1 00:00:05,400 --> 00:00:09,840 THANK YOU FOR JOINING US FOR DAY 2 00:00:09,840 --> 00:00:12,480 TWO OF THE NIH PRAGMATIC TRIALS 3 00:00:12,480 --> 00:00:15,080 COLLABORATORY 2022 ANNUAL 4 00:00:15,080 --> 00:00:16,320 WORKSHOP. 5 00:00:16,320 --> 00:00:18,720 WE ARE EXCITED TO CONTINUE OUR 6 00:00:18,720 --> 00:00:19,920 DISCUSSIONS TODAY TALKING ABOUT 7 00:00:19,920 --> 00:00:24,720 THE CRITICAL QUESTIONS FOR 8 00:00:24,720 --> 00:00:25,960 PRAGMATIC CLINICAL TRIALISTS AND 9 00:00:25,960 --> 00:00:29,440 GIVE YOU INSIGHT THE NIH 10 00:00:29,440 --> 00:00:30,680 PRAGMATIC TRIAL HEARSAY 11 00:00:30,680 --> 00:00:32,040 COLLABORATORIES FIRST DECADE. 12 00:00:32,040 --> 00:00:33,720 WE KICKED OFF YESTERDAY AND 13 00:00:33,720 --> 00:00:34,680 TALKED ABOUT A VARIETY OF 14 00:00:34,680 --> 00:00:35,040 TOPICS. 15 00:00:35,040 --> 00:00:38,240 WE HAD A WONDERFUL KEYNOTE 16 00:00:38,240 --> 00:00:40,240 PRESENTATION FROM THE DIRECTOR 17 00:00:40,240 --> 00:00:45,240 OF NINR THE NURSING RESEARCH 18 00:00:45,240 --> 00:00:48,080 INSTITUTE WITH DR. SHANNON ZENK 19 00:00:48,080 --> 00:00:48,840 STARTING US OFF. 20 00:00:48,840 --> 00:00:50,840 IT WAS A WONDERFUL KEYNOTE 21 00:00:50,840 --> 00:00:51,800 TALKING ABOUT HOW NURSING 22 00:00:51,800 --> 00:00:53,800 SCIENCE FITS INTO AREA OF DO 23 00:00:53,800 --> 00:00:54,720 TRIALS IN HEALTHCARE SYSTEMS 24 00:00:54,720 --> 00:00:56,520 WHEN WE EMBED THESE 25 00:00:56,520 --> 00:00:57,160 INTERVENTIONS INTO FAIR 26 00:00:57,160 --> 00:00:57,560 DELIVERY. 27 00:00:57,560 --> 00:00:58,760 SO THAT WAS A WONDERFUL WAY TO 28 00:00:58,760 --> 00:01:02,160 START THE DAY. 29 00:01:02,160 --> 00:01:03,480 THEN OUR FIRST PANEL TALKED 30 00:01:03,480 --> 00:01:05,440 ABOUT WHAT WE LEARNED ABOUT 31 00:01:05,440 --> 00:01:06,360 ELECTRONIC HEALTH RECORD DATA 32 00:01:06,360 --> 00:01:08,440 AND HOW TO USE ELECTRONIC HEALTH 33 00:01:08,440 --> 00:01:10,400 RECORD DATA IN DIFFERENT STUDIES 34 00:01:10,400 --> 00:01:13,040 AND IN SOME WAYS SOME OF THE 35 00:01:13,040 --> 00:01:15,800 ADVANCES AND INCREASING 36 00:01:15,800 --> 00:01:16,920 CAPABILITIES WE HAVE FOR GETTING 37 00:01:16,920 --> 00:01:21,680 INFORMATION EITHER DIRECTLY TO 38 00:01:21,680 --> 00:01:23,200 PATIENTS OR THROUGH CARE 39 00:01:23,200 --> 00:01:25,760 PATHWAYS OR WORK FLOWS INTO THE 40 00:01:25,760 --> 00:01:26,760 ELECTRONIC HEALTH RECORD BUT 41 00:01:26,760 --> 00:01:30,960 ALSO COLLECTING BETTER OUTCOMES 42 00:01:30,960 --> 00:01:32,760 MAKING THOSE OUTCOMES LESS LIKE 43 00:01:32,760 --> 00:01:34,520 RESEARCH SURVEYS AND 44 00:01:34,520 --> 00:01:35,640 FUNDAMENTALLY DESIGNED AND MUCH 45 00:01:35,640 --> 00:01:36,760 MORE USER FRIENDLY FOR THE 46 00:01:36,760 --> 00:01:37,880 PATIENTS WHO ARE ANSWERING THOSE 47 00:01:37,880 --> 00:01:45,400 QUESTIONS. 48 00:01:45,400 --> 00:01:46,800 A WONDERFUL MEETING YESTERDAY. 49 00:01:46,800 --> 00:01:48,560 WE THEN MOVED TO A WONDERFUL 50 00:01:48,560 --> 00:01:52,280 PANEL DISCUSSION AROUND THE 51 00:01:52,280 --> 00:01:53,480 DESIGN OPTIONS THINKING 52 00:01:53,480 --> 00:01:54,720 DIFFERENT STUDY DESIGNS AND WHAT 53 00:01:54,720 --> 00:01:56,400 WE LEARNED ABOUT DESIGNING 54 00:01:56,400 --> 00:01:57,840 STUDIES FOR TRIALS CONDUCTED 55 00:01:57,840 --> 00:02:03,360 WITHIN THESE HEALTHCARE SYSTEMS. 56 00:02:03,360 --> 00:02:05,200 IF YOU MISSED US YESTERDAYS IT 57 00:02:05,200 --> 00:02:06,320 IS AN ARCHIVED PRESENTATION SO 58 00:02:06,320 --> 00:02:09,280 BY NEXT WEEK THAT WILL BE UP AND 59 00:02:09,280 --> 00:02:11,800 POSTED AND YOU CAN FIND IT ON 60 00:02:11,800 --> 00:02:13,920 THE NIH VIDEOCAST WEBSITE OF 61 00:02:13,920 --> 00:02:14,400 PAST PRESENTATIONS. 62 00:02:14,400 --> 00:02:16,920 WE WILL ALSO PUT LINKS TO THE 63 00:02:16,920 --> 00:02:18,800 WORKSHOP AND TO THOSE RECORDINGS 64 00:02:18,800 --> 00:02:20,240 ON THE HEALTHCARE SYSTEMS 65 00:02:20,240 --> 00:02:21,800 RESEARCH COLLABORATORY WE ALL 66 00:02:21,800 --> 00:02:24,560 KNOW IS NOW REBRANDED AS THE 67 00:02:24,560 --> 00:02:27,480 PRAGMATIC TRIALS COLLABORATORY 68 00:02:27,480 --> 00:02:28,320 WEBSITE. 69 00:02:28,320 --> 00:02:29,880 WHICH IS RETHINKING CLINICAL 70 00:02:29,880 --> 00:02:30,480 TRIALS.ORG. 71 00:02:30,480 --> 00:02:33,560 SO WE LOOK FORWARD TO YOU BEING 72 00:02:33,560 --> 00:02:36,280 ABLE TO GET THOSE PRESENTATIONS 73 00:02:36,280 --> 00:02:37,840 EVEN IF YOU WEREN'T ABLE TO JOIN 74 00:02:37,840 --> 00:02:38,520 US YESTERDAY. 75 00:02:38,520 --> 00:02:41,560 TODAY I GET TO START MODERATING 76 00:02:41,560 --> 00:02:43,360 OUR FIRST PANEL, TODAY WE HAVE 77 00:02:43,360 --> 00:02:46,240 TWO DIFFERENT PANEL SESSIONS 78 00:02:46,240 --> 00:02:49,400 PLANNED. 79 00:02:49,400 --> 00:02:50,560 FIRST LOOKING AT THE USEFULNESS 80 00:02:50,560 --> 00:02:51,920 OF THE PLANNING YEAR AND HOW WE 81 00:02:51,920 --> 00:02:55,680 CAN USE THAT PLANNING YEAR OR 82 00:02:55,680 --> 00:02:58,280 START UP TIME TO ENSURE SUCCESS 83 00:02:58,280 --> 00:02:59,600 OF THE TRIAL ONCE LAUNCHED. 84 00:02:59,600 --> 00:03:02,680 ALL THE TRIALS THAT HAVE BEEN 85 00:03:02,680 --> 00:03:05,120 LAUNCHED THROUGH THE PRAGMATIC 86 00:03:05,120 --> 00:03:06,480 TRIALS COLLABORATORY HAD A ONE 87 00:03:06,480 --> 00:03:07,720 YEAR PLANNING PERIOD WHICH IS 88 00:03:07,720 --> 00:03:09,840 REALLY CLOSER TO NINE OR TEN 89 00:03:09,840 --> 00:03:11,280 MONTHS, YOU DON'T GET THE FULL 90 00:03:11,280 --> 00:03:13,960 YEAR BECAUSE WE NEED SOME TIME 91 00:03:13,960 --> 00:03:15,800 TO TRANSITION AND APPROVE THOSE 92 00:03:15,800 --> 00:03:16,960 REQUESTS TO GO TO THE SECOND 93 00:03:16,960 --> 00:03:19,520 PHASE. 94 00:03:19,520 --> 00:03:22,280 SO A LOT OF THINGS HAPPEN IN 95 00:03:22,280 --> 00:03:23,920 THAT STARTUP TIME AND WE WILL 96 00:03:23,920 --> 00:03:24,800 HEAR FROM FOUR INVESTIGATORS 97 00:03:24,800 --> 00:03:26,840 ABOUT THE KEY THINGS THEY FOUND 98 00:03:26,840 --> 00:03:28,160 HELPFUL DURING THAT PLANNING 99 00:03:28,160 --> 00:03:30,400 PERIOD AND ADVICE THEY HAVE FOR 100 00:03:30,400 --> 00:03:31,240 INVESTIGATORS THAT ARE THINKING 101 00:03:31,240 --> 00:03:32,640 ABOUT DOING THESE TRIALS AND HOW 102 00:03:32,640 --> 00:03:38,080 TO BEST UTILIZE THAT TIME. 103 00:03:38,080 --> 00:03:39,320 OUR SECOND PANEL OF PRESENTER 104 00:03:39,320 --> 00:03:40,680 WILL TALK ABOUT THE 105 00:03:40,680 --> 00:03:41,920 IMPLEMENTATION CHALLENGES OF 106 00:03:41,920 --> 00:03:46,560 DOING STUDIES IN HEALTHCARE 107 00:03:46,560 --> 00:03:48,120 SYSTEMS WHAT WE LEARNED AND 108 00:03:48,120 --> 00:03:49,920 BRINGING FROM OUR COLLEAGUES IN 109 00:03:49,920 --> 00:03:51,320 THE FIELD OF IMPLEMENTATION 110 00:03:51,320 --> 00:03:52,480 SCIENCE ABOUT WHAT METHODS CAN 111 00:03:52,480 --> 00:03:56,240 BE USED TO ENSURE INTERVENTIONS 112 00:03:56,240 --> 00:03:56,800 ARE DELIVERED IN THESE 113 00:03:56,800 --> 00:03:57,840 HEALTHCARE SETTINGS. 114 00:03:57,840 --> 00:03:59,720 IT IS NOT ALWAYS EASY TO DO AND 115 00:03:59,720 --> 00:04:00,840 EVERY SITE IS DIFFERENT SO HOW 116 00:04:00,840 --> 00:04:02,280 DO YOU TAKE ON THOSE CHALLENGES 117 00:04:02,280 --> 00:04:03,440 AND WE WILL HEAR FROM A NUMBER 118 00:04:03,440 --> 00:04:10,240 OF OUR SPEAKERS THERE. 119 00:04:10,240 --> 00:04:12,320 DO I HAVE LO GIST UKS SLIDE 120 00:04:12,320 --> 00:04:12,920 NEXT? 121 00:04:12,920 --> 00:04:15,240 A LITTLE COUPLE OF NOTES ABOUT 122 00:04:15,240 --> 00:04:15,920 HOUSEKEEPING. 123 00:04:15,920 --> 00:04:18,040 FOR THOSE PARTICIPATING VIA 124 00:04:18,040 --> 00:04:20,040 VIDEOCAST WE ARE MONITORING THIS 125 00:04:20,040 --> 00:04:22,360 EMAIL BOX AND WE WILL PUT IT UP 126 00:04:22,360 --> 00:04:25,400 AGAIN AT THE Q&A PERIOD BUT IF 127 00:04:25,400 --> 00:04:28,800 YOU WANT TO JOT IT DOWN, PLEASE 128 00:04:28,800 --> 00:04:31,680 SEND YOUR QUESTIONS IN WE WILL 129 00:04:31,680 --> 00:04:33,200 GET TO AS MANY QUESTIONS AS WE 130 00:04:33,200 --> 00:04:34,840 CAN WITH OUR VIDEOCAST AUDIENCE. 131 00:04:34,840 --> 00:04:36,760 IF WE DON'T GET BACK TO YOUR 132 00:04:36,760 --> 00:04:38,200 QUESTION, WE WILL RESPOND TO YOU 133 00:04:38,200 --> 00:04:42,240 VIA EMAIL TO YOUR GET ANSWER TO 134 00:04:42,240 --> 00:04:43,400 YOUR QUESTION. 135 00:04:43,400 --> 00:04:44,640 PLEASE DON'T HESITATE TO SEND 136 00:04:44,640 --> 00:04:46,160 QUESTIONS THROUGHOUT THE 137 00:04:46,160 --> 00:04:50,600 WORKSHOP THIS AFTERNOON. 138 00:04:50,600 --> 00:04:59,160 NOTE FOR THOSE PANELISTS AND OUR 139 00:04:59,160 --> 00:05:00,280 PRESENTERS TODAY WE HAVE AN 140 00:05:00,280 --> 00:05:01,960 OPTION TO USE OUR CHAT BUT KEEP 141 00:05:01,960 --> 00:05:04,040 IN MIND OUR VIDEOCAST AUDIENCE 142 00:05:04,040 --> 00:05:06,360 CANNOT SEE THAT. 143 00:05:06,360 --> 00:05:07,600 SO PLEASE FEEL FREE TO PUT YOUR 144 00:05:07,600 --> 00:05:09,040 QUESTIONS THERE AND WE WILL ADD 145 00:05:09,040 --> 00:05:10,600 THOSE TO THE MIX AS WE ARE 146 00:05:10,600 --> 00:05:12,360 GETTING TO THE DISCUSSION 147 00:05:12,360 --> 00:05:14,120 SESSION AS WELL AS FEEL FREE 148 00:05:14,120 --> 00:05:15,560 WHEN WE GET TO DISCUSSION 149 00:05:15,560 --> 00:05:16,760 SESSION IF YOU WANT TO ASK THE 150 00:05:16,760 --> 00:05:18,160 QUESTION TO RAISE YOUR HAND. 151 00:05:18,160 --> 00:05:19,520 YOU ARE CERTAINLY WELCOME TO DO 152 00:05:19,520 --> 00:05:23,160 THAT AS WELL. 153 00:05:23,160 --> 00:05:28,760 I DID SEE DR. LANGEVIN POP IN, 154 00:05:28,760 --> 00:05:30,440 ANY WELL COMING REMARKS BEFORE 155 00:05:30,440 --> 00:05:32,240 WE START THIS AFTERNOON? 156 00:05:32,240 --> 00:05:35,320 >> SURE, HELLO, NICE TO BE BACK. 157 00:05:35,320 --> 00:05:37,080 I WAS POPPING IN AND OUT 158 00:05:37,080 --> 00:05:39,400 YESTERDAY AND I WAS REALLY BLOWN 159 00:05:39,400 --> 00:05:41,920 AWAY BY WHAT I HEARD. 160 00:05:41,920 --> 00:05:45,120 SOME JUST VERY SUBSTANTIVE 161 00:05:45,120 --> 00:05:46,680 DISCUSSIONS GETTING TO THE 162 00:05:46,680 --> 00:05:47,760 HEARTS OF THE MATTER SO I LOOK 163 00:05:47,760 --> 00:05:53,560 FORWARD TO US HEARING MORE. 164 00:05:53,560 --> 00:05:56,880 >> WONDERFUL, THANK YOU FOR JOIN 165 00:05:56,880 --> 00:05:57,920 US TODAY AND LOOKING FORWARD TO 166 00:05:57,920 --> 00:05:58,520 OUR SESSIONS TODAY. 167 00:05:58,520 --> 00:06:00,280 I THOUGHT IT WAS A GREAT SET OF 168 00:06:00,280 --> 00:06:01,560 DISCUSSIONS YESTERDAY. 169 00:06:01,560 --> 00:06:02,440 REALLY INTERESTING. 170 00:06:02,440 --> 00:06:04,680 SO WONDERFUL. 171 00:06:04,680 --> 00:06:06,760 WHY DON'T I GO AHEAD AND MOVE 172 00:06:06,760 --> 00:06:12,000 ON, I AM THE MODERATOR FOR OUR 173 00:06:12,000 --> 00:06:13,840 FIRST PANEL. 174 00:06:13,840 --> 00:06:15,840 WHAT WE WILL DO FOR EACH SPEAKER 175 00:06:15,840 --> 00:06:17,760 IS YOU CAN TURN CAMERAS ON WHEN 176 00:06:17,760 --> 00:06:19,000 PRESENTING AND WE GET TO 177 00:06:19,000 --> 00:06:22,920 DISCUSSION TIME POINTS, WE 178 00:06:22,920 --> 00:06:24,280 ENCOURAGE YOU TO TURN OFF YOUR 179 00:06:24,280 --> 00:06:25,920 CAMERA WHEN YOU ARE NOT SPEAKING 180 00:06:25,920 --> 00:06:27,920 AND SOMEONE ELSE IS IN THE WAY 181 00:06:27,920 --> 00:06:29,560 IT PRESENTS ON THE VIDEOCAST 182 00:06:29,560 --> 00:06:32,760 MAKES IT CLEANER AND AS I 183 00:06:32,760 --> 00:06:34,200 MENTIONED, THE VIDEOCAST IS 184 00:06:34,200 --> 00:06:35,640 ARCHIVED AND AVAILABLE FOREVER 185 00:06:35,640 --> 00:06:37,440 SO YOU KEEP YOUR CAMERA UP, YOU 186 00:06:37,440 --> 00:06:41,160 WILL BE ON THAT FOR EVERYONE TO 187 00:06:41,160 --> 00:06:42,280 SEE IN THE FUTURE IF NOT 188 00:06:42,280 --> 00:06:43,800 SPEAKING SO TRY TO REMEMBER TO 189 00:06:43,800 --> 00:06:47,640 DO THAT MYSELF. 190 00:06:47,640 --> 00:06:51,400 I'M WENDY WEBER, SNATCHOR 191 00:06:51,400 --> 00:06:52,440 NATIONAL CENTER FOR 192 00:06:52,440 --> 00:06:53,440 COMPLIMENTARY AND INTEGRATIVE 193 00:06:53,440 --> 00:06:55,520 HEALTH. 194 00:06:55,520 --> 00:06:56,880 THE DECLARE CLINICAL TRIALS 195 00:06:56,880 --> 00:06:58,200 COLLABORATORY PROGRAM HAS BEEN 196 00:06:58,200 --> 00:06:59,920 COMMON FUND PROGRAM FOR THE 197 00:06:59,920 --> 00:07:02,200 LASQUE DADE AND DR. HELENE 198 00:07:02,200 --> 00:07:03,880 LANGEVIN, THE NATIONAL CENTER 199 00:07:03,880 --> 00:07:04,960 FOR COMPLIMENTARY AND 200 00:07:04,960 --> 00:07:06,800 INTEGRATIVE HEALTH AS WELL AS 201 00:07:06,800 --> 00:07:07,560 DR. RICHARD HODES, THE DIRECTOR 202 00:07:07,560 --> 00:07:11,560 OF THE NATIONAL INSTITUTE ON 203 00:07:11,560 --> 00:07:12,640 AGING, HAVE BEEN CO-CHAIRS OF 204 00:07:12,640 --> 00:07:14,960 THE THAT COMMON FUND PROGRAM AND 205 00:07:14,960 --> 00:07:17,240 WE ARE NOW TRANSITIONING THE 206 00:07:17,240 --> 00:07:18,800 COMMON FUND SUPPORT TO ALL THE 207 00:07:18,800 --> 00:07:20,560 INSTITUTES AND CENTERS ACROSS 208 00:07:20,560 --> 00:07:23,720 NIH TO CONTINUE THIS PROGRAM OF 209 00:07:23,720 --> 00:07:24,880 DOING CLINICAL TRIALS MR. THEY 210 00:07:24,880 --> 00:07:26,880 ARE PRAGMATIC TRIALS OR 211 00:07:26,880 --> 00:07:28,120 IMPLEMENTATION TRIALS, EMBEDDED 212 00:07:28,120 --> 00:07:30,320 IN HEALTHCARE SYSTEMS ACROSS THE 213 00:07:30,320 --> 00:07:33,600 PRAGMATIC TRIALS COLLABORATORY. 214 00:07:33,600 --> 00:07:35,920 I HAVE BEEN WORKING WITH THE 215 00:07:35,920 --> 00:07:36,920 PROGRAM OFFICER FOR THE 216 00:07:36,920 --> 00:07:38,000 COORDINATING CENTER SINCE THE 217 00:07:38,000 --> 00:07:41,920 PROGRAM STARTED BACK IN 2012. 218 00:07:41,920 --> 00:07:45,200 NEXT SLIDE. 219 00:07:45,200 --> 00:07:46,120 OUR OBJECTIVE IN THIS SESSION 220 00:07:46,120 --> 00:07:48,200 WHERE WE ARE TALKING HOW TO BEST 221 00:07:48,200 --> 00:07:51,320 UTILIZE THAT PLANNING YEAR IS 222 00:07:51,320 --> 00:07:52,800 WHAT IS IT THAT YOU CAN DO 223 00:07:52,800 --> 00:07:55,000 DURING THAT TIME TO REALLY 224 00:07:55,000 --> 00:07:56,000 INCREASE THE SUCCESSFUL 225 00:07:56,000 --> 00:07:58,440 COMPLETION OF THE PRAGMATIC 226 00:07:58,440 --> 00:07:58,840 TRIAL. 227 00:07:58,840 --> 00:08:01,640 WE WILL GIVE EXAMPLES, FROM 228 00:08:01,640 --> 00:08:03,840 SEVERAL OF OUR INVESTIGATORS, 229 00:08:03,840 --> 00:08:06,240 AND PROVIDE AT THE END A FEW 230 00:08:06,240 --> 00:08:07,560 RESOURCES THAT MIGHT HELP YOU 231 00:08:07,560 --> 00:08:09,920 AND DEVELOPING PLANNING BOTH THE 232 00:08:09,920 --> 00:08:11,680 PLANNING OR STARTUP PERIOD BUT 233 00:08:11,680 --> 00:08:13,240 ALSO YOUR TRIALS OVERALL IF YOU 234 00:08:13,240 --> 00:08:15,360 ARE THINKING ABOUT SUBMITTING AN 235 00:08:15,360 --> 00:08:17,560 APPLICATION TO NIH OR TO OTHER 236 00:08:17,560 --> 00:08:20,880 FUNDERS WHO SUPPORT THIS TYPE OF 237 00:08:20,880 --> 00:08:25,040 RESEARCH. 238 00:08:25,040 --> 00:08:26,400 A FEW KEY CONSIDERATIONS YOU ARE 239 00:08:26,400 --> 00:08:30,440 GOING TO HEAR FROM OUR SPEAKERS 240 00:08:30,440 --> 00:08:32,240 IS IN THAT PLANNING PERIOD 241 00:08:32,240 --> 00:08:33,760 FOCUSING ON CHALLENGING OR 242 00:08:33,760 --> 00:08:34,640 DIFFICULT THINGS YOU KNOW WILL 243 00:08:34,640 --> 00:08:35,600 BE TOUGH TO DO YOUR TRIAL. 244 00:08:35,600 --> 00:08:38,880 SO FOCUS ON THOSE PAIN POINTS 245 00:08:38,880 --> 00:08:40,440 AND WORKING OUT DETAILS DURING 246 00:08:40,440 --> 00:08:44,840 THAT STARTUP OR PLANNING PHASE. 247 00:08:44,840 --> 00:08:46,120 FIGURING OUT ALL OUR STUDIES 248 00:08:46,120 --> 00:08:47,400 WORKED ACROSS THREE HEALTHCARE 249 00:08:47,400 --> 00:08:49,600 SYSTEMS SO HOW TO AMERICAN AND 250 00:08:49,600 --> 00:08:51,280 AGGREGATE THAT DATA, CAN YOU DO 251 00:08:51,280 --> 00:08:52,400 THAT FIGURING THAT OUT IN YOUR 252 00:08:52,400 --> 00:08:54,200 PLANNING PHASE WILL HELP YOU 253 00:08:54,200 --> 00:08:55,120 TREMENDOUSLY BEFORE YOU GET TO 254 00:08:55,120 --> 00:08:57,640 THE END. 255 00:08:57,640 --> 00:08:58,880 ANOTHER LESSON LEARNED IS FIGURE 256 00:08:58,880 --> 00:09:04,400 WHAT DOESN'T WORK QUICKLY. 257 00:09:04,400 --> 00:09:05,960 FAIL FAST AND TRY DIFFERENT 258 00:09:05,960 --> 00:09:06,960 THINGS TO SOLVE PROBLEMS AND 259 00:09:06,960 --> 00:09:08,640 BETTER TO TRY SOMETHING, IF IT 260 00:09:08,640 --> 00:09:09,720 DOESN'T WORK GO TO THE NEXT 261 00:09:09,720 --> 00:09:10,080 THING. 262 00:09:10,080 --> 00:09:12,000 THAT IS SUCH A SHORT TIME TO 263 00:09:12,000 --> 00:09:14,120 START UP AND PLAN STUDIES THAT 264 00:09:14,120 --> 00:09:15,680 FAILING FAST CAN BE REALLY 265 00:09:15,680 --> 00:09:16,680 IMPORTANT. 266 00:09:16,680 --> 00:09:18,640 WE CERTAINLY WANT OUR TRIALS 267 00:09:18,640 --> 00:09:20,640 HAVE GENERALIZABLE POPULATION SO 268 00:09:20,640 --> 00:09:22,360 DURING THAT PLANNING TIME CAN 269 00:09:22,360 --> 00:09:25,080 YOU ACTUALLY MAXIMIZE AND 270 00:09:25,080 --> 00:09:26,400 EVALUATE ARE YOU GETTING A 271 00:09:26,400 --> 00:09:28,760 DIVERSE SET OF POPULATIONS, ARE 272 00:09:28,760 --> 00:09:31,040 YOU ACTUALLY EQUITABLY OFFERING 273 00:09:31,040 --> 00:09:35,440 THE INTERVENTION TO EVERYONE 274 00:09:35,440 --> 00:09:36,720 WHOSE WOULD BE ELIGIBLE FOR THE 275 00:09:36,720 --> 00:09:38,640 STUDY AND NOT CREATING 276 00:09:38,640 --> 00:09:39,640 UNFORESEEN BARRIERS FOR THE 277 00:09:39,640 --> 00:09:41,160 IMPLEMENTATION OF THE 278 00:09:41,160 --> 00:09:42,440 INTERVENTION TO BE STUDIED 279 00:09:42,440 --> 00:09:43,280 ACROSS YOUR DIFFERENT HEALTHCARE 280 00:09:43,280 --> 00:09:45,120 SYSTEMS. 281 00:09:45,120 --> 00:09:49,240 ANOTHER THING WE LEARNED THOUGH 282 00:09:49,240 --> 00:09:50,880 HARD TO DO IS FALLS IN THE FAIL 283 00:09:50,880 --> 00:09:52,440 FAST OR FOCUS ON PAIN POINTS, 284 00:09:52,440 --> 00:09:54,120 START WITH DIFFICULT SITES FIRST 285 00:09:54,120 --> 00:09:56,440 AND FIGURE HOW TO MAKE IT HAPPEN 286 00:09:56,440 --> 00:09:56,960 THERE. 287 00:09:56,960 --> 00:09:58,480 THAT MAY MAKE IT EASIER TO DO 288 00:09:58,480 --> 00:10:01,000 THINGS IN ALL OF YOUR OTHER 289 00:10:01,000 --> 00:10:01,560 SITES. 290 00:10:01,560 --> 00:10:03,480 THE BIGGEST QUESTION IS WHAT DO 291 00:10:03,480 --> 00:10:04,520 YOU NEED TO FIGURE OUT BEFORE 292 00:10:04,520 --> 00:10:05,640 YOU START YOUR TRIAL AND THAT IS 293 00:10:05,640 --> 00:10:08,080 WHAT YOU WANT TO FOCUS ON IN 294 00:10:08,080 --> 00:10:10,800 YOUR PLANNING PHASE. 295 00:10:10,800 --> 00:10:11,640 NEXT SLIDE. 296 00:10:11,640 --> 00:10:13,920 SO AS I MENTIONED WE HAVE FOUR 297 00:10:13,920 --> 00:10:16,920 AMAZING INVESTIGATORS FROM OUR 298 00:10:16,920 --> 00:10:18,880 DIFFERENT TRIALS ACROSS THE 299 00:10:18,880 --> 00:10:20,120 COLLABORATORY PROGRAM, AND THEY 300 00:10:20,120 --> 00:10:21,480 ARE GOING TO TALK ABOUT THEIR 301 00:10:21,480 --> 00:10:22,520 EXPERIENCE WHAT THEY LEARNED 302 00:10:22,520 --> 00:10:24,120 DURING THEIR PLANNING PHASES AND 303 00:10:24,120 --> 00:10:26,000 WHAT ADVICE THEY HAVE FOR ALL OF 304 00:10:26,000 --> 00:10:26,440 YOU. 305 00:10:26,440 --> 00:10:28,360 WE ARE GOING TO START OFF WITH 306 00:10:28,360 --> 00:10:29,880 BRIEF PRESENTATIONS FROM EACH SO 307 00:10:29,880 --> 00:10:31,960 THEY CAN GIVE YOU THE CONTEXT OF 308 00:10:31,960 --> 00:10:34,760 WHAT THEIR TRIAL IS AS WELL AS 309 00:10:34,760 --> 00:10:38,400 KEY THINGS THEY LOOK AT IN THEIR 310 00:10:38,400 --> 00:10:39,360 PLANNING PHASE. 311 00:10:39,360 --> 00:10:40,840 WE HAVE A SET OF QUESTIONS WE 312 00:10:40,840 --> 00:10:43,040 WILL DISCUSS AS A GROUP, THAT I 313 00:10:43,040 --> 00:10:46,600 WILL POSE TO THE GROUP AND WE 314 00:10:46,600 --> 00:10:47,480 WILL ANSWER MOST KEY ELEMENTS 315 00:10:47,480 --> 00:10:49,680 YOU SAW IN THOSE KEY TAKE AWAYS, 316 00:10:49,680 --> 00:10:51,240 WE WILL PROVIDE EXAMPLES OF EACH 317 00:10:51,240 --> 00:10:52,680 OF THOSE. 318 00:10:52,680 --> 00:10:54,440 THEN WE WILL OPEN UP FOR THE 319 00:10:54,440 --> 00:10:57,680 AUDIENCE FOR QUESTIONS FROM THE 320 00:10:57,680 --> 00:10:59,520 AUDIENCE AND THEN WRAP UP WITH A 321 00:10:59,520 --> 00:11:02,080 FEW RESOURCES THAT MIGHT BE 322 00:11:02,080 --> 00:11:03,760 HELPFUL FOR EVERYONE AS THINKING 323 00:11:03,760 --> 00:11:04,880 ABOUT PLANNING AND CONDUCTING 324 00:11:04,880 --> 00:11:09,040 THESE TYPES OF STUDIES. 325 00:11:09,040 --> 00:11:11,400 BY INTRODUCTION WE HAVE DR. GAIL 326 00:11:11,400 --> 00:11:13,240 D'ONOFRIO WHO HAS JOINED FROM 327 00:11:13,240 --> 00:11:15,680 THE ALBERT E KENT PROFESSOR 328 00:11:15,680 --> 00:11:18,520 EMERGENCY MEDICINE AT THE YALE 329 00:11:18,520 --> 00:11:20,320 SCHOOL OF MEDICINE AND PROFESSOR 330 00:11:20,320 --> 00:11:21,880 OF MEDICINE AND PUBLIC HEALTH 331 00:11:21,880 --> 00:11:23,640 AND SHE WILL TALK TO US ABOUT 332 00:11:23,640 --> 00:11:25,520 THE EMBED STUDY. 333 00:11:25,520 --> 00:11:28,720 WE HAVE DR. JAMES TULSKY, CHAIR 334 00:11:28,720 --> 00:11:29,920 DEPARTMENT OF PSYCHOSOCIAL 335 00:11:29,920 --> 00:11:36,080 ONCOLOGY AND PALLIATIVE CARE AT 336 00:11:36,080 --> 00:11:37,080 DANA-FARBER CANCER INSTITUTE AND 337 00:11:37,080 --> 00:11:38,760 PROFESSOR MEDICINE AT HARVARD 338 00:11:38,760 --> 00:11:39,800 MEDICAL SCHOOL AND HE WILL TALK 339 00:11:39,800 --> 00:11:44,040 ABOUT THE ECPP STUDY, WE HAVE 340 00:11:44,040 --> 00:11:45,600 DR. DOUG ZATZICK, A REPEAT FROM 341 00:11:45,600 --> 00:11:47,200 YESTERDAY WE HAD TO BRING HIM 342 00:11:47,200 --> 00:11:48,480 BACK BECAUSE WE HAVE GOOD 343 00:11:48,480 --> 00:11:50,000 STORIES TO TELL, HE IS PROFESSOR 344 00:11:50,000 --> 00:11:51,840 IN THE DEPARTMENT OF PSYCHIATRY 345 00:11:51,840 --> 00:11:53,600 AND BEHAVIORAL SCIENCES AT THE 346 00:11:53,600 --> 00:11:55,000 UNIVERSITY OF WASHINGTON SCHOOL 347 00:11:55,000 --> 00:11:58,600 OF MEDICINE AND HE WILL TALK TO 348 00:11:58,600 --> 00:12:02,520 US ABOUT THE T STUDY. 349 00:12:02,520 --> 00:12:04,520 FINALLY WE HAVE DR. MICHAEL HO 350 00:12:04,520 --> 00:12:09,160 WHO IS GOING TO TALK TO US ABOUT 351 00:12:09,160 --> 00:12:10,520 THE NUDGE STUDY AND HE IS A 352 00:12:10,520 --> 00:12:12,480 PROFESSOR OF MEDICINE AT THE 353 00:12:12,480 --> 00:12:14,640 UNIVERSITY OF COLORADO. 354 00:12:14,640 --> 00:12:16,640 SO WE ARE REALLY EXCITED TO HAVE 355 00:12:16,640 --> 00:12:20,440 ALL OF OUR SPEAKERS HERE. 356 00:12:20,440 --> 00:12:22,320 AND WE WILL GET START AND I 357 00:12:22,320 --> 00:12:24,480 THINK GAIL, YOU ARE OUR FIRST 358 00:12:24,480 --> 00:12:25,920 SPEAKER SO I WILL TURN THINGS 359 00:12:25,920 --> 00:12:35,000 OVER TO YOU. 360 00:12:35,000 --> 00:12:37,440 >> I AM TRYING TO START THE 361 00:12:37,440 --> 00:12:39,920 VIDEO, DID YOU PUT ME ON THE 362 00:12:39,920 --> 00:12:42,080 HOST HAS SOPPED IT, IT SAID MY 363 00:12:42,080 --> 00:12:42,760 VIDEO. 364 00:12:42,760 --> 00:12:44,920 >> MARY JOE CAN YOU REQUEST FOR 365 00:12:44,920 --> 00:12:55,040 HER TO TURN IT BACK ON? 366 00:12:55,040 --> 00:12:57,160 >> I CAN START ANYWAY. 367 00:12:57,160 --> 00:12:58,960 >> I THINK WE SHOULD BE ABLE TO 368 00:12:58,960 --> 00:13:00,480 GET THAT UP. 369 00:13:00,480 --> 00:13:02,480 FOR TAMMY, YOUR CO-HOST AS WELL, 370 00:13:02,480 --> 00:13:05,200 DO YOU HAVE THE ABILITY TO DO 371 00:13:05,200 --> 00:13:15,320 THAT? 372 00:13:19,800 --> 00:13:21,880 >> SHE JUST ASKED ME. 373 00:13:21,880 --> 00:13:23,720 >> PERFECT. 374 00:13:23,720 --> 00:13:27,800 >> I'M GOING TO TALK TO YOU 375 00:13:27,800 --> 00:13:29,720 ABOUT EMBED, I WANT TO REALLY 376 00:13:29,720 --> 00:13:33,440 TELL YOU THAT THIS WAS A REALLY 377 00:13:33,440 --> 00:13:36,280 GROUP EFFORT, DR. MALNAC IS PI 378 00:13:36,280 --> 00:13:37,840 ON THIS WITH ME AND A HUGE GROUP 379 00:13:37,840 --> 00:13:40,680 OF PEOPLE INTERESTED IN THE MOST 380 00:13:40,680 --> 00:13:44,720 IMPORTANT THING IS THAT DR. 381 00:13:44,720 --> 00:13:47,320 MONAC EXPERTISE IN INFORMATICS 382 00:13:47,320 --> 00:13:48,480 MAKES THIS WORK SO ON TO THE 383 00:13:48,480 --> 00:13:51,000 NEXT SLIDE. 384 00:13:51,000 --> 00:13:53,680 SO EMBED IS A PRAGMATIC TRIAL 385 00:13:53,680 --> 00:13:55,800 USER CENTERED CLINICAL DECISION 386 00:13:55,800 --> 00:13:57,640 FOR EMERGENCY DEPARTMENT 387 00:13:57,640 --> 00:13:58,960 INITIATED BUPRENORPHINE FOR 388 00:13:58,960 --> 00:14:00,560 OPIATE USE DISORDER. 389 00:14:00,560 --> 00:14:03,520 RIGHT A WAY IT IS A PRAGMATIC 390 00:14:03,520 --> 00:14:05,840 TRIAL WHICH IS ITSELF USING 391 00:14:05,840 --> 00:14:07,240 USUAL CONDITIONS AND WHEN 392 00:14:07,240 --> 00:14:09,600 APPLIED GENERALLY THAT USUAL 393 00:14:09,600 --> 00:14:10,880 CARE MAKES IT MORE DIFFICULT, IT 394 00:14:10,880 --> 00:14:13,640 IS A FIVE YEAR PROJECT. 395 00:14:13,640 --> 00:14:14,560 PLANNING PHASE ET CETERA AND 396 00:14:14,560 --> 00:14:19,960 WHAT WE DID WAS TAKE WHAT WAS A 397 00:14:19,960 --> 00:14:22,920 VERY STATIC INITIATED 398 00:14:22,920 --> 00:14:24,920 BUPRENORPHINE ALGORITHM AND MAKE 399 00:14:24,920 --> 00:14:26,600 IT DYNAMIC TO AUTOMATED 400 00:14:26,600 --> 00:14:27,560 APPLICATION, AS YOU CAN SEE ON 401 00:14:27,560 --> 00:14:32,200 THE RIGHT HAND SIDE, AND TO OUR 402 00:14:32,200 --> 00:14:33,920 INTERVENTION SITES IT WAS AN 18 403 00:14:33,920 --> 00:14:34,800 MONTH TRIAL. 404 00:14:34,800 --> 00:14:38,840 THERE WERE 21 ED SITES OVER FIVE 405 00:14:38,840 --> 00:14:40,200 HEALTH SYSTEMS, YOU CAN SEE THEM 406 00:14:40,200 --> 00:14:41,720 THERE AND THAT INTERVENTION WAS 407 00:14:41,720 --> 00:14:43,360 USING THAT CLINICAL DECISION 408 00:14:43,360 --> 00:14:44,840 SUPPORT AND IT WAS RANDOMIZED 409 00:14:44,840 --> 00:14:47,360 ONE TO ONE RATIO INTERVENTION 410 00:14:47,360 --> 00:14:48,680 VERSUS USUAL CARE ARM WITH OUR 411 00:14:48,680 --> 00:14:52,720 PRIMARY OUTCOME BEING INITIATION 412 00:14:52,720 --> 00:14:55,440 OF IN ED PATIENTS AT THE PATIENT 413 00:14:55,440 --> 00:14:55,640 LEVEL. 414 00:14:55,640 --> 00:14:57,600 THAT WAS FROM THE CLINICIAN 415 00:14:57,600 --> 00:14:58,240 USING IT. 416 00:14:58,240 --> 00:15:02,320 SO LET'S GO ON. 417 00:15:02,320 --> 00:15:03,960 WE HAD PLANNING PHASE AND THIS 418 00:15:03,960 --> 00:15:06,440 IS WHAT OUR MILESTONES WERE. 419 00:15:06,440 --> 00:15:08,000 WE ARE GOING TO DESIGN DEVELOP 420 00:15:08,000 --> 00:15:09,800 OUR PROTOTYPE, WE DID THE IT 421 00:15:09,800 --> 00:15:12,160 BUILD WITH LOCAL EHR INTEGRATION 422 00:15:12,160 --> 00:15:13,080 AND TESTED THAT ON SITE. 423 00:15:13,080 --> 00:15:16,400 AND WE DID THE TRIAL PLANNING 424 00:15:16,400 --> 00:15:16,880 PHASE. 425 00:15:16,880 --> 00:15:20,640 YOU CAN SEE WE REALLY DID HAVE 426 00:15:20,640 --> 00:15:21,880 SOME DIFFICULTIES AND CHALLENGES 427 00:15:21,880 --> 00:15:23,840 AND THEY WERE IN ALL THEIRSIAS 428 00:15:23,840 --> 00:15:26,160 HERE. 429 00:15:26,160 --> 00:15:29,760 AND WE CAN MOVE FORWARD. 430 00:15:29,760 --> 00:15:31,080 THIS WAS OUR ORIGIN MALL DESIGN 431 00:15:31,080 --> 00:15:32,400 HOW WE CHANGED IT AND SO YOU CAN 432 00:15:32,400 --> 00:15:35,480 SEE REALLY VERY QUICKLY THE BLUE 433 00:15:35,480 --> 00:15:36,720 REPRESENTED WHAT WE PLANNED ON 434 00:15:36,720 --> 00:15:40,120 DOING IN OUR ORIGINAL PLAN, AND 435 00:15:40,120 --> 00:15:41,760 GREEN WE ACTUALLY DID SO THAT 436 00:15:41,760 --> 00:15:43,960 YOU CAN SEE THAT THINGS CHANGED 437 00:15:43,960 --> 00:15:45,600 THROUGHOUT, ONE HAS TO BE FAIRLY 438 00:15:45,600 --> 00:15:46,720 NIMBLE AND RESILIENT. 439 00:15:46,720 --> 00:15:49,600 SO THE NEXT SLIDE IS SHOWING WE 440 00:15:49,600 --> 00:15:51,040 HAD THE FIRST BIG HURDLE WAS 441 00:15:51,040 --> 00:15:53,320 THAT WE HAD A CHANGE IN ONE OF 442 00:15:53,320 --> 00:15:56,920 OUR PIs AT MAYO, MIGRATED TO 443 00:15:56,920 --> 00:15:58,120 UNIVERSITY OF ALABAMA HEALTH 444 00:15:58,120 --> 00:16:01,560 SYSTEM SO WE ADDED THEM TO THE 445 00:16:01,560 --> 00:16:02,200 EMBED SITE. 446 00:16:02,200 --> 00:16:04,840 ALSO IN THE ORIGINAL TRIAL WE 447 00:16:04,840 --> 00:16:06,840 WERE DOING A STEP WEDGE, SHOW 448 00:16:06,840 --> 00:16:09,520 THE NEXT SLIDE. 449 00:16:09,520 --> 00:16:11,960 YOU CAN SEE WE WERE ORIGINALLY 450 00:16:11,960 --> 00:16:14,080 PLANNING A STEP WEDGE DESIGN BUT 451 00:16:14,080 --> 00:16:18,400 THE NIH STEERING COMMITTEE THAT 452 00:16:18,400 --> 00:16:19,840 WENT TO 2018 TOLD US WE WOULD BE 453 00:16:19,840 --> 00:16:21,360 BETTER OFF IF WE CHANGED THAT 454 00:16:21,360 --> 00:16:23,760 BECAUSE OF THE GROWING PRICES 455 00:16:23,760 --> 00:16:25,440 AND LOT OF TEMPORAL CHANGES AND 456 00:16:25,440 --> 00:16:27,960 WE NEEDED TO FIND A SOLUTION TO 457 00:16:27,960 --> 00:16:28,960 THAT. 458 00:16:28,960 --> 00:16:31,800 SO WE DID THE CLUSTER DESIGN. 459 00:16:31,800 --> 00:16:33,600 SO THAT HAPPENED RIGHT THERE AND 460 00:16:33,600 --> 00:16:35,120 YOU CAN SEE WHAT HAPPENED. 461 00:16:35,120 --> 00:16:38,440 WE SUBMITTED A SUPPLEMENT 462 00:16:38,440 --> 00:16:39,600 APPLICATION TOO WHICH THEN ALLOW 463 00:16:39,600 --> 00:16:41,760 US TO ADD TWO ADDITIONAL HEALTH 464 00:16:41,760 --> 00:16:43,400 SYSTEMS TO ACHIEVE OUR TARGET 465 00:16:43,400 --> 00:16:44,800 POWER WHICH WERE THE UNIVERSITY 466 00:16:44,800 --> 00:16:51,760 OF COLORADO OR AURORA AND WE HAD 467 00:16:51,760 --> 00:16:57,440 MORE RESOURCES TO IMD BY 468 00:16:57,440 --> 00:17:00,000 DISSEMINATION SO WE HAD TIME 469 00:17:00,000 --> 00:17:01,360 TOPHI FISH, ANALYZE RESULTS AND 470 00:17:01,360 --> 00:17:05,760 DO DISSEMINATION. 471 00:17:05,760 --> 00:17:07,560 WE WILL NOT GO OVER THIS NOW, WE 472 00:17:07,560 --> 00:17:09,600 WILL ANSWER MANY QUESTIONS BUT 473 00:17:09,600 --> 00:17:10,920 THOUGHT GIVE OUT THE SLIDES IT 474 00:17:10,920 --> 00:17:15,040 IS NICE FOR THE PEOPLE WHO ARE 475 00:17:15,040 --> 00:17:18,640 ON TO HAVE IT TALKS REALLY 476 00:17:18,640 --> 00:17:20,120 ISSUES BARRIERS AND SOLUTIONS WE 477 00:17:20,120 --> 00:17:21,280 WILL WILL TALK ABOUT THAT AS WE 478 00:17:21,280 --> 00:17:26,440 GO THROUGH. 479 00:17:26,440 --> 00:17:28,480 FINALLY AS YOU CAN SEE HERE 480 00:17:28,480 --> 00:17:31,400 THERE WERE DATA COLLECTION 481 00:17:31,400 --> 00:17:32,200 CHALLENGES, MANY THINGS THAT 482 00:17:32,200 --> 00:17:35,360 WERE ISSUES HERE, WE HAD TO GO 483 00:17:35,360 --> 00:17:37,040 THROUGH EACH ONE OF THEM AND 484 00:17:37,040 --> 00:17:38,840 THESE ARE IT THINGS THAT NEED TO 485 00:17:38,840 --> 00:17:42,160 BE DRESSED DURING THE TIME. 486 00:17:42,160 --> 00:17:44,040 HAVING THE MASTER DICTIONARY 487 00:17:44,040 --> 00:17:47,240 READY ENSURING THE DATA WAS 488 00:17:47,240 --> 00:17:49,120 CONSISTENT, THE MOST REALLY THE 489 00:17:49,120 --> 00:17:50,360 MOST IMPORTANT THING IS WE DID 490 00:17:50,360 --> 00:17:52,480 MONTHLY POLLS DURING THE TRIAL 491 00:17:52,480 --> 00:17:55,360 TO MAKE SURE THIS DATA WAS 492 00:17:55,360 --> 00:17:56,800 COMPLETE, THE -- THEY WERE 493 00:17:56,800 --> 00:17:59,120 CORRECTLY MAPPED TO EHR FIELDS 494 00:17:59,120 --> 00:18:00,360 THAT CORRESPONDED TO CLINICAL 495 00:18:00,360 --> 00:18:01,680 INTENT OF THE VARIABLE AFTER 496 00:18:01,680 --> 00:18:03,880 ACCOUNTING FOR DOCK MEN TAKES 497 00:18:03,880 --> 00:18:05,800 PLAQUE AT THIS AND WORK FLOW AT 498 00:18:05,800 --> 00:18:06,120 EACH SITE. 499 00:18:06,120 --> 00:18:08,160 WE HAD TO HAVE QUALITY ASSURANCE 500 00:18:08,160 --> 00:18:09,120 SO THAT WAS VERY DIFFICULT, IT 501 00:18:09,120 --> 00:18:11,080 WAS VIGOROUS AND WE HAD A LOT OF 502 00:18:11,080 --> 00:18:13,960 CHALLENGES WE DID MULTIPLE 503 00:18:13,960 --> 00:18:16,440 ROUNDS OF ITERATIONS AND SAMPLE 504 00:18:16,440 --> 00:18:19,960 DATA VALIDATION BY THE -- OUR 505 00:18:19,960 --> 00:18:22,480 DATA COORDINATING CENTER HERE AT 506 00:18:22,480 --> 00:18:23,040 YALE. 507 00:18:23,040 --> 00:18:24,360 SO MANY THINGS WE CAN TALK ABOUT 508 00:18:24,360 --> 00:18:34,680 FOR THE NEXT HOUR. 509 00:18:35,360 --> 00:18:36,960 RUNNING A CHECKLIST TELLING 510 00:18:36,960 --> 00:18:38,000 EVERYBODY THAT WAS ESSENTIAL TO 511 00:18:38,000 --> 00:18:40,080 GET EVERYBODY UP TO SPEED AND 512 00:18:40,080 --> 00:18:42,080 KNOW WORKS THOSE SITES THAT NEED 513 00:18:42,080 --> 00:18:43,200 MORE WORK WITH AND THOSE THAT 514 00:18:43,200 --> 00:18:45,320 DIDN'T AND MAKE SURE THAT ALL OF 515 00:18:45,320 --> 00:18:47,560 YOUR MILESTONES WERE REACHED FOR 516 00:18:47,560 --> 00:18:50,240 LOTS OF THINGS, WE HAD TO GO TO 517 00:18:50,240 --> 00:18:50,640 MOVE FOR. 518 00:18:50,640 --> 00:18:52,760 GO AHEAD. 519 00:18:52,760 --> 00:18:55,080 THESE ARE BUNCH OF PUBLICATION, 520 00:18:55,080 --> 00:18:56,240 YOU HAVE TO READ WHICH WENT 521 00:18:56,240 --> 00:18:57,600 THROUGH EACH OF THESE DIFFERENT 522 00:18:57,600 --> 00:18:59,480 AREAS AND ISSUES THAT WE HAD AND 523 00:18:59,480 --> 00:19:05,640 HOW WE REALLY MET SOME OF THOSE 524 00:19:05,640 --> 00:19:06,880 BARRIERS AND FOUND THOSE 525 00:19:06,880 --> 00:19:08,080 SOLUTIONS YOU CAN FIND THEM ALL 526 00:19:08,080 --> 00:19:08,560 IN THESE PAPERS. 527 00:19:08,560 --> 00:19:11,120 SO THAT IS IT, WENDY. 528 00:19:11,120 --> 00:19:13,120 >> GREAT, THAW SO MUCH FOR THE 529 00:19:13,120 --> 00:19:14,480 INTRODUCTION -- THANK YOU SO 530 00:19:14,480 --> 00:19:15,680 MUCH, I HOPE THAT GIVING 531 00:19:15,680 --> 00:19:16,760 EVERYBODY A GOOD IDEA AND WE 532 00:19:16,760 --> 00:19:20,040 WILL GET INTO THE DETAILS OF 533 00:19:20,040 --> 00:19:21,800 SPECIFIC ISSUES AND CHALLENGES 534 00:19:21,800 --> 00:19:23,960 YOU FACE AS WE GET INTO 535 00:19:23,960 --> 00:19:24,560 DISCUSSION. 536 00:19:24,560 --> 00:19:27,120 WE GO TO THE NEXT SLIDE. 537 00:19:27,120 --> 00:19:31,640 SO IT LOOKS LIKE WE HAVE A 538 00:19:31,640 --> 00:19:34,000 LITTLE DELAY WITH DR. HO JOINING 539 00:19:34,000 --> 00:19:38,560 US SO WE WILL SKIP AHEAD IF THAT 540 00:19:38,560 --> 00:19:40,440 OKAY, MARY JOE, JAMESLY ASK YOU 541 00:19:40,440 --> 00:19:42,520 TO COME UP DR. TULSKY AND GO 542 00:19:42,520 --> 00:19:45,920 NEXT FOR US AND WE WILL COME 543 00:19:45,920 --> 00:19:47,920 BACK TO DR. HO'S SLIDES WHEN HE 544 00:19:47,920 --> 00:19:50,120 IS ABLE TO JOIN US, HE HAS A 545 00:19:50,120 --> 00:19:51,920 DELAY IN JOINING US, IF YOU CAN 546 00:19:51,920 --> 00:19:56,840 BRING UP YOUR VIDEO WHICH YOU 547 00:19:56,840 --> 00:19:59,400 MIGHT HAVE ALREADY. 548 00:19:59,400 --> 00:20:01,200 I WILL TURN THINGS OVER TO YOU. 549 00:20:01,200 --> 00:20:04,280 >> THANK YOU SO MUCH WENDY. 550 00:20:04,280 --> 00:20:05,920 HAPPY TO SPEAK ABOUT OUR STUDY 551 00:20:05,920 --> 00:20:10,920 WHICH WAS ACPP WHICH STANDS FOR 552 00:20:10,920 --> 00:20:12,560 PLANNING PROMOTE EFFECTIVE AND 553 00:20:12,560 --> 00:20:13,560 RELIANT COMMUNICATION MANY THE 554 00:20:13,560 --> 00:20:15,640 ELDERLY. 555 00:20:15,640 --> 00:20:17,160 AND I WOULD BE REMISS IF I DID 556 00:20:17,160 --> 00:20:24,400 NOT ACKNOWLEDGE MY CO-PI MASS 557 00:20:24,400 --> 00:20:25,960 GENERAL HOSPITAL WITHOUT NONE OF 558 00:20:25,960 --> 00:20:28,040 THIS WOULD BE POSSIBLE. 559 00:20:28,040 --> 00:20:30,920 WONDERFUL TEAM LOTS OF YOUNG 560 00:20:30,920 --> 00:20:31,360 PEOPLE. 561 00:20:31,360 --> 00:20:33,760 NEXT SLIDE PLEASE. 562 00:20:33,760 --> 00:20:38,680 SO WHAT ACPP IS IS A PRAGMATIC 563 00:20:38,680 --> 00:20:42,760 STEP WEDGE CLUSTER RANDOMIZE 564 00:20:42,760 --> 00:20:44,200 CONTROL RILE WHICH IS TESTING 565 00:20:44,200 --> 00:20:45,840 WHETHER CLINICIAN COMMUNICATION 566 00:20:45,840 --> 00:20:48,840 SKILLS TRAINING ON THE ONE HAND 567 00:20:48,840 --> 00:20:50,960 PLUS PATIENT VIDEO DECISION AIDS 568 00:20:50,960 --> 00:20:52,920 ON THE OTHER WILL INCREASE 569 00:20:52,920 --> 00:20:56,440 ADVANCE CARE PLANNING OUTCOMES 570 00:20:56,440 --> 00:20:58,960 FOUR OUTCOMES WE LOOK AT IN THE 571 00:20:58,960 --> 00:21:03,160 STUDY ARE ADVANCE CARE PLANNING, 572 00:21:03,160 --> 00:21:05,160 COMPLETION, RESUSCITATION ORDERS 573 00:21:05,160 --> 00:21:08,680 IN THE CHART, PALLIATIVE CARE 574 00:21:08,680 --> 00:21:09,800 CONSULTATION AND HOSPICE USE, 575 00:21:09,800 --> 00:21:11,480 ALL THIS IS ADVANCE CANCER 576 00:21:11,480 --> 00:21:14,240 PATIENT WHO ARE OVER THE AGE OF 577 00:21:14,240 --> 00:21:15,040 65. 578 00:21:15,040 --> 00:21:19,560 IF YOU CAN JUST ADVANCE ONCE. 579 00:21:19,560 --> 00:21:21,320 SO THE TWO DIFFERENT 580 00:21:21,320 --> 00:21:24,000 INTERVENTIONS, ONE IS VITAL TALK 581 00:21:24,000 --> 00:21:27,600 WHICH IS A STANDARD GOLD 582 00:21:27,600 --> 00:21:29,800 STANDARD CLINICIAN COMMUNICATION 583 00:21:29,800 --> 00:21:30,680 SKILLS TRAINING PROGRAM OUT 584 00:21:30,680 --> 00:21:33,400 THERE FOR SERIOUS ILLNESS 585 00:21:33,400 --> 00:21:33,800 COMMUNICATION. 586 00:21:33,800 --> 00:21:39,120 AND IT IS COMBINED TOGETHER WITH 587 00:21:39,120 --> 00:21:40,440 CARE BINDING DECISIONS WHICH IS 588 00:21:40,440 --> 00:21:42,680 THE VIDEO LIBRARY, ALWAYS USED 589 00:21:42,680 --> 00:21:44,400 TO EDUCATE PATIENTS HELP THEM 590 00:21:44,400 --> 00:21:45,600 MAKE DECISIONS. 591 00:21:45,600 --> 00:21:48,120 AND WE WERE DOING THIS, WE ARE 592 00:21:48,120 --> 00:21:50,120 DOING THIS IN THREE HEALTH 593 00:21:50,120 --> 00:21:54,240 SYSTEMS YOU CAN ADVANCE MORE, 594 00:21:54,240 --> 00:21:57,640 AND 36 ONCOLOGY CLINICS WHICH 595 00:21:57,640 --> 00:21:58,960 REPRESENTS ONCOLOGY CLINIC BUT 596 00:21:58,960 --> 00:22:01,520 THIS IS A DISEASE FOCUS ONCOLOGY 597 00:22:01,520 --> 00:22:04,600 CLINIC SO FOR EXAMPLE THORACIC 598 00:22:04,600 --> 00:22:08,360 GI ONCOLOGY OR LEUKEMIA OR 599 00:22:08,360 --> 00:22:10,360 WHATEVER AND THERE ARE 12 IN 600 00:22:10,360 --> 00:22:13,320 EACH OF THESE SITES, PROBABLY IN 601 00:22:13,320 --> 00:22:16,240 A SENSE THREE DIFFERENT KINDS OF 602 00:22:16,240 --> 00:22:18,800 PLACES, DUKE IS CLASSIC ACADEMIC 603 00:22:18,800 --> 00:22:25,080 MEDICAL CENTER, MAYO IS AS WELL, 604 00:22:25,080 --> 00:22:26,280 CLINIC ENVIRONMENT AND SERVE AS 605 00:22:26,280 --> 00:22:28,280 BIT MORE COMMUNITY POPULATION 606 00:22:28,280 --> 00:22:31,640 THOUGH THEY HAVE ACADEMIC ARMS 607 00:22:31,640 --> 00:22:32,040 AS WELL. 608 00:22:32,040 --> 00:22:35,720 THE NUMBER OF PATIENTS THAT WE 609 00:22:35,720 --> 00:22:37,720 WERE -- WE CALL ENROLLING BUT 610 00:22:37,720 --> 00:22:39,920 NOT REALLY ENROLLING BECAUSE IT 611 00:22:39,920 --> 00:22:41,240 IS LOOKING AT THEIR DATA. 612 00:22:41,240 --> 00:22:45,240 THEY END UP BEING 30,000, IF YOU 613 00:22:45,240 --> 00:22:47,000 EVER DO GRAND ROUNDS OR STUDY 614 00:22:47,000 --> 00:22:49,760 BEFORE THAT NUMBER WAS 4500, 615 00:22:49,760 --> 00:22:52,400 TURNS OUT WE WERE OFF, WAY MORE 616 00:22:52,400 --> 00:22:54,440 PEOPLE THAN WE ANTICIPATED, WE 617 00:22:54,440 --> 00:22:57,040 NEED TO MAKE ADJUSTMENTS, 618 00:22:57,040 --> 00:23:00,040 UNUSUALLY GOOD PROBLEM TO HAVE. 619 00:23:00,040 --> 00:23:03,080 NEXT SLIDE PLEASE. 620 00:23:03,080 --> 00:23:04,000 ADVANCE. 621 00:23:04,000 --> 00:23:06,080 IN THE ORIGINAL DESIGN OUR PLAN 622 00:23:06,080 --> 00:23:08,880 HAD BEEN WE WERE GOING TO HAVE 623 00:23:08,880 --> 00:23:10,600 SIX STEPS THAT WERE GOING TO 624 00:23:10,600 --> 00:23:12,920 INVOLVE TOTAL OF 12 CLUSTERS AND 625 00:23:12,920 --> 00:23:16,360 EACH OF THESE CLUSTERS WAS GOING 626 00:23:16,360 --> 00:23:19,480 TO BE COMMUNITY CLINICS. 627 00:23:19,480 --> 00:23:21,360 SO THEN WE WERE GOING TO HAVE A 628 00:23:21,360 --> 00:23:22,480 BASELINE PHASE, GOING TO 629 00:23:22,480 --> 00:23:23,920 BASICALLY HAVE ONE END AND 630 00:23:23,920 --> 00:23:25,680 COLLECT THE DATA FROM THE 631 00:23:25,680 --> 00:23:27,360 ELECTRONIC ALL THE DATA COMES 632 00:23:27,360 --> 00:23:29,520 OUT OF -- COMES OUT OF 633 00:23:29,520 --> 00:23:30,320 ELECTRONIC HEALTH RECORDS, WE 634 00:23:30,320 --> 00:23:35,080 WERE THEN GOING TO DO EACH OF 635 00:23:35,080 --> 00:23:37,680 THE STEPS AND IN THE CLASSIC 636 00:23:37,680 --> 00:23:38,480 FORMAT. 637 00:23:38,480 --> 00:23:42,360 HOWEVER YOU CAN ADVANCE ONCE. 638 00:23:42,360 --> 00:23:45,320 THAT IS ONE MORE TIME THAT 639 00:23:45,320 --> 00:23:46,480 STARTED. 640 00:23:46,480 --> 00:23:50,000 WE DID DO THE FIRST STEP. 641 00:23:50,000 --> 00:23:50,760 EVERYTHING WENT GREAT. 642 00:23:50,760 --> 00:23:53,000 WE GOT HIT BY COVID. 643 00:23:53,000 --> 00:23:56,640 SO THIS OBVIOUSLY REQUIRED 644 00:23:56,640 --> 00:23:59,520 CHANGES I DON'T WANT TO GET INTO 645 00:23:59,520 --> 00:24:00,560 IT BUT BLEW UP EVERYTHING WE 646 00:24:00,560 --> 00:24:02,840 WERE DOING SO WE REVISED THE 647 00:24:02,840 --> 00:24:03,520 STUDY. 648 00:24:03,520 --> 00:24:04,000 NEXT SLIDE. 649 00:24:04,000 --> 00:24:07,320 SO WHEN WE DID THE REVISED 650 00:24:07,320 --> 00:24:08,880 DESIGN, WE -- THERE WERE NUMBER 651 00:24:08,880 --> 00:24:10,680 OF ISSUES, FIRST WE HAD A WHOLE 652 00:24:10,680 --> 00:24:16,720 PERIOD OF TIME TO SKIP SO WE 653 00:24:16,720 --> 00:24:17,400 (INAUDIBLE) RESEARCH. 654 00:24:17,400 --> 00:24:21,960 THE OTHER THING WAS THAT 655 00:24:21,960 --> 00:24:24,040 REALIZED THAT BECAUSE OF COVID 656 00:24:24,040 --> 00:24:25,920 IT CHANGED A LOT OF APPROACHES 657 00:24:25,920 --> 00:24:29,480 TO ADVANCE CARE PLANNING IN 658 00:24:29,480 --> 00:24:30,000 THESE INSTITUTIONS. 