Vision: Health for Oregonians
A fully representative Oregon Health Consensus that leads to measurable improvement in Oregonians' health, and of their understanding of the health-related resources available to them.
Mission: The Oregon Health Consensus
We are committed to creating a statement that clearly articulates what all Oregonians want for their health and the health of their communities. We call this statement The Oregon Health Consensus. We will also research and document existing health care resources, and past and present efforts to reform health-related policy.
The Oregon Health Consensus will lead directly to legislation, health care policy, public initiatives, and programs that are aligned with our intentions for our health and the health of our communities.
Create and moderate a web site where every citizen can productively contribute to The Oregon Health Consensus whether they have 5 minutes or 5 hours a week.
The web site will build The Oregon Health Consensus document in stages. Each successive stage will build upon the preceding stage, increasing the number of participants and the scope of the document we are agreeing upon. Each stage will conclude once 90% of all participants are satisfied with the current state of the document.
Documentation of past and present health-related issues will inform us in developing reform proposals, and will serve as a resource for all Oregonians as they make individual and/or collective decisions about their health.
At least 90% of 40 Oregonians agree on the Vision and Demographic Minimums sections of The Oregon Health Consensus.
First Consensus Project
As practice for large group consensus, and to unify our vision, we've done the consensus process on the above Vision section.
|Angela Beane||✓ YES|
|Mark Dilley||✓ YES|
|Pete Forsyth (contact)||✓ YES|
|Amy Sample Ward||✓ YES|
|Brandon Sanders||✓ YES|
|Shelley Sanders||✓ YES|
|Gerald Schoepflin||✓ YES|
|Shirley Schoepflin||✓ YES|
|Ray King||✓ YES|
|Janet Johnson||✓ YES|
- Add new participants' names here. The more the merrier!
- What: Consensus on the Vision section of The Oregon Health Consensus
- Done When: 100% of at least 8 participants are at YES.
- Edit the Vision Section until it works for you.
- Change your status from NotYet to YES.
- Listen to the others who are at NotYet and help them edit to get to YES.
8/14/08 Congratulations on achieving consensus on our first version of the Oregon Health Consensus! --ShelleySchoepflinSanders 15:28, 14 August 2008 (PDT)
Second Consensus Project
This is still under construction.
This is the next section we will be working on. In this section we will determine the minimum levels of participation and consensus required from various demographic groups in order to consider our consensus fully representative.
The Oregon Health Consensus will develop via the following stages:
- 100% of 8 Oregonians agree on Vision
- 90% of 40 Oregonians agree on Vision and Demographic Minimums
- 90% of 200 Oregonians agree on Vision, Demographic Minimums, and Values
- 90% of 1,000 Oregonians agree on Vision, Demographic Minimums, Values, Factual Background
- 90% of 5,000 Oregonians agree on Vision, Demographic Minimums, Values, Factual Background, Potential Next Steps (including Legislation, Policy, Programs, etc.)
- 90% of 25,000 Oregonians agree on Vision, Demographic Minimums, Values, Factual Background, Potential Next Steps, and Actual Next Steps (including Legislation, Policy, Programs, etc.)
PLEASE NOTE: Work will begin immediately on sections that will not come up for agreement until later stages.
Four Month Timeline with Milestones
- Target Community: Twenty diverse Oregonians who want to build a consensus vision statement for health.
- Four Month Goal: Develop a website that supports the Oregon Health Consensus Vision and Purpose by October 23, 2008.
- Possibility this Project Opens Up: Health for Oregonians
- Project Name: The Oregon Health Consensus
- Specific Measurable Results with Timeline:
|W, July 23, 7:30 pm @ Sanders||Planning meeting for Aug 6 WikiWed.||✓ Done|
|W, Aug 6, 6:00 pm @ AboutUs||Planning meeting for Sept 3 WikiWed||✓ Done|
|Sat, Aug 16||Increase our core group from 8 to about 20 members. Each one of the 8 will invite at least one other person.||In process|
|W, Sept 3, 6:00 pm @ AboutUs|| Sept 3 WikiWed: Major outreach event to communities that might like to partner with our project.
|Th, Sept 4|| Start Website Vision Consensus Process
|Sat, Sept 20|| Finish Website Vision Consensus
|Sun, Sept 21||Begin tasks assigned during Website Vision Consensus Process||Planning|
|Th, Oct 23||Launch Website||Planning|
|Sat, Nov 29|| Site use goals:
|Th, Jan 1, 2009|| Beyond Yes Consensus Process Begins:
|Long term goals (dates TBA)||
- Everyone currently involved tells their story about why they are involved and how they hope to contribute.
