QUESTIONS FOR DR. WILSON Dr. Wilson, can you tell us about your own involvement with Regional Medical Programs (RMPs)? What can you tell us about the intellectual and political origins of the RMP program? How and why did the program as it emerged differ from the recommendations in the DeBakey report? What do you think were the major accomplishments of RMPs? What specific aspect were you personally most pleased with? Why was the RMP program moved in 1968 from NIH to HSMHA, an agency that you headed from 1970 to 1973? What can you tell us about why and how RMPs were terminated? How did RMPs relate to other programs designed to integrate health care activities, such as Comprehensive Health Planning? What can we learn from the RMP experience? Is there any other point that you would like to make concerning RMPs? GENERAL STATEMENT TO OPEN WILSON INTERVIEW This is Dr. Donald Lindberg, Director of the National Library of Medicine in Bethesda, Maryland. The interview that I am about to conduct is one of a series of interviews designed to record and document the history of Regional Medical Programs. With me in the NLM studio today, July 24, 1991, is Dr. Vernon E. Wilson. Background for Wilson Interview Dr. Wilson was Administrator of the Health Services and Mental Health Administration (HSMHA) in HEW, 1970-73. He also served as the first Program Coordinator of the Missouri Regional Medical Program (established in 1966). He served under two Secretaries of HEW: June, 1970 - October, 1972 Elliot Richardson From November, 1972 Caspar Weinberger House RMP Oversight Hearings held May 8, 1973 Attachments: american Men and Women of Science biographical sketch of Wilson Copy of his presentation on "Program Evaluation" at the 1967 Conference on RMPs r Exp Sta, Auburn Univ, 75-80; vpres agr, home econ & vet med, bU-; CHEM GENETICS, NAT HEART, LUNG & BLOOD INST, STS HEALTH, BETHESDA, MD. Mem: AAAS; Genetics Soc Am; sei Asn; Am Soc Animal Sci; Am Genetic Asn. Res: Selection studies nium, mice, poultry and swine; effects of mating systems on selection tic parameters. Mailing Add: Nat Heart Lung & Blood Inst NIH Bldg Rockville Pike Bethesda MD 20205 STEPHEN ROSS, b Oklahoma City, Okla, Mar 13, 46; m 67; ¢ 2. ETIC ORGANIC CHEMISTRY. Educ: Rice Univ, BA, 69, MA, 72, chem), 72. Prof Exp: NIH fel org chem, Calif Inst Technol, 72-74; org chem, Ind Univ, Bloomington, 74-78, assoc prof, 78-80; ASSOC 1RG CHEM, NY UNIV, 80- Concurrent Pos: Sigma Xi res award, v, 72, Mem: Royal Soc Chem; Am Chem Soc. Res: Development of roaches to the synthesis of naturally occurring compounds of | significance, and the structure elucidation and total synthesis of stances. Mailing Add: Dept Chem NY Univ Washington Square New 7 10003 STEPHEN W,b Hackensack, NJ, Feb 6, 52; m 73; c 1. OMY OF PLANTHOPPERS. Educ: Rutgers Univ, BS, 73; st Mo State Univ, MA, 75; Southern Ill Univ, PhD(zool), 80. Prof t prof biol, Calif State Univ, Chico, 80-82; asst prof, 82-85, ASSOC 1OL, CENT MO STATE UNIV, WARRENSBURG, 85- Mem: oc Am. Res: Systematics and ecology of planthoppers (Homoptera: dea) with emphasis on Delphacidae. Mailing Add: Dept Biol Cent > Univ Warrensburg MO 64093-5053 STEVEN PAUL, b New Castle, Pa, Oct 12, 50; m 72; ¢ 1. CHEMISTRY. Educ: Univ Pittsburgh, BS, 72; Duke Univ, shem), 76. Prof Exp: Guest worker, Nat Heart, Lung & Blood Inst, .78, staff fel, 78-79; vis scientist, Dept Med Biochem, Wellcome Res rroughs Wellcome Co, Research Triangle Park, NC, 79-81; ASST 3S PROF, DEPT PHARM, DUKE UNIV MED CTR, DURHAM, Concurrent Pos: Fel neurol, Sch Med & Dent, George Washington 6-78. Mem: Soc Neurosci. Res: Biochemical aspects of asmitter secretion and synapse formation; regulation of -mine and opioid peptide biosynthesis, neurobiology of adrenal in cells. Mailing Add: Dept Pharmacol Box 3813 Duke Univ Med am NC 27710 , THEODORE A(LEXANDER),b Elgin, Ill, June 20, 35. AUTICAL ENGINEERING, BIOMECHANICS. Educ: Cornell ingPhysics, 58, PhD(aeronaut eng), 62. Prof Exp: Res scientist, erett Res Lab, 62-63 & Jet Propulsion Lab, 63-64; from asst prof to of aeronaut & eng mech, 64-72, PROF AEROSPACE ENG & UNIV MINN, MINNEAPOLIS, 72- Mem: Am Physiol Soc. Res: wry mechanics; acoustics; fluid mechanics. Mailing Add: Dept of -e Eng & Mech Univ of Minn Minneapolis MN 55455 THOMAS EDWARD, b Chicago, Ill, Feb 20, 42; m 66; c 2. INMENTAL & CHEMICAL ENGINEERING. = Educ: stern Univ, BS, 64, MS, 67; I Inst Technol, PhD(environ eng), 69. >: Asst prof environ eng, Rutgers Univ, New Brunswick, 