1 00:00:05,320 --> 00:00:07,920 >>MY NAME IS 2 00:00:07,920 --> 00:00:10,480 DAVID MURRAY, ASSOCIATE DIRECTOR 3 00:00:10,480 --> 00:00:12,640 FOR PREVENTION AT NIH AND 4 00:00:12,640 --> 00:00:13,440 DIRECTOR OF THE OFFICE OF 5 00:00:13,440 --> 00:00:14,960 DISEASE PREVENTION. PLEASED TO 6 00:00:14,960 --> 00:00:18,400 WELCOME YOU TO THE 2023 ROBERT S 7 00:00:18,400 --> 00:00:20,040 GORDON JR. LECTURE IN 8 00:00:20,040 --> 00:00:21,720 EPIDEMIOLOGY. THE GORDON LECTURE 9 00:00:21,720 --> 00:00:23,840 IS AWARDED EACH YEAR TO A 10 00:00:23,840 --> 00:00:24,960 SCIENTIST WHO MADE MAJOR 11 00:00:24,960 --> 00:00:26,240 CONTRIBUTIONS TO RESEARCHER 12 00:00:26,240 --> 00:00:28,160 TRAINING IN THE FIELD OF 13 00:00:28,160 --> 00:00:29,320 EPIDEMIOLOGY OR IN THE CONDUCT 14 00:00:29,320 --> 00:00:31,760 OF CLINICAL TRIALS. THE SPEAKER 15 00:00:31,760 --> 00:00:33,200 SELECTION IS COORDINATED BY THE 16 00:00:33,200 --> 00:00:34,920 OFFICE OF DISEASE PREVENTION AND 17 00:00:34,920 --> 00:00:37,440 THIS IS THE 28TH YEAR THAT ODP 18 00:00:37,440 --> 00:00:39,680 HAS SPONSORED THE GORDON 19 00:00:39,680 --> 00:00:41,800 LECTURE. THE LECTURE AWARD WAS 20 00:00:41,800 --> 00:00:43,920 ESTABLISHED IN TRIBUTE TO ROBERT 21 00:00:43,920 --> 00:00:46,120 S. GORDON JR. FOR HIS DEDICATION 22 00:00:46,120 --> 00:00:48,360 TO FIELD OF EPIDEMIOLOGY AND 23 00:00:48,360 --> 00:00:50,480 DISTINGUISHED SERVICE TO NIH. 24 00:00:50,480 --> 00:00:52,360 OVER THE COURSE OF 30 YEARS DR. 25 00:00:52,360 --> 00:00:54,880 GORDON SERVED IN NUMEROUS SENIOR 26 00:00:54,880 --> 00:00:56,320 LEADERSHIP POSITIONS INCLUDING 27 00:00:56,320 --> 00:00:57,560 SPECIAL ASSISTANT TO THE 28 00:00:57,560 --> 00:00:59,400 DIRECTOR AND CHIEF ADVISOR FOR 29 00:00:59,400 --> 00:01:01,480 CLINICAL PRACTICE AND RESEARCH. 30 00:01:01,480 --> 00:01:04,560 DR. GORDON WAS EARLY ORGANIZER 31 00:01:04,560 --> 00:01:06,800 OF EFFORTS TO ADDRESS EMERGING 32 00:01:06,800 --> 00:01:08,560 PROBLEM OF HIV AIDS AND BECAME A 33 00:01:08,560 --> 00:01:10,040 KEY COORDINATOR OF AIDS 34 00:01:10,040 --> 00:01:11,760 RESEARCH. 35 00:01:11,760 --> 00:01:14,320 TODAY'S SPEAKER IS DR. LISA 36 00:01:14,320 --> 00:01:17,320 COOPER. DR. COOPER IS THE JAMES 37 00:01:17,320 --> 00:01:19,200 F FRIES PROFESSOR OF MEDICINE 38 00:01:19,200 --> 00:01:20,360 AND BLOOMBERG DISTINGUISHED 39 00:01:20,360 --> 00:01:22,840 PROFESSOR AT JOHNS HOPKINS 40 00:01:22,840 --> 00:01:25,120 UNIVERSITY SCHOOLS OF MEDICINE, 41 00:01:25,120 --> 00:01:26,360 NURSING, AND THE BLOOMBERG 42 00:01:26,360 --> 00:01:28,280 SCHOOL OF PUBLIC HEALTH. SHE IS 43 00:01:28,280 --> 00:01:29,800 ALSO THE FOUNDER AND DIRECTOR OF 44 00:01:29,800 --> 00:01:31,320 THE JOHNS HOPKINS CENTER FOR 45 00:01:31,320 --> 00:01:33,160 HEALTH EQUITY. DR. COOPER 46 00:01:33,160 --> 00:01:34,720 STUDIES HOW RACE AND 47 00:01:34,720 --> 00:01:37,280 SOCIOECONOMIC FACTORS SHAPE 48 00:01:37,280 --> 00:01:39,240 PATIENT CARE, AND HOW HEALTH 49 00:01:39,240 --> 00:01:40,280 SYSTEMS WITH COMMUNITIES CAN 50 00:01:40,280 --> 00:01:42,160 IMPROVE THE HEALTH OF 51 00:01:42,160 --> 00:01:43,160 POPULATIONS THAT EXPERIENCE 52 00:01:43,160 --> 00:01:46,400 HEALTH DISPARITIES. AN INTERNAL 53 00:01:46,400 --> 00:01:48,240 MEDICINE PHYSICIAN 54 00:01:48,240 --> 00:01:49,040 EPIDEMIOLOGIST AND HEALTH 55 00:01:49,040 --> 00:01:51,720 SERVICES RESEARCHER DR. COOP E 56 00:01:51,720 --> 00:01:53,000 AND HER TEAM WORK IN PARTNERSHIP 57 00:01:53,000 --> 00:01:53,840 WITH HEALTH SYSTEMS AND 58 00:01:53,840 --> 00:01:56,120 COMMUNITY BASED ORGANIZATIONS TO 59 00:01:56,120 --> 00:01:57,640 IDENTIFY INTERVENTIONS THAT 60 00:01:57,640 --> 00:01:59,240 ALLEVIATE HEALTH DISPARITIES AND 61 00:01:59,240 --> 00:02:01,640 TRANSLATE THEM INTO PRACTICE AND 62 00:02:01,640 --> 00:02:02,600 POLICY CHANGES THAT IMPROVE 63 00:02:02,600 --> 00:02:05,240 COMMUNITY HEALTH. HER 64 00:02:05,240 --> 00:02:07,120 PRESENTATION TODAY IS TITLED 65 00:02:07,120 --> 00:02:08,800 GETTING TO HEART OF 66 00:02:08,800 --> 00:02:10,080 CARDIOMETABOLIC HEALTH 67 00:02:10,080 --> 00:02:12,200 DISPARITIES. PLEASE JOIN ME 68 00:02:12,200 --> 00:02:14,960 WELCOMING THE 2023 ROBERT S 69 00:02:14,960 --> 00:02:16,960 GORDON JR. LECTURE AWARD 70 00:02:16,960 --> 00:02:17,080 RECIPIENT, DR. LISA ANGELINENE 71 00:02:17,080 --> 00:02:18,680 COOPER. 72 00:02:18,680 --> 00:02:20,640 >>THANK YOU VERY MUCH, DR. 73 00:02:20,640 --> 00:02:22,560 MURRAY. I WOULD LIKE TO THANK 74 00:02:22,560 --> 00:02:24,880 DR. MURRAY AND THE OFFICE OF 75 00:02:24,880 --> 00:02:26,120 DISEASE PREVENTION AS WELL AS 76 00:02:26,120 --> 00:02:28,240 ALL THE ORGANIZERS OF THE 77 00:02:28,240 --> 00:02:29,120 WEDNESDAY AFTERNOON LECTURE 78 00:02:29,120 --> 00:02:32,120 SERIES FOR INVITING ME TO GIVE 79 00:02:32,120 --> 00:02:33,720 THIS 2023 ROBERT S GORDON JR. 80 00:02:33,720 --> 00:02:35,360 LECTURE IN EPIDEMIOLOGY. THE 81 00:02:35,360 --> 00:02:37,360 LAST TIME I SPOKE AT THE 82 00:02:37,360 --> 00:02:39,280 WEDNESDAY AFTERNOON RECKTURE 83 00:02:39,280 --> 00:02:41,840 SERIES IT WAS NOVEMBER 2020, FOR 84 00:02:41,840 --> 00:02:43,320 THE DIRE LECTURE I HOPED TO BE 85 00:02:43,320 --> 00:02:45,280 IN PERSON TODAY BUT ALAS 86 00:02:45,280 --> 00:02:46,480 CIRCUMSTANCES MADE IT DIFFICULT 87 00:02:46,480 --> 00:02:48,840 SO I AM AGAIN JOINING YOU MT. 88 00:02:48,840 --> 00:02:50,520 VIRTUAL SPACE. IT IS AN HONOR 89 00:02:50,520 --> 00:02:51,920 TO SPEAK TO YOU TODAY ABOUT 90 00:02:51,920 --> 00:02:54,040 GETTING TO THE HEART OF 91 00:02:54,040 --> 00:02:54,680 CARDIOMETABOLIC HEALTH 92 00:02:54,680 --> 00:02:58,720 DISPARITIES. YOU HAVE SEEN MY 93 00:02:58,720 --> 00:03:03,600 DISCLOSURES ON PREVIOUS SLIDES. 94 00:03:03,600 --> 00:03:05,000 THE LEARNING OBJECTIVES AS WELL 95 00:03:05,000 --> 00:03:06,920 WHICH WILL FOCUS ON LISTING 96 00:03:06,920 --> 00:03:09,360 CONTRIBUTORS TO RACIAL AND 97 00:03:09,360 --> 00:03:11,360 SOCIOECONOMIC DISPARITIES AND 98 00:03:11,360 --> 00:03:12,400 CARDIOMETABOLIC HEALTH, 99 00:03:12,400 --> 00:03:13,320 DESCRIBING EFFECTIVE 100 00:03:13,320 --> 00:03:15,840 INTERVENTION APPROACH, AND 101 00:03:15,840 --> 00:03:17,320 DISCUSSING KEY CHALLENGES AND 102 00:03:17,320 --> 00:03:18,160 OPPORTUNITIES AND TRANSLATING 103 00:03:18,160 --> 00:03:19,320 EVIDENCE INTO PRACTICE AND 104 00:03:19,320 --> 00:03:24,440 POLICY. LET'S START WITH 105 00:03:24,440 --> 00:03:25,760 UNDERSTANDING THE ORIGINS AND 106 00:03:25,760 --> 00:03:28,200 CONTRIBUTORS TO HEALTH 107 00:03:28,200 --> 00:03:29,600 DISPARITIES. WE HAVE HEARD A LOT 108 00:03:29,600 --> 00:03:32,800 ABOUT HEALTH DISPARITIES IN 109 00:03:32,800 --> 00:03:37,000 RECENT YEARS BECAUSE OF THE HUGE 110 00:03:37,000 --> 00:03:39,400 DISPARITIES THAT WERE OBSERVED 111 00:03:39,400 --> 00:03:40,400 DURING THE COVID-19 PANDEMIC BUT 112 00:03:40,400 --> 00:03:41,800 HAVE EXISTED FOR QUITE A LONG 113 00:03:41,800 --> 00:03:46,080 TIME. SO WHAT ARE HEALTH 114 00:03:46,080 --> 00:03:47,720 DISPARITIES? THEY ARE 115 00:03:47,720 --> 00:03:49,400 PREVENTABLE DIFFERENCES IN 116 00:03:49,400 --> 00:03:50,760 BURDEN OF DISEASE, INJURY 117 00:03:50,760 --> 00:03:52,200 VIOLENCE OR OPPORTUNITIES TO 118 00:03:52,200 --> 00:03:54,480 ACHIEVE OPTIMAL HEALTH 119 00:03:54,480 --> 00:03:55,480 EXPERIENCED BY SOCIALLY 120 00:03:55,480 --> 00:03:56,600 DISADVANTAGED POPULATIONS AND 121 00:03:56,600 --> 00:04:00,840 THAT IS ONE OF MANY DEFINITIONS 122 00:04:00,840 --> 00:04:01,960 IN THE UNITED STATES THERE ARE 123 00:04:01,960 --> 00:04:04,320 NUMEROUS POPULATIONS AND GROUPS 124 00:04:04,320 --> 00:04:06,080 THAT EXPERIENCE HEALTH 125 00:04:06,080 --> 00:04:07,240 DISPARITIES, THESE ARE THE ONES 126 00:04:07,240 --> 00:04:08,560 LIVED ON THIS SLIDE HAVE BEEN 127 00:04:08,560 --> 00:04:10,080 DESCRIBED IN THE NATIONAL 128 00:04:10,080 --> 00:04:12,160 HEALTHCARE QUALITY AND 129 00:04:12,160 --> 00:04:13,600 DISPARITIES REPORT AS WELL AS 130 00:04:13,600 --> 00:04:16,720 DOCUMENTED IN NUMEROUS NATIONAL 131 00:04:16,720 --> 00:04:18,960 SURVEYS AND COLLECTIONS OF DATA 132 00:04:18,960 --> 00:04:21,600 AND EXTENTSIVE RESEARCH. SO WE 133 00:04:21,600 --> 00:04:23,080 HAVE NUMEROUS POPULATIONS THAT 134 00:04:23,080 --> 00:04:27,000 ARE AFFECTED BY DISPARITIES. WE 135 00:04:27,000 --> 00:04:31,160 KNOW DISPARITIES ARE PERVASIVE 136 00:04:31,160 --> 00:04:32,560 ACROSS CONDITIONS NUMEROUS 137 00:04:32,560 --> 00:04:36,400 CONDITIONS AND POPULATIONS. THEY 138 00:04:36,400 --> 00:04:38,680 COST OUR ENTIRE SOCIETY 139 00:04:38,680 --> 00:04:40,080 SUBSTANTIAL AMOUNT IN DIRECT 140 00:04:40,080 --> 00:04:42,720 MEDICAL COSTS BUT INDIRECT COSTS 141 00:04:42,720 --> 00:04:44,360 IN TERMS OF LOSSES OF 142 00:04:44,360 --> 00:04:48,160 PRODUCTIVITY DUE TO PREMATURE 143 00:04:48,160 --> 00:04:51,640 DEATHS. THEY HAVE EXISTED FOR A 144 00:04:51,640 --> 00:04:53,120 LONG TIME ONE OF THE THINGS WE 145 00:04:53,120 --> 00:04:55,520 HAVE KNOWN IS THESE DISPARITIES 146 00:04:55,520 --> 00:04:59,600 HAVE ACTUALLY PERSISTED THOUGH 147 00:04:59,600 --> 00:05:00,960 WE MADE SOME PROGRESS IN SOME 148 00:05:00,960 --> 00:05:03,880 AREAS THE PROGRESS HAS NOT BEEN 149 00:05:03,880 --> 00:05:07,040 DRAMATIC. THEN WE HAD THE 150 00:05:07,040 --> 00:05:11,080 COVID-19 PANDEMIC THAT BEGAN IN 151 00:05:11,080 --> 00:05:12,760 2019, 2020, AND THAT HAS SHOWN A 152 00:05:12,760 --> 00:05:16,040 BRIGHT SPOTLIGHT ON THESE 153 00:05:16,040 --> 00:05:18,120 DISPARITIES AND MAGNIFIED THEM. 154 00:05:18,120 --> 00:05:21,040 TODAY WE ARE GOING TO TALK ABOUT 155 00:05:21,040 --> 00:05:22,760 CARDIOMETABOLIC HEALTH 156 00:05:22,760 --> 00:05:25,680 DISPARITIES IN PARTICULAR. WHY 157 00:05:25,680 --> 00:05:26,640 TALK ABOUT CARDIOVASCULAR AND 158 00:05:26,640 --> 00:05:29,720 CARDIOMETABOLIC DISEASES? 159 00:05:29,720 --> 00:05:31,840 BECAUSE THESE ARE EXTREMELY 160 00:05:31,840 --> 00:05:35,400 COMMON CONDITIONS, THEY INCLUDE 161 00:05:35,400 --> 00:05:36,440 CARDIOVASCULAR DISEASE, DIABETES 162 00:05:36,440 --> 00:05:39,840 AND CHRONIC KIDNEY DISEASE AND 163 00:05:39,840 --> 00:05:40,920 CARDIOVASCULAR DISEASE AS YOU 164 00:05:40,920 --> 00:05:43,120 KNOW INCLUDES CORONARY HEART 165 00:05:43,120 --> 00:05:45,560 DISEASE, STROKE, HYPERTENSION 166 00:05:45,560 --> 00:05:47,920 CONGESTIVE HEART FAILURE AS WELL 167 00:05:47,920 --> 00:05:49,400 AS MANY OTHER CARDIAC AND 168 00:05:49,400 --> 00:05:51,280 VASCULAR CONDITIONS. THESE 169 00:05:51,280 --> 00:05:52,760 COMBINED SHARE MULTIPLE COMMON 170 00:05:52,760 --> 00:05:55,240 RISK FACTORS. INCLUDING 171 00:05:55,240 --> 00:05:58,640 HYPERTENSION, OBESITY, HIGH 172 00:05:58,640 --> 00:06:00,880 CHOLESTEROL AND DISLIPIDEMIA OR 173 00:06:00,880 --> 00:06:02,160 ABNORMAL CHOLESTEROL LEVELS. 174 00:06:02,160 --> 00:06:05,080 THEY ARE EXCEEDINGLY COMMON AND 175 00:06:05,080 --> 00:06:06,400 WIDELY CONSIDERED TO BE THE 176 00:06:06,400 --> 00:06:07,480 LEADING CAUSES OF DEATH 177 00:06:07,480 --> 00:06:12,440 WORLDWIDE. FOR EXAMPLE JUST IN 178 00:06:12,440 --> 00:06:14,440 THE UNITED STATES, WE HAVE 179 00:06:14,440 --> 00:06:16,480 CARDIOVASCULAR DISEASE THAT 180 00:06:16,480 --> 00:06:18,520 AFFECTS ABOUT 40% OF OUR ADULT 181 00:06:18,520 --> 00:06:21,320 POPULATION OVER THE AGE OF 40. 182 00:06:21,320 --> 00:06:23,880 CORONARY HEART DISEASE AFFECTING 183 00:06:23,880 --> 00:06:26,920 20 MILLION INDIVIDUALS, 184 00:06:26,920 --> 00:06:29,200 HYPERTENSION 116 MILLION PEOPLE, 185 00:06:29,200 --> 00:06:30,760 STROKE CLOSE TO 800,000 186 00:06:30,760 --> 00:06:37,000 INDIVIDUALS. DIABETES WE ARE 187 00:06:37,000 --> 00:06:39,640 TALKING 8.7% OF THE ADULT 188 00:06:39,640 --> 00:06:42,400 POPULATION OR 28.7 MILLION 189 00:06:42,400 --> 00:06:45,040 PEOPLE IN CHRONIC KIDNEY DISEASE 190 00:06:45,040 --> 00:06:46,600 ABOUT 37 MILLION PEOPLE. SO JUST 191 00:06:46,600 --> 00:06:48,440 IN THE UNITED STATES ALONE, 192 00:06:48,440 --> 00:06:51,160 THESE ARE DISEASES THAT INFLICT 193 00:06:51,160 --> 00:06:54,400 A LARGE BURDEN OF ILLNESS AND 194 00:06:54,400 --> 00:06:55,280 PREMATURE DEATH IN OUR 195 00:06:55,280 --> 00:06:57,520 POPULATION. THEY ALSO AFFECT 196 00:06:57,520 --> 00:06:59,880 SEVERAL GENERATIONS WITHIN 197 00:06:59,880 --> 00:07:01,160 FAMILY, THEY CAN DEVELOP AND BE 198 00:07:01,160 --> 00:07:03,640 MADE WORSE AT DIFFERENT POINTS 199 00:07:03,640 --> 00:07:04,800 TOWARDS -- DURING A PERSON'S 200 00:07:04,800 --> 00:07:07,480 LIFE SPAN. AND THEY ARE ALSO THE 201 00:07:07,480 --> 00:07:10,200 LEADING CONTRIBUTORS TO RACIAL 202 00:07:10,200 --> 00:07:13,960 AND INCOME DISPARITIES IN 203 00:07:13,960 --> 00:07:16,760 MORBIDITY AND MORTALITY. IF WE 204 00:07:16,760 --> 00:07:19,440 LOOK AT JUST THE CURRENT STATE 205 00:07:19,440 --> 00:07:20,480 OF CARDIOVASCULAR HEALTH 206 00:07:20,480 --> 00:07:21,840 DISPARITIES JUST OVER THE PAST 207 00:07:21,840 --> 00:07:25,880 FEW YEARS, WHAT WE CAN SEE FROM 208 00:07:25,880 --> 00:07:27,920 THIS STATEMENT PUBLISHED BY THE 209 00:07:27,920 --> 00:07:30,800 AMERICAN HEART ASSOCIATION IS 210 00:07:30,800 --> 00:07:33,160 THAT THE DEATH RATES FROM 211 00:07:33,160 --> 00:07:35,280 CARDIOVASCULAR DISEASE HAVE 212 00:07:35,280 --> 00:07:37,880 DECLINED OVER THE LAST DECADE OR 213 00:07:37,880 --> 00:07:39,560 SO. THEY HAVE BEEN DECREASING 214 00:07:39,560 --> 00:07:42,200 FOR ALL RACIAL GROUPS. HOWEVER 215 00:07:42,200 --> 00:07:44,600 THE RATE OF DECREASE HAS SLOWED 216 00:07:44,600 --> 00:07:46,400 AND IT IS NOT BEEN THE SAME 217 00:07:46,400 --> 00:07:48,640 ACROSS RACIAL AND ETHNIC GROUPS. 