I'm with CMSS. It's great to see all of you. I've met some of you in person, not all of you. I recognize you all. about all of the great projects that were funded in the first round of the Diagnostic Excellence Grants. We're going to hear in this session from four of the grantees about their projects. But first, before we do that, I just wanted to congratulate the newest round of Diagnostic Excellence Grantees. We just announced awards this month for the 2023 Promoting Diagnostic Excellence Grantees. We made another 11 awards in this round. It was another competitive process. Very high-quality proposals that were very well reviewed by our external advisory panel. And I'll just go through on a couple of slides. You can see the projects that were funded in this most current round. There are handouts on your chairs if you want to read a little bit about this newest round of awards. You can see what this, what's going to be happening in this next round. And then we're really going to focus in this session on what happened with the grants that are just coming to a close. The ones that were awarded in 2022 are coming to the end of their one-year projects and have results to share and learnings to share. And it's just great to be able to hear from them. So we're going to switch to the other slide deck. And I'm going to turn it over to Helen Burstyn. Wonderful. Well, this is, is this one on? Yes. Oh, I think that one is on, too. All right. We have one mic, not making any feedback. Okay, excellent. Really a treat to be here today to hear from just a few of our grantees, and I have to say having done the walk this morning of the posters, it was hard to pick. There are just so many, so many great projects. So we're going to hear from four of our, there's still lots of feedback here today. I'll put this further away. My phone, can I have my phone? I mean the mic. The mic is off. Maybe, I don't know. We'll try everything. How's that? Better? There you go. Process of elimination. Okay. So we're going to hear from four of our grantees this morning who are here with us. It's still not fun. How's that? OK, so we'll just use the hand out. So I hear that our folks have decided they want to come up one at a time to the mic, and then they'll join me at the podium. So our first person we hear from is Dr. Greg Martin, who is a, oh, very nice you have that up there, of course, who is a professor of critical care medicine, pulmonary. Remember, you have like 17 titles. Last time I looked, Greg, at Emory, representing Society of Critical Care Medicine, talking about the work they've been doing, which is just incredible. So we've had a lot of experience with Greg because of their amazing work on the virus registry during the pandemic. So Greg, it's all yours. Thank you, Helen. It's certainly great to be here. And as you would guess or know, I really am here just representing a much larger group. So I have the privilege of presenting for the Society of Critical Care Medicine really the work that has been done on training around diagnostic excellence. And this is an initiative that I'll talk, obviously, more about, but something that's been not just part and parcel, but really right to the core and heart of what SCCM does as a multi-professional society. So I'll talk about this as the project that we did, particularly using sepsis as a model for this. So the background of this, as you would know, I'm sure everyone in the room realizes the importance of diagnostic errors and how often they occur in health care in America. SCCM particularly is relevant here because we are the largest multi-professional society dedicated to the care of critically ill and injured patients with over 17,000 members in 80 countries. But also, SCCM, for many years now, has really focused on diagnostic excellence and avoiding or improving the ability to avoid diagnostic errors. And that's, again, part and parcel of the society because of the fact that critical care, by its nature, is highly acute. There's a lot of cognitive workload that goes along with it, and the diagnoses are time sensitive. And so for us, there's several factors that come together for why this is so important. The program that we ran that I'll describe really was trying to enhance diagnostic excellence and address both the implicit bias and as it relates to diagnostic errors in critically ill patients. And again, using sepsis as a model for that. So SCCM's mission is to secure the highest quality critical care for all critically ill and injured patients. And the Diagnostic Excellence Program, which you can learn more about, really is looking at the entire landscape of diagnostic practices in our specialty, realizing, again, that we are a multi-professional society, not only physicians, but really the entire critical care team working together and how that plays out for patient care and advancing the field of critical care medicine and diagnostic excellence. So our goal in this initiative was to develop and deliver the diagnostic excellence education in a variety of formats, including webcasts, podcasts, and then toolkits that people could take and use and implement. And again, using sepsis detection and diagnosis as the model to reduce delays and errors in that condition. So we had four main outputs that I'll talk about, and these are the webcasts, podcasts particularly. So the first of these was the sepsis one hour bundle. For those of you, I hope you're familiar with sepsis as a condition, but even more so that there is a campaign, a global campaign, which has launched and run for 20 years now. And the current iteration of that has an hour one bundle, meaning how do you identify patients with sepsis and implement care? And this was the first webcast, which had over 2,000 views immediately, and then even more, almost 13,000 podcast listens later. And this was all about taking that hour one bundle and finding ways to implement that. And particularly focusing on early identification of patients who otherwise might be missed or might have delays in care. And then the other ones are similar using the same model, but now mitigating diagnostic delays and errors, really addressing the causes of morbidity and mortality in these conditions and how diagnostic delays play a role. And then mitigating implicit bias in diagnosing these patients, which was obviously another very important part. And then finally, engaging health care leaders in the fight against sepsis. And as you look at all those, there's different focus. Part of it is implementation science. Part of it is at the level of the clinician or the team in the ICU. And part of it is focused on our health care systems and where we might have an impact. The examples, I'll give you one of the examples of our toolkit. So then I mentioned we did all the education, but we also then created and rolled out toolkits as part of that as well. So this is one taking that mitigating diagnostic delays and errors through communication in the ICU. And the background of that I've covered, but really the point being that sepsis is certainly a time-sensitive diagnosis that requires the entire team working together. Much of that is around communication and pulling together the tools that are