67-70; _T POLLUTION CONTROL & WATER TREATMENT, SY & HANSEN, 70- Mem: Am Inst Chem Engrs; Int Asn Water Res; Water Pollution Control Fedn; Am Soc Civil Engrs; Am Water sn; Sigma Xi. Res: Pollution control; advanced waste treatment; chemical treatment processes; solids and sludge disposal; industrial atment; treatment plant operations. Mailing Add: 1527 E Fleming ngton Heights IL 60004 THOMAS G(EORGE), b Annapolis, Md, Jan 19, 26; m 49; c 3. ICAL ENGINEERING. Educ: Harvard Univ, AB, 47, SM, 49, eng), 53. Prof Exp: Physicist, US Naval Ord Lab, 48, elec engr, US s Lab, 49-53; mgr res & develop, Magnetics, Inc, 53-59; assoc prof, mn dept, 64-70, PROF ELEC ENG, DUKE UNIV, 63- Mem: Inst lectronics Engrs; Sigma Xi. Res: Magnetic devices, materials and 3; nonlinear electromagnetics; energy conversion. Mailing Add: 2lec Eng Duke Univ Durham NC 27706 THOMAS HASTINGS, b Philadelphia, Pa, Jan 31, 25; m 52; c 2. LOGY. Educ: Univ Pa, MD, 48; Sheffield Univ, 51-53, hem), 53. Prof Exp: Instr physiol, Univ Pa, 49-50; instr biochem, iv, 56-57; assoc physiol, 57-59, from asst prof to assoc prof, 59-68, TYSIOL, HARVARD MED SCH, 68- Mem: Am Soc Biol Chem; iol Soc; Brit Biochem Soc. Res: Active transport of materials across sranes. Mailing Add: Dept of Physiol Harvard Med Sch Boston MA decomposition; rubber and inorganic chemistry. Mailing Add: 7 Rockbrook Dr Camden ME 04843 WILSON, THOMAS PUTNAM, b New York, NY, Sept 4, 18; m 44, 80; 1. HETEROGENOUS CATALYSIS. Educ: Amherst Col, BA, 39; Harvard Univ, PhD(chem physics), 43. Prof Exp: Res chemist, Manhattan Proj, M W Kellogg Co, NJ, 43-44; res chemist, Kellex Corp, 44-45; res chemist, Manhattan Proj & S A M Labs, Chems & Plastics Div, 45-46 & 46-62, asst dir res, 62-72, res assoc, 72-73, CORP RES FEL, RES & DEVELOP DEPT, ETHYLENE OXIDE/GLYCOL DIV, UNION CARBIDE CORP, 73- Mem: Am Chem Soc; Catalysis Soc. Res: Kinetics and catalysis; catalytic reaction mechanisms; ethylene polymerization; catalyst development and characterization. Mailing Add: 701 Myrtle Rd South Charleston WV 25314 WILSON, THORNTON ARNOLD, b Sikeston, Mo, Feb 8, 21; m 44; ¢ 3. AERONAUTICS. Educ: Iowa State Col, BS, 43; Calif Inst Technol, MS, 48. Prof Exp: Mem staff, 43-57, asst chief tech staff & proj eng mgr, 57-58, vpres & mgr Minuteman br, Aerospace Div, 62-64, vpres opers & planning, 64-66, exec vpres & dir, 66-68, pres, 68-72, CHIEF EXEC OFFICER & CHMN BD, BOEING CO, 72- Concurrent Pos: Sloan fel, Mass Inst Technol, 52-53; mem bd gov, Iowa State Univ Found. Mem: Nat Acad Eng; fel Am Inst Aeronaut & Astronaut. Mailing Add: Boeing Co PO Box 3707 Seattle WA 98124 WILSON, TIMOTHY M, b Columbus, Ohio, Aug 3, 38; ¢ 2. SOLID STATE PHYSICS. Educ: Univ Fla, BS, 61, PhD(chem physics), 66. Prof Exp: Fel solid state physics, Univ Fla, 66-68, asst prof chem, 68-69; from asst prof to assoc prof physics, 69-78, asst dir exten, Col Arts & Sci, 77-79, assoc dir - exten, 79-82, PROF PHYSICS, OKLA STATE UNIV, 78- Concurrent Pos: Res staff mem, Solid State Div, Oak Ridge Nat Lab, 74-75. Mem: Am Phys Soc; Sigma Xi; Am Asn Physics Teachers. Res: Theoretical studies of the optical and magnetic properties of impurities and defects in crystalline solids. Mailing Add: Dept Physics Okla State Univ Stillwater OK 74078 ‘WILSON, VERNON EARL, b Plymouth Co, Iowa, Feb 16, 15; m 47; ¢ 2. MEDICAL ADMINISTRATION, FAMILY MEDICINE. Edue: Univ Ill, BS, 50, MS & MD, 52. Prof Exp: Asst pharmacol, Univ Ill, 50-52; intern, Univ Hosp, Chicago, 52-53; asst prof, Sch Med, Univ Kans, 53-59, asst dean sch med, 57-59, actg dean sch med & actg dir med ctr, 59; prof pharmacol, Univ Mo-Columbia, 59-70, dean sch med & dir med ctr, 59-67, exec dir health affairs, 67-68, vpres acad affairs, 68-70; adminr, Health Serv & Ment Health Admin, Dept Health Educ & Welfare, Md, 70-73; prof community health, Univ Mo-Columbia, 73-74; vchancellor med affairs, Vanderbilt Univ, 74-81; RETIRED. Concurrent Pos: Exec officer, Mo State Crippled Children's Serv, 60-68; mem exec coun, Am Asn Med Cols, 61-67; mem, Am Bd Family Pract, 62-74; consult, USPHS, 65-69; coun mem med educ, AMA, 67-75; coordr, Mo Regional Med Prog, 66-68; mem coun fed relationship, Am Asn Univ, 68-70; ed, Continuing Educ for Family Physician, 73-75; mem liaison comt, Grad Med Educ, 73-75. Mem: AMA; hon mem Acad Anesthesiol. Res: Renal pharmacology; medical education; public health administration. Mailing Add: Box 196 Rte No 1 Ashland MD 65010 WILSON, VERNON ELDRIDGE, genetics, phytopathology, see previous edition