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>>> GOOD AFTERNOON, EVERYBODY. IT'S 1:00 P.M., TIME TO BEGIN
THE GRAND ROUNDS. I'M TANJA POPOVIC, SCIENTIFIC
DIRECTOR OF THE GRAND ROUNDS. I WAS WONDERING WHETHER IT'S
TIME FOR ME TO DO SOMETHING ELSE BECAUSE THE LAST TWO TIMES
I TRIED TO DO THE GRAND ROUNDS SOMETHING WENT WRONG.
FOR THOSE OF YOU WHO HAVE BEEN HERE FOR THE ADVANCED MOLECULAR
DETECTION, IT WAS THE GOVERNMENT SHUTDOWN.
TODAY THE GOVERNMENT OFFICES ARE SHUT IN WASHINGTON, D.C., SO OUR
SPEAKER, DR. HARVEY FINEBERG, IS JOINING US VIA SKYPE THAT WE
WORKED OUT AT THE LAST MINUTE. HE WAS SUPPOSED SO JOIN US IN A
LITTLE BIT MORE COORDINATED MANNER.
I APPRECIATE YOUR PATIENCE IN ADVANCE.
SO TODAY WE'RE GOING TO BE TALKING ABOUT MEASURING SCIENCE
IMPACTS AND IT'S WONDERFUL TO SEE SO MANY INTERESTED IN THIS
TOPIC. I WILL GO EXTREMELY QUICKLY
THROUGH MY INTRO TO ALLOW TIME FOR THE SPEAKERS AN PANEL
DISCUSSION. THESE ARE OUR EXPANSION INTO THE
SOCIAL MEDIA WORLD. THIS IS WHERE YOU CAN FIND US
AND FOLLOW US. WE ARE REQUIRED TO DISCLOSE THAT
WE HAVE NOTHING TO DISCLOSE SO I HAD TO PUT THE FOLLOWING TEXT.
THIS IS PER NEW RULES. TODAY'S FORMAT IS GOING TO BE A
LITTLE BIT DIFFERENT. SEVERAL OF YOU, INCLUDING MY
BOSS, SAID, MAYBE WE COULD DO SOMETHING A LITTLE BIT
DIFFERENT, NOT ALWAYS HAVE THE SPEAKERS.
SO I SAID, LET'S TRY SOMETHING DIFFERENT.
SO THIS IS GOING TO BE A DEBATE CLUB.
WE'RE GOING TO HAVE DR. FINEBERG AND DR. ARI GIVE INTRODUCTORY
TALKS. THEN WE'LL HAVE OUR
DISTINGUISHED CDC PANELISTS PARTICIPATE IN A DISCUSSION
ABOUT THEIR OWN EXPERIENCES. SO, WITH THAT, I'M GOING TO TURN
IT IMMEDIATELY TO THE CDC DIRECTOR, DR. TOM FRIEDEN.
[ APPLAUSE ] >> THE VERY FIRST TIME I CAME TO
A CDC CONFERENCE IT WAS THE EIS CONFERENCE AT WHICH I WAS
ENTERING EIS. AND THE THING THAT BOTH STARTLED
AND IMPRESSED ME MOST ABOUT CDC WAS THAT THERE WAS NO
COMPUNCTION FROM PEOPLE IN THE AUDIENCE FOR STANDING UP ASKING
SOMEBODY WHO HAD WORKED LONG AND *** THE PROJECT, PEOPLE IN
THE AUDIENCE, CDC STAFF WOULD ASK, WELL, SO WHAT?
WHY IS THIS IMPORTANT? MEASURING IMPACT IS SO IMPORTANT
BECAUSE IT ALLOWS US TO PRIORITIZE WHAT WE'RE GOING TO
DO, TO SUSTAIN IT IF IT'S EFFECTIVE, AND TO IMPROVE IT IF
IT'S NOT EFFECTIVE. THE BASIC GOAL IS VERY
STRAIGHTFORWARD. HOW CAN WE HAVE MAXIMUM HEALTH
IMPACT. TRADITIONAL JOURNAL BIB LOW
METRICS ARE IMPORTANT, AND THEY SHOW HOW OFTEN SOMETHING IS
MEASURED OR TALKED ABOUT, BUT THEY DON'T NECESSARILY DISCUSS
WHETHER IT CHANGED THE WORLD. AND WHAT YOU'LL SEE TODAY IS THE
PROCESS AND A TOOL FOR BEGINNING TO MEASURE THAT, HOW OUR WORK
CHANGES LIFE NOT ONLY IN JOURNALS AND IN A WAY THAT IS
UNDERSTANDABLE, SIMPLE, CLEAR, AND UNDERSTANDABLE,
STRAIGHTFORWARD AND MODIFIABLE FOR DIFFERENT USES.
I THINK IT WILL BE IMPORTANT FOR YOU TO TRACK HOW IT WAS
DEVELOPED. IT'S NOT EASY.
AND HOW IT CAN POTENTIALLY BE USED.
AND TO THINK ABOUT HOW YOU CAN APPLY THAT IN YOUR AREA.
SO THIS IS A NEW WAY OF ANSWERING THAT VERY IMPORTANT,
IN FACT, MOST IMPORTANT, QUESTION OF "SO WHAT."
AND IT REMINDS ME OF WHAT MY FATHER USED TO SAY.
MY FATHER HAD DONE BOTH CLINICAL RESEARCH, BASIC RESEARCH AND
CLINICAL CARE, AND AFTER MANY YEARS AND PUBLISHING MANY
ARTICLES AND BOOKS HE HAD WAS A LITTLE JAUNDICED ABOUT THE VALUE
OF SOME OF THE THINGS THAT GET WRITTEN IN THE LITERATURE.
HE PUT THAT IN PERSPECTIVE BY S
SAYING, YOU KNOW, NEVER FORGET THAT 20 ARTICLES EQUALS ONE BOOK
EQUALS ONE LINE IN YOUR OBITUARY.
I THINK WHAT'S IMPORTANT ABOUT THIS TOPIC IS THAT IT ENCOURAGES
US -- THIS IS JUST ONE WAY, BUT THERE ARE MANY WAYS THAT I THINK
WE HAVE TO HAVE A HEALTHY OBSESSION WITH IMPACT.
TO ALWAYS BE ASKING OURSELVES, WHAT IS THE REAL IMPACT OF OUR
WORK ON IMPROVING HEALTH, OF HELPING PEOPLE REACH THEIR FULL
POTENTIAL? AND THAT'S WHY I'M SO GLAD THAT
OUR SPEAKERS AND DISCUSSANTS AND OTHERS, HARVEY, THAT YOU'RE ABLE
TO JOIN US TO COVER THIS IMPORTANT TOPIC AND REALLY
ADVANCE THE PROCESS OF TRYING TO BETTER ANALYZE, UNDERSTAND AND
IMPROVE BOTH OUR MEASUREMENT OF THE "SO WHAT" AND THE OUTCOMES.
THANK YOU VERY MUCH. [ APPLAUSE ]
>> AND SO IT'S REALLY OUR GREAT PLEASURE TO INTRODUCE OUR FIRST
SPEAKER, DR. HARVEY FINEBERG, PRESIDENT INSTITUTE OF MEDICINE.
>> THANK YOU SO VERY MUCH. AND THANK YOU, EVERYONE, FOR
INDULGING MY PARTICIPATION IN THIS WAY FROM A DISTANCE.
I'M VERY GLAD TO BE ABLE TO TAKE PART IN A VERY IMPORTANT
DISCUSSION ABOUT A VERY FUNDAMENTAL QUESTION, AS
DR. NEEDDR. DR. FRIEDEN JUST DESCRIBED --
WHAT DIFFERENCE ARE WE MAKING? WHEN I STARTED AT THE INSTITUTE
OF MEDICINE 12 YEARS AGO, I POSED THIS QUESTION TO MY STAFF.
OF I CALLED IN THE DEPUTY EXECUTIVE OFFICER, AND I ASKED
HIM IF HE COULD ASSEMBLE EXAMPLES OF THE VERY BEST WORK
THAT THE INSTITUTE OF MEDICINE HAD DONE SO THAT I MIGHT LEARN
FROM OUR SUCCESS. IN A FEW MINUTES, HE CAME BACK
TO MY OFFICE, AND I THOUGHT, BOY, THAT WAS FAST.
BUT INSTEAD OF AN ANSWER, HE CAME WITH A QUESTION.
HE SAID, WHAT EXACTLY DO YOU MEAN BY "BEST"?
WELL, I HAD BEEN A DEAN SO I KNEW HOW TO RESPOND TO THAT.
I SAID, WELL, WHAT DO YOU MEAN WHAT DO YOU MEAN BY "BEST"?
AND HE SAID, WELL, DO YOU MEAN BY BEST THE KIND OF STUDY THAT
IS THE MOST SCIENTIFICALLY RIGOROUS, ROUNDED IN THE
EVIDENCE, LOGICALLY REASONED AND CLEARLY PRESENTED?
OR DO YOU MEAN THE STUDY THAT MADE THE MOST DIFFERENCE IN THE
WORLD?
WELL, I SAID, I GUESS I MEAN BOTH.
SO A FEW DAYS LATER, AFTER CONFERRING WITH OUR BOARD
DIRECTORS, HE CAME BACK WITH TWO LISTS.
NOW, I'M VERY GLAD TO REPORT THAT THERE WAS SOME OVERLAP IN
THE TWO LISTS. THERE WAS SOME CONNECTION
BETWEEN SCIENTIFIC RIGOR AND EFFECT ON THE WORLD.
BUT IT WASN'T PERFECT. AND I LEARNED FROM THAT THAT
UNDERTAKING THE BEST OF SCIENTIFIC WORKS OR METHOD OWE
LOGICAL REASON AND UNDERTAKING THE BEST SCIENTIFIC WORK TO
INFLUENCE THE WORLD ARE NOT NECESSARILY IDENTICAL GOALS.
BOTH I THINK ARE VERY IMPORTANT. AND WHAT I CAME TO BELIEVE IS
THAT THE REASON TO DO SCIENTIFICALLY SOUND, ABSOLUTELY
RIGOROUS WORK IS NOT BECAUSE THAT GUARANTEES IT WILL HAVE AN
EFFECT ON THE WORLD BUT JUST IN CASE IT DOES, YOU WANT IT TO BE
CORRECT. YOU WANT TO HAVE DONE THE VERY
BEST IN SCIENCE SO THAT WHATEVER FOLLOWS CAN BE BASED ON THE BEST
IN SCIENCE. NOW, THAT LEFT ME WITH AN ANSWER
TO MY SPECIFIC ORIGINAL QUESTION OF PAST STUDIES, BUT IT AT ANY
TIME LEAVE ME WITH AN ANSWER AS TO, HOW ARE WE GOING TO KNOW
WHETHER WE ARE MAKING A DIFFERENCE?
