QE MEMOR ANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE TO FROM SUBJECT: PUBLIC HEALTH SERVICE HEALTH RESOURCES ADMINISTRATION BUREAU OF HEALTH RESOURCES DEVELOPMENT William F. Donaldson, M.D. DATE: December 12, 1974 Lawrence Shulman, M.D. | I yY Mat td cca Matthew Spea Public Health Advisor, DRMP Selecting a Chairman for the January Arthritis Conference It would be helpful if the identification of the conference Chairman were resolved soon. The Chairman should be involved in the final development of the conference both for information, and to develop strategy to achieve conference objectives. Several alternatives came to mind: a. AAOS, and ARA representatives alternate in the chair; b. The two share the Chairmanship, as was done at the April 1 meeting in Chicago; C. An individual be selected who is acceptable to all. With regard to the latter, we recommend consideration of Dr. Roger D. Mason. We have found him to be an effective Chairman, and very helpful in resolving problems. He represents objectivity in coming from an RMP which did not apply for an arthritis grant, and involvement as a practicing physician who is a victim of arthritis. On January 1, Dr. Mason will assume directorship of medical affairs for the "Blues", in Omaha, Nebraska. MEMORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE TO FROM SUBJECT: PUBLIC HEALTH SERVICE HEALTH RESOURCES ADMINISTRATION BUREAU OF HEALTH RESOURCES DEVELOPMENT See below (Participants in the DATE: December 12, 1974 Nov. 17 Chicago "fly-in") a Htc! peta 4tthew Spear, Public Health Advisor, DRMP Plans for the Arthritis Conference, January 19-20, 1975 The enclosed pages present draft plans, conference "play script", etc., for your information, and to elicit suggestions for the final format of the Arthritis Conference. YOUR RESPONSE ON THIS MATERIAL IS NEEDED WITHIN TWO (2) WEEKS to assure that the conference will be acceptably structured and conducted. As you go through the material, two factors should be kept foremost. The preposed structure will permit pre-conference assignment of par- ticipants to the workshops. For tighter structuring, we could make a pre-conference distribution of workshop guides, and instructions. Secondly, conference attendance will be mixed; i.e., only half of the participants wii ve puysicians speciricairy LUNE LAULIUE ad department heads, or practicing arthritis providers. The remainder will be AF Chapter heads, and RMP Coordinators. Your guidance is particularly needed with respect to the following questions: 1. Who shall chair the workshops? 2. Who should prepare the conference report? 3. How should post-conference action followup be handled? It has been suggested that a short wrap-up meeting on conference plans be held in New York City before or after the ARA Executive Committee meeting on January 10. Who whould be available to attend such a meeting? . Please let me have your comments and suggestions at an early date. I will be away from Washington during the week of December 14-21. Page 2 I wish to maintain contact with you, however, and can be contacted at, or through the following numbers: Office: 301/443-1916 301/443-1500 ‘Florida: Holiday Inn - Oceanside Vero Beach 305/562-4164 Addressees: Mr. Kevin Anderson Dr. William Donaldson Dr. Ephraim Engleman Mr. Gerald Gardell Dr. Satoru Izutsu Dr. Roger D. Mason Dr. Lawrence Petrocelli Mr. David Shobe Dr. Clement Sledge Dr. Lsaac Yaylor Dr. Charles Tourtelotte For Information: Dr. Robert Brown, Director, Kansas RMP Mr. Gordon Waller, Executive Director, Kansas City Division AF MEMORAND UM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE TO PUBLIC HEALTH SERVICE HEALTH RESOURCES ADMINISTRATION BUREAU OF HEALTH RESOURCES DEVELOPMENT See below (Participants in the DATE: December 12, 1974 Nov. 17 Chicago "fly-in") FROM ss: thew Spear, SUBJECT: Public Health Advisor, DRMP Plans for the Arthritis Conference, January 19-20, 1975 The enclosed pages present draft plans, conference "play script", etc., for your information, and to elicit suggestions for the final format of the Arthritis Conference. YOUR RESPONSE ON THIS MATERIAL IS NEEDED WITHIN TWO (2) WEEKS to assure that the conference will be acceptably structured and conducted. As you go through the material, two factors should be kept foremost. The preposed structure will permit pre-conference assignment of par- ticipants to the workshops. For tighter structuring, we could make a pre-conference distribution of workshop guides, and instructions. Secondly, conference attendance will be mixed; i.e., only half of tne parvicipants wii ve pnysicidaus specifically Lfunecivuning ao department heads, or practicing arthritis providers. The remainder will be AF Chapter heads, and RMP Coordinators. Your guidance is particularly needed with respect to the following questions: , , 1. Who shall chair the workshops? 