DIVISION OF REGIONAL MEDICAL PROGRAMS PILOT ARTHRITIS PROGRAM Summary Reports Of Projec@ Regional Medical Program @e Alabama 1 Albany 3 Arizona 5 Arkansas 12 v'Calif ornia 14 Central New York @(Syracuse) 23 Colorado-Wyoming (Denver) 25 Greater Delaware Valley (Philadelphia) 29 Georgia 34 Hawaii 38 @,ntemountain (Salt@Lak6 City) 39 Iowa 41 Kansas 43 Metropolitan Washington 46 Mic@higan 48 --Mississippi (To be included later) Mexico 51 v'North darolina 53 @orth Dakota 57 Ohio Valley 60 @klahoma 62 Puerto Rico 65 Tennessee Mid-South 69 @exas 72 Tri-State (Boston) 80 Virginia 82 ashington/Alaska (To be included later) v4estetn Pennsylvania (Pittsburgh) 83 Wisconsin 85 a@Mp 'ALABAMA REGIONAL MEDICAL PROGRAM Alabarita Rfptonal Medtcaf Ptof,,r3m ARTHRITIS PILOT PROJECT #95 P.O. Box 3256 A Model Center to Clinic Service 1108 South 20111 SI: Summary Bitmiiigh3ir., AlahAttia 352M 3 @05) 9 4.5394 a) Objective of the Program Increase access to and availability of high quality care in rheumatic. diseases in the major population areas in Alabama. b) Nature and Locale of the Activities' The establishment of clinics in Tuscaloosa, Mobile and Huntsville health,care'and educational facilities; i curriculum development aid for University of South Alabama College of Medicine. c) Name and Address of. Project Director Gene,V. Ball, M.D. Professor of Medicine Division of Clinical .Liiuiiuiiu.Lugy ancL @neumar-o-Logy University of Alabama Medical School in Birmingham d) methodology of Studies Model clinics will emphasize improvement of patient access to specialty care in rheumatology. Patient care conferences will stress the various ramifications of diagnoses and treatments and serve as the educational vehicle. The laboratory in Birmingham will function as the central service laboratory. Tests to be -developed include ENA, anti-mitoclion- drial antibody,.immune complex precipitation tests, im'munoassay of IgEi B, and T lymphocyte procedures, Serum DNA,,ahd immunofluorescent immunoglobulin and complement complexes in tissues and C4 by honiolytic-assay. Nurseso internists, physical therapists and occupational therapists will be integrated into these modcl,clinics and they will serve as the education specialists in the training of others. The education of public health nurses through whom case finding will be @'acilitated'will be emphasized. Recognition of all treatable musculo-skeletal syndromes ranging from hyperthyr6idism to_polymyalqia rheiiiiiatica will be stressed. The model clinic program will be an outreach effort to extend ,the expert services of rheumatologists, orthopedic surgeons, occupational therapists to family practice physicians, public health nurses and existing facilities in -clinics in three major population areas of the state. An Arthritis Advisory Committee will serve as external advisors, monitors and evaluators. c) Source of Training and Educational Curricula The expertise of the University of Alabama in Birmingham will be employed in developing training and educational curricula for the three clinic areas. In addition to the physicians who are specialists in rheumatology, there will be occupational therapists physical therapists and nurses involved in developing the programs and curricula. 'The expertise of the Spain Rehabilitation Center Rheumatology Service and their facilities will be utilized. f) Ifivolv'ement-of Community Resources in Groups The University of Alabama in Huntsville School of Primary Medi- cal care, the University of Alabama at Tuscaloosa College of Community Health Sciences and the Department of Medicine of.the University of South Alabama and facilities of those institutions and the UAB Rhouitatology Laboratory will be participants in this project. There will be Cooperation with the Veterans Administration Hospitals in Birmingham, Montgomery and Tuscaloosa as well as the utilization of UAB's Spain Rehabilitation Center Rheumatology Services. The University of Alabama in Birmingham Medical Information Service via Telephone (IIIST) will assist in disseminating new and pertinent information. 2 Albany Itegional Jft@dietri ALBANY MEDICAL COLLEGE/ALBANY, NEW YORK 12203 *'(518) 44S-5313 NORTHEASTERN NEW YORK REGIONAL ARTHRITIS PROGRAM The major objectives of the Northeastern New York Regional Arthritis Program are as follows: To establish two sub-regional Arthritis Diagnostic and Treatment Centers in regional areas where there is an established need for such A center, with interest shown by the local practicing physicians. The two sites chosen were Glens Falls, (Warren County) New York and oneontai (Otsego County) New York. II. To strengthen the existing Albany Medical.Center Arthritis Clinic by the addition of professional personnel to form a multi-disci- plinary teaching program to be made available to physicians in the, 21 county region, especially the two satellite centers. III. To establish a diagnostic Rheumatology Laboratory available not only to the Albany Medical Center,, but to,the Outreach Arthritis Diagnostic and Treatment Centers. At the outset of this DroRiam. Lee E. B;;rtholompt-7. li 1) . Projo-tt DirettoT, Protessor of Medicine and Head of the Medical Specialty Division of Rlietimatology, Albany Medical College, called a meeting at the Albany Medical College in which physicians from various communities in the ARMP area were invited to discuss the possibility of establishing the outreach arthritis programs. Based primarily upon apparent.need and interest of local physicians, the,two communities as noted above were chosen for the original arthritis programs. Glens Falls is a small city of approximately 18,000 people in a 4.1 square mile area with a population density of 4,463 per square mile. It is located 45 miles from Albany. On the other hand, Oneonta is-a town.of approximately 4,500 in a 33 square mile area, with a population density of 131 per square mile and located 75 miles from Albany. I. -The Glens Falls Clinic began operation in October, 1974 after arrange- ments had been made.with the Glens Falls Hospital for clinic space and after the appointment of an assistant director of the program 'or Glens Falls. This phys cian is a board-certified internist with a concern for Rheumatologic diseases. Prior to the first clinic, a five and one half hour invitational Rheu- matology Postgraduate Program was held at the Albany Medical Center early in October, arranged by the Department of Postgrad&ate Medicine., Four hours AMA continuing education credit was offered. The program incltid(!d discussions on evaluation of patients with rheumatic ' diseases, pathogenesis and treatment of riieuin--3toid arthritis. It also included diagnosis and mana),Iomeiit of patients with systemic lupus and polymyalgia rheum@itica and diagnosis and treatment of crystal- induced syndvitis. The program was attended by eight pliv,,;J.ciins from the Glens Falls area and was successful in orieiitLrig physicians of that area to the Diig- nostic and Treatment Center In Glens Falls. 