218 00:07:48,640 --> 00:07:51,200 IN PARTICULAR YOU CAN SEE THAT 219 00:07:51,200 --> 00:07:52,360 BLACK AMERICANS CONTINUE TO HAVE 220 00:07:52,360 --> 00:07:55,600 THE HIGHEST RATES OF AGE 221 00:07:55,600 --> 00:07:57,080 ADJUSTED DEATH RATES FROM 222 00:07:57,080 --> 00:08:00,000 CARDIOVASCULAR DISEASE. WHEN WE 223 00:08:00,000 --> 00:08:01,760 LOOK AT WHAT THE RISK FACTORS 224 00:08:01,760 --> 00:08:03,560 ARE THAT CONTRIBUTE TO 225 00:08:03,560 --> 00:08:06,720 CARDIOVASCULAR DISEASE AS WELL 226 00:08:06,720 --> 00:08:08,000 AS SOME OF THE OTHER 227 00:08:08,000 --> 00:08:08,960 CARDIOMETABOLIC CONDITIONS YOU 228 00:08:08,960 --> 00:08:11,440 CAN SEE THEY ARE HYPERTENSION 229 00:08:11,440 --> 00:08:12,200 OBESITY, DIABETES AND TOTAL 230 00:08:12,200 --> 00:08:15,680 CHOLESTEROL. SO THIS SNAP SHOT 231 00:08:15,680 --> 00:08:17,200 FROM 2015 THROUGH 2016 USING 232 00:08:17,200 --> 00:08:18,400 DATA FROM THE NATIONAL HEALTH 233 00:08:18,400 --> 00:08:20,640 AND NUTRITION EXAMINATION SURVEY 234 00:08:20,640 --> 00:08:24,440 OR N HAYNES REALLY SHOWED THAT 235 00:08:24,440 --> 00:08:26,200 FOR HYPERTENSION NON-HISPANIC 236 00:08:26,200 --> 00:08:27,880 BLACKS WERE MOST LIKELY ALL 237 00:08:27,880 --> 00:08:32,320 OTHER ETHNIC GROUPS TO HAVE 238 00:08:32,320 --> 00:08:33,480 HYPERTENSION. FOR OBESITY THAT 239 00:08:33,480 --> 00:08:36,520 WAS THE CASE FOR HISPANIC AND 240 00:08:36,520 --> 00:08:37,160 NON-HISPANIC BLACK INDIVIDUALS 241 00:08:37,160 --> 00:08:41,120 MORE LIKELY TO HAVE OBESITY. 242 00:08:41,120 --> 00:08:43,880 SAME FOR DIABETES. THOSE TWO 243 00:08:43,880 --> 00:08:46,640 ETHNIC GROUPS HISPANICS AN 244 00:08:46,640 --> 00:08:49,080 NON-HISPANIC BLACKS AND FOR HIGH 245 00:08:49,080 --> 00:08:50,400 TOTAL CHOLESTEROL THE ETHNIC 246 00:08:50,400 --> 00:08:52,720 GROUPS WERE EQUALLY LIKELY TO 247 00:08:52,720 --> 00:08:58,480 HAVE HIGH CHOLESTEROL. THIS 248 00:08:58,480 --> 00:09:01,080 ANALYSIS WAS DONE BASICALLY TO 249 00:09:01,080 --> 00:09:04,120 LOOK AT TRENDS AND DISPARITIES 250 00:09:04,120 --> 00:09:05,000 IN CARDIOMETABOLIC HEALTH SO 251 00:09:05,000 --> 00:09:06,040 INSTEAD OF LOOKING AT DISEASE WE 252 00:09:06,040 --> 00:09:07,480 ARE LOOKING AT WHAT IS THE STATE 253 00:09:07,480 --> 00:09:09,720 OF HEALTH WITH REGARD TO 254 00:09:09,720 --> 00:09:13,000 CARDIOMETABOLIC RISK FACTORS 255 00:09:13,000 --> 00:09:15,800 OVER THE PAST 20 YEARS OR SO. SO 256 00:09:15,800 --> 00:09:19,000 WHAT WE SEE IS THAT 257 00:09:19,000 --> 00:09:20,440 CARDIOMETABOLIC HEALTH IF YOU 258 00:09:20,440 --> 00:09:23,320 LOOK AT THESE LINES ON THE 259 00:09:23,320 --> 00:09:26,520 SCREEN YOU CAN SEE THAT IT HAS 260 00:09:26,520 --> 00:09:29,320 BEEN POOR. IF YOU LOOK AT PEOPLE 261 00:09:29,320 --> 00:09:30,200 WITH OPTIMAL CARDIOVASCULAR 262 00:09:30,200 --> 00:09:32,240 HEALTH YOU CAN SEE ALL OF THESE 263 00:09:32,240 --> 00:09:35,440 GRAPHS START AT LIKE 20% OR 15% 264 00:09:35,440 --> 00:09:37,120 SO VERY LOW PERCENTAGES OF THE 265 00:09:37,120 --> 00:09:40,240 OVERALL POPULATION HAVE OPTIMAL 266 00:09:40,240 --> 00:09:42,520 CARDIOMETABOLIC HEALTH. THIS IS 267 00:09:42,520 --> 00:09:44,840 WORSENING AND IN 2017 TO 2018 268 00:09:44,840 --> 00:09:47,200 THE MOST RECENT PERIOD ONLY 269 00:09:47,200 --> 00:09:50,720 ABOUT 6% OF U.S. ADULTS HAD 270 00:09:50,720 --> 00:09:52,960 OPTIMAL CARDIOMETABOLIC HEALTH. 271 00:09:52,960 --> 00:09:55,600 THEY ARE ALSO DISPARITIES IF YOU 272 00:09:55,600 --> 00:09:58,200 LOOK, THESE GRAPHSES ARE SHOWING 273 00:09:58,200 --> 00:10:01,000 DISPARITIES BY AGE ON THE FAR 274 00:10:01,000 --> 00:10:03,240 LEFT. THEN BY RACE AN ETHNICITY 275 00:10:03,240 --> 00:10:04,680 AND THEN BY EDUCATION AND 276 00:10:04,680 --> 00:10:06,440 INCOME. THE WAY THE AUTHORS 277 00:10:06,440 --> 00:10:10,080 ACTUALLY MEASURED THIS WAS THAT 278 00:10:10,080 --> 00:10:13,280 THEY USED THE AMERICAN HEART 279 00:10:13,280 --> 00:10:14,240 ASSOCIATION HEALTH SCORE AND 280 00:10:14,240 --> 00:10:15,840 THEY INCLUDED UPDATES TO THAT. 281 00:10:15,840 --> 00:10:18,400 SO THAT INCLUDES THINGS LIKE 282 00:10:18,400 --> 00:10:20,880 MEASURE OF BODY MASS INDEX, 283 00:10:20,880 --> 00:10:23,520 BLOOD PRESSURE CONTROL H BLOOD 284 00:10:23,520 --> 00:10:26,600 LIPIDS AND THE ABSENCE OF 285 00:10:26,600 --> 00:10:27,760 PREVIOUS CARDIOVASCULAR DISEASE 286 00:10:27,760 --> 00:10:30,560 EVENTS. SO WHAT YOU CAN SEE HERE 287 00:10:30,560 --> 00:10:33,000 IS THAT THERE ARE DISPARITIES BY 288 00:10:33,000 --> 00:10:36,240 AGE, BY RACE ETHNICITY, BY 289 00:10:36,240 --> 00:10:37,640 EDUCATION LEVEL AS WELL AS BY 290 00:10:37,640 --> 00:10:39,920 INCOME LEVEL. THAT WE ARE NOT 291 00:10:39,920 --> 00:10:42,440 REALLY SEEING MUCH IN THE WAY OF 292 00:10:42,440 --> 00:10:45,120 CLOSING OF THOSE GAPS. IN FACT 293 00:10:45,120 --> 00:10:46,480 IN SOME CASES THEY ACTUALLY 294 00:10:46,480 --> 00:10:51,640 WORSENED. SO WHY DO WE HAVE 295 00:10:51,640 --> 00:10:53,200 HEALTH DISPARITIES? IF BEREALLY 296 00:10:53,200 --> 00:10:56,320 WANT TO ADDRESS -- IF WE WANT TO 297 00:10:56,320 --> 00:10:57,480 ADDRESS THEM WE WANT TO 298 00:10:57,480 --> 00:11:00,480 UNDERSTAND THE CAUSAL CHAIN, 299 00:11:00,480 --> 00:11:02,000 SOMETIMESES IT'S WHAT HAPPENS ON 300 00:11:02,000 --> 00:11:03,400 THE INDIVIDUAL LEVEL BUT THIS 301 00:11:03,400 --> 00:11:04,960 SCHEMATIC IS HERE TO REMIND US 302 00:11:04,960 --> 00:11:09,240 THAT THERE IS A CAUSAL CHANGE 303 00:11:09,240 --> 00:11:10,440 THAT BEGINS WITH SYSTEMS OF 304 00:11:10,440 --> 00:11:11,840 POWER. WHEN YOU THINK ABOUT 305 00:11:11,840 --> 00:11:14,440 FACTORS THAT ACTUALLY INFLUENCE 306 00:11:14,440 --> 00:11:16,240 OUR LIVES AND OUR HEALTH THEY 307 00:11:16,240 --> 00:11:18,760 ACTUALLY BEGIN AT A VERY LARGE 308 00:11:18,760 --> 00:11:21,320 LEVEL, IT HAS TO DO WITH OUR 309 00:11:21,320 --> 00:11:22,840 SOCIAL NORMS AND BELIEFS AND 310 00:11:22,840 --> 00:11:24,920 VALUES AND WHERE WE INVEST OUR 311 00:11:24,920 --> 00:11:28,320 RESOURCES. SO THINGS LIKE 312 00:11:28,320 --> 00:11:31,840 RACISM AND SEXISM CLASSISM 313 00:11:31,840 --> 00:11:33,600 ABLEISM AND HOMOPHOBIA, THESE 314 00:11:33,600 --> 00:11:37,000 SORT OF GENERAL BELIEFS AND 315 00:11:37,000 --> 00:11:40,720 VALUES AROUND WHO IN OUR SOCIETY 316 00:11:40,720 --> 00:11:43,880 OUGHT TO HAVE CERTAIN 317 00:11:43,880 --> 00:11:47,680 OPPORTUNITIES AND RESOURCES, 318 00:11:47,680 --> 00:11:50,880 THEY SHAPE BASICALLY WHO GETS TO 319 00:11:50,880 --> 00:11:53,360 BE INVOLVED AND THEY PROVIDE 320 00:11:53,360 --> 00:11:55,120 HIERARCHIES OF POWER WITHIN OUR 321 00:11:55,120 --> 00:11:57,240 INSTITUTIONS SO WE CALL THOSE 322 00:11:57,240 --> 00:11:59,200 STRUCTURAL DRIVERS SO THESE 323 00:11:59,200 --> 00:12:00,520 NORMS AND BELIEFS DETERMINE WHO 324 00:12:00,520 --> 00:12:02,640 IS AT THE TOP OF THE HIERARCHY 325 00:12:02,640 --> 00:12:04,720 OF OUR INSTITUTIONS AND AS Y'ALL 326 00:12:04,720 --> 00:12:05,640 KNOW OUR INSTITUTIONS DETERMINE 327 00:12:05,640 --> 00:12:07,240 HOW WE ARE GOVERNED, WHAT 328 00:12:07,240 --> 00:12:09,640 PRACTICES AND POLICIES WE 329 00:12:09,640 --> 00:12:11,680 SUPPORT, AND WHAT OUR 330 00:12:11,680 --> 00:12:14,840 REGULATIONS AN LAWS ARE. SO 331 00:12:14,840 --> 00:12:16,760 THOSE ARE THE FACTORS. THESE 332 00:12:16,760 --> 00:12:17,640 STRUCTURAL DRIVERS ARE THE 333 00:12:17,640 --> 00:12:19,560 FACTORS THAT DETERMINE WHAT OUR 334 00:12:19,560 --> 00:12:21,320 LIVING CONDITIONS ARE. SO OUR 335 00:12:21,320 --> 00:12:22,360 LIVING CONDITIONS ARE THINGS 336 00:12:22,360 --> 00:12:24,520 LIKE THE PHYSICAL AND SOCIAL 337 00:12:24,520 --> 00:12:26,600 ENVIRONMENT, THE ECONOMIC 338 00:12:26,600 --> 00:12:28,320 ENVIRONMENT, AND THIS SERVICE 339 00:12:28,320 --> 00:12:28,920 ENVIRONMENT WHETHER WE HAVE 340 00:12:28,920 --> 00:12:30,680 ACCESS TO RESOURCES LIKE 341 00:12:30,680 --> 00:12:31,840 HEALTHCARE OR SOCIAL SERVICES 342 00:12:31,840 --> 00:12:37,080 FOR EXAMPLE WHETHER WE HAVE 343 00:12:37,080 --> 00:12:39,760 OPPORTUNITIES TO WORK, WHETHER 344 00:12:39,760 --> 00:12:40,800 THERE ARE GOOD RELATIONSHIPS 345 00:12:40,800 --> 00:12:42,800 AMONG GROUPS OF PEOPLE IN 346 00:12:42,800 --> 00:12:44,400 SOCIETY, WHETHER OR NOT WE WERE 347 00:12:44,400 --> 00:12:46,400 EXPOSED TO DIFFERENT TOXINS. WE 348 00:12:46,400 --> 00:12:47,600 CALL THESE SOCIAL DETERMINANTS 349 00:12:47,600 --> 00:12:49,640 BUT THEY ARE REALLY SHAPED BY 350 00:12:49,640 --> 00:12:51,840 THE STRUCTURAL AND SYSTEMS OF 351 00:12:51,840 --> 00:12:54,400 POWER. AND THAT IS WHAT 352 00:12:54,400 --> 00:12:55,800 DETERMINES WHAT BEHAVIORS WE ARE 353 00:12:55,800 --> 00:12:56,720 ABLE TO ENGAGE IN AS 354 00:12:56,720 --> 00:12:59,080 INDIVIDUALS. WHAT OPPORTUNITIES 355 00:12:59,080 --> 00:13:02,400 DO WE HAVE TO MAKE DECISIONS 356 00:13:02,400 --> 00:13:03,880 REGARDING WHETHER WE ARE GOING 357 00:13:03,880 --> 00:13:07,360 TO CHOOSE TO SMOKE OR ENGAGE IN 358 00:13:07,360 --> 00:13:09,800 HEALTHY EATING BEHAVIORS, 359 00:13:09,800 --> 00:13:11,480 PHYSICAL ACTIVITY WHETHER WE ARE 360 00:13:11,480 --> 00:13:13,680 GOING TO USE ALCOHOL OR DRUGS AT 361 00:13:13,680 --> 00:13:15,360 UNHEALTHY LEVELS. THOSE 362 00:13:15,360 --> 00:13:16,440 INDIVIDUAL ACTIONS ARE NOT 363 00:13:16,440 --> 00:13:18,680 THINGS THAT OCCUR IN THE VACUUM, 364 00:13:18,680 --> 00:13:20,280 THEY OCCUR AS A RESULT OF WHAT 365 00:13:20,280 --> 00:13:21,760 OPPORTUNITIES WE HAVE BASED ON 366 00:13:21,760 --> 00:13:23,520 WHERE WE LIVE AND THE OTHER 367 00:13:23,520 --> 00:13:25,040 SORTS OF RESOURCES WE HAVE IN 368 00:13:25,040 --> 00:13:26,440 OUR LIVES. IT IS THOSE 369 00:13:26,440 --> 00:13:28,120 INDIVIDUAL ACTIONS THAT 370 00:13:28,120 --> 00:13:30,320 ULTIMATELY DETERMINE WHETHER OR 371 00:13:30,320 --> 00:13:34,360 NOT WE BECOME ILL. THAT TERMS 372 00:13:34,360 --> 00:13:38,120 OUR EXPOSURES, THAT IMPACT OUR 373 00:13:38,120 --> 00:13:40,880 PSYCHOLOGICAL AND BIOLOGICAL 374 00:13:40,880 --> 00:13:42,720 RESPONSES. AND SHAPE HOW WELL WE 375 00:13:42,720 --> 00:13:44,400 ARE, WHETHER WE DEVELOP 376 00:13:44,400 --> 00:13:46,360 DISEASES, WHETHER WE ARE INJURED 377 00:13:46,360 --> 00:13:48,600 AND WHETHER WE DIE SOONER THAN 378 00:13:48,600 --> 00:13:53,280 WE WOULD IF WE HAD OPTIMAL 379 00:13:53,280 --> 00:13:55,400 EXPOSURES SO IS H IS THE FULL 380 00:13:55,400 --> 00:13:56,520 CAUSAL CHAIN AND UNTIL WE 381 00:13:56,520 --> 00:13:57,200 UNDERSTAND THIS AND UNDERSTAND 382 00:13:57,200 --> 00:13:59,440 WE NEED TO INTERVENE AT EACH OF 383 00:13:59,440 --> 00:14:01,720 THESE POINTS, WE ARE NEVER GOING 384 00:14:01,720 --> 00:14:04,880 TO SOLVE DISPARITIES PROBLEM. 385 00:14:04,880 --> 00:14:06,360 KEEP THIS IN MIND AS WE MOVE 386 00:14:06,360 --> 00:14:08,680 FORWARD AND TALKING ABOUT THE 387 00:14:08,680 --> 00:14:10,320 FIELD OF HEALTH DISPARITIES 388 00:14:10,320 --> 00:14:12,760 RESEARCH. BECAUSE IT REALLY HAS 389 00:14:12,760 --> 00:14:14,960 EVOLVED. EARLY ON IN DISPARITIES 390 00:14:14,960 --> 00:14:17,160 RESEARCH THERE WAS A LOT OF 391 00:14:17,160 --> 00:14:18,760 RESEARCH THAT BASICALLY 392 00:14:18,760 --> 00:14:22,000 DESCRIBED THE PROBLEM. COLLECTED 393 00:14:22,000 --> 00:14:23,560 DATA FROM PEOPLE OF DIFFERENT 394 00:14:23,560 --> 00:14:25,200 RACIAL ETHNIC GROUPS. FOR A LONG 395 00:14:25,200 --> 00:14:26,960 TIME WE DIDN'T HAVE DATA ON 396 00:14:26,960 --> 00:14:28,240 CERTAIN GROUPS SO WE COULDN'T 397 00:14:28,240 --> 00:14:29,680 DESCRIBE WHAT WAS GOING ON BUT 398 00:14:29,680 --> 00:14:32,040 FOR A LONG TIME RESEARCH WE DID 399 00:14:32,040 --> 00:14:33,480 HAVE WAS VERY DESCRIPTIVE. THEN 400 00:14:33,480 --> 00:14:35,680 WE MOVED TO MECHANISTIC WORK 401 00:14:35,680 --> 00:14:37,720 WHERE WE ARE LOOKING AT THE 402 00:14:37,720 --> 00:14:39,680 DIFFERENT DISTRIBUTORS AND -- 403 00:14:39,680 --> 00:14:40,880 CONTRIBUTORS AND WHAT PART THEY 404 00:14:40,880 --> 00:14:45,320 PLAYED. THE FIELD HAS NOW MOVED 405 00:14:45,320 --> 00:14:46,400 TO THE DIRECTION OF 406 00:14:46,400 --> 00:14:47,360 INTERVENTIONS BECAUSE THERE IS 407 00:14:47,360 --> 00:14:48,960 URGENCY FOR US TO INTERVENE. 