tillilillill@@ * I DIVISION OF REGIONAL MEDICAL PROGRAMS PILOT ARTHRITIS PROGRAM Summary Reports Of Projects Regional Medical Program Page Alabama Albany 3 Arizona 5 .krkansas 12 California 14 Central New York @(Syracuse) 23 Colorado-Wyoming (Denver) 25 Greater Delaware Valley (Philadelphia) 29 Georgia 34 Hawaii 38 Inte=ountain (Salt Lake City) 39 Iowa. 41 Kansas 43 Metropolitan Washington 46 Michigan 48 Mississippi 50A New Mexico 51 North darolina 53 North Dakota 57 Ohio Valley 60 Oklahoma 62 Puerto Rico' 65 Tennessee Mid-South 69 Texas 72 Tri-State (Boston) 80 Virginia 82 Washington/Alaska 89 Western Pennsylvania (Pittsburgh) 83 Wisconsin 85 ALABAMA REGIONAL MEDICAL PROGRAM eil ic a IPfoi,,ram ARTHRITIS PILOT PROJECT #95 P.O. Box 3256 @ A Model Center to Clinic Service 1108 South 20tti St, Summary Birmiiigharr., Alib4itia 35205 -5394 .05) 934 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; curriculum development aid,for University of South Alabama College of medicine. c), Name and Address of. Project Director Gene,V. Ballp M.D. Professor of Medicine Division of Clinical i.Liuttuiiu.Luyy ana Kneumatoiogy 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 laborato Iry in Birmingham will function as the central service laboratory. Tests to be developed include- ENA, anti-mitoclion- drial antibody,,immune complex precipitation t6sts, immunoassay of IgEi B, and T lymphocyte procedures, Serum DNA, and immunofluoresce@nt immunoglobulin and complement complexes in tissues and C4 by hemolytic-assay. Nurseso internists, Physical therapists and occupational therapists will be integrated into these model,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 'Lacilitated'will be emphasized. Recognition of all treatable musculo-skele-tal syndromes ranging from hyperthyr6idism to@_poly y rheiiiiiatica will be stressed. The model- clinic program will be an outreach effort to extend the expert services of rheumatologists, orthopedic surgconsi 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 clini c areas. In addition to the physicians w o are specialists in rheumatology, there will be occupational therapists, physical therapists and nurses involved in developing the programs and curricula. The expertise of .the S ain Rehabilitation Center Rheumatology Se ' p rvice and their facilities will be utilized. f) Iiivolv'ement-of Community Resources in Groups The University of Alabama in Huntsville School of Primary Medi- cal care, the Univers@ of Alabama at Tuscaloosa College of Community Health Sciences and the Department of Medicine of the University of South Alabama and facilities of these institutions and the UAB Rhoumatol6gy 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 Rhe.umatology Services@. The University of Alabama in Birmingham Medical Information Service via Telephone (MIST) will assist in disseminating new and pertinent information. 2 Alban!l Regional ALBANY MEDICAL COLLEGE/ALBANY, NEW YORK 12208 *'(518) 44S-5313 NORTHEASTERN NEW YORK REGIONAL ARTHRITIS PROG.RAM The major objectives of the Northeastern New York Regional Arthritis Program are as follows:. I. 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 Droa,iam. Lee E. Bartholom,-T@7. 14 1) . Projn-tt Dirg"o-r, Protessor of Medicine and Head of the Medical Specialty Division of Rlieumatology, 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 p above were chosen for the original arthritis programs. Glens Falls is a small city of approximatel 18,000 people in a 4.1 square mile area with a population y density o@ 4,463 pet 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 popi4lation.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 '7or Glens Falls. This pliysi- cidn 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 Postgrad6ate Medicine... Four hours AMA continu'ing.education credit was offered. The program incltid(!d discussions on evaluation of patients with rheumatic 'diseases, pathogenesis, and treatment of rficuin,-3toid arthritis.. It also included diagnosis and management of pAtients with systemic lupus and polymyalgia rheumatica and diagnosis and treatment of crystal- i.nduced syndvitis. The program was attended by eight physicians from the Glens Falls Area and was successful in orieiitLiig physicians of that area to the Ding- nostic and Treatment Center in Glens Falls. 0 3 mately one-half day per clinic. Clinics are held in the DepLirtmelit of Physical Medicine where examining booths and patient waiting areas arc available. Appoint- ment's are made by the secretary at the Department of Piiysicztl Medicine, while the pliysician-director is responsible for medical and -tdininistrative arrangements Through the Northeastern New York Chapter of the Arthritis Foundation, volunteers have been working in th6.cliiiics-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 Rh@umatology, Albany Medical.College, two Physician Therapists and other interested physicians who often accompany their patients. During each clinic six to eight new patients are evaluated by one of the Rheumatologists and receive complete history and physi- cal examinations. Appropriate blood studies ate 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 present 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-6linic. 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 L that a clinic will be held one day each month initially. A board-certified in- ternis t has been appointed assistant director with organizational responsibilities. A board-ce rtified Rheumatologist from the Mary Imogene Bassett Hospital in Cooperstown.-New York will be one of the attending Rheumatolo ists,, and will serve as an assistant director. A member of the Division of Rheumatology 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 anticipated that all p..atients will be referred by their physicians, many of i,ihom'will be in,attendance with their own.patients. At the beginning, a limit of eight hew,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 interest in Rlieumatology. 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 originally planned. 4 III. T.he 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. Personnellin 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 Rheumatology Fellow and two attending 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 party payment Carriers to arrange mechanisms.for re- imbursement to these clinics, THE UNIVERSITY OF ARIZONA' TUCSON, ARIZONA 85721 COLLEGE OF MEDICINE ADDRESSREPLYTO: ARIZONA REGIONAL PAEDICAL PROGR. AR17ONA REGIONAL MEDICAL PROGRAM 5 572 E. STH STREET TUCSON, ARIZONA 2571 I SUMMARY 3 S=CES PROGRAM Director: Warren Benson 3813 East 2nd Street Coo@ator: Beth Ziebell Tucson, Arizona 85716 T'he project@was proposed.to develop a network (center) Of diagnostic, treatmnt and rehabilitation services for arthritis patients and their families in the rural c ties of Southern Arizona and in a PresentlY radically underserved mdel cities population in Tucson. 5 I'hls networic-'Will include the services of the Southwest Chapter, The Arthritis Foundation a Tucson based mrrber of the national organiza- tion, as well 'as the resources of other public 6nd private arthritis related health services agencies throughout the area. The project will pass on special knowledge and skills 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 Arizona. This will stay .with the c ties, to be reinforced by Continijlnir (,.nn-hq(,i..-, wi@h fpnm 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. @or health'center. -1. A Tucson Interagency Liaison Condttee composed of individuals and representatives from'agencies participating.in network services. The ncson Interagency Liaison Comdttee will meet at least quarterly during the project year. Individual co@ttee Tmmber will be called upon to provide counsel and services to local communities. The role of the Liaison C6ndtt'e'e is perceived as consultative and as a vital com- munic,4tion link with their organizations and the local condttees. It will also be responsible for evaluating project nrogress and ipipact. 2. Since a @or strerv.,,th of this project will rest in its ability to-inotivate local comunities to mobilize resources.and to fonfl linkages.to existing services, local c(rnunity condttees All be fo@ied in each participation tarftet area-. These coarnittees will be made up of representatives of organizations such as Health P Councils, Councils of Government Services, Medical Societies, hospita administrators and the Cooperative Ex- tension Service, as well as allied health personnel, con'smers, in- te.rested laymen large eWloyers, educators'and others. The evaluation-of- this project will be conducted by Pima Health Systems (PHS), an expe@ntal health service delivery system program,, ORGANIZATIONS EXPE@ TO COOPERATIVELY PARTICIPAAE IN PROGRAM IMP ATION 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.fleilth Sciences:Serve on Liaison Comdttee, 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 @unology 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 in4workshops c. Department of Surgery Participate in workshops 3. Crippled Children's Service Provide consultation services Provide surgery for children 4. College of Agriculture Cooperative Extension Services Assist in the recruitment of community leadership for member- ship on local committees.. Assist in the identification of patients and families needing no-twork'services. 5. 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 facilities for physicians' in-service training program. 7. Pima County Health Department Tucson Liaison Committee Liaison to other county medical societies. 8. Pima County Medical Society Tucson L iaison C@ttee Liaison to other county medical societies, 7 Health Planning Council Tucson Liaison Committee Ongoing review of project objectives 10. Pima Health Systems Tucson Liaison Condttee Project evaluation 11. Councils of Governrrent Serve on co@ty comdttees 12. County Health Dep@ments (other than Pima) Conbunity c@ttees L3. qotlth Tticson/Model Cities.Project (arm of city government). Serve on Tucson Liaison Condttee Identif'y,indigenous comunity leaders whose.awareness and involvement in the project will increase utilization by minority groups to be served .,14. United-Way (Comunity Service DiVisi on Serve on Liaison Co@ttee Raise funds for continuation of.progm 15. Easter Seal Society Serve on Liaison Committee Transportation services .16. sisters of H Clinic Serve-on.Liaisbri Co@ttee Ref6rrals to clinic. 17. Veterans Administration Hospital Lend facilities for in-service training 18. VisitJ.ng Nur-ses Association Referral of patients for 61inic services Dissemination of educational materials 19. Arizona Regional Medical Program Provide-ongoing fiscal supervision., program.monitoring., and evaluation Serve on Liaison Condttee Po. Departrwnt of Economic Security Serve on@Liaison Condttee Training and rehabilitation'services @loymnt 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. Community colleges Use project personnel as resource materials B. Secondary schools Schedule speakers for health education classes 23. YL-dia Representatives serve on Li,31son Committee and local c@.ttees Provide outlet for educational prograndng Publicize local meetings 24. Family Service Agencies Serve on Liaison Condttee Provide services to arthritic patients and their fandlies SPECIFIC SERVICES: 1. CONSULTATION CLINICS: We provide visiting teams to rural communities on a re @ ar basis. 'Rheumatologst Social 14orker/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 piooiosis and outline treatment (d) Consultation with the patient's physician concern@ not only disease management but environwrital, social, mchanical factors, work simpli.cation and the like. 2. PHYSICIAN TRAINING PROGRAM: One-wwek intensive clinical experiencein Rheumatology in Tucson for twenty physicians fran the six southern counties. Twenty physicians from the six southern counties will participate in a one-week, intensive c@cal. experience in arthritis in Tucson. The physicians will be under the jurisdiction of the administration of the Arizona Medical Cneter. This pro All include attendance in gram 9 the out-patient arthritis clinics in the Arizona Medical Center, the three.existing clinics operated by the Southwest Chapter, the clinic at the Pima County.liospital, and the Veterans A@istration-Hospital. Local rheumatologists 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 Family of the Arthritis Patient Conference for Ancillary Health Personnel MINI-WORKSHOPS In rural communities: One-evenirig programs designed for continuing education of physicians and allied health personnel. 5. 140ME 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 family, and the home as to possible changes, innovations, and modifications,. alorkr, with the prescription and purchaze of materials and equipment that will make it possible for tIhe patient to function at a higher level of independence in the home environment. B. To make available 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 about new developments coordinated home care and self-help devices for the arthritis patient. 6. EwcATIOiqAL MA Use of Mark IV projectors with cassettes illustrating handling @of the patient-with Arthritis. Appropriate pamphlets for patient education 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 regimn in the management of arthritis. Distribute thro@ the Arthriti.,,, Foundation tl-ir,(@e (@.I,flit-intriute color film5 which have already been produced for use In nursing stations (as an example) to teach health personnel proper tranage- rwnt of the arthritis patient. Identify 1,500 additional persons to receive the Chapter's Newsletter. 7. OTJT-PATIENT CLINIC: A comprehensive service utili.zed by presently medically underserved patients with arthritis and their families in the Southern Tucson/Model Cities area. Illo assemble a professional ste.ff, including a part-time rheumtologist, a part-time nurse, a full-time physical therapist, a full-tim resident in rheumatology, a rehabilitation counselor, and a full-tim home modification specialist to provide a demonstration weekly clinic and ongoing outreach services throughout the term of the project to the South Tucson/Model Cities areas of Tucson. Through the demonstration clinic, the patient's needs for radical care, occ c ivitie@ of.dail upational therapy, physical therapy, and a t y living will be assessed. ARI SAS RE4 GIONAL MFDICAL PROGRAM Evergreeti Place, Sijite 215, Evergreen at University, Little Rock, Arkansas 72207 Roger J. Warner, Coordinator 501-664-5253 Through the grant for.tne 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.py-ovide a networl,, of@interrelationships for the dissemina-. 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:,' 1. 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.establis6ed in eight of the larger communi- ties of the state (Fayetteville, Harrison, Jonesboro, Mountain Home, Camden, El Dorado, Texarkana, and West 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 consulting rheumatol'ogists 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 a program at the State Convention of Arkansas Pediatricians in May, 1975, to insure that the'pediatricians of the state.are aware of the most recent developments in the detection and treatment of arthritis in children.- 2. A statewide program of public education will be instituted to itistill 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 committees in each county, coordinate an all-media educational program in each district, as@ist the local clinic sponsors in arranging consultative visits, and assist local physicians in arranging referrals for secondary and tertiary care. In addition, the educational coordinators will'work closely with the area-wide Health 12 Pi the.Arkansas Rehabilita on SeF@ices and -the Arkansas anners,, soc' Services in order to advise patients as to the financial and rehabilita- tive assistance th3t is available to them through governmental agencies. An incoming Wats 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 gain access to-the system. The,Arthriti,s 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 series 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 tile 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 Quantity of physical- therapy services available to arthritis patients. The orogram 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 a4, State College of Arkansas and give him three months intensive practice in post graduate training in the care of arthritis patients at Leo rl. Levi 'lospital in Hot.Springs, Arkansas. After completion of trai-ni national e wi I' be assigned to the same duties as the Foundatioh's present thera- pist, permitting an ex pansion 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 con duct two 2-day demon- stration workshops in arthritis physical therapy to indoctrinate the 73 physical therapists now working in Arkansas in the special techniques useful in the treatment of rheumatoid arthritis. The Project Director is, @.0on Riggin, Executive Director of the Arkansas;Chapter of the Arthritis Foundati.,on,.Post Offic-e@Box 125, Little Rock, Arkansas 72203. 13 CALIFORNIA REGIONAL MEDICAL PROGRAM- (A Non-Profit Corporation) 7700 Edgewater Drive- - Oakland, California 94621 Telephone (415) 635-0290. Project No. ROP-74E-165-154C 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, CX 94616 Project'Staff James Castles . M.D. ; Robert Shapiro, M.D.; Barry Brian, M.D. an RN; I.Physical Therapist; and a Secretary 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 physicians who will be encouraged to provide the primary care for arthritic childrdn.. Methodology Paramedical personnel i-iiii be ut4ilized for patient evaluations in order to maximize the time that the two available rheumatologists will have for direct patient care. OULWCZI I VI t, IL Ml Li ltC PCJ I C3111CU I @CS I IJU I Z)VI II IIC I WI II IJICI I UI III I U IiL)W-Up t::Vcl I Uci LI Ul I U@ patients in conjunction with theie primary physicians. Pu'bl ic and private agencies whose input might assist the arthritic child and his family will be identified and Utilized in, ordier to maximize total care. This includes the possible development of satellite clinics in the area. Progress Clinics are scheduled for every other Friday at the U. C. Davis si@te. A referral 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's 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-166-154D 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. Engleman, M.D. Project Address : Division of Rhcumatology, School of Medicine, U.C.S.F., 3rd and Parnassus, San Francisco, CA 94i43 -Project Staff : Brenda Spriggs, M.D.; Hope Snowhite, P.T.; Carol Lavine and Gwen Ciewle y, Social Workers; Nurse; Secretary; 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'cohduct demonstration teaching programs in selected community hospitals which are diverse in geographical location, patient population and organizational structure. Progress Audit criteria for the follow Ing forms of arthritis have been developed and are currently in use: a. systemic lupus erythemastosus d. ankylosing spondylitis bo gout and,pseudog6ut e. Reiter's syndrome co rheumatoid arthritis f. juvenile rheumatoid arthritis 2. The following hospitals have been contacted and clinic plans arranged as follows: a. Valley Medical Center Regional Medical Program in Arthritis, Fresno - Working. rare providers will be the family practice residents and one medical student. Project assistance will be provided,through the design of varied programs depending on need of the clinic and social service consultation. The clinic will meet every other week. b. 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-patient 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) pliysi- clans currently pr oviding care at the hospital, Project staff! 'is attemtp,ing to coordinate the Physical Medicine Department with the Arthritis Clinic. d. Children s Hospital, 0a.kiiand - 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 b y the project staff oncea month in consultation rounds held by the outpatient department. Funding Period 9/l/74 8/31/75 Date December 3, 1974 Project 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. Mary Is Hospital and Medical Center, Hayes and Stanyan Streets, San Francisco, CA 94118 Project Staff : Richard Welch, M.D.; Kathy Gomez, Admin. Asst.-, Patient Education Department;.