DIVISION OF REGIONAL MEDICAL PROGRAMS

                                              PILOT ARTHRITIS PROGRAM


                                                   Summary Reports
                                                         Of
                                                      Projec@



                Regional Medical Program                                                   @e
                Alabama                                                                       1
                Albany                                                                        3
                Arizona                                                                       5
                Arkansas                                                                    12
              v'Calif ornia                                                                 14
                Central New York  @(Syracuse)                                               23
                Colorado-Wyoming (Denver)                                                   25
                Greater Delaware Valley  (Philadelphia)                                     29
                Georgia                                                                     34
                Hawaii                                                                      38
              @,ntemountain  (Salt@Lak6 City)                                               39
                Iowa                                                                        41
                Kansas                                                                      43
                Metropolitan Washington                                                     46
                Mic@higan                                                                   48
            --Mississippi  (To be included later)
                     Mexico                                                                 51
              v'North darolina                                                              53
              @orth Dakota                                                                  57
                Ohio Valley                                                                 60
              @klahoma                                                                      62
                Puerto Rico                                                                 65
                Tennessee Mid-South                                                         69
              @exas                                                                         72
                Tri-State  (Boston)                                                         80
                Virginia                                                                    82
                 ashington/Alaska     (To be included later)
              v4estetn Pennsylvania  (Pittsburgh)                                           83
                Wisconsin                                                                   85




            a@Mp                                       'ALABAMA  REGIONAL  MEDICAL  PROGRAM
            Alabarita Rfptonal Medtcaf Ptof,,r3m
                                                             ARTHRITIS  PILOT  PROJECT                                #95
            P.O. Box  3256
                                                        A  Model  Center  to  Clinic  Service
            1108 South 20111 SI:
                                                                                     Summary
            Bitmiiigh3ir., AlahAttia 352M

                  3
             @05) 9 4.5394


                         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  health,care'and  educational                                            facilities;
                                  i
                         curriculum             development  aid  for  University  of  South  Alabama
                         College  of            Medicine.
                         c)     Name  and  Address                    of.  Project  Director

                         Gene,V.   Ball,  M.D.
                         Professor  of  Medicine
                         Division  of  Clinical
                             .Liiuiiuiiu.Lugy  ancL  @neumar-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,
                         im'munoassay  of  IgEi   B,   and  T  lymphocyte  procedures,   Serum
                         DNA,,ahd  immunofluorescent  immunoglobulin  and  complement
                         complexes  in  tissues  and  C4  by  honiolytic-assay.     Nurseso
                         internists,  physical  therapists  and  occupational  therapists
                         will  be  integrated  into  these  modcl,clinics  and  they  will
                         serve  as  the  education  specialists  in  the  training  of  others.
                         The  education  of  public  health  nurses  through  whom  case
                         finding  will  be  @'acilitated'will  be  emphasized.     Recognition
                         of  all  treatable  musculo-skeletal  syndromes  ranging  from
                         hyperthyr6idism  to_polymyalqia  rheiiiiiatica  will  be  stressed.









            The model clinic program will be an outreach effort to extend
            ,the expert services of rheumatologists, orthopedic surgeons,
            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.

            c)  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 Rehabilitation Center Rheumatology Service and
            their facilities will be utilized.
            f)  Ifivolv'ement-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 Rhouitatology Laboratory
            will be participants in this project.  There will be
            Cooperation with the Veterans Administration Hospitals
            in Birmingham, Montgomery and Tuscaloosa as well as the
            utilization of UAB's Spain Rehabilitation Center
            Rheumatology Services.  The University of Alabama in
            Birmingham Medical Information Service via Telephone
            (IIIST) will assist in disseminating new and pertinent
            information.






















                                        2




                                  Albany Itegional Jft@dietri
                                   ALBANY MEDICAL COLLEGE/ALBANY, NEW YORK 12203 *'(518) 44S-5313




                              NORTHEASTERN NEW YORK REGIONAL ARTHRITIS PROGRAM


                 The major   objectives  of  the  Northeastern  New  York  Regional   Arthritis   Program
            are as follows:

                      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
                      oneontai (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-
                      plinary 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 DroRiam. Lee E. B;;rtholompt-7.     li 1) . Projo-tt  DirettoT,
            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 approximately  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 had 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  phys
            cian  is  a  board-certified  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  Postgrad&ate  Medicine.,  Four  hours   AMA
            continuing  education  credit  was  offered.  The  program  incltid(!d  discussions   on
            evaluation of patients with rheumatic    ' diseases,  pathogenesis  and   treatment   of
            riieuin--3toid arthritis. It also included  diagnosis  and  mana),Iomeiit  of  patients  with
            systemic  lupus  and  polymyalgia  rheum@itica  and  diagnosis  and  treatment  of   crystal-
            induced syndvitis. The program  was  attended  by  eight  pliv,,;J.ciins  from  the  Glens
            Falls area and was successful  in  orieiitLrig  physicians  of  that  area  to  the  Diig-
            nostic and Treatment Center In Glens Falls.


                                                         3



              mately one-half day per clinic. Clinics are  held  in  the  Department  of  Physical
              Medicine' where examining booths and patient waiting areas arc available.  Appoint-
              ment.s are made by the secretary at the Department of Pliysictl Medicine, while
              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.clihi.ts 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,
              Albany 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 preseftt 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-i6l-inic.

                  II. The Oneonta Clinic will officially start  operation  in  mid-January,  1975.
              A number.of meetings have been held in Oneonta with  hospital  administrators  and
                                                             @LL-IL CL t-!-'LLL-'Lk- J- L16 diL   L   LCIpa   Leu
              that a,dlinic 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  Rheunatology  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 and laboratory tests. She  will  also  perform  the
              transcription of patient records.

                      The Oneonta Clinic also will be held in the Department  of  Physical  Medicine
              where examining booths. and patient waiting area is available. As in  Glens  Falls
              it is ahtic'ipated 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 allowing 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 inter6st in Riieumatology.

                     An invitational Riieumatology Postgraduate Program will 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.origiftally planned.


                                                     4







             111.  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 Rheumatol      *Ilow and two  attending
                                                               ogy Fe
          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 clinic, 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 Rheumatology 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 clinicst
                                         programs to provide information that  would  enable
          these clinics to become self-supporting in the future.  Specifically, negotiations
          will be arranged with third patty payment carriers to arrange mechanisms  for  re-
          imbursement to these clinics.






                     THE UNIVERSITY OF ARIZONA'

                     TUCSON,  ARIZONA  85721



                     COLLEGE  OF  MEDICINE                                 ADDRESSREPLYTO:
                                                                            ARIZONA REGIONAL MEDICAL PROGR.
                     ARIZONA REGIONAL NIEDICAL PROGRAM                      5725 E. STH STREET
                                                                            TUCSON, ARIZONA  IS711



                                            s     y


                     IS SERVICES PROGRAM                 Director: Warr-en Benson
              3813 East 2nd Street                       Coo@ator: Beth Ziebell
              Tucson) Arizona  85716


              The proJect@was propo sed.to develop a network (center) Of diagnostic,
              treatmnt and rehabilitation services for arthritis patients and
              their families in the rural camunities Of Southern Arizona and in a
              presently radically underserved mdel cities population in Tucson.

                                                 5






                    ,I!hls networOZ-Will'include the services  of  the  Southwest  Chapter,  The
                    Arthritis  Foundation  a  Tucson  based  mrrber-of  the  national   organiza-
                    tion as well 'as A;he  resources  of  other  public  6nd  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-
                    shop settings.
                    By the  end  of  the  proposed  demonstration  program,  the  comprehensive-
                    ness of services  will  be  increased  in  Southern  Arizonai  This  will  stay
                    with the c       ties, to be reinforced b.,v dontiniiing7           wii-.h Irpnm
                    personnel and agencies.
                    The extension of  the  linkages  of  outlying  areas  will  demonstrate  how
                    effectively rural and  urban  health  services  can  be  linked  to  benefit
                    the  arthritis  patient  living  distances  from  a.rmjor  health  center.
                          1. A Tucson   Interagency  Liaison  Comniittee  composed  of  individuals
                    and representatives from'agencies    participating-in   network    services.
                    The  Tucson  Interagency  Liaison  Co@ttee  will  meet  at  least   quarterly
                    during  the  project  year.  Individual  c@ttee  r,mmber  will   be   called
                    upon  to  provide  counsel  and  services  to  local  co@ties.  The   role   of
                    the Liaison.C,6.ndtt6e is perceived as consultative and as a vital com-
                    munic'ation link with  their  organizations  and  the  local  cormdttees.  it
                    will also be  responsible  for.  evaluating  project  nrogress  and  impact.
                         2.  Since a @or strerv,,th of this project      will rest in its
                    ability to-mtivate  local  comunities  to  mobilize   resources   and   to
                    form  linkages.to  existing  services,  local  camunity   comrdttees   will
                    be'f6r'v'L-d in each participating tarf!,et area,.

                    Th6se conraittees will  be  made  up  of  representatives  of  organizations
                    such  as Health  Planning  Councils,  Councils  of  Government   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   Syst@
                    (PHS), an experimntal health service delivery system program..

                    ORGANIZATIONS EXPECTED TO COOPERAT=Y PARTICIPAa'E IN PROGRAM IMPLUMATION

               ..  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 of Arizona Office of Vice President for Health
             Sciences:Serve on Liaison Comittee, Serve on Arthritis Foundation
             Board of Directors, Serve on Project Executive Coamittee, Assist
             with development of, and provide facilities for workshops.
                  2.  College of Medicine (Arizona Medical Center and VA Out-Patient
                       Clinic)
                       a.  Section on Tmunology 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 Childrents 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 committees.
                       Assist in the identification of patients and fwd.lies needing
                       n(-,twork'services.

                       Arizona Training Center for the Handicapped
                       Will manufacture self-help devices and some components of how
                       modifications.

                    6.  Tucson Medical Center (Hospital)
                        Will release allied health professionals to work in outlying
                        areas.
                        Use of fac @ ties for physicians' in-service training program.

                    7.  Pima County'Health Department
                        Tucson Liaison Committee
                        Liaison to other 'county medical societies.

                    8. Pima  County  @dical  Society
                        Tucson Liaison Co @ ttee
                        Liaison to other county medical societies.



                                                7






                        9.  Health Plaming Council
                            Tucson.Liaison Comdttee
                            Ongoing review of project objectives

                        10. Pirin Health Systems'
                            Tucson Liaison Coffdttee
                            Project evaluation

                        11. Councils of Government
                            Serve on comunity committees
                        12. County Health Departnents (other than  Pima)
                            Co@mity c@ttees

                        ;Ll. I;ntith Tticsnn/Model Cities.Project (arm of city government)
                            Serve on Tucson Liaison Camdttee
                            Identif'y,indigenous community leaders whose.awareness and
                             involvemnt in the project will increase    utilization by
                             minority groups to be served
                        i4i. United WpLy (Corrmunity Service Division)
                            Serve  on  Liaison  Comdttee
                            Raise funds for continuation of program

                        15. Easter Seal Society
                            Serve on Liaison  Com-nittee
                            Transportation services

                        .16. sisters of H       Clinic
                            Serve-on,Liaisoii  Committee
                            Referrals to clinic.

                        17. Veterans Administration @lospital
                            Lend facilities for in-service training

                        18. VisitJ.ng Nurses Association
                            Referral of patients for clinic services
                            Dissemination of educational materials

                        19. Arizona Regional Medical. Program
                                             fiscal supervision               toririg,
                           .Provide-ongoing                      program moni
                             and.evaluation
                            Serve  on  Liaison  Condttee

                        20. Departmnt of Economic Security
                            Serve  on-Liaison   Comdttee
                            Training and rehabilitation services
                            Employmnt and welfare



                                                       8









                   21.  KUAT Radio and TV Bureau, University 6f Arizona
                        Produce educational material
                        Serve on Liaison Committee
                        Enlist cooperation of outlying stations

                   22. A. Co     ty colleges
                           Use proi6et personnel as resource materials
                        B. Secondary schools
                           Schedule speakers for health education classes

                   23.  Media
                        Representatives serve on Liaison Co @ ttee and local
                        c@.ttees.
                        Provide outlet for educational programTdng
                        Publicize local meetings

                   24. Family Service Agencies
                        Serve on Liaison C@ttee
                        Provide services to arthritic patients and their.families


              SPECIFIC  SERVICES:

                   1.   CONSULTATION CLINICS:  We provide visiting teams to rural
                        communities on a regular basis.

                          'Rheumatolog:Lst                  Social tiorker/Counselor
                           Orthopedist                      Hom 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 radical pio@osis and outline treatment
                   (d)  Consultation with the patient's physician concerning not only
                        disease managemnt but envirormerital, social, mechanical factors,
                        work simpli.cation and the like.

                   2.   PHYSICIAN TRAINING PROGRAM: One-wwek intensive clinical
                        experience in Rheumtology in Tucson for twenty physicians
                        fran the six southern counties.
              Twenty Physicians from the six southern counties will participate in
              a one-week, intensive clinical experience in arthritis in @csoni The
              physicians will be @r the Jurisdiction of the administration of
              the Arizona Medical Cneter.  This
                                                Program will include attendance in



                                               9







               ttie out-patient arthritis  clinics in the Arizona Medical Center, the
               threeexisting clinics operated by the Southwest Chapter, the clinic
               at the Pima County.liospital, and the Veterans A@istration-Hospital.
               Local rheumatoiogists will invite the physicians in training to parti-
               cipate for one-half day in their practice.

                     3.  WORKSHOPS - In.Tucson:   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.Fandly of the Arthritis Patient
                             Conference for Ancillary Health Personnel

                     4.  MT-NI-WORKSHOPS - In rural communities:  One-evening pro@
                         designed 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 funily, and the home  as  to  possible
                     changes, innovations, and modifications, alork7, with  the  prescription
                     and purchase of mate rI.als and eqLLipmnt that, will make it  possible
                     for the patient to function at a higher level of independence        the
                     home environment.
                     B.  To make av@la@le such self-help devices as will complement the
                     patient's behavior as previously described  on  a  demonstration  basis.

                     C. To collect and make available information  -.ibout  new  developments
                     in coordinated home care and self-help devices for the arthritis
                     patient.

                     6.  EDUCATIONAL MATERIALS:
                     Use of @k, IV projectors with cassettes illustrating handling
                     @of,the patient-w:fth Arthritis.
                                       lets for patient education
                     Appropriate pamph
                     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
                 rep-@n in the management of arthritis.

                 Distribute throw
                                 .,h the Arthriti.,,, Foundation tli-r,(-@e c@Iflit-intriute
                 color films which hav(@ already been produced for use In nursing
                 stations (as an example) to teach health personnel proper inanage-
                 ment of the arthritis patient.

                 Identify 1 500 additional persons to receive the Chapter's Newsletter.

                 7.  OW-PATIENT CLINIC:

            A comprehensive service utilized by presently medically underserved
            patients with arthritis and their families in the Southern Tucson/Model
            Cities area.