necessary to understand which patients may have sepsis and how do you manage that in an acute environment. And then here's another one that's more about implementation. So as I was talking about the fact that some of these are directed more towards physicians and other care providers in the ICU and across our teams working not all in the ICU, but even pre-hospital and pre-ICU environments. And then for the health care system, how do you implement this? And what you see here is there's the upper left corner sort of the guides, guidelines, or the broader perspective of this, the tools and toolkits that we have. And then finally, even literature-based and other education that we can provide to people. So I want to certainly thank, obviously, CMSS for their support. We've had terrific collaboration with the Gordon and Betty Moore Foundation. And again, sepsis is one of those conditions we've dealt with for many years. The Surviving Substance Campaign has brought that to awareness and recognition globally. But it's still one of the most difficult ones that we all struggle with in health care in terms of making a timely and accurate diagnosis. So we were very fortunate to have the opportunity to develop the webcasts and make those work, but also then the toolkits that hopefully will be sustainable and run for many years. So thank you very much, and I'll look forward to the rest of the discussion. Thank you. Thanks. It's good to hear that. Wonderful. Thank you so much. And actually, one of the things I didn't mention at the beginning, which you're excited about, in addition to giving out these awards, we also have funding for CMSS as the coordinating center with Sarah and Damon to help pull all the sort of learnings and the strategies that seem to work based on the evidence and the findings to actually share them with our second round of grantees, but also just sort of general learnings about what works in terms of diagnostic excellence. So I'm next going to invite Zane Peters to join us here. He's a research fellow at the ACS working with one of my other favorite people, Cliff Coe. He's also a surgical resident at Loyola, and he'll talk about some work that's actually funded by the Hartford Foundation. Good morning. Thank you, Dr. Burson, and for all of your attention. As was mentioned, I'm Zane Peters. I'm a clinical scholar at the ACS. I have no relevant disclosures. Older adults, so just for some background, older adults in the United States are a population of growing importance and interest, especially to surgeons, because while they constitute about a fifth of the population of the U.S., they comprise 40% of all total annual surgeries performed in the United States. This is also an at-risk population by virtue of their age-related vulnerabilities that increase risk of adverse perioperative events. Among these vulnerabilities, dementia and cognitive impairment was really the target of our work, which for the purposes of this project, we treat as a single entity. This dysfunction can affect memory, attention, language, problem-solving, and decision-making skills, and importantly, cognitive impairment is frequently previously unrecognized in surgical patients when they present for their surgical care episode. These numbers are really staggering. A recent systematic review and meta-analysis reports that this is as high as 37% in non-cardiac elective surgery patients, almost 50% of emergency orthopedic surgery patients, and almost two-thirds of emergency general surgery patients, so it's a big problem. Why do surgeons care about this? Simply put, because it increases the risk of serious complications that we really care about and manage for these patients. This includes things like surgical site infection, pneumonia, ICU admission, but really importantly, a big one we care about is delirium and the subsequent risk for long-term cognitive decline. It also affects patient-centered outcomes, things that patients really care about, like functional decline after surgery, prolonged hospital stay, inability to be discharged home, and of course, increased costs, which further burden the healthcare system. Recognizing the vulnerabilities of this population and the impact that this has, our goal at the ACS with this funding opportunity was to develop and disseminate comprehensive educational resources that focus on diagnostic excellence for dementia and cognitive impairment for older adults as they prepare to undergo surgery. In order to accomplish this, we engaged several working groups with experts from multiple disciplines to contribute to iteratively develop these resources, which ultimately included a provider-focused toolkit, a patient and caregiver brochure, an ACS bulletin article, and an ACS House of Surgery podcast, and an in-person expert panel at the Quality and Safety Conference earlier this year. To highlight some of these resources, our provider toolkit was really targeting non-expert clinicians that care for patients in the surgical setting, and so we start by answering just some fundamental questions. Why is this important? Why are we conducting a cognitive assessment for patients that are coming in for a surgical procedure? And really, we frame this in the context of maximizing the surgical care episode to improve the patient's overall total care. We also importantly address this issue of who should undergo a preoperative cognitive screen, and this is consistent with our recommendations from the Geriatric Surgery Verification Program from the ACS. We do state that we recommend that patients aged 75 years and older undergo these screens, also importantly recognizing that the urgent and emergent surgical population is fundamentally different in terms of opportunity for preoperative screening and optimization, and so those patients may not have the opportunity for preoperative screening but should be screened within 48 hours of their operation. I think this is a really important and interesting piece. We provide some example script for how clinicians can engage patients in talking about and framing this issue of cognitive screening for a surgical care episode. It may not be intuitively obvious to patients why they need to be screened for their cognitive function before getting treatment for pain in the groin and an inclinal hernia, and I really like the language that we use in our toolkit that basically frames in the context of just like we evaluate your lung and heart health before surgery, we also like to evaluate your brain health. This also helps frame cognitive screening as an opportunity to assess for additional risks after surgery. Our toolkit contains several potential tools. We don't recommend one single screening tool, but we do offer eight specific sort of bulleted components for each of these tools to help clinicians decide on which tool to use. We offer information about the preparation required for the tools, what the components are included in the tools, how to interpret the results. Of course, the amount of time that it takes to complete, as you can imagine, this is a big issue among surgeons, as well as relative strengths and weaknesses, reported accuracy, and importantly here, too, the language availability for each