659 00:24:30,000 --> 00:24:32,520 PATIENTS WERE LOOKING AT IT 660 00:24:32,520 --> 00:24:34,200 DIFFERENTLY, A LOT NEW CHANGES 661 00:24:34,200 --> 00:24:36,640 BUT BASICALLY HUGE SECULAR TREND 662 00:24:36,640 --> 00:24:37,240 TO ACCOUNT FOR. 663 00:24:37,240 --> 00:24:40,280 SO WE DECIDED HOW MUCH COULD WE 664 00:24:40,280 --> 00:24:42,480 LEARN FROM THIS SO WE DECIDED 665 00:24:42,480 --> 00:24:43,760 THAT WHAT WE WERE GOING TO DO IS 666 00:24:43,760 --> 00:24:45,960 WE WERE GOING TO USE THE DATA WE 667 00:24:45,960 --> 00:24:48,680 HAVE STEPS 1 AND 2 AND COLLECT 668 00:24:48,680 --> 00:24:50,120 THE ADVANCE CARE PLANNING RATE 669 00:24:50,120 --> 00:24:52,040 BEFORE AND AFTER INTERVENTION, 670 00:24:52,040 --> 00:24:53,800 THIS WOULD BE CLEAN, JUST UNDER 671 00:24:53,800 --> 00:24:55,680 POWERED BECAUSE IT IS ONLY ONE 672 00:24:55,680 --> 00:24:57,200 STEP. 673 00:24:57,200 --> 00:25:01,040 ONLY ONE STEP AND OBVIOUSLY 674 00:25:01,040 --> 00:25:03,840 WASN'T ENTIRELY RANDOM. 675 00:25:03,840 --> 00:25:06,600 NEXT NOW WHAT WE WILL DO IS TAKE 676 00:25:06,600 --> 00:25:07,640 STEPS 3 THROUGH 12. 677 00:25:07,640 --> 00:25:10,080 LOOK AT THE INTERVENTION EFFECT 678 00:25:10,080 --> 00:25:11,640 POST COVID-19. 679 00:25:11,640 --> 00:25:12,920 BASICALLY AT THIS POINT WE HAVE 680 00:25:12,920 --> 00:25:14,600 A NEW BASELINE AND WE WERE GOING 681 00:25:14,600 --> 00:25:16,560 TO WORK OFF THAT NEW BASELINE 682 00:25:16,560 --> 00:25:18,440 AND STUDY THE -- IN FACT WE 683 00:25:18,440 --> 00:25:20,320 COULDN'T STUDY -- WE HAD TO KEEP 684 00:25:20,320 --> 00:25:22,400 IT SEPARATE FROM STEPS 1 AND 2. 685 00:25:22,400 --> 00:25:23,840 OBVIOUSLY THAT WASN'T GOING TO 686 00:25:23,840 --> 00:25:24,240 WORK. 687 00:25:24,240 --> 00:25:26,800 WE CREATED FOUR STEPS WHERE 688 00:25:26,800 --> 00:25:27,880 THERE SHOULD BE FIVE AND AS YOU 689 00:25:27,880 --> 00:25:30,560 CAN SEE WE INCLUDED MORE CLINIC 690 00:25:30,560 --> 00:25:32,760 CLUSTERS IN THE LAST TWO STEPS 691 00:25:32,760 --> 00:25:39,080 IN ORDER TO GET EVERYBODY IN. 692 00:25:39,080 --> 00:25:40,120 ONE MORE AFTER THAT. 693 00:25:40,120 --> 00:25:41,760 SORRY. 694 00:25:41,760 --> 00:25:42,480 ONE MORE YET. 695 00:25:42,480 --> 00:25:43,080 GREAT. 696 00:25:43,080 --> 00:25:44,640 SO THEN THE OTHER THING WE WERE 697 00:25:44,640 --> 00:25:46,640 GOING -- WE ARE DOING IS 698 00:25:46,640 --> 00:25:48,480 MEASURING THE COVID-19 EFFECT. 699 00:25:48,480 --> 00:25:50,840 WE WERE GOING TO ESTIMATE THE 700 00:25:50,840 --> 00:25:52,280 PRE-COVID ADVANCE CARE PLAN RATE 701 00:25:52,280 --> 00:25:54,400 FROM THE ORIGINAL BASE PIPELINE 702 00:25:54,400 --> 00:25:56,080 PLUS STEP 1. 703 00:25:56,080 --> 00:25:58,720 THE POST COVID RATE FROM STEP 2 704 00:25:58,720 --> 00:26:00,480 DATA AND WE CAN EXAMINE TRENDS 705 00:26:00,480 --> 00:26:01,920 OVER TIME SO TURNS OUT WE ARE 706 00:26:01,920 --> 00:26:04,280 NOT ONLY GOING TO DO AND BE ABLE 707 00:26:04,280 --> 00:26:05,800 TO SUCCESSFULLY COMPLETE THE 708 00:26:05,800 --> 00:26:08,440 STUDY WE ORIGINALLY PLANNED WE 709 00:26:08,440 --> 00:26:10,120 ALSO ARE ALSO GOING TO HOPEFULLY 710 00:26:10,120 --> 00:26:11,920 LEARN SOMETHING ABOUT THE EFFECT 711 00:26:11,920 --> 00:26:13,680 COVID HAD ON ADVANCE CARE 712 00:26:13,680 --> 00:26:18,240 PLANNING AT LEAST IN THE SET OF 713 00:26:18,240 --> 00:26:19,200 ONCOLOGY. 714 00:26:19,200 --> 00:26:20,320 THIS IS MY LAST SLIDE. 715 00:26:20,320 --> 00:26:23,000 I JUST WANTED TO BRIEFLY SPEAK 716 00:26:23,000 --> 00:26:24,640 ABOUT SOME DATA CHALLENGES WE 717 00:26:24,640 --> 00:26:27,640 RAN INTO AND AGAIN THESE ARE -- 718 00:26:27,640 --> 00:26:29,640 THIS IS SOMETHING YOU MIGHT BE 719 00:26:29,640 --> 00:26:33,040 TALKING ABOUT MORE DISCUSSION 720 00:26:33,040 --> 00:26:35,680 BUT WE WENT INTO THIS WITH THE 721 00:26:35,680 --> 00:26:38,960 PLAN THAT WE WERE GOING TO USE 722 00:26:38,960 --> 00:26:44,000 STRUCTURED DATA ELEMENTS FROM 723 00:26:44,000 --> 00:26:46,040 ELECTRONIC HEALTH RECORDS TWO 724 00:26:46,040 --> 00:26:50,840 WHICH WERE -- AND ONE WHICH WAS. 725 00:26:50,840 --> 00:26:54,240 WE WERE GOING TO STRUCTURE DATA 726 00:26:54,240 --> 00:26:55,800 ELEMENTS MEANING THERE IS A 727 00:26:55,800 --> 00:26:59,000 PLACE IN THE RECORD WHERE 728 00:26:59,000 --> 00:27:00,560 ADVANCE CARE PLAN DISCUSSION 729 00:27:00,560 --> 00:27:02,320 DOCUMENT, WHERE THERE IS A MOST 730 00:27:02,320 --> 00:27:05,560 -- DNR OR HEALTHCARE. 731 00:27:05,560 --> 00:27:08,320 WE PULL THESE OUT AND THAT WAS 732 00:27:08,320 --> 00:27:10,440 THE OUTCOME. 733 00:27:10,440 --> 00:27:12,320 WE DID A CHART REVIEW OF THE 734 00:27:12,320 --> 00:27:14,680 DATA ELEMENTS THAT WE POLLED 735 00:27:14,680 --> 00:27:18,400 FROM THE SITES IN OUR INITIAL 736 00:27:18,400 --> 00:27:21,360 PERIOD WHEN WE FIRST PLAN THE 737 00:27:21,360 --> 00:27:21,880 STUDY. 738 00:27:21,880 --> 00:27:23,400 WHAT WE FOUND IS VERY DIFFERENT 739 00:27:23,400 --> 00:27:25,520 SO KEY YOUR EYES TO THE BOLDFACE 740 00:27:25,520 --> 00:27:26,680 HERE AND IF YOU LOOK AT THE TOP 741 00:27:26,680 --> 00:27:29,760 WHERE IT SAYS TOTAL CORRECT 742 00:27:29,760 --> 00:27:31,720 OCCUPANTS, YOU CAN SEE ACROSS 743 00:27:31,720 --> 00:27:35,760 ALL THREE SITES UNDER 60% 744 00:27:35,760 --> 00:27:37,040 ACTUALLY HAD THE CORRECT 745 00:27:37,040 --> 00:27:39,000 DOCUMENTS WE THOUGHT WE WERE 746 00:27:39,000 --> 00:27:40,040 POLLING FROM THOSE SITES. 747 00:27:40,040 --> 00:27:42,560 IF YOU LOOK DOWN AT THE BOTTOM 748 00:27:42,560 --> 00:27:46,840 YOU CAN SEE THERE WERE 24% 749 00:27:46,840 --> 00:27:48,920 INCORRECT DOCUMENTS, WHERE 750 00:27:48,920 --> 00:27:52,000 SUPPOSEDLY DOCUMENT EXISTED OR 751 00:27:52,000 --> 00:27:53,480 ANOTHER 17% OF DIGITAL DOCUMENTS 752 00:27:53,480 --> 00:27:57,240 SO WE LEARN LEARNED IN THAT PROS 753 00:27:57,240 --> 00:27:59,640 THAT DATA ELEMENTS WHICH APPEAR 754 00:27:59,640 --> 00:28:01,080 TO HAVE BEEN FULL PROOF WAY OF 755 00:28:01,080 --> 00:28:03,800 GETTING DATA, WAS GOING TO BE 756 00:28:03,800 --> 00:28:04,160 ACCURATE. 757 00:28:04,160 --> 00:28:07,680 SO WE WERE GOING TO DO LOTS OF 758 00:28:07,680 --> 00:28:10,240 CHART REVIEW, IMPRACTICAL 759 00:28:10,240 --> 00:28:11,880 PARTICULARLY WHEN NUMBERS GO TO 760 00:28:11,880 --> 00:28:13,120 30,000 OR WE HAD TO THINK OF 761 00:28:13,120 --> 00:28:15,680 SOMETHING ELSE, THIS IS WHERE WE 762 00:28:15,680 --> 00:28:16,640 HAD ADVANTAGE OF HAVING A 763 00:28:16,640 --> 00:28:18,360 LABORATORY HERE THAT WORKS ON 764 00:28:18,360 --> 00:28:21,040 NATURAL LANGUAGE PROCESSING AND 765 00:28:21,040 --> 00:28:24,480 WAS ABLE TO APPLY NATURAL 766 00:28:24,480 --> 00:28:26,160 LANGUAGE PROCESSING ALLOT THES 767 00:28:26,160 --> 00:28:28,600 AT DANA-FARBER TO THE SITES AN 768 00:28:28,600 --> 00:28:31,440 EXTRACT THE SAME DATA WITH -- 769 00:28:31,440 --> 00:28:33,240 NOT SHOWING YOU THE OUTCOMES 770 00:28:33,240 --> 00:28:36,280 HERE BUT WITH FAR MORE ACCURACY 771 00:28:36,280 --> 00:28:37,880 LIKE EXCEEDINGLY FAR MORE 772 00:28:37,880 --> 00:28:39,320 ACCURACY THAN WE GOT 773 00:28:39,320 --> 00:28:40,920 CONSTRUCTION DATA ELEMENTS. 774 00:28:40,920 --> 00:28:42,520 SO THAT SOMETHING WE LEARNED 775 00:28:42,520 --> 00:28:43,640 EARLY ON THAT COMPLETELY CHANGED 776 00:28:43,640 --> 00:28:44,600 THE STUDY LATER ON. 777 00:28:44,600 --> 00:28:48,200 SO I WILL STOP THERE AND HAND IT 778 00:28:48,200 --> 00:28:50,040 BACK TO WENDY. 779 00:28:50,040 --> 00:28:51,720 >> GREAT, THANK YOU SO MUCH, 780 00:28:51,720 --> 00:28:52,320 JAMES. 781 00:28:52,320 --> 00:28:54,320 WONDERFUL INTRODUCTION TO YOUR 782 00:28:54,320 --> 00:28:55,640 STUDY AS WELL. 783 00:28:55,640 --> 00:28:57,080 I WILL TURN THINGS OVER, THE 784 00:28:57,080 --> 00:29:03,040 NEXT SLIDE WILL BRING UP DR. 785 00:29:03,040 --> 00:29:04,920 ZATZICK'S STUDY. 786 00:29:04,920 --> 00:29:06,680 DOUGLY TURN TO YOU ABOUT THE 787 00:29:06,680 --> 00:29:07,040 TSOS TRIAL. 788 00:29:07,040 --> 00:29:08,360 >> THANKS WENDY. 789 00:29:08,360 --> 00:29:10,240 A BRIEF OVERVIEW TO GET INTO 790 00:29:10,240 --> 00:29:17,080 DISCUSSION, NEXT SLIDE PLEASE. 791 00:29:17,080 --> 00:29:18,920 OUTCOMES SUPPORT WAS A STEP 792 00:29:18,920 --> 00:29:22,560 WEDGE CLUSTER DESIGNED TRIAL 793 00:29:22,560 --> 00:29:24,640 THAT LOOKED AT INNOVATIVE 794 00:29:24,640 --> 00:29:25,520 COLLABORATIVE CARE INTERVENTION 795 00:29:25,520 --> 00:29:27,160 FOR PATIENTS WHO WERE ADMITTED 796 00:29:27,160 --> 00:29:30,600 TO LEVEL ONE TRAUMA CENTERS 797 00:29:30,600 --> 00:29:32,640 NATIONALLY. 798 00:29:32,640 --> 00:29:35,240 635 PATIENTS RANDOMIZED INTO THE 799 00:29:35,240 --> 00:29:36,760 TRIAL COLLABORATIVE CARE VERSUS 800 00:29:36,760 --> 00:29:40,360 USUAL CARE CONTROL, AND BASELINE 801 00:29:40,360 --> 00:29:44,120 SURGERY ADMISSION WAS BEGAN WITH 802 00:29:44,120 --> 00:29:46,680 PTSD SCREEN TO IDENTIFY PATIENTS 803 00:29:46,680 --> 00:29:48,400 AT LEVEL FOR HIGH SYMPTOM 804 00:29:48,400 --> 00:29:49,880 LEVELS, THE MAIN OUTCOME WAS 805 00:29:49,880 --> 00:29:51,520 SYMPTOMS ASSESSED BY INTERVIEW 806 00:29:51,520 --> 00:29:54,480 AT 3, 6, 12 MONTHS POST INJURY, 807 00:29:54,480 --> 00:29:56,160 THE MAIN TRIAL PAPER WAS 808 00:29:56,160 --> 00:29:57,600 PUBLISHED LAST YEAR IN JAMA 809 00:29:57,600 --> 00:30:00,040 SURGERY AND SHOWED SIGNIFICANT 810 00:30:00,040 --> 00:30:00,760 CLINICALLY STATISTICALLY 811 00:30:00,760 --> 00:30:03,800 SIGNIFICANT REDUCTION IN PTSD 812 00:30:03,800 --> 00:30:05,400 SYMPTOMS SIX MONTHS BUT NOT 12 813 00:30:05,400 --> 00:30:09,040 MONTHS AFTER THE INJURY. 814 00:30:09,040 --> 00:30:10,840 SO THE PLANNING PHASE WAS 815 00:30:10,840 --> 00:30:14,480 COMPLEX FOR TSOS THAT WE WERE 816 00:30:14,480 --> 00:30:18,120 INTERESTED IN GETTING 24, 25 817 00:30:18,120 --> 00:30:19,680 SITES FROM THE POPULATION OF 818 00:30:19,680 --> 00:30:20,880 LEVEL 1 TRAUMA CENTERS 819 00:30:20,880 --> 00:30:21,520 NATIONALLY. 820 00:30:21,520 --> 00:30:24,680 SO ON THE LEFT YOU SEE A GRAPHIC 821 00:30:24,680 --> 00:30:26,560 OF ALL TRAUMA CENTERS IN THE 822 00:30:26,560 --> 00:30:28,040 UNITED STATES, OVER A THOUSAND 823 00:30:28,040 --> 00:30:29,880 AND ON THE RIGHT YOU SEE THE 824 00:30:29,880 --> 00:30:32,360 GREEN DOTS, SMALL GREEN DOTS, 25 825 00:30:32,360 --> 00:30:33,560 SITES THAT ACTUALLY RECRUITED 826 00:30:33,560 --> 00:30:37,360 INTO THE TSOS TRIAL. 827 00:30:37,360 --> 00:30:40,840 YOU SEE IN SEATTLE, AND OUR TEAM 828 00:30:40,840 --> 00:30:42,960 IS A BIG DOT, WE COORDINATED THE 829 00:30:42,960 --> 00:30:47,480 STUDY FROM SEATTLE AND DID OUR 830 00:30:47,480 --> 00:30:49,280 PILOTING AT TWO LEVEL 2 TRAUMA 831 00:30:49,280 --> 00:30:50,640 CENTERS SO MANY THE PLANNING 832 00:30:50,640 --> 00:30:53,000 PHASE WE RECRUIT THESE SITES AND 833 00:30:53,000 --> 00:30:54,520 AT THE SAME TIME DOING A SMALL 834 00:30:54,520 --> 00:31:00,040 PILOT OF THE PROCEDURES. 835 00:31:00,040 --> 00:31:03,920 AND WE HAD A VERY SORT OF 836 00:31:03,920 --> 00:31:05,200 IMPLEMENTATION SCIENCE INFORM 837 00:31:05,200 --> 00:31:06,560 CONCEPTUAL FRAMEWORK USING REAIM 838 00:31:06,560 --> 00:31:08,400 TO THINK ABOUT THIS POPULATION 839 00:31:08,400 --> 00:31:10,280 OF LEVEL 1 TRAUMA CENTERS AND 840 00:31:10,280 --> 00:31:11,840 SORT OF SOME OF THE POINTS WENDY 841 00:31:11,840 --> 00:31:13,080 WAS ARTICULATING WE WERE 842 00:31:13,080 --> 00:31:15,640 INTERESTED IN A REPRESENTATIVE 843 00:31:15,640 --> 00:31:17,840 SAMPLE OF LEVEL 1 TRAUMA 844 00:31:17,840 --> 00:31:19,600 CENTERS, WE DIDN'T WANT ACADEMIC 845 00:31:19,600 --> 00:31:20,880 SITES WE WANTED RURAL SITES, SO 846 00:31:20,880 --> 00:31:25,520 THIS IS IS THE TABLE ONE OR 847 00:31:25,520 --> 00:31:27,200 TABLE 5 DESIGN PAPER SHOWING THE 848 00:31:27,200 --> 00:31:28,400 CHARACTERISTICS WE RECRUITED IN 849 00:31:28,400 --> 00:31:30,920 THE STUDY, ORGANIZAL 850 00:31:30,920 --> 00:31:31,800 CHARACTERISTICS, ADMISSION 851 00:31:31,800 --> 00:31:35,960 VOLUME, RESIDENCY TRAIN STATUS, 852 00:31:35,960 --> 00:31:37,400 REGIONAL LOCATION RURAL VERSUS 853 00:31:37,400 --> 00:31:40,800 URBAN AND WE DID WELL BALANCING 854 00:31:40,800 --> 00:31:41,600 THE ORGANIZATIONAL 855 00:31:41,600 --> 00:31:42,800 CHARACTERISTICS OF THE SITES IN 856 00:31:42,800 --> 00:31:50,840 THE STUDY WITH THE 200 TRAUMA 857 00:31:50,840 --> 00:31:53,720 CENTERS ELIGIBLE FOR THE STUDY. 858 00:31:53,720 --> 00:31:58,800 SO VERY DIFFERENT FROM REAIM 859 00:31:58,800 --> 00:31:59,760 IMPLEMENTATION SCIENCE FRAMEWORK 860 00:31:59,760 --> 00:32:01,920 PRAGMATIC ISSUES THAT NEEDED TO 861 00:32:01,920 --> 00:32:05,600 BE TESTED BEFORE THE UH 3 ROLL 862 00:32:05,600 --> 00:32:08,560 OUT IN THAT UH 2 ONE YEAR 863 00:32:08,560 --> 00:32:10,840 PERIOD. 864 00:32:10,840 --> 00:32:12,360 SO THERE WAS TREMENDOUS 865 00:32:12,360 --> 00:32:14,320 VARIABILITY AT SITES AT BASELINE 866 00:32:14,320 --> 00:32:16,760 AND THEN OVER TIME, MANY OF 867 00:32:16,760 --> 00:32:23,320 THESE BASELINE ISSUES WE DIDN'T 868 00:32:23,320 --> 00:32:24,840 GET GOOD ENOUGH CHANCE WHILE 869 00:32:24,840 --> 00:32:26,080 RECRUITING WE DIDN'T HAVE A 870 00:32:26,080 --> 00:32:31,080 CHANCE TO PILOT ISSUES THAT 871 00:32:31,080 --> 00:32:31,880 CAUSE DIFFICULTY OVER TIME SUCH 872 00:32:31,880 --> 00:32:33,200 AS ELECTRONIC HEALTH RECORD 873 00:32:33,200 --> 00:32:35,960 CAPACITY, THE RESEARCH 874 00:32:35,960 --> 00:32:37,200 EXPERIENCE OF TRAUMA CENTER 875 00:32:37,200 --> 00:32:39,320 SITES AND PTSD INTERVENTION 876 00:32:39,320 --> 00:32:44,360 EXPERIENCE. 877 00:32:44,360 --> 00:32:47,120 HONING IN ON EHR CAPACITY, WE 878 00:32:47,120 --> 00:32:49,840 HAD A TEN DOMAIN ELECTRONIC 879 00:32:49,840 --> 00:32:51,960 HEALTH RECORD PTSD SCREEN 880 00:32:51,960 --> 00:32:53,520 DESIGNED TO BE AUTOMATED, YOU 881 00:32:53,520 --> 00:32:57,680 COME IN AND YOU DO AUTOMATED 882 00:32:57,680 --> 00:33:00,240 SWATH OF TRAUMA ADMISSION SINCE 883 00:33:00,240 --> 00:33:02,880 THE LAST TIME YOU RECRUITED, 884 00:33:02,880 --> 00:33:04,600 THAT WOULD SAVE TIME SO YOU CAN 885 00:33:04,600 --> 00:33:06,600 MOVE TO RECRUITMENT AND 886 00:33:06,600 --> 00:33:07,640 INTERVENTION. 887 00:33:07,640 --> 00:33:10,400 TURNED OUT, WE DIDN'T PILOT THAT 888 00:33:10,400 --> 00:33:12,280 SUFFICIENTLY AND WE DIDN'T 889 00:33:12,280 --> 00:33:13,920 CAPTURE THE VARIABILITY ACROSS 890 00:33:13,920 --> 00:33:19,360 THE 25 SITES, MANY SITES THAT 891 00:33:19,360 --> 00:33:20,960 WERE UNARABLE TO AUTOMATE OR 892 00:33:20,960 --> 00:33:23,720 MANUALLY GO THROUGH IN A HYBRID 893 00:33:23,720 --> 00:33:25,520 FASHION TEN DOMAIN MAYBE 5 AND 894 00:33:25,520 --> 00:33:27,080 THAT ENDED UP SLOWING THINGS 895 00:33:27,080 --> 00:33:31,720 DOWN IN TERMS OF OUR ABILITY TO 896 00:33:31,720 --> 00:33:33,280 RECRUIT AND OVER TIME SAW SITES 897 00:33:33,280 --> 00:33:35,080 THAT HAD TO SPEND MORE TIME 898 00:33:35,080 --> 00:33:36,400 MANUALLY RATHER THAN 899 00:33:36,400 --> 00:33:38,360 ELECTRONICALLY DOING PRELIMINARY 900 00:33:38,360 --> 00:33:45,160 SCREEN. 901 00:33:45,160 --> 00:33:46,920 SO LEGS SONS LEARNED WE ALREADY 902 00:33:46,920 --> 00:33:48,320 HEARD, MAXIMIZING THE DIVERSITY 903 00:33:48,320 --> 00:33:49,640 OF SITE CHARACTERISTIC IN THE 904 00:33:49,640 --> 00:33:52,960 PLANNING AND ESPECIALLY THE 905 00:33:52,960 --> 00:33:55,680 PILOTING, AND THEN TRYING DATURE 906 00:33:55,680 --> 00:33:56,920 AS MUCH INFORMATION AS POSSIBLE 907 00:33:56,920 --> 00:33:58,200 ACROSS KEY DOMAINS WHICH ARE 908 00:33:58,200 --> 00:34:01,240 CHALLENGING TO IDENTIFY IN THAT 909 00:34:01,240 --> 00:34:01,640 START UP. 910 00:34:01,640 --> 00:34:03,800 THAT IS WHY WE ALSO THINK 911 00:34:03,800 --> 00:34:05,680 FURTHER EVALUATION MAYBE TOO 912 00:34:05,680 --> 00:34:07,160 STRONG A WORD BECAUSE YOU DON'T 913 00:34:07,160 --> 00:34:09,120 WANT TO COLLECT REAMS OF 914 00:34:09,120 --> 00:34:11,520 QUALITATIVE DATA YOU NEED NIMBLE 915 00:34:11,520 --> 00:34:16,040 DATA COLLECTION THAT ALLOWS THE 916 00:34:16,040 --> 00:34:17,400 STUDY LEADERSHIP TEAM TO KNOW 917 00:34:17,400 --> 00:34:19,080 WHAT IS HAPPENING ON THE GROUND. 918 00:34:19,080 --> 00:34:22,240 WITHOUT EXTENSIVE ANALYSIS YOU 919 00:34:22,240 --> 00:34:23,280 WANT TO KNOW WHAT IS HAPPENING 920 00:34:23,280 --> 00:34:27,520 IN THE ROLL OUT YEAR AND WE IN 921 00:34:27,520 --> 00:34:31,360 TSOS A LOT KEPT HAPPENING 922 00:34:31,360 --> 00:34:32,600 INTERCURRENT EVENTS PATRICK 923 00:34:32,600 --> 00:34:34,720 HAGGERTY CALLED YESTERDAY, JUST 924 00:34:34,720 --> 00:34:36,400 THINGS HAPPEN IN PRAGMATIC 925 00:34:36,400 --> 00:34:38,240 TRIALS SO YOU WANT THAT CAPACITY 926 00:34:38,240 --> 00:34:42,880 IN PLANNING PHASE FORM 927 00:34:42,880 --> 00:34:44,440 EVALUATION CAPACITY AND ONGOING 928 00:34:44,440 --> 00:34:47,280 AND I WILL LEAVE IT AT THAT. 929 00:34:47,280 --> 00:34:47,960 >> GREAT. 930 00:34:47,960 --> 00:34:48,760 THANKS SO MUCH, DOUG. 931 00:34:48,760 --> 00:34:52,880 I THINK WE ARE GOING TO GO MARY 932 00:34:52,880 --> 00:34:54,840 JOE, IF YOU CAN GO BACK WE WILL 933 00:34:54,840 --> 00:34:56,600 GO TO DR. MICHAEL HO WHO WILL 934 00:34:56,600 --> 00:34:59,360 TALK TO US ABOUT THE NUDGE 935 00:34:59,360 --> 00:34:59,800 STUDY. 936 00:34:59,800 --> 00:35:01,400 I WILL TURN OVER TO YOU IF YOU 937 00:35:01,400 --> 00:35:03,120 WANT BRING YOUR CAMERA UP AND 938 00:35:03,120 --> 00:35:06,640 TURN YOUR AUDIO ON. 939 00:35:06,640 --> 00:35:07,960 >> THANK YOU. 940 00:35:07,960 --> 00:35:10,120 SO MY NAME IS MICHAEL HO, I'M 941 00:35:10,120 --> 00:35:12,360 GOING TO TALK ABOUT THE 942 00:35:12,360 --> 00:35:14,920 PERSONALIZED PATIENT DATA AND 943 00:35:14,920 --> 00:35:16,000 BEHAVIORAL NUDGES TO IMPROVE 944 00:35:16,000 --> 00:35:19,080 ADHERENCE TO CHRONIC 945 00:35:19,080 --> 00:35:20,000 CARDIOVASCULAR MEDS. 946 00:35:20,000 --> 00:35:22,080 WE HAVE BEEN CALLING IT THE 947 00:35:22,080 --> 00:35:24,440 NUDGE STUDY FOR SHORT. 948 00:35:24,440 --> 00:35:26,520 I WILL PROVIDE A QUICK OVERVIEW 949 00:35:26,520 --> 00:35:31,760 AND HIGHLIGHT KEY CHALLENGES OR 950 00:35:31,760 --> 00:35:35,720 LESSONS LEARNED THAT FIRST YEAR. 951 00:35:35,720 --> 00:35:38,000 THIS WAS A PATIENT LEVEL 952 00:35:38,000 --> 00:35:41,800 RANDOMIZED STUDY ACROSS THE 953 00:35:41,800 --> 00:35:43,320 HEALTH SYSTEMS WITH PRIMARY GOAL 954 00:35:43,320 --> 00:35:45,440 OF IMPROVING ADHERENCE TO 955 00:35:45,440 --> 00:35:47,400 CHRONIC CARDIOVASCULAR 956 00:35:47,400 --> 00:35:47,960 MEDICATIONS. 957 00:35:47,960 --> 00:35:51,880 AND THE PRIMARY OUTCOMES PRIMARY 958 00:35:51,880 --> 00:35:53,280 OUTCOME WILL BE MEDICATION 959 00:35:53,280 --> 00:35:56,520 ADHERENCE AS DEFINED BY PHARMACY 960 00:35:56,520 --> 00:35:57,320 REFILL DATA. 961 00:35:57,320 --> 00:35:59,880 AND THEN THE SECONDARY OUTCOMES 962 00:35:59,880 --> 00:36:02,960 ARE SOME CLINICAL MEASURES, 963 00:36:02,960 --> 00:36:05,720 CLINICAL EVENTS AND HEALTHCARE 964 00:36:05,720 --> 00:36:06,360 UTILIZATION. 965 00:36:06,360 --> 00:36:10,600 WE ARE CONDUCTING THIS TRIAL AT 966 00:36:10,600 --> 00:36:13,160 THREE HEALTH SYSTEMS IN COLORADO 967 00:36:13,160 --> 00:36:16,360 THE FIRST ONE IS FDA, SECOND IS 968 00:36:16,360 --> 00:36:19,520 DENVER HEALTH WHICH IS THE 969 00:36:19,520 --> 00:36:22,160 SAFETY NET HOSPITAL, HOSPITAL 970 00:36:22,160 --> 00:36:25,280 SYSTEM FOR DENVER COUNTY, THE 971 00:36:25,280 --> 00:36:28,120 THIRD IS UNIVERSITY OF COLORADO 972 00:36:28,120 --> 00:36:33,000 HEALTH WHICH HAS 11 HOSPITALS 973 00:36:33,000 --> 00:36:36,160 THROUGHOUT COLORADO. 974 00:36:36,160 --> 00:36:38,760 SO IN TERMS OF PATIENTS INCLUDED 975 00:36:38,760 --> 00:36:42,000 WE INCLUDE PATIENTS WHO ARE 976 00:36:42,000 --> 00:36:44,440 DIAGNOSED WITH ONE OR MORE OF 977 00:36:44,440 --> 00:36:45,680 THE CARDIOVASCULAR CONDITIONS 978 00:36:45,680 --> 00:36:48,800 THAT ARE LISTED IN THE TABLE AS 979 00:36:48,800 --> 00:36:50,320 WELL AS BEING PRESCRIBED AT 980 00:36:50,320 --> 00:36:53,040 LEAST ONE MEDICATION CLASS OF 981 00:36:53,040 --> 00:36:53,440 INTEREST. 982 00:36:53,440 --> 00:36:56,880 THEY HAVE TO HAVE HYPERTENSION, 983 00:36:56,880 --> 00:36:58,280 HYPERLIPIDEMIA DIABETES CORONARY 984 00:36:58,280 --> 00:37:01,480 ARTERY DISEASE OR ATRIAL 985 00:37:01,480 --> 00:37:02,280 FIBRILLATION AND HAVE TO BE ON 986 00:37:02,280 --> 00:37:05,040 MEDICATION TO TREAT THAT 987 00:37:05,040 --> 00:37:07,120 MEDICATION. 988 00:37:07,120 --> 00:37:07,760 NEXT SLIDE. 989 00:37:07,760 --> 00:37:11,760 FOR OUR STUDY WE USED A KNOCKED 990 00:37:11,760 --> 00:37:14,480 OUT DESIGN AND REALLY THE 991 00:37:14,480 --> 00:37:16,040 PROCESS WAS THAT WE IDENTIFY 992 00:37:16,040 --> 00:37:19,760 PATIENTS USING THE EHR EACH OF 993 00:37:19,760 --> 00:37:22,320 THE HEALTH SYSTEMS, BASED ON 994 00:37:22,320 --> 00:37:25,320 DIAGNOSIS, PRESCRIBED 995 00:37:25,320 --> 00:37:28,480 MEDICATION, ONCE THEY WERE 996 00:37:28,480 --> 00:37:30,480 IDENTIFIED AS HAVING THESE 997 00:37:30,480 --> 00:37:32,720 CONDITIONS AND BEING PRESCRIBED 998 00:37:32,720 --> 00:37:35,600 MEDICATIONS, WE SENT THEM A 999 00:37:35,600 --> 00:37:39,480 LETTER ABOUT THE STUDY AS WELL 1000 00:37:39,480 --> 00:37:43,160 AS AN OPT OUT LETTER THAT THEY 1001 00:37:43,160 --> 00:37:45,760 COULD MAIL BACK TO US IF THEY 1002 00:37:45,760 --> 00:37:47,360 WANTED TO OPT OUT OF THE STUDY. 1003 00:37:47,360 --> 00:37:50,200 FOR THOSE PATIENTS WHO DIDN'T 1004 00:37:50,200 --> 00:37:52,640 SEND US THE OPT OUT LETTER BACK 1005 00:37:52,640 --> 00:37:55,640 WE MONITOR THEM OVER TIME TO SEE 1006 00:37:55,640 --> 00:37:57,280 IF THEY WOULD HAVE A GAP IN 1007 00:37:57,280 --> 00:38:00,680 THEIR MEDICATION REFILLS IN 1008 00:38:00,680 --> 00:38:03,680 TERMS OF WE LOOK AND ANTICIPATED 1009 00:38:03,680 --> 00:38:05,480 REFILL DATE AND IF THEY DIDN'T 1010 00:38:05,480 --> 00:38:16,040 FILL AFTER SEVEN DAYS THEY WERE 1011 00:38:16,320 --> 00:38:16,960 ELIGIBLE. 1012 00:38:16,960 --> 00:38:18,880 THESE ARE FOUR ARMS OF THE 1013 00:38:18,880 --> 00:38:20,960 STUDY, PATIENTS ARE RANDOMIZED 1014 00:38:20,960 --> 00:38:23,760 TO USUAL CARE GENERIC TEXT 1015 00:38:23,760 --> 00:38:26,960 MESSAGES OPTIMIZE TEXT MESSAGES 1016 00:38:26,960 --> 00:38:30,440 MESSAGES THAT HAD THESE 1017 00:38:30,440 --> 00:38:31,880 BEHAVIORAL NUDGES, AND THEN 1018 00:38:31,880 --> 00:38:34,320 FOURTH ARM WHERE THEY CAN BE 1019 00:38:34,320 --> 00:38:36,280 RANDOMIZED TO BEHAVIORAL NUDGES 1020 00:38:36,280 --> 00:38:39,640 AS WELL AS AI CHAT BOT THE CHAT 1021 00:38:39,640 --> 00:38:42,840 BOT WHICH TRY TO ENGAGE THE 1022 00:38:42,840 --> 00:38:46,120 PATIENTS IN TERMS OF TRYING TO 1023 00:38:46,120 --> 00:38:48,040 IDENTIFY WHY THEY WERE DELAYING 1024 00:38:48,040 --> 00:38:52,880 REFILLING THEIR MEDICATIONS AND 1025 00:38:52,880 --> 00:38:57,400 PROVIDE POTENTIAL SOLUTIONS. 1026 00:38:57,400 --> 00:38:58,880 TO HELP THEM WITH REFILLING 1027 00:38:58,880 --> 00:39:04,040 MEDICATIONS. 1028 00:39:04,040 --> 00:39:08,520 THESE WERE OUR YEAR ONE 1029 00:39:08,520 --> 00:39:10,840 MILESTONES, WE BROKE OUR 1030 00:39:10,840 --> 00:39:13,880 MILESTONES FOR THAT YEAR INTO 1031 00:39:13,880 --> 00:39:15,360 DIFFERENT CORES. 1032 00:39:15,360 --> 00:39:17,760 BASICALLY WHAT WE DID WAS WE DID 1033 00:39:17,760 --> 00:39:24,760 A PILOT STUDY OF THE LARGER 1034 00:39:24,760 --> 00:39:28,360 TRIAL WHERE WE EHR PATIENT 1035 00:39:28,360 --> 00:39:30,560 IDENTIFICATION PROCESS WE SENT 1036 00:39:30,560 --> 00:39:35,600 THE OPT OUT LETTERS AND 1037 00:39:35,600 --> 00:39:37,960 RANDOMIZE PATIENTS TO EACH OF 1038 00:39:37,960 --> 00:39:41,400 THE INTERVENTION ARMS AND 1039 00:39:41,400 --> 00:39:43,280 PILOTED TEXT MESSAGING 1040 00:39:43,280 --> 00:39:44,160 INTERVENTION TERMS OF SENDING 1041 00:39:44,160 --> 00:39:48,080 OUT THE TEXT MESSAGES SEEING IF 1042 00:39:48,080 --> 00:39:52,800 PATIENTS WE RESPOND TO THOSE 1043 00:39:52,800 --> 00:39:54,800 MESSAGES ASSESS WHETHER WE COULD 1044 00:39:54,800 --> 00:39:56,760 COLLECT OUTCOMES WHICH WERE 1045 00:39:56,760 --> 00:39:59,520 MEDICATION REFILL DATA AT EACH 1046 00:39:59,520 --> 00:40:02,720 OF THE HEALTH SYSTEMS OF THE 1047 00:40:02,720 --> 00:40:09,200 STUDY SO THAT CONSISTED OF 1048 00:40:09,200 --> 00:40:13,640 MILESTONES FOR THAT YEAR 1. 1049 00:40:13,640 --> 00:40:16,080 IN TERMS OF LESSONS LEARNED FROM 1050 00:40:16,080 --> 00:40:17,720 THAT INITIAL YEAR IS THAT THE 1051 00:40:17,720 --> 00:40:20,400 TIME FRAME IS PRETTY SHORT. 1052 00:40:20,400 --> 00:40:22,320 WHILE IT IS STATED THAT YOU HAVE 1053 00:40:22,320 --> 00:40:24,520 12 MONTHS TO DO THE PILOT, YOU 1054 00:40:24,520 --> 00:40:26,600 REALLY ONLY HAVE ABOUT TEN 1055 00:40:26,600 --> 00:40:29,960 MONTHS IN TERMS OF FINISHING THE 1056 00:40:29,960 --> 00:40:32,560 PILOT AND WRITING THE RESULTS OF 1057 00:40:32,560 --> 00:40:39,400 THE PILOT UP IN PREPARATION WITH 1058 00:40:39,400 --> 00:40:41,760 THE UH 3 PHASE OF THE STUDY. 1059 00:40:41,760 --> 00:40:44,640 A LOT OF OUR ADMINISTRATIVE 1060 00:40:44,640 --> 00:40:47,280 BARRIERS WERE RELATED TO 1061 00:40:47,280 --> 00:40:49,400 CONTRACTING AS PART OF OUR 1062 00:40:49,400 --> 00:40:52,840 INTERVENTION WE NEEDED PHARMACY 1063 00:40:52,840 --> 00:40:53,280 DATA. 1064 00:40:53,280 --> 00:40:55,960 AND AT TWO OF OUR HEALTH SYSTEMS 1065 00:40:55,960 --> 00:40:58,920 WE HAD TO WORK THROUGH GETTING 1066 00:40:58,920 --> 00:41:02,400 SURE SCRIPS PHARMACY DATA AND A 1067 00:41:02,400 --> 00:41:04,520 MORE FREQUENT -- MORE FREQUENT 1068 00:41:04,520 --> 00:41:05,960 INTERVAL THAN WHAT THE HEALTH 1069 00:41:05,960 --> 00:41:07,680 SYSTEM WAS GETTING AT THAT TIME. 1070 00:41:07,680 --> 00:41:11,360 SO THAT TOOK A LOT OF WORK IN 1071 00:41:11,360 --> 00:41:13,560 TERMS OF WORKING WITH HEALTH 1072 00:41:13,560 --> 00:41:16,840 SYSTEM WHO THEN HAD TO WORK WITH 1073 00:41:16,840 --> 00:41:22,960 SURE SCRIPS IN ORDER TO PLAN FOR 1074 00:41:22,960 --> 00:41:25,120 GETTING THAT PHARMACY DATA. 1075 00:41:25,120 --> 00:41:27,880 I THINK IN TERMS OF WHAT WE 1076 00:41:27,880 --> 00:41:31,520 LEARNED AND WHAT WAS HELPFUL FOR 1077 00:41:31,520 --> 00:41:32,840 US THROUGHOUT THE STUDY AND 1078 00:41:32,840 --> 00:41:34,120 RIGHT NOW WE ARE IN THE 1079 00:41:34,120 --> 00:41:36,560 FOLLOW-UP PHASE OF THE STUDY IS 1080 00:41:36,560 --> 00:41:37,840 FORMING COLLABORATIVE 1081 00:41:37,840 --> 00:41:39,960 PARTNERSHIPS AT EACH O OUR 1082 00:41:39,960 --> 00:41:40,800 SITES. 1083 00:41:40,800 --> 00:41:44,520 AND OUR HEALTH SYSTEMS AND IT 1084 00:41:44,520 --> 00:41:47,400 HAS PREVIOUSLY ALLUDED TO COVID 1085 00:41:47,400 --> 00:41:48,920 HIT IN THE MIDST OF OUR 1086 00:41:48,920 --> 00:41:51,120 INTERVENTION SO WE HAD TO REALLY 1087 00:41:51,120 --> 00:41:54,000 WORK WITH OUR PARTNERS TO COME 1088 00:41:54,000 --> 00:41:59,080 UP WITH INTERIM SOLUTIONS AS THE 1089 00:41:59,080 --> 00:42:00,600 PANDEMIC HIT AND THEN FOR US AS 1090 00:42:00,600 --> 00:42:03,120 A TEAM IT WAS HELPFUL TO HAVE A 1091 00:42:03,120 --> 00:42:05,240 PROJECT MANAGER THAT HAD DONE 1092 00:42:05,240 --> 00:42:07,680 THIS BEFORE IN TERMS OF 1093 00:42:07,680 --> 00:42:11,200 ORCHESTRATING OR MANAGING A 1094 00:42:11,200 --> 00:42:17,120 MULTI-SITE STUDY WHERE THERE WAS 1095 00:42:17,120 --> 00:42:19,800 MULTIPLE DIFFERENT CORES WORKING 1096 00:42:19,800 --> 00:42:23,720 DURING THAT PILOT YEAR TO GET 1097 00:42:23,720 --> 00:42:29,200 ALL MILESTONES COMPLETED. 1098 00:42:29,200 --> 00:42:31,080 WITH ANY GRANT WE DID PRE-WORK 1099 00:42:31,080 --> 00:42:33,680 IN TERMS OF GETTING IRB ON 1100 00:42:33,680 --> 00:42:35,400 BOARD, MAKING SURE THAT THEY 1101 00:42:35,400 --> 00:42:38,680 WOULD BE OKAY WITH THE OPT OUT 1102 00:42:38,680 --> 00:42:41,760 STRATEGY THAT WE THOUGHT WAS 1103 00:42:41,760 --> 00:42:45,200 CRITICAL FOR ENTERVENGES. 1104 00:42:45,200 --> 00:42:46,920 SO THEY WERE ON BOARD BY THE 1105 00:42:46,920 --> 00:42:51,200 TIME THAT THE GRANT WAS APPROVE 1106 00:42:51,200 --> 00:42:52,760 AND FUND AND WE SUBMITTED OUR 1107 00:42:52,760 --> 00:42:53,440 IRB APPLICATION. 1108 00:42:53,440 --> 00:42:56,480 SO GETTING SOME OF THAT PRE-WORK 1109 00:42:56,480 --> 00:42:59,440 DONE I THINK IS CRITICAL TO HIT 1110 00:42:59,440 --> 00:43:05,680 THE GROUND RUNNING. 1111 00:43:05,680 --> 00:43:07,240 THAT IS ALL I HAD, LOOKING 1112 00:43:07,240 --> 00:43:09,080 FORWARD TO THE DISCUSSION. 1113 00:43:09,080 --> 00:43:10,880 >> THANK YOU SO MUCH, MICHAEL. 1114 00:43:10,880 --> 00:43:14,080 SO WE CAN GO TO THE FIRST 1115 00:43:14,080 --> 00:43:17,480 QUESTION AND THEN INVITE THE 1116 00:43:17,480 --> 00:43:18,920 PANELISTS TO TURN ON YOUR VIDEO, 1117 00:43:18,920 --> 00:43:20,600 ON VIDEOCAST THEY WILL SEE THE 1118 00:43:20,600 --> 00:43:21,840 SLIDE WITH QUESTION AND ALL FOUR 1119 00:43:21,840 --> 00:43:24,760 OR FIVE OUR OUR FACES SO THEY 1120 00:43:24,760 --> 00:43:26,640 WILL BE ABLE TO SEE US ON VIDEO. 1121 00:43:26,640 --> 00:43:29,720 SO TO START OFF A DISCUSSION I 1122 00:43:29,720 --> 00:43:32,280 WANTED TO ASK THE GROUP, THINK 1123 00:43:32,280 --> 00:43:35,360 WE WILL START OFF WITH THIS 1124 00:43:35,360 --> 00:43:36,480 QUESTION TO YOU JAMES AND THEN 1125 00:43:36,480 --> 00:43:38,600 OPEN UP TO EVERYBODY ELSE TO ADD 1126 00:43:38,600 --> 00:43:38,920 COMMENTS. 1127 00:43:38,920 --> 00:43:40,680 WHAT IS THE ONE THING YOU DID 1128 00:43:40,680 --> 00:43:41,720 YOU THINK DURING THE PLANNING 1129 00:43:41,720 --> 00:43:43,280 PHASE THAT REALLY SET YOUR TRIAL 1130 00:43:43,280 --> 00:43:47,120 UP FOR SUCCESS? 1131 00:43:47,120 --> 00:43:48,720 >> FIRST I SHOULD SAY I 1132 00:43:48,720 --> 00:43:49,920 APPRECIATE THAT QUESTION AND I 1133 00:43:49,920 --> 00:43:51,680 WILL ANSWER IT BUT THERE'S SO 1134 00:43:51,680 --> 00:43:55,480 MANY THINGS WE DIDN'T DO. 1135 00:43:55,480 --> 00:43:58,240 DIDN'T SET UP FOR SUCCESS. 1136 00:43:58,240 --> 00:44:00,560 THAT WE LEARNED OVER TIME. 1137 00:44:00,560 --> 00:44:02,800 I THINK THAT WHAT I WOULD POINT 1138 00:44:02,800 --> 00:44:08,200 TO IS WHAT I MENTIONED ABOUT THE 1139 00:44:08,200 --> 00:44:08,960 DATA. 1140 00:44:08,960 --> 00:44:09,720 MY SHORT RECITATION ABOUT THE 1141 00:44:09,720 --> 00:44:11,440 DATA. 1142 00:44:11,440 --> 00:44:12,880 WE KNEW WE WERE GOING TO BE 1143 00:44:12,880 --> 00:44:14,520 USING ELECTRONIC HEALTH RECORD 1144 00:44:14,520 --> 00:44:18,080 WE WERE GOING TO EXTRACT DATA 1145 00:44:18,080 --> 00:44:18,560 ELEMENTS. 1146 00:44:18,560 --> 00:44:20,720 IF YOU THINK LET'S SAY WE WERE 1147 00:44:20,720 --> 00:44:22,680 STUDYING DIABETES AND GOING TO 1148 00:44:22,680 --> 00:44:26,640 BE PULLING HEMOGLOBIN A 1C, MOST 1149 00:44:26,640 --> 00:44:27,720 WOULDN'T HAVE THOUGHT, WE WOULD 1150 00:44:27,720 --> 00:44:29,800 HAVE THOUGHT THE DATA THAT COMES 1151 00:44:29,800 --> 00:44:31,200 OUT ABOUT HEMOGLOBIN A 1C FROM 1152 00:44:31,200 --> 00:44:32,920 PATIENTS WAS ACCURATE. 1153 00:44:32,920 --> 00:44:36,160 AND IF YOU HAVE THE DATA FOR 1154 00:44:36,160 --> 00:44:37,520 THOSE PATIENTS MAYBE SOME PEOPLE 1155 00:44:37,520 --> 00:44:42,400 WILL BE OBSESSIVE TO ACTUALLY 1156 00:44:42,400 --> 00:44:43,520 VALIDATE THAT BUT MANY WOULDN'T 1157 00:44:43,520 --> 00:44:46,080 BE. 1158 00:44:46,080 --> 00:44:48,720 ONLY BECAUSE WE GOT SOME HINTS 1159 00:44:48,720 --> 00:44:49,560 AND HAD CONCERNS RAISE SOD WE 1160 00:44:49,560 --> 00:44:51,120 DECIDED TO GO AHEAD AND DO A 1161 00:44:51,120 --> 00:44:55,040 CHART REVIEW. 1162 00:44:55,040 --> 00:44:56,880 OF DATA ELEMENTS FOR ADVANCE 1163 00:44:56,880 --> 00:45:00,440 CARE PLANNING PIECES. 1164 00:45:00,440 --> 00:45:02,360 FOUND OUT AS I SHOWED YOU IT WAS 1165 00:45:02,360 --> 00:45:07,200 WILDLY INACCURATE. 1166 00:45:07,200 --> 00:45:09,080 THAT COULD HAVE BEEN A KILLER 1167 00:45:09,080 --> 00:45:10,440 FOR US. 1168 00:45:10,440 --> 00:45:11,880 LUCKILY WE WERE ABLE TO HAVE -- 1169 00:45:11,880 --> 00:45:13,680 WE HAD ANOTHER ALTERNATIVE 1170 00:45:13,680 --> 00:45:17,800 METHOD TO GO. 1171 00:45:17,800 --> 00:45:20,880 AND USE BUT IN RETROSPECT WE 1172 00:45:20,880 --> 00:45:22,760 WOULD HAVE COLLECTED ALL THOSE 1173 00:45:22,760 --> 00:45:24,520 DATA SOMEWHERE ALONG THE WAY 1174 00:45:24,520 --> 00:45:25,960 ALERTED TO THE FACT THIS DATA 1175 00:45:25,960 --> 00:45:28,720 WERE NOT SO ACCURATE AND HAVE I 1176 00:45:28,720 --> 00:45:30,720 DON'T KNOW RESEARCH ASSISTANCE 1177 00:45:30,720 --> 00:45:31,760 MEDICAL STUDENTS POURING THROUGH 1178 00:45:31,760 --> 00:45:35,600 CHART REVIEWS TRYING TO CLEAN 1179 00:45:35,600 --> 00:45:39,920 THE DATA THAT WAS REALLY MESSY. 1180 00:45:39,920 --> 00:45:46,080 SO I GUESS THE POINT OF LEARNING 1181 00:45:46,080 --> 00:45:48,640 AND MADE THIS WORK WOULD BE TO 1182 00:45:48,640 --> 00:45:50,960 MAKE SURE VERY EARLY ON THE DATA 1183 00:45:50,960 --> 00:45:52,080 WE ARE COLLECTING THE IS DATA 1184 00:45:52,080 --> 00:45:53,080 YOU THINK YOU ARE COLLECTING. 1185 00:45:53,080 --> 00:45:56,720 AND IF THERE IS ANY REASON 1186 00:45:56,720 --> 00:45:58,480 WHATSOEVER TO THINK OTHERWISE, 1187 00:45:58,480 --> 00:46:02,360 WE ALL KNOW MANY OF US ARE 1188 00:46:02,360 --> 00:46:03,520 PULLING ADMINISTRATIVE DATA FROM 1189 00:46:03,520 --> 00:46:04,080 CHARTS. 1190 00:46:04,080 --> 00:46:05,560 IF YOU WORRY ABOUT BEING 1191 00:46:05,560 --> 00:46:08,440 OTHERWISE THE VALIDATE IN SOME 1192 00:46:08,440 --> 00:46:09,000 WAY. 1193 00:46:09,000 --> 00:46:10,960 HONESTLY IDEALLY WE HAVE BEEN 1194 00:46:10,960 --> 00:46:12,800 DOING WHEN YOU WRITE A GRANT OR 1195 00:46:12,800 --> 00:46:14,520 PRE-PILOT PHASE BUT A LOT OF US 1196 00:46:14,520 --> 00:46:17,440 DON'T (INAUDIBLE). 1197 00:46:17,440 --> 00:46:18,640 >> THANK YOU FOR SHARING THAT. 1198 00:46:18,640 --> 00:46:21,120 SO I WILL OPEN UP TO THE REST OF 1199 00:46:21,120 --> 00:46:21,680 THE PANEL. 1200 00:46:21,680 --> 00:46:22,920 ARE THERE -- IS THERE A 1201 00:46:22,920 --> 00:46:24,160 PARTICULAR THING YOU THINK THAT 1202 00:46:24,160 --> 00:46:28,440 MADE YOUR TRIAL SUCCESSFUL BY 1203 00:46:28,440 --> 00:46:29,360 DOING IT PLANNING PHASE? 1204 00:46:29,360 --> 00:46:30,080 GAIL. 1205 00:46:30,080 --> 00:46:32,440 >> I THINK THERE MANY THINGS, 1206 00:46:32,440 --> 00:46:35,960 JUST LIKE PREVIOUS PERSON SAID 1207 00:46:35,960 --> 00:46:36,360 THAT WERE IMPORTANT. 1208 00:46:36,360 --> 00:46:38,800 I THINK THE MOST IMPORTANT WERE 1209 00:46:38,800 --> 00:46:40,480 TO THINK ABOUT ALL THE ISSUES 1210 00:46:40,480 --> 00:46:45,080 THAT CAN HAPPEN WITH EHR FOLDS 1211 00:46:45,080 --> 00:46:46,840 WHETHER FROM DIFFERENT VENDORS, 1212 00:46:46,840 --> 00:46:49,600 WE HAD (INAUDIBLE) EPIC AND 1213 00:46:49,600 --> 00:46:51,360 REALLY MAKE SURE THAT DATA 1214 00:46:51,360 --> 00:46:52,480 DICTIONARIES ARE PERFECT, PEOPLE 1215 00:46:52,480 --> 00:46:53,520 ARE SENDING YOU THE DATA THAT 1216 00:46:53,520 --> 00:46:57,360 YOU CAN LOOK AT IT WE WERE 1217 00:46:57,360 --> 00:46:58,480 CONSTANTLY DOING THAT EVERY 1218 00:46:58,480 --> 00:47:00,200 MONTH. 1219 00:47:00,200 --> 00:47:02,200 DON'T WAIT TO THE END TO SEE 1220 00:47:02,200 --> 00:47:02,920 WHAT HAPPENS. 1221 00:47:02,920 --> 00:47:05,440 AND THEN SAY WE WILL PULL IT 1222 00:47:05,440 --> 00:47:06,320 BECAUSE THERE ARE MILLION 1223 00:47:06,320 --> 00:47:08,400 DIFFERENT REITERATIONS AND 1224 00:47:08,400 --> 00:47:10,560 SAMPLE VALIDATIONS THAT NEED TO 1225 00:47:10,560 --> 00:47:13,800 BE DONE AND HAVE SOME REALLY 1226 00:47:13,800 --> 00:47:18,640 GREAT IT PEOPLE WITH YOU HAVE 1227 00:47:18,640 --> 00:47:20,000 DONE OTHER STUDIES TO THAT 1228 00:47:20,000 --> 00:47:21,560 REQUIRE HR AT EACH STUDY, NEED 1229 00:47:21,560 --> 00:47:22,880 TO FUND PEOPLE WELL THAT ARE THE 1230 00:47:22,880 --> 00:47:28,880 IT PEOPLE, SO THEY WILL BE 1231 00:47:28,880 --> 00:47:30,800 ENGAGED IN YOUR STUDY AND THEY 1232 00:47:30,800 --> 00:47:32,120 WILL WANT TO MAKE SURE IT IS 1233 00:47:32,120 --> 00:47:33,280 CORRECT AND GET YOU INFORMATION 1234 00:47:33,280 --> 00:47:36,000 ON TIME. 1235 00:47:36,000 --> 00:47:36,480 >> GREAT. 1236 00:47:36,480 --> 00:47:37,520 THANK YOU. 1237 00:47:37,520 --> 00:47:40,320 DOUG, DID I SEE YOU? 1238 00:47:40,320 --> 00:47:42,480 THEN MICHAEL. 1239 00:47:42,480 --> 00:47:46,560 >> MICHAEL GO I A HEA GO AHEAD. 1240 00:47:46,560 --> 00:47:48,040 >> SO THANKS. 1241 00:47:48,040 --> 00:47:51,880 I DEFINITELY AGREE WITH GAIL'S 1242 00:47:51,880 --> 00:47:54,640 COMMENT ABOUT FUNDING, THE RIGHT 1243 00:47:54,640 --> 00:47:59,040 AMOUNT OF IT TIME AS FAR AS OUR 1244 00:47:59,040 --> 00:48:00,680 STUDY WE USE PHARMACY DATA TO 1245 00:48:00,680 --> 00:48:02,320 IDENTIFY PATIENTS AND TO SEND 1246 00:48:02,320 --> 00:48:04,920 OUT TEXT MESSAGES. 1247 00:48:04,920 --> 00:48:07,560 DURING THE COURSE OF THIS STUDY 1248 00:48:07,560 --> 00:48:08,920 THIS HAPPENED A COUPLE OF TIMES 1249 00:48:08,920 --> 00:48:11,960 WHERE THE HEALTH SYSTEM HAS 1250 00:48:11,960 --> 00:48:14,600 CHANGED THEIR CODES FROM 1251 00:48:14,600 --> 00:48:15,840 MEDICATIONS AND SO THAT RESULTED 1252 00:48:15,840 --> 00:48:17,920 IN PATIENTS NOT GETTING TEXT 1253 00:48:17,920 --> 00:48:20,920 MESSAGES OR GETTING TEXT 1254 00:48:20,920 --> 00:48:21,880 MESSAGES THAT THEY WEREN'T 1255 00:48:21,880 --> 00:48:23,560 SUPPOSED TO AND WE WOULDN'T HAVE 1256 00:48:23,560 --> 00:48:25,760 FOUND OUT IF OUR LOCAL IT STAFF 1257 00:48:25,760 --> 00:48:27,240 HADN'T ALERTED US TO THOSE 1258 00:48:27,240 --> 00:48:27,760 CHANGES. 1259 00:48:27,760 --> 00:48:29,720 SO I THINK IT IS CRITICAL TO 1260 00:48:29,720 --> 00:48:31,400 TEST THE PROCESS DURING THAT 1261 00:48:31,400 --> 00:48:36,080 YEAR ONE BUT ALSO TO FUND THEM 1262 00:48:36,080 --> 00:48:40,120 THROUGHOUT THE STUDY SO THAT YOU 1263 00:48:40,120 --> 00:48:42,080 CAN GET THAT SUPPORT WHEN THINGS 1264 00:48:42,080 --> 00:48:45,880 CHANGE AT THE HEALTH SYSTEM. 1265 00:48:45,880 --> 00:48:46,720 >> DOUG. 1266 00:48:46,720 --> 00:48:50,440 >> HAVING HEARD JAMES MICHAEL 1267 00:48:50,440 --> 00:48:53,840 AND GAIL, THE ONE THING TSOS DID 1268 00:48:53,840 --> 00:48:56,920 NOT WELL PLANNED BUT STUDY 1269 00:48:56,920 --> 00:48:59,000 FOLLOW-UP AND FINISH BEFORE 1270 00:48:59,000 --> 00:49:01,920 COVID HIT UNLIKE THE OTHER LEE 1271 00:49:01,920 --> 00:49:04,440 STUDIES, IT WAS A STEP WEDGE 1272 00:49:04,440 --> 00:49:09,480 DESIGN, ASIDE FROM THAT WE HAVE 1273 00:49:09,480 --> 00:49:14,280 A WE RECRUIT CHAMPIONS AT EACH 1274 00:49:14,280 --> 00:49:14,800 SITE. 1275 00:49:14,800 --> 00:49:17,680 WE HAD AD CHAMPION WHO 1276 00:49:17,680 --> 00:49:19,000 ESTABLISHED RELATIONSHIPS WITH 1277 00:49:19,000 --> 00:49:21,360 CHAMPIONS AT EACH OF SITES. 1278 00:49:21,360 --> 00:49:24,760 WHAT HAPPENED THROUGHOUT THE 1279 00:49:24,760 --> 00:49:27,320 TRIAL IF THINGS GOT TOUGH JERRY 1280 00:49:27,320 --> 00:49:28,760 WOULD STEP IN AND USE HIS 1281 00:49:28,760 --> 00:49:30,920 RELATIONSHIP WITH PEOPLE THE 1282 00:49:30,920 --> 00:49:32,640 SURGICAL CHAMPIONS TO TRY TO 1283 00:49:32,640 --> 00:49:33,840 RECTIFY WHATEVER WAS GOING ON AT 1284 00:49:33,840 --> 00:49:37,320 THE SITE WE NEEDED TO ADDRESS. 1285 00:49:37,320 --> 00:49:38,240 >> GREAT. 1286 00:49:38,240 --> 00:49:39,840 WHY NOT GO TO NEXT SLIDE. 1287 00:49:39,840 --> 00:49:43,040 I HAVE ANOTHER QUESTION, I WILL 1288 00:49:43,040 --> 00:49:44,240 START WITH YOU DOUG ON THIS ONE 1289 00:49:44,240 --> 00:49:47,280 AND THEN OPEN UP FOR EVERYBODY 1290 00:49:47,280 --> 00:49:47,840 ELSE. 1291 00:49:47,840 --> 00:49:49,360 IF YOU HAD IT TO DO OVER, ARE 1292 00:49:49,360 --> 00:49:51,000 ARE THERE ACTIVITIES YOU WOULD 1293 00:49:51,000 --> 00:49:52,480 HAVE ADDED TO YOUR PLANNING 1294 00:49:52,480 --> 00:49:54,480 PHASE, IF YOU PILOTED CERTAIN 1295 00:49:54,480 --> 00:49:56,480 PARTS WHEN YOU CHANGE WHAT YOUR 1296 00:49:56,480 --> 00:50:03,080 HIGHLIGHTED DURING THAT TIME. 1297 00:50:03,080 --> 00:50:06,560 >> THERE WAS INTENSIVE DATA 1298 00:50:06,560 --> 00:50:07,640 ACQUISITION AND PILOTING GOING 1299 00:50:07,640 --> 00:50:08,360 ON. 1300 00:50:08,360 --> 00:50:12,480 WE HAD A TRAUMA SYSTEM AND 1301 00:50:12,480 --> 00:50:15,560 TRAUMA SURGEON, WE HAD PTSD 1302 00:50:15,560 --> 00:50:17,320 INTERVENTION CHAMPION AND IT 1303 00:50:17,320 --> 00:50:19,080 CHAMPION BUT DIDN'T DIG DEEPER, 1304 00:50:19,080 --> 00:50:22,000 WE JUST REQUIRED CHECKLIST SITE 1305 00:50:22,000 --> 00:50:24,240 HAD AN IT CHAMPION AND WE DID 1306 00:50:24,240 --> 00:50:29,320 NOT ACTUALLY DIVE INTO THE WEEDS 1307 00:50:29,320 --> 00:50:30,360 ON WHETHER OR NOT OR NOT THE 1308 00:50:30,360 --> 00:50:33,760 SITES AUTOMATE THE PTSD SCREEN 1309 00:50:33,760 --> 00:50:37,200 OR OTHER IT FUNCTIONS IN EHR 1310 00:50:37,200 --> 00:50:39,720 CAPACITY DIDN'T DO DRILLING 1311 00:50:39,720 --> 00:50:42,080 ENOUGH DRILLING DOWN, TO SLOW 1312 00:50:42,080 --> 00:50:43,480 DOWN RECRUITMENT AND NUMBER OF 1313 00:50:43,480 --> 00:50:44,480 OTHER CHALLENGES THROUGHOUT THE 1314 00:50:44,480 --> 00:50:48,480 TRIAL. 