3/8/2018 Disclosure: Advisor to Pfizer. No conflicts of interest relevant to this topic. Yvonne Maldonado, MD Professor of Pediatrics and Health Research and Policy Stanford University School of Medicine 2 Stanford Precision Health for Ethnic and Racial Equity Center (SPHERE) Overview • SPHERE will focus on identifying genetic and biological markers that could be used to help reduce disease in minority populations in the United States. • The center will develop analytical tools for precision health, data sets and outreach programs that help accelerate the integration of treatments and interventions within target communities. • This model can address populations with other health disparities as well 4 1
3/8/2018 SPHERE Aims The Center consists of three research projects and five core areas dedicated to the following overarching aims: 1. Successfully implement three projects while evolving into an integrated and sustainable science ”team” able to take on novel projects proposed by our community consortium partners. 2. Expand Stanford’s portfolio of precision health work focusing on health disparities. 3. Develop and expand relationships with our project partners to facilitate critical bidirectional relationships in the community to ensure inclusion of further adversely impacted populations as projects and programs go forward. 4. Develop broad experience with “translation” of genetic and biologic information within different racial and ethnic populations to optimize the application of such precision health approaches to reduce ethnic and racial disparities where such approaches are most relevant. 5 SPHERE Structure SPHERE CENTER Steering Committee Administrative Core Laboratory Core Project 1 BRAICELET Bio-Repository for American Indian Capacity, Education, Law, Economics and Technology Stakeholders Analytics and Modeling Core Project 2 iPOP for Obesity and Diabetes Risk in Latino Youth Implementation Core Project 3 Community Partners Consortium Core Communicating Cancer Genetics Information – Differential Response of Latino and Chinese Families to Information on Cancer Genetics 2
3/8/2018 Project 1: BRAICELET Aims Project 1: BRAICELET Bio-Repository for American Indian Capacity, 1. Establish American Indian Biobank with BRAICELET- Bio-Repository for American Education, Law, Economics and Technology Indian Capacity, Education, Law, Economics and Technology. • Create a Lakota Health Community Advisory Group that will optimize To help reduce the myriad of health disparities in American Indian educational methods and promote cultural exchange populations, this proposal’s primary aim focuses on the establishment of • Establish Lakota Biobank infrastructure and engage, educate and train tribal the first tribally-owned biobank as a conduit for education on the community members as biobank personnel • benefits of precision medicine and big-data health science. Endorse longterm sustainability through strategic and business management and early pursuit of diverse funding approaches. 2. Establish pilot for first set of biobank material through the collection of 200 additional participants for SAIL (Studies of AutoImmune Illnesses with the Lakota). 3. Develop, implement and evaluate Science Health Education and Literacy among Lakota as part of BRAICELET. 9 Project 2: iPOP Project 2: iPOP Aims Integrative Personalized Omics Profiling 1. To assess associations of iPOP markers with measures of adiposity and To reduce health disparities by developing and applying ‘omics diabetes risk at baseline. technologies to more effectively prevent and treat excess weight 2. To assess the associations of baseline and 3-year longitudinal iPOP markers gain and diabetes risk. The first step toward this goal, is to with changes in measures of adiposity and diabetes risk. quantify metabolic and bio-molecular differences among children 3. To test the additional predictive value of iPOP signatures for changes in that are associated with and/or predict obesity and diabetes risk, adiposity and diabetes risk over 3-years when combined with cognitive, and to characterize the heterogeneous biological responses and behavioral, socio-demographic and environmental measures, across all moderators and mediators to interventions to reduce weight gain. participants and as possible moderators and mediators of intervention effects. 11 3
