DIVISION OF REGIONAL MEDICAL PROGRAMS PILOT ARTHRITIS PROGRAM Summ@ Reports Of Projects Regional Medical Program @e Alabama 1 3 Albany Arizona 5 Arkansas 12 California 14 Central New York (Syracuse) 23 Colorado-Wyoming (Denver) 25 Greater Delaware Valley (Philadelphia) 29 Georgia 34 Hawaii 38 Intermountain (Salt. Lake City) 39 Iowa 41 Kansas 43 Metropolitan Washington 46 Michigan 48 Mississippi SOA New Mexico 51 North darolina 53 North Dakota 7 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 armne ALABAMA REGIONAL MEDICAL PROGRAM Alabarria Rppional Metlical Piof,,ram ARTHRITIS PILOT PROJECT #95 P.O. Box 3256 @ A Model Center to Clinic Service 1108 South 20tti St, Summary Bifmitigharr., AlabAivia 3520S (205) 934-5394 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 healthcare and educational facilities; curriculum development aid for University of South Alabama College of Medicine. c) Name and Address of. Project Director Gefte V. Ball, M.D. Professor of medicine Division of Clinical .Lituituiiuj-ugy anci Kneuinar-o.Logy 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 laboratory in Birmingham will function as 'the central service laboratory. Tests to be developed include ENA, anti-mitoclion- drial antibody,.immune.complex precipitation tests, irmunoassay of IgEi B, and T lymphocyte procedures, Serum DNA, and iramunofluorescont immunoglobulin and complement complexes in tissues and C4 by heniolytic-assay. Nurses, internists, physical therapists and occupational therapists will be integrated into these modcl,clinics and they will -tining of others. serve as the education specialists in the trL The education of public health nurses through whom case finding will be 'Lacilitated'will be emphasized. IZecognition of all treatable musculo-skeletal syndromes ranging from hyperthyroidism to polymyalgia rlieuitiatica will be stressed. The model clinic program will be an outreach effort to extend the expert services of rheumatologists, orthopedic surgconsil 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. e) 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 clinic areas. In addition to the physicians who.are specialists in rheumatology, there will be occupational therapists, physical therapists and nurses involved in developing the programs and curricula. The expertise of -the Spain Rehabilitati'on Center Rheumatology Service and their facilities will be utilized. f) lhvblvement-of Community Resources in Groups The University of Alabama in. Huntsville School of Primary Medi- cal care, the University of Alabama at Tuscaloosa College of Community Health Sciences and the Department of Medicine of the University of South Alabama and facilities of those institutions and the UAB Rhouinatology laboratory will be participants @n this project. There will bf-- 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 (IIIST) will assist in disseminating new and pertinent information. 2 n tl JJ'#? e A llptsirt!l Regio t ALBANY MEDICAL COLLEGE/ALBANY, NEW YORK 12208 *'(518) 445-5313 NORTHEASTERN NEW YORK REGIONAL ARTHRITIS PROGRAM 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 Oneonta, (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- plenary 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 Drolziam. Lee E. BArtholom,-T.7, M Project DirQttor, Protessor of Medicine and Head of the Medical Specialty Division of Rlietimatology, 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 above were chosen for the original arthritis programs. Glens Falls is a small city of Approxiraately 18,000 people in a 4.1 square mile area with a population density of 4,463 per 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 population 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 ha d been made with the Glens Falls Hospital for clinic space and after the appointment of an assistant director of the program 'or Glens Falls. This pliysi- cidn is a board-eertified 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 continuing education credit was offered. 'Fhe program incltid(!d discussions oil evaluation of patients with rheumatic 'diseases, pathogenesis, an(] treatment of riieuin@-3toid arthritis. It also included diagnosis and of patients with systemic lupus and Volymyalgia rheumzit-Lca and diagnosis and treatment of crystal- i.nduced syndvitis. The program was attended by ci@,,ht pliv.,3iciins from tile Glens I Falls area and was successful in orieiitLiig physicians of that Irel to the Diap,- nostic and Treatment Center in Glens Falls. 3 - - - - - -A.Ll@@ SICAO LI@@LL UIJL;LaL.Lltr, iflUilLil.LY LUU lipproxl- mately one-half day per clinic. Clinics are held in the I)cl)tirtment of Physical Medicine where examining booths and patient waiting areas arc available. Appoint- ment,s are made by the secretary at the De artment of Physical Medicine, while p the pliysician-director is responsible for medical and administrative arrangements. Through the Northeastern New York Chapter of the Arthritis Foundation, volunteers have been working in the clinics-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 Rheumatology, AlSany Medical,College, two Physician Therapists and other interested physicians who often accompany their patients. During each clinic six to eight new patient's are evaluated by one of the Rheumatologists and receive complete history and physi- cal examinations. Appropriate blood studies are 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.clinic. II. The Oneonta Clinic will officially start operation in mid-January, 1975. A number of meetings have been held in Oneonta with hos pital administrators and 10 LL CL %-.LJ.LLJ-%-. LiiiL6 but-' i.L lb aLLL.LC.LpaLeu that actinic will be held one day each month initially. A board-certified in- ternist has been appointed assistant director, with organizational responsibilities. A board-certified Rheumatologist from the Mary Imogene Bassett Hospital in Cooperstown,.New York will be one of the attending Rheumatologists, 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 an d laboratory tests. She will also perform the transcription of patient records. The Oneonta Clinic also will be hold in the Depirtment of Physical Medicine where examining booths and patient waiting area is available. As in Glens Falls, it is anticipated that all patients will be referred by their physicians, many of whom will be in attendance with their own patients. At the beginning, a limit of eight new patients will be set for each clinic, thus al.low:Lng 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 wi 11 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. The 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. Personnel,in 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 clinic3l 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, Rhe=atology 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 clinics' 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 UNIVEPSITY OF APIZONA' TUCSON, ARIZONA 85721 COLLEGE OF MEDICINE ADDRESS REPLY TO: ARIZONA REGIONAL MEDICAL PROGR. ARIZONA REGIONAL NIEDICAL PROGRAM 5725 r. STH STREET TUCSON, ARIZONA 85711 s y IS SERVICES PROGRAM Director: Warren Benson 3813 East 2nd Street Coo@ator: Beth Ziebell Tucson, Arizona 85?16 The proJect@was proposed.to develop a network (center) Of diagnostic, treatmnt and rehabilitation services for arthritis Patients and their families in the rural camunities of Southem Arizona and in a presently radically underserved model cities population in Tucson. 5 netwo@Z-Will'include the services of the Southwest Chapter, The Arthritis Foundation a Tucson based rmrrber of the national organiza- tion, as well as the resources of other public @d private arthritis related health services agencies throughout the area. The project will pass on special knowledge and s.kills 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- ettings. shop s By the end of the proposed demonstration Progrw, the comprehensive- ness of services will be increased in Southern Arizona. This will stay ,with the c ties, to be reinforced by oontiniiino wi@h i-.,-nm personnel and agencies. The extension of the linkages of outlying areas will demonstrate how effectively rural and urban health services can be linkbd to benefit the arthritis patient living distances from a. @or health center. 1. A 'Pucson Interagency Liaison Condttee composed of individuals a.nd representatives from'agencies participating.in network services. The Tucson Interagency Liaison Condttee will meet at least quarterly during the project year. Individual comdttee inner will be called upon to provide counsel and services to local co ties. The role of the Liaison Clomdtt6e is perceived as consultative and as a vital com- munic'ation link with their organizations and the local committees. it will also be responsible for evaluating project nrogress and :Uipact. 2. Since a rrojor strerV,th of this project will rest in its ability to wtivate local comunities to mobilizo- resources and to form linkages-to existing services, local cmnunity committees will be f6rried in each participating tarfiet area. These coianittees will be made up of representatives of organizations such-as Health Planning Councils, Councils of GoverTmnt Services, MedicAl Societies, hospita administrators and the Cooperative Ex- tension Service, as well as allied health personnel, consumers, in- terested laymen large employers, educatots-and others The evaluation of-this project will be conducted by Pima Health Systems (PHS),'an experimntal health service delivery system program.. ORGANIZATIONS EXPECTM TO COOPERATIVELY PARTICIPAriE IN PROGRAM D4P 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 o-f Arizona Office of Vice President for Health Sciences:Serve on Liaison Comdttee, Serve on Arthritis Foundation Board of Directors, Serve on Project F@ecutive Committee,, Assist with development of,, and provide facilities for workshops. 2. College of Medicine (Arizona Medical Center and VA Out-Patient Clinic) a. Section on Dnunology 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 in@workshops 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 c ty leadership for member- ship on local comdttees,. Assist in the identification of patients and families needing n(--twork'services. 5. Arizona Trai@7 Cent(-r for the Elandicapped Will manufacture self-help devices and some components of home 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 C@ttee Liaison to other county medical societies. 8. Pima County Medical Society Tucson Liaison Committee Liaison to other county medical societies. 7 9. Health Planning Council Tucson Liaison Comittee Ongoing review of project objectives 10. Piria Health Systems'- Tucson Liaison Condttee Project evaluation 11. Councils of Governmnt ,.,Serve on community co@ttees 12. County Health Departrrients (other than Pima) Community c@ttees t3. Soilf-h TucF;on/Model Cities. @roject (arm of city government Serve on Tucson Liaison C@ttee Identify-indigenous comimity leaders whose.aw@ness and involvement in the project will increase utilization by minority groups to be served 14. United Way (Community Service Division) Serve on Liaison C@ttee Raise funds for continuation of program 15. F4ster Seal Society Serve on Liaison Condttee Transportation servides .16. sisters of Hungary Clinic Serve-on-Liaisoti Committee Referrals to clinic, 17. Veterans Administration Ilospital Lend facilities for in-service training 18. Visiting Nur-ses Association Referral of patients for c@ic se@ces Dissemination of educational materials 19. Arizona Regional Medical Program Provide-ongoing fiscal supervision, program monitoring., and evaluation Serve on Liaison Comittee 20. Departmnt of Economic Security Serve on-Liaison Co@ttee Training and rehabilitation services DTloymnt and welfare 8 21. KUAT Radio and TV Bureau, University 6f Arizona Produce educational material Serve on Liaison Camittee Enlist cooperation of outlying stations 22. A. Co ty colleges Use proj6ct personnel as resource materials B. Secondary schools Schedule speakers for health education classes 23. Media Representatives serve on Liaison Committee and local c@.ttees Provide outlet for educational programdng Publicize local meetings 24. Family Service Agencies Serve on Liaison Condttee Provide services to arthritic pa tients and their families SPECIFIC SERVICES: 1. CONSULTATION CLINICS,. We provide visiting teams to rural comunities on a regular basis. Rheumatologist Social 14orker/Counselor Orthopedist How 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 rwdical prognosis and outline treatment (d) Consultation with the patient's physician concer@ not only disease management but environrwyital, social, mechanical factors, work simpli.cation and the 1 ke. 2. PHYSICIAN TRAINING PROGRAM: One-wwek intensive clinical experience in Rheumatology in Tucson for twenty physicians from the six southern co unties. Twenty physicians from the six southern counties will participate in a one-week, intensive clinical experience in arthritis in Tucson. The physicians will be under the Jurisdiction of the adrrdnistration of the Arizona Medical Cneter. This program will include attendance in 9 ttie 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 Administration Hospital. Local rheumatologists will invite the physicians in training to parti- cipate for one-half day in their practice. 3. WORKSHOPS - In.Tueson: 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 Faridly of the Arthritis Patient Conference for Ancillary Health Personnel 4. MINI-WORKSHOPS - In rural comunities: One-evening programs desi@ed for continuing education of physicians and allied health personnel. 5. HOME 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 furiily, and the home as to pof-,sible changes,. innovations, and modifications, alonLT, with the proscription and purchase of materials and equipmnt that will make it possible for the 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 pat.lent's behavior as previously described on a demonstration basis. C. To collect and make available information qbout new do.v(,'lop@,nts in coordinated lioirr;. care and self-help devices for the arthritis 'patient. 6. EDtJCATIOiiAL MATERIALS: 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 re@n in the management of arthritis. Distribute throLVh the Arthriti.,,, Foundation tlir-(-,o (@lij)t-intriute color films which have already been produced for use In nursing ,tations (as an example) to teach health persomel proper manage mntlof the arthritis patient. Identify 1,500 additional persons to receive the Chapter's Newsletter. 