A DEPARTMENT OF HEALTH, EDUCATION AND WELFARE Health Services and Mental Health Administration Division of Regional Medical Programs National Advisory. Council on Regional Medical Programs Minutes ‘of Meeting .December 16-17, 1969 National Institutes of Health Conference Room 4 Building 31 . +) DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE National Advisory Council on Regional Medical Programs Minutes of the Eignteenth Meeting 1/ 2/ December 16-17, 1969 The National Advisory Council on Regional Medical Programs . convened for its eighteenth meeting at 8:30 a.m., Tuesday, December 16, 1959, in Conference Room 4, Building 31, National Institutes of Health, Bucsda, Maryland. Dr. Stanley W. Olson, Director, Regional Medical Programs Service presided for the Administrator, Health Services and Mental Health Administration, who was unable to attend the meeting. : _ The Council members present were: Dr. Michael J. Brennan Dr. Clark H. Millikan Dr. Bland W. Cannon ' Dr. Edmund D. Pellegrino Dr. Edwin L. Crosby (12/15 only) Dr. Alfred M. Popma Dr. Michael E. DeBakey - Dr. Russell B. Roth Dr. Bruce W. Everist - Dr. Mack I. Shanholtz Dr. John R. Hogness (32,16 only) Mrs. Florence R. Wyckoff A listing of RMP staff members, and others attending is appended. — CALL TO ORDER AND OPENING REMARKS Doctor Olson called the meeting to order at 8:30 a.m. ANNOUNCEMENTS Tt was noted that Doctor Hogness was meeting with the Council for the last time prior to his resignation to accept an appointment to a rom reee advisory. *.0 the Director of the National Institutes of Health. 7 | Proceedings of meetings are restricted unless cleared by the Office ~ of the Administrator, HSMHA. The restriction relates to all material submitted for discussion at the meetings, the supplemental material, — and all other official documents, including the agenda. . For the record, it is noted that members absent themselves from the - meeting when the Council is discussing applications: (a) from their. . respective institutions, or (b) in which a conflict of interest might Phe tex ae 4 dss ore Moat peri sponge bee ¢ wr RRA sate Das fla. oe, 7 foe TLE 7 . . wesas CONE . Se TED ODO ED Ar ie On io wire individual discussiorn,: Til. Page 2 CONSIDERATION OF FUTURE MEETING DATES The dates of March 31-April 1, 1970 and December 8-9, 1970 were confirmed. The July 14-15 date was changed to July 28-29, 1970. CONSIDERATION OF MINUTES OF THE AUGUST 1969 MEETING The Council unanimously recommended approval of the August 26-27 , 1969, meeting as written. EXTENSION OF LEGISLATION -- Proposed and In Planning Doctor Chadwick called the attention of the Council to the two legislative proposals for extension of Regional Medical Programs that have been introduced into the House of Representatives. These are House Bill 14284 introduced by Congressman Harley O. Staggers (D. West Virginia) and House Bill 14486 introduced by Congressman Paul G. Rogers (D. Florida). He reviewed briefly the contents of each, particularly as they modify the current legislation. He also reported his understanding that Senator Ralph Yarborough (D. Texas) is preparing still another proposal to be introduced into the Senate sometime later in the session. Council was reminded of the formal recommendation, which it made at the time of the August meeting, that the scope of the authority of Title IX be expanded to include Kidney Disease explicitly and that the expanded authority be administered under the Regional Medical Programs Service. Doctor Chadwick reported that this recommendation was forwarded promptly for consideration by the Administration in its own plans for development of legislative proposals. He said that he "had had several indications that such a plan was included in the legislative proposal being prepared by Senator Yarborough. REGIONAL MEDICAL. PROGRAMS IN FY 1970 AND BEYOND -- SOME FUNDAMENTAL ASSUMPTIONS ; . A. Projections of Available Resources -- 1970 and 1971 Doctor Olson reviewed for the Council the current status of the. . Appropriation legislation for FY 1970.. The proposal currently under consideration in the Senate had been forwarded by the House of ~~ Representatives with a substantial cut having been applied to the Administration's original budget proposal. ‘The net effect of the legislative process to date would allow $73.5 million for Regional Medical Program grants. oe co Sate Page 3 Doctor Olson explained that against this figure it is necessary to project a $59.1 million requirement for continuation of on- going activities in the 55 Regions, leaving a balarce of slightly over 54 million to be used to fund operational programs in the Regions which still have only planning grants. The Division estimates that a tctal of approximately $6.5 million will be approved by the National Advisory Council during FY 1970 for the initiation of operational grants in ten of the remaining eleven Regions. This allows no margin for inflation of costs or for new funding of any supplemental activities in operational Regions. The Council reconfirmed its previously stated position by voting unanimously in support of Doctor Olson's stated intention to adopt, as first priority for FY 1970 and 1971.the funding of operational grants to all 55 Regions as they are approved for such ‘funding by the National Advisory Council. There was considerable discussion of a variety of proposals for reallocation of grant dollars in order to make this funding possible. There was essential agreement that reallocation could have a favorable effect only if priorities can be agreed upon for administration of the program. Doctor Pellegrino suggested the following five steps toward accomplishing these ends: (1) Each new initial request should be examined carefully to determine