- Brainstorm potential allies and folks to invite to participate.
- Consider how to reach those who aren't already online.
- Develop marketing plan.
- Build website. May need to recruit assistants.
Discussion Regarding First Consensus Project
The hurdle one needs to surmount to begin editing in Wiki is so high as to frustrate the novice.
- Jerry, I think you are right about the barrier to getting started. We're building a new site with a primary goal of making it easier to participate for the novice. -- Brandon CS Sanders 09:14, 23 July 2008 (PDT)
I am concerned that 90% is a very high bar. Two concerns: one is that people will drift away without "voting," and remain at "not yet." ::The second concern: there are usually people attracted to politically-oriented projects who adhere rigidly to an ideology of one sort or another, and have trouble with the whole "genuine engagement" thing. Keeping that number down to 10% (presumably by coaxing people into a little flexibility/creativity) is a noble goal indeed, but could prove difficult to attain. -Pete 14:19, 18 July 2008 (PDT)
- Hi Pete. 90% does seem like a high bar and I'm concerned about it too. We'll have to care for the drifters and engage participants in a different way than they are used to. If we get 90% of lots of Oregonians, then we are very clearly done. Also, when shooting for 90% people act differently in their listening than when going for a lower number. There is a sense that we can afford to ignore so-and-so :problem participant when the number is lower. In my experience we've been able to get to 90% even though most participants initially feel that getting even a majority is out of reach. Admittedly these have been small polls, the largest being only about 60 people. I find the prospect of going for 90% inspiring and worth my best efforts (in your words a "noble goal"). As the number gets lower I begin to ask why I would even bother. --Brandon CS Sanders 16:05, 18 July 2008 (PDT)
Your points are all well taken, especially the idea of people approaching the project in a different way because of the ambitiousness of the goal. Thanks. Now, a procedural question: I feel close to "yes," but would feel a little better about it after some face time. Will I be holding the group back if I hold off until our meeting Wednesday? -Pete 18:51, 18 July 2008 (PDT)
- Hi Pete, I feel as you do that the document is close to done, but I too want some face time. It's ok to stay at "not yet" until after our meeting Wed. --Shelley 06:55, 20 July 2008 (PDT)
Hi Shelley, Be sure to sign in as yourself when editing and sign your posts as you :-) --Brandon CS Sanders 10:04, 21 July 2008 (PDT)
- Oops! Didn't mean to virtually forge your sig. Good catch! --ShelleySchoepflinSanders 00:37, 22 July 2008 (PDT)
I am sorry to have missed the most recent meeting. Sorry in principle, but also regretful specifically because I feel like the discussion has drifted in a direction that I don't understand, and doesn't seem like it reflects my goals very well. I do think I have a better idea, now, what my goals and strategic approach would be for this project, so I'll try to present them here (feel free to move this around if it belongs somewhere else).
The way I would like to measure the success of this project, in the near term, is by the amount of robust and productive discussion taking place, as opposed to a measurable consensus. Developing a strong and broad consensus is something that makes sense to me only as a long range goal -- something that, if we do everything right, we might be able to think clearly about in a couple of years.
In the meantime, the things I'd like to see happening are all related to building community, and building public resources. In fact, I think that building a public resource is the best approach available for building community; the "barnraising" spirit seems to attract people to online communities like no other force I've seen.
If we put our energy into documenting health care policy, and/or best practices for healthy living, that would attract readership, and build trust and respect among contributors. We would be creating something that is potentially useful to all Oregonians. I think that would establish some fertile ground for developing recommendations and consensus down the road, too.
Is this sort of resource building/barnraising part of what others are envisioning, too? Or have I misunderstood the aim of this project? What kind of scope is envisioned for a "consensus document" -- would it say "Oregonians believe that tobacco smoke causes cancer"? Would it say "Oregonians recommend a single payer health care insurance program"? Would it say "Oregonians demand that all children have access to health care"? Would it say "Oregonians would like to see soda and junk food machines removed from public schools"?