AND OUT OF THAT REFLECTION, OVER TIME, CAME AN APPROACH THAT
THINKING ABOUT MEASURING EFFECT AND MEASURING IMPACT THAT WE
CAME TO CALL DEGREES OF IMPACT. WE STARTED WITH A NOTION THAT
THERE WOULD BE SOME EFFECT FROM DISEMANATING AND COMMUNICATING,
BUT WE WANTED TO IDENTIFY AND TRACK A HIERARCHY OF INFLUENCES,
SHAPING OPINION, AFFECTING ACTIONS, AND ULTIMATELY
AFFECTING OUTCOMES PARTICULARLY THE HEALTH OUTCOME THAT WE ALL
CARE MOST ABOUT. WHEN I THINK ABOUT EVALUATIONS,
I THINK THERE ARE THREE REASONS WHY WE MAY WANT TO EVALUATE.
FIRST, WE WANT TO KNOW OURSELVES WHAT WORKS AND WHAT ISN'T
WORKING. SECONDLY, WE WANT TO PERSUADE
OTHERS ABOUT THE IMPACT AND IMPORTANCE OF WHAT WE ARE DOING.
AND, THIRD, WE WANT TO MANAGE MORE SUCCESS, SET BETTER
PRIORITIES, IDENTIFY PROGRAMS IT THAT SHOULD BE CHANGED OR THAT
SHOULD BE SELL OPERATE ACELEBRAE MIDCOURSE CORRECTION IN A WAY
THAT IS INFORMED BY THE EVIDENCE.
ALL OF THESE PURPOSES CAN BE SERVED IF WE DEVELOP INSTRUMENTS
TO TRY TO TRACK AND MEASURE HOW WELL WE ARE DOING.
WHEN WE LOOKED AT EXAMPLES FROM THE INSTITUTE OF MEDICINE, I
COULD GO BACK TO THINKING ABOUT EVEN THE *** PANDEMIC IN THE
1980s WHEN CDC WAS HOT ON THE PROBLEM BUT MUCH OF THEGLECTING.
A VERY IMPORTANT REPORT CALLED CONFRONTING AIDS IN THE
MID-1980s IN THE INSTITUTE OF MEDICINE REALLY AFFECTED A
POLICY DEBATE ABOUT WHAT WE SHOULD BE DOING AS A COUNTRY.
MANY OF YOU I'M SURE ARE FAMILIAR WITH THE WORK FROM THE
INSTITUTE ON ERROR IN HEALTH CARE AND ARE IMPROVING THE
QUALITY OF CARE. AND THERE ARE MANY MORE RECENT
EXAMPLES SUCH AS THE REPORT WE RELEASED JUST A FEW YEARS AGO ON
NUTRITIONAL VALUE IN SCHOOL MEALS THAT REALLY WAS TRANSLATED
ALMOST DIRECTLY INTO THE HEALTHY HUNGER-FREE KIDS ACT OF 2010.
WE ALSO DID A STUDY, FOR EXAMPLE, ON BREAST CANCER AND
THE ENVIRONMENT AND THE SUSAN G. KOMEN FOLLOWED UP WITH A $4.5
MILLION RESEARCH PROGRAM ALONG THE LINES RECOMMENDED BY THE
COMMITTEE. AND SOMETIMES OUR WORK RELATES
VERY DIRECTLY TO ORGANIZATIONAL DECISIONS SUCHES THE PROJECT
THAT WE DID AT THE REQUEST OF NIH ON THE ROLE AND NEED FOR
CHIMPANZEES IN RESEARCH. WHEN WE THINK ABOUT THE IMPACT
OF THAT WHICH CHANGED IMMEDIATELY THE POLICY OR
PRACTICE ABOUT CHIMPANZEE IN RESEARCH, IT'S ONE SMALL
ILLUSTRATION OF WHAT WE TRY TO TRACK.
HOW MUCH ARE WE AFFECTING, UNDERSTANDING, ACTION, AND
OUTCOME? WHEN ALL OF US THINK ABOUT
DESIGNING A FRAMEWORK FOR EVALUATION, I THINK WE WANT TO
KEEP SEVERAL THINGS IN MIND. FIRST, WE WANT IT TO APPLY
CONSISTENTLY ACROSS MANY PROGRAMS SO THAT IT'S NOT
DIFFERENT FROM ONE OF OUR AREAS TO ANOTHER.
SECONDLY, I THINK WE WANT A FRAMEWORK THAT WILL ENABLE US TO
FOCUS ON THE OUTCOMES THAT WE REALLY CARE ABOUT WITHOUT LOSING
SIGHT OF THE INTERIM STEPS THAT WILL BE NECESSARY TO REACH THOSE
OUTCOMES. AND, THIRD, WE WANT A FRAMEWORK
THAT IS CLEAR, THAT CAN BE READILY UNDERSTOOD, READILY
APPLIED, AND BE A REAL AND EFFECTIVE TOOL TO HELP US KNOW,
TO PERSUADE OTHERS, AND TO MANAGE OUR PROGRAMS.
WE HAVE A WONDERFUL OPPORTUNITY TODAY IN THIS HOUR TO HEAR FROM
MANY LEADERS AT THE CDC WHO HAVE TAKEN STEPS TO ASSURE THAT HAD
THEY CAN ANSWER THE QUESTION, WHAT DIFFERENCE ARE WE MAKING.
AND WITH THOSE OPENING COMMENTS, I'D LIKE NOW TO TURN BACK TO THE
PROGRAM AND OUR MAIN SPEAKER, MA
MARY ARI, WHO WILL BEGIN THE DISCUSSION FOR US AT THE CDC.
THANK YOU AGAIN FOR ALLOWING ME TO PARTICIPATE IN THIS WAY.
[ APPLAUSE ] >> GOOD AFTERNOON.
MY NAME IS MARY ARI, AND I'M A SENIOR SCIENTIST IN THE OFFICE
IT -- DIRECTOR FOR SCIENCE. CDC'S PUBLIC HEALTH ROLE IS
CLEAR. WE FIND WHAT WORKS AND PUT
SCIENCE INTO ACTION TO KEEP PEOPLE SAFE AND HEALTHY.
HOW DO WE KNOW THAT THE SCIENCE HAS BEEN PUT INTO ACTION?
OUR ULTIMATE GOAL IS POSITIVE HEALTH OUTCOME, IMPROVING
WELL-BEING AND REDUCING MORTALITY.
HOWEVER, THIS TAKES TIME AND MULTIPLE PLAYERS.
IS A DATED APPROACH. IT DOES NOT CORRECTLY INFLUENCE
THE PUBLICATION SUCH AS RESULTING ACTIONS OR CHANGES OR
THE -- IN WHICH THE AGE IS USED. THIS PRACTICE MUST TAKE INTO
CONSIDERATION BROADER IMPACT USING A COMBINATION OF
NARRATIVE, QUANTITATIVE AND QUALITATIVE INDICATORS.
-- WILL PROVIDE A USE OF IMPACT CDC SCIENCE, TRACKING THE
SCIENCE ON LINKING EVENTS AND ACTIONS THAT CLEARLY SHOW HOW
THEY CONTRIBUTED TO THE ULTIMATE OUTCOME OF IMPROVING HEALTH.
SEVERAL OF THEIR FRAMEWORKS REVIEWED CONTRIBUTED TO OUR
FRAMEWORK WHICH IS MORE BASED ON THE INSTITUTE OF MEDICINE'S
DEGREES OF IMPACT. IT WAS DEVELOPED BY A GROUP LED
BY THE ASSOCIATE DIRECTOR FOR SCIENCE.
THE KEY ATTRACTION IS THE FOCUS ON INFLUENCE WITH FIVE ELEMENTS,
SPREADING THE MESSAGE, RECEIVING -- INFORMING THE
FIELD, ACTION AND EFFECTING CHANGE.
THIS SUGGESTS AN INCREMENTAL PROGRESSION OF PROCESSES AND
ACTIONS. HERE IS A FRAMEWORK.
IT HAS FIVE LEVELS OF INFLUENCE. THERE ARE A NUMBER OF KEY
INDICATORS AT EACH LEVEL THAT CAN BE IDENTIFIED.
KEY INDICATORS WHICH -- MAY INCLUDE PUBLICATIONS,
PRESENTATION AT CONFERENCES OR SOCIAL MEDIA, CREATING AWARENESS
MAY INCLUDE INFORMATION SHARING AMONG PROFESSIONAL SOCIETIES AND
THEIR LOOK IN THE SCIENTIFIC COMMUNITY.
MAY INCLUDE RESULTING PARTNERSHIPS, TECHNOLOGY
CREATION OR CONGRESSIONAL HEARING.
EFFECTING CHANGE MAY INCLUDE RESULTING CAPACITY BUILDING,
CHANGES IN PRACTICE OR POLICY AND OTHER IMPACTS.
SHAPING THE FUTURE MAY INCLUDE NEW HYPOTHESIS, PROGRAMS OR
INITIATIVES TO BE CONSIDERED THAT WOULD RESULT IN FURTHER
PROGRESS OF QUALITY AND IMPROVEMENT.
IN THE END, POSITIVE OUTCOME IS THE DESIRED OUTCOME AND THE
ULTIMATE GOAL. HERE IS A POSSIBLY SIMPLER
ANSWER SHOWING THE LEVEL OF INFLUENCE DO NOT HAVE TO HAPPEN
IN A -- THAT IS REALLY IMPORTANT.
I WILL USE THIS DEPICTION TO DEMONSTRATE A STUDY.
THE FRAMEWORK WAS TESTED USING NINE CASE STUDIES
IDENTIFIED FROM -- AWARD WINNING PAPERS AND ONE GUIDELINE
RECOMMENDATION. THINK ABOUT BROAD AREAS OF
RESEARCH. EVENTS RELATED TO ORIGINAL
MANUSCRIPT WERE PLACED WITHIN ONE OF THE FIVE LEVELS OF
INFLUENCE. THE IDENTIFIED EVENTS ARE LINKED
WITH THE SUBJECT MATTER EXPERTS IN EACH AREA.