whether or not it will improve cooperative arrangements ‘in the Region. (2) Careful attention should be given to the progress of Regional Medical Programs and their component projects when they. are reviewed for renewal. (3) Requests for purchase of major hardware should be closely examined, eliminating all but those which are absolutely essential and for which no other source of funding is available. (4) aAttenct should be made to increase, - whenever possible, the concentration of program effort on the specifically related categorical disease. (5) Care should be taken to identify project activites which can serve as models and to avoid umecessary duplication of these models among and within individual Regions. _ B. Anniversary Review -- A Way to Look at Program Aspects of RMP Based upon the foregoing discussion of budget limitations, both in the current year and as projected, Doctor Olson posed several questions regarding the continued development of Regional Medical Programs . throughout the nation as organizational entities. (1) What kind of organizations should the 55 Regional Medical Programs be? (2) What kind of programs should they plan for and institute? few years, it is apparent that project development , review, and tmnalementation cannot represent the total, nor even the dominant a een . suggested an alterne’. “2 concept of Regional Medical Programs as "change agents.’::: < related this coneept to the need for operational and organization flexibility in each of the Regions rather than the stability which Regions have sought and continue to seek in operating a project grant program. There is agreement on the part of all members that the Council must continue to accept responsibility for setting broad National priorities for the program. They recognize the growing importance of the development of an arrangement by which they can assess the progress of individual Regions in implementing these priorities and in actually af*..'.ing the patterns of delivery of care in the areas they serve. _ Mrs. Phillips reviewed the Division's proposal for a system of "anniversary Review" which has been studied and refined by an ad hoe Subcommittee of representatives of both the Review Committee and Council and has also been discussed by the Review Committee. There was general agreement with Doctor Millikan's assessment of the Anniversary Review proposal which he summarized as being "generally meritorious but requiring extreme care in its implemen- tation.'' He pointed especially to its potential for rewarding Regional achievement but to the possibility, on the other hand. of its serving to ++ alize Regions whose slower start resulted from the timing o/ their initial operational application. There was agreement that the implementation of a system of Anniversary Review will emphasize the need for the Council to have a set of well defined priorities against which they may evaluate Regional Medical Programs both now and over time. Doctor Brennan warned against "cannonizing a system of distribution of resources, which came about by chance." Mr. Paul Ward, who represented the Coordinator's Steering Committee at the Council meeting, pointed out the advantages and ‘disadvantages of such a system to the chief administrative officers of Regional Medical Programs, noting especially their vulnerability to local pressures for all. sition of "flexible monies." Doctor DeBakey recommended caution in the development of restrictive puidelines which could stifle the whole concept of regionalization, which he said was visualized in the original legislation as the mechanism of carrying out the purposes of the program. It is his. opinion that the Council should concentrate on the development of standards by means of’ -which regions' progress towards the programs objectives could be measured, rather than on attempting to change the basic program 'i:jectives. These, he reminded the group, were established by law. -.. | . Final Council action on the anniversary review pronosal was post nones yreryy Teepe ett ot sede ka wi ~ we OE AL Se Page 5 Following the discussion of priorities (Item C below) the Council returned to and unanimously endorsed Doctor Cannon's original motion - for approval, in principle, or the anniversary review concept, with a suggestion to starf that they begin to work with selected regions in the administrative oreanization of their programs along these lines, and with the further scipulation that the Guidelines for Eligibility and Criteria for Approval sections of the Anniversary pn nn eT 2 Review document be restudied and restructured in line with the findings of the special subcommittee of Council on priorities. Cc. National priorities —- How they will affect and will pe Affected by RMPS and PSMA Strategy : The Council recognized the necessity of reaching general agreement about the nature of the program and its objectives pefore it would be possible to consider a new program mechanism such as Anniversary Review. There was also, however, 4 considerable difference of opinion as to what kind of a program Regional Medical Programs is, anda is becoming. Doctor DeBakey recalled the terms of the present legislation, and the legislative history which urged the program's placement within the NIH; since in summary its major purpose was carrying forward the work of NIH. Tt is his opinion that the shift of the program into HSMHA was for ease of organization ard management and not to change its goals or directions. . Doctor Hogness expressed general agreement with this position, stating that within the last six months he has been increasingly impressed with the importance of maintaining RMP's unique ~ capability to carry on activities of this kind; especially as the efforts of other agencies are being