                 ,i,o asse@le a professional ste.ff., including a part-time rheumtologist,
            a part-time nurse, a full-tim physical therapist, a full-tim resident in
            rheumatology, a rehabilitation counselor, and a full-time home modification
            specialist to provide a demonstration weekly clinic  and ongoing outreach
            services throughout the tem of the project to the South Tucson/Model Cities
            areas of Tucson.

                 Through the demonstration clinic, the patient's needs for radical
            care  occupational therap   physical therapy, and activities of daily
                                     Y
            living will be assessed.







                                      s @4                    DICAL PROGRAM
                                             GIONAIIMF
                        Evergreen Place, SLjite 215, Evergreen at University, Little Rock, Arkansas 72207
        Roger J. Warner, Coordinator
        501-664-5253







        Through the          grant for.-cne 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 facilities and organizational
        structures to provide a network 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:!
        I,.  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  conimuni-
        ties of the state (Fayetteville, Harrison, Jonesboro,  Mountain  Home,
        Camden, El Dorado, Texarkana, and Wett 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@ (hold
        quarterly).  Five corysulting rheumatologists have agreed 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
                                                            -r.icians in May,
        a program at the State Convention of Arkansas Pedia4L
        1975, to insu're that the'pediatricians of the state.are aware of  the
        most recent developments in the detection and treatment  of  arthritis
        in children;

           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  cIonimittees in each county, coordinate  an
        all-media educational program in each district, as@ist the local clinic
        sponsor in arranging consultative visits, and assist local physicians in
        arranging referrals for secondary and ter4t-.iary care. In addition,  the
        educational coordinators will'work closely with the  area-wide  Health




                                                12










             Planners,.the Arkansas Rehabilitation Services and Lhe  Arkansas  Social
             Services in order to advise patients as to the financial and rehabilita-
             tive assistance th3t is available to them through governmental agencies.
             An incoming 14ats 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 gai;i access to-the
             system.  The@Arthritis Foundation will contract with a public relations
             organization to develop an all-med4ia educational program aimed at the
             arthritis patient, family and Physicians.  The organization will develop
             a seri,es 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 the Little Rock Veterans Administration Hospital. ,
             3.  The Foundation plans to expand the existing program of physical
             therapy clinics in order to improve.the quality and (juaritity of physical-
             therapy services available to arthritis patients.  The program has been
             extremely effective, but utilizing, as it has, the services of a single
             individual, it has been-inadequate in its coverage.  The Foundation will
             employ a graduate of the four year physical therapy Course a@ State
             College of Arkansas and give him three months intensive practice in post
             graduate training in the care of arthritis patients at Leo r@. Levi
             National hospital in Hot.Springs, Arkansas.  After completion of trai,ni
             e@w@i I' be assigned to the same duties as the Foundation's present thera-
             pis.t, 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 workshop@ in arthritis physical therapy to indoctrinate the,73
             physical tlieraoists now working in Arkansas in the  special  techniques
             useful in the treatment of rheumatoid arthritis.  The Project Director is,
                              t-.ive Director of the Arkansas Chapter
             .00h Riggin, Execu4                                     of the Arthritis
             Foundati.,on,:Post Office@Box 125, Little Rock, Arkansas 72203.










                                                 13





                                                                 EDICAL PROGRAM
                  CALIFORNIA REGIONAL M
                                                                                 (A Non-Profit Corporation)

                        7.700 Edgewater Drive Oakland, California 94621 Telephone (415) 635-0290.
                                                              Project No.       ROP-74E-i65-154c


                                                              Date              Decemoer 3, 1974



        Project 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.- Robert Shapiro,  M.D.;,Barry  Brian,  M.D.;  an
                                                       and a Secretary
                            RN;,ci Physical Therapist;


        Obiettives
        To establish a university-based clinic for patients with Juvenile Rheumatoid.Arthritis.
        This will be a referral clinic directed toward providing consultative expertise to
        area physiciaIns  who will be encouraged to provide the primary care for arthritic
        children.



        Methodology
        Pa rarhc di ca Ipersonnel t-4ill.be-ut'llized for patient evaluations in order to  maximize
        the time that the two available rheumatologists will have for direct patient care.
        Vt:LWt:Zi I 4-1 1 11 Is- VI:> IL@ Lilt: PCS I clillr-U I I-Cl I Pt: 1 73VI I! lU I WI II Pt:: II U I III IL)i iL)W-Up UVCIIUdLIUll Ut
        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
        u.tilized in,order to maximize total care.  This includes the possible development of
        satellite clinics in the area.



        Progress
        Clinics are scheduled for ever  other Friday at the U. C. Davis site.  A referr6l
                                      y
        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 Community Organizations
        Community Involvement contact has been  made with the California Crippled Children   Is
        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 physical therapy consultative services.

                                                  14




                                                              project No.         ROP-74E-166-1 54D
                                                              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
     -Project Director    Ephraim P. Englcman, M.D.
     Project Address      Division of Rheumatology,  School  of  Medicine,  U.C.S.F.,  3rd  and
                           Parnassus, San Francisco, CA  94143
     ,Project Staff       Brenda Spriggs, M.D.; Hope Snowhite,  P.T.;  Carol  Lavine  and  Gwen
                           Ciewley, Social Workers;  Nurse;.S6cretary;  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  hospitals  which  are
     diverse in geographical location, patient population and organizational structure.

     Progress

     1.  Audit criteria for the following forms  of  arthritis  hove  been  developed  and  are
         currently in use:

         a.  systemic lupus erythemastosus            d.  ankylosing spondylitis
         b.  gout and pseudog6ut                      e.  Reiter's syndrome
         C.  rheumatoid arthritis                      f.  juvenile rheumatoid arthritis

     2o  The following hospitals have been contacted and clinic plans arranged as follows:

         a.  Valley Medical Center   Regional Medical Proqram in Arthritisi Fresno     Working;
             care providers will be the family practice residents and one medical student.
             Project assistance will be prov.ided,through the design of varied programs
             depending on heed of the  clinic  and  social  service  consultation.  The  clinic
             will meet every other week.
             Chinese Hospital, S.F.; and Highland Hospital, Oakland - Project 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'lent teaching case material.
         c.  Ft. Miley, VA Hospital     Project staff to  provide  consultation  on  in-patient
             teaching rounds once a week.  These sessions to be attended by, five (5) piiysi-
             cians currently providing care at the hospital.  Project  staff!  'is  attemtping  to
             coordinate the Physical Medicine Department with the Arthritis Clinic.
         d.  Children's Hospital, Oakl!and - 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.




                                                              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. Maryis Hospital and Medical
                            Center, Hayes and Stanyan Streets, San Francisco, CA  94118
       Project Staff       Rithar8 Welch, M.D.; Kathy Gomez, Admin. Asst.- Patient Education
                            Departmont;.-and a consultant staff of four physicians.



       Objectives
       St. Mary's  Hospital 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 trained allied health  professionals  and  monitored  by  attending
       and house staff concerned with rheumatic diseases.  Instruction will-include all
       essential components of patient self care, plus assistance in utilizing community
       rehabilitation-and occupational therapy resources.



      .Progress
       In order  to accomplish the above objectives two  teams  have  been  developed.  The  first
       team consists  of  rheumatologists,  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 sbtting long term  treatment  goals  for  both  clinic  and
                                      As of November
       private arthritis-patients.                    15, 1974, three conferences  had  been  held
       and five patients,have been'  medically evaluated.

       The hospitals Patient Education  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-Typist.  The
       Committee consists of representatives from  attending  and  house  staff  physicians,  clinic
       nursing staff, representatives from the Physical Therapy Department and the Haight-
       Ashbury 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 the 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 Assessment form which when
       approved will be pre-tested with several  patients  before  presentation  for  general  use
       by patients.


                                                    16




                                                                      Project No.     :    ROP-/4E-,od-1541
                                                                      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 nurse, 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
                                      Siiiiiu I :@ut,Iipital b,iti Wl)lte ;-Ieii)ui  t LO I , 0 a t.; IC ac a I  v
          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/l/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 will be completed by the patient and the other
          half by the staff.  Consequently,  technical  as  well  as  pers(?nal  information  will  be
          obtained, The too] 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 Or6anizations
          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.

                                                             17





                                                              Date              December  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  9'2668
       Project Staff       Physical Therapist, Occupational Therapist  and  a  half-time  nurse



       Obiectives
       To increase services at Orange County Medical Center Arthritis Clinici Orthopedic
       Clinic and at Community Clin.ic (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 Oran e-County,(one for physicians and one for allied health personnel)
       concerned with the comprehensive treatment of rheumatic diseases.


       Methodology
       The three new staff members wil I acquire skills related to arthritis by Dr. Reynolds
       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 Visits; 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 therapy programs,
       including routine daily activities cis 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 Organizations
       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
       professionals and the lay community.       isz



                                                                   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.



           Ob.iectivcs
           To establish a two-way communication channel    for the  referral  community  physician,  to
           establish teathing 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 tare.


           Methodology
           The nurse will-develop the  educational  component  of  the  program.  She,  in  conjunction
           with 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 ettorts, 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 6rthritis 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 o  a skiti
           Seven sessions were given with approximately 300 nurses attending.  Also, for the
          .hospital staff, Dr. Emorl presented a case and.discuss6d the diagnosis of arthritis
           during grand rounds on Novem@er 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. gailie 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 arrangements for the community seminars in Paris and Barstow.





                                                                Date              December  3,   1974


        Project Title       Comprehensive Outpatient Evaluation and Treatment
        Operating  Agency:  University of California, San Diego
        Project  Director:  F. Richard Convery, M.D.
        Project Address  :  Physical Medicine  and  Rehabilitation,  University  Hospital,  225  West
                             Dickenson Street, San Diego, CA  92103
        Project Staff    :  Physical Therapist and Occupational Therapist


        Objectives
        To es tab Iish a system of cost eva Iuati on for the Arthritis C Iinic University Hospita I
        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.im,  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 'Is progress and needs during rehabilitative care.  Also, it should
                         *k- nT      DT     off.,ri-;@fe.


        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  deveiloping the  form
        and will be the key people completing i t for each patienti  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
        too) 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 De. 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
        wi.11 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
        Hospital next-month,  They are also in the process of planning the home visit program.



                                                     20




           involvement of Community Organization
                                                                       rtive of this project.  Currently,
           The San Dieqo Arthritis Foundation is aware and sup                             One  viomin,
                                                                   3"Ouding     furniture.
           they have assisted by providing small donations, inci
           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 Represented                   Address and Phone'
             Ms. Phyllis Annett, RN         Allied Health Association                    Golden Gate Nurses
                                                                                         1155 Pine Street
                                                                                         San Francisco,  CA  9440@
                                                                                         415-885-4200
             Ms. Nancy Canham               Crippled Children Service                    4480 Clarewood Drive
                                                                                         Oakland, CA 94618
                                                                                         415-557-0637
             Ephraim P. Engleman, 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.  Hospita'
                                                                                         Stanford, CA 94305
                                                                                         415-497-6001

             Mr. Robert Geller              Easter Seal                                  Association Division  o,,
                                                                                         Rehabilitation    Facili.
                                                                                         ties
                                                                                         1225 - 8th Street
                                                                                         Suite 320
                                                                                         Sac'ramento, CA 95814


             Ms. Charlotte  Gawland         Occupational Therapist                       OT Department
                                                                                         Rancho Los Amigos    Hosp
                                                                                         7601 E. Imperial M-7y.
                                                                                         Downey, CA 90242
                                                                                         213-922-7464
             Ronald L. Kaye, M.D.           California Medical Association               Palo  Alto  Medical  Ctr.
                                                                                         300 Homer Avenue
                                                                                         Palo Alto, CA 94301
                                                                                         415-321-4121

             James Klinenberg,   MiD.       Arthritis Foundation,                        4833 Fountain Avenue
                                              Los Angeles Chapter                        LOS Angeles, CA 90029
                                                                                         213-662-9111  X-131

             Ms. B6tty 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          3719   4th Avenue
                                         Chapter                                    Box 3344
                                                                                    San Diego,. CA 92103
                                                                                    714;-291-0430

        Dr. Harold Mozar                Chronic Disease Unit and                    State  Health  Dept.
                                        'RehabilitAtion Facilities                  714 "PI' Street
                                                                                    Sacramento,  CA  95814
                                                                                    916-322-4704

        Ms. Jean Reid                   Physical Therapist                          Arthritis   Foundation
                                                                                    So. Calif. Chapter
                                                                                    311 Wilshire Blvd.
                                                                                    Los Argeles, CA 90010
                                                                                    213-938-6111

        Dr. Ronald Restito
                                        Arthriti,s 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 ChaDter                          Room 209
                                                                                    Sacramento,  CA  95814
                                                                                    916-447-3248

        Ms. Addie  Thomas               Social Worker                               2421 Foothill Blvd.
                                                                                     Verne, C      75
                                                                                    714-593-3383


















                                                      22











                  CENTRAL NEW YORK REGIONAL MEDICAL PROGRAM 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. Water Street                                       750 E.  Adams  Street
         Syracuse, New York     13210                              Syracuse, New York    13210
         Attention:  Monty Eust6n                                  phone:  315-473-5820
         phone:  315-422-8114


                                        Summary of Activities


         A.  'Upgrading the level of patient care at the principal referral facility, the
              Arthritis Clinic at Upstate Medical Center9 Syracuse, New York.

              1.  TraininR a Nurse Clinician to deal wit'h thp -nroblpTn-, nf  -nqtion+c
                  with stable chronic arthritis, individuals who would benefit from
                  6 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  clinic 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 problein-6tiented 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
                  candidates 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.hou@,e 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 clin@cs  and  conferences  in  major  cities  in  the
                  Central  New  York  region  for  physician  edutati.on.

             2.   Training ateam 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@'..7ew 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  dame  model has been started in Ithaca.

             3.   A consultation clinic on the Utica model, directed primarily        at
                  diagnosi and therapeutic reco=endations for the individual         patient,
                  will be established in Watertown.


