REGIONAL MEDICAL PROGRAMS SERVICE

Number 23 Office of Program Planning and Evaluation
March 24, 1971 IV-38

PROGRAM ANALYSIS MEMORANDUM

 

SUBJECT: Funding Duration of Operational Projects

PREPARED BY: Teresa Schoen, Leah Resnick, and Gene Nelson

SUMMARY

RMP grant support of operational activities and projects has generally
been understood to be limited in duration. This has been explicit or
implicit in both grant requests and awards.

An analysis of the status of disposition of the 87 operational projects
initially undertaken by six (6) Regions (Albany, Intermountain, Kansas,
Missouri, Tennessee Mid-South, and Wisconsin) which were among the very
first to achieve operational status (in 1967-8), reveals that less than
40 percent of their operational projects (35 of 87) have had RMP grant

‘support terminated within three years or less; and, conversely, over

one-third (31 of 87) are now in the fourth year of support. Other high-
lights are as follows:

* There was a significant disparity between the estimated duration
of required support as reflected in initial requests and the
actual duration of support. Initial estimates suggested that
over 90 percent of the projects (81 of 87) would require RMP
grant support for only three years or less. Actually well over
one-third of them (33 of 87) are (or were) funded into the
fourth year.

* About 67 percent of the projects supported (58 of 87) have
required more grant funds than was initially estimated.

* There are significant variations among the six Regions. Both
Tennessee Mid-South and Kansas had much higher rates of termin-
ation of RMP grant support within’ three years (70 and 60 percent
respectively) than the other four Regions.

* There also are variations influenced by the kind of sponsoring
institution and/or functional nature of the operational activity.
For example, only 21 percent of the projects sponsored by
medical schools have had project support discontinued within
three years in contrast to 76 percent of those sponsored by com-
munity hospitals, and 72 percent of the patient care demonstration
projects have had their grant support terminated within three
years while only 37 percent of the training activities (broadly
defined) had their support terminated.
TI.

~ DISCUSSION

The purpose of this analysis was to examine not only the actual
duration, and amounts of project funding compared with initial regional
estimates, but also to determine the disposition of projects after
termination of RMP support. The data in these regards is. summarized
in the two attached tables. One is a "Comparison by Region" (At-
tachment A) and the other a "Comparison by Sponsorship, Functional
Activity, and Disease Category" (Attachment B). Both compare esti-
mated with actual figures; only the first also reflects disposition

of projects.

A.

Sources of Data and Method

Projects selected for this study were those initiated in the

‘Albany, Intermountain, Kansas, Missouri, Tennessee Mid-South,

and Wisconsin Regions during their first 18 to 24 months of oper-
ational activity. The large number (23) of projects for Tennessee
Mid-South includes eleven (11) coronary care unit activities which
constituted part of a network but were requested, identified, and
budgeted for separately. The Missouri total includes eight (8)
bioengineering projects which were initially requested and funded
aS separate entities, but were combined in the fourth operational

year.

‘Data as to the requested and actual duration of funding and dollar

amounts were drawn from initial and subsequent operational appli-
cations and grant awards. Card files, printouts and other data
sources of the Grants Review and Grants Management Branches were
also utilized as necessary. The current status of projects was
determined by consulting subsequent applications, progress reports,

and awards where possible. In some instances, it was necessary to
telephone coordinators to establish or confirm this.

Regarding the comparison of years of support requested versus years
of RMP support granted, it must be recalled that, for some early
applications, RMPS rather strictly limited the number of years

for which funding could be requested, usually three. Thus, the
requested duration of support no doubt was shorter than the
realistic estimates for some projects; and the data reflect this.
It also should be noted that some of the award figures used (upon
which are based comparisons of amounts requested versus awarded)
include carryover in varying degrees. Thus, the number of projects
in which the amount actually received was greater than initial
estimates of requirements, is overstated to some extent.

In classifying project status, the designation "ongoing" was used
where either funding of the original project was being continued
or the original activity in large measure had been incorporated

 

 

 
3

into core or related new projects. Comparison of total funds ~
awarded with totals requested only refers to funding for the
original project, however (excluding funding for projects after
incorporation).

Projects were classified by disease, functional activity, or
sponsor in accordance with previous codings following an interim
set of descriptors developed for the Management Information
System.