1315 00:50:48,480 --> 00:50:50,280 >> OTHERS WANT TO CONTRIBUTE 1316 00:50:50,280 --> 00:50:52,080 WHAT YOU WISH YOU WOULD HAVE 1317 00:50:52,080 --> 00:50:53,360 DONE OR DONE DIFFERENTLY IF YOU 1318 00:50:53,360 --> 00:50:58,080 DO IT ALL OVER? 1319 00:50:58,080 --> 00:50:58,880 THIS IS GAIL. 1320 00:50:58,880 --> 00:51:03,120 I WOULD SAY THAT WE SHOULD HAVE 1321 00:51:03,120 --> 00:51:05,200 PROBABLY DONE MORE ROBUST 1322 00:51:05,200 --> 00:51:07,520 TRAINING ON THE IMPLEMENTATION 1323 00:51:07,520 --> 00:51:12,880 WITH THE IT INTERVENTION AND IT 1324 00:51:12,880 --> 00:51:15,760 WAS TOUGH TO DO THIS, AT PILOT 1325 00:51:15,760 --> 00:51:18,640 SITE BUT WE COULD HAVE ADDED 1326 00:51:18,640 --> 00:51:21,080 OTHER SITES AND LOOKED MORE 1327 00:51:21,080 --> 00:51:22,640 CAREFULLY. 1328 00:51:22,640 --> 00:51:28,800 >> I THINK THAT IS THE TWO 1329 00:51:28,800 --> 00:51:32,480 THINGS DIFFERENTLY, ONE IS TRY 1330 00:51:32,480 --> 00:51:34,400 TO HAVE GOTTEN BETTER BUY IN 1331 00:51:34,400 --> 00:51:36,360 FROM CLINICS AND DIFFERENT 1332 00:51:36,360 --> 00:51:38,560 CLINIC LEADERS, AND TURNED OUT 1333 00:51:38,560 --> 00:51:40,080 IN ONE SITE WE WERE ABLE THE GET 1334 00:51:40,080 --> 00:51:44,800 THE BUY IN AND ALMOST 1335 00:51:44,800 --> 00:51:46,320 INVENTORIALLY HAD CANCER CENTER 1336 00:51:46,320 --> 00:51:50,360 DIRECTOR WHO ATTENDED OUR PILOT 1337 00:51:50,360 --> 00:51:51,720 TRAINING, THAT MADE ALL THE 1338 00:51:51,720 --> 00:51:52,920 DIFFERENCE, WHEREAS ELSEWHERE WE 1339 00:51:52,920 --> 00:51:56,280 DIDN'T HAVE QUITE THAT LEVEL AND 1340 00:51:56,280 --> 00:51:56,960 WE PROBABLY SHOULD HAVE. 1341 00:51:56,960 --> 00:51:59,640 WORKED A LITTLE BIT HARDER TO DO 1342 00:51:59,640 --> 00:52:00,840 THAT. 1343 00:52:00,840 --> 00:52:02,880 ALSO THE VIDEO IMPLEMENTATION 1344 00:52:02,880 --> 00:52:07,400 WHAT WE CAME TO UNDERSTAND OVER 1345 00:52:07,400 --> 00:52:09,480 TIME WAS THAT EACH CLINIC WAS 1346 00:52:09,480 --> 00:52:11,560 GOING TO WANT TO DO THIS 1347 00:52:11,560 --> 00:52:13,480 DIFFERENTLY, NOT ONLY EACH SITE 1348 00:52:13,480 --> 00:52:15,880 WHICH IS WHAT WE MIGHT HAVE 1349 00:52:15,880 --> 00:52:17,880 EXPECTED, MAYOR NORTH WELL AND 1350 00:52:17,880 --> 00:52:20,520 DUKE, BUT WITHIN MAYO CLINIC 1351 00:52:20,520 --> 00:52:21,760 THORACIC ONCOLOGY GROUP WANTED 1352 00:52:21,760 --> 00:52:23,840 ONE WAY, THE BREAST ONCOLOGY 1353 00:52:23,840 --> 00:52:26,040 GROUP A DIFFERENT WAY. 1354 00:52:26,040 --> 00:52:28,440 WE ARE NOT REALLY NECESSARILY 1355 00:52:28,440 --> 00:52:30,600 PREPARED FOR DIFFERENT 1356 00:52:30,600 --> 00:52:31,800 PERMUTATION AND WHAT THAT MEANT, 1357 00:52:31,800 --> 00:52:34,320 SHOULD THE PATIENTS GET EMAIL OR 1358 00:52:34,320 --> 00:52:38,960 VIDEO -- CODES THAT WAY, 1359 00:52:38,960 --> 00:52:40,880 PHYSICIANS OR BY CARE 1360 00:52:40,880 --> 00:52:43,600 COORDINATORS OR WHOEVER. 1361 00:52:43,600 --> 00:52:46,920 SO I'M NOT SURE WE COULD HAVE 1362 00:52:46,920 --> 00:52:48,920 COME TO FACT ALL THE SITES HAD 1363 00:52:48,920 --> 00:52:50,240 DIFFERENT APPROACHES TO DOING 1364 00:52:50,240 --> 00:52:50,640 THIS. 1365 00:52:50,640 --> 00:52:53,840 I THINK WE COULD HAVE BEEN A 1366 00:52:53,840 --> 00:52:58,320 BETTER PREPARED FOR (INAUDIBLE) 1367 00:52:58,320 --> 00:52:58,720 EARLIER. 1368 00:52:58,720 --> 00:53:00,400 >> ABSOLUTELY. 1369 00:53:00,400 --> 00:53:03,280 AND ONE THING MAY COME UP IN THE 1370 00:53:03,280 --> 00:53:04,920 NEXT PANEL TOO IS SOMETIMES WITH 1371 00:53:04,920 --> 00:53:06,240 THOSE IMPLEMENTATION CHALLENGES 1372 00:53:06,240 --> 00:53:07,680 FIGURING WHAT IS CORE AND WHAT 1373 00:53:07,680 --> 00:53:09,200 YOU DON'T WANT THEM TO CHANGE 1374 00:53:09,200 --> 00:53:10,640 VERSUS WHAT IS VARIABLE AND WHAT 1375 00:53:10,640 --> 00:53:12,440 YOU WOULD ALLOW THEM TO CHANGE 1376 00:53:12,440 --> 00:53:15,760 CAN BE REALLY HELPFUL TOO IN 1377 00:53:15,760 --> 00:53:17,920 THOSE SORT OF PLANNING THIS OUT 1378 00:53:17,920 --> 00:53:19,800 HOW YOU DO IT ACROSS SITES. 1379 00:53:19,800 --> 00:53:20,920 MICHAEL, DO YOU WANT TO ADD 1380 00:53:20,920 --> 00:53:22,800 ANYTHING OR WANT ME TO GO THE 1381 00:53:22,800 --> 00:53:23,200 NEXT QUESTION? 1382 00:53:23,200 --> 00:53:27,000 >> I THINK I WOULD JUST AGREE 1383 00:53:27,000 --> 00:53:29,840 WITH JAMES IN TERMS OF BEING 1384 00:53:29,840 --> 00:53:33,600 ABLE TO ENGAGE THE SITES AND 1385 00:53:33,600 --> 00:53:38,760 FINDING A GOOD PARTNER THERE 1386 00:53:38,760 --> 00:53:40,920 ALTHOUGH WITH US I FOUND AT 1387 00:53:40,920 --> 00:53:43,520 LEAST FOR ONE OF OUR SITES, OUR 1388 00:53:43,520 --> 00:53:47,040 PARTNERS KEPT CHANGING SO IT WAS 1389 00:53:47,040 --> 00:53:48,560 REALLY HARD TO ESTABLISH A 1390 00:53:48,560 --> 00:53:49,360 COLLABORATIVE RELATIONSHIP IN 1391 00:53:49,360 --> 00:53:51,240 TERMS OF TRYING TO MOVE THE 1392 00:53:51,240 --> 00:53:52,600 STUDY FORWARD. 1393 00:53:52,600 --> 00:53:54,960 SO I THINK PROBABLY TRYING TO 1394 00:53:54,960 --> 00:53:58,480 FIND MORE THAN ONE PERSON AT 1395 00:53:58,480 --> 00:54:00,600 ASYME, SEEMS LIKE AT A LOT OF 1396 00:54:00,600 --> 00:54:04,760 HOSPITALS THE CLINICAL STAFF 1397 00:54:04,760 --> 00:54:05,280 CHANGE. 1398 00:54:05,280 --> 00:54:07,320 YOU DON'T WANT TO DEPEND ON ONE 1399 00:54:07,320 --> 00:54:09,200 PERSON AND WHEN THEY LEAVE HAVE 1400 00:54:09,200 --> 00:54:12,800 TO BE -- RESTART THESE 1401 00:54:12,800 --> 00:54:13,480 RELATIONSHIPS. 1402 00:54:13,480 --> 00:54:17,760 >> ABSOLUTELY. 1403 00:54:17,760 --> 00:54:19,960 MARY JOE IF WE CAN GO TO THE 1404 00:54:19,960 --> 00:54:20,360 NEXT SLIDE. 1405 00:54:20,360 --> 00:54:22,280 I THINK THIS ONE, I THINK SORT 1406 00:54:22,280 --> 00:54:24,360 OF FOLLOWS ON WHAT YOU WERE JUST 1407 00:54:24,360 --> 00:54:26,960 SAYING MICHAEL, GOING TO BRING 1408 00:54:26,960 --> 00:54:27,960 THIS QUESTION TO YOU. 1409 00:54:27,960 --> 00:54:29,640 SO WHAT OTHER ADVICE DO YOU HAVE 1410 00:54:29,640 --> 00:54:31,640 IN WORKING WITH THE HEALTHCARE 1411 00:54:31,640 --> 00:54:34,240 SYSTEM PARTNERS DURING THAT 1412 00:54:34,240 --> 00:54:35,080 PLANNING PHASE. 1413 00:54:35,080 --> 00:54:37,000 IN THINKING THROUGH THAT, AS WE 1414 00:54:37,000 --> 00:54:38,560 ARE THINKING MORE ABOUT 1415 00:54:38,560 --> 00:54:41,520 GENERALIZABILITY OF THE STUDIES, 1416 00:54:41,520 --> 00:54:43,520 MAKING SURE WE GET 1417 00:54:43,520 --> 00:54:44,720 REPRESENTATIVE PATIENT 1418 00:54:44,720 --> 00:54:45,840 POPULATIONS, ARE THE THINGS YOU 1419 00:54:45,840 --> 00:54:49,760 CAN DO DURING THAT TIME TO 1420 00:54:49,760 --> 00:54:51,200 ENHANCE DIVERSITY OF 1421 00:54:51,200 --> 00:54:52,960 PARTICIPANTS OR EVEN THINKING 1422 00:54:52,960 --> 00:54:54,520 ABOUT OTHER SITES AND WOULD IT 1423 00:54:54,520 --> 00:54:55,920 BE POSSIBLE TO BRING ON OTHER 1424 00:54:55,920 --> 00:55:01,960 SITES DURING THE PLANNING PHASE. 1425 00:55:01,960 --> 00:55:05,720 >> I THINK IN TERMS OF WORKING 1426 00:55:05,720 --> 00:55:08,920 WITH THE HEALTH SYSTEM PARTNERS, 1427 00:55:08,920 --> 00:55:12,760 I THINK PART OF IT IS REALLY 1428 00:55:12,760 --> 00:55:16,880 TRYING TO AS A RESEARCHER TRYING 1429 00:55:16,880 --> 00:55:18,000 TO REFRAME THE GOALS OF THE 1430 00:55:18,000 --> 00:55:21,600 STUDY SO THAT THEY SEE THAT THE 1431 00:55:21,600 --> 00:55:22,720 INTERVENTION COULD BE 1432 00:55:22,720 --> 00:55:25,920 POTENTIALLY BENEFICIAL TO THEM 1433 00:55:25,920 --> 00:55:28,120 AND THEIR WORK BECAUSE I THINK A 1434 00:55:28,120 --> 00:55:32,000 LOT OF TIMES IT FEELS LIKE AT 1435 00:55:32,000 --> 00:55:33,880 LEAST TO THEM WE ARE 1436 00:55:33,880 --> 00:55:35,240 RESEARCHERS, WE KNOW HOW TO DO 1437 00:55:35,240 --> 00:55:39,480 THIS STUDY, BUT THEIR -- ON THE 1438 00:55:39,480 --> 00:55:43,640 OTHER HAND THE HEALTH SYSTEM 1439 00:55:43,640 --> 00:55:44,640 PARTNERS ARE TASSENINGED WITH 1440 00:55:44,640 --> 00:55:46,040 TRYING TO IMPROVE -- FATSKED 1441 00:55:46,040 --> 00:55:47,840 WITH TRYING TO -- TASKED WITH 1442 00:55:47,840 --> 00:55:49,000 TRYING TO IMPROVE CLINICAL CARE 1443 00:55:49,000 --> 00:55:51,320 AND EFFICIENCY AND OFTENTIMES 1444 00:55:51,320 --> 00:55:52,400 RESEARCH IS SEEN AS SOMETHING 1445 00:55:52,400 --> 00:55:56,120 THAT IS GOING TO SLOW THE 1446 00:55:56,120 --> 00:55:57,080 PROCESS DOWN. 1447 00:55:57,080 --> 00:55:58,680 IF WE CAN FRAME OUR RESEARCH AS 1448 00:55:58,680 --> 00:56:03,560 A WIN WIN FOR OUR PARTNERS THAT 1449 00:56:03,560 --> 00:56:05,640 MIGHT GO A LONG WAYS IN TERMS OF 1450 00:56:05,640 --> 00:56:09,720 HELPING TO ENGAGE THEM WITH 1451 00:56:09,720 --> 00:56:13,360 STUDY AND HAVING THEM HELP 1452 00:56:13,360 --> 00:56:20,000 FACILITATE THE PROCESS. 1453 00:56:20,000 --> 00:56:21,320 IN TERMS OF TRYING TO ENHANCE 1454 00:56:21,320 --> 00:56:25,440 DIVERSITY N OUR STUDY WE USE EHR 1455 00:56:25,440 --> 00:56:27,400 TO IDENTIFY PATIENTS, SO 1456 00:56:27,400 --> 00:56:28,480 HOPEFULLY THERE IS LESS 1457 00:56:28,480 --> 00:56:32,040 SELECTION BIAS IN TERMS OF 1458 00:56:32,040 --> 00:56:33,920 PARTICIPANTS WHO ARE APPROACHED 1459 00:56:33,920 --> 00:56:35,320 FOR THE STUDY BECAUSE ALL 1460 00:56:35,320 --> 00:56:37,120 PATIENTS WHO ARE ELIGIBLE WOULD 1461 00:56:37,120 --> 00:56:40,200 BE APPROACHED. 1462 00:56:40,200 --> 00:56:41,560 I THINK IT WOULD BE HARD IN THAT 1463 00:56:41,560 --> 00:56:45,080 ONE YEAR PLANNING PHASE TO 1464 00:56:45,080 --> 00:56:48,600 ENGAGE NEW SITES AND I THINK 1465 00:56:48,600 --> 00:56:50,360 GOING IN IT WOULD BE NICE TO 1466 00:56:50,360 --> 00:56:51,560 HAVE THOSE SITES IDENTIFIED 1467 00:56:51,560 --> 00:56:53,320 BECAUSE SOME OF THESE 1468 00:56:53,320 --> 00:56:55,040 RELATIONSHIP BUILDING AND THEN 1469 00:56:55,040 --> 00:57:00,080 ALL THE TECHNICAL ISSUES MAY 1470 00:57:00,080 --> 00:57:03,400 TAKE MORE THAN THAT ONE YEAR TO 1471 00:57:03,400 --> 00:57:06,120 KIND OF DEVELOP RELATIONSHIPS 1472 00:57:06,120 --> 00:57:08,400 AND EXECUTE THAT PILOT WORK TO 1473 00:57:08,400 --> 00:57:14,360 MAKE SURE THAT THE DATA IS WHAT 1474 00:57:14,360 --> 00:57:15,280 YOU THINK IT IS. 1475 00:57:15,280 --> 00:57:16,000 >> GREAT. 1476 00:57:16,000 --> 00:57:17,720 GAIL. 1477 00:57:17,720 --> 00:57:21,040 >> I WAS GOING TO SAY THIS IS 1478 00:57:21,040 --> 00:57:25,800 WHY THIS IS SUCH A GRANT THAT IS 1479 00:57:25,800 --> 00:57:26,800 FRAUGHT WITH DIFFICULTIES AND 1480 00:57:26,800 --> 00:57:28,120 ONE HAS TO TRY TO ANTICIPATE 1481 00:57:28,120 --> 00:57:30,680 THEM. 1482 00:57:30,680 --> 00:57:32,240 SO WHEN YOU DESIGNING GRANT, 1483 00:57:32,240 --> 00:57:34,880 SUBMITTING A GRANT YOU WANT TO 1484 00:57:34,880 --> 00:57:36,520 ENGAGE DIFFERENT HEALTHCARE 1485 00:57:36,520 --> 00:57:39,520 SYSTEMS BUT YOU NEVER KNOW ABOUT 1486 00:57:39,520 --> 00:57:40,720 THEIR LEVEL OF INTEREST ALWAYS 1487 00:57:40,720 --> 00:57:42,640 FROM THE BEGINNING SO YOU HAVE 1488 00:57:42,640 --> 00:57:46,360 TO SPEND A LOT OF TIME ON 1489 00:57:46,360 --> 00:57:48,360 THINKING ABOUT THAT BEFORE YOU 1490 00:57:48,360 --> 00:57:49,400 GET THE GRANT. 1491 00:57:49,400 --> 00:57:51,920 SO LOT OF RELATIONSHIP BUILDING 1492 00:57:51,920 --> 00:57:53,440 BEFORE THAT TO MAKE SURE IT IS 1493 00:57:53,440 --> 00:57:55,000 GOING TO GO WELL BECAUSE MANY 1494 00:57:55,000 --> 00:57:56,240 THAT TEN MONTHS YOU DON'T HAVE A 1495 00:57:56,240 --> 00:57:57,640 LOT OF TIME. 1496 00:57:57,640 --> 00:58:00,960 WE WERE STRESSED BY THE FACT 1497 00:58:00,960 --> 00:58:03,160 THAT WE NEEDED TO MOVE SITES AND 1498 00:58:03,160 --> 00:58:05,280 WE NEED TO ADD SITES AND WE WERE 1499 00:58:05,280 --> 00:58:07,720 VERY LUCKY TO GET A SUPPLEMENT, 1500 00:58:07,720 --> 00:58:09,600 WE WOULD HAVE BEEN ABLE TO DO 1501 00:58:09,600 --> 00:58:11,560 THAT WITHOUT HEALING COMMUNITY 1502 00:58:11,560 --> 00:58:12,400 SUPPLEMENT, SO THAT WAS GREAT. 1503 00:58:12,400 --> 00:58:14,600 BUT IT REALLY STARTS PUTTING THE 1504 00:58:14,600 --> 00:58:16,520 -- THE APPLICATION IN, NOT AT 1505 00:58:16,520 --> 00:58:19,360 THE TIME YOU ARE AWARDED THE 1506 00:58:19,360 --> 00:58:22,920 APPLICATION, AND GETTING THOSE 1507 00:58:22,920 --> 00:58:25,360 PARTNERS AND IN PLACE AND AS 1508 00:58:25,360 --> 00:58:26,800 SOMEONE SAID MORE THAN ONE 1509 00:58:26,800 --> 00:58:29,640 PARTNER, BECAUSE THAT PERSON CAN 1510 00:58:29,640 --> 00:58:31,280 LEAD SO YOU WANT TO MAKE SURE 1511 00:58:31,280 --> 00:58:33,040 YOU HAVE MULTIPLE PARTNER THERE 1512 00:58:33,040 --> 00:58:36,200 AND IN THE PLANNING STAGE 1513 00:58:36,200 --> 00:58:37,560 LOOKING AT THE DIVERSITY OF 1514 00:58:37,560 --> 00:58:39,240 PARTICIPANTS WOULD BE RIGHT OFF 1515 00:58:39,240 --> 00:58:42,720 THE BAT, WHERE DEMOGRAPHICS ARE 1516 00:58:42,720 --> 00:58:43,720 IN THE PARTICULAR SITE THAT YOU 1517 00:58:43,720 --> 00:58:45,280 ARE GOING TO USE BECAUSE THERE 1518 00:58:45,280 --> 00:58:47,280 IS NOT MUCH YOU CAN DO ONCE YOU 1519 00:58:47,280 --> 00:58:53,440 PICK YOUR SITE. 1520 00:58:53,440 --> 00:58:58,520 >> YEAH, I ECHO WHAT MIKE AND 1521 00:58:58,520 --> 00:59:00,520 GAIL ARE SAYING. 1522 00:59:00,520 --> 00:59:03,600 IN THE TSOS STUDY WE STARTED, IT 1523 00:59:03,600 --> 00:59:07,800 IS THE OPPOSITE OF GAIL WE START 1524 00:59:07,800 --> 00:59:09,760 WITH PARALLEL GROUP CLUSTER 1525 00:59:09,760 --> 00:59:12,400 RANDOMIZE DESIGN AND SWITCHED TO 1526 00:59:12,400 --> 00:59:14,200 THE STEP WEDGE SIMULTANEOUSLY 1527 00:59:14,200 --> 00:59:16,840 LOOKING AT THE BIOSTATS SCORE, 1528 00:59:16,840 --> 00:59:19,320 WE HAD 20 SITES, WE HAD A A 1529 00:59:19,320 --> 00:59:21,640 PREVIOUS PRAGMATIC TRIAL LOOKING 1530 00:59:21,640 --> 00:59:23,120 AT ALCOHOL PRIOR TO PROPOSING 1531 00:59:23,120 --> 00:59:25,440 THE TSOS TRIAL SO WE HAD A 1532 00:59:25,440 --> 00:59:26,920 PRACTICE NETWORK, 20 SITES WE 1533 00:59:26,920 --> 00:59:31,920 WORKED WITH THAT HAVE RESEARCH 1534 00:59:31,920 --> 00:59:34,200 EXMEANS DATA EXPERIENCE IRB 1535 00:59:34,200 --> 00:59:34,920 EXPERIENCE. 1536 00:59:34,920 --> 00:59:37,440 BUT WE DIDN'T WANT TO USE THOSE 1537 00:59:37,440 --> 00:59:40,200 20 SITES AND IT WASN'T UNTIL WE 1538 00:59:40,200 --> 00:59:42,440 WERE ASKED TO GO FROM 20 TO 24 1539 00:59:42,440 --> 00:59:44,200 SITES WE WENT BACK WITH NUMBER 1540 00:59:44,200 --> 00:59:46,080 OF THOSE PREVIOUSLY WORKED WITH 1541 00:59:46,080 --> 00:59:49,120 SITES AND SAID HEY WE HAVE THE 1542 00:59:49,120 --> 00:59:50,360 SECOND TRIAL, YOU HAVE DONE 1543 00:59:50,360 --> 00:59:52,720 RESEARCH WITH US BEFORE, CAN YOU 1544 00:59:52,720 --> 00:59:54,240 SIGN ON AND THAT WAS DURING THE 1545 00:59:54,240 --> 00:59:55,600 PLANNING PHASE AND SORT OF 1546 00:59:55,600 --> 00:59:58,680 RUSHED BUT WE WORKED WITH THOSE 1547 00:59:58,680 --> 01:00:00,720 SITES BEFORE. 1548 01:00:00,720 --> 01:00:02,680 OTHERWISE 21 SITES WE HADN'T 1549 01:00:02,680 --> 01:00:06,000 WORKED WITH BEFORE. 1550 01:00:06,000 --> 01:00:08,760 >> I WOULD AGREE WITH ALL THAT I 1551 01:00:08,760 --> 01:00:11,720 HEARD BEFORE AND I THINK WITH 1552 01:00:11,720 --> 01:00:12,840 REGARD TO DIVERSITY WHILE THERE 1553 01:00:12,840 --> 01:00:14,960 MAY BE SOME THINGS THAT CAN BE 1554 01:00:14,960 --> 01:00:16,840 DONE WITHIN THE CONTEXT OF 1555 01:00:16,840 --> 01:00:17,840 EXISTING SITES I BELIEVE THE 1556 01:00:17,840 --> 01:00:22,000 SITES DICTATE THE PERSON MORE 1557 01:00:22,000 --> 01:00:23,320 THAN ANYTHING ELSE, THAT IS 1558 01:00:23,320 --> 01:00:26,480 WHERE THAT DECISION HAS TO BE 1559 01:00:26,480 --> 01:00:26,960 MADE. 1560 01:00:26,960 --> 01:00:29,360 THIS WHOLE ISSUE OF BRINGING IN 1561 01:00:29,360 --> 01:00:33,400 SITES HOW YOU GET SITES TO WORK 1562 01:00:33,400 --> 01:00:37,760 AT MULTI-SITE STUDY, IS ONE THAT 1563 01:00:37,760 --> 01:00:40,040 IS ALWAYS FAR FOR ME BECAUSE THE 1564 01:00:40,040 --> 01:00:44,800 TRUTH IS, YOU NEED TO GO IN WITH 1565 01:00:44,800 --> 01:00:46,560 A GRANT, WITH AT LEAST SOME 1566 01:00:46,560 --> 01:00:47,880 COMMITMENT AND SOME SENSE OF 1567 01:00:47,880 --> 01:00:49,680 WHERE YOU ARE GOING TO BE DOING 1568 01:00:49,680 --> 01:00:50,880 IT AND PRE-EXISTING 1569 01:00:50,880 --> 01:00:52,080 RELATIONSHIPS TO KNOW THAT YOU 1570 01:00:52,080 --> 01:00:54,480 CAN DO IT BECAUSE IT WILL SAVE 1571 01:00:54,480 --> 01:00:56,600 YOU TIME IN THE PLANNING PHASE 1572 01:00:56,600 --> 01:00:59,040 OR JUMPING INTO THE WORK, BUT 1573 01:00:59,040 --> 01:01:02,480 ALSO GRANTSMANSHIP PERSPECTIVE 1574 01:01:02,480 --> 01:01:04,400 REVIEWERS ARE KEPT CAN BELIEVE 1575 01:01:04,400 --> 01:01:06,600 IF THEY DON'T FEEL LIKE IT IS 1576 01:01:06,600 --> 01:01:08,560 REALLY THERE. 1577 01:01:08,560 --> 01:01:09,640 ON THE OTHER HAND THERE IS SO 1578 01:01:09,640 --> 01:01:11,880 MUCH WORK YOU CAN DO, UNLESS YOU 1579 01:01:11,880 --> 01:01:12,600 HAVE A LONG STANDING 1580 01:01:12,600 --> 01:01:13,760 RELATIONSHIP WITH THE SITE AND 1581 01:01:13,760 --> 01:01:17,000 DONE OTHER PROJECTS WITH THEM, 1582 01:01:17,000 --> 01:01:19,400 THERE IS SO MUCH WORK YOU CAN DO 1583 01:01:19,400 --> 01:01:24,120 IN A PRE-SUBMISSION STATE. 1584 01:01:24,120 --> 01:01:26,160 WHERE YOU HAVE NO FUNDS TO BE 1585 01:01:26,160 --> 01:01:26,520 DOING THIS. 1586 01:01:26,520 --> 01:01:28,080 TO REALLY FIND OUT WHAT IT IS 1587 01:01:28,080 --> 01:01:30,960 GOING TO LOOK LIKE WHEN YOU ARE 1588 01:01:30,960 --> 01:01:37,120 ACTUALLY DOING THE PROJECT. 1589 01:01:37,120 --> 01:01:38,880 SOME PROJECTS I FOUND THESE 1590 01:01:38,880 --> 01:01:41,880 THINGS YOU DISCOVER, DISCOVERY 1591 01:01:41,880 --> 01:01:45,600 THINGS, WHAT IS DOABLE AND NOT 1592 01:01:45,600 --> 01:01:46,160 DOABLE. 1593 01:01:46,160 --> 01:01:49,960 IF I HAD I DON'T KNOW HOW 1594 01:01:49,960 --> 01:01:50,960 PRACTICAL THIS IS. 1595 01:01:50,960 --> 01:01:54,040 I DON'T KNOW IF ANYONE HAS DONE 1596 01:01:54,040 --> 01:01:57,360 THIS BEFORE BUT IN AN IDEAL 1597 01:01:57,360 --> 01:02:00,760 WORLD WHICH ISN'T NICE I MIGHT 1598 01:02:00,760 --> 01:02:02,440 GO IN, IF I NEED THREE SITES I 1599 01:02:02,440 --> 01:02:06,160 MIGHT GO INTO FIVE AND SEE WHO 1600 01:02:06,160 --> 01:02:07,360 WOE UNDERSTANDING OF COMPETITION 1601 01:02:07,360 --> 01:02:10,960 TO SEE WHO IS GOING TO SUCCEEDS. 1602 01:02:10,960 --> 01:02:12,160 AND THEN GO FORWARD BECAUSE THE 1603 01:02:12,160 --> 01:02:13,600 PROBLEM OF GOING WITH THREE AND 1604 01:02:13,600 --> 01:02:16,880 THEN NEEDING FIVE ADDITIONAL IS 1605 01:02:16,880 --> 01:02:18,840 DO YOU HAVE THE BUDGET EXTENDED 1606 01:02:18,840 --> 01:02:20,480 ACCOUNTED FOR YOUR BUDGET, I 1607 01:02:20,480 --> 01:02:22,600 GUESS GAIL GOT A SETTLEMENT BUT 1608 01:02:22,600 --> 01:02:24,600 THAT IS SOMETIMES HARD TO DO. 1609 01:02:24,600 --> 01:02:25,800 SO IT WOULD BE GREAT TO BE ABLE 1610 01:02:25,800 --> 01:02:29,200 TO GO INTO THIS KIND OF A PHASE 1611 01:02:29,200 --> 01:02:32,800 AND HAVE THE BEST ONES SURVIVE 1612 01:02:32,800 --> 01:02:37,680 ALTHOUGH IT IS BRUTAL AND 1613 01:02:37,680 --> 01:02:38,320 PROBABLY NOT GREAT FOR 1614 01:02:38,320 --> 01:02:39,240 RELATIONSHIPS IF YOU WANT TO 1615 01:02:39,240 --> 01:02:42,440 CONTINUE WITH OTHERS SO NOT 1616 01:02:42,440 --> 01:02:44,400 NECESSARILY FROM THAT BUT 1617 01:02:44,400 --> 01:02:47,440 (INAUDIBLE) PERSPECTIVE GETTING 1618 01:02:47,440 --> 01:02:50,960 IT DONE. 1619 01:02:50,960 --> 01:02:52,200 >> WE HAVE IN IF OTHER PROGRAMS 1620 01:02:52,200 --> 01:02:54,280 SEEN PEOPLE WHO HAVE A SET OF 1621 01:02:54,280 --> 01:02:56,600 POTENTIAL SITES BUT THEY THEN 1622 01:02:56,600 --> 01:02:57,840 NEGOTIATE WITH OVER TIME BUT I 1623 01:02:57,840 --> 01:03:00,720 THINK YOU ARE RIGHT, JAMES, THIS 1624 01:03:00,720 --> 01:03:02,640 IDEA OF IT IS HARD TO FIX A 1625 01:03:02,640 --> 01:03:05,120 DIVERSITY ISSUE LATER. 1626 01:03:05,120 --> 01:03:07,320 IF YOU DON'T HAVE COME IN WITH 1627 01:03:07,320 --> 01:03:08,560 SITES THAT REACH WHETHER 1628 01:03:08,560 --> 01:03:10,200 UNDERSERVED POPULATIONS OR 1629 01:03:10,200 --> 01:03:11,440 DIVERSE COMMUNITIES OR WHOEVER 1630 01:03:11,440 --> 01:03:14,640 IT IS, SO IN YOUR APPLICATION 1631 01:03:14,640 --> 01:03:16,520 PROCESS REALLY NEEDING CAREFULLY 1632 01:03:16,520 --> 01:03:18,920 TO LOOK AT THOSE ISSUES, MAKING 1633 01:03:18,920 --> 01:03:21,680 SURE THAT YOU ARE GOING TO GET 1634 01:03:21,680 --> 01:03:23,080 THE POPULATION YOU WANT WITH THE 1635 01:03:23,080 --> 01:03:24,840 PARTNERS THAT YOU COME IN WITH, 1636 01:03:24,840 --> 01:03:26,720 I THINK IS A REALLY INTERESTING 1637 01:03:26,720 --> 01:03:27,200 ELEMENT. 1638 01:03:27,200 --> 01:03:30,160 AND MICHAEL, YOUR THOUGHT THERE 1639 01:03:30,160 --> 01:03:32,360 ABOUT THE WAY YOU REACHED OUT TO 1640 01:03:32,360 --> 01:03:34,800 FOLKS, YOU WEREN'T WAIT FOR A 1641 01:03:34,800 --> 01:03:36,040 REFERRAL FROM SOMEBODY, YOU WERE 1642 01:03:36,040 --> 01:03:38,160 DIRECTLY GOING TO THE EHR AND 1643 01:03:38,160 --> 01:03:39,680 REACHING OUT OF EVERYBODY WHO 1644 01:03:39,680 --> 01:03:42,680 WAS ELIGIBLE INSTEAD OF HAVING 1645 01:03:42,680 --> 01:03:44,400 POTENTIAL REFERRAL BIAS IN THE 1646 01:03:44,400 --> 01:03:46,640 TYPES OF PATIENTS THAT WERE 1647 01:03:46,640 --> 01:03:49,160 REFERRED FOR STUDIES. 1648 01:03:49,160 --> 01:03:55,320 >> I WAS JUST GOING TO SAY I 1649 01:03:55,320 --> 01:03:57,200 TOTALLY AGREE WITH JAMES, SEEMS 1650 01:03:57,200 --> 01:04:01,000 LIKE THE GRANT PROCESS DOESN'T 1651 01:04:01,000 --> 01:04:04,760 ALLOW FOR TRYING TO INCREASE 1652 01:04:04,760 --> 01:04:06,080 DIVERSITY IF YOU DON'T ALREADY 1653 01:04:06,080 --> 01:04:11,000 HAVE IT GOING IN JUST BECAUSE IT 1654 01:04:11,000 --> 01:04:12,800 IS HARD WHEN YOU ARE WRITING THE 1655 01:04:12,800 --> 01:04:15,880 GRANT TO ASK SITES TO DO A LOT 1656 01:04:15,880 --> 01:04:18,240 OF THIS EXTRA WORK WHEN YOU KNOW 1657 01:04:18,240 --> 01:04:21,320 CHANCES OF GETTING THE GRANT ARE 1658 01:04:21,320 --> 01:04:23,080 SMALL, ASKING FOR ALL THIS DATA 1659 01:04:23,080 --> 01:04:27,160 AND PILOT LIEU THIS PROCESS. 1660 01:04:27,160 --> 01:04:29,240 ONCE YOU GET THE GRANT YOU 1661 01:04:29,240 --> 01:04:30,840 WANTED TO EXECUTE IT AND IT IS 1662 01:04:30,840 --> 01:04:32,720 VERY HARD TO THEN GET NEW SITES 1663 01:04:32,720 --> 01:04:36,880 ON BOARD JUST BECAUSE YOU ARE 1664 01:04:36,880 --> 01:04:38,640 STARTING FROM GROUNDS ZERO IN 1665 01:04:38,640 --> 01:04:41,240 TERMS OF TRYING TO DEVELOP THESE 1666 01:04:41,240 --> 01:04:44,280 RELATIONSHIPS THAT ARE CRITICAL 1667 01:04:44,280 --> 01:04:45,280 BECAUSE IT IS NOT JUST A ONE 1668 01:04:45,280 --> 01:04:46,720 YEAR PROCESS, YOU ARE TRYING TO 1669 01:04:46,720 --> 01:04:53,000 DEVELOP THIS RELATIONSHIP FOR 1670 01:04:53,000 --> 01:04:57,760 OVER A FOUR TO FIVE YEAR PERIOD. 1671 01:04:57,760 --> 01:04:59,040 >> IT IS INTERESTING THIS IDEA 1672 01:04:59,040 --> 01:04:59,920 YOU WERE ABLE TO GET A 1673 01:04:59,920 --> 01:05:01,280 SUPPLEMENT TO BRING ON 1674 01:05:01,280 --> 01:05:02,280 ADDITIONAL SITES AND MAYBE THAT 1675 01:05:02,280 --> 01:05:04,200 SOMETHING FROM THE FUNDING SIDE 1676 01:05:04,200 --> 01:05:05,880 WE COULD THINK ABOUT. 1677 01:05:05,880 --> 01:05:07,000 THE OTHER QUESTION WE SOMETIMES 1678 01:05:07,000 --> 01:05:08,480 HAVE FROM THE FUNDING SITE WE 1679 01:05:08,480 --> 01:05:11,920 ALWAYS USE THE SAME HEALTHCARE 1680 01:05:11,920 --> 01:05:14,240 SYSTEMS, SEE THE SAME HEALTHCARE 1681 01:05:14,240 --> 01:05:15,280 SYSTEMS COME THROUGH THE SYSTEM 1682 01:05:15,280 --> 01:05:16,760 WHO WERE GREAT AT DOING THIS 1683 01:05:16,760 --> 01:05:19,000 WORK. 1684 01:05:19,000 --> 01:05:22,080 HOW DO WE DO RESEARCH IN GROUPS 1685 01:05:22,080 --> 01:05:23,600 AND POPULATIONS THAT DON'T 1686 01:05:23,600 --> 01:05:25,160 TYPICALLY PARTICIPATE OR 1687 01:05:25,160 --> 01:05:26,640 HEALTHCARE SYSTEMS THAT REACH 1688 01:05:26,640 --> 01:05:28,160 PEOPLE THAT DON'T OFTEN 1689 01:05:28,160 --> 01:05:30,120 PARTICIPATE IN RESEARCH AND 1690 01:05:30,120 --> 01:05:32,080 MAYBE DON'T KNOW HOW THESE 1691 01:05:32,080 --> 01:05:33,160 INTERVENTIONS WORK IN THESE 1692 01:05:33,160 --> 01:05:34,880 DIFFERENT POPULATIONS. 1693 01:05:34,880 --> 01:05:36,520 WHAT WAS YOUR EXPERIENCE IN 1694 01:05:36,520 --> 01:05:39,720 GETTING SUPPLEMENT TO GET TO DO 1695 01:05:39,720 --> 01:05:41,640 THAT WORK AND ADD ON SITES? 1696 01:05:41,640 --> 01:05:43,240 >> WE ARE EXTREMELY LUCKY 1697 01:05:43,240 --> 01:05:44,560 BECAUSE WE ARE WORKING MANY THE 1698 01:05:44,560 --> 01:05:47,680 SPACE, USE DISORDER SO IN THAT 1699 01:05:47,680 --> 01:05:50,240 SPACE THERE IS MONEY AVAILABLE 1700 01:05:50,240 --> 01:05:51,480 THROUGH THE HEALING COMMUNITIES 1701 01:05:51,480 --> 01:05:52,640 INITIATIVE. 1702 01:05:52,640 --> 01:05:54,160 SO WE WERE FORTUNATE. 1703 01:05:54,160 --> 01:05:55,200 WOULDN'T BE ABLE TO DO THAT 1704 01:05:55,200 --> 01:05:58,880 OBVIOUSLY. 1705 01:05:58,880 --> 01:05:59,840 THAT WOULD HAVE BEEN HORRIBLE 1706 01:05:59,840 --> 01:06:01,840 FOR US IF WE WEREN'T ABLE TO DO 1707 01:06:01,840 --> 01:06:02,320 THAT. 1708 01:06:02,320 --> 01:06:05,520 SO THAT WAS JUST WE WERE LUCKY 1709 01:06:05,520 --> 01:06:08,960 TO BE ABLE TO. 1710 01:06:08,960 --> 01:06:11,200 I WOULD SAY THAT THIS -- 1711 01:06:11,200 --> 01:06:12,840 EVERYTHING COSTS A LOT OF MONEY 1712 01:06:12,840 --> 01:06:14,600 SO IT IS A GIVE AND TAKE OF WHAT 1713 01:06:14,600 --> 01:06:16,480 YOU CAN DO. 1714 01:06:16,480 --> 01:06:19,120 AND WHAT YOU CAN'T DO AND THE 1715 01:06:19,120 --> 01:06:20,880 OTHER REALLY DIFFICULT THING 1716 01:06:20,880 --> 01:06:22,680 WITH USING THIS STUDY AND OTHER 1717 01:06:22,680 --> 01:06:24,680 STUDIES THAT I HAVE DONE WITH 1718 01:06:24,680 --> 01:06:26,480 COMMUNITY SITES, IS THAT THE NIH 1719 01:06:26,480 --> 01:06:29,280 IS NOT THAT NIMBLE ABOUT GIVING 1720 01:06:29,280 --> 01:06:31,920 WHEN THE NOAs COME OUT AND HOW 1721 01:06:31,920 --> 01:06:35,680 MONEY IS GIVEN SO YOU CAN OFTEN 1722 01:06:35,680 --> 01:06:37,120 -- YOU CAN OFTEN DO AT RISK 1723 01:06:37,120 --> 01:06:41,520 ACCOUNTS IN MULTIPLE YEARS, YOU 1724 01:06:41,520 --> 01:06:43,200 DO ACCOUNTS FOR ACADEMIC SITES 1725 01:06:43,200 --> 01:06:44,520 AND THAT HAPPENS ALL THE TIME, 1726 01:06:44,520 --> 01:06:47,280 WE SAY OKAY, BUT YOU CAN'T 1727 01:06:47,280 --> 01:06:49,360 REALLY TELL A COMMUNITY PLACE 1728 01:06:49,360 --> 01:06:53,440 THAT'S GOT ONE IT -- ONE IT 1729 01:06:53,440 --> 01:06:54,880 PERSON OR SOMETHING OH BY WAY, 1730 01:06:54,880 --> 01:06:57,480 YOU NEED TO DO THIS EXTRA AMOUNT 1731 01:06:57,480 --> 01:07:00,000 OF WORK BECAUSE THEY CAN HIRE A 1732 01:07:00,000 --> 01:07:01,640 WHOLE NEW IT PERSON, IT IS 1733 01:07:01,640 --> 01:07:03,840 REALLY PUTTING IT ON ONE PERSON 1734 01:07:03,840 --> 01:07:05,520 AND BY THE WAY, YOUR MONEY IS 1735 01:07:05,520 --> 01:07:08,600 COMING, I PROMISE YOU NOT QUITE 1736 01:07:08,600 --> 01:07:09,320 SURE WHEN. 1737 01:07:09,320 --> 01:07:11,400 SO THAT WITH IS WHAT MAKES IT 1738 01:07:11,400 --> 01:07:15,080 DIFFICULT TO INCLUDE COMMUNITY 1739 01:07:15,080 --> 01:07:18,280 SMALLER WORLD WHICH WE NEED TO 1740 01:07:18,280 --> 01:07:20,400 INCLUDE BUT WE HAVE TO GIVE THEM 1741 01:07:20,400 --> 01:07:22,000 ALMOST EXTRA MONEY IN A WAY AND 1742 01:07:22,000 --> 01:07:25,200 MAKING SURE THAT WE ARE PAYING 1743 01:07:25,200 --> 01:07:28,920 THEM ON TIME. 1744 01:07:28,920 --> 01:07:30,560 >> HELPFUL FEEDBACK. 1745 01:07:30,560 --> 01:07:33,200 DEFINITELY FOR US AS FUNDERS TO 1746 01:07:33,200 --> 01:07:35,080 THINK ABOUT IN MY COLLEAGUES 1747 01:07:35,080 --> 01:07:36,640 WHETHER NIH AND OTHER FUNDING 1748 01:07:36,640 --> 01:07:38,200 AGENCIES IMPORTANT TO THINK HOW 1749 01:07:38,200 --> 01:07:39,320 WE MIGHT BE ABLE TO DO THAT. 1750 01:07:39,320 --> 01:07:41,280 BECAUSE I THINK THERE IS 1751 01:07:41,280 --> 01:07:43,640 DEFINITELY INTEREST THERE. 1752 01:07:43,640 --> 01:07:45,160 WHY DON'T WE GO TO THE NEXT 1753 01:07:45,160 --> 01:07:45,760 QUESTION. 1754 01:07:45,760 --> 01:07:46,680 THIS IS THE LAST STANDARD 1755 01:07:46,680 --> 01:07:48,640 QUESTION THAT I HAVE AND I WILL 1756 01:07:48,640 --> 01:07:50,560 ENCOURAGE THE AUDIENCE TO SEND 1757 01:07:50,560 --> 01:07:52,760 IN QUESTIONS VIA EMAIL AS WELL 1758 01:07:52,760 --> 01:07:55,680 AS OUR PANELISTS THAT ARE HERE 1759 01:07:55,680 --> 01:07:58,360 ON THE ZOOM TO SUBMIT QUESTIONS 1760 01:07:58,360 --> 01:07:59,680 TO CHAT BECAUSE WE WILL HAVE 1761 01:07:59,680 --> 01:08:01,080 TIME FOR QUESTIONS BUT THIS LAST 1762 01:08:01,080 --> 01:08:04,800 QUESTION I WILL FIRST POSE TO 1763 01:08:04,800 --> 01:08:09,880 YOU GAIL WHAT ACTIVITIES IN 1764 01:08:09,880 --> 01:08:10,960 PLANNING PHASE TO DETERMINE 1765 01:08:10,960 --> 01:08:12,440 QUALITY OF DATA AND HOW YOU END 1766 01:08:12,440 --> 01:08:14,320 UP PUTTING THE DATA ACROSS YOUR 1767 01:08:14,320 --> 01:08:18,800 DIFFERENT HEALTHCARE SYSTEMS? 1768 01:08:18,800 --> 01:08:21,680 >> I THINK I MENTIONED EARLY ON 1769 01:08:21,680 --> 01:08:24,200 WE NEEDED TO I GUESS DURING THE 1770 01:08:24,200 --> 01:08:25,200 PLANNING PHASE TEST SOME OF 1771 01:08:25,200 --> 01:08:25,640 THIS. 1772 01:08:25,640 --> 01:08:28,000 SO WE HAVE TO REALLY LOOK AT ALL 1773 01:08:28,000 --> 01:08:31,200 OF THOSE HR DATA ELEMENTS AND 1774 01:08:31,200 --> 01:08:33,120 HOW THEY WOULD BE INTERPRETED AT 1775 01:08:33,120 --> 01:08:36,080 EACH SITE, HOW TO DO THAT AND 1776 01:08:36,080 --> 01:08:38,720 FACILITATE ON LARGE SCALE 1777 01:08:38,720 --> 01:08:39,120 COLLECTION. 1778 01:08:39,120 --> 01:08:43,840 WE HAD TO ENSURE THAT DATA 1779 01:08:43,840 --> 01:08:45,600 COLLECTION WAS CONSISTENT 1780 01:08:45,600 --> 01:08:48,240 BETWEEN EACH SITE AND WE HAD TO 1781 01:08:48,240 --> 01:08:49,800 VALIDATE IT AT EACH SITE SO THIS 1782 01:08:49,800 --> 01:08:52,480 WHOLE THING, THIS WHOLE MAPPING 1783 01:08:52,480 --> 01:08:57,080 AND QUALITY ASSURANCE WAS A HUGE 1784 01:08:57,080 --> 01:08:58,920 LIFT. 1785 01:08:58,920 --> 01:09:00,200 WE HAD TO DO THAT EARLY ON AND 1786 01:09:00,200 --> 01:09:02,280 MAKE SURE IT HAPPENS SO WE KEPT 1787 01:09:02,280 --> 01:09:04,040 ASKING THEM FOR SOME DATA 1788 01:09:04,040 --> 01:09:05,560 INITIALLY AND THEN SEND TO OUR 1789 01:09:05,560 --> 01:09:09,320 DATA COORDINATING SESSION WE DID 1790 01:09:09,320 --> 01:09:11,280 MULTIPLE ROUND AND SAMPLED DATA 1791 01:09:11,280 --> 01:09:13,440 BY OUR TEAM WHICH WAS GREAT HERE 1792 01:09:13,440 --> 01:09:16,000 ARE DATA COORDINATING CENTER. 1793 01:09:16,000 --> 01:09:19,520 WE HAD TO DO THAT WITH BOTH 1794 01:09:19,520 --> 01:09:21,280 SYSTEMS, TURNER AN EPIC SYSTEMS 1795 01:09:21,280 --> 01:09:24,480 SO THAT BECAME MORE COMPLICATED 1796 01:09:24,480 --> 01:09:26,160 BUT BY MONTHLY DATA COLLECTION 1797 01:09:26,160 --> 01:09:27,240 FROM SITES SENT HERE WE WERE 1798 01:09:27,240 --> 01:09:29,960 ABLE TO MONITOR THAT. 1799 01:09:29,960 --> 01:09:31,640 ALL DATA WAS DEIDENTIFIED SO WE 1800 01:09:31,640 --> 01:09:34,240 WERE ABLE TO SHARE IT WITH 1801 01:09:34,240 --> 01:09:35,400 INVESTIGATIVE TEAM IN OUR STUDY. 1802 01:09:35,400 --> 01:09:43,880 SO THAT WAS GOOD. 1803 01:09:43,880 --> 01:09:45,080 >> OTHER COMMENTS ON IN QUESTION 1804 01:09:45,080 --> 01:09:49,520 FROM THE PANELISTS? 1805 01:09:49,520 --> 01:09:53,000 >> FROM OUR PERSPECTIVE IT WAS 1806 01:09:53,000 --> 01:09:55,880 ALL ABOUT GETTING PEOPLE -- IT 1807 01:09:55,880 --> 01:09:59,760 WAS ALL ABOUT GETTING GOOD 1808 01:09:59,760 --> 01:10:01,480 ACCESS O THE SITE AND MADE ALL 1809 01:10:01,480 --> 01:10:02,480 THE DIFFERENCE AND WHERE WE HAD 1810 01:10:02,480 --> 01:10:03,600 THAT, THE DATA WAS SO MUCH 1811 01:10:03,600 --> 01:10:09,240 BETTER. 1812 01:10:09,240 --> 01:10:14,040 WHERE WE DIDN'T SEND TO DO THIS 1813 01:10:14,040 --> 01:10:18,160 THEN THE QUESTION WAS PAYMENT, 1814 01:10:18,160 --> 01:10:20,680 SO FORTH. 1815 01:10:20,680 --> 01:10:27,640 THAT WAS THE ISSUE. 1816 01:10:27,640 --> 01:10:32,200 >> DOUG OR MICHAEL. 1817 01:10:32,200 --> 01:10:34,920 >> I THINK FOR US IT WAS 1818 01:10:34,920 --> 01:10:40,960 CREATING A DATA DICTIONARY 1819 01:10:40,960 --> 01:10:42,800 AGREED UPON DATA DICTIONARY THAT 1820 01:10:42,800 --> 01:10:50,080 WE CAN MAP OUT USE IT TO MAP OUT 1821 01:10:50,080 --> 01:10:52,200 ANOTHER EACH SITE, EACH OF THE 1822 01:10:52,200 --> 01:10:57,560 SITES HAD DIFFERENT WAYS OF 1823 01:10:57,560 --> 01:10:58,720 IDENTIFYING THE CLINICAL 1824 01:10:58,720 --> 01:10:59,920 PHENOTYPE THAT WE WERE 1825 01:10:59,920 --> 01:11:00,360 INTERESTED. 1826 01:11:00,360 --> 01:11:04,640 FOR EXAMPLE HYPERTENSION 1827 01:11:04,640 --> 01:11:05,800 PATIENTS WITH HYPERTENSION THE 1828 01:11:05,800 --> 01:11:08,680 CODES TO IDENTIFY THESE PATIENTS 1829 01:11:08,680 --> 01:11:10,000 WERE DIFFERENT AT EACH OF THE 1830 01:11:10,000 --> 01:11:12,760 SITES AND WE NEEDED THE 1831 01:11:12,760 --> 01:11:19,040 EXPERTISE OF EACH OF OUR DATA 1832 01:11:19,040 --> 01:11:21,120 PERSON AND IT PEOPLE AT EACH 1833 01:11:21,120 --> 01:11:22,520 SITE FOR US THESE ARE THE CODES 1834 01:11:22,520 --> 01:11:24,320 THAT WOULD HELP YOU IDENTIFY 1835 01:11:24,320 --> 01:11:26,320 PATIENTS WITH HYPERTENSION. 1836 01:11:26,320 --> 01:11:29,640 I THINK HAVING EXPLICIT CRITERIA 1837 01:11:29,640 --> 01:11:33,520 AND HAVING THE SITES TELL US 1838 01:11:33,520 --> 01:11:38,240 WHAT WOULD BE THE BEST CODES WAS 1839 01:11:38,240 --> 01:11:38,720 HELPFUL. 1840 01:11:38,720 --> 01:11:42,320 >> I WOULD ADD THAT TOO, WE DID 1841 01:11:42,320 --> 01:11:45,040 PEEN TYPE OF OUD AND REALLY CHAD 1842 01:11:45,040 --> 01:11:46,520 AND HIS GROUP DEVELOPED WHAT 1843 01:11:46,520 --> 01:11:47,640 THOSE WOULD LOOK LIKE AND TESTED 1844 01:11:47,640 --> 01:11:52,760 THEM. 1845 01:11:52,760 --> 01:11:53,440 >> DOUG. 1846 01:11:53,440 --> 01:11:55,880 >> THE ELECTRONIC HEALTH RECORD 1847 01:11:55,880 --> 01:11:58,080 PILOTING OF THE PTSD SCREEN WAS 1848 01:11:58,080 --> 01:11:59,280 ONE THING WE DIDN'T DO WELL 1849 01:11:59,280 --> 01:12:01,960 ENOUGH IN THE PILOT PHASE. 1850 01:12:01,960 --> 01:12:05,840 WE DO CENTERS REQUIRE TO KEEP 1851 01:12:05,840 --> 01:12:09,720 REGISTRIES COMPLETE CENSUS OF 1852 01:12:09,720 --> 01:12:11,680 ALL PATIENTS WITH MULTIPLE 1853 01:12:11,680 --> 01:12:14,360 VARIABLES WITH REGARD TO CD 1854 01:12:14,360 --> 01:12:14,960 SUBSTANCE USE. 1855 01:12:14,960 --> 01:12:18,000 WE HAVE DONE A PRIOR PRAGMATIC 1856 01:12:18,000 --> 01:12:20,360 TRIAL SO WE KNEW WE COULD GET 1857 01:12:20,360 --> 01:12:23,160 THAT DATA ALREADY NICELY 1858 01:12:23,160 --> 01:12:25,240 CATEGORIZED, THAT WAS ONE OF THE 1859 01:12:25,240 --> 01:12:28,640 DESIGN FEATURES THAT WE NEW 1860 01:12:28,640 --> 01:12:29,800 GOING IN EVERYBODY WOULD HAVE A 1861 01:12:29,800 --> 01:12:31,680 TRAUMA REGISTER, THEY HAD TO AND 1862 01:12:31,680 --> 01:12:33,560 WE COULD MANIPULATE THAT DATA AT 1863 01:12:33,560 --> 01:12:34,360 THENT OF THE STUDY ONCE WE GOT 1864 01:12:34,360 --> 01:12:36,880 IT FROM THEM. 1865 01:12:36,880 --> 01:12:38,120 >> THANKS, DOUG. 1866 01:12:38,120 --> 01:12:41,120 THERE IS A QUESTION THAT CAME IN 1867 01:12:41,120 --> 01:12:43,760 VIA THE CHAT WHICH IS A COMMON 1868 01:12:43,760 --> 01:12:45,120 -- BUT WONDERING DOUG I WILL 1869 01:12:45,120 --> 01:12:49,120 READ IT OUT BUT I THINK ONE OF 1870 01:12:49,120 --> 01:12:50,400 THE THINGS YOU MENTIONED SORT OF 1871 01:12:50,400 --> 01:12:52,200 MADE ME THINK OF YOU TO MAYBE 1872 01:12:52,200 --> 01:12:54,280 TALK ABOUT THIS. 1873 01:12:54,280 --> 01:12:56,160 THE COMMENT IS THAT THE 1874 01:12:56,160 --> 01:12:57,480 SELECTION OF SITES AND PICKING 1875 01:12:57,480 --> 01:12:59,280 SITES THAT HAVE A TRACK RECORD 1876 01:12:59,280 --> 01:13:02,040 SEEMS TO BE REALLY IMPORTANT 1877 01:13:02,040 --> 01:13:02,800 CRITICAL CONSIDERATION BECAUSE 1878 01:13:02,800 --> 01:13:04,560 IF YOU PICK SITES THAT REALLY 1879 01:13:04,560 --> 01:13:06,880 DON'T KNOW HOW TO DO THIS, IT 1880 01:13:06,880 --> 01:13:07,880 COULD INTRODUCE A LOT OF 1881 01:13:07,880 --> 01:13:08,840 PROBLEMS ALONG THE WAY. 1882 01:13:08,840 --> 01:13:10,720 I REMEMBER HEARING YOU SAY THE 1883 01:13:10,720 --> 01:13:12,760 SITES YOU CAME IN WITH WERE ONES 1884 01:13:12,760 --> 01:13:14,320 THAT HADN'T WORKED IN YOUR 1885 01:13:14,320 --> 01:13:16,200 PREVIOUS STUDY OR HADN'T WORKED 1886 01:13:16,200 --> 01:13:17,320 WITHIN YOUR PREVIOUS TRIAL SO 1887 01:13:17,320 --> 01:13:18,680 WHAT IS YOUR THOUGHT ABOUT 1888 01:13:18,680 --> 01:13:20,320 WORKING WITH SITES THAT ARE 1889 01:13:20,320 --> 01:13:23,080 MAYBE NEW TO RESEARCH OR NEW TO 1890 01:13:23,080 --> 01:13:27,480 MULTI-SITE KINDS OF TRIALS. 1891 01:13:27,480 --> 01:13:30,440 >> TOTALLY AGREE THERE IS THIS 1892 01:13:30,440 --> 01:13:32,360 TENSION. 1893 01:13:32,360 --> 01:13:34,160 FOR US WE WANT A REPRESENTATIVE 1894 01:13:34,160 --> 01:13:35,280 SAMPLE OF SITES BECAUSE WE ARE 1895 01:13:35,280 --> 01:13:39,480 GOING TO TAKE OUR DATA AND MAKE 1896 01:13:39,480 --> 01:13:41,240 CASES FOR ALCOHOL SCREENING OR 1897 01:13:41,240 --> 01:13:43,880 BRIEF INTERVENTION PTSD BRIEF 1898 01:13:43,880 --> 01:13:44,640 INTERVENTION AMERICAN COLLEGE OF 1899 01:13:44,640 --> 01:13:45,320 SURGEONS. 1900 01:13:45,320 --> 01:13:48,800 THERE IS NOTHING WORSE THAN 1901 01:13:48,800 --> 01:13:50,360 PICKING 15 -- 24 UNIVERSITY 1902 01:13:50,360 --> 01:13:52,480 SITES AND THEN HAVING COMMUNITY 1903 01:13:52,480 --> 01:13:53,920 HOSPITALS THAT HAPPEN TO HAVE 1904 01:13:53,920 --> 01:13:56,240 LEVEL ONE TRAUMA CENTERS HAVE TO 1905 01:13:56,240 --> 01:13:58,080 SORT OF DO SCREENING AN 1906 01:13:58,080 --> 01:14:00,200 INTERVENTION PROCEDURES THAT 1907 01:14:00,200 --> 01:14:05,400 DERIVE FROM UNIVERSITY SITES SO 1908 01:14:05,400 --> 01:14:08,160 WE REALLY TRY TO NOT JUST GO 1909 01:14:08,160 --> 01:14:12,560 WITH UNIVERSITY ACADEMIC SITES 1910 01:14:12,560 --> 01:14:13,600 THIS IS ATTENTION TO PRACTICE 1911 01:14:13,600 --> 01:14:14,640 RESEARCH NETS WORK. 1912 01:14:14,640 --> 01:14:17,280 THERE ARE ACUTE CARE PRACTICE 1913 01:14:17,280 --> 01:14:19,920 RESEARCH NETWORKS A LOT OF KEY 1914 01:14:19,920 --> 01:14:20,600 STUDIES ARE DONE. 1915 01:14:20,600 --> 01:14:22,680 WHEN IT COMES TO WIDESPREAD 1916 01:14:22,680 --> 01:14:26,560 SCALE UP AND IMPLEMENTATION, 1917 01:14:26,560 --> 01:14:27,760 THAT DOESN'T WORK, YOU WANT TO 1918 01:14:27,760 --> 01:14:28,960 HAVE THE PROBLEMS YOU HAVE AT 1919 01:14:28,960 --> 01:14:33,080 THE SITES THAT ARE MORE 1920 01:14:33,080 --> 01:14:34,200 REPRESENTATIVE OF THE REAL 1921 01:14:34,200 --> 01:14:35,240 WORLDERS THERE'S ALSO DIVERSITY 1922 01:14:35,240 --> 01:14:36,160 OF PARTICIPANTS SO IT IS A REAL 1923 01:14:36,160 --> 01:14:38,640 TENSION. 1924 01:14:38,640 --> 01:14:40,120 AND WE A LOT OF REGULATORY 1925 01:14:40,120 --> 01:14:41,840 PROBLEMS, THE OTHER THING, THE 1926 01:14:41,840 --> 01:14:43,040 SITE HASN'T DONE A LOT OF 1927 01:14:43,040 --> 01:14:45,440 RESEARCH YOU CAN RAN RUN INTO 1928 01:14:45,440 --> 01:14:47,440 MAJOR REGULATORY PROBLEMS AN 1929 01:14:47,440 --> 01:14:48,800 TSOS RAN INTO THAT. 1930 01:14:48,800 --> 01:14:50,640 AND THAT IS ONE OF THE PROBLEMS 1931 01:14:50,640 --> 01:14:51,680 WITH DIVERSITY OF SCIENCE THAT 1932 01:14:51,680 --> 01:14:55,800 DON'T HAVE THE FULL EXPERIENCE. 1933 01:14:55,800 --> 01:14:58,840 >> I WILL SECOND THAT, THAT IS 1934 01:14:58,840 --> 01:15:00,280 REALLY IMPORTANT. 1935 01:15:00,280 --> 01:15:03,640 EFFICACY STUDIES ARE DONE BEST 1936 01:15:03,640 --> 01:15:05,080 IN LARGE COMPLICATED HEALTH 1937 01:15:05,080 --> 01:15:10,000 SYSTEMS WHO CAN DO THINGS. 1938 01:15:10,000 --> 01:15:10,920 PRAGMATIC TRIALS OR 1939 01:15:10,920 --> 01:15:12,800 IMPLEMENTATION TRIALS, IF WE 1940 01:15:12,800 --> 01:15:17,280 DON'T PUSH THEM OUT TO MORE 1941 01:15:17,280 --> 01:15:18,200 REPRESENTATIVE SITES AROUND THE 1942 01:15:18,200 --> 01:15:19,400 COUNTRY, THERE'S ONLY A FEW 1943 01:15:19,400 --> 01:15:22,680 SITES COMPARED TO ALL OF THE 1944 01:15:22,680 --> 01:15:25,040 COMMUNITY RURAL SITES, IF WE 1945 01:15:25,040 --> 01:15:26,600 DON'T PUSH THE ENVELOPE TRYING 1946 01:15:26,600 --> 01:15:28,800 TO INCLUDE THOSE IN THESE 1947 01:15:28,800 --> 01:15:29,800 PRAGMATIC IMPLEMENTATION TRIALS 1948 01:15:29,800 --> 01:15:35,160 WE REALLY AREN'T DOING ANYONE A 1949 01:15:35,160 --> 01:15:36,160 FAVOR. 