The Stanford Arthritis Center (SAC) conducts research, educational and patient care programs to improve health outcomes of arthritic patients. In particular, SAC designs and implements new educational and community programs and guages their success by outcomes experienced by patients. To do so, SAC draws upon multi-faceted research activities, large numbers of patients and community physicians, cooperating hospitals and health services, a major system for managing data (ARAMIS), and skills of economists, epidemiologists, educators, and health professionals in assessing new programs. Central to SAC activities is development of reliable methods to evaluate health outcomes. SAC has developed instruments measuring functional status, symptoms, adverse effects of drugs and costs of health care for arthritic persons; other instruments, particularly concerning psychological variables and quality of life, are in developmental phases. This work depends upon a Core Unit which assists in experimental design, instrument development, data management and computational issues, biostatistics and data analysis. Seven successful programs will continue concerning: long term outcomes for rheumatoid arthritis, juvenile arthritis and joint replacement; self-management education for paatients; comparison of osteoarthritis outcomes in 3 different health services; comparison of team vs. individual physician care of chronic arthritis of the elderly; treatment of refractory lupus nephritis with total lymphoid irradiation. Six new projects are added, all related to chronic arthritis: identification of influential psychological factors; analysis of incidence by population characteristics; a new method for estimating indirect costs; the impact of exercise on incidence of osteoarthritis; distinction between seronegative and seropositive arthropathies; and search for a pathogenic antigen in cartilage of rheumatoid joints. Improved outcomes for arthritic patients nationally must occur within limits of financial resources. This Center develops and/or evaluates care programs for large groups of arthritic patients with the objective of improving the effectiveness, efficiency and satisfaction achieved by health services.
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