SUMMARY 5010 03:27:48,240 --> 03:27:48,440 SLIDE. 5011 03:27:48,440 --> 03:27:50,760 OTHER COMMENTS? 5012 03:27:50,760 --> 03:27:54,360 >> I WOULD ADD TO THAT MAYBE 5013 03:27:54,360 --> 03:27:56,000 25,000 VIEW BASED ON WHAT YOU 5014 03:27:56,000 --> 03:27:56,960 SAID INDIVIDUAL RANDOMIZATION 5015 03:27:56,960 --> 03:28:02,640 WOULD ALWAYS BE THE WINNER. 5016 03:28:02,640 --> 03:28:06,360 IF YOU HAVE AN INTERVENTION THAT 5017 03:28:06,360 --> 03:28:08,600 DOES NOT NEED INFORMED CONSENT 5018 03:28:08,600 --> 03:28:15,880 AND YOU COULD GET HUGE SWATHS OF 5019 03:28:15,880 --> 03:28:18,560 NUMBERS IN ONE FELL SWOOP WITH 5020 03:28:18,560 --> 03:28:19,560 CLUSTER RANDOMIZATION THAT'S 5021 03:28:19,560 --> 03:28:20,920 PERHAPS AN OPPORTUNITY WHERE 5022 03:28:20,920 --> 03:28:22,280 OPERATIONALLY IT'S EASIER AND 5023 03:28:22,280 --> 03:28:27,360 YOU CAN OVERCOME THE STATISTICAL 5024 03:28:27,360 --> 03:28:28,480 HEAD WITH NUMBERS. 5025 03:28:28,480 --> 03:28:30,440 IF CONSENT'S INVOLVED YOU HAVE 5026 03:28:30,440 --> 03:28:31,560 TO DO INDIVIDUAL LEVEL 5027 03:28:31,560 --> 03:28:32,000 RANDOMIZATION. 5028 03:28:32,000 --> 03:28:35,480 IF YOU DON'T HAVE CONSENT, THEN 5029 03:28:35,480 --> 03:28:38,960 IT BECOMES MUCH MORE NUANCED AND 5030 03:28:38,960 --> 03:28:41,960 THE ADVANTAGES START TO PILE UP 5031 03:28:41,960 --> 03:28:44,040 A LITTLE BIT MORE IN THE CLUSTER 5032 03:28:44,040 --> 03:28:54,280 SIDE. 5033 03:28:54,280 --> 03:28:55,600 >> THE OTHER INTERCURRENT 5034 03:28:55,600 --> 03:28:55,840 EVENTS. 5035 03:28:55,840 --> 03:28:58,120 WE ALL SURVIVED COVID AND MANY 5036 03:28:58,120 --> 03:29:00,720 ARE INVOLVED IN HEAL, PAIN, 5037 03:29:00,720 --> 03:29:01,320 OPIOID TRIALS. 5038 03:29:01,320 --> 03:29:04,000 A COUPLE YEARS AGO THERE WAS A 5039 03:29:04,000 --> 03:29:06,400 METH EPIDEMIC LIKE PATRICK 5040 03:29:06,400 --> 03:29:09,320 CALLED -- WE'RE INVOLVED IN AN 5041 03:29:09,320 --> 03:29:11,120 OPIOID TRIAL. 5042 03:29:11,120 --> 03:29:13,720 COVID IS ITS OWN EPIDEMIC THEN 5043 03:29:13,720 --> 03:29:16,600 THERE'S METH NOW THERE'S 5044 03:29:16,600 --> 03:29:16,840 FENTANYL. 5045 03:29:16,840 --> 03:29:18,440 THINK OF THE NATIONAL 5046 03:29:18,440 --> 03:29:19,040 VARIABILITY IN THE DIFFERENT 5047 03:29:19,040 --> 03:29:20,840 DRUGS AND MYLES IF YOU HAVE ALL 5048 03:29:20,840 --> 03:29:24,640 THESE SITES AND THE EAST COAST 5049 03:29:24,640 --> 03:29:26,360 HAS SEEN THE FENTANYL WAVE AND 5050 03:29:26,360 --> 03:29:29,480 NOW IT'S ROCK FENTANYL IN THE 5051 03:29:29,480 --> 03:29:29,920 MIDWEST. 5052 03:29:29,920 --> 03:29:31,240 THANK GOD FOR INDIVIDUAL 5053 03:29:31,240 --> 03:29:31,560 RANDOMIZATION. 5054 03:29:31,560 --> 03:29:41,280 THAT'S JUST MY BIAS. 5055 03:29:41,280 --> 03:29:43,360 >> MYLES, IF YOU DON'T NEED TO 5056 03:29:43,360 --> 03:29:46,520 CONSENT AND THE INTERVENTION IS 5057 03:29:46,520 --> 03:29:49,360 DELIVERED AT THE CLINIC OR 5058 03:29:49,360 --> 03:29:51,240 FACILITY LEVEL BECAUSE THERE'S 5059 03:29:51,240 --> 03:29:52,280 TOO MUCH BLEEDING WITHIN PLACE 5060 03:29:52,280 --> 03:29:54,280 YOU NEED TO DO CLUSTER DESIGN. 5061 03:29:54,280 --> 03:29:55,840 YOU REALLY GOT TO KNOW WHAT ELSE 5062 03:29:55,840 --> 03:30:02,000 IS GOING ON TO DO THE PROPER 5063 03:30:02,000 --> 03:30:04,000 STRATIFICATION IN ADVANCE. 5064 03:30:04,000 --> 03:30:06,560 I'VE DONE A LARGE TRIAL OF 5065 03:30:06,560 --> 03:30:09,600 VACCINE HIGH DOSE VERSUS 5066 03:30:09,600 --> 03:30:10,120 STANDARD DOSE INFLUENZA 5067 03:30:10,120 --> 03:30:12,000 VACCINATION IN NURSING HOMES. 5068 03:30:12,000 --> 03:30:15,160 WE HAD 400 IN THE CONTROL AND I 5069 03:30:15,160 --> 03:30:15,960 STILL GOT SCREWED BECAUSE WE 5070 03:30:15,960 --> 03:30:18,800 DIDN'T STRATIFY ON THE 5071 03:30:18,800 --> 03:30:24,040 PROPORTION OF AFRICAN AMERICAN 5072 03:30:24,040 --> 03:30:27,240 AND DIFFERENTIAL RESPONSES AND 5073 03:30:27,240 --> 03:30:28,440 YOU THINK HOW COULD I NOT HAVE 5074 03:30:28,440 --> 03:30:30,120 DONE THAT WHEN YOU THINK THE LAW 5075 03:30:30,120 --> 03:30:32,040 OF LARGE NUMBERS IS GOING TO 5076 03:30:32,040 --> 03:30:35,280 WORK BUT SOMETIMES DOESN'T. 5077 03:30:35,280 --> 03:30:36,520 >> I LIKE THAT COROLLARY. 