408 00:14:48,960 --> 00:14:50,240 THESE PROBLEMS HAVE BEEN GOING 409 00:14:50,240 --> 00:14:53,360 ON FOR DECADES AND EVEN MORE 410 00:14:53,360 --> 00:14:57,600 THAN A CENTURY FOR MANY OF THESE 411 00:14:57,600 --> 00:14:59,600 CONDITIONS MORE THAN SEVERAL 412 00:14:59,600 --> 00:15:01,800 CENTURIES. SO IT IS TIME FOR US 413 00:15:01,800 --> 00:15:04,160 TO INTERVENE ESPECIALLY AS OUR 414 00:15:04,160 --> 00:15:06,680 COUNTRY BECOMES MORE AND MORE 415 00:15:06,680 --> 00:15:09,360 DIVERSE AND OUR INEQUITIES BY 416 00:15:09,360 --> 00:15:10,600 THESE SOCIAL CONDITIONS HAVE 417 00:15:10,600 --> 00:15:15,080 GROWN. SO ONE THING, THIS IS A 418 00:15:15,080 --> 00:15:17,520 SLIDE I SHARED BEFORE AT THIS 419 00:15:17,520 --> 00:15:20,120 LECTURE BUT JUST I THINK IT IS A 420 00:15:20,120 --> 00:15:21,960 GOOD REMINDER FOR US THAT WE 421 00:15:21,960 --> 00:15:23,520 NEED A LOT OF KNOWLEDGE IN ORDER 422 00:15:23,520 --> 00:15:25,760 TO SOLVE THESE REALLY COMPLEX 423 00:15:25,760 --> 00:15:29,520 PROBLEMS AND THAT IS WHY WE ARE 424 00:15:29,520 --> 00:15:32,720 FORTUNATE TO HAVE INSTITUTES 425 00:15:32,720 --> 00:15:34,320 LIKE THE NIH AND OTHER FUNDERS 426 00:15:34,320 --> 00:15:35,400 THAT SUPPORT RESEARCH ON 427 00:15:35,400 --> 00:15:37,280 CLINICAL EFFICACY AND 428 00:15:37,280 --> 00:15:38,840 EFFECTIVENESS ON BASIC 429 00:15:38,840 --> 00:15:41,200 BIOMEDICAL AND BEHAVIORAL 430 00:15:41,200 --> 00:15:43,680 SCIENCE DISCOVERIES AND ON 431 00:15:43,680 --> 00:15:45,000 EPIDEMIOLOGY. THIS SLIDE IS 432 00:15:45,000 --> 00:15:47,920 SHOWING WE HAVE DEVELOPED A 433 00:15:47,920 --> 00:15:48,920 SUBSTANTIVE KNOWLEDGE BASE 434 00:15:48,920 --> 00:15:50,320 RELATED TO HEALTH DISPARITIES 435 00:15:50,320 --> 00:15:52,360 BUT WE HAVE A GAP BETWEEN WHAT 436 00:15:52,360 --> 00:15:54,240 WE KNOW AND WHAT WE DO TO 437 00:15:54,240 --> 00:15:56,920 ACHIEVE EQUITY. SO THAT GAP IS 438 00:15:56,920 --> 00:16:00,840 REALLY IN THE AREA OF -- THAT WE 439 00:16:00,840 --> 00:16:02,400 NEED MORE TRANSDISCIPLINARY 440 00:16:02,400 --> 00:16:04,080 RESEARCH. AS I MENTIONED TO YOU, 441 00:16:04,080 --> 00:16:05,920 BECAUSE THE PROBLEM IS SO 442 00:16:05,920 --> 00:16:09,400 COMPLEX, AFFECTS SO MANY 443 00:16:09,400 --> 00:16:11,040 DIFFERENT SYSTEMS AND ASPECTS OF 444 00:16:11,040 --> 00:16:13,040 OUR SOCIETY, THAT IT IS GOING TO 445 00:16:13,040 --> 00:16:15,080 TAKE SCIENTISTS FROM A VARIETY 446 00:16:15,080 --> 00:16:17,000 OF DIFFERENT DISCIPLINESS. IT IS 447 00:16:17,000 --> 00:16:19,080 ALSO GOING TO TAKE EFFORTS TO 448 00:16:19,080 --> 00:16:20,480 REALLY DISSEMINATE AND TRANSLATE 449 00:16:20,480 --> 00:16:24,000 THE KNOWLEDGE WE DO HAVE. HOW DO 450 00:16:24,000 --> 00:16:26,920 WE GET THAT KNOWLEDGE JUST OUT 451 00:16:26,920 --> 00:16:30,920 OF SCIENTIFIC JOURNALS AND OUT 452 00:16:30,920 --> 00:16:32,760 OF MAYBE THE MOST HIGHLY 453 00:16:32,760 --> 00:16:33,760 RESOURCED INSTITUTIONS AND HOW 454 00:16:33,760 --> 00:16:35,120 DO WE GET THEM OUT TO THE 455 00:16:35,120 --> 00:16:37,400 COMMUNITIES THAT ARE REALLY 456 00:16:37,400 --> 00:16:40,720 AFFECTED BY INIQUITIES? HOW CO-- 457 00:16:40,720 --> 00:16:43,840 INEQUITIES? HOW DO WE KNOW 458 00:16:43,840 --> 00:16:45,720 APPROACHES ARE SUSTAINABLE 459 00:16:45,720 --> 00:16:46,760 OUTSIDE THE SETTING OF THE REAL 460 00:16:46,760 --> 00:16:48,760 WORLD AND HOW TO EFFECTIVELY 461 00:16:48,760 --> 00:16:50,000 ENGAGE WITH COMMUNITIES, IT IS 462 00:16:50,000 --> 00:16:51,200 NOT JUST THE SCIENTISTS OR THE 463 00:16:51,200 --> 00:16:54,880 PEOPLE WHO ARE IN POSITIONS OF 464 00:16:54,880 --> 00:16:56,280 INSTITUTIONAL POWER, BUT IT IS 465 00:16:56,280 --> 00:16:57,760 ALSO ABOUT THE PEOPLE WHO LIVE 466 00:16:57,760 --> 00:17:01,480 IN THE COMMUNITIES THAT ARE 467 00:17:01,480 --> 00:17:02,560 AFFECTED BY DISPARITIES BECAUSE 468 00:17:02,560 --> 00:17:05,200 THEY KNOW ONLY TOO WELL WHAT THE 469 00:17:05,200 --> 00:17:06,600 PROBLEMS ARE, AND WHAT SOME OF 470 00:17:06,600 --> 00:17:08,480 THE BARRIERS ARE TO SOLUTIONS, 471 00:17:08,480 --> 00:17:11,680 THEY ALSO KNOW WHAT THE 472 00:17:11,680 --> 00:17:13,040 STRENGTHS ARE MUCH MORE SO THAN 473 00:17:13,040 --> 00:17:14,600 SCIENTIST WHOSE MAY NOT COME 474 00:17:14,600 --> 00:17:16,080 FROM THOSE COMMUNITIES OR NOT 475 00:17:16,080 --> 00:17:19,040 HAD THE LIVED EXPERIENCES OF 476 00:17:19,040 --> 00:17:22,400 THOSE GROUPS. SO THIS APPROACH 477 00:17:22,400 --> 00:17:24,440 WE WROTE ABOUT IN A BOOK 478 00:17:24,440 --> 00:17:25,800 PUBLISHED BY THE NATIONAL 479 00:17:25,800 --> 00:17:27,920 INSTITUTE ON MINORITY HEALTH AND 480 00:17:27,920 --> 00:17:30,200 HEALTH DISPARITIES, BASICALLY ON 481 00:17:30,200 --> 00:17:31,520 THE HEALTH SCIENCE OF HEALTH 482 00:17:31,520 --> 00:17:35,840 DISPARITIES RESEARCH. SO WHAT 483 00:17:35,840 --> 00:17:37,360 ARE SOME OF THE APPROACHES WE DO 484 00:17:37,360 --> 00:17:40,960 HAVE THAT WE DO KNOW BASED ON 485 00:17:40,960 --> 00:17:42,520 EVIDENCE COLLECTED BY SCIENTISTS 486 00:17:42,520 --> 00:17:48,000 OVER MANY, MANY DECADES? WE KNOW 487 00:17:48,000 --> 00:17:49,040 THREE BROAD CATEGORIES OF 488 00:17:49,040 --> 00:17:50,640 APPROACHES THAT REDUCE 489 00:17:50,640 --> 00:17:54,040 INEQUITIES IN HEALTH IF WE 490 00:17:54,040 --> 00:17:55,800 SIMPLY IMPLEMENTED THEM. SO THE 491 00:17:55,800 --> 00:17:58,480 THREE BROAD CATEGORIES ARE 492 00:17:58,480 --> 00:18:00,080 CREATING COMMUNITIES OF 493 00:18:00,080 --> 00:18:01,120 OPPORTUNITY, INFUSING MORE 494 00:18:01,120 --> 00:18:02,560 HEALTH INTO THE DELIVERY OF 495 00:18:02,560 --> 00:18:04,120 MEDICAL CARE, AND BUILDING 496 00:18:04,120 --> 00:18:08,920 POLITICAL WILL. SO WE WILL GO 497 00:18:08,920 --> 00:18:11,080 THROUGH MORE DETAIL WHAT DO WE 498 00:18:11,080 --> 00:18:14,280 MEAN CREATE OPPORTUNITY? DR. 499 00:18:14,280 --> 00:18:15,240 DAVID WILLIAMS MY COLLEAGUE AND 500 00:18:15,240 --> 00:18:16,400 I WROTE ABOUT THIS A FEW YEARS 501 00:18:16,400 --> 00:18:21,240 AGO. WE KNOW EARLY CHILDHOOD 502 00:18:21,240 --> 00:18:23,240 INITIATIVES ARE AFFECTED AT 503 00:18:23,240 --> 00:18:25,720 IMPROVING THE HEALTH AND THE 504 00:18:25,720 --> 00:18:26,720 DEVELOPMENTAL OUTCOMES OF 505 00:18:26,720 --> 00:18:29,360 CHILDREN. WE NODE TO IMPLEMENT 506 00:18:29,360 --> 00:18:31,200 THEM, REDUCE CHILDHOOD POVERTY, 507 00:18:31,200 --> 00:18:33,040 WE KNOW THAT THAT PLEADS TO 508 00:18:33,040 --> 00:18:34,280 BETTER HEALTH IN ADULTHOOD. WE 509 00:18:34,280 --> 00:18:36,280 KNOW ENHANCING INCOME AND 510 00:18:36,280 --> 00:18:37,560 EMPLOYMENT OPPORTUNITIES AMONG 511 00:18:37,560 --> 00:18:39,520 YOUNG PEOPLE IN ADULT -- AND 512 00:18:39,520 --> 00:18:40,720 ADULTS IMPROVE IT IS HEALTH OF 513 00:18:40,720 --> 00:18:41,640 THOSE INDIVIDUALS AND THEIR 514 00:18:41,640 --> 00:18:43,800 FAMILIEFAMILIES. WE JUST KNOW Y 515 00:18:43,800 --> 00:18:45,280 THINGS LIKE INCREASING THE 516 00:18:45,280 --> 00:18:47,400 MINIMUM WAGE FOR EXAMPLE. WE 517 00:18:47,400 --> 00:18:49,240 KNOW IMPROVING NEIGHBORHOOD AND 518 00:18:49,240 --> 00:18:51,040 HOUSING CONDITIONS CONTRIBUTES 519 00:18:51,040 --> 00:18:54,360 TO BETTER HEALTH. THAT'S BEEN 520 00:18:54,360 --> 00:18:57,240 SHOWN BY BEHAVIORAL SCIENTISTS. 521 00:18:57,240 --> 00:18:58,960 THAT MANY OF WHOM HAVE BEEN 522 00:18:58,960 --> 00:19:00,040 FUNDED BY THE NATIONAL 523 00:19:00,040 --> 00:19:01,040 INSTITUTES OF HEALTH AND 524 00:19:01,040 --> 00:19:03,840 NATIONAL SCIENCE FOUNDATION. 525 00:19:03,840 --> 00:19:05,960 THE OTHER THING WE KNOW IS ABOUT 526 00:19:05,960 --> 00:19:07,480 INFUSING MORE HEALTH INTO THE 527 00:19:07,480 --> 00:19:08,600 DELIVERY OF HEALTHCARE. WE KNOW 528 00:19:08,600 --> 00:19:11,120 FOR EXAMPLE THAT IMPROVING 529 00:19:11,120 --> 00:19:13,520 ACCESS TO CARE IMPROVES HEALTH 530 00:19:13,520 --> 00:19:18,400 OUTCOMES. WE HAVE SEEN THAT. 531 00:19:18,400 --> 00:19:20,240 FROM THE CHILDREN, INSURANCE 532 00:19:20,240 --> 00:19:22,200 PROGRAM FOR CHILDREN, CHIPS. WE 533 00:19:22,200 --> 00:19:23,680 HAVE SEEN THAT FROM THE 534 00:19:23,680 --> 00:19:24,920 AFFORDABLE CARE ACT WHEN 535 00:19:24,920 --> 00:19:26,480 INSURANCE IS PROVIDED THAT IT 536 00:19:26,480 --> 00:19:27,480 DOES IMPROVE HEALTH. WE KNOW IT 537 00:19:27,480 --> 00:19:28,960 IS NOT THE ONLY THING BUT WE 538 00:19:28,960 --> 00:19:31,200 KNOW IT IS AN IMPORTANT 539 00:19:31,200 --> 00:19:32,720 COMPONENT. WE KNOW THAT 540 00:19:32,720 --> 00:19:33,960 EMPHASIZING PREVENTION AND 541 00:19:33,960 --> 00:19:35,760 PRIMARY CARE IS IMPORTANT. 542 00:19:35,760 --> 00:19:38,080 RATHER THAN WAITING UNTIL PEOPLE 543 00:19:38,080 --> 00:19:39,200 GET SICK THEN TRYING TO TREAT 544 00:19:39,200 --> 00:19:40,880 ALL THE COMPLICATED ISSUES THEY 545 00:19:40,880 --> 00:19:43,360 HAVE AT THAT POINT, THERE IS SO 546 00:19:43,360 --> 00:19:45,400 MUCH SCIENCE THAT WE HAVE ABOUT 547 00:19:45,400 --> 00:19:48,680 WHAT -- HOW WE -- HOW TO EAT 548 00:19:48,680 --> 00:19:50,280 HEALTHY, HOW TO KEEP OUR BLOOD 549 00:19:50,280 --> 00:19:52,000 PRESSURE DOWN, WHICH KNOW WHICH 550 00:19:52,000 --> 00:19:53,760 MEDICATIONS WORK, WE KNOW WE 551 00:19:53,760 --> 00:19:55,320 SHOULD WEAR OUR SEAT BELTS WHEN 552 00:19:55,320 --> 00:19:58,000 WE DRIVE, WE KNOW WE SHOULD WEAR 553 00:19:58,000 --> 00:20:00,200 HELMETS WHEN WE RIDE A BICYCLE, 554 00:20:00,200 --> 00:20:01,320 ALL THOSE ARE PREVENTION. WE 555 00:20:01,320 --> 00:20:02,840 KNOW HOW TO PREVENT AND SCREEN 556 00:20:02,840 --> 00:20:04,280 FOR CANCER. BUT IT IS NOT 557 00:20:04,280 --> 00:20:06,080 ACTUALLY BEING EMPHASIZED AND 558 00:20:06,080 --> 00:20:08,520 PROVIDED TO EVERYONE. WE KNOW 559 00:20:08,520 --> 00:20:10,280 THERE ARE DISPARITIES IN THE 560 00:20:10,280 --> 00:20:11,880 QUALITY OF CARE, WE KNOW SOME OF 561 00:20:11,880 --> 00:20:13,080 THE FACTORS THAT CONTRIBUTE TO 562 00:20:13,080 --> 00:20:16,800 THAT, WHETHER IT BE POOR PATIENT 563 00:20:16,800 --> 00:20:20,280 PROVIDER COMMUNICATION. OR 564 00:20:20,280 --> 00:20:21,840 INADEQUATELY RESOURCED 565 00:20:21,840 --> 00:20:23,320 INSTITUTIONS AND CERTAIN 566 00:20:23,320 --> 00:20:24,720 COMMUNITIES. WE KNOW WE DO A 567 00:20:24,720 --> 00:20:26,880 BETTER JOB OF ADDRESSING 568 00:20:26,880 --> 00:20:28,960 PATIENTS' SOCIAL RISK FACTORS BY 569 00:20:28,960 --> 00:20:30,000 CONNECTING HEALTHCARE WITH OTHER 570 00:20:30,000 --> 00:20:31,600 RESOURCES WITHIN COMMUNITIES. 571 00:20:31,600 --> 00:20:33,560 WE KNOW THAT DIVERSIFYING THE 572 00:20:33,560 --> 00:20:34,880 HEALTHCARE WORK FORCE IMPROVES 573 00:20:34,880 --> 00:20:36,720 OUTCOMES. SO THERE'S SO MANY 574 00:20:36,720 --> 00:20:38,200 THINGS WE KNOW ABOUT THAT WE 575 00:20:38,200 --> 00:20:39,600 JUST ACTUALLY NEED TO DO. WHEN 576 00:20:39,600 --> 00:20:42,520 IT COMES TO BUILDING POLITICAL 577 00:20:42,520 --> 00:20:45,080 WILL, A LOT OF THESE THINGS 578 00:20:45,080 --> 00:20:46,200 HAVEN'T BEEN DOCUMENTED YET BUT 579 00:20:46,200 --> 00:20:48,160 CERTAINLY THERE IS A LOT OF 580 00:20:48,160 --> 00:20:49,520 WISDOM AROUND THE FACT THAT IF 581 00:20:49,520 --> 00:20:53,040 WE INCREASE AWARENESS OF THE 582 00:20:53,040 --> 00:20:55,200 INEQUITIES THAT WE CAN MOBILIZE 583 00:20:55,200 --> 00:20:56,680 COMMUNITIES. INTO SUPPORTING 584 00:20:56,680 --> 00:20:59,160 POLICIES AND POLICY MAKERS THAT 585 00:20:59,160 --> 00:21:00,960 WOULD ADDRESS INEQUITIES. WE 586 00:21:00,960 --> 00:21:02,760 KNOW GETTING PEOPLE MORE 587 00:21:02,760 --> 00:21:05,840 CIVICICALLY ENGAGED IS BETTER 588 00:21:05,840 --> 00:21:07,040 FOR THEIR HEALTH, INDIVIDUAL 589 00:21:07,040 --> 00:21:08,200 HEALTH AS WELL AS HEALTH OF 590 00:21:08,200 --> 00:21:10,520 ENTIRE COMMUNITIES. WE KNOW 591 00:21:10,520 --> 00:21:11,640 REDUCING STEREOTYPES AND 592 00:21:11,640 --> 00:21:15,040 PREJUDICE WILL REDUCE THINGS 593 00:21:15,040 --> 00:21:16,120 LIKE VIOLENCE, CRIME AND OTHER 594 00:21:16,120 --> 00:21:20,840 FORMS OF HARM. THESE ARE BROAD 595 00:21:20,840 --> 00:21:22,120 APPROACHES. THE OTHER THING WE 596 00:21:22,120 --> 00:21:23,360 KNOW IS THAT IT IS GOING TO TAKE 597 00:21:23,360 --> 00:21:25,560 MORE THAN ONE THING. SO THIS 598 00:21:25,560 --> 00:21:29,120 DIAGRAM, THIS IS AN 599 00:21:29,120 --> 00:21:31,960 INTERVENTIONS MODEL THAT IS 600 00:21:31,960 --> 00:21:33,160 MULTI-LEVEL INTERVENTION MODEL. 601 00:21:33,160 --> 00:21:36,040 IT IS BASICALLY -- IT IS BASED 602 00:21:36,040 --> 00:21:39,120 ON THE SOCIO ECOLOGICAL MODEL. 603 00:21:39,120 --> 00:21:40,880 WHICH SORT OF ACKNOWLEDGES THE 604 00:21:40,880 --> 00:21:42,240 FACT THAT HEALTH IS INFLUENCED 605 00:21:42,240 --> 00:21:44,000 BY FACTORS AT MULTIPLE LEVELS. 