2. Who should prepare the conference report? 3. How should pest-conference action followup be handled? It has been suggested that a short wrap-up meeting on conference plans be held in New York City before or after the ARA Executive Committee meeting on January 10. Who whould be available to attend such a meeting? Please let me have your comments and suggestions at an early date. I will be away from Washington during the week of December 14-21. Page 2 I wish to maintain contact with you, however, and can be contacted at, or through the following numbers: Office: 301/443-1916 301/443-1500 "Florida: Holiday Inn - Oceanside Vero Beach 305/562-4164 Addressees: Mr. Kevin Anderson Dr. William Donaldson Dr. Ephraim Engleman Mr. Gerald Gardell Dr.. Satoru Izutsu Dr. Roger D. Mason Dr. Lawrence Petrocelli Mr. David Shobe Dr. Clement Sledge Dr. lsaac Yaylor Dr. Charles Tourtelotte For Information: Dr. Robert Brown, Director, Kansas RMP Mr. Gordon Waller, - Executive Director, Kansas City Division AF Arthritis Conference INDEX OF DRAFT MATERIALS Subject Pages Conferemce Operational Assignments, and Estimated Costs 1-4 Outline of Conference Program Events 5 =13 General 5 First Day 6 -11 Second Day | 12 -13 Workehane: Giutdee & Tnetruntinne Th 9h First Day (A-~1 through A-6) . 14 -23 Second Day (B-1 through B-6) 24 Conference Announcement 25 -27 Mailing List -- Project Directors and Coordinators "28 ~36 ARTHRITI 5 CONFE..ENCE Schedule, Site, Assignments Estimated Costs, ard Related Matters EST, PROPOSED (Typed = Spear; other write in ITEMS AMOUN | SOURCES COMMENTS ox telephone Spear) A. PLACE: Hotel Muehlebach Kansas City, Missouri B, DATES: January 19-20,. 1975 Cc. CONFERENCE HOSTS: Kansas City Division, Arthritis Foundation . Kansas Regional Medical Program D. CONFERENCE SPONSORS: American Academy of Orthopaedic Surgeons Arthritis Foundation . . Participating Regional Medical Program E. AVAILABLE RESOURCES: ; Travel/PerDiem of Participant and Project Directors. Others (DRMP, Associations, e Conference Sité/Service Allow a. $2,500 American Acade b. $2,500 Arthritis Foun c. $1,060 Kansas RMP, pl d. Staff Support, KC Art e. Staff Support, Div. R s: $21,000 py tic.)}: Cost pa ces: (haxin of Orthopa tion staff supp itis Chaptd ional Medic 4] ovided by 29 ams ) edic Surgeon “Or ‘ort oc al Programs } RMP's for participation of Coordinators, id by organipation (1) Abbreviations: AAOS Am, Acad. of Ortho. Surgecns AF Arthritis Foundation DRMP Div. of Reg'l Med. Prograns EM Hotel Muehlebach KCAF Kansas City Arth. Chapter KRMP Kansas Reg'l Med. Prog. RMP Participating RMP program(s) (ii) Footnotes: “* Indicates items which could be partially or wholly charged to participants. i/ ttems not required if costs covered by conference sponsors. ITEMS (Typed = Spear; other write in COMMENTS or telephone Spear) F. ESTIMATED COSTS: i. Facilities: Plenary room, school room style Conf. Admin. Room 6 Committee Rooms, Schoolroom styld Lunch Room 2 days Dining Room 1 night Sleeping Rooms for 120 - 150 VIP Rooms (2 or 3) Post-Conference Work Room (same as Admin. Room above) Services: Paging PA system, Plenary Room Tape Recording, Plenary, Lunch, and Dinner Rooms Typewriters, typing Secretaries (2+5) (messengers) Reproduction equipment/services Pre-Conference- Post Conference Reproduction EST PROPOSED AMOUN - SOURCES 0 HM 0 HM 0 HM 0- HM 0 HM $17.00 sglq RMP's,othex 23,00 dbld RMP's,othex 0 HM 0 HM 0 HM - 0 ‘HM 0 KRMP-KCAF 0 KRMP-KCAF 0 KRMP-KCAF 0 KRMP-KCAF 0 DRMP WW Blackboard & easel available in room Outlets for typewriters, & tape player Blackboard & easel available in each room Presume hotel will also extend assistance in flight rescheduling, if necessary Re. Key Question sessions. (see Conference Playscript), need fast service for reproduction of documents to go into workshops; also, re. workshop reports to be presented in Plenary. (i) Abbreviations; AAOS Am. Acad. of Ortho. Surgecns AF Arthritis Foundation DRMP Div. of Reg'l Med. Prograns EM Hotel Muehlebach KCAF Kansas City Arth. Chapter KRMP Kansas Reg'1 Med. Prog. RMP Participating RMP program(s) (ii) Footnotes: * Indicates items which could be partially or wholly charged to participants. 