WILSON, VICTOR JOSEPH, b Berlin, Ger, Dec 24, 28; m 53; ¢ 2. NEUROPHYSIOLOGY. Educ: Tufts Col, BS, 48; Univ Ill, PhD(physiol), 53. Prof Exp: Res assoc, 56-58, from asst prof to prof neurophysiol, 58-69, PROF NEUROPHYSIOL, ROCKEFELLER UNIV, 69- Mem: Am Physiol Soc; Soc Neurosci; Int Brain Res Org. Res: Organization and synaptic transmission in the central nervous system, particularly the spinal cord and brain stem; vestibular system. Mailing Add: Rockefeller Univ 1230 York Ave New York NY 10021-6399 WILSON, VINCENT L, CHEMICAL CARCINOGENESIS, GENE REGULATION. Educ: Ore State Univ, PhD(pharmacol & toxicol), 80. Prof Exp: SR STAFF FEL, NAT CANCER INST, NIH, 83- Mailing Add: Nat Cancer Inst NIH Bldg 37 Rm 2C09 Bethesda MD 20892 WILSON, WALTER DAVIS, b Merced, Calif, Oct 20, 35, m 59; ¢ 3. ATOMIC PHYSICS. Educ: Univ Calif, Berkeley, BS, 57, PhD(nuclear eng), 66. Prof Exp: Chem engr, Aerojet Gen Nucleonics, Calif, 58-59; mem tech staff high-altitude nuclear effects, Aerospace Corp, 65-69; PROF PHYSICS, CALIF POLYTECH STATE UNIV, SAN LUIS OBISPO, 69- Concurrent Pos: Tech consult, Sci Applns, Inc, Calif, 71-75. Mem: Am Inst Physics. Res: High altitude physics, particularly electromagnetic field propagation, chemistry and trapped radiation; plasma physics; nuclear reactor theory. Mailing Add: Dept of Physics Calif Polytech Univ San Luis Obispo CA 93407 WILSON, WALTER ERVIN, b Salem, Ore, Apr 1, 34. RADIOLOGICAL PHYSICS. Educ: Willamette Univ, BA, 56; Univ Wis, MS, 58, PhD(physics). 61. Prof Exp: RADIATION PHYSICIST, PAC NORTHWEST LABS. See et te 0a A Nas. Dal DacalTiniu 41-42? & Univ Proceedings: a a Mile SF Conference on Regional Medical Programs January 15-17, 1967 Washington, D.C. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service National Institutes of Health Division of Regional Medical Programs For Sale by the Superintendent of Documents, U. S. Government Printing Office, Washington, D.C. 20402 Price 75 cents (paper covers) Vernon E. Wilson, M.D. Dean, School of Medicine, University of Missouri Program Coordinator, Missouri Regional Medical Program ed baal = — —_—— _ pa eer ae Seat a ae FR etre oe cps ai ec ee et er a ‘The dilemma of a dean from the day H of his appointment is to know when to speak out and when to remain silent. Speaking requires at least an acknowl- edged topic and at best a brief, flavor- ful and meaty content, In pursuing the somewhat evanescent title assigned “for this topic——which evolved from “Program,"' to ‘Program and Evalua- tlon,” to “Program Evaluation,” | must confess that the merit of silence loomed ever more attractive. evaluation procedures would not be appropriate under our limits of time, let us compromise and discuss some well known principles of program and, for the health field, some relatively unused principles of evaluation. We will examine both in the light of bppor- tunities presented by the Regional Medical Programs. The challenge to Regionat Medica! Pro- grams, as | see it, is to demonstrate that this new endeavor, established primarily in behalf of heart, stroke, cancer, and related diseases, is more than a static assemblage of existing resources, This in itself is a basis for very careful thought. Most of the prin- ciples and programs which can be con- sidered in the field of health and health care have been studied by one ‘or another of the existing Govern- mental, academic, professional or vol- untary groups. Thus, at the outset it seems apparent that the aim of the Regional Medical Programs must be one of synthesis, an effort to combine these various factors into a whole which will be greater than the sum of the parts. Since detailed discussion of technical ery ee wee eee i Se ise, We have already heard that the ap- pearance of the Regional Medical Pro- grams through Federal legislation was a direct result of growing public and professional unrest centered around the slow rate at which new knowledge was being put to use. This concern is not unique to the heaith field but it is new aS a major emphasis among the concerns of the health care profes- sions. The agricultural and engineering experiment stations, long an_ integral part of the land-grant colleges, repre- sent one attempt to deal with this problem, The Engineers already have a térm for it. They label this activity the “transfer of technology.” . . It would appear then that the special mission of Regional Medical Programs is primarily one of. research in the “distribution of health care” with the