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WELCOME, EVERYONE, TO OUR

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NINTH ANNUAL WORKSHOP HOSTED BY

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NIH AND THE PRAGMATIC TRIALS

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COLLABORATORY.

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MY NAME IS WENDY WEBER, AND I AM

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THE BRANCH CHIEF FOR CLINICAL

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RESEARCH IN COMPLEMENTARY AND

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INTEGRATIVE HEALTH AT THE

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NATIONAL CENTER FOR

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COMPLEMENTARY AND INTEGRATIVE

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HEALTH AT NIH.

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I HAVE SERVED AS THE PROGRAM

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OFFICER FOR THE COORDINATING

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CENTER OF THE PRAGMATIC TRIALS

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COLLABORATORY SINCE WE LAUNCHED

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IN 2012.

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AND WE'RE JOINED BY MANY OF OUR

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NIH COLLEAGUES AND MANY OF THE

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PRINCIPAL INVESTIGATORS, ALL OF

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THE DIFFERENT TRIALS THAT WE'VE

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HAD OVER THE COURSE OF THE

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YEARS, AND I KNOW MANY OF YOU

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ARE JOINING US VIA VIDEOCAST

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TODAY AS WELL.

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WE'RE ALSO JOINED BY ONE OF OUR

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CO-CHAIRS, DR. HELENE LANGEVIN.

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SHE IS THE DIRECTOR OF THE

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NATIONAL CENTER FOR

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COMPLEMENTARY AND INTEGRATIVE

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HEALTH, AND WE'LL HEAR MORE FROM

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HER TOMORROW.

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 ABOUT SOME OF THE

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EXCITING THINGS THAT ARE

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HAPPENING AT NIH RELATED TO

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PRAGMATIC RESEARCH.

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OUR OTHER CO-CHAIR IS

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DR. RICHARD HODES, WHO IS THE

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DIRECTOR OF THE NATIONAL

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INSTITUTE ON AGING.

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HE'LL BE JOINING US, I THINK, AS

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WELL.

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SO IN THE PAST, I MENTIONED THIS

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WAS THE NINTH YEAR WE'VE DONE

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THIS WORKSHOP, WE'VE COVERED A

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RANGE OF DIFFERENT TOPICS

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RELATIVE TO PRAGUE MA TUCK

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TRIAPRAGMATIC TRIALSCONDUCTED IE

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SETTING, EVERYTHING FROM

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BIOETHICS, STUDY DESIGN AND

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ANALYSIS OF THESE TYPES OF

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PRAGMATIC TRIALS, HOW TO THINK

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ABOUT DESIGNING FOR

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IMPLEMENTATION AND

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SUSTAINABILITY, AS WELL AS THE

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INCLUSION OF DIVERSE

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PARTICIPANTS.

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THIS YEAR, OUR TOPIC IS GOING

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FROM ZERO TO 100: GENERATING

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EVIDENCE THROUGH PRAGMATC

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RESEARCH TO ADDRESS PRESSING

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HEALTHCARE ISSUES.

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AND TODAY WE'RE GOING TO FOCUS

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ON THAT PHASE ZERO IN OUR

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SESSIONS, WHICH IS WHAT REALLY

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ACTUALLY NEEDS TO HAPPEN BEFORE

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THE RESEARCH APPLICATION IS EVEN

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SUBMITTED TO YOUR FUNDING

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AGENCY.

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AND WE'RE GOING TO FOCUS ON

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GETTING THE QUESTION RIGHT, AND

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ENGAGING FRONT-LINE CLINICIANS,

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PATIENTS AND COMMUNITY PARTNERS

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TO MAKE SURE THAT THE EVIDENCE

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THAT'S GENERATED IS USEFUL AND

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CAN POTENTIALLY IMPACT

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HEALTHCARE ISSUES AND

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POLICYMAKING AS IT RELATES TO

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HEALTHCARE DELIVERY.

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SO WE'LL BE HERE TODAY FOR ABOUT

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FOUR HOURS, AND THEN -- THREE

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HOURS, SORRY, TODAY, AND THEN

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TOMORROW, WE'RE GOING TO START

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AT 11:00 A.M. EASTERN AND WE'LL

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BE JOINED BY THE NIH DIRECTOR,

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DR. MONICA BERTAGNOLLI, WHO WILL

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BE GIVING OUR KEYNOTE ADDRESS

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ENTITLED "CONNECTING LAB, CLINIC

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AND COMMUNITY:  COMMUNITIES

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ADVANCING RESEARCH EQUITY," OR

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THE CARE FOR HEALTH PROGRAM.

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AND TOMORROW, WE'LL HAVE THREE

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ADDITIONAL PANEL DISCUSSIONS

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FOCUSED MORE ON ONCE YOU GET

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THINGS UP AND GOING, USING THAT

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DATA FROM DISPARATE DATA

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SYSTEMS, REACHING POPULATIONS

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THAT ARE MOST AFFECTED BY HEALTH

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INEQUITIES, AND OVERCOMING THE

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MANY ADMINISTRATIVE BURDENS IN

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PRAGMATIC RESEARCH TO REALLY DO

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WHAT WE'RE TRAIN TODAY DO, WHICH

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IS GENERATE THAT -- TRAINED TO

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DO, WHICH IS GENERATE THAT

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EVIDENCE AND MOVE FORWARD

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QUICKLY.

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WE WANT TO THANK, OF COURSE, ALL

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OF OUR PRESENTERS FOR BEING

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WILLING TO SHARE THEIR

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EXPERIENCES IN THESE IMPORTANT

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TOPICS.

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MANY OF THE INVESTIGATORS YOU'LL

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HEAR FROM OVER THE NEXT TWO DAYS

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COME FROM THE PRAGMATIC TRIALS

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COLLABORATORY PROGRAM.

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FOR THOSE OF YOU WHO ARE

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UNFAMILIAR WITH THE PROGRAM, WE

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LAUNCHED AS I SAID IN 2012, WITH

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THE GOAL OF DETERMINING HOW TO

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CONDUCT CLINICAL TRIALS IN THE

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CLINICAL CARE SETTING WITH

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HEALTHCARE SYSTEMS AS PARTNERS

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IN THE TRIAL.

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OVER THE COURSE OF THE LAST JUST

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OVER A DECADE, THE PROGRAM HAS

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WORKED WITH 32 DIFFERENT TRIALS

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AND LEARNED A GREAT DEAL.

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AND THE LESSONS LEARNED ARE

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AVAILABLE ON THE PROGRAM'S

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WEBSITE, WHICH IS RE-THINK

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RE-THINKINGCLINICALTRIALS.ORG.

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IT HAS DETAILED LIVING TEXTBOOK

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WITH CHAPTERS AND INFORMATION

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ABOUT EACH OF THE TRIALS, IT HAS

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AN EXTENSIVE SET OF RESOURCES,

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INCLUDING ARCHIVING OF THE

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WEEKLY GRAND ROUNDS AND TRAINING

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MATERIALS FOR THOSE WHO WANT TO

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LEARN MORE.

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BEFORE I TURN IT OVER TO OUR

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FIRST SESSION AND OUR FIRST

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MODERATOR, I ALSO WANT TO THANK

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THE ORGANIZERS OF THE WORKSHOP.

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AS YOU KNOW, THESE WORKSHOPS

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DON'T HAPPEN MAGICALLY.

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THERE'S A LOT OF HARD WORK THAT

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GOES INTO THEM.

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SO I WANT TO GIVE A SPECIAL

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THANKS TO OUR PLANNING GROUP,

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LESLIE CURTIS, TAMMY REESE, GINA

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OLENBROCK AND MARIJO MAR MENCI.,

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I'M SURE I'VE MISSED A COUPLE OF

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INDIVIDUALS BUT THIS IS A HUGE

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GROUP EFFORT AND I WANT TO THANK

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EVERYBODY FOR JOINING US TODAY.

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SO KEVIN, I'M GOING TO TURN IT

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OVER TO YOU TO GET US STARTED

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WITH OUR VERY FIRST SESSION.

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I DO HAVE ONE HOUSEKEEPING NOTE,

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WHICH IS IF YOU HAVE QUESTIONS

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FOR US, PLEASE EMAIL THEM TO US.

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IF YOU HAVE A MOMENT, JUST JOT

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THIS EMAIL DOWN.

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WE WILL BE TAKING QUESTIONS FROM

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EVERYONE VIA THIS EMAIL.

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AND WE WOULD LOVE TO HEAR FROM

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YOU AND WHAT YOUR QUESTIONS ARE.

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WE WILL DO OUR BEST TO

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PRIORITIZE THOSE QUESTIONS AND

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GET TO AS MANY AS POSSIBLE, AND

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WE MAY DO A LITTLE BIT OF

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LUMPING THINGS TOGETHER.

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BUT KEVIN, I'LL TURN IT OVER TO

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YOU TO TALK ABOUT THIS PHASE

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ZERO TOPIC ABOUT GETTING THE

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QUESTION RIGHT.

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>> GREAT.

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THANKS SO MUCH, WENDY, AND

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WELCOME, EVERYONE.

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WE'RE SO EXCITED ABOUT THIS

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TOPIC BECAUSE THIS IS REALLY THE

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FIRST TIME TO OUR WRECK LITION N

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THE FIRST TIME WE ADDRESSED THIS

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ISSUE OF HOW YOU DEFINE THE

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RESEARCH QUESTION.

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WE'RE USUALLY FOCUSED ABOUT

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THINGS WE'RE LEARNING ABOUT

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DESIGNING THE TRIALS,

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IMPLEMENTING THOSE DESIGNS,

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INTERPRETING THE RESULTS, ET

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CETERA, AND SO WE'RE HAPPY TO

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GET A CHANCE TO TALK ABOUT THIS

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WITH FOUR PEOPLE WHO HAVE BEEN

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THINKING ABOUT THIS A LOT AND

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WELCOME YOUR QUESTIONS ABOUT

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THIS AS WELL.

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SO WE HAVE FOUR PANELISTS

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REPRESENTING TWO OF OUR MORE

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RECENT TRIALS, AND TWO OF OUR

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OLDER TRIALS.

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WE'VE GOT ANDREA CHEVILLE, KEVIN

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MCLAWSLIN, KUSHANG PATEL AND

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GREG SIMON.

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WE'RE GOING STOORT OFF WITH

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KEVIN TALKING ABOUT EXPERIENCES

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WITH THE ARBOR TELEHEALTH

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STUDIES SO LET ME TURN IT OVER

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TO KEVIN.

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EACH PERSON IS GOING TO TAKE

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ABOUT 10 MINUTES, AND TALK ABOUT

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HOW THEY'VE SORT OF TRIED TO

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ALIGN THE RESEARCH QUESTION WITH

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THE PATIENT HEALTHCARE SYSTEM

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PRIORITIES AND HOW THEY CRAFTED

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THAT QUESTION TO HELP

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DECISION-MAKERS.

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WE ASKED EVERYONE TO TELL THE

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REAL STORY, WARTS AND ALL, ABOUT

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HOW THEY ARRIVED AT THE QUESTION

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THEY DID, WHAT WERE ALL THE

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CONSIDERATIONS THAT WENT INTO

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THAT.

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SO EACH PERSON IS GOING TO TELL

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THAT STORY AND SORT OF END UP

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WITH THEIR FINAL RESEARCH

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QUESTION.

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SO IT SHOULD BE A LOT OF FUN,

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THEN WE'LL HAVE DISCUSSION

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AFTERWARDS.

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SO LET ME TURN IT OVER TO KEVIN

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TO BEGIN.

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>> THANKS VERY MUCH, TODAY
I'M

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GOING TO BE TALKING ABOUT THE

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ARBOR TELEHEALTH STUDY.

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I'M GOING TO NOT NECESSARILY

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GIVE AWAY ALL THE DETAILS OF OUR

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RESEARCH QUESTION RIGHT OFF THE

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BAT IN ATTEMPT TO BUILD UP A

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LITTLE BIT OF SUSPENSE AS HOW I

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TELL YOU THE STORY OF HOW WE

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EVENTUALLY GOT TO OUR RESEARCH

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QUESTION.

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SO TO TELL YOU THAT STORY I

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THINK WE NEED TO PROVIDE

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HISTORICAL CONTEXT.

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TELEHEALTH PHYSICAL THERAPY HAS

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ALWAYS BEEN USED AS A MEANS TO

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IMPROVING ACCESS TO PT FOR

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PEOPLE WHO CAN'T QUITE MAKE TO

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IN-CLINIC PT FOR WHATEVER

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REASON.

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BUT ITS REAL WORLD USE HAS

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ALWAYS BEEN REALLY LIMITED BY

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POLICY REIMBURSEMENT.

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SO MEDICARE HAS TRADITIONALLY

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NOT PAID FOR PHYSICAL THERAPY

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DELIVERED BY TELEHEALTH,

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COMMERCIAL PAYORS KIND OF HAVE

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HAD THE SAME STANCE, AND MOST --

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OR MANY STATES IN THE U.S. SH

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RESTRICTIONS ON THIS IN THEIR

261
00:08:18,571 --> 00:08:20,739
STATE PRACTICE ACTS, BANNING

262
00:08:20,739 --> 00:08:22,174
PHYSICAL THERAPISTS FROM

263
00:08:22,174 --> 00:08:23,175
PROVIDING CARE BY TELEHEALTH.

264
00:08:23,175 --> 00:08:26,545
SO IT REALLY WAS VERY LITTLE

265
00:08:26,545 --> 00:08:27,213
REAL WORLD OPPORTUNITY TO

266
00:08:27,213 --> 00:08:28,314
PROVIDE THESE TYPES OF

267
00:08:28,314 --> 00:08:28,647
INTERVENTIONS.

268
00:08:28,647 --> 00:08:30,282
BUT THAT CHANGED, IT SEEMED LIKE

269
00:08:30,282 --> 00:08:31,984
IN A MATTER OF DAYS DURING THE

270
00:08:31,984 --> 00:08:33,219
EARLY PHASES OF THE PANDEMIC,

271
00:08:33,219 --> 00:08:34,854
WHERE IT FELT LIKE ONE WEEK, WE

272
00:08:34,854 --> 00:08:37,490
COULD NOT PROVIDE CARE BY

273
00:08:37,490 --> 00:08:39,658
TELEHEALTH AND THEN THE NEXT

274
00:08:39,658 --> 00:08:41,427
WEEK, YOU KNOW, PHYSICAL

275
00:08:41,427 --> 00:08:42,528
THERAPISTS LIKE MYSELF WERE ABLE

276
00:08:42,528 --> 00:08:43,829
TO PROVIDE TELEHEALTH

277
00:08:43,829 --> 00:08:44,230
IMMEDIATELY.

278
00:08:44,230 --> 00:08:46,132
SO IT REALLY MOVED QUITE

279
00:08:46,132 --> 00:08:47,566
QUICKLY.

280
00:08:47,566 --> 00:08:50,069
IF WE GO TO THE NEXT SLIDE, I

281
00:08:50,069 --> 00:08:51,704
HAVE A GRAPH, WITHOUT GOING INTO

282
00:08:51,704 --> 00:08:53,139
A LOT OF DETAIL ABOUT THIS

283
00:08:53,139 --> 00:08:55,407
PARTICULAR STUDY, PROVIDES A

284
00:08:55,407 --> 00:08:57,176
LITTLE BIT OF CONTEXT AS TO HOW

285
00:08:57,176 --> 00:08:58,611
QUICKLY THIS ALL HAPPENED.

286
00:08:58,611 --> 00:09:02,414
SO THIS IS A RETROSPECTIVE

287
00:09:02,414 --> 00:09:04,950
ANALYSIS OF COMMERCIAL CLAIMS WE

288
00:09:04,950 --> 00:09:06,252
DID USING THE MARKET SCAN

289
00:09:06,252 --> 00:09:06,519
DATABASE.

290
00:09:06,519 --> 00:09:07,586
YOU CAN SEE IN JANUARY AND

291
00:09:07,586 --> 00:09:11,590
FEBRUARY OF 2020, ALL OF ZERO

292
00:09:11,590 --> 00:09:13,025
VISITS CONDUCTED BY A PHYSICAL

293
00:09:13,025 --> 00:09:14,560
THERAPIST WERE CONDUCTED BY

294
00:09:14,560 --> 00:09:15,327
TELEHEALTH.

295
00:09:15,327 --> 00:09:18,397
IMMEDIATELY BY APRIL OF 2020,

296
00:09:18,397 --> 00:09:20,799
OVER 12,000 PSM T OR

297
00:09:20,799 --> 00:09:22,234
OCCUPATIONAL THERAPY, OT, VISITS

298
00:09:22,234 --> 00:09:23,636
WERE CONDUCTED BY TELEHEALTH.

299
00:09:23,636 --> 00:09:25,404
SO THAT'S WANED DOWN SINCE THIS

300
00:09:25,404 --> 00:09:27,506
INITIAL PEAK BUT GIVES YOU AN

301
00:09:27,506 --> 00:09:28,874
IDEA OF JUST HOW QUICKLY THESE

302
00:09:28,874 --> 00:09:29,975
TYPES OF THINGS CHANGED DURING

303
00:09:29,975 --> 00:09:35,114
THE PANDEMIC.

304
00:09:35,114 --> 00:09:36,549
SO QUICKLY, WE HAD OUR

305
00:09:36,549 --> 00:09:37,750
INTERVENTION, AND YOU CAN SEE

306
00:09:37,750 --> 00:09:38,951
RIGHT AWAY, WE'RE GOING OUT OF

307
00:09:38,951 --> 00:09:39,285
ORDER.

308
00:09:39,285 --> 00:09:41,820
WE HADN'T REALLY IDENTIFIED OUR

309
00:09:41,820 --> 00:09:42,454
POPULATION YET.

310
00:09:42,454 --> 00:09:44,223
WE JUST KNEW BASED ON THE WAY

311
00:09:44,223 --> 00:09:45,424
THINGS WERE HAPPENING IN THE

312
00:09:45,424 --> 00:09:47,493
WORLD, WE NEEDED TO DO, WANTED

313
00:09:47,493 --> 00:09:50,763
TO DO SOMETHING WITH TELEHEALTH

314
00:09:50,763 --> 00:09:52,298
PT WE KNEW THIS WAS PROBABLY

315
00:09:52,298 --> 00:09:53,732
PROVIDING AN OPPORTUNITY TO

316
00:09:53,732 --> 00:09:56,235
BENEFIT SPECIFIC POPULATIONS BUT

317
00:09:56,235 --> 00:09:57,536
ACTUALLY IDENTIFIED THE

318
00:09:57,536 --> 00:09:58,003
INTERVENTION FIRST.

319
00:09:58,003 --> 00:09:59,338
SO WE STARTED WITH THE

320
00:09:59,338 --> 00:10:00,506
INTERVENTION PHASE OF OUR

321
00:10:00,506 --> 00:10:05,544
RESEARCH QUESTION.

322
00:10:05,544 --> 00:10:06,745
SO ON THE NEXT SLIDE, WE'RE

323
00:10:06,745 --> 00:10:07,613
TALKING ABOUT POPULATION.

324
00:10:07,613 --> 00:10:09,248
NOW WE'RE GOING BACKWARDS AND

325
00:10:09,248 --> 00:10:10,916
FIGURING OUT, WELL, WHO WOULD

326
00:10:10,916 --> 00:10:12,618
TELEHEALTH PT MAYBE BE

327
00:10:12,618 --> 00:10:13,319
BENEFICIAL FOR?

328
00:10:13,319 --> 00:10:16,055
SO THE THOUGHT PROCESS WE WENT

329
00:10:16,055 --> 00:10:17,022
WITH HERE INCLUDED SOME

330
00:10:17,022 --> 00:10:17,523
QUESTIONS.

331
00:10:17,523 --> 00:10:18,657
FIRST QUESTION WAS WHAT

332
00:10:18,657 --> 00:10:19,925
POPULATIONS HAVE LIMITED ACCESS

333
00:10:19,925 --> 00:10:21,160
TO PT?

334
00:10:21,160 --> 00:10:23,028
AND AMONG THOSE POPULATIONS,

335
00:10:23,028 --> 00:10:24,997
WHICH CLINICAL GROUPS AMONG

336
00:10:24,997 --> 00:10:26,265
GROUPS THAT HAVE DECREASED

337
00:10:26,265 --> 00:10:28,067
ACCESS TO PT ARE MOST LIKELY TO

338
00:10:28,067 --> 00:10:30,903
BENEFIT FROM INCREASED ACCESS TO

339
00:10:30,903 --> 00:10:32,104
PT?

340
00:10:32,104 --> 00:10:33,305
THEN ON THE FEASIBILITY SIDE OF

341
00:10:33,305 --> 00:10:34,506
THINGS, WE HAD TO THINK ABOUT,

342
00:10:34,506 --> 00:10:36,275
WELL, WHAT POPULATIONS DO WE AS

343
00:10:36,275 --> 00:10:37,810
RESEARCHERS REALLY HAVE ACCESS

344
00:10:37,810 --> 00:10:39,979
TO, AND IN WHAT AREAS DOES OUR

345
00:10:39,979 --> 00:10:41,513
TRACK RECORD REALLY PUT US IN A

346
00:10:41,513 --> 00:10:42,381
GOOD POSITION TO CONTRIBUTE TO

347
00:10:42,381 --> 00:10:45,784
NEW RESEARCH?

348
00:10:45,784 --> 00:10:47,419
SO ON THE NEXT SLIDE, WE HAVE

349
00:10:47,419 --> 00:10:48,520
SORT OF A GRAPHIC THAT JUST PUTS

350
00:10:48,520 --> 00:10:50,456
ALL OF THESE FACTORS INTO ONE

351
00:10:50,456 --> 00:10:52,358
SPOT SO WE CAN KIND OF DESCRIBE

352
00:10:52,358 --> 00:10:54,326
THEM AS A GROUP.

353
00:10:54,326 --> 00:10:55,828
ON THE LEFT SIDE OF THE SLIDE,

354
00:10:55,828 --> 00:10:59,999
WE'VE GOT FACTORS THAT HELPED US

355
00:10:59,999 --> 00:11:01,100
IDENTIFY POPULATIONS WITH A

356
00:11:01,100 --> 00:11:02,001
CLINICAL NEED, AND ON THE RIGHT

357
00:11:02,001 --> 00:11:03,302
SIDE OF THE SLIDE, WE'VE GOT

358
00:11:03,302 --> 00:11:04,837
FACTORS THAT INFLUENCE JUST

359
00:11:04,837 --> 00:11:05,704
FEASIBILITY AND YOU COULD EVEN

360
00:11:05,704 --> 00:11:07,106
SAY A LITTLE BIT OF

361
00:11:07,106 --> 00:11:08,040
GRANTSMANSHIP.

362
00:11:08,040 --> 00:11:10,276
SO WE KNEW THAT CHRONIC LOW BACK

363
00:11:10,276 --> 00:11:12,811
PAIN IS JUST A MAJOR BURDEN ON

364
00:11:12,811 --> 00:11:13,245
SOCIETY.

365
00:11:13,245 --> 00:11:14,546
IT'S THE NUMBER ONE CAUSE OF

366
00:11:14,546 --> 00:11:15,848
DISABILITY IN THE COUNTRY, AND

367
00:11:15,848 --> 00:11:18,150
IT'S THE TOP NON-CANCER REASON

368
00:11:18,150 --> 00:11:19,818
THAT PEOPLE GET OPIOIDS.

369
00:11:19,818 --> 00:11:21,220
WE KNOW ALSO THAT PHYSICAL

370
00:11:21,220 --> 00:11:23,322
THERAPY IS EFFECTIVE FOR LOW

371
00:11:23,322 --> 00:11:24,490
BACK PAIN AND THAT THERE'S

372
00:11:24,490 --> 00:11:25,591
DECREASED ACCESS TO PHYSICAL

373
00:11:25,591 --> 00:11:26,392
THERAPY IN RURAL COMMUNITIES

374
00:11:26,392 --> 00:11:28,227
WITH STUDIES SHOWING THAT

375
00:11:28,227 --> 00:11:30,963
THERE'S ABOUT 40% FEWER PTs

376
00:11:30,963 --> 00:11:32,831
PER CAPITA IN RURAL COMMUNITIES

377
00:11:32,831 --> 00:11:35,434
VERSUS NON-RURAL COMMUNITIES.

378
00:11:35,434 --> 00:11:36,969
AND THEN FROM A FEASIBILITY

379
00:11:36,969 --> 00:11:38,170
STANDPOINT, OUR TEAM HAD

380
00:11:38,170 --> 00:11:39,772
EXPERIENCE CONDUCTING CLINICAL

381
00:11:39,772 --> 00:11:41,340
TRIALS AMONG PATIENTS WITH LOW

382
00:11:41,340 --> 00:11:41,940
BACK PAIN.

383
00:11:41,940 --> 00:11:43,309
WE HAD SOME PRELIMINARY DATA

384
00:11:43,309 --> 00:11:45,711
FROM THE PANDEMIC WHEN WE WERE

385
00:11:45,711 --> 00:11:47,012
DELIVERING CARE VIA TELEHEALTH

386
00:11:47,012 --> 00:11:48,781
TO PATIENTS WITH CHRONIC LOW

387
00:11:48,781 --> 00:11:49,481
BACK PAIN.

388
00:11:49,481 --> 00:11:51,183
WE HAD CLINICAL EXPERTISE IN

389
00:11:51,183 --> 00:11:53,152
THIS AREA, AND THEN MAYBE MOST

390
00:11:53,152 --> 00:11:56,755
IMPORTANTLY, WE HAD A RESEARCH

391
00:11:56,755 --> 00:11:57,956
PARTNER IN TITLE HEALTH.

392
00:11:57,956 --> 00:11:59,491
TITLE HEALTH IS A HEALTHCARE

393
00:11:59,491 --> 00:12:00,726
SYSTEM ON MARYLAND'S EASTERN

394
00:12:00,726 --> 00:12:02,995
SHORE WHICH INCLUDES A FEW

395
00:12:02,995 --> 00:12:03,929
FEDERALLY RECOGNIZED RURAL

396
00:12:03,929 --> 00:12:05,531
COUNTIES THAT IS PART OF THE

397
00:12:05,531 --> 00:12:07,066
JOHNS HOPKINS CLINICAL RESEARCH

398
00:12:07,066 --> 00:12:08,267
NETWORK, WHICH PROVIDED US

399
00:12:08,267 --> 00:12:10,102
ACCESS TO A RURAL HEALTHCARE

400
00:12:10,102 --> 00:12:11,537
SYSTEM AND PATIENTS THAT RECEIVE

401
00:12:11,537 --> 00:12:12,438
CARE THERE.

402
00:12:12,438 --> 00:12:15,140
SO ALL THESE FACTORS COMBINED

403
00:12:15,140 --> 00:12:17,543
LED US TO OUR POPULATION, WHICH

404
00:12:17,543 --> 00:12:19,078
IS PATIENTS WITH CHRONIC LOW

405
00:12:19,078 --> 00:12:21,280
BACK PAIN LIVING IN RURAL

406
00:12:21,280 --> 00:12:22,781
MARYLAND, SPECIFICALLY THOSE

407
00:12:22,781 --> 00:12:24,516
RECEIVING CARE FROM TITLE HEALTH

408
00:12:24,516 --> 00:12:29,688
ON THE EASTERN SHORE.

409
00:12:29,688 --> 00:12:32,658
SO NOW WE HAVE OUR POPULATION

410
00:12:32,658 --> 00:12:34,159
AND THE INTERVENTION COMPONENTS

411
00:12:34,159 --> 00:12:35,594
OF OUR RESEARCH QUESTION, AND

412
00:12:35,594 --> 00:12:38,030
THEN WE'LL MOVE ON TO THE

413
00:12:38,030 --> 00:12:39,865
CONTROL OR COMPARISON ARM.

414
00:12:39,865 --> 00:12:42,167
SO THIS WAS A LITTLE BIT MORE

415
00:12:42,167 --> 00:12:42,935
CHALLENGING.

416
00:12:42,935 --> 00:12:43,936
THERE'S A LOT OF COMPARISONS

417
00:12:43,936 --> 00:12:45,337
THAT WE COULD THINK OF WHEN

418
00:12:45,337 --> 00:12:46,872
YOU'RE THINKING OF TELEHEALTH

419
00:12:46,872 --> 00:12:47,306
PT.

420
00:12:47,306 --> 00:12:48,507
ONE OF THE MOST TEMPTING AND ONE

421
00:12:48,507 --> 00:12:49,608
OF THE ONES THAT COMES UP THAT

422
00:12:49,608 --> 00:12:53,645
PEOPLE ARE MOST INTERESTED IN

423
00:12:53,645 --> 00:12:54,713
WAS ONE OF OUR INITIAL THOUGHTS,

424
00:12:54,713 --> 00:12:56,815
WAS MAYBE WE SHOULD COMPARE

425
00:12:56,815 --> 00:12:59,318
TELEHEALTH PT TO IN-CLINIC PT.

426
00:12:59,318 --> 00:13:00,753
THAT CERTAINLY SEEMS TO BE THE

427
00:13:00,753 --> 00:13:01,754
MOST OBVIOUS COMPARISON, BUT

428
00:13:01,754 --> 00:13:02,755
THEN WHEN WE REALLY THOUGHT

429
00:13:02,755 --> 00:13:06,458
ABOUT IT, OUR PAPILLATION, THE

430
00:13:06,458 --> 00:13:10,796
POPULATION, THEWHOLE REASON WE O

431
00:13:10,796 --> 00:13:12,564
RESEARCH IN THIS AREA IS PEOPLE

432
00:13:12,564 --> 00:13:14,233
IN RURAL COMMUNITIES DON'T HAVE

433
00:13:14,233 --> 00:13:15,901
ACCESS TO IN-CLINIC PT SO IS

434
00:13:15,901 --> 00:13:17,302
THAT REALLY THE MOST USEFUL

435
00:13:17,302 --> 00:13:17,836
INFORMATION FOR US?

436
00:13:17,836 --> 00:13:19,338
WE EVENTUALLY GOT TO THIS

437
00:13:19,338 --> 00:13:20,239
QUESTION, THE QUESTION BEFORE

438
00:13:20,239 --> 00:13:21,740
THE QUESTION, AND THIS FIRST

439
00:13:21,740 --> 00:13:23,942
QUESTION WAS, WELL, WHAT IS

440
00:13:23,942 --> 00:13:26,245
USUAL CARE FOR PATIENTS WITH LOW

441
00:13:26,245 --> 00:13:27,346
BACK PAIN LIVING IN RURAL

442
00:13:27,346 --> 00:13:28,547
COMMUNITIES WHEN PT IS NOT

443
00:13:28,547 --> 00:13:28,981
AVAILABLE?

444
00:13:28,981 --> 00:13:30,716
AND WE WERE GOING TO USE THAT

445
00:13:30,716 --> 00:13:33,352
QUESTION TO REALLY HELP IDENTIFY

446
00:13:33,352 --> 00:13:36,522
OUR COMPARISON ARM.

447
00:13:36,522 --> 00:13:38,624
SO IN THIS NEXT SLIDE, WE HAVE

448
00:13:38,624 --> 00:13:40,793
SOME -- SO WE THOUGHT ABOUT,

449
00:13:40,793 --> 00:13:43,195
WELL, WHAT IS GUIDELINE ADHERENT

450
00:13:43,195 --> 00:13:44,730
CARE, LET'S AT LEAST THINK ABOUT

451
00:13:44,730 --> 00:13:47,399
ALL THE OPTIONS THAT WOULD BE

452
00:13:47,399 --> 00:13:48,667
USEFUL FOR PATIENTS WITH LOW

453
00:13:48,667 --> 00:13:50,869
BACK PAIN AND NARROW IT DOWN

454
00:13:50,869 --> 00:13:51,270
FROM THERE.

455
00:13:51,270 --> 00:13:53,272
THE CLINICAL GUIDELINES FOR

456
00:13:53,272 --> 00:13:55,340
NONSPECIFIC LOW BACK PAIN

457
00:13:55,340 --> 00:13:57,309
INCLUDE ADVICE, NON-OPIOID

458
00:13:57,309 --> 00:13:59,478
MEDICATION AND NON-PHARMACOLOGIC

459
00:13:59,478 --> 00:14:00,712
PAIN INTERVENTIONS LIKE PT.

460
00:14:00,712 --> 00:14:02,681
THEN ON THIS NEXT SLIDE, WE HAVE

461
00:14:02,681 --> 00:14:03,449
SOME OTHER CONSIDERATIONS THAT

462
00:14:03,449 --> 00:14:13,759
WE THOUGHT ABOUT.

463
00:14:14,526 --> 00:14:15,661
THESE ARE THINGS WHEN WE WERE

464
00:14:15,661 --> 00:14:16,528
SELECTING OUR INTERVENTION THAT

465
00:14:16,528 --> 00:14:18,797
WE REALLY WANTED TO DO OR MAYBE

466
00:14:18,797 --> 00:14:21,333
AVOID TIMES.

467
00:14:21,333 --> 00:14:23,302
WE DEFINITELY WANTED TO AVOID

468
00:14:23,302 --> 00:14:24,870
DISRUPTION IN USUAL CARE.

469
00:14:24,870 --> 00:14:26,438
WE, A RESEARCH TEAM AT JOHNS

470
00:14:26,438 --> 00:14:28,340
HOPKINS, WERE COMING INTO THIS

471
00:14:28,340 --> 00:14:29,308
DIFFERENT SEPARATE RURAL

472
00:14:29,308 --> 00:14:31,043
HEALTHCARE SYSTEM THAT WE HAD AN

473
00:14:31,043 --> 00:14:31,977
AFFILIATION WITH BUT CERTAINLY

474
00:14:31,977 --> 00:14:33,145
IS A DIFFERENT HEALTHCARE

475
00:14:33,145 --> 00:14:33,579
SYSTEM.

476
00:14:33,579 --> 00:14:35,714
THE LAST THING WE WANTED TO DO

477
00:14:35,714 --> 00:14:37,082
WAS COMPLETELY DISRUPT THE WAY

478
00:14:37,082 --> 00:14:38,150
THAT THEY'RE ALREADY PROVIDING

479
00:14:38,150 --> 00:14:38,617
CARE.

480
00:14:38,617 --> 00:14:41,453
SO WE WANTED TO BE MINIMALLY

481
00:14:41,453 --> 00:14:41,987
DISRUPTIVE.

482
00:14:41,987 --> 00:14:43,856
AND WE CERTAINLY WANTED TO DO NO

483
00:14:43,856 --> 00:14:45,390
HARM, AND WHEN YOU THINK ABOUT

484
00:14:45,390 --> 00:14:49,328
THE RISK OF TELEHEALTH PT, IT'S

485
00:14:49,328 --> 00:14:50,629
PRETTY MUCH AS LOW RISK AS IT

486
00:14:50,629 --> 00:14:53,165
COMES.

487
00:14:53,165 --> 00:14:55,567
AND SO PICKING A CONTROL ARM

488
00:14:55,567 --> 00:14:57,302
THAT HAD INHERENTLY MORE RISK

489
00:14:57,302 --> 00:14:58,303
SEEMED LIKE JUST NOT A GOOD

490
00:14:58,303 --> 00:14:58,737
IDEA.

491
00:14:58,737 --> 00:15:01,540
SO THINGS LIKE MEDICATION,

492
00:15:01,540 --> 00:15:04,042
INVASIVE PROCEDURES LIKE SPINE

493
00:15:04,042 --> 00:15:06,144
INJECTIONS, WERE PRETTY

494
00:15:06,144 --> 00:15:07,112
IMMEDIATELY OFF THE TABLE FOR US

495
00:15:07,112 --> 00:15:08,747
AS IT FELT LIKE PEOPLE IN THE

496
00:15:08,747 --> 00:15:09,748
CONTROL ARM WOULD ALL OF A

497
00:15:09,748 --> 00:15:10,949
SUDDEN HAVE MORE RISK THAN

498
00:15:10,949 --> 00:15:12,351
PEOPLE IN OUR INTERVENTION ARM,

499
00:15:12,351 --> 00:15:13,685
WHICH DIDN'T MAKE SENSE AND

500
00:15:13,685 --> 00:15:18,557
DIDN'T SEEM ETHICAL.

501
00:15:18,557 --> 00:15:21,927
WE REALLY WANTED TO MAXIMIZE THE

502
00:15:21,927 --> 00:15:23,595
GENERALIZABILITY TO THE RURAL

503
00:15:23,595 --> 00:15:24,029
SETTING.

504
00:15:24,029 --> 00:15:25,230
AFTER THINKING ABOUT ALL OF

505
00:15:25,230 --> 00:15:27,199
THESE DIFFERENT OPTIONS, WE FELT

506
00:15:27,199 --> 00:15:29,835
THAT IN LOWER RESOURCE RURAL

507
00:15:29,835 --> 00:15:33,338
COMMUNITIES, ADVICE WAS PROBABLY

508
00:15:33,338 --> 00:15:34,573
THE INTERVENTION MOST COMMONLY

509
00:15:34,573 --> 00:15:36,074
BEING DELIVERED BY PRIMARY CARE

510
00:15:36,074 --> 00:15:37,576
PROVIDERS TO THEIR PATIENTS WITH

511
00:15:37,576 --> 00:15:38,911
CHRONIC LOW BACK PAIN.

512
00:15:38,911 --> 00:15:40,779
SO ADVICE SEEMED TO MAKE THE

513
00:15:40,779 --> 00:15:42,614
MOST SENSE GENERALLY SPEAKING.

514
00:15:42,614 --> 00:15:44,383
AND THEN WE HAD TO REALLY THINK

515
00:15:44,383 --> 00:15:47,419
ABOUT WHEN OUR KIND OF IN THE

516
00:15:47,419 --> 00:15:48,420
BIGGER PICTURE, OUR

517
00:15:48,420 --> 00:15:50,589
INTERVENTIONS WOULD BE

518
00:15:50,589 --> 00:15:53,458
DELIVERED, AND BASED ON OUR

519
00:15:53,458 --> 00:15:55,093
EXPERIENCE ON OTHER STUDIES, WE

520
00:15:55,093 --> 00:15:56,728
TYPICALLY USE A RECRUITMENT

521
00:15:56,728 --> 00:15:59,331
STRATEGY THAT LEVERAGES THE

522
00:15:59,331 --> 00:16:00,566
ELECTRONIC HEALTH RECORD TO

523
00:16:00,566 --> 00:16:01,800
IDENTIFY PEOPLE WHO HAD RECENTLY

524
00:16:01,800 --> 00:16:03,302
BEEN TREATED BY THEIR PRIMARY

525
00:16:03,302 --> 00:16:04,603
CARE PROVIDER FOR CHRONIC LOW

526
00:16:04,603 --> 00:16:07,005
BACK PAIN, WHICH MEANS THAT THAT

527
00:16:07,005 --> 00:16:08,206
PRIMARY CARE INTERACTION HAS

528
00:16:08,206 --> 00:16:12,044
ALREADY OCCURRED AND YOU CAN'T

529
00:16:12,044 --> 00:16:13,145
GO BACK IN TIME AND CHANGE IT,

530
00:16:13,145 --> 00:16:16,515
AND TRYING TO IMPLEMENT A

531
00:16:16,515 --> 00:16:17,716
STANDARD PRACTICE IN PRIMARY

532
00:16:17,716 --> 00:16:21,019
CARE CLINICS THAT HAPPENS BEFORE

533
00:16:21,019 --> 00:16:22,521
ENROLLMENT IS JUST INCREDIBLY

534
00:16:22,521 --> 00:16:22,821
CHALLENGING.

535
00:16:22,821 --> 00:16:24,523
SO WE NEEDED SOMETHING THAT CAN

536
00:16:24,523 --> 00:16:26,692
BE DELIVERED POST-INITIAL

537
00:16:26,692 --> 00:16:32,364
INTERACTION WITH A PROVIDER.

538
00:16:32,364 --> 00:16:33,899
SO ON THIS NEXT SLIDE, YOU CAN

539
00:16:33,899 --> 00:16:37,636
SEE OUR CONTROL OR COMPARISON,

540
00:16:37,636 --> 00:16:38,303
STANDARDIZED EDUCATION WE'RE

541
00:16:38,303 --> 00:16:39,271
DELIVERING THROUGH A STUDY

542
00:16:39,271 --> 00:16:39,705
WEBSITE.

543
00:16:39,705 --> 00:16:40,906
OUR PROCESS HERE IS THAT THIS

544
00:16:40,906 --> 00:16:42,874
WILL ESSENTIALLY RAISE THE FLOOR

545
00:16:42,874 --> 00:16:43,842
FOR EVERYBODY IN THE CONTROL

546
00:16:43,842 --> 00:16:45,277
GROUP, THOSE WHO FOR WHATEVER

547
00:16:45,277 --> 00:16:48,680
REASON DON'T RECEIVE BEST

548
00:16:48,680 --> 00:16:49,548
PRACTICE ADVICE FROM THEIR

549
00:16:49,548 --> 00:16:50,115
PHYSICIAN WILL RECEIVE IT

550
00:16:50,115 --> 00:16:51,950
THROUGH THE STUDY, AND THOSE WHO

551
00:16:51,950 --> 00:16:53,919
RECEIVE IT FROM THEIR PHYSICIAN,

552
00:16:53,919 --> 00:16:55,354
WHICH WE THINK IS PROBABLY A

553
00:16:55,354 --> 00:16:56,755
HIGH PERCENTAGE OF PATIENT, WILL

554
00:16:56,755 --> 00:16:58,290
GET REPETITION, WHICH CERTAINLY

555
00:16:58,290 --> 00:16:59,524
CAN'T HURT AND IS LIKELY TO

556
00:16:59,524 --> 00:17:01,159
PROVIDE SOME ADDITIONAL BENEFIT.

557
00:17:01,159 --> 00:17:04,329
SO WE HAVE POPULATION

558
00:17:04,329 --> 00:17:05,530
INTERVENTION AND CONTROL

559
00:17:05,530 --> 00:17:07,833
COMPONENTS OF OUR RESEARCH

560
00:17:07,833 --> 00:17:08,800
QUESTION, AND ON THIS NEXT

561
00:17:08,800 --> 00:17:12,204
SLIDE, WE START TO TALK ABOUT

562
00:17:12,204 --> 00:17:15,273
OUTCOMES.

563
00:17:15,273 --> 00:17:16,141
THIS IS A BIT MORE

564
00:17:16,141 --> 00:17:17,342
STRAIGHTFORWARD WHEN IT COMES TO

565
00:17:17,342 --> 00:17:18,343
CHRONIC LOW BACK PAIN.

566
00:17:18,343 --> 00:17:22,814
WE WANT TO BE REFLECTIVE OF THE

567
00:17:22,814 --> 00:17:24,116
REAL WORLD BURDEN OF CHRONIC LOW

568
00:17:24,116 --> 00:17:27,085
BACK PAIN IN THAT THE MAIN

569
00:17:27,085 --> 00:17:28,053
PROBLEMS SURROUNDING BACK PAIN

570
00:17:28,053 --> 00:17:30,088
ARE THE DISABILITY IT CREATES,

571
00:17:30,088 --> 00:17:31,690
THE PAIN ITSELF, AND THE OPIOID

572
00:17:31,690 --> 00:17:31,890
USE.

573
00:17:31,890 --> 00:17:33,191
SO WE WANTED TO MAKE SURE WE

574
00:17:33,191 --> 00:17:34,292
WERE MEASURING THOSE THREE.

575
00:17:34,292 --> 00:17:35,594
WE WANTED TO MAKE SURE THAT WE

576
00:17:35,594 --> 00:17:37,029
COULD MAKE COMPARISONS TO

577
00:17:37,029 --> 00:17:38,664
PREVIOUS AND FUTURE STUDIES IN

578
00:17:38,664 --> 00:17:40,632
THIS AREA, AND WE WANTED TO

579
00:17:40,632 --> 00:17:42,501
INCORPORATE ALL OF THE GREAT

580
00:17:42,501 --> 00:17:43,802
GUIDANCE THAT WAS AVAILABLE

581
00:17:43,802 --> 00:17:46,638
THROUGH THE BAC PAC MINIMUM

582
00:17:46,638 --> 00:17:47,839
DATASET, AND THEN THE HEAL

583
00:17:47,839 --> 00:17:50,342
COMMON DATA ELEMENTS DATASET,

584
00:17:50,342 --> 00:17:52,010
WHICH IS ALWAYS USEFUL AND WE

585
00:17:52,010 --> 00:17:54,413
WERE ALSO APPLYING FOR A HEAL

586
00:17:54,413 --> 00:17:55,414
FUNDING MECHANISM, SO IT WAS

587
00:17:55,414 --> 00:17:57,816
IMPORTANT WE INCLUDED THAT.

588
00:17:57,816 --> 00:17:59,117
AND THEN MOVE ON TO THE NEXT

589
00:17:59,117 --> 00:18:00,452
SLIDE.

590
00:18:00,452 --> 00:18:02,954
SO OUR OUTCOMES -- OUR PRIMARY

591
00:18:02,954 --> 00:18:04,790
OUT COME IS LOW BACK

592
00:18:04,790 --> 00:18:06,758
PAIN-RELATED DISABILITY,

593
00:18:06,758 --> 00:18:09,928
MEASURED BY THE OSWESTRY

594
00:18:09,928 --> 00:18:11,263
DISABILITY INDEX, PAIN IN WHICH

595
00:18:11,263 --> 00:18:13,532
WE MEASURE IN MULTIPLE WAYS,

596
00:18:13,532 --> 00:18:15,067
THEN OPIOID USE, WHICH WE

597
00:18:15,067 --> 00:18:16,535
MEASURE BY SELF-REPORT AND

598
00:18:16,535 --> 00:18:20,439
THROUGH EHR DATA EXTRACTION.

599
00:18:20,439 --> 00:18:23,175
THEN MOVING ON TO THE NEXT SLY,

600
00:18:23,175 --> 00:18:25,410
WE'VE GOT THE LAST COMPONENT OF

601
00:18:25,410 --> 00:18:27,813
OUR RESEARCH QUESTION WHICH IS

602
00:18:27,813 --> 00:18:28,146
TIME.

603
00:18:28,146 --> 00:18:29,915
THE CONSIDERATIONS WE HAD HERE

604
00:18:29,915 --> 00:18:30,716
WERE FIRST THE LENGTH OF

605
00:18:30,716 --> 00:18:31,049
INTERVENTION.

606
00:18:31,049 --> 00:18:32,417
WE WANTED OUR PRIMARY END POINT

607
00:18:32,417 --> 00:18:34,352
TO OCCUR SHORTLY AFTER THE

608
00:18:34,352 --> 00:18:37,389
INTERVENTION WAS DELIVERED, BUT

609
00:18:37,389 --> 00:18:40,425
BEING A BEHAVIORAL INTERVENTION

610
00:18:40,425 --> 00:18:41,526
LIKE P.T., IT TAKES EIGHT WEEKS

611
00:18:41,526 --> 00:18:43,261
TO DELIVER THE INTERVENTION.

612
00:18:43,261 --> 00:18:44,930
IT'S NOT SORT OF A ONE-TIME

613
00:18:44,930 --> 00:18:45,263
INTERVENTION.

614
00:18:45,263 --> 00:18:46,431
AND WE WANTED TO PROVIDE A

615
00:18:46,431 --> 00:18:49,167
LITTLE BIT OF FLEX IBILITY IN

616
00:18:49,167 --> 00:18:50,302
THE EVENT THAT SHOULD SOMEONE

617
00:18:50,302 --> 00:18:51,903
NEED TO RESCHEDULE ONE OF THESE

618
00:18:51,903 --> 00:18:53,705
EIGHT VISITS, IT COULD TAKE NINE

619
00:18:53,705 --> 00:18:55,373
OR 10 WEEKS TO GET ALL EIGHT

620
00:18:55,373 --> 00:18:56,842
WEEKLY VISITS, SO WE WANTED TO

621
00:18:56,842 --> 00:18:59,144
PROVIDE SOME FLEXIBILITY THERE.

622
00:18:59,144 --> 00:19:00,545
WE ALSO WANTED TO MAKE SURE WE

623
00:19:00,545 --> 00:19:03,849
WERE MEASURING CARRYOVER OF

624
00:19:03,849 --> 00:19:04,716
TREATMENT EFFECTS AFTER THE

625
00:19:04,716 --> 00:19:05,817
IMMEDIATE POST INTERVENTION

626
00:19:05,817 --> 00:19:07,018
PHASE, AND THEN AGAIN WANTED TO

627
00:19:07,018 --> 00:19:08,553
MAKE SURE THAT WE COULD MAKE

628
00:19:08,553 --> 00:19:10,288
COMPARISONS TO PAST AND FUTURE

629
00:19:10,288 --> 00:19:11,456
STUDIES, ONE OF THEM, FOR

630
00:19:11,456 --> 00:19:14,793
EXAMPLE, THE OPTIMIZE TRIAL,

631
00:19:14,793 --> 00:19:17,162
WHICH IS A PCORI FUNDED STUDY

632
00:19:17,162 --> 00:19:17,829
THAT JOHNS HOPKINS IS

633
00:19:17,829 --> 00:19:19,264
PARTICIPATING IN, WHICH INCLUDES

634
00:19:19,264 --> 00:19:20,565
PHYSICAL THERAPIES AND ACTIVE

635
00:19:20,565 --> 00:19:21,967
TREATMENT INTERVENTION FOR

636
00:19:21,967 --> 00:19:23,101
PATIENTS WITH CHRONIC LOW BACK

637
00:19:23,101 --> 00:19:24,536
PAIN, MAKING SURE WE HAD SIMILAR

638
00:19:24,536 --> 00:19:25,804
TIME POINTS TO THAT STUDY WOULD

639
00:19:25,804 --> 00:19:27,572
ALLOW US TO MAKE SOME IMPORTANT

640
00:19:27,572 --> 00:19:30,108
COMPARISONS DOWN THE ROAD.

641
00:19:30,108 --> 00:19:34,379
SO ON OUR LAST SLIDE HERE, WE'VE

642
00:19:34,379 --> 00:19:35,981
GOT ALL COMPONENTS OF OUR

643
00:19:35,981 --> 00:19:37,082
RESEARCH QUESTION, SO FOR TIME,

644
00:19:37,082 --> 00:19:39,384
WE LANDED ON OUR PRIMARY END

645
00:19:39,384 --> 00:19:41,019
POINT BEING 10 WEEKS, WHICH

646
00:19:41,019 --> 00:19:42,020
PROVIDES A LITTLE BIT OF

647
00:19:42,020 --> 00:19:44,756
FLEXIBILITY AFTER THAT 8-WEEK

648
00:19:44,756 --> 00:19:45,190
INTERVENTION.

649
00:19:45,190 --> 00:19:46,558
FOUR MONTH IS WHEN WE WILL

650
00:19:46,558 --> 00:19:53,265
MEASURE OUR INTERMEDIATE CARRY

651
00:19:53,265 --> 00:19:55,233
CARRYOVER AND 12 MONTHS IS OUR

652
00:19:55,233 --> 00:19:58,870
LONG TERM FOLLOW YU.  FOLLOW-UP.

653
00:19:58,870 --> 00:20:00,071
THANK YOU VERY MUCH, THIS IS OUR

654
00:20:00,071 --> 00:20:01,072
RESEARCH QUESTION AND LOOKING

655
00:20:01,072 --> 00:20:02,007
FORWARD TO THE PANEL DISCUSSION.

656
00:20:02,007 --> 00:20:03,008
>> THANK YOU VERY MUCH,
KEVIN.

657
00:20:03,008 --> 00:20:04,009
THAT WAS GREAT.

658
00:20:04,009 --> 00:20:06,611
LET'S GO TO KUSHANG PATEL FOR

659
00:20:06,611 --> 00:20:13,084
THE PE PERSPECTIVE FROM THE AIMP

660
00:20:13,084 --> 00:20:13,752
TRIAL.

661
00:20:13,752 --> 00:20:14,786
KUSHANG, ARE YOU ALL SET?

662
00:20:14,786 --> 00:20:18,657
>> THANKS, I'M A RESEARCH

663
00:20:18,657 --> 00:20:19,191
PROFESSOR, UNIVERSITY OF

664
00:20:19,191 --> 00:20:19,491
WASHINGTON.

665
00:20:19,491 --> 00:20:21,827
I HAVE A STRONG INTEREST IN --

666
00:20:21,827 --> 00:20:23,862
TREATMENTS FOR PAIN MANAGEMENT.

667
00:20:23,862 --> 00:20:28,600
ON THIS PROJECT, AIM-CP,

668
00:20:28,600 --> 00:20:31,236
FORTUNATE TO TEAM UP WITH

669
00:20:31,236 --> 00:20:41,880
DR. SBA C SEBASTIAN TONG.

670
00:20:43,114 --> 00:20:45,450
SO WE ARE MOTIVATED BY THE DATA

671
00:20:45,450 --> 00:20:49,521
SHOWN IN THESE FIGURES.

672
00:20:49,521 --> 00:20:50,689
CLEARLY THESE DATA SHOW THAT THE

673
00:20:50,689 --> 00:20:52,891
BURDEN OF PAIN IS HIGHER AMONG

674
00:20:52,891 --> 00:20:54,526
ADULTS IN MORE RURAL AREAS THAN

675
00:20:54,526 --> 00:20:56,394
IN URBAN AREAS.

676
00:20:56,394 --> 00:20:58,129
THERE ARE APPROXIMATELY

677
00:20:58,129 --> 00:20:59,631
9 MILLION ADULTS IN RURAL AREAS

678
00:20:59,631 --> 00:21:04,569
WHO HAVE CHRONIC PAIN, AND 3 1/2

679
00:21:04,569 --> 00:21:06,438
MILLION OF THEM HAVE HIGH IMPACT

680
00:21:06,438 --> 00:21:09,074
OR ACTIVITY-LIMITING PAIN.

681
00:21:09,074 --> 00:21:12,744
SIMILAR TO WHAT KEVIN HAD TALKED

682
00:21:12,744 --> 00:21:16,281
ABOUT, MANY OF THESE INDIVIDUALS

683
00:21:16,281 --> 00:21:18,016
DO NOT HAVE ACCESS TO MULTIMODAL

684
00:21:18,016 --> 00:21:19,351
PAIN MANAGEMENT AND WE KNOW FOR

685
00:21:19,351 --> 00:21:20,986
MANY CHRONIC PAIN CONDITIONS

686
00:21:20,986 --> 00:21:23,688
THAT EXERCISE IS A FIRST-LINE

687
00:21:23,688 --> 00:21:25,323
TREATMENT, BUT ACCESS TO

688
00:21:25,323 --> 00:21:26,758
EVIDENCE-BASED PROGRAMS IS

689
00:21:26,758 --> 00:21:28,293
SEVERELY LIMITED IN RURAL AREAS,

690
00:21:28,293 --> 00:21:29,628
AND THERE ARE SEVERAL BARRIERS

691
00:21:29,628 --> 00:21:32,464
TO PARTICIPATING IN PHYSICAL

692
00:21:32,464 --> 00:21:36,268
ACTIVITY.

693
00:21:36,268 --> 00:21:39,771
SO BASED ON STUDIES -- PREVIOUS

694
00:21:39,771 --> 00:21:41,206
STUDIES IN OUR OWN INTERVIEWS

695
00:21:41,206 --> 00:21:42,841
WITH RURAL PATIENTS WHO HAVE

696
00:21:42,841 --> 00:21:46,111
CHRONIC PAIN, WE KNOW THAT THERE

697
00:21:46,111 --> 00:21:49,714
ARE SEVERAL BARRIERS INCLUDING

698
00:21:49,714 --> 00:21:52,584
FEW IF ANY OPTIONS FOR

699
00:21:52,584 --> 00:21:55,420
STRUCTURED EXERCISE PROGRAMS OR

700
00:21:55,420 --> 00:21:57,255
FACILITIES IN RURAL AREAS.

701
00:21:57,255 --> 00:21:59,357
IF CLASSES DO EXIST, THEY ARE

702
00:21:59,357 --> 00:22:01,660
OFTEN INCONSISTENTLY OFFERED

703
00:22:01,660 --> 00:22:03,295
BECAUSE OF LIMITATIONS IN

704
00:22:03,295 --> 00:22:06,698
STAFFING OR COST.

705
00:22:06,698 --> 00:22:09,000
IF THEY ARE OFFERED, THEY ARE

706
00:22:09,000 --> 00:22:10,635
OFTEN FAR AWAY FROM A PATIENT'S

707
00:22:10,635 --> 00:22:12,504
HOME, WHICH IS PARTICULARLY

708
00:22:12,504 --> 00:22:14,005
CHALLENGING FOR OLDER PATIENTS

709
00:22:14,005 --> 00:22:15,540
WHO DO NOT DRIVE OR DON'T HAVE

710
00:22:15,540 --> 00:22:19,477
ACCESS TO TRANSPORTATION.

711
00:22:19,477 --> 00:22:20,478
AND LONG DISTANCES ARE

712
00:22:20,478 --> 00:22:21,913
PARTICULARLY CHALLENGING FOR

713
00:22:21,913 --> 00:22:26,584
THOSE WHO ARE CAREGIVERS WHO

714
00:22:26,584 --> 00:22:28,553
NEED TO STAY CLOSE TO LOVED ONES

715
00:22:28,553 --> 00:22:29,254
THAT THEY'RE CARING FOR.

716
00:22:29,254 --> 00:22:30,655
THERE ARE ALSO BARRIERS TO

717
00:22:30,655 --> 00:22:32,190
WALKING FOR EXERCISE IN RURAL

718
00:22:32,190 --> 00:22:33,291
AREAS.

719
00:22:33,291 --> 00:22:34,626
INCLUDING A LACK OF SIDEWALKS

720
00:22:34,626 --> 00:22:38,430
AND STREETLIGHTS, UNEVEN

721
00:22:38,430 --> 00:22:39,731
SURFACES, HILLY AREAS WHICH CAN

722
00:22:39,731 --> 00:22:41,700
BE PARTICULARLY CHALLENGING FOR

723
00:22:41,700 --> 00:22:43,335
THOSE WITH LOW BACK PAIN OR PAIN

724
00:22:43,335 --> 00:22:46,738
IN THE LOWER EXTREMITIES.

725
00:22:46,738 --> 00:22:48,273
SO -- AND LASTLY, DESTINATIONS

726
00:22:48,273 --> 00:22:50,542
ARE OFTEN MORE SPREAD OUT AND

727
00:22:50,542 --> 00:22:54,045
LESS CONDUCIVE TO WALKING IN

728
00:22:54,045 --> 00:22:54,412
RURAL AREAS.

729
00:22:54,412 --> 00:22:57,115
THERE ARE ALSO ADDITIONAL SAFETY

730
00:22:57,115 --> 00:22:58,850
CONCERNS THAT HAVE BEEN

731
00:22:58,850 --> 00:23:00,852
EXPRESSED BY PATIENTS IN RURAL

732
00:23:00,852 --> 00:23:03,788
AREAS, INDIGENOUS WOMEN CITE

733
00:23:03,788 --> 00:23:05,523
FEAR OF VIOLENCE OR BEING

734
00:23:05,523 --> 00:23:06,758
ABDUCTED WHEN WALKING, AS WELL

735
00:23:06,758 --> 00:23:08,626
AS DANGERS FROM WILDLIFE.

736
00:23:08,626 --> 00:23:11,363
AND CERTAINLY EXTREME WEATHER

737
00:23:11,363 --> 00:23:13,531
CAN ALSO LIMIT OUTDOOR PHYSICAL

738
00:23:13,531 --> 00:23:13,865
ACTIVITY.

739
00:23:13,865 --> 00:23:15,834
SO MANY OF THESE BARRIERS CAN BE

740
00:23:15,834 --> 00:23:18,470
ADDRESSED THROUGH TELEEXERCISE,

741
00:23:18,470 --> 00:23:21,106
AND AS WE HAVE ALL EXPERIENCED,

742
00:23:21,106 --> 00:23:23,375
COVID-19 WAS A GREAT ACCELERATOR

743
00:23:23,375 --> 00:23:24,542
OF TELEHEALTH, SO DURING THE

744
00:23:24,542 --> 00:23:27,979
EARLY PHASE OF THE PANDEMIC, WE

745
00:23:27,979 --> 00:23:30,815
NEED A DELIBERATE PARTICIPATORY

746
00:23:30,815 --> 00:23:32,884
APPROACH TO ADAPTING AN

747
00:23:32,884 --> 00:23:34,953
EVIDENCE-BASED EXERCISE PROGRAM

748
00:23:34,953 --> 00:23:36,621
CALLED ENHANCE FITNESS.

749
00:23:36,621 --> 00:23:39,657
THIS IS AN INSTRUCTOR-LED

750
00:23:39,657 --> 00:23:40,358
GROUP-BASED MULTICOMPONENT

751
00:23:40,358 --> 00:23:42,193
EXERCISE PROGRAM INVOLVING

752
00:23:42,193 --> 00:23:43,828
STRENGTH, ENDURANCE AND BALANCE

753
00:23:43,828 --> 00:23:47,332
TRAINING TA IS HELD FOR AN HOUR

754
00:23:47,332 --> 00:23:49,067
THREE DAYS A WEEK IN COMMUNITY

755
00:23:49,067 --> 00:23:50,735
CENTERS LIKE YMCAs.

756
00:23:50,735 --> 00:23:52,904
THIS PROGRAM IS NOW WIDELY

757
00:23:52,904 --> 00:23:54,873
DISSEMINATED, AVAILABLE IN OVER

758
00:23:54,873 --> 00:23:59,677
800 SITES IN 44 STATES, AND

759
00:23:59,677 --> 00:24:03,314
RANDOMIZED CLINICAL TRIALS HAVE

760
00:24:03,314 --> 00:24:05,950
SHOWN IT SHOWS ENHANCEMENT OF

761
00:24:05,950 --> 00:24:06,785
PHYSICAL FUNCTIONS IN OLDER

762
00:24:06,785 --> 00:24:07,352
ADULTS.

763
00:24:07,352 --> 00:24:09,754
SO PRIOR TO THE PANDEMIC,

764
00:24:09,754 --> 00:24:11,389
ENHANCE FITNESS WAS NOT ABLE

765
00:24:11,389 --> 00:24:13,158
TO -- OR NOT ACCESSIBLE TO

766
00:24:13,158 --> 00:24:15,760
PEOPLE IN RURAL AREAS.

767
00:24:15,760 --> 00:24:18,263
SO TO ADAPT IT FOR REMOTE

768
00:24:18,263 --> 00:24:20,899
DELIVERY, WE ENGAGED ENHANCE

769
00:24:20,899 --> 00:24:23,034
FITNESS USERS, INSTRUCTORRED AND

770
00:24:23,034 --> 00:24:24,636
THE NATIONAL LEADERSHIP ABOUT

771
00:24:24,636 --> 00:24:26,371
WHAT THEY WOULD LIKE TO HAVE IN

772
00:24:26,371 --> 00:24:28,506
TERMS OF SAFETY, EFFECTIVENESS,

773
00:24:28,506 --> 00:24:31,743
AND CONCERNS ABOUT TECHNOLOGY

774
00:24:31,743 --> 00:24:33,044
FOR REMOTELY DELIVERED VERSION

775
00:24:33,044 --> 00:24:35,580
OF ENHANCED FITNESS, SO WE USED

776
00:24:35,580 --> 00:24:37,182
AN ITERATIVE PROCESS TO DEVELOP

777
00:24:37,182 --> 00:24:39,284
AND THEN PREPILOT THE REMOTE

778
00:24:39,284 --> 00:24:41,886
DELIVERY PROTOCOL AND THEN WE

779
00:24:41,886 --> 00:24:43,788
PARTNERED WITH A RURAL SERVING

780
00:24:43,788 --> 00:24:44,622
HEALTH SYSTEM CALLED ARBOR

781
00:24:44,622 --> 00:24:47,926
HEALTH IN WASHINGTON STATE.

782
00:24:47,926 --> 00:24:49,994
THIS HEALTH SYSTEM WAS TRULY

783
00:24:49,994 --> 00:24:50,762
AMAZING.

784
00:24:50,762 --> 00:24:52,197
ARBOR HEALTH HAD PROMOTED OUR

785
00:24:52,197 --> 00:24:53,598
PILOT STUDY THROUGH MULTIPLE

786
00:24:53,598 --> 00:24:57,435
CHANNELS, INCLUDING SOCIAL MEDIA

787
00:24:57,435 --> 00:24:59,404
IN PRINTS, AND THEN THEY EMAILED

788
00:24:59,404 --> 00:25:00,839
THEIR PATIENTS WITH KNEE

789
00:25:00,839 --> 00:25:01,706
OSTEOARTHRITIS, WHICH WAS OUR

790
00:25:01,706 --> 00:25:03,341
TARGET POPULATION FOR THIS PILOT

791
00:25:03,341 --> 00:25:05,643
STUDY, AND IN THE END, THE PILOT

792
00:25:05,643 --> 00:25:08,713
HAD DEMONSTRATED THAT REMOTELY

793
00:25:08,713 --> 00:25:11,316
DELIVERED ENHANCED FITNESS IS

794
00:25:11,316 --> 00:25:12,217
FEASIBLE AND ACCEPTABLE TO RURAL

795
00:25:12,217 --> 00:25:13,518
PATIENTS WHO HAVE CHRONIC PAIN.

796
00:25:13,518 --> 00:25:15,720
THERE WERE HIGH RATES OF

797
00:25:15,720 --> 00:25:18,556
TREATMENT SATISFACTION.

798
00:25:18,556 --> 00:25:20,625
87% HAD COMPLETED THE THREE

799
00:25:20,625 --> 00:25:24,896
MONTH EXERCISE PROGRAM, AND

800
00:25:24,896 --> 00:25:26,664
MEDIAN CLASS ATTENDANCE RATES

801
00:25:26,664 --> 00:25:27,398
WERE 91%.

802
00:25:27,398 --> 00:25:29,267
SO REALLY POSITIVE RESULTS.

803
00:25:29,267 --> 00:25:32,537
SO BASED ON THIS PILOT, ARBOR

804
00:25:32,537 --> 00:25:35,273
HEALTH HAS ACTUALLY, IN FACT,

805
00:25:35,273 --> 00:25:38,009
SUSTAINED THE TELE-EF PROGRAM

806
00:25:38,009 --> 00:25:40,745
FOR THE PAST 2 1/2 YEARS, SO

807
00:25:40,745 --> 00:25:43,915
THEY'VE ADOPTED IT, AND THE

808
00:25:43,915 --> 00:25:45,683
REMOTE DELIVERY PROGRAM THAT WE

809
00:25:45,683 --> 00:25:47,852
DEVELOPED IS NOW NATIONALLY

810
00:25:47,852 --> 00:25:49,154
DISSEMINATED TO ALL ENHANCE

811
00:25:49,154 --> 00:25:50,355
FITNESS SAITS THROUGHOUT THE

812
00:25:50,355 --> 00:25:51,556
COUNTRY.

813
00:25:51,556 --> 00:25:52,557
ONE OF THE LEARNINGS THAT WE

814
00:25:52,557 --> 00:25:56,294
TOOK AWAY FROM THE PILOT WAS

815
00:25:56,294 --> 00:25:57,495
THAT THROUGH EXIT INTERVIEWS

816
00:25:57,495 --> 00:26:01,566
WITH PARTICIPANTS, THE

817
00:26:01,566 --> 00:26:03,001
IMPORTANCE OF ENGAGING WITH

818
00:26:03,001 --> 00:26:06,271
HEALTH SYSTEMS WAS REALLY KEY TO

819
00:26:06,271 --> 00:26:08,573
OUR SUCCESS FOR, ONE, ACCESSING

820
00:26:08,573 --> 00:26:09,807
RURAL PATIENTS, AND FOR GAINING

821
00:26:09,807 --> 00:26:12,076
THEIR TRUST.

822
00:26:12,076 --> 00:26:16,347
IN FACT SOME OF THE PARTICIPANTS

823
00:26:16,347 --> 00:26:18,950
HAD EXPRESSED TO US THAT THEY

824
00:26:18,950 --> 00:26:22,153
HAD CONTACTED THEIR PRIMARY CARE

825
00:26:22,153 --> 00:26:23,454
PROVIDERS BEFORE DECIDING TO

826
00:26:23,454 --> 00:26:25,857
PARTICIPATE IN THE STUDY.

827
00:26:25,857 --> 00:26:27,492
SO DESPITE A LOT OF PROMOTION

828
00:26:27,492 --> 00:26:30,461
THROUGH THE HEALTH SYSTEM THAT

829
00:26:30,461 --> 00:26:31,896
MANY PATIENTS REALLY WANTED TO

830
00:26:31,896 --> 00:26:35,266
STILL TALK TO THEIR PCPs ABOUT

831
00:26:35,266 --> 00:26:36,034
ABOUT THIS PROGRAM AND WHETHER

832
00:26:36,034 --> 00:26:41,839
IT WOULD BE A GOOD FIT FOR THEM,

833
00:26:41,839 --> 00:26:49,514
SO WE SOUGHT TO ENGAGE A RURAL

834
00:26:49,514 --> 00:26:51,683
SERVING PRIMARY CARE PHYSICIANS

835
00:26:51,683 --> 00:26:54,085
AND PRACTICES BY CONDUCTING

836
00:26:54,085 --> 00:26:56,421
INTERVIEWS WITH THEM ABOUT

837
00:26:56,421 --> 00:26:57,388
EXERCISE COUNSELING AND

838
00:26:57,388 --> 00:26:58,389
PRESCRIBING AND REFERRING

839
00:26:58,389 --> 00:27:01,125
PATIENTS TO TELE-ENHANCED

840
00:27:01,125 --> 00:27:02,560
FITNESS BASED ON THOSE RESULTS,

841
00:27:02,560 --> 00:27:08,466
WE DESIGNED AN EXERCISE PATHWAY

842
00:27:08,466 --> 00:27:11,402
AND IMPLEMENTED IT THROUGH

843
00:27:11,402 --> 00:27:15,106
PRIMARY CARE CLINIC IN WYOMING.

844
00:27:15,106 --> 00:27:16,741
THIS INVOLVES SCREENING OF

845
00:27:16,741 --> 00:27:19,410
PHYSICAL ACTIVITY AND PROVIDER

846
00:27:19,410 --> 00:27:21,579
COUNSELING PATIENTS ON PHYSICAL

847
00:27:21,579 --> 00:27:24,082
ACTIVITY AND REFERRING PATIENTS

848
00:27:24,082 --> 00:27:28,386
TO TELE-ENHANCED FITNESS.

849
00:27:28,386 --> 00:27:30,655
HOWEVER, THIS PILOT FACED A

850
00:27:30,655 --> 00:27:34,392
NUMBER OF CHALLENGES DURING THE

851
00:27:34,392 --> 00:27:35,493
COVID-19 PANDEMIC.

852
00:27:35,493 --> 00:27:38,129
AND WE WERE ONLY ABLE TO SCREEN

853
00:27:38,129 --> 00:27:40,298
SIX PATIENTS FOR THE STUDY OVER

854
00:27:40,298 --> 00:27:43,901
A 4 1/2 MONTH PERIOD.

855
00:27:43,901 --> 00:27:46,304
AND ONLY FOUR PATIENTS WERE

856
00:27:46,304 --> 00:27:49,507
REFERRED -- FOUR OF THE SIX WERE

857
00:27:49,507 --> 00:27:51,676
REFERRED TO TELEHEALTH ENHANCED

858
00:27:51,676 --> 00:27:52,777
FITNESS.

859
00:27:52,777 --> 00:27:54,078
THERE WERE MANY LESSONS WE

860
00:27:54,078 --> 00:27:55,280
LEARNED FROM THIS PILOT,

861
00:27:55,280 --> 00:27:56,381
INCLUDING THAT PRIMARY CARE

862
00:27:56,381 --> 00:27:57,315
PHYSICIANS HAVE LITTLE TIME TO

863
00:27:57,315 --> 00:27:59,150
SPARE AND HAVE MANY CO-MORBID

864
00:27:59,150 --> 00:28:00,985
CONDITIONS TO MANAGE, SO

865
00:28:00,985 --> 00:28:04,055
EXERCISE WAS OFTEN NOT A

866
00:28:04,055 --> 00:28:06,457
PRIORITY DURING VISITS AND OFTEN

867
00:28:06,457 --> 00:28:09,193
GOT PUSHED BACK TO THE BACK

868
00:28:09,193 --> 00:28:13,331
BURNER.

869
00:28:13,331 --> 00:28:14,766
PCPs ALSO WANTED TO REFER ANY

870
00:28:14,766 --> 00:28:19,037
OF THEIR PATIENTS TO EXERCISE,

871
00:28:19,037 --> 00:28:20,772
VERSUS WE FOCUSED ON

872
00:28:20,772 --> 00:28:21,472
OSTEOARTHRITIS IN THIS

873
00:28:21,472 --> 00:28:23,841
PARTICULAR STUDY, SO THAT WAS

874
00:28:23,841 --> 00:28:25,877
ANOTHER LIMITATION OF THE

875
00:28:25,877 --> 00:28:28,446
PROJECT.

876
00:28:28,446 --> 00:28:32,817
KEY FOR US WAS ROOMING STAFF WHO

877
00:28:32,817 --> 00:28:35,219
ORIGINALLY -- WHO WERE SUPPOSED

878
00:28:35,219 --> 00:28:37,622
TO ORIGINALLY SCREEN FOR

879
00:28:37,622 --> 00:28:39,691
PHYSICAL ACTIVITY WERE BURNED

880
00:28:39,691 --> 00:28:41,225
OUT BECAUSE OF STAFFING

881
00:28:41,225 --> 00:28:43,528
SHORTAGES DURING THE COVID-19

882
00:28:43,528 --> 00:28:45,730
PANDEMIC, SO ADDING THIS

883
00:28:45,730 --> 00:28:47,165
SCREENING TO THEIR PLATE WAS NOT

884
00:28:47,165 --> 00:28:53,738
FEASIBLE.

885
00:28:53,738 --> 00:28:55,173
SO ALL OF THESE LEARNINGS FED

886
00:28:55,173 --> 00:28:58,776
INTO OUR M ACATION FOR FUNDING

887
00:28:58,776 --> 00:29:01,913
AND IN RESPONSE TO THE HEAL

888
00:29:01,913 --> 00:29:06,751
INITIATIVE, THE NOSY FOR RURAL

889
00:29:06,751 --> 00:29:07,418
PATIENTS.

890
00:29:07,418 --> 00:29:10,788
WE DECIDED TO ADAPT A NURSE CARE

891
00:29:10,788 --> 00:29:13,091
MANAGEMENT MODEL TO IMPROVE PAIN

892
00:29:13,091 --> 00:29:14,625
OUTCOMES AMONG RURAL PRIMARY

893
00:29:14,625 --> 00:29:15,059
CARE PATIENTS.

894
00:29:15,059 --> 00:29:16,227
THERE ARE A NUMBER OF ADVANTAGES

895
00:29:16,227 --> 00:29:20,732
FOR THIS MODEL, KR INCLUDING ONE

896
00:29:20,732 --> 00:29:22,066
HAVING FOCUS, A NURSE CARE

897
00:29:22,066 --> 00:29:24,802
MANAGER WOULD HAVE FOCUS TIME TO

898
00:29:24,802 --> 00:29:28,172
DIG INTO PAIN, PHYSICAL ACTIVITY

899
00:29:28,172 --> 00:29:31,709
AND COUNSEL THEM AROUND PAIN

900
00:29:31,709 --> 00:29:32,677
MANAGEMENT AS WELL AS PHYSICAL

901
00:29:32,677 --> 00:29:33,544
ACTIVITY.

902
00:29:33,544 --> 00:29:42,854
AND SO THIS ELIMINA EE -- NURSEE

903
00:29:42,854 --> 00:29:45,490
MANAGEMENT MODEL WOULD REDUCE

904
00:29:45,490 --> 00:29:48,559
COMPETING ATTENTION FROM OTHER

905
00:29:48,559 --> 00:29:50,728
COMORBIDITIES AND REALLY FOCUS

906
00:29:50,728 --> 00:29:54,799
ON PAIN AND THEN PROVIDED FOR A

907
00:29:54,799 --> 00:29:57,201
VERY SIMPLIFIED REFERRAL

908
00:29:57,201 --> 00:29:59,804
MECHANISM TO TELEENHANCED

909
00:29:59,804 --> 00:30:00,805
FITNESS, AND SO FOR THIS

910
00:30:00,805 --> 00:30:03,541
PROJECT, OUR NURSE CARE MANAGER

911
00:30:03,541 --> 00:30:09,680
MEETS WITH PATIENTS SIX TIMES TO

912
00:30:09,680 --> 00:30:13,418
COORDINATE THEIR CARE, AND

913
00:30:13,418 --> 00:30:18,122
POTENTIALLY DELIVER COGNITIVE

914
00:30:18,122 --> 00:30:19,657
BEHAVIORAL THERAPY FOR 6 TO 10

915
00:30:19,657 --> 00:30:20,725
SESSIONS, DEPENDING ON THE

916
00:30:20,725 --> 00:30:23,895
PATIENT'S NEEDS, AND THEN REFER

917
00:30:23,895 --> 00:30:27,298
THEM TO ENHANCE FITNESS IF THE

918
00:30:27,298 --> 00:30:32,003
PATIENT IS READY.

919
00:30:32,003 --> 00:30:38,609
SO WE HAD A LOT OF -- CONDUCT A

920
00:30:38,609 --> 00:30:41,646
LOT OF PILOT STUDIES IN ADVANCE

921
00:30:41,646 --> 00:30:45,917
OF OUR CURRENT PROJECT, AND SO

922
00:30:45,917 --> 00:30:50,288
BASED ON THE LEARNINGS OF THOSE

923
00:30:50,288 --> 00:30:51,823
PILOTS AS WELL AS THE EXPERIENCE

924
00:30:51,823 --> 00:30:58,262
OF OUR COLLABORATORS, OUR PICOT

925
00:30:58,262 --> 00:31:00,698
FOR OUR PROJECT IS HERE, OUR

926
00:31:00,698 --> 00:31:02,567
POPULATION RURAL DWELLING

927
00:31:02,567 --> 00:31:04,001
PATIENT WHO HAVE CHRONIC PAIN.

928
00:31:04,001 --> 00:31:05,503
THE INTERVENTION INVOLVES NURSE

929
00:31:05,503 --> 00:31:09,006
CARE COORDINATION OF PAIN

930
00:31:09,006 --> 00:31:11,876
MANAGEMENT AS WELL AS COGNITIVE

931
00:31:11,876 --> 00:31:13,311
BEHAVIORAL THERAPY FOR MANAGING

932
00:31:13,311 --> 00:31:15,513
NOT ONLY PAIN BUT ALSO OTHER

933
00:31:15,513 --> 00:31:17,782
ACTIVITY LIVING SYMPTOMS SUCH AS

934
00:31:17,782 --> 00:31:20,751
DEPRESSED MOOD, ANXIETY, FEAR OF

935
00:31:20,751 --> 00:31:22,720
MOVEMENT, AND THE CBT IS

936
00:31:22,720 --> 00:31:25,323
INTENDED TO HELP BEHAVIORALLY

937
00:31:25,323 --> 00:31:26,224
ACTIVATE OUR PATIENTS AND

938
00:31:26,224 --> 00:31:27,425
DEPENDING ON WHERE THE PATIENT

939
00:31:27,425 --> 00:31:31,362
IS AT, THE NURSE CARE MANAGER

940
00:31:31,362 --> 00:31:33,331
WILL MAKE A REFERRAL TO

941
00:31:33,331 --> 00:31:35,099
TELEENHANCE FITNESS.

942
00:31:35,099 --> 00:31:38,236
FOR OUR COMPARISON GROUP, WE

943
00:31:38,236 --> 00:31:39,704
DECIDED ON USUAL CARE TO REFLECT

944
00:31:39,704 --> 00:31:41,672
THE REALITY THAT MANY OF THESE

945
00:31:41,672 --> 00:31:45,042
PATIENTS DO NOT HAVE ACCESS TO

946
00:31:45,042 --> 00:31:45,977
PHARMACOLOGIC TREATMENTS AND

947
00:31:45,977 --> 00:31:49,180
COMING UP WITH A ACTIVE

948
00:31:49,180 --> 00:31:50,515
COMPARISON GROUP WOULD HAVE

949
00:31:50,515 --> 00:31:56,320
BEEN -- IS CHALLENGING AND

950
00:31:56,320 --> 00:31:57,722
RESOURCE-INTENSIVE FOR -- GIVEN

951
00:31:57,722 --> 00:31:59,490
THE AMOUNT OF MONEY THAT WE

952
00:31:59,490 --> 00:32:00,258
HAVE -- FUNDING WE HAVE

953
00:32:00,258 --> 00:32:02,226
AVAILABLE FOR THE PROJECT.

954
00:32:02,226 --> 00:32:05,296
OUR PRIMARY OUTCOME IS PAIN

955
00:32:05,296 --> 00:32:06,531
INTERFERENCE AS MEASURED BY THE

956
00:32:06,531 --> 00:32:07,398
PEG.

957
00:32:07,398 --> 00:32:10,468
IN TERMS OF TIMING, SIMILAR TO

958
00:32:10,468 --> 00:32:12,870
THE PREVIOUS SPEAKER, WE DECIDED

959
00:32:12,870 --> 00:32:14,739
ON A 6-MONTH INTERVENTION PERIOD

960
00:32:14,739 --> 00:32:19,844
TO ALLOW FOR TIME FOR ASSESSMENT

961
00:32:19,844 --> 00:32:23,915
OF THE PATIENT AS WELL AS

962
00:32:23,915 --> 00:32:28,419
DELIVERY OF PAIN CARE SERVICES

963
00:32:28,419 --> 00:32:33,457
AS WELL AS TIME FOR THE CBT AND

964
00:32:33,457 --> 00:32:34,225
ENGAGEMENT WITH THE ENHANCE

965
00:32:34,225 --> 00:32:34,659
FITNESS PROGRAM.

966
00:32:34,659 --> 00:32:35,993
SO IN TERMS OF OUR OUTCOMES,

967
00:32:35,993 --> 00:32:38,296
WE'LL BE ASSESSING THEM AT

968
00:32:38,296 --> 00:32:39,397
BASELINE, 6 MONTHS AND 12 MONTHS

969
00:32:39,397 --> 00:32:42,266
AND OUR PRIMARY END POINT IS AT

970
00:32:42,266 --> 00:32:47,171
6 MONTHS.

971
00:32:47,171 --> 00:32:52,743
THANK YOU ALL.

972
00:32:52,743 --> 00:32:53,611
APPRECIATE THIS OPPORTUNITY.

973
00:32:53,611 --> 00:32:54,946
>> THANKS, KUSHANG.

974
00:32:54,946 --> 00:32:56,047
THAT WAS TERRIFIC.

975
00:32:56,047 --> 00:32:58,683
OKAY, LET'S HEAR FROM TWO OF THE

976
00:32:58,683 --> 00:33:03,821
TRIALS THAT ARE FURTHER ALONG OR

977
00:33:03,821 --> 00:33:04,822
COMPLETED.

978
00:33:04,822 --> 00:33:05,856
ANDREA, ARE YOU READY TO GO?

979
00:33:05,856 --> 00:33:06,691
>> YEAH, I AM.

980
00:33:06,691 --> 00:33:08,092
CAN YOU HEAR ME OKAY?

981
00:33:08,092 --> 00:33:11,162
>> WE CAN HEAR YOU JUST
FINE.

982
00:33:11,162 --> 00:33:11,362
YEAH.

983
00:33:11,362 --> 00:33:11,929
>> EXCELLENT.

984
00:33:11,929 --> 00:33:12,930
WELL, THANK YOU VERY MUCH FOR

985
00:33:12,930 --> 00:33:17,301
ALLOWING ME TO SHARE THE THOUGHT

986
00:33:17,301 --> 00:33:20,137
AND EVENTS THAT LED TO THE

987
00:33:20,137 --> 00:33:22,773
KNOW-HARM PRAGMATIC TRIAL.

988
00:33:22,773 --> 00:33:24,742
NO HARM STANDS FOR

989
00:33:24,742 --> 00:33:25,943
NON-PHARMACOLOGIC OPTIONS IN

990
00:33:25,943 --> 00:33:27,578
POST HOSPITAL AND REHABL PAIN

991
00:33:27,578 --> 00:33:35,319
MANAGEMENT.

992
00:33:35,319 --> 00:33:37,088
VERY MUCH INFLUENCED BY CONTEXT.

993
00:33:37,088 --> 00:33:40,191
IT WAS EARLY 2019.

994
00:33:40,191 --> 00:33:42,727
AND OUR TEAM WAS IN THE MIDST OF

995
00:33:42,727 --> 00:33:44,462
GOING LIVE WITH THE INTERVENTION

996
00:33:44,462 --> 00:33:48,099
FOR THE E2C2 TRIAL, ALSO

997
00:33:48,099 --> 00:33:50,501
PRAGMATIC TRIAL.

998
00:33:50,501 --> 00:33:52,336
E2C2 STANDS FOR ENHANCED EHR

999
00:33:52,336 --> 00:33:53,070
FACILITATED CANCER SYMPTOM

1000
00:33:53,070 --> 00:33:57,274
CONTROL.

1001
00:33:57,274 --> 00:34:01,212
THE INTERVENTION SYSTEMATIZED

1002
00:34:01,212 --> 00:34:03,014
ELECTRONIC REPORTED SCREENING AT

1003
00:34:03,014 --> 00:34:06,784
THE POPULATION LEVEL AMONG

1004
00:34:06,784 --> 00:34:08,953
CANCER PATIENTS IN MIDWEST

1005
00:34:08,953 --> 00:34:09,654
PRACTICES.

1006
00:34:09,654 --> 00:34:12,023
IT ATTEMPTED TO AUTOMATE EHR

1007
00:34:12,023 --> 00:34:13,257
RESPONSES FOR CLINICALLY

1008
00:34:13,257 --> 00:34:17,895
ACTIONABLE SCORES WHICH THE

1009
00:34:17,895 --> 00:34:20,498
LITERATURE IS QUITE ROBUST IN

1010
00:34:20,498 --> 00:34:22,033
DEMONSTRATING THAT ARE

1011
00:34:22,033 --> 00:34:22,366
INCONSISTENT.

1012
00:34:22,366 --> 00:34:27,004
SO WE WANTED TO OUGHT MADE

1013
00:34:27,004 --> 00:34:27,772
PREFERENCE-CONCORDANT,

1014
00:34:27,772 --> 00:34:29,407
EVIDENCE-BASED AND ACTIONABLE

1015
00:34:29,407 --> 00:34:30,841
SCORES TO PROBLEMATIC LEVELS OF

1016
00:34:30,841 --> 00:34:36,614
SYMPTOMS.

1017
00:34:36,614 --> 00:34:40,451
THROUGH EHR PARAMETERIZATION.

1018
00:34:40,451 --> 00:34:42,853
WE ACHIEVED A VERY HIGH REACH BY

1019
00:34:42,853 --> 00:34:45,389
VIRTUE OF TWO FACTORS, THE EHR

1020
00:34:45,389 --> 00:34:46,057
ENROLLMENT, AS WELL AS THE FACT

1021
00:34:46,057 --> 00:34:49,427
THAT OUR INSTITUTIONAL IRB

1022
00:34:49,427 --> 00:34:52,730
AWARDED A WAY FOR INFORMED

1023
00:34:52,730 --> 00:34:54,265
CONSENT, THIS BEING CONSIDERED A

1024
00:34:54,265 --> 00:34:55,800
STANDARD OF CARE TRIAL.

1025
00:34:55,800 --> 00:34:57,101
BUT WE GRAPPLED WITH LIMITED

1026
00:34:57,101 --> 00:34:58,102
PROVIDER ENGAGEMENT AS WELL AS

1027
00:34:58,102 --> 00:35:00,705
THE FACT THAT PATIENTS JUST

1028
00:35:00,705 --> 00:35:02,940
DON'T LOVE PROMs OFTEN AND

1029
00:35:02,940 --> 00:35:05,676
THEY REALLY -- IN QUALITATIVE

1030
00:35:05,676 --> 00:35:06,877
INTERVIEWS, THEY REQUESTED

1031
00:35:06,877 --> 00:35:10,581
GREATER PERSONALIZATION.

1032
00:35:10,581 --> 00:35:15,186
SO AT THIS TIME, AN RFA APPEARED

1033
00:35:15,186 --> 00:35:17,188
ENTITLED PRAGMATIC AND

1034
00:35:17,188 --> 00:35:18,055
IMPLEMENTATION STUDIES FOR THE

1035
00:35:18,055 --> 00:35:20,357
MANAGEMENT OF PAIN TO REDUCE

1036
00:35:20,357 --> 00:35:28,666
OPIOID PRESCRIBING, OR PRISM,

1037
00:35:28,666 --> 00:35:31,202
AND IT GALVANIZED OUR TEAM TO

1038
00:35:31,202 --> 00:35:33,204
CAREFULLY CONSIDER NEXT

1039
00:35:33,204 --> 00:35:33,938
PROGRAMMATIC STEPS.

1040
00:35:33,938 --> 00:35:35,806
WAS THIS RELEVANT TO OUR PROGRAM

1041
00:35:35,806 --> 00:35:37,041
AND THE DIRECTION WE WANTED TO

1042
00:35:37,041 --> 00:35:39,977
GO, AND WE DECIDED VERY MUCH SO.

1043
00:35:39,977 --> 00:35:43,814
AND THAT WE WERE TRYING TO FIND

1044
00:35:43,814 --> 00:35:45,883
EFFECTIVE WAYS TO LEVERAGE

1045
00:35:45,883 --> 00:35:48,285
DIGITAL TOOLS TO ADVANCE

1046
00:35:48,285 --> 00:35:49,820
EFFECTIVE AND EQUITABLE

1047
00:35:49,820 --> 00:35:50,855
SUPPORTIVE CARE DELIVERY IN

1048
00:35:50,855 --> 00:35:52,923
VULNERABLE POPULATIONS.

1049
00:35:52,923 --> 00:35:54,992
WE HAD LIMITED BANDWIDTH.

1050
00:35:54,992 --> 00:35:55,960
WE THOUGHT THIS WOULD BE

1051
00:35:55,960 --> 00:35:57,294
INTERESTING AND ENJOYABLE.

1052
00:35:57,294 --> 00:35:58,395
VERY IMPORTANTLY.

1053
00:35:58,395 --> 00:36:00,364
BUT GRAPPLED WITH WHETHER WE

1054
00:36:00,364 --> 00:36:08,339
COULD COME UP WITH FUNDABLE

1055
00:36:08,339 --> 00:36:09,673
OPPORTUNITY TO LEGITIMATELY

1056
00:36:09,673 --> 00:36:10,474
ADVANCE THE STATE OF THE

1057
00:36:10,474 --> 00:36:13,644
SCIENCE.

1058
00:36:13,644 --> 00:36:15,045
AND NOT MUCH HEADWAY WAS MADE

1059
00:36:15,045 --> 00:36:19,450
FOR QUITE A WHILE, UNTIL IN VERY

1060
00:36:19,450 --> 00:36:22,253
CASUAL SETTINGS AN IDEA CAME UP

1061
00:36:22,253 --> 00:36:24,588
THAT WAS GROUNDED IN OUR

1062
00:36:24,588 --> 00:36:25,156
UNDERSTANDING OF THE CURRENT

1063
00:36:25,156 --> 00:36:26,791
STATE.

1064
00:36:26,791 --> 00:36:28,793
IN EPROM-BASED SYMPTOM

1065
00:36:28,793 --> 00:36:29,360
SCREENING.

1066
00:36:29,360 --> 00:36:31,929
AND THAT WAS THAT PATIENT WOULD

1067
00:36:31,929 --> 00:36:34,331
ENGAGE WITH FAIRLY STERILE,

1068
00:36:34,331 --> 00:36:37,735
HIGHLY STRUCTURED PROM

1069
00:36:37,735 --> 00:36:40,805
INTERFACES, THE SCORES WOULD

1070
00:36:40,805 --> 00:36:45,176
THEN POPULATE EHR CHARTS,

1071
00:36:45,176 --> 00:36:47,378
TABLES, THEY MIGHT BE DELIVERED

1072
00:36:47,378 --> 00:36:49,580
TO CLINICIANS WHO MAY OR MAY NOT

1073
00:36:49,580 --> 00:36:51,315
INCLUDE THEM IN THEIR CLINICAL

1074
00:36:51,315 --> 00:36:52,416
NOTES.

1075
00:36:52,416 --> 00:36:55,419
BUT AT THAT POINT, OFTEN THE

1076
00:36:55,419 --> 00:36:58,222
DATA DID NOT GO ANY FURTHER, AND

1077
00:36:58,222 --> 00:37:01,292
WERE NOT LEVERAGED TO IMPROVE

1078
00:37:01,292 --> 00:37:02,393
PATIENTS' EXPERIENCE OR

1079
00:37:02,393 --> 00:37:04,228
OUTCOMES.

1080
00:37:04,228 --> 00:37:06,897
AND WE CONCEPTUALIZED AN

1081
00:37:06,897 --> 00:37:10,167
ENHANCED FUTURE STATE, WHEREBY

1082
00:37:10,167 --> 00:37:11,168
PATIENTS WOULD ENGAGE WITH A

1083
00:37:11,168 --> 00:37:15,339
MUCH MORE ESTHETICALLY APPEALING

1084
00:37:15,339 --> 00:37:17,541
INDIVIDUALIZED INTERFACE THAT

1085
00:37:17,541 --> 00:37:19,844
DIDN'T JUST -- WASN'T

1086
00:37:19,844 --> 00:37:20,511
UNIDIRECTIONAL, DIDN'T JUST

1087
00:37:20,511 --> 00:37:21,378
SERVE TO COLLECT THEIR

1088
00:37:21,378 --> 00:37:24,648
INFORMATION, BUT ALSO TO DELIVER

1089
00:37:24,648 --> 00:37:27,518
EDUCATION TO BUILD THERAPEUTIC

1090
00:37:27,518 --> 00:37:28,586
ALLIANCE, AND WE THOUGHT THAT

1091
00:37:28,586 --> 00:37:29,587
PERHAPS THE INFORMATION

1092
00:37:29,587 --> 00:37:32,122
COLLECTED FROM SUCH AN INTERFACE

1093
00:37:32,122 --> 00:37:34,191
COULD THEN DRIVE CLINICAL

1094
00:37:34,191 --> 00:37:37,928
DECISION SUPPORT TOOLS IN THE

1095
00:37:37,928 --> 00:37:41,765
EHR TO SEND DIRECT TO PATIENT

1096
00:37:41,765 --> 00:37:43,500
CONTENT, TO PROMPT PROVIDERS,

1097
00:37:43,500 --> 00:37:45,135
FOR TIMELY CARE INTEGRATION, TO

1098
00:37:45,135 --> 00:37:47,137
RESPOND TO CONTEXTUAL TRIGGERS,

1099
00:37:47,137 --> 00:37:52,810
AND TO INFORM DEFAULT SETTINGS.

1100
00:37:52,810 --> 00:37:54,345
AND AS OTHERS HAVE MENTIONED, WE

1101
00:37:54,345 --> 00:37:57,314
TOOK STOCK.

1102
00:37:57,314 --> 00:37:58,649
WE WERE EXCITED ABOUT THIS IDEA

1103
00:37:58,649 --> 00:38:00,718
BUT RECOGNIZED THAT IT HAD TO BE

1104
00:38:00,718 --> 00:38:07,591
TRANSLATED INTO A TETHERRABLE TE

1105
00:38:07,591 --> 00:38:08,959
HYPOTHESIS.

1106
00:38:08,959 --> 00:38:10,594
CONSIDERING OUR ASSET, WE WERE

1107
00:38:10,594 --> 00:38:13,163
AT A HIGH DESTINATION MEDICAL

1108
00:38:13,163 --> 00:38:14,131
CENTER WITH EXCELLENT RURAL

1109
00:38:14,131 --> 00:38:15,232
REPRESENTATION AND BROAD

1110
00:38:15,232 --> 00:38:15,900
GEOGRAPHIC COVERAGE.

1111
00:38:15,900 --> 00:38:17,668
WE ALSO IDENTIFIED SOME

1112
00:38:17,668 --> 00:38:19,303
OPPORTUNITIES FROM THE

1113
00:38:19,303 --> 00:38:20,838
E2C2 TRIAL, NAMELY POPULATION

1114
00:38:20,838 --> 00:38:24,508
ENROLLMENT THROUGH THE EHR, AS

1115
00:38:24,508 --> 00:38:27,544
WELL AS WAYS THAT EHR,

1116
00:38:27,544 --> 00:38:29,413
SPECIFICALLY EPIC CLINICAL

1117
00:38:29,413 --> 00:38:31,382
DECISION SUPPORT COULD BE

1118
00:38:31,382 --> 00:38:32,182
PARAMETERIZED TO INFLUENCE

1119
00:38:32,182 --> 00:38:33,918
PATIENT EXPERIENCE.

1120
00:38:33,918 --> 00:38:36,287
BUT WE RECOGNIZED LIMITATIONS.

1121
00:38:36,287 --> 00:38:39,390
WE HAD A FAIRLY CONSTRAINED

1122
00:38:39,390 --> 00:38:41,458
PRIMARY CARE PRACTICE AT MAYO

1123
00:38:41,458 --> 00:38:43,227
WITH LIMITED OPTIONS FOR

1124
00:38:43,227 --> 00:38:44,762
LONGITUDAL FOLLOW-UP.

1125
00:38:44,762 --> 00:38:48,465
RACIAL AND ETHNIC DIVERSITY WAS

1126
00:38:48,465 --> 00:38:51,368
ALSO A LIMITATION.

1127
00:38:51,368 --> 00:38:53,137
WE WERE ALREADY GRAPPLEING WITH

1128
00:38:53,137 --> 00:38:55,205
CLINICIAN ENGAGEMENT ISSUES AND

1129
00:38:55,205 --> 00:38:57,942
HAD RECENTLY GONE THROUGH THE

1130
00:38:57,942 --> 00:39:02,079
PAINS OF ADVANCING FAIRLY

1131
00:39:02,079 --> 00:39:03,547
CUSTOMIZED BESPOKE EHR BUILD

1132
00:39:03,547 --> 00:39:05,616
THAT SPANNED MULTIPLE EPIC

1133
00:39:05,616 --> 00:39:10,888
FUNCTIONALITIES.

1134
00:39:10,888 --> 00:39:11,989
BUT WE WANTED TO GO FORWARD.

1135
00:39:11,989 --> 00:39:14,425
WE WERE UNDETERRED, AND THAT

1136
00:39:14,425 --> 00:39:16,794
LEFT A NUMBER OF QUESTIONS, AND

1137
00:39:16,794 --> 00:39:19,096
WE THOUGHT PRINCIPAL AMONG THESE

1138
00:39:19,096 --> 00:39:20,164
WERE WHO WOULD THE TEAM BE AND

1139
00:39:20,164 --> 00:39:21,966
WHAT WOULD THE INTERVENTION BE?

1140
00:39:21,966 --> 00:39:30,274
IT WOULD ENABLE US TO ADVANCE AN

1141
00:39:30,274 --> 00:39:31,809
IDEA WITH STRONG EMPIRICAL

1142
00:39:31,809 --> 00:39:33,344
SUPPORT THAT WAS INNOVATIVE, AND

1143
00:39:33,344 --> 00:39:36,413
FOR WHICH WE COULD MARSHAL

1144
00:39:36,413 --> 00:39:38,716
ADEQUATE RESOURCES AND AN

1145
00:39:38,716 --> 00:39:40,084
INVESTIGATIVE TEAM.

1146
00:39:40,084 --> 00:39:45,723
AND SO WE TACKLED THE TEAM FIRST

1147
00:39:45,723 --> 00:39:46,390
AND RECOGNIZED THAT AMONG A

1148
00:39:46,390 --> 00:39:49,360
GROUP OF FAIRLY SEASONED

1149
00:39:49,360 --> 00:39:51,662
TRIALISTS AND NIH-FUNDED

1150
00:39:51,662 --> 00:39:52,730
INVESTIGATORS, WE HAD WHAT WE

1151
00:39:52,730 --> 00:39:54,498
THOUGHT WERE A UNIQUE SKILLSET,

1152
00:39:54,498 --> 00:40:00,004
A COLLECTION OF SKILLSETS IN EHR

1153
00:40:00,004 --> 00:40:04,041
BUILD BESPOKE EHR BUILD SHARED

1154
00:40:04,041 --> 00:40:06,810
DECISION-MAKING WITH DECISION

1155
00:40:06,810 --> 00:40:08,412
AIDS, INTEGRATIVE MEDICINE, USER

1156
00:40:08,412 --> 00:40:10,214
CENTERED E DESIGN, PARTICULARLY

1157
00:40:10,214 --> 00:40:11,515
PATIENT DIRECTED E DESIGN, AS

1158
00:40:11,515 --> 00:40:14,151
WELL AS REHABILITATIVE AND

1159
00:40:14,151 --> 00:40:15,452
TELEREHABILITATIVE APPROACHES TO

1160
00:40:15,452 --> 00:40:18,222
PAIN CONTROL.

1161
00:40:18,222 --> 00:40:19,757
SO WE FURTHER MATURED THE IDEA

1162
00:40:19,757 --> 00:40:22,259
AT THIS POINT AND DECIDED

1163
00:40:22,259 --> 00:40:25,362
INSTEAD OF -- WE KNEW WE WANTED

1164
00:40:25,362 --> 00:40:26,864
TO ADVANCE NON-PHARMACOLOGIC

1165
00:40:26,864 --> 00:40:27,231
PAIN CARE.

1166
00:40:27,231 --> 00:40:29,533
AND WE DECIDED THAT IF WE POOLED

1167
00:40:29,533 --> 00:40:30,868
REHABILITATIVE APPROACHES AND

1168
00:40:30,868 --> 00:40:34,805
INTEGRATIVE APPRO APPROACHES THT

1169
00:40:34,805 --> 00:40:36,106
PERHAPS INSTEAD OF ADVANCING A

1170
00:40:36,106 --> 00:40:37,541
FEW MORE MODALITY, WE COULD

1171
00:40:37,541 --> 00:40:39,510
OFFER PATIENT A BROADER ARRAY

1172
00:40:39,510 --> 00:40:41,378
AND PROVIDE THEM AGENCY TO

1173
00:40:41,378 --> 00:40:44,248
SELECT THOSE THAT WERE APPEALING

1174
00:40:44,248 --> 00:40:48,952
AND IDEALLY EFFECTIVE FOR THEM.

1175
00:40:48,952 --> 00:40:52,990
YOU SO THE IDEA WAS BORN TO

1176
00:40:52,990 --> 00:40:57,728
ESSENTIALLY CREATE -- EMBED A

1177
00:40:57,728 --> 00:40:59,163
PROMPT, A GUIDE THAT WOULD TEACH

1178
00:40:59,163 --> 00:41:00,664
PATIENTS ABOUT NON-PHARMACOLOGIC

1179
00:41:00,664 --> 00:41:03,267
PAIN CARE OPTIONS, AND THE DOWN

1180
00:41:03,267 --> 00:41:05,335
SIDES OF OPIOIDS, WHILE

1181
00:41:05,335 --> 00:41:07,171
COLLECTING THEIR NPPC

1182
00:41:07,171 --> 00:41:08,939
PREFERENCES AND THEIR MOTIVATION

1183
00:41:08,939 --> 00:41:11,341
AND CONFIDENCE FOR USE.

1184
00:41:11,341 --> 00:41:13,544
BUT THIS LEFT US WITH THE

1185
00:41:13,544 --> 00:41:15,512
QUESTION OF WHO WOULD THE

1186
00:41:15,512 --> 00:41:19,583
POPULATION BE AND HOW WOULD WE

1187
00:41:19,583 --> 00:41:21,885
CREATE CLINICAL DECISION SUPPORT

1188
00:41:21,885 --> 00:41:25,155
TO CREATE UNIFIED SUPPORT FOR AN

1189
00:41:25,155 --> 00:41:25,756
INDIVIDUALIZED PAIN MANAGEMENT

1190
00:41:25,756 --> 00:41:25,989
PLAN.

1191
00:41:25,989 --> 00:41:27,758
SO WE THOUGHT AT THAT POINT

1192
00:41:27,758 --> 00:41:29,059
PERHAPS THE NEXT MOST IMPORTANT

1193
00:41:29,059 --> 00:41:33,430
DECISION WAS POPULATION.

1194
00:41:33,430 --> 00:41:34,998
WE WERE VERY MUCH CONSIDERING

1195
00:41:34,998 --> 00:41:37,101
AND HOPING TO ACHIEVE A WAIVER

1196
00:41:37,101 --> 00:41:38,635
OF INFORMED CONSENT AND RECRUIT

1197
00:41:38,635 --> 00:41:39,503
AT THE POPULATION LEVEL.

1198
00:41:39,503 --> 00:41:41,171
SO THAT INFLUENCED OUR CHOICE OF

1199
00:41:41,171 --> 00:41:41,839
POPULATIONS.

1200
00:41:41,839 --> 00:41:43,674
WE CONSIDERED CANCER PATIENTS,

1201
00:41:43,674 --> 00:41:45,876
VARIOUS TYPES OF MUSCULOSKELETAL

1202
00:41:45,876 --> 00:41:47,511
PAIN, CHRONIC PAIN, BUT WE

1203
00:41:47,511 --> 00:41:49,680
ULTIMATELY DECIDE ON SURGICAL

1204
00:41:49,680 --> 00:41:52,316
PATIENTS FOR THREE REASONS.

1205
00:41:52,316 --> 00:41:55,853
THIS WAS IMPACTFUL AS OPIOIDS

1206
00:41:55,853 --> 00:41:57,955
PRESCRIBED FOR PERIOPERATIVE

1207
00:41:57,955 --> 00:41:59,156
CARE CONTINUED TO FUEL THE

1208
00:41:59,156 --> 00:42:03,994
OPIOID CRISIS, IMPROVE

1209
00:42:03,994 --> 00:42:06,163
PERIOPERATIVE PAIN CONTROL, AND

1210
00:42:06,163 --> 00:42:07,030
GUIDELINE CONCORDANT PAIN

1211
00:42:07,030 --> 00:42:11,568
CONTROL WAS VERY APPEALING TO

1212
00:42:11,568 --> 00:42:12,369
INSTITUTIONAL LEADERSHIP, AND

1213
00:42:12,369 --> 00:42:15,072
ALSO WE FOUND THAT THERE WAS

1214
00:42:15,072 --> 00:42:17,141
STRONG EMPIRICAL SUPPORT FOR

1215
00:42:17,141 --> 00:42:20,544
MULTIPLE NPPC APPROACHES FOR

1216
00:42:20,544 --> 00:42:21,111
MANAGING PERIOPERATIVE CARE.

1217
00:42:21,111 --> 00:42:23,180
SO THIS WAS ENCOURAGING.

1218
00:42:23,180 --> 00:42:27,584
WE ALSO THOUGHT ABOUT CONTEXT

1219
00:42:27,584 --> 00:42:28,785
AND CONSIDERED EXPANDING BEYOND

1220
00:42:28,785 --> 00:42:30,087
OUR SETTING TO ENGAGE OTHER

1221
00:42:30,087 --> 00:42:33,891
HEALTHCARE SYSTEMS, BUT GIVEN

1222
00:42:33,891 --> 00:42:35,592
ONE OF OUR SALIENT STRENGTHS WAS

1223
00:42:35,592 --> 00:42:41,732
A UNIFIED EHR ACROSS DIVERSE AND

1224
00:42:41,732 --> 00:42:42,866
GEOGRAPHICALLY DISBURSED CENTERS

1225
00:42:42,866 --> 00:42:45,903
AND THE FACT THAT WE HAD

1226
00:42:45,903 --> 00:42:46,470
EXPERIENCED A DIFFICULTY

1227
00:42:46,470 --> 00:42:48,739
ADVANCING EHR BUILD, WE GAVE UP

1228
00:42:48,739 --> 00:42:51,608
THAT OPTION AND EVENTUALLY

1229
00:42:51,608 --> 00:42:56,313
DECIDED TO TARGET AND ENGAGE THE

1230
00:42:56,313 --> 00:42:59,550
ENTIRE MAYO CLINIC EN ENTERPRIS,

1231
00:42:59,550 --> 00:43:01,618
WHICH SPANNED SIX STATES WITH

1232
00:43:01,618 --> 00:43:02,586
VERY, VERY LARGE CATCHMENT

1233
00:43:02,586 --> 00:43:02,920
AREAS.

1234
00:43:02,920 --> 00:43:04,721
SO AT THIS TIME OUR CONCEPT HAD

1235
00:43:04,721 --> 00:43:06,023
MATURED TO WE WOULD DELIVER THE

1236
00:43:06,023 --> 00:43:08,225
CONVERSATION TO SURGICAL

1237
00:43:08,225 --> 00:43:09,860
PATIENTS, IT WOULD STAY WITH

1238
00:43:09,860 --> 00:43:11,228
THEM THROUGHOUT THE ENTIRE

1239
00:43:11,228 --> 00:43:12,963
PERIOPERATIVE TRAJECTORY.

1240
00:43:12,963 --> 00:43:18,669
WE WOULD COLLECT THEIR NPPC OR

1241
00:43:18,669 --> 00:43:20,671
CAM PREFERENCES AND THEN CREATE

1242
00:43:20,671 --> 00:43:24,508
VERY DISCRETE ALIQUOTS OF

1243
00:43:24,508 --> 00:43:26,476
INFORMATION THAT WE WOULD

1244
00:43:26,476 --> 00:43:30,080
STRATEGICALLY DELIVER ACROSS

1245
00:43:30,080 --> 00:43:32,149
MULTIPLE CLINICAL STAKEHOLDERS,

1246
00:43:32,149 --> 00:43:33,817
SPANNING THE FULL PERIOPERATIVE

1247
00:43:33,817 --> 00:43:36,019
TRAJECTORY.

1248
00:43:36,019 --> 00:43:37,221
 TO ADVANCE THIS

1249
00:43:37,221 --> 00:43:39,223
AGENDA OF NPPC INTEGRATION, AND

1250
00:43:39,223 --> 00:43:40,657
THAT INCLUDED ALLIED HEALTH,

1251
00:43:40,657 --> 00:43:43,060
SURGICAL TEAM MEMBERS, BEDSIDE

1252
00:43:43,060 --> 00:43:45,162
NURSES, PREOPERATIVE CLINICS,

1253
00:43:45,162 --> 00:43:46,563
AND POSTOPERATIVE FOLLOW-UP

1254
00:43:46,563 --> 00:43:48,532
CLINICS.

1255
00:43:48,532 --> 00:43:51,235
AND THE IDEA WAS TO DELIVER JUST

1256
00:43:51,235 --> 00:43:52,869
THE RIGHT INFORMATION TO THE

1257
00:43:52,869 --> 00:43:53,937
RIGHT PERSON AT THE RIGHT TIME

1258
00:43:53,937 --> 00:43:58,775
SO THEY COULD DO A REASONABLE --

1259
00:43:58,775 --> 00:44:01,411
HAVE A REASONABLE EVENT ON

1260
00:44:01,411 --> 00:44:03,380
PATIENTS' USE OF NPPC.

1261
00:44:03,380 --> 00:44:05,582
AND AT THIS POINT, WE THOUGHT

1262
00:44:05,582 --> 00:44:07,818
WE'D CHECKED ALL OUR BOXES WITH

1263
00:44:07,818 --> 00:44:09,886
RESPECT TO EMPIRICAL SUPPORT,

1264
00:44:09,886 --> 00:44:12,956
INNOVATION, RESOURCES AND TEAM.

1265
00:44:12,956 --> 00:44:14,958
AND SO THE CONCEPT WAS A

1266
00:44:14,958 --> 00:44:17,027
CLINICALLY INTEGRATED EHR SYSTEM

1267
00:44:17,027 --> 00:44:20,430
TO INCREASE THE USE OF SAFE,

1268
00:44:20,430 --> 00:44:23,967
VALIDATED AND EVIDENCE-BASED

1269
00:44:23,967 --> 00:44:24,835
PREFERENCE-CONCORDANT

1270
00:44:24,835 --> 00:44:25,602
NON-PHARMACOLOGIC PAIN CARE

1271
00:44:25,602 --> 00:44:26,803
OPTIONS.

1272
00:44:26,803 --> 00:44:29,006
SUCH THAT ACROSS THE FULL

1273
00:44:29,006 --> 00:44:31,875
PERIOPERATIVE TRAJECTORY, WE

1274
00:44:31,875 --> 00:44:35,012
WOULD ENCOMPASS DIVERSE

1275
00:44:35,012 --> 00:44:36,813
CLINICIAN, SETTING AND WORKFLOWS

1276
00:44:36,813 --> 00:44:40,083
TO ADVANCE THIS AGENDA OF NPPC

1277
00:44:40,083 --> 00:44:42,519
INTEGRATION.

1278
00:44:42,519 --> 00:44:44,621
OUR OUTCOMES WERE ACTUALLY

1279
00:44:44,621 --> 00:44:46,590
FAIRLY SIMPLE BECAUSE THE HEAL

1280
00:44:46,590 --> 00:44:48,025
INITIATED MANDATED THESE, AND

1281
00:44:48,025 --> 00:44:50,861
THEY ALIGNED OUR COPRIMARY

1282
00:44:50,861 --> 00:44:51,862
OUTCOMES FOR PAIN MANAGEMENT AND

1283
00:44:51,862 --> 00:44:52,195
FUNCTION.

1284
00:44:52,195 --> 00:44:56,600
WE CHOSE A STEPPED WEDGE CLUSTER

1285
00:44:56,600 --> 00:44:57,968
RANDOMIZED DESIGN FOR TWO

1286
00:44:57,968 --> 00:44:58,769
PRINCIPAL REASONS.

1287
00:44:58,769 --> 00:45:00,537
ONE, WE WERE WORRIED ABOUT

1288
00:45:00,537 --> 00:45:01,838
TEMPORAL TRENDS WITH RESPECT TO

1289
00:45:01,838 --> 00:45:02,706
OPIOID AVAILABILITY AND

1290
00:45:02,706 --> 00:45:04,074
LEGISLATION, AND ALSO, BECAUSE

1291
00:45:04,074 --> 00:45:06,710
WE HAD LIVED THROUGH THE

1292
00:45:06,710 --> 00:45:08,445
CHALLENGES OF COMPLEX

1293
00:45:08,445 --> 00:45:10,947
INFORMATICS IMPLEMENTATION OF

1294
00:45:10,947 --> 00:45:13,183
EHR CLINICAL DECISION SUPPORT

1295
00:45:13,183 --> 00:45:16,019
WITH THE E2C2 TRIAL.

1296
00:45:16,019 --> 00:45:19,623
AND APPRECIATED THE HIGH HUMAN

1297
00:45:19,623 --> 00:45:20,624
RESOURCE REQUIREMENTS AND

1298
00:45:20,624 --> 00:45:23,694
REALIZED WE COULD NOT DO ALL OR

1299
00:45:23,694 --> 00:45:26,797
HALF OF THE CLUSTERS AT ONE TI 

1300
00:45:26,797 --> 00:45:29,599
TIME.

1301
00:45:29,599 --> 00:45:30,600
SURGICAL TYPE -- PRACTICE AND

1302
00:45:30,600 --> 00:45:31,034
DEPARTMENT.

1303
00:45:31,034 --> 00:45:32,502
SO WE WENT WITH A CLUSTER

1304
00:45:32,502 --> 00:45:36,540
RANDOMIZED APPROACH.

1305
00:45:36,540 --> 00:45:38,742
AND OUR USUAL CARE, WE REALLY

1306
00:45:38,742 --> 00:45:40,844
COULDN'T, IT WAS A BIG LIFT TO

1307
00:45:40,844 --> 00:45:43,480
IMPLEMENT AS WE WERE, BUT IT WAS

1308
00:45:43,480 --> 00:45:43,914
USUAL CARE.

1309
00:45:43,914 --> 00:45:46,750
AND WITH THAT, I'LL THANK YOU

1310
00:45:46,750 --> 00:45:49,286
FOR YOUR ATTENTION, AND PASS THE

1311
00:45:49,286 --> 00:45:53,156
MIC BACK TO KEVIN.

1312
00:45:53,156 --> 00:45:54,758
>> THANK YOU SO MUCH,
ANDREA.

1313
00:45:54,758 --> 00:45:56,993
LET'S GO TO OUR FINAL TRIAL

1314
00:45:56,993 --> 00:45:59,629
DISCUSSING THE SPOT TRIALS, GREG

1315
00:45:59,629 --> 00:46:00,063
SIMON.

1316
00:46:00,063 --> 00:46:00,831
GREG, YOU ARE ALL SET?

1317
00:46:00,831 --> 00:46:01,164
>> I DIDN'T.

1318
00:46:01,164 --> 00:46:03,400
CAN YOU HEAR ME OKAY?

1319
00:46:03,400 --> 00:46:03,633
>> YEP.

1320
00:46:03,633 --> 00:46:04,801
>> OKAY, THANKS VERY MUCH.

1321
00:46:04,801 --> 00:46:06,336
SO I'LL BE TALKING TO YOU ABOUT

1322
00:46:06,336 --> 00:46:10,474
ONE OF THE VERY FIRST IN THE

1323
00:46:10,474 --> 00:46:13,610
FIRST COHORT OF PRAGMATIC TRI 

1324
00:46:13,610 --> 00:46:15,045
TRIALS.

1325
00:46:15,045 --> 00:46:16,012
WE'RE GOING TO HAVE TO PUT

1326
00:46:16,012 --> 00:46:17,214
OURSELVES IN A TIME MACHINE AND

1327
00:46:17,214 --> 00:46:18,582
TAKE OURSELVES BACK TO JANUARY

1328
00:46:18,582 --> 00:46:19,483
OF 2012 IN TERMS OF WHERE WE

1329
00:46:19,483 --> 00:46:24,588
WERE AND WHAT WE KNEW.

1330
00:46:24,588 --> 00:46:25,722
SO OUR SITUATION THEN IN TERMS

1331
00:46:25,722 --> 00:46:27,257
OF SUICIDE PREVENTION, WE WERE

1332
00:46:27,257 --> 00:46:29,126
MOTIVATED BY THIS SORT OF

1333
00:46:29,126 --> 00:46:29,860
CONVERGENCE OF PRIORITIES.

1334
00:46:29,860 --> 00:46:31,361
THERE HAD BEEN A STEADY INCREASE

1335
00:46:31,361 --> 00:46:33,096
IN U.S. SUICIDE MORTALITY RATES

1336
00:46:33,096 --> 00:46:37,467
FOR AT THAT .15, 20 YEARS.

1337
00:46:37,467 --> 00:46:40,804
THE SURGEON GENERAL'S CALL TO

1338
00:46:40,804 --> 00:46:42,339
ACTION TO PREVENT SUICIDE

1339
00:46:42,339 --> 00:46:45,509
PUBLISHED IN 1999, THE STRATEGIC

1340
00:46:45,509 --> 00:46:48,712
PLAN AT NIMH IN PLACE AT THE

1341
00:46:48,712 --> 00:46:49,913
TIME IDENTIFIED SUICIDE

1342
00:46:49,913 --> 00:46:51,214
PREVENTION AS ONE OF THREE TOP

1343
00:46:51,214 --> 00:46:52,716
PRIORITIES FOR NIMH RESEARCH,

1344
00:46:52,716 --> 00:46:53,717
AND VERY IMPORTANT THE HEALTH

1345
00:46:53,717 --> 00:46:54,818
SYSTEMS PART OF OUR MENTAL

1346
00:46:54,818 --> 00:46:55,986
HEALTH RESEARCH NETWORK, MANY OF

1347
00:46:55,986 --> 00:46:57,888
THEM HAD STARTED TO FOCUS ON

1348
00:46:57,888 --> 00:46:59,322
SUICIDE PREVENTION AS ONE OF

1349
00:46:59,322 --> 00:47:00,524
THEIR TOP QUALITY AND SAFETY

1350
00:47:00,524 --> 00:47:02,492
PRIORITIES.

1351
00:47:02,492 --> 00:47:04,294
THE NATIONAL ACTION ALLIANCE FOR

1352
00:47:04,294 --> 00:47:06,029
SUICIDE PREVENTION WHICH IS A

1353
00:47:06,029 --> 00:47:07,998
NATIONAL SORT OF COORDINATING OR

1354
00:47:07,998 --> 00:47:10,567
CONVENING ORGANIZATION INCLUDING

1355
00:47:10,567 --> 00:47:11,868
INSURERS, HEALTH SYSTEMS, LARGE

1356
00:47:11,868 --> 00:47:14,304
EMPLOYERS, RESEARCH FUNDERS AND

1357
00:47:14,304 --> 00:47:15,639
RESEARCHERS, HAD PUT OUT THIS

1358
00:47:15,639 --> 00:47:18,708
IDEA ABOUT ZERO SUICIDE AS A

1359
00:47:18,708 --> 00:47:20,143
SCHEME FOR REDUCING OR

1360
00:47:20,143 --> 00:47:22,245
ADDRESSING THE RISK OF SUICIDE

1361
00:47:22,245 --> 00:47:23,146
IN HEALTHCARE.

1362
00:47:23,146 --> 00:47:24,080
SO THERE WAS DEFINITELY THIS

1363
00:47:24,080 --> 00:47:26,416
SORT OF CONVERGENCE OF

1364
00:47:26,416 --> 00:47:28,251
PRIORITIES FROM DIFFERENT

1365
00:47:28,251 --> 00:47:31,555
DIRECTIONS.