7. OLU-PATIENT CLD4IC: A comprehensive service utilized by presently medically underserved patients with arthritis and their f@lies in the Southern Tucson/Model Cities area. ll'o assemble a professional ste.ff, including a pa@-time rheumtologist, a pait-tim nurse, a full-tim physical therapist, a full-tine resident in rheumtology, a rehabilitation counselor, and a full-time 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 demnstration clinic, the patient's needs for radical care, occupational therapy, physical therapy, and activities of daily living will be assessed. S RE4 GIONAL MFDICAL PROGRLAM Evergreen Place, Suite 215, Evergreen at Utiiv,rsity, Little Rock, Arkansas 72207 Roger J. Warner, Coordinator 501-664-5253 Through the grant for.zne 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 fac:lli-ties-and organizational structures to provide a networt,, of interrelationships for the ditsemina- 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.established in eight of the larger communi- ties of the state (Fayetteville, Harrison, Jonesboro, Mountain Home, Camden, El Dorado, Texarkana, and ',-lest 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"S (hold quarterly). Five corysulting rheumatologists have agr6ed 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 instill 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-modia educational program in each district, assist the local clinic sponsors in arranging consultative visits, and assist local physicians in arranging referrals for secondary and ter@iary care. In addition, the educational coordinators will work closely with the area-wide Health 12 Pi s and the Arkansas Soc anners, tile Arkansas Rehabilitation Service ial Services in order to advise patients as to the financial and rehabilita- tive assistance th3t is available to them through governmental agencies. An incoming llats 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'Arthritis Foundation will contract with a public relations organization to develop an all-Med'ia educational program aimed at the arthritis patient, family and Dhy§icians. 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 pilysica therapy clinics in order to improve.the quality and cluiritity of pfiysical therapy services available to arthritis patients. The program has been extremely effective, but utilizing, as it has, the serv ices 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 ri. Levi national Hospital in Hot Springs, Arkansas. After completion of trai,n' --N-e-w@i I be assigned-to the same duties as the Foundation's present thera- pist, permitting an expansion 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 conduct two 2-day demon- stration work5hop@ in arthritis physical therapy to indoctrinate the 73 physical tlierapistt now working in Arkansas in the special techniques useful in the treatment of rheumatoid arthritis. The Project Director is, ,.Don Riggin, Exec@ul Live Director of.the Arkansas Chapter of the Arthritis Foundati.-onSI-Post Office@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-i65-154c Date Decemoer 3, 1974 Pro ect 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, CA- 94616 Pro ect Staff : James Castles M D.i Robert Shapiro, M.D.; Barry Brian, M.D.; an RN; a- Physical Therapist; and a Secretary Objectives To establish auniversity-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 children. Methodology Paramedical personn el tqill be.ut'llized for patient evaluations in order to maximiz:e the time that the two avai lable rheumatologists will have for direct patient care. I U-; @d IJC I @Vl If IW'I IJ I @U I III V"-LWZIZII 4- It t,, V =I L t, Ll@ IJC31 C311@1IIt IUIIUW-UP UVdiUdLIUll VI patients in conjunction with their primary physicians. Public and private agencies whose input might assist the arthritic child and his fami ly will be identified and utilized in order to m6ximize 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 site. 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 Ccmmunity 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 phy.sical 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 -Pro'cct Director Ephraim P. Englcman, M.D. Project Address Division of Rheumatology, School of Medicine, U.C.S.F., 3rd and Parnassus, San Franciscci, CA 94143 -Project Staff Brenda Spriggs, M.D.; Hope Snowhite, P.T.; Cbrol Lavine and Gwen Clewley, 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 conduct demonstration teaching programs in selected community hospita Is which are diverse in geographical location, patient population pnd organizational structure. Progress 1. Audit criteria for the follow Ing forms of arthritis have been developed and are currently in use: a. systemic lupus erythemastosus d. ankylosing spondylitis b 's syndrome 0 gout and pseudogout e. Reiter c. 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 care 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. be Chinese Hospital, S.F.; and Highland Hospital, Oakland - P rojiect 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-pat Iient teaching case material. C. Ft. Miley, VA Hos@al - Project staff to provide consultation on in-patient teaching rounds once a week. These sessions to be attended bX five (5) pliysi- cians currently providing care at the hospital. Project staff is attemtp.ing to coordinate the Physical Medicine Department with the Arthritis Clinic. d. Chi ldren's Hospital, Oakl!ahd - 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 by the project staff oncea month in consultation rounds held by the outpatient department. Projecr- NO. : Kur-/-tt- i o I - j:)-+t Funding Period : 9/i/74 - 8/31/75 Date : December 3, 1974 Pro ect 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's Hospital and Medical Center, Hayes and Stanyan Streets, San Francisco, CA 94118 Project Staff Rithari Welch, M.D.; Kathy Gomez, Admin Asst.- Patient Education Departmont;..and a consultant staff of four physicians. Obiectives St. Mary's Hospita I and Medical Center proposes to provide diagnostic consultation 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 tr6.ined allied health professionals and monitored by attending and house staff concerned with rheumatic diseases Instruction will-include all essential components of atient self .care, plus assistance in utilizing community p rehabilitation-and occupational theeapy,resourcds. .Progress In order to accomplish the above objectives two teams have been developed. The-first team consists of rheumatol -ogists, 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 s"etting long term treatment goals for both clinic and ' te arthritis patients. priva As of November 15, 1974, theee conferences had been held and five patients have been medically evaluated. The hospitals Patient Educ;tion 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-Ty ist. The p Committee consists of representatives from attending and house staff physicians, clinic nursing staff, representatives from the Physical Therapy Department and the Haight- I Ashbuty 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 t'he 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 Assessme nt form which when approved will be pre-tested with several patients before presentation for general use by patients. 16 Project No. : ROP-74E-,o8-l541 Funding Period: 8/l/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 RheLimatology 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 arthritis 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 La,, tal b.i@ WI-iice LOI , C3Z L;IC@t; 01 C 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, the staff has been successful in developing the questionnaire that will be used for their research. Half of the instrument y4i]] be completed by the patient and the other half by the staff. Consequently, technical as well as personal information will be obtained. The tool 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 breaking 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 organizations. 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. 1 7 Date Dece mber 3. 1974 Project Title Treatment and Education Program for Rheumatic Diseases Operating Agency: Orange County Medical Center Project Director: Michael Reynolds, M.D. Project Address Department-of Medicine, 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 Clinici Orthopedic Clinic and at Community Clinic (a satellite of OCMC) by directing 100 clinic visits per month to a physical therapist, 60 visits per month to an occupational therapist, and 30 patients screened per month by a nurse 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 allied health personnel) concerned with the comprehensive treatment of rheumatic diseases. Methodology The three new staff members will acquire skills related to arthritis by Dr. Reynol ds 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 initial 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 physical 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, All patients repeatedly attending the Arthritis Clinic at OCMC are being seen by the therapist for evaluation and revision of their personal physical the .rapy programs, including routine daily activities 4s well as formal 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 space for classes, are being dealt with. Involvement of Community 0 rganizations 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 nrofessionals 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. Obiectives 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 witVi 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 ettortsi 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 throughout 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.discussed 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 arrangement for the community seminars in Paris and Barstow. la uliullid vt;l ovu-1 /4 Da te December 3, 1974 Project Title Comprehensive Outpatient Evaluation and Treatment Operating Agency: University of California, San Diego Pro ect Director: F. Richard Convery, M.D. Project Address Physical Medicine and Rehabilitation, University Hospital, 225 West Dickenson Street, San Diego, CA 92103 Pro ect Staff Physical Therapist and Occupational Therapist Objectives 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 Clinic, 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.1m, 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 pIrogress and needs during rehabilitative care. Also, it should #.k^ nT -1,4 PT Pirp Progress The primary activity of this project thus far has been the development of the "Art -hritis Activity Asses'sment" 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 for 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't.he 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 supportive of this project. Currently, they have assisted by providing small donations, including furniture. One viomin, 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 Repro-sented 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. Eng.leman, M.D. CRMP Project Directors' Group 359 San Mateo Drive 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 Gowland Occupational Therapist OT Department Rancho Los Amigos Hosp 7601 E. Imperial ffi-7y. Downey, CA 90242 213-922-7464 Ronald L. Kay&, m.D. California Medical Association Palo Alto Medical Ctr. 300 Homer Avenue Palo Alto, CA 94301 415-321-4121 James Klinenberg, M.D. Arthritis Foundation, 4833 Fou-,itain 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- Center Division Cedars-Lebanon Hospital Box 54265 Los Angeles, CA 90054 213-662-9111 Mr. Clark McElmurry Arthritis Foundation, San Diego 37 19 4th Ave- nue Chapter Box 3344 San Diego, CA 92103 714;-291-0430 Dr. ltardild Mozar Chronic Disease.Unit.and State Health Dept. Rehabilitation FAdilit3.eS 714 "P" 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 Restito 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 Schelcher Arthritis Foundation, 1507 21st Street Sacramento Chanter Room 20'i Sacramento, CA 95814 MS. Addie Thomas Social Worker 2421 Foothill Blvd. LaVerne, CA 91750 714-593-3383 22 CENTRAL NEW YORK REGIONAL MEDICAL PR9GRAM 716 East Washington St., Syracuse, 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. WaGer Street 750 E. Adams Street Syracuse, New York 13210 Syracuse, New York 13210 Attention: Monty Euston phone: 315-473-5820 phone: 315-422-8lT4 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. TraininR a Nurse Clinician to dead with tbp -nroblpmq nf- 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 c';.inic 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). 5. Surveying vocational motivation and potential in a population of .patients with arthritis. Questionnaires will be used to identify cIandidates for vocational rehabilitation, who will then be interviewed and-evaluated. 6. Holding 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 'Rheumatic Diseases 1. 'Holding regular cliInics and conferences in major cities in the Central New York region for physician education. 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 therapy, 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 same model has been started in Ithaca. 3. A consultation clinic on the LT+,ice model, directed primarily at diag.nosi@-and therapeutic recommendations for the individual patient, will be established in Watertown. Clinic sites- ljticr- Cbildren's Hoc;pital and, Rehabilitation Center, Utica, New York 13@0' Binghamton bimonthly at: C;".S. - 14ilson Yerorial Binghamton General T, c.-7 4- z: 33-57 Harrison Street !4itchell Avenu@ Johnson City, II.Y. 13790 Binghamton, New Yor'@ 15903 r'@ordinator: Dr. V4.ncent @ta.ddi Ithaca Tompkins County HosDital, Ithaca, New Yorl, 14850 Watertown site not yet determined 24 COLORAno WYOMING REGIONAL PROGRAM Estoblis4ed Jon 1, 1967, under Public Low 89-239 to Combat Heart Disease, Cancer, Stroke, Kidney Disease and Related Conditions Su.tc 410, Pron@lin Lluilding 0 2C'45 Pionklin& C,@intaclo 80205 a i3O3) 892-9527 T'hornas A. Nicholas, M.D. / Executive Director 9 Robert C. Jones, M.D. / Program Director COLORADO-ViyoliING RWI014AL ARTliRITIS PROGRAM S Report - Dec 6) 1974 lloy L. Cleere, M.D. arir- i-ncluded in the Colorad@elyo.,@e,, Re6onal Artlit,itis Pro[,rTn are: 1. rwnt ol f ice 2. P.,,-tlii-itis Divisionp University of Colo,-ado !k-dical Center 3. renver Ceiicral libsp'-tall Depa--t@nt of' Health and Hospitals, City of Denver 4. Artlu-itis Iri-eatmnt Center, @neral Rose I,'jermrial Hospital 5. fic@onal Arthritis Centers, Colorado and Vly @g Spoi,isoring arencies: Ti-,e Arth--itis Fo,.Lndation and University of Colorado @ledical Center Collaborating aEencies (in addition t o those listed above): Colorado ,-nd l@voninf,, Health Departrm-nts Colora(l@e.l.vemini- Pefr@c,-Lil I-edical Prog= Colorado and WyoranF, iledical Societies County or District 11edical Societies IkL,,p,ose and objective: To upgrade the'a@lity of the diaMostic procc.