5078 03:30:36,520 --> 03:30:39,360 I WAS GOING TO ADD THAT TO YOUR 5079 03:30:39,360 --> 03:30:44,000 COMMENT, MYLES, YES, NUMBERS IN 5080 03:30:44,000 --> 03:30:46,400 INDIVIDUAL PATIENTS BUT WHAT 5081 03:30:46,400 --> 03:30:49,800 ABOUT REPLICATION OF CLIN IBZ TO 5082 03:30:49,800 --> 03:30:51,600 CONTROL THAT VARIATION THROUGH 5083 03:30:51,600 --> 03:30:52,680 AVERAGING. 5084 03:30:52,680 --> 03:30:54,800 WE'RE CONTROL BY AVERAGING BUT 5085 03:30:54,800 --> 03:30:58,240 HOW TO THINK OF ADDRESSING 5086 03:30:58,240 --> 03:30:59,240 CONTROL OF THE CLINIC-LEVEL 5087 03:30:59,240 --> 03:31:00,560 VARIATION AND WHAT WE HEARD IN 5088 03:31:00,560 --> 03:31:02,200 POPULATION AND HOW THEY DELIVER 5089 03:31:02,200 --> 03:31:05,280 THE INTERVENTION AND HOW THEY 5090 03:31:05,280 --> 03:31:06,480 MAY OR MAY NOT CAPTURE THE 5091 03:31:06,480 --> 03:31:10,720 OUTCOME FOR YOU AND WHAT ARE THE 5092 03:31:10,720 --> 03:31:12,520 SETTING CHARACTERISTICS, VINCE, 5093 03:31:12,520 --> 03:31:13,480 YOU CANNOT CAPTURE AND SAY THOSE 5094 03:31:13,480 --> 03:31:14,600 ARE IMPORTANT. 5095 03:31:14,600 --> 03:31:16,720 I'M GOING TO CONTROL THAT 5096 03:31:16,720 --> 03:31:24,440 VARIATION UP FRONT. 5097 03:31:24,440 --> 03:31:28,720 >> WE DID A TRIAL IN THE MIDST 5098 03:31:28,720 --> 03:31:31,120 OF COVID ON VACCINATION RATES. 5099 03:31:31,120 --> 03:31:32,480 IN SOME PLACES THERE WEREN'T 5100 03:31:32,480 --> 03:31:34,680 MUCH COVID SO THEY DIDN'T WANT 5101 03:31:34,680 --> 03:31:37,640 TO GET VACCINATED. 5102 03:31:37,640 --> 03:31:42,600 IT'S YOU HAVE TO HAVE THE 5103 03:31:42,600 --> 03:31:43,280 STRATIFICATION IN PLACE. 5104 03:31:43,280 --> 03:31:45,480 >> I WANT TO BRING SOMETHING UP 5105 03:31:45,480 --> 03:31:48,920 BECAUSE I THINK THERE'S A 5106 03:31:48,920 --> 03:31:51,000 MISNOMER THAT CLUSTER 5107 03:31:51,000 --> 03:31:54,560 RANDOMIZATION CAN PREVENT 5108 03:31:54,560 --> 03:31:55,800 CONTAMINATION AND I WANT TO 5109 03:31:55,800 --> 03:31:58,440 TOUCH ON IT AND IT'S ACROSS THE 5110 03:31:58,440 --> 03:32:00,000 BOARD AND ACROSS FIELD. 5111 03:32:00,000 --> 03:32:02,760 THAT'S NOT OFTEN THE CASE. 5112 03:32:02,760 --> 03:32:03,360 I PERSONALLY THINK. 5113 03:32:03,360 --> 03:32:05,120 I THINK WHAT THE INTERVENTION IS 5114 03:32:05,120 --> 03:32:06,600 AND HOW IT WOULD BE DELIVERED IS 5115 03:32:06,600 --> 03:32:11,160 THE MOST IMPORTANT THING IN 5116 03:32:11,160 --> 03:32:14,800 DECIDING WHO SHOULD BE CLUSTERED 5117 03:32:14,800 --> 03:32:16,000 AND AT WHAT LEVEL AND HEALTH 5118 03:32:16,000 --> 03:32:18,320 CARE IS MORE COMPLICATED THAN 5119 03:32:18,320 --> 03:32:20,760 WHO YOUR PRIMARY DOCTOR IS OR 5120 03:32:20,760 --> 03:32:21,120 CARDIOLOGIST. 5121 03:32:21,120 --> 03:32:24,440 I WANT TO BRING THAT UP AS A 5122 03:32:24,440 --> 03:32:25,960 COMPLEXITY OF CONTAMINATION GOES 5123 03:32:25,960 --> 03:32:28,000 BOTH WAYS AND IT'S THINKING 5124 03:32:28,000 --> 03:32:38,080 THROUGH THAT WHOLE PROCESS. 5125 03:32:38,080 --> 03:32:43,080 >> I WANT TO ASK ONE QUESTION. 5126 03:32:43,080 --> 03:32:48,000 I HEARD FROM YOU, DOUG, VINCE 5127 03:32:48,000 --> 03:32:49,840 AND SUSAN THERE WAS A LOT OF 5128 03:32:49,840 --> 03:32:52,320 VARIABILITY IN THE UPTAKE OF THE 5129 03:32:52,320 --> 03:32:57,160 INTERVENTION OR THE FIDELITY TO 5130 03:32:57,160 --> 03:32:59,120 THE INTERVENTION. 5131 03:32:59,120 --> 03:33:02,520 YOU CALLED THAT OUT. 5132 03:33:02,520 --> 03:33:06,920 ANY LESSON LEARNED ON HOW -- 5133 03:33:06,920 --> 03:33:08,600 VINCE, YOU OFFERED ONE LESSON. 5134 03:33:08,600 --> 03:33:12,680 CAN YOU PREDICT IT AND CONTROL 5135 03:33:12,680 --> 03:33:14,760 IT BUT ANY ADVICE ON SOMEONE 5136 03:33:14,760 --> 03:33:18,440 THINKING OF A TRIAL AND THE 5137 03:33:18,440 --> 03:33:21,360 PRAGMATIC EMBEDDED CONTEXT ON 5138 03:33:21,360 --> 03:33:24,000 HOW TO DEAL WITH OR MITIGATE 5139 03:33:24,000 --> 03:33:28,000 MAYBE VARIABILITY OF THE 5140 03:33:28,000 --> 03:33:31,160 INTERVENTION UPTAKE? 5141 03:33:31,160 --> 03:33:32,280 ANY THOUGHTS? 5142 03:33:32,280 --> 03:33:34,760 >> THIS IS BASICALLY WHAT OUR 5143 03:33:34,760 --> 03:33:38,600 HEALTH CARE SYSTEM IS ALL ABOUT. 