SPECIAL ACTION REQUEST Colorado/Wyoming Regional Medical Program Purpose: The purpose of this request is to raise the current recommended National Advisory Council level for the Colorado/Wyoming RMP from $1,102,346 to $1,252,346 effective July 1, 1972. This recommended increase of $150,000 is exclusive of any EMS or Community Based Manpower Educational System applications (out-of-phase supplements) which might be presented to this meeting of the Council membership. Rationale of Request: The Colorado/Wyoming RMP was approved for Triennial status and was awarded developmental component funds by the November, 1971 NAC. At the time the Region submitted its application, a tight-funding policy. was in existence since all Regions had suffered a 12% reduction some 4 months earlier. Because of this reason, the Colorado/Wyoming RMP had submitted a three-year application which requested a most conservative budget proposal. All activities which had been approved by the RAG were rated utilizing a priority system. This process allowed only 9 of the 24 approved activities to be included in the application in order for the request to stay within the limited funding forecasted for the Region. As a result, an additional 12-15 proposals could not be considered for funding during the first year of the Triennial which started January 1, 1972. Additionally, at the end of this calendar year, only 3 of the 9 project activities currently being funded are due to terminate. These terminations will provide only $73,000 for new activities next year. Also, of © paramount interest is the fact that several new activities have already been stimulated which have a direct bearing on the new mission of this Region. One such activity is entitled, "Student Health Program for Migrant Agricultural Workers and Rural Poor." This proposal has come about through the leadership of a Chicano who now serves on the RAG. This particular type of activity had been strongly recommended by the site visit team which had visited the Program in September, 1971. _ Conclusion: RMPS staff are of the opinion that this Region is beginning to move and needs additional funds in order to pursue those activities which have been stimulated with developmental component funds. In view of the tight turn-around monies available next year, we feel that an increase of $150,000 (d.c.) for each of the next 2 1/2 years, starting July 1, 1972, would be a good investment. If approved, this Region would be receiving an increase of approximately 15% over the pre April 1971 level. Respectfully submitted, Mid-Continent Operations Branch May 25, 1972 aS ' ~2-. 0 a @ . Component ‘and Finanedal Summary - Anniversary Application 7 —_ a JOMPORENT CURREN AiO. YEAR --f 06. YEAR RECCOMHENDYD YR'S AWARD ‘COUNCIL FUNDIN +05 OPER. ce ENDED "REQUEST X SARP YEAR EVEL oo REV. CON, | sone | 932,846 SSE 1,020 ,400 ~{Sub«Contracts Lf ane NO “4 Sr wank - OPER. ACTIV, 415,757 SOK SOS hes 577,500 DEVET., COMP, DISAPPROVED IEE SE ___ 134,860 | ves ( _) or to EARMARKS ¢ 7 xrpney (#40) 111 ,826(dd) (125,000) 125,000 Mode | . , a Cities (#45) §2,810(de) (39,550) “BES #51 : ; , See Below seeres ( | RUPS DIRECT 1,348,603 “|. 1,800,00c2: — 732, 760 1,425 ,000**® . MSS > KY Axe ee 7 Staff Review Report. .. . 6 ee ee ee ee eee es 8-10 RMP Review Criteria. . 6 6 ee ee ee tee ee es 11-13 PART II | Kidney -- not applicable PART III Funding History (01-07 period) KRMP Funding Statement Summary of Core Feasibility and Planning Studies KRMP Core Breakdown and EEO Breakdown KRMP RAC and Committee Data ® PART IV KRMP Trip Report: Staff Visit KRMP Trip Report: Staff Evaluation Report: Meeting of Dr. Margulies, KRMP Staff PART V Advice Letter PART VI Management Assessment Visit -- not applicable PART I RMPS STAFF BRIEFING DOCUMENT REGION Kansas : OPERATIONS £7 Eastern £7 Mid-Continent . _ BRANCH /J South-Central £/ Western BRANCH — TYPE APPLICATION: B _IAST RATING | Tel. No. _ 443-1790 Room __10-15 £7 TRIENNIAL Feb. 197.1 DATE | BRANCH CHIEF Michael J. Posta EJ ist ANNIV YEAR = 7 SARP BRANCH STAFF Mary E. Murphy (7 2nd ANNIV YEAR —_Z7 FEV. COM. “RO. REP, Ray Maddox [7 OTHER | fy7 OTHER Staff | Last Mgt. Assm't Visit - 197_ Chairman - LAST S.V. Mar 4-5 197.1; Chairwan Alexander M, Schmidt, M.D. caff Visits, last 12 mos. (Daves, Chairman's Name and Type of Visit) /16/71 —- Technical Site Visit - Ccmrehensive Nephrology Train. Prog. UKMC - Francisco a Gonzales, M.D. 9.12/71 =— “RMP Evaluation visit - Harold O'Flaherty Qe -26/77> “Staff Grientetion Visit - sary fb. Murohy and caus Ziglavsky MAJOR EVENTS W..ICH OCCURRED IN THE R°GION AFFEC.ING THE RMP SINCE ITS LAST REVIEW in May 197.1: | | a, KANSAS EVENTS . | 7, EBA Devel onrental Grant of $122,270 to Detea City Medical Sarrteas Comoration (772 2. Social and Rehabilitation Service Contract of $55,800 to Atchison, Topeka and Santa Fe Memorial Hospitals, Inc. to explore a possible HMO (FY '72) fre’ RMP. EVENTS i. Mr. 1» in Anderson, former Ditrector:of Planning Services, Kansas Blue Cross—Blue Shiels, Topeka; and Regional Advisory Council member, appointed KRMP Associate Director 2, Mr. Roy C. Hot e nominated and approved as Chairman, Regional Advisory Council. Mrs. Tom Gordon approved as Vice-Chairman. 3, Subregional Office changes: (1) Northwest (Colby) Coordinator resigned; (2) Flint Hil: (Emporia) Coordinator resigned and office closed 7/71; (3) Central (Great .Bend) Coordinator resigned 2/1/72; (4) Northcentral (Salina) Coordinator resigned. Coordins: replacements appointed to Great Bend and Salina. ae [ KANSAS REGIONAL A PROGRAM Subregional Areas and Office Locations July 1, 197] - & Wevanne | Rawlins | oscaToa | Noaron [PAIULI © | SMITH [) JEWELL | REPUBLIC) ’ncHINGTOM MARSHALL |NEMAHA (clouo ft ERMAN FUSHAS [SHERIDAN | GRAHAM | Rooks See UTCHELL | B COLBY - _ ee aria |, wea th YALLaca | LOGEN GOVE | Tasco | ELus faUEseLL} ror HE ALINE Y 7 SALINA 3 EELBY jwiciita | Scovr | Lana | NESS a sn oP NERSCEMARIO anon | KEARNY [FINNEY ODSEMAn — oDser4 HARVEY cry Ray ; , eS a _jpepowien ad 4 - o 4 INTON [GRANT [RASKELL ; WICHITA MEADS | CLARY SUMNER RTON [STEVENS [Ss WaRD KANSAS PROPLLE " REGIONAL CHARACTERISTICS @ econ Kansas RMP encampases. the State of Kansas (82,048 sq. miles) Counties - 105 Congressional Districts - 5 POPULATION (1970 Census) Total Population: 2,249,100 Population Density: 27 per sq. mile. % Urban: 66 % Non-White: 6 (American Indians: 8,700) _. AGE DISTRIBUTION @ Under 18 yrs.: 33 % 18 - 65 yrs.: 55 % 65 yrs. & over: 12 INCOME, Average Income per Individual (1970) - $3,804 U.S. Average - $3,910 MORTALITY RATES - per 100,006 (1968) _ / Kans Heart Disease 380.8 ~ .Cancer 157.2 Vaseu’ar Lesions (Afr. ONS) 115.4 @ -All c uses, all ages - 970.0 ‘FACILITIES AND RESOURCES SCHOOLS Medical School - Univ. of Kansas School of Medicine 1969/70 - Student Enrollment: 497 1969/70 - Graduates: 149 Professional Nursing Schools » 19 Schools - 5 College Affiliates Accredited Schools for Health Professionals Cyto Technology - 3 (Hospitals: 1 -- Medical Centers: 2) Medical Technology - 9 Radiologic Technology:- 22 (Hospital or Medical Center Based) Physical Therapy - 1 Inhalati n Therapy - 3 HOSPITALS - Community General and V.A. General No. Beds Short Term TH6 11,613 Long Term (special) 1 154 V.A.. (General 2 QUT MAN 2OWER: Physicians - Non~Federai M.D.s and D.O.s (1967) Active: 2,388 © Inactive: 292 . Ratio: 106 active per 100,000 population U.S. Rate: 132 per 100,000 population Graduate Nurses fo fn m a” M.D. Group Practices (1969) Single Specialty: 24 General Practice: 21 Multispecialty: NS Ne aa ee TN ONY PREVIOUS YEAR (06) | RECOMMENDED YR'S AWARD COUNCIL _| FUNDING 05 OPER. RECOMMENDED | REQUEST [77 SARP COMPONENT YEAR LEVEL FJ REV. COM. 7/1/70-6/30/71 CORE and 932,846 1,020 ,400 OPER. ACTIV. 415,757 TOTAL BUDGET 1,762,044 NS saz jia7 REQUESTED 2,750,577 ; COUNCIL APPROVED LEVEL 1,800,000 *Withdrawn by KRMP | REGION Kansas June 1972, REVIEW CYCLE COMPONENT AND FINANCIAL SUMMARY -- ANNIVERSARY APPLICATION CURRENT eee * #3 REGION = KANSAS MARCH 1791972 © ‘ , BREAKOUT OF REQUEST RM 00002 06/72 ' ’ : - _ 06 PROGRAM PERICO eee cd wemee wetemesces cue mom gens cee ences PRMPSSOSMAIT OGRE ; (5) Ce) (4) a) IDENTIFICATION OF COMPONENT | CONT. WITHIN] CONT. BEYONOI APPR. NOT | NEWs NOT | CURRENT $° CURRENT. | \ | APPR. PERIOO} APPR. PERICO!] PREVIOUSLY 1 PREVIOUSLY | ptrectT fF wnNorrRecT -| TOTAL I oe | cE suppoRT. | OF SurPORT | FUNDED { APPROVED I costs 1 costs ~ Oe me be ce FO. 4 1 | ‘ | eee be een COCO PROGPAM CORE ! i 1 { { | i 128110202400) i 1 } $12020.200-1__a2284058- Piste Alsat to, . * 0000: CEVELCPMENT COMPONENT Prd } { 1 | a OG8AN CORE | i 1 $134,840_1 $1342880 i sisssaso Lt OOL GREAT BEND EDLCATECRAL 7 I ! I { . | { a we BUCIAS $60,000 1 1 J } sonun09 4. -a2ze3e0 9920320 0234 KENSAS MEDICAL LIBRARY 7 1 ! { ! . 1 I wee STEM $45,000 1 i 1 1 $45,000 i $11.6651 5562665 i 040° OEVEL UF COYPRENENSE VE 7 { i i I I ! WE PHOCL CGY [epg 2eOGe Ay. dl 25.000 J i 1 l $1252000. 1 _n227s820_1_ 1524620. Je O41 CANCER LNFORMATION SERVI 1 1 | | 1 |. eg en Ee ac mer mn a a nt ee Lun $A. 000 L i L $o0,000_1_—_$134520_ Lown $ 23.530. Le 042° CANCER CARE CONTINUING El | - | 1 J i 1 i ow NUCALIGN SROGRAL 1 420.000 1 i ! £20,000.) $22992_1 $224922 21 loa 044 NURSE CLEINICLARK PROGRAM | - j I | | I. j }. ee ee ot ee en en eine __ {i s100,000.1 L J I $300,900. ped bh tht Sliss466 1 O25. PUGEL CITY HEALTH HANPOW | I | | t | t I. me fB EO 2ECEU LIM ENT PeOG 1) $39-50o 1 J { 1 $3292 55001 1 $392500. 1 O46 HEAL TH SERVICES TAALNTNG! { | i | 1}: | to . f i 1 "40,000 1 $40,000 To $4800 1 see sho f : 047 DIASETES DETECTION AND cl i | { | . | 1 wee PU CAL LOD CENTS i L J £26.000_! $28,000) $10,500.) $30.500_f 048 PHOBLEM CREENTED meareaCt i- 1 1 a i : 1 j “ Ly neh LEOROS J i £252,000. 1 £25,000 4 $22500_1 £27s500_) 049 SHARED MANAGSMENT encivel i S | i | 1 I wee hb LAG. P2CG QAM l ! ! $25,000 4 $15,000] £12500. 1 $162500_5 O50 HEALTH OCCUPATIONS shore] I I | ! | to t TLOWAL PPO GRASS - l i ~ l 227.0a000_1 $20,000] $2,000) 32200001 : j 1 { j - | ! J pT i | [$262,860 | $197329760 1 $4249387 I $20L47e1 47 ! TOTAL 1 $12469, 900. *Withdrawn by KRMP. ne ne ee ee Pe cr 0 eee cae nee ne eee es ft am am + tee ane» aan * ree naet % MARCH 27,1972 ‘ . REGION = KANSAS _ . . BREAXCUT UF REQUEST RM 00002 06/72 . .. OT PROGRAM PERO ke cereus wmennrenen AMPS=OSM@STOGRZ - 3 (2) (4) a . ae LOENT IFICATION OF COMPONENT 1 CONT. WITHIN] COVT. BEYOND) APPR. NOT | NEW, NOT 1 ACOtL YEAR | 1 Tora | .. | APPR. PERICOL APoR. PERTCOL PREVIOUSLY | PREVIOUSLY | OIRECT | { ALL YEARS (4 oe | CF SUPPORT | OF SUPPORT | FUNDEC i APPROVED i costs jorRect co costs § ~ pee ee Pee ee i coon { 1 en Se cictee metewe ce eb Po COCO PROGRAM CCRE | ! | { J ! | “Ye L_$1,07214507.! { k Li$).071,507) | 42.091,907 f DOOD CEVELOPMENT COMPONENT PRI i \ ! | | } hs wee AM COPE } ! 1 £17352276_ 1 £1735276_ 1 J S$208s136 J Ook os BEND EDUCATICNAL 31 I ! | | | { | Lae ROGES 1 $50,000 2 L ! 1 $50,000.) } $110,090. 1 C23 RUNS AS MEDICAL LIBRARY ${ 1 | | j i | i MSLEs } $47,000 1. i l j 545720001 I $92,900. _. 040° CEVEL OF CUMPREHENSIVE NJ { ! | \ 1. | » "4 a EREEOLOGY T28G_ Pence am ! i262 05001 l } i $1162050_ 1 L $241,050 bo O41 CANCER INFURMATION SERVI] ! : j ! | | I eee Ee 1 $62,380). 1 ! i $622 380 0) I ~$122.3280 4 . 042. CANCER CARE CONTINUING €] | - ! | ! | t 1 wn BUCATLOD_PECG RAM 1 4 { i i 1 4 £20,000 4 . 054 NURSE CLINICIAN PREGRAP } | i 1 { { t ~ L $102.815_! ] 1 1 $102,815 1 j $2025815 I 045. FCMEL CETY HEALTH HANPOW] | 1 { | t { } 7 we we bE EDUSECBULIME NT Pag j £41,060 | I ! 3 $41,000 1 L $60,500. 1 066 HEALTH SERVICES TRALENING| | [ ! { | | J ee _l } ! ! $44,000 J $44,000] i $84,090} ; 047. OLASETES DETECTION AND EJ 1 { J | I 1 l- : Same BUCAL LON CENTER L t j $302000. 1 £302000. 4 L £382,000 4 _ 048. PRUALEM ORIENTED MEDICAL 4 i ! ; 1 | { | ~ co re BELO E OS { i ! $27.900 tf $27,000. 1: i $52,000 4 049 .SHAREO MANAGEMENT en THEI | | 1 ! | i : | . ERING paoGa es } | ! $12,000.45 £17.000 1 \ $32,000_] O50. HEALTH CCCUPATIONS enonB I i f , ! . i ! j JIGNSL PANGRAMS j ! ! £22,000 5 $22,000 jl $42,000 ! * : j 1 { t I t I a TOTAL b_$19490, 752-1 to { $323,276 | $1 8045028. | ib .$39536e786 | *Withdrawn -by-KRMP-- a a, LC , on cee Siren meme ee ne batpes we mt alam ay ee ak no ee - ee Se elite erence «wen Be ag fe mem stncmmnee ee Ls ee oe eae am meen tm eee Fe ceeaemane amen IS Vt le St NA I ah te a NN ES OS ee te ee oy ae boas ee ee ae te sw adn ’ . we e OUTSTANDING ACCOMPLISHMENTS BY RMP since i. 2. o Ted / REVIEW CYCEE dime 197 _itey 197 Regional Advisory Council redirected Program activity from a project oriented direction to one with major erphasis on imorovement in the distribution of medica: care services through regionalization. . . KRMP had an active role in data compilation on which were based the plans for. establishment of the Univ. of Kansas School of Medicine at Wichita State Univ. (WE pending Kansas Legislation. KRMP. actively assisted WSU College of Health Related Professions in getting underway and supports it in part. Negotiations are underway to develop several cities, in addition to Wichita, as Area Health Education or Area Health Service Centers, namely, Topeka, Salina, and Hays. . Bylaws of Regional Advisory Council to KRMP amended Oct. 2, 1971 to include the category of Ex-officio Membership; to represent Veterans Administration, CHP "b" agency, and Kansas Dental Association. Dr. Brown has consulted freely with area physicians involved in HMO, EMS, and AHE( activities. His assistance has been commended. __ PRINCIPAL PROBLEMS l. i ee em yom ge epee ee ee ree Dr. Brown's mode of canmmmication, especially to subregional staff has presented : problem. He has also limited LAG input into the establishment of regional goals and objectives. Do RAC relies heavily on Dr. Brown for direction of the Program and for setting goals objectives, end priorities. — Kansas has severe medical manpower problems throughout the state. . One subregional office has closed and coordinators have resigned in three additic: offices. Dr. Brown does not view the fact as a failure or subregionalization how DOU Mega AHLa ita UE TO vi : 1, . 2. Communication to the subregions, staff and LAG requires improvement. Relative to the setting of policy, priorities, goals and objectives: a. RAC should assume more leadership . b. Priorities should be based on the available data base ce. Core staff's expertise should be more readily utilized. The Developmental Component's entire emphasis is directed toward Area Health Education, Seience, and Service Centers, Should it be so restricted? RALMAD DSI VV alse RU sap pr e a eee Re a Mary E. Murphy, Chairman Participants: Date: March 24, 1972 Michael J, Posta (MCOB) Calvin Sullivan, (MCOB) Frank Zizlavsky (MCOB) Margaret Hulbert (DPTD) Harold O'Flaherty (MCOB) Marlene Hall (DP&E) Joan Williams (MCOB) Annie Stubbs (GMB) Recommendation: Approval of the application which requests $1,732,760 (direct costs) was unanimously accepted by staff. The amount requested is below the National Advisory Council approved level of $1,800,000, The request includes funding of the following: I. A Developmental Component for the amount of $134,860 II. Continuation of Core (includes 11 projects of 46 components) III. Continuation of 7 ongoing projects IV. Implementation of 5 new projects V. Termination of 4 projects Please refer to MIS Breakout of Reguest. Concern was expressed by staff regarding the following points, ‘There is much lack of CHP "b" Agency planning activity in Kansas. Therefore, RMP Core staff have assumed much responsibility for health planning. Kansas RMP should perhaps observe and evaluate how the Iowa RMP was successful in stimulating CHP “"b" agency activity. As CHP functions on 4 50% shared cost basis, local “jurisdictions should be encouraged to elicit funds and stimulate CHP "b" agency development in the Kansas subregions. Each Kansas subregion has its own Local Advisory Group (LAG). Questions were raised relative to the actual initiative of the LAG in stimulating health activity and in initiating projects, The be deta Af bn WHabitn Gabhent af Midied Werlth Prvrofornions a : ‘ my aoe FE Kee “bald Rah ee dal adhe ci eat dd at at dh ee a ate eee Beh Te ee ne aa a et at he he tee ah het cae Neel St Rt nds Net hohe in which the Dean, Dr. Cramer Reed, played such an active role, was cited as an example. Dr. Reed was a member of the Wichita LAG, In reviewing the Regional Advisory Council membership of 24 members, of which 3 ard ex-officio, it was noted that the members are thinly spread throughout the five, newly established committees, namely: 1) Finance; 2) Planning; 3) Evaluation; 4) Annual Report; and 5) Technical Review Committee. Consideration should be given to increasing Council membership which would alleviate over extension of members. Staff also felt that there should be more consumer representation on the Council. The KRMP has not yet received a Management Assessment Visit. Staff - pecommended that the visit bé made as soon as possible. Special emphasis should be placed on how actively involved is the RAC? Committees, more representative of the program thrust and new national emphasis, shouid be instituted. The presently standing é categorical committees snoulLa pe apoLisnea, muwever, au uu way should the experts on these committees, representative of the heart, cancer, stroke, kidney, and related disease fields be disregarded, These experts are valuable and could be used on Ad Hoc committees established to give technical support and to review related activities and project proposals. ‘ - It was apparent that the RAC is maturing and apparently assuming a bit more leadership, A criticism of the RAC, to date, has been its lack of leadership in policy and decision making. It has functioned in a more or less reactionary manner to what has been presented for consideration, With the establishment and involvement by RAC “members on the new committees, staff hoped for more direct involvement, Dr. Robert Brown's capability as a Coordinator with leadership ability was acknowledged. His staff was considered a capable one. It was felt that their input could be used to even greater advantage than has already been demonstrated. . The subregional staff have felt somewhat cut off from the core of activity and information source. The communication system could stand improvement. os An evaluation system to be applied to Core personnel is in need of development. This evaluation process would be the responsibility of the RAC, Two areas of concern were expressed regarding ongoing projects. The Great Bend Educational Program, of which Dr, Brown was the former Project Director, is requesting its 06 year of funding, The project ‘was submitted in the Triennial Application and funded for an additional three years which will carry it through an O07 year. Council policy was later enacted limiting projects to five years of funding. A recommendation was made that RMPS staff consider the possibility of an in-depth evaluation of the Great Bend Project and determine what impact it has had on the area it has served, : The question of Licensure was raised regarding the training of Physician's Assistants. by the Nurse Clinician Program. The present progoct. aucludcs tic tyadning of Regist oak 2 Tals 2 not present a licensure problem, However, should the training be extended to a non-licensed health professional, problems of licensure would arise. This is a National concern, however, and is presently being pursued by interested factions. we a KD dw dake WD Interest was expressed in the number of projects continued with outside funds when RMPS funding. ceases, The Developmental Component emphasis is on the development of Area Health Science and Education Centers. The Education Center would be directed toward the development of faculty, consultative and technical, The Science Center would be directed toward the necessary educational and science function to maximize potential to meet the public demand for primary health and medical care, The concepts of the AHEC, Area Health Science Center and the Area Health Service Center seem to fit the Kansas Medical Community. The Administrative ‘framework among these responsible medical communities wouiu snciuue the establishment of a Vice Chancellor for Health Affairs "Office for KUMC Associated (Affiliated) Programs," Concern was expressed that the entire Developmental Component addresses itself to the AHEC, etc, concept. Staff did not feel that such set limitation should exist. i Staff reviewed the KRMP according to the RMP Review Criteria. Please refer to comments recorded on RMP Review Criteria Form. There was-active participation by staff in the review of the KRMP and the new application submitted. . REGION Kansas RMPS. REVIEW CRITERTA FORM hr ‘REVIEW CYCLE June Ls A.. PERFORMANCE 1. Goals, Objectives and Priorities (1) ~ Developed and broadly stated. Not based on available hard data. Health problems not prioritized by utilizing a systematic approach to planning, needs. Objectives and priorities should be determined. 2, Accomplishments and Implexentation (2) - KRMP no longer dominated by KU Medical Center, Grantee. Redirection of Progre activity from project orientation to major emphasis on improvement in distribution of medical care services through regionalization. KRMP evaluatic section has built in-project review. Instrumental in establishment of WSU School of Medicine, through Kansas Legislation, and in assisting WSU College. of Health Related Professions. 3, Continued Support (3) ‘Continuation of projects which have exhibited merit and productivity is KR philosophy. Continued source of funding outside of RMPS is-explored. Has been accomplished in several instances. 4, Minority Interests (4) In conformance. Minority representation needs strengthening, however, in core project staff, RAC and Committees. Minroity emphasis on Blacks and American Indians. Attention to increasing female representation. 'B, PROCESS : : 1. Coordinator (5) : Excellent Leadership. Respect of Staff, RAC and Health Associates in the Svea Knowledgeable regarding state resources and has productive health contacts. Has a dominative-type personality. Could relate more effectively to staff, especially subregional assignees. Has demonstrated success in removing KR from domination of KU Medical Center, grantee institution. Deputy Coordinate: is effective, On 83% time basis (Coordinator). 2. Core Staff (6) Larger staff (57) with much professional expertise. Excellent Evaluation Sec’ Most staff essentially full-time. Regional Advisory Group (7) goals, objectives, etc. too bread. Good feedback to project staff ana Rac. 3. Regional Advisory Council is maturing. ‘Instituted 5 new RAC staffed Committees within year. Needs to become more active in deciding policy, setting priorities, goals and objectives. Consumer, female, and minority representation should be increased. 4, Grantee Organization (8) Provides services as required. No longer dominates KRMP or RAC. 5. Participation (9) Key health interests, institutions, health providers , ete. appear to actively participate in KRMP. No interference from any one major interest or politica. force. . 6. Local Planning (10) CHP has been .neffective, excepting in Kansas City area. RMP staff have assumed responsibility for majority of health planning. Each sub-region has local advisory group (LAG) finctioning. Interest and input varies considerably be ween subregions. CHP reviews and submits written comments relative to each KEMP application. 7. Assessment _of Needs and esources (11) Manpower needs have been given top priority. KRMP is continually assessing needs and resources. Data bose is available, whether it provides basis for decisions is somewhat: questionable. 8. Management (12) Core activities appear to be well coordinated. The ongoing number of activit: is high (11 projects - 46 components). Project review is built in, held peric ically, and seems a most effective ccntrol mechanism, Progress reports provided at each review session. 9, Evaluation (13) Evaluation section with full-time director and staff is superb. Project evaluation provided on periodic basis. Program evaluation less successful és &e . C. PROGRAM PROPOSAL 1. Action Plan (14) Priorities established and congruent with National goals and objectives. Proposed activities in keeping with same, are realistic end feasible. More definitive program priorities receiving attention and work-up of RAC Planning Committee. oe 2, Dissemination of Knowledge (15) KRMP has been successful in this area. Active participation of health educati and research institutions of Kansas. Better care, at a reduced cost is being demonstrated. Profile periodical, published by KRMP has wide circulation. 3. Utilization Manpower and Facilities (16) Major emphasis and thrust of Program. Expect increase in manpower will result with beneficial effect to entire state. oo 4, ‘Improvement of Care (17) Proposed activities will markedly improve the delivery of health care. 5, Short-Term Payoff (18) Projects have demonstrated short-term payoffs. 6, Regionalization (19) KRWP has subregiona‘lized with limited success. Is the accepted philosophy and recognizable mode of a successful operation. AHEC philosophy expected to further strengthen concept. 7. Other Funding (20) KRMP has been looking for outside fimding mechanisms in order to continue project activities which have had a demonstrable and beneficial effect. - Some success, to date. ~l- , MEMORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE y TO FROM SUBJECT: PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION Acting Director DATE: April 18, 1972 Division of Operations and Development (Xt _ Director Regional Medical Programs Service Action on April 10-11 Staff Anniversary Review Panel Recommendation Concerning the Kansas Regional Medical Program Application RM 00002 6/72, Accepted don i INT ate Rejected (date) Modifications: a ee . .. 2 =, Component and Financial Summary _ - Anniversary Appiication + COMPONENT CURRENT “Tih YEAR -|. ES << NON-RMPS and TIKCOME ® Under 2/8/72 NAC Policy, the approved NAC level for the first year of the . Triennium prevails . *® Withdrawn by KRMP - **8 PLUS kidney funds of $125,000 - ek This amount includes 91255 000. for #40 and $39, 550. ‘for #45°_ : oom _ of’. v REGION KANSAS June 1972, REVIEW CYCLE “Revised 5/2/72 “ REGION Kansas : REVIEW CYCLE dune 197 2 Type of Application Anniversa RECOMMENDATIONS FROM within trienniu @ (OX SARP [J Review Committee paring 264 [J] Site Visit £77 Council : i i d that ; 2ECOMMENDATION: The Staff Anniversary Review Panel (SARP) recommende 1 FUNDING REC KRMP be funded in the amount of $1,550,000 to incu: kidney j i tional year. funds (Project #40) which are not to exceed $125 ,000 for the 06 opera funds rod e380 000) reflects a reduction in that the application request was for the amount of $1,732,/60. : t that the recommended amount would provide the Program sufficient AO Pi haneial latitude for the projected expansion of activities within the Region especially since the KRMP now plans to pursue the supplemental funding route for several community health manpower programs. Since the prerogative of an ou -° - phase supplement was not available to the Coordinator at the time that the presen, application was prepared, a Developmental Component had been requested for the sole purpose of establishing activities dealing with expansion and augmentation of manpower programs at the community Jevel. In view of the new option now available, the Region has chosen to withdraw the Developmental: Component and compete for supplemental fun S using both the May 1 and June 1, 1972, protocols. Since the Region plans to ia available liquid assets in the Core budget for 46 planning and feasibility studies, reviewers did not feel that additional developmental funds were needed at this time. Qrgue: SARP concurred with Staff regarding its assessment of the KRMP. The Coordinator's "style" and his apparent dominance over his RAC and staff suggest some problems and weaknesses. Program staff is talented but apparently underutilized. Turnover of subregional staff is significant. The reviewers believed that the Regional Advisory Council should address these problems. In the past, the RAC has been somewhat of a "rubber stamp" organization although the Coordinator indicates that this body is becoming more mature. More involvement by the Local Advisory Groups and the RAC is strongly recommended, Committee organization and. Program Staff participation are indicative of increased interest and involvement. SARP felt that since KRMP was one of the first Programs to become operational, their track record was somewhat disappointing. Although there has been a great deal of Core and Project activity, it is very difficult to obtain any real sense of explicit accomplishment. Because of the above mentioned problems, SARP had recommended that the Developmental Component be disapproved. Since this request has subsequently been withdrawn and the requested funding level is below the NAC approved level for the 02 year, it would not be necessary that this application be submitted to the Review Committee. Technical assistance was recommended, as follows: (1) Plan a Management Assessment Visi to KRMP in the immediate future. (2) Invite Mr. Ray House, recently appointed RAC Chairman, to participate in a site visit to an "A" Region with a strong Advisory Group. (3) Invite Dr. Brown, Coordinator, to participate in a site visit to an "A" Region. (4) r OG Technical Assistance to the KRMP in. regard to the pending 910 Kidney application Ccomposite; Bi-State, Missouri, and Kansas estimated at $1,000,000), (5) Assist and encourage KRMP how best to use the results of their intensive a Region Missourl Review Cycle — June 1972 Type of Application: , Anniversary within Triemium oo Recommendations From Rating: 188.3 “i L/ SARP 7 kJ Review Committee [7] Site Visit [J Councit CRITIQUE: Review Committee considered MUMP's application for their 06 | year which presented two Phans -- Plan A for the committed amount of $1.8 million and Plan B for an expanded program level of $4.4 million. During its deliberation, the Committee accepted the report of the April 4-5 technical site visit to review the computer and bioengineering activities (Projects #69, 72 and 75), Committee concurred with SARP's recommendations to disapprove the developméntal component and further funding for the three technological projects: #69, Automated EKG in a Rural Area; #72, Automated Physician's Assistant; and #75, Biomedical Tnformation Service. As a further measure, Committee withdrew Triennial status and reduced the funding level to $1.6 million. ‘The $1.6 figure was computed by deducting from the committed level of $1.8 million the amount of $200,000 (the request for the technological projects). Conmittee also recommended a site visit be scheduled after ‘Council to communicate reviewers’ concern about the Program to the Region. The two EMS projects in the application (#73, Subregional Emergency Services, and #85, Community Emergency Health System) were deferred for special review. A community-based manpower proposal for Springfield, Missouri, was submitted on May 1 and was reviewed by the special ad hoc education review panel, The discussion of the present application began within the context of earlier reviewers! concerns about this RMP. Reviewers mentioned the vagueness of the goals and noted that projects still seemed to have developed around the interest of local physicians or hospitals without regard to regional planning. The overall program still appeared to be a collection of projects, many of which continue to cling to the ‘eategorical emphasis. ‘The Coordinator is not a strong director and the large staff have not been organized or utilized to provide assistance in designing regionalized programs to groups in the periphery. Minority representation is low on Program Staff and review bodies. Reviewers were concerned about possible University domination of the Program as a result’of the large number of part-time University faculty on the RMP payroll, since they questioned the investment in underwriting faculty salaries beyond the financial capability of the University to continue to sustain them when RMP support is phased out. . 6 Region Missouri Review Cycle June 1972 Recommendations From Review Committee Page 2 Missouri's continuing insistance on developing the technological projects in contradiction to the previous advice from Council also disturbed the reviewers. From‘the technical site visitors findings, it appeared that Missouri seemed to be pursuing expansion of past developments and responding to an essentially rural constituency with urban methods and lots of expensive hardware. With regard to Project #69, Automated EKG in a Rural Area, Committee agreed with SARP that no funds be provided for the project. The site visitors had suggested that perhaps some funds could be provided ($60,000) to redirect the activity to provide a telephone consultation service for the rural physician, since this seemed more valuable than further automation of certain tests. Since the primary service of the Biomedical Information Service (#75) will soon be offered nationally by the National Library of Medicine, NIH, and it did.-not appear likely that MRMP could enroll enough subscribers to support their system in the near future without substantial Federal investment, reviewers recommended that the system be phased out and no future support be provided from MRMP. The Automated Physician's Assistant proposal was also disapproved.. While the basic concept has merit, the site visitors determined that at its present level of achievement and project direction, it shows no potential for providing a very useful or marketable aid for the practicing physician. They pointed out that the course MRMP has taken -- expansion of past developments, rather than an innovative attempt to solve the actual problems of rural health care delivery -~ has been misguided. In addition to cost. considerations, reviewers found that the system had serious design deficiencies which made it difficult for the physician and his office staff to use in an optional fashion. Present efforts should be discontinued, and planned expansion to the Satellite Clinic and Family Practice and Surgery Clinics should be put aside. If in the future, any work is contemplated, it should first take into consideration the following: 1) a reassessment of the goals and specific approachable objectives of the project; 2) other advances in computer assistance to medical care around the country; 3) a revision of hardware choices so as to provide a more flexible, lower cost and more adaptable service to the physician; 4) a redesign of the overall system in order to aid the physician in delivering comprehensive, efficient, high quality and reasonably priced health care. The Region has made progress in several areas as noted in the staff materials. These include the addition of a new Planning Director, consolidation of Program Staff funetions, formation of Goals and Evaluation Committees, and greater success in seeking outside sources: of support for MRMP activities. MRMP has also increased its program activity in communities outside of Columbia, including Kansas City. Newer projects, such as the Green Hills, the Docent Nurse Outreach and Pediatric Nurse Associate appear more relevant to the Region's needs and RMPS! review criteria. sa \ . Region Missouri a , Review Cycle June 1972 _ Recommendations From Review Committee Page 3 Reviewers still thought, however, that the application showed little evidence that MRMP leadership had clearly thought out their mission or had committed themselves to bring about substantial change in the Program. Committee believed that a drastic approach was necessary to show the leadership responsible for this RMP that they are not pleased with the way the Program has met its responsibilities. After discarding SARP's recommendations, Committee proposed measures to. Council which they hoped would be a first step in reversing the Region's poor showing. They recommended that Triennial status be with- drawn and that a site visit be held in the near future to inform the Region what steps they might take to become a better RMP. They further recommended a reduction in funding from the committed level of $1.8 to a $1.6 m. (direct costs) level for the 06 year and a disapproval of the developmental component request and further RMP funding for projects #69, 72 and 75. APPROVED LEVEL 2,500,000 age oN © Component and Financial Summary - Anniversary Application | COMPONENT CURRENT " 06 YEAR 06 YEAR RECOMMENDED ° YR'S AWARD FUNDING O5, OPER. {7 sarP YEAR COUNCIL “RECOMMENDED REQUEST [xX 7 REV. LEVEL . COM. PI SIS IPP IEP REA O78, 17 FER CORE $ 828,441 eT A - Ae B 1,137,302 Sub-Contracts -0— PreK, fee° ~0- Pye 930,920 OPER. ACTIV, 1,118,976 Pg B 3,133,050 é iy 16,350 DEVEL. COMP. -0- “4B 190,000 Yes(_) or No(X) EARMARKS: KIDNEY ~0- ~0- ‘ £ - EMS See Below ** 1,947,417-12 mos. [| A $1,825,417 **- RMPS DIRECT 2.251, 653-14 mos.) | $2, 500,000 # BH N60 852 Shs 625. lope | REQUESTED 5 061.062 3 ee Boise 3 as COUNCIL INCOME NON=RMPS and fs Nes, APN exe Under 2/8/72 National Advisory Council policy, REGION Missouri % the approved NAC level for the first year of the triennium prevails. ' May/June 197 _2_ Review Cycl ®% The EMS proposals were part of the basic application and are pending special review. Funds for these projects are not included in this figure. *#% Plan A requests the committed amount of $1,825,417. Plan B requests the optimum amount of $4, 460, 852, Staff and SARP recommend Plan A. | Plan A Current Program request $1,825,417 Supplemental CBE request 385 ,817 Supplemental EMS request 1,345,185 Tf fe ae - + woe “s on . . 1 . . wo , 4 . 7 . . ep moe 2 oat RUPS - © Hoo . STAFF BRIEFING DOCUMENT : ; . OPERATIONS: / "7 Eastern -EGION Missouri _ . BRANCH ‘£-J South-Centr'l Mos . | BRANCH | 'YPE APPLICATION: LAST RATING“. | Tel. No. __443-1790 Room 10-21 7 ‘TRIENNIAL 4 1972: DATE) 7 BRANCH -CIIEF_ Michael Posta | 7 ist ANNIV YEAR 7 sare” | BRANCH STAFF_Dona Houseal rT 2nd ANNIV. YEAR _ [7 REV. COM. " RO REP, Ray Maddox ry OTHER a fc] OTHER : Last Mgt. Assm't Visit__--- 197 _ - Chairman ee AST 8.V.__3__ 197_1; Chairman_Dr. G. V. Brindley __ stage Visits, Last 12 mos. (Dates, Chairman's Name and Type of Visit). . ctober, 1971 --= Four day staff visit by D. Houseal. "April 4-5, 1972 —. " Technical Site Visit scheduled to review computer and bioengineering activities _+-~chairman---Dr. Octo Barnett. ecient arnt. — . * ‘BACKGROUND: Since MRMP became an operational program in 1967, it has undergone several program and oneantuatiodal changes. These _changes have been a consequence of several occurances: | 1. Dr. Rikli succeeded. Dr. Wilson as Coordinator. in 1968. 2. A new medical school has been established in Kansas City. The MRMP's office dn Kansas City has linked ‘some of its activities to this new school, whose ~ concept is to develop a comuunity-oriented medical education program. “3. Two program site visits were-held by BMPS (in 1969 ‘and 1971). A copy of the last visit's results is attached. . f 4. Asa result of these two critical reviews and the relative slowness of MRMP in responding to the change in the RMPS program direction, MRMP's budget has decreased from a $5. 0 million toa $2. 0 million level during the past two years. . ©} 5. In response to reviewers’ recommendations » MRMP has: - gradually reduced the proportion of their monies allocated to computer and bioengineering ‘activities, and increased the amount of funds for community-based projects. MISSOURI REGIONAL MEDICAL PROGRAM , ' RM 00009 State of Missouri, except for St. Louis Metropolitan area which established program later-- Bi-State. — SO State has 115 counties; 10 Congressional Districts | Population ( 1970 Census) - - 4,677,400; RMP estimates overlap of about 1.5 million with Bi-State ( city of St.Louis) and County State: Land Area 69,138 square miles; density 68 per sq. mile.. Urban - 70% 3 non-white 10%( 500,000 of whom 480.1 are Negro) Metropolitan areas; 3 excl. St.Louis -(total of 1478.4) St. Joseph, Springfield, Kansas City,Mo.-Kansas. . ~ 7, an WORTH | | | PUTHAM scnuner| mercer |. SCOTLAND] CLARK NODAWAY HARRISON ~f . GENTRY SULLIVAN ADAIR ar GRUNOY xROX Lewis ANDREW - | eaves l DE wALe nm, UMN MACON succay | MARION bALa ST. JOSEPH Fy) HANNI . , | CALOWERL . . CLINTON . 7 " 4, MOWROL : a 0, p : Ray ny E : . -. CLAY . ee ot . 72227 AUORAIN : . LAFAYETTE HOWERD - > oon “ LINCOLN . . KANSAS CITY &sJNDEPENDENCE . 