        Clinic sites:
             ljtice-   Children's   HoGpil"al ard. Rehabilitation Center, Utica  New York  13@Ci"'
             Binghamton     bi-monthly,at:     C; ".S, Wilson' Merori al    Binghamton General
                                               33-57 Harrison Ild'Ureet     !@litchell Avenu@
                                               Johnson City, II.Y. 13790    Binghamton, New Yor-@  15903
                                                    Coordinator:  Dr.  V4.ncent   @;addi
             Ithaca    Tomtkins County   Hospitsi, Ithaca, New York      14850
             Watertown     site not yet  determined
























                                                       24






                                                                  COLORAD(.)   WYOMING

                                                     REGI(                                 PROGRA

                    Estoblis4c,d Jon. 1, 1967, under Public Low 89-239 to Combat Heart Disease, Cancer, Siroke, Kidney Disease and Related Conditions
                          Suitc 410, @tan@lin Mcl-cal Lluilding 0 2C4@ Pitsnklin 5ttt:,,i & Der@@@r. C.@insocio 80205 a   i3O3) 892-9527
                                  Thomas A. Nicholas, M.D. / Executive Director 0 Robert C. Jones, M.D. / Program Director
                                               COLORADO-V4YOIqING RLrI014AL ARN-IRITIS PROGRAM
                                                       S           Report - December 6, 1974
                                                                  Iloy L. Cleere, M.D.
              ir,,- five co:@oncnlk-'s included in the Colorado-lelyominp,, Re6onal Arthritis ProCrain  are:

                    1.    I!;-imrerwnt office
                    2.                   Division, University of Colorado !t-dical Center
                    3.    @nver Ceic-ral hospitals Dep,4@-t@nt of' Ilealth and IA'ospitals, City of Denver
                    4,    Arthritis ,treatment Center, General Rose I.'iermrial hospital
                    5.    Hormonal Arthritis Centers, Colorado and Vly @g
              Spotisoring arencies:  Ti-,e Arthritis Fo,@ndation and University of Colorado @ledical Center
              collaborating agencies (in addition to those listed above):

                    Colorado and        l@,,ioming Health Departrm-nts
                    Color@id@-'e.l.vominr. ficiri m-il I-edical Pro@,
                    Colorado and Wyorang I,:edical Societies
                    County or District 11edical Societies
              )@,T.ose and objective:  To upgrade thel;a@lity                          of the diaL7nostic  procr--dwvs arti c(x:-.-
              prch.--nsive ccim of the arthritic patients. in the tv.,o-state areas of Colorado and 1--lyoairLE;
              zuid to @.LA this ir;)ro-ved radical service.. roxv widc@ly available.
              Tais Rei-,io.-kal    Arthrit-.'.s ProCram is staffed by specialists fron severA. arthritis uiJ.ts
              ii-s- the DL-iiver   f-etropolitan area, mst of v,.'Iom axes with th@ facL.,lty of the  Llnivei,sity
              of Col.oi@ndo I.'/--dic,'il Center.          i@iis is the only t(%achinr- I,'!c(,Idcal Centex, in these two
              -.-.taWs. It is Liter-r--lated with 6thet,  m@dical  and  hospital  facilities  and  with  the
              I,--altli professionals Physic4-ans, PLblic Health st<i.Ifs,'@ses, Pliysical qi,er,)-pists,
              Cr-eup,,itio,nal Thera-pists and Social '.-,Iorkers whose services am needed to make good
              art@itis care available and acceptable,

              I.    Viana@-rnnt Of fice
                    A&-.@.strator - Roy L.              Cle@, M.D., M@P,HO
                    @icdidal Coordinator              Jairre        Bravo, M.D., Rheumtologist
                    Adr,dnistrativ@ Secietary@-                    I-ariame Sevier
                    Offite:  800 Clermnt Street  #410
                                  Dcnver, Colorado 80220
                                  Telephone:  303-3-22-5944
                    Titts office will be the base of oceral.-icn of the r)rorr@.  being condu--tcd in several
                    'different partici,@l*lini-, institutic,-is and t.-,e local :uvis served.  illie--ccnsibility is
                    also assurvd for coordination of services rendered by the sevz--rd dc.=c,,ien-Ls.
                    ,%L,dical Coordinator I-.as direct responsibility  for  or,.-@zinr-  the  services  of  t@
                    14alth professicr.,als to staff the re.-@icnal c@Ics, ,--,d cccrdl-.-,aces t-l-,ese cu-@-reach
                    c@-cs with           the A          strators of 11,1@ affiliated and co-srcnsoi-ing aCencies.


                                                                           25




             MICIfjnlncial function of tt-.c project will be centered in tlii:, orfce.  Al@6L..@,oul@@
             tr@iistr-,,tion..o" the prci                 cn                             tnd@mct su-er-
             ,-.L            I                                          A.
                                             Is      rc,.,p  ability co this
             vision is r-.aintai'ncd.by an Adrr.Lnist.-al-.ivc- Cc::ritttee, corpcs@,(i ot' eip-,Ii.-, @,ey perso.-,z
             .n,cf,l Colorado @nd Wy@, includirc.- fo,,a, physicians,  I'hc Chai-@,=, is    t .'. rc-., c r t
             I-'r.rrick,  @jicnt E)c-nver          who  is  also  t  P  sident of          @itis
                                                                  he  m,                 Ai
             Foundation (Rocky Mountain Chapter).  Close liaison is also  i@tiined          with    the
             offices of the Executive  Director,  Arthritis  Foundation@,  and  the  Ro-Gional  I!c-dical
             Program.
             Arrangermnts for  Regional  Clinics  and  Viorkshops-  for  physicians  and  other  health
             'professionals  are  Trade  by.  the  @gemnt   Office.
             A  working  relationship  has  been  established  with Dr.  David   M-ills.,   Rheumtologist,
             who is conducting a special study on the cost of care for arthritics,
      II..  University  of  Colorado  I-ledical  Center,  Arthritis Division:
             Acting Head,.Dr,  David  Mills,  who  also  serves  as Rheurratblogist  for   VA   Hospital
             'Address:  4200  East  9th  Avenue,   Denver,.Colorado
             @lephone: .303-394-7592
             A bio'-chendst is eM, loyed  in  the  Arthritis  Division  to  work  under  the  supervision
             of  Dr.  Jams  Steigemald,  full-titm  Rhematologist   in   the   Arthritis   Division.   He
             has set up new diagnostic procedures, effective Novenber 1974, as a service to the
             affiliated hospitals and the eivht.centers where Arthritis Clinics have been
             conducted.
                erk-typist has also been-added to the division.         This  position  is  filled  by  a
             A cl
             person  familiar  with  the  recording  of  arthritis  scientific  data.  She  works   under
             the direction of Dr. 14ills  with  respect  to  use  of  record  foras  and  data  analysis,
             She also assists Dr.. Bravo.
                                @for the eight Regional Medical Coordinators was conducted at
             .The first workshop
             this II)edical Center on Noverrber 22, 1974.  Seven of the eight @re in attendance
                                              rwrrbers of  the  Panel  of  Consultants  who  conduct  the
             and which e,,as also attended by
             teaching and consultation cEnics.  Faculty rwiTbers of the fledical School were the
             guest lecturers.  Additionals workshops and seminars       will be held in the future.
             In  this  way,.the local coordinating - hysicians  v.,ere  brought  up  to  date  with  the
                                                     p
             :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 mdical coordinators and t,R a @istrative staff.  In this %,ay, ideas
             for changing future cli-nics and vanel sessions, evolve
      III.   Denver Departirent of Health and    Hospitals
             Arthritis Unit - Dr. Jams Steigerwald, Rhe@tologlst
             @lephone:. 893-6ooo
             Five arthritic-orthopedic beds are available at Denver General Hospital.           The
             Denver Ncithborhood Health Centers will also be uL-,ilized 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. She has also  attended  two  to  three  weekly  Arthritis
               Clinics at the University of Colorado l@'j'odical Center and Denver General  Hospital.
               Her services have been useful in conducting  clinics  in  the  affiliated  hospitals
               located in the ReC4oml Centers.  'rhe renuests for services of Nurse-practitioner-o
               by local nurses have substantially increased.

         IV.   General Rose i,lemrial liosp-Ltal Arthritis Treatnent Center
               1050 Cler=nt Street  Denver 'Colorado 80220
               Medical Director - Charley J.  SrVth,  14.D.,  I\Iatiomlly  recoMized  rheumtologist
                                  and fo@r Head Arthritis Division, University of Colorado
                                  @dical Center
               Tblephone:  303-320-2480
               ,Tnis new center will provide 22 beds for arthritis patients, who will receive
               the most modern t-reatmn.t. The building is constructed as  a  model  unit  for  the
               care and rehabilitation of arthritics.  It is physicially connected with the
               physicial mdicine and rehabilitation departrmnt of the hospital,
               A well@ualified nurse-practitioner is an addidtional  vember  of  the  staff  of  this
               center.  She has also received special training in.arthritis patient care as a
               imuber of the rehabilitation team at  General  Rose  @mrial  Hospital  and  she  has
               also attended two to three Arthritis Clinics each week at the University of
               Colorado l,)edical Center. @s nurse-pratitioner has also served  as  a  team  n-errber
               at several visits to the Regional Arthritis Clinics.

          V.   Regional or Co=mity Clinics.
               It was necessary to strenthen the so-called "in-reach" orograms in several of
               the Denv'er institutions in,order to render the required consultation-teaching
               servces in the "out-reach" areas,
               The early success of this pilot demonstration p@oje.ct has depended ot.the effec-
               tiveness of the tervic 3 rendered to  the  physicians,  other  health  professionals
               and arthritis patients in the selected regions, -Fach  of  the  eight  centers  have
               conducted one teaching-ccnsultation c@ic and the reception in every instance
               has been excellent and much appreciated.
               Taking into consideration,, dernography and accessibility, the following eight
               0      ty centers serving regional areas in the two states were selected

               Colorado:  Sterling - North East
                          Pueblo - South and South East
                          Grand Jmction - Central @,lestern Slope
                          Durango - South West
               WY@:       Sheridan - North Central
                          @nliopolis - West Central
                          Casper    Central
                          la@, e     South



                                                    27





     Before launching plans for clinics in the eiffnt regional centers, the progw
     plan was presented ' to the Presidents and Sueakers of the House of  Delegates  of
     the Colorado and wyondng f-jedical Societies. Tneir support was solicited and  the
     program received the endoreserr@nt of both societies.  axis is Considered of major
     @ortance in getting these prograirz accepted.  Ojubseauently, the Presidents of each
     of the ei8bt local 'A.edical Societies ;,.,ere asi(ed for assistance in the selection of
     the eight regional medical coordinators.  In every case, these leaders of the caTponent
     radical @,ocieties offered their full cooperation.

         Listed are the names of these coordimtors:

                 Colorado--Charles A. Hanson,, M.D., Pueblo
                           Kemeth.Beebe, M.D., Sterling
                           Dea.1 L. Furry, M.D,, Durango
                           Roger Shenkel, r-I.D., Grand Junction
                 Vlyo@g-Seymour Tnickman, M.D., Sheridan
                           R. David Reith , fl. D. , T-,rermopolis
                           Joseph Murphy, M.D., Casper
                           Lloyd Evans , M. D. Larande
         In addition to the clinics scheduled in the selected regionss it is planned  to
         offer lectures by consultant team rwnbers to other radical and health professional
         groups.  In this way,, additional communities  will be reached by this out-reach
         educati@l pro@,
         One clinic has been conducted in each of the eight regions.  The  team mrrbers
         conducting the clinics included  a rheumtologist, ant orthopedist, a psysiatrist,
         and nurse-practitioner.
         Ube Regional f@ledical'Coordinator Assumed the responsibilitiy for local arrange-
         mnts with assistance from the i@germnt Office.  He arranged for use of a local
         hospital and collaborated with the physicians in his regton'for  selection  ot
         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: (1)  One-hundred
         fifty-nine ph,)vsidi ans  sixty-six nurses and twenty-two other health professionals
         attended lectures during the eight regional programs; (2) oiie-,iundred tjentv-ttiree
         physicians, fifty-eight nurses and thirty-six other health profiessiomls  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
         itferred to the c@ic -team.  gills would allow more tim for detailed discussion ,
         and physician . consultations@  Folio;.i-up service is also planned for patients
         seen at the clinics.
         Repeat clinics have been conducted in Grand Junction and ImajTde on Decerrber 3, 1974.
     Although definite progress has been achieved in meting stated objectives, a continu-
     ing review of the program will be conducted.


                                                28







      In addition to an evaluation based on numrical  count  of  physicians  and  other  health
      professiomls who have attended clinics and  patients  seen  in  clinics,  other  criteria
      for evaluating the program will be explored.  For instance, it is desirable to ascertain
      v.,I)ether @,alth professionals and arthritics have  developed  a  @ater  avureness  with
      respect to modern concepts of diaf3iosis and treatmnt. Vihettier,  also,  there  is  in-
      creased utilization of existing facilities ard resources for care of arthritics during
      the tenure of the demonstration prot,7,am.  Has the aLL-ilJty and a@'intity of ho@m health
      cam services improved and has there been an increase in  the  use  of  the  services  of
      nurse-practiticners 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
      out-r,each 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




                  G),,!'@%TER Dl;,IAt%TARE V,,Aa,LEY REGIONAL MEDICAL PROGRAM
                  Aj)%.,PiJlt'ITIS (,'ON'FROL PROGRAM


                          Director:
                                                               @IEdical Director:
                     ',.':jrr(-,n Saltiion
                                                               Cli,irj.c,@ I). 'rotirL@llotte, M.D.
                  GD@IP Arthritis Control Program              Section of Rl)eLlmatology
                  C/O lialinem,-tnti Medical College           Temple University
                  1505 Race Street, 4th floor                  School. of- M,-Idicine
                  Philadelphia, Pennsylvania 19104             Broad and Ontario Streets
                                                               Philadelphia,.Pennsylvania 19140


                  PROCRAM SmiARY:    The Greater Delaware Valley RMP
                  @he fiscal year, 1974-75 to carry out the overall pilot arthritis program
                       consists of five component parts: 1) Facilititing tile Development  of
                  Arthritis Demonstration Clinics; 2) Professional EdudatiOn to Expand the
                  Responsibilities of Physicians; 3) Training Allied Health Arthritic Care
                  Teams; 4) Patient/Family Awareness and Independence; 5) Pediatric  Arthritis
                  Initiative.

                  The Pt6gram'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-ptofit- hospitals and the Arthritis Foundation of Eastern Pennsylvania has
                  been achieved in the 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







                   'develo  ment  and  major  activities  are   conducted   at   decentralized   locations
                         .P
                   to establish new and upgrade existing capabilities in arthritis diagnosis,
                   treatment and rehabilitation.


                   Efforts  are  continuing  to  be  made  to   promote   cross-fertilization   of   ideas
                   with  the  other  28  RMP  funded  @ilot  arthritis  programs,   and   some'   significant
                   s,uccess in building relationships among pediatric projects have been
                   developed.