1950 01:15:36,160 --> 01:15:37,680 IF WE HAVE OUR NIH PARTNERS 1951 01:15:37,680 --> 01:15:41,080 HERE, THAT INVOLVES A LOT OF 1952 01:15:41,080 --> 01:15:43,000 MONEY. 1953 01:15:43,000 --> 01:15:45,000 GETTING THOSE SITES REALLY 1954 01:15:45,000 --> 01:15:47,440 ALMOST FTEs WORTH OF PEOPLE TO 1955 01:15:47,440 --> 01:15:49,000 BE ABLE TO BRING THEM IN. 1956 01:15:49,000 --> 01:15:52,880 AND TRY IT. 1957 01:15:52,880 --> 01:15:56,520 WE HAVE TO HAVE GOOD FAITH THAT 1958 01:15:56,520 --> 01:15:57,720 WE ARE GOING TO SEE IT THROUGH 1959 01:15:57,720 --> 01:16:00,200 IF THEY HIRE PEOPLE. 1960 01:16:00,200 --> 01:16:01,960 IT IS A PROBLEM WE ARE NOT GOING 1961 01:16:01,960 --> 01:16:04,760 TO SOLVE TODAY BUT IT IS 1962 01:16:04,760 --> 01:16:06,040 IMPORTANT WE SPREAD THESE OUT 1963 01:16:06,040 --> 01:16:10,800 FOR IMPLEMENTATION TRIALS. 1964 01:16:10,800 --> 01:16:12,000 NOT EFFICACY TRIALS BUT 1965 01:16:12,000 --> 01:16:13,320 IMPLEMENTATION TRIALS IS 1966 01:16:13,320 --> 01:16:13,600 ESSENTIAL. 1967 01:16:13,600 --> 01:16:18,000 >> I SEE DR. TURN NEAR, DID YOU 1968 01:16:18,000 --> 01:16:19,040 WANT TO GET IN ON THIS 1969 01:16:19,040 --> 01:16:20,560 CONVERSATION? 1970 01:16:20,560 --> 01:16:22,000 >> THANK YOU. 1971 01:16:22,000 --> 01:16:23,960 QUICKLY I WANT TO SAY I THINK 1972 01:16:23,960 --> 01:16:25,000 THIS CONFERENCE IS FANTASTIC, I 1973 01:16:25,000 --> 01:16:27,880 HAVE BEEN LISTENING FOR THE LAST 1974 01:16:27,880 --> 01:16:34,120 TWO DAYS MY COMMENT DOUG AND 1975 01:16:34,120 --> 01:16:38,080 DALE, I THINK THAT WHAT I AM 1976 01:16:38,080 --> 01:16:40,280 LEARNING FROM OUR EXPERIENCE AND 1977 01:16:40,280 --> 01:16:44,400 SOME -- HEARING SOME OF THIS 1978 01:16:44,400 --> 01:16:50,960 GROUP, WE NEED TO FIGURE OUT OR 1979 01:16:50,960 --> 01:16:52,840 DEVELOP STRATEGIES HOW TO GET 1980 01:16:52,840 --> 01:16:53,920 OUTSIDE GROUPS WE ARE ALL 1981 01:16:53,920 --> 01:16:58,080 REACHING OUT TO RYE TO BE GET 1982 01:16:58,080 --> 01:16:59,240 DIVERSITY, COMMUNITY PEOPLE 1983 01:16:59,240 --> 01:17:02,600 ENGAGED SO IT IS REAL WORLD. 1984 01:17:02,600 --> 01:17:04,840 IT IS TOUGH ENOUGH IN YOUR OWN 1985 01:17:04,840 --> 01:17:06,280 ACADEMIC HEALTH CENTER TO GET 1986 01:17:06,280 --> 01:17:08,040 YOUR HEALTH SYSTEM TO APPLY AND 1987 01:17:08,040 --> 01:17:09,920 AGREE AND DELIVER POINT OF CARE, 1988 01:17:09,920 --> 01:17:10,560 WHATEVER. 1989 01:17:10,560 --> 01:17:11,640 INTERVENTION IS THAT YOU ARE 1990 01:17:11,640 --> 01:17:13,160 TRYING TO DO. 1991 01:17:13,160 --> 01:17:14,480 LET ALONE SOMEBODY WHO YOU MAY 1992 01:17:14,480 --> 01:17:19,000 NOT HAVE WORKED WITH FOR TEN, 1993 01:17:19,000 --> 01:17:19,560 10, 20 YEARS. 1994 01:17:19,560 --> 01:17:26,480 I DON'T KNOW IF THERE MANY OF 1995 01:17:26,480 --> 01:17:29,080 YOU, MANY OF YOU ARE 1996 01:17:29,080 --> 01:17:30,480 CO-INVESTIGATORS, I HAVE NEVER 1997 01:17:30,480 --> 01:17:32,680 BEEN INVOLVED WITH PCORI, MAYBE 1998 01:17:32,680 --> 01:17:33,960 THERE'S LESSONS, I DON'T KNOW. 1999 01:17:33,960 --> 01:17:36,520 BUT THIS GROUP IS PROBABLY 2000 01:17:36,520 --> 01:17:39,040 LEADING EDGE IN THIS COUNTRY FOR 2001 01:17:39,040 --> 01:17:40,320 THESE KINDS OF TRIALS. 2002 01:17:40,320 --> 01:17:41,760 IT IS SOMETHING -- A TOUGH NUT 2003 01:17:41,760 --> 01:17:43,520 TO CRACK BUT WE HAVE TO COME UP 2004 01:17:43,520 --> 01:17:44,840 WITH STRATEGIES AND FIGURE HOW 2005 01:17:44,840 --> 01:17:45,560 TO DO THAT. 2006 01:17:45,560 --> 01:17:47,160 I DON'T HAVE THE ANSWER. 2007 01:17:47,160 --> 01:17:51,000 JUST RAISING THIS BECAUSE IT IS 2008 01:17:51,000 --> 01:17:51,400 PEEKING NOW. 2009 01:17:51,400 --> 01:17:52,720 YOU CAN'T JUST GO INTO THE 2010 01:17:52,720 --> 01:17:54,600 COMMUNITY AS PEOPLE HAVE SAID, 2011 01:17:54,600 --> 01:17:56,320 YOU CAN'T JUST GO INTO COMMUNITY 2012 01:17:56,320 --> 01:17:58,800 AND SAY WE WANT TO PARTNER AND 2013 01:17:58,800 --> 01:18:00,440 GET THIS GRANT AND THEY SAY 2014 01:18:00,440 --> 01:18:02,200 YEAH, WE WANT TO PARTICIPATE AND 2015 01:18:02,200 --> 01:18:03,480 WITH RECOGNIZED BUT DOWN THE 2016 01:18:03,480 --> 01:18:08,880 ROAD THEY GET SOLD OFF. 2017 01:18:08,880 --> 01:18:10,680 YOU HAVE A NEW SHERIFF IN TOWN. 2018 01:18:10,680 --> 01:18:11,760 NOTHING YOU CAN DO ABOUT THAT 2019 01:18:11,760 --> 01:18:15,120 PER SE. 2020 01:18:15,120 --> 01:18:16,560 PROACTIVELY WHAT I AM THINKING 2021 01:18:16,560 --> 01:18:20,560 NEXT TIME I WILL WRITE PRAGMATIC 2022 01:18:20,560 --> 01:18:23,760 CLINICAL TRIAL I WILL DO MY 2023 01:18:23,760 --> 01:18:25,600 DARNEST TO IDENTIFY WHEREVER 2024 01:18:25,600 --> 01:18:28,360 THEY ARE, PLACES THAT HAVE A 2025 01:18:28,360 --> 01:18:29,800 TRACK RECORD DOING THIS, ALREADY 2026 01:18:29,800 --> 01:18:32,040 HAD SOME EXPERIENCES EVEN THOUGH 2027 01:18:32,040 --> 01:18:33,680 MAY NOT BE PERFECT AND TRY TO 2028 01:18:33,680 --> 01:18:35,600 GET THEM ENGAGED. 2029 01:18:35,600 --> 01:18:38,480 MAYBE Y'ALL ALREADY KNOW ALL 2030 01:18:38,480 --> 01:18:40,960 THIS. 2031 01:18:40,960 --> 01:18:47,760 BUT I THINK THIS IS GROUP IS THE 2032 01:18:47,760 --> 01:18:49,120 LEADERS HELP MOVE THIS FIELD 2033 01:18:49,120 --> 01:18:50,320 FORWARD AND DEFINITELY NEEDS TO 2034 01:18:50,320 --> 01:18:58,080 MOVE FORWARD. 2035 01:18:58,080 --> 01:18:58,960 >> THANK YOU SO MUCH. 2036 01:18:58,960 --> 01:19:00,600 GREAT TO HAVE YOUR INPUT. 2037 01:19:00,600 --> 01:19:01,880 ANY OTHER REACTION FROM THE 2038 01:19:01,880 --> 01:19:03,360 PANELISTS? 2039 01:19:03,360 --> 01:19:06,720 IN TERMS OR THOUGHTS OF HOW BECK 2040 01:19:06,720 --> 01:19:10,040 DO THIS? 2041 01:19:10,040 --> 01:19:11,240 >> ANOTHER THING WITH RFA YOU 2042 01:19:11,240 --> 01:19:16,880 HAVE POT OF MONEY PUT ASIDE FOR 2043 01:19:16,880 --> 01:19:18,200 UNFORESEEN CHALLENGES THAT COME 2044 01:19:18,200 --> 01:19:20,320 UP WITH A GRANT LIKE THIS. 2045 01:19:20,320 --> 01:19:21,960 AND THAT MONEY IS APPLIED FOR 2046 01:19:21,960 --> 01:19:25,720 FOR THE SITES THAT YOU HAVE 2047 01:19:25,720 --> 01:19:26,400 CHOSEN. 2048 01:19:26,400 --> 01:19:28,320 YOU CAN ACTUALLY -- WE ARE 2049 01:19:28,320 --> 01:19:29,120 EMERGENCY PHYSICIAN SO YOU HAVE 2050 01:19:29,120 --> 01:19:30,280 TO PREPARE FOR EVERYTHING AND 2051 01:19:30,280 --> 01:19:31,600 WHEN YOU PREPARE FOR SOMETHING 2052 01:19:31,600 --> 01:19:33,280 THERE IS NO EMERGENCY. 2053 01:19:33,280 --> 01:19:35,400 IF YOU WERE TO PREPARE UP FRONT 2054 01:19:35,400 --> 01:19:37,440 THERE IS GOING TO BE TROUBLE 2055 01:19:37,440 --> 01:19:38,760 THERE WILL BE CHALLENGES AND 2056 01:19:38,760 --> 01:19:43,240 THAT THERE IS THIS POT LEFT AND 2057 01:19:43,240 --> 01:19:45,160 THAT POT CAN BE DIVIDED OR GIVEN 2058 01:19:45,160 --> 01:19:48,320 TO SYSTEMS THAT RUN INTO 2059 01:19:48,320 --> 01:19:49,560 DIFFICULTIES IT MIGHT BE BETTER 2060 01:19:49,560 --> 01:19:52,680 TO DO THAT THAN HAVE FIVE OR SIX 2061 01:19:52,680 --> 01:19:55,880 SITES STRUGGLE AND NOT GET THE 2062 01:19:55,880 --> 01:19:56,640 OUTCOMES THEY NEED. 2063 01:19:56,640 --> 01:19:58,480 >> I WOULD QUESTION WHETHER OR 2064 01:19:58,480 --> 01:20:00,400 NOT IT IS A MONEY ISSUE. 2065 01:20:00,400 --> 01:20:02,160 IN OTHER WORDS HAVING MORE MONEY 2066 01:20:02,160 --> 01:20:08,800 MAY OR MAY NOT SOLVE RECRUITMENT 2067 01:20:08,800 --> 01:20:10,760 OR INTERVENTION HETEROGENEITY 2068 01:20:10,760 --> 01:20:12,360 PROBLEM YOU FACE EVEN IF YOU 2069 01:20:12,360 --> 01:20:13,680 THROW MORE DOLLARS, NOT SAYING I 2070 01:20:13,680 --> 01:20:16,120 DON'T WANT MORE MONEY, EPAULES 2071 01:20:16,120 --> 01:20:16,280 DO. 2072 01:20:16,280 --> 01:20:18,480 JUST SAYING IF YOU HAVE THAT 2073 01:20:18,480 --> 01:20:20,600 MORE MONEY YOU HAVE TO HAVE A 2074 01:20:20,600 --> 01:20:23,280 DARN GOOD REASON FOR HAVING IT 2075 01:20:23,280 --> 01:20:26,400 AND THEN SPENDING IT YOU HAVE TO 2076 01:20:26,400 --> 01:20:27,840 HAVE OUTCOME YOU EXPECT TO 2077 01:20:27,840 --> 01:20:31,840 ACHIEVE BY SPENDING. 2078 01:20:31,840 --> 01:20:34,960 >> WE ARE WORKING INDUCTIVELY 2079 01:20:34,960 --> 01:20:36,120 FROM A FEW TRIALS. 2080 01:20:36,120 --> 01:20:37,840 ONE THAT COMES TO MIND THAT 2081 01:20:37,840 --> 01:20:40,200 ADDRESSES THE ISSUE IN A NOVEL 2082 01:20:40,200 --> 01:20:44,920 WAY IS THE COLLABORATION BETWEEN 2083 01:20:44,920 --> 01:20:47,400 SUSAN WONG AND BAIT AND REDUCE 2084 01:20:47,400 --> 01:20:49,720 PRAGMATIC TRIALS WHERE THEY HOE 2085 01:20:49,720 --> 01:20:51,080 I FORGET WHAT HIS ORGANIZATIONAL 2086 01:20:51,080 --> 01:20:56,640 TITLE WAS BUT HE BASICALLY 2087 01:20:56,640 --> 01:20:57,280 OVERSAW HOSPITAL CORPORATION OF 2088 01:20:57,280 --> 01:21:03,360 AMERICA, THEY HAD A BACTERIAL 2089 01:21:03,360 --> 01:21:04,720 ANTIBACTERIAL BATHING PROTOCOL. 2090 01:21:04,720 --> 01:21:09,120 AND BASICALLY THE DEAL WAS IF IT 2091 01:21:09,120 --> 01:21:10,560 WORKED THERE WOULD BE UPTAKE. 2092 01:21:10,560 --> 01:21:15,080 THEY HAD OVER 50 HOSPITALS 2093 01:21:15,080 --> 01:21:15,920 DIVERSE GROUP OF HOSPITALS ALL 2094 01:21:15,920 --> 01:21:19,120 ONE CORPORATION SO THAT IS STAKE 2095 01:21:19,120 --> 01:21:22,800 HOLDER BUY IN AT THE GET GO CAN 2096 01:21:22,800 --> 01:21:24,000 BE REALLY IMPORTANT. 2097 01:21:24,000 --> 01:21:25,480 IN TERMS OF SORT OF THINKING 2098 01:21:25,480 --> 01:21:26,880 DIFFERENTLY, IN TERMS OF 2099 01:21:26,880 --> 01:21:27,880 COMPARATIVE HEALTHCARE SYSTEMS, 2100 01:21:27,880 --> 01:21:31,920 SO OFTEN WE ARE TRYING TO HELP 2101 01:21:31,920 --> 01:21:34,040 IT HAPPEN BUT BEING ABLE TO 2102 01:21:34,040 --> 01:21:35,600 DECREE THIS WORK THAT IS SORT OF 2103 01:21:35,600 --> 01:21:36,520 A MAKE IT HAPPEN SYSTEM. 2104 01:21:36,520 --> 01:21:37,720 THAT IS ONE WAY AROUND THIS 2105 01:21:37,720 --> 01:21:39,760 ISSUE. 2106 01:21:39,760 --> 01:21:41,440 >> THAT MEANS YOU HAVE GOT A 2107 01:21:41,440 --> 01:21:43,240 COMMITTED LEADERSHIP. 2108 01:21:43,240 --> 01:21:45,640 YOU HAVE PEOPLE COMMITTED AT 2109 01:21:45,640 --> 01:21:51,120 THAT HIGH LEVEL TO GET THAT 2110 01:21:51,120 --> 01:21:51,680 DONE. 2111 01:21:51,680 --> 01:21:56,600 AGREE WITH THAT. 2112 01:21:56,600 --> 01:21:57,640 THAT IS A STRATEGY WE ARE 2113 01:21:57,640 --> 01:21:59,400 WORKING WITH AT OUR INSTITUTION. 2114 01:21:59,400 --> 01:22:01,360 NOT PARTICULARLY IMPACT TRAUMA 2115 01:22:01,360 --> 01:22:03,120 BUT OTHER AREAS THAT INVOLVE 2116 01:22:03,120 --> 01:22:08,760 HEALTH SYSTEM NECESSARILY. 2117 01:22:08,760 --> 01:22:11,320 >> THE OTHER PROGRAM FOR LAST 2118 01:22:11,320 --> 01:22:12,960 YEAR'S WORKSHOP WE DID A GRAND 2119 01:22:12,960 --> 01:22:16,320 ROUNDS SERIES. 2120 01:22:16,320 --> 01:22:20,000 JULIE FRITZSCHE PRESENTED WITH 2121 01:22:20,000 --> 01:22:21,520 HER CAN'T REMEMBER NAME OFF TOP 2122 01:22:21,520 --> 01:22:23,720 OF MY HEAD, HER IMMUNITY PARTNER 2123 01:22:23,720 --> 01:22:25,520 WORKING WITH FEDERALLY QUALIFIED 2124 01:22:25,520 --> 01:22:26,800 HEALTH CENTERS ACROSS THE STATE 2125 01:22:26,800 --> 01:22:28,360 OF UTAH FOR A NUMBER OF YEARS. 2126 01:22:28,360 --> 01:22:29,880 AND THEY HAVE BUILT THIS LONG 2127 01:22:29,880 --> 01:22:32,560 STANDING PARTNERSHIP WITH THE 2128 01:22:32,560 --> 01:22:35,080 COMMUNITY CLINICS ACROSS THE 2129 01:22:35,080 --> 01:22:35,880 STATE. 2130 01:22:35,880 --> 01:22:39,680 THEY CAME TO HER WITH A QUESTION 2131 01:22:39,680 --> 01:22:41,080 SAYING HOW DO WE ADDRESS PAIN 2132 01:22:41,080 --> 01:22:42,320 WITH OUR FACILITIES AND SHE WAS 2133 01:22:42,320 --> 01:22:43,720 THE PAIN RESEARCHER WHO THEN 2134 01:22:43,720 --> 01:22:45,080 BROUGHT IN HOW DO WE DO THIS TO 2135 01:22:45,080 --> 01:22:47,840 HELP THE COMMUNITY CLINICS SO 2136 01:22:47,840 --> 01:22:48,840 THEY HAVE LOOK WHERE THE 2137 01:22:48,840 --> 01:22:52,920 COMMUNITY CLINICS HAVE BEEN 2138 01:22:52,920 --> 01:22:54,840 IDENTIFYING WHAT THE QUESTIONS 2139 01:22:54,840 --> 01:22:56,720 ARE, HE GOES AND FIND RESEARCHER 2140 01:22:56,720 --> 01:22:58,280 TO ADDRESS THE QUESTIONS AT THE 2141 01:22:58,280 --> 01:23:00,240 COMMUNITY HEALTH CENTERS HAVE 2142 01:23:00,240 --> 01:23:02,240 WHICH IS A REALLY INTERESTING 2143 01:23:02,240 --> 01:23:04,800 DIFFERENT WAY THAT I HAVEN'T 2144 01:23:04,800 --> 01:23:09,400 SEEN GROUPS DO WHAT WOULD BE 2145 01:23:09,400 --> 01:23:13,520 GREAT MARY JO I WILL COME AHEAD 2146 01:23:13,520 --> 01:23:15,320 A MOMENT AND THEN GO TO VICTOR. 2147 01:23:15,320 --> 01:23:18,120 IF YOU CAN GO TO THE QUESTION 2148 01:23:18,120 --> 01:23:22,560 SLIDE, SKIP THROUGH -- PERFECT. 2149 01:23:22,560 --> 01:23:23,640 ENCOURAGE OUR AUDIENCE, IF YOU 2150 01:23:23,640 --> 01:23:26,680 HAVE QUESTIONS, PLEASE SEND THEM 2151 01:23:26,680 --> 01:23:27,120 IN. 2152 01:23:27,120 --> 01:23:29,240 BUT DR. SOLAS DID YOU WANT TO 2153 01:23:29,240 --> 01:23:30,200 JUMP INTO THE CONVERSATION AS 2154 01:23:30,200 --> 01:23:30,400 WELL? 2155 01:23:30,400 --> 01:23:33,240 >> I WANTED TO CLARIFY THAT THAT 2156 01:23:33,240 --> 01:23:35,960 ORGANIZATION NAME IS OUCH. 2157 01:23:35,960 --> 01:23:39,560 ASSOCIATION FOR UTAH COMMUNITY 2158 01:23:39,560 --> 01:23:40,440 HEALTH GROUP. 2159 01:23:40,440 --> 01:23:42,440 WHAT YOU SAID WAS ACCURATE. 2160 01:23:42,440 --> 01:23:44,720 JUST SPEAKING ON BEHALF OF DR. 2161 01:23:44,720 --> 01:23:44,960 FRITZSCHE. 2162 01:23:44,960 --> 01:23:50,760 >> THANK YOU SO MUCH. 2163 01:23:50,760 --> 01:23:52,320 OTHER QUESTIONS FROM OUR GROUP 2164 01:23:52,320 --> 01:23:52,800 HERE? 2165 01:23:52,800 --> 01:23:54,360 I WILL TAKE A MOMENT AND SEE IF 2166 01:23:54,360 --> 01:23:56,960 THERE'S ANYTHING FROM THE 2167 01:23:56,960 --> 01:23:58,880 AUDIENCE. 2168 01:23:58,880 --> 01:23:59,920 ONE THING WE TALKED ABOUT IN 2169 01:23:59,920 --> 01:24:01,600 PLANNING FOR THIS MEETING AND 2170 01:24:01,600 --> 01:24:06,840 THE SESSION WAS SORT OF IS THERE 2171 01:24:06,840 --> 01:24:07,600 ANYTHING YOU CAN DO PLANNING 2172 01:24:07,600 --> 01:24:10,960 PHASE TO ANTICIPATE THINGS THAT 2173 01:24:10,960 --> 01:24:13,960 MIGHT COME UP DURING THE TRIAL? 2174 01:24:13,960 --> 01:24:16,480 DOUG YOUR TALKED SECULAR TRENDS 2175 01:24:16,480 --> 01:24:17,600 AND CHANGES THAT HAPPENED 2176 01:24:17,600 --> 01:24:19,080 NATURALLY OVER TIME AND WE HEARD 2177 01:24:19,080 --> 01:24:21,600 FROM A FEW PANELISTS, HAVING 2178 01:24:21,600 --> 01:24:25,160 MULTIPLE CHAMPIONS AT EACH SITE 2179 01:24:25,160 --> 01:24:26,680 BECAUSE INEVITABLY PEOPLE MOVE 2180 01:24:26,680 --> 01:24:28,440 ON OR MORE LIKELY THEY PROMOTE 2181 01:24:28,440 --> 01:24:33,760 IT OR HIRED OUT BY SOMEBODY EL 2182 01:24:33,760 --> 01:24:33,960 ELSE. 2183 01:24:33,960 --> 01:24:34,760 ANYTHING YOU RECOMMEND IN TERMS 2184 01:24:34,760 --> 01:24:36,800 HOW YOU ANTICIPATE THOSE SECULAR 2185 01:24:36,800 --> 01:24:40,360 TRENDS? 2186 01:24:40,360 --> 01:24:42,040 >> THIS IS NOT SECULAR TRENDS, 2187 01:24:42,040 --> 01:24:46,200 THIS IS ABOUT OTHER -- BUT OTHER 2188 01:24:46,200 --> 01:24:47,080 THINGS SPECIFIC SECULAR TRENDS 2189 01:24:47,080 --> 01:24:51,840 ARE HARD TO PREDICT IF YOU -- 2190 01:24:51,840 --> 01:24:57,440 YOU ADDRESS CREATE SKILL. 2191 01:24:57,440 --> 01:24:58,760 BUT I THINK YOU MENTIONED THIS 2192 01:24:58,760 --> 01:25:01,800 IN YOUR INTRODUCTION AND NONE 2193 01:25:01,800 --> 01:25:08,320 TALKED ABOUT IT. 2194 01:25:08,320 --> 01:25:09,880 THIS ISSUE WITH HARD SITES, I 2195 01:25:09,880 --> 01:25:14,440 WANT TO EMPHASIZE THAT. 2196 01:25:14,440 --> 01:25:17,240 BECAUSE IT IS NATURAL DURING 2197 01:25:17,240 --> 01:25:18,560 PILOT PHASE OR INITIATION PHASE 2198 01:25:18,560 --> 01:25:20,760 TO GO TO THE PLACE WHERE YOU 2199 01:25:20,760 --> 01:25:22,560 KNOW YOU CAN GET THE THING DONE 2200 01:25:22,560 --> 01:25:26,280 YOU HAVE YOUR BEST WORKING 2201 01:25:26,280 --> 01:25:27,200 PARTNERS, YOU CAN FEEL LIKE YOU 2202 01:25:27,200 --> 01:25:29,320 CAN TRY THINGS OUT. 2203 01:25:29,320 --> 01:25:32,160 I HAVE FOUND NOT JUST 2204 01:25:32,160 --> 01:25:33,520 (INAUDIBLE) BUT OTHER STUDIES I 2205 01:25:33,520 --> 01:25:37,880 HAVE BEEN INVOLVED WITH, THAT IT 2206 01:25:37,880 --> 01:25:41,680 CAN LEAD ONE TO FALSE CONFLICTS 2207 01:25:41,680 --> 01:25:45,080 BECAUSE YOU CONSCIOUSLY OR 2208 01:25:45,080 --> 01:25:48,240 UNCONSCIOUSLY WE BIAS FORWARD 2209 01:25:48,240 --> 01:25:50,000 STARTING WITH THE GROUP WHATEVER 2210 01:25:50,000 --> 01:25:53,720 THAT MIGHT BE THAT IS MOST -- 2211 01:25:53,720 --> 01:25:55,480 THAT IS EASIEST OR GOING TO BE 2212 01:25:55,480 --> 01:25:56,680 MOST AMENABLE. 2213 01:25:56,680 --> 01:25:59,960 AND THAT IS A NATURAL 2214 01:25:59,960 --> 01:26:01,720 INCLINATION. 2215 01:26:01,720 --> 01:26:07,440 IN FACT YOU THEN THE NEXT SIDE 2216 01:26:07,440 --> 01:26:08,440 TURNED OUT VERY DIFFERENCE AND 2217 01:26:08,440 --> 01:26:09,080 HARD. 2218 01:26:09,080 --> 01:26:12,920 SO I THINK IT IS AS CRAZY AS IT 2219 01:26:12,920 --> 01:26:16,040 SOUNDS IDEALLY YOU CAN DO TWO 2220 01:26:16,040 --> 01:26:18,880 PLACES ONE WHERE YOU CAN GET 2221 01:26:18,880 --> 01:26:20,720 PROCESSES EASILY PUT INTO PLACE 2222 01:26:20,720 --> 01:26:22,040 AND MAKE SURE YOU HAVE 2223 01:26:22,040 --> 01:26:22,640 COOPERATION. 2224 01:26:22,640 --> 01:26:25,320 MAYBE A SITE THAT YOU ARE 2225 01:26:25,320 --> 01:26:26,240 WORRIED ABOUT. 2226 01:26:26,240 --> 01:26:29,680 AND GET A SENSE OF WHAT ARE THE 2227 01:26:29,680 --> 01:26:31,840 CONCERNS, BECAUSE WHERE IS THE 2228 01:26:31,840 --> 01:26:33,760 PUSH BACK COMING FROM. 2229 01:26:33,760 --> 01:26:37,000 WHAT ARE THE RESISTANCE. 2230 01:26:37,000 --> 01:26:39,920 TO RESEARCH OR GETTING THE DATA 2231 01:26:39,920 --> 01:26:43,440 OUT. 2232 01:26:43,440 --> 01:26:47,520 THAT IS ANY MODULE FOR ME GOING 2233 01:26:47,520 --> 01:26:48,960 FORWARD START WITH SOME SITES 2234 01:26:48,960 --> 01:26:54,440 THAT ARE NOT GOING TO BE AS 2235 01:26:54,440 --> 01:26:56,000 EASY. 2236 01:26:56,000 --> 01:26:59,240 >> GOOD ADVICE. 2237 01:26:59,240 --> 01:27:04,360 OTHERS? 2238 01:27:04,360 --> 01:27:07,440 JAMES THIS TRANSITIONS MADE TO 2239 01:27:07,440 --> 01:27:10,320 THIS LAST QUESTION I WAS GOING 2240 01:27:10,320 --> 01:27:11,960 ASK YOU AND TIME FOR ALL OF YOU 2241 01:27:11,960 --> 01:27:14,400 TO ADDRESS THIS, THIS SORT OF -- 2242 01:27:14,400 --> 01:27:17,920 WHAT IS YOUR ADVICE TO THOSE 2243 01:27:17,920 --> 01:27:19,000 PUTTING THESE APPLICATIONS 2244 01:27:19,000 --> 01:27:20,320 TOGETHER OR THINKING ABOUT 2245 01:27:20,320 --> 01:27:23,800 DURING PRAGMATIC TRIALS COUPLE 2246 01:27:23,800 --> 01:27:25,240 OF THINGS YOU ENCOURAGE THEM TO 2247 01:27:25,240 --> 01:27:29,400 DO DURING THEIR PLANNING PHASE. 2248 01:27:29,400 --> 01:27:31,040 YOU THINK KEY ELEMENTS SET UP 2249 01:27:31,040 --> 01:27:35,280 FOR SUCCESS. 2250 01:27:35,280 --> 01:27:43,280 >> I LOVER THE OUCH ACRONYM. 2251 01:27:43,280 --> 01:27:44,360 I HAVE BEEN SAYING THIS QUITE A 2252 01:27:44,360 --> 01:27:46,880 WHILE BUT THE MORE YOU CAN ALIGN 2253 01:27:46,880 --> 01:27:51,240 YOUR TRIAL, THESE TRIALS ARE SO 2254 01:27:51,240 --> 01:27:55,720 HARD I SURVIVED COVID BUT ALMOST 2255 01:27:55,720 --> 01:27:56,640 DIDN'T SURVIVE (INAUDIBLE) 2256 01:27:56,640 --> 01:27:57,560 YESTERDAY. 2257 01:27:57,560 --> 01:27:59,520 HAVING SOME UMF AT THE COMMUNITY 2258 01:27:59,520 --> 01:28:02,440 LEVEL AND POLICY LEVEL, IT IS 2259 01:28:02,440 --> 01:28:06,360 IMPORTANT FOR THE TRIAL AND 2260 01:28:06,360 --> 01:28:08,520 MOREALE OF THE TEAM BUT ALSO A 2261 01:28:08,520 --> 01:28:10,680 REASON TO DO THE TRIAL. 2262 01:28:10,680 --> 01:28:15,040 I WAS UNAWARE OF THE OUCH GROUP. 2263 01:28:15,040 --> 01:28:17,000 THAT IS FANTASTIC BECAUSE THAT 2264 01:28:17,000 --> 01:28:18,440 GETS YOU THROUGH -- IF YOU CAN 2265 01:28:18,440 --> 01:28:21,080 TAKE AN ISSUE REALLY IMPORTANT 2266 01:28:21,080 --> 01:28:22,840 AND YOU HAVE A POLICY GROUP OR 2267 01:28:22,840 --> 01:28:24,160 COMMUNITY GROUP WILLING TO TAKE 2268 01:28:24,160 --> 01:28:25,920 ACTION ON THE RESULTS, AND YOU 2269 01:28:25,920 --> 01:28:29,640 LINE THAT UP TO BEGIN WITH, THAT 2270 01:28:29,640 --> 01:28:31,440 CAN KEEP THE VIGOR AND THE LIFE 2271 01:28:31,440 --> 01:28:33,600 FORCE GOING. 2272 01:28:33,600 --> 01:28:38,880 TO WHAT IS REALLY A PAST PREDICT 2273 01:28:38,880 --> 01:28:47,920 FUTURE THESE ARE HARD TO DO. 2274 01:28:47,920 --> 01:28:51,400 >> OTHER ADVICE TO THOSE WHO ARE 2275 01:28:51,400 --> 01:28:52,960 GOING TO PURSUE THE SAME PATH 2276 01:28:52,960 --> 01:28:58,960 YOU HAVE? 2277 01:28:58,960 --> 01:29:01,160 >> I FEEL I SAID THINGS I WOULD 2278 01:29:01,160 --> 01:29:07,000 RECOMMEND BUT DOUG'S COMMENT 2279 01:29:07,000 --> 01:29:08,440 THINGS I HEARD HIGHLIGHT THIS 2280 01:29:08,440 --> 01:29:10,400 QUESTION IS ARE SITES PARTNERS 2281 01:29:10,400 --> 01:29:14,320 OR SCOTI SUBJECTS? 2282 01:29:14,320 --> 01:29:15,960 WHEN WE TREAT THEM LIKE SUBJECTS 2283 01:29:15,960 --> 01:29:17,080 WHEN THEY ARE SUBJECTS 2284 01:29:17,080 --> 01:29:19,840 DROPPENING TRYING TO DO 2285 01:29:19,840 --> 01:29:20,520 SOMETHING BECAUSE THEY HAVE WHAT 2286 01:29:20,520 --> 01:29:23,520 WE NEED, WE STRUGGLE. 2287 01:29:23,520 --> 01:29:25,320 IF THEY ARE TRUE PARTNERS, I 2288 01:29:25,320 --> 01:29:27,640 LOVE THIS IDEA THE SITES 2289 01:29:27,640 --> 01:29:30,560 GENERATING IDEAS RESEARCH ON, IF 2290 01:29:30,560 --> 01:29:32,880 THEY ARE TRUE PARTNERS THEN THEY 2291 01:29:32,880 --> 01:29:34,520 ARE TRUE PARTNERS, THEN IT WILL 2292 01:29:34,520 --> 01:29:35,600 BE DIFFERENT, THEY ARE MUCH MORE 2293 01:29:35,600 --> 01:29:36,640 INVESTED. 2294 01:29:36,640 --> 01:29:38,240 WHAT THAT MEANS IS USUALLY 2295 01:29:38,240 --> 01:29:40,720 HAVING LONGITUDINAL 2296 01:29:40,720 --> 01:29:41,320 RELATIONSHIPS OVER VERY LONG 2297 01:29:41,320 --> 01:29:45,800 PERIOD OF TIME. 2298 01:29:45,800 --> 01:29:48,480 WITH PLACES, TO THE EXTENT ONE 2299 01:29:48,480 --> 01:29:54,440 DEVELOP (INAUDIBLE). 2300 01:29:54,440 --> 01:29:57,040 >> GAIL OR MICHAEL. 2301 01:29:57,040 --> 01:30:00,600 >> I REALLY LIKE WHAT JAMES SAID 2302 01:30:00,600 --> 01:30:02,200 IN TERMS OF HAVING PARTNERS. 2303 01:30:02,200 --> 01:30:05,600 FORMING COLLABORATIVE 2304 01:30:05,600 --> 01:30:07,600 RELATIONSHIPS WITH YOUR SITES, 2305 01:30:07,600 --> 01:30:10,880 SO I THINK IT RESONATES WELL 2306 01:30:10,880 --> 01:30:11,400 WITH ME. 2307 01:30:11,400 --> 01:30:14,200 I THINK YOU REALLY -- IT HAS 2308 01:30:14,200 --> 01:30:18,200 BEEN HELPFUL TO HAVE SITES AS 2309 01:30:18,200 --> 01:30:20,040 PARTNERS AND COLLABORATORS 2310 01:30:20,040 --> 01:30:23,960 RATHER THAN WHERE RESEARCHERS, 2311 01:30:23,960 --> 01:30:27,680 YOU DON'T HAVE ANY SAY, I THINK 2312 01:30:27,680 --> 01:30:30,440 THE CONVERSATIONS AND THE 2313 01:30:30,440 --> 01:30:32,560 COLLABORATION HAS BEEN GREAT AND 2314 01:30:32,560 --> 01:30:34,760 REALLY HAS MADE RESEARCH BETTER. 2315 01:30:34,760 --> 01:30:39,320 I THINK IT ALSO HELPED WHEN 2316 01:30:39,320 --> 01:30:40,760 COVID HIT IN TERMS OF BEING ABLE 2317 01:30:40,760 --> 01:30:44,840 TO COME UP WITH SOLUTIONS 2318 01:30:44,840 --> 01:30:50,840 LOCALLY. 2319 01:30:50,840 --> 01:30:53,000 >> I WOULD ADD YOU WANT TO 2320 01:30:53,000 --> 01:30:54,480 CONTRIBUTE TO SOMETHING EVEN IF 2321 01:30:54,480 --> 01:30:55,320 ONE YOUR CONTROL SITES OR 2322 01:30:55,320 --> 01:30:59,240 WHATEVER. 2323 01:30:59,240 --> 01:31:01,320 TO KEEP EVERYBODY ON BOARD TO BE 2324 01:31:01,320 --> 01:31:03,000 PASSIONATE ABOUT WHAT YOU ARE 2325 01:31:03,000 --> 01:31:06,000 DOING, WHATEVER THE RESULTS ARE 2326 01:31:06,000 --> 01:31:09,560 MOVING FORWARD SOME OF THAT WE 2327 01:31:09,560 --> 01:31:11,400 ARE LUCKY EMBED THAT EPIC IS 2328 01:31:11,400 --> 01:31:14,520 GOING TO EMBED THIS IN THEIR NEW 2329 01:31:14,520 --> 01:31:16,040 ITERATION SO IT IS GIVEN TO 2330 01:31:16,040 --> 01:31:17,880 EVERY SIGHT NO MATTER WHAT THEY 2331 01:31:17,880 --> 01:31:21,400 WERE CONTROL SITE OR NOT. 2332 01:31:21,400 --> 01:31:23,040 EVEN IF NOT THE CASE TO FIGURE 2333 01:31:23,040 --> 01:31:25,040 OUT WHAT YOU CAN DO TO MAKE 2334 01:31:25,040 --> 01:31:26,480 THINGS BETTER FOR EACH SITES 2335 01:31:26,480 --> 01:31:27,520 THAT ARE WORKING WITH YOU AND 2336 01:31:27,520 --> 01:31:30,360 THESE COLLABORATORS. 2337 01:31:30,360 --> 01:31:32,960 IT IS HARD TO SAY TO A GROUP 2338 01:31:32,960 --> 01:31:35,520 WHAT DO YOU WANT BEFORE YOU GET 2339 01:31:35,520 --> 01:31:38,720 THE GRANT BECAUSE I HAVE BEEN IN 2340 01:31:38,720 --> 01:31:42,600 THAT POSITION TOO WORKED WITH A 2341 01:31:42,600 --> 01:31:44,080 SYSTEM AND DIDN'T GET IT. 2342 01:31:44,080 --> 01:31:45,200 LET'S TRY SOMETHING ELSE, ONLY 2343 01:31:45,200 --> 01:31:48,040 SO MUCH YOU CAN DO TO GET THAT 2344 01:31:48,040 --> 01:31:48,440 FUNDED. 2345 01:31:48,440 --> 01:31:50,200 SO IT IS A CATCH 22 BUT IF YOU 2346 01:31:50,200 --> 01:31:51,800 HAVE THE STUDY OF COURSE IT IS 2347 01:31:51,800 --> 01:31:53,800 GREAT TO GO OUT AND SEE WHAT 2348 01:31:53,800 --> 01:31:54,880 MOTIVATES THEM, WHAT ARE THE 2349 01:31:54,880 --> 01:31:58,280 REAL ISSUES AND HOW HELP THEM IN 2350 01:31:58,280 --> 01:31:59,080 ANY WAY POSSIBLE DURING THE 2351 01:31:59,080 --> 01:32:06,080 PROCESS. 2352 01:32:06,080 --> 01:32:07,320 >> GOOD ADVISE. 2353 01:32:07,320 --> 01:32:09,320 ANY PANELISTS OR QUESTIONS YOU 2354 01:32:09,320 --> 01:32:11,960 HAVE FOR ONE ANOTHER OR ITEMS, 2355 01:32:11,960 --> 01:32:13,760 WE HAVE A FEW MORE MINUTES 2356 01:32:13,760 --> 01:32:14,760 BEFORE I WRAP UP WITH RESOURCES 2357 01:32:14,760 --> 01:32:20,400 FOR THE AUDIENCE. 2358 01:32:20,400 --> 01:32:30,680 GREAT DISCUSSION. 2359 01:32:32,120 --> 01:32:33,840 I THINK WE TALKED ABOUT 2360 01:32:33,840 --> 01:32:36,840 RESOURCES, WE TALKED SOME ABOUT 2361 01:32:36,840 --> 01:32:42,120 CHALLENGES. 2362 01:32:42,120 --> 01:32:45,400 THIS IDEA OF REMINDS ME THE 2363 01:32:45,400 --> 01:32:48,720 QUOTE WE BRING UP A LOT FROM 2364 01:32:48,720 --> 01:32:50,960 GREG SIMON OF THE TAIL WAGGING 2365 01:32:50,960 --> 01:32:54,680 THE DOG AND THIS IDEA OF 2366 01:32:54,680 --> 01:32:57,520 RESEARCH IS REALLY THE TAIL AND 2367 01:32:57,520 --> 01:32:59,720 DOG IS THE HEALTHCARE SYSTEM AND 2368 01:32:59,720 --> 01:33:01,720 GOT TO REMEMBER WHO IS IN CHARGE 2369 01:33:01,720 --> 01:33:06,000 KIND OF THING. 2370 01:33:06,000 --> 01:33:07,520 HOW WE BUILD PARTNERSHIPS AND 2371 01:33:07,520 --> 01:33:09,520 TIME IT TAKES TO BUILD 2372 01:33:09,520 --> 01:33:12,720 PARTNERSHIPS AND COME UP WITH 2373 01:33:12,720 --> 01:33:16,000 QUESTIONS IMPORTANT ABOUT AND 2374 01:33:16,000 --> 01:33:18,960 DOUG, YOU DIDN'T TALK TODAY OR 2375 01:33:18,960 --> 01:33:22,040 YESTERDAY ABOUT RELATIONSHIP YOU 2376 01:33:22,040 --> 01:33:24,360 HAVE AND REALLY PUTTING THIS 2377 01:33:24,360 --> 01:33:26,880 TOGETHER WITH ACCREDITATION 2378 01:33:26,880 --> 01:33:28,520 AGENCY AND YOUR PLANNING 2379 01:33:28,520 --> 01:33:29,320 PROCESS. 2380 01:33:29,320 --> 01:33:32,160 THAT SOMETHING THAT IS UNIQUE, 2381 01:33:32,160 --> 01:33:34,000 CAN YOU TELL US A LITTLE BIT 2382 01:33:34,000 --> 01:33:36,800 ABOUT SORT OF HOW YOU REALLY 2383 01:33:36,800 --> 01:33:38,560 HAVE FROM THE TIME OF DOING THE 2384 01:33:38,560 --> 01:33:39,720 TRIAL YOU HAVE THIS PLAN HOW IT 2385 01:33:39,720 --> 01:33:40,800 WILL BE IMPLEMENTED TO THE VERY 2386 01:33:40,800 --> 01:33:45,160 END. 2387 01:33:45,160 --> 01:33:46,800 >> YOU SAID AT THE INTRO I TELL 2388 01:33:46,800 --> 01:33:49,200 GOOD STORIES SO I STARTED OUT 2389 01:33:49,200 --> 01:33:52,320 WITH STORY, I BELIEVE I WON THE 2390 01:33:52,320 --> 01:33:55,720 COLLABORATORY OPRAH WINFREY 2391 01:33:55,720 --> 01:33:57,360 AWARD SINGING THE PRAISE OF THE 2392 01:33:57,360 --> 01:33:59,200 TSOS TRIAL O I MANAGED NOT THE 2393 01:33:59,200 --> 01:34:00,800 TALK ABOUT THAT. 2394 01:34:00,800 --> 01:34:06,000 BUT I WILL PUT ON MY OPRAH HAD. 2395 01:34:06,000 --> 01:34:08,640 IT HAS TO DO WITH PLANNING 2396 01:34:08,640 --> 01:34:09,800 PHASE, THE REASON WE ARE 2397 01:34:09,800 --> 01:34:10,800 INTERESTED IN THAT 2398 01:34:10,800 --> 01:34:13,080 REPRESENTATIVE POPULATION OF 2399 01:34:13,080 --> 01:34:15,480 SITES IS BECAUSE IF WE KNEW 2400 01:34:15,480 --> 01:34:17,160 ONGOING DIALOGUE WITH AMERICAN 2401 01:34:17,160 --> 01:34:19,800 COLLEGE OF SURGEONS' COMMITTEE 2402 01:34:19,800 --> 01:34:22,000 ON TRAUMA WHICH HAS CAPACITY TO 2403 01:34:22,000 --> 01:34:24,120 REQUIRE ALCOHOL SCREENING AND 2404 01:34:24,120 --> 01:34:25,960 INTERVENTION, AFTER OUR PAST 2405 01:34:25,960 --> 01:34:28,640 TRIAL THEY REQUIRED ALL LEVEL 1 2406 01:34:28,640 --> 01:34:30,960 AND 2 TRAUMA CENTERS TO SCREEN 2407 01:34:30,960 --> 01:34:34,000 INTERVENE FOR ALCOHOL SO WE WERE 2408 01:34:34,000 --> 01:34:35,000 LOOKING FOR SOMETHING SIMILAR 2409 01:34:35,000 --> 01:34:37,760 FROM RESULTS OF TSOS FOR PTSD 2410 01:34:37,760 --> 01:34:42,800 FROM THE COLLEGE. 2411 01:34:42,800 --> 01:34:44,120 WITH THAT SURGERY PUBLICATION 2412 01:34:44,120 --> 01:34:46,600 THERE IS AN EDITORIAL BY LEADING 2413 01:34:46,600 --> 01:34:49,720 TRAUMA SURGEON, LETS'S JUST DO 2414 01:34:49,720 --> 01:34:52,320 THIS, LET'S IMPLEMENT 2415 01:34:52,320 --> 01:34:53,400 COLLABORATIVE CARE. 2416 01:34:53,400 --> 01:34:55,720 BECAUSE OF THE RESULTS OF THE 2417 01:34:55,720 --> 01:34:58,360 TRIAL, HELD BACK, WE DIDN'T 2418 01:34:58,360 --> 01:35:00,000 RECOMMEND INTERVENTION, WE 2419 01:35:00,000 --> 01:35:01,040 THOUGHT SCREENING AND REFERRAL 2420 01:35:01,040 --> 01:35:03,120 WOULD BE APPROPRIATE AND NOW 2421 01:35:03,120 --> 01:35:05,640 THERE IS THIS YEAR COLLEGE 2422 01:35:05,640 --> 01:35:07,200 REQUIREMENT NATIONWIDE THAT 2423 01:35:07,200 --> 01:35:09,360 LEVEL 1 AND 2 TRAUMA CENTERS 2424 01:35:09,360 --> 01:35:11,720 SCREEN AND REFER FOR PTSD. 2425 01:35:11,720 --> 01:35:15,840 DATA FROM OUR TRIAL ACTUALLY WE 2426 01:35:15,840 --> 01:35:20,240 SAW THAT -- WE SAW -- WE TALKED 2427 01:35:20,240 --> 01:35:22,200 A BUNCH OF SITES THAT DIDN'T DO 2428 01:35:22,200 --> 01:35:23,680 A GOOD JOB WITH THE 2429 01:35:23,680 --> 01:35:24,400 INTERVENTION. 2430 01:35:24,400 --> 01:35:26,840 THAT WORRIED US IF THERE COULD 2431 01:35:26,840 --> 01:35:30,600 BE REQUIREMENT WITHOUT NATIONAL 2432 01:35:30,600 --> 01:35:32,600 QUALITY RUBRIC WE HAVE SITES 2433 01:35:32,600 --> 01:35:34,160 DOING THIS BUT NOT DOING IT 2434 01:35:34,160 --> 01:35:35,640 WELL. 2435 01:35:35,640 --> 01:35:39,040 SO THE TRIAL DID INFORM POLICY 2436 01:35:39,040 --> 01:35:41,800 AND WHILE WE LOVE TO HAVE SEEN A 2437 01:35:41,800 --> 01:35:44,040 NATIONWIDE REQUIREMENT FOR PTSD 2438 01:35:44,040 --> 01:35:45,840 INTERVENTION WE DIDN'T FEEL THE 2439 01:35:45,840 --> 01:35:48,240 DATA WAS THERE. 2440 01:35:48,240 --> 01:35:50,840 IT HAS BEEN REALLY INTERESTING 2441 01:35:50,840 --> 01:35:52,280 PROCESS AND IT IS A LOT OF 2442 01:35:52,280 --> 01:35:55,280 WEIGHT ON A TRIAL ESPECIALLY IF 2443 01:35:55,280 --> 01:35:57,840 YOU MAKE AS GAIL SAID COMMUNITY 2444 01:35:57,840 --> 01:35:59,040 HOSPITALS THAT AREN'T UNIVERSITY 2445 01:35:59,040 --> 01:36:00,640 SITES DO SOMETHING LIKE THIS SO 2446 01:36:00,640 --> 01:36:02,200 THAT IS WHERE YOU WANT TO BE 2447 01:36:02,200 --> 01:36:03,880 CERTAIN YOU KICK THE TIRES AND 2448 01:36:03,880 --> 01:36:05,560 WENT TO SITES THAT HAVEN'T DONE 2449 01:36:05,560 --> 01:36:07,880 RESEARCH BUT HAVE TO ROLE THIS 2450 01:36:07,880 --> 01:36:09,360 OUT AS PART OF COLLEGE MANDATE 2451 01:36:09,360 --> 01:36:11,600 OR REQUIREMENT. 2452 01:36:11,600 --> 01:36:16,840 I WILL TAKE OFF THE OPRAH HAT. 2453 01:36:16,840 --> 01:36:18,080 I WAS WITH THE STEERING 2454 01:36:18,080 --> 01:36:19,200 COMMITTEE LIKE TO KNOW WHAT SOME 2455 01:36:19,200 --> 01:36:22,080 OF THE OTHER AWARDS WERE, AND -- 2456 01:36:22,080 --> 01:36:23,000 I WILL STOP. 2457 01:36:23,000 --> 01:36:24,480 >> WE WILL GET THE LIST FOR YOU 2458 01:36:24,480 --> 01:36:27,040 DOUG. 2459 01:36:27,040 --> 01:36:28,600 GAIL DID YOU WANT TO COMMENT? 2460 01:36:28,600 --> 01:36:31,320 >> I WAS GOING TO SAY WE -- SO 2461 01:36:31,320 --> 01:36:34,200 REAL PROBLEM WITH UNFUNDED 2462 01:36:34,200 --> 01:36:35,120 MANDATES. 2463 01:36:35,120 --> 01:36:38,720 TO COMMUNITY SMALLER HOSPITALS 2464 01:36:38,720 --> 01:36:41,280 AND EVEN LARGER HOSPITALS THAT 2465 01:36:41,280 --> 01:36:43,600 CAN'T WIN OVER LEADERSHIP ENTETE 2466 01:36:43,600 --> 01:36:47,120 SO THAT IS A REAL PROBLEM. 2467 01:36:47,120 --> 01:36:48,680 AGAIN WHEN DOING THIS, DOUG WHEN 2468 01:36:48,680 --> 01:36:51,040 YOU HAVE DONE PHENOMENAL WORK IT 2469 01:36:51,040 --> 01:36:53,240 NEEDS TO GO TO CMS AND CMS HAS 2470 01:36:53,240 --> 01:36:54,920 TO TAKE IT OVER, ONE THING THAT 2471 01:36:54,920 --> 01:36:56,240 IS REQUIRED AND THEN GETS DONE. 2472 01:36:56,240 --> 01:36:58,680 WITHOUT THAT, IT IS AN UNFUNDED 2473 01:36:58,680 --> 01:37:00,680 MANDATE AND IT DOESN'T WORK. 2474 01:37:00,680 --> 01:37:02,680 JUST LIKE REFERRAL DOESN'T WORK 2475 01:37:02,680 --> 01:37:04,760 IN MOST PLACES NO ONE TO SEND 2476 01:37:04,760 --> 01:37:05,600 THEM TO. 2477 01:37:05,600 --> 01:37:09,960 BUT IF CMS GET IN LINE THEN 2478 01:37:09,960 --> 01:37:10,720 THINGS WORK. 2479 01:37:10,720 --> 01:37:14,360 >> GAIL, AS YOU KNOW, TRAUMA 2480 01:37:14,360 --> 01:37:17,840 SURGERY WORK BEFORE WENT TO SEE 2481 01:37:17,840 --> 01:37:19,600 GALVANIZING TRAUMA SURGEON, GOT 2482 01:37:19,600 --> 01:37:21,920 THE CPT CODES FOR ALCOHOL 2483 01:37:21,920 --> 01:37:23,200 SCREENING AND BRIEF INTERVENTION 2484 01:37:23,200 --> 01:37:24,640 AS PARTS OF THE LAST TRIAL. 2485 01:37:24,640 --> 01:37:26,160 IT IS A LOT -- THERE IS A LOT OF 2486 01:37:26,160 --> 01:37:27,360 WORK ON THAT END AS WELL. 2487 01:37:27,360 --> 01:37:29,000 >> LOT TO DO. 2488 01:37:29,000 --> 01:37:30,720 LOT TO DO. 2489 01:37:30,720 --> 01:37:33,080 >> IT IS AMAZING THESE TRIALS 2490 01:37:33,080 --> 01:37:35,480 CAN INFORM THOSE KINDS OF POLICY 2491 01:37:35,480 --> 01:37:37,280 DECISIONS, AND INFORM THOSE 2492 01:37:37,280 --> 01:37:40,760 PAYER DECISIONS, ABOUT WHEN DOES 2493 01:37:40,760 --> 01:37:42,320 IT MAKE SENSE TO HAVE A 2494 01:37:42,320 --> 01:37:43,640 SCREENING PIECE VERSUS AN 2495 01:37:43,640 --> 01:37:45,960 INTERVENTION PIECE AND THE 2496 01:37:45,960 --> 01:37:49,240 NUANCES, REALLY EXCITING AND I 2497 01:37:49,240 --> 01:37:52,400 THINK CERTAINLY AS A -- WHO 2498 01:37:52,400 --> 01:37:53,440 TALKS TO INVESTIGATORS I WANT TO 2499 01:37:53,440 --> 01:37:55,200 DO A PRAGMATIC TRIAL, WHAT IS 2500 01:37:55,200 --> 01:37:56,120 YOUR RESEARCH QUESTION? 2501 01:37:56,120 --> 01:37:58,000 AND FIGURE OUT IF PRAGMATIC 2502 01:37:58,000 --> 01:37:59,000 TRIAL IS THE BEST WAY TO DO 2503 01:37:59,000 --> 01:37:59,360 THAT. 2504 01:37:59,360 --> 01:38:01,760 AS YOU HAVE SHARED, THESE ARE 2505 01:38:01,760 --> 01:38:04,000 TOUGH STUDIES TO DO, THEY ANSWER 2506 01:38:04,000 --> 01:38:05,880 DIFFERENT QUESTIONS AND REALLY 2507 01:38:05,880 --> 01:38:06,680 IMPORTANT QUESTIONS BUT THEY ARE 2508 01:38:06,680 --> 01:38:08,360 NOT NECESSARILY THE EASIEST 2509 01:38:08,360 --> 01:38:11,160 KINDS OF STUDIES TO DO. 2510 01:38:11,160 --> 01:38:13,840 WITH THAT I WANT TO THANK OUR 2511 01:38:13,840 --> 01:38:15,560 AMAZING INVESTIGATORS FOR 2512 01:38:15,560 --> 01:38:17,480 SHARING ALL OF YOUR CHALLENGES 2513 01:38:17,480 --> 01:38:19,760 AND HOW YOU OVERCAME THEM DURING 2514 01:38:19,760 --> 01:38:20,560 PLANNING PHASE. 2515 01:38:20,560 --> 01:38:23,760 I WILL GO MARY JO BACK A COUPLE 2516 01:38:23,760 --> 01:38:26,640 OF SLIDES, ON THOSE RESOURCES 2517 01:38:26,640 --> 01:38:29,200 SLIDES, I DID WANT TO SHARE WITH 2518 01:38:29,200 --> 01:38:30,680 EVERYONE SOME INFORMATION THAT 2519 01:38:30,680 --> 01:38:33,280 IS AVAILABLE ON THE PRAGMATIC 2520 01:38:33,280 --> 01:38:35,040 TRIALS COLLABORATORY WEBSITE. 2521 01:38:35,040 --> 01:38:37,120 ONE IS THIS LIVING TEXTBOOK 2522 01:38:37,120 --> 01:38:38,760 WHICH IS WHERE YOU WILL END UP 2523 01:38:38,760 --> 01:38:41,280 WHEN YOU CLICK OR DO THE SEARCH 2524 01:38:41,280 --> 01:38:42,480 FOR THIS PARTICULAR SITE. 2525 01:38:42,480 --> 01:38:44,360 THAT HAS A WEALTH OF INFORMATION 2526 01:38:44,360 --> 01:38:46,480 AND RESOURCES THAT HAVE BEEN PUT 2527 01:38:46,480 --> 01:38:48,000 TOGETHER BY THE COORDINATING 2528 01:38:48,000 --> 01:38:49,440 CENTER AND MANY OF THE LESSONS 2529 01:38:49,440 --> 01:38:51,560 LEARNED ACROSS THE DIFFERENT 2530 01:38:51,560 --> 01:38:51,960 TRIALS. 2531 01:38:51,960 --> 01:38:55,360 THERE IS A WHOLE SERIES OF 2532 01:38:55,360 --> 01:38:58,480 CHAPTERS HERE AROUND DESIGN, 2533 01:38:58,480 --> 01:39:02,440 AROUND DATA TOOLS AND CONDUCT OF 2534 01:39:02,440 --> 01:39:04,200 PRAGMATIC TRIALS AS WELL AS 2535 01:39:04,200 --> 01:39:06,640 DISSEMINEIGH AND YOU LEARN A LOT 2536 01:39:06,640 --> 01:39:07,040 OF INFORMATION. 2537 01:39:07,040 --> 01:39:09,680 IF YOU GO TO THE NEXT SLIDE I 2538 01:39:09,680 --> 01:39:14,640 THINK I PULLED UP HERE IN THE 2539 01:39:14,640 --> 01:39:16,560 TOOL SECTION YOU CAN FIND SERIES 2540 01:39:16,560 --> 01:39:19,000 OF DIFFERENT QUICK START GUIDES 2541 01:39:19,000 --> 01:39:20,920 WHICH AS YOU THINK ABOUT 2542 01:39:20,920 --> 01:39:23,520 DEVELOPING OR PUTTING TOGETHER A 2543 01:39:23,520 --> 01:39:25,400 TRIAL DONE IN THE A HEALTHCARE 2544 01:39:25,400 --> 01:39:28,280 SYSTEM REALLY PROVIDES STEP BY 2545 01:39:28,280 --> 01:39:29,720 STEP RECOMMENDATIONS FOR WHAT 2546 01:39:29,720 --> 01:39:32,800 CHAPTER TO START WITH THAT HAS 2547 01:39:32,800 --> 01:39:34,040 INFORMATION ABOUT WHAT HER FIRST 2548 01:39:34,040 --> 01:39:35,920 STEP MIGHT BE, BUILDING 2549 01:39:35,920 --> 01:39:38,240 PARTNERSHIPS WITH HEALTHCARE 2550 01:39:38,240 --> 01:39:39,680 SYSTEMS OR SELECTING THE RIGHT 2551 01:39:39,680 --> 01:39:42,240 STUDY DESIGN LIKE WHAT WE TALKED 2552 01:39:42,240 --> 01:39:44,000 ABOUT YESTERDAY AS WELL AS SORT 2553 01:39:44,000 --> 01:39:45,880 OF IMPORTANT THINGS YOU NEED TO 2554 01:39:45,880 --> 01:39:46,360 KNOW. 2555 01:39:46,360 --> 01:39:47,840 THESE ARE JUST ALL REALLY 2556 01:39:47,840 --> 01:39:49,280 WONDERFUL RESOURCES THAT YOU CAN 2557 01:39:49,280 --> 01:39:53,560 TAKE A LOOK AT AND IF YOU GO TO 2558 01:39:53,560 --> 01:39:55,280 THE NEXT SLIDE THIS IS WHAT WILL 2559 01:39:55,280 --> 01:39:57,000 COME UP AS YOU CLICK ON THE 2560 01:39:57,000 --> 01:40:00,040 QUICK START GUIDE FOR 2561 01:40:00,040 --> 01:40:00,880 INVESTIGATORS. 2562 01:40:00,880 --> 01:40:02,960 LEARNING WHAT MAKES THESE 2563 01:40:02,960 --> 01:40:03,960 PRAGMATIC TRIALS DIFFERENT, 2564 01:40:03,960 --> 01:40:05,720 BUILDING THE PARTNERSHIPS TO 2565 01:40:05,720 --> 01:40:07,800 ENSURE SUCCESSFUL TRIAL, 2566 01:40:07,800 --> 01:40:09,160 PLANNING FOR SUSTAINABILITY FROM 2567 01:40:09,160 --> 01:40:11,440 THE VERY BEGINNING, SUCH THAT IF 2568 01:40:11,440 --> 01:40:12,640 THE INTERVENTION WORKS HOW DO 2569 01:40:12,640 --> 01:40:14,120 YOU MAKE SURE THAT IT CAN BE 2570 01:40:14,120 --> 01:40:16,440 MAINTAINED IN THAT HEALTHCARE 2571 01:40:16,440 --> 01:40:18,240 SYSTEM. 2572 01:40:18,240 --> 01:40:19,240 ALL THESE DIFFERENT THINGS 2573 01:40:19,240 --> 01:40:20,880 IMPORTANT TO KNOW AND ALL THE 2574 01:40:20,880 --> 01:40:23,240 LINKS WILL TAKE YOU TO DIFFERENT 2575 01:40:23,240 --> 01:40:26,000 RESOURCES WITHIN THE WEBSITE 2576 01:40:26,000 --> 01:40:27,680 HERE AND INFORMATION AND USEFUL 2577 01:40:27,680 --> 01:40:29,600 TOOLS AND RESOURCES. 2578 01:40:29,600 --> 01:40:33,880 NEXT SLIDE. 2579 01:40:33,880 --> 01:40:35,240 ANOTHER HELPFUL QUICK START 2580 01:40:35,240 --> 01:40:36,880 GUIDE THERE IS A READINESS 2581 01:40:36,880 --> 01:40:38,000 CHECKLIST, THE THINGS YOU WANT 2582 01:40:38,000 --> 01:40:43,800 TO DO. 2583 01:40:43,800 --> 01:40:45,240 SET OF MILESTONES YOU MIGHT WANT 2584 01:40:45,240 --> 01:40:46,440 TO THINK ABOUT ACCOMPLISHING 2585 01:40:46,440 --> 01:40:49,080 DURING YOUR PLANNING PHASE IN 2586 01:40:49,080 --> 01:40:50,440 THE SLIDE YOU SAW FROM EACH OF 2587 01:40:50,440 --> 01:40:51,440 OUR PRESENTERS, THEY TALKED 2588 01:40:51,440 --> 01:40:53,360 ABOUT THE DIFFERENT MILESTONES 2589 01:40:53,360 --> 01:40:55,480 THEY WANTED TO ACCOMPLISH DURING 2590 01:40:55,480 --> 01:40:57,160 THEIR PLANNING PHASE. 2591 01:40:57,160 --> 01:40:58,800 WE HAVE BROKEN THESE DOWN INTO 2592 01:40:58,800 --> 01:40:59,960 RECRUITMENT ISSUE, HOW YOU ARE 2593 01:40:59,960 --> 01:41:02,360 GOING TO DO THAT, HAVE YOU 2594 01:41:02,360 --> 01:41:04,040 TACKLED ALL THE ETHICAL AND 2595 01:41:04,040 --> 01:41:06,680 REGULATORY ASPECT AROUND CONSENT 2596 01:41:06,680 --> 01:41:09,400 OR WAIVERS OR THAT TYPE OF 2597 01:41:09,400 --> 01:41:09,960 THING. 