ROBERT B. BRIGHAM MULTIPURPOSE ARTHRITIS CENTER

这笔赠款用于开发三个特别感兴趣的领域。 第一 是应用研究，我们的目标是：1）制定一个必要的和充分的 合理规划关节炎卫生服务的数据库，以及2） 制定和评估成本效益高的保健服务模式， 关节炎患者 因此，在社区组成部分下，我们建议开发和 批判性地评估：七天的康复工作时间表;模范健康 关节炎残疾护理系统;加强康复服务， 居家病人;风湿病病人的跟踪系统 从三级医疗机构出院;以病人为导向的战略，以改善 临床结果;以及低血糖一级预防的教育策略 在工作场所背部受伤。 作为四大关节置换术之一， 中心在世界上，我们建议评估联合的成本效益 由多维度结果评估取代。 我们试图记录 关节炎的经济负担和目前医疗保健的不足 偿还计划。 我们建议评估干预措施 可以通过比较现有健康状况的相对优点来评估 功能性工具。 第二个优先事项是发展一个核心单位 定量研究方法，临床流行病学和评估 研究工作将与中心的许多活动重叠， 调查员培训和建立调查员。 该股将 支持至少10个项目从特殊疾病的日常管理 旨在改善临床策略的临床研究注册， 流变学的决策和基础研究的应用。 最后， 我们建议在一个被忽视的研究领域进行试点研究， 所有常规治疗失败的严重类风湿关节炎患者： 因此，解决总节点的关键评估的协议 放射治疗和白细胞分离治疗难治性类风湿关节炎。

This grant is requested to develop three areas of special interest. The first is applied research in which we aim to: 1) develop a necessary and sufficient data base for the rational planning of health services to arthritics, and 2) develop and evaluate model components of cost-effective health care delivery for arthritis patients. Thus under Community Component, we propose to develop and critically evaluate: a seven-day rehabilitation work schedule; a model health care system for arthritis disability; stepped-up rehabilitation services to homebound patients; a system of followup of rheumatic disease patients discharged from a tertiary care facility; a patient-oriented strategy to improve clinical outcomes; and an educational strategy for the primary prevention of low back injuries in the work place. As one of the 4 major joint replacement centers in the world, we propose to evaluate the cost-effectiveness of joint replacement by a multi-dimensional outcome assessment. We seek to document the economic burden to arthritics and shortfalls in the present health care reimbursement scheme. We propose to evaluate the means by which interventions can be evaluated by comparing the relative merits of existing health status functional instruments. The second priority is the development of a Core Unit for quantitative research methods, Clinical Epidemiology and Evaluation Research, which would overlap with many activities of the Center and would aid investigators in training and establishing investigators. The Unit would support at least 10 projects from the day-to-day management of special disease registries to clinical studies directed at improving clinical strategies and decision making in rheumatology, and applications of basic research. Finally, we propose pilot studies in a neglected area of research, the management of severe rheumatoid arthritis patients who have failed all conventional therapy: thus, the protocols addressing the critical evaluation of total nodal irradiation therapy and leukapheresis therapy of refectory rheumatoid arthritis.