3 mately one-half day per clinic. Clinics are held in the Department of Physical Medicine' where examining booths and patient waiting areas arc available. Appoint- ment.s are made by the secretary at the Department of Pliysictl Medicine, while the pliysician-director is responsible for medical and administrative arrangements. Through the Northeastern New York Chapter of the Arthritis Foundation, volunteers have been working in the.clihi.ts providing secretarial help and other program assistance. Literature fkom the:'Arthritis Foundation is distributed to the patients, visiting the clinic. In addition to the assistant director, professional personnel at the Glens Falls clinic includes two Rheumatologists from the Division of Rheumatology, Albany Medical,College, two Physician Therapists and other interested physicians who often accompany their patients. During each clinic six to eight new patient's are evaluated by one of the Rheumatologists and receive complete history and physi- cal examinations. Appropriate blood studies are drawn and sent to the Rheumatology Laboratory at Albany Medical Center, where the tests are provided. History and physical examinations are dictated and recorded on special data collecting forms which have been designed by the Division of Rheumatology. Copies of the reports are sent to the referring physician. Patients are often seen for a follow-up visit and complete evaluation of the x-rays and diagnostic tests. The interest and response to date has been encouraging, and many of the referring physicians are preseftt during the patient's evaluation. In addition, hospital in-patients are seen in consultation upon their physician's request., One of the Orthopedists With a special interest in Rheumatologic surgery has been present and contributes significantly to the-i6l-inic. II. The Oneonta Clinic will officially start operation in mid-January, 1975. A number.of meetings have been held in Oneonta with hospital administrators and @LL-IL CL t-!-'LLL-'Lk- J- L16 diL L LCIpa Leu that a,dlinic will be held one day each month initially. A board-certified in- ternist has been appointed assistant director, with organizational responsibilities. A board-certified Rheumatologist from the Mary Imogene Bassett Hospital in Cooperstown, New York will be one of the attending Rheumatologists, and will serve as an assistant director. A member of the Division of Rheunatology from Albany Medical College will be in attendance at each clinic. A secretary has been ap- pointed and will be responsible for all patient appointments, and the obtaining of all patient.records, x-rays and laboratory tests. She will also perform the transcription of patient records. The Oneonta Clinic also will be held in the Department of Physical Medicine where examining booths. and patient waiting area is available. As in Glens Falls it is ahtic'ipated that all patients will be referred by their physicians, many of whom will be in attendance with their own patients. At the beginning, a limit of eight new pAtients will be set for each clinic, thus allowing time for patient return visits. Summaries of patient evaluations will be sent to referring physi- cians who will provide follow-up patient care. In addition to the above mentioned personnel, other staff will consist of the regional program physical therapist and a local Orthopedist with a special inter6st in Riieumatology. An invitational Riieumatology Postgraduate Program will be held for inter- ested physicians in this area. It is anticipated that the successful operation of these clinics will demand operation at two week intervals, rather than at four week intervals as.origiftally planned. 4 111. The Albany Medical Center Ilospital Arthritis Clinic has become a multi- disciplinary clinic. This clinic is primarily established as a referral diagnos- tic; however, patients may come without physician referral. Personnel,in this clinic include-two interns from general medicine, one resident in physical medicine with students on the physical medicine rotation, two residents in internal medicine on the Rheumatology rotation elective, the Rheumatol *Ilow and two attending ogy Fe Rheumatologists.. Also, members of the Division of Orthopedics, two physical thera- pists and one occupational therapist are in attendance. Several physicians from nearby areas also participate in these clinics and arrangements are being made for physicians to make in-patient rounds either weekly or bi-weekly followed by attendance at the Arthritis Clinic. At the end of each clinic, case presentations are conducted and followed with discussion by participating physicians, residents and students. Finally, through funding by the Albany Regional Medical Program, a Diag- nostic Rheumatology Laboratory has been established. The following tests are being performed and available to all patients seen in the various clinics: rheuma- toid factor by the latex fixation method fluorescent antinuclear antibody test using mouse liver substrate with titer and patterns of fluorescence, hemolytic complement levels, synovial fluid analyses, antibody to ENA by hemagglutination and hemagglutination tests for DNA antibody. With assistance of the ARMP Program Staff, plans are being formulated to evaluate the outreach clinicst programs to provide information that would enable these clinics to become self-supporting in the future. Specifically, negotiations will be arranged with third patty payment carriers to arrange mechanisms for re- imbursement to these clinics. THE UNIVERSITY OF ARIZONA' TUCSON, ARIZONA 85721 COLLEGE OF MEDICINE ADDRESSREPLYTO: ARIZONA REGIONAL MEDICAL PROGR. ARIZONA REGIONAL NIEDICAL PROGRAM 5725 E. STH STREET TUCSON, ARIZONA IS711 s y IS SERVICES PROGRAM Director: Warr-en Benson 3813 East 2nd Street Coo@ator: Beth Ziebell Tucson) Arizona 85716 The proJect@was propo sed.to develop a network (center) Of diagnostic, treatmnt and rehabilitation services for arthritis patients and their families in the rural camunities Of Southern Arizona and in a presently radically underserved mdel cities population in Tucson. 5 ,I!hls networOZ-Will'include the services of the Southwest Chapter, The Arthritis Foundation a Tucson based mrrber-of the national organiza- tion as well 'as A;he resources of other public 6nd private arthritis related health services agencies throughout the area. The project will pass on special knowledge and.s.kills to the public and health professionals living and working in the areas to be served through demonstrations., on-the-spot training and where feasible, by bringing together varied groups to share learning experiences in work- shop settings. By the end of the proposed demonstration program, the comprehensive- ness of services will be increased in Southern Arizonai This will stay with the c ties, to be reinforced b.,v dontiniiing7 wii-.h Irpnm personnel and agencies. The extension of the linkages of outlying areas will demonstrate how effectively rural and urban health services can be linked to benefit the arthritis patient living distances from a.rmjor health center. 