 

B. General
As noted in the Summary, only 38 percent of all operational
projects in the six Regions have been terminated within three
years or less. This percentage understates the situation inas-
much as projects now in their first, second, or third year of
support may be terminated in their current year. Table 1 below
indicates, by Region, the breakdown of projects actually termin-
ated by program year and those still ongoing.
Table 1
DURATION OF RMP SUPPORT
Region Year Total No.
~ 01 02 03 04 Projects
Albany Ongoing in - 1 - 3 (4)
Terminated after - 2 2 (4)
Intermountain Ongoing in - 1 4 9 (14)
Terminated after - - 1 - (1)
Kansas Ongoing in 1 1 2 2 (6)
Terminated after 5 3 1 - (9)
Missouri Ongoing in - 2 2 1 (15)
Terminated after - 1 1 - (2)
Tennessee Ongoing in - 1 1 5 (7)
Mid-South Terminated after - - 16 - (16)
Wisconsin Ongoing in ~ 2 3 1 (6)
Terminated after - 1 2 - (3)
TOTAL Ongoing — 1 8 12 31 (52)
Terminated 5 5 23 2 (35)
4

Not all of the project terminations to date have reflected
regional initiatives. Often the initiative has come from the
Federal level. In some cases Regions were in effect advised
during the review process that certain projects would not be
renewed beyond the current or subsequent year. In other in-
stances, certain projects were disapproved (or approved but
unfunded) by the Review Committee and Council.

 

The status of projects after termination, as a rough indicator

of the acceptance and effectiveness of the ''seed-money'' concept
of RMP funding is of particular importance. Of the 35 projects
terminated to date, over one-half (18) were being continued

with "other funding"; and almost one-third (11) were "completed"
(one-time-only projects such as continuing education and training
seminars). In only 6 cases was some "other disposition" such

as the early termination and non-continuation of a project because
of its limited effectiveness, noted or the project's status fol-
lowing termination "unknown'

 

The high rates of termination in both Tennessee Mid-South and
Kansas are in part related to the nature of projects involved. Of
the nine terminated projects in Kansas, six were requested for

one year of funding only and were terminated on schedule. Five

of these were seminars or workshops, and the sixth a special study.

In Tennessee Mid-South, eleven of the sixteen projects termin-
ated made up a coronary care network -- requested for three years'
funding and terminated on schedule. Most of the training and
other costs which may have been involved are now being borne by
hospitals or other local resources.

Analyses of the same projects by sponsorship, function, and
disease category shows some definite, though not entirely un-
anticipated differences. Twice the number of projects were
sponsored by medical schools (42) as community hospitals (21.
Conversely, the rate of termination (in 3 years or less) for
community hospital sponsored projects (76%) was more than three
times that for medical school sponsored projects (21%).

 

From a functional standpoint there were twice as many training
(38 which includes all three sub-categories) as patient care

demonstration projects (18). The latter, however, were being
terminated at about twice the rate as the former (72% compared

to 37%).
III. COMMENTS AND CONCLUSIONS

The ability of Regions to terminate (or phase out) operational
activities and projects within a relatively few years becomes partic-
ularly critical in a time when there are no additional funds. Tor
it is only in this way, through turnover of existing grant funds,
5

that "new'' monies will become available for re-investment in new
and different activities.

The extent to which activities initially stimulated and supported
by RMP grant funds are continued after grant funds are withdrawn,
certainly constitutes one important albeit gross measure of a
program's relative success (or failure). For unless meritorious
activities can be continued after RMP grant support is terminated,
either by having become self-sustaining or obtaining other support,
little of lasting benefit or value has been achieved.

The early experience suggests that these six Regions overall have

not been as successful in turning over funds in one set of operational |

projects for use in another as they perhaps might have been. In
that sense, it is somewhat disappointing. There is, on the other
hand, concrete evidence that individual Regions to a considerable
extent can phase out support within three years and thus, in effect,
free up funds for reinvestment. In that sense, it is encouraging.

The data also suggest that most activities for which RMP grant
support has been terminated have been continued where appropriate.
The stamina or staying power of such RMP initiated activities needs
to be followed closely over the next several years.
 

Attachment A

COMPARISON BY REGIONS

FUNDING DURATION:

Actual. vs. Est.

“Total Years Support

Continuing

Terminated

 

steak TTB)

 

 

 

 

 

 

 

 

 

 

 

 

Amt. of Support

 

 

 

 

 

 

 

(Est. vs. Actual)

 

 

 

 

 

 

 

 

 

 

 

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