EN
MEMOR ANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE
HEALTH RESOURCES ADMINISTRATION
BUREAU OF HEALTH RESOURCES DEVELOPMENT

TO : Acting Director, Division of DATE: December 5, 1974
Regional Medical Programs yo
fj

hi ,
FROM : Ae ear aA

Public Heélth Advisor

SUBJECT: Background material for discussion on Arthritis Conference on Dec. 5

ee

With reference to our telephone conversation this morning, the enclosed
material is the basis of the general discussion I would like to have with
you at 3:00 p.m. today. The discussion need.not be long, as my agenda is
to go over with you (a) where matters stand, (b) explore any potential
problem areas vis a vis DRMP, and (c) obtain clearance on potential,
small cost items.

Since I do not ¢learly recall which documents have been forwarded to
you for information, I am énclosing the following:

1. A letter to Dr. Shulman, President of the Americal Rheumatism
Association, the professional organization of the Arthritis
Foundation. The letter updates him on events, and transmits
the report on the Chicago Discussion.

2. A memorandum to 5 of the "consultants" who were, on November 25,
in Washington to testify on the Cranston Bill. I was able to
deliver this material to them at the Rayburn Building. There has
been no play=back, to date. This document is the first "hard"
proposal on the Conference, proper; it is the result of the
experience I had at the San Francisco meeting of the western
Coordinators on arthritis, and discussions which Dr. Englemen.
and I had on the plane, returning to Washington.

3. The third document is an itemization of activities and functions
surrounding the conference proper. It will become a part of a
larger document I am preparing to send to the involved people
for (a) their information, and (b) concurrence on what is being
done. I may be able at the same time to include some concepts
on conference subject matter which, I hope, will elicit ecten-
sion of ideas from them.

Items Nos. 2, and 3, are most pertinent to our discussion.

Enclosures

dc. Mon Dain
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
PUBLIC HEALTH SERVICE
HEALTH RESOURCES ADMINISTRATION
ROCKVILLE, MARYLAND 20852

 

BUREAU OF HEALTH RESOURCES DEVELOPMENT

November 22, 1974

’

Lawrence E, Shulman, M.D., Ph.D.
916 Clinical Science Building
Johns Hopkins Hospita’
Baltimore, Maryland 21205

Dear Dr. Shulman:

This follows up our telephone conversation of about two weeks ago to keep
you advised regarding progress and arrangements for pilot arthritis pro-
gran followup.

I have enclosed a statement I developed for our guidance in the Division
of Regional Medical Programs regarding the Chicago O'Hare "fly-in"
discussion on November 17. It is enclosed not only to save rewriting,
but to permit others receiving copies of this letter to advise nme of

any misrepresentations.

I wish, first, to convey our feelings of sincere appreciation of the
interest and thoughtfulness extended by each of the participants in

the Chicago discussion. This was not a "pat" meeting; most of the points
I have enumerated in the enclosure elicited initial differences of opinions,
and were subjected to considerable scrutiny by the group. I believe
however, that doubts have been moderated if not retired, and that there
is positive consensus regarding the need for the arthritis conference,
and the potential it provides for substantive results.

Several key factors affected the outcome of the Chicago discussion which
are not apparent in my summary. First, enroute to the meeting, I was
advised by Mr. Gardell, Acting Division Chief, that funds I had believed
to be available as our contribution toward the conference were not, in
fact, available. We will continue to seek identification of a Federal
contribution, but the prospect is not bright. Secondly, it was agreed
that the conference should constitute a working session on the present
funded pilot programs, their present circumstances, and future; atten-
dance should be limited accordingly. It was agreed that the members

of the Arthritis Ad Hoc Review Committee should be invited.

I estimate that the conference will require the attendance of about

120 people. This includes 29 RMP representatives, about 60 Project
Directors, and the remainder made up by representatives of the sponsor-
ing agencies, resource specialists, and guests.
~2-

For your information, Dr. Evelyn Hess is contacting all of the pilot
arthritis Project Directors to explore the possibility of developing
data within the ARA uniform reporting format. Also, the Michigan RMP
is contracting with the University of Michigan School of Public Health
to carry out evaluation of Dr. Ivan Duff's geriatric demonstration.
This might provide an avenue of interest other schools of public health
to perform similar evaluative work.