2 . KE OM BOONE 7 a €: pf culumaiae e : a [Sony J ntaway * ST. CHARLES ©. COOPER eee WARREN we JOHNSON a one 2 cil “anal © “857, LOUIS CASS Fi woniteau g SOA Gs 7e Konig {| ___y—4_JEFFERSONHY % c/* > Peed : t ms * ol MORGAN cove OSAGE +, FOANKUP / , HENRY a 9 ¢ BATES ; 2 miter | , ee ee wanes pend BT. CLAIR CAMDEN = HICKORY VERNON PULASKI ~ CEDAR by ° POLK, DALLAS TT Lacieve Bantoa bape P—— a WEBSTER TOUS GREENE WRIGHT JASPER nl : Spemcrieto glOPUN Lawrence }—————-—L CHRISTIAN Ls NEWTON STONE BUTLER BARRY OREGON TANEY x . RLey MC DONALO . OZARK ro a - | . ol . ~~ . . , . \ ; _ mo. = County with two or more Congressionol. Districts 4 x 7 ‘ Fick | RM 00009 " MISSOURL | , | Selected Death Rates ( per 100,000) 1968 Age Distribution -Percent Mo. U.S. Age group Mo. U.S. Heart Disease 426.8 37206 Under 18 37 35 Malig. Neopl. 178.9 159.4 . - 18s 64 51 - 55 Vasc. Lesions(CNSJ 136.8 105.5 Accidents 6361 57.5 65 and over 12 10. Diabetes 22.0 19.2 Broncho-pneumon. | 19.4 - 16.6 RESOURCES AND FACILITIES ( Outside cf Ste Louis) Medical School ~ Univ. of Mo. School of Medicine, Columbia 1969/70 + Enrollment : 367 _ Graduates: 77 - Developing School « Univ. of Mo., Kansas City, Mo. ‘Professional Nursing Schools - 20, of which 11 are college or Univ.based. Practical Nurse Training ~- 21 of which 5 are college based Allied Health Carzers Program, Univ. of Missouri,Columbia Schools of C.ceopathy - 1967/08. + Enrollment. Graduates Kansas City Coll. of Osteopathy 428 106 and Surger_, Kansas City.o. Kirksville Coll. of Osteopathy 396 93 _vand Surgery, Kirksville, Mo. Cytotechnolosy - 1 ¢ Snodgrass Lahoratory, St. Louis City Hosp.) hedic.l Technology - 12 ( outside vf Ste Louis) Radiologic Technology - 20 ¢ " “ ) ‘Physical Therapy - 1 at Uni-. of Mo., Columbia ‘Medical Record Librarian ( 2 in St. Louis) Hospitals | . e . Beds - Extended Care Facilitie: “General short term 90 - 12,095 Skilled Nursing Hones - 208 (incl. some osteopathic) © (18,138. bed - Long term general 7 1,644 Long Ede abet Odses 23 V.A. general 2 729 « - Manpower Outside of St. Louis St. Louis. and. County. Physicians, Active 2,873 . 2976 “oo Inactive MDs 113 . | 103 Osteopaths 797 119 Professional Nurses ( adj. 1966 data) Actively empl. in nursing 8,389 . 2632 Not empl. in nursing 2,362 . 1183 | Group Practices ( 1969) State Totai:’ “ Fotal 1723. single specialty - 101 . General practice 20 beetle d anantinlees a1 MISSOURI REGIONAL MEDICAL PROGRAM Anniversary Application with a Triennium Page PART I: Staff Briefing Document Face Page...cscccsenccercesssceesesssscscesscenee I Demographic Information......seesesseereersserers 2 Component & Financial Summary...+sesssoerereeeres 4 MIS Breakout of Request (06 Year) ..cecesssscerers 5 Accomplishments, Problems & Issues aheet....se565 7 9 Completed Criteria Sheet....sseeceeesesrerreerers PART II: Kidney - not applicable PART III: April 4-5, 1972 Technical Site Visit Report * PART IV: Site Visit report of March, 1971 PART V: Advice letter of May, 1971 PART VI: Management Assessment visit - not applicable *Will be available for Review Committee . 1. 2. ISSUES AND PROBLEMS: 1. wren SS Te MRMP has reviewed the structure of its tripartite RAG and made the . - Region Missouri ’ SOV cle 5/6 197 2 FEB . _ Review Cyc rye #2 ar - f.- ‘ / OUTSTANDING ACCOMPLISHMENTS BY RNP since Febpryary 197 3 Reduced the size of and consolidated the functions of Program Staff Dr. Phillip Morgan has replaced Dr. George Wakerlin as Chief of Planning. ‘Formed a Goals Committee with embers of each of the three review bodies . oo aes ” . a, * * ‘ 4 2 > . = to develop a néw set of goals and cbjectives., Established an Evaluation . Committee tc propose evaluation procedures for review, . oe Increased the program activicy da Kansas City te the extent that ell of -the three new activities in the prescui application originate in the , . - subregion, . Heeded Counet 1 advice to imerease the propurtion of its total program committed to community-based activities. ane Green Hills project (#83) - : is one of the bet ter examples of a community-based activity directed ; toward the organization of services and educ cation. . Se - Rednéed the amount of RMPS funding fox the computer. and bioengineering 7+ activities and sought cthax - sources o£ support (NCHSR&D funds for the oT hiissourt Automated Radiology - Service and the Automated Physician's Assistant pr rojects), The current. level of RMPS support for these activities is approximately $422, GOO, including the contract with Dr.. Bass. ~ + vo. : ae . . decision that the Advisory Coumpil (one of ,she former three parts).is the RAG. Staff is concerned that the twe lve-member Advisory Council ‘does not fulfill the ilegad requi renents for RAG membership ; particularly VA.and CHP representation. Funding level for MRMP. The commitment :is 81.8 million.and the Council ° approved level is $2,012. “MBMP submits plans for use of $1.8 million and $4.6 million. The preseat twelve-month level of funding is $1.9 million, co OT . vee PL ete Tem A technical site visit was neld April 4 and 5 to review MRMP's - $805 ,094 request fOr continuation of computer and bioengineering activities and to provide assistance to RMS in monitoring the - contract with Di. Base in Salem. The findings of the visit. will be available for: Reviaw Committee and Council, — “e . The need to develop a workable set of goals and objectives and an action plan. Staff agreed “hat any of the projects in the application addressed the target areas ip, 50) but they were unable to find in the - application evidence of au for addressing these target areas in any unified way. ; : ° . * meee me Oe a ER fe ec te ote Page 2 braft: Region Missouri Review Cycle_5/6 1972 MRMP's approach to rural health. MRMP's projects dealing with the rural health care problem still appear disease category~oriented to some extent, but the more recently funded projects reflect a shift toward a more comprehensive emphasis, particularly in the Green Hills project. It appears from the application that MRMP staff has not developed an overall organized attack on the problem, again reflecting the need for a regional plan. The use of Program resources. Despite the size of Program staff (60 positions; 48.5 F.T.E.)}. Program resources do not appear to be organized or deployed in a manner which permits the Kmr to more rapidly respond to new program goals and special initiatives, or to requests for assistance at the subregional level. MRMP's continuing education and training proposals include many health professions, and teaching methods and are conducted at various institutions. Some of the more innovative activities involve the health care team approach (Docent Unit - #86) and the pediatric nurse associate (#86) in Kansas City. A problem for reviewers in this area is the fact that MRMP has submitted the Continuing Education--Coordination Project for the fourth time. Reviewers will recall previous criticisms relate to the lack of coordination with the overall MRMP program, and the emphasis in determination of needs at the University rather than the community level. Since the proposal is several years old, staff believes that it should be reexamined in the light of possible development of future community health education systems in Missouri. MPQNENT { CONT. WITHIN] CONT. BEYCND| APPR. ! NEW, NOT I GURRENT) 1 CURRENB I eal f APPR. PERION] appa. PEGING] PoFV! L:Peevraus_y | DIePeECT oo | ENOLerRCT I y | } } OF SuPPNnRT | OF SUPPNRY [| FUNNE [ APPROVED t costs t costs ‘ f 7 a t ] | 1 | ! a FICE NF. COORDINATOR © | 1 ! ‘ 1 | I 4 ' nee j $4723130_1 ! J i $4272130_1 $191,227 1 £9249357 4 MH ICE OF OPERATIONS I ay | I { : | I | be = a es ot ! $199¢5946 | 1 ! £199,594 1 40,854 I S240 622] ‘2 OFFICE OF Pts t t t | I | , 1 I acim a { $19342994_ 1 ! 1 1 $1932994. 1 $52,253. 1: $252,847. 1 SKC AISTRICT A t -° I | ! I | a. I § i a sats L $154,977 1 L ! tL SILEAL TI t 412811. ! SLOT AAD {... w su REGTENAL DISTRICTS 4 1 | ! | I = | | tos 4d $1152297 21 i i Ll a1152997_ | S27828 J Rae eee] is GFeice OF CONTINUING. EDU} | i \ I ceob st I LSTICN ome on ! $5n neo | 1 j t $59,900 1 $1421931. $64e593. 1 rqee Ie a $C $l 21372852711 1 j MU $y 27. 2921S S25Z CANDLE £12461 e Sh 27) ELNOYENTAL COMPONENT | | { | 1 . | ae ee et i | L | g19c,con ] #jor.n0n_f wud R90, 900 1 ROKE INTENSIVE CAGE | | | 1 1 1 ol costes l eh, | 1 $296,964 1 J | $206,564 _ 1 $93,943 4 i & lays | INING OF CMM -ENSPITAT | I ! ' ee | oad, J Lt ss 1 £522.364_ 4 ! I 4 $522264_1 $152260_1 $674624 sTABETES. is { | { { { | ood f. e t $21,986 1 l I ] $91.986_1 $222295 1 £199,283.) > | | | { cee se Pals pol { { ! J $27,448 4 272448 1 $P,729..4 o£ 26,) 871 1 $835996))_- j {4 $27244B) It. £109, 424d TE $2693411 aitas set de 1 { i { i ae: i $179,458. 1 ! 1 $129,458) wl € 179,458. i | 1 | | I ! t “fp jo: J { J $1R85.548_ 1 $120.56 1 cal $2993 542] i $17954580 1 i Lt SiO, S4a) tt $2602004)4 poate $3402006) 1 DEVENTICRT: ' t t od j : qo to $432.357 1 | I I $434357 1 od 883235I_1 7 I I { | i : Pek oe cet et £952214 J l J i $95.214 1 $32,009.14 $118 2212 4 vi wl { I | | ea fe gel l. $129,511 1 1 i | 8129. sit J dee F129 SLL. | I | | | | a eB ob { 2412298 l L ! | $4 757901 $13,478.) $612187_1 I. I 1 | | rs t ep a Tie 2h. ! } £31,582. 1 1 $31,582] $1.853.1 $39,438). i $67.095_ 5 I f | $67.995_1 $285 O48 £105.2143 1 { 1 J | | poo a | oer oo eof [ $179,037.21 t L { $1794932_1 £40 oat $219,110 1 { : I I I { mek A E ep zd | ! $752740. 1 I -$7527491 $12.614-1 $22225£_1. S14 I | 1 | poss | “f een ee I 1 g2n0,nna | | L $207, 0004 $214175 i g2Ual ISL | { J { 1 Sed I oad |. j ! i $378,309 ] $3742209_ 1 $59,648 L $436 5949 id ! $20NSON)) ($3782 209d $523.20911 ~f2cs8T Siti we Soh8e 241 b. vw web BUPA BEG BREAKCUT CF REQUEST ROVULUN 7 MEDIUM’ RM 04009 F6/72 N& PROGRAM PERIOD RMPS oS eo SE a Oo » [REQUESTED 2449 940 LEIS EE CE ESSE . es NOON. ~ A er se _ [councrL PSS EOE SCE “JAPPROYVED LEVEL 1,741,000 XY “NT *, Se ONAN PSL OSES “< >< ROR-RMPS and INCOME * Under 2/8/72 National Advisory Council . ‘policy, the approved NAC level for the first : ; REGION Mountain States year of the triennium prevails. “S . , “May/June 1972, REVIEW CY **K 1s0 pending are the following requests Ol 02 03 EMS 375,576 234,945 CBES 219,575 182,000 100,000 Current Prog, Request 1,829,955 Total or 2,425,106 5/23/72 WOB/RMPS RMPS - Page 1 STAFF BRIEFING DOCUMENT , __ | OPERATIONS (4's Eastern | iL! Mid-Con t x estern REGION MOUNTAIN STATES REGIONAL MEDICAL PROGRAM | BRANCH = -— outh Centr * {= | BRANCH TYPE APPLICATION LAST RATING Tel. No. 443-2816 Room _1Q« 25 a {7 TRIENNIAL 197 DATE BRANCH CHIEF Richard Russell fo _— 197 /*f 1st ANNIV YEAR fx] SARP BRANCH STAFF James A. Smith [7 2nd ANNIV YEAR [] REV. COM. RO REP. Dan Webster L/ OTHER LT OTHER Last Mgt. Assm't Visit N/A 193 ’ Chairman LAST §.V.March 197.1 ; Chairman Clark H. Millikan, M.D, ‘ aff Visits, Last 12 mc . (Dates, Chaiz.uan's Name and Type of Visit) Staff visit to observe the Region's oe 1971 Jessie Salazar, Jim Smith project review panel. Major Events Which Occurred in the Region Affe.ting the RMP Since Its Last Review in May 197-1 Alfred Popma, M.D., Coordinator, retired in December, 1971 after five years of service to the program. His deputy, John Gerdes, Ph.D., was named interim coordinator until a new coordinator is appointed. Dr. Gerdes is a candidate for the job. The other significant happening for MS/RMP during the past year has been the emergence of long suppressed feelings of discontent with its grantee, WICHE. MS/RMP complains that the grantee (WICHE) maintains undue restraint on the programmatic efforts which hinders the Region from being responsive to many of the new national priorities. The Region feels that its progression of development and maturity is at the level where it can consider the possibility of becoming a nonprofit corporation. WICHE is resisting that notion, maintaining that the success of MS/RMP to a large degree has been through its affiliation with them. Currently, it appears that the two parties are working toward an acceptable compromise. WICHE will probably remain as grantee, but extend more programmatic latitude to the MS/RMP. Page 2 Mountain States Regional Medical Program an ’ nl 7 Late*tH ores sueem 1A gee tomy watt onat - by) ih leegets 0 bore Ley Rem od Kalisoalt f paw Core I a 6.) 5 ' A . (— 4 Cte 7 os Pa * re ‘gma “— eae ewer men Pewee Pant od _ omnte IDAHO — Z Lane MONTANA pee fie one NEVADA Ho | amas ay oes Phapeboy WYOMING y om ay af, Mpeg mete os > de REGIONAL OFFICE - Boise SUBREGIONAL OFFICES @ Idaho - Boise @ Montana - Great Falls @Nevada - Reno @ Wyoming - Cheyenne oa) Page 3 ADDITIONAL, Mountain States RMP (Wiche) . INFORMATION 3/72 Geography and Demography 4 State area: Idaho, Montana, Nevada, Wyoming; interface with Colorado-Wyoming and parts of Intermountain “Land Area: 435,643 square miles Population (1970 Census compared with 1960) Total in 000's Density 1970 Per Capita 1970 1960 (1970) Income Idaho 694 667 8.7 $3206 Montana 713 675 4.8 3381 Nevada 489 285 (4.2 4544 Wyoming _ 332 330 3.3 3420 (U.S. Total 2,228 1,957 3910 Average) Rounded to 2,230,000; average density 5.1 per sq. mile Increase of 14% compared to 1960 Median age: (1960) each State below U.S. average of 29.5 Percent Urban: Idaho - 54%; Montana - 53% Nevada - 81%; Wyoming - 61% 4 State average - 59% urban; 41% rural ; Metropolitan areas - 1970 preliminary population, compared with 1960 1970, 1960 Billings, Montana 86.1 79.0 Boise, Idaho 109.4 93. Great Falls, Montana 79.7 73.4 Las Vegas 270.1 127.0 Reno Nevada 120.0 84.7 665.3 457.6 Non-white - 95,100 (4.2% of 4 State total) Black - 34,500 . Other 60,600 (mainly Indian and Spanish-surname) Vital Statistics - mortality rates (per 100,000 population) 1967 : U.S. Idaho Montana Nevada Wyoming Heart. disease 364.5 305.9 326.5 239.6 312.4 Malignant neopl. 157.2 131.3 142.9 122.7 130.2 Vasc. lesions 102.2 95.1 96.7 68.9 91.4 (aff. CNS) Diabetes 17.7 18.7 20.1 11.3 16.5 Broncho pneumonia 14.8 18.8 17.0 20.7 27.3 excl. infl. & pneum) Accidents (1968) 57.5 79.5 79.4 85.1 89,2 Shasi Mountain States (continued) é Facilities and Resources Medical School - 1 developing 2 year school - Univ. of Nevada, Reno; first class (24) to enter fall of 1972 Allied Health Sch - Idaho State Univ. Coll of Medical Arts, Pocatello Professional Nursing Schools Licensed Practical Nurses _ 15 - each affil. with school district or college . 5 - 4 college or high sch affil. ¢- 8 - 6 hosp; 2 priv. schools = _ 2-1 college based Idaho -— 4 (4 College or Univ. affil.) Montana - 6 (4 College affil.) Nevada - 2 @ University based) Wyoming - 3 (3 College affil.) 30 (20 are high school or Total 15 (13 college or college affiliated) university based) Schools of Medical Technology Schools’ of Radiologic Technology. Idaho - 6 Idaho - 7 Montana - 4 Montana - 6 Nevada - 3 Nevada - 7 (2 Univ. based) Wyoming - 1. Wyoming - 2. , 1 14 (each at hospitals) 2 (20 at hospitals) Cytotechnology training - no schools Hospitals - Community General and v.A. General yong EL). Short-term special) v.A. General # Hosp. Beds # ~=Beds # | Beds _ Idaho 48 2,879 1 37 1 172 Montana 56 3,841 1 228, - 2 256° Nevada 17 1,951 ~-- 1 224 Wyoming 27 1,825 2 _ 698 1 174 *148 10,496 4 963 5 826 ° *1965 report - 142 short term, 8814 beds _§ V.A. General hospitals, having total of 826 beds Special Hospital Facilities 1969 . Idaho ‘Montaha Nevada Wyoming 1 1 Intensive CCU 1 Cobalt Therapy Radium . Isotape Facility Renal dialysis Impatient Rehabilitation Impatient wrauren Qunaro Fo neuUue oO Ne Bw Ww Ww: - Page 5 Manpower Physicians - Non-Federal Graduate Nurses 1966 Active MDs and DOs no. Empl. in 1967 Not empl. Nursing MD DO Total Inactive Total in nursing —(adj.) Idaho 610. 37 647 29 3049 1090 1954 Montana 656 40 696 30 3404 916 . 2483 Nevada 423, 28 451 26 1533 470 1060 Wyoming _293_ _13 306 16 1621 410 1209 Total 1982118 2100 101 9607 2886 6706 Ratios of active practicing physicians About: 70% were actively range from 89 per 100,000 population . employed in nursing. in Idaho to 102 in Nevada. Average Average ratio for region -- for region is 94/100,000 compared about 301 per 100,000 with national average of 132. compared to 313 for U.S. as a whole. *Of the total active practicing MDs (1982) 802, about 40%, are in general practice. The majority of the remaining are specialists; a small number are hospital based and a smaller number are in other professional activities. Group Practices - 1969 Single General. Muiti- By State Total , Spectalty Practice Spectalty Idaho 28 10 7 11 Montana* 36 5 9 22 Nevada 27 18 2 7 Wyoming 10 2 4 4 Component and Financial Summary - Anniversary Application o Page 6 APPROVED LEVEL a COMPONERT CURRENT D5_ YEAR ~| 05. YEAR RECOMMENDED YR'S AWARD COUNCIL FUNDING + O4 OPER. RECOMMENDED ‘REQUEST SARP YEAR LEVEL REV. COM. LORE 788,286 LK 947 034 Sub-Contracts u PML NLM PLASM u ASK : SX OPER. ACTIV. 630, 066 ONKOL 708 , 345 ‘ DEVEL, COMP. 0 CS 100,000 Yes (_) or ¥o (_) ARMARKS ! KIDNEY Kidney #24 O- 7h 576 Health Train- . ane #23 Network 0 219,575 RMPS b_ ECT 1418, 352_ 1,511,000, - 3 —— REQUESTED 2 Wg 94g. COUNCIL 1,741,000 NON-RMPS and INCOME 374,000 Tne O4 Year is beijing extended, to 9/1 and the regio the three month extension resulting in a direct cos UTE oY REGION June Mountain States RMP + 1972, REVIEW CYCLE n will receive $354,588. for. t award of $1,772,940 for 15 months. former MARCH 1791972 BAEAKCUT OF REQUEST REGION = MOUNTAIN RM 00032 06/72 RHPS-OSM~JTOGR2 oe ee ee eee nee cree _ 0S PROGRAM PERIOD . ee ee : {5} ; (23 (4) on oe IDENTIFICATION OF. COMPONENT | CONT. WITHIN] CONT. BEYOND] APPA. NOT | NEWe NOT j CURRENT { CURRENT | t | APPR. PERIGC] APPR. PEAICO| PREVIGUSLY | PREVIOUSLY {| OIECT [| INDERECT | ‘Total = _. 1 CF supPORT .1 OF SUPPORT | FUNDEO t APPROVED costs costs | i en Coe { i sa . we eee eee i caoo CORE I i I ! | ' ! t i I $947,034 5 l 1 1 $947,034.) $2042647_ 1. $1,152,681 1 DOGO DEVELOPMENTAL COMPONENT | j 1 1 i |. 1 L. 1 j L $100,000. \ $100.000_1 1 $100,000. J 002 PROGRAM 10 PROVIDE CORCNI | ) ( ! | | I waub®Y CASSEL TOATNING MISSOULAL $109, 863.1 1 1 4 $109,861] $15.2339_ 1 $1252.200_1 003 MGUNTALN STATES TUMOR IN] i { I i . | i | me A LLIVIE. WW. 1 £)65.000_1 1 L i 4164..000_1 $43. 5664 1 $208,566. | 007 CONTINUENG EOUCATION For] I i t § | I j NUS SENG NEVADA $o42101 5 I \ $44.10) 1 $18.869_1 $82,970. 1 _ OL CONTINUING ECUCATICN rea j | | | | { _.BUBSISG.LDABE. $52.370.1 1 1 l $$22370_1 $152,986) $66.256 1 Diz CORCNAKY CARE TRAINING i 4 ot I i I ! i quInwesl_Loauo $12,808. 1 I l I $12,808 $1,058_1 $132844.1 O13 CUNTINUING EDUCATICN reat I i I j t i j — oe NUR SIBG. WY CUING. : $6).127_ 5 i l 1 $olel27J $202449 $Hi.576 1 015 CGATINUIAG EOUCAT ION i j j j j t , I —— MUBSING HONTAYA_ $492.253_1 i I 1 849.253." Latesa tees 022 NEW MANPOWER FOR THE TT i | i | NIADN. SIAIES REGION I i J i $274:550.1 $1742550 I $243763 | $199,313 t 023. REGIONAL AREA HEALTH Eoul i t I I I t LA CATION. PROGRAM I l j $219:525..5 $219,575 1 $35,672! $255,247 1 02% KIGWEY DISEASE CONTROL 7 | I ! - { - 1 rr ee ~ BOGSAS . j i i $24,576_1 $274.576.1 $11,765 4 $66.34%5.1 O25 PREDEVELOPHNTL PLANALNG ! t I 5 t i jo ah DLE EICER HMO, I l 1 j £19,275] $19,275.4 $5635.13 424.9105 } 5 I | L | I } TOTAL 1 $2,462,554 | i $100,000 } $487,976 1 $24049-$30 j $4129401 | $2e461,931 | _ seta Seven ne is ti. <5 se a mt Page 8 Cee MARCH 17,1972 , REGION = MOUNTAIN BREAKOUT OF REQUEST RM 00032 06/72 coe ee ce _ _ _. 06 PROGRAM PERIO0 . _ Oe eee cece ee RUPS@OSM 1,020 ,400 Sub-Contracts ex re NO KO = PER ACTIY. 4] 5 »f57 ee Soh Seek 577 500 EVEL. COMP, DISAPPROVED IEEE’ 134 860% Yes () or No_¢ EARMARKS $ _ xipuey (#40) 111,826(dd) » (125,000) 125,000 Mode _. Cities (#45) 52 ,810(dd) (39,550) ~~ + 98 DIRECT 1,348,603 | 1,800,000 1,732,760 1,425, noo PSS “KL. Ko OK SOLS Sep LADS OSE ON OR ROS. ‘OUEST ELISE OSEAN OS OEE STS| ERE SEES REQUESTED 2,750,577 7 OO > Oe PSS S EES. , > ¢ < : COUNCIL < APPROVED LEVEL 1,800 ,000 SOS NON-RHPS and INCOME @® Under 2/8/72 NAC Policy, the approved NAC level for the first year of the . Triennium prevails . *& Withdrawn by KRMP - «x9 PLUS kidney funds of $125, 000 seek This amount incluges $125, 000, for #40 and $39, $501 “tor #45 v - o- REGION June KANSAS 1972, REVIEW CYCLE Revised 5/2/72 ‘ a AVAYA LAA OY 1 mf REGION Kansas . REVIEW CYCLE dune 197 nee nt RECOMMENDATIONS FROM within orion e [XX7 —-SARP [<7 Review Committee rating 264 [fj Site Visit [7 =Counci} “UNDING RECOMMENDATION: The Staff Anniversary Raview Panel (SARP) recommended that ENDING Fee : KRMP be funded in the amount of $1,550,000 to include kidney funds (Project #40) which are not to exceed $125,000 for the 06 operational year. This a ount ($1,550,000) reflects a reduction in that the application request was for the amount of $1,732,760. RATIONALE: SARP felt that the recommended amount would provide the Program sufficient as financial latitude for the projected expansion of activities within the Region especially since the KRMP now plans to pursue the supplemental funding route for several community health manpower prograls. — Since the prerogative of an out-of phase supplement was not available to the Coordinator at the time that tne presens application was prepared, 4 Developmental Component had been reques ted for tne sale purpose of establishing activities dealing with expansion and augmentation of manpower nS aunity level. In view of the new option now available, the Region programs at the communi ty jeontal funds has chosen to withdraw the Developmental’ Component and compete for Supp 1 Tb using both the May 1 and June |, 1972, protocols. Since the Region plans to utilize available liquid assets in tne Core budget for 46 planning and feasibility studies, reviewers did not feel that additional developmental funds were needed at this time. CRITIQUE: SARP concurred with Staff regarding its assessment of the KRMP. The 6 Coordinator's "style" and his apparent dominance over his RAC and staff suggest some problems and weaknesses. Program staff is talented but apparently underutilized. Turnover of subregional staff is significant. The reviewers believed that the Regional Advisory Council should address these problems. In the past, the RAC has been somewhat of a "rubber stamp" organization although the Coordinator indicates that this body is becoming more mature. More involvement by the Local Advisory Groups and the RAC is strongly recommended, Committee organization and. Program Staff participation are indicative of increased interest and involvement. SARP felt that since KRMP was one of the first Programs to become operational, their track record was somewhat disappointing. Although there has been a great deal of Core and Project activity, it is very difficult to obtain any real sense of explicit accomplishment. Because of the above mentioned problems, SARP had recommended that the Developmental Component be disapproved. Since this request has subsequently been withdrawn and the requested funding level is below the NAC approved level for the 02 year, it would not be necessary that this application be submitted to the Review Committee. Technical assistance was recommended, as follows: (1) Pldn a Management Assessment Visi to KRMP in the immediate future. (2) Invite Mr. Ray House, recently appointed RAC Chairman, to participate in a site visit to an "A" Region with a strong Advisory Group. (3) Invite Dr. Brown, Coordinator, to participate in a site visit to an "A" Region, (4) 6... Technical Assistance to the KRMP in. regard to the pending 910 Kidney application Jomposite; Bi-State, Missouri, and Kansas estimated at $1,000,000). (5) Assist and encourage KRMP how best to use the results of their intensive evaluat ia G7 iors. ‘ 1 bet ge en PT rae Marta 21, 972 pet Post MinieSAxP xeport Mountain States Resional Medical Program Kidney Disease Control Program Proposal Froosa. ey Based on a lack of any Kidney Disease Program, it is proposea that 2 centers each in [daho, Montana, Neveda, and Wyoming be developed for the retrieval and transnortation of cadaveric kidneys to 6 trans- plantation centers outside of the region in Seattle, Denver, Porte land, Salt Lake City, San Francisco, and Los Angeles, Furthermore, it is proposed to establish a continuing education program for appropriate health professional directed toward the management of patients with chronic renal disease. It is also proposed to devel- op a reeional public education program regarding kidney disease. The projected Ist year budget for the program is $76,000. MinieSARP Action The Mini»SA&P recommended that the MSRMP Kidney Disease Control Program Proposal not be approved for funding. The Panel feels that the intent of the Local Technical Review Panel recommenda-~ tions have not been embodied in this proposal, and the Panel believes that the proposal does not fit the guidelines of Noveme- ber 19706 and the more recent position paper of January 1972 on Kidney Disease. The panel felt the technicai aspects of the establishment of the retrieval and transportation network were sound in terms of zeozraphic distribution, professional person» nel availability, and population concentration, however, more than a retrieval and transportation network is necessary to ese tablish a Kidney Disease Control Program. The panel fears that the proposal does not assure that any Mountain States Region rpatient will necessarily benefit or receive transplantation as a result of the proeram., The program does not address itself to providing chronic or home dialysis, and it does not address it self to the delivery of services to the nonewealthy patient with chronic renal disease. Tae Mountain States Region should prepare and present a new Kidney Disease Control program after the following steps have been taken: L. A Survey to determine the number of potential harvestable Kidneys within the rezion should be conducted to determine whether in determining where retrieval centers should be established. 2. A survey of tne incidence, prevalence, morbidity, potential number of transplant candidates, and mortality of chronic renal 2ase in the two unsurveyed states of Nevada and Wyoming should be conducted to aid the region in determining the scope and size of the various aspects of its Kidney Disease Control Program. The proposal should contain: 3. 4e &. More substantiative arrangements and agreements with the partic- ipating transplant medical centers concerning kidney usage, shar- ing, and transplantation of Mountain States patients. A program for the development of a chronic dialysis program and 3rd party & State support for chronic dialysis for the patient in the Mountain States. , Provisions so that the patient without unlimited wealth can be a renal transplant recipient i€ medically acceptable. Provision for continuing professional education in the areas enumer- ated in the present proposal and including professional education in home dialysis and its supervision to dovetail with currently developing home dialysis training programs. Explanation of the 24 times increase in 2nd year equipment ex- penses when equipment purchased in year 02 is only 5/4 of that to be purchased in year Ol. Acceloration of the public education program timetable so that it may have some impact in meeting its objectives in the program. Jimny L. Roberts, M.D. RMPS/DPTD JLR/jlr Review Cycle: June 1972 Type of Application: Anniversary‘Within Triennium Rating: 319.4 (B) Recommendations From /_ / SARP . ; / x/ Review Committee i: = / 7 Site Visit / / Council RECOMMENDATION: The Committee agreed with the site visitors in recommending increasing the Council approved level for the 02 and 03 year, approval of the developmental component request, continuation of program staff and seven ongoing projects, the implementation of an approved and unfunded . project and the initiation of three new projects. The Committee, parelleling the recommendation of the Kidney Staff Review panel and the site visitors disapproved Project #15 - Home Dialysis Training Program with advice to seek consultation from existing and proficient home. dialysis training programs. The total request and recommendations are as follows: Direct Costs Year | Requested Recommended 02 $1,316,577 $1,099,000 * 03 1,211,672 1,138,135 *Includes $27,060 for Project #14 - Kidney Organ Donor Program CRITIQUE: The N/SRMP continues to exhibit the strength that led the Committee to recommend an approval of the triennium application last year. The problem areas identified during last year's Site Visit have received attention, and‘although not all have been solved, definite progress has been accomplished. The reorganization of the corporation, both at the policy-making level and at the operational-level will undoubtedly increase the effectiveness of the Program. The policy-making level is still cumbersome. However, the Committee recognized the problems encountered in restructuring the organization to meet RMPS guidelines and believed that the organization as now formulated will prove to be functional. The Committee believed that the administrative capabilities of the Coordinator and his key-staff have increased and that the Progran, although somewhat lacking in. formal community participation, has developed valuable informal participation linkages. Committee further noted that the goals and aims committee does not include any minorities. A mechanism needs to be developed to enable minority groups to present their views to RAG. The Region was,found to be developing coordinated program thrust that is realistic in terms of community needs and there are adequate review mechanisms to establish priorities, formulate projects and Program staff actions into programs and monitor these programs after they are operationalized. -2- . . : e The Committee questioned specifically two projects; The Pediatric Nurse Practitioner Training - Project #12 and A Regional Approach to Computer Assisted Electro Cardiograph and Spirometry - Project #7. Regarding the latter project reviewers felt the expenditures were justified on two levels namely creating linkages among hospitals and early plans to make this project self sufficient. The Pediatric Nurse Practitioner Project was found to be designed in line with the joint "Guidelines on Programs for Pediatric Nurse Associates" issued by the American. Nurses' Association and the American Academy of Pediatrics. In addition the project also complies with the laws and standards set forth by the State of New York. Special Council Action Committee recommends to Council for their review and consideration that HSMHA joint fund the Nassau-Suffolk RMP-CHP Inc. From an organizational and theoretical point of view committee feels this would be beneficial to the region. It would mean in effect that HSMHA would be receiving a single application from a single agency and that a joint award would be issued either from CHP or RMPS. In effect RMPS would be coordinating our central and regional office efforts with CHP in the review of the application and the expenditures of the region. Component and Financial summary - anniversary appiicectio at - - i ! j COMPONENT “#8794, 494 was awarded. for ‘the 12-month -b ydget period 7/71-6/72. Region has een extended two months to $772 to accommodate the three-cycld.reyiew system. _ Been awarded for. the two- -month extension. ae x CURRENT 2. YEAR --| 02. YAR ~ RECOMMENDED YR'S AWARD - COUNCIL FUNDING or. OPER. RECOMMENDED | ‘REQUEST SARP YEAR LEVEL _ REV. COM.) ~ core 331,234 446,179 $3815;000 ; Sub-Contracts - foper, ACTIV. 463,260 729,569 611,940 . OR Fr XS 79,000 DEVEL, COMP, SiO 79,449 yes (2) or Ko ( EARMARKS $ 61,360 27,060 " KIDNEY .. |RMPS DIRECT #194 494 - 268.408. {41,316,522 4 099 ogo ‘ . ? RLS yp KN AN PS” SCS J 2 REQUESTED 1,467,221. LEE E Ps SOLES ST LES OS OSE COUNCIL ~ APPROVED LEVEL 829 ,755 NON-RMPS and . INCOME -- ° REGION Nassau-Suffolk RMP : es “May/June 1972, REVIEW CYC A pro-rated: amount of $132,414 has RMPS STAFF BRIEFING DOCUMENT * * —— — OPERATIONS /X/ Eastern / | Mid-Co: EGION Nassau/Suffolk Regional Med. Program BRANCH fT South Centr'l /“7 Wester! BRANCH . YPE APPLICATION Not ratedLAST RATING Tel. No. 301-443-1810 Room 10-35 “] TRIENNIAL 197 DATE BRANCH CHIEF Mr. Frank Nash X7 1st ANNIV YEAR {7 SARP BRANCH STAFF Jerome J. Stolov/E. I. Faat _/ 2nd ANNIV YEAR /-] REV. COM. RO REP. Mr. Robert Shaw 7 “7 OTHER j _/ OTHER fi Last Mgt. Assm't Visit Inly 19; Mr. Simonds, Mr. Haglund Chairman > ? March Mr. baker AST S.V..25-26 197 1 ; Chairman Dr. John Kralewski taff Visits, Last 12 mos. (Dates, Chairman's Name and Type of Visit) 1. Nov. 11, 1971 Mr. Simonds, Mr. Mercker, Ms. Faatz ajor Events Which Occurred in the Region Affecting the RMP Since Its Last Review n__ April 197 1 =; March 1972 14-15 CHP Site Visit Revision of grantee and RAG bylaws to form new corporation. ‘ Revision of cost accounting practices to better accaunt for RMP dollars. Feb. 1972 Sept. 1 was designated to be the’ new anniversary date for the NSRMP grant. Jan. 1972. Dr. Marguliés comments on the need for RMP fund accountability and RAG responsibility for program matters. < . Dec. 1971 Dr. Hastings responds to Management Team Report. States his . objections to forming new grantee organization. Nov. 1971 11 Management Survey Team Report May 1971 Advisory Council recommendation for 01-$829,755 02-$868,408 03-$908 ,043. @:: 1971 25-26 Last Site Visit. REGIONAL CHARACTERISTICS OF NASSAU-SUFFOLK REGIONAL MEDICAL PROGRAM Nassau~Suffolk Congressional Districts 1-5 1. Otis G. Pike (D) 3. Lester L. Wolff (D) 2. James R. Grover, Jr. (R)_ 4. John W. Wydler (R) 5. Norman F. Leut (R) Geography and Demography--Region encompasses two counties, with an increasing population and urbanization. Nassau County--1,428,000; Suffolk County--1,011,000; Total--2,438,000 Population (1970 Census)~-2,539,700 compared with 1,967,000 in 1960 Land Area: Nassau--300 sq. miles; Suffolk--922 sq. miles; Total 1,222 sq. miles; Density, 2,080 per sq. mile. Urban: Nassau--nearly 100%; Suffolk--about 90% Non-White Population, Nassau and Suffolk, 1960-1970 Year Number Per Cent 1960 76,919 3.9 1970 143,027 5.5 Population per Square Mile, Nassau and Suffolk, 1950-1960 1950 1960 Nassau (300)4 2,243 4,334 Suffolk (922) 300 723 4 Area in square miles Population Growth 1950 1960 1970 (EST.) Nassau 672,765 1,300,171 1,461, 250 Suffolk 276,129 666 , 784 1,133,845 Total 948,894 1,966,955 2,595,095 U.S. Census; Long Island Lighting Co. Population Survey Population, Distribution by Age, Nassau-Suffolk, 1960-1975 bh of % of 7% of 1960 Total 1970 Total 1975 Total Under 15 667,617 33.94 833,470 32.00 872,229 30.15 15-19 119,335 6.07 244 ,649 9.39 282,556 9.77 20-24 75,614 3.84 184,666 7.09 222,411 7.69 25-29 105,637 5.37 145,005 5.57 206,255 7.13 30-39 331,777 16.87 318,754 12.24 348,037 12.03 40-49 279,825 14.23 380 ,462 14.61 371,220 12.83 50-69 304 ,993 15.51 402,038 15.43 484 ,078 16.73 70 and over 82,157 4.18 95,778 3.68 106,433 3.68 TOTAL 1,966,955 100.01 2,604,822 100.01 2,893,219 100.01 Health Manpower Physicians--Nassau, one practicing physician for every 716 residents (U.S. 1/653); Suffolk, one M.D./1,014. 50% of physicians--some type of specialty 25% of physicians-~general practitioners 25% of physicians--in both Counties registered no hospital affiliation Dentists--Nassau, 1,457; Suffolk, 649; Total--2,106. Nurses--Nassau, 8,827; Suffolk, 7,193; Total--16,020. Inactive: Nassau, 3,750; Suffolk, 2,345; Total--6,050 Allied Health--The present market for budgeted allied health positions is 16,965. The employment figures reported are 15,304 allied health positions. Health Facilities--38 hospitals in Bi-County Region; 32,000 beds. A. 25,698 for mental care 1,068 beds at V.A. hospitals 510 proprietary hospitals 86 Nassau County Medical Center 44 in voluntary non-profit hospitals 23,990 State mental institutions B. 6,657 General care beds and TB and Rehab. 3,745 or 56.3% in voluntary hospitals 2,176 or 32.77% in proprietary hospitals 736 or 11.0% local Government Long Term Care--5,897 beds in six nursing homes 4,581 or 77.7% proprietary 1,087 or 18.4% Government 229 or 3.9% non-profit Developing Medical School--State University of New York, Stony Brook, L.I. Health Sciences Center--Medical School plans include establishment of 600 bed University Hospital ‘Nassau/Suf folk Pegtonal Medical Program Approved Level 829,755 Component and Financial] Summary — ’ Next Year Recommended 02 year Funding if Current Award Council () SARP Component Ol yr. Recommended Level} Request C¥ Review Committee Core $§ 331,234 $ 446,179 Operational . ‘Activities 463,260 729 ,569 Developmental ‘Component 79,449 : : Earmarks: Kidney -0- 61,380 RMPS Direct 794 494% $ 868,408 $1,316,577 | TOTAL RMPS $ 794,494 | $1,316,577 Non-RMPS & Income -0- -0- TOTAL BUDGET 794,494 1,316,577 : i REQUESTED $1,467,221 | ! Council | | - *§794,494 was awarded for the 12-month budget period 7/71-6/72. Region has heen extended two months to 8/72 to accommodate the three-cycle review system. A pro-rated amount of $132,414 has been awarded for the two-month extension. ACCOMPLISHMENTS 5 TNC L. Region: Nassau/Suf folk RMP Review Cycle: June, 1972 _ LAST REVIEW The proposed reorganization of the RAG/Grantee structure to eliminate confusion and clearly spell out the roles of each. The development of new cost accounting procedures for better control of RMP and CHP dollars. Reorganization of core. Apparent continuation of good and productive relationships with numerous other organizations. Revision and simplification of the review process. PROBLEM AREAS 1. There is some indication that the joint RMP/CHP direction and staffing, with its organizational and functional reflections, is not only confusing to the larger provider community but may be counter-productive from an RMP vantage point in achieving the cooperation of providers. The N/SRMP has invested a considerable amount of effort in planning studies. How have the results of the planning affected the Region, both the RMP and others? Does the application present an overall plan of action into which the various activities logically fit? Is the membership of the Joint Aims and Goals Committee and the Joint Program Committee such to raise question as to the main~ tenance of separate identities for the RMP and CHP? OTHER ISSUES REQUIRING ATTENTION OF REVIEWERS 1. 2. The reasonableness of the new RAG/Grantee structure. Adequacy of core organization and management, and the need for additional core staff. The functions of the 19 local CHP planning committees. The mechanics of the project evaluation strategy. Adequacy of review process, both programmatic and technical. Has the progress of the Region during the past year been sufficient to warrant an increase in the Council-recommended level? Pus eee MARCH 17,1972 REGION = NASSAU*SFK BREAKOUT OF REQUEST . RM 00066 06/72 02 PROGRAM PERIOD ; . ____ RMP S=OSM=JTOGR2 _ (5) (2) (4) 1) / TOENTIFICATION OF COMPONENT | CCNT. wITHIA] CONT. SEYCNDL APPR. NOT | NEW, NOT | CURRENT f CURRENT ! ! | APPR. PERICG| APPR. PERIOD! PREVIOUSLY | PREVICUSLY | CIRECT J INDIRECT | TCTAL ‘| OF SUPPURT | GF SUPPORT {| FUNDED | APPROVED | costs l costs a | - { ! I . I to COoO CORE | | | [ { | | | -—— t $446,179 1 i 1 l $446s 179 1 L $446,179 1 OOCO DEVELCPMENTAL COMPCKENT ] | I | i x i 1 ] wae nee -~ 1 4 L 1 $794449_ 4 $292449_ 4 I $792449 1 O01 CCMYPREFENSIVE HOME CARE | I ! | | I i ! --- J 9542601 i ! Lio $95.260 1 I $95.260. 1 002 NASSAU SUFFOLK STROKE EV] | I ! ! j | | -ALUATL ON ASD OfEEQ 2 AL i $241196 J i i L $94,196. 1 1 $94 2196} O03 DEVELCPMENT CF PAP SHEARI | 1 | | | | . | WAS DS ELE BREAST EAM ot £05. 4n8 | L J Li 8losesee tot gos. eek | CO4 REGICAAL MEDICAL LIBRARY| | | } i 1 | / | i $462,250) - i i L $46,750] 1 £46,750. 1 905 COMPUTERIZED RADIATICA TI | I | | i | ] HERAPY 1 £24,619 1 L 1 i $34,619 1 { $34,619 1 006 SMCKERS WITHORAWAL WORKS] l ! I ! Jt | | --—HO2 1 $7,050 1 i . d 1 $71050_] 1 $2.050 | OOF COMPUTERIZED EKG AND SPI] : j | | | : ! | \ we ROME TOY a J 292.574 1 J I { $922576 J j $92,576. 1 O09 REGILUNAL ORUG LAFCRWATIC | | | | I ! | m= NOEL Ee CES --- L L L £79329 } i 4£794200_ 1 1 £292200_1 OL PLOUATRIC HURSE PRACTITI | ! ] I | ! j we UES _T2ALN LNG P2STOAM 1 i i J $72.450_1 £781450 1 1 $792450_ 1 O13 O€VELOPMENT CF A DEPARTH] | | | | | | 1 ~--ENT_DE_COSFUNIIY MEDICINE J L L L £962000 1 $962090_ 5 1 $26,000 1 O14 NASSAU SLFFCLK REGIONAL | | I I I | | t —-~O8G AN CONOP esa co Ay L I i ! £274660_1 $22,080 1 L $27,040 1 Q15 HOME DLALYSIS TRAINING P| | | | a4 | id d SRAM J 1 id i $34,320.) $34,320) l $345320 1 id if il : il tt ~ tl ub il- ee EOL [] s$$22.0987] 3$79,200 i] s$3L5e279 1] s$lv3ben5T7 HI _ tA 840316657711 & rome wera MARCH 17,1972 B REGION — NASSAU SFK BREAKOUT OF REQUEST . RM 00065 06/72 03 PRUGRAM PER IUD _. RMP S-OSH-JTOGR2 {5} (2) (4) (1) {DENTIFICATIGN OF COMPONENT | CCNT. wITHIN] CUNTe GEYOND| APPR. NOT | NEW, NOT } ADD'L YEAR | \ TOTAL i ] APPR. PERICO] APPR. PERICDI PREVIOUSLY | PREVIGUSLY | OFRECT { | ALL YEARS | ] OF SUPPORT | CF SUPPORT | FUNDED | APPROVED | casts | borREct costs _ a LE Le _ Io I _. I oo. __| Poe C000 CORE i i ' I | j 1 { . 