2598 01:41:09,960 --> 01:41:11,880 IS INTERVENTION READY TO GO, DO 2599 01:41:11,880 --> 01:41:13,000 YOU HAVE TRAINING MATERIALS 2600 01:41:13,000 --> 01:41:15,040 READY TO GO, ARE YOU READY TO 2601 01:41:15,040 --> 01:41:16,600 ROLL OUT ACROSS YOUR SITE AND 2602 01:41:16,600 --> 01:41:18,040 THEN I THINK WHAT YOU HEARD FROM 2603 01:41:18,040 --> 01:41:20,480 OUR INVESTIGATORS TODAY IS THIS 2604 01:41:20,480 --> 01:41:21,480 DATA COLLECTION ELEMENT AND 2605 01:41:21,480 --> 01:41:23,280 BEING ABLE TO GET THE DATA YOU 2606 01:41:23,280 --> 01:41:26,720 NEED FROM THE RECORDS, AND AS 2607 01:41:26,720 --> 01:41:28,480 WELL AS BEING ABLE TO MAKE SURE 2608 01:41:28,480 --> 01:41:30,720 THERE IS GOOD QUALITY OF THAT 2609 01:41:30,720 --> 01:41:35,080 DATA AND I THINK WE HEARD SOME 2610 01:41:35,080 --> 01:41:36,400 GOOD INFORMATION AND TIPS ABOUT 2611 01:41:36,400 --> 01:41:38,600 THE BUDGET NOT FORGETTING THE 2612 01:41:38,600 --> 01:41:41,160 IMPORTANCE OF THE IT EXPERTISE 2613 01:41:41,160 --> 01:41:42,800 THAT YOU ARE GOING TO NEED AND 2614 01:41:42,800 --> 01:41:44,520 MAKING SURE THAT YOU BUDGET FOR 2615 01:41:44,520 --> 01:41:49,560 THAT ACROSS YOUR DIFFERENT 2616 01:41:49,560 --> 01:41:50,400 SITES. 2617 01:41:50,400 --> 01:41:50,800 NEXT SLIDE. 2618 01:41:50,800 --> 01:41:52,960 WE ARE READY FOR OUR BREAK. 2619 01:41:52,960 --> 01:41:55,840 SO WE ARE GOING TO START BACK AT 2620 01:41:55,840 --> 01:41:58,080 3 O'CLOCK. 2621 01:41:58,080 --> 01:41:59,200 WITH OUR NEXT SESSION WHICH IS 2622 01:41:59,200 --> 01:42:01,440 HOW DO WE IMPLEMENT 2623 01:42:01,440 --> 01:42:03,480 INTERVENTIONS AND COMPLEX 2624 01:42:03,480 --> 01:42:05,120 HEALTHCARE SYSTEMS AND OUR 2625 01:42:05,120 --> 01:42:07,280 MODERATOR WILL BE DR. STEVEN 2626 01:42:07,280 --> 01:42:07,520 GEORGE. 2627 01:42:07,520 --> 01:42:09,120 THANK YOU AGAIN TO ALL OF THE 2628 01:42:09,120 --> 01:42:10,280 GREAT INVESTIGATORS WHO JOINED 2629 01:42:10,280 --> 01:42:11,440 ME ON THE FIRST PANEL. 2630 01:42:11,440 --> 01:42:13,360 WE WILL SEE YOU ALL BACK AT 3 2631 01:42:13,360 --> 01:42:15,040 O'CLOCK. 2632 01:42:15,040 --> 01:42:16,760 ENCOURAGE EVERYBODY ON THE ZOOM 2633 01:42:16,760 --> 01:42:19,400 TO GO AHEAD AND TURN OFF YOUR 2634 01:42:19,400 --> 01:42:20,960 CAMERAS AND SEE YOU BACK AT 3 2635 01:42:20,960 --> 01:42:23,520 O'CLOCK. 2636 01:42:23,520 --> 01:42:24,320 THANK YOU SO MUCH EVERYONE. 2637 01:42:24,320 --> 01:42:26,160 WE ARE GOING TO GET STARTED I 2638 01:42:26,160 --> 01:42:28,440 THINK RIGHT ON TIME. 2639 01:42:28,440 --> 01:42:32,320 WITH THE FOURTH AND FINAL PANEL. 2640 01:42:32,320 --> 01:42:35,080 AS YOU CAN SEE THIS ONE IS 2641 01:42:35,080 --> 01:42:38,080 CENTERED ON CRITICAL QUESTIONS 2642 01:42:38,080 --> 01:42:42,240 RELATED TO HOW TO IMPLEMENT 2643 01:42:42,240 --> 01:42:43,720 INTERVENTIONS IN COMPLEX 2644 01:42:43,720 --> 01:42:44,520 HEALTHCARE SYSTEMS. 2645 01:42:44,520 --> 01:42:48,840 A VERY BRIEF INTRODUCTION, OF 2646 01:42:48,840 --> 01:42:49,720 THE PANEL. 2647 01:42:49,720 --> 01:42:52,080 MY NAME IS STEVEN GEORGE, I'M 2648 01:42:52,080 --> 01:42:54,360 SERVING AS MODERATOR, I'M AT 2649 01:42:54,360 --> 01:42:56,960 DUKE UNIVERSITY AND THEN OUR 2650 01:42:56,960 --> 01:42:59,080 ESTEEMED PANEL INCLUDES GLORIA 2651 01:42:59,080 --> 01:43:00,080 CORONADO AS YOU CAN SEE FROM 2652 01:43:00,080 --> 01:43:05,200 KEISER PERMANENTE, MIRIAM 2653 01:43:05,200 --> 01:43:09,360 EZENWA, UNIVERSITY OF FLORIDA. 2654 01:43:09,360 --> 01:43:12,040 MARGARET KUKLINSKI UNIVERSITY OF 2655 01:43:12,040 --> 01:43:13,320 WASHINGTON AND MIGUEL VASQUEZ 2656 01:43:13,320 --> 01:43:14,480 UNIVERSITY OF TEXAS SOUTH 2657 01:43:14,480 --> 01:43:15,160 WESTERN MEDICAL CENTER. 2658 01:43:15,160 --> 01:43:17,480 SO WE ARE VERY MUCH LOOKING 2659 01:43:17,480 --> 01:43:18,400 FORWARD TO DISCUSSING THIS WITH 2660 01:43:18,400 --> 01:43:21,080 YOU. 2661 01:43:21,080 --> 01:43:22,960 THE PATH WE TOOK WAS TO HAVE A 2662 01:43:22,960 --> 01:43:23,920 VERY BRIEF INTRODUCTION WHICH 2663 01:43:23,920 --> 01:43:28,640 I'M GOING TO DO. 2664 01:43:28,640 --> 01:43:29,760 THAT INTRODUCTION WILL ALSO 2665 01:43:29,760 --> 01:43:31,120 PANELISTS EXPLAIN A LITTLE BIT 2666 01:43:31,120 --> 01:43:32,600 ABOUT EACH TRIAL. 2667 01:43:32,600 --> 01:43:35,160 JUST ENOUGH TO PROVIDE CONTEXT 2668 01:43:35,160 --> 01:43:37,040 AND IF THERE ARE QUESTIONS OR 2669 01:43:37,040 --> 01:43:38,480 MORE DETAILS AROUND A PARTICULAR 2670 01:43:38,480 --> 01:43:41,640 QUESTION THEY WILL ADD TO THAT. 2671 01:43:41,640 --> 01:43:45,440 THEN WE HAVE FIVE KEY QUESTIONS. 2672 01:43:45,440 --> 01:43:46,640 IT DID SEEM THERE WAS ACTIVITY 2673 01:43:46,640 --> 01:43:48,120 IN THE CHAT OR THIRD PANEL THE 2674 01:43:48,120 --> 01:43:49,720 FIRST PANEL FOR TODAY. 2675 01:43:49,720 --> 01:43:53,800 SO WE WILL SEE IF WE CAN PLUCK A 2676 01:43:53,800 --> 01:43:57,520 FEW QUESTIONS FROM THE CHAT AND 2677 01:43:57,520 --> 01:43:59,120 CERTAINLY ENCOURAGE PEOPLE TO DO 2678 01:43:59,120 --> 01:43:59,440 THAT. 2679 01:43:59,440 --> 01:44:02,640 GO TO THE NEXT SLIDE. 2680 01:44:02,640 --> 01:44:06,600 THIS IS WELL KNOWN, THIS IS A 2681 01:44:06,600 --> 01:44:09,240 VISUAL FROM THE LIVING TEXTBOOK 2682 01:44:09,240 --> 01:44:11,800 WENDY MENTIONED THAT EMBEDDED 2683 01:44:11,800 --> 01:44:13,240 TRIALS CLINICAL CARE RESEARCH. 2684 01:44:13,240 --> 01:44:15,400 THERE'S MANY WAYS THEY DO THAT. 2685 01:44:15,400 --> 01:44:18,680 OUR SESSION IS REALLY GOING TO 2686 01:44:18,680 --> 01:44:24,680 FOCUS ON THAT REDDISH BROWN 2687 01:44:24,680 --> 01:44:26,200 COLOR CIRCLE THERE ABOUT 2688 01:44:26,200 --> 01:44:27,720 INTERVENTIONS THAT ARE 2689 01:44:27,720 --> 01:44:29,280 INCORPORATED IN ROUTINE CLINICAL 2690 01:44:29,280 --> 01:44:30,120 WORK FLOW. 2691 01:44:30,120 --> 01:44:32,520 THAT DOESN'T HAPPEN IN 2692 01:44:32,520 --> 01:44:35,600 ISOLATION, THAT WILL BE THE 2693 01:44:35,600 --> 01:44:37,240 EMPHASIS OF OUR SESSION. 2694 01:44:37,240 --> 01:44:43,440 NEXT SLIDE. 2695 01:44:43,440 --> 01:44:45,880 UNDERESTIMATING THE COMPLEXITY 2696 01:44:45,880 --> 01:44:49,840 OF DOING THAT IS A COMMON 2697 01:44:49,840 --> 01:44:51,600 CHALLENGE IN EMBEDDED TRIALS, WE 2698 01:44:51,600 --> 01:44:54,360 ARE HOPEFULLY GOING TO EXAMINE 2699 01:44:54,360 --> 01:44:57,280 HOW THIS SETOFF TRIALISTS 2700 01:44:57,280 --> 01:44:58,440 THOUGHT ABOUT THIS DURING TRIAL 2701 01:44:58,440 --> 01:44:59,760 PLANNING AND CONDUCT AND IT 2702 01:44:59,760 --> 01:45:00,760 BOILS DOWN TO THINKING ABOUT THE 2703 01:45:00,760 --> 01:45:03,640 COMPLEXITY OF THE INTERVENTION 2704 01:45:03,640 --> 01:45:06,520 ITSELF AND ALSO INTERVENTION OF 2705 01:45:06,520 --> 01:45:09,080 THE SYSTEM OR THE COMPLEXITY OF 2706 01:45:09,080 --> 01:45:10,480 THE SYSTEM THAT WILL BE 2707 01:45:10,480 --> 01:45:12,600 DELIVERED AND THEN OF COURSE THE 2708 01:45:12,600 --> 01:45:15,160 INTERSECTION OF THOSE TWO. 2709 01:45:15,160 --> 01:45:18,360 WE HAVE BEEN CHARGED TO 2710 01:45:18,360 --> 01:45:20,920 HIGHLIGHT IMPLEMENTATION SCIENCE 2711 01:45:20,920 --> 01:45:22,680 STRATEGIES THAT BOLSTERED 2712 01:45:22,680 --> 01:45:25,240 SUCCESS FOR THE TRIAL. 2713 01:45:25,240 --> 01:45:29,680 SO THIS PANEL WILL FOCUS VERY 2714 01:45:29,680 --> 01:45:32,280 MUCH IMPLEMENTATION SCIENCE 2715 01:45:32,280 --> 01:45:33,480 STORIES. 2716 01:45:33,480 --> 01:45:36,560 FIRST I THOUGHT WE WOULD TAKE A 2717 01:45:36,560 --> 01:45:37,680 BRIEF TANGENT, TO THE NEXT 2718 01:45:37,680 --> 01:45:39,440 SLIDE. 2719 01:45:39,440 --> 01:45:40,600 ONE OF THE REASONS COMPLEXITY 2720 01:45:40,600 --> 01:45:42,120 MAYBE UNDERESTIMATED IS THAT IT 2721 01:45:42,120 --> 01:45:43,800 IS A HARD THING TO MEASURE, WE 2722 01:45:43,800 --> 01:45:45,240 TALK ABOUT IT A LOT. 2723 01:45:45,240 --> 01:45:48,160 IT IS ACKNOWLEDGED. 2724 01:45:48,160 --> 01:45:50,520 BUT IT IS ARD HARD THING TO 2725 01:45:50,520 --> 01:45:51,080 MEASURE. 2726 01:45:51,080 --> 01:45:53,120 SO ONE OF THE THINGS NIH 2727 01:45:53,120 --> 01:45:54,000 PRAGMATIC TRIALS COLLABORATORY 2728 01:45:54,000 --> 01:45:55,880 IS WORKING ON, I HAVE BEEN LUCKY 2729 01:45:55,880 --> 01:45:58,440 ENOUGH TO BE INVOLVED IS A TOOL 2730 01:45:58,440 --> 01:46:00,040 TO ADDRESS THIS ISSUE. 2731 01:46:00,040 --> 01:46:04,120 SO I THOUGHT WITH THE NEXT SLIDE 2732 01:46:04,120 --> 01:46:06,000 I WILL SHOW SOME OF THE 2733 01:46:06,000 --> 01:46:06,920 COMPONENTS. 2734 01:46:06,920 --> 01:46:07,880 THIS TOOL HAS GONE THROUGH 2735 01:46:07,880 --> 01:46:11,560 DERIVATIONS AND ITERATIONS AND 2736 01:46:11,560 --> 01:46:15,440 TALKING WITH TRIALISTS IN THE 2737 01:46:15,440 --> 01:46:18,200 COLLABORATORY, AND REALLY HAVE 2738 01:46:18,200 --> 01:46:21,600 BOILED IT DOWN TO SOME OF THE 2739 01:46:21,600 --> 01:46:24,160 KEY COMPONENTS WE THINK MAY 2740 01:46:24,160 --> 01:46:24,760 DRIVE COMPLEXITY. 2741 01:46:24,760 --> 01:46:26,960 THIS IS MORE COMPLEXITY OF 2742 01:46:26,960 --> 01:46:27,600 INTERVENTION. 2743 01:46:27,600 --> 01:46:28,800 I'M SHOWING THESE BECAUSE I 2744 01:46:28,800 --> 01:46:32,360 THINK YOU WILL HEAR THESE POP UP 2745 01:46:32,360 --> 01:46:33,240 IN DIFFERENT DISCUSSION AND 2746 01:46:33,240 --> 01:46:35,240 DIFFERENT AREAS BECAUSE A LOT OF 2747 01:46:35,240 --> 01:46:37,920 THEM DO HAVE A DIRECT LINKAGE TO 2748 01:46:37,920 --> 01:46:39,880 THE IMPLEMENTATION STRATEGY THAT 2749 01:46:39,880 --> 01:46:42,600 IS GOING TO USE SO YOU CAN SEE 2750 01:46:42,600 --> 01:46:45,800 HOW DISRUPTIVE AN INTERVENTION 2751 01:46:45,800 --> 01:46:47,560 IS TO EXISTING WORK FLOW OR 2752 01:46:47,560 --> 01:46:48,320 TASKS. 2753 01:46:48,320 --> 01:46:49,800 CERTAINLY CONTRIBUTES TO THE 2754 01:46:49,800 --> 01:46:52,080 COMPLEXITY, THE TRAINING BURDEN, 2755 01:46:52,080 --> 01:46:53,640 THE SHEER VOLUME OF CLINICS AN 2756 01:46:53,640 --> 01:46:55,320 HEALTH SYSTEMS BECAUSE OF THE 2757 01:46:55,320 --> 01:46:56,680 VARIABILITY WE KNOW THAT EXISTS 2758 01:46:56,680 --> 01:46:59,480 ACROSS EACH OF THOSE. 2759 01:46:59,480 --> 01:47:02,360 HOW DEPENDENT THE SETTING OR 2760 01:47:02,360 --> 01:47:04,920 SPECIFIC THE SETTING IS. 2761 01:47:04,920 --> 01:47:06,600 FOR THE INTERVENTION BOTH 2762 01:47:06,600 --> 01:47:08,080 QUALITY AND QUANTITY OF THE 2763 01:47:08,080 --> 01:47:10,640 INTERVENTION COMPONENTS NUMBER 2764 01:47:10,640 --> 01:47:11,880 OF STEPS BETWEEN THAT 2765 01:47:11,880 --> 01:47:13,280 INTERVENTION AND THE OUTCOME 2766 01:47:13,280 --> 01:47:15,560 BEING MEASURED. 2767 01:47:15,560 --> 01:47:18,520 SO STAY TUNED THIS TOOL IS 2768 01:47:18,520 --> 01:47:20,920 GETTING CLOSE TO THE FACT WHERE 2769 01:47:20,920 --> 01:47:22,480 WE ARE TRYING TO DISSEMINATE IT 2770 01:47:22,480 --> 01:47:25,920 BUT I THOUGHT LOOKING AT THE 2771 01:47:25,920 --> 01:47:28,440 COMPONENTS WE WOULD PRIME THE 2772 01:47:28,440 --> 01:47:29,440 AUDIENCE FOR THEMES BACK UP. 2773 01:47:29,440 --> 01:47:32,320 SO THANK YOU FOR THAT SOMEWHAT 2774 01:47:32,320 --> 01:47:34,120 SHAMELESS PLUG THERE FOR TOOL. 2775 01:47:34,120 --> 01:47:35,800 FROM THE COLLABORATORY AND NOW 2776 01:47:35,800 --> 01:47:37,480 WE WILL GET BACK TO OUR 2777 01:47:37,480 --> 01:47:42,320 REGULARLY SCHEDULED PROGRAMMING. 2778 01:47:42,320 --> 01:47:45,200 WITH THAT, LET'S GO TO THE NEXT 2779 01:47:45,200 --> 01:47:46,080 SLIDE. 2780 01:47:46,080 --> 01:47:48,080 NOW WE HAVE THE TRIALISTS HERE 2781 01:47:48,080 --> 01:47:50,520 BETTER TO HEAR FROM THEM ON 2782 01:47:50,520 --> 01:47:52,920 THEIR VERY OWN TRIALS SO 2783 01:47:52,920 --> 01:47:53,720 MARGARET, YOU WANT TO KICK IT 2784 01:47:53,720 --> 01:47:54,560 OFF. 2785 01:47:54,560 --> 01:47:55,520 >> SURE. 2786 01:47:55,520 --> 01:47:58,320 THANK YOU, STEVE. 2787 01:47:58,320 --> 01:48:00,960 I'M MARGARET KUKLINSKI, ONE PI 2788 01:48:00,960 --> 01:48:03,640 ALONG WITH STACY STERLING ON THE 2789 01:48:03,640 --> 01:48:07,280 GUIDING GOOD CHOICES FOR HEALTH 2790 01:48:07,280 --> 01:48:08,200 ORGGC 4H STUDY. 2791 01:48:08,200 --> 01:48:10,200 OURS IS A CLUSTER RANDOMIZED 2792 01:48:10,200 --> 01:48:12,480 TRIAL INVOLVING ADOLESCENTS IN 2793 01:48:12,480 --> 01:48:14,720 PRIMARY CARE AND THEIR FAMILIES. 2794 01:48:14,720 --> 01:48:17,040 IN THE TRIAL WE ARE FOCUSED ON 2795 01:48:17,040 --> 01:48:18,680 DELIVERING GUIDING GOOD CHOICES 2796 01:48:18,680 --> 01:48:22,680 WHICH IS A PREVENTION AND HEALTH 2797 01:48:22,680 --> 01:48:23,760 PROMOTION PROGRAM FOR PARENTS 2798 01:48:23,760 --> 01:48:25,960 YOUNGER ADOLESCENTS. 2799 01:48:25,960 --> 01:48:28,600 THE GOAL IS TO PREVENT PRIMARY 2800 01:48:28,600 --> 01:48:32,240 OUTCOME TO REDUCE SUBSTANCE USE 2801 01:48:32,240 --> 01:48:37,960 INDICATED BY ALCOHOL CANNABIS 2802 01:48:37,960 --> 01:48:39,280 eCIGARETTE AND CIGARETTE USE, 2803 01:48:39,280 --> 01:48:41,080 FOLLOWING AD LESSENS OVER COUPLE 2804 01:48:41,080 --> 01:48:43,000 OF YEARS BECAUSE PREVENTION 2805 01:48:43,000 --> 01:48:44,840 OUTCOMES TEND TO TAKE TIME TO 2806 01:48:44,840 --> 01:48:47,560 REALIZE IN THIS POPULATION. 2807 01:48:47,560 --> 01:48:48,960 T BECAUSE INITIATION RATES 2808 01:48:48,960 --> 01:48:49,800 INCREASE DRAMATICALLY. 2809 01:48:49,800 --> 01:48:53,120 WITH AGE. 2810 01:48:53,120 --> 01:48:55,680 SO THAT IS OUR TRIAL IN A 2811 01:48:55,680 --> 01:48:56,240 NUTSHELL. 2812 01:48:56,240 --> 01:48:57,320 >> THANK YOU. 2813 01:48:57,320 --> 01:49:01,320 AS I MENTIONED, IF THERE IS 2814 01:49:01,320 --> 01:49:02,640 INTEREST IN MORE DETAILS 2815 01:49:02,640 --> 01:49:04,480 ESPECIALLY WHEN WE GETS TO 2816 01:49:04,480 --> 01:49:07,200 IMPLEMENTATION FEEL FEE TO PING 2817 01:49:07,200 --> 01:49:08,960 ME AND I WILL TRY TO GET THAT OR 2818 01:49:08,960 --> 01:49:10,200 ASK DIRECTLY. 2819 01:49:10,200 --> 01:49:11,640 SO THIS WON'T BE THE LAST TIME 2820 01:49:11,640 --> 01:49:14,400 YOU HEAR ABOUT THE TRIALS. 2821 01:49:14,400 --> 01:49:17,640 MIRIAM, YOU ARE UP. 2822 01:49:17,640 --> 01:49:21,640 >> OUR TRIAL IS HYBRID 1 2823 01:49:21,640 --> 01:49:25,000 EFFECTIVE IMPLEMENTATION TRIAL 2824 01:49:25,000 --> 01:49:28,440 FOR RELAXATION AND ACUPUNCTURE 2825 01:49:28,440 --> 01:49:29,320 IN CHRONIC PAIN AND PATIENTS 2826 01:49:29,320 --> 01:49:32,640 WITH SICKLE CELL DISEASE. 2827 01:49:32,640 --> 01:49:37,360 PRIMARY OUTCOME CONTROL ONE TO 2828 01:49:37,360 --> 01:49:42,200 ONE TO ONE (INAUDIBLE) VISUAL 2829 01:49:42,200 --> 01:49:44,200 CARE AND INTERVENTION ABOUT FIVE 2830 01:49:44,200 --> 01:49:46,360 TO SIX WEEKS AND THEN PATIENTS 2831 01:49:46,360 --> 01:49:54,920 ARE RERANDOMIZED SO IF THEY ARE 2832 01:49:54,920 --> 01:49:59,560 NOT -- ACUPUNCTURE OR ADAPTATION 2833 01:49:59,560 --> 01:50:01,880 AND IN THAT INTERVENTION FOR SIX 2834 01:50:01,880 --> 01:50:04,520 WEEKS AGAIN THEN THEY ARE 2835 01:50:04,520 --> 01:50:08,520 FOLLOWED -- FOLLOW-UP AT SIX, 12 2836 01:50:08,520 --> 01:50:10,160 WEEKS AND 24 WEEKS TO SEE IF 2837 01:50:10,160 --> 01:50:11,160 INFORMATION IS (INAUDIBLE) 2838 01:50:11,160 --> 01:50:13,360 REDUCING CHRONIC PAIN AN SICKLE 2839 01:50:13,360 --> 01:50:15,120 CELL DISEASE. 2840 01:50:15,120 --> 01:50:17,640 SO THAT OUR TRIAL. 2841 01:50:17,640 --> 01:50:24,040 >> THANK YOU, MIRIAM. 2842 01:50:24,040 --> 01:50:27,800 GO TO THE NEXT SLIDE. 2843 01:50:27,800 --> 01:50:28,360 GLORIA. 2844 01:50:28,360 --> 01:50:29,360 >> I WILL STEP IN. 2845 01:50:29,360 --> 01:50:35,920 SO I CO-LED WITH DR. GREEN FROM 2846 01:50:35,920 --> 01:50:37,800 KEISER PERMANENTE WASHINGTON. 2847 01:50:37,800 --> 01:50:39,600 OURS WAS A CLUSTER RANDOMIZED 2848 01:50:39,600 --> 01:50:41,520 TRIAL THAT INCLUDED 26 FEDERALLY 2849 01:50:41,520 --> 01:50:43,560 QUALIFIED HEALTH CENTERS AND WE 2850 01:50:43,560 --> 01:50:45,440 IDENTIFIED OVER 40,000 PATIENTS 2851 01:50:45,440 --> 01:50:47,080 WHO WERE DUE FOR COLORECTAL 2852 01:50:47,080 --> 01:50:50,160 CANCER SCREENING, OUR 2853 01:50:50,160 --> 01:50:52,680 INTERVENTION WAS A MALE OUTREACH 2854 01:50:52,680 --> 01:50:54,800 PROGRAM BUT PROVIDED REAL TIME 2855 01:50:54,800 --> 01:50:55,840 ELECTRONIC HEALTH RECORD TOOLS 2856 01:50:55,840 --> 01:50:58,280 AND TRAINING TO DELIVER THE 2857 01:50:58,280 --> 01:51:01,640 PROGRAM IN OUR PRIMARY OUTCOME 2858 01:51:01,640 --> 01:51:03,560 WAS FIT COMPLETION WITHIN 12 2859 01:51:03,560 --> 01:51:08,880 MONTHS PATIENT IDENTIFICATION. 2860 01:51:08,880 --> 01:51:12,280 >> GREAT. 2861 01:51:12,280 --> 01:51:13,200 MIGUEL HAS THE LAST TRIAL THAT 2862 01:51:13,200 --> 01:51:23,680 WILL BE FEATURED YOU ARE UP. 2863 01:51:26,920 --> 01:51:27,400 ON MUTE MIGUEL. 2864 01:51:27,400 --> 01:51:33,400 SORRY. 2865 01:51:33,400 --> 01:51:36,840 >> I'M MIGUEL VASQUEZ, SPEAKING 2866 01:51:36,840 --> 01:51:39,560 ON BEHALF OF (INAUDIBLE) WITH MY 2867 01:51:39,560 --> 01:51:40,480 CO-INVESTIGATOR. 2868 01:51:40,480 --> 01:51:42,480 WE ARE A GROUP IMPROVING CHRONIC 2869 01:51:42,480 --> 01:51:44,880 DISEASE MANAGEMENT WITH 2870 01:51:44,880 --> 01:51:46,680 PRAGMATIC TRIALS TO ADDRESS 2871 01:51:46,680 --> 01:51:51,480 MULTIPLE CHRONIC CONDITIONS. 2872 01:51:51,480 --> 01:51:56,640 IN OUR CLUSTER RANDOMIZE TRIAL 2873 01:51:56,640 --> 01:52:00,720 WE STUDIED PATIENTS WHO HAD 2874 01:52:00,720 --> 01:52:03,560 CHRONIC KIDNEY DISEASE 2875 01:52:03,560 --> 01:52:05,640 (INAUDIBLE) WE ENROLLED 11,000 2876 01:52:05,640 --> 01:52:07,400 PATIENTS PLUS FOUR LARGE HEALTH 2877 01:52:07,400 --> 01:52:10,320 SYSTEMS IN THE MAIN INTERVEN 2878 01:52:10,320 --> 01:52:15,440 INTERVENTIONS WERE (INAUDIBLE) 2879 01:52:15,440 --> 01:52:23,920 FACILITATING THE (INAUDIBLE) FOR 2880 01:52:23,920 --> 01:52:24,440 INTERVENTIONS PROVEN TO BE 2881 01:52:24,440 --> 01:52:25,560 EFFECTIVE FOR KIDNEY DISEASE, 2882 01:52:25,560 --> 01:52:27,560 DIABETES AND HYPERTENSION. 2883 01:52:27,560 --> 01:52:30,240 THAT PRIMARY OUTCOME WAS A ONE 2884 01:52:30,240 --> 01:52:31,240 YEAR HOSPITALIZATION RATE, WE 2885 01:52:31,240 --> 01:52:34,200 ALSO LOOK AT OTHER IMPORTANT 2886 01:52:34,200 --> 01:52:37,000 OUTCOMES LIKE (INAUDIBLE) 2887 01:52:37,000 --> 01:52:38,760 CARDIOVASCULAR EVENTS. 2888 01:52:38,760 --> 01:52:45,120 (INAUDIBLE) TRIAL. 2889 01:52:45,120 --> 01:52:48,240 >> THANK YOU. 2890 01:52:48,240 --> 01:52:50,000 WE WILL GO ON TO THE NEXT SLIDE 2891 01:52:50,000 --> 01:52:51,320 AND I THINK OUR PANELISTS ARE 2892 01:52:51,320 --> 01:52:53,240 GOING TO REMAIN ON SO WE DID 2893 01:52:53,240 --> 01:52:56,160 MEET BEFORE THE SESSION AND 2894 01:52:56,160 --> 01:52:57,360 IDENTIFIED SOME QUESTIONS THAT 2895 01:52:57,360 --> 01:53:02,320 WE THOUGHT WOULD SHOWCASE THE 2896 01:53:02,320 --> 01:53:04,200 THEMES OF INTEREST SO WE WILL 2897 01:53:04,200 --> 01:53:05,120 DIVE INTO THOSE AND HAVE 2898 01:53:05,120 --> 01:53:05,840 DISCUSSION AROUND THAT. 2899 01:53:05,840 --> 01:53:09,120 THE FIRST QUESTION IS IN 2900 01:53:09,120 --> 01:53:11,120 PLANNING YOUR TRIAL, THINK ABOUT 2901 01:53:11,120 --> 01:53:14,640 INTERVENTION AN HEALTH SYSTEM 2902 01:53:14,640 --> 01:53:15,880 COMPLEXITY AND HOW DID THIS 2903 01:53:15,880 --> 01:53:17,200 CHANGE DURING YOUR TRIAL 2904 01:53:17,200 --> 01:53:17,600 CONDUCT. 2905 01:53:17,600 --> 01:53:21,280 WE WILL GO TO MARGARET FIRST FOR 2906 01:53:21,280 --> 01:53:22,400 THIS QUESTION. 2907 01:53:22,400 --> 01:53:23,080 >> THANK YOU. 2908 01:53:23,080 --> 01:53:25,320 WE REALLY DID THINK ABOUT THIS 2909 01:53:25,320 --> 01:53:25,960 QUESTION A LOT AND WE THOUGHT 2910 01:53:25,960 --> 01:53:30,520 ABOUT IT A LOT THROUGHOUT OUR 2911 01:53:30,520 --> 01:53:31,040 TRIAL. 2912 01:53:31,040 --> 01:53:32,760 AND DEPENDING ON POINT IN THE 2913 01:53:32,760 --> 01:53:34,240 TRIAL WE WERE AT. 2914 01:53:34,240 --> 01:53:37,560 JUST AS REMINDER INTERVENTION 2915 01:53:37,560 --> 01:53:40,840 WAS COMPLEX, IT IS A SIX SESSION 2916 01:53:40,840 --> 01:53:42,400 PARENTING PROGRAM DELIVERED AS A 2917 01:53:42,400 --> 01:53:44,080 RESULT OF COVID VIRTUALLY BUT 2918 01:53:44,080 --> 01:53:45,440 OVER SIX WEEKS. 2919 01:53:45,440 --> 01:53:47,720 SO RESOURCE INTENSIVE. 2920 01:53:47,720 --> 01:53:49,840 SO COMBINE THAT WITH THE 2921 01:53:49,840 --> 01:53:51,560 COMPLEXITY THAT OUR HEALTHCARE 2922 01:53:51,560 --> 01:53:53,880 SYSTEMS AGAIN PARTICULARLY 2923 01:53:53,880 --> 01:53:58,160 DURING COVID, THERE IS A LOT TO 2924 01:53:58,160 --> 01:53:58,760 NAVIGATE. 2925 01:53:58,760 --> 01:53:59,960 IN RESPONSE TO THIS QUESTION IS 2926 01:53:59,960 --> 01:54:01,640 BRIEFLY HIGHLIGHT THREE OF THE 2927 01:54:01,640 --> 01:54:03,640 WAYS IN WHICH WE ADDRESS THIS 2928 01:54:03,640 --> 01:54:05,840 COMPLEXITY THAT I THINK MIGHT 2929 01:54:05,840 --> 01:54:08,280 YIELD GENERALIZABLE LESSONS OR 2930 01:54:08,280 --> 01:54:14,480 POINTS FOR OTHERS. 2931 01:54:14,480 --> 01:54:15,200 CONSIDERING YOU ARE IN THE 2932 01:54:15,200 --> 01:54:17,160 MIDDLE OF PRAGMATIC TRIALS. 2933 01:54:17,160 --> 01:54:18,200 WE KNEW FROM THE BEGINNING THAT 2934 01:54:18,200 --> 01:54:21,240 IT WAS GOING TO BE ESSENTIAL TO 2935 01:54:21,240 --> 01:54:24,080 WORK WITH RESEARCH TEAMS THAT 2936 01:54:24,080 --> 01:54:26,760 HAD EXPERIENCE THING EMBEDDED 2937 01:54:26,760 --> 01:54:28,240 RESEARCH IN HEALTHCARE SYSTEMS. 2938 01:54:28,240 --> 01:54:30,520 WE ARE WORKING WITH KEISER 2939 01:54:30,520 --> 01:54:33,320 PERMANENTE COLORADO, NORTHERN 2940 01:54:33,320 --> 01:54:35,640 CALIFORNIA AND HENRY FORD HEALTH 2941 01:54:35,640 --> 01:54:38,600 SYSTEM IN THIS TRIAL AND EACH OF 2942 01:54:38,600 --> 01:54:40,160 THOSE SITES HAS EMBEDDED 2943 01:54:40,160 --> 01:54:42,000 RESEARCH TEAMS WITH 2944 01:54:42,000 --> 01:54:43,920 PROFESSIONALS IN A VARIETY OF 2945 01:54:43,920 --> 01:54:46,800 ROLES FROM PIs TO CLINICAL 2946 01:54:46,800 --> 01:54:52,840 STAFF TO INFORMATICISTS TO IRB 2947 01:54:52,840 --> 01:54:53,240 EXPERTS. 2948 01:54:53,240 --> 01:54:54,680 AS A RESULT OF HAVING LOTS OF 2949 01:54:54,680 --> 01:54:56,000 EXPERIENCE DOING MANY TRIALS 2950 01:54:56,000 --> 01:54:58,560 OVER MANY YEARS, THEY KNOW HOW 2951 01:54:58,560 --> 01:55:01,000 TO WORK WITH SYSTEMS, THEY KNOW 2952 01:55:01,000 --> 01:55:02,120 WHAT WILL FLY AND WHAT WON'T. 2953 01:55:02,120 --> 01:55:03,840 THEY HAVE GOT THAN 2954 01:55:03,840 --> 01:55:04,920 RELATIONSHIPS, THE EXPERIENCE, 2955 01:55:04,920 --> 01:55:06,880 THE RIGHT MIND SET. 2956 01:55:06,880 --> 01:55:09,720 THAT ACTUALLY MADE OUR ENTRY 2957 01:55:09,720 --> 01:55:13,040 INTO THIS SYSTEM AND OUR WORK 2958 01:55:13,040 --> 01:55:14,920 WITH CLINICS RELATIVERY STRAIGHT 2959 01:55:14,920 --> 01:55:17,360 FORWARD AT THE BEGINNING AND SO 2960 01:55:17,360 --> 01:55:22,680 I JUST THINK THAT WHAT THEY KNEW 2961 01:55:22,680 --> 01:55:23,600 ABOUT HEALTHCARE SYSTEMS AND HOW 2962 01:55:23,600 --> 01:55:27,240 TO DO TRIALS IS CRITICAL TO 2963 01:55:27,240 --> 01:55:30,880 SUCCESS OF ABILITY TO GET OFF 2964 01:55:30,880 --> 01:55:34,280 THE GROUND. 2965 01:55:34,280 --> 01:55:35,480 SECOND THING TO HOY LIGHT IS HOW 2966 01:55:35,480 --> 01:55:37,320 WE NAVIGATE THAT COMPLEXITY IS A 2967 01:55:37,320 --> 01:55:38,760 MONITOR REALLY WHEN WE WERE 2968 01:55:38,760 --> 01:55:40,680 COMING OUR PROTOCOLS, WAS THAT 2969 01:55:40,680 --> 01:55:43,960 WE HAD TO DO THINGS IN A WAY 2970 01:55:43,960 --> 01:55:48,240 THAT FIT WITHIN NORMAL BUSINESS 2971 01:55:48,240 --> 01:55:50,760 OPERATION AND REALLY BUSY WORLD 2972 01:55:50,760 --> 01:55:53,440 DAY TO DAY PEDIATRICS PRACTICE. 2973 01:55:53,440 --> 01:55:55,040 SO IT IS THAT RUST COLORED 2974 01:55:55,040 --> 01:55:58,160 CIRCLE THAT STEVE HIGHLIGHTED 2975 01:55:58,160 --> 01:55:59,600 THAT WAS A CENTER OF OUR 2976 01:55:59,600 --> 01:56:00,920 THINKING BOTH AT THE PLANNING 2977 01:56:00,920 --> 01:56:01,440 PHASE AND THROUGHOUT THE 2978 01:56:01,440 --> 01:56:03,440 PROJECT. 2979 01:56:03,440 --> 01:56:05,080 COUPLE OF EXAMPLES OF THE WAY 2980 01:56:05,080 --> 01:56:09,400 THIS CAME UP WAS AGAIN SIX 2981 01:56:09,400 --> 01:56:11,480 SESSION INTERVENTION, WE WERE 2982 01:56:11,480 --> 01:56:13,280 UNDER NO ILLUSIONS THAT THE 2983 01:56:13,280 --> 01:56:14,280 DOCTORS WERE GOING TO DELIVER 2984 01:56:14,280 --> 01:56:15,920 THE INTERVENTION BUT THEIR ROLE 2985 01:56:15,920 --> 01:56:19,760 IN RECOMMENDING PARENTS TO AWE 2986 01:56:19,760 --> 01:56:21,120 PROGRAM WE FELT WAS CRITICAL. 2987 01:56:21,120 --> 01:56:24,720 WE HAD SOME EVIDENCE FROM PRIOR 2988 01:56:24,720 --> 01:56:27,240 WORK THAT PARENTS CARE ABOUT 2989 01:56:27,240 --> 01:56:30,040 WHAT DOCTORS HAVE TO SAY AND 2990 01:56:30,040 --> 01:56:34,080 THAT DOCTORS RECOMMENDATIONS TO 2991 01:56:34,080 --> 01:56:35,760 PROGRAM LIKE OURS COULD BE 2992 01:56:35,760 --> 01:56:36,680 PERSUASIVE. 2993 01:56:36,680 --> 01:56:38,320 WE NEED TO ASK DOCTORS TO FILL 2994 01:56:38,320 --> 01:56:41,640 THIS ROLE IN A WAY THAT WAS LOW 2995 01:56:41,640 --> 01:56:42,720 BURDEN. 2996 01:56:42,720 --> 01:56:44,720 SO WE GAVE SCRIPTS TO MAKE THAT 2997 01:56:44,720 --> 01:56:46,400 RECOMMENDATION, GAVE A NUMBER OF 2998 01:56:46,400 --> 01:56:47,520 DIFFERENT SCRIPS TO FIT 2999 01:56:47,520 --> 01:56:48,200 DIFFERENT STYLES. 3000 01:56:48,200 --> 01:56:50,760 AND LET THEM USE THEM TO 3001 01:56:50,760 --> 01:56:52,080 WHATEVER DEGREE THEY WANT TO, WE 3002 01:56:52,080 --> 01:56:53,400 DIDN'T TRY TO OVERCONTROL. 3003 01:56:53,400 --> 01:56:55,760 BUT I HOPE THEY WOULD MAKE THAT 3004 01:56:55,760 --> 01:56:56,560 RECOMMENDATION. 3005 01:56:56,560 --> 01:56:58,840 WE ALSO OFFER SOME PRESCRIPTION 3006 01:56:58,840 --> 01:57:01,400 PADS QUOTE UNQUOTE THEY CAN USE 3007 01:57:01,400 --> 01:57:04,240 TO -- GIVE TO PARENTS WITH 3008 01:57:04,240 --> 01:57:05,240 INFORMATION ABOUT OUR 3009 01:57:05,240 --> 01:57:06,440 INTERVENTION AND WAYS TO CONTACT 3010 01:57:06,440 --> 01:57:06,840 US. 3011 01:57:06,840 --> 01:57:08,240 AND WE PROVIDED THEM WITH 3012 01:57:08,240 --> 01:57:10,120 REMINDERS TO THE HR WHEN 3013 01:57:10,120 --> 01:57:12,440 ELIGIBLE PATIENTS WERE GOING TO 3014 01:57:12,440 --> 01:57:14,240 COME IN AND THEY COULD ACTUALLY 3015 01:57:14,240 --> 01:57:15,760 BE IN A POSITION TO MAKE 3016 01:57:15,760 --> 01:57:18,760 REFERRAL TO THOSE FAMILIES. 3017 01:57:18,760 --> 01:57:20,320 SO WE WERE -- I THINK THAT WAS 3018 01:57:20,320 --> 01:57:22,520 PRETTY SUCCESSFUL AND ABLE TO 3019 01:57:22,520 --> 01:57:24,320 KEEP BURDEN ON PEDIATRICIANS LOW 3020 01:57:24,320 --> 01:57:27,360 AND THE OTHER THING WE DID IN 3021 01:57:27,360 --> 01:57:29,760 OUR STUDY WAS TO HAVE THE 3022 01:57:29,760 --> 01:57:31,200 INTERVENTION ROLE THOUGH CARRIED 3023 01:57:31,200 --> 01:57:34,600 OUT BY MEMBER OF THESE EMBEDDED 3024 01:57:34,600 --> 01:57:36,080 TEAMS DIFFERENT MEMBERS THAT 3025 01:57:36,080 --> 01:57:40,120 ROLE MIMICKED THE ROLE OF HEALTH 3026 01:57:40,120 --> 01:57:41,840 EDUCATOR, REAL ROLE WITHIN 3027 01:57:41,840 --> 01:57:43,040 SYSTEMS SO THINKING THROUGHOUT 3028 01:57:43,040 --> 01:57:44,680 THE TRIAL HOW TO STRUCTURE WHAT 3029 01:57:44,680 --> 01:57:46,680 WE ARE DOING IN WAY THAT COULD 3030 01:57:46,680 --> 01:57:50,080 BE SUSTAINABLE. 3031 01:57:50,080 --> 01:57:51,640 THE LAST POINTLY MAKE BRIEFLY, 3032 01:57:51,640 --> 01:57:55,920 WE TRY TO ADOPT A MIND SET OF 3033 01:57:55,920 --> 01:57:57,760 PATIENTS WITH THE UNEXPECTED. 3034 01:57:57,760 --> 01:58:01,280 COVID OF COURSE I THINK WAS THE 3035 01:58:01,280 --> 01:58:02,720 ULTIMATE UNEXPECTED FOR MANY OF 3036 01:58:02,720 --> 01:58:07,800 US BUT OTHER THINGS CAME UP 3037 01:58:07,800 --> 01:58:10,360 ALONG THE WAY IN OUR TRIAL LIKE 3038 01:58:10,360 --> 01:58:11,600 PEDIATRICS BEING REORGANIZED IN 3039 01:58:11,600 --> 01:58:13,480 ONE OUR SYSTEMS WHICH THREATENED 3040 01:58:13,480 --> 01:58:13,840 RANDOMIZATION. 3041 01:58:13,840 --> 01:58:17,800 THIS HAPPENED EARLY AND WE CAN 3042 01:58:17,800 --> 01:58:21,640 WAIT SO WHICH DEALT WITH THAT IN 3043 01:58:21,640 --> 01:58:22,240 THAT WAY. 3044 01:58:22,240 --> 01:58:24,080 I WOULD ALSO SAY BE PREPARED FOR 3045 01:58:24,080 --> 01:58:26,400 UNEXPECTED AND TRY TO JUST DEAL 3046 01:58:26,400 --> 01:58:30,160 WITH AS PATIENTLY AND WELL AS 3047 01:58:30,160 --> 01:58:31,560 YOU CAN BECAUSE IT IS GOING TO 3048 01:58:31,560 --> 01:58:32,160 HAPPEN DURING THE COURSE OF OUR 3049 01:58:32,160 --> 01:58:41,200 TRIAL. 3050 01:58:41,200 --> 01:58:42,000 >> MIGUEL YOU WANTED TO JUMP ON 3051 01:58:42,000 --> 01:58:46,800 THIS ONE. 3052 01:58:46,800 --> 01:58:49,120 >> FOR US IT WAS HAVING 3053 01:58:49,120 --> 01:58:50,040 INTERVENTION THAT HAVE SOME 3054 01:58:50,040 --> 01:58:51,680 DEGREE OF COMPLEXITY. 3055 01:58:51,680 --> 01:58:53,840 WE WERE EXPRESSING THREE 3056 01:58:53,840 --> 01:58:55,480 DIFFERENCE CONDITIONS THAT 3057 01:58:55,480 --> 01:58:58,160 CO-EXISTED IN PATIENT AND 3058 01:58:58,160 --> 01:59:03,520 COMPLEXITIES ON THE HEALTH 3059 01:59:03,520 --> 01:59:05,960 SYSTEMS FIRST INTERVENTION WAS 3060 01:59:05,960 --> 01:59:06,920 MULTI-LEVEL MULTI-COMPONENT AND 3061 01:59:06,920 --> 01:59:13,280 REPEATED OVER TIME. 3062 01:59:13,280 --> 01:59:14,240 BUT SOMETHING TO SUSTAIN DURING 3063 01:59:14,240 --> 01:59:15,480 THE ITERATION OF THE STUDY AND 3064 01:59:15,480 --> 01:59:17,440 PUT THAT INTO THE CONTEXT OF 3065 01:59:17,440 --> 01:59:22,520 FOUR DIFFERENT HEALTH SYSTEMS TO 3066 01:59:22,520 --> 01:59:24,080 REMIND EVERYONE WE HAD A ONE FOR 3067 01:59:24,080 --> 01:59:26,880 EXAMPLE LEVEL OF INTEGRATION, WE 3068 01:59:26,880 --> 01:59:28,280 HAD QUITE DIVERSITY ON THE 3069 01:59:28,280 --> 01:59:30,920 HEALTH SYSTEMS, WE HAD PUBLIC 3070 01:59:30,920 --> 01:59:33,800 SAFETY NET HOSPITAL VERY 3071 01:59:33,800 --> 01:59:35,000 INTEGRATED. 3072 01:59:35,000 --> 01:59:37,600 SAME AS VA HOSPITAL INTEGRATED. 3073 01:59:37,600 --> 01:59:45,080 WE HAD LESS INTEGRATION LEVEL OF 3074 01:59:45,080 --> 01:59:47,360 NETWORKING IN EXTHE TEAKS. 3075 01:59:47,360 --> 01:59:49,040 THEY HAD LOOSE INTEGRATION WITH 3076 01:59:49,040 --> 01:59:50,640 ACL CONNECTOR SO DIFFERENT 3077 01:59:50,640 --> 01:59:51,960 LEVELS OF INTEGRATION WHICH 3078 01:59:51,960 --> 01:59:53,840 BROUGHT DIFFERENCES IN TERMS OF 3079 01:59:53,840 --> 01:59:54,840 HOW TO PLAN IS A FOR 3080 01:59:54,840 --> 01:59:59,360 IMPLEMENTATION. 3081 01:59:59,360 --> 02:00:01,320 THE PATIENTS SERVED OR DIFFERENT 3082 02:00:01,320 --> 02:00:03,120 FROM UNDERSERVED POPULATIONS TO 3083 02:00:03,120 --> 02:00:06,640 VETERANS TO PATIENTS IN NORTH 3084 02:00:06,640 --> 02:00:09,720 TEXAS BY PRIVATE SYSTEM VERSUS 3085 02:00:09,720 --> 02:00:12,400 -- THAT IS VERY DIFFERENT EHRs 3086 02:00:12,400 --> 02:00:13,840 THAT I MENTIONED YESTERDAY 3087 02:00:13,840 --> 02:00:16,840 INCLUDE EPIC OR SCRIPS, CBRS, SO 3088 02:00:16,840 --> 02:00:18,400 IT REQUIRES TAKING ALL THESE 3089 02:00:18,400 --> 02:00:22,960 THINGS INTO CONSIDERATION. 3090 02:00:22,960 --> 02:00:25,000 WE HAD TO PUT INTERVENTIONS 3091 02:00:25,000 --> 02:00:26,760 INCLUDING MANAGING DIABETES AND 3092 02:00:26,760 --> 02:00:27,840 HYPERTENSION ON THIS. 3093 02:00:27,840 --> 02:00:32,000 ,WE HAVE TO BE FLEXIBLE BECAUSE 3094 02:00:32,000 --> 02:00:34,880 INITIAL PLANS VERY WELL DEFINE 3095 02:00:34,880 --> 02:00:36,640 THERAPY PLANS WERE NOT INITIALLY 3096 02:00:36,640 --> 02:00:39,600 WELL RECEIVED BY SOME OF THE 3097 02:00:39,600 --> 02:00:43,960 PROVIDERS SO WE HAD VERY EARLY 3098 02:00:43,960 --> 02:00:46,800 STAGE PLANNING PHASE REVIEWED 3099 02:00:46,800 --> 02:00:50,120 EARLIER TO MAKE ADJUSTMENTS TO 3100 02:00:50,120 --> 02:00:51,200 ADDRESS. 3101 02:00:51,200 --> 02:00:53,600 ACADEMIC AND NON-ACADEMIC 3102 02:00:53,600 --> 02:00:56,120 SETTINGS AND THIS WAS ALSO A 3103 02:00:56,120 --> 02:00:59,880 REFERENCE IN THE PRIOR SESSION 3104 02:00:59,880 --> 02:01:03,840 DOUG AND WENDY TALK ABOUT 3105 02:01:03,840 --> 02:01:04,480 DIFFERENCES. 3106 02:01:04,480 --> 02:01:11,000 AND IT WAS EASIER TO ACADEMIC 3107 02:01:11,000 --> 02:01:12,320 SETTINGS BUT REAL WORLD ALSO 3108 02:01:12,320 --> 02:01:13,640 INVOLVES NON-ACADEMIC SETTINGS 3109 02:01:13,640 --> 02:01:18,360 SO WE THOUGHT IT WAS IMPORTANT 3110 02:01:18,360 --> 02:01:22,560 AS FAR AS EXPERIENCE IN RESEARCH 3111 02:01:22,560 --> 02:01:24,160 MARGARET ALLUDED TO HOW HELPFUL 3112 02:01:24,160 --> 02:01:26,160 TO HAVE PARTNERS WHO KNOW HOW TO 3113 02:01:26,160 --> 02:01:30,280 DO RESEARCH IN OUR CASE YES 3114 02:01:30,280 --> 02:01:31,440 COLLABORATOR AT DONE RESEARCH. 3115 02:01:31,440 --> 02:01:33,840 WE HAVE TO SAY THAT PRAGMATIC 3116 02:01:33,840 --> 02:01:38,240 RESEARCH IS NOT COMMONLY A 3117 02:01:38,240 --> 02:01:41,400 FAMILIAR TO COLLABORATORS SO IT 3118 02:01:41,400 --> 02:01:45,080 WAS A UPLIFT IN AREA IN TERMS OF 3119 02:01:45,080 --> 02:01:47,360 HOW TO SET THESE COLLABORATIONS 3120 02:01:47,360 --> 02:01:49,160 WITH OUR HEALTH SYSTEMS HOWEVER 3121 02:01:49,160 --> 02:01:50,680 RECEPTIVE AND WILLING TO HELP US 3122 02:01:50,680 --> 02:01:53,280 WITH THIS. 3123 02:01:53,280 --> 02:01:56,440 AS FAR AS SETTING THIS UP THEN 3124 02:01:56,440 --> 02:01:59,880 TO IMPLEMENT WE HAD TO ADDRESS 3125 02:01:59,880 --> 02:02:06,040 HEALTH SYSTEMS DIFFERENT. 3126 02:02:06,040 --> 02:02:07,640 ENT LEARN COMPLEXITY, MORE 3127 02:02:07,640 --> 02:02:08,520 INTEGRATED HEALTH SYSTEM, 3128 02:02:08,520 --> 02:02:09,640 STARTED WITH CONVERSATIONS WITH 3129 02:02:09,640 --> 02:02:10,880 LEADERS AND IT WAS SOMETHING 3130 02:02:10,880 --> 02:02:16,120 THAT PERMEATED DOWN TO THE 3131 02:02:16,120 --> 02:02:18,040 INDIVIDUAL PRACTICES. 3132 02:02:18,040 --> 02:02:19,640 MOSTLY AGGRAVATED RECORD 3133 02:02:19,640 --> 02:02:21,720 INTEGRATED HELP SYSTEMS, IT WAS 3134 02:02:21,720 --> 02:02:24,760 REALLY VISITING EACH INDIVIDUAL 3135 02:02:24,760 --> 02:02:27,080 PRACTICE IN WORKING WITH ONE OR 3136 02:02:27,080 --> 02:02:30,800 TWO INDIVIDUALS TO BUY IN TO A 3137 02:02:30,800 --> 02:02:34,400 WHAT WE WERE DOING TOGETHER. 3138 02:02:34,400 --> 02:02:39,120 AS FAR AS HOW TO PLAN TO DELIVER 3139 02:02:39,120 --> 02:02:41,680 THIS IMPLEMENT ALSO HAD TO BE 3140 02:02:41,680 --> 02:02:42,440 FLEXIBLE. 3141 02:02:42,440 --> 02:02:44,280 EVERYONE REBS FROM THE PRESSES 3142 02:02:44,280 --> 02:02:46,080 THAT FLEXIBILITY ON THE DELIVERY 3143 02:02:46,080 --> 02:02:47,440 OF INTERVENTION. 3144 02:02:47,440 --> 02:02:48,560 THAT SOMETHING WE WERE AWARE 3145 02:02:48,560 --> 02:02:50,000 FROM THE BEGINNING. 3146 02:02:50,000 --> 02:02:52,680 AND LOT OF EMPHASIS IN THIS. 3147 02:02:52,680 --> 02:02:54,760 FOR EXAMPLE IN TWO HEALTH 3148 02:02:54,760 --> 02:02:57,960 SYSTEMS WE USE A PHARMACIST TO 3149 02:02:57,960 --> 02:03:00,920 HELP US DELIVER INTERVENTION. 3150 02:03:00,920 --> 02:03:03,800 THE OTHER TWO HEALTH SYSTEMS IT 3151 02:03:03,800 --> 02:03:05,720 WAS DONE BY POPULATION NURSES. 3152 02:03:05,720 --> 02:03:08,280 HEALTH SYSTEMS LOOKED INTO THIS 3153 02:03:08,280 --> 02:03:09,600 IN DIFFERENT -- AND PUT HIGHER 3154 02:03:09,600 --> 02:03:12,240 VALUE ONE WAY OR ANOTHER THEY 3155 02:03:12,240 --> 02:03:13,600 FELT MORE COMFORTABLE WITHIN 3156 02:03:13,600 --> 02:03:14,720 THEIR SYSTEM. 3157 02:03:14,720 --> 02:03:16,440 OBVIOUSLY THIS INTRODUCES 3158 02:03:16,440 --> 02:03:17,600 HETEROGENEITY BUT WE HOPE THAT 3159 02:03:17,600 --> 02:03:22,640 THAT WILL ALLOW TO BE MORE 3160 02:03:22,640 --> 02:03:23,520 GENERALIZABLE. 3161 02:03:23,520 --> 02:03:24,680 FOR VARIOUS HEALTH SYSTEMS. 3162 02:03:24,680 --> 02:03:26,960 WHEN WE GET DOWN TO INDIVIDUAL 3163 02:03:26,960 --> 02:03:28,800 INTERVENTION, WE WERE ALSO 3164 02:03:28,800 --> 02:03:32,240 FLEXIBLE FOR EXAMPLE, SPARSE 3165 02:03:32,240 --> 02:03:33,800 EDUCATION -- AS FAR AS EDUCATION 3166 02:03:33,800 --> 02:03:35,920 SOME HEALTH SYSTEMS WANT TO USE 3167 02:03:35,920 --> 02:03:36,760 BROCHURES. 3168 02:03:36,760 --> 02:03:37,760 AND OTHER HEALTH SYSTEM WANTED 3169 02:03:37,760 --> 02:03:41,760 TO USE VIDEOS. 3170 02:03:41,760 --> 02:03:44,160 OTHER INFORMATIONAL. 3171 02:03:44,160 --> 02:03:47,120 SO AGAIN WE HAVE VARIETY, THERE 3172 02:03:47,120 --> 02:03:50,440 WAS SOMETHING THAT INITIALLY 3173 02:03:50,440 --> 02:03:51,680 BROUGHT ADDITIONAL WORK TO 3174 02:03:51,680 --> 02:03:53,560 SETTLE THIS ACROSS FOUR 3175 02:03:53,560 --> 02:03:55,680 DIFFERENT HEALTH SYSTEMS BUT AT 3176 02:03:55,680 --> 02:03:57,240 THE END WE BELIEVE IT ALLOWS US 3177 02:03:57,240 --> 02:04:00,360 TO HAVE A WIDER PERSPECTIVE OF 3178 02:04:00,360 --> 02:04:01,800 WHAT WORKS AND WHAT IS BEST IN 3179 02:04:01,800 --> 02:04:06,960 ONE SYSTEM OR ANOTHER AND BE 3180 02:04:06,960 --> 02:04:08,920 FLEXIBLE AND READY TO ADAPT. 3181 02:04:08,920 --> 02:04:13,800 THANK YOU. 3182 02:04:13,800 --> 02:04:15,440 >> THANK YOU, QUICK FOLLOW-UP 3183 02:04:15,440 --> 02:04:17,640 BUT BEFORE I ASK MARGARET OR 3184 02:04:17,640 --> 02:04:18,840 MIGUEL OR ANYONE ELSE ON THE 3185 02:04:18,840 --> 02:04:21,160 PANEL BUT WONDER IF GLORIA OR 3186 02:04:21,160 --> 02:04:22,360 MIRIAM WANTED TO ADD ANYTHING 3187 02:04:22,360 --> 02:04:23,320 THAT POPPED INTO THEIR MIND 3188 02:04:23,320 --> 02:04:27,760 LISTENING TO THESE RESPONSES. 3189 02:04:27,760 --> 02:04:29,920 >> THIS IS GLORIA. 3190 02:04:29,920 --> 02:04:33,200 I CAN ADD A LITTLE EMPHASIS ON 3191 02:04:33,200 --> 02:04:35,200 SOMETHING THAT MIGUEL SAID WHICH 3192 02:04:35,200 --> 02:04:37,120 WAS THAT HIS SYSTEMS WEREN'T 3193 02:04:37,120 --> 02:04:39,360 THAT FAMILIAR WITH PRAGMATIC 3194 02:04:39,360 --> 02:04:40,920 RESEARCH. 3195 02:04:40,920 --> 02:04:43,320 IN OUR CASE STEPS YOU SEE WE 3196 02:04:43,320 --> 02:04:44,920 DEFINITELY ENCOUNTERED THAT WITH 3197 02:04:44,920 --> 02:04:46,960 OUR (INAUDIBLE) AS WELL. 3198 02:04:46,960 --> 02:04:48,640 SOMETIMES WHEN WE PITCH THE IDEA 3199 02:04:48,640 --> 02:04:50,960 TO CLINIC THEY SAID OKAY WELL, 3200 02:04:50,960 --> 02:04:52,520 WHEN IS THE STUDY GOING TO BE 3201 02:04:52,520 --> 02:04:52,880 DONE? 3202 02:04:52,880 --> 02:04:56,520 WE SAID WELL, WE ARE HOPING YOU 3203 02:04:56,520 --> 02:04:57,880 MIGHT INCORPORATE THIS AS PART 3204 02:04:57,880 --> 02:04:59,920 OF USUAL CARE. 3205 02:04:59,920 --> 02:05:04,000 REALLY THE CONCEPT OF LIKE DOING 3206 02:05:04,000 --> 02:05:05,400 IMPROVEMENT SUSTAINING THAT 3207 02:05:05,400 --> 02:05:08,400 IMPROVEMENT OVER TIME WAS 3208 02:05:08,400 --> 02:05:13,560 UNFAMILIAR TO THEM THE OTHER 3209 02:05:13,560 --> 02:05:14,480 CONCEPT, EVEN DURING THE TRIAL 3210 02:05:14,480 --> 02:05:16,160 SOME CLINICS FELT LIKE OKAY 3211 02:05:16,160 --> 02:05:18,000 THOSE CLINICS ARE RESEARCH 3212 02:05:18,000 --> 02:05:20,080 CLINICS SO WE ARE NOT GOING TO 3213 02:05:20,080 --> 02:05:20,600 TOUCH THEM. 3214 02:05:20,600 --> 02:05:22,120 SO IF WE WANT TO DO ANY 3215 02:05:22,120 --> 02:05:23,560 IMPROVEMENT WE ARE GOING TO DO 3216 02:05:23,560 --> 02:05:24,960 THE IMPROVEMENT IN THE USUAL 3217 02:05:24,960 --> 02:05:25,880 CARE CLINICS. 3218 02:05:25,880 --> 02:05:28,320 SO I THINK THAT IN SOME CASES, 3219 02:05:28,320 --> 02:05:31,600 THERE WAS SOME CONCERNS THAT WE 3220 02:05:31,600 --> 02:05:33,880 HAS ABOUT CONFOUNDING SO FORTH 3221 02:05:33,880 --> 02:05:36,640 BECAUSE OF THEIR PERCEPTION THAT 3222 02:05:36,640 --> 02:05:37,520 DON'T TOUCH CLINICS THAT ARE 3223 02:05:37,520 --> 02:05:38,760 PART OF THE RESEARCH WHEN IN 3224 02:05:38,760 --> 02:05:42,520 FACT WE WANTED THEM TO ENGAGE IN 3225 02:05:42,520 --> 02:05:44,680 WORK AND THAT THEY HAD IDEAS FOR 3226 02:05:44,680 --> 02:05:46,400 HOW TO FURTHER ADAPT THE PROGRAM 3227 02:05:46,400 --> 02:05:49,560 OR MAKE IMPROVEMENTS WE WANTED 3228 02:05:49,560 --> 02:05:51,440 THEM TO WORK WITH US TO DO THAT. 3229 02:05:51,440 --> 02:05:53,320 IT WAS REALLY INTERESTING JUST 3230 02:05:53,320 --> 02:05:57,840 TO KIND OF TRY TO OVERCOME MORE 3231 02:05:57,840 --> 02:05:58,840 TRADITIONAL IDEA THEY HAD ABOUT 3232 02:05:58,840 --> 02:06:03,560 RESEARCH AND WHAT OUR ROLE WAS. 3233 02:06:03,560 --> 02:06:05,280 THERE WERE STRATEGIES WE USE 3234 02:06:05,280 --> 02:06:06,600 THAT ARE HELPFUL AND I MIGHT 3235 02:06:06,600 --> 02:06:08,040 TALK ABOUT THESE LATER BUT WE 3236 02:06:08,040 --> 02:06:10,560 DID HAVE CLINICS DO PLAN STUDY 3237 02:06:10,560 --> 02:06:16,400 CYCLES SO THIS WAS A COMMON 3238 02:06:16,400 --> 02:06:17,880 QUALITY IMPROVEMENT STRATEGY 3239 02:06:17,880 --> 02:06:19,600 THEY WERE FAMILIAR WITH, SO IT 3240 02:06:19,600 --> 02:06:21,160 WAS EASY TO DO AND THAT HELPED 3241 02:06:21,160 --> 02:06:26,000 ENGAGE THEM IN THE WORK. 3242 02:06:26,000 --> 02:06:34,600 I WILL STOPPLE THERE. 