5144 03:33:38,600 --> 03:33:40,000 MASSIVE AMOUNTS OF VARIABILITY. 5145 03:33:40,000 --> 03:33:41,920 AT THE DOCTOR LEVEL AND HOSPITAL 5146 03:33:41,920 --> 03:33:44,040 SYSTEM LEVEL. 5147 03:33:44,040 --> 03:33:46,920 THERE'S A LOT OF VARIABILITY. 5148 03:33:46,920 --> 03:33:51,640 TO THINK WE CAN ACTUALLY GET A 5149 03:33:51,640 --> 03:33:54,240 HEALTH CARE PROVIDER OR GROUP TO 5150 03:33:54,240 --> 03:33:56,680 SAY OH, YEAH WE'LL ALL DO THIS 5151 03:33:56,680 --> 03:33:58,600 ONE THING WITHOUT ACTUALLY 5152 03:33:58,600 --> 03:34:00,040 ENGINEERING IT WITH THE WORK 5153 03:34:00,040 --> 03:34:02,000 FLOW IN A DIFFERENT WAY FROM ONE 5154 03:34:02,000 --> 03:34:04,000 PLACE TO THE OTHER BECAUSE THE 5155 03:34:04,000 --> 03:34:06,480 WORK FLOW IS NOT NECESSARILY 5156 03:34:06,480 --> 03:34:08,080 ACROSS THE SAME ACROSS THE 5157 03:34:08,080 --> 03:34:15,440 DIFFERENT UNITS, IT'S VERY 5158 03:34:15,440 --> 03:34:17,480 DISHEARTENING BUT BASICALLY SEEN 5159 03:34:17,480 --> 03:34:21,760 AS A MAJOR ISSUE ABOUT 5160 03:34:21,760 --> 03:34:22,240 IMPLEMENTATION. 5161 03:34:22,240 --> 03:34:23,720 I KEEP ASKING PEOPLE WHO RUN 5162 03:34:23,720 --> 03:34:24,480 HEALTH CARE SYSTEMS HOW DO YOU 5163 03:34:24,480 --> 03:34:25,640 GET ANYTHING DONE AT ALL? 5164 03:34:25,640 --> 03:34:26,800 I KNOW THEY DO. 5165 03:34:26,800 --> 03:34:29,920 >> ONE ANSWER IS ACCEPTANCE. 5166 03:34:29,920 --> 03:34:31,480 IT'S A LOT OF VARIABILITY. 5167 03:34:31,480 --> 03:34:32,760 DEAL WITH IT, YOU CAN'T CHANGE 5168 03:34:32,760 --> 03:34:37,800 IT BUT YOU HINTED AT POTENTIAL 5169 03:34:37,800 --> 03:34:40,040 PATHS TO INFLUENCE CARE 5170 03:34:40,040 --> 03:34:43,440 PROCESSES. 5171 03:34:43,440 --> 03:34:45,880 IT WOULD BE GOOD. 5172 03:34:45,880 --> 03:34:48,800 HE SAID IT'S IMPORTANT TO BE 5173 03:34:48,800 --> 03:34:49,440 PRAGMATIC BUT SOMETIMES YOU HAVE 5174 03:34:49,440 --> 03:34:50,560 TO GO IN ON THE WHEEL. 5175 03:34:50,560 --> 03:34:53,760 WHETHER IT'S THE 5:00 ARM OR 5176 03:34:53,760 --> 03:34:58,720 7:00 ON, YOU GUYS TELL ME. 5177 03:34:58,720 --> 03:35:02,120 THE TRACKING EVEN IF YOU'RE NOT 5178 03:35:02,120 --> 03:35:03,720 GOING TO CONTROL THE 5179 03:35:03,720 --> 03:35:07,560 INTERVENTION AND WE WERE ABLE TO 5180 03:35:07,560 --> 03:35:09,920 PICK UP AND RATE THE VARIABILITY 5181 03:35:09,920 --> 03:35:15,600 IN THE SITE IMPLEMENTATION 5182 03:35:15,600 --> 03:35:15,880 PROCESSES. 5183 03:35:15,880 --> 03:35:20,720 TSOS LOOKS LIKE A FLAT TIRE AND 5184 03:35:20,720 --> 03:35:25,640 DAVID CHAMBERS HAS APROVIDER WH 5185 03:35:25,640 --> 03:35:27,360 FOLKS AT NCI. 5186 03:35:27,360 --> 03:35:32,280 IT'S A DIMPLE AND FLAT TOOIR BUT 5187 03:35:32,280 --> 03:35:34,440 IT'S REALLY IMPORTANT BECAUSE 5188 03:35:34,440 --> 03:35:37,240 FOR TSOS WE HAVE THIS NEBULOUS 5189 03:35:37,240 --> 03:35:37,480 EFFECT. 5190 03:35:37,480 --> 03:35:40,920 WE HAD A SIX-MONTH REDUCTION IN 5191 03:35:40,920 --> 03:35:42,720 PTSD SYMPTOMS BUT ONCE YOU LOOK 5192 03:35:42,720 --> 03:35:45,240 MORE CAREFULLY, SOME OF OUR 5193 03:35:45,240 --> 03:35:47,960 IMPLEMENTATION WAS CUT AND 5194 03:35:47,960 --> 03:35:48,160 DRIVE. 5195 03:35:48,160 --> 03:35:50,080 LIKE HOW MUCH PATIENTS DID YOU 5196 03:35:50,080 --> 03:35:50,640 RECRUIT. 5197 03:35:50,640 --> 03:35:51,640 THE FIDELITY OF THE INTERVENTION 5198 03:35:51,640 --> 03:36:02,200 IS WE SPENT TIME ON AND CREATED 5199 03:36:04,160 --> 03:36:06,760 INDEX AND THE GOOD IMPLEMENTERS 5200 03:36:06,760 --> 03:36:10,800 DID A MUCH BETTER JOB IN 5201 03:36:10,800 --> 03:36:12,720 REDUCING PTSD SYMPTOMS. 5202 03:36:12,720 --> 03:36:14,720 >> WE HAD AN OUTREACH 5203 03:36:14,720 --> 03:36:15,520 INTERVENTION WHICH MAY BE 5204 03:36:15,520 --> 03:36:18,800 DIFFERENT BUT THE FIRST QUESTION 5205 03:36:18,800 --> 03:36:20,720 IS IS FIDELITY PART OF YOUR 5206 03:36:20,720 --> 03:36:20,960 QUESTION. 5207 03:36:20,960 --> 03:36:23,080 FROM A PATIENT-CENTERED 5208 03:36:23,080 --> 03:36:23,360 APPROACH. 