PILOT ARTHRITI-S PROGRAM Distribution of Continuation & New Funds Requested 1975 Incr. 1975 Base: in 1974 Project Region 1:9 7 5 -@;. 19 7 4 Pr2jects Add-on Alabama 148,529 - Albany 0 - Arizona 214,155 - Arkansas 100,000 + 25,261 - California 289,146 - Central New York 40,000 - Colorado-Wyoming 174,290 4 24,604 - Georgia 173,377 - - Greater Delaware Valley 247,500 - - Hax,7aii 216,000 + 3,383 - Intermountain 84,123 - - Iowa 0 - - Kansas 226,400 - - Metropolitan Washington 94,920 - - Michigan 194,700 @@il-04 + 30, ovu .49 224 Mississippi 58,000 Mountain States - 4 14,090 New Mekico 101,11.0 - North Carolina 211,500 + c), OL,)-) - North Dakota 111,000 9,000 - Ohio Valley 35,225 - - Oklahoma 867, - Puerto Rico 92,160 4- -Slovo .-4&i 4-74:- - Susquehanna Valley - 139,500 Tennessee Mid-South I/ (107,484) (124 838) I/ Texas 105,200 L+ "3,() 0,2 Tri-State 145,260 Virginia 40,000 Washington/Alaska 2/ 35,622) @42,995 2/ Western Pennsylvania 133,330 - Wisconsin 62,000 +.,2@, Lu-P Totals: 3,338,792 507,357 931,953 Cumulative Totals: 3 338,792 3,846,149 4,778,102 1/ Funds for Tennessee Mid-South 1974 arthritis program were made available from non-earmarked funds available to the Grant request for 1975 treated as new. 2/ Washington/Alaska: Same.circumstances as T-ennessee Mi.d-South. CIrl PILOT ARTHRITIS PROGRAM Alabama Region Location Year ect Period Funds 1974 .95 7/74-9/75 228,400 10/75-6/76 148,529 1975 65,617) 1/ I/(1975 1/76-6/76 J/ Reqt;est of $65,617 was included in regular May application, and is al ces of Pde funds which @ determined to apply to made up of b an dropped if the supplemental re- this program. This request will be quest of $148,529 is approved. to develop The continuation request covers 9 monthts Continued efforts ell as arth- arthritis clinics at Huntsville, Mobile, and Tuscaloosa, as w ritis laboratory services expanded as a central service at the University, of Alabama in Birmingham. Inclusion of arthritis information of the MIST telephone system is projected. Emphasis will be placed on increased use of laboratory services, and increased practicing phsycian and allied health personnel in monthly clinics. UAB has assisted the establishment of the University of Southern Alabamals (Mobile) teaching curriculum, and is con- tinuing to provide teaching services there until the rheumatology'facili- ties are developed. PILOT ARTIIRITIS PROGRAM Albany Region: Location Year Project Period Funds 1974 51 7/74-6/75 130,940 1975 0 Albany Medical College has developed a multidisciplinary arthritis clinic in conjunction with arthritis laboratory services. From this base, out- reach clinics 'were established at Glen Falls in October 1974, and Oneonta, in JanuAry 1975. The program has achieved sustaining support through participating hospitals, and third party payments. PILOT ARTIIRITIS PROGRAM Ari2ona Region: Location Year Project Period Funds 1974 30 7/74-6/75 215,000 1975 7/75-6/76 214,155 The continuation proposal projects continu-ed development and demonstration activities in the 6 southern counties centered on Tucson. Expansion of services to selected counties to the North is planned. In the first year, 17 communities were selected as the sites of developmental activities; 28 consultation clinics were conducted in rural communities, and 21 home modifications were completed. Physical therapy services were provided regularly at 6 rural sites, and additionally in homes to groups and indi- viduals. A weekly clinic has been presented at a local hospital, and 13 physicians'.have received arthritis training. In the coming year, emphasis will be placed on continued rural outreach, and development of information services to Indian, and Spanish speaking populations. Additional home modifications are planned for demonstration purposes, and some vehicular modifications. PILOT ARTIIRITIS PROGRAM Region: Arkansas Location Year Project Period Funds 1974 95 .7/74-6/75 100,000 1975 7/75-6176 125,261 Ten (10) physical therapy clinics are being established, and 2 rounds of 3 planned rheumatology consulting clinics have been conducted for 164 physicians, and 147 health professionals. A statewide patient education program has been mounted, as well as WATS telephone services to physicians, and public education Diagnostic and therapeutic criteria for arthritis diseases are being presented in clinics. Continuation activities will provide development of education and consultation for juvenile rheumatoid arthritis. Home care physical therapy services will be expanded through workshops for therapists and others in outlying areas. Arthritis consult- ation clinics will be expanded by 50 percent, and increased activities will be developed with respect to patient education through County volun- teer action committees, and public seminars. PILOT ARTHRITIS PROGRAM Region: California Location Year Project Period Funds 1974 all 7/74-8//5 397,250 1975 9/75-6/76 289,146 U.C. Davis 1974 154L; 9/7 4-8/7@ 52,751 19/5 7/75-6/76 43,UOO ii.C. San Francisco 1974 154D 9/74-8/75 122,078 1975 9/75-6/76 70,OUO St. Mary's Hospital, S.F. 1974 154E 9/74-8/75 40,586 1975 9/7:)-6/76 33,821 UCLA 19/4 154I 8/74-7/75 45,u49 1975 8//5-6/7b 47,805 Orange County Med. Center 1974 154J 8/74-8/7@ 39,225 1915 9/75-6//6 35,956 Loma'Linda University 1974 j-54K 9/74-6/75 25,,456 1 7 9/75-6/76 21,2j-3 U.C., San Diego 1974 154M 9/74-8//5 4.5,783 1975 9/75-6/76 38,000 'The CC@IP arthritis program is provided policy and priority direction t)y a 17 member State Arthrit:Ls Council. Project 154C serves a juvenile.ciientele by establisning a referral system for JRA's in northern'California. 