@c]Lucs anti prely-@llr,ivL, care of the arthritic vatients in the tv.,o-state areas o" Colorado and 1--lyo.@dnE; and to @,e this im@oved radical service., mm widely available. TrLis Arthrit-I.s ProCram is staffed by specialists from, several. arthritis uiJ.ts ii-s- the Oliver f@',ctropolitan area most or v-iom drop with th@ faculty of the Ulnivei,sitv <,f Col.oindo I.'P-dllc,,il Center. i@iis is the only teachinr r.'!c(@ldcal Center in these two and with the 0 .,taWs. It is Liter-r--lated wiL'.Ii the@ medical and Hospital facilities I,--altli pr@ofessionals; Fhysic4-ans, Public Health st,-iPfs,@",Iurses, Pliysical 'licrapists @cup,,itio,nal Tnerapists and Social Workers wnose services am needed to make good arthritis care available and acceptable. 1. l@lana@-r,-ent Office A(I-.-J-nJ.str-ator - Roy L. Cleere, M.D., ',%4*P*He @L-dica,l Coordinator - Jain-e @-avo, M.D., Rheumtolo@st Adrdnistr,,,tive Se.-Iietary-- I-arianne Sevier Office: 800 Cler imnt Street, #410 Dcnver, Colorado 80220 Telephone: 303-3-22-5944@ This -office will be the base of operation of the t)roL-ram being conducted in several different particimli-ire-, Institutions 6nd the local cuvas served. Pe----cnsibility is tion of services rendered by the several dcmc.,-ien-us. also assumed for coo ,*vL,dical Coo, -tor has direct respcrsibil" ty for or@,@z:Ln.@ the ervices of t@,e lvalth professicrals to staff the re;;icnal c@Ics, n,-,d cccrt@-nates t,;',ese cuk"-zvacn c@ with the A @strators of @6'@ affiliated and co-socnsoi,4-ng aCencies. .cs 25 7lie fJn-incial Action of ti-c project will be centered in tlii:, oPflcc. A"I'@,ou a(br,iii.istrat' on -of the prci Is tl,-, rv-pcn-l-bility of t@-'s c.@fi-c, .1rd@rect suner- vi.,;irin is rnintained by an Adr.Lnist-I.-ak-ivc- Cc::r-Littee, corpcs@1(i of ei-li-. @,ey persons Colorado ,-nd Wy@, incl,,:dirr- ,L- physicians. c Chai-@.=& fo is t,'.r. P.c,.,ert 1-@-i,rick, ,L p:-o-Jjicnt Denver who Is also the President of '2@#1 Arthrltis Foundation (Rocky Mountain Chapter), Close liaison is also n'nintiined with the offices of the Executive Director, Arthritis Foundation; mid the Regional medical Program. Arrangermnts, for Regiaml Clinics and Vlorkshops- for physicians and. other health professionals are Trade by, the Mmgermnt Office, A wo'rking relationship has been established with Dr. David M-ills., Rhematologist, 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 Mills, who also serves as Rhematologist "or VA Hospital .Address: 4200 East 9th Avenue, @nver,.Colorado @lephone: -303-394-7592 A bio-cheridst is errr)loyed in the Arthritis Division to work under the supervision of Dr. Jan-cs Steigerw-ald, full-tifm Rheun-atologist in the Arthritis Division. . He has set up new diagnostic procedures, effective Novenber 1974 as a service to the affiliated hospitals and the eight centers where Arthritis Clinics have been conducted, A clerk-t@,pist has also been-added to the division4 This 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 forms and data analysis. She also assists Dr.. Bravo. The first workshop for the eight Regional Medical Coordinators was conducted at this It)edical Center on Novenber 22, 1974. Seven of -the eight were in attendance and which was also attended by mrrbers of the Panel of Consultants who conduct the teaching and consultation clinics.. Faculty rwitbers of the @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 dia 'stic.techniques and diagnostic mthods at a teaching centeri At this MO meting, there was an opportunity for free exchange between the teachers, the local radical coordinators and t.@ administrative staff. In this %,ay, ideas for changing future c@cs and va:nel sessions, evolved. III. Denver Departrrent of Health and Hospitals Arthritis Unit - Dr. Jarms Steigerwalds Rheu'rratologist Tt-lephone:. 893-6ooo Five arthritic-orthopedic -beds are available at Denver General Hospital. The Denver Neifhborhood Health Centers will also be utilized in the consultation- teaching services 26 A nurse who has had advanced training as a Nurse-practitioner has been added to the staff at Denver General. S.@ has also attended two to three weekly Arthritis Clinics at the University of Colorado Medical Center and Denver' General Hospital. Her services have been useful in conducting, cLinics in the affiliated hospitals located in the ReCicml Centers. The requests for services of Nurse-practiticner-. by local nurses have substantially increased. IV. General Rose lio-mrial Hospital - 4ithritis Treatuent Center 1050 Clermont Street, Denver, Colorado 80220 Yedical Director - Charley J. SrVths 14.Di, Nationally recognized rheumtologist and fo@r Ifead Arthritis Division, University of Colorado @dical Center @lephone: 303-320-248o nAs new center will provide 22 beds for arthritis patients, who will receive the most modern treatmn,t. The building is constructed as a model unit for the care and rehabilitation of arthritics. It is physicially connected with the physicial rwdicine and rehabilitation departmnt of the hospital, A well-qualified nurse-practitioner is an addidtional mrrber of the staff of this center. She has also received special training in-arthritis patient care as a miTber of the rehabilitation team at General Rose @mrial Ilospital and she has also attended two to three Arthritis Clinics each week at the University of Colorado Iiedical Center. @s nurse-pratitioner has also served as a team rmrrber at several visits to the Regional Arthritis Clinics. V. Regional or C ity Clinics. It was necessary to strenthen the so-called "in-reach" programs in several of the Denv'er institutions in.order to render the required consultation-teaching servees 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 conducted one teachin-@cnsultation c@ic and the reception in every instance has been excel"Lz!nt and much appreciated. Taking into consideration, demography and accessibility, the following eight co ty centers serving regional areas in the two states were selected Colorado: Sterling - North East Pueblo - South and South East Grand Jmction - Central @,lestem Slope DLwanEr,o South West Wyoming: Sheridan North Central @rmiopolis - West Central Casper Central Larar,de South 27 Before launching plans for clinics in the ei@t regional centers, the progw plan was prese-nted ' to the Presidents and. Speakers of the flouse of Delegates of the Colorado and wyordng 1-jedical Societies. Tneir support was solicited and the program received the endoreserri2nt of both societies. 'Lhis is considered of major @ortance in getting these prograrrz accepted. Subsecuently, the Presidents of each of the eight local '.Jcdical Ojocieties v.,ere asi@ed for assistance in the selection of the eight regional radical coordinators. In every case, these leaders of the c@onent radical societies offered their full cooperation. Listed are the nams of these coordinators: Colorado--Charles A. @scn, M.D., Pueblo Kemeth.Beebe, M.D., Sterling Dea,.i L. Furry, M.D., Durango Roger Shenkel, M.D., Grand Junction Vlyo@g-Sp@,mour Tnickmn, M.D., Sheridan R. David Reith, M.D., Tnennopolis Joseph Murphy, M.D., Casp-pr Lloyd Evans, M. D, Laran-Lie In addition to the clinics scheduled in the selected regims, it is planned to offer lectures by consultant team rwnters 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 eight regions. The team rwrrbers conducting the clinics included . a rheurratolo;dst ant orthopedist, a psysiatrist and nurse-practiticner. 7be Regional r-ledical Coordinator assured t he responsibilitiy for local arrange- mhts with assistance from the I'@gemnt Office. He arranged for use of a local hospital and collaborated with the physicians in his refion: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: (j) One-hundred fift.y-nine physicians, sixty-six nurses and twenty-two other health professionals attended lectures during the eight regional pro&rarz; (2) one-,iundred t-4entV-tlirce physicians, fifty-ei,@t nurses and thirty-six other health profiessicnals 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 mre tire for detailed discussion and physician. consultations. Follovi-up service is also planned for patients seen at the clinics. Repeat clinics have been conducted in Grand Junction and Laiaude on Decerrber 3, 1974, Although definite pro@.ss has been achieved in imeting stated objectives, a continu- ing review of the program will be conducted. 28 In addition to an evaluation based on nL=rical count of physicians and other health professionals who have attended c@cs and patients seen in c@cs, other criteria for evaluating the prof7am will be explored. For instance, it is desirable to ascertain v.,I)cthcr health professionals and arthritics have d(?veloped a rmatc@r awareness with respect to modern concepts of diapiosis and treatmnt. Vhrtlicr, also, there is in- creased utilization of existing facilities and resources for care of arthritics during the tenure of the demonstration prot7,am. Ila.-, the aLLility and aLLantity of horm health care services i-i-.proved and has there been an increase in the use of the services of nurse-practitioners and other physician-extcnders needs to be determined. Also, of pri@ importance, will be an analysis of the costs for conducting this type of an outreach prorxam in two 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 Cl',i,@%Tl-"R D-I,',L@t,%TARE VT@T,LEY REGIONAL MEDICAL PROGRAM Al)"UIJR'ITT,S ('ON'fROL PROGRAM Director-. @tt'dicll Dir(@ctor@ Salnion GD@,IP Arthritis Control Program T@)iirLollottc,, M.D. Section of RliCLImatology C/O lialinem,,inti @to-dical College Temple University If@705 Race Street, 4t:h floor 11 School. of M(-,dicine Philadelphia, Pennsylvania 19104 Broad and Ontario Streets Philadelphia,.Pennsylvania 19140 PROCRAM SmiARY: The Greater Delaware valley RMP the 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 Program'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 collaborative effort joining the five Philadelphia medical schools with non-profit hospitals and the Arthritis Foundation of Eastern Pennsylvania has been achieved in tile 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-fertiliz@itioti of ideas with the other 28 RMP funded @ilot arthritis programs, and some'significant success in building relationships among pediatric projects have been' developed. O@ll'O,NENT: FACILITATING TIIE'DEVELOPMENT OF ARTHRITIS DEMONSTRATION CLINICS Director, Charles D. Tourtellotte, M.D., Professor of Medicine and Chief of kheuma'Eology, Temple University School of Medicine and hospital, Philadelphia, Pa. 19140. @@m onent Summary: Tiid Artfir-itis Demonstration Cliiii.c (AI)C) component represents the ni@ijor tliru-,t oL- the CDV,ZMP Art,liriti.,; (.,oliLrol Prol,,ram. Its objectives vary according to local needs for improved arthritis care delivery, Clinic programs I,iave been: 1) developed t-iliere nonexistent; 2) im roved where .limited capability exists for diagnosis, treatment p an(] rehabilitation; and 3) strengthened wli(2re full cztp@ibility Ind responsibility for arthritis care deliv(!ry and education. A serious effort has been tiiade to create and ,;trengtheii- patterns for coordination of existing local resources, ADC's and the Arthritis Clini.c,,il Research Centers to provide a rational, efficient,, and quality (I(-,livery system for arthritis and allied An tdditional obje(:tive-bas been to foster a multidisciplinary profe:;sfonal approach with supportive allied health specialists in the i,iana).emeiit 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 Hospital,. Allentown, Pa. Dr. George Ehrlich; Allied Services Institute, Scranton, Pa.,' Dr. Charles Tourtellotte; Cooper Hospital, Camden, N.J., Dr. Sheldon Solomon; Gnaden Huetten Hospital, Lehighton, Pi., Dr. George Ehrlich; Millville 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 I to 4'sessions monthly. The program of the ADC is somewhat variable according to the pre-existing capability and self-sufficiency status for arthritis care in each locale. In each implementation, however, there is full'utilization of the other Arthritis Control Program Components and resources (Professional Education; Allied Health Professional Training; Pediatric Arthritis Prog4am; Patient/Family Awareness Program). Patients ,are,evaluated in the ADC's upon physician and/or appropriate health agency referral. The patient problem thereby serves as the medium for either direct preceptorsliip 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 Foundation. 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 project year. The vis-iting team leader coordinates the program and as$iRns visiting consultants as the program evolves. Community personnel 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. OiNfrONENT: PROFESSIOiqAL EDUCATION TO EXPAI%'D RESPONSIB'.ELITIFS OF PHYSICIANS Director: Warren Katz, M.D., Chief of Rheumatology, Medical College of Pennsylvania, 3300 Henry 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 rehematic disease. The major thrust for this education is provided by consultation to practicing physicians in each of the Arthritis Demonstration Clinics. At least on(,- liour-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/Deiiionstratiotis have been designed to cover a ranIge of topics. Additionally, three refional seminars in locations convenient to przicti.eili@, physicians throughout the Greater Delaware Valley are scheduled for SI)ritil, to cover q cont lete ran@, p ,e of disease topics. Coordination with the Allied Health Care Team component and the Pediatric Initiative Icomponent of tile GDVW,IP Arthritis Control Pro,,,r@,im has been ,3ticc(-@rsful In d(!si.giifill,, these seminars to provide a mullispecialty and interdisciplinary orientation. CRI:'-ATER DEIA14ARE VALLEY REGIONAL MEDICAL PROGRAM ARTHRITIS CONTROL'PROGRAil roi4poLIENT: TRAINING ALLIED HEALTH ARTHRITIS CARE TEAMS Director: George E. Ehrlich, M.D., Arthritis Center Albert Einstein Medical Center York and Tabor Roads Philadelphiail 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 undertook to fill. these training needs with specific reference to the Arthritis D emonstration 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 Mountains area. 4) Lecture sessions in conjunction with colle es of allied health 9 professions and area health education centers.