Region: ALBANY Review Cycle: October 1972 Type. of Application: Triennial Rating: 303 RECOMMENDATIONS FROM ff SARP ‘ / X/ Review Committee / ¢ Site Visit ; [ / Council RECOMMENDATION The National Review Committee concurred with the site visitors in recommending three year's funding (triennial status) for the program's 06, 07, and 08 years, approval of the developmental component for three years in the reduced amounts of $30,000 (06), $45,000 (07), and $60,000 (08), continuation of program staff and seven ongoing pro- jects, and the implementation of 13 proposed projects. The Committee, paralleling the recommendation of the site visit team, recommended that Project #23, Health Career Incentive Program, have ARMP support terminated by December 31, 1973, because it is counter to RMPS. policy to support health careers recruitment projects. Further, the Committee advises, as did the site visit team, that ARMP carefully review projects #24, #31, and #43, In the case of project #24, further refinement and integration with other health activities are suggested. Project #31 was viewed as too global in nature and not specifically directed at the health needs of the Albany region. Project #43 was looked upon as too expensive on a cost/benefit basis and possibly duplicative of work which has already been done in other RMPs, The total request and recommendations are as follows: Direct Costs - Year . Requested Recommended* 06 $2,426,921 $1,618,000 07 $2,646,254 $1,783,090 08 $3,060,317 $1,940,725 ** The recommended amounts include Developmental Component monies in the amounts of $30,000, $45,000, and $60,000 for the 06, 07, and 08 years respectively. CRITIQUE The ARMP has made substantial progress since last year's site visit. The RAG has been expanded and restructured in a manner which insures greater community and less university participation in the program's decisionmaking process. The RAG now includes greater minority representation. The new RAG Chairman, Dr. James Bordley, III, was identified as a particularly capable and dedicated man who made a major contribution to the program's rapid development. Further, the Committee concurred with the site visitors that the appointment of Dr. Girard Craft to the position of Deputy Director provided the impetus required to coordinate the large and gglented program staff into a cohesived unit capable of administering an enlarged program, The Committee shared the site visitors' concerns about the program staff's lack of fiscal management competence in light of the program's many projects. They were pleased to note that the ARMP had hired a fiscal specialist in the interim period between the site visit and the Committee's review. This tended to reflect the program's respons- iveness to site visit recommendations and assured increased staff competence in an area which had been seen as a deficient. The Committee shared the site visitors' emphasis that the ARMP's excellent projects should be converted into a more integrated program. ‘There was a consensus that this would be done in light of the com- petence of Dr. Craft, Dr. Bordley, and Mr. Robert M. Briber, Vice Chairman of the RAG, In summary, the Committee accepted the report and recommendations of the site visitors as expressed in the site visit report. EOB/DOD 9/26/72 COMPONENT AND FINANCIAL’ SUMMARY TRIENNIAL APPLICATION Region: ALBANY zu 000 . Review Cycle: October 19) Committee Recommendation for Current Annualized Request for Triennial Council-Approved Level Component Level Year lst year 2nd year | 3rd year Ist year | 2nd year | 3rd year PROGRAM STAFF 774,592 768,230 787,563] 811,626 638,000} 693,090 731,225 CONTRACTS x X x x x x X DEVELOPMENTAL COMPONENT -0- 90,000 90,000 90,000 30,000 45,000 60,000 OPERATIONAL PROJECTS 75,314 1,568,691 | 1,768,691{2,158,691 950,0001/1,045,000 } 1,149,500 Kidney ( )- EMS C ) hs/ea ¢ ) Pediatric Pulmonary ( ) Other ( ) TOTAL DIRECT COSTS 900 ,000 2,426,921 | 2,646,254|3,060,317 1,618,00011,783,090 | 1,940,725 COUNCIL RECOMMENDED LEVEL 900, 000 Site Visit Report Albany Regional Medical Program August 1-2, 1972 Site Visit Participants Consultants John Kralewski, Ph.D., Chairman, Associate Professor and Director, Division of Health Administration, University of Colorado Medical Center, Denver, Colorado, RMPS Review Committee Member _ Adelbert L. Campbell, Acting Coordinator, California Regional Medical Program, Area 9 Granville W. Larimore, M. D., State Director, Florida Regional Medical Program John §. Lloyd, Ph.D., Associate Coordinator, California Regional Medical Program, Area 5 Alton Ochsner, M.D., Ochsner Clinic, New Orleans, Louisiana,.-NAC Member Robert C. Ogden, President and General Counsel, North Coast Life © Insurance Company, Spokane, Washington, NAC Member RMPS Staff Thomas C. Croft, Jr., Financial Management Officer A. Burt Kline, Jr., Public Health Advisor, Fastern Operations Branch Frank Nash, Acting Chief, Eastern Operations Branch © Miss Elsa J. Nelson, Senior Health Consultant, Division of Professional and Technical Development Mr. Robert Shaw, Program Director for Regional Medical Programs Service, Region II, DHEW Regional Advisory Group “ James Bordley III, M.D., Chairman, Executive Committee Robert M. Briber, Vice Chairman, Executive Committee, Executive Director Hudson-Mohawk Association of Colleges and Universities Peter Crawford, Director, Community Medical Care Program, Executive Committee Member Robert A. Dyer, Executive Committee Member : Marjory A. Keenan, R.N., Associate Professor of Nursing, Russell Sage College, .Executive Committee Member F. Donald Lewis, President, Heart Association of Eastern New York, Executive Committee Member Daniel P, McMahon, M.D., Regional Health Director, State of New York Department of Health, Executive Committee Member Paul F. Robinson, Associate Executive Director, New York State Health © Planning Commission, Executive Committee Member -2- Regional Advisory Group (continued) Eugene H. Bohi, General Manager, WAST Television, Menands, New York Ruth Buchholz, R.N., Directorof Nursing Service, Columbia Memorial . Hospital, Hudson, New York * Charles Eckert, M.D., Professor and Chairman, Department of Surgery, - Albany Medical College, Albany New York Elizabeth B. Haile, Schenectady, New York FO Thomas L. Hawkins, Jr., M.D., Executive Vice President and Director, Albany Medical Center Hospital, Albany New York John C. Marsh, Vice President~Treasurer, Blue Cross of Northeastern New York, Inc., Albany New York : Thomas W. Mou, M.D., Provost for the Health Sciences, State University of New York, Albany, New York John Murphy, Administrator, Saranac Lake General Hospital, Saranac Lake, New York . ‘ William H. Raymond, M.D., Johnstown, New York . ; Bernard Siegel, Vice President-Business & Finance, Albany Medical College, ‘Albany, New York: “The Rev. John R. Sise, Cooperstown, New York Seth W. Spellman, D.S.W., Dean, James E. Allen, Jr. Collegiate Center, State University of New York, Albany New York che Jerome C. Stewart, Executive Director, St. Clare's Hospital, Schenectady, New York ° Marie N. Tarver, Executive Director, Model Cities Program, Poughkeepsie, David E. Wall, Hospital Director, Veterans Administration Hospital, Albany, New York Harold C. Wiggers, Ph.D., Executive Vice President and Dean, Albany __ Medical College, Albany, New York PROJECTS Director . Title Michael A. Nardolillo South End Community Health Center Nathaniel McNeil Carver Comprehensive Community Health Center: Lawrence N,. Fuchs Training for the Delivery of Home Care Peter Jones Health Career Incentive Program Harold A. Rodgers Migrant Health in Columbia County Ursula Poland — Medical Library and Information Service Bernard H. Rudwick Community Health Education Service Donald C. Walker, M.D. Design and Development of a Comprehensive Emergency Health Care System Bette Hanson Rural Community Health Guides Henry Tulgan, M.D. County-wide Cardiac Monitoring System _ Mary C. Bromirski, R.N. An Expanded Concept of Home Health Care Freyda M, Craw To Have a Voice -~ Post-Laryngectomy Rehabilitation John A. Olivet, M.D. Cooperative Training Program for Allied Health Professionals Donald E, Schein This Week in Health Tee -3- COMMUNITY REPRESENTATIVES Joseph Byrne Joseph E. Harrigan Catherine Harwood Janes Heron Sister Anne Lawlor Dorothy Paul Leo J. Roy Capital Aree HMO Planning Council Upper Hudson Regional Conprehensive Health Planning Organization Schoharie County Community Action Program Council of Community Services Maria College Community Medical Care Program Heart Association of Eastern New York PROGRAM STAFF Frank M. Woolsey, Jr., M.D. Girard J. Craft, M.D. J. Clark Winslow Byron E. Howe, Jr., M.D. William P. Nelson, III, M.D. Ward L. Oliver, M.D. John B. Phillips, M.D. Arnold W. Pohl, M.D. Paul L. Brading, Ph.D. Robert J. Ambrosino, Ph.D. Raymond Forer, Ph.D. Anne M. Anzola Irma Wilhelm, R.P.T. @ally K. Rorabaugh, R.N. Arthur A. DeLuca Jeremiah Blanton Date L. Morgan Roy E. Perry Henry J. Zarzycki William C. Batchelder Robert W. O'Neill Albert P. Fredette Robert B. Marshall Carl Oberle Director Deputy Director Administrative Assistant Associate Coordinator, Northern Division Associate Coordinator, Eastern and ‘Interface Divisions Associate Coordinator, Western Division Associate Coordinator, Southern Division Associate Soordinator, Central Division Evaluation Specialist, Educational Psychologist Evaluation Specialist, Educational’ Psychologist Eveluation Specialist, Sociologist Coordinator, Community Health Education Coordinator of Physical Therapy Acting Coordinator, Nursing Director, Comunity Affairs Commmity Affairs Specialist Community Affairs Specialist Community Affairs Specialist Community Affairs Specialist Director, Information Service Director, Public Relations Coordinator, Instructional Communications Fiscal Specialist ‘Fiscal Specialist oo INTRODUCTION: The Albany Regional Medical Program was site visited in June 1971 and . at that time the site team was concerned over the program's rather. _ narrow and unimaginative thrusts, based largely on a two-way radio " continuing education program. The team was also concerned over the : atructure of the program in terms of minority representation, the . lack of a deputy director and indeed the lack.of any depth in admin~-— istration, a weak RAG, and a dependent relationship on the Medical School. These deficiencies were called to the ARMP's attention when their grant was awarded last year and they immediately began to restructure their program to implement these suggestions. As the current site visit report will indicate, the ARMP sugcessfully . restructured the RAG and involved it in the program's development, - gtrengthened the program staff, attracted the interest of the region's health professionals and, in all, met with considerable success in overcoming most of the deficiencies noted by the site visit team of 1971, The turnabout in the programs direction can be traced to some specific events which highlighted the activities of the past year. ., September 1971 - A meeting between the Director; RMPS, and the ARMP Coordinator, the RAG Chairman and four members of the RAG's Executive Committee. At this meeting, the Director, _ RMPS, provided specific guidance to the key personnel. of the ARMP and outlined what they would need to do to enhance their success as an RMP. . Bo oe -, September 1971.- Mr. Jeremiah Blanton is appointed as the “ARMP's first black professional. program staff member. In his role as a Community Information Coordinator, Mr. Blanton begins to provide an important link between ARMP and the region's black communities. In retrospect, it is possible to see that the ARMP involvement in improving the availability and accessibility of health care in the region's black. commu- nities can be traced to this appointment. " . December 1971 - Mr. Roger Warner, Evaluator, Arkansas. RMP visits the ARMP to advise on matters related to the program's organizational structure, review process, and project development. . January 1972 - Dr. James Bordley assumes the post of RAG Chairman following the resignation of Dr. Harold Wiggers, Dean, Albany ’ Medical College. This was the program's first change in RAG Chairmen since it began operation in 1966. Dr. Girard Craft is officially appointed as Deputy Coordinator to Dr. Woolsey. a INTRODUCTION (CONTD) Dr. Bordley, former Chairman of the RAG Executive Committee, and Dr. Craft, former program staff member, as a result of . their past experiences, brought outstanding competence to their new positions. At this juncture, the ARMP had gained strength - dn two vital areas and the major ingredients for radical change had been added. . January 1972 - The RAG, at Dr. Bordley's urging, votes to meet nine times per year instead of four times per year. . January 1972 - The entire RAG membership, now expanded from 27-37 wembers, is broken into four "goal oriented" task forces to more closely involve each member in the review process and program development. . ° . . February - June 1972 - The RAG Task Forces meet two to three times per month; the RAG Executive Committee meets twice monthly, and the full RAG meets monthly. The product of these meetings “is as follows: me . 52 project proposals reviewed and ranked relative to ARMP's goals, objectives and priorities . 47 project proposals approved with varying degrees of priority . 23 projects voted for inclusion in the June 1972 ‘appli~ cation for triennial support o During this period of furious activity, Dr. Craft coordinated, * channeled, and guided the program staff energies while, at the game time, Dr. Bordley motivated the RAG, its Executive Committee, and ite Task Forces to successfully meet the tremendous work load. . being forced upon it by the need to review the projects being developed. by the ARMP program staff, , . April il, 1972 - Roger Warner, at the request of the ARMP, visits the region to review and comment on the progress made since his December consultative visit. His report reflects that he per- ceived significant progress. -6- INTRODUCTION (CONTD) . April 30, 1972 - All ARMP support for the Two-Way Radio and ‘Goronary Care Unit terminates. At this ‘past pro ject efforts ends and the ARMP “which involved only projects which had. the previous year's site visit. December 1971 - July 1972 - Throughout staff worked in a dedicated fashion to assist the the ARMP 52 project applicants to refine their 0 sound pr The following ' changes reulti some residual be resolved. oject proposals. site visit report will document ng from the above events and wi deficiencies and some of the pr point,.all vestiges of entered into a new era " been developed since this extended period, riginal concepts into the impact of the 11 attempt to point out oblems that remain to -T- RMP: ALBANY PREPARED BY: A. Burton Kline DATE: 10/72 L. Goals, Objectives and Priorities (8) At the time of the June 1971 site visit ARMP was found to have two long-range program goals and seven short-range objectives as follows: Goals l. To promote and influence regional cooperative arrangements for health services in a manner which will permit the best in modern health care to be available to all. 2... To assure the quality, quantity , and effectiveness of professional and allied health manpower. Objectives — 1. To explore and encourage innovative methods of health care delivery with particular attention to improving delivery in medically deprived urban end rural communities. 2, o mobilize consumer-provider participation in the identi- fication and solution of local and regional health problems. 3. ®o recruit health manpower and improve its distribution and utilization. h. ‘To introduce methods to relieve overburdened health profes- sionals. : 5. To engage in the education and training of health personnel with particuler attention to continuing education and to | the training of personnel to fill recognized gaps in critical areas. - , 1 . 6. To promote public education in health matters. 7. ‘To further the process of regional cooperative arrangements. At that time the site visit team felt that the ARMP needed "a set of operating objectives which are quantifiable and measurable, time- dependent, and ranked in priority order." This recommendation wes conveyed to the Coordinator via the RMP8 Advice Letter. -8- RMP: ALBANY ‘PREPARED BY: A. BURTON KLINE DATE: 10/72 At the time of the August 1972 site visit the following goals and objectives for ARMP were presented: . GOAL Ii To improve the delivery of health care. OBJECTIVE A: To improve the accessibility of comprehensive health care with particular attention to medically deprived urban and rural commmities. OBJECTIVE B: To design and implement innovative methods of health care delivery through the utilization of personnel ". in new roles. , | OBJECTIVE C: fo improve emergency health services. OBJECTIVE D: fo increase public awareness in health matters. GOAL II: To monitor and improve the quality of health care. . ‘ ! OBJECTIVE A: fo plan, promote and conduct educational and training programs for members of the health team. OBJECTIVE B: To design and develop mechanisms for evaluating the quality of health care delivered. GOAL IIT: fo help solve the health manpower problem. OBJECTIVE A: fo recruit health manpower . OBJECTIVE B: To increase the efficiency of health manpower. OBJECTIVE C: To improve the distribution and utilization - of health manpower. — o | GOAL IV: To further the process of regional cooperative a arvangements. OBJECTIVE A: To mobilize consumer and provider participation in the identification and solution of local and regional health problems. -9- RMP: ALBANY PREPARED BY: A. BURTON KLINE DATE: 10/72 The goals and long-range objectives were prioritized as follows: Very High Priority High Priority Average Priority I-A TII - B ' YI «A Tir - ¢ I -¢ | TTT -A I -B IT -D Iv -A II -B Projected activities and already funded projects were listed under each of the goals and objectives to which they pertained and the © @istribution was as follows: me Very High Priority Objectives: 7 projects 46% of project funds High Priority Objectives: 10 projects 35% of project funds Average Priority Objectives: 6 projects 19% of project funds In summary, the goals and obgectives have been restated and prioritized gince the 1971 site visit and the progress has been significant. As the program matures, there should be a continued effort to further refine these goals and objectives in terms which can be more easily quantified and measured and more specifically related to the identi- fied health needs of the Albany region. The current goals and objectives were developed by the ARMP program staff and approved and prioritized by the BAG. They have been published throughout the region via their newsletter, the Albany Regional Medical Program Report. ans we = ea eo a oe oe @ Se Recommended Action Bee pages 27-30. -10- 2. | Medical College. The program staff is proud to have been able to RMP: ALBANY PREPARED BY: A. BURTON KLINE DATE: 10/72. Accomplishments and _ Implementation (15) The change in the goals and objectives of the RAG has been reflected in the change in activities and emphasis of the program staff. The program staff now has more direction and enthusiasm to operate within that direction. The result has been the stimulation of 52 new pro- posals and the development of new and fruitful relationships between ARMP and several community organizetions which had not previously “peen a part of the ARMP process. A significant accomplishment of ARMP has been the phasing out of old projects and the development of new funding support for the continu-. . ation of successful programs. The Cancer Coordinator Project for Schenectady is now supported by Ellis Hospital. The Coronary .Care ain Program has made 4 great contribution to the manpower pool of the region and continues at 6 reduced level under the auspices of the Heart Associat#on and 4 consortium of community hospitals with some ARMP. program staff support as faculty. The Two-Way Redio Project, ARMP's oldest. project and most successful in terms of regional impact and acceptability, 18 being continued as & program of the Albany phase out of successful projects and direct its energies into new activities. Provider groups have long looked to the ARMP for. technical and professional assistance, now as the program staff broadens its spectrum of activities in conjunction with its new directions, COn« sumer groups are also becoming acquainted with the ARMP and are seeking assistance ‘in the development of new programe. Recommended Action See. pages 27-30. -ll- RMP: ALBANY PREPARED BY: A. BURTON KLINE ATE: 10/72 a Continued Support (10) At the time of the June 1971 site visit it was recommended that “mechanisms for the phase out of RMP support should be developed for the Two-Way Radio and Coronary Care Training activities with the understanding that: 1. RMP funds for the Two-Way Radio will not be forthcoming for longer than 18 months. ARMP financial input for this operation mist cease by Merch 1973; 2. No more than one year's terminal support for coronary care unit training can be borne by RMP. Other sources of support must be found by September 1972." These recommendations were made in the Advice Letter of August 1971, with the exception that the Two-Way Radio operation was to cease by September 1972, rather than March 1973. Both of these projects were phased out in an orderly fashion and each is now sustained, in whole or in part, with funde provided by sources other than RMPS. This was accomplished by April 30, 1972, well in advance of the deadline