700 physicians have been contacted about the service, and 40 physicians are pre- sently referring children to twice-monthly clinics. In 1-975, emphasis will be on increased outreach to family physicians, professional training, and inventory of the JRA patient load in northern California. Project 154D ii3 developing arthritis diagnosis and treatment teams in the San Francisco area. A multidisciplinary staff has instituted training and clinics in 9 hospitals. A wide variety of clinics, rounds, lectures, and conferences have been employed to catch the interest of personnel, and obtain .involvement. In 1975, teaching services will be taken to-6 additional fios- pital staffs, and standardized diagnostic tests will be established. The teaching program will be evaluated with uniform audit criteria in 4 hospitals. Project 154E utilizes two teams to (a) provide multidisciplinary evaluation land diagnosis for clinic and private arthritis patients, and (b) an allied health professions team to develop n@rsing and patient assessment, and ult.i- mately to produce teaching outlines. Of 26 patients reviewed by the lst team, 18 were accompanied by private physicians. In 1975 clinics and con- Page 2 - California ferencos will be schedull.ed weekly, and increased patient followup will be performed. Arthritis treatment resources will be inventoried, and patient evaluation criteria will be tested. Project 154I is cooperating with a-Los Angeles County Department of Health survey of means to establish decentralized health clinics. Data has been collected on 90% of the area's known arthritis patients, and is now being analyzed. A high missed-appoint-nient rate has been identified. In 1975, data collection will be continued and indicators refined, and a bilingual clinic will be demonstrated in an established neighborhood health unit. Project 154J is developing outpatient and home services by increased utili- zation of professional allied health personnel-. The objectives are to identify the needs for arthritis outpatient services, reduce physician patient overloads, and improve services for patients unable to come to clinics. The need for home services has been identified as less than had been anticipated. Services have increased by 40 additional patients monthly, and 180 additional treatments. In 1975, the demonstration will be continued, and public education and support resources will be developed. Patient eval- uation criteria will be tested. Project 154K emphasizes training and service outreach from Loma Linda Uni- versity hospital. Professional and public education services are provided by a multidisciplinary team which conducts clinics, conferences, and seminars. In 1975, in-house physician conferences for practicing physicians will be conducted weekly, as well as monthly allied health seminars. Project 154M has resulted in the establishment of comprehensive arthritis services at University Hospital, in San Diego. Allied health personnel have been added to &xisting research, training, and-surgical services. A rehabi- litation grant has added significant rehabilitation capacity, and an active return-to-work program is developing with enthusiastic employer support. A strong patient counseling and outreach program is operational. A cost analysis system has been instituted to provide cost breakout for billing and reimbursement purposes. The scope of coordinated services permits assess- ment of care screening, care input quantification, and definition of allied health roles in comprehensive care delivery. In 1975, training, treatment, counseling, and rehabilitation services will be continued, with emphasis on patient evaluation, and development of allied health cost effectiveness data (re. reimbursements. PILOT ARTIIRITIS PROGRAM Region,. Central New York Location Year Project Period Funds 1974 .61 9/74-8/75 70,200 1975 .12/75-6/76 .40,000 The Department of Rehabilitation Medicine,.Upstate Medical'Center in Syracuse, is.the center for arthritis activities comprising 4 clinics each week at LZIC, and provision of consulting team assistance.for clinics at Utica, Binghampton, and Ithaca. The.latter two clinics have focussed on professional education, while at Utica, emphasis-has been on patient diagnosis and evaluation. In 1975, increased numbers of trained personnel, and additional clinics at St. Camillus, and Watertown, will increase the number of patients seen by 30%, and the number of practicing physicians assisted in dealing with arthritis. PILOT ARTHRITIS PROGRAM Colorado-Wyoming Region: Location Year Project Period Funds 1974 @all 7/74-6/75 174,290 1975 7/75-6/76 198,894 General Rose Hospital 1974 51 same 1975 23,418 Roc@,y Mntn. Chapter, 1974 52 same -Arthritis Fnd. 1975 77,160 Denver General Hospit al 1974 53 same 1975 20@518 Community clinics 1.974 54 same 1975 34,000 Univ. of Colorado 1974 58 same Medical Center 1975 43,79 Project 52 is the management office of the C/W RMP.pilOt arthritis program$ and operates with an advisory co@ittee of 9 members appointed from the ocky-Mountain Arthritis Foundation. The office organ- membership of the R iz6s the services of health professionals to staff regional clinics, and coordinates outreach clinics with co-sponsor3.ng, or cooperating State and County agencies, and professional organizations. General Rose Memorial Hospital (51) has-22 arthritis beds, and services a teaching center in a new facility constructed as a model unit for arthritis care and rehabili- tation. Denver General Hospital (53) has 5arthritis beds, and provides professional resources,for multidisciplinary consulting and teaching clinics. University of Colorado Medical Center, and Denver General Hospi- tal jointly operate an arthritis "walk-in" clinic, and have conducted 9 workshops and clinics in Colorado and Wyoming eomniunities, attended by 363 physicians-, and 379 nurses and other allied health personnel.