1/-Items not required if costs covered by conference sponsors. EST. PROPOSED (Typed = Spear; other write in ITEMS AMOUNT SOURCES COMMENTS or telephone Spear) 3. Travel: * Representatives of 29 RMP $21,009 RMP 's programs * Arthritis AD Hoc Review $ 3,40) [Individual Committee (14 @ est. $240.00 ea.) VIP's (est. 2 @ $500 travel) $ 50) |fAAOS - AF Rep's AAOS, AF, DRMP, NIAMDD 0 Individual Special resource people, Est}3 $ 75) {|AAOS — AF: 4. Meals: * Lunch (2 x $4.50 x 120) $ 1,08) |AAOS — AF ae . * Dinner (1 x $10.00 x 120) $ 1,20) {AAOS - AF Estimated at $10.00/per as banquet; could , be cheaper ($8.50/per) if handled ‘as a : buffet "western". * Cocktails (1 x $1.25 x 240) $ 35) | AAOS = AF. Perhaps KCAF can get this tab picked up VIP's, included above - -—. oo , Breakfast (2) 0 Individual - a . * Coffee Breaks (3 times) $ 24) |AAOS - AF Prefer this be set up on 1 or 2 carts, Coffee $0.35/serving Tea 0.35/serving Cake 0.40/serving in large urns; might be cheaper in this mode. (i) Abbreviations: AAOS Am. Acad. of Ortho. Surgeons (ii) Footnotes: * Indicates itmes which could be partially or wholly charges to AF Arthritis Foundation DRMP Div. of Reg'l Med, Progreéms participants. HM Eotel Muehlebach KCAF Kansas City Arth. Chapter i/ Items not required if costs KRMP Kansas Reg'] Med. Prog. covered by conference sponsors RMP Participating RMP program(s) EST. PROPOSED (Typed = Spear; other write in ITEMS AMOUNT SOURCES COMMENTS or telephone Spear) 5. Supplies: May need to call on KRMP/KCAF if DRMP Name Tags (150) 0 DRMP supply serviaes balk at some of this. Registration Books (2) 0 DRMP : 1/ Meal Tickets (450) 0 HM Re. 2 lunches, and 1 dinner. Would need ~ 3M x 5" pads (500) 0 DRMP if (a) sponors don't desire to fully Plastic Bags (10) 0 DRMP cover meal costs, and/or (b) there is Writing Paper (150) ° 0- DRMP is a question of the attendance at the Pencils (200) Est 0 DRMP dinner. Typing Paper 10 ° 0 KRMP ~ KCAF Paper, Reprocuction{ Penne 0 KRMP —- KCAF Envelopes 0 DRMP Postage 0 DRMP Reproducing Agenda 0 DRMP If these can be drawn up in sufficient 0 DRMP time before the conference; otherwise, Reproducing Dinner Program will have to call on KRMP/KCAF. CONFERENCE ON PILOT ARTHRITIS PROGRAM Nature and Sequence of Events Overall Conference Process: The conference is planned to proceed on the basis of development and discovery. That is, no preconference issue or position papers will be developed. The conference brings together professional individuals each of whom is informed generally on the overall program, and specifically with respect to the project(s) with which each is associated. The process will capitalize upon their collective past experiences in the health field, and the current experiences of the pilot arthritis program to: a) define and describe the program; . b) identify salient features of note; c) explore its potential; and d) specify a number of feasible activities which can be undertaken individually and jointly to round out the pilet effort. The deliberations in the conference will be by the pilot arthritis program leaders, about the parts, and the sum of the program. Thus, the only input papers required are those prepared by assigned program speakers, and special resource people and guests invited to make a formal presentation. Conference outcome is dependent upon the will of the leading program participants with regard to: a) improved program comprehension; b) identification of program potentials; and c) specifica- tion of actions which the assembly agrees to undertake. Conference Program Playscript Proposed Comment First Day, January 19 8:00 a.m. Registration Sign-in books will be available on at least 3 tables, each table (book) representing a separate alphabetical group (e.g., a-~ i; j-4r3s- Zz). The names of the signers will be checked against a listing to identify unexpected attenders. , Signers will be handed: 1. a name tag (prepared preconference, insofar as possible), and 2. a piece of paper (possibly color coded) identigy- Assignments indicated by color coded, or ing the workshops the individual is assigned to. symbol-marked, slips - need not carry the individual's name. The lists in the hands of the Registrars will indicate what assignment to hand each participant. The name tag can also carry a color mark, or symbol so loss of slip doesn't matter. 3. Conference agenda 9:00 a.m. Call to Order May be smoother if Dr. Brown (KRMP), or Mr. Waller (KDAF) convenes conference, and introduces Chairman Chairman (who)calls meeting to order in Plenary Room Proposed Comment Plenary room is arranged on a schoolroom basis (tables for all). At each place is: 1. writing pad 2. several 3" x 5" pads 3. a pencil 4, any background documents Chairman makes welcoming comments. Chairman makes introductions. Only 1 or 2 other people should be on the podium with the Chairman. Introductions may include special guests present, and individuals to contact for personal help. Chairman makes short talk about conference purpose Can be another person. Chairmen summarizesagenda. pointing out pre~assignment Can be another person. of participants to workshops. 