screening tool. We recognize that many of these tools might underperform or have not been validated in patients that don't speak English as a primary language. Our patient and caregiver brochure highlights some salient elements that patients should be aware of and their families and caregivers should be aware of when engaging with a surgical care team and a cognitive impairment screen. We really just start by providing some basic vocabulary that I think improves their ability to understand words that they will hear, things like cognitive impairment, dementia, and delirium. We also importantly frame cognitive impairment screening as an important step in prevention delirium, and I think it's also relevant to mention that we really sort of characterize dementia or, excuse me, delirium as a distinct clinical entity that we are. It's a known complication, but we are equipped to prevent and treat it. We offer some guidance questions for patients to engage their clinical care team, things like asking several times to make sure that the procedure is completely understood and that their goals and wishes are appropriately reviewed. And then, in the interest of time, I didn't include the full-length patient and caregiver brochure, but we also highlight some salient things that the family members and patients can do before surgery to prepare for both the inpatient surgical care episode and recovery after surgery. We also created an audio recording of a panel discussion podcast with three experts. This was hosted on the ACS House of Surgery podcast and included a clinical case format. Again, this was targeting sort of pearls, things that you must know for non-experts that are involved in the care of the surgical patient, and we discussed sort of perioperative screening in practice, how it's actually working on the clinical front lines, and how we take what we know about how it works in practice to overall improve practice patterns. We also held an in-person panel at this year's ACS Quality and Safety Conference in Minneapolis. It was moderated by one of my mentors, Dr. Ronnie Rosenthal, and had representation from a variety of specialties, including surgery, anesthesia, surgical palliative care, and internal medicine and geriatrics. And finally, we wrote a review, a sort of narrative review-style article with the target being surgeons that was published in the ACS Bulletin article, excuse me, ACS Bulletin, which is our monthly membership magazine. And again, this reviews a lot of the content that we had covered in previous materials, but really focuses on surgeons and what questions they should be asking themselves for these patients and what they can do to maximize care in patients that do have cognitive impairment. All of these materials are publicly available on the ACS website. There's an extremely small QR code on my poster if you are interested in accessing that. We also disseminate these through the GSV newsletter, which goes out to all parties that participate in the Geriatric Surgery Verification Program and interested members as well, totaling over 600 providers quarterly. And just in my last few moments here, I would like to say, of course, this was not a one-person show. This is a substantial amount of work. So in addition to thanking CMSS for the opportunity to do this, I would be remiss if I didn't thank everyone on the slides for putting all this together. I certainly could not have done it by myself. And with that, I will thank you all again for your attention, and I look forward to our panel discussion. Thank you. gratified by the work of ACS, by ASA, and also now AUA coming forward. And just great, great work. Super excited by it. So next is Colleen. Where is Colleen? Colleen Scow, College of Medical Pathologists. I love all these projects. I will say I'm especially somewhat partial to the fact that this one actually thinks about how patients think about diagnosis and changing the pathology report to be more readable and meaningful to patients. So thank you, Colleen. Thank you so much. Which one of these buttons moves it? Thank you. Not intuitively obvious, just like a pathology report. So I'm Colleen Scowan with the College of American Pathologists. I have nothing to disclose. So today, I'm going to talk about our work. And it's a little bit different than some of the other work that we've heard from, because we're looking at how we make pathology reports more patient-centered. I'm going to talk first about why we're doing this, and then what we actually did, what we learned, and where we're going from here. So first of all, just to sort of set the stage, pathology reports are, as many of you know, not intended for pathologists. They are intended for everyone else. So they're complex, and they serve a lot of different stakeholders. So they have important clinical information that an oncologist needs, and a surgeon needs, and like that. But also, pathology reports are necessary for things like billing and coding, accreditation, quality metrics, all of that. So there's a lot of stakeholders in a pathology report. And what this means is that oftentimes, patients, as a stakeholder, get kind of lost. Pathology reports are not centered on patients. So here, you can see an excerpt from a pathology report. I'm not going to read it aloud. You can read it to yourselves. I work in pathology. I read pathology reports for a living. I still have no idea what this means. I've read this pathology report so many times, and I don't know what it means. And why this really matters is that a couple of years ago, the Cures Act final rule put in place that patients must have access to their results as soon as they're signed out, except in rare circumstances. So as a clinician, you can't say, oh, well, I'm not seeing this patient for two weeks, so I'm just going to hold on to the report. Results must be available to patients. So a lot of patients now see their results without a clinician present. And a lot of times, they also see results before the clinicians see results. And what this leads to is a lot of potential implications for the patient, a lot of anxiety, confusion, et cetera, et cetera. And because of that, we are looking to move toward what we refer to as a patient-centered diagnostic excellence paradigm, so putting the patient at the center of things, which I think for many of you is a little bit more intuitive than it is for pathologists. But we're trying to get there. And we think that this is important because studies in the literature show that improving patient experience with pathology reports will promote a number of different things. First of all, it will promote patient engagement with diagnosis and treatment. If you understand a report better, you can ask better questions. You can understand what's coming next. One of the patients said to us, the pathology report sets the stage for everything that's coming up. And we think that's critical. Similarly, a patient understanding of pathology report does help promote effective teamwork. If patients can be a partner in their treatment, that will help close the loop on communication. Patients are in a better place to catch potential mistakes or answer questions like, oh, have you ever had BRCA