DEPAR OF HEALTH, EDUCATION,, AND WELFARE HEALTH RESOURCES ADMIN-,TRATION ANNUAL REPORT OF THE -Arthritis Ad Hoc Review Committee Division of Regional Medical Programs MANDATE The C-, ittee shall review applications.for grants for the support of a pilot arthritis program and make recommendations to the-National Advisory Council on Regional Medical Programs with respect to the approval and funding of such applications. MEMBERSHIP The C-iiiittee was composed of the following members: Chairman: Roger D. Mason, M.D. Ephraim P. Eng eman, M.D. Southwest Nebraska Medical Center Clinical Prof. of Medicine and 305 East lst Street Head, Rheumatic Disease Group McCook, Nebraska 69001 Univ. of California School of Medicine Members: San Francisco Medical Center 3rd and Parnassus Avenues Ms. Phyllis C. Amett San Francisco, California 94122 San Francisco Nurses Association 1155 Pine Street Henry L. Feffer, M.D, San Francisco, California 94109 Professor of Orthopedic Surgery George Washington University Joseph P. Bailey, M.D. Medical Center Associate I)ean for Clinical Sciences 2150 Pennsylvania Avenue, N.W. Chief, Section of Rheumatology Washington, D.C. Medical College of Georgia Augusta, Georgia 30902 Alicia E. Hastings, M.D. Professor and Chairman William F. Donaldson, M.D. Department of Physical Medicine Clinical Prof. of Orthopedic Surgery and Rehabilitation University of Pittsburgh Freedmans Hospital School of Medicine 6th and Bryant Street, N.W. 128 N. Craid Street Washington, D.C. 20001 Pittsburgh, Pa. 15213 Page 2 - Annual Report, FY 1974 Arthritis Ad Hoc Review Committee John E. Kralewsk-L, Ph.D. Miss Patricia Yarborough Acting Chairman Assoc. Prof. of Physical Therapy Department of Preventive Medicine School of Allied Health Science and Comprehensive Health Georgia State University Box 2582 Atlanta, Georgia 30303 University of Colorado 4200 E. Ninth Avenue Denver, Colorado 80220 Carroll B. Larson, M.D. Professor of Orthopedic Surgery Childrens Hospital Iowa City, Iowa 52242 Frank R. Schmid, M.D. Chief, Section of Arthritis- Connective Tissue Diseases Northwestern University Medical School 303 E. Chicago Avenue Chicago, Illinois 60611 Lawrence E. Shulman, M.D. Director Connective Tissue Division Department of Medicine Johns'Hopkins University ience Bldg. 942 Blalock Clinical Sc Baltimore, Maryland 21205 Mrs. Frances S. Silverstein Chief, Occupational Therapy Dept. Good Samaritan Hospital 6501 Loch Raven Blvd. Baltimore, Maryland 21239 -Mrs. Honora K. Wilson Coordinator of Education and Clinical Social Worker in Arthritis Rancho Los Amigos 7601 E. Imperial Highway Downey, California 90242 Page 3 - Annual Report, FY 1974 Arthritis Ad Hoc Review C,rlittee MEETINGS The Cnmittee met one time in Fiscal Year 1974: May 23-24-25, 1974 ACCOMPLISHMENTS The Arthritis Ad Hoc Review C-, ittee made an extraordinary contribution to the development of what hopefully will be a significant national program. The Arthritis funds were made available under a Congressional earmark in December 1973. The appropriation language simply suggested that $5-m4llion in RMP funds be used to develop Pilot Arthritis Centers. It pXovided no other legislative history or guidance. At that time of passage, there were no RMP funds available. A large portion of the Fiscal Year 1974 appropriation had not been released, and those funds that were released had already been fully obligated. In addition, there was virtually no Federal expertise available in arthritis, save a small staff at NIH with A.scientific research orientation. Only one or two members of the National Institute of Arthritis, Metabolism, and Digestive Diseases Council were versed in arthritis, and there appeared to be a complete lack of expertise anywhere in the Federal GovetL=ent on problems of arthritis care at the com- mmity level. Arthritis Center applications were solicited by the Division of Regional Medical Programs (DRMP) on February 27, 1974, after release of the remaining Fiscal Year 1974 funds pursuant to a Court Order. The program announcement described in general terms the purposes for which funds could be used, the review process, and a few criteria. It was not.until applications actually were submitted early in May 1974 that the process of defining a sound., initial national program could begin. The Ad Hoc Committeels great contribution was to study the applications themselves together with staff summaries and distill from these the principles that would lead to a sensible, one-time national pilot effort. The proposals which were developed by applicants under great time pressure contained many of the following featurds: (a) an inpatient or other central facility with affiliated satellite clinics; (b) strong patient and public education components; (c) some research; (d) major equipment acquisition, usually vehicles and laboratory equipment; and, frequently, (e) special ems such as juvenile arthritis and gout. programs for specific probl After nearly a day in which primary and secondary reviewers described each of the 43,proposals individually, the Committee developed a series of guide- lines which gave priority to projects of national significance, or providing outreach, or serving the disadvantaged. Likewise, the Committee agreed generally not to support major equipment purchases, public education, motion picture and videotape production, research, data banks and registries. It was felt that these latter types of activities were either too costly, or far Annual Report, FY 1974 - Arthritis Ad Hoc Review C, ittee Page 4 outweighed by greater needs at the present time. C@ittee members then evaluated the merits of each application individually by using the principles that they had developed. In this manner, the group considered the 43 requests for $15-million and finally recommended approval of 31 applications for ap- proximately the earmarked amount, also providing numerical priority rankings for each. It is remarkable that so much could have been accomplished in a single, three-day meeting. The Committee provided expert advice and basic thinking about what should be funded and why, based on their knowledge of national needs, capabilities, and the state of the art. Their advice was vital in view of the Federal Govern- ment's meager resources in arthritis and the short time in which to initiate and fund the new program. Without the group's hard work and thoughtful input, the taxpayers would have been poorer. Anyone who wishes to see an example of con- structive use of an outside, expert advisory group should read the transcript of this C7i, ittee's deliberations. aum, Executive Secretary Date