given in the Advice Letter. fhe region's proposal review criterla contain items which refer to the need for continued support after RMP funding. In addition, each proposal addresses this point. The ARMP policy is to reduce or terminate funding to any project which cannot produce adequate assurance of continued support by the end of the first year of ARMP . funding. Recommended Action Bee pages 27-30. -~]2- ied RMP; _ ALBANY PREPARED BY: A. BURTON KLINE DATE: 10/72 Minority Interests (7) Objective I-A, "To improve the accessibility of comprehensive nea lth eare with particular attention to medically deprived urban and rural communities", has four top priority projects. Three of these address themselves to the health problems of minority groups and minority communities. The fact that these projects grow out of the new relationships with minority communities 4g reflected by some of the uneasy alliances which exist between the providers and consumers who are involved in some of the projects. Until the minority community , i.e., those 4nvolved in the direction of projects and those who are the recipients of the benefits of these activities, have worked with the ARMP for some period of time they will retain some degree of skepticism with respect to the ARMP's sincerity in its efforts to help them. The - ARMP will need to work closely and faithfully with these groups to win ’ their confidence. They should bear this in mind in all their future:efforts with projects involving minority members who have become conditioned to being suspicious because they have been the victims of insincere efforts in the past. The program staff bas only one black professional and one black secretary. Staff needs more black professionals as well as support staff. The Coordinator seems most anxious to get more minority representation on staff, but needs assistance in this regerd. Since the top priority projects of ARMP address themselves to minority. interests, considerable effort should be made to increase minority representation on the RAG. The site visit team acknowledges and leuds the efforts made to date to improve minority representation on the RAG; however, it is 4mportant that the trend be continued beyond its present status. The Coordinator must seek innovative approaches to minority professional involvement in the RMP process. He my need to seek outside consultation in this regard; however, he may find it possible to use some of the good people he has already involved. Minorities need to be involved, particularly on his Executive Committee, and in working on project development. The program staff could be instrumental in assisting other providers in the region to improve their services to and their relationships with minority groups. Recommended Action ' See pages 27-30. -13- RMP: ALBANY PREPARED BY: A. BURTON KLINE TATE: 10/72 5. Coordinator (10) Although Dr. Woolsey, the Coordinator, is not what one would consider to be an outstanding Administrator, he has built a capable organization and hss proven his leadership capabilities by re-orienting the program from the categorical projects previously developed and displayed last year to a totally new program thrust designed to strengthen the health care delivery system. The program staff is committed to this re-orien- tation, appear to be solidly behind the program and the administration and appear to be functioning as a cohesive unit, even though the , organization lacks clear cut job descriptions and well defined lines of authority and responsibility. Dr. Woolsey's success in this regard has, in part, resulted from the efforts of Deputy Director, Dr. Girard Craft, who was appointed by the RAG last January. Dr. Craft has a great deal of organizational experience and has provided a focal point for staff direction and cohesion. Dr. Woolsey has also been greatly aided in his attempt to restructure the program by his close working relationship with the RAG and the leadership which has been displayed by Dr. James Bordley, the RAG Chairman, as weil as the Executive Committee. . @ «see Recommended Action See pages 27-30. 6. Program Staff (3) Although some program staff changes have taken place during the past year, much remains to be done. The staff is currently overweighted with physician talent and lacks skills in other areas such as finan- cial management and general program administration. Similarly, the lack of well defined job descriptions and work assignments still allow the perpetration of what appears to He at least some duplication of effort, especially between the community affairs steff and the area health coordinators. ‘The program staff provides a good basic full- time resource with diversified talents and the site visit team felt that Dr. Craft had mde substantial progress in developing the staff into a cohesive production unit. The team also felt that Dr. Craft's - 1h. RMP: ALBANY PREPARED BY: A. BURTON KLINE DATE: 10/72. oh 6. Program Starr (Contd) - plans for future program staff reorgenization were sound and that. he will continue to strengthen the organization as he implements these plans. | aw www eee ree Recommended Action See pages 27-30. 7. Regional Advisory Group (5) The RAG has been greatly expanded within the last year and is now far more representative of the region. Membership from the Albany Medical College has been reduced to a reasonable percentage, and program staff members no longer serve on the RAG. ‘The RAG has met with more than usual frequency (monthly) over the past nine months with an excellent ‘level of participation and dedication during a period of great change -and redirection of the program. The attendance and attention my - decline now that the pueh is over. , . The RAG has played an effective role in establishing objectives and priorities and its Executive Committee has, airing this period, _exampled true leadership. It has met twice a month, and, in addition, its Chairman spends one day & week in the ARMP office. Te RAG bylaws call for adequate representation of the interests, institutions and groups in the region. Recommended Action. See pages 2T7- 30. -15- RMP: ALBANY PREPARED BY: A. BURTON KLINE ATE: 10/72 8. Grantee Organization (2) Albany Medical College, the Grantee Organization, provides adequate and effective fiscal administrative support. Alli of the program staff of ARMP are employees of the Albany Medical College and participate in its fringe benefits including insurance and retire- ment programs. The physicians on the ARMP staff hold faculty appointments and are expected to give some teaching time to Albany Medical College. The grantee appears to have given the ARMP full freedom on programmatic action without restraint or veto. Albany Medical College has a mandatory retirement age of 65, but we were told that this would not apply to employees of ARMP; although at 65, those with faculty status would lose it unless an — exception (1 year) was granted or emeritus status voted. Recommended Action @ See pages 27-30. 9. Participation (3) Participation of professional and voluntary health agencies in ARMP is judged to be quite satisfactory. Among the agencies and groups involved in the program are: (1) the Medical Society of the State of New York, whose two District Branches III and IV within the region are represented on the RAG; (2) Hospitals, while the New York State Hospital Association is not represented officially there are three hospital administrators on the RAG together with a VA hospital administrator who serves in an ex-officio role. Nursing homes are also represented; (3) Official Health Agencies both State and local are represented in the membership of the RAG; (4) Educational representation including the State University system is included on > the RAG; (5 . Nursing and Allied Health are also well represented on the RAG; (6) The Model Cities Program, Catholic Charities, the Albany Council of Community Services also participate in ARMP; (7) Voluntary =16- RMP: ALBANY PREPARED BY: A. BURTON KLINE DATE: 10/72 9. Participation (Contd) Health Agencies: The New York State Heart Association is represented on the RAG and the TB and RD Association 4s well as other voluntary health agencies are included in the membership of ARMP's consultant groups. Recommended Action See pages 27-30. 10, Local Planning (3) For reasons, which are described as "political" in a broad sense, there are no CHP "b" agencies within the area encompassed by the ARMP. The State CHP “a” agency is, however, represented on the RAG by its Associate Director who also serves 8s a member of the RAG's Executive Committee. ARMP mainteins working relationships with several councils of social agencies within its area and with the State and local health departments. These groups have enhanced local health planning input because of the absence of CHP "b" agencies in the area. In view of the circumstances, ARMP's partic- ipation in local planning activities is considered to pe satisfactory... Recommended Action See pages 27-30. -17- RMP: ALBANY PREPARED BY: A. BURTON KLINE DATE: 10/72 ll. Assessment of Resources and Needs (3) The ARMP has hed a history of compiling an excellent data base upon which to plan and implement its program. Ironically, as of 1971, this data base was extensive; however, the program had not developed in such & way that it could meet the needs the data brought to light. In 1972 when a program developed to meet the needs which had been previously identified by the data base, it was learned that the pro- gram was no longer mintaining the data base as current as it had been done in the past. However, it was indicated that it had been maintained at a level sufficient to guide the program in its emphasis and priority establishment. Unlike the situation a year ago, this excellent source of data is being used by the ARMP for project development and is being shared with other agencies in the region. Generally, the ARMP programmatic efforts are consonant with the identified needs of the region and the current development is being guided by a talented and representative RAG which, as e body, has a firm hand on the health pulse of the region. ee ee ee ~_— teem ete Recommended Action See pages 27-30. _ 12. Management (3) The Coordinator directs the program staff in a style which might be described as somewhat “over participative management”. His essential pelief is that one who expresses an interest and desire to do a specific task is more likely to be syccessful at that task than one- who receives it as an arbitrary assignment. This approach, in part, accounts for the extremely high morale exhibited throughout the program staff. However, a valid question would be to ask what happens to @ specific task which needs to be done to further the program's stated goals and objectives when there is no program staff member who expresses & willingness to undertake the task. There was evidence that the question is academic, since the staff has a great loyalty to the Coordinator, is made up of long-term professionals, has high morale, and appears dedicated to the enhancement of the ARMP program. The scope of the efforts put forth by the program staff in the past -18- | ot RMP: ALBANY PREPARED BY: A. BURTON KLINE DATE: 10/72 12. Menagement (Contd) year are testimony to the fact that, in this instance at least, the Coordinator's style appears to work well for him. . - Since the ARMP, now embarking on the. fiscal management and surveil- lance of projects scattered throughout the region, needs to nodify its program staff competencies in a manner consistent with the programmatic change which has recently taken place. The ARMP needs to supplement its current staff competencies with people having skills in fiscal administration and.in "in house" personnel management. For a program which has grown 4s large and complex as the ARMP, there is a need for more formlized direction of program staff efforts and an increased utilization of project data and surveillence infor- mation for making enlightened decisions with respect to reducing support, terminating support, and rebudgeting of funds to support new initiatives which may be required to accelerate the accomplishment of program's stated goals. The need for these competencies has been - ddentified by the key ARMP people and they are currently taking steps to enhance the staff's competency in these areas. Recommended Action See peges 27-30. ; oN 13. Evaluation (3) There is a Regional Program Staff Planning and Evaluation Section consisting of three part-time evaluation specialists, one of whom is the Chairman of the Section. It is difficult to discern how the results of evaluation have been used in the region's decisionmking process. While the recommendations and suggestions of the Planning and Evaluation Section are built into the ARMP's proposal review procedures, it appears that their recommendations and suggestions do not have es much impact on the final decision as they should. The ARMP should consider placing more emphasis on the skills these people bring to the program and utilize their talents in program planning. Furthermore, the RAG and Coordinator should make use of the efforts — -19- “RMP: ALBANY PREPARED BY: A. BURTON KLINE ATE: 10/72 13. Evaluation (Contd) of the Planning and Evaluation Section in their determinations “regarding the extent to which ARMP funded activities contribute: 7 to the attainment of the region's goals and cbjectives.'" 6." ": Recommended Action whee va bral ‘See pages 27-30. | a “ = Yh. Action Plan (5) As previously indicated, the region nas stated its goals and objectives, : . and prioritized them, and they are congruent with RMPS directions: Both proposed and actually funded operational projects, planning and feasibility studies, and central regional service activities have been related to the region's goals and objectives. Although the ARMP appears to be on course at the moment, it is suggested that they could enhance the probability of staying on course as their program develops if they were to carefully assess and document the “region's current and projected needs and, from this, develop a short- range plan to serve as @ guide to enlightened decisionmking. Each “project, as it passes through the local review process,.could be assessed from a technical standpoint, but could also be assessed in light of how it fits into the overall plen the ARMP hes developed to insure that it continues to address the region's real problems. The hazard eesociated with such a plan is that it may become outdated and, as such, ineffective. If such ea plan were designed, provisions should be made to insure that it remains current. This appears tobe. a task . which lies within the competencies of the ARMP program staff and its RAG and should be seriously considered since it will tend*to insure meximum involvement of many of these people in the pursuit cf an even more effective program surveillance. The preliminary plan. developed for the conduct of monitoring and of the project activities appears to be a sound beginning for an effective and systematic assessment of ~20- ana e ew ee eo oo oe © RMP: ALBANY PREPARED BY: A. BURTON KLINE DATE: 10/72 . 1h. Action Plan (Contd) progress. The ARMP should be complimented for its awareness of the problem and for taking the initial steps which will insure a good orientation for project directors. ~ Recommended Action See peges 27-30. “15. Dissemination of Knowledge (2) he ARMP has always been heavily involved in the dissemination of new knowledge and technical material for providers through its Two- Way Project. It also seems to have 4 good communications relation- ship with other educational institutions in the region. Pope One of its top new projects, being sponsored by New York State. Education Department, will disseminate new. knowledge about health: occupations to secondary school educators and counselors. The public information officer on the program staff reports high "pickup" of news releases to local media. With new emphasis on new ‘target groups, considerable time and effort should be given to . developing ways of disseminating information to these groups. There ., is a need to be able to identify the community health education component in all proposals. With community understanding and appropriate utilization of new resources generated by the new projects, better health care should result for people who previously had been neglected and deprived. Consideration should be given to widening the distribution of the fine ARMP Newsletter. Te ARMP should be applauded for having 4 Health Educator on its -21- RMP: ALBANY PREPARED BY: A. BURTON KLINE PATE: 10/72 15. Dissemination of Knowledge (Conta) staff. These special skills and talents should be utilized in program staff development activities as well as commnity activities. — eT ee eee emma Recommended Action See pages 27-30. 16. Utilization of Manpower and Facilities (4) Several of the high priority projects encourage the better utilization of existing resources. The South End Community Health Center Project will develop a satellite type ambulatory care center and more fully utilize the resources of St. Peters Hospital. This kind of resource © sharing should be encouraged. Several projects and activities of the program staff are directed at training and utilization of allied health manpower. These projects should have closer monitoring and evaluation to insure effectiveness of training and proper utilization after training. Recommended Action See pages 27-30. -22~ RMP; ALBANY PREPARED BY: A. BURTON KLINE DATE: 10/72 L7. Improvement of Care (4) fhe program currently being conducted by the ARMP places heavy emphasis on the improved access to health care for people who are underserved. The low income groups in the inner city areas of Albany and Schenectedy have had the availability of health care enhanced by the establishment of community health centers in the area. These centers have been _made. possible by the coordination and mobilization of existing resources in the community. The ARMP did the coordinating and provided partial - support to the conduct of these activities. These activities, 4s satellites of established hospitals, will tend to strengthen the relationships between primary care and specialty care. In the rural area of Chateaugay (Franklin County) the ARMP program - gtaff provided the needed professionsl competence to secure a physical plant, state licenses, etc., so that the National Health Service Corps | was able to place two physicians, & dentist, and a dental hygienist into a remote community which, up until this time, had not had access to health care services. - In a joint project with the OEO, the ARMP helped develop the curriculum, underwrote 50% of the costs ($10,000) for the training of Primary Care Nurses. After their training has been completed, the ARMP will assume the role of proper placement of these highly trained nurses, i.e., they will attempt to locate the communities which have the most critical need for the nurses and which express & willingness to accept then in thie rather new role. In all, the recently {implemented projects, the projected activities, the program staff services, and the program staff feasibility studies reflect a recognition of the need to improve the quality and quantity of health care throughout the region. The recognition of the need appears to be accompanied by the development and implementation of _efforte which will help meet the needs in the Albany region. Recommended Action See pages 27-30. -23- RMP: ALBANY _ PREPARED BY: A. BURTON KLINE TATE: 10/72 18. Short-Term Payoff (3) It is apparent that many of the activities currently in progress or projected will bring immediate relief of those who currently require health services. There are plans to enhance the effectiveness of the monitoring and surveillance of projects to feedback the infor- mation required to gauge prospective payoffs from each of the activities. This procedure is in its infancy at present; however, 4s the ARMP becomes more sophisticated it is reasonable to expect that the system will improve since there appears to be 4 great sensitivity among the key people in the program to the need for such monitoring. «aw wm ww wm wm mw mmm mmm mw mm mm eee Recommended Action See pages 27-30. 