testing done before? Well, you have to understand a pathology report to know if you've ever had BRCA testing. And as I mentioned briefly earlier, we think it will promote patient safety and mental health, reduce anxiety, reduce confusion, reduce stress about the whole process. And long term, we think that better understanding of pathology reports will also have a positive impact on health equity. It's not just more information. It's better information, better information that is understandable to everyone, lets everyone participate more in this process. So we really think, based on what's in the literature, that patients do want to understand their pathology reports. The question is how we make that happen. And that's exactly what we were trying to do. So the goals of this project, for reasons that I can talk about later, we focused on patients with a diagnosis of colorectal cancer. And we started by just trying to understand their experience. Before we can say, here's what a patient-centered report looks like, I mean, we have to know what patients want out of a report. And from there, we went on to identify actionable areas of improvement for pathology reports. And really importantly, the whole time, we wanted to engage pathologists in the conversation for change. Pathologists, just like all doctors, want to do better. Just not necessarily obvious what better really is. If we're asking people to make a change in their practice of medicine, we need to get them on board with that and get them to understand what we're asking and why we're asking it. So what did we actually do? The first thing we did was get feedback from patients. We started with a survey covering the patient experience of the pathology report. And this isn't just how well did you understand the report, how satisfied were you. We did ask that. But we also asked things like, where were you? Were you alone? Were you at home at your kitchen table? Did your clinician hand you a report and say, here, here's your pathology report. What questions do you have? Those are really different experiences. And we wanted to understand all of that. We also asked, where did you go for additional information? Spoiler alert, it's always Google. But we asked anyway, even though it's always Google. And we collected some really limited demographic and self-reported health literacy data. We then moved on from the broader survey to individual interviews to talk to patients more in-depth about their experience and understand what was helpful and what would have been helpful. And also, was there anything you hated? We did ask patients, was there anything on the report that you would say, just get rid of it? So then the last thing that, well, in this first round, the last thing that we're doing is we're moving on to focus groups. And those are coming up in just a couple of weeks with patients where we're kind of doing, not exactly A-B testing, but sort of based on what we've heard, here's an improved version of the pathology report. What do you think? Is this better? Is this better? What would you change about this? To really start getting feedback on concrete things we can do to improve the reports. And then also at our annual meeting about a month ago, we presented this as a hot topic again. We really want to engage pathologists in the organizational conversation for change. And we did some audience polling because we wanted to know, pathologists, what are you already doing? Have you made changes to your report? How do you think about this? Because this is a really important ongoing conversation with the pathologists. So what did we find? I think this is probably not a tremendous surprise to a lot of you. You can see here on the left, most people said it was difficult or somewhat difficult to understand the report, to identify the diagnosis, to understand the terminology. It wasn't a surprise, but it is still evidence that we've got a ways to go. I will say I was pleasantly surprised that there's a decent number of people who are satisfied or somewhat satisfied with their reports. That's all the way on the far right. There's also a decent number of people that are somewhat unsatisfied with their reports. The next part of the survey, we asked about what would be helpful. And we listed just a number of options, all the things we could think of. Far and away, the biggest thing, and we heard this in individual interviews, we saw this on the survey, a few sentences at the top explaining the diagnosis. There were a couple of other things that kind of rose to the top. A surprising number of people wanted to see the cancer diagnosis in bold font at the top. That one, I did not expect that, but that was highly selected. And then a glossary of medical terms with definitions. I hope that people would actually use that, so I was pleased to see that on there. There were also things that we suggested that there was not as much interest in. Let's say that. So only about a quarter of patients had any interest in seeing images of their tumors. I agree with that head shaking that's going on there. I wouldn't want to see that. And only about a quarter of patients were interested in an audio or a video explanation of their results, which was another thing that we suggested. So then we are now working, as I said, we did individual interviews. We are now working on a draft set of recommendations for potential changes to the pathology report. Thinking about what can be implemented by the pathologist essentially right now versus what would be more of like a structural change to the electronic health record. That's a really important consideration when we're thinking about the actual implementation of these reports. And the next step is, as I said at the beginning, the pathology report serves a lot of stakeholders. We don't want to get to a place where we inadvertently bury or omit information that the surgeon needs or the oncologist needs. The report still has to serve all of those stakeholders. So we actually are moving on to convene a technical expert panel of a lot of the other stakeholders in the pathology report to talk to them about both the recommendations we've gotten from patients, but also how can we improve for you as well. And I think I've been in touch with a lot of different folks about this work. Thank you to everyone that has already signed on. If you are interested in improving pathology reports for patients with colorectal cancer, please email me. Always happy to talk to basically anyone about this. And with that, I will just acknowledge everyone involved in this work. So funding, of course, we had a great clinical team leading this. We also had some really great patient partner groups. So we distributed the survey via these different patient advocacy organizations. And particularly special thanks to AGA gastroenterology for helping put us in touch with some of these patient groups. Thank you. Such a great project. Thank you, Colleen. Last, but certainly not least, Miguel Paniagua, Vice President MedEd from ACP will talk about their work on implicit bias. And I just want to say I'm so excited. Again, an equity-focused project. And as we really define diagnostic excellence in working with the Moore