{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T09:10:30Z","timestamp":1790327430616,"version":"4.1.0"},"reference-count":10,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100008648","name":"Pfizer Foundation","doi-asserted-by":"publisher","award":["A142712"],"award-info":[{"award-number":["A142712"]}],"id":[{"id":"10.13039\/100008648","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The Navajo Nation, the largest Native American reservation, faces a high prevalence of rheumatoid arthritis (RA) and a critical shortage of rheumatology providers. To address this gap, we developed an RA training program for primary care providers (PCPs) using the Project Extension for Community Healthcare Outcomes (ECHO) telementorship model. This study evaluates the impact of the RA ECHO curriculum on PCPs\u2019 knowledge, confidence, and self\u2010reported clinical behaviors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We designed a 12\u2010week RA curriculum of weekly 60\u2010minute Zoom sessions with expert\u2010led didactics and case discussions. Content was informed by a needs assessment and input from Navajo cultural interpreters. PCPs completed precourse, postcourse, and one\u2010year follow\u2010up surveys assessing medical knowledge (multiple\u2010choice test) and self\u2010reported confidence (five\u2010point Likert scale) in RA diagnosis and treatment. The one\u2010year follow\u2010up also assessed changes in self\u2010reported clinical behaviors. Paired\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests were used to assess score changes over time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 46 clinicians completed the program across three cohorts. Knowledge scores improved from 46% to 71% postcourse (+25%, 95% confidence interval [CI] 7%\u201343%,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.009) and remained 69% after one year. Confidence scores increased from 2.9 (\u201cneutral\u201d) to 3.9 (\u201csomewhat comfortable\u201d; +1.0, 95% CI 0.23\u20131.74,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.01), sustained at one year. One year later, participants reported favorable changes in clinical behaviors including performing more detailed joint examinations and ordering preimmunosuppression laboratory tests and vaccines.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The RA ECHO curriculum improved PCPs\u2019 knowledge, confidence, and self\u2010reported clinical behaviors in RA care in the Navajo Nation. This culturally grounded, disease\u2010focused model demonstrates feasibility, acceptability, and scalability as a workforce expansion strategy in settings with limited rheumatology access.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr.80044","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T12:16:12Z","timestamp":1774268172000},"page":"1380-1386","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Rheumatoid Arthritis Training Program for Primary Care Providers on the Navajo Nation"],"prefix":"10.1002","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9415-4812","authenticated-orcid":false,"given":"Jennifer","family":"Mandal","sequence":"first","affiliation":[{"name":"University of California  San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tabitha","family":"Carroway","sequence":"additional","affiliation":[{"name":"University of California  San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwendolyn","family":"Grant","sequence":"additional","affiliation":[{"name":"CommonSpirit Rheumatology  Durango Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2268-539X","authenticated-orcid":false,"given":"Mary","family":"Margaretten","sequence":"additional","affiliation":[{"name":"University of California  San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Starla H.","family":"Blanks","sequence":"additional","affiliation":[{"name":"Collaborative Initiatives Division, American College of Rheumatology  Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nataya","family":"Cabrera","sequence":"additional","affiliation":[{"name":"Collaborative Initiatives Division, American College of Rheumatology  Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannie","family":"Hong","sequence":"additional","affiliation":[{"name":"Phoenix Area Indian Health Service  Phoenix Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1867-0905","authenticated-orcid":false,"given":"Zara","family":"Izadi","sequence":"additional","affiliation":[{"name":"University of California  San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marita","family":"Jones","sequence":"additional","affiliation":[{"name":"Healthy Native Communities Partnership  Shiprock New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Tso","sequence":"additional","affiliation":[{"name":"Healthy Native Communities Partnership  Shiprock New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3508-4094","authenticated-orcid":false,"given":"Jinoos","family":"Yazdany","sequence":"additional","affiliation":[{"name":"University of California  San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Navajo Nation Population Profile: U.S. Census 2020","author":"Navajo Epidemiology Center","year":"2024"},{"issue":"9","key":"e_1_2_7_3_1","article-title":"Perceived barriers and opportunities to accessing rheumatoid arthritis care on Navajo Nation: the primary care providers\u2019 perspectives [abstract]","volume":"74","author":"Mandal J","year":"2022","journal-title":"Arthritis Rheumatol"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2004.08.003"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.091452"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar3517"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23518"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.38167"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000051"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000001328"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23889"}],"container-title":["Arthritis Care &amp; 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