19, Regionalization (1) © One of the primary concerns voiced by the site visit team of 1971 was the region's failure to regionalize its activities. Interestingly enough, one of the primary concerns of the site team of 1972 is that the program's activities are so geographically spread out that there is a need to consolidate some related activities under a multi-project umbrella to simplify their administration and fiscal control. The ARMP, if anything, over reacted to the need to regionalize and must now look toward the orderly assembling of projects by logical grouping to insure that it is possible to relate the program's goals and ‘ objectives to the efforts underway, and those which can be expected to be introduced into the system nov that there 1s widespread interest in the ARMP throughout the region. The ARMP, now that it had decen- tralized its base of operations from Albany to points scattered throughout the region, must begin to pay closer attention to improving linkages and to 8 more coordinated approach to the provision of health care on a regionwide basis. This problem is perceived by the key people in the program and as the program settles into 4 more routine course of doing business it is reasonable to assume that the "shot-gun" region- alization will give way to a more tightly knit program conducted on 4 regionwide base. — ee wet - Recommended Action See pages 27-30. ~2h. RMP: ALBANY "PREPARED BY: A. BURTON KLINE” DATE: 10/72 20. OTHER FUNDING (3) The’ current group of projects reflects an excellent input from funding sources other than RMPS. Approximately 30% of the total request for project support (or $800,000) has been acquired from ether community agencies or charities. This can be attributed to a sensitivity to the need for this type of outside support and to the administrative skills of the Deputy Coordinator in negotiations which involve the input of dollars from sources other than the ARMP. Recommended Action , See pages 27-30. ~25- RMP: ALBANY PREPARED BY: A. BURTON KLINE DATE: 10/72 SUMMARY The ARMP has made substantial progress since last year's site visit. The RAG has been expanded and restructured in a manner that will insure greater community and less university participation in the program's activities and provisions have been made to include more minority groups. The RAG Chairman is devoting considerable time and energy to the program and has been instrumental in creating excitement and enthusiasm over the program among the entire RAG membership. It ig clear that RAG now establishes priorities for the projects and assumes responsibility for the program's activities. In addition to these changes at the policy making level, substantial changes have taken place at the organizational level. Dr. Craft, a physician with considerable experience in medical group practices, has been appointed Deputy Director of the program and under his leadership, the program staff is being restructured and reformulated into a strong operating group. As a result of the above changes, the program has been completely reoriented from what could at best be described as unimaginative to a new array of “interesting” projects. It is evident, however, that these projects have been hastily conceived and do not as yet fit together nto a coordinated effort. Similarly, the program staff, although strengthened since last year's visit, still remains somewhat lacking in their ability to moritor, evaluate, and, in general, manage these projects. It was also noted that some of the proposed projects must be excluded from the program due to RMPS' policies. , The site team, therefore, recommends that project numbers 23, 31, and 43 be excluded from consideration and that the budget be accordingly reduced. Furthermore, in order to force the organization to rethink and restructure the remaining proposed projects, we recommend that the project budget be reduced from the requested $1,653,329 to $950,000 for the first year, $1,045,000 for the second year, and then $1,249,500 for the final year. Under this funding scheme, the RAG will have to again review the projects and reformulate them to a program scheme. In terms of the program staff budget, we recommend that the program be funded at the present levels with a 5% increase per year for the second and third year and a $20,000 one position increase in the second year to be carried also through the third year. This will allow some program expansion but will encourage a reallocation of the present budget and a reorganization of} the present staff. -26- RMP: ALBANY _ PREPARED BY: A. BURTON KLINE DATE: 10/72 The site team recommends.that, as part of their. total funds, the * ARMP has a developmental component identified for three years in the reduced amounts as follows: Ol . . + 02 03 $30,000 - . $45,000 $60,000 ~ We also recommend that the university be requested to furnish space for the program in return for the 52% overhead that is being charged, and that the space rental funds requested in this application therefore be removed from the budget. The site team further recommends that the above budgets be accompanied by the following advice and recommendations to the program. : . = : ~27- RMP: ALBANY | PREPARED BY: A.» BURTON KLINE DATE: 10/72 RECOMMENDATIONS The site visit team recommends that the ARMP be funded for three years in the reduced amounts as follows: 01 operational year $1,618,000 02 operational year $1,783,090 03 operational year $1,940,725 Specifically, the site visit team makes the following recommendations and suggestions. , 1. Project #23 is a health careers recruitment activity and is not permitted under RMPS policy. On page 38 of a booklet entitled A Special Report to the National Advisory Council--Regional Medical Programs Service (dated May 11-12, 1971) it states "RMP grant funds are not to be used for direct operational health careers recruitment projects." It is recommended that this activity be phased out of ARMP support during the next 12 months. The program development appeared to be hastily conceived and, as a result, there emerged a general feeling among the site visit team members that the program now faces a need to consolidate their project activities, to integrate those activities which, on a. region- wide basis are interrelated, and to, insofar as possible, reduce the fragmentation of efforts resultant when activities/projects are conducted in a somewhat autonomous fashion. Project #24, Design and Development of a Comprehensive Emergency Health Care System, appears to need additional developmental work. It 1s suggested that, prior to initiating this projéct, the advice of competent people with specific expertise in the area of emergency medical care be obtained. Project #31, Orientation of Non-Practicing Physicians to Clinical Practice, was viewed as too global in nature and not sufficiently directed at the priority health needs of the. Albany region. Project #43 was considered too expensive from a cost/ benefit standpoint and possibly duplicative of similar work done by other RMP programs. It is strongly recommended that ARMP explore what is available before venturing forth too far in the production of visual materials. The ARMP is becoming extensively involved in the management of grants to support the conduct of many projects. This is a relatively new function for the program and will require increased program staff - -28. RMP; ALBANY PREPARED BY: A. BURTON KLINE DATE: 10/72 5. competence in the financial management discipline. The significant size and the increasing complexity of the tasks to be performed by the program staff brings about a need for additional expertise in organizational structuring and personnel management. It is recom- mended that future recruitment activities place high priority on securing staff members who will increase the fiscal, administrative, and personnel management competencies of the existing staff. Ne The Albany Medical College (AMC) expects that ARMP program staff members holding faculty appointments will spend 10% (approximately four hours/week) of their time teaching for the college. It is recommended that this mutual understanding be documented in the form of a written agreement between the AMC and the ARMP, Most of the site visitors viewed this arrangement to be mutually beneficial; however, there was a feeling that a written agreement should be prepared to serve as a safeguard to protect the interests of both parties. This agreement should clarify any misunderstanding which could develop in the event there are changes in the administrative hierarchy of either the college or the program. The ARMP faces a need to update and revise the current RAG bylaws. At present they are silent on the RAG's role in hiring/firing/ appointing the ‘ARMP Coordinator and they empower the grantee to appoint RAG members. It is recommended that the bylaws be updated to reflect the recent RMPS policy statement which defines the roles of the grantee, the RAG, and the program staff. This statement was sent to all Coordinators on June 13, 1972, as part of highlights ‘of the June National Advisory Council meeting. It is recommended that a document which defines the relationship between the AMC and the ARMP be prepared to guarantee a clear under- standing: on the part of both parties with respect to their roles in the conduct of the ARMP. This document will be a safeguard. against misunderstandings of this relationship which could potenti- ally arise and also will provide guidance for the actions of new people which come into the system when there are administrative changes in the hierarchy of either party. The site visitors, as a group, perceived a need for the ARMP to more specifically identify its operational objectives, to delineate the tasks necessary to achieve these objectives, and to assign the conduct of these tasks to particular job classifications. Specif- ically, it is recommended that the program staff be tailored to the -29- : RMP: ALBANY PREPARED BY: A. BURTON KLINE ATE: 10/72 needs of the program rather than gearing the program, to the com- petencies and interests of the existent program staff. . 9, The site visit team noted that the ARMP Coordinator and four other staff members were quartered in the AMC while the remainder of the program staff had their offices in a nearby off-campus building. This arrangement was questioned from an administrative standpoint in light of the difficulties it imposes on the Coordinator and the program staff in terms of communication, management, supervision, etc. It is recommended that the program attempt to find a means to consolidate its offices in one location. 10. The site visit team expressed concern over the high overhead rate being charged by the AMC, Since the program staff expressed a belief that the college was providing services which could not be purchased at a lesser cost, it is recommended that a cost analysis, study be conducted to document these statements. The RAG Task Force which recently studied the current relationships between the AMC and the ARMP concluded that the current arrangement was, "at this time" the best arrangement for the program. However, this report made no apparent reference to a cost/benefit analysis and this leaves the conclusion open to question in this particular aspect. 11. There was an expression of concern over the future development of the program from the standpoint of monitoring, surveillance and evaluation of interrelated activities. It is recommended that the RAG designate a subcommittee of its members to maintain close watch on the course followed by the program during its upcoming imple- mentation period, The subcommittee should be responsible for the evaluation of the impact of all funded activities (i.e. Program Staff, Planning and Feasibility Studies, Central Regional Service Activities, Operational and Developmental Component projects) on the regional goals and objectives. The subcommittee should work closely with the Planning and Evaluation section. The need to pro- vide a mechanism for continuous programmatic evaluation is viewed as a matter of high priority since the program is in the early stages of its development and attention to these important matters at this time could prevent difficulties in the future. 12. The site visit team recommends that the rental money from the ARMP program staff budget be removed and that the AMC be informed that they are expected to provide quarters for the ARMP staff in light of the overhead monies they are currently receiving from the program. -30- RMP: ALBANY: PREPARED BY: A» BURTON KLINE DATE: 10/72 The report of this site visit team would not be complete unless it . _ was clearly pointed out that the ARMP, complied in fact and in . spirit, with the recommendations forwarded in the Advice Letter . following the 1971 site visit. Further, it should be noted that ’ although the ARMP still has problems to resolve, that it has, in fact, been successful at bringing about a dramatic turnabout in the program's direction and thrust. While a year ago it was operating on the inside, looking out at the region's health pro- blems; this year it is operating throughout the region and is looking at its own inside administrative problems which have been brought about as a‘result of the many health activities that have been initiated throughout the region. This type of change is a healthy one. Review Cycle: October 1972 [- RMPS STAFF BRIEFING DOCUMENT 107 ped REGION: Albany RMP oS _ OPERATIONS BRANCH: Eastern NUMBER: 00004 : “Chief: Frank Nash COORDINATOR: Frank M. Woolsey, Jr, M.D. Staff for RMP: Burt Kline LAST RATING: ‘TYPE OF APPLICATION: 7 3rd Year Regional Office Representative: fyl/ Triennial /- / Triennial Robert Shaw . 2nd Year Management Survey (Date): /__/ Triennial /_ / Other _ . . Conducted: 1970 y~_ or Ss Scheduled: ‘ Last Site Visit: June 2-3, 1971 (List Dates, Chairman, Other Committee/Council Members, Consultants) Chairman - John E. Kralewski, Ph.D. (NRC) Consultants - Joseph G. Gordon, Vice Chairman, North Carolina RMP RAGY os Edward D. Coppola, M.D., James P. Harkness, Ph.D., Deputy Coordinator, New Jersey RMP, Roger Warner, Director of Planning & Evaluation, _Arkansas RMP. Staff Visits in Last 12 Months: * (List Date and Purpose) \ mo Oct. 1971 To provide staff assistance to the region in its efforts to Nov. 1971 \ develop clearer goals and objectives which would ultimately Dec. 1971 lead to a more viable program which could acquire triennial April 1972 \status. an ' 4 Recent events occurring in geographic area of Region that are affecting RMP program: the region currently does not have any CHP (b) agenties and there | are movements at this time to get them established in one or two areas. The ARMP is assisting in their dévelopment with the thought that, in so doing, they will have good working relationships with the emerging complementary agencies, The National Health Service Corps recently designated the town of Chateaugay in the Northwest corner of Franklin County (one of the ARMP's Interface Division's * counties) as a location for the placement of three health professionals. The , ARMP staff provided the required expertise and staff time required to, secure the operational headquarters for these workers, the licenses and certificates grequired by New York State law,etc., to permit this placement to take place effectively. This early placement is the Albany region brought forth good working relationships between the ARMP and the NHSC representative in the Region II office and, indirectly, enhanced the, program's working relationship with a number of Region II's regional office staff. ; ae CENTRAI. DIV. SOUTHERN DIV, ALB.-VT. INTERFACE DIV. - TY. Albany TBpitchess— -—Ss«O ESC . 17. Utster 7. Clinton NORTHERN OIV. 18. Sullivan 8. Franklin. | 2: Rensselacr 19. Delaware 23, Bennington 3. Saratoya 20. Greene | 24. Windhain » ALB.-VT. 4, Washington 21. Columbia INTERFACE DIV. 5. Warren | WESTERN DIV. EASTERN DIV. 9, Scnenectady 5%, Berkshire 10. Montgomery L1. Schoharie 12, Otseyo 13, Herkimer 14. Hamilton 15. Fuiton Vermont NORTHERN DIV, AL8.-VT. TTT <—TNT CRFACE DIV WESTERN DIV. ) Massachusetts CENTRAL DIV: EASTERN DIV. ~, fw ome” DIVISIONS AND COUNTIES tN ms ALBANY REGIONAL MEDICAL PROGRAM SOUTHERN Div. «3 Region: Alban Review Cycle: 10/72° Demographic Information Population of the Region: 1,993,261 Population densityiis 101“per :square:mile. Population of Albany County: 285 ,618 Population of Albany: 114,873 Rural population: 46.7% of total Urban population: 53.3% of total Minority Facts % of entire region's population: 4.3% (85,710) % in Albany County: 5.4% (15,423) % in Albany: 12.5% (14,359) SN ———————_— — Component Current Annualized COMPONENT AND FINANCIAL SUMMARY TRIENNIAL APPLICATION ” We ett . aa tt bb 10/72 Review Cycle: Request for Triennial 0/72 te eee = er ae Comnittee Recommencation for Council-Approves x vel ee OGRAM STAFF NTRACTS SVELOPMENTAL COMPONENT SERATIONAL PROJECTS Kidney EMS hs/ea Pediatric Pulmonary other TOTAL DIRECT COSTS COUNCIL RECOMMENDED LEVEL Includes $397, kkInc ludes $829,2 N.B. The growth pro be in the program 8 reliably forecasted. otf= 37 project ed growth in pre jected is pL taff and pro ject are’ ject category between the lst aced in the * The division cannot be and 3rd years. project category, but will Level 05: Year Ist year 2nd year 3rd year. Ist year 2nd year ; ord year $ 774,592 5 768,230 |$ 787,563) § 811,626 -- . | | -0- 90,000 90,000 90,000 I ; a . 75,314 1,568,691 et 2,158, 691* | . 4 ( - ) — -~ : ( - ) -- -- ‘ ( - ) -- -- ‘ { ( - ) - -- ie 50,094 ( - } -— -- : - i _ i $ 900,000 $2 426,921 52,646,254 $3,060, 317 ooeee $ 900,000 | 603 projected growth in project category between the ist and 2nd years. ' wv s | AUGLET 251972 3 REGICARAL MEDICAL PROGRAMS SERVICE \e “FUNDING HISTCeY LIST RMP S=OSH= JTOFHT “AS 8” REGION C4 ALBAKY AMF SUPP YR 05. CPFRATIONAL, GRANT (DIRECT COSTS: ONLY) ALL RECUEST ANC AWARGS AS CF JUNE 305 197 ‘ ? AWARDED AbARDED AWARCEC AWARDED AWAARTET AWARCEC * REQUESTED REQUESTED REGUESTED REQUEST#O a COMFCKEAT or 2 ¢3 te o¢ oo 06” oT 08 5 NO TITLE wos7i = TOTAL * C1/73- C1/74 = cl/15 = TOTAL 10 rms ee eee “— 12/72 ” * Y2/7s— T2774 Y27 75 8: * 32 —TOCT PROGRAM STAFF TT2000 TCSSCC W205 SCTHOO T4592 2972992 4 160230 TETESS BY16zZ6 236041 F COOL FEASTEILITY AN . 36254 35294 ® —CoCZ COMMENT TY INFO 738CC 784007 — “eee : "152200 % COOO CEVELCEMENTAL C . * 90000 sooce 90000 27¢60Ce GOLA THC way RACIO T 86500 32006 Fiéce 10666 E79 166379 * OOLB 1hO WAY RADIO C 576CC S27ce 112400 123400 $8160 444280 4 BOS PCSTCPAT INSTRU TCZE0T 65500 CCIE YETCE ZIL9OC # cos CCWMLAT Ty HOSP 758cc 16600 111100 11300 274900 # 906 “CCECNAFY CAREY T282¢C rc3ascc 71700 sISscC 7250 “399950 ¥ COTA COMFK HSF CC TRA 27700 20700 179¢0 Goce * ——G078 COMM FSP CC TPN 2717cé resot T$eco $5600 9 O12 ICCU FERKMER PE 26500 3350C 7206 66200: * “CLS CCOCROTRATICR FOR 210U 5400 5000 SO05 17200" * Olé DEVELOPMENT OF $000 .7300 _ 4225 20525 * , ; —"920°7 SCuth enc CCHF “seem 6 2840 6384L * 119226 122465 132850 374535 021 CARVER COMPREH 41000 41000 * 101133 ¥a5227 107223 323583 02277 TRAINING FORT 24910 “24910 8 44926 48273 $3417 14662t€ C23. HEALTH CAREER 23202 232202 * 36050 * #1225 42177 122452 “924 “BIGRANT +E acto 19576 T9576 © T8952 12922 31874 ‘ 026 RGAL PREPS FCR 145912 14612 * 41134 42834 44750 128718 z on O26 “MEDICAL LIBRARY ” . * 42600 4043é 41858 124934 2 = O27 SPECIAL TRNC FO * 56845 55775 57495 17CL15 3 — 26 ~ CCHPLAL TY HEAL 37560 37560 8 ° —yj 029 COMMUNITY HEALT * 197611 1G1LEST 196924 seezc2 * i O30 ¥MCBILE PRTPARY + 93765 58787 100494 «289956 O31 CRIENTATICN OF * 172380 127e30 61478 351688 932°" PRIM CERE TEAM — "38700 © 142571 149648 430919 033. «#cCyM FLIH EC S . 14800 1480C * 148¢0 . 14800 O34 ~ CESTICN GEV CCHP * 91599 $4513 $7656 Ze43E2 ' 035 RURAL CCYPURITY * 57915 : $7915 ——o3€ “EVACLATECN PRPS * 3€245 35445 36542 108232 037? CCUATY WICE CAR * 15475 15475) “Cae TRUE AL ELIF CAFE FR 41383 —~el383, 036 EXPANDED CCACEP . . §2357 &5834 46634 1628826 “G40 COPPREFENSIVE K ome mene BGS TS : 19575 O42 TC HAVE & VCICE * 12163 18163 DES COOP TREINING P * 14675 714675 043 TKIS REEK_IN HE ee oe. oo OE 1543246 160064 454236 ~— ESTIMATED GROWT oes a * — qiecce 13rccco ' 2ozceete. a 1715007 ~~ 1237500 “hirticce «=~ 836000 “ “{¥2s000° "5153700 ¢ 2426922 29586SL 3$41080 6926652. OTE < se Ww iid WE ' @ , TM JULY 18 21972 Pr ee ee PREAK(UT cr P UG FRULRAP F REGICN ~ ALBARY am 00004 1as7? PAGE Fenrst 1 nePS-LoMed ruune-t enieu * 5) (2) (4) a LOENT 1F 1CaT LON OF COMPONENT } CONT. MITHIAL CONT. BEYCADI] APPR. NOT { NEw, NOT 1 18ST YEAR | ast year | { , | APPR. FERICO} APPR. PERTCCY PREVIOUSLY “| PREVIOUSLY | oirect | rNorRECT $ TOTAL 1 1 Cf SUPPORT | CE SsuPPORT | FUNDED } APPROVED \ costs i costs 1 { . \ t ( | J ‘ \ ‘ cote PROGRAM STAFF { { | | i | I ( a : \ $768s23_1 i ! $768.230- 4 $341,826 1 $1.110,056-) poo00 DEVELCFHENT AL COMPONENT ! j ! \ 1 1 ! . J i 1 vonvong | —-ss0an0g. | ————— tS O20. souTH END COMMUNITY HEALS 1 | j | ’ \ | _: JER | j $119s.2209.! j i $1193220.1 $353700_1 $1543220 ! com ! , ¢ ! : a eh CCHPREFENS NE | : $101,132 { ¢ i ¢101:133.1 $30,297 t $132,030 O22 IRAINING FOR DELIVERY cri t | \ $ | i a CME CABE j $45,926.) L j pesesps | anand} 88D} O23 HEALTH CAREER INCEATIVE { j { { t CGRAB i i $29,050.14 i i pasannn | saan ats — 024 FIGRANT. PEALTH IN couusBt 1 ‘ | { i $198.952_1 { | 5362982 tL 4¢,561 L $252919.1 o25 8CG 713 FOR HLTH TCHRS { { 1 1 CE CuSiBS TBE J 943201341 . | re a ae 026 vECICAL LIBRARY ABC inet ! | | LIQ SERVICE. t 4 j__-$422600_|__—_s475.600-7- zesag_ | ——22.406-f 88860} — ‘o2z7 «spectel TRNG FOR EMERG it 5 | { URSES il i l ves gas | 2568851 $133353 | $7021.98. 1 025 COPALAITY HEALTH cous j j j i { oh i. i j__$19726134 srozebhi 1 —---#552999-1-—-$2532610-1_——— 030 WCRILE PRIMARY CARE Ttam { \ ' J | —UbLIS $_ECR_2 pupst pb FL 1 L 1 wgag.ras | ——s9zeza5-{_——a200305 8120288] O31. CRIENTATECN CF NCA PRACTI { i 1: t i BG PDS.1 JO_SLIS_EEL j 1 } $172.380.1 pi2.3ag_|_—_s68a14 {S22 032 PRIM CARE TEAP TRAG AAC ! ' 1 t EL IVELY PROJECT. ar j } L “s.ogston_|_—stsnsana |——s28s208-)- EME 033 COMMUNITY HLTH EO sys il 1 { ! i i $14,800 4 L ' $14,200. 5 $43482 1 $19.289 1 O34 a aeR DEY CURPR or i | | { ( | , sk B i i l $912999 l $9139799 i $242,596 $1.162595 \ 035 RURAL COMMUNITY HEALTE < t j t { _--WILES.