NOT&.-DO NOT USE THIS ROUTE SLIP TO DA- SHOW FORMAL CLURMCM OR APPROVAU 71@ TO: AGENX BLDG. ROOM /Ky.. ida@ell A'P'OVAL @EVIEW 0 PER CONVERSATION SIGN TURE n NOTE AND SEE ME Cl AS REQUESTED El COMMENT El NOTE AND RETURN El NECESSARY ACTION El FOR YOUR INFORMATION Cl PREPARE REPLY FOR SIGNATURE OF REMARKS: toy .1 0 to o5 -a /. A f //,04W ,/a. (Fold here for return) ---------------------------- To From PHONE BUILDIAG @m Fonm HEW-30 RiEv. 11/56 ROUTE SLIP 11 - 517 12i -.V-EMORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND NVELFARE PUBLIC HEALTH SERVICE HEALTH RESOURCES ADMINISTRATION BUREAU OF HEALTH RESOURCES DEVELOPMENT TO Acting Director, Division of DATE: July 23, 1974 Regional Medical Programs FROM M p Public Health Advisor SUBJECT: Recommendations for special activities to support the pilot arthritis program This memorandum and following material present recommendations for film production and program coordination activities related to the subject program. The bases for these proposals are the recommendations made by the Arthritis Ad Hoc Review Committee at its meeting May 23 - 25, and ratified by the National Advi- sory Council on Regional Programs on June 13. Two principal areas were addressed by the Committee: 1. Film and Tape Development and Production: The portions of arthritis program applications which requested support for the purchas,-- of hardware for film and video tape produc- tion were not funded. Review Committee members were sensi- tive to the need for such materials, being personally aware of the capabilities of films and casettes to support patient and other educational activities. It was not con- sidered wise, however, to assent to the volume and diver- sity of requests made for these purposes. The Committee proposed that DRMP cooperate with concerned RMP's to pro- duce selected films and video tapes on subject matter widely needed. The Committee believed that the widespread, high cost need could be met best in this manner. 2. Program coordination and stimulation: The Committee's re- view of pilot arthritis grant applications aimed to achieve effective and cohesive program. Having recommended approval for a body of arthritis projects which emphasize outreach to patients, and the development of care providing resources,, the Committee noted that approved projects represented dis- persed activities requiring a connective, unifying force in order to achieve cohesiveness. The Committee perceived that collateral losses, or gains would emerge respectively 2 with, or without such a unifying persuasion. With outside attention to the pilot arthritis program being largely expended, with the granting of funds, the terminal nature of the grant program could result in increased conserva- tion in achieving objectives, and decreasing enthusiasm on the part of participants. Activities which insure a "looking in" by others, however, could sustain interest and enthusiasm, facilitate professional exchanges, and foster momentum beyond the grant period. While the Committee was unanimous that "something be done," it was not unanimous about what the actions should be. The enclos- ed material presents recommendations regarding courses of actions to satisfy the Committeels suggestions. Cost estimates are also provided. These activities have been discussed preliminarily with a number of knowledgable persons. The proposals on film and tape pro- duction have been discussed with: Mr. Robert Sumpter Mr. Adrian Sybor Special Assistant to Acting Information Officer the Director BHRD National Medical Audio- visual Center, NLM (Atlanta) Ms. Frances Dearman Public Information Specialist Mr. Fred Buschmeyer, Jr. BHRD Special Assistant (Medical AVS), NLM, (Bethesda) The proposal on arthritis program coordination has been discus- sed with Dr. Charles Sisk, Director of Medical Affairs, National Arthritis Foundation. The sequence of the following material is: I. Proposal and cost estimates for films. II. Proposal and cost estimates on coordination and evaluative activities. III. Accumulated costs of sections I, and II. I will be pleased to discuss these recommendations with you at your convenience. Enclosures 3 Recommendations for the Conduct of Special Activities to Support the National Pilot Arthritis Program I. Production of Films and Tapes for Professional Education A. Recommendation Films and tapes suitable for use in professional arthritis training activities across the country should be developed and produced. B. ose To provide and enlarged, and contemporary library of audio visual materials specifically focussed on arthritis. C. Need The pilot arthritis program funded by DRMP reflects a strong interest in outreach activities to develop increased referral and care delivery capabilities among private practitioners, and professional allied health personnel. Greater access to arthritis training !or medical students, and improved skills for parapro- fessional personnel is also planned. The current list of professional and teaching films issued by the National Arthritis Foundation lists