ETHNIC DISPARITY IN THE USE OF JOINT ARTHROPLASTY

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5. ENVIRONMENT AND INSTITUTIONAL COMMITMENT TO CANDIDATE. 5 A. Description of Institutional Environment Dr. Dennis Ang is a Clinical Assistant Professor of Medicine in the Division of Rheumatology and in the Department of Medicine at IU School of Medicine. The academic environment provides Dr. Ang with critical resources for his professional development, and each is described below. Indiana University School of Medicine: Over the last 3 years the extramural funding for the School of Medicine rose from $75 million to $105 million. It ranks 34mamong schools of medicine in PHS/NIH funding, while its Department of Medicine ranks 15t" among all departments of medicine nationwide. In 1989, the Research Investment Fund was established to commit approximately 22% of recovered indirect costs to research development at IU. This Fund supports development of research resources, and new initiatives in interdisciplinary research. A second program, the Research Venture Award, also supports initiatives in research. Beginning in 1998, the newly formed Clarian Health Research Committee recommended that $3,000,000 be available to support clinical research in the form of infrastructure and direct support. More than half of Dr. Ang's current salary comes from the Indiana University School of Medicine. Indiana University Division of Rheumatology: The Rheumatology Division was established in 1975 with the arrival at Indiana University of Kenneth Brandt, MD. Clinical research has been a growing part of the activities of the Rheumatology Division since that time, with support coming from both the National Institutes of Health (NIH) and the pharmaceutical industry. NIH support has included continuous funding of a Multipurpose Arthritis Musculoskeletal Disease Center, and several individual investigator grants (RO-1), and program project-type grants. Pharmaceutical industry-sponsored projects have included investigator-initiated studies, as well as industry-initiated multi-center clinical trials. IU Division of Rheumatology is one of three Divisions in the country where OA is primary research focus. Therapeutic agents that have been investigated include analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), intra-articular hyaluronate preparations, and "novel" drugs. The Rheumatology Division is on the 5thfloor of the Long Hospital Building (part of IU Medical Center), where the offices of Dr. Brandt and Dr. Ang are located. Four full-time research nurses (three RNs, one LPN) assist in the research activities of the division. Dr. Brandt has generously agreed to provide funding for one part-time research associate and one full-time research assistant for the candidate's research project if this application is funded by NIH. Multipurpose Arthritis and Musculoskeletal Disease Center (MAC): The Center consists of a Biomedical Research Component, an Education/Epidemiology/Health Services Research (EEHSR) Component, and an Administration Unit. It is the mission of the Center to pursue major biomedical research interests relevant to the rheumatic diseases. Most recently, the center became the lead institution in a clinical study of doxycycline and its ability to prevent the progression of joint damage caused by OA. The study is funded by an $8.3 million NIH grant. Dr. Kenneth Brandt is principal investigator for the nationwide study and also the principal director of the center. The center supports Dr. Ang through access to secretarial and computer assistance. The candidate's office is adjacent to the Arthritis Center. Regenstrief Institutefor Health Care (RIHC): The RIHC was established in 1969 and is maintained by the philanthropic Regenstrief Foundation. The RIHC houses 18 full-time investigators (including Dr. Kurt Kroenke), and an additional 9 full-time investigators hold affiliated scientist positions. RIHC provides substantial in-kind support for a fellowship program that includes 12 trainees in health services research, medical informatics, and geriatrics. Access to truly rich and supportive research environment is available to the candidate. In fact, Teresa Damush PhD, a social psychologist (with a focus in health psychology) and full-time investigator in RIHC has agreed to serve as a consultant for 43 this project. (See Statement of Support from Dr. Damush). The Regenstrief Institute also houses 8 data managers who are crucial in the candidate's research proposal. RIHC is walking distance (2 minutes) away from Dr. Ang's office. Reqenstrief Medical Record System (RMRS): RMRS is one of the largest general medical data systems in the world. Established in 1974, the RMRS has registered more than 1 million patients, has over 2 million dictated records, and is accessed nearly 5 million times each year. Currently, the RMRS is used at more than 40 inpatient and outpatient facilities in Indianapolis and surrounding counties and is the largest coded, continuously operated medical records system in the United States. It provides innumerable opportunities for database research, computer-based interventions, and training in medical informatics. Dr. Ang can access RMRS from his office computer. General Clinical Research Center (GCRC): The primary purpose of the GCRC is to support patient research funded by the Public Health Service. The GCRC supports a substantial proportion of the faculty holding PHS/NIH funding at IU School of Medicine. The grant support of GCRC users for 1996-1997 was over $45,000,000 (direct) with over $32,000,000 from federal sources, over $9,000,000 from industry and over $1,500,000 from foundations. The Program Director, Munro Peacock, M.D., was appointed in July 1987. The GCRC was