1. A Tucson Interagency Liaison Comniittee composed of individuals and representatives from'agencies participating-in network services. The Tucson Interagency Liaison Co@ttee will meet at least quarterly during the project year. Individual c@ttee r,mmber will be called upon to provide counsel and services to local co@ties. The role of the Liaison.C,6.ndtt6e is perceived as consultative and as a vital com- munic'ation link with their organizations and the local cormdttees. it will also be responsible for. evaluating project nrogress and impact. 2. Since a @or strerv,,th of this project will rest in its ability to-mtivate local comunities to mobilize resources and to form linkages.to existing services, local camunity comrdttees will be'f6r'v'L-d in each participating tarf!,et area,. Th6se conraittees will be made up of representatives of organizations such as Health Planning Councils, Councils of Government Services., Medical Societies, hospita administrators and the Cooperative Ex- tension Service, as well as allied health personnel, consumers, in- terested laymen, large employers, educatots'and others. The evaluation@of-this proJect will be conducted by Pima Health Syst@ (PHS), an experimntal health service delivery system program.. ORGANIZATIONS EXPECTED TO COOPERAT=Y PARTICIPAa'E IN PROGRAM IMPLUMATION .. The Arthritis Foundation expects to involve the following agencies or groups in the project. The follows outline describes the agencies and their expected role. - 6 . 1. University of Arizona Office of Vice President for Health Sciences:Serve on Liaison Comittee, Serve on Arthritis Foundation Board of Directors, Serve on Project Executive Coamittee, Assist with development of, and provide facilities for workshops. 2. College of Medicine (Arizona Medical Center and VA Out-Patient Clinic) a. Section on Tmunology and Rheumtology Will supervise visiting rural physicians' training program. Will open their facilities for-physicians' training. Will serve on Tucson Liaison Committee workshop partici- pation. b. Department of Pediatrics Serve children's clinic Participate in@workshops c. Department of Surgery Participate in workshops 3. Crippled Childrents Service Provide consultation services Provide surgery for children 4. College of Agriculture Cooperative Extension Services Assist in the recruitment of c ty leadership for member- ship on local committees. Assist in the identification of patients and fwd.lies needing n(-,twork'services. Arizona Training Center for the Handicapped Will manufacture self-help devices and some components of how modifications. 6. Tucson Medical Center (Hospital) Will release allied health professionals to work in outlying areas. Use of fac @ ties for physicians' in-service training program. 7. Pima County'Health Department Tucson Liaison Committee Liaison to other 'county medical societies. 8. Pima County @dical Society Tucson Liaison Co @ ttee Liaison to other county medical societies. 7 9. Health Plaming Council Tucson.Liaison Comdttee Ongoing review of project objectives 10. Pirin Health Systems' Tucson Liaison Coffdttee Project evaluation 11. Councils of Government Serve on comunity committees 12. County Health Departnents (other than Pima) Co@mity c@ttees ;Ll. I;ntith Tticsnn/Model Cities.Project (arm of city government) Serve on Tucson Liaison Camdttee Identif'y,indigenous community leaders whose.awareness and involvemnt in the project will increase utilization by minority groups to be served i4i. United WpLy (Corrmunity Service Division) Serve on Liaison Comdttee Raise funds for continuation of program 15. Easter Seal Society Serve on Liaison Com-nittee Transportation services .16. sisters of H Clinic Serve-on,Liaisoii Committee Referrals to clinic. 17. Veterans Administration @lospital Lend facilities for in-service training 18. VisitJ.ng Nurses Association Referral of patients for clinic services Dissemination of educational materials 19. Arizona Regional Medical. Program fiscal supervision toririg, .Provide-ongoing program moni and.evaluation Serve on Liaison Condttee 20. Departmnt of Economic Security Serve on-Liaison Comdttee Training and rehabilitation services Employmnt and welfare 8 21. KUAT Radio and TV Bureau, University 6f Arizona Produce educational material Serve on Liaison Committee Enlist cooperation of outlying stations 22. A. Co ty colleges Use proi6et personnel as resource materials B. Secondary schools Schedule speakers for health education classes 23. Media Representatives serve on Liaison Co @ ttee and local c@.ttees. Provide outlet for educational programTdng Publicize local meetings 24. Family Service Agencies Serve on Liaison C@ttee Provide services to arthritic patients and their.families SPECIFIC SERVICES: 1. CONSULTATION CLINICS: We provide visiting teams to rural communities on a regular basis. 'Rheumatolog:Lst Social tiorker/Counselor Orthopedist Hom Modification Specialist Physical Therapist The team will,. (a) Meet with the patient's physician to review case histories prior to the presentation of patients-. (b) Examine the patients (c) Appraise radical pio@osis and outline treatment (d) Consultation with the patient's physician concerning not only disease managemnt but envirormerital, social, mechanical factors, work simpli.cation and the like. 2. PHYSICIAN TRAINING PROGRAM: One-wwek intensive clinical experience in Rheumtology in Tucson for twenty physicians fran the six southern counties. Twenty Physicians from the six southern counties will participate in a one-week, intensive clinical experience in arthritis in @csoni The physicians will be @r the Jurisdiction of the administration of the Arizona Medical Cneter. This Program will include attendance in 9 ttie out-patient arthritis clinics in the Arizona Medical Center, the threeexisting clinics operated by the Southwest Chapter, the clinic at the Pima County.liospital, and the Veterans A@istration-Hospital. Local rheumatoiogists will invite the physicians in training to parti- cipate for one-half day in their practice. 3. WORKSHOPS - In.Tucson: One day workshop experiences in Arthritis for various levels of health personnel. Training for Allied Health Personnel Management of the Child with Arthritis Medical and Surgical Management of Arthritis Role of the.Fandly of the Arthritis Patient Conference for Ancillary Health Personnel 4. MT-NI-WORKSHOPS - In rural communities: One-evening pro@ designed for continuing education of physicians and allied health personnel. 