- Regional clinics (54) were established in Colorado at Sterling, Pueblo, Grand .Junction, and Durango, and in Wyoming at Sheridan, Thermopolis, Casper and Laraniie. These centers serve regional population groups and provide a-base for consulting outreach clinics. In 1975, the program will continue development of the multistructure arth- ritis center for continued teaching and developinent.of :Cmproved arthritis diagnostic, treatment, and rehabilitation methods. PILOT ARTHRFTIS PROGRAM Georgia Region: Location Year Project Period Funds 1974 76A 8/74-6/75 200,000 1975 7/75-6/76 173,377 The GRMP program is organized under the regional "umbrella" plan with'2 regional, and 2 area focal facilities. The Medical College of Georgia is a regional center, cooperating with an area facility at Memorial Medical Center, Savannah. MCG is presenting 4 clinics weekly, and parti- cipates monthly in clinics at Savannah. Emory University School of Medi- cine is a regional center cooperating with the Arthritis Area Facility at the Columbus Medical Center. EUSM holds 2 arthritis clinics weekly, and provides multidisciplinary consulting services to AAF staff. AAF staff are receiving specialized training at Grady Memorial Hospital. 1975 funding is requested to continue program development, including necessary specialized recruitment, and extension of services to community levels. PILOT ARTHRITIS PROGRAM Region: Greater Delaware Valley Location Year Project Period Funds 1974 all 7/74-6/75 247,500 1975 .7/75-6/76 247,500 Jefferson Med. College 1974 60. 7/'74-6/75 4,000 1975 7/75-6/76 4,000 Arthritis Foundation of 1974 .60A same 18,000 East Pennsylvania 1975 18,000 Habneman Medical Center 1974 61 same 64,326 1975 64,326 Temple University 1974 62 same 72,956 1975 72,956 Medical College'of Penn. 1974 63 same 17,000 1975 17,000 Einstein Medical Center 1974 64 same 38t2l9 1975 38,219 Children's Seashore Hous6' 1974 65 same 32,999 1975 32,999 GDV-P,IIP's arthritis program has operated under a regional Arthritis Control Council to establish a cooperative effort to link 5 Philadelphia medica schools with non-profit hospitals, and the Arthriti& Foundation. rojects 60, and 60A, are program-wide activities directed to (a) development of a physician self-assessment examination form, and (b) public and patient/fam-7 ily education, and referral assistance. Project 61: patient workshops and forums are closely related to Arthritis Demonstration Clinics (AI)C) spon- sored by Hahneman Medical Center. Patients and their families meet n groups with physicians and allied health personnel to explore the-nature and impact of their disease. Project 62: Temple University School of ,Ifedicine sponsors ArC's (7 to date) in, and outside of Philadelphia (e.g., Allentown, Scranton, Camden, East Stroudsburg, Wilkes-Barre, @fillville) on .a weekly basis. ADC's provide access to multidiciplinary diagnosis and con- sultation, and preceptorshi.p/group training of physicians and allied health personnel. Project 63: Medical College of. Pennsylvania specifically provides professional training in conjunction with ADC'S. An hotir's lecture i5 Page 2 - Greater Delaware Valley. arranged at each ADC, plus special lectures and seminars, regionally. Specific coordination has been achieved with respect to allied health team training, and pediatric services. Project 64: Albert Einstein Medical Center has focussed on adding arthritis capability to existing allied health resources. Training has been offered through seminars and symposia, and in conjunction with ADC'S. Various hospitals, State and County agencies, pro- fessional organizations and the Arthritis Foundation are providing community support to the program. Project 65: Children's Seashore House has emphar sized cooperative and collaborative approaches to pediatric arthritis - problems among Philadelphia hospitals. Pediatric consultation is provided other GDV/RMP arthritis components, as well as participation in the ADC'S. Regular pediatric clinics are held twice monthly. In 1975, program continuation financing will be sought, along with improve- ment in program development throughout the 24 County Region. PILOT ARTHRITIS PROGRAM Hawaii Region, Location Year Project Period Funds 1974 69 9/74-8/75' 216,000 1975 7/75-6/76, 219,383. The HRMP arthritis program is based on a Center (Kuakini H6 spital), with support from the University of Hawaii School of Ifedicine, and the Hawai Arthritis Foundation. Three (3) objectives are: develop a center with a multidisciplinary approach to diagnosis, and treatment; extension of ser- vices in Honolulu, and to outlying is lands in the Pacific Basin; and, pro- fessional training. These objectives were achieved. 115 patients have completed mustidisciplinary diagnosis and evaluation at the Center. Gen- eral and specialty clinics have been conducted, and conferences, clinics, and teaching consultations have been presented at Ponape, Saipan, Guam, Palau, and Yap. In 1975 emphasis will be placed on further education of hea lth professionals in arthritis, assessment of service needs, increased utilization of allied health personnel, and increased consulting services and backup to Pacific Basin areas. PILOT ARTIIRITIS PROGIWI 'Iowa Region: Location Year Project Period Funds 1974 63 9/74-6/75 87,550 1975 0 University of Iowa College of Medicine expanded.multidisciplinary profes- sional education, and-therapy, and supported the establishment.of arthri- tis clinics in Des Moines, and Muscatine. The program is self-supporting through financing by participating hos itals, and third party payments. p PILOT ARTHRITIS PROGRAM Region: Intermountain Location Year Project Period Funds 1974 123 7/74-6/75- 169,500 1975 7/75-6/76 84,123 The Intermountain Arthritis Center has been established as a non-treatment center to coordinate and develop the program.. The center has applied for a Provider number, and'has instituted cost reporting procedures required by Medicare/Me