Foundation, we made it very clear it is diagnostic safety, quality, and equity, as we do as well for our NAM Scholars Program, as well, in which more than half of our scholars are doing equity-related work. So Miguel, all yours. Thank you. And Colleen, I asked to take my gallbladder home after my surgery. I would have really liked to have seen that. Did they let you? No, of course not. Of course not. Probably for the best. Thanks for having us. I am grateful on behalf of our team at ACP to talk a little bit about the work we did with the support of CMSS and the Moore Foundation. I am going to invite you to use the QR code to look at the content that we were able to develop during the course of this process. It is free to peruse. And if you're a member, you get free CME with it. Otherwise, you can pay for CME if you want it. I'm indebted to our team of instructional designers and project managers, specifically Claire Sippler, Kelly Tuttle, Nick Gogno, as well as David Disbrow, who is the director of our unit. We have a robust team, and I'd love to talk to other societies about resources and things. And of course, I'm sure we'll talk about lessons learned as it relates to this grant work. Our subject matter experts for this were recruited very deliberately for their expertise in diagnostic reasoning and disparities in care. Denise Connor from the University of California San Francisco, as well as Verity Shea from New York University, were the leads on this. We also had help. And so you'll see, as you look at the module's curricula, that was supported by Christina Gonzalez at, I believe, is now at NYU as well, and some of the work that she did. I would also say that, as you go through these, and I'm just going to describe them briefly. And again, I'm going to invite you to look at them. The first module that we created was specifically understanding and addressing disparities and diagnosis, really the core concepts behind this. It even includes a link to a University of Washington implicit bias IAT instrument so that you can actually sort of level set yourself in terms of going into using this material. It even gives you warnings about a lot of this stuff, a lot of the things you're going to see in these cases. It's heavy, and it's real. And when we talked about the cases we wanted to illustrate these concepts, these were real patients that we had seen, or conglomerations of patients that we had seen on multiple occasions. So it talks about individual and systemic bias and how this affects the care we deliver. And it does it in an interactive way. These are not just static web pages. These are modular. They're done in RISE, Adobe RISE modules. And there's even the opportunity at the end of the first module to play around with illness scripts, create your own illness scripts, even print a PDF of examples for them to use in a teaching session, say, with residents and students. In module two, the first case is introduced. And it's a hospital-based case of a Latina who shows up to the emergency department, does not speak any English. There's not an interpreter. You know this story if you're a clinician. There's no interpreter available. And there is a misdiagnosis of acute coronary syndrome. So the concepts of missing a diagnosis and the lack of communication at the provider level, and even some of the issues with stress and burnout are even touched on in this when it comes to missing this diagnosis. And goes through, again, individual and systematic reasons for why this happened and teaching the provider, the physician, on how to address these things. The third module is the second case. And it's an outpatient case, which I think is really, really powerful. And it talks about the therapeutic partnership as its main learning outcome and gives folks doing the modules means of practicing some of these phrases, some of the things that we need to say. And myself, as a palliative care provider, my procedure in medicine is exactly the words that I use. This is no different. And it teaches folks that are using this how you address what happened in this case. And what it was is an African-American female who showed up to the clinic with a low-grade fever and a swollen knee. And it turns out, years before, she had seen the same provider. And her rash was brushed off as just being an allergic reaction, was given a cortisone cream. What it turned out is that she had a tick bite and had Lyme disease. And it ended up not being treated and, therefore, became systemic and caused these other problems later. So it goes through and unfolds throughout the case to teach some of these things related to the therapeutic partnership, what was breached, what can be repaired, and how do you address it, as an example. And gets back to the notion of how we're taught in medical school, that most of the Lyme erythema migraines rashes we see in textbooks are on white skin. They're not on melanotic skin. And this is yet another place we need to work. Along with these, we also have two podcasts, what we call our day shift, or our DEI day shift. There's an hour-long episode that's also attached to this material. And a core IM session podcast that also goes through diagnostic errors and decision-making. And all meant to be a complement to the modules that you do online. Oh, OK, I think that's the next slide. So for those that don't know American College of Physicians, we are a very large medical site. We have 160,000 members. And just to give you a sense of how we got the word out, these episodes, these modules dropped, I believe, August 10th. So they've only been out a little bit of time. We did emails to a variety of all of the members and had actually a pretty good open rate. Almost a fifth of folks that we contacted went to these and opened them up, at least. Whether or not they finished them is a whole other thing. So this is another good lesson learned for this in terms of how do you get the word out? How do you get folks to interact with the content you created? We know it's important. How do we make it important to them? Our online learning center email in September went to over 103,000 and, again, had a relatively small open rate. And then, of course, we have our publication side, our internist weekly email went out and had some relatively good opens. I think it's also important to realize that if you did all of this content that we created with the help of this grant, you were eligible for four continuing medical education credits. And that's important. It doesn't sound like a lot, but there are actually 10 states and the District of Columbia that require content in the area of cultural competency, content in the area of DEI, content in the area of implicit bias. And this content would actually satisfy those things. So that's really important in terms of creating a need, at least in some instances. So this is an up-to-date dashboard of some of the views that we've had and some of the feedback that we've gotten. And we've had thousands and thousands of page views. We've had almost probably over 1,000 total attempts on the three activities since this dropped in August. And over half have completed all three activities, which is really, really good. And over 80% have rated