606 00:21:44,000 --> 00:21:47,320 SO WE WANT TO INTERVENE ON A 607 00:21:47,320 --> 00:21:49,680 PARTICULAR PROBLEM, WE NEED TO 608 00:21:49,680 --> 00:21:52,320 MOVE BEYOND ADDRESSING 609 00:21:52,320 --> 00:21:53,400 INDIVIDUAL PATIENT BEHAVIORS FOR 610 00:21:53,400 --> 00:21:54,960 EXAMPLE. THIS IS A MODEL THAT 611 00:21:54,960 --> 00:21:57,120 FOCUSES ON HEALTHCARE BUT THIS 612 00:21:57,120 --> 00:21:58,400 MODEL COULD BE REPLICATED FOR 613 00:21:58,400 --> 00:22:00,600 ANY OTHER SETTING FOR 614 00:22:00,600 --> 00:22:01,760 EDUCATIONAL SETTING FOR AN 615 00:22:01,760 --> 00:22:03,360 EMPLOYMENT SETTING. FOR 616 00:22:03,360 --> 00:22:06,280 COMMUNITY BASED SETTING. SO THE 617 00:22:06,280 --> 00:22:07,800 FACT IS THAT THERE ARE PEOPLE'S 618 00:22:07,800 --> 00:22:09,800 BEHAVIORS ARE SHAPED BY THEIR 619 00:22:09,800 --> 00:22:11,600 SOCIAL CONNECTION AND SOCIAL 620 00:22:11,600 --> 00:22:15,080 NETWORKS. BY THE ORGANIZATIONS 621 00:22:15,080 --> 00:22:17,520 IN WHICH THEY OPERATE AND WORK 622 00:22:17,520 --> 00:22:19,760 AND OBTAIN SERVICES. AND BY THE 623 00:22:19,760 --> 00:22:21,240 POLICIES AND THE COMMUNITY 624 00:22:21,240 --> 00:22:23,000 RESOURCES THAT ARE AVAILABLE TO 625 00:22:23,000 --> 00:22:24,480 THEM AND THEIR COMMUNITIES. WE 626 00:22:24,480 --> 00:22:26,200 DON'T HAVE TO INTERVENE ON ALL 627 00:22:26,200 --> 00:22:28,280 AT THE SAME TIME, BUT WE KNOW 628 00:22:28,280 --> 00:22:29,800 AND THE RESEARCH HAS SHOWN US 629 00:22:29,800 --> 00:22:32,120 THAT INTERVENING ON ONLY ONE 630 00:22:32,120 --> 00:22:33,640 LEVEL VERY RARELY ACCOMPLISHES 631 00:22:33,640 --> 00:22:35,360 THE GOAL OF REDUCING 632 00:22:35,360 --> 00:22:37,120 DISPARITIES. SO THE FIELD IS NOW 633 00:22:37,120 --> 00:22:38,720 MOVED TOWARDS TESTING 634 00:22:38,720 --> 00:22:41,520 MULTI-LEVEL INTERVENTIONS AND 635 00:22:41,520 --> 00:22:43,360 THANKS TO NIH IN PARTICULAR MANY 636 00:22:43,360 --> 00:22:45,600 OTHER FUNDING AGENCIES BUT NIH 637 00:22:45,600 --> 00:22:46,760 IN PARTICULAR, HAS BEEN VERY 638 00:22:46,760 --> 00:22:49,560 SUPPORTIVE OF THE TESTING OF 639 00:22:49,560 --> 00:22:51,120 MULTI-LEVEL INTERVENTIONS AND 640 00:22:51,120 --> 00:22:52,720 LOOKING AT HOW THOSE 641 00:22:52,720 --> 00:22:55,520 INTERVENTIONS INFLUENCE KEY 642 00:22:55,520 --> 00:22:56,480 INTERACTIONS WITHIN THE 643 00:22:56,480 --> 00:22:57,880 ENVIRONMENT OR IN THE 644 00:22:57,880 --> 00:22:58,800 ORGANIZATION IN WHICH WE ARE 645 00:22:58,800 --> 00:23:01,040 OPERATING AND THEN SUBSEQUENTLY 646 00:23:01,040 --> 00:23:04,320 HOW THOSE INTERACTIONS THEN 647 00:23:04,320 --> 00:23:05,600 INFLUENCE OUTCOMES. IT IS 648 00:23:05,600 --> 00:23:07,680 IMPORTANT TO NOTE THAT WE ARE 649 00:23:07,680 --> 00:23:11,520 NOW FOCUSED NOT ONLY ON CLINICAL 650 00:23:11,520 --> 00:23:13,680 OUTCOMES BUT ON ORGANIZATIONAL 651 00:23:13,680 --> 00:23:15,680 OUTCOMES SUCH AS COSTS, ON 652 00:23:15,680 --> 00:23:19,280 PATIENT EXPERIENCES, EQUITY OF 653 00:23:19,280 --> 00:23:22,040 SERVICES, ALL THOSE THINGS THAT 654 00:23:22,040 --> 00:23:23,120 MATTER TO INDIVIDUAL PEOPLE, TO 655 00:23:23,120 --> 00:23:24,120 COMMUNITIES AND TO DECISION 656 00:23:24,120 --> 00:23:28,440 MAKERS. SO WHEN WE LOOK AT 657 00:23:28,440 --> 00:23:29,200 CARDIOMETABOLIC DISEASE IN 658 00:23:29,200 --> 00:23:30,680 PARTICULAR YOU LOOK AT ALL THESE 659 00:23:30,680 --> 00:23:32,960 MULTIPLE LEVELS OF INFLUENCE YOU 660 00:23:32,960 --> 00:23:36,920 CAN SEE WE GET MORE SPECIFIC ONE 661 00:23:36,920 --> 00:23:37,800 MIGHT CHOOSE ON INDIVIDUAL 662 00:23:37,800 --> 00:23:39,320 PATIENT LEVEL TO FOCUS ON AN 663 00:23:39,320 --> 00:23:40,840 ISSUE SUCH AS ADHERENCE TO 664 00:23:40,840 --> 00:23:44,320 MEDICATIONS. ON THE PROVIDER OR 665 00:23:44,320 --> 00:23:45,080 CLINICAL TEAM LEVEL, THERE MIGHT 666 00:23:45,080 --> 00:23:47,960 BE A FOCUS ON SOMETHING RELATED 667 00:23:47,960 --> 00:23:48,880 TO COMMUNICATION SKILLS OR 668 00:23:48,880 --> 00:23:51,080 RELATED TO SOME OTHER TECHNICAL 669 00:23:51,080 --> 00:23:53,720 SKILLS IN THE DELIVERY OF CARE. 670 00:23:53,720 --> 00:23:56,640 AT THE LOCAL COMMUNITY LEVEL ONE 671 00:23:56,640 --> 00:23:57,520 MIGHT CHOOSE TO FOCUS ON 672 00:23:57,520 --> 00:23:58,280 SOMETHING RELATED TO FOOD 673 00:23:58,280 --> 00:24:02,200 AVAILABILITY. IF IT IS NOT 674 00:24:02,200 --> 00:24:03,680 CHANGING THE ACTUAL AVAILABILITY 675 00:24:03,680 --> 00:24:07,440 OF FOOD, LIKE CHANGING HOW 676 00:24:07,440 --> 00:24:09,400 INDIVIDUALS CAN OBTAIN ACCESS TO 677 00:24:09,400 --> 00:24:10,600 FOOD WITHIN THEIR ENVIRONMENTS 678 00:24:10,600 --> 00:24:12,440 AND SIMILARLY ON THE OTHER SIDE 679 00:24:12,440 --> 00:24:15,440 DIAGRAM YOU CAN SEE MULTIPLE 680 00:24:15,440 --> 00:24:16,960 AREAS IN WHICH ONE MIGHT CHOOSE 681 00:24:16,960 --> 00:24:21,360 TO FOCUS ON AND OBVIOUSLY THE 682 00:24:21,360 --> 00:24:22,760 CHOICE OF WHAT TO INTERVENE UPON 683 00:24:22,760 --> 00:24:23,880 IS INFLUENCED BY WHAT IS KNOWN 684 00:24:23,880 --> 00:24:29,120 IN THE EXISTING RESEARCH. THAT 685 00:24:29,120 --> 00:24:32,320 RESEARCH ON ON CONTRIBUTORS TO 686 00:24:32,320 --> 00:24:33,920 HEALTH DISPARITIES AND MEDIATORS 687 00:24:33,920 --> 00:24:35,680 WILL LET YOU KNOW WHICH FACTORS 688 00:24:35,680 --> 00:24:39,480 CONTRIBUTES THE MOST AND IS MOST 689 00:24:39,480 --> 00:24:40,880 AMENABLE TO CHANGE. THAT IS 690 00:24:40,880 --> 00:24:43,520 WHERE YOU WANT TO THEN DIRECT 691 00:24:43,520 --> 00:24:46,600 YOUR EFFORTS. I WAS FORTUNATE IN 692 00:24:46,600 --> 00:24:50,080 2010 TO BE AWARDED A P 50 GRANT 693 00:24:50,080 --> 00:24:51,640 FROM THE NATIONAL HEART LUNG AND 694 00:24:51,640 --> 00:24:52,760 BLOOD INSTITUTE TO ESTABLISH A 695 00:24:52,760 --> 00:24:55,480 CENTER FOCUSED ON HEALTH EQUITY 696 00:24:55,480 --> 00:24:58,880 SO WE HAVE BEEN IN EXISTENCE 697 00:24:58,880 --> 00:25:00,800 SINCE 2010 AND NOW SO WE ARE IN 698 00:25:00,800 --> 00:25:03,440 OUR 23RD YEAR. OUR MISSION IS TO 699 00:25:03,440 --> 00:25:05,680 PROMOTE EQUITY AND HEALTH IN 700 00:25:05,680 --> 00:25:07,440 POPULATIONS THAT HAVE BEEN 701 00:25:07,440 --> 00:25:09,280 SOCIALLY MARGINALIZED BY A THREE 702 00:25:09,280 --> 00:25:11,600 PRONGED APPROACH. ADVANCING 703 00:25:11,600 --> 00:25:12,680 SCIENTIFIC KNOWLEDGE, HE BELIEVE 704 00:25:12,680 --> 00:25:14,360 KATEING AND TRAINING LEADERS -- 705 00:25:14,360 --> 00:25:15,600 EDUCATING AND TRAINING LEADERS 706 00:25:15,600 --> 00:25:17,120 AND PARTNERING WITH COMMUNITIES 707 00:25:17,120 --> 00:25:19,880 SO THIS PHOTO SHOWS OUR 708 00:25:19,880 --> 00:25:21,400 COMMUNITY ADVISORY BOARD WHICH 709 00:25:21,400 --> 00:25:24,880 HAS ALSO BEEN ACTIVE SINCE 2010 710 00:25:24,880 --> 00:25:28,040 SO BACK IN 2010, WE WROTE A 711 00:25:28,040 --> 00:25:30,360 PAPER ABOUT WHAT WAS INVOLVED IN 712 00:25:30,360 --> 00:25:32,280 CREATING THIS TRANSDISCIPLINARY 713 00:25:32,280 --> 00:25:34,000 RESEARCH CENTER. SOME OF OUR 714 00:25:34,000 --> 00:25:36,680 EARLY LESSONS LEARNED. WE WROTE 715 00:25:36,680 --> 00:25:39,040 THE MULTI-LEVEL INTERVENTIONS WE 716 00:25:39,040 --> 00:25:42,280 TESTED AND SO SOME OF THEM, THIS 717 00:25:42,280 --> 00:25:43,720 PARTICULAR CENTER WE WERE 718 00:25:43,720 --> 00:25:45,440 FOCUSED AT THIS TIME ON 719 00:25:45,440 --> 00:25:46,920 HYPERTENSION DISPARITIES. . WE 720 00:25:46,920 --> 00:25:49,040 HAD ONE PROJECT RED CHIP WHICH 721 00:25:49,040 --> 00:25:51,400 WAS PRIMARILY FOCUSED ON HEALTH 722 00:25:51,400 --> 00:25:52,520 SYSTEM APPROACHES. BUT WE 723 00:25:52,520 --> 00:25:54,520 INTERVENED AT THE LEVEL OF 724 00:25:54,520 --> 00:25:56,040 CLINICAL AND FRONT LINE STAFF AS 725 00:25:56,040 --> 00:25:57,360 WELL AS ON THE LEVEL OF 726 00:25:57,360 --> 00:25:59,320 PATIENTS. WE INTERVENE ON THE 727 00:25:59,320 --> 00:26:00,320 ORGANIZATIONAL LEVEL BY 728 00:26:00,320 --> 00:26:03,040 PROVIDING ADDITIONAL STAFFING 729 00:26:03,040 --> 00:26:04,440 THROUGH REGISTERED DIETITIAN AND 730 00:26:04,440 --> 00:26:07,800 PHARMACIST. TO ADDRESS 731 00:26:07,800 --> 00:26:11,560 UNCONTROLLED HYPERTENSION IN 732 00:26:11,560 --> 00:26:13,080 PRIMARY CARE PATIENTS. THE FIVE 733 00:26:13,080 --> 00:26:14,840 PLUS NUTS AN BEANS TRIAL 734 00:26:14,840 --> 00:26:16,320 INTERVENED MORE ON THE FOOD 735 00:26:16,320 --> 00:26:18,160 ACCESSIBILITY ISSUE IN BALTIMORE 736 00:26:18,160 --> 00:26:21,840 CITY. WE HAD PEOPLE FROM A FOOD 737 00:26:21,840 --> 00:26:23,880 DESERT WHICH IS AN AREA WHICH 738 00:26:23,880 --> 00:26:27,200 LACKS HEALTHY FOOD OPTIONS FOR 739 00:26:27,200 --> 00:26:29,480 PEOPLE. SO WHAT WE DID IS 740 00:26:29,480 --> 00:26:32,120 PROVIDED DIETARY COACHING AND A 741 00:26:32,120 --> 00:26:35,080 FOOD DELIVERY TO THE LOCAL 742 00:26:35,080 --> 00:26:37,560 LIBRARY BECAUSE MANY OF THE 743 00:26:37,560 --> 00:26:38,720 FOLKS THAT WERE PARTICIPATING IN 744 00:26:38,720 --> 00:26:41,320 THIS TRIAL HAD NO ACCESS TO 745 00:26:41,320 --> 00:26:43,280 FRESH FRUITS VEGETABLES NUTS AND 746 00:26:43,280 --> 00:26:45,360 BEANS, PART OF THE DASH DIET 747 00:26:45,360 --> 00:26:47,560 WHICH WE KNOW IS EFFECTIVE FOR 748 00:26:47,560 --> 00:26:49,160 REDUCING BLOOD PRESSURE. WE HAD 749 00:26:49,160 --> 00:26:51,000 A THIRD STUDY CALLED THE ACT 750 00:26:51,000 --> 00:26:52,880 STUDY WHICH INCLUDED COMMUNITY 751 00:26:52,880 --> 00:26:55,200 HEALTH WORKER OUTREACH TO 752 00:26:55,200 --> 00:26:57,760 PATIENTS WITH UNCONTROLLED BLOOD 753 00:26:57,760 --> 00:26:59,400 PRESSURE, PROVISION OF HOME 754 00:26:59,400 --> 00:27:01,360 BLOOD PRESSURE MONITORS AND SOME 755 00:27:01,360 --> 00:27:04,720 FOCUS ON PROBLEM SOLVING. SO 756 00:27:04,720 --> 00:27:08,880 INTERVENING THERE ON THE SOCIAL 757 00:27:08,880 --> 00:27:11,280 SUPPORT ENVIRONMENT AS WELL AS 758 00:27:11,280 --> 00:27:12,760 ON THE HEALTHCARE ENVIRONMENT 759 00:27:12,760 --> 00:27:15,800 AND THE INDIVIDUAL. WE HAD SOME 760 00:27:15,800 --> 00:27:17,280 INTERESTING LESSONS LEARNED. L 761 00:27:17,280 --> 00:27:18,840 WE SHOWED SOME EFFECTIVENESS IN 762 00:27:18,840 --> 00:27:21,760 THOSE THREE STUDIES. NOT AS 763 00:27:21,760 --> 00:27:23,360 DRAMATIC AS WE WOULD HAVE LIKED 764 00:27:23,360 --> 00:27:24,720 AND SOME OF THE LESSONS WE 765 00:27:24,720 --> 00:27:26,320 LEARNED WERE APPLIED TO OUR NEXT 766 00:27:26,320 --> 00:27:28,480 GENERATION OF STUDIES WHICH NOW 767 00:27:28,480 --> 00:27:31,080 WHAT WE ARE DOING IS FOR 768 00:27:31,080 --> 00:27:32,520 EXAMPLE, THE HEALTH SYSTEM 769 00:27:32,520 --> 00:27:33,880 APPROACH NOW ALSO INCORPORATES 770 00:27:33,880 --> 00:27:36,360 THE COMMUNITY OUTREACH BECAUSE 771 00:27:36,360 --> 00:27:37,760 WE DIDN'T REACH SO MANY OF THE 772 00:27:37,760 --> 00:27:40,280 PEOPLE WHO WERE ELIGIBLE FOR OUR 773 00:27:40,280 --> 00:27:42,480 PROGRAM. BY FOCUSING ONLY ON THE 774 00:27:42,480 --> 00:27:43,720 HEALTH SYSTEM OR THE PEOPLE THAT 775 00:27:43,720 --> 00:27:44,720 WERE ALREADY ENGAGE MISDEMEANOR 776 00:27:44,720 --> 00:27:47,080 THE HEALTH SYSTEM. ON THE FOOD 777 00:27:47,080 --> 00:27:48,120 -- ENGAGE MISDEMEANOR THE HEALTH 778 00:27:48,120 --> 00:27:49,240 SYSTEM. ON THE FOOD DELIVERY 779 00:27:49,240 --> 00:27:50,440 APPROACH WE LEARNED PARTICULAR 780 00:27:50,440 --> 00:27:52,040 PEOPLE AT HIGHER RISK COULD 781 00:27:52,040 --> 00:27:53,800 BENEFIT MORE FROM THE HEALTHIER 782 00:27:53,800 --> 00:27:57,680 DIET SO WE ARE T FOCUSING ON THE 783 00:27:57,680 --> 00:27:59,160 HIGHER RISK INDIVIDUAL WHOSE HAD 784 00:27:59,160 --> 00:28:00,480 EARLY KIDNEY DISEASE AND JOINED 785 00:28:00,480 --> 00:28:02,320 THE DIETARY COACHING FOOD 786 00:28:02,320 --> 00:28:03,600 DELIVERY WITH THAT HIGHER RISK 787 00:28:03,600 --> 00:28:05,400 POPULATION. SO THESE ARE OUR 788 00:28:05,400 --> 00:28:07,400 THREE MOST RECENT TRIALS ARE THE 789 00:28:07,400 --> 00:28:09,520 RICH LIFE PROJECT, THE FIVE PLUS 790 00:28:09,520 --> 00:28:11,000 NUTS AND BEANS FOR KIDNEYS 791 00:28:11,000 --> 00:28:12,960 TRIAL, AND THEN WE ALSO HAVE A 792 00:28:12,960 --> 00:28:16,480 TRIAL THAT WE CONDUCTED IN GANA 793 00:28:16,480 --> 00:28:18,240 WHICH TESTED TASK SHIFTING FROM 794 00:28:18,240 --> 00:28:19,680 PHYSICIANS TO COMMUNITY HEALTH 795 00:28:19,680 --> 00:28:21,800 NURSES IN A SETTING WHERE THERE 796 00:28:21,800 --> 00:28:25,120 WERE -- THERE WAS A LIMITED 797 00:28:25,120 --> 00:28:26,600 NUMBER OF PRIMARY CARE 798 00:28:26,600 --> 00:28:28,160 PHYSICIANS TO CARE FOR PATIENTS 799 00:28:28,160 --> 00:28:32,480 WE ALSO PROVIDED HOME BLOOD 800 00:28:32,480 --> 00:28:34,240 PRESSURE MONITORS AND CELL PHONE 801 00:28:34,240 --> 00:28:35,600 APP FOR TRACKING OF PATIENTS 802 00:28:35,600 --> 00:28:37,840 BLOOD PRESSURE AND DIABETES 803 00:28:37,840 --> 00:28:39,320 OUTCOMES, USING HEALTH 804 00:28:39,320 --> 00:28:40,400 INFORMATION TECHNOLOGY. WE WERE 805 00:28:40,400 --> 00:28:44,360 DOING THIS BEFORE THE PANDEMIC 806 00:28:44,360 --> 00:28:46,120 AND SO MANY LESSONS LEARNED FROM 807 00:28:46,120 --> 00:28:48,200 THAT STUDY THAT CAN BE APPLIED 808 00:28:48,200 --> 00:28:49,600 NOW IN THE UNITED STATES. SO AS 809 00:28:49,600 --> 00:28:51,480 I MENTION OUR CENTER HAS A THREE 810 00:28:51,480 --> 00:28:53,480 PRONGED APPROACH, OUR ENGAGEMENT 811 00:28:53,480 --> 00:28:54,560 WITH COMMUNITY THROUGH OUR 812 00:28:54,560 --> 00:28:55,720 COMMUNITY ADVISORY BOARD AND 813 00:28:55,720 --> 00:28:58,560 WITH NUMEROUS HEALTH SYSTEM 814 00:28:58,560 --> 00:29:00,080 PARTNERS. OUR RESEARCH ARM AND 815 00:29:00,080 --> 00:29:01,800 THEN OUR TRAINING ARM WHICH 816 00:29:01,800 --> 00:29:06,120 FOCUSES ON PROVIDING COURSES AND 817 00:29:06,120 --> 00:29:07,840 SYMPOSIUM AND INDIVIDUALIZED 818 00:29:07,840 --> 00:29:09,920 MENTORING OPPORTUNITIES FOR THE 819 00:29:09,920 --> 00:29:11,560 NEXT GENERATION OF RESEARCHERS 820 00:29:11,560 --> 00:29:12,840 AND LEADERS IN HEALTH EQUITY. SO 821 00:29:12,840 --> 00:29:15,440 I'M GOING TO TELL YOU NOW FOCUS 822 00:29:15,440 --> 00:29:17,280 MORE ON THE SPECIFIC STUDY ON 823 00:29:17,280 --> 00:29:19,280 THE RICH LIFE PROJECT. SO THAT 824 00:29:19,280 --> 00:29:21,720 YOU CAN GET A LITTLE BIT MORE 825 00:29:21,720 --> 00:29:23,560 IDEA OF EXACTLY WHAT I'M TALKING 826 00:29:23,560 --> 00:29:25,560 ABOUT. SO THIS STUDY RICH LIFE 827 00:29:25,560 --> 00:29:29,960 WAS FUNDED BY PCORI AND NHLBI. 828 00:29:29,960 --> 00:29:33,440 IT IS A CLUSTER RANDOMIZED 829 00:29:33,440 --> 00:29:35,560 PRAGMATIC TRIAL THAT INCLUDED 30 830 00:29:35,560 --> 00:29:37,680 PRACTICES IN MARYLAND AN 831 00:29:37,680 --> 00:29:41,880 PENNSYLVANIA. WE ENROLLED 1,820 832 00:29:41,880 --> 00:29:43,920 ADULT PATIENTS, APPROXIMATELY 63 833 00:29:43,920 --> 00:29:45,400 PER PRACTICE. THE PATIENTS HAD 834 00:29:45,400 --> 00:29:46,560 TO HAVE UNCONTROLLED 835 00:29:46,560 --> 00:29:48,320 HYPERTENSION PLUS AT LEAST ONE 836 00:29:48,320 --> 00:29:50,000 OTHER CO-MORBID CONDITION WHICH 837 00:29:50,000 --> 00:29:51,360 INCLUDED DIABETES, DEPRESSION, 838 00:29:51,360 --> 00:29:53,840 HIGH CHOLESTEROL, HEART DISEASE 839 00:29:53,840 --> 00:29:56,520 OR TOBACCO SMOKING AND WE 840 00:29:56,520 --> 00:29:57,920 COMPARED TWO INTERVENTION, ONE 841 00:29:57,920 --> 00:29:59,600 STANDARD OF CARE PLUS 842 00:29:59,600 --> 00:30:00,800 INTERVENTION, WHICH ACTUALLY 843 00:30:00,800 --> 00:30:04,440 FOCUSED ON PROVIDING SKILLS AND 844 00:30:04,440 --> 00:30:06,320 KNOWLEDGE AND RESOURCES TO FRONT 845 00:30:06,320 --> 00:30:09,680 LINE CLINIC STAFF AND SYSTEM 846 00:30:09,680 --> 00:30:11,160 LEADERS. AND THEN THE SECOND 847 00:30:11,160 --> 00:30:12,560 APPROACH COLLABORATIVE CARE 848 00:30:12,560 --> 00:30:14,000 STEPPED CARE WHICH INCLUDED ALL 849 00:30:14,000 --> 00:30:16,280 THE COMPONENTS OF STANDARD OF 850 00:30:16,280 --> 00:30:18,160 CARE PLUS BUT ALSO INCORPORATED 851 00:30:18,160 --> 00:30:20,720 A CARE MANAGER COMMUNITY HEALTH 852 00:30:20,720 --> 00:30:22,560 WORKER AND A SPECIALIST TEAM 853 00:30:22,560 --> 00:30:25,040 THAT WOULD BE AVAILABLE 854 00:30:25,040 --> 00:30:26,000 VIRTUALLY TO DELIVER 855 00:30:26,000 --> 00:30:27,640 INDIVIDUALIZED CARE TO PATIENTS 856 00:30:27,640 --> 00:30:30,200 SO LET ME TELL YOU A LITTLE BIT 857 00:30:30,200 --> 00:30:31,400 MORE ABOUT THOSE INTERVENTIONS 858 00:30:31,400 --> 00:30:33,440 IN A FEW MINUTE BUS OUR MAIN 859 00:30:33,440 --> 00:30:35,320 OUTCOMES AT 12 AND 24 MONTHS 860 00:30:35,320 --> 00:30:37,840 WERE BLOOD PRESSURE CONTROL AND 861 00:30:37,840 --> 00:30:40,840 CHANGE IN PATIENT AGGRAVATION. 862 00:30:40,840 --> 00:30:41,880 WE DID POLICIES THAT WERE 863 00:30:41,880 --> 00:30:43,640 PLANNED PRE-PLANNED SUBGROUP 864 00:30:43,640 --> 00:30:45,240 ANALYSIS WITH PRIMARY ONE BEING 865 00:30:45,240 --> 00:30:48,080 LOOKING TO SEE IF WE COULD -- IF 866 00:30:48,080 --> 00:30:51,920 THE INTERVENTION WOULD REDUCE 867 00:30:51,920 --> 00:30:53,120 DISPARITIES IN CARDIOVASCULAR 868 00:30:53,120 --> 00:30:55,960 DISEASE AND HYPERTENSION LEVELS 869 00:30:55,960 --> 00:30:59,320 THAT WERE PRESENT AT BASELINE. 870 00:30:59,320 --> 00:31:01,680 SO BRIEFLY, THE STANDARD OF CARE 871 00:31:01,680 --> 00:31:03,640 PLUS INTERVENTION INCLUDED 872 00:31:03,640 --> 00:31:04,800 STANDARDIZED BLOOD PRESSURE 873 00:31:04,800 --> 00:31:06,840 MEASURING TRAINING FOR ALL FRONT 874 00:31:06,840 --> 00:31:08,200 LINE STAFF AND CLINICIANS, 875 00:31:08,200 --> 00:31:10,360 INCLUDED A HYPERTENSION BEST 876 00:31:10,360 --> 00:31:14,040 CARE AN BEST PRACTICES TRAINING 877 00:31:14,040 --> 00:31:18,480 DELIVERED BY AUDIO-VISUAL 878 00:31:18,480 --> 00:31:20,000 WEB-BASED TRAINING PROGRAM. ALSO 879 00:31:20,000 --> 00:31:22,200 INCLUDED A LEARNING NETWORK FOR 880 00:31:22,200 --> 00:31:23,360 HEALTH SYSTEM LEADERS SO THIS 881 00:31:23,360 --> 00:31:29,960 WAS LIKE A SERIES OF ORDERLY 882 00:31:29,960 --> 00:31:32,600 SEMINARS ON KEY TOPICS. THEN WE 883 00:31:32,600 --> 00:31:34,640 HAD A HYPERTENSION DASHBOARD 884 00:31:34,640 --> 00:31:37,280 THAT WAS PROVIDED TO ALL 885 00:31:37,280 --> 00:31:39,680 PRACTICES, EXTRACTING DATA FROM 886 00:31:39,680 --> 00:31:41,280 ELECTRONIC MEDICAL RECORDS AND 887 00:31:41,280 --> 00:31:43,240 GIVING FEEDBACK ON HOW PROVIDERS 888 00:31:43,240 --> 00:31:45,840 AND HOW THE CLINIC OVERALL WAS 889 00:31:45,840 --> 00:31:47,000 PERFORMING WITH REGARD TO 890 00:31:47,000 --> 00:31:49,920 ACHIEVING BLOODS FROM SURE 891 00:31:49,920 --> 00:31:51,360 CONTROL METRICS BROKEN DOWN BY 892 00:31:51,360 --> 00:31:54,480 RACE AND ETHNICITY. THIS IS A 893 00:31:54,480 --> 00:31:56,240 VERY ACTIVE COMPARATOR ARM. SO 894 00:31:56,240 --> 00:31:59,160 HERE IS WHAT WE DID FOR THE 895 00:31:59,160 --> 00:32:00,200 STANDARDIZATION OF BLOOD 896 00:32:00,200 --> 00:32:02,320 PRESSURE MEASUREMENT, WE HAD A 897 00:32:02,320 --> 00:32:04,400 SCREEN AND CONFIRM PROTOCOL, WE 898 00:32:04,400 --> 00:32:05,880 INTRODUCED AUTOMATED BLOOD 899 00:32:05,880 --> 00:32:09,240 PRESSURE DEVICES TO ALL THE AT 900 00:32:09,240 --> 00:32:12,000 THISES. WE HAD STAFF TRAINING 901 00:32:12,000 --> 00:32:14,400 IN PERSON FOR THE TRAINERS AND 902 00:32:14,400 --> 00:32:16,880 THEN THE TRAINERS CAN TRAIN THE 903 00:32:16,880 --> 00:32:19,800 FRONT LINE STAF STAFF. E WE ALSD 904 00:32:19,800 --> 00:32:21,840 OBSERVATION VISITS OR A FIDELITY 905 00:32:21,840 --> 00:32:24,680 AUDIT OVER THE PERIOD OF THE 906 00:32:24,680 --> 00:32:27,880 STUDY. THEN AS I MENTIONED TO 907 00:32:27,880 --> 00:32:29,000 YOU, THE HYPERTENSION BEST 908 00:32:29,000 --> 00:32:31,640 PRACTICES TRAINING. SO THE 909 00:32:31,640 --> 00:32:34,920 SCREEN AND CONFIRM PROTOCOL IS 910 00:32:34,920 --> 00:32:36,560 BASICALLY THAT EVERY PATIENT IS 911 00:32:36,560 --> 00:32:37,760 SCREENED FOR BLOOD PRESSURE 912 00:32:37,760 --> 00:32:39,880 USING AUTOMATED BLOOD PRESSURE 913 00:32:39,880 --> 00:32:42,360 DEVICE. AND USING THESE STEPS 914 00:32:42,360 --> 00:32:44,560 FOR POSITIONING THE PATIENT 915 00:32:44,560 --> 00:32:48,400 USING THE DEVICE CORRECTLY. THE 916 00:32:48,400 --> 00:32:49,720 CONFIRMATION PIECE IS DONE ONLY 917 00:32:49,720 --> 00:32:51,440 FOR PATIENTS WHO HAVE A 918 00:32:51,440 --> 00:32:52,560 SCREENING BLOOD PRESSURE THAT IS 919 00:32:52,560 --> 00:32:54,880 ABOVE THE THRESHOLD. WE USE AT 920 00:32:54,880 --> 00:32:57,800 THE TIME WE USE THE THRESHOLD OF 921 00:32:57,800 --> 00:32:59,480 140 SYSTOLIC BECAUSE THAT IS 922 00:32:59,480 --> 00:33:01,040 WHAT THE GUIDELINES SAID AT THE 923 00:33:01,040 --> 00:33:04,720 TIME. NOW THEY CHANGED TO 130. 924 00:33:04,720 --> 00:33:07,400 THAT IS WHERE WE STARTED OUT. IF 925 00:33:07,400 --> 00:33:09,120 PEOPLE HAD A HIGH SCREENING 926 00:33:09,120 --> 00:33:10,920 BLOOD PRESSURE, THE STAFF WERE 927 00:33:10,920 --> 00:33:15,000 TRAINED TO THEN CONFIRM IT, THE 928 00:33:15,000 --> 00:33:16,120 CONFIRMATORY MEASUREMENT 929 00:33:16,120 --> 00:33:18,800 BASICALLY ALLOWS THE DEVICE TO 930 00:33:18,800 --> 00:33:21,160 COLLECT THREE BACK TO BACK 931 00:33:21,160 --> 00:33:24,280 READINGS WITH A FIVE MINUTE WAIT 932 00:33:24,280 --> 00:33:26,000 IN BETWEEN. EACH READING AND 933 00:33:26,000 --> 00:33:28,240 THOSE READINGS ARE AVERAGED. 934 00:33:28,240 --> 00:33:29,600 THEN IF THE PATIENT STILL HAD A 935 00:33:29,600 --> 00:33:32,360 HIGH BROOD PRESSURE READING 936 00:33:32,360 --> 00:33:34,480 AFTER CONFIRMATORY MEASURE THEY 937 00:33:34,480 --> 00:33:36,520 ARE DEEMED UNCONTROLLED BLOOD 938 00:33:36,520 --> 00:33:38,680 PRESSURE. SO AGAIN, THE 939 00:33:38,680 --> 00:33:40,960 LEADERSHIP INTERVENTION INVOLVED 940 00:33:40,960 --> 00:33:42,760 INTRODUCTORY SESSION, QUARTERLY 941 00:33:42,760 --> 00:33:44,560 WEBINARS, AS WELL AS COACHING 942 00:33:44,560 --> 00:33:46,080 CALLS, BUT THE COACHING CALLS 943 00:33:46,080 --> 00:33:48,080 WERE ONLY FOR THE MORE INTENSIVE 944 00:33:48,080 --> 00:33:50,040 ARM OF THE STUDY, NOT FOR THE 945 00:33:50,040 --> 00:33:53,240 STANDARD ARM. AGAIN, SEVERAL 946 00:33:53,240 --> 00:33:56,640 TOPICS ALL WAY FROM THINGS LIKE 947 00:33:56,640 --> 00:33:59,880 ADDRESSING INEQUITIES, ON YOUR 948 00:33:59,880 --> 00:34:01,000 DASHBOARD, WORKING WITH 949 00:34:01,000 --> 00:34:04,800 COMMUNITY PARTNERS, ADDRESSING 950 00:34:04,800 --> 00:34:06,360 PATIENT SOCIAL NEEDS, 951 00:34:06,360 --> 00:34:09,320 PSYCHOLOGICAL SAFETY FOR YOUR 952 00:34:09,320 --> 00:34:14,000 EMPLOYEES. ADDRESSING IMPLICIT 953 00:34:14,000 --> 00:34:19,160 BIAS, SEVERAL TOPICS OF INTEREST 954 00:34:19,160 --> 00:34:20,400 THAT WE DEVELOPED BASICALLY 955 00:34:20,400 --> 00:34:21,760 BASED ON INPUT FROM OUR 956 00:34:21,760 --> 00:34:24,720 STAKEHOLDERS. ARM TWO OF THE 957 00:34:24,720 --> 00:34:28,560 TRIAL HAD ALL OF THOSE STANDARD 958 00:34:28,560 --> 00:34:30,120 OF CARE ELEMENTS PLUS THE 959 00:34:30,120 --> 00:34:31,640 MONTHLY COACHING CALL FOR THE 960 00:34:31,640 --> 00:34:35,000 CLINIC BASED CHAMPIONS. A 961 00:34:35,000 --> 00:34:36,320 DASHBOARD REVIEW FACILITATED BY 962 00:34:36,320 --> 00:34:39,600 THE CLINIC CHAMPION SO NOT JUST 963 00:34:39,600 --> 00:34:42,240 HAVING THE DASHBOARD AVAILABLE 964 00:34:42,240 --> 00:34:45,000 BUT HAVING A PROCESS BY WHICH TO 965 00:34:45,000 --> 00:34:47,120 REVIEW THAT DASHBOARD AND COME 966 00:34:47,120 --> 00:34:49,400 UP WITH IMPROVEMENT PLANS. THEN 967 00:34:49,400 --> 00:34:51,760 THE ADDITION OF A CARE MANAGER 968 00:34:51,760 --> 00:34:54,960 TO THE TEAM. SO THE CARE MANAGER 969 00:34:54,960 --> 00:34:56,920 WAS ADDED TO THE TEAM WHICH 970 00:34:56,920 --> 00:34:58,480 INCLUDED THE PRIMARY CARE 971 00:34:58,480 --> 00:34:59,440 PROVIDER AND THE PATIENT AND THE 972 00:34:59,440 --> 00:35:02,720 CARE MANAGER THEN HAD THE OPTION 973 00:35:02,720 --> 00:35:04,200 OF ALSO WHAT WE CALL STEPPING 974 00:35:04,200 --> 00:35:06,360 THE PATIENT UP. IF THE PATIENT 975 00:35:06,360 --> 00:35:09,880 WAS NOT IMPROVING IN BLOOD 976 00:35:09,880 --> 00:35:11,720 PRESSURE OR OTHER ASSOCIATED 977 00:35:11,720 --> 00:35:13,240 CONDITION OVER TIME CARE MANAGER 978 00:35:13,240 --> 00:35:14,480 COULD INCORPORATE THE SUPPORT OF 979 00:35:14,480 --> 00:35:19,480 A COMMUNITY HEALTH WORKER. OR 980 00:35:19,480 --> 00:35:20,880 ENGAGE WITH A SPECIALIST CORE 981 00:35:20,880 --> 00:35:23,200 AVAILABLE THROUGH VIRTUAL 982 00:35:23,200 --> 00:35:25,560 CONSULTATION THE CARE MANAGER 983 00:35:25,560 --> 00:35:28,360 ALSO HAD ACCESS AT ALL TIMES TO 984 00:35:28,360 --> 00:35:30,240 A BEHAVIORAL HEALTH SPECIALIST. 985 00:35:30,240 --> 00:35:31,640 SO IN MOST CASES IN THIS TRIAL 986 00:35:31,640 --> 00:35:33,680 WE USED EXISTING STAFF WITHIN 987 00:35:33,680 --> 00:35:36,400 THE PRACTICES AND TRAIN THEM 988 00:35:36,400 --> 00:35:38,160 BECAUSE WE WANTED THIS TO BE AS 989 00:35:38,160 --> 00:35:40,000 PRAGMATIC AND REALISTIC AS 990 00:35:40,000 --> 00:35:43,080 POSSIBLE SO IT CUB AS 991 00:35:43,080 --> 00:35:46,120 SUSTAINABLE AS POSSIBLE. THE 992 00:35:46,120 --> 00:35:48,000 ORGANIZATIONSES WE WORKED WITH 993 00:35:48,000 --> 00:35:49,520 WERE RESPONSIBLE FOR IDENTIFYING 994 00:35:49,520 --> 00:35:51,080 AND HIRING THESE INDIVIDUALS AND 995 00:35:51,080 --> 00:35:52,080 THE RESEARCH TEAM WORKED WITH 996 00:35:52,080 --> 00:35:53,360 THEM TO TRAIN THEM AND OVERSEE 997 00:35:53,360 --> 00:35:54,520 THEM OVER THE COURSE OF THE 998 00:35:54,520 --> 00:35:58,280 PROJECT. SO THE COMMUNITY HEALTH 999 00:35:58,280 --> 00:35:59,520 WORKERS REALLY PROVIDED 1000 00:35:59,520 --> 00:36:01,720 COMMUNITY BASED 1001 00:36:01,720 --> 00:36:03,160 CONTEXTUALIZATION OF CARE FOR 1002 00:36:03,160 --> 00:36:04,640 PATIENTS IN THIS INTENSIVE ARM. 1003 00:36:04,640 --> 00:36:06,040 THEY WOULD SUPPORT PATIENTS 1004 00:36:06,040 --> 00:36:07,760 REACHING THEIR SELF MANAGEMENT 1005 00:36:07,760 --> 00:36:10,720 GOLDSBY HELPING THEM TO ADDRESS 1006 00:36:10,720 --> 00:36:12,600 ANY SOCIAL AND ENVIRONMENTSAL 1007 00:36:12,600 --> 00:36:13,880 ISSUES, WE ARE THINKING ABOUT 1008 00:36:13,880 --> 00:36:16,360 THINGS LIKE FOOD INSECURITY OR 1009 00:36:16,360 --> 00:36:17,960 HOUSING INSECURITY OR FINANCIAL 1010 00:36:17,960 --> 00:36:18,960 PROBLEMS WITH GETTING 1011 00:36:18,960 --> 00:36:20,800 MEDICATIONS COVERED. THEY WOULD 1012 00:36:20,800 --> 00:36:25,920 ALSO SUPPORT PATIENTS IN 1013 00:36:25,920 --> 00:36:27,920 ADVOCATING FOR THEMSELVES WITH 1014 00:36:27,920 --> 00:36:29,120 THEIR HEALTHCARE PROVIDERS. 1015 00:36:29,120 --> 00:36:30,880 HELP NAVIGATE THE HEALTHCARE 1016 00:36:30,880 --> 00:36:33,680 SYSTEM SO SOME OF OUR PATIENTS 1017 00:36:33,680 --> 00:36:35,360 IN THIS INTERVENTION ARM 1018 00:36:35,360 --> 00:36:40,000 RECEIVED THIS MORE STEPPED UP 1019 00:36:40,000 --> 00:36:41,800 INTENSIVE APPROACH. OTHERS WITH 1020 00:36:41,800 --> 00:36:44,480 MORE MEDICALLY COMPLEX SITUATION 1021 00:36:44,480 --> 00:36:47,480 IT IS CARE MANAGER WOULD OPT TO 1022 00:36:47,480 --> 00:36:48,840 CONSULT WITH A SPECIALIST TEAM 1023 00:36:48,840 --> 00:36:51,600 SO WE HAD SPECIALISTS IN HYPE 1024 00:36:51,600 --> 00:36:54,520 TENSION, DIABETES, PSYCHIATRY, 1025 00:36:54,520 --> 00:36:55,920 PREVENTIVE CARDIOLOGY AND 1026 00:36:55,920 --> 00:36:56,880 SPOKING CESSATION AND DISCUSS 1027 00:36:56,880 --> 00:36:59,760 THE PATIENTS CASE AND PROVIDE 1028 00:36:59,760 --> 00:37:01,040 RECOMMENDATIONS BACK TO PRIMARY 1029 00:37:01,040 --> 00:37:05,040 CARE TEAM. SO I WILL TELL YOU 1030 00:37:05,040 --> 00:37:06,920 ABOUT SOME OF THE IMPLEMENTATION 1031 00:37:06,920 --> 00:37:08,760 PROCESS MEASURES. THEN MOVE ON 1032 00:37:08,760 --> 00:37:14,400 TO RESULTS. WHAT DID WE DO TO 1033 00:37:14,400 --> 00:37:15,760 DETERMINE WHETHER OR NOT OUR 1034 00:37:15,760 --> 00:37:16,960 IMPLEMENTATION WAS ACTUALLY 1035 00:37:16,960 --> 00:37:19,560 SUCCESSFUL? FOR THE BLOOD 1036 00:37:19,560 --> 00:37:20,800 PRESSURE MEASUREMENT PIECE WE 1037 00:37:20,800 --> 00:37:22,040 HAD A NUMBER OF MEASURES. ONE 1038 00:37:22,040 --> 00:37:25,520 WAS CALLED THE TERMINAL DIGIT 1039 00:37:25,520 --> 00:37:28,680 ZERO PREFERENCE. THAT LETS YOU 1040 00:37:28,680 --> 00:37:30,960 KNOW IF YOU CAN THINK OF BLOOD 1041 00:37:30,960 --> 00:37:35,520 PRESSURE DEVICES AS HAVING 1042 00:37:35,520 --> 00:37:37,560 NUMBERS ON THEM AND BETWEEN EACH 1043 00:37:37,560 --> 00:37:40,160 NUMBER THERE IS NUMBERS FROM 1044 00:37:40,160 --> 00:37:45,360 ZERO TO 10. YOU HAVE 130, 131, 1045 00:37:45,360 --> 00:37:49,080 132, 135, 137. 