dicaid. With only 2 practicing rheumatologists in the 3-State area served, considerable education and use of family physicians and allied health personnel is needed. Clinics were scheduled and conducted with family physicians and their patients in (Idaho) Boise and Pocotello, (Nevada) Las Vegas and Reno, and (Utah) Ogden.and St. George. Clinics in 2 additional communities are schedulled. In 1975, community clinics will be continued, and diagnostic and treatmen standards will be developed for practicing physicians. Pati'entlfamily education will be developed, and increased support including service reim- bursements will be sought. PILOT ARTHRITIS PROGRAM Region, Kansas Location Year Pro_iect Period Funds 1974' 88 7/74-6/75 .242,400 1975 7/75-6/76 226,400 KRMP, Kansas Arthrit:ks Chapter, KU School of Medicine, and the K.C. Vet- eran s Administration Hospital collaborated to establish Information and Education Unites (IEU's) at Kansas City, Topeka, Salina, and Wichita, to improve arthritis patient information, education, diagnosis, and treatment. The units are sponsored and staffed by local hospitals (physicians and allied health personnel). Physicians were recruited to make patient referrals to the Unites. Program sponsors provided Unit siting, and start- up assistance. Multidisciplinary consultation and folloiiup services ar&-.provided-each Unit twice monthly. The IEU's individually present demonstrations for the other IEU'S, and local health professionals ' Spe- cial training support-is provided by KUMC, which with the Arthritis Chapter, provides a standard patient record to accumulate a data base. The ItU's are responsible for training, and for .lending assistance to community physicians in arthritis patient assessment, diagnosis, and -treatment. In 1975, efforts will be made to expand IEU capacities through partici- pation of increased numbers of physicians, nurses, and therapists. PILOT ARTHRITIS PROGRAM Region: Metropolitan Washing@on Location Year Project Period Funds 1974 @all 7/74-8/75 176,900 1975 9/75-6/76 94,920 Freedman's Hospital 1974 58. 10/74-8/75 95,400 1975 0 Washington Hosp. Center 1974 59 10/74-8/75 81,500 1975 9/75-6/76 94,920 Washington Hospital Center (WHC) and Shaw Community Health Center, where 12% of all clinic visits are arthritis-related, have collaborated to pro- vide improved arthritis care to inner city residents. An Arthritis Tech- nical Review and Advisory Committee comprised on consumer and provider members assists the projects IQHC provides a 'multidisciplinary team, diag- nosis and treatment, and other services at its own, and the Shaw center. Freedman's Hospital has focussed on professional and patient/family edu- cation, including home services. The program has been delayed by inability to recruit, and the move to new quarters. in 1975, both institutions will expand treatment capabilities, and inten- sify referral and education activities. PILOT ARTHRITIS PROGRAM Region: Michigan Location Yeeir Project Period Funds 1974 125 9/74-9/75' 194,700 1975 q/75-9/76' 448,028 Geriatric Program 1974 125 Same 194,700 1975 same 398,804 Evaluation (Univ. Mich) 1974 (MRMP Eval. Funds) (25,000) 1975 149 9/75-8/76 49,224 The MRMP pilot arthritis program is primarily.a study project to define effective treatment which will delay, prevent, or.reduce hospitalization of geriatric patients (+55). The program has 3 components: health services delivery; patient education; and,, family,.provider and program evaluation. Representatives from 4 UM departments provide an Advisory Board; there is an 18 member (consumers and providers) Community Advisory Board (CAB), and and Executive Committee of senior project staff, whose policies are re- viewed by CAB. The demonstration is centered on Washtenaw County and the County Health Department, Arthritis Foundation, and the Council on Aging are cooperating. Multidisciplinary staff resources assure a com- prehensive.approach to patient problems and needs, and a detection program and intensive followup activities have been conducted. There are 214 patients enrolled in the program. Public, patient, and professional edu- cation activities have been intensively developed, including special visual aid, and other materials. In 1975, utilizing experience and data accumulated in,-.1974, it is planned to develop a referral clinic, intensify demonstration of the roles of clinical and public health nurses, and to define criteria for geriatric arthritis care, emphasizing home care. Increased attention will be pro- vided to professional education needs outside of Washtenaw Count@, and replication of the existing system will be pursued. The program evaluation project was initiated in 1974,with DPM concurrence, .with @ evaluation funds. The study is a special project of the Michigan University School of Public Health, and $25,000 was provided by MRMP through a contract. The project was not eligible for direct grant support under 1974 program guidelines. It may, however, provide useful geriatric ata for use under the provisions of the National Arthritis Act of 1974 (P.L. 93-640) in view of the NIH Commission on Arthritis curr@t seeking of. arthritis disease and patient information. PILOT ARTIIRITIS PROGRAM Region: Mississippi Location Year Pro _Ject Period Funds 40 9/74-6/75 58,000 1974 1975 7/75-6/76 58,000 The Mississippi pilot arthritis program was initiated by, and in conjunc- tion with the newly-completed Mississippi.Metbodist Rehabilitation Center in Jackson. Two (2) outlying satellite clinics have been established at Belzoni (north), and Centerville (south). These clinics are staffed with paid specialists who conduct screening, referrals, and physician consulta- tions. A fire at the new Jackson Hospital has delayed development of referral and consultation services from the center resource. In 