- S J j { Se Lassa f sine} —stst} 036 EVALUATION [ePACT POS AS\ 1 1 t J j HLIE_ CARE i i 1 $362248 \ 3622451 $1L,119.1 $472304 1 G37 CCUNTY wiCe CeRcrac wcatt t t { t \ { t SYSTES i 1 l j $15.475 1 31524751 j $2%5.575_1 O38. fukAL FLTF cere CeL TEROI | i 1 | t i l BLS CAPE ARUPBSES. j i { 1 - $41,383 1 $412383 l $132932 I $553315 } 033 EXPARDCE | ConcePy cF Hcret i ‘ | I 1 { { i i i $525357-4 $522397-4 $les.bl21 $68.9¢9.1 040. Ee a ive woraiv Tena j 1 1 i t t i ] { 193313 i $192575 l $605981 $26,223. I 041 TO FAVE A VOICE rat iat ( ! \ | \ | 1 - CErCcrcey PEA j l i 142163 i $1°,lt3 i $1,;995.1 $70 a157_-1 042 - CCCP By FRCG CTE \ 1 { , { 1 1 LS. j i i $142675.) $24,675 3 $421,411 $)8.814_! oP JULY 16,1972 : . eee eee RREAKFUT CF PFOUEST PM onthe Unset? Pace 9- Go PRULFAR FEEIEL : AMP SU SM~ J FUGR 2- i 15) (2) - (4) qu) IDENTIFICATION OF COMPOAENT | CCRT. BITHIA[ COAT. BEYCAD| APPR. NOT { NEW, KCT i 1ST YEAR { LST YEAR 1 t } APPR. PERICC! APPR. PERICC] PREVIOUSLY [ PREVIOUSLY 1 CIRECT | INDIRECT 1} TCTAL t } OF SUPPORT {| LF SUPPORT | FUNDEO | APFREVED i CCSTS cosTs | { j i | j { : { t 043 THIS WEEK EN HEALTF t ‘ | | j | i J . i I } l $1392848_ 1 $1352948.1 $28s802_1 $168,65C | ESTIMATED GROBTH FUAOS | | 1 { | | i i i 1 i L 1 1 i 1 j i i | ‘ i i ' | pt “TOTAL _ Jd. . $ $191479445 | iE 8102790 6TH 1 $20 426 921 { «$777,081 | $39204,002 | § . -o7 - " PEGION - ALBANY JULY 1891972 . . BREAKOUT OF REQUEST RM C0004 10/72 PAGE 3 . . o7 PROGRAM PERILO oe RMP S-O SM~ JIOGR 2-1. a. (2) | PPR. NOT | Nene NOT ! 2ND YEAR ATION OF COMPONENT } CONT. RITHIN| CCNTo BEYGND| APPR. ®. 2 TDENTIFICATE | APPR. PERICC| APPR. PERIOTI PREVIOUSLY { PREVIGUSLY | DIRECT 1 { of support | CF SUPPCRT FUNDED APPRCVED ccsTs | { \ | ! | Coco PROGRAM STAFF \ | gyn7.563-t i ! $787.563 PPLAENT t ' | DaGG DEVELOPMENTAL CU E ' ' 50.0001 ssc.00n_t LIN ENC COPYUNITY HEALI j { { | | 020 ENTER i 1 12224681 { $1222465 , — . CR 4 ve coms - 1 j 021 5 ie COMPREFENS} ° | | $105-2227_1 i L $1052227 ‘ RY CF 1 | i 022 Rt FOR DELIVE | t $4£,2122.1 I f $482273_1 O23. FEALTH CAREER INCENTIVE | j 1 | \ i pECGEAB__ I 1. $415225_4 L 1 44122251 O24 MIGRANT HEALTH IN CCLUREY i | 1 ' { [A.COUATY \ t $122922.1 1 aon nhh2922_4 _—- ae O25. EG FROG FCR FLTE TCERS J j | { DANCE CUSLRS OIMESS j j $422934.)_. 1 $42:834) O26 WECICAL LIBRARY AND INECH I 1 { i PMALLOK. SERVICE j j L ! $402436 1. $40,436_1 O27. SPECIAL TRAG FCR EPERG CI { ' | { t EPABIMENY BUSSES. { j { j $55,175 1 $55,775_! 029. CCPMUNITY HEALTH ECUCATII ‘ I t I ! ts. SYSTEM i ! 3 j $191,657] $193.£57.) B3c MCBILE PRIPARY CARE. TEAMI j { 1° { { ___-UbITS_£CB.BUBSL HITE cee. 1 t j $55.757_1 $95,757 1 O31 CRIENTATICA CF ACK PRACTE { { j 1 t lt $10 NMED i l i Il $117.820 1 $117,830 1 O32 PRIM CARE TEAP TRAG AKD 1 \ j 1 1 t DELIVERY PROJECT 4 j } I $142.51)_1 $142252) ! $33. CCPALAETY HLTK EC sys ctl ' { { { ! ER In Cos l l t i j 034 CESIGN DEY CCMPR EMERG HI i ( 1 i j LTH CAPE SYSIEM j t i 1 $54,513 1 $94:513.1 035 RURAL COPFPUNITY HEALTH GI ( 1 ' J 1 LIDES i j i i I 1 O36 EVALUATICN IPPACT rcs aS} j 1 1 t t __-50 ELIH_GARE l i i j 935.4451 $352445_1 O37 COUNTY WIEICE CARDIAC echt} t t { t { G_SYSITEP j 1 i i 1 I O36 RURAL HLTH CARE CEL THEOL | { I j | UCr PRIM CARE NURSES i 1 4 i i 039 EXPANGEG CONCEPT CF HOPE | | 1 t 1 I HEALTH CAPE j 1 i i $652824 1 $65,234 1 040 COMPREHEASEVE NUTRAITICKAL j 1 i 1 - 4 FEN COUATY i i i Osi TC HAVE & VOICE POST LAR i 1 1 YSGECTCMY REFAB l i l 42. «CCCP TRAINING PRCE ALLIE i 1 1 - ___D_ELTB PACEESS JONALS. i i i l -9. JULY 18,1972 REGIUN = ALBARY BREAKCUT CF REQUEST RM Q0CC4 10/72 PAGE «& ° OF PRUGKAM PLELCU RMP S+0 SM J TUG 2- I 45) $2) C4) 41) IDONTIFICATION GF COMPONENT | CONT. WITHER] CONT. BEYCADE APPR. NOT =| NEWe ACT 1 2nd YEAR 4} . 1 APPR. PERICC] APPR. PERIOC! PREVIOUSLY |. PREVICUSLY | OFRECT 1 | OF ‘SUPPORT 4 CF SUPPORT | FUNDEO | AFERCVED | ccsts i } I { ' 1 1 043 THIS WEEK IN HEALTF | t I { | I i i $154.324_1 $154,324 1 ESTIMATED GROWTH FUNDS { j j | | I i j { $710,000 1 $710,000 1 i j { j i t . TOTAL . aaa f $19160,509 I... _.. | $29798¢142 | $25958,651 | Lo ce eeemee vee oe 4 -LuU? : REGION - ALBANY 3 . —_ BREAKOUT OF REQUEST KM GOOO4 10/72 PACE 5 . 08 PRCGRAW PERICC ; RPPS-CSM-JTOGR2-1 oct NiwW,y Nut { 3RD YLAR TIAL ive eet ist COAT. WITHEN| COAT. BEYCAD| APPR~ not LuNTyY_. O41 TO HAVE A VOICE PCST LARI YSGECTCMY PELAL l 642 COOP TRAINING PROG ALLIE! © __-D_HE TH PROFE SSICNALS i Sifialés 1 ATEON CF CCMFCRENT | 1 ! | ileal CPPR. PERIOC] APPR. PERICD] PREVIOUSLY | PREVICUSLY | pirect =f 4 ALL YEARS | { OF supPORT ft CF SuppcRt {| FUNDED AFPACVED costs J OIRECT COSTS ' j 1 j t 1 ! } | CO0O PROGRAM STAFF ' 1 Weyeee t } ; 48112626 ! $2.2675415 1 - 1 ! Beco DEYELUPMEATAL CCYPCNENT i ' ! i $9c.occe | $929,000 1 $270,000 __. MURITY FEAL | 1 { { poet re cen ; | } $132-850 1 L $1322850 1 $3742525 A O21 CARVER COPPREHENSI VE cent ' $1072223 ' i 1 $19722223 i $3135583 1 . 1 ‘ 622 wine CARE FoR DELIVERY crt t $522417 H j $532417 1 1462616 L 1 023 RAE CAREER INCENTIVE | t $42,172 | l } $42,125 i $4222452_1 024 MIGRANT HEALTH IN cCLUret { 1 j ‘ | | J _ t TA CCUBTY j 1 { J = eee ceeenes ot qu. G30, 834 { O25. REG FACG FOR FLTh TCrAS J 1 { j | i ' QU ICaNCE CUSLES OTHERS ! J $44750_1 d j $442750 t _$125s7143 O26 MECICAL LIBRARY AND IAFCI f 1 i i ' j } Re SERVICE } 1 j l $41,258 4 £$4r205e i $1242.934 1 O27 SPECIAL TRNG FOR ERERS th 1 | ' j . { t EPAPLMENT NURSES j j j L $572495.1 $572495 4 L $170s115_1 029 COMMUNITY HEALTH EOUCATI4 ' j 1 j i ‘ Cu_SYSIEM I 1 ! i $1965934 1 $19629394 1 J $$86.202_ 1 O36 MOBILE PRIPARY CARE TeEsnt i ! { ( . t i I UNITS FOP PuPsL HLTE DELS \ j tl $1002454 1 $1002494 3 j $2892956_1 O31. «CRIERTATICN CF NON PRACTI 1 1 t . 1 i i | ICING. 4OS_10_CLIN MED i i i 1 $612478_! $61.47. 1 l $351.688_! O32 PREM CARE TEAN TANG AND | ! i { 1 1 i } . DELIVERY PROJECT { ] | j $1551042_1 $145,648 1 i $430291S5._} O33 CCMPUNITY HLTH EC SYS CLI { 1 i ' ! j 1 | Ll SES_ERENKLIN_COS__t : ! I ! i j 1 oi4.cc f . 034 DESTEN DEV COMPR EMERG H| 1 ' 1 i I i { : CARE. SYSIEM { i i I £97.850_1 $91,250 | ! $284.32] 035 RURAL COPPURITY HEALTH GI ' | { ! , 1 t 1 VICES 3 3 4 l { { i $572.918_L 036 EVALUATICN IMPACT MOS ASt j t 1 { 1 t ( SCC_ON MLIt CAPE : I l ! 4 $362542_1 $362542_1 i $1082232_1 537 COUNTY WIDE CARDIAC POAT] { ! 1 ' | b j ICRIBG SYSTEM { j 1 1 L 1 I $15.475_1 G36 PURAL HLTh CAFE CEL THRCI i | ' | ! t ! UGH PEIM CAPE NURSES i j 1 i i j $412383_1 039 EXPARCEC CCACEPT CF HOPES I 1 1 i | j ' . HEALTE CARE L 1 i 1 $462634_1 $462634 1 j $168,825.) 040 COMPREFENSIVE NUTRITICKAI 1 I | | I { j PER COUNTY i i i i J L $19.575 1 { | j | i t j l i j i i l i i ' 1 i t j r i i i 1 $142675 JULY 18,1572 , : , , . REGION - ALBANY BREAKCUT CF RECUEST RM 00004 10/72 PAGE 6 O8 PROGRAM PER TUL ' RMPS-GSM-sTCOGR2-1 eo (a ta) ; a : LUENTIEACATION UF COMPOAENT «| CORT. WITEANT CONT. BEYGNU] APPRe NOT | Neb, NU! t 3RD YEAR | t CTA i . [ APPR. PERECD] APPR. PERICCS PREVIOUSLY J PREVICUSLY | CIRECT 4 } ALL YEARS °] | CF SLeFCRT { CF SUPPORT § FUNDED | APERCVED { costs t {DIRECT COSTS | t t , ! 1 { I | O43 THIS WEEK IN HEALTH t i J | | t i | 1 4 l $1£0.084_1 £160,064 3 i $4542236.) ESTIPATED GAUBIH FLADS | t 1 . a I { CUBLENT 1 i i $15319,000 1. $1.320,000 f 1 $2,020,000 1 “ i J ’ § ! i i TOTAL j fo $1,292,043 |. _— $29 345,037 | $39541,080 | {. $8.926.652 | -1l- -12- Region: _ Albany RMP Review Cycle: 10/72 HISTORICAL PROGRAM PROFILE OF REGION The Albany RMP received a planning award in June 1966 and its operational award in April 1967. The program's Coordinator from the outset has been Dr. Frank M. Woolsey, Jr. and his orientation and background experience, prior to becoming a part of RMPS, was in the field of Continuing Education ' for Physicians, specifically he believed in the use of two-way radio communication for this purpose. The program's single-minded approach to the improvement of health care for the residents of the Albany region began to cause concern to RMPS by May 1969. At that time, the National Advisory Council expressed concern about the over concentration of this aspect of the region's program which they believed was retarding the program's overall development. Further, there was a feeling that this activity was too closely linked to the Albany Medical College's Department of Postgraduate Medicine and that this close relationship obscured the accomplishments of the ARMP. The region's apparent inability to phase out projects after the three year support period was also a matter of concern at this time. In September 1970, subsequent to a site visit, there was continued concern about the program's failure to develop new activities, to phase out activities, l.e., the two-way radio network and to regionalize the program's operations. At this time, there was only one activity conducted outside the confines of the Albany area and this was in its embryonic stages with little visible progress. It was noted that the RAG met only four times per year and that 11 of its 27 members were associated with the Albany Medical College and seven were on the ARMP's program staff. Thus, it was apparent that the RAG was somewhat inactive, not representative of the community at large and, as a result of its composition, doomed to a myopic vision of program development. During this period in the region's history the goals, objectives and priorities - of the program were somewhat diffuse, global and, generally, not indicative of an organization that had given serious thought to where it! was going or how it intended to get there. Subsequent to the site visit of June 1971, the ARMP began to enter into a new era. The RAG was expanded to 37 members who were representative of the entire region (see RAG Chairman's report submitted with the current application), i.e., the program staff participation was eliminated, the Albany Medical College members were reduced to two members, the meetings were increased to nine times per year and the RAG Chairmanship — passed from Dr. Harold Wiggers, Dean of the Albany Medical College to Dr. James T. Bordley III, a practicing physician from Cooperstown, N.Y. During this recent period the ARMP concentrated its efforts in several identifiable areas, e.g., goals, objectives and priorities were developed and clearly articulated and the RAG was subdivided into four Task Forces * which were assigned the task of studying, developing, reviewing, and implementing activities which would assist in the accomplishment ofa specific goal. The program staff and RAG members worked together to solicit, develop, review and initiate projects and activities which would generate a broad-based, viable, regionalized program. -13- HISTORICAL PROGRAM PROFILE OF REGION (Continued) To speed up the review process and to provide additional RAG involvement, the RAG Task Forces met twice each month to review projects for submission to the Executive Committee of the RAG and, ultimately, to the full RAG for final ranking (prioritization) and funding. An ARMP program staff member was given a primary responsibility to follow through and assist in the development of each potential project. This approach provided assistance and continuity of communication between a potential project director and the ARMP. As a result of this intensive effort, the program was able to develop and review (prior to the submission of the current application) a total of 47 projects. Of these 47 developed projects, 23 are included as part of the current proposal. It is of interest, in light of past criticism about the program's failure to phase out old activities, that all previous projects have been phased out. ‘The phasing out was done in an orderly fashion and all the old activities are still being conducted in whole or in part with financial support from sources other than RMPS. In summary, this brief history indicates that there are two. identifiable periods in this region's history, the period from June 1966 ~ June 1971 and the period since June 1971, i.e., the era of transition which has seen the two-way radio phased out and 23 new activities developed throughout the entire region and submitted for consideration with the present application. : Region: Alban STAFF OBSERVATIONS Review Cycle 10/72 Principal Problems The program is entering a new era and is somewhat inexperienced in grants management. They are working on agreements of affiliation; however,.at present they are not sophisticated. The region is planning a method of project surveillance, monitoring etc. but it has not yet been tested thoroughly. The program staff, essentially unchanged from past years, needs increased administrative competencies which are consistent with the current and projected program. They need to squarely address the problems and techniques of rebudgetting. " Most all of the aforementioned deficiencies are potential problems and may not develop since the ARMP Director and Deputy Director appear to recognize them and are in the process of taking steps to prevent the program from encountering these types of problems which arise when there are many projects being conducted simultaneously. The ARMP, in order to permit all potential project directors to have a chance to acquire funds, has extended project development assistance (using program staff) to everyone who has applied, i.e. they have done no preliminary screening except for a few cases in which the: project was completely out of the program's area of activity. _This has placed. a tremendous load on staff and reviewers which has been made. possible only by efforts above and beyond the reasonable. call of duty. . Admini- stratively, this mementum and workload cannot be carried on indefinitely and the ARMP will have to develop a suitable technique for initial screening of all potential projects to save work on the part of all parties involved. _ Testimony to this approach is illustrated by the fact that (in the current application) support is being sought for only 23 of the 47 projects which were completely developed and evaluated by the RAG. In summary, the ARMP faces the problems associated with coming to an accomodation with the new approaches they are using in the imple- mentation of a new program The Coordinator and his deputy are cognizant of these problems, are attempting to resolve them, and, in time, will probably do so. However, at present, the ARMP faces the need to retrench because they have, in fact, come too far in too short a time period. Issues Requiring the Attention of Reviewers Most of these were brought out under the category of problems; however, the reviewers should probably be aware of this region!s need and desire for guidance for future development. This can best be accomplished by carefully scrutinizing their past efforts, detecting deficiencies, and then pointing out means by which these oversights or errors might be corrected in the future. Otherwise, the problems the region faces and the issues the site visitors may wish to pay close attention to are those which may arise out of the development and implementation of a sophisticated program by a group of highly skilled and dedicated professionals who find themselves engaged in an activity which is somewhat new to then. -15- Region: Alban Review Cycle 10/72, Principal Accomplishments 1. The RAG has been revitalized. This has included an expansion of the membership to 37 to include new members who would provide broader representation of the region's health interests. To increase individual RAG member involvement each new member was carefully selected, was provided an orientation to the role he was expected to play, and was then assigned to one of the RAG's four task forces. The four RAG task forces are set up to initiate, develop, and review activities or projects which would tend to advance the progress in the goal area the group was assigned to pay close attention to. Each of the task forces met twice per month and the full RAG, which evaluated the reports and recommendations of the task forces, met monthly. In the past there were no task forces, only quarterly RAG meetings and rather casual RAG member involvement. In the current situation each member is kept well informed and immersed in program activities. 2. Through the revitalized RAG, the ARMP developed four clearly stated goals, set their objectives and prioritized the objectives within each of the four major goal areas. 3. With increased assistance from the RAG, a new program was developed which reached into all areasof the region. The projects were evaluated in terms of the new goals and objectives. 4, All past projects were phased out in an orderly fashion and each is now sustained in whole or in part with funds provided by sources other than RMPS. This was accomplished by April 30, 1972. 5. The program staff was realigned and enlarged (slightly) to be better able to assist potential project directors in the development of effective projects. Dr. Girard Craft was officially appointed the Deputy Director and has been instrumental in providing the ARMP with more directed and coordinated staff efforts, Each program staff member was assigned primary responsibility to follow through on the develop- . ment of a project from its inception to its submission to the RAG for a funding decision. In the event the project was approved and funded, the staff member was then assigned to the role of monitoring its progress and providing €ontinuous feedback to the ARMP on its status. This approach permitted greater staff involvement and better communications with project directors and potential project directors. 6. The ARMP has successfully involved the black community in the program development and permitted it to be the beneficiary of project support. This was accomplished, in part, by adding a full time black professional staff member who could and did relate to the minority community and assist in the development of projects which would serve these under- served residents of the region. Beyond this, the ARMP was successful in attracting an outstanding black to participate as a RAG task force chairman. -16- J. The relationship between the ARMP and the Albany Medical College were studied by a subcommittee of the RAG and was found to be complementary and mutually supportative. The subcommittee reported that each understood its respective role and the interests of the ARMP program development could best be served by continuing to have the Albany Medical College serve in the role of grantee. 1 Region _ Bi-State RM 00056 Review cyete Sept/Octi9zZ Type of Application Triennial Rating: _ 247 Recommendations From . L/ SARP , Lxx/ Review Committee £7 “Site viett | | L/ Council REQUEST: Review Committee considered BSRMP's triennial application which requested support in the following amounts: | 04 - $1,387,617 05 - $1,463,310 06 - $1,567,610. i oo el RECOMMENDATIONS: Committee concurred with the site visitors’ recommendation to award triennial status, to disapprove the developmental component, and provide funding at the following level: 04 ~ $1,150,000 05 - $1,230,500 06 - $1,316,600. Committee also recommended that a thorough evaluation, including a site visit, be held at the end of the 04 year, to assess the Region's progress toward meeting the reviewers' program concerns and to determine the level of funding for the 05 and 06 years. : REGIONS STRENGTHS: The review of the Program began with a report of the Site visitors’ findings which delineated the RMP's accomplishments, program plans and organizational problems. Among the Region's accomplish- ments are a strong and dedicated Coordinator, a highly capable program staff, a well-developed and relevant set of goals and objectives, and a new approach to program development. This approach involves the promulgation of the program goals and objectives to the health providers and institutions of the Region through the distribution of a prospectus to 8,000 individuals and agencies. Their program plan, which solicited small ($25,000) proposals around the goals and objectives, appeared to reviewers to present a realistic method of developing activities whose results can be evaluated at the end of one year to enable the RMP to focus its resources on the most promising activities for future expansion and development. The site visitors also reported that the RMP, through Dr. Stoneman's involvement as a faculty member and his ability in relating to university representatives, has maintained the original interest and “Region Bi-State RM 00056 Review Cycle Sept/Oct 1972 Page 2 backing of Washington, St. Louis, and Southern Illinois Universities in the program. The St. Louis-based medical schools have been brought closer together as’a result of the RMP's categorical projects. Reviewers also noted that the BSRMP's Emergency Medical System proposal in St. Louis and two health service/education activities build on existing relationships of the RMP with groups such as an interagency council on allied health in St. Louis, the Southern Illinois University, and local hospitals. The Committee observed that while the original projects were highly categorical, the proposals in the present submission reflect a trend toward more comprehensive activities. In addition, the newer proposals are more concerned with health care delivery problems in underserved areas, both rural and urban. CRITIQUE: Despite all these positive points, the BSRMP has several serious problems which adversely affect its program operation at the present time. One is the threat to the BSRMP from the Illinois RMP in the southern Lilinois area. The Illinois RMP has not until recentTYy extended much program assistance to the area under question. However, within the last two months, the I7]inois RMP leadership now appears desirous of assuming the entire state as its service area. In the light of these developments, some Committee members questioned the need for a Bi-State RMP. The response from those Committee members who visited the RMP indicated that both the medical referral-patterns in the southern part of the State, which relate to St. Louis, and the relationships of the three medical schools which originally substantiated the need for a separate Region still exist. In addition, the Bi-State ~ PMP now has developed an organization which is