5209 03:36:23,360 --> 03:36:26,400 IF WE'RE OFFERING PEOPLE THINGS 5210 03:36:26,400 --> 03:36:28,960 THEY DON'T WANT IN A WAY OR IN A 5211 03:36:28,960 --> 03:36:31,360 WAY THEY DON'T WANT I DON'T KNOW 5212 03:36:31,360 --> 03:36:33,240 IF FORCING OUR POPULATION INTO A 5213 03:36:33,240 --> 03:36:34,840 GROUP OF PEOPLE WILLING TO DO 5214 03:36:34,840 --> 03:36:36,600 WHAT WE ASK THEM TO DO IS GOING 5215 03:36:36,600 --> 03:36:40,000 GIVE US THE QUESTIONS WE NEED IN 5216 03:36:40,000 --> 03:36:41,160 THE HEALTH CARE SETTING. 5217 03:36:41,160 --> 03:36:44,520 SO THAT'S MY FIRST THING AS A 5218 03:36:44,520 --> 03:36:46,800 STATISTICIAN, IS THE FIDELITY 5219 03:36:46,800 --> 03:36:48,840 PART IT? 5220 03:36:48,840 --> 03:36:50,800 WE'RE MAKING GENERALIZATION IT'S 5221 03:36:50,800 --> 03:36:52,960 WE WENT TO A DIFFERENT 5222 03:36:52,960 --> 03:36:54,360 POPULATION IT'D BE 30% BUT IT'S 5223 03:36:54,360 --> 03:36:57,280 AN IMPORTANT QUESTION WE SWEEP 5224 03:36:57,280 --> 03:36:59,120 UNDER THE RUG IN RESEARCH IN THE 5225 03:36:59,120 --> 03:36:59,800 NAME OF RIGOR AND IS PART OF THE 5226 03:36:59,800 --> 03:37:03,720 QUESTION. 5227 03:37:03,720 --> 03:37:06,840 >> EXCELLENT POINT. 5228 03:37:06,840 --> 03:37:13,480 I APPRECIATE THAT. 5229 03:37:13,480 --> 03:37:14,800 >> I GOT THREE MINUTES. 5230 03:37:14,800 --> 03:37:18,120 LET ME ASK ABOUT VARIABILITY AND 5231 03:37:18,120 --> 03:37:20,400 CONTROL AND CHARACTERIZE IT. 5232 03:37:20,400 --> 03:37:26,320 I THINK FOR THE POPULATIONS WE 5233 03:37:26,320 --> 03:37:28,000 HEARD SOME COMMENTS ABOUT 5234 03:37:28,000 --> 03:37:29,440 SPECIFIC RESTRICTION OF THE 5235 03:37:29,440 --> 03:37:35,760 POPULATION OR CLARIFICATION. 5236 03:37:35,760 --> 03:37:38,800 PRAGMATIC TRIALS AND MANY 5237 03:37:38,800 --> 03:37:43,360 CLUSTERS POTENTIAL STUDY WOULD 5238 03:37:43,360 --> 03:37:43,920 INCLUDE VARIABILITY IN THE 5239 03:37:43,920 --> 03:37:46,480 PARTICIPANTS. 5240 03:37:46,480 --> 03:37:52,920 DID YOUR STUDIES REALLY HAVE AN 5241 03:37:52,920 --> 03:37:55,320 INTEREST IN DOING THOSE SUBGROUP 5242 03:37:55,320 --> 03:37:55,880 ANALYSES? 5243 03:37:55,880 --> 03:37:57,520 WAS THAT IMPORTANT AND IS THAT 5244 03:37:57,520 --> 03:37:59,440 VARIABILITY YOU SHOULD TRY TO 5245 03:37:59,440 --> 03:38:04,080 LEARN FROM OR WOULD YOU SAY IT'S 5246 03:38:04,080 --> 03:38:05,680 REALLY CHALLENGING TO LEARN FROM 5247 03:38:05,680 --> 03:38:07,240 THAT VARIABILITY? 5248 03:38:07,240 --> 03:38:08,600 ANY THOUGHTS ON THAT? 5249 03:38:08,600 --> 03:38:09,080 WHAT ABOUT PARTICIPANT 5250 03:38:09,080 --> 03:38:13,280 VARIATION? 5251 03:38:13,280 --> 03:38:14,800 >> I'LL JUMP IN. 5252 03:38:14,800 --> 03:38:17,920 I DON'T THINK THIS IS DIFFERENT 5253 03:38:17,920 --> 03:38:19,400 BETWEEN A TYPICAL CLINICAL TRIAL 5254 03:38:19,400 --> 03:38:23,680 OR PRAGMATIC TRIAL. 5255 03:38:23,680 --> 03:38:24,640 YOU'RE GOING TO GO AND PUT IN 5256 03:38:24,640 --> 03:38:25,920 THE KIND OF WORK THAT ALL THE 5257 03:38:25,920 --> 03:38:29,680 PEOPLE WHO ARE PANELISTS, DOUG 5258 03:38:29,680 --> 03:38:32,600 SAID WE SURVIVED COVID BUT WE 5259 03:38:32,600 --> 03:38:35,320 MAY OR MAY NOT SURVIVE THE 5260 03:38:35,320 --> 03:38:37,000 TRIALS WE'RE DOING. 5261 03:38:37,000 --> 03:38:39,720 TO NOT EXTRACT ALL THE VALUE OUT 5262 03:38:39,720 --> 03:38:43,840 OF THE DATA AT THE END OF ALL 5263 03:38:43,840 --> 03:38:46,160 THAT JUST SEEMS SILLY TO ME. 5264 03:38:46,160 --> 03:38:48,560 OF COURSE YOU'VE GOT TO HAVE A 5265 03:38:48,560 --> 03:38:51,440 GRAIN OF SALT WITH THE ANALYSIS 5266 03:38:51,440 --> 03:38:52,320 YOU'RE DOING TO UNDERSTAND THAT 5267 03:38:52,320 --> 03:38:56,680 WHEN YOU DO A STRATIFIED 5268 03:38:56,680 --> 03:38:58,720 ANALYSIS MAY NOT HAVE RANDOMIZED 5269 03:38:58,720 --> 03:39:02,520 ASSIGNMENT ANYMORE BECAUSE YOU 5270 03:39:02,520 --> 03:39:05,760 CAN RANDOMIZE ON THAT FACTOR OR 5271 03:39:05,760 --> 03:39:07,200 WITHIN THAT SUBGROUP. 5272 03:39:07,200 --> 03:39:08,600 I THINK YOU HAVE TO BE CAUTIOUS. 5273 03:39:08,600 --> 03:39:10,800 I THINK YOU HAVE TO UNDERSTAND 5274 03:39:10,800 --> 03:39:12,720 HOW INTERPRET THOSE RESULTS AND 5275 03:39:12,720 --> 03:39:14,480 WHAT YOU'LL DO WITH THEM 5276 03:39:14,480 --> 03:39:15,960 AFTERWARDS BUT TO TAKE THIS HARD 5277 03:39:15,960 --> 03:39:18,480 LINE VIEW IT'S THE PRIMARY END 5278 03:39:18,480 --> 03:39:19,720 POINT AND EVERYTHING ELSE YOU 5279 03:39:19,720 --> 03:39:22,840 LOOK AT, I DON'T SEE HOW THAT 5280 03:39:22,840 --> 03:39:31,920 HELPS ANYONE. 