-at these centers, at neutral site;3, or at the AEMC Arthritis Center. Training programs have been devised that permit allied health professionals in nur sing, physical and occupational therapy and vocational rehabilitation to participate in the day-'to-day activities of the arthritis center, AEMC as observers and active participants. In addition, lecture-demonstration's have been designed to fill in the identified gaps in knowledge. Educational materials' for curricula include books and pamphlets (privately published or published by the-Arthritis Foundation), reprints of sali'etit articles, outlines and instructional materials specifically devised for this GDVRMP Arthritis Control Program, and established problem solving techniques. Assessihent.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 Peiiiisylvanl.'l the Department of Vocational Rehabilitation of New Jersey, the Creater Philadelphia ('Iiapter of the Re-liabilit@ition Nurses' Associatioll, the colleges of allied hea;th professions it Temple University and the University of P(-@iiii.,;ylvania, the nursing schools of participatiiii,, Irca hospitals, and local chapters of physical therapy and occupational tlicripy organizations provide. platforms and community resources to assist with this program. GREATER DELA14ARE VALLEY REGIOIIAL MEDICAL PROGRAM ARTIIRITIS CONTROL PROGRAM COMPONENT: PATIENT-FMIILY AWARENESS AND INDEPENDENCE PROJECT Directress: Rodantlii C. Kitridou, M.D. Directress and Associate Professor Divi@ion of Rlleumatology Hahnemann Medical College 230 North Broad Street Philadelphia, Pa. 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 care, to'reducatf! the patient and family of the impact of spec arthritis and adjustment requirements; also, to emphasize that the ultimate goal of the therapeutic tearm,7ork is independence of the arthritic and rehabilitation and retraining. At the same time, the project mechanism provides@-for a forurff 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. .COIL4PONENT: PEDIATRIC 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 tile Pediatric Arthritis Clinics at Children's Hospital of Philadelphia; St. Christopher's hospital. for Children in Philadelphia; and Children's Seashore House in Atlantic City, New Jersey; an(] 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 greater capabilities in arthritis -are. Specific consultation is being provided to the other program components of the GDVI@IP Arthritis (control Progrim to r(!iicier 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 R6gion, 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-homd program to meet the unique needs of children suffering from arthritis and their families. 33 938 PEACHTREE STREET, N.E. al.-.Medical Program ATLANTA, GEORGIA 30309 xcD-C!ANCER, STROKE AND RELATE@DI$EAMS PHONE 1404) 876-8231 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 @etween a large medical school and a community @hospital. ,B.. 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 actually 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 tailored programs of training and continuing education for Area Fa@l;lty 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. A. The general f this pilot ddltorsrt2latlon project in arthritis objective 0 is to a&hieve 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. B. This Arthritis Area Facility project at Memorial Medical Center in Savannah will work closely with the Medical 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 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 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 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. Bo This 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 iAcility 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 inst tute specially 'tailored programs of training and continuing education for Area Facility staff, gomo of which will take place on site in Savannah and other programs will be held at the Regional Facility site in Augusta. Regional Facility staff will wbrk,closely with Area Facility staff in developing and instituting long-range programs of continuing education in akt@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 size, and will attempt to imp--ove-the.@i,@ 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. Co Related staff at MCG, including MCG resources in the area of patient and family education, as well as cooperative efforts of the Georgia Chapter of The Arthritis Foundat,ion and the Georgia Rheumatism Society. 36 Arthritis Area Facility The Medical Center Columbus, Georgia M.D. Howard vigrass@ in arthritis A. .rhe general objective of this pilot demonstration project mproved arthritis care by increasing the number of is to achieve i arthritis patients served.and by improving the quality of services pro- using as a vehicle the develo ent and implementation of a close vided PM community working relationship between a large medical school and a hospital. B. 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 Emory Univprsity arthritis 'clinic at Grady Memorial Hbzpital in Atlanta., Area Facility staff will also participate in specially tailored programs of training and!continuing education, developed by the Regional Facility staff in respon se to Area Facility staff needs. Some of this training will take place on site in Columbus 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 in the Columbus medical service area, so as to extend the improvement ofIarthritis care be or%4 the walls of The Medical .y Center. 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 W-111 provide patient and family education resources and The Family Practice Program at The Medical Center will be working closely with this project. D. Documentation of the efficacy of this pilot approach to th e improvement of Arthritis care in Georgia, both in terms of quality and quantity. 37 Regional Medical Progratn of Hawaii@' 77@ 0 Xapiciani Blvd, Suit* 706, Honolulu, Hawaii 96813, Phone (808) 531-6525 PROJECT 69, PILOT ARTHRITIS PROJECT The' School of.Medicine of the University of Hawaii, in doop- e@tion with the Regional Medical Program of Hawaii, and the Hawaii Arthritis Fouadation began'the project September 1, 1974, and will terminate, it on August 31, 1975. The budget is $216,000. The Arthritis Center of Hawaiitis 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 su@-fer from arthritis in Hawaii and 15,000 in the Pacific Basin. The need in Hawaii is for improved, diagaostic'treatment and rehabilitation services to arthritis sufferers. The'objectives and related activities are threefold (1) A multidisciplinary approach to referral, diagnosis, evaluation, and .treatment recommendation-of arthritis patients in a clinic setting; -n -"4v.Ls-t;o uu uuLiylrlg ana racitic 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 refer 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, M.D.,Pdieumatologist, Medical I)irectortwith Dr. Eugene Lance, Orthopedic.Surgeon and Dr. Raquel Ilicks, Pediatric Pdieumatologist, as part-time members. The Adminis.tr.ative 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 rrilst Territory of the Pacific Islands Intermountain Regional Medical Program University of Utoh Research Pork 540 Aropeon 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) in establishing ongoing, self-sustaining clinics and patient education programs. Methodologies: Presently, six communities (Boise, Pocatello, Idaho; Las Vegas, Reno, 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 each 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 core team. Consultative clinics and patient and family education sessions then scheduled in the community with consultants (provided by the project) attending to assist the local team in caring for -irthritis patients and, consequently, improving its capability in delivering arthritis care. The fom6t 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 vast area, there was 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.titied the Intermountain Arthritis q.,enter has been established to coordinate, manage, and promote arthritis 'care. Furthermore, by establishing the Intermountain Arthritis Center, it was possible to make application for ci provider number. This gives the Inter- 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 i 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 been7received from the local Arthritis Foundation and drug representatives. Presently, we are combining the patient materials into a viori@book w',I;.c7') 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 nurses were identified depending upon availability and interest in providing ir.,i,.lroved arthritis care. Local state health agencies, i.e. , vocational rehabilitation, home health, -etc. .were contacted and requested to support and 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 arrangemen ts 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 i-@.ave 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, 801/581-5537. IOWA REGIONAL MEDICAL PROGRAM Oakdale Hospital - Oakdale, Iowa 52319 The University of Iowa . (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 I) College of Medicine, Iowa City, is the sponsor. M. Paul Strottmann M.D., (Assistant Professor, Orthopedic Medicine, IVest 100 Children's-Hospital U of I, Iowa City, Iowa) is the project dire.ctor. 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 hich quality specialized care of ambulatory arthritic patients in a community setting. 2. 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 un-it 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 1 inic for To meet the first Objective, a demonstration patient care c ambula- tory 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 studlents'on rotation through the-clinic. An arthritis patient clinic has been established at Broadlawns Polk County, Hospital, d comprehensive medical center in Des Moines, to meet the second objective. The clinic is staffed by the project director and a rheumatologist 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: demand for specialized arthritic care and has expanded its program to train physicians in providing this care. A rheumatologist is giving 60% of his 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 patien:ts.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 ac quaint physicians with the diagnosis and treatment of the arthritic patient. This one-day con- will be conducted during the spring of 197,5. 42 KAr,J!7-,AS RE-.G-lONAL 111111 ML=C)IC;AL. PRC)GRAM 4125 RAINBOW KANSAS CITY. KANSAS CiG'103 1913),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 Universitv of Kansas School of Medicine at Kansas CitV. Kansas, and the Veterans Administration Hospital of Kansas City, Missouri. Project headquarters are 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.Uls 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 RobertGodfrey, M.D. 31 School of Medicine Project Director 39th and Rainbow 4125 Rainbow Kansas City, Kansas 66103 Kansas City, Kansas 66103 (913) 831-5371 Daniel J. Steclischulte, 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 Topeka Topeka-Shawnee County John Lynch, M.D. Health Department Associate Project Director 1615 West Eighth'Street 1001 Garfield Topeka, Kansas 66606 Topeka, Kansas 66606 (913) 357-0301 IEU Nurse Geneva Panton, R.N. Topeka-Shawnee County Health Department (913) 233-8961 43 spi tal 5. Dean Bray, M.D. Sal ina St. John's Ho ct Director P. 0. Box 214 ..Associate Proje Salina, Kansas 67401 311 North Mill 67467 Minneapolis, Kansas -2144 (913) 392 IEU Nurse Loretta Kreie, R.N. St. John's Hospital -(913) 827-5591 Wichita WI chita State University Bran h Frederick Wolfe, M.D. c University of Kapsas, Associate Project Director School of Medicine 345 North Hillside Fa i @mou n t Towe rs Wichi,ta, Kansas 67214 2221 North Hillside (316)' 685-1335 @wichita Kansas 67219 IEU Nurse Marjorie Wilbur, R.N. WSU Branch (316) 689-3144 The units will be staffed by a full-time arthritis nurse specialist and a full- time secretary. The nurses completed a three and one-half month intensive course in rheumat6logy and IEU operation on November 27, 1974; and the secretaries will complete a one-week course, in IEU operation at the University of Kansas Medical Center during the week of December 16. Each IEU.will be directed and supervised on a part-time basis by 6 local rheumalologist, whose name appears above, as associate-project directors. The Pro.ject Executive Committee 'will be made up of the Project Director, Associate Projpct Directors, as well as a representative of 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 Rheumatism Association-and comparable with the automated and semi- automated format currently in use by the Rheumat@ic Diseases Division all- Stanford University. While-the arthritis nurse specialists were completing their training program, the unit directors supervised the establishment of the IE U physical sites. In addition, they have recruited local physicians and 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 dare system. They provide individual and .group informational services to arthritis patients and their families either at the request of, these:in.dividdals o@ preferrably upon referral from their private 44 physician. They also have the capability of providing initial or ongoing history and phys ica I assess men t 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. All area physicians and allied health Professionals are invited tn ptfpnd send nmrfi,;nnf@ ;n these demonstration staffings.both as a means of professional education as well as improved patient care. Every two months one of the four IEUs servos 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. i Project evaluation and coordination is the responsibil ity 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 evaluation and basic program monitoring in the Arthritis Clinics at KUMC and the KCVA Hospital and finally in the KUMC IEU itself. When the individual [EUs become operational on January 6, 1975, a complete log of unit activities will be kept as well as evaluative information from patients, pl)ysicians and allied health professionals. Evaluation and progress reports performed by the unit staff %@ii I I 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 the-se contacts and the individual evaluations of the quality and value 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 'withothe 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. Finally, 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 segment of their Nurse Practitioner Training Program. The Arth r i t i s Nu r5e Spec i a] i s t Tra i n i ng P rogram concluded on November 27, 1974. The individual [EUs 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 will. have much in common.with many-of the other projects and knowing the,common features and possibly by incorporating some of the uncommon but generally suitable ideas- of o'thers,,we are confident we can evolve a coordinated evaluative methodology that will permit not-only an 6rgani'zed and meaningful consideration of the present.program over the next year but also assist in im lamenting -and expa@d,in rtptional arthritis centers program in the future. P, NIETROPOLITAN WASHING-FON 2007 Eye Street, N.W. REGIONAL MEDICAL PROGRAM Wasliingto'n, D..C. 20006 Tclcpholic: 202/@23-8050 loll Vaughan E. Choate ProgruinCoorditiator 11 Project: "P ilot Arthritis Center in the Inner City Location.