directed to the development of _ proad scale programs to meet minimum requirements for health care service of special population groups. Doctor DeBakey and Doctor Hogness both emphasized the increasing importance of Regional “Medical Programs concentrating its Limited funding resources on the improvement of the quality of care. They cited the example of the tremendous dollar investment in Medicare which has admittedly improved the delivery of care to one clearly defined grcup of individuals (those over 65) but has completely "tipped the balance in the system" at the expense of medical research training and education. While agreeing with the need for the development of program guidelines , they strongly recommend that Council attempt to keep them sufficiently flexible ee weet arwances arising from research and. clinical coms for try We pmrrnaAneiue Ff eying men eet we Lae ee ee a ~ their implementav.ct:. Lo. that Racional Medical Programs has Page 6 health care. Whether this has been as a result of "the farsightedness of the framers of the legislation or by serendipity," he believes that top priority must be given to maintaining and further encouraging these cooperative arrangements and communications and that only secondary emphasis placed on the delivery of care, the development tit * or acquisition of hardware, or’ concentration on any specific disease entities. Doctor Brennan expressed another approach to the matter of program priorities. He viewed the most successful Regions as being those which have developed effective core staff and operational mechanisms which are bringing about change whether or not the changes are those authorized" in the law. He suggests that two kinds of "technology" must be employed: (1) the translation of "new advances in health care" into "improved resources for health care;" and (2) the use of those resources to bring about actual improvement in care. He used as an example the control of cervical cancer in a certain geographic area. He stated that by the application of new advances we know "how" to control the disease, but that we’ still do not know exactly what are the costs and effects of various approaches to the use of this knowledge. It is his opinion that the development of this secon "technology" is an important RMP function. At the opening of the afternoon session of the meeting, Doctor Olson briefly reviewed the foregoing discussion. In response to Doctor Pellegrino's motion, the Council recommended that there be created a subcommittee on priorities which would inelude one or two members of the Review Committee and at least one representative of the Regional Medical Programs Coordinators' Steering Committee. Tt was further agreed that there should be close working liaison between this subcommittee and the one previously convened to consider the matter of Anniversary Review. As a possible point of departure for the deliberations of this group, Doctor Everist offered a series of four priorities which he follows in considering Regional Medical Programs: (1) The quality of the core program — the personal qualification of the staff memoers; their capability of developing and handling information between and among the core staff, the cooperating agencies in the Region, and the national level; (2) the effectiveness of the core program ~ which he believes can be judged almost solely on the extent, effectiveness, and permanence of the cooperative arrangements which are developed and developing; (3) the accessibility of the core program — its responsiveness to needs for services and the degree of regionalization of services by means of RMP project monies and otherwise; and (4) the capacity of the core program — to be judged by the. continuing enlargement of the system of both care and information in the Region. In view of the importance of the establishment of some priority miidelines as the ne-zram moves jn FY '71 and urder new or extended Page 7 legislative authority, the Council agreed on the necessity of a special meeting of the entire Council to review the recommendations of the subcommittee. Such a meeting was tentatively set for Monday, March 2, 1970. CHRONIC DISEASE PROGRAMS Doctor Olson reviewed for the Council the events leading to the amalgamation of tne Division of Chronic Disease with the Division of Regional Medical Programs to form the Regional Medical Prograns Service, and the subsequent discontinuance of five of the categorical programs which had been part of the Chronic Disease Division. Doctor DeBakey asked that the Council consider seriously the effect of the phase-out of these programs "as a further diminution of the grand total of all Federal funds available to fight the categorical diseases (ineluding research, training, education, clinical studies, service demonstrations, etc.)." There was a general expression or concern and the Council requested that the staff prepare an analysis of activities of these programs and the Administration's plans for their continuation. They also requested that further discussion of this issue, based on their better understanding of the programs and their potential, be placed on the agenda of the next meeting of the National Advisory Council. Brief progress notes from each of the three remaining program Branches (Clearinghouse for Nutrition and Health, Clearinghouse for Smoking and Health, and the Kidney Disease Control Program) _ were presented. Doctor Olson reported briefly on the Vinite - House Conference on Food, Nutrition, and Health and some of the activities being planned by the Nutrition and Health program for carrying out some of the recommemations of the Conference. “He mentioned specially the work on a series of convracts for commnity nutrition demonstration projects to ascertain