9:30 a.m. Key Question Period Leader introduced. Describes the purpose of this session; i.e., the experience of the total plenary group is being tapped to assist each subject workshop in completing its assignment. The plenary session will be asked to respond to 2 or 3 "How" questions about each workshop subject (see section under each workshop). — : : Proposed These are "knowledge" questions; the analytical factors of each subject must be developed within the workshop. (Average of 1% - 8% of such responses will turn out to be useable; imagery stimulation to workshop can be quite high, however. Process: Leader will state one "How" question, and will indicate the time allowed to give answers (mever over 2 minutes). Participants write their individual responses on the 3" x 5" pads, tearing off completed sheets (normally, one answer per page). Whatever comes to respondent's mind should be written down. At "TIME", ushers go down the aisles with plasic bags (marked to show what sheets they contain), and collect the 3" x 5" pages. Ushers take the bags to the Administrative room, and return to Plenary with new marked bags. Leader poses a second question, and the above process is repeated. Comment Need minimum of 2 professional people in Admin. Room to go over slips; such responses typically fall into categories. Profes- sionals need to set up 2-3 categorics per question, and select not more than 12 ans- wers per category to be typed on the sheet for the workshop. After master sheet is typed, a copy is run for each member and delivered to workshop leader. There should not be pre-selection by the professionals-— the novel, and the "different", is where this can pay off most. It will not be catastrophic if these sheets reach the workshops after they have convened. Proposed Process is repeated until all "How" questions for the Ist day are completed. 10:30 a.m. Coffee Break 10:45 a.m. Reassemble in Plenary Room Presentation of 3 or 4 representative pilot arthritis programs by Coordinator, or Project Director Speakers. Short time allotted to each (15 - 20 min.) is offset by the fact that participants already have in hand a program summary (these were called for by DRMP by memo November 11, 1974). 12:00 Noon ~ LUNCH Two (2) short presentations on special subjects. Suggested: 1. Demographic applications 2. Evaluating chronic disease programs Conment This is a demanding exercise on partici- pants. It is proposed that; a) not more than 3 questions be posed at one time; b) question g¥reups _of up to 3 questions each be interposed between program presentations described immedi- ately below. Coffee ~- tea - cokes, available in hall-way, or at back of Plenary Room on 2 - 3 carts. See above. Fatigue factors asscciated with, a) answering quesrions, and o) list- ening to speakers can be reduced by inter- spersing the two. E.g., 3 questions 15 min. 1 speaker 15 min. 3 questions 15 min. 1 speaker 15 min. Coffee Break 15 min. 3 questions 15 min. 1 speaker 15 min. 3 questions 15 min. 1 speaker _15 min. 135 min. Recommend Mr. Lynn, Director Michigan RMP Recommend speaker from Am. Soc. State Territorial Health Offices Proposed Comment _ 1:30 p.m. Convene Workshops A-1 Physician Education AAOS and AF should recommend workshop _A-2 Paramedical Education leaders. A-3 Patient Education A-4 Demographic Factors A-5 Arthritis Services A-6 Service deployment Each member of each workshop has available in the Secretarial service available in Admin. workshop room: Room to type up Workshop reports insofar 1. Statement of instructions and charge : as time permits before presentation. 2. "How" responses pertinent to this workshop. A typed workshop report is required in all cases - either from tape recording of Plenary report or from Workshop Chairmen's notes. 3:30 p.m. Coffee Break 3:45 p.m. Reassemble in Plenary Room ae b. c. Tf 15 min reports from each of six (6) workshops. Plenary discussion of reports. Plenary vote/resolution on any positions, or actions conference decides to take. appropriate, Chairman either Schedule and reporting responsibilities 1. designates an individual to follow up must be established. conference action notes, or : . 2. designates a group. --- Adjourn O7 Proposed 6:00 p.m. Cocktails 7:00 p.m. Dinner If speaker desired, can schedule a) Cranston, or similar, or, b) David Rogers, or similar Comment i Proposed Second Day, January 20, 1975 8:00 a.m. 8:05 a.m. Convene in Plenary Room Key Question Period Same as lst day, but relating to 2nd Day's workshops. 