5281 03:39:31,920 --> 03:39:33,080 >> YOU HAVE SO MUCH RICH DATA. 5282 03:39:33,080 --> 03:39:34,800 THE PRIMARY OUTCOME I KEEP 5283 03:39:34,800 --> 03:39:37,320 THINKING WITH THE RESULTS OF OUR 5284 03:39:37,320 --> 03:39:39,920 STUDY FROM THE PERSPECTIVE OF 5285 03:39:39,920 --> 03:39:41,080 THE HEALTH CARE SYSTEM. 5286 03:39:41,080 --> 03:39:43,160 IF YOU WENT TO THE CHIEF MEDICAL 5287 03:39:43,160 --> 03:39:45,040 OFFICER AND SAID LISTEN, WE 5288 03:39:45,040 --> 03:39:46,800 DIDN'T REALLY ACHIEVE OUR 5289 03:39:46,800 --> 03:39:49,400 PRIMARY OUTCOME BUT 30% OF YOUR 5290 03:39:49,400 --> 03:39:55,520 BUILDING SEEMED TO DO A GOOD JOB 5291 03:39:55,520 --> 03:39:57,000 AND THE OTHER 30% ACHIEVED A 5292 03:39:57,000 --> 03:39:57,560 GOOD RESULT AND NOBODY WAS 5293 03:39:57,560 --> 03:40:03,480 UNHAPPY. 5294 03:40:03,480 --> 03:40:05,840 IT'S NOT THAT DIFFERENT FROM 5295 03:40:05,840 --> 03:40:06,880 WHAT SUSAN WAS SAYING IS 5296 03:40:06,880 --> 03:40:08,320 OFFERING TRIAL. 5297 03:40:08,320 --> 03:40:09,880 WE WERE OFFERING TO THE 5298 03:40:09,880 --> 03:40:10,800 ADMINISTRATORS EACH OF THESE 5299 03:40:10,800 --> 03:40:14,800 CLINICS OR BUILDINGS, ETCETERA, 5300 03:40:14,800 --> 03:40:19,520 SOMETHING NEW. 5301 03:40:19,520 --> 03:40:21,280 SOME DID AND THE SOME DIDN'T AND 5302 03:40:21,280 --> 03:40:23,720 THE ONES THAT DIT THEIR PATIENTS 5303 03:40:23,720 --> 03:40:25,040 SEEMED TO HAVE IF THERE WAS 5304 03:40:25,040 --> 03:40:27,880 BENEFIT THAT'S WHERE IT WAS. 5305 03:40:27,880 --> 03:40:32,360 >> LET ME CLOSE BY SAYING THIS 5306 03:40:32,360 --> 03:40:35,720 IS A FUN SESSION FOR ME. 5307 03:40:35,720 --> 03:40:37,160 I KEPT TRACK OF VERY INTERESTING 5308 03:40:37,160 --> 03:40:38,240 THINGS. 5309 03:40:38,240 --> 03:40:40,760 DIFFERENCES IN POSITIONS, ACUTE 5310 03:40:40,760 --> 03:40:45,520 INJURY AND ESRD, ADVANCED 5311 03:40:45,520 --> 03:40:47,280 ILLNESS, NURSING HOME RESIDENTS, 5312 03:40:47,280 --> 03:40:49,760 FOLKS WITH SUICIDE IDEATION. 5313 03:40:49,760 --> 03:40:50,480 HUGE VARIATION. 5314 03:40:50,480 --> 03:40:54,640 THE SETTINGS AND EMERGENCY 5315 03:40:54,640 --> 03:40:58,240 DEPARTMENT DIALYSIS, NURSING 5316 03:40:58,240 --> 03:41:02,800 FACILITIES OR HEALTH SYSTEMS. 5317 03:41:02,800 --> 03:41:04,000 REALLY RICH AND INTERESTING 5318 03:41:04,000 --> 03:41:05,160 VARIATION IN EACH OF THESE 5319 03:41:05,160 --> 03:41:06,880 TRIALS THAT I THINK HELPS US 5320 03:41:06,880 --> 03:41:09,080 LEARN ABOUT HOW TO APPROACH 5321 03:41:09,080 --> 03:41:10,200 DESIGNING TRIALS, THINKING ABOUT 5322 03:41:10,200 --> 03:41:12,200 EACH OF THESE THINGS. 5323 03:41:12,200 --> 03:41:12,680 THANK YOU VERY MUCH. 5324 03:41:12,680 --> 03:41:14,000 I KNOW WENDY, HAVE YOU A 5325 03:41:14,000 --> 03:41:17,080 QUESTION BUT YOU CONTROL THE 5326 03:41:17,080 --> 03:41:19,360 TIME FROM NOW FORWARD. 5327 03:41:19,360 --> 03:41:21,240 I'LL JUST TURN IT OVER TO YOU 5328 03:41:21,240 --> 03:41:23,640 BUT I WANT TO SAY MANY THANKS 5329 03:41:23,640 --> 03:41:25,120 FOR THE PANELISTS FOR PUTTING 5330 03:41:25,120 --> 03:41:26,800 THIS TOGETHER AND SPENDING TIME 5331 03:41:26,800 --> 03:41:27,640 WITH US TODAY. 5332 03:41:27,640 --> 03:41:34,800 >> REALLY WONDERFUL DISCUSSION 5333 03:41:34,800 --> 03:41:38,280 AND WE HAVE QUESTIONS SO WE MAY 5334 03:41:38,280 --> 03:41:39,360 FOLLOW-UP VIA E-MAIL TO RESPOND 5335 03:41:39,360 --> 03:41:40,000 TO PEOPLE. 5336 03:41:40,000 --> 03:41:42,800 PEOPLE HAD QUESTIONS ABOUT THE 5337 03:41:42,800 --> 03:41:45,120 SPECIFIC ANALYSIS THAT YOU'RE 5338 03:41:45,120 --> 03:41:47,200 USING AND ANALYTIC APPROACHES 5339 03:41:47,200 --> 03:41:48,840 YOU'RE USING. 5340 03:41:48,840 --> 03:41:50,800 WE'LL KEEP THE QUESTIONS AND GO 5341 03:41:50,800 --> 03:41:52,800 AHEAD AND MOVE ON AND SO. 5342 03:41:52,800 --> 03:41:56,600 I'D ASK PATRICK AND LESLIE AND 5343 03:41:56,600 --> 03:42:01,400 KEITH, IF KEITH IS STILL ON TO 5344 03:42:01,400 --> 03:42:04,240 JOIN US FOR A CLOSING PANEL AND 5345 03:42:04,240 --> 03:42:07,400 OTHERS CAN TURN OFF YOUR CAMERA 5346 03:42:07,400 --> 03:42:09,560 ON ONE OF THE FEATURES OF 5347 03:42:09,560 --> 03:42:11,600 VIDEOCAST IS IF YOU'RE CAMERA IS 5348 03:42:11,600 --> 03:42:13,480 ON YOU'RE LIVE ON SCREEN AND 5349 03:42:13,480 --> 03:42:14,800 ARCHIVED FOREVER. 