3243 02:06:34,600 --> 02:06:35,840 FAMILIARITY WITH PRAGMATIC 3244 02:06:35,840 --> 02:06:37,000 RESEARCH, IT IS INTERESTING 3245 02:06:37,000 --> 02:06:38,880 ESPECIALLY AT TRIALS WHETHER 3246 02:06:38,880 --> 02:06:41,040 THAT IS SOMETIME GOING TO BRING 3247 02:06:41,040 --> 02:06:42,480 CONTEMPT OR GOING TO BE 3248 02:06:42,480 --> 02:06:45,240 SOMETHING THAT IS HELPFUL 3249 02:06:45,240 --> 02:06:46,840 BECAUSE I THINK THAT PRESSURE TO 3250 02:06:46,840 --> 02:06:48,360 CONTINUE IT OR AT LEAST INTEREST 3251 02:06:48,360 --> 02:06:50,200 IN CONTINUING IT SOMETIMES 3252 02:06:50,200 --> 02:06:53,160 PLACES ARE HAPPY TO DO RESEARCH 3253 02:06:53,160 --> 02:06:56,680 AND BE DONE WHEREAS THIS IS A 3254 02:06:56,680 --> 02:06:57,960 LITTLE DIFFERENT PATH. 3255 02:06:57,960 --> 02:07:00,160 BEFORE WE MOVE ON I DID WANT TO 3256 02:07:00,160 --> 02:07:01,720 MAYBE THROW THIS TO MARGARET 3257 02:07:01,720 --> 02:07:04,800 BECAUSE I APPRECIATED THE THREE 3258 02:07:04,800 --> 02:07:05,840 BIG THEMES. 3259 02:07:05,840 --> 02:07:07,520 IS THERE A THEME YOU CAN LINK TO 3260 02:07:07,520 --> 02:07:08,600 CHANGING HOW YOUR THOUGHTS 3261 02:07:08,600 --> 02:07:08,920 CHANGE? 3262 02:07:08,920 --> 02:07:10,440 OR DO YOU THINK IT IS KEY TO BE 3263 02:07:10,440 --> 02:07:11,280 FLEXIBLE OR DO YOU THINK THERE 3264 02:07:11,280 --> 02:07:13,160 IS WAYS THAT GENERALIZATION 3265 02:07:13,160 --> 02:07:16,040 ABOUT HOW THAT THINKING HAS TO 3266 02:07:16,040 --> 02:07:18,640 CHANGE FROM PRESET NOTIONS TO 3267 02:07:18,640 --> 02:07:21,080 HOW IT ENDS UP OR IS IT JUST 3268 02:07:21,080 --> 02:07:26,200 THAT F WORD WE HAVE BEEN HEARING 3269 02:07:26,200 --> 02:07:26,720 FLEXIBILITY? 3270 02:07:26,720 --> 02:07:29,080 >> I THINK IT IS THAT F WORD. 3271 02:07:29,080 --> 02:07:33,680 I THINK THAT IS BOTH AROUND WHAT 3272 02:07:33,680 --> 02:07:37,200 IS UNEXPECTED WHAT WE KNOW WE 3273 02:07:37,200 --> 02:07:40,040 WILL LEARN AND LEARN WHAT WORKS 3274 02:07:40,040 --> 02:07:41,080 BETTER AROUND INTERVENTION 3275 02:07:41,080 --> 02:07:42,280 DELIVERY AND OTHER ASPECTS OVER 3276 02:07:42,280 --> 02:07:43,440 TIME. 3277 02:07:43,440 --> 02:07:45,480 SO I THINK IT IS THE F WORD AND 3278 02:07:45,480 --> 02:07:49,320 N WORD, THE NIMBLE WORD THAT TO 3279 02:07:49,320 --> 02:07:58,000 MY MIND FEEL MOST IMPORTANT. 3280 02:07:58,000 --> 02:08:00,160 >> I APPRECIATE THAT WILLINGNESS 3281 02:08:00,160 --> 02:08:01,120 TO LEARN BECAUSE THAT 3282 02:08:01,120 --> 02:08:02,640 DIFFERENTIATES THE DESIGN WHERE 3283 02:08:02,640 --> 02:08:05,840 WE -- WHEREAS YOU DON'T COME IN 3284 02:08:05,840 --> 02:08:07,760 THIS IS THE WORK BOOK AND MANUAL 3285 02:08:07,760 --> 02:08:09,120 AND SEE YOU LATER. 3286 02:08:09,120 --> 02:08:13,080 IT REALLY IS, THERE HAS TO BE 3287 02:08:13,080 --> 02:08:15,480 THAT WILLINGNESS TO WORK WITH 3288 02:08:15,480 --> 02:08:18,280 THE LOCAL TEAM. 3289 02:08:18,280 --> 02:08:19,640 AND LEARN FROM THEM AND REALIZE 3290 02:08:19,640 --> 02:08:21,480 THEY WILL PROBABLY ANTICIPATE 3291 02:08:21,480 --> 02:08:23,480 SOME THINGS BETTER THAN WE COULD 3292 02:08:23,480 --> 02:08:27,480 HAVE WHEN WE HAD IT ON THE WHITE 3293 02:08:27,480 --> 02:08:28,520 BOARD. 3294 02:08:28,520 --> 02:08:30,160 THANK YOU, SORRY TO PUT YOU ON 3295 02:08:30,160 --> 02:08:32,440 THE SPOT. 3296 02:08:32,440 --> 02:08:34,440 MARY JO, WE WILL GO TO NEXT 3297 02:08:34,440 --> 02:08:37,240 SLIDE. 3298 02:08:37,240 --> 02:08:38,600 THIS QUESTION IS HOW TO 3299 02:08:38,600 --> 02:08:41,480 INCORPORATE WHAT IS KNOWN ABOUT 3300 02:08:41,480 --> 02:08:42,240 IMPLEMENTATION SCIENCE 3301 02:08:42,240 --> 02:08:44,920 STRATEGIES IN YOUR TRIAL AND 3302 02:08:44,920 --> 02:08:51,960 GLORIA WE WILL GO BACK. 3303 02:08:51,960 --> 02:08:54,080 >> SO I ALREADY TALKED ABOUT THE 3304 02:08:54,080 --> 02:08:58,160 FACT THAT WE USE PLAN STUDY 3305 02:08:58,160 --> 02:08:59,520 CYCLES WHICH WERE REALLY HELPFUL 3306 02:08:59,520 --> 02:09:00,440 FOR COUPLE OF REASONS. 3307 02:09:00,440 --> 02:09:03,720 ONE IS THAT REALLY HELPED OUR 3308 02:09:03,720 --> 02:09:05,960 CLINIC BECOME ENGAGE MISDEMEANOR 3309 02:09:05,960 --> 02:09:07,640 THE WORK AND NOT TO THINK ABOUT 3310 02:09:07,640 --> 02:09:10,320 US DOING RESEARCH ON THEIR 3311 02:09:10,320 --> 02:09:13,840 CLINICS BUT AS PARTNERS IN 3312 02:09:13,840 --> 02:09:15,840 REALLY IMPLEMENTING THE PROGRAM. 3313 02:09:15,840 --> 02:09:17,600 SECONDLY, IT HELPED US 3314 02:09:17,600 --> 02:09:19,160 UNDERSTAND WHAT THE 3315 02:09:19,160 --> 02:09:20,640 IMPLEMENTATION BARRIERS WERE. 3316 02:09:20,640 --> 02:09:24,840 SO GOING IN IN TO THE PLAN STUDY 3317 02:09:24,840 --> 02:09:26,400 ADD CYCLES IN COLLABORATION WITH 3318 02:09:26,400 --> 02:09:30,280 OUR PRIMARY CARE ORGANIZATIONS 3319 02:09:30,280 --> 02:09:32,080 LOCALLY TO RETRAIN CLINICS HOW 3320 02:09:32,080 --> 02:09:34,520 TO DO PSAs AND SET BENCHMARKS 3321 02:09:34,520 --> 02:09:36,480 WHEN THEY NEED TO SUBMIT 3322 02:09:36,480 --> 02:09:37,960 DOCUMENTS TO US. 3323 02:09:37,960 --> 02:09:39,720 OUR EXPECTATION WAS THAT EACH OF 3324 02:09:39,720 --> 02:09:43,920 THESE CLINICS WOULD TEST OUT A 3325 02:09:43,920 --> 02:09:45,600 REMINDER TO THE PROGRAM. 3326 02:09:45,600 --> 02:09:49,560 OUR STANDARD INTERVENTION 3327 02:09:49,560 --> 02:09:52,640 INCLUDED AN INTERLETTER MAIL A 3328 02:09:52,640 --> 02:09:55,400 REMINDER BUT THOUGHT THEY MIGHT 3329 02:09:55,400 --> 02:09:57,160 TEST OUT TELEPHONE CALLS OR 3330 02:09:57,160 --> 02:09:59,000 AUTOMATED APPROACHES AND TO OUR 3331 02:09:59,000 --> 02:10:00,680 SURPRISE, ONLY A FEW CLINICS 3332 02:10:00,680 --> 02:10:04,400 DECIDED TO DO THAT. 3333 02:10:04,400 --> 02:10:05,720 BUT SOME OTHER CLINICS SAID WE 3334 02:10:05,720 --> 02:10:09,080 WILL WORK ON WORK FLOW OR WE ARE 3335 02:10:09,080 --> 02:10:10,920 GOING TO FIGURE OUT THIS ISSUE 3336 02:10:10,920 --> 02:10:12,960 WE ARE HAVING WITH OUR LAB AND 3337 02:10:12,960 --> 02:10:15,000 THE FACT PATIENTS AREN'T PUTTING 3338 02:10:15,000 --> 02:10:16,360 DATES ON THE KITS WHEN THEY 3339 02:10:16,360 --> 02:10:21,480 COLLECT THEM SO WE -- DONE HAVE 3340 02:10:21,480 --> 02:10:22,480 COLLECTION DATES, SO WE 3341 02:10:22,480 --> 02:10:24,000 IDENTIFIED CHALLENGES WE MAY NOT 3342 02:10:24,000 --> 02:10:26,360 HAVE KNOWN EXISTED HAD WE NOT 3343 02:10:26,360 --> 02:10:28,440 DONE THE PSA CYCLES SO THAT WAS 3344 02:10:28,440 --> 02:10:31,320 ONE EXAMPLE OF REALLY MERGING 3345 02:10:31,320 --> 02:10:33,960 OUR PROGRAM INTO A STANDARD 3346 02:10:33,960 --> 02:10:35,720 QUALITY IMPROVEMENT FRAMEWORK, 3347 02:10:35,720 --> 02:10:37,880 CLINICS WERE INTERESTED IN. 3348 02:10:37,880 --> 02:10:40,280 IN ADDITION TO THAT, WE WERE 3349 02:10:40,280 --> 02:10:42,920 REALLY INTERESTED IN ASSESSING 3350 02:10:42,920 --> 02:10:44,760 DIFFERENT CHARACTERISTICS AT THE 3351 02:10:44,760 --> 02:10:46,720 LEVEL OF OUR CLINICS. 3352 02:10:46,720 --> 02:10:47,640 THE ORGANIZATIONAL LEVEL 3353 02:10:47,640 --> 02:10:48,520 CHARACTERISTICS. 3354 02:10:48,520 --> 02:10:50,880 THE INFLUENCE THAT THAT HAD ON 3355 02:10:50,880 --> 02:10:53,000 OUR IMPLEMENTATION SUCCESS. 3356 02:10:53,000 --> 02:10:55,720 WE BEGAN COLLABORATION WITH 3357 02:10:55,720 --> 02:10:58,680 EDWARD MIC FROM THE VA IN 3358 02:10:58,680 --> 02:11:00,440 INDIANA WHO AGREED TO SERVE AS 3359 02:11:00,440 --> 02:11:02,440 CONSULTANT TO OUR STUDY TO DO 3360 02:11:02,440 --> 02:11:08,040 SOME CONFIGURATIONAL COMPARATIVE 3361 02:11:08,040 --> 02:11:10,800 METHODS TO LOOK AT THE 3362 02:11:10,800 --> 02:11:11,920 ORGANIZATION, ROLE OF THE 3363 02:11:11,920 --> 02:11:13,120 ORGANIZATION LEVEL 3364 02:11:13,120 --> 02:11:14,480 CHARACTERISTICS IN THE SUCCESS 3365 02:11:14,480 --> 02:11:15,680 OF IMPLEMENTATION OF OUR 3366 02:11:15,680 --> 02:11:16,360 PROGRAM. 3367 02:11:16,360 --> 02:11:18,360 SO THAT IS ANOTHER EXAMPLE HOW 3368 02:11:18,360 --> 02:11:20,400 WE INCORPORATED THOSE PRINCIPLES 3369 02:11:20,400 --> 02:11:23,880 THROUGH OUR STUDY. 3370 02:11:23,880 --> 02:11:28,960 >> THANK YOU. 3371 02:11:28,960 --> 02:11:36,560 MIRIAM. 3372 02:11:36,560 --> 02:11:41,040 >> (INAUDIBLE) EFFECTIVENESS 3373 02:11:41,040 --> 02:11:42,080 PATIENT TRIAL FOCUSING MORE ON 3374 02:11:42,080 --> 02:11:49,960 THE EFFECTIVENESS LOOKING AT 3375 02:11:49,960 --> 02:11:52,560 ACUPUNCTURE TESTING USING SICKLE 3376 02:11:52,560 --> 02:11:53,840 CELL DISEASE PAIN, WHILE AT THE 3377 02:11:53,840 --> 02:11:57,360 SAME TIME OBSERVING UNDOCUMENTED 3378 02:11:57,360 --> 02:12:02,520 SOME OF THE BARRIERS, AS WELL AS 3379 02:12:02,520 --> 02:12:06,240 SOLUTIONS, TO THESE BARRIERS SO 3380 02:12:06,240 --> 02:12:13,280 HAVING SAID THAT WE ARE USING 3381 02:12:13,280 --> 02:12:15,720 (INAUDIBLE) IMPLEMENTATION 3382 02:12:15,720 --> 02:12:24,400 RESEARCH THAT WE DO UNDERSTAND 3383 02:12:24,400 --> 02:12:29,600 THEY IMPLEMENT TRIAL WITH FOCUS, 3384 02:12:29,600 --> 02:12:30,960 SO (INDISCERNIBLE) LEVEL THAT WE 3385 02:12:30,960 --> 02:12:34,520 ALSO FOCUSED ON POINT BLANK -- 3386 02:12:34,520 --> 02:12:37,600 WE ARE FOCUSING ON POLICY LEVEL 3387 02:12:37,600 --> 02:12:39,840 AS WELL AS (INAUDIBLE) LEVEL SO 3388 02:12:39,840 --> 02:12:43,400 TOGETHER TO IMPLEMENT OUR STUDY 3389 02:12:43,400 --> 02:12:45,920 SUCCESSFULLY EFFECTIVENESS, OUR 3390 02:12:45,920 --> 02:12:48,040 TEAM INCLUDES A 3391 02:12:48,040 --> 02:12:48,920 MULTIDISCIPLINARY TEAM THAT 3392 02:12:48,920 --> 02:12:50,840 INCLUDES CLINICIANS AN LOW POLL 3393 02:12:50,840 --> 02:12:54,480 GISTS, NURSING, MEDICINE, AS 3394 02:12:54,480 --> 02:13:05,000 WELL AS PEOPLE WITH EXPERTISE IN 3395 02:13:09,040 --> 02:13:12,840 BOARD SO HELP UNDERSTAND 3396 02:13:12,840 --> 02:13:13,720 PERSPECTIVE ON (INAUDIBLE) IN 3397 02:13:13,720 --> 02:13:14,160 THIS POPULATION. 3398 02:13:14,160 --> 02:13:19,080 SO HAVING SAID THAT, WE ALSO 3399 02:13:19,080 --> 02:13:20,480 ENGAGED MULTIPLE STAKEHOLDERS I 3400 02:13:20,480 --> 02:13:25,960 MENTIONED EARLIER, WE USE 3401 02:13:25,960 --> 02:13:29,520 SEMISTRUCTURED INTERVIEW TO 3402 02:13:29,520 --> 02:13:31,480 (INAUDIBLE) ABOUT SOME OF THESE 3403 02:13:31,480 --> 02:13:32,720 FACILITATORS BARRIERS AND AS 3404 02:13:32,720 --> 02:13:35,440 WELL AS SOLUTIONS TO THESE 3405 02:13:35,440 --> 02:13:35,960 PROBLEMS. 3406 02:13:35,960 --> 02:13:39,080 THE OTHER THING THAT WE HAVE 3407 02:13:39,080 --> 02:13:46,600 BEEN ALSO TO -- WE ARE WE ARE 3408 02:13:46,600 --> 02:13:48,680 DEVELOPING LOGO, WE JUST DIDN'T 3409 02:13:48,680 --> 02:13:50,680 WANT TO CHOOSE ANY LOGO WE 3410 02:13:50,680 --> 02:13:53,880 WANTED SO WE CONVERTED WITH 3411 02:13:53,880 --> 02:13:55,960 PATIENTS DOING INTERVIEW AND 3412 02:13:55,960 --> 02:13:59,040 PROVIDED WHAT YOU THINK ABOUT 3413 02:13:59,040 --> 02:14:09,560 THIS LEVEL, VERY CRITICAL SICKLE 3414 02:14:10,040 --> 02:14:12,640 CELL DISEASE OR (INAUDIBLE) LENS 3415 02:14:12,640 --> 02:14:15,760 SO THAT CULTURALLY SENSITIVE AS 3416 02:14:15,760 --> 02:14:18,200 WELL AS HAVE SOME RED BLOOD 3417 02:14:18,200 --> 02:14:19,800 CELLS TO SHOW WHAT IS HAPPENING 3418 02:14:19,800 --> 02:14:21,160 IN THE RED BLOOD CELL OF THESE 3419 02:14:21,160 --> 02:14:22,400 PATIENT WITH SICKLE CELL DISEASE 3420 02:14:22,400 --> 02:14:25,240 SO THAT WAS VERY, VERY GOOD FOR 3421 02:14:25,240 --> 02:14:27,480 OUR TEAM BECAUSE WE WERE ABLE TO 3422 02:14:27,480 --> 02:14:31,240 ENGAGE ABOUT THAT LEVEL AND ABLE 3423 02:14:31,240 --> 02:14:37,320 TO GET CRITICAL INFORMATION THAT 3424 02:14:37,320 --> 02:14:38,360 WAS LET US MOVE FORWARD. 3425 02:14:38,360 --> 02:14:41,720 WE ALSO HAVE PATIENTS SOME 3426 02:14:41,720 --> 02:14:42,960 QUESTIONS ABOUT INTERVENTIONS 3427 02:14:42,960 --> 02:14:46,680 AND SOME OF THE ISSUES THAT CAME 3428 02:14:46,680 --> 02:14:52,160 UP WAS (INAUDIBLE) PATIENT LIKE 3429 02:14:52,160 --> 02:14:54,840 GET INTO (INAUDIBLE) ALL THE 3430 02:14:54,840 --> 02:14:58,440 TIME BLOOD DRAWN, MONTHLY 3431 02:14:58,440 --> 02:15:04,480 SOMETIMES MORE SO THEY HAVE A 3432 02:15:04,480 --> 02:15:08,080 REAL VERSION (INAUDIBLE) WHAT 3433 02:15:08,080 --> 02:15:14,560 ARE WE GOING TO DO TO HELP YOU 3434 02:15:14,560 --> 02:15:15,920 UNDERSTANDNA WE POSSIBLE -- 3435 02:15:15,920 --> 02:15:20,080 LEVEL OF BLOOD DRAWN SO SOME OF 3436 02:15:20,080 --> 02:15:23,960 THE ADVICE THEY GIVE US TO 3437 02:15:23,960 --> 02:15:26,800 CORRECT -- TO HELP SHOW WHAT 3438 02:15:26,800 --> 02:15:28,880 ACUPUNCTURE IS LIKE IN THE 3439 02:15:28,880 --> 02:15:30,240 MIDDLE, YOU CAN USE -- THAT WE 3440 02:15:30,240 --> 02:15:32,320 USE FOR ACUPUNCTURE TO HELP THEM 3441 02:15:32,320 --> 02:15:33,680 TRULY UNDERSTAND AND THEY ARE 3442 02:15:33,680 --> 02:15:37,960 GOING TO PARTICIPATE IN THE 3443 02:15:37,960 --> 02:15:38,440 TRIAL. 3444 02:15:38,440 --> 02:15:40,560 THEN THE INFORMATION WE GATHERED 3445 02:15:40,560 --> 02:15:43,720 WE DID A BLUEPRINT 3446 02:15:43,720 --> 02:15:45,440 IMPLEMENTATION BLUEPRINT THAT 3447 02:15:45,440 --> 02:15:49,280 GUIDED THE PHASE AS WELL AS NOW, 3448 02:15:49,280 --> 02:15:51,480 ONE BEAUTY ABOUT THE BLUEPRINT, 3449 02:15:51,480 --> 02:15:53,800 IT IS A BLUEPRINT, THAT IS WE 3450 02:15:53,800 --> 02:15:58,240 ARE ABLE TO REVISE IT AS STUDIES 3451 02:15:58,240 --> 02:16:00,800 ONGOING, WHAT WE LEARN IT IS ONE 3452 02:16:00,800 --> 02:16:05,960 WHAT WE ARE LEARNING NOW IN THE 3453 02:16:05,960 --> 02:16:08,520 TRIAL PART OF THE STUDY. 3454 02:16:08,520 --> 02:16:10,080 SO THESE ARE SOME OF THE WAYS 3455 02:16:10,080 --> 02:16:11,760 ABLE TO INCORPORATE WHAT IS 3456 02:16:11,760 --> 02:16:15,280 KNOWN ABOUT IMPLEMENTATION 3457 02:16:15,280 --> 02:16:16,080 SCIENCE IN CLINICAL TRIALS. 3458 02:16:16,080 --> 02:16:18,960 T SO I'M GOING TO STOP AND ALLOW 3459 02:16:18,960 --> 02:16:20,400 OTHERS TO CHIME IN AND ANSWER 3460 02:16:20,400 --> 02:16:24,640 QUESTIONS THAT COME UP WITH THIS 3461 02:16:24,640 --> 02:16:25,200 TRIAL. 3462 02:16:25,200 --> 02:16:27,520 >> THANKS. 3463 02:16:27,520 --> 02:16:32,440 WE HAVE MARGARET IS NEXT ON THE 3464 02:16:32,440 --> 02:16:32,920 SIGN UP LIST. 3465 02:16:32,920 --> 02:16:34,040 GO AHEAD MARGARET. 3466 02:16:34,040 --> 02:16:35,120 THANK YOU MIRIAM. 3467 02:16:35,120 --> 02:16:39,520 >> SURE IT IS SOME OVERLAP WHAT 3468 02:16:39,520 --> 02:16:41,680 I'M GOING TO SAY AND POINTS 3469 02:16:41,680 --> 02:16:43,800 GLORIA AND MIRIAM MADE, I WOULD 3470 02:16:43,800 --> 02:16:45,240 SAY IMPLEMENTATION SCIENCE AND 3471 02:16:45,240 --> 02:16:48,000 RELATED STRATEGIES WERE REALLY 3472 02:16:48,000 --> 02:16:49,320 IMPORTANT IN OUR TRIAL, I THINK 3473 02:16:49,320 --> 02:16:52,320 WE ARE VERY FORTUNATE TO HAVE 3474 02:16:52,320 --> 02:16:59,600 TWO LEADERS INCLUDING CO-PI 3475 02:16:59,600 --> 02:17:01,880 STACY STERLING INCORPORATED 3476 02:17:01,880 --> 02:17:03,440 SCIENCE. 3477 02:17:03,440 --> 02:17:05,000 WE INCORPORATED EXPLICITLY, I 3478 02:17:05,000 --> 02:17:07,520 WANT TO HIGH LIE WAYS WE 3479 02:17:07,520 --> 02:17:08,600 INCORPORATED IT EXPLICITLY. 3480 02:17:08,600 --> 02:17:10,920 WE USE THE PRISM AND FRAME 3481 02:17:10,920 --> 02:17:12,800 NETWORKS TO GUIDE MEASUREMENT OF 3482 02:17:12,800 --> 02:17:14,080 CONSTRUCTS IN OUR TRIAL SO IT 3483 02:17:14,080 --> 02:17:16,440 WAS A HUGE ANCHOR FOR STUDY 3484 02:17:16,440 --> 02:17:26,840 DESIGN AND MEASUREMENT. 3485 02:17:42,240 --> 02:17:44,000 WITH AD LESS SENT CLINIC LEADER 3486 02:17:44,000 --> 02:17:45,120 AND DOCTORS AND HEALTH TRAINING 3487 02:17:45,120 --> 02:17:46,480 WITH STAFF TO TRY TO GET 3488 02:17:46,480 --> 02:17:47,400 EVERYBODY THAT MIGHT BE AFFECTED 3489 02:17:47,400 --> 02:17:51,000 IN OUR CLINICS BY THE 3490 02:17:51,000 --> 02:17:52,280 INTERVENTION ON BOARD FAMILIAR 3491 02:17:52,280 --> 02:17:53,440 WITH WHAT IS GOING ON. 3492 02:17:53,440 --> 02:17:57,040 SO THAT WAS IMPORTANT AT THE 3493 02:17:57,040 --> 02:17:57,960 BEGINNING THEN DURING THE TRIAL 3494 02:17:57,960 --> 02:17:59,360 WHEN COVID HIT WE ENGAGED 3495 02:17:59,360 --> 02:18:02,760 PARENTS WE WANTED TO KNOW IF OUR 3496 02:18:02,760 --> 02:18:05,520 GROUPS WOULD ESSENTIALLY BE IN 3497 02:18:05,520 --> 02:18:07,280 DEMAND, GIVEN THE STREAMS THAT 3498 02:18:07,280 --> 02:18:09,760 THE PANDEMIC MEANT FOR -- 3499 02:18:09,760 --> 02:18:10,960 STRAINS PANDEMIC MEANT FOR 3500 02:18:10,960 --> 02:18:12,840 FAMILIES OF AD LESSENS AND KIDS 3501 02:18:12,840 --> 02:18:14,560 OF -- AD LESS SEASONS AND ALL 3502 02:18:14,560 --> 02:18:15,800 AGE KIDS REALLY. 3503 02:18:15,800 --> 02:18:18,920 SO WE WANTED TO SEE OFFER AS A 3504 02:18:18,920 --> 02:18:20,680 WAY OF CONNECTING WITH OTHER 3505 02:18:20,680 --> 02:18:22,080 PARENTS AND ENGAGE AROUND 3506 02:18:22,080 --> 02:18:24,040 PARTICULAR ISSUES IN 3507 02:18:24,040 --> 02:18:24,680 ADOLESCENTS, MIGHT BE SOMETHING 3508 02:18:24,680 --> 02:18:27,560 THEY WANT TO DO EVEN DURING THIS 3509 02:18:27,560 --> 02:18:30,360 DIFFICULT TIME IN THE LIFE OF A 3510 02:18:30,360 --> 02:18:31,480 PANDEMIC. 3511 02:18:31,480 --> 02:18:32,520 WHILE THE PARENTS DIFFERED WE 3512 02:18:32,520 --> 02:18:33,960 HAVE THE SENSE THEY DID WANT US 3513 02:18:33,960 --> 02:18:37,080 TO OFFER THE PROGRAM AND WE 3514 02:18:37,080 --> 02:18:40,600 WANTED TO DO IT AND THAT ENGA 3515 02:18:40,600 --> 02:18:42,200 ENGAGEMENT IN PARENTS IS REALLY 3516 02:18:42,200 --> 02:18:43,280 IMPORTANT TO US GOING FORWARD 3517 02:18:43,280 --> 02:18:44,400 AND HOW WE THOUGHT ABOUT THE 3518 02:18:44,400 --> 02:18:46,960 INTERVENTION AND WHAT IT MIGHT 3519 02:18:46,960 --> 02:18:48,880 DO TO SUPPORT PARENTS. 3520 02:18:48,880 --> 02:18:51,280 WE ALSO MADE SURE TO MAINTAIN 3521 02:18:51,280 --> 02:18:54,040 CONNECTIONS WITH PEDIATRICS 3522 02:18:54,040 --> 02:18:55,680 PEDIATRICIANS AND THE CLINICS IN 3523 02:18:55,680 --> 02:18:57,080 WHICH WE WERE WORKING. 3524 02:18:57,080 --> 02:18:59,240 TO TELL THEM HOW THE TRAVEL IS 3525 02:18:59,240 --> 02:19:01,120 GOING TO SHARE QUOTE FROM 3526 02:19:01,120 --> 02:19:02,680 PARENTS, TO DO OTHER THINGS TO 3527 02:19:02,680 --> 02:19:06,200 SUPPORT THEIR ONGOING ENGAGEMENT 3528 02:19:06,200 --> 02:19:08,760 AND SUPPORT FOR WHAT WE WERE 3529 02:19:08,760 --> 02:19:09,120 DOING. 3530 02:19:09,120 --> 02:19:10,480 THINK THOSE ARE REALLY IMPORTANT 3531 02:19:10,480 --> 02:19:12,800 AND THE FINAL THING THAT I WANT 3532 02:19:12,800 --> 02:19:17,160 TO HIGHLIGHT AS ELIMINATION 3533 02:19:17,160 --> 02:19:18,720 SCIENCE STRATEGY H IS IMPORTANT 3534 02:19:18,720 --> 02:19:19,840 TO YIELD SUCH RICH INFORMATION 3535 02:19:19,840 --> 02:19:22,040 IS A QUALITATIVE INTERVIEW STUDY 3536 02:19:22,040 --> 02:19:25,280 THAT STACY IS LEADING THAT IS 3537 02:19:25,280 --> 02:19:27,280 FRAMED IN THE PRISM FRAMEWORK 3538 02:19:27,280 --> 02:19:27,760 PRINCIPLES. 3539 02:19:27,760 --> 02:19:31,520 AND THAT STUDY IS INVOLVING 3540 02:19:31,520 --> 02:19:34,400 STAFF AT EACH OF OUR SITES 3541 02:19:34,400 --> 02:19:35,760 INTERVIEW SEMISTRUCTURED 3542 02:19:35,760 --> 02:19:38,560 QUALITATIVE INTERVIEWS WITH 3543 02:19:38,560 --> 02:19:41,120 VARIOUS PEDIATRIC STAFF 3544 02:19:41,120 --> 02:19:42,680 LEADERSHIP AND NON-PEDIATRICS, 3545 02:19:42,680 --> 02:19:43,960 OTHER PARTS OF THE HEALTHCARE 3546 02:19:43,960 --> 02:19:47,800 SYSTEM AS WELL. 3547 02:19:47,800 --> 02:19:49,160 PEDIATRICS LEADERS SOMETIMES 3548 02:19:49,160 --> 02:19:50,560 FINANCE BUSINESS PEOPLE, 3549 02:19:50,560 --> 02:19:52,640 SOMETIMES PEDIATRICIANS TO 3550 02:19:52,640 --> 02:19:54,840 REALLY UNDERSTAND MULTIPLE 3551 02:19:54,840 --> 02:19:56,000 PERSPECTIVES SUPPORT FOR 3552 02:19:56,000 --> 02:19:58,560 PREVENTIVE INTERVENTIONS. 3553 02:19:58,560 --> 02:20:02,280 LIKE GGC BUT NOT LIMITED. 3554 02:20:02,280 --> 02:20:04,200 AND BETTER UNDERSTAND CONDITIONS 3555 02:20:04,200 --> 02:20:06,040 NECESSARY TO SUPPORT INVESTMENTS 3556 02:20:06,040 --> 02:20:08,000 IN EFFECTIVE PREVENTION APPROACH 3557 02:20:08,000 --> 02:20:11,880 FOR PEDIATRICS POPULATIONS. 3558 02:20:11,880 --> 02:20:13,880 I JUST THINK THE WORK THAT STACY 3559 02:20:13,880 --> 02:20:15,120 IS LEADING AND OTHERS ARE 3560 02:20:15,120 --> 02:20:16,760 PARTICIPATING IN, ARE GOING TO 3561 02:20:16,760 --> 02:20:18,720 PROVIDE YET ANOTHER SET OF 3562 02:20:18,720 --> 02:20:19,960 PERSPECTIVES NOW THAT WE ARE IN 3563 02:20:19,960 --> 02:20:22,800 A DIFFERENT POINT IN THE TRIAL 3564 02:20:22,800 --> 02:20:24,040 THAT WILL HELP BRIDGE 3565 02:20:24,040 --> 02:20:26,120 IMPLEMENTATION TO 3566 02:20:26,120 --> 02:20:27,160 SUSTAINABILITY. 3567 02:20:27,160 --> 02:20:28,840 THOSE ARE A FEW DIFFERENT WAYS 3568 02:20:28,840 --> 02:20:31,600 IN WHICH IMPLEMENTATION SCIENCE 3569 02:20:31,600 --> 02:20:33,640 CONSTRUCTS THAT ARE EMPHASIZED 3570 02:20:33,640 --> 02:20:35,720 FRAME WORKS, HAVE BEEN REALLY 3571 02:20:35,720 --> 02:20:41,480 CENTRAL IN OUR WORK ALL ALONG. 3572 02:20:41,480 --> 02:20:42,960 >> THANKS. 3573 02:20:42,960 --> 02:20:45,040 I'M A PRAGMATIC TRIALS RUBE BUT 3574 02:20:45,040 --> 02:20:46,680 DID HAVE SOMETHING THAT POPPED 3575 02:20:46,680 --> 02:20:51,920 IN MY HEAD THAT I WAS INTERESTED 3576 02:20:51,920 --> 02:20:58,080 IN PERSPECTIVE, SO MUCH TALK AND 3577 02:20:58,080 --> 02:20:59,200 TIME INVESTED IN IMPLEMENTATION 3578 02:20:59,200 --> 02:21:01,840 STRATEGIES ACROSS ALL THREE 3579 02:21:01,840 --> 02:21:02,240 TRIALS. 3580 02:21:02,240 --> 02:21:05,040 ONE WAS PRE-DETERMINED HYBRID 3581 02:21:05,040 --> 02:21:07,640 EFFECTIVENESS IMPLEMENTATION 3582 02:21:07,640 --> 02:21:09,440 TRIAL, CLUSTER RANDOMIZATION 3583 02:21:09,440 --> 02:21:09,760 TRIALS. 3584 02:21:09,760 --> 02:21:11,640 MOVING FORWARD YOU THINK THAT 3585 02:21:11,640 --> 02:21:12,240 LINE WILL BLUR OR DO YOU THINK 3586 02:21:12,240 --> 02:21:15,320 THERE IS SOME ADVANTAGE OF 3587 02:21:15,320 --> 02:21:18,840 DECLARING THAT HYBRID DESIGN? 3588 02:21:18,840 --> 02:21:20,400 CURIOUS BECAUSE I'M SITTING HERE 3589 02:21:20,400 --> 02:21:23,160 THINKING IF I DIDN'T SEE HOW YOU 3590 02:21:23,160 --> 02:21:25,240 DID THE TRIAL DESIGN, I WOULD 3591 02:21:25,240 --> 02:21:27,440 HAVE HEARD A LOT ABOUT 3592 02:21:27,440 --> 02:21:28,400 IMPLEMENTATION. 3593 02:21:28,400 --> 02:21:29,760 SO CURIOUS ABOUT WHAT YOUR 3594 02:21:29,760 --> 02:21:32,440 THOUGHTS ARE MOVING FORWARD, IS 3595 02:21:32,440 --> 02:21:34,360 THAT LINE BLURRIER OR DO YOU 3596 02:21:34,360 --> 02:21:35,840 THINK THERE IS SOME 3597 02:21:35,840 --> 02:21:36,600 DISTINCTIONTIVENESS THERE THAT 3598 02:21:36,600 --> 02:21:37,440 WILL CHARACTERIZE THE 3599 02:21:37,440 --> 02:21:42,160 DIFFERENCES IN THE TRIALS? 3600 02:21:42,160 --> 02:21:44,560 SORRY THAT POPPED IN MY HEAD 3601 02:21:44,560 --> 02:21:45,840 CURIOUS WHAT YOU THREE MIGHT 3602 02:21:45,840 --> 02:21:53,640 THINK ABOUT THAT. 3603 02:21:53,640 --> 02:21:56,360 THIS IS THE DANGER OF GONE OFF 3604 02:21:56,360 --> 02:21:59,200 MENU. 3605 02:21:59,200 --> 02:22:00,440 ANY THOUGHT? 3606 02:22:00,440 --> 02:22:03,880 >> I WILL JUMP IN HOPE THAT IS 3607 02:22:03,880 --> 02:22:08,120 OKAY WITH GLORIA AND MIRIAM AND 3608 02:22:08,120 --> 02:22:08,640 MIGUEL. 3609 02:22:08,640 --> 02:22:09,600 IMPLEMENTATION SCIENCE IN THE 3610 02:22:09,600 --> 02:22:11,400 WAY IN WHICH IMPLEMENTATION 3611 02:22:11,400 --> 02:22:13,680 CONSTRUCTS MODERATE IMPACT IS 3612 02:22:13,680 --> 02:22:15,440 JUST GOING TO GAIN MORE 3613 02:22:15,440 --> 02:22:17,400 ATTENTION, WE ARE GOING TO 3614 02:22:17,400 --> 02:22:19,880 REALLY CONTINUE TO HAVE AND GROW 3615 02:22:19,880 --> 02:22:21,880 OUR APPRECIATION FOR THE SYSTEMS 3616 02:22:21,880 --> 02:22:23,120 LEVEL FACTORS AND OTHER THINGS 3617 02:22:23,120 --> 02:22:27,160 THAT INFLUENCE WHAT WE DO. 3618 02:22:27,160 --> 02:22:29,520 I THINK THE FRAMEWORK LIKE MIR 3619 02:22:29,520 --> 02:22:31,040 GRAM IS USING I THINK ARE REALLY 3620 02:22:31,040 --> 02:22:37,320 IMPORTANT TO HELPING US WHAT WE 3621 02:22:37,320 --> 02:22:38,560 ARE TRYING TO CONTROL AND WHAT 3622 02:22:38,560 --> 02:22:43,240 WERE NOT. 3623 02:22:43,240 --> 02:22:44,720 I THINK THEY WILL CONTINUE TO BE 3624 02:22:44,720 --> 02:22:47,000 IMPORTANT EVEN IF WE GET MORE 3625 02:22:47,000 --> 02:22:48,760 PRAGMATIC PERHAPS AS WE GIVE 3626 02:22:48,760 --> 02:22:49,520 STRONGER CONSIDERATION TO THE 3627 02:22:49,520 --> 02:22:50,800 ROLE OF IMPLEMENTATION. 3628 02:22:50,800 --> 02:22:52,240 I DON'T WANT THEM AS FRAMEWORK 3629 02:22:52,240 --> 02:22:54,560 TO GO AWAY OR LINES TO BLUR TOO 3630 02:22:54,560 --> 02:22:56,640 MUCH BECAUSE I THINK THEY ARE 3631 02:22:56,640 --> 02:23:01,920 HELPFUL. 3632 02:23:01,920 --> 02:23:02,840 >> THIS IS GREAT. 3633 02:23:02,840 --> 02:23:07,040 I WILL ADD COUPLE OF THINGS. 3634 02:23:07,040 --> 02:23:09,800 I THINK THE EMPHASIS OF YOUR 3635 02:23:09,800 --> 02:23:14,200 TRIAL NEEDS TO DEPEND UPON THE 3636 02:23:14,200 --> 02:23:15,840 LITERATURE AND WHAT HAS BEEN 3637 02:23:15,840 --> 02:23:16,560 DONE TO DATE. 3638 02:23:16,560 --> 02:23:19,760 SO WHETHER YOU ARE CHOOSING TYPE 3639 02:23:19,760 --> 02:23:21,960 1, 2 OR 3 HYBRID EFFECTIVENESS 3640 02:23:21,960 --> 02:23:24,040 DESIGN DEPENDS ON WHAT IS THAT 3641 02:23:24,040 --> 02:23:26,560 FOUNDATION OF RESEARCH TELLING 3642 02:23:26,560 --> 02:23:28,720 YOU BUT I WILL ADD TO THAT I 3643 02:23:28,720 --> 02:23:30,560 THINK THERE CONTINUES TO BE A 3644 02:23:30,560 --> 02:23:33,440 BIAS ON STUDY SECTIONS FOR THE 3645 02:23:33,440 --> 02:23:34,280 RANDOMIZED TRIAL. 3646 02:23:34,280 --> 02:23:37,000 SO I THINK THAT WE NEED TO 3647 02:23:37,000 --> 02:23:39,480 CONTINUE TO EMPHASIZE THE 3648 02:23:39,480 --> 02:23:41,280 IMPORTANCE OF IMPLEMENTATION AND 3649 02:23:41,280 --> 02:23:45,000 FIGURING OUT IMPLEMENTATION 3650 02:23:45,000 --> 02:23:46,880 BARRIERS MOVING THOSE MODELS 3651 02:23:46,880 --> 02:23:49,560 REFINE DEVELOP CONCEPTUAL MODELS 3652 02:23:49,560 --> 02:23:55,720 THAT ARE INFORMING OUR WORK. 3653 02:23:55,720 --> 02:23:59,200 >> I WOULD LIKE TO ADD IN MY -- 3654 02:23:59,200 --> 02:24:06,000 GIVEN WHAT WE KNOW FROM GRACE 3655 02:24:06,000 --> 02:24:10,600 THAT TRIALS TYPE 1 BECAUSE 3656 02:24:10,600 --> 02:24:17,080 EFFECTIVENESS PART OF THIS STUDY 3657 02:24:17,080 --> 02:24:19,600 COLLECTING DATA OR DOCUMENTING 3658 02:24:19,600 --> 02:24:23,000 THE FACILITATORS AND BARRIERS 3659 02:24:23,000 --> 02:24:26,000 AND SOLUTIONS TO SOME OF THOSE 3660 02:24:26,000 --> 02:24:28,560 BARRIERS SO BAD, EFFECTIVENESS 3661 02:24:28,560 --> 02:24:32,320 OUT OF THE TRIAL IS SUCCESSFUL 3662 02:24:32,320 --> 02:24:34,840 INTERVENTIONS ARE EFFECTIVE IN 3663 02:24:34,840 --> 02:24:39,640 WHATEVER OUTCOME YOU LOOK AT. 3664 02:24:39,640 --> 02:24:41,160 YOU HAVE SOME PROBLEMS AHEAD OF 3665 02:24:41,160 --> 02:24:43,560 TIME SOME OF O THOSE BARRIERS 3666 02:24:43,560 --> 02:24:47,000 ABOUT VISIBLE STRATEGIES TO 3667 02:24:47,000 --> 02:24:51,160 IMPLEMENT SO THAT WILL HELP 3668 02:24:51,160 --> 02:24:52,360 INTERVENTION IN THE HEALTHCARE 3669 02:24:52,360 --> 02:24:52,960 SYSTEM. 3670 02:24:52,960 --> 02:24:55,600 SO THAT IS ONE THING THINKING 3671 02:24:55,600 --> 02:24:58,040 ABOUT GIVEN OUR STUDY SOME OF 3672 02:24:58,040 --> 02:25:04,680 THE BARRIERS WE ARE FACING AND 3673 02:25:04,680 --> 02:25:05,840 EFFECTIVE IMPLEMENTATION WE ARE 3674 02:25:05,840 --> 02:25:07,960 AHEAD OF TIME OUTCOMES OF THIS 3675 02:25:07,960 --> 02:25:09,760 PROBLEM, WE ARE STARTING SOME OF 3676 02:25:09,760 --> 02:25:11,480 THEM NOW. 3677 02:25:11,480 --> 02:25:12,720 THEY ARE EACH GOING TO INCLUDE 3678 02:25:12,720 --> 02:25:14,720 POLICY MAKERS. 3679 02:25:14,720 --> 02:25:17,320 HOW TO MANAGE HELPERS WITH 3680 02:25:17,320 --> 02:25:23,280 BIGGER ISSUES WE CAN OBSERVE SO 3681 02:25:23,280 --> 02:25:28,640 HAVE THAT VISION FOR THE FUTURE. 3682 02:25:28,640 --> 02:25:29,360 >> THANK YOU. 3683 02:25:29,360 --> 02:25:32,680 THANK YOU ALL THREE FOR FIELDING 3684 02:25:32,680 --> 02:25:36,480 THAT QUESTION FROM THE ROOM OF 3685 02:25:36,480 --> 02:25:36,920 THE PANEL. 3686 02:25:36,920 --> 02:25:37,960 LET'S MOVE ON THE NEXT ONE IS A 3687 02:25:37,960 --> 02:25:39,360 LITTLE BIT OF A QUICK HITTER BUT 3688 02:25:39,360 --> 02:25:46,680 IT IS A GOOD FOLLOW-UP TO THE 3689 02:25:46,680 --> 02:25:47,280 IMPORTANCE IMPLEMENTATION 3690 02:25:47,280 --> 02:25:51,600 SCIENCE IS EMPHASIZED. 3691 02:25:51,600 --> 02:25:54,040 WHERE DID YOU FIND THIS 3692 02:25:54,040 --> 02:25:54,600 EXPERTISE? 3693 02:25:54,600 --> 02:25:55,360 GLORIA, DO YOU WANT TO LEAD OFF 3694 02:25:55,360 --> 02:25:56,000 WITH THAT ONE? 3695 02:25:56,000 --> 02:26:00,840 >> I THINK THAT WE WERE LUCKY 3696 02:26:00,840 --> 02:26:04,720 BECAUSE MY CO-P I PARTICIPATED 3697 02:26:04,720 --> 02:26:05,920 IN THE TITLER PROGRAM THAT 3698 02:26:05,920 --> 02:26:07,480 TRAINS PEOPLE IN IMPLEMENTATION 3699 02:26:07,480 --> 02:26:08,720 SCIENCE SO THAT IS REALLY 3700 02:26:08,720 --> 02:26:09,600 HELPFUL AND I HEARD THAT 3701 02:26:09,600 --> 02:26:11,840 MENTIONED BY MARGARET AND OTHERS 3702 02:26:11,840 --> 02:26:13,280 THAT HAVING THAT EXPERTISE ON 3703 02:26:13,280 --> 02:26:17,000 YOUR LEADERSHIP TEAM MAKES A 3704 02:26:17,000 --> 02:26:17,920 DIFFERENCE. 3705 02:26:17,920 --> 02:26:18,960 THEN ALSO MENTION WE REACHED OUT 3706 02:26:18,960 --> 02:26:21,160 TO THE PRIMARY CARE ASSOCIATION 3707 02:26:21,160 --> 02:26:24,440 TO HELP US WITH PLAN STUDY 3708 02:26:24,440 --> 02:26:25,920 CYCLES TO MAKE SURE THAT WHAT WE 3709 02:26:25,920 --> 02:26:28,000 WERE DOING WAS REALLY CONSISTENT 3710 02:26:28,000 --> 02:26:30,520 WITH HOW THE CLINICS ARE BEING 3711 02:26:30,520 --> 02:26:32,520 TAUGHT THAT QUALITY IMPROVEMENT 3712 02:26:32,520 --> 02:26:33,080 STRATEGY. 3713 02:26:33,080 --> 02:26:34,240 THERE COULD BE LOCAL RESOURCES 3714 02:26:34,240 --> 02:26:37,440 THAT CAN BE ACCESSED WE DID FIND 3715 02:26:37,440 --> 02:26:40,440 PARTNERS TO DO MORE 3716 02:26:40,440 --> 02:26:42,400 SOPHISTICATED CONFIGURATIONAL 3717 02:26:42,400 --> 02:26:45,920 COMPARATIVE METHODS TYPE WORK 3718 02:26:45,920 --> 02:26:47,120 AGAIN ONCE STUDY FUNDED WESTERN 3719 02:26:47,120 --> 02:26:48,720 ABLE TO MAKE THOSE PARTNERSHIPS 3720 02:26:48,720 --> 02:26:50,120 AND COLLABORATIONS HAPPEN SO 3721 02:26:50,120 --> 02:26:51,520 THAT WE CAN DO SOME MORE STATE 3722 02:26:51,520 --> 02:26:55,040 OF THE ART CUTTING EDGE ANALY 3723 02:26:55,040 --> 02:26:55,560 ANALYSIS. 3724 02:26:55,560 --> 02:26:56,760 WE BENEFITED FROM THOSE 3725 02:26:56,760 --> 02:27:04,480 DIFFERENT RESOURCES. 3726 02:27:04,480 --> 02:27:08,440 >> QUICK HITTER BUT GIVE ANYONE 3727 02:27:08,440 --> 02:27:10,360 ELSE IN THE PANEL TO ADD TO THAT 3728 02:27:10,360 --> 02:27:10,680 ONE. 3729 02:27:10,680 --> 02:27:18,680 GO AHEAD MARY. 3730 02:27:18,680 --> 02:27:23,560 >> I USED TO BE UIC PRIMARY 3731 02:27:23,560 --> 02:27:25,520 INSTITUTION FOR THIS STUDY. 3732 02:27:25,520 --> 02:27:28,480 SO WE HAVE DEVELOPED 3733 02:27:28,480 --> 02:27:31,000 COLLABORATION RELATIONSHIP WITH 3734 02:27:31,000 --> 02:27:34,200 PROVIDERS OF OTHER RESEARCHERS 3735 02:27:34,200 --> 02:27:39,560 IMPLEMENTATION SCIENTIST DATA SO 3736 02:27:39,560 --> 02:27:40,840 CHICAGO TO FLORIDA WE ALSO 3737 02:27:40,840 --> 02:27:45,920 DEVELOP EXPERTISE HERE, WHEN UIC 3738 02:27:45,920 --> 02:27:49,320 REACHED TO US ESTABLISHED IN 3739 02:27:49,320 --> 02:27:54,400 FLORIDA COLLEAGUES IN CHICAGO I 3740 02:27:54,400 --> 02:28:00,320 THINK THE OUTCOMES THAT WE DO, 3741 02:28:00,320 --> 02:28:01,760 WITH THOSE WE HAVE PEOPLE WORK 3742 02:28:01,760 --> 02:28:05,280 WITH THEM IN THE PAST AND THEY 3743 02:28:05,280 --> 02:28:07,960 HAVE A -- CRITICAL FOR ALL SO WE 3744 02:28:07,960 --> 02:28:12,400 GET TOGETHER AS A TEAM WITH A 3745 02:28:12,400 --> 02:28:15,160 NAME WITH EXPERTISE 3746 02:28:15,160 --> 02:28:19,800 ANTHROPOLOGY, CHINESE MEDICINE, 3747 02:28:19,800 --> 02:28:22,240 CLINICIANS, SUCH BEAUTIFUL HOW 3748 02:28:22,240 --> 02:28:28,640 OUR TEAM IS CONFIGURED HOW 3749 02:28:28,640 --> 02:28:34,360 STIMULATION TO EVERYONE 3750 02:28:34,360 --> 02:28:38,280 FUNCTION, HOW OUR (INAUDIBLE) 3751 02:28:38,280 --> 02:28:38,560 DEVELOP -- 3752 02:28:38,560 --> 02:28:40,920 >> I WILL ADD ONE MORE THING. 3753 02:28:40,920 --> 02:28:44,400 IN THE FIRST YEAR TWO STOP CRC 3754 02:28:44,400 --> 02:28:48,880 WE BENEFITED FROM OUR OFFICERS 3755 02:28:48,880 --> 02:28:50,800 BEING (INAUDIBLE) AS MANY PEOPLE 3756 02:28:50,800 --> 02:28:53,560 KNOW IS THE FOUNDER OF THE REAIM 3757 02:28:53,560 --> 02:28:56,120 FRAME WORK SO THAT ALSO REALLY 3758 02:28:56,120 --> 02:28:59,640 BOLLED OUR EMPHASIS ON 3759 02:28:59,640 --> 02:29:00,360 IMPLEMENTATION SCIENCE. 3760 02:29:00,360 --> 02:29:02,920 AND JUST TO PUT IN ANOTHER PLUG, 3761 02:29:02,920 --> 02:29:07,240 I MENTION THAT MY CO-PI ATTENDED 3762 02:29:07,240 --> 02:29:08,800 A TRAINING PROGRAM I AM SERVING 3763 02:29:08,800 --> 02:29:11,280 AS A MENTOR AND TRAINING PROGRAM 3764 02:29:11,280 --> 02:29:12,720 CALLED IMPLEMENTATION SCIENCE 3765 02:29:12,720 --> 02:29:15,000 SCHOLARS RUN OUT OF WASHINGTON 3766 02:29:15,000 --> 02:29:15,280 UNIVERSITY. 3767 02:29:15,280 --> 02:29:17,560 IT IS REALLY GREAT PROGRAM FOR 3768 02:29:17,560 --> 02:29:19,640 EARLY STAGE INVESTIGATORS, SO IF 3769 02:29:19,640 --> 02:29:21,080 ANYBODY ON YOUR TEAM IS NEEDING 3770 02:29:21,080 --> 02:29:23,040 TO GET TRAINED IN IMPLEMENTATION 3771 02:29:23,040 --> 02:29:25,440 SCIENCE I WOULD HIGHLY RECOMMEND 3772 02:29:25,440 --> 02:29:25,960 THAT PROGRAM. 3773 02:29:25,960 --> 02:29:28,520 THERE MIGHT BE OTHERS OUT THERE 3774 02:29:28,520 --> 02:29:31,960 THAT ARE REALLY GOOD. 3775 02:29:31,960 --> 02:29:35,120 >> FOR US WE WERE FORTUNATE IN 3776 02:29:35,120 --> 02:29:38,640 ONE OF OUR CO-INVESTIGATORS CHAD 3777 02:29:38,640 --> 02:29:41,000 FOX HAD ALREADY GONE QUITE A LOT 3778 02:29:41,000 --> 02:29:43,560 OF THIS WORK IMPLEMENTATION 3779 02:29:43,560 --> 02:29:45,000 INTERVENTIONS, WITHIN OUR 3780 02:29:45,000 --> 02:29:47,520 SETTINGS. 3781 02:29:47,520 --> 02:29:51,520 AND THEN A ONE OF OUR NIH 3782 02:29:51,520 --> 02:29:53,960 OFFICERS IN EXPERIENCE THIS WITH 3783 02:29:53,960 --> 02:29:57,400 INDIAN HEALTH SERVICES WHICH 3784 02:29:57,400 --> 02:29:59,280 SOME VERY IMPORTANT -- SAW VERY 3785 02:29:59,280 --> 02:30:00,120 IMPORTANT WORK AS FAR AS 3786 02:30:00,120 --> 02:30:02,760 IMPLEMENTING INTERVENTIONS IN 3787 02:30:02,760 --> 02:30:03,880 THOSE SPECIFIC POPULATIONS SO WE 3788 02:30:03,880 --> 02:30:05,080 WERE FORTUNATE WE WERE ABLE TO 3789 02:30:05,080 --> 02:30:08,800 BRING THAT EXPERTISE. 3790 02:30:08,800 --> 02:30:14,360 IN OUR STUDY. 3791 02:30:14,360 --> 02:30:19,680 >> I THINK JUST GOING TO TAKE A 3792 02:30:19,680 --> 02:30:22,560 ADVANTAGE OF BEING MODERATOR TO 3793 02:30:22,560 --> 02:30:25,200 TALK BRIEFLY REFLECT ON MY OWN 3794 02:30:25,200 --> 02:30:26,840 EXPERIENCE BUT I WAS INVOLVED 3795 02:30:26,840 --> 02:30:29,720 WITH A TRIAL WHERE WE TRAINED 3796 02:30:29,720 --> 02:30:31,280 PROVIDERS ON INTERVENTIONS 3797 02:30:31,280 --> 02:30:32,280 ACROSS FIVE DIFFERENT HEALTH 3798 02:30:32,280 --> 02:30:35,160 SYSTEMS AND IT WAS REALLY 3799 02:30:35,160 --> 02:30:35,880 FASCINATING/FRUSTRATING FOR US 3800 02:30:35,880 --> 02:30:39,280 AS THE TRIAL TEAMS TO WATCH THE 3801 02:30:39,280 --> 02:30:41,040 HEALTH SYSTEMS THAT HAVE THIS IN 3802 02:30:41,040 --> 02:30:42,520 THEIR CULTURE TAKE WHAT WE DID 3803 02:30:42,520 --> 02:30:45,720 AND RUN WITH IT IT WAS 3804 02:30:45,720 --> 02:30:47,320 INCREDIBLY FSTRATING TO 3805 02:30:47,320 --> 02:30:49,640 REALIZE WE SPENT LOT OF TIME 3806 02:30:49,640 --> 02:30:51,360 TRAINING AND IN SOME OF THE 3807 02:30:51,360 --> 02:30:53,240 OTHER SYSTEMS THAT DIDN'T HAVE 3808 02:30:53,240 --> 02:30:55,240 THIS CULTURE TO THAT IT WAS 3809 02:30:55,240 --> 02:30:58,000 GOING TO BASICALLY BEGIN AND END 3810 02:30:58,000 --> 02:31:01,240 WITH OUR TRAINING, IT WAS AN EYE 3811 02:31:01,240 --> 02:31:03,080 OPENING EXPERIENCE FROM SOMEONE 3812 02:31:03,080 --> 02:31:08,080 NEW TO THIS AREA. 3813 02:31:08,080 --> 02:31:09,080 MAYBE THE MOST IMPORTANT THING 3814 02:31:09,080 --> 02:31:10,480 IS MAKE SURE IF YOU DON'T HAVE 3815 02:31:10,480 --> 02:31:13,000 IT YOU DO FIND IT OUT OF ALL 3816 02:31:13,000 --> 02:31:14,960 THIS BUT SOUNDS LIKE THAT IS 3817 02:31:14,960 --> 02:31:16,280 JUST BECOMING MORE AND MORE, 3818 02:31:16,280 --> 02:31:17,920 THERE'S MORE TRAINING 3819 02:31:17,920 --> 02:31:19,480 OPPORTUNITIES AND CERTAINLY THE 3820 02:31:19,480 --> 02:31:23,360 PANEL HAS HIGHLIGHTED THAT. 3821 02:31:23,360 --> 02:31:25,000 SO I THINK THANK YOU FOR THE 3822 02:31:25,000 --> 02:31:28,480 INPUT ON THAT ONE. 3823 02:31:28,480 --> 02:31:31,720 WHY DON'T WE GO TO NEXT SLIDE. 3824 02:31:31,720 --> 02:31:33,440 MIGUEL STICKING WITH YOU TO TAKE 3825 02:31:33,440 --> 02:31:37,120 THE FIRST SHOT AT QUESTION FOUR. 3826 02:31:37,120 --> 02:31:45,960 MARY JO NEXT SLIDE. 3827 02:31:45,960 --> 02:31:47,640 WHAT IS VALUE OF MAPPING OUT 3828 02:31:47,640 --> 02:31:49,160 WORK FLOW AND HOW WERE THESE 3829 02:31:49,160 --> 02:31:53,880 MAPS USED DURING THE TRIAL? 3830 02:31:53,880 --> 02:31:55,680 >> HAPPY TO START WITH THIS ONE. 3831 02:31:55,680 --> 02:31:58,560 MAPPING WAS EXTREMELY IMPORTANT 3832 02:31:58,560 --> 02:32:01,200 FOR US, HOW DIFFERENCE OUR 3833 02:32:01,200 --> 02:32:03,360 HEALTH SYSTEMS WERE. 3834 02:32:03,360 --> 02:32:07,520 I THINK ONE THING WE HAD NOT 3835 02:32:07,520 --> 02:32:08,640 REALIZED PLANNING WAS IMPORTANCE 3836 02:32:08,640 --> 02:32:14,680 OF PLANNING TOGETHER INDIVIDUAL 3837 02:32:14,680 --> 02:32:18,000 OF EACH HEALTH SYSTEM, THE EARLY 3838 02:32:18,000 --> 02:32:19,520 SESSIONS WITH HEALTH SYSTEMS 3839 02:32:19,520 --> 02:32:21,080 TOGETHER, SOMEONE SAY OKAY WE 3840 02:32:21,080 --> 02:32:22,840 UNDERSTAND WHAT YOU WANT TO 3841 02:32:22,840 --> 02:32:25,560 ACCOMPLISH AND WHAT TOOLS YOU 3842 02:32:25,560 --> 02:32:27,800 GOING TO BE MADE AVAILABLE? 3843 02:32:27,800 --> 02:32:30,440 CAN WE COME UP WITH THE 3844 02:32:30,440 --> 02:32:32,800 DIFFERENT SWING RATES HERE TO 3845 02:32:32,800 --> 02:32:33,280 GET THERE. 3846 02:32:33,280 --> 02:32:34,840 THIS IS ONE OF THE MORE 3847 02:32:34,840 --> 02:32:35,720 INTEGRATED HEALTH SYSTEMS WITH 3848 02:32:35,720 --> 02:32:38,520 MANY RESOURCES. 3849 02:32:38,520 --> 02:32:41,400 WE DON'T HAVE TO MAP IN SWIM 3850 02:32:41,400 --> 02:32:43,400 LANES WE ONLY HAVE ONE SWIMMER 3851 02:32:43,400 --> 02:32:44,720 SO NO REASON TO MAP ANYTHING 3852 02:32:44,720 --> 02:32:46,480 HERE FOR DIFFERENT SWIMMERS. 3853 02:32:46,480 --> 02:32:49,000 EVERYTHING FOR ONE. 3854 02:32:49,000 --> 02:32:49,720 IN ONE. 3855 02:32:49,720 --> 02:32:51,920 THE MAPPING IS VERY IMPORTANT 3856 02:32:51,920 --> 02:32:54,600 BUT IT HAS TO BE DIFFERENT, 3857 02:32:54,600 --> 02:32:55,880 ACCORDING TO WHAT HEALTH SYSTEM 3858 02:32:55,880 --> 02:32:59,080 YOU HAVE. 3859 02:32:59,080 --> 02:33:05,120 KNOWING WHAT TO DO AND WHEN. 3860 02:33:05,120 --> 02:33:09,160 ALSO ALEAVE YATES CONCERNS THERE 3861 02:33:09,160 --> 02:33:12,000 WAS INITIALLY SOME -- I GUESS 3862 02:33:12,000 --> 02:33:12,840 ANXIETY, SOME OF THE HEALTH IN 3863 02:33:12,840 --> 02:33:14,840 THE PRACTICES, THIS IS GOING TO 3864 02:33:14,840 --> 02:33:18,200 BE MORE WORK, ARE WE GOING MORE 3865 02:33:18,200 --> 02:33:20,640 RESEARCH INSTEAD OF WORKING, AS 3866 02:33:20,640 --> 02:33:22,400 I SAID BEFORE WHAT WE ARE DOING 3867 02:33:22,400 --> 02:33:26,320 IS DELIVERING INTERVENTION 3868 02:33:26,320 --> 02:33:28,320 SYSTEM BUT WE WANT TO MAKE CLEAR 3869 02:33:28,320 --> 02:33:31,720 WE DO THE RESEARCH FOR THE 3870 02:33:31,720 --> 02:33:34,880 HEALTH SYSTEM IMPLEMENT THESE 3871 02:33:34,880 --> 02:33:35,560 PRACTICES. 3872 02:33:35,560 --> 02:33:38,200 HAVING THIS VERY CLEARLY DEFINED 3873 02:33:38,200 --> 02:33:40,840 AND CREATED THIS WORK FLOWS BY 3874 02:33:40,840 --> 02:33:42,400 STANDING DOWN NOT ONLY 3875 02:33:42,400 --> 02:33:46,680 INVESTIGATORS BUT THE PROVIDERS, 3876 02:33:46,680 --> 02:33:48,040 MANAGERS LEADERSHIP FROM THE 3877 02:33:48,040 --> 02:33:49,720 HEALTH SYSTEMS DO CLEAR WHAT 3878 02:33:49,720 --> 02:33:52,960 POINT EACH PERSON WAS DOING 3879 02:33:52,960 --> 02:33:53,960 WHAT, IN P WHAT HEALTH SYSTEM. 3880 02:33:53,960 --> 02:33:56,920 IT ALLOWS THEM TO PROVIDE EARLY 3881 02:33:56,920 --> 02:34:00,280 REPORTS TO THE HEALTH SYSTEM, WE 3882 02:34:00,280 --> 02:34:02,080 SAID THAT A WITH SOME OF THE 3883 02:34:02,080 --> 02:34:03,320 QUALITY GROUPS WITH SOME 3884 02:34:03,320 --> 02:34:04,520 PERFORMANCE IMPROVEMENT GROUPS 3885 02:34:04,520 --> 02:34:06,760 IN QA, THEY WERE SAYING THIS IS 3886 02:34:06,760 --> 02:34:09,400 GREAT, WORKING FOR SOME OF YOUR 3887 02:34:09,400 --> 02:34:10,480 SYSTEMS WE TELL THEM WE ARE 3888 02:34:10,480 --> 02:34:12,360 HAVING SOME CHALLENGES HERE, CAN 3889 02:34:12,360 --> 02:34:14,760 YOU HELP US TO ADVANCE THIS 3890 02:34:14,760 --> 02:34:18,560 WITHIN YOUR HEALTH SYSTEM. 