v, DEPA.RQAENT OF HEALTH, ED[.JCATION, A LFARE PUf.3LIC I-!EALTH SE[Z?VICCI I-IEALTH RESOUIRCES ADMINISTriA-FION ROCKVILLI-, FIARYL.AND 20852 BLIR@,AU OF HEALTLL RESOURCES DEVELOPMENT August 28, 1974 Dear On June 29, 1974, the Division of Regional Medical Programs (DRMP) issued advice letters to the 43 Regional Medical Programs (RMP's) which applied for earmarked, pilot arthritis grant funds, advising them of the actions of the National Advisory Council on Regional Medical Programs on these applications. The advice letters to ' "your comments the successful RMP applicants included a request for about the ways in which all of the currently approved pilot centers may develop and effect a coordinated effort, and how staff here may assist in addressing those issues common to each center". This letter is a followup to that request for your comments. Informa- tion about the proposed individual @ activities, which collectively comprise the National pilot arthritis program, could not be provided at that time before the awards were accepted. With acceptances in hand,, we are now able to provide summary information about the pilot arthritis activities for your consideration in recommending surveil- lance and coordination to lend a national perspective to this work. We would appreciate receiving a written response to this request not later than September 16. Some urgency attaches to arthritis program followup activities in that they should be related to program startup, and continue as an integral part of program development and evaluation. We are seeking your counsel and assistance to facilitate program quality, and ways to capture the experiences of this national initia- tive for f4rther assessment, interpretation, and promulgation. The recommendations of the Arthritis Ad Hoc Review Committee, which provided technical review of the arthritis grant applications, included unanimous support for pilot arthritis program coordination. Members variousl suggested methods for program intercommunication, report g y and information exchange, and program evaluation. Page 2 Enclosed background material for your information and assistance includes an overall summary program statement, and a brief descrip- tion of the individual RMP activities. Please2'call Mr. Matthew Spear (301/443-19i6) if you need additional information; Sincerely yours, Herbert B. Pahl, Ph.D. Acting Director Division of Regional Medical Programs Enclosures SUMMARY DESCRIPTION OF THE NATIONAL PILOT ARTHRITIS PROGPkm TO BE CARRIED OUT THROUGH REGIONAL MEDICAL PROGRAMS A national pilot arthritis program has been initiated in 29 Regional Medical Programs through special grants and program approvals. These grants were made possible by a Congressional earmark of pilot arthritis funds in the 1974 RNP appropriation. It is anticipated that approxi- mately $4,500,000 will-be expended this year for the special pilot arthritis program. The grant applications, received from 43 RMP'S, were reviewed and assessed by the Arthritis Ad Hoc Review Committee, comprised of arth- ritis specialists from across the country, and the National Advisory Council on Regional Mddical Programs. Reviewers formulated an arthritis grant review-perspective to establish a uniform basis on which to analyze the applications under highly competitive circumstances resulting from total requests amounting to four times the available funds. The review perspective (or guides) defined program emphasis which, in addition to .professional judgements of merit and achievability 'resulting from the review, lent increased cohesiveness to the overall approved pilot arthritis thrust. The emphasis of the approved Pilot program is the extension of Present knowledge in Arthritis diagnosis, treatment, and care, through coordi- nated services which demonstrate improved patient access to care, and .extension of professional services through expanded utilization of professional and paraprofessional personnel, and existing community resources. Arthritis clinics will be established in medical centers, community hospitals, and other community health facilities. Educa- tional programs in hospitals, and through visiting multidisciplinary teams, will increase the arthritis-handling capabilities of hospitals and private physicians, and will equip larger numbers of medical and health personnel to support services in hospitals, clinics, and home care settings. 'Increased patient self-care will be demonstrated through the development of phtient/family training activities. Seminars and workshops will be conducted at many sites for improved utilization of community resources'for arthritis services, including home care guid- ance and surveillance. Existing health department personnel and facilities, and health roups such as the Visiting Nurse Association, . g local councils on Aging, and operating community health worker train- ing programs, are cooperating in demonstrations of improved arthritis health care delivery. Several modest studies to develop criteria for quality care through provider performance standards are being conducted. An industry survey is planned in one Region, and an employee/employer education program will be developed in.concert with better organized occupa- tional health services. A number of programs are focusing on the problems of low income rural groups, and others are developing, demonstrations of care delivery to economically disadvahtaged'inner city residents. Pediatric arthritis services will be developed in a variety of settings, ahd*one program is demonstrating improved services to a geriatric population. Localities which presently have little, or no rheumatological resources are being supported in the initiation or expansion of new medical institution teaching capabilities. Across the country, Chapters of the Arthritis Founda- tion are providing program coordination, dissemination of pub.lica@ tions, and increased numbers of volunteer workers in support of services and increased,patient referrals to local services and resources. The constraints imposed by one-year limited funds were keenly appreciated by the review bodies. It was recognized that while much