focus placed firmly upon the patient's needs, rather than upon those of the institution or the health professions. Until the early part of this century the healing arts possessed a dismally small amount of scientific information; consequently, the need was primarily for basic medicat knowledge. With the momentum now established in basic research we can give increased empha: sis to Indirect factors, such as popula- tion size, number of related organiza: tlons and groups, increased capabilities in communication facilities, -and an ever accelerating rate of obsolescence of knowledge. The magnitude of recent Congressional appropriations Indicates the need for immediate actlon. Addi- tional and similar legislation is under serious consideration. The comprehen: 21 sive health planning act provides a logical outlet for knowledge developed under Regional Medical Programs. Thus, research being done in the more limited field of Regional Medical Pro- grams can be of value throughout the total health care field. Because of the large amount of time and money to be expended, realistic evaluation of the results is mandatory. Unfortunately, we are hampered by a lack of effective measurement tools. We must start by using available and simple techniques, while admitting their inadequacies. It is essential that collaborative research in system de- sign for the distribution of health care be initiated in concert with those aca- demic disciplines which have a long tradition in simulation, systems re- search, and communications research, thus providing a base for continuing analysis and measurement. Existing resources for use in the design of such systems are impres- sive indeed. If one looks at the great array of governmental health agencies, academic institutions, voluntary and professional groups, as well as sup- portive organizations like welfare agen- cies, community action groups and others, it readily becomes apparent that the major problem is not that of creating resources which could appro- priately handle the problem but rather a coordination of those resources into an effective unit. Although to some the comparison may be a bit unpalatable, | submit that this is a market and dis- tribution process and should be han- dled as such. An approach of this kind does not deny the essential nature of professional and academic con- tributions; it will require a forma! and scientific search for an appropriate re- lationship between all academicians and professionals whose skills can be helpful. Concurrently, the integrity of the academic and research communi- ty must be preserved, both as an in- ternal system and as a part of society at large. Thus, the analogy of market- ing is in all probability much more than an analogy. It may prove to be an actual pattern which will provide us with illustrations and some basic prin- ciples for fruitful pursuit of the tasks ahead. The Distribution Process. As a layman in this special field, may | offer the oversimplified explanation that the production and distribution process amounts to a coordination of many disciplines, assembled for the con- tribution which each can make to a single goal. While such grouping of re- sources, particularly in the research process, suggests the antithesis of the traditional academic departmental or- ganization, the concept is not unfamil- iar to academic institutions. It is exemplified frequently in institutes on university campuses, in land-grant ex- periment stations, and . research centers. These patterns allow many disciplines to proceed in a systematic fashion in searching for new informa- tion and combining that information into an orderly whole. Taking the marketing analogy one step further, the rational distribution proc- ess would be simulated and developed as follows: The first step is the establishment of need, either recognized or unrecog: nized. The next step, after the need is determined, is to define it and to create recognition of that specific need in both the consumer and producer. Here we have a direct parallel with the opportunities open to Regional Medical Programs. Having identified a specific need or needs, it is necessary to undertake basic and applied research in materi- als, resources and their synthesis. The medical profession has expended pro- portionately small amounts of its own energies in the endeavor of synthesis and at the same time has frequently poorly utilized the contributions which could be made by other disciplines. Having