Better with the tools at hand thank you. And then dr. Colleen reilly. Good evening, commissioners and directors thank you i want to take the opportunity to speaking speak laguna honda is a hundred and 7 a bed we provide the Nursing Services and rehabilitation one of the few that are Public Library owned, of course, were proud to be on or about integral part of the San Francisco network last year, we saw 12 and 18 patient 5 homicide women we cared for the demographics after hearing the general demographics on race in particular were interesting so thirty percent of our women are white and 29 percent are africanamerican and 25 percent are asian and 13 percent hispanic latino so quite is a disparity we i wanted to highlight a couple of services we provide to so we have a unique integrated pain and heavily clinic we started in 2011 weve seen over one hundred and 40 patient there now this is a masculine where we have medical providers acupuncture and music and different types of movement and massage as pharmacy all happening there at once so about 45 percent of the patient in this clinic are women r our Respite Services provided religious pit for patient that are cared for in the home this is a service that is actually used more heal will i by women patients weve served 56 percent that are women we have a 60 bed unit and serve about 60 patients that were female that came there and probably the largest section is our Skilled Nursing session we have 3 hundred and 33 patient and women make up 45 percent and the top two diagnoses were stroke and dementia and with rehab about 80 women came there our physical program and the top diagnoses is stroke but post physical trauma we have a i think a very kind of a one of a kind hiv aids unit in 1989 a 60 bed unit last year 22 women and a pretty active Substance Abuse treatment and 33 percent of our rfrlz were from women i wanted to quickly share one story because the roll of honda is not in the numbers when i first came to the honda in the 1990s i was a physician on the hiv aids unit shortly after i got there i ended up taking care of a mother and daith date who had hiv the mother was in her 60s and had a pretty hard life living in an sro it burned down a couple of months later her daughter arrived they hadnt seen each other in years but she recognized here right now and came up to me and said my daughter is her should had a little bit of dementia so i didnt believe her at first but her daughter was ill with insensitive nights she made an amazing rove and the mother ended up being diagnosed out in the hydrohad cancer and died but the daughter recovered they were able to share a room and the daughter did some of her care taxing and the daughter eventually recovered to a point which a year and a half was daze charged to another setting so i appreciate the opportunity to 1956 with you and thank you so much further explanation . I do appreciate the fact that the department has worked hard at this and they have highlighted several things im wondering as we move into the new Health Network that we actually will be doing a lot more measurements in the actual performance and outcomes of the work were doing Health Network is tint on developing a series of perimeters we gave you the kohlman report to show you what could be done with one disorder it was number 6 as overall women and the problems theyre the disparities in which in certain populations and weve heard a little bit of that already like the black community the diagnoses are later and so i think this creates a challenge into our system to say that while that is an overall San Francisco profile our network mirrors that and give us an opportunity to look at how we can do better well be taking not only common but those factors that are important for women care and developing a dashboard as well as we do for all the rest and this will be a subset of the dashboard that will allow one to fellow how well, we were murray the clinic al height of those taking care of in the population so we thought that would be good and heard the preliminaries as to where our Health Network is 2i7b9d to get to i was going to say that ac a wants to clump those together and smaller is better as we look at the the code the highest rates of poverty among the asian Asian Pacific islanders living in the sunset but its good to know that the clinics are a part of San Francisco and that accounted for us looking at hearthier we have high rates of asian Asian Pacific islanders that has federal bureau of investigation reduced breakfast tissue now doctors are sending those mailers along with mammograms like the notes i have breakfast tissue issues and given our population it happens in more asian Asian Pacific islander thats one thing i would like our department of Public Health and commission to focus on. Just to note we have a clinic in that area ocean park and not only part of our San Francisco but part of our network with the contract weve established with them theyre great providers our hope is that ac a has come and were able to oracle orientation into a network our screenings should be much better than now because this will become part of the routine in the care coronation weve heard of then the team is finding even within a Commercial Area which c chp all asianamericans for the most partying part their mammograms are close to if not greater than 72 the normal of public the normal public is 65 percent so again as a group our Health Network and as ata creates and creates the nation well see an improvement. The asian Asian Pacific islander women do we go favorite than the traditional mammograms thats on an open and a question. Lets hear the expertise. Its an important findings we do in but its hard to read the fine perspective you wanted to have a discussion with our patients whats the next steps all the services are available should they choose to be seen in a breakfast clinic and mri you have to weigh it if what is going to help them the most we have data on the choices women make on if cancer diagnosed its a personal choices but a conversation that providers will have with the patients fortunately weve got the resources to make the referrals. And particularly if theyre limited to be proficient. Thats where the team comes in we ask i know were fortunate to have the Workforce Development young people in our centers that can act as Health Coaches not necessarily a practitioner but someone that takes time to find out what they heard and understand and make the next decision. Thank you, commissioner. Id like to ask a question about lark i was glad to see you have a lark project but im wondering how far has it begun in terms of Public Education its probably the most safe and reliable source of conservatives for women but the numbers are low due to provider bias that it might increase project executes you might know that right. Im wondering how much have we done in terms of Public Education and awareness around lark in San Francisco. Dr. A james. Were ableers theres no question about that so i believe to date 3 of our clinics have gloen the training its a real clinic wide effort from the person answering the phone to you know the janitor everyone is on board we want to support women in those choices so and then the rest of the clinics were hoping to bring that over time we have 3 pioneers it started this theyve doubted their rates of ivs and the Public Awareness campaign and you know, i think the h pc are v is something weve been successful not only for the young women but young men as well. Dr. Would you like to dr. You wanted to say a couple of words. In terms of of the long acting we have a Birth Outcomes Initiative that is going on right now it has two main strategies and one of them to improve the sergeant of lark and this is focused on the disparity and access to Family Planning and lark for young africanamerican women so we are working with the initiative thats a collaborative with many partners including the clinics and this Pilot Project but theres a workshop that is focusing on lark in particular and the Public Education piece of it is on their agenda this is one of the main strategies with the idea we have to really focus on the health of the young woman and thats going to lead towards better birth outcomes for the family yeah, thats one thing i wanted to add. Any other questions . I just want to make a couple of comments especially around those really personal stories that you all shared and its really heart living and when i look at the way that the Community Oriented prim care 52 percent of those patients of women i think that those become important as we continue to move into the ac a era when we look at the patient retention and outreaching and 345shg9d the services we provide i think there will be more and more opportunity with those stories to be shared, you know, so its not necessarily the stories we hear about primary care laughter but 101 youve seen one of them its important and i think thats part of what we havent touched on how do we really educate those who are eligible for our services that you know the transfer of the services we actually especially in this case it looks like it will be more women a than men ceasing those questions. I wonder if the director of the health would like to respond to our strategy. Good evening, commissioners im roland director of the Health Network in terms of respond to the community im sure youre aware of the Health Network were in the process of rolling out a marketing and branding campaign which youll be hearing more about on the october 7th commissioner meeting but part thought is both an internal and external Communications Plan we worked for the last 6 months on the external and now moving into the face of the Overall Community part of that will be the development of a newsletter that will be administered by the network and distributed to the patient who are assigned to our network same were part of the San Francisco health plan that actually has a Robust Communications system already in play so well continue to strengthen our partnership with them in terms of getting out the information of the services we provide. Thank you so the other questions i have is the do those numbers include the other Community Clinics signatures martin and the free clinic and i see the deputy shaking his head and nates thats our network by the way, u. Because those are somewhat of a speciality clinic so serving the women in the community do we see any value in creating a medical home oh. Oh, absolutely some of the