   O',IIMNEtiT:    FACILITATINC TIIE  DEVELOPMENT OF ARTHRITIS DEMONSTRATION CLINICS


                   Director- Charles D. Tourtellotte, M.D., Professor of Medicine
                              and Chief of Pheuma;'tology, Temple University School of
                              Medicine and Ilospi.t.,il, Pliiladel.)Iiia, Pa. 19140.
                                                                   I

                   @@m onciit Summary:    Tlid Arthritis Demonstration Clinic (AI)C) component
                   represents the major thrust of, the CDV,Z,14P Artliriti.,; (.,oiiLrol Pro@,ram.
                   Its objccti.ve,.q vary according to local needs for improved arthritis care
                   delivery,.  Clinic programs have been: 1) (](.-veloped wlicre nonexistent;
                   2)  improved  wherc.l.imite(i  capability  exists   for   skilled   diagnosis,   treatment
                   'in(] rehabilitation; and 3) strengthened wltq2re full czt ability itid responsibility
                                                                                 p
                   exists for arthritis care deliv(!ry and education.         A  t;criotis  effort  has  been
                   made to create  find  ,;trengtheii-  I)Zttterns  for  coordination  of  existing  local
                   re.,3ourt-es, ADC's and the- Arthritis  Clinical  Reseircli   Centers   to   provide   a
                   r;itio,i,it, efficient,-  and  quality  delivery  system  for  irtfirl.tis  ind  allied
                   d i,;or(l(!rs. An additional objective has been to fostcr a multidisciplinary
                   pFoff-.,,."fonal approach with stti)portive allied health specialists in the
                   i:ian,ii,,cmctit 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 Hospitali Allentown, Pa.  Dr. George Ehrlich; Allied Services
                   Institute, Scranton, Pa.,' Dr. Charles Tourtellotte; Cooper Ilospital, Camden,
                   N.J., Dr. Sheldon Solomon; Gnaden Huetten Ilospital, Lehighton, Pa.,
                   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  1  to  4'sessions  monthly.  The  program  of   the   ADC   is   somewhat
                   variable according to the preexisting 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 Progtam; Patient/Family Awareness Program).                Patients
                   are ev aluated in the ADC'   s upon physician and/or appropriate health agency
                   referral.  The patient problem thereby serves as the medium for either
                   direct preceptorship 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 visiting  team  leader  coordinates  the  program  and
                  assiIgns   visitin.g consultan-ts 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  n  tuprov  ng
                  professional awareness of arthritis knowledge levels.

    O@l -MNENT:   PROFESSIONAL EDUCATION TO EXPAI\'D RESPONSIB'ILITIES OF PI[YSICIANS

                  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  famil.y 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  one  hour-is  allocated
                  for professional education at each AI)C geared to problems in treating
                  rheuniatological disorders'in patients rather  than  the  disease  approach.
                  Lecture/Demonstratioiis have been designed to cover a range of topics.

                  Additionally, three repional seminars in locations convenient to practicing
                  physicians throughout the Greater Delaware  Valley  are  scheduled  for  Spring
                  to cover A complete ra.n@,e of disease topics.  Coordination  with  the  Allied
                  Ilcalth Care Team component and the  Pediatric  Initiative  component  of  the
                  GDVR1,IP Arthritis Control Pro,,ram has b(!cti successful. In dc!st@,iifiii,, there
                  seminars to provide  a  mullispecialty  and  Interdisciplinary  orientation.
                   CRT-,-ATER DELAWARE VALLEY REGIONAL @IEDICAL PROGRAM
                   ARTHRITIS CONTROL'PROGRAK

    COMPONENT:     TRAINING ALLIED HEALTH ARTHRITIS,CARE TEAMS

                   Director: George E. Ehrlich, M.D., Arthritis Center
                              Albert Einstein Medical Center
                              York and Tabor-Roads
                              Philadelphia, Pennsylvania, 19141

                   Component  Summary:  Many  allied  health  professionals,  while,otlierwise
                   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  Arthr.itis   Demonst
                                                                                             ration
                   Clinics and also with  independent  programs  to  provide  training  sessions
                   throughout the Region directly  aimed  at  all  allied  health  professionals
                   to promote an interdisciplin@ary'team 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 (AEMC)
                 @nd-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 colleges of allied health
                 professions and area health  education  centers,,at  these  centers,  at  neutral
                 sites, or at the AEMC Arthritis Center.

                 Training programs have been  devised  that  permit  allied  health  professionals
                 in nursing, 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-demonstratiotis
                 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 salient articles,
                 outlines and instructional materials specifically devised for this GDVRMP
                 Arthritis Control Program, and established problem solving techniques.
                 Assessffient, of results is made by, individually directed questions and, by
                 evaluation of performance. The  book,  Total  Management  of  the  Arthritic
                 Patient, (J.B. Lippihc ott, 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 Peiiiisylvant-i
                 the Department of Vocational Reliabilitition of New Jersey, the Creater
                 Philadelphia Chapter of the Rehabilitation Nurses' Arsociitioll, the colleges
                 of allied health professions at Tc@nipl(, University and the  University  of
                 Pennsylvania, the nursing schools of participating Irca hospital,-,, and
                 local chapters of physical therapy an(] occupational therapy organizations
                 'provide. platforms and community resources to assist with this program.


                  GREATER DELA14ARE VALLEY REGIOl."@AL MEDICAL PROGRAM
                  'ART]IRITIS CONTROL PROGRAM
     O,'IPONENT:  PATIENT-FI%IIILY A14APFNESS AND INDEPENDENCE PROJECT
                  D ire'ctress:  Rodanthi C. Kitridou, M.D.
                                Directress and Associate Professor
                                Divi@ion of Rlieumatology
                               '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  the.ir illness, to
                  emphasize  the available therapeutic means and motivate patients to seek
                  specialized care,, to'feducatp, the patient and family of the impact of
                  arthritis and adjustment requirements; also, to emphasize that the ultimate
                  goal of the therapeutic teamwork is independence of the arthritic and
                  rehabilitation and retraining.  At the same time, the project mechanism
                  provides;for a forurff for the patients' and famil
                                                                    .y 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 aid$
                    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.

    .COIAPONENT:    PEDIATRIC ARTHRITIS INITIATIVE

                    Director: Balu Athreya, Clinical  Director,  Children's  Seashore  liouse,
                              Atlantic City New Jersey

                    Component Summary: Tlid, purpose of the Pediatric Arthritis Initiative is
                    to upgrade the Pediitric Arthritis Clinics at Child-ren's I-losl)ital  of
                    Philadclpliia4, St. Christopher's Hospital for Children in Philadelphia;
                    and Children's Seashore House in Atlantic City, New Jersey; and 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, i,,reatcr capabilities in arthritis
                    -are. Specific consultation is being  provided  to  the  other  program
                    components of the GDVI@P Arthritis Control Progrlm to r(!ilcier 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  ADd's  in  the
                    Region, 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 Gkeater Delaware Valley in the Spring to reach family
                    and pediatric practitioners  and  related  allied  health  professionals.
                    A nurse coordinator is conducting a  demonstration  in-homei  program  to
                    meet the unique needs of children  suffering  from  arthritis  and  their
                    families.







                                                     33





                    -.Medical Program                                      938 PEACHTREE STREET. N.E.
                                                                             ATLANTA, GEORGIA 30309
                      AN   R. T@ROKE AND RELATED,.D.ISEASES
                                                                                 PHONE (404) 876-8MI



           Arthritis Regiooal Facility
           Emory University School of Medicine
           Atlantao 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 between 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 pacility 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 pati ent care, staff of the Regional  Facility  will
               institute specialty tailored programs of training and continuing education
               for Area Facility 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 Sodiety.








                                               34









                Arthritis Area Facility
                Memorial Medical Center,
                Savannah, Georgia



                Theodora L. Gongaware, M.D.
              A.   The general objective of this pilot dditorgtetttlon project in arthritis
                   is to adhieve 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 assistedon 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 attem t
                   to improve the quality of care through the addition of a more complete
                   complement of the-necessary,;dlisciplines--- 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 projects









                                                      35











             Arthritis Regional Facility
             Medical College of Georgia
             Augusta, Georgia


             Joseph P. Bailey, Jr., M.D.




                                                              ation project in arthritis
             A.   The general objective of this Pilot demonstr
                  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 w th
                  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
                  Facility staff in improving patient care in arthritis at  Memorial  Medical
                  CeInter.  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
                  institute speciall'ytailoted programs of training and  continuing  education
                  for Area Facility staff,,gome 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
                  arthritis 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 i,4CG setting, by virtue of increased staff size, and will
                  attempt to imp--ove- the.      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 MCG, including MCG 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.






                                                 36









            Arthritis Area Facility
            The Medical Center
            Columbuss, Georgia


                            M.D.
            Howard Vigrass)


                                         his pilot demonstration project in arthritis
           A.   The general objective of t
                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.
            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 Facil3',t  staff at the Emory U@ivprsity arthritis
                                               y
                .clinic at Grady Memorial HoSp ital in Atlanta.
                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 ColW&@s 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 4n the Columbus medical service area, so as to
                extend the improvement of arthritis care be   4 the walls of The Medical
                                                           yort

                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 will 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 the improvement of
                Arthritis care in Georgia, both in terms of q@-ality and quantity.






                                                   37




                  Regional Medical Progratn of Hawaii@/ 77'0 Kapialini Blvd.. Suite 706, Honolulu, Hawaii 96813, Phone (808) 531-6525


                                PROJECT 69,, PILOT ARTHRITIS PROJECT

                       The' School of.Medicine of the University of Hawaii, in        doop-
                  eration with the  Regional  Medical Program of Hawaii, and the     H
                                                                                      awaii
                  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 Hawaii is based in a community hospital,
                  .Xuakihi Hospital, 347.N. Kuakini Street, Honolulu, Hawaii  96817, a
                  -250-bed medical surgical facility,
                       It is estimated that 80,600'patients     suffer  from  arthritis  in
                  Hawaii and 15,000 in  the  Pacific  Basin.  The  need.in  Hawaii  is  for
                  improved diagnostic'treatment and rehabilitation services      to arthritis
                  sufferers

                      The"object:tves. and  related activities are threefold:     (1) A
                  multidisciplinary  approach  to  referral,  diagnosis,  evaluation,  and.
                  .treatment recommendat.ion.of arthritis patients  in  a  clinic  setting;
                                  @,l          -"4vj.%-co Lu uuL.Lyj-llg ana raciric    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  wit
                                                                                       h
                  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.,Rlieumatologist,
                  Medical  Dir'ector$with Dr.  Eugene  Lance,  Orthopedic  Surgeon  and  Dr.
                  ,Raquel Ilicks, Pediatric Flieumatologist,  as  part-time  members.  The
                  Adminis.trative Director is  Henry  Tliompson,,M.A..  Other  staff  mem-
                  bers are  Assistant  Director,  Patient  Services  Coordinator,  Patient
                  Care Specialist (R.N.),  Registrar,  and.a  part-time  social  worker,
                  physical therapist,.and occupational therapist.

                  Nov,ember-26, 1974




                                                      38
                           An;erican Samoa, Guam and the rrilst Territory of the Pacific Islands




                    Intermountain Regional Medical Program
                                         University of Utah Research Park
                               540 Arape*n Drivo, 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 ongofn4,'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 Wor.,cer,
                    and, R.N.) are also identified to establish a local arthritis hpalth care
                    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 arthritis patients and,
                    consequently, improving its capability in delivering arthritis care.  The
                    format 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 va st area, there wa s 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. titled 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, 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
                  been@received from the local Arthritis Foundation and drug representatives..
                  Presently, we are combining the patient materials into a      viori@book
                  will become the major source of information for the patient in t e 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 iri,-Iroved
                  arthritis care.  Local state health agencies, i.e. , vocational rehabilita      tion,
                  home health, etc.  ,  were  contacted  and  requested  to  support  and  participate
                  as-well.

                  The State Chapters of-the National Arthritis Foundation have been ver,, in-
                                                                                               I
                  strumental in the implementation of the project activities.. They have been
                  .very helpful in developing the local support and making the local arrangements
                  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 begn very encouraging and beneficial to the
                   project, specifically in procuring the support and involvement,of other
                   state health agencies.

                   Further information m,-iy 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 52316 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, l@est 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:

                     I.  To establish a clinic that will demonstrate high quality
                         specialized care of ambulatory arthritic patients in a
                         community setting.
                     2.  To establish at a Des Moines hospital a  clinic  to  sene
                         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 c,are to patients referred to the un-Lt with
                         arthritis or related conditions.
                     4.  To develop physician education programs dealing with the
                         diagnosis, treatment and rehabilitation of  persons  with
                                   and related conditions.









                                                      41








             To meet the first objective, a demonstration patient care clinic for 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,center's physicians, allied health personnel (physi-
             cian assistants and nurses) and medical students'on rotation through the-clinic.
             An arthritis patient clinic has  been established at Broadlawns Polk County.
             Hospit4li d comprehensive medical center in Des Moines, to meet the second
             objective.   The clinic is.s.ta.ffed by the project director and a rheumatologist

             from Mason City, $-ruce 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 Centeris
             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 patients 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 acquaint physicians
             with.the diagnosis and treatment of the arthritic patient.  This one-day con-
             ference will be conducted during the spring.of 1975.


















                                                 42





      -KAI'I!:3AS RE-GIONAL@     milli I am
       mL=o!C;AL PROGRAM           4125 RAINBOW          KANSAS CITY, KANSAS 66-103   -(913)@ 631-5100







            The Kansas Arthritis Centers Project administered by Kansas Regional Medical
            Program is jointly sponsored by the Kansas Chapter of the Arthritis Foundation,
            the Universitv of Kansas School of Medicine at Kansas City, 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 IEIJ's 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,               Robert Godfrey, M.D.
                                 School of Medicine                Project Director
                               39th and Rainbow                    4125 Rainbow
                               Kansas City, Kansas 66103           Kansas City, I<ansas.66103
                                                                   (913) 831 -5371

                                                                   Daniel J. Stec@ischulte, 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


                                                                   John Lynch, M.D.
            Topeka             Topeka-Shawnee County
                                 Health Department                 Associate Project Director
                               1615 West Ei hth'Street             1001 Garfield
                                           9
                               Topeka, Kansas 66606                Topeka, Kansas 66606
                                                                   (913) 357-0301

                                                                   IEU Nurse
                                                                     Geneva Panton,  R.N.
                                                                     Topeka-Shawnee County
                                                                       Health  Department
                                                                     (913) 233-8961



                                                      43






                                           ospi tal                E. Dean Bray, M.D.
                               St. John's H
             Sal Ina           P. 0. Box  214                      Associate  Project   Director
                                                                              mill
                               Salina, Kansas 67401                311   North
                                                                   Minneapolis,  Kansas   67467
                                                                   (913) 392-2i44

                                                                   IEU   Nurse
                                                                      Loretta Kreie,  R.N.
                                                                             n's  Hospital
                                                                      St.  Joh
                                                                      -(913) 827-5591


             Wichita           Wi.chita State University Bran h    Frederick  Wolfe,  M.D.
                                                              c
                               University of Kapsas,               Associate  Project Di  rector
                                 School of Medicine                345   North Hillside
                                                                   Wichita,  Kansas  67214
                               Fairmount Towers
                               2221 North Hillside                 (316)' 685-1335
                               'Wichita  Kansas-67219
                                                                   IEU   Nurse
                                                                      Marjorie Wilbur,  R.N.
                                                                      WSU Branch
                                                                      (3i6) 689-3i44


             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 r,heumat6logy and [EU 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 rheumaLologi'st,, whose name appears above, as
             associate,project directors.   The Pro.ject  Executive  Committee.will be made  up  of
             the Project Director, Associate Project  Directors,  as  well  as   representative of
             the :.ansa@ Chapter of the Arthritis Foundation and of  the  KRMP..  The  arthritis
             nurse tpecialists have been. trained  to have a broad@knowledge of the major
             rheumatic diseates, 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  AssIociation- and comparable with the automated and semi-
             automated format currently in use by the  Rheumatic  Diseases  Division  at  Stanford
             University.
          While.the arthritis nurse   specialists were completing their training program, the
          unit directors supervised   the establishment of the IEU 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
          at 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 care system.  They provide individual and
          group informational services to arthritis  patients  and  their  families  either  at
          the request of. these individuals o@ preferrably  upon  referral  from  their  private

                                                    44






          physician.  They also have the capability of providing initial or ongoing history
          and physical assessment ei ther pre] iminary to referral to a  private  physician  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 fol@low-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 to Aftp'nd AnA
          these demonstration staffings.both as a means of professional education as well as
          improved patient. care.  Every two months one of the four IEUs serves 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.