strengthening the relationships among the providers, medical schools, and community groups, and which cannot be easily discounted. It was suggested by Committee that the issue be resolved by bringing the two RMPs together and declaring areas of primary and joint concern. In the meantime, Committee recommended that additional program staff funds be provided in order to permit the Coordinator an opportunity for promoting catalytic activities in the southern Illinois area. The second major problem area is organization. Committee agreed that the RAG is large, overly provider-oriented and inactive. It has few working committees and had delegated much of its responsibility to the university-dominated Scientific and Educational Review Committee (SERC) and Administrative Liaison Committee (ALC). It was recommended by both the site visitors and Review Committee that 1) the ALC be made advisory to the RAG in fulfilling its fiscal responsibilities; 2) the SERC should be abolished and the Program Review Committee chairmen and the Executive Committee, join to determine how the proposals fit into the overall program. The RMP should also decrease the size of the RAG, establish working committees of the RAG around the Program's objectives and give the RAG membership greater responsibility. As far as the review process is concerned, Committee agreed that a formal structured process should be established, records of review be consistently maintained and the management of the process by staff be improved. ‘Region Bi-State RM 00056 Review Cycle Sept/Oct 1972 Page 3 The management style of the Coordinator was also discussed. While Dr. Stoneman is a strong and able leader, his effectiveness is reduced because of the time he devotes to a part-time private practice in plastic surgery, his occasional teaching and a cumbersome program staff organization in which practically everyone reports directly to him. The fact that he has no effective deputy and does not appear to have the confidence in his staff to delegate much of the "inside" responsibility is a further drain on his time and energies. While some Committee members agreed that an important quality of a good Coordinator is delegating to and deyeloping a staff, others replied that Dr. Stoneman's strengths in other areas made him & capable Coordinator. However, Committee felt strongly that the Coordinator be a full-time position and also recommended that a deputy coordinator with strong management skills be hired. With regard to the part-time associate coordinator positions heid by faculty of each of the three universities, Committee agreed with the site visitors that if the RMP wants them to continue to be involved that full-time positions would be more valuable to the RMP. ~~ The last area of major concern of review was the highly provider and categorical-disease orientation of the program. While the higher priority objectives are more comprehensive in nature (manpower, health care delivery systems, etc.), categorical medical care is still listed fourth in a ranking of seven program areas. Some of the associate coordinators continue to have categorical titles. The Pruitt Igoe project has been the only project funded until this year which addressed the health care neads of the underserved urban population and it has not been well-managed. Committee recommended that in light of RMPS’ deemphasis of traditional categorical interests and the RMP's pressing needs in the urban and rural underserved areas, that the RMP should give greater attention to more comprenensive programs. Consumers and minority members have not been involved in the development of goals and objectives and are generally under-represented on decisionmaking and review groups. Committee felt strongly that minority, women and consumer participation needed to be more actively integrated in the Program. Special assistance should be given to orienting these members and to bringing the community groups and institutions with which they are involved into a, working relationship with the RMP. It was also recommended that the Coordinator add more minorities to program staff and that the knowledge of present staff be better utilized to assess special need areas. Review Committee also agreed with the site visitors that the supplemental request for $90,000 to obtain a needew assessment from CHP(b) agencies was not the best way to secure consumer input and should be disapproved. CONCLUSION: Finally, Committee approved triennial status, but warns the Region that it is expected to make the changes recommended above. A thorough evaluation, including a site visit should be made next year to determine the RMP's progress. Committee also withheld approval of the developmental component this year until the RAG could prove it has obtained the maturity to handle the responsibility. The funding recommendation wo | ‘Region Bi-State RM 00056 - . Review CycTe Sept/Oct 1972 - Page 4 © for the 04 year ($1,150,000) includes funds to hire a Deputy Coordinator and to give Dr. Stoneman. some flexibility in the program staff budget ($50,000) to allow him to take advantage of catalytic opportunities. MCOB:D0D:10/3/72 COMPONENT AND FINANCIAL SUMMARY TRIENNIAL APPLICATION Region: Bi-State Review Cycle: sept/uct. 9/2 Committee Recommendation for Current Annualized Request for Triennial Council-Approved Level Component Level 03 Year ist year {| 2nd year | 3rd year lst year {| 2nd year | 3rd year $924,113 04 05 06 04 05 06 PROGRAM STAFF , $517,962 $ 650,126 1§ 696,100)$ 744,000 CONTRACTS 49 392 - : - DEVELOPMENTAL COMPONENT, - 115,513 127,210 133,610 . OPERATIONAL PROJECTS 356 ,759 621,978 | 640 ,000 690 ,000 Cidney eg vt { } EMS I~ a ( 25,000) hs/ea wn feumestian - us. MONPOE pats Cae bee 4 car | vor [aE RL on | LL , sola AVIORAT ! ee uv a LAFAYETTE : coer JACKSON 23" COOKE bene ~~ fens ee - JOHNSON | PETTIS . AA oa wen Sf > CLINTON “* Paws HENRY MORGAN Tow OSASE % FRABRUN fen . . Row Pate penton untea | * Meg tee we ST. CLAIR Mh espe. moe FRANKLIN VERNON LE ser APRs { C£oAR ye ! loatuss] LACL EOS, Pou farve rene oe GANTON . “= +] Ose f . soerat a . + ol wacur JASPER os SREENE | . a wee} wetter] tees J | _ CRISTIAN a HEWION bovcus oo ¥ mowen 2 BAR: Oveelt MC HONALO may PS TANEY ous weees OREGON “4 HEW Regional Office VII. Total Population ( MO. and ILL) Combined: 4,130,800 31 counties and City of St. Louis §0 counties in Illinois ; some interface and overlap with Illinois RMP oes - Missouri;+overlap with Mo.Rit Covering Demographic Information Population Characteristics: The Region centers around the Missouri and Illinois area around metropolitan St. Louis. Definite boundaries have not been established, but the Region encompasses more than 30 adjacent Missouri counties and about 50 counties in the southern half of Illinois. Overlap with the Missouri and Illinois RMPs account for an additional 30 counties and population of about 650,000. The following is a sumary of population distribution: Missouri St. Lowis County and City 1,573,600 Congressional Districts 8, 9, 10 (30 counties) 6594300 Less overlap - 194,000 2,030, 300 Illinois Congressional Districts 20, 21, 23, 24 (50 counties) 158525300 plus seattered other areas 240,500 092,50 Approximate combined population 4,130,800 ~ Selected Population Characteristics: State of Missouri Total Pop. % Urban % Rural % White 2 Non-White Density ‘Average Per Capita* * Income 4,677.5 m. 64 36 91 ll 68 «$3,659 State of Illinois Total Pop. % Urban % Rural % White % Non-White Density Average Per Capita* Income 11,114.0 m, 80 20 86 14 198 $4516 St. Louis Metropolitan Area Total Pop. % White % Non-White Density Average per Capita® . Income 1,882,900 80 20 4,088 $3,919 Springfield, Illinois . Total Pop. % White % Non-White Density Average Per Capita* Income 120,800 93 7 3,606 $3,415 *average for U. S. is $3,680" Page 2 — Demographic Information Average Age Distribution Missourl Illinois St. Louis U.S. 5 % Under 18 33 a 34, 32 35 % 18-64 © 55 56 - 53 55 % 65 + 12 10 15 10 Health Education Institutions Medical Schools: . St. Louis University Washington University . Southern Illinois University (developing) Dental Schools: St. Louis University , Washington University Southern Illinois University (students will enter Fall 1972) Pharmacy : st. Louis College of Pharmacy Nursing Schools: 15 Professional 4 Practical Approved Allied Health Schools: 26 (includes cytotechnology, medical technology, radiologic --— technology, physical therapy, and medical record librarian) Pertinent Health Data Hospital Facilities (Community General) Missouri St. Louis Other Counties . Tllinois 46 26 20 ~ 80 (includes 1 VA Hospital) Manpower Physicians (active, non-Federal; includes O.Dis): 4,627 Graduate Nurses (active): 9,920 Licensed Practica; Nurses (active): 3,822 1 ts A Region: Bi-State Review Cycle: Sept ae Kai: JOU asic COMPONENT AND FINANCIAL SUMMARY TRIENNIAL APPLICATION Committee Recommendaticn for : Current Annualized Request for.Triennial | Council-Asproved Level Component. Level Year ist year | 2nd year | 3rd year, lst year | 2nd year { 3rd year ao : PROGRAM STAFF ‘8 517,962 $ 650,126 |$ 696,109 $ 744,000 CONTRACTS 4g ,392 — foo oe} one . DEVELOPMENTAL COMPONENT -——— 115,513 127,214 133,610 ‘ . ee OPERATIONAL PROJECTS 356,759 621,978 640,000 690,000 uo Kidney C: ) 7 \, i EMS C 25,008 hs/ea C } , Pediatric Pulmonary ( ) , , Other ¢ )- : ~ “TOTAL DIRECT COSTS $ 924,113 - $15412,617 | $1,463,31¢ $1,567,610 COUNCIL RECOMMENDED LEVEL $ 924,113 at : AS & z 6 17 JULY 2192572 GREAKCUT CF REQUEST 04 FACGRAM PERIOD REGICN - BI-STA ke COOS6 LO/T2 Toran PAGE i REPS@CEMASTCGRZ=2 TE qs) (2) (4) qt) IDENTIFICATICN CF CCRPCAENT CONT. WITHIN] CCNT. BEYOND{ APPR.» NOT } NEW, NOT t 1st YeaR § LST YEAR | t | APPR. PERICCH APFRe PERICE] PREVIAUSLY | PREVICUSLY. t prReEct 1 INOTPECT t TOTAL ‘ {| ce supporT | CF SUPPFCRT | FURCEC | APPRCVED ' costs costs \ } { J t £050 PROGRAM. STAFF i i I t { j ! i } $650,126 5 i $6502126 1 $225269C_) 192528161 SCCO DEVELCPRENTAL COPPCNEAT | ! | ' I t { | j } j 1 $11525i3_ 1 glis,5t3 t i $126£2512_1 068. CCCP AEG INFGRMATICN syst I ! { } \ j 4 Tee FC2 FEALIE Peres i $427434 } j } $42763.1 $£93_1 $8026¢_1 30d FEALTH SLAV ED CARE FCR | , 1 1 { i ! \ _ AVR ES HSG ERS } $10G,900 1 L I $10020c0 1 $lp,6ic.t $111s61¢6.1 O12 CLBCNAFY CAAE TRAINIAG PI ! \ { I i __ RC ORAM_ ECR SLESES } 4452351 1 j l I $452391_4 $272032.{-----41244221-—— Sia CLIA ANS CYTC DETECT CAN} J { t ! t l cee INCG_ Efe PoP i i i $462000_1 4 $o0.G00. 1 4 yececce lo C15 PUS ED PROG BI ST MET AR} t 1 i { | t I £A_GA_ CIC. SUK j i $352290 1 l l $35,29C_1 | 252236.) Dis. GEVCLCP POCEL PHYS CUAT ! | j I { | wb LAL wued S s $15285C_1 i i $15sf2c_1 jo f152fse te Tie PEALTR Scavict AICE EcUCI { | t | : | 1 i + ATION { j $14.729_1 1 j $14,725_1 d £2427221 1g. PAY PEALTH CARE CEL WELL! 1 1 { 1 ' i ee YENES SE ILO i j $22acs4_t i 1 2223034.) 1 12206541. S30 EAS EVAL EPPLOYING POA ! | { | | I t i PLE VAS OLS. SELILEGS } i $16.561_1 i f $ieéscélii $82926 4 .-- 42224512 1. Jal WARAGIANG PEC PROELEKS crel i i | t i t { AvauL AICRY PATIENTS j $232236 1 j 1 $2222364 4iiCai2u.1 g22a2t4 1 O22 CEV ALTERNATIVE PCLS HLTH i : \ l | i ! i H_INEO SYSIE# ! l $18.224 1 I l $1923245 1 $e.625_1 $26324S_1 G23 REG BLCCL SANK RES 1KFO 4 i i t { { t t NETRCRK i 1 $25,600.) J j $252c6C 1 j $26,996). O2e TRANSPCMTATION PROPATURE | 1 j j i t ' 1 woe ARO TLL IREZEL 1 i £232124_4 a4 1 $240234 1 t 42221242 D286 FSTARLESH CCLNTY FEALTR j t | ! | { , bw MATOS SY2TES 1 1 £252663_1 I 1 $250666 denne tne Sheed Bae HEALTH Cane (ST CCP in| 1 { ! t t t 3ee ALLE cee merece deena bene Ed ZIT 1 jae bat2o.i_----------- Jone ++ $ebatidsJo- O27 Nt w OURERAR FRIBARY CARE St I l I 1 { i I YSIEMS j I $2%.900_ 1 ! j $25,50C_} $10.209_1 $3eshCC_1 “O25 EMERGENCY MEDICAL CARE t | t { { { . \ i j $252990.1 I j $29,00C_1 1 $25,¢6C¢6.1 326 «USE OF SID MEU REC TC ACI i { I l t-: { ___HLEYE_ SELIER_£AL_ CLE 1 i $14,600 1 j J $14,600.21 $62672—-J-——-2192272.1-_ Dl FEAL TH FE ARCTE Cree ad ‘ ' ! ‘ i i i . CUPP CRt reuun ar Wo. ~ ce ee ee ee ee dee Bhd LS eee ne Jf. reece ewe Deven DA b edt de Be dub t eomee Sebati. t o-. OL reAsPULULyY ct CUPPUILKES t t ! i { ! { ___ZATICS 1uée2_BEGisIBLes 1 1 41032501 1 { $1¢3250_] £$22412.1 31422221 O32. STROKE RERSEILAITATICH ! { 7 I ! | ‘ ‘oo ji J 1 $102483_ 1... --~ 1 4 $hessed w£hfefsi-L0 J33 SFACKE RERAE { t t J | | t ! ; : l i $2622259_1 eee eda wen ne ee bate tg deed ned baie tn © © * ~ S REGICN = ElASTATE JULY 2491572 BREAKCUT CF REQUEST RM coosé 10/72 PAGE 2 - ce . 04 PROGRAM PERLOO . KMPSTCTAL __ 603.000 60206C 60200 €9,C00 186.000 CONTINUATION WITHIN, APPROVED PERIOD CF SUPPORT 008 COOP REG INFGRMATICH SYST Q3 . + 44763 603 52 36E 42163 HEM FOR FESLTE PROFS cee ee we cane te Oe ae CO9 HEALTH SURV EO CARE FOR A 04 100,000; 110610 LL1,E1C 166,000 URB FSG PROV O12 CORCNAFY CARE TRAINING FR 63 45,351 27¢C3T T2 9428 45,391 CGRAM FOR NURSES COAT. WITHIN SUE-TCTAL 1609154 399250 189 5404 150,154 BEGICS ICIALS Lp date El? 4362216 196232832 $38 e170 1 9020 9632 323460419 cee een ae TE A RT SETS TS * § pany Bd ' My © © ’ ~ © . : . . ¥ B G MULY_ 2491972 -REGIGAAL MEDICAL PROGRAMS SERVICE ‘O} LISTING CF ADDITICAAL FUNDS PAGE 3 i REGION 56 BI~STA RAP SUPP YR REQUEST CCTOBER 1972 REVIE DESK: KIC-CONTINENT , RM PS-0SH- JTOGRB-3 . OTHER OTHER TOTAL COPPONENT. RMPS GRANT RELATED ENCOFE STATE UccAL FECERAL NON~F EDERAL DIRECT TOTAL FUNDS ALHBER TCTAL IATEREST OTKER FUNDS FUNDS FUNDS FUNDS ASSISTANCE THIS PERIOCS KEW WCT PREVIOUSLY APPROVED occo 1152513 115 9513 $39 AEW. SUB~TCT AL 115,513 115,513 CONTINUATION BEYCND APPRCVED PERICO CF SUPPCRT ns) 9850616 925,816 015 35,390 " 35 5390 die 15, €5¢ , “159850 018 14,729 14,729 o19 22,094 22 094 020 22,451 a 23,497 2 Oat 33,366 , 33 9366 022 267345 269349 — 623 25 5000 25,000 G24 Z2,734 . ; 239734 025 &, 665 252665 —_ 026 21,620 — 21620 y oa7 3€y100 ~~ 36,100, © "028 28, 006 = 25,000 tage aspere ee cae cee ee ee ate eee nn | cae eee SG DT TT _—_ "930 Z49920 214910 ~ 031 Fa 322 Wooo nena orn semen ns — 14,322 ”. 32 16,483 10,483 -$I- atl __SULY 241972 REGIONAL, MEDICAL _PRCGRAMS SERVICE fs LISTING OF ADDITIONAL FUNCS PAGE 4 “S/ REGION 56 BI-STATE RMP SUPP YR C4 REQUEST OCTOBER 1972 REVIEW CYCLE DESK FIC-CCATIAENT RMPS-OSM-JTOGRE=3 ~ CTHER CTFER TOTAL __CCWPCKE KT RHPS _——CRANT RELSTEC INCOPE __ST ATE LOCAL _FEOERAL NOA-FEDERAL_OTRECT. TCTAL _FUNCS NUMBER TOTAL TKTEREST © CTHER FUADS | FUNDS FUACS FUNCS ASSISTANCE THIS PERIOD 033 262359 26 1399 034 £3,326 $3,320 COATe BEYCNC SU@-TCTAL * , Le4EE SLE 19450 e516 APPRCVEC NOT PREVIGUSLY FUNDED O14 6C,C00 60 ,000 NOT PREV: SUB~TOTAL a : _ 60,000 60,000 ~ CONTINGATION WITHIN APPRCVEC FERICO CF SUPPCRT . ; 0068 5, 366 5,266 009 111610 1114610 0i2- 72,42€ “423428 COAT. WITHIN SUE-TOTAL LES 9404 189-4404 RECION TOTALS 1 126239033 176237633 BI-STATE RMP ALLOCATION OF DOLLARS AND STAFFING RESOURCES 1972-73 Region: Bi=State RM 00056 1971-72 03. o4 (Request ) Dollars % of Total Dollars % of Total © Program Staff $542,083 58.7 $ 650,126 46.9 Projects 382,030 41.3 621,978 44 8 Developmental Component — _—— 115 913 8.3 Total $924 ,113 100.0 $1,387,617 - 100.0 Positions (F.T.E.} Dollars 4% of Positions (F.T.E.) Dollars 4% of Total Total Central 19 (18.00) $264,865 61.1 19 (18.25) $295,726 61.1 Field 6 = ( 5.25) 60,256 13.9 6 ( 5.25) 67,300 13.9 University 10 (6.50) 108,373 25.0 10 (6.50) 121,100 25.0 Total | 35. (29.75 + $433,494 100.0 35 (29.75 $484,326 100.0 F.T.E.) F.T.E.) “LT- -18- Region: pj-State Review Cycle: Sept/OQct_1972 HISTORICAL PROGRAM PROFILE OF REGION _ The BSRMP began its planning in an area rich in medical resources and . complex in government structure and inner city.problems. The initial planning award was made in April 1967. Drs. Danforth and Felix (Washington University and St. Louis University respectively) acted as co-coordinators until Dr. William Stoneman, a plastic surgeon and faculty member at St. Louis University, was appointed Coordinator in November 1968. A consortium of the Region's three universities (Washington, St. Louls and Southern Illinois) delegated the grantee responsibilities to Washington University. Early concerns of reviewers dealt with 1) the need for more minority members on the RAG, 2) the question of meaningful input from a RAG whose membership was so large (56 members), and 3) the heavy categorical emphasis. With regard to the latter, the RMP had structured its planning and proposal development utilizing a mechanism of eight program committees and associate categorical directors on Program Staff. University people were heavily involved in the Scientific and Educational Review and Administrative Liaison Committees. During its second planning year the RAG's Executive Committee developed recommendations which sought to involve its members more directly in the planning and direction of the program by increasing 4ts membership, holding more meetings and studying the RMP in depth. After a pre-operational site visit, the RMP applied for and received + operational status in 1969. Problems in getting the RMP going took RMPS Director, Dr. Stanley Olson, to St. Louis to meet with RMP representatives. “He found intense separation of the two St. Louis medical schools which had shared a history of not being particularly interésté@ in serving the community. It was hoped that the RMP might serve as a catalyst in getting the schools to pull together in an attempt to improve the health care delivery system. The program received an award of $881,387.for Program Staff and five projects for its first operational year. Project activities included: #2 Radiation Therapy Support Program #4 Comprehensive Diagnostic . Demonstration Unit for Stroke #5 Nursing Demonstration Unit in Early Intensive Care of Acute Stroke #8 Cooperative Regional Information System for the Health Professions ae #9 Health Surveillance, Education and Care for Residents — of Pruitt Igoe. . ~19- Page 2 - Historical Program Profile of Region Region: Bi-State Review Cycle: Sept/Oct 1972 The new Southern Illinois University School of Medicine appointed a Dean and plans were made to add associate. coordinators from S. I. U. to the staff. Problems began.to surface in 1970 with the S. I. U. Medical School in Springfield where both Illinois and Bi-~State RMPs pianned to establish subregional offices in the area. The Illinois RMP placed a Subregional Coordinator in Springfield for a time, but neither RMP presently has staff in that area, In reviewing the RMP's application for its second operational year, RMPS staff was concerned that the projects proposed had minimal impact outside the existing system and did little to improve the existing inequities. Reviewers noted that minority and consumer input on RAG had been increased, the Executive Committee was reorganized, and evaluation and outreach capabLlities were added to Program Staff. ‘The following projects were funded: #2 Radiation Therapy #4 Diagnostic Demonstration Unit for Stroke #5 Nursing Demonstration Unit for Stroke #8 Regional Information System for the Health Professions #9 = Pruitt Igoe #12 CCU Nurse Training The RMP is presently in its 03 year. Although the RMP requested triennial support last year, Council believed that an additional year was needed in order for the RMP to realign itself in order to develop a program more in line with the RMPS mission. While Bi-State had gained increased consumer participation in its program, most of the funds in the application were destined for institutional rather than community ventures. In addition, continuation and approved but unfunded projects appeared to be more of the "same old thing" Reviewers were also concerned about the continued categorical emphasis and the actual contribution of the categorical associate directors based in the medical schools. It was recommended that the RMP give further attention to the fragmentation of the Region in relation to the Illinois RMP. Parenthetically, since that time the Coordinators of the two programs have met with Southern Illinois University and Dr. Stoneman prepared a statement concerning BSRMP involvement in this part of the Region. As a result of this, S. I. U. has reaffirmed its commitment to the consortium. The BSRMP is actively recruiting for the two S. I. U. associate coordinatorships’ and the positions may be filled by the end of September. Dr. Stoneman also has someone in mind for the regional field coordinator position for the Springfield area. -20- | Page 3 ~ Historical Program Profile of Region Region: Bi-State Review Cycle: Sept/Oct 1972 2 A management assessment visit was held. in April 1972. The team found the RAG and Executive Committee to be inactive and its members uninformed. The powerful committees created by the consortium of the three medical schools appeared to have assumed almost total authority for both the program and administrative aspects of the RMP. ‘The team's recommendations included: 1) giving the RAG more decisionmaking authority, 2) reorganizing program staff, 3) improving fiscal reparting procedures, and 4) developing a property management system. The RMP's response to these recommendations is expected before the time of the site visit. 