whether the capacity for dealing with malnutrition can be substantially increased by using a primary health care mechanism as an out- reach to the community. Close ties will be sought with local Regional Medical Programs to coordinate these efforts. RMP PARTICIPATION IN FLANNING COMPREHENSIVE HEALTH SERVICE PROGRAMS The staff reported increasing numbers of inquiries concerning — the appropriate role of individual Regional Medical Program staffs, and utilization of RMP grant dollars, in comprehensive community health service programs. — After some discussion of SEVELEL SPCCLia& cau Les, biw DuuELh JOUSU UFSbLEbbue 2g to delegate to the Director, Regional Medical Programs Service, Page 8 the authority to administratively approve requests, which _ bear Regional Advisory Group approval, for reallocation of Resional Medical Program resources (cersonnel and/or dollars) for participation in planning of comzrehensive health service programs for communities within the region. Such approval may not include or imply commitment for continuation beyond one year of planning nor involvement in the provision or financing of the services. REVIEW OF APPLICATIONS A. Issues requiring clarification and interpretation of , policy guidelines mo 1. Cardiopulmonary Resuscitation Training After hearing:a report from Doctor Olson of his discussion of this matter with Dr. Campbell Moses, Medical Director, American Heart Association, the Council was reassured that its position in regard to RMP support of projects of this kind was entirely in keeping with the position of the American Heart Association. Council therefore voted unanimously to restate, as a formal policy guideline, the position it had adopted at the time of the August -meeting in regard to a group of pending projects: Regional Medical Program grant funding for projects in cardiovascular resuscitation training 4s to be limited to training activities which are directed principally to medical and allied health personnel who are employed in hospitals and in other in-patient facilities, or in out- patient or emergency facilities operated by or directly related to institutions in which follow-up care is immediately available. 2, Kidney Disease Applications from three Regional Medical Programs (Wisconsin, New York Metropolitan and Metropolitan Washington, D. ©.) propose expensive projects in various aspects of end-stage care of chronic renal disease. In discussing these particular proposals , Council reconsidered the policy guideline that it adopted in May 1969. It was agreed that the policy remains perfectly appropriate but 4t is becoming increasingly difficult to apply in the case of the very complicated and complex project applications of the kind represented by these three and about eight more of which, Council was informed by staff, are currently in the review process. Council discussed again the futility of attempting to provide, under the present amd currently projected RMP budget, programs like these in all 55 of the Regions. They were also reminded of the fact that it is possible that kidney disease may be targeted for special consideration in extension of Regional Medical Program legislation next year. After consideration of a number of options the Council recommended that action on the three specific proposals be deferred at this time. They also requested continued study of the mtter by staff and the preparation of proposed draft guidelines for Council's consideration at a later meeting. 3. Categorical Relevance In this round of review the Review Committee was unable to come to a final recommendation on a.number of projects the subjects of which they felt were of questionable relevance to the purposes of Regional Medical Programs. These were grouped under four headings and included the training for and implementation of Home Health Aide programs (Western Pennsylvania RMP and New York Metropolitan RMP), . training and demonstrations of perinatal monitoring (California RMP and Indiana RMP), training for and implementation of a nutrition program for rural poverty. groups (Ohio State RMP), and production cf a set of audio-visual aids . - principally for in-service training of medical students and house staff (Florida RMP). In considering the matter of the "relevance" of component activities of any Regional Medical Program, the Council generally agreed witn Doctor Millikan's statement that rather than being a matter of its direct relationship to one of the disease entities mentioned in Title IX, a project should be reviewed according to five basic considerations: (1) is it a valid scientific experiment; (2) is it a model for educational experience; (3) is it something other than a direct patient service; (4) will it open commmnications channels for improved local and Regional arrangements that will help to reach the long range goal of the Regional Medical Program; and (5) is it something that should be replicated in this or another Region? These questions were arniied "9 the sme ‘fic nmnoeals and recomendations were 4, Genetic Cormseling (See Discussicn of Western New York Regional Medical Program) 1/ B. Recormendations for Action ~ The Council agreed to record their reconmendations in the slightly altered format which was proposed by the staff and already adopted by the technical panels and the Review Committee (Appendix I). ALABAMA REGIONAL MEDICAL PROGRAM 12/69.1 — Operational Supplement. - Approval with the specific conditions as detailed by the Review Committee. OL — $242,238 02 - $136,035 ARKANSAS REGIONAL MEDICAL PROGRAM - 12/69.1 - Operational Supplement - Approval with specific conditions as detiz:.ed by the Review Conmittee. 