I was provided an opportunity yesterday to discuss conference plans with
the Steering Committee of the National Association of RMP Coordinators.
On Saturday, November 23, there will be an opportunity to discuss the
program and coference plans at a one-day arthritis conference in San

Francisco of the Western Regional Medical Programs (7 or 8 states).

I will need and sincerely appreciate your counsel about the conference
as it develops. We will be able to announce the date and location next
week. I am obtaining cost and support information on both Kansas City
and St. Louis, which are, in the aggregate, the least-cost sites of 11
which we priced out in some detail. I prefer Kansas City because of the
existance of a strong Kansas RMP and arthritis program, and an active
local Arthritis Chapter. We are inviting these respective K.C offices
to serve as hosts to the conference if it is, in fact, schedulled there.

LI trust that these comments will assure you that plans for an effective
conference are moving forward. I look forward to your counsel with

respecte iv pLograu SUVSLALLE y aud ney opeanciss

Sincerely,

1, HE Ap
Matthew Spear A
Public Health Advisor
Division of Regional Medical Programs

Enclosure

Tele: 301/443-1916

Address: Division of Regional Medical Programs
Parklawn Building, Room 15-42 ,

5600 Fishers Lane

Rockville, Maryland 20852

cc:

Dr. Roger D. Mason Dr. Lawrence M. Petrocilli
Mr. Kevin Anderson Mr. David Shobe

Dr. William F. Donaldson Dr. Clement W. Sledge

Dr. Ephraim P. Engleman Dr. Isaac Taylor

Dr. Satoru Izutsu Dr. Charles D. Tourtelotte

Mr. Gerald Gardell
ORGANIZATION FOR A NATIONAL ARTHRITIS CONFERENCE

A discussion was held at O'Hare International airport, Chicago, Illinois, on
Sunday, Noverber 17, to cxplore the feasibility of convening a conference to
develop coordinated activities, including program reporting and evaluation,
among, 29 Regional Medical Progrars (ReP's) conducting pilot arthritis grant
" prograns. Participants in the discussion were:

Dr.

Mr.
Dr.

Dr.

Dr.
Tir

Mr.
Dr.
Dr.
Dr.

Roger D. Mason, discussion moderator; Chairman of the former Arthritis
ad hoc Review Committee .

Kevin Anderson, staff member, Michigan RMP

William F. Donaldson, 1st Vice President, American Academy of Ortho-
paedic Surgeons (Pittsburgh) .

‘Ephraim P. Engleman, UCLA; chairman of the ARA "committee of five"

designated to provide iiaison with DRP (San Francisco)
Satoru lzutsu, Executive Director, Hawaii Kir .
Tawrence M Patrracelli, Chief Arthritis Activities. NIAMDD
David Shobe, Arthritis Foundation (Washington, D.C., and N.Y.)
Clement W. Sledge, Robert Breck Brigham Hospital (Boston)
Isaac Taylor, Deputy Director, Tri-State RMP
Charles D. Tourtelotte, Chief of Rheumatology, Temple University
(Philadelphia) .

From the Division of Regional Medical Programs:

Mr.

Gerald T. Gardell, Acting Director

Mr. Matthew Spear, Staff member

The consensusses reached ‘by the discussion participants are the following:

J. There should be a conference to develop coordination, evaluation, and follow-
'. up activities among the 29 funded pilot arthritis programs.

2. The conference should be convened at a site which results in least cost for
‘both the conduct of the conference, and the attendance of the participants.

3. Total cost of the conference proper (site and services
exceed $10,000. -

costs) should not
De

12.

Conference sponsors will be, jointly:

)
f ft I fe

Arthritis Foundation a

M uy
American Academy of Orthopaedic Surgeons a Wa
National Institute of Arthritis, Metabolism, and Digestive Diseases¢ .

Regional Medical Programs (29 collectively)
The sponsors will jointly contrive to pay the costs of the conference.