5. HOME MODIFICATIONS Demonstrate through a minimum of 25 home modifications and all referred self-help device consultations to arthritis patients and health profes- sionals living in the geographical area served by the project the value ,of such services. A.. To assess the patient, the funily, and the home as to possible changes, innovations, and modifications, alork7, with the prescription and purchase of mate rI.als and eqLLipmnt that, will make it possible for the patient to function at a higher level of independence the home environment. B. To make av@la@le such self-help devices as will complement the patient's behavior as previously described on a demonstration basis. C. To collect and make available information -.ibout new developments in coordinated home care and self-help devices for the arthritis patient. 6. EDUCATIONAL MATERIALS: Use of @k, IV projectors with cassettes illustrating handling @of,the patient-w:fth Arthritis. lets for patient education Appropriate pamph Provide professionals with existing suitable printed materials (i.e., The Bulletin on Rheumatic Disease for Physicians). 10 Develop radio programs and spots, conferences, and clinics focused on motivating the population to follow a prescribed therapeutic rep-@n in the management of arthritis. Distribute throw .,h the Arthriti.,,, Foundation tli-r,(-@e c@Iflit-intriute color films which hav(@ already been produced for use In nursing stations (as an example) to teach health personnel proper inanage- ment of the arthritis patient. Identify 1 500 additional persons to receive the Chapter's Newsletter. 7. OW-PATIENT CLINIC: A comprehensive service utilized by presently medically underserved patients with arthritis and their families in the Southern Tucson/Model Cities area. ,i,o asse@le a professional ste.ff., including a part-time rheumtologist, a part-time nurse, a full-tim physical therapist, a full-tim resident in rheumatology, a rehabilitation counselor, and a full-time home modification specialist to provide a demonstration weekly clinic and ongoing outreach services throughout the tem of the project to the South Tucson/Model Cities areas of Tucson. Through the demonstration clinic, the patient's needs for radical care occupational therap physical therapy, and activities of daily Y living will be assessed. s @4 DICAL PROGRAM GIONAIIMF Evergreen Place, SLjite 215, Evergreen at University, Little Rock, Arkansas 72207 Roger J. Warner, Coordinator 501-664-5253 Through the grant for.-cne Arkansas pilot arthritis program the Arkansas Chapter of the Arthritis Foundation has established the goals of (1) improving the quality, availability and accessibility of medical service for arthritis patients-throughout the State of Arkansas; and, (2) expanding existing, and developing new facilities and organizational structures to provide a network of interrelationships for the ditsemina-. tion-of infomation and services 'and.for the referral of patients to the most appropriate levels of care-available. To reach these goals'.the following objettives have been set-up:! I,. To inform the local primary care physician on the most modern techniques for the diagnosis and'therapy of the arthritis patient. Arthritis clinics will be.established in eight of the larger conimuni- ties of the state (Fayetteville, Harrison, Jonesboro, Mountain Home, Camden, El Dorado, Texarkana, and Wett Memphis). Each of these will be sponsored by a local physician who will secure the cooperation of local area physicians in,presentinq patients to the clinic@ (hold quarterly). Five corysulting rheumatologists have agreed to attend each clinic, to see patients referred, and to make chart rounds, or to hold seminars for the.local physicians.' To improve the care of.pediatric arthritis patients a specialist in-pediatric rheumatology will present -r.icians in May, a program at the State Convention of Arkansas Pedia4L 1975, to insu're that the'pediatricians of the state.are aware of the most recent developments in the detection and treatment of arthritis in children; A statewide program of public education will be instituted to instill A knowledge of arthritis, the therapeutic possibilities, and the agencies and modalities available in the state for primary and secondary care. Mr. Basil Smith, educational supervisor, has been hired to provide overall direction and coordination of the public education program. He will supervise four part-time district education coordinators who will organize and work with local advisory cIonimittees in each county, coordinate an all-media educational program in each district, as@ist the local clinic sponsor§ in arranging consultative visits, and assist local physicians in arranging referrals for secondary and ter4t-.iary care. In addition, the educational coordinators will'work closely with the area-wide Health 12 Planners,.the Arkansas Rehabilitation Services and Lhe Arkansas Social Services in order to advise patients as to the financial and rehabilita- tive assistance th3t is available to them through governmental agencies. An incoming 14ats line has been installed in the Little Rock Foundation office to supply information to arthritis victims or their families as to the nature and course of the disease, and the services available to the patient, and the best method for the individual to gai;i access to-the system. The@Arthritis Foundation will contract with a public relations organization to develop an all-med4ia educational program aimed at the arthritis patient, family and Physicians. The organization will develop a seri,es of three to five minute Educational radio programs, develop a brochure outlining services presently available. A number of five minute technical tapes on arthritic diseases will be developed to be added to.and used by'the existing system of dial-a-tape recordings for physicians and nurses operated by the University of' Arkansas Medical Center and the Little Rock Veterans Administration Hospital. , 3. The Foundation plans to expand the existing program of physical therapy clinics in order to improve.the quality and (juaritity of physical- therapy services available to arthritis patients. The program has been extremely effective, but utilizing, as it has, the services of a single individual, it has been-inadequate in its coverage. The Foundation will employ a graduate of the four year physical therapy Course a@ State College of Arkansas and give him three months intensive practice in post graduate training in the care of arthritis patients at Leo r@. Levi National hospital in Hot.Springs, Arkansas. After completion of trai,ni e@w@i I' be assigned to the same duties as the Foundation's present thera- pis.t, permitting an expansion of the physical therapy program. It is expected that,ten new physical therapy clinics will be opened during the project period. 