01 - $60,621 02 - $42,102 03 - $44,016 CALIFORNIA REGIONAL MEDICAL PROGRAM 12/69.1 - Operational Supplement’ - Approval with specific conditions as follows: “ Project #41 - Non-approval II = The revised application to answer, as far as possible, the . questions raised by the site visit team woe and the Review Committee, and to be me ‘studied by a special technical panel. Project #44_- Approval with the conditions specified by the Review Committee. : (Continued) All amounts are direct costs only and unless ‘otherwise specified refer to 12-month periods. . The designation 01,02, etc. relates to the first, second, etc., budget: periods oLrttie’ subject application, not necessarily .the budget periods that will actually be supplemented. Page 11 CALIFORNIA REGIONAL MEDICAL PROGRAM (Continued) - Project #46 - Approval with the conditions specified by the Review Committee. _ Project #47 - Withdrawn. Project #48 ~ Approval with the conditions specified by the Review Conmittee. Project #49 - Non-approval I. Project #50 ~. Approval I Project #51 - Non-approval I (the inappropriateness of this project for Regional Medical Program funding was based on the- Council's opinion that training of this kind is the legitimate concern of the hospitals and clinical pathologists as a part of - their regular in-service training activities.) Approval with the conditions spécified by the Review Comittee, and to be studied by the special technical panel. Project #53 - Non-approval IT. Project #52 Ol - $569,776 02 - $526 ,065 03-$520, 310 COLORADO/WYOMING REGIONAL MEDICAL PROGRAM 12/69.1, 12/69.2, 12/69.3 - Operational Supplement, ~ Approval . with specific conditions as follows: Project #15 - Approval with the conditions specifi by the-Review Committee. To Project #16 - Approval II = Council concurs with the Review Committee and further recommends that the "coordination" furictions proposed here te carried out within the existing core staff framework. , Project #17 - Approval I with the conditions specified by the Review Conmittee. Project #18 - Approval with the conditions specified . by the Review Committee in the amounts considered appropriate by the staff. Ol - $117,505 02 - $127,714 03 - $24,944 STOTT rye 12/69.1 - Operational Supplement (Including renewal of core support) _ Page le. FLORIDA REGIONAL MEDICAL PROGRAM (Continued ) Approval with soecific conditions as follows: Core - Approval I for one year as specified by the Review Committee. Project #28 - Approval I. Project #29 - Non--approval IT porject #30 -- Non-approval IT Project #31. - Non-approval I (the inappropriateness of this project for RMP funding is based on the Council's opinion that this project is designed principally for the education of medical students and house staff and has no plan for regional outreach or for the encouragement of cooperative arrangements ). Project #32 - Non-approval IL 01 — $43,370 02 - $725,180 03 - $45,100 NOTE: The Council further concurred with the Review Committee in recommending a site visit which is specially designed to assist the Region in assessing its entire Program and ‘in balancing the activities in the three areas of the Region. HAWATI REGIONAL MEDICAL PROGRAM 12/69.1 — Operational Supplement - Approval (of the core supplement _ only) with specific conditions as detailed by the Review Committee. Projects 12 through 16 ~ Non-approval IT | Council ‘further recommended that no additional funds beyond this presently approved core supplement be approved for this region until a site visit has been made and there is some further delineation of a pla both for Hawaii and for the extension of programs into Guam and the Trust Territories. The site visit is also charged with specific investigation of projects #15 and #16 along the lines recommended by the Review Committee. 01 - $87,387 02 - $90,295 INDIANA REGIONAL MEDICAL PROGRAM (Continued ) Page 13 INDIANA REGIONAL MEDICAL PROGRAM (Continued Core Staff Supplement - Approval Project #15 - Approval, in principle, contingent upon the findings of a technical panel regarding this particular application of perinatal monitoring in clinical practice; and upon the submission of better evidence of the relationship of the project to regionalization in TRMP. 01 — $265,445 02 - $293,052 03 ~ $43,048 INTERMOUNTAIN REGIONAL MEDICAL PROGRAM 12/69.1 - Operational Renewal - Approval with specific conditions as detailed by the site visit team and with the advice and guidance on the individual projects as detailed by the Review Committee. Council further recommends that the Region be advised to undertake an orderly phase-out of the projects which are predominantly "R&D" and be discouraged from further development of “automated gadgetry" aspects of the other projects. - OL — $2,064,229 - 02 - $2,145,656 03 - $2,199,208 OM = $123,756 05 - $82,504 12/69.2 - Project #25 - Approval with specific conditions, for three years, in amounts to be determined by staff but not in excess of the amounts requested. Ol - $165,170 02 - $161,868. 03 - $174,130 NOTE: This project was not among those held for further consideration of the kidney disease issue (see VIII, A, 2 of the-Minutes) because it had been revised to comply with the existing policy guidelines ard built into the cooperative arrangements framework which is the basis of IRMP. Also, it represents an opportunity for IRMP to contribute to the operation of a complete and extremely high quality chronic renal disease service. Page 14 LOUISIANA REGIONAL MEDICAL PROGRAM 12/69.1 — Operational Supplement - Disapproval. The Council concurred with the Review Committee in their assessment of this proposal. The Region's requested withdrawal was received after the application had been distributed to the Council members. The Council agreed with the panels and the Review Committee that the current proposal is elaborately budgeted but weak and ill-defined and would require major revision before it could be considered for funding. The Council considered the Region's plan to withdraw the application as an opportunity for developing a revised proposal to be submitted for a complete review cycle, of which a site visit would probably be an approprias part. MEMPHIS REGIONAL MEDICAL PROGRAM 12/69.1 - Operational Supplement - Approval with specific conditions as detailed by the Review Committee. 