IS ON CONTRIBUTION RATHER THAN -- AS IT IS DIFFICULT TO
ASSIGN CREDIT TO ANY SINGLE ENTITY.
THIS IS A COMBINATION OF WORK AND EXPERT OPINION.
THAT IS WHY IT IS IMPORTANT TO FIND THOSE SHORT-TERM INDICATORS
WITHIN THE FIVE LEVELS OF INFLUENCE AS THEY ARE
PREDICTABLE OF LONG-TERM HEALTH IMPACTS.
THESE ARE SOURCES, A MIXTURE OF STAKEHOLDERS WHO KNOW AND CAN
FIED FIVE SOURCES, SYSTEMS THAT CAN PROVIDE DATA AND ACTUAL
MEASURE. EXAMPLE OF DATA SOURCES INCLUDED
MEDLINE, GOOGLE INVESTIGATOR, SURVEILLANCE SYSTEMS,
LEGISLATION AND TRADEMARKS. THE WEST NILE VIRUS, THE CDC
MANUSCRIPT WAS PUBLISHED IN 2001 WHICH DEMONSTRATED THAT A SINGLE
DOSE OF A DNA -- COULD PREVENT WEST NILE VIRUS INFECTION IN
MICE AND HORSES. THE BIBL YOE METRICS SHOW A
TOTAL OF -- CITATIONS. THAT DOES NOT CAPTURE THE
SIGNIFICANT CONTRIBUTIONS OF THIS PAPER TO THE IMPACT THAT I
WI WILL DESCRIBE.
IN 2002, THE CALIFORNIA CONDOR -- EXPERIMENTAL CDC
VACCINE WAS PROVEN TO PROTECT AGAINST WEST NILE VIRUS IN
SEVERAL SPECIES. TO PREVENT CALIFORNIA CANDORS
HAVE BECOMING EXTINCT DUE TO WEST NILE, CDC EXPEDITED THE
DELIVERY OF THE EQUINE WEST NILE VIRUS FOR USE IN CONDORS.
IN 2004, THE VACCINE WAS -- EFFECTIVE IN PROTECTING CONDORS
FROM CONTRACTING WEST NILE VIRUS.
THE CDC EQUINE DNA VACCINE WAS LICENSED IN 2005 FOR PREVENTING
WEST NILE IN HORSES. THIS WAS THE FIRST LICENSE
GRANTED FOR A DNA VACCINE FOR USE IN ANIMALS.
THIS LED TO CLINICAL TRIALS FOR VACCINATION IN HUMANS.
IT WAS VERY SIMILAR TO THE DNA VACCINATION.
THE VACCINE WAS SHOWN TO INDUCE -- ANTIBODY RESPONSES IN
LEVELS PROTECTIVE IN STUDIES OF HORSES.
IN 2008, THE WEST NILE VIRUS -- INNOVATION AWARD.
THE SUCCESS OF ONE CLINICAL TRIAL LED DIFFERENT
INVESTIGATORS TO THE DNA VACCINE.
IN ANOTHER CLINICAL TRIAL -- FOR THAT INFORMATION CAN BE FOUND AT
THE SCIENCE FRAMEWORK WEB PAGE. WE NOW MOVE ON TO THE PANEL
DISCUSSION. OUR PANELISTS WILL SHARE THEIR
EXPERIENCES WITH AND PLAN FOR USE WITH THE CD C.
>> THANK YOU, MARY. [ APPLAUSE ]
DR. FINEBERG IS GOING TO BE LEA
LEADING THE PANEL AND I'LL BE LE
HERE TO TECHNICALLY ASSIST IN CASE WE HAVE TECHNICAL
DIFFICULTIES. ALSO, WE WOULD LIKE TO DO
QUESTIONS AND ANSWERS A LITTLE BIT DIFFERENTLY THIS TIME.
IF YOU HAVE A QUESTION AND YOU SEE THAT IT VERY NICELY FITS
WITH THE SPECIFICS OF THE DISCUSSION, PLEASE INDICATE SO
BY EITHER RAISING A HAND OR STANDING NEXT TO THE MICROPHONE.
IF YOU HAVE QUESTIONS -- AND I WILL ASK YOU TO JOIN IN THE
CONVERSATION -- THAT ARE MORE GENERAL IN NATURE OR YOU WOULD
LIKE TO HOLD THEM UNTIL THE PANEL DISCUSSION IS OVER, WE
WILL LEAVE A FEW MINUTES AT THE END OF THE PANEL DISCUSSION FOR
THAT AS WELL. SO, WITH THAT, I'M GOING TO TURN
IT TO DR. HARVEY FINEBERG AND BEGIN OUR PANEL DISCUSSION.
>> THANK YOU VERY MUCH, TANJA. AGAIN, AN EXCELLENT OVERVIEW.
WE HAVE SO MANY WONDERFUL LEADERS FROM CDC ON THE PANEL.
I WONDER IF WE MIGHT JUST BEGIN BY ASKING EACH OF THE PANELISTS
IF YOU COULD TELL US BRIEFLY, HOW DID YOU GET YOURSELF ENGAGED
IN THE SCIENCE IMPACT FRAMEWORK EFFORT AT THE CDC?
AND ARE YOU USING IT IN YOUR PROGRAM, OR ARE YOU PLANNING TO
USE IT IN WHAT WAY? I THINK IT WOULD BE GREAT TO
HEAR FROM EACH PERSON, BUT MAYBE DR. CASEY WOULD START US OFF AND
WE'LL WORK OUR WAY DOWN THE LINE.
TANJA, YOU CAN HELP ME ALONG THE IDENTIFICATION, IF YOU WOULD, AS
WE GO FORWARD. >> EXCELLENT.
HIM OR HERSELF AND SAY A FEW WORDS.
>> THANK YOU. MY NAME IS CHRISTINE CASEY.
I SERVE AS THE DEPUTY EDITOR OF THE MMWR SEREAL.
IN 2011, TO DESCRIBE THE PUBLIC HEALTH -- OF A SELECTED MMWR
RECOMMENDATIONS AND REPORT. MMWR PARTNERED WITH THE OFFICE
OF THE ASSOCIATE DIRECTOR FOR SCIENCE AND THE NATIONAL CENTER
FOR INJURY PREVENTION AND CONTROL.
USING A CASE STUDY APPROACH THAT DID NOT RELY PRIMARILY ON
CONVENTIONAL JOURNAL -- THE GROUP DESCRIBED THE REESE END
INFLUENCE OF THE GUIDELINES FOR FEEL TRIAGE OF INJURED PATIENTS,
RECOMMENDATIONS OF THE NATIONAL EXPERT PANEL ON FIELD TRIAGE.
THAT WORK IS AN EARLY EXAMPLE OF THE CDC'S SCIENCE IMPACT
FRAMEWORK PRESENTED TODAY. OFTEN CALLED THE VOICE OFF CDC,
THE MMWR SERIES IS VIEWED BY APPROXIMATELY 1 MILLION PERSONS
PER MONTH AND IS CITED WIDELY IN THE SCIENTIFIC LITERATURE AND
MEDIA. HOWEVER, MMWR CANNOT OBTAIN
CERTAIN JOURNAL METRICS DUE TO GOVERNMENT COLLECTION
REQUIREMENTS AND INDEXING CONSIDERATIONS.
SO THE STORY-BASED FRAMEWORKREW
COLLABORATORS' MUTUAL INTEREST IN ASSESSING CDC SCIENCE AND
MMWR'S SPECIFIC NEED TO AN ALTERNATIVE TO TRADITIONAL
JOURNAL METRICS. FOR BACKGROUND, EDITORS AND
PUBLISHERS RELY ON MANY DIFFERENT TYPE OF JOURNAL
METRICS, BUT NO SINGLE INDICATOR CAN ADEQUATELY MEASURE THE
MULTIDIMENSIONAL ASPECT OF IMPACT FOR PUBLICATION.
FOR EXAMPLE, THERE'S BIBL YOE METRICS THAT LOOKS AT CITATION,
IMPACT FACTOR IMPACT, WHICH LOOKS AT ACKNOWLEDGEMENT PATENTS
AND SYLLABUSES, WEBO METRICS LOOKING AT HYPER LINKING THE
NETWORKS, BASED ON THE ACTIVITY IN ONLINE TOOLS AND
ENVIRONMENTS, AND ENT YOE METRICS WHICH IS KNOWLEDGE,
UNITS FOR FURTHER DISCOVERY. I'LL RESERVE MY REMARKS DURING
THE PANEL DISCUSSION TO DESCRIBE THE LESSONS LEARNED IN OUR NEXT
STEP. >> THANK YOU, DR. CASEY.
MY NAME IS REX ASTLES. I'M WITH THE DIVISION OF
LABORATORY PROGRAMS AND STANDARDS AND BY THE WAY THAT'S
THE HARDEST PART OF MY TALK BECAUSE OUR NAME HAS CHANGED.
AS SCIENTIFIC CONSULTANTS TO CMS, WE'VE HAD A LONG
UNDERSTANDING AND DEEP INTEREST IN UNDERSTANDING HOW VOLUNTARILY
PRACTICE GUIDELINES CAN BE DISSEMINATED AND PROMOTED IN THE
COMMUNITIES OF LABORATORIES THAT FOLLOW.
WE REALIZED FOR A LONG TIME THAT REGULATIONS CAN ONLY GET SO MUCH
TRACTION BECAUSE THEY SET A LOW BAR.
WE'VE HAD A LONGSTANDING INTEREST IN UNDERSTANDING HOW WE
CAN PROMOTE LABORATORY GUIDELINES OR LPGs.
LPGs ARE WRITTEN BY VARIOUS ORGANIZATIONS, INCLUDING PUBLIC
HEALTH AGENCIES, AND PRIVATE ORGANIZATIONS.
THEY'RE INTENDED TO INFLUENCE LABORATORY PROFESSIONALS AND
CLINICIANS AS THEY DECIDE HOW TO PERFORM TESTING.
THE FIGURE THAT IS SHOWN HERE DEPICTS WHAT WE'RE NOW CALLING
THE LIFE CYCLE OF THE LABORATORY PRACTICE GUIDELINE.
IT BEGINS WITH A GAP ANALYSIS HOPE FWLI SOMEONE HAS DONE SOME
ASSESSMENT AND DECIDED THERE'S SOME THINGS THAT NEED TO BE
CHANGED IN THE WAY LABORATORY TESTING IS DONE.