          Project evaluation and coordination is the responsibility  of  the  project  director
          acting with concurrence of the Project Executive Committee.  Evaluation of the
          nurse specialists training program his 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  IEUs  become  operational
          on January 6, 1975, a complete log of unit activities will be kept )s well as
          evaluative information from patients, physicians  and  allied  health  professionals.
          Evaluation and progress reports performed by the  unit  staff  will  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 these 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
            with the assittance.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 segnient.of their Nurse
            PIractitioner Training Program.  The Arthritis Nurse  Specialist  Training  Program
            concluded on November 27, 1974..  The individual IEUs will  become  operational  on
            January 6, 1975.
                                                  45





         We bel leve that the foregoing fal rly summarizes our pf ans for the Kansas Arthri t is
         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'comm6n features and possibly by incorporating some of the uncommon,
         but generally suitable ideas-of others         we are confident we can evolve a coordinated
         evaluative methodology that will permit        not-only an organized and meaningful
         consideration of the present,program over the next yeari but also assist in
         implementing.and    exp6ndin    a    national    atthritis.center.s.prograin in the future.




       &iETROPOLITAN  WASHING-RON
                                                                         2007 Eye Street, N.W.
                                                                         1,Vasliingto.ii, D@C. 20006
        REGIONAL MEDICAL PROGRAM'
                                                                         Tclephojie: 202/@23-8050


                                                                  Vaughan E. Choate      Prograiii Coorditiolor
                                                     loll



             Project'        "Pilot Arthritis Center in the Inner City"

             Location.,      Washington Hospital Center
                             110    Irving'Street    N.W.
                             Washington,   D.C.     20010

             Director of'    Werner F. Barth,    M.D.
             Project:        Chief, Section of     Rh@umatology

             Objectives:
                                                   improve the   care of inner city patients with
             1)  To'develop, strengthen, and
                 arthritic diseases.
                                              rvices and treatment not currently available
                    a.   provide     medicall@e
                         to   these   patients.
                    b.   develop a planned,program of patient education and rehabilitation
                    C.   train a registered nurse as a rheumatologic nurse-practitioner.
                    d.   develop a system to iynprove patient compliance and.present
                         patient loss.
                                               with a wider range of social problems,
                         to   assist   patients            ut of "ob-s-'-bec-a-u's@ of their disability.
                         specifically those patients o            i
             2   To determine the magnitude of arthritis problems in the inner city.
                         define the relative frequency of.various rheumatological disorder
                    a.
                         in.the   inner   city.
                    b.,  define the needs of -inner-city patients for arthritic management.
                    c.   determine the cost of these needs.


                                                        46










                 Acti

                 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 Centers.  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 will  use  a  multidisciplinary  approach  to  both
                 diagnosis and treatment. The medical team  will  consist  of  the  prime  investigators
                 a rheumatology fellow, eheumatology nurse,  two  rheumatology  attendants,  a  physical
                 therapist, and an orthopedic attendant.  Other needed supportive services, such
                 as social services, will be provided at both Centers.

                 The Metropolitan Washington Regional Medical Program has established a Community
                 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 University
                               6th & BryOnt 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 defor  mity, and maintenance of the patie'nt's role in society.

              Activi!X:
              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 Qptimum benefit because of -,-heir physical
                       limitations.



                                                     47





                                 (3)     @Determine        whether       patient       requires  to  be  placed  on  home  care  program with
                                         visits         4y ph'ysidian's.         assistant,         nurse,,         physical         and         occupational  'therapist
                                                social  worker  to, visit  patient's  home  and  provide  pub) ic  health  nurses'
                                         homemakers         and  health  aide            services          when          required.
                                 .(4).   Educate  pat-ient  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/RMP Arthritis  Advisory  Committee.                                             It  is  felt
                                         that        these        sessions will        be        very        helpful        in,coordinating        total        arthritis.
                                         activities;





                                                                      .MICHIGAN
                                                                                               ASSOCIATION

                                                                                             FOR
                                                           REGIONAL MEDICAL, PROGRAMS
                             .:p

                                                                                                                     '3,TELEPHONE   517-351-0290
                                                SUITE             hllCH,'GAN  "E;/EAST LANSING.@ MICHIGAN 488,



                                                                                                                                      TTER'
                                                               (-,AI.4  PILOT        GFRIATRIC             ARTH,RITIS              CE@,


                                                                            SU!IMARY         DESCRIPTION




                                                                                                                 ter       is       to       conform       with        the
                                         m6@    t!ie     Universit,7  of               Michigan                Cen
                        ,7%-eral         1    th   .itis          thru-t          initiated          in          Reqional          medical          Progran@s          and
                                         a-       r-
                                         s4ble  bN'  the  1974  Conqressional  earTnark  of  $4,500,000.  The
                                        Os
                                                                                                                         care  activities  were
                        e--b-iec4-4ves          c@  nilot  artir  tis                   'center  oatient
                                                                                             ro  ed  diagno8s  and  -reatmc,-it  b,,  a
                                              de-ined  to  'Lnciide                       irn-   v
                                                                                                       ng-conserva
                                              r                                                                  tive  nianacTc.,i-.--rt  in  the  lctast
                                         -,c-A..14Lnarv   Lleain  utilizi
                                                                                                                 ion,   delay  and@reducticn
                                                         SC,-*ir,',a         to         achieve          :,nrevent
                                                                                                                                      -o r'
                                                                                                                                            :  d        t           -a-th-
                                 ain            s4z    3   r I:unctic,7!,         disabiji.tv         arc,         loss         of  i.
                                                              L,
                        r J-,L   s                  -@a.@e        should        be        delivered        to         a         defined         not@,-,lation

                                                                                             hritis           Center           has  a@cT,ted          these
                                 ',Iic'ni(,-ai@           Pilot  C-eriak@ric               Art
                                                                                                                  -ned     as       residents               0
                                 C t.    @re  s
                                                ..or     its    'target  ponulation,  defi
                                                  @A  Iv  Ml&hiaan,  at  least  55  %,ears                                 oc       ace,       @..,ho have  rheurv.-
                          a--41@tenpv.,  Co, r'
                                         boilers.           As        a        second         objective         the         Center  was      to      @e      a       model
                            i.   c      @r
                                                                                                                                                    ffective-
                        o-c  Geriatric                r t'16i. r i. t i scAr,e       which        in        its        efficiency        and        c
                        n E., s   IV-10 u  1  d b c-  s.u i-  t  b I- 6  for  wide.,,cread  replication.


                                                                                            48









                    !:i     thLs     Center     a     comprehensive     approach     is      taken      to      rescl,,,,(,-      unniet
                    -@-ods     o;@     the     arthritis     natient,      especially      tl-,ose      out      of      reach      of
                    '-@e-a'@th      ser%,4-ces      bN,      reason       of       infirmity,       remote       acogranhic       location
                    O?--      liMiteL,      -inancial      resources.      The      service       program       e-ii;iliasizes       a
                    ,-Iol;-Stic             of  the  older person  and  his  needs.  A  spectrum of
                    '-eal--h  rrc      -cssionals        -)anticipate         in         delivering         service.         Ut-'Ll4-zinq
                    @h6-  team arnroach,  onnortunities  exist  for  cooperative  planning  and
                    @articinat4.on  bv  physicians,  a podiatrist,  nursesi  social  scientists
                    and        iqor!cers,        nhvsical        and        occupational        theraoists,        a         nutritionist,
                    ccunsellors,'adrin4Lstrators  and  others  with  experience  in  the  health
                    ser@,ices.  Es-@ablishineftt of  the  Center entailed expansion,  elaboration
                    and      coirjr,-,nitv      orientation      of      services       available       in       the       A,,rthritis
                    :)4-vj.s,-cn,  Denar-,ment  o@        f      Internal      medicine,       Tiniversit-@..,       of       @@lichiaan
                    'ledical        CL--
                                       r-er.

                    .7lIcencies      represented      on      the      Advisory      Board      and       care       staff       include
                    4@-',-,c-@rthri--is       Division       and       DeT)artment       of        Postgraduate        Medicine        and
                    i.ealth      Pro-lession      Education      of       the       Tiniversity       of       r4icl-iiaan       Medical
                    .Center,      t.@e       -Tn.stitute.of       Gerontology,       the       School       of       Public       Health,,





                    1.       Guidel;-nes       and       Reviele.?       Procedures       for       Arthritis       Proaram,       BliRD,'
                                   Piis.  tebruarv  21@,  1974.,  pp  3.
                    2.    or.    c-;-t,    no    1


                    f.l.-i.z.'-tona,...,  Coiintv Fzealth  Department.and the  Arthriti-q  Founcia-:,-)-,.  Th-3
                                                 Counci.1  on  Aain@i,  Incornorated,  thc-,-  ri--co
                                                                                                                              t      h a s
                                                        .c),)i)lration  of  the  au,-a
                    ---c,                           %--Yiti.(-c-tl  resource,  assur,@ric,.
                         i  a..
                                                                                            and  direc-t  service                   til-Le
                                        -zlu---or,t,    nrL)aram      development
                                                     those       wl-io are  members        0 L   a  minor4-4'@.-       arou,@f       @ow
                    -Incc-,:-.e,   z!na' :-,rL@-insti.tutionalized.
                               3                    sirce        beainninq,  includ            4 i-7,  2  ii-@on;-_',q  --f
                                       41--he.program has  become  a  functioning,  effective                               ard
                    c,@-7 ;clv  --e@-o,,inized  arthritis  @ervi.ce.

                          T) T- c, q@2- Li@i  ri.rector is:
                                             Duff,.     @-1. D.    .@rofessor of  Internal  Yiedicine  an,@4
                                                 in   Charce,        .Arthritis  Divisio-1,  Uni,%7ersit,,
                                       A.-&:)o-@,  "ichiaan,         assisted bv          5  Co-Directors t@ho  coin.-.rise
                               an  Executi-ve         Coirmittee.  Thei  are:-

                                               C.  Pec;-.er,        r@p          T    D.,  for  klealt'
                                                                                  )a



                                                                          49








                                                                                  oc,,.@ for
                        ,,,.,ne   Barnev,      S.      Institute of     .('@rontol'
                        Geriatric Services

                        0. L,,nn Deni-ston, @I.P.H., School of        Public   Health,    Proararti
                        in Health Behavior, for Evaluation

                        Roland r,.  I!is8  M.D.,.Denartment of        Postgraduate     Medici-no,
                        for Eeucation

                        Willi.am M. ",ikkelsen, M.D.,, Arthritis         Division, for     Hn-alt'.
                        Ser,.-4.ce Delivery

                 01@icieg of the                                                          mc-,7Lber
                                   Executive Committee are reviewed bv an 18
             r-orr,n-,unit\! Z'%d-@isory Board rcr)resenting consumers  (including rroaram
             clients)    an,d   Providers.   Int)ut   from   the   community   to careful rational
             @ni,inning  of'the-Pi7ogr@   and    its    associated    oh    sical and social
                                                                        y
             e-ivironmont    will be    significant to development         of   a Pilot Center of
             .excellence:.

             T  o  Center.!-lroaram has 3     components:     health      Service deliver-., cduca
             -ci-.oti o--F -atient, family-and provider and program evaluation. E-.:alua-
             t i c,,n.  -v!as not r-ermitted-'b@, the siDonsor  but.we considered it        so
             e-@sential that"alt4rria'tive      fundin  for this-component has been
                                                         9
             --btained.-...


































                                                       so





                           NEW MEXICO REGIONAL MEDICAL PROGRAM
                           2701FRONI'IERN.E. 0 SURGEBI,DG. @ AI,BIJQUERQIJE,N.M.87131
                           PliONE 505:277-34340Al"I'liE LJNM lil7)Xl,l'li SCIENCI.-,S CIN'RER



             Pilot Arthritis Project
             New  Mexico  Regional  Medical  Program


               1. Purpose. and Objectives
                  The imp rovement of the quality of care for the arthritis sufferer in New Mexico:
                  A.  The identification of persons with arthritis in the outreach 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 sufferer 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)
                             ening ot the main ottice at Albuquerque, New Mexico (population -
                  A.  I he op
                      300,000; location - Central):

                                 John M   Hunt, Administrative,Di@rector
                                 114 Amherst, S.  E.
                                 Albuqueruqe, New Mexico 87106

                      The establishment of two Ili lot center offices and placei-nent of Comi-nunity
                      Resource Work6rs. One in Taos, New Mexico (POPLII'atiori     4,.000; loca-
                      tion - North Central) at Holy Cro-5s Hospital:

                                 Donald E.  liold4n, CRW
                                 General Delivery
                                 Taos,  New   Mexico 87571

                      One in Las Cruces     New Mexico (Population     65,000,- location -South-
                      western):

                                 JoAnh Marquez, CRW
                                 21-1 West Griggs
                                 Las Cruces, Now Mexico 83001







                           B. The, composition of a Travelin
                                                                 g Resource Team (Rhournatologists,
                                                                                                             0 rtho-,
                             pedists, OTR.- RPT) to serve as consultants to private i.)I.Iysicialls in  the
                             outreach are-,is (local OTRs and RPTs are being used as teiiii  iiiet-nbei-s).
                           C. The developtyient   of tli@ training team (RliCLII-,Irltol()@jists, Orthopedists,
                             RNP, OTR, RPT, Psychiatric Nurse),to be used  in  AlbLIqLl(!I-qLje,  Las  Cru'
                                                                                                                   ces,
                             Farmington (Northwestern) , Portales (Southeastern), zind Santa Fe (North
                             Central).   -Specific.ti-ainitig   programs   include   physicians   via   TRT-,    one
                             FNP in year long Rheusnatology training at Albuquerque, tlii-6e day, work-
                             shops foi- FNPs and PAs, day long workshops for RNs, LPNS, OTRS., RPTS,
                             and other AHP.. Patient and patient family education  rograiiis in conjunc-
                                                                                             p
                             tion with TRT and A[iP training visits.