8:30 a.m. Presentation of Special Programs Select 3 or 4 from: 1. °2. 3. 4, Michigan geriatric program Galveston minimal care unit North Carolina industrial detection program One of the Wisconsin studies: a. Patient/family education b. Quality of nursing care. New Mexico, or Hawaii discussion of techniques to mobilize lay people. : Physician from Philadelphia to briefly highlight pediatric aspects of the pilot initiative. Kansas, Alabama, or other RMP outline of program impact on physician at secondary level of service. Virginia, Utah, or other outline of impact on physician at primary level of service. Summary by Dr. Evelyn Hess on automated reporting opportunities. Other Comments Recommend interspersing with talks (sce below) as indicated above for lst day. Schedule is shortened on the 2nd day. This can be accommodated by altexnatetively, or jointly: asking fewer questions, 2. banking on more efficient operations, given Ist day's experience; and/or, 3. sliding schedule downward a bic. If some of these which cannot be scheduled in program are of sufficient interest, maybe desirable to request selected RMP's to submit "abstracts" on these subjects as background papers for the conference. “er 9:30 9:45 Proposed a.m. Coffee Break a.m. Workshops Convene B-1 Evaluating physician training B-2 Evaluating paramedical training B-3 Evaluating patient training B-4 Evaluating program services B-5 Evaluating special studies B-6 Establishing continuing work groups to follow through on conference recommendations 11:30 a.m. Reassemble in Plenary Workshop reports 1:00 p.m. Lunch 2:30 3:30 4:00 2 short talkson alternative funding opportunities. p.m. Reassemble in Plenary Conference consideration of workshop reports; resolutions or voting on positions, or follow up actions p.m. Plenary Continued Resolution or voting on overall conference positions, or activity plans. p.m. Adjourn Conference ~- Post conference: KRMP, KDAF, AAOS, AF, and DRMP representatives must meet in Admin. Room to resolve -- wrap up specific conference cost and action requirements. Comment Who are the key people who are must participants in these workshops? What alternative sequence of work- shops might be better? $1 WORKSHOP A - 1 Guides and Instructions Subject: Physician Education Chairman: Recorder: Workshop Product: A document which describes: physician education generally undertaken across the country under the pilot arthritis program; indications of potential problems, as well as techniques and opportunities to enhance success; suggestions regarding maintenance of program quality to improve chances for continuity support; indications of subject areas, or training methodology which appears to be potentially most fruitful; the kind of documentation it may be feasible to obtain to record the overall pilot training activities; the recommended source of forms, or format; recommendation of who should centrally, or otherwise collect this information; recommendation as to who should receive this information, and how it should be disseminated. The workshop report should be dictated in the Administration Room if it is too long to write and have typed for the Plenary report. The Plenary report will necessarily have to be a summarization, but all specific recommendations will have to be acted on in a Plenary session, Discussion guides: Program description and development. What: a. physician education activities are being undertaken in the pilot arthritis program. b. existing curricula are being employed c. new curricula are being developed d. is the approximate ratio of physicians being reached respectively at the tertiary, secondary, and primary levels of practice. e. distinctions, if any, are indicated in methodology, and/or curricula in reaching different categories of physicians. £. degree of physician service upgrading is being accomplished through: increased knowledge; patient referrals; consulting teams; increased utilization of Allied Health, and lay personnel. g. are the major problems in obtaining physician cooperation and participation in pilot programs. h. measures are effective in overcoming resistance, or problems. i, Other: 1S How: (discussion will be reinforced by responses obtained in Plenary session) a. can physician resistance to involvement in arthritis treatment be overcome, . b. can teaching methodologies and currisula be made widely available. c. can individual projects obtain assistance, or counsel on program problems, WORKSHOP A - 2 Guides and Instructions Subject: Allied Health Education Chairman: Recorder: Workshop Product: