The revised proposal from the UCLA MAMDC builds upon our prior work in the basic science of autoimmunity, and in defining and modifying some factors that impact on outcome in patients with rheumatoid arthritis (RA). Twenty- five investigators are participating directly in the proposed projects and core units; many more as expected to use the core to enrich their scientific endeavors. The proposal offers 4 development and feasibility (D&F) studies, all designed to develop the career of a beginning faculty- level investigator, and a biomedical core unit for peptide synthesis. The D&F studies will explore the role of CD1-restricted T cells in host defense against staphylococci, both in normal people and in patients with septic arthritis; 3) the influence of loading MHC Class I and II molecules with T-cell stimulatory peptides via administration of mini-genes on the T cell functions that influence autoantibody formation in murine lupus, and 4) the importance of a chromosome region near the beta2-glycoprotein I locus on ability to make antibodies to cardiolipin, and the influence of those antibodies on lipoprotein metabolism in autoimmune mice with accelerated coronary artery disease. In the education, epidemiology and health services research (EESHR) portion of the proposal, we aim to establish methods for assessing quality of care in patients with new onset RA, assuming that appropriate interventions in this cohort influence outcomes. A core unit and two projects will focus on developing valid methods to measure care as a function of structure (patient demographics and characteristics of the health unit administering care), process (the interventions that happen to patients such as physician visits), and outcome (physical, socioeconomic, administering care), process (the interventions that happen to patients such as physician units), and outcome (physical, socioeconomic, psychological characteristics of patients from entry to two years later). The core will develop and validate measuring instruments, train data collectors, collect and clean data, and provide advise regarding data analysis. In one project (Claims Data), claims data on 400 patients with new onset RA from a large managed care organization will be analyzed and validity compared to information obtained from chart review and patient self-report. In the second project (Practice Patterns), information will be obtained from chart review and patient self-report from 400 patients with new onset RA receiving care at VA Medical Centers, Kaiser Permanente, and Mullikin MedPartners. The purposes of this HSR component is to establish valid measures of quality of care in RA, based on structure process and outcomes. Each project will identify and enter patients, supervise the scientific aspects of data collection and management, and analyze the data. The MAMDC efforts will be supervised and coordinated by an administrative unit.
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