2 ft The RMP was awarded $1,450,757 for a 15-month budget period ($1,160,604 on an annualized level). This figure includeg funds for the following groups of activities: A. Program Staff B. St. Louis EMS project C. Two health services/education activities (Carbondale and St. Louis) D. Other approved projects #2 Radiation Therapy _ #4 Comprehensive Stroke Unit #5 Nursing Demonstration Unit - Stroke #8 Regional Information System #9 Pruitt Igoe #12 CCU Nurse Training #15 Smoking and Health #16 Physician Continuing Education for Patient Management E. Three-months of support for 17 new one-year activities included in the triennial application. , 2D DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE MEMORANDUM PUBLIC HEALTH SERVICE TO FROM SUBJECT: -21- HEALTH SERVICES AND MENTAL HEALTH aosinisrenTio iy DATE: : The Site Visitors of the Bi-State RMP " August 15, 1972 ® * Operations Officer Mid-Continent Operations Branch Staff Review of the Bi~State Triennial Application, RM 00056 A staff review of the Bi-State Triennial Application was held Monday, July 31, and was attended by the following people: Marlene Hall, Office of Planning and Evaluation Loren Hellickson, Office of Systems Management Dona Houseal, Mid-Continent Operations Branch Margaret Hulbert, Division of Professional and Technical Development Jennie Peterson, Mid-Continent Operations Branch Pat Schoeni, Office of Commnications Annie Stubbs, Grants Management Branch ©} Jone Williams, Mid-Continent Operations Branch Staff met to discuss the RMP's accomlishments, problems and issues for the visit. The RMP's request for the triennium includes: o4 05 06 Core 650,126 696 ,100 744,000 Projects 621,978 610, 000 690. 000 Developmental Component 115,513 227,210 133,610 TOTAL $1,412,617 $1,463,310 $1,567,610 Staff. noted that the request for the developmental component exceeded “ the permissible amount of $92,400 (computed on the basis of ten percent of the 03 year direct cost funding level). A. Accomplishments The Bi-State RMP has taken a new approach to program development which staff found noteworthy. Their plan, which solicited small ($25,000 range) proposals around ideas generated by the RAC, appeared to present a © realistic method of developing activities which would be relevant to the Region's goals, objectives and priorities. In addition, some of the -22- Page 2 - The Site Visitors of the Bi-State RMP, projects address regional health care delivery problems in ways which are more innovative and which may have more immediate payoff. Examples include primary health care programs for children and an urban population use of the pediatric. nurse practitioner, and an investigation of techniques of improving ambulatory care. In addition to those examples of program staff assistance described in the RAG Report (pp. 42-45) and in the Core Activities summary (p. 137), RMPS staff noted that the Bi-State RMP provided staff assistance in developing the Experimental Health Services Delivery System application, which was recently approved and funded by the National Center for Health Services Research and Development, HSMHA. B. ‘Problems and Issues 1. The Region's response to the management assessment report will be 4n two parts. The first response has been submitted by the grantee agency and was included in the site visit packet. The second to be sent from the Coordinator and the RAG, will be available to you at the time of the site visit. In regard to the first, members of the : management assessment team reiterated their belief. that the problem basically lies in a difference of philosophy between-RMPS and the , Bi-~State RMP as to who should control the program —~ RAG. or grantee (the Consortium). While the RMP maintains that the Consortium review projects only to assure good stewardship of federal funds, the management assessment team's observation was that their fiscal control overlaps into program areas. The team feared that the schools would recommend funding only for projects which suit their: special interests and that the RAG would be either unwilling or too weak to oppose the medical establishment. Staff also noted that Form 14 indicated minimal involvement of RAG in project monitoring. Staff noted that of the 23 projects in the application, ten are university-sponsored and another five are associated with university- ‘affiliated hospitals. 2, Staff examined the goals and objectives and concluded that the RMP needs a clearer understanding of the separation between goals, objectives and activities. The rationale behind the matching of goals, objectives and activities with each other, as well as the progression from one year to the next (with some goals and objectives being added or dropped) was unclear. © , . 3. The charge to the site visit team with regard to the turf problem will be to gather more information arid possibly make suggestions to RMPS staff as to how this might be handled. It will not be the responsibility of the team to settle this issue. Incidentally, staff ~23- Page 3 - The Site Visitors of the Bi-State RMP learned that Dr. Creditc’. Coordinator of the Illinois RMP, had sent letters (copy attacicd) to the Illinois CHP "b" agencies requesting their impressions on the boundary problem. Of the 74 RAG members, 46 are from St. Louis, five from Missouri and 23 from Illinois. . 4, Staff thought there was a need for more minorities on program staff and the RAG. They also found the representation of women on the RAG (8) and Executive Committee (2) to be low. 5. It was noted that Dr. Stoneman is President-Elect of the St. Louis Medical Society. Since Dr. Stoneman also carries out - a part-time practice in plastic surgery, staff thought it imperative for him to consider both hiring a strong Deputy Director. and reorganizing staff to allow him more time for overall program direction and development. 6. Staff was also concerned with the categorical emphasis as exhibited in the categorical associate directors on program staff, the program committees and a number of the projects. Some staff members indicated a need for more projects which would provide the consumer with information on how to better enter and use the health care system. They were also curious about the extent of consumer involvement on the health care delivery committee, as well as the amount of collaboration with CHP "b" agencies in subregional planning. | Dona E. Houseal Attachment - COMPONENT AND FINANCIAL SUMMARY TRIENNIAL APPLICATION * - Region: Bi-s Review Cycle: ot rave ept/Oct e . Committee Recommendation for Current Annualized Request for Triennial | Council-Anproved Level Component Level ep Teer Ist year and year 3rd year, lst year | 2nd year | 3rd year ‘OGRAM STAFF '$ 517,962 $ 650,126 | ¢ 696,10d $ 744,000 INTRACTS 49,392. — __ a 'VELOPMENTAL COMPONENT = [| 2 15,513 127,21d 133,610” _ -ERATIONAL PROJECTS 356,759 621,978 640,000 690,000 , | Kidney ( . ) 5 EMS C 25,000 | hs/ea C : ) \ Pediatric Pulmonary ( ) . ’ Other ¢ | ) ~ TAL DIRECT COSTS $928,123 $1,387,617 | $1,463,314 $1,567 ,610 - YUNCIL RECOMMENDED LEVEL $ 924,113 Tore an JULY 2141572 REGICN = BI-STATE GREAKCUT CF REQUEST BM COSS6 Losi2 back 04 PACGREM PERICO EMESHCLMM ST CGR ZL 5) (2) (4) (1) , LOENTIFICATICA CF CCMFCAENT 3} CCNT. WITFIA| CCRT. BEYGNC] APPR. NOT | N&Ws, NOT { 1ST YEAR | LST YEAF 1 1 { APP2, PERICC) APER. PERICCE PREVICESLY | PAEVICUSLY. i DSAECT { INCTeECT ! TCTAL { | ce support {| CF SUPFCRT | FUACEC ] APPRCVED. \ ccsTs | costs } J | J I { 50C0 PRCGRAM STAFF \ t i i ! ' f \ I t £650212¢_4 I i $6502126 1 £2252650 5. a--4225251s_1_.-. Doce DEVELCPRENTAL COPFCAiAT 1 i | i t ! t j { 1 jl $3352513 J $115,513 t wow 1 g)isetle i 069 CCCP REG INFGRMATICN SYS] j t ! I [ t | TEMES I KEEL IE Peces j $42743_1 j j 4 £42162_1 jég2_4 Son2ttud ocg fee use SlLav ED CARE FCR 4 | ! ! | I ( _ AVES SG EPCS 1 £10c,008 1 j I I $yOosecu_t $lhstic_t $1las6h0.i--.. a12 peecnaey CARE TRAINING ri { 1 \ { ' ] WS COAM ECR SLesta £45035] 1 1 i J $452351 4 $27263721_.---$22022£ 1. D314 CLIik ARE CYTC GETECT CARI 4 I 5 | I i . \ SEM INDG Fey Fep i i i $40,000. 4 4. €6C,G90. 4 1 ge6acee. 1 CLS Pus ED PREG PI $7 MET ARI ! 1 t { t \ ! EAOR CIC. S¢ } i $352290_ 4 I 1 $355295_1 i $25223f.) Qt6 C8VvVELCP MCCEL PRYS CCKT | j { ! 1 . { I t wenn PATO kext 1 j $2528590 408 L j Seb atit go see Set mie PEALTP SePVvICk ACE ECUCI i I | | J ! wUATICN 1 1 $142725_1 i I $14.725_1 j 4,222.1 200 CLS P&L HEALTH CARE CEL WELLI I | | t \ I we YUMES SELLE i 1 $223094 1 IL j $22aCo4_L 1 1244054. 1- Joo. FEAS EVAL ESPLTYING PA | 1 \ t \ | I Pda Yt sss TTi tao. i 1 tlosdso1_1 - 1 i bigstélidiw sas ill peta) te Sel KFARAGIAG MEE FAELees CFI i 1 { t I ABBULSIERY CATIES iS i J $232226_1 i 1 ge2arae_t Sonar cit bocacit-l O22. CEV ALTERNATIVE PCLS ALTI t . t | 1 ' H_UINEG_SYST2¥ l J $18,224 1 _] i 11922241 $6,625 fees $s L G23. REG ALCCL SAKK RES TSFO | t t { i j ! { NEIWEEK ! $25,600) ! i $28acce t ! £2£.020.1..0 4 THARSHECG TATION’. eT EEIURTT { 1 { 1 t t f 2 MD ULL IEEE i i $Z22324_5 1 sédnTas_Lb doe .45 222.5. Q26 ESTAALISE coundy FEALTR | t i | ! , 1 ' oad etALGs. Sysd2 i J 12526631 L i 425sfb8 fd wee boiabiiuilnee 326 ME ALTH CArié F657 COOP INS { ! j I. t { we EYL gd eed neds 22} ---e 1 he Selat2ct._--------- Jon. -dedasesede.- oe Mew thet AR FRIBARY CAL ST { f | { t "ys1ies j 4 £252500 1 ! J $25250C_1 Uisacuctd SPeadueol O22 EMERGENCY FECICA¢L CAKE 4 \ \ { 1 i i { 1 $252000_1.. L i $252090 4 i $25.0C_1_—. 329 USE OF Stu KEL HEC TC ACI i ! | { ' t —--HLEYS_ BEITTCR EAL CLeE. Ud di $140,600 1.2 { 1 $14s¢0C_l.-. - $42572-J 815 r2212. —_ va ob PASE ESE OC Agee Ci Me nd 1 J 1 t | t . “uriued Ceuidar - obec ce ee eee bee J baa sud ee ee Dee ot ce hve u fel. 2 Pbedwho T..n- Jekecte.| so Sep rrastaadcaey cr cuvrurird | j { | t ' i PATIL ILNOT LSE CLSTELZS Ud Lo Ede PHO L 4 sioyfso_ ls easdll ill 14422221 52 STAKE FERAEELITATICA { t ' ' \ ! { Jo B10 S43 ee oa i wnt hvetbolt wae ee da —--S nathan tan D353 STACKE REPAB 1 | j ' . - 1 | 26,209 1. ed - pees fede ee JULY 216167? BREAKCUT CF REQUE ST RPEGICN RM COOSE 1C/72 © EY \ 7 ‘ . us hon, : in ne ” : : a D _ DEMOGRAPHY » . , eo — 6 -: POPULATION: (See 4 a) Approximate populations by Subaress, Total Population 19,953,100. %Urbant 9L | Population Density : 128 per sq..mi. % Non-white? lly Rural % Be os) Bhacke 7% . | METROPOLITAN AREAS = = 0 7 ve other a | Name of SMSA _ Pepe 654°2) a Total (14) - 17,944.6 "| Anaheim-Santa Ana (Orange Cty) 1, 409.3 : | Bakersfield-Kera C tty. 325.07 | Fresno Los Angeles-Long. “Beach 6,974.1 ‘| Oxnard-Ventura (Vent. Cty) 376.4 Sacramento 853.1! : Salinas-Monterey — . .. 248.8 ,Santa Barbara - 260.3 Stockton (San Joaquin) 284.5 | Vallejo- Napa . 241.3 San Bernadino. . 1222.0 ‘Riverside-Ontario-San Diego — —-1,318.0-: | San’ Franeisco-Oakland ~ " 3,069.98 “| San Jose (Santa Clara Cty) . 1,057.0. “AGE DISTRIBUTION - - . Percent of Total by Specified Age Group, 1970 - Age Group State | U.S./ dader 18 yrs. 34 33° 18-65 yrs. 55 33. 65 yrs.& over 9 = a Source: Bureau of the Census- PC ( V1 & V2) 1970 - - 1970 Census. '. of Population; ' State and County #6 . Bureau of the Census - PC (P3) - 3, U.S, Population. of Standard Metropolitan Statistical Areas, oe INCOME ¢ ‘Average Income per Individual, 1969 /1976 ' WState-( of RMP) =» $4272. — $446 9=== -*Ranks 8th “Wnited States _. $3680 $3910 ce . } an Sources State data from Statistical Abstract of the U.S., 1970 (Dept. of ConmeFee) California - Sub Areas Population and Counties (1970 Census) Cmer£ ~- Calif. RMP comprises 9 sub areas, 3 in the Northern part and 6 in the Southern part, each centered around a medical school or develop- ing center. Northern Areas Counties | Approx. pop. Area I - San Francisco il 3,029 , 800 II - Davis-Sacramento 20 1,448,200 III ~ Stanford (Palo Alto) 11 2,644,100 42 | 7,122,100 Southern Areas 1,406, 700 Area IV ~ UCLA 7 | Y= USC (Los Angeles) 1 6,882 ,000% VI ~ Loma Linda 4 1,162,800 i VIL ~ San Diego 2 - 1,432,400 | VIII -. Irwine 1 1,420,400 | IX - Watts-Willowbrook 1 526,700 | . 16 ' “12,831,000 | Totals 58 19,953,100 Total population since the Census is probably over 20 million. *Parts of Los Angeles County overlap with other areas. | ‘ California — Sub Areas Population by’ County (1970 Census) Northern Areas Area I ~ San Francisco (12 Counties) San Francisco 715.7 Del. Norte 14,6 Humboldt 99.7 Trinity 7.6 Menetocino 51,1 ~ Saudma 204.9 Lake 19.5 Napa 79.1 Marin. 206.0 Contra Coste 558.4 Alameda 1073.2 © | 3029.8 hem ee A rea IIIf - (Stanford) _.; Palo Alto “*" (iT Counties) San Joaquin 290.2 © Calaveras 13.6 Tuolumne. 2 2. 22.2 Mariposa ~ > "60 Merced - 104.6 - $tanislous 194.5 Santa Clara 1064.7 | Santa. Cruz 123.8 _ Moneterey 250.1 * San Mateo '.§56,2 _ San Benito 8.2 2644.1 Total of 42 Counties (Northern) (in thousands) Area II ~ Davis-Sacramento om (20 Counties) — ‘Siskiyon Modoc Shasta Tehama Lasswn Glenn Butte Colusa Plumas Sutter Yolo 33.2 TIS. 77.5 29.5 15.0 17.5. 102.0 12.4 41.9. 91.8: Solano * Sacramento Yuba Sierra © Placer Amador Alpine El Dorado Nevada 169.9 631.5 44.7 2.4 77.3 11.8 05 43.8 26.3 144852 California - Population by County (1970) Southern Areas Area IV ~ UCLA-L.A. (7 Counties) Madera — 44.5 Freéno 413.1 Tulare 188.3 King aa 64.6 Kern 329.2 San Luis Obispo 105.7 Santa Barbara 264.3 1406.7 Area V -~ USC Los Angeles Co. 6882.0 Area VI - Loma Linda (4 Counties) Mano 4.0 Inyo 15.6 . San Bernadino 684.1 Riverside 459.1 1162.8 Area VII. ~ San Diego (2 Counties) San Diego 1357.9 Imperial 74.5 1432.4 Area VIII - Irwine Orange County 1420.4 Area IX — Watts - W. Ventura County 376.4 (part L.A.) + 150.3 526.7 (e) (in thousands) Total of 16 Counties (So. Calif.) ‘ — I. REGIONAL CHARACTERISTICS (Cont'd) ~ yo ‘y FACILITIES AND RESOURCES f SCHOOLS | : . - Schools No. Enrollment Graduates Location __ (1969/70). ° (1969/70) Medicine and (Osteopathy) (8) tt | “Loma Linda U.-Seh-of Med OT BZ mE eg mr ea Linda Stanford Univ. Sch of Med, 342 | 69 Palo Alto | Univ. of Calif. Col. of Med 445 78 Los Angeles - Univ. of Calif. Col. of Med. 254 . 58 Irvihe Univ. of Calif. Sch-of Med. 516 288 ' San Francisco Univ. of So. Calif." - 302 72 , Los Angeles Univ. of Calif. Sch of Med. 101 = San Diego Uniy. of Calif. Sch. of Med. 99. “= , Davis Charles C. Drew Postgraduate Sch.m of Med. Developing. — WattseW. LA Dental — _° (3) Loma Linda, U. of Calif,LA, Univ. of Southern Calif., San Francisco MC., Pharmacy (4967/68), (3) _ Coll. of the Pacific, SF Schools of .Public Health 3) . U. of Calif. Berkeley; U. of Cal. LA, - Loma Linda, Nursing Schools , 7 ™~ _ ProtéssTonaT Nursing . , -__Number ii__._( 49 are College or Univ, based)... _. " Practical Nursing Number _ 67 The majority at technical and_ me v : co Junior Colleges. Allied Health Schools (Approved Programs) * . Cytotechnology ; “ Number _ 6 « Medical technology — ; ‘Number ”™ __65 ( 2 at VA hosp. Long Beach & LA) Radiologic Technology fe __Number 110 ( 2 at VA hosp. Los Angeles andi SF) Physical therapy Number 7 Medical record pebrerian n- 2 ce Re “4: Adana See Manpower Table for sources - ‘Page 8. \ _ ; ~ | ) " Sourcesi« Directory of Approved Allied Medical Educational Programs , Council on Medical Education, Amer. Med. Assoc. Chicago 1971. I; REGIONAL CHARACTERISTICS (Cont'd) FACILITIES AND RESOURCES (Cont'd) “! HOSPITALS: a ee rs ca te me SS “Ys Federal short. and Long-term general hospitals »1969_ a Number "Number of Beds. - "aoe 7 ~ Short tera “334 sy 2, 160... eet: Long: tern oe 24. aro 870: Day te a Ae General. boopttats Oe oe 24623" ates wt ste are : Latte a et re © Bed- size ( cenoval hospitals 5) HT Number ‘of hogpitals with # of hy hospitals Special Facilities: Under 50 . &@ of £¢ focil. 50 - 100 ae — Intensive Ccu “243 100 - 200. Cobalt therapy 68 . 200 - 300 . Radium therapy 128 .300 - 400 -- Te, Renal Dialysis - 58 400 - 500. —_ iin patient 600 and over ee Rehab- in patient ~~ 54 et Fo, -. Isotope facility 213 Bources fs at ngage! asco. 1 1970 Guide Issue 7 toe eet bene rer NURSING: AND PERSONAL CARE HOMES, 1967 bo Number Nunber of Beds Skilled Nursing Homes 1148 77,354, Personal care Hones 451 “16,015 with Nursing Care Long-term care’ Units © 108. 5,997 Source: NCHS - A Naster Facilities Inventory County and Metropolitan Area Data Book Pis- Runibie® 2043 + Section 2, November ane - ON *There are approximately 35, 224 physicians in the Region, including all but about 100 Osteopaths and” about. 91, 961 nurses: of whom | 37 700 are active, BES? 1971 COMPONENT AND FINANCIAL SUMMARY ANNIVERSARY APPLICATION DURING TRIENNIUM Region: Calif ornia RMP ® Review Cycle: Sept./Oct. 1972 Current Council- Recommended Recommended Annualized Approved Region's Funding For Level For . Funding Level For Request For TR Year Remainder Component TR Year 0] TR Year TR Year _ 92 __ of Trienniun 04 operational 05. operational /__/ SARP year year —_ ; /__/ Review. ' Committee 7 #11), SFC (OGRAM. STAFF $ 4,313,532 - SG; 112; 506 — INTRACTS 859,896 . . :VELOPMENTAL COMP. 586,692 800 ,000 /_}xes /_/ No . G,//0, 773 f ERATICNAL PROJECTS 3,196, 786 710, f 7 I ' . Kidney ( 532,157 ) ( ) a wo ‘ EMS ( 377,930 ) ( ) * hs/ee ( -0- ) C ) Pediatric Pulmonary C 110,000 ) ¢ ) Other ( egpeepepeam ) | ) ITAL DIRECT COSTS 8,956,906 ~$ 15, 02258535 a | . th, 622,859 QUNCIL-APPROVED $10,043,175 $10,043,175 LEVEL . ~ ’ AUGUST 291972 REGIONAL MEDICAL PROGRAMS SERVICE 4 -——EUNOLAG HISTCRY CIST AVPSCOSRSITCFHU- AT 5 + REGION 19 CALEFCRATA AMP supp YR C4 OPERATIONAL GRANT {OLRECT COSTS ONLY) ALL RECUEST ANC AWARCS AS CF JUNE 30+ 197. ‘ — : ; . awaRncec AWARCEC pwaRCEC AW ARCEC AWARCED *# REQLESTED REQUESTED REQUESTED REQUESTEC ‘ CCHPCNENT eyo mg 7“ ae oe 05 “=~ 86 — eg | NC TITLE C9/T1- 12/12 TOTAL #% 01/73-12/73 OLs 412/74 OL/TS~“1L2/75 TOTAL te s we COOA PECICKAL CFFICE 17465 617495 *# 488332 §C4312 992544 a —TOCK PECGRAM STAFF C ANGE CES SCS IS FFT 00 96205 CGCO RECTONAL KIONEY g1gcc azeecc 493006 1013500 ** —tocl aREA T= ee gece gues $8002 —ecie TELE SE geee aug in __ £002 ApEA IT = PROGR 58500 244900 210700 364312 BOB4SI3 &F 285235 313758 , 598993 COO} APEA TIT = PROG 1300C° 3£42CC 2ec7ce 4csaisc “p091090 *F* 924693, 357382 682275 COce AREA [V = PROGR - 189900 802200 €7760C€ 1O15777 2EBS5TT FF BOE634 8at297 1693931 —TCOCS ARER V— PROGRA T497CU EE OECTA STS ——~409 {a6 ¥* “FE ESOE SCOTS T2E1 Ess | __€006 AREA vi - FRCGR 34200 1sa7ca 14430C 2ES9ES E431ES ¥F 247456 272000: §19456 . coor area Vil = proe 4Ttco s34b007 7500S EST 7 29TT1 #4 20036 294840 862876 __ C008 AFEA VILE = PRO §$0cc 2251cc 17860C 31a55C 777250 8 286206 314820 eoLc20 COC 4REA Ix = ~ PRO _$5006 _taesga-——tizsce 220125 arpa ores SOS~S:SCS COCG DEVELOPMENTAL C 427882 427882 %* eccoce acoo00 rececca —pnool FCSPITAL BBSET ree TYTWTC ## OCC2 HCSPITAL OFSCHA — 150C 1500 *¢ —poo3 CCATIACUS PROGR Ta CTAB FP DOCS HEALTH EVALLATI - 31005 a1Cc8 #* . —rocs EMS SAN DIEGO C - ———"470907 ~*17090 #8 . Doce TRAINING ERC TE . 1c4cCc . acacc ** . ’ peer Geacri iy cr PATE {474s ~ T4149 *# * coos MOBILE CLINIC F : 19350 _ 19350 ** ‘ a4 2 poce CUTREACH FRCCRED ce ——C*ia‘SCL GE im = Doro SICKLE CELL ANE : 35700 15700 ** i? pote Siete cet wg Bre s i poiz CCCRCIAATICN CF 2740C 274CC *# i —DOIT NO SIERRA TROTA 53905 43900 4 ” OOL CC TFNG NW SF 4 274900. 3LZ2ECC 27820C 82£909 **, . , : , Me “9677 CCRT re mtg DEN esc SCOOT a1s0077OT”C~™OC~C«S 2G} oe 004 TRXG CCU PHYS C zye2cc 22ezcc 1§140C 605800 *# 94 TANG cou Phys 315355 ——-dansag———sat2ee 961M era eID COSCS~*C«C BGT , 7 STES27 7 QOT RMP MEO TV NETH 324700 392CCC€ 250006 966700 9% : Bil CCU TREATING PF 525406 T4renT sseect TO*Hi3h ** . 015 CAKCER PHASE 1 330600 312200 234864 __ B1THE4 FF, oS w O18 TRNG PHYS SM HOT CCE : ricee™ CS OOOC ee 103000 ** 020 CERCA UCSF FYFE 268800 362100 23890C Besecc +# —o217 PEO PULM rtvRE 268000 __JoGsou— 125600 pari oe ; ro O23 CFFCRIC RESPIRA , : 1136CcC §S2cc 76112 287212 ** : " —B2G ACR IFEAST WAL £09085 610d 3760CcC ** : . : 025 REFABILITATICN Le7zice 14880C 105546 GOL ane # 026° CPR TRG EMRGY 19 600 z30¢7. oF IGCE HF 627 RURAL CCMMUNITY 93000 - 92500 £6562 242002 ¢* —Q275° FAMILY pRacticE OCC eee : -———~ §scee «55000 ## «1902 ’ c2@ CCMPREFFASIVE S$ 370800 313600 217574 9c1974 #% 03 CORONARY CARE © rséte 69200 F587 ~~ Ss ‘164982 ** C655 4 O37 STACKE BREA ITT TEC sasce ss -3zass2 244553 4 56196 107 038 MULTIPH SCRN eS a 25000 +~«—« 94900 . ~ 79900 *#* — 9 043 STROKE AREA ft as 451CC 1é67CC 2443ce #96108 oes 95888 @77045 ~STRCKE AREAL OCS “= “37500 7 66400 94500 — 473400 #8 4€000 +3) O46) «SAN JOAQUIN KUL 2€7CC 160000 247427 Q3412T 88 39711 OSH PACER EKER 4TIEO Sy76C 12687 Liztit ** 28194 s O52 PERINATAL MONIT _ 56800 _ 68500 93796248096 ae. 41648 | we me . : ~”s - * at 4 “’ i —- cae — © . 3 r *~ = Bt = - ae = i . AUGLST 261972 _ _ _ MEGTONAL MEDICAL PROGRAMS SERVICE _ - A FURDIAG HISTORY LIST q RYPS-CSP=STCFHL ~ ‘ REGION 19 CALIFORNIA R&&P SUPP YR 04 CPERATICAAL GRANT (CERECT COSTS CNLY) ALL REQUEST ANE AWARCS AS OF JUNE 3064 157 ‘ ? aa AWARCEC AWARLEC SwePCES AWARDED | AWARDFO *# REQLESTEO REGLESTED PEQLESTED RECUESTEC s “CONPGAENT OF c2 03 O46 ~ "ee cs 06 oF * nc TUTE €7/69~C8/70 _ CS/TIANZ/72_— TOTAL «ON ST3$12/73 OLFT4-12/74 OL/TE-12/75 TOTAL 0 ee uw 054 RAPIC M1 AREA 56334 $6334 98 16666 LEEEE 2 "956 Cove TEC AKG A 53574 £3574 o¢ 46480 26987 67467 660 MEDICAL INFORMA 19929 19929 46 2coo0 13323 33333 O62” CCATINUING HECT §$3.75 99275 es 78720 65600 144326 £063 PEPIAATAL CRISE $6000 96000 +*¢ 72006 48000 © 120000 O67 RESPIFATORY Car 12¢248 4120248 ++ 204816 * 206816 &CSE32 be CCPPERCIUE CFL 694CC éS4CC oo szece 44000 96800 CES COND” WESOTRATER 70200 7O200 +e $240C §206C 1144CG O70. ALLIED MEALTF E . 48ecl ss HEC Oe §c000 ‘50000 poooce_.- O72” RAOIATION THERA 23334 22334 69 68252 62603 130855. “O73. CACOLGCY sREA IT nzece 42800 *¢ 9600 6400 16cce C75 IsCIAN FEALTE ~ 263881 eseel s¢ 131663 91188 222841 OTT _ INTENSIVE CARE 209329 “209329 08 206354 Y26E67 335021 OTS EXTENEET CARE 78214 JaZ1 4 se FC901 $5084 129985 081 URBAR TAOTAN H $2525 _ $2525 ee $2497 34938 87345 “084 WEQRATAL INTEN icesee £08368 ¢* Lr9ead 120006 220666 5085 AECRROCAC #CDEL _ 196€2, IS5E2 40 50762 . $0762 Ceca” KIONEY OFSEASE 76480 T6480 94 icesas 3651 1607 37 CATA. KIDNEY. ~ GREAT scssa 50558 ## 41076 23266 . 64342 tei TRARE. EC CREAR e000 e0c0 #6 : _O87C REGL TRANSPL AN oe. . 