valuable work could@be accomplished with the earmarked funds, .many meritorious activities could not be approved under the limited, one-year pilot character of this program. In this respect,.the Arthritis Ad Hoc Review Committee Tioted, "...we consider this a very meager effort toward a tremendous problems, and it in no way reaches a point of beginning to provide a solution of any definitive kind... DIVISION OF REGIONAL MEDICAL PROGRAMS BUREAU OF HEALTH RESOURCES DEVELOPMENT The following capsule statements of arthritis program content are provided from the original applications, following Committee, and Council Review. A-nuniber of program changes have been effected, and are reflected where such changes have been reported to DRMP. The specifics of individual programs should be obtained from the RMP, or the principle investigators when more complete information is desired. RMP Arthritis Program Synopsis Alabama University of Alabama, Birmingham, will establish new arthritis clinics at Huntsville, Tuscaloosa, and Mobile. UAB will carry out periodic demon- stration-teaching clinics at these sites for clinic staffs, local physicians, and PH Nurses. Albany Albany Medical College will establish two arthritis clinics with local staffing to serve rural populations. Arizona Arizona Arthritis Foundation, with a variety of University and other medical and health organizations, will develop a network of diag- nostic, treatment, and rehabilitation services in the southern 6 counties surrounding Tucson. Multidisciplinary consulting teams, and local coordinating committees will be formed. Arkansas Arkansas Arthritis Foundation will coordinate r, Little Rock VA Hospital, the UA Medical Cente Leo N. Levi Nat'l Arthritis Hospital in the' establishment of 6 locally staffed clinics in outlying population centers. An active education program will be provided. calif ornia CCW will coordinate service development and outreach activities at 8 centers; UC, Davis (JRA clinic); UC San Francisco; USC; UC San Diego; St Mary's Hospital, San Francisco; Orange County Medical Center; Loma Linda University; and Scripps Clinic and Research Foundation, El Centro. CCRMP, itself, may compile demographic information at oxie or two sites toward developing cirteria of care; 2 Arthr @n o S. @T Central New York central NY Arthritis Foundation will coordinate activities of Upstate Medical Center, and others, to develop referral,diagnosis, and treatment services in outlying areas, especially northern and eastern rural areas of the Region. Colorado-Wyoming Rocky, Mountain Arthritis Foundation will coordi- nate development and expansion of referral, diag- nosis, treatment, rehabilitation, and training services at UC Med. Center, General Rose Hospital, Gottsche Rehabilitation Hospital, and St. Joseph's Hospital. Up to 8 new, outlying diagnostic and teaching clinics will be established, and visiting multidisciplinary teams will be formed. r ia, GRNP will coordinate activities based from Emory University, and Georgia Medical College to establish model arthritis programs in defined areas of the Region. Service networks will be developed, training will be expanded, and stand- for diagnosis, treatment, and rehabilitation will be developed. Greater Delaware Valley GDV/KT will coordinate activities in 6 institu- tions: Univ. Pa., HahnamAn Medical School; Child- rens Seashore House; Thomas Jefferson Univ., Albert Einstein Med. Center; and Temple Univ. Health Sciences Center. Diagnosis, treatment, and rehabilitation will be upgraded at a number of outlying sites. Professional education and training will be expanded. Pediatric services will be improved at a number of sites. Hawaii University of Hawaii will establish the (ATETCP) Arthritis Treatment, Education and Training-Cetter of the Pacific,comprised of multidisciplinary staff. Extensive outreach services are planned' in the Pacific basin, including technician, and patient/family training. Intermountain Univ. Utah will devel op a number of primary and secondary care facilities in the Region. Multi- disciplinary services will be developed as well as a home and midway care program. Education will be provided at U.U., especially focussed on develop- ment of primary and secondary care providers. Iowa Univ. of Iowa will establish clinics at Des Moines and Muscatine. Multidisciplinary teams will be established at each site, and professional education will be provided. 3 RMP Ar ttiri Kansas Kansas Univ. and the VA Hospital at Kansas City will collaborate in establishment of a referral, diagnosis, treatment, and rehabilitation system based on professional/patient information and education centers to be established at Kansas City, Topeka, Salina, and Wichita, under local ponsorship. s itan D.C. Freedmen's Hospital, and Washington Hospital Center will establish inner city referral, diagnosis, treatment, rehabilitation and training programs. Un-iv. of Michigan will establish a program speci- fically dealing with needs and problems of geriatric patients (age +55) in a selected area. Special emphasis will be placed on patients who can be made ready, or who are recently released from institutional care. Professional and patient education and training will be pr @ ded. Mississippi Univ. of Miss. Medical Center, and the Methodist Rehabilitation Center will establish up to 4 clinics in outlying sections of the Region with physicians trained and cooperating closely'with central resources in Jackson. Training will be provided for physician and allied health personnel, and for patients.. A nurses handbook in arthritis care may result from a proposed RN preceptor program. New'Nexico will coordinate activities of the Univ. N.M., N.M. Arthritis Foundation, and others in establish- ing 2 outlying clinics in selected areas, one of which may incorporate pediatric services. Multi- disciplinary teams will be formed, and local community coordinating committees will be establish- ed. Professional, allied health, and patient/ family training will be provided. North Carolina N.C. Arthritie Foundation will coordinate a variety of activities. It will also organize referral services, provide literature, and