completed the “basic” research and formulated working models, the next step is the production and de- livery of materials and services which may come from a variety of places. In the analogy the patient may move to the resources, or the resources may be brought to the patient, but finally the delivery process requires that the end product of health care be synthe- sized in a coordinated and personalized manner for the benefit of the consumer. Market identification. If we consider health care in the light of the patient’s need, recognized or unrecognized, the first painful but necessary step will be a shift in emphasis. Much basic re- search has been sponsored upon the assumption that improvement of the professions and institutions will auto- matically benefit patients. However, it may be that the goals of the patient and those of the profession are not always the same. To accomplish our task we must now direct extensive study toward the patient and his needs within the context of his normal pat: tern of fiving. Professional action has classically been one of response, after the patient requests and is given access to the formal health care system. We must now accept responsibility for health care of the public as a dynamic, inti- mate part of daily performance. Identification of needs for concentrat- ed research endeavors will require the development of end points or goals against which the effect of change In qualitative performance can be meas- ured. Unfortunately, at present, such end points are few and largely unpro- ven. Most of the measurement systems cur rently used in the health professions are quantitative rather than qualitative in nature. We can measure quite ade: quately deaths, morbidity, numbers of personnel, and similar items, but we have few means by which we can tes! the impact of health care upon the daily performance of a given individual. Thus, our first requirement is for < measurement system which can asses: the ability of the individual to perforn as a useful member of society and hi: own attitude toward that performance Also required will be a measurement o the social or peer group’s estimate a the value of the individual's contribu tion to the group and their attitud: toward that contribution. No single on: of these factors can be used as th sole parameter, put when assembled as a pattern they should provide at least the first steps in a qualitative measurement of health care. Since diagnosis is also a part of mar- ket definition and since diagnosis of- ten opens communications between professional individuals, early detec- tion of disease would appear to be a logical first research effort for improve- ment in the distribution of health care. Such research avoids «he necessity of premature decisions having to do with delivery of health care and would allow a “tooling up” of the communications system under reduced emotional ten- sion, Much diagnostic support can be provided to individual practitioners with a minimal change in their present practice patterns. Status of the patient needs study. In- teraction between individuals is heavily influenced by the status, stated and felt, of each person. We are proposing major changes in the status of the pa- tient in the health care system. This calls for “shorthand” method inter- woven into the system itself to assess status, and change in status, particu: larly of the patient. An. interesting correlation exists be- tween the way we use the time of others and our estimate of their im- portance. Consequently, accurate de- termination of our expenditure of the patient's time through the design of health services is accessible, measur eable, and potentially valuable. Another little used field of knowledge . tenad in advertising re rty in the in- assigned him alc. Patients, { sub- helpless as some d seem to imply. logy should b motivated pa terchanue, yet we the most passive ¢ mit, may not be § of our practices wo Our friends in socio to help us here. in the fourth a analogy, we W lems in the health is not est acquainted wledge about utilized even by witty it. Advertisin f basic knowledge ith facilitators, ne service or other. These tools d so successfully in miques dealing W people choose 0 as opposed to an phase of our face a variety of pr delivery of h plementation of development { s should have ac- advertising cou should be usef education and per in health care. broadening pu tribution. All patient to the best regardless of ge sources, OF speci