4 $4822246 J 4 L 1 $4822246 5 i $92914254 DOCO DEVELCEMENTAL CUMPCNENT | i 1 } | : { j | Le Le L 1 1 $793449_1 $791469 1 j $158.898. 1. OOl CUMPREFENSIVE HOME CARE | { t I \ { | | ee we ee ee dn 8 FIG S0F_1K ] i ! $97.503_1 } $192s863. 1.0 CO2 NASSAU SLFFOLK STRCKE EV] I | i | | | \ . _SLUSLICA ASD SERESStL dL glo. 226 L L | I $119.4524.1 } $212,822 1. 003. CEVELCPMENT CF PAP SKE4R | I i | | { | \ ee ba O SELE SREASTE SAH WL $106.55 74 1 l 4 $106,557 1 i $212,025 1. 004 &CGIGNAL MEDICAL LIBRARY] | | | ! | | | ¢ ee ee eee eee $48129¢_ 4 4 L { $45,994 1 ] $99,744 1 005. COMPUTERIZED RACIATION TI | | | 1 j j | — we EB SEY ee eee Lie $24. 11 $l } J 4 £2421)9 1 } £592338 1 OCS S¥LKERS wITHORAWAL WORKS] i 1 ! | j | : we EIR. 1 1 1 1 L L . ! $74950_]4 G7 CuMPuleRIZeO EKG AND SFT | ! \ I i { 1! ‘ _ LL BOYET EY ln TL L 1 4 $5£4233_1 1 $151.364_1 __ C39 REGICNAL CRUG INFORMATIO[ | | | { I { { Neb ilal2h eee L i $64a1720_1 J £64, 7720.1 L £163,970] Ol2 PEDIATRIC NURSE PRACTITIL | I t { | | t WU OSER_TSALy ISG. PeoGeas j } 1 L $63,040 1 $432043.1 { $1413¢90_ 1 O13 DEVELCPMENT CF A CEPARTM| | | { { t 1 _ __ESI_CE_COMMUSILY MEQICISE 1 — 1 L J $670090 1 $62,080 J 89080 ee O14 NASSAU SUFFCLK REGIONAL | | { I t ! j { we ORCAS QGNUR_ PSccRas 4 _} 1 4 i L l $27,000_1 , OLS NOME DIALYSIS TRAINING PI | | t | | | | en BOGESY 1 1 i | L 4 L $34.320_1 Ft, ! 1 | j j | i _ ee otal $937,333 | | $64,770 | $209,569 | SbeZble672 | _ _ | 205281249 Joo “ . . eee ee eee oe a a, NASSAU-SUFFOLK REGLONAL MEDICAL PROGRAM The Nassau-Suffolk Regional Medical Program organizational structure at both the Core level and the Corporate and RAG level was the source of concern for a Site Visit team on March 25-26, 1971. The team recommended that the region be made operational for three years with the condition that they obtain the services of an outside management consultant to examine the organizational structure and operating procedures with specif attention directed toward the Rie/CHP relationships. On September 258, ] Dr. Margulies offered the services of the Management Survey Team. On November 11, 1971, a team composed of Tom Simonds, Rod Mercker, Eileen Faatz, and Spero Moutsatsos visited NSRP to examine these organizational structures and the relationship between RMP and CHP. : By way of summary, the following comments are made. Each is discussed more fully in-the body of this report. The team concluded that the identities of RMP and CHP have been maintained while at the same time effecting an unusually close working relation: There is however, a need for more accurate cost allocation. The presence of corporate members on the RAG is. not a great concern to RMPS, but they should not be in a position of domPaance. The RAG must develop its own set of By-Laws establishing it as an independent body responsible for all program decisions. The team did not find any cause for concern regarding the administration of the Core offices or the span of control of the Executive Director. RMP-CHP RELATIONSHIP . The Nassau-Suffolk Regional Medical Program is unique in its relationship to CHP in a couple of significant respects. Although the advisory boards of the two organizations are separate (the RAG and the CHP Council), there is being created a joint committee structure for both programmatic and administrative aspects of both organizations as indicated on the attached chart. (See page 5). The RMP Coordinator shares his time equally between RMP and CHP "b" activities and serves also as Director of the CHP "b" area wide agency. He directs a joint RMP/CHP core staff, all the members of which are, for bookkeeping purposes, on one payroll or another in an ‘approximate ratio of 40% CHP and 60% RMP. In actuality all employees -devote their time to whatever area is timely, regardless of whether it is classified as RMP or CHP. _ Although the two advisory groups are separate bodies, the staff team fully expected to find this division to be primarily a paper creation, with a phantom superstructure composed of the overlapping memberships between the two groups providing for a RMP/CHP program merger in fact, if not officially. This supposition appears not to be borne out by an analysis of the membership of the two groups, although attendance records might alter the analysis result. Page 2 - Our analysis revcals that there are 8&2 seats on the RAG and 93 on the CHP Council. ‘Twenty-two people hold membership on both groups. Therefore, of the total representation of 153, approximately 14% of the members have joint interests in both groups; 27% of the RAG and 24% of the CHP Council. In terms of activity, using as an indicator membership on a committee or election to an office, it appears that for most of the overlapping members, their predominant interest lies with either one group or another. For instance, of the 22 overlapping members only seven belong to a committee or hold office for both the RAG and the CHP Council. The rest concentrate their membership on one group, with only token membership on the other organization. To counterbalance power exerted by the 22 joint members, each organization ‘has a large number of active members who are interested in one organization only. There is a sizable number of active members (activity, again, measured by participation in at least one committee or election to office) on each body which has no overlap with the other group: 23 on the RAG and 19 on the CHP Council. It does seem then that the Region is maintaining separation at the Council level, although RMPS staff should keep! an eye on situations which may mitigate against this division. Primary among these might be the future formation of joint committees and the membership on each. For example, the Joint Aims and Goals Committee presumably has been functioning since the Spring of 1971. It has an "open" membership;. i.e., the dates of meetings are circularized and those who are interested attend. This is further complicated by the fact that membership lists furnished to the staff visitors in mid-November still contained listings for separate goals committees for the two organizations. There remains some question then as to who participates in the important functions of this committee--primarily, the fashioning of generalized goals, priorities, and a program plan for the two-county region. - Similarily the joint Program Committee has not yet been formed, but when it is, it will have the task of allocating resources between RMP and CHP and monitoring the joint program effort. Clearly, the membership on these committees is important... REGIONAL MEDICAL PROGRAM GRANT FUND ACCOUNTABILITY The unique relationship between the Regional Medical Program and Comprehensive Health Planning in the Nassau-Suffolk Regional Medical Program has resulted in. the establishment of one health planning and administration organization that is funded from two Federal Government sources. Accountability for the Regional Medical Program grant funds is based on the relative amounts awarded - by the two sponsors. Accountability is not based on the RMP-CHP identification of the activity for which funds are actually expended. The RMP-CHP organi- zation prepares separate applications which are sent to the RMPS and CHP. Each staff member, with the exception of the Coordinator is assigned to the budget of the most appropriate sponsor. These assignments are made on the basis of general criteria which provide that RMP administers operational projects exclusively:and Comprehensive Health Planning includes such things 2 ‘ Page 3 - as Environmental Health and air pollution. All other activities are considered RMP-CHP activities. os The Core staff has a system that is intended to account for their expendi- ture of grant funds to both the RMP and CUP as their granting agencies. Accountability for the expenditure of grant funds throughout the year is. based on the budget requests submitted to the two sponsors. At the beginning of the grant year, Core staff establishes a ratio of RMP-CHP grant support requested and awarded. Then as grant funds are spent the costs are attributed to RMP and CHP grants on the basis of the ratio. Thus costs incurred throughout the year are charged to the two sponsors on a prorata basis. The demands placed upon RHPS dictate that more accurate accounta~ bility should be based upon expenditures and not budget estimates. ‘A system should be developed and implemented through which grant expenditures are periodically identified and allocated between RMP and CHP grant support. The minimal requirements for such a system will be developed jointly bet- ween the RMPS and CHP. The CHP has been contacted to initiate joint development of minimal acceptable grant fund accountability requirements. REGIONAL ADVISORY GROUP AND CORPORATION ’ : The duplication of responsibilities and membership between the NSRMP Regional Advisory Group and the Corporation has been the source of considerable confusion and some concern. The difficulty in understanding the organization at this level results from thinking of the Corporation and RAG as separate bodies, each with its own identity, when in reality there is little difference. Interviews with NSRMP officials and a review-of the By-Laws bear out this conclusion. As an example, there is only one set of By-Laws which incorporates both Corporation and RAG rules. Again, it must be kept in mind that except for the semantics, there is virtually no dif- ference in the two. : Originally it was the plan of NSRMP that there be only one group and that the incorporators would also be the RAG. The Regional Medical Programs Service would not permit this arrangement and required that there be both a corporate body and a Regional Advisory Group. To satisfy this requirement,. NSRMP added more members and designated them as non-corporate members of the RAG. The 67 Corporate members remained as voting members of the 82 member RAG. Although all RAG members may vote only Corporate members may hold office in the RAG or be a committee chairman. The dual nature of membership in the Corporation and RAG and of the By-Laws is inconsistent with the basic need for the RAG to be separate and distinct from the grantee. To remove the appearance of dominance by the Corporation, ’ the Corporate membership should be reduced to the minimum number necessary to meet the legal requirements of the State of New York and to provide the fiscal, personnel and other administrative affairs of NSRMP. This small Page 4 - group should be considered as the Board of Directors of the Corporation and should conduct its affairs in periodic meetings apart from the total RAG. There is no objection to the Board of Directors being members of the RAG; however, they should not hold office. The designations of corporate and non-corporate members should be removed. The By-Laws should be re-written to establish the Regional Advisory Group as an independent, self-sustaining entity responsible for all pYogran decisions. It should not concern itself with the administrative deli- berations of the Board of Directors. “SPAN OF CONTROL ; The Executive Director shares his time equally between RMP and CHP activities and in addition, is responsible for the management of the Core offices * and supervision of the Core staff. On the surface this would appear to be a herculean task. In reality, the Executive Director does not perform his managerial duties without assistance. The combined RMP-CHP staff is organized into three Divisions; namely, Administration, Program Development and Evaluation, and Sub~Area Planning. Each*Division is headed by an Associate Director who is responsible for the management of his Division and who reports directly to the Executive Director. Appropriate delegations of authority have been made in writing to the Associate Directors to carry out their day-to-day duties and to service the appropriate committees of the RAG and CHP Council. The Associate Directors also serve as.Deputies in the absence of the Director and in the performance of their assigned responsibilities, relieve’ the Executive Director of a great amount of detail. The team concludes that the span of control of the Executive Director and the supervisory staff is reasonable and that responsibilities and delegations of authority have been assigned in a manner to provide for a properly managed program. The team did not review the management practices and actions of the supervisory staff and, therefore, draws no conclusions on how well the staff is directed below the Division level. Bade 2@ Loren cme gee den enn ei a terete oe ee . fs NASSAU-SUPFOLK RMP /CUP approx, 13% overlap CHP ~ fn membership os | ‘Council (119 Members) | ' “N 4 RAG (82 members) ¢ -| Admin, | i} Bd, of | Conn. : ;, Directors | cree cnnrcteatnnrnnemmntneraomncnnt . ‘ i Aims & Goals : Conn, . ; Exec. ! ' 4 Coma. | ieee | -\ Progran | L______—-} Coan, = [--——— Admin, | La re tne rca Conn, . * , : Le THROUGH: DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE . Ss poetal_ Magaye met” Sel valion Director, Regional Medical Programs Service March 27, 1972 Acting Director, Division of Operations & Development, RMPS Chief, Grants Management Branch Division of Operations & Development Regional Medical Programs Service Visit to Nassau/Suffolk Regional Medical Program to Resolve the Problem of Accountability of RMPS Funds/ Enciosed is a copy of Mr. Miller's subject report indicating alternatives for administering the supject programs grant funds. We have two decisions to make: 1) How to sutisfy expenditure in the current budget period, and 2) How to simplify an existing complex situation. fo facilitate -ccounting for cucrent budget expenditure, I feel that Mr. Miller has indicatee that detailed records must be maintained to identify the efforts of the employees in the pursuits of the two grant orograms to the :xtent that they are able to charge costs appropriately. ‘fhey have tried this on a weekly, one-time basis and have shown that to a great extent it can be a-complished. This we must do in order to satsify requirements based on twe separate budgets and awards. For those activities thot crimot ve identified on a speciiic percentage of efforts basis, I concur in Mr. Miller's recommendations that the percentage eatablished in the budget as azarded be applied. ‘his sould be communicated to the grantee so that there will be a basis for future audit. With respect to future years, I strongly urge that we pursue a joint avard with CHP. This is what Dr. Hastings would like to do and has so stated orally to me. If you concur, we will pursue this matter with CHP and appropriate offices. It is ironic that this program is viewed by both RMPS and CHP as being something less than we would hope the program could be. This point might well be one for consideration when and if we review a budg t jointly with CHP. In a jointly-funded grant, a percent of support is established by the programs and is fuaded on that basis unless during the year:the efforts vary. In that case, the grantee should advise us and request an appropriate revision to the budget. If the volume of business in the future remains as it is, in all likelihood we would be the lead agency. | | | | OFFICE SURNAME, DATE OFFICE SURNAME DATE OFFICE SURNAME DATE Page 2 - Director, RMPS My alternate recommendation for future years would be to require the organization to become separate. As Mr. Miller points out, total costs would then be increased and we would probably not end up with that clean a break in the total picture anyway. We should be glad to discuss this matter with you. /s| Gerald T. Gardell Enclosure cc: Official Grant File Nash/Stolov Mr. Chambliss. Mr. Miller ‘Board File GMB/GTGardesl: re. 3/27/72 ME I ji OR A N | I } | DG AIWLIVLEIN EL Ub bauer DAP URE RAR Dake eee ee aA , @. FROM SUBJECT: PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION . Chief, Grants Management Branch DATE: March 20, 1972 Division of Operations and Development Grants Management Officer Grants Management Branch, DOD Visit to Nassau/Suffolk Regional Medical Program to Resolve the Problem of Accountability for RMPS Funds The individuals participating in the discussion of this subject from both the Grantee, RMPS and the Regional Office were as follows: Mr. Glen Hastings, Coordinator, Nassau/Suffolk RMP, Mr. Harrison Owen, Associate Coordinator, Nassau/Suffolk RMP, Mrs. Elaine Kaldor, Accountant, Nassau/Suffolk RMP, Mr. Gerald Hunt, Grants Management Officer, Region II and Mr. Roger Miller, Grants Management Branch, RMPS,. The Nassau/Suffolk organization currently allocates expenditures to its two Federal Programs based on the relative amount awarded by each Program. The basis for allocation, however, does not include funds set aside for direct RMPS "project" activities. The basis for distribution is RMPS funds provided for Core activities versus CHP Federal and matching funds provided for the same type activities. As the grant funds are spent the cost attributed to RMP and the CHP grants are distributed on the basis of this ratio which at the present time is 61.8% RMP and 38.2% CHP. Where contributory funds from either RMP, CHP or matching varies substantially, then the percentage ratio of each programs' contribution to the total, is revised and a retroactive adjustment for the entire budget period is made, to reflect the current level of contribution by each program to the total, The grantee's. method of recording its expenditures, is to enter all joint RMP and CHP expenditures in the RMP cash disbursement ledger. Once this is accomplished, at the end of each monthly period the CHP portion is allocated from each expense nomenclature account in the cash disbursement ledger at the contributory percentage of 38.2%. This journal entry in effect, represents the transfer of the CHP portion of its total expenses to the CHP program; the balance naturally represents the RMP's share of its expenditures. Since generally accepted accounting procedures dictate that an allocation of expenditures should be based on actual experience rather than initial budget estimates, I felt it was my assignment to determine a means of resolving the above situation. During the week immediately prior to my visit the staff of the Nassau/Suffolk organization prepared individual time-sheets by employee, whereby each employee accounted for their time on 15 minute intervals for an entire weekly periods A careful review of these time-sheets by the members participating in this group indicated that time fell into three major categories which were (1) directly attributable to RMP activities, (2) directly attributable to CHP activities, or (3) falling into a category that could not be specifically identified to either program. Chief, Grants Management Branch, DOD 2 Based on the review of the records and the ensuing discussion, it was resolved that we would come up with five alternatives solutions to this problem. These are as follows, and are discussed in greater depth in a latter section of this memorandum: RECOMMENDATIONS: ~ 1, Combine the organizations by issuance of a joint award under the joint funding concept. 2. Completely separate the organizations by requaring two separate staffs at two separate locations. 3. Allocate costs as presently operating. 4, Prepare a time study on quarterly basis for all employees to determine what portion of effort is devoted to each program. If it is fuund that a larger portion of effort is devoted to one pr gram than the ac-ual funds provided then it would be recommended that the operational program be adjusted accordingly. 5. Place a restriction on the RMPS grant award that funds could not be used for the Core activity that would result in more than a 50-50 split of Core costs between those funds provided by the RMP program and the CHP pro,vam inclusive of both Federal and matching shares. Based on my study of the entire situation, the following are my pros and cons to the above recommendations which I am listing in priority order with one being my most favored recommendation: 1. I feel the most efficient recommendation which would encompass the least problems would be to joint fund this entire operation with a combined grant of RMP and CHP funds. Since RMP provides the major portion of funds for the operation of this organization, this option would include RMPS admiristration of the total grant. Since RMP is now extending the grant to this organization to August 31, beginning 9/1/72, the CHP grant and the RMP grant would be on the same fiscal period. Since there are costs of the combined operations that éannot be specifically identified with either one program or the othr, I am of the opinion that this option would be the most feasible. In addition, since Dr. Wilson has proposed this concept, "it would be a feather in the cap" of RMPsSto be one of the first programs to attempt to implement such a concept, with the results of the implementation being made available to the Administrator. My second recommendation would’ be to require the grantee to prepare a time study on a quarterly basis utilizing a period of an entire week each quarter as the basis for the allocation of costs to Chief, Grants Management Branch, DOD 3. each program, In discussions with the Nassau/Suffolk representatives on this recommendation, they feel that if a hypothetical situation resulted where 30% of time could be specifically allocated to CHP and 30% of time could be specially allocated to RMP, and 40% of total time fell into the category of both, they were of the opinion that they could make the managerial decision to allocate the time into either category as they saw fit, to come back to the current allocation ' ratio of the 61.8% and 31.2%. I did not agree with their conclusion, since I feel that the time that fell into both categories would have to be allocated 50-50, and if this study indicated a disproportion of effort based upon funds provided, they would have to redistribute their program activities accordingly. My third recommendation would be to place a restriction on the RMPS award to this organiz..tion, that RMPS funds could not be used for the Core activity, in a larger percentage than those funds provided by either Federal or matching funds by the CHP program. The representa- tives of the Nassau/Suffolk program were adamantly opposed to this proposal since they said it %uld severely restrict their operations. ‘I felt, however, that since Mr. Hunt indicated that their is little or no community involvement in CHP, that such action would force them to stimuiatc community involvement in CHP to obtain increased local “support for the CHP operation which in eff-ct, allow them to put more RMP funds into the Core activity. I realize this suggestion is harsh in nature, but I feel we may have to take such action if this is the recommendatica that is proposed. My fourth recommendation would be to allocate costs based on the original budget estimates as is the current practice. Although I am completely opposed to chis proposal, this is the procedure the Nassau/Suffolk organization would like to continue following. CHP programs are de- creasing while funds available to the RMP program are increasing. As a result of this situation, continuation of the current method of allocation could eventually evolve in RMPS picking up 90% of the total Core staff salaries aud related expenses while CHP would only be picking up 10%. It is currently the practice of Suffolk County, who contributes a portion of the matching share to the CHP project to be very restric- tive as far as the amount of funds that are actually provided for the CHP operation. Suffolk County is trying their best to cut costs in view of a potential deficit, and as a result the Nassau/Suffolk CHP operation is looking forward to less of a contribution from this - county. A lower contribution from Suffolk County by $5.00, in effect, results in a lower contribution from Nassau County of the same amount and a lower contribution from the Federal Government of twice the amount. So a loss of $5.00 from Suffolk County results in a total loss of $30.00 to the CHP program. My last and least favored recommendation would be to completely separate the organizations, This in effect, would solve the problem, but would result in increased administrative costs to both the RMP and CHP for duplicate staff in all administrative areas. I feel that taking such a step would be an extreme measure since 1 do feel that there Chief, Grants Management Branch, DOD 4 is some merit to having these organizations combined and within close proximity to each other. ° I am willing to discuss all of the above recommendations at length and write a letter to the Nassau/Suffolk Regional Medical Program indicating the recommendation selected for adoption by the Nassau/Suffolk organization. I indicated upon leaving the Nassau/Suffolk organization that we would inform them of our decision within the next week, so that the site visit team visiting the Nassau/Suffolk organization during the last week of March would be aware that this area has been resolved. pee wf} LO Miller ce: Dr. Margulies Dr. Pahl Mr. Chambliss Mr. Nash/Stolov IVE SU IVE ER ALIN U LV r FROM SUBJECT: PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION For the Record DATE: March 21, 1972 Edward T. Blomquist, M.D. Post-Mini SARP Meeting, March 20, 1972, Nassau-Suffolk Regional Medical Program Renal Organ Donor Program Purpose of Program ~ To procure cadaver kidneys from 24 donors each year from seven named hospitals in which there is a physician committed to the program. Part time physician coordinator and a secretary will be employed to administer the program. Participating surgeons and hospitals will be paid a standard fee for service Cost for developing and training procurement teams for maintaining transplantation registries, and for payment of cadaver kidneys will be $27,060 for the first year. J itient selection, histocompatability testing. and transplantation will 2» performed at facilities located in New York City. Action - Recomrerd approvel of appl*cation as submitted for the first year of operation, Future funding will be determined after review of application from Metropolitan New York Region requesting support for a Tri-Regional (New York City, lew Jersey, Nassau-Suffolk) Transplantation Program is received. Home Dialysis Training Program Purpose of Program - To develop 50 validated, modular, single concept lessons and tests for home dialysis patients after a period of studying dialysis units in New York City and after developing patient behavioral objectives. , . Costs are projected for the first year only. During the first year, 6 validated lessons and tests will be completed at a cost of $31,200. Action - Disapproval with advice to sxek consultation from mature home dialysis training programs, as previously recommended by staff. Information for Local Regional Medical Program The objective to train the majority of patients for home care is admirable but the time and expense of the proposed program is excessive. It is Page 2 - For the Record recommended that full advantage be taken of the experience and teach- ing aids now available at mature home training dialysis centers. Specifically it is recommended that contact be made with such resources as the Northwest Kidney Center in Seattle, Washington, and those listed by staff in earlier letters of advice. Further, it is recommended that the anticipated caseload of patients . needing dialysis and transplantation be reviewed. The quoted rate of 70 patients per million population needing dialysis requires validation. Further, the need for expanding existing dialysis facilities as implied in General Objective 1 requires additional study. we § Edward T. Blomquist, M.D. - Region: Nebraska @ Review Cycle: June 1972. Type of Application: Anniversary prior to we 5 Triennium Rating: 200 8B € Recommendations From f_] SARP 1xx/ Review Committee /_7 Site Visit [7 Council Recommended Level of Funding $725,000 $700,000 Review Committee concurred with the funding recommendations of the March 30-31,1972 Site Visit Team and agreed that the Nebraska RMP has demonstrated substantial progress by adequately responding to the eight specific issues raised in the June 11, 1971 RMPS advice letter. The recommended $725,000 funding level included full support of the Program Staff in the amount of $401,641 which includes $25,000 for the initiation of small planning and feasibility studies. @- Review Committee accepted the Ad Hoc Renal Disease Staff Committee and the site visitor's recommendation to disapprove Project #6 entitled, Kidney Continuing Education Program and Project #7 entitled, Renal Dialysis Training Proposal. In this connection, the reviewers strongly suggested that the Program develop a comprehensive statewide plan before pursuing any specific operational activities in the kidney disease area. When comparing last year's Program Staff Budget with the current request, reviewers agreed the proposed increase was justified. The Reviewers believed that the additional four Program Staff will greatly strengthen programmatic efforts needed to develop a Triennial Application, Members of the Review Committee were impressed with the progress achieved especially since it had been accomplished within a six-month period, Favorable comments included the increased involvement of the RAG membership, its vastly improved review process, its committee structure and its monitoring of ongoing activities. Reviewers recommended that the composition of the RAG and its supporting committees should be strengthened through the addition of more minority group representation and allied health disciplines. TOTAL _RYPS ~ [4 NN | NON-RMPS and Ss Xn INCOME’ : a» TOTAL BUDGET — a fs a was awarded “Fay, jhe b2-month udge eriod egion has REQUESTED 850,120 = been extended 15 “months £8 agcommeda te m . the three ‘cycle REGION ras : COUNCIL -) Zeya y § syste ee A pro- rated amount of 790,070 ° 394 oh © © : 2 @ APRIL 4918972 REGION ~ NEBRASKA BREAKOUT OF REQUEST RM GO0C68 06/72 2 PROGRAM PERICD __RMPS~OSM-JTOGR2 + (5) (2) (4) a) INTIFICATION OF COMPONENT | CONT. WITHIN] CONT. BEYOND] APPR. NOT | NEWe NOT 1 ~*~ CURRENT I CURRENT Pope | APPR. PERIOD] APPR. PERIOO} PREVIOUSLY {1 PREVIOUSLY | OFRECT {| . INOIRECT } TOTAL | ~~ + = =~ -f QF SUPPORT | OF SUPPORT {| FUNDED ] APPROVED | costs | costs $0 EOC | { | { j | { 1 -¢ CORE NEGRASKA REGIONAL 4M] - 1 { | | j — to 7 CEDICAL PRPOBAM } $376,641 1 i { ! $376.64) J $73,107] $4492748 1 [A CORONARY CAPE TRAINING S| I j 1 \ | { UPPORT PPI GRAM i $5626561 I j L $56:656 | $1).972 1 $682628 1 i8 CORCNARY CARE TRAINING SI I | | I | { UPPOeT PROGRAM i $29 24733 I { L $29,408} $62958.) $369366_ | iC COPGNARY CARE TRAINING S] | 1 { | | ; { j JMPPORE PROGPAM i $2i12.339 1] j i j $20 2339. 1 $42485_) $242,024 1 L._ CORPCNENT TOTAL Li $106s4C3) 1 j | di $1063403) 10 $230415) 11 $1292818) | 3. MOBILE CANCER CETECTION | | t 1 { ! I i USL jl $190,854.) ! { i $190,954 1 $412124 1 $231,978 1 4 PULL ICATIONS CERERROVASCI t j | I I | | NLA AUD BELATEO OLSEASES | | l } $14,378 1 $14,378 | $2,853 1 $17.23) 3 & NESRASKA PPOJECT FOR RESI 1 | { t | i { _PIBALOSY [HERAPY j L j 1 $452)83_ 1 $45.083_ 1 $103635 1 $55,718 1 1 & KIDNEY CONTINUING EDUCAT I t 1 | t 1 { toi ION PROGR AY 1 i j l $45,049 4 $42640_ 1 $1: 160 1 $52890_ 1 7 RENAL DIALYSES TRAINING | | { | t t t l “PROPOSAL ~ L x j anaes j $44,198. 1 $44,198) $10.362 4 $545560 4 1 i t t { t { j TOTAL “ j $673,898 | t i $108,299 | $782¢197 | $162,656 | ' $944,853 | APRIL 451972 BREAKOUT OF REQUEST 03 PROGRAM PERIOD REGION - NEBRASKA RM 00068 06/72 _ RMPS~OSH~JTOGR2 , (5) (2) (4) (h) ENTIFICATION OF COMPONENT [| CONT. WITHIN] CONT. BEYOND] APPR. NOT ] NEW, NOT | AOD'L YEAR | 1 Total ~ | | APPR. PERIOD] APPR. PERIOD] PREVIOUSLY | PREVIOUSLY | DIRECT ] J ALL YEARS { | | GCF SUPPORT | CF SUPPORT | FUNDED | APPROVED ! costs j JOIRECT COSTS | 1 | { I t { 1 I 02 CORE NELZASKA REGIONAL MI [ | I [ ! | j EDICAL PROSPAM i $3985439 J) | j L $398.439 | i $775,080 1 1A CORONARY CARE TRAINING Sf i i | ! 1 [ | NP PORT P2OGRAN J f 1 § I i i $562656 J 1B CORONARY CARE TRAINING st 1 I t { { | | UPPORT PROGRAM j l I i { I $29:408 J. LC CORONARY CARE TRAINING I j ye ~ f i 1 j t UPPOLT P2CSlaM ] 4 1 L I l $202339 1 1 COPeCurNT JOTAL t 1 ] { I 1 wi $106. 4U2)) 3 MOBILE CANCER DETECTION | | 1 | | ! I I UNLT I 1 { i j j $190,854 I 4 PUSLICATIONS SERESROVASCI | ! | i I t t WULAS “0 2 FLATED DISEASES | : I L $12,778 | $12,178 _1 1 $272156 ) 5 NEDRASKA PROJECT FOR RES| | 1 | I ! | ~ 4 PIRAIOZY_THESAPY. j l t $42.146 1 $420146 1 1 $874229 4 '@ KIDNEY CCNTINUENG eBueaTt J | I i i | I LON PROGRAM j I j 1. t j $42.64 1 7 RENAL OLALYSIS TRAINING i | { { | 1 I oo, ‘ae Z PROPOSAL jh eee | = 1. = J '$38.748 1 $48,748.) L $92,946.) I ! t | t | | 1 ~~ $398,439 } | t $93,672 | $492,111 | | $1,274,308 | TOTAL CTT y 3 |. 4 | 5s [ 8 oj rT 8 | 9 J i0 | it 7 i2 J is 7 4 js T1216 TY ys . o A NRMP. AC “IVITY SITES i “4 4 s0un §. DAR nie cate iON, KEYA PAHA BOYD Bore . — A Spencer a I . : KNOX ° Barton pRown HOLT | oe con AR : . 4 RUK Yorders Center .. s+ : C rnsnoaer , O asset © ey Mae CJ a * plocntiatt tating ones), . } 9.2 Pus es ‘ONeill |_Greightongy Waving tous, E ie an rn ‘ A page? | ANTELOPE T picre £ — ToRendaipn a : ete t Oeehord Lainie WAYNE sock’ we wo a fe Yo --—- Wayne . les oChoarwuter hy ” 6 ree Sn “4 3 4 ! - v2 wo letoride Netegh ——- sale fe > o a = J AWridol stata) | THOMAS BLAINE LouP GARFIELD | WrEELER "bles Nortel’ oe cigs) “teman! MORRILL GARDEN Hyoan’g A Elgin g A wanet fg Deco vem ga" uf Thedford |? owstor wean {MADISON 1 Stanton tyoms ia Dn 2 ateler] BOONE | ana pron” | Dm D e Hy cores te MRE © peyara GRANT] HOOKER * dated Toylor, | yurwett My | gNexmn Geb ee Ter amah ar 4 ARTHUR McFHERSON LOGAN CUSTER VALLEY GREELEY wi PLATTE COLFAX | © DUOGE ae . % Moti at edge part Sorgen 3 poldng set: one. wasting, ' A Matromorg ahh reve" Aniotma® 1 “Ge Codon fst Euoord Brg : 4 ° - ; foomen a Utes . Stpptatan N. loved Grooley Con |e” Culumbued “eo Rose Bend freemen £3 ‘ _ Ochen * a 0 Arnold toten Bow | oArcudio _ NANCE Genes - —_—~ ts _ . jes Ao tevonege | METH LINCOLN a & PSHERMAN | HOWARD foe fa De wo guruer SAUNpENS * cn fe gs So ——_-_-—] e Antes © a eL\| » nae gha ha ue covet gt DEVEL sion 62 ver Loup fay | StPeul a | _MERRIS pep on toa %@ 3 ereeud fem Gee @ boterre'e A chapoct Onion fourne | GF | @HNorth Platte 0 Oconte (: PARPY a Jensvatt i NEYEN Ay, ein, | ag Spee Petibncain Highway gy «prea COREE) est _ stmt Le fe a ge garth ” COLa Lo. a orn jes ‘9 QAWSON BUFFALO _aSvenna "a 3 cS 4 YORK SEWARD |LANCASTEM) tauisnita” ‘ ; ( LA coun nburg rand 8, o Weeving rent, oModid | QWoline tag : Sheton htond@ | "9 wen - be oy mee 3 cass _ TO" ot ! jf vamp ov/elttoet é vay Paes HAMILTON] - If LintSln “TOE 5 weoeathagen 4 A pe CHALE HAYES — Mayfrood® Curtin °]GOSPER Ld Scale AAI Chay satan FILUMONE | GP oend g ZS | spuds Se +S viemow FRONTIER fa xearney |° [Hava bie -- By Beymer A Astoctetln | Eee a Hestings div con ceneve™ wine JOHNSON | perso ; ees Moyes Con. io Minds yA ADAMS fa , ge tui iD — & ite A} Reotrica {Terme t EMAHA ! ed i] vuNcY rotinade | REO WILLOW Aapahe} HARLAN | FRANKLIN | Blue Hu? NUCKOLLS | THAY JEFFERSON er th - Colberneng Dts Outud WEBSTER A pro a : PAWNEE yCitaROSU x renton a &, Indsonolo FURNAS Orleans Frontlin A Nehion Destter, @ aitbury| A & tut bolt Ba a oA" Sratten Boore Cy oA a " 3 a | . Hyrer Faunce Bo, tit i 4 Peto HECHCOCK Red Cloud go." Chewet prams 25 EERE RCSD rowated GaP LW TCHCOCK Nes 1 TN BF FEE ML FPTI EY Deemer SEO EN RIE 8 FOIA SEIN 5 KANS. : NEBRASKA LEGEND . Seale of Mites ® Learning Resource Center - B Store Copitol A County Seots 24 40 60 : ¢ MADISON . County Numos = ene £ a Y A Drug Informa tion & rape Librar POPULATION KEY it AME cornet ANY, INC, GaCorona ry Care & . Uni & Over 100,000 @ 19,000 te 20,000 MERICAN HAP COMPAN ES i : y - ~ : ’ Mobile Cancer Detection nit EF} $0,000 10 100,000 © 5.00 10,000 : 4 © 75,000 10 50,000 © ‘1,000 to 5,000 . sy N a Populeticn classification besod un the Frdoral 20.000 to 25,000 © Under 1,000 ‘ - ~ Census of 1969, corrected to lal-st stale report, RM 00068 _6- PROF ILE STATE OF NEBRASKA Geography: 93 Counties 76, 612 square miles Population: Total - 1,483,500 ( 1970 Census) Density - 19 per sq. nile ( 1/3 as high as U.S. average of 57.5) Urban - 61.5% ( 912,800) Non-White - approx. 3% ( 50,800) Negro - 40,000 Other - 10,600 ( about 6,600 are Amer. Indians) Age Groups Under 18 yrs. - 347 18 - 64 yrs. = 54 65 and over 12 Metropolitan Areas; Lincoln 166,000 Omaha, Nebr.538, 700 Iowa Sioux City,Lowa- 113,900 Nebr.*( Dakota Cty) ~ 13,200 Average Income per Individual, 1969 Nebraska - $3642 U.S. 3680 Political Information: Governor - J.J. Exon (D) Senators - Carl T. Curtis, (R) Roman L. Hruska (R) - Appropriations Committee Representatives - Cong. District 1 - Charles Thone (R) 7 2 - John Y. McCollister (R) 3 - David T. Martin (R) Vital Statistics Rates* - Leading Causes of Death, 1968 Nebr. U.S. Heart Disease - GO7.1 372.6 Malizn. Neopl - 176.3 159.4 Cerebro vasc. - 125.4 105.8 Accidents - 65.3 57.5 Related -- Diabetes 20.1 19.2 Arteriosclerosis 22.3 16.8 Bronchitis, emphy. © 24.4 16.6 "RM VUUOS State of Nebraska ~T~ FACILITIES AND RESUURCES SCHOOLS — 2 Medicine , 1969 69/70 Enrollment Graduates Creighton Univ. School of Medicine, Omaha 3 Univ. of Nebraska,Coll. of Medicine, Omaha 397 94 Dental - 2 ( Creighton and U. of Nebr.,Lincoln) 422 Pharmacy - 2 ( " . 7 ) 300 Nursing Professional - 13 of which 4 are College or Univ. Based Licensed Practical - 7 Allied Health Schools 2Yr. Community and/or Cytotechnology - 1 Univ. of ‘Nebraska Junior Colleges 7 - majority Jr. Colleges Medical Technology - 9 Radiologic Technology- 9 Physical Therapy - None Medical Recu.ds - 1 + College of St. Mary © FACILITIES Non-Federal Short and Long-Term General Hospitals, 1970 Beds Short Term Gen. & Special 101 9149 wong ferm Gen.& Szpacial 2 334 Veterans Admin. Genera’ 3 850 Number of ‘ospitals with Special Facilities, 1969 Iccu 30 Cobalt Therapy 6 Isotope Facility 11 Renal Dialysis 7 Inpatient Rehab - Inpatient 9 Long-Term Care Facilities ( Extended Care) 1969 Skilled Nursing iomes 152 9174 Beds Long-term care Units a) 1482 Beds ~8- State of Nebraska MANPOWER . Physicians _ Total Physicians ( incl. inactive) - 1711 Total Active Practitioners, reporting 1439 (inc. interns and a resident Of fice-Based ; 1188 esidents) Other 251 Active Practitioners, by Specialty General Practice 506 Medical Specialties 258 Surgical Specialties ; 385 Other Specialties, Research, 290 admin. and other , Group Practices? Total 81 Single specialty 37 General praccice 17 Multispecialty 27 Doctors of Ostcopathy ( as of Dec. 31, 1967) 32 Professionai .iurses; Actively enployed in nursing “™ 4,730 Not activel, employed in nursing 2,547 Licensed Practical Nurses‘ Actively empl. in nursing 1,147 Not actively empl. i- nursing 348 Licensed Pharmacists ( in active practice) 1969 -1,020 X-ray Technologists 485 Radiation therapists( technologists) 3 Physical Therapists, 1970 - members in active 60 . full-time practice ( APT Assoc.) 9 part-time 2 eecies “aa BACKGROUND & HISTORY The November 1970 National Advisory Council approved the separation of South Dakota from the Nebraska-South Dakota RMP. To provide interim support for the Nebraska-South Dakota RMP's core staff and three projects (beginning January 1, 1970), the first year award was extended for six months until June 30, 1971 at the Region's current level of support. The February 1971 Council recommended approval of South Dakota's planning application for three years including support for their part of the coronary care activities for one year, Nebraska RMP was site visited on April 1-2, 1971 because an initial application for operational status as a separate Region was submitted to RMPS. The site visitors assessed the program structure, achievements and capability. The site visit report, which received National Advisory Council concurrence, recommended that the Nebraska Regional Medical Program must develop and accomplish, as soon as possible, solutions to the following: 1. There is the need for stronger and more effective central program direction. The operating objectives and priorities need to be better defined and understood. 