1975, the PM proposes to develop the program as initially planned. The outlying clinics will provide out-State resources for patient assess- ments, and referrals, and centers for communication with community health workers. (Note: MRMP project #Cl76 includes arthritis providing further operational latitude for the pilot program.) PILOT ARTIIRITIS PROGRAM Region: Mountain States Location Year Project Period Funds Idaho 1974 0 1975 32 7/75 6/76 6,180 Montana 1974 0 1975 32 7/75 6/76 7,910 14,090 Mountain States RMP arthritis program represents part icipation in allied health training provided at the Virginia Mason Medical Center, Seattle, through the Wa,-,hington/Alaska arthritis program. That training center wag financed by non-earmarked funds, and thus required that Idaho and Montana reimburse training provided their allied health personnel (physical, and orthopedic therapy). -During 1974, these two States each sent 6 therapists for training, The 1975 request is for support of specialized training for 12 therapists from Idaho, and 20 from Montana. This activity wil contribute to regionalization of the Waghington/Alaska artliirtis program, .and provide urgently needed therapists for services in the sponsoring states. PILOT AWRHRITIS PROGRAM New Mexico Region: Location Year Project Period Funds 1974 .37 7/74-6/75 163,600 1975 7/75-6/76 101,110 Outreach clinics have been established at-Taos, Albuquerque, and Las Cruces, for physician and allied health education, patient and public education and patient'referral. The program has wide local participation. 8 physician education, and 8 allied health education seminars, and 1 joint education session have been held. 14 patient education programs have been conducted. A traveling consulting team has received 48 referrals-by prac.. ticing physicians, and these clinics have been attended by 114 physicians, and 32 allied health personnel. 2 family nurse practitioners have received extensive training, and will be key resources for.statewide patient edu- cation services. A trained family nurse practitioner will be a full-time member of the traveling team. Clinical followup training will be provided for 23 family nurse practitioners, physician assistants, and community health medics who have completed initial clinical training in rheumatology. Additional nurses and medics will be entered into the program in 1975. PILOT ARTHRITIS PROGRAM Region: North Carolina Location Year Project Period Funds 1974 all 7/74-6/75 211,500 1975 7/75-6/76 354,806 Orthopedic Hospital & 1974 75A same 30,00@O Rehabilitation Center 1975 69,715 N.C. Arthritis Fndn. 1974 75B same 51,500 1975 52,378 Univ. North Carolina 1974 75C same 90,100 1975 140,000 Bowman-Gray School 1974 75F same 39,900 of Medicine 1975 92,713 The NC Arthritis Foundation provides overall program administration, and supports training and information services. An arthritis seminar for 90 nurses in industrial plants was conducted, and several other professional symposia were presented. The Orthopedic Hospital in Asheville has .1 expand- led to treat 4-times the ntLmber of patients handled before the grant by development of highly routinized administrative procedures, and extensive utilization.of allied health personnel. University of NC rheumatologists are conducting weekly clinics in Greensboro, Raleigh, Pinehurst, and Wilson, and the number of patients seen at UNC medical center has been doubled to 60/week. Bowman-Gray has established 3 outlying clinics, and new outreach clinical services are extended to these sites 22 days-of the month'. In 1975, OHRC plans to again double the output capacity of the patient treatment and followup system. nurses, therpists, and parame ics are being trained to be trainers, and to backup practicing phsycians'(70 now participating) in performing drug toxicity monitoring, patient education, and followup services, particularly to remote patients. Allied health personnel will also staff an outlying station,for evaluation of retinal function for potential toxicity of antimalarial drugs. .UNC, and the NC Arthritis Foundation have cooperatively developed a sce&n- ing, counseling, treatment, and rehabilitation program in the facilities of Burlington Industries. NCAF will continue overall program administra- tion and monitoring. UNC will expand.its clinic.by 50%rthrough standard- ized intake procedures, and increased employment of'allied health staff. Page 2 - North Carolina A travelling team approach will be intensified for the conduct of clinics at AIIEC and orthopedic units at Greensboro, and Raleigh, and two new clinic'units will be developed. Bowman-Gray will continue clinical visits of a travelling team to 3 estab- lished clinics, expand its clinic at Babtist Hospital, and extend new services to Farmington Nurse Practitioner Clinic in Davis County. PILOT ARTIIRITIS PROGRAM North Dakota Region: Location Year Project Period Funds 1974 7/74-6/75- lil,000 1975 7/75'6176 120,000 In 1974, comprehensive arthritis clinics were established at Fargo, as a. central coordination site, and Grand Forks, and Bismark. A patient eval- uation process was developed, in concert with patient followup, and data accumulation. A multidisciplinary tram provides services to Grand Forks, and Bismark, and assures uniform performance of. patient diagnosis, eval- uation, treatment, followup, and data collection and reporting under pub-'. lished ARA procedures. Appropriate referrals are made when other ailments are discovered at the clinics. The program is increasing utilization of allied bealth,personnel. In 1975, it is planned to extend professional consulting services, home services, and professional and patient/family education into more outlying areas. A study will be conducted on patient compliance with prescribed therapy. A "patient contract" enunciating physician, nurse, patient res- ponsibilities will be tested with 100 patients. A biochemical study on load analysis of lower extremities with load will be continued. The pro- gram involves ND medical schools, State Vocational Rehabilitation,"ND arthritis foundation, PH nurses, the USDA Fuman Nutrition Laboratory, and liareall medical and paramedical consultants. PILOT ARTHRITIS PROGRAM Ohio Valley Region, Location Year Project Period Funds 1974 .49 11/74-10/75 46,500 .11/75-6/76 35p225 1975' The arthritis clinic of the Louisville Genpral Hospital, which is the teaching facility forthe University of Louisville School of Medicine, had been able to see and give adequate attention weekly to approximately 25-30 followu patients, and 2 - 3 new patients. A coordinator of patient I p services has been appointed to evalua te each arthritis patient, with professional assistance, and develop a comprehensive management program. The management program will, as appropriate, involve existing community resources such as social service agencies, vocational education and reha- bilitation centers, home care centers, and other appropriate organizations. These services should expedite the disassociation of followup services from clinic premises, permitting a larger intake of new patients. Patients are referred to the program through the arthritis clinics at Louisville General Hospital, St. Josephs Infirmary, and the Louisville VA Hospital. Patient information is being accumulated to assist program assessment, and to aid development of patient education services. in 1975, development of the program will continue, and special eff'orts will be extended to develop service reimbursement sources. PILOT ARTHRITIS PROGRAM Region: Oklahoma Location Year Project Period Funds 1974 .47 7/74-6/75 66,050 1975 7/75-6/76 40,867 Oklahoma University Health Science Center .(OUHSC), and Oklahoma City VA hospital (OCVA) have cooperatively developed an arthritis program for medical education, And are seeking through the RNP grant to establish a pilot arthritis referral, treatment, and training resource, working through the 10-County Regional Health Development Area Program, centered at ABa. Initial efforts have been directed public and patient education, improved patient scheduling for clinic, family physician counseling, and increased utilization of the Physical Therapy,Department at Valley View Hospital, at Ada. A critical need for a second rheuratilogist has not been met, and recruiting efforts ate continuing; this additional pro- fessional is critical for expansion of the referral, therapy, and follow- up syi3tem being developed. The'-1975 request is to cover the salary of the second rheumatologist, whose recruitment has been reported'as imminent. PILOT ARTHRITIS PROGRAM Puerto Rico Region: Location Year Project Period Funds 1974 20 7./ 7 4-'6 / 7 5. 92,160 1975 7/75-6/76 140,634 The considerable rheumatologic resources at the central arthritis clinic at the University of Puerto Rico School of @ledicine serve as the major support and coordinating force for patient diagnosis. and assessment, management procedures, professional education, and extension of services into outlying areas. Initial outreach has been achieved with a regional arthritis clinic at Bayam6n Hospital, serving northeastern Puerto Rico. It is planned to establish 3 additional clinics over time until all regional ar6as are being served. Over 100 professional personnel re- ceived training in arthritis at UPP14S, and in northeastern communities, and the new and followup patient lead is being increased. UPRMS provides central laboratory services. In 1975, the weekly clinic at PR medical center will be continued with multidisciplinary participants, and clinics at Bayam6n will be increased from twice monthly, to weekly. It is anticipated that the new patient load will increase by 60%, and patient followup visits will increase roportionate p ly. PILOT ARTHRITIS PROGRAM Region: Susquehanna Valley Location Year Project Period Funds 1974 42 7/74-6/75 0 1975 42 7/75-6/76 139,500 Susquehanna Valley RMP was approved in 197,4 for pilot arthritis activities up to 139,500, but wqs not allocated earmarked funds. The region was unable to provide arthritis funding from other funds. The 1975 request is a repeat of the 1974 proposal, with the request reduced to last year's approved level. A new clinic will be started up with monthly sesbions at Williamsport Hospital (WH) by contracting for a fellow in rheumatology, and training a nurse for support services. The 1974 request indicated that WH possesses. it an 80 bed rehabilitation unit staffed by 13 physical therapists, 3 board certified physiatrists, and 3 occupational therapists,, and provides psy- chologi6al, audiology, speech pathology, social services and vocational rehabilitation services." WR will provide the nurse resource for patient referral at Lock Haven Hospital, and the Blossbe'rg Family Health Center. The Geisinger Medical Center (GMC) reported in 1974 that in addition to the rheumatologist, it had-2 board certified internists'with special train- ,ing in rheumatology, 6 orthopaedic surgeons, and significant practice in neurology, neurosurgery, pediatric rehabilitation, physical medicine and rehabilitation,, and all appropriate ancillary services." "Current patient load includes an average of 90 patients seen weekly in the Rlieumatology Section of the Medical Center. The earlier application indicated ah,,. intent to employ a clinical nurse in expanded patient care responsibi- lities, but otherwise, "The resources of the Geisinger Medical Center continue to be dedicated to the provision of and access to quality care to the region. In cooperation with the Arthritis Foundation of Central Pennsylvania and the other participating components of this program'. the Medical Center continues to commit its full support and services." Both institutions propose to provide professional education at unnamed outlying sites. The Central Pennsylvania Arthritis Foundation will under- take and extensive program of patient, professional, and allied health education. All training activities of the proposal will be related to ongoing activities of the Northcentral Pennsylvania Area Health Education System. PILOT ARTHRITIS PROO=4 Region: Tehnessee Ilid-South Location Year Project Period Funds 1974 all 9/74-6/75 107,484 1975 7/75-6/76 232,322 East Tenn. Children's 1974 107 9/74-6/75. 34,463 Hospital 1975 7/75-6/76 54,480 Reg'l Arthritis Center 1974 108 same 33,566 Foundation (Appalachianl975 94,900 Vanderbilt Schoolof Medicine 1974 109 same 39,455 1975 82,942 The TMS-RMP pilot arthritis program was one of 2 programs funded with non- earmarked funds. Program approval for up to 138,500 was approved by the Council. Three activities fitted to different local capabilities were initiated. In Knoxville (107) a juvenile arthritis clinic was opene on a twice-weekly basis at the Arthritis Center, East Tennessee Children's Hospital. In Chattanooga (108), the Appalachian Regional Arthriti"s Cen- ter was established as a non-profit organization under tne aegis of the Baroness Erlanger Hospital. In Nashville (109), combined arthritis clinics were established at the VA Hospital (-2 da./i,7k), and Nashville General Hospital (-2 da./i..Tk). A clinic at Vanderbilt University Hospital was de- layed until May, when a 1-2 da./wk. clinic began operations. The Knoxville and Chattanooga clinics began operations in December 1974, ETCH has provided 2 clinics monthly. Significant accumulation..of senior adult patients has developed, and home services ate being provided. In Chat- tanooga, 6 clinics were held in a 4-monty period, with 23 patients seen, and 77 registered for clinical evaluation. An outlying clinic at Cross- ville is planned in August 1975. Third-party reimbursements are-beginning to be collected At Nashville, 85 patients were under care by Marc In 1975, efforts will focus on broadening and extending services, and linking up these, and additional clinics. In Nashville, clinical care, patient education, and social services will be organized with cooperative .activities of the 3 estab lished clinics, the Metropolitan Public Health Department, the Arthritis Foundation, and new Immunology and Arthritis Divisions at Vanderbilt. Patient education, outreach, and social services will be expanded. About 2,000 patients will be seen byr-the combined_. clinics. ARAC will extend services to outlying community chronic di@ease Page 2 - Tennessee Mid-South clinics, and will expand training for physicians, and nurses. A patient load of 2,500 is projected in 1976. In Knoxville, improved and increased followtip services will be developed for both juvenile and adult patients. Biomedical engineering services have been, and will continue to develop patient aids for meeting environmental needs. Out-patient services will include case finding, home care and home modifications, education, and patient referral. It is estimated that in one year, 25 patients will be restored, and patient load will be 100. PILOT ARTIIRITIS PROGRAM Texas Region: Year Project Period Funds Location 1974 113 .7/74-6/75 244,200 1975 7/75-3/76 105,200 The 1974 pilot arthritis program was comprised of 6 component activities for the development of improved and increased patient care services, and extensive professional, and patient/fainily education. The program linked university,centers in Galveston, San Antonia, Lubbock, El Paso, and Dallas with practicing health professionals to improve arthritis care, and increase community involvement. Conferences, clinical consultations, seminars, and public forums were widely presented. Arthritis patient education@.materials are being translated into Spanish. A model minimal care facility, which attracted much interest among technical program reviewers in Rockville, was operated at Galveston. The minimal care program simulates the home environment v7hile patients undergo physical and occupational therapy. The unit also provided an excellent self-contained classroom for therapy, nursing, and social service education. The program is proposed to be supported for'an additional mont s. PILOT ARTHRITIS PROGRAM Tri-State Region: Location Year Project Period Funds all 9/74- 6/75 213,370 1974 1975 7/75-6/76 599,082 Boston City Hospital- 1974 55 11/74-10/75 78,600 1975 11/75-6/76 78,600 Tufts-Nex-7 England 1974 56 9/74-12/75 134,770 Medical Center 1975 1/76-6/76 66,660 Robert Breck Brigham 1974 54 0 Hospital 1975 .7/75-6/76 74,808 Mass. General Hosp. 1974 57 0 1975 7/75-6/76 163,297 0 Medical Care & Educa- 1974 58 tion Foundation, Inc. 1975 7/75-6/76 215,717 In 1974, projects were funded at Boston City Hospital for an urban-based program, and Tufts-Nei-i England Medical Center for an outreach program involving 3 Maine, and 5 Massachusetts community hospitals. At Boston CH, 2 RN nurses have received intensive rheumatological training preparatory to initiation of_outreach (home followup) activities. At Tufts, arthritis clifiic8 have been opened in Maine at Bangor, Presque Island, and Rockland. In Massachusetts,-a clinic is operational at New Bedford, are planned to become operational in May at Everett, and Chelsea, and are under develop- ment for later startup at Springfield, Waltham, Nantucket, and Beverly. Tufts provides a multidisciplinary resource for arthritis diagnosis, and treatment, and provides teams to open up outlying clinics. In 1975, both projects plan to expand outreach activities. Projects NOS. 54, 57, and 58, are resubmittals of applications not approved in 1974. Nos. 54, and 57, are verbatim restatements of the previous