The National Association of Chronic Disease Directors (NACDD) applied for and received in 2021, Advancing Arthritis Public Health Approaches through National Organizations (CDC DP21-2106), a five-year cooperative agreement from the Centers for Disease Control and Prevention (CDC). NACDD is one of five organizations funded under this agreement which includes two components, and the only organization funded to work in both component 1) to promote public health strategies to help people with arthritis, and 2) to build health care providers’ capacity to promote physical activity to reduce arthritis pain and disability.
Upon receipt of funding in 2021, NACDD began a comprehensive national landscape assessment in partnership with Leavitt Partners to better understand the U.S. healthcare system’s current approach to arthritis care. This assessment included the identification of barriers to conducting function, pain and physical activity screenings; patient counseling on the benefits of physical activity; and referral to AAEBIs.
The landscape assessment was conducted in two parts: 1) an environmental scan of known literature related to arthritis care; and 2) stakeholder interviews and listening sessions with key advocacy organizations, health systems, providers/clinicians, payers and public health experts at State Health Departments to better understand barriers and opportunities.
The environmental scan explored information related to:
- Arthritis clinical care delivery approaches, including innovative approaches to arthritis care
- Availability and types of AAEBIs throughout the U.S.
- Current processes related to pain, function, and physical activity screening; counseling; and referring eligible individuals to AAEBIs
- Incentives related to AAEBIs (e.g., reimbursement, quality measures, etc.)
- Past successes and challenges of increasing provider approaches to conduct function, pain, and physical activity screening; counseling; and referral
- Variables/characteristics that will be important to consider in a pilot site
The interviews and listening sessions explored:
- Current practices related to arthritis management, including screening, counseling, and referrals; healthcare provider awareness of the benefits of appropriate physical activity for individuals with arthritis; promotion of AAEBIs; and incentives to screen, counsel, and refer to AAEBIs
- Pain points related to healthcare providers’ engagement with AAEBIs, including reasons why providers do not screen, counsel, and refer patients to interventions
- Ideas for how to increase healthcare provider engagement with AAEBIs
Key learnings from the landscape assessment were used to support the formation of a panel of experts to guide the development of an arthritis care model.
NACDD, in partnership with Medscape, designed and implemented a Clinical Practice Assessment (CPA) to evaluate knowledge, competence, and attitudes regarding the management of patients with arthritis and provide a baseline snapshot of the identified audiences’ current practices and educational needs.
The CPA was conducted in conjunction with the landscape assessment and results were used to inform the development of an arthritis care model.
The Lifestyle Management Programs for Arthritis: Expand Your knowledge on Evidence-Based Interventions activity is for healthcare providers to assess their learning needs related to non-pharmacological approaches for managing arthritis. The goal is to enhance providers’ understanding of arthritis-appropriate, evidence-based interventions (AAEBIs) and to explore additional physical activity opportunities that can benefit patients with arthritis.
Faculty: Elizabeth A Joy, MD, MPH
0.25 CME/ABIM MOC/CE Credit
- Link to Medscape CPA: https://www.medscape.org/viewarticle/983780
- Link to Medscape Flyers (2)
- Link to Medscape Article (once published)
In November 2022, NACDD, CDC, and key partners convened the Arthritis Expert Panel and Design Team to guide the development of an arthritis care model for healthcare providers. This framework focuses on conducting screenings for function, pain, and physical activity, providing patient counseling on the benefits of physical activity, and making referrals to community-based Arthritis Appropriate, Evidence-Based Interventions (AAEBIs) and other non-pharmacological interventions. The panel members participated in three Human-Centered Design (HCD) and eight additional design sessions, where they shared barriers, discussed solutions, and reached consensus on key considerations for improving arthritis management and promoting well-being
Link to Expert Panel press release: https://chronicdisease.org/wp-content/uploads/2023/12/Arthritis-Expert-Panel-and-Design-Team-Summary.pdf
Framework image with description and/or video (like element currently in LMS)
Link to Harvard Perspectives in Primary Care article (when available)
An Expert Advisory Panel guides the implementation of the Framework, bringing together diverse expertise from across the healthcare and public health spectrum. The panel includes specialists in primary care medicine, rheumatology, physical therapy, health system management, informatics, community-based organization leadership, and state public health. This multidisciplinary approach ensures comprehensive oversight of the Framework's implementation. The panel meets quarterly to provide critical guidance on the pilot project's execution. Their oversight has been instrumental in refining the Framework's approach to integrated care delivery.
Two innovative components that attend panel meetings and operate in parallel are our project’s Learning Advisors and National Partners. CDC-Funded Arthritis recipients from North Carolina serve as a Learning Advisors, positioning themselves to implement the Framework in the future based on insights from the current pilot. National partners, including the Arthritis Foundation, Osteoarthritis Action Alliance, YMCA of the USA, and National Recreation and Park Association, who were integral to the Framework's design, continue their involvement through the panel's work.
Iowa Community HUB and Primary Health Care
- Data evaluation plan; Blog format for updates?
- Link to the webinar that provided an update on Component 2
- Information about LMS courses (possibly linking to TRAIN system or to NACDD system)
The first year of the pilot focused on building a robust and sustainable infrastructure and partnership between Iowa Community HUB and Primary Health Care (PHC) in Des Moines. This foundational work yielded crucial insights about implementing the care models as we look toward the future.
A key learning was the importance of engaging multiple champions with diverse skills and organizational touchpoints. These champions in both organizations proved essential in navigating both clinical and operational changes. The project team discovered that understanding existing clinical workflows and tools was fundamental to successful integration of the Framework.
A site visit to the partners and the Iowa HHS emerged as crucial for building mutual understanding and assessing needs. The team found that while community care hub concepts were initially unfamiliar to clinical staff, direct interaction and multiple training approaches helped bridge this knowledge gap. Technical aspects of referral and communication systems require careful attention.
On the technical side, both organizations undertook substantial infrastructure development, including modifications to PHC's electronic health record system and enhancements to the HUB's bidirectional e-referral capabilities. These changes were guided by careful attention to data availability and communication needs between partners.
Perhaps most significantly, the pilot is reinforcing that this type of change to a complex system requires patience and persistence. Community-clinical connections require time and commitment. The arthritis team is balancing ambitious goals with realistic timelines, recognizing that sustainable change often develops incrementally.
The Framework's expansion strategy builds on NACDD's technical assistance approach with the arthritis funded state programs, leveraging existing partnerships and infrastructure to extend the model's reach. North Carolina is leading the way as an early adopter, having participated as a learning advisor during the Iowa pilot. Their implementation is already underway, informed by direct observations and insights gained from the pilot project.
This peer-to-peer learning model demonstrates the Framework's potential for wider adoption across state public health programs. North Carolina's transition from observer to implementer provides a valuable blueprint for other states in the adoption of the Framework.
The scale and spread strategy will emphasize the importance of context and state-specific adaptations while maintaining fidelity to the Framework's core elements. We will ensure that future framework implementation can be adapted for diverse healthcare settings beyond FQHCs, including private practices, hospital-based clinics, rehabilitation settings, and integrated health systems. The Framework's flexibility allows for engagement of an expanded set of care team members including community health workers, physical therapists, and behavioral health specialists, primary care physicians, rheumatologists, nurse practitioners, and physician assistants. This approach to expansion will allow each state to build on the foundational learnings from Iowa while tailoring local implementation to their unique healthcare landscape, workforce capacity, and community needs.