THEN THE GUIDELINE IS CREATED USUALLY TAKING SEVERAL YEARS AND
A LOT OF MAN HOURS AND WORK AND PHONE CALLS.
IT'S DISSEMINATED AND PROMOTED AND HOPEFULLY USED BY THE TARGET
AUDIENCE. BUT USAGE DEPENDS UPON AWARENESS
AND ADOPTION OR ADAPTATION TO LOCAL CONDITIONS YET LITTLE IS
EVER DONE TO COLLECT DATA FROM THE USERS OF THE GUIDELINES.
AND WE SEE THAT AS A GREAT OPPORTUNITY.
DR. FRIEDEN MENTIONED HIS FATHER'S QUOTE, AND I'LL NOW
MENTION MINE, WHICH WAS, IF SOMETHING IS WORTH DOING IT'S
WORTH DOING RIGHT. AND THE ONLY WAY TO KNOW WHETHER
YOU'RE DOING A GOOD JOB IS TO COLLECT DATA.
SO THIS IS SOMETHING MANY OF US ARE VERY PASSIONATE ABOUT IN OUR
DIVISION. WE KNOW THAT LABORATORY PRACTICE
GUIDELINES REQUIRE HUNDREDS OF HOURS OF WORK AND AS GOOD
STEWARDS OF THE WORK THAT WENT INTO THOSE PRACTICE GUIDELINES,
WE STRONGLY BELIEVE THAT WE NEED TO LEARN HOW TO COLLECT DATA AND
MAKE THEM BETTER FOR THE TARGET AUDIENCE.
SOME ORGANIZATIONS SUCH AS THE AMERICAN ASSOCIATION FOR
CLINICAL CHEMISTRY HAVE ALREADY BEGUN TO DO PROCESS EVALUATIONS
USING THE DEGREE INSTRUMENT, BUT THAT'S JUST BEGINNING TO SCRATCH
THE SURFACE OF WHAT CAN BE DONE TO BETTER EVALUATE THE
LABORATORY PRACTICE GUIDELINES. THE 2011 INSTITUTE OF MEDICINE
REPORT ENTITLED CLINICAL PRACTICE GUIDELINES WE CAN
TRUST, TOGETHER WITH THE IOM REPORT -- I'M SORRY, TOGETHER
WITH THE CDC SCIENTIFIC IMPACT FRAMEWORK, HAVE BEEN
INSPIRATIONAL TO OUR GROUP AND WE'RE USING THOSE TO LEVERAGE
OUR FURTHER INTEREST IN PROMOTING COOPERATIVE AGREEMENTS
WHICH WE'VE RECENTLY VETTED AND ARE WORKING WITH ORGANIZATIONS
TO HELP THEM IMPROVE HOW THEY WRITE AND DISSEMINATE LABORATORY
PRACTICE GUIDELINES. THANK YOU.
>> IT'S MY PLEASURE TO BE HERE AND SHARE WITH YOU EXPERIENCES
FROM THE PREVENTION RESEARCH CENTER'S PROGRAM.
ONE OF CDC'S FLAGSHIP PROGRAMS, THE PRC PROGRAM, WAS ESTABLISHED
IN 1984 AND THEY'RE A UNIQUE NETWORK OF ACADEMIC RESEARCH
CENTERS PARTNERING WITH PUBLIC HEALTH AGENCIES AND COMMUNITIES
TO CONDUCT APPLIED PUBLIC HEALTH RESEARCH, HEALTH RISK ASSESSM T
ASSESSMENTS AND OTHER PUBLIC HEALTH PROMOTION AND DISEASE
PROVENGS PERHAPS. THE PRC PROGRAM AND THE FUNDED
CENTERS ARE LEADERS IN TRANSLATING RESEARCH RESULTS
INTO POLICY AND PUBLIC HEALTH PRACTICE.
THAT IS SUSTAINABLE AND SCALEABLE.
INNOVATION, TRANSLATION, DISSEMINATION, AND
IMPLEMENTATION SCIENCE ARE THE CORNERSTONES OF THE PRC NETWORK.
IN OTHER WORDS, APPLYING RESEARCH INTO PRACTICE.
WE AGREE ON THE IMPORTANCE OF EVALUATING IMPACT AND ALL THAT
HAS BEEN SAID SO FAR. THE ELEMENTS OF THE SCIENCE
IMPACT FRAMEWORK COMBINED WITH OTHER MAJOR PUBLISHED
TRANSITIONAL FRAMEWORKS HELP TO SHOWCASE PRC CONTRIBUTIONS.
BECAUSE OF THE APPLIED NATURE OF OUR PREVENTION RESEARCH, WE WILL
PROSPECTIVELY BE EXAMINING HOW ELEMENTS OF THE SCIENCE IMPACT
FRAMEWORK AND THESE OTHER MODELS FIT TO PROVIDE OVERALL PUBLIC
HEALTH IMPACT. >> THANKS.
GOOD AFTERNOON, I'M LEE WARNER, ASSOCIATE DIRECTOR FOR SCIENCE
IN THE DIVISIONAL REPRODUCTIVE HEALTH.
I'M HERE TO TALK ABOUT HOW WE SEE THIS FRAMEWORK AIDING THE
WORK THAT WE DO IN THE AREA OF REPRODUCTIVE HEALTH.
WE BASICALLY SEE APPLICATIONS IN TWO MAIN AREAS.
ONE IS THE GUIDELINES WE'VE HAD AND ANOTHER ON THE SURVEILLANCE
SYSTEMS. I WANT TO BRIEFLY DISCUSS EACH
OF THESE. THE FIRST ONE IS A CC CLINICAL
GUIDANCE. THAT'S BEEN ONE OF THE FLAGSHIP
ACTIVITIES FOR OUR DIVISION, THE U.S. MEDICAL ELIGIBILITY
CRITERIA FOR CONVICT TRACEPTION. CHARACTERISTICS LIKE SMOKING AND
WHY THIS IS REALLY IMPORTANT IS THAT MOST WOMEN, EVEN THOSE WHO
HAVE MEDICAL CONDITIONS THAT CAN AFFECT THEIR RISK OF PREGNANCY,
CAN SAFELY USE A VARIETY OF CONTRACEPTIVE METHODS.
WE NEED TO GET NTHIS MESSAGE OU THERE.
WE'RE WORKING WITH PROFESSIONAL ORGANIZATIONS LIKE A COG AND
STAKEHOLDERS TO DISSEMINATE THIS GUIDANCE AND SURVEYING PROVIDERS
ON THE USE OF THEIR GUIDANCE. WHAT WE REALLY NEED TO KNOW 0 IS
HOW THE GUIDANCE IS TRANSLATING INTO AFFECTING PROVIDER PRACTICE
AND ULTIMATELY WOMEN'S HEALTH. FOR THE SURVEILLANCE SYSTEM, THE
SECOND EXAMPLE, I WANT TO TALK ABOUT PRAMS PRA SYSTEM WE'VE HA
ONGOING FOR 25 YEARS IN COLLABORATION WITH STATE HEALTH
DEPARTMENTS. WHAT PRAMS DOES IS COLLECT DATA
ON MATERNAL EXPERIENCES BEFORE, DURING AND AFTER PREGNANCY, ONE
OF THE NATION'S BEST SOURCES OF DATA.
SO WHILE WE ARE WORKING WITH THE STATE PARTNERS TO COLLECT DATA
AND IT'S BEEN VERY HELPFUL, WE'VE NOT REALLY CAPTURED THIS
IN A SYSTEMATIC MANNER. WE ALSO SEE THE USEFULNESS OF
THE FRAMEWORK FOR HELPING US THINK THROUGH USING PRAMS FOR
OTHER THINGS. SO HOW CAN WE MEASURE THE IMPACT
OF CDC CLINICAL GUIDANCE. FOR EXAMPLE, WITH THE
CONTRACEPTION GUIDANCE, CAN WE -- OR WE ARE.
HOW WE USE PRAMS TO ASSESS WHETHER WOMEN WITH MEDICAL
CONDITIONS ARE BEING GIVEN KNOWLEDGE OF THEIR RAY OF
CONTRACEPTION OPTIONS AVAILABLE TO THEM POSTPARTUM.
FINALLY FOR THE CONCEPT OF USE GUIDANCE AND PRAMS, WE AGREE
WITH THE PRESENTERS ON THE IMPORTANCE OF DEVELOPING
STANDARDIZED METRICS TO MONITOR THE USE OF THESE PRODUCTS IN
REALTIME. THANKS.
TOM? >> I'M TOM CHAPEL, THE CHIEF
EMOTION OFFICER FOR THE AGENCY. LET ME SPEND ABOUT 30 SECONDS
TALKING ABOUT HOW WE EVALUATE PROGRAMS AT CDC, THEN THAT WILL
MORPH INTO WHY I THINK THE SCIENCE IMPACT FRAMEWORK IS SO
VALUABLE. THIS IS A FAMILIAR GRAPHIC I
HOPE TO MOST IN THE AUDIENCE, THE SUMMARY OF OUR FRAMEWORK FOR
PROGRAM EVALUATION. A LITTLE OVER A DECADE OLD.
FROM THE VERY START, WE REALLY CONCERNED OURSELVES WITH THE
LEFT SIDE, THAT BUBBLE ON THE LEFT-HAND SIDE.
WE WANTED PEOPLE TO EVALUATE IN A WAY THAT THE FINDINGS WOULD
GET USED AND ESPECIALLY THAT THE FINDS WOULD GET USED TO IMPROVE
THEIR EFFORTS. WE NEVER CARED FROM THE START
WHAT THOSE EFFORTS WERE. WE WANTED EVERYONE TO SEE
THEMSELVES AS HAVING A PROGRAM. EVEN THOUGH WE CALLED IT PROGRAM
EVALUATION, WE REALLY WANTED EVERYBODY NO MATTER WHERE THEY
SAT AT CDC TO SEE THEMSELVES HAVING A PROGRAM TO THE DEGREE
THEY HAD AN ACTIVITY THEY COULD NAME AND A SO WHAT OF THOSE
ACTIVITIES THEY COULD ALSO NAME. SO OUR COACHING OF PROGRAMS HAS
ALWAYS BEEN ABOUT THAT BUBBLE ON THE RIGHT HAND SIDE, HOMING IN
ON THAT IDEA OF PROGRAM DESCRIPTION, HELPING PEOPLE
FIGURE OUT THE WHAT OF WHAT THEY DO, THE SO WHAT OF WHAT THEY DO.
