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                              GUIDELIiTE8 MTD REVIEW PROCEDURES FOR ARTHRITIS
                                                PROG@IS

              A.  BACKGROUND
                   Congressional Action on the KIP appropriation for FY 1974 included an
                   earmark of "up to $4,500,000" for planning and development of pilot
                   arthritis centers.  This document sets forther the governing RMP arthri-
                   tis program guidelines and related information for activities to be
                   carried out with these funds.  In developing the guidelines, the Division
                   of Regional Medical Programs has had the benefit of informal consultation
                   and advice from RMP coordinators, members of the American Arthritis
                   Association, and the National Advisory Council on Regional Medical

                   Programs.

               B.  PROGRAM El@TnSIS A.N;D DEFINITION
                   "Pilot arthritis centers" is defined for purpo'ses.of this RMP initiative
                   as organized pilot programs of patient referral and care delivery which
                   relate existing skills and resources at all community levels for the
                   optimal provision of-care to arthritis patients in a defined population.
                   The goal of the arthritis program is to develop, strengthen, and improve
                   arthritis care delivery in order to achieve more accessible, efficient
                   and high quality care for arthritis victims.  Programs will be developed
                   and processed through the PIIP's in order that Regional counsel and ass4-s-
                   tance will be available to applicants so that arthritis pro-rams can
                   benefit directly from the health care delivery experience and resources

                   developed *-i-thiA the Regions.


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              C.  TYPES OF ARTHRITIS PROG@L ACTIVITIES
                    Activities developed should contribute to organized programs of patient
                    services relating expanded skills and resources to all community levels
                    for optimal provision of care to arthritis patients in the populat on
                    served. Programs approved for support should project exemplary-.- demon-
                    strations of community mobilization and coordination of health  resources
                    through delivery systems responsive to the needs of the  community.  Both
                    care providers (physicians, nurses, and allied health) and consumers
                    should be involved.in planning and executing proposed pilot programs.
                    Characteristic activities contemplated within pilot arthritis programs
                    includej but are in no way limited to development such as:
                    1. Community arthritis clinics to broaden the care delivery base, as
                       well as to augment multidisciplinary diagnosis and tre atment of

                       adult and pediatric arthritis.
                    2. Home and "half-way" care programs to improve care access,  and  reduce
                       outpatient loads on hospitals and clinics.
                    3. Center-to@ceftter, and center-to-clinic integration of services  which
                       expands the specialty base of patient services, and accelerates  the
                       dissemination of advanced care methods and techniques.  Particular
                       note should be taken or opportunities to relate to VA, putilicly-spon-
                       sored rehabilitation, and other operating health services.
                    4. Community advisory bodies representing provider and consumer interests
                       to maintain surveillance and evaluation of activities, and facilitate
                       the coordination of community services.  Such groups might also estab-
                       lish liaison with other arthritis and chronic disease programs, as
                       well as undertake studies of cake delivery problems.


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                  5.  Alternative sources of service funding to sustain program viability

                      when RMP funding ends.

                  6.  Program-wide reporting system to aid patient referral, prevent
                      patient loss from the system, reflect program progress, and to

                      indicate program deficiencies to program authorities.

                  7.  Standards of care quality and procedures for improved services.
                  8.  Professional education, including physician, nursing, and allied
                      health personnel refresher courses to improve quality of care, and

                      motivation to act on arthritis disease in a positiv'& and united manner.
                  9.  Public education programs tolmotivate patients to seek qualified
                      provider services, and to formulate more positive public attitudes

                      toward arthritis.

              D.  OBJECTIVES OF PILOT ARTIIRITIS ACTIVITIES

                  1.  Patient Care
                      a.  Improved access to competent care, including multidisciplinary

                          treatment planning encompassing conservative management to

                          prevent, reduce, or delay pain and loss o   unction.
                      b.  Expeditious referral of patients to appropriate care in the

                                    -intensive setting.
                          least care

                      c.  Improved diagnosis and treatment.

                      d.  Reduced loss of work caused by arthritis.

                      e.  Reduced pain and loss of function due to arthritis.


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                    2. Facilities and Services
                      a. Integration of arthritis services with existing care delivery

                         services.
                      b. Optimal utilization of health personnel.
                      c. Development of new care delivery methods .responsive to special

                         needs.
                      d. Accelerated exchange of advanced technical and semi-tecbnical

                         information.

                      e. Effective program evaluation system.