- Washington Hospital Center 110 Irving Streets'N.W. Washington, D.C. 20010 Director of Werner F. Barth, M.D., Chief, Section of Rh6umatology Project: objectives: city patients with 1) To'develop, strengthen, and improve the care of inner ar.thritic.diseases. t currently available p,-rovide medical services and 'treatment no a. to these patients. develop a planned,program of patient education and rehabilitation c. train a registered nurse as a rheumatologic nurse-practitioner. tient compliance and present d. develop a system to ilmprove pa patient-loss. e. to assist patients with a wider range of social problems. t of @ob-s"because of their disability. specifically those p@tients ou i of arthritis problems in the inner city. 2) To determine the magnitude a. define the relative frequency of.various rheumatological disorder .in.the inner city. tients for arthritic management. b. define the ndeds,of -inner-city pa C. determine the cost of these needs. 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 Center-S. The Shaw Center is serving a target population of 80,000. Twelve percent (or 11500) of all clinic visits to the Center are arthritis-related. The Washington Hospital Center ejill use a multidisciplinary approach to both diagnosis and treatment. The medical team %,/ill consist of the prime investigators a rheumatology fellow, rheumatolo,gy nurse, two rheumatoiogy attendants, a physical therapist, and an orthopedic attendant. Other needed supportive services, such as social services, will be provided at'botli Centers. The Metro olitan Washington Regional Medical Program has established a Community p Arthritis Technical Review and Advisory Committee with its members representing providers and consumers. This Committee will be active throughout the tenure of the project's activity. Project: "Comprehensive,Care Programs for Arthritis" Location: Freedmen's Hospital-College of Medicine Howard Universi-ty 6th & Bry8nt 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. ActiviLL: 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 c'linic (arthritis or physical therapy) as often as would be.desirable for optimum benefit because of ,-heir physical limitations. 47 @Determine whether patient requires to be placed on home care program with visits 4y physitian's assistant, nurse, physical and occupational therapist and social worker to.visit patient's home and provide public health nurses, homemakers and health aide services when required. Educate patient and family in planning health care to offset negative aspects of arthritis treatment due to lack of understanding poor motivation, poor physical arrangements wiih home, or negative attitude of family, members. 'Plans have been made to have periodic sharing sessions between both project Directors and MW/RM.P Arthritis Advisory Coinniittee. It is felt that these sessions will be very helpful in coordinating total arthritis. activities MICHIGAN. AssocIATION FOR 1D REGIONAL MEDICAL PROGRA'ms 13,TELEPHONE 517-351-0290 SUITE P.'.ICHIGAN AvE.,-EAST LANSING, MICHIGAN 488, 'TER' -.F ICI-,ICAN PILOT r.RIATRIC ARTHRITIS CE@, SU"I.MARY DESCRIPTION o-: t!ie Universit,7 of Yichigan Center is to conform t-iith the thrust initiated in Reqional Mcdical Programs and arthritis b,,, the 197!,- Conqressional earmark of $4,5C,0,000. The 'center oatient care activities were c-4ves,cf pilot arth@itis -reatrent b,, a t-,) include irn-roved diagnosis an d. u 1 -,-,--isc'@.riinarv 4L-ean utilizing conservative nianacei..ert in the least i -.-e ca--re sLttirci to achievp- @revention, dela,. ' aiid.reducticn 47 cuncticn, disability and !Os-,g of c!ss j. in, s c a r c should be delivered to a d--fined not,,-,Iation'. '-ichi(-,,aii' ?ilot C-e-,ial@-ric Arthritis Cent.er has -,i@cT,tcd @@hcse Ti, defined as "residents of c t. ta tarcet poT)ulatio L.CS -or ave rileum- t e n P. C v I mi ch i a a n , at lea-qt 55 @,ears o.L ace, @..,ho h was to @e a model -rob!6-yrs." i@s a second objective the Center ia+--'c ,arthritis care which in its efficl'c-icy and effective- r lication ne s u I dbc- sLi4-tE?.blc for widescread rep 48 Ce.-iter a cc.-nnrehensive aTDiDroech is taken to rescl@rc- unnt,--t --'-e a--Llhri-tis icati-ent, especially tl-,cse cu'. of re@ich of '-c@a'.th ser,.,-L--es bN, reason of infiri.-,itv, remote acogranhic location o-- ii-4-te@ll -li-nan--Ial resources. The service program e-,,ii)hasizes a of the older person and his needs. A spectrum of ..-a'L-.h rrc@cssionals -)a.-ticilDate in delivering service. Ut-Ll.;-zinq -:he team anrroach, onnortunities exist for cooperative L-laniiirig and z-articinat4-on bv physicians, a podiatrist, nurses, social scientists and %%tor!@er@, rh,,,sical and occupational therapists, a nutritionist, cc-uisellors, adri-n4.strators and others v;ith experience in the health scr@,ices. -7s-L"-ablishr,.eftt of the Center entailed expansion, elaboration :-..-d orientation of se.-vices available in the Arthritis D-'-vj,s4-cn, Denar@Lment of Internal Medicine, Universit-,.,- of '.iichican e-r-er. .iedical C .encies r c, enresented on the Advisory Board and car@ staff include ,@-1-ic Prthr:Ltis Division and Der)artment of Postgraduate Medicine and 17--alth Pro-@ession Education of the University of @4icl-iiaan '-,,--clical Cer.ter, the -7n.stitute.of C2erontology, the School of Public Health, 2. Gui@el@--es and Reviev! Procedures for Arthritis Proaram, BliRD IIM,., vebruarv 21, 1974,, pT) 3. 2. or. c@-t, Y-D 1 Coiintv F-ealth Department.and the Arthritis Founcl@a Th-? --o Lirc; 1 4r)n A ain @i , Incort-,c)r@atc-,cl th@. trial of ti-,e au-@(3 t-. has an resource, assLir,,ric,, c@'i direct qcrvico z:-) t e rr,.@)@-ram developir-ent- and 'v those wi-io are members o-L- a minor7',..,., arou,@.,, -ncc,@.e .:!nc r,re-institutionalized. -n. 3 s!L,- ce i:3 beriin,,iinq, inclu@ii-- 2 n-,,-;n@h- of c.;, c:-@e r:i t.i@@i- , -,he, Frogram has become a f unctioning, ef f ecti,,re a.-, d recognized arthritis service. ')rcar@izi L',j.rector is- a. n Duff, @,!.D., 'rofessor of Internal @@@2dicine an@ Cl-lili in @harce, ."arthritis Division, U-ni@rers i t@, tal, "ichiaan, assisted bv 5 (--o-Direc:tors tqho 1-cin-7rise --in F-x@-cuti-N7e CoTrjriittee. The,i are:- r C . r . T . , vlh. D. f or 49 t ute of (,erontoloc,,. for ..(.,.ne Barnev, S. I,.'. Ins it .C-e.-iatric Services 0. L,,nn Deni-ston, @I.P.H., School of Public Health, Proarari in 1;7ealth Behavior, for Evaluation Poland r,. I!iss, DeTDartment of Postaraduate Medici-,-a, for T-'ducation wil.,L@@am i'4. ",,ikkelsen, M.D., Arthritis Division, for Healt'.11 Ser,.-4-ce Delivery -Policies of the Executive Committee are reviewed bv an 18 me,-Lber Co,-.n-,unitv ,-.d-,7isory Board rcoresentihg consumers (including rroc-ram clients) an,ri.r)roviders,. Input from the community to careful ra-@ional ni-anr,ing of'the P.rogr@ and its'associated physical and soci-I-I e-i@,I'ronment will be significant to devel-c-,,,,,ment of a Pilot Center of excellence:. TI@e Center !@roaram has 3 components: health service deliver--, educa- ,i.on o--F -a--ientl family and provider and program evaluation. E-..,=Llua- tion.%..,as not rermitted.bn, the sponsor, but.we considered it so -hat"alterria'tive funding for this comuonen ehtial t has been obtained. so 4 MISSISSIPPI REGIONAL MEDICAL PROGRAM P 880 LAKELAND DRIVE JACKSON, MISSISSIPPI 392i6 (6oi) 362-73II T. D. LAMPTON, M.D. COORDINATOR The Mississippi Pilot Arthritis project is an interdiscipli nary 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 'Care 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. videotapes 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 six: NEW MEXICO REGIONAI, MEDICAL PROGRAM mn 2701 FRONI'IER N.E. 0 SURGE 131,DG. f@ AL.BIJQUERQIJE, N.M, 87131. 'S Cl,N'rER Pi iONE 505: 277-34340A'I"I'IIE tiNNl I SCIENCII Pilot Arthritis Project New Mexico Regional Medical Program 1. Purpose and Objectives The improvement of the quality of care for the arthritis sufferer in New Mexico: A. The identification of. persons with arthritis in the outreaci-i area through contact and coordination with existing 1-iealth-agencies 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 possible. C. The improvement of the quality of care for the arthritis sufferei- through education activities at all levels (patients and their fami'lies, Allied 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 114 Amherst, S. E. Albuqueruqe, New Mexico 87106 The establishment of two pilot center of fices and placeinc@nt of Coi-ninunity Resource Workers. One in Taos, Nf,,iv Mexico (POPLIlatiori 4,000; loca- tion @lorth Central) at Holy Cro&,s Hospital: Donald E. I-loiden, CRVI General Delivery Taos, New Mexico 87571 One in Las Cruces, New Mexico (pop,,ilatiori - 65,000; location Sou th- western): JoAnn Marquez, CRW 211 Wt.!st Griggs Las Cruces, New Me;,ico 83001 51 B The composition of a Traveling Resource Team (Rheurnatologists, Ot-tho-, pedists, OTR, RPT) to serve as consultants to private i-.)Iiysiciaris in the outreach are-,is (local OTRs and RPTs at-(,- being LIS'-(] ZIS te,-Ilii members). C. The development of tied training team (RiieLIl',IItOIO@jists, 01-tliopc(iists, RNP, OTR, RPT, Psychiatric Nurse),to be used in Albt.ICILI(!I-qL$e, Las Ci-.u ces, Fa rm, itigton (Northwestern), Portales (Southeastern), -lind Santa Fe (North Cdntra-1). Specific training programs include physicians via TRT one FNP in yeai- long Rheuiiiatology training at Albuquerque, tlii-6e day wo'rk- shops foi, FNPs and PAs, day long workshops for R@is, LPN,S, OTRS., RPTS, and other AHP. Patient and patient family education.prograiiis in conjunc- tion with TRT and AliP training visits. Ill. Sources and. Employment of'Education Curricula Training programs developed by the University of New Mexico School of Medicine, Department of Medicine, Division of RheLimatolcgy. Procui-eriient and distribution of Arthritis, Foundation literature and audio-visual material for.pationts AHP, and physician education as well as the preparation and pro- duction of the new material. IV. Community Resources Involved A. Statewide 7 The New Mexico Chapter of the Artl-ii-itis Foundation (Medical an'd Scientific Cot-,imittee) ,RMP - Manpower Registry and.'related I)rograi-ns, Now Mexico Association of Itiot-ne Health Agencies Indian Health Set-vice, Division of Vocational Rehabilitation, State Health Agencies (Statf) Depart- ment of Public Health) , New Mexico NLirses Association, and Schools of ..t4tirsing. B. Taos - Taos County Unit of the Arthritis Foundation, private physicians, 1-fol y Cross Hosljital, HSSD, Indian Health Center, Centro Cat-npcsino de Salud. C. LasCt-uces - Dona Ana Cou@ tity Unit of the Arthritis Foundation, Public Health Dc,,Dai-Li-ntnt (Public 'ricaltli Officet-), liSSD, pi-ivi-ite pl)ysicians, .Dotia Ana County Ge.-iei-al Hospital. D. Al!)L.-CIU(@f-CfLie - fict-i-i,-ilillo County Unit of he(-, 17OLIt-,Cll--Iti0i 1, L)NM BCt,.4C - Adult Arthritis Cliriic, I-ublic Fit-iily IlL@,iltli Centers, HSSD, UNM Depai-tiiient of REC and PE pool) . V. Coi-nnILinit oorL,,,alron I'lic utilization of existing information and referral network -incJ 'kiie participa- tion in the development of such systems and areas wlici-e they do not 31i-el(ly exist. 52 THE ASSOCIATION FOR THE NORTH CAR.OLINA REGIONAL MEDICAL PROGRAM EXCCLJtiVe Office 4Ql9 North Roxboro Road, P. 0. Box 8248, Durham, N. C. 27704 919- 477-0461 Program Component: North Carolina Chapter, The Arthritis Foundation Component Direc.tor: John L. Kline, Executive Director 906 Ninth Street, P.O. Box 2505 Durham, N.C. 27705 Purposes: To perform program coordination, 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, Purham, and Charlotte. Methodology:. 1. Evaluation and reporting operational and fiscal data-is col, lected by each program on specially designed forms and sent to the Arthritis Foundation (NCAF). The-data will be tabu- lated, analyzed and reported regularly to all pro.gram compo- nents. A system of functional categories has been developed to measure patient progress. 2. Patient.referral - The NCAF operates a patient referral systei to provide the.patient's family physician with information wh@ taciiitates referrals to the most convenient treatment faci- lity. Since NCAF already served as a focal point for informa. tion on arthritis, it was ideally suited for -this test. The NCAF has received responses from over 400 physicians in the State-who have expressed interest in Lr'eatmeiit and diagnostic centers for their patients. Further, the same physicians hav( requested,that they receive distributions of-professional and educational materials for their patients, 3. Patient/Indus-try Program - NCAF has launched I pilot pa-tii2nt/i dustry arthritis program in a cooperating industry which has implant medical staff. This program includes professional training for the.inqdir-al personnel to facilitate early detec- tion of arthritis and to enliance the counseling and referral function. Further, this program includes a patient- education 53 component which encourages employees -to 3eck ciar nt ly treatine of the disease. Proper einployer/employee education should greatly-reduce the present problem of ar thritis victims Iiid- ing their disease for fear of losing their jobs. 4. Professi.onal Education - has been undertaken .,in support of .the five pilot arthritis centers included in t his program. This education program includes both 'medical personnel and patient components'. Medical materials and texts are'being by NCAF to physicians requesting them. In addi- tion, a series of education materials now available from other sources is produce(] ind distributed to the program' elements for education of- physicians and medical personnel. Program Component:, Orthopedi@c Hospital and Rehabilitation Center Component Director: Paul Youi-ig, M.D. Orthopedic Hospital and Rehabilitation Center One Rotary Drive Asheville, N.C. 28803 Purpose: Expand an existing delivery system usin paramedical personnel. 