KIND OF SEQUENCING THAT SO WHAT. WHAT DO I EXPECT TO SEE IN THE
EARLY, MIDDLE AND LATE TERM, THE LATE TERM BEING SOME OF THE
MORTALITY INCIDENCE AND PREVALENCE STUFF WE ALL FEAR
OWNERSHIP OF. THEN HELPING THEM UNDERSTAND
WHAT PART OF CHAIN OF OUTCOMES ARE THEY DIRECTLY ACCOUNTABLE
FOR AND WHICH PART OF IT ARE THEY TRYING TO JUST MAKE A DR S
CONTRIBUTION TO. THIS HAS BEEN A REALLY GOOD
DISCUSSION AND WE'VE KEPT IT REALLY BROAD BECAUSE OUR SENSE
IS THAT, EVEN THOUGH THE ANSWERS WILL BE DIFFERENT, THE QUESTIONS
IN THE FRAMEWORK ARE EXACTLY THE SAME, WHETHER YOU HAVE A
CLINICAL INTERVENTION, A TRAINING PROGRAM, A HEALTH
COMMUNICATION INTERVENTION OR NOW A SCIENCE INTERVENTION.
WHAT'S BEEN HARD ABOUT ENGAGING SCIENTISTS AROUND THIS IS THAT
SCIENCE IS OFTEN INDUCTIVE AND THAT IF YOU ASK A SCIENTIST WHAT
YOUR IMPACT IS, AUTOMATICALLY THEY'RE THINKING, WHAT HAVE I
DONE FOR YOU LATELY ON MORBIDITY AND MORTALITY.
THAT'S SO FAR DOWN THE ROAD THAT PEOPLE LOGICALLY PANIC AND
DEFAULT TO HOW MANY PUBLICATIONS, EXPERIMENTS,
ET CETERA. SO WHAT THE SCIENCE IMPACT
FRAMEWORK DOES IS IT DOES FOR SCIENCE WHAT THE KIRKPAT ICK
MODEL DOES FOR TRAINING OR HEALTHCOM.
IT ALLOWS YOU UNDERSTAND THE CONTRIBUTION YOU'RE MAKING TO
THESE DOWNSTREAM HEALTH OUTCOMES BUT REMINDS YOU THERE'S A BUNCH
OF PORTALS ON THE WAY THERE THAT AREN'T JUST APOLOGIES TO GETTING
TO MORBIDITY AND MORTALITY BUT VIABLE DRIVERS WE BRING TO THE
PUZZLE AS SCIENCE FOLKS. MARY AND I HAVE BEEN WORKING A
LOT ON HOW TO TREAT SCIENCE AS A PROGRAM AND HOW TO USE THE
FRAMEWORK TO DO THAT. REX AND I HAD A CHANCE TO DO IT
WITH HIS FOA ON LABORATORY PRACTICE GUIDELINES.
IT WAS SO HELPFUL TO HAVE THIS POOL OF GUIDELINES AND USE THE
SCIENCE IMPACT FRAMEWORK TO SAY, WE DON'T EXPECT THESE PEOPLE TO
PROVE THAT THEY -- BUT WE EXPECT THEM TO PROVE THE MILE
STEENSTONES ALONG THE WAY. I'LL TALK LATER ABOUT HOW I
THINK IT HELPS US IN PLANNING AND IMPLEMENTING OUR PROGRAMS AS
WELL AS EVALUATING THEM. >> SO WITH THESE INTRODUCTIONS,
I'M TURNING IT BACK TO DR. FINEBERG.
YOU SHOULD BE UP ON THE SCREEN MOMENTARILY.
>> THANK YOU VERY MUCH, EVERYONE.
EACH OF YOU HAVE REALLY IMPORTANT RESPONSIBILITIES.
TOM, YOUR RISK SPECIFICALLY IS IN THE DOMAIN OF EVALUATION SO
I'D LIKE TO TURN BACK TO YOU, IF I MAY, AND ASK, WHAT ABOUT THE
SCIENTIFIC IMPACT FRAMEWORK DO YOU LIKE THE MOST?
WHAT PARTS OF IT DO YOU THINK ARE LEAST SUCCESSFUL?
AND PERHAPS SHOULD BE MODIFIED? OF.
>> I DON'T HAVE ANY PARTS I WOULD WANT TO MESS WITH AT THIS
EARLY STAGE, BUT THE POINTS I'M EXCITED ABOUT ARE THE THREE
PURPOSES FOR WHICH WE EVALUATE. WE'RE NOT FOOLING OURSELVES, SO
THAT WE CAN MAKE THE CASE TO OTHERS AND SO WE HAVE SOME SENSE
WHEN THINGS ARE NOT GOING WELL OF HOW TO IMPROVE.
THAT'S WHAT I REALLY SEE AS THE BIG ADVANTAGE OF THE SCIENCE
IMPACT FRAMEWORK. AND I FEEL LIKE THAT HELPS US IN
TWO WAYS. IT HELPS US PRIMARILY TO MAKE
THE CASE TO STAKEHOLDERS AND ESPECIALLY TO SKEPTICAL
STAKEHOLDERS THAT WHAT WE DO MAKES AN IMPACT EVEN IF THAT
ISN'T MORBIDITY AND MORTALITY. I THINK EVEN MORE IMPORTANTLY IS
IT HELPS SCIENCE PEOPLE WHEN THEY VIEW THEIR WORLD AS A
PROGRAM ATTIC ONE, THEY SEE THEMSELVES AS TRYING TO PRODUCE
SORT OF EARLY AND MIDDLE OUTCOMES, IF THAT LOGIC IS
CORRECT, DARN IT, IF THEY'RE NOT GETTING IT EARLY, NOT EVEN
GETTING PUBLICATIONS, IF THIS ISN'T MAKING ITS WAY INTO
POLICY, NOT BEING ADAPTED OR ADOPTED BY PEOPLE, THEY KNOW
THEY CAN'T MAKE THAT ULTIMATE IMPACT ON MORBIDITY AND MORT
MORTALITY. SO IT WILL CAUSE THEM TO STOP
AND TAKE STOCK OF WHAT WE'RE DOING AND HOW TO DID IT BETTER.
THAT'S WHAT I LIKE ABOUT IT. THE OTHER THING I LIKE IS PEOPLE
GET SCARED WHENEVER THEY SEE THESE FRAMEWORKS TH S THAT, OH,
GOSH, THIS HAS TO HAPPEN IN A SEQUENCE.
IT HAS TO BE KNOWLEDGE, ATTITUDE AND BELIEF, BEHAVIOR, IT DOES A
MUCH BETTER JOB OF SAYING, NO, THIS IS A SMORGASBORD OF STUFF,
ALL OF WHICH IS REALLY GOOD, ALL OF WHICH DRIVES THE HEALTH
IMPACTS AND POPULATION HEALTH OUTCOMES WE'RE LOOKING FOR.
BUT YOUR CASE MAY BE DIFFERENCE AND THE SEQUENCE WITH WHICH IT
HAPPENS MAY BE DIFFERENT. I REALLY LIKE THAT.
I THINK IT'S A REAL BOON. AT THIS POINT, THE EXPERIENCE I
HAD USING IT WITH TWO FOAs LAST YEAR, IS EXACTLY WHAT THE DOCTOR
ORDERED TO HELP ORGANIZE THE THINKING FOR THE FOAs AND MAKE
LIFE REALLY CLEAR. >> GREAT.
THANK YOU VERY MUCH. OTHERS OF YOU I KNOW HAVE BEGUN
TO ADOPT THE SCIENCE IMPACT FRAMEWORK AND LOOK AT OTHER
OPPORTUNITIES AS WELL. IN FACT, YOU ALLUDED TO AN
EXPRESS IDEA OF INCORPORATING IDEAS FROM A VARIETY OF
FRAMEWORKS THAT ARE AVAILABLE FOR ASSISTING AN EVALUATION.
BUT I'D BE INTERESTED, MAYBE YOU WANT TO START US OFF, FROM
EVERYONE WHAT YOU'VE LEARNED ALREADY, IF ANYTHING, ABOUT
APPLICABILITY AND OTHER THINGS. RON, DO YOU WANT TO START US
OFF? >> THANK YOU, DR. FINEBERG.
AS MENTIONED, PRCs, CONTRIBUTED PUBLIC HEALTH FINDINGS FROM
HUNDREDS OF PROJECTS. THEY'RE EFFECTIVE AT REACHING
NEARLY 30 MILLION PEOPLE IN 103 PARTNER COMMUNITIES AND PRC
RESEARCH OUTPUTS ARE EVENT VALU ANNUALLY.
WE'VE USED THE SCIENCE IMPACT FRAMEWORK TO CREATE CASE STUDIES
THAT ACTUALLY SHOW CASE THE IMPACT OF THE PRC WORK.
ONE SUCH EXAMPLE WILL IS A PRC PROJECT AT THE UNIVERSITY OF
NORTH CAROLINA CHAPEL HILL THAT EFFECTED CHANGE THROUGH RESEARCH
CONDUCTED ON TOBACCO SALES TO TEENS BY ASSESSING INTERNET
VENDOR SALES AND MARKETING PRACTICES.
THE RESEARCH CONDUCTED BY THE PRC SIGNIFICANTLY CONTRIBUTED TO
THE EVIDENCE BASE POUR SUBSEQUENT LEGISLATION.
34 STATES PASSED STATE LAWS REGULATING INTERNET AND MAIL
ORDER CIGARETTE SALES AND THEN THE U.S. SENATE PASSED IN 2010
THE PREVENT ALL CIGARETTE TRAFFICKING ACT TO CURTAIL THE
SALE OF UNTAXED CIGARETTES AND OTHER TOBACCO PRODUCTS VIA THE
INTERNET. THAT'S ONE EXAM AM OF THE WORK
WE'VE RETROSPECTIVELY BEEN ABLE TO PUT TOGETHER.
WE HOPE TO DO SO FOR OTHER PRC WORK AS WELL.
>> VERY GRATIFYING EXAMPLE. HOW ABOUT OTHERS ON THE PANEL?
>> I'D LIKE TO SHARE OUR LESSONS LEARNED.