01 - $20,600, 02 ~ $23,972 03 - $27,657 (See also "Special Actions" at the end of this Section). METROPOLITAN WASHINGTON, D. C. REGIONAL MEDICAL PROGRAM 12/69.1 - Operational Supplement. - Approval with specific conditic as follows: Project 27 - Non-approval IT. Project 28 ~ Approval with the contingencies specified by the Review Committee. _ Project 29 - Approval with the specified conditions ve described by the Review Committee. Project 30 - Non-approval II. Project 31 - Deferral for further consideration (see Section VIII, A, 2 of the Minutes). Ol - $168,369 02 - $54,471 — 03 - $55,860 12/69.2 - Operational Supplement. - Council concurred with the recommendation of the Review Committee for non-approval. Project 32 - Non-approval I. Page 15 “ SSIGAN REGIONAL MEDIC... PROGRAM 12/69.1 - Operational Supplement — Approval The Council agreed with the importance of the questions raised by the. Review Committee all of which had also been identified ' in the process of review of this project at the local level. Answers to these questions, prepared in response to the MRMP review process and submitted to the Division too late for consideration by the Review Committee, were found to be adequate by the Council, ™ey therefore recommend approval of vinis project. o1 - $74,400 02 = $77,139 _ MISSISSIPPI REGIONAL MEDICAL PROGRAM 12/69.1 - Operational Project Renewal - Approval with the specific conditions described by the Review Committee. 01 - $149,754 02 - $131,094 03 - $142,623 (15 Months) . MISSOURI REGIONAL MED,'ab PROGRAM 12/69.1, 12/69.2, 12/69.3 - Approval with specific conditions. The: National Advisory Council concurred with the recommendation of the site visitors and the Review Committee that the extension of the components of the Missouri Regional Medical Program be approved, as requested, for three months ending June 30, 1970... Project #46 - Approval with the specific conditions recommended by the Review Committee. Project #47,.- Non-approval IT, according to the + ». pecommendations of the site visitors. ‘ol - $155,995 02 - $160,237 03 ~ $273,094 MOUNTAIN STATES REGIONAL MEDICAL PROGRAM Yo/eeed - Operat fina? * 2pplement - Approval with specific c ndi tions detailed dy "kx -Review Committee. ‘Ol - $84,235 02 - $109,071 93 - $110,209 Page 16 NEW JERSEY REGTONAL. MEDICAL PROGRAM 12/69.1 - Ooerational Supolement - Approval with the conditions detailed by the Review Comittee. o1 - $60,450 02 - $62,463 03 ~ $63,156 NEW YORK METROPOLITAN REGIONAL MEDICAL PROGRAM 12/69.1 ~- Operational Suppsment - Approval with specific conditions. Project #10 - Deferral for a site visit. If the visitors are persuaded that the project is (1) feasible and (2) relevant to the New York Metropolitan Regional Medical Program (see Section VIII, A, 3 of the ‘Minutes) the proposal should be revised accordingly and resubmitted. Project #11 - Approval I with the advice provided by the .Review Committee. Project #12 - Approval I with the advice provided by the Review Committee. Project #13 - Deferral for a site visit and possible revision (see Section VIIT, A,-2 of the Minutes). Ol - $144,446 02 - $147,823 03 - $156,501 NORTH CAROLINA REGIONAL MEDICAL PROGRAM 12/69.1 - Operational Supolement ~ Approval with specific conditions. Project #24 — Approval II. Council believes that this can be done through the core staff without ~. additional funds being assigned to a specific project. Project #25 - Approval I Ol - $43,443 02 ~ $44,374 03 - $45,309 NORTHLANDS REGIONAL MEDICAL PROGRAM 12/60.1 ager tte y] See tenoet oo Appreval ufth anecd tie condthtens we ee - fet ‘ * eee ha Oe eaaa ae ew a me tee Se ENP me tat . a + ‘Project #2S - Approval I. Project #12 - Approval I with the advice provided by Page 17 Project 13 - Approval I with the specific conditions - getailed by the Review Committee. Project 14 - Approval I contingent upon the submission by the proposer of evidence satisfactory to staff that they are working with the American Academy of Opthamology, and the AMA Council on Education towards the development of their curriculum and training standards. 01 - $248,670 02 - $219,512 03 - $142,953 NORTHWESTERN OHIO REGIONAL MEDICAL PROGRAM 12/69.1 - Coerational Supplement - Return for Revision. The Council concurred with the Review Committee in each of its recommendations . OHIO STATE REGIONAL MEDICAL, PROGRAM 12/69.1 - Coerational Supplement - Approval with specific conditions. Project 15 - Approval I with the contingencies detailed by the Review Committee. Project 16 - Non-approval II with the advice of . - the Review Committee. Project 17 - Non-approval I. 01 - $79,400 02 - $67,500° = 03 ~ $79,100 = 04 ~. $59,200 PUERTO RICO REGIONAL MEDICAL PROGRAM 12/69.1 - Initial Operational - Approval with specific conditions. The Council coneurred with the Review Committee in its recommendations that this Region be awarded operational status, and in their recommendations regarding each of the individual application components. The Council also requested that staff make very certain that the disapproval of Project #8 does not — serve to discourage the development of stroke activities in the Puerto Rico Regional Medical Program. 01 - $1,134,087" 02 ~ $1,190,760 03 - $1,200,064 Bo flee Lae Page 18 ROCHESTER REGIONAL MEDICA "7 5AM 12/69.1 - Operational Renewal (Core Component) - Approval with specific conditions. The Council concurred with the Review Committee in approving this application for one year only in the amount requested. 