9 Improve cbst/effectiveness of treatment by using antimalarial drugs with monitoring. Location: Orthopedic Hospital and Rehabilitation Center Methodology: The focus of the Ortlio edic Hospital and Rel-iibilitation Center p (OHRC) project is a significant expansion of an existing delivery 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; 2. @s-cL.'LIL Le8LbL@L'e-U ilurses and otner paramedical personnel to perform,.patient screening unctions; 3. train registered nurses as a physician's assistant to deliver routine followup services, I:IiaL-by reducing rheumatologist time required per patient;. 54 4. train a-physical therapist to deliver educational information to -Arthritis patients; and 5. establish a station for the evaluation of retinal function and monitoring of potential retinal toxicity of aiilimalarial drugs in areas not conveniently located to OfiRC. In total, it is estimated tl-iit the existing delivery system @IL11 be expanded from the p're-grant level of four sessions per iiionth to four sessions per week at OliRC. Even more important, the (,-X- pansion will accommodate from two to four times as miiiy patients per physician hour as is now possible in the office o pri-va c rliei-imatologists. This ca acity increase is made I)o.,,;.,@ible ei-it:ire- p ly through the expanded use of paramedical personnel; no increise in physician time is anticipated. Program Component: Bowman Gray School of Medicine Component Director: Ro.bert Turner, M.D. Department of Rheumatology Bowman Gray School of Medicine Winston Salem, N.C. 27103 Purpose: To augment health care seminars presently beiftg'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, Farming-ton Methodology: In each location, an existing health care delivers system has been expanded -to include an arthritis team on a regularly scheduled basis. 'Care is delivered on site and if necessary, refer the pa- tient to Bowman Gray Medical Center for treatment, Emphasis is olacprl nn little; a ror ttie 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 educational materials are availabl.e.tllrough tlle Arthritis Foundation of North Carolina for medical personnel and patients.' Most patients are self--referred 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 of North Carolina, Chapel Hill, N..c. 27514 Purpose:, To ex a ,p nd service delivery. To develop model arthritis clinics.' To conduct a statewide professional arthritis symposium. 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 arthritis referral clinic at N.C. Memorial Hospital has been expanded 'from '10 -V- r-O 4-zrtz per vv@eIr. @L'Liirir-is teams are visiting four hospitals in Piedmont, North Carol:tna.to conduct a, day-long arthritis consultation clinic. Visits are once pet mouth, per hospital. An annual professional symposium will be sponsored'for all physl'.' cians.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 v@ar.Lous clinics in this program and the dissemination of tliis.information to' interested physicians throughout the State. A special -qtudy is being developed in cooperation @4i-tli a North Carolina textile plant to determine theprovalitice of arthritis ill the hands of-a selected sainplQ of employees. PI-iysical- examinations and x-rays will be employed. 56 NORTH DAKOTA REGIONAL MEDICAL PROGRAM 2200 LifinAF4Y CIFICLV GRAND FORKS, NORTI-I DAKOTA 5a2oi TEI-I--PHONE: 701-771,-!)53f, I. Purpose: Thp Arthrit-ir, Clinir Prociram whirl) wA-, fiindpd thrniinh the Nnrth n;)@nt;l Regional Medical Program has been organized with the primary purpose of creating two functioning arthritis clinics committed to the diagnosis, func- tional evaluation and treatment 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. Ill. Project Directors: In Fargo: Ip Grand Forks: Dr. John tiagness Dr. Donald Barcome Arthritis Clinic University of north Dakota Children's Village Rehabilitation Center Dakota Medical Foundation School of Medicine Fargo, ND 58102 -G@and Forks, @!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. 2. 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. A follow-up Outreach Program into the home environment via the public health nursing system and the local physician for treatment impletilen- tation. 5. Rticumatologic educ6tion which should include not only iiiedica. student and residency education but also allied health educational programs I[if-IUUIII!j Lile I livulveu uiscipiiiies of sociai service, occupaLioriai therapy, physical therapy, nursing specialists arid pharmacy programs. It is the projected plan'of the clitiic at the present time to utilize the standard diita base for rlietjii)zttic disease as utilized by Dr. James Fries of iho.Stz)nford Univcrsity,14edical Center as a guide for collection and iagliosisIvia -ill be diagnosed arid cate- classification of patient data. -The d' de w gorizcd 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 a physician panel created and the treatment programs will be recommended and carried out at the local level under tile 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-Artliritis Clinic Program is at present sul)por e-d- by the University of North Dakota School of Medicine, North Dakota State University School of Pharmacy, the Fargo @oorhead Area Health Education Center is Foundation. It is our intention and the D@ko'ta Chapter of to select patients with.rlieumatoid arthritis and inflammatory joint disease preferentially into the clinic.program as it is felt that these patients are.in the, greatest'ne.ed of treatment in our area. Vi. Specific Programs: 1. Phamaceutical Services: The pharmaceutical service will be designed so that m,,,dicational-histories are taken by the pharmacist and the niedication 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 re view: with the patient the possibility of side effects, the importance of reginien compliance, and evaluate all other medications in the patients program for possible pharmacologic incompatibility. 58 2. Social Service Department- Tile Social Service Department in conjunction with the 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 toe clinic. Social Service Department and the Nurse Specialist Will DISU be respoiisiblc@ ror c)rgciiiiziAtioii of the rurdl OutrCdcri 't--ruyrti[ii i-or@ follow-up to determine adequacy of home program particularly in occupational therapy and physical therapy and for compliance with the iiiedication(il [)rogrini and need for additional help in the Home environment. A vocational study will be made to evaluate tile improved vocational orientation of tile patient during continued iii(?dical surveillance. The Social Service Depztrtiii(-'nt his organized a one day workshop in January in both Gr,-lnd Forks and Fargo to instruct Public Health Nurses in the care of the arthritic patient and the 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. HoiTiemakitig and home assessment forms will be developed to project need for architectural review and adaptive equipment in the home environment. The physical therapist will be actively involved in. determination of the activity of the disease including measure- 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 list will be involved in helping to interpret patient interview sheets and obtaining maximal patient evaluation and examination data prior to the patients being reviewed by the physician. This Nurse Specialist in addition to the other members will be trained in collecting data so 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 carried on in -the Grand Forks project utilizing the United States Nutrition Laboratory personnel in conjunction with tile 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 patient data with optimal use of the standard data base for presentation and recording of.tliis data with a multispeci'alty physician panel review of the patients problem and with a comprehensive Outreach Follow-up Program in order .to determine adequacy pf the,continuing home treatment program. 59 1733 Harrodsburg Road P.O. Box 4098 Lexington, kentticky 40504 '(606) 278-6071 Project Number: 049 Title.: Comprehensive Arthritis Care Ilrogram with Home Care @@.-t@Director: David fl. Neustadt, M.D. :Chief, Section on )l'tictizTiatic Disease Department of Medicine University of Louisville School of Medicine 500'South Preston Street Lo uisville, 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- matic diseases have been @eceiving specialized rheumatologic medical care. The arthritis clinic of the Louisville General Hospital, which is the teaching facility for the University of Louisville School of Medicine, had been able to see and give adequate attention weekly to approximately 25-30 follow-up patients and 2-3 new patients. However, outside of the one day a week the arthritis cli@nic was held, there was no staff readily available to handle patient management. problems. Prompt pati.ent evaluation, effective treatment programs, and adequate follow-up were all hampered by the lack of trained para-inedical,personnel and the enormous patient load requiring attention. Proj,ect Attivities: 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 organizations 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 resour c-es for the long term follow-up and treatment of chronic arthritis patients wil I result in better care while reducing the frequency of clinic and hospital visits. As a further consequence, the caseload of the weekly arthritis clinic should become primarily new patients, particularly those with multiple problems with a lesser number of old .1 .patients returning to check on potential complications or obtain treatment for new problems. 1 60 Pertinent patient cai-c data will be collected and ev,,iltiited to demonstrate the effectiveness of this approach over the course of the pilot project. Another major act4l,vit,,, of the coordination ()f patient services will be patient education. A questionnaire has been prepare and adiiiini.,itured to arthritis clinic patients In order to Determine botli col.lecti.vc@l.v liid in(livi.ciLially, patient un(lt.@rst,,iticliii@,, of tiic@l.r and problems involved in col)i.ng with it. Information obtained in this in,,iiiner will b(-. used to structure educational. proi,,rams aimed at patients and their families as well. as to'other grouDs. Finally, the project director and coordinator of patient services wil.1 work with existing educational resources such as the University of Louisville Office of Cont;ntiliip, I'dii(,at.ion, the Arthritis Foundati-oll, professional. orgini- zati.ons, find other groul)s to develop programs and seminars dealing with arthritis treatment and management. In summary, Dr. Neitstadt's project is designed as a comprehensive program for rheumatoid arthritis and other systemic arthropathics emphasizing proper long term management-to control symptoms and restrain the disease uti iz ng existing community resources and thus expanding the capacity of the arthritis clinic by reducing the frequency of clinic visits and liospitalization. 61 ma CAf The cuniversity-of Oklahoma Health Sciences Center 800 N.E. 15th, Room 405 Oklahoma City, Oklahoma 73104 (405) 271-5731 INTRODUCTION Oklahoma is unique among the states of the United States in that a formal medical training program in arthritis for physicians has never existed at the Oklahoma University Health Sciences Center (OUHSC). Only recently have'medical students and physician trainees participated, even to a limited extent, 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 other specialty interests with little or no knowledge about diagnostic and treat- ment-aspects of,arthritis. Primary care physicians in 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 (OCVAH) ha've.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 clinics are simply too understaffed to have much of an impact on the total arthritis problem in Oklahoma., ACTIVITY PURPOSE AND OBJECTIVES .T he major purpose is to further develop the OUHSC and OCVAH as major resources for the early ref-2rral of patients with arthritis with costs to the patient ke,-,t to a minimum or even eliminated@in some instances. It is -lanned to have t,...,o full time rheumatolbgists to operate this consultation service. Orthopedic evaluation and treatment will be readily available through the OUHSC. The major objective of the 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 c,)ur-,e of the disease thereby enabling continued care by the.referring 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 of unnecessary x-ray and laboratory procedures and reducing hospital in-patient care-to the lowest level consistent with quality care standrads 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 patient'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 r, 1) cuniversity-of Oklahoma Health Sciences Center SC)O N-E. 15tt,, Room 405 Oklahoma '@ity, Oklahoma 73104 (405) 271-5731 clinics will attend most of the return visit patients. They will also be responsible for initiating all correspondence to community physicians. ill provide for initial Physician trainees and senior mqdical students w evaluation of all new 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 care.4 The clinic will be operated primarily to assisl-- 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 patients'with se'rious chronic rheumatic diseases who require follow-up care by a rheumatologist. Another important part-of the clinic's function will be to assist in disability evaluation. The clinic will work in close association with the disability evaluation section of the,state welfare department and the vocational rehab@l,',,-@' counselor at the OUHSC. OUTREACH PROGRAM - SOUTH CENTRAL OKLAHOMA: Promotion of the arthritis program will begin in 10 counties of south-central Oklahoma where a well established ORMP supported Regional Health Development Area Program (RHDAP) is now in operation. Included in the RHDAP activities centered in Ada, Oklahoma, is a program designed to provide an.outreach program of public awareness through educatic,,:, information directed toviard the follo%@.,ing categories of diseases: pulmonary disease, and arthritis. i'lu@)!,.