5350 03:42:14,800 --> 03:42:15,640 WE LIKE TO LET PEOPLE KNOW THAT 5351 03:42:15,640 --> 03:42:23,640 ON ZOOM. 5352 03:42:23,640 --> 03:42:25,160 LESLEY, YOUR THOUGHTS AND WE'D 5353 03:42:25,160 --> 03:42:27,600 LOVE TO HEAR KEITH AND PATRICK'S 5354 03:42:27,600 --> 03:42:30,200 THOUGHTS ABOUT FIRST-DAY WRAP-UP 5355 03:42:30,200 --> 03:42:31,400 THOUGHTS AND WHERE WE'RE HEADED. 5356 03:42:31,400 --> 03:42:36,680 >> THANK YOU, WENDY. 5357 03:42:36,680 --> 03:42:38,800 FIRST OF ALL, WHAT A RICH 5358 03:42:38,800 --> 03:42:39,240 AFTERNOON. 5359 03:42:39,240 --> 03:42:41,440 MY THANKS TO THE MODERATORS, 5360 03:42:41,440 --> 03:42:45,440 KEITH AND PATRICK AND TO ALL THE 5361 03:42:45,440 --> 03:42:47,240 PANELISTS REALLY FOR PROVIDING 5362 03:42:47,240 --> 03:42:49,360 SUCH INSIGHT ABOUT WHAT THEY 5363 03:42:49,360 --> 03:42:50,720 LEARNED, WHAT THEY ENCOUNTERED 5364 03:42:50,720 --> 03:42:53,200 AND WHAT THEY MIGHT DO AGAIN 5365 03:42:53,200 --> 03:42:57,560 DIFFERENTLY OR NOT DO AGAIN, 5366 03:42:57,560 --> 03:42:58,800 PERIOD. 5367 03:42:58,800 --> 03:43:00,440 I ALWAYS APPRECIATE THE CANDOR 5368 03:43:00,440 --> 03:43:02,800 FOLKS BRING TO THESE 5369 03:43:02,800 --> 03:43:08,000 DISCUSSIONS. 5370 03:43:08,000 --> 03:43:10,240 I WOULD LOVE TO ASK KEITH AND 5371 03:43:10,240 --> 03:43:12,160 THEN PATRICK -- I KNOW WE DON'T 5372 03:43:12,160 --> 03:43:12,640 HAVE A LOT OF TIME. 5373 03:43:12,640 --> 03:43:16,280 AS YOU LISTENED TO ALL THE PANEL 5374 03:43:16,280 --> 03:43:20,240 HAD TO SAY, WHAT WERE SOME KEY 5375 03:43:20,240 --> 03:43:21,240 TAKEAWAYS FOR YOU AND MAYBE 5376 03:43:21,240 --> 03:43:23,040 WE'LL START WITH YOU, KEITH, 5377 03:43:23,040 --> 03:43:25,840 SOME KEY TAKEAWAYS THAT REALLY 5378 03:43:25,840 --> 03:43:28,880 COULD INFORM HOW WE DO EMBEDDED 5379 03:43:28,880 --> 03:43:29,680 PRAGMATIC TRIALS DIFFERENTLY 5380 03:43:29,680 --> 03:43:40,080 GOING FORWARD OR BETTER. 5381 03:43:41,640 --> 03:43:44,400 >> IT WAS FASCINATING TO LISTEN 5382 03:43:44,400 --> 03:43:45,280 TO THE PANELISTS AND WHAT WORKED 5383 03:43:45,280 --> 03:43:49,360 WELL AND WHAT DIDN'T AND 5384 03:43:49,360 --> 03:43:50,080 LESSONED LEARNED. 5385 03:43:50,080 --> 03:43:54,080 TAKING NOTES AS THEY WERE 5386 03:43:54,080 --> 03:43:56,200 SPEAKING AND IE'LL IN NO WAY BE 5387 03:43:56,200 --> 03:43:57,920 ABLE TO DO JUSTICE TO WHAT THEY 5388 03:43:57,920 --> 03:43:59,880 TALKED ABOUT. 5389 03:43:59,880 --> 03:44:05,160 THERE WERE THINGS THAT STOOD 5390 03:44:05,160 --> 03:44:05,360 OUT. 5391 03:44:05,360 --> 03:44:08,080 PART WAS E.H.R.s CAN PROVIDE A 5392 03:44:08,080 --> 03:44:16,640 LOT OF AUTOMATION IN A LOT CASES 5393 03:44:16,640 --> 03:44:20,200 BUT MANUAL REVIEW MAY STILL BE 5394 03:44:20,200 --> 03:44:22,240 REQUIRED AND YOU'RE IDENTIFYING 5395 03:44:22,240 --> 03:44:24,480 PATIENTS AND CAN USE THE LAB 5396 03:44:24,480 --> 03:44:27,560 VALUES AND NEED TO MANUALLY 5397 03:44:27,560 --> 03:44:31,080 REVIEW TO SCREEN PEOPLE 5398 03:44:31,080 --> 03:44:41,240 PROPERLY. 5399 03:44:42,680 --> 03:44:43,840 AND A KEY POINT I WROTE DOWN 5400 03:44:43,840 --> 03:44:47,280 MANY TIMES IS THE PROCESS IN 5401 03:44:47,280 --> 03:44:50,000 MONITORING VARIOUS ASPECTS OF 5402 03:44:50,000 --> 03:44:52,560 THE SYSTEM TO LET YOU KNOW THAT 5403 03:44:52,560 --> 03:44:55,160 THINGS ARE HAPPENING AS YOU 5404 03:44:55,160 --> 03:44:55,880 EXPECT AND THINGS ARE NOT 5405 03:44:55,880 --> 03:45:05,640 CHANGING UNDERNEATH YOU. 5406 03:45:05,640 --> 03:45:06,880 AND MONITORING TO DELIVERY AND 5407 03:45:06,880 --> 03:45:09,880 MONITORING IT AND CHECKING 5408 03:45:09,880 --> 03:45:10,280 OUTCOMES. 5409 03:45:10,280 --> 03:45:12,560 THERE'S DIFFERENT PROCESSES THEY 5410 03:45:12,560 --> 03:45:14,600 HAD BUILT INTO THEIR SYSTEMS TO 5411 03:45:14,600 --> 03:45:16,560 LET THEM MONITOR THINGS. 