the content quality as very good or excellent, which is wonderful. And 72% of the respondents plan to do some sort of practice change. So 3 quarters have said, wow, I went through this and I actually had a transformative experience utilizing this content. And then you can see our CME quiz in terms of folks that attempted each of the modules. A significant amount of them at least completed the first one, the one that kind of introduced the concepts. And certainly, a lot of them at least attempted to do the quiz at the end of the module. So that's great in terms it's only been a few months that we've actually rolled this out. A couple of nice open-ended learner feedback that we got on the modules. A great place to start. I get overwhelmed by this topic, and I feel like the module helped me just start the process. A great case, great food for thought. The subject's important to develop confidence, patient and practitioner relationships, and address patients properly. I think that's just as much about the content, but it's also equally as much about the methodology we use and the pedagogy that we employed to make sure that this just wasn't a static thing to read. It was something that was meant to create behavior change. I will end there. I'm grateful again for the support we got for this and the results that we're continuing to get. Thank you. Thank you. Wow, four incredible, incredible presentations. Thank you so much to all of you. We still have about 15 minutes. I have some questions for all of you, but if anybody has any questions from the audience, please come up. I will say a couple of things. There was also a poster in the back here. SGIM is doing similar work as well on implicit bias. Christina Gonzalez, who you mentioned, was one of the leads for that award as well. I will say we also gave an award in this year's round, since you mentioned the dermatology example, American Academy of Dermatology. I don't know if anybody's here from that group. Yes, thank you. They just got an award specifically to look at diagnostic equity in terms of skin and the inequities of only having white examples of dermatologic conditions and working to create more equitable atlases and working closely with one of our former NAMS scholars as well, which is just, we love those connections with our scholars. So I want to open up. Actually, something you said, Colleen, really stuck with me, that you thought only pathology, it was especially that it didn't have a patient-centered excellence paradigm. I'm not sure that's really true. I think all of us are kind of wrapping our heads around that. I wonder if the other panelists really want to give their sense of how really patient-centered around diagnostic excellence we've been from that sort of patient mindset. Anybody want to reflect? Greg, anyone? I'm happy to. Does that not work? Can you hear me? There we go. Yes. So very much so. And it's interesting. There's a lot of variety here in different implementation or different approaches of trying to understand diagnostic excellence and the application sometimes of trying to address health equity. And I agree with that completely. I mean, we're all patient-centered in the sense that we're all trying to get to this. And as I think about what we do in the ICU, often we struggle with understanding patient preferences and patient goals, because many times the patient is not taken out of the conversation, but they may not be capable of having that conversation. And it feels a little bit like maybe that's the case that is experienced with the College of Surgeons in emergent and urgent surgery, where maybe the screening or the things that you can do are different. So often when we think about diagnostic excellence, we're really thinking about it from the provider perspective or the health system perspective. That doesn't mean it's not patient-oriented. I mean, our goal is still to try and identify and make the diagnosis correctly, equitably, timely, and all those things. But I was particularly struck by how applicable some of the things that we're doing could be taken from one to the other. And the things that we've done are all different, but they're actually pretty complementary. Yeah. Yeah, this is, OK. I think that there's a nice convergence of, so I sort of imagine if patients were walking through this room and looking at these projects, I think they would really be in support of a lot of the work that's been done. You don't see any, of course, reducing hospital costs or necessarily focus on things like the connection between diagnostic excellence and, for example, readmission or hospital-level metrics. I think a lot of this really does break down to the patient level. And certainly that was the case for us. It's a big part of, obviously, the work that we do with geriatric surgical patients. But a lot of the, I see among all the other posters here, a lot of these issues are really things that I think that if we offered patients an opportunity to tell us what's really important, they would echo a lot of the work that's been done here if they had the opportunity to do so. Totally agree. Miguel, any reflections about what you've heard? I would just say, I'm reflecting a lot in the plenary as well and just kind of bringing it back to what we talked about with the race-based medicine conundrum we're in. And what we're doing here, I mean, what we're really positing in a lot of these talks is, we have to fix this on a patient-by-patient basis. And the work never ends. I'm seeing that now. And I think it's easy to feel overwhelmed by that. But I feel like a lot of the work we've seen here in these posters and in these presentations really get to that, which is really encouraging. Yeah, and it's also striking how many of the strategies you're all using are so transferable. And just also the scale. I mean, I think about the old strategies of sort of like the handouts we'd give to people in clinic or what we'd do. I mean, the scale of what you've been able to do in terms of tens of thousands of people downloading and looking at these things, and even just the amount of behavior change you saw, Miguel, is really like the pre-post tests we're used to seeing on CME. But people actually used it. And really, I'd love your reflections on that. The idea that people did a CME. I'm one of the people who started it. I didn't finish my CME. I didn't have time. I'm going back to it, because I have to do my license. And I will use that for my DC license. Thank you very much. But the idea that people would use that and actually really feel like it changed their behavior, I'd love your reflections on how you think, what was different about this that really you think a tool like this could change behavior? Well, again, it goes back to one of my last comments, which was it's not just the content. It's how we're delivering it. And I told my instructional design team on more than once, I said, if we don't have somebody who's 25 or younger on this team, then we've already made ourselves 10 years behind. Gone are the days of just recording a lecture and having them watch it for 60 minutes. We have to think of better ways to get these really important concepts across. And I think that's what we