1366
00:47:31,555 --> 00:47:32,823
ALSO AT THAT TIME WHEN WE LOOKED

1367
00:47:32,823 --> 00:47:33,657
AT THE STATE OF THE EVIDENCE,

1368
00:47:33,657 --> 00:47:35,859
WHAT WE SAW WAS, ACCUMULATING

1369
00:47:35,859 --> 00:47:38,862
EVIDENCE THAT WE COULD ACTUALLY

1370
00:47:38,862 --> 00:47:39,596
ACCURATELY IDENTIFY PEOPLE WHO

1371
00:47:39,596 --> 00:47:42,799
WERE AT RISK.

1372
00:47:42,799 --> 00:47:44,100
WE FEW PEOPLE WHO ATTEMPTED OR

1373
00:47:44,100 --> 00:47:46,236
DIED BY SUICIDE THAT MORE THAN

1374
00:47:46,236 --> 00:47:48,438
70% OF THEM HAD AN OUTPATIENT

1375
00:47:48,438 --> 00:47:50,607
HEALTHCARE CONTACT IN THE PRIOR

1376
00:47:50,607 --> 00:47:52,209
YEAR, AS THE HEALTHCARE SYSTEMS,

1377
00:47:52,209 --> 00:47:53,710
WE WORKED AND STARTED TO USE

1378
00:47:53,710 --> 00:47:55,045
THESE STANDARD DEPRESSION

1379
00:47:55,045 --> 00:47:56,780
QUESTIONNAIRES LIKE THE PHQ9.

1380
00:47:56,780 --> 00:47:58,014
WE FOUND THAT HOW PEOPLE

1381
00:47:58,014 --> 00:47:59,850
RESPONDED TO THAT NINTH QUESTION

1382
00:47:59,850 --> 00:48:01,852
ON THE PHQ9 REGARDING THOUGHTS

1383
00:48:01,852 --> 00:48:03,887
OF SUICIDE OR SELF-HARM ACTUALLY

1384
00:48:03,887 --> 00:48:05,422
DID IDENTIFY PEOPLE WHO WERE AT

1385
00:48:05,422 --> 00:48:07,491
SIGNIFICANT RISK, PEOPLE WHO

1386
00:48:07,491 --> 00:48:09,226
REPORTED THOUGHTS OF DEATH OR

1387
00:48:09,226 --> 00:48:10,260
SELF-HARM MORE THAN HALF THE

1388
00:48:10,260 --> 00:48:11,795
DAYS OR NEARLY EVERY DAY HAD

1389
00:48:11,795 --> 00:48:14,631
ABOUT A 4% RISK OF A SUICIDE

1390
00:48:14,631 --> 00:48:16,132
RISK OR SELF-HARM EVENT IN THE

1391
00:48:16,132 --> 00:48:16,867
FOLLOWING YEAR.

1392
00:48:16,867 --> 00:48:18,335
WE ALSO WERE AWARE OF EVIDENCE

1393
00:48:18,335 --> 00:48:20,637
FOR THE EFFECTIVENESS OF VARIOUS

1394
00:48:20,637 --> 00:48:21,638
INTERVENTIONS THAT ADDRESSED

1395
00:48:21,638 --> 00:48:23,940
VARIOUS PARTS OF THE RISK

1396
00:48:23,940 --> 00:48:26,776
SPECTRUM.

1397
00:48:26,776 --> 00:48:27,878
THERE WERE SEVERAL STUDIES

1398
00:48:27,878 --> 00:48:29,079
ROARED BUT WHAT WE WOULD CALL AT

1399
00:48:29,079 --> 00:48:30,780
THE TIME CARING LETTERS BUT NOW

1400
00:48:30,780 --> 00:48:32,516
WHAT WE WOULD CALL CARING

1401
00:48:32,516 --> 00:48:34,217
CONTACTS WHICH WERE SORT OF LOW

1402
00:48:34,217 --> 00:48:35,952
INTENSITY SUPPORTIVE CONTACTS

1403
00:48:35,952 --> 00:48:37,587
OFTEN FOR PEOPLE WHO HAD BEEN IN

1404
00:48:37,587 --> 00:48:38,922
AN EMERGENCY DEPARTMENT FOR A

1405
00:48:38,922 --> 00:48:40,257
SELF-HARM EVENT OR HOSPITALIZED

1406
00:48:40,257 --> 00:48:42,225
SHOWING THAT EVEN THIS LOW

1407
00:48:42,225 --> 00:48:44,961
INTENSITY CONTACT MIGHT DECREASE

1408
00:48:44,961 --> 00:48:46,496
RISK.

1409
00:48:46,496 --> 00:48:48,098
THERE WERE PRETTY GOOD

1410
00:48:48,098 --> 00:48:50,066
RANDOMIZED TRIAL EVIDENCE THAT

1411
00:48:50,066 --> 00:48:51,701
SIGNIFICANT PSYCHOTHERAPIES,

1412
00:48:51,701 --> 00:48:54,237
COGNITIVE BEHAVIOR THERAPIES CAN

1413
00:48:54,237 --> 00:48:56,806
REDUCE RISK, ESPECIALLY FOR

1414
00:48:56,806 --> 00:48:58,742
PEOPLE WHO RECENTLY EXPERIENCED

1415
00:48:58,742 --> 00:48:59,743
A SELF-HARM EVENT OR HAD

1416
00:48:59,743 --> 00:49:00,911
RECENTLY BEEN HOSPITALIZED OR

1417
00:49:00,911 --> 00:49:02,546
SEEN IN THE EMERGENCY DEPARTMENT

1418
00:49:02,546 --> 00:49:05,248
FOR SUICIDE RISK.

1419
00:49:05,248 --> 00:49:06,116
AND THERE WAS SOME EVIDENCE THAT

1420
00:49:06,116 --> 00:49:07,951
IN THESE PSYCHOTHERAPY PROGRAMS,

1421
00:49:07,951 --> 00:49:09,886
THERE WERE SPECIFIC SKILLS OR

1422
00:49:09,886 --> 00:49:11,321
SKILLS TRAINING THAT WERE THE

1423
00:49:11,321 --> 00:49:15,592
KEY ACTIVE INGREDIENTS.

1424
00:49:15,592 --> 00:49:16,927
WE ALSO WERE AWARE AND MANY OF

1425
00:49:16,927 --> 00:49:18,194
US HAD BEEN INVOLVED IN SOME OF

1426
00:49:18,194 --> 00:49:21,097
THE WORK ON OUTREACH TO IMPROVE

1427
00:49:21,097 --> 00:49:23,900
CARE OF COMMON MENTAL HEALTH

1428
00:49:23,900 --> 00:49:24,534
CONDITIONS.

1429
00:49:24,534 --> 00:49:25,735
THESE CARE MANAGEMENT OR

1430
00:49:25,735 --> 00:49:27,837
COLLABORATIVE CARE INTERVENTIONS

1431
00:49:27,837 --> 00:49:31,041
WHERE THE MOTUS OPERANDI WAS

1432
00:49:31,041 --> 00:49:33,343
SORT OF ACTIVE OUTREACH, CARE

1433
00:49:33,343 --> 00:49:34,110
NAVIGATION TO KEEP PEOPLE

1434
00:49:34,110 --> 00:49:34,778
ENGAGED IN CARE.

1435
00:49:34,778 --> 00:49:37,981
AND HEN REA FOR HENRY FORD RECEY

1436
00:49:37,981 --> 00:49:39,082
PUBLISHED THEIR EXPERIENCE WITH

1437
00:49:39,082 --> 00:49:40,517
SOMETHING THEY CALLED THE

1438
00:49:40,517 --> 00:49:41,251
PERFECT DEPRESSION CARE PROGRAM,

1439
00:49:41,251 --> 00:49:43,286
WHICH WAS VERY MUCH FOCUSED ON

1440
00:49:43,286 --> 00:49:43,987
SYSTEMATICALLY IDENTIFYING

1441
00:49:43,987 --> 00:49:46,389
PEOPLE WHO WERE AT HIGH RISK,

1442
00:49:46,389 --> 00:49:48,024
WHO HAD DROPPED OUT OF

1443
00:49:48,024 --> 00:49:49,025
TREATMENT, MAKING SURE THEY

1444
00:49:49,025 --> 00:49:50,760
STAYED ENGAGED IN CARE, AND THEY

1445
00:49:50,760 --> 00:49:54,197
HAD REPORTED IN SORT OF A REALLY

1446
00:49:54,197 --> 00:49:55,832
BEFORE/AFTER OBSERVATIONAL

1447
00:49:55,832 --> 00:49:57,701
DESIGN SIGNIFICANT REDUCTION IN

1448
00:49:57,701 --> 00:49:58,969
SUICIDE RATES IN PEOPLE WHO THEY

1449
00:49:58,969 --> 00:50:01,271
WERE SEEING IN THEIR MENTAL

1450
00:50:01,271 --> 00:50:04,641
HEALTH SPECIALTY CLINIC.

1451
00:50:04,641 --> 00:50:05,942
SO FIRST WE CAN IDENTIFY PEOPLE

1452
00:50:05,942 --> 00:50:07,744
WHO WERE AT HIGH RISK FOR

1453
00:50:07,744 --> 00:50:08,178
SELF-HARM.

1454
00:50:08,178 --> 00:50:09,279
WE HAVE INTERVENTIONS THAT

1455
00:50:09,279 --> 00:50:10,714
APPEAR TO BE EFFECTIVE IN PEOPLE

1456
00:50:10,714 --> 00:50:12,248
WHO ARE AT THE REALLY HIGH END

1457
00:50:12,248 --> 00:50:14,718
OF THE RISK SPECTRUM.

1458
00:50:14,718 --> 00:50:16,019
PEOPLE WHO TO PUT A NUMBER ON IT

1459
00:50:16,019 --> 00:50:18,321
SAY MIGHT HAVE A 40 OR EVEN 50%

1460
00:50:18,321 --> 00:50:20,991
CHANCE OF A SELF-HARM EVENT.

1461
00:50:20,991 --> 00:50:24,628
WHAT WE WERE VERY INTERESTED IN

1462
00:50:24,628 --> 00:50:26,329
IS, ARE THERE POPULATION-BASED

1463
00:50:26,329 --> 00:50:27,197
APPROACHES THAT COULD BE HELPFUL

1464
00:50:27,197 --> 00:50:29,165
FOR PEOPLE WHO WERE A ONE STEP

1465
00:50:29,165 --> 00:50:33,269
DOWN ON THE RISK SCALE.

1466
00:50:33,269 --> 00:50:36,106
IF YOU THINK ABOUT THE PARADOX

1467
00:50:36,106 --> 00:50:37,307
FOR CARDIOVASCULAR DISEASE OR

1468
00:50:37,307 --> 00:50:39,376
OTHER HEALTH CONDITIONS, THE

1469
00:50:39,376 --> 00:50:40,644
PARADOX IS THAT ALTHOUGH THERE

1470
00:50:40,644 --> 00:50:42,278
ARE PEOPLE NE VERY TOP TIER OF

1471
00:50:42,278 --> 00:50:44,114
RISK MAY HAVE A HIGH RISK, MANY

1472
00:50:44,114 --> 00:50:45,382
OF THE EVENTS OCCUR IN THOSE WHO

1473
00:50:45,382 --> 00:50:47,017
ARE AT MODERATE RISK, AND THAT

1474
00:50:47,017 --> 00:50:48,652
WAS WHAT WE HAD HOPED TO BE ABLE

1475
00:50:48,652 --> 00:50:52,455
TO ADDRESS.

1476
00:50:52,455 --> 00:50:53,556
ALSO IMPORTANT TO THINK ABOUT

1477
00:50:53,556 --> 00:50:55,325
THE CONSTRAINTS AT THE TIME,

1478
00:50:55,325 --> 00:50:56,493
BECAUSE THIS WAS 2012.

1479
00:50:56,493 --> 00:50:58,428
IF WE WERE THINKING ABOUT USING

1480
00:50:58,428 --> 00:51:00,830
SORT OF NEW TECHNOLOGY TOOLS TO

1481
00:51:00,830 --> 00:51:02,499
DELIVER LOW INTENSITY

1482
00:51:02,499 --> 00:51:03,900
INTERVENTIONS AT A POPULATION

1483
00:51:03,900 --> 00:51:05,168
LEVEL, THE NEW TECHNOLOGY THEN

1484
00:51:05,168 --> 00:51:07,337
WAS NOT THAT NEW.

1485
00:51:07,337 --> 00:51:09,105
THE I PHONE WAS 4 YEARS OLD AT

1486
00:51:09,105 --> 00:51:09,539
THAT TIME.

1487
00:51:09,539 --> 00:51:11,074
SO WE REALLY WERE FOCUSED ON

1488
00:51:11,074 --> 00:51:12,642
THINGS THAT COULD BE DELIVERED

1489
00:51:12,642 --> 00:51:13,843
THROUGH WEBSITES RATHER THAN

1490
00:51:13,843 --> 00:51:15,045
THINGS THAT COULD BE DELIVERED

1491
00:51:15,045 --> 00:51:18,214
THROUGH MOBILE APPS.

1492
00:51:18,214 --> 00:51:19,683
BACK THEN IT ALMOST HARD TO

1493
00:51:19,683 --> 00:51:20,884
BELIEVE, THERE WAS MESSAGING

1494
00:51:20,884 --> 00:51:22,652
CAPABILITIES IN THE ELECTRONIC

1495
00:51:22,652 --> 00:51:23,319
HEALTH RECORD THROUGH THE

1496
00:51:23,319 --> 00:51:24,754
PATIENT PORTAL, BUT THEY WERE

1497
00:51:24,754 --> 00:51:26,089
REALLY LIMITED TO PLAIN TEXT.

1498
00:51:26,089 --> 00:51:27,390
AT THE TIME WE STARTED THIS

1499
00:51:27,390 --> 00:51:28,358
PROJECT, IT WAS NOT EVEN

1500
00:51:28,358 --> 00:51:29,993
POSSIBLE TO SEND A LINK TO A

1501
00:51:29,993 --> 00:51:30,960
QUESTIONNAIRE THAT SOMEONE COULD

1502
00:51:30,960 --> 00:51:31,394
COMPLETE.

1503
00:51:31,394 --> 00:51:33,363
WE HAD TO SORT OF SET UP AN

1504
00:51:33,363 --> 00:51:34,864
OUTSIDE WORKAROUND FOR THAT.

1505
00:51:34,864 --> 00:51:36,833
AND ALTHOUGH WE DEVELOPED A SORT

1506
00:51:36,833 --> 00:51:38,034
OF INTERACTIVE SKILLS TRAINING

1507
00:51:38,034 --> 00:51:39,936
PROGRAM, I THINK IT WOULD NOT

1508
00:51:39,936 --> 00:51:41,371
NECESSARILY BE THOUGHT OF AS

1509
00:51:41,371 --> 00:51:42,572
THAT INTERACTIVE BY TODAY'S

1510
00:51:42,572 --> 00:51:42,906
STANDARD.

1511
00:51:42,906 --> 00:51:44,974
I'LL BE HONEST, IT WAS SOMEWHAT

1512
00:51:44,974 --> 00:51:46,242
CLUNKY, BUT IT WAS THE

1513
00:51:46,242 --> 00:51:50,613
TECHNOLOGY AVAILABLE TO US IN

1514
00:51:50,613 --> 00:51:51,281
2012.

1515
00:51:51,281 --> 00:51:52,248
ONE OTHER IMPORTANT CONSTRAINT

1516
00:51:52,248 --> 00:51:53,717
FOR US WAS ABOUT AFFORDABILITY.

1517
00:51:53,717 --> 00:51:55,719
SOME OF THIS MAY HAVE BEEN

1518
00:51:55,719 --> 00:51:56,953
INFLUENCED BY MY OWN PERSONAL

1519
00:51:56,953 --> 00:51:58,321
EXPERIENCE IN MANY OF THESE

1520
00:51:58,321 --> 00:52:00,690
COLLABORATIVE CARE TRIALS, OF

1521
00:52:00,690 --> 00:52:02,759
DEMONSTRATING THE EFFECTIVENESS

1522
00:52:02,759 --> 00:52:04,294
OF POPULATION BASED CARE

1523
00:52:04,294 --> 00:52:05,161
IMPROVEMENT PROGRAMS THAT WERE

1524
00:52:05,161 --> 00:52:05,962
NOT IMPLEMENTED BECAUSE THEY

1525
00:52:05,962 --> 00:52:07,197
WERE CONSIDERED TO BE TOO

1526
00:52:07,197 --> 00:52:07,464
EXPENSIVE.

1527
00:52:07,464 --> 00:52:09,165
SO WE ACTUALLY DID A FAIRLY

1528
00:52:09,165 --> 00:52:10,533
EXPLICIT AND I HOPE THIS DOESN'T

1529
00:52:10,533 --> 00:52:12,736
SOUND TOO MERCENARY CALCULATION

1530
00:52:12,736 --> 00:52:14,671
TO SAY, IF WE'RE FOCUSED ON A

1531
00:52:14,671 --> 00:52:17,474
POPULATION THAT HAS AN ABSOLUTE

1532
00:52:17,474 --> 00:52:20,443
RISK OF A SELF-HARM EVENT OF 4%

1533
00:52:20,443 --> 00:52:22,078
AND WE WOULD HOPE TO REDUCE THAT

1534
00:52:22,078 --> 00:52:24,114
TO 3%, THAT'S AN ABSOLUTE RISK

1535
00:52:24,114 --> 00:52:26,416
REDUCTION OF 1% OR NUMBER NEEDED

1536
00:52:26,416 --> 00:52:28,318
TO TREAT 100, AND WE KNEW BASED

1537
00:52:28,318 --> 00:52:29,519
ON DATA FROM OUR HEALTH SYSTEM

1538
00:52:29,519 --> 00:52:30,820
AND OTHERS THAT THE DIRECT

1539
00:52:30,820 --> 00:52:31,621
HEALTHCARE COSTS OF SOMEONE WHO

1540
00:52:31,621 --> 00:52:33,189
WAS SEEN IN EMERGENCY DEPARTMENT

1541
00:52:33,189 --> 00:52:35,391
OR HOSPITALIZED FOR SELF-HARM

1542
00:52:35,391 --> 00:52:36,993
EVENT WAS AT THAT TIME ABOUT

1543
00:52:36,993 --> 00:52:38,495
$9,000.

1544
00:52:38,495 --> 00:52:40,463
IF YOU DO THE ARITHMETIC, YOU'D

1545
00:52:40,463 --> 00:52:42,098
SAY A NUMBER NEEDED TO TREAT OF

1546
00:52:42,098 --> 00:52:44,934
100, AND A PER-EVENT COST OF

1547
00:52:44,934 --> 00:52:47,337
$9,000, MEANS THE BREAK-EVEN

1548
00:52:47,337 --> 00:52:48,972
COST FOR A HEALTHCARE SYSTEM TO

1549
00:52:48,972 --> 00:52:51,975
SAY IF WE CAN REDUCE RISK, THE

1550
00:52:51,975 --> 00:52:53,710
ABSOLUTE RISK BY 1%, WHERE WOULD

1551
00:52:53,710 --> 00:52:55,378
THE BREAK-EVEN POINT BE, IT

1552
00:52:55,378 --> 00:52:56,679
WOULD BE AN INTERVENTION THAT

1553
00:52:56,679 --> 00:53:03,186
KOCOST $90 PER PERSON.

1554
00:53:03,186 --> 00:53:04,687
SO RATHER THAN THOSE PROGRAMS

1555
00:53:04,687 --> 00:53:06,756
LIKE THE SORT OF FULL BORE

1556
00:53:06,756 --> 00:53:07,423
DIALECTICAL BEHAVIOR THERAPY

1557
00:53:07,423 --> 00:53:08,625
WHICH WOULD BE ON THE ORDER OF

1558
00:53:08,625 --> 00:53:10,126
AT LEAST A THOUSAND DOLLARS PER

1559
00:53:10,126 --> 00:53:16,232
PERSON.

1560
00:53:16,232 --> 00:53:17,467
I WOULDN'T NECESSARILY SAY THIS

1561
00:53:17,467 --> 00:53:19,068
WAS A CONSTRAINT BUT IT WAS

1562
00:53:19,068 --> 00:53:19,936
RECOGNITION OF WHAT I WOULD CALL

1563
00:53:19,936 --> 00:53:21,671
THE ROOM FOR EXPERIMENTATION OR

1564
00:53:21,671 --> 00:53:23,239
THE WINDOW FOR EXPERIMENTATION.

1565
00:53:23,239 --> 00:53:24,541
AT THE TIME WE WERE STARTING

1566
00:53:24,541 --> 00:53:26,509
THIS WORK, HEALTHCARE SYSTEMS

1567
00:53:26,509 --> 00:53:27,911
HAD BEGUN TO IMPLEMENT THESE

1568
00:53:27,911 --> 00:53:29,345
ROUTINE SCREENING PROCESSES

1569
00:53:29,345 --> 00:53:31,181
WHICH BEGAN REALLY AS SCREENING

1570
00:53:31,181 --> 00:53:32,282
FOR DEPRESSION BUT I THINK THEY

1571
00:53:32,282 --> 00:53:34,117
RECOGNIZED THAT THAT NINTH ITEM

1572
00:53:34,117 --> 00:53:37,620
OF THE PHQ9 IDENTIFIED PEOPLE

1573
00:53:37,620 --> 00:53:39,856
WITH SELF-HARM AND HEALTHCARE

1574
00:53:39,856 --> 00:53:42,826
SYSTEMS WE WORKED WITH TO USING

1575
00:53:42,826 --> 00:53:43,793
THESE IN MENTAL HEALTH SPECIALTY

1576
00:53:43,793 --> 00:53:45,395
CARE AND EVEN IN PRIMARY CARE

1577
00:53:45,395 --> 00:53:47,263
WHEN PEOPLE WERE IDENTIFIED AS

1578
00:53:47,263 --> 00:53:48,898
HAVING DEPRESSION OR SOME OTHER

1579
00:53:48,898 --> 00:53:49,432
MENTAL HEALTH CONDITION.

1580
00:53:49,432 --> 00:53:50,800
TO US THAT WAS REALLY GOOD NEWS,

1581
00:53:50,800 --> 00:53:51,935
BUT IT WAS NOT A RESEARCH

1582
00:53:51,935 --> 00:53:52,202
QUESTION.

1583
00:53:52,202 --> 00:53:54,470
THIS WAS A DONE DEAL.

1584
00:53:54,470 --> 00:53:56,873
THE HEALTHCARE SYSTEMS ALSO HAD

1585
00:53:56,873 --> 00:53:58,141
BEGUN FOLLOWING THIS ZERO

1586
00:53:58,141 --> 00:53:59,776
SUICIDE MODEL TO IMPLEMENT

1587
00:53:59,776 --> 00:54:02,712
SYSTEMATIC PROCESSES FOR

1588
00:54:02,712 --> 00:54:03,880
ADDRESSING RISK AT THE TIME OF A

1589
00:54:03,880 --> 00:54:04,948
HEALTHCARE VISIT.

1590
00:54:04,948 --> 00:54:06,316
AS WHAT WE WOULD CALL STANDARD

1591
00:54:06,316 --> 00:54:11,120
WORK THAT PEOPLE WHO IN RESPONSE

1592
00:54:11,120 --> 00:54:15,425
TO THAT NINTH ITEM OF THE PHQ9,

1593
00:54:15,425 --> 00:54:16,960
STRUCTURED PROCESSES FOR RISK

1594
00:54:16,960 --> 00:54:17,594
ASSESSMENT USING SOMETHING

1595
00:54:17,594 --> 00:54:19,095
CALLED THE COLUMBIA SUICIDE

1596
00:54:19,095 --> 00:54:20,663
SEVERITY RATING SCALE,

1597
00:54:20,663 --> 00:54:22,498
DEVELOPING COLLABORATIVE SAFETY

1598
00:54:22,498 --> 00:54:23,867
PLANS, THIS WAS ALSO NOT A

1599
00:54:23,867 --> 00:54:25,001
RESEARCH QUESTION.

1600
00:54:25,001 --> 00:54:28,137
TO US THIS WAS REALLY GOOD NEWS,

1601
00:54:28,137 --> 00:54:29,672
BUT THIS WAS NOT THE PLACE FOR

1602
00:54:29,672 --> 00:54:30,039
EXPERIMENTATION.

1603
00:54:30,039 --> 00:54:30,874
THIS WAS DECIDED.

1604
00:54:30,874 --> 00:54:32,642
THE SPACE FOR EXPERIMENTATION

1605
00:54:32,642 --> 00:54:34,477
WAS THE HEALTHCARE SYSTEM

1606
00:54:34,477 --> 00:54:35,778
SAYING, WHAT ABOUT OUTREACH AND

1607
00:54:35,778 --> 00:54:37,513
THESE OTHER PROGRAMS FOR PEOPLE

1608
00:54:37,513 --> 00:54:41,317
WHO SEEM TO HAVE LEFT CARE, BEEN

1609
00:54:41,317 --> 00:54:42,085
DISCONNECTED FROM CARE, SHOULD

1610
00:54:42,085 --> 00:54:44,120
WE GO OUT AND MAKE ACTIVE

1611
00:54:44,120 --> 00:54:46,856
EFFORTS TO RE-ENGAGE PEOPLE AND

1612
00:54:46,856 --> 00:54:49,058
TO DELIVER THESE LOW INTENSITY

1613
00:54:49,058 --> 00:54:50,693
PROGRAMS AND THAT WAS THE SPACE

1614
00:54:50,693 --> 00:54:51,728
FOR EXPERIMENTATION THAT WE

1615
00:54:51,728 --> 00:54:58,067
FOCUSED ON.

1616
00:54:58,067 --> 00:54:59,569
ALSO IMPORTANT TO ACKNOWLEDGE

1617
00:54:59,569 --> 00:55:00,703
WHAT WE DID NOT KNOW AT THE

1618
00:55:00,703 --> 00:55:00,937
TIME.

1619
00:55:00,937 --> 00:55:03,039
WHAT WE WERE HOPING TO DO WAS TO

1620
00:55:03,039 --> 00:55:06,109
PUT IN PLACE A CARE MANAGEMENT

1621
00:55:06,109 --> 00:55:07,210
PROGRAM FOR PEOPLE AT HIGH RISK

1622
00:55:07,210 --> 00:55:09,012
OF SELF-HARM OR SUICIDE ATTEMPT

1623
00:55:09,012 --> 00:55:10,880
WOULD RECEIVE OUTREACH FROM A

1624
00:55:10,880 --> 00:55:11,514
STRANGER REALLY, SOMEONE WHO WAS

1625
00:55:11,514 --> 00:55:12,749
PART OF THEIR HEALTHCARE CYST

1626
00:55:12,749 --> 00:55:14,550
TESTIMONY BUT SOMEONE THEY'D NOT

1627
00:55:14,550 --> 00:55:15,985
EVER MET, AND WE DID NOT KNOW

1628
00:55:15,985 --> 00:55:20,356
HOW ACCEPTABLE THAT WOULD BE.

1629
00:55:20,356 --> 00:55:22,258
WE WERE HOPING TO PUT IN PLACE

1630
00:55:22,258 --> 00:55:24,894
THESE LOW INTENSITY ONLINE

1631
00:55:24,894 --> 00:55:25,762
INTERVENTIONS AND SUPPORT THEM

1632
00:55:25,762 --> 00:55:27,096
WITH A COACHING PROGRAM, BUT

1633
00:55:27,096 --> 00:55:29,032
COACHING WAS BY ASYNCHRONOUS

1634
00:55:29,032 --> 00:55:30,233
MESSAGING, NOT LIVE TELEPHONE

1635
00:55:30,233 --> 00:55:32,435
CONTACT OR ANYTHING THAT WOULD

1636
00:55:32,435 --> 00:55:34,504
BE RESOURCE-INTENSIVE.

1637
00:55:34,504 --> 00:55:36,005
WE HAD EVIDENCE FOR THE

1638
00:55:36,005 --> 00:55:38,942
EFFECTIVENESS OF THESE

1639
00:55:38,942 --> 00:55:41,811
DIALECTICAL -- IN PEOPLE SEEKING

1640
00:55:41,811 --> 00:55:43,346
TREATMENT OR WHO VOLUNTEERED TO

1641
00:55:43,346 --> 00:55:44,147
PARTICIPATE IN RESEARCH BUT WE

1642
00:55:44,147 --> 00:55:46,015
DID NOT KNOW ABOUT THEIR

1643
00:55:46,015 --> 00:55:46,783
ACCEPTABILITY OR EFFECTIVENESS

1644
00:55:46,783 --> 00:55:49,919
IN PEOPLE NOT SEEKING TREATMENT.

1645
00:55:49,919 --> 00:55:51,988
AND WE CERTAINLY HOPED AND

1646
00:55:51,988 --> 00:55:53,089
BELIEVED THAT KEEPING PEOPLE

1647
00:55:53,089 --> 00:55:54,757
ENGAGED IN TRADITIONAL MENTAL

1648
00:55:54,757 --> 00:55:56,326
HEALTHCARE, CARE FOR THEIR

1649
00:55:56,326 --> 00:55:57,627
PRIMARY MENTAL HEALTH DIAGNOSIS,

1650
00:55:57,627 --> 00:55:59,829
WHATEVER THAT WAS, WOULD REDUCE

1651
00:55:59,829 --> 00:56:01,698
RISK OF SELF-HARM BUT WE DID NOT

1652
00:56:01,698 --> 00:56:07,203
HAVE STRONG EVIDENCE FOR THAT.

1653
00:56:07,203 --> 00:56:09,405
SO I'M AM KNOWLEDGING WE MADE A

1654
00:56:09,405 --> 00:56:10,506
RELATIVELY SIGNIFICANT LEAP.

1655
00:56:10,506 --> 00:56:12,108
THE SORT OF -- YOU COULD SAY

1656
00:56:12,108 --> 00:56:14,610
LOGIC MODEL WE HAD WAS THAT

1657
00:56:14,610 --> 00:56:17,447
PEOPLE WHO WERE AT HIGH RISK FOR

1658
00:56:17,447 --> 00:56:18,414
SUICIDE OR SELF-HARM.

1659
00:56:18,414 --> 00:56:20,149
IF WE COULD GET THEM AND KEEP

1660
00:56:20,149 --> 00:56:21,784
THEM ENGAGED IN THIS

1661
00:56:21,784 --> 00:56:22,785
INTERVENTION, THAT WOULD LEAD TO

1662
00:56:22,785 --> 00:56:24,354
REDUCTION IN THEIR SUICIDAL

1663
00:56:24,354 --> 00:56:28,324
IDEATION OR SUICIDAL EVENT,

1664
00:56:28,324 --> 00:56:29,525
EVENTUALLY REDUCTION IN SUICIDAL

1665
00:56:29,525 --> 00:56:29,826
BEHAVIOR.

1666
00:56:29,826 --> 00:56:31,127
IN OUR TRIAL WE KNEW WE COULD

1667
00:56:31,127 --> 00:56:33,830
NOT VERY ACCURATELY MEASURE

1668
00:56:33,830 --> 00:56:35,031
SUICIDAL IDEATION OIRN TENT BUT

1669
00:56:35,031 --> 00:56:37,533
WE COULD MEASURE SUICIDAL

1670
00:56:37,533 --> 00:56:39,369
BEHAVIOR BECAUSE THAT APPEARS IN

1671
00:56:39,369 --> 00:56:40,503
HEALTHCARE RECORD OR INSURANCE

1672
00:56:40,503 --> 00:56:41,004
CLAIMS.

1673
00:56:41,004 --> 00:56:42,472
SO THAT WAS WHERE WE ENDED UP,

1674
00:56:42,472 --> 00:56:43,272
ACKNOWLEDGING THIS WAS A LEAP,

1675
00:56:43,272 --> 00:56:45,408
AND EVEN AT THE TIME, GOING BACK

1676
00:56:45,408 --> 00:56:47,410
AND READING THE APPLICATION THAT

1677
00:56:47,410 --> 00:56:50,980
WE WROTE FOR FUNDING AT THE

1678
00:56:50,980 --> 00:56:52,615
TIME, WE ACKNOWLEDGED THIS WAS A

1679
00:56:52,615 --> 00:56:53,716
SIGNIFICANT LEAP AND ACTUAL LU

1680
00:56:53,716 --> 00:56:55,218
QUOTED THE RFA WE WERE

1681
00:56:55,218 --> 00:56:56,652
RESPONDING FOR THAT CALLED FOR

1682
00:56:56,652 --> 00:56:58,488
BOLD, INNOVATIVE AND OFTEN RISKY

1683
00:56:58,488 --> 00:56:59,889
APPROACHES TO ADDRESS PROBLEMS

1684
00:56:59,889 --> 00:57:05,995
THAT MAY SEEM INTRACTABLE.

1685
00:57:05,995 --> 00:57:07,530
SO THIS IS WHERE WE ENDED UP.

1686
00:57:07,530 --> 00:57:09,032
WE FOCUSED ON THE POPULATION OF

1687
00:57:09,032 --> 00:57:10,099
PEOPLE WHO REPORTED FREQUENT

1688
00:57:10,099 --> 00:57:12,135
THOUGHTS OF SUICIDE OR SELF-HARM

1689
00:57:12,135 --> 00:57:13,936
AT AN OUTPATIENT VISIT WHEN THEY

1690
00:57:13,936 --> 00:57:16,539
FILLED OUT ONE OF THESE STANDARD

1691
00:57:16,539 --> 00:57:17,140
QUESTIONNAIRES, REGARDLESS OF

1692
00:57:17,140 --> 00:57:20,777
WHETHER THEY WANT OED OR SEEKING

1693
00:57:20,777 --> 00:57:21,978
TREATMENT OR WERE ENGAGED IN

1694
00:57:21,978 --> 00:57:22,245
TREATMENT.

1695
00:57:22,245 --> 00:57:24,347
WE TESTED TWO LOW INTENSITY

1696
00:57:24,347 --> 00:57:26,149
OUTREACH INTERVENTIONS, ONE MORE

1697
00:57:26,149 --> 00:57:27,850
FOCUSED ON THE DIALECTICAL

1698
00:57:27,850 --> 00:57:28,718
BEHAVIOR THERAPY SKILLS, THE

1699
00:57:28,718 --> 00:57:30,887
OTHER ON CARE NAVIGATION, TO

1700
00:57:30,887 --> 00:57:31,854
MAINTAIN ENGAGEMENT IN

1701
00:57:31,854 --> 00:57:33,056
OUTPATIENT TREATMENT.

1702
00:57:33,056 --> 00:57:34,824
THESE WERE DELIVERED PRIMARILY

1703
00:57:34,824 --> 00:57:37,193
BY ASYNCHRONOUS ONLINE MESSAGES

1704
00:57:37,193 --> 00:57:39,062
THROUGH THE EHR PATIENT PORTAL,

1705
00:57:39,062 --> 00:57:40,630
THE INTERVENTIONS LASTING UP TO

1706
00:57:40,630 --> 00:57:41,097
12 MONTHS.

1707
00:57:41,097 --> 00:57:43,199
THE COMPARISON WAS USUAL CARE.

1708
00:57:43,199 --> 00:57:46,702
PEOPLE MIGHT GET MENTAL

1709
00:57:46,702 --> 00:57:48,871
HEALTHCARE, BUT THERE WAS NO

1710
00:57:48,871 --> 00:57:53,342
ADDED INTERVENTION OR CONTACT.

1711
00:57:53,342 --> 00:57:56,079
THE OUTCOME WAS CODED AS

1712
00:57:56,079 --> 00:57:58,915
SELF-HARM OR SOME CODED AN

1713
00:57:58,915 --> 00:57:59,782
UNDETERMINED INTENT, AND THE

1714
00:57:59,782 --> 00:58:01,717
TIME FRAME WAS UP TO -- SORRY,

1715
00:58:01,717 --> 00:58:03,853
THAT SHOULD BE A YEAR PLUS 180

1716
00:58:03,853 --> 00:58:06,422
DAYS FOLLOWING RANDOM ASSIGNMENT

1717
00:58:06,422 --> 00:58:10,660
OR 540 DAYS.

1718
00:58:10,660 --> 00:58:11,861
AND THAT'S WHERE WE ENDED.

1719
00:58:11,861 --> 00:58:13,062
I THINK I'LL TURN IT BACK TO

1720
00:58:13,062 --> 00:58:13,963
KEVIN TO MODERATE THE

1721
00:58:13,963 --> 00:58:15,264
DISCUSSION.

1722
00:58:15,264 --> 00:58:18,501
>> THANK YOU VERY MUCH,
GREG.

1723
00:58:18,501 --> 00:58:20,036
AND MARIJO, CAN WE STOP THE

1724
00:58:20,036 --> 00:58:21,971
SCREEN SHARE SO WE CAN SEE THE

1725
00:58:21,971 --> 00:58:22,438
FACES?

1726
00:58:22,438 --> 00:58:24,273
AND I'D INVITE OUR PANELISTS TO

1727
00:58:24,273 --> 00:58:26,576
COME ON CAMERA IF YOU CAN.

1728
00:58:26,576 --> 00:58:29,712
THAT WAS A TERRIFIC VERY

1729
00:58:29,712 --> 00:58:31,647
EFFICIENT OVERVIEW.

1730
00:58:31,647 --> 00:58:33,516
 EVERYONE

1731
00:58:33,516 --> 00:58:33,883
PROVIDED THERE.

1732
00:58:33,883 --> 00:58:34,784
ONE OF THE THINGS I THINK IS

1733
00:58:34,784 --> 00:58:37,220
INTERESTING IS TO LA LOOK AT HOW

1734
00:58:37,220 --> 00:58:39,388
THAT RESEARCH QUESTION CAME

1735
00:58:39,388 --> 00:58:40,456
TOGETHER AND WHEN WE PRESENT

1736
00:58:40,456 --> 00:58:42,525
THESE THINGS TO PEOPLE IN THE

1737
00:58:42,525 --> 00:58:45,128
CONTEXT OF SCIENTIFIC

1738
00:58:45,128 --> 00:58:46,129
PRESENTATIONS, WE USUALLY ADAPT

1739
00:58:46,129 --> 00:58:48,798
A FAIRLY LINEAR PRESENTATION

1740
00:58:48,798 --> 00:58:51,868
BECAUSE THAT'S AN EFFECTIVE WAY

1741
00:58:51,868 --> 00:58:55,705
TO PRESENT THAT, BUT SOME OF YOU

1742
00:58:55,705 --> 00:58:56,572
MENTIONED SOME THINGS THAT

1743
00:58:56,572 --> 00:59:01,244
SUGGESTED THAT THERE WERE SOME

1744
00:59:01,244 --> 00:59:03,646
NON-LINEAR ASPECTS TO THE

1745
00:59:03,646 --> 00:59:04,614
DEVELOPMENT PROCESS, MAYBE A

1746
00:59:04,614 --> 00:59:06,983
LITTLE BIT OF SERENDIPITY, MAYBE

1747
00:59:06,983 --> 00:59:08,217
SOME FALSE STARTS.

1748
00:59:08,217 --> 00:59:10,253
I WONDER IF YOU COULD COMMENT A

1749
00:59:10,253 --> 00:59:13,689
LITTLE BIT ABOUT THAT AND MAYBE

1750
00:59:13,689 --> 00:59:14,824
FOR SOMEONE WHO'S NOT GONE

1751
00:59:14,824 --> 00:59:16,692
THROUGH THIS PROCESS, WHAT ARE

1752
00:59:16,692 --> 00:59:18,327
REALISTIC EXPECTATIONS ABOUT

1753
00:59:18,327 --> 00:59:19,729
WHAT THIS PHASE ZERO LOOKS AND

1754
00:59:19,729 --> 00:59:20,696
FEELS LIKE FROM YOUR

1755
00:59:20,696 --> 00:59:29,572
PERSPECTIVE?

1756
00:59:29,572 --> 00:59:31,307
>> I CAN SHARE THAT IT'S
QUITE

1757
00:59:31,307 --> 00:59:33,176
UNCOMFORTABLE.

1758
00:59:33,176 --> 00:59:36,646
IT WAS NOT PLEASANT.

1759
00:59:36,646 --> 00:59:39,048
IN RETROSPECT, IT'S EASY TO MAKE

1760
00:59:39,048 --> 00:59:40,683
A LINEAR -- AS YOU'RE

1761
00:59:40,683 --> 00:59:42,185
HIGHLIGHTING, A LINEAR STORY,

1762
00:59:42,185 --> 00:59:44,053
BUT IT WAS NOT.

1763
00:59:44,053 --> 00:59:45,488
AND EVERY DECISION HAD

1764
00:59:45,488 --> 00:59:46,389
RAMIFICATIONS FOR PRIOR

1765
00:59:46,389 --> 00:59:47,456
DECISIONS.

1766
00:59:47,456 --> 00:59:49,192
AND SO FOR US, THERE WAS A LOT

1767
00:59:49,192 --> 00:59:52,128
OF ITERATIVE AND CYCLICAL

1768
00:59:52,128 --> 00:59:59,468
REFINEMENT OF THE IDEA.

1769
00:59:59,468 --> 01:00:01,604
I THINK WE WERE VERY EXCITED

1770
01:00:01,604 --> 01:00:03,005
ABOUT THE IDEA, AND THAT'S --

1771
01:00:03,005 --> 01:00:04,106
AND THAT WAS KIND OF A TRUE

1772
01:00:04,106 --> 01:00:07,276
NORTH FOR US.

1773
01:00:07,276 --> 01:00:10,947
ONCE WE WANTED THAT TO BE

1774
01:00:10,947 --> 01:00:12,381
PRAGMATIC AND GREG HIGHLIGHTS

1775
01:00:12,381 --> 01:00:13,282
CRITICAL -- THE CRITICAL

1776
01:00:13,282 --> 01:00:16,319
IMPORTANCE OF AFFORDABILITY AND

1777
01:00:16,319 --> 01:00:16,652
SCALABILITY.

1778
01:00:16,652 --> 01:00:19,222
WE WANTED TO REALIZE THIS

1779
01:00:19,222 --> 01:00:22,191
CONCEPT IN AN IMPACTFUL WAY AND

1780
01:00:22,191 --> 01:00:24,760
ONE -- I EARLIER ELIMINATED A

1781
01:00:24,760 --> 01:00:26,429
SLIDE THAT TALKED ABOUT CHECKING

1782
01:00:26,429 --> 01:00:28,698
IN WITH MYRIAD STAKEHOLDERS

1783
01:00:28,698 --> 01:00:31,734
ACROSS THE INSTITUTION TO ENSURE

1784
01:00:31,734 --> 01:00:37,240
APPETITE AND SUPPORT.

1785
01:00:37,240 --> 01:00:39,175
>> GREAT, THANKS, ANDREA.

1786
01:00:39,175 --> 01:00:39,942
WHAT ABOUT OTHERS?

1787
01:00:39,942 --> 01:00:43,045
ANY COMMENTS ON THAT IN THE

1788
01:00:43,045 --> 01:00:44,046
NON-PRETTY, NON-LINEAR ASPECT OF

1789
01:00:44,046 --> 01:00:51,187
THAT DEVELOPMENT WORK?

1790
01:00:51,187 --> 01:00:53,889
>> I CAN COMMENT ON THAT.

1791
01:00:53,889 --> 01:00:56,158
I REALLY TRIED TO HIGHLIGHT IN

1792
01:00:56,158 --> 01:00:57,560
THE INTRODUCTION TO THE ARBOR

1793
01:00:57,560 --> 01:01:02,498
TELEHEALTH STUDY, WE CERTAINLY

1794
01:01:02,498 --> 01:01:04,767
DIDN'T START WITH THE P IN PICOT

1795
01:01:04,767 --> 01:01:06,068
AND JUMPED RIGHT TO THE

1796
01:01:06,068 --> 01:01:07,169
INTERVENTION BECAUSE OF CURRENT

1797
01:01:07,169 --> 01:01:08,604
WORLD EVENT AND THEN SORT OF

1798
01:01:08,604 --> 01:01:09,972
BUILT IN PIECES AROUND IT AND

1799
01:01:09,972 --> 01:01:11,941
EVEN THEN, IT WAS PROBABLY NOT

1800
01:01:11,941 --> 01:01:15,978
AS CLEAN AS THE STORIES I TOLD.

1801
01:01:15,978 --> 01:01:18,247
I MEAN, WE'RE STILL IN OUR

1802
01:01:18,247 --> 01:01:20,316
UG3 PHASE, AND WE'VE EVEN --

1803
01:01:20,316 --> 01:01:22,685
SINCE WE GOT FUNDED ABOUT A YEAR

1804
01:01:22,685 --> 01:01:24,320
AGO, WE'VE CHANGED PARTS OF OUR

1805
01:01:24,320 --> 01:01:25,655
INTERVENTION AND DELIVERY

1806
01:01:25,655 --> 01:01:28,090
STRATEGY SINCE WE STARTED

1807
01:01:28,090 --> 01:01:30,526
PLANNING, WHICH IS THE NATURE OF

1808
01:01:30,526 --> 01:01:31,727
A PLANNING YEAR, THAT'S WHAT

1809
01:01:31,727 --> 01:01:32,194
IT'S FOR.

1810
01:01:32,194 --> 01:01:35,464
BUT YOU KNOW, WE HAD ORIGINALLY

1811
01:01:35,464 --> 01:01:38,067
DESIGNED THIS WORK COMPLEX

1812
01:01:38,067 --> 01:01:39,602
INTERVENTION STRATEGY THAT WAS

1813
01:01:39,602 --> 01:01:41,037
GOING TO INCLUDE A

1814
01:01:41,037 --> 01:01:42,505
PSYCHOSOCIALLY RISK STRATIFIED

1815
01:01:42,505 --> 01:01:43,272
CARE DELIVERY MECHANISM AND

1816
01:01:43,272 --> 01:01:45,241
YOU'D USE AN APP VERSUS, YOU

1817
01:01:45,241 --> 01:01:47,009
KNOW, SYNCHRONOUS TELEHEALTH AND

1818
01:01:47,009 --> 01:01:48,711
THEN WE GOT FEEDBACK FROM

1819
01:01:48,711 --> 01:01:49,578
STAKEHOLDERS THAT SAID MAYBE

1820
01:01:49,578 --> 01:01:51,347
THAT'S REALLY COMPLICATED FOR A

1821
01:01:51,347 --> 01:01:54,917
RURAL HEALTHCARE SYSTEM, SO EVEN

1822
01:01:54,917 --> 01:01:55,685
SOMETIMES AFTER YOU THINK THE

1823
01:01:55,685 --> 01:01:56,786
RESEARCH QUESTION IS FINALIZED

1824
01:01:56,786 --> 01:01:58,921
AND IT'S EVEN BEEN FUNDED, IT'S

1825
01:01:58,921 --> 01:02:00,089
NOT FINALIZED, AND YOU'VE GOT TO

1826
01:02:00,089 --> 01:02:01,624
GO BACK AND PULL IN MORE INPUT

1827
01:02:01,624 --> 01:02:04,193
AND SO YEAH, IT CAN BE VERY

1828
01:02:04,193 --> 01:02:05,261
CIRCULAR IN WAYS.

1829
01:02:05,261 --> 01:02:07,096
BUT I THINK IN THE END, IT'S

1830
01:02:07,096 --> 01:02:08,331
ABOUT A RESEARCH QUESTION FOR

1831
01:02:08,331 --> 01:02:09,532
ALL THE WORK THAT'S GONE INTO

1832
01:02:09,532 --> 01:02:12,568
IT.

1833
01:02:12,568 --> 01:02:15,738
>> THANKS, KEVIN.

1834
01:02:15,738 --> 01:02:18,574
ANYONE ELSE ON THAT QUESTION?

1835
01:02:18,574 --> 01:02:18,808
KUSHANG?

1836
01:02:18,808 --> 01:02:20,409
>> I WOULD JUST ADD THAT
WE HAD

1837
01:02:20,409 --> 01:02:23,012
SIMILAR EXPERIENCES, LIKE REALLY

1838
01:02:23,012 --> 01:02:26,982
HAD SERENDIPITY -- SERENDIPITOUS

1839
01:02:26,982 --> 01:02:29,919
OPPORTUNITIES TO CONDUCT A

1840
01:02:29,919 --> 01:02:31,087
VARIETY OF DIFFERENT PILOT

1841
01:02:31,087 --> 01:02:34,590
STUDIES AND THEN JUST THE RFA

1842
01:02:34,590 --> 01:02:39,195
CAME OUT AFTER BEING AWARDED,

1843
01:02:39,195 --> 01:02:40,896
WORKING WITH A VARIETY OF

1844
01:02:40,896 --> 01:02:42,231
DIFFERENT HEALTHCARE SYSTEMS,

1845
01:02:42,231 --> 01:02:46,702
WE'RE REALLY HAVING TO ADJUST TO

1846
01:02:46,702 --> 01:02:52,475
MEET LOCAL CONTEXT AND TO BE

1847
01:02:52,475 --> 01:02:56,078
FLEXIBLE IN IMPLEMENTING OUR

1848
01:02:56,078 --> 01:02:57,880
INTERVENTION TO -- IN ONE

1849
01:02:57,880 --> 01:02:59,915
HEALTHCARE SYSTEM, IT WILL BE A

1850
01:02:59,915 --> 01:03:01,817
NURSE AND POTENTIALLY ANOTHER

1851
01:03:01,817 --> 01:03:06,122
HEALTHCARE SYSTEM MIGHT BE A

1852
01:03:06,122 --> 01:03:06,789
DIFFERENT HEALTHCARE PROVIDER

1853
01:03:06,789 --> 01:03:08,424
THAT'S DOING THE CARE

1854
01:03:08,424 --> 01:03:12,027
COORDINATION.

1855
01:03:12,027 --> 01:03:14,730
SO WE'RE STILL LEARNING, AND

1856
01:03:14,730 --> 01:03:17,233
SIMILAR TO WHAT KEVIN JUST SAID,

1857
01:03:17,233 --> 01:03:19,769
WE'RE IN THE EG3 PHASE AND

1858
01:03:19,769 --> 01:03:20,936
PILOTING, AND SO WE HAVEN'T

1859
01:03:20,936 --> 01:03:24,106
FULLY LANDED ON OUR INTERVENTION

1860
01:03:24,106 --> 01:03:26,842
YET, AND SO TAKE ADVANTAGE OF

1861
01:03:26,842 --> 01:03:29,378
PILOTING OPPORTUNITIES FOR SURE.

1862
01:03:29,378 --> 01:03:30,246
>> GREAT.

1863
01:03:30,246 --> 01:03:32,515
AND FOR FOLKS WHO ARE LISTENING

1864
01:03:32,515 --> 01:03:35,351
OR LESS FAMILIAR WITH

1865
01:03:35,351 --> 01:03:37,720
COLLABORATORY LINGO, THE

1866
01:03:37,720 --> 01:03:40,055
UG3 PHASE IS THAT FIRST YEAR OF

1867
01:03:40,055 --> 01:03:41,690
PLANNING, THE UH3 PHASE FOR MOST

1868
01:03:41,690 --> 01:03:43,426
OF THE TRIALS WOULD BE THE

1869
01:03:43,426 --> 01:03:44,727
ACTUAL IMPLEMENTATION OF THE

1870
01:03:44,727 --> 01:03:46,162
TRIAL.

1871
01:03:46,162 --> 01:03:48,264
SO KEVIN, KUSHANG, REFERRING TO

1872
01:03:48,264 --> 01:03:49,298
ACTIVITIES DURING THAT FIRST

1873
01:03:49,298 --> 01:03:49,698
YEAR.

1874
01:03:49,698 --> 01:03:50,966
AFTER YOU GET THE FUNDING, YOU

1875
01:03:50,966 --> 01:03:52,601
GET A YEAR OF PLANNING.

1876
01:03:52,601 --> 01:03:54,003
GREG, DO YOU HAVE ANYTHING TO

1877
01:03:54,003 --> 01:03:55,070
NOTE ON IT?

1878
01:03:55,070 --> 01:03:58,007
>> THE ONLY THING I'D ADD,
AND I

1879
01:03:58,007 --> 01:03:59,308
REFER TO THAT IN ONE OF THE

1880
01:03:59,308 --> 01:04:01,977
SLIDES I SHOWED IS SORT OF, YOU

1881
01:04:01,977 --> 01:04:03,145
KNOW, THINKING ABOUT WHAT IS THE

1882
01:04:03,145 --> 01:04:06,849
SPACE FOR EXPERIMENTATION.

1883
01:04:06,849 --> 01:04:08,050
WHAT THINGS ARE ALREADY DECIDED

1884
01:04:08,050 --> 01:04:10,886
OR ARE GOING TO HAPPEN REGA

1885
01:04:10,886 --> 01:04:11,687
REGARDLESS.

1886
01:04:11,687 --> 01:04:13,489
WHAT THINGS ARE PROBABLY NEVER

1887
01:04:13,489 --> 01:04:14,490
GOING TO HAPPEN REGARD

1888
01:04:14,490 --> 01:04:15,224
LEUKOENCEPHALOPATHY, AND WHAT

1889
01:04:15,224 --> 01:04:17,226
SORT OF IN BETWEEN IS THIS WOULD

1890
01:04:17,226 --> 01:04:18,494
HAPPEN WITH EVIDENCE BUT WON'T

1891
01:04:18,494 --> 01:04:21,230
HAPPEN WITHOUT.

1892
01:04:21,230 --> 01:04:23,299
BUT THAT WINDOW IS NOT STATIC

1893
01:04:23,299 --> 01:04:25,935
OVER TIME, THE WORLD CHANGES.

1894
01:04:25,935 --> 01:04:28,737
BUT UNDERSTANDING WHERE IS THAT

1895
01:04:28,737 --> 01:04:29,839
SORT OF SPACE IF YOU COULD THINK

1896
01:04:29,839 --> 01:04:32,041
OF IT AS ORGANIZATIONAL

1897
01:04:32,041 --> 01:04:35,311
EQUIPOISE, YOU KNOW, WE'RE NOT

1898
01:04:35,311 --> 01:04:36,378
READY TO DO THIS RIGHT NOW, WE

1899
01:04:36,378 --> 01:04:38,347
WOULD BE READY TO DO IF WE HAD

1900
01:04:38,347 --> 01:04:39,648
EVIDENCE THAT IT WORKED, WHICH

1901
01:04:39,648 --> 01:04:42,351
IS SORT OF BETWEEN -- THAT

1902
01:04:42,351 --> 01:04:43,886
DOESN'T SOUND LIKE ANYTHING WE'D

1903
01:04:43,886 --> 01:04:44,453
EVER DO.

1904
01:04:44,453 --> 01:04:45,521
WE'RE DOING THAT NEXT WEEK,

1905
01:04:45,521 --> 01:04:46,422
WE'RE NOT WAITING.

1906
01:04:46,422 --> 01:04:49,758
>> RIGHT.

1907
01:04:49,758 --> 01:04:54,230
YOU KNOW, ONE OF THE ASPECTS OF

1908
01:04:54,230 --> 01:04:56,665
THE RESEARCH QUESTION, IT SEEMS

1909
01:04:56,665 --> 01:04:58,601
LIKE WE DISCUSS LESS FREQUENTLY

1910
01:04:58,601 --> 01:05:02,872
IS THAT COMPARISON GROUP.

1911
01:05:02,872 --> 01:05:07,977
KEVIN RVETIO, I THOUGHT, HAD SOT

1912
01:05:07,977 --> 01:05:09,712
CONSIDERATIONS OF HOW THEY

1913
01:05:09,712 --> 01:05:13,616
ARRIVED AIN'T PRE TAITION OF ATF

1914
01:05:13,616 --> 01:05:15,184
USUAL CARE THERE, KEVIN I THINK

1915
01:05:15,184 --> 01:05:17,152
YOU SAID RAISING THE FLOOR FOR

1916
01:05:17,152 --> 01:05:19,421
EVERYONE WITH WEB-BASED

1917
01:05:19,421 --> 01:05:20,823
EDUCATION TO REFLECT ADVICE.

1918
01:05:20,823 --> 01:05:25,461
I'M JUST WONDERING IF ANYONE

1919
01:05:25,461 --> 01:05:26,629
COULD TALK THROUGH A LITTLE BIT

1920
01:05:26,629 --> 01:05:29,798
ABOUT SOME OF THE CHALLENGES AND

1921
01:05:29,798 --> 01:05:31,300
THINKING THROUGH WHAT THAT RIGHT

1922
01:05:31,300 --> 01:05:38,874
COMPARISON GROUP OUGHT TO BE.

1923
01:05:38,874 --> 01:05:41,110
>> THE SHORT ANSWER IS
USUAL

1924
01:05:41,110 --> 01:05:43,779
CARE, BUT I THINK A LONGER

1925
01:05:43,779 --> 01:05:47,349
ANSWER IS, USUAL CARE AT THE

1926
01:05:47,349 --> 01:05:48,350
TIME AND PLACE WHERE THESE

1927
01:05:48,350 --> 01:05:50,486
RESULTS MIGHT BE APPLIED.

1928
01:05:50,486 --> 01:05:54,790
WHICH IS SOMETIMES COMPLICATED.

1929
01:05:54,790 --> 01:05:56,959
BECAUSE YOU MAY BE STUDYING

1930
01:05:56,959 --> 01:05:58,060
THESE INTERVENTIONS IN SETTINGS

1931
01:05:58,060 --> 01:05:59,862
THAT ACTUALLY MAY BE FARTHER

1932
01:05:59,862 --> 01:06:01,964
ALONG IN TERMS OF CARE,

1933
01:06:01,964 --> 01:06:04,533
IMPROVEMENT IN THIS AREA OR MAY

1934
01:06:04,533 --> 01:06:05,301
HAVE RESOURCES THAT OTHER

1935
01:06:05,301 --> 01:06:06,368
SETTINGS DON'T HAVE, AND THEN OF

1936
01:06:06,368 --> 01:06:07,503
COURSE THE RESULTS ARE GOING TO

1937
01:06:07,503 --> 01:06:09,271
BE APPLIED OFTEN FOUR, FIVE-PLUS

1938
01:06:09,271 --> 01:06:10,439
YEARS FROM NOW AND SO YOU'RE

1939
01:06:10,439 --> 01:06:13,609
SORT OF ANTICIPATING -- YOU HOPE

1940
01:06:13,609 --> 01:06:14,610
ANTICIPATING WHERE THINGS ARE

1941
01:06:14,610 --> 01:06:15,644
GOING AND THINKING THIS IS WHERE

1942
01:06:15,644 --> 01:06:17,613
WE THINK THE WORLD MIGHT BE SOME

1943
01:06:17,613 --> 01:06:20,349
YEARS FROM NOW.

1944
01:06:20,349 --> 01:06:23,218
AND THEN QUALIFIED AS I THINK WE

1945
01:06:23,218 --> 01:06:25,821
HEARD EARLIER, YOU MAY HAVE SOME

1946
01:06:25,821 --> 01:06:29,391
ETHICAL OBLIGATION, YOU KNOW, IF

1947
01:06:29,391 --> 01:06:33,996
THE RESEARCH IS DISCOVERING SOME

1948
01:06:33,996 --> 01:06:37,700
NEED THAT CANNOT BE IGNORED, YOU

1949
01:06:37,700 --> 01:06:39,001
MIGHT SAY PROBABLY WE NEED TO

1950
01:06:39,001 --> 01:06:40,302
PUT IN PLACE SOME SAFETY VALVE

1951
01:06:40,302 --> 01:06:41,670
TO MAKE SURE WE'RE NOT IGNORING

1952
01:06:41,670 --> 01:06:42,838
SOMETHING THAT WOULD BE

1953
01:06:42,838 --> 01:06:44,707
UNETHICAL TO IGNORE.

1954
01:06:44,707 --> 01:06:48,243
SO I THINK THAT I THINK USUAL

1955
01:06:48,243 --> 01:06:49,478
CARE IS USUALLY THE RIGHT

1956
01:06:49,478 --> 01:06:51,547
COMPARISON, BUT IT'S USUAL CARE

1957
01:06:51,547 --> 01:06:53,949
WHEN AND WHERE THE RESULTS OF

1958
01:06:53,949 --> 01:07:02,391
THIS RESEARCH WOULD BE APPLIED.

1959
01:07:02,391 --> 01:07:04,126
>> I THINK FOR US I'LL
JUST NOTE

1960
01:07:04,126 --> 01:07:08,831
THAT WE DECIDE ON USUAL CARE AS

1961
01:07:08,831 --> 01:07:11,867
GREG SAID, TYPICALLY FOR PAIN

1962
01:07:11,867 --> 01:07:13,068
PRAGMATIC TRIALS, USUAL CARE IS

1963
01:07:13,068 --> 01:07:15,604
THE TYPICAL COMPARATOR.

1964
01:07:15,604 --> 01:07:17,039
WE'RE WORKING WITH MULTIPLE

1965
01:07:17,039 --> 01:07:20,409
HEALTHCARE SYSTEMS, SO HAVING A

1966
01:07:20,409 --> 01:07:21,710
HEALTHCARE SYSTEM, IN ADDITION

1967
01:07:21,710 --> 01:07:23,445
TO IMPLEMENTING THE NURSE CARE

1968
01:07:23,445 --> 01:07:25,514
MANAGEMENT MODEL IMPLEMENT

1969
01:07:25,514 --> 01:07:28,350
ANOTHER ACTIVE CONTROL OR SOME

1970
01:07:28,350 --> 01:07:30,986
OTHER COMPARATOR MIGHT BE A

1971
01:07:30,986 --> 01:07:32,087
HEAVY LIFT.

1972
01:07:32,087 --> 01:07:34,890
FOR US, WHAT WE PLAN TO DO IS

1973
01:07:34,890 --> 01:07:36,759
BECAUSE WE HAVE DIFFERENT

1974
01:07:36,759 --> 01:07:40,162
HEALTHCARE SYSTEMS IS TO REALLY

1975
01:07:40,162 --> 01:07:41,463
CHARACTERIZE WHAT CARE PEOPLE

1976
01:07:41,463 --> 01:07:45,801
GET IN USUAL -- IN THE USUAL

1977
01:07:45,801 --> 01:07:48,437
CARE ARM, SO WE MAKE GREAT

1978
01:07:48,437 --> 01:07:50,506
EFFORTS TO MONITOR WHAT TYPES OF

1979
01:07:50,506 --> 01:07:51,507
MEDICATIONS PEOPLE ARE GETTING,

1980
01:07:51,507 --> 01:07:53,776
WHAT KIND OF REFERRALS FOLKS ARE

1981
01:07:53,776 --> 01:07:55,944
GETTING TO SPECIALTY SERVICES,

1982
01:07:55,944 --> 01:07:59,114
AND SO YEAH, WE JUST DEFAULTED

1983
01:07:59,114 --> 01:08:01,517
TO USUAL CARE, BUT WE'LL DO A

1984
01:08:01,517 --> 01:08:03,352
GOOD JOB OF CHARACTERIZING IT

1985
01:08:03,352 --> 01:08:08,323
ACROSS SYSTEMS.

1986
01:08:08,323 --> 01:08:10,426
>> I CAN SAY THE TWO
IMPORTANT

1987
01:08:10,426 --> 01:08:16,498
CONSIDERATIONS FOR US WERE POOR

1988
01:08:16,498 --> 01:08:17,700
RESOURCES, IMPLEMENTING TWO

1989
01:08:17,700 --> 01:08:18,667
INTERVENTIONS ACROSS A VERY

1990
01:08:18,667 --> 01:08:22,938
LARGE NATIONAL HEALTH SYSTEM.

1991
01:08:22,938 --> 01:08:24,573
WOULD HAVE BEEN CHALLENGING.

1992
01:08:24,573 --> 01:08:25,441
WE POTENTIALLY COULD HAVE

1993
01:08:25,441 --> 01:08:28,944
CONSIDERED AN EHR-BASED

1994
01:08:28,944 --> 01:08:31,880
ALTERATION OF USUAL CARE.

1995
01:08:31,880 --> 01:08:33,549
BUT THAT'S NOT A TRIVIAL

1996
01:08:33,549 --> 01:08:34,917
RESOURCE INVESTMENT AT ALL.

1997
01:08:34,917 --> 01:08:39,188
AND ALSO, PREVENTING

1998
01:08:39,188 --> 01:08:39,655
CONTAMINATION.

1999
01:08:39,655 --> 01:08:42,558
WE WERE TRYING TO MAKE A VERY

2000
01:08:42,558 --> 01:08:46,628
CLEAN DISTINCTION BETWEEN THE

2001
01:08:46,628 --> 01:08:51,533
INTERVENTION AND USUAL CARE.

2002
01:08:51,533 --> 01:08:53,736
SO WE THOUGHT ABOUT IT, THERE

2003
01:08:53,736 --> 01:08:58,307
DIDN'T SEEM TO BE A CLEAR WAY OF

2004
01:08:58,307 --> 01:08:58,841
DOING THIS.

2005
01:08:58,841 --> 01:09:01,143
AND THE POTENTIAL FOR

2006
01:09:01,143 --> 01:09:03,312
MAINTAINING FIDELITY WITHIN THE

2007
01:09:03,312 --> 01:09:06,048
INTERVENTION AS WE HAD IT WAS A

2008
01:09:06,048 --> 01:09:07,816
CHALLENGE.

2009
01:09:07,816 --> 01:09:09,084
MAINTAINING FIDELITY OF A USUAL

2010
01:09:09,084 --> 01:09:15,891
CARE STATE THAT WE KR CREATED WD

2011
01:09:15,891 --> 01:09:17,526
PROBABLY HAVE BEEN BEYOND OUR

2012
01:09:17,526 --> 01:09:19,261
RESOURCE, RESOURCES.

2013
01:09:19,261 --> 01:09:25,367
>> THANKS, ANDREA.

2014
01:09:25,367 --> 01:09:27,870
OKAY.

2015
01:09:27,870 --> 01:09:28,804
WENDY WEBER'S POSTED A QUESTION

2016
01:09:28,804 --> 01:09:30,472
HERE, AND THIS IS FOR ANDREA AND

2017
01:09:30,472 --> 01:09:31,907
GREG.

2018
01:09:31,907 --> 01:09:33,342
LOOKING BACK NOW THAT YOU'VE

2019
01:09:33,342 --> 01:09:34,309
COMPLETED OR ALMOST COMPLETED

2020
01:09:34,309 --> 01:09:36,044
THE TRIAL, IS THERE ANYTHING YOU

2021
01:09:36,044 --> 01:09:38,013
WISHED YOU HAD PILOTED BETTER

2022
01:09:38,013 --> 01:09:39,448
THAT WOULD HAVE HELPED YOU

2023
01:09:39,448 --> 01:09:40,849
ADDRESS CHALLENGES THAT AROSE

2024
01:09:40,849 --> 01:09:46,455
DURING THE TRIAL?

2025
01:09:46,455 --> 01:09:48,824
>> YEAH, IT'S A GOOD
QUESTION.

2026
01:09:48,824 --> 01:09:51,226
I MEAN, I THINK AS PEOPLE KNOW,

2027
01:09:51,226 --> 01:09:52,628
ALTHOUGH I DIDN'T SAY, AT THE

2028
01:09:52,628 --> 01:09:53,996
END OF THE DAY, THE

2029
01:09:53,996 --> 01:09:55,364
INTERVENTIONS WE TESTED WERE NOT

2030
01:09:55,364 --> 01:09:55,697
EFFECTIVE.

2031
01:09:55,697 --> 01:09:57,633
YOU KNOW, THEY DID NOT REDUCE

2032
01:09:57,633 --> 01:09:59,835
RISK OF SELF-HARM OR SUICIDE

2033
01:09:59,835 --> 01:10:01,570
ATTEMPT.

2034
01:10:01,570 --> 01:10:03,572
AND THE LEVEL OF ENGAGEMENT IN

2035
01:10:03,572 --> 01:10:05,808
THE INTERVENTIONS WAS ACTUALLY

2036
01:10:05,808 --> 01:10:06,575
RELATIVELY LOW.

2037
01:10:06,575 --> 01:10:08,110
NOT THAT MUCH LOWER THAN WE

2038
01:10:08,110 --> 01:10:10,312
EXPECTED BASED ON OUR PILOT

2039
01:10:10,312 --> 01:10:12,381
WORK, BUT THE ENGAGEMENT WAS

2040
01:10:12,381 --> 01:10:17,186
RELATIVELY LOW.

2041
01:10:17,186 --> 01:10:20,823
LOOKING BACK ON IT, THE

2042
01:10:20,823 --> 01:10:21,523
QUESTION -- THE INTERESTING

2043
01:10:21,523 --> 01:10:22,991
THING AND MAYBE SORT OF

2044
01:10:22,991 --> 01:10:25,260
RELATIVELY SORT OF UNIQUE TO OUR

2045
01:10:25,260 --> 01:10:26,795
TRIAL, AND THIS IS THAT SLIDE I

2046
01:10:26,795 --> 01:10:28,096
SHOWED WHERE WE TALKED ABOUT

2047
01:10:28,096 --> 01:10:33,468
SORT OF MAKING A LEAP.

2048
01:10:33,468 --> 01:10:35,737
MUCH OF THE RESEARCH ON THE

2049
01:10:35,737 --> 01:10:38,173
EFFECTIVENESS OF INTERVENTIONS

2050
01:10:38,173 --> 01:10:43,378
TO REDUCE SELF-HARM OR SUICIDE

2051
01:10:43,378 --> 01:10:44,479
ATTEMPT HAD BEEN PEOPLE WHO

2052
01:10:44,479 --> 01:10:45,581
PARTICIPATE IN RESEARCH TO

2053
01:10:45,581 --> 01:10:49,418
PREVENT SUICIDE.

2054
01:10:49,418 --> 01:10:51,453
SO YOU MIGHT SAY WELL WHAT ABOUT

2055
01:10:51,453 --> 01:10:52,354
THOSE PEOPLE WHO DIDN'T

2056
01:10:52,354 --> 01:10:53,355
VOLUNTEER TO PARTICIPATE IN

2057
01:10:53,355 --> 01:10:54,256
RESEARCH ABOUT SUICIDE, THOSE

2058
01:10:54,256 --> 01:10:55,490
MIGHT BE THE PEOPLE YOU WOULD

2059
01:10:55,490 --> 01:10:56,692
CARE ABOUT THE MOST, THAT'S WHAT

2060
01:10:56,692 --> 01:10:57,793
I WOULD SAY AT LEAST.

2061
01:10:57,793 --> 01:11:02,831
IT'S HARD TO KNOW HOW YOU MIGHT

2062
01:11:02,831 --> 01:11:06,935
HAVE UNDERSTOOD MORE ABOUT THAT

2063
01:11:06,935 --> 01:11:08,303
GROUP OF PEOPLE WITHOUT TAKING A

2064
01:11:08,303 --> 01:11:09,938
LEAP.

2065
01:11:09,938 --> 01:11:13,642
YOU WOULD LIKE YOUR LEAPS TO BE

2066
01:11:13,642 --> 01:11:14,409
MAYBE SMALLER.

2067
01:11:14,409 --> 01:11:16,578
WHEN I LOOK BACK ON IT, I SAY,

2068
01:11:16,578 --> 01:11:19,481
WELL, MAYBE WE SHOULD HAVE DONE

2069
01:11:19,481 --> 01:11:20,949
SOMETHING SMALLER IN SCOPE, YOU

2070
01:11:20,949 --> 01:11:22,818
KNOW, A SMALLER NUMBER OF PEOPLE

2071
01:11:22,818 --> 01:11:25,420
AND FOCUS ON SORT OF MORE KIND

2072
01:11:25,420 --> 01:11:28,056
OF APPROXIMATE OR IPT IMMEDIATE

2073
01:11:28,056 --> 01:11:30,325
OUTCOMES RATHER THAN TAKING A

2074
01:11:30,325 --> 01:11:32,861
BIG LEAP, BUT THEN AT THAT

2075
01:11:32,861 --> 01:11:35,130
POINT, YOU'D SAY WELL, YOU KNOW,

2076
01:11:35,130 --> 01:11:36,231
NOW I KNOW THAT MIGHT HAVE BEEN

2077
01:11:36,231 --> 01:11:38,867
THE RIGHT THING TO DO.

2078
01:11:38,867 --> 01:11:41,036
BUT THAT WOULD HAVE BEEN

2079
01:11:41,036 --> 01:11:42,704
ANOTHER -- THAT WOULD NOT BE, TO

2080
01:11:42,704 --> 01:11:44,206
USE OUR JARGON, THAT WOULD NOT

2081
01:11:44,206 --> 01:11:45,507
BE THE SORT OF PILOT YEAR.

2082
01:11:45,507 --> 01:11:49,111
THAT WOULD BE ITSELF A THREE- TO

2083
01:11:49,111 --> 01:11:50,112
FIVE-YEAR PROJECT.

2084
01:11:50,112 --> 01:11:52,281
SO WOULD YOU SAY WE SHOULD DO A

2085
01:11:52,281 --> 01:11:53,849
THREE- TO FIVE-YEAR PROJECT FOR

2086
01:11:53,849 --> 01:11:55,684
THAT INTERMEDIATE STEP.

2087
01:11:55,684 --> 01:11:58,086
AND PROBABLY, YOU KNOW, FOR WHAT

2088
01:11:58,086 --> 01:11:59,288
I THINK FUNDERS SHOULD THINK

2089
01:11:59,288 --> 01:12:00,689
ABOUT IS WHAT DOES A PORTFOLIO

2090
01:12:00,689 --> 01:12:02,958
LOOK LIKE?

2091
01:12:02,958 --> 01:12:04,960
YOU KNOW, A PORTFOLIO SHOULD

2092
01:12:04,960 --> 01:12:06,595
PROBABLY LOOK LIKE SOME BIG

2093
01:12:06,595 --> 01:12:11,066
STEPS AND SOME SMALL STEPS.

2094
01:12:11,066 --> 01:12:12,234
AND THINKING ABOUT THE

2095
01:12:12,234 --> 01:12:13,368
APPROPRIATE BALANCE OF BIG STEPS

2096
01:12:13,368 --> 01:12:16,171
AND SMALL STEPS, YOU PROBABLY

2097
01:12:16,171 --> 01:12:17,406
DON'T WANT TO HAVE ONLY BIG

2098
01:12:17,406 --> 01:12:19,241
LEAPS AND YOU DON'T WANT TO HAVE

2099
01:12:19,241 --> 01:12:21,543
ONLY SMALL STEPS, YOU WANT TO

2100
01:12:21,543 --> 01:12:25,614
HAVE SOME MIX OF THOSE.

2101
01:12:25,614 --> 01:12:27,316
>> THANKS, GREG.

2102
01:12:27,316 --> 01:12:28,617
ANDREA, ANY THOUGHTS ABOUT THAT?

2103
01:12:28,617 --> 01:12:32,354
>> YEAH, TWO.

2104
01:12:32,354 --> 01:12:34,623
I IN RETROSPECT WISH WE HAD DONE

2105
01:12:34,623 --> 01:12:38,360
MORE DUE DILIGENCE IN DEVELOPING

2106
01:12:38,360 --> 01:12:41,296
SAFETY CHECKS FOR OUR EHR

2107
01:12:41,296 --> 01:12:42,564
PROCESSES.

2108
01:12:42,564 --> 01:12:45,233
I THINK WE ASSUMED EPIC WAS

2109
01:12:45,233 --> 01:12:48,070
GOING TO DO WHAT WE TOLD TO DO,

2110
01:12:48,070 --> 01:12:51,573
AND THAT WAS INCORRECT SO I WISH

2111
01:12:51,573 --> 01:12:53,842
WE HAD CONSIDERED THAT EARLIER

2112
01:12:53,842 --> 01:12:59,414
ON AND BEEN MUCH MORE SYSTEMATIC

2113
01:12:59,414 --> 01:13:01,850
IN STEP WISE VALIDATION.

2114
01:13:01,850 --> 01:13:03,919
I ALSO WISH THAT WE HAD SPENT

2115
01:13:03,919 --> 01:13:07,289
MORE TIME ON INFORMATICS

2116
01:13:07,289 --> 01:13:10,659
IMPLEMENTATION.

2117
01:13:10,659 --> 01:13:11,994
WE REALIZED THIS WAS CRITICAL

2118
01:13:11,994 --> 01:13:15,364
WITH E2C2 AND ADVANCED IT

2119
01:13:15,364 --> 01:13:17,232
FURTHER, BUT IF WE'RE GOING TO

2120
01:13:17,232 --> 01:13:21,403
USE DIGITAL TOOLS AND TRY AND

2121
01:13:21,403 --> 01:13:23,105
ENGAGE VERY BUSY CLINICIANS WHO

2122
01:13:23,105 --> 01:13:28,477
MAY NOT SHARE YOUR PRIORITIES

2123
01:13:28,477 --> 01:13:29,778
USING THESE DOLLS,

2124
01:13:29,778 --> 01:13:30,912
IMPLEMENTATION BECOMES

2125
01:13:30,912 --> 01:13:31,947
ABSOLUTELY CRITICAL.

2126
01:13:31,947 --> 01:13:34,249
SO I WISH WE HAD HAD THE

2127
01:13:34,249 --> 01:13:36,985
LATITUDE TO BUY LOT SOME

2128
01:13:36,985 --> 01:13:37,753
ADDITIONAL STRATEGIES.

2129
01:13:37,753 --> 01:13:42,224
WE DID THIS ON THE FLY OF

2130
01:13:42,224 --> 01:13:45,060
NECESSITY, BUT IT WOULD HAVE

2131
01:13:45,060 --> 01:13:46,495
BEEN NICE TO HAVE THE LUXURY TO

2132
01:13:46,495 --> 01:13:51,299
DO THAT IN A MORE FOCUSED WAY.

2133
01:13:51,299 --> 01:13:52,801
>> YOU KNOW, I'D LIKE TO
GO BACK

2134
01:13:52,801 --> 01:13:54,236
TO SOME OF THE COMMENTS THAT

2135
01:13:54,236 --> 01:13:56,104
WERE JUST MADE AND MADE EARLIER

2136
01:13:56,104 --> 01:13:58,407
TOO ABOUT THE ROLE OF THE CALL

2137
01:13:58,407 --> 01:14:01,443
FOR FUNDING.

2138
01:14:01,443 --> 01:14:02,344
 IN SHAPING THE

2139
01:14:02,344 --> 01:14:05,180
APPROACH THAT YOUR TEAMS TOOK,

2140
01:14:05,180 --> 01:14:07,682
AND THIS IS THE NIH WORKSHOP,

2141
01:14:07,682 --> 01:14:08,784
PART OF THE REASON WHY WE HAVE

2142
01:14:08,784 --> 01:14:10,752
THIS WORKSHOP IS TO TRY TO

2143
01:14:10,752 --> 01:14:12,254
ENGAGE WITH OUR NIH COLLEAGUES,

2144
01:14:12,254 --> 01:14:15,123
AND I WONDER IF WE THOUGHT FOR A

2145
01:14:15,123 --> 01:14:19,494
MINUTE ABOUT THOSE NIH CALLS FOR

2146
01:14:19,494 --> 01:14:20,695
APPLICATIONS, FOR THESE

2147
01:14:20,695 --> 01:14:22,130
PARTICULAR TRIALS BUT FOR OTHER

2148
01:14:22,130 --> 01:14:23,865
ONES YOU MIGHT HAVE CONSIDERED

2149
01:14:23,865 --> 01:14:26,935
TOO, ARE THERE THINGS THAT CAN

2150
01:14:26,935 --> 01:14:30,005
BE INCLUDED IN THOSE CALLS THAT

2151
01:14:30,005 --> 01:14:31,973
FACILITATE YOU HONING IN ON AN

2152
01:14:31,973 --> 01:14:33,842
IMPACTFUL RESEARCH QUESTION, ARE

2153
01:14:33,842 --> 01:14:35,043
THERE ANY ELEMENTS THAT

2154
01:14:35,043 --> 01:14:38,213
SOMETIMES CONTRIBUTE TO SOME

2155
01:14:38,213 --> 01:14:39,181
UNCERTAINTY OR CONFUSION WHEN

2156
01:14:39,181 --> 01:14:42,017
TRYING TO CRAFT A RESEARCH

2157
01:14:42,017 --> 01:14:42,918
QUESTION?

2158
01:14:42,918 --> 01:14:44,019
HOPEFULLY THAT'S NOT TOO BROAD,

2159
01:14:44,019 --> 01:14:45,320
BUT I KNOW GREG PULLED OUT THAT

2160
01:14:45,320 --> 01:14:49,925
QUOTE FROM THE ORIGINAL

2161
01:14:49,925 --> 01:14:52,327
COLLABORATORY ENCOURAGING BOLD,

2162
01:14:52,327 --> 01:14:54,062
RISKY PROJECTS, AND THAT

2163
01:14:54,062 --> 01:14:56,498
DIRECTLY INFORMED HOW BIG OF A

2164
01:14:56,498 --> 01:15:00,969
LEAP OVER THOSE VARIOUS UNKNOWNS

2165
01:15:00,969 --> 01:15:01,837
YOU LISTED YOU WERE WILLING TO

2166
01:15:01,837 --> 01:15:02,270
TAKE.

2167
01:15:02,270 --> 01:15:03,905
SO JUST WONDERED WHETHER PEOPLE

2168
01:15:03,905 --> 01:15:07,843
HAD THOUGHTS ABOUT WAYS THAT THE

2169
01:15:07,843 --> 01:15:09,077
CALL FOR FUNDING ITSELF IS

2170
01:15:09,077 --> 01:15:13,315
SOMETIMES HELPFUL OR PERHAPS

2171
01:15:13,315 --> 01:15:14,015
INTRODUCES SOME UNCERTAINTY IN

2172
01:15:14,015 --> 01:15:18,120
THE THINGS IT SAYS.

2173
01:15:18,120 --> 01:15:20,021
GLL I PERSON

2174
01:15:20,021 --> 01:15:22,457
>> I PERSONALLY REALLY
LEAN ON

2175
01:15:22,457 --> 01:15:23,091
THE EXAMPLES.

2176
01:15:23,091 --> 01:15:24,392
I LIKE WHEN EVERYTHING IS

2177
01:15:24,392 --> 01:15:25,927
EXPLAINED BUT THERE'S A LOT OF

2178
01:15:25,927 --> 01:15:27,229
JARGON IN THERE AND IT'S VERY

2179
01:15:27,229 --> 01:15:28,430
CAREFULLY WORDED.

2180
01:15:28,430 --> 01:15:29,664
THEY'RE WRITTEN WELL, BUT

2181
01:15:29,664 --> 01:15:30,732
OFTENTIMES I THINK THINGS ARE

2182
01:15:30,732 --> 01:15:31,933
GOING IN ONE DIRECTION AND THEN

2183
01:15:31,933 --> 01:15:34,669
I GET DOWN TO THE EXAMPLES OF

2184
01:15:34,669 --> 01:15:36,638
PROJECTS THAT WILL BE RESPONSIVE

2185
01:15:36,638 --> 01:15:38,206
TO THIS AND I GO, OH, THIS IS

2186
01:15:38,206 --> 01:15:41,977
WHAT HE TH THEY MEAN.

2187
01:15:41,977 --> 01:15:44,513
SO I THINK THOSE HYPOTHETICAL

2188
01:15:44,513 --> 01:15:45,881
STUDIES THAT WOULD BE RESPONSIVE

2189
01:15:45,881 --> 01:15:48,450
AND WOULD NOT BE RESPONSIVE ARE

2190
01:15:48,450 --> 01:15:50,185
ALWAYS REALLY HELPFUL FOR ME AND

2191
01:15:50,185 --> 01:15:51,620
OFTEN GIVE ME AN IDEA THAT MAYBE

2192
01:15:51,620 --> 01:15:54,122
I HADN'T ALREADY HAD BUT IS

2193
01:15:54,122 --> 01:15:55,323
SIMILAR TO ONE OF THE

2194
01:15:55,323 --> 01:15:56,391
HYPOTHETICAL STUDIES THEY

2195
01:15:56,391 --> 01:15:56,658
MENTIONED.

2196
01:15:56,658 --> 01:16:01,229
>> OKAY.

2197
01:16:01,229 --> 01:16:05,534
OTHER THOUGHTS ON THAT?

2198
01:16:05,534 --> 01:16:07,335
>> GOING BACK TO WHAT I
SET

2199
01:16:07,335 --> 01:16:08,670
ABOUT SORT OF YOU WANT THE SORT

2200
01:16:08,670 --> 01:16:10,172
OF DIVERSITY IN AN OVERALL

2201
01:16:10,172 --> 01:16:11,406
PORTFOLIO, I THINK IT'S

2202
01:16:11,406 --> 01:16:14,576
CERTAINLY POSSIBLE FOR FUNDING

2203
01:16:14,576 --> 01:16:15,443
OPPORTUNITIES, ESPECIALLY HAVING

2204
01:16:15,443 --> 01:16:16,845
MULTIPLE FUNDING OPPORTUNITIES,

2205
01:16:16,845 --> 01:16:20,448
ITHAT REALLY PINPOINT DIFFERENT

2206
01:16:20,448 --> 01:16:22,250
SORT OF -- WHERE IS THIS

2207
01:16:22,250 --> 01:16:23,285
OPPORTUNITY FOCUSED AND WHERE

2208
01:16:23,285 --> 01:16:24,286
ARE YOU GOING.

2209
01:16:24,286 --> 01:16:25,287
ONE THAT I'M JUST VERY

2210
01:16:25,287 --> 01:16:26,154
INTERESTED IN PAYING ATTENTION

2211
01:16:26,154 --> 01:16:28,123
TO, YOU KNOW, I'LL JUST USE AS

2212
01:16:28,123 --> 01:16:31,426
AN EXAMPLE, NIMH HAS JUST PUT

2213
01:16:31,426 --> 01:16:32,928
OUT SOME FUNDING ANNOUNCEMENTS

2214
01:16:32,928 --> 01:16:35,463
ABOUT PERSO PERSONALIZING MENTAL

2215
01:16:35,463 --> 01:16:36,531
HEALTH TREATMENTS.

2216
01:16:36,531 --> 01:16:38,667
INTERESTINGLY THERE'S ONE

2217
01:16:38,667 --> 01:16:39,701
ANNOUNCEMENT MORE ABOUT WE NEED

2218
01:16:39,701 --> 01:16:40,802
TO DEVELOP TOOLS OR DEVELOP

2219
01:16:40,802 --> 01:16:42,671
TOOLS THAT WOULD ALLOW FUTURE

2220
01:16:42,671 --> 01:16:43,438
PERSONALIZATION AND THE OTHER IS

2221
01:16:43,438 --> 01:16:44,973
WE NEED TO TEST THE TOOLS WE

2222
01:16:44,973 --> 01:16:46,608
HAVE RIGHT NOW.

2223
01:16:46,608 --> 01:16:47,809
NOW THOSE ARE TWO REALLY

2224
01:16:47,809 --> 01:16:48,777
DIFFERENT THINGS, AND I THOUGHT

2225
01:16:48,777 --> 01:16:50,612
IT WAS ACTUALLY WISE TO SAY WE

2226
01:16:50,612 --> 01:16:52,280
WANT BOTH.

2227
01:16:52,280 --> 01:16:53,281
YOU KNOW?

2228
01:16:53,281 --> 01:16:55,116
WE WANT TO KNOW WHAT'S THE BEST

2229
01:16:55,116 --> 01:16:58,853
WE CAN DO WITH WHAT WE HAVE NOW,

2230
01:16:58,853 --> 01:17:00,388
BUT KNOWING WHAT WE HAVE NOW IS

2231
01:17:00,388 --> 01:17:02,123
ACTUALLY NOT VERY GOOD, WOULD

2232
01:17:02,123 --> 01:17:03,058
LIKE SOMETHING THAT WE CAN USE

2233
01:17:03,058 --> 01:17:05,293
IN THE FUTURE THAT WILL BE

2234
01:17:05,293 --> 01:17:10,699
BETTER, BUT WE WANT BOTH.

2235
01:17:10,699 --> 01:17:16,271
>> AIL JUST ADD TO ADREE
WITH

2236
01:17:16,271 --> 01:17:19,274
WHAT GREG AND KEVIN, THE RFA

2237
01:17:19,274 --> 01:17:22,944
THAT WE RESPONDED TO WAS VERY --

2238
01:17:22,944 --> 01:17:27,415
HAD VERY SPECIFIC CALLS AND FOR

2239
01:17:27,415 --> 01:17:31,019
AN EXAMPLE, WHAT IS RURAL AND

2240
01:17:31,019 --> 01:17:33,221
THAT REALLY HELPED, I THINK, TO

2241
01:17:33,221 --> 01:17:35,624
DEFINE -- HELPED ALL THE

2242
01:17:35,624 --> 01:17:38,326
APPLICANTS IDENTIFY HEALTHCARE

2243
01:17:38,326 --> 01:17:39,561
PARTNERS THAT HAD REASONABLE

2244
01:17:39,561 --> 01:17:41,296
NUMBERS OF PEOPLE THAT WOULD

2245
01:17:41,296 --> 01:17:42,931
MEET -- PATIENTS THAT WOULD MEET

2246
01:17:42,931 --> 01:17:47,435
THE DEFINITION OF RURALITY OR

2247
01:17:47,435 --> 01:17:47,636
RURAL.

2248
01:17:47,636 --> 01:17:53,008
SO HAVING SPECIFIC CRITERION AND

2249
01:17:53,008 --> 01:17:57,279
THEN ALSO HAVING, LIKE KEVIN WAS

2250
01:17:57,279 --> 01:17:58,813
SAYING, THIS WAS A RANGE OF

2251
01:17:58,813 --> 01:18:01,516
EXAMPLES TO DESCRIBE THE TYPES

2252
01:18:01,516 --> 01:18:03,952
OF INTERVENTIONS WAS SUPER

2253
01:18:03,952 --> 01:18:06,454
HELPFUL.

2254
01:18:06,454 --> 01:18:08,089
JUST IN TERMS OF THE POPULATION,

2255
01:18:08,089 --> 01:18:12,260
I REALLY APPRECIATED HAVING VERY

2256
01:18:12,260 --> 01:18:14,663
SPECIFIC CRITERIA BEING LISTED

2257
01:18:14,663 --> 01:18:18,166
IN THE RFA.

2258
01:18:18,166 --> 01:18:20,335
>> I WOULD JUST FOLLOW UP
WITH

2259
01:18:20,335 --> 01:18:21,569
THAT IN THAT WE ALL KNOW

2260
01:18:21,569 --> 01:18:23,204
LANGUAGE IS POWERFUL AND

2261
01:18:23,204 --> 01:18:24,773
SOMETIMES AMBIGUOUS LANGUAGE IN

2262
01:18:24,773 --> 01:18:26,241
THE RFA, IN OUR SITUATION, WE

2263
01:18:26,241 --> 01:18:27,676
WERE VERY MUCH ON THE FENCE.

2264
01:18:27,676 --> 01:18:30,845
WE WERE WORRIED ABOUT BANDWIDTH,

2265
01:18:30,845 --> 01:18:34,115
AND HAVING THE SPECIFICITY OF

2266
01:18:34,115 --> 01:18:36,451
LANGUAGE, I THINK HELPS EMPOWER

2267
01:18:36,451 --> 01:18:38,620
A TEAM TO FEEL LIKE WE HAVE A

2268
01:18:38,620 --> 01:18:40,255
FIGHTING SHOT.

2269
01:18:40,255 --> 01:18:42,891
THE OPPORTUNITY COST OF

2270
01:18:42,891 --> 01:18:49,331
DEVELOPING A MISFIRE, MISAIMED

2271
01:18:49,331 --> 01:18:50,198
POPULATION ARE NOT TRIVIAL.

2272
01:18:50,198 --> 01:18:53,501
SO I THINK IT'S IMPORTANT TO USE

2273
01:18:53,501 --> 01:18:59,841
OPEN-ENDED LANGUAGE WH, CREATIVE

2274
01:18:59,841 --> 01:19:01,476
THOUGHT, PUSHING THE ENVELOPE,

2275
01:19:01,476 --> 01:19:02,677
DISRUPTION IS DESIRED.

2276
01:19:02,677 --> 01:19:05,947
THE FLIP SIDE OF THAT IS THAT IN

2277
01:19:05,947 --> 01:19:07,615
THAT AMBIGUOUS LANGUAGE CAN BE

2278
01:19:07,615 --> 01:19:09,017
VERY DISCOURAGING AND

2279
01:19:09,017 --> 01:19:12,187
OFFPUTTING, BECAUSE OF THE

2280
01:19:12,187 --> 01:19:14,389
POTENTIAL, AGAIN, TO COMPLETELY

2281
01:19:14,389 --> 01:19:15,323
MISSPECIFY AN APPLICATION THAT

2282
01:19:15,323 --> 01:19:20,095
DOES NOT HIT THE MARK.

2283
01:19:20,095 --> 01:19:20,862
>> ALL RIGHT.

2284
01:19:20,862 --> 01:19:22,497
WELL, GOOD.

2285
01:19:22,497 --> 01:19:26,000
THAT'S HELPFUL.

2286
01:19:26,000 --> 01:19:30,372
SO HE HELENE, YOU'VE COME ON

2287
01:19:30,372 --> 01:19:32,340
CAMERA.

2288
01:19:32,340 --> 01:19:32,907
DO YOU FIND THAT --

2289
01:19:32,907 --> 01:19:34,275
>> I FIND THIS WHOLE
DISCUSSION

2290
01:19:34,275 --> 01:19:34,743
REALLY INTERESTING.

2291
01:19:34,743 --> 01:19:36,544
THIS IS SOMETHING THAT I WORRY A

2292
01:19:36,544 --> 01:19:37,579
LOT ABOUT.

2293
01:19:37,579 --> 01:19:43,385
IN TERMS OF WELL-INTENTIONED

2294
01:19:43,385 --> 01:19:45,587
LANGUAGE, RIGHT, IN RFAs THAT

2295
01:19:45,587 --> 01:19:52,026
ARE MEANT TO GUIDE AND ENCOURAGE

2296
01:19:52,026 --> 01:19:57,198
HOW OFTEN DOES THAT END UP

2297
01:19:57,198 --> 01:19:58,867
MISFIRING, MISLEADING, WITHOUT,

2298
01:19:58,867 --> 01:20:02,003
YOU KNOW, SENDING PEOPLE IN A

2299
01:20:02,003 --> 01:20:03,538
DIRECTION THAT MAY NOT BE

2300
01:20:03,538 --> 01:20:06,274
NECESSARILY THE BEST.

2301
01:20:06,274 --> 01:20:09,444
WHAT I WORRY ABOUT IS THAT, I

2302
01:20:09,444 --> 01:20:11,079
MEAN, I'VE BEEN AN INVESTIGATOR

2303
01:20:11,079 --> 01:20:13,281
FOR 25 YEARS, I KNOW WHAT IT

2304
01:20:13,281 --> 01:20:15,016
LIKE, YOU KNOW, READING THESE

2305
01:20:15,016 --> 01:20:18,520
RFAs AND TRYING TO -- YOU'RE

2306
01:20:18,520 --> 01:20:19,521
CONFLICTED, RIGHT?

2307
01:20:19,521 --> 01:20:21,256
ON ONE HAND, YOU WANT YOUR

2308
01:20:21,256 --> 01:20:22,457
APPLICATION TO GET FUNDED.

2309
01:20:22,457 --> 01:20:23,658
ON THE OTHER HAND, YOU MAY HAVE

2310
01:20:23,658 --> 01:20:25,527
YOUR OWN IDEAS ABOUT WHAT'S THE

2311
01:20:25,527 --> 01:20:27,495
BEST THING TO DO.

2312
01:20:27,495 --> 01:20:29,998
AND HOW DO YOU RECONCILE THAT?

2313
01:20:29,998 --> 01:20:32,200
AND SO I THINK THIS IS WHERE

2314
01:20:32,200 --> 01:20:33,168
DISCUSSIONS LIKE THEEZ THAT ARE,

2315
01:20:33,168 --> 01:20:34,936
YOU KNOW, REALLY CANDID AND OPEN

2316
01:20:34,936 --> 01:20:37,005
WHERE YOU ALL CAN REALLY GIVE US

2317
01:20:37,005 --> 01:20:42,043
THE FEEDBACK IS SO IMPORTANT.

2318
01:20:42,043 --> 01:20:45,647
WE NEED TO UNDERSTAND THE EXTENT

2319
01:20:45,647 --> 01:20:48,049
TO WHICH THE DETAIL AND THE

2320
01:20:48,049 --> 01:20:52,987
EFFORTS THAT WE PUT IN IN

2321
01:20:52,987 --> 01:20:56,691
CREATING THESE RFAs ARE

2322
01:20:56,691 --> 01:20:58,560
HITTING THE MARK, YOU KNOW, AND

2323
01:20:58,560 --> 01:21:01,629
SO -- AND IF IT ENDS UP CREATING

2324
01:21:01,629 --> 01:21:03,398
EITHER CONFUSION OR SENDING YOU

2325
01:21:03,398 --> 01:21:06,134
ALL IN DIRECTIONS THAT YOU

2326
01:21:06,134 --> 01:21:07,702
PERSONALLY IN THE BACK OF YOUR

2327
01:21:07,702 --> 01:21:08,770
HEADS ARE WONDERING MAYBE THAT'S

2328
01:21:08,770 --> 01:21:10,171
NOT THE RIGHT THING BUT I'LL DO

2329
01:21:10,171 --> 01:21:12,474
IT THIS WAY BECAUSE THAT'S WHAT

2330
01:21:12,474 --> 01:21:13,341
THE RFA SAYS.

2331
01:21:13,341 --> 01:21:14,375
YOU KNOW?

2332
01:21:14,375 --> 01:21:15,677
I'M JUST CURIOUS WHAT YOU ALL

2333
01:21:15,677 --> 01:21:16,778
THINK ABOUT THAT.

2334
01:21:16,778 --> 01:21:19,414
IS THERE -- YOU KNOW, I THINK

2335
01:21:19,414 --> 01:21:20,715
THIS IS PARTLY WHAT THIS

2336
01:21:20,715 --> 01:21:21,816
DISCUSSION IS ABOUT, IS YOU'RE

2337
01:21:21,816 --> 01:21:24,786
ALL VERY POLITE AND TELLING US

2338
01:21:24,786 --> 01:21:26,855
THAT WE SHOULD THINK ABOUT

2339
01:21:26,855 --> 01:21:27,856
CAREFULLY HOW THESE RFAs ARE

2340
01:21:27,856 --> 01:21:31,192
WRITTEN.

2341
01:21:31,192 --> 01:21:32,861
>> WELL, I MEAN, I'D GO
BACK TO

2342
01:21:32,861 --> 01:21:34,295
THAT EXAMPLE I CITED WHICH I

2343
01:21:34,295 --> 01:21:36,297
THOUGHT WAS QUITE WISE.

2344
01:21:36,297 --> 01:21:38,132
NIMH SAYING WE NEED BOTH OF

2345
01:21:38,132 --> 01:21:38,566
THESE.

2346
01:21:38,566 --> 01:21:40,001
SO WE'RE GOING TO HAVE ONE RFA

2347
01:21:40,001 --> 01:21:41,302
FOR THIS AND ONE RFA FOR THAT

2348
01:21:41,302 --> 01:21:42,504
AND THEY'RE GOING TO BE VERY

2349
01:21:42,504 --> 01:21:43,938
CLEAR, AS OPPOSED TO BEING

2350
01:21:43,938 --> 01:21:44,939
RELATIVELY VAGUE AND ENDING UP

2351
01:21:44,939 --> 01:21:46,241
WITH ALL ONE OR ALL THE OTHER

2352
01:21:46,241 --> 01:21:47,675
SAYING WE NEED BOTH.

2353
01:21:47,675 --> 01:21:51,079
I ACTUALLY AGREE WITH THAT.

2354
01:21:51,079 --> 01:21:52,814
>> SO IN SOME CASES IT'S
GOOD TO

2355
01:21:52,814 --> 01:21:53,414
BE SPECIFIC.

2356
01:21:53,414 --> 01:21:55,116
>> YEAH, WELL --

2357
01:21:55,116 --> 01:21:56,184
>> WHAT IF IT'S WRONG?

2358
01:21:56,184 --> 01:21:58,286
>> BUT SPECIFIC IN TERMS
OF

2359
01:21:58,286 --> 01:21:59,587
PORTFOLIO BALANCE, YOU KNOW?

2360
01:21:59,587 --> 01:21:59,854
>> RIGHT.

2361
01:21:59,854 --> 01:22:02,223
>>  IN TERMS OF, OKAY, I
THINK

2362
01:22:02,223 --> 01:22:04,325
TO SAY FIRST OF ALL, THIS

2363
01:22:04,325 --> 01:22:07,262
PROBLEM IS A PRIORITY, A AND

2364
01:22:07,262 --> 01:22:09,497
THEN TO SAY WHAT DOES A BALANCED

2365
01:22:09,497 --> 01:22:10,398
PORTFOLIO LOOK LIKE TO ADDRESS

2366
01:22:10,398 --> 01:22:13,067
THIS PROBLEM, AND THAT BALANCED

2367
01:22:13,067 --> 01:22:15,470
PORTFOLIO OFTEN NEEDS TO INCLUDE

2368
01:22:15,470 --> 01:22:20,408
SOME -- TO USE THE FOOTBALL

2369
01:22:20,408 --> 01:22:21,709
ANALOGY, IT NEEDS TO INCLUDE A

2370
01:22:21,709 --> 01:22:23,111
FEW SHOTS DOWN THE FIELD AND A

2371
01:22:23,111 --> 01:22:24,245
FEW 6-YARD PASSES AND THINGS

2372
01:22:24,245 --> 01:22:25,380
LIKE THAT, AND YOU'RE GOING TO

2373
01:22:25,380 --> 01:22:26,548
NEED A MIX OF THOSE THINGS.

2374
01:22:26,548 --> 01:22:29,717
AND I THINK IT'S FINE FOR RFAs

2375
01:22:29,717 --> 01:22:31,920
TO BE PRETTY CLEAR ABOUT THIS IS

2376
01:22:31,920 --> 01:22:33,221
THE RFA FOR THIS AND THIS IS THE

2377
01:22:33,221 --> 01:22:34,088
RFA FOR THAT.

2378
01:22:34,088 --> 01:22:35,957
NOW THAT IS MORE WORK FOR

2379
01:22:35,957 --> 01:22:37,759
PROGRAM STAFF TO PUT OUT

2380
01:22:37,759 --> 01:22:39,060
MULTIPLE RFAs BUT I ACTUALLY

2381
01:22:39,060 --> 01:22:41,029
THINK THAT'S HELPFUL.

2382
01:22:41,029 --> 01:22:42,664
THE ONE THING THAT I'VE

2383
01:22:42,664 --> 01:22:45,199
SOMETIMES FOUND SORT OF

2384
01:22:45,199 --> 01:22:47,835
CHALLENGING IS, IT SEEMS THAT

2385
01:22:47,835 --> 01:22:48,803
EVERYONE HAS THEIR OWN

2386
01:22:48,803 --> 01:22:52,874
DEFINITION OF INNOVATIVE.

2387
01:22:52,874 --> 01:22:54,709
AND IT ACTUALLY MIGHT BE HELPFUL

2388
01:22:54,709 --> 01:22:56,110
IF RFAs WERE A LITTLE MORE

2389
01:22:56,110 --> 01:22:59,147
SPECIFIC ABOUT IN THIS RFA, WHAT

2390
01:22:59,147 --> 01:23:00,281
KIND OF INNOVATION ARE WE

2391
01:23:00,281 --> 01:23:00,848
LACKING FOR?

2392
01:23:00,848 --> 01:23:03,251
DON'T MEAN TO  WHINE TOO MUCH

2393
01:23:03,251 --> 01:23:04,919
BUT HAVING HAD THE EXPERIENCE OF

2394
01:23:04,919 --> 01:23:06,454
A PROPOSAL BEING REVIEWED WHERE

2395
01:23:06,454 --> 01:23:07,755
ONE REVIEWER SAYS, YOU KNOW,

2396
01:23:07,755 --> 01:23:10,525
THIS IS COMPLETELY IMPOSSIBLE,

2397
01:23:10,525 --> 01:23:12,260
THIS COULD NEVER BE DONE, WHICH

2398
01:23:12,260 --> 01:23:13,695
ACTUALLY I WOULD SAY IS A PRETTY

2399
01:23:13,695 --> 01:23:15,129
GOOD MARKER OF INNOVATION IF

2400
01:23:15,129 --> 01:23:19,834
SOMEBODY SAYS NOT EVEN POSSIBLE.

2401
01:23:19,834 --> 01:23:22,437
AND ANOTHER REVIEWER SAYS NOT

2402
01:23:22,437 --> 01:23:23,605
INNOVATIVE AT ALL.

2403
01:23:23,605 --> 01:23:24,772
THE CHALLENGE IS THAT PEOPLE ARE

2404
01:23:24,772 --> 01:23:25,673
FOCUSED ON VERY DIFFERENT

2405
01:23:25,673 --> 01:23:26,574
THINGS.

2406
01:23:26,574 --> 01:23:28,276
SOMEBODY SAYS, YOU KNOW, THIS IS

2407
01:23:28,276 --> 01:23:29,944
A HUGE STRETCH, TRYING TO APPLY

2408
01:23:29,944 --> 01:23:30,945
SOMETHING THAT'S NEVER BEEN DONE

2409
01:23:30,945 --> 01:23:33,781
IN THIS FIELD BEFORE, AND THEN

2410
01:23:33,781 --> 01:23:35,984
ANOTHER REVIEWER SAYS OH, BUT

2411
01:23:35,984 --> 01:23:37,852
YOUR STATISTICAL METHODS ARE

2412
01:23:37,852 --> 01:23:39,354
TOTALLY ESTABLISHED.

2413
01:23:39,354 --> 01:23:42,991
SO IT WOULD BE HELPFUL IF AN RFA

2414
01:23:42,991 --> 01:23:44,092
SAID IN THIS RFA, THIS IS THE

2415
01:23:44,092 --> 01:23:46,060
KIND OF INNOVATION WE'RE LOOKING

2416
01:23:46,060 --> 01:23:48,463
FOR.

2417
01:23:48,463 --> 01:23:49,464
BECAUSE I THINK SOMETIMES YOU

2418
01:23:49,464 --> 01:23:51,432
ARE LOOKING FOR INNOVATION IN

2419
01:23:51,432 --> 01:23:53,067
SPECIFIC AREAS.

2420
01:23:53,067 --> 01:23:54,535
YOU'RE SAYING HERE WE'RE LOOKING

2421
01:23:54,535 --> 01:23:56,804
FOR INNOVATION FOR REALLY NEW

2422
01:23:56,804 --> 01:23:57,038
METHODS.

2423
01:23:57,038 --> 01:23:58,006
HERE WE'RE LOOKING FOR

2424
01:23:58,006 --> 01:23:59,674
INNOVATION IN A REALLY DIFFERENT

2425
01:23:59,674 --> 01:24:01,542
SETTING OR A NEW POPULATION.

2426
01:24:01,542 --> 01:24:03,077
HERE WE'RE LOOKING FOR

2427
01:24:03,077 --> 01:24:05,613
INNOVATION IN THIS AREA.

2428
01:24:05,613 --> 01:24:06,948
>> THAT'S ASSUMING WE'RE
LOOKING

2429
01:24:06,948 --> 01:24:07,815
FOR THE RIGHT THING.

2430
01:24:07,815 --> 01:24:09,317
>> YEAH.

2431
01:24:09,317 --> 01:24:13,054
WELL, YOU KNOW, I HAVE TO SAY,

2432
01:24:13,054 --> 01:24:14,689
MY OWN EXPERIENCE, BELIEVE ME,

2433
01:24:14,689 --> 01:24:17,191
I'M NOT JUST SUCKING UP HERE,

2434
01:24:17,191 --> 01:24:20,928
THAT THE NIMH, OUR SCIENTIFIC

2435
01:24:20,928 --> 01:24:22,563
COLLEAGUES AT NIH ARE OFTEN MUCH

2436
01:24:22,563 --> 01:24:23,998
MORE INTERESTED IN AND TO BE

2437
01:24:23,998 --> 01:24:27,068
HONEST WITH YOU ATTUNED TO WHAT

2438
01:24:27,068 --> 01:24:28,269
INNOVATION IS NECESSARY THAN

2439
01:24:28,269 --> 01:24:29,504
SOME OF US RESEARCHERS.

2440
01:24:29,504 --> 01:24:31,372
>> WELL, MAYBE -- THAT'S
MAYBE

2441
01:24:31,372 --> 01:24:32,874
FROM WHERE WE SIT, WE HAVE A

2442
01:24:32,874 --> 01:24:34,642
BIGGER IDEA ON BIG PICTURE, BUT

2443
01:24:34,642 --> 01:24:38,046
I ALSO DO BELIEVE THAT SOMETIMES

2444
01:24:38,046 --> 01:24:41,115
INVESTIGATORS CAN HAVE INSIGHTS

2445
01:24:41,115 --> 01:24:46,821
THAT ARE QUITE IMPORTANT AND IF

2446
01:24:46,821 --> 01:24:48,790
THERE'S -- DON'T FIT THE RFA

2447
01:24:48,790 --> 01:24:50,458
THEN THEY WON'T GET FUNDED AND

2448
01:24:50,458 --> 01:24:51,893
THEN THAT IDEA WILL BE WASTED.

2449
01:24:51,893 --> 01:24:53,161
>> AND THERE, I THINK ONCE

2450
01:24:53,161 --> 01:24:55,263
AGAIN, I THINK ABOUT PORTFOLIO

2451
01:24:55,263 --> 01:24:57,131
BALANCE, YOU KNOW, IT IS, I

2452
01:24:57,131 --> 01:24:58,666
THINK, YOU KNOW, TO SAY, YOU

2453
01:24:58,666 --> 01:25:00,535
KNOW, WE'RE GOING TO HAVE SOME

2454
01:25:00,535 --> 01:25:01,102
FUNDING OPPORTUNITIES THAT

2455
01:25:01,102 --> 01:25:03,071
REALLY ARE FOCUSED IN TERMS OF

2456
01:25:03,071 --> 01:25:05,339
THIS IS ABOUT THIS PROBLEM AND

2457
01:25:05,339 --> 01:25:07,208
THIS IS REALLY ABOUT THIS LEVEL

2458
01:25:07,208 --> 01:25:08,876
OF LEAP FOR THIS PROBLEM.

2459
01:25:08,876 --> 01:25:10,411
BUT IT'S GOOD TO HAVE SOME

2460
01:25:10,411 --> 01:25:14,248
THINGS THAT ARE JUST LIKE ALLOW

2461
01:25:14,248 --> 01:25:16,017
ANY TOTALLY UNHEARD OF IDEA THAT

2462
01:25:16,017 --> 01:25:17,085
SOMEBODY THOUGHT OF, I THINK YOU

2463
01:25:17,085 --> 01:25:18,653
HAVE TO HAVE ALL OF THOSE, BUT

2464
01:25:18,653 --> 01:25:20,021
NOT ALL ONE OR NOT ALL THE

2465
01:25:20,021 --> 01:25:20,221
OTHER.

2466
01:25:20,221 --> 01:25:20,955
>> ABSOLUTELY.

2467
01:25:20,955 --> 01:25:22,356
COULD NOT AGREE MORE.

2468
01:25:22,356 --> 01:25:24,125
I SEE YOU PUT YOUR FINGER RIGHT

2469
01:25:24,125 --> 01:25:24,392
ON IT.

2470
01:25:24,392 --> 01:25:26,127
>> I ALSO THINK IT'S VERY

2471
01:25:26,127 --> 01:25:31,699
IMPORTANT TO USE LANGUAGE TO

2472
01:25:31,699 --> 01:25:33,101
CALIBRATE INVESTIGATORS AND TO

2473
01:25:33,101 --> 01:25:37,505
CAL GREAT REVIEWERS.

2474
01:25:37,505 --> 01:25:39,040
BECAUSE SOMETIMES IF YOU WANT

2475
01:25:39,040 --> 01:25:40,908
INNOVATION YOU KIND OF GET

2476
01:25:40,908 --> 01:25:42,877
LET -- OR GREG'S EXPERIENCE,

2477
01:25:42,877 --> 01:25:46,547
THAT THIS IS -- YOU SHOOT FOR

2478
01:25:46,547 --> 01:25:48,683
THE STARS AND IT ABSOLUTELY

2479
01:25:48,683 --> 01:25:49,450
FALLS FLAT.

2480
01:25:49,450 --> 01:25:51,986
ONCE REVIEWER JUST KILLS IT.

2481
01:25:51,986 --> 01:25:54,822
AND I DO THINK THE SROs CAN BE

2482
01:25:54,822 --> 01:25:58,092
VERY, VERY EFFECTIVE IN

2483
01:25:58,092 --> 01:25:58,860
EMPHASIZING, JUST PUTTING IT AT

2484
01:25:58,860 --> 01:26:00,094
THE TOP OF THE REVIEW FORM IS

2485
01:26:00,094 --> 01:26:00,661
NOT ENOUGH.

2486
01:26:00,661 --> 01:26:05,133
BUT TO REALLY EMPHASIZE REPEA 

2487
01:26:05,133 --> 01:26:06,334
REPEATEDLY THAT THIS IS THE

2488
01:26:06,334 --> 01:26:08,236
LEVEL, AS GREG WAS HIGHLIGHTING,

2489
01:26:08,236 --> 01:26:11,072
THE TYPE, MAYBE THE LEVEL OF

2490
01:26:11,072 --> 01:26:12,373
INNOVATION THAT WE'RE LOOKING

2491
01:26:12,373 --> 01:26:13,808
FOR, BECAUSE THAT'S, I THINK,

2492
01:26:13,808 --> 01:26:15,877
REASSURING AND EMPOWERING TO AN

2493
01:26:15,877 --> 01:26:17,979
INVESTIGATIVE TEAM.

2494
01:26:17,979 --> 01:26:22,517
IT TELLS US WHERE TO AIM.

2495
01:26:22,517 --> 01:26:24,118
>> I DON'T WANT TO
MONOPOLIZE

2496
01:26:24,118 --> 01:26:25,319
THE WHOLE CONVERSATION, BUT I

2497
01:26:25,319 --> 01:26:27,121
REALLY THINK THIS HAS BEEN VERY

2498
01:26:27,121 --> 01:26:30,958
INTERESTING, SO THANK YOU.

2499
01:26:30,958 --> 01:26:32,460
>> MAYBE I'LL JUST ADD ON
TOP OF

2500
01:26:32,460 --> 01:26:34,228
THIS TOO, IT SOUNDED LIKE ONE OF

2501
01:26:34,228 --> 01:26:36,330
THE THINGS THAT WAS REALLY

2502
01:26:36,330 --> 01:26:39,700
USEFUL FOR PARTICULAR RFAs IS

2503
01:26:39,700 --> 01:26:43,638
WHEN THEY'RE COMMUNICATING THE

2504
01:26:43,638 --> 01:26:45,106
EXTENT TO WHICH THERE'S INTEREST

2505
01:26:45,106 --> 01:26:47,175
IN LOOKING AT OUTCOMES WITHOUT

2506
01:26:47,175 --> 01:26:49,677
HAVING PRIOR EVIDENCE OF A

2507
01:26:49,677 --> 01:26:53,181
MECHANISTIC OUT COME EFFECT.

2508
01:26:53,181 --> 01:26:55,383
AND THAT'S HOW GREG INTERPRETED

2509
01:26:55,383 --> 01:26:57,251
THE BOLD PART IN SOME WAYS, THE

2510
01:26:57,251 --> 01:26:59,453
RISKY PART, THERE WASN'T --

2511
01:26:59,453 --> 01:27:00,655
THERE WEREN'T THOSE STUDIES IN

2512
01:27:00,655 --> 01:27:02,223
THAT POPULATION OF PEOPLE WHO

2513
01:27:02,223 --> 01:27:05,359
DON'T VOLUNTEER FOR RESEARCH ON

2514
01:27:05,359 --> 01:27:06,561
WHETHER IT MIGHT REDUCE

2515
01:27:06,561 --> 01:27:08,462
IDEATION, THAT SORT OF THING.

2516
01:27:08,462 --> 01:27:12,166
SO SIGNALING SOMEHOW WHAT LEVEL

2517
01:27:12,166 --> 01:27:15,937
OF PRIOR EVIDENCE IS REQUIRED

2518
01:27:15,937 --> 01:27:17,104
NOT ONLY ABOUT THE FEASIBILITY

2519
01:27:17,104 --> 01:27:19,941
BUT ALSO ABOUT SORT OF THE

2520
01:27:19,941 --> 01:27:21,709
CAUSAL CHAIN INVOLVED IN THIS,

2521
01:27:21,709 --> 01:27:23,544
SEEMS LIKE THAT'S HELPFUL WHEN

2522
01:27:23,544 --> 01:27:25,680
THOSE THINGS COME OUT, AND I

2523
01:27:25,680 --> 01:27:26,647
REALLY SECOND ANDREA'S REMARK

2524
01:27:26,647 --> 01:27:28,950
THAT FOR STUDY SECTIONS, MAKING

2525
01:27:28,950 --> 01:27:30,651
SURE TO REMIND THE REVIEWERS

2526
01:27:30,651 --> 01:27:31,719
ESPECIALLY WHEN YOU'RE SITTING

2527
01:27:31,719 --> 01:27:33,354
FOR REVIEWING MULTIPLE

2528
01:27:33,354 --> 01:27:35,923
MECHANISMS THAT DIFFER IN THOSE

2529
01:27:35,923 --> 01:27:37,458
PARAMETERS, IT'S REALLY HELPFUL

2530
01:27:37,458 --> 01:27:41,362
TO GET THE REMINDERS, AND I WAS

2531
01:27:41,362 --> 01:27:44,699
JUST -- AND THEN NCCIH REVIEW

2532
01:27:44,699 --> 01:27:46,234
THAT WAS -- THEY DID JUST THAT

2533
01:27:46,234 --> 01:27:47,869
REALLY, REALLY WELL, I THOUGHT.

2534
01:27:47,869 --> 01:27:52,039
SO VERY HELPFUL.

2535
01:27:52,039 --> 01:27:53,374
WE'VE GOT ONE QUESTION FROM

2536
01:27:53,374 --> 01:27:55,676
WENDY HERE.

2537
01:27:55,676 --> 01:27:57,778
WHEN PLANNING A PCT AND CREATING

2538
01:27:57,778 --> 01:27:58,980
A RESEARCH QUESTION, DO YOU

2539
01:27:58,980 --> 01:28:01,515
WORRY ABOUT OR TAKE INTO

2540
01:28:01,515 --> 01:28:02,283
CONSIDERATION OTHER TRIALS THAT

2541
01:28:02,283 --> 01:28:04,552
THE POPULATION MAY BE OR

2542
01:28:04,552 --> 01:28:06,220
DEFINITELY ARE PARTICIPATING IN,

2543
01:28:06,220 --> 01:28:09,290
AND IF OR HOW IT COULD AFFECT

2544
01:28:09,290 --> 01:28:09,724
OUTCOMES?

2545
01:28:09,724 --> 01:28:11,492
BY THE WAY, WHEN I SAY QUESTION

2546
01:28:11,492 --> 01:28:14,362
FROM WENDY, WE WENDY IS CHANNELG

2547
01:28:14,362 --> 01:28:15,663
THE VIDEO WEBCAST AUDIENCE FOR

2548
01:28:15,663 --> 01:28:17,098
US.

2549
01:28:17,098 --> 01:28:19,533
ANY TAKERS ON THIS QUESTION?

2550
01:28:19,533 --> 01:28:23,137
WORRYING ABOUT OTHER TRIALS THAT

2551
01:28:23,137 --> 01:28:24,438
THE POPULATIONS MAY BE

2552
01:28:24,438 --> 01:28:27,742
PARTICIPATING IN.

2553
01:28:27,742 --> 01:28:28,843
WE'VE GOT A COUPLE MINUTES LEFT

2554
01:28:28,843 --> 01:28:29,210
HERE.

2555
01:28:29,210 --> 01:28:30,278
GREG, WERE YOU GOING TO SAY

2556
01:28:30,278 --> 01:28:30,544
SOMETHING?

2557
01:28:30,544 --> 01:28:32,847
>> I'M NOT SURE IF SHE'S
ASKING

2558
01:28:32,847 --> 01:28:34,482
ABOUT THE BROADER SORT OF

2559
01:28:34,482 --> 01:28:35,783
ECOSYSTEM OF ARE THERE OTHER

2560
01:28:35,783 --> 01:28:37,418
TRIALS GOING ON, WHAT WILL THEY

2561
01:28:37,418 --> 01:28:39,287
LEARN OR HOW MIGHT THAT CHANGE,

2562
01:28:39,287 --> 01:28:40,721
OR IF SHE'S TALKING ABOUT WITHIN

2563
01:28:40,721 --> 01:28:41,689
THE CERTAIN PATIENT POPULATION,

2564
01:28:41,689 --> 01:28:43,157
THERE MIGHT BE OTHER TRIALS

2565
01:28:43,157 --> 01:28:44,458
GOING ON WITHIN THIS SYSTEM OR

2566
01:28:44,458 --> 01:28:45,092
WITHIN THIS CLINIC.

2567
01:28:45,092 --> 01:28:46,727
I'M NOT SURE WHAT -- YEAH.

2568
01:28:46,727 --> 01:28:49,830
>> I THINK IT'S WITHIN THE

2569
01:28:49,830 --> 01:28:50,598
POPULATION.

2570
01:28:50,598 --> 01:28:51,599
SO IT WITHIN THE SAME

2571
01:28:51,599 --> 01:28:52,033
POPULATION.

2572
01:28:52,033 --> 01:28:53,801
SO FOLKS MIGHT BE PARTICIPATING

2573
01:28:53,801 --> 01:28:55,102
IN OTHER TRIALS.