application, land No. 58 provides verbatim extracts of.the prior submittal.. Reviewers considered the projects poorly organized, and not well thought out, par- ticularly in view of the extensive arthritis expertise represented by each of the institutions. The Medical Care and Education Foundation, Inc., plans to contract with the New England Rehabilitation Hospital, Inc.,, a for-profit corporat on. PILOT ARTIIRITIS PROGRtill n Virginia Regio Location Year Project Period Funds 1974 46 7/74-6/75 80,000 1975 -7/75-6/76. .40,000 developm@'t: Tidewater, Virginia was divided into four areas for program n Richmond, Central Vinginia, and Northern Virginia. Each area has designa- ted one or two 'physician coordinators of program. The Family Practice Units of the 2 Universities are the sources of special professional arthritis expertise, and the central coordination points for scheduling visiting multidisciplinary teams. It was recently reported that over 20 clinic and physician coll6quia sites will be visited during the first year by arthritis specialists from the university, and area centers; many of the sites visited are quite isolated, but have responded enthusiastical- ly to these training opportunities. Emphasis is on provision of physician specialist and allied health sdrvicesto economically disadvantaged popu- lations. In 1975, outreach training will be continued, and increased patient follow- -up with increasingly trained allied health personnel will be sought. PILOT ARTHRITIS PROCRAM -Alaska Region: Washington Location Year Project Period Funds 1974 89 9/74-6/75 35,622 1975 7/75-6/76 42,995 W/APM's pilot arthritis Activities were funded by non-earmarked funds. A larger program of $75,000 was approved by Council, but Regional planners felt that the approved level was too restrictive to undertake the full program approved. Unfunded was a travelling therapist team modelled after the widely-recognized Canadian program. The funded program is therapist training at the Virginia Mason Medical Center in Seattle, and the Home Care Program operated by the Western Washington Arthritis Foundation. Idaho, and Montana were invited to utilize the tra n ng program on a setvice-reimbursement basis. Trainees enrolled total 55, and 35 have com- pleted the training course. All major arthritis disciplines are presente iri the training program and graduates receive an assessment visit by a Supervisory Therapist several months after course completion. In 1975, it is proposed to provide therapist training "to the remaining untrained physical and occupational therapists in this four state region @desiring this type of instruction." An inventory of arthritis services will be completed, and lay organizations will be solicited to assist with referral and patient transport problems in outlying areas. PILOT ARTHRITIS PROGMM Re ion: Western Pennsylvania 9 Location Year Project Period Funds 1974 45 7/74-6/75. 140,400 1975 7/75-6/76 @133,330 In 1974, an inventory of educational needs, and arthritis'resources was conducted in the Region. Five (5) sites were identified for establish- ment of clinics, and 3.are functioning. The -remaining 2 will be opera- tional in June 1.975. Each of the 5 participating hospitals were requir- ed to commit 8 physicians and allied health personnel to the clinic pro- ject. On the basis of the needs inventory, a training curriculum was de- veloped, and 1/wk training sessions of 6 week's duration was begun for each of the center staffs. Training was presented at both the centers, and ad St. Margaret's Hospital. Training participants include personnel from Red Cross, United Fund, and planning commissions, as well as commu- nity physicians and allied haalth personnel. A program evaluation pro- cess is being developed by training professional program participants in outcome assessment. In 1975 two (2) additional centers will be activitated. Professional and lay education sessions will be continued, and a periodic schedule of multidisciplinary specialist clinic visits will be instituted. " Spe- cialized training will be provided for teams from non-center communities to expand available arthritis resources, and improve patient referral. A model patient education center will be developed to demonstrate and assess patient instruction methods. An individual professional study course will be developed for personnel without access to classroom. training. PILOT ARTHRITIS PROGRAM Region: Wisconsin Location Year Project Period Funds 1974 all .7/74-6/75 62,000 1975 7/75-6/76 111,225 Sacred Heart, & 1974 123 7/74-6/75 55,000 Columbia Hospitals 1975 7/75-6/76 71,@25 Consulting Teams 1974 Colo same 7,000 1975 40,000 provided modest support for.travel costs of prof- Approved 1974 program essional consulting teams from UIMC and affiliated hospitals, and support for a combined patient/family - nursing care study at two hospitals. The study is operated under a Statewide nurse-advisory group, and seek improved nursing practice through Development of arthritis nursing criteria, and concommitant development of patient education materials. A nominal group process is employed in writing nursing criteria by the participating nurse 'staffs. Projected criteria are tested against outcomes of actual practice with 2 identified patient groups, and modified as experience ,dictates. Increased capability to quantify patient responses to nursing care has been reported, as well as much more nurse sensitivity.to patient needs. In 1975 the nursing studies will be continued, and proven patient educa- tional materials will be developed. Workshops will be organized and pre- sented to professional staff, and increased emphasis will be placed on out-patient care. In connection with the travelling consulting teams, improved referral, and institutional intercommunication will be sought.