                       Sources    and- Employment'of'Education Curricula

                       Training   programs develooed by the University of New Mexico School Of
                       Medicine, Department of Medicine, Division of RheLlmatology.                      Procurement
                       and  distribution   of   Arthritis,   Fo@indation   literature   and   audiovisual   material
                       for.patients  AHP, and physician education as well as the preparation arid pro-
                       duction of the new mate'r al

                  IV.  Community Resources Involved

                       A.   Statewide  7  The   New   Mexico   Chapter   of   the   Arthritis   Foundation   (Medical
                            and Scientific Committee) ,     RMP - Manpower Regist            and Oersted programs,
                                                                                         ry
                            New   Mexico   Association   oflioi-ne   Heal'Lh.Agencies,   Indian   Health   Set-vice,
                            Division of Vocational Reliabi I itation, State. Health Agencies (Sta
                                                                                                         t(@ Depart-
                            ment  of   Public   Health),   New   Mexico   Nurses   Association,   and   Schools   of
                            -@Nuesing.
                      B.    Taos  -  Taos  County  Unit   of   the   Arthritis   Foundation,   private   physicians,
                            1-foly  Cross   Hosljital,   HSSD,   Indian   Health   Center,   Centro   Campesino   de
                            Salud.
                      C.    Las' Cruces - Dona Ana County Unit of the Arthritis Foundation, PLib lic
                            Health De,,:)ai-ti,,lt-nt (Public I-lc;aitli Officet-), HSSD, pi-ivi-4te physicians,
                            @Dotici Ana County General Hospital.
                      D.    All.)L.'CIU(@i'(,TLie - Beriiili [lo County Unit of the At-tlit-itis r-OLII-.ClltiOll, L)NM
                            BCMC - Adult Arthritis Cliriic, I-ublic Fle@iltli                    Fitiily    Ifealtli
                            Centers, HSSD, UNM.Depai-iiiient of REC and PE                           pool).

                 V. Community Coordination

                     I'lic utilization of existin
                                                  ,g information and referral      netwoi-l<  incJ  'the   participa
                     tion in the development of such systems and areas            whei-e  they  do  not   alre,-!Cly
                       exist.





                                                                52





                                       THE ASSOCIATION FOR THE
                               NORTH CAROLINA REGIONAL MEDICAL PROGRAM

                                             Executive Office
                               4019 North Roxboro Road, P. 0. Box 8248,-Durtiam, N. C. 27704
                                              919 - 477-0461




     Program Component:
           North Carolina Chapter, The Arthritis Foundation

     Component Director:
           John L. Kline, Executive Director
           906 Ninth Street  P'.0. Box 2505
           Durham,  N.C.   27705

     Purposes:
           To perform program coordination, monitoring and evaluation.
           Td 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-
               lat'ed, analyzed'and reported  regularly  to  all  program  compo-
               nents.  A system  of  functional  categories  bas  been  developed
               to.measure patient progress.
           ,2. Patient referral   - The NCAF operates a  patient  referral  syst6i
               to provide the.@patient's family  physician  with  information  wh-
                                                          'ient  treatment  faci-
               taciiitates referrals to the most conven
               lity.  Since NCAF  already served as a  focal  point  for  informi.
               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  treatment  and  diagnostic
               centers for their pat;'ents,- Further, the same ph si'L.clans  hav(
                                                                    y
               requeste,d,that they  receive  distributions  of-professional   and
               educational materials for their patients.
           3.  Patierit/Industry Program    NCAF has launched  a  pilot  patibnt/i
               dustry arthritis'program  in  a  cooperating  industry  which  has
               implant medical staff. This program includes professional
               training for the.inpdical  personnel  to  facilitate  early  detec-
               tion of arthritis and to enhance the                aiicl referral
               function. Further,  this  program  includes  a  patient  education,

                                         53





                component which encourages employees       -to ,30-ek early treatment
                of  the  disease..  Proper   einployer/employbp   education   should
                greatly@reduce the present problem of       arthritis victims liid-
                ing their disease for fear of losing their jobs.'
           .4.  ..Profe.,i-,3ional Education - has  been  undertiken.in  support  of
                tlie five, pilot arthritis.  centers  included  in  t  his  program.
                ,This education  program  includes  both  'Tne(licil  personnel  and
                patient  components'.  Medical   materials   and   texts   are'being
                .distributed by NCAF to physicians requesting them.   In addi-
                tion,.a.series o,f,cducati.on materials now avail.abl(,. from
                other sources   is produced in(] distributed to the program
                                      io-i of- physicians and medical personnel.
                elements for edLicat  I

     Program'C,oinponent:
          ..@Orthopedi-c Hospital and Rehabilitation Center

     Component   Director,:
           Paul  Yoi-ing M.D.,
           Orthopedic   Hospital  and  Rehabilitation Center
           One    Rotary Drive
           Asheville,   N.Ce   28803

     Purpose:
           Expand an   existing  delivery   system using paramedical personnel.
           @@Impto.ve c6st/effectiveness of treatment by-i4sing antimalarial
           drugs    i-th monitoring.

     Location:
           Orthopedic   Hospital  and Rehabilitation Center

     Methodology.
           The  focus  of  the  Orthopedic  Hospital   and   Rehabilitation   Center
           (OHRC)  project is a'signific'ant expansion of an existing delivery
           system  through    the increased use of paramedical personnel and the
           expanded utilization of antimalarial drug treatmen.t.and monitoring
           to significantly 'improve the cost effectiveness of treatment.
           Specifically, the delivery system is being.expanded through the
           followl'ng steps:
                1.   train    registered nurses 'to monitor drug toxicity;
                                                and other  aramedical personnel
                     u A. CL.L i iL:1   Le   Uiiurses       p
                     to perform,.patient screening functions;
                3..  train registered nurses as a physician's assistant to
                -    deliver routine   followup services !:II-acby 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
                   aii,timalarial drugs in areas not conveniently located
                   to OHRC.
          In total, it is estimated that Llio- existing delivery system will
          be expanded from the p're-grant level of four sessioiiq per month
          to four sessions per week at OliRC.      Even more important, the ex-
          pansion will accommodate from two to four times as many patients
          per physician hour as is now possible in the office of pri-vate
          rlieumatologists.  This ca acity increase is made possible entire-
                                      p
          ly through the expanded use of paramedical personnel; no increase
          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 beiiig'-delivered at
            several locations inthe area.


      Locations:
            North Carolina Baptist Hospital, Winston Salem
            East Bend Community Family Physician Assistant Clin3'.c,,
              East -Bend
            Farmington Nurse Practitioner Clinic, Farmington

      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 ol acprl nn :Ilt-4 1                          ror the de-
            ii.%,rery of primary carei,  After initial physician contact, it is
            planned that physiclan/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 available through the
         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.


     Program    Component:
           University.of   North Carolina School of Medicine,.

     Component     Director:
           WilliAm    Yount, M.D.
            'Departm
                   ent  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-tho    reval6nce  of arthritis in the hands of     tex-
                              P.
           tile   workers.


     Locations:.
           UNC   School  of Medicine, Chapel Hill
           Wake   Memorial Hospital-, Ralei   h
                                            9
           Moses   Cone Hospital,     Greensboro
           Pinehurst  Clinic, Pinehurst

     Methodology:
           The arthritis referral    clinic  at N.C. Memorial Hospital has been
           expanded 'from '10 tn ro  L-' +-4-nto pei:      AL-Lilriris teams are
           visiting     four'hospital8 in  Piedmont,   North Carol:na to conduct a
           day-long   arthritis    consultation clinic.  Visits are once per month
           per   hospital.
           An annual professional symposium     will be sponsored' for all physi-
           cians in the State to further disseminate the latest techniques
           for  the  treatment  and  management  of  arthri tis.  This symposium pro-
           vidds a vehicle for synthesizing expertise developed in the various
           clinics in this program and the dissemination of this information
           td interested physicians throughout the State.
           A special  gtud   is being developed in coo oration with a North
                           y                              p
           Carolina  textile. plii-it to determine tlieprevalaiice of arthritis   ill
           the hands of i solectqd sample of employees.        Physical examinations
           and x-rays will be employed.
                                            56






                             NORTH DAKOTA REGIONAL MEDICAL PROGRAM

                                                 2200 LIONAFIY CIF4CLE:
                                        GRAND FORKS, NORT14 DAKOTA se2of




                                                                                        TEI-I-PHONE: 701-775-';535











                  1.  Purpose:
                         Thp Arthritic, rlinir Prociram which wi-, fiindpd thrnii(lh thp Nnrth n;4@nf;k
                  Regional Medical Program has been organized with the primary purpose,of
                  creating two functioning arthritis clinics committed to the, diagnosis, func-
                  tional evaluation and @reatmeyt 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 G'rand!Forks is located at the Rehabilitation Center of North
                  Dakota University School of Medicine.


                  III.   Project    Directors:
                         In Fargo:                                  .1p Grand Forks:
                         Dr. John Magness                            Dr. Donald.Barcome
                         Arthritis Clinic,                           University of North Dakota
                         Children's Village                          Rehabilitation Center
                         Dakota Medical Foundation                   School of Medicine
                         Fargo, ND 58102                            -Glr@nd Fbrks, @ID 58201
                   IV.   Methodology:
                         'The  methodology  of the Clinic includes a commitment to,the following
                    areas:
                         1.  Limi,tation of  the Clinic activities to patients with      joint disease
                             as a i ngle@tystem 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   multispetialty
                             physician.rev'iew panel.


                                                          57







                     4., A follow-up Outreach Program  into  the  home  environment  Via  the  Public
                        health nurs,ing system and the  local  physician  for  treatment  implenien-
                        -tation.

                     5., Rheumitologic educ6tion which  should  include  not  only  medical,  student
                        and residency  education  but  also  allied  health  educational  programs
                         llltIUUIIIY L[IC IIIVUIVL'U UISCiplifies of sociai service,  occupational
                        therapy, physical  therapy,  nursing  specialists  and.  pharmacy  programs.
                     It is the projected planof   the clinic at the  present  time  to   utilize
               the standard data I)ase for rheumatic  disease  as  utilized  by  Dr.  James  Fries
               of the Stanford Univor@.ity,Medical Center as a guide for collection and
               classification of patient data.    -The diagtiosis'niade w   be'di(ignosed and cate-
               gorized  under  the  American  Rheumatism  Association  criteria.  -Evaluation  will
               be done in the medic a]., social, vocational,  psychological,  and  niedicatioiial
              ,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 locaI level  under the direction of the  clinic  as  it  is  able  to  project
               surveillance through  the'public health  nurse  and  the  local  inedical.dbctor.
                     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 ahd.phannacist 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 supported
               by the Un.iversity of North Dakota School of Medicine, North Dakota State
               University School of Pharmacy,  'the  Fargo  Moorhead  Area  Health  Education  Center
               and the Dakota Ch6-p't-e-r--'6f-t-6i' N@thrit'is Foundation.  'It is our -intention
               to select patients with:rlieumatoid arthritis  and  inflanimatory@joint  disease
               preferentially into the clinic program as,it is felt that these patients
               are in the,greatest'need of treatment in our area.


               V.I.  Specific Programs:

               1.  Ph amaceutical Set-vices: The  pharmaceutical  service  will  be  designed  so
                   that m,,,dicational,.histories are taken by the pharmacist and the medication
                   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 review  with the patient the  possibility  of  side  effects,
                   the importance_of regimen compliance,  and  evaluate  all  other  medications
                   iii, th6- patients program for possible pharmacologic incompatibility





                                                      58






                    2.  Social Service Department:  The Social Service Department in conunction
                        with the  arthritis  nurse  specialist  will  be  responsible  for  initial
                        contact with the patient and  collection  of  some  data  prior  to  tile  patient
                        being-seen at the clinic.  Social Service Department and the Nurse.Speciall,st
                        Will dllb-U be responsible (or organization of the rurdl OutrLdLil @rugraiii  i-,ur,-
                        follow-up to determine adequacy of floiiiL, program particularly in occupational
                        therapy and physical therapy and for compliance with the inedicational program
                        and need for additional help in the Home environment.        A@  vocational  study
                        will be  made  to  evaluate  the  improved  vocational  orientation  of  the  patient
                        during continued medical surveillance.      The  Sociil  Service  Department   his
                                                                                -and Forks arid Fargo to
                        ,organized a one day workshop in January in both GrL
                        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 Thera y and
                                                                                                   p
                        Occupational  Therapy  Departments   are   organizing   functional   evaluations.that
                        will assess the abil-ity of  the  patient  to  do  activities  of  daily  living
                        and-creating an  upper  extremity  profile  to  determine  the  extent  of  the
                        disease  involveiiiept  in  the  upper  extremity.  Homemaking  and  home  assessment
                        forms will be dbv6loped to project need for architectural review and adaptive
                        equipment,in  the  home  environment.  The  physical  therapist  will   be   actively
                        involved  in,  determination  of  the  activit@@of  the  disease  including  measure-
                        ment,of specific parariieters of disease activity and determination of quanti-
                        tative studies of joint involv6nient.
                    4.  The  Arthritis  Nurse  Specialist:  The  Arthritis  Nurse   Speciali-s.t  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  ro  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
                        cat@ied on  in  the  Grand  Forks  project  utilizing  the  United  States  Nutrition
                        Laboratory  personnel  in  conjunction  with  the  Rehabilitation  Center   Staff.


                    Vii.  Summary

                         The organization Of the North Dakota Arthritis Clinic Prograin 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 pati.ent data with  optimal  use.of  the  standard  data  base  for  presentation
                    and@recording of tliis data with a multispecialty physician panel review of the
                    patients  problem  and-with  a  comprefiensive  OutreachFollow-up  Program  in   order
                    .to de,tenii.ine-adoqu4cy pf theconpinuing home treatment program.







                                                            59





                                                                      ATAAJJJA%JKAAA A  AV%N%AAXIKRITA

                                                                                      1733   Haffodsburg   Road
                                                                                               P.O.  Box   4098
                                                                                  Lexington,   Kentucky   40504
                                                                                              '(606)   278-6071







                                                                                     Project    Number:     049

                    Title:    Comprehensive Arthritis Care Program with Home Care

                    Pr.oje..@'t@-Director:  David H.    Neustadt, M.D.
                                            :Chief, Section on ll'hetitnatic Disease
                                            Department of Medicine
                                            University of Louisville School of Medicine
                                            500'South-Prestoft Street
                                            Louisville  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-
                    matit   diseases   have   been   receiving    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-se@ and give adequate       attention   weekly    to    a    proximately'25-30    follow-up
                                                                              p
                    patients  and  2-3  new  pati6nts.  However,   outside   of   the   one   day   a   week   the
                    arthritis   -clinic,was   held   there   was   no   staff   readily   available   to   handle
                    patient, management problems.   Prompt patient evaluation, effective treatment
                    programs,  and  adequate   follow-up   were   all   hampered   by   the   lack   of   trained
                    paramedical   personnel   and   the    enormous    patient    load    requiring    attention.

                    Proj.ect Activities:  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    comprehensi "ve
                    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 appropriatl- 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 resources
                    for the long term follow-up and         treatment of chronic arthritis patients will 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..pitients returning to check on potential complications or obtain
                    treatment for new problems.