Participating program attendees will be required to meet their travel and
other costs from local sources.

Pregram attendance/participation will be limited to Coordinators of the
29 RMP's with funded pilot arthritis programs, their arthritis Project
Directors, and others directly associated with the conduct of the
conference.

Special guests, and expert resource personnel will be invited. Their costs
of participation will be reimbursed by the sponsors, when necessary.

The conference will be ‘schedulled for 2 days in the period between
January 18, and February 2, 1975.

DRMP will provide staff support -- in effect, an Executive Secretariat --
for development, conduct, and perhaps followup of the conference.

The tentative program structure is:

I. Educational impact
A. Physicians
B. Paramedical
C. Patients

JI. Delivery Impact
A. Demographic aspects
B. Types of services
C. Distribution of services

III. Objective analysis of results
A. Each of the above
B. Functional analysis of therapy

IV. Continuation funding
The structure relates to the following tentative agenda:

a. short introductory plenary session
b. workshops on sections I, and II

ce. plenary session for reports and discussions
d. workshops on sections III, and IV
€. summary plenary session
I3

‘14, Snecial resource people should be available in both the workshop, and
plenary sessions. Types (or specialties noted):

demography

program evaluation

program funding

program information disseminators
program image builders

Names mentioned:

demography ~- William Ranke (?), Johns Hopkins, Md.

evaluation ~- Dennison, Mich.; Plotz, N.Y.; Dr. Smyth, Colo.;
Confree, Cal.; Joseph Barbaccia, Cal.

funding --- David Rogers, Johnson Foundation
Kellogg Foundation
State Health Department specialists

program delivery -- Ed. Smith, Va.; John Sharp, Houston, and
Smiley, Dallas, Texas; Neustadt, Louiseville;
Iven Duff, Mich. Dr. Klineberg, ‘and George
Freo (7), Cal. , ,

program information -- one or two widely known science writers

program image -~ Sen. Cranston: Anne Landers
MEMORAND UM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARI

TO

FROM

PUBLIC HEALTH SERVICE
HEALTH RESOURCES ADMINISTRATION
BUREAU OF HEALTIE RESOURCES DEVELOPMENT

:Dr. Donaldson DATE: November 25, 1974

Dr. Engleman
Mr. Shobe
Dr. Shulman
Dr. Sledge

Matt fat Gece

SUBJECT:

Proposed organization of an arthritis conference

The enclosed pages set forth (albeit hurriedly) a proposed format and
organization for the arthritis conference discussed at Chicago on Nov. 17.
The format sceks to provide maximum participation to develop a forward looking
perspective, and a degree of collective action by program participants.

The characteristics seem critical to me in view of the prospects. If we dry
up and go away for lack of Federal support, the. present investment must be-
optimally employed, adequately documented, and permitted to provide a bridge
to whatever local continuity as can be elicited. If. additional, similar
support evolves, the present program must be in position to move forward
appropriately.

This is the basis on which I have striven to define a method to* through which
the combined elements of the existing pilot arthritis program can, focussed

on a forward looking, active venture. The conference must not, in my thinking,
be allowed to lapse into a passive talkfest. Similarly, it must occur in a
time and manner in which there is maximum involvement and interest, and

serve to maintain or build on those characteristics.

The proposed attendance results in the presence of a wide spectrum of

experience and outlook, The proposed techniques are an attempt to capture
both the conscious, and subconscious expressions of this reservoir, and to
highlight program perspectives which are, respectively, shared and unique.

It may be too much to anticipate and plan for collaborative actions as an
outcome from this single conference. However, we can assure | “undershooting"

if we don' t aim, and press for hard targets.

The proposal needs critical examination. If we progress in this, or a_
similar format, planning and logistics must be carefully developed.

Enclosures
Conference on Pilot Arthritis Programs

Purposes

A. Share program expericnces

1. Program developmental approaches
2. Significant problems
3. Problem resolutions

B. Define overall program goal (s)

1. Identify major obectives
2. Identify principal forces, or
program elements

C. Identify major criteria of program
outcome for delivery

ap - ll, Professional training
2. Patient training
3, Program services

n TAAn bt Fer FRnnthil nan mnnnnraman ~

techniques (to emply criteria)
1. - 2. - 3. - (as C above)

E. Identify feasible program continuation
(activities/support)

1. - 2. - 3. -— (as C above)

A.

to,

E.