2574
01:28:55,102 --> 01:28:58,739
>> YEAH.

2575
01:28:58,739 --> 01:29:00,675
>> I CAN SHARE, THIS WAS A

2576
01:29:00,675 --> 01:29:04,312
PRETTY SIGNIFICANT ISSUE FOR US 

2577
01:29:04,312 --> 01:29:06,547
IN NOHARM.

2578
01:29:06,547 --> 01:29:08,816
IT ACTUALLY WORKED IN OUR FAVOR,

2579
01:29:08,816 --> 01:29:11,118
IN THAT THE ORTHOPEDIC SURGERY

2580
01:29:11,118 --> 01:29:12,486
WAS ONE OF THE CLUSTERS AT ALL

2581
01:29:12,486 --> 01:29:13,788
OF THE SITES THAT WERE

2582
01:29:13,788 --> 01:29:14,555
PARTICIPATING.

2583
01:29:14,555 --> 01:29:17,391
THEY WERE ALREADY COLLECTING

2584
01:29:17,391 --> 01:29:18,159
OUTCOMES.

2585
01:29:18,159 --> 01:29:24,198
SOME FOR JUST SURVEILLANCE,

2586
01:29:24,198 --> 01:29:29,337
BUT -- OUTCOME LONGITUDAL -- BUT

2587
01:29:29,337 --> 01:29:30,404
SOME WERE OTHER TRIALS.

2588
01:29:30,404 --> 01:29:32,840
WE RECEIVED QUITE A BIT OF

2589
01:29:32,840 --> 01:29:33,708
PUSHBACK OF THE RETURN BECAUSE

2590
01:29:33,708 --> 01:29:36,110
WE WOULD CANNIBALIZE THEIR

2591
01:29:36,110 --> 01:29:38,079
RESPONSES, IF WE ADDED MORE

2592
01:29:38,079 --> 01:29:40,281
EPROMS TO THE POOL, WE WOULD

2593
01:29:40,281 --> 01:29:40,614
CANNIBALIZE.

2594
01:29:40,614 --> 01:29:41,716
ACTUALLY WE WERE ABLE TO WORK

2595
01:29:41,716 --> 01:29:42,917
WITH THEM AND IT WORKED OUT VERY

2596
01:29:42,917 --> 01:29:44,151
WELL BECAUSE WE LEVERAGED THEIR

2597
01:29:44,151 --> 01:29:45,586
RESPONSES AS WELL.

2598
01:29:45,586 --> 01:29:47,121
WE RECOGNIZED THAT WE WERE

2599
01:29:47,121 --> 01:29:48,990
COLLECTING INFORMATION ON

2600
01:29:48,990 --> 01:29:51,425
SIMILAR OUTCOMES, AND IT WAS A

2601
01:29:51,425 --> 01:29:55,363
WIN-WIN.

2602
01:29:55,363 --> 01:29:57,098
BUT I THINK IT HIGHLIGHTED

2603
01:29:57,098 --> 01:29:58,933
PARTICULARLY IN A CLINICAL GROUP

2604
01:29:58,933 --> 01:30:01,302
THAT YOU'RE TRYING TO ENGAGE

2605
01:30:01,302 --> 01:30:07,041
WITH AND IMPLEM T IMPLEMENT INN,

2606
01:30:07,041 --> 01:30:08,209
IT DOESN'T GO REALLY WELL WHEN

2607
01:30:08,209 --> 01:30:09,944
THEY PERCEIVE YOU AS A THREAT TO

2608
01:30:09,944 --> 01:30:12,380
THEIR ONGOING RESEARCH, SO

2609
01:30:12,380 --> 01:30:13,481
THERE'S DEFINITELY A TENSION.

2610
01:30:13,481 --> 01:30:14,348
>> THANKS, ANDREA.

2611
01:30:14,348 --> 01:30:15,883
WE ARE ACTUALLY AT TIME, AND I

2612
01:30:15,883 --> 01:30:17,651
WANT TO BE RESPECTFUL OF THE

2613
01:30:17,651 --> 01:30:20,955
REST OF OUR AGENDA HERE, SO I

2614
01:30:20,955 --> 01:30:24,892
WANT TO THANK KEVIN, KUSHANG,

2615
01:30:24,892 --> 01:30:25,826
ANDREA AND GREG FOR SHARING

2616
01:30:25,826 --> 01:30:29,196
THEIR EXPERIENCES AND CANDOR

2617
01:30:29,196 --> 01:30:29,530
WITH US.

2618
01:30:29,530 --> 01:30:31,198
THIS WAS A REALLY INTERESTING

2619
01:30:31,198 --> 01:30:32,400
DISCUSSION, AND I THINK WE COULD

2620
01:30:32,400 --> 01:30:35,102
HAVE GONE ON EVEN LONGER, BUT WE

2621
01:30:35,102 --> 01:30:36,337
JUST THANK YOU ALL, AND I THINK

2622
01:30:36,337 --> 01:30:38,873
I'LL TURN IT BACK TO YOU, WENDY,

2623
01:30:38,873 --> 01:30:42,710
FOR NEXT STEPS?

2624
01:30:42,710 --> 01:30:44,879
>> I THINK WE'RE GOING TO
TAKE

2625
01:30:44,879 --> 01:30:47,448
JUST MAYBE A 5-MINUTE BIOBREAK

2626
01:30:47,448 --> 01:30:49,717
AND COME BACK, GREG, WITH YOUR

2627
01:30:49,717 --> 01:30:51,585
PANEL AT 2:35.

2628
01:30:51,585 --> 01:30:53,997
SO WE'LL GIVE EVERYONE JUST A

2629
01:30:53,997 --> 01:30:55,532
SO GOOD MORNING OR GOOD

2630
01:30:55,532 --> 01:30:56,466
AFTERNOON, EVERYBODY.

2631
01:30:56,466 --> 01:30:58,535
I'M GREG SIMON, INVESTIGATOR,

2632
01:30:58,535 --> 01:30:59,836
KAISER PERMANENTE RESEARCH

2633
01:30:59,836 --> 01:31:00,170
INSTITUTE.

2634
01:31:00,170 --> 01:31:01,738
I'LL BE YOUR SORT OF HOST AND

2635
01:31:01,738 --> 01:31:05,676
MOD KAY TORMODERATOR, FOR THIS T

2636
01:31:05,676 --> 01:31:06,710
SESSION.

2637
01:31:06,710 --> 01:31:10,147
WHAT WE'LL BE TALKING ABOUT HERE

2638
01:31:10,147 --> 01:31:12,616
IS ENGAGEMENT AS SORT OF THE

2639
01:31:12,616 --> 01:31:14,218
CORNERSTONE OF PRAGMATIC

2640
01:31:14,218 --> 01:31:15,085
RESEARCH AND ESPECIALLY

2641
01:31:15,085 --> 01:31:15,953
ENGAGEMENT THROUGHOUT THE

2642
01:31:15,953 --> 01:31:16,954
LIFECYCLE OF A PROJECT.

2643
01:31:16,954 --> 01:31:18,188
IN SOME WAYS, IT'S A

2644
01:31:18,188 --> 01:31:18,889
CONTINUATION OF A DISCUSSION

2645
01:31:18,889 --> 01:31:20,591
THAT WE HAD AT OUR INVESTIGATOR

2646
01:31:20,591 --> 01:31:22,693
MEETING A MONTH OR SO AGO.

2647
01:31:22,693 --> 01:31:25,462
AND YOU KNOW, THERE, WE STARTED

2648
01:31:25,462 --> 01:31:27,431
TALKING ABOUT INFRASTRUCTURE AND

2649
01:31:27,431 --> 01:31:28,832
MY RECOLLECTION WOULD BE WE

2650
01:31:28,832 --> 01:31:29,800
ENDED UP SAYING INFRASTRUCTURE

2651
01:31:29,800 --> 01:31:32,202
IS REALLY ABOUT RELATIONSHIPS.

2652
01:31:32,202 --> 01:31:33,170
SO ENGAGEMENT IS ABOUT

2653
01:31:33,170 --> 01:31:34,171
RELATIONSHIPS AS WELL, THAT'S

2654
01:31:34,171 --> 01:31:34,972
WHAT WE'LL BE TALKING ABOUT

2655
01:31:34,972 --> 01:31:35,539
HERE.

2656
01:31:35,539 --> 01:31:37,908
WE'RE GOING TO HEAR FROM FOUR OF

2657
01:31:37,908 --> 01:31:40,877
OUR INVESTIGATORS AND THEY'LL BE

2658
01:31:40,877 --> 01:31:41,645
SOMEWHAT DIFFERENT.

2659
01:31:41,645 --> 01:31:43,347
WE'LL HEAR FIRST FROM NATALIA

2660
01:31:43,347 --> 01:31:44,881
FROM THE OPTIMUM TRIAL, WHO WILL

2661
01:31:44,881 --> 01:31:47,384
BE TALKING ABOUT SORT OF A

2662
01:31:47,384 --> 01:31:48,619
PARTICULAR SORT OF ENGAGEMENT

2663
01:31:48,619 --> 01:31:51,021
STRATEGY OR ENGAGEMENT PROCESS.

2664
01:31:51,021 --> 01:31:53,890
AND THEN WE'LL HEAR FROM JULIE

2665
01:31:53,890 --> 01:31:57,427
FRITZ REGARDING BEATPAIN UTAH,

2666
01:31:57,427 --> 01:32:01,465
ANNA KRUPP REGARDING BEST-ICU

2667
01:32:01,465 --> 01:32:03,033
AND SEBASTIAN TONG ABOUT AIM-CP

2668
01:32:03,033 --> 01:32:04,901
TALKING ABOUT THEIR EXPERIENCE

2669
01:32:04,901 --> 01:32:06,436
WITH ENGAGEMENT ESPECIALLY

2670
01:32:06,436 --> 01:32:07,304
ENGAGEMENT THROUGHOUT THE

2671
01:32:07,304 --> 01:32:08,672
LIFECYCLE OF THE PROJECT, HOW IT

2672
01:32:08,672 --> 01:32:09,873
STARTS, WHAT THE RELATIONSHIPS

2673
01:32:09,873 --> 01:32:12,175
ARE AND HOW THAT CHANGES OVER

2674
01:32:12,175 --> 01:32:12,743
TIME.

2675
01:32:12,743 --> 01:32:14,278
AND THEN WE'LL COME BACK FOR

2676
01:32:14,278 --> 01:32:15,312
SOME QUESTIONS AT THE END.

2677
01:32:15,312 --> 01:32:16,980
SO I'LL TURN IT OVER TO NATALIA

2678
01:32:16,980 --> 01:32:21,785
TO START US OFF.

2679
01:32:21,785 --> 01:32:24,988
>> THANK YOU SO MUCH,
GREG.

2680
01:32:24,988 --> 01:32:26,323
IT'S REALLY WONDERFUL TO BE

2681
01:32:26,323 --> 01:32:26,723
HERE.

2682
01:32:26,723 --> 01:32:28,492
I'M ASSUMING YOU CAN HEAR ME,

2683
01:32:28,492 --> 01:32:29,526
BECAUSE I HAVEN'T HEARD

2684
01:32:29,526 --> 01:32:29,793
OTHERWISE.

2685
01:32:29,793 --> 01:32:31,828
>> YES, WE CAN HEAR YOU
FINE.

2686
01:32:31,828 --> 01:32:32,929
>> SO WONDERFUL.

2687
01:32:32,929 --> 01:32:35,599
SO YES, I'M NATALIA MORONE, I'M

2688
01:32:35,599 --> 01:32:38,235
AT BOSTON UNIVERSITY AND BOSTON

2689
01:32:38,235 --> 01:32:40,037
MEDICAL CENTER, AND I'M REALLY

2690
01:32:40,037 --> 01:32:46,910
HAPPY TO GET US STARTED ON THI

2691
01:32:46,910 --> 01:32:54,551
THIS -- ON THIS SERIES OF TALKS.

2692
01:32:54,551 --> 01:32:59,723
JUST REAL QUICK, OPTIMIZING PAIN

2693
01:32:59,723 --> 01:33:00,957
TREATMENT IN MEDICAL SETTINGS

2694
01:33:00,957 --> 01:33:04,795
USING MINDFULNESS IS OBVIOUSLY A

2695
01:33:04,795 --> 01:33:06,363
PRAGMATIC CLINICAL TRIAL AS THEY

2696
01:33:06,363 --> 01:33:07,564
ARE TODAY.

2697
01:33:07,564 --> 01:33:10,867
IT INTEGRATING A TELEHEALTH

2698
01:33:10,867 --> 01:33:13,570
GROUP-BASED STRESS REDUCTION

2699
01:33:13,570 --> 01:33:15,138
PROGRAM INTO PRIMARY CARE

2700
01:33:15,138 --> 01:33:16,239
SETTINGS FOR PEOPLE WHO HAVE

2701
01:33:16,239 --> 01:33:20,510
CHRONIC LOW BACK PAIN.

2702
01:33:20,510 --> 01:33:21,745
WE'RE FOLLOWING PEOPLE UP FOR A

2703
01:33:21,745 --> 01:33:22,079
YEAR.

2704
01:33:22,079 --> 01:33:24,748
WE'VE ACTUALLY COMPLETED --

2705
01:33:24,748 --> 01:33:25,849
WE'RE ALMOST COMPLETE WITH

2706
01:33:25,849 --> 01:33:27,718
12-MONTH FOLLOW-UP NOW, WE'LL BE

2707
01:33:27,718 --> 01:33:29,119
DONE SOON.

2708
01:33:29,119 --> 01:33:34,091
WE'VE RANDOMIZED 451 PEOPLE IN

2709
01:33:34,091 --> 01:33:35,525
THREE HEALTHCARE SYSTEMS, BOSTON

2710
01:33:35,525 --> 01:33:37,394
MEDICAL CENTER, THE UNIVERSITY

2711
01:33:37,394 --> 01:33:39,796
OF PITTSBURGH AND UNIVERSITY OF

2712
01:33:39,796 --> 01:33:42,699
NORTH CAROLINA CHAPEL HILL.

2713
01:33:42,699 --> 01:33:44,868
THE CONTROL GROUP IS USUAL CARE.

2714
01:33:44,868 --> 01:33:47,871
AND THE PRIMARY OUTCOME IS THE

2715
01:33:47,871 --> 01:33:50,574
PEG, AS WAS MANY PAIN STUDIES,

2716
01:33:50,574 --> 01:33:53,243
SO WE ARE ALSO LOOKING AT OTHER

2717
01:33:53,243 --> 01:33:55,679
MEASURES THAT IMPACT PAIN LIKE

2718
01:33:55,679 --> 01:33:56,913
PSYCHOLOGICAL FUNCTION, PHYSICAL

2719
01:33:56,913 --> 01:34:00,951
FUNCTION, QUALITY OF LIFE, THEIR

2720
01:34:00,951 --> 01:34:02,085
HEALTHCARE UTILIZATION AS WELL

2721
01:34:02,085 --> 01:34:04,054
AS THEIR MEDICATION AND OPIOID

2722
01:34:04,054 --> 01:34:06,690
USE.

2723
01:34:06,690 --> 01:34:08,125
SO PRIMARY ENGAGEMENT HAS BEEN

2724
01:34:08,125 --> 01:34:11,728
AN IMPORTANT PART OF THE OPTIMUM

2725
01:34:11,728 --> 01:34:13,630
STUDY.

2726
01:34:13,630 --> 01:34:15,298
AND I'M GOING TO JUST TELL YOU A

2727
01:34:15,298 --> 01:34:17,901
LITTLE BIT ABOUT HOW WE'VE BEEN

2728
01:34:17,901 --> 01:34:20,003
DOING THAT AND HOW REALLY

2729
01:34:20,003 --> 01:34:27,577
CRITICAL IT BEEN FOR US.

2730
01:34:27,577 --> 01:34:29,012
SO PARTNERS ARE PEOPLE WHO COME

2731
01:34:29,012 --> 01:34:31,114
FROM GROUPS OR ORGANIZATIONS

2732
01:34:31,114 --> 01:34:33,083
SUCH AS HEALTHCARE

2733
01:34:33,083 --> 01:34:35,519
ADMINISTRATORS, INSURERS,

2734
01:34:35,519 --> 01:34:36,953
PATIENTS, ADVOCATES, COMMUNITY

2735
01:34:36,953 --> 01:34:38,488
MEMBERS, POLICY MAKERS, ALL OF

2736
01:34:38,488 --> 01:34:41,024
THESE TYPES OF PEOPLE CAN BE A

2737
01:34:41,024 --> 01:34:43,126
PARTNER AND THEY HAVE BEEN A

2738
01:34:43,126 --> 01:34:46,496
PARTNER FOR OPTIMUM.

2739
01:34:46,496 --> 01:34:48,532
AND THEY CAN SERVE MULTIPLE

2740
01:34:48,532 --> 01:34:50,834
ROLES AND BRING SEVERAL

2741
01:34:50,834 --> 01:34:53,770
PERSPECTIVES TO A PROJECT.

2742
01:34:53,770 --> 01:34:56,273
AND ALSO YOU HAVE INDIVIDUALS

2743
01:34:56,273 --> 01:34:57,974
THAT CAN BE INVOLVED BUT YOU CAN

2744
01:34:57,974 --> 01:34:59,409
ALSO HAVE A COMMUNITY ADVISORY

2745
01:34:59,409 --> 01:35:01,378
BOARD AND WE SET UP OUR

2746
01:35:01,378 --> 01:35:03,046
COMMUNITY ADVISORY BOARD AND

2747
01:35:03,046 --> 01:35:07,117
THEY REALLY DO PARTNER WITH

2748
01:35:07,117 --> 01:35:08,351
OPTIMUM AND HAVE BEEN REALLY

2749
01:35:08,351 --> 01:35:12,055
IMPORTANT TO THE STUDY

2750
01:35:12,055 --> 01:35:13,156
THROUGHOUT BECAUSE OF THE UNIT

2751
01:35:13,156 --> 01:35:15,659
PERSPECTIVES AND EXPERTISE THAT

2752
01:35:15,659 --> 01:35:23,500
THEY BRING AND OFFER.

2753
01:35:23,500 --> 01:35:25,469
SO SOME OF THE COMMUNITY

2754
01:35:25,469 --> 01:35:26,470
ADVISORY BOARD CONTRIBUTIONS

2755
01:35:26,470 --> 01:35:29,840
THAT THEY'VE GIVEN US, FOR

2756
01:35:29,840 --> 01:35:32,876
EXAMPLE, IS THEY REALLY PROVIDE

2757
01:35:32,876 --> 01:35:34,344
FEEDBACK ON THE NEEDS PERSONS

2758
01:35:34,344 --> 01:35:36,313
WHO ARE LIVING WITH CHRONIC LOW

2759
01:35:36,313 --> 01:35:37,013
BACK PAIN.

2760
01:35:37,013 --> 01:35:38,181
THEY ADVISE ON THE BEST WAYS TO

2761
01:35:38,181 --> 01:35:40,484
ENGAGE WITH THE PROVIDERS AND

2762
01:35:40,484 --> 01:35:42,252
SERVE POTENTIAL OF PARTICIPANTS

2763
01:35:42,252 --> 01:35:43,420
AS WELL AS INTEGRATING INTO THE

2764
01:35:43,420 --> 01:35:46,289
HEALTHCARE CY SYSTEM.

2765
01:35:46,289 --> 01:35:48,859
BECAUSE THIS IS A MINDFULNESS

2766
01:35:48,859 --> 01:35:51,728
STUDY, THEY HAVE ADVISED ON WAYS

2767
01:35:51,728 --> 01:35:53,096
TO PROVIDE MINDFULNESS IN

2768
01:35:53,096 --> 01:35:55,298
PRIMARY CARE AND THAT

2769
01:35:55,298 --> 01:35:57,367
INTEGRATION.

2770
01:35:57,367 --> 01:35:58,668
THEY'VE ALSO PROVIDED ADVICE

2771
01:35:58,668 --> 01:36:01,271
WHEN PATIENTS ARE RESISTANT TO

2772
01:36:01,271 --> 01:36:03,340
MINDFULNESS AND HOW WE CAN POE

2773
01:36:03,340 --> 01:36:07,344
TEXT TENSIPOTENTIALLY YOU A DRE.

2774
01:36:07,344 --> 01:36:08,345
THEY'VE ALSO BEEN VERY HELPFUL

2775
01:36:08,345 --> 01:36:11,181
IN THE NUTS AND BOLTS OF RUNNING

2776
01:36:11,181 --> 01:36:13,550
THE STUDY, SUCH AS TAILORING THE

2777
01:36:13,550 --> 01:36:15,852
STUT DI AND RECRUITMENT METHODS.

2778
01:36:15,852 --> 01:36:17,020
AND CURRENTLY THEY'RE PLAYING AN

2779
01:36:17,020 --> 01:36:18,188
IMPORTANT ROLE ON NEXT STEPS AS

2780
01:36:18,188 --> 01:36:21,591
OUR STUDY IS COMING TO

2781
01:36:21,591 --> 01:36:27,264
COMPLETION.

2782
01:36:27,264 --> 01:36:29,332
NOW WE HAVE DONE ONE-TIME

2783
01:36:29,332 --> 01:36:32,702
INTERVIEWS ALSO, ACTUALLY QUITE

2784
01:36:32,702 --> 01:36:33,370
A FEW OF THEM.

2785
01:36:33,370 --> 01:36:35,772
I THINK WE'RE GOING ON 25

2786
01:36:35,772 --> 01:36:38,108
ONE-TIME INTERVIEWS, THESE HAVE

2787
01:36:38,108 --> 01:36:38,875
BEEN EXTREMELY EYE OPENING FOR

2788
01:36:38,875 --> 01:36:40,544
US TO UNDERSTAND SOME OF THE

2789
01:36:40,544 --> 01:36:43,847
REAL BARRIERS THAT EXIST FOR

2790
01:36:43,847 --> 01:36:45,415
INTEGRATING GROUP-BASED

2791
01:36:45,415 --> 01:36:49,119
MINDFULNESS INTO PRIMARY CARE.

2792
01:36:49,119 --> 01:36:51,521
SO FOR EXAMPLE, WE'VE

2793
01:36:51,521 --> 01:36:52,889
INTERVIEWED MEDICAL DIRECTORS OF

2794
01:36:52,889 --> 01:36:53,990
INTERNAL MEDICINE CLINIC.

2795
01:36:53,990 --> 01:36:55,425
I DIDN'T MENTION IT BUT I'M A

2796
01:36:55,425 --> 01:36:56,293
GENERAL INTERNIST.

2797
01:36:56,293 --> 01:36:57,994
THAT'S WHERE MY STRONG INTEREST

2798
01:36:57,994 --> 01:37:01,164
IN BRINGING PAIN TREATMENT AND

2799
01:37:01,164 --> 01:37:02,832
CHRONIC PAIN TREATMENT INTO

2800
01:37:02,832 --> 01:37:04,768
PRIMARY CARE IS REALLY GROUNDED

2801
01:37:04,768 --> 01:37:08,605
IN.

2802
01:37:08,605 --> 01:37:10,407
BUT WE'VE ALSO INTERVIEWED

2803
01:37:10,407 --> 01:37:12,976
PEOPLE WHO AN EXECUTIVE DIRECTOR

2804
01:37:12,976 --> 01:37:14,911
OF A BUSINESS FOR GROUP MEDICAL

2805
01:37:14,911 --> 01:37:16,212
VISITS, AND GROUP MEDICAL VISITS

2806
01:37:16,212 --> 01:37:20,216
IS THE MODEL THAT WE USE IN

2807
01:37:20,216 --> 01:37:22,752
OPTIMUM TO DELIVER GROUP-BASED

2808
01:37:22,752 --> 01:37:24,120
MINDFULNESS IN PRIMARY CARE, BUT

2809
01:37:24,120 --> 01:37:27,924
WE'VE ALSO LOOKED AT PEOPLE WHO

2810
01:37:27,924 --> 01:37:30,327
ARE INVOLVED WITH BUSINESS

2811
01:37:30,327 --> 01:37:32,596
DEVELOPMENT AND POLICY LEADS TO

2812
01:37:32,596 --> 01:37:36,099
UNDERSTAND THAT, ADVOCACY, PAIN

2813
01:37:36,099 --> 01:37:37,634
ADVOCACY GROUP LEADERS HAVE BEEN

2814
01:37:37,634 --> 01:37:38,501
VERY HELPFUL.

2815
01:37:38,501 --> 01:37:40,437
LOOKING AT FOLKS WHO ARE

2816
01:37:40,437 --> 01:37:42,606
ACTUALLY LEAD MEDICAL GROUP

2817
01:37:42,606 --> 01:37:43,540
VISITS LIKE A FAMILY PHYSICIAN

2818
01:37:43,540 --> 01:37:47,010
AND GETTING THEIR FEEDBACK.

2819
01:37:47,010 --> 01:37:49,346
WE'VE TALKED TO MINDFULNESS

2820
01:37:49,346 --> 01:37:51,081
INSTRUCTORS, WE'VE LOOKED AT --

2821
01:37:51,081 --> 01:37:55,919
WE'VE SPOKEN WITH A DIRECTOR OF

2822
01:37:55,919 --> 01:37:58,121
A FAMILY MEDICINE DIRECTOR OF

2823
01:37:58,121 --> 01:37:59,522
COMMUNITY HEALTH INITIATIVE, AS

2824
01:37:59,522 --> 01:38:01,858
WELL AS ENSURE REPRESENTATIVES.

2825
01:38:01,858 --> 01:38:04,127
SO ALL OF THESE HAVE BEEN REALLY

2826
01:38:04,127 --> 01:38:09,599
GIVING US A MUCH MORE FULL

2827
01:38:09,599 --> 01:38:10,734
PICTURE OF WHAT IT ACTUALLY

2828
01:38:10,734 --> 01:38:12,369
MEANS TO MOVE TO THE NEXT PHASE

2829
01:38:12,369 --> 01:38:15,038
OF IMPLEMENTING IN PRIMARY CARE

2830
01:38:15,038 --> 01:38:16,773
GROUP-BASED MINDFULNESS.

2831
01:38:16,773 --> 01:38:18,108
AND OF COURSE THIS IS ALL

2832
01:38:18,108 --> 01:38:24,447
FOLLOWING THE QUALITATIVE

2833
01:38:24,447 --> 01:38:26,916
ETHNOGRAPHIC INTERVIEW GUIDES.

2834
01:38:26,916 --> 01:38:29,619
SO IN OUR COMMUNITY ADVISORY

2835
01:38:29,619 --> 01:38:32,922
BOARD, AGAIN REFLECTS A BROAD

2836
01:38:32,922 --> 01:38:34,791
ARRAY OF PEOPLE, SO PATIENTS WHO

2837
01:38:34,791 --> 01:38:36,593
HAVE LIVED EXPERIENCE OF LOW

2838
01:38:36,593 --> 01:38:37,894
BACK PAIN BUT HAVE ALSO

2839
01:38:37,894 --> 01:38:40,864
UNDERGONE THE MINDFULNESS-BASED

2840
01:38:40,864 --> 01:38:41,931
STRESS REDUCTION PROGRAM.

2841
01:38:41,931 --> 01:38:44,634
WE HAVE MINDFULNESS INSTRUCTORS

2842
01:38:44,634 --> 01:38:46,736
AND HEALTHCARE PROFESSIONAL THE,

2843
01:38:46,736 --> 01:38:49,973
PAIN ADVOCACY GROUP LEADERS AND

2844
01:38:49,973 --> 01:38:51,107
ADMINISTRATORS, AND ALL 10

2845
01:38:51,107 --> 01:38:52,275
MEMBERS MEET MONTHLY FOR AN HOUR

2846
01:38:52,275 --> 01:38:57,614
AND THEY GET REIMBURSED.

2847
01:38:57,614 --> 01:39:00,316
JUST QUICKLY, THERE ARE SOME

2848
01:39:00,316 --> 01:39:01,851
WONDERFUL RESOURCES OUT THERE

2849
01:39:01,851 --> 01:39:05,789
FOR STARTING A COMMUNITY

2850
01:39:05,789 --> 01:39:07,090
ADVISORY BOARD, AND THIS

2851
01:39:07,090 --> 01:39:11,227
PARTICULAR ONE BY TRACY BATAGLIA

2852
01:39:11,227 --> 01:39:12,262
IS CONNECTING COMMUNITY TO

2853
01:39:12,262 --> 01:39:13,797
RESEARCH AND IT REALLY IS A STEP

2854
01:39:13,797 --> 01:39:18,935
BY STEP GUIDE.

2855
01:39:18,935 --> 01:39:20,370
JUST SO YOU GET A SENSE THAT WE

2856
01:39:20,370 --> 01:39:24,207
REALLY HAVE BEEN INTEGRATING THE

2857
01:39:24,207 --> 01:39:30,013
CAB RECOMMENDATIONS INTO WHAT WE

2858
01:39:30,013 --> 01:39:31,648
DO, THE CAB WILL MEET AND THEY

2859
01:39:31,648 --> 01:39:33,016
MIGHT, FOR EXAMPLE, REVIEW

2860
01:39:33,016 --> 01:39:35,752
MATERIALS THAT WE PROVIDE FOR

2861
01:39:35,752 --> 01:39:39,689
THEM OR CURRENTLY BECAUSE WE'RE

2862
01:39:39,689 --> 01:39:40,724
IN THE WRITING PHASE, THEY'VE

2863
01:39:40,724 --> 01:39:42,092
BEEN GIVING US COMMENTS BACK ON

2864
01:39:42,092 --> 01:39:46,229
SOME OF OUR PAPERS THAT WE'RE

2865
01:39:46,229 --> 01:39:46,896
WRITING.

2866
01:39:46,896 --> 01:39:48,298
SO ANYWAY, THEY MEET AND WE

2867
01:39:48,298 --> 01:39:50,133
CREATE A QUICK LIGHTNING REPORT

2868
01:39:50,133 --> 01:39:52,302
OF THE KEY POINTS OF WHAT

2869
01:39:52,302 --> 01:39:53,069
THEY'VE SAID.

2870
01:39:53,069 --> 01:39:55,472
WE BRING THAT BACK TO THE TEAM

2871
01:39:55,472 --> 01:40:00,410
SO THE TEAM CAN IMPLEMENT WHAT

2872
01:40:00,410 --> 01:40:01,044
WE RECOMMEND.

2873
01:40:01,044 --> 01:40:03,113
WE BRING THAT BACK TO THE

2874
01:40:03,113 --> 01:40:05,515
ADVISORY BOARD, SO THERE'S THIS

2875
01:40:05,515 --> 01:40:07,951
CYCLE AND WE'RE CLOSING THE LOOP

2876
01:40:07,951 --> 01:40:08,985
WITH THE ADVISORY BOARD SO THEY

2877
01:40:08,985 --> 01:40:10,987
CAN SEE WHAT WE'RE DOING.

2878
01:40:10,987 --> 01:40:16,092
SO THERE'S THIS CYCLE OF THE CAB

2879
01:40:16,092 --> 01:40:17,393
MEETING, GIVING US

2880
01:40:17,393 --> 01:40:17,961
RECOMMENDATIONS, INTEGRATING

2881
01:40:17,961 --> 01:40:19,462
THAT INTO WHAT WE'RE DOING AND

2882
01:40:19,462 --> 01:40:24,400
THEN SHOWING THEM THE RESULT OF

2883
01:40:24,400 --> 01:40:29,806
THAT.

2884
01:40:29,806 --> 01:40:31,674
AND TOPICS CAN VARY.

2885
01:40:31,674 --> 01:40:33,109
AT THE BEGINNING OF THE STUDY,

2886
01:40:33,109 --> 01:40:35,111
AS YOU CAN IMAGINE, IT WAS ABOUT

2887
01:40:35,111 --> 01:40:38,314
FEEDBACK ON OUR FLYERS AND

2888
01:40:38,314 --> 01:40:40,950
LANGUAGE IN THE MATERIALS,

2889
01:40:40,950 --> 01:40:44,654
REALLY BRAINSTORMING IDEAS FOR

2890
01:40:44,654 --> 01:40:45,722
PARTICIPANT ENGAGEMENT IN

2891
01:40:45,722 --> 01:40:47,023
STUDIES, IN THE STUDY, AND THEN

2892
01:40:47,023 --> 01:40:48,658
ALSO JUST UPDATES BECAUSE

2893
01:40:48,658 --> 01:40:50,026
THEY'RE CURIOUS ON THE UPDATES

2894
01:40:50,026 --> 01:40:56,966
OF HOW THINGS ARE GOING.

2895
01:40:56,966 --> 01:40:58,701
OF COURSE THE MONTHLY TOPICS

2896
01:40:58,701 --> 01:41:01,271
CHAIKED OVER TIME.

2897
01:41:01,271 --> 01:41:02,906
CHANGED OVER TIME, IT CAN'T BE

2898
01:41:02,906 --> 01:41:03,139
STATIC.

2899
01:41:03,139 --> 01:41:08,711
SO CURRENTLY THEY GIVE US --

2900
01:41:08,711 --> 01:41:10,647
INTO THE MANUSCRIPTS WE'RE

2901
01:41:10,647 --> 01:41:12,382
WRITING, THE PARTNER INTERVIEWS

2902
01:41:12,382 --> 01:41:14,050
WE TALKED ABOUT, WE DISCUSSED

2903
01:41:14,050 --> 01:41:15,852
THAT WITH FOLKS, BRAINSTORMING

2904
01:41:15,852 --> 01:41:16,553
DISSEMINATION WITH THEM AS WELL

2905
01:41:16,553 --> 01:41:26,162
AS NEXT STEPS.

2906
01:41:26,162 --> 01:41:27,263
SO SOME OF THE CHALLENGES WHEN

2907
01:41:27,263 --> 01:41:28,731
YOU'RE WORKING WITH PARTNERS

2908
01:41:28,731 --> 01:41:30,400
LIKE WE ARE, THERE'S A LOT OF

2909
01:41:30,400 --> 01:41:31,301
BENEFITS, I JUST MENTIONED THEM

2910
01:41:31,301 --> 01:41:34,838
TO YOU, WI BUT YOU KNOW, WE DO T

2911
01:41:34,838 --> 01:41:35,271
INCONSISTENT FACTS.

2912
01:41:35,271 --> 01:41:37,006
FOR EXAMPLE, WE'VE

2913
01:41:37,006 --> 01:41:40,443
INTERVIEWED -- AND THIS WAS TRUE

2914
01:41:40,443 --> 01:41:42,879
FOR ONE OF THE REPRESENTATIVES

2915
01:41:42,879 --> 01:41:45,748
FROM AN INSURANCE COMPANY, THEY

2916
01:41:45,748 --> 01:41:47,183
WERE LIKE MEDICAL GROUP VIS RITZ

2917
01:41:47,183 --> 01:41:51,754
NOT POSSIBLE IN PRIMARY CARE.

2918
01:41:51,754 --> 01:41:54,657
SO PEOPLE ARE CURRENTLY DOING IT

2919
01:41:54,657 --> 01:42:01,998
BUT WE WILL GET INCONSISTENT

2920
01:42:01,998 --> 01:42:03,299
FACTS OR OPINIONS FROM PEOPLE.

2921
01:42:03,299 --> 01:42:06,169
WE ALSO GET CHALLENGES LIKE THE

2922
01:42:06,169 --> 01:42:07,637
PROVIDERS AREN'T INTERESTED IN

2923
01:42:07,637 --> 01:42:11,374
GROUP MEDICAL VISITS, OR THAT

2924
01:42:11,374 --> 01:42:12,375
MINDFULNESS FOR CHRONIC LOW BACK

2925
01:42:12,375 --> 01:42:13,643
PAIN IS NOT EVIDENCE-BASED.

2926
01:42:13,643 --> 01:42:18,348
THIS IS ALL FEEDBACK WHEN WE DO

2927
01:42:18,348 --> 01:42:19,015
THE INTERVIEWS.

2928
01:42:19,015 --> 01:42:20,617
SO IT IS A CHALLENGE WHEN WE

2929
01:42:20,617 --> 01:42:24,454
START GETTING, YOU KNOW,

2930
01:42:24,454 --> 01:42:26,189
FEEDBACK THAT IS ILLUSTRATED

2931
01:42:26,189 --> 01:42:28,091
THAT PEOPLE AREN'T COMPLETELY

2932
01:42:28,091 --> 01:42:29,759
AWARE OF EITHER THE EVIDENCE OR

2933
01:42:29,759 --> 01:42:32,061
WHAT CURRENT PRACTICE MIGHT BE

2934
01:42:32,061 --> 01:42:33,696
IN ANOTHER STATE.

2935
01:42:33,696 --> 01:42:39,903
FOR EXAMPLE.

2936
01:42:39,903 --> 01:42:42,739
SO IN CONCLUSION, SO THE

2937
01:42:42,739 --> 01:42:43,706
ENGAGEMENT -- WE FOUND

2938
01:42:43,706 --> 01:42:45,341
ENGAGEMENT REALLY TO BE CRITICAL

2939
01:42:45,341 --> 01:42:47,510
IN OUR PRAGMATIC TRIAL, IT

2940
01:42:47,510 --> 01:42:50,480
REALLY PROVIDED REALLY IMPORTANT

2941
01:42:50,480 --> 01:42:52,115
PERSPECTIVES THAT HELP TO

2942
01:42:52,115 --> 01:42:53,850
ACTUALLY MOVE OUR RESEARCH

2943
01:42:53,850 --> 01:42:54,217
FORWARD.

2944
01:42:54,217 --> 01:42:57,320
WE FOUND THAT INVESTIGATORS AND

2945
01:42:57,320 --> 01:42:58,621
STAFF FAMILIAR WITH ENGAGEMENT

2946
01:42:58,621 --> 01:43:03,259
ARENESS SARE NECESSARY TO CARRYN

2947
01:43:03,259 --> 01:43:05,028
ENGAGEMENT SO WE HAD A TEAM VERY

2948
01:43:05,028 --> 01:43:08,031
WELL VERSED AND HOW TO WORK WITH

2949
01:43:08,031 --> 01:43:12,201
PARTNERS SUCCESSFULLY.

2950
01:43:12,201 --> 01:43:14,070
ENGAGEMENT REALLY SHOULD BEGIN

2951
01:43:14,070 --> 01:43:15,038
BEFORE A TRIAL STARTS BUT

2952
01:43:15,038 --> 01:43:17,106
THERE'S NO REALLY -- NOT A LOT

2953
01:43:17,106 --> 01:43:18,608
OF CURRENT FUNDING OR MECHANISM

2954
01:43:18,608 --> 01:43:22,378
FOR THAT, SO THAT KIND OF HAS TO

2955
01:43:22,378 --> 01:43:23,546
COME -- IT KIND OF HAS TO HAPPEN

2956
01:43:23,546 --> 01:43:25,048
WITHOUT THAT KIND OF FUNDING.

2957
01:43:25,048 --> 01:43:28,117
BUT PARTNERS REALLY DO PROVIDE

2958
01:43:28,117 --> 01:43:28,985
PERSPECTIVES AND RECOMMENDATIONS

2959
01:43:28,985 --> 01:43:30,153
THAT ASSIST IN IDENTIFYING

2960
01:43:30,153 --> 01:43:31,454
BARRIERS AND THEY CAN PROVIDE

2961
01:43:31,454 --> 01:43:32,889
POSSIBLE SOLUTIONS.

2962
01:43:32,889 --> 01:43:35,258
SO SOME OF THE INCONSISTENCIES

2963
01:43:35,258 --> 01:43:36,726
OF THE FEEDBACK WE'RE GETTING,

2964
01:43:36,726 --> 01:43:38,061
FOR EXAMPLE, WE CAN BRING BACK

2965
01:43:38,061 --> 01:43:40,229
TO OUR CAB AND DISCUSS.

2966
01:43:40,229 --> 01:43:42,131
THE CAB TOPICS HAVE TO, OFTEN,

2967
01:43:42,131 --> 01:43:43,099
CHANGE WHEN YOU'RE DEALING WITH

2968
01:43:43,099 --> 01:43:43,766
YOUR PARTNERS.

2969
01:43:43,766 --> 01:43:45,335
THEY HAVE TO CHANGE OVER TIME

2970
01:43:45,335 --> 01:43:48,304
DEPENDING ON THE STAGE OF THE

2971
01:43:48,304 --> 01:43:49,172
STUDY.

2972
01:43:49,172 --> 01:43:50,707
AS I MENTIONED, THEIR

2973
01:43:50,707 --> 01:43:52,442
PERSPECTIVES MAY BE CONSISTENT,

2974
01:43:52,442 --> 01:43:57,680
YOUR PARTNER PERSPECTIVE,

2975
01:43:57,680 --> 01:43:58,448
UNCOVERING OPPORTUNITIES FOR

2976
01:43:58,448 --> 01:44:00,516
INTERVENTION AND DISSEMINATION

2977
01:44:00,516 --> 01:44:04,220
TO ADDRESS SOME OF THE INCON 

2978
01:44:04,220 --> 01:44:04,787
INCONSISTENCY.

2979
01:44:04,787 --> 01:44:06,489
SO I JUST WANT TO THANK MY TEAM.

2980
01:44:06,489 --> 01:44:07,256
NONE OF THIS COULD HAPPEN

2981
01:44:07,256 --> 01:44:09,325
WITHOUT THEM.

2982
01:44:09,325 --> 01:44:11,761
SO I THINK THAT'S IT.

2983
01:44:11,761 --> 01:44:13,696
IS THE LAST SLIDE A THANK YOU

2984
01:44:13,696 --> 01:44:14,430
SLIDE?

2985
01:44:14,430 --> 01:44:14,597
YES.

2986
01:44:14,597 --> 01:44:17,300
>> THANKS, NATALIA.

2987
01:44:17,300 --> 01:44:18,434
NOW WE'LL HEAR FROM JULIE.

2988
01:44:18,434 --> 01:44:21,170
>> GREAT, THANK YOU.

2989
01:44:21,170 --> 01:44:22,305
AND FIRST OFF, THANKS FOR THE

2990
01:44:22,305 --> 01:44:23,606
INVITATION TO TALK ABOUT OUR

2991
01:44:23,606 --> 01:44:25,041
WORK HERE, AND IT'S NICE TO

2992
01:44:25,041 --> 01:44:28,378
FOLLOW NATALIA, BECAUSE WE'RE

2993
01:44:28,378 --> 01:44:30,046
WORKING WITH SIMILAR QUESTIONS,

2994
01:44:30,046 --> 01:44:31,114
SIMILAR PATIENT POPULATION.

2995
01:44:31,114 --> 01:44:32,448
SO I LEAD THIS PROJECT THAT

2996
01:44:32,448 --> 01:44:34,917
WE'VE LABELED BEATPAIN UTAH, AND

2997
01:44:34,917 --> 01:44:36,552
WE'RE WORKING WITH A SIMILAR

2998
01:44:36,552 --> 01:44:38,621
POPULATION OF INDIVIDUALS WITH

2999
01:44:38,621 --> 01:44:42,325
CHRONIC LOW BACK PAIN,

3000
01:44:42,325 --> 01:44:43,092
SPECIFICALLY, AND PARTNERING

3001
01:44:43,092 --> 01:44:44,527
WITH FEDERALLY QUALIFIED HEALTH

3002
01:44:44,527 --> 01:44:47,930
CENTERS AROUND THE STATE OF UT 

3003
01:44:47,930 --> 01:44:54,370
UTAH.

3004
01:44:54,370 --> 01:44:56,305
SIMILAR TO WHAT NATALIA WAS

3005
01:44:56,305 --> 01:44:59,142
TALKING ABOUT, PAIN MANAGEMENT

3006
01:44:59,142 --> 01:45:04,180
WAS PARTICULARLY -- DETERMINANTS

3007
01:45:04,180 --> 01:45:05,448
IN PATIENTS THAT SEEK CARE IN

3008
01:45:05,448 --> 01:45:06,883
COMMUNITY HEALTH CENTERS LIKE

3009
01:45:06,883 --> 01:45:08,951
WE'RE PARTNERING WITH.

3010
01:45:08,951 --> 01:45:10,486
SO UNLIKE MY PRIMARY EXPERIENCE

3011
01:45:10,486 --> 01:45:12,855
WHICH IS IN ACADEMIC MEDICAL

3012
01:45:12,855 --> 01:45:15,258
CENTERS, REALLY WORKING WITH

3013
01:45:15,258 --> 01:45:17,126
PATIENTS WHERE LIVING IN RURAL

3014
01:45:17,126 --> 01:45:18,528
COMMUNITIES AND HAVING LOWER

3015
01:45:18,528 --> 01:45:19,829
EDUCATIONAL ATTAINMENT, LOWER

3016
01:45:19,829 --> 01:45:22,465
INCOME LEVELS, ARE REALLY

3017
01:45:22,465 --> 01:45:23,566
PREVALENT WITH PATIENT

3018
01:45:23,566 --> 01:45:24,333
POPULATION THAT WE'RE WORKING

3019
01:45:24,333 --> 01:45:27,837
WITH.

3020
01:45:27,837 --> 01:45:29,772
SO JUST TO BE A LITTLE BIT MORE

3021
01:45:29,772 --> 01:45:31,741
SPECIFIC ABOUT THE PATIENT

3022
01:45:31,741 --> 01:45:33,609
POPULATION, THIS IS DATA FROM

3023
01:45:33,609 --> 01:45:35,545
HRSA BOTH IN MY STATE IN UTAH

3024
01:45:35,545 --> 01:45:39,282
AND THEN NATIONALLY ABOUT WHO

3025
01:45:39,282 --> 01:45:40,416
RECEIVES CARE IN COMMUNITY

3026
01:45:40,416 --> 01:45:41,150
HEALTH CENTERS.

3027
01:45:41,150 --> 01:45:43,719
AGAIN, YOU CAN SEE THE

3028
01:45:43,719 --> 01:45:44,587
REPRESENTATION OF INDIVIDUALS

3029
01:45:44,587 --> 01:45:46,122
WHO LIVE IN RURAL COMMUNITIES

3030
01:45:46,122 --> 01:45:50,193
ESPECIALLY IN THE STATE OF UTAH,

3031
01:45:50,193 --> 01:45:52,128
PEOPLE AT THE FEDERAL POVERTY

3032
01:45:52,128 --> 01:45:55,631
LEVEL, AND THEN IN UTAH, THE

3033
01:45:55,631 --> 01:45:56,833
ETHNIC AND RACIAL DIVERSITY

3034
01:45:56,833 --> 01:45:58,034
THAT'S REPRESENTED IN THESE

3035
01:45:58,034 --> 01:45:58,935
CLINICS IS INDIVIDUALS OF

3036
01:45:58,935 --> 01:46:01,037
HISPANIC AND LATINO ETHNICITY,

3037
01:46:01,037 --> 01:46:03,039
MANY OF WHOM COMMUNICATE

3038
01:46:03,039 --> 01:46:03,906
PRIMARILY IN SPANISH.

3039
01:46:03,906 --> 01:46:06,509
SO IN THINKING ABOUT ENGAGEMENT

3040
01:46:06,509 --> 01:46:08,144
WITH THE PATIENT POPULATION AS

3041
01:46:08,144 --> 01:46:09,879
WELL AS CLINICS SERVING THE

3042
01:46:09,879 --> 01:46:11,013
PATIENTS, THESE WERE FACTORS WE

3043
01:46:11,013 --> 01:46:13,082
HAD TO BE VERY COGNIZANT OF

3044
01:46:13,082 --> 01:46:18,221
GOING INTO OUR PARTNERSHIP.

3045
01:46:18,221 --> 01:46:21,357
SO THIS IS THE STUDY THAT WE'RE

3046
01:46:21,357 --> 01:46:21,557
DOING.

3047
01:46:21,557 --> 01:46:22,658
OUR PROJECT IS ABOUT TWO THIRDS

3048
01:46:22,658 --> 01:46:24,961
OF THE WAY THROUGH RECRUITING

3049
01:46:24,961 --> 01:46:26,496
PATIENTS, SO WE'RE NOT AS FAR

3050
01:46:26,496 --> 01:46:28,531
ALONG AS NATALIA IS IN HER

3051
01:46:28,531 --> 01:46:29,098
STUDY.

3052
01:46:29,098 --> 01:46:32,702
YOU CAN SEE THE TRIAL DESIGN

3053
01:46:32,702 --> 01:46:34,137
HERE, AND THERE'S A COUPLE

3054
01:46:34,137 --> 01:46:35,304
REALLY KEY THINGS THAT I'LL

3055
01:46:35,304 --> 01:46:37,940
POINT OUT HERE TO UNDERSTAND HOW

3056
01:46:37,940 --> 01:46:41,110
ENGAGEMENT LOOKS IN OUR PROJECT.

3057
01:46:41,110 --> 01:46:43,846
ONE IS IN THE RECRUITMENT SIDE,

3058
01:46:43,846 --> 01:46:45,047
AND ENGAGING WITH THE CLINICS

3059
01:46:45,047 --> 01:46:47,450
AND THE PROVIDERS WHO WORK IN

3060
01:46:47,450 --> 01:46:48,217
THE SETTINGS THAT WE'RE

3061
01:46:48,217 --> 01:46:51,053
PARTNERING WITH.

3062
01:46:51,053 --> 01:46:52,588
WE NEEDED TO UNDERSTAND HOW TO

3063
01:46:52,588 --> 01:46:56,058
ENGAGE THESE CLINICS WHO DON'T

3064
01:46:56,058 --> 01:46:57,960
HAVE A LONG HISTORY OR A LOT OF

3065
01:46:57,960 --> 01:46:59,462
EXPERIENCE PARTICIPATING IN

3066
01:46:59,462 --> 01:47:00,630
CLINICAL RESEARCH, AND WE HAD TO

3067
01:47:00,630 --> 01:47:03,132
DO IT IN A WAY THAT WAS

3068
01:47:03,132 --> 01:47:03,900
DECENTRALIZED BECAUSE THESE

3069
01:47:03,900 --> 01:47:05,668
CLINICS ARE LOCATED THROUGHOUT

3070
01:47:05,668 --> 01:47:06,736
THE STATE OF UTAH.

3071
01:47:06,736 --> 01:47:08,671
SO THAT PIECE OF ENGAGEMENT WAS

3072
01:47:08,671 --> 01:47:09,572
REALLY CRITICAL TO THE SUCCESS

3073
01:47:09,572 --> 01:47:12,642
OF THE PROJECT.

3074
01:47:12,642 --> 01:47:13,743
THEN THERE'S THE PATIENT

3075
01:47:13,743 --> 01:47:15,144
ENGAGEMENT THAT PLAYS OUT AS WE

3076
01:47:15,144 --> 01:47:17,280
SEEK TO ENROLL PATIENTS IN THE

3077
01:47:17,280 --> 01:47:18,714
PROJECT, AND THEN PROVIDE

3078
01:47:18,714 --> 01:47:20,683
DIFFERENT TYPES OF TELEHEALTH

3079
01:47:20,683 --> 01:47:24,787
PHYSICAL THERAPY SERVICES FOR

3080
01:47:24,787 --> 01:47:25,855
PAIN MANAGEMENT, WHICH IS THE

3081
01:47:25,855 --> 01:47:26,989
CORE INTERVENTION THAT WE'RE

3082
01:47:26,989 --> 01:47:29,292
STUDYING IN OUR PATIENT

3083
01:47:29,292 --> 01:47:29,959
POPULATION.

3084
01:47:29,959 --> 01:47:30,826
SO THERE'S A COUPLE DIFFERENT

3085
01:47:30,826 --> 01:47:33,329
WAYS THAT WE'RE DELIVERING THAT

3086
01:47:33,329 --> 01:47:34,664
TREATMENT, BUT WE HAD TO THINK

3087
01:47:34,664 --> 01:47:38,134
VERY CAREFULLY ABOUT HOW TO

3088
01:47:38,134 --> 01:47:39,168
ENGAGE PATIENTS WHO HAVE THE

3089
01:47:39,168 --> 01:47:41,537
TYPE OF CHARACTERISTICS THAT I

3090
01:47:41,537 --> 01:47:44,907
SHOWED YOU EARLIER IN A

3091
01:47:44,907 --> 01:47:45,641
TELEHEALTH INTERVENTION THAT

3092
01:47:45,641 --> 01:47:47,843
COULD BE UNFAMILIAR TO THEM IN A

3093
01:47:47,843 --> 01:47:54,951
NUMBER OF DIFFERENT WAYS.

3094
01:47:54,951 --> 01:47:56,619
AND ONE OF THE THINGS THAT I WAS

3095
01:47:56,619 --> 01:47:58,087
REALLY FORTUNATE AT THE

3096
01:47:58,087 --> 01:48:00,856
UNIVERSITY OF UTAH WAS TO BE

3097
01:48:00,856 --> 01:48:03,025
ABLE TO REALLY BRING OUR PROJECT

3098
01:48:03,025 --> 01:48:06,529
INTO AN EXISTING PARTNERSHIP

3099
01:48:06,529 --> 01:48:08,130
MODEL THAT WAS BASED AT A GROUP

3100
01:48:08,130 --> 01:48:09,131
CALLED THE CENTER FOR HOPE,

3101
01:48:09,131 --> 01:48:11,000
WHICH IS ACTUALLY IN OUR CANCER

3102
01:48:11,000 --> 01:48:13,302
INSTITUTE AT THE UNIVERSITY, WHO

3103
01:48:13,302 --> 01:48:16,072
WAS ALREADY WORKING WITH THE

3104
01:48:16,072 --> 01:48:17,006
COMMUNITY HEALTH CENTERS THAT

3105
01:48:17,006 --> 01:48:18,441
ARE PARTNERS IN OUR STUDY.

3106
01:48:18,441 --> 01:48:20,376
SO THEY HAD REALLY DEVELOPED

3107
01:48:20,376 --> 01:48:24,213
THIS PARTNERSHIP AND ENGAGEMENT

3108
01:48:24,213 --> 01:48:25,615
MODEL THAT I'VE JUST FOUND

3109
01:48:25,615 --> 01:48:26,849
REALLY INVALUABLE IN TERMS OF

3110
01:48:26,849 --> 01:48:28,050
COMING INTO PARTNERSHIP WITH

3111
01:48:28,050 --> 01:48:29,452
GROUPS THAT I WAS UNFAMILIAR

3112
01:48:29,452 --> 01:48:31,187
WITH AND WHO ARE UNFAMILIAR WITH

3113
01:48:31,187 --> 01:48:32,855
ME AND THE WORK THAT OUR TEAM

3114
01:48:32,855 --> 01:48:33,256
DOES.

3115
01:48:33,256 --> 01:48:34,657
SO A COUPLE THINGS THAT I'LL

3116
01:48:34,657 --> 01:48:37,627
POINT OUT HERE THAT I THINK ARE

3117
01:48:37,627 --> 01:48:39,462
REALLY IMPORTANT TO THE TOPIC AT

3118
01:48:39,462 --> 01:48:41,897
HAND ARE THE ENGAGEMENT

3119
01:48:41,897 --> 01:48:43,532
ACTIVITIES.

3120
01:48:43,532 --> 01:48:48,137
SO WE REALLY HAVE VERY MUCH A

3121
01:48:48,137 --> 01:48:55,011
SHARED MUTUAL RESPECT KIND OF

3122
01:48:55,011 --> 01:48:57,079
COLLABORATIVE AGREEMENT AMONGST

3123
01:48:57,079 --> 01:49:01,684
OUR PARTNERS, AND THAT REALLY

3124
01:49:01,684 --> 01:49:02,985
FEEDS INTO A COUPLE OF REALLY

3125
01:49:02,985 --> 01:49:04,120
KEY ENGAGEMENT ACTIVITIES.

3126
01:49:04,120 --> 01:49:06,889
ONE IS NATALIA REALLY EMPHASIZED

3127
01:49:06,889 --> 01:49:08,624
NICELY, HAVING PATIENTS IN STUDY

3128
01:49:08,624 --> 01:49:09,725
ADVISORY COMMITTEES WHO ARE NOT

3129
01:49:09,725 --> 01:49:14,664
ONLY SPECIFIC TO ONE PROJECT,

3130
01:49:14,664 --> 01:49:15,965
BUT WHO CAN THINK ABOUT HOW

3131
01:49:15,965 --> 01:49:17,266
CLINICS AND PATIENTS MIGHT BE

3132
01:49:17,266 --> 01:49:17,967
PARTICIPATING IN SEVERAL

3133
01:49:17,967 --> 01:49:20,002
DIFFERENT STUDIES AND MAKING

3134
01:49:20,002 --> 01:49:23,506
SURE THAT WE'RE NOT

3135
01:49:23,506 --> 01:49:24,840
OVERBURDENING EITHER CLINICS OR

3136
01:49:24,840 --> 01:49:25,941
PARTICIPANTS WITH RESEARCH

3137
01:49:25,941 --> 01:49:28,978
ACTIVITIES.

3138
01:49:28,978 --> 01:49:30,946
TO REALLY THINK ABOUT

3139
01:49:30,946 --> 01:49:32,782
IMPLEMENTING PROJECTS WITH AN

3140
01:49:32,782 --> 01:49:33,883
EYE TOWARDS CLINIC WORKFLOWS AND

3141
01:49:33,883 --> 01:49:37,386
HOW WE ANALYZE AND EXAMINE AND

3142
01:49:37,386 --> 01:49:38,587
FIT NEW PROJECTS INTO THE

3143
01:49:38,587 --> 01:49:40,856
WORKFLOW TO BE AS MINIMALLY

3144
01:49:40,856 --> 01:49:47,530
DISRUPTIVE AS IS POSSIBLE.

3145
01:49:47,530 --> 01:49:48,664
AND TO UNDERSTAND THAT WORKING

3146
01:49:48,664 --> 01:49:50,132
WITH CLINICS THAT ARE VERY

3147
01:49:50,132 --> 01:49:53,202
DIFFERENT IN TERMS OF THEIR

3148
01:49:53,202 --> 01:49:55,271
PHYSICAL INFRASTRUCTURE, WHERE

3149
01:49:55,271 --> 01:49:56,605
THEY'RE SITUATED IN EITHER URBAN

3150
01:49:56,605 --> 01:49:58,341
OR RURAL SETTINGS, THE NATURE OF

3151
01:49:58,341 --> 01:50:01,210
THE PATIENT POPULATION THEY

3152
01:50:01,210 --> 01:50:03,679
SERVE, THAT ADAPTATIONS TO

3153
01:50:03,679 --> 01:50:04,547
IMPLEMENTATION STRATEGIES HAD TO

3154
01:50:04,547 --> 01:50:07,717
BE REALLY BUILT INTO HOW WE

3155
01:50:07,717 --> 01:50:09,051
PLANNED TO PARTNER AND CONDUCT

3156
01:50:09,051 --> 01:50:15,257
CLINICAL RESEARCH.

3157
01:50:15,257 --> 01:50:16,592
SO I WANT TO JUST KIND OF

3158
01:50:16,592 --> 01:50:18,160
EMPHASIZE A COUPLE OF POINTS IN

3159
01:50:18,160 --> 01:50:19,195
THOSE ENGAGEMENT ACTIVITIES A

3160
01:50:19,195 --> 01:50:20,429
LITTLE BIT FURTHER.

3161
01:50:20,429 --> 01:50:22,698
SO FIRST OFF, I THINK FOR US

3162
01:50:22,698 --> 01:50:23,799
IT'S BEEN VERY IMPORTANT TO HAVE

3163
01:50:23,799 --> 01:50:27,269
A PARTNERSHIP MODEL THAT HELPS

3164
01:50:27,269 --> 01:50:29,038
KEEP ALL OF US GROUNDED TO THE

3165
01:50:29,038 --> 01:50:30,139
PRINCIPLES THAT WE'VE AGREED ON

3166
01:50:30,139 --> 01:50:33,075
ABOUT HOW TO PARTNER.

3167
01:50:33,075 --> 01:50:34,810
SO FOR US ON THE RESEARCH SIDE,

3168
01:50:34,810 --> 01:50:36,245
FOR OUR CLINICAL PARTNERS, TO

3169
01:50:36,245 --> 01:50:37,246
REALLY UNDERSTAND WHAT OUR

3170
01:50:37,246 --> 01:50:39,849
SHARED VALUES ARE AND TO

3171
01:50:39,849 --> 01:50:42,017
RECOGNIZE THAT ANY RESEARCH

3172
01:50:42,017 --> 01:50:44,420
TOPIC HAS TO REFLECT THE

3173
01:50:44,420 --> 01:50:46,122
PRIORITY DOMAINS FOR COMMUNITY

3174
01:50:46,122 --> 01:50:49,024
HEALTH CENTERS.