WE LEARNED MANY, BUT I THINK MOST NOTABLY WE SHOWED THAT
USING THE FRAMEWORK IS FEASIBLE AND VALUABLE.
WE PUBLISHED OUR FINDINGS IN A SUBSEQUENT PUBLICATION OF THE
TRIAGE GUIDELINES WHICH INCLUDED A DESCRIPTION OF EACH STAGE OF
THE FRAMEWORK AND HIGHLIGHTS FOR EFFECTING CHANGE.
WE LEARNED THAT THE NATIONAL REGISTRY FOR EMERGENCY MEDICAL
TECHNICIANS ADOPTED THE GUIDELINES AS A STANDARD FOR THE
CERTIFICATION EXAM FOR ALMOST 270,000 EMTs.
FOR SHAPING THE FUTURE, WHICH IS A CATEGORY THAT DIFFERS FROM THE
IOM'S MODEL, THE AUTHORS EMPHASIZE THE IMPORTANT OF
LINKING NATIONALLY REPRESENTATIVE DATABASES ACROSS
THE PRE-HOSPITAL TRIAGE TO THE IN-HOSPITAL TREATMENT AND
OUTCOME. THEY ALSO CALLED FOR THE
APPLICATION OF UNIFORM CASE DEFINITIONS AND DATA STANDARDS
TO ASSESS AND IMPROVE ALL PHASES OF CARE.
AS A RESULT OF THIS FORESIETS, MMWR NOW TRIES TO INCORPORATE
THE CONCEPT OF FUTURE DIRECTIONS TO OTHER SERIAL REPORTS BECAUSE
WE RECOGNIZE THE VALUE AND WERE VERY IMPRESSED WITH HOW THIS
THINKING HAS HELPED SHAPE THE PROGRAM STRATEGIES.
SOME OF OUR NEXT STEPS WE CAN TAKE THIS BEYOND THE AGENCY IS
TO OTHER EDITORS AND PUBLISHERS BECAUSE WE HAVE THE CAPACITY TO
TRANSFORM SCIENTIFIC FIELDS BY DETERMINING THE PRIORITIES TO
SHOWCASE IN OUR JOURNALS, BY ESTABLISHING THE CRITERIA FOR
ARTICLE SELECTION, AND EXPLORING NEW FORMAT AND INFORMING
SUBSEQUENT COMMUNICATION. SO TO MY EDITOR COLLEAGUES I
WOULD SAY BE EXPLICIT, INTENT N INTENTIONAL.
SHOWCASING IT HERE AT GRAND ROUNDS IS A WONDERFUL GREAT
STEP, BUT I'D LOCH TO TAKE THE FRAMEWORK BEYOND CITATIONS.
WE NEED TO DO THAT BY EDUCATING THEM, WORKING WITH AUTHORS,
EDITORS, PUBLISHERS SO THEY WILL ADOPT THE FRAMEWORK SO THEY CAN
COMMUNICATE SCIENCE IMPACT IN A DIFFERENT WAY IN THE LITERATURE,
MAKE DECISIONS AND PLAN THE FUTURE.
AND FINALLY TO EVALUATE AND REVISE, TO CONTINUE TO CLB RATE
AND IMPROVE THE FRAMEWORK AS WE LEARN.
>> THANKS. HOW ABOUT OTHERS?
>> IF I MIGHT CHIME IN, THIS IS DR. ASTLE.
IN OUR DIVISION, WE'RE REALLY JAZZED ABOUT THE OPPORTUNITIES
THAT WE SEE TO GET THINGS DONE WITH THESE COOPERATIVE
AGREEMENTS I MENTIONED. THE CLINICAL AND LABORATORY
STANDARDS INSTITUTE WRITES A TREMENDOUS NUMBER OF GUIDELINES
FOR LABORATORY PRACTICES FOR BOTH PUBLIC HEALTH AND CLINICAL
TESTING, YET THEY'VE DONE VERY LITTLE SO FAR TO MEASURE IMPACT.
ONE OF THE PROJECTS WE'RE ASKING THEM TO FOCUS ON LABORATORY
PRACTICE GUIDELINES FOR GLUE COME TER USE AND THERE'S
LITERALLY TENS OF THOUSANDS OF LABORATORIES THAT ARE WAIVED,
FOR EXAMPLE, NEVER INSPECTED, DON'T DO PT AND SO FORTH.
THESE LABORATORIES ARE SORT OF ORPHANED, NOT REACHED THROUGH
ANY ACCREDITATION PROGRAM, NEVER REALLY INSPECTED.
THERE'S A TREMENDOUS OPPORTUNITY FOR CLSI TO BEGIN TO UNDERSTAND,
THEY'RE NOT EVEN REALLY YET FULLY COGNIZANT OF THIS
POTENTIAL NEW MARKET, BUT I DON'T NEED TO TELL THIS AUDIENCE
THAT DIABETES TESTING AND MONITORING IS EXTREMELY
IMPORTANT TO PUBLIC HEALTH. BY GETTING THESE VOLUNTARY
PRACTICE GUIDELINES IN THE HANDS AND APPROPRIATELY DESIGN ODD FOR
THEIR USE, WE JUST SEE TREMENDOUS OPPORTUNITIES.
ALSO, THE AMERICAN SOCIETY FOR MICROBIOLOGY IS DOING WORK TO
PROMOTE A NEW GUIDELINE FOR ACUTE LEUKEMIA TESTING AND THE
COLLEGE OF AMERICAN PATHOLOGISTS -- I'M SORRY, THE
COLLEGE OF AMERICAN PATHOLOGISTS IS DOING THE LEUKEMIA TESTING
AND THE AMERICAN SOCIETY FOR MICROBIOLOGY IS DOING WORK TO
ASSESS THE IMPACT OF GUIDELINES THAT THE CDC CREATED TO PREVENT
HIP MOL SIS. WE THINK GREAT THINGS ARE
HAPPENING AND WE HOPE THIS WILL BEGIN TO SNOWBALL AND THAT THE
DISTAL IMPACT THAT DR. ARI TALKED ABOUT WITH CHANGING THE
FUFRT, WE THINK THAT WILL HAPPEN AS THESE ORGANIZATIONS PUBLISH
THE RESULTS OF THEIR DMON 0 STRAI
STRATION PROJECTS. THANKS.
>> GREAT. [ INAUDIBLE ]
>> SO WE'VE HAD SOME VERY NICE PRESENTATIONS OF ASSESSING THE
IMPACT OF THINGS POSITIVE. WHAT ABOUT THE FAILURES?
HOW MANY TIMES HAVE THINGS BEEN IDENTIFIED AS A FAILURE, PIECE
OF SCIENCE THAT DIDN'T DEVELOP INTO A NEW TECHNOLOGY OR PIECE
OF INFORMATION THAT IMPACTED PEOPLE'S LIVES ONE WAY OR THE
OTHER? AND THE FUNDING WAS SUBSEQUENTLY
CUT. WHAT'S THE THRESHOLD WHERE YOU
GOGO IN AND CUT? >> THAT IS AN EXCELLENT
QUESTION, AND IT REALLY GETS TO THE HEART OF WHY WE ARE EXCITED
ABOUT THIS SCIENCE IMPACT FRAMEWORK, BECAUSE LOTS OF TIMES
IT'S ONE THING TO HAVE THE UNDERSTANDING THAT SOMETHING IS
GOING TO HAVE POTENTIAL IMPACT. IT'S ANOTHER THING TO ACTUALLY
PRODUCE THAT IMPACT THAT WE ARE ANTICIPATING.
SOMETIMES THERE MAY BE THINGS HAPPENING THAT NOT IN THE REALM
OF WHAT WE'RE ANTICIPATING. I'M SURE EVERYBODY IN THIS ROOM
IS FAMILIAR WITH THE UNINTENDED CONSEQUENCE.
NOW, THAT WHAT IS NOT IN EXISTENCE BY ACCIDENT AND SOME
HAVE HAD THE MISFORTUNE OF ACTUALLY GETTING TO USE IT.
PARTLY BECAUSE THE MEASUREMENT ENVIRONMENT IS REALLY VERY
COMPLEX. THERE ARE MULTIPLE PLAYERS,
STRATEGIES AND MULTIPLE APPROACHES OUT THERE.
SO WHEN YOU COME IN WITH YOUR SCIENCE OR YOUR ACTIONS, IT
DOESN'T MEAN THAT THE TRAJECTORY IS GOING TO BE EXACTLY AS YOU
ANTICIPATED IT TO BE. SO THE BEAUTY FOR THE SCIENCE
IMPACT FRAMEWORK IS IT ALLOWS YOU TO ACTUALLY IN REALTIME
MONITOR AND TRY THE EFFECTS OCCURRING.
IT'S NOT TO CONTROL THE ENVIRONMENT.
THAT ALLOWS YOU TO DO THE TRACKING FOR THINGS THAT YOU DID
NOT ANTICIPATE. AND IT ALSO LOOKS TO THE FACT
THAT REALLY CITATION DOES NOT DO THE JOB BECAUSE YOU ALL KNOW
SOMETIMES PEOPLE ARE EXCITED JUST BECAUSE THEY ARE ABOUT
SCIENCE. A GOOD EXAMPLE OF BAD SCIENCE.
THAT'S WHY CITATION IS REALLY A LITTLE BIT DIFFERENT THAN JUST
CITATION AND GETS TO THE HEART OF THE ACTUAL KNOWLEDGE THAT IS
BEING SHARED OR USED. >> IF I CAN JUST QUICKLY ADD,
OBVIOUSLY, THERE ARE DIFFERENT PARAMETERS THAT INFLUENCE
WHETHER SOMETHING IS GOING TO BE WORKED ON, CONTINUED, NOT
NECESSARILY ONLY THE HIGHEST QUALITY.
WE WOULD ALWAYS LIKE THAT TO BE THE HIGHEST QUALITY, BUT
SOMETIMES WE ARE REQUIRED TO DO CERTAIN ACTIVITIES.
AND I THINK IN THAT CONTEXT WE CAN ACTUALLY USE THE SCIENCE
FRAMEWORK TO SEE IN WHICH AREA OF THE BROADER DIRECTIVE OR
GUIDANCE WE HAVE TO WORK ON, WE CAN ACTUALLY FOCUS ON.