140. WE KNOW WHEN 1046 00:37:49,080 --> 00:37:50,880 PEOPLE DON'T USE AUTOMATED 1047 00:37:50,880 --> 00:37:53,040 DEVICES, THAT OFTEN TIMES IN 1048 00:37:53,040 --> 00:37:53,960 MEASURING BLOOD PRESSURE THERE 1049 00:37:53,960 --> 00:37:56,440 IS UNCERTAINTY AROUND WHAT THE 1050 00:37:56,440 --> 00:37:58,640 MEASURE IS SO PEOPLE TEND TO 1051 00:37:58,640 --> 00:38:00,960 ROUND NUMBERS TO ZERO. WHAT WE 1052 00:38:00,960 --> 00:38:02,480 WERE LOOKING FOR IN OUR MEASURES 1053 00:38:02,480 --> 00:38:05,280 OF BLOOD PRESSURE WE OBTAIN FROM 1054 00:38:05,280 --> 00:38:08,280 ELECTRONIC MEDICAL RECORD IS 1055 00:38:08,280 --> 00:38:10,040 ZERO PREFERENCE WOULD GO DOWN. 1056 00:38:10,040 --> 00:38:11,680 INDEED IT DID, THE ZERO 1057 00:38:11,680 --> 00:38:12,720 PREFERENCE OF THE MEASURES 1058 00:38:12,720 --> 00:38:16,240 BEFORE WE PRODUCED OUR TRAINING 1059 00:38:16,240 --> 00:38:18,000 WAS AROUND 16%, IT WAS REDUCED 1060 00:38:18,000 --> 00:38:20,720 TO ABOUT 11% AFTER OUR TRAINING 1061 00:38:20,720 --> 00:38:23,240 WHICH IS MORE EXPECTED BECAUSE 1062 00:38:23,240 --> 00:38:26,240 IF YOU HAVE NUMBERS FROM 0 TO 9 1063 00:38:26,240 --> 00:38:28,560 YOU EXPECT ZERO DIGIT PREFERENCE 1064 00:38:28,560 --> 00:38:30,920 TO BE SOMEWHERE AROUND 10% SO 1065 00:38:30,920 --> 00:38:34,480 11% IS NOT BAD. WE HAD A MEDIAN 1066 00:38:34,480 --> 00:38:37,320 BLOOD PRESSURE MEASUREMENT 1067 00:38:37,320 --> 00:38:38,760 PERFORMANCE SCORE OR PREPARATION 1068 00:38:38,760 --> 00:38:39,920 SCORE LIKE THINGS LIKE WHETHER 1069 00:38:39,920 --> 00:38:42,520 THE PATIENT WAS SEEDED CORRECTLY 1070 00:38:42,520 --> 00:38:44,440 -- SEATED CORRECT WITH FEET ON 1071 00:38:44,440 --> 00:38:45,760 THE FLOOR AND WHETHER ARM WAS 1072 00:38:45,760 --> 00:38:47,320 ELEVATED AT LEVEL OF HEART. 1073 00:38:47,320 --> 00:38:48,320 WHETHER OR NOT THE PATIENT WAS 1074 00:38:48,320 --> 00:38:49,760 NOT SPEAKING AND HAD EMPTIED 1075 00:38:49,760 --> 00:38:53,000 THEIR BLADDER, SO WE LOOK AT 1076 00:38:53,000 --> 00:38:54,960 MEDIAN BLOOD PRESSURE 1077 00:38:54,960 --> 00:38:56,040 MEASUREMENT PREPARATION SCORE 1078 00:38:56,040 --> 00:38:57,320 BEFORE, MIDWAY THROUGH TRAINING 1079 00:38:57,320 --> 00:38:59,480 AND A YEAR LATER AND WE FOUND 1080 00:38:59,480 --> 00:39:00,600 IMPROVEMENTS IN ALL OF THOSE 1081 00:39:00,600 --> 00:39:03,560 SCORES. NOW, THERE WERE SOME 1082 00:39:03,560 --> 00:39:04,880 SIDES WHERE WE DIDN'T SHOW 1083 00:39:04,880 --> 00:39:06,000 IMPROVEMENTS IN THE MIDDLE OF 1084 00:39:06,000 --> 00:39:08,600 THE STUDY, IN THAT CASE WE WOULD 1085 00:39:08,600 --> 00:39:10,800 SEND OUR TEAM OUT TO DO 1086 00:39:10,800 --> 00:39:11,840 TROUBLESHOOTING AND SOME 1087 00:39:11,840 --> 00:39:13,240 RETRAINING AS NEEDED. SO AT THE 1088 00:39:13,240 --> 00:39:16,160 END OF THE STUDY WE DID SHOW 1089 00:39:16,160 --> 00:39:17,920 IMPROVEMENT IN PRETTY MUCH 1090 00:39:17,920 --> 00:39:19,440 ACROSS THE BOARD IN OUR 1091 00:39:19,440 --> 00:39:20,520 PRACTICES. WE ALSO SAW HIGH 1092 00:39:20,520 --> 00:39:23,400 LEVELS OF ADHERENCE TO THE FIVE 1093 00:39:23,400 --> 00:39:25,240 MINUTE REST PERIOD. BEFORE THE 1094 00:39:25,240 --> 00:39:26,800 CONFIRMATORY MEASUREMENT. SO 1095 00:39:26,800 --> 00:39:29,160 THAT WAS SOMETHING THAT THERE 1096 00:39:29,160 --> 00:39:32,800 WERE PEOPLE NOT ALLOWING THAT 1097 00:39:32,800 --> 00:39:33,960 FIVE MINUTE REST WHEN WE FIRST 1098 00:39:33,960 --> 00:39:37,680 DID THE TRAINING AND AFTER TIME 1099 00:39:37,680 --> 00:39:39,080 WE SAW THEY DID IMPROVE WITH 1100 00:39:39,080 --> 00:39:42,320 THAT AND WE ALSO SAW IMPROVED 1101 00:39:42,320 --> 00:39:44,120 ADHERENCE THREE READINGS 1102 00:39:44,120 --> 00:39:45,600 CONFIRMATORY MEASUREMENT SO THE 1103 00:39:45,600 --> 00:39:46,760 BLOOD PRESSURE MEASUREMENT 1104 00:39:46,760 --> 00:39:48,600 PROGRAM IS A SUCCESS STORY. 1105 00:39:48,600 --> 00:39:50,880 THERE ARE SOME PRACTICES THAT 1106 00:39:50,880 --> 00:39:52,840 WERE SCORE -- CERTAINLY SCORED 1107 00:39:52,840 --> 00:39:54,000 BETTER THAN OTHERS SO WE KNOW 1108 00:39:54,000 --> 00:39:55,400 THERE IS SOME UNIQUE 1109 00:39:55,400 --> 00:39:56,600 ORGANIZATIONAL FACTORS THAT 1110 00:39:56,600 --> 00:39:58,000 COULD CONTRIBUTE TO THAT, FOR 1111 00:39:58,000 --> 00:39:59,360 EXAMPLE WE HAD A CHAMPION WHO 1112 00:39:59,360 --> 00:40:01,560 WAS REALLY ENGAGING THIS PROCESS 1113 00:40:01,560 --> 00:40:03,440 WE DEFINITELY SAW GREATER 1114 00:40:03,440 --> 00:40:04,440 IMPROVEMENTS IN THE BLOOD 1115 00:40:04,440 --> 00:40:06,520 PRESSURE SCORE. SO HERE ARE SOME 1116 00:40:06,520 --> 00:40:08,600 OTHER MEASURES OF 1117 00:40:08,600 --> 00:40:09,560 IMPLEMENTATION. FOR CARE 1118 00:40:09,560 --> 00:40:11,800 MANAGEMENT WE SAW THAT OUR 1119 00:40:11,800 --> 00:40:13,760 CARING MANAGERS CONDUCTED OVER 1120 00:40:13,760 --> 00:40:17,720 4,000 VISITS. SO 88% OF THE 1121 00:40:17,720 --> 00:40:19,320 PATIENTS WHO WERE ASSIGNED TO 1122 00:40:19,320 --> 00:40:21,000 THIS ARM DID ATTEND ONE CARE 1123 00:40:21,000 --> 00:40:23,640 MANAGEMENT VISIT AND 77% 1124 00:40:23,640 --> 00:40:26,360 ATTENDED TWO OR MORE. MOST OF 1125 00:40:26,360 --> 00:40:29,840 THESE VISITS WERE BY THEM PHONE. 1126 00:40:29,840 --> 00:40:31,400 AS BUT KNOW THE STUDY BEGAN 1127 00:40:31,400 --> 00:40:33,000 BEFORE THE PANDEMIC BUT IT DID 1128 00:40:33,000 --> 00:40:34,040 OCCUR DURING THE PANDEMIC SO I 1129 00:40:34,040 --> 00:40:36,600 BELIEVE THAT THAT PROBABLY 1130 00:40:36,600 --> 00:40:38,000 INFLUENCED THE MODE OF DELIVERY 1131 00:40:38,000 --> 00:40:39,720 OF THE INTERVENTION IN SOME 1132 00:40:39,720 --> 00:40:43,080 WAYS. BUT PEOPLE WHO COULDN'T 1133 00:40:43,080 --> 00:40:44,400 MEET THE CARE MANAGER IN PERSON 1134 00:40:44,400 --> 00:40:47,440 DID MEET BY PHONE AND CARE 1135 00:40:47,440 --> 00:40:49,680 MANAGER SPENT NOST TIME TALKING 1136 00:40:49,680 --> 00:40:50,920 MEDICAL CONDITIONS WHICH MAKES 1137 00:40:50,920 --> 00:40:53,520 SENSE BECAUSE MOST WERE NURSES. 1138 00:40:53,520 --> 00:40:55,680 SOME CLINICAL SOCIAL WORKERS AND 1139 00:40:55,680 --> 00:40:57,120 THEN THEY SPENT LOWER AMOUNT OF 1140 00:40:57,120 --> 00:40:59,160 TIME TALKING ABOUT LIFESTYLE 1141 00:40:59,160 --> 00:41:02,120 BARRIERS AND SOCIAL DETERMINANTS 1142 00:41:02,120 --> 00:41:04,400 OF HEALTH. THESE TERMS OF 1143 00:41:04,400 --> 00:41:05,960 REFERRALS TO THE STEPPED CARE 1144 00:41:05,960 --> 00:41:09,840 PROGRAM, WE HAD EXPECTED ABOUT 1145 00:41:09,840 --> 00:41:13,000 THE NURSE CARE MANAGERS WOULD 1146 00:41:13,000 --> 00:41:14,240 REFER HALF THE PATIENTS TO A 1147 00:41:14,240 --> 00:41:16,840 COMMUNITY HEALTH WORKER WHILE WE 1148 00:41:16,840 --> 00:41:21,200 SAW ABOUT REFERRAL RATE OF 30% 1149 00:41:21,200 --> 00:41:23,240 IN TERMS OF REFERRAL TO 1150 00:41:23,240 --> 00:41:24,520 SPECIALIST INTERVENTION WE SAW 1151 00:41:24,520 --> 00:41:27,760 REFERRAL RATE OF 2%%. YOU CAN SE 1152 00:41:27,760 --> 00:41:29,720 IT VARIED QUITE A BIT ACROSS 1153 00:41:29,720 --> 00:41:31,160 HEALTH SYSTEMS SO THE 30 1154 00:41:31,160 --> 00:41:32,880 PRACTICES IN FIVE DIFFERENT 1155 00:41:32,880 --> 00:41:34,200 HEALTH SYSTEMS AND YOU CAN SEE 1156 00:41:34,200 --> 00:41:36,720 THERE IS ONE HEALTH SYSTEM WHERE 1157 00:41:36,720 --> 00:41:38,600 THERE WAS A HIGH REFERRAL RATE 1158 00:41:38,600 --> 00:41:40,920 FOR COMMUNITY HEALTH PATIENTS TO 1159 00:41:40,920 --> 00:41:42,400 COMMUNITY HEALTH WORKERS, THAT 1160 00:41:42,400 --> 00:41:44,040 WAS A FEDERALLY QUALIFIED 1161 00:41:44,040 --> 00:41:45,640 COMMUNITY HEALTH CENTER AND 1162 00:41:45,640 --> 00:41:47,800 THERE WERE PATIENTS WITH HIGH 1163 00:41:47,800 --> 00:41:49,560 SOCIAL NEEDS BUT THERE IS ALSO 1164 00:41:49,560 --> 00:41:50,800 RECEPTIVITY TO HAVING COMMUNITY 1165 00:41:50,800 --> 00:41:52,440 HEALTH WORKERS BE PART OF THE 1166 00:41:52,440 --> 00:41:53,800 PRIMARY CARE TEAM. SOME OF THE 1167 00:41:53,800 --> 00:41:54,880 BARRIERS WE HEARD ABOUT WERE 1168 00:41:54,880 --> 00:41:57,040 RELATED TO THINGS LIKE PEOPLE 1169 00:41:57,040 --> 00:41:59,960 NOT BEING USED TO WORKING WITH 1170 00:41:59,960 --> 00:42:02,120 COMMUNITY HEALTH WORKER, FEELING 1171 00:42:02,120 --> 00:42:03,560 LIKE THE NURSES FEELING LIKE 1172 00:42:03,560 --> 00:42:04,960 THEY COULD ADDRESS A LOT OF 1173 00:42:04,960 --> 00:42:06,360 ISSUES THE COMMUNITY HEALTH 1174 00:42:06,360 --> 00:42:08,680 WORKERS BEFORE ADDRESSING JUST 1175 00:42:08,680 --> 00:42:11,040 INERTIA IN CHANGING EXISTING 1176 00:42:11,040 --> 00:42:14,240 PRACTICES. FOR THE SPECIALIST 1177 00:42:14,240 --> 00:42:15,960 REFERRAL PIECE, WE LEARNED A LOT 1178 00:42:15,960 --> 00:42:19,120 OF NURSE CARE MANAGERS WERE 1179 00:42:19,120 --> 00:42:20,720 CONCERNED THAT SUGGESTING A 1180 00:42:20,720 --> 00:42:23,040 REFERRAL TO SPECIALIST CORPS 1181 00:42:23,040 --> 00:42:24,480 MIGHT BE OFFENSIVE TO THE 1182 00:42:24,480 --> 00:42:25,920 PRIMARY CARE PROVIDER. 1183 00:42:25,920 --> 00:42:29,000 ESPECIALLY IF THEY SAW THAT THE 1184 00:42:29,000 --> 00:42:30,480 PATIENT WAS ALREADY RECEIVING 1185 00:42:30,480 --> 00:42:31,600 CARE FROM SPECIALISTS SO 1186 00:42:31,600 --> 00:42:33,040 HESITANT TO MAKE REFERRALS AND 1187 00:42:33,040 --> 00:42:35,600 DESPITE THE FACT THAT WE DID A 1188 00:42:35,600 --> 00:42:37,040 LOT OF EXPLAINING TO THEM AROUND 1189 00:42:37,040 --> 00:42:39,200 THE FACT THE SPECIALIST CORE WAS 1190 00:42:39,200 --> 00:42:41,120 NOT TO REPLACE THE PATIENT USUAL 1191 00:42:41,120 --> 00:42:42,960 CARE BUT PROVIDE ADDITIONAL 1192 00:42:42,960 --> 00:42:44,400 SUPPORT THERE WERE STILL LACK OF 1193 00:42:44,400 --> 00:42:48,400 UPTAKE OF THAT INTERVENTION. SO 1194 00:42:48,400 --> 00:42:50,120 LET'S TALK PATIENTS WHO WERE 1195 00:42:50,120 --> 00:42:51,640 REFERRED TO THE COMMUNITY HEALTH 1196 00:42:51,640 --> 00:42:54,600 WORKERS. A COMMUNITY HEALTH 1197 00:42:54,600 --> 00:42:57,560 WORKERS CONDUCTED 600 VISITS, 1198 00:42:57,560 --> 00:42:58,880 91% PEOPLE WHO WERE REFERRING TO 1199 00:42:58,880 --> 00:43:00,080 COMMUNITY HEALTH WORKER HAD AT 1200 00:43:00,080 --> 00:43:01,360 LEAST ONE VISIT WITH THE 1201 00:43:01,360 --> 00:43:02,800 COMMUNITY HEALTH WORKER AND JUST 1202 00:43:02,800 --> 00:43:05,680 OVER HALF OF THEM HAD TWO OR 1203 00:43:05,680 --> 00:43:06,960 MORE. MOST VISITS WERE DONE BY 1204 00:43:06,960 --> 00:43:08,880 PHONE, WE DID HAVE SOME 1205 00:43:08,880 --> 00:43:10,000 COMMUNITY HEALTH WORKERS 1206 00:43:10,000 --> 00:43:12,160 ACTUALLY GO OUT TO PEOPLE'S 1207 00:43:12,160 --> 00:43:14,280 HOMES TO TAKE THEM BLOOD 1208 00:43:14,280 --> 00:43:17,120 PRESSURE MEASUREMENT DEVICES OR 1209 00:43:17,120 --> 00:43:19,040 TRY TO FIND THEM IF THEY HADN'T 1210 00:43:19,040 --> 00:43:21,920 HEARD FROM THEM. TO ACCOMPANY 1211 00:43:21,920 --> 00:43:23,840 THEM TO OTHER APPOINTMENTS AND 1212 00:43:23,840 --> 00:43:25,360 THINGS LIKE THAT. AGAIN WITH THE 1213 00:43:25,360 --> 00:43:26,840 PANDEMIC IT WAS MUCH LESS THAN 1214 00:43:26,840 --> 00:43:28,600 WE HAD EXPECTED. ON THE 1215 00:43:28,600 --> 00:43:29,840 COMMUNITY HEALTH WORKERS TALKED 1216 00:43:29,840 --> 00:43:31,680 ABOUT A VARIETY OF DIFFERENT 1217 00:43:31,680 --> 00:43:34,040 THINGS, SURPRISINGLY A LOT OF 1218 00:43:34,040 --> 00:43:35,080 BIOMEDICAL CONDITIONS BUT THIS 1219 00:43:35,080 --> 00:43:36,160 WAS PROBABLY MORE ABOUT THINGS 1220 00:43:36,160 --> 00:43:37,920 LIKE HOW PEOPLE COULD GET ACCESS 1221 00:43:37,920 --> 00:43:39,880 TO THEIR MEDICATION AND TO OTHER 1222 00:43:39,880 --> 00:43:42,080 MEDICAL SUPPLIES. AND NOT SO 1223 00:43:42,080 --> 00:43:45,360 MUCH ABOUT THE MEDICAL CONDITION 1224 00:43:45,360 --> 00:43:46,480 ITSELF. A LOT OF THOSE 1225 00:43:46,480 --> 00:43:47,960 CONVERSATIONS WERE HOW TO USE A 1226 00:43:47,960 --> 00:43:48,960 HOME BLOOD PRESSURE MONITOR 1227 00:43:48,960 --> 00:43:50,600 WHICH THE COMMUNITY HEALTH 1228 00:43:50,600 --> 00:43:53,600 WORKERS WERE VERY HELPFUL IN 1229 00:43:53,600 --> 00:43:56,080 TEACHING PATIENTS HOW TO USE 1230 00:43:56,080 --> 00:43:58,680 HOME BLOOD PRESSURE MONITORS. 1231 00:43:58,680 --> 00:44:00,040 THEN YOU CAN SEE A LOT OF TIME 1232 00:44:00,040 --> 00:44:01,320 SPENT DEALING WITH SOCIAL 1233 00:44:01,320 --> 00:44:04,040 DETERMINANTS OF HEALTH. GETTING 1234 00:44:04,040 --> 00:44:06,920 ACCESS TO FOOD, TO HOUSING, 1235 00:44:06,920 --> 00:44:09,440 GETTING SIGNED UP FOR HEALTH 1236 00:44:09,440 --> 00:44:11,360 INSURANCE MAKING SURE THEIR 1237 00:44:11,360 --> 00:44:12,280 UTILITIES COULD BE PAID THINGS 1238 00:44:12,280 --> 00:44:16,800 LIKE THAT. SO WE WILL GO ON TO 1239 00:44:16,800 --> 00:44:17,960 RESULTS. BECAUSE WITH E DON'T 1240 00:44:17,960 --> 00:44:19,400 HAVE MUCH MORE TIME LEFT. SO WHO 1241 00:44:19,400 --> 00:44:21,720 ARE THE PATIENTS WE ENROLL? YOU 1242 00:44:21,720 --> 00:44:26,760 CAN SEE WE ENROLLED OVER 1800 1243 00:44:26,760 --> 00:44:30,240 PATIENTS, ON AVERAGE 60 YEARS 1244 00:44:30,240 --> 00:44:34,680 OLDS, 60% WOMEN. WE HAD ALMOST 1245 00:44:34,680 --> 00:44:37,000 60% WHO WORE BLACK. 