conduct a detection program at Burlington Industries incor- porating the development of services, and a model employer/employee education program. The Asheville .Orthopaedic Hospital and Rehabilitation Center will train allied health personnel as physician assist- ants, including drug toxicity monitoring. Univ. NC, Chapel Hill, will improve its clinical operations, and provide a multidisciplinary team to assist the development of outlying model clinics. Duke Univ. will establish outlying clinics, and provide RNP Arthritis Program S s is professional training. Bowman Gray School of Medicine will establish multidisciplinary teams to improve'and expand services at several existing community clinics. North Dakota N.D. Medical Research Foundation will coordinate the establishment by the Dakota Medical Foundation of 2 pilot centers to develop service delivery systems in designated areas of the Region. Multi- disciplinary teams and itinerant services will be developed. Medical planning groups will assist coordination, supervise program, and relate activities with AHEC's for coordinated training. Ohio Valley Louisville General Hospital,primary center for low income and minority city residents, will expand its services to coordinate a care delivery system in cooperation with Community Hospital, and the VA Hospital. Overall supervision will emanate from the U.L. School of Medicine, Section on Rheumatic Disease. Combined multidisciplinary medical confer- ences will be held. EmphAsis will be placed on home care services with active participation of the VNA, the.,Arthritis Foundation, and other community agencies. Increased professional and patient/ family education will be provided. Oklahoma. O.U. Health Sciences Center will enlarge clinics onsored by the OU., and VA Hospital, to improve Sp available services. k.pilot outreach program will I)e organized in cooperation with the Ada Regional Health Development Area Program, as a demonstration in improved rural health services. Puerto Rico P,; R. School of Medicine will develop a model clinic at the Medical Center,, and at least one clinic at an outlying community for improved referral, diag- nos@s, treatment, and rehabilitation services. Professional, ajlied health, and patient/family education will be provided. Tennessee Mid-South Vanderbilt Univ., with cooperation of the VA Hospital, and the Nashville Metropolitan General Hospital will establish a center at V.U. One or 2 outlying clinics may be.established related to improved.adult and/or pediatric services. RMP Arthritis Program Synopsis Texas TRNP, Inc., will coordinate a variety of activities at 5 medical schools, and cooperating Texas Arthritis Foundations. UT Medical Branch, Galveston, will develop a model minimal care unit for serious chronic arthritis, to simulate the home environment while patients undergo PT/OT therapy, and related services. All major medical schools, large clinics, medical societies and the Arthritis Chapters will cooperatively establish a State@wide education program. Conferences and clinic's for professional and patient audiences will be schedulled at many communities.. A series of regional workshops for practicing allied health personnel will be conducted at several major institutions. Postgraduate refresher physician courses will be presented at several institutions; also, 75 Texas, and 13 other hospitals will have access to conference telephone seminars from UT, 'San Antonio. A number of existing clinics will be expanded and additional home service and other outreach activities may be generated. Tri-State T-S RNP will coordinate activities of several institutions. Boston City Hospital- will. devO-I.op a multidisciplinary team and expanded services for outreach to inner city residents. Emphasis is on development of allied health personnel and physician assistants. Tufts New England Medical Center will develop community clinics at a number of outlying Massachusetts, and Maine locations, designed to facilitate multidisciplinary diag- nosis and treatment services. Professional and allied health education will be developed in relation to the needs of the program. Virginia Arthritis Foundation in cooperation with MCV, and U.V. Hospital, will coordinate the establishment of a number of community satellite clinics, with emphasis on the sout-iwesterm area of the State, staffed by local physicians and allied health personnel. Multidisciplinary teams will provide training, and assist clinic develop- ment. Patient education will be developed. Washington-Alaska Western Washington Arthritis Foundation will operate an PT/OT training program at the Virginia Mason Medical Center for personnel from Washington, Alaska, Idaho, and Montana. Support for partici- pants from Idaho, and Montana must be borne by their sponsors. Home therapy will be taught at -WWCAF. Up to 40 therapists are expected to be trained under this program. 6 RMP Arthritis Program Synopsis Western Pennsylvania St. Margaret Memorial Hospital and Schools of the Health-Professions, University of Pittsburgh, will collaborate in establishing a network of centers in both inner city ( Alleghany only), and up to 6 other western Pennsylvania communities, locally staffed. Multidisciplinary teams will help locate, organize, and provide periodic consultation to the centers. Physician and allied health training will be provided at up to 10 Regional facilities. In addition to disease phenomena, training will cover the roles of various community health resources; increased use of vocational assessment, rehabilita- tionland counseling services will be promoted in all courses. A health resources,directory will be developed. Wisconsin Wisconsin Arthritis Foundation will coordinate 3 pilot activities. A pilot patient/family education program will be conducted by the Sacred Heart Rehabilitation Hospital. A pilot, multi-hospital-quality assurance of nursing care for selected patients (early RA, and total hip replacement) will be conducted by the Columbia Hospital. Professional health education will be fostered through visits of multi-disciplinary teams,formed from the medical schools, and their major affiliated hospitals.