70353 70353 ee 8 _. a i TOSTO REGICAAL TRAAS $2221 13321 *¢ ~~ 41700 41 700 63400 z GRE PEGIONAL TRANS ee 26988 2eoae ¢ = 3 €80€ 2s6c¢ . 71800 z ““OB7F” REGICKAL TRANS z2eccc 26000 ## 30006 30000 * 60000 i J2GRTG PEGICRAL TRANS aaaat 24485 *¢ §430€ $4300 108600 i Ob} REGIONAL TRANS 23747 23747 ee: 3€S5CC 38500 “FICCE _ MOTI REGICKAL CREAR oo _ 48772 45773 © 47200 8116 _$S52LE “C875” TPANSPLANT SAL , / 27089 27089 4% 39165 22597 61782 ORT FEGTCNAL TRANSP aa ee ee ROD 16200 324C0 ‘CBIL REGICNAL TRANSP™ — : o% 25000 29000 "$8000 OBT4 RECTONSL TRANSP . ee 13000 13000 ’ 260ce OGTN RECICKAL TRAKSE *¢ 34000 34000 68000 OPA KEPHROLCGY AKC __ ee -. 18500 18500 #4 . os oo dsaC”Fecrex evone F — $0468 $0466 #4 20834 V216F - 33001 __ Tze FH SFO CAPE PLAN aeEA IT! 1 1 i 1 _°) OG BAVA meee TT Vt eee eee _--—L- bls sat atk $63+122 | _3zs) EEE CFRE CALTICALLY ILL i | \ | { t he BER Sees Pires yee eee | 4bi4sl23_1- sbi Le 8 {__. 8178-195 ! Qo. . vee 20. CLF Enay Te GUADALUPE PLP a eee Pe 1 nr otk sche ili a ee ered “be e $212,258 3 © 13t TeRG PFGE come FLTE WORKI 1 " 1 1 i _o t wUErs BREA LLL aR at $115a202-L-—-—-8262169- [_. $141.962 | . _ 132 COMPREHENSIVE core “DENTAI l 4 Do. | . oe __ beh ty PEes _fRES 1. -——=-— Th nate 4270309.) 82228 le: -$30.576 | o __.133 2 EYS SPECIALISTS IN EF PE Lo ee t TB ee 1 . “ foe _ Ten cack seeb Ly L see at $144,425 1 __30,582- joe ~ $200991 ! 2 Tae FaRAverIc EM CAPE AREA ra 1 , \ : i i. 9 EY EELS me eee TT Bec weeaea | s0ss02 1 sat fi. . $64" 944 ' .. 135 ee NURSE caneTin ; ‘ a : ° © OP EA Yan nr ae i ee | syuszat7i- {51522121 L—__$4438- _[.-. $157+607 ! oe i dé aie Troe BND DEAT SERV I ie |. eee wee ee we we bee eee foe. i t TE Mere: Viti We "ga ya52 ——-£.110892-1 #410037 - 1 $94,909 | © __ 137 TELE WED AREA VI { 1 1 i 1 oe _ eo, _—_— a _aaeee ne [hp 2)222322L1- _nsnnz.a2L | ——a2geas- “Le. $143e143 ! : _. 238 Geni eTaIC “NURSE E practitit | . ! ble + : o SyER SERA VEL USS 1 j tt __so3a286 1——t2sT8 _ $874537 | Qo: pee ae 13S CHP ICN SICKLE CELL PREGI...-..— ————~ Dee be eee Do ene T_ je : ° TS see ppee a EBB EB \ ; "51922326... awe — ~9lb2- 7120 i { © ' oe . i - i, ow . a co nee ee } TOTAL 1 $94140,637 | 1 { $1,8920222 | " $1190225 859 { $2,3580498 | $13,381 5357 | Gv oO eee nee ne ee ce A i eee ne eee CS 47h 9 ~~ - ae wee city eee eye - ee _ SULY 2501572 | BREAKCUT CF REQUEST 9h PROGRAM PERICO REGION ~ CALTFCPNIA RM QOOLS 10/72 PAGE 5 __._ BMPS -OSM- JT OG COG orcs SIE _ ICTSL ty $4,485, B78} {$4 06852878) ‘OQ CEVELOPMENTAL COMPONENT. I LL 582598. 4641 ‘ (5) (2) (4) as TOENT IF TCATIGA CE CCMECKENT «1 CONT. WITKIN] CONT. BEYCND] APPR. ACT = | NEWs NOT 1. aber, YEAR | } TOTAL t teu ed | APPR, PERLGCOL APPR. PERTCOL PREVIEGUSLY {| PREVICUSLY | cIRECT ¢ P ALL YEARS | , I ce suepceT | CF SUPPORT | FUNDED { APPROVED 1 costs ' JorrecT costs | ea . a {oo en { to. j | ad. t COCA PROGRAM STAFF PEGICAAL CI { { I ( | f ‘ EFICE i $5040212_1 k j } $50450212_1 jf... $9922644 | COO8 PROGRAM STAFF CRERF STUCI 1 { { t { 1 { a IES j $452100_1 I I i $492,100 1 1... 898-200 ¢ COOL PROGRAM STAFF AREA 1 UCSi { t i j ' { £ I $6192744.1 ‘ 1 i $6192144_1 £12183 0144 ! COG? PROGRAM STAFF AREA 11 LC} i t i t 7 a CANIS... i $212,752 1 i j $333.9598.4 [_. .$5986993 COO} PRCGRAW STAFF AREA ILI SI | 1 I t wo wom bASECEE L $2575 3£2 J i $252,382_3 i... $682-275 C004, PROGRAM STAFF AREA T¥ UC] t ‘ { I ein aga i $887 .297 i i £8872 29TL 1. $15693.931 (OES PRCGRAM STAFF APEA V USCI ! ‘ i | 1 we j £6£00552 L i $660,992). L__$ ls 261.894 tees PREGRAY STAFE AREA VE LLS . I { i ' : i $272.C06 i i $2722000_1 Li -$9199458 rae PRTGRAM STAFF AREA WIT Uf j 1 i } 6.55 1 $2942240 t i $2794. 240.1 i. $562.876 COCR PROGRAW STAFF AREA Vili | t { i { Le UC LPVIKE j £314.62¢6 4 { $3142829 3 Li. $601.020 £009 PROGRAM STAFF AREA 1X cel 1 i ‘ | i 4 ce oG_ $2112633 Il l $2112633-1 _f... $404,027 { 1 l 1 t { j | I ! 1 \ l { ! { i { L ' | I 4 1 _L L I j | 1 | \ { I ! 4 { | t i ‘ ! L j | i t i { { cee te ce ge eres HE i te aes aes OE OE ee ae az~T i \ Oo oO @ @ 0:29 | t i j “ mre om ag ca) range ~ o@7N PECICNAL Lot ot aRTATICR | | j j | ' t AREA 1% DREW PE j i ‘ L Lt $24,000 3 $24,000 1 «+ J. . $692000 | QA7. COPPCNFAT TCT AL Lf. $294037S5)1 ! it $922 200114 $346. 57914 IL. $806e640)1 | CBSC FROTER BLECD TRANSFUSICA { { | t - 4 I 1 . ee BEGIZNALLOLEICE de L | i 4 $12.167_1 1. $33.001 | . O8Oh FLEVERTICN OF INMUNTZATHI i t | i { t E . > LCN _KIDSEY SEES LY UCLA i $524102 4 1 lL i $520102_ f{._ $8L7.048 1 ype CELE HCWE HEMCOTALYSIS A#REA VE. cee ee dee ee I ween De ee DO ] -- | 1 _____-. LL CSo 1 L j ‘ i lL ~ ud. 8206407 f B - GBSF CUTREACH KICKEY CISEASE 1 i 1 t ' t j . bo a ALES TI_UGBSV2S £24052 1 i 1 i $24:986_1 1... $486116 ¢ O98. COMPONENT _IOTAL Hi $8922551) { I i $9$32552) LL... $206-57218. pe Ss C89 FERAL LISEASE BCHINISHRAL i | j ‘ 1 { TION BEG QFEICE $tlsi4s_1 { j i $522145_) {$98 9295 it. ~ O98} MANACEMENT CF FEDICAL ot j | { i i t { ne ISES AREA VEULLU l $108,075] i i \ $10P:075 1 i $2420400 Foo. C$2Z NELGRECRECCE EMFRE TRAAS! I $ j i . | t i : ECRILIFEAT_ BEES IX Ld $308.995_14 1 J 1 £309,955 f 4. $553,560 1 3 OS4A FEGICN AL. CANCER EXTENDED I | i | i . ! | i aya PREGRAM AREAL uc SE i $95,784 3 ! J j $95,786! LG h7G9369 PL a 0948 REG CANCER PHYSICS CCwPC! t | i [ | i { o BENT ARE? 1 UCSE i $1212509_1 L l i $121,500 1 LL. $243,000 }. oe 904 COMPCRERT TOTAL dd F2L Tee EN | j Li. $2) 2a 28611 TL _ $422.3699¢ : So. OES MEDICAL ALEIT AREA I vest { I { ! { { Be o a ae 1 t 1 4 1 bu. . $66.379 1 096 HEALTR CARE RURAL “AREAS 1 | i i 1 1 1. Be ca tw . AR EALLL UC DAVIS $203,242 1 ‘4 L i £20 32242_1 J... $399-331 | o COF ASSESTANT TG PRERARY tat 1 I I { { j bo. - £_ PHYS ALES ILI_STANECEC. | $1793 4274 t 1 4 927904271 2... $353-613.5 - 096 FIKERZUGF FEADCTA FFALtr t { | ! ! i | } vs gee bbe. ASEA_LY i $128,541} i j | $1282941.1 _L.. $256.992 1 899 PEBLATS IC NURSE PreCTATE t | I { { ee | io . OWNER AREA LY UCLA $100-747_1 L 1 J $100.741 5 Lo. $183~4505 ! o 100 VERTURS. REAETR SEPVICES 1 t i | | ' a ~_LLNEINCEE ZR EA TV : $952198_) } A 1 $95,198. 1 LL. . $19502466 8. . 1Ol FEALTH CAREER RETENTION . t i t t { { ! ~ eo ae APE UY $59..885 3 1 l j $55,984.14 J. $118.337°1. tip 02: MEOLEAL TRANSPGRTATION. q weer ec lee neem wb ee ee be. t Net cee bree _ wwe ckPYIGES SBEALVIULEU $1262146 1 l { i $1260l46.1. L_. $232,198 | oe £03 VOLUNTEER STRCKE AREA TK t | ! t I 1 Bo Diek PG $96.852 1 j i I $96.855 1 t $195.291 1 w= BLDG REG STR PROG REENTRY ctat i { 1 ! 1 i tooo. oS PD_ALL 2AREAS_EXCEOT- TIE i ! L $6222001 $62.200_1 fic. $1743 ft 426 VOLUNTEERS. IN STROKE MESE 2 ceed eee Ne eee een nh eee eb le ce eee eee tense cen cerene i eee meee ne ! J 1 __l j j ji. «=$280103 | QOLALIZATICN AREAL aM @ 8 Or oO: a & re) SULLY. 25219720 ee REGION - CALIFCRNIA 9 BREAKCUT CF REQUEST RM OOC19 LO/T2 PAGE 8 oO tre _ 06, PROGRAM PERTQQ 0 eo, RAPS*OSM-JTOGR I<} oO _. (5) t2) i) qi} oa. 2 IDEST IFICATION GF COMPONENT 1 CONT. WITHIAT CCNT. FEYOND[ APPR. ACT =f KEW, KCT { ACC*t YEAR | i TOTAL t . } EPPR. PERICOL Appr. FERICCI POEVEWUSLY | PREVUUSLY J DIRECT { | ALL YEARS 1 oO CFE SUPPCRI | CF SUPPURT | FUNDED | APPRCVED 1 costs ! [OrRECY casts | © ee ee Dc ee | ce ee Pee ben Dice Pe i _. 122 €FSCKE VCLURTEER PROJECTS | 1 ! { { 1 I . © EEL UVC cayds j i 1 I $21,50!_1 $21.56) 5 LL... 20381 1. sO L2Z STELKE RESOCLAL IZATION Al 1 { { { { 1 | _. cia Ty UCLa } 1 j L $22,294 1 $22,284 1 1 $42.974 | a © 22 SIPLKE VCLUEATEER PRCGRAFI 1 ' 1 { 1 | 1 © REES f { : I iL r 1: f $18.73) 124 STPOWE VCLUATEER FFCGFAMI { | { { { { ‘ Oo _. BDES YE LLY f l ! ! $242972_1 $34,872 1 j_.. $57-4921.. °... © G2 ¥TL IM SESTCLALIZATICN A} t i 1 1 1 | j _- RT 2EeAP AFEA VIE UC Sf 1 Low $l2.b43.1 $1663.41 ]_.. $34.617 2 a QO ~ IZ WLUATEER STRCKE PFCCF AM ! j { t { ! 1 Qo Th epee VILI UC IRVINE L j { l $108 .122 5 $108,122. I $1734992 1 TzZ7a L& CC EM MEC CARE MGMT Al | t ! ° ! 1 { 1 : oS _ a tye 2 PEA IM CRW PL i j j 1 $745,510 4 £25,510. 15 Loe $i4se7ei tooo oO 1236 LA CC EY WED CARE EC AREI { | i f 1 1 . i _.. — BUBMESP COUNCIL SC Cal Ij t f $122.55) $1222.55) 1 L. $209-695 1. ° To7t ba CC €P WED CAFE CEVELCI 1 ! t 1 . ' t oe | © porrcs YX UCLA } I ! i £117.359 1 $117:358 1 b$:2630837 Its S27 See PSNENT ICTAL. 1 _—_- } i if $2) 5,4i521f. $215.41 E01 Li. $621.993)1 O . tae =e MED CARE PLAN AREA IT] 1 t t. | 1 4 i. 8 ee ev S_ ] 4d. } ewe eee el u- i i Le $51.698 | Tpe rwrt CGE CRITICALLY ILLI { \ | I ! I i ~ O- ot pices Sob4 LIL STANECE Lek 1. ! $1222252 4. $1325353 1 ul $266¢538 1 © gis a LF LALY OF CUABALUEE LLI.W ld eee eee be ee ee ee : ___ Ie C1? AGEA_ LLL STANECeQ_ | ! J L $224,253 1 $2641293 1 ___-b_.. $4576551 1 CG _ TFi Tes proc COMM HLTH HOPE | | t { . a roo Ezz AREA LIT _ i 4 ! $101,318) $1lo0i.s3le | {__. .$216.520 | . _ YSRE CCRPFEHENSTVE CGRM CEATAI 1 t { 1 t j . | o Leet’ PECS_AR EA Ty de L i i $759245 1 $751345_1 io... $1020645 | oO (ESB) OMS SPECIALISTS IN EW FL owe. i be ee eee be . fw. bo eee ee be Hee de TS SD EIDE AREA Ty UChAL Lou t J £1821219 45 $1521219 J LE. «6$296+646 ft OG T2y See avELIC ER CAPE ASEA 1 { | { | { 1 _ 9 yuCi4 I ! } __t $52,023.14 $522023_) {__. $102.522.1 _.. DRE 25CLESCENT NURSE PRACTITI i, 1 I f 1 ! t . eo IO5Ef PRES Y _ Le. ub i f $204.672_1 $204.672_1 $__. $356.843 1 © pee oo MTeaTION ANC CENT SERV TP . ---W--.--. { . | _- ww. be. . bo. t oe web ee 1 Piyez SIDE CO_AREA YE LLL |} 1 j 4 £78,170 $78,170. 4 {___ $156+022 | © _..3zT TELE HEC APEA VIO. | a { i I 1 i . tt.. to... @ t i L j £1242426.1 $1242436_4 4. $2466763 ! TZ: FECIATFIC ALRSE PRACTITIY | I t . ! ; 4 t es Oo cere PRES VIT_UCSD. 1 j } #6754944 $670454 1 J... $1320208 { °o yee oe 39. SCP TCE. SICKLE CELL PROGL ne De ne ee be eb ee ee One cen vce al eae th ee oe oes ce be geo * TA Ly Unsh PS { } rl $1073943.1 ~$1072943.1 f{.... $2106273 1 On nee be eee de De be ar eee 4 too 8 TuTAL 1 $85477,E83 | $126,667 | {$2,034,547 1 $104639,097 | 1 $2126612986 | | o € if - 02 = - 21.- Region: California RMP | Review Cycle: Oetober, 1972 HISTORICAL PROGRAM PROFILE O|: REGION With the passage of P,L, 89-239 in 1965, the California State Department of Health,.together with the active participation of representatives. of the California Medical Association, the California Hospital Association, the deans of the eight schools of medicine, and voluntary health agencies and resources, organized a "Coordination Agency" for the purpose of developing an overall plan for cooperative medical arrangements through- out the State, Planning for developing regional medical programs proceeded at each of the participating medical centers, The Coordination Agency developed geographic areas of responsibility for each of the medical centers, and coordinated and mediated other questions, The proposed method of cooperation relied heavily on systems analysis techniques, The coordinating agency submitted an application to RMPS outlining its structue and goals as described above, Reviewers criticized the proposal, feeling that it was "poorly tied together", had a vague chronological plan for development, and overemphasized systems analysis. The major question raised by the application was the creation of a4 'mega-region"--a question not discussed in P,L, 89-329. The Office of Legal Counsel advised against RMP creating a central agency unless it were to coordinate a group of "subregions," The Region decided on this kind of structure and UCLA withdrew the planning , application it had independently submitted. The various medical centers agreed to reconsider at a later date whether to break up into several regions--perhaps before receiving operational grants. A revised application, incorporating the recommendations of the site visit team and the National Advisory Council, was. submitted. The coordinating agency became a ‘nonprofit corporation and changed its name to California Committee on Regional Medical Programs (CCRMP), with the California Medical Education and Research Foundation (CMERF), a second nonprofit corporation, as the grantee. Eight area offices were organized and based with the administrative structure of California's eight medical schools, Area IX, the most recent addition to the "federation" is based at the Drew Postgraduatk School of Medicine in Watts. , The region'é first planning grant in the amount of $223,400 was made in November 1966 and Mr, Paul Ward was appointed program coordinator in February 1967, Another site visit team visited the region in February 1967 and expressed concern about the apparent lack of cooperation among the subregion and little evidence of overall planning. , - 22 - Historical Program Profile of Region (cont.) The region organized along the lines of its original plan and a site visit team went out in March 1967 to review progress and the "revised application." The full year award for planning included the areas of UCSF--Area 1, UCLA--Area IV, USC--Area V, and California Medical Association and California Hospital Association, Three supplemental planning grants during the first year added the areas of Davis--Area II, San Diego--Area VII, and Stanford--Area III. The region's first operational grant was made effective July 1, 1968, including nine projects out of a total of 21 submitted, which included planning for the Northeast San Fernando Valley. In April 1969, the CCRMP was site visited for the purpose of evaluating progress of the overall program and to review in depth the individual program staff requests. The site team was impressed with most of the areas, particularly Area I--San Francisco, Area II-~Davis, Area IV-- Los Angeles, Area V--UCSA, Area VII--San Diego, and Area VIII-~Irvine. Most impressive was the evidence of true peripheral involvement. During the visit, Area IV (UCLA) raised the question of the possibility of making each area a separate region; there was little support for this position outside of Area IV. Subsequent review cycles have included supplemental. project requests from this region, resulting in several program and technical site visits. With the award of the continuation for the third operational year, on September 1, 1970, the region was supported at the direct cost level of $7,548,457 which included a carryover from previous years unexpended balance of $480,168. The base level at that time was $7,068,289. In April 1971, all regions were notified of national funding constraints which would require reduced budgets, California submitted two plans designated A and B. A, reduced the programs to the $6,2 million level and plan B was presented at a $10 million level in the hope that additional funds might become available. In June 1971, the site visitors and the Review Committee << tis ‘eat felt that the $6.2 million plan A was viable and represented good dectsionmaking. The $10 million plan developed, should funds become available, proposed the activation of several previously approved, but unfunded activities which would require careful screening in view of the region's new program direction in response to new RMPS priorities. The Council, however, recommended a level of funding at $10,043,175 on the basis that the CCRMP and its subdivisions had demonstrated a high level of competency in decisionmaking.» The CCRMP 04 operational year originally Sept. 1, 1971, through August 31, 1972, was extended four months to Dec. 31, 1972, due to -~ 23+ Historical Program Profile of Region (cont.) the RMPS change from a four to three review cycle year. In addition to the initial award of $8,956,936, funds were provided for the grant extension and for support of health services and educational activities and emergency medical service projects, which increased the grant to its current level of $12,180,123, Region: California RMP _ ro 24 ~~ Review Cycle: Ogtpbery "7 STAFF OBSERVATIONS Principal Problems: 1. Continued support to the weak areas for the purpose of strengthening and raising the areas to CCRMP standards, Considerable progress . has been made with this problem and only Area VI--Loma Linda, Area VII--University of California--San Diego, and Area VIII-- University of California--Irvine--are considered weak. 2. Although the CCRMP has made a great improvement in ‘preparing | budget sheets (forms’ 16's), there appears to be an administrative problem at the central office with regards to. budget, Principal Accomplishments: lL, The CCRMP central office has undergone an organizational reorganiza~ tion which has permitted the provision of a much broader range of technical assistance to area offices in the first year of anniversary review status, 2, A regional kidney disease program plan with specific component objectives has been developed, and priorities have been established among these objectives, 3, .One of the new program emphasis of the CCRMP is on manpower assessment, They have been sponsoring programs to develop a regional health services/educational activities plan, _Issues Requiring Attention of Reviewers: It might be well to keep in mind the CHP/RMP controversy. 7: 195 Co FUNDING HISTORY (Direct Cost Only) Planning Stage Grant Year Period Funded (d.c.0.) 01 11/1/66-~12/31/67 (14 mos.) $1,368,137 02 1/1/68--2/28/69 (14 mos.) 2,613,500 Operational Stage (overlaps with planning stage) a Grant Year Period Funded (d.c.0.) 01 7/1/68~-6/30/69 $ 2,917,144 02 7/1/69=-8/31/70 (14 mos.) 8,012,055 03 | 9/1/70-~8/31/71 7,548,457 * a 9/1/71=-8/31/72 8,956,936 O6(with 4 mos. 9/1/71--12/31/72 (16 mos.) 12,180,123 ** extension) * Ag avard statement was issued reducing this amount to $6,292,065 plus $703,509 reauthorized unspent. +k This amount includes HS/EA and EMS supplementals: funded at 1, 940,153 and $100,000 respectively. MEMORANDUM , DEPAISENENT OF HEALTH, EDUCATION, AND WELFARE TO FROM SUBJECT: PUBLIC HEALTH SERVICE HEALTH SERVIGES AND MENTAL HEALTH ADMINISTRATION Director, Division of anne Ol gts DATE: September 8, 1972 Operations and Development ~ [| ¢ Director, Regional Medical Programs Service Action of September 56 Staff Anniversary Review Panel Recommendation Concerning the Application of the California Gonmittee on Regional Medical Programs Ril 00019 fy, Aj . Gf “Ss Accepted Li i [> 2. (date) Ae jected (date) Modifications: . - 4k if rlivirt sfitus a aren 7 ?) t LASS feel f y 2 ; / ) fe 5 Let ees ct Fes Fite C CO Ake CEC Cie ae : \ pf TF / mw 4 sag fv wy COP HS y) Neo A pl Go f fe boyy es £~ iG Atay oath 2 S FA fu ae Cou CEA ae PULL aS a GA f flows Region: California RMP RM _00019 Type of Application:_Anniversary during triennium Rating: 355 RECOMMENDATIONS FROM / X / SARP /__/ Review Committee {_/ Site Visit 77] Council The Staff Anniversary Review Panel recommends a $9,951,175 direct cost funding level for the CCRMP 02 year anniversary application (1/1/73-12/31/73). The above figure includes $800,000 for the developmental funding request and $322,000 direct cost earmarked. funds for kidney disease activities, The SARP recommendation does not exceed the National Advisory Council approved funding level of $10,043,175 for the 02 year, This recommendation was reached from the following conclusions. Although the CCRMP has made good progress during the past year it was the consensus of the reviewers that the program did not merit an increase over the National Advisory Council approved funding level. Also, an in depth discussion of the problems related to the region's kidney disease activities resulted in the following recommendations: 1. Projects 87K, 87L, 87M, and 87N, which are new proposals to begin in FY 73, have not received appropriate technical review utilizing outside consultants as prescribed in the guidelines, Therefore, the region is to be notified that these proposals cannot be considered and approved for funding at this time. If the region wishes to have them reviewed locally by outside technical consultants, RMPS will supply the region with a list of consultants. If these projects are reviewed by outside technical consultants and approved, the region may then resubmit them according to the method outlined in the guidelines for consideration for supplemental | funding. 2. Projects 873, 88C 88D, 88E and 88F did not receive appropriate preclearance and technical review prior to approval by CCRMP RAG, although the region was informed of the necessity of such action in the May 3, 1972, Guidelines. However, since these projects are currently operational, this requirement will be waived, The region is to be notified that it may choose to continue support of these projects by appropriating monies from its operational budget, but no earmarked kidney monies have been approved for support of these projects. ~ 2 - Projects 86, 87A, 87D, 87E, 87F, 87G, 87H, 871, and 89 are the original projects begun in FY 72 following Council approval of the California Kidney Disease proposal. The region is to be notified that continuation of these projects is approved for FY 73 at a funding level of $322,000. Any greater support of these projects is inappropriate in that we have received no justification for an increased funding level when guidelines call for a decremental funding pattern in the 02 and 03 years. Because of the confusion regarding the current status of the CCRMP's kidney activities, staff from RMPS will make a consultation visit to assess the situation on October 2 and 3, The $9,951,175 funding recommendation was decided on when SARP anticipated that CCRMP would resubmit the new kidney proposals 87K, 87L, 87M, and 87N, and deducted $92,000 (requested amount for these activities) from the National Advisory Council approved level of $10,043,175. This maneuver will keep the CCRMP within the Council approved level for the 02 anniversary year. Other specific concerns noted by SARP relative to several of the nine CCRMP area programs were? ‘ . 