DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE HEALTH RESOUFiCr@S ADMINISTRATION ROCKVILLE, MARYLAND 2005Z BUREAU OF HEALTH RESOURCES DEVELOi'MENT November 26, 1974 James R. Klinenberg, M.D. Director, Department of Medicine Cedars of Lebanon Ilospital. Division Box 54265 Los Angeles, California 90054 Dear Dr. Klinenberg: The California Regional Medical Program (CRMP) has invited us to respond to the concerns you expressed to them regarding the recommendation for disapproval of the pilot@thritis grant application submitted by Cedars- Sinia Medical Cente @We share in some degree your disappointment in the Review Committee's, and Advisory Council's recommendations for disapproval on this, and others' applications. Even though we have no choice but to implement the recommendations for the Cedars-Sinai application, we assure you that both we and the review bodies are keenly aware of the Response to your questions raised with the CMFP requires that we attempt to accurately reflect the assessments of the reviewers, recognizing that these are evaluative and judgemental expressions of a diversified group working within severe fiscal restraints. The underlying reasons for the recommendation for disapproval of the Cedars- Sinai pilot arthritis grant application were the relatively long period committed to data collection and planning, and the absence of specific outreach measures. While the accumulation and analysis of disease related information in the process of developing a comprehensive program is normally desirable, the one- year life of these giants militated against the allocation of limited funds for solely analytical and planning purposes. To the best of our recollection, no application of this kind was recommended for approval. Given the aggregate scope of the applications in comparison with the amount and term of available grant funds, reviewers expressed preference for feasibility and demonstration proposals which improved service capa- bi-lities within the grant period. Plans to develop morbidity, prevalence, and resource data in relatively small areas were generally discounted. Reviewers considered State health aaencies as more appropriate sources for the development of such information, preferably on-a wider scale. There was concern that data presently available in State offices, PIQ'S, and other agencies was@being overlooked. 2@ The procedures, positions, and recommendations of the Review Committee were brought before, and were ratified by the National Advisory Council, whose recommendation for approval. is requisite to grant approval. While the Cedars-Sinai proposal thus was not recommended for approval under the conditions of the RMP pilot arthritis initiative, we cons er it -promising under other circumstances. I'liere is legislation pending in the field of arthritis which, i.f enacted, woiil.d support broader and longer term arthritis efforts. For this reason, we urge that you do not permit this disappointment to dissuade you from further development of your arthritis program plans'. We trust that this information will adequately resolve your concerns. We will. be pl-eased to provide such further information as we can if you have further questions. Yours truly, t4alt-lew Spe@a-@. Public Health A Division of Regional Medical Programs cc: Ephraim Engleman, MiD. Gerald Gardell, DPIT Paul Ward, CRMP