01 - $373,573 SUSQUEHANNA VALLEY REGION. ° SuCAL PROGRAM 12/69.1 - Operational Supplement - Approval with specific conditions (project #0R only). — The Council concurred with all of the recommendations of the Review Committee, both in regard to the individual projects and to the Region as a whole. They further specified that the staff arrange for a site visit to this Region for purposes of assisting the Region in better organization and delineation of its plans and organizational arrangements, and in the revision of Project #16. Council was unable to determine precisely which of the trzi..:ag components of this project were supportable and whic:-.:ere not. They were also interested in further information on the capability of the hospital to provide training of all these kinds and in this depth. Project #6R - Approval I. Projects 10 through 16 - Non-approval II. " Ol - $26,978 02 = $29,425 03 - $31,551 TRI-STATE REGIONAL MEDICAL PROGRAM 12/69.1 - Operational Sur) tznt_(Core Staff and Planning Activities) - Approval. — The Council concurs with the recommendations of the Review Committee and suggests that staff convey to the Region the need for greater detail and more specificity in future applications —— both in presenting progress ‘to date and plans for the future. Ol ~ $1,348,732 12/69.2 - Operational Supplenent - Approval with specific conditions as follows: Loa. 4 vyte ib F doe ac etre F ELGG Sou Tp tT ap pee Oo ~ (Continued) Page 19 TRI-STATE REGIONAL MEDICAL PROGRAM (Continued) Project #8 - Approval with the advice specifically ~ set forth by the Review Committee. 01 - $14,575 (02 - $14,375 03 - $14,375 VIRGINIA REGIONAL MEDICAL PROGRAM 12/69.1 - Initial Operational - Approval with specific conditions. The Council concurred in the reconmendation of the site visitors and the Review Committee that this Region be awarded operational status. Tnere were however some rather specific aifferences © of opinion between the two bodies regarding individual components and the total to be awarded. The Council recommends as follows: Project #1 - Approval I with the specific conditions recommended by the Review Committee. Project #2 - Approval I as recommended by the site visitors with the condition that the. project director be apprised of the questions raised by the Cardiovascular Panel and seek the necessary consultation to find the answers. — Project #3 - Approval I with the specific conditions recommended by the. Review Committee. Approval I as recommended by the site visitors, contingent upon the necessary. certification of the extended care facility involved. Project #5 - Non-approval II as recommerded by both a the Review committee and site visitors. Project #6 - Non-approval II as recommended by both . the Review Committee and site visitors. Project #7 - Approval I with the conditions specified by the Review Committee. Project #4 O1 ~ $345,695 92 - $330,776 03 - $337,379 WASHINGTON/ ALASKA REGIONAL MEDICAL PROGRAM 12/69.1 — Operational Renewal - Approval with specific conditions. The Council concurred with the Review Committee in its . : yr tiers 7 feo bash Eb te ne _ grant to this Regio be ceuneweu Lom unites YEG, wausl vais (continued) Page 20 conditions specified in each case. O1 ~ $1,494,586 02 - $1,555,984 03 - $1,605,248 12/69.2.- Operational Supplement - Approval with specific conditions. The Council concurred with the Review Committee in regard to each of its recommendations on each of the Tour supplemental projects. 01 - $100,611 02 - $46,700 _ 03 ~ $48,570 WESTERN NEW YORK REGIONAL MEDICAL PROGRAM 12/69.1 - Operational Supplement - Approval with specific, conditions. The Council coneurred with the recommendations of the Review Committee on each of the three component requests. Ol - $276,522 02 - $81,644 03 ~ $84,788 Oh = $54,954 05 - $57,859 12/69.2 -— Operational Supplement - Disapproval. After : a great deal of consideration and review of the special information obtained by the staff at the request of the Council at its last meeting, the Council decided that this project proposes the demonstration of a technique which has not yet been developed to the extent that it is of primary importance in patient care and one which is not sufficiently relevant to the problems of the categorical diseases. In recognition of the continuing basic research and clinical investigation ‘on this technique the Council has agreed to reconsider, two years from now, its applicability to direct patient care. WESTERN PENNSYLVANIA REGIONAL MEDICAL PROGRAM 12/69.1 - Operational Supplerent - Non-approval I. The Council considered this application very carefully in the light of the Review Committee's request for policy guidance on projects of this general. nature. Although they agreed that - under appropriate circumstances the training and demonstration of home health aide activities could be very relevant to Regional Medical Programs, {see Section VIII, A, 3 of the M4 rhea). Cm wail 7 : ny At a acan tha anast = vans arr ysy 3 “Medical Programs 2 tena “they eed vacate te other funds be sought for the pursuit of this program plan. Four requests for special actions by the Council were presented by . the staff. MEMPHIS REGIONAL MEDICAL PROGRAM The Council recommends approval of the continuation of the activities . 