4. In March, 1975,,the Foundation proposes to conduct two 2-day demon- stration workshop@ in arthritis physical therapy to indoctrinate the,73 physical tlieraoists now working in Arkansas in the special techniques useful in the treatment of rheumatoid arthritis. The Project Director is, t-.ive Director of the Arkansas Chapter .00h Riggin, Execu4 of the Arthritis Foundati.,on,:Post Office@Box 125, Little Rock, Arkansas 72203. 13 EDICAL PROGRAM CALIFORNIA REGIONAL M (A Non-Profit Corporation) 7.700 Edgewater Drive Oakland, California 94621 Telephone (415) 635-0290. Project No. ROP-74E-i65-154c Date Decemoer 3, 1974 Project Title Development of a Juvenile Rheumatoid Arthritis Clinic Operating Agency: University of California at Davis Project Director: James Castles, M.D. Project Address Department of Internal Medicine, Section of Rheumatology, U. C. Davis, Davis, CA- 94616 Pro'ect'Staff James Castles, M.D.- Robert Shapiro, M.D.;,Barry Brian, M.D.; an and a Secretary RN;,ci Physical Therapist; Obiettives To establish a university-based clinic for patients with Juvenile Rheumatoid.Arthritis. This will be a referral clinic directed toward providing consultative expertise to area physiciaIns who will be encouraged to provide the primary care for arthritic children. Methodology Pa rarhc di ca Ipersonnel t-4ill.be-ut'llized for patient evaluations in order to maximize the time that the two available rheumatologists will have for direct patient care. Vt:LWt:Zi I 4-1 1 11 Is- VI:> IL@ Lilt: PCS I clillr-U I I-Cl I Pt: 1 73VI I! lU I WI II Pt:: II U I III IL)i iL)W-Up UVCIIUdLIUll Ut patients in conjunction with their primary physicians. Public and private agencies whose input might assist the arthritic child and his fami ly will be identified and u.tilized in,order to maximize total care. This includes the possible development of satellite clinics in the area. Progress Clinics are scheduled for ever other Friday at the U. C. Davis site. A referr6l y network is being set up throughout northeastern California. Local physicians with JRA patients will be invited to attend clinics and/or send patients ' During the month of November, two clinics were held and seven patients were medically evaluated and treated. Staff pediatricians participated as observers during the clinic. Involvement of Community Organizations Community Involvement contact has been made with the California Crippled Children Is Association and the possibility of using their school facilities as satellite clinics appears favorable. The Association has also agreed to assist in recruiting of interested physicians and in providing physical therapy consultative services. 14 project No. ROP-74E-166-1 54D Funding Period: 9/i/74 - 8/31/75 Date December 3. 1974 Project Title Arthritis Program for Community Hospitals Operating Agency University of California Medical School at San Francisco -Project Director Ephraim P. Englcman, M.D. Project Address Division of Rheumatology, School of Medicine, U.C.S.F., 3rd and Parnassus, San Francisco, CA 94143 ,Project Staff Brenda Spriggs, M.D.; Hope Snowhite, P.T.; Carol Lavine and Gwen Ciewley, Social Workers; Nurse;.S6cretary; plus a consulting staff of 11 physicians Oblectives .To stimulate interest and train professional manpower in the care of the arthritic patient; to demonstrate exemplary arthritic patient care; and to make readily available such care in defined population areas. Methodology To conduct demonstration teaching programs in selected community hospitals which are diverse in geographical location, patient population and organizational structure. Progress 1. Audit criteria for the following forms of arthritis hove been developed and are currently in use: a. systemic lupus erythemastosus d. ankylosing spondylitis b. gout and pseudog6ut e. Reiter's syndrome C. rheumatoid arthritis f. juvenile rheumatoid arthritis 2o The following hospitals have been contacted and clinic plans arranged as follows: a. Valley Medical Center Regional Medical Proqram in Arthritisi Fresno Working; care providers will be the family practice residents and one medical student. Project assistance will be prov.ided,through the design of varied programs depending on heed of the clinic and social service consultation. The clinic will meet every other week. Chinese Hospital, S.F.; and Highland Hospital, Oakland - Project staff to con- duct 9-rand rounds with conference held once.a month to follow the Arthritis Clinics with exemplary patients and/or a teaching session. Conferences are opened to general medical house staff and orthopedic residents. in-patient consultation is available depending on in-pat'lent teaching case material. c. Ft. Miley, VA Hospital Project staff to provide consultation on in-patient teaching rounds once a week. These sessions to be attended by, five (5) piiysi- cians currently providing care at the hospital. Project staff! 'is attemtping to coordinate the Physical Medicine Department with the Arthritis Clinic. d. Children's Hospital, Oakl!and - An introductory grand rounds was conducted in November consisting of discussions on rheumatic disease in childhood, the immuno- logical aspects of rheumatic diseases, and orthopedic aspects of rheumatic diseases. Patients will be seen by the project staff oncea month in consultation rounds held by the outpatient department. Funding Period 9/i/74 - 8/31/75 Date December 3, 1974 Pro.ect Title Arthritis Patient Evaluation and Education Program Operating Agency: Saint Mary's Hospital Project Director: Richard.Welch, M.D. Project Address Department of Orthopedic Surgery, St. Maryis Hospital and Medical Center, Hayes and Stanyan Streets, San Francisco, CA 94118 Project Staff Rithar8 Welch, M.D.; Kathy Gomez, Admin. Asst.- Patient Education Departmont;.-and a consultant staff of four physicians. Objectives St. Mary's Hospital and Medical Center proposes to provide diagnostic consultation to a maximum of 85 arthritis patients.- It also seeks to formulate and test a program of patient education-in-arthritis-to be conducted in out-patient, in-patient home, and private sector settings. Methodology Under a regimen prescribed by a physician, the patient instruction program will be conducted by a' team of trained allied health professionals and monitored by attending and house staff concerned with rheumatic diseases. Instruction will-include all essential components of patient self care, plus assistance in utilizing community rehabilitation-and occupational therapy resources. .Progress In order to accomplish the above objectives two teams have been developed. The first team consists of rheumatologists, orthopedists and internists. They conduct bimonthly case conferences on the second and fourth Wednesdays of.each month.for the purpose of offering medical evaluation and sbtting long term treatment goals for both clinic and As of November private arthritis-patients. 