- high blood pressure, kidney disease, l@ Information and education activities directed toward preventive health care ..iiii utilize services and systems of the follov4inq: (a),Oklahoma Heart Associatl'c-c. (b) Oklahoma Tuberculosis and Respiratory Disease Association, (c) National Bl.ood Pressure Education Program, (dl) Oklahoma Cancer Society, and the (e) 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 include promotional efforts including information and referral and further assist in the scheduling of appointments for the Arthritis Clinic. The sponsor of the Ada RHDAP is Valley View hospital which has a very excellent Physical Therapist department and a progressive program for physical rehabilitation. This will enable a,direct'relationship between the Arthritis Center program and follow-up rehabilitative services which will be accessible to arthritis patients in the area. 63 A- A The cUniversitY-of OAklahoma Health Sciences Center 800 N.E. 15th, Room 405 Oklahoma City. Oklahoma 73104 (4o5) 27i.5731 Outreach education programs developed by the professional personnel of the Arthriti@t Center at OUHSC will be transmitted over the ORMP teleconference network for physicians and related professionals throughout the region. It is also probable that short-course@ and 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 orIivate arthritis speciality clinics will be Invited to attend some of'the clinic sessions. Several have previously participated in this consultation service and will continue-fo assist in the long term follow-up of these patients. This %.;ill occur in their own offices where this is appropriate. The cl'fnic's activities t-n anfic w I ho d,- c i n n O-rf nrn%lidp n =Iltnttnn nf- the. Dat;l 'rnmnt nnd iccurAte ?v dition and promDt tranmittal of this'lnformation to the referring physician al@ori with recommendations for treatmen It. It is planned to re-evaluate patients at appropriate time intervals for any further diagnostic measure of changes in treatment.proaram. The monitoring of patient follow-up and corespondenr-e t-iith referrin@.physicians wi@.11 be handled by a part-time clinic nurse and a full-time clinic secretary. 64. Prograrna @edico'Re,dional de I-'Iuei-to )(i CO Telefono 767-7370 PILOT ARTHRITIS PROGRAM SUMMARY Project Sponsor: University of Puerto Rico School of Medicine Project Title: Pilot Arthritis Program Project.Ntimber (RMP number): 75-203-8355 Project Director and Staff Members: Dra. Esther Gonz6lez Par&s - Project Director Dr. William Matos - Assistant Director Dr. Susano de la Cruz Dr. Rafael Gonz@iez Alcover All of them are staff members at the Medical Department, Rheumatoloav SOc- 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 RegionaII Clinic at the Bayam6n Subrecjional Hospital Goals an-A objectives The final goal of the Regional @Aeclical Program Pilot Arthritis Pi-oc .-I I-a mI s to significantly improve the accesibility and the quality of care received by patients with Arthritis in the island Of Puerto Rico. Its principal objectives are as follows: 1 Patients referred from the regional clinic will be evalLiate(@f, treat- ment started by the medical stiff of the RIleL$nl,3tOl@ly Se(.-tion at the 65 Central Clinic at Puerto Rico Medical Center and sent back to the regional clinic for furtliei- 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 will serve in the peripheral clinics. 3 -The project staff will stablish a Regional Clinic closely associated with the Medical Center in which the trained physicians will contin- ue the treatment of patents evaluated at the Medical Center Clinic. Methodology I Patients included in the project will be those refered to the Me'dical Center from the Northeastern Region of the island,of Puerto Rico. The local health centers have been informed of our new facilities, vii;; .'love #.fie uppul tuliity L)I- rieirici evaiuatea and followed up by adecuately traihed 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 programmed to I)e held during the months of noveniber and december, 1974. The Project Assistant Director w,ill fix the schedule and will cleve-- lop' the context of the course, while different staff members of the Rheumatology Section of the Department of Mcclicitic it the (Jnivc@t'si-- 66 ty Of PLiet,Ito Rico, School of Medicine will be in charged of each of the conferences to be offered. The trainess will be summited to a "pre-instructjion" and "post- instruction" 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 Bayam6n SLibre.- 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 will 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 Bayam6n includes,sevei-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-me-,i of the new facilities, thus, we will be able to see on increased numbers of atients. p As a public service, the community has been informed of the new facilities fo r the treatment of arthritis patients through the mass media. 67 Pro(-4ress The general Practioners and Internists at the Bayam6ii Subregional Hospital had already taken the pre-instructional evaluation on November 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 Systei-nic'manifestations of rheumatic diseases (blood, eyes, skin, etc. 10 Basics of surgical and physical therapy- A Post-instructional evaluation and practical demostration with patients 'II be wi given and the end. In January, 1975, the regional clinic will be fully in operation. 68 1108 BA KER BLDG. 110 21s,r. AVE. S. NASHVILLE, TENN. 37203 FOR TENNESSEE MID-SOUTH December 9, 1974 Re: #107 Restoration of the Arthritic @.o the Community A clinic has been developed at the East Tennessee Ciiil(lren's Hosoital which provides biomedical engineering, medical, social., nursing and physical therapy services to-patincts with muscular skeletal diseases. This clinic cooperates with United Cerebral Palsy, The Arthritis Fotinda- tion and the University of TeniRespee. Project Director: Ed@iird J. Hyring, M.D., Ph.D. Suite 605 Ft. Sanders Prnfp,,qirn!,l Ynoxville, TN 37916 Current Objectives: 1) To expand services, e@,pecially-- a) lal)orator and therapy services, y 1)) environmental Modifications, d) the follow-up and referral systems. 2) To make services ivaiiil)le to children and to, adul.ts not elii,,Lble for the clinic for indigent persons it the University of Tennessee @f'c(lical Center. ,3) To stitiiiiiitc ref,,ionil ai4arcnc,;@, tiiroul,,Ii PLII)liCa- t@Lons iii( I sl)ezik@infv in the ini(Idl.c-bist Tennes!;ee area. floa BAKER BLDG. 110 21ST. AVE. S. NASHVILLE, TENN. 37203 FOR TENNESSEE MID-SOUTH December 9, 1974 Mr. Matthew Spear DP,BT -DIIEW 11-07 Parklawn Building 5600 Fishers Lane Rockville, Maryland 20852 Re: #108 Regional Arthritis Center with Sub-Regional Clinics Dear Mr. Spear: The Appalachian Regional Arthritis Center is a non-profit organization,,. chartered under the lixqs of the State -of Tennessee for the Sole purpose of establishing an arthritis treatment center'.in Chattaftoo-a under the aegis of Baroness ]Erlanger Hospital and the University of Tennessee College of 1-tedicine Clinical Education Center. All groups inter.ested.ifi arthritis will help raise the necessary money for the complete development of the Center (such as; patient service Ofllo-Rnct T pnp@cpp Arl-b-ri.tis Fouri,datin'll, Pnri 1-1-1,qnt-ersinf the Foundation 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 tlir6uMiout 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 riieumatolof,,@Est an(I provide follo%.i-up care as necessary. 3) Develop zitid'.Lmnleinent i protocol. for diagnosis and treatment in t!ic clinic and protor-ol.,, for physicians doing follow7up care In outlying clinics. 70 1108 BAKER BLDG. 110 21ST. AVE. S. NASHVILLE, TENN. 372 @,@ll FOR TENNESSEE'MID-SOUTH 0 Deceml)er 9, 1974 Re: #109 A Total Care Program in Arthritis 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. Depirtnient of orthopedic tnd Relial,)ilitation Vanderbilt University School of Medicine Nashville, TN 37232 615/322-2051 UUJ@T- L.L V-- to cuor(ILnitLC tite ci,.Lnicil care, patient education zind social set- vice needs on An individualized basis for the arthritis patients Methods: 1) To establish combined clinics at Vinderbilt Ilospital (I!i days/week),i, Nashville General liosoital ('I diy/weck) and Nashville Vctcriii Hospital ('I day/week) 2) To provide a therapeutic team, clinical specialist, physical tlicrapt@ and pro4ect coordinator. 3) To further develop a problem-oriented protocol for use in assessing. and treating the arthritic patient. 4) To coordinate the inpatient and outpatient c@irc for the arthritic it the affiliated hospitals. 5) To utilize the Metropolitan I)cl),irtnient of I'til)].Lc Health ;iti(I ArtliritiE Foundation in the dcvt@lol)rit!tit ziii(i iinl)lr!r,iciititi.oti of this project--(-,,,;pcciiLly home care, patient education @iiid pati(-@nt @riii.,;I)orL@itioii. 6) 'J.'o pl@,iii @i il)l)ro;icli to tlit, zti:tlirLti:,. pitt. 7) To worl,. W.Ltli the Sc.iiooL of Ntir.-;I.tii,, for trzti.ii.Lii),, Lo be teacher. in the nurse practitioner curriculum. 8) To coordinate Veteriini. A(litiLiii@;I-rii-f.oti f,,iciLf.tt(!r, In Ni-;IivLl.lc, Cliittr noo-,i,. and Knoxville iii(I future li.nkip,(,,.-; w[L)i @li-@iiii:ry llof.- pit;il and Y4ittlict-7 Wilkcr-Clinic for the of y)L! ;it:tlii-Lttc. 71 Ka REGIONAL MEDICAL PROGRAM OF TEXAS 4200 NORTH LAMAR, SUITE 200, AUSTIN, TEXAS 78756 512/454-3555 all V) Ou'treach Sites Project Sites 7 2 Program: Minimal-Care Unit Demonstration Institution: The University of Texas Medical Branch at Galveston Project Director: Frank E. Emery, M.D. Statistical'Information (as of 12/l/74): Unit size - 8 patient room s 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, 0 'liLy @r.C:a'.-L tlil-OU91. '%.I'iL u t. i 6 I A.%A A l4A II %A Lab I 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, @l D. Statistical-Information: Post-graduate seminars: 1 seminar scheduled in February .Physicians 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. iThe concentration by Baylor is in outreach education for physicians. out- reach clinic sessions 'have been established through hospital staffs and med- icalsocietiesi Post-graduate seminar's for physicians and allied,health professionals are to De.conauctea. Ins pnysician seminar is planned tor @@bruary 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 for spring and will emphasize the latest patient care methodology and expo- sure to the minimal-care process. Contact: John T. Sharp, M.D. Rheumatology Ba ylor College of Medicine 1200 f4oursund 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) Allied Health Professional - .Outreach Workshops Planned - 6 to 7 seminars scheduled in March and April Outreach Workshops Completed 0 Attendees-(public forum) 0 Attendees, (professional clinic) 0 Description: The Texas Tech component concentrates its outreach efforts in West Texas. A modest number of'programs is planned because of the extr6med s- tances to be covered The outreach approach dovetails nicely wi th 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. A'Post-graduat6 seminar was offered on November 15-16, 1974 in Lubbock. %,a I I I I uiii U Ltit:i '-Ulllpul it:!lIIt. ctr, LI,i,; LI zi yr ujeclzi @t: Ivcu' a @ -a@u I I.,Y, WI'tii -1 t:ACX6 .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 Insti,tuti4on: The University of Texas Health Science Center at Dallas Project Directors: J. Donald Smiley, M.D. and Morri s 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 forum) 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 100-300 while physician attendees at clinic sessions average about 30. This is particularly important in this area of the.state, where outreach programs 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.-,ho Family ilracti-_;-. Peter Smith Hospital in Fort.Worth. This effort has broadened the exposure of medical students, interns, and residents.to the latest.inf,ormation about the diagnosis and treatment of arthritis and related diseases. Contact: J. Donald Smiley, M.D. or Morris F. Ziff, M.D. Department 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: 1 seminar scheduled Physicians All,ied Health Professionals - Outreach Workshops Planned - 13 Outreach Workshops Completed 7 Attendees (public forum) 698 Attendees (professional clinic) 823 Teleconference Presentation 2 scheduled; 1 completed Attendance - 15075 Description: The outreach education programs of this component concentrate in South Central Texas. Presentations offered the public on "14hat's New in Arthritis Treatment" have been most popular with average attendance of more than 150. .Clinical conferences address Problems in Arthritis Treatment" and invite iocai physicians to present particular prob em cases tor discussion. tten- dance at clinical presentations ranges from 20-50. The Iarthritis chapter staff and volunteers have been most helpful in the arrangement and sclied- uling of outreach programs. A.po st-graduate seminar for physicians is scheduled for the spring in San Antonioi San Antonio and other project personnel as,sisted the Texas Tech staff in a Oost-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 Octobe@ lo,-1974. Nearly ninety sites (mostly hospitals) receive these therapeutic seminars. A program on "Crises in Arthritis" will be presented on January 9, 1975. Contact,: Robert H. Perse.Ilin, M.D. The University of Texas Health Science Center at San Antonio 7703 F@loyd 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. Gilmer 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 indicates that Most patients capable of reading such booklets can and would prefer to read them in English. The Chapter will re-do at ]-east two popular arthritis brochures 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 Cehtral 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 representative. 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 policy group. The regional' arthritis foundation representative serves ex officio on the steering committee. 79 Medi@al Care aiiil Edit,.Ittioii Foi4iiilatiori, 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 Hos' ital p 171 Harrison Avenue Boston, MA 02111 Summary: This program will improve care of arthritis patients in communities in Maine and Massacliusetts.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 Cente r. The existing outreach of TNEMC including the TNEMC AIIEC progrr.-m forms the basis for this new arthritis endeavor. The resources of the Tufts Continuing Medical Education Program.are also being 6sed. 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@ne -Residents to-work in the geographicall y more remoE:e communir3 es ratner tnan in tne qrea or tne state served by tne maine medical Center in Portland4 In January, 1975, an arthritis clinic will be started at the Eastern Maine.Mtdical Center'. in 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 of-Augusta, 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 clinic which will begin on January 9,.1975.