4nitiated under project #4, under the circumstances presented by the staff, for 4 sufficient time to allow the Region to submit a revised proposal for full operational project support for Review Committee and Council consideration. ° NEBRASKA/SOUTH DAKOTA REGIONAL MEDICAL PROGRAM The Council recomnends approval, without additional funds, of the reinstatement of the mobile unit aspect of project #4 as presented and explained by the staff. welt OHIO VALLEY REGIONAL MEDICAL PROGRAM In February 1969 the Council approved , in principle, a proposal tO establish a multiphasic screening activity in this region. The - approval was contingent upon submission of evidence that the project, as conceived, could be accomplished within the limit of the budget recommended. The consensus Of Council is that the revised proposal is acceptable, although the project is to be watched closely py staff for assurance that the necessary provisions are being made for patient follow-up and that plans are being pursued for support of the continuity of this project beyond the two year Limit of this grant. . The recommendation of approval is reaffirmed. WISCONSIN REGIONAL MEDICAL PROGRAM After further consideration of project #15 and of the entire issue of Regional Medical Program support of projects. related to control of. chronic renal disease (see Section VIII, A, 2 of the Minutes), the Council again deferred final action on this application. ~ a a, “hee Page 22 X. ADJOURNMENT The meeting was adjourned at 12:30 p.m. on December 17, 1969. I hereby certify that, to the best of my knowledge, the foregoing minutes are accurate and complete. Stanley W. Olsorf, M.D. . Director Regional Medical Programs Service % Text of the statements and additional materials which were distributed at the meeting are available in the Office of the Council Secretary. page 23 ATTENDANCE AT THE NATIONAL ADVISORY COUNCIL MEETING December 16-17, 1969 > RMPS STAFF ATTENDING Dr. Donald R. Chadwick, Deputy Director, DHMP Mr. Cleveland Chambliss, Office of Organizational Liaison Dr. Veronica Conley; Continuing Education & Training Branch Dr. Sam Fox, Chief, Heart Disease & stroke Control Program cc Mr. Rdward Friedlander, Assistant Director for Communications “and Public Information > Mr, Sam Gilmer, Programs Assistance Branch Mr. Charles Hilsenroth, Assistant Director for Management Mr. Robert Jones, Chief, Programs Assistance Branch Mrs. Lorraine Kyttle, office of Grants Review Mr. Gregory Lewis 5 Dr. Richard Manegold, Associate Director for RMP Operations g Development Dr. Frank Mark, Chief, Operations Research & Systems Analysis Branch ny Assistant Director for Plaming & Evaluation Contract Policy . Meo. Roland Peterso: ove (Martha Phillips, Associate Director for Grant and Li -Miloslav Rechcigl, Special Assistant to the Director for Nutrition and Health . Mr. Donald Riedesel, Fxecutive Officer, Mr. Richard Russell, Office of Grants Review Mrs. Judy Silsbee, Assistant Director for Grants Review Dr. Margaret Sloan, Associate Director for Organizational Liaison Mr, Frank Zizlavsky, Programs OTHERS ATTENDING _L. G. Christianson, Veterans Administration _ J. H. Dunlop, A. D. Little, Inc. — Frederick Featherstone , HSMHA/OA Charles Rosenberger, NCI _ John Pendleton, NCHS&RD R. A. Walkington, NLM _ Eugene Veverka, , William J. Zukel, NHI #8 WERRRY Page at RECORDING OF RECOMMENDATIONS From the Panels to the Review Conmittee (On Projects Only) Technically sound and capably directed Feasible under specified conditions Unapprovable on technical grounds From the Review Committee to the National Advisory Council (On Projects) “Approval I ~- Additional funds recommended Approval II - No additional funds recommended Non-approval I — Inappropriate for DRMP funding Non-approval II - Revision required No action taken - Need additional information , Need site visit Need Council decision (On Entire Applications) Approval Approval with specific conditions Deferral Return for Revision | Disapproval - Inappropriate for DRMP funding From the National Advisory Council to the Administrator (On Entire Applications) Approval Approval with specific conditions (as recommended by the Review Committee or others ) Deferral a Return for Revison Disapproval - Inappropriate for DRMP funding NATIONAL ADVISO"Y REGIONAL FEDS: BRENNAN, Michael J., M.D- (72) President , “Michigan Cancer Foundation 4811 Jcin R Street Detroit, Michigan 48201 nn cea Professor of Medicine ‘Wayne State University _ CANNON, Bland, W., M.D. (73) 910 Madison Avenue Memphis, Tennessee 38103 ee Division of Neurosurgery University of Tennessee College of Medicine CROSBY, Edwin L., M.D. (71) Director American Hospital Association “nicago , Illinois 60611 DeBAKEY, Michael E., M.D. (72) a President and Chief Executive officer Baylor College of Medicine Houston, Texas 77025 Professor and Chairman Department of Surgery College of Medicine EVERIST, Bruce W., M.D. (71) Chief of Pediatrics Green Clinic 709 South Vienna Street . wo Ruston, Louisiana 71270 «7 HOGNESS, John R., M.D. (70) ~ Executive Vice President University of Washington Seattle, Washington 98105 CHATRAN 3 + = z ago edward Se ee ¥ debt we foe hoe se dA eo 5600 Fishers Dr. Joseph T. English “COUNCIL_ON Pr MILLIKAN, Clark H., M.D. (72) Consultant in Neurology Mayo Clinic Rochester 5 Minnesota 55902 PELLEGRINO, Famund D., M.D. (70) Vice President for the Health Sciences and Director of the Center state University of New York stony Brook, New York 11790 PpOPMA, Alfred M., M.D. (70). Regional Director . Regional Medical Program - 525 West Jefferson Street Boise, Idaho 83702 ROTH, Russell B., M.D. (73) o40 West 41st Street Erie, Pennsylvania 16508 vice Speaker of the House of. Delegates of the American Medical Association SHANHOLTZ, Mack I., M.D. (70) State Health Commissioner State Department of Health Richmond, Virginia 23219 TREEN, Mr. Curtis (71) United Rubber, Cork, Linoleum: and Plastic Workers of America 87 South High Street Akron, Ohio 44308 Director Pension and Insurance Department WYCKOFF, Mrs. Florence R. (72) 243 Corralitos Road Watsonville, California 95076 Rockville, Maryland 20853