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  Dhyicians.  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