                                                                 60







                  Pertinent patient care data will be collected and evaluated to demonstrate the
                  effectiveness  of  thi.s approach over the course of the pilot project.
                  Another major activity-of the coordination (.)f patient services wi.11 be   patient
                  education.  A questionnaire has been prepared and administered to arthritis
                  clinic patients In order to determine both collective    I.v and  individually,
                  patient un(IL@rstiiiditif, of tliei.r disease and problems involved in col)i-ng with it.
                  Information obtained in this manner will  be  used  to  structure  educational.
                  programs armed at patients and their families  as  well.  as  to'other  groups.
                  Finally, the project director and coordinator of patient services will work
                  with existing educational resources such as the University of Louisville
                  Office of Continuing Education, the Arthritis Foundati.on,.professional organi-
                  zations, and other groul)s to develop programs and seminars dealing with
                  arthritis treatment and management.
                  In summary, Dr. Netistadt s project is  designed  as  a  comprehensive  program
                  for rheumatoid arthritis and other systemic arthropathies emphasizing proper
                  long term management,to control symptoms and restrain the disease utilizing
                  existing communlity-resources and thus expanding the capacity of the arthritis
                  clinic by reducing the frequency of clinic visits and hospitalization.
























                                                          61




                                                                          ma           GM






               "University-of Oklahoma
               Hcalth Scienccs Ccntcr   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 s ecialty interests with  little  or  no  knowledge  about  diagnostic  and  treat-
               ffient.aspects of.arthritis.  Primary care physicians in rural'area.s are    too   often
               lefi on,their  own  to  manage  patients  with  severe,  progressive  rheumatic  diseases.
               The   OUHSC and the Oklahoma  C'ity'Veterans  Hospital  (OCVAH)  'ha've.o6ly-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 cli nics are simply too understaffed to have     much  of  an
               impact  oh the total arthritis problem in Oklahoma.,

               ACTIVITY PURPO'3E  AND  OBJECTIVES

             .The  major  puIrpose is to further develop the  OUHSC and  OCVAH as major resou  I rces
               for the early referral of patients  with  arthritis  with  'Costs  to  the  patient  kept
               to a minimum or even eliminated in some instances.      it is Planned to have  t@@,o
               full time rheumatologist's to operate this consultation service.      Orthopedic
               evaluation and treatment will be readily available through the OUHSC.
             .The   major objective  of   th6,prog ram will be to provide a major resource to physicians
               in a selected rural area  for  referral  of  their  patients  with  arthritis  problems
               early- iri, the course of the disease thereby enabling continued care by the.referring
               physician with close support and cooperation of all clinic services.        Cost effect-
             @ivehess 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














              GUniversit
                        .rof Oklahoma                                                     (405) 271-5731
               Health Sciences Center    800 N.E. 15th, Room 405 Oklahoma 'city, Oklahoma 73104


                 clinics will attend most of the return visit patients. They will also be
                 responsible for initiating all correspondence to community physicians.
                 Physician trainees and senior mqdical students will provide for initial
                 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 assist
               '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 minimumi       con-
                 sistlng primarily of those patients'with serious chronic rheumatic diseases       who
                 require follow-up care by a rheumatologist.
                 Another important  part-of the clinic s funct-ion 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 reh6bilii,@-"---
                 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 ele7@-r--
                 designed to  provide  an.outreach  program  of  public  awareness through education
                                             d the  follo%          ori6s of diseases:  H
                 information di,rected toiiar            -iing categ                      . @y,)-r@
                                                                                            r
                 high blood pressure, kidney disease,    pulmonary  disease,   and Arthritis.  Pu!)Ilc
                 Information and education activities    directed toward preventive health care @..iiii
                 utilize services and systems of the following: (a),Oklahoma Heart Associatic.-,,
                 @b)@ Oklahoma Tuberculosis and Respiratory Disease Association, (c) National Hic:r-.
                 Blood Pressure Education Program, (d) Oklahoma Cancer Society, and the (e)
                 Oklahoma Arthritis Foundation.
                 Staff of the Ada RHDAP will provioe basic services as necessary to assist the
                 OUHSC,based Arthritis Program   Iin achieving its objectives.  These services will
                 include promotional efforts including information and referral and further assist
                 in the scheduling of  ap,  intments  for  the  Arthritis  Clinic.
                                          PO
                 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@,dir-ect'rel ii tiopship between the Arthritis Center program and
                 follow-up rehabilitative services which will be accessible to arthritis patients,
                 In the area.




                                                            63









            'University'of Oklahoma
             Hcalth Sciences Center   800. N.E. I Sth, Room 405 Oklo'homa Ciiy. Oklahoma 73id4 405) 271-5731


             Outreach education   programs  developed  by the professional, personnel of  the Arth-riti@s
             Center at OUHSC  will  be  transmitted  over the ORMP teleconference  network for
             physicians and related professionals throughout the region.       It  is also probable
                                                                  I  be held  for various  health
             @that short-coutses  and institutes in arthritis wi I
             professionals  as  the  program  progresses.

            .SOURt'IE@AND EMPLOYMENT OF TRAINING! ANb EDUCATION CURRICULA

               -is                   two physicians entraining at all times to     assist  in  the
             It    @planiied to have
             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 patierfts'who.are referred.  Physicians from some of the local
           ,@oriVate arthritis speciality clinics will be invited to attend some df'the clinic
           .@sessions..-Several have previously participated in this consultation service and
             will t:onti-nue-fo assist in -the long term follow-up of these patients.  This will
             occur  in.tlie,ir own offices where this  is  appropriate.  The  clinic's  activities
                                                                                 he r
             wi-il ho ej,-einnpd fn nrniiide nrnmnt send ic-c-!-lr;4i-,e
             dition and prompt  tranmittal of this'  .information to the referring  physician.alor.-i
             with,recomm,endations for treatment.  It is planned to reevaluate      patients at
                          tiri,.c,interva'].s for any further diagnostic measure of changes in
             trecitment,procram. The monitoring of  patient  follow-.up  and  corespondence  with'
                       physidians will be handled by a paet-time clinic nurse and a full-tim
                                                                                                  e
             clinic secretary.




                                                                                                      I

























                                                        64.





                        Programa
                       @edico 9?egiona I
                       depuerto                                                Tel6fono 767-7370
                                     ICCO


                                            PILOT ARTHRITIS PROGRAM



                                                     SUMMARY



                  Project Sponsor:  University of Puerto Rico School of Medicine

                  Project Title:  Pilot Arthritis Program

                  Project.Number (RMP number): 75-203-8355

                  Project Director and Staff Members:

                        Dra. Esther Gonz'alez Par@s - Project Director
                        Dr. William Matos - Assistant Director
                        Dr. Susano de  la Cruz
                        Dr. Rafael Gonz6lez Alcover



                        All of them are staff members   at the Medical DepArtment, Rheumatologv Ser-
                  tion, School of.Medicine, University of Puerto Rico.  'rhe Assistant Director is
                  paid by the Regional Medical Program fund.

                  Locale of activities:


                        Central Clinic at the Puerto Rico Medical Center


                        Regional Clinic at the Bayam'on Subregional Hospital


                  Goals anA objectives

                        The final goa Iof the Regional taedcal Program Pilot Arthritis Program is

                  to significantly improve the accesibility and the quality of care received by

                  patients with Arthritis in the island Of Puerto Rico.

                        l@ts principal objectives are as follows:

                        1   Patients referred from the regional clinic will be evaluated, treat-

                            ment started by the medical staff of the RtieLiniatolorjy Section at the

                                                         65




                                Central  Clinic at Puerto Rico Medical Center and sent back to     the

                                regional  clinic for further 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 Med'ical 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 Medical

                                Center from  the Northeastern Region of the island of Puerto Rico.

                                The local  health centers  have been informed of our    new facilities


                                                        i  oidve@'#.iiev putluiiity us ueirici evaiuatea

                                and followed up by   adecuately trained 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 6 series of conferences

                                offered to'the local physicians in the regional clinic area.  The

                                confere'nces.had been programmed to I)e field during the months

                                of novembdr and december, .1974.

                                The Project Assistant Director w,il I fix the schedule and  will  cleve-

                                loo the context of ti-ie course' while different staff  embers of
                                                                                      m            the


                                Rheumatology Section of the   Department of Meciicitie at t[ic tjnivet'si-





                                                          66







                               ty of Puer to 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 Bayam'on Subre--

                               gional Hospital, which serves an estimated population of 336, 900

                               inhabitants in 1974.  In it, patients evaluated at the Central Clinic

                               wi II receive further treatment.  In the near future similar 'regional

                               clinics wil.1 be established in the other four health regions of the

                               island. This is subjected to the availability of human resources

                               in the project.

                               The Subregional Area of !3ayam'on includes.several municipalities

                               (Bayam6n, Corozal, Barranquitas, Comerio, Naranjito, Toa Alta,

                               Orocovis, Vega Alta)..  The personnel at the local health centers

                               of Northeastern Region  has been informed of the new facilities,

                               ,thus, we will be able- to see on increased numbers of  a.tients.
                                                                                      p

                               As a public service. the community has been informed of the new

                               facilities for the. treatment of arthritis patients throuc h the mass
                                                                                     9


                               ,media.







                                                        67





                 Pr6clress

                       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 s novial fluids and connection tissue.
                                                y

                       3.     General immunology

                       4      Rheumathoid arthritis


                       5      Degeneration joint and disc diseases.

                       6      S. L. E.


                       'I     Dermatomyositis Scleroderma, gout and pseudogout.

                              Rheumatic diseases

                       9      Systemi@'manifestations of rheumatic diseases (blood  eyes, skin,

                              etc.)

                       10     Basics of surgical and physical therapy.

                       A Post-instructional evaluation and practical  demostration with patients

                  ill be given and the end.
                 w

                       In January, 1975,' the regional clinic will be fully in operation.









                                                        68












          1108 BAKER BLDG. 110 @1ST. AVE. S. NASHVILLE, TENN. 372                   FOR TENNESSEE MID-SOUTH



                                                                        December   9,    1974










                                                                          s                 -ie Arthritic
                                                          Re:  #107     Re  eoration  of   tl
                                                                        io   the    community


                               A  clinic  has  been  developed  at  the@East   Tennessee   Chil(Iren's
                 Hospital  which   provides   biomedical   engineering,   medical,   social.,   nursing
                 and  physical  therapy   services   tq-patincts   with   muscular   skeletal diseases.
                 This  clinic,  cooperates  with  United  Cerebral   Palsy,   The   Arthritis  Fotinda-
                       and the University-of Tenliespee.

                               Proj.ect Director:         'Ed@@7.ird j.'Eyring,   M.D.,   Ph.D,.
                                                          Suite 605
                                                    i     Ft. Sanders Prnfoqqinriil
                                                          Ynoxville, TN 37916

                 Current Objectives:      1)  To expand  services, c,@pecially--
                                             a)  laboratory and therapy services,
                                             1)) environmental modifications,
                                                 the  follow-up  and   referral   systems,

                                          2) To  mike  services  ivailil)le  to   children  and to.
                                             adults  not  eligible  for  the  clinic   for  iiitiipent
                                             persons  at  the'l-Iiiiversity  of  rennessee  Medical
                                             Center.


                                         -3) To stiijitili-te regional   awareness   through   pitblica-
                                             t:tons zliiil speaking enp,.tf,,c-ictit,, in the mi(idle-bast
                                             Tennes.--,ce. area.







         1109 BAKER BLDG. 110 21ST "E. S. NASHVILLE, TENN. 3720            FOR TENNESSEE MID-SOUTH


                                                                December 9,  1974



                 Mr. Matthew  Spear
                 DUT -  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 1,4xvs of the State-of Tennessee, for
                 the s6le purpose of  establishing  an  arthritis treatment center in
                 Chattanoo&a under the aegis  of Baroness Erlanger Hospital and the
                 University of Tennessee College of  Medicine  Clinical  Education  Center.
                 All groups  inter'ested-iri arthritis will help  raise.the  necessary  money
                 for the complete development of the Center  (such  as;  patient  service
                                                                    'nn
                             ,44!,P-Vncf- Ternpgco,? Art-bri.tis Founditi Anti 1-1-Iqnf-ers, nf
                 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  eventua  ly
                               operate a clinic that will be  affiliated  with  a  series
                               of clinics located strategically throughout 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 r'lieumatolol,,@i-st an(I provide folloii-un care as necessary.
                               3) Develop and Lmnleinent i protocol. for diagnosis and
                               treatment in t!ie clinic and protocol@3 for physicians doing
                               follow-7up care In outlying clinics.







                                                   70














                                                                                                    FOR TENNESSEE MID-SOUTH
             110813AKER BLDG. 110  21ST.  AVE.  S.  NASHVIILLE, TENN. 3720@",


                                                                                      Deceml)cr 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 Ilospitals and the
                  Middle and East Tennessee Arthritis Foundations.


                .Project Director:           William-C. Sale, M.D.
                                             Department of Ortliopedici and Rclial,)ili.tation
                                             Vanderbilt University School of Medicine
                                             Ilashville, TN 37232            615/322-2051

                  %J&)j@$-Llve;   to coor(ILnilLC rite clinical cire, patient education and social ser-
                  vice needs     on an individualized basis for the trtliritis patient.
                  Methods:        1)   To   establish    combined    clinics    at    Vanderbilt    Ilospital    (1@i    days/week),l
                  Nashville      General  ilosr)ital  ('I  day/weck)  and   14aslivi.Ile   Vetcr@iii   llo.,;pitil   ('Z-   day/week)
                                  2)   To   provide    a    therapeutic    team,    clinical    specialist,    physical    tlierapie,
                  and project     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 care for the arthritic at
                  the affiliated hospitals.
                                  5)  To  utilize  the  Metroi)olitin  I)cl),irtnient  ol  -Pttl)].Lc   Health   ;itl(l   Artliriti,-
                  Foundation in tile dev(ilol)iic2tit tii(i iinl)l(!rici-Lt.,iti.oii of-' ttil..,3 I)roject--t--.,;pcc.i;iLly home
                  care, Patient education aiia pitient priii,,,porLitioil.
                                  6)@ 'J.-O P.I@.111 ii Colltl)Lllt!(l          il)l)ro.-icii to tli(@            iii:tlii-Lti:-, piti.
                                  7)  ro  war],, with tlit! ScliooL of NLir,,;J,tif,, for               trii.ii.Liij, Lo be  inclti(-
                  In the nurse practitioner curriculum.
                                  8) To coor(lin;tt(i Vi--t(-%riinii                                         N@l!;iivtl.le,   ClilLtr
                  noocy,.i,. and Knoxville iti(i future li.nklf,,o..-; w    I.Lli @lc@lliiry
                  pit;il and YLittlici-i Wilker'Clinic for the                 of yVe ;irtlii-[tLc.









                                                                      71





                         REGIONAL MEDICAL PROGRAM OF TEXAS


                         4200 NORTH LAMAR, SUITE 200, AUSTIN, TEXAS 78756            512/454-3555




































                                                                                              MCV)







               Ou'treach Sites
               Proj'ect Sites







                                                    72










                 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 I  , 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 pa  tients in a minimal-care  facility   near
                 the medical centeri  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-
                 sehted in the spring.  Statistical data are being maintained on the cost,
                              'Al
                     ld.%A-,iVill                                         A 'A -4

                      The staff at-UTMB is also working   through the Area Ilealth 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, M.D.