-and a consultant staff of four physicians. Objectives St. Mary's Hospital and Medical Center proposes to provide diagnostic consultat on 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 compohents,of patient self car plus assistance in utilizing community rehabilitation..ahd 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 @tting long term treatment goals for both clinic and private arthritis@patients. As of November 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 I Project No. : ROP-74E-@o8-l541 Funding Period: 8/i/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 nut-se, 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 Rhetimatology 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 arthriti@ 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 3- @ Sijiii.. ;I@sp;tal b,i@ White i"ieiiiui I @l "-C3 I , C3 @ LiIC 3 IC 0 1 K; 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/i/74 to 10/31/74 Thus far, @he 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 breakin 9 appointments. The nurse will begin her work on the project in November. Involvement of Community Organizations The project has not yet been actively involved with community o rganizations. 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. Date December 3, 1974 Project Title Treatment and IEducation Program for Rheumatic Diseases Operating Agency: Orange County Medical Center Project Director: Michael Reynolds, M.D. Project Address Department-of Medicin'e, Orange County Medical Center, 101 The City Drive, Orange, CA 92668 Project Staff Physical Therapist, Occupational Therapist and a half-time nurse To increase services at Orange County Medical Center Arthritis Clinic, Orthopedic C I i n I c and a t Commun i ty C I i n.i c (a sa te I I i te of OCMC) by d i rect i ng I 00 c I i n i c v i s I ts per month to a ph sical therapist, 60 visits per month to an occupational therapist, and 30 y patients screened per month by a nu.rse, 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 Orange. County (one for physicians and one for a] I led heal th personnel concerned with the comprehensive treatment of rheumatic diseases. Methodology The three new staff members-will 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 i.nitial 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, phy sical 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 @isits; ordering or fabricating aids on 18 occasions -@peatedly attending the Ar All patients r thri.tis Clinic at OCMC are being seen by the therapist for evaluation and revision'of their personal physical the rapy programs, including routine daily activities Is well as f.ormal 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 spate 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. 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. Objectives To establish a two-way communication channel for the referral community physician, to establish teaching 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 care. 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 arthritis 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 throug out 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 of a skit. Seven sessions were given with approximately 300 nurses attending. Also, for the 'hospital staff, Dr. Emori presented a case and.discusged the diagnosis of arthritis during grand rounds on'November 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. Bailie 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 Oblectives To establish a system of cost evaluation for the Arthritis Clinic University Hospital 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 Clinici 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's progress and needs during rehabilitative care. Also, it should@-". 4-k,+ 4-k- nT @lt4 OT Pi ro @f f Pr' ress rroq The primary activity of this project thus far has been the development of the "Art hritis Activity Assessment" form. Numerous drafts and pre-tests were necessary to insure that the form was valid and reliable. The therapists participated in developing the form and will be the key people completing it for each patient@ 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 tool 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 Dr. Welch in San Francisco. They will review it and decide whether it is feasible foe 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 will 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'the OT and PT will be able to begin working clinics at Mercy Hospi.tal next-month. They are also in the process of planning the home visit program. 20 involvement of Community Organizations The San Diego Arthritis Foundation is aware and supoortive of this project. Currently, r they have assisted by providing small donations, including furnitu e. One viomon, 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 Reprasented Address and Phone Ms. Phyllis Annett, RN Allied Health Association Golden Gate Nurses 1155 Pine Street San Francisco, CA 9440S 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 Drivei Chairman San Mateo, CA 94401 415-342-9068 James Fries, M.D. Data Systems Specialist Department of Medicine Stanford Univ. Hospital Stanford,, CA 94305 415-497-6001 Mr. Robert Geller Easter Seal Association Division ol 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 Hwy. Downey, CA 90242 213-922-7464 Ronald L. Kayei, M.D. California Medical Association Palo Alto Medical Otr. 300 Homer Avenue Palo Alto, CA 54301 415-321-4121 James Klinenberg, MiD. Arthritis Foundation, 4833 Fountain Avenue Los Angeles Chapter Los Angeles, CA 90029 213-662-9111 X-131 Ms. Betty 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--@t- 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 4311 Wilshire Blvd. Los Argeles, CA 90010 213-938-6111 Dr. Ronald Restifo Arthritis 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 Schelch@r Arthritis Foundation, 1507 21st Street Satramento Chaoter Room 205 Sa' cramento, CA 95814 916-447-3248 Ms. Addie Thomas Social Worker 2421 Foothill Blvd. LaVerne, CA 91750 714-593-3383 22 CENTRAL NEW YORK REGIONAL MEDICAL PR9GRAM 716 Eost Washington St., Syrocuse, 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 Euston phone: 315-473-5820 phone; 315-422-8174 Summary of Activities A. 'Upgrading the level of patient care at the principal referral facility, the Arthritis Clinic at Upstate Medical Center, Syracuse, New York. 1. Training a Nurse Clinician to deal with top -nroblp.Tn-, r)f' with stable chronic arthritis, individuals who would benefit from a 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 problem-otiented 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). 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. Holditg 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.house officers in the value of interaction between various disciplines in clinical and social problem-solving. 23 B. 'Professional Education in the Rh,(--umatic Diseases 1. 'Holding regular clinics and conferences in major cities in the Central New York region for physician'edudation. 2. Training a,team 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 therapyl, 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,:.Tew 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 Ltica model, directed primarily at diag.nosig-and therapeutic reco=endations for the individual patient, will be established in Watertown. Clinic sites: tjtice. Cbildren's Hospital and Rehabilitation Center, Utica', New York 13@o@' Binghamton bimonthly at: C;".S.-Wilson Yerorial Binghamton General 33-57 Harrison Street Mitchell Avenu@ Johnson City, II.Y. 13790 Binghamton, New Yorl- 13903 coordinator: Dr. Vincent @laddi Ithaca Tompkins County Hospital, Ithaca, New York 14850 Watertown .4 site not yet determined 24 COLORAL)(.) WYOMING REGIONAL PROGRAM Estoblis4gd Jon 1, 1967, under Public Low 89-239 to Combat Heart Disease. Cancer, Stroke, Kidney Disease and Related Conditions Su.to 410, @tonLlin Mc,,!,col Building o 2LI45 Franklin 5tre@-I * Ucry.,r. Coinra(lo 80205 i3O3) $92-9527 Thomas A. Nicholas, M.D. / Executive Director 0 Robert C, Jones, M.D. / Program Director COLORADO-VNO14ING R93IO1,LAL ARrn-IRITIS PROGRAM S Report - December 6, 1974 lloy L. Cleere, M.D. lrir-.five cr,.@- enen4k-ls included in the Colorado-lelyo,.ning Re@onal Artlix,itis ProCrmn are: 1. f,;@iaFemnt office 26 Pv,Llu-I.tis Division, Universi+.-y of Colo.-ado !@dical Center 3. @nver ociic-ral libsp'.tall Dep@t@nt of Health and Hospitals City of Denver It. Arthritis 'I'reatmnt Center@ C@neral Rose I,'iermrial )iospital 50 fic@onal Arthritis Centers, Coloraco and Vlyoraing Sponsoring arencies: Ti-,e Arthritis Fo,.mdation and University of Colorado @;edical Center Collaborating aeencies (in addition to those listed above): Colorado and Wyoning Health Departrm-nts Color@icl@i,.',voming Reiricnal I-edical Pro@. Colorado and WyoranG f@edical Societies County or District 1edical Societies I%L,,p,ose and objective: To uperade the'au4lity of the diaMostic procc.@clwes anti prely--ilrivc- care of the arthritic patients in the tvio-state areas oL@.Colorc-.do and ';Iyo,,-AnE; and to @e this i.=@oved imdJcal service,. mm widc@ly available, TrLis Rei-,io-val Arthritis Program is staffed by specialists from several. arthritis ui ts ii-i the DL,,,iver f@',ctropolitan area, most of v-iom arc, with th@ faculty of the Llnivei,sitv of Colorado Center. 'iliis is the only te,,.chinr I.'!c(,'I.cal Centex, in these two @.-tates. It is Liter-r--Iated with other m@dical and hospital facilities and with the traalti! professionals; Fhysicl.ans, Public Health staff3.,'Iurses, Physical qicrapists, @eu I @rapists and Social ',-.Iorkers whose services axv needed to make good . p,,itiona arthritis care available and acceptable. 1. Vanarc-rent, Of fice Ad,-r-J-nJstr-ator - Roy L. Cleere, M.D., r4.P.H4 VL-dical Coordinator - Jairre F. R.-avo, M.D., Rheunatolo@st Adrdnistrativ@ Secretary,- I.'.arianne Sevier Offite: 800 Clerrrnt Street, #41P Dcnver Colorado 80220 Telephone: 303-3@22-5944; This -office will be I the base of oneral.-icA-1 of the Dro-LTarz being conducted in several 'different partici-,)at*linr, institutions tnd the local @as served. Res-cnsibility is also assu7ed for coo tion of services reridci,ed by the -,L-vL-rLL1 d=cienk,.s. ,%L,dical Coo@,,tor has direct respcrsibil-ilty for or,.,@zin- t@e services of the @lth professicrals to staf f t,-,e re -@i cnal- c@' ts i ,-,d ccc-@4-rates t.;,,ese cut-macn c@cs with the Adrdnistrators of ",,-e affiliated and co-socnsot-ing aCencies. 25 Mic fJn-incial Action of the project will be ccntercd in ti-.ir, ol,fl-ce. Al.,,-,hou,3h a@i.istration.-c" the pro[ li A - - Is the xv,--pcn-l-bility oO t@,is c.,'fi--c, tndirect sutlerAm visiui is raintained.by an AdrrJnistmi@.ive Cc:-r-,iittee, corpcs@,fi o't' ei,-,-Iill Vey perso.-.@' .n,c,@n Colorado ,-nd Wycr.LirC,, including fotl- p!iysic@s, ac Ch@..@, is f-r. .;',c',.,ert I-'P.l,rick p.,-o-,bient Denver who is also the President of Arth-r@tIs Foundation (Rocky Ybmtain Chapter), Close liaison is also @&-iined with the offices of the Executive Director, Arthritis Foundation; wid'the Regional I!jcdical Program. Arrangemnts.for Regional Clinics and Vlorkshops-for physicians and other health 'professionals are Trade by.the @gemnt Office. A working relationship has been established with Dr. David M-ills., Rheunntologist, who is conducting a special study on the cost of care for arthritics. ii...University of Colorado 1--ledical Center, Arthritis Division: Acting Head,. Dr. David 14ills, who also serves as RhewTatologist for VA Hospital .Address: 4200 East 9th Avenue Denver,,Colorado Telephone: 303-394-7592 A bio-chendst is eppl@ved in the Arthritis Division to work under the supervision of Dr. Jams Steiger%,ald, full-tifm RheLmatologist in the Arthritis Division. He has set up new diagnostic procedures, effective Noverrber 1974, as a service to the affiliated hospitals and the.eight.centers where Arthritis Clinics have been conducted, A clerk-typist has also been.added to the division. @s position is filled by a'..- person familiar with the recording of arthritis scientific data. She works under the direction of Dr. 14ills with respect to use of record forrm and data analysis, She also assists Dr.. Bravo, e first workshop for the eight Regional Medical Coordinators was conducted at this f,)edical Center on Noverrber 22, 1974. Seven of the eight were in attendance andIwhich was also attended by rwrrbers of the Panel of Consultants who conduct the teaching and consultation clinics.. Faculty rwitbers of the l@iedical School were the guest lecturers. Additional's workshops and seminars will be held in the future. In this way, the local coordinating physicians were brought up to date with the latest diapnbstic-techniques and diagnostic mthods at a teaching centeri At this meting, there was an opport-mity for free exchan-@ between the teachers, the local radical coordinators and t.@ adrLLnistrative staff. In this Aay, ideas for changing future clinics and Lanel sessions, evolved. III. Denver Departmnt of Health and Hospitals Arthritis Unit - Dr. Jares Steigerwald, Rhe@tologLst @lephone: 893-6000 Five arthriti,c-orthopedic beds are available at Denver General Hospital. The 'Denver Ncirhbo@nood Health Centers will also be u@L-ili-"ed in the consultation- @teaching services 26 A nurse who has had advanced training as a liurse-practitioner has been added to the staff at Denver General. S.@ has also attended two to three weekly Arthritis CLihics at the University of Colorado radical Center and Denver General Hospital. Her services have been useful in conducting clinics in the affiliated hospitals located'in the ReC4cnal Centers. 'rhe requests for services of Nurse-practiticner-o by local nurses have substantially incm3zcd. IV. -General Rose N',ewrial Hospital - Arthritis TreatiTLnt Center 1050 Clermont Street,, Denver, Colorado 80220 Medical Director - Charley J. SrVth, 14.D., Nationally Recognized rheumtologist and formr Head Arthritis Division, University of Colorado @dical Centeri I @lephone: 303-320-2480 'Tais now center will provide 22 beds for arthritis patients, who will receive the most modern treatmnt. The building is constructed as a-model unit for the care and rehabilitation of arthritics , It is physicially connected with the p@icial rmdicine and rehabilitation department of the hospital, A well-qualified nurse-practitioner is an addidtional verrber of the staff of this center. She has also received special training in-arthritis patient cam as a Tmnber of the rehabilitation team at General Rose @rmrial Hospital and she has also attended two to three Arthritis Clinics each week at the University of Colorado f@'edical Center. @s nurse-pratitioner has.also served as a team imn-ber at several visits to the Regional Arthritis Clinics, V. Regional or Can=ity Clinics. It was necessary to strenthen the so-called Ilin-reach" Drograms in several of the Denver institutions in.order to render the required consultation-teaching.. servces in the "out-reach" areas, The early success of this pilot demonstration project has depended on the effec- tiveness of the servic 3 rendered to the physicians, other health professionals and arthritis patients in the selected regions& -Each of the eight centers have y instance conducted one teaching-ccnsultation clinic and the reception in ever has been excel"Lant and much appreciated. Taking into consideration, detrography and accessibility, the following eight c ty centers serving regional areas in the two states were selected Colorado: Sterling - North East Pueblo - South and South East Grand J@ction - Central @,lestern Slope Durango South West Wyoming: Sheridan North Central @rmiopolis - West Central Casper Central lararde South 27 Before launching plans for clinics in the eiffnt regional centerso the proUw plan was presented '. to the Presidents,and Speakers of the House of Delegates of the Colorado and wyondng f-jedical Societies. Tneir support was solicited and the program, received the endoresefjbht of both societies, axis is considered of mjor importance in getting these prog=z accepted. O,ubsecuently.-the Presidents of each of the eight local Alliedical Societies were asi(ed for assistance in the selection of the eight regional radical coordinators. In every case, these leaders of the caTpomnt radical ,,-ocieties offered their full cooperation. Listed are the nams of these coordinators: Colorado--Charles A. Hanson M.D., Pueblo Kemeth.Beebe, 14,D., Sterling Deai L. Furry, M.D., Durango Roger Shenkel, M.D., Grand Juncticn VlyoWng-Se@,inour Tnickrran, M.D., Sheridan R. David Reith, r@I.D., @.ermopolis Joseph Murphy, M.D., Casper Lloyd Evans, 14.D.,'Larwnie In addition to the clinics scheduled in the selected regions, it is planned to offer lectures by consultant team rwn-bers to other mdical and health professional groups. In this way, additional co@ties will be reached by this out-reach educational pro@, One clinic has been conducted in each of the ei@t regions. The team mnbers conducting the clinics included a rheunatologist, ant orthopedist, a psysiatrist. and riurse-pradtiticner,, Ilhe Regional Medical Coordinator 4ssumd t he responsibilitiy for local arrange- mnts with assistance from the ilamgemnt Office. He arranged for use of a local hospital and collaborated with the physicians in his region for selection of patients to be referrred to the clinic. As evidence of the exceptional response by physicians and other health professionals to the lectures and. clinics held thus far are the following: (1) One-hundred fift -nine physicians, sixty-six nurses and twenty-two other health professionals y attended lectures during the eight regional progrags; (2) oiie-liundred tvientv-ttire-e physicians, fifty-eight nurses and thirty-six other health profiessionals attended the eight clinics and (3) a total of 54 patients were seen, it is the consensus following the clinics that not over six patients should be referred to the clinic -team. IMs would allow mom tire for, detailed discussion and physician. consultations* Follovi-up service is also planned for patients seen at the clinics. Repeat cltnics have,been conducted in Grand Junction and Laiande on Decerrber 3, 1974, Although definite pro@'ss has been achieved in rweting stated objectives, a cont:Lnu- @ review of the pro@ will be conducted. 28 addition to an evaluation based on n @ rical count of physicians and other health professionals who have attended c@cs and patients seen in clinics, other criteria for evaluating the prof7am will be explored For instance, it is desirable to ascertain v.,I)cther health professionals and arthritics have developed a F_mater awareness with respect to modern concepts of diaE7iosis and trL@atmnt. V@,tticr, also, there is in- creased utilization of existing facilities and resources for care of arthritics during the tenure of the demonstration prot,7,am. lias the aLLility and aLLintity of hom health cam services improved and has there been an increase in the use of the services of nurse-practiticners and other physician-extcnders needs to be determined. Also, of pri@ ijTportance, will be an analysis of the costs for conducting this type of an out-m-,ach prorxam in @,,o states where population centers are separated by long distances which require air travel. Greater. Delaware Valley Regional Medical I-rogram 551'WEST LANCASTER AVENUE HAVERFORD, PENNSYLVANIA 19041 (PHONE) 215 527-3220 G!I,f,@%TER Dl,'Ij@l,,IARE V,@1,LEY REGIONAL MEDICAL PROGRAM Al)@'riJIt'ITTS CONTROL PROGRAM Director: Medical Dir(!ctori ',-:;Arren Salnion ToilrLollottL,, M.D. CDMIP Arthritis Control Program Section of RfieLlmatology C/o liatineminti Medical College Temple University 1"05 Race Street, 4th floor I:1 School. of- M(-,dicine Philadelphia, Penns' 4 Broad and Ontario Streets ylvania 1910 Philadelphia,.Pennsylvania 19140' PROGRAM SMLARY: The Greater Delaware Valley RMP @he fiscal year, 1974-75 to carry out the overall pilot arthritis program consists of five component parts: 1) Facilitating the Development of Arthritis Demonstration Clinics; 2) Professional Education to Expand the Responsibilities of Physicians; 3) Training Allied Ilealth Arthritic Care Teams; 4) Patient/Family Awareness and Independence; 5) Pediatric Arthritis Initiative. The Piogram's design has been based on the principle of regionalization of rheumatological resources through a multi-institutional effort to permeate the entire twenty-four counties of the Greater Delaware Valley. A unique 0 collaborative effort joining the five Philadelphia medical schools with nonprofit hospitals and the Arthritis Foundation of Eastern Pennsylvania has been achieved in the Program and in the formation of its policy-,making body, the GDMIP Arthritis Control Program Council. The existing structure of the Greater Delaware Valley RMP has been utilized to enhance program 29 development and major activities are conducted at decentralized locations to establish new and upgrade existing capabilities in arthritis diagnosis, treatment and rehabilitation. Efforts are continuing to be made to promote cross-fertilization of ideas with the other 28 RMP funded 'pilot arthritis programs, and some significant success in building relationships among pediatric projects have been developed. )@ll'ONENT: FACILITATING TIIE'DEVELOPMENT OF ARTHRITIS DEMONSTRATION CLINICS Director-. Charles D.. Tourtellotte, M.D., Professor of Medicine and Chief of Pheuma'tology, Temple University School of Medicine and ilospJ.til, Philadelphia, Pa. 19140. 