>> I WONDER IF I COULD JUMP IN AGAIN AND BUILD ON THIS LAST
QUESTION AND THE COMMENTS. BECAUSE ALTHOUGH THE SCIENCE
IMPACT FRAMEWORK IS A RELATIVELY NEW TOOL PER SE, I WONDER IF ANY
OF THE PANELISTS COULD GIVE US AN EXAMPLE WHERE THEY HAVE
LEARNED SOMETHING FROM THEIR EVALUATION EFFORTS THAT DIRECTLY
AFFECTED EITHER THEIR DECISIONS ABOUT INITIATING A PROGRAM OR
FUNDING A PROGRAM OR MODIFYING A PROGRAM IN ACTION.
THERE'S AN EXAMPLE OR TWO, THAT WOULD BE I THINK VERY
ENLIGHTENING FOR US. >> I'LL TAKE THAT ONE.
THE BEST EXAMPLE WE CAN THINK OF OR I CAN OFFER YOU IS THE WORK
WE'RE DOING WITH THE CONTRACEPTIVE GUIDANCE WHERE
WE'RE TRYING TO MAKE WOMEN PROVIDERS AWARE OF THE FULL
ARRAY OF CONTRACEPTION METHODS AVAILABLE.
SOME OF THE RESEARCH PRIORITIES WE THINK THAT COULD COME OUT OF
THIS ARE FOLK YCUSING ON PROVID WHO MAY NOT BE GETTING THE
SAFETY MEASURES, ESPECIALLY THOSE SERVING THE CHRONIC
DISEASE OR MEDICAL CONDITION BUT MAY NOT BE WORKING AS MUCH ON
THE CONTRACEPTIVE ANGLE. ALSO TO LOOK AT WHAT
RECOMMENDATIONS NEED TO BE BETTER EXPLAINED.
WHERE WE'VE REALLY -- WE'RE NEW TO PUTTING THIS FRAMEWORK INTO
WHAT WE'RE DOING, BUT IN THE PROCESS OF CREATING AWARENESS
WE'VE MET WITH FOLKS WHO DO OUR -- GUIDANCE AND FOLKS WITH
PRAMS. I THINK THIS DISCUSSION ABOUT
THIS FRAMEWORK AND THE IMPACT MADE US REALIZE THERE ARE
OPPORTUNITIES THAT WE OTHERWISE MAY NOT HAVE SEEN.
FOR EXAMPLE, WE ARE TWEAKING SOME OF OUR PRAMS WE QUESTIONS
MAKE SURE WE CAN EVALUATE WHETHER WOMEN ARE USING THE
APPROPRIATE FORMS OF CONTRACEPTION AND WHETHER PRAMS
IS MAKING IT AVAILABLE. WE'RE ALSO WORKING WITH
COLLEAGUES ACROSS THE AGENCY AT NCHS TO LIKEWISE MAKE SURE WE
HAVE THE APPROPRIATE MEASURES IN PLACE.
SO FOR US IT'S GOT US THINKING ABOUT DOWNSTREAM WHAT OUR
OPPORTUNITIES ARE TO ASSESS THE IMPACT OF THE GUIDANCE.
>> GREAT. ANY OTHER EXAMPLE ANYONE WOULD
LIKE TO OFFER? >> I'LL JUST CHIME IN AND ASK,
IS DR. BIN CHEN IN THE AUDIENCE? I DON'T SEE HER.
OH, I'M SORRY, WHERE ARE YOU, BIN?
BIN WORKED -- HI. YOU MIGHT WANT TO SAY A FEW
WORDS TO THE AUDIENCE. BIN IS DOING AN EVALUATION OF A
COUPLE OF GOOD LABORATORY PRACTICE GUIDELINES THAT SHE
WROTE WITH OTHERS THAT THE CDC PUBLISHED AS MWRs.
I DON'T WANT TO PUT YOU ON THE SPOT, BUT SHE'S RECENTLY DONE
SOME FOCUS GROUPS. I THINK WHAT WE'VE DISCOVERED IS
THAT -- I'VE DONE FOCUS GROUPS TOO, LABORATORY PRACTICE
GUIDELINES, AND ONE DISCOVERS PRETTY QUICKLY THAT WHAT THE
MESSAGE THAT YOU THOUGHT WAS VERY CLEAR AND UNDERSTANDABLE IS
OFTEN MUDDIED BY THE WAY IT'S WRITTEN.
I WONDER IF YOU WANTED TO SAY ANYTHING, BIN?
THIS HAS TO DO WITH LESSONS LEARNED FROM YOUR EXPERIENCE.
>> THANKS. YES, WE DID LEARN A LOT.
>> OVER TO YOUR LEFT THERE'S A MICROPHONE, BIN.
SORRY. IS IT TURNED ON?
>> YES, WE DID LEARN A LOT OF HOW MESSAGES FROM THE FOCUS
GROUPS. WELL, I THINK -- SO WE -- THE
PROJECT THAT WE'RE CONDUCTING NOW IS A COOPERATIVE AGREEMENT
WITH THE ASSOCIATION OF PUBLIC HEALTH LABORATORIES TO ASSESS
THE IMPACT OF CDC GOOD LABORATORY PRACTICE
RECOMMENDATIONS FOR NEWBORN SCREENING AND BIOCHEMICAL OR
GENETIC TESTING. SO WE ARE TRYING TO COLLECT
INFORMATION FROM THE TWO DISTINCT COMMUNITYIES BECAUSE
THEY PERFORM ESSENTIAL FOLLOW-UP TESTING FOR PRESUMPTIVE NEWBORN
SCREENING POSITIVES. SO THEY TOGETHER ENSURE THE
QUALITY OF LABORATORY SERVICES -- DISEASES.
SO WE LEARNED THAT BASICALLY THE TWO COMMUNITIES HAVE DIFFERENT
PERCEPTIONS ABOUT THE CDC RECOMMENDATIONS.
AND THEY PERCEIVE THE USEFULNESS AND THE INTENT AND WAYS TO
INCORPORATE THE CDC RECOMMENDATIONS DRASTICALLY
DIFFERENTLY. AND TO ADD TO THAT, THE FEEDBACK
CONTRASTED WITH THAT THAT WE HAD COLLECTING FROM THE CONTINUING
EDUCATION ACTIVITIES CDC PROVIDES FOR THE MMWRC ACTIVITY.
SO RIGHT NOW WE ARE WORKING WITH APHL TO ASSESS THE -- OF THE
INFORMATION AND USE THE INFORMATION TOOL TO INFORM OUR
NEXT STEPS. >> THANK YOU VERY MUCH.
>> WE HAVE ANOTHER QUESTION FROM THE AUDIENCE.
DR. DAVE SWARDLOW. >> YES, THANKS.
DID YOU SAY HOW MUCH TIME IT TAKES TO DO THESE EVALUATIONS,
HOW MUCH TIME THE CASE STUDIES TOOK?
AS WELL AS, DO YOU ANTICIPATE THESE BEING USED FOR MAJOR
PROGRAMS LIKE AT THE CENTER LEVEL OR FOR MAJOR GUIDANCE, OR
CAN IT BE USED FOR INDIVIDUAL PAPERS?
>> IT DEPENDS WHAT YOU'RE USING FOR.
I'M GOING TO MAKE JUST A COUPLE OF CLOSING COMMENTS, BUT LET ME
JUST SHARE. IT CAN BE USED TO EVALUATE MAJOR
SCIENTIFIC PROGRAMS AND ACTIVITIES.
IT CAN BE LOOKED -- YOU CAN LOOK AT THE INDIVIDUAL MAJOR
MANUSCRIPT. YOU CAN LOOK AT THE BODY OF WORK
OF AN XRINDIVIDUAL SCIENTIST. IT DEPENDS.
THE CASES WE HAVE WORKED ON, NINE CASES THAT MARY HAS
DESCRIBED AND GIVEN YOU ONCE, WERE REALLY BASED STARTING ON A
MANUSCRIPT. MARY CAN SAY A FEW WORDS ABOUT
HOW LONG THAT TOOK. AND THEY WERE ALL OBVIOUSLY
RETROSPECTIVE. >> SO THE CASE STUDIES,
ACTUALLY, ONE OF THE REASONS WHY I WAS TOUCHING POINT WITH THE
MANUSCRIPT IS REALLY BECAUSE IT DOESN'T MATTER WHAT WE DO,
WHETHER WE CREATE TECHNOLOGY OR WE COME UP WITH A NEW
METHODOLOGY. WHATEVER IT IS, WE TEND TO
REALLY TALK ABOUT IT IN WRITING. WE SHARE THE INFORMATION IN
WRITING. SO THAT'S WHY WE USE MANAGERS TO
THAT POINT. IT DOESN'T HAVE TO BE A PEER
MANUSCRIPT. IT COULD BE A REPORT.
BUT HAVING SAID THAT, IT DID TAKE A VARIOUS AMOUNT OF TIME,
IN SOME CASES ABOUT A WEEK, IN OTHER CASES ABOUT TWO WEEKS,
SOME OF THEM A LITTLE LONGER THAN THAT.
PART OF IT DEPENDS ON THE PROGRAM WHERE THE WORK CAME OUT
FROM, HOW VIGILANT THEY ARE IN THE WAY OF THE ENVIRONMENT
WITHIN WHICH THEY ARE PUTTING ON THESE PROGRAMS AND THE WORK
THAT -- AND THE EFFECT IT IS HAVING.
IN SOME CASES THERE WASN'T ANYTHING SO WE WERE LITERALLY
STARTING FROM SCRATCH TRYING TO FIND WHERE THE INFORMATION
SOURCES WERE. AND SOME OTHER CASES, THE
PROGRAM ALREADY HAVE SOME INFORMATION SO WE HAD SOMETHING
TO WORK ON. >> YOU CAN IMAGINE WHEN WE CAME
BACK TO THE PROGRAMS AND SAID, HERE IS A MANUSCRIPT THAT WON A
BUNCH OF AWARDS BUT WE CAN FIND TO CITATION IN THE LITERATURE.
A LOT OF PROGRAMS WERE ACTUALLY VERY EAGER TO FIND ANYTHING ELSE
THAT WAS INFLUENCED BY THAT PAPER AS A RULE, WE'RE ALWAYS
ABLE TO FIND THAT. IF WE LOOKED ONLY BY THE
CITATI CITATIONS, WE WOULDN'T HAVE HAD
A SENSE. NEITHER DID THE PROGRAM AT THAT
TIME. WE ARE ABOUT FIVE MINUTES BEFORE
2:00. DR. FIEINBERFINEBERG, MAYBE ONE
QUESTION TO THE PANELISTS. THEN WE'LL BRING IT TO CLOSE.