3175
01:50:49,024 --> 01:50:52,161
THAT BRINGING IN NEW PROCEDURES,

3176
01:50:52,161 --> 01:50:53,929
IMPLEMENTING ANYTHING THAT'S

3177
01:50:53,929 --> 01:50:55,564
GOING TO BE POTENTIALLY

3178
01:50:55,564 --> 01:50:56,799
DISRUPTIVE TO THE CLINICAL

3179
01:50:56,799 --> 01:50:58,501
WORKFLOW REALLY TAKES AN

3180
01:50:58,501 --> 01:51:00,136
INFORMED AND INTENTIONAL EFFORT,

3181
01:51:00,136 --> 01:51:02,004
AND WE FOUND IMPLEMENTATION

3182
01:51:02,004 --> 01:51:03,539
MAPPING A PROCESS THAT'S BEEN

3183
01:51:03,539 --> 01:51:06,609
REALLY HELPFUL FOR THINKING

3184
01:51:06,609 --> 01:51:08,244
ABOUT THAT, AND BEING VERY

3185
01:51:08,244 --> 01:51:11,280
SPECIFIC ABOUT HOW WE IMPLEMENT

3186
01:51:11,280 --> 01:51:12,915
NEW PROCESSES.

3187
01:51:12,915 --> 01:51:17,953
WHAT WE REALLY DESIRED TO DO, IT

3188
01:51:17,953 --> 01:51:19,355
GOT A LITTLE BIT CHANGED WITH

3189
01:51:19,355 --> 01:51:21,757
THE TIMING WITH RESPECT TO

3190
01:51:21,757 --> 01:51:23,626
COVID, IS TO EXAMINE THE

3191
01:51:23,626 --> 01:51:25,161
CLINICAL WORKFLOW FROM AN ON THE

3192
01:51:25,161 --> 01:51:27,563
GROUND SOCIAL TECHNICAL

3193
01:51:27,563 --> 01:51:29,064
PERSPECTIVE.

3194
01:51:29,064 --> 01:51:30,633
SO NOT ONLY UNDERSTANDING THE

3195
01:51:30,633 --> 01:51:32,134
TECHNICAL OPERATIONS OF HOW

3196
01:51:32,134 --> 01:51:33,769
CLINIC STAFF INTERACT WITH THEIR

3197
01:51:33,769 --> 01:51:35,404
I.T., BUT TO REALLY UNDERSTAND

3198
01:51:35,404 --> 01:51:38,474
SORT OF HOW IT FITS INTO THE

3199
01:51:38,474 --> 01:51:40,776
FLOW AND THE WORKDAY FOR

3200
01:51:40,776 --> 01:51:44,680
INDIVIDUAL STAFF MEMBERS AND HOW

3201
01:51:44,680 --> 01:51:46,115
OUR PROJECT COULD FIT INTO THAT

3202
01:51:46,115 --> 01:51:47,450
WITH CAUSING AS LITTLE

3203
01:51:47,450 --> 01:51:53,122
DISRUPTION AS POSSIBLE.

3204
01:51:53,122 --> 01:51:54,890
THEN FINALLY RECOGNIZING THAT

3205
01:51:54,890 --> 01:51:55,724
BECAUSE OF THE GEOGRAPHIC

3206
01:51:55,724 --> 01:51:56,959
DISTRIBUTION OF CLINICS, THAT WE

3207
01:51:56,959 --> 01:51:58,794
HAD TO REALLY THINK ABOUT HOW TO

3208
01:51:58,794 --> 01:52:01,630
PARTNER IN A WAY THAT'S VERY

3209
01:52:01,630 --> 01:52:03,399
DECENTRALIZED FOR BOTH RESEARCH

3210
01:52:03,399 --> 01:52:04,900
AND CLINICAL PROCEDURES.

3211
01:52:04,900 --> 01:52:07,870
SO THAT TOOK SOME UNIQUE

3212
01:52:07,870 --> 01:52:09,038
CONSIDERATIONS FROM RESEARCH AT

3213
01:52:09,038 --> 01:52:11,140
LEAST THAT I WAS FAMILIAR WITH

3214
01:52:11,140 --> 01:52:16,479
FROM PRIOR STUDIES.

3215
01:52:16,479 --> 01:52:18,447
SO I WANT TO JUST AGAIN SAY

3216
01:52:18,447 --> 01:52:19,548
ANOTHER LITTLE WORD ABOUT

3217
01:52:19,548 --> 01:52:20,549
IMPLEMENTATION MAPPING BECAUSE I

3218
01:52:20,549 --> 01:52:22,017
REALLY THINK THIS WAS THE KEY TO

3219
01:52:22,017 --> 01:52:25,788
US IN OUR UG3 PHASE, AND HAVING

3220
01:52:25,788 --> 01:52:27,223
THE TIME TO KIND OF WORK THROUGH

3221
01:52:27,223 --> 01:52:30,593
THIS WAS REALLY IMPORTANT FOR US

3222
01:52:30,593 --> 01:52:31,360
IMPLEMENTING SOMETHING NEW.

3223
01:52:31,360 --> 01:52:33,028
SO I WON'T GO INTO THE DETAILS

3224
01:52:33,028 --> 01:52:35,531
OF THIS PROCESS, BUT IT REALLY

3225
01:52:35,531 --> 01:52:40,236
BEGINS WITH THINKING ABOUT WHO

3226
01:52:40,236 --> 01:52:41,570
ARE WE ASKING TO DO SOMETHING

3227
01:52:41,570 --> 01:52:43,372
THAT THEY'RE NOT USED TO DOING,

3228
01:52:43,372 --> 01:52:44,573
IN OUR CASE THAT INCLUDED

3229
01:52:44,573 --> 01:52:45,674
CLINIC, STAFF MEMBERS AND

3230
01:52:45,674 --> 01:52:47,376
PATIENTS SO WE THOUGHT OF THEM

3231
01:52:47,376 --> 01:52:48,177
BOTH AS IMPLEMENTERS.

3232
01:52:48,177 --> 01:52:49,478
AND THEN REALLY UNDERSTANDING

3233
01:52:49,478 --> 01:52:52,314
WHAT ARE WE ASKING THEM TO DO,

3234
01:52:52,314 --> 01:52:53,949
AND HOW CAN WE DO IT.

3235
01:52:53,949 --> 01:52:56,252
AND THEN OBVIOUSLY AS THE

3236
01:52:56,252 --> 01:52:57,887
RESEARCH CONTEXT EVALUATING

3237
01:52:57,887 --> 01:52:59,355
WHETHER WE WERE SUCCESSFUL OR

3238
01:52:59,355 --> 01:52:59,722
NOT.

3239
01:52:59,722 --> 01:53:01,156
AND THINKING THIS THROUGH REALLY

3240
01:53:01,156 --> 01:53:03,792
REVEALED SOME THINGS THAT

3241
01:53:03,792 --> 01:53:05,227
MODIFIED SOME OF OUR PROCESSES

3242
01:53:05,227 --> 01:53:06,729
IN THE UG3 PHASE, AND I THINK

3243
01:53:06,729 --> 01:53:13,168
GENERALLY FOR THE BETTER.

3244
01:53:13,168 --> 01:53:15,571
SO FROM A PATIENT STANDPOINT,

3245
01:53:15,571 --> 01:53:16,105
THESE WERE SOME OF THE KEY

3246
01:53:16,105 --> 01:53:18,207
THINGS THAT WE PULLED OUT OF

3247
01:53:18,207 --> 01:53:19,608
THIS PROCESS.

3248
01:53:19,608 --> 01:53:21,477
AGAIN, THERE'S A LOT THAT WE

3249
01:53:21,477 --> 01:53:25,548
LEARNED FROM THE PROCESS, BUT WE

3250
01:53:25,548 --> 01:53:27,082
RECOGNIZE THAT PATIENTS HAD

3251
01:53:27,082 --> 01:53:28,384
UNIQUE ACCESS CONCERNS, BOTH

3252
01:53:28,384 --> 01:53:30,786
WITH RESPECT TO TECHNOLOGY AND

3253
01:53:30,786 --> 01:53:34,723
THE HOURS THEY WERE AVAILABLE,

3254
01:53:34,723 --> 01:53:37,359
AND ISSUES AROUND HOW WE WOULD

3255
01:53:37,359 --> 01:53:37,793
DELIVER CARE.

3256
01:53:37,793 --> 01:53:40,729
WE HAD TO ADAPT OUR PT

3257
01:53:40,729 --> 01:53:42,898
INTERVENTIONS TO UNDERSTAND THE

3258
01:53:42,898 --> 01:53:44,333
COMMUNITIES WHERE PATIENTS LIVED

3259
01:53:44,333 --> 01:53:45,534
AND THE PARTICULAR STRESSORS

3260
01:53:45,534 --> 01:53:47,002
THAT WERE MORE PREVALENT IN THE

3261
01:53:47,002 --> 01:53:49,305
PATIENT POPULATION.

3262
01:53:49,305 --> 01:53:50,573
WE HAD TO THINK QUITE A BIT

3263
01:53:50,573 --> 01:53:52,541
ABOUT HOW TO DEVELOP STRONG

3264
01:53:52,541 --> 01:53:55,277
RELATIONSHIPS WITH PATIENTS WHEN

3265
01:53:55,277 --> 01:53:56,245
EVERYTHING WAS BEING DONE

3266
01:53:56,245 --> 01:53:56,679
REMOTE.

3267
01:53:56,679 --> 01:53:58,347
AND TO THINK ABOUT THE UNIQUE

3268
01:53:58,347 --> 01:54:02,318
CULTURAL ASPECTS OF THE PATIENTS

3269
01:54:02,318 --> 01:54:03,085
IN THE COMMUNITIES THAT RECEIVED

3270
01:54:03,085 --> 01:54:05,220
CARE IN THESE CLINICS.

3271
01:54:05,220 --> 01:54:09,358
SO THIS INCLUDED THE ETHNIC

3272
01:54:09,358 --> 01:54:10,159
DIVERSITY AS WELL AS THINKING

3273
01:54:10,159 --> 01:54:11,894
ABOUT THE UNIQUE CONSIDERATIONS

3274
01:54:11,894 --> 01:54:12,861
OF PERSONS WHO LIVE IN VERY

3275
01:54:12,861 --> 01:54:20,836
RURAL AREAS OF THE STATE.

3276
01:54:20,836 --> 01:54:22,171
HE THEN FROM A CLINIC OR

3277
01:54:22,171 --> 01:54:23,572
PROVIDER STANDPOINT, SEVERAL

3278
01:54:23,572 --> 01:54:24,340
DIFFERENT THINGS THAT WERE VERY

3279
01:54:24,340 --> 01:54:26,508
IMPORTANT THAT CAME OUT OF THIS

3280
01:54:26,508 --> 01:54:28,711
PROCESS REALLY AROUND TECHNOLOGY

3281
01:54:28,711 --> 01:54:30,346
AND TRUST ARE THE PRIMARY THINGS

3282
01:54:30,346 --> 01:54:35,384
I WOULD HIGHLIGHT HERE.

3283
01:54:35,384 --> 01:54:37,019
HAVING SUFFICIENT SUPPORT AND

3284
01:54:37,019 --> 01:54:38,654
EXPERTISE TO HELP WITH EHR

3285
01:54:38,654 --> 01:54:42,391
SYSTEMS WAS CRITICAL.

3286
01:54:42,391 --> 01:54:44,026
AND THEN REALLY BUILDING TRUST

3287
01:54:44,026 --> 01:54:47,196
THROUGH VERY DIFFICULT TIMES,

3288
01:54:47,196 --> 01:54:48,697
PARTICULARLY WHERE CLINICS WERE

3289
01:54:48,697 --> 01:54:51,133
QUITE OVERWHELMED WITH COVID

3290
01:54:51,133 --> 01:54:55,704
CONCERNS, WAS AT TIMES VERY --

3291
01:54:55,704 --> 01:54:56,939
IT TOOK A LONG TIME SOMETIMES TO

3292
01:54:56,939 --> 01:55:00,075
WORK THROUGH SOME OF THE ISSUES

3293
01:55:00,075 --> 01:55:02,044
AND HAVE WHAT WE WERE WORKING ON

3294
01:55:02,044 --> 01:55:04,246
RISE TO THE TOP OF THE PRIORITY

3295
01:55:04,246 --> 01:55:06,181
LIST WHEN A LOT ELSE WAS GOING

3296
01:55:06,181 --> 01:55:08,317
ON, AND THAT TOOK A GOOD BIT OF

3297
01:55:08,317 --> 01:55:12,154
PATIENCE ON OUR PART AS

3298
01:55:12,154 --> 01:55:13,989
RESEARCHERS AND A REAL

3299
01:55:13,989 --> 01:55:16,525
COMMITMENT TO WORKING WITH AND

3300
01:55:16,525 --> 01:55:17,493
PARTNERING WITH CLINICS THAT

3301
01:55:17,493 --> 01:55:18,827
WERE GOING THROUGH LOTS OF

3302
01:55:18,827 --> 01:55:29,271
REALLY CHALLENGING TIMES.

3303
01:55:30,706 --> 01:55:32,174
SO THIS IS REALLY WHAT IT ENDED

3304
01:55:32,174 --> 01:55:34,576
UP LOOKING LIKE WITH MORE DETAIL

3305
01:55:34,576 --> 01:55:35,678
AFTER WE WENT THROUGH THIS

3306
01:55:35,678 --> 01:55:36,078
PROCESS.

3307
01:55:36,078 --> 01:55:39,782
JUST A COUPLE THINGS THAT I'LL

3308
01:55:39,782 --> 01:55:41,984
POINT OUT.

3309
01:55:41,984 --> 01:55:43,752
WE KNEW WE NEEDED TO HAVE A WAY

3310
01:55:43,752 --> 01:55:45,587
FOR PROVIDERS TO REFER PATIENTS

3311
01:55:45,587 --> 01:55:47,756
ON A ONE TO ONE BASIS IN THE

3312
01:55:47,756 --> 01:55:49,158
MIDST OF A CLINICAL ENCOUNTER,

3313
01:55:49,158 --> 01:55:51,627
AND THAT WE NEEDED TO USE VERY

3314
01:55:51,627 --> 01:55:52,828
STANDARDS-BASED WAYS OF DOING

3315
01:55:52,828 --> 01:55:54,096
THAT, BECAUSE OF THE DIVERSITY

3316
01:55:54,096 --> 01:55:57,299
OF THE EHRs.

3317
01:55:57,299 --> 01:55:58,634
SO WE SET UP A PROCESS THAT

3318
01:55:58,634 --> 01:56:01,336
COULD BE FLEXIBLE AND ADAPT TO

3319
01:56:01,336 --> 01:56:03,639
THE DIFFERENT EHRs, BUT WOULD

3320
01:56:03,639 --> 01:56:06,141
ALSO PROVIDE THE OPPORTUNITY FOR

3321
01:56:06,141 --> 01:56:09,244
A PROVIDER TO REFER A PATIENT TO

3322
01:56:09,244 --> 01:56:09,678
US.

3323
01:56:09,678 --> 01:56:10,979
AND IMPORTANTLY FOR US TO

3324
01:56:10,979 --> 01:56:12,181
PROVIDE FEEDBACK ABOUT THE

3325
01:56:12,181 --> 01:56:15,250
STATUS OF THAT PATIENT.

3326
01:56:15,250 --> 01:56:18,087
BUT WE ALSO KNOW THAT WE WOULD

3327
01:56:18,087 --> 01:56:19,188
MISS THE OPPORTUNITY TO OFFER

3328
01:56:19,188 --> 01:56:23,792
WHAT WE WERE DOING TO PATIENTS

3329
01:56:23,792 --> 01:56:25,094
WITH THIS PROCESS BEING OUR ONLY

3330
01:56:25,094 --> 01:56:26,428
WAY TO IDENTIFY PARTICIPANTS.

3331
01:56:26,428 --> 01:56:28,497
SO WE ALSO HAVE IMPLEMENTED,

3332
01:56:28,497 --> 01:56:31,667
WITH THE CLINIC'S PERMISSION, A

3333
01:56:31,667 --> 01:56:35,504
TEXT MESSAGING-BASED OUTREACH TO

3334
01:56:35,504 --> 01:56:37,906
ALLOW US TO REALLY DO A MORE

3335
01:56:37,906 --> 01:56:39,341
POPULATION-BASED EFFORT TO LET

3336
01:56:39,341 --> 01:56:40,776
PATIENTS KNOW THAT THIS SERVICE

3337
01:56:40,776 --> 01:56:42,177
IS AVAILABLE TO THEM.

3338
01:56:42,177 --> 01:56:43,512
AND WE FOUND BOTH OF THESE

3339
01:56:43,512 --> 01:56:44,847
STRATEGIES TO BE VERY IMPORTANT

3340
01:56:44,847 --> 01:56:48,183
IN TERMS OF RECRUITING PATIENTS

3341
01:56:48,183 --> 01:56:49,752
AND MAKING SURE THAT THEY'RE

3342
01:56:49,752 --> 01:56:53,021
AWARE THAT THEY MAY WANT TO

3343
01:56:53,021 --> 01:57:01,430
PARTICIPATE IN WHAT WE'RE DOING.

3344
01:57:01,430 --> 01:57:03,398
SO JUST A COUPLE OF LESSONS

3345
01:57:03,398 --> 01:57:04,466
LEARNED THAT MIGHT BE HELPFUL

3346
01:57:04,466 --> 01:57:05,801
FOR OUR CONVERSATION HERE TODAY.

3347
01:57:05,801 --> 01:57:08,737
AGAIN I THINK FOR ME IN

3348
01:57:08,737 --> 01:57:11,273
PARTICULAR, HAVING A MODEL TO

3349
01:57:11,273 --> 01:57:14,109
UNDERSTAND HOW TO PARTNER WITH

3350
01:57:14,109 --> 01:57:15,511
GROUPS THAT I WASN'T USED TO

3351
01:57:15,511 --> 01:57:20,549
PARTNERING WITH, THAT WAS REALLY

3352
01:57:20,549 --> 01:57:21,650
KEY.

3353
01:57:21,650 --> 01:57:22,918
THE COMMUNITY HEALTH CENTERS IN

3354
01:57:22,918 --> 01:57:27,222
THE STATE OF UTAH HAVE A PRIMARY

3355
01:57:27,222 --> 01:57:30,793
CARE ASSOCIATION THAT THE

3356
01:57:30,793 --> 01:57:31,660
UNIVERSITY AND COLLEAGUES OF

3357
01:57:31,660 --> 01:57:32,694
MINE HAVE BUILT A STRONG

3358
01:57:32,694 --> 01:57:33,562
TRUSTING RELATIONSHIP, AND

3359
01:57:33,562 --> 01:57:35,998
THAT'S REALLY BENEFITED US IN

3360
01:57:35,998 --> 01:57:36,999
THIS PARTICULAR PROJECT, AND

3361
01:57:36,999 --> 01:57:39,368
THAT TOOK A LOT OF TIME TO

3362
01:57:39,368 --> 01:57:41,036
DEVELOP AS NATALIA MENTIONED

3363
01:57:41,036 --> 01:57:42,771
WELL BEFORE THIS STUDY WAS EVER

3364
01:57:42,771 --> 01:57:46,375
FUNDED.

3365
01:57:46,375 --> 01:57:49,945
I THINK THE UG3/UH3 MECHANISM

3366
01:57:49,945 --> 01:57:53,816
HAS BEEN CRITICAL IN PARTNERING

3367
01:57:53,816 --> 01:57:56,451
WITH CLINICS THAT AREN'T USED TO

3368
01:57:56,451 --> 01:57:57,553
PARTICIPATING IN CLINICAL

3369
01:57:57,553 --> 01:57:59,721
RESEARCH THAT HAVE FEWER

3370
01:57:59,721 --> 01:58:01,623
RESOURCES, THAT THAT UG3 YEAR

3371
01:58:01,623 --> 01:58:03,759
AND THE ABILITY TO REALLY THINK

3372
01:58:03,759 --> 01:58:04,660
INTENTIONALLY ABOUT HOW WE WERE

3373
01:58:04,660 --> 01:58:05,894
GOING TO PARTNER AND IMPLEMENT

3374
01:58:05,894 --> 01:58:09,364
WHAT WE WERE DOING WAS REALLY

3375
01:58:09,364 --> 01:58:11,767
CRUCIAL TO BUILDING TRUST AND TO

3376
01:58:11,767 --> 01:58:13,268
BEING SUCCESSFUL.

3377
01:58:13,268 --> 01:58:14,770
AND THEN THE FINAL POINT HERE

3378
01:58:14,770 --> 01:58:17,339
AGAIN, THE IT CAPACITY HAS JUST

3379
01:58:17,339 --> 01:58:19,775
BEEN CRITICAL, AND THAT LEVEL OF

3380
01:58:19,775 --> 01:58:22,477
EXPERTISE HAS BEEN ALSO REALLY

3381
01:58:22,477 --> 01:58:24,179
KEY TO OUR SUCCESS AND HAS

3382
01:58:24,179 --> 01:58:25,280
BROUGHT SOMETHING VALUABLE, I

3383
01:58:25,280 --> 01:58:27,549
THINK, TO THE CLINICS AND THE

3384
01:58:27,549 --> 01:58:29,184
STAFF THAT WERE ABLE TO HELP

3385
01:58:29,184 --> 01:58:30,385
TROUBLESHOOT IT-RELATED

3386
01:58:30,385 --> 01:58:30,886
PROBLEMS.

3387
01:58:30,886 --> 01:58:32,487
I THINK THAT'S BEEN A

3388
01:58:32,487 --> 01:58:33,922
VALUE-ADDED FOR THE CLINICS OF

3389
01:58:33,922 --> 01:58:35,023
THEIR PARTICIPATION WITH US IN

3390
01:58:35,023 --> 01:58:39,728
THIS RESEARCH PROJECT.

3391
01:58:39,728 --> 01:58:40,362
SO THANK YOU VERY MUCH.

3392
01:58:40,362 --> 01:58:41,897
THIS IS THE TEAM THAT I'VE BEEN

3393
01:58:41,897 --> 01:58:43,232
WORKING WITH ON THIS PROJECT,

3394
01:58:43,232 --> 01:58:48,804
AND ALL OUR PARTNERS.

3395
01:58:48,804 --> 01:58:50,005
AND I'LL HAND IT OVER TO THE

3396
01:58:50,005 --> 01:58:51,273
NEXT SPEAKER.

3397
01:58:51,273 --> 01:58:53,308
>> THANKS VERY MUCH,
JULIE.

3398
01:58:53,308 --> 01:58:55,777
AND I THINK ANNA IS UP NEXT, IS

3399
01:58:55,777 --> 01:58:57,379
THAT RIGHT?

3400
01:58:57,379 --> 01:58:58,046
>> GOOD AFTERNOON.

3401
01:58:58,046 --> 01:59:00,315
MY NAME IS ANNA KRUPP.

3402
01:59:00,315 --> 01:59:03,719
I AM A SITE P.I. ON THE BESTICU

3403
01:59:03,719 --> 01:59:05,487
TRIAL AND ALSO AN ASSISTANT

3404
01:59:05,487 --> 01:59:06,855
PROFESSOR AT THE UNIVERSITY OF

3405
01:59:06,855 --> 01:59:09,725
IOWA COLLEGE OF NURSING.

3406
01:59:09,725 --> 01:59:12,394
BEST-ICU IS LED BY MPIs

3407
01:59:12,394 --> 01:59:14,429
DR. MICHELLE BALAS AT THE

3408
01:59:14,429 --> 01:59:16,265
UNIVERSITY OF NEBRASKA AND THE

3409
01:59:16,265 --> 01:59:17,332
UNIVERSITY OF WISCONSIN.

3410
01:59:17,332 --> 01:59:20,802
AND OUR STUDY BEST-ICU DESCRIBES

3411
01:59:20,802 --> 01:59:21,470
BEHAVIORAL, ECONOMIC AND

3412
01:59:21,470 --> 01:59:24,306
STAFFING STRATEGIES TO INCREASE

3413
01:59:24,306 --> 01:59:27,109
ADOPTION OF THE ABCDEF BUNDLE IN

3414
01:59:27,109 --> 01:59:27,709
THE ICU.

3415
01:59:27,709 --> 01:59:29,011
ON THE NEXT SLIDE YOU'LL SEE

3416
01:59:29,011 --> 01:59:30,112
THAT WHAT WE'RE REALLY

3417
01:59:30,112 --> 01:59:32,414
INTERESTED IN IS IMPROVING ICU

3418
01:59:32,414 --> 01:59:33,081
SURVIVORSHIP.

3419
01:59:33,081 --> 01:59:35,150
WE KNOW THAT AN INCREASING

3420
01:59:35,150 --> 01:59:36,885
NUMBER OF PATIENTS ARE SURVIVING

3421
01:59:36,885 --> 01:59:38,987
THEIR INITIAL CRITICAL ILLNESS,

3422
01:59:38,987 --> 01:59:40,956
BUT BEING DISCHARGED WITH

3423
01:59:40,956 --> 01:59:43,492
WORSENING OR NEW IMPAIRMENTS

3424
01:59:43,492 --> 01:59:45,093
INCLUDING CHANGES IN MENTAL

3425
01:59:45,093 --> 01:59:46,962
HEALTH, NEW COGNITIVE AND/OR

3426
01:59:46,962 --> 01:59:49,598
PHYSICAL IMPAIRMENTS, AND THESE

3427
01:59:49,598 --> 01:59:51,566
ALSO IMPACT PATIENTS AND

3428
01:59:51,566 --> 01:59:53,969
FAMILIES' FINANCES AND LARGER

3429
01:59:53,969 --> 01:59:55,070
FAMILY IMPACT.

3430
01:59:55,070 --> 01:59:56,905
THIS IS BROADLY CALLED POST

3431
01:59:56,905 --> 01:59:57,706
INTENSIVE CARE SYNDROME.

3432
01:59:57,706 --> 01:59:59,574
ON THE NEXT SLIDE, WE KNOW THAT

3433
01:59:59,574 --> 02:00:02,744
THIS MORBIDITY IS POTENTIALLY

3434
02:00:02,744 --> 02:00:03,545
PREVENTABLE THROUGH THE

3435
02:00:03,545 --> 02:00:04,947
APPLICATION OF EVIDENCE-BASED

3436
02:00:04,947 --> 02:00:06,214
GUIDELINES FROM THE SOCIETY OF

3437
02:00:06,214 --> 02:00:07,916
CRITICAL CARE MEDICINE.

3438
02:00:07,916 --> 02:00:10,652
SO THESE GUIDELINES REALLY

3439
02:00:10,652 --> 02:00:11,520
PROVIDE INTERDISCIPLINARY

3440
02:00:11,520 --> 02:00:13,689
APPROACH TO MANAGE AND TREAT

3441
02:00:13,689 --> 02:00:16,892
COMMON ICU INTERVENTIONS AND

3442
02:00:16,892 --> 02:00:18,393
SYMPTOMS, IN AN

3443
02:00:18,393 --> 02:00:19,194
INTERDISCIPLINARY FASHION.

3444
02:00:19,194 --> 02:00:21,897
ONE WAY THAT THESE GUIDELINES

3445
02:00:21,897 --> 02:00:24,733
HAVE BEEN PROMOTED TO BE

3446
02:00:24,733 --> 02:00:25,400
IMPLEMENTED INTO PRACTICE IS

3447
02:00:25,400 --> 02:00:28,036
THROUGH THE ABCDEF BUNDLE, AND

3448
02:00:28,036 --> 02:00:30,105
YOU CAN SEE ON THE RIGHT-HAND

3449
02:00:30,105 --> 02:00:31,640
SIDE OF THE SLIDE SORT OF WHAT

3450
02:00:31,640 --> 02:00:34,376
THE BUNDLE INCLUDES, AND REALLY

3451
02:00:34,376 --> 02:00:36,678
HOW IT IS A MULTIDISCIPLINARY

3452
02:00:36,678 --> 02:00:38,113
TEAM-BASED APPROACH THAT

3453
02:00:38,113 --> 02:00:40,849
INCLUDES NURSES, PHYSICIANS,

3454
02:00:40,849 --> 02:00:41,616
RESPIRATORY THEIR PACIFIC

3455
02:00:41,616 --> 02:00:44,052
ISLANDERS, PHYSICAL AND

3456
02:00:44,052 --> 02:00:44,820
OCCUPATIONAL THERAPISTS, AS WELL

3457
02:00:44,820 --> 02:00:46,221
AS THE WHOLE TEAM REALLY WORKING

3458
02:00:46,221 --> 02:00:47,556
TOGETHER EACH DAY TO IMPLEMENT

3459
02:00:47,556 --> 02:00:48,523
THE BUNDLE.

3460
02:00:48,523 --> 02:00:49,858
BUT THE CHALLENGE IS, EVEN

3461
02:00:49,858 --> 02:00:51,727
THOUGH THE BUNDLE IS HIGHLY

3462
02:00:51,727 --> 02:00:53,261
EFFICACIOUS, IT'S NOT ALWAYS

3463
02:00:53,261 --> 02:00:58,166
HAPPENING ROUTINELY IN CARE.

3464
02:00:58,166 --> 02:01:00,502
SO THERE'S MULTIPLE BARRIERS TO

3465
02:01:00,502 --> 02:01:04,206
THE DELIVER REE REST OF THE BUNE

3466
02:01:04,206 --> 02:01:06,575
BUT WHAT BEST-ICU DOES IS TO

3467
02:01:06,575 --> 02:01:07,409
TEST THE IMPLEMENTATION

3468
02:01:07,409 --> 02:01:08,243
STRATEGIES.

3469
02:01:08,243 --> 02:01:10,345
SO OUR TRIAL IS BEING CONDUCTED

3470
02:01:10,345 --> 02:01:12,948
IN THREE GEOGRAPHICALLY AND

3471
02:01:12,948 --> 02:01:14,483
ORGANIZATIONALLY SEPARATE SAFETY

3472
02:01:14,483 --> 02:01:15,817
NET HOSPITALS IN THE MIDWEST,

3473
02:01:15,817 --> 02:01:18,653
AND WE'LL BE TESTING TWO

3474
02:01:18,653 --> 02:01:19,521
IMPLEMENTATION STRATEGIES.

3475
02:01:19,521 --> 02:01:22,290
THESE ARE UNIT-BASED STRATEGIES.

3476
02:01:22,290 --> 02:01:24,359
THE FIRST ONE IS AN ELECTRONIC

3477
02:01:24,359 --> 02:01:27,295
UNIT DASHBOARD THAT PROVIDES

3478
02:01:27,295 --> 02:01:28,964
REALTIME AUDIT AND FEEDBACK TO

3479
02:01:28,964 --> 02:01:30,799
ALL CLINICIANS ON THE UNIT,

3480
02:01:30,799 --> 02:01:32,734
USING A DEDICATED DISPLAY ON THE

3481
02:01:32,734 --> 02:01:33,001
MONITOR.

3482
02:01:33,001 --> 02:01:34,770
IT REALLY SHOWS COMPLETION

3483
02:01:34,770 --> 02:01:36,838
STATUS OF EACH BUNDLE ELEMENT IN

3484
02:01:36,838 --> 02:01:40,442
REALTIME.

3485
02:01:40,442 --> 02:01:42,310
THE SECOND IMPLEMENTATION

3486
02:01:42,310 --> 02:01:44,746
STRATEGY IS A NURSE FACILITATOR,

3487
02:01:44,746 --> 02:01:46,581
WHICH IS A DEDICATED ICU NURSE

3488
02:01:46,581 --> 02:01:50,152
OUT OF STAFFING WHO HELPS THE

3489
02:01:50,152 --> 02:01:52,788
ICU TEAM TASKED WITH THE BUNDLE

3490
02:01:52,788 --> 02:01:54,523
DONE, ALSO SERVING AS A COACH OR

3491
02:01:54,523 --> 02:01:55,190
CHAMPION ON THE UNIT.

3492
02:01:55,190 --> 02:01:56,825
UNITS WILL BE RANDOMIZED TO

3493
02:01:56,825 --> 02:01:58,794
THESE STRATEGIES IN A STEPPED

3494
02:01:58,794 --> 02:02:02,230
WEDGE FASHION WITH THE FIRST TWO

3495
02:02:02,230 --> 02:02:03,398
ICUs GETTING READY TO

3496
02:02:03,398 --> 02:02:04,499
IMPLEMENT IN OCTOBER OF 2024.

3497
02:02:04,499 --> 02:02:06,601
WITH THE LAST TWO UNITS BEING

3498
02:02:06,601 --> 02:02:10,672
RANDOMIZED IN JANUARY OF 2026.

3499
02:02:10,672 --> 02:02:13,408
THIS IS A HYBRID TYPE THREE

3500
02:02:13,408 --> 02:02:13,608
TRIAL.

3501
02:02:13,608 --> 02:02:15,510
OUR PRIMARY OUT COME IS BUNDLE

3502
02:02:15,510 --> 02:02:16,311
ADOPTION.

3503
02:02:16,311 --> 02:02:17,579
ALSO EVALUATING CLINICAL

3504
02:02:17,579 --> 02:02:20,649
OUTCOMES AND THEN CLINICIAN WORK

3505
02:02:20,649 --> 02:02:22,317
INTENSITY ACCEPTABILITY BARRIERS

3506
02:02:22,317 --> 02:02:27,155
AND FACILITATORS.

3507
02:02:27,155 --> 02:02:29,224
I'M GOING TO TALK A BIT ON HOW

3508
02:02:29,224 --> 02:02:30,125
WE'VE STARTED TO ENGAGE THE

3509
02:02:30,125 --> 02:02:30,559
HEALTH SYSTEM.

3510
02:02:30,559 --> 02:02:33,395
ONE OF OUR MILESTONES IN THE

3511
02:02:33,395 --> 02:02:35,197
PLANNING PHASE WAS WORKING WITH

3512
02:02:35,197 --> 02:02:37,699
STAKEHOLDERS AT EACH SITE TO

3513
02:02:37,699 --> 02:02:39,000
TAILOR OUR IMPLEMENTATION

3514
02:02:39,000 --> 02:02:40,302
STRATEGIES.

3515
02:02:40,302 --> 02:02:41,303
SO WE CONDUCTED STAKEHOLDER

3516
02:02:41,303 --> 02:02:42,737
FOCUS GROUPS ACROSS ALL SITES,

3517
02:02:42,737 --> 02:02:44,172
REALLY TALKING ABOUT THE

3518
02:02:44,172 --> 02:02:45,540
IMPLEMENTATION STRATEGIES THAT

3519
02:02:45,540 --> 02:02:47,809
WE WERE PLANNING TO TEST AND GET

3520
02:02:47,809 --> 02:02:49,211
IN THEIR FEEDBACK ABOUT WHAT

3521
02:02:49,211 --> 02:02:52,080
MIGHT BE NEEDED IN THEIR UNIT TO

3522
02:02:52,080 --> 02:02:53,048
ADOPT ONE OF THESE STRATEGIES.

3523
02:02:53,048 --> 02:02:54,716
SO YOU CAN SEE FROM THE SECOND

3524
02:02:54,716 --> 02:02:56,451
COLUMN THAT WE GOT REALLY

3525
02:02:56,451 --> 02:02:58,887
HELPFUL INFORMATION FROM

3526
02:02:58,887 --> 02:03:00,956
STAKEHOLDERS THAT THEN HELP US

3527
02:03:00,956 --> 02:03:02,157
FURTHER SPECIFY OUR

3528
02:03:02,157 --> 02:03:03,158
IMPLEMENTATION STRATEGIES.

3529
02:03:03,158 --> 02:03:05,327
SO FOR EXAMPLE, WITH THE NURSE

3530
02:03:05,327 --> 02:03:07,963
FACILITATOR, WE'VE ADJUSTED OUR

3531
02:03:07,963 --> 02:03:09,498
TRAINING AND ONGOING CONNECTION

3532
02:03:09,498 --> 02:03:10,866
WITH FACILITATORS TO ENSURE THAT

3533
02:03:10,866 --> 02:03:12,033
THEY HAVE THE SKILLS THEY NEED

3534
02:03:12,033 --> 02:03:14,436
TO COMPLETE THE ROLE.

3535
02:03:14,436 --> 02:03:17,539
ON THE NEXT SLIDE, WE DESCRIBE

3536
02:03:17,539 --> 02:03:18,840
ADDITIONAL ENGAGEMENT THAT WE'VE

3537
02:03:18,840 --> 02:03:22,777
CONDUCTED AT THE HEALTH SYSTEM,

3538
02:03:22,777 --> 02:03:23,879
BOTH ACROSS LEVELS IN THE HEALTH

3539
02:03:23,879 --> 02:03:27,082
SYSTEM AND ALSO OVER TIME.

3540
02:03:27,082 --> 02:03:29,484
SO THINKING ABOUT WHO WE ENGAGED

3541
02:03:29,484 --> 02:03:31,786
IN THE PLANNING PHASE OF THE

3542
02:03:31,786 --> 02:03:33,688
GRANT, OUR ENGAGEMENT FOCUSED

3543
02:03:33,688 --> 02:03:35,957
MORE ON EXECUTIVE LEADERSHIP AND

3544
02:03:35,957 --> 02:03:37,726
ICU LEADERSHIP IN GETTING

3545
02:03:37,726 --> 02:03:39,828
INTEREST AND BUY-IN, POTENTIALLY

3546
02:03:39,828 --> 02:03:40,695
PARTICIPATING IN THE STUDY.

3547
02:03:40,695 --> 02:03:43,632
NOW THAT WE ARE IN THE PLANNING

3548
02:03:43,632 --> 02:03:46,001
PHASE STARTING THE CLINICAL

3549
02:03:46,001 --> 02:03:48,270
TRIAL, WE'VE ENGAGED MUCH MORE

3550
02:03:48,270 --> 02:03:50,705
WITH ICU LEADERS AND UNIT

3551
02:03:50,705 --> 02:03:51,373
LEADERS, INCLUDING NURSE

3552
02:03:51,373 --> 02:03:53,108
MANAGERS AND MEDICAL DIRECTORS,

3553
02:03:53,108 --> 02:03:54,442
BECAUSE WE REALLY WANT TO ENSURE

3554
02:03:54,442 --> 02:03:56,745
THAT THE INTERVENTIONS ARE

3555
02:03:56,745 --> 02:03:59,915
TAILORED TO THEIR UNIT.

3556
02:03:59,915 --> 02:04:06,488
ANOTHER KEY MEMBERS,

3557
02:04:06,488 --> 02:04:10,759
MULTI-DI DISCIPLINARY, ALL

3558
02:04:10,759 --> 02:04:11,526
CLINICIANS ARE FAMILIAR WITH THE

3559
02:04:11,526 --> 02:04:11,860
STUDY.

3560
02:04:11,860 --> 02:04:13,061
PATIENT AND FAMILY ENGAGEMENT

3561
02:04:13,061 --> 02:04:15,697
REALLY HAS HAPPENED FROM THE

3562
02:04:15,697 --> 02:04:15,964
BEGINNING.

3563
02:04:15,964 --> 02:04:18,099
THE SOCIETY OF CRITICAL CARE

3564
02:04:18,099 --> 02:04:19,634
MEDICINE'S GUIDELINES INCLUDE

3565
02:04:19,634 --> 02:04:20,869
PATIENTS, FAMILIES AND THEIR

3566
02:04:20,869 --> 02:04:22,370
DEVELOPMENT, SO YOU KNOW THEIR

3567
02:04:22,370 --> 02:04:24,139
VOICES HAVE BEEN INCLUDED EARLY

3568
02:04:24,139 --> 02:04:25,006
IN THIS WORK.

3569
02:04:25,006 --> 02:04:27,242
AND THEN FINALLY, IT HAS BEEN

3570
02:04:27,242 --> 02:04:29,311
REALLY EARLY ON IN ENGAGEMENT

3571
02:04:29,311 --> 02:04:31,446
BECAUSE AS I MENTIONED, ONE OF

3572
02:04:31,446 --> 02:04:34,015
OUR IMPLEMENTATION STRATEGIES IS

3573
02:04:34,015 --> 02:04:36,418
AN EHR DASHBOARD, SO ENSURING

3574
02:04:36,418 --> 02:04:37,852
THAT THAT WAS BUILT AT EACH SITE

3575
02:04:37,852 --> 02:04:40,021
TOOK A LOT OF ENGAGEMENT.

3576
02:04:40,021 --> 02:04:41,890
AND THEN OVER TIME AS FAR AS

3577
02:04:41,890 --> 02:04:44,192
WHEN WE INVOLVED HEALTH SYSTEM

3578
02:04:44,192 --> 02:04:45,994
PARTNERS, DURING THE PLANNING

3579
02:04:45,994 --> 02:04:49,464
PHASE OF THE GRANT, WE SPENT

3580
02:04:49,464 --> 02:04:51,099
TIME, EACH OF THE SITE PIs

3581
02:04:51,099 --> 02:04:53,101
REVIEWED LOCAL POLICIES AND EH

3582
02:04:53,101 --> 02:04:54,202
RDOC EUM TAITION TO ENSURE THAT

3583
02:04:54,202 --> 02:04:56,171
THE EVIDENCE-BASED PRACTICES

3584
02:04:56,171 --> 02:04:58,173
WERE PRESENT, AND WE ALSO

3585
02:04:58,173 --> 02:05:00,809
IDENTIFIED WHEN THERE WERE

3586
02:05:00,809 --> 02:05:01,276
ORGANIZATION-SPECIFIC

3587
02:05:01,276 --> 02:05:02,210
CHARACTERISTICS THAT MAY DIFFER

3588
02:05:02,210 --> 02:05:04,846
BUT DIDN'T NEED TO CHANGE.

3589
02:05:04,846 --> 02:05:07,816
THEN LIKE I MENTIONED, WE ALSO

3590
02:05:07,816 --> 02:05:09,884
INVOLVED THE SITES AND TAILORING

3591
02:05:09,884 --> 02:05:10,885
IMPLEMENTATION STRATEGIES.

3592
02:05:10,885 --> 02:05:12,320
NOW THAT WE'RE CONDUCTING STUT

3593
02:05:12,320 --> 02:05:15,290
DI, WE'RE WORKING ON ENGAGE OUR

3594
02:05:15,290 --> 02:05:17,259
UNIT CHAMPIONS MORE FULLY BY

3595
02:05:17,259 --> 02:05:18,360
PROVIDING RESOURCES BOTH

3596
02:05:18,360 --> 02:05:20,328
WEB-BASED AND UPDATES AS THE

3597
02:05:20,328 --> 02:05:23,598
STUDY CONTINUES.

3598
02:05:23,598 --> 02:05:24,933
ON THE NEXT SLIDE, I WANTED TO

3599
02:05:24,933 --> 02:05:30,071
MENTION A BIT ABOUT OUR TEAM

3600
02:05:30,071 --> 02:05:31,072
COMPOSITION FOR THE STUDY,

3601
02:05:31,072 --> 02:05:32,274
BECAUSE I THINK THAT IT'S BEEN

3602
02:05:32,274 --> 02:05:34,476
REALLY HELPFUL THAT TEAM MEMBERS

3603
02:05:34,476 --> 02:05:37,345
AT EACH SITE HAVE RESEARCH

3604
02:05:37,345 --> 02:05:38,313
CRITICAL CARE QUALITY

3605
02:05:38,313 --> 02:05:41,383
IMPROVEMENT AND HEALTH SYSTEMS

3606
02:05:41,383 --> 02:05:42,517
EXPERTISE, AND WE'VE REALLY

3607
02:05:42,517 --> 02:05:44,753
BUILT OUR RELATIONSHIPS WITH

3608
02:05:44,753 --> 02:05:46,554
BEST ICU ON PREVIOUS

3609
02:05:46,554 --> 02:05:47,522
COLLABORATIONS.

3610
02:05:47,522 --> 02:05:50,458
SO WE'VE HAD PREVIOUS WORK WITH

3611
02:05:50,458 --> 02:05:51,893
UNIT COMMITTEES SUCH AS QUALITY

3612
02:05:51,893 --> 02:05:53,328
IMPROVEMENT AND THAT SORT OF

3613
02:05:53,328 --> 02:05:55,196
EXISTING TRUST HAS BEEN REALLY

3614
02:05:55,196 --> 02:05:56,298
HELPFUL ENGAGING THEM WITH THIS

3615
02:05:56,298 --> 02:05:59,801
RESEARCH.

3616
02:05:59,801 --> 02:06:02,103
AND THEN FINALLY FROM A SITE

3617
02:06:02,103 --> 02:06:03,405
P.I. PERSPECTIVE, WHAT'S BEEN

3618
02:06:03,405 --> 02:06:05,273
REALLY HELPFUL FOR ME IS THE

3619
02:06:05,273 --> 02:06:06,174
FREQUENCY OF MEETINGS.

3620
02:06:06,174 --> 02:06:08,677
OUR RESEARCH TEAM MEETS BYE

3621
02:06:08,677 --> 02:06:13,281
WEEKLYBIWEEKLY, SERVING AS THE

3622
02:06:13,281 --> 02:06:14,516
INTERFACE BETWEEN THE BROADER

3623
02:06:14,516 --> 02:06:16,818
RESEARCH TEAM AND THE HEALTH

3624
02:06:16,818 --> 02:06:18,153
SYSTEM, BECAUSE I CAN TAKE

3625
02:06:18,153 --> 02:06:19,421
INFORMATION FROM THE TEAM TO THE

3626
02:06:19,421 --> 02:06:22,390
HEALTH SYSTEM, BUT I CAN ALSO

3627
02:06:22,390 --> 02:06:24,359
QUICKLY -- LOCAL SITES THAT NEED

3628
02:06:24,359 --> 02:06:25,794
TO BE PROVIDED TO THE RESEARCH

3629
02:06:25,794 --> 02:06:28,863
TEAMS, SO IT REALLY HELPS

3630
02:06:28,863 --> 02:06:32,567
PROMOTE THAT COMMUNICATION.

3631
02:06:32,567 --> 02:06:33,635
FREQUENCY OF MEETINGS, YOU CAN

3632
02:06:33,635 --> 02:06:35,437
SEE OUR INTERVENTIONS ARE PRETTY

3633
02:06:35,437 --> 02:06:36,338
COMPLEX SO WE NEEDED TO BREAK

3634
02:06:36,338 --> 02:06:37,772
OUT ADDITIONAL MEETINGS TO GET

3635
02:06:37,772 --> 02:06:39,174
THOSE UP AND RUNNING DURING THE

3636
02:06:39,174 --> 02:06:39,874
PLANNING PHASE.

3637
02:06:39,874 --> 02:06:41,176
AND THEN FINALLY, IT'S BEEN

3638
02:06:41,176 --> 02:06:42,944
REALLY HELPFUL FOR OUR TEAM TO

3639
02:06:42,944 --> 02:06:45,347
BE ENGAGED WITH THE PRAGMATIC

3640
02:06:45,347 --> 02:06:46,448
TRIALS COLLABORATORY AND

3641
02:06:46,448 --> 02:06:51,152
REFINING OUR RESEARCH PROJECT.

3642
02:06:51,152 --> 02:06:52,587
ARE JUST THINKING ABOUT SOME

3643
02:06:52,587 --> 02:06:54,456
CONSIDERATIONS THAT WE'VE

3644
02:06:54,456 --> 02:06:55,423
LEARNED JUST IN THE LAST YEAR

3645
02:06:55,423 --> 02:06:59,227
AND A HALF WITH THIS WORK, BUN

3646
02:06:59,227 --> 02:07:01,129
OF THE THINGS WE CONTINUED TO

3647
02:07:01,129 --> 02:07:02,697
NAVIGATE IS SO SOME OF THOSE

3648
02:07:02,697 --> 02:07:05,567
HEALTH SYSTEM STRUCTURES, LIKE

3649
02:07:05,567 --> 02:07:07,302
FOR EXAMPLE, HOW WE COMPENSATE

3650
02:07:07,302 --> 02:07:08,803
THE NURSE FACILITATOR THAT IS

3651
02:07:08,803 --> 02:07:10,505
ONE OF OUR IMPLEMENTATION

3652
02:07:10,505 --> 02:07:13,675
STRATEGIES BUT REALLY ENSURING

3653
02:07:13,675 --> 02:07:15,410
HOW THE UNIT GETS REIMBURSED FOR

3654
02:07:15,410 --> 02:07:17,746
THAT HOURLY RATE TAKES

3655
02:07:17,746 --> 02:07:19,280
NAVIGATING THROUGH VARIOUS HR

3656
02:07:19,280 --> 02:07:21,049
AND NURSING APPROVAL COMMITTEES,

3657
02:07:21,049 --> 02:07:23,585
AND IT DIFFERS AT EACH SITE.

3658
02:07:23,585 --> 02:07:27,088
BLENDING RESEARCH AND CLINICAL

3659
02:07:27,088 --> 02:07:29,290
TIMELINES HAS BEEN A LEARNING

3660
02:07:29,290 --> 02:07:30,425
CURVE, RECOGNIZING THAT WE'VE

3661
02:07:30,425 --> 02:07:32,927
HAD DASHBOARD BUILD AT EACH SITE

3662
02:07:32,927 --> 02:07:35,997
AND THAT CLINICAL I.T. SUPPORT

3663
02:07:35,997 --> 02:07:37,866
WILL HAVE HAD A FULL LIST OF

3664
02:07:37,866 --> 02:07:38,967
CLINICAL RESPONSIBILITIES.

3665
02:07:38,967 --> 02:07:41,736
SO HOW WE FIT IN OUR RESEARCH

3666
02:07:41,736 --> 02:07:43,104
REQUEST AND THE TIMELINE

3667
02:07:43,104 --> 02:07:46,441
NAVIGATING THAT AT EACH SITE WAS

3668
02:07:46,441 --> 02:07:48,610
DOABLE BUT IT TOOK SOME TIME.

3669
02:07:48,610 --> 02:07:51,613
THEN FINALLY HIRING THE NURSE

3670
02:07:51,613 --> 02:07:52,347
FACILITATOR INTERVENTION CAN

3671
02:07:52,347 --> 02:07:56,751
FEEL LIKE A BIG ASK, GIVI GIVENT

3672
02:07:56,751 --> 02:07:58,787
THERE IS A NATIONWIDE NURSING

3673
02:07:58,787 --> 02:08:00,522
SHORTAGE AND HIGH BURNOUT, BUT

3674
02:08:00,522 --> 02:08:01,723
ENGAGING WITH THE NURSE MANAGERS

3675
02:08:01,723 --> 02:08:03,258
EARLY AND REALLY HAVING THEM

3676
02:08:03,258 --> 02:08:04,359
UNDERSTAND THE INTERVENTION HAS

3677
02:08:04,359 --> 02:08:05,894
BEEN HELPFUL IN THIS PROCESS.

3678
02:08:05,894 --> 02:08:07,862
SO I THINK BOTH OF THOSE POINTS

3679
02:08:07,862 --> 02:08:09,431
JUST DESCRIBE THE LAYERS OF

3680
02:08:09,431 --> 02:08:11,733
APPROVAL AND REALLY NAVIGATING A

3681
02:08:11,733 --> 02:08:13,034
LARGE ACADEMIC HEALTH SYSTEM, IT

3682
02:08:13,034 --> 02:08:16,204
JUST TAKES SOME TIME.

3683
02:08:16,204 --> 02:08:17,338
FINALLY ONE THING THAT WE'VE

3684
02:08:17,338 --> 02:08:18,773
BEEN THINKING ABOUT IS THE

3685
02:08:18,773 --> 02:08:20,508
FREQUENCY OF ENGAGEMENT,

3686
02:08:20,508 --> 02:08:22,610
PARTICULARLY AS IT RELATES TO

3687
02:08:22,610 --> 02:08:24,813
SITES THAT MIGHT NOT BE

3688
02:08:24,813 --> 02:08:26,014
RANDOMIZED TO AN INTERVENTION

3689
02:08:26,014 --> 02:08:28,016
UNTIL A YEAR AND A HALF LATER,

3690
02:08:28,016 --> 02:08:29,083
SO WE'RE REALLY THINKING ABOUT

3691
02:08:29,083 --> 02:08:32,387
HOW WE CAN KEEP THOSE UNITS

3692
02:08:32,387 --> 02:08:35,957
ENGAGED BUT NOT OVERBURDEN THEM.

3693
02:08:35,957 --> 02:08:37,859
SO I THINK MY LAST COMMENTS JUST

3694
02:08:37,859 --> 02:08:39,494
RELATE TO OUR CONCLUSIONS.

3695
02:08:39,494 --> 02:08:40,929
WHAT WE'VE FOUND IS THAT OUR

3696
02:08:40,929 --> 02:08:43,164
RESEARCH TOPIC, IT'S BEEN

3697
02:08:43,164 --> 02:08:44,332
HELPFUL, THAT IT'S MEANINGFUL

3698
02:08:44,332 --> 02:08:47,202
AND TIMELY FOR HEALTHCARE

3699
02:08:47,202 --> 02:08:47,635
SYSTEMS.

3700
02:08:47,635 --> 02:08:49,471
EACH OF THE SITES HAS BEEN

3701
02:08:49,471 --> 02:08:51,172
WORKING ALREADY ON INCREASING

3702
02:08:51,172 --> 02:08:54,242
THEIR ADOPTION OF THE A BSM CDEF

3703
02:08:54,242 --> 02:08:55,009
BUNDLE SO THEY'RE VERY

3704
02:08:55,009 --> 02:08:56,344
INTERESTED IN THIS STUDY.

3705
02:08:56,344 --> 02:08:59,747
IT WAS ALSO HELPFUL FOR US TO

3706
02:08:59,747 --> 02:09:01,516
BUILD ON PREVIOUS COLLABORATIONS

3707
02:09:01,516 --> 02:09:03,251
AND PARTNERSHIPS AT EACH SIDE R.

3708
02:09:03,251 --> 02:09:04,285
SITE THAT WE'VE ESTABLISHED

3709
02:09:04,285 --> 02:09:05,453
THAT'S HELPED THIS WORK MOVE

3710
02:09:05,453 --> 02:09:06,554
FORWARD, AND THEN FINALLY WOULD

3711
02:09:06,554 --> 02:09:08,089
SAY THAT THIS MECHANISM HAS BEEN

3712
02:09:08,089 --> 02:09:09,991
REALLY HELPFUL TO BUILD

3713
02:09:09,991 --> 02:09:12,393
INFRASTRUCTURE FOR COMPLEX

3714
02:09:12,393 --> 02:09:14,262
INTERVENTIONS THAT WE'RE TESTING

3715
02:09:14,262 --> 02:09:15,563
IN REAL WORLD SETTINGS.

3716
02:09:15,563 --> 02:09:17,599
SO I JUST WANTED TO THANK THE

3717
02:09:17,599 --> 02:09:20,335
BROADER BEST-ICU TEAM,

3718
02:09:20,335 --> 02:09:25,707
RECOGNIZING DRS. MICHELLE BALAS

3719
02:09:25,707 --> 02:09:27,008
FOR LEADING THIS TEAM.

3720
02:09:27,008 --> 02:09:27,709
>> THANKS VERY MUCH.

3721
02:09:27,709 --> 02:09:30,144
WE'LL HEAR NEXT FROM SEBASTIAN.

3722
02:09:30,144 --> 02:09:30,778
>> HI.

3723
02:09:30,778 --> 02:09:32,514
MY NAME IS SEBASTIAN TONG.

3724
02:09:32,514 --> 02:09:34,282
I'M A FAMILY PHYSICIAN AND

3725
02:09:34,282 --> 02:09:35,049
ASSISTANT PROFESSOR AT THE

3726
02:09:35,049 --> 02:09:35,917
UNIVERSITY OF WASHINGTON AND I'M

3727
02:09:35,917 --> 02:09:45,460
ONE OF THE CO-PIs WITH CUE

3728
02:09:45,460 --> 02:09:54,669
SHK -- HOWWE ENGAGE WITH OUR PRN

3729
02:09:54,669 --> 02:09:56,938
COMPLEMENTING KIND OF ENGAGEMENT

3730
02:09:56,938 --> 02:09:58,473
IN SPECIFIC STUDIES, AND I WANT

3731
02:09:58,473 --> 02:10:01,876
TO TALK MORE TODAY ABOUT A

3732
02:10:01,876 --> 02:10:02,977
LARGER ENGAGEMENT INFRASTRUCTURE

3733
02:10:02,977 --> 02:10:05,847
KIND OF PRE AND POST STUDY AND

3734
02:10:05,847 --> 02:10:11,786
ALSO LONGITUDALLY.

3735
02:10:11,786 --> 02:10:13,988
SO I'M GOING TO BRIEFLY REVIEW

3736
02:10:13,988 --> 02:10:15,590
OUR STUDY AGAIN, I THINK YOU

3737
02:10:15,590 --> 02:10:17,392
HEARD IT FROM DR. PATEL EARLIER.

3738
02:10:17,392 --> 02:10:19,027
WE'RE USING A NURSE CARE

3739
02:10:19,027 --> 02:10:21,229
MANAGEMENT MODEL TO PROVIDE

3740
02:10:21,229 --> 02:10:22,664
NON-PHARMACOLOGICAL TREATMENTS

3741
02:10:22,664 --> 02:10:23,665
TO CHRONIC PAIN ESPECIALLY IF

3742
02:10:23,665 --> 02:10:25,400
RURAL AREAS.

3743
02:10:25,400 --> 02:10:29,037
AND OUR PROJECT HAS A NURSE CARE

3744
02:10:29,037 --> 02:10:30,438
MANAGER PROVIDE THREE DIFFERENT

3745
02:10:30,438 --> 02:10:33,541
COMPONENTS OF CARE, DOING SOME

3746
02:10:33,541 --> 02:10:35,410
CARE COORDINATION FOR CHRONIC

3747
02:10:35,410 --> 02:10:36,411
PAIN MANAGEMENT, THEY'LL BE

3748
02:10:36,411 --> 02:10:39,981
TRAINED TO PROVIDE COGNITIVE

3749
02:10:39,981 --> 02:10:43,117
BEHAVIORAL THERAPY AND HAVE

3750
02:10:43,117 --> 02:10:43,851
ONGOING CASE-BASED SESSIONS WITH

3751
02:10:43,851 --> 02:10:46,187
ONE OF OUR CLINICAL

3752
02:10:46,187 --> 02:10:47,889
PSYCHOLOGISTS AT UW, AND THEN

3753
02:10:47,889 --> 02:10:50,592
THERE WILL ALSO BE PREPARING

3754
02:10:50,592 --> 02:10:52,126
PATIENTS AND REFERRING PATIENTS

3755
02:10:52,126 --> 02:10:54,896
TO PARTICIPATE IN A REMOTELY

3756
02:10:54,896 --> 02:10:56,631
DELIVERED ENHANCED FITNESS

3757
02:10:56,631 --> 02:10:57,832
EXERCISE PROGRAM, WITH THE

3758
02:10:57,832 --> 02:10:59,267
ULTIMATE GOAL WITH THESE

3759
02:10:59,267 --> 02:11:01,603
ELEMENTS OF REDUCING PAIN

3760
02:11:01,603 --> 02:11:02,604
INTERFERENCE IN PEOPLE'S DAILY

3761
02:11:02,604 --> 02:11:06,975
LIVES.

3762
02:11:06,975 --> 02:11:09,611
SO OUR STUDY IS TAKING PLACE IN

3763
02:11:09,611 --> 02:11:11,713
TWO REALLY DIVERSE SETTINGS.

3764
02:11:11,713 --> 02:11:14,349
WE'RE DOING THIS WITHIN OUR

3765
02:11:14,349 --> 02:11:16,517
EXISTING PRACTICE-BASED RESEARCH

3766
02:11:16,517 --> 02:11:18,920
NETWORK INFRASTRUCTURES IN WHAT

3767
02:11:18,920 --> 02:11:24,559
WE CALL THE WASHINGTON WYOMING

3768
02:11:24,559 --> 02:11:29,731
ALASKA WYOMING  WIE ONLY ACROSSE

3769
02:11:29,731 --> 02:11:31,499
COUNTRY, IN THE MECKLENBURG AREA

3770
02:11:31,499 --> 02:11:32,567
PARTNERSHIP FOR PRIMARY CARE

3771
02:11:32,567 --> 02:11:33,034
RESEARCH.

3772
02:11:33,034 --> 02:11:35,203
SO THESE ARE TWO WELL

3773
02:11:35,203 --> 02:11:38,439
ESTABLISHED PRIMARY CARE

3774
02:11:38,439 --> 02:11:39,741
PRACTICE-BASED RESEARCH NETWORKS

3775
02:11:39,741 --> 02:11:42,243
THAT DO ONGOING STUDIES WITH

3776
02:11:42,243 --> 02:11:45,880
THEIR PRIMARY CARE PRACTICES AT

3777
02:11:45,880 --> 02:11:47,081
A NUMBER OF PRACTICES.

3778
02:11:47,081 --> 02:11:51,919
SO I'LL TALK NEXT ABOUT SOME OF

3779
02:11:51,919 --> 02:11:53,021
THE PRACTICE ENGAGEMENT

3780
02:11:53,021 --> 02:11:54,555
STRATEGIES THAT ARE ONGOING,

3781
02:11:54,555 --> 02:11:57,291
ESPECIALLY WITHIN THE WAMY

3782
02:11:57,291 --> 02:12:01,796
REGION BUT APPLY TO DIFFERENT

3783
02:12:01,796 --> 02:12:02,430
ELEMENTS AS WELL.