1.@m oneiit Summay_y: Tlid Arthritis Doinoiistrition Clinic (AI)C) component rel)rc.,icnts the niijor thrust of the GI)V',Z".IP Artliriti.,; (.:Ofltl:ol Prol,ram. Its objectives vary according to local iie(ids for improved arthritis care delivery,. Clinic programs have been: 1) developed wliere nonexistent; 2) imIroved where ].imited capability exists or sl@il.l,(-d diagnosis, treatment p and rehabilitation; and 3) streni,,tlic, ii(2d full capability and responsibility exist.,; for arthritis care deliv(!ry and education. A serious c ort has been made to create and ,;t-.rengtheii- patterns for coordination of existing local resources, ADC's and the Arthritis Clinl.cil Reseircii Centers to provide a rational, efficient,- and quality delivery system for Irtfirit-is Ind allied d,i,;or(l(!rs. An idditional objc(.-tive-has been to foster a multidisciplinary proft@.,,sional approach with supportive illied health specialists in the t!iana@I,(--metit of all- levels of arthritis care delivery. The ADC's are.conducted throughout the Region in areas largely removed from the university medical centers in Philadelphia. Seven ADC are operational-(exclusive of pediatric clinics) with designated team leaders-- Allentown Hospitali Allentown, Pa. Dr. George Ehrlich; Allied Services Institute, Scranton, Pa..' Dr. Charles Tourtellotte; Cooper Ilospital, Camden, N.J., Dr. Sheldon Solomon; Gnaden Huetten Hospital, Lehighton, Pa., Dr. George Ehrlich; Miliville Hospital, N.J., Dr. Charles Tourtellotte; Monroe County Hospital, E. Stroudsburg, Pa., Dr. John Martin; Wilkes-Barre General.Hospital, Pa., Dr. Rodanthi Kitridou. The frequency of clinics ranges from 1 to 4'sessions monthly. The program of the ADC is somewhat variable according to the pre-existing capability and self-sufficiency status.for arthritis card in each locale. In each implementation, however, there is full'utilizat,ion of the other Arthritis Control Program Components and resources fprofessibnal Education; Allied Health Professional Training-, Pediatric Arthritis Prog;am; Patient/Family Awareness Program). Patients are ev aluated in the ADC's upon physician and/or appropriate health agency .referial. The patient problem thereby serves as the medium for either direct preceptorship and/or larger group instruction of physicians and allied health professionals. Exemplary patient care is provided, but as an indirect 30 result of primary emphasis upon education. More structured instructional programs are typically@a regular feature of the ADC for both professionals as well as patients and their families. Educational materials are those which have been developed over the years in university medical centers and by the Arthritis Founddtion. Staffing of the ADC is similarly somewhat variable according to individual community needs, but requires significant local physician involvement for successful operation and continuity beyond the proect year. The visiting team leader coordinates the program and i assi.gns visiting consultants as the program evolves. Community personne and existing health care programs are utilized to the maximum extent possible, so that working relationships are established and improved.. A self-assessment examination has been developed to assist in improving professional awareness of arthritis knowledge levels.@ C-0i,frONENT: PROFESSIONAL EDUCATION TO EXPAND RESPONSIBILITIES OF PIFYSICIANS Director: Warren Katz, M.D., Chief of Rheumatology Medical College of Pennsylvania, 3300 Ilenry Avenue, Philadelphia, Pa. 19140 Component summary: The intent of the Professional Education Component is to increase the awareness of family practitioners, pediatricians, internists, and orthopedists for the multiple diagnostic, therapeutic, emotional and social problems,of pa-ti@nts with reliematic disease. The major thrust for this education is provided by consultation to practicing physicians in each of the Arthritis Demonstration Clinics. At least one hour-is allocated for professional education at each AI)C geared to prol)!.oms in treating rheuniatological disorders'in,.patients rather than the disease approach Lecture/Demonstratiotis have been designed to cover a range of topics. Additionally, three re@,,ional seminars in locations convenient to practicing' physicians throughout the Greater Delaware Valley are scheduled for Spring to cover A coni lete ranF,,e of disease topics. Coordination with tile Allied p Health Care Team component and the Pediatric Initiative component of the GDVW4P Arthritis Control Pro,,r@,im has been successful in these seminars to provide a multispecialey and interdisciplinary orientation. CRR@ATER DELAWARE VALLEY REGIONAL MEDICAL PROGRAM ARTHRITIS CONTROL'PROGMK CO',4PONENT: TRAINING ALLIED HEALTH ARTHRITIS CARE TEAMS Director: George E. Ehrlich, M.D., Arthritis Center Albert Einstein Medical Center York and Tabor-Roads Philadelphia Pennsylvania 19141 Component Summary: Many allied health professionals, while otherwise proficient, are.inadequately trained to understand the total management of rheumatic disorders. Therefore, this component undertoIok to fill. these training needs with specific reference to the,Arthritis Demonstration Clinics and also with independent programs to provide training sessions throughout the Region directly aimed at all allied health professionals to promote an interdisciplinary Iteam approach to arthritis care, treatment and rehabilitation,.- 31 The nature and local of activities includes: 1) On-the-job training demonstrations at the Arthritis Center, Albert Einstein Medical -Center. (AFMC) and-Moss Rehabilitation Hospital in Philadelphia. 2) Training sessions in conjunction with the Arthritis Demonstration Clinics. 3) Special seminars in conjunction with professional education sessions--- three are planned, in Philadelphia, Atlantic City, and the Pocono Motititzti ns area. 4) Lecture sessions in conjunction with colle es of allied health 9 professions and area health education centers, at these centers, at neutral sites, or at the AEMC Arthritis Center. Training programs have been devised thit permit allied health professionals nd vocational rehabilitation in nursing, physical and occupational therapy a to participate in the day-to-day activities of the arthritis center, AEMC as observers and active participants. In addition, lecturc-demonstrations have been designed to fill in the identified gaps in knowledge. Educational materials' for curricula include books and pamphlets (privately Published p or published by the. Arthritis Foundation), reprints of salient articles, outlines and instructional materials specifically devised for this CDVRMP Arthritis Control Program, and established problem solving techniques. Assessment of results is made by, individually directed questions and by evaluation of performance. The book, Total Management of the Arthritic Patient, (J.B. Lippincott, 1973) under the editorship of the Project Director, serves as a basis of the training program. The Arthritis Foundation, the Bureau of Vocational Rehabilitation of Peniisylvanin tile Department of Vocatioll;ll Rehabilitation of New Jersey, the Creater Philadelphia Chapter of the R(@liztbilitzition Nurses' ArsociaLioil, tile colleges of allied health pr ofessions at Temple University and the University of I'L@titi.,;ylvaiiia, the nursing schools of participating irca hospitals, and local diiapters of physical therapy and occupational therapy organizatio tis provide. platforms and community resources to assist with this program. GREATER DELA14AR.E VALLEY REGIOKZAL @IMICAL P ROGRAM ARTIlkITIS CONTROL PROGRAM '%"O,"IPONENT: PATIENT-FMIILY AWARENESS AND I?,\TDEPENDEN.CE PROJECT Dire'ctress: Rodanthi C. Kitridou, M.D. Directress and Associate Professor Divi@ion of Rlieumatology Hahnemann Medical College 230 hTorth Broad Street Philadelphia, Pd. 19102 Component Summary: The project was created with the following objectives: To inform rheumatic disease patients of the nature of their illness, to emphasize the available therapeutic means and motivate, patients to seek specialized care .1 reeducate the patient and family of the impact of arthritis and adjustment requirements; also, to emphasize that the 'ultimate goal of the therapeutic teamwork is independence of the arthritic and rehabilitation and retraining. At the same time, the project mechanism provides: 'for a forun for the@ patients' and family members' expression of idea, fears, misconceptions and experiences. 32 Concurrent with the conduct of the Arthritis Demonstration Clinics, patients and family members gather with physicians and allied health professionals in an informal group discussion dealing with the above objectives. Informational material for patients is disturbed (the Arthritis Foundation booklets and pamphlets) and self-care and home-making aids are demonstrated. A list of literature for rheumatic disease patients is also made available. The Demonstration Clinic leader is responsible for moderating the discussion; however, it is expected that allied health professionals and local physicians already involved in these clinics will eventually take over. the leadership under the auspices of the Eastern Pennsylvania Chapter of the Arthritis Foundation. COLMPONENT: _MDIATRIC ARTHRITIS INITIATIVE Director: Balu Athreya, Clinical Director, Children's Seashore Ilouse, Atlantic City New Jersey Component Summary: The. purpose of the,Pediatric Arthritis Initiative is to upgrade the Pediitric Arthritis Clinics at Child-ren's I-losl)ital of Philadelphia,, St. Christopher's hospital for Children in Philadelphia; and Children's Seashore House in Atlantic City, New Jersey; and to lend support to the other Arthritis Demonstration Clinics throughout the Region to provide Specialized sensitivities necessary for the management of arthritis in children. A special effort has been made to build cooperative and collaborative relationships with the Pediatric Departments in the Philadelphia medical schools to encourage their developing Freater capabilities in arthritis -are. Specific consultation is bein@, provided to the other program components of the GDVRMP Arthritis (control Progrim to r(!iider pediatric applications to the physician and allied health training and patient/ family awareness projects. A uniform pediatric arthritis case sheet has been developed which is being implemented at the Pediatric ADC'S, the other ADC's in the Region, and.hopefully by various practitioners and pediatric clinics of hospitals and medical schools. Correspondence with other DRMP funded pilot arthritis programs has provided acceptance of-the case sheet by two pediatric projects. Regional Seminars in pediatrict arthritis care will be conducted in three areas of,the Greater Delaware Valley in the Spring to reach family and pediatric practitioners and related allied health professionals. A nurse coordinator is conducting a demonstration in-homei program to meet the unique needs of children suffering from arthritis and their families. 33 ia'l-.'Medical Program 938 PEACHTREE STREET. N.E. ANC R, STROKE AND @TED. DIISEAMS ATLAN' , GEORGIA 303 PHONE (404) 876-SMI Arthritis Regiooal Facility Emory University School of Medicine Atlanta, Georgia Charles H. Wilson, M.D. A. The general objective of this pilot demonstration project in arthritis is to achieve improved arthritis care by increasing the number of arthritis patients served and by improving the quality of services pro- vided, using as a vehicle the development and implementation of a close working relationship between a large medical school and a community .:hospital. 'k.; This Arthritis Regional'Facility project at Emory will work closely with a large community hospital, The Medical Center in Columbus, Ga. The Regional Facility staff will spend a significant amount of time actu.ally working with Area Facility staff on site in Columbus, assisting the Area Facility staff in improving patient care in arthritis in The Medical Center. This will include multidiscipline Regional Facility staff members, each of whom will be responsible for assisting his counterpart on the Area Facility Staff. In addition, Area Facility staff will spend a significant amount of time working in the provision of arthritis services to patients in the Regional Facility, working along with Regional Facility staff at the Emory University arthritis clinic at Grady Memorial Hospital in Atlanta. Besides working in direct patient care, staff of the Regional Facility will institute specially @ailored programs of training and continuing education for Area Facility staff, some of which will take place on site in Columbus and other programs will be.held at.the Regional Facility site in Atlanta. Regional Facility staff will work closely with Area Facility staff in developing and instituting long-range programs of continuing education in arthritis for health professionals in the Columbus medical service area, so as to extend the improvement of arthritis care beyond the walls of The :Medical Center. Regional Facility staff will also increase the number of arthritis patients seen in the Grady Memorial Hospital setting, by virtue of increased staff size, and will attempt to improve the quality of Care through the addition of a more complete complement of the necessary disciplines -- e.g., PT, OT, Social Services -- to work with the physician and nursing manpower. C. Related staff at Emory, including University resources in the area of patient and family education, as well as cooperative,efforts of the Georgia Chapter of The Arthritis Foundation and the Georgia Rheumatism Society. 34 Arthritis Area Facility Memorial Medical Center, Savannah, Georgia Theodora L. Gongaware, M.D. ect in arthritis A. The general objective of this pilot dditoYrlftlgtlon prqj er of is to a6hieve improved arthritis care by increasing the numb arthritis patients served and by improving the quality of services pro- 1 ment and implementation of a close vided, using as a vehicle the develon school and a community working relationship between a large medical hospital. B. This Arthritis Area Facility project at Memorial Medical Center in Savannah will work closely with .the Modiqal College of Georgia in Augusta. The Area Facility staff will be assisted on site in Savannah by staff from the Regional Facility, in improving patient care in arthritis at Memorial Medical Center. In addition, Area Facility staff will spend a significant amount of time working in the provision of arthritis services to patients in the Regional Facility, working along with the Regional Facility staff at the Medical College of Georgia arthritis clinic. Area Facility staff will also participate in Specially tailored programs of training and continuing education, developed by the Regional Facility staff in response to Area Facility staff needs ' Some of this training will take place on site in Savannah and some: will occur at the Regional Facility. Area Facility staff will assist Regional Facility staff in the development and implementation of-long-range programs of continuing education in arth- ritis for health professionals in the Savannah medical service area, so as to extend the improvement of arthritis care beyond the walls of Memorial Medical center. Area Facility staff will increase the number of arthritis patients seen at Memorial Medical Center, by virtue of increased staff size, and will attem t @p to improve the quality .of care through the addition of a more complete complement of the-necessary5;dlilsciplines--- e.g., PT, OT, Social Services to work with the physician and nursing manpower. C. The Medical Center will provide patient and family education resources, and related staff especially that,of the-physical rehabilitation pro- gram at Memorial will participate in this project* 35 Arthritis Regional Facility Medical College of Georgia Augusta, Georgia Joseph P. Bailey, Jr., M.D. A. The general objective of this pilot demonstration project in arthritis is to achieve improved arthritis care by increasing the number of d by improving the qual6ty of services pro- arthritis patients served an I vided, using as a vehicle the development and implementation of a close working relationship @etween a large medical school and a community hospital. B. Thi.s Arthritis Regional Facility project at MCG will work closely with a large community hospital, Memorial Medical Center in Savannah, Ga. The Regional Facility staff will spend a significant amount of time actually working with Area Facility staff on site in Savannah, assisting the Area Facility staff in improving patient care in-arthritis at Memorial Medical Center. This will include multidiscipline Regional Facility staff members, each of whom will be responsible for assisting his counterpart on the Area Facility staff. In addition, Area Facility staff will spend a significant amount of time working in the provision of arthritis services to patients in -the Regional Facilit , working along with Regional Facility staff at the MCG .Y arthritis clinic. Besides working in direct patient care, staff of the Regional Facility will institute specialty 'tailoted programs of training and continuing education for Area Facility-staff, pome of which will take place on site in Savannah and other programs will @,6 held at the Regional Facility site in Augusta. Regional Facility staff will work dlosely with Area Facility staff in developing and instituting long-range programs of continuing education in art@itis for health professionals in the Savannah medical service area, so as to extend the improvement of arthritis care beyond the walls of Memorial Medical Center. Regional Facility staff will also increase the number of arthritis patients @seen in'the MCG setting, by virtue of increased staff site, and will attempt to improve. the.@L@ of care through the addition of a more complete complement of the necessary disciplines -- e,g. PT, OT, Social Services to -work with the physician and nursing manpower. C. Related staff at MCG, including MCG resources in the area of patient an family education, as well as cooperative efforts of the Georgia Chapter of The Arthritis foundation and the Georgia Rheumatism Society. 36 Arthritis Area Facility The Medical Center Columbus, Georgia M.D. Howard vigrass2 A. Ttle general objective of this pilot demonstration project in arthritis itis care by increasing the number of is to achieve improved arthr and by improving the quality of services pro- arthritis patients served. vided, using as a vehicle the development and implementation of a close en a large medical school and a,cdmunity working relationship betwe @pital. 84 This Arthritis Area Facility project at The Medical Center in Columbus will work closely with Emory University in Atlanta. The Area Facility staff will be assisted on site in Columbus by staff from the Regional Facility,'in im- -proving patient care in arthritis at The Medical Center. In addition, Area Facility staff will spend a significant amount of time working in the pro- vision of arthritis services to patients in the Regional Facility,.working along with the Regional Facility staff at the Mwry University arthritis .clinic at Grad Memorial Hospital in Atlanta., y Area Facility staff will also participate in.specially tailore programs of training and''continuing education, developed by the Regional Facility staff in response to Area Facility staff needs. Some of this training will take place on site in Col@us and some -. will occur at the Regional Facility.- Area Facility staff will assist Regional Facility staff in the development and ,implementation of long-range programs of continuing education in arthritis for health professionals 4n the Columbus medical service area, so as to extend the improvement of arthritis care beyori4 the walls of The Medical Cehter4 Area Facility staff will increase the number of arthritis patients seen at The Medical Center, by virtue; of'increased staff size, and will attempt to improve the quality of care through the addition of a more complete complement of the necessary disciplines -- e.g., PT, OT, Social Services ---.to work with the physician and nursing manpower. C. The Medical Center Will provide patient and family education resources# and The Family Practice Program at The Medical Center will be working closely with this project. ,the efficacy of this pilot approach to D. Do,bumentation of the improvement of arthritis care in Georgia, both in terms of quality and quantity. 