15, 1974, three conferences had been held and five patients,have been' medically evaluated. The hospitals Patient Education Department and an Arthritis Patient Education Advisory Committee comprise the second team. The Patient Education Department is staffed by a Coordinator, Nurse-instructor, Occupational Therapist, and a Clerk-Typist. The Committee consists of representatives from attending and house staff physicians, clinic nursing staff, representatives from the Physical Therapy Department and the Haight- Ashbury Health Committee. Meetings-are scheduled to coincide'with those of the Case Conference Team'. Educational objectives and a teaching outline for patient learning have been developed by the Patient Education Staff and modified by the Advisory Committee and are scheduled to be reviewed for approval within the'month. The team has also completed the first draft of a Nursing Assessment form which when approved will be pre-tested with several patients before presentation for general use by patients. 16 Project No. : ROP-/4E-,od-1541 Funding Period: 8/l/74 - 7/31/75 Date December 3 ' 1974 'Project Title Arthritis Care Planning for Los Angeles County Central Region Operating Agency: University of Southern California Project Director: George Friou, M.D. Project Address Clinical Immunology & Rheumatology Section, LAC-USC Medical Center, OCD Building, 2025 Zonal Avenue, Los Angeles, CA 90033 Project Staff one physician (half-time), one nurse, and one secretary Objectives To obtain information needed to make rational recommendations to the Los Angeles County Department of Health Services as to how the RheLimatology Unit at USC can best meet the needs of the new County plan, to develop organizational plans and principles which can be used by other Regions in Los Angeles County in providing arthritis care, to decrease the number of patients lost to follow-up care by 5%. Methodology Decentralization of services has been the thrust of health planning for the last two years in Los Angeles County. The question this project attempts to answer is whether decentralized satellite clinics are feasible for the care of arthritis patients. If so, this project must recommend where the clinics should be located and what services should be provided. Project staff plans to develop a questionnaire which will provide comprehensive informa- tion on all the patients currently.receiving care at the USC Arthritis Clinics. They will also utilize the instrument to obtain information on arthritis patients at Rancho Siiiiiu I :@ut,Iipital b,iti Wl)lte ;-Ieii)ui t LO I , 0 a t.; IC ac a I v providers of care in the Central Region. Later in the year they hope to assist Martin Luther King Jr..Hospital survey their arthritis patients. At USC there are approximately 1,200 patients, at Rancho approximately 600, at White Memorial approximately 50 and at Good Samaritan approximately 30. Martin Luther King Jr. Hospital is. a relatively new hospital in the process of developing their arthritis clinic. Many patients now at USC will eventually be referred to Martin Luther King Jr. During the course of the year, the project staff will also attempt to reduce the broken ,appointment rate at the USC clinic. The nurse will telephone patients, attempt to find out why they missed their appointments, and eventually attempt to offer solutions to their problems.. The staff suspects'that transportation and long waiting periods in the clinic may be reasons why patients break appointments. Progress - 8/l/74 to 10/31/74 Thus far, the staff has been successful in developing the questionnaire that will be used for their research. Half of the instrument will be completed by the patient and the other half by the staff. Consequently, technical as well as pers(?nal information will be obtained, The too] has been pretested and will be administered on a regular basis in November. -A questionnaire@has also been written for the telephone survey to patients breaking appointments. The nurse will begin her work on the project in November. Involvement of Community Or6anizations The project has not yet been actively involved with community organizations. This may .occur when the data has been collected and preliminary recommendations are being made. Presently, there is ongoing communications with the officials of each Region and with representatives of the Los Angeles County Board of Supervisors. 17 Date December 3, 1974 Project Title Treatment and Education Program for Rheumatic Diseases Operating Agency: Orange County Medical Center Project Director: Michael Reynolds, M.D. Project Address Department-of Medicine, Orange County Medical Center, 101 The City Drive, Orange, CA 9'2668 Project Staff Physical Therapist, Occupational Therapist and a half-time nurse Obiectives To increase services at Orange County Medical Center Arthritis Clinici Orthopedic Clinic and at Community Clin.ic (a satellite of OCMC) by directing 100 clinic visits per month to a physical therapist, 60 visits per month to an occupational therapist, and 30 patients screened per month by a nurse practitioner, to improve the patients' perform- ance of home and self care,.to increase the amount of physician service to 50 patients per month in the Arthritis Clinic, to reduce the rate of missed appointments in the Arthritis Clinic by 6 patients per month, and to conduct two professional education programs in Oran e-County,(one for physicians and one for allied health personnel) concerned with the comprehensive treatment of rheumatic diseases. Methodology The three new staff members wil I acquire skills related to arthritis by Dr. Reynolds and the other team members of OCMC. The arthritis team consists of.two full-time rheumatologists,'three consulting rheumatologists, a consulting orthopedic surgeon and a social worker. The nurse on the project will be trained to do initial screening and certain routine follow-up care. As a consequence, the physician will have more. time for complex diagnostic and therapeutic problems. .Progress The occupational therapist physical therapist and nurse were hired for the project in .August. -During the first-two months the two therapists performed the following: 244 treatments of 72 patients, 18 home Visits; ordering or fabricating aids on 18 occasions All patients repeatedly attending the Arthritis Clinic at OCMC are .being seen by the therapist for.evaluation and revision'of their personal physical therapy programs, including routine daily activities cis well as formal exercises. The nurse practitioner has assumed certain routine follow-up and screening activities in the Arthritis Clinic. Though difficult to measure on quantitative terms, her services are equal to providing an additional physician to the clinic five hours a week. The arthritis team currently provides extensive education on home visits. Currently, the team is attempting to develop a patient education program in the clinic itself. Technical