What kind of issues are we trying to get consensus on? And, if applicable, what makes us think that consensus is out there to be had, on issues that are generally understood to be controversial? -Pete 21:38, 25 July 2008 (PDT)
- Hi Pete, thanks for writing. I hear you saying that gathering participants (readers/contributors) feels like the most important next step, with the thought that this group might move toward consensus in the future (2-3 yrs). For me, gathering participants is indeed one of the most important next steps, but I am hopeful that the vision of consensus can itself attract people to the site.
- The "barnraising" I had envisioned was for each visitor to the site to start by sharing his/her story. Those of us "already there" would listen to the story by "writing back" a single summary sentence like, "Wow, it sounds like when your mom was in the hospital, you realized that it would be really great to have other cancer services like a support group and an acupuncturist right there integrated into the hospital cancer center." Because there are already a lot of websites that document health care policy and/or best practices for healthy living, I hadn't really imagined recreating that content on our site. Certainly as questions arise that aren't readily answered by a link to an outside page, we could build some content in those areas. But I guess I hadn't imagined our site as primarily a reference site, even though I agree that that might be an effective way to get more participants on the site.
- So, after the meeting Angela and Brandon and I were talking and we realized that we still need to be more clear about an overarching plan. Angela has agreed to write that for us (but she just moved so it may be a week or two) based on our conversation July 23. A brief sketch, as I recall:
- We currently have a core group of about 8 people.
- Expand that group to about 20.
- Build a website.
- Publicize the website to lots of groups with diverse demographics. Ask people to login and share their personal story.
- "Listeners" listen to the stories, and "Extractors" start building a document that summarizes the values expressed in the stories. The values document will be short. It will link to the stories, but not contain them.
- When we have 200 participants, we'll open a "Beyond Yes" process to be performed on the values document ("Beyond Yes" = the new name for what we used to call "Consensus Poll." We'll ask our 200 participants to reach 90% consensus on the values expressed. For the cancer story I suggested, the value might be "Integrated services, including complementary and alternative medicine."
- Once we have this first consensus on values, we would continue the process of trying to recruit more and more people to the site, with the goal of having thousands of Oregonians participate. The next Beyond Yes process might include 2000 participants, and this time instead of just a document of values, we might ask the participants to order the values. "Prevention of Cancer" might be higher up than "Integrated Services." As you point out, consensus may be difficult, but we believe the reason many efforts to revise healthcare policy have fizzled in the legislature is that they have started with building policies rather than doing the work of building consensus around values. We believe that once listeners really hear others' values and we work together to build an ordered values statement, it will be possible to agree on policy.
- Gradually, more and more participants would join the site. Now, since there will already be a values statement, they might start by looking at the values statement. If they like it, they just click "yes" and move on. If they don't, they edit the document, and they add their story as "evidence" supporting whatever value they added.
- Once we feel confident that we have a consensus on values (we will need to come up w/ some criteria to document diversity, perhaps including participants' zip codes (rural/urban), age, gender, race/ethnicity, etc.) then we would move forward with trying to build policy, probably utilizing what has already been done by others. Only then would we be ready for the next stage of the process, which would be to make some specific recommendations like what you had said as an example, "Oregonians want junk food machines removed from public schools".
- Does this help clarify the vision at all? --ShelleySchoepflinSanders 15:02, 27 July 2008 (PDT)
Yes, this definitely helps me to understand what you're proposing -- though I think there's still more I need to figure out. I'm feeling a little discouraged (which I'm sure will pass!) because I had thought I had a clear understanding what you were proposing, but now I feel like I was making a lot of assumptions that may not have been accurate.
(Small procedural question: Do I understand right that the only thing we're seeking consensus on at this stage is the "Vision and purpose" section?)
As for specifics, this one is tough for me: "A fully representative consensus of Oregonians that comprehensively addresses our health." I'm not sure how a vision can "address" anything. I feel some trepidation at bringing this up, as I know it will sound like a semantic quibble -- but it's more than that for me. I'm having a hard time understanding what this is "supposed" to mean. I can see how things like policies, laws, court rulings, grants/endowments, information resources, or services are able to address things, but I don't understand how a consensus can address something. I feel like there's something here that I'm "just not getting."