3891 02:34:18,560 --> 02:34:20,640 FROM THAT PERSPECTIVE IT WAS 3892 02:34:20,640 --> 02:34:21,680 VERY HELPFUL. 3893 02:34:21,680 --> 02:34:24,440 WE ALSO WERE ABLE TO IDENTIFY IN 3894 02:34:24,440 --> 02:34:26,320 ADVANCE BEFORE WITH SOME OF THE 3895 02:34:26,320 --> 02:34:28,440 LEADERSHIP WHAT PRACTICES WERE 3896 02:34:28,440 --> 02:34:30,280 READY FOR THIS AT DIFFERENT 3897 02:34:30,280 --> 02:34:30,680 POINTS. 3898 02:34:30,680 --> 02:34:34,200 WE DID NOT ACTIVATE ALL SITES AT 3899 02:34:34,200 --> 02:34:36,960 THE SAME TIME, WE WERE JUST IN A 3900 02:34:36,960 --> 02:34:38,000 SEQUENTIAL FASHION IN THE FIRST 3901 02:34:38,000 --> 02:34:39,440 FEW MONTHS OF THE STUDY. 3902 02:34:39,440 --> 02:34:42,080 AND REALLY HELP TO ENSURE IF 3903 02:34:42,080 --> 02:34:44,480 SOMEBODY WAS GETTING RANDOMIZED, 3904 02:34:44,480 --> 02:34:47,160 THEY WOULD BE CAPABLE, THEY 3905 02:34:47,160 --> 02:34:50,440 CONTROL TO ACTUALLY DO WHAT WAS 3906 02:34:50,440 --> 02:34:51,000 NEEDED. 3907 02:34:51,000 --> 02:34:52,840 NOVEL PRACTICES READY AT ALL 3908 02:34:52,840 --> 02:34:57,080 TIMES AS FAR AS RESOURCES 3909 02:34:57,080 --> 02:34:58,680 WILLINGNESS AND CULTURE TO CARRY 3910 02:34:58,680 --> 02:34:59,960 OUT THIS TYPE OF WORK. 3911 02:34:59,960 --> 02:35:03,880 SO IT WAS HELPFUL TO HAVE WORK 3912 02:35:03,880 --> 02:35:06,800 FLOWS SO IT CAN BE IN PLACE AND 3913 02:35:06,800 --> 02:35:08,120 RETHE I TO GO IN INDIAN HEALTH 3914 02:35:08,120 --> 02:35:09,320 SYSTEM WHEN THE TIME CAME FOR 3915 02:35:09,320 --> 02:35:11,080 THEM. 3916 02:35:11,080 --> 02:35:12,800 THEN WE COULD GO BACK AS FAR AS 3917 02:35:12,800 --> 02:35:15,560 HOW THEY WERE USED IN THE TRIAL, 3918 02:35:15,560 --> 02:35:17,000 A DIFFERENT TIME DIFFERENT 3919 02:35:17,000 --> 02:35:18,200 HEALTH SYSTEMS DIFFERENT CLINICS 3920 02:35:18,200 --> 02:35:20,960 WE HAVE SOME HICCUPS THERE WAS 3921 02:35:20,960 --> 02:35:24,600 TURN OVER OF PERSONNEL ACROSS 3922 02:35:24,600 --> 02:35:26,920 ALL SITES IN HAVING CLEAR WORK 3923 02:35:26,920 --> 02:35:30,240 FLOWS WAS JUST A SO HELPFUL 3924 02:35:30,240 --> 02:35:32,880 BECAUSE NO MATTER HOW WELL 3925 02:35:32,880 --> 02:35:34,240 SOMEONE WAS PERFORMING THERE WAS 3926 02:35:34,240 --> 02:35:35,680 NO GUARANTEE THAT THAT 3927 02:35:35,680 --> 02:35:37,240 INDIVIDUAL OR THOSE INDIVIDUALS 3928 02:35:37,240 --> 02:35:38,680 ARE CHAMPIONS, GOING TO BE THERE 3929 02:35:38,680 --> 02:35:40,920 FOR THE DURATION OF THE STUDY. 3930 02:35:40,920 --> 02:35:45,440 SO BESIDES HAVING NOTES AND 3931 02:35:45,440 --> 02:35:46,760 ASSIGNING TO ETCH OOH OTHER 3932 02:35:46,760 --> 02:35:47,880 HAVING THE WORK FLOWS THERE, 3933 02:35:47,880 --> 02:35:49,960 HAVING SOMETHING THAT CAN PROVE 3934 02:35:49,960 --> 02:35:51,760 IT IS READY TO GO NO MATTER WHO 3935 02:35:51,760 --> 02:35:54,920 IS COMING TO BE THE NEXT 3936 02:35:54,920 --> 02:35:58,120 CHAMPION WAS EXTREMELY HELPFUL. 3937 02:35:58,120 --> 02:36:00,680 TURN OVER IS A MAJOR REALITY FOR 3938 02:36:00,680 --> 02:36:02,920 THESE STUDIES IN THE WORK FLOWS 3939 02:36:02,920 --> 02:36:07,400 ARE TO KEEP THE INTEGRITY OF 3940 02:36:07,400 --> 02:36:07,880 STUDY. 3941 02:36:07,880 --> 02:36:10,840 >> THANK YOU. 3942 02:36:10,840 --> 02:36:11,280 MIRIAM. 3943 02:36:11,280 --> 02:36:14,520 YOU WANT TO ADD ON? 3944 02:36:14,520 --> 02:36:17,960 >> YES, I DO. 3945 02:36:17,960 --> 02:36:22,160 JUST LIKE MIGUEL SAID WE FOUND 3946 02:36:22,160 --> 02:36:25,160 THE HEALTHCARE SYSTEMS SLIGHTLY 3947 02:36:25,160 --> 02:36:27,360 DIFFERENT. 3948 02:36:27,360 --> 02:36:30,320 DIFFERENT STRUCTURE AND CULTURE 3949 02:36:30,320 --> 02:36:36,640 WHEN WE DID THE MAP FOUND SOME 3950 02:36:36,640 --> 02:36:40,320 SIMILARITIES ONE DIFFERENCE WE 3951 02:36:40,320 --> 02:36:43,400 FOUND WAS THAT AT DUKE PATIENT 3952 02:36:43,400 --> 02:36:50,000 TRIED TO MAP OUT WHAT HAPPENS 3953 02:36:50,000 --> 02:36:51,240 WHEN PATIENT (INAUDIBLE) AT WHAT 3954 02:36:51,240 --> 02:36:53,480 POINT WE CAN VENTURE OUT AND 3955 02:36:53,480 --> 02:36:54,480 INCLUDE IT IN STUDY. 3956 02:36:54,480 --> 02:36:56,600 IN DOING THAT WE FOUND THAT THE 3957 02:36:56,600 --> 02:36:59,880 ONLY DIFFERENT AMONG (INAUDIBLE) 3958 02:36:59,880 --> 02:37:02,640 IS TIMING OF THE BLOOD DRAW SO 3959 02:37:02,640 --> 02:37:05,520 AT DUKE THEY COME GET THEIR 3960 02:37:05,520 --> 02:37:11,640 BLOOD DRAWN, BUT FOR -- BLOOD 3961 02:37:11,640 --> 02:37:17,360 DRAW HAS ANY TIME OF VISIT SO 3962 02:37:17,360 --> 02:37:20,440 KNOWING THAT FOCUS CLINICIAN, 3963 02:37:20,440 --> 02:37:24,320 HOW DO WE RECRUIT THE ONE IN A 3964 02:37:24,320 --> 02:37:33,400 LITTLE AMOUNT OF TIME, XYZ GET 3965 02:37:33,400 --> 02:37:35,160 TAKING CLINICIAN SEE THEM COME 3966 02:37:35,160 --> 02:37:38,640 OUT DO BLOOD TEST AND THEN 3967 02:37:38,640 --> 02:37:39,200 LEAVE. 3968 02:37:39,200 --> 02:37:47,040 WE WERE ADVISED TO (INAUDIBLE) 3969 02:37:47,040 --> 02:37:48,240 (INAUDIBLE) LOCATION BUT PATIENT 3970 02:37:48,240 --> 02:37:50,320 COME OUT OF CLINIC, TO HAVE 3971 02:37:50,320 --> 02:37:55,200 OPPORTUNITY TO ENCOUNTER US SO 3972 02:37:55,200 --> 02:37:59,960 WE HAVE STUDIES, SO VERY BRIGHT 3973 02:37:59,960 --> 02:38:01,240 COLORS SO THEY CAN STOP AND SAY 3974 02:38:01,240 --> 02:38:09,920 WHAT IS GOING ON CAN BE BOTH, 3975 02:38:09,920 --> 02:38:16,440 BECAUSE TELL ME MORE. 3976 02:38:16,440 --> 02:38:20,160 (INDISCERNIBLE) THINGS 3977 02:38:20,160 --> 02:38:29,080 CONDUCTING THEN ABOUT MAP 3978 02:38:29,080 --> 02:38:33,120 CLINICIANS IMPLEMENT PLAN PHASE 3979 02:38:33,120 --> 02:38:40,480 SO WE CAN'T REALLY BY CLINIC 3980 02:38:40,480 --> 02:38:41,840 STAFF (INAUDIBLE) CLINICIAN SO 3981 02:38:41,840 --> 02:38:46,560 THEY HAVE THE OPTION TO THEY 3982 02:38:46,560 --> 02:38:48,640 HAVE THE TIME OR INTRODUCE STUDY 3983 02:38:48,640 --> 02:38:51,880 TO THE PATIENT BY BRINGING THEM 3984 02:38:51,880 --> 02:38:56,800 AND ASK THEM TO (INAUDIBLE) 3985 02:38:56,800 --> 02:38:58,760 OPPORTUNITY WHICH IS IMPORTANT 3986 02:38:58,760 --> 02:39:00,560 FOR INTO THE CLINIC WHEN THEY 3987 02:39:00,560 --> 02:39:02,960 ARE DONE THEY HAVE OPPORTUNITY 3988 02:39:02,960 --> 02:39:04,880 BECAUSE WE FOUND WAS WAS THAT 3989 02:39:04,880 --> 02:39:06,760 WHEN PATIENT GOT DONE WITH THAT 3990 02:39:06,760 --> 02:39:12,040 CLINIC VISIT, THERE IS 3991 02:39:12,040 --> 02:39:17,560 (INAUDIBLE) BECAUSE 3992 02:39:17,560 --> 02:39:18,160 TRANSPORTATION SO JUST A FEW 3993 02:39:18,160 --> 02:39:20,520 MINUTES TO STOP AND SAY OKAY, 3994 02:39:20,520 --> 02:39:28,160 CAN YOU PLEASE CALL ME, SO 3995 02:39:28,160 --> 02:39:29,600 (INAUDIBLE) CAN YOU CALL ME 3996 02:39:29,600 --> 02:39:32,360 LATER AND THEY GIVE -- WHICH IS 3997 02:39:32,360 --> 02:39:36,960 -- HAVE THAT INTRODUCTION SO 3998 02:39:36,960 --> 02:39:38,640 THAT WE CAN (INAUDIBLE) DO STUDY 3999 02:39:38,640 --> 02:39:42,080 PROCESS SO THAT IS HOW THE 4000 02:39:42,080 --> 02:39:43,760 CLINIC IS REALLY HELPFUL FOR OUR 4001 02:39:43,760 --> 02:39:47,880 STUDY. 4002 02:39:47,880 --> 02:39:49,040 >> THANK YOU. 4003 02:39:49,040 --> 02:39:50,600 THANKS MIRIAM. 4004 02:39:50,600 --> 02:39:54,440 I THINK GLORIA, YOU ARE NEXT. 4005 02:39:54,440 --> 02:39:58,560 >> I CAN JUST EMPHASIZE WHAT 4006 02:39:58,560 --> 02:39:59,440 MIGUEL AND MIRIAM SAID THAT THE 4007 02:39:59,440 --> 02:40:01,480 WORK FLOW MAPPING WAS HELPFUL 4008 02:40:01,480 --> 02:40:03,640 FOR OUR STUDY AS WELL. 4009 02:40:03,640 --> 02:40:06,520 I THINK IN ADDITION TO WORK FLOW 4010 02:40:06,520 --> 02:40:10,560 MAPPING WE ALSO DID SOME DATA 4011 02:40:10,560 --> 02:40:11,240 MAPPING. 4012 02:40:11,240 --> 02:40:14,920 REASON THIS WAS HELPFUL IS 4013 02:40:14,920 --> 02:40:16,520 BECAUSE WE -- OUR CLINICS USED 4014 02:40:16,520 --> 02:40:18,840 EPIC BUT USED IT IN DIFFERENT 4015 02:40:18,840 --> 02:40:19,440 WAYS. 4016 02:40:19,440 --> 02:40:22,320 THEY HADN'T PREVIOUSLY USED 4017 02:40:22,320 --> 02:40:22,920 REPORTING WORKBENCH WHICH WAS 4018 02:40:22,920 --> 02:40:23,920 THE TOOL THAT WE WERE PLANNING 4019 02:40:23,920 --> 02:40:25,320 TO USE AND THAT WE DID USE FOR 4020 02:40:25,320 --> 02:40:27,600 OUR STUDY. 4021 02:40:27,600 --> 02:40:30,320 SO WE NEEDED TO MAKE SURE WHEN 4022 02:40:30,320 --> 02:40:33,480 WE WERE CREATING REPORTS 4023 02:40:33,480 --> 02:40:34,360 REPORTING WORKBENCH THEY WERE 4024 02:40:34,360 --> 02:40:36,120 ACCURATELY POOLING THOSE 4025 02:40:36,120 --> 02:40:37,680 PATIENTS THAT WERE DOING 4026 02:40:37,680 --> 02:40:39,280 CO-COLORECTAL CANCER SCREENING 4027 02:40:39,280 --> 02:40:40,120 INTO THOSE REPORTS. 4028 02:40:40,120 --> 02:40:43,200 SO WE MET WITH ALL THE IT SITE 4029 02:40:43,200 --> 02:40:44,320 SPECIALISTS, REALLY MAPPED OUT 4030 02:40:44,320 --> 02:40:46,400 WHERE THE DATA -- HOW IS THE 4031 02:40:46,400 --> 02:40:48,600 DATA BEING ENTERED WHO WAS 4032 02:40:48,600 --> 02:40:51,360 INTERRING IT TO MAKE SURE AND 4033 02:40:51,360 --> 02:40:53,600 CAPTURE THE HETEROGENEITY AND 4034 02:40:53,600 --> 02:40:55,720 HOW THE EHR TOOLS ARE BEING USED 4035 02:40:55,720 --> 02:40:56,960 TO MAKE SURE THEY WOULD SERVE 4036 02:40:56,960 --> 02:41:00,120 THE PURPOSE OF OUR STUDY. 4037 02:41:00,120 --> 02:41:02,320 IN ADDITION TO THE SWIM LANES 4038 02:41:02,320 --> 02:41:04,760 AND WHO IS DOING WHAT WE NEEDED 4039 02:41:04,760 --> 02:41:07,880 TO GET VERIFICATION THAT WHO IS 4040 02:41:07,880 --> 02:41:10,280 DOING WHAT FROM PERSPECTIVE OF 4041 02:41:10,280 --> 02:41:12,000 THE DATA TO ENSURE TOOLS WORK 4042 02:41:12,000 --> 02:41:16,040 PROPERLY. 4043 02:41:16,040 --> 02:41:18,120 >> THAT IS A GOOD POINT 4044 02:41:18,120 --> 02:41:21,880 ESPECIALLY WITH THE HR CONCERNS 4045 02:41:21,880 --> 02:41:22,640 OR QUESTIONS. 4046 02:41:22,640 --> 02:41:24,680 SORRY MARGARET GO AHEAD. 4047 02:41:24,680 --> 02:41:26,960 >> I WAS GOING TO SAY WHAT YOU 4048 02:41:26,960 --> 02:41:28,600 SAID, GLORIA'S COMMENT MADE ME 4049 02:41:28,600 --> 02:41:30,600 REALIZE THAT WE ACTUALLY DID A 4050 02:41:30,600 --> 02:41:33,080 LOT OF THAT DATA MAPPING AS WELL 4051 02:41:33,080 --> 02:41:35,640 WAS REALLY IMPORTANT TO KNOW IF 4052 02:41:35,640 --> 02:41:39,200 CONSTRUCTS MEASURED SIMILARLY 4053 02:41:39,200 --> 02:41:39,720 ACROSS SYSTEMS WHICH WERE 4054 02:41:39,720 --> 02:41:42,960 AVAILABLE IN THE HR AND I WANT 4055 02:41:42,960 --> 02:41:46,680 TO EMPHASIZE GLORIA'S POINT AND 4056 02:41:46,680 --> 02:41:48,640 SAY I HAVE ENCOURAGED THAT FOR 4057 02:41:48,640 --> 02:41:52,680 ALL THE REASONS. 4058 02:41:52,680 --> 02:41:54,040 >> THANK YOU. 4059 02:41:54,040 --> 02:41:55,800 THERE IS A QUESTION FROM THE 4060 02:41:55,800 --> 02:41:57,280 AUDIENCE THAT IS RELEVANT TO 4061 02:41:57,280 --> 02:41:59,560 THIS AND MAYBE WE CAN TOUCH ON 4062 02:41:59,560 --> 02:42:01,560 IT, IT MAY COME OUT IN OUR 4063 02:42:01,560 --> 02:42:03,280 SUMMARY THEMES TOO BUT WHILE WE 4064 02:42:03,280 --> 02:42:05,040 ARE HERE WITH MAPPING OUT BEFORE 4065 02:42:05,040 --> 02:42:06,400 WE GET TO THE NEXT QUESTION 4066 02:42:06,400 --> 02:42:08,000 WHICH I THIS HI IS A REALLY 4067 02:42:08,000 --> 02:42:08,720 IMPORTANT ONE I WANT TO LEAVE 4068 02:42:08,720 --> 02:42:10,600 TIME FOR IT OBVIOUSLY BUT THERE 4069 02:42:10,600 --> 02:42:13,760 IS A QUESTION ABOUT BALANCE OF 4070 02:42:13,760 --> 02:42:16,960 STAYING FLEXIBLE AND I'M 4071 02:42:16,960 --> 02:42:17,800 PARAPHRASING IT. 4072 02:42:17,800 --> 02:42:19,680 WHAT IS THE -- TALKING ABOUT 4073 02:42:19,680 --> 02:42:21,120 STAYING FLEXIBLE WHEN DOES IT 4074 02:42:21,120 --> 02:42:22,920 BECOME -- WHEN DOES 4075 02:42:22,920 --> 02:42:25,520 IMPLEMENTATION STRATEGY BECOME 4076 02:42:25,520 --> 02:42:29,560 ADAPTATION AND ACKNOWLEDGING 4077 02:42:29,560 --> 02:42:31,160 THAT YOU NEED TO BE FLEXIBLE 4078 02:42:31,160 --> 02:42:33,480 WHEN YOU NEED TO TRAP THESE 4079 02:42:33,480 --> 02:42:34,880 ADAPTATIONS, I BRING THIS 4080 02:42:34,880 --> 02:42:36,640 QUESTION UP BECAUSE WONDER IF 4081 02:42:36,640 --> 02:42:37,760 WORK FLOW MAPPING HELPS WITH 4082 02:42:37,760 --> 02:42:41,000 THAT OR NOT, IF THAT SOMETHING 4083 02:42:41,000 --> 02:42:42,560 MAPPED OUT BEFOREHAND DO YOU 4084 02:42:42,560 --> 02:42:45,080 THINK THAT HIMSELF IN PROVIDING 4085 02:42:45,080 --> 02:42:47,960 SOME OF THE SWIM LANES FOR WHAT 4086 02:42:47,960 --> 02:42:51,080 IS TOO FLEXIBLE AND ALSO 4087 02:42:51,080 --> 02:42:52,200 ADAPTATIONS THAT CAN BE TRACKED 4088 02:42:52,200 --> 02:42:53,920 SO HOPEFULLY THAT IS NOT TOO 4089 02:42:53,920 --> 02:42:54,960 MUCH A SQUEEZE BUT I SAW THAT 4090 02:42:54,960 --> 02:42:57,400 QUESTION, I THINK IT MAY COME UP 4091 02:42:57,400 --> 02:42:58,720 AGAIN, BUT SEEMS RELEVANT TO 4092 02:42:58,720 --> 02:43:00,920 THIS WORK FLOW MAPPING. 4093 02:43:00,920 --> 02:43:03,600 WONDER IF ANY PANELISTS HAD A 4094 02:43:03,600 --> 02:43:04,840 THOUGHT ON THAT. 4095 02:43:04,840 --> 02:43:06,760 IT IS IN THE CHAT FOR THOSE OF 4096 02:43:06,760 --> 02:43:07,680 YOU THAT ARE ON THE ZOOM IF YOU 4097 02:43:07,680 --> 02:43:09,680 WANT TO SEE HOW BAD A JOB I DID 4098 02:43:09,680 --> 02:43:13,000 MANY IN PARAPHRASING IT. 4099 02:43:13,000 --> 02:43:16,440 >> I CAN TIE IN A LITTLE BIT. 4100 02:43:16,440 --> 02:43:18,440 THERE ARE PATIENT POPULATION 4101 02:43:18,440 --> 02:43:23,280 WITH SICKLE CELL DISEASE, 4102 02:43:23,280 --> 02:43:24,720 COMPLICATIONS OF DISEASE IS 4103 02:43:24,720 --> 02:43:27,040 (INAUDIBLE) CHRONIC PAIN, THEY 4104 02:43:27,040 --> 02:43:29,840 HAVE RECURRENT ONGOING DISABLING 4105 02:43:29,840 --> 02:43:32,040 PAIN. 4106 02:43:32,040 --> 02:43:33,520 SO WE HAVE WORKING WITH THIS 4107 02:43:33,520 --> 02:43:40,200 POPULATION FOR OVER TEN YEARS, 4108 02:43:40,200 --> 02:43:42,000 SCHEDULE TODAY OR SCHEDULE FOR 4109 02:43:42,000 --> 02:43:43,120 VISIT, THEY WAKE UP IN THE 4110 02:43:43,120 --> 02:43:46,720 MORNING THEY HAVE SO MUCH PAIN, 4111 02:43:46,720 --> 02:43:53,280 THEY CANNOT COME TO THE VISIT 4112 02:43:53,280 --> 02:43:55,600 HAVE TO STOP, HAVE TO FINISH 4113 02:43:55,600 --> 02:44:00,320 THIS NOW SO WE SOMETIMES 4114 02:44:00,320 --> 02:44:03,120 (INAUDIBLE) SEVERAL TIMES TO 4115 02:44:03,120 --> 02:44:11,040 EVEN GET SCHEDULE, SOMETIME SO 4116 02:44:11,040 --> 02:44:14,480 (INAUDIBLE) DISEASE PROCESSES 4117 02:44:14,480 --> 02:44:16,240 AND DIRECTION THEY OBTAIN AND 4118 02:44:16,240 --> 02:44:20,240 MORE THAN FLEXIBLE AND STANDARD 4119 02:44:20,240 --> 02:44:21,760 THAT THIS IS THE WAY IT IS WE 4120 02:44:21,760 --> 02:44:24,000 ARE GOING TO BE (INAUDIBLE) 4121 02:44:24,000 --> 02:44:27,160 THOSE PATIENTS AND ANOTHER 4122 02:44:27,160 --> 02:44:32,440 EXAMPLE WE USE ACUPUNCTURE FOR 4123 02:44:32,440 --> 02:44:37,120 THE TREATMENT ARMS, MANY OF 4124 02:44:37,120 --> 02:44:39,920 THESE (INAUDIBLE) TRIAL TOO FAR 4125 02:44:39,920 --> 02:44:43,760 AWAY, AND THEN THE QUESTION IS 4126 02:44:43,760 --> 02:44:45,360 WHY GAS PRICE SO HIGH WHAT DO 4127 02:44:45,360 --> 02:44:49,080 YOU DO TO HELP GET THEM TO VISIT 4128 02:44:49,080 --> 02:44:50,520 SO YOU HAVE TO BE FLEXIBLE 4129 02:44:50,520 --> 02:44:52,000 THINKING OUTSIDE THE BOX, 4130 02:44:52,000 --> 02:44:54,240 THINKING HOW TO HELP THEM TO BE 4131 02:44:54,240 --> 02:44:55,680 ABLE TO DO INTERVENTION BECAUSE 4132 02:44:55,680 --> 02:44:58,440 WE CAN HAVE ALL THESE STUDIES 4133 02:44:58,440 --> 02:45:01,200 AND PATIENT HAVE THOSE STUDIES. 4134 02:45:01,200 --> 02:45:03,360 SO THAT IS MY RESPONSE TO THAT 4135 02:45:03,360 --> 02:45:05,720 QUESTION, FLEXIBILITY CONDUCT 4136 02:45:05,720 --> 02:45:07,840 PATIENTS SO JUST TRYING TO 4137 02:45:07,840 --> 02:45:10,880 ACCOMMODATE PATIENTS BECAUSE 4138 02:45:10,880 --> 02:45:13,760 PRAGMATIC TRIAL REAL WORLD 4139 02:45:13,760 --> 02:45:17,600 SITUATION FOR THIS PATIENT WHICH 4140 02:45:17,600 --> 02:45:19,520 IS PAIN MEASURE EACH DELIVERY AS 4141 02:45:19,520 --> 02:45:23,600 PART OF THAT DISEASE 4142 02:45:23,600 --> 02:45:26,200 >> THANKS MIRIAM. 4143 02:45:26,200 --> 02:45:29,040 OTHER THOUGHTS ON THE VALUE OF 4144 02:45:29,040 --> 02:45:32,240 THE MAP FOR FLEXIBILITY VERSUS 4145 02:45:32,240 --> 02:45:34,240 ADAPTATIONS AND IF AND WHEN, 4146 02:45:34,240 --> 02:45:36,880 LIKE I SAID THIS MAY COME UP 4147 02:45:36,880 --> 02:45:38,560 AGAIN IN THE GRAND SUMMARY BUT 4148 02:45:38,560 --> 02:45:40,520 ANY THOUGHTS ON THAT NOW? 4149 02:45:40,520 --> 02:45:41,680 >> I CAN ADD A FEW THINGS. 4150 02:45:41,680 --> 02:45:43,840 THIS IS GLORIA. 4151 02:45:43,840 --> 02:45:45,760 IN OUR TRIAL WE MADE SURE THAT 4152 02:45:45,760 --> 02:45:47,560 WE WERE REALLY CLEAR ON WHAT THE 4153 02:45:47,560 --> 02:45:49,400 CORE COMPONENTS WERE AND WHAT 4154 02:45:49,400 --> 02:45:51,840 THINGS COULD BE ADAPTED, IN OUR 4155 02:45:51,840 --> 02:45:56,520 CASE THE CORE COMPONENT WAS A 4156 02:45:56,520 --> 02:45:58,000 MALE (INAUDIBLE) ANYTHING ELSE 4157 02:45:58,000 --> 02:46:01,040 CLINICS DID WHETHER THEY SENT 4158 02:46:01,040 --> 02:46:03,160 REMINDERS OR DID TELEPHONE CALLS 4159 02:46:03,160 --> 02:46:05,880 WHATEVER, THAT WAS CONSIDERED 4160 02:46:05,880 --> 02:46:08,000 ADAPTATION. 4161 02:46:08,000 --> 02:46:13,480 IN SUBSEQUENT WORK WE HAVE CODED 4162 02:46:13,480 --> 02:46:14,560 ADAPTATIONS ACCORDING TO 4163 02:46:14,560 --> 02:46:16,920 (INAUDIBLE) INSTRUMENTS 4164 02:46:16,920 --> 02:46:18,840 FRAMEWORK SO WE LOOK AT THEM 4165 02:46:18,840 --> 02:46:20,960 ACROSS DIFFERENT DOMAINS AND I 4166 02:46:20,960 --> 02:46:22,360 THINK IT HAS BEEN REALLY USEFUL 4167 02:46:22,360 --> 02:46:24,280 EXERCISE, WE HAVE USED PERIODIC 4168 02:46:24,280 --> 02:46:26,960 REFLECTIONS TO REALLY CAPTURE 4169 02:46:26,960 --> 02:46:28,800 WHAT ARE THEY ADAPTATIONS 4170 02:46:28,800 --> 02:46:29,520 HAPPENING OVER TIME. 4171 02:46:29,520 --> 02:46:34,680 I THINK THERE ARE CHALLENGES TO 4172 02:46:34,680 --> 02:46:35,640 DOING THAT WHEN CLINIC STAFF 4173 02:46:35,640 --> 02:46:40,720 TURN OVER AS MIGUEL MENTIONED, 4174 02:46:40,720 --> 02:46:42,600 CLINICAL TRIALS TRIAL TOO 4175 02:46:42,600 --> 02:46:44,320 SOMETIMES IT IS CAPTURING THE 4176 02:46:44,320 --> 02:46:45,240 ADAPTATIONS THAT ARE OCCURRING 4177 02:46:45,240 --> 02:46:46,520 IF YOU DON'T KNOW PEOPLE MIGHT 4178 02:46:46,520 --> 02:46:49,120 BE LEAVING THEIR POSITION, BUT I 4179 02:46:49,120 --> 02:46:51,320 FEEL LIKE WE GOT A LOT OF GOOD 4180 02:46:51,320 --> 02:46:53,160 INFORMATION FROM USING PERIODIC 4181 02:46:53,160 --> 02:46:55,160 REFLECTIONS AND PUTTING THEM 4182 02:46:55,160 --> 02:46:58,240 ACCORDING TO SHANNON'S 4183 02:46:58,240 --> 02:47:03,360 FRAMEWORK. 4184 02:47:03,360 --> 02:47:05,880 >> I WILL ADD WE TOO PAID 4185 02:47:05,880 --> 02:47:08,640 ATTENTION TO FIDELITY AND CORE 4186 02:47:08,640 --> 02:47:10,280 COMPONENTS VERSUS THE NEED TO 4187 02:47:10,280 --> 02:47:11,480 CONSIDER WHAT WE WERE HEARING 4188 02:47:11,480 --> 02:47:14,640 FROM PARENTS AND CONSIDER HOW TO 4189 02:47:14,640 --> 02:47:15,440 ADAPT. 4190 02:47:15,440 --> 02:47:18,360 THE WAY WE WORK THAT OUT IS 4191 02:47:18,360 --> 02:47:19,880 THROUGH THE FACT WE HAD REGULAR 4192 02:47:19,880 --> 02:47:21,520 MEETINGS OF INTERVENTION TEAM 4193 02:47:21,520 --> 02:47:24,520 MASTER TRAINER WHO KNOWS THOSE 4194 02:47:24,520 --> 02:47:25,240 CORE COMET POINTS OF OUR 4195 02:47:25,240 --> 02:47:26,840 INTERVENTION EXTREMELY WELL. 4196 02:47:26,840 --> 02:47:28,760 IT WAS IN THE DIALOGUE THAT 4197 02:47:28,760 --> 02:47:30,040 OCCURRED IN THOSE MEETINGS THAT 4198 02:47:30,040 --> 02:47:33,440 WE FIGURED OUT I THINK HOW TO 4199 02:47:33,440 --> 02:47:34,920 FIND THE RIGHT BALANCE OF SAYING 4200 02:47:34,920 --> 02:47:36,480 TRUE TO THOSE CORE COMPONENTS 4201 02:47:36,480 --> 02:47:38,400 WHILE MAKING SURE WE WERE 4202 02:47:38,400 --> 02:47:42,440 RESPONSIVE TO THE OTHER THINGS 4203 02:47:42,440 --> 02:47:44,080 PARENTS WERE BRINGING THEIR WAY 4204 02:47:44,080 --> 02:47:45,200 BECAUSE IF YOU ARE NOT 4205 02:47:45,200 --> 02:47:46,240 RESPONSIVE TO PARENTS YOUR 4206 02:47:46,240 --> 02:47:47,960 UPTAKE WILL SUFFER AND YOU WON'T 4207 02:47:47,960 --> 02:47:49,200 GET THE IMPACT YOU HOPE FOR. 4208 02:47:49,200 --> 02:47:52,760 SO I THINK IT IS ALL A DELICATE 4209 02:47:52,760 --> 02:47:54,080 BALANCE, IT IS I GUESS THAT WAS 4210 02:47:54,080 --> 02:47:57,280 OUR VERSION OF REFLECTION IN A 4211 02:47:57,280 --> 02:47:57,760 WAY. 4212 02:47:57,760 --> 02:47:59,320 THAT ALLOWED US TO COME TO A 4213 02:47:59,320 --> 02:48:00,480 POINT WE WERE COMFORTABLE WITH. 4214 02:48:00,480 --> 02:48:05,560 AND WE ALSO HAD A MEMBER OF OUR 4215 02:48:05,560 --> 02:48:08,680 TEAM TRACKING, DEPACKTURES WE 4216 02:48:08,680 --> 02:48:10,000 PLANNED SO I DON'T KNOW IF I 4217 02:48:10,000 --> 02:48:12,200 CALL THIS ADAPTATIONS NOT 4218 02:48:12,200 --> 02:48:13,560 ADAPTATIONS OF THE INTERVENTION 4219 02:48:13,560 --> 02:48:15,040 BUT JUST THINGS THAT DIDN'T GO 4220 02:48:15,040 --> 02:48:17,040 THE WAY WE INITIALLY PLANNED. 4221 02:48:17,040 --> 02:48:20,120 I THINK THAT THAT IS GOING TO BE 4222 02:48:20,120 --> 02:48:22,120 HELPFUL AS WE EXAMINE WHAT WE 4223 02:48:22,120 --> 02:48:24,160 ARE FINDENING OUR OUTCOMES DAY 4224 02:48:24,160 --> 02:48:25,600 AND TRY TO INTERPRET IT. 4225 02:48:25,600 --> 02:48:28,160 WHAT WE EXPECTED TO FIND. 4226 02:48:28,160 --> 02:48:31,600 >> I CAN'T GET TRIALS FOR US 4227 02:48:31,600 --> 02:48:33,680 ADAPTING FLEXIBILITIES IN THE 4228 02:48:33,680 --> 02:48:37,760 AREAS WAS KEY TO SURVIVAL 4229 02:48:37,760 --> 02:48:39,520 CHANGES NOT ONLY LEVEL OF HEALTH 4230 02:48:39,520 --> 02:48:41,320 SYSTEMS BUT PRACTICES. 4231 02:48:41,320 --> 02:48:45,360 I MENTION THE EVIDENCE 4232 02:48:45,360 --> 02:48:47,000 GUIDELINES INTERVENTION, THOSE 4233 02:48:47,000 --> 02:48:52,480 CHANGED FOR SOME OF OUR MAIN 4234 02:48:52,480 --> 02:48:58,720 CONDITIONS FOR -- SO WHAT WE FOR 4235 02:48:58,720 --> 02:49:03,000 CHANGES IN TERMS OF WHAT WAS 4236 02:49:03,000 --> 02:49:05,120 DONE IN HOW OR NOT IN TERMS OF 4237 02:49:05,120 --> 02:49:10,080 THE GOAL OR THE OVERALL PLAN OF 4238 02:49:10,080 --> 02:49:15,440 WHAT WAS A DESIRED INTERVENTION 4239 02:49:15,440 --> 02:49:18,960 BUT HOW WAS ALWAYS SOME 4240 02:49:18,960 --> 02:49:19,960 CONVERSATION ABOUT HOW IT COULD 4241 02:49:19,960 --> 02:49:25,080 BE DONE WITH SOME DIFFERENCES. 4242 02:49:25,080 --> 02:49:28,080 >> GREAT. 4243 02:49:28,080 --> 02:49:29,240 FANTASTIC. 4244 02:49:29,240 --> 02:49:30,880 RESPONSE, THANKS FOR DIGGING 4245 02:49:30,880 --> 02:49:34,640 DEEP AND RESPONDING TO THAT. 4246 02:49:34,640 --> 02:49:38,800 LET'S MOVE ON TO QUESTION FIVE 4247 02:49:38,800 --> 02:49:40,560 HOW CAN PRAGMATIC TRIALS BE 4248 02:49:40,560 --> 02:49:43,640 CONDUCTED TO REDUCE HEALTH 4249 02:49:43,640 --> 02:49:45,360 DISPARITIES. 4250 02:49:45,360 --> 02:49:46,560 MIRIAM YOU OKAY FIRST ON THIS 4251 02:49:46,560 --> 02:49:47,000 ONE? 4252 02:49:47,000 --> 02:49:50,320 YOUR TURN TO LEAD OFF. 4253 02:49:50,320 --> 02:49:51,960 >> 4254 02:49:51,960 --> 02:49:52,640 >> OKAY. 4255 02:49:52,640 --> 02:49:58,480 FINE WITH ME. 4256 02:49:58,480 --> 02:49:59,400 THINKING ABOUT THIS QUESTION 4257 02:49:59,400 --> 02:50:06,920 WHAT CAME TO MY MIND WAS THAT 4258 02:50:06,920 --> 02:50:09,720 WHAT PATIENTS ARE, RATHER THAN 4259 02:50:09,720 --> 02:50:13,760 WHERE HEALTHCARE SYSTEM IS FOR 4260 02:50:13,760 --> 02:50:18,240 GIVE BUT WE DO KNOW HOW 4261 02:50:18,240 --> 02:50:27,160 (INAUDIBLE) TO THE PATIENT AND 4262 02:50:27,160 --> 02:50:30,800 TRANSPORTATION WHICH IS KNOWN AS 4263 02:50:30,800 --> 02:50:35,280 SOCIAL DETERMINANTS OF HEALTH, 4264 02:50:35,280 --> 02:50:36,240 IMPACTED (INAUDIBLE). 4265 02:50:36,240 --> 02:50:39,280 SO WE TO OUT WE WOULD SOLVE THIS 4266 02:50:39,280 --> 02:50:41,120 PROBLEM, GETTING TO THIS 4267 02:50:41,120 --> 02:50:42,800 PROBLEM, AND FOR ACUPUNCTURE TO 4268 02:50:42,800 --> 02:50:51,240 COME TO ICV FOR FIVE WEEKS. 4269 02:50:51,240 --> 02:50:55,760 MANY PATIENTS SOME OF THEM SAY 4270 02:50:55,760 --> 02:50:57,840 (INAUDIBLE) I DON'T HAVE THE 4271 02:50:57,840 --> 02:50:58,400 TRANSPORTATION, I DON'T HAVE 4272 02:50:58,400 --> 02:51:01,400 (INAUDIBLE) TO BE ABLE TO COME. 4273 02:51:01,400 --> 02:51:05,240 SO WE HAVE TO THINK ABOUT OUR 4274 02:51:05,240 --> 02:51:08,360 STUDY ADDRESSING HEALTH 4275 02:51:08,360 --> 02:51:12,960 DISPARITIES WE HAVE TO ACCESS 4276 02:51:12,960 --> 02:51:13,320 TRANSPORTATION. 4277 02:51:13,320 --> 02:51:16,320 FOR GENERAL PART OF THE STUDY WE 4278 02:51:16,320 --> 02:51:19,080 ARE IN ISSUE OF PATIENT MIGHT BE 4279 02:51:19,080 --> 02:51:22,280 -- RUN OUT OF THE PLAN TO BE 4280 02:51:22,280 --> 02:51:28,280 ABLE THE GO TO OUR STUDY OF FIVE 4281 02:51:28,280 --> 02:51:32,840 TO SIX WEEKS, STUDIES WITH SMART 4282 02:51:32,840 --> 02:51:35,040 DEVICE OR CELL PHONE IS ONLY 4283 02:51:35,040 --> 02:51:36,680 ACCEPTABLE DEVICE, MIGHT BE TIME 4284 02:51:36,680 --> 02:51:38,680 FOR THEM (INAUDIBLE) STUDY. 4285 02:51:38,680 --> 02:51:46,280 SO IN THINKING ABOUT THIS, -- 4286 02:51:46,280 --> 02:51:49,720 SIMILAR INFORMATION SO THE 4287 02:51:49,720 --> 02:51:52,640 PROBLEM RANDOMIZE PATIENT 4288 02:51:52,640 --> 02:51:53,760 ACUPUNCTURE, TREATMENT ARM WHO 4289 02:51:53,760 --> 02:51:59,920 HAVE ACCESS TRANSPORTATION 4290 02:51:59,920 --> 02:52:01,160 INFORMATION TO HAVE CELL PHONE 4291 02:52:01,160 --> 02:52:05,880 DATA OR QUALITY DATA OR 4292 02:52:05,880 --> 02:52:08,600 (INAUDIBLE) HAVE WE (INAUDIBLE) 4293 02:52:08,600 --> 02:52:13,960 HEALTH DISPARITIES, BECAUSE WHO 4294 02:52:13,960 --> 02:52:19,800 MIGHT HAVE BENEFITED FROM 4295 02:52:19,800 --> 02:52:23,040 INTERVENTION SO THIS (INAUDIBLE) 4296 02:52:23,040 --> 02:52:26,080 SOME TRIALS JOINT HEALTH 4297 02:52:26,080 --> 02:52:29,560 DISPARITIES ARE MAGNIFIED. 4298 02:52:29,560 --> 02:52:32,400 THINKING ABOUT HOW TO USE THIS 4299 02:52:32,400 --> 02:52:36,200 PROBLEM, OUR TEAM TALKING ABOUT 4300 02:52:36,200 --> 02:52:40,000 THESE PATIENTS DEVELOP 4301 02:52:40,000 --> 02:52:42,640 ADDITIONAL FOR THOSE IN THE 4302 02:52:42,640 --> 02:52:43,840 ACUPUNCTURE TREATMENT ARM TO BE 4303 02:52:43,840 --> 02:52:48,720 ABLE TO COME BUT LARGE 4304 02:52:48,720 --> 02:52:49,680 (INAUDIBLE) COME TWICE A WEEK. 4305 02:52:49,680 --> 02:52:55,520 THE PROBLEM IS CONFOUNDED BY THE 4306 02:52:55,520 --> 02:53:02,760 HIGH GAS PRICE. 4307 02:53:02,760 --> 02:53:09,360 MY FINAL THOUGHT (INAUDIBLE) AS 4308 02:53:09,360 --> 02:53:11,400 WELL AS SEE IF YOU CAN HAVE 4309 02:53:11,400 --> 02:53:12,080 AQUEUE PUNCTURE IN THE COMMUNITY 4310 02:53:12,080 --> 02:53:18,840 AS OPPOSED TO HAVING VISUAL 4311 02:53:18,840 --> 02:53:22,080 CENTERS HAVE MORE ACUPUNCTURE IN 4312 02:53:22,080 --> 02:53:24,200 THE COMMUNITY WE HAVE TO LOOK AT 4313 02:53:24,200 --> 02:53:26,400 SCHEDULING BECAUSE THIS PATIENT 4314 02:53:26,400 --> 02:53:28,280 SOME OF THE WORK THEY HAVE CHILD 4315 02:53:28,280 --> 02:53:31,400 CARE ISSUES, SO HOW DO WE THEN 4316 02:53:31,400 --> 02:53:33,080 TAKE CARE OF THESE SOCIAL 4317 02:53:33,080 --> 02:53:36,040 DETERMINANTS OF HEALTH TO THEN 4318 02:53:36,040 --> 02:53:37,600 USE INFORMATION. 4319 02:53:37,600 --> 02:53:41,040 FOR THOSE (INAUDIBLE) THINKING 4320 02:53:41,040 --> 02:53:44,480 ABOUT DEVICE TO THEM AS WELL AS 4321 02:53:44,480 --> 02:53:46,560 PROVIDE SOME INCENTIVE TO HELP 4322 02:53:46,560 --> 02:53:51,760 THEM BE ABLE TO (INAUDIBLE) -- 4323 02:53:51,760 --> 02:53:53,880 THIS PROBLEM WE HAVE SELECT 4324 02:53:53,880 --> 02:54:01,000 GROUP IN OUR -- PRAGMATIC TRIAL. 4325 02:54:01,000 --> 02:54:05,640 >> THANK YOU. 4326 02:54:05,640 --> 02:54:07,880 MIGUEL, DO YOU WANT TO GO NEXT? 4327 02:54:07,880 --> 02:54:10,320 >> I THINK THIS IS A REALLY 4328 02:54:10,320 --> 02:54:12,560 IMPORTANT QUESTION AT THIS TIME. 4329 02:54:12,560 --> 02:54:15,360 HOW CAN THIS TRIAL BE CONDUCTED 4330 02:54:15,360 --> 02:54:16,560 TO HEALTH DISPARITIES AND I 4331 02:54:16,560 --> 02:54:18,320 THINK THAT WE HAVE TO GO TO THE 4332 02:54:18,320 --> 02:54:20,440 VERY BEGINNING ABOUT CHOOSING 4333 02:54:20,440 --> 02:54:22,240 YOUR PARTNERS. 4334 02:54:22,240 --> 02:54:27,080 THAT AS INVESTIGATORS WE HAVE 4335 02:54:27,080 --> 02:54:29,760 THE ABILITY TO CHOOSE PARTNERS, 4336 02:54:29,760 --> 02:54:31,000 HOPEFULLY THE PARTNERS WANT TO 4337 02:54:31,000 --> 02:54:32,600 WORK WITH US. 4338 02:54:32,600 --> 02:54:33,640 VERY EARLY IN THE PROCESS. 4339 02:54:33,640 --> 02:54:37,320 I THINK WE HAVE TO ANSWER TWO 4340 02:54:37,320 --> 02:54:37,960 KEY QUESTIONS. 4341 02:54:37,960 --> 02:54:41,280 WHERE CAN I DO THIS TRIAL. 4342 02:54:41,280 --> 02:54:48,200 WHERE SHOULD I DO THIS TRIAL. 4343 02:54:48,200 --> 02:54:49,200 FIRST ARE VERY DIFFERENT WHETHER 4344 02:54:49,200 --> 02:54:50,680 WE SHOULD BE DOING THE TRIAL, 4345 02:54:50,680 --> 02:54:51,400 SOMETHING THAT HASOR HAS TO 4346 02:54:51,400 --> 02:54:53,680 CHANGE, WE NEED TO FIND NEW 4347 02:54:53,680 --> 02:54:56,840 PARTNER OR PARTNERS TO DO THIS 4348 02:54:56,840 --> 02:54:58,080 STUDY OR THE QUESTION MAYBE 4349 02:54:58,080 --> 02:54:59,280 DIFFERENCE. 4350 02:54:59,280 --> 02:55:02,800 IN OUR CASE WE WANTED TO STUDY 4351 02:55:02,800 --> 02:55:05,760 SOME CONDITIONS THAT HAVE 4352 02:55:05,760 --> 02:55:11,520 DISPROPORTIONATE BURDENS IN SOME 4353 02:55:11,520 --> 02:55:12,120 POPULATIONS. 4354 02:55:12,120 --> 02:55:14,360 I HAVE OVERREPRESENTED IN SOME 4355 02:55:14,360 --> 02:55:17,360 OF OUR SAFETY NET HOSPITALS SO 4356 02:55:17,360 --> 02:55:23,360 WE IMMEDIATELY HAVE SYNERGY OF 4357 02:55:23,360 --> 02:55:25,040 INTEREST HERE WITH HEALTH SYSTEM 4358 02:55:25,040 --> 02:55:29,320 TAKING CARE OF OUR INDIGENT 4359 02:55:29,320 --> 02:55:37,880 PATIENTS IN DALLAS COUNTY. 4360 02:55:37,880 --> 02:55:40,440 IMMEDIATELY QUESTION ABOUT HOW 4361 02:55:40,440 --> 02:55:42,680 PROOF OF CARE FOR THESE CHRONIC 4362 02:55:42,680 --> 02:55:43,840 CONDITIONS AND MAY BE MORE 4363 02:55:43,840 --> 02:55:45,600 LIKELY TO GET THEM BINDING FROM 4364 02:55:45,600 --> 02:55:48,480 LEADERSHIP AND FROM PROVIDERS IN 4365 02:55:48,480 --> 02:55:49,720 THE CLINICAL STEP. 4366 02:55:49,720 --> 02:55:51,120 ABOUT HOW TO MAKE IT HAPPEN. 4367 02:55:51,120 --> 02:55:54,400 FROM THE PERSPECTIVE OF 4368 02:55:54,400 --> 02:55:55,600 PATIENTS, IT IS ALSO MUCH BETTER 4369 02:55:55,600 --> 02:55:57,720 FIT WHEN THE HEALTH SYSTEM TAKES 4370 02:55:57,720 --> 02:55:59,800 CARE OF THESE PATIENTS IN THE 4371 02:55:59,800 --> 02:56:01,840 HEALTH SYSTEM IS WITH US 4372 02:56:01,840 --> 02:56:03,240 INVESTIGATORS, BECAUSE THEN THE 4373 02:56:03,240 --> 02:56:06,000 PATIENT SEE THAT THIS IS STUDIES 4374 02:56:06,000 --> 02:56:07,800 IN CARE THROUGH HEALTH SYSTEM 4375 02:56:07,800 --> 02:56:09,480 WHERE THEY ARE COMFORTABLE, 4376 02:56:09,480 --> 02:56:11,880 FAMILIAR, KNOW THE CARE SYSTEM 4377 02:56:11,880 --> 02:56:16,120 IS INTERESTED IN THEIR WELFARE. 4378 02:56:16,120 --> 02:56:17,880 THEY ARE FAMILIAR WITH THEIR 4379 02:56:17,880 --> 02:56:19,400 PROVIDERS AN CLINICS AND WE ARE 4380 02:56:19,400 --> 02:56:22,240 NOT ASKING FOR ADDITIONAL VISITS 4381 02:56:22,240 --> 02:56:23,360 OR THING THAT CAN BE PART OF 4382 02:56:23,360 --> 02:56:27,040 SOME OTHER STUDIES BUT PRAGMATIC 4383 02:56:27,040 --> 02:56:29,440 CLINICAL TRIALS BUT WE HAVE 4384 02:56:29,440 --> 02:56:31,040 GREATER OPPORTUNITY HERE IN 4385 02:56:31,040 --> 02:56:34,200 PRAGMATIC TRIALS TO ADDRESS 4386 02:56:34,200 --> 02:56:36,400 HEALTH DISPARITIES, ESPECIALLY 4387 02:56:36,400 --> 02:56:38,280 IF WE CAN CHOOSE SYSTEMS AND 4388 02:56:38,280 --> 02:56:39,320 THOSE HEMAL HEALTH SYSTEMS WANT 4389 02:56:39,320 --> 02:56:46,080 TO WORK WITH US. 4390 02:56:46,080 --> 02:56:48,200 >> THANKS, MARGARET DO YOU WANT 4391 02:56:48,200 --> 02:56:49,800 TO GO NEXT? 4392 02:56:49,800 --> 02:56:50,840 >> SURE. 4393 02:56:50,840 --> 02:56:53,120 HAVING A CHANCE TO TALK ABOUT 4394 02:56:53,120 --> 02:56:56,000 THIS QUESTION WHICH FOR ME I 4395 02:56:56,000 --> 02:56:57,880 SUSPECT LIKE MANY OF US IS 4396 02:56:57,880 --> 02:56:59,960 MOVING LARGER OVER TIME GIVEN 4397 02:56:59,960 --> 02:57:01,000 TIMES WE LIVE IN AND FOR 4398 02:57:01,000 --> 02:57:03,080 POPULATIONS WE ARE WORKING WITH 4399 02:57:03,080 --> 02:57:05,080 AND THE CHOICER TO HEALTH STUDY 4400 02:57:05,080 --> 02:57:06,280 DISPARITIES AMONG YOUNG PEOPLE 4401 02:57:06,280 --> 02:57:08,040 AND THEIR FAMILIES ARE 4402 02:57:08,040 --> 02:57:10,800 INCREASING WITH COVID. 4403 02:57:10,800 --> 02:57:12,120 SO MY THINKING OF THIS IS 4404 02:57:12,120 --> 02:57:13,880 INFLUENCED BY COUPLE OF PAPERS 4405 02:57:13,880 --> 02:57:15,560 AND IMPLEMENTATION SCIENCE THAT 4406 02:57:15,560 --> 02:57:17,000 FRAME THE ISSUE OF EQUITY AND 4407 02:57:17,000 --> 02:57:19,280 HEALTH DISPARITIES AND 4408 02:57:19,280 --> 02:57:22,920 CENTRALLY, BY RACHEL SHELL TON 4409 02:57:22,920 --> 02:57:24,000 AND BOWMAN PUBLISHED THE LAST 4410 02:57:24,000 --> 02:57:26,160 COUPLE OF YEARS. 4411 02:57:26,160 --> 02:57:27,680 THERE CENTRAL POINT THAT I'M 4412 02:57:27,680 --> 02:57:30,240 TRYING TO HANG ON TO IN MY WORK 4413 02:57:30,240 --> 02:57:31,960 IS IF WE WANTS TO REDUCE HEALTH 4414 02:57:31,960 --> 02:57:33,280 DISPARITIES IN THE OUTCOMES WE 4415 02:57:33,280 --> 02:57:36,320 ARE CARING ABOUT, WE NEED TO 4416 02:57:36,320 --> 02:57:38,240 CENTER EACH STEP OF THE WAY, 4417 02:57:38,240 --> 02:57:40,040 ECHOING MIGUEL'S POINT WE NEED 4418 02:57:40,040 --> 02:57:41,920 TO DO THAT FROM THE BEGINNING 4419 02:57:41,920 --> 02:57:43,240 THROUGHOUT THE EXPLORATION 4420 02:57:43,240 --> 02:57:45,680 PLANNING AND IMPLEMENTATION AN 4421 02:57:45,680 --> 02:57:46,440 SUSTAINABILITY PHASES. 4422 02:57:46,440 --> 02:57:49,480 THIS DOES PLAY OUT IN THE 4423 02:57:49,480 --> 02:57:53,960 PERTINENT SITES WE CHOOSE TO DO 4424 02:57:53,960 --> 02:57:54,600 INTERVENTIONS IN. 4425 02:57:54,600 --> 02:57:57,680 IN OUR STUDY WE BROUGHT TOGETHER 4426 02:57:57,680 --> 02:57:59,480 KEISER PERMANENTE COLORADO, 4427 02:57:59,480 --> 02:58:02,200 NORTHERN CALIFORNIA AND HENRY 4428 02:58:02,200 --> 02:58:04,840 FORD HEALTH DETROIT AND TOGETHER 4429 02:58:04,840 --> 02:58:07,600 WE HAD A DIVERSE SET OF 4430 02:58:07,600 --> 02:58:08,200 FAMILIES. 4431 02:58:08,200 --> 02:58:09,840 OUR EXPLICIT GOAL WASN'T TO 4432 02:58:09,840 --> 02:58:13,200 REDUCE HEALTH DISPARITIES BUT 4433 02:58:13,200 --> 02:58:16,440 WAS TO SHOW WE HAVE UPTAKE BY 4434 02:58:16,440 --> 02:58:19,240 FAMILIES FROM REGIONALLY DIVERSE 4435 02:58:19,240 --> 02:58:22,680 LOCATIONS AND SOCIO DEMOGRAP 4436 02:58:22,680 --> 02:58:23,160 DEMOGRAPHICALLY DEVOIRS 4437 02:58:23,160 --> 02:58:24,840 BACKGROUNDS SHOWED INTEREST IN 4438 02:58:24,840 --> 02:58:25,880 GOOD CHOICES. 4439 02:58:25,880 --> 02:58:28,000 IF YOU WANT TO REDUCE HEALTH 4440 02:58:28,000 --> 02:58:29,000 DISPARITIES MAYBE THAT NEEDS TO 4441 02:58:29,000 --> 02:58:31,840 BE A PRIMARY END POINT, IT IS 4442 02:58:31,840 --> 02:58:35,160 NOT JUST THE INITIATION OF 4443 02:58:35,160 --> 02:58:39,120 SUBSTANCE USE WE ARE AIMING FOR 4444 02:58:39,120 --> 02:58:41,200 EXAMPLE BUT REDUCTIONS IN 4445 02:58:41,200 --> 02:58:42,800 INITIATION AMONG THIS IN THAT 4446 02:58:42,800 --> 02:58:43,800 POPULATION MIGHT BE THE WAY WE 4447 02:58:43,800 --> 02:58:45,400 CENTER STUDY IF WE WANT TO 4448 02:58:45,400 --> 02:58:47,680 REDUCE HEALTH DISPARITIES. 4449 02:58:47,680 --> 02:58:49,440 I THINK THEN WE NEED TO REALLY 4450 02:58:49,440 --> 02:58:50,760 THINK HARD ABOUT HOW WE ARE 4451 02:58:50,760 --> 02:58:55,080 STAFFING OUR INTERVENTIONS. 4452 02:58:55,080 --> 02:58:57,160 TO BE MODIFIED MORE CERTAIN WAYS 4453 02:58:57,160 --> 02:58:59,120 TO BE ACCEPTABLE AND SATISFYING 4454 02:58:59,120 --> 02:59:03,400 TO CERTAIN POPULATIONS TO FIT 4455 02:59:03,400 --> 02:59:05,400 BETTER HOW DO WE KNOW WHAT TO 4456 02:59:05,400 --> 02:59:07,200 DO, WHO ARE WE LISTENING TO AS 4457 02:59:07,200 --> 02:59:09,360 WE DECIDE HOW TO TRY TO INCREASE 4458 02:59:09,360 --> 02:59:12,760 THE FIT AND ATTRACTIVENESS OF 4459 02:59:12,760 --> 02:59:14,960 THE INTERVENTION TO POPULATIONS 4460 02:59:14,960 --> 02:59:18,800 THAN WE REALLY WANT TO REACH. 4461 02:59:18,800 --> 02:59:20,800 ANOTHER THINK MIGUEL AND MARY 4462 02:59:20,800 --> 02:59:22,440 TALKED ABOUT IS BARRIERS TO 4463 02:59:22,440 --> 02:59:23,600 GETTING TOWARD INTERVENTIONS WE 4464 02:59:23,600 --> 02:59:24,800 NEED TO THINK ABOUT HOW TO 4465 02:59:24,800 --> 02:59:26,600 REDUCE THOSE BECAUSE THEY DON'T 4466 02:59:26,600 --> 02:59:28,120 FALL EVENLY, THEY FALL IN LINE 4467 02:59:28,120 --> 02:59:29,760 WITH DISPAIR IT IS QUITE OFTEN. 4468 02:59:29,760 --> 02:59:31,800 -- DISPAIR IT IS QUITE OFTEN. 4469 02:59:31,800 --> 02:59:32,840 -- DISPARITIES QUITE OFTEN. 4470 02:59:32,840 --> 02:59:35,040 WHEN WE THINK ABOUT SETTINGS 4471 02:59:35,040 --> 02:59:38,360 LIKE CMHCs, SOMETIMES BE THE 4472 02:59:38,360 --> 02:59:40,240 MOST WELL-POSITIONED TO REACH 4473 02:59:40,240 --> 02:59:41,600 THE POPULATIONS WE WANT TO WORK 4474 02:59:41,600 --> 02:59:45,320 WITH, THEY MIGHT ALSO BE THE 4475 02:59:45,320 --> 02:59:46,400 LEAST RESOURCED TO REACH 4476 02:59:46,400 --> 02:59:48,560 POPULATIONS SO WE NEED TO THINK 4477 02:59:48,560 --> 02:59:49,640 ABOUT HOW WE ARE GOING TO 4478 02:59:49,640 --> 02:59:51,800 PROVIDE RESOURCES TO SUPPORT 4479 02:59:51,800 --> 02:59:54,840 IMPLEMENTATION. 4480 02:59:54,840 --> 02:59:57,280 IF WE WANT TO REACH POPULATIONS 4481 02:59:57,280 --> 02:59:58,600 SUCH THAT DISPARITIES ARE 4482 02:59:58,600 --> 02:59:59,200 REDUCED. 4483 02:59:59,200 --> 03:00:01,280 THERE'S THINGS ON ANALYSIS SIDE 4484 03:00:01,280 --> 03:00:02,720 ALSO BUT WANT TO STOP THERE AND 4485 03:00:02,720 --> 03:00:03,640 MAKE SURE THERE'S TIME FOR 4486 03:00:03,640 --> 03:00:07,920 OTHERS TO SPEAK. 4487 03:00:07,920 --> 03:00:10,720 >> THANK YOU. 4488 03:00:10,720 --> 03:00:11,720 GLORIA. 4489 03:00:11,720 --> 03:00:13,120 >> I WILL OFFER A FEW -- 4490 03:00:13,120 --> 03:00:14,320 >> ON THIS QUESTION. 4491 03:00:14,320 --> 03:00:16,000 >> I WILL OFFER A FEW ADDITIONAL 4492 03:00:16,000 --> 03:00:17,520 WORDS. 4493 03:00:17,520 --> 03:00:19,280 APPRECIATE MY COLLEAGUES TALKING 4494 03:00:19,280 --> 03:00:20,840 ABOUT THE IMPORTANCE OF BRINGING 4495 03:00:20,840 --> 03:00:22,200 SERVICES TO THE COMMUNITY AND 4496 03:00:22,200 --> 03:00:25,080 BEING FLEXIBLE AND OPERATING 4497 03:00:25,080 --> 03:00:26,480 INCENTIVES TO PARTICIPANTS AND 4498 03:00:26,480 --> 03:00:27,920 THINKING ABOUT THE PARTNERS AS 4499 03:00:27,920 --> 03:00:30,560 WELL AS STAFFING AND CONSIDERING 4500 03:00:30,560 --> 03:00:31,840 EQUITY ACROSS ALL THE ACTIVITIES 4501 03:00:31,840 --> 03:00:35,200 OF THE PROJECT. 4502 03:00:35,200 --> 03:00:38,600 I WOULD ECHO ALL THIS AND SAY I 4503 03:00:38,600 --> 03:00:41,040 ENCOURAGE TO SEE NEW 4504 03:00:41,040 --> 03:00:42,040 IMPLEMENTATION SCIENCE MODELS 4505 03:00:42,040 --> 03:00:44,480 THAT INVITE US NOT SIMPLY TO 4506 03:00:44,480 --> 03:00:45,480 LOOK AT DISPARITIES WITH REGARD 4507 03:00:45,480 --> 03:00:48,360 TO THE EFFECTIVENESS OF OUR 4508 03:00:48,360 --> 03:00:50,120 PROGRAM BUT ALSO IMPLEMENTATION 4509 03:00:50,120 --> 03:00:52,320 REACH AND OTHER COMPONENTS ALONG 4510 03:00:52,320 --> 03:00:55,560 THE ENTIRE CONCEPTUAL MODEL SO I 4511 03:00:55,560 --> 03:00:57,960 FEEL LIKE WE ARE CALLED TO THINK 4512 03:00:57,960 --> 03:01:02,520 ABOUT THIS HOLISTICALLY WHICH IS 4513 03:01:02,520 --> 03:01:04,440 ECHOING WHAT MARGARET SAID. 4514 03:01:04,440 --> 03:01:06,040 I SEE IN OUR TRIAL TO GIVE A 4515 03:01:06,040 --> 03:01:09,680 COUPLE OF EXAMPLES, IN OUR TRIAL 4516 03:01:09,680 --> 03:01:11,520 WE DECIDED SPECIFICALLY 4517 03:01:11,520 --> 03:01:13,280 INTENTIONALLY TO WORK WITH OUR 4518 03:01:13,280 --> 03:01:16,320 MOST DIVERSE CLINIC AS OUR PILOT 4519 03:01:16,320 --> 03:01:22,120 SO IN DOING SO WE GOT TO 4520 03:01:22,120 --> 03:01:23,920 UNDERSTAND UNIQUE ISSUES AND HOW 4521 03:01:23,920 --> 03:01:25,920 TO ENGAGE LATINO PATIENTS IN 4522 03:01:25,920 --> 03:01:26,960 PARTICULAR AND AS A RESULT OF 4523 03:01:26,960 --> 03:01:29,720 WORKING WITH THISICALLY MCWE 4524 03:01:29,720 --> 03:01:31,040 DEVELOPED WORD LIST INSTRUCTIONS 4525 03:01:31,040 --> 03:01:33,400 FOR COMPLETING A FIT TEST FOR 4526 03:01:33,400 --> 03:01:35,240 COLORECTAL CANCER SCREENING, 4527 03:01:35,240 --> 03:01:36,920 THESE -- THIS WAS DONE ON THE 4528 03:01:36,920 --> 03:01:38,680 SUGGESTION OF OUR PROJECT 4529 03:01:38,680 --> 03:01:43,200 OFFICER, AND IT REALLY HELPED US 4530 03:01:43,200 --> 03:01:44,640 BECAUSE IT IS CHALLENGING TO GET 4531 03:01:44,640 --> 03:01:45,360 THE RIGHT LANGUAGE INSTRUCTION 4532 03:01:45,360 --> 03:01:48,520 TO THE RIGHT PATIENT IF YOU ARE 4533 03:01:48,520 --> 03:01:51,480 INCLUDING TWO DIFFERENT WORDED 4534 03:01:51,480 --> 03:01:52,120 INSTRUCTIONS. 