                Statistical-Information:

                     Post-graduate seminars:  1 -seminar scheduled in February
                         Physicians
                         Allied -Health Professionals,-
                     Outreach Workshops Planned -  4
                     Outreach Workshops Compl6ted -  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.
                The concentration by Baylor is  in  outreach  education  for  physicians.  Out-
                teach clinic sessions'have been established through hospital staffs and med-
                ical.societies4

                     Post-graduate seminar@ for  physicians  and  allied  health  professionals
                are to De conauctea. lh6 pnysician  seminar  is  planned  tor  Pbbruary  and'is
                expected toldraw 50-75 area practitioners.  A seminar for allied health pro-.
                fessionals will be or anized in cooperation with The University of Texas
                                      9
                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 floursund Avenue
                          Houston, Texas    77025
















                                                       74






                Program:  Outreach and Post-graduate Education
                Institution:  Texas Tech Univbrsity School of Medicine
                Project Director:  Bruce A. Bartholomew, M.D.

                Statistical Information:

                    Post-graduate Seminars:  2 seminars scheduled
                       Physician - 1 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
                              es         ional clini
                       Attende . (profets4          C)

                Descri pti on:
                    The Texas Tech component  concIentrates its'outreach efforts in West
                Texas.  A modest number of programs is planned because of the extremedis-
                tances to be covered.  The outreach approach dovetails nicely with the
                medical school's educational'aporoach of satellite clinical training.
                Assistance in setting up ibcal seminars i.s provided by local arthritis chap-
                ter volunteers.
                    A'Post-graduate seminar was offered on November 15-16, 1974 in Lubbock.
                 ta I I I I viii u Ltit:i 1-vi,lipu I lei I I. cL@'Li It' i Li zi Pf ujec Ls @c I.VC6 ct@ -(;,,-u I 'LY wi @; I -1 t:AQi
              .Tech staff and out-df-state speakers.  The thirty participants, composed
                of area physicians, School of Medicine staff@ and senior medical students,
                          I
                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

                Institutio n:  The University   of Texas Health Science Center at Dallas

                Project  Directors:  J. Donald Smiley, M.D. and Morris F. Ziff, M.D.

                Statistical Information:

                      Outreach Workshops Planned -  10 Forums and 10 Professional Cl     inics
                      Outreach Workshops Completed - 4 Forums and 2 Clinics
                         Attendees  publi@ foeum)       365
                         Attendees professional clinic         33

                Description:

                      This component is devoting nearly all  of  its  RMP  funded  effort  to  oOt-
                reach.   They will try toreach  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
                Iprograms 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.
                   -J. . - L !  .-  -- 'I _, @ _,
                                             41-. @.,ho Family Iracti-.f--
                                       zi
                Peter ISmith  Hospital  in  Fort.Worth.  This  effort  has  broadened  the  exposure
                of medical  students,  interns,  and  residents.to  the  lates-t.information  about
                the diagnosis and treatment of              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)    323
                     Teleconference Presentation   2 scheduled; I completed
                        Attendance     1,075


                Description:
                     The outreach  education  proIgrams 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
                iotai physicians to present particular problem cases tor discussion.  Atten-
                dance at clinical presentations ranges from 20-50.  The arthritis chapter
                staff and volunteers have been most helpful in the arrangement and sclied-
                uling of outreach programs.
                     A po st-graduate seminar for ph sicians is scheduled for the spring in
                                                   y
                San Antonio.  San Antonio and other project personnel assisted the Texas
                Tech staff in a post-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 October 10,,1974.  Nearly ninety sites
                (mostly hospitals)  receive-thes.e therapeutic seminars.  A program on "Crises
                in Arthritis" will be presented on January 9, 1975.


                Contact,:  Robert H. Perse.llin, M.D.
                          The University of Texas Health
                            Science Center at Sap Antonio
                          7703 Floyd 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 piost patients capable of reading such booklets
              can and would prefer to read them i.n English.  The Chapter will re-do at
              1-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




                                     Medical Care iiiiii Eilitc,itiLjtz Foi4titlatioti, Inc.



           Title:      Tuf ts-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 Hospital
                       171 Harrison Avenue
                       Boston, MA  02111

                Summary:  This program will improve care of arthritis patients in communities
           in Maine and Massacliusetts.associate,d 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 fro@-the Medical
           Center.  The existing outreach of TNEMC including the TNE-MC AILEC program forms the
           basis for this new arthritis endeavor.  The resources of the Tufts Continuing
           Medical Education Program,are also being Used,

              @'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 geographically more
           remoEe communities. ratner tnan in tne area ot tne state served by tne maine medical
           Center in Portland4  In January, 1975, an arthritis clinic will be started at the
           Eastern Maine -Medical Center 'in Bangor,  A consultant team from TNEMC will visit
           monthly.  Locdl medical and par@ medical personnel will be involved and training
           will be offered where necessary.  Negotiations are underway in the communities
           bf-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  FIall 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 Hosp.it4l and at the Chelsea Soldiers' Home.     Both
           of these institutions have strong 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 wl.11 develop with the appoint-
           ment of a nurse clinician in the Rheumatic 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 titid Ediication Foittidation, Inc.



           Title:      Arthritis Care Center - Boston City Hospital

           Sponsor:,   -Trustees of Health & Hospitals of the City of Boston
           Director:   Edgar S. Cathcart, M.D.
                       Boston University Medical Center
                       University Hospital
                       750 Harrison Avenue
                       Boston, MA  02118

                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 ire also affiliated
           with the Arthritis Center.'  The personnel and resources of the Departments of
           Rehabilitation Medicine of BUMC and BCH are also part of the Arthritis Care
           Center.


                               %JL Lti@ ntLtiricis Care 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 in 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 Study of the
           American Rhuematism Association will become part of the system.  The time-oriented-
           computer format record develo,,)ed at the Stanford University Medical Center  will
           be.u8ed.

               The Arthritis Care Center began operations on December 1, 1974.













                                                    81





                                  Vs
                                     irginia Regional Medical Program


            700 BUIL.DING, SUITE 1025 0700  EAST  MAIN  STREET RICHMOND, VA.,23219 PHONE(8041644-1907


                                                   SUt,.t@IARY
                                  Virginia Regional t'jpdical Program
                      Project #0046 - Rehabilitation-of Arthritics     in  Virginia
            Ti'i eVRt;'jP Art4ritis Progran in Virginia is composed of four  4) divisions:
            Ticipviater - D. 'Edviards Sn, itli, M.D. ; Richmond - Elain Toone, M.D. , Robert
            IF by, l@I.D. and Duncan Owen, 1,1.0. ;. Northern V-irqin-ia - Paul B. Rochi-niS, M.D.
            and Central Virqinia - John S. Da i@s I ,  -I.D.. and 14ill'lam O'Bi,ieti, 'M.D.
            T'tie  dmini Lrat ones primarily -from the two medical schools involved; the
            I-'.ed-ical College -of Virginia in Richmond (Doctors Toone, Irby and Owen) and
            the University of Vi'@ginia Medical School in-Charlottesville (Doctors Davis
            and O'Brien)...
            ',-,Iorking -L-hro ugh the Family Practice Unit (FPU), clinic visits -From the MCV
            Unit havp hppn Prtahliqhod ih  Pirhinnn,4  Tnn
                                                         .er       D-,),,4A..
                   cl,
            and Bla stoiie.  There are seven physicians specially tra              Rheumatic
            'Diseases wiio visit these clinics on a regular schedule  at  which  time  the  local
            i)l'lysiciaii schedules, arthritic patients to ittend for consultation and treatment.
            In addition, FPIJ residents are trained at that time in -the care -of arthritis
            patients.
            From the University of Vir ginia, FPU residents are currently being exposed to
            consultation with patients and lectures on  the  subject  of  drug  therapy  and  re-
            16-ted matters. Clinic visits outside the  area  are  being  @ield@twice  inonthly.in
            Buckingham County and in southwest Virginia by  rheuniatologi.st  li.  C.  Alexander,
            1-1.0. of Roanoke.
            In northern Virginia, Paul D. lzochiiiis, il.D. is conducting monthly seminars on
            peitient diagnosis and treatment.   The first such clinic i.ias a-ttencied by over
            thirty (@,O) area practitioners and four, (4) patients ,,jere  -thoroughly  examinedj
            and treatment prescribed.
            In summary, the'V.Rt.iP Arthritis Progrim (clinical aspects) did not beg  -in i-iith
            the funding date. . Time %,ias essential for orderly organization.   A meeting of
            those concerned was held on- Decciiibcr 7, 1974 at which time future plans were
            formulated for the balance of the funding period.
            Those plan--) include: expansion of present activity into more cireas, pa),ticu-
            lately ill so'u-ttii-iest Virginia; evaluation 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-.i.ng adilinistei-ed by the Virginia Chapter of the  A'rt@iritis
            Foundation, Mr. Fred Dabney, Executive Secretary.

            "hen the. program via   first,. instituted, ne,,,is   Bases %,iere s L.
                                 s                            relc             on'- -to and published
            in nev/spap-- rs L@hroughout the covered area.  Since that time, all inquiries to
            the Chap-ter office have been channeled to the proper FPU.







                                                                  WL@,STEi,IE4 PC-NNSYLVANIA
                                                           REGIONAL MEDICAL PROGRAM

                               2-00 MEYRAN AVENUE, PITTSBURGH, PENNSYLVANIA 15213 .1412) 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 rehabilitative 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
                    3o  Greensburg Hospital
                    4.  Washington Hospital
                    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 region,  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  'Weaknegs  as
           determined by the interviews in the management of the arthritic patient
           by health care personnel:
                1.  Lack of base  know'ledge as to current practices in diagnosing
                    land 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 oth
                                                                                  er.
                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  determining
           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  fa6ility's.medical  staff
           and allied health personnel but also from various community agencies i.e.,
           Red 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
           a.nd 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  an.d 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 treatment 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, however@lidentifying additional facilities  does  present
           a problem due to. the uncertainty of continued funding.





                                                  84



                             Wisconsin Regional Medical Program, Inc.
                              5721 Odano Road    Madison, Wisconssn 53719 Area Cod4i 6081263-3600


                            A DEVELOPMENTAL PROJECT TO ESTABLISH THE BASIS FOR
                          IMPROVED TOTAL CARE OF RIIEUMATIC DISEASES IN WISCONSIN



            Project Director:   Don McNeil
                                Executive Director
            Address:            Wisconsin Arthritis 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'lly 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,
            Tho MpairAl Cnllpap nf W4qrnnqin. Milwaukee, Coltimbii Hosoitil  ind  Sacred  Heart
            Rehabilitation Hospital, Milwaukee, Matshfield Clinic, Marshfield and the
            Gundersen Clinic in LaCrosse.  The administration and coordination of the pro-
            ject will be handled by the Wisconsin Arthritis Foundation.
            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  sta  f
            for the project.

            Some 300,000 men, women and 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  and  health  care
            professionals throughout the state.








                                                      85








                                         NG MEDICAL CONSULTATION TEAM
                                  TRAVEL!




          PROJECT            Don McNeil
          DIRECTOR           Executive Director
                             Wisconsin Arthritis Foundation
                             225 E. Michigan Street
                             Milwaukee, Wisconsin 53202


          OBJECTIVE:         To improve and increase utilization  by  community  medical
                             practitioners of.the.diagnostic  and  consultative  service
                             available through identified arthritis centers as  well  as
                             the oth6r,,mbdalities of comprehensive care as  needed.


          NATURE.OF          Traveling consultatio team will make between  5  and  7
                                                  n
          ACTIVITY           community visits. The.team will consist  of  a  rheuma-tolo-
                             gist, nurse specialist in rheumatism,  occupational  thera-
                             pist, physical'therapist and orthopedic surgeon (if
                             desired by the host community).  The community visits will
                             include the involvement of ill appropriate  service  re

                             Worksh6p,.Department of Vocational  Rehabilitation  and
                             other allidd.services. The medical  construction  team  has
                             met once in-Ashland, Wisconsin on October  17,  1974.  Four
                             more visits are in the planning stages and shoul,d,be  com-
                             pleted by mid-June, 1975.





















                                                  86




                   DEVELOPMENT OF OUTCOME CRITERIA AND PROTOCOLS OF NURSING CARE FOR:
                                     THE EARLY RHEUMATOID PATIENT

             p.ROJECT          Janic Pigg. R.N., B.S.N., Nurse ConsultaTit-RlicumatologY
             DIRECTOR          Rheumatic Disease Program, Columbia Hospital
                               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. Health/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-
                               teria 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  will  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 'Eotal Hili
                               Arthrbplasty.
             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  rheumatology  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 group.,
                               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
                                   other health professionals ind revis(!(l 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 .guide-,for patients, referral information  for  continuity
                               of care, use by new practitioners and curriculum  content  in  basic.
                               nursing education.  Within nursing, the models can be Used to
                               increase and upgrade knowledge of nursing cire of these two rtictima-
                               tology patient populations, as well  as  encouraging  development  of
                               criteria for other patient populations.




                                                     87





                              PATIENT AND FAMILY EDUCATION IN RHEUMATIC DISEASES



            PROJECT             Mrs. Madge A. Malecki, R.N., M.S.
            DIRECTOR            Director of Nursing Service
                                Sacred Heart 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  protocol$  will  be  developed  in  those  areas  necessary
                                to enhance the learning process for the client.

            PROTOCOLS           Initial In' terview               Work Simpliciation
            DEVELOPMENT         Reference Sheet                   Social Service-Asses'sment
                                Self Medication                   Exercise
                                Clie                              Nursing Guidelines
                                    nt    Education
                                Family    Education               Staff InSetvice 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
                                't-hp        of  this  Dtoject  in  terms  of  the  client's understand-
                                ing-

            EDUCATIONAL  AND    'Understanding  Rheumatoid  Artliri  is  (videotape  by  Arth.   Fndtn
            TEACHING MEDIA      The Truth  About,  Asprin  and  Arthritis  (Arthritis  Foun(lition)
                                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  &  I)olime)
                                Self Help Device for Arthritis Patients (Merck, Sharp & I)ohme)
                                                                  -icred Heart)
                                More  Information  About  Gold  (S.
                                Joint Protection  (Slides  shown  by  Sacred  Ileart'Occtipatiotiil
                                                                                           Tlicrtpy)
                                "The Homemaker"   (videotape  shown  by  Sacred  Iteart   Occupational
                                                                                           Therapy)

            COMMUNITY           Two members  of  the  Advisory  Committee  serve  to  provide  very
            RESOURCES           necessary community and consumer input.       One  member  has  pro-
                                vide(i a critique of the teaching efforts from i(Imi.ssioii to
                                discharge at Sacred Heart Rehibilltation Hospital.         This  in-
                                formation  will  enable  us  to  modify  and  evaluate  our,efforts
                                from the consumer's viewpoint.

                                A Luptis group has  been  startbd  under  the  guidance  of  the  Pro-
                                ject Coordinator and @i represeiitativ(-- from social service.
                                The emphasis is upon commonalities within the protip, with
                                mutual support, encouragement, and correct knowledge being,,
                                goals..
                                                       88