accomplished with this. The other thing that struck me is, and you mentioned it as an open rate, but also the views, the podcast, the downloads, the toolkit development that was used was really remarkable, which speaks to me in terms of member interest, right? I mean, there's a lot of engagement there. But the fact that it happened, like for us, the first one that we delivered was really highly engaged from our members. And it sounds like that was sort of true for all of us, which I think speaks to the interest of our members and probably the broader community in this topic and the material. Yeah. Yeah. I think it relates to both patients and clinicians. I think we all just get it. It's just a very logical place. It's actually interesting. I was thinking about the work that you're doing, Colleen. And just a reflection, when I was at AHRQ, I oversaw the US Preventive Services Task Force. And we would put out these documents every time we had a new recommendation. And we had a four-page document we put out for clinicians explaining the new recommendations. And we had a one-pager we put out for patients. And what we quickly discovered was that almost nobody downloaded the four-pager for doctors. And all the doctors downloaded the one-pager for patients because they loved them. They were clear. They were simple to read. And I'm really curious, I think, I'm curious if you've actually asked people like me, primary care docs, or others. I mean, I find pathology reports pretty impossible to read as well. And I'm curious if at some point, you're going to go and actually ask other clinicians, or if you've already done that work, their perceptions of how it would actually help my ability to diagnose better if I could read them too. Yeah. Yeah, I fully agree. So that is where we're going from here, basically, is we are trying to get the other stakeholders on board. And I'll say, when we sort of started, initially started thinking about who's a stakeholder in a pathology report for, again, specific to a diagnosis of colorectal cancer, we kind of started from like, well, obviously, the oncologist, the surgeon. Who else? And then I was actually talking to a friend of mine at the American College of Physicians. And she was like, oh, we're really invested in this. We absolutely want to be part of this. This is really important to us. Which I think, again, I don't know that pathologists would immediately have a great sense of that. So we are trying to be as broad as we can be at this point, acknowledging that different stakeholders are going to want different things. We have to do the best we can to address as many of them as possible. Yeah, I mean, the primary care doc is the first person they call when they find it on their portal and they're terrified. And then I have to figure out how to read it or quote a friend, which is usually what I do. Miguel, any reflections on any of this from where you sit? In terms of what you would love to see in terms of our ability to work across specialties? Yeah, well, I guess, again, going back to the pathology reports, words matter. And words matter to clinicians, and they matter to patients. And what we're doing here is really trying to make ourselves more aware of how we're using them, for sure. In terms of lessons learned, I would say, we're very lucky. We're a large society. And we have a really great team that can produce this kind of stuff. So I think one lesson learned was we ran out of money pretty quickly during the grant period. Still finished the work, by the way. And be judicious with your resources and with your team members. We did perfectly fine with just two and a half subject matter experts to create all this content, which I think is really important in terms of meeting goals and meeting deadlines as one lesson. I want to ask if any of the new grantees or anybody else have any questions for these folks? New grantee? ASCP, please. All the great work. Thank you very much. I have a question, actually, to Helen, you also. And again, I think it's an open question for, again, talking about the patient-centered care. Like, for example, you talked about the one-hour bundle. But the patient care not started for the sepsis in the critical unit. It started in the emergency department, right? And when the patient came in emergency. So my question is, how we can disseminate or circulate or educate other physicians also, other members of other societies? Like, for example, the toolkit you created. How we can disseminate to ASAP, for instance? And for example, I was just looking at the nephrology. And this is a question I just was going to ask in the previous, the race discussion. Like, nephrology, the ASN are working on a toolkit to educate primary care physicians, not the nephrologists. Because nephrologists, they are already sort of, they are the one who knew about the recommendation, but not the primary cares. So how we can disseminate this kind of education to other departments? Thank you so much. It is absolutely a great question. And it's one of the reasons why we chose sepsis as a model, is because it's not just difficult, but it often requires early identification in an environment that's not intuitively obvious for the ICU, right? I mean, sure, it can happen in the ICU. But sepsis is often first suspected or diagnosed in the emergency department, or even earlier in the pre-hospital environment via ambulance and EMS teams. So to your point, how do we take the materials? I mean, some of that, things like the Surviving Sepsis Campaign, definitely work across specialties, and across countries, and across settings to try and do that. Part of what we tried to do is also then think about it from the health system perspective. So that if we're taking a health system and say, how do we impact care? Then it's clearly not just the ICU, or the wards, or the ER. It's really all of those together where sepsis might occur, and thinking about how an individual hospital might address that. I mean, the easy answer is probably, sure, we can work together as societies, which we do, and I think maybe these kinds of projects that we're seeing here all lend themselves to that. But at the end of the day, it has to be patient-centered, right, if that's the goal. And for us, that's very much not just the ICU. It really requires the other professionals that are touching the patient. Yeah, and for example, I think if you look at the APA project up here, the one on eating disorders, they really thought about how they had a new guideline. And from the start, the idea of the project was to go think about how it would be disseminated to primary care, because that's where those patients are first seen. I know the new project AUA is doing, or the ASAP project on AAA, right? Those patients, like if you ever have a patient who's got low blood pressure and you're coming from primary care, think AAA, right? I mean, there are going to be things you're going to have to get out before they get to the ED. So I think it's a great question of really how, maybe even as you're working into these new projects, maybe one of the first questions is, what are the other specialties I should engage and get them involved early as you're starting to plan your