professional group are required. d item in our analo- h in materials and omment first on s a long uni- he foundation Turning to the thir phy. financial re- al interests © 5s. New patterns basic researc versity tradition upon which ap ted. Basic research academic discip tant contributions on the list shoul sis of systems, In our past, s had little sy$ comprehensive n almost all I} make impor: h care. High d be research in including model testing through hip between ellence and the popu they would se defined. Most orca port health car d boundaries, county, of State. gaining coordinat interested organizatio ance of a single and be enhanced by a lap in geograp responsibility. lation which ons which sup- olitically deter- The probability of ed support fro ns for the assist- specific individual maximum over: s of designed This is particularly i savings in time, put will require t sting discipline ple, who until re- lly invited into h conversation. a variety of exi s, for exam cently were Se the health researc nd upon many group their information. An interesting lated to manpow that although we mendous shortage o and a low level of n s a health c largely ignored one tentiais—the to be considered Should such dis- ally under the Ith professions? are faced with a tre A second problem f health personnel ationa! unemploy- are group have ur greatest po- tribution systems control of the not, how much o be conducted in c interested groups trol be turned ta them? cooperation with other most involved, often the 2? Wheo should con: and certainly the A third problem concerns the obsoles- cent mind, both as it relates to the medical profession itself. and to the public at large. It is clear that planned, continuing education for the profession and the public is necessary: A searching look at potential integra: tion of such education with the care process seems called for. Feedback mechanisms must be established for a progressive analysis of cause and eftect, or, at feast, correlation between continuing education and change. A successful distribution system will It self require an integrated information service. Information should be derived from the home, from the avenue of access to the health care system, the local hospital, and the large medical center. It will require the development of common identification systems and vocabularies. Many of us hope that in the very near future the social security number will be issued at the time of birth, or entry into the country, and will provide such identification. The proposed information system should be designed to utilize, assist and refine present systems, not compete. with them. - The decision for diagnosis and treat ment of the patient will take into ac- count his desires which, among other things. relate to the distance from health care and the patient's knowl- edge of and confidence in the recom: mended resource. Other considerations are the adequacy of the health care resources, the cost to the patient and the involved apencies, and the maxi- mum benefit from the care process 23 which includes such by-products as education, research, and economic im- pact upon the community at large. Finally, as we have already heard, no matter how one may describe a Medi- ca! Region, it must interact with other regions. Mechanisms must be devel- oped which will minimize the mechani- cal problems of interregional relation- ships and permit us to focus upon the patient. The Example. With no claims to as- sured success, the Missouri Regional Program has attempted to face these challenges in the planning process. Projects will arise from community .groups and be funneled through a refinement process. This should en- courage maximum motivation and par- ticipation at the grassroots level, A general objective of the program is the development of models of early detection integrated with continuing education. Primary emphasis will be placed on those endeavors which can be quanti- tatively evaluated, and the initial as- sumption is made that adequate infor- mation and communication will provide qualitative improvement. The jong range plan provides for qualita- tive measurement of delivered health care. Only a few projects are proposed for studies of delivery of care. It is our intent simply to be supportive to exist- ing care patterns while setting up the necessary information-gathering mech- anisms. Under this plan, a request for information by the physician will be met by a specific answer to the