2. The role of the RAG should be strengthened. For example, the RAG should have a strong role in the selection of the Program Coordinator, It should display, also, its interest in his continuing education in program management. 3, The following documents should be developed and officially adapted by the RAG: Mechanism of appointment of Committees Objectives of each Committee Procedure for reallocation of funds within RMP Procedures for monitoring projects over programs Procedures for project development Procedures for project review Procedure for project termination e Rmehooaoewn 4. The role of grantee organization should be re-defined in a way which will delineate the manner in which its responsibilities and authorities are separate from those of the Regional Advisory Group. ~10- 5. The capabilities of already available resources on Core staff should be more effectively utilized in program planning, monitoring and evaluation, 6, Available resources should be utilized more effectively in defining needs and carrying this through to project operation. 7. There should be organized plans for phasing worthwhile ; projects to funding mechanisms other than RMP. ' 8. There should be strong involvement of core staff and RAG in directing the course of the mobile cancer project. The May 1971 National Advisory Council recommended approval as a separate and new Region with operational status for three years at the current level with the following conditions: 1. The concerns of visitors be communicated back to the Region, 2. The review of the second year continuation request include a site visit to assess progress during the next year, and 3, The level of funding be increased if significant progress is achieved in the first year. Additional concerns are contained in April 1-2, 1971 site visit report. During June 1971, Harold S. Morgan, M.D. resigned as Coordinator. Deane S. Marcy, M.D. became the. new: Gbordinator as of July B,1971., The Nebraska RMP is currently in its Ol operational year. The direct cost award for the present budget period is $500,000 and indirect costs amount to $125,639 (24.4%). The current budget period has been extended two months until August 31, 1972. The Region has submitted an Anniversary Application before the triennial requesting 02 year support of $782,197 direct costs for the following: I. Continuation support for Core 376, 641 Il. Continuation support for two ongoing projects 297,257 III, Support for four new projects 108, 299 Total 782,197 -11- Region Nebraska __ Review Cycle June 19/2 @ son ACCOMPLISHMENTS BY RMP SINCE April 1-2 197 1. 1. Region has defined RAG, Grantee, and Coordinator responsibilities. RAG has been actively involved in the Regions review process. Developed "Procedural Manual", "Administrative Policy Manual". (pg 13, 15) Core Staff is developing outreach to community rather than strict confinement to medical community. Good relationships with CHP exist. CHP is actively involved in RMP review process. Assisted community of Creighton, Nebraska in developing an Experimental Health Delivery Sub-systems proposal. RAG is active in terms of overall developmental aspect of programs. Nine functioning committees are involved. Program Coordinator has made successful accomplishments in reorganizing the NRMP. Education projects seem to include a methodology for evaluation. Inter-regional cooperative arrangements have been excellent. Central program direction has been strengthened. OWc-™’w ALE Wr ed PRINCIPAL PROBLEMS 1. NRMP has clearly articulated its goals, objectives and priorities, however, they are not time-framed and an overall plan for the Region does not emerge. 2, Program is still quite "project-oriented". 3. NRMP is not focusing its attention on improving the total delivery of health care. 4. Collection and use of data to determine funding priorities or delineation of program direction. @:- are no minority group members on core staff or the various project staffs, nor on he 9 RAG Committees. (One black on the RAG) Special health problems of Indians and migrant farm workers have not been addressed. 6. Too much conceptual planning (CHP responsibility). 7. Emphasis of kidney programs. 8. Needs should be defined before action statements on goals, priorities and objectives. OTHER ISSUES REQUIRING ATTENTION OF REVIEWERS 1. The emphasis of NRMP is still categorical, and continuing education and training; they should be encouraged to broaden their health "Horizons". 2, RAG should be encouraged to become more involved in the evaluation process. SUGGESTION: A "Planning and Evaluation Committee" to assist in monitoring overall program as well as specific projects and core staff activities. (Compare this to role of Planner-Evaluator, pg. 22.) 3. The data accruing from the Westinghouse Corporation study should be used as a basis for carrying out an overall needs assessment of the Region for developing a related 3-year plan of action. 4, Two part-time salaried positions of grantee being paid by Core funds. 5. Clarification of CHP "b" representative on RAG. 6. Future relationships with two medical schools. 7. Core staff position descriptions. 8. Position of RAG chairman and president of Nebraska State Medical Association (same). 9, Although manpower is a stated objective, what activities are planned. 10, The role of 2 "Kidney projects" in NRMP statewide Kidney plans. TABLE OF CONTENTS NORTH CAROLINA REGIONAL MEDICAL PROGRAM ANNIVERSARY APPLICATION Staff Briefing Document Face Page Regional Maps Geography and Demography Component and Financial Summary Breakout of Request Problems, Accomplishments, Issues Review Criteria Addendum to Briefing Document Organizational Structure Regional Office Comments Supplement. to Application 23 27 37 38 43 46 d RMPS STAFF BRIEFING DOCUMENT EGION North Carolina 00006 YPE APPLICATION TRIENNIAL 2nd ANNIV YEAR J YW ist ANNIV YEAR J _/ OTHER N/A LAST RATING April 1972 DATE TH sarp 7 REV. COM. — 7 OTHER ne! OPERATIONS / / Eastern ° / / Mid-Cont BRANCH /X7 South Centr'l / 7 Western BRANCH Tel. No. 31740 Room 10-22 BRANCH CHIEF Lee E. Van Winkle BRANCH STAFF Bill Reist RO REP. Ted_ Griffith Last Mgt. Assm't Visit Planned for 197 - ta isits, Last 12 mos. ——— Early Chairman N/A Edward Coppola, M.D. (Consultant) RMPS STAFF: Dan Spain, ‘eo Nov. 197° _; ChairmanHenry Lemon, M.D. (Committee); Bland Cannon, M.D. (Council); (Dates, Chairman's Name and Type ef Visit) Buddy Says, & Ted Griffith November 15, 1972- Bill Reist- Met Staff- Attended RAG Meeting- Consulted on Migrant Projec March 7-9, 1972- Bill Reist- Met Staff- Obtain supplemental Information for Application A REVIEW PROCESS VERIFICATION VISIT is scheduled for April 27, 1972 jor Events Whi n_. May 1971 ch Occurred in the Region Affecting the RMP Since Its Last Review _ Eastern Carolina University in Greenville has been appropriated funds by the State legis- lature, for a 2 year Medical School and School of Allied Health. . , State Legislature has passed a bill which provides payment for dialysis of Kidney patents Legislation Research Committee has been appointed to study and make recommendations on EMS in North Carolina It will be announced on April 7, 1972 that University of North Carolina has been selected by NCHSRD as the grantee for a University Center for Health Evaluation award - . . North Carolina RMP ' Map of Congressional Districts, Counties, and Selected Cities | Metropolitan Areas: (11 Districts) \sheville - 135.4 —_—_— Tharlotte - 406.0 Jurham - 188.8 ireensboro— ¥. Salem 598.9 faliegh - 225.6 TIORTHAMPTON ALLEGHANY CASWELL Sw ASHE son ome ROCKINGHAM PERSON £ WARREN = GREENSBORO} BURLINGTON “a YADKIN FORSYTH e 7 oe | WINSTON-SALEM@, | sutrono ] Fis , < c@ @iiGH POINT 3 DURH M GREENVILLE. jront ® $ S, SFA 2 = vu (omy XA ee NORINAMPION f o cars” v 7 5 PERSON GOANVILEE vance | wantin Cin HERTFORD “by casweal f ALLEGHANY LF surey sraxts ROCRINGHAM : ¥ § ; wih ES. rm Jd . Sy . i p A . ee 55 ENTE a : ate FORS YIN Guink 6 1B taDeEN varonD ALAMANCE OANGE 7 TeANKtiNds 4 4 § ae " yf NASH a ‘ ne . ah, A ere YS YF ecerit toaicomac ee omanren Ryed ment Boavet LE Aree DAVIDSON RANDOLPH Wwhson ROWAN a . sau A ag (ABA MELTS wy moet Tse_fi f y hors | frew 4 f STANLY f Tf ot 7 : ¥ fe ceaven u . ¢ AS = », EVEL AND RIONTGO at % Leh! MECKLENBURG ~: ] 4 f AF PaMLCO Cit ANSON abe wt Bianl u unto ) COhAno & or RORTION Gm canteret Ans % SRTH CAROLINA MULTI-COUNTY PLANNING REGIONS (2) HANOVER Established By Executive Order Robert W. Scott Governor Of North Carolina May 7, 1970 rY) NORTH CAROLINA RMP Geography and Demography Congressional Districts - Ii Counties - 100 Population (1970 Census) -- 5,082,100 Land Area: 49,067 sq. miles Urban 45% Density 103 per square mile Metropolitan Areas: (5) - Total population RM 00006 3/15/72 -- Regional boundaries coincide with the State of 1,555,000 Asheville - 135.4 Greensboro - Winston Charlotte - 406.0 . Salem - 598.9 Durham - 188.8 Raleigh - 225.6 Race: White - 77% - 3,891,500 Age Distribution Negro - - 1,137,700 under 18 yrs - 35% Other - 52,900 18-64 yrs. - 57% (majority indians) 65 & Over - 8% Migrant Population: Home Based - 17,307 Migration into State_ - 9,053 Total 26 , 360 Per Capita Income: North Carolina $3,188 - (Ranks #39) (1970) United States $3,910 - Mortality: Deaths per 100,000 population, 1967 NORTH CAROLINA U.S. Heart Disease 303.6 364.5 Malignant neopl. 115.4 157.2 Vascular lesions (aff. CNS-Stroke) 105.2 102.2 Diabetes 15.2 17.7 Broncho-pneumonic 11.0 14.8 (other) — Accidents 67.2 57.5 1970-1971 Resources and Facilities: (3) Medical Schools - Bowman Gray, Wake Forest Winston - Salem Duke Univ. School of Durham Univ. of N. Carolina Chapel Hill th School, University Based (1) Allied Heal Bowman Gray School o Enrollment § Graduates 273 58 Med. 383 80 337 76 f Med.,Winston Salem Division of Allied Health Programs RM 00006 3/15/72 Professional Nursing Schools Practical Nursing Schools 40 - 17 are college or 37 Schools University-Based Accredited Schools - Allied Heal th Cytotechnology - 7 Medical Technology - 14 Radiologic Technology - 28 Physical Therapy - 2 (University Based) Medical Record Librarian - 1 Hospitals -Community General § V.A. General Hospital Special Facilities if Beds Short Term 136 18,681 ICCcU 51 Long Term- Cobalt 12 (special) 7 484 Radium 34 Isotope V.A. (general) 3 1,505 Facility 37 Renal Dial- 13 ysis (in-patient) Rehabil. 6 Manpower : (in-patient) Physicians - Non-Federal M.D.s and D.O.s (1967) Active 4,484 Inactive 199 Osteopaths 21 Graduate Nurses , 1966: Actively employed in nursing 12,126 Not employed in nursing 3,475 Group Medical Practices, 1969: Total 153 Single Speciality 92 | General Practice 18 Multi-Specialty 43 RMPS/SCOB/DOD 6 Component and Financial Summary - Anniversary Application COMPONENT CURRENT O53. YEAR Q2.. YEAR RECOMMENDED YR'S AWARD COUNCIL — FUNDING -04_ OPER. RECOMMENDED REQUEST SARP YEAR * ___LEVEL REV, COM. CORE 558,193 , Sa 643,940 Sub-Contracts -0- SON OY A (73,000) . /. ~ = ‘OPER, ACTIV. 1,152,129 |. 1.248.175 DEVEL, COMP. 168 , 605 DK OSA KL OE 187.893 Yes ( ) or No (_) RARMARKS ¢ KIDNEY #28 (145,400) AHEC $41 (200,000) | RMPS DIRECT 1,878,927 _|_ 2,194,400. 2.080.008 Sy ” oy C3? SN REQUESTED 3,875,178 Noses COUNCIL nn ‘APPROVED LEVEL 2,194,400 NON-RMPS and INCOME 100.000 REGION North Carolina ~ June 1972, REVIEW CYCLE * The 04 year is being extended to 9/1 and the region will received $365,733 for the two month extension resulting in a direct cost award of $2,244,660 for 14 months. e MARCH L7¢1972 BREAKCUY OF REQUEST 05 PROGRAM PERIOD REGION = N CAROLINA RM 00006 06/72 4 ___ RMPS-OSM=JTOGRZ an (6) - 2) (4) (1) IDENT IFICATION OF COMPONENT [ CONT. WITHIN] CONT. BEYOND] APPR. NOT [| NEW, NOT j CURRENT | . CURRENT { { | APPR. PERICO] APPR. PERIOC! PREVIOUSLY | PREVIOUSLY ¢ DIRECT | INOLRECT: | TOTAL ‘I { cE SUPPORT | OF SUPPORT [| FUNDED | APPROVED 1 costs: } costs I t | an . | I ee | to 2000 CORE STAFF | 1 t I { ! | I j $643.940_1 1 1 1 $6432940 1 $2412939.1 £8852879_1 0000. DEVELCPMEATAL COMPCNENT | t | ! 1 1 | 1 \ $1873893_1 1 { ! $187.893 1 \ $187s893_1 OG3 DIABETIC CONSULTATICN AN] ! ! ! 1 I } I

>, NOT | NEW, NOT 1 CURRENT | CHORERT 1 1 J] APPR, PFRICO] APPR. PERENC] PREVINUSLY | PRPEVIGCUSLY | HIRECT { INDERECT | TCTAL i | OF SuPPneT |} CF SUPPCRT | FUNCEND | APPROVED I COSTS { casts ! { an | | | ! t WAN CRE ’ I | | | I i of I $6372796 1 L i l $6372796 | $22.89" J $665,686) YE -OHOSPETAL LEP@ARY CONSULTI 1 1 1 1 t t j ING SEPVICE 1 $320785_ 4 | = { 1 $222785 1 $4,057 1 $2824? 1 YF OCOU NURSE TOATNTAG | | { | 1 I | | I $822144 J 1 i ] $829144 1 $6e347 1 88s 49s 1 YF STREP CULTURE PROGRAM 1 { | 1 t t | | t $572496_ 1 i i $522496 } $6,224. 1 $554320. | 17 STROKE PEMAPELITATION DE] | 1 { ! ; ] | ! MONSTRATICON J $262176 1 1 | L $262776_ 1 1 $26207h ! { | 1 ! { | 1 TOTAL | #P71,2S57 | | ! } £821,257 | $5terts I $882,415 | MARCH. 23,1972 _ REGION 6% NE OHIO I PERSONAL SERVICES SALARIES + WAGES “EMPLOYEE BENEFITS “FOTAL DIR & IND 669,686 | TOTAL II PATIENT CARE INPATIENT OUT-PATIENT TOTAL EQUIPMENT BUILT-IN MOVABLE TOTAL IV. CONSTRUCTION NEW MAJ ALT 6 REN TOTAL VY OTHER CONSULTANTS SUPPLIES OMST TRAVEL FPGN TRAVEL RENT SPACE PENT OTHER MIN ALY & ®EN PUBLICATIONS CONTRECTUAL COMMUNICATION COMPUTERS OTHER . TOTAL VI TRAINEE COSTS STIPENDS OTHER TOTAL TOTAL DIRECT COST “INDIRECT COST REGLONAL MEDICAL PROGRAMS SERVICE PAGE 1 SUMMARY BUOGET CATEGORIES BY COMPONENT RHP S-OSM-JTOGK2 & _ REQUEST MAY/JUNE 1972 REVIEW CYCLE . . : COMPONENT COMPONENT = COMPONENT = COMPONENT = COMPONENT “REGION NO C900 NO 001 NO 0C2 NO 003 NO 007 TOTALS 385» S22 265920 _ 474226 | 25,000 204034 $04,702 | 529876 39365 5,668 3,125 19042 66,074 438398 30,285 52,894 28125 212076 570,778 . (64399 10,000 500 ‘ 16,899 _., 69399 Le. . 109600. oe ..500 ce tee ee . wee ve ween ween ee £69899, 16,528 2,200 “ 18,825 12,597 250 5750 24,371 550. 439510 | 19,845 850 3,500 19750. eee cote ee B59 94S oe _ 30,000. 700 _ . . ow. 2309709 by 300 . 6300 20,272 500 8,000 a 28,772 §5,°90 an ., .55,909. 19,857 200. 24000 | .224057.. __. 125500 a warn 122509 192,999 21500 19,250 24,372 41500 . _ on ") 2439620... 637,796 329785 829144 524496 26,076 ” 9319297 31,890 6,057 60347 65824 , ~ Sl,li6 “305842. ~~ —«88p492~S*~S:*«~SH ZO” 26016. OO gaz 4s . ne te ORES . . . $44 MARCH 08,1972 REGIONAL MEDICAL PROGRAMS SERVICE LIST OF COMPONENTS REQUESTEO FOR NEXT SUPPURY YEAR REGION 64 NE CHIG CL 9 RMP@SUPP~YR O02 ote See a ae aes COMPONENT COMPONENT NEXT DIRECT COST EST OATE NF NUMBER TITLE SUPPORT YEAR NEXT PERIOD TERMINATION coon CORE 02 637,796 . 001 HOSPITAL LIBRARY CONSULTING SERVICE 02 329785 06/73! . O02 CCU NURSE TRAINING o2 B2y 144 ~ 06/73 7 ~ 003 STREP CULTURE PROGRAM 02 524496 06/73 77 "" " Q07 STROKE REHABILITATION DEMONSTRATION =~ "gg 260%] TTT oes7R TTT . . ¢ . TOTAL REGION 64 | COMPONENTS $. ; , 831,297 _ - - che a ner : - . -- wee wa deecec ee ne _ wipe et ph tee f en ee wees coos wee see ume cnet weaves le nese eS eamlggmniageoege " - “ - ~ 1s b he . REQUEST MAY/JUN 1972 REVIEW CYCLE DESK SOUTH CENTRAL AREA : © ~ ' . * RMP-OS$M-PEMOO! oo lee “ ° 4 ee = . a - ~ « mee o : mn MARCH 1951972 REGIONAL. MENISCAL PROGRAMS SFRVICE ' . SUMMAPY BUDGET. AY TYPE NF SUPPORT REGION 64 ME O4IO |__| RMP SUPP YR 02 oo _ XESK SOUTH CENTRAL RMPS RMPS COMPONENT COMPONENT OrecT INDIRECT TOTAL, NOs TITLE SUPPORT YEAR 1st ¥R 1SY¥ YR 1ST YR ‘CONTINUATION WITHIN APPROVEO PERIOD OF SUPPORT coon CORE 02 6379794 31,890 669 9686 AOL HMASPITAL LIBRARY CONSULT! 02 324785 6,057 38,842 NG SERVICE . "O02 CCU RURSE TRAINING 02 B2e144 6,347 "88 y491 N03 STREP CULTURE PROGRAM 92 524496. 6,824 59,320 307 STROKE REHABILITATION DEM 02 26,076 | 24 N76 ONSTRATION CONT. WITHIN SUB-TOTAL 831,297 519118 8829415 REGIUN IDIALS. kt . 83149297 Ske llO «c= 8820415 ~ RMPS RMPS_ NLRECT DIRECT 2NO YR 3RO YR ee eee — 265976 [REQUEST MAY/JUNE 1972 REVIEW CYCLE RMPS-OS4=-JTOGRE TATAL NTRECT ALL 3 YRS 637,796 329785 $2,144 529496 8315297 831297, - 2 ee ee ee pee |! ‘we @.. LO, 1972 MEGIOH 64 NE OHIO RMP SUPP ¥P 02 STATE FUNDS GRANT RELATED INCOME INTEPEST OTHER REPS TOTAL COMPONENT NUMBER * CONTINUATION WITHIN. APPROVED PERTOO DF SUPPORT 1 ¥ é 6079 669, 65% a1 38 6842 902 884491 N03 594320 27,099 007 269976. ‘CONT. WITHIN SUB-TOTAL . 682,415 27,090 PEGION TOTALS oe 8A2 9415 27490 ‘es a “Mahe 3 . oe — PEGTONAL MEDICAL ©. SERVICE LISTING OF AD AL FINDS : REQUEST MAY/J OTHER OTHFE TOTAL LOCAL FENCRAL NON@FEDERAL OIRFCT 4 FUNDS FUNDS FUNDS ASSISTANCE 305900 . oo. . 30,990 304770 om, UNE 1972 REVIFW CYCLE ‘ TOTAL FUNDS aye THES. PER TOO ¢ ey 669,686 gy 38 e842 Le 68,491 . & 22603290 coo. eo 26,976 on f 939,415 . & . 939,415 Ee \ ‘ 6 G i ~ .- en: we eee ween MA 4 ~ ee . te te ce pe ee oe ee a S er MAREE 19,2972 REGION 64 NE CHIO CL COMPONENT PERSONAL PATIENT EQUIP. Ko. S¥C CARE . CONTINUATION WITHIN APPROVED PERIOD OF alate 438,395 69399 mY 394285 , an2 52,894 * 14,009 193 7 CONT. WITHIN SUS-TOTAL $215577 165399 REQUEST TOTALS 571,577 167399 2ECLON TOTALS 521577 169399 CO4PNN ENT sd TITLE CIN CORE ° VOL HOSPITAL LTARARY CONSULTING SERVICE 372, CCU NURSE TRAINING 303. STREP CULTURE PROGRAM O7 STROKE REHABILITATION DEMONSTRATION REGIONAL MFOTCAL SPOGRANS SERVICE SUMMARY BUOGFT BY TYPE SF SUPPORT , . RPS CONST. OTHER TRAINING OISFECT INDIRECT & FELLOWS. 1st ¥R VsTt YR support 192,999 6376796 31,890 25599 329785 6,°ST 19,250 . " A2,144 6,347 574496 6 A224 76,074 2146749 8415297 Sl,lis 714,749 831,297 $1,118 2147749 9314297 51,118 CNYOONTNT YF AR ' 2 ° 0? c2 G2 02 SO406e REQUEST FERRUAPY Ly RMPS TOTAL 1ST ¥P_ 669,686 3A e842 RR,SOl] $9—320 26,076 BAILS AB2415 8829415 DIRECT CST PREVIOUS YEAR AWARD 865,918 489224 139,844 2929155 84,907 14339,048 193392948 ft 193397048 PMPSHOSM> ITACHI RMPS OrRECT 22ND YR ‘ 1972 OTAOLIAE RMPS DIRECT 3RO YR _ yr ey « - OT wEREO ‘ CRP ONT NUMAFS OWED OL RAS TOT AL GUSTING oe AQOET GPANT RELATED INCOME STATE Lagat INTEREST OTHER — FUNDS FUNTS CONTINUATION WITHIN: APPROVED PERIOO OF SUPPORT e079 OGY Hee N43 OT CONT. WITHIN SUB-TOTAL 659 ,HPG 38 9842 BEB 49) 59,320 757976 BA2,415 REGION TOTALS ‘Rte HO etn ee Ae ie p= el ns nee 2 » BA2,445 a mncnemine e 27,909 30,999 27,000 39,000 27,900 3,000 NYHFR NON@~FFOER AL FUNDS ¥. ROQUIST EF ORUARY Ye TOTAL OIRECT ASSISTANCE TOTAL FUNOAS THIS PER INO 669,686 38,842 885491 116,320 26,076 9390415 LOR) OFADLENE: ont a. e er sary fe ~ Tl soon MARCH 17,1972 . REGION ~ NE OHIO BREAKCUT OF REQUEST RM 00064 06/72 ee ee a ee O2 PROGRAM PERIOD ae _LRMPS*OSM“JTOGR2 (5) (2) (4) (1) TOENTIFICATION OF COMPONENT | CONT. WITHIN] CONT. BEYCAD] APPR. NOT [| NEW, KOT 1 CURRENT [| CURRENT } | } APPR. PERICO! APPR. PERICOL PREVINUSLY | PREVIOUSLY | OfRECT | INDIRECT 4} TOTAL I | OF SUPPORT | CF SUPPGRT | FUNDED 1 APPROVED ! costs { cosrTs J ee ee | | ! ! I to . meee C009 CORE I 1 { I J { i —_ L $6370796 1 1 i 1 £637,796_1 $31.820 1 $OAh9, 686 1 GGL HOSPITAL LI@RARY CONSULT] | \ i { } i 7 LuG Sf@VICe j £32,785 3 4 | L $32,785 | 46.0571 £385842_) OG2 CCU NUPSE TRAINING I ! { i j ' ! ! _— a 1 482.144.1_ ! i 1 $32.1¢4 1 £6,347 1 -$28n491_1 _ C33 STREP CULTUPE PROG2AM I | ] | | I I ! a EEN j $52.496 1 1 1 4 $522494 1 $6.82¢ 1 $551320 1 CGT STROKE REHABILITATION CE] i I J I ! | { we ZONSIZATION l $20,076 I 1 L 1 £26,078. 1 i $262075_ | , : ‘ ! , ! { { I I o I I dee eee ee, TOTAL, EL 8881297 | Io 1... $631,257 | $51e118 1° $8825415 | oo _ 1 hn eee en cote, . ~ - _ No [ t tw . © 2 MARCH 17,1972 . SUMMARY OF ALL REGICNS BREAKOUT OF REQUEST 06/72 - UST @UDGCT YEAR RHPS-CSH<-JTCGR2 (5) (2) (4) 1) }. CONT. WITHINE CONT. GEYOND!] APPR. -KOY = | NCW, KOT ! 1ST YEAR | UST veaR | { an ] APPR. PERLOD] APPR. PERICD] PREVIGUSLY | PREVIGUSLY | OIRECT - | INDIRECT. | TOTAL sf. : { GF. SUPPORT | OF SUPPORT [ FUNDED | appRoveD | costs 4 costs | “7 1 : i | “4 l orem pm q j I * J : ! ! { I 1 ! } GRAND“TOTAL £ $14,062,690 |] $22893¢850 [| $10467-376 | $4e21Le693 | $2106354609 | $4e2080768 | $25 ¢744,377 | J 1 L i { l i } | | 1 ! | sq ! i { j ! | t { i 1 en ener ee ~ | I 2ND BUCGET YEAR 1 - Type ep . I | I { ! ! j 1 | CONT. WITHIN] CONT. BEYONO] APPR. NOY |] NEW, NOT J 2ND YEAR. {| l { { APPR. PERICD] APPR. PERIOO} PREVIQUSLY | PREVICUSLY | DIRECT J ! ! | OF SuPPORT { OF SUPPORT { FUNDED | APPROVED 1 cosTs | | I i | J l ! j | } “GRAND=TOTALC ——*#Esé$11,383,076 | $704,248 [| 61960365745 J $49002,273 1 81791285242 >| ap mmr np rm mae L i 1 i i i { i I t | t | 1 t j ! | | t } { | I | i 3RD BUDGET YEAR ! t | I _l [ t dt | 1 t eo ode = | CONT. WITHIN] CONT. BEYONO] APPR. NOY" | NEW, NOT 73RD YEAR 4 YO" rorar | | APPR. PERICO] APPR. PERICDL PREVIGUSLY | PREVICUSLY | DIRECT J} ALL YEARS = | | CF SuPPORT | CF SUPPORT | FUNDED { APPROVED I costs I [OiRECT Costs {| ! ! I { t i i i GRAKO-TOTAL I $437,719 | $28,966 | $19160,844 | $2,627,529 | 1. $40 93925380 | 3 i i i i sey teers tee ~ €T MEOKML Region -i4- v Rev. Cycle PRINCIPAL ACCOMPLISHMENTS BY RMP since 197 The Region has excelled in the development of cooperative relationships throughout the area and has involved large numbers of providers in the committee and overall organizational stricture. It has a good data base and has the cooperation of all of the resources necessary to establish a complete data system. Strong ties with CHP, state health planning agencies and other institutions and agencies have been developed. PRINCIPAL PROBLEMS 1. The absence of critical staff members. 2. Relationship between the Board of Trustees and the RAG and the question of where decision making authority rests. 3. Currently supported activities for the most part do not reflect program goals or priorities. ISSUES REQUIRING ATTENTION OF REVIEWERS Same as problems. i) i ™ ~] / . ~1 twa ~ . a = 15 - . RMP: Northeast Ohio. Prepared By: Vernie D, Asbby Date: s, Objectives and Priorities: The statement of goals and priorities submitted with the first operational grant continues without change. Hach problem is classified on a scale of urgency (Urgent. - 4, Important - 5, Significant- and Pertinent - 1) and this scale is used in the priority: ranking by the Board of Trustees of the projects that go through the review cycle. . . Immediate health service needs of the poor of the cities of ‘NE Ohio (priority 4 -.urger NEORMP organizational goals (priority 4 - urgent) Prevention and early detection of disease (priority 3 - important) Increase in the potential for the delivery of health services (priority 3 - - important) Equalization of the distribution of health services (priority 3 -.important) - _Improvement of the quality of medical services (priority 1 - pertinent) Currently Supported activities for the most part do not reflect program goals aay emphasis. Shun Be LAID Re Recommended Action: - / Accomplishments and Implementation: The NEO/RMP has done a good job in conceptual planning. It has a good data base and has the cooperation of all resources necessary to establish a complete data system. A proposed computerized network should be a valuable tool in improving the distribution | of medical services in the Region. All 56 hospitals, having 400,000 discharges per year, are cooperating in submitting summaries of those respective discharged patients. Core supported feasibility planning studies which show promise are: 1. The Laser TV Transmission with Case Western Reserve University, a prototype one-way laser system for TV: transmission will be expanded into a two-way system for health services- communications. This study will examine the value and reliability of the system as well as implications for wider application. 2... The organization for University cooperation in health which was formed to encourage and coordinate joint planning for health manpower education through Greater Cleveland Institutions (Cuyahoga Commmity College, Cleveland State University and Case Western : Reserve University with the Metropolitan Health Planning Corporation and NEO/RMP representi the consumer and provider interest in the commmity. This study will explore the feasibility of establishing a formal mechanism through which the resources of the three’ institutions could be used in the preparations of personnel in existing health occupations and new categories of health manpower as these develop. If such a mechanism is feasible, this could be the foundation for the establishment of a jointly sponsored School of Allied neailth ee ee en R 0/ RMP Core staff has always been very active and have excelled in providing catalytic functions for the program. Substantial staff effort is spent in convening and facilitating activities. There is a very close working relationship among agencies, associations and institutions within the Region. Fp: Northeast Ohio Prepared By: Vernie D. Ashby Date: 3/7/72 3. Continued Support: _ The Hospital Library Consulting Service project #1 to insure continuity of services following the phase-out of NEORMP support now has a fee for service arrangement. At present fifty institutions are now providing support for services instituted as a result of the project. Income is expected to increase thus insuring continuity of services to member institutions. Project #2 continuing education of nurses in Coronary Care will probably be university-based following termination of RMP support. Means to finance this activity are being explored. There is no indication'that the other two operational projects will be continued after termination of NEORMP support. Recommended Action: + rg oo 4. Minority Interests: There are eleven full-time professional and technical positions on Core staff. Six of these positions are-filled with females and five with males. However, none of these are filled with blacks. The Coordinator of the NEORMP is actively recruiting a black physician to fill the position of Deputy Coordinator. Minorities occupy three of the seven clerical positions on Core staff. , Two of the eighteen professional and technical positions on project staff are filled by minorities and one of the five clerical positions. Seven of the members of the 55 member RAG are minorities. The Coordinator of the NEORMP will strive for a balance with regard to employment of minority employees and minority representation on the RAG and committees. | the planning study to develop a comprehensive health care program for the medically indigent of Lorain County is a plan to bring high quality care to these people in their own neighborhood. This is an area with a large minority population. ee a Oe am em Oy mee a me ee oe ee ee ee ee ne me ee ce ne Oe ae ee ee ee - on ee en ae ee ee oe — a - ee ee - ~ - ee es ae Oe ca a ae ee ee ee ete es _ ee ee ee. oo Om ee ee se - ewes = 47 = ; oRMP: NEOhio Prepared By: Vernie D. Ashby Date: 3/7/72 é. Coordinator: NEO/RMP was without a Coordinator or Deputy Coordinator for approximately eighteen months. Dr. Donald M. Glover was appointed coordinator on January 1, 1972. Dr. Glover was not on board in time. to have input into the present application. Although Dr. Glover is 76 years old, he seems to be in excellent health and also seems to be quite alert. ‘Recommended: Action: - 6. Core Staff: The Core. staff includes eleven full-time professional personnel. The majority of the. - Core staff is physically located in the central offices in Cleveland with regional offices in Youngstown and Akron housing small contingents of Core. The following critical staff positions have never been filled : 1. Director, Evaluation 2. Director, Communications 3. Deputy Coordinator Si. ie i A i a: a a ie is NO a a Ma a ne Ae st ime © Recommended Action: at ee a ee ate a ee - 18 - prepared By: Vernie D. Ashby Date: 3/7/72 RMP: Northeast Ohio 7. Regional Advisory Group: cy - fhe RAG has been meeting quarterly for the past year with a membership changed broader representation according to significantly from previous years. There is now a hére has been a marked improvement in attendance at vocation of individual members. T RAG meetings during the past year. After a study by an Ad Hoc Committee of RAG, RAG itself concluded that its functions were purely advisory. This would’ indicate 4 serious weakness in the entire organizational structure of the NEORMP." There is a need tor involve the RAG more actively in both the planning and decisionmaking — process. ee a ee ee ee cre tee te ee ee ee a ee ee Recomended Action: ‘ 8. Grantee Organization: The grantee is a non-profit corporation which receives fiscal services from the Case Western Reserve University. - The members of the corporation are the Board of Trustees. Decisionmaking responsibility for program policy and direction rest are drawn from the membership of the Board with an Executive Committee, whose members of Trustees. This arrangement has raised serious concerns as to whether the decisionmaking responsibility in this Region rested with the Board of Trustees or with the Regional Advisory Group. . . ee A ne Sa Sec et ee cle rm ee nee Oe a em te ce mH ce ee ~ ~-~ - - ee ee ee se te ce ee ee i an a ee an nO ae le cee Oe Se mm wee are ee Recommended Action: - 19 ‘RMP: Northeast Ohio . Participation: nwuJRMP has succeeded in the relationships among agencies __Prepared By: Vernie D, Ashby Date: 3/7/72 - development of cooperative arrangements and close working » associations, and institutions within the Region., i.e., Blue Cross, CHP 314(a) and (b), the Health Department, the Welfare Federation, the Medical School faculties, the Academy of Medicine, volunteer organizations, and the Community Colleges. 10. Local Planning: The area planning committees meet on a quarterly basis. These committees are responsible for assessing area needs and for advising the Coordinator, Board of Trustees, and the ¢ RAG on NEORMP proposais. Core assistance to proposers led to four approved feasibility comment and CHP reviews and TO ee Studies including developmental planning for an AHEC for the Youngstown-Warren area NEORMP has a field office adjacent to the Summit -Portage County CHP office. Staff and office equipment are shared, CHP circulates pertinent applications to RMP for comments upon NEORMP proposals. Also a NEORMP staff person is located in the Mahoning Valley Health Planning Association office and shares many daily pianning and coordinating activities with CHP, ee RMP: Northeast Ohio Prepared By: Vernie D. Ashby Date: 3/7/72 11. Assessment of Needs and Resources:” SO pre i \ method of total program evaluation has been designed and is under development. Liaison’ activities in Akron resulted in a discharge planning study. Assistance to proposers led co four approved feasibility studies including, developmental planning for an Area Health Education Center for the Youngstown-Warren area involving major Universities, nedical centers, physicians, and health organizations. NEORMP in conjunction with Blue Cross of Northeast Ohio and four CHP "'B'' agencies are co-founders of Center for Health Data of Northeast Ohio. This center has supplied the necessary, data for a ' series of studies concerning hospital utilization and discharges and manpower data : analysis. Joint data collection has been carried out in the areas of health manpower, health manpower training programs, emergency services, and other surveys. ne a oe ee -_ ewe wena nan emer mmn ween eee Recommended Action: . ‘ 12. Management. The real meat of the NEORMP has been in the realm of its Core functions. Core activities have been varied and imaginative. Three critical positions remain vacant, these and the positions of Deputy Coordinator, Evaluation Director and Communications Director. - NEORMP has a written procedure for the review of project applications with Core staff input beginning with staff assistance in the development of projects, regular and systematic monitoring and evaluation with quarterly expenditure and progress reports. » a ee ee i i dal ~- re ee a Recommended, Action:. - . RMP: Northeast Ohio” - 21- Prepared | By: Vetnie. D. Ashby “Pate: 0/7/72. 2}. _ Evaluation: The position of Evaluation Director on core staff is vacant and considered to be a critically needed position. However, specific Core staff are assigned to monitor and provide supportive services to individual projects. Major Core staff responsibilities are evaluation and financial administration. Two reports are required quarterly from each project. These are expenditure reports and progress reports. An Assistant Director for Evaluation was hired in April 1971. A system for appraising and strengthening funded projects with periodic reports, committee review and consultation is under way. A method of total program evaluation has been designed and is under development. ~ Recommended’ Action: ’ ® 14. Program Proposal: The program priorities against ‘which projects are reviewed are: .. Immediate health service needs of-the Urban poor. ‘I. Prevention of Disease: Prevention of Cofplications of Chronic Disease: Early Detection of Chronic Disease. ‘IL. Increasing the Potential for the Delivery of Health Services. Vv. Long Range Equilization of the Distribution of Health Services. V. Improving the, Quality of Medical Service - All proposals receive an evaluation rating which determines funding. Present operational projects show little relationship to goals and priorities. However, certain Core activities and Core-supported feasibility and planning studies show promise. For’ example: 1) The ‘ development of indices of community health through the Center for Health Data. 2) Develop- ment of the model for Youngstown-Warren AHEC. 3) Expand discharge planning throughout the Region and, 4) development of an educational data system. | . - econmended Action: = Prepared By: ° - £27; var. 15. Dissemination of Knowledge: the ngoRMP has developed cooperative arrangements and close relationships among agencies, i.e, Blue Cross, various hospital administrators, CHP 314(a) and 314(b), the Health Department, the Welfare Federation, the Medical School faculties, the Academy of Medicine, and the Community Colleges. Data.collection needs have been identified and publications on health-related data have been compiled and distributed. ee ee ee ee ae en ee OR ROE SOROS EEE SEES SHEN SSH DENK Recommended: Action: 16. Utilization of Manpower and Facilities: 4 structure has been developed which can stimulate grass roots interest- and need major health factions - in the region. Close relationships prevail among agencies, i.e., Blue Cross, hospitals, CHP "A" & "B" aggncies, the Health: Department, the Welfare Federation, the Medical School faculties: the Academy of Medicine, and the Community Colleges. ° eee eee won - - Ee. -—oee -RMP: - Prepared By: - oa Date: —17. Improvement of Care: A planning study is in progress to medically indigent Lorain County. Initially, it will serve 5,000 of 28,000 poor in the county. ’ A discharge planning study for continuity of care will test the feasibility of a coordinated discharge planning system for the improvement of continuity of care. A study titled "Preventive and Rehabilitative Needs of the Under Sixty-five Homebound" is directed toward a typical inner-city with a population of approximately 40,000 to determine the magnitude of the needs of homebound persons under 65 years of age. 7 ’ Recommended Action: 18. Short-term Payoff: the Hospital Library Consulting Service provides a network of informational services to fifty institutions which are now providing support to the project. -This project will be expanded further and should be self-supporting upon termination of NEORMP support in June 1973. The Continuing Education of Nurses in Coronary Care project has developed the necessary components to structure an effective educational program. Means of support are being explored for this project which if terminate’ on or before June 31, 1973. Since the inception of the Stroke Rehabilitation project over sixty patients have benefited from treatment received in this program. Improvement has been noted in terms of shortening the length of hospital stay, the course (of rehabilitation, and the course of the disease. oe eee we ee ewe ee we Oe we mee ROO RECO RHEE SBOE HBO TED ECE HT eH eww Ean mar NTT eD Ee ETS Oe Recommended Action: . . . . RMP : _ | Prepared By: ~ 24 - | Date: 19. Regionalization: For the most part, perational activities are aimed at nurses and other hospital health professionals. Fifty hospitals are participating in the Hospital Library Consulting Service project and-the network of informational services will be expanded further. 20. Other Funding: The Strep Culture Program which is NEORMP operational project #3 has $27,000 State funds and $30,000 Local funds allocated for this budget period. Blue Cross of Northeast: Ohio has jointly sponsored a computerized tumor registry, supplied basic data for Radiation Therapy Guidelines and helped develop average cost of kidney transplants and other procedures. a ea ee ee ee ee eee ee ee ee me et eee ee ae ae ee ae ee eee em ee mee men ae em ewe ee me Oe em me we me we ee me ee ee ee ee ee Recommended Action: “4 @ DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE * EMORANDUM PUBLIC HEALTH SERVICE TO FROM SUBJECT: HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION Acting Director Ce DATE: April 18, 1972 Division of Operations §& Development Directox{\) Regional \Medical Programs Service Action on April.10-11, Staff Anniversary Review Panel Recommendation Concerning the Northeast Ohio Regional Medical Program Application. Accepted “a f LL te) Rejected ~ (Date) Modifications s Component and Financial Summary - Anniversary Application COMPONENT CURRENT wee YEAR «we YEAR RECOMMENDED YR'S AWARD COUNCIL FUNDING OPER. RECOMMENDED REQUEST SARP YEAR LEVEL REV, COM. 4 CORE * 481,424 AMAL KAR 637,796 Sub-Contracts 55,000 NOM NY KKILAL ES pe ACTIV. * 208,763 ASOPL PRESET 193,501 ° COR PS PS EVEL. COMP. SOK OAKEY Yes ( ) or No (X) armas: KIDNEY RMPS DIRECT * 690,187 803,696 831,297 jf 786,187 REQUESTED 1,232,075 COUNCIL JAPPROVED LEVEL 786, 187 NON-RMPS and INCOME -* Does not include 24 Month REGION Northeast Ohio . extension for 01 yr. of $2,376,158 May/June 197.2, REVIEW CYCLE 01 Al 01. A2 . Core 677 ,826 Core 865,918 Projects -359 5284 Projects 473,130 Direct Cost 1,037,110 Direct Cost 1,339,048 4/18/72 SCOB/RMPS Region . NEORMP Review Cycle June 1972 Type of Application: _Anniv. Prior to Triennial Rating 245 Recommendations From Ki / SARP . / / Review Committee /_/ Site Visit /_/ council Recommendations: 1. The funding level and period recommended by the National , Advisory Council at its February 8-9, 1972 meeting be approved. Specifically that the Program be continued for 1 year at the present level of funding. (786,187 D.C.) 2. That RMPS recommend to the Region that they take a good look at Program staff to see if there are unneeded positions and that they give consideration to phasing down or out the present operational projects, utilizing any funds freed-up to mount new programs and initate activities indicted by their data base. 3. That RMPS take a good look at the organizational structure of the Grantee and make specific recommendations. 4. That technical assistance be provided to the Region by RMPS. This assistance to include strong RMP Coordinators in addition to RMPS staff. 5. That the new coordinator, Dr. Donald Glover and the RAG Chairman be brought into Rockville for RMPS indoctrination. 6. That program progress be assessed by RMPS at the end of 6 months. Critique: The Panel concured with staffs recommendations including the continuation of the Regions funding for 1 year at the current level. Decision making responsibility for NEORMP policy and direction. rest with an Executive Committee, whose members are drawn from the membership of the Board of Trustees. Reviewers were very concerned about the relationship between the Board of ee Trustees and the RAG and the question of where the decision making authority rests. Page 2 - Critique The reviewers of the application were in agreement that very little progress had been made by the Region since it attained operational status July 1, 1970. The panel agreed with staff that there was little apparent relationship between Regional goals and the operational activities which are presently supported by the Region and further that there was an absence of critical Program staff members in the areas of evaluation and communications. The panel was concerned about the lack of minority repre-~ sentation on the Board of Trustees and the Executive Committee and the inadequate representation on Program staff, RAG and committee structure of the NEORMP. Panel in their deliberations considered the facts that NEORMP had been without a full-time coordinator for 17 of the first 19 months of operational status and tnat Dr. Donald Glover was appointed full-time coordinator on January 1, 1972 and was not on board in time to have input into the present application. It was the opinion of panel that NEORMP was actually back to a planning grant basis and that Dr. Glover, the new coordinator, should be given all of the assistance possible to give him a chance to turn this program around and head it in the right direction. Panel felt that some of the following forms of assistance could be helpful to the Region: 1. Staff assistance visits. 