               E.   FINANCING
                    Awared for approved pilot arthritis programs will be i@,-.addition to the
                    regular RMP program award.  The amount allocated for arthritis will be
                    indicated under "Remarks" of the Notice of Grant Award (Form HSM-457).
                    Arthritis funds may not be rebudgeted to other activities without prior
                    written approval by the Division of Regional Medical Programs.

                    To avoid misunderstanding, applicants should be clearly advised  that  the
                    arthritis funds provided in PL 93-192 are available in FY 1974,  only,  an
                    therefore will be one-time grants.  The funded programs should include
                    development of third-party payment mechanisms, or rigorously seek recovery
                    of costs for services to maintain program viability.   Existing   restric-
                    tions on the use of RMP funds apply to these grants; e.g., direct patient

                    care costs, research, construction, etc.

                F.  APPLICATION REQUIREIIEIITS
                    Applicat,ions for support of pilot arthritis programs should  be  submitted
                    separately (not included as a section) from applications for regular  PIIP
                    program support.  Ilouev.@.2r, discrete of different arthritis programs wit-hin
                    the same PI-T may be presented '@n a single aDplicct-L.on.


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                    For each application (form RmP-34-1), only one Face Page (Page 1), and

                                                                                    The Face
                    one set of Assurances and Certifications (Page 2) are required.
                    Page should show the entire amount, both direct and indirect costss if
                    the application includes several discrete program proposals.  Each discrete
                    pilot arthritis program porposal involving different local sponsors (or
                    applicants) must have a separate Page 3 and Page 16 for each separately
                    sponsored program component, or activity.  In lieu of Page 15, a Program
                    Description must be submitted for each arthritis program providing
                    essential points or elements noted below, "Program Description".
                    Description of each domponent, or element of the overall arthritis appli-
                    cation should normally be less than 20 pages.

               G. PROGRAM DESCRIPTIO14
                    Arthritis program descriptions should include the following information:
                    1.  Title and project number assigned.
                    2.  Name of the sponsoring institution, or organization.
                    3.  Name, current title and address of the proposed Project Director.
                    4.  Total RMP funds requested, and the period for which such support is

                       requested.
                    A description of the substantive nature and activities of each component
                    Of a-pilot arthritis program is rqquired (component examples:  establish-
                    ment of clinics; refresher professional education; home care delivery

                    The description should include:
                    1. The output objectives stated in concrete and specific terms
                        (e.g., to provide at least one-half, or 500, of the primary
                        physicians in the area with four hours of instruction in the
                        proven methods for diagnosi-.,i,-, rheumatoid arthritis).
                    2.  T'l.-                                        to bit services     ill


                                  prima-   physicians practicing in the greater metropolitan area).
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                            3.    The anticipated number of persons that will @e served by the
                                  proposed activity expressed in terms of -

                                  a.   persons trained  (e.g.,  500 physicians);  and
                                  b.   persons served by persons trained  (e.g.,  an estimated

                                       10,000);  or
                                  c.   persons served directly, given direct patient services as
                                       part of a demonstration project  (e.g.,  75-100 persons will
                                       receive physical therapy).
                            4.   Brief description of the plan of action (or methodology.'  for

                                  achieving the stated objectives.
                            5.    Names,  and/or titles of persons to whom any reports will be made,
                                  and reporting, or activity review schedules.

                            6.'   Summary budget  (page 16) indicating-
                                  a.  personnel,  equipment and supplies and other costs, including
                                      any overhead, for which RMP funds are requested;  and
                                  b.  non-PIT support that will be available, including funds or
                                      services-in-kind from participating institutions or agencies,
                                      other public sources,  and patient fees for services tendered.
                            7.    Need z-;.-."' prospects for continuation support following termination
                                  of RMP funding, including the anticipated sources,  amounts and
                                  nature of such support  (e.g., patient fees,  services-in-kind).
                            8.   An evaluation plan to monitor program progress, including criteria
                                  to be applied, and the schedule of evaluation activities.

                            A,PPT-T  (I/AI.TTO@T r   it                     I
                                               1 T 'n, fT S S T O'Lq REOUIRT-:@IEI'TS