Outcomes

Relate and coordinate like
activities
1. Obtain interprogram
assistance
2. Establish a newsletter -

Establish a central program
reporting and analysis
activity.

Establish a reporting format
and schedule

Baenhlianth na nawnanam mantenntan~
Fetablich na preagram monitoring

and counseling activity

Report (via newsletter)
activities which win
continuity support.
Schematic plan for an arthritis conference January 1975

 

Basis of Plan

Representatives of 29 pilot arthritis programs will be convened;
with others, to:

a. Share program experiences.

b. Develop a perspective of the program, as an initiation
of arthritis control activities.

Ce Identify salient factors of program strengths, and
continuity elements.

d. Devise processes for program reporting for coordination,
and evaluation.

e. Specify collaborative roles, or functions, to be executed
to effect program quality improvement, coordination of
like activities, and evaluation.

Thus, the conference process must be a joint working session which
initiates, if it cannot fully realize, leadership roles which draw
forth participatory commitments from a wide range of individuals

and groups. The objective is the establishment and coalescence of

a broad constituency embracing both those required to effect delivery
of good program, and those who can elicit active awareness from
Muricipel, State, and Federal ansrifurions, and agencies.

Conference Program Plan a

 

Conference events must be formulated to elicit the experiences and
judgements of present program ledders, and amalgamate their perspec~
tives and expectations into unified objectives to be achieved within
a stated period. To achieve this, conference activities will put

the participants to work almost at the outset, and keep them
actively engaged in a process of rapid definition of feasible actions
which they can agree to undertake individually, and jointly. ,

A series of workshops will be conducted which will:

1. highlight major program requirements

2. emphasize similarities of perspectives

3. reveal innovative approaches

4. specify actions required to be undertaken with some
uniformity. :

The process is an offshoot of the "brainstorming" conference approach,
and will permit:

a. direction: The matters to be addressed by the conference
will be determined by the key questions posed
to the participants.
b.

Cc.

maximum input: everyone will be provided opportunity to
express judgements and opinions.

rapidity of response: participant responses will be
obtained simultaneously; the workshop
function is to focus participant responses
into coherent statements of perspectives,
objectives, and initiatives.

It remains questionable at this time whether the brainstorming process
can be effectively conducted as a plenary session activity because of
logistic, and pzrticipant fatigue problems. However, this plan
assumes that these problems can be managed.

A.

Requirements

1. A leader with a set of focussed questions. The questions
must be orally stated to the participants and also ,
individually displayed, as they are posed, on a large
placard.

2. Participants must have several 3" x 5" pads of note
paper, and pen/pencil.

3. Ushers must be available tp pick up the 3" x 5" pages
HLLEL each question session.

4. A small collator and typing staff must be cea
in a separate room.

5. Meeting rooms are ‘needed for designated groups (work-
sips). Workshops address themselves to specific
questions, and the responses provided by plenary

.aetivity; the plenary responses are, in the hands of
the: members of the designated workshop via the
collator/typing team.

Sample process:

1.

2.
3.

4.

a.

Leader states the question, which is simultaneously displayed
in large print. x

: eS
Leader states the time limit (2-3°min.) which participants
have to write down all the responses which occur to them.

Participants write one answer on one 3" x 5" page, proceed-~ ©
ing to successive pages as responses occur.

Leader calls TIME; ushers pick up all answers (collect in
plastic bage). Responses are delivered to the collatot/

typing room.

Leader proceeds to next question; etc.
oe

' When all (or a designated set) questions are completed, a series of

talks is presented relating to the conference interest. This provides

the collator/typing team time to complete their work in preparrtion

for the workshops. The collator/typing team process must not screen
responses. The limiting factor will be time; all the responses s which

can be typed within a time limit must be prepared for perusal, discussion,
and resolution by the designated workshop. Everyone must know what is
occurring, but nothing must be done overtly which inhibits full, and

free response from all participants.