2. Strong RMP Coordinator going out to the Region as a part of the technical assistance process. 3. Have the coordinator and RAG Chairman participate in site visits to other regions. 4. Refer coordinator to Regions that have solved programs. 5. Have the coordinator and RAG Chairman visit Rockville for RMPS indoctrination. 4/18/72 SCOB/RMPS Region . OHIO Review Cycle June 1972 © oe 7 a. % Type of Application _ Anniv. ° Prior to Trienniun Recommendstions From Rating 197.7 L/ _ SARP- | , Lx Review Committee L/ Site Visit L7 Council Recommended Level of Funding: The Region requests one year of support, 9/72 - 8/73. However, the Review Committee recommended two years of support to; (1) provide the Region with the opportunity to take the necessary steps of putting the two programs together and (2) to build a strong and effective Program Staff. The Committee recommended a total of $1,400,000 for the (01) year as compared to the Region's request of $2,082,820. In arriving at this amount,. members of the Review Committee: . . 1. Recommended $900,000 for Program Staff. This amount is approximately . 40% over the current Ohio State and Northwestern Ohio RMPs one year © _ ‘expenditures for the Program Staff component. 2. ‘Recommended $500,000 for operational activities. Included in this amount was the proviso that this include $201,535 for Project #3, Ohio Renal Disease, if the project was approved and that this amount was to be deducted if it was not approved. (The 3 part Ohio Renal Disease project was reviewed on May 8, 1972 by a staff AD HOC panel. The recommendations of this group are the subject of separate documents). Also included was $162,393 for the 10 month continuation of Project #1, Ottawa Valley Council for Continuing Education, and #2, Computer Assisted Instruction, which have one additional year of Council approved support through the merging RMPs. . : 3. Recommended no support for Project #8, Health Careers of Ohio, as the activity was believed to be outside the guidelines of RMPS. The Committee recommended a total of $1,515,000 for the (02) year. .This was built on a 10% increase for Program Staff, $990,000 versus (01) year $900,000, and a 5% increase for operational activities, $525,000 versus (01) year. $500,000. Critique: This application was not reviewed by SARP. A site visit was not performed. Members of the Review Committee had a great deal of difficulty in considering @ this application. Page 2 - Critique First, they commended the very poignant comments of the two members “~.. o£ Council who participated in a January 10, 1972 Factfinding visit to the three Ohio RMPs. They were then in the dilemma of attempting to consider total program rather than individual projects when in reality there was, as yet, no total program to consider. Two of the present three Ohio RMPs, Ohio State and Northwestern Ohio, have complied with Council's recommendation to merge, effective September 1, 1972, to become the Ohio RMP with the Ohio State University Research Foundation as Grantee agency. The Review Committee considered the following as concerns: 1. The Acting Coordinator, Dr. William Pace, will resign, effective June 30, 1972. (He has elected to assume a full-time position with the Medical School). 2. The Region has no formalized review process. 3. The goals and objectives are very general, non-specific statements. ‘4. The Regional Advisory Group is temporary and is in the process of expansion. 5. Major staff changes will not occur until the Region becomes operational. 6. Nine of the twelve proposals in the application are from the existing Northwestern Ohio RMP. (Members of the Committee had a considerable amount of concern that previous activities in the Northwestern Ohio Region were aimed towards the support of the newly developed Medical School at Toledo with emphasis on that rather than to a greater degree on the RMP component). Conversely, the Committee believed the Region had taken some positive steps to deal with the problems. These are: 1. A Search Committee has been active (and successful) in locating several qualified candidates for the Coordinator position. A final decision is expected by June 30, 1972. 2. The local review process is being prepared and will be completed before the Region becomes operational, 9/1/72. The review process will be a part of a developing policy and procedure statement. Also, the Region plans to have all projects proposals, feasibility/planning studies and many of of the program activities in this application reviewed by an external review group prior to June 1, 1972. Time constraints 4. 5. Critique made this impossible prior to the submission of the application. The application describes a detailed program management planning process. The Region has established a committee to reconsider and monitor the goals and objectives. After September 1, 1972, membership of the RAG may be expanded to include broader representatives as outlined in the By-laws. Because of the pending appointment of a new Coordinator, the Region has made little effort to recruit personnel. In the merging Regions there are currently a total of 22 professional positions ~ this is to be increased to 32 professionals in the new organization. , The Region has agreed on a grantee and fiscal agent, the Ohio State University Research Foundation, which has demonstrated competency in the fiscal area. The Region currently has a relatively strong Acting RAG Chairman, Dr. Brian Bradford, (who, it is understood, will remain in this position) and an Interim Regional Advisory Group that apparently has participated fully and actively in the merger effort. The reviewers commented that the RAG has established an innovative task force arrangement to continually monitor the progress of the new program. Conclusions: That the Region has made progress in merging. That they have attempted, as requested by Council, to merge with the Northeast Ohio and Ohio Valley RMPs. This has not been effective. That the Region be encouraged to devote themselves to planning and development activities rather than to immediately launch new project activities. That the Region be encouraged to attract additional minorities to its staff, RAG and Committees. That the new Region has some unusually strong support through the Director of the CHP "a" agency as well as the Director of health. oe | Page 4 - Conclusions ue + - hat the new organization appears sound and indicates intent to establish field offices. Also, the.planned assignment of field personnel to work in CHP "b" areas should add a demension heretofore unknown to this area. DOD/SCOB . 5/23/72 L. a . ‘ Component and Financial Summary - Anniversary Appiication af sue UL YEAR COMPONERT CURRENT ** —_ YEAR ; RECOMMEND ZD YR'S AWARD COUNCIL FUNDING : ~ . OPER, RECOMMENDED "REQUEST Sere YEAR “LEVEL - REV. COM. — ; 7 02 ~ oRE 1.237.668 900,000 | 990,00 : Sub-Contracts - JOPER, ACTIV. 643,617 500,000 525.00 DEVEL. COMP, -0- Yes ( ) or Ro ( . JRARMARKS : KIDHEY #3 201,535 CBE #15, 16,17 See Below * RMPS DIRECT 2,082,820 1 515,00 ~ “eS REQUESTED | SESS SESE OSS COUNCIL LEZ : < _ APPROVED LEVEL ESE KOKR-RHPS and INCOME ~0- * Also pending are CBE requests as follows: ‘ #15 O1- ..78,019 Total Costs,“ : REGION OHTO _ #16 ~ O1- , 870,169 Direct Costs — a . #17. Ol- :-49,900-- Direct Costs is June 1972, REVIEW crc! Current Program Request owt 2,082,820 . oar . Supplemental CBE Request - . _ 998,088 7 ° Region's, Total Request © - 3,080,908 | ete eg OHIO STATE N.W. OHIO} * TOTALS Total Direct Costs - 702,467 692°,800_- 1,395,267 Program Support (CORE) °- 452,851 +. 358,900 811,751 @ vrojects . _ 249,616 333,900 ° - :583,516.. ** Summary of actual expenditures for ‘the one year period af t C L. ending March 31, 1972 « 4 ary aN} Bpeewres were \ . se > Review Cycle May/Jurb97_¢ . ? : , i Type of hop lication yo Fe 0s “" .° Anniver'sary Continuation -Cly mal hes andnetonn Th : prior. to submission of a. . Reconmendations From. *. triemial POT Ts me am mee '- Rating: Review Commnittée It [—7 SARP. ee , . . Key Review Committee (C fT Site V Visit fee "+ [77 Council Se " RECOMMENDATION: ..The Review Conmi-t bes -cohcummed..with. staff-reviewers and SARP-——--- that the application be approved*fér one-year in the reduced amount "$839,205 (d.c.) This recommendation also includessadvice to the Region as follows: 1) recruitment of .a strong Coordinator, ineluding consideration of a. qualified non~physician; . 2) strengthen the Program by reorganization of RAG and Program Staff, as well as continued subregionalization;: and 3 improve relationships and responsiveness to CHP Np" agencies. This action does not include nergeticy Medical. Services (ENS) project 425. pending -a special review. As reported -by.staff, it.was also: noted that a. supplemental — application for planning several. local health. manpower systems was expectéd - _ dune 1 for special, review prior to the oe "Te Council, ~ RATIONALE FOR FUNDING RECOMMENDATION: Recommended funding is at. the 03 year level prior to the April | '7L board ,reductions;-and shduld be adequate to inerease Program. Staff, necessary: reorganization activities, and to fund some projects (particularly continuation of those within the previously- approved _ support periods ‘and activities developed by t the Tulsa NE Subregion and approved by the CHP. agencies). ; . ‘CRITIQUE: The recommendation 1 was reached after long discussion’ ‘and debate about the status of this. Region and an appropriate level of ‘funding. Staff's narrative comments including ORMP's. strengths and wealmesses 5 the subject of SARP's discussions were noted. “The Review Committee expresséd concern, about some of ‘the disparity - in- project ‘ratings. and they questioned whether CHP comments were considered in the RAG . * . decisionmaking process.. ‘The. reviewers recognized and discussed the need for a different ddministrative mechanism to provide the needed | leadership for a “meaningful reorganizational thrust in Program Staffing and continued education of the RAG and its. committees..: Turnover.of staff added to-the difficulty in wie identifying current Program Staff ‘vacancies and new positions. Concern was expressed about the number of projects submitted for support, during a time when major efforts should be in reorganizing to: turn the Region around in‘ the right - direction. Even though minimal breakthroughs were recognized, some members of the Committee questioned. whether ORMP had really. gotten the message and favored sharp funding reduction, . On the positive side, staff reported that the Coordinator’ has ‘armounced his ’ decision to resign as soon as the active Search Committee reeruits a qualified successor; and the Committee is thinking about the kind of leadership and - organization that... is needed including competence which does not require a M.D. . ae Region Oklahoma . Review Cycle June/July 1972 * Recommendations. From Review Committee Page 2 . / Another hopeful sign recognized by staff is that the Director of the University 6 Medical Center and the people in Oklahoma more and more are defining the University Health Science Center as an institution to serve the State, and the ORMP represents the necessary link for community service. Other noted progress included the implementation of subresionalization in the Tulsa Area, the Macer Committee Study, and efforts by some Program Staff to strengthen ORMP.. — Component and Financial Summary < Anniversary Application ra ‘ “ COMPONENT CURRENT ~ OH” YEAR Ol YEAR RECOMHENDED ys YR'S AWARD CCUNCIL _ FUNDING . - 03 OPER. RECOMMENDED "REQUEST 77 SARP po YEAR LEVEL REV, COM. ’ < s, cf 4 ae . CORE $354 ,000 POPK APS $677 ,300 Sub-Contracts -0- CPN PLES 47 100 5 o oe 3 : Xe - JOPER. ACTIV. 384 ,500 SOK OSE 629,782 . SKOOL OI DEVEL. COMP, ~0- SOLEIL —0- Yes ( ) or No (% EARMARKS ¢ os KIDHEY -0- -0- -0~ EMS #25 See Below ** : A = : Y j aPS TD. ECT 738,500 * ; 1,354 ,182%* 839 ,205%* . . RTI ON SOOO SESE SIE EEE IES REQUESTED 22 064 LELEEERER AN SIGS i SE o : So / Ss Se" eh Me C . = COUNCIL PENS [APPROVED LEVEL 962,564 > PRS S NON-RMPS and INCOME -0- 7 74 REGION —_ Oklahoma May/June 197.2, REVIEW CYCLE .* This Region! current -period ts being charigéd to 6/71-8/72 (15 months) and funds ar RK The EMS- proposal: special review. e- ‘ Funds are not included in this figure. Current Program request . Supplemental EMS request |, Region's. Total request ‘a e $1,354,182 ee 140,690 $1,494 ,872 to be incréased to $923,125 d.c. was a part of the basic application and is pending - ($140,690 for one. year*only) for that project OKLAHOMA REGIONAL MEDICAL PROGRAM Anniversary Application . For Consideration by June 1972 Advisory Council TABLE OF CONTENTS PART I: STAFF BRIEFING DOCUMENT Page Face Page Smee eee race asereedeenenaereeegeneeressese usr ees 1 Map, Geography & Demography neceecucedecevevesebeecedeas 2- 4 History oe, eesne eee e ne ee eee eae hoseeseesreseeeeeatreeaeeeeoese 5 Component and Financial Summary ....ssceesescerccesncees 6 MIS Breakout of Request (04 year) ..ssscsecccceneceseees 7 Accomplishments, Principal Problems & ISSUES ...++++eees 8 Pre-Sarp Staff Meeting Comments in Rating Criteria Order oe eae ena ee ate eer ore ee eee eeeeeneeneeses 9-14 PART If: KIDNEY ACTIVITIES —- None PART III: APPENDIX Site Visit Report ~ July 1971 em ee nese racer ee soe nse ses A-1 Advice Letter -August 1971 .cececeesscccccccrsescesccens A-2 % ee Dy ’ Staff Visit Report “_ January 1972 deme eee eee eee mee eee eae! fn Macer Report - December 1971 Cr oe i A-3a gets i . PS a * . ~~ v6 ‘ STATE BRIDFING NOCUMENT . . . et : . an! : ‘ ‘ . . . eo: : : . * "wa e on OPERATIONS /7/ Eastern FR] Mid-Co: REGION Oklahoma BRAKCH (J South-Centr'l {77 Wester: Te | BRANCH ; an "¥PE APPLICATION:| Not rated LAST RATING: +} Tel. No. _44-31590 Room__ 10-15 [7 TRIENNIAL “497. DATE. BRANCH CHIEF Michael Posta Pay ist ANNIV YEAR fy sare” | BRANCH STAFF Luther Says (7 2na anniv yearn) =. [77 REV. COM. | RO REP.__Dale Robertson Next Mgt. Assit Visic___ June 197 [CJ OTHER annivergary [7] OTHER Beh yr Chairman LAST S.V. July 1971 ; Chairran Leonard Sherlis, M.D. (Review Committee Member) anon safe Visits, Last 12 mos. (Dates, Chairman's Name and Type of Vipit). eb, 1972 « L. J. Says(1st visit) Monitor Progress and consultation prior to submission Meir present application. vo "AP Core Staff visited RMPS, woordinator and Executive Vice-P % staff (ine luding the Director-1 three staff for 2 davs-9/71; two staff for 2 doys 3/72, resident tor Medical Affairs and Dir. of UMC met with 0/71. 3) The R.O.R. visited ORMP several times includi RAG meetings. ‘Major Events Which Occurred in t dn May ‘ 1971 =; eo, oo pel 1)The site visitors identified many ORMP problems which must be seriously addressed if thi “Region is to move forward. The visitors' main concern was lack of capable Core leadership. (report and advice letter are included in this document). 2) Following the site visit, the ORMP appointed a special gommittee ("Macer Commit tee") ~ineluding the Coordinator from Colorado/Wyoming RMP to assess the Region. 3) During the: meeting of the ORMP Coordinator, Director of the Univ. Med. Center with the Director of RMPS and other staff, there was a clear understanding of the site visit visit findings. It was reported that the Coordinator intended to resign. : seember ‘71 retreat of the RAG and Cote staff, program directions were light of the site visitors.and Macer Committee ‘findings. . hy 172 meeting, the RAG approved some affirmative changes in the RAG and mn ttee ‘ucture, subregionalization and strengthening the Core staff ... in eeping with new goals and objectives. Lo : he Region Affecting the RMP Since Ite Last Review Map of Congressional Districty” anties, and Selected Cities (6 Distasis) Se ~” \ . — HARPER CIMARRCN WO 0s BARTLESVILLE OSAGE | TEXAS BEAVER ALFALFA WASHINGTON AT arene ad \ NOWATA . ; @ENID WOODWARD fm GARTIELO DELAWARE ELUS ‘@)) MAJOR ‘ PAYNE DEWEY i KINGFISHER | LOGAN BLAINE . CREEK § “ : e MUSKOGEE 5 ROGE — LINCOLN ‘ R MILLS . CUSTER . 3 ; a OKMULGEE MUSKOGEE \ CANADIAN OnLANEER 4 OKFusKEE SEQUOYAH . pe OKLANOMA CHYG? 9 Piri - . Fal MOWEST ww ND | MCINTOSH | . BECKHAM WASHITA { carr ¢ \ CLEVELAND <= HASKELL ls NORMAN | & , . : GRADY & HUGHES a MCCLAIN pITTsSURG | AyyeR LE FLORE . HARMON PONTOTOC . ° COMANCHE GARVIN — JACKSON o LAWTON ° _ CON DUNCAN MURRAY PUSHMATAHA TILLMAN : STEPHENS : . ' cotron JOHNSTON CARTER RTAIN . JEFFERSON | ARD/AORE? — MC CURTA : MARSHALL CHOCTAW i ; ah : 4s ve : . County with “wo or more Congressional Districts te ~ BRYAN . ; x ’ . * US, Department ef Commerce Bereau of the Cr - . Ly: MTEL LI T6 4044.4 UsIOW nmauUstNoEs NS a# ey @ | Resources. and Facilities ‘ RDB 3/17/71 Oklahoma RMP . ‘Geography and Demography ~~ Region encompasses the State. Counties: 77 . Congressional Districts: 6 Population (1970 Census) - 2,559,300 . Land Area: 68,887 square miles Density: 37 per square mile Urban: 68% , Metropolitan areas: (4) 1,356,600 Fort Smith, Ark-Okla. 156.8 . Oklahoma City 623.6 Lawton 104.5 Tulsa 471.7 -Race:. White 89% Negro 7% Other 4% (majority Indian) . “Mortality - deaths per 100,000 population, 1967 : Oklahoma . U.S. “Heart Disease 368.8 364.5 Malignant neopl. 157.6 157.2 Vascular tesions 127.4 102.2 (aff. CNS - stroke) “ Diabetes 16.9 17.7 - Broncho-pneumonic 16.6 14.8 . (other) + Medical Schools - Univ. of Okla., School of Medicine, Okla. City 1969/70 - Enrollment 442 1969/70 - Graduates 94 ‘Allied Health School, Univ. . Univ. of Okla., School of Health Related Professions, Okla. City — Professional Nursing Schools Practical Nurse Training. 13.~ 7 of them college or 16 Schoois ‘ university based vAceredited Schools Cytotechnology - 1 (Univ. of Okla. M.C.) Medical Technology - 13 Radiologic Technology - 9 Physical Therapy - 1 (Univ. of Okla. M.C.) Medical: Record Librarian - 1 inhalation Therapy Technician - 2 Oklahoma (continued) Hospitals ~ Community General and VA. General . # | Beds | Short term 127 : 10,438 Long term (special) — 3 153 (130) (10,591) V.A. (general) 2 — 739 Manpower Physicians ~ Non-Federal M.D.s and D.0.8s (1967) Active 2622 Inactive 382 i Ratio of active (per 100,000 pop.): 106 providing patient care Graduate Nurses, 1966 Actively empl. in nursing 4650 Not empl. in nursing 1842 Ratio of empl. (per 100,000 pop.): 188 RDB 3/17/71 — strengthen evaluation. OKLAHOMA REGIONAL MEDLCAL PROGRAM HISTORY This Region was approved and funded for 2 years. and 8 months of planning, 8/1/66 ~ 4/30/69, $835,902, including $121,032 indirect costs, Kelly West, M.D., now Professor of Medicine and Continuing Education, University of Oklahoma School of Medicine, served as Coordinator during the planning phase, He currently serves on core staff (20%) as Coordinator for Related Diseases. Following a favorable site visit in November 1968, the ORMP was approved for three years of operations and funded at (d.c.) $1,074,145 #01, $1,162,157 -02 and $738,500 -03. The 02 year application was reviewed by staff. Most of their concerns were answered satisfactorily by ORMP. A BMPS staff team visited the Region in June, 1970, Within pix months the Region responded directly to most of their questions and tecommendations. Concerns not addressed by ORMP, were deferred until the next application was received and reviewed. Upon review of the ORMP Triennium Application for the 03, 04 and 05 | years. by the Review Committee and May 1971 National Advisory Committee, approval was recommended for one year only in a significantly reduced amount including disapproval of the Developmental Component. A site visit was recommended to determine actual progress; to study activities" impact on tiealth care delivery; and to offer guidance to the Region in developing a mere meaningful Triennium Application for submission the following year. The July 1971 site visitors were greatly concerned about the leadership. There was some question about the Coordinator's capability and commitment. fhe visitors were also skeptical about the strengths of the incoming BAG chairman, January 1972. The outgoing chairman appeared to be immaginative and relatively liberal, Other identified areas in need of strengthening: (1) development of more optimistic core attitudes 3 (2) attempt to adopt a program philosophy more consistent with the RMPS mission and Oklahoma health care necds; (3) evaluate and strengthen the professional core staff; (4) involve more "yeal" consumers on the --RAG: (5) involve RAG in actual project monitoring; (6) reconsider goals and objectives relative to current trends (including time frames) and identify priorities; (7) implement subregionalization; (8) establish better working relationships with appropriate groups including Federal supported programs, i.e., OEO, Model Cities and CHP "a & b's and (9) a Component and Financial Sumeary - Auniversary Application _ ee COMPONENT PREVIOUS CURRENT 04 YEAR. RECOMMENDED . YR'S AWARD eonicin FURDING ’ . 03 _OPER. RECOMMERDED | REQUEST | /-7 Sarr YEAR * . LEVEL mo [7] REV. COM, é . : a , 3 CORE and "354,000 NN LS 724,400 7 OPER, ACTIV. 384 , 500 Dv 770,472 DEVEL. COMP. -0- Lo Iw ~0- EARMARKS ! -O-— . ~ 0- KIDNEY Teme” At RAPS DIRECT 738,500 "1 ,494:872 ” " i ” ; | RMPS INDIRECT 224.064 NN 255,770 oN, a TOTAL RUPS 962,564 ra 1,750,642 oN NON-RMPS and Pr oe . INCOME ~0- : C |. TOTAL BUDGET 962, 564 Zo oo REQUESTED 2.020. 5A5 - — . REGION Oklahoma COUNCIL . . APPROVED LEVEL 913,500 : June 1972_, REVIEW CYCLE 4 * This Regions current period -is being changed to 6/71-8/72 (15 months) and funds are to be increased to $923,125 d.c. my , FEnQuy | 1972 me ~ REGION - CKLAUIVA | me BOFAKCL QUEST RM 7923 N6/72 4 PRO RIAD Y pe gTERP “ (5) (2) t4) (1) DENTIFICATION CE CCMPCNENT | CONT. WETHIN] CONT. CYANO] ADDO, ROT { NEW, NOT ! CURRENT = [ CURQENT i Z | ACEO. PE2TOG] apom, PERT] PPEVISLSLY | PReVTCUSLY [ . CIPECT } INQ ERECT | TCTAL ! 1 OF SUPPOAT | GF SupptRT ff FUNDES {| app2cven 1 COSTS 1 CCSTS | 1 1 \ i we he 1 \ qoo CORE I | 1 I ep i | ! | f £724,409 1] - i | E724 eA00_ ffs 7,yes fo teh. Fos A? CPPCNARY CARE PECERAM FOI ! { { } i { i 2 OSTA { €27,515_] ! 1 £27,525 1 0 $14s 226 tO wo fede tht TO RESICAAL UFCLEGY PELJECT I { | | i I ! j ~ i ! $5224) 1 i j #82241) $458_1 $i2555_1-—. 14 CONT TNUING ERUCATION CEN] { | | i 1 { i LTFe vACTLE SMILE \ i $48,413 1000 i 4 £40,422 1 ii 843-9130 5. TEC EEHT OSGING EGUCATION CEN] | i | C Te ans ! i $27. 829_1 j 1 £372230_) i £37,830, Te ASA CENTINGING CAPE STPCI ! i | ] { 4 oS “SE i j ! $64,744 _ 7 ! £445,744} t £649.799. 0 SP STOVAL THe @ kev *Nf CATEE| | } } | t i ! TER CARE l } 432,500 1 ! I $33,800 05 2,275) £362 878i! Th PPECEPTS? PROG FC2 PUPALT t { 1 t t. t bos LWUUHES EL ESP Sov TIATNINE i 1 L ‘J $31,290 [31.208 To sees | 294.746 5. 7e CE MUNTTY IN SESYICE EN J ! i | ! I a aff £02 Ze sitet PEeSCyMeL 1 { { } €35,759 1 $25,787 _ 4) epe, ste 1 250.366 JL 71. Tuts vatee CITES CONSUI | | t 1 | | ! a i i l j 452,009 | es2,ec7_ 1 ~----1-----482099-1-. 2? cq | | ! 1 ! i aod C { I L ae I $54,618] £54,610 1 “ginineg fo ceeeyese 33. FPPEL ALLEER BEALTH AND] { 1 ! , { | br “Py EQ orean Scr Our st Os | i ! een $222011_! $27,911 4 { R732 ble 3G NE DMEA SEGTONAL Bere c{ I | { { \ j i pe neweres sPerysy cack ot t i ! B5E,4 20 | €58,630 | : ! 5s -3e do PE OCOYMINTTY TRAPNTAG FOR Ol 1 1 | I | } ! LuKLA AMR ALCS DESSCANEL oJ } \ 1 6140,69% 1 si4sraser i £240 e602 1 PRO PKLA POOLLTETO NURSE ASST ] ] \ 1 { 1 ! LEE _LebInine seece ss ad 1 1 J £42,247 | $495,347 $7.25? 3 e88,596 Fo (27 ENT EAR VATESAAL ANT CHILI J | { I | i i WLM HESE Te 1 1 1 1 $47,825. | $472 895 _ ) $4.673_] 0 Shee 2th Ie CO CONTINGENG FrUCS CENTE® | 1 ! | | t i UMEOGyY HE SOE TAL { L 1 ! £60s026 | $60,086 | i seteres doo | | 1 { | . I : i { TOTAL 1 ] | £64,744 | $553,129 § 8124945872 | $255e77L To. SL e THC VEZ | $£76,999 4, De G, Dex Ye. Goals and object May AEE tty a reerec JL 3 RY) eee tees mew nee this opolieation is o ereal dinovovemont over the previous fog gid with the Some Gafni in pvads ard objoetss Evaluator end others 1 HOP apae iSte goeds Well os prioritius are to be dove eaterorleal] aoprouch, Biforts widerwey to strengthen the data be: jnelwlin 4 plarnne i] arid CCYISUS Batter cocperative Jinkups underirey GHP essences. mubresieng ligation undorvway. vs RAG report indicates Lney recognize Seman ord tsites Wea Pad fe ti set Core and better consiications... fone dmprovensnit in evaluation, > singe Jmrc cet ee ren ee enema ee ky 10 “as new Vilanner noun te OW. and objectives in tim: icped in the OM year, Changs: in organizeticn including new functional comslttees - depaitur the need for RAG training, strengthening Strengthen Core lopmont and mye ye de ee rt shoxib oF RAG Prioritics nee a as not eucdUe esion Fron Gin PUG ietgrepnie represent true of physicians. vbion Plan (ll row pr ejects). seems like putting the cart before the horse. wh eee ae mee ee cee eee ee ue cine ee emmy Rit oCONNE vise ay te ee er eee eee ae OE ne Ng pe Ie Ne ee fa Approval. un ‘he yoduced arount of $839,205. G.c. of the £63 project #25 (renked number ou& py RAG and ‘nile sa-Nis Subresic: Gu RY ee ah we ATE CRO fe high by CHP "a & b!" azencies). TS Ope TN We wai % with Loo a 2 new comnl.t te ad to be more explicit and me Lili over-velented — cons topes and rated WERT LOTION Be TE PST eens een ee ee ee ee ~~ -— — 8 Su % follemo stare exthon, tnelioting te mace Wig weyien. both aceumplisisecits and problems noted sbove. 9 : ATED DEPARTMENT OF HEALTH, BRUGATION, AND WREEARE foe eh i Aa the . ; ne PUBLIG HEAUEH SERVICE HEALTH SERVICES AND MUNTAL HEALTED ADMINISTRATION THE RECORD DATE: April 3, 1972 ae ANY _FROM :. Operations Officer iy N Mid-Continent Operations Branch 4 { ~ | SUBJECT: Comments Agreed Upon at the Pre-SAKP state Meeting 3/27/72 Regarding the Oklahoma RMP Anniversary Application ~ ort Participants: Michael J. Posta, Chief, MCOB Luther J. Says, Operations Officer, MCOB *Carol Larson, DPID Mary Asdell, DPID * Prepared written ¥ Joan Ensor, OPPE comments. *Catherine Scurlock, OPFE #amnie Stubbs, GMB | *Harold O'Flaherty, MCOB, was unable to be present. 1, Goals, Objectives, and Prioritics (page HN.H6) ( eo The new goals and objectives have been expanded but are still too general. According to recent telephone conversations with Dr. Cooper, the Planner, in concert with. the new Community and Consumer Health and. Involvement Committee; he is in the process, of redeveloping goals mes and objectives (long and short term) which will be more specific and my equated to time frames. Priorities will also be established (current Me priorities are not listed, but ara the sane as listed in last years application). OP is working, with CHP "a" Task Force on health statistics to establish a data bank for Oklahoma Relative to goals and objectives there is now better cooperation with consumer groups (CHP alt and "p') and a move toward regionalization. 2, Accomplishments and Implementation In addition to the site visit recommendations, ORMP appointed a Committee (Macer) to study its organi zation including core staff after which attempts have been made to reorganize and strengthen $is capability. As indicated in the Coordinator's cover letter and RAG report, transition 4neludes broader representation from consumer ay minority groups, as well as new functional committee structure in lieu 6f traditional pg categorical approach, ‘The new Tulsa North East Suvregion, its staff : and Advisory Group is evidence of their move to decentralization. Feasibility studies should be helpful in developing new outreach health care approaches. yy a res meee Continued Support (page 89-90) Projects are monitored by monthly expenditure reports, auerterly progress reports, semi-armual monitoring and cvaluation by staff, RAG - and Committee site visits. Efforts have heen inude to terminate FMP support after reysonable periods. OF the 11 ypanjects implemented since the Region became operntional, support of 3 wes terminoted after two years (l was unsuccessful and 2 continue) |W tertiinate 5/31/72. - (03 year) after three years suppovt (3 will beself-sustaining and one has applied for support from NIH/NLM). One epproved and supperted for three years will be extended three months, coritinued support for one more yeur is requested for.the CCU project funded for three years, (The CCU project will contime and the urology project is seeking support from NIH/NCI). Continued support is requested for three projects which began in the 03 operaticnal year (each approved for three years). , Minority Interests Although some progress had been made there is an obvious need for much more "real" minority and consumer participation at all levels of organization. Goals and objectives do not specifically mention minorities, but speak to advancing the delivery of health services so each individual may have access to the system, The Coordinator's letter and RAG report (page 38) address more involvement of consumers. | RAG membership has been expanded to include more consumer input, . ineluding CHP "al" and "b" representatives. RAG (60) includes 11 (16%) minority representutives (1 Mexlean-Americun, 3 Blocks, and 7 American — indians}. ‘len tentilles (17%) serve on the RAG. Executive Comittee (12) - only 1 minority (black, no females). All Committees (192) - only 3 minority members (black) and 42 (22%) are females, Core professional staff (FTE) 13.15 - 8.65 male, 4.5 female - only 1 black. Core clerical staff (FIE) 8 - all female, 1 black. Project professional staff (FIE) 16.5 - 6.4 male, 10.1 female, no minorities. Project clerical staff (FTE) 4.3- all female, no minorities, Coordinator The Coordinator is extremely lacking in leadership sbility necessary to move this Region forward. ‘ihe furture of the Region, despite the capable efforts of a few of the more competent and committed core staff, rests in employment of a new Coordinator as soon as possible. A study by the Operations Officer indicates: (1) of 16 professionals on board at the time of the July 1971 site visit, 8 have terminated. Of 9 employed since that visit, 2 have terminated. (2) Of 9 clerical staff emploved at the time of the site visit, 4 have since terminated and 2 have been hired. It's BMPS! understanding that the Coordinator is to be replaced. However, as of 3/31/72 there has been no formal announcement of his leaving or effective date. (© 6. Te oO. li Core Staff The lack of able core Leadership and consistent staff turnover are major problems. Despite these handicaps, core has made good progress particularly since the arrival of Dr. Cooper, Planner, in Noverber 1971. The RMPS Operations Ofticer has observed his charisma with most of the staff, i.e. Director Tulsa-NE subregion, Evaluator, and Chief of Grants Management. The "Macer’ Committee report contains some very worthwhile recanmendations for reorganizing core. BMPS staff also agrees with the concerns about the Communications Media Staff functions which might be more effective and less expensive on a contractual basis. The RAG report (page 42) is also right on target. RAG Composition of RAG and Conmittes as they relate to consurer and minority representation iis deseribed under Minority Interests of this report. Of the RAG (60) 62% are providers (22 physicians), 25% are consumers, and 13% represent Voluntary Health Agencies and others. Forty-three percent (26) of the RAG are from Oklahoma City, 13% (8) from Tulsa, and 44% (26) are from 19 other communities. Toeve (8 a ip-medher Exceulive Comittee (& physicians, 1 other provider and 3 consumers) - (5 from Oklahoma City, 2 from Tulsa, and 5 fron other communities). Tne RAG met 3 times and the Executive Committee met 6 times. The Manpower Committee met once and the Continuing Education Committee did not meet. The categorical committees have been replaced by six new, more functional committees. However, these committees were not approved until January 1972 and all members have not been recruited and no meetings are reported. As indicated in the RAG report, there 1s a need for better orientation, 25 well as improved communications with the staff. According to conversations with Core staff, KAG will be more involved in the future, l.e., site visits, committee work, and earlier involvement in development of activities and review. Grantee Institution The Grantee seems to provide adequate administrative support to ORME and permits RAG flexibility regarding decision and policy making. NOM: The University Medical Center is applicant of 9 of the 16 proposed projects in the present app.ication. Participation and 10. ‘Local Planning Proposed projects involve 107 sites and indicate. outreach 1p There has been some improvement in cooperative relationships ; ii. le. 13. aneluding the CHP a and b agencies comments. Analysis of data from significant disparity Subregion. There are and disapprovals. JZ , ORMP, not in between rank and the application ineludes their cluded in the application, indicates , ings by RAG, Core and the Tulsa-NE some divergencies in CHP a and b approvals Assessment_of Needs and Resources The ORMP Planner serves on a "task force on health statistics" to establish a data pank . gharing arrangements . for Oklahoma ORMP data £ . ORMP has some reciprocal data athering includes health status in NE Okla., rural health studies, and continuing education and manpower needs. Proposed fensibilicy and p ‘Lanning studies SJnelude child health ,emphy.sema , rural health delivery» problems of the urban poor, and nenoto lozy/onco logy consultative s Proposed project activities relate Management Fiscal management seems good. Chi. attenpting to strengtnen fiscal co Texas KEMP. ervices to two Indian Hospitals. to stated goals and objectives.” ef of Grants Management is ntrol and recently visited ‘inere is evidence that monitoring of activities by core and RAG is underway - An BMPS Management Assessment visit is tentatively scheduled for June '72 Evaluation In addition to the information (form 14, page 89-90) and the staff visit to ORMP, the Region's Planne with RMPS' Planning Evaluation staff since submission of the application. In pener is reason to be optimistic in plarming process. ‘91 the two & r and Evaluator visited at length eem to work well together. There terms of ORMP developing a viable ‘The Planner seem to understand the need to carry out an assessment of needs, relate them to resources, establish objectives and priorities, and building appropriate methodologies (including time -phased objectives and terminal points for The Evaluator is less & evaluation). impressive than the Planner, but nevertheless appears to possess the skills and out his task. BMPS Review Criteri an ORMP's evaluation. Concerns: for monitoring and evaluation core does not seem to be a sy ouer to: determine impact of activities, on delivery, 1.e-; target Bro, experience to effectively carry a have been modified and are used 1) does not seem to be a procedure staff activities; and 2) there realth delivery (quallty, acccss, ato. ). ay (@ 14, Action.Plan (one year application) Congruent with the new three eyele review, the current period has been extended to 15 months, ending Aug. 31, 1972 (new start date Sept. 1, '72), with additional furs prorated on the current level. This was not known to ORMP when this application was submitted. MCOB staff is concerned about the ambitious O4-proposal - more than tuice the amount of the current level. While ORMP has made some progress, beginning about Nov. '71, the number of new activities proposed seems unreasonable. As the Region develops a prograin during the remainder of the current year ana the 0/} and prepares for Tri enial-submission, potential projects may have more importance than those currently proposed. . Hence, the pre-sarp staff reviewers are concerned about their submission of 11 new projects. It would appear that much of the effort should be accomplished through core activities until a meaningful three year spending plan is developed. The proposed core budget could be scaled down by one third or more. Dissemination of Knowledge Alluded to elsewhere in the report, 1.e., approx. 107 project performance sites, core studies, and cooperative relationships. Utilization of Manpower and Facilities CRMP is doing a better job of this through better tle in with other agencies, including an attempt to establish a State data bank. Improvement of Care Of those activities supported and those to be continued, there are no measurements. of their impact on delivery. The CCU project, ‘requesting one additional year, Will attempt to do this type of evaluation. It can be reasonably assumed that care improves through support of these activities, but tangible evidence is needed. Project #19 Preceptor Program for Rural Hosp. Lib. Training and Consultation is compatible with #6«Library Information. Support of the later is being phased out and an application has been made to NIH/NIM (parts not qualifying for NIM support will be supported through Core). Activities receiving highest RAG rankings (8 out of 16) are #25 * Emergency Health Care Training, #2 CCU, #15 Continuing Education Center at Ada, and #14 at Bartlesville, #26 Pediatric Nurse Training, #17 Stomal Therapy and Catherter Care, #16 Continuing Stroke Care~ Ada, #28 Continuing Education Center, Mercy Hosp. (Core staff rated 5 of these 8 highest). In the 8 ranked highest by Core, #24 Newborn Care in NE, #23 Rural Allied Health Manpower, and #20 Community Tr-Service Education for Health Personnel, took priority over #14, 17 and 23. 18. 19. 20. 7 Core studies may unfold areas for stimulating and assisting in the development of new projects in future years. ~ Short Term Pay Off The budget sheets reflect no shared project support. ‘ORMP's history of phase out support (see no. 3 Continuing Support) and continuation of the activities is good. Regionali zation They ave well on the way~having, established the Tulsa NE Subregion with an. Advisory Group (page 65), headquarters at Tulsa with 4 professional and secretary. Four more are planned in the O04 year at Ada (SE), Fnia (NC), Bartlesville (NE) and McAlester (SE). Perhaps there would be more wisdom in staffing one in the SE at Ada or McAlester and one in the north central area at Enid, and using two other field representatives from the central office to service other areas. Other Funding Already discussed... see no. 3 "Continuing Support" and no. 18 "Short ‘Term Pay Off". - ; -1- we DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE MEMORANDUM " 4 PUBLIC HEALTH SERVICE 6 HRALTH SERVICES AND MENTAL HEALTH ADMINISTRATION TO . Acting Director DATE: April 13, 1972 Division of Operations and Development KC FROM : Director, Regional Medical Programs Service SUBJECT: Action on April 10-11, 1972 Staff Anniversary Review Panel Recommendation Concerning Oklahoma Regional Medical Program Application RM 00023 dated 2/V72. Accepted: A\ Yfs—/ 22. . PA ] Date Rejected: Date — enue: 4% a Component ‘and Winwnedal Summary ‘ Ann{ vergary Anpt fention -2-.° COMPONER?T CURRENT 04 YEAR ~Ol YEAR RECOMHEND ED YR'S AWARD COUNCIL FUNDING ' 03 OPER. RECOMMENDED ‘REQUEST SARP YEAR LEVEL 2 REV. COM. " KORE $354 , 000 < | $677 , 300 , {Sub-Contracts De f Nor NZ oF “e 47 100 . SZ NY : (OPER, ACTIV. 384 500 DSS 629 ,782 * OE los Ms OS DEVEL. COMP, -0-. iste LEE ONY -0~ Yes (_) or No (x ) EARMARKS 3 co KIDREY ~O- -~0~ -0- EMS. 140,690 -0~ 140,690 RR a RUPS vskkCt # 738,500 1 494 8 872 ee” 2322 205 . LO, 7 7’. ~~ q SESS OSS cS REQUESTED wou O64 LEO SOK OSL SESS « SSS SEE SE < ? Co >t SS od o> AL SOS COUNCIL BEET Soe Se ES ZEEE EES. APPROVED LEVEL 962,564 {POS oe 669,059 irevit 2 Early Diag. & Therapy 152,436 144,012 27,825 324,273 3 Surgical Treatnent : . : , ‘ of Vascular Lesions 9,375 : 10,281 19,656 , 4 Comprehensive Stroke Care with Regional kd. 44,800 51,396 56,859 61,002 214,056 3 Project Evaluation 22,578 27,621 31,567 . 81,766 6 CC Trng - Salem Mem Hosp 54,084 46,225 52,164 45,210 197,683 27,169 . 7 CC Trng Sacred Heart Hosp 59,772 69,345 73,848 52,691 255,856 ‘ 9 Central Oreg Heart, Cancer : : and Stroke Pilot 26,367 24,233 23,070 73,670 19 Coronary Care Teaching 4/ . Aids : 12,774 ~' 5,572 713 19,059 2100 Guiding Adult Patients with Asphaata : 27,120 27,019 21,980 76,119 12. S0,' Oregon Diabetic last- . 7 Evaluation 186,064 22,091 40,155 13° Mobile Emerg. Cardiac ' Project 39,499 6,249 . 45,748 14 Trng. Prog. Care of Diabetic Patient 32,886 39,285 28,815 100,986 15. Phys. In Res. Course . , Tech. Cardiology 28,920 32,599 61,519 16 0 A Training Program for Personnel of Oregon Hosp, : 23,419 39,122 62,541 24,373 17” Diabetic Patient . 