Also, it seems like we have a pretty different perception about what resources exist, and what Oregon needs. I actually don't see a good resource out there for understanding Oregon's health care policies and procedures, etc. Maybe it would help if you could direct me to some that you think are pretty good. (The sorts of questions in the "Pete" section, below, are representative of the kind of information that I think should be more accessible than it is.) Also, I already see lots of opportunities for people to share stories online -- newsgroups, blogs, forums, etc. So, what is it about those that is lacking, that we could do better? -Pete 21:01, 27 July 2008 (PDT)
- Hi Pete, I'm committed to finding a vision that works for all of us. I will look forward to talking with you in person today! --ShelleySchoepflinSanders 08:00, 29 July 2008 (PDT)
- Pete and I talked. We've adjusted the vision/strategy section significantly. And, to make it more clear what exactly we're trying reach consensus on, we've made the consensus document (Vision, Timeline, and Next Steps) all subheadings of the First Consensus Project. --ShelleySchoepflinSanders 20:11, 29 July 2008 (PDT)
I've just been wordsmithing what we wrote together, Pete. Does it work for you and the group? Here are the "brainstorming" ideas we don't want to lose:
More specifics on strategy -- not to be included in the Vision and Purpose statement, but to start an expanded document elsewhere . . .
- Participants have a choice of various ways to participate.
- Oregonians from all different demographics will participate.
- Listen to each Oregonian's health story and concerns.
- Extract values from the stories, building an Oregon Health Consensus document that describes our shared values.
- Research and document policy context.
- Once we understand the policy context, and once we have a truly representative grassroots values statement, develop policies to achieve our goal of healthy Oregonians.
- Use the Beyond Yes consensus process to build and demonstrate large-scale Oregon consensus on our shared values and proposed legislation.
After sleeping on it, I'm back at "Not Yet" b/c I'm just not sure "Outcome Desired" is legislation for me. I am more excited about creating a consensus -- which will naturally lead to change, which might be enacted by policy/legislation, or might create a groundswell for action in another arena that we just don't yet imagine. If we could stick to broader language and talk about an "Oregon Health Consensus" that leads to "significant changes in the health of Oregonians" that would work better for me. Legislation alone as an outcome feels limiting. Anyone have other thoughts? --ShelleySchoepflinSanders 06:13, 30 July 2008 (PDT)
- Shelley, I agree with that -- but I think legislative change is the most obvious vehicle. I'd like to see language that mentions leg. change specifically, but does not limit us to pursuing that. I'll keep grinding the mental gears on that. -Pete 09:45, 30 July 2008 (PDT)
Desired Outcome Thought Process
Desired Outcome: Draft and pass new legislation for health in Oregon.
Maybe: Draft and pass new legislation that supports health in Oregon. I'm confused though that the desired outcome is 'draft and pass new legislation' when I feel like it would be more appropriate to what I understand of the group's focus/work to say something about finding consensus around or areas of highest interest to seed or support legislation. Maybe I just need clarification though. ----Amy Sample Ward 09:35, 30 July 2008 (PDT)
- Suggestion: Effect change (legislative or otherwise) that promotes a healthy Oregon
Another suggestion: To have a measurable impact in the improvement of health for Oregonians.
Oh -- I really like "another suggestion"!!! I too don't like the restriction to legislative action, but I want to respect Pete's commitment to legislation as one important vehicle for measurable impact.
Suggestion #4: A fully representative Oregon Health Consensus that leads to measurable improvement in the health of Oregonians.
Suggestion #5:A fully representative Oregon Health Consensus that leads to measurable improvement in the health of Oregonians through action in our communities and legislature. --ShelleySchoepflinSanders 08:28, 31 July 2008 (PDT)
- I think I like #5 best. Though maybe, "lawmaking bodies" instead of "legislature." Maybe it's a couple of county governments that need to change, or a City ordinance... Thanks both for your ideas, I like the way this is going. -Pete 01:02, 1 August 2008 (PDT)
Website Front Page Material (?)
- Our vision is a collaborative platform which involves a diverse population of Oregon residents where individuals can explain their personal viewpoint (perspective/ experience/ desires) on health related topics in Oregon. This platform provides a forum for contribution, exchange and synthesis for action to positively affect the health of Oregonians through several means. These means may include and not be limited to passing new legislation, policy changes with healthcare providers, additional public initiatives promoting healthy choices and activities for residents.
