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, we're 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 african-american 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 we've 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 we've 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 hadn't 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 didn't 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 i'm 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 we're 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 they're the disparities in which in certain populations and we've 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 we'll 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 it's 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 that's 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 we've established with them they're great providers our hope is that ac a has come and we're 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 we've heard of then the team is finding even within a commercial area which c chp all asian-americans 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 we'll see an improvement. >> the asian asian pacific islander women do we go favorite than the traditional mammograms that's on an open and a question. >> let's hear the expertise. >> it's an important findings we do in but it's hard to read the fine perspective you wanted to have a discussion with our patients what's 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 it's a personal choices but a conversation that providers will have with the patients fortunately we've got the resources to make the referrals. >> and particularly if they're limited to be proficient. >> that's where the team comes in we ask i know we're 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. >> i'd like to ask a question about lark i was glad to see you have a lark project but i'm wondering how far has it begun in terms of public education it's 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. >> i'm wondering how much have we done in terms of public education and awareness around lark in san francisco. >> dr. a james. >> we're ableers there's no question about that so i believe to date 3 of our clinics have gloen the training it's 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 we're hoping to bring that over time we have 3 pioneers it started this they've doubted their rates of ivs and the public awareness campaign and you know, i think the h pc are v is something we've 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 african-