2/ Project (9, 762)=' 18 Coronary Care . Monitoring ‘ . 99,851 20 Cor. Coorda/Cont. Med. y Education . (9,945) = 22 Emerg. Med. Tech. Tra. for . rural areas = 53,452 23. Mobile Cancer Det. Clinic , 63,438 24 Comm. Cancer Ser. & Trs. Protas 24,632 25 > Comm. Stroke Reh, 22,085 Progran 26 Cadaver Organ Procure- ment & Tissue Typing Pro. 94,940 TOTAL 522,287 ° 854,146 837,328 746,386 2,960,147 929,655 NOTES: 1. Core Budget (first year); merged with operational in the second operatfonal year. 2. Project #17 funded from Core Budget 8/5/71 3. Project #20 funded from Core Budget 8/5/71 . 4. Project #10 funded 5,572 + 3,200 from core = 8,772 3/25/71 Il. Oregon RMP -7- RM 00012 6/72 History of ORMP Development ORMP was funded for planning in April 1967 and became operational exactly one year later, following an enthusiastic endorsement from a site visit in February 1968. In early 1968, ORMP was concentrating on recruiting needed staff, assessing the medical needs of the Region, setting proper priorities for action plans and setting up adequate evaluation mechanisms. At that time, the National Review Committee had its doubts about the Region's readiness to move into the operational stage, however, the site visitors seemed satisfied that a working list of objectives and a scheme for setting priorities had been developed and that core was capable of moving the program into this phase. The Region was encouraged to arrange for assistance from the College of Education of the University of Oregon for better evaluation of the program and some of its projects. In October 1968, Edward L. Goldblatt, M.D., replaced Myron R. Grover, Jr., M.D., who had served as the original program coordinator. The ORMP was site visited again in April 1969 and the team was greatly impressed with all aspects of the program, including core staff, Regional Advisory Group, and evaluation efforts. The program appeared to be heavily provider and continuing education-oriented, and there was evidence that staff was beginning to involve many groups throughout the Region. The report stated that the application was an unusually well-written- clear-"Model" application. The team concluded that ORMP was as good as the words written about it. The ORMP staff had a sound understanding of the purpose of RMP and the abilities of Dr. Edward L. Goldblatt and Dr. Delbert M. Kole, Coordinator for Project Development, were favorably noted. Relationships between ORMP and Oregon Medical School were more than. adequate. The Region's request for continuation of core and ten projects for the third year was well-received by RMPS staff. It appeared that the Region had come a long way in establishing itself as a broadly-based, ongoing program as opposed to a series of isolated projects. The RAG chairman, Dr. Herman Dickel, was proud that all projects submitted by Oregon had been approved for funding at the National level. RAG had seemed to develop an awareness of local autonomy and had developed a mechanism for evaluating both incoming proposals and ongoing projects. Some projects were terminated early as a result of this evaluation. To further this internal evaluation effort, a contract was let to the Northwest Regional Education Laboratory to evaluate the policies and procedures of the core staff. Iil. Oregon RMP -8- _ RM 00012 6/72 € Two changes in leadership took place in the third year. Dr. Goldblatt was replaced by Dr. David Johnson, who served as Associate Professor of Public Health and Preventive Medicine at the University of Oregon. Dr. Johnson resigned in November 1970 to become Regional Health Director for Region X, and was replaced by Dr. J. S. Reinschmidt, who had been with the Student Health Service for the past seven years... , During the four years since its first operational award, the ORMP has submitted project applications regularly. Eleven projects plus core activities constitute the current program. The new coordinator has had a year of RMP involvement. Some of the more notable events which have transpired since the inception of the Program in 1967 are that the influence upon heart disease has been unswerving and unmistakable. From the start, the Board launched a concerted attack upon acute myocardial infarction, and ORMP efforts have undoubtedly shortened the interval required to implement improved techniques in the treatment of patients with this condition. Two coronary care unit projects have schooled scores of nurses for a new life-saving role as electrocardiographic monitors and initiators of urgent cardiac therapy. Another project offered analogous courses to physicians, with special emphasis upon the insertion of emergency pacemakers. Exploration of radio-telemetric monitoring of coronary patients while in transport to the hospital has continued. Continuing education grants have been ORMP forte from the very beginning. The Circuit Course Program, the first project funded, continues in its fourth year to provide courses to physicians, nurses, and allied health professionals throughout the Region, Idaho, and Montana. Other training projects have been instrumental in providing a network of volunteer directors of medical education on a statewide basis. With one or two exceptions, the continuing education projects will come to an end on July 1, 1972, and a new look of a constellation of projects will commence on that date. Performance In planning for the next three years, the Oregon RMP has reassessed core and project activity in the light of changing national priorities. ORMP RAG has adopted three major goals and recognizes an increased Federal emphasis upon them: (1) improving access to health care, especially for disadvantaged urban and isolated rural populations; (2) enhancing the quality of primary and other health services in Oregon; and (3) containing unit costs of health care by promoting greater efficiency within the delivery system. The proposed projects, core endeavors, and other ORMP activities have been designed as a move toward meeting their objectives. © Oregon RMP -9- RM 00012 6/72 Core staff's most important consultative and planning contributions during the past year: , The newly organized Gresham Clinic for the indigent. The Josephine~Jackson Counties Health Maintenance organization planning application. Physician assistant/nurse practitioner training program. Family practice primary entrance clinics, and outreach worker training program. . Concentrated employment program. Metropolitan Portland Comprehensive Health Planning Association. . Multnomah County Public Health Division. Model Cities, Tri-Metropolitan Bus System. Multnomah-Clackamas Counties Association for retarded @ children. . City-County Council of Aging. Five feasibility and planning studies are now in progress and one additional study is proposed. These include: patient origin study and health care utilization data system; a patient transportation system; a demonstration family practice clinic; a primary entry health care clinic; and a peer review system in collaboration with the State Medical Society. A. Goals The ORMP has elected to work toward the following: 1. To improve the accessibility of primary health services in impoverished urban and isolated rural areas of Oregon through the stimulation and support of activities which: (a) augment the supply of health care personnel and resources, or otherwise enhance the capacity of the health core systems; (b) encourage a more equitable geographic distribution of health care personnel and resources; (c) facilitate the more effective emergency and routine transportation of patients or of health care personnel; (d) utilize new types of health personnel or IV. Oregon RMP -10- RM 00012 6/72 traditional health team members in innovative ways; (e) improve the continuity and comprehensiveness of health care delivery; and (f) facilitate the implementation of the Emergency Health Personnel Act which is designed to place public health service physicians in areas with other- wise unsolvable primary health service problems. 2. To improve the quality of primary and other health services in Oregon with particular but not exclusive emphasis upon the prevention, early detection, and rehabilitation of heart disease, cancer, stroke, kidney disease and other conditions deemed of major importance by regional agencies by means of: (a) encouraging the formation of peer review and ombudsman committees; (b) promulgating the most efficacious techniques of disease control in primary medical practice, and (c) facilitating the establishing of subregional education centers. 3. To contain or reduce unit costs of health care delivery, and to promote greater efficiency with the health care delivery system by (a) promoting cooperative managerial arrangements which permit quantity purchasing, nonduplication of services, sharing of resources, and expanded use of ambulatory care units or outpatient facilities; (b) en- couraging the development of utilization review committees within appropriate medical agencies; (c) stimulating consideration of automated and/or computerized record keeping systems, data storage and retrieval methods, and multiphasic screening techniques; and (d) encouraging the use of those health care resources which provide the least costly method of service per unit without compromising the quality of those services. B. Methodological Objectives The Region has enumerated six methodological objectives for achieving the three major goals. These include the conduct of specific projects with staff support and expertise in developing them in concert with ORMP goals, to provide educational experiences for providers of health services and the general public, to provide data and information on health care resources, to cooperate with CHP agencies, and to continually assess the management and organization of ORMP staff, Board, and Committee systems. Process A number of organizational reconstructions has taken place with the Committee structure and program staffing. The former Grants Application Review Committee has been renamed the Program and Application Review Committee to signify an expansion of preview beyond pre-Board scrutiny of individual project applications. The committee's new charges include: (1) assessing compatibility of all proposals with ORMP programmatic goals; Oregon RMP -11- RM 00012 6/72 (2) advising all proponents of unsolicited project ideas on relevance to the triennial plan prior to the furnishing of definitive developmental assistance by staff; and (3) recommending to the Board priority rankings for all approval project activities. . Conversion of the Regional Cooperation Committee into the Health Resources Development Subcommittee brought about a cadre of knowledgeable Board members, assisted by a rotating panel of experts, to address each health care delivery proposal. Still another change in subcommittee procedure is the rescinding of a former rule that all project applications be reviewed by the Continuing Education Subcommittee, in view of the program shift,this no longer is a requirement. At the present time, each project proposal is reviewed by the Program and Application Review Committee, by the Evaluation Committee (to ensure adequacy of design), by the new Comprehensive Health Planning Subcommittee, and by either the Health Resources Develop- ment Subcommittee or a single technical subcommittee appropriate to the predominant thrust of the application. All proposals are given a final verdict by the Regional Advisory Board. Eleven committees or groups form the framework of the Region. All are standing committees with the exception of the Ad Hoc Triennial Applica- tion Review. Number of Members Meetings Last Year Executive Committee 9 il ° Program Application and Review 10 3 Committee Evaluation Committee 7 5 . Health Resources Development 8 2 Subcommittee Comprehensive Health Planning 11 1 Subcommittee (activated November 4, 1971) . Kidney Subcommittee 13 2 . Ad Hoc Triennial Application Review 10 3 Oregon RMP | -12- RM 00012 6/72 Number of Members Meetings ‘Last Year . Heart Subcommittee _ a 8 2 . Cancer Subcommittee 9 2 . Stroke Subcommittee . 8 1 . Continuing Education Subcommittee 9 1 Organization changes in core staff reflect a markedly augmented level of activities for core personnel. Core is now divided into four distinct units: (1) Program Administration; (2) Needs Assessment and Continuing Education Programming; (3) Specific Disease, and (4) Health Resources Development. Each unit professes its own set of operational objectives although personnel fully interchange between units for purposes of economy and integration. Some staff members assigned to the Needs Assessment Unit are derived from individuals presently working within the circuit course project. The Program Director is immediately accountable to the Oregon Regional Medical Program Chairman, Executive Committee, and Regional Advisory Board of effective overall functioning of program staff and project personnel in meeting the goals and objectives set by the RAB. In addition to assisting the Program Director, the Program Administration Unit provides consultation and assistance in development of project activities. This includes fiscal management of projects and activities, designing evaluation techniques, and designing informational-communication techniques. The Needs Assessment and Continuing Education Programming Unit, as a major problem-solving and needs assessing component, will promote the quality of health services in Oregon. The number one objective will be to establish a network of problem-solving groups composed of physicians and led by a trained coordinator. Also, 13 local nursing groups will be established along the same lines. The Specific Disease Unit will have the primary responsibility for activities focused on improved health service through prevention, early detection, and rehabilitation of the major diseases. Primary monitoring and liaison interface between ORMP and projects will be a specialized objective of this Unit. Health Resources Development Unit will focus on improved accessibility of primary health services for impoverished urban and isolated rural areas. Identification of meritorious project activities which can be transferred to other communities and agencies and to offer consultation will be two major thrusts of this Unit. © Oregon RMP -13- RM 00012 6/72 The core positions will be increased to ten with six of these full- time; two, 95%; one, 75%; and one, 50% time. The positions of Health Care Needs Assessment Unit and Project Liaison Officer are vacant. This staff will continue the facilitator, convenor role in the Region; implement the Needs Assessment Program; develop programs for the medically indigent; assist in teminating projects; and explore area- wide health education activities. Total funds requested for salary and wages of ten positions plus eight supportive personnel is $231,266. V. Program Proposal The ORMP requests $1,081,312 (direct and indirect) for the first increment _of a three year period, July 1, 1972, to June 30, 1973. This amount includes core activities, feasibility studies, two continuation projects, and six new programs. Developmental Component funds are not requested for the first year. It should be noted that increased funds are requested in the second and third years of the triennial and these will be extensions of formal projects and potential subcontracts; a variety of other ideas for activities has been explored by program staff. These activities have not been fully developed, however, they are included in the estimated funding section of the grant and will be addressed separately. © Core Support (C00) Requested Fifth Year $519,718 The staff will be increased from six to ten professionals and from five to eight supportive personnel. Six feasibility and planning studies will be conducted during the year. The following broad estimates of time/effort allocation have been made for core staff based on requested. funds: . Program Direction and Administration--267 Project Development, Review, and Management -~437% Professional Consultation, Committee Relations~-227 Planning Studies and Inventories-~5% Feasibility Studies--47 . e 8* ©. @ Sixth Year Seventh Year $427,336 $437,719 Oregon RMP . -14- RM 00012 6/72 Project #006--Coronary Care Training Program. Requested : , Fifth Year $27,169 This project was initially funded beginning July 1, 1968, with April 1 as the anniversary date. On April 1, 1971, it began fulfillment of a 15-month renewal application so that, in total, the project will have completed 48 months of operation on June 30, 1972. To offset the cost of the program, a tuition charge has been implemented. The activity is entirely compatible with the general goals of the ORMP and is germane to the State's comprehensive health plan. Future program activities will be financed by increased tuition, indirect subsidy by Salem Hospital and the development of an endowment fund derived from private individuals and corporations of sufficient size to provide adequate income for the project. Continuation support is requested for one year only to train an additional forty nurses in coronary care. Project #016--A_Training Program for Personnel Requested of Oregon Hospitals Third Year $24,373 The purpose of the project is to improve the care of patients in health care institutions in’ the ORMP by providing one to three day courses aimed at the entire spectrum of personnel who deal with patients in various ways. Courses in emergency cardio-pulmonary resuscitation, infection control, middle management, body mechanics and safety, and legal problems (a total of 42 courses) have been presented to 1,220 students (nurses, nurses aides, orderlies, various technicians, emergency personnel firemen, law enforcement personnel, and others). The important goal is "to effect cost containment and efficiency in hospital management." This project was approved and subsequently funded beginning October 1, 1970. By June 30, 1972, the project will have completed 21 months of operation. It contains a mechanism for take-over so that the affiliate institution is assuming one-third of the cost of the project. At the end of the second year, two-thirds will be assumed by the association and, finally, after three years, the association will support the project totally. Fourth Year $9,164 Oregon RMP -15- RM 00012 6/72 NEW PROJECTS Project #018--Operational Service for Remote Requested Coronary Care Monitoring First Year $99,851 The objective of this new activity is to improve accessibility of care to patients with myocardial infarction in less populated areas of Oregon. The sponsoring institution, Emanuel Hospital, requests three years support to link five and communities to other consulting coronary care units. Electrocardiographic monitoring will be transmitted on a 24 hour basis over telephone lines. Critical EKG diagnoses and therapeutic suggestions may be made by highly experienced CCR nurses and ph located at Emanuel Hospital. This project was previously appeowed ns by the Oregon RAB, and by the National Advisory Council, but not instituted due to budgetary reductions. Second Year Third Year $53,508 $28 , 966 ' Project #026--Cadaver Organ Procurement Program Requested and Tissue Typing Laboratory First Year $94 ,940 This is a three-year proposal to permit the University of Oregon Medical School to double the cadaveric transplant program to 40 kidneys per year and to increase tissue typing capabilities to support the expanded transplant program. It will serve the interests of the entire state and will cooperate fully with the Veteran's Administration Hospital. The public education component of the project will be subcontracted to the Kidney Association of Oregon. This project addresses a special Federal emphasis being placed on kidney disease, as well as fulfilling general ORMP goals and objectives. < Second Year Third Year $88 ,675 $91,572 Project #022--Emergency Medical Technical Requested Training Course for Rural Areas First Year $53,452 The Oregon Division of Health requests three years support to expand their ongoing emergency programs to include the training of ambulance drivers and to conduct the prescribed 72 hour course to volunteers. Less than 20% of the 2,000 ambulance personnel have received the recommended course. Training for 500 attendants annually is proposed, utilizing video-taped physicians presentations developed by the University of Kentucky Medical School. Second Year Third Year $45,277 $46,675 -16- . - RM 00012 6/72 Oregon RMP Project #023--Mobile Cancer Detection Unit Requested | First Year $63,438 This three year program will offer advantages of early cancer detection to female residents of Portland and of rural, low income areas of Oregon. A major obstacle in reducing mortality from genital and breast cancer is the failure of seemingly healthy individuals to undergo periodic examinations. Approximately 4,000 examinations will be conducted during the first year, ali in the Portland metropolitan area. The van will be manned by physicians, nurses, and volunteers organized through the Oregon Cancer Society, and all services will be provided free. 4 FET TE B Although the mobile unit will be used for cancer detection, it is recognized that there are a number of organizations and agencies who can utilize the mobile unit to carry out objectives if their programs, i.e., classroom for education programs for nursing home personnel, a ‘facility for individual genetic counseling, or general well-body care clinics. epi gd CEE AR nore Second Year Third Year $59 ,893 $66,325 : Project #024--Community Cancer Service and Requested ; Training Program First Year us , $24,632 The indigent population of southeast Oregon will be the target of this program. Services to 3,000 residents include genital and breast screening for malignant tumors. Diagnostic and therapeutic services are pledged by the Portland Adventist Hospital and medical staff at no cost to the indigent patient. The applicant, Portland Adventist Hospital, plans to test the feasibility _of employing nurses specially trained in this project to conduct preliminary screening examinations under the supervision of physicians. Second Year Third Year. $33 ,326 $34,121 Project #025--Community Stroke Rehabilitation Requested Program First Year . $22,085 This project is sponsored by Good Samaritan Hospital and its affiliate, the Rehabilitation Institute of Oregon. A multidisciplinary team approach will be employed to coordinate rehabilitation services for stroke patients. Local teams will be developed in six areas the first year and an additional Oregon RMP -17- RM 00012 6/72 eight committees will be chosen during the first and second years. This proposal appears to be germane to the quality and accessibility of both primary and secondary care of stroke patients in Oregon. Second Year Third Year $21,651 $22,151 GROWTH FUNDS Increased funding of ORMP is requested in the second and third year of the triennial program. Most of these activities are still being investigated and are scheduled for further staff development. Developmental Component--ORMP has not requested developmental funds the first year of its triennial plan because the Region needs more core support staff to implement such a program. Additional staff will be employed the first year and the Region should assume the responsibility of a developmental program the second and third years of the triennial plan. Estimated fund requirements: Second Year Third Year $75,000 $100,000 Patient Transportation System--This activity is presently being pursued by a planning study and will be developed further during the second and third years of the triennial. ‘Estimated fund requirements: Second Year Third Year “$75,000 $50,000 Peer Review System Development--A peer review program is being devised in collaboration with the Oregon Medical Association for the establish- ment of a state-wide system. During the second and third years, the system will be tested and refined before the operational phase of the system is implemented. Second Year Third Year $50,000 $50,000 Oregon RMP -18- RM 00012 6/72 Television Communication System--This proposal would link large metropolitan medical centers with remote rural h Continual education, consultation for physicians ealth care facilities. » health personnel and others will be fully utilized. "sg Low-scan" television techniques could be used at a much reduced cost. Second Year $125,000 Demonstration of a Primar Entrance Clinic~-The the access to adequate health care for persons 1 urban and remote rural areas of this State, the developing primary entrance health care clinics. areas where these clinics may be initiated and, development and coordination, at least one clini in an appropriate location. Second Year $150,000 Third. Year $175,000 objective is to improve iving in impoverished ORMP plans to assist in There are several after careful study, ¢ will be established Third Year $150,000 Demonstration Family Practice Clinic--A demonstration Family Practice Clinic is planned that would provide a model for a geographically or sociologically isolated community in Oregon. It is designed to provide a professional environment capable of attracting, sustaining, and main- taining a family practice physician, and affilia ted with a family practice residency program in order to provide consultation, training, continuing education, peer group contact, and innovative use of allied health personnel and preventive technologies. One of the more difficult health care delivery problems of the Region has been the recruitment and the retention of family practice physicians - jn some rural and impoverished urban areas of the state. One or more demonstration clinics will be established to see how these problems might be overcome by use of paramedical personnel, improved consultation resources, relevant and convenient continuing education, etc. Second Year $150,000 Third Year $150,000 Feasibility Study and Devel opment of Area Health Education Centers -~-ORMP has followed with considerable interest the development of the concept of Area Health Education Centers. There are several areas where this concept could be applied beneficially in the State. Funds will be used to develop Area Health Education Centers that could have considerable impact on the improvement of health care delivery in the Region. Second Year $100,000 Third Year $150,000 peg sce renee VER EF wi AS wR LK SOISVAIS A MILIND UL PEISAAIAL UL, MPU CANE LUIN, ZXUNISZ WV ata INI MEMORANDUM | a FROM SUBJECT: PUBLIG HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION For the Record DATE: Murch 22, 1972 Edward T. Blomquist, M.D. Post Mini-SARP Meeting, March 20, 1972 - Oregon Regional Medical Program Cadaver Kidney Procurement, Tissue Typing Program, Public Education and Information Programs Purpose of the Program ~ To double the number of cadaver kidney transplants from 20 to 40 each year. Under the direction of the Chief, Division of Nephrology, University of Oregon, employs a full time coordinator and secretary to: 1. develop a 24-hour, seven days a week tissue typing service, 2. develop organprocurement teams in 6 large cities, 3. develop a 24-hour communication and transplantation program between transplantation center and cooperating hospitals, 4. develop public support for a kidney donor card program adequate to meet the Region's long term need for cadaver kidneys. Action - Approval in principle for a 3-year period with budget reductions to be negotiated by outside consultant and staff at early site visit. Advice to Region - The reviewers were very favorably impressed with the proposed program. They were particularly pleased with 1) the degree of regionalization to be effected, 2) with the planned efficient use of resources available at the Veterans’ Hospital, and at the University Hospital, and 3) with the planned integration of dialysis and transplan- tation services. Several aspects of the budget were considered excessive. It was recommended that the site visitors review the total budget with special instructions to: 1) reduce the costs for cach year's operation by amounts that can be reasonable expected from third party vendors and from service charges, 2) to examine the need for major equipment and as Many organ procurement teams as planned and to recommend any needed adjustments in the budget, 3) to evaluate the means by which the standard fees for hospitals and surgeons were established and to recommend any needed charges. . —-s f~«-. : CoE Mog A ee tena Edward T. Blomquist,°M.D. | | : — Region Puerto Rico Review Cycle June 1972 Type of Application: Anniversary prior to . Triennium Rating - 325.5 Recommendatidns From [7 SARP [X/ Review Committee [7 Site Visit [77 Council The Review Committee recommended that the Puerto Rico RMP be supported at a direct cost level of $1,100,000 for the requested -03 operational year. While agreeing with the SARP that generous support should be provided, Committee questioned the Region's capability to effectively utilize too great an increase in support at this time in its development. It was pointed out that the Region would be submitting a triennial application next year and tht the initiation of new activities that do not appear to be terribly exciting could limit the Region's funding flexibility at a time when it will be outlining a new three-year plan. Committee viewed the goals and objectives as being clearly stated and in the direction of RMPS planning with the main thrust in education and health manpower, health services delivery system, and collection of data and statistics. The goals emphasize increasing the availability of care and enhancing the quality and the moderation of health care cost. Ongoing activities were considered to be designed to have an almost immediate impact on the provision of health services even if the impact is not directly measurable. It was recognized that some of the accomplishments are quite dramatic and involve active participation from official agencies, governmental and non-profit organizations with the contribution of substantial funding support. The intensive efforts toward regionali- gation, decentralization of treatment centers, the continuing education of health providers in isolated areas, and the comprehensiveness of the educational aspects of ongoing activities in that they include the community, the patients, and their families were favorably recognized. The administrative capabilities of the newly appointed Coordinator and the Region's activities directed toward the development of leadership roles for paramedical type personnel were also discussed. Committee concerns included the absence of minority interests such as allied health and nursing personnel on the Program Staff and the Regional Advisory Group. Regional Advisory Group criticisms included inadequate representation geographically, from the Caucasians living in the community, and from consumer groups although the Coordinator's effort in the latter was recognized. The reviewers sensed that the hope for comprehensive accessible health services in Puerto Rico are going to be dependent on governmental sponsorship and expressed concern that very little contri- bution from the private physician and private hospital sector toward a really enlightened kind of health care system was visible. Component and Financial > Summary ec ANhiversary Application @ COMPONENT ida YEAR CURRENT 2, YEAR RECOMMENDED ¥R'S AWARD COUNCIL FUNDING - 02. OPER. RECOMMENDED REQUEST, ) XEREREXX YEAR LEVEL 7 REV. COM. ~ bore $ 248,370 $ 447,597 Sub-Contracts - 0 - (22,000) OPER, ACTIV. 594,813 1,049,034

_ REQUESTED $1,136,564 COUNCIL APPROVED LEVEL 989,762 NON-RKPS and IRCOME ~ 980 ,676 INDIRECT 95,130 178,969 Puerto Rico :request for - Project #16 - Nuclear Medicine per PR-RMP telephone conversation - 3/16/72. -5- Region_ Puerto Rico Review Cycle May/June 1972 | “OUTSTANDING ACCOMPLISHMENTS BY RMP since _ May 1970 (1) Involvement of governmental and private non-profit organizations with the operational projects. This involvement demonstrates the impact of RMP in Ene ‘community and guarantees phasing out for ongoing projects. (2) Expansion of the geographical scope of ongoing projects and the replication ‘of sucdessful features on an: island-wide basis. (3) Active participation from the Department of Health, Department of Labor, Labor Unions, ‘and Community and Civic Organizations as well as health related organizations. -(4) The outstanding success in obtaining other funding participation in activities . from the Commonwealth, and local and Federal sources. (5) The Region's continued active involvement and emphasis devoted to looking for. other sources of support with a view toward phasing-out RMP support. .(6) The comprehensiveness of the educational aspects of ongoing activities that include education for the health providers, the community, and the patients and their families. ae ee APRIL 4.1972 REGION - PRTO RICO ; - ih , De “ “BREAKOUT OF REQUEST RH 00065 +06/72 : ; O03 PROGRAM PERIOD oe __ _REFS~OSM-JSTOGR2, [ee cee cee een __ bee __. peter oe. 93 PI AM PER TOD . . (5) (2) (4) (1) . | IDENTIFICATION OF COMPONENT [| CONT. WITHIN] CONT. BEYOND] APPR. NOT | NEW, NOT i CURRENT | CURRENI t 1 | APPR. PERIOD] APPR. PERICO] PREVIOUSLY | PREVIOUSLY | DIRECT | INDIRECT | TOTAL I ! OF SuPPURT | QF SUPPORT | FUNDED } APPROVED 1. costs | costs | | {. | | | J Q ‘C900 CENTRAL OFFICE CO PT rr er re ne oT | L io 1 l $447,597 | 1 1 ! $4472597. | $63,824 | $5112421 1 _ OL PEDIATRIC CARDIOVASCULAR | ~ ! { | | | | DISEASES j $150.000 | i l i $150,000 J $15,757 J $165,757 } O02 HEMATOLOGY CANCER CHEMOT] I i | ! i i ——-HEDAPY AND BLOCO BANKING | $725,301 | ! I ! $722301 | $10.353_1 $82.654 | aa 003. PEDIAT2IC PULMONARY DISE] Ee pe et Pp | " 1 1! ASES CENTER { £122:066 |] { | 1 $122.066 | $15.492 [| $137,558 | S54 EDUCATION PROGRAM IN DIA] pee Ty “fo I. I ! i : BETES MELLITUS L.. $412168 {| 1 i } $412168 J $40368 | $452536 | J “O07 ED TRAINING PROG FOR MD fT i. ] ee fT | ! i i 1~--RN_LN ICU _EOR CATDIAL PT | $782442 1 i l I $782442_) $122290 } $20 2732_] _ ‘GOS COMMUNITY APPROACH TO CO —t.COT i i t i : MBAT CANCER IN PONCE _t $81.936 } | i | $81.936 J $8,580 | $90,495 J _ (O10 GUAYNABO STROKE PREVENTI} OP ey = 1 j | | { | i $148,916 | | - l L L $148,916 } $212660 | $1702576 | O11 COMPUTERIZED DOSE DISTRI| =~ = foo I | 1 { { i |! BUTICN i L i $160,932 ] L $1602932 1 $521)9 | $166,051 J O12” INFORMATICN DETECTION ANE YJ ns as | lL r= D_TREAIMENT CANCER CENTER | j | $100.000_] i $100.000 I $112850 I $111,850 J | ,O15 EOUCATION PROGRAM FOR G fo. | 1 | I i i --P_LN_JTYE WESTERN RECTON ft $153172 1 I I 1 $15,172 J $1,116 | $16,288 | : (‘OLT "PUBLIC EDUCATION GN CANC] SCOOP | po | j ! | ER : I { 1 Jt $78:10) } $78,101 1 $8,520 1 sor681_t —— | i aa i i Se ee ener SO Lee TOTAL | $1,157,598 | ! $260; 932 | $78,101 | $12496,631 | _$1781969 | $196759600 | 4 | t ee a ee cc aoe - Wee es a ef nee ee ea. eee _ - a ae eh te ee a nee a as eee. a ' -Br RMP: PUERTO RICO PREPARED BY: GEORGE HINKLE 1. GOALS, OBJECTIVES, AND PRIORITIES (8) The Puerto Rico Regional Medical Program goals, objectives and priorities are clearly and explicitly stated. “The PRRMP stated objectives in Education and Manpower, Health Services Delivery Systems, and Collection of Data and Statistical Projections are considered to be consonant with the RMP mission of increasing availability of care, enhancing its quality and moderating its costs -- thus making the organization of services and delivery of care.more efficient. . PRRMP MASTER PLAN for obtaining the Program's objectives (Annual Report 1970-71) provided an analysis of program priorities with respect to geographical health regions. The current application indicates that a quantitative system is now being devised whereby relative weight is assigned to the technical quality of the proposed project, its relationship to the goals and objectives of the Region, the reliability of the sponsoring organization and the competency of the project director. This system will yield a numerical score that will allow objective classification on the basis of relative merit. Consumer representation on the RAG represented this group in the establishment of goals, objectives and priorities, and the present proposed amendments to the RAG by-laws provided for increased consumer representation from all socio-economic groups. a aa el; Recommended Action: 2. ACCOMPLISHMENTS AND IMPLEMENTATION (145) The Regional Advisory Group reports that there is no doubt that there has been contributions to the present health delivery systems and to the different governmental agencies involved with the health care of the Island. All on-going activities are reported as being highly successful with respect to established project objectives. The geographic scope of the activities are either being expanded to an Island-wide endeavor or plans provide for this expansion. The Program has been successful in establishment of treatment centers, teaching programs for health providers, patients, and families of patients. The training of health personnel in new skills and the training of new health assistants along with the establishment of new treatment centers have greatly enhanced the availability and accessibility of care. Project activities have been and are being conducted not only in the more affluent areas but also in Model City areas, ghettos, and rural and mountaineous regions of the Island. © Notable Program Staff planning studies include the establishment and Pee utilization of a Program action plan which outlines procedures for the development and implementation of education activities by the _ operational projects, and the Program staff maintained library. and Health Services Personnel Inventory that is made available to all health professions and governmental institutions. : laa RECOMMENDED ACTION: + i - 10 -. BMP 3 3. CONTINUED SUPPORT (10) The PR-RMP has a definitely established policy toward developing other sources of support. RMP support for only one activity has been discontinued to date and it is: being continued with full support being provided by the Department of. Health. Ic. is reported that as RMP funds are phased-out (such as the recent 12% reduction) other sources of funds have become available to continue the activity. All on-going activities make reference to possible future sources of support as being either firm or highly probable. Recommended Action: 4. MINORITY INTERESTS (7) Tne goals and objectives are directed to all the people of Puerto Rico. farouzh intensive efforts toward regionalization, decentralization of treatment Centers, continuation education of health providers in isolated areas and educational programs directed at both the patient and the patients family, all interests are considered to be served. it is noted that the Regional Advisory Group includes female representation. ~ 11 - PUERTO RICO PREPARED BY: GEORGE HINKLE DATE: 4-5-72 “COORDINATOR (10) Dr, Jorge Fernandez is the newly appointed Coordinator (PRRMP letter of December 3, 1971) although Dr. Cristino Colon, the previous Coordinator still serves as a consultant to the Program. | Dr. Fernandez is described as a brilliant, young faculty member of the School of Dentistry with experience and interest in the field of education, — particularly continuing education in the health professions. He has served on ‘various committees of the Regional Medical Program and during the last a year as Special Consultant in Education and Evaluation. He now serves on the Health Manpower Task Force at the National Institutes of Health. Dr. Fernandez has initiated a reorganization of the Program Staff to more: closely ally it to the new RMP mission. He has also directed efforts - toward the amendment of existing RAG by-laws in an effort to increase - the consumer representation at all socio-economic levels. The inadequate involvement of the RAG and past review criticisms directed toward project interrelationships are also recognized areas of concern in ‘which Dr. Fernandez is directing his efforts. He appears, to have gained the confidence of the Project directors and Program Staff personnel. | we em em tae mm meme mms me cmmended Action: 6. PROGRAM STAFF (3) : 7 Program staff is almost starting anew in that most of the staff resigned subsequent to the recent reductions in Program funding. tod The Coordinator has reorganized the Central Office in line with the objectives of the program to optimize efficiency. Staff is now organized into three sections: HEALTH EDUCATION AND MANPOWER, ADMINISTRATION AND | HEALTH SERVICES SYSTEMS, and PLANNING AND EVALUATION. Secretarial, clerical and other non-professional and non-technical are in a Central Office to provide supportative services to each of the three sections. Zcogram Staff will utilize RAG Task Forces as resources in the development of the plans of action (Regional Planning, Health Education and Manpower, 9» - Proposals Review). ue There is an absence of allied health personnel ~ no nurse discipline; Last application requested 44 positions - current application is for , with 21 on-board, all full time, (5-professional are vacant, 5 7. REGIONAL ADVISORY GROUP (5) , : The RAG report states that the group realizes and has accepted its new - role and responsibilities as a result of the decentralization of procedures within RMP. The new Coordinator reports that he believes the RAG has not discharged its duties, to date, but that he will encourage the RAG to exercise its prerogatives. He has already assigned a Program Staff member with liaison responsibilities for greater involvement of Staff and the RAG in daily operations. Representative of health interest groups and special task forces (and project directors) provide an excellent representation of the most outstanding ‘ nealth professionals in the. Region. Currently 28 members - 4 vacancies, four women; 20 are located in the Northeast area, 2 in the South, and one in the West. Currenc proposed amendments to the RAG by-laws place numerical limits to the types of representation on the RAG and states that "the public and consumers category shall include at least ten health services consumers proportionally representative of all socio-economic levels in Puerto Rico. RAG has regular quarterly meeting; meeting will be held in sub-regions to encourage attendance. . ‘acommerceod Action: : L GRANTEE ORGANIZATION (2) The University of Puerto Rico is the Grantee and Fiscal Agent for the Program. Cordial relationships exist between the Grantee and the Puerto Rico RMP. Adequate administrative assistance is provided and many of the Grantee facilities are made available to the RMP project staff in the day to day operational activities. Gr. Adan Nigaglioni, Chancellor, University of Puerto Rico was the first Coordinator for the Program and is highly knowledgeable with respect to its goals and objectives. There are no indications of Grantee domination and/or interference with policy setting functions of the Regional Advisory Group. mee wm mm RECOMMENDED ACTION: - 13.