3784
02:12:02,430 --> 02:12:06,834
SO THREE OF THE WAYS WE HAVE

3785
02:12:06,834 --> 02:12:07,735
ONGOING ENGAGEMENT IS THROUGH

3786
02:12:07,735 --> 02:12:09,570
OUR STEERING COMMITTEE, THREUR

3787
02:12:09,570 --> 02:12:11,039
OUR ANNUAL CONFERENCE THAT WE

3788
02:12:11,039 --> 02:12:12,040
HOST EACH YEAR WITHIN OUR

3789
02:12:12,040 --> 02:12:14,776
NETWORK, AND ALSO THROUGH A

3790
02:12:14,776 --> 02:12:16,310
SURVEY AND INTERVIEW RESEARCH

3791
02:12:16,310 --> 02:12:18,012
PANEL THAT WE HAVE.

3792
02:12:18,012 --> 02:12:19,847
SO FIRST TO TALK A BIT ABOUT OUR

3793
02:12:19,847 --> 02:12:27,722
STEERING COMMITTEE, SO WE HAVE

3794
02:12:27,722 --> 02:12:29,190
MONTHLY CALLS ABOUT WHAT WE CALL

3795
02:12:29,190 --> 02:12:30,291
OUR STEERING COMMITTEE FOR OUR

3796
02:12:30,291 --> 02:12:31,759
PRACTICE BASED RESEARCH NETWORK,

3797
02:12:31,759 --> 02:12:35,697
AND THIS IS A GROUP OF

3798
02:12:35,697 --> 02:12:37,565
CLINICIANS THAT IS ACROSS OUR

3799
02:12:37,565 --> 02:12:39,667
FIVE-STATE PACIFIC NORTHWEST

3800
02:12:39,667 --> 02:12:42,136
INTERMOUNTAIN WEST REGION, AND

3801
02:12:42,136 --> 02:12:44,505
THEY INCLUDE BEHAVIORAL HEALTH

3802
02:12:44,505 --> 02:12:46,174
PROVIDERS, PHARMACISTS, PRIMARY

3803
02:12:46,174 --> 02:12:47,875
CARE CLINICIANS, RESIDENCY

3804
02:12:47,875 --> 02:12:49,343
LEADERSHIP FOR FAMILY MEDICINE

3805
02:12:49,343 --> 02:12:52,180
PROGRAMS, AND ALSO SOME HEALTH

3806
02:12:52,180 --> 02:12:53,514
SYSTEM LEADERSHIP FOR RURAL

3807
02:12:53,514 --> 02:12:54,549
HEALTH SYSTEMS AS WELL.

3808
02:12:54,549 --> 02:12:57,285
AND THEY DO BASICALLY STUDY

3809
02:12:57,285 --> 02:13:00,021
AGNOSTIC DISEASE AGNOSTIC

3810
02:13:00,021 --> 02:13:01,355
FEEDBACK AND APPROVAL FOR ALL

3811
02:13:01,355 --> 02:13:03,024
THE STUDIES THAT HAPPEN IN OUR

3812
02:13:03,024 --> 02:13:03,357
NETWORK.

3813
02:13:03,357 --> 02:13:08,596
SO THEY MEET MONTHLY TO PROVIDE

3814
02:13:08,596 --> 02:13:10,131
FEEDBACK ON ANY STUDY THAT COMES

3815
02:13:10,131 --> 02:13:11,165
TO OUR NETWORK.

3816
02:13:11,165 --> 02:13:14,102
AND THEY ALSO HELP SET RESEARCH

3817
02:13:14,102 --> 02:13:15,536
PRIORITIES FOR NETWORK AND SAY

3818
02:13:15,536 --> 02:13:16,704
THESE ARE THE THINGS THAT ARE

3819
02:13:16,704 --> 02:13:17,872
IMPORTANT, THESE ARE THE WAYS

3820
02:13:17,872 --> 02:13:20,508
AND METHODS THAT COULD BE REALLY

3821
02:13:20,508 --> 02:13:23,044
IMPORTANT, AND THEN HELP GUIDE

3822
02:13:23,044 --> 02:13:29,617
THE PRAGMATISM IN THAT WAY.

3823
02:13:29,617 --> 02:13:31,486
SO REALLY THEY SERVE AS A

3824
02:13:31,486 --> 02:13:33,788
CONDUIT BETWEEN THE RESEARCH

3825
02:13:33,788 --> 02:13:35,256
INVESTIGATORS AT KIND OF WHAT I

3826
02:13:35,256 --> 02:13:37,658
CALL THE IVY TOWER IN SEATTLE

3827
02:13:37,658 --> 02:13:40,595
AND OTHER ACADEMIC INSTITUTIONS

3828
02:13:40,595 --> 02:13:42,497
AND THE STEERING COMMITTEE

3829
02:13:42,497 --> 02:13:45,767
SERVES AS A CONDUIT TO THE

3830
02:13:45,767 --> 02:13:47,201
PRACTICES OF WHAT WE HAVE ABOUT

3831
02:13:47,201 --> 02:13:49,103
140 AT THIS POINT AND KIND OF

3832
02:13:49,103 --> 02:13:50,538
REPRESENT THEIR VIEWPOINTS AND

3833
02:13:50,538 --> 02:13:54,142
BRING THEIR VIEWPOINTS TO THE

3834
02:13:54,142 --> 02:13:57,779
FOREFRONT.

3835
02:13:57,779 --> 02:14:00,214
ANOTHER WAY WE GET DIRECT MEMBER

3836
02:14:00,214 --> 02:14:01,749
FEEDBACK, NOT THROUGH THE

3837
02:14:01,749 --> 02:14:02,950
STEERING COMMITTEE, IS THROUGH

3838
02:14:02,950 --> 02:14:04,152
OUR ANNUAL MEETING.

3839
02:14:04,152 --> 02:14:05,820
WE ARE FORTUNATE TO BE

3840
02:14:05,820 --> 02:14:07,255
PARTNERING WITH THE UNIVERSITY

3841
02:14:07,255 --> 02:14:10,558
OF WASHINGTON CTSA TO GET

3842
02:14:10,558 --> 02:14:13,394
FUNDING TO BRING TOGETHER ANYONE

3843
02:14:13,394 --> 02:14:16,631
WHO IS A PRACTICE CHAMPION OR

3844
02:14:16,631 --> 02:14:18,132
REPRESENTING A PRACTICE THAT IS

3845
02:14:18,132 --> 02:14:21,569
INTERESTED IN RESEARCH, ENPHAGED

3846
02:14:21,569 --> 02:14:23,638
IN RESEARCH, TOGETHER FOR AN SL

3847
02:14:23,638 --> 02:14:24,772
ANNUAL MEETING IN SEATTLE.

3848
02:14:24,772 --> 02:14:26,140
THIS IS A PHOTO AT THIS YEAR'S

3849
02:14:26,140 --> 02:14:26,808
ANNUAL MEETING.

3850
02:14:26,808 --> 02:14:28,276
WE WERE FORTUNATE TO HAVE SUN IN

3851
02:14:28,276 --> 02:14:32,814
SEATTLE FOR THE DAY.

3852
02:14:32,814 --> 02:14:34,415
AND THE PRACTICE CHAMPIONS COME

3853
02:14:34,415 --> 02:14:36,050
TOGETHER WITH INVESTIGATORS TO

3854
02:14:36,050 --> 02:14:39,320
REALLY THINK ABOUT RESEARCH

3855
02:14:39,320 --> 02:14:40,688
TOPICS AND WAYS THAT RESEARCH

3856
02:14:40,688 --> 02:14:42,990
STUDIES CAN BE ACTUALIZED AND

3857
02:14:42,990 --> 02:14:44,192
PRAGMATIC FOR PRIMARY CARE

3858
02:14:44,192 --> 02:14:48,229
SETTINGS.

3859
02:14:48,229 --> 02:14:50,231
SO SOME OF THE THINGS WE DO, WE

3860
02:14:50,231 --> 02:14:52,533
HAVE WHAT WOULD BE THE USUAL

3861
02:14:52,533 --> 02:14:59,407
POSTER SESSION, FOR CHAMPIONS,

3862
02:14:59,407 --> 02:15:01,342
SO THAT'S BOTH ACTUALLY

3863
02:15:01,342 --> 02:15:04,512
CHAMPIONS SHOWCASING QI DONE IN

3864
02:15:04,512 --> 02:15:05,813
THEIR PRACTICES SO INVESTIGATORS

3865
02:15:05,813 --> 02:15:07,949
CLERN AND MAYBE BROADEN THAT

3866
02:15:07,949 --> 02:15:10,017
INTO A BROADER CONTRACT OR FOR

3867
02:15:10,017 --> 02:15:11,118
INVESTIGATORS TO PRESENT POSTERS

3868
02:15:11,118 --> 02:15:14,789
AND SHOWCASE AND GET FEEDBACK

3869
02:15:14,789 --> 02:15:16,958
FROM CLINICAL SITES.

3870
02:15:16,958 --> 02:15:19,827
ANOTHER THING WE DO IS HAVE WHAT

3871
02:15:19,827 --> 02:15:21,529
WE CALL NEW COLLABORATORS

3872
02:15:21,529 --> 02:15:21,963
DISCUSSION.

3873
02:15:21,963 --> 02:15:23,598
SO EACH INVESTIGATOR COMES IN

3874
02:15:23,598 --> 02:15:24,932
AND GIVES A FIVE-MINUTE

3875
02:15:24,932 --> 02:15:28,369
PRESENTATION AND THEN BREAK OUT

3876
02:15:28,369 --> 02:15:31,339
INTO SMALL GROUPS WHERE

3877
02:15:31,339 --> 02:15:32,306
CLINICIANS WHO SPEND MOST OF

3878
02:15:32,306 --> 02:15:34,141
THEIR TIME IN PRACTICE SIT DOWN

3879
02:15:34,141 --> 02:15:36,177
IN SMALL GROUP SETTINGS AND FOR

3880
02:15:36,177 --> 02:15:37,612
20 MINUTES GIVE FEEDBACK TO

3881
02:15:37,612 --> 02:15:39,013
INVESTIGATORS ABOUT THEIR STUDY

3882
02:15:39,013 --> 02:15:41,015
DESIGN, THEIR STUDY TOPIC,

3883
02:15:41,015 --> 02:15:43,217
WHAT'S ACTUALLY PRAGMATIC,

3884
02:15:43,217 --> 02:15:47,922
WHAT'S NOT, AND THEY USUALLY ARE

3885
02:15:47,922 --> 02:15:50,157
IN A PROCESS OF GETTING READY TO

3886
02:15:50,157 --> 02:15:51,259
SUBMIT A GRANT APPLICATION AT

3887
02:15:51,259 --> 02:15:53,394
THAT POINT.

3888
02:15:53,394 --> 02:15:54,762
WE HAVE DISCUSSION OF SPECIFIC

3889
02:15:54,762 --> 02:15:58,065
TOM IX AS WELL.

3890
02:15:58,065 --> 02:16:00,534
AND THE FINAL ENGAGEMENT WAY I

3891
02:16:00,534 --> 02:16:02,503
WANT TO HIGHLIGHT IS OUR PARTNER

3892
02:16:02,503 --> 02:16:05,873
PANEL FOR RESEARCH, SO THIS IS A

3893
02:16:05,873 --> 02:16:08,209
GROUP OF CLINICIANS FROM WITHIN

3894
02:16:08,209 --> 02:16:10,878
OUR PRACTICES WHO AGREE TO

3895
02:16:10,878 --> 02:16:13,047
RECEIVE REQUESTS FOR UP TO FIVE

3896
02:16:13,047 --> 02:16:15,616
SURVEYS OF QUALITATIVE

3897
02:16:15,616 --> 02:16:18,119
INTERVIEWS A YEAR.

3898
02:16:18,119 --> 02:16:20,755
THEY DON'T COMMIT TO -- BUT WE

3899
02:16:20,755 --> 02:16:22,390
ACTUALLY HAVE A PRETTY GOOD

3900
02:16:22,390 --> 02:16:25,626
RESPONSE RATE FOR RECRUITING FOR

3901
02:16:25,626 --> 02:16:26,627
INTERVIEWS AND SURVEYS.

3902
02:16:26,627 --> 02:16:29,463
THESE CAN BE CLINICIANS WHO ARE

3903
02:16:29,463 --> 02:16:30,965
IN PRACTICES WHERE THE PRACTICE

3904
02:16:30,965 --> 02:16:36,837
IS PART OF A MEMBER -- OF THE

3905
02:16:36,837 --> 02:16:39,974
WPRN AND HAS PARTICIPATED OR IS

3906
02:16:39,974 --> 02:16:40,741
ONGOINGLY PARTICIPATING IN

3907
02:16:40,741 --> 02:16:41,709
RESEARCH, OR THE OPPOSITE WOULD

3908
02:16:41,709 --> 02:16:42,910
BE CLINICIANS INTERESTED IN

3909
02:16:42,910 --> 02:16:44,712
RESEARCH BUT THEIR PRACTICE

3910
02:16:44,712 --> 02:16:45,246
LEADERSHIP INFRASTRUCTURE

3911
02:16:45,246 --> 02:16:46,914
DOESN'T ALLOW THEM TO REALLY

3912
02:16:46,914 --> 02:16:48,416
ENGAGE IN RESEARCH, SO THAT

3913
02:16:48,416 --> 02:16:50,017
HELPING OUT IN THE WAY THAT --

3914
02:16:50,017 --> 02:16:52,320
SOME WAY THAT THEY CAN.

3915
02:16:52,320 --> 02:16:53,854
AND IT'S DESIGNED TO HELP

3916
02:16:53,854 --> 02:16:54,956
INVESTIGATORS GET PERSPECTIVES

3917
02:16:54,956 --> 02:16:55,957
OF INDIVIDUALS WORKING IN

3918
02:16:55,957 --> 02:16:59,794
PRIMARY CARE PRACTICES.

3919
02:16:59,794 --> 02:17:02,096
WE'VE HAD REALLY GOOD SUCCESS

3920
02:17:02,096 --> 02:17:06,267
WITH GETTING INVESTIGATORS WHO

3921
02:17:06,267 --> 02:17:07,301
LAUNCH THESE SURVEYS OR

3922
02:17:07,301 --> 02:17:09,270
INTERVIEWS ACTUALLY GET FUNDED

3923
02:17:09,270 --> 02:17:11,205
OR USE IT AS A PART OF

3924
02:17:11,205 --> 02:17:13,074
ENGAGEMENT STRATEGY EARLY ON IN

3925
02:17:13,074 --> 02:17:15,676
THEIR STUDY TO REFINE OR ADAPT

3926
02:17:15,676 --> 02:17:19,113
THEIR STUDIES TO PRIMARY CARE

3927
02:17:19,113 --> 02:17:20,448
PRACTICES.

3928
02:17:20,448 --> 02:17:25,252
SO SPEAKING SPECIFICALLY ABOUT

3929
02:17:25,252 --> 02:17:26,654
AIM-CP, WE USED A COMBINATION OF

3930
02:17:26,654 --> 02:17:30,324
ALL THESE STRATEGIES TO ENGAGE

3931
02:17:30,324 --> 02:17:32,626
PRACTICES WITHIN A BROADER

3932
02:17:32,626 --> 02:17:36,263
INFRASTRUCTURE.

3933
02:17:36,263 --> 02:17:39,000
WE DID HAVE A SURVEY LAUNCHED

3934
02:17:39,000 --> 02:17:40,234
SPECIFICALLY ABOUT OUR ENHANCED

3935
02:17:40,234 --> 02:17:41,435
FITNESS COMPONENT AND HOW TO

3936
02:17:41,435 --> 02:17:42,403
ADAPT THAT.

3937
02:17:42,403 --> 02:17:45,106
WE ALSO DID A QUALITATIVE STUDY

3938
02:17:45,106 --> 02:17:47,174
WHERE WE REALLY LEARNED ABOUT

3939
02:17:47,174 --> 02:17:49,710
THE PARTNER PANEL -- PARTNER

3940
02:17:49,710 --> 02:17:51,245
PANEL FOR RESEARCH AND WE

3941
02:17:51,245 --> 02:17:54,015
LEARNED ABOUT HOW ARE PRACTICES

3942
02:17:54,015 --> 02:17:55,416
IMPLEMENTING NON-PHARMACOLOGICAL

3943
02:17:55,416 --> 02:17:56,851
TREATMENT MODALITIES, AND THEN

3944
02:17:56,851 --> 02:18:02,490
AS WE WERE FINISHING UP, CHRONIC

3945
02:18:02,490 --> 02:18:03,524
PAIN MANAGEMENT CAME OUT SO IT

3946
02:18:03,524 --> 02:18:08,629
WAS A REALLY TIMELY RFA FOR US.

3947
02:18:08,629 --> 02:18:11,165
WE'VE HAD DISCUSSIONS WITH OUR

3948
02:18:11,165 --> 02:18:12,700
WPRN STEERING COMMITTEE TO SEE

3949
02:18:12,700 --> 02:18:14,135
THE RELEVANCE, HELP ADAPT OUR

3950
02:18:14,135 --> 02:18:15,836
STUDY AND WE'VE BEEN PRESENTING

3951
02:18:15,836 --> 02:18:17,238
POSTERS AT THE ANNUAL

3952
02:18:17,238 --> 02:18:19,206
CONFERENCE, AND HEARING ABOUT

3953
02:18:19,206 --> 02:18:19,874
NETWORK RESEARCH PRIORITY AND

3954
02:18:19,874 --> 02:18:22,143
HOW OUR STUDY FITS TOGETHER WITH

3955
02:18:22,143 --> 02:18:22,643
THAT.

3956
02:18:22,643 --> 02:18:26,781
AND I'LL SAY WHAT'S CORE TO KIND

3957
02:18:26,781 --> 02:18:29,583
OF OUR ENGAGEMENT IS REALLY

3958
02:18:29,583 --> 02:18:30,351
LONGITUDAL RELATIONSHIPS WITH

3959
02:18:30,351 --> 02:18:34,722
THE PRACTICES, AND LONGITUDAL

3960
02:18:34,722 --> 02:18:37,291
CONNECTIONS GOING TO SITES, AND

3961
02:18:37,291 --> 02:18:39,293
HEARING -- AND GOING TO

3962
02:18:39,293 --> 02:18:40,594
COMMUNITIES AND FULLY ENGAGING

3963
02:18:40,594 --> 02:18:42,563
AND BEING OPEN AND RECEPTIVE TO

3964
02:18:42,563 --> 02:18:44,732
A BIDIRECTIONAL WAY OF DOING

3965
02:18:44,732 --> 02:18:45,933
RESEARCH.

3966
02:18:45,933 --> 02:18:49,103
AND SECOND, I WOULD SAY HAVING

3967
02:18:49,103 --> 02:18:50,671
ONGOING INFRASTRUCTURAL SUPPORT,

3968
02:18:50,671 --> 02:18:53,207
SO WE ARE FORTUNATE ENOUGH TO

3969
02:18:53,207 --> 02:18:56,043
HAVE ONGOING SUPPORT FROM OUR

3970
02:18:56,043 --> 02:18:57,545
CTSA THAT'S FUNDED THROUGH NCATS

3971
02:18:57,545 --> 02:18:59,513
TO DO A LOT OF THIS WORK,

3972
02:18:59,513 --> 02:19:00,681
BECAUSE NONE OF THIS WORK

3973
02:19:00,681 --> 02:19:01,549
HAPPENS WITHOUT DOLLARS

3974
02:19:01,549 --> 02:19:04,085
UNFORTUNATELY.

3975
02:19:04,085 --> 02:19:06,220
AND THE OTHER THING WE'VE DONE

3976
02:19:06,220 --> 02:19:07,655
ON AN ONGOING BASIS IS WE'VE

3977
02:19:07,655 --> 02:19:09,290
ASKED FUNDED STUDIES THAT WORK

3978
02:19:09,290 --> 02:19:13,327
THROUGH OUR NETWORK TO PROVIDE A

3979
02:19:13,327 --> 02:19:15,463
SMALL AMOUNT THAT KIND OF FEEDS

3980
02:19:15,463 --> 02:19:17,665
BACK INTO THE NETWORK AND

3981
02:19:17,665 --> 02:19:19,733
SUPPORTS THE INFRASTRUCTURE.

3982
02:19:19,733 --> 02:19:21,302
SO THAT'S KIND OF WHAT I HAVE.

3983
02:19:21,302 --> 02:19:22,436
I THINK WE'LL BE HAPPY TO ANSWER

3984
02:19:22,436 --> 02:19:25,573
ANY QUESTIONS ABOUT WHAT I

3985
02:19:25,573 --> 02:19:27,007
TALKED ABOUT OR KIND OF THE

3986
02:19:27,007 --> 02:19:28,142
LARGER PICTURE AS WELL.

3987
02:19:28,142 --> 02:19:30,478
THANK YOU.

3988
02:19:30,478 --> 02:19:32,213
>> THANKS, SEBASTIAN, AND
THANKS

3989
02:19:32,213 --> 02:19:33,080
TO ALL OF YOU.

3990
02:19:33,080 --> 02:19:34,782
SO I'LL ASK ALL OF OUR PANELISTS

3991
02:19:34,782 --> 02:19:37,351
TO COME BACK ON CAMERA IF YOU

3992
02:19:37,351 --> 02:19:40,221
CAN, AND FOR A MINUTE, BEFORE WE

3993
02:19:40,221 --> 02:19:41,889
UNDUE THE SLIDE SHARING, WE'LL

3994
02:19:41,889 --> 02:19:42,423
LEAVE THIS SLIDE UP THERE

3995
02:19:42,423 --> 02:19:43,757
BECAUSE YOU CAN SEE THAT EMAIL

3996
02:19:43,757 --> 02:19:45,059
ADDRESS FOR PEOPLE TO EMAIL IN

3997
02:19:45,059 --> 02:19:45,993
QUESTIONS.

3998
02:19:45,993 --> 02:19:46,794
SO WE'LL AT LEAST LEAVE THAT UP

3999
02:19:46,794 --> 02:19:48,295
THERE FOR A FEW MINUTES WHILE WE

4000
02:19:48,295 --> 02:19:52,466
GET STARTED ON THE DISCUSSION.

4001
02:19:52,466 --> 02:19:54,235
THEN I HAVE TO SWITCH BACK AND

4002
02:19:54,235 --> 02:19:55,769
SEE, WE'VE GOT OUR FOLKS BACK ON

4003
02:19:55,769 --> 02:19:56,537
CAMERA AGAIN.

4004
02:19:56,537 --> 02:19:57,204
THANKS.

4005
02:19:57,204 --> 02:19:58,272
BUT I'LL START WHILE WE'RE

4006
02:19:58,272 --> 02:20:01,942
WAITING FOR QUESTIONS TO COME

4007
02:20:01,942 --> 02:20:03,244
IN, I'LL START WITH ONE.

4008
02:20:03,244 --> 02:20:05,012
THIS WAS INSPIRED BY SOMETHING

4009
02:20:05,012 --> 02:20:06,247
NATALIA SAID BUT I'D BE

4010
02:20:06,247 --> 02:20:07,148
INTERESTED IN WHAT ALL OF YOU

4011
02:20:07,148 --> 02:20:08,215
THINK ABOUT THIS.

4012
02:20:08,215 --> 02:20:09,984
NATALIA TALKED ABOUT SORT OF

4013
02:20:09,984 --> 02:20:12,186
GETTING INPUT FROM DIVERSE

4014
02:20:12,186 --> 02:20:17,024
STAKEHOLDERS AND GETTING PRETTY

4015
02:20:17,024 --> 02:20:18,959
DIVERSE -- YEAH, PEOPLE HAD

4016
02:20:18,959 --> 02:20:25,132
DIFFERENT FACTS.

4017
02:20:25,132 --> 02:20:26,433
SOUNDS LIKE THIS IS A DIFFERENT

4018
02:20:26,433 --> 02:20:27,968
DEFINITION OF ECK POISE, WHERE

4019
02:20:27,968 --> 02:20:29,303
DIFFERENT PEOPLE ARE UNSURE

4020
02:20:29,303 --> 02:20:31,939
ABOUT DIFFERENT THINGS AND THEY

4021
02:20:31,939 --> 02:20:32,506
CONFLICT WITH EACH OTHER.

4022
02:20:32,506 --> 02:20:34,241
SO WHAT DO YOU DO ABOUT THAT?

4023
02:20:34,241 --> 02:20:37,311
HOW DO YOU HEAR THAT, WHAT'S

4024
02:20:37,311 --> 02:20:41,415
YOUR ROLE IN RESOLVING OR NOT

4025
02:20:41,415 --> 02:20:42,383
RESOLVING ANY OF THAT, HOW DO

4026
02:20:42,383 --> 02:20:43,684
YOU LEARN FROM THAT WHEN YOU

4027
02:20:43,684 --> 02:20:45,052
HEAR VERY DIFFERENT THINGS FROM

4028
02:20:45,052 --> 02:20:45,853
DIFFERENT PEOPLE.

4029
02:20:45,853 --> 02:20:46,720
NATALIA, MAYBE I'LL START WITH

4030
02:20:46,720 --> 02:20:47,821
YOU SINCE YOU BROUGHT THE

4031
02:20:47,821 --> 02:20:49,223
QUESTION UP, AND I'M SURE THE

4032
02:20:49,223 --> 02:20:50,591
REST OF YOU MAY HAVE HAD THAT

4033
02:20:50,591 --> 02:20:52,326
EXPERIENCE AS WELL, ABOUT

4034
02:20:52,326 --> 02:20:53,527
HEARING DIFFERENT THINGS FROM

4035
02:20:53,527 --> 02:20:55,863
DIFFERENT PEOPLE.

4036
02:20:55,863 --> 02:20:57,431
>> THANKS, GREG, FOR
BRINGING

4037
02:20:57,431 --> 02:20:57,765
THAT UP.

4038
02:20:57,765 --> 02:21:00,267
YOU CAN IMAGINE HOW KIND OF

4039
02:21:00,267 --> 02:21:04,305
FRUSTRATING IT IS IN SOME WAYS.

4040
02:21:04,305 --> 02:21:06,040
I THINK WHAT WAS EYE OPENING,

4041
02:21:06,040 --> 02:21:07,775
THOUGH, IS SOME OF THE PEOPLE

4042
02:21:07,775 --> 02:21:09,643
WHO HAD DIFFERING IDEAS, FOR

4043
02:21:09,643 --> 02:21:11,946
EXAMPLE, ABOUT GROUP MEDICAL

4044
02:21:11,946 --> 02:21:16,050
VISITS OR THE EVIDENCE BASE

4045
02:21:16,050 --> 02:21:17,685
IN -- FOR BACK PAIN, THEY SAID

4046
02:21:17,685 --> 02:21:19,520
PEOPLE HAD VERY HIGH LEVELS

4047
02:21:19,520 --> 02:21:24,024
WITHIN INSURANCE COMPANIES.

4048
02:21:24,024 --> 02:21:27,695
SO CERTAINLY ONE OF THE WAYS

4049
02:21:27,695 --> 02:21:30,231
THAT WE'RE APPROACHING IT IS

4050
02:21:30,231 --> 02:21:31,632
SOMETIMES NOW WE'RE TALKING

4051
02:21:31,632 --> 02:21:33,601
ABOUT ISSUES THAT AREN'T JUST AT

4052
02:21:33,601 --> 02:21:36,070
OUR LOCAL LEVEL BUT POTENTIALLY

4053
02:21:36,070 --> 02:21:37,171
AT A STATE OR EVEN NATIONAL

4054
02:21:37,171 --> 02:21:39,473
LEVEL WHERE YOU HAVE THESE

4055
02:21:39,473 --> 02:21:41,175
DIFFERENT VIEWPOINTS, AND SO

4056
02:21:41,175 --> 02:21:43,911
PART OF IT FOR US NEEDS TO BE

4057
02:21:43,911 --> 02:21:48,949
HOW TO MORE EVENTUALLY

4058
02:21:48,949 --> 02:21:50,050
DISSEMINATE THE EVIDENCE.

4059
02:21:50,050 --> 02:21:51,619
WE ALWAYS -- I KNOW WE TALK

4060
02:21:51,619 --> 02:21:54,688
ABOUT THAT ALL THE TIME, BUT

4061
02:21:54,688 --> 02:21:56,123
IT'S MORE DIFFICULT THAN IT

4062
02:21:56,123 --> 02:21:58,525
SOUNDS BECAUSE WE HAVE -- YOU

4063
02:21:58,525 --> 02:22:01,228
KNOW, WE HAVE OUR STUDIES THAT

4064
02:22:01,228 --> 02:22:02,329
ARE -- WE DON'T WANT THEM

4065
02:22:02,329 --> 02:22:06,567
SITTING IN, YOU KNOW, IN THE WEB

4066
02:22:06,567 --> 02:22:07,034
VIRTUALLY SOMEWHERE.

4067
02:22:07,034 --> 02:22:09,470
SO PART OF IT IS WE'RE REALLY

4068
02:22:09,470 --> 02:22:11,572
THINKING ABOUT DIFFERENT WAYS TO

4069
02:22:11,572 --> 02:22:16,543
STRATEGIZE AROUND IMPLEMENT 

4070
02:22:16,543 --> 02:22:16,910
IMPLEMENTATION.

4071
02:22:16,910 --> 02:22:17,311
AND DISSEMINATION.

4072
02:22:17,311 --> 02:22:17,645
>> THANKS.

4073
02:22:17,645 --> 02:22:18,746
ANYONE ELSE WITH THOUGHT ABOUT

4074
02:22:18,746 --> 02:22:20,180
THAT, ABOUT WHEN YOU'RE ENGAGING

4075
02:22:20,180 --> 02:22:21,582
WITH SORT OF DIFFERENT PARTNERS

4076
02:22:21,582 --> 02:22:22,750
AND DIFFERENT COMMUNITIES AND

4077
02:22:22,750 --> 02:22:23,417
HEARING DIFFERENT THINGS, HOW

4078
02:22:23,417 --> 02:22:28,689
YOU DEAL WITH THAT?

4079
02:22:28,689 --> 02:22:31,058
>> I CAN JUMP IN AND SAY
WE

4080
02:22:31,058 --> 02:22:32,426
DEFINITELY FELT THAT FROM

4081
02:22:32,426 --> 02:22:33,193
DIFFERENT HEALTH SYSTEMS AND

4082
02:22:33,193 --> 02:22:34,528
COMMUNITIES THAT WE'VE ENGAGED

4083
02:22:34,528 --> 02:22:35,396
WITH.

4084
02:22:35,396 --> 02:22:38,565
AND I THINK ONE OF THE THINGS

4085
02:22:38,565 --> 02:22:40,034
THEY WERE STRUGGLING WITH, WITH

4086
02:22:40,034 --> 02:22:42,670
A PRAGMATIC TRIAL, IS FIGURING

4087
02:22:42,670 --> 02:22:45,339
OUT WHAT ARE THE KIND OF CORE

4088
02:22:45,339 --> 02:22:47,341
EVIDENCE-BASED COMPONENTS THAT

4089
02:22:47,341 --> 02:22:48,309
CONSTITUTE AN INTERVENTION?

4090
02:22:48,309 --> 02:22:50,944
WE CAN'T BE TESTING DIFFERENT

4091
02:22:50,944 --> 02:22:52,479
THINGS AT DIFFERENT SITES.

4092
02:22:52,479 --> 02:22:56,550
BUT ARE THERE WAYS WE CAN DO

4093
02:22:56,550 --> 02:22:59,653
SLIGHTLY ADAPTED RECRUITMENT,

4094
02:22:59,653 --> 02:23:01,288
SLIGHTLY DIFFERENT ENGAGEMENT

4095
02:23:01,288 --> 02:23:03,324
STRATEGIES THAT WOULD STILL HAVE

4096
02:23:03,324 --> 02:23:05,426
THE CORE COMPONENT OF OUR

4097
02:23:05,426 --> 02:23:06,393
INTERVENTION STAY THE SAME, AND

4098
02:23:06,393 --> 02:23:08,162
THAT CAN BE COMPARABLE ACROSS

4099
02:23:08,162 --> 02:23:13,534
SITES.

4100
02:23:13,534 --> 02:23:15,302
>> LOOKING TO SEE IF IB
ELSE HAD

4101
02:23:15,302 --> 02:23:16,070
THOUGHTS ABOUT THAT.

4102
02:23:16,070 --> 02:23:17,271
MAYBE A SPECIFIC ONE, I'LL START

4103
02:23:17,271 --> 02:23:18,772
WITH NATALIA AND SEE WHAT THE

4104
02:23:18,772 --> 02:23:19,540
REST OF YOU SAY.

4105
02:23:19,540 --> 02:23:21,742
SOUNDS LIKE, NATALIA, YOU DID

4106
02:23:21,742 --> 02:23:24,044
BOTH SORT OF INDIVIDUAL

4107
02:23:24,044 --> 02:23:25,212
INTERVAWS WITH DIFFERENT

4108
02:23:25,212 --> 02:23:26,613
INTERESTED PARTIES, AND THEN YOU

4109
02:23:26,613 --> 02:23:30,017
ALSO HAD A BOARD WHERE PEOPLE

4110
02:23:30,017 --> 02:23:31,018
CAME TOGETHER.

4111
02:23:31,018 --> 02:23:32,686
CAN YOU TALK ABOUT THE PROS AND

4112
02:23:32,686 --> 02:23:34,455
CONS OF THOSE IN TERMS OF

4113
02:23:34,455 --> 02:23:35,756
EVERYBODY BEING IN THE SAME ROOM

4114
02:23:35,756 --> 02:23:36,857
WHEN THEY MIGHT HAVE VERY

4115
02:23:36,857 --> 02:23:39,093
DIFFERENT VIEWS, OR BEING ABLE

4116
02:23:39,093 --> 02:23:41,295
TO SPEAK TO PEOPLE SEPARATELY

4117
02:23:41,295 --> 02:23:42,363
AND MAYBE YOU'D HEAR MORE ABOUT

4118
02:23:42,363 --> 02:23:46,567
THE VERY DIFFERENT VIEWS?

4119
02:23:46,567 --> 02:23:50,104
>> FOR SURE THE PROS OF
THE

4120
02:23:50,104 --> 02:23:54,608
GROUP IS KIND OF WHAT I'M ALMOST

4121
02:23:54,608 --> 02:23:56,777
HEARING WHEN JULIE SAID THAT AND

4122
02:23:56,777 --> 02:23:58,178
SEBASTIAN SPOKE ABOUT WHERE

4123
02:23:58,178 --> 02:24:00,547
THERE WAS AN ALREADY ESTABLISHED

4124
02:24:00,547 --> 02:24:01,315
GROUP, SO THEY'RE FAMILIAR.

4125
02:24:01,315 --> 02:24:03,417
THERE'S A FAMILIARITY NOW THAT

4126
02:24:03,417 --> 02:24:06,420
THEY CAN HAVE WITH THE PROCESS,

4127
02:24:06,420 --> 02:24:08,722
WHICH IS ABSOLUTELY CRITICAL,

4128
02:24:08,722 --> 02:24:10,157
BECAUSE IT TAKES EDUCATION TO

4129
02:24:10,157 --> 02:24:14,862
GET PEOPLE TO THAT POINT.

4130
02:24:14,862 --> 02:24:17,664
SO ONE -- SO THAT IS A HUGE --

4131
02:24:17,664 --> 02:24:18,966
YOU KNOW, IS A HUGE ADVANTAGE,

4132
02:24:18,966 --> 02:24:22,302
BUT IN SOME WAYS, YOU WANT

4133
02:24:22,302 --> 02:24:23,303
TURNOVER, NEW PEOPLE, SO YOU CAN

4134
02:24:23,303 --> 02:24:25,272
GET NEW VOICES, NEW

4135
02:24:25,272 --> 02:24:26,240
PERSPECTIVES, AND THIS IS WHERE

4136
02:24:26,240 --> 02:24:29,176
THE INDIVIDUAL INTERVIEWS ARE SO

4137
02:24:29,176 --> 02:24:31,445
HELPFUL.

4138
02:24:31,445 --> 02:24:33,414
BECAUSE THIS ALLOWS YOU FOR

4139
02:24:33,414 --> 02:24:35,816
ADDITIONAL PERSPECTIVES.

4140
02:24:35,816 --> 02:24:39,286
SO THEY BOTH HAVE THEIR PART,

4141
02:24:39,286 --> 02:24:41,155
THEIR PROS, AND I THINK IN

4142
02:24:41,155 --> 02:24:44,391
GENERAL, THEY OUTWEIGH THE CONS

4143
02:24:44,391 --> 02:24:48,328
JUST SOME QUICK THOUGHTS.

4144
02:24:48,328 --> 02:24:50,097
>> I'D SECOND WHAT NATALIA
SAID

4145
02:24:50,097 --> 02:24:51,932
IN TERMS OF THINKING ABOUT THE

4146
02:24:51,932 --> 02:24:55,836
PURPOSE OF THE ENGAGEMENT AND

4147
02:24:55,836 --> 02:24:58,572
ARE YOU THINKING NOW OF ENGAGING

4148
02:24:58,572 --> 02:25:00,040
PROVIDERS AND CLINICIANS, ARE

4149
02:25:00,040 --> 02:25:01,575
YOU SOLVING A SPECIFIC

4150
02:25:01,575 --> 02:25:02,176
IMPLEMENTATION PROBLEM THAT'S

4151
02:25:02,176 --> 02:25:04,311
VERY SPECIFIC TO THE CONTEXT OF

4152
02:25:04,311 --> 02:25:07,648
A CLINIC OR A PROVIDER OR REALLY

4153
02:25:07,648 --> 02:25:13,020
TRYING TO BUILD MORE OF A MODEL

4154
02:25:13,020 --> 02:25:14,321
OF SHARED VALUES AND

4155
02:25:14,321 --> 02:25:14,888
COMMUNICATION AT THE

4156
02:25:14,888 --> 02:25:15,622
ORGANIZATIONAL LEVEL WHERE

4157
02:25:15,622 --> 02:25:16,824
GROUPS REALLY HELPFUL.

4158
02:25:16,824 --> 02:25:19,226
THE ONE OTHER THING I'D JUST ADD

4159
02:25:19,226 --> 02:25:22,162
IN IS BEING COGNIZANT ALSO OF

4160
02:25:22,162 --> 02:25:25,332
SORT OF THE OVERALL BURDEN AND

4161
02:25:25,332 --> 02:25:27,601
THAT THESE DIFFERENT ENGAGEMENTS

4162
02:25:27,601 --> 02:25:28,569
TAKE ON.

4163
02:25:28,569 --> 02:25:30,204
I THINK SOMETIMES ON THE

4164
02:25:30,204 --> 02:25:32,172
RESEARCH SIDE WE THINK MORE IS

4165
02:25:32,172 --> 02:25:34,541
ALWAYS BETTER FROM OUR

4166
02:25:34,541 --> 02:25:35,642
PERSPECTIVE IN TERMS OF

4167
02:25:35,642 --> 02:25:38,445
ENGAGEMENT, BUT THERE HAS TO BE

4168
02:25:38,445 --> 02:25:40,113
A LOT OF ATTENTIVENESS TO WHAT

4169
02:25:40,113 --> 02:25:42,683
THE ASK IS ON THE PART OF THE

4170
02:25:42,683 --> 02:25:47,187
PARTNERS, AND REALLY TRYING TO

4171
02:25:47,187 --> 02:25:48,922
BE EFFICIENT WITH THEIR TIME AND

4172
02:25:48,922 --> 02:25:49,790
HOW MUCH BURDEN IS PLACED THERE.

4173
02:25:49,790 --> 02:25:51,191
>> I SHOULD ASK ON THE
PART OF

4174
02:25:51,191 --> 02:25:56,029
THE PARTNERS, SOMETHING

4175
02:25:56,029 --> 02:25:56,897
SEBASTIAN SAID WHEN YOU TALKED

4176
02:25:56,897 --> 02:25:57,831
ABOUT THIS PANEL OF PEOPLE WHO

4177
02:25:57,831 --> 02:26:00,100
HAVE AGREED TO RECEIVE SURVEYS,

4178
02:26:00,100 --> 02:26:02,336
MADE ME WONDER ABOUT HOW YOU

4179
02:26:02,336 --> 02:26:03,470
THINK ABOUT THE DIVERSITY AMONG

4180
02:26:03,470 --> 02:26:04,404
THE PEOPLE YOU'D WANT TO HEAR

4181
02:26:04,404 --> 02:26:05,973
FROM IN TERMS OF I DON'T KNOW

4182
02:26:05,973 --> 02:26:06,773
WHAT TO CALL IT SEPTEMBER THEIR

4183
02:26:06,773 --> 02:26:12,346
EXCEPT THEIRLEVEL OF ENGAGEMENT.

4184
02:26:12,346 --> 02:26:13,180
YOU MAY BE HEARING FROM THE

4185
02:26:13,180 --> 02:26:15,916
ALREADY ENTHUSIASTIC AND NOT

4186
02:26:15,916 --> 02:26:19,253
HEARING FROM THOSE WHO ARE

4187
02:26:19,253 --> 02:26:21,788
UNENTHUSIASTIC OR EVEN ACTIVELY

4188
02:26:21,788 --> 02:26:22,222
OPPOSED.

4189
02:26:22,222 --> 02:26:24,858
HOW DOES ONE ENGAGE WITH THE

4190
02:26:24,858 --> 02:26:26,260
DISENGAGED OR HOW DOES ONE

4191
02:26:26,260 --> 02:26:26,894
ENGAGE WITH THE DIFFICULTY TO

4192
02:26:26,894 --> 02:26:28,061
ENGAGE AND HOW DO YOU MAKE SURE

4193
02:26:28,061 --> 02:26:29,062
YOU'RE HEARING FROM THAT

4194
02:26:29,062 --> 02:26:30,330
DIVERSITY, OR MAYBE YOU DON'T

4195
02:26:30,330 --> 02:26:31,265
NEED TO HEAR FROM THAT

4196
02:26:31,265 --> 02:26:32,065
DIVERSITY.

4197
02:26:32,065 --> 02:26:35,335
BUT HOW YOU THINK ABOUT THE

4198
02:26:35,335 --> 02:26:36,904
VARIETY OF THE VIEWS OUT THERE,

4199
02:26:36,904 --> 02:26:38,972
EVEN SAY WITHIN A PARTICULAR

4200
02:26:38,972 --> 02:26:40,207
GROUP, THE VARIETY OF CLINICIAN

4201
02:26:40,207 --> 02:26:41,875
VIEWS ABOUT THIS, THE VARIETY OF

4202
02:26:41,875 --> 02:26:43,076
PATIENT OR FAMILY MEMBERS' VIEWS

4203
02:26:43,076 --> 02:26:45,279
ABOUT THIS.

4204
02:26:45,279 --> 02:26:46,480
ESPECIALLY THOSE PEOPLE WHO WILL

4205
02:26:46,480 --> 02:26:47,848
NOT BE THE PEOPLE WHO ARE GOING

4206
02:26:47,848 --> 02:26:48,916
TO SIGN UP FOR A COMMUNITY

4207
02:26:48,916 --> 02:26:49,716
ADVISORY BOARD OR SOMETHING LIKE

4208
02:26:49,716 --> 02:26:54,621
THAT.

4209
02:26:54,621 --> 02:26:58,158
>> I THINK THAT'S AN
ONGOING

4210
02:26:58,158 --> 02:26:59,192
CHALLENGE NOT JUST FOR

4211
02:26:59,192 --> 02:27:01,695
ENGAGEMENT BUT FOR ALL RESEARCH,

4212
02:27:01,695 --> 02:27:03,063
FOR THOSE WHO SIGN UP FOR A

4213
02:27:03,063 --> 02:27:04,531
RESEARCH STUDY ARE MORE LIKELY

4214
02:27:04,531 --> 02:27:06,500
TO BE ENGAGED IN GENERAL.

4215
02:27:06,500 --> 02:27:08,035
I THINK IN SEVERAL WAYS WE'RE

4216
02:27:08,035 --> 02:27:10,404
MORE ATTENTIVE TO THAT.

4217
02:27:10,404 --> 02:27:12,806
AS NATALIA SAID, KIND OF

4218
02:27:12,806 --> 02:27:14,408
ONE-ON-ONE, ONE-OFF INTERVIEWS

4219
02:27:14,408 --> 02:27:17,344
CAN AB BETTER WAY TO ENGAGE

4220
02:27:17,344 --> 02:27:18,979
SOMETIMES THAN LIKE A MONTHLY OR

4221
02:27:18,979 --> 02:27:20,747
QUARTERLY OR ONGOING KIND OF

4222
02:27:20,747 --> 02:27:24,551
COMMITTEE ADVISORY GROUP MEET 

4223
02:27:24,551 --> 02:27:24,785
MEETING.

4224
02:27:24,785 --> 02:27:25,852
I THINK ANOTHER WAY WE GET

4225
02:27:25,852 --> 02:27:27,621
OPINIONS IS KIND OF SECONDHAND

4226
02:27:27,621 --> 02:27:29,423
WE ASK PEOPLE WHO DO SIGN UP FOR

4227
02:27:29,423 --> 02:27:30,390
THE INTERVIEWS OR SURVEYS, WHAT

4228
02:27:30,390 --> 02:27:31,892
HAVE YOU HEARD FROM YOUR

4229
02:27:31,892 --> 02:27:32,225
COLLEAGUES?

4230
02:27:32,225 --> 02:27:35,295
SO IT'S A BIT OF KIND OF

4231
02:27:35,295 --> 02:27:38,432
SECONDARY FEEDBACK, BUT IT DOES

4232
02:27:38,432 --> 02:27:42,269
GET TO THAT ISSUE SOMEWHAT.

4233
02:27:42,269 --> 02:27:44,705
AND I THINK INTENTIONALLY WE TRY

4234
02:27:44,705 --> 02:27:47,007
TO GO INTO COMMUNITIES THAT ARE

4235
02:27:47,007 --> 02:27:48,108
UNDERREPRESENTED IN RESEARCH AND

4236
02:27:48,108 --> 02:27:50,077
TRY TO RECRUIT PEOPLE IN THOSE

4237
02:27:50,077 --> 02:27:51,111
COMMUNITIES BUT THERE ARE

4238
02:27:51,111 --> 02:27:51,878
LIMITATIONS EVEN WITHIN THAT

4239
02:27:51,878 --> 02:27:55,382
WITH WHO WILL SIGN UP.

4240
02:27:55,382 --> 02:27:57,584
GLB OTHER PEOPLE IN TERMS OF

4241
02:27:57,584 --> 02:27:59,152
THAT DIVERSITY AND HOW YOU HEAR

4242
02:27:59,152 --> 02:28:01,622
FROM THOSE WHO MIGHT NOT

4243
02:28:01,622 --> 02:28:02,656
NECESSARILY BE THAT EXCITED

4244
02:28:02,656 --> 02:28:03,957
ABOUT THE IDEA YOU'RE PURSUING?

4245
02:28:03,957 --> 02:28:05,959
>> I'LL JUST SECOND ONE
THING

4246
02:28:05,959 --> 02:28:07,628
THAT SEBASTIAN SAID ABOUT IF YOU

4247
02:28:07,628 --> 02:28:09,963
HAVE SORT OF AN INTERMEDIARY, SO

4248
02:28:09,963 --> 02:28:15,669
FOR US, WE HAVE INDIVIDUAL FQHC

4249
02:28:15,669 --> 02:28:16,770
CLINICS, THEN WE HAVE THIS

4250
02:28:16,770 --> 02:28:18,672
ASSOCIATION THAT REPRESENTS THEM

4251
02:28:18,672 --> 02:28:19,873
AND SORT OF SERVES AS A LIAISON

4252
02:28:19,873 --> 02:28:20,874
BETWEEN THE UNIVERSITY AND THE

4253
02:28:20,874 --> 02:28:21,842
RESEARCH TEAMS AND THE CLINICS

4254
02:28:21,842 --> 02:28:25,278
AND THE STAFF, AND THEY HAVE

4255
02:28:25,278 --> 02:28:28,148
THEIR EAR TO THE GROUND AND WHEN

4256
02:28:28,148 --> 02:28:30,317
SOME PROVIDER OR CLINIC OR GROUP

4257
02:28:30,317 --> 02:28:33,954
IS JUST NOT THAT INTO WHAT WE'RE

4258
02:28:33,954 --> 02:28:36,189
DOING OR WE'VE DONE SOMETHING

4259
02:28:36,189 --> 02:28:38,258
THAT HASN'T BEEN A REALLY GOOD

4260
02:28:38,258 --> 02:28:42,329
EFFORT AT PARTNERSHIP, WE HAVE

4261
02:28:42,329 --> 02:28:44,164
THAT WAY TO GET THE FEEDBACK

4262
02:28:44,164 --> 02:28:45,032
THROUGH THEM OF WHAT'S HAPPENED,

4263
02:28:45,032 --> 02:28:46,433
WHICH HAS BEEN REALLY

4264
02:28:46,433 --> 02:28:48,402
INVALUABLE, AND AT TIMES THE

4265
02:28:48,402 --> 02:28:50,070
PROVIDER RS, INDIVIDUAL

4266
02:28:50,070 --> 02:28:50,971
PROVIDERS CAN KIND OF PLAY A

4267
02:28:50,971 --> 02:28:53,373
SIMILAR ROLE WITH PATIENTS.

4268
02:28:53,373 --> 02:28:55,242
PATIENT WHO THEY'VE OFFERED THE

4269
02:28:55,242 --> 02:28:58,845
OPPORTUNITY TO PARTICIPATE AND

4270
02:28:58,845 --> 02:28:59,946
PATIENTS AREN'T INTERESTED AND

4271
02:28:59,946 --> 02:29:01,314
SOMETIMES WE GET SOME FEEDBACK

4272
02:29:01,314 --> 02:29:03,850
ABOUT WHAT THEY HEAR FROM

4273
02:29:03,850 --> 02:29:05,252
PATIENTS THAT WAY, SO SORT OF

4274
02:29:05,252 --> 02:29:06,720
THAT THIRD PARTY CAN BE REALLY

4275
02:29:06,720 --> 02:29:09,890
VALUABLE IF THAT EXISTS TO GET

4276
02:29:09,890 --> 02:29:10,924
FEEDBACK FROM PEOPLE THAT YOU'RE

4277
02:29:10,924 --> 02:29:15,395
NOT ABLE TO CONNECT WITH.

4278
02:29:15,395 --> 02:29:17,397
>> ANOTHER PIECE I WOULD
ADD

4279
02:29:17,397 --> 02:29:18,999
FROM OUR TRIAL IS THAT IN

4280
02:29:18,999 --> 02:29:21,568
ADDITION TO ONE-ON-ONE MEETINGS,

4281
02:29:21,568 --> 02:29:23,970
FITTING INTO EXISTING MEETINGS

4282
02:29:23,970 --> 02:29:25,005
HAS BEEN HELPFUL AS WELL, SO

4283
02:29:25,005 --> 02:29:26,440
MAYBE IT'S SORT OF A QUICK

4284
02:29:26,440 --> 02:29:27,641
ANNOUNCEMENT ABOUT OUR STUDY,

4285
02:29:27,641 --> 02:29:29,643
BUT IT ALSO HELPS US SEE SORT OF

4286
02:29:29,643 --> 02:29:31,311
THE OTHER TOPICS THAT THE TEAM

4287
02:29:31,311 --> 02:29:33,346
IS WORKING ON, WHETHER IT BE THE

4288
02:29:33,346 --> 02:29:36,316
CRITICAL CARE COMMITTEE OR THE

4289
02:29:36,316 --> 02:29:37,718
NURSE LEADERSHIP MEETING OR UNIT

4290
02:29:37,718 --> 02:29:38,919
COUNCIL, I THINK THAT HELPS WITH

4291
02:29:38,919 --> 02:29:40,921
A LOT OF INFORMATION AS WELL.

4292
02:29:40,921 --> 02:29:42,756
>> SO WHAT THEY'RE
COMPLAINING

4293
02:29:42,756 --> 02:29:44,958
ABOUT WHEN THEY'RE NOT TALKING

4294
02:29:44,958 --> 02:29:47,561
ABOUT YOUR STUDY BUT THEY'RE

4295
02:29:47,561 --> 02:29:48,929
TALKING ABOUT THEIR LIFE IN

4296
02:29:48,929 --> 02:29:49,162
GENERAL.

4297
02:29:49,162 --> 02:29:50,464
YOU'D LIKE TO KNOW WHAT

4298
02:29:50,464 --> 02:29:51,465
BOTHERS -- THE PEOPLE YOU'RE

4299
02:29:51,465 --> 02:29:52,766
TRYING TO HELP, YOU'D LIKE TO

4300
02:29:52,766 --> 02:29:54,134
KNOW WHAT BOTHERS THEM THE MOST,

4301
02:29:54,134 --> 02:29:55,469
EVEN IF IT'S NOT DIRECTLY

4302
02:29:55,469 --> 02:30:00,607
RELEVANT TO YOUR PROJECT.

4303
02:30:00,607 --> 02:30:02,075
RELATED TO -- THERE WAS A

4304
02:30:02,075 --> 02:30:04,911
QUESTION ABOUT COMPENSATING

4305
02:30:04,911 --> 02:30:06,680
PEOPLE, AND HOW THAT'S WORKED,

4306
02:30:06,680 --> 02:30:07,748
AND ESPECIALLY WHEN YOU THINK

4307
02:30:07,748 --> 02:30:09,382
ABOUT PEOPLE WHO ARE ENGAGED --

4308
02:30:09,382 --> 02:30:10,917
SOMEONE WHO MIGHT BE AN ONGOING

4309
02:30:10,917 --> 02:30:12,319
MEMBER OF A COMMUNITY ADVISORY

4310
02:30:12,319 --> 02:30:13,487
BOARD, SOMEBODY WHO MIGHT BE A

4311
02:30:13,487 --> 02:30:15,088
MEMBER OF THE SURVEY PANEL,

4312
02:30:15,088 --> 02:30:16,423
SOMEBODY WHO MIGHT BE

4313
02:30:16,423 --> 02:30:18,492
PARTICIPATING IN ONE OF THESE

4314
02:30:18,492 --> 02:30:21,628
ONE-OFF INTERVIEWS, SOME OF YOU

4315
02:30:21,628 --> 02:30:22,929
MENTIONED, I'M ASSUMING YOU'RE

4316
02:30:22,929 --> 02:30:26,666
SAYING THAT THESE ARE PEOPLE WHO

4317
02:30:26,666 --> 02:30:27,801
ARE -- THEY'RE CONTRIBUTING

4318
02:30:27,801 --> 02:30:28,401
EXPERTISE, THEY'RE NOT SUBJECT

4319
02:30:28,401 --> 02:30:30,137
TO RESEARCH, THEY'RE PARTNERS,

4320
02:30:30,137 --> 02:30:31,972
AND YOU WOULD PROBABLY, I

4321
02:30:31,972 --> 02:30:33,140
SUSPECT, PAY THEM FOR THEIR

4322
02:30:33,140 --> 02:30:35,008
TIME, BUT WHO WANTS TO TELL ME

4323
02:30:35,008 --> 02:30:40,914
HOW YOU'VE DONE THAT?

4324
02:30:40,914 --> 02:30:43,116
>> SO I CAN SAY WE
COMPENSATE

4325
02:30:43,116 --> 02:30:44,718
PEOPLE FOR EACH MEETING THEY

4326
02:30:44,718 --> 02:30:46,319
ATTEND OR FOR EACH SURVEY

4327
02:30:46,319 --> 02:30:48,088
INTERVIEW THEY COMPLETE.

4328
02:30:48,088 --> 02:30:53,326
AND WHAT WE'VE DONE IN OUR U

4329
02:30:53,326 --> 02:30:56,930
UG3 PHASE, UG3/UH3 EMBED THAT

4330
02:30:56,930 --> 02:30:58,965
COST WITHIN THE GRANT AND WE

4331
02:30:58,965 --> 02:31:03,436
ALSO HAVE FUNDS IN THE -- TO

4332
02:31:03,436 --> 02:31:03,970
COMPENSATE ONGOING

4333
02:31:03,970 --> 02:31:04,337
INFRASTRUCTURE.

4334
02:31:04,337 --> 02:31:07,374
>> AGREE WITH THE SAME
WITH

4335
02:31:07,374 --> 02:31:07,908
SEBASTIAN.

4336
02:31:07,908 --> 02:31:09,075
ACTUALLY I THINK IT'S REALLY

4337
02:31:09,075 --> 02:31:11,578
IMPORTANT TO VALUE PEOPLE'S TIME

4338
02:31:11,578 --> 02:31:13,980
BY COMPENSATING THEM.

4339
02:31:13,980 --> 02:31:15,515
YOU KNOW, IN SOME WAY.

4340
02:31:15,515 --> 02:31:20,854
I WAS A LITTLE BIT WORRIED WITH

4341
02:31:20,854 --> 02:31:22,589
SOME OF THE HIGHER PAID

4342
02:31:22,589 --> 02:31:24,090
PARTNERS, BUT THEY WANTED THE

4343
02:31:24,090 --> 02:31:27,427
COMPENSATION TOO, SO THEY

4344
02:31:27,427 --> 02:31:28,228
APPRECIATED THE COMPENSATION.

4345
02:31:28,228 --> 02:31:32,632
SO I THINK IT'S -- THE VALUE OF

4346
02:31:32,632 --> 02:31:33,500
PEOPLE'S TIME AND THAT COMES

4347
02:31:33,500 --> 02:31:36,536
BACK TO -- I'M REALLY GLAD THAT

4348
02:31:36,536 --> 02:31:38,805
THERE'S STARTING TO BE GREATER

4349
02:31:38,805 --> 02:31:40,340
APPRECIATION OF HOW IMPORTANT

4350
02:31:40,340 --> 02:31:42,742
INVOLVING PARTNERS IS, BECAUSE

4351
02:31:42,742 --> 02:31:46,479
THEY REALLY ARE TRYING TO MOVE

4352
02:31:46,479 --> 02:31:48,982
OUR WORK INTO HEALTHCARE, AND IT

4353
02:31:48,982 --> 02:31:51,017
TURNS OUT THAT THIS IS A REALLY

4354
02:31:51,017 --> 02:31:52,886
VALUABLE PIECE OF GETTING IT IN

4355
02:31:52,886 --> 02:31:54,187
INSTEAD OF NOT BEING ABLE TO GET

4356
02:31:54,187 --> 02:31:56,289
IT IN.

4357
02:31:56,289 --> 02:32:00,427
SO THAT'S WHAT WE DO.

4358
02:32:00,427 --> 02:32:05,532
>> OTHER THOUGHTS ABOUT
THAT?

4359
02:32:05,532 --> 02:32:06,533
ONE OF THE OTHER QUESTIONS THAT

4360
02:32:06,533 --> 02:32:07,734
CAME IN, A LOT OF YOU TALKED

4361
02:32:07,734 --> 02:32:09,736
ABOUT HAVING THESE SORT OF

4362
02:32:09,736 --> 02:32:10,370
ONGOING RELATIONSHIPS OR EVEN A

4363
02:32:10,370 --> 02:32:12,472
SORT OF SOMETIMES FORMAL

4364
02:32:12,472 --> 02:32:14,307
INFRASTRUCTURE TO SUPPORT THESE

4365
02:32:14,307 --> 02:32:15,842
ONGOING RELATIONSHIPS AND THE

4366
02:32:15,842 --> 02:32:18,044
IMPORTANCE OF THAT ESPECIALLY

4367
02:32:18,044 --> 02:32:19,779
NOT TALKING TO PEOPLE WHEN IT'S

4368
02:32:19,779 --> 02:32:20,747
TOO LATE.

4369
02:32:20,747 --> 02:32:22,148
TALKING TO PEOPLE EARLY ON IN

4370
02:32:22,148 --> 02:32:23,550
THE PROCESS.

4371
02:32:23,550 --> 02:32:25,218
THERE'S A TENSION THERE, THOUGH,

4372
02:32:25,218 --> 02:32:28,688
ABOUT DOES THAT MEAN THAT THIS

4373
02:32:28,688 --> 02:32:30,724
RESEARCH CAN ONLY BE DONE OR

4374
02:32:30,724 --> 02:32:32,025
SHOULD ONLY BE DONE IN PLACES

4375
02:32:32,025 --> 02:32:34,361
THAT HAVE THIS INFRASTRUCTURE,

4376
02:32:34,361 --> 02:32:35,962
WHAT DOES THAT MEAN ABOUT

4377
02:32:35,962 --> 02:32:37,664
REACHING COMMUNITIES THAT HAVE

4378
02:32:37,664 --> 02:32:38,965
TRADITIONALLY BEEN

4379
02:32:38,965 --> 02:32:39,766
UNDERREPRESENTED ABOUT

4380
02:32:39,766 --> 02:32:40,867
INSTITUTIONS THAT HAVE SERVED

4381
02:32:40,867 --> 02:32:42,435
PEOPLE WHO HAVE BEEN

4382
02:32:42,435 --> 02:32:43,303
UNDERREPRESENTED IN RESEARCH,

4383
02:32:43,303 --> 02:32:44,838
AND SORT OF SPREADING THE

4384
02:32:44,838 --> 02:32:49,643
RESEARCH ENTERPRISE.