only two (2) recent film/slide products. Other films are at least 10 years old; the majority of NAF films, in- cluding those produced by local Chapters, are for lay audiences. Thus, there is no significant selection of contemporary film training instruments. This shortage appears to exist primarily because of the high costs of film products. The interest for such products was reflected in the many requests for support for film production capabilities among the 43 pilot arthritis program grant applications. While professional reviews disapproved all such requests as inappropriately expensive under one-year, limited funds circumstances, they under- scored the widespread need for high quality training films. They unanimously requested the DRMP to seek authority, and/or support for the production of quality film training tools. it is proposed that a single film, or film product would not be responsive to this stated need. It is proposed that authority and resources for three (3), to six (6) professional training film products be provided to assure a meaningful selection of training film subjects and products. D. Estimated Costs The following estimated costs were developed in preliminary discussions with experienced PHS audio visual and information personnel. Variations in costs apart from those indicated could result from different product selections, and shorter film lengths than those indicated. The estimated budget also reflects the purpose and amounts of costs arising from collateral activities other than the production costs. Number of Films Produced Unit Costs Quantitv Costs Items 3 4 1. Audio visual ect $8,400 $8,400 $8 4@00 $ @400 $8,400 Identification (Est. 12 people) 12 trips @ $300.00 3,600 Service fee $100/da. x 12 x 3 3,600 Per them $25/da. x 12 x 3 900 Materials 300 2. P ification $L22000 36,000 8,000 0,000 L2,000 (14hat will be depicted about the subject) $2.000/min 180 000 240,000 300 000 360 000 3. Production 16mr,i color film (est. 30 min.) .(Alternatives; color video tape $1,800/min; film strip or sound/slides $800/min.) 4. Professional Surveillance $6@600 6,600 6,600 13,200 13,200 of Production (est. 6 people) 12 trips @ $300 ea. 3,600 Service fee $100/da x 6 x 4 2,400 Per them $25/da x 6x 4 600 5. Product testing $2,000 6,000 8@000 10,000 12,000 ESTIMATED TOTALS: $237,000 $311,000 $391,600 $465,600 F I)ISAT31I..I'TY FROM HOME MANA(3EMENT 0 TEACIIING SLIDES AND SYLLABUS i ARTHRITIS. ifi 1964@ care service for tli(, cliroriic@--illy ill. for CLINICAL SLIDE COLLECTION ON THE RIIEU- physicians .In(i oti-ier ll)C MATIC DISEASES. 240 211 x 211 color slides pro- program is sponsored by The Arthritis Fotjndi- vi(ling visual material of high medical arid tech- tion arid carried out through i.1 I(.)Cil visiting nical quality for icachinf,, arid t@r,@iininf,,. Eml)h- nurse ag(@ricy. 29 iiiiri., 16mi-n., black ;in(I white. asis is on clinical pliotopr@iphs ind x-r.@iys in PROFESSIO'I%Ij'AL addition to pliotomi(-rogi-@iptis of r)-,ittiolof,,ical Ris specimens, Accoinr.),.)ni(@(i by ;i syllat)t,is cont@,iin- SELF-HELP DEVICES FOR PATIENTS WITH PUBLICATIOI %j ing a description arid a black and wliit(@ photo- ARTHRITIS. I)roCILI('(:@(i in 1962. I-low@ii,cl A. graph of each slide. $110.00. Rusk, M.D., and Edward W. [-owni@iri, M.1)., of NYU Medical Cent(@,r join forces in ri(@iiioristt@@it- and I I ing the ma;iy useful tools available to hell@ the disabled meet c[ialleiiges in everyday living. FILMS 20 min., 16mm., color. PROFESSIONAL FILMS on PHYSICAL THERAPY FOR A HOMEBOUND These films are available on a loan basis within the ARTHRITIC. Produced in 1962. Made in coop- Unitecl States, of a service charge of $10.00 plus eration with The Arthritis FOLind@)tion Ohio Val- shipping charges for each filter. Pleast- write rlirectly ley Chapter, arid the American Ptiy!:ical Tlieripy I I s Association. Depicts one chapter's ilipro,,icl) to to The Ariliritis Foundation 1-ifni Library, c/o A.5so- physical tli(,@ripy treatment in the hor-,i@,@ r@f,.coni- ciation fiffiis, 600 Gr(inct Avt@ntj(!, N. J. meii(le(.1 for showings to all -illie(i h(@,,@liti 1)rof(-'s- 07657. Purch(ise prices (Ivcii/cil)ie from The Arthritis sion@ils. 27 min., 161TIm., color. Fouriclation. a% JOINT FLUID ANALYSIS, AN IMPOI@TANT DIAG- NOSTIC TEST. Produced in 1961). Written an(] PREVENTION OF DISABILITY IN RHEUMATOID narrated by Robert A, C,@itter, M.D., of ARTHRITIS. Produced in 1961. Coriipt-oh(@tisive mann Medical Collep ,e. Desirned for report on the most cripplirig foriyi of rl leLIM@ltiC practitioners, internists and t'lieuniitolot,,iFts, disease. Examines effective treatment methods medical sttjcl(@ilts arid i-nedical De-. including physicil therapy, drug therapy, ortho- scribes in detail the gross an(] microscopic pedic meisures and value of rest. 28 min., examinations of joint fluid from the -,.ispil'ation 16mm., color. of a knee joint tliroupli a visual reproduction of all the various crystals and cellular components which might be found Linder polari7ed light and phase light microscopy with special emphasis PHYSICAL JOINT EXAMI@IATION OF T14E ARTH- on sodium urate and calcium pyrol)hospliate RITIS PATIENT. PART 1: EXAMINATION OF THE crystals and their diagnostic significance. 