< ©: __PUERTO RICO PREPARED BY: GEORGE HINKLE DATE 14-5-72. y PARTICIPATION (3) , Active participation of other health agencies is obtained through member- ships on the PR RMP RAG. Program Staff planning studies are planned in cooperation with the State: Department, prepaid health insurance organizations, the P. R. Hospitals Association, Department of Health, the San Juan Municipal Government and other Municipal Governments. 7 : Veterans Administration has cooperated in continuing education courses, offered hospital facilities in joint efforts, and joined in negotiations for the establishment of community based health education facilities. Joint activities have been conducted with the P. R. Medical Association and the Coordinator is a member of the Committee for Medical Education. . Local Health Planning Board Director has offered to cooperate with the Modei Cities Program of the City of San Juan - Colloborative efforts are being initiated. a “THe amounts of funds provided the RMP activities from other sources (Approximately matching funds) is highly indicative of participation from State and local organizations. ‘an | etm cam mewn meh amy nom me ae mem me commended Action: “19. LOCAL PLANNING (3) _ | ee . Regular meetings are held with members of the section of the Department of Heaith Communication for better coordination and avoidance of duplication. oF Members of the CHP are on the Regional Advisory Group. PR-RMP. has been appointed to the Municipal Advisory Board of the planning office for the Area of San Juan. CHP and PR-RMP share the health professions human resources inventory and cooperative arrangements have been made in the publication of the updated inventory. The Central Program Staff Planning and Evaluation Section has served as nsultant and taken steps to provide requested consultation services eo the Planning Board. and the Department of Health. Consortium of RMP and other health agencies is being formed to combine - efforts in the collection of health data relevant to all concerned. ee me a ee mee mem nm em me em me MMENDED CTION: ~ oer PUERTO RICO GEORGE HINKLE 4-572 RMP: PREPARED BY: DATE: £4-5> e 11. ASSESSMENT OF NEEDS AND RESOURCES (3) Health professions human resources inventory has been completed, transferred to the local CHP for sharing and arrangements have been made for updating the inventory. Efforts are underway to establish a consortium of RMP and other health agencies to combine efforts in the collection of health data relevant to all concerned to improve. channels of communication and avoid duplication of efforts. Core staff has planned activities and studies to gather additional basic -nformation for the development of the operational plan for the next triennium. Many of these studies are referred to and a direct result of the Program Master Plan developed for the Region. Listing of activities are provided on page 33 of the application. Prior activities associated with need and resource determinations are recorded in the Master Plan and involved collection and analysis of data relative to health regions, medical, nursing and other paramedical and auxiliary personnel, as well as financial, physical, and organizational yesources. ee Recommended Action: 12. MANAGEMENT (3) Written records of the project review are maintained by staff, the Regional Advisory Group, and other Review Groups. Specific core staff is assigned to monitor and/or provide supportive services to individual projects. Monthly meetings are held with project directors to share with them all RMP plans and activities and thus encourage more constant communication between the Coordinator and the project directors. Progress and expenditure reports are required and these are reviewed periodically as follows: Expenditure: RAG - annually, staff - quarterly; Progress - staff bi-monthly. ee ee ee RECOMMENDED ACTION: - 215 - @ PUERTO RICO PREPARED BY: GEORGE HINKLE DATE: 4~5-72 13. EVALUATION (3) Evaluation procedures are required for each project; all projects are evaluated by Program Staff and consultants; evaluation is of both a qualitative and a quantitative nature. During the past year evaluation reports have been completed on six projects ~- all that were initially funded except Project #10, this ; activity was very slow in being initiated. me Program Staff is actively working toward completion of the development and implementation of the total Program Evaluation Plan. It is anti- cipated that it will be completed during the coming year. a ee ee ee ee eT ee Recommended Action: 14, ACTION PLAN (5) .. Priorities have been established that are considered to be consonant with national cals and the goals of the Region. The Region plans to continue currently ongoing categorical activities and as restated its goals and objectives in terminology agreeable to the RMPS published mission; it is noted that activities appear to be in. complete agreement with these goals. Ongoing activities are | most comprehensive with respect to patient services; education of health - providers, patients, their families and the communities; manpower _ utilization and establishment of new skills and types of personnel, etc. ee be ee ee ee ee “RECOMMENDED ACTION: - 16 - RMP: PUERTO_RICO PREPARED BY: GEORGE HINKLE DATE :4~5-72. 15. DISSEMINATION OF KNOWLEDGE (2) Health professions human resources inventory has been turned over to the CHP agency for sharing and mutual updating arrangements have been made. Analysis of educational plans and activities sponsored by the Program has resulted in establishment of procedures for the development and implementation of educational activities by the Program's operational \ projects. IT IS ANTICIPATED THAT THESE EDUCATIONAL MODELS and MATERIALS WILL BE MADE AVAILABLE TO ALL AGENCIES AND GROUPS CONCERNED WITH HEALTH EDUCATION to achieve their ample utilization. Data inventory of medical and paramedical personnel is kept and distributed to all health professions. Medical library services is maintained and services are provided to governmental institutions and hospitals. Three hospitals in different areas have requested help in establishing their medical libraries. oe ee ee ee Recommended Action: 16. UTILIZATION MANPOWER AND FACILITIES (4) Efforts directed toward continuing education of health providers and the training of health personnel in new skills and training of health assistants and family health workers tend to increase productivity of physicians and other health manpower. The utilization of facilities of the Department of Health, Veterans Administration, and community medical centers as nuclei for the establishment of prototypes prior to replication throughout the Island provide for more effective utilization of community facilities. 8 ee ee ee ee RECOMMENDED ACTION: @- PUERTO RICO PREPARED BY: GEORGE HINKLE DATE :4-5-72 =), IMPROVEMENT OF CARE (4) Activity progress toward established objectives depicts the practicality of the projects. Establishment of new and satellite treatment centers, the change in patient referral patterns as reported by one project, and the extreme degree of direct patient involvement are positive indications of improvement of care. a Health maintenance, screening, diagnosis, treatment and rehabilitation are terms that are most outstanding when one reviews this application. These are most certainly directed toward improvement of care. ee ee ee ee ee mm se Recommended Action: “8. SHORT-TERM PAYOFF (3) Short-cerm education courses for the development of professional and community leaders in the areas are planned and conducted. Operational activities appear to have visible payoff in the availability a me of care. : Periodic reports (bi-monthly) are reviewed by Program staff and regular meetings of Project Directors and Program Staff are conducted. a oan gi COMMENDED ACTION: - 18 - 2MP: PUERTO RICO PREPARED BY: GEORGE HINKLE DATE: 4757! -g, REGIONALIZATION (4) The Program Staff is located in the San Juan area, Northeast. Sub-regional offices. are located in Ponce, Southern Region and Mayaquez, Western Region. However, these offices consist of only an associate coordinator and a clerical staff-member. ? Project activities are located in each of these areas, put the greater ; number are headquartered in the San Juan area. Project activities appear to be reaching out into the underserved areas throughout the Region, or at least this outreach is projected for the forthcoming program year. Although activities are initiated in a specific predefined area, they are considered to be prototypes with the expressed intention of duplication and/or expansion of the concept on an Island wide scope. 8 ee ee Recommended Action: 20. OTHER FUNDING (3) The only project to be terminated will be continued with support provided by the Department of Health. All ongoing projects and all except one to be initiated project reports funding support from other sources. Funding from other sources, as reported, approximates the direct cost support level provided by RMPS. Other funding sources for continuation of the activities after termination of RMPS support is a most active concern of the PRRMP. eee ee err RECOMMENDED ACTION: TABLE OF CONTENTS SOUTH CAROLINA REGIONAL MEDICAL PROGRAM ANNIVERSARY APPLICATION Staff Briefing Document Page Face Page , 1 Regional Map 2 Geography and Demography 3 Component and Financial Summary 5 Breakout of Request (05 period) 6 Problems, Accomplishments , Issues | 8 Review Criteria 15 4a RMPS © | STAFF BRIEFING DOCUMENT OPERATIONS / / Eastern [-] Mid-con LEGION BRANCH {XT South Centr'l / 7 Western South Carolina oe not . BRANCH moe ‘'YPE APPLICATION | applicable LAST RATING Tel. No. 31740 Room 10-22 7 TRIENNIAL 197. DATE BRANCH CHIEF ___Mr. Lee Van Winkle Xf ist ANNIV YEAR £7 SaRP ; BRANCH STAFF Mrs. Lorraine Kyttle _ “7 nd ANNIV YEAR [7] REV. COM. RO REP. Mr, Ted Griffith OTHER a uh nee fo. LT Last Mgt. Assm't Visit January. 197 _ (specify) sa Chairman Dr. Albert Heustis we AST 5. V. “March | 1973 ; Chairman__-Dr. Edmund Lewis, Review Comm; Dr. Everist, Council — — aff Visite, ‘Last 12 mc . (Dates, Chaizuan's Name and Type of Visit) 1972 - Lorraine Kyttle - discus e ing RAG retreat. — ine rei Which Occurred in the Region Affe.ting the RMP Since Its Last Review April/May 1971__ 5 "Movement | ‘within State to establish second medical school at Columbia gaining impetus. - SCRMP views'this as having possibly favorable or negative impact on relationships with their grantee (Medical University of South Carolina). Favorable in that they: gee it as an. assist to their efforts to regionalize way beyond present concepts of grantee =- r gative in that efforts to counter establishment of second school may. polarize interests of grantee at a time when SCRMP proposes etgaificant programmatic — and organizational changes. me 2084 lino Jeccaitaeves aK oh et f ~ 7 tein tvame trast | 7 A eet I ) a leon Ccunons Lem ASTER CmEeTCarae A ameton SOUTH CAROLINA SUB-STATE . ’ DISTRICTS hoa 1. Appalachia Regional Planning and Development Commission 2. Upper Savannah Development District ~“ . 3. Central Piedmont Regional Planning Commission Kesamanct *4. Central Midlands Regional Planning Council > 5. Lower Savannah Regional Planning and Development tesa Commission 6. Santee-Wateree Regional Planning Council 7. Pee Dee Economic and Development District 8, Waccumaw Regional Planning Commission *9, — Charleston-Rerkeley-Dorchester Development District Atos 10. Low Country Regional Planning Commission * Districts with funded CHP "Bp" agencies 1/71 , . D Crateae | Component and Financiol Summary - Anniversary Application . _ COMPONENT CURRENT “OS. YEAR .-|_—U2 YEAR RECOMHENDED | YR'S AWARD COUNCIL FUNDING -04 OPER. * RECOMMENDED "REQUEST SARP YEAR LEVEL . REV. COM. ‘ORE 415,587 PEK LOK A 499,818 . Sub-Contraces - FMAM YAS PER, ACTIV. 596,137 OXPL KOLA RES 2,032,541 poe ‘ en /4, " EVEL. come. 62,500 SILI -_ 100,000 Yes ( ) or No ( RES: #55 43,500 323,920) KIDNEY 1,074,224 2,991,048 1,550,000 N-RMPS. and IRCOME * REGION. South Carolina oe : June 197.2, REVIEW CYCLE f * "x The 04 year jis being ‘extended to 9/1 and the region has been period. oat advised that the funding. level will be $1,550,000 for. the 14 month MARCH £7,1972 BREAKOUT OF REQUEST REGION - S CAROLINA RM 00035 06/72 __. . 05 PROGRAM PERIOD _RMPS-OSH=JTOGR2 (5) (2) (4) a) IDENTIFICATION GF CGMPCAENT | CCNT. WITHIN] CONT. BEYOND| APPR. NOT | NEW, NOT t CURRENT | CURRENT | | | APPR. PERIGO| APPR. PERICO! PREVIGUSLY | PREVICUSLY | crrect | InOERECT | TOTAL to | OF SupPoRT {[ CF SUPPORT | FUNDED | APPROVED | COSTS I costs 1 “| _- . I oe | . | | | ! I | C000 CORE | | 1 { ! | po ! £499,818 1 1 L 1 $499,818 | $)83.609_1 $683,427 1 DOOO DEVELCPMENTAL | ! l 1 t | J : ! L $100,000. 1 } 4 ! $100.000_ 1 $100,000 | O22 MEDICAL UNIVERSITY OF SOl 1 1 1 1 { I j me UIH CAROLINAS HEART CLINIC 1] 4. i $67,816 1. t- $67,816} $LIs1LIL SL $84,987! O39 STATEWIOE HEART CLINIC El 1 I I 1 ft ! _ po __ DUCATION 1 1 | $59,718.) L $59,718 1 $11.695.) $71,213 1 040 UNIVERSITY GF SOUTH CARCI] J | : | ! | { 1 a LLYA STROKE NURSE TRAINING) $61.202 1 | ad } $612262_] £182943.) $80.2051 0462 HEART IMPLEMENTATION | i | j ! i 1 io 0 _- i $1172208 4 1 L L $117.208.1 $24,171_1 $141.3721 044 STATEWIDE CANCER CLINIC | 1 ! \ ! 1 1 1 —~-£DUCAT IOS 1 $502.032 1 i I $50.032. 4 $8.1271 $58.1591 __ 045 NUCLEAR MEDICINE TRAININI i | ! 1 i | l ~ G { $602049_1 } 1 L $60.649.1 t $60,649 1 _. 048 GYKECGLOGIC RADLOTHERAPY | | i | 1 | | \ ~ PROGRAM £2011633_1 1 L 1 $201,633] $68249¢ J $27Q2127_4 “O49 STATEWIOE LABCRATCRY a i | \ l 1 ‘ 1 ~ i ___SOQUSEL BEEZESHER TRAINING L____$25,094.1 4 i I $252096 1 $.22995_1 28.089 1 050 CENTRAL MIOLANDS MEDICAL ' \ | j } \ i — EDUCATION. PROGRAM 1 1 $129,118. 1 I $129,118.14 $23.710_1 £152,888 1 051 CONTINUING EDUCATICN sient | \ ! | | { . we bIX PBOEESSLONALS 1 £152.782_1 1 i 4d $152,782. 1 $15.772_ 1 $168s554 053 INFURM | 1 j | \ | 1 17 i $96,617 4 i i } $96,617} 42327568 1b $120,373. 4 054 PLANNED DISCHARGE AND PRI i i ! i ! 1 ! Wn -O22ESSIVE CASE J { 4d $50,800 1 i $50.800_! { $50,800 1 _ C554 HEMODIALYSIS CONTINUIAG | | | \ | | | J - —W~EQUCAL LON f $55.000_1 i l j $551,000.14 $16,699 1 £271.899. 1 055B EXPANSION OF HOME TRAINI| I t | | | t 17 * __ NG Lu DLALYSLS I i t l $158,480 | $158,480 3 $3,841 | $162,321. | G550 PARTIAL SUPPCRT OF 2 HED] J I j | I t 1 ~ bOLOLbG UbLT COLUMBIA J L ! 1 £14,000_1 £14,000 1 1 $14,000_1 055D CEVELCFMENT OF TRAKS PLAN! | 1 ! I | I ! LUNI L ' I $96,440. 4 $96,440 4 $23,165 4 $119,605} 955_ COMPONENT TOTAL ti $55.00011 1 ! $268292C) 1 $323,920) 14 $43,705111 _$307.62511 556 COMPREHENSIVE RESPIRATOR | I 1 ! 4 \ __-YL_DISEASE IBALNLUG 1 $934156_1 k 1 L $232196-1 $31.152-] $124.308 057 SPARTANBURG MEDICAL EDUC! | | I ! I | __-SLLOK ioe i L $100.250_) t $100,850. 1 $24,107 1 sizer ~ 658 COMPREHENSIVE CORCAARY CI j | ! j I Io WARE UII {_£1152.445.] ! 1 i $135.645_ 1 £412392_ 1. $156:997 [ =t 059 GREENWCOO C C U LINKAGE | | j | | ] l —- i | L 1 $26:500 4 $26.500_ 4 I $26.500 060 CHILCRENS CARDIO RESPIRAL 1 1 l 1 j t ~--l ORY L 4 i 1 298,186] aot. tat— eee Lsizoess2 1” O61 CIABETIC TRAINING i | | I | I 1 4 1 i £291400_1 £2944090 $5205.45 $34.95) 1° \) —_ MARCH 17-1972 - REGION = a eNO BREAKOUT OF request ae 00035 oesi2 ee oe ee 05 PROGRAM PERIOD 9 em : AMPS-OSM-STOORE ° (5) (2) (4) a LOENTIFICATION OF COMPONENT | COAT. WITHIN] CONT. BEYOND! APPR. NOT [ NEW, NOT .t CURRENT | CURRENT 1 1 ; . ; ] APPR. PERICOL APPR. PERICCI PREVIOUSLY | previcuseyY | DIRECT j inorrect | TOTAL ' | : i ce suppoRT | CF support | FUNCED | APPROVED i costs \ - COSTS ALIN {oe ee too. . ! 4 cee eee | 062 RURAL MOBILE HEALTH i | ! | | 1 ! 1 gppagas | ats bp | 064 RICHLAND MEMORIAL ALLIES! | | i A \ | | __—HEALTH. , i } de aa s00_, —-sissaso0 4294942. 1- S244 [--— {i TOTAL |__$19628,896 | ee 1. $408+302 1 _$5952161 | __$296329359_| ($59529T9 1 $3,228,338 | \ — il \ - . | ee ‘ - oe . . _ i eet eee eee ee 7 i eo ee _ nents ome i eee eee eT wee em cn ce a nc NN AS eee ee i a eee ee eee a cee ee Cage eet i ee Ce ee et TE a a ew ee Lg a ee ca enamine ntti tiee raed ka _ wooo 6 South Carolina RMP Geography and Demography Region encompasses state -- 46 counties; 10 medical districts Population -- (1970 Census) - 2,590,500 Increase of about 9% since 1960; Land area - 30,272 Population per Square Mile by Medical Districts Population per Numbers of Square Mile Medical Districts 120-170 3 60- 90 3 30~ 60 4 Of the 46 counties only 6 have greater than 50% urban populations. Of these 6 counties, 3 (Greenville, Richland and Charleston counties) have 70% or greater metropolitian populations. Within each of these 3 counties there are 3 metropolitian areas vith populations greater than 60,000 each, The state has a non-white population of 33%. In the 6 counties with large urban populations the distribution of. non-white population is comparable to that of the state. In areas of the state that are isolated rural the percentage of non-white population is much higher (approx. 50%). Age distribution: Range for 10 districts 19 years and under 38 to 45% 65 years and over 5 to 9% Average life expectancy is 66.4 years for the state. Mortality -- Deaths per 1,000 population, 1969 South Carolina United States All Causes 8.8 9.4 Heart Disease 3.2 3.6 Cancer 1.2 1.6 Stroke 1.1 1.0 Infant Mortality 24.2 21.7 The five leading causes of death in South Carolina respectively are: Heart, Cancer, Stroke, Influenza and Pneumonia and Early Infant Mortality. 45% of all deaths in the state occur before age 50. Resources and Facilities Medical Schools: Medical College, University of South Carolina, Charleston oo have no! Resources and Facilities (con't) Med. College of $.C. - School of Allied Health Sciences Professional Nursing Schools - 9 of which 7::are college or university based Practical Nursing Schools - 25.of which 5 are hospital based Accredited allied health schools Cytotechnology - 1 - Greenville Gen. Hospital 1 - Med. College - School of Allied Health Sciences Medical: Technology -6 Radiologic Technology - 13 Hospital Facilities ‘There are 97 community hospitals in South Carolina of which 80% have 150 _ beds ‘or less. Only 8 community hospitals exceed 300 beds. Four count ies epital facility. Manpower “Physicians per 100,000 population (1967) So. Carolina United States 84 163 103 205 , 71 153 “A jacent to Urban 45 96 35 59 &¥ PRINCIPAL PROBLEMS - based on current application SCRMP's attempt to embrace new initiatives must compete with this appli- cation which does not leave much fiscal: room for innovation. The Region could be reviewed as being pretty well locked into a 3 year project Program approved and begun last year that might be difficult to remold. Core tells us (not in this application) that many of on going activities can be expanded and/or redirected. This application reflects minimal response to specifics of last year's advice letter. PRINCIPAL ACCOMPLISHMENTS Please see attached statement. ISSUES REQUIRING ATTENTION OF REVIEWERS 1, The Region's funding level for the current year was raised from $1,074,224 for a 12 month period to $1,550,000 for a 14 month period. They responded quickly with new budgets (RAG approved) which sub- stantiates their intent to put their money where their new directions are. The on going projects generally were given only add on dollars for time extension; the Developmental Component account was more than doubled (to accommodate the new look activities to be presented to RAG next month); a sub-contract account ($12,500) under Core was established for the first time in the Region's history (to provide Core flexible response capability) and upon learning that additional prorated funds could be applied for, the region requested that their supplemental application be deferred so that the April 29th and 30th RAG retreat could consider new activities in light of hoped for prior- ity changes. 2. The issue of what delayed the region's response to national, HEW, HSMHA and RMPS signals until this time probably has no single answer. Its geographic traditions, the reception of the original legislation, the conservatism of the grantee and the professional societies cer~ tainly were influences. Possibly also contributing was South Carolina's fairly successful track record of submitting applications that allo~ cated 61% of the requested funds to activities beamed at general con- tinuing education of existing health professionals, 38% at coordinating existing health services and less than 1% at patient care delivery. This was the descriptor profile of their triennial application. The descriptors for this application are not yet available but the content of it indicates probably there would be some shifting of the former percentages but not to a substantial degree, SOUTH CAROLINA IS AT THE CROSSROADS South Carolina's Executive Committee has finally heard the word and has relayed it to the RAG. Originally, this program was built upon a premise absolutely confined to the legislative mandate to improve the care of patients suffering from, heart disease, cancer, and stroke. Through cooperative arrange- ments affording specialized training, SCRMP proposed to upgrade the medical’ care spoken to in the original legislation. Given this con- finement., South Carolina made substantial progress during its first three years of operation. For its. fourth year of operation, the region submitted a triennial application which, while still concentrating on the upgrading of skills.of existing health manpower, was reaching some major health ms in the state -- the rural physician and the improvement of ‘es and services in communities, most of which are far below onal ranking for health services. the spade work was underway for the development of this appli- (which continues the bulk of the program approved for activa- st year) SCRMP core and the Chairman of the RAG were making into the traditional mold of the program attempting to move it the categorical constraints. The terms "expanded mission" ew: challenges" were introduced as agenda items for RAG meetings and ought. and was given delegated authority from a December 1971 ting for the Executive Committee to make some final funding and ational restructuring decisions which were deferred pending the of the January meeting in St. Louis. lowing excerpt from a January 28th special meeting of the ve Committee of RAG is interesting ~-- "The expanded RMP ‘is now a fact. Even though existing legislation has not fied the types of activities, new legislation will and the RMPS - authorization has already been doubled to facilitate the final ion of programs from the strict categorical focus to the d: concern with health services at a community level." aff has developed a RAG retreat for April 29-30 at which the d: mission and new challenges (their words) will be explored. da‘has been developed for the purpose of generating several hich Core believes to be the pivots for redirecting the entire An Expanded Mission Study Group ~ from which new goals will be sought. The areas of inquiry will be: A. Health Manpower Development 10 Page 2 - South Carolina B. Primary Health Care Delivery Patterns Cc. Regionalization of Specialized Care & Support Services A Reorganization Study Group - from which new RAG & Core structures will be sought. A meeting of the entire RAG from which programming of Developmental Component monies in new directions will be sought; a charge to Core to develop the reorganized structure; and a reassessment of program priorities. At this juncture, all of this is a promissory note. Core feels it can come away from the retreat with enough to move the program way beyond where this application shows it to be. Dr. Moseley is very realistic about making RAG restructure moves first and membership moves next. The region tells us that for a while they will have to operate both programs in tandem, gradually phasing out those activ- ities not able or not willing to expand or redirect themselves. For openers, staff says it has many new look developmental activities it will present to RAG at the retreat. All of this is presented by way of alerting SARP that South Carolina is indeed at the crossroads...albeit rather tardy. These exciting, hoped for changes are not reflected in the application you are reviewing. oe, a When RMPS staff met on March 22nd to preliminarily review SCRMP's anniversary application, they agreed that the events Core had generated since the application was prepared put the region in a different light. We were faced with a timing problem -- our pro- cedures call for a review of the region on April 10-11 and the success of the first stages of SCRMP's expanded directions cannot be assessed until April 29-30. Most of the staff reviewers felt a postponement of review was justified. Mindful of the procedural and administrative complications such a decision may entail, the reviewers also agreed to prepare this document and request that it be given the weight of an addendum to the application should a postponement of review not be feasible. In that event, we agreed upon a recommendation that the region be continued at its newly approved funding level of $1,550,000 (the Council approved level) for its upcoming 12 month 05 year. This figure is exclusive of the expanded kidney proposal which is the subject of a technical site visit on April 10 by Drs. Gonzales and Gross. By pruning the requested budgets for the continuation activities, the region could develop some fiscal room for activation of new initiatives. Attending-the March 22nd staff review were: M“/ @ Page 3 - South Carolina Frank Nash EOB Bill Reist SCOB Larry Pullen GRB Lee Teets GRB Ted Griffith ROR Lorranie Kyttle SCOB po bee: Gene. Nelson P&E had to cancel just prior to the meeting and has sub- bs mitted his. recommendations which are in agreeement with the above. His. memo is attached. ca? | J oe Lorraine M.. Kyttle Public. Health Advisor South Central Operations Branch 4/3/72 MEMORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE TO THRU: FROM SUBJECT: eH PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION (= : Lorraine Kyttle DATE: March 31, 1972 Public Health Advisor South Central Operations Branch, DOD Acting Chief South Central Operations Branch, DOD Program Analyst Planning Branch Pending SARP Review of SCRMP Application -- P&E Input For background information it should be stated that I have only recently been assigned responsibilities relative to SCRMP. I have neither visited the Region nor otherwise been personally exposed to its program, My input, therefore, is based on review of the appli- cation per se, review. of past records, your report of findings and impressions, and informal discussions with house staff. In keeping with the P§E function and joint appointment philosophy (at least so far as I view them) I have directed my attention more to the general planning context than to content of the application per se, viewing the latter as fitting more properly into the schema of reviewing groups other than P§E. This approach is not unique to this application but is consistent with the approach I have always taken, As to application content, suffice it to say I find it leaves much to be desired. In that aspect I concur with majority mini- SARP opinion. It strikes me as speaking more to the past than to the future. As to context, I submit the following: The evidence as I perceive it points up a problem common to planning-oriented efforts, i.e., the conflict between critical factors. Such factors generally include (but are not limited to) lack of planning expertise, internal and external circun- stances over which participating interests have little or no control, differing goals, objectives, etc., among mutually con- cerned organizations, the myraid problems associated with in- novation, communication, administration and funding at various levels, changing signals and processes, timing, and the like. In my opinion, successful planning efforts are generally those which view such critical factors in proper perspective, draw them into desired relationships to one another, and adapt well as those relationships shift, always keeping an eye on the ultimate goal. In a nutshell, it seems to me that South Carolina has not been able to do these things well, and thus has not been able to stay on top of its planning process. The Region's need for bending 43 Page 2 - Lorraine Kyttle the rules reflects that. One of the critical factors in this case seems to be (an apparent) lack of planning expertise. This has resulted in lack of planning foresight which in turn con- tributed to the present "'timing'’ problem relative to its application. The region has also been heavily affected, however, by internal circumstances (Dr. Moseley's illness with its attendant. influences), changing national signals (including timing, scheduling, and processing) and commmications gap problems at various levels. I will not expand on the first two of these as you have already ably done so. My input speaks primarily to the communication gap, one of the more difficult problems facing the program at both headquarters and field levels. As I see it an intimate knowledge of an ap- plication is not worth a tinker's dam without an appreciation of the context within which that application subsists. Your report _of findings and recommendations indicates an attempt to reach the proper balance between content and context; and I think a very valid and successful one. ' Mini-SARP's decision to supplement this application with additional information for SARP's perusal was a sound one, in which I concur. In fact, I consider it essential to a proper review of this ap- plication. In totality, it.seems to me certain basic issues arise: 1. In view of the imminence of the South Carolina RAG retreat - at which significant changes apparently will be made - is it realistic to make decisions now which might dilute effectiveness of those changes? Would that be consistent with our efforts to promote planning? . 2. Is the SARP process one to which applications and planning must of necessity respond with little flexibility, or can the process lend itself to mutual accommodation? If so, should it in this instance? 3. Dr. Margulies’ directive of 2-22 states that certain regions should receive extra field assistance for upgrading their programs. Does the same underlying philosophy carry over into the SARP (and mini-SARP) process? As a corollary, how do you establish effective commmication between field assistance staff and SARP reviewers in order to get the most mileage from the © 3 ) process? : 17 Page 3 - Lorraine Kyttle ~4, In the final test does the evidence warrant reviewing this application in its larger context rather than reviewing it on the merits of application content per se? It seems to me the answers to- these questions hold the key to effective review of this application and that those answers rather obviously favor the total context approach. What adjustments that approach entails is another issue. So is your problem of pre- , senting the extra information and insights required. Eugene J. Nelson . Bb rete [7 b ” AS _f — South Carolina -PREPARED -BY2b. Kyttle DATE: 3/30/72 ‘ne 1. GOALS, OBJECTIVES, AND PRIORITIFS (8) — - Region states goals, objectives, and priorities are to be subject of a 2 day retreat for the purpose of updating in line with expanded mission. As presently stated, goal is to improve patient care through: l. Continuing Education 2. Improved health manpower 3. Demonstrations 4, Improvement of facilities 5. Research and Training These goals were established prior to triennial application and were reaffirmed at beginning of triennium. In this application they carry the additional provision that activities generated to meet goals should be designed to meet needs that Medical Districts determine to be their priorities. . - memes ee _ R ecommended Action: a. , ¢ 2. ACCOMPLISHMENTS AND IMPLEMENTATION (15) Most operational activities center on specialized education for existing health professionals. In this context, they are on target and are meeting- objectives. From its beginning SCRMP had to court South Carolina Medical Association who viewed program with suspicion. Cere feels program has reached point where SCRMP can move in new directions such as primary health care delivery. Care supported activities have made subtle forays into new areas. Example: Terminating project 5A concerned with training RN's in CCU functions; while Developmental Component activity #2 sponsored by Pee Dee Economic Development and Planning Commission concerned with determining requirements for a health facility in Florence and plann- ing study to follow has pledged funding from Economic Development Administration, the Coastal Plains Regional Commission and SCRM. RECOMMENDED ACTION: “16 Pz South Carolina PREPARED BY. L. Kyttle . CONTINUED SUPPORT (10) © 19 of original projects self supporting» RAG Manual (updated January 1972) speaks specifically to concept of SCRMP support to establish needed activity or service. and then shift to other sources if continued beyond general 3 year period. At this time, SCRMP is rather locked in to supporting 3 year projects, most of which were "new" at the time triennal application was approved and have 2 years to run. 2commended Action: MINORITY INTERESTS (7) While funded activities specify target groups to be all inclusive regardless of race or economic status, most activities primarily concern specialized training programs . for health professionals. Wording of present goals and objectives does not lend them to an evlauation on this point. Minority providers and consumers not adequately represented on RAG. In response to specific recommendation last year, member from Palmetto Medical Society added to RAG. At present time Care professional staff all white and all male (form 7 notwithstanding) - ECOMMENDED ACTION: -4] @ South Carolina _ PREPARED. BY ct eeneniteyttle DATE: 3/30/; * 5, COORDINATOR (10) Coordinator generally acknowledged as person with stature in the state who can meld. S medical school, professionals and community interests. He just returned to office © from severe illness. Apparently developed competent staff as program generated: ground ‘work for hoped for sweeping changes in his absence from office but which: he ' "managed" from hospital and convalescence at home. Summerall, a 50% deputy, stepped : in and gave 100% during that time. good Yange of competence for existing Cere structure, but not neces- xestructured mission they describe. Very categorical. Housed in incred~ juate quarters. Entire staff literally cannot all sit at desks at same time. | -49 RMP: South Carolina PREPARED.BY.: L. Kyttle 7. REGIONAL ADVISORY GROUP (5) RAG has 72 members. Core walizes too large. Very elite Executive Committee. ' Meetings usually attended by slightly more than half of membership. Last full meeting, RAG adopted an attend or be dropped provision. Mosely hopes to prune . by this mechanism and make consumer additions as well. RAG plays very active role in all program decisions. 7 ee meee meme Recommended Action: 8. GRANTEE ORGANIZATION (2) MUSC grantee. Several bones of contention. Most important: Is new and expanded mission which SCRMP sees as its legitimate mandate also viewed as a legitimate mission by grantee? Myrtle Beach retreat at end of April may open this up. ce eae tECOMMENDED ACTION: ee — LA ®@ South Carolina PREPARED BY: L. Kyttle pare 3/30/ -9, PARTICIPATION (3) Region's medical political complex deeply involved in program. RAG membership s;o0 - ‘attests.. Coordinator represents astute link between MUSC and SCRMP. CHPA viewed as ineffective by SCRMP. Two funded 8B agencies out of 10 medical districts. ommended Action: : es - 10. “LOCAL PLANNING (3) -Provision'-in review procedure for CHP review and comment. “SCRMP structure in medical _districts,SCRMP organized Annual Conference of Health Planning Council whereby eawide planning councils of CHP meet to review all programs and plans. Overlapping SCRMP.’ ‘and ; ‘CHP membership on local district committees. | RE MENDED ACTION: - ZO (Pp; __ South Carolina PREPARED.BY.: L. Kyttle 1. ASSESSMENT OF NEEDS AND RESOURCES (3) SCRMP developed South Carolina Health Data Profile which represents most in depth attempt to accumulate inter-related health data in State's history. Medical Districts update. 