- The purpose of the collaboration is to summarize the values of participants on health topics and reach consensus through the process of defining the desired action. The consensus provides leverage for change that is measurable in improving the health of Oregonians.
I think this could become the front page of our website. Brandon has significantly edited the vision section above and I don't want this chunk to be lost. --ShelleySchoepflinSanders 12:12, 3 August 2008 (PDT)
September 3 Wiki Wednesday
In conjunction with the Portland Wiki Wednesday crowd, we're hosting a gala to get out the word about the Oregon Health Consensus.
- Angela Beane ... varied, art and most in business, mba right now, common thread of volunteering ... interested in the money and organizational aspects of health care ... also interested in technology too ... generalist point of view ... learning and advocacy
- Mark Dilley
- Pete Forsyth (contact): background in advocacy, public policy, collaborative Internet technology. Interactive web has allows large groups to collaborate more effectively; Pete wants to bring that power to more traditional advocacy organizations, government, etc. See The Open Lobby for notes for a similar, but more general, project Pete has been developing.
- Amy Sample Ward ... non-profit tech, technology non-profits can adopt to do their work more effectively, especially using social media
- Brandon Sanders . . . computer scientist and collaboration enthusiast. I like to work with people to help them create things, especially things they didn't think they could create.
- Shelley Sanders ... brand new internist ... work 3 days a week ... having baby ... spend time not working in hospital working on a project that would make a difference for large group of people
- Gerald Schoepflin ... rheumatology ... take care of patients one at a time ... served on state committees that do evidence-based recommendations ... thought about expanding reach of influence
- Shirley Schoepflin--BS in Nursing, have worked in Rheumatology practice over 20 yrs. Now work actively getting prior authorization for treatment of Rheumatic disease...submit claims to ins. for payment. I've worked with children at church for over 30 yrs. I would like to see children as part of the goal for this group.
- Matt Webber
- Bob Gluckman of the Oregon American College of Physicians
- Don Hall
- Isaac Holeman of SquarePeg
- Chuck Kilo of the Better Health Initiative
- Carl Parker
- Harold Burden and the Coronary Health Improvement Project
- Louise Hoy at Providence
Ways to Contribute to Consensus
Health matters to all of us. Many of us want to contribute. Defined tasks will help us contribute effectively, whether we have 5 minutes or 5 hours to give.
- Share ... my story/values/needs, our story/values/needs, responding to questions, comments, and the document as it evolves
- Listen ... hear the sharings of others
- Coach ... help others improve their sharing/listening
- Research ... collecting references to comments, papers, studies about a particular question or topic
- Synthesize ... distill ideas
- Edit ... craft the presentation of ideas
- Coach ... help others improve their researching/synthesizing/editing
- Specify Tasks ... identify coaching opportunities and questions to share, research, and synthesize against
- Prioritize Tasks
- Coach ...
- Viral outreach ... participants share with family, friends, colleagues, and customers
- Media outreach ...
- Coach ...
7/8/08 Shelley's conversation with Matt Webber
last legislative session, AM tried to put legislation through. Senate Bill 27.
certain entities weren't jazzed b/c we were talking about using Medicare dollars. bold plan that state leaders were not ready to take on.
Large public is not ready to have the conversation about health care in the way we want to have it.
We want to ask people "What do you want out of the health system" but they're not ready. Ask people what they want a benefit to look like and they cannot tell you.
We realized instead of starting with legislation we should start with conversations to create a groudswell of interest. AM will intersect again with the political process but we need to educated army and organized grassroots movement ready for that time.
So now we're trying to create a citizen committee to expose the flaws in the current system to create a ground swell of interest so that state or federal change actually will happen.
When Gov'r Kitzhaber created the Oregon Health Plan (OHP), they broke federal law. It could work to do that again if we had a groundswell or "tension" where the people are kind of "demanding" change. Key is to create tension between state and federal gov.
Ross Perot, Bill Clinton, George Bush Sr. all were asked to comment, which shows that local Oregon events can affect national policies.
Main goal right now is to educate the public. We've had one speaker's bureau training.
Next session we may or may not do a piece of legislation, b/c the presidential election will take a lot of energy/attention.
We do have principles and values -- they are in Senate Bill 329 (2007) - the Healthy Oregon Act. "our language" and "their bill."