5412 03:45:16,560 --> 03:45:18,840 I THINK ONE OF THE LESSONS 5413 03:45:18,840 --> 03:45:21,200 LEARNED WAS TO DO AS FREQUENT AS 5414 03:45:21,200 --> 03:45:25,080 POSSIBLE SO YOU DON'T MISS 5415 03:45:25,080 --> 03:45:25,320 THINGS. 5416 03:45:25,320 --> 03:45:27,960 AND IN SOME CASES HAVING BACKUPS 5417 03:45:27,960 --> 03:45:29,760 TO SOME OF YOUR OTHER PROCESSES 5418 03:45:29,760 --> 03:45:32,240 BECAUSE YOU MAY BE MONITORING 5419 03:45:32,240 --> 03:45:34,280 SOMETHING BUT THEN IT'S NOT 5420 03:45:34,280 --> 03:45:37,720 ACTUALLY MEASURING THE 5421 03:45:37,720 --> 03:45:38,720 UNDERLYING DATA. 5422 03:45:38,720 --> 03:45:39,120 SPOT CHECKING. 5423 03:45:39,120 --> 03:45:46,600 SO THOSE WERE A FEW THINGS I 5424 03:45:46,600 --> 03:45:47,960 STOOD OUT TO ME. 5425 03:45:47,960 --> 03:45:50,800 THE OTHER IS THERE ISN'T A ONE 5426 03:45:50,800 --> 03:45:53,680 SIZE FITS ALL APPROACH IN 5427 03:45:53,680 --> 03:45:54,800 DELIVERING INTERVENTIONS. 5428 03:45:54,800 --> 03:46:00,040 WE HEARD FROM A TRIAL HAVING 5429 03:46:00,040 --> 03:46:02,800 SOME REPORTS AND SOME PEOPLE 5430 03:46:02,800 --> 03:46:06,080 WANTED AN ALERT OPPOSED TO 5431 03:46:06,080 --> 03:46:06,320 EMBEDDED. 5432 03:46:06,320 --> 03:46:10,120 BEING NIMBLE AND BEING ABLE TO 5433 03:46:10,120 --> 03:46:12,200 TAILOR THE INTERVENTIONS TO BEST 5434 03:46:12,200 --> 03:46:13,880 SUIT THE CARE SETTINGS IN THE 5435 03:46:13,880 --> 03:46:16,240 E.H.R.s. 5436 03:46:16,240 --> 03:46:17,960 THOSE WERE SOME OF THE HIGH 5437 03:46:17,960 --> 03:46:26,400 POINTS I HAD WRITTEN DOWN. 5438 03:46:26,400 --> 03:46:29,600 >> AND THERE'S THE NEED FOR 5439 03:46:29,600 --> 03:46:30,840 AGILITY AND CONTINUAL MONITORING 5440 03:46:30,840 --> 03:46:31,440 OF THE PROCESSES. 5441 03:46:31,440 --> 03:46:33,240 WE ACTUALLY HEARD ABOUT THAT ON 5442 03:46:33,240 --> 03:46:36,280 THE PANEL FROM THE PANEL THAT 5443 03:46:36,280 --> 03:46:38,080 PATRICK MODERATED AS WELL IN 5444 03:46:38,080 --> 03:46:39,360 THIS CONCEPT OF YOU CAN'T WAIT 5445 03:46:39,360 --> 03:46:41,080 UNTIL THE END OF A PRAGMATIC 5446 03:46:41,080 --> 03:46:44,720 TRIAL TO LOOK AT YOUR DATA AND 5447 03:46:44,720 --> 03:46:46,720 DATA QUALITY WHICH IS AN ISSUE I 5448 03:46:46,720 --> 03:46:49,800 KNOW IS NEAR AND DEAR TO YOUR 5449 03:46:49,800 --> 03:46:50,000 HEART. 5450 03:46:50,000 --> 03:46:52,360 PATRICK, I'D LOVE YOUR 5451 03:46:52,360 --> 03:46:53,000 REFLECTIONS TOO AND WHAT YOU 5452 03:46:53,000 --> 03:46:59,800 WOULD ADD TO THAT SUMMARY. 5453 03:46:59,800 --> 03:47:01,720 >> PART OF WHAT SEE IS SOME OF 5454 03:47:01,720 --> 03:47:04,280 WHAT WE PUT IN UP FRONT AND 5455 03:47:04,280 --> 03:47:10,680 STRUCTURE AND MOTIVATE IT. 5456 03:47:10,680 --> 03:47:13,240 AND WHAT WE'RE LEARNING BY BEING 5457 03:47:13,240 --> 03:47:14,280 ENGAGED IN DIFFERENT TRIALS IS 5458 03:47:14,280 --> 03:47:15,560 WHAT ARE THE THINGS WE NEED TO 5459 03:47:15,560 --> 03:47:16,960 THINK ABOUT OVER AND OVER AGAIN. 5460 03:47:16,960 --> 03:47:19,400 WHAT ARE THE PATTERNS WE NEED TO 5461 03:47:19,400 --> 03:47:21,560 THINK ABOUT IN RESEARCH DESIGN 5462 03:47:21,560 --> 03:47:24,960 AND WE TRIED TO PUT SOME OF THAT 5463 03:47:24,960 --> 03:47:25,680 TOGETHER TODAY. 5464 03:47:25,680 --> 03:47:30,760 YOU SAW IT WASN'T JUST ABOUT 5465 03:47:30,760 --> 03:47:37,400 WHAT'S YOUR RANDOMIZATION 5466 03:47:37,400 --> 03:47:38,440 ORGANIZATION AND THE INFLUENCE 5467 03:47:38,440 --> 03:47:39,560 OF THE INTERVENTION. 5468 03:47:39,560 --> 03:47:42,560 IT'S ISSUES AROUND POPULATION 5469 03:47:42,560 --> 03:47:46,080 AND POPULATION HETEROGENEITY AND 5470 03:47:46,080 --> 03:47:51,360 THE QUESTIONS WE DIDN'T GET TO 5471 03:47:51,360 --> 03:47:54,400 TALK ABOUT IMPLEMENTATION 5472 03:47:54,400 --> 03:47:55,280 IMPLEMENTATION EFFECTIVENESS 5473 03:47:55,280 --> 03:47:55,520 DESIGN. 5474 03:47:55,520 --> 03:47:56,920 ONE THING IS RESEARCH DESIGN FOR 5475 03:47:56,920 --> 03:48:00,920 THE EMBEDDED PRAGMATIC TRIALS IS 5476 03:48:00,920 --> 03:48:01,320 PRETTY BROAD. 5477 03:48:01,320 --> 03:48:11,840 THERE'S A LOT PUT ON THE TABLE. 5478 03:48:14,640 --> 03:48:19,040 IT TAKES A BIGGER TEAM TO DO IT 5479 03:48:19,040 --> 03:48:22,160 AND WE HEARD TODAY THERE'S 5480 03:48:22,160 --> 03:48:24,600 ETHICS AND INFORMATICS IS 5481 03:48:24,600 --> 03:48:26,320 IMPORTANT TO INCLUDE FOR 5482 03:48:26,320 --> 03:48:26,600 OUTCOMES. 