37 Regional Medical Program of Hawaii@'/ 77'0 Kapiolani Blvd.- Suite 706, Honolulu, Hawaii 96813, Phone (808) 531-6525 PROJECT 69, PILOT ARTHRITIS PROJECT The' School of.Medicine of the University of,Hawaii, in coop- eration with the Regional Medical Program of Hawaii, and the Hawaii Arthritis Fouadation began'the project September 1, 19@4, and will terminate it on August 31, 1975. The budget is $216,000. The Arthritis Center of Hawaii is based in a community hospital, Kuakihi Hospital, 347,N. Kuakini Street, Honolulu, Hawaii 96817, a -250-bed medical surgical facility. It is estimated that 80,000'patients suffer from.arthritis in Hawaii and 15,000 in the Pacific Basin. The need.in Hawaii is for improved diagnostic'treatment and rehabilitation services to arthritis sufferers. The' obj ectives and related activities are threefold: (1) A multidisciplinary approach to referral, diagnosis, evaluation, and .treatment recommendation of arthritis patients in a clinic setting; -f t%ZL.- - n t-u uuL.LyjLrig and raciric Basin areas at a later time;and,(3) the training of health personnel and medical students in the care of arthritis patients.. The first of these three programs is in progress at three weekly half-day sessions. Two sessions per month are at the kauikeolani Children's Hospital on juvenile rheumatoid arthritis and other arthritis affecting children. The approach is a direct appeal to community physicians to patients to the center for complete evaluations and recommendations for treatment which the physician may subsequently carry on with his patient. On a consultative basis, community physicians with rheumatology training, orthopedic surgeons and pliysiatrists are in clinic attendance at least one if not two times per month.. The Project Staff includes Melvin Levin, If.D.,Rlieumatologist, Medical Dir.ector*with Dr. Eugene Lance, Orthopedic.Surgeon and Dr. ,Raquel Ilicks, Pediatric Rlieumatologist, as part-time members. The Adminis.trative Director is Henry Thompson,,@I.A.. Other staff mem- bers are Assistant Director, Patient Services Coordinator, Patient Care Speci alist (R.N.), Registrar, and a part-time social worker, physical therapist,.and occupational therapist. November-26, 1974 38 American Samoa, Guam and the Trust ;Territory of the Pacific Islands al Medi Intermountain Region cal Program University of Utah Remrch Park 540 Arepeon Drive, Room 201 - Salt Lake City, Utah 84108 (801) 581.7901 Purpose' The general purpose of the Discrete Arthritis Activity is to design and establish a "Pilot Arthritis Center" with a health care delivery system of procedures and activities which will 1) favorably affect the provider's management and treatment of arthritis care;. 3) improve patient compliance to prescribed treatment regimens; and 4) increase awareness of existing resources available to providers and consumers in their communities. Nature and Locale of the Activities: The nature of the activities are: 1) establishing consultative arthritis clinics for the purpose of enhancing the providers' knowledge of arthritis treatment thereby improving the accessibility and quality of care and 2) providing educational programs for patients and family members to favorably affect patient compliance and use of existing resources. Pres- ently, the project and the local chapters of the Arthritis Foundation are working with six (6) communities (two each in Idaho, Nevada and Utah) -sustaining clinic in establishing ongoing , self s and patient education programs. Methodologies: Presently, six communities (Boise, Pocatello, Idaho; Las Vegas Re I no, Nevada; and Ogden, St.'George, Utah) have been selected as initial sites for the project's activities. Specialized rheumatology services are not available in these communities. Therefore, a local physician has been identified in eac h community to serve.as a coordinator for the project in that community. Allied health personnel (R. P. T. , O. T. , Social Worker, and- R.N.) are also identified to establish a local arthritis health care team. Consultative clinics and patient and family education sessions F-tl,c then scheduled in the community with consultants (provided by the project) attending to assist the local team in caring for arthritis patients and, consequently, improving its capability in delivering arthritis care. The format followed has been for the referring physician or the community coordinator to present the patient to the arthritis care team of local pro- viders and consultants. The patient is then examined and/or evaluated and a comprehensive treatment program prescribed'-by those involved. The 'patient'is then referred to a patient and family education session to provide the patient and his family an understanding of the treatment program. 39 With limited resources . for. such a va st area, there wa s a need to bring available resources together in a cooperative effort of improving the arthritis care in the three state area. Therefore, a non-treatment center, titled the intermountain Arthritis (.;enter has been established to coordinate, manage, and promote arthritis 'care. Furthermore, by establishing the Intermountain Arthritis Center, it 'was ossible to make application for a provider number. This gives the Inter- p mountain Arthritis Center the legal base needed to bill third -party insurance carriers and welfare agencies for services rendered. This, then, is the first step.in making the activities of the project income-producing and as the program expands, self-sustaining. Proposals have been submitted to the Medicaid and Medicare agencies requesting approval of-the medical services provided. Additional proposals are being prepared for submission to other third party carriers requesting reimbursement approval. IV. Source of Materials: The supply of quality materials available for use in arthritis clinics and - educational programs has been found to be very meager. Materials have beenireceived from the local Arthritis Foundation and drug representatives. Presently, we are combining the patient materials into a vioricbook w,iL.-Ii will become the major source of information for the patient in the patient education program. In addition, a patient committee has been initiated to advise'the project staff as to comprehensiveness and appropriateness of the materials being used. V. 'Community Involvement: Each initial community was selected on the basis of available community interest and resources. Physicians, therapists, social workers, and nurser, were identified depending upon availability and interest in providing ir.,i,-lroved arthritis care. Local state health age ncies, i.e. , vocational rehabilitation, home health, -etc. .were contacted and requested to support a nd participate as,well. The State Chapters of-the National Arthritis Foundation have been very in- strumental in the implementation of the project activities.. They have been very helpful in developing the local support and making the local arrangements for the clinics and the education sessions in their respective states. It is anticipated that eventually the education sessions will be provided entirely by-the state chapters. - 40 - In addition, meetings leave been held with each state's health officers and the program e;,plained. Enthusiastic support has been given in all three instances which has been very encouraging and beneficial to the project, specifically in procuring the support and involvement,of other state health agencies. Further information miy be received by contacting the Project Medical Director, Steven J. Anderson, M.D. , I.R.M.P. , 540 Arapeen Drive, #201, Salt Lake City, Utah 84108, BOi/581-5537. IOWA REGIONAL MEDICAL PROGRAM Oakdale Hospital . Oakdale, Iowa 52319 The University of lovva - (319) 353-4018 The Iowa Regional Medical Program is currently funding "A Program for Im- proving Arthritis Care". The Department of Orthopedic Surgery, University of Iowa (U of 1) College of Medicine, Iowa City, is the sponsor. M. Paul Strottmann, ikl.D., (Assistant Professor, Orthopedic Medicine, l@est 100 Children's-Hospit,al U of I, Iowa City, Iowa) is the project director. The budget is for the period July 1, 1974, through June 30, 1975. The objectives of this activity are: 1. To establish a clinic that will demonstrate hiah qLialitv specialized care of ambulatory arthritic patients in a community setting. Z. To establish at a Des Moines hospital a clinic to serve' arthritis patients in Central Iowa. 3. To expand the ability of the Rheumatology Unit of the University of Iowa Medical Center for providing highly specialized care to patients referred to the unit with arthritis or related conditions. 4. To develop physician education programs dealing with the, diagnosis, treatment and rehabilitation of persons with ,arthritis and related conditions. 41 care clinic for s b-- To meet the fiT t 0 jective, a demonstration patient ambula- to-ry arthritis patients has been established at the Muscatine Community Health Center, Muscatine. The focus of this demonstration unit is on providing clinical training to the denter's physicians, allied health personnel (physi- cian 'assistants and nurses) and'medical students'on rotation through the-clinic. An arthritis patient clinic has been established at Broadlawns Polk County. Hospit4l, A comprehensive medical center in Des Moines, to meet the second The clinic is staffed by the project director and a rheumatologist objective. from Mason City, Bruce Trimble, M.D., and offers arthritis patients diag- nostic and treatment services otherwise unavailable in Central Iowa. To meet the third objective of this project, the U of I Medical.Center's Rheumatology Unit has.significantly increased its ability to meet,a growing anded its program to tr demand for specialized arthritic care and has exp ain physicians in roviding this care. A rheumatologist is-giving 60% of his p time and two orthopedists. are each giving 25% of their time to such training and arthritic patient care-. This arrangement is increasing the coordination. of the Rheumatology Unit and the Department of orthopedic Surgery in jointly providing arthritis patients .with quality comprehensive treatment,and in teaching current arthritis treatment techniques to medical students and physicians. .A statewide educational conference will be held to better acquaint physicians with the diagnosis and treatment of the arthritic patient. This one-day con- ferdnce will be conducted during the spring of 1975. 42 -KA('J!3AS REC-@IONAL- !NEI; @ I 7 NJEOICAL PROGRAM 4125 RAINBOW KANSAS CITY, KANSAS 66-103 -(913).831-5100 The Kansas Arthritis Centers Project administered by Kansas Regional Medical Program is jointly sponsored by the Kansas Chapter of the Arthriti .s Foundation, the University of Kansas School of Medicine at Kansas City, Kansas, and the Veterans Administration Hospital of Kansas City, Missouri. Project headquarters ate in the same building,as KRMP at the University.of Kansas Medical Center in Kansas City, Kansas. The Kansas Arthritis Centers Project is establishing an arthritis information and evaluation unit (IEU) in each of four major population centers throughout the state of Kansas. These 1E.IJ's will be based and staffed in the following locations: Name of Director, Unit nurse and city Institution and Address Telephone Number Kansas City, KS University of Kansas, Robert Godfrey, M.D. School of Medicine Project Director 39th and Rainbow 4125 Rainbow Kansas City, Kansas 66103 Kansas City, kansas,66103 (913) 831-5371 Daniel J. Stechschulte, M.D. Associate Project Director Department of Medicine, KUMC (913) 831-6oo8 IEU Nurse Virginia Wolfe, R.N. Department of Medicine, KUMC (913) 831 -5687 John Lynch, M.D. Topeka Topeka-Shawnee County Associate Project Director Health Department 1001 Garfield 1615 West Eiqhth'street Topeka, Kansas 66606 Topeka, Kansas 66606 (913) 357-0301 IEU Nurse Geneva Panton, R.N. Topeka-Shawnee County Health Department (913) 233-8961 43 E. Dean Bray, M.D. Salina St. John's Hospital Associate Project Director P. 0. Box 214 s 67401 .311 North Mill Salina, Kansa Minneapolis, Kansas 67467 -2144 (913) 392 IEU Nurse Loretta Kreie, R.N. St. Johnis Hospital (913) 827-5591 y Branch Frederick Wolfell M.D. Wichita Wichita State Universit Associate Project Director 'ity of Kapsas, Univers School of Medicine 345 North Hillside Wichita, Kansas 67214 u Faiemo n.t Towers (316)' 685-1335 222i North Hillside Wichita Kan@as@'67219 IEU Nurse Marjorie Wilbur, R.N. WSU Branch 89-3144 (316) 6 arthritis nurse specialist and a full- The units will. be staffed by a full-time one-half month intensive course mpleted 'a three and time secretary. The nurses co ries will in rheumat6logy and IEU operation on November 27, 1974; and the 5ecreta IEU operation at the University of Kansas Medical complete a one-week course. in ill be directed 'and supervised Center dIuring the week of December 16. Each IEU.W pears above, as I rheum6LOlogi'st,' whose name ap on a part-time basis by 6 loca Committee 'will be made up of associate-project directors. The Pro.ject Executive ' I enlative of the Project Director, Associate Project Directors, as well as a repres the :'.ansas Chapter of the Arthritis Foundation and of the KRMP. The arthritis nurse specialists have been.trained to have a broad@knowledge of the major rheumatic diseases, as well as having considerable skill in collecting and re- cording history and physical assessments utilizing the data base recently evolved by the American Rheuniatis"m Association@ and comparable with the automated and semi automated format currently in use by the Rheumatic Diseases Division at,Stanford University. While-the arthritis nurse specialists we re compi et i ng the i r t rai n i ng program, the unit directors supervised the establishm ent of the IEU physical sites. In addition they have recruited local phys-ici .ads a'nd.Allied Health Professionals who wish to serve as consultants and arthritis care team members. They have also recruited as large a panel as possible of physicians and allied health professional who are willing to accept referrals from, @nd possible make referrals toi the IEU. The IEUs will serve as a highly visible point of access for-information about and entry into the existing local health care system. They provide individual and group informational services to arthritis patients and their families either at the request of these individuals o@ preferrably upon referral from their private 44 physician. They also have the capability of providing initial or ongoing history and phys i ca I assessment ei the r pre Iimi nary to referra I to a private phys ici an or subsequent to referral by such physicians. A primary role of each IEU is to offer coordination of the various team members recommendations for management of an indivi- dual arthritic patient as a supportive service for participating team members or co- operating referring physicians. If requested to do so, they are capable of es- tablishing, evaluating and monitoring a patient's individualized "basic )rogram" with a coordinated progress report going back to the referring physician and other involved allied health professionals to simplify continuing follow-up by team members. Consultant and participating team members are conducting team staffing demonstrations at least twice a month in conjunction with the IEU staff and unit director. Al] area physicians and allied health Professionals are invited tn ntfpnd send nnef;,;nntn ;m these demonstration staffings.both as a means of professional education as w@ll as improved patient care. Every two months one of the four IEUs serves as host for the other units, and will conduct a "super staffing demonstration." These meetings will' include an outside guest speaker as well as discussion groups and workshops for physicians and,allied health professionals. Individual IEUs are also encouraged to develop and conduct group classes on ar- thritis in conjunction with the Kansas Chapter of the Arthritis Foundation. They are also being encouraged to develop and implement other types of physician education programs that are particularly suited to their local area. Project evaluation and coordination is the responsibility of the project director acting with concurrence of the Project Executive Committee. Evaluation of the nurse specialists training program h'as conducted with pre and post testing for factual knowledge as well as trainee and faculty evaluation of each phase of the training process including direct faculty supervision of patient evalua ion and basic program monitoring in the Arthritis Clinics at KUMC and the KCVA Hospital and finally in the KUMC IEU itself. When the individual IEUs become operational on January 6, 1975, a complete log of unit activities will be kept as well as evaluative information from patients, physicians and allied health professionals. Evaluation and progress reports performed by the unit. staff will be.sent to the project headquarters in Kansas City for processing and/or recording. The numbers and types of patient and physician contacts with the units as well as the units response to these contacts and the individual evaluations of the quality and valIue of these responses will form the primary basis for ongoing evaluation of the project. Educational Support The Division of Immunology, Allergy and Rheumatology of the Department of Medicine with the assistance,'of the Department of Physical Medicine and Rehabilitation and the Department of Orthopedic-Surgery provided most of the faculty and resources for the nurse specialists training program as well as the project director and the KUMC IEU director. F inally, the Division of Nursing Education at KUMC provided a large segment of the Arthritis Nurse Specialist Training Program by including these trainees in the history and-physical assessment segnient@of their Nurse Practitioner Training Program. The Arthritis Nurse Specialist Training Program concluded on November 27, 19744 The individual IEUs will become operational on January 6, 1975. 45 'We believe that the foregoing fairly summarizes our plans for the Kansas Arthritis Project-a's well-as our current status and some of our plans for ongoing evaluation. We suspect that our plans wi II. have much in common.wi th many of the' other projects and knowing the, common features and possibly by incorporating some of the uncommon, but generally suitable ideas- of others, we are confident we can evolve a coordinated evaluative methodology that will permit' not-only an organized and meaningful consideration of the present.program over the next year but also assist in implementin -and exp odin q_qptional arthritis centers prograin in the. future. NIETROPOLITAN WASHING-FON 2007 Eye Street, N.W. REGIONAL MEDICAL PROGRAM 'Nas[iingtoii, D.,C. 20006 Telephone: 202/@23-8050 t 6 Prograin Coorditiator Vaughan E. Choa Project: "Pilot Arthritis Center in the Inner City" Hospital Center Location.- Washington N.W. 110 Irving Street, Washington, D.C. 20010 Director of Werner F. Barth, M.D. Chief, Section of Rh6umatology Project: Objectives: of inner city patients with 1) To'd,evelop, strengthen, and improve the care arthritic.diseases. - ces and treatment not currently available a. provide medical servi, to these patients. ehab6litation develop a planned,program of patient education and r I c. train a registered.nurse as a rheumatologic nurse-practitioner. d. develop a system to iynprove patient compliance and present paiiient loss.. th a wider range of social problems, e. to Assist patients Wi ec-'--'s- of their disability. specifically those p@tients out of "oVs"'b au e 2 To determine the magnitude of arthritis problems in the inner city rheumatol6gical disorder a. define the relative frequency of.various .in the inner city. b. define the needs of -inner-city patients for arthritic management. these needs. c. determine the cost of 46 Activ I ty: The Washington Hospital Center proposes to collaborate with the.Shaw Community Health Center, a primary care facility, in a joint effort, in offering better care to inner city patients using the facilities and resources of both Centers. The Shaw Center is serving a target population of 80,000. Twelve percent (or 11500) of all clinic visits to the Center are artliritis-related. The Washington Hospital Center will use a multi-disciplinary approach to both diagnosis and treatment. The medical team will consist of the prime investigators a rheumatology fellow, eheumatolopy nurse, two rheumatology attendants, a physical therapist, and an orthopedic attendant. Other needed supportive services, such as social services, will be provided at both Centers. The Metropolitan Washington Regional Medical Program has established a Community Arthritis Technical Review and Advisory Committee with its members representing providers and consumers. This Committee will be active througl)out the tenure of the project's activity. .Project: "Comprehensive Care Programs for Arthritis" Location: Freedmen's Hospital-College of Medicine Howard Universi-ty 6th & Bryant Streets, N.W. Washington, D.C. 20001 Director of Kenneth 1. Austin, M.D. Project: Assistant Professor of Medicine Chief, Division of Arthritis Objectives: The Medical Center proposes to establish a Comprehensive Care Program for the arthritic wherein would be provided in-patient service (medical service of Freedmen's Hospital), clinic service (arthritis clinic of Freedmen"S Hospital) and home care services, The overall objective of the program are relief of pain, long range of deformity, and maintenance of the patie'nt's role in society. Activity: A. (1) Develop and embark on a publicity campaign to educate local physicians, paramedical personnel, neighborhood health centers, social agencies and the public concerning the availability of the services provided by the program. (2) Identify, beginning the current clinic population, those patients who are not attending clinic (arthritis or physical therapy) as often as would be desirable for optimum benefit because of +,-heir physical limitations. 47 (3) @Detdrmine whether patient requi res to be placed on home care program wi t h visits 4y physitian's,assistant, nurse, physical and occupational therapist 'd ome and provide public health nurs an social worker to-visit patient's h es,, homemakers and health aide services when required Edueate.patient and family in planning health care to offset.negative aspects of arthritis treatment due to lack of understanding, poor motivation, oor@pbysical arrangements with hom ive attitude of p e, or ntgat family, members. .Plans have been made to have periodic haring sessions between both s project Directors and MWRMP Arthritis Advisory Comniittee. It is felt that these sessions will be Very helpful'in coordinating total arthritis. activities; .MICHIGAN. 0 IATION Ass c FOR ID m PROGRAMS &vEGIONAL EDICAL. ',/E..-EAST LANSING, Mil@HIGAN 488,'3,TELEPHONE 517-351-0290 SUITE 2CC.11.11 Kli@-MIGAN A 'TER' IC-l,IrAN PILOT rFRIATRIC ARTHRITIS CE@, SU!I.MARY DESCRIPTION of ,,-,,ichigan Center is to conforrp with the t!le Universit, ---e--all a-tir4-tis thrust initiated in ReOional Mcdica,l Programs and e. @TDoss4,ble b%, the 1974 Conqtessional earrnark of $4 01500 TOOO. The C;b-i,e-ct4@ves:cf rilot arth'ri@,is'center loatient care activities were treatment b@, a dc-'in(-,d t,,),include irnroved diagnosis and -"I@,d'sc@rlinarv tearilutilizing conservative nianacei-.ert in the leas tion core settirc-to achievp- Prevention, delay aid.re.duc u.-ictic,@-, disability and loss of -ain, i-,ss -3,F ion -are should be delivered to a defined,nopulat hritis center has -i@cTitcd these 7 inilot C-eria@Lric Art or its .'tarqet pon-ulation, defined as "residents of settle s V., mi'chican, at least 55 %,ear.s oLa acT@, N..,ho have rheum cour,;t- nrobl---r.-,." As a second objective the Center was to @e a model c rthritis care which in its efficic!lcy and effective- c ead replication. nes:, -v.-6uld bc- s.ui-te-bi-b.. for wide.,,.r 48 th'Ls Cp-nter a co,,nnrehensive approach is taken tc) rescl,,re- unn-tet o;@ t!ie arthritis natient, especially tl-,ose ou'. of reach of '-,c.a'.th ser,.,4-ces bv reason of infirmitv, remote deogranhic location o-r liniteL', financial re-sources. The service program eri-,-)hasizes a ;,Oli-stic OIL the older nerson and his needs. A spectrum of '-eal-.h rrc@essionals -)a.-ticliDate in delivering service. Ut-'Llizinq @he team arnroach, onnortunities exist for cooperative vlaniiiiig and t 4 z-artici-)a @on bv physicians, a podiatrist, nurses, social scientists and @,,rorkers, nh@,sical and oqcu ational therapists, a nutritionist, p counsellors, 'administrators and others v;ith experience in the health services. Es-Lablishr.-ett of the Center entailed expansion, elaboration --.nd corrn,-,nit-@., orientation of services available in the Arthritis D4-vi,s;-cn, Denar4t-ment of Internal Medicine, Tiniversit-,,.- of ;"@Lichican .iedical Center. @7".cencies represented on the Advisory Board and care staff include '&--'-Ic.,Prthr:L--is Division and DeT)artment of Postgraduate @,ledicine and Health Profession Education of the University of r4icliiaan "-ise.1cal Center, tie -Tn.stitUte.of Cerontology, the School of ilubiic Health, 2. Guidel;-nes and '.Revie-vy Procedures for Arthritis rroarari, BliRD, I ' P.,AJF PIIIS. zebruarv 21, 1974., pr) 3. 2i or,. ro I Coiintv Health Department.and the Arthriti-q FounOPt:.-),,. Th@- Council c,,n Aain,7i, Incort,)or,.ated t, ,a,. t has rvi ci,l ,c),)i2l-ation of t!-,e acec3 :@,-i L 11 n 0: I,, , r, 1. n e7 C r) I' r",,U n, I-,I L e.1 ar, resource, assur' rr,,)aram develo -t --service t j-Le i -ii son -t- c? zu---or,t, prr-en -- and direc + .3 C-, r a r those who are members oi- a mineral..,:, arou;@, I-ow z! n 46nalized. n cc,,@-e , r) rL--insti-tuti L o n s -- f @ sirce i.*--i L-eainninq, includ-'-i-c, 2 n @.he.program his become a functioning, effe--til,,e and recognized Arthritis service. Prrcf@-@i:Ti U)i.rector is: ',.@@.n Du f f @-1. D. L"rofessor of Internal @'@edicin,-- an-@4 in k-@harce, ..?arthritis Division, Uni%rersit,- P-xin A.-@or, '@lichioan, assisted bv 5 Co-Directors t,7ho coin.,-.rise -in F -mittee. The,i are:- -V xecuti e CoTr. C. iec;:er, P..P.-L., Ph.D. , for Health 49 ,,..ne L. Barnev, Institute of C-,erontolo.c,, :for Geriatric Services 0. L,,nn Deni-ston .@l. P. H. School of Public Health, Proararii in@K,eAlth Behavior, for EvAluation Poland r,. fliss, !'.',.D., Denartment of Postaradua,te Medicine, ,for Lducation Wil.'Liam M. ',".ikkelsen, M.D.., Arthritis Division, for Healt',.i So r,,- ice Delivery of the Executive Committee are reviewed bv an 1 8 me.-,.b 6 r Comn-turiitv advisory Board rcDresenting consumers (including rroqram Clients) and Providers Inr)ut from the community to careful ta4--ional ni-ar.r,inq of'the Progrc-& and,its'associate4.ohysical and so6i-,-l e-iiironment will be significant to development of a Pilot Center of .excellence,. Tl:-e Center, !-troaram has'3 components: health service deliver-.-, educa- .li-.o.ri o--F -atient, family-and provider and program evaluation. E,.,alua- tic,,n.%.i,as.not r-ermitted-'b@, the sponsor- but,@we considered it so al hat" 9 sehtl t alternative fundin for this.component his been ob+-- ained., - 50 MISSISSIPPI REGIONAL MEDICAL PROGRAM 880 LAKELAND DRIVE JACKSON, MISSISSIPPI 392i6 (6oi) 362-73II T. D. LAMPTON, M.D. COORDINATOR The Mississippi Pilot Arthritis project is an interdisciplinary approach to patient care involving the cooperative efforts of physical and occu- pational therapists,, liaison-nurses and nurse practitioners, biomedical engineers, vocational rehabilitation counselors, orthotist and phy- sicians from several specialties. These personnel will enable the delivery of comprehensive bare to the arthritic patient at one location and will prevent fragmented care by several individuals often working independently Of each other. There will be two satellite centers in the north and south part of the state. These centers will be staffed by a team of paid specialists who will screen patients, consult.with local physicians, and make referrals to the Jackson Rehabilitation Center. Special efforts are also being made to educate patients and the public concerning arthritis. 'Vidbotapes will be developed and there will be a special arthritis day at the-Mississippi State Medical Association. The long range goal of this project is to,cause physicians in Miss- issippi to become more acutely aware of the arthritic patient and to know what services the new Methodist Rehabilitation Center can provide on a referral basis. 50 A ICAL PRO NEW MEXICO REGIONAL MED GRAM, 2701 FRONTIER N.E. 0 SURGE BI,DG. r-3 ALBIJQUERQ[JE, N.M. 87131. -'N,rER Pi IONE 505: 277-3434 0 Al"I'liELJNMIII',AI,I'IiSCIENCESC), Pilot Arthritis Project New Mexico Regional Medical Program 1. Eurpose and 0 jectives The improvement of the quality of care for the arthritis sufferer in New exico: A. The identification of persons with arthritis in the outreaci-i area th rough ontact and coordination with existing 1-iealth-agencies. c B.. The introduction to the health care system of those persons with arthritis by information and. referral and the facilitation of third party payment when ossible. p C. The improvement of the quality of care for the arthritis sufferer through education activities at all levels (patients and their families, All@ied Health Professionals and physicians).. II. Nature and Locale- (New Mexico population - 1.016 million, area -121,666 square miles) A. I he opening ot the main ottice at Albuquerque, New Mexico (population - 300,000; location - Central): John M. Hunt, Administrative -Director 114Amherst, S.E. Albuqueruqe, New Mexico 87106 The establishment of two pilot center offices and placement of Cbi-nmunity Resource Workers.. One in Taos, New Mexico (population 4.-,000; loca- tion - North Central) at Holy Cross Hospital: Donald E. Holden, CRW General Delivery Taos, New Mexico 87571 One in Las Cruces, New Mexico (POPLilation -'C)5,000,- location-South- Western): JoAnn Marquez,'CRW 21.1 West Griggs Las Cruces, New Mexico 88001 0 51 . B. The composition of a Traveli ng Resource Team (Rhournatologists, Ot-tho-. pedists', OTR., RPT) to serve as consultants to private I-)I.Iysiciatis in the outreach areas (local OTRs and RPTs are being LISfz-ld ZIS telill Illembei-s). C. The developtiient of tli@ training tea;-n (RIIL-Lil-,IItOl(.)@JiSIS, 01-tilOp--CiiStS, RNP OTR, RPT, Psychiatric Nu'rse),to be used in Albt.iqLl(.@rqLie, Las Cru' ces, Farmington (Northwestern), Portales (SOLltl,.Ieasterti), @ind Santa Fe (North Centra-1). -Specific training programs include physicians via,TRt- one FNP tin yeai- long Rheutnatology training at Albuquerque, tilt-ibe day work- sho s for.FNPs and PA's, day long workshops for R@is, LPN.S, OTRS, RPTS, and other AHP. Patient and patient family education.programs in conjunc- tion with TRT and A[iP training visits. Ill. Sources and, Einployme6t'of'E-ducation Curricula Training programs developed by the University of New Mexico School of Medicine, Department of Medicine, Division of RheLiMatology. Procurement and distribution of Arthritis Foundation literature and audiovisual. material for.patients AHP, and physician education as well as the preparation arid pro- duction of the new material. IV;. Cominunity Resources Involved A. Statewide - The New Mexico Chapter of the Arthritis Foundation (Medical wer Registry and.' a and Scientific Cotimittee), RMP - Manpo rel'ted programs, New Mexico Association oftiot-ne Health Agencies, Indian Health Set-vice, Division-of Vocational Reliabi litation, State. Health Agencies (Statc! Depart- ment of Public Health) New Mexico Nurses Association, and Sc@iools of B. Taos - Taos County Unit of the Artiii-.itis Foundation, private pi-iysicians, liol y Cross Ht)sljrital,'HSSD, Indian Health Centbr, Centro Campesino de Salud. C. . Las -Cruces - Dona Ana Co6 i-ity Unit of the Arthritis FoLlticiation, Public Health De,,Dai-ti-ntnt (Public health Officet,), 1-iSSD, pi-ivi-ite pliy:;ici'ans, ,Dotlci Ana County General Hospital. D. Al!),Lcluc-l-c,,Lle - Beri-iifillo County Unit of the Ai-tlit-itis FOLII-,Cl,'-Itiorl, L)NM BCMC - Adult Ar'thritis Cliriic, I-)ul)lic I-lealtli Fzit-iily Health Centers, HSSD, UNM Depai-ttyient of REC and PE pool) V. COintliLinity Coordination I'lic utilization of existing iiifor-i)iatiot-i and referral i-ictwoi-[< @in(I 'the participa- tion in the development of such systems and areas wlici-e they do nc)t alreirly e.xist. 52 THE ASSOCIATION FOR THE NORTH CAROLINA REGIONAL MEDICAL PROGRAM Executive Office 4019 North Roxboro Road, P. 0. Box 8248,-Durham, N. C. 27704 919 - 477-0461 Program Component: North Carolina Chapter, The Arthritis Foundation Component Director: John L. Kline, Executive Director 906 Ninth Street P.O. Box 2505 Durham,, N.C. 27705 Purposes: To perform program c oordination, monitoring and evaluation. To carry out a pilot patient/industry arthritis,program. ,TO operate-a patient referral program. To provide patient and.,professional education materials. Locations: Chapter offices in Raleigh, I?urham, and Charlotte. Oethodology:, 1. Evaluation and reporting operational and fiscal data-is col@ le.cted by each program on specially designed forms and sent to the Arthritis Foundation (NCAF). The-data will be tabu- lat'ed, analyzed'and reported regularly to all pro.g@am compo- nents. A system of functional categories,bas been developed to measure patient progress. 2. Patient referral - The NCAF operates a patient referral systei to provide the.'patient,ls family physician with information wh- convenient treatment fddi- tacilitates retertals to the most lity., Since NCAF already served as a focal point for informa. tionIon arthritis, it,was ideall suited for this test. The y NCAF has@@received responses from over 400 physician$ in the c State-who have expressed interest in treatment and diagnostic centers for their patients.. Further, the same physicians hav( requesto.d.that.they receive distrib-4tions@of-professional and --ducati@onal. materials for their patients. 3.@ Patient/Industry Program - NCAF has launched a pilot pa-tii2nt/i dustry arthritis program in a cooperating industry which has implant medical staff. This program includes professional training for the.ine-dir-al@ personnel to facilitate early detcc- tion of arthritis and to enhance the coujiF,(,-Ii.l'lg aiid ref6rral a patient educat).on' function. Further, this program includes 53 component which-'en'courages employees -to ,3eek Carl treatmen y of the.dise. ase. Proper einployer/employep education should greatly-reduce the present problem of arthritis victims Iiid- Llig their disease for fear of.losing,their jobs. 4.. -.Professional Education has been undertlkcn.in support of the five,pilot arthritis. centers included ititliis program. This education program includes both 'me(lical.T)crsoriiiel and patient components'. Medical materials and texts are'bcing .distributed by NCAF.to physicians requesting them. En addi- tion,.a.series of education materials now aviil.ablL-- from other sources is produced an(] distributed'to the program elementsI for education of- physicians and medical personnel. Program -Component: "Ottho edi-c Hospital and Rehabilitation Center p Component Director.-' Paul Young M. D. Orthopedic Hospital and Rehabilitation Center One Rotary Drive Asheville, N.C. 28803 Purpose: Expand an existing.delivery system using paramedical personnel @Improvelcdst/effectiveness of treatment 'by using antimalarial drugs with monitorin Location: Orthopedic Hospital and Rehabilitation Center -@leth6dology- The focus of the Orthopedic Hospital and Rehabilitation Center (OH RC) project is a'si nifica',nt expansion of an existing delivery 9 system through the increased use of paramedical personnel and the expanded utilization of antimalarial drug treatment and monitoring to significantly 'improve the cost effectiveness of treatment. Specifically, the delivery system is being expanded through the .following steps: 1. train,registered nurses -to monitor drug toxicity; "A. CL.LIL L@8LbL@rL@u iturses and other paramedical personnel to erform.@patient screening functions; p 3. train registered nurses as a physician's assistant to deliver routine foll6wup services, @lialby reducing rheumatologist time required per patient,,. 54 4. train a-physical therapist to delivcr'educationa-I information to arthritis patients; and 5. establish a station for the evaluation of retinal function and monitoring of potential retinal toxicity of aii,timalarial drugs in areas not conveniently located to OHRC. Ii-i total, it is estimated that the existing delivery system will .,be expanded from the p're-grant level of four sessions per month to four sessions per week at OliRC. Even more important, the ex- pansion will accommodate from two to four times .as many patients per physician hour as is now possible in the office of pri-vate rheumatologists. This ca atity increase is made possible entire- p ly through the expanded use of paramedical personnel; no increase in physician time is anticipated. Program Component: Bowman Gray School of-medicine Component Director. Robert Turner M.D. Department of Rheumatology Bowman Gray School 6-f Medicine Winston Salem, N.C. 27103 Purpose: To augment healthcare seminars presently beiiig,.delivered at several locations inthe area. Locations: North Carolina Baptist Hospital, Winston Salem East Bend Community Family Physician Assistant Clinic, East,,-Bend Farmington Nurse Practitioner Clinic, Farmington Methodology.: Ift each location, an existing health care delivers system has been expanded -to include an arthritis team on a regularly scheduled @basis. Car,e is delivered on site and if necessary, refer the pa- tient to Bowman Gray Medical Center for treatment. Emohasis is Dl Arl@pa nn fill 1 C, ii L CL %- L Liviier ror the de- livery of primary care. After initial physician contact, it is planned that physician/patient encounters would be approximately every three months.. More frequent encounters would be at the dis- cretion of the nurse practitioner. 55 Other Features: Training and educati .onal materials are availabl.e.through th e Arthritis Foundation of North Carolina for medical personnel and,fe patients. ' Most patients are self-referre,d to the rural clinics, by press releases printed in community newspapers. Progrdm Component: -University.of North Carolina School of Medicine.. Component-Director:' WilliAm Yount,,.M.D. 'Department, of Immunology Butler Building University 6f-North Carolina Chapel H-ill, N.C. .27514. Purpose, To expand service deliver'y'- To develo model arthritis clinics. p To conductla statewide. professional arthritis sympo.s i.um. To determine. the prevalence of arthritis in the hands of tex- tile workers. ,]Locations: UNC School of Medicine, Chapel Hill Wake Memorial Hospital@, Raleigh Moses Cone Hospital, Greensboro Pinehurst Clinic, Pinehurst Methodology: The arthr@it is referral clinic at N.C. Memorial Hospital has beeA expanded'from '10 f-- r- 0 per w@e@. @L'Liirit!8 teams are visiting four hospitals in Piedmont, North Carol:na to conduct a day-long arthritis consultation clinic. Visits are once per month per hospital. An annual Professional symposium will be sponsored' for all physi- ci.ans. in the State to further disseminate the latest techniques for the treatment and management of arthritis. This symposium pro- vides a vehicle for synthesizing expertise developed in the various clinics in, this program and the dissemination of this. information to' interested physicians throughout the State, A special study is being developed in cooperation i4i.tli a North Carolina textile plant to determine tl-ieprevalatice of arthritis in the hands of a s(-,,lectfed sainpli4 of employees. Physical exaininat s and x-rays will be employed. 5 NORTH DAKOTA REGIONAL MEDICAL PROGRAM 2200 LiDnAFiY CIRCLE GRAND FORKS, NORTI-I DAKOTA 5a2oi Tr-t-l--PHONE: 701-77!)-')53!, 1. Purpose: Thp Arthrif-.i-, Clinir Prnciram which wA-, ftindpd thrniinh than Nnrth n@@nf;i Regional Medical Program has been organized with the primary purpose of creating two functioning arthritis clinics committed to the, diagnosis, func- tional evaluation and @reatmept recommendations of patients with arthritis primarily those with rheumatoid arthritis and inflammatory joint disease. II. Locale: The Arthritis Clinic Center is located in Fargo in Children's Village, Dakota Hospital and Dakota Medical Foundation on South University Drive. The Clinic center in Grand-Forks is located at the Rehabilitation Center of North Dakota University School of Medicine. III. Project Directors: In Fargo: In Grand Forks: Dr. John Magness Dr. Donald Barcome Arthritis Clinic, University of tlorth Dakota Children's Village Rehabilitation Center Dakota Medical Foundation School of Medicine Fargo, ND 58102 -G@and Fbrks, @!D 58201 IV. Methodology: The methodology of the Clinic includes a commitment to,t he fol lowing areas: 1. Limitation of the Clinic activities to patients with joint disease as a single system oriented clinic program. Z. Maximal use.of allied health personnel in the evaluation of the patient and documentation of the patients functional, vocational, psychological and medical data. 3. Evaluation.of all patients and collected data by a multispecialty physician review panel. 57 4.1 A follow-up Outreach Program into the home environment via the public health nursing system and the local physician for treatment implcnien- .tation. 5. Rheumatologic educ6tion which should include not only medical. student and residency education but also allied health educational programs ill,--IUUI,ily Lllt! IIIVUIVVU UISCipiiiies of social service, occupational therapy, physical therapy, nursing specialists and pharmacy programs. It is the projected plan'of the clinic at the present time to utilize, the standard data base for rheumatic disease as utilized by Dr. James Fries edical Center 'idc@ for collection and of thc,Stanford Univcrs,ity:14 as a gu @niadc, will be diagnosed and cate- classification of patient data. -The diagnosis' gbrized under the American Rheumatism Association criteria. Evaluation will be done in the medical., social, vocational, psychological, and iiiedicatiotial areas and precise methods of presenting this material to aphysician panel created and the treatment programs will be recommended and carried out at the local level under the direction of the clinic as it is able to project surveillance through the Public health nurse and the local medical doctor. The above, program is being implemented by a staff of 14 people consisting of physicians in internal medicine, orthopedics and rehabilitation medicine, and a supportive staff including physical and occupational therapy, social services, nurse 'specialists, educational coordinators and pharmacist support. V. Involvement of Community Resources: Doctors involved in the Arthritis Clinic Program comprise all segments of the medical community and the-Artl)ritis Clinic Program is at present sul)p ol'ted by the University of North Dakota School of Medicine, North Dakota State University School of Pharmacy, the Farg,o @oorhead Area Health Education Center and the D@kota Chap'-t-e-r--'o--f-t-h'@'-A@thrit-is Foundation. It is our intention to select patients with:rlieumatoid arthritis and inflammatory joint disease preferentially intolthe clinic.program as it is felt that these patients are in the greatest need of treatment in our area. VI. Specific Programs: 1. Pharmaceutical Services: The pharmaceutical service will be designed so that medicational -histories are taken by the pharmacist and the medication history evaluated and prescribed medicines are screened for,niedicational interaction. Follow-up on compliance with prescribed medications will be made.on an outpatient basis so that optimal therapy may be achieved. The Pharmacist will review with the patient the possibility of side effects, the importance of regimen compliance, and evaluate all other medications in the patient's.prograin for possible pharmacologic incompatibility. 58 2. Social Service Departtiicnti Tile Social Service Department in conjunction with tile arthritis riui-se specialist will be responsible for initial contact with the patient and collection of some data prior to tile patient being seen at the clinic. Social Service Department and the Nurse Specialist Will dl@U be responsible (or orgdiiizatior, of the rurdl Outredcii tlrogr,.Illl i-or@ follow-up to determine ad(,qLlclCy of home program particularly in occupational therapy and physical therapy and for compliance with the ITIL'dicational program and need for additional help in the Home environment. A vocational study will be made to evaluate tile improved vocational orientation of the patient during continued iii(@dical surveillance. The Sociil Se,rvice Dep(-Irtillent li(is organized a one day workshop in January in both Grand Forks and Fargo to instruct Public Ifealtli flurses in the care of the arthritic patient and tile function of the arthritic program in their areas. 3. Physical and Occupational Therapy Departments: The Physical Therapy and Occupational Therapy Departments are organizing functional evaluations.that will assess the ability of the patient to do activities of daily living and- creating an upper extremity profile to determine the extent of tile disease involvement in the upper extremity. Homemaking and home assessment forms will be developed to project need for architectural review and adaptive equipment,in tile home environment. The physical therapist will be actively involved in determination of the activit' of the disease including measure- y ment of specific parameters of disease activity and determination of quanti- tative studies of joint involvement. 4. The Arthritis Nurse Specialist: The Arthritis Nurse.Specia li@st will be involved in helping reinterpret patient interview sheets and obtaining maximal patient evaluation and examination data prior to the Datients being reviewed by the physician. This Nurse Specialist in addition to the other members will be trained in collecting data -co that it can be projected as part of the standard data base for rheumatic diseases. 5. As a result of special interest, there will be nutritional analysis I carried on in the Grand Forks project utilizing the United States Nutrition Laboratory personnel in conjunction with the Rehabilitation Center Staff. VII. Summary The organization of the North Dakota Arthritis Clinic Program is designed primarily to provide,diagnosis, patient evaluation and treatment recommendations in a rural area wi-th maximal use of allied health personnel for collection of pati,ent data with optimal use of the standard data base for presentation and recording of -tills data with a multispeci.alty physician panel review of the patients problem and with a comprehensive Outreach Follow-up Program in order -to deteniiine-adpquocy pf the,continuing home treatment program. 0 59 &%PJLJV.4&%FLVLAJLA AVAJLJ&oF&%JAAJLA & ASP%R%AA%PAAAWA 1733 Harrodsburg Road P.O. Box 4098 Lexington, Kentucky 40504 '(606) 278-6071 Project Number: 049 Title: Comprehensive Arthritis Care Progrim with Home Care @@.,.t.Director: David H. Neustadt, M.D. 'heiiinatic Disease :Chief, Section on 1, Department of Medicine Univeirsity of Louisville School of Medicine 500'South-Preston Street Louisville, Kentucky 40202 Telephone (502) 585-4163 Setting:, The arthritic population of more than 82,000 in the three-county Louisville metropolitan area is too large to be effectively served by the existing clinical facilities for rheumatologic diagnosis and treatment. To date only,a small percentage of Louisville area patients with serious rheu- .matit diseases have been receiving specialized rheumatologic medical care. The arthritis clinic of the Louisville General Hospital, which is the teaching facility for@tbe University of Louisville School of Medicine, had been able ,to see and give adequate attention weekly to approximately 25-30 follow-up pAti6nts and 2-3 new patients. However, outside of the one day a week the arthrit-is.clinic was held, there was no staff readily available to handle patient management problems. Prompt patient evaluation, effective treatment programs, and adequate follow-up were all hampered by the lack of trained paramedical personnel and the enormous patient load requiring attention. Proj,ect Activities: This comprehensive arthritis treatment program is designed to improve and expand care of arthritic patients to obtain timely follow-up care And reduce the frequency of clinic visits and hospitalization. Key to this effort is a coordinator of patient services who will, under the direction of the rheumatologist,'evaluate each arthritis clinic patient and develop a comprehensive management program. This management program will be geared toward obtaining optimal utilization of existing community resources such as social service agencies, vocational education and rehabilitation centers, home care agencies and other appropriate o rganizations and people. The coordinator will further serve as-liaison between the arthritis clinic and these-various community resources. It is expected that utilization of home care services and other community resources for the long term follow-up and treatment of chronic arthritis patients will result in better care while reducing the frequency of clinic and hospital visits. As fur.ther consequence, the caseload of the weekly arthritis clinic should become primarily new patients, particularly those with multiple problems with a lesser number of old,,patients returning to check on potential complications or obtain treatment for new problems. 60 Pertinent patient care data will be collected and evalttited to demonstrate the effectiveness of this approach over the course of the pilot project. Another major activity of the coordination (.)f patient services will be patient education. A questionnaire has been prepared and idfiiinistered to arthritis clinic patients In order to determine both col.lecti.vclv and individually, patient un(It@rstiiidiiii, of their disease and problems involvcd in col)i-ng with it. Information obtained in this manner will be used to structure educational. programs aimed at patients and their families as well as tol'other grbUDS. Final.1y, the project director and coordinator of patient services wil.1 work with existing educational resources such as the University of Louisville Office of Continuing Education, the Arthritis Foundati. on, professional organi- zations, and other groups to develop programs and seminars dealing Iwith Arthritis treatment and management. in summary, Dr. Netistadt'-s project is designed as a comprehensive program for rheumatoid arthritis and other systemic arthropathies emphasizing proper long term management-to control symptoms and restrain the disease utilizing .existing community resources and thus expanding the capacity of the arthritis clinic by reducing the frequency of clinic visits and hospitalization. 61 0. maRcgionalW The GUniversity-of Oklahoma Health ScienCe$ Center SW N.E. 15th, Room 405 Oklahoma City, Oklahoma 73164 (405) 271-5731 INTRODUCTION Oklahoma is unique among the states of the United States in that a formal medical program in rthritis for physicians has never existed at the Oklahoma training a University Health Sciences Center (OUHSC). Only recently liave'medical students and physician trainees participated, even to a limited extentf in the arthritis @programs at this medical center. As a natural consequence, the medical education. system produces physicians entering practice throughout Oklahoma who have had oth cialty interests with little or no knowledge about diagnostic and treat- ,pr spe me,nt@aspects of-arthritis. Primary care physicians i.n rural areas are too often left'on their own to manage patients with severe, progressive rheumatic diseases. the OUHSC and the Oklahoma C'ity'Veterans Hospital (OCVAHY h' ave.only-recently developed a beginning arthritis program but this service has not been promoted extensively as a resource.for early referral by rural community physicians. -Both institutions have had arthritis clinics staffed by a single internist- rheumatalogist and the clin-ics.are simply too understaffed to have much of an im act on the total arthritis problem in Oklahoma., p ACTIVITY PURPOSE AND OBJECTIVES @The major puIrpose is to further develop the OUHSC and OCVAH as major resources for the early referral of patients with arthritis with costs to the patient kept to a minimum or even eliminated-in some instances. It is planned to have t,.@,o full time rheumatologist's to operate this consultation service. Orthopedic evaluation and treatment will be readily available through the OUHSC@ .The major objective of th@@program will be to provide a major resource to physicians in a selected rural area for referral of their patients with arthritis problems early- in, the course of the disease thereby enabling continued care by the.refer'ring physician with close support and cooperation of all clinic services. Cost effect- .iveness of the services will be attained by using trainees and medical students to. assist with initial evaluation procedures. Elimination o unnecessary x-ray and laborIatory procedures and reducing hospital in-patient care -to the lowest level consistent with quality care ttandrads will also control and contain costs to a greater degree. The direct responsibility for the patient's care will- more effectively be retained in the hands of the primary care physician who knows the p6tient's- family, environment and community resources the best. NATURE AND LOCALE OF ACTIVITIES O.U. HEALTH SCIENCES CENTER: Plans are under way to increase the number of arthritis clinics at the OUHSC .from 2 sessions a week to 3 sessions per week. Eight or more examining rooms will be available for-each'clinic session. The two.full time staff internist-- rheumatologists and physicians from selected local private arthritis specialty OkWioina I?@oral' @-'s cuniversity-of Oklahoma .Health Scicnccs @nter 800 N.E. 16tti, Room 405 Oklahoma city, Oklahoma 73104 1405) 271-5731 clinics,will attend moi5t of the return visit patients. They will also be responsible for initiating all correspondence to community physicians. Physician trainees and senior mqdical students will provide for initial evaluation of all Inew patients. Patients will then be presented to one of the staff rheumatologists for decisions with regard to indicated laboratory and x-ray procedures, diagnosis, recommendations for management, and appropriate disposition for follow-up ca@re..' The clinic will be operated primarily to assist community physicians in making earlier decision with respect to the problems presented by their patients with rheumatic disease. The number of patients returning for long term care will thereby (hopefully) be kept to-a minimum, con@ sisting primarily of those patidnts'with serious ch'roni'c-rheumatic diseases who require follow-up care by a rheumatologi5t. Another important part-of the clinic's funct-ion will be to assist in disability I I evaluation. The clinic will work in close association with the d isability evaluation section of the state'welfar6 department and the vocational rehabililla..,-- counselor at the OUHSC. OUTREACH PROGRAM - SOUTH CENTRAL OKLAHOMA: Promotion of the arthri tis program will begin in 10 counties of south-central Oklahoma where a well established ORMP supported Regional Health Development p Area, rogram (RHDAP) is how in operation. Included in the RHOAP activities centered in Ada, Oklahoma, is a program el-er-@,- designed to provide an.outreach program of public awareness through education a,,!"! information directed to,,iard the following categories of diseases: HN/por, hi h blood pressure, kidne disease, pulmonary disease, and Arthritis. Pul.)iic 9 y educ tion activ' ted toward Information and a ities direc preVentive health care @-!ill Utilize-services and systems of the folir,-,ving: (a).Oklahom6 Heart@ IAssociatioln. (b)@ Oklahoma Tuberculosi@s and Respiratory Disease Assocjation, (c),National l-'Icjr" Blood Pres'sUre,Education Pflogr'smo:@(d) Oklahoma Cancer Society, and the (6) Oklahoma Arthritis Foundation. Staff of the Ada RHDAP will provide basic services as necessary to assist the OUHSC,based Arthritis Program in achieving its objectives. These services will lnci@ude promotional efforts including information and referral and@further assist @in the scheduling of appointme.nts,for the Arthritis Clinic. The spon,soIr of the Ada RHDAP is Valley View hospital which has a very excellent Physical Therapist department and a pIregressive program for physical rehabilitation. This will enable a@,direct relqtiopship between the Arthritis Center program and follow-up rehabilitative servi'ces which will be accessible to arthritis patients' in the area. 63 'University-of Oklahoma He,?lth Sciences Center 800. N.E. 15th, Room 405 Oklahoma City, Oklahoma 73104 (405) 271-5731 Outreach education programs dev'eloped by the professional personnel of the Arthritis Center at OUHSC will be transmitted over the ORMP teleconference nettqork-for physicians and related professionals throughout the region. It is also probable that short-coursesIand institutes in arthritis will be held for various health professionals as the program progresses. .SOURCE AND EMPLOYMENT OF TRAINING@ ANb EDUCATION CURRICULA It-is-planned to have two physicians entraining at all times to assist in the initial workup of patients who are-referred. Interested senior medical students Will also be encouraged to participate in this initial evaluation. Physicians in practice will be encouraged to come to the clinic to participate in the evaluation of the patien,ts who are referred. Physicians from some of the local 'private arthritis speciality clinics will be invited to attend some of'the clinic sessions. Several have previously participated in this consultation service and wil I continue-fo assist in the long term follow-up of these patients.. This %-.ill occur in their own offices where this is appropriate. The clinic's activities w I -1 I hp dac i nnpri t-n n rn-.i i rip n rnmnt nnd icctir=te t-kp Dat; dition and promot tranmittal of this'information to the referring physician alor.- with eecomr,,,,2ndations for treatment. It is planned to reevaluate patients at appropriate tinic intervals for any further diagnostic measure of changes in treatment.proaram. The monitoring of patient follow-up and corespondence i-jith r6ferrin'.physicians will be handled by a part-time clinic nurse and a full-time 9 clinic secretary. 64 Pro@ra.rna cmedico'Regional de Puerto @l CO Telefono 767-7370 PILOT ARTHRITIS PROGRAM SUMMARY Project Sponsor: University of Puerto Rico School of Medicine Project Title: Pilot Arthritis Program Project,NLimber (RMP number): 75-203-8355 Project Director and Staff Members: Dra. Esther Gonz5lez Parbs - Project Director Dr. William Matos - Assistant Director Dr. Susano de la Cruz 'Dr. Rafael Gonz@lez Alcover All of them are staff members at the Medical Department, Rheumatologv Ser- tion, School of Medicine, University of Puerto Rico. 'Fhe Assistant Director is paid by the Regional Medical Program fund. Locale of activities: Central Clinic at the Puerto Rico Medical Center Regional Clinic at the Bayambn Subrecjional Vlospital Goals an-I objectives ,The final goal of the Regional @Aeclical Program Pilot Arthritis Program is to significantly improve the accesibility and the quality of care received by patients with Arthritis in the island Of PLiei-Ito Rico. Its principal objectives are as follows: I Patients referred from the regional clinic will be evalLiate(,I, treat- ment started by the medical stiff of tl-)e RlieLiniatology Section at the 65 Central Clinic at Puerto Rico Medical Center and sent back to the regional clinic for further treatment and management. 2 The project staff will develop an educational program and will train the staff physicians (general practitioners and internists) from the regional area that wi 11 serve in the peripheral clinics. 3 The project staff will stablish a Regional Clinic closely associated with the Medical Center in which the trai.ned physicians will contin- ue the treatment of patents evaluated at the Medical Center Clinic. Methodoloily Patients included in the project Will be those refered to the Medical Center from the Northeastern Region of the island,of Puerto Rico. The local health centers have been informed of our new facilities, vii.; @lave ;le upput fully ui ueiriq evaiuatea and followed up by adecuately trained personnel. These patients will receive an exhaustive evaluation' and then will be referred to the regional clinic in their locality. 2 The educational program will be based on a series of conferences offered to'the local physicians in the regional clinic area. The conferences.liad been progi-amnieci to I)e held during the months of noveniber and december, 1974. The Project Assistant Director w,ill fix the schedule and will (leve- lo the context of the course while different staff members of tile p Rheumatolog Section of the De partment of Mcclicitie at the t.Jniversi-- y 66 ty of Puerto Rico, School of Medicine will he in charged of each of the conferences to be offered. The trainess will be summited to a "pre-instructjion" and "post- i.nstruction" evaluation in order to determine the 'efectivity of the course. 3 The Project will arrange with the local health center to provide the facilities neccesary to carry out the clinics. The first regional clinic has been established in Bayam6 n Subre- gional Hospital, which serves an estimated population of 336, 900 inhabitants in 1974. In it, patients evaluated at the Central Clinic will receive further treatment. In the near future similar regional clinics wil.1 be established in the other four health regions of the island. This is subjected to the availability of huma'n resources In the project. The Subregional Area of Bayam'on includes,sevL@i-al municipalities (Bayam6n, Corozal, Barranquitas, Comerio, Naranjito, Toa Alta, Orocovis, Vega Alta). The personnel at the local health centers of Northeastern Region has been infoi-niecl of the new facilities, thus, we will be able to see on increased numbers of patients. As a public service, the Community has been informed of the new facilities for the treatment of arthritis patients through the mass media. 67 Progress The general Practioners and Internists at the Bayani6ii Subi-egional Hospital had already taken the pre-instructional evaluation on Nov,ember 4th, 1974. Subse- quently the scheduled conferences to be held at this hospital are under way. (during November and. December, 1974). The series of conferences includes the following: I The structure,, histology and pathology of joints. -2 Biochemistry of synovial fluids and connection tissue. 3. General immunology 4 Rheumathoid arthritis 5 Degeneration joint and disc diseases. 6 S. L. E. 7 Dermatomyositis Scleroderma, gout and pseudogout. 8 Rheumatic diseases 9 Systemic manifestations of rheumatic diseases blood, eyes, skin, etc. 10 Basics of surgical and physical therapy. -ation with patients A Post-instructional evaluation and practical demostt will be given and the end. In January, 1975, the regional clinic will be fully in operation. 68 1108 BAKER BLDG. 110 21ST. AVE. S. NASHVILLE, TENN. 372( FOR TENNESSEE MID-SOUTH December 9 1974 Re: #107 Restoration of the Arthritic io the Community A clinic has been developed at the@East Tennessee Cliil(lren's Hospital which provides biomedical engineering, medical, social., nursing and physical therapy services to-patinets with muscular skeletal diseases. This clinic. cooperates with United Cerebral Palsy, The Arthritis Fotilida- tion and the University of TeniRessee. Project Director: Ed@iird J. Eyring, M.D., Ph.D. Suite 605 Ft. Sanders Prof(,.qzinn.,ll -,4 Ynoxville, TN 37916 Current Objectives: 1) To expand services, especially-- a) laboratory and therapy services, 1)) environmental Modifications, c) the follow-up and referral systems. 2) To make services ivailal)le to children and to adults not eligible for the clinic for indigent persons at the University of Tennessee Medical Center. @3) To stiriitilite regional awarcnc,,,:--, through pul)lica- t@Lons tii( I speaking ong..if,,c-,leiits in the ini(idle-cist Tonneg!;ec area. 1108 BAKER BLDG. 110 21ST. AVE. S. NASHVIL LE, TENN. 37203 FOR TENNESSEE MID'-SOUTH December 9, 1974 Mr. Matthew Spear DPIT - DHEW 11-07 Parklawn Building 5600 Fishers Lane Rockville Nlaryland 20852 Re: #108 Regional Arthritis Center with Sub-Re ional Clinics 9 .Dear Mr. Spear: The Appalachian Regional Arthritis Center is a non-profit organization,,. chartered under the laws of the State -of Tennessee, for the sdle pu-rpose of establishing an arthritis treatment center'.in Chattanooga under the aegis of Baroness Erlanger Hospital and the University of Tenness ee College of Medicine Clinical Education Center. All groups interested-iii arthritis will help raise the necessary money for the complete development of the Center (such as; patient service Ternpgcpe Artbri.tis Fbupdatinn, Pnti rl-innters@nf the.roundation in each county to be served). Project Director: Charles R. Richardson, M.D. Department of Internal Medicine Baroness Erlanger Hospital 241 14ielil Street Chattanooga, TN 37403 615/755-7011 Objective: To accumulate a,nucleus of staff which will eventually operate a clinic that will be affiliated with a series of clinics located strategically throughout the region. Methods: 1) Provide services of a rlieumatologist one day per week to see patients and consult with physicians. 2) Provide the services of two house officers to work with the-.r'lieumatolof,,@Lst and provide follo%-i-up care, as necessary. 3) Develop and Lmnletrient a protocol. for (lizipnosis and treatment in t!ic clinic and protoco for physicians (oing follow-7up care In outlying clinics. 70 1108 BAKER BLDG. 110 21ST. AVE. S. NASHVILLE, TENN. 372 FOR TENNESSEE'MID-SOUTH December 9, 1974 Re: #109 A Total Care Proaram in Arthritis u for Middle Tennessee The project is administered by the Department of Orthopedics Rehabilitation, Vanderbilt.University School of Medicine, in cooperation with the Vanderbilt University School of Medicine and Affiliated Hospitals and the Middle and East Tennessee Arthritis Foundations. -Project Director: William G. Sale, M.D. Departnient of Ortliopedici ind Rclial.)ilitation Vanderbilt Uiiiversit School of Medicine y 14ashville, TN 37232 615/322-2051 uujv-t-LAve; io courULnitce Elie clinical care, patient edtictition and social set- vice needs on an individualized basis for the arthritis patient. Methods: 1) To establish combined clIinics at Vanderbilt Ilospital (1!1 da s/week),I. y 14asliville General hospital ('I day/weck) and 't4aslivi.lle Vetcrill hospital ('i day/week) 2) To provide a therapeutic team, clinical specialist, physical tlierapil., and project coordinator. 3) To further develop a problem-oricnted protocol for use in assessing, and treating tile arthritic patient. 4) To coordinate the inpatient and outpatient care for the arthritic It tile affiliated hospitals. 5) To utilize the @letrol)olitin I)cl)@irtnient of Ilkil)].Ic Health ;iii(i Artlirttic Foundation in the dev(,-lol)tic,!tit iiid iinl)l(!riciit,,.iti.oii of this I)rojecL--(-,.,;pcc.tilly liomc care, patient (idticati.oii -itid pitient pr;iii.,lporLitioii. o,,i(@li to viie 6), 'J'o plan ;i cc)iitl)Liit!(l iiv:LlirLti.,, piti. 7) To worl,. with tli(!' Sc.iiooL of for Lo be itielti(- the nurse practitioner curriculum. 8) To coordinate Vo-ter@ini; A(iiiiLiii.,;Lrit.-I.oii Ni!;Ilvll.lc, Cliittz noo-,.i,. and Knoxville iii(I future li,nkif,,(,.,; wi.Lii pit;il and Y"ItLileiz 14.ilker'Clinic for tlll- of kVc ;irLlit-LtLc., 71 REGIONAL MEDICAL PROGRAM OF TEXAS 4@00 NORTH LAMAR, SUITE 200, AUSTIN, TEXAS 78756 512/454-3555 VKTftd L-SCO" kow.ts .9@, C.-, . ... ........ Ws, Outreach Sites Project Sites 72 Program: Minimal-Care onit Demonstration Institution:. The University of Texas Medical Branch at Galveston Project Director: Frank E. Emery, M.D. ,Statistical'Informatiort (as of 12/l/74): Unit size - 8 patient rooms housing 12 patients/1 each OT, PT treatment rooms Daily cost Patient cost $4.00 per day,if spouse present $6.00 per day Date opened October 1, 1974 - First patient October 7, 1974 Overnight occupants 4 as of December 17, 1974 Outpatient occupants PT 17 patient treatments OT 12 patient treatments Description: 8 individual patients The University of Texas Medical Branch component centers around the demonstration of care of arthritis patients in a minimal-care facility near the medical center. This facility, supported by third-party reimbursement, provides short-term stay quarters operated on a self-help basis and is also a site for outpatient therapy. Therapists are trained on the unit and infor- mational programs regarding the practicality of such a facility will be pre- sented in the spring. Statistical data are being maintained on the cost, 'liLy @f.cai-c till-OUgh 'k.)-,L i t. . The staff at.UTMB is also working through the Area Health Education Center at Galveston to increase the exposure of allied health professionals to the latest information in the care of the arthritic patient. This train- ing extends to programs throughout a seventeen-'county area of South Texas. .Contact: Frank E. Emery, M.D. Arthritic Minimal Care Unit Unit "D" The University of Texas Medical Branch Galveston, Texas, 77550 73 Program: Outreach and Post-graduate Education Institution: Baylor College of Medicine (Houston) Project Director.: 'John T. Sharp, M.D. Statistical -Information: Post-qraduate seminars: I seminar scheduled in February Physitians Allied Health Professionals,- .Outreach Workshops Planned - 4 Outreach Workshops Conipl6ted - 2 Attendees (professional clinic) 76 Description: The Baylor component devotes its outreach programs to the area around and east of Houston. 'Several workshops have been conducted with good success. The concentration by Baylor is in outreach education for physicians. Out- teach clinic sessions'have been established through hospital staffs and med- ical@societies. Post-graduate seminar's for physicians and allied health professionals are to De conducted. lh6 pnysician seminar is planned tor @bbruary and . is expected to draw 50-75 area practitioners. A seminar for allied health pro-. fessionals will be organized in cooperation with The University of Texas Medical Branch at Galveston minimal-care unit. This workshop is planned tor spring and will emphasize the latest patient care methodology and expo- sure to the minimal-care process. Contact: John T. Sharp, M.D. Rheumatology Baylor College of Medicine 1200 Moursund Avenue Houston, Texas 77025 74 Program: Outreach and Post-graduate Education Institution: Texas Tech University School of Medicine Project Director: Bruce A. Bartholomew, M.D. Statistical Information: Post-graduate Seminars: 2 seminars scheduled Physician - I seminar (30 attendees) Alli6d Health Professional - .Outreach Workshops Planned - 6 to 7 sFpinars scheduled in March and April Outreach Workshops Completed 0 Attendees (public forum) Attendees, (professional clinic) 0 Description: The Texas Tech component concentrates it§'outreach efforts in West Texas. A modest number of'prbgrams is planned because of the oxtr6medis- tances to be covered. The outreach approach dovetails nicely with the medical school's educational approach of satellite clinical training. Assistance in setting up Ibcal seminars i.s provided by local arthritis chap- ter volunteers. -d on No A'post-graduate seminar was offere vember 15-16, 1974 in Lubbock. 'Li I t:l vcu a@ - ' ' '34.ct II II Vill UL-i It I I-viiipu IIeii't, ci@" ',I,' Li @ pt ujeclzi b-'a,-uLy w; @;i TT:AU@ Tech staff and out-of-state speakers. The thirty participants, composed of area physicians, School of 14edicine staffi and senior medical students, discussed '.Diagnosis and Treatment of Rheumatic Diseases". The program was evaluated as a practical and informative seminar. Contact: Bruce A. Bartholomew, M.D. Chief, Division of Rheumatology Texas Tech University School of Medicine ;P. 0. Box 4269 :Lubbock, Texas 79409 75 Program-. Outreach Education Institution: The University of Texas Health Science Center at Dallas Project Directors: J. Donald Smiley, M.D. and Morris F. Ziff, M.D. Statistical Information: Outreach Workshops Planned.- 10 Forums and 10 Professional Clinics Outreach Workshops Completed.- 4 Forums and 2 Clinics Attendees (publit f&@um) 365 Attendees (professional clinic) 33 Description: This component is devoting nearly all of its RMP funded effort to oOt- reach. They will try to@reach as many as twenty communities by june, 1975. Initial programs have been most successful. Public attendance ranges from .100-jOO while physician attendees at clinic sessions average about 30. this is particularly important in this area of the.state, where outreach Iprograms have been limited. Cooperation from the local arthritis -chapters in setting up these workshops has been a key to their success. Project staff, working through the Rheumatology Department, have been. 4- I-,hc Family ilractif-f- Petee Smith Hospital ip Fort.Worth. This effort has broadened the exposure of medical students, interns, and residents to the latest.information about the diagnosis and treatment of arthritis and related diseases. Contact J. Donald Smiley, M.D. or Morris F. Ziff, M.D. Departm'ent of Internal Medicine The University of Texas Health Science Center at Dallas 5323 Harry Hines Boulevard Dallas, Texas. '.75235 76 Program: Outreach and Post-graduate Education Institution,. The University of Texas Health Science Center at San Antonio Project Director: Robert H. Persellin, M.D. Statistical Information: Post-graduate Seminars: I seminar scheduled Physicians All,ied Health Professionals - Outreach Workshops Planned - 1 3 Outreach Workshops Completed 7 Attendees (public forum) 698 Attendees (professional clinic) 323 Teleconference Presentation 2 scheduled; I completed Attendance 1,075 Description:' The outreach education programs of this component concentrate in South Central Texas. Presentations offered the public on "What's New in Arthritis Treatment" have been most popular with average attendance of more than 150. .Clinical conferences address 6'Problems in Arthritis Treatment" and invite iocal Physicians to present particular problem cases tor discussion. Atteh- dance at clinical presentations ranges from 20-50. The arthritis chapter staff and volunteers have been most helpful In the arrangement and sciled- uling of outreach programs. A heduled for the spring in ,post-graduate seminar for physicians is sc San Antonio. San Antonio and other project personnel as-sisted the Texas Tech staff in a post-graduate seminar for.physicians in Lubbock in November and will help with a similar program for allied health professionals in Amarillo in May, 1975. The subject of "Lab Aids in Arthritis Treatment" was offered via tele- conference network from San Antonio on October 10,-1974. Nearly ninety sites (mostly hospitals) receive-thes.e therapeutic seminars. A program on "Crises in Arthritis" will be presented on January 9, 1975. Contact,: Robert H. Perse.llin, M.D. The University of Texas Health Science Center at Sap Antonio 7703 Floyd Curl Drive. San Antonio, Texas 78284 77 Program: Spanish Language Pripted Material Institution: South Central Texas Chapter, The Arthritis Foundation (San Antonio) Project Director: Mr. Gilrber E. Walker Description: Several Spanish-language leaflets are currently in use in Texas. The presentation in many of these publications is.complete and heavy in text. Experience Vindicates that [nost patients capable of reading such booklets can and would prefer to read them in English. The Chapter will re-do at least two popular arthritis brochu'res.in the rudimentary language suitable for use among the area's Mexican-American'communities. An initial supply of this material will be provided the other components for use in public out- reach programs. Additional copies wil'I be provided at cost when tile initial supply is exhausted,' Contact: Mr. Gilmer E. Walker, Executive Director South Central,Texas Chapter, The Arthritis Foundation 4814 West Avenue, Room III San@Antonio, Texas 78213 78 Advisory Committee: The program advisory committee is organized primarily to carry out the evaluation process. This,group of twenty-seven includes the six project directors,fourteen laypersons, and seven physicians. It is geographically represeMtative. Members were selected from nominations from area arthritis chapters. Individual members will attend, critique, and evaluate outreach pro- grams. An evaluation process has been agreed to by the committee. Physi- cian members will critique outreach clinics and post-graduate seminars. Results of evaluation will be forwarded to the Regional Medical Program of Texas and discussed with the responsible project director. The advisory committee will meet about six times during the year. A steering committee composed of the project directors, a practicing physi- cian, the RMPT director, and a lay member of the advisory'committee acts between advisory committee meetings and serves as the operational poli.cy group. The regional' arthritis foundation representative serves ex officio on the steering committee. 40 79 Medical Care iiiiii Efiticittiopi Foi4titiatioti, Inc. Title: Tufts-New England Medical Center (TNEMC) Community Arthritis Program Sponsor: Tufts-New England Medical Center Director: Raymond E.'H'. Partridge, M.D. .New England Medical.Center Hospital 171 Harrison Avenue Boston, MA 02111 Summary: This program will improve care of arthritis patients in communities in Maine and Massachusetts.associated with the Tufts-New England Medical Center. Three community hospitals in@Maine and five in Massachusetts will be selected for the purpose of demonstrating how the special knowledge and resources of an academic teaching center can be applied to the diagnosis and treatment of patients with arthritic disease in communities located at some distance from.the Medical Center. The existing outreach of TNEMC including the TNEMC AILEC progrzm forms the basis for this new arthritis endeavor. The resources of the Tufts Continuing Medical Education Program-are also being Used, As of early December, 1974, project staff members have been devoting their time to development,of sites for community arthritis programs in Maine and Massachusetts. In Maine, the decision was reached after consultation with the Maine Arthritis Foundation and concerned@Mai@e residents to-work in the geographically more remor-e commun:Lries.raLner tnan in tne area ot tne state served oy tne Maine Medicai center in P6rtlahd4 In January, 1975, an arthritis clinic will be started at the Eastern Maine-Mo-dical Centorin Bangor, A consultant team from TNEMC will visit monthly. Local medical and para' medical personnel will 'be involved and training will be offered where necessary. Negotiations are underway in the communities 6f,Augus@ta, Presque Isle, Rockland and Rumford,. From these, two additional clinic sites will-be chosen. In Massachusetts, St. Luke's Hospital.at New Bedford has agreed to be the site of an arthritis clinicwhich will begin'on January 9, 1975.- Discussions are underway with hospitals in fall River, Springfield, Salem, Medford, and Everett. Clinics will be developed in two or more of these. In the Boston area, it is planned to develop comprehensive arthritis training programs and patient care programs at Saint Elizabdtli Hosplitql and at the.Chelsea Soldiers' Home. Both of these institutions have strong ties to TNEMC. Training:. Plans are being made in conjunction with the Rehabilitation Services at TNEMC to institute special arthritis car(a training programs for physical therapists to work in the developing community arthritis clinics in Maine and Massachusetts. Nurse clinician training will develop with the appoint- ment of a nutse clinician in the Rheumatic Disease unit at TN@1C., This person will participate in developing nurse clinician training programs in other Tufts associated hospitals. 80 TRI-STATE REGIONAL MEDICAL PROGRAM Medical Care and Ediication Fotitzdi7tion, Inc. Title: Arthritis Care Center Boston City Ifos pital Sponsor:. Trustees of Health & Hospitals of the City of Boston Director: Edgar S. Cathcart, M.D. Boston University Medical Center University Hospital 750 Harrison Avenue Boston, MA 02118 Summary: This program will improve care of arthritis patients in an urban setting served by the Boston City Hospital (BCH), the Boston University Medical Center (BUMC), the neighborhood health centers of the Department of Health & Hospitals, and the Home Medical Service of BUMC. The arthritis section of BUMC is a well developed, comprehensive unit. Its staff has the responsibility for operation of the Arthritis Screening and Evaluation Clinic of the Boston City Hospital, the Arthritis Clinic of BCH, the Arthritis Clinic of University Hospital, and the Arthritis Pediatric Clinic of BCHI The resources for management of arthritic patients at the Boston Veterans Administration Hospital are also affiliated i4itli the Arthritis Center.' The personnel and resources of the Departments of Rehabilitation Medicine of BUMC and BCH are also part of the Arthritis Care Center. j--,@V@ U.L Lt@ ni:rtirILlS L;are Center established by this present grant will be to see that the extensive resources of the BUMC-BCH complex are available to all who might benefit from.them in the population served by the Department of Health & Hospitals of the City of Boston. Highly trained professional and para professional personnel will be employed and trained as necessary. Surveillance And evaluation will rely upon an existing financial management and patient service reporting system of the ambulatory care resources of the Department of Health & Hospitals. The classification systems of the Standard Data BIse Stu(ly of the American Rhuematism Association will become part of the system. The time-6riented- computer format record develo,,)ed at the Stanford University Medical Center will be used. The Arthritis Care Center began operations on December 1, 1974. 81 Vs 0 0 0. irginia Kegional Medical Program 700 BUILDING, SUITE 1025 700 EAST MAIN STREET RICHMOND, VA.. 23219 PHONE(804)644-1'907 SUtitIARY Virginia Regional tlpdical Program Project #0046 - Rehabilitation of Arthritics in Virginia T'le VR[I,P Arthritis Program in Virginia is composed of four (4) divisions: Tidewater - D.':Edviards Smith, M.D.; Ric4mond - Elain Toone, M.D., Robert Irby, l@I.D. and Duncan Owen, I-,I.D. ;. 'r.,Iortliei@'n V-j'rqin-ja - Paul D. Rochmis, M.D. and Central Virqinia - John S. Davis IV, [-).D. and 14illiam O'Brien, M.D. T;ie administra:Con@is primarily from the two medical schools involved; the I-'jedical College,of Virginia in Richmond (Doctors Toone@ Irby and Owen) and the University of Virginia Medical School in-CharlotjL-esville (Doctors Davis and O'Brien)... ',-,Iorking -through the Family Practice Unit (FPU), clinic visits -from the MCV Unit havp bppn P-,tahliqhpd in Pirhinnpri Tnner rifxl D"r)%ti A@- - - and Blaclf-.Stoiie. There are seven physicians specially trained in PIieumatic Diseases wl?io visit these c-linics on a regular schedule at which time the local physician schedules, arthritic patients to it-'Lcnd for consultation and treatment. In addition, FPIJ residents are trained at that time in-the care of arthritis patients From the University of Virginia,, FPU residents are currently being exposed to consultation with patients and lectures on the subject of drug therapy and re- ]6ted matters. Clinic visits outside the area are being held twice monthly in Buckingham CounLy and in southwest Virginia by rheuniatologist II. C. Alexander, f-I.D. of Roanoke. in northern Virginia, Paul D. l@ochiiiis, '4.D. is conducting monthly seminars on peitient (Iiigiiosis and treatment The first such clinic t.ias attc-,n(led by over thirty (@JO) area practitioners and four (4) patients ,,iore 'thoroughly examined- and treatment prescribed. In summary, the'VRtiP Arthritis Program (clinical aspects) did not begin with the funding date. Time was essential for orderly organization. A Pleetiilg of those concerned %-;as held on Decei,,ibor 7, 1974 at which 'L-ililC future plans were formulated for the balance of the funding period. Those plane include: expansion of present activity into more ireas, pa)-ticu- lai,ly ill southwest Virginia; evaluation of effectiveness of -LfiL, program (-in April); anjthe use of physical therapists to a greater degree in treatment programs. 82 Virginia Chapter of the A'thritis The program is b--i.ng administered by the@ . r Foundation, Mr. Fred Dabney, Executive Secretary. '-,'hen the. program vias first insEi-tu@ed, ne-,js rele@ises Here sen't-. -to and published in n,-vispape'rs -Lhroughout the covered area. Since that time, all inquiries to the Chap-ter office have been channeled to the proper FPU. t4VC,-STEPtE4 PL-NNSYLVANIA REGIONAL MEDICAL PROGRAM 200 MEYRAN AVENUE, PITTSBURGH, PENNSYLVANIA 15213 .(412) 624-3320 In response to your request for Summaries of Pilot Arthritis Programs we wish to submit the following data: The purpose and objective of the Program is to develop and implement a coordinated network of Regional Arthritis facilities within tbe geographical boundaries of the WP/RMP. Emphasis is being given.to provide an awareness of what services are presently available and to assist in development of a program to provide quality diagnostic, therapeutic, and rehabilitative services throughout the region, utilizing existing manpower, institutions, and Agencies. Outreach services and educational programs will be designed to increase adcessi- bility to comprehensive care and to improve patient referral flow for the arthritic patient to appropriate level of service they require. At the present tim46 five (5) area institutions have been identified, they are: 1. Latrobe Hospital 2. Aliquippa Hospital 3. Greensburg Hospital 4. Washington Hospital 5. ..Falk Clinic of Pittsburgh Each facility was required to make a commitment of staff to the project: 1. Coordinator 5. Physical Therapist 2. Orthopedic Physician 6i Occupational Therapist. 3. Medical Physician 7. Social Worker 4. Nurse 8. Vocational Counselor 83 views with In an atte t to define actual needs of the region, inter MP the aid of questionnaires were conducted at each of the five facilities with their designated personnel. The following are the main areas of weakness as determined by the interviews in the management of the arthritic patient by health care-personnel: 1. Lack of base knowledge as to current practices in diagnosing @and treatment of the patient with arthritis. 2. Lack of multi-disciplinary approach in care of the arthritic. 3. Failure of health care personnel to communicate with each other. 4. Inadequate documentation in various phases of management of arthritic patient. 5@.' Lack of awareness of community resources for continuing care of arthritic patient. Using the above areas of'known weaknesses as a base for determinin "9 educational needs, a curriculum was developed to meet the immediate needs of.the facilities. Courses are arranged on a once-a-week basis for a period of six weeks. The initial day of this program will be conducted at the facility. Session two through five will be conducted at St. Margaret's Memorial HospitAl in order to utilize patients and equipment they have avail- able. The sixth (6) session will be conducted at the facility. Plans are for the participants Ito be drawn not only from each facility's medical staff and allied health personnel but also from various community agencies i.e., Red Cross, United Fund, Chamber of Commerce, Planning Commissions, etc The Curriculum Plan provides for each discipline to participate not only as a single'unit but also to participate with other disciplines which will enable them to get a broader view into the total management of.-the arthritic .patient. In an attempt to-,establish as broad a base as possible for local commu.nity involvement, Outreach Seminars are conducted in each area. Announcements are mailed to surrounding community agencies, physicians, allied health personnel,, community service agencies, United Fund, Red Cross,, Goveriamental agencies, etc. Presentations are made by Project Directors, Orthopedists and Rheumatologists, these presentations explain the incidence and financial impact of arthritis on a community. The reasoning behind the' development of this project. and current trends in the treatment, diagnosing, and total management of the arthritic patient. The second phase of the educational program will provide advanced training Icourses in rheumatic disease management methodology. Course content is designed to provide an in-depth study of new an.d advanced methods of treatment for the arthritic patient. It will consist of-three, two.week courses and will provide to physician, nurses and therapists a mor e compre- hensive and detailed method of treatment for the arthritic patient. At present the second phase is in its final stages and will be available at a later date. The program this far has received enthusiastic support from the present participants, howeverlidentifying additional facilities does present a problem due to the uncertainty of continued funding. 84 Wisconsin Regional Medical Program, Inc. 5721 Odano Road Madison, Wisconsin 53719 Area Code 6081263-3600 A DEVELOPMENTAL PROJECT TO ESTABLISH THE BASIS FOR IMPROVED TOTAL CARE OF RIIEUMATIC DISEASES IN WISCONSIN Project Director: Don McNeil Executive Director Address: Wisconsin Arthritis Foundation 225 E. Michigan Street Milwaukee, Wisconsin 53202 Overall Program Objective: The delivery of more efficient and effective health care for rheumatic disease patients in Wisconsin. This is the first time that Federal funds are being used in Wisconsin to help improve treatment to people suffering from arthritis. The project will run for one year and will consist qf a three-part demonstration effort. The three features of the pr oject are: 1) To bring consultation and medical management techniques to community level health service delivery facilities; 2) Patient-fam'ily education to support-and explain reasons for treatment pre- scribed for arthritis utilizing allied health personnel; 3) Development of nursing c7are quality assurance -criteria, measuring effectiveness of prescribed treatment programs carried out by nursing personnel. The demonstration project is statewide and will involve personnel and facili- ties including the University of Wisconsin Center for Health Sciences, Madison, Tho MpriirAl rr)llpcyp nf Wiqrnnsin. T4ilwaiikee. Coltimbii HosniLil ind Sacred Heart Rehabilitation Hospital, Milwaukee, Mat-shfield Clinic, Marshfield and the Gundersen Clinic in LaCrosse. The administration and coordination of the pro- ject will be handled by the Wisconsin Arthritis Foundation. It is hoped that the,Wisconsin Arthritis Foundation will generate funds to con- tinue the project after the year of Federal funding is completed, June 30, 1975. The Wisconsin Arthritis Foundation has.also provided the administrative staff for the project. Some 300,000 men, women and children in Wisconsin have arthritis. The project is designed to develop the capability for improved quality and quantity of health care for Wisconsin citizens afflicted with rheumatic and arthritic diseases. The project also encourages cooperation between institutions and health care professions 19 throughout the state. 85 TRAVELING MEDICAL CONSULTATION TEAM PROJECT Don McNeil DIRECTOR Executive Director Wisconsin Arthritis Foundation .225 E. Michigan Street Milwaukee, Wisconsin 53202 OBJECTIVE: To improve and increase utilization by community medical practitioners of.the.diagnostic and consultative service available through identified arthritis centers as well as the other.Imodalities of comprehensive care as needed. eam will make between 5 and 7 NATURE OF Traveling consultatio n t ACTIVITY community visits. The team will consist of a rheuma-tolo- gist, nurse specialist in rheumatism, occupational tliera- pist, physical therapist and orthopedic surgeon (if desired by the host community). The community visits will include the involvement of All appropriate service re @h vi ci t-.-tn 'Ni,r r. 4 Workshop,.Department of Vocational Rehabilitation and other allied services. The medic 1 construction team has a met once in-Ashland, Wisconsin on October 17, 1974. Four mote visits are in the planning stages and should'be com- pleted by mid-June, 1975. 86 DEVELOPMENT OF OUTCOME CRITERIA AND PROTOCOLS OF NURSING CARE FOR: THE EARLY RHEUMATOID PATIENT PIROJECT Janic Pigg. R.N., B.@S.N., Nurse Consultaiit-Rli(,-umatology DIRECTOR Rheumatic Disease Program, Columbia Hospital 3321 North Maryland Avenue, Milwaukee, Wisconsin 53211 DESCRIPTION Increased consumer participation, national legislation and a pro- fessional responsibility to define nursing accountability are the stimuli for this project. Healtli/Wellness standards are being de- veloped to assure quality care for two groups of hospitalized pa- tients: those with Rheumatoid Arthritis and those having a Total Hip Replacement. This is being accomplished in a pilot project at Columbia Hospital by consumers, staff nurses and a statewide nurs-@ ing advisory committee. These standards will improve care of these individuals by more clearly defining the nursing role and by iden- tifying areas for further nursing research. OBJECTIVES The objectives of this project are to develop patient outcome cri-@ teria subject to influence by nursing activities for the named pa- tient populations in an.acute care setting, meanwhile establishing nursing protocols of care. These outcome criteria-will then be articulated with those of other health professionals who care for these patients. It is anticipated that in the process, the devel- opers of the criteria will become more aware of consumer needs and expectations and stimulated to better observations, recording and nursing practice. The project will also increase awareness and define accountability for nursing and other disciplines in the care of these patients as well as identifying other areas for research.' TARGET The target populations identified are: The patient with "earlyll GROUP Rheumatoid Arthritis and the patient u ndergoing a 'Eotal Hi@ Arthroplas.ty. METHODOLOGY This process is being undertaken by establishment of an advisory committee of nurses from the State of Wisconsin who are practi- tioners of medical and/or surgical aspects of rheumatology nursing or who have expertise in the process of Quality k,;§urance. They will contribute their knowledge as well as serving as disseminators of,information stemming from this project. Two nursing staff group,, from Columbia Hospital are identifying and gathering nursing data and will write the criteria. In addition, a consumer committee will add input. :The criteria will be tested by nurses, consumers other health professionals and revised as needed. These cri- teria will then be united with those of other health professionals The outcome criteria will serve as a model to other nursing units both within the developing institution and without. These c iteria can be used for unit reference files, ntirsi,ng care, staff develop- ment, care .guide"@for patients, referral information for continuity of care,'use by new practitioners and curri.cill.tim content in basic, nursing education. Within nursing, the models can be used to increase and upgrade knowledge of,nutsing care of these two tology patient populations, as well as encouraging development of criteria for other patient populations. 0 87 PATIENT AND FAMILY EDUCATION IN RHEUMATIC DISEASES PROJECT Mrs. Madge A. Malecki, R.N., M.S. DIRECTOR Director of Nursing Service Sacred Heart Rehabilitation Hospital Milwaukee, Wisconsin NATURE OF An ongoing development, refinement and implementation of goals ACTIVITIES di rected toward assisting a client to attain maximum function and adjustment to rheumatic disease. This is a multi-discipli- nary approach, utilizing the expertise of the memebers of a rheumatology rehabilitation team; physical therapy, occupations therapy, social service, psychologist, clinical specialist in rehabilitation, rheumatologist, physiatrist, nurse therapist. Written protocol$ will be developed in those areas necessary to enhance the learning process for the client. PROTOCOLS Initial Interview Work Simpliciation DEVELOPMENT Reference Sheet Social Service:Asses,.-ment Self Medication Exercise Client Education Nursing Guidelines Family Education Staff InSetvice Education Joint Protection Discharge Follow-Up EDUCATIONAL An individual knowledgeable in the teaching/learning process CONSULTANT will serve advisory to enable the proposer to better quantify of this Droiect in terms of the client's understand- ing. EDUCATIONAL AND "Understanding Rheumatoid Artliritis"(videotlpe by Arth. Fndtn) TTACHING MEDIA The Truth About Asprin and Arthritis (Arthritis Foundation) The Truth About Arthritis and Diet (Arthritis Foundation) What You Should Know About Arthritis Quackery (Arth. Fiidtn.) Arthritis Quackery (Arthritis Fouiiditibn) Facts YotL Should Know About Arthritis (Merck, Sharp @ Dohme Self Help Device for Arthritis Patients (Merck, Sharp & I)ohme) More Information About Cold (Sacred Heart) Joint Protection (Slides shown by Sacred Heart . Occtipatioliil Tlicripy) I$The Homemaker" (videotape shown by Sacred Heart Occupational Therapy) CO@LklUNITY Two members of the Advisory Committee serve to provide very RF,,SOURCES necessary community and consumer input. One member iiis pro- vide(i i critique of the teaching efforts from admission to discharge at Sacred heart Rehabilitation Hospital. This in- formation will enable us to modify and evaluate our'e orts from the consumer's viewpoint. A Luptfs group has been started under the Ptiidance of the Pro- ject CoordinitQr and a representative from social service. The emphasis is upon commonalities within the group, wit mutual su'port, encouragement, and correct knowledge being p goals.. 88 WASHINGTON/ALASKA REGIONAL MEDICAL PROGRAM 500 UNIVERSITY DISTRICT BUILDING / SEATTLE, WASHINGTON 98105 / PHONE: (2061 543 - 8540 The Washington-Alaska arthritis program provides OT/PT training at the Virginia Mason Medical Center, and the premises (Home care) of the Western Washington Chapter, Arthritis Foundation. The objective is to improve care quality, and patient access to care. A series of five-day training courses in arthritis skills is offered (Arthro'therapy Training Program). To date, applicants from Washington, Alaska, Idaho, and Montana have been selected, and all training positions filled. Ten trainees have graduated from the program, and an evaluation process is underway. ARTHROTHERAPY TRAININ6 PMM A TRAINING PROGRAM IN ARTHRITIS TREATMENT SKILLS FOR OCCUPATIONAL & PHYSICAL THERAPISTS oroject oj@ Al@TilRfTI,5 f,'OUNDATION, WASHLNGTON CHAPTER, Room 326'. Smith Tower, .506 2nd Ave., Seattle, WA 98104 (206)622-2481 Funded by a grant from the WASHINTONIALASKA REGIONAL MFDICAL PROGRAM Proper physical therapy and occupational therapy are an integral part of the treatment pro- gram for the patient with arthritis. The long term care for the arthritic patient would be greatly helped if instruction in joint-ranging and strengthening exercises, self-hezp de- vices, etc. were readily available for all patients without their having to travel long distances. Through the Arthrot-herapy Training Program, physical therapists and-occupational therapists will be trained to provide instruction for appropriate patients in their local communities. .It is hoped that such trained therapists will not only be a community resource of great I assistance t@ the patient with arthritis, but @ZZ also save the physidian's time. - ff IS ELIGIBIE? Any practicing registered occupational or physical therapist in Washington or Alaska. gEfE WILL TIE COURSE BE TAUGIT? BY Wdr. AT "T COST? The course will be conducted at Virginia Mason Medical Center (9th & Seneca) in Seattle, with field visits with the therapist in the Home Living Assistance Program of the Arthritis Foundation Chapter, to the Chapter headquarters, and to other sites as appropriate. There Is no cost to the trainee. Tuition, travel & living expenses are paid by the grant @from the Wa8hinpton/Alaska Regional Medical Program to the Arthritis @'(.)undation al) er. ravel: tourist air fare or private auto at 120 a mile. Living expenses: $3() per them for .*e five days in Seattle.) The faculty will include rheumtologists, orthopedists, physidtrists, physical therapists and occupational therapists who are experienced in the latest approach to arthritis treatment. 89 giAT WILL BE jflE M ff OF IflE TMINING PROM. g,cg In addition to the basic medicallsur a, ph sical medicine orientation, all traineeb wil y have instruction and supervised practice in both occupational therapy and physical therapy skills. These will include manual muscle testing, joint ranging, R.A. exercise program, home, physical therapy modalities, ambulatioh equipment (including shoe modifications), splinting, activities of daily living 'ev'aluations,,homemaking evaluations and uses of and procurement of adaptive equipment. The field visit to the Arthritis Foundation Chapter headquarters will' emphasize community resour.ces, as well as supply the trainee with extensive current literature for both patients and p.rofessional health care workers. (Some literature,@,as well as a bibli@ ography of selected references, will be sent to the trainee before arrival. Usuallyi not more than 1 or 2 trainees.will be accepted at a time. This will allow for some individualization of program content. 14AT Pff TM PLM' S MR PRIPM EVALLATION & FDLLW. During the training program, teaching effectiveness and trainee learning will be,,6 valuated by written, oral and practical examinations, as well as trainee/faculty conferences. The Coor- inating Inieral)ist will also visit graduates in their home community. Such visits will be fo, @-@her evaluation of the suitability of the training and to assist the graduate by serving as a consultant who represents the expertise of the faculty and program advisors. In general it is hoped that the graduates of the Arthrotherapy Training Program will develop an, ongoing working relationship with the Arthritis Foundation, and not only help to foster further con- tinuing education opportunities, but also actively promote and participate in arthritts-educa tion programs in their home communities. HOW AK AMLICgffS BEING FECRJITB MD HOW WILL APPLICATIONS BE PROCESSEIP. 1. This fact sheet, covering letter and application form are being sent to all occupational therapists 4nd physical therapists in Washington and Alaska. Information Copies of the mailing are also being sent to all hospital administrators and chiefs of staff in the two states. Coverage is as complete as current association mailing lists allow. 2. Applications received in the Arthritis Foundation Chapber office will 'be reviewed and acted upon by a Selection Committee of physicians and therapists representing Virginia- - Mason Medical Center, the Wa8hinton/Alaska Regional Medical Program and the Arthritis Foundation Chapter. Applicants will be notified as soon as pogBibXe. ITHERAPISTS ARE URGED TO APPLY AS SOON AS POSSIBLE, EVEN IF THEY DO NOT WANT TO PARTICIPATEI I.IN THE PROGRAM UNTIL,LATE IN THE PROJECT PERIOD. I Address applications & correspondence to Me. Shirley Bowing, M.A., O.T.R... Coorqinating Therapist, Arthrotherapy Training Program, Arthritis Foundation, Room 326, Smith Tower, 506 2nd Ave., Seattle, WA 98104 89 A