3/8/2018 Project 3 Project 3: Communicating Genetics Information Aims Communicating Cancer Genetics Information 1. To assess genomic confidence of clinicians communicating genetic test results and genetic risk information on breast cancer to diverse patients. This project addresses the possible worsening of health disparities 2. To audiotape the information that clinicians communicate during the clinical associated with not comprehending genetic health risks. It includes a encounter in delivering genetic test results and to assess whether the information multi-ethnic, multi-lingual, two-site study (Stanford University Health that is provided to patients differs by patient ethnicity, health literacy, and study site. Alliance and University of Southern California Los Angeles County 3. To assess the correspondence between the recommendations of doctors and the Hospital) of how breast cancer genetic risk information is communicated subsequent actions of patients over and whether this correspondence differs by to Hispanic, Chinese, and Non-Hispanic White women, what they ethnicity, health literacy, and study sites. understand, how they respond, and with whom they share this 4. To identify if/when patients share their personal genetic risk information with family information. member(s) and to what extent this process is influenced by ethnicity, health literacy, and study sites. 13 Consortium Core Members of the Consortium Core will join forces to: 1. Create a strategic alliance among diverse partners at the local, regional, and state levels to address health disparities through innovative precision health projects. 2. Build capacity among patients, providers, and communities to incorporate Administration Core precision health topics and applications for the promotion of health equity. Consortium Core 3. Systematically evaluate the function and progress of SPHERE project partnerships in promoting health equity through precision health approaches. Implementation Core 4. Develop and implement an effective pilot grant program to facilitate assessment Analytics and Modeling Core of emerging needs in precision health related to communities with health Laboratory Core disparities. 4
3/8/2018 Implementation Core SPHERE Partners Members of the Consortium Core will collaborate to accomplish objectives aimed at supporting implementation of results from SPHERE projects: 1. Develop and evaluate the SPHERE ethical guidelines for participation in precision health projects and delivery of precision health approaches among American Indians, Latinos, and Asians. 2. Systematically assess the potential for dissemination and implementation of precision health interventions with mixed methods using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) model among American Indians, Latinos, and Asians. 3. Establish a “Precision Health Innovation Lab” in Stanford Primary Care where precision health implementation strategies can be rapidly utilized and refined among racial/ethnic minority and low-income patients in order to improve clinical care. 4. Develop, implement, and evaluate a precision health-training curriculum for providers that serve racial/ethnic minority and low-income patients in community settings. 17 Analytics and Modeling Core Laboratory Core Members of the Laboratory Core will provide services to different projects in the Center as well as any other groups in the consortium Members of the Analytics and Modeling Core will: 1. Perform ancestry estimation and genome-wide association analyses using a 1. Develop generalizable models to understand impact on health disparities of genotyping array and software designed for diverse populations (Projects 1 emerging precision medicine approaches and 2). 2. Facilitate development of models to study disparities impact of precision 2. Perform RNA-SEQ laboratory work including analysis (Projects 1 and 2). medicine developments 3. Perform Metabolomics laboratory work and analyses (Project 2). › Starting to generate base models for later data input 4. Perform Microbiome laboratory work and analyses (Project 2). 5. Assist any other groups in the Center with Omics activities (All Projects). 6. Assist in dissemination of results and technologies (All Projects). 5
3/8/2018 Early Successes 1. Project 1 team traveled to South Dakota and developed an engagement plan with community members of the Cheyenne River Reservation. 2. Focus groups conducted in January 2017, based on the guide designed by the Implementation Core. Results will lead to the development of Ethical Guidelines for Precision Health Research. Thank you! 3. Lab Core developed partnership with a lab in Mexico, run by a senior scientist from Stanford, to expand genotyping/sequencing core lab capabilities for projects 1 and 2. 4. Held a successful and well attended Community Consortium meeting to work with our community partners in understanding the importance and impact of Precision Health in reducing health disparities. 5. Analytics and Modeling Core published: “ Comparative effectiveness and cost- effectiveness of treat-to-target versus benefit-based tailored treatment of type 2 diabetes in low-income and middle-income countries: a modelling analysis” in Lancet Diabetes Endocrinol 2016 Oct 4. 6
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