2commended Action: can 12. MANAGEMENT (3) Region received one of the first management assessment visits in January 1970. Very well rated at that time. Recent visits continue to comfirm original assessment. wee mmm ar a ECOMMENDED ACTION: @& South Carolina _ PREPARED. BY: ls Kyttle DATE: 3230/3 13. EVALUATION (3) There is no full time evaluation director. There is a full time program analysis . eoordinator. Region proposes evaluation (both individual project and program impact) as an area to be specifically spoken to under a reorganization. ae So ae be twee we ee meme a meee mae emer teme me ee l inte 14. ACTION PLAN (5) It is dn this area that region proposes sweeping changes to be aired at Myrtle — Beach | retreat. As program now stands, goals and objectives do not embrace national goals or HSMHA mission entirely. The activities proposed by Region are for most he. second year request for continuation of specialized education activ~ kidney propsal expands beyond this concept and some of the flavor of _ the new a ivities is to train patients, link a ton and expand services. In ; Spartanbu es General Hospital. RECOMMENDED ACTION: - 12 ip: South Carolina PREPARED BY: Kyttle 15, DISSEMINATION OF KNOWLEDGE (2) On the basis of information in this application and free standing documents, the. region appears to be meeting the requirements under this category. Dee ee ee ee ee ee ee eR eee zcommended Action: d 16. UTILIZATION MANPOWER AND FACILITIES (4) The region's currently identified priority of improving patient care through con- tinuing education is certainly proportionally reflected in the overail program. Existing community health faculities are utilized in the educational programs and it is more than lakely that productivity of existing health manpower will be increased. Each of the 10 medical districts in South Carolina is below the U.S. in health resources, the Central Piedmont district showing the largest discrepancy. eae eee ee ee eee KR meee 3COMMENDED ACTION: 23 @ 00: Carolina PREPARED. BY ieeereeneen dV Lh erermnererer OTE nL3O/7: Ly. IMPROVEMENT OF CARE (4) Studies pursued under the Developmental Component are beginning to focus this program on the exten@ to which ambulatory care might be expanded. Continuity of care is the gubject of further activity pmposed under the Developmental Component but not speci- fied as an activity in this application. Most of the activities in this proposal deal with improving specialized care. The step of strengthening primary care and _, the relationship between primary care and specialized care is one of the subjects of the upcoming retreat. . SHORT-TERM PAYOFF (3) The proposed activities will increase the quality of specialized care and to a | lesser exten increase services available in‘a short ‘term time frame. & NMENDED ACTION: Pp: South Carolina 19. REGLONALIZATION (4) SCRMP is building linkages and in this concept has regionalized well. Its district structure has contributed to this and a strengthening of the medical districts is a priority of the upcoming year. “a me ee - ee eww wen were wer ewer errr rere ee —_ — = - ed -” sacommended Action: 20. OTHER FUNDING (3) SCRMP, like many other regions,has not done a good job of telling this part of their story. Without exception, the 16's show no other sources of support and the 15's do not speak to other contributions whereas when the staff described the activities in more depth on a recent staff visit, I found that many of the hospitals had con- tributed financially and otherwise to the training projects and the MUSC had made substantial contributions as well. Conversely, SCRMP has co-authored several grant applications ultimately submitted to Appalachian organizations (federal and state) as well as NCR&D and BHM. en ad - a ied ~.-<-e8e se eee enr rere —_— -— « ed ‘ECOMMENDED_ ACTION: . TO FROM SUBJECT: EMORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION : Acting Director DATEApril 18, 1972 Division of Operations § Development * Director es Regional ical Programs Service Action on April 10-11 Staff Anniversary Review Panel Recommendation concerning the South Carolina Regional Medical Program Application. Accepted 4 | Lf (A. Fe (Date) Rejected (Date) Modifications Component and Financial Summary <- Anniversary Application COMPONENT CURRENT Yo YEAR U2. YEAR RECOMMENDED YR'S AWARD | COUNCIL FUNDING = 04. OPER. RECOMMENDED REQUEST SARP YEAR LEVEL REV. COM. CORE 415,587 499 ,818 Sub-Contracts 2 1,550,001 OPER, ACTIV. 596 ,137 2,032,541 »? Uy OO IDEVEL. COMP. 62,500 190 ,000 Yes (xX) or No (_) EARMARKS : KIDNEY #S< 43,500 323,920 150,308 RMPS DIRECT 1,074,224 1,550,000 2 632,359 1,700,368 NL SC" AS OSS. POSS nt REQUESTED 2,991,048 NS SSE SEES ESAS COUNCIL SSS APPROVED LEVEL [1,550,000 NON-RMPS and IRCOME RECION South Carolina June 1972, REVIEW CYCLE *The 04 year.is being extended to 9/1 and the region has been advised that. the: funding level will be $1,808,324 for the 14 month period. This represents a pro-ration of the $1,550,000 Council approved level. . 4/18/72 SCOB/RMPS Region South Carolina RMP Review Cycle June 1972 Type of Application: Anniv. within a Triennial— Recommendations From Rating - 240 A/ SARP [/ Review Committee [] Site Visit ) LL] Councit Recommendations: 1. That the Region's funding level be continued at $1,550,000 for its 0S operational year. This level is exclusive of the kidney proposal. 2. That the kidney proposal be approved as recommended by the site visitors at a level of $150,368 for the first year and $104,691 for the second year. 3, That disbursement of funds for the second year of the transplantation portion of the kidney proposal be contingent upon an appraisal of the first year's performance. 4. That the advice letter cover the specific points discussed by the Panel and delineated under the Critique portion of this document. Critique: The Panel first considered the staff reviewers' proposal for postponement of the review of this application until an assessment could be made of critical programmatic issues to be acted on by South Carolina's RAG at a 2-day retreat to be held at the end of this month. SARP agreed that although the retreat 1ssues were central to moving this Region in expanded and new initiatives, the real program impact of decisions made there could not be assessed in the immediate future. Therefore, Panel decided to proceed with a review of the application as.presented with consideration also being given to the documents presented by staff covering developments in the Region since the application was prepared. The reviewers agreed that the application reflected a failure to respond to specific recommendations included in the advice letter last June. The heavy categorical emphasis of the program; the traditional continuing education activities through which it is implemented; the Region's goals, objectives and priorities, the composition of the Regional Advisory Group; all were cited as continuing weaknesses. With what Panel sees as superb lack of timing, the Region did not address these issues in its anniversary application, but stands ready to do so at the RAG meeting which takes place while this application is under review. Page 2 -Critique South Carolina RMP Panel agreed that the classical academic approaches characterizing most of South Carolina's activity to date reflect the confinement of the very conservative and influential medical/political structure. To have moved this program in this State to the point of addressing the basic program issue of a mandate beyond that confinement and to have cultivated a preliminary endorsement of the proposal by key members of the RAG's Executive Committee, is, in the Panel's view, encouraging evidence of Dr. Moseley's leadership. What South Carolina has undertaken through its operational project activity has been done well, and the reviewers felt the program could be expected to embark on new initiatives with characteristic efficiency. The reviewers voted to accept staff's alternative recommendation that the Region's funding level be continued at $1,550,000 for its 05 operational year. In arriving at this recommendation, the reviewers agreed to accept the Region's promissory note and,therefore, felt the funding should be so established as toallow South Carolina to implement its promised new initiatives. The recommended level would also require the Region to prune the requested budgets for the continuation activities. The $1,550,000 level is exclusive of the kidney proposal which will be reported on later in this document. @ vx: recommends that the advice letter to this Region specifically cover the points that previously identified weaknesses continue in this application; that the recommended funding level represents a reliance on the Region's ability and intent to implement significant programmatic and organizational improvements in the very near future; and that any issues remaining unanswered following the RAG retreat be explicitly identified. The kidney proposal was considered and the recommendations of the site visitors were accepted. The report of the site visit is attached which recommends $150,368 for the first year and $104,691 for the second. A qualification was added to the site visitors’ second year funding recommendation, that being that funds for the second year for the transplantation portion are contingent upon an appraisal of the first year's performance. RMPS/SCOB/Kyttle/4/18/72 sf Component and Financial Summary - Anniversary application af e COMPONENT CURRENT Q5.. YEAR Oh. YEAR RECOMHENDED YR'S AWARD COUNCIL | FUNDING . 04 OPER. RECOMMENDED “REQUEST SARP YEAR , LEVEL oO REV. COM, . (14° mo. period) ZS AX (12 mo. period)| (12 mo. period) ~ CORE 620,627 < C252 499.818 , Sub-Contracts MANS KYAT - o y! . Sv oN . JOPER, ACTIV. 981,947 SKILL Kd 1,708,621 1,550,000 : PRX LORLRL, . DEVEL. COMP, 155,000 OIE 100 ,000 Yes (*) or No RARHARKS ¢ KIDREY #55 50,750 323,920 150, 368%* CBE #63 See below* _« |RMPS D...ECT 1.808.324 1,550,000. 2,632, 359 1; 700 , 368 REQUESTED 2,991,048 COUNCIL 1,550,000~-12 md 1,808,324-14 ma? . APPROVED LEVEL NON-RHPS and INCOME * Also pending is a request. as follows: CBE component | #63 Ol - $722,140; 02 - -$820,523; “03+ "3942, 186° . “o~ “REGION June *k The level of approval for the second year of the kidney component is $104, pote og 7 Current, program réquest $2,632,359. ' ~~ Supplemental ,CBE request_ 722,140" Region's total request. $3,354,499 _ * . . seme ~ o + SOUTH CAROLINA 1972, REVIEW CYC 5/23/72 ° PAIGE SAIN A vd bath NPR LALLA Ry Re RN A Re ty be er nee oe ee (RAE VIE A; PLEA MIE VEOISAUN Db U id : PUBLIC HEALTH SERVICE FROM SUBJECT: I. “Ii. HEALTH SERVICES AND MENTAL HWEALTIT ADMINISTRATION MA 407" For the Record DATE: AR 30 i972 : Medical Consultant Division of Professional and Technical Development, RMPS Recommendations of the Mini-SARP regarding South Carolina Kidney Disease Proposal (55-B, 55-C, and 55-D) Purpose of the Program To expand an already existing Home Dialysis Training Program (55-B), as well as to establish a satellite dialysis unit at Columbia, South Carolina (55-C), and to initiate a university-based transplantation program (55-D). Action A. The recomendations of the Mini-SARP were for the general approval but with the stipulation that a site visit be made with the use of an out- side consultant plus staff for the purpose of: 1, Determining a more realistic, overallleve)] of funding; 2. Resolving the issue of a proposed satel lite dialysis unit at Baptist Hospital versus Richland Memorial Hogpital; and 3, Discussing in greater detail the proposed transplantation ectivity in view of making specific recommendations regarding the level of RMPS support. B, It is advised that this consultative activity be carried out as soon as poasibie, preferabiy in time for our recommendation that can be wade to the SARP at itg next meeting on April 4, 1972. NO N : (. CN — ss, JAMES B. GROSS, M.D. \ 4 At VE N 7 Region: South Dakota Review Cycle:June 1972 Type of Application:02 continuation planning © Rating: 290.3 Recommendat tons From {7 SARP /XX7 Review Committee fT Site Visit fT Council RECOMMENDATION: The Review Committee concurred with staff reviewers and SARP that the application should be approved in the time and for the amount requested ($424,662). This figure is exclusive of EMS and CBES supplemental requests which are presently under review, CRITIQUE: The Committee reiterated many of the points raised by SARP during the course of their review of this application; therefore, they will not be repeated in the blue sheet. As mentioned previously, the Committee strongly endorsed SARP's recommendation. , However, mention was made of the fact that even though the Regional Advisory Group is comprised of 51% consumers, there appears to be a dearth of consumer representation from such interest groups as the poor, farmers and organized labor. Of interest is the fact that the primary reviewer lauded the Region for its efforts in terms of establishing what 6: to be a very viable working relationship with the Nebraska Regional Medical am from whom it. was divorced. In summary, the Review Committee agreed with other reviewers that the Region has demonstrated considerable progress during its first year of development. Further, the Committee reinforced the recommendation made by those who had previously scrutinized this application that the Region's planning status should in no way deter it from being considered for out-of-phase supplements in the areas of Emergency Medical Services and Community-Based Education Systems, In conclusion, Committee noted that they concurred with SARP and were recommending an additional years support for the Coronary Care Unit Nurse Training Project. © Component and Financial Summary - Anniversary Application COMPONENT CURRENT ‘. O1 YEAR 02 YEAR RECOMMENDED Ot Oren. SARP __ YEAR COUNCIL ET RECOMMENDED REQUEST [Xx 7 REV. LEVEL COM, KSC SP CORE 259,500 Ler 320,000 | Sub-Contracts NA yg r (30,000) xe § OPER. ACTIV. . 120,000 A} 104,662 424 662 DEVEL. COMP. NA NA Yes () No (Xx) EARMARKS : - KIONEY NA NA °, © | EMS # 2 x**k see below : CBES. #3 , kk see below RMPS’ DIRECT #379500 ~W24 662 #8424 662 Ae ae read REQUESTED 786 ,500 COUNCIL 3g Re Ba oi APPROVED LEVEL 379,500 IPL LEAL EPO NON-RMPS and sty INCOME t ® Region extended for 2 months at $63,250 for a total ' oo¢ $442,750. REGION South Dakota . . | . June 197 2 Review Cyc xk In considering an increased NAC funding level for the ———mecee meme 02 year, it should be noted that out-of-phase supplements in the areas of EMS and Community-Based Educational Systems have been submitted. akk Pending are the following requests: EMS, $470,000 (for one year); CBES, $165,000 (for one year). © Current program request $424 662 EMS request © $470,000 CBES request $165,000 Reaions total request VTOCg 66> © SOUTH DAKOTA REGIONAL MEDICAL PROGRAM 4 02 Planning Grant Application ao TABLE OF CONTENTS Page Part: | Staff Briefing Document - Face Page 1 Geography and Demography 2-3 Fiscal Summary hed MIS Printouts 6-7 Accomplishments, Problems, Issues 8 Staff Comments 9-11 Part i Kidney.- not applicable Part $14 @-.- Material Statement of Need for Coronary Care Training Program Trip Report - Harold O'Flaherty and Luther Says, Jr. 2 Part IV Site Visit Report Trip Report - Bruce Everist and Clark Millikan ' Part V «Advice Letter - not applicable “Part Vi Management Assessment visit report - not applicable RMPS @ STAFF BRIEFING DOCUMENT REGION South Dakota OPERATIONS CUBASTERN = ZQ7NID-CONTINE 7 BRANCH LUSOUTH-CENTRAL £—/WESTERN Fe BRANCH TYPE APPLICATION: NONE LAST RATING Tel. No. 443-1790 Room 10-15 £7 TRIENNIAL 197__ DATE BRANCH CHIEF Michael J. Posta £7 Ast ANNIV YEAR LJ SARP BRANCH STAFF Harold F. O'Flaherty LJ 2nd ANNIV YEAR L/ REV. COM. RO. REP. Daniel P. Webster 2i7 OIMER 02 planning | / OTHER Last Mgt. Assm't Visit NA 197__ Chairman Last $.V. Oct.27197_0_; Chairman Bruce Everist and Clark Milliken National Advisory Counc Staff Visits, Last 12 mos. (Dates, Chairman's Name and Type of Visit) October 5-6, 1971 ~ Richard Clanton — to meet with new Director January 26-27, 1972 — Harold O'Flaherty ~ to assess the overall program progress @.: EVENTS WHICH OCCURRED IN THE REGION AFFECTING THE RMP SINCE ITS LAST REVIEW IN April 1971: As of 9-1-71 the RMP recruited a full-time Director, Dr. John A. Lowe. The Dean of the Medical School has been removed from his position. A’decision. regarding the establishment of a 4-year medical school has been put off till the next session of the legislature. . ‘The State legislature has funded a project entitled "Minimum Uniform Health Services" (MUHS) which will make it possible for persons to have access to the health care. syste in a 4-county area where there are no doctors, nurses, dentists or hospitals. ($186 ,00 resets AeA LTE TTS GEOGRAPHY - » (2 Districts) : 67 Courities 2 Congressional Di Districts ‘ | - | . COKSON cAMPacte MC PHERSON i MARSHALL t HARDING | ft gaown RoocaTs PERKINS po — | . | x WALWORTH t COMUNDS ., | i \— | _ : ; : | ocwey | oT . “nen ; POTTER FAULK i iN sure . coach — sree CLARK r : . ' pever i i SuLLy , | | , . , . . \ MCAOE F, . HOE HAND . oc no (ov PIER RE * ecaore i : , [AWRENSE . STANLEY oN HUGHES . “qscsouer i BACORINGS ‘ , HAAKON ° i - _ , J : _—— i | rs | |. ®aario city . . . . gurfAaLo JERAULD gansoRrs \ NER Lat | saooY : , / to JONCS LYMAN 4 t | JACKSON . ? | cusrer ° | AURORA | manson | #CCOO8 ~owanenana | | t DAVISON f MANS siOUx FALLS WASHAGAUGH | MELLETIC I . | . . * SHANNON reir DOUGLAS HUTCHINSON tyrace | | UNCOLS FALL AIWER of . oO BENNCTT 1000 : GREGORY CHARLES MI heme or eee Q 4 | > emmeei ——=_——— ry ~ . , ~ ts OLIVICAL INFORMATION ‘ POPULATION=197(0 eee, overnor: Rickard F. Kneip " (D) _ Total Population: ° 666 , 300 enators: George S. vicGovern (D) Select committee on Nutrition Population Density: 9 per 5q- mile Karl Ei Mundt (RP), . % Urbart: 49 . . ; epresentatives by Congressional District (Jend congress )-January 1971. % N Non-white : 5 (approx. 35 ,000-mainly Indian) 7. Frank &. Denholn (Dp) 2, James G. Abourezk (dD) nO REGION South Dakota PROFILE REVIEW June 197 2 © TEES AND RESOURCES -—- SCHOOLS | Enrollment Graduates chools Number (1969/70) (1969/70) Location sdicine and Osteopat. State Univ. of S. Dakota —_ 95 —— Vermillion School of Medicing - 2 yr. es Basie. Med, Science ental: harmacy (1967/68) S.D. State Univ. College (1) 171 4g of Pharmacy Brookings ursing Schools Professional Nursing 9 (5 of which are college or Univ. Based) Practical Nursing 5 (Technical-Vocational Schools) untor & Community Colleges 1 dr, College No University~based School Tited Health Schools (approved programs) Cytotechnology 0 Inhalation Therapy 2 Medical Technology 6 Radiologic Technology t ysical Therapy 0 ical Record Librarian 0 '‘AGELITIES AND RESOURCES -~ HOSPITALS on Federal Short and Long-term General Hospitals, 1969 Nursing & Personal Care Homes, 1967 - Number Number Woe Number of Beds Type Number of Beds short. term 5 3,512 Skilled Nursing Homes 134 35955 ong term ~ 1 76 Personal Care Homes iA General Hospitals 2 560 with Nursing Care ute 1,704 48 Indian 5 194 Long-term Care Units 9 249 Number of Hospitals with Special Facilities Type Facility # of Facilities hype Facility # of Facilities (ntensive CCU 14 Radium Therapy 6 Sobalt Therapy ~— Renal Dialysis (in-pt.) 3 [sotope Facility 5 Rehab-in patient _ t *ACILITIES AND RESOURCES -- MANPOWER >pofession Number |% Total | Per 100,000 Profession Number {Per 100,000 Shysician — active 75] Professional nurses general practice 40. active 2,089 308 medical specialties 13 inactive _ 804 cal specialties 25 Lic. Pract. Nurses r actively empl. a = inactive (31) in nursing 615 92 Osteopath 31 not empl. : in nursing 159 Mikal antdtire MOR MN B16 77 ye COMPONENT CURRENT “Ol. YEAR 02. YEAR RECOMMENDED YR'S AWARD “COUNCIL FUNDING Oi OPER. RECOMMENDED "REQUEST (SARP) “YEAR LEVEL oo REV. COM. ORE 259,500 320 ,000 ‘ub-Contracts NA 30,000 \PER, ACTIV. 120,000 104,662 EVEL, COMP. NA 7 Dyes ( ) or No _(X% 2ARMARRS . KIDUEY NA NA RUPS DIRECT # 379,500 |-___ 3.13, 000 SS ROI REQUEST _D 786,237 LEE IER OSE Sh | 7 oo, . a F COUNCIL APPROVED LEVEL 379,500 NON-RMPS and “INCOME " wk on cagnsidering ‘an increased noted that-ous ‘educational: systems hav ~of-phase supp e been submitted. --:. REGION . June WAC. funding level far: the 02 year, oe lements in the areas of EMS ang Comm South Dakota 197, tee Region ext-nded for 2. months at $63, 250 for a total of sun 750. it should be unity-based REVIEW CYCLE IDENTIFICATION OF COMPONENT BREAKOUT OF REQUEST 01 PROGRAM PERIOD South Dakota RM 00067 AMOUNT AWARDED AWARDED DIRECT COSTS AWARDED INDIRECT COSTS TOTAL Core 259,500 259,500 80 , 359 339,859 Coronary Care Training 120,000 120,000 12,339 132,339 TOTALS 379 ,500 379,500 92,698 472,198 FEBRUARY 28,1972 BREAKOUT CF REQUEST 02 PPCGRAM PERIOD REGION - S DAKOTA RM NNM6T Ch/T2 RMPS-OSK-JTC (5) (2) (4) a) LDENTIFICATION OF COMPONENT 1 CONT. WITHIN] CONT. BEYOND] APPR. NOT |] NEW, NOT j CURRENT | CURRENT J { ] APPR. PERICO] APPR. PERICC! PREVICUSLY | PREVIOUSLY t DIRECT | INCIRECT t TOTAL | ] CF SuppnRT | CF SUPPORT | FUNCER ° I APPROVED 1 costs | costs ! I ] | | { | COON CORE STAFF PLANNING t 1 I | ! | | | { $320,000 _ | 1 ] } $320,900 J $1°5.523_1 £425,523 1 COLA CORONAPY CARE TRAINING Ul | { | _ it { ! | NIT_USD ! $45,844 _1 I I ! $452244_ 1 $13.0°54_] g5e,n98_ t OOLR CORANAFY CARE TRAINING Ul { I 1 | { { | NIT ST _JCHAS MCAAMARA ! $282950_ 1 1 J L $28,950] £42871 1 S27R,P2L_ f_ AALC COPONAPY CATE TRAINING UJ | | | | | | 1 NIT SICUX VALLEY $292868_ 1 tl ! j $255 862 1 $2,024 _] $3242892_1. ASL _COMPCRENT TOTAL if $194,642) 5 1 1 i $104e662) EL $20,945 11 $125s611i 1 | 1 | I . 1 I | TOTAL ! | ! 1 $424,662 | ‘$126,472 | $551-134 | $424,662 } 5 REGION = S DAKOTA @ FEBRUARY 24,1972 BREAKCUT CF REQUEST RM: ON067 06/72 D3 PROGRAM PERIND RMP S-OSN=JTOGR (5) {2) (4) tt ENTTFICATICN CE COMPONENT. | CONT. WITHIN] CONT. REYCND] APPR. NOT { NEW, NOT | aco'e YEAR | 1 TOTAL I ] APPR. PERTON] APPR. PERFOD] PREvICUSLY [ PREVIOUSLY | NIRECT | f ALL YFARS i 1 OF SUPPORT {| OF SUPPORT 1 FUKDED | APPROVED t casts POrRECT casts : t | ! ! | I AA CORE STAFF PLANNING I | | | ! | i I ! $376.000 1 I | t $37GH20h00_ 1 i $68,000] tA CORONARY. CAPE. TRATNING Uf ! } I { t { { JHET US { \ L } ! om L i $45,844 4 18 COPONASY CAPE T@ATNIKG Ul I | | i | { I NET ST CHAS VCR AM ABA f | { J | f ! 2A .25C_ | TC CORONARY CARE TRAINING UI { | I { 1 | i wALTOSIOUX. VALLE | 1 —— l | I j $29,368 1 Low QRPENENT OICTAL j } ! l 1 L Mg e1css.662yt I | ! | J { f I TOTAL | $376,900: | I I | $376,CC0 | t $erc,és2 | REGION South Dakota REVIEW CYCLE ime 197 2 SUTSTANDING ACCOMPLISHMENTS BY RMP since April 197 1 1. The relationship between RMP and CHP has been clearly delineated. 2, ‘The RAG plays a very active role in the development of the overall, program. 3. A process-problem-oriented approach has been utilized for planning. 4, Goals, objectives and priorities have been clearly articulated. 5, A talented core staff has been assembled. 6. The core curriculum project funded by PHME to the State Department of Health has brought together representatives from all 60 manpower training programs in the State to determine similarities, gaps and duplications in health curricula now being offered in South Dakota. 7. The Medical School canponent of core staff was phased out. PRINCIPAL PROBLEMS 1. SDRMP is requesting a 3rd year of support for the CCU Nurse Training project in line with the commitment made to the project sponsors when there existed a Nebraska/South Dakota RMP, Review Cammittee and Council when they acted to establish SDRMP felt that only a l-year canmitment should be made in order that the Region might determine if the project was germane to their goals, objectives and priorities. SDRMP feels that the project is both relevant and important and should be funded for only one more year; staff concurred. - , 2, There are no minority group representatives on core staff. 3. Goals, objectives and priorities are somewhat global. 4. The mechanism to be used by RAG to monitor the program is unclear. ISSUES REQUIRING ATTENTION OF REVIEWERS 1. South Dakota became a free standing RMP separate from Nebraska on July 1, 1971, it was awarded planning status. 2, The review criteria that will be used to rate the 02 planning grant application are geared primarily to be used in rating an operational grant application; therefore, some adjustment in the system is warranted. ; 3, The question was raised as to whether or not a need exists to fund the CCU Nurse Training project for an additional year. 4h. ‘The staff reviewers agreed that the $313,000 dco for the 02-year was too low; all those attending the pre-SARP meeting recommended approval'in the amount requested $424,662 dco 3 REGION South Dakota REVIEW CYCLE June 197 2 © STAFF DOCUMENT A. PERFORMANCE 1. Goals, Objectives and Priorities (1) a. goals, objectives and priorities have been determined b. lack time-frame but represent areas of program emphasis for their three—year plan 2. Accomplishments and Implementation (2) a. as a planning Region they have been underway six-months when application was submitted b. have delineated staffing patterns and organizational structure e. only one operational project underway - has more than met its objectives dad. . staff felt Region accomplished a great deal in only a few months 3. Continued Support. (3) a. reduced funding requested for CCU project b.- plans made to continue it with local dollars once its initial three- year commitment terminates @ 4, Minority Interests (4) a. minority interests are at parity in terms of minority interests on RAG . b. Emil Redfish,.Indian leader, member of RAG, has been appointed to Governors cabinet to head up Indian affairs e.. should encourage Region to follow through on commitment to hire minority group representative for core staff B, PROCESS 1. Coordinator (5) a. excellent. Coordinator b. been on beard since 9/1/71 e. has established himself as leader of the Program 2. Core Staff (6) a. small but talented core staff b. . know the Region well @.. are very competent d.: need to establish senlor level position for evaluation and planning purposes 3. Regional Advisory Group (7) » a. geographically, organizationally balanced b. very actively involved in the Program c. should be encouraged to establish a committee for monitoring and evaluation purposes 10 a, RAG Chairman being nominated for membership on National Review — Committee e. RAG serves both CHP and RMP - role of both agencies clearly . articulated 4, Grantee Organization (8) a. grantee is medical school b. role to be trustee c, does not have veto power over RAG d. reviewers felt - does not provide enough services for funds received in the indirect costs category 5. Participation (9) a. key health interests participating b. program is not captured by any particular group 6. Local Planning (10) a. RMP has field staff assigned in major areas to do local planning b. no "bd" agencies have been formally established cc. "a" agency not interested in establishing "b" agencies 7. Assessment_of Needs and Resources (11) a. RAG and core staff have systematically attempted to assess needs and resources b. these were translated into priority areas c, feasibility studies are and will be carried out in each of these areas 8, Management (12) a. core staff activities well coordinated b. Region needs to formalize its monitoring procedures c, time-framed reports gathered from project sponsor and other recipients of core staff funds 9. Evaluation (13) qa. full-time Evaluation Director not hired b. highly trained person on core staff provides this function, as well as establishing an EMS plan ec. Region still in planning - therefore little to evaluate d. application indicates that evaluation to be built into each phase of the three-year plan e. Region should be encouraged to move more rapidly in this area & 1 PROGRAM PROPOSAL 1. Action Plan (14) a. Region still in planning stage b. have set priorities and objectives to be addressed in three-year plan c. these relate to National mission 2. Dissemination of Knowledge (15) a. only one operational project - CCU Nurse Training widely accepted - has done well in this area of dissemination of knowledge b. reviewers hoped that this would be a microcosm of what might happen regarding the dissemination of knowledge 3. Utilization Manpower and Facilities (16) a. most of the major medical care facilities represented on RAG b. too early to tell about utilization ec. manpower high priority d. health manpower education systems viewed as common denominator to all other priorities e,. out-of-phase supplements in this area will soon be received in Rockville 4, Improvement of Care (17) a. improvement of chronic care high program priority b. EMS number one priority c. out-of-phase EMS supplement to be submitted by April 15 5. Short-Term Payoff (18) a, reviewers felt too early to tell | b. experierice with CCU Nurse project indicates progress in this area 6. Regionalization (19) a. regionalization, conceptually speaking, used as a frame of reference for planning b. considerable interchange of resources and information takes place among various health related groups 7. Other Funding (20) a. concept of decremental funding is a part of Regions philosophy b. plans have been made to phase out support for CCU nurse training project ce. reviewers felt this was a positive sign } TO FROM SUBJECT: : Acting Director : - l- PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION VEE MORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE eo DATE: April 17, 1972 Division of Operations and Deve lopment Cay t : Director, Regional Medical Programs Service Action on April 10-11, 1972 Staff Anniversary Review Panel Recommendation Concerning South Dakota Regional Medical Program ’ Application RM00067 dated 2/14/72. Accepted: Vrfoo- ‘1 Date Rejected: Date Component and Financial Summary - Anniversary Application COMPONENT CURRENT “2. YEAR 02. YEAR RECOMHENDED YR'S AWARD COUNCIL FUNDING -Ol_ OPER. RECOMMENDED "REQUEST (SARP) “YEAR LEVEL REV, COM. s . “sh CORE 259,500 OSX X? LAO 320,000 Sub-Contracts NA MLNS KR LLAL 30,000 r aye . : oye OPER, ACTIV. 120,000 € SIS 104,662 wy SX LOK RL, : DEVEL. COMP, NA Ke o> ORL LE NA 7 Yes ( ) or No (XX' EARMARKS ¢ KIDHEY NA NA RMPS DIRECT *_379,500 REQUESTED 786 ,237, COUNCIL APPROVED LEVEL 379,500 NON-RMPS and INCOME NA *» Region extended | **+ Jn considering an increased NAC. funding level for noted that- out-of-phase supplements in the areas *:educational systems have been submitted. - . REGION South Dakota 1972, REVIEW CYCLE for 2.months at $63,250 for @ -fotal of $442,750. ‘the 02 year, it should be of EMS and Community-based ~3- REGION South Dakota REVIEW CYCLE June_ 197 2_ RECOMMENDATIONS FROM 7x7 SARP 7/ Review Committee 77 Site Visit . [7 Council os ‘/ECOMMENDATION: The Staff Anniversary Review Panel concurred with the staff reviewers that the second year planning grant application submitted from the South Dakota Regional Medical Program should be approved in the amount requested for direct costs, 5424 662. 2ATIONALE: The justification for recommending an increase in the funding level from $313,000 dco to the above mentioned figure was predicated upon the fact that the Coronary Care Unit Nurse Training Project has requested support for an additional year. An initial three year commitment was made to the project sponsors when it was under” the purvue of the Nebraska-South Dakota Regional Medical Program, The present request in actuality represents the last year of that initial three year commitment. The 4 panel also was aware of the fact that when the South Dakota Regional Medical Program ‘ was initially established, it would be given the prerogative of determining whether or not the Coronary Care Unit Nurse Training Project was consonant with its overall goals, objectives and priorities. Based upon the material presented in the application as well as the data appended to the briefing document, the reviewers agreed that the Coronary Care Unit Nurse Training Project was relevant to the overall goals of the Region and should receive an additional year of support. CRITIQUE: In view of the fact that the RMPS review criteria were designed to rate a Regional Medical Program that has achieved operational status, the panel agreed not to rate the Region, as South Dakota is still in the planning phase of development. However, the panel did indicate that the Region's planning status should in no way deter it from being considered for out of phase supplements in the areas of Emergency Medical Services and Community Based Educational Systems; proposals in these two areas will be submitted on or before the appropriate deadlines. In assessing the region, the reviewers were pleased with the progress that has been made to date. The panel felt the new director, Dr. John A, Lowe, hired affective September 1, 1971, has established himself as the leader of the program and is supported by a talented though small staff. It was the concensus of the reviewers that the goals, objectives and priorities that have been delineated are somewhat global and lack a time frame, but it was felt that they represent areas to be addressed in the triennial grant application to be submitted one year hence. From all the data that were available to the panel it seemed that the Regional Advisory Group was very much involved in the affairs of the program, therefore, the RAG was viewed as being a major strength of this Region. Also, the reviewers were pleased to learn that the relationship between RMP and CHP had been delineated and the two agencies seem to be working together in a positive fashion. The reviewers did note that no one on program staff ts assigned the responsibility for planning and evaluation perse. Therefore, It was felt that a senior level position in this area should be established. In thts connection, the reviewers further suggested that the Region consider the feasibility of establishing an evaluation Page 2 - Recommendations From SARP Region South Nakota ©@ Review Cycle June 197 20 committee to monitor not only projects; but also, the activities of program staff. A major area of concern to the reviewers was the fact that there are no minority ‘group representatives on the program staff. While the application makes reference to ameliorating this situation, the panel felt stronaly that the Region should be encouraged to actively recruit for such individuals. ‘The reviewers felt that at least two types of technical assistance should be provided the Region during the insuing year: 1) As the Region continues to implement its planning process, outside consultation should be provided to insure that: a) needs have been adequately assessed, b) the identified needs have been translated into time-framed, action-oriented goals, objectives and priorities, and c) the programs that are proposed include a viable strategy for evaluation which should be carried out at specifically planned intervals. 2). lt was suggested that the central headquarters staff from both RMPS and CHP visit South Dakota to evaluate the unique relationship between the Regional Medical Program and the 314aacomprehensive health planning agency, i.e., the RAG, which is comprised of 51% consumers is the advisory board to both agencies. In addition, the panel agreed that ft would be most helpful to Dr. Lowe if he were to be invited to take part in a site visit to a Regional Medical Program in the near future. The panel felt that this experience would greatly enhance Or. Lowe's orientation to Regional Medical Programs. TABLE OF CONTENTS WESTERN PENNSYLVANIA REGIONAL MEDICAL PROGRAM - ANNIVERSARY APPLICATION Staff Briefing Document Page Face Page 1 Regional Profile 2 Regional Map 3 Component and Financial Summary 4 Breakout of Request (04 period) , 5 Breakout of Request (05 period) 6 Accomplishment, Problems, Issues 7 RMP Review Criteria Form 8 Additional Printouts it RMPS STAFF BRIEFING DOCUMENT OPERATIONS /x/ Eastern /-] Mid-Con EGION Western Pennsylvania BRANCH rt South Centr'l / 7 Western BRANCH YPE APPLICATION N.A. LAST RATING Tel. No. 301-443-1810 Room 10-35 “7 TRIENNIAL 197 DATE BRANCH CHIEF Frank Nash Xf 1st ANNIV YEAR f 7 SaRP BRANCH STAFF Norman Anderson _/ 2nd ANNIV YEAR {f/f REV. COM. RO REP. Clyde Couchman “7 OTHER 7 OTHER 2}, OTHE Lf Last Mgt. Assm't Visit_N.A. 197 March Chairman ~~ AST $.V. 10-11 197 1. 3 Chairman_ Leonard Scherlis, M.D, taff Visits, Last 12 mos. (Dates, Chairman's Name and Type of Visit) Verification of Review Process Visit, September 28, 1971 (Roland. Peterson) a ajor Events Which Occurred in the Region Affecting the RMP Since Its Last Review n May 197 1°53 i. The Development of an Experimental Health Care Delivery System in the Region with little relationship to other plans for the health care system. ’ ~ 2. HMO's of both prepaid group practices and Medical Foundation types have begun to develop with little relationship to Region-wide planning. 3, In 1970, House Bill 1311 was enacted. It established a program for the care and treatment of persons suffering from renal disease. The legislation calls for an appropriation of $1,000,000 for fiscal year 19/1. < 4. Dr. Carpenter, Coordinator of WPRMP is resigning June 30; 1972. 5, Harry K. Wilcox, elected Chairman of the Regional Advisory Committee. ~2- Demography and Resources Data: Geography and Demography: Population--1970 Census 4,138,000: no real increase since 1960. Race: no updated data from 1970 census available: 1960 census: State of Pa. non-white--7.5%. For 28 counties, non-white ranged from 0.1% to high of 8.3% in Allegheny County (Pittsburgh). Resources and Facilities: Medical School~-University of Pittsburgh, School of Medicine School of Allied Health Professions, University of Pittsburgh Inhalation Therapy ~- Community College of Allegheny Physical Therapy - Dept. of P.T., D.T. Watson School Medical Technilogy, university affiliated Schools of Nursing - 32 (16 in Pittsburgh, of which 4 are college or university affiliated). Practical Nurse Training - 14 (3 in Pittsburgh and arrangement with public schools) Accredited Schools: Cytotechnology (2 in Pittsburgh); Medical Technology--8 (4 in Pittsburgh; plus 1 at School of Allied Health Professions) Certified Laboratory assistants - 7 (2 in Pittsburgh); Radiologic technicians-23 (6 in Pittsburgh); Medical Record librarian 1 Hospitals - Non-Federal* short-term and V.A. General Community V.A. Gen. Hospitals Hospitals __# Beds _# Beds Pittsburgh 20 6,919 1 945 Other _60 10,555 _1 _170 Total 80 17,474 2 1,115 *These counts are subject to revision; they were determined on the basis of county location, from A.H.A. Guide Issue, 1970 Edition. Manpower - Physicians and Osteopaths Practicing MDs Osteopaths Total Active 4,593 (as of 12/31/67) 182 4775 Inactive 172 (not updated) Ratio: 115 per 100,000 population, compared with 132 for U.S. Professional nurses (no data available by county) 1962: Total 27,569; active 16,574 ratio of 395/100,000 pop. tole BUFFALO A . WESTERN PENNSYLVANIA ===) REGIONAL Mf EDICAL PROGRAM | CLEVELAND Metropolitan Areas ~ declining pop. sincef 1970 1960 1960 .§ ' YOUNGSTOWN Altoona 134.1 137.3 . “ J&hys town 260.7 - 280.7 joa tfsburg 2383.8 2405.5 { ; OHIO * Western Pa. —2 BEAVER , Comprehensive Healthy ag BpRcH Planning Agency ' 1 & \ PENNSYLVANIA H ALLEGHENY ' = . 9 ae STEUBENVILLE 8: Wh QaiiGonwestudac: Ano @ HERSHEY Greater Nelaware & ! PHILADELPHIA 9 i WHEELING @ } 6,099 @ / PoREENE COLUMBUS) / i a | / sogfrrown ' oN NN / West Virginia RMP 1 won ‘ MARYLAND 4 Vy i tw wee WEST VIRGINIA ne ress, ; / ‘. i i ; NEW YORK | 262,654 2 3082 eet Western Pa. RMP 181, 342 counties Crawford Population---1970 Census | 4,138,000 . ~ 4 -« Cornonent and Financial Summary - Anniversary Appiication . COMPONENT CURRENT O4_ YEAR 4 YEAR RECOMMENDED YR'S AWARD COUNCIL FUNDING . 03 OPER. RECOMMEKRDED ‘REQUEST Z~ SARP YEAR LEVEL 9/1/72-8/31/72 27 REV. COM. CORE 5 604,479 PR XPKXZ2K AC $887,900 Sub-Contracts EMP NS K KILLS { XS ONE t OPER, ACTIV. 378,359 _ NIKI SCA 388, 169 - RS = DEVEL, COMP, 13,500 DOS LOSS RISE 99,633 Yes (_) or No (_)' EARMARKS ¢ KIDNEY RMPS DIRECT 996,338 _|- $1,450,000. 1,375,702 "Se ; SOK VE SON SSE REQUESTED 1,757,550 LEI ES A OSS OSES SA 2 PESOS Ve . ; SOS _ LoS fy OS ; se COUNCIL ° APPROVED LEVEL $1,450,000 NON-RMPS and INCOME *7/1/71-6/30/72 2 mo. extension 7 /1/71-8/31/72 - $166,056 extended (2 mo.)--new grant period 9/1/72-8/31/72 . ~. REGION _ Western Pennsylvania June 1972, REVIEW CYCLE MARCH 17,1972 : REGION = WESTERN PA BREAKCUT OF REQUEST RM OCO4L 06/72 oo 0% PROGRAM PERIOD . oo oo a __RMPS-OSM=JTOGR2 (5) (2) (4) on IDENTIFICATION OF COMPONENT [| CONT. WITHIN] CONT. BEYONG] APPR. NOT 1 NEW» NOT ! CURRENT. | CURRENT | : j ] APPR. PERICO{ APPR. PERICC) PREVIOUSLY [| PREVIOUSLY | OLRECT [ ENOERECT | TOTAL i 1] CF SUPPORT | OF SUPPORT | FUNDED } APPROVED I costs J costs t ! ] | | j ! I l 4 OOO CCHE ' I ! { { ! { a j 25652800 1 i | Low. oi ee 8272189 1. COOL CUE P&GFCSSEGKAL TRAIN] } I t t we ee BOD LOCATION i $314,100 1 1 L 1 S31 BsL00 i si20sse0 1 438.006 1 . CoC OCREL TILT ALS di sfaTe gilt { J Liss 200ILL $328, IGS Sle 2le. 865) DOGO BEVELCPMENTAL COMPCKEAT | j 1 ! t , ! t fo $29,633] . 1 1 ! $992633_4 i £23,632 100" { | | I t } 255.6151 1 i $59,615 4 } $55 Aout I ! 1 I £28.Cac.t L i I $28,0f0_ 1 £42956 4 $325958 1 : PLO TOR PATIENTS . | I { I | ! bo wo LLY SICAL E CELL ANDY IAL OL £63,900 1 1 J $03,000 1 £20,703 J $83,703 J OL2 REG FHCSRAY FOR PETIENTS] | i i | t 1 eee hI GLABh ES PELLET ES i a30.000_1 1 I | $30:600_1 $1 02710 : $415310 : O13 BUCKTATL AEA PULBCAARY | I | i 1 J 4262190 I awk 1 i $262190_4 ached sazse NURSE PY a , | i I I eeeerare i t ; { $B 36238 Ae S235 _—t—— werk 10 808 -bsnabiescez | GGRAM IN wee DAMLAT LON SIMBA cy 1 I j | $49,530 1 £492530 Lo g5sb3e do shales GO OLTA PEAWA COUNTY LIPIO SCRE! I i ! ! ! | t weet DIELS FEC IELT L L wt. 1 3262486.) $2614 864 wd $2£3456 1 OLT® REAVER COUNTY LIPIO SCRE] | i ! I | 1 Poo we EE ING CR OECT = | i } $23,.514.1 $232214 1 $62030_ 1. 829.5446 1 QL2_ Coelcueul TOTAL. f : i; Lf $o2e00014 ——— 1 FOTAL { $14127,938 } $63,000 | ! $1845764 | $149375,702 | $4242879 | $19790,581 | ] . - _ nn ne een cee eee ene oe cote net HAMCH LI, 1972 BREAKOUT OF REQUEST 05 PROGRAM PERIOO . REGION - WESTERN PA RM 00041 06/72 RMPS ORT ALL souRaceEs OF TOTAL Poo. . rh 0 775,189 inn vege "14,750 4524446 97 a og "99,633 ~SO”C*é~