- Discussions are underway with hospitals in r-,all River, Springfield, Saleni, 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 Elizabeth Hospitql and at the,Chelsea Soldiers' Home. Both of these institutions have str6ng ties to TNEMC. Training:. Plans are being made in conjunction with the Rehabilitation Services at TNEMC to institute special arthritis care 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 nurse clinician in the R!ieumatic Disease unit at TNEMC., 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 Fotiiidt7tion, Inc. Title: Arthritis Care Center - Boston City Hospital Sponsor: Trustees of Health & Hospitals of the City of Boston Director: Fdgar S. Cathcart, M.D. Boston University Medical Center University Hospital 750 Harrison Avenue Boston, MA 02i!8 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 BCH. The resources for management of arthritic patients at the Boston Veterans Administration Hospital are also affiliated with the Arthritis Cent-er.' The personnel and resources of the Departments of Rehabilitation Medicine of BUMC and BCH are also part of the Arthritis Care Center. Lti@ tittLiricis uare 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 irr 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 Base Stu(ly of the American Rhuematism Association will become part of the system. The time-oriented- computer format record developed at the Stanford University Medical Center will be used. The Arthritis Care Center began operations on December 1, 1974. 81 Virginia R Medical Pr egiona ogram 700 BUIL,DING,, SUITE 1025' 700 EAST MAIN STREET RICHMOND, VA., 23219 PHONE(804)644-1907 SUt,,tIARY Virginia Regional tlpdical Program Project #0046 Rehabilitation-of Arthr .itics in Virginia Ti'le VRt;'.P Art4ritis Program in Virginia is composed of four (4) divisions: Tidewater - D. 'Edv./ards Smith, @I.D.; Rich - Elain Toone, M.D., Robert mond -!-by, l@I.D. and Duncan Owen, I"I.D.; I-,'6r-tlTin Virginia - Paul B. Rochmis, M.D.; and Centra . - John S. DavTS-1 , fl. D. a-nd-14i I I 'i am O'B),i eii, M D. 'ie cidmini s T, primarily from the two medical schools involved'; the medical College,of Virginia in Richmond (Doctors Toonei Irby and Oweo) and tli---UniversitY of Vi.eginia. Medical School in-Charlot-Le,,ville (Doctors Davis and O'Brien),... ,,.Iorking through the Family Practice Unit (FPU), clinic Visits 'From the MCV Unit havp hppn P@tahliqhnd in Pirhi-nnrrl Tnner Citti, and Blaci@stotie. There are seven physicians sp umatic ecially trained in Rtie Diseases wo@io visit these c-linics on a regular schedule at which time the local I)i'iysiciati schedules @rtliriti,c patients to at-'end for co (I nsul-tatioti and treatment. In addition, FPIJ residents are trained at that time in -the care -of artliritis patients. From the University of Virginia . FPU residents are currently being exposed to consultation viith 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 County and in southwest Vi.rginia by rheumatol.ogist 11. C. Alexander, PI.D. of Roanoke. Ili northern Virginia, Paul D. Rochi)iis, '4.D. is conducting monthly seminars on pcitient (Iii(itiosis and treatment. The first such clinic i.ias atL(-,ncied by over thirty (@aO) area practitioners and four, (4) patients were tlioroughly examined- and treatment prescribed. In surrtnary, the'VRt.!P Arthritis Program (clinical aspects) did not beg in i-iith the funding date. . Time was essential for orderly organization. A meetiiig of those concerned %-;as held on- Deceiijber 7, 1974 at which t'-iiiie future plans were formulated for the balance of the funding period. Those pl all,> include: expansion of present activity into more areas, pai,ticu- lately ill SOU,LIl@.,L@St L Virginia; evaluatior) of effectiveness of the program (in April); and the use of physical therapists to a greater degree in treatment programs. 82 Th- program is,b--ing administered by the Virginia Chapter of the A'rtfiritis Foundation, Mr. Fred Dabney, Executive Secretary. 'Cohen the, pi- gram @,ias 'irs' ins@i-tu@ed, ne,,@is rcle@ises %,iere senjl- -to and published 0 in nevispapers Throughout 'Lhe covered area. Since that time, all inquiries to the Chapter office have been channeled to the proper FPU. WC@,STEP,,E4 PL-NNSYLVANIA REGIONAL MEDICAL PROGRAM 200 MEYRA@L 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 the 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 rehabilita tive services throughout the region, utilizing existing manpower, institutions, and Agencies. outreach services and educational programs will be designed to increase accessi- bility to comprehensive care and to improve patient referral flow for the arthritic patient to appropriate level of service they require. At the present time five (5) area institutions have been identified, they are: 1. Latrobe Hospital 2. Aliquippa Hospital 3. Greensburg Hospital 4. Washington Hospita 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 6. occupational Therapist. 3. Medical Physician 7. Social Worker 4. Nurse 8. Vocational Counselor 83 In an attempt to define actual needs of the regioIn, interviews with 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 g 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 to be drawn not only from each facility's medical staff and allied health personnel but also from various community agencies i.e., R6d.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 community 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, Governmental 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 courses in rheumatic disease management methodology. Course content is designed to provide an in-depth study of new and 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 tre'atment 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, howeveri@identifying additional facilities does present a problem due to. the uncertainty Of continued funding. 84 Wisco-nsin Regional Medical Program, Inc. 5721 Odano Road Madlion, Wiscontii $3719 Area Code 6081263-3600 A DEVELOPMENTAL PROJECT TO ESTABLISH THE BASIS FOR IMPROVED TOTAL CARE OF RHEUMATIC DISEASES IN WISCONSIN Project Director: Don McNeil Executive Director Address: Wisconsin Arthri-tis 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 project are: 1) To bring consultation and medical management techniques to community level health service delivery facilities; 2) Patient-fam"'Tly education to support and explain reasons for treatment pre- scribed for arthritis utilizing allied health personnel; 3) Development of nursing care 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, Tlhp MpdirAl Cnllpap nf wiqrnngin. Milwnlikt-.e, Coliimbiq Hosr)it@il and Sacred heart Rehabilitation Hospital, Milwaukee, Marshfield Clinic, Marshfield and the Gundersen Clinic in LaCrosse. The administration and coordination of the pro- ject will be handled by the Wisconsin Arthritis Foundation. I 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 a nd 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 Ind II(-'altli care professionals throughout the state. 85 TRAVELIN G MEDICAL CONSULTATION TEAM PROJECT Don McNeil DIRECTOR Executive Director Wisconsin Arthritis Foundation 225 E. Michigan Street Milwaukee, Wisconsin 53202 OBJECTIVE: To improve and incre ase utilization by community medical practitioners of the diagnostic and consultative service available through identified arthritis centers as well as the other..mbdalities of comprehensive care as needed. NATURE OF Traveling consultatio n eam will make between 5 and 7 ACTIVITY community visits. The team will consist of a rheuma-tolo- gist, nurse specialist in rheumatism, occupational ttiera- pistl physical therapist and orthopedic surgeon (if desired by the host community). The community visits will include the involvement of All appropriate service re- t? 4.4 Workshop, Department 'of Vocational Rehabilitation and other allied services. The medical construction team has 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 FOR6 THE EARLY RHEUMATOID PATIENT pIROJECT Janic Pigg. R.N., B.@S.N., Nurse Consultant-Rlicumatology DIRECTOR Rheumatic Disease Program, Columbia Ilospital 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- ter,ia 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'@,yill 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 "early" GROUP Rheumatoid Arthritis and the patient undergoing a Total Hi@ Arthroplasty. 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 rtieumatology nursing or who have expertise in the process of Quality Assurance. They will contribute their knowledge as well as serving as disseminators of,information stemming from this project.. Two nursing staff proup,, 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 and other health professiohals,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 criteria can be used for unit reference files, nursing care, staff develop- ment, care gu.ide",for patients, referral inlorinition for continuity of care, use by new practitioners and curriculum content in as c. nursing education. Within nursing, the models ciTi be used to increase and upgrade knowledge of,nursing care of these two rtictim@l- tology patient populations, as well as encouraging development o criteria for other patient populations. 87 PATIENT AND FAMILY EDUCATION IN RHEUMATIC DISEASES 'PROJECT )trs. Madge A. Malecki, R.N., M.S. DIRECTOR Director of Nursing Service Sacred H.eart Rehabilitation Hospital Milwaukee, Wisconsin NATURE OF An ongoing development, refinement and implementation of goals ACTIVITIES directed 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, occupational therapy, social service, psychologist, clinical specialist in rehabilitation, rheumatologist, physiatri st, nurse therapist. Written protocols 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 Assessment Self Medication Exercise Client Education Nursing Guidelines Family Education Staff IiiSetvice 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 f-nn - rpcziyl t-q of this Droi ect in terms of the client's unders tand- ing. EDUCATIONAL AND "Understanding Rheumatoid Artliritis"(vi(leotape by Arth. Fndtn) TEACHING 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. Fndtn.) Arthritis Quackery (Arthritis Foundation) Facts You. Should Know About Arthritis (Merck, Sharp & Dolime) Self Help Device for Arthritis Patient,3 (Merck, Sharp & I)ohme) More Information About Gold (Sacred Heart) Joint Protection (Slides shown by Sacred Ileart Occupational Tlicripy) "The HomLmaker" (videotape shown by Sacred Ileart Occupational Therapy) COMMUNITY Two members of the Advisory Committee serve Lo provide very RESOURCES necessary community and consumer input. One member flits pro- a critique of the teaching efforts from admission to discharge at Sacred llecirL RehibilLtiition Hospital. This in- formation will enable us to modify and evaluate our'efforts from the consumer's viewpoint. A Lupu's group has been started under the guidance of the Pro- ject Coordinator and a representative from socLil service. .The emphasis is upon commonalities within the i,,rOLIP, With mutual support, encouragement, and correct knowledge being goals.. 88 WASHINGTON/ALASKA REGIONAL MEDICAL PROGRAM 500 UNIVERSITY DISTRICT BUILDING / SEATTLE, WASHINGTON 9BlO5/ 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. DA ARTHROTHERAPY TIVIINING PRXFM A TRAINING PROGRAM IN ARTHRITIS TREATMENT SKILLS FOR OCCUPATIONAL & PHYSICAL THERAPISTS vyoject oj' 7'IIL,' ill@'TiIRITI,',' f,'OUNDATION, WASHLNGTON CHAPTER Room ;526 qmith 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, sezf-help de- vices, etc. were readily available for all patients without their having to travel long distances. Through the Arthrotherapy 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 assistance to-the patient with arthritis., but will also save the physician's time. H IS ELIGIBIE? Any practicing registered occupational or physical therapist in Washington or Alaska. MEF;E Wlti N COUFE BE TAUGK? BY Wfflff.? AT "T COST? The course will be conducted at Virginia Mason Medical Center (gth & 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 Washinpton/Alaska Regional MErdical Program to the Arthritis Foundation Cbal)ter. (Travel: tourist air fare or private auto at i2O a mile. Living expenses: @-@) per them for the five days in Seattle.) The faculty will include rheumatologists, orthopedists, physi@trists, physical therapists and occupational therapists who are experienced in the latest approach to arthritis treatment. 89 IiiAT WILL BE TflE CY 4T OF N TMINING PRDMV. e ,,cg In addition to the basic medical/sur a, physical medicine orientation, 611 trainees will hi.ive 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, ambulation equipment (including shoe modifications), splinting, activities of daily living'evaluations, homemaking evaluations and uses of and procurement of adaptive equipment. The field visit to the Arthritis Foundation Chapter headquarters will emphasize community resources, as well as supply the trainee with extensive, current literatur for both patients and professional health care workers. (Some literature,,;as well as a bibli ography of selected references, will be sent to the trainee before arrival.) jUsually, not more than 1 or 2 trainees will be accepted at a time. This will a]-low for some individualization of program content. 14AT ARE THB PLA' S FOR PRDGRAM EVALLIATION & FOLMP. During the training program, teaching effectiveness and trainee learning will be,,6valuated by written, oral and practical examinations, as well as trainee/faculty conferences. The Coor- inating nierttl)ist will also visit graduates in their home community. Such visits will be fol @ut-@ber evaluation of the suitability of the training and to assist the graduate by serving a@ 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 arthritis-educa. tion programs in their home communities. NOW AFE APPLICANTS BEING FECRJITED AND HOW WILL APPLICATIONS BE PROCESSED.? 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. A plications received in the Arthritis Foundation Chapter office will be reviewed and p acted upon by a Selection Committee of physicians and therapists representing Virginia - Mason Medical Center, the Washintoh/Alaska Regional Medical Program and the Arthritis Foundation Chapter. Applicants will be notified as soon as possible. !THERAPISTS ARE URGED TO APPLY AS SOON AS POSSIBLE, EVEN IF THEY DO NOT WANT TO PARTICIPATEI I.lq THE PROGRAM UNTIL LATE IN THE PROJECT PERIOD. I Address applications & correspondence to Ms. Shirley Bowing., M.A... O.T.R., Coor4inating Therapist, Arthrotherapy Training Program, Arthritis Foundation, Room 326, Smith Tower, 506 2nd Ave.. Seattle, WA 98104 89 A