>> THANK YOU VERY MUCH. I THINK THAT THE DISCUSSION HAS
BEEN REALLY EXCITING AROUND BOTH THE EARLY USE AND COMMUNICATION,
BUT I WONDER IF ANY OF THE PANELISTS WOULD LIKE TO
SPECULATE ON THE FUTURE APPLICABILITY OF YOUR OWN
FRAMEWORK OR BEYOND. >> THANK YOU, DR. FINEBERG.
ONE THING THAT THIS FRAMEWORK AND THIS DISCUSSION HAS REALLY
HELPED US IN THE PREVENTION RESEARCH CENTER'S PROGRAM IS THE
EXAMPLE THAT I USED NORTH CAROLINA PRC.
THE MANUSCRIPT WAS PUBLISHED IN A VERY HIGHLY ESTEEMED JOURNAL
JAMA, SOME OF YOU MAY HAVE HEARD OF IT.
THAT WAS IN 2003. SO THE LEGISLATION IN CONGRESS
WAS 2010. SO BABOUT A SEVEN-YEAR
DIFFERENCE. I THINK ONE OF THE THINGS THIS
FRAMEWORK ALLOWS US TO CONSIDER IS HOW LONG CERTAIN THINGS TAKE.
SO FAR US TO BE PATIENT AND TO RECOGNIZE THE FACT THAT IMPACTS
ARE SOMETHING THAT ARE NOT GOING TO BE MEASURED, AS TANJA
MENTIONED, THAT SHEPHERD AWARD PAPERS MAY NOT GET CITED RIGHT
AWAY, BUT I THINK IT HELPS US PROSPECTIVELY MOVE FORWARD TO
HAVE CLEAR EXPECTATIONS OF WHAT THE WORK THAT WE'RE DOING AND TO
CONSIDER THAT THINGS TAKE A LONG TIME, ESPECIALLY IN TERMS OF THE
PRCs WHERE THEY'RE APPLIED PREVENTION WORK WHERE THEY'RE
WORKING WITH COMMUNITIES AND WITH PUBLIC HEALTH AGENCIES TO
INSTITUTE THINGS THAT ARE SUSTAINABLE AND SCALEABLE
>> THAT'S A GREAT REMINDER, ESPECIALLY WHEN YOU HAVE A
FRAMEWORK THAT ALSO ALLOWS YOU TO KEEP TRACK OVER THAT PERIOD
OF TIME AND MONITOR WHETHER YOU ARE AND HOW FAR YOU ARE MAKING
PROGRESS. OTHER COMMENTS?
>> I WANT TO ADD ONE MORE BASED ON -- AND I AGREE WITH RON ABOUT
THE IMPORTANCE OF COLLECTING THIS DATA.
FOR THE GUIDANCE THAT I WAS TALKING ABOUT WITH CONVICT RA
SEPGS, TH -- CONTRACEPTION, IT WAS
PUBLISHED IN 2010. I THANK CHRIS CASEY FOR TELLING
US TO COLLECT THE DATA IN REALTIME.
WE'VE GOT ABOUT 15 PAGES OF EVERY PRESENTATION WE'VE MADE,
OUR CONTRACEPTIVE WHEEL. WE DIDN'T KNOW WHAT TO DO WITH
IT, THOUGH. I THINK WE'RE LOOKING FORWARD TO
PUTTING THIS INTO A SUCCINCT ONE OR TWO PAGES INTO THE WORK WE'RE
DOING. HAVING HAD THIS PRACTICE WITH
THE CONTRACEPTIVE GUIDELINES IT WILL BENEFIT US WITH THE FUTURE
GUIDANCE COMING OUT. WE HAVE ONE COMING OUT ON
QUALITY FAMILY PLANNING SERVICES THIS SPRING AND WE JUST HAD ONE
ON CONTRACEPTIVE MANAGEMENT ISSUES IN WHICH WE WILL HAVE HAD
THE BENEFIT OF GOING THROUGH THIS WITH THE FIRST GUIDANCE AND
WE CAN CONTINUALLY TWEAK THIS IN A GOOD FEEDBACK PROCESS.
>> THANK YOU. WE HAVE JUST A MINUTE LEFT.
CHRIS, DO YOU WANT TO COMMENT? OR OTHERS?
>> JUST REALLY QUICKLY, I DO THINK THAT THE CLOLLABORATION I
VERY KEY. THE PROGRAM LEARNED A LOT ABOUT
THEIR OWN PROGRAM AND HELPED SHAPE THEIR OWN PRIORITIES.
WE LEARNED THE POWER OF PUTTING SOMETHING IN THE LITERATURE.
TALKING ABOUT UNIFORM CASE DEFINITIONS AND DATA STANDARDS
AND CALLING OUT LINKAGES TO NATIONALLY REPRESENTATIVE
DATABASES SETS A CHALLENGE TO THE FIELD, AND IT'S NOT
SOMETHING THAT WE NORMALLY DO IN OUR RECOMMENDATIONS AND REPORTS
BUT IT'S SOMETHING WE'RE STARTING TO DO ROUTINELY
BECAUSE, NOT ONLY WHAT YOU'RE REPORTING IS A DISCOVERY AND YOU
CAN COMMENT ON THAT, BUT YOU REALLY NEED TO THINK ABOUT HOW
THAT AFFECTS THE FUTURE. AND THAT SPEAKS TO YOUR POINT,
DR. FINEBERG, THAT NOT ONLY THE "SO WHAT" BUT "NOW WHAT".
>> GREAT POINT TO COME TO A CONCLUSION.
I BELIEVE WE'VE REACHED THE END OF THE HOUR.
TANJA, LET ME TURN THE PROGRAM BACK OVER TO YOU.
>> AND I WILL QUICKLY RUN THROUGH A FEW SLIDES.
I WANT TO POINT OUT, DR. FINEBERG TALKED ABOUT
UNIQUENESS OF THE DEGREES OF IMPACT FOR THE INSTITUTE OF
MEDICINE. THERE ARE SOME UNIQUENESS ABOUT
OUR FRAMEWORK. AND I HOPE YOU HAVE GOTTEN THE
FEEL OF THEM. IT REALLY MAKES US FOCUS WITH A
HEALTHY OBSESSION, AS DR. FRIEDEN SAYS, ON WHAT WE DO,
BUT IT ALSO HAD A NUMBER OF ADDITIONAL BENEFITS.
ONE OF THE THINGS THAT I WOULD LIKE FOR YOU TO LEAVE WITH --
AND THIS IS WHAT DR. FINEBERG KIND OF HARPED ON AS WE WERE
TALKING ABOUT THIS SESSION -- IS WHAT DO WE WANT YOU TO THINK AND
WHAT DO WE WANT YOU TO DO NEXT.
WHAT IS IT THIS FRAMEWORK CAN DO FOR YOU?
IT CAN HELP YOU TRACK RETROSPECTIVELY AND MONITOR
PROSPECTIVELY THE IMPACT OF YOUR WORK.
AND TO DAVID'S QUESTION, PROGRAMS, INDIVIDUAL SCIENTISTS,
SCIENTIFIC DOCUMENTS. IT CAN STRENGTHEN THE REVIEW
PROCESS, WHETHER IT'S AN EXTERNAL PEER REVIEW WHERE WE
WANT TO ASSESS IMPACT OF WHAT WE ALREADY ARE FUNDING OR LINK WHAT
WE ARE ABOUT TO FUND TO WHAT WE WANT TO FUND.
AND WHAT OUR PRIORITIES ARE. IT CAN ACTUALLY BE USEFUL IN
SCIENTIFIC REVIEW PROCESSES, AND WE HAVE ALREADY USED IT IN THE
SHEPHERD. IT IS REALLY HELPFUL WHEN YOU
COMMUNICATE FOR CONSISTENCY OF YOUR NARRATIVE THAT YOU CAN
ADJUST TO INDIVIDUAL AUDIENCES, WHETHER IT'S INTERNAL OR
EXTERNAL. OBVIOUSLY, NOT EVERYTHING THAT
COUNTS CAN BE COUNTED AND NOT EVERYTHING THAT CAN BE COUNTED
COUNTS. AND THAT IS TRUE.
HOWEVER, A LOT OF OUR COLLEAGUES HAVE SHOWN YOU THAT WE CAN, IN A
QUANTITATIVE AND QUALITATIVE WAY, ACTUALLY LOOK AT WHAT WE DO
AND WHAT IMPACT IT HAS. SO WHAT SHOULD YOU DO NOW WHEN
YOU LEAVE THIS ROOM? MARY DID A PRESENTATION FOR
DR. FEEDEN AND SENIOR LEADERSHIP JUST A WEEK AGO, AND SHE GOT
SEVERAL RESPONSES FROM THE DIRECTOR OF NIOSH AND SEA SELLS.
THIS IS EXACTLY WHAT YOU NEED TO DO.
CAN YOU SEND ME A COPY OF YOUR SLIDES?
I WANT TO SHARE WITH SENIOR LEADERSHIP HERE.
I WANT TO SAY HOW MUCH I ENJOYED YOUR PRESENTATION AND I'M
WONDERING IF YOU MIGHT CONSIDER SPEAKING WITH OUR ASSOCIATE
DIRECTORS OF SCIENCE. AND ANOTHER ONE TO MARY AND ME,
PLEASE COME AND TALK TO US. MARY HAS ALREADY MADE
ARRANGEMENTS TO COME TALK TO THEM.
I DON'T KNOW EXACTLY TO WHOM TO ATTRIBUTE THIS QUOTE, BUT I LOVE
IT. IF YOU ONLY GOT POTENTIAL, THEN
YOU REALLY HAVEN'T DONE ANYTHING.
WE ALL HAVE THE POTENTIAL TO MEASURE THE WORK SO PLEASE GO
OUT THERE AND MOVE. MEASURE THE IMPACT OF WHAT YOU
DO. REACH OUT TO US.
HERE IS THE WEB PAGE THAT BECAME AVAILABLE OVER THE WEEKEND.
REACH OUT TO US. HELP US DEVELOP YOUR CASES.
HELP US SHAPE THE FUTURE OF OUR WORK.
THANK YOU ALL SO VERY MUCH. SPECIAL THANKS TO DR. FINEBERG
FOR HIS REMOTE PARTICIPATION. THANK YOU ALL.
SEE YOU NEXT TIME. [ APPLAUSE ]