33% WHITE, 1246 00:44:37,000 --> 00:44:38,920 ABOUT CLOSE TO 10% HISPANIC. WE 1247 00:44:38,920 --> 00:44:42,480 HAD ABOUT A QUARTER WHO WERE ON 1248 00:44:42,480 --> 00:44:43,320 MEDICAID INSURANCE. THERE WERE 1249 00:44:43,320 --> 00:44:46,000 NO DIFFERENCES BETWEEN OUR 1250 00:44:46,000 --> 00:44:47,120 INTERVENTION GROUPS WHEN WE 1251 00:44:47,120 --> 00:44:48,400 ADJUSTED FOR CLUSTERING, THOUGH 1252 00:44:48,400 --> 00:44:49,720 YOU CAN SEE THAT THERE IS A 1253 00:44:49,720 --> 00:44:52,880 LIGHTLY HIGHER PERCENTAGE OF 1254 00:44:52,880 --> 00:44:54,640 MEDICAID AND ENSURED PATIENTS IN 1255 00:44:54,640 --> 00:44:56,560 THE COLLABORATIVE CARE STEPPED 1256 00:44:56,560 --> 00:44:59,720 CARE ARM. THERE WERE ALSO NO 1257 00:44:59,720 --> 00:45:00,720 DIFFERENCES SUBSTANTIAL 1258 00:45:00,720 --> 00:45:03,840 DIFFERENCES CLINICALLY IN THE 1259 00:45:03,840 --> 00:45:04,880 INTERVENTION GROUPS WITH MOST 1260 00:45:04,880 --> 00:45:07,080 PATIENTS HAVING SLIGHTLY 1261 00:45:07,080 --> 00:45:10,080 ELEVATED SYSTOLIC BLOOD PRESSURE 1262 00:45:10,080 --> 00:45:12,400 DIASTOLIC BEING 85.5 ON AVERAGE, 1263 00:45:12,400 --> 00:45:13,680 TO BE IN THE STUDY YOU SIMPLY 1264 00:45:13,680 --> 00:45:15,720 HAD TO HAVE A SYSTOLIC BLOOD 1265 00:45:15,720 --> 00:45:18,640 PRESSURE OF 140 OR GREATER. YOU 1266 00:45:18,640 --> 00:45:20,800 CAN SEE THERE WERE CO-MORBID 1267 00:45:20,800 --> 00:45:22,920 CONDITIONS REPRESENTED WITH THE 1268 00:45:22,920 --> 00:45:26,720 MOST COMMON ONE BEING 1269 00:45:26,720 --> 00:45:27,440 HYPERLIPIDEMIA FOLLOWED BY 1270 00:45:27,440 --> 00:45:29,920 DIABETES. AND NO SUBSTANTIAL 1271 00:45:29,920 --> 00:45:32,960 DIFFERENCES BETWEEN THE TWO 1272 00:45:32,960 --> 00:45:36,040 GROUPS WHEN WE ADJUST FOR 1273 00:45:36,040 --> 00:45:37,080 CLUSTERING BUT SOMEWHAT A 1274 00:45:37,080 --> 00:45:38,640 DIFFERENCE IN THE PREVALENCE OF 1275 00:45:38,640 --> 00:45:39,760 CORONARY HEART DISEASE WITH THAT 1276 00:45:39,760 --> 00:45:41,640 BEING A LITTLE BIT HIGHER IN 1277 00:45:41,640 --> 00:45:42,880 STANDARD OF CARE GROUP THAN IT 1278 00:45:42,880 --> 00:45:44,560 WAS IN THE CC STEPPED CARE 1279 00:45:44,560 --> 00:45:50,200 GROUP. SO WHAT WERE OUR 12 MONTH 1280 00:45:50,200 --> 00:45:51,000 OUTCOME? 1281 00:45:51,000 --> 00:45:53,960 WE SUCCESSFULLY ENGAGED, 1800 1282 00:45:53,960 --> 00:45:55,320 PATIENTS OUR FOLLOW-UP RATES 1283 00:45:55,320 --> 00:45:57,600 WERE APPROXIMATELY 80% IN BOTH 1284 00:45:57,600 --> 00:45:59,240 GROUPS SO NO DIFFERENCES IN 1285 00:45:59,240 --> 00:46:02,040 FOLLOW UP. BETWEEN TWO 1286 00:46:02,040 --> 00:46:04,600 INTERVENTION GROUPS. WE DID HAVE 1287 00:46:04,600 --> 00:46:06,080 PEOPLE WHO SOME WHO WITHDREW 1288 00:46:06,080 --> 00:46:10,000 FROM THE STUDY, BUT MOST 1289 00:46:10,000 --> 00:46:11,640 PATIENTS WHO WE DIDN'T FIND WERE 1290 00:46:11,640 --> 00:46:15,480 THE ONES WHO WERE DECEASED OR 1291 00:46:15,480 --> 00:46:19,840 SIMPLY MOVED OUT OF THE AREA. SO 1292 00:46:19,840 --> 00:46:24,600 WHAT DID WE FIND? WE FOUND THAT 1293 00:46:24,600 --> 00:46:26,520 ABOUT 60% OF THESE PATIENTS 1294 00:46:26,520 --> 00:46:27,680 OBTAINED BLOOD PRESSURE CONTROL 1295 00:46:27,680 --> 00:46:30,280 OVER THE 12 MONTH PERIOD. SO OUT 1296 00:46:30,280 --> 00:46:36,280 OF THE 100% UNCONTROLLED, 60% 1297 00:46:36,280 --> 00:46:39,280 OBTAINED CONTROL OVER TIME. WE 1298 00:46:39,280 --> 00:46:40,400 DIDN'T SEE DIFFERENCES BETWEEN 1299 00:46:40,400 --> 00:46:42,720 THE TWO INTERVENTION GROUPS 1300 00:46:42,720 --> 00:46:44,760 ALTHOUGH YOU CAN SEE THAT AT 1301 00:46:44,760 --> 00:46:49,760 BASELINE BLOOD PRESSURE CONTROL 1302 00:46:49,760 --> 00:46:53,440 WAS BASICALLY LOWER AMONG BLACKS 1303 00:46:53,440 --> 00:46:56,280 HAHN IT WAS AMONG WHITES AND 1304 00:46:56,280 --> 00:46:58,280 HISPANICS. BUT WE DIDN'T SEE ANY 1305 00:46:58,280 --> 00:46:59,920 DIFFERENCES IN BLOOD PRESSURE 1306 00:46:59,920 --> 00:47:01,880 CONTROL OVER TIME. SORRY THIS IS 1307 00:47:01,880 --> 00:47:03,240 NOT AT BASELINE, THIS IS 12 1308 00:47:03,240 --> 00:47:05,240 MONTHS SO WE SAW DISPARITIES IN 1309 00:47:05,240 --> 00:47:06,560 BLOOD PRESSURE LEVELS AT 1310 00:47:06,560 --> 00:47:10,960 BASELINE. UNFORTUNATELY THOSE 1311 00:47:10,960 --> 00:47:12,880 WERE NOT CLOSED AT FOLLOW-UP 1312 00:47:12,880 --> 00:47:15,960 THOUGH EVERYONE DID OBTAIN BLOOD 1313 00:47:15,960 --> 00:47:18,360 PRESSURE CONTROL OVER FOLLOW-UP 1314 00:47:18,360 --> 00:47:19,080 NOT EVERYONE BUT SIMILAR 1315 00:47:19,080 --> 00:47:23,040 CONTROLS. RATES OVER TIME. WHAT 1316 00:47:23,040 --> 00:47:24,520 WE DID DO SOME PRE-PLANNED 1317 00:47:24,520 --> 00:47:26,880 SUBGROUP ANALYSES AND I'M ONLY 1318 00:47:26,880 --> 00:47:27,960 SHOWING A COUPLE HERE BECAUSE 1319 00:47:27,960 --> 00:47:29,480 THESE ARE THE ONES WHERE THERE 1320 00:47:29,480 --> 00:47:31,080 WAS A DIFFERENCE. SO AMONG 1321 00:47:31,080 --> 00:47:35,800 PATIENTS WITH MEDICAID WE SAW 1322 00:47:35,800 --> 00:47:38,080 THAT PATIENTS WITH MEDICAID HAD 1323 00:47:38,080 --> 00:47:40,480 A HIGHER LIKELIHOOD OF OBTAINING 1324 00:47:40,480 --> 00:47:43,600 BLOOD PRESSURE CONTROL WHEN IN 1325 00:47:43,600 --> 00:47:46,120 THE COLLABORATIVE CARE ARM THAN 1326 00:47:46,120 --> 00:47:48,600 PATIENTS WHO WERE NOT ON 1327 00:47:48,600 --> 00:47:50,080 MEDICAID. A SIMILAR PATTERN SEEN 1328 00:47:50,080 --> 00:47:52,240 FOR PEOPLE WITH CORONARY HEART 1329 00:47:52,240 --> 00:47:55,400 DISEASE, THOSE WHO HAD CORONARY 1330 00:47:55,400 --> 00:47:57,440 HEART DISEASE WERE MORE LIKELY 1331 00:47:57,440 --> 00:47:59,240 TO OBTAIN BLOOD PRESSURE CONTROL 1332 00:47:59,240 --> 00:48:01,480 IN COLLABORATIVE CARE ARM THAN 1333 00:48:01,480 --> 00:48:04,920 PEOPLE WHO DIDN'T HAVE CORONARY 1334 00:48:04,920 --> 00:48:08,520 HEART DISEASE. WHEN WE LOOK AT 1335 00:48:08,520 --> 00:48:10,280 REDUCTION IN SYSTOLIC BLOOD 1336 00:48:10,280 --> 00:48:11,720 PRESSURE OVER TIME IT WAS 1337 00:48:11,720 --> 00:48:12,960 CLINICALLY AND STATISTICALLY 1338 00:48:12,960 --> 00:48:15,240 SIGNIFICANT IN BOTH REDUCTION 1339 00:48:15,240 --> 00:48:17,920 ARMSES WITH REDUCTION IN 14 TO 1340 00:48:17,920 --> 00:48:19,120 15-MILLIMETERS OF MERCURY AND 1341 00:48:19,120 --> 00:48:21,120 SYSTOLIC BLOOD PRESSURE IN BOTH 1342 00:48:21,120 --> 00:48:23,000 GROUPS AND REDUCTION ANYWHERE 1343 00:48:23,000 --> 00:48:25,400 FROM 6 TO 7-MILLIMETERS OF 1344 00:48:25,400 --> 00:48:27,040 MERCURY FOR DIASTOLIC BLOOD 1345 00:48:27,040 --> 00:48:29,240 PRESSURE. THE DIFFERENCE BETWEEN 1346 00:48:29,240 --> 00:48:30,840 THE TWO INTERVENTION GROUPS WAS 1347 00:48:30,840 --> 00:48:33,040 ONLY SIGNIFICANT FOR DIASTOLIC 1348 00:48:33,040 --> 00:48:34,480 BLOOD PRESSURE WHERE PATIENTS IN 1349 00:48:34,480 --> 00:48:36,360 THE CC STEPPED CARE ARM HAD A 1350 00:48:36,360 --> 00:48:38,680 SLIGHTLY GREATER IMPROVEMENT IN 1351 00:48:38,680 --> 00:48:40,720 DIASTOLIC THAN THOSE FINAL 1352 00:48:40,720 --> 00:48:44,040 STANDARD ARM. IN TERMS OF 1353 00:48:44,040 --> 00:48:45,960 PATIENT REPORTED OUTCOMES WE SAW 1354 00:48:45,960 --> 00:48:47,840 IMPROVEMENT IN PATIENT 1355 00:48:47,840 --> 00:48:49,960 ACTIVATION. IN BOTH GROUPS THAT 1356 00:48:49,960 --> 00:48:51,600 WERE NOT SIGNIFICANTLY DIFFERENT 1357 00:48:51,600 --> 00:48:53,800 BETWEEN GROUPS. WE DID SEE 1358 00:48:53,800 --> 00:48:55,240 IMPROVEMENT IN PATIENTS 1359 00:48:55,240 --> 00:48:56,840 ASSESSMENT OF CHRONIC ILLNESS 1360 00:48:56,840 --> 00:48:59,360 CARE IN BOTH GROUPS THAT WAS 1361 00:48:59,360 --> 00:49:00,800 SLIGHTLY GREATER IN THE 1362 00:49:00,800 --> 00:49:01,680 COLLABORATIVE CARE STEPPED CARE 1363 00:49:01,680 --> 00:49:05,840 ARM. SO WHAT DID WE LEARN? WE 1364 00:49:05,840 --> 00:49:07,880 LEARNED ENHANCED STANDARD OF 1365 00:49:07,880 --> 00:49:09,080 CARE PROGRAM IMPROVED BLOOD 1366 00:49:09,080 --> 00:49:12,240 PRESSURE CONTROL SUBSTANTIALLY. 1367 00:49:12,240 --> 00:49:14,600 PATIENTS WITH HYPERTENSION AND 1368 00:49:14,600 --> 00:49:15,840 ASSOCIATED CO-MORBIDITIES. WHEN 1369 00:49:15,840 --> 00:49:18,080 WE ADDED A COLLABORATIVE CARE 1370 00:49:18,080 --> 00:49:19,760 PIECE TO THAT, WE SAW SIMILAR 1371 00:49:19,760 --> 00:49:21,560 BENEFITS FOR BLOOD PRESSURE 1372 00:49:21,560 --> 00:49:24,200 CONTROL. OVERALL BLOOD PRESSURE 1373 00:49:24,200 --> 00:49:26,240 LEVELS. WE DID SEE SOME GREATER 1374 00:49:26,240 --> 00:49:27,920 IMPROVEMENTS FOR PATIENTS WITH 1375 00:49:27,920 --> 00:49:29,240 MEDICAID INSURANCE AN PATIENTS 1376 00:49:29,240 --> 00:49:31,440 WITH CORONARY HEART DISEASE IN 1377 00:49:31,440 --> 00:49:33,440 THAT INTERVENTION. AND WE SAW 1378 00:49:33,440 --> 00:49:35,240 SOME GREATER IMPROVEMENTS IN 1379 00:49:35,240 --> 00:49:36,920 PATIENT EXPERIENCES OF CHRONIC 1380 00:49:36,920 --> 00:49:39,160 ILLNESS CARE. SO WE CONCLUDED 1381 00:49:39,160 --> 00:49:42,120 THAT O TO REDUCE DISPARITIES IN 1382 00:49:42,120 --> 00:49:42,880 HYPERTENSION HEALTH SYSTEM 1383 00:49:42,880 --> 00:49:44,840 LEADERS AND POLICY MAKERS SHOULD 1384 00:49:44,840 --> 00:49:45,640 SUPPORT MULTI-LEVEL 1385 00:49:45,640 --> 00:49:46,800 INTERVENTIONS AND RESERVE THE 1386 00:49:46,800 --> 00:49:47,920 MOST INTENSIVE APPROACHES FOR 1387 00:49:47,920 --> 00:49:49,480 PATIENTS WITH COMPLEX MEDICAL 1388 00:49:49,480 --> 00:49:50,800 AND SOCIAL NEEDS. THAT THERE IS 1389 00:49:50,800 --> 00:49:53,600 A NEED FOR FURTHER RESEARCH TO 1390 00:49:53,600 --> 00:49:55,360 ADDRESS AND ELUCIDATE 1391 00:49:55,360 --> 00:49:56,560 IMPLEMENTATION BARRIERS. SO WE 1392 00:49:56,560 --> 00:49:58,080 HAVE A FEW MINUTES LEFT, I'M 1393 00:49:58,080 --> 00:50:01,000 GOING TO TALK ABOUT SOME 1394 00:50:01,000 --> 00:50:02,440 CHALLENGES AND OPPORTUNITIES. 1395 00:50:02,440 --> 00:50:04,680 ONE OF OUR I THINK OUR REAL 1396 00:50:04,680 --> 00:50:05,960 STRENGTHS AND CONTINUED 1397 00:50:05,960 --> 00:50:08,040 OPPORTUNITIES IS IN THE 1398 00:50:08,040 --> 00:50:09,080 EXTENSIVE ENGAGEMENT WITH A 1399 00:50:09,080 --> 00:50:10,840 BROAD GROUP OF STAKEHOLDERS, WE 1400 00:50:10,840 --> 00:50:12,680 HAD PEOPLE FROM ALL LEVELS OF 1401 00:50:12,680 --> 00:50:13,520 HEALTH SYSTEM INVOLVED IN 1402 00:50:13,520 --> 00:50:16,160 GETTING INPUT TO THE DESIGN AND 1403 00:50:16,160 --> 00:50:17,520 IMPLEMENTATION OF THE TRIAL AS 1404 00:50:17,520 --> 00:50:20,600 WELL AS WE HAD PATIENTS AND 1405 00:50:20,600 --> 00:50:22,000 COMMUNITY MEMBERS ON OUR 1406 00:50:22,000 --> 00:50:23,920 ADVISORY BOARD AND LEADERSES OF 1407 00:50:23,920 --> 00:50:25,400 COMMUNITY BASED ORGANIZATIONS. 1408 00:50:25,400 --> 00:50:27,000 WE HAD THE INVOLVEMENT OF FIVE 1409 00:50:27,000 --> 00:50:29,200 HEALTH SYSTEMS THAT INCLUDED 1410 00:50:29,200 --> 00:50:31,040 FQHCs, WE INCLUDED DIVERSE 1411 00:50:31,040 --> 00:50:32,480 POPULATION AT HIGH RISK AND WE 1412 00:50:32,480 --> 00:50:34,000 USED EXISTING STAFF, SO THERE 1413 00:50:34,000 --> 00:50:36,400 ARE PLENTY OF OPPORTUNITIES HERE 1414 00:50:36,400 --> 00:50:39,680 TO USE EXISTING RESOURCES AND 1415 00:50:39,680 --> 00:50:42,080 STAFF TO BRING ABOUT CHANGES. 1416 00:50:42,080 --> 00:50:44,120 SOME OF THE CHALLENGES WERE 1417 00:50:44,120 --> 00:50:46,400 USING AN ACTIVE COMPARATOR GROUP 1418 00:50:46,400 --> 00:50:48,640 MADE IT SOMEWHAT DIFFICULT TO 1419 00:50:48,640 --> 00:50:50,480 DETERMINE, TO DETECT A 1420 00:50:50,480 --> 00:50:54,720 DIFFERENCE OFFERED BY ADDING THE 1421 00:50:54,720 --> 00:50:56,560 PATIENT FACING COMPONENT. THERE 1422 00:50:56,560 --> 00:50:58,360 MAY HAVE BEEN SOME CONTAMINATION 1423 00:50:58,360 --> 00:50:59,560 BETWEEN PRACTICES IN THE SAME 1424 00:50:59,560 --> 00:51:01,800 HEALTH SYSTEM. WE HAD SOME 1425 00:51:01,800 --> 00:51:02,880 IMPLEMENTATION BARRIERS WHICH WE 1426 00:51:02,880 --> 00:51:04,920 CAN GO INTO MORE DETAIL WITH IN 1427 00:51:04,920 --> 00:51:07,360 OUR DISCUSSION PERIOD. WE DID 1428 00:51:07,360 --> 00:51:10,000 USE CLINIC BASED MEASUREMENTS OF 1429 00:51:10,000 --> 00:51:11,360 BLOOD PRESSURE FOR OUTCOMES SO 1430 00:51:11,360 --> 00:51:12,640 WE DIDN'T HAVE RESEARCH STAFF 1431 00:51:12,640 --> 00:51:15,080 BUT USED CLINIC BASED 1432 00:51:15,080 --> 00:51:15,960 MEASUREMENTS BUT WE THOUGHT THAT 1433 00:51:15,960 --> 00:51:18,800 WAS A GOOD WAY TO HAVE -- TO USE 1434 00:51:18,800 --> 00:51:20,760 PRAGMATIC MEASURES, MEASURES 1435 00:51:20,760 --> 00:51:22,640 THAT WOULD BE USED IN CLINICAL 1436 00:51:22,640 --> 00:51:24,960 CARE AND WITH TRAINING WE 1437 00:51:24,960 --> 00:51:26,480 PROVIDED AND THE FIDELITY TO 1438 00:51:26,480 --> 00:51:28,120 TRAINING WE REALLY FELT 1439 00:51:28,120 --> 00:51:29,160 COMFORTABLE ABOUT QUALITY OF THE 1440 00:51:29,160 --> 00:51:30,840 BLOOD PRESSURE MEASUREMENTS. WE 1441 00:51:30,840 --> 00:51:33,040 DID HAVE SOME DISRUPTIONS DURING 1442 00:51:33,040 --> 00:51:34,440 THE COVID-19 ALL THESE ARE REAL 1443 00:51:34,440 --> 00:51:35,760 LIFE THINGS THAT HAPPEN. WE HAD 1444 00:51:35,760 --> 00:51:37,240 SOME LIMITED STATISTICAL POWER 1445 00:51:37,240 --> 00:51:39,280 FOR SOME OF OUR SUBGROUP 1446 00:51:39,280 --> 00:51:41,240 ANALYSES. WE KNOW RELATIONSHIPS 1447 00:51:41,240 --> 00:51:44,400 CENTERED APPROACHES AND 1448 00:51:44,400 --> 00:51:45,640 ENGAGEMENTS IS IMPORTANT AND 1449 00:51:45,640 --> 00:51:48,520 KNOW SOME ORGANIZATIONAL FACTORS 1450 00:51:48,520 --> 00:51:49,880 CAN CONSTRAIN SUCCESSFUL 1451 00:51:49,880 --> 00:51:50,960 IMPLEMENTATION SO WE WANT TO 1452 00:51:50,960 --> 00:51:52,600 LEARN MORE ABOUT THOSE THROUGH 1453 00:51:52,600 --> 00:51:54,760 OUR -- SOME OF OUR 1454 00:51:54,760 --> 00:51:56,920 IMPLEMENTATION MEASURES. WE KNOW 1455 00:51:56,920 --> 00:51:59,760 STAFFING AND FINANCIAL ISSUES 1456 00:51:59,760 --> 00:52:01,040 WERE PROBLEM FOR MANY OF OUR 1457 00:52:01,040 --> 00:52:03,280 SETTINGS. WE KNOW THERE WAS A 1458 00:52:03,280 --> 00:52:05,560 LOT OF TURN-OVER. THERE WERE 1459 00:52:05,560 --> 00:52:08,160 SOME COMPETING PRIORITIES 1460 00:52:08,160 --> 00:52:10,560 INCLUDING COVID-19. THERE IS 1461 00:52:10,560 --> 00:52:12,560 ORGANIZATIONAL INERTIA AND SOME 1462 00:52:12,560 --> 00:52:14,160 INDIVIDUAL ATTITUDE AND 1463 00:52:14,160 --> 00:52:15,360 BEHAVIORS OF STAFF MEMBERS THAT 1464 00:52:15,360 --> 00:52:17,640 HAVE TO BE ADDRESSED STILL. SO 1465 00:52:17,640 --> 00:52:20,240 I'M GOING TO WRAP UP WITH JUST A 1466 00:52:20,240 --> 00:52:21,760 SNAP SHOT OF SOME OF OUR CURRENT 1467 00:52:21,760 --> 00:52:24,080 RESEARCH TO ADVANCE 1468 00:52:24,080 --> 00:52:25,080 CARDIOMETABOLIC HEALTH EQUITY. 