problems, such as available space for classes, are being dealt with. Involvement of Community Organizations The Orange County Arthritis Foundation currently provides supplemental support for services at OCMC. Dr. Reynolds cooperates with the arthritis program in efforts to educate both professionals and the lay community. isz Project No. : ROP-74E-170-154K Funding Period: 9/i/74 - 8/31/75 Date : December 3, 1974 Project Title' Interdisciplinary Team for the Treatment of Arthritis Operating Agency: Loma Linda University Project Director: H. Walter Emori, M.D. Project Address Department' of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA 92354 Project Staff Cheryl Bailie, RN; Rheumatologist; Orthopedic Surgeon, Occupational Therapis*L', and Physical Therapist. Ob.iectivcs To establish a two-way communication channel for the referral community physician, to establish teathing programs by the Arthritis Team for the medical and paramedical personnel in the community, and to establish in the lay community an awareness, Interest and involvement in arthritis tare. Methodology The nurse will-develop the educational component of the program. She, in conjunction with other team members, will provide educational seminars on the care and treatment of arthritis to medical personnel in the hosp,ital and the neighboring cities, and to lay people within the community. Through such educational ettorts, it is hoped that an improved referral system will result, as well as better patient care. The nurse will receive training specifically related to the rheumatic diseases by Dr. Emori and the members of the 6rthritis team at Loma Linda Hospital. Progress During September, the nurse received training related to the various types of arthritis. She was also involved in the development of educational materials to be used throughout the year. In October, in-service programs were given to nurses at Loma Linda Hospital. The topic was rheumatoid arthritis and the staff did the presentation in the format o a skiti Seven sessions were given with approximately 300 nurses attending. Also, for the .hospital staff, Dr. Emorl presented a case and.discuss6d the diagnosis of arthritis during grand rounds on Novem@er 13. Two programs were given for the lay public. One, in the City of Paris, was for a club of over 100 retired people. The other was in Barstow and was open to the general public. Over 50 people attended. Ms. gailie and Dr. Emori have spent time writing two articles on arthritis which they hope to have published in magazines read by the general public. One is on arthritis in general and the,other is on'rheumatoid arthritis. Involvement of Community Organizations The Arthritis Foundation of Riverside is actively involved with this project. They made the arrangements for the community seminars in Paris and Barstow. Date December 3, 1974 Project Title Comprehensive Outpatient Evaluation and Treatment Operating Agency: University of California, San Diego Project Director: F. Richard Convery, M.D. Project Address : Physical Medicine and Rehabilitation, University Hospital, 225 West Dickenson Street, San Diego, CA 92103 Project Staff : Physical Therapist and Occupational Therapist Objectives To es tab Iish a system of cost eva Iuati on for the Arthritis C Iinic University Hospita I that will identify the economic feasibility of the patient care system, to provide new services to patients at two sites in San Diego: University Hospital Arthritis Clinic and Mercy Hospital Arthritis Clinic, and to assess the comprehensive patient care system through patient evaluation. Methodology The primary thrust of this project is to establish a comprehensive rehabilitation at University Hospital for patients in the San Diego area. Currently, such a program does not exist. The staff is also committed to the idea of developing a system for evalua- ting the progress of patients-as they undergo treatment. Toward this a.im, an arthritis assessment form will be developed whereby a numerical score will be assigned to various levels of physical capability. It is planned that allied health personnel will be trained to complete the forms. This method will hopefully prove to be-a more objective measure of the patient 'Is progress and needs during rehabilitative care. Also, it should *k- nT DT off.,ri-;@fe. Progress The primary activity of this project thus far has been the development of the,"Art-hritis Activity Asses-sment" form. Numerous drafts and pre-tests were necessary to insure that the form was valid and reliable. The therapists participated in deveiloping the form and will be the key people completing i t for each patienti In December, it will be used on a regular basis for clinic patients. This form may possibly be utilized by other RMP projects and thus serve as the primary too) for measuring the impact.of the statewide arthritis program. In December, the form will be sent to Doctors Castles-and Shapiro in Davis, Dr. Reynolds in Orange County and De. Welch in San Francisco. They will review it and decide whether it is feasible for use in their projects. The physical and occupational therapists have thus far only been seeing patients at University Hospital.' in addition to their training, it has been necessary to educate the other team members of services they can provide to patients. To help facilitate the referral process, a list is being developed which outlines ' the services of an OT and PT. This list will be stamped on a page in the patient's'chart. The physician wi.11 check the.services'needed and sign the form. Not only will this assist the OT and PT,- but it will be a document utilized for future Medi-Cal billing. Dr. Convery feels that't.he OT and PT will be able to begin working clinics at Mercy Hospital next-month, They are also in the process of planning the home visit program. 20 involvement of Community Organization rtive of this project. Currently, The San Dieqo Arthritis Foundation is aware and sup One viomin, 3"Ouding furniture. they have assisted by providing small donations, inci learning of the project through the Foundation, donated $500 to Dr. Convery so that he could buy whatever he felt would best assist his program. STATE ARTHRITIS COUNCIL Name Organization Represented Address and Phone' Ms. Phyllis Annett, RN Allied Health Association Golden Gate Nurses 1155 Pine Street San Francisco, CA 9440@ 415-885-4200 Ms. Nancy Canham Crippled Children Service 4480 Clarewood Drive Oakland, CA 94618 415-557-0637 Ephraim P. Engleman, M.D. CRMP Project Directors' Group 359 San Mateo Drive' Chairman San Mateo, CA 94401 415-342-9068 James Fries, M.D. Data Systems Specialist Department of Medicine Stanford Univ. Hospita' Stanford, CA 94305 415-497-6001 Mr. Robert Geller Easter Seal Association Division o,, Rehabilitation Facili. ties 1225 - 8th Street Suite 320 Sac'ramento, CA 95814 Ms. Charlotte Gawland Occupational Therapist OT Department Rancho Los Amigos Hosp 7601 E. Imperial M-7y. Downey, CA 90242 213-922-7464 Ronald L. Kaye, M.D. California Medical Association Palo Alto Medical Ctr. 300 Homer Avenue Palo Alto, CA 94301 415-321-4121 James Klinenberg, MiD. Arthritis Foundation, 4833 Fountain Avenue Los Angeles Chapter LOS Angeles, CA 90029 213-662-9111 X-131 Ms. B6tty Maesar Vocational Rehabilitation State Rehabilitation Counselor 2550 Mariposa Fresno, CA 209-488-5061 Name Organization Represented Address and Phone Mr. Stewart Marylander California Hospital Association Cedars-Sinai Medical, Center Division Cedars-Lebanon Hospital Box 54265 Los Angeles, CA 90054 213-662-9111 Mr. Clark McElmurry Arthritis Foundation San Diego 3719 4th Avenue Chapter Box 3344 San Diego,. CA 92103 714;-291-0430 Dr. Harold Mozar Chronic Disease Unit and State Health Dept. 