work? I would just add, I would get your team around a table and just start brainstorming. What are the reasons, what are the ends goals that our target audience need to reach to click on my resource, to use my resource? Because that was really big with nephrology. I've got 30 minutes a day, and that's my commute. What am I going to spend my time on? Is it going to be, I may not automatically think to click on something. I'm not picking on nephrologists, but a nephrology thing, because I probably need to spend my 30 minutes in a different way. The urology folks are doing a really cool thing with prostate-specific antigen. Wow, I've got 160,000 members that really need to hear that information. But will they necessarily click on the American Urological Association module unless we find a way to package it and make them realize they need it? Sorry, I'll just say one thing really briefly about this, which was a learning for us, is don't reinvent the wheel. A lot of this stuff already exists, I mean, both in terms of other societies that are doing this kind of work, but also kind of partnerships that you might not think of, or groups that you might not have automatically approached. So we talked to Fight Colorectal Cancer to help us distribute the survey, which is a patient advocacy group. And when I talked to them, the person I was talking to said, you know, we just completed a lecture series about how to understand your pathology report, which we had no idea that that was something that they were invested in. So I would say, you know, before you start something new, see who else is out there already doing it. Sorry, I got moved because I was blocking the shot. Well, thank you. I really appreciate it. Just for the record, I work for the American Society of Nephrology, and I don't spend my commute to nephrology podcasts. So I think of that as being healthy. I guess, just to circle back to the connectivity issue, sort of two disconnected thoughts. One is, we're increasingly trying to figure out how we're going to interact with the value based care companies. And I'm wondering if that model is an opportunity. In other words, going to them and saying, you're incentivized for providing higher quality care. Therefore, you're incentivized, in our case, for identifying people earlier for kidney disease. And hopefully, the US Preventive Services Task Force will come through and start to require screening. And then that way, they will be more, I think, amenable to wanting some of these learning modules, et cetera. So that'd be one question. It's just any advice on how we could maybe rethink our project to that audience. The other issue, which is disconnected from it, but I think is related, is recently, the American Heart Association said, we're going to think about cardiovascular disease, kidney disease, and metabolic disease as one set of diseases, which I think, on the one hand, is a positive step, because it starts to put things in context from a patient perspective. But at the same time, I'm concerned that's going to leave out, again, in the nephrology arena, anyone with genetic kidney diseases, where there's been a lot of discoveries, say, in the type 1, et cetera. And so how do we handle that sort of deconstructional, I guess it's constructionalist, approach to medicine? So on the one hand, we have the payers thinking very much of the whole patient and then being incentivized to keep people from progressing to disease. On the other hand, we have the experts saying, let's start to combine, as we look at patient populations. That seems disconnected to me. And then how we relate to, then, diagnostic excellence. Who wants to take that one on? That's a toughie. It's certainly a lot to think about. And certainly, I appreciate the complexity of that. And I maybe take one step back for sepsis, specifically. And the way I think about that, from a value-based purchasing or care perspective, is we sort of assume or hope that those programs are advocating or pushing towards the highest quality, patient-centered care. And when I think about that for sepsis, there's CMS programs and core measures that go into that. And that drives quality. But it's not always. And one of the biggest challenges we've had is how connected is that to the outcomes and or the patient experience or the patient care? And so as much as value-based care, I think, would be oriented towards providing the best care, we haven't really thought about it as much from purely that perspective. Because I think we've tried to think about it more from the patient or the outcome perspective, which is why we targeted a lot of our approach to either the clinicians or the health systems. And obviously, the health system probably is thinking about it from the economics and the value-based purchasing and even core metrics and things. My bias is that we should always be targeting the patient outcome or the patient experience. That sort of is the core of what we're trying to get to. And in almost every case, that aligns with the other stuff, whether it's core measures and things. But sometimes, they don't align perfectly. And again, the example for us would be that sepsis has a bunch of process measures, but not so much outcome measures. And so trying to make sure you're doing things and how many of the things are you doing purely for compliance reasons and how many are really patient-centered. Sensitive to time, since I think we're supposed to start lunch soon. I just wanted to say thank you, Helen, for bringing this together. I mean, what a great bunch of presentations. We at AUA are so excited to get the tailwind that you all have picked up and be able to do this work. And I think, I can't remember who said it, but just sort of visually, we have all of our society's logos, and we're doing this work, and we're driving meaningful change together. But having the patient at the center and connecting the team-based care model across our specialties, I feel like this initiative really captures the vision that you have brought to this organization. So thank you, Helen, so much. Really, really excited. And I'm excited to work with you on breaking down the distrust among the internists. Great. Thank you so much. And actually, it's true. This is a great example, I think, of where we really can work together. This is just absolutely perfect. And even, I think the other thing that we were talking a little bit offline earlier, I mean, even your offer earlier, the fact that ACP has incredible design resources, right? It isn't just content here. I think we also have just different skills we bring to the table in terms of how to do this work. It's not just the what, it's the how. So I'm also excited about learning what each of you bring to the table in terms of how we provide these kind of resources to our members and how we can share in that. I do want to make sure I don't starve you guys. It is 12.05. Is there anything else we need to do? All right, you guys have been a wonderful audience. Please look at the posters. Thank you all. Wonderful.

CMSS

Diagnostic Excellence Grants

sepsis detection

dementia

cognitive impairment

pathology reports

disparities in diagnosis

value-based care

patient-centeredness