4535 03:01:52,120 --> 03:01:53,320 WE DEVELOPED WORD LIST 4536 03:01:53,320 --> 03:01:54,760 INSTRUCTIONS USED BY ALL OUR 4537 03:01:54,760 --> 03:01:56,520 SYSTEMS AND THEY SINCE HAVE BEEN 4538 03:01:56,520 --> 03:01:59,960 ADOPTED BY KEISER PERM 4539 03:01:59,960 --> 03:02:01,640 PERMANENTE REGIONS AND ONCE OR 4540 03:02:01,640 --> 03:02:03,200 TWICE A MONTH WE REACH OUT FROM 4541 03:02:03,200 --> 03:02:04,320 A HEALTH SYSTEM THAT WANTS TO 4542 03:02:04,320 --> 03:02:07,520 USE THOSE INSTRUCTIONS SO IF YOU 4543 03:02:07,520 --> 03:02:09,560 HAVEN'T SEEN THEM, MAILFIT.ORG 4544 03:02:09,560 --> 03:02:10,640 THEY AVAILABLE ON OUR SITE. 4545 03:02:10,640 --> 03:02:13,960 THAT IS ONE OF THE GREAT 4546 03:02:13,960 --> 03:02:16,160 SUCCESSES IS THAT BECAUSE WE 4547 03:02:16,160 --> 03:02:17,800 STARTED WITH THAT CLINIC WE 4548 03:02:17,800 --> 03:02:19,280 DEVELOPED TOOLS LATER USED BY 4549 03:02:19,280 --> 03:02:24,120 ALL OF OUR SYSTEMS THAT WERE 4550 03:02:24,120 --> 03:02:25,320 MORE COULDLY APPROPRIATE AND 4551 03:02:25,320 --> 03:02:26,040 RELEVANT. 4552 03:02:26,040 --> 03:02:27,600 I WOULD ALSO SAY IT IS IMPORTANT 4553 03:02:27,600 --> 03:02:29,960 TO THINK ABOUT IN OUR CASE THE 4554 03:02:29,960 --> 03:02:31,080 CONTINUUM OF CARE. 4555 03:02:31,080 --> 03:02:33,800 SO WE CHOSE AN INTERVENTION THAT 4556 03:02:33,800 --> 03:02:36,200 IN EARLY DATA SHOWED MORE 4557 03:02:36,200 --> 03:02:39,280 EFFECTIVE IN LATINO PATIENTS 4558 03:02:39,280 --> 03:02:40,800 WHICH NATURALLY HAVE LOWEST 4559 03:02:40,800 --> 03:02:42,480 RATES OF COLORECTAL CANCER 4560 03:02:42,480 --> 03:02:49,520 SCREENING, IN OUR DATA CONFIRMED 4561 03:02:49,520 --> 03:02:52,080 OUR INTERVENTION HAD HIGHER 4562 03:02:52,080 --> 03:02:53,920 EFFECTIVEN 'T IN THE LATIN 4563 03:02:53,920 --> 03:02:55,160 COMMUNITY BECAUSE IT WAS 4564 03:02:55,160 --> 03:02:58,040 ENCOURAGING TO ADDRESS THAT 4565 03:02:58,040 --> 03:02:58,440 INEQUITY. 4566 03:02:58,440 --> 03:02:59,960 IT WAS IMPORTANT FOR US TO LOOK 4567 03:02:59,960 --> 03:03:02,320 AT FOLLOW-UP COLONOSCOPY RATES 4568 03:03:02,320 --> 03:03:08,360 AND I THINK THAT AT THE END OF 4569 03:03:08,360 --> 03:03:11,320 THE DAY IS OUR INTERVENTION 4570 03:03:11,320 --> 03:03:13,560 COLORECTAL SAVING LIVES, WE DID 4571 03:03:13,560 --> 03:03:15,560 SEE MANY HEALTH CENTERS THE 4572 03:03:15,560 --> 03:03:17,640 RATES OF FOLLOW-UP WERE 4573 03:03:17,640 --> 03:03:18,560 DISAPPOINTINGLY LOW. 4574 03:03:18,560 --> 03:03:19,960 THOUGH OUR INTERVENTION DIDN'T 4575 03:03:19,960 --> 03:03:23,000 FOCUS ON THAT, IT IS REALLY 4576 03:03:23,000 --> 03:03:25,880 IMPORTANT TO CONSIDER IN OUR 4577 03:03:25,880 --> 03:03:28,000 CASE CANCER CONTINUUM BUT OTHER 4578 03:03:28,000 --> 03:03:30,080 CASES MIGHT BE FOLLOW-UP CARE 4579 03:03:30,080 --> 03:03:31,080 PATIENT NEEDS IF THEY HAVE 4580 03:03:31,080 --> 03:03:37,720 ABNORMAL TEST RESULT. 4581 03:03:37,720 --> 03:03:39,200 >> THANK YOU WE ARE COMING UP ON 4582 03:03:39,200 --> 03:03:45,320 OUR TIME HERE. 4583 03:03:45,320 --> 03:03:46,800 NOW THAT WE HEARD EVERYONE ON 4584 03:03:46,800 --> 03:03:48,320 THE PANEL DOES ANYONE WANT TO 4585 03:03:48,320 --> 03:03:49,960 ASK SOMETHING RELATED TO THIS 4586 03:03:49,960 --> 03:03:52,280 HEALTH DISPARITIES TO KEEP 4587 03:03:52,280 --> 03:03:52,800 ECHOING? 4588 03:03:52,800 --> 03:03:53,840 I HAVE ANOTHER QUESTION FROM THE 4589 03:03:53,840 --> 03:03:57,400 CHAT THAT I CAN USE THEN 4590 03:03:57,400 --> 03:03:59,080 PLANNING TO TRANSITION TO 4591 03:03:59,080 --> 03:04:00,240 SUMMARY FINAL THOUGHTS AND 4592 03:04:00,240 --> 03:04:03,280 GIVING YOU A MINUTE OR TWO TO DO 4593 03:04:03,280 --> 03:04:09,560 THAT STARTING AT 4:25 DO YOU 4594 03:04:09,560 --> 03:04:10,760 WANT KNOW THROW THIS QUESTION 4595 03:04:10,760 --> 03:04:12,160 OUT AND SEE WHAT PEOPLE THINK OR 4596 03:04:12,160 --> 03:04:18,840 CONTINUE THIS CONVERSATION? 4597 03:04:18,840 --> 03:04:20,400 >> THIS IS A QUESTION ABOUT 4598 03:04:20,400 --> 03:04:21,960 ADVANTAGES AND DISADVANTAGES OF 4599 03:04:21,960 --> 03:04:26,920 THE HYBRID DESIGN BOILS DOWN TO 4600 03:04:26,920 --> 03:04:30,360 WHAT -- WHEN YOU DECIDE WHAT IS 4601 03:04:30,360 --> 03:04:33,560 THE DEFINITION OF WELL 4602 03:04:33,560 --> 03:04:35,120 ESTABLISHED INTERVENTION 4603 03:04:35,120 --> 03:04:37,000 ADVANTAGES DISADVANTAGES OF THE 4604 03:04:37,000 --> 03:04:38,440 IMPLEMENTATION STUDY APPROACHES 4605 03:04:38,440 --> 03:04:40,000 WHEN EFFECTIVENESS OF 4606 03:04:40,000 --> 03:04:41,240 INTERVENTION IS NOT WELL 4607 03:04:41,240 --> 03:04:42,600 ESTABLISHED AND WHAT IS THE 4608 03:04:42,600 --> 03:04:45,360 DEFINITION OF WELL ESTABLISHED 4609 03:04:45,360 --> 03:04:46,040 INTERVENTION. 4610 03:04:46,040 --> 03:04:47,960 IS THAT IS A LITTLE BIT MAYBE 4611 03:04:47,960 --> 03:04:49,320 LONGER BUT MAYBE IF ONE OF YOU 4612 03:04:49,320 --> 03:04:54,480 ONE OR TWO BRIEFLY COMMENT ON 4613 03:04:54,480 --> 03:04:56,040 EITHER THAT IS THE DECISION ONLY 4614 03:04:56,040 --> 03:04:58,200 TO USE WELL ESTABLISHED 4615 03:04:58,200 --> 03:04:58,880 INTERVENTIONS? 4616 03:04:58,880 --> 03:05:01,280 IF SO, WHAT MEETS THAT 4617 03:05:01,280 --> 03:05:11,720 DEFINITION IN YOUR MIND. 4618 03:05:18,960 --> 03:05:20,400 THIS IS WHY I DON'T WORK IN 4619 03:05:20,400 --> 03:05:22,000 RADIO, DEAD AIR DOESN'T BOTHER 4620 03:05:22,000 --> 03:05:22,480 ME A BIT. 4621 03:05:22,480 --> 03:05:25,000 WE CAN LET PEOPLE THINK ABOUT IT 4622 03:05:25,000 --> 03:05:30,680 OR WE CAN MOVE ON. 4623 03:05:30,680 --> 03:05:32,920 >> I CAN JUMP IN. 4624 03:05:32,920 --> 03:05:35,040 I THINK THERE IS GRAY AREA 4625 03:05:35,040 --> 03:05:35,400 AROUND THIS. 4626 03:05:35,400 --> 03:05:38,600 IT IS GOING TO -- I THINK ONE 4627 03:05:38,600 --> 03:05:40,760 CAN MAKE ARGUMENTS TO SUPPORT 4628 03:05:40,760 --> 03:05:45,800 WHERE THEY WANT TO GO, CLEARLY 4629 03:05:45,800 --> 03:05:49,560 EVIDENCE FROM EFFICACY TRIALS 4630 03:05:49,560 --> 03:05:50,760 GIVES SENSE INTERVENTION IS 4631 03:05:50,760 --> 03:05:53,560 ESTABLISHED BUT THERE ARE LOTS 4632 03:05:53,560 --> 03:05:57,800 OF CAVEATS LIKE WHAT POPULATION 4633 03:05:57,800 --> 03:05:58,800 ESTABLISH AND WHERE ARE YOU MOW 4634 03:05:58,800 --> 03:06:00,440 TRYING TO IMPLEMENT AND THE ONUS 4635 03:06:00,440 --> 03:06:05,040 IS ON US TO THINK CAREFULLY 4636 03:06:05,040 --> 03:06:07,160 ABOUT HOW WHAT DATA IMPACT DATA 4637 03:06:07,160 --> 03:06:08,480 ARE IN EXISTENCE RELATE TO WHAT 4638 03:06:08,480 --> 03:06:11,760 WE ARE TRYING TO DO. 4639 03:06:11,760 --> 03:06:13,560 THERE ARE TRADE OFFS COMPARED TO 4640 03:06:13,560 --> 03:06:15,360 DOING IMPLEMENTATION STUDY. 4641 03:06:15,360 --> 03:06:17,680 SO YOU HAVE TO WEIGH PROS AND 4642 03:06:17,680 --> 03:06:22,160 CONS OF THOSE CHOICES AND TRY TO 4643 03:06:22,160 --> 03:06:22,960 MAKE THE BEST YOU CAN FOR 4644 03:06:22,960 --> 03:06:23,960 ADVANCING THE SCIENCE HOW YOU 4645 03:06:23,960 --> 03:06:25,560 THINK IT NEEDS TO BE DONE. 4646 03:06:25,560 --> 03:06:28,080 IN LIGHT OF THE BODY OF EVIDENCE 4647 03:06:28,080 --> 03:06:29,280 AGAINST WHAT YOU ARE TRYING TO 4648 03:06:29,280 --> 03:06:29,720 DO. 4649 03:06:29,720 --> 03:06:31,880 SO I'M SPEAKING GENERALLY BUT I 4650 03:06:31,880 --> 03:06:34,080 DON'T THINK THAT THERE IS JUST A 4651 03:06:34,080 --> 03:06:44,360 SINGLE ANSWER HERE. 4652 03:06:44,360 --> 03:06:45,840 >> THANK YOU, MARGARET. 4653 03:06:45,840 --> 03:06:47,840 ONE THING THAT POPPED UP WHEN 4654 03:06:47,840 --> 03:06:49,840 YOU SAID THAT IS GLORIA 4655 03:06:49,840 --> 03:06:51,160 MENTIONED DIFFERENTIAL EFFECTS 4656 03:06:51,160 --> 03:06:52,160 LATINO POPULATION BENEFITING 4657 03:06:52,160 --> 03:06:54,040 MORE FROM THE SCREENING, I THINK 4658 03:06:54,040 --> 03:06:55,920 THE MORE YOU THINK ABOUT THESE 4659 03:06:55,920 --> 03:06:57,120 PRAGMATIC TRIALS WONDER IF 4660 03:06:57,120 --> 03:06:58,320 TREATMENT MODERATORS THINGS LIKE 4661 03:06:58,320 --> 03:06:59,960 THAT WILL BECOME REALLY 4662 03:06:59,960 --> 03:07:00,760 IMPORTANT BECAUSE EVERYONE 4663 03:07:00,760 --> 03:07:02,720 THINKS OF THIS CLASSIC AS A 4664 03:07:02,720 --> 03:07:04,600 DEMONSTRATED EFFICACY BUT LOOK 4665 03:07:04,600 --> 03:07:06,600 AT POPULATION SOMETIMES THOSE 4666 03:07:06,600 --> 03:07:08,040 ARE WHICH THOSE ARE TESTED AND 4667 03:07:08,040 --> 03:07:10,120 HOW TESTED, I WONDER IF 4668 03:07:10,120 --> 03:07:11,080 TREATMENT MODERATORS ARE GOING 4669 03:07:11,080 --> 03:07:15,520 TO BE REALLY HELPFUL IN THIS 4670 03:07:15,520 --> 03:07:17,080 DECISION TO INSTEAD OF JUST 4671 03:07:17,080 --> 03:07:18,960 HAVING THAT DEMONSTRATION 4672 03:07:18,960 --> 03:07:20,960 BECAUSE WE COULD BE MISSING 4673 03:07:20,960 --> 03:07:21,560 SOMETHING ET CETERA SPECIALLY 4674 03:07:21,560 --> 03:07:26,520 FOR POPULATIONS LIKE WE SAID 4675 03:07:26,520 --> 03:07:28,080 PRAGMATIC TRIALS MIGHT BE THE 4676 03:07:28,080 --> 03:07:29,960 ANSWER TO SOME OF THESE, WE NEED 4677 03:07:29,960 --> 03:07:32,280 TO THINK ABOUT THAT BAR A LITTLE 4678 03:07:32,280 --> 03:07:34,440 BIT AND THAT MAKES IT GRAY IROF 4679 03:07:34,440 --> 03:07:36,200 COURSE BUT GLAD YOU CHARACTERIZE 4680 03:07:36,200 --> 03:07:38,200 IT AS A GRAY ZONE BECAUSE I 4681 03:07:38,200 --> 03:07:41,640 THINK UNFORTUNATELY IS ONE OF 4682 03:07:41,640 --> 03:07:47,000 THE GRAYEST ZONES. 4683 03:07:47,000 --> 03:07:47,840 ANY OTHER THOUGHTS ON THAT 4684 03:07:47,840 --> 03:07:49,040 QUESTION? 4685 03:07:49,040 --> 03:07:50,680 I DON'T KNOW IF MIGUEL WANTED TO 4686 03:07:50,680 --> 03:07:52,440 -- I THOUGHT I SAW HIM GO OFF 4687 03:07:52,440 --> 03:07:53,360 MUTE MAYBE NOT. 4688 03:07:53,360 --> 03:07:55,680 >>PROFESSOR: I THINK THAT 4689 03:07:55,680 --> 03:07:58,880 DEPENDS ALSO ON QUESTION FOR IN 4690 03:07:58,880 --> 03:08:00,520 OUR TRIAL WE WENT WITH EVIDENCE 4691 03:08:00,520 --> 03:08:06,920 BASED GUIDELINES BUT THERE WAS 4692 03:08:06,920 --> 03:08:10,160 (INAUDIBLE) RAPIDLY PROBABLY 4693 03:08:10,160 --> 03:08:13,360 WOULD BE A DIFFERENCE QUESTION. 4694 03:08:13,360 --> 03:08:14,440 A DIFFERENT QUESTION. 4695 03:08:14,440 --> 03:08:15,040 >> THANK YOU. 4696 03:08:15,040 --> 03:08:18,080 ALL RIGHT LET'S GO TO NEXT 4697 03:08:18,080 --> 03:08:22,320 SLIDE. 4698 03:08:22,320 --> 03:08:23,880 THIS IS WHERE WE GIVE EACH 4699 03:08:23,880 --> 03:08:28,520 PANELIST A VERY BRIEF FINAL 4700 03:08:28,520 --> 03:08:28,880 THOUGHT. 4701 03:08:28,880 --> 03:08:30,920 AND THEY CAN STICK TO ONE OF 4702 03:08:30,920 --> 03:08:32,320 THESE THEMES OR THEY CAN GO ON 4703 03:08:32,320 --> 03:08:32,640 THEIR OWN. 4704 03:08:32,640 --> 03:08:36,040 THIS IS WHAT WE USE TO SUMMARIZE 4705 03:08:36,040 --> 03:08:36,960 PRE-MEETING DISCUSSION. 4706 03:08:36,960 --> 03:08:42,120 WE SPENT MORE TIME IN DEVELOPING 4707 03:08:42,120 --> 03:08:43,160 DIFFERENT DIRECTION SO WHO WOULD 4708 03:08:43,160 --> 03:08:44,200 LIKE TO GO FIRST? 4709 03:08:44,200 --> 03:08:47,080 OR DO I GET TO PICK? 4710 03:08:47,080 --> 03:08:50,040 REMEMBER THIS IS BRIEF, THIS IS 4711 03:08:50,040 --> 03:08:59,600 THE LIGHTNING ROUND. 4712 03:08:59,600 --> 03:09:04,840 >> I CAN START THIS IS GLORIA. 4713 03:09:04,840 --> 03:09:06,720 I THINK THAT ONE OF THE -- THE 4714 03:09:06,720 --> 03:09:08,360 QUESTION THAT RESONATED WITH ME 4715 03:09:08,360 --> 03:09:09,400 WAS THE LAST ONE. 4716 03:09:09,400 --> 03:09:12,520 IS WHAT WE DID FOR OUR PRAGMATIC 4717 03:09:12,520 --> 03:09:14,360 TRIAL IS IT GOING TO BE 4718 03:09:14,360 --> 03:09:15,760 SUSTAINABLE AFTER THE TRIAL? 4719 03:09:15,760 --> 03:09:19,160 AND I THINK THIS IS SUCH A 4720 03:09:19,160 --> 03:09:20,160 CRITICAL QUESTION. 4721 03:09:20,160 --> 03:09:22,360 IN OUR WORK WHEN WE BROUGHT 4722 03:09:22,360 --> 03:09:23,840 TOGETHER ADVISORY BOARD WHICH 4723 03:09:23,840 --> 03:09:25,880 CONSISTED OF MANY OF THE MEDICAL 4724 03:09:25,880 --> 03:09:27,680 DIRECTORS FROM OUR FEDERALLY 4725 03:09:27,680 --> 03:09:29,040 QUALIFIED HEALTH CENTER CLINICS 4726 03:09:29,040 --> 03:09:32,520 THEY TALKED ABOUT AN IMPORTANT 4727 03:09:32,520 --> 03:09:34,440 BARRIER TO DOING FIT TESTING. 4728 03:09:34,440 --> 03:09:37,720 AND THAT IS THAT PATIENTS WITH 4729 03:09:37,720 --> 03:09:40,280 ABNORMAL TEST RESULT MIGHT FACE 4730 03:09:40,280 --> 03:09:42,200 CO-PAYS WHEN THEY NEED THAT 4731 03:09:42,200 --> 03:09:45,320 COLONS SO PI PROCEDURE. 4732 03:09:45,320 --> 03:09:48,680 SO WE TALKED ABOUT THIS ISSUE, 4733 03:09:48,680 --> 03:09:49,920 BECAUSE THEY WERE CONCERNED IT 4734 03:09:49,920 --> 03:09:51,480 PREVENTED THEM FROM REALLY 4735 03:09:51,480 --> 03:09:57,040 STRONGLY ENDORSING FECAL 4736 03:09:57,040 --> 03:09:57,640 TESTING. 4737 03:09:57,640 --> 03:10:01,040 ON OUR ADVISE BOARD WE HAD MITCH 4738 03:10:01,040 --> 03:10:02,840 GREENLICH WHO WAS LEGISLATOR AND 4739 03:10:02,840 --> 03:10:05,680 HE WAS ACTUALLY CO-FOUNDER OF MY 4740 03:10:05,680 --> 03:10:06,480 RESEARCH INSTITUTE. 4741 03:10:06,480 --> 03:10:09,480 AND WE DECIDED TO TAKE THIS 4742 03:10:09,480 --> 03:10:12,240 ISSUE TO HIM AND CHANGE STATE 4743 03:10:12,240 --> 03:10:13,920 POLICY TO NO LONGER BE BARRIER 4744 03:10:13,920 --> 03:10:15,000 FOR PATIENTS. 4745 03:10:15,000 --> 03:10:17,960 AND SO I THINK WE WERE AGE TO 4746 03:10:17,960 --> 03:10:18,840 BREAK DOWN SOME OF THE POLICY 4747 03:10:18,840 --> 03:10:21,920 ISSUES BECAUSE I THINK THAT 4748 03:10:21,920 --> 03:10:24,880 OFTEN TIMES AS RESEARCHERS WE 4749 03:10:24,880 --> 03:10:27,600 STAY AWAY FROM POLICY BUT 4750 03:10:27,600 --> 03:10:29,040 SOMETIMES YOU HAVE TO TACKLE 4751 03:10:29,040 --> 03:10:30,200 POLICY IF IT IS GETTING IN THE 4752 03:10:30,200 --> 03:10:32,040 WAY OF YOUR PROGRAM BEING 4753 03:10:32,040 --> 03:10:33,120 SUCCESSFUL. 4754 03:10:33,120 --> 03:10:36,480 SO IN ADDITION THE THAT, I JOIN 4755 03:10:36,480 --> 03:10:37,800 THE SCORING COMMITTEE FOR 4756 03:10:37,800 --> 03:10:40,800 MEDICATE HEALTH PLANS AND 4757 03:10:40,800 --> 03:10:44,840 INCORPORATED COLORECTAL CANCER 4758 03:10:44,840 --> 03:10:46,560 SCREENING, HELPS MAKES CLINICS 4759 03:10:46,560 --> 03:10:47,800 MORE INTERESTED BEING PART OF 4760 03:10:47,800 --> 03:10:49,440 OUR STUDY SO THOSE ARE EXAMPLES 4761 03:10:49,440 --> 03:10:51,320 OF THINGS WE DID TO KIND OF 4762 03:10:51,320 --> 03:10:54,720 REALLY CREATE MORE CONTEXT FOR 4763 03:10:54,720 --> 03:10:55,400 SUSTAINABILITY OVER THE LONG 4764 03:10:55,400 --> 03:10:58,840 TERM. 4765 03:10:58,840 --> 03:11:00,400 SORRY TO TAKE SO MUCH TIME. 4766 03:11:00,400 --> 03:11:03,760 >> THAT IS ALL RIGHT. 4767 03:11:03,760 --> 03:11:07,400 >> I WOULD ASK THE SAME QUESTION 4768 03:11:07,400 --> 03:11:08,200 BECAUSE WE HAVE BEEN THINKING 4769 03:11:08,200 --> 03:11:12,240 ABOUT THIS A LOTTEN OUR TEAM. 4770 03:11:12,240 --> 03:11:18,280 WE GOT RELAXATION ACUPUNCTURE, 4771 03:11:18,280 --> 03:11:22,480 GIVEN THE BARRIER THEY HAVE 4772 03:11:22,480 --> 03:11:24,760 TRANSPORTATION, ABILITY TO PAY 4773 03:11:24,760 --> 03:11:25,960 BECAUSE PAYING FOR (INAUDIBLE) 4774 03:11:25,960 --> 03:11:28,520 TO DO THIS SESSION SO IF THE 4775 03:11:28,520 --> 03:11:29,760 TRIAL IS OVER PATIENT WANT TO 4776 03:11:29,760 --> 03:11:32,720 CONTINUE THEY HAVE ACCESS TO 4777 03:11:32,720 --> 03:11:36,040 CARE, I SHOULD SAY, SO ONE OF 4778 03:11:36,040 --> 03:11:41,960 THE BARRIER FOR PAIN FOR THIS 4779 03:11:41,960 --> 03:11:42,960 (INAUDIBLE) WE HAVE INSURANCE 4780 03:11:42,960 --> 03:11:46,600 COMPANIES PAY FOR OUR THE 4781 03:11:46,600 --> 03:11:50,680 INFORMATION AND FOR THEM TO PAY 4782 03:11:50,680 --> 03:11:53,520 PROVIDE ACTUALLY PRESCRIBE 4783 03:11:53,520 --> 03:11:56,160 BETTER RELAXATION, PRESCRIBE 4784 03:11:56,160 --> 03:11:58,120 ACUPUNCTURE FOR YOUR PAIN AND 4785 03:11:58,120 --> 03:12:00,880 HAVE A CHANCE TO SEPARATE. 4786 03:12:00,880 --> 03:12:05,720 SO THIS IS THE WAY I SEE WITH 4787 03:12:05,720 --> 03:12:07,280 OUR INFORMATION (INAUDIBLE) 4788 03:12:07,280 --> 03:12:08,680 AFTER THE TRIAL SO FAR. 4789 03:12:08,680 --> 03:12:15,720 AND POLICY LEVEL AT LEAST. 4790 03:12:15,720 --> 03:12:18,600 >> THANK YOU, MIRIAM. 4791 03:12:18,600 --> 03:12:24,480 MARGARET OR MIGUEL. 4792 03:12:24,480 --> 03:12:28,200 >> I THINK REGARDING 4793 03:12:28,200 --> 03:12:31,520 SUSTAINABILITY I THINK WHAT WE 4794 03:12:31,520 --> 03:12:33,720 LEARNED IS IS SUSTAINABLE AS FAR 4795 03:12:33,720 --> 03:12:35,240 AS PRINCIPLES HOW TO ADDRESS 4796 03:12:35,240 --> 03:12:36,280 THESE TYPES OF QUESTIONS. 4797 03:12:36,280 --> 03:12:37,400 SPECIFICS ARE LESS IMPORTANT 4798 03:12:37,400 --> 03:12:40,640 BECAUSE AGAIN THE FIELDS CHANGES 4799 03:12:40,640 --> 03:12:43,280 SO FAST THE QUESTIONS WE ASK 4800 03:12:43,280 --> 03:12:44,800 WILL BE (INAUDIBLE) ARE NOT EVEN 4801 03:12:44,800 --> 03:12:48,080 THE SAME QUESTIONS WE WOULD ASK 4802 03:12:48,080 --> 03:12:49,640 TODAY BUT CERTAINLY THE APPROACH 4803 03:12:49,640 --> 03:12:55,760 IN THE OVERALL WAY TO CARRY THIS 4804 03:12:55,760 --> 03:12:57,120 TYPE OF RESEARCH IS SUSTAINABLE 4805 03:12:57,120 --> 03:13:02,680 NO QUESTION. 4806 03:13:02,680 --> 03:13:04,880 >> THANK YOU, MARGARET, YOU GET 4807 03:13:04,880 --> 03:13:05,680 TO WRAP THIS UP. 4808 03:13:05,680 --> 03:13:09,200 >> MY COMMENTS ARE GOING 4809 03:13:09,200 --> 03:13:10,160 DIFFERENT DIRECTION. 4810 03:13:10,160 --> 03:13:12,640 I RESONATE WITH THE FIRST BULLET 4811 03:13:12,640 --> 03:13:15,440 POINT I THINK ALL PCTs RUN 4812 03:13:15,440 --> 03:13:16,840 THROUGH IMPLEMENTATION SCIENCE 4813 03:13:16,840 --> 03:13:18,760 AND OUR COMMENTS IN THIS PANEL I 4814 03:13:18,760 --> 03:13:21,680 THINK SUPPORT THAT. 4815 03:13:21,680 --> 03:13:26,280 I WANT TO SHARE SOMETHING MY 4816 03:13:26,280 --> 03:13:27,880 COLLEAGUE PRESENTED, JIM BOGS 4817 03:13:27,880 --> 03:13:33,720 SAID TO ME, WHEN INTERVENTIONS 4818 03:13:33,720 --> 03:13:34,920 WORK IN HEALTHCARE SETTINGS AND 4819 03:13:34,920 --> 03:13:38,000 WE KNOW SETTINGS ARE COMPLEX. 4820 03:13:38,000 --> 03:13:39,240 HEALTHCARE SYSTEMS HAVE CAPACITY 4821 03:13:39,240 --> 03:13:41,800 TO DISSEMINATE THEM AND REACH SO 4822 03:13:41,800 --> 03:13:43,680 MANY CHILDREN AND FAMILIES. 4823 03:13:43,680 --> 03:13:44,960 AND WHATEVER POPULATION WE ARE 4824 03:13:44,960 --> 03:13:45,320 WORKING WITH. 4825 03:13:45,320 --> 03:13:48,840 SO WILL IS THE POTENTIAL FOR 4826 03:13:48,840 --> 03:13:51,360 IMPACT WE CAN CRAFT THAT 4827 03:13:51,360 --> 03:13:54,520 COMPLEXITY IMPLEMENTATION 4828 03:13:54,520 --> 03:13:55,080 BARRIERS. 4829 03:13:55,080 --> 03:13:56,800 I WANTED TO ADD I WAS IMPRESSED 4830 03:13:56,800 --> 03:13:59,080 WHEN I WAS AT HEALTHCARE SYSTEMS 4831 03:13:59,080 --> 03:14:00,760 TEN YEAR ANNIVERSARY PETE 4832 03:14:00,760 --> 03:14:02,320 MEETING A COUPLE OF MONTHS AGO 4833 03:14:02,320 --> 03:14:04,320 MADE ME AWARE OF MANY RESOURCES 4834 03:14:04,320 --> 03:14:05,840 DEVELOPED OVER THE COURSE OF 4835 03:14:05,840 --> 03:14:08,040 THOSE TEN YEARS TO SUPPORT 4836 03:14:08,040 --> 03:14:10,560 TRIALS LIKE OURS IN BEING 4837 03:14:10,560 --> 03:14:12,000 SUCCESSFUL AND ABLE TO MANAGE 4838 03:14:12,000 --> 03:14:13,640 THAT COMPLEXITY AND GET TO THE 4839 03:14:13,640 --> 03:14:21,640 OUTCOMES THAT WE ARE HOPING TO. 4840 03:14:21,640 --> 03:14:23,480 >> THANK YOU. 4841 03:14:23,480 --> 03:14:27,440 THANK YOU TO ALL PANELISTS FOR A 4842 03:14:27,440 --> 03:14:28,200 GREAT DISCUSSION. 4843 03:14:28,200 --> 03:14:29,600 I REALLY APPRECIATED WORKING 4844 03:14:29,600 --> 03:14:32,280 WITH YOU ON THIS. 4845 03:14:32,280 --> 03:14:34,480 AND HOPEFULLY THIS WAS -- WE MET 4846 03:14:34,480 --> 03:14:36,160 OUR CHARGE WHICH I THINK WENDY 4847 03:14:36,160 --> 03:14:37,360 HAS GIVEN US A PRELIMINARY 4848 03:14:37,360 --> 03:14:39,320 INDICATION THAT WE HAVE THERE IN 4849 03:14:39,320 --> 03:14:40,080 THE CHAT ROOM. 4850 03:14:40,080 --> 03:14:43,160 I THINK THATS IS MY QUEUE TO END 4851 03:14:43,160 --> 03:14:44,680 IT BACK OVER TO HER. 4852 03:14:44,680 --> 03:14:45,960 THANK YOU ALL. 4853 03:14:45,960 --> 03:14:49,480 REALLY ENJOYED IT. 4854 03:14:49,480 --> 03:14:50,400 >> YES. 4855 03:14:50,400 --> 03:14:54,040 LET ME ADD MY THANKS TO YOU 4856 03:14:54,040 --> 03:14:56,840 STEVEN AND THE ENTIRE PANEL FOR 4857 03:14:56,840 --> 03:14:59,640 REALLY AN EXCELLENT SESSION AS 4858 03:14:59,640 --> 03:15:02,480 WELL AS TO YOU WENDY FOR THE 4859 03:15:02,480 --> 03:15:05,800 EXCELLENT SESSION YOU LED. 4860 03:15:05,800 --> 03:15:07,240 WENDY WILL PROBABLY COME BACK ON 4861 03:15:07,240 --> 03:15:08,920 CAMERA AND THE PANELISTS FROM 4862 03:15:08,920 --> 03:15:11,840 THIS LAST SESSION CAN TURN THEIR 4863 03:15:11,840 --> 03:15:13,520 VIDEOS OFF AND MAYBE IF STEVE 4864 03:15:13,520 --> 03:15:14,960 YOU CAN JOIN US ON CAMERA WE 4865 03:15:14,960 --> 03:15:18,800 WILL DO A QUICK WRAP UP WITH 4866 03:15:18,800 --> 03:15:19,960 TODAY. 4867 03:15:19,960 --> 03:15:22,240 FIRST I THOUGHT I MIGHT JUST 4868 03:15:22,240 --> 03:15:27,600 REFLECT ON SOME OF WHAT WE HEARD 4869 03:15:27,600 --> 03:15:30,160 YESTERDAY AND PULL TOGETHER 4870 03:15:30,160 --> 03:15:30,640 OVERARCHING THEMES WHICH 4871 03:15:30,640 --> 03:15:35,040 THEREUPON A FEW THAT REALLY WE 4872 03:15:35,040 --> 03:15:37,000 HEARD TIME AND AGAIN. 4873 03:15:37,000 --> 03:15:39,320 WHEN KEITH MARSOLO AND THE FIRST 4874 03:15:39,320 --> 03:15:43,360 PANEL TALKED ABOUT WHAT ABOUT 4875 03:15:43,360 --> 03:15:48,120 THE LEK TROPIC HEALTH RECORD CAN 4876 03:15:48,120 --> 03:15:49,880 SQUEEZE MORE VALUE FROM THAT, A 4877 03:15:49,880 --> 03:15:54,240 TAKE AWAY IS FLEXIBILITY AND 4878 03:15:54,240 --> 03:15:55,800 AGILITY, GIVEN HOW DYNAMIC THE 4879 03:15:55,800 --> 03:15:57,800 SYSTEMS ARE AND HOW DYNAMIC THE 4880 03:15:57,800 --> 03:15:59,040 ORGANIZATIONS ARE AND REAL NEED 4881 03:15:59,040 --> 03:16:03,000 TO PAY ATTENTION TO POTENTIAL 4882 03:16:03,000 --> 03:16:04,360 IMPACT OF EVEN SMALL CHANGES. 4883 03:16:04,360 --> 03:16:08,600 I GUESS FROM MY PERSPECTIVE, IFF 4884 03:16:08,600 --> 03:16:10,680 THERE IS A OVERALL TAKE AWAY 4885 03:16:10,680 --> 03:16:12,640 FROM BOTH DAYS, IT IS NOT DON'T 4886 03:16:12,640 --> 03:16:14,160 SWEAT THE SMALL STUFF, IT IS PAY 4887 03:16:14,160 --> 03:16:18,200 ATTENTION TO THE SMALL STUFF. 4888 03:16:18,200 --> 03:16:20,760 THAT IS IMPORTANT. 4889 03:16:20,760 --> 03:16:24,400 THEN PATRICK AND THE TEAM OR 4890 03:16:24,400 --> 03:16:26,200 PANEL THAT ASKED OR ANSWERED THE 4891 03:16:26,200 --> 03:16:27,720 QUESTION ABOUT WHETHER WE SHOULD 4892 03:16:27,720 --> 03:16:30,400 CONSIDER DIFFERENT STUDY DESIGN, 4893 03:16:30,400 --> 03:16:31,640 REALLY UNDERSCORED THE 4894 03:16:31,640 --> 03:16:33,960 IMPORTANCE OF MONITORING AT 4895 03:16:33,960 --> 03:16:35,280 EVERY STEP ALONG THE WAY, 4896 03:16:35,280 --> 03:16:37,040 INCLUDING THE QUALITY OF THE 4897 03:16:37,040 --> 03:16:41,680 DATA AND ALSO THE IMPORTANCE OF 4898 03:16:41,680 --> 03:16:42,800 MULTI-DISCIPLINARY STUDY TEAM 4899 03:16:42,800 --> 03:16:45,640 AND DATA SAFETY MONITORING 4900 03:16:45,640 --> 03:16:46,200 BOARD. 4901 03:16:46,200 --> 03:16:48,120 I FELT LIKE THOSE THEMES WE 4902 03:16:48,120 --> 03:16:49,560 HEARD AGAIN TODAY AS WELL, NOT 4903 03:16:49,560 --> 03:16:52,240 JUST ABOUT FLEXIBILITY AND 4904 03:16:52,240 --> 03:16:55,120 PAYING ATTENTION BUT THE NEED 4905 03:16:55,120 --> 03:16:58,560 FOR TRUE MULTI-DISCIPLINARY TEAM 4906 03:16:58,560 --> 03:17:01,800 TO MANAGE THE COMPLEXITY AND 4907 03:17:01,800 --> 03:17:05,600 MANY FACETS OF PRAGMATIC TRIALS. 4908 03:17:05,600 --> 03:17:07,360 WENDY, I WONDER AS YOU REFLECT 4909 03:17:07,360 --> 03:17:09,640 ON THE PANEL THAT YOU MODERATED, 4910 03:17:09,640 --> 03:17:11,280 WHAT REALLY STOOD OUT FOR YOU AS 4911 03:17:11,280 --> 03:17:13,680 KEY TAKE AWAYS? 4912 03:17:13,680 --> 03:17:16,440 >> THERE'S SO MUCH EXPERIENCE 4913 03:17:16,440 --> 03:17:17,280 THESE INVESTIGATORS HAVE. 4914 03:17:17,280 --> 03:17:19,240 I THINK IS THE BIGGEST THING. 4915 03:17:19,240 --> 03:17:22,240 I FEEL LIKE EVERY TIME I TALK TO 4916 03:17:22,240 --> 03:17:23,680 TEAM AND INVESTIGATORS, I LEARN 4917 03:17:23,680 --> 03:17:25,120 A LITTLE BIT MORE, I THINK I 4918 03:17:25,120 --> 03:17:26,680 SAID THAT YESTERDAY. 4919 03:17:26,680 --> 03:17:29,160 LEARN NEW NUANCE OR NEW THING 4920 03:17:29,160 --> 03:17:31,160 THAT WE DIDN'T KNOW THEY DID. 4921 03:17:31,160 --> 03:17:36,880 AND WAS A KEY ELEMENT FOR 4922 03:17:36,880 --> 03:17:38,120 SUCCESS FOR THOSE STUDIES. 4923 03:17:38,120 --> 03:17:38,920 IT WAS INTERESTING HOW EACH OF 4924 03:17:38,920 --> 03:17:43,000 THE PROJECTS REALLY USED THEIR 4925 03:17:43,000 --> 03:17:44,880 PLANNING PHASES DIFFERENTLY TO 4926 03:17:44,880 --> 03:17:46,200 TACKLE WHAT THEY THOUGHT WERE 4927 03:17:46,200 --> 03:17:48,760 GOING TO BE THE TOUGHEST PIECES. 4928 03:17:48,760 --> 03:17:51,880 THAT IS A REALLY INTERESTING 4929 03:17:51,880 --> 03:17:53,080 NUANCE OF PLANNING PERIODS, 4930 03:17:53,080 --> 03:17:54,200 THERE IS NOT NECESSARILY A 4931 03:17:54,200 --> 03:17:56,680 STANDARD SET OF THINGS YOU NEED 4932 03:17:56,680 --> 03:17:57,240 TO DO. 4933 03:17:57,240 --> 03:17:59,000 THERE ARE IN SOME WAYS YOU GOT 4934 03:17:59,000 --> 03:18:01,160 TO FIGURE HOW YOU RECRUIT AND 4935 03:18:01,160 --> 03:18:05,440 HOW TO GET OUTCOMES BUT HOW 4936 03:18:05,440 --> 03:18:06,640 CHALLENGES FOR EACH INDIVIDUAL 4937 03:18:06,640 --> 03:18:07,560 TRIAL FOR DIFFERENT PARTS OF 4938 03:18:07,560 --> 03:18:11,880 THOSE ELEMENTS IS UNIQUE AND HOW 4939 03:18:11,880 --> 03:18:15,200 DO YOU PRIORITIZE EVERYTHING YOU 4940 03:18:15,200 --> 03:18:17,480 COULD DO IN THE PLANNING PHASE 4941 03:18:17,480 --> 03:18:19,360 WITH WHAT YOU GOT TO FIGURE OUT, 4942 03:18:19,360 --> 03:18:21,080 THERE'S JUST NO WAY YOU ARE ABLE 4943 03:18:21,080 --> 03:18:24,920 TO DO THE TRIAL. 4944 03:18:24,920 --> 03:18:27,680 THAT WAS THE TAKE AWAY FOR ME, 4945 03:18:27,680 --> 03:18:29,320 HOW MUCH VARIABILITY ACROSS THE 4946 03:18:29,320 --> 03:18:31,080 DIFFERENT STUDIES. 4947 03:18:31,080 --> 03:18:36,200 AND HOW EACH TEAM TOOK ON THEIR 4948 03:18:36,200 --> 03:18:36,880 APPROACH DIFFERENTLY DEPENDING 4949 03:18:36,880 --> 03:18:37,880 WHAT IT WAS TO BE THE MOST 4950 03:18:37,880 --> 03:18:40,240 CHALLENGING THING TO DO. 4951 03:18:40,240 --> 03:18:42,800 >> THAT CAME ACROSS LOUDLY. 4952 03:18:42,800 --> 03:18:43,520 AND CLEARLY. 4953 03:18:43,520 --> 03:18:47,680 IT REALLY DID. 4954 03:18:47,680 --> 03:18:54,080 STEVE, WHAT ABOUT YOU AND THESE 4955 03:18:54,080 --> 03:18:58,240 REALLY HUGE CHALLENGE 4956 03:18:58,240 --> 03:19:00,040 IMPLEMENTING INTERVENTIONS THAT 4957 03:19:00,040 --> 03:19:02,280 ARE OFTEN COMPLEX OR CAN BECOME 4958 03:19:02,280 --> 03:19:08,640 COMPLEX IN DYNAMIC COMPLEX 4959 03:19:08,640 --> 03:19:09,160 HEALTHCARE SYSTEM? 4960 03:19:09,160 --> 03:19:10,600 >> IN THE THREE AND A HALF 4961 03:19:10,600 --> 03:19:13,760 MINUTES I HAD TO REFLECT, 4962 03:19:13,760 --> 03:19:14,240 LESLIE. 4963 03:19:14,240 --> 03:19:16,200 I THINK YOUR COMMENT ABOUT 4964 03:19:16,200 --> 03:19:17,960 SWEATING THE SMALL STUFF, ONE OF 4965 03:19:17,960 --> 03:19:19,440 THE THINGS IMPLEMENTATION 4966 03:19:19,440 --> 03:19:21,760 SCIENCE DOES IS MAYBE GIVE YOU A 4967 03:19:21,760 --> 03:19:23,480 FRAMEWORK TO SWEAT -- TO -- 4968 03:19:23,480 --> 03:19:26,160 BECAUSE OTHERWISE YOU RUN INTO A 4969 03:19:26,160 --> 03:19:28,600 CASE WHERE YOU ARE WORRYING 4970 03:19:28,600 --> 03:19:29,840 ABOUT EVERYTHING OR IT IS 4971 03:19:29,840 --> 03:19:31,280 CONTROLLING YOU BUT IF YOU HAVE 4972 03:19:31,280 --> 03:19:34,000 THE IMPLEMENTATION EXPERTISE YOU 4973 03:19:34,000 --> 03:19:35,400 ARE ABLE TO HANDLE IT AS IT 4974 03:19:35,400 --> 03:19:37,120 COMES TO YOU IN WAVES SO I 4975 03:19:37,120 --> 03:19:38,440 HADN'T THOUGHT OF IT THAT WAY 4976 03:19:38,440 --> 03:19:40,120 UNTIL YOU SAID -- OBVIOUSLY YOU 4977 03:19:40,120 --> 03:19:41,680 ARE NOT OFTEN ENCOURAGED TO 4978 03:19:41,680 --> 03:19:43,360 SWEAT THE SMALL STUFF BUT IN 4979 03:19:43,360 --> 03:19:45,560 PRAGMATIC TRIALS YOU HAVE TO. 4980 03:19:45,560 --> 03:19:47,560 BUT YOU NEED A FRAMEWORK TO DO 4981 03:19:47,560 --> 03:19:49,240 THAT OR IT WILL OVERWHELM YOU. 4982 03:19:49,240 --> 03:19:54,160 SO EACH OF THE TRIALISTS ON OUR 4983 03:19:54,160 --> 03:19:56,440 PANEL HAD CLEAR ROLES AND 4984 03:19:56,440 --> 03:20:00,280 ADVOCATED FOR INVOLVEMENT OF 4985 03:20:00,280 --> 03:20:02,960 IMPLEMENTATION SCIENCE. 4986 03:20:02,960 --> 03:20:05,640 THE TENSION OF BEING FLEXIBLE 4987 03:20:05,640 --> 03:20:06,880 ENOUGH TO WORK BUT MAINTAINING 4988 03:20:06,880 --> 03:20:09,680 THE CORE COMPONENTS IS THAT IS 4989 03:20:09,680 --> 03:20:10,520 GOING TO CONTINUE TO BE THERE 4990 03:20:10,520 --> 03:20:13,120 AND THERE IS JUST SOME PEOPLE 4991 03:20:13,120 --> 03:20:14,720 THAT ARE PURE CLINICAL TRIALISTS 4992 03:20:14,720 --> 03:20:18,360 THAT IS A VERY UNSATISFYING WAY 4993 03:20:18,360 --> 03:20:20,560 BUT THE MORE YOU WORK IN HEALTH 4994 03:20:20,560 --> 03:20:22,040 SYSTEMS THE MORE IT IS VERY 4995 03:20:22,040 --> 03:20:24,960 HELPFUL TO KNOW WHAT THOSE CORE 4996 03:20:24,960 --> 03:20:25,960 COMPONENTS ARE. 4997 03:20:25,960 --> 03:20:27,520 IN MY EXPERIENCE WE DECIDE THAT 4998 03:20:27,520 --> 03:20:31,160 AHEAD OF TIME BECAUSE WHAT YOU 4999 03:20:31,160 --> 03:20:33,160 FIND IN MY EXPERIENCE IS YOU 5000 03:20:33,160 --> 03:20:36,480 WANT TO WORK WITH PEOPLE BUT YOU 5001 03:20:36,480 --> 03:20:39,480 HAVE TO HAVE THAT SENOR CORE SO 5002 03:20:39,480 --> 03:20:40,640 IF SOMEONE DOES HAVE A 5003 03:20:40,640 --> 03:20:42,080 SUGGESTION THAT IS A REALLY GOOD 5004 03:20:42,080 --> 03:20:45,880 IDEA AND WOULD WORK CLINICALLY 5005 03:20:45,880 --> 03:20:47,520 BUT DOES PULL YOU TOO FAR AFIELD 5006 03:20:47,520 --> 03:20:48,560 YOU HAVE IT THERE SO EVERYONE 5007 03:20:48,560 --> 03:20:49,840 CAN MAKE THAT DECISION AND YOU 5008 03:20:49,840 --> 03:20:52,560 ARE NOT MAKING IT BASED ON THE 5009 03:20:52,560 --> 03:20:54,960 FACT THAT OH WE NEED SIX MORE 5010 03:20:54,960 --> 03:20:57,280 SITES TO GO TO UH 3 AND THIS ONE 5011 03:20:57,280 --> 03:20:57,640 MIGHT WORK. 5012 03:20:57,640 --> 03:21:00,640 SO I THINK THAT FLEXIBILITY 5013 03:21:00,640 --> 03:21:02,960 ADAPTATION AND HAVING SOME OF 5014 03:21:02,960 --> 03:21:05,720 THAT STANDARD IS REALLY 5015 03:21:05,720 --> 03:21:06,080 IMPORTANT. 5016 03:21:06,080 --> 03:21:07,280 AND THEN I THINK THE THIRD PART 5017 03:21:07,280 --> 03:21:08,640 THAT CAME UP AT THE END IS JUST 5018 03:21:08,640 --> 03:21:10,080 THERE IS AN INCREDIBLE 5019 03:21:10,080 --> 03:21:13,160 OPPORTUNITY TO ADDRESS THE 5020 03:21:13,160 --> 03:21:14,360 DISPARITIES BECAUSE IF YOU DO 5021 03:21:14,360 --> 03:21:15,840 THE TRIALS, THE WAY THAT A LOT 5022 03:21:15,840 --> 03:21:18,920 OF THEM ARE DONE, THE CONSENT 5023 03:21:18,920 --> 03:21:21,760 BAR MIGHT BE LOWER THAN -- THERE 5024 03:21:21,760 --> 03:21:23,400 ARE SON THINGS THAT REALLY IF WE 5025 03:21:23,400 --> 03:21:26,480 GET GOOD AT LEVERAGING IN THE 5026 03:21:26,480 --> 03:21:28,920 SPACE, I AGREE MIGUEL BROUGHT UP 5027 03:21:28,920 --> 03:21:30,960 FIRST BUT EVERYONE REINFORCED IT 5028 03:21:30,960 --> 03:21:32,840 PARTNERING WITH NEW PLACES, THAT 5029 03:21:32,840 --> 03:21:34,280 HAVEN'T DONE RESEARCH AS MUCH 5030 03:21:34,280 --> 03:21:35,520 BECAUSE I THINK THOSE PLACE -- 5031 03:21:35,520 --> 03:21:40,840 NOT THAT THERE IS ANYTHING CRONK 5032 03:21:40,840 --> 03:21:42,160 WITH PLACES THAT DO RESEARCH A 5033 03:21:42,160 --> 03:21:43,520 LOT BUT TENT TO NOT HAVE THE 5034 03:21:43,520 --> 03:21:44,960 POPULATIONS WE LIKE TO EXPAND 5035 03:21:44,960 --> 03:21:45,360 TO. 5036 03:21:45,360 --> 03:21:46,800 AND THEN TO GO BACK TO 5037 03:21:46,800 --> 03:21:48,920 IMPLEMENTATION PART OF THAT 5038 03:21:48,920 --> 03:21:51,200 LESLIE, WE HEARD SOME OF IT WITH 5039 03:21:51,200 --> 03:21:53,200 GLORIA'S EXAMPLE OF THE WORD 5040 03:21:53,200 --> 03:21:53,880 LIST INSTRUCTIONS BUT 5041 03:21:53,880 --> 03:21:56,160 IMPLEMENTATION TEAM HAS TO BE 5042 03:21:56,160 --> 03:21:59,200 READY TO TAKE ON THAT CHALLENGE. 5043 03:21:59,200 --> 03:22:01,320 BECAUSE IT CAN'T BE SAME 5044 03:22:01,320 --> 03:22:02,520 APPROACH AS MOVING INTO 5045 03:22:02,520 --> 03:22:03,960 DIFFERENT POPULATIONS. 5046 03:22:03,960 --> 03:22:05,880 >> EXCELLENT. 5047 03:22:05,880 --> 03:22:07,400 >> THAT'S THE STICKS WITH ME. 5048 03:22:07,400 --> 03:22:09,240 >> EXCELLENT. 5049 03:22:09,240 --> 03:22:10,280 EXCELLENT TAKE AWAYS. 5050 03:22:10,280 --> 03:22:12,320 THANK YOU, STEVE. 5051 03:22:12,320 --> 03:22:16,720 WENDY I WILL HAND OFF TO YOU FOR 5052 03:22:16,720 --> 03:22:17,880 FINAL COMMENTS. 5053 03:22:17,880 --> 03:22:21,520 I GUESS ONE OTHER SORT OF REAL 5054 03:22:21,520 --> 03:22:23,400 -- NOT REALIZATION BUT ONE OTHER 5055 03:22:23,400 --> 03:22:26,120 ASPECT THAT STRUCK ME I THINK 5056 03:22:26,120 --> 03:22:28,160 TEN YEARS AGO WHEN THE 5057 03:22:28,160 --> 03:22:30,000 COLLABORATORY WAS JUST 5058 03:22:30,000 --> 03:22:31,240 LAUNCHING, I WOULD SAY THERE WAS 5059 03:22:31,240 --> 03:22:33,320 IN SOME AREAS AN ASSUMPTION 5060 03:22:33,320 --> 03:22:35,320 MAYBE NOT AMONG US BUT AMONG 5061 03:22:35,320 --> 03:22:36,840 OTHERS THAT PRAGMATIC TRIALS 5062 03:22:36,840 --> 03:22:43,080 WERE THE EASY ONES TO DO, THE 5063 03:22:43,080 --> 03:22:44,080 FLEXIBILITY MADE THEM EASIER AND 5064 03:22:44,080 --> 03:22:45,760 WHAT WE HAVE LEARNED AND WHAT WE 5065 03:22:45,760 --> 03:22:47,720 HAVE HEARD REPEATEDLY TODAY IS 5066 03:22:47,720 --> 03:22:53,080 THAT THE FLEXIBILITY BRINGS SUCH 5067 03:22:53,080 --> 03:22:54,240 CHALLENGE AND OPPORTUNITY BUT 5068 03:22:54,240 --> 03:22:55,920 REAL CHALLENGE. 5069 03:22:55,920 --> 03:22:58,560 WITH THAT I WILL HAND IT OFF TO 5070 03:22:58,560 --> 03:23:00,840 YOU FOR ANY FINAL THOUGHTS OR 5071 03:23:00,840 --> 03:23:02,360 REMARKS YOU HAVE. 5072 03:23:02,360 --> 03:23:03,320 >> THANK YOU SO MUCH. 5073 03:23:03,320 --> 03:23:05,760 I JUST WANT TO THANK ALL OF OUR 5074 03:23:05,760 --> 03:23:08,400 SPEAKERS AND OUR MODERATORS AND 5075 03:23:08,400 --> 03:23:11,200 ALL OF OUR PARTNERS ACROSS NIH 5076 03:23:11,200 --> 03:23:13,000 AND ALL THE OTHER ORGANIZATIONS 5077 03:23:13,000 --> 03:23:15,200 THAT WE WORK WITH HERE AS PART 5078 03:23:15,200 --> 03:23:17,040 OF THE PRAGMATIC TRIALS 5079 03:23:17,040 --> 03:23:18,040 COLLABORATORY, IT HAS BEEN AN 5080 03:23:18,040 --> 03:23:20,240 AMAZING TWO DAYS, THANK YOU FOR 5081 03:23:20,240 --> 03:23:22,120 STICKING THROUGH TO THE END, I 5082 03:23:22,120 --> 03:23:24,560 KNOW EVERYONE HAS BUSY SCHEDULES 5083 03:23:24,560 --> 03:23:27,920 AND REALLY APPRECIATE EVERYONE'S 5084 03:23:27,920 --> 03:23:28,440 INPUT, WE HAVE FOB LAWS 5085 03:23:28,440 --> 03:23:29,280 QUESTIONS COME IN FROM THE 5086 03:23:29,280 --> 03:23:30,640 AUDIENCE AND IF WE DIDN'T GET TO 5087 03:23:30,640 --> 03:23:31,920 YOUR QUESTION, WE WILL GET BACK 5088 03:23:31,920 --> 03:23:33,640 TO YOU VIA EMAIL. 5089 03:23:33,640 --> 03:23:37,160 I THINK ONE OF MY BIG TAKE AWAYS 5090 03:23:37,160 --> 03:23:39,080 IS SORT OF REFLECTING BACK TO 5091 03:23:39,080 --> 03:23:43,600 THE OPENING KEYNOTE HONESTLY. 5092 03:23:43,600 --> 03:23:47,360 IN THINKING BACK TEN YEARS AGO 5093 03:23:47,360 --> 03:23:51,560 TAKING THIS ADVENTURE TO DOING 5094 03:23:51,560 --> 03:23:52,440 TRIALS AND HEALTHCARE SYSTEMS 5095 03:23:52,440 --> 03:23:53,880 AND NOT KNOWING HOW MANY 5096 03:23:53,880 --> 03:23:54,600 INSTITUTES AND CENTERS THOUGHT 5097 03:23:54,600 --> 03:23:58,600 WE COULD DO THIS AND CAN YOU DO 5098 03:23:58,600 --> 03:24:00,680 RANDOMIZE STUDIES OR SO MUCH 5099 03:24:00,680 --> 03:24:01,720 EASIER TO DO OBSERVATIONAL WORK 5100 03:24:01,720 --> 03:24:03,680 WITH ELECTRONIC HEALTH RECORDS 5101 03:24:03,680 --> 03:24:06,520 AND PUSHING ALONG AND REALLY 5102 03:24:06,520 --> 03:24:08,080 WANTING TO SEE IF WE -- LET'S DO 5103 03:24:08,080 --> 03:24:10,040 TRIALS. 5104 03:24:10,040 --> 03:24:12,480 SEE IF WE CAN TAKE ADVANTAGE OF 5105 03:24:12,480 --> 03:24:14,800 RANDOMIZATION TO REDUCE BIAS AND 5106 03:24:14,800 --> 03:24:16,000 LOOK AT ALL THESE DIFFERENT 5107 03:24:16,000 --> 03:24:17,880 STUDY DESIGNS AND WE HAVE 5108 03:24:17,880 --> 03:24:20,200 LEARNED SO MUCH OVER THE LAST 5109 03:24:20,200 --> 03:24:20,600 DECADE. 5110 03:24:20,600 --> 03:24:23,240 I THINK THE KEYNOTE FROM DR. 5111 03:24:23,240 --> 03:24:30,560 SHANNON ZENK FROM NINR REALLY 5112 03:24:30,560 --> 03:24:32,600 OPENED YOU GUYS' EYES AND MR. 'S 5113 03:24:32,600 --> 03:24:34,800 PLACES ACROSS THE NIH AS WELL AS 5114 03:24:34,800 --> 03:24:37,480 OUTSIDE THE NIH THAT ARE FUNDING 5115 03:24:37,480 --> 03:24:39,360 THIS KIND OF WORK AND THERE ARE 5116 03:24:39,360 --> 03:24:42,360 OPPORTUNITIES TO DO TRIALS IN 5117 03:24:42,360 --> 03:24:43,120 HEALTHCARE SYSTEM, COMMUNITY 5118 03:24:43,120 --> 03:24:44,680 BASED CLINICS AND OTHER 5119 03:24:44,680 --> 03:24:46,360 FACILITIES AND THINGS LIKE THIS, 5120 03:24:46,360 --> 03:24:48,000 THAT CAN ANSWER QUESTIONS THAT 5121 03:24:48,000 --> 03:24:51,400 WILL REALLY ADDRESS QUESTIONS TO 5122 03:24:51,400 --> 03:24:53,920 HELP IMPROVE CARE FOR PATIENTS. 5123 03:24:53,920 --> 03:24:56,320 THIS IDEA OF ADDRESSING HEALTH 5124 03:24:56,320 --> 03:24:59,640 DISPARITIES AND INEQUITIES IS 5125 03:24:59,640 --> 03:25:00,520 AMAZING OPPORTUNITY AND FINDING 5126 03:25:00,520 --> 03:25:02,160 THE RIGHT PARTNERS TO ANSWER 5127 03:25:02,160 --> 03:25:03,400 QUESTIONSNA WILL HELP THEM 5128 03:25:03,400 --> 03:25:05,760 DELIVER BETTER CARE TO PATIENTS. 5129 03:25:05,760 --> 03:25:07,440 THOSE STUDIES MAY INFORM NOT 5130 03:25:07,440 --> 03:25:09,520 ONLY PATIENTS AND PROVIDERS BUT 5131 03:25:09,520 --> 03:25:13,480 ALSO PAYERS AND ORGANIZATIONS 5132 03:25:13,480 --> 03:25:14,400 THAT DELIVER HEALTHCARE. 5133 03:25:14,400 --> 03:25:15,960 SO WE HAVE AMAZING SETS OF 5134 03:25:15,960 --> 03:25:17,400 PARTNERS THAT WE CAN WORK WITH 5135 03:25:17,400 --> 03:25:19,640 FOR THIS RESEARCH. 5136 03:25:19,640 --> 03:25:21,840 I'M EXCITED I THINK THERE IS A 5137 03:25:21,840 --> 03:25:23,400 BRIGHT FUTURE AND I THINK WE 5138 03:25:23,400 --> 03:25:24,600 HAVE LEARNED A LOT AND SURE 5139 03:25:24,600 --> 03:25:26,840 THERE IS MORE TO LEARN. 5140 03:25:26,840 --> 03:25:29,120 AND CERTAINLY THERE IS KNOW SYBO 5141 03:25:29,120 --> 03:25:31,800 TON WHEN IT COMES TO PRAGMATIC 5142 03:25:31,800 --> 03:25:33,440 TRIALS BUT IT IS A DIFFERENT WAY 5143 03:25:33,440 --> 03:25:36,000 TO ANSWER QUESTIONS ABOUT HOW DO 5144 03:25:36,000 --> 03:25:37,000 THESE INTERVENTIONS WORK ONCE 5145 03:25:37,000 --> 03:25:39,120 YOU PUT INTO THE HEALTHCARE 5146 03:25:39,120 --> 03:25:39,680 SYSTEMS. 5147 03:25:39,680 --> 03:25:41,120 AND IMPORTANTLY CAN WE GET THEM 5148 03:25:41,120 --> 03:25:42,760 INTO HEALTHCARE SYSTEMS AND 5149 03:25:42,760 --> 03:25:43,960 ACTUALLY IMPLEMENT THEM IN A WAY 5150 03:25:43,960 --> 03:25:45,480 THAT IS POTENTIALLY SUSTAINABLE 5151 03:25:45,480 --> 03:25:47,320 IN THE LONG TERM. 5152 03:25:47,320 --> 03:25:50,720 TO INFLUENCE PATIENT CARE. 5153 03:25:50,720 --> 03:25:53,560 I WILL CLOSE THERE AND THANK 5154 03:25:53,560 --> 03:25:55,560 EVERYONE BEHIND THE SCENES 5155 03:25:55,560 --> 03:25:58,400 INCLUDING OUR AMAZING STAFF AT 5156 03:25:58,400 --> 03:26:00,000 NCCIH AND COMMUNICATIONS OFFICE 5157 03:26:00,000 --> 03:26:04,160 AND IT GROUPS AS WELL AS 5158 03:26:04,160 --> 03:26:06,400 FABULOUS TEAM AT THE 5159 03:26:06,400 --> 03:26:10,000 COORDINATING CENTER MARY JH 5160 03:26:10,000 --> 03:26:11,040 TAMMY AND OTHERS THAT HELPED 5161 03:26:11,040 --> 03:26:13,920 MAKE THIS HAPPEN AS WELL AS OUR 5162 03:26:13,920 --> 03:26:15,400 NIH VIDEOCAST COLLEAGUES MAKING 5163 03:26:15,400 --> 03:26:18,440 SURE WE ARE ABLE TO BROADCAST 5164 03:26:18,440 --> 03:26:21,920 LIVE AND ARCHIVE TO MAKE 5165 03:26:21,920 --> 03:26:23,040 AVAILABLE FOR THOSE WATCHING 5166 03:26:23,040 --> 03:26:24,560 AFTER THE FACT IF NOT ABLE TO 5167 03:26:24,560 --> 03:26:25,840 TUNE IN LIVE. 5168 03:26:25,840 --> 03:26:27,440 WITH THAT I WILL CLOSE US FOR 5169 03:26:27,440 --> 03:26:28,880 THE AFTERNOON AND THANK YOU ALL 5170 03:26:28,880 --> 03:26:31,840 AGAIN FOR PARTICIPATING WE LOOK 5171 03:26:31,840 --> 03:26:34,160 FORWARD TO SEEING YOU FOR FUTURE 5172 03:26:34,160 --> 03:26:36,360 WORKSHOPS WE HOLD AND SEE YOU 5173 03:26:36,360 --> 03:26:36,560 THEN. 5174 03:26:36,560 --> 03:26:46,840 THANKS SO MUCH.