'RehabilitAtion Facilities 714 "PI' Street Sacramento, CA 95814 916-322-4704 Ms. Jean Reid Physical Therapist Arthritis Foundation So. Calif. Chapter 311 Wilshire Blvd. Los Argeles, CA 90010 213-938-6111 Dr. Ronald Restito Arthriti,s Foundation, No. 2040 Forest Avenue California Chapter San Jose, CA 95128 408-297-8919 Mr. William Salter State Office on Aging 1405 Market Street San Francisco, CA 94102 415-557-3900 Mrs. Thelma Schelcher Arthritis Foundation, 1507 21st Street Sacramento ChaDter Room 209 Sacramento, CA 95814 916-447-3248 Ms. Addie Thomas Social Worker 2421 Foothill Blvd. Verne, C 75 714-593-3383 22 CENTRAL NEW YORK REGIONAL MEDICAL PROGRAM 716 East Washington St., Syracuse, N.Y. 13210/315-473-5600 Pilot Arthritis Program Project Sponsor: Project Director: Central New York Chapter of the Robert Pinals, M.D. Arthritis Foundation Department of Rehabilitation Medicine 319 Midtown Plaza Upstate Medical Center 700 E. Water Street 750 E. Adams Street Syracuse, New York 13210 Syracuse, New York 13210 Attention: Monty Eust6n phone: 315-473-5820 phone: 315-422-8114 Summary of Activities A. 'Upgrading the level of patient care at the principal referral facility, the Arthritis Clinic at Upstate Medical Center9 Syracuse, New York. 1. TraininR a Nurse Clinician to deal wit'h thp -nroblpTn-, nf -nqtion+c with stable chronic arthritis, individuals who would benefit from 6 close relationship@with a single professional person. 2. Organizing the Clinic visit to include continuing evaluation and .instruction by a physical therapist, occupational therapist and vocational counselor, 3. Add@@ng an additional clinic session to the two already held each week, to permit more attention for each patient by the therapeutic team and for an increase in new patients accepted with a minimum of delay. 4. Adopting a problein-6tiented record system which will contribute to efficient operation. The education protocol will include the standard data base in rheumatic diseases of the (Arthritis"& Rheumatism May 1974). 5. Surveying vocational motivation and potential in a population of ,patients with arthritis. Questionnaires will be used to identify candidates for vocational rehabilitation, who will then be interviewed and'evaluated. 6. Holding a conference after each clinic in which the problems of each patient are reviewed by,members of the therapeutic team. The conference will be used as an instrument for instruction of medical students and.hou@,e officers in the value of interaction between various disciplines in clinical and social problem-solving. 23 B. 'Professional Education in the Rheumatic Diseases 1. 'Holding regular clin@cs and conferences in major cities in the Central New York region for physician edutati.on. 2. Training ateam of allied health professionals who will be able to meet either collectively or individually with their counterparts in other hospitals, to expand -the role of nursing, physical'and occupational therapy vocational counseling and social service in. the management of problems in patients with rheumatic disease. C. Extending consultation services,to other communities. 1. A consultation clinic in Utica has served as a successful model, meeting monthly under the auspices of the Arthritis Foundation of Central@'..7ew York. A similar session, held irregularly in Binghamton, focused to a greater extent on physician education using cases presented at the clinic as a basis for discussion of certain diagnostic and therapeutic problems. 2. The Binghamton Clinic will be expanded and held on a regular basis. A clinic on the dame model has been started in Ithaca. 3. A consultation clinic on the Utica model, directed primarily at diagnosi§ and therapeutic reco=endations for the individual patient, will be established in Watertown. Clinic sites: ljtice- Children's HoGpil"al ard. Rehabilitation Center, Utica New York 13@Ci"' Binghamton bi-monthly,at: C; ".S, Wilson' Merori al Binghamton General 33-57 Harrison Ild'Ureet !@litchell Avenu@ Johnson City, II.Y. 13790 Binghamton, New Yor-@ 15903 Coordinator: Dr. V4.ncent @;addi Ithaca Tomtkins County Hospitsi, Ithaca, New York 14850 Watertown site not yet determined 24 COLORAD(.) WYOMING REGI( PROGRA Estoblis4c,d Jon. 1, 1967, under Public Low 89-239 to Combat Heart Disease, Cancer, Siroke, Kidney Disease and Related Conditions Suitc 410, @tan@lin Mcl-cal Lluilding 0 2C4@ Pitsnklin 5ttt:,,i & Der@@@r. C.@insocio 80205 a i3O3) 892-9527 Thomas A. Nicholas, M.D. / Executive Director 0 Robert C. Jones, M.D. / Program Director COLORADO-V4YOIqING RLrI014AL ARN-IRITIS PROGRAM S Report - December 6, 1974 Iloy L. Cleere, M.D. ir,,- five co:@oncnlk-'s included in the Colorado-lelyominp,, Re6onal Arthritis ProCrain are: 1. I!;-imrerwnt office 2. Division, University of Colorado !t-dical Center 3. @nver Ceic-ral hospitals Dep,4@-t@nt of' Ilealth and IA'ospitals, City of Denver 4, Arthritis ,treatment Center, General Rose I.'iermrial hospital 5. Hormonal Arthritis Centers, Colorado and Vly @g Spotisoring arencies: Ti-,e Arthritis Fo,@ndation and University of Colorado @ledical Center collaborating agencies (in addition to those listed above): Colorado and l@,,ioming Health Departrm-nts Color@id@-'e.l.vominr. ficiri m-il I-edical Pro@, Colorado and Wyorang I,:edical Societies County or District 11edical Societies )@,T.ose and objective: To upgrade thel;a@lity of the diaL7nostic procr--dwvs arti c(x:-.- prch.--nsive ccim of the arthritic patients. in the tv.,o-state areas of Colorado and 1--lyoairLE; zuid to @.LA this ir;)ro-ved radical service.. roxv widc@ly available. Tais Rei-,io.-kal Arthrit-.'.s ProCram is staffed by specialists fron severA. arthritis uiJ.ts ii-s- the DL-iiver f-etropolitan area, mst of v,.'Iom axes with th@ facL.,lty of the Llnivei,sity of Col.oi@ndo I.'/--dic,'il Center. i@iis is the only t(%achinr- I,'!c(,Idcal Centex, in these two -.-.taWs. It is Liter-r--lated with 6thet, m@dical and hospital facilities and with the I,--altli professionals Physic4-ans, PLblic Health st