ques- tion, along with additional synoptic background information or bibliogra- phies which should be helpful in his continuing education. Such inquiries will also serve as a guide to the physi- cian’s needs. In this manner diagnos- tic and delivery patterns of health care can quickly be modified in detail when research indicates the desirability of doing so. The data handling facility developed at the University of Missouri for the pur- pose of extending the competency of the physician will be integrated with cooperative data handling programs established by hospitals, physician's offices, and state agencies. This inte- grated system is expected to furnish feedback and monitoring which will make it possible to provide the desired information while studying and coordi- nating the total process in an objective and efficient manner. A University multidiscipline research unit is developing new tools with which to measure achievement. Its staff members have joint appointments with other schools on campus, includ- ing Nursing, Education, Engineering, Journalism, Business and Public Ad- ministration, Liberal Arts, and Veteri- nary Medicine. Presently members of this unit are studying two different communities in which they will meas- ure efforts toward community health goals, such as rehabilitation of the pa- tient, family reactions and the like. In conclusion, let us review, quite briefly, some goals worthy of consider- ation. These goals were picked be- cause progress toward them can be measured. Their evaluation should give — us some insight into whether or not we are moving in the direction that may be most effective in meeting the actual needs of patients. © The primary goal is to deliver the highest percentage of quality patient care as close to the patient’s home as possible. This is not only economical in the total picture but in keeping with the desires of most patients. Certainly the latter assumption merits study. © Every patient should have equal ac- cess to any needed national resource. For very special services which are not available in the area, patients can be sent to centers of excellence else- where, thus eliminating the necessity for neediess duplication of expensive equipment, staff and facilities. © Maximum coordination — will be sought between the inputs of those who provide health care directly, as well as those involved in supporting that care, such as welfare, community resources, environmental control groups, and others. © The development of programs to assist in early and effective detection of disease will be an important goal. The information gained can be used to effect changes in delivery of health care, both through personne! and systems. Early detection is perhaps least threatening to the present health care professions and is among the easiest procedures to measure quanti- tatively. It also possesses ‘the highest potential for successful qualitative measurements of health care. © Postgraduate education should be integrated with detection and health care systems. © Lay health education will be a vital part of the regional program. Existing adult education and extension pro- grams and activities of voluntary or- ganizations will be utilized so that the potential recipient of care may be in- formed as to the role which his physi- cian, the hospital, and the various SUp- porting agencies will play and to the things which he, the patient, can ex- pect. We need more scientifically de- signed studies of public attitudes to- ward health care. © Finally, in my view, a crucial goal will be for each of the several regions to take a unique approach to the spe- cial needs for their particular areas. Through meetings such as this one, we can share ideas so that a minimum of waste will ensue as we seek to meet our respective responsibilities. New paths are seldom explored by faint hearts. We need to be mindful in the development of new systems thai one may at times work with less than perfect parts in order to set the sys: tem itself in operation. It is possible even desirable, to have “proof runs” a practice long utilized by the printing industry. From less than perfect initia operations, changes and correction can be made to improve the fing product. As participants in this national pre gram, | believe we dare not do les than marshal the best available ta ents, from whatever quarters, to joi in this quest for improved health car: The opportunities are attractive arn challenging, to say the least.