4385
02:32:49,643 --> 02:32:51,211
MANY OF THE PEOPLE INVOLVED IN

4386
02:32:51,211 --> 02:32:52,879
THE COLLABORATORY IN TERMS OF

4387
02:32:52,879 --> 02:32:54,414
THESE SORT OF -- ARE THE HAVES

4388
02:32:54,414 --> 02:32:56,783
OR THE HAVE-NOTS OR

4389
02:32:56,783 --> 02:32:57,417
TRADITIONALLY BETTER RESOURCED,

4390
02:32:57,417 --> 02:32:58,652
THAT'S GOOD, BUT WHAT ABOUT

4391
02:32:58,652 --> 02:33:00,520
THOSE -- HOW WOULD THAT WORK FOR

4392
02:33:00,520 --> 02:33:04,758
PEOPLE WHO NODE TO  NEED TO GETD

4393
02:33:04,758 --> 02:33:05,625
AND HAVEN'T DONE THIS BEFORE,

4394
02:33:05,625 --> 02:33:06,826
WHERE WOULD THE RESOURCES COME

4395
02:33:06,826 --> 02:33:07,460
FROM?

4396
02:33:07,460 --> 02:33:08,428
HARD QUESTION, BUT WOULD ANYBODY

4397
02:33:08,428 --> 02:33:14,034
HAVE ADVICE ABOUT THAT?

4398
02:33:14,034 --> 02:33:15,635
>> WELL, I GUESS TO BE

4399
02:33:15,635 --> 02:33:16,803
PRESUMPTIVE, I WOULD SAY FROM A

4400
02:33:16,803 --> 02:33:19,205
FUNDING STANDPOINT, FUNDING THE

4401
02:33:19,205 --> 02:33:20,073
INFRASTRUCTURE BUILDING IS

4402
02:33:20,073 --> 02:33:22,042
REALLY CRITICAL, AND WHETHER

4403
02:33:22,042 --> 02:33:24,110
THAT'S IN KIND OF A PHASED

4404
02:33:24,110 --> 02:33:26,947
MECHANISM WHERE THERE'S ADEQUATE

4405
02:33:26,947 --> 02:33:30,116
TIME FOR THAT AS MILESTONES OF

4406
02:33:30,116 --> 02:33:33,253
PROGRESSION WHERE YOU ARE

4407
02:33:33,253 --> 02:33:35,555
BUILDING OR SEPARATE STANDALONE

4408
02:33:35,555 --> 02:33:37,290
OPPORTUNITIES FOR FUNDING FOR

4409
02:33:37,290 --> 02:33:38,391
THE ECK PRESS PURPOSE OF

4410
02:33:38,391 --> 02:33:40,327
BUILDING THE PARTNERSHIP, IT

4411
02:33:40,327 --> 02:33:44,030
JUST CAN'T BE DONE ON THE QUICK,

4412
02:33:44,030 --> 02:33:48,702
AND IN  IF IT DOESN'T EXIST, JUG

4413
02:33:48,702 --> 02:33:50,570
INTO A COMPLEX IMPLEMENTATION

4414
02:33:50,570 --> 02:33:51,538
PRAGMATIC TRIAL IS PROBABLY

4415
02:33:51,538 --> 02:33:59,980
GOING TO FAIL.

4416
02:33:59,980 --> 02:34:01,881
>> OTHER THOUGHTS ABOUT
THAT,

4417
02:34:01,881 --> 02:34:03,216
HOW WOULD NEWCOMERS TO THIS

4418
02:34:03,216 --> 02:34:10,890
WORLD GET STARTED?

4419
02:34:10,890 --> 02:34:13,493
>> I THINK NEWCOMERS, WE

4420
02:34:13,493 --> 02:34:15,895
GENERALLY WELCOME

4421
02:34:15,895 --> 02:34:17,197
COLLABORATIONS, SO FINDING AN

4422
02:34:17,197 --> 02:34:18,932
EXISTING GROUP WITH THAT KIND OF

4423
02:34:18,932 --> 02:34:21,301
INFRASTRUCTURE, AND THEN I THINK

4424
02:34:21,301 --> 02:34:24,838
WHAT I SEE EMERGING IN THE

4425
02:34:24,838 --> 02:34:25,905
ENVIRONMENT IS ALSO MORE

4426
02:34:25,905 --> 02:34:27,107
RECOGNITION THAT THERE NEEDS TO

4427
02:34:27,107 --> 02:34:28,742
BE FUNDING FOR INFRASTRUCTURE

4428
02:34:28,742 --> 02:34:29,275
ACTUAL SUPPORT.

4429
02:34:29,275 --> 02:34:33,980
SO WHETHER THAT'S WITHIN PCORI,

4430
02:34:33,980 --> 02:34:35,849
I KNOW THE NIH COMMON FUND HAS

4431
02:34:35,849 --> 02:34:38,551
AN INITIATIVE NOW FOR PRIMARY

4432
02:34:38,551 --> 02:34:39,619
CARE RESEARCH NETWORKS, SO

4433
02:34:39,619 --> 02:34:42,956
WITHIN THOSE STUCK HAVE STRUCTU,

4434
02:34:42,956 --> 02:34:44,524
DEVELOPING A NEW STRUCTURE I

4435
02:34:44,524 --> 02:34:45,658
THINK IS AN OPPORTUNITY AT IT

4436
02:34:45,658 --> 02:34:45,859
POINT.

4437
02:34:45,859 --> 02:34:46,459
>> YEAH.

4438
02:34:46,459 --> 02:34:51,598
I DON'T THINK INTASES CHAN WAS T

4439
02:34:51,598 --> 02:34:54,734
UP TO IT BUT THAT WAS SORT OF AN

4440
02:34:54,734 --> 02:34:55,535
ANNOUNCEMENT WE WANT EVERYONE TO

4441
02:34:55,535 --> 02:34:56,936
COME BACK TOMORROW TO LISTEN TO

4442
02:34:56,936 --> 02:34:59,339
THE NIH DIRECTOR TALK ABOUT THIS

4443
02:34:59,339 --> 02:35:00,907
PROGRAM BECAUSE THAT'S ONE

4444
02:35:00,907 --> 02:35:01,841
EXAMPLE OF WHERE THAT MIGHT COME

4445
02:35:01,841 --> 02:35:02,042
FROM.

4446
02:35:02,042 --> 02:35:03,376
SO THE FACT THAT IN OUR LAST

4447
02:35:03,376 --> 02:35:04,644
SESSION, WE HAD THE DISCUSSION

4448
02:35:04,644 --> 02:35:09,015
SORT OF WENT ON TO SORT OF THE

4449
02:35:09,015 --> 02:35:10,583
NIH SORT OF STRATEGY, WHAT SORT

4450
02:35:10,583 --> 02:35:13,253
OF FUNDING STRATEGIES ARE, WHAT

4451
02:35:13,253 --> 02:35:15,722
A RESEARCH PORTFOLIO LOOKED LIKE

4452
02:35:15,722 --> 02:35:17,057
GOT ME THINKING, THE QUESTION I

4453
02:35:17,057 --> 02:35:18,691
WROTE DOWN IN MY LITTLE PAD AS

4454
02:35:18,691 --> 02:35:23,129
YOU WERE TALKING WAS, WELL,

4455
02:35:23,129 --> 02:35:25,098
SHOULD EACH RFA HAVE A COMMUNITY

4456
02:35:25,098 --> 02:35:26,666
ADVISORY BOARD?

4457
02:35:26,666 --> 02:35:31,037
YOU KNOW, IS IT -- WHEN NIH

4458
02:35:31,037 --> 02:35:32,605
DECIDES WE WANT TO FUND RESEARCH

4459
02:35:32,605 --> 02:35:35,575
IN THIS AREA, HOW DO THE

4460
02:35:35,575 --> 02:35:39,045
INTERESTED PARTIES OR THE PEOPLE

4461
02:35:39,045 --> 02:35:41,247
AFFECTED, HOW DO THEY HAVE INPUT

4462
02:35:41,247 --> 02:35:42,415
INTO THAT PROCESS?

4463
02:35:42,415 --> 02:35:43,616
I'M CURIOUS IF ANY OF YOU HAVE

4464
02:35:43,616 --> 02:35:45,685
THOUGHTS ABOUT THAT, OR WE COULD

4465
02:35:45,685 --> 02:35:50,390
EVEN INVITE ANY OF OUR NIH

4466
02:35:50,390 --> 02:35:56,863
COLLEAGUES WHOO ARE JO WHO ARE O

4467
02:35:56,863 --> 02:35:58,164
THEY HAVE INPUT AT THE NIH

4468
02:35:58,164 --> 02:36:00,733
LEVEL?

4469
02:36:00,733 --> 02:36:02,302
THIS IS YOUR OPPORTUNITY TO TELL

4470
02:36:02,302 --> 02:36:03,736
NIH WHAT THEY SHOULD DO.

4471
02:36:03,736 --> 02:36:08,308
BEFORE WE ASK THEM TO TALK.

4472
02:36:08,308 --> 02:36:14,380
SOMEBODY'S GOT TO BITE ON THAT.

4473
02:36:14,380 --> 02:36:17,717
>> I THINK ONE OF THE KEY
THINGS

4474
02:36:17,717 --> 02:36:18,818
IS -- WHAT I THINK MANY OF US

4475
02:36:18,818 --> 02:36:20,553
DID IS PUT SOME FEEDBACK FROM

4476
02:36:20,553 --> 02:36:23,056
COMMUNITY GROUPS INTO OUR

4477
02:36:23,056 --> 02:36:24,691
PROPOSALS, SO LIKE SEEING THAT

4478
02:36:24,691 --> 02:36:28,495
AS A NECESSARY COMPONENT OF A

4479
02:36:28,495 --> 02:36:29,796
GRANT APPLICATION OR LIKE A MUCH

4480
02:36:29,796 --> 02:36:31,631
DESIRED COMPONENT OF A GRANT

4481
02:36:31,631 --> 02:36:32,966
APPLICATION IS A WAY THAT NIH

4482
02:36:32,966 --> 02:36:36,669
COULD HEAR THAT.

4483
02:36:36,669 --> 02:36:38,505
I THINK HISTORICALLY STUDY

4484
02:36:38,505 --> 02:36:39,839
REVIEW SECTIONS HAVE BEEN MADE

4485
02:36:39,839 --> 02:36:43,309
UP OF PEOPLE WHO ARE ACADEMIC

4486
02:36:43,309 --> 02:36:43,643
RESEARCHERS.

4487
02:36:43,643 --> 02:36:47,113
SO A POTENTIAL OPPORTUNITY IS

4488
02:36:47,113 --> 02:36:49,749
HAVING COMMUNITY MEMBERS OR

4489
02:36:49,749 --> 02:36:54,554
VOICES BE IN SECTIONS TO PROVIDE

4490
02:36:54,554 --> 02:37:00,426
THAT PERSPECTIVE.

4491
02:37:00,426 --> 02:37:01,528
>> ANY OTHER THOUGHTS
ABOUT

4492
02:37:01,528 --> 02:37:02,095
THAT?

4493
02:37:02,095 --> 02:37:04,063
OKAY.

4494
02:37:04,063 --> 02:37:05,932
I GOT WENDY TO TURN HER CAMERA

4495
02:37:05,932 --> 02:37:07,367
ON.

4496
02:37:07,367 --> 02:37:09,035
>> SURE, GREG.

4497
02:37:09,035 --> 02:37:11,237
I'LL NOT SPEAK ON BEHALF OF NIH

4498
02:37:11,237 --> 02:37:13,006
BUT I'LL GIVE YOU SOME IDEAS OF

4499
02:37:13,006 --> 02:37:15,875
HOW WE DO TRY TO ENGAGE MORE

4500
02:37:15,875 --> 02:37:18,211
SORT OF COMMUNITY VOICES AND I

4501
02:37:18,211 --> 02:37:19,612
THINK SEBASTIAN, AS YOU

4502
02:37:19,612 --> 02:37:21,281
MENTIONED, YOU'RE SEEING MORE OF

4503
02:37:21,281 --> 02:37:23,550
THIS ACROSS NEW NIH INITIATIVES

4504
02:37:23,550 --> 02:37:25,952
AND THINKING ABOUT THIS.

4505
02:37:25,952 --> 02:37:28,454
AND SO THERE ARE TIMES WHEN WE

4506
02:37:28,454 --> 02:37:31,591
CAN GET COMMUNITY INPUT AND

4507
02:37:31,591 --> 02:37:35,195
THOSE OPPORTUNITIES ARE -- YOU

4508
02:37:35,195 --> 02:37:36,196
KNOW, WATCH FOR REQUESTS FOR

4509
02:37:36,196 --> 02:37:36,729
INFORMATION.

4510
02:37:36,729 --> 02:37:38,131
THAT IS HOW WE SEEK INFORMATION

4511
02:37:38,131 --> 02:37:39,766
FROM THE COMMUNITY.

4512
02:37:39,766 --> 02:37:42,168
HOW DO WE GET THE COMMUNITY TO

4513
02:37:42,168 --> 02:37:43,703
UNDERSTAND THAT IS ANOTHER

4514
02:37:43,703 --> 02:37:45,572
QUESTION IN TERMS OF HOW DO WE

4515
02:37:45,572 --> 02:37:47,307
ENGAGE THEM IN THAT PROCESS AND

4516
02:37:47,307 --> 02:37:50,610
GET THEM TO PROVIDE US INPUT,

4517
02:37:50,610 --> 02:37:52,212
BECAUSE THAT'S THE FORMAL WAY

4518
02:37:52,212 --> 02:37:54,480
THE GOVERNMENT CAN ASK FOR BROAD

4519
02:37:54,480 --> 02:37:56,883
INPUT ON THINGS.

4520
02:37:56,883 --> 02:38:00,153
OTHER PLACES WHERE WE COLLECT

4521
02:38:00,153 --> 02:38:01,154
INFORMATION THAT SORT OF GUIDE

4522
02:38:01,154 --> 02:38:02,956
US AS WE'RE DEVELOPING NEW

4523
02:38:02,956 --> 02:38:04,290
INITIATIVES, CERTAINLY ARE WHEN

4524
02:38:04,290 --> 02:38:06,926
WE HOST WORKSHOPS, WE'RE OFTEN

4525
02:38:06,926 --> 02:38:08,728
TRYING TO UNDERSTAND A GIVEN

4526
02:38:08,728 --> 02:38:10,063
AREA AND WHAT'S HAPPENING IN

4527
02:38:10,063 --> 02:38:11,598
DIFFERENT PLACES, AND SO THOSE

4528
02:38:11,598 --> 02:38:12,799
ARE OPPORTUNITIES TO GIVE US

4529
02:38:12,799 --> 02:38:14,267
FEEDBACK AND LET US KNOW WHAT'S

4530
02:38:14,267 --> 02:38:17,237
HAPPENING IN A FIELD.

4531
02:38:17,237 --> 02:38:18,905
AND THEN THE OTHER ONE THAT I

4532
02:38:18,905 --> 02:38:24,210
WAS THINKING OF IS, YOU KNOW,

4533
02:38:24,210 --> 02:38:27,680
OCCASIONALLY WE WILL HAVE OTHER

4534
02:38:27,680 --> 02:38:33,086
SORT OF PLATFORMS LIKE THESE

4535
02:38:33,086 --> 02:38:34,554
WORKSHOPS, ROUND TABLES OR STATE

4536
02:38:34,554 --> 02:38:35,955
OF THE SCIENCE TYPE

4537
02:38:35,955 --> 02:38:36,990
OPPORTUNITIES FOR PEOPLE TO GIVE

4538
02:38:36,990 --> 02:38:37,857
US INFORMATION.

4539
02:38:37,857 --> 02:38:41,594
WE HAVE VERY STRONG GUIDELINES

4540
02:38:41,594 --> 02:38:43,329
ABOUT WHEN PEOPLE CAN PROVIDE

4541
02:38:43,329 --> 02:38:45,265
INPUT AND AT WHAT STAGE IT HAS

4542
02:38:45,265 --> 02:38:46,799
TO BE SORT OF INCUBATED

4543
02:38:46,799 --> 02:38:49,636
INTERNALLY AT NIH, AND PART OF

4544
02:38:49,636 --> 02:38:52,071
THAT IS NOT TO GIVE ANYONE AN

4545
02:38:52,071 --> 02:38:53,339
UNFAIR ADVANTAGE IN TERMS OF

4546
02:38:53,339 --> 02:38:56,342
APPLYING FOR POTENTIAL FUNDING

4547
02:38:56,342 --> 02:38:57,944
ANNOUNCEMENTS.

4548
02:38:57,944 --> 02:38:59,545
BUT I DO THINK THAT WE CERTAINLY

4549
02:38:59,545 --> 02:39:01,714
HAVE SEEN OTHER FUNDING AGENCIES

4550
02:39:01,714 --> 02:39:04,150
ENGAGE MORE NOT NECESSARILY

4551
02:39:04,150 --> 02:39:06,286
APPLICANTS LIKE RESEARCHERS, BUT

4552
02:39:06,286 --> 02:39:08,821
MAYBE COMMUNITY MEMBERS IN OTHER

4553
02:39:08,821 --> 02:39:10,990
WAYS, AND PATIENTS WITH LIVED

4554
02:39:10,990 --> 02:39:13,159
EXPERIENCE AND OTHER THINGS LIKE

4555
02:39:13,159 --> 02:39:14,327
THAT INTO DIFFERENT ACTIVITIES,

4556
02:39:14,327 --> 02:39:15,461
WE'RE STARTING TO SEE THAT MORE

4557
02:39:15,461 --> 02:39:17,964
IN OUR WORKSHOPS EVEN WHERE IT'S

4558
02:39:17,964 --> 02:39:19,365
NOT JUST SCIENCE THAT'S

4559
02:39:19,365 --> 02:39:21,000
PRESENTED BUT WE ALSO BRING

4560
02:39:21,000 --> 02:39:24,070
INDIVIDUALS WITH LIVED

4561
02:39:24,070 --> 02:39:25,038
EXPERIENCE TO TALK TO

4562
02:39:25,038 --> 02:39:26,139
RESEARCHERS THAT ARE AT THOSE

4563
02:39:26,139 --> 02:39:27,440
WORKSHOPS AND SO THAT NIH CAN

4564
02:39:27,440 --> 02:39:29,609
ALSO HEAR THAT PERSPECTIVE.

4565
02:39:29,609 --> 02:39:32,145
BUT I DO SEE SOME OTHER

4566
02:39:32,145 --> 02:39:33,513
COLLEAGUES ON THE CALL, I DON'T

4567
02:39:33,513 --> 02:39:35,281
KNOW IF ANYONE ELSE WANTS TO

4568
02:39:35,281 --> 02:39:37,116
VOLUNTEER TO RESPOND TO THAT

4569
02:39:37,116 --> 02:39:39,986
SORT OF GENERAL INQUIRY, BUT

4570
02:39:39,986 --> 02:39:41,187
THOSE ARE SOME OF THE AVENUES

4571
02:39:41,187 --> 02:39:42,922
WHEN WE ARE TYPICALLY AND ARE

4572
02:39:42,922 --> 02:39:44,791
ABLE TO SEEK MORE BROADER

4573
02:39:44,791 --> 02:39:46,092
COMMUNITY INPUT ON DIFFERENT

4574
02:39:46,092 --> 02:39:50,129
ELEMENTS.

4575
02:39:50,129 --> 02:39:50,463
DR. LANGEVIN.

4576
02:39:50,463 --> 02:39:52,298
>> I HAVE TO JUMP OFF IN A

4577
02:39:52,298 --> 02:39:53,299
MINUTE FOR ANOTHER MEETING BUT I

4578
02:39:53,299 --> 02:39:55,535
JUST WANT TO SAY COMPLETELY 100%

4579
02:39:55,535 --> 02:39:57,203
AGREE WITH EVERYTHING WENDY

4580
02:39:57,203 --> 02:39:58,404
EXPLAINED IT REALLY NICELY.

4581
02:39:58,404 --> 02:40:01,908
I MEAN, WE HAVE TO BALANCE

4582
02:40:01,908 --> 02:40:04,377
THINGS, RIGHT?

4583
02:40:04,377 --> 02:40:07,347
AND THERE ARE STRICT RULES,

4584
02:40:07,347 --> 02:40:09,849
RIGHT, ABOUT WHO CAN BE ON THE

4585
02:40:09,849 --> 02:40:11,150
STUDY SECTION, WHAT KIND OF

4586
02:40:11,150 --> 02:40:13,486
INFORMATION WE CAN COMMUNICATE

4587
02:40:13,486 --> 02:40:16,522
ABOUT A SPECIFIC PROJECT, SAY A

4588
02:40:16,522 --> 02:40:18,591
PROGRAM ANNOUNCEMENT, WHEN WE

4589
02:40:18,591 --> 02:40:19,225
CAN COMMUNICATE THAT

4590
02:40:19,225 --> 02:40:20,093
INFORMATION.

4591
02:40:20,093 --> 02:40:24,931
THAT'S ALL VERY, VERY STRICTLY

4592
02:40:24,931 --> 02:40:27,200
REGULATED, AND THE ULTIMATE GOAL

4593
02:40:27,200 --> 02:40:31,237
IS TO PROVIDE A FAIR PROCESS

4594
02:40:31,237 --> 02:40:33,973
THAT IS COMPLETELY -- AS

4595
02:40:33,973 --> 02:40:35,375
UNBIASED AS POSSIBLE, AND WHERE

4596
02:40:35,375 --> 02:40:38,745
PEOPLE DO NOT HAVE UNDUE

4597
02:40:38,745 --> 02:40:40,046
ADVANTAGE OVER OTHERS IN

4598
02:40:40,046 --> 02:40:40,480
APPLYING.

4599
02:40:40,480 --> 02:40:43,649
BUT HAVING SAID THAT, WE ARE

4600
02:40:43,649 --> 02:40:48,488
VERY, VERY COGNIZANT OF THE FACT

4601
02:40:48,488 --> 02:40:50,523
THAT SOMETIMES NIH CAN BE KIND

4602
02:40:50,523 --> 02:40:53,259
OF A LITTLE BIT OF ITS OWN

4603
02:40:53,259 --> 02:40:55,328
ISLAND, AND WE WANT TO MAKE SURE

4604
02:40:55,328 --> 02:40:59,365
THAT BY DEVELOPING THESE FUNDING

4605
02:40:59,365 --> 02:41:02,034
OPPORTUNITIES, WE GET -- WE

4606
02:41:02,034 --> 02:41:04,404
DEVELOP IT IN A CONTEXT THAT'S

4607
02:41:04,404 --> 02:41:06,539
AS APPROPRIATE AS POSSIBLE, AND

4608
02:41:06,539 --> 02:41:10,710
WE DON'T WANT TO BE KIND OF, YOU

4609
02:41:10,710 --> 02:41:12,678
KNOW, TONE DEAF TO SOME OF THE

4610
02:41:12,678 --> 02:41:14,647
PROBLEMS THAT ARE IN THE REAL

4611
02:41:14,647 --> 02:41:16,582
WORLD, AND I THINK THAT THIS

4612
02:41:16,582 --> 02:41:19,452
WHOLE THING ABOUT I REALLY LOVE

4613
02:41:19,452 --> 02:41:21,954
THE EMPHASIS OF THE PRAGMATIC

4614
02:41:21,954 --> 02:41:23,689
TRIALS COLLABORATORY ON THE REAL

4615
02:41:23,689 --> 02:41:25,458
WORLD.

4616
02:41:25,458 --> 02:41:28,227
BECAUSE YOU DON'T WANT SCIENCE

4617
02:41:28,227 --> 02:41:29,395
TO BE IRRELEVANT TO THE REAL

4618
02:41:29,395 --> 02:41:29,729
WORLD.

4619
02:41:29,729 --> 02:41:31,030
AND I THINK THAT THIS IS WHAT

4620
02:41:31,030 --> 02:41:32,899
THE COLLABORATORY HAS REALLY

4621
02:41:32,899 --> 02:41:36,502
DONE, IS CREATING THIS BRIDGE TO

4622
02:41:36,502 --> 02:41:39,138
REALITY THAT WE CAN KEEP

4623
02:41:39,138 --> 02:41:42,074
WORKING, AND MAKING THIS AS --

4624
02:41:42,074 --> 02:41:43,810
THESE FUNDING OPPORTUNITIES THAT

4625
02:41:43,810 --> 02:41:46,879
ARE ISSUED THROUGH THE

4626
02:41:46,879 --> 02:41:49,582
COLLABORATORY AS REAL AS

4627
02:41:49,582 --> 02:41:50,249
POSSIBLE.

4628
02:41:50,249 --> 02:41:52,852
AND IT'S A PROCESS TO GET THERE.

4629
02:41:52,852 --> 02:41:53,953
SO THE INPUT THAT WE'RE GETTING

4630
02:41:53,953 --> 02:41:58,758
FROM YOU ALL IS SO VALUABLE.

4631
02:41:58,758 --> 02:41:59,058
 IN

4632
02:41:59,058 --> 02:42:01,360
HELPING US TO DO THIS AS

4633
02:42:01,360 --> 02:42:02,361
QUICKLY -- AS WELL AS POSSIBLE

4634
02:42:02,361 --> 02:42:03,563
AND AS QUICKLY AS POSSIBLE.

4635
02:42:03,563 --> 02:42:05,298
SO ANYWAY, I'M SORRY, I HAVE TO

4636
02:42:05,298 --> 02:42:06,466
JUMP OFF, BUT GREAT DISCUSSION.

4637
02:42:06,466 --> 02:42:08,434
THANK YOU SO MUCH, ALL OF YOU,

4638
02:42:08,434 --> 02:42:11,604
FOR SUCH THOUGHTFUL INPUT.

4639
02:42:11,604 --> 02:42:13,606
WE'LL SEE YOU TOMORROW.

4640
02:42:13,606 --> 02:42:16,075
>> I THINK WE HAVE A
COUPLE MORE

4641
02:42:16,075 --> 02:42:17,710
MINUTES, MAYBE TIME FOR ONE MORE

4642
02:42:17,710 --> 02:42:18,578
QUESTION, AND SOMETHING I WANTED

4643
02:42:18,578 --> 02:42:19,345
TO GET BACK TO.

4644
02:42:19,345 --> 02:42:23,616
SEVERAL OF YOU TALKED ABOUT SORT

4645
02:42:23,616 --> 02:42:24,617
OF THE DIFFERENT PHASES OF THIS

4646
02:42:24,617 --> 02:42:25,852
WORK AND THE QUESTIONS THAT COME

4647
02:42:25,852 --> 02:42:27,453
UP AND THE THINGS THAT YOU NEED

4648
02:42:27,453 --> 02:42:28,654
ADVICE ABOUT AT DIFFERENT

4649
02:42:28,654 --> 02:42:29,822
PHASES, RANGING FROM SORT OF THE

4650
02:42:29,822 --> 02:42:33,526
OVERALL STUDY DESIGN AND HOW YOU

4651
02:42:33,526 --> 02:42:34,861
WOULD STRUCTURE SOME NEW PROGRAM

4652
02:42:34,861 --> 02:42:36,596
OR SERVICE, WHAT OUTCOMES THERE

4653
02:42:36,596 --> 02:42:38,865
ARE AS YOU'RE TRYING TO ENROLL

4654
02:42:38,865 --> 02:42:41,934
OR ENGAGE PEOPLE, AS YOU'RE SORT

4655
02:42:41,934 --> 02:42:43,669
OF TRYING TO MAINTAIN

4656
02:42:43,669 --> 02:42:44,437
ENTHUSIASM.

4657
02:42:44,437 --> 02:42:47,707
I'M CURIOUS, THOUGH, THAT TRUE

4658
02:42:47,707 --> 02:42:48,441
ENGAGEMENT MEANS -- AS YOU'RE

4659
02:42:48,441 --> 02:42:49,575
LISTENING TO PEOPLE ALONG THE

4660
02:42:49,575 --> 02:42:51,077
WAY, YOU MIGHT HEAR THINGS LATER

4661
02:42:51,077 --> 02:42:53,579
ON THAT REALLY -- ABOUT THINGS

4662
02:42:53,579 --> 02:42:55,882
YOU CAN'T CHANGE ANYMORE.

4663
02:42:55,882 --> 02:42:59,252
SOMEONE SAYS, YOU REALLY SHOULD

4664
02:42:59,252 --> 02:43:01,454
BE STUDYING SOMETHING DIFFERENT,

4665
02:43:01,454 --> 02:43:03,623
YOU REALLY SHOULD BE ASSESSING

4666
02:43:03,623 --> 02:43:04,490
DIFFERENT OUTCOMES.

4667
02:43:04,490 --> 02:43:06,125
THE PERSON GIVING YOU THAT

4668
02:43:06,125 --> 02:43:06,893
ADVICE ACTUALLY MAY BE RIGHT,

4669
02:43:06,893 --> 02:43:08,261
BUT WHAT DO YOU DO WITH THAT?

4670
02:43:08,261 --> 02:43:10,396
YOU KNOW, HOW DO YOU HEAR AND

4671
02:43:10,396 --> 02:43:15,301
REALLY LISTEN TO FEAD BACK THAT

4672
02:43:15,301 --> 02:43:17,270
IN SOME WAYS IS TRUE,

4673
02:43:17,270 --> 02:43:18,237
INVALUABLE, BUT YOU CAN'T DO

4674
02:43:18,237 --> 02:43:23,943
ANYTHING ABOUT IT RIGHT NOW?

4675
02:43:23,943 --> 02:43:34,620
NEVER HAPPENED TO ANY OF YOU?

4676
02:43:34,620 --> 02:43:37,156
>> I GUESS WHAT RESONATES
WITH

4677
02:43:37,156 --> 02:43:39,125
ME WITH THAT QUESTION, GREG, IS

4678
02:43:39,125 --> 02:43:42,261
MAYBE THE LARGER CONTEXT OF

4679
02:43:42,261 --> 02:43:43,229
ESPECIALLY WORKING WITH SITES

4680
02:43:43,229 --> 02:43:44,764
AND WITH PATIENTS WHO MAY BE

4681
02:43:44,764 --> 02:43:47,400
LESS FAMILIAR WITH CLINICAL

4682
02:43:47,400 --> 02:43:52,305
RESEARCH AND SORT OF ITS RULES

4683
02:43:52,305 --> 02:43:55,241
AND SOMETIMES THAT CREATES SOME

4684
02:43:55,241 --> 02:43:56,909
CHALLENGES OR SOME NEED TO HELP

4685
02:43:56,909 --> 02:43:58,411
FOLKS UNDERSTAND WHY CERTAIN

4686
02:43:58,411 --> 02:44:00,379
THINGS CAN OR CAN'T BE DONE.

4687
02:44:00,379 --> 02:44:01,781
FOR INSTANCE, THE EXAMPLE THAT

4688
02:44:01,781 --> 02:44:04,216
COMES TO MY MIND IS JUST THE

4689
02:44:04,216 --> 02:44:06,185
TIMELINE OF HAVING AN IDEA AND

4690
02:44:06,185 --> 02:44:08,888
SUBMITTING A GRANT AND GETTING

4691
02:44:08,888 --> 02:44:12,291
FUNDING AND IT IS AND IT SEEMS

4692
02:44:12,291 --> 02:44:15,127
PARTICULARLY TO AN OUTSIDER LONG

4693
02:44:15,127 --> 02:44:16,529
AND DELAYED AND THIS IDEA OF

4694
02:44:16,529 --> 02:44:19,265
LIKE I'M ASKING YOU TO COMMIT

4695
02:44:19,265 --> 02:44:20,633
WITH A LETTER OF SUPPORT FOR

4696
02:44:20,633 --> 02:44:22,134
THIS THING THAT MAY OR MAY NOT

4697
02:44:22,134 --> 02:44:23,736
EVER HAPPEN, AND IF IT DOES

4698
02:44:23,736 --> 02:44:24,837
HAPPEN, IT'S GOING TO HAPPEN

4699
02:44:24,837 --> 02:44:27,873
MAYBE A YEAR FROM NOW AND YOUR

4700
02:44:27,873 --> 02:44:30,376
PRIORITIES MAY HAVE MOVED ON, IT

4701
02:44:30,376 --> 02:44:31,477
IMPORTANT AT MINIMUM OR AT LEAST

4702
02:44:31,477 --> 02:44:33,679
IN MY -- MY THOUGHT ON THAT IS

4703
02:44:33,679 --> 02:44:35,615
JUST TO NOT ASSUME PEOPLE KIND

4704
02:44:35,615 --> 02:44:36,916
OF UNDERSTAND THAT, LIKE AN

4705
02:44:36,916 --> 02:44:39,552
ACADEMIC COLLEAGUE WOULD, AND TO

4706
02:44:39,552 --> 02:44:42,188
EXPLAIN WHAT IT MEANS, WHAT

4707
02:44:42,188 --> 02:44:43,389
STAGE WE'RE AT, WHAT THE NEXT

4708
02:44:43,389 --> 02:44:44,790
STAGE IS AND WHAT THAT TIMELINE

4709
02:44:44,790 --> 02:44:52,832
MAY LOOK LIKE.

4710
02:44:52,832 --> 02:44:54,000
>> ANYBODY ELSE WITH
THOUGHTS

4711
02:44:54,000 --> 02:44:58,604
ABOUT THAT?

4712
02:44:58,604 --> 02:45:01,040
>> I AGREE WITH JULIE,
THAT'S

4713
02:45:01,040 --> 02:45:03,275
WHY I SEE THAT PROBABLY THE MOST

4714
02:45:03,275 --> 02:45:03,909
FREQUENT, BUT AT THE SAME TIME,

4715
02:45:03,909 --> 02:45:07,980
IT COULD BE THE MOST VALUABLE.

4716
02:45:07,980 --> 02:45:09,749
SO SOMEONE IN THE COMMUNITY WHO

4717
02:45:09,749 --> 02:45:12,585
DOESN'T KNOW THE WHOLE SCIENCE

4718
02:45:12,585 --> 02:45:15,855
BEHIND HOW TO CARRY OUT A

4719
02:45:15,855 --> 02:45:18,591
CLINICAL TRIAL, AND WHY ALL OF A

4720
02:45:18,591 --> 02:45:20,026
SUDDEN YOU'RE NOT ASKING THESE

4721
02:45:20,026 --> 02:45:24,597
QUESTIONS BECAUSE I MIG THAT MIE

4722
02:45:24,597 --> 02:45:25,264
THEIR PARTICULAR INTEREST.

4723
02:45:25,264 --> 02:45:27,833
SO I THINK ADDRESSING THOSE HAS

4724
02:45:27,833 --> 02:45:30,403
TO DO AAGAIN -- WHY IT TAKES

4725
02:45:30,403 --> 02:45:35,408
TIME TO BUILD YOUR PARTNERS WHO

4726
02:45:35,408 --> 02:45:38,577
UNDERSTAND THE RESEARCH DOESN'T

4727
02:45:38,577 --> 02:45:41,213
HAPPEN OVERNIGHT, YOU KNOW?

4728
02:45:41,213 --> 02:45:42,515
BUT ON THE OTHER HAND, I

4729
02:45:42,515 --> 02:45:43,949
ACTUALLY -- I ACTUALLY LIKE

4730
02:45:43,949 --> 02:45:47,119
BEING CHALLENGED, I LIKE IT WHEN

4731
02:45:47,119 --> 02:45:48,320
I SEE PEOPLE DON'T UNDERSTAND

4732
02:45:48,320 --> 02:45:50,823
BECAUSE I KIND OF PUT THAT IN MY

4733
02:45:50,823 --> 02:45:53,225
MIND TO WHAT'S THE POSITIVE, HOW

4734
02:45:53,225 --> 02:45:55,728
CAN WE ADDRESS THIS LACK OF

4735
02:45:55,728 --> 02:45:56,929
UNDERSTANDING, HOW CAN WE MAKE

4736
02:45:56,929 --> 02:46:00,299
THIS BETTER UNDERSTOOD, OR MAYBE

4737
02:46:00,299 --> 02:46:01,400
THEY'RE BRINGING UP A CHALLENGE

4738
02:46:01,400 --> 02:46:04,170
THAT I HADN'T THOUGHT ABOUT.

4739
02:46:04,170 --> 02:46:06,305
>> SO IN THE MIDDLE OF
YOUR

4740
02:46:06,305 --> 02:46:07,273
VACATION AT THE BEACH WHEN THE

4741
02:46:07,273 --> 02:46:08,908
KIDS SAY WE SHOULD HAVE GONE TO

4742
02:46:08,908 --> 02:46:10,242
THE MOUNTAINS, YOU CAN'T EXACTLY

4743
02:46:10,242 --> 02:46:11,444
PACK UP AND GO TO THE MOUNTAINS

4744
02:46:11,444 --> 02:46:13,079
BUT YOU CAN SAY WE'LL GO ON

4745
02:46:13,079 --> 02:46:16,015
VACATION NEXT YEAR.

4746
02:46:16,015 --> 02:46:17,750
I'LL REMEMBER THAT NEXT YEAR.

4747
02:46:17,750 --> 02:46:18,517
OKAY.

4748
02:46:18,517 --> 02:46:20,052
SO WE'VE GOT TO ASK KEVIN AND

4749
02:46:20,052 --> 02:46:21,387
OTHERS TO COME BACK ON FOR THE

4750
02:46:21,387 --> 02:46:25,391
SORT OF WRAPPING UP OF TODAY.

4751
02:46:25,391 --> 02:46:25,725
>> GREAT.

4752
02:46:25,725 --> 02:46:28,661
THANK YOU SO MUCH TO ALL OF OUR

4753
02:46:28,661 --> 02:46:29,628
SPEAKERS, AND I SEE LESLIE, DO

4754
02:46:29,628 --> 02:46:32,264
YOU WANT TO START US OFF ON OUR

4755
02:46:32,264 --> 02:46:34,100
WRAP-UP?

4756
02:46:34,100 --> 02:46:36,635
>> WELL, FIRST OF ALL,
THANKS TO

4757
02:46:36,635 --> 02:46:40,473
GREG AND TO KEVIN FOR MODERATING

4758
02:46:40,473 --> 02:46:42,341
SUCH EXCELLENT SESSIONS TODAY.

4759
02:46:42,341 --> 02:46:47,379
WHAT A GREAT WAY TO START.

4760
02:46:47,379 --> 02:46:49,115
YOU KNOW, I WOULD SAY A KEY

4761
02:46:49,115 --> 02:46:51,283
TAKEAWAY FOR ME FROM THESE PANEL

4762
02:46:51,283 --> 02:46:52,685
DISCUSSIONS IS JUST THE

4763
02:46:52,685 --> 02:46:53,819
CREATIVITY THAT IS REQUIRED.

4764
02:46:53,819 --> 02:46:54,887
VERY EARLY ON.

4765
02:46:54,887 --> 02:46:58,390
LONG BEFORE THE IDEA TAKES ITS

4766
02:46:58,390 --> 02:47:01,227
FINAL SHAPE, THE CREATIVITY

4767
02:47:01,227 --> 02:47:03,229
THAT'S REQUIRED IN THINKING

4768
02:47:03,229 --> 02:47:05,097
CAREFULLY ABOUT THE QUESTION AND

4769
02:47:05,097 --> 02:47:07,333
THEN BRINGING TOGETHER ALL OF

4770
02:47:07,333 --> 02:47:09,034
THE DIFFERENT -- ALL OF THE

4771
02:47:09,034 --> 02:47:10,770
DIFFERENT PERSPECTIVES.

4772
02:47:10,770 --> 02:47:15,908
SO IT NO SURPRISE THAT THE PIs

4773
02:47:15,908 --> 02:47:17,176
AND THE TEAMS THAT ARE PART OF

4774
02:47:17,176 --> 02:47:18,778
THE COLLABORATORY, THEY'RE A

4775
02:47:18,778 --> 02:47:20,279
CREATIVE BUNCH OF FOLKS BECAUSE

4776
02:47:20,279 --> 02:47:23,115
IT'S INTEGRAL TO GETTING THE

4777
02:47:23,115 --> 02:47:25,951
QUESTION RIGHT, AND TO TRULY

4778
02:47:25,951 --> 02:47:28,954
ENGAGING THE COMMUNITIES IN

4779
02:47:28,954 --> 02:47:32,258
WHICH THIS RESEARCH IS CONDUC 

4780
02:47:32,258 --> 02:47:36,495
CONDUCTED.

4781
02:47:36,495 --> 02:47:38,197
>> KEVIN AND GREG, I'M
REALLY

4782
02:47:38,197 --> 02:47:39,532
CURIOUS TO HEAR FROM YOU.

4783
02:47:39,532 --> 02:47:40,966
WHAT SURPRISED YOU?

4784
02:47:40,966 --> 02:47:45,437
WHAT DID YOU LEARN FROM YOUR

4785
02:47:45,437 --> 02:47:47,506
PANELISTS TODAY THAT MAYBE

4786
02:47:47,506 --> 02:47:49,141
SURPRISED YOU A LITTLE BIT?

4787
02:47:49,141 --> 02:47:51,243
KEVIN, DO YOU WANT TO GO FIRST?

4788
02:47:51,243 --> 02:47:51,877
>> SURE.

4789
02:47:51,877 --> 02:47:53,846
YOU KNOW, I GUESS ONE OF THE BIG

4790
02:47:53,846 --> 02:47:56,816
THINGS THAT CAME OUT, I'M NOT SO

4791
02:47:56,816 --> 02:48:01,520
SURE IT WAS A SURPRISE BUT

4792
02:48:01,520 --> 02:48:03,055
HEARING THE STORIES IN BOTH

4793
02:48:03,055 --> 02:48:07,526
PANELS, ACTUALLY, REALLY PUT

4794
02:48:07,526 --> 02:48:09,061
SOME MORE FLESH AND FLOOD ON

4795
02:48:09,061 --> 02:48:11,163
THESE IDEAS, AND THAT WAS THE

4796
02:48:11,163 --> 02:48:17,269
IMPORTANCE OF ALREADY HAVING A

4797
02:48:17,269 --> 02:48:20,773
NETWORK OF CLINICAL COLLEAGUES,

4798
02:48:20,773 --> 02:48:22,842
PATIENT REPRESENTATIVES, HEALTH

4799
02:48:22,842 --> 02:48:23,943
SYSTEMS LEADERSHIP.

4800
02:48:23,943 --> 02:48:26,946
PEOPLE TALKED ABOUT THE EXISTING

4801
02:48:26,946 --> 02:48:29,415
CONTEXT AND THE ASSETS THEY HAD

4802
02:48:29,415 --> 02:48:32,151
WHEN A CALL FOR APPLICATIONS

4803
02:48:32,151 --> 02:48:33,452
CAME OUT.

4804
02:48:33,452 --> 02:48:39,592
YOU KNOW, AND HAVING THOSE

4805
02:48:39,592 --> 02:48:43,295
PARTNERS ALREADY IN PLACE AT

4806
02:48:43,295 --> 02:48:46,465
LEAST AT SOME MINIMUM KIND OF

4807
02:48:46,465 --> 02:48:48,434
RELATIONSHIP.

4808
02:48:48,434 --> 02:48:50,102
IT SEEM LIKE THAT WAS A CONSTANT

4809
02:48:50,102 --> 02:48:52,705
INCREED YENT ACROSS -- THESE ARE

4810
02:48:52,705 --> 02:48:54,039
ALL VERY SUCCESSFUL PROJECTS

4811
02:48:54,039 --> 02:48:55,875
TOO, THESE ARE THE ONES WHO WERE

4812
02:48:55,875 --> 02:48:57,509
SELECTED TO BE FUNDED.

4813
02:48:57,509 --> 02:48:59,278
THEY ALL HAD THAT TO SOME EXTENT

4814
02:48:59,278 --> 02:49:03,082
AND IT REALLY -- I THINK THAT

4815
02:49:03,082 --> 02:49:05,050
STRUCK ME MORE IN THESE STORIES

4816
02:49:05,050 --> 02:49:06,252
THIS TIME AROUND AND HOW

4817
02:49:06,252 --> 02:49:08,020
CRITICAL THAT IS IF YOU WANT TO

4818
02:49:08,020 --> 02:49:10,856
BE MAKING MOVES IN THIS SPACE,

4819
02:49:10,856 --> 02:49:14,460
TO NOT WAIT UNTIL THE CALL COMES

4820
02:49:14,460 --> 02:49:16,328
OUT, START GENERATING THOSE

4821
02:49:16,328 --> 02:49:18,831
RELATIONSHIPS AND INVESTING IN

4822
02:49:18,831 --> 02:49:21,467
THEM NOW SO THAT YOU CAN TAKE

4823
02:49:21,467 --> 02:49:23,636
ADVANTAGE WHEN SOMETHING POPS

4824
02:49:23,636 --> 02:49:25,104
UP.

4825
02:49:25,104 --> 02:49:25,838
>> RIGHT.

4826
02:49:25,838 --> 02:49:29,208
AND ALONG THOSE LINES, WE HEARD

4827
02:49:29,208 --> 02:49:29,909
ABOUT THE IMPORTANCE AND

4828
02:49:29,909 --> 02:49:32,411
CHALLENGES OF KEEPING ALL OF

4829
02:49:32,411 --> 02:49:33,178
THAT WARM.

4830
02:49:33,178 --> 02:49:36,348
WHILE YOU WAIT FOR, UNTIL THAT

4831
02:49:36,348 --> 02:49:40,085
OPPORTUNITY COMES ALONG.

4832
02:49:40,085 --> 02:49:42,388
GREG, WHAT ABOUT YOUR KEY

4833
02:49:42,388 --> 02:49:43,289
TAKEAWAYS, SURPRISES?

4834
02:49:43,289 --> 02:49:46,091
>> WELL, GOING BACK TO THE
OTHER

4835
02:49:46,091 --> 02:49:46,992
QUESTION I ASKED AND WHAT

4836
02:49:46,992 --> 02:49:48,527
NATALIA SAID, I LIKED THE WAY

4837
02:49:48,527 --> 02:49:49,728
SHE PUT IT ABOUT HEARING FROM

4838
02:49:49,728 --> 02:49:53,666
PEOPLE AND THEY' THEY'RE HAVING

4839
02:49:53,666 --> 02:49:54,967
STRONGLY HELD OPINIONS THAT ARE

4840
02:49:54,967 --> 02:49:57,036
DISPARATE OR DIVERGENT AND HOW

4841
02:49:57,036 --> 02:49:58,804
YOU DEAL WITH THAT.

4842
02:49:58,804 --> 02:50:00,139
WELL, THE GOOD NEWS IS THAT

4843
02:50:00,139 --> 02:50:01,674
PEOPLE CARE ABOUT THIS, WHICH IS

4844
02:50:01,674 --> 02:50:02,975
GOOD.

4845
02:50:02,975 --> 02:50:04,410
YOU WOULDN'T WANT TO BE

4846
02:50:04,410 --> 02:50:05,277
INVESTING SIGNIFICANT RESOURCES

4847
02:50:05,277 --> 02:50:06,912
AND FOR AN INVESTIGATOR A

4848
02:50:06,912 --> 02:50:08,514
SIGNIFICANT CHUNK OF YOUR LIFE

4849
02:50:08,514 --> 02:50:09,348
IN SOMETHING THAT NOBODY CARES

4850
02:50:09,348 --> 02:50:09,748
ABOUT.

4851
02:50:09,748 --> 02:50:13,919
SO PEOPLE HAVE OPINIONS IT'S --

4852
02:50:13,919 --> 02:50:15,220
CREATES A CHALLENGE I THINK IN

4853
02:50:15,220 --> 02:50:16,855
TERMS OF BEING ABLE TO TAKE ALL

4854
02:50:16,855 --> 02:50:19,258
THAT IN, TO LISTEN TO ALL THAT,

4855
02:50:19,258 --> 02:50:22,995
TO REALIZE THAT THE GOAL IS NOT

4856
02:50:22,995 --> 02:50:24,863
IN, SAY, A MEETING WHERE YOU'RE

4857
02:50:24,863 --> 02:50:26,165
ENGAGING WITH VARIOUS INTERESTED

4858
02:50:26,165 --> 02:50:26,398
PARTIES.

4859
02:50:26,398 --> 02:50:28,701
THE GOAL OF SUCH A MEETING IS

4860
02:50:28,701 --> 02:50:31,203
NOT TO SETTLE THE QUESTION, AT

4861
02:50:31,203 --> 02:50:33,072
LEAST THAT'S NOT THE GOAL OF THE

4862
02:50:33,072 --> 02:50:35,474
INVESTIGATOR BECAUSE DATASET EL

4863
02:50:35,474 --> 02:50:38,344
THE QUESTION, WE HOPE, NOT

4864
02:50:38,344 --> 02:50:39,311
OPINIONS SETTLE THE QUESTION.

4865
02:50:39,311 --> 02:50:40,679
BUT WE NEED TO KNOW ABOUT ALL

4866
02:50:40,679 --> 02:50:41,513
THOSE OPINIONS AND WE NEED TO

4867
02:50:41,513 --> 02:50:42,815
THINK ABOUT THIS IS THE WORLD I

4868
02:50:42,815 --> 02:50:44,750
AM OPERATING IN, AND EVENTUALLY

4869
02:50:44,750 --> 02:50:45,851
AS NATALIA POINTED OUT, THESE

4870
02:50:45,851 --> 02:50:47,920
ARE THE PEOPLE WHO WILL NEED TO

4871
02:50:47,920 --> 02:50:49,822
TRUST ME IF THE DATA I PRODUCE

4872
02:50:49,822 --> 02:50:53,726
ARE ACTUALLY TO LEAD TO CHANGE.

4873
02:50:53,726 --> 02:50:55,060
SO THAT IS AN INTERESTING DANCE,

4874
02:50:55,060 --> 02:50:57,329
I THINK.

4875
02:50:57,329 --> 02:51:01,667
BEING ABLE TO HEAR THAT, TO

4876
02:51:01,667 --> 02:51:02,267
ACKNOWLEDGE THE IMPORTANCE OF

4877
02:51:02,267 --> 02:51:07,306
ALL THOSE DIFFERENT VIEWS, TO

4878
02:51:07,306 --> 02:51:09,274
KNOW THAT PROBABLY NO SINGLE ONE

4879
02:51:09,274 --> 02:51:10,609
OF THEM IS EVER GOING TO BE

4880
02:51:10,609 --> 02:51:12,044
COMPLETELY RIGHT, THAT IDEALLY I

4881
02:51:12,044 --> 02:51:17,049
NEED TO PRODUCE -- ULTIMATELY I

4882
02:51:17,049 --> 02:51:18,350
WANT TO CREATE INFORMATION OR

4883
02:51:18,350 --> 02:51:19,451
PRODUCE EVIDENCE THAT ADDRESSES

4884
02:51:19,451 --> 02:51:20,719
ALL OF THOSE CONCERNS AND IS

4885
02:51:20,719 --> 02:51:29,561
STILL CREDIBLE TO THOSE PEOPLE.

4886
02:51:29,561 --> 02:51:31,296
>> WENDY, WHAT ARE YOUR
THOUGHTS

4887
02:51:31,296 --> 02:51:31,797
AFTER TODAY?

4888
02:51:31,797 --> 02:51:33,365
>> SO I THINK IT WAS
REALLY

4889
02:51:33,365 --> 02:51:35,234
INTERESTING TO HEAR THE VERY

4890
02:51:35,234 --> 02:51:37,503
DIFFERENT WAYS PEOPLE GOT TO THE

4891
02:51:37,503 --> 02:51:38,937
SAME -- GOT TO THEIR RESEARCH

4892
02:51:38,937 --> 02:51:39,605
QUESTION.

4893
02:51:39,605 --> 02:51:41,473
LIKE THERE'S NOT A COOKBOOK FOR

4894
02:51:41,473 --> 02:51:43,108
THIS, RIGHT, YOU KNOW, WE HEARD

4895
02:51:43,108 --> 02:51:45,210
IT'S ITERATIVE, YOU MAKE ONE

4896
02:51:45,210 --> 02:51:46,211
DECISION AND THEN YOU MAKE

4897
02:51:46,211 --> 02:51:47,913
ANOTHER DECISION THAT CHANGES

4898
02:51:47,913 --> 02:51:51,283
THE FIRST DECISION A LITTLE BIT

4899
02:51:51,283 --> 02:51:54,019
AND YOU NEED TIME TO SORT OF

4900
02:51:54,019 --> 02:51:56,221
WORK THROUGH THOSE THINGS AND

4901
02:51:56,221 --> 02:51:57,423
PLAN ALL OF THOSE DIFFERENT

4902
02:51:57,423 --> 02:51:57,856
ELEMENTS OUT.

4903
02:51:57,856 --> 02:51:59,191
SO I THINK THAT WAS REALLY

4904
02:51:59,191 --> 02:52:02,027
INTERESTING, AND THEN WHAT I

4905
02:52:02,027 --> 02:52:04,663
HEARD ALSO WAS NEEDING TO BRING

4906
02:52:04,663 --> 02:52:06,198
THE RIGHT PEOPLE INTO THE

4907
02:52:06,198 --> 02:52:07,066
CONVERSATION, EVEN JUST TO

4908
02:52:07,066 --> 02:52:10,736
DESIGN THE STUDY, AND THINK

4909
02:52:10,736 --> 02:52:14,740
ABOUT WHO YOU NEED TO ENGAGE AND

4910
02:52:14,740 --> 02:52:16,542
FOR THE ENGAGEMENT ELEMENT BUT

4911
02:52:16,542 --> 02:52:17,810
ALSO FOR THE DESIGN ELEMENTS

4912
02:52:17,810 --> 02:52:18,110
TOO.

4913
02:52:18,110 --> 02:52:20,212
A LOT OF THE STUDIES HAD

4914
02:52:20,212 --> 02:52:23,248
IMPLEMENTATION SCIENCE EXPERTISE

4915
02:52:23,248 --> 02:52:25,150
OR THEY HAD ENGAGEMENT EXPERTISE

4916
02:52:25,150 --> 02:52:26,118
THAT THEY BROUGHT ON TO THEIR

4917
02:52:26,118 --> 02:52:28,620
TEAM, WHICH IF YOU'VE DONE

4918
02:52:28,620 --> 02:52:31,590
TRIALS BEFORE IS SORT OF MORE A

4919
02:52:31,590 --> 02:52:35,227
CLASSIC EFFICACY STUDY, THOSE

4920
02:52:35,227 --> 02:52:36,195
USUALLY AREN'T PEOPLE YOU'RE

4921
02:52:36,195 --> 02:52:37,529
PARTNERING WITH SO BEING ABLE TO

4922
02:52:37,529 --> 02:52:38,597
FIND THOSE FOLKS I THINK IS

4923
02:52:38,597 --> 02:52:39,498
REALLY IMPORTANT AND BEING ABLE

4924
02:52:39,498 --> 02:52:41,033
TO FIND THAT EXPERTISE.

4925
02:52:41,033 --> 02:52:43,335
SO AS ALWAYS, LOTS OF LESSONS

4926
02:52:43,335 --> 02:52:44,570
LEARNED FROM ALL OF OUR

4927
02:52:44,570 --> 02:52:49,475
INVESTIGATE SORES, AND MORE --

4928
02:52:49,475 --> 02:52:50,442
INVESTIGATORS AND MORE TO THINK

4929
02:52:50,442 --> 02:52:50,642
ABOUT.

4930
02:52:50,642 --> 02:52:51,110
>> GREAT.

4931
02:52:51,110 --> 02:52:52,544
WELL, IT WAS A TERRIFIC START,

4932
02:52:52,544 --> 02:52:55,714
DAY ONE OF A TWO-DAY WORKSHOP,

4933
02:52:55,714 --> 02:52:58,250
AND YOU KNOW, WENDY, I'M LOOKING

4934
02:52:58,250 --> 02:52:59,718
AT THE CLOCK AND I SEE THAT WE

4935
02:52:59,718 --> 02:53:00,786
REALLY ONLY HAVE A COUPLE OF

4936
02:53:00,786 --> 02:53:02,521
MINUTES, SO PERHAPS WE SHOULD

4937
02:53:02,521 --> 02:53:03,722
JUST POINT FOLKS TO WHAT'S UP

4938
02:53:03,722 --> 02:53:04,723
FOR TOMORROW.

4939
02:53:04,723 --> 02:53:05,657
DOES THAT SOUND GOOD?

4940
02:53:05,657 --> 02:53:06,825
>> THAT SOUND GREAT.

4941
02:53:06,825 --> 02:53:08,327
>> GREAT.

4942
02:53:08,327 --> 02:53:11,497
SO WE HOPE YOU'LL ALL JOIN US

4943
02:53:11,497 --> 02:53:12,064
TOMORROW.

4944
02:53:12,064 --> 02:53:16,101
WE'LL BEGIN WITH A KEYNOTE

4945
02:53:16,101 --> 02:53:17,970
PRESENTATION FROM DR. MONICA

4946
02:53:17,970 --> 02:53:19,171
BERTAGNOLLI, AND REALLY LOOKING

4947
02:53:19,171 --> 02:53:24,076
FORWARD TO THAT, FOCUSING ON

4948
02:53:24,076 --> 02:53:25,611
REALLY IDENTIFYING THOSE HIGH

4949
02:53:25,611 --> 02:53:27,045
PRIORITY HEALTHCARE ISSUES THAT

4950
02:53:27,045 --> 02:53:28,147
REALLY REQUIRE WHAT WE'VE BEEN

4951
02:53:28,147 --> 02:53:29,314
TALKING ABOUT HERE, THE EFFORT,

4952
02:53:29,314 --> 02:53:33,318
TIME AND FUNDING OF A TRIAL.

4953
02:53:33,318 --> 02:53:34,953
WE'LL GO FROM THERE TO HEAR FROM

4954
02:53:34,953 --> 02:53:36,922
OUR PIs ABOUT HOW THEY'VE USED

4955
02:53:36,922 --> 02:53:41,827
DATA FROM DISPARATE DATA

4956
02:53:41,827 --> 02:53:42,828
SYSTEMS, A CHALLENGE THAT'S

4957
02:53:42,828 --> 02:53:44,496
COMMON TO ALL PRAGMATIC TRIALS.

4958
02:53:44,496 --> 02:53:46,365
WE'LL HEAR FROM ANOTHER PANEL

4959
02:53:46,365 --> 02:53:48,901
ABOUT HOW TO REACH THE

4960
02:53:48,901 --> 02:53:50,969
POPULATIONS THAT ARE MOST

4961
02:53:50,969 --> 02:53:55,340
AFFECTED BY HEALTH INEQUITIES,

4962
02:53:55,340 --> 02:53:56,875
AND THEN WE'LL REALLY ROUND IT

4963
02:53:56,875 --> 02:54:00,179
OUT BY TALKING ABOUT HOW TO

4964
02:54:00,179 --> 02:54:01,480
OVERCOME SOME OF THE

4965
02:54:01,480 --> 02:54:02,447
ADMINISTRATIVE BURDENS THAT

4966
02:54:02,447 --> 02:54:03,782
THREATEN PRAGMATIC RESEARCH.

4967
02:54:03,782 --> 02:54:06,285
SO IT WILL BE A FANTASTIC DAY,

4968
02:54:06,285 --> 02:54:08,720
MORE INSIGHTS TO COME, AND MAYBE

4969
02:54:08,720 --> 02:54:10,355
WITH THAT, WENDY, I'LL TURN IT

4970
02:54:10,355 --> 02:54:13,859
OVER TO YOU FOR THE THANK YOU

4971
02:54:13,859 --> 02:54:15,294
AND FAREWELL.

4972
02:54:15,294 --> 02:54:16,028
>> YEAH.

4973
02:54:16,028 --> 02:54:18,330
SO AGAIN, THANKS TO ALL OF OUR

4974
02:54:18,330 --> 02:54:20,866
ORGANIZERS, ALL OF OUR SPEAKERS,

4975
02:54:20,866 --> 02:54:22,167
OUR MODERATORS, AND EVERYONE FOR

4976
02:54:22,167 --> 02:54:22,734
JOINING US.

4977
02:54:22,734 --> 02:54:24,369
WE WILL LOOK FORWARD TO SEEING

4978
02:54:24,369 --> 02:54:25,037
YOU TOMORROW.

4979
02:54:25,037 --> 02:54:27,539
WE'RE STARTING AT 11:00 A.M.

4980
02:54:27,539 --> 02:54:29,608
EASTERN, WHICH IS 8:00 A.M.

4981
02:54:29,608 --> 02:54:30,509
PACIFIC.

4982
02:54:30,509 --> 02:54:33,679
AND WE'LL SEE YOU ALL TOMORROW.

4983
02:54:33,679 --> 02:54:34,813
BYE-BYE, EVERYONE.

4984
02:54:34,813 --> 02:54:45,023
>> GOODBYE.