The Oregon Health Fund Board (appointed by the state) has just finished 13 community town halls around the state to develop 329 process. AM members are on these committees.
Matt's suggestion: Type a summary of this idea and let Matt present it to Julie, Rick, Liz (director), and Gov'r.
There's an amendment to the Oregon Constitution to guarantee "healthchare" (not "health") for Oregonians.
Names for the Website
July 9 Meeting
Present: Amy, Pete, Jerry, Angela, Brandon, Shelley
The purpose of this meeting is to create version 0.1 of the following:
- vision ... improve health for oregonians?
- desired outcome ... a fully representative Oregon consensus that comprehensively addresses the health of Oregonians ... an accessible document that reflects the consensus of all Oregonians about their health? or a conversation about health? a fully representative conversation? fewer diabetics in 2020? more informed patients visiting the doctor? more preventative interventions, fewer acute healthcare visits? less helplessness? healthier according to standard measures (life expectancy)? spending less money on healthcare? spending healthcare dollars earlier in life? 1) educating ourselves 2) educating public/advocacy 3) generating legislation
- strategy ... create a website where interested citizen can productively contribute to the consensus whether they have 5 minutes or 5 hours a week
- next steps
- Consensus on
- RDI ... Rural Development Initiative
- AARP ... American Association of Retired Persons
- Lower income ... equity atlas ... measures indices of equity ... coalition for a livable future ... health disparities
- Outside I-5 cooridor
- Mechanism for participation needs to broader than the web
July 23 Meeting
Present: Amy, Angela, Jerry, Shirley, Brandon, Shelley
Here are undigested notes. If someone has the energy to edit/consolidate that would be great!
Explicitly say ... really accessible ... even having a computer in the waiting room ... so that even people who haven't already found it can participate. Experience with own insurance where they are trying to offer nurse help. Big mailing ... you can call in and use our nurses. Have all this information available to you. How we are going to get people to feel the need for this consensus.
Feels low if number of people is 100, high if 100,000 ... dependent upon what the community builds into that document. If it turns into something involved and deep could be harder to reach 90%.
What is in the document depends upon the population. Gamut from low to high income. Talk about going to a clinic ... etc to a much smaller niche issue. Difficulty with the number. Who is going to react to what. Maybe they have a hierarchy of their health concerns.
The consensus ... Document
Thinking out loud had a piece on juries ... 100% or 10 out of 12 ... the lower the percentage the more bullying that goes on.
Learning process too ... set a goal like that ... we may have
Concern about overlapping ... duplicate efforts of other people ... why go down the same path ... technology piece is the common ground ... they haven't incorporated to ...
If we individually ... Pete and some other people ...
Why are we involved personally ... what do we hope to get out of it ... how can we contribute ... how do I fit ... how can my own generalist point of view fit
- Everyone currently involved tells their story about why they are involved, how they can contribute, what they are looking for
Shirley brings up children and homeless. Talking about giving people opportunity to get online and give them a voice. How can we make this available to a homeless person.
Amy ... planning the group does implied by website every citizen can ... setting up a computer in clinic so that someone who doesn't have it can participate ... outreach to shelters where you can take a shower look for jobs etc ... brainstorm allies ... network of clinics (planned parenthood, etc, check out and tell your story) another idea ... what if we could get insurance carriers to send our card
Next steps ... add to bulleted list partners and brainstorm ideas ... groups to reach, children, teenagers, homeless
Include a way to comfort the blow ... this is about labeling things gluten free ... I thought this was important to me ... build a buffer so that you can find a topic that is important to you ... landing pad ... what to do next
Jerry ... A person can add a section or idea along the way ... but that might be outside the scope of the current stage ... but that is okay
Topic for the day ... the host will cut a caller off ... we have to take a break now
- Brainstorm with Amy, Pete, Angela, and Brandon at Shelley's house -- Wed July 9 at 7:30 pm. Dessert provided -- yum yum!
- Shelley coffee with Matt Th, July 10, 11:30 am Chance of Rain
- Create one page vision statement for Matt to share with Archimedes Movement
- Get Pivotal Tracker going and invite Amy, Pete, Angela, Gerald, and Shirley
- Send note to Wiki folk about upcoming Aug Wiki Wed session
QUESTION: Can this be incorporated into the table, above, to simplify this page? -Pete 11:27, 30 July 2008 (PDT)