WASHINGTON—How likely is it that underserved patients lacking health care, who frequently go untreated for chronic diseases, would ever see a rheumatologist? How about seeing one at no charge? Or seeing a clinician being trained at the National Institutes of Health?

For patients coming in to the Upper Cardozo Neighborhood Health Center in Washington, D.C. that is exactly what they can expect.

As part of a health partnership initiative, the National Institute of Arthritis and Musculoskeletal Diseases has run a community health center out of the Cardozo clinic since 2001. The 800 square feet of crammed office space NIAMS occupies at the facility serves as a subclinic specializing in rheumatic diseases. For patients, it provides access to specialty care they would have diffi culty procuring otherwise. For NIAMS, it is a venue for community-based research on the clinical aspects of rheumatic diseases.

Partnering with the Community

Founded through a collaboration between NIAMS, the NIH intramural research program, the NIH office of communications and over 60 partners representing various sectors of the Washington, D.C. community, the center was designed to demonstrate NIAMS’ commitment to serving minority communities as well as to provide patient care and valuable research information on rheumatic disease and health disparities.

Every patient who is referred to the center is entered into a rheumatic disease history research protocol, which lets NIAMS track their RA symptoms, as well as a minority disparities research protocol. They might also be entered into other protocols as their condition warrants. This allows NIAMS to provide patient care—something NIAMS physician-researchers would not be able to do otherwise.

“It’s not the role of NIAMS to deliver patient care except under the auspices of a research protocol,” explained NIAMS director Stephen Katz, M.D., Ph.D., at a meeting of the NIAMS advisory council last month. “Everyone in the clinic is under a research protocol of some sort.”

However, it took some time for the community to accept NIH’s presence at the local clinic. “Everyone was suspicious. What are you trying to do to us, not for us? There were many meetings before this was even established, because trust had to be established,” Dr. Katz said.

Improving Community Care

The center allows NIAMS to pursue several missions, including public health education, patient care, health disparities research, community relations and recruitment to research careers.

“There are several missions that we have. One mission is the education of fellows,” explained Dr. Mark Gourley, a clinical rheumatologist and director of NIAMS’ Rheumatology Fellowship Training Program. “This provides the bread and butter for all our fellows. We have five half-day sessions. Fellows typically see one new patient a day along with three to five follow-up patients. Our services are at no charge. So patients who might not be able to see a rheumatologist now have an opportunity.”

Patients at the clinic are mostly Hispanic and African American, with over 50 percent Spanish speaking. Most are referred to the center by county clinics, Catholic health services and private practices.

“We insist that every patient have a primary care provider,” Dr. Gourley said. “Trenches are built to help provide patient care, and we are finding that providers are hungry for information. And we’ve been going out and giving a rheumatology 101 course for these providers. We saw that, after one year, the quality of our referrals improved dramatically.”

Better referrals has allowed NIAMS fellows to make dramatic changes in the way they practice medicine at the clinic, worrying less about proper diagnosis and going right to thinking about proper treatment.

“It’s such a valuable resource for people to be able to refer a patient for rheumatic care. There are really no ads or anything, but people are drenched by NIAMS arthritis care. They know we’re out there,” Dr. Gourley said. “We ask for primary care providers to refer all [patients] with detailed lab and office notes, we triage upon severity of illness. If someone has a severe illness, we’ll see them that week if we can.”

Patients who need X-rays and other laboratory tests are taken to the NIH Clinical Center in nearby Bethesda, Md.

But the future of the center is in question, not because of any failure on NIAMS part, but because of the changing demographics of Washington, D.C. Located in an area that was once what Dr. Katz referred to as a “wasteland,” the clinic now finds itself in the center of a gentrifying neighborhood.

“Over the last two years, the demographics have changed remarkably. What was once a primarily Hispanic community has become a Congressional Hill young people [community],” Dr. Gourley said.

“I think a challenge for us is that community,” Dr. Katz added. “That community has changed so much since it’s inception, one wonders if the community is going to stay there [and] whether it’s going to be serving that same population, which has really moved away from that area.”