13 PERIPHERAL JOINTS. PART II: EXAMINATION min., 16mm., color. OF THE HIP, SHOULDER AND BACK. Produced in 1961 and 1964 respectively. Written and narrated by Paul J. Bilk,.i, M.D., of the U. of Available from Minn. Medical School. Interi(,Ied primarily as a THE ARTHRITIS FOUNDATION suppler-ri(?iit to the medical si,u(](@rit's introduc- tion to physical diagnosis. Fully detailed pres- 1212 Avenue of the Americas entation of examiiiat;on techniques employed in New York, N.Y. 10036 the diagnosis of all forms of arthritis. 29 min. each, 16mm., color. 7 ProRram Coordination and Evaluation A. Recommendation Activities be organized and implemented to provide coordination and evaluation of the pilot arthritis program. B. ose To provide a National perspective to the body of pilot arthritis grant programs which have been funded. To provide increased unification to like activities in the various programs. To sustain interest and perseverance in the pursuit of program objectives, simultaneously insuring quality performances. To provide objective evaluation to both @ programs, and the National pilot effort in arthritis. C. Need Applications for DPM grant support to pilot arthritis programs were required by the sequence of events to be developed and submitted in two (2) months. The quality of planning suffered from this deadline pressure, as well as from competition for RMPs' staff time being otherwise devoted to the development of regular PM program applications under similar deadlines. Plans for pilot arthritis program evaluations similarly suffered, and are generally inadequate. The review process of these grant applications resulted in significantly modified proaram approvals such that the majority of approved pilot arthritis program sponsors are having to rethink, and restructure major program components. Information received in RMP grant acceptance letters and through tel ephone conversa- tions indicates that thoughtful regrouping is proceeding. The technical reviewers for the pilot arthritis grant programs, whose recommendations were fully endorsed by the National Advisory Council, imposed drastic downward modifications on the applications to obtain approvable program within available financial resources, improve uniformity of effort and achiev- ability, and remove generally meritorious activity proposals not considered appropriate under the pilot characterization, and limited funding of the National program. The reviewers, with Council approval, also recommended that D@ support coordinative, and evaluative activities; a clincher is needed for coordination which cannot reasonably be obtained from individual RMP'S, and for objective assessment of the overall pilot effort. 8 D. Estimated Costs The development of sound estimates is inhibited by present lack of knowledge about a practical procedure. For this reason, the estimates start with a planning conference, and proceed with subsequent activities which may result. The range of possible DRMP costs varies from: (a) the planning conference (or workshop) only, in the event that there is insufficient motivation to proceed further; to (b) the initial conference, and a later evaluation session; to (c) the above activities, and selected continuity activities. DRMP staff costs are not included in these estimates. Cum Items Total Total Prop-ram coordination and evaluation 53,600 53,600 planning meeting (Basis of estimation: 1 RMP, and 2 professional attendees from each of 30 RNP's for 3 days (2 1/2 da. meeting). RNP attendees may be supported by RNP funds.) 30 RMP x $300 travel each $9,000 30 RNP x $25 x 3 2,300 30 RNP x $20 other 600 60 Prof x $300 Travel each $18,000 60 Prof x $100 x 3 18,000 60 Prof x $25 x 3 4,500 60 Prof x $20 Other 1,200 .!/Might be partially or wholly offset by existing grant funds as part of approved program. !/Range of costs per above notes.: Minimum anticipated $32,000 Middle range $41,000 2. ProRram assessment Conference 41,700 95,300 Prof. attendees per above (I honorarium offset 50%, total of item would be: Min $32,700 Min Cum $84,300) 3. ProRress assessment Conferences 53 600 148,900 (Est. same s planning conf) (Range of costs with above offsets: Min. Cumulative $96,700 Middle range Cumulative $123,700 9 Other Costs 15,100 64,000 a. Development and printing of 9,100 (158,000) reporting forms. 2 day meet of 5 people $3,000 printing 1,000 mailing x 3 times 100 analysis x 4 times 5,000 (1 part-time person) b. Reports to participants, including 6,000 (164,000) special program highlights 6 reports @ 1,000 copies ea. (Assume use of NAF) 10 III Stimmary of I, and II Costs 3 4 5 6 A. Films 237,000 311,000 391,600 465,600 B. Coordinative Evaluation Minimum Est. 111,800 111,800 111,800 111,800 Maximum Est. 164,000 164,000 164,000 164,000 C. Totals Estimated - Total Minimum: 348,800 422,100 503,400 577,400 Total Maximum: 401,000 475,000 555,600 629,600