Workshops then proceed on the questions, and responses provided in
the plenary question session. Unless logistic prospects require
modification of this plan, each workshop will deal with specific
propositions with respect to which it has input from the aggregate
conference.

Workshop output is: ‘
1. A synthesis of ‘the conference perspectives
2. Statement of feasible objectives

3. Recommendations on conference positions, and appropriate
followon initiatives.

Workshop deliberations will be reported to a plenary session by the
Workshop leader. |

2
An approximate sequence for th£g “proposed activities is attached.
ah

Ist DAY

 

 

Time Program Related
Sequence Activities Activities
a.ine9:00~--- Welcome/Introductions
- Explanation of Agenda
~_ Instructions on Questions
- Questions posed
10:00---~ Collation/typing team pick up
, -- responses, arrange, and type
w~- == -- == Coffee Break in form to be handed to workshops
11:00---- Reassemble, Introduce speakers
- (15 min. presentations of
“— representative arthritis
- pregrams.)
Noon12:00---- LUNCH
“ Presentation on
- operating program
p-m.1:00--~~ evaluation.

~—- -~ <= -= Workshops

ee 2:00---- (Simultaneous consideration
- of Education Impact, and
-— Delivery Impact aspects
= by a number of workshops.
3:00---— Breakout determined by

-_ BPecCLLACLev OL questions.)
we ee Coffee Break

- Reassemble in Plenary
4:00---- Workshop Reports Ke
5:00---- Plenary Discussions

- Positions defined; voting

-- proceeds, if appropriate.

6:00---- Cocktails Types

7:00---- . Dinner
~— Conference Keynote Speaker *
8:00----

of Record pee e Su / >
 

 

Time Program Related
Sequence Activities Activities
a.m, 8:00---- Assemble in Plenary
- Questions posed
-- Collator/typing tream
~ Presentations of , pick up responses, arrange
9:00---- special programs’ and type to hand to
- workshops.
~- -- «= -= Workshops
10:00----
11:00----

Reassemble in Plenary
Workshop reports -4-

LUNCH

(Presentations on
funding opportunities) ¥

Typing of previous
Reassemble in Plenary H papers, etc.
(Act on morning's workshops
and overall Conference
positions/outcomes. If there
is to be suggested designation
of persons/organizations to take
actions, it should occur here.)

ADJOURN

(Post-donference wrap-up
taken up -- e.g., transcript
wording, individual followup
assignments, etc.)
Typing as required

¥ Record proceedings -
Schedule, Site, Agenda, Formal, Assignments, Estimaled Cosh, and
Related MaTlexs

| lage : Hote | Muehlebach
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Dates: | Jeauary 19-20, /F7o”

Comperence Hasts. Kansas Cily ChayiTey, Axtheitis Founds Pe

Kansas Resa) Medica! Program

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Arthritis Foundation

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a%2,500 American Academe oF Ovtho vedic Surgeons
bf2sv0 Arthvilis Foundalom

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d. = KC Asthilis Cha jilev stage suypel

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DRWP Dav. og Req] Med. Programs
HM Hate) Muchlebach
KCAF Kansas én Avth. Chapler
KRme Kansas a Med, Freq.
Rm Parhewpah nq RmP prvegram (s)

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Paying ° MM
PA Sus om , Plenary Kaen 0 eawe-Kone
Ta pe Recor ding , Plenary, o — IKiCmP- KCAF
hunch, d Dinner [Gnas
Type wy ijers 6 krem- Kear
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V P's (ext 2.@* sof travel) 4 S00 |AAts- AF
Rep's Abas, AF, DRmP NZAmOD NA | Tadividual
4, Meals:
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* Divine (1x 40.00 x joe) # 1,200 \AAos-AF
* boclabis (1 x bas’ x 240) 4 350 |AAos-AE
s, iicluded above. _ —_—
B Lakeast (2) 0 Dadividua!
* gee Breaks ( 3 times) |* 240 [Akos -Af

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