1469 00:52:25,080 --> 00:52:27,000 SO WE HAVE BEEN FUNDED RECENTLY 1470 00:52:27,000 --> 00:52:31,960 BY NIMHD TO CONDUCT A SERIES OF 1471 00:52:31,960 --> 00:52:34,080 STUDIES IN THE MID ATLANTIC 1472 00:52:34,080 --> 00:52:36,320 REGION. THAT WILL ADDRESS NOT 1473 00:52:36,320 --> 00:52:38,560 ONLY HYPERTENSION BUT OTHER 1474 00:52:38,560 --> 00:52:39,560 CARDIOMETABOLIC CONDITIONS. SO 1475 00:52:39,560 --> 00:52:41,160 WE WILL BE TESTING THE 1476 00:52:41,160 --> 00:52:42,280 EFFECTIVENESS OF THESE 1477 00:52:42,280 --> 00:52:43,640 INTERVENTIONS USING COMMUNITY 1478 00:52:43,640 --> 00:52:45,440 BASED RESEARCH AND PATIENT 1479 00:52:45,440 --> 00:52:47,440 CENTERED OUTCOMES PRINCIPLES. 1480 00:52:47,440 --> 00:52:48,920 AND THEN AGAIN USING THIS 1481 00:52:48,920 --> 00:52:50,080 KNOWLEDGE TO PROMOTE CHANGES IN 1482 00:52:50,080 --> 00:52:52,960 PRACTICE AND POLICY IN -- ACROSS 1483 00:52:52,960 --> 00:52:54,600 MARYLAND AND THE MID ATLANTIC 1484 00:52:54,600 --> 00:52:56,360 REGION. WE ARE FOCUSING ON 1485 00:52:56,360 --> 00:52:57,320 SOCIALLY DISADVANTAGED 1486 00:52:57,320 --> 00:52:58,400 POPULATIONS IN A NUMBER OF 1487 00:52:58,400 --> 00:53:00,680 DIFFERENT COMMUNITIES ACROSS THE 1488 00:53:00,680 --> 00:53:02,840 STATE, RURAL AS WELL AS URBAN 1489 00:53:02,840 --> 00:53:04,640 LOOKING AT A VARIETY OF 1490 00:53:04,640 --> 00:53:07,120 DIFFERENT CARDIOMETABOLIC 1491 00:53:07,120 --> 00:53:09,160 FACTORS. WE HAVE THESE THREE 1492 00:53:09,160 --> 00:53:12,720 TRIALS, ONE FOCUSES ON PEOPLE IN 1493 00:53:12,720 --> 00:53:15,040 THE PREGNANCY AND POSTPARTUM 1494 00:53:15,040 --> 00:53:17,240 PERIOD, TRYING TO INTERVENE WITH 1495 00:53:17,240 --> 00:53:20,360 HEIGHT RISK GROUP. WE KNOW 1496 00:53:20,360 --> 00:53:21,760 MATERNAL MORTALITY DISPARITIES 1497 00:53:21,760 --> 00:53:24,520 ARE DRIVEN IN LARGE PART BY 1498 00:53:24,520 --> 00:53:25,040 CARDIOVASCULAR AND 1499 00:53:25,040 --> 00:53:27,000 CARDIOMETABOLIC INEQUITIES. 1500 00:53:27,000 --> 00:53:28,440 ANOTHER STUDY FOCUSED ON 1501 00:53:28,440 --> 00:53:31,480 INDIVIDUALS WITH EARLY HEART 1502 00:53:31,480 --> 00:53:33,400 FAILURE AND ONE AGAIN FOCUSED ON 1503 00:53:33,400 --> 00:53:34,920 HYPERTENSION DIABETES AND 1504 00:53:34,920 --> 00:53:37,560 CHRONIC KIDNEY DISEASE BUT THIS 1505 00:53:37,560 --> 00:53:40,640 TIME USING TELEMEDICINE AND 1506 00:53:40,640 --> 00:53:42,520 TELEMONITORING APPROACHES TO 1507 00:53:42,520 --> 00:53:46,760 ENGAGE PATIENTS AND TO IMPROVE 1508 00:53:46,760 --> 00:53:50,080 THEIR SELF-MANAGEMENT PROCED 1509 00:53:50,080 --> 00:53:52,000 PROCEDURES. SO WHEN WE ARE DOING 1510 00:53:52,000 --> 00:53:53,240 THIS WE HAVE TO BE MINDFUL OF 1511 00:53:53,240 --> 00:53:55,040 THE FACT THAT OUR WORK SHOULD BE 1512 00:53:55,040 --> 00:53:56,480 INFORMATIVE TO POLICY MAKERS AND 1513 00:53:56,480 --> 00:53:58,720 I JUST WANTED TO SAY THAT IT HAS 1514 00:53:58,720 --> 00:54:00,640 BEEN AN HONOR AND PRIVILEGE TO 1515 00:54:00,640 --> 00:54:02,480 PROVIDED A VICE TO POLICY MAKERS 1516 00:54:02,480 --> 00:54:04,280 IN MARYLAND AS WELL AS TO SERVE 1517 00:54:04,280 --> 00:54:06,600 ON NATIONAL ACADEMIES COMMITTEES 1518 00:54:06,600 --> 00:54:08,720 TO PROVIDE CONGRESSIONAL 1519 00:54:08,720 --> 00:54:10,640 TESTIMONIES ON THESE ISSUES, TO 1520 00:54:10,640 --> 00:54:12,600 PROVIDE BRIEFINGS, TO POLICY 1521 00:54:12,600 --> 00:54:14,520 MAKERS AT ALL LEVELS DURING 1522 00:54:14,520 --> 00:54:17,120 COVID-19 AND ALSO TO CONTRIBUTE 1523 00:54:17,120 --> 00:54:18,480 TO POLICY BRIEF AND REPORTS, 1524 00:54:18,480 --> 00:54:21,760 WHETHER IT IS ABOUT CHANGES IN 1525 00:54:21,760 --> 00:54:24,320 HOSPITAL PERFORMANCE AND 1526 00:54:24,320 --> 00:54:26,080 MEASUREMENT REWARD SYSTEMS AND 1527 00:54:26,080 --> 00:54:28,000 WHETHER IT IS LIKE ADVISING HOW 1528 00:54:28,000 --> 00:54:29,760 TO ADVANCING SUSTAINED COMMUNITY 1529 00:54:29,760 --> 00:54:32,600 HEALTH WORKER WORK FORCE. WE 1530 00:54:32,600 --> 00:54:34,640 HAVE -- WE SEE MULTIPLE 1531 00:54:34,640 --> 00:54:36,200 OPPORTUNITIES FOR FUTURE POLICY 1532 00:54:36,200 --> 00:54:38,160 ENGAGEMENT, FOR EXAMPLE IMPLICIT 1533 00:54:38,160 --> 00:54:41,320 BIAS TRAINING AREA. THAT'S BEEN 1534 00:54:41,320 --> 00:54:43,280 MANDATED IN SO MANY STATES, WHAT 1535 00:54:43,280 --> 00:54:44,600 CAN WE DO TO BE SURE 1536 00:54:44,600 --> 00:54:47,960 IMPLEMENTATION IS SUCCESSFUL? 1537 00:54:47,960 --> 00:54:49,160 LEGISLATION TO OFF LOAD 1538 00:54:49,160 --> 00:54:51,080 FINANCIAL BURDEN ON PATIENTS. 1539 00:54:51,080 --> 00:54:52,280 SUPPORT FOR COMMUNITY HEALTH 1540 00:54:52,280 --> 00:54:54,320 WORKERS AND THEN ALSO HEALTH 1541 00:54:54,320 --> 00:54:55,560 SYSTEM COLLECTION OF SOCIAL 1542 00:54:55,560 --> 00:54:56,680 DETERMINANTS DATA AND HOW THEY 1543 00:54:56,680 --> 00:55:01,080 USE IT. WE KNOW IT IS NOT ONLY 1544 00:55:01,080 --> 00:55:04,560 ABOUT RESEARCH BUT IT IS ABOUT 1545 00:55:04,560 --> 00:55:05,280 ENGAGEMENT TOWARDS ACTION 1546 00:55:05,280 --> 00:55:08,000 BECAUSE IT WILL TAKE TRANSLATION 1547 00:55:08,000 --> 00:55:11,000 OF SCIENCE INTO PRACTICE AND 1548 00:55:11,000 --> 00:55:13,040 POLICY IF WE WANT TO ACHIEVE 1549 00:55:13,040 --> 00:55:14,760 HEALTH EQUITY WHICH IS WHAT 1550 00:55:14,760 --> 00:55:16,160 EVERY PERSON HAS THE OPPORTUNITY 1551 00:55:16,160 --> 00:55:18,080 TO OBTAIN HIS OR HER FULL 1552 00:55:18,080 --> 00:55:19,920 POTENTIAL. I WANT TO JUST 1553 00:55:19,920 --> 00:55:24,360 ACKNOWLEDGE ALL THE MANY PEOPLE 1554 00:55:24,360 --> 00:55:25,880 COLLEAGUES ACROSS THE SPECTRUM, 1555 00:55:25,880 --> 00:55:27,560 COMMUNITY PARTNERS, STAFF 1556 00:55:27,560 --> 00:55:29,760 MEMBERS WHO DO A LOT OF DAY TO 1557 00:55:29,760 --> 00:55:32,000 DAY WORK, PARTNERS IN THE HEALTH 1558 00:55:32,000 --> 00:55:35,240 SYSTEM AND COMMUNITY WHETHER 1559 00:55:35,240 --> 00:55:37,000 ORGANIZATIONS MORE INVESTIGATORS 1560 00:55:37,000 --> 00:55:39,640 AND STAFF AND AGAIN OUR 1561 00:55:39,640 --> 00:55:42,240 COMMUNITY ADVISORY BOARD OVER 65 1562 00:55:42,240 --> 00:55:43,480 PEOPLE HAVE BEEN COMMITTED TO 1563 00:55:43,480 --> 00:55:46,280 THIS WORK FOR MORE THAN A 1564 00:55:46,280 --> 00:55:49,280 DECADE. I WILL CLOSE BY LEAVING 1565 00:55:49,280 --> 00:55:51,240 YOU WITH AN OPTION IF YOU ARE 1566 00:55:51,240 --> 00:55:52,720 INTERESTED IN READING MORE ABOUT 1567 00:55:52,720 --> 00:55:54,360 THIS OR LEARNING MORE ABOUT 1568 00:55:54,360 --> 00:55:56,320 THIS, IN MY BOOK WHY ARE HEALTH 1569 00:55:56,320 --> 00:55:57,360 DISPARITIES EVERYONE'S PROBLEM? 1570 00:55:57,360 --> 00:56:00,000 THERE IS A DISCOUNT CODE THAT IS 1571 00:56:00,000 --> 00:56:00,800 SHOWN ON THE SLIDE AND THAT WILL 1572 00:56:00,800 --> 00:56:05,680 BE PROVIDED TO YOU LATER. I WILL 1573 00:56:05,680 --> 00:56:07,680 CLOSE AND SAY THANK YOU. 1574 00:56:07,680 --> 00:56:12,240 >>THANK YOU, DR. COOPER. 1575 00:56:12,240 --> 00:56:14,960 TERRIFIC PRESENTATION. WE HAVE 1576 00:56:14,960 --> 00:56:19,880 TIME FOR ONE OR TWO QUESTIONS. 1577 00:56:19,880 --> 00:56:21,440 SPEAKER5: MIGHT BE A LITTLE 1578 00:56:21,440 --> 00:56:22,800 FEEDBACK DR. MURRAY. I DON'T 1579 00:56:22,800 --> 00:56:24,320 KNOW IF YOU CAN MUTE SOME 1580 00:56:24,320 --> 00:56:25,480 VIDEOCAST IF YOU MIGHT BE 1581 00:56:25,480 --> 00:56:30,760 WATCHING ON THAT. 1582 00:56:30,760 --> 00:56:32,720 >>I'M GOING TO TRY TO -- 1583 00:56:32,720 --> 00:56:35,360 >>I THINK WE FIXED IT, WHATEVER 1584 00:56:35,360 --> 00:56:37,040 YOU JUST DID. 1585 00:56:37,040 --> 00:56:39,120 >>LET ME POST THIS -- POSE THIS 1586 00:56:39,120 --> 00:56:41,200 QUESTION. MULTI-LEVEL 1587 00:56:41,200 --> 00:56:46,000 ENTERRECOMULTI-LEVELINTERVENTIOE 1588 00:56:46,000 --> 00:56:46,880 COMPLICATED THAN AT THE 1589 00:56:46,880 --> 00:56:48,600 INDIVIDUAL LEVEL. WHAT ADVICE 1590 00:56:48,600 --> 00:56:50,200 YOU GIVE POST-DOCS GRAD STUDENTS 1591 00:56:50,200 --> 00:56:51,720 WHO WANT TO DEVELOP MULTI-LEVEL 1592 00:56:51,720 --> 00:56:53,040 INTERVENTIONS? WHAT ARE SOME OF 1593 00:56:53,040 --> 00:56:53,600 THE MOST IMPORTANT 1594 00:56:53,600 --> 00:56:54,520 CONSIDERATIONS? 1595 00:56:54,520 --> 00:56:56,320 >>I THINK WHAT IS IMPORTANT 1596 00:56:56,320 --> 00:56:57,920 FIRST OF ALL IS TO GET THE RIGHT 1597 00:56:57,920 --> 00:57:03,520 TRAINING. IN THE SCIENTIFIC 1598 00:57:03,520 --> 00:57:04,520 PRINCIPLES, THAT ARE -- THAT 1599 00:57:04,520 --> 00:57:06,040 WILL INFORM DEVELOPMENT OF THESE 1600 00:57:06,040 --> 00:57:08,360 INTERVENTIONS. GET THE RIGHT 1601 00:57:08,360 --> 00:57:11,120 TRAINING AND MENTORSHIP TO 1602 00:57:11,120 --> 00:57:12,920 REALLY IMMERSE YOURSELF NOT ONLY 1603 00:57:12,920 --> 00:57:14,720 IN DOING THE SCIENCE BUT ALSO 1604 00:57:14,720 --> 00:57:17,000 ENGAGING WITH THE PEOPLE WHO 1605 00:57:17,000 --> 00:57:18,640 WOULD BE IMPLEMENTING THE 1606 00:57:18,640 --> 00:57:19,680 INTERVENTIONS, WHO WOULD BE 1607 00:57:19,680 --> 00:57:21,240 USING THE INTERVENTIONS, SO YOU 1608 00:57:21,240 --> 00:57:24,040 ACTUALLY UNDERSTAND HOW TO APPLY 1609 00:57:24,040 --> 00:57:25,880 WHAT YOU HAVE LEARNED 1610 00:57:25,880 --> 00:57:28,240 CONCEPTUALLY IN A PRACTICAL 1611 00:57:28,240 --> 00:57:30,680 SENSE, THAT IS THE -- THOSE ARE 1612 00:57:30,680 --> 00:57:31,920 THE TWO MOST IMPORTANT THINGS I 1613 00:57:31,920 --> 00:57:34,560 WOULD SAY. OBTAIN FORMAL 1614 00:57:34,560 --> 00:57:37,680 TRAINING, MENTORSHIP AND 1615 00:57:37,680 --> 00:57:39,240 EXPERIENTIAL LEARNING. 1616 00:57:39,240 --> 00:57:41,120 >>HOW ABOUT LEARNING TO 1617 00:57:41,120 --> 00:57:42,640 EVALUATE MULTI-LEVEL 1618 00:57:42,640 --> 00:57:43,240 INTERVENTION? 1619 00:57:43,240 --> 00:57:44,920 THAT IS PERHAPS MORE COMPLICATED 1620 00:57:44,920 --> 00:57:46,400 THAN DEVELOPING MULTI-LEVEL 1621 00:57:46,400 --> 00:57:47,600 INTERVENTIONS. WHAT -- 1622 00:57:47,600 --> 00:57:49,640 >>I AGREE. 1623 00:57:49,640 --> 00:57:52,520 >>ABOUT THOSE METHODS? 1624 00:57:52,520 --> 00:57:54,960 >>I THINK THEY CAN LEARN BY 1625 00:57:54,960 --> 00:57:55,840 COLLABORATING WITH 1626 00:57:55,840 --> 00:57:57,360 MULTI-DISCIPLINARY TEAMS. FOR 1627 00:57:57,360 --> 00:57:59,040 EXAMPLE, I LEARNED A LOT OF HOW 1628 00:57:59,040 --> 00:58:01,280 TO MEASURE COMMUNICATION QUALITY 1629 00:58:01,280 --> 00:58:03,480 FROM A SOCIAL BEHAVIORAL 1630 00:58:03,480 --> 00:58:04,760 SCIENTIST MENTOR AND I HAVE 1631 00:58:04,760 --> 00:58:07,120 LEARNED MORE ABOUT HOW TO 1632 00:58:07,120 --> 00:58:08,720 MEASURE ECONOMIC OUTCOMES FROM 1633 00:58:08,720 --> 00:58:10,560 MY COLLEAGUES WHO ARE HEALTH 1634 00:58:10,560 --> 00:58:11,800 ECONOMISTS. I HAVE A COLLEAGUE 1635 00:58:11,800 --> 00:58:13,560 WHO IS AN ORGANIZATIONAL 1636 00:58:13,560 --> 00:58:14,760 BEHAVIOR SPECIALIST AND I HAVE 1637 00:58:14,760 --> 00:58:16,720 LEARNED SO MUCH FROM HER ABOUT 1638 00:58:16,720 --> 00:58:19,280 HOW YOU MEASURE ORGANIZATIONAL 1639 00:58:19,280 --> 00:58:21,000 ATTITUDES AND PERFORMANCE. L YOU 1640 00:58:21,000 --> 00:58:22,320 KNOW, YOU CAN START OFF BEING AN 1641 00:58:22,320 --> 00:58:23,600 EXPERT IN ONE THING AND 1642 00:58:23,600 --> 00:58:25,400 COLLABORATING WITH OTHER PEOPLE 1643 00:58:25,400 --> 00:58:28,760 TO LEARN ABOUT THEIR METHODS AND 1644 00:58:28,760 --> 00:58:30,840 OVER TIME A JUNIOR PERSON IS NOT 1645 00:58:30,840 --> 00:58:32,840 GOING TO NECESSARILY BE ABLE TO 1646 00:58:32,840 --> 00:58:34,880 IMPLEMENT A MULTI-LEVEL 1647 00:58:34,880 --> 00:58:36,400 INTERVENTION IMMEDIATELY BUT YOU 1648 00:58:36,400 --> 00:58:37,440 CAN PUT PIECES TOGETHER AND 1649 00:58:37,440 --> 00:58:38,640 BECOME PART OF A TEAM SO THAT 1650 00:58:38,640 --> 00:58:41,640 YOU LEARN FROM THE OTHER PEOPLE 1651 00:58:41,640 --> 00:58:42,120 AROUND YOU. 1652 00:58:42,120 --> 00:58:44,360 >>I COULD NOT AGREE MORE. IT IS 1653 00:58:44,360 --> 00:58:47,680 A TEAM SPORT. AND ONE PERSON 1654 00:58:47,680 --> 00:58:48,960 CAN'T LEARN ALL THE PIECES. I 1655 00:58:48,960 --> 00:58:50,840 WANT TO THANK YOU, DR. COOPER, 1656 00:58:50,840 --> 00:58:52,680 FOR TERRIFIC PRESENTATION AND 1657 00:58:52,680 --> 00:58:54,000 THANK OUR AUDIENCE FOR GREAT 1658 00:58:54,000 --> 00:58:55,960 QUESTIONS AND A LIVELY 1659 00:58:55,960 --> 00:58:56,200 DISCUSSION. 1660 00:58:56,200 --> 00:58:57,480 I WANT TO 1661 00:58:57,480 --> 00:58:58,920 THANK EVERYONE FOR JOINING 1662 00:58:58,920 --> 00:00:00,000 TODAY'S LECTURE.