5483 03:48:26,600 --> 03:48:27,600 THE DELIVERY SYSTEM AND WHAT 5484 03:48:27,600 --> 03:48:29,560 HAPPENS THERE IS AN IMPORTANT 5485 03:48:29,560 --> 03:48:30,040 TEAM MEMBER. 5486 03:48:30,040 --> 03:48:34,320 I THINK WE'VE LEARNED THAT 5487 03:48:34,320 --> 03:48:45,960 THROUGH THE COLLABORATCOLLABOCO. 5488 03:48:47,320 --> 03:48:49,400 ARE THERE OTHERS THAT MAY COME 5489 03:48:49,400 --> 03:48:50,720 OUT TODAY AND THERE'S A TEAM 5490 03:48:50,720 --> 03:48:51,360 SPORT AND WHO NEEDS TO BE ON THE 5491 03:48:51,360 --> 03:48:59,320 TEAM. 5492 03:48:59,320 --> 03:49:02,000 >> LET ME TURN IT BACK TO YOU 5493 03:49:02,000 --> 03:49:03,000 FOR CLOSING REMARKS AND ANY 5494 03:49:03,000 --> 03:49:11,680 INFORMATION ABOUT TOMORROW. 5495 03:49:11,680 --> 03:49:13,520 >> WHAT A GREAT KICKOFF FOR OUR 5496 03:49:13,520 --> 03:49:15,280 FIRST DAY. 5497 03:49:15,280 --> 03:49:17,840 EXCELLENT PANELS AND SUCH 5498 03:49:17,840 --> 03:49:18,280 NUANCED COMMENTS. 5499 03:49:18,280 --> 03:49:22,400 I FEEL LIKE I'VE GOTTEN TO KNOW 5500 03:49:22,400 --> 03:49:23,800 THE TRIALS SO MUCH OVER THE LT 5501 03:49:23,800 --> 03:49:25,280 DECADE AND THERE'S ALWAYS NEW 5502 03:49:25,280 --> 03:49:28,320 THINGS AS WE TALK ABOUT EACH OF 5503 03:49:28,320 --> 03:49:32,320 THE STUDIES AND ONE OF THE 5504 03:49:32,320 --> 03:49:33,640 QUESTIONS WE DIDN'T GET TO I 5505 03:49:33,640 --> 03:49:34,880 DIDN'T HAVE A CHANCE TO PUT IN 5506 03:49:34,880 --> 03:49:37,120 THE CHAT IS WHAT ARE WE DOING TO 5507 03:49:37,120 --> 03:49:38,280 BUILD RESOURCES AND TO EDUCATE 5508 03:49:38,280 --> 03:49:40,520 THE BROADER COMMUNITY ABOUT HOW 5509 03:49:40,520 --> 03:49:45,560 TO DO THESE TRIALS AND ALSO 5510 03:49:45,560 --> 03:49:47,000 WITHIN NIH TO BETTER EDUCATE OR 5511 03:49:47,000 --> 03:49:49,240 MAKE INFORMATION AND RESOURCES 5512 03:49:49,240 --> 03:49:50,760 AVAILABLE TO OTHER PROGRAM 5513 03:49:50,760 --> 03:49:54,760 OFFICERS OR OTHER PARTS OF NIH 5514 03:49:54,760 --> 03:49:58,280 AS WELL AS REVIEWERS AND THE 5515 03:49:58,280 --> 03:50:00,040 DSMB MEMBERS AND WE EVEN TALKED 5516 03:50:00,040 --> 03:50:06,640 ABOUT PEER REVIEWERS OF 5517 03:50:06,640 --> 03:50:07,920 MANUSCRIPTS AND SO MAYBE 5518 03:50:07,920 --> 03:50:12,640 TOMORROW WE CAN HIGHLIGHT 5519 03:50:12,640 --> 03:50:14,720 RESOURCES AVAILABLE AND HAVE 5520 03:50:14,720 --> 03:50:15,560 RESOURCES AVAILABLE FOR PEOPLE 5521 03:50:15,560 --> 03:50:17,360 BUT CERTAINLY THE WEBSITE IS A 5522 03:50:17,360 --> 03:50:20,720 GREAT RESOURCE TO START FOR 5523 03:50:20,720 --> 03:50:23,600 PEOPLE AND FIND INFORMATION AND 5524 03:50:23,600 --> 03:50:26,760 SO STATE TUNED FOR TOMORROW. 5525 03:50:26,760 --> 03:50:30,160 WE HAVE ANOTHER ACTION-FILLED 5526 03:50:30,160 --> 03:50:32,760 DAY PLANNED WITH TWO DIFFERENT 5527 03:50:32,760 --> 03:50:34,440 PANELS AGAIN OF SPEAKERS. 5528 03:50:34,440 --> 03:50:36,120 I'M GOING TO KICK US OFF WITH 5529 03:50:36,120 --> 03:50:38,480 THE FIRST ONE TALKING ABOUT HOW 5530 03:50:38,480 --> 03:50:40,920 BEST TO USE THAT PLANNING OR 5531 03:50:40,920 --> 03:50:43,040 START-UP PERIOD. 5532 03:50:43,040 --> 03:50:47,560 WHAT CAN WE DO TO SET YOURSELF 5533 03:50:47,560 --> 03:50:48,560 UP FOR SUCCESS IN DOING THE 5534 03:50:48,560 --> 03:50:48,880 TRIALS. 5535 03:50:48,880 --> 03:50:51,560 YOU HEARD ABOUT THE DIFFICULTIES 5536 03:50:51,560 --> 03:50:53,920 AND TRIBULATIONS AND UNEXPECTED 5537 03:50:53,920 --> 03:50:57,000 THINGS THAT PEOPLE RAN INTO AND 5538 03:50:57,000 --> 03:51:00,960 WE'RE GOING TO HEAR FROM FOUR 5539 03:51:00,960 --> 03:51:03,480 GREAT INVESTIGATORS ABOUT MAYBE 5540 03:51:03,480 --> 03:51:07,120 WHAT THEY WISHED THEY'D DONE AND 5541 03:51:07,120 --> 03:51:09,480 TOMORROW IS THE IMPLEMENTATION 5542 03:51:09,480 --> 03:51:10,800 QUESTION AROUND HOW TO WE 5543 03:51:10,800 --> 03:51:13,080 IMPLEMENT THE INTERVENTIONS IN 5544 03:51:13,080 --> 03:51:14,720 THE COMPLEX HEALTH CARE SYSTEMS. 5545 03:51:14,720 --> 03:51:20,560 WE MAY BE ABLE TO FOLLOW ON THAT 5546 03:51:20,560 --> 00:00:00,000 QUESTION