1. De 66 Areas I, IV, and VI, are not requiring written assurances from program sponsors of conformance to Title VI of the Civil Rights Act. Area VII has a half-time coordinator, SARP believes the coordinator's position should be a full-time job. SARP questioned the practice of salaried chairmen for consultant paneis in Area V. , Area III has a 12-member faculty advisory committee which recommends approval or disapproval of all RMP proposals for funding and advises the coordinator. SARP believes that this committee is functioning in the same capacity as the Area Advisory Group. Additionally, it was noted that the dean of the medical school appoints new Area Advisory Group members, Because of these two factors, it appears that the medical school may be dominating the program. Several of the areas are not following proper review and management procedures; i.e., failure to distribute review and procedure criteria to applicants and/or failure to review expenditure reports from operational activities. Evaluation procedures are weak or nonexistent in Areas III, IV, V and VII; i.e., Area III has no overall program evaluation, and Area IV, V and VII do not have RAG involvement in program evaluation, - 3 -— Area I appears to be in violation of RMPS policy guidelines by supporting basic medical education training; i.e., the Area is supporting medical residents in a family practice program. SARP noted the sickle cell request from Area IX, Although there is no clearly defined RMPS policy regarding support of this kind of activity, it was noted that similar projects from other RMPs have been advised by the National Advisory Council to seek funding from the Sickle Cell Anemia Program, National Center for Family Planning Services, HSMHA, RMPS /WOB 9/8/72 ae wwe hte hail Aaa et NA lm © Review Cycle: october 72 8 COMPONENT AND FINANCIAL SUMMARY . re ANNIVERSARY APPLICATION DURING TRIENNIUM Current Moyes atie Atrnualized Council- Aw wry yo road Approved Region's Funding Level For Request For I mponent TR Year Ql TR Year TR Year 2 __ (04 operational (05 operational /x/ SARP 1 ear — year) . y ) /_f Review Commitzice YY / . . % f AM STAPF § 4,313,532 \ / $ 4,112,586 $ 4,112,586 y / - i f ACTS 859,896 ‘ f \ Zé ‘ 7 \ f __.800,000__ % f OPMENTAL COMP. 586 ,692 \, / 800,000 fejves [/ Xo \ , ‘ e : 4 ‘ 4 , % # 2 \ fo TIONAL PROJECTS 3,196,786 \ i 4,814,402 4,114,132 YY? \ ‘ % . re “of ' Ya - ney N fi fA ( 693,414 ): ( 322,000 } Q ® Sy . - \ fo ( 492,457 J) | *( 492,457 ) f sy Se oo / ‘4 a ea * ¢ - ) ( - ) ; ‘ f~ / \ iatric Pulmonary & ‘ . ( 110,000 } *{ 110,000 3) f i Zo fy 5, ) \ er Poo Cs dpc - ) \ . DIRECT COSTS 8,956,906 11,022,859 9,951,175 $10,043,175 *“SARP gave no specific recommendations on these projects. Region Central New York Review Cycle 10/72 Type of Application; Anniversary before Triennium Rating 239 Recommendations From [7 SARP [X7 Review Committee [-] Site Visit £7] Council RECOMMENDATION: The Committee agreed with the site visitors in recommending approval of the anniversary request for the 05 year in a reduced amount of $889,000. This amount includes the continuation of Project #6--Home Dialysis Training Program with no increase in funding above its 1972 level. The Committee paralleling the recommendation of the site visitors and outside technical reviewers disapproved Project #38--Cooperative Organ Bank with advice to follow the Kidney Guidelines and develop a regional plan for renal disease. . The recommended funding level would permit the region to actively recruit a well qualified staff and at the same time not permit the program to be overburdened by a large number of projects. Committee also recommended the scheduling of a Management Survey visit to evaluate and strengthen the region's fiscal capabilities. The total request and recommendation are as follows: Year Requested Recommended 05 $1,420,349 _ . $889, 000% Critique - The CNYRMP has made a valiant effort during the past year to remedy the deficiencies noted during the 1971 site visit. For most of the year the program worked with an Acting Director which was a difficult arrangement for him and an even greater handicap to a program making an attempt to bring about required changes. The region has established new goals and objectives which are consistent with national goals, but still fail to directly reflect the local health needs. The RAG has been expanded to include more consumer representation, but still needs to strengthen its representation to insure additional imput from young providers, minorities, nurses and allied health members. *Includes $16,000 for Project #6--Home Dialysis Training $429,000 for recruiting and hiring an adequate program staff $469,000 for support of project activities. -~2- Unquestionably, the program's highest priority is to increase its program staff size, It requires competencies which can be provided by physicians, health planners, nurses, fiscal managers and workers in the allied health areas. In the area of fiscal management, the program has an overriding need to strengthen its competencies in light of the unexpended funds accumulated during the past year. The Management Assessment visit will help the program to identify its problems in more specific terms and will provide guidance to the implementation of possible solutions. In summary, the program did well during the past year in light of the circumstances; however, it faces a need to correct many deficiencies if it is to become a mature RMP. It must abandon its emphasis on the "mini-contract" mechanism and place its faith on acquiring a program staff which is capable of generating and implementing a plan which will address some of ‘the region's pressing health needs. The year ahead is seen as a year in which the CNYRMP acquires a program staff which is capable of developing and implementing an integrated, coordinated group of activities which will result in a solid RMP program in the Central New York region. The recommended funding level has been carefully scrutinized and was broken into two distinct categories, i.e., program staff and project support. The Review Committee felt strongly that the CNYRMP would be well advised to place its priorities in the coming year to these two categories in the proportions indicated and to view the neer future as a "staffing up and planning" period. Implementation should be relegated to a point in time which comes after the program has acquired a program staff with a wide range of competencies and has developed a sound plan for the future programmatic efforts to be undertaken by the CNYRMP. In so far as possible, they should avoid the "piecemeal" approach which charaterizes the mini- contracts efforts. There was considerable discussion by the Committee concerning the site visitors recommendations. EOB/DOD 9/25/72 COMPONENT AND FINANCIAL SUMMARY ANNIVERSARY APPLICATION BEFORE TRIENNIUM NOB LU. VEU Se seer at eee ww we Review Cycle: Current Annualized. Level Request For Request Funding For Component _ 04 __ Year __05_ Year _ —=— Year /__/ SARP /X/ Review Committe PROGRAM STAFF ' $444,908 $489,102 $889,000 combined CONTRACTS . , * DEVELOPMENTAL COMPONENT /_/ Yes f_/ No "OPERATIONAL PROJECTS $255,183 $931, 247 oo Kidney ( 44,660 y ( 16,000 =») EMS | (91,062 ) ( * ) hs/ea ( 142,320 .) ( * -) Pediatric Pulmonary ( .) ( ) Other ( ) ( ) o » TOTAL DIRECT COSTS $700,091 $1,420,349 $889,000 ” “COUNCIL=APPROVED' LEVEL $850,000 *Committee does not specifically discuss these projects. CENTRAL NEW YORK REGIONAL MEDICAL PROGRAM SITE VISIT REPORT August 9-10, 1972 I. Site Visit Participants Consul tants Dorothy E. Anderson, R.N., M.P.H., Site Visit Chairperson, Review Committee, Associate Coordinator Area V, California RMP George E. Scheiner, M.D., National Advisory Council, Professor of Medicine, Georgetown University - F, M, Simmons Patterson, M.D., Executive Director, Association for North Carolina RMP RMPS Frank S. Nash, Acting Chief, Eastern Operations Branch Robert Shaw, Program Director, DHEW Region II Nicholas Manos, Emergency Medical Service Task Force, Division of Professional & Technical Development Jerome J. Stolov, Public Health Advisor, Eastern Operations Branch Central New York RMP John J. Murray, Coordinator Ernest Carhart, M.D., Medical Advisor Sandra Anglund, Public Relations Marjorie Jordal, Assistant Director for Administration Walter Curry, Emergency Medical System, Coordinator Robert Wheeler, Ph.D., EMS Consultant Nicholas Collis, Ed.D., Director Health Service/ Education Activities Ottilia Nesbit, Health Planner co ‘ Robert Schneider, Evaluator Lawrence Polly, Audio Visual Maintenance John Koch, Technical Assistant, Learning Resource Center Suzanne Murray, Librarian Larry Rummel, Community Coordinator (East) Micheal Reich, Administrative Assistant Trainee CNYRMP Executive Committee Clarke T. Case, M.D., Chairman, Physician (Surgeon) Private Practice* Gordon J. Cummings, Ph.D., Rural Sociologist, Cornell University* Horace S. Ivey, M.A., Director of Social Service Department, Upstate Medical Center* : Bruce E. Chamberlain, M.D., Physician (Surgeon) Private Practice* * Central New York RAG Members -~2- CNYRMP Review and Evaluation Committee ~- Generalist Nurse Clinician---° ~ Training Program _ . Barbara Bates, M.D., Consultant, University of Rochester an ; Irwin K. Stone, M.D., Physician (Gen. Prac.) Emergency Room * Oo , . Virginia McAllister, B.S., SUNY Agricultural & Technical College, - Professor & Chairman, Department of Health Technology * Gertrude Cherescavich, Project Director of Nurse-Clinician Program Betty Katona, Acting Nurse Coordinator Helmon Rubinson, M.D., Physician Coordinator Sister John Nicholas, Nurse-Clinician Student Maryanne Miraglilo, Nurse-Clinician Student Benjamin Levy, M.D., Preceptor, N. Y. Telephone Co. Robert F. McMahon, Preceptor, General Practitioner, Syracuse CNYRMP Primary Patient Care Committee McDonald Dixon, Foreman, Revere Copper & Brass, Inc. * Herbert K. Ensworth, M.D., Physician (Internist) Private Practice/Ithaca * Robert Gelder, M.D., Physician (Surgeon) Private Practice in Sidney, New York * . Jerome Wayland Smith, Oneida Ltd., Silversmiths, Secretary of Company * Robert Westlake, M.D., Chairman, Physician (Internist) Private Practice - Syracuse * CNYRMP Regional Kidney Disease Meeting B, A. Bernstein, M.D., Physician Private Practice - Syracuse Dorothy Bruno, staff - Senator Lombardi - Albany Paul Bray, staff - Senator Lombardi - Albany . Thomas Flanagan, M.D., Physician, Private Practice * Ron Fonda, Syracuse-Onondaga Planning Office John Harding, M.D., Binghamton Bucky Helmer, NY-Penn Gerald Hoffman, Legislative Assistant - Senator Lombardi Edward C. Hughes, M.D., RMP, Chairman Planning & Priorities Committee CNY RAG * . ; A. O. McPherson, Upstate Medical Center Stephen Kucera, M.D., Johnson City Otto Lilien, M.D., Department of Urology, Upstate Medical Center Honorable Tarky Lombardi, Chairman, Senate Health Committee Jason Moyer, Medical Director - Binghamton General Hospital Ms. Harriet Morse, Fxecutive Director - Senate Health Committee Zahi Nia Makhul, M.D., Department of Urology - SUH Richard Schlesinger, CHP, ALPHA, Syracuse Richard Schmidt, M.D., Dean, Medical School, Upstate Medical Center * Edward T. Schroeder, M.D., RMP Project Director, Home Dialysis Training Program ‘ Ronald D. Smith, M.D., Utica * Central New York RAG Members Il. IIt. INTRODUCTION The Central New York Regional Medical Program (CNYRMP) site visit was conducted following the receipt of their application for one year's support in the amount of $1,420,349 direct cost. The application requests support for the continuation of six projects and ten new activities. Of the ten new projects, two had previ-~ ously been funded as nine separate projects and are now administra= tively merged under two new project numbers. The charge to the site visit team was: 1. To review the region's overall progress since the last site visit in June 1971. : 2. To determine the newly appointed Director's role in program direction. 3. To determine how regional needs and resources are identified and analyzed. 4. To evaluate the monitoring and surveillance of ongoing program activities. 5. To study the roles of RAG and its committees in program direction and to relate them to the recently published RMPS policy governing these relationships. 6. To review the region's mini~contract activities and obtain progress reports on those projects which have recently been initiated as supplementary activities. 7, To arrive at a funding recommendation which would include the region's kidney activities as well as its general programmatic activities. Conclusions and General Impressions The site visit team was fortunate in having three members who took part in last year's visit. The site visitors noted that the region had made many positive changes since the last site visit. The region has established new goals and objectives which are con- sistent with national goals, but still fail to directly reflect the local needs. The RAG has been expanded to include more consumer representation, but still needs to strengthen its representation to include more input from young providers, minorities, nurses and allied health members. The Executive Committee has also added consumers. The team found the RAG Chairman to be dedicated and knowledgeable about the total program. ~4&- The recently appointed Director has generated a new enthusiasm within the RMP and has been successful in achieving a greater . visibility for the program throughout the entire region. The program staff needs to be expanded. It requires competencies in the physician, nursing and allied health personnel. areas. The region has made a sincere effort to comply with the recom mendations set forth in the 1971 advice letter. However, a Physician Associate Director has not been appointed. The team was favorably impressed with the CNYRMP's ability to involve CHP "b" agencies as an aid to the program in its project review and program planning. While the site visitors noted the program's progress and its new direction, the following deficiencies and concerns were reported to the region during the feedbaek session. 1. The site visitors felt that the present program staff is not large enough to effectively implement a successful RMP program. The following positions and competencies are recommended. a. A full-time physician in the role of an Associate Director. In the recruitment process the program should attempt to attract an individual who would bring strong administrative and public relations competencies to this position. It was noted that the CNYRMP has successfully recruited a Medical Consultant; however, his primary value is as a family practice consultant and, as such, does not fill the program's needs for strengthening its administative and public relations capabilities. b. There is a need for the recruitment of program staff in the roles of Assistant Director for Operations, an Assistant Director for Administration, and an Assistant Director for Program Planning and Development. c. There is a need for a Nurse Generalist to aid the Manpower Coordinator in the planning and development of health service/education activities. d. The utilization of community resources could be enhanced by the hiring of a Community Coordinator for each of the area's subregions. e. Evaluation is an important aspect of a successful RMP and although this is currently being done, there is. a need to enhance this awpect of the program's operations. Consideration should be given to the recruitment of an experienced: full-time Evaluator. In summary, there is a need to enlarge the staff in a manner which will provide the competencies outlined. In the recruitment process there should be an attempt to recruit minority candidates who can provide the balance and insights which will be helpful in program development. In addition, minority staff members can provide a communication link with the minority groups in the CNYRMP area who have a-need for the benefits which can be provided through the auspices of the RMP. 2. The site visit team recommends that no additional mini-contracts be initiated. It was noted that these contracts required an excessive number of program staff man-hours to monitor and evaluate. In light of the small program staff, the efficiency of manpower utilization must be optimal and in using the mini~contracts approach, the manpower/dollar administrative costs appear unwarranted. 3. The CNYRMP's goals and objectives are broad and fail to specifically reflect the local needs of the region. It is recommended that the program systematically identify the needs of the region, develop short and long term objectives to meet these needs and, in the process, redefine its goals and objectives in a manner — which more specifically addresses the region's pressing health problems. 4. There is evidence that a programmatic thrust is developing in one of the subregions; however, there is a need to coordinate the relationship between program planning, operational projects, and program staff activities to capitalize on these positive developments. 5. The RAG membership needs a greater balance to provide insight from various sectors of the region. Specifically, there is a need for greater representation from young providers, minorities, women, and allied health personnel. ° 6. ‘There is no formalized appeal procedure provided in the current CNYRMP grant application packet. The region's review process is scheduled for a complete analysis at a later date; however, there should be the immediate implementation of a formalized appeal procedure for all grant applicants. 7. Project #38, The Cooperative Organ Bank is disapproved. . The project, as presently conceived, demonstrated a lack of coordination and integration with other renal activities and fails to meet the |. region's total needs for a kidney program. 8. Project #6, Home Hemodialysis Training Program is recommended for continued support at its present level. It was noted that the goals of the training unit are not clearly stated and that the project will not attain maximum efficiency until such time as this has been accomplished. : -~-6- * 9. Project #40, Satellite Clinics Serving Rural Areas of Central New York, This project is disapproved on administrative grounds. In its present form the agreement of affiliation is to be with two private physicians rather than with a nonprofit corporation or . institution as required by grants management policy. 10. The CNYRMP Bylaws fail to comply with the RMPS policy which sets forth the respective roles and responsibilities of the grantee, the RAG, and the program staff. This policy was formally issued in the form of a News, Information and Data (NID) publication on August 30, 1972 and has been sent to all regions. Under the current Bylaws, the Council of the Upstate Medical Center is given the authority to appoint RAG members upon the advice of the RAG. The Bylaws require modification to turn the authority for RAG member appointment over to the RAG, thus making the RAG a self-perpetuating body. 11. The region has a need to strengthen its figeal management capabilities. A Management Survey Visit will be scheduled in the future to evaluate the situation and to provide constructive guidance. The site visitors expressed concern over the low rate of expenditures and the resultant lapsing of funds. Funding Recommendation The site visit team recommends approval of the anniversary request for program staff and projects in a reduced amount of $889,000. The team recommended $429,000 for program staff salaries and $460,000 for project activities. It was believed that this amount would be sufficient to permit the active recruiting of a well qualified staff and, at the same time, not permit the program to be overburdened by a large number of project activities. The site team is impressed with the program's need for an.enlarged. staff which will increase its competencies to develop a solid program. This must be the region's highest priority in the upcoming year. -7- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 1. GOALS, OBJECTIVES, AND PRIORITIES (8) The region's new goals and objectives represent a new direction which ig consistent with the RMPS mission statement; however, as noted earlier, they do not reflect local health needs. The objectives were developed by the Planning & Priorities Committee created in December 1971. ‘The Committee was chaired by Dr. Edwaré Hughes, Director of Community Medical Service (New York Medical Society). Other members of the Committee were chosen because of their personal knowledge of the region's health needs. The Committee had representatives from both consumers and providers. The CHP "B" and the CHP "A" agencies were also invited to participate in the formulation of the region's new goals and objectives. ms The Planning & Priorities Committee used the following basis for the formilation of the goals and objectives: 1. The data made available at the RAG meeting of December 2, 1971. 2. The stated goals and priorities of the CHP "A" end CHP "B" agencies. 3. Mini-contract proposals which had been submitted by health pro- - fessionals. ‘This procedure enabled the region to see what people in the region perceived to be their problem areas. kh. The RMPS mission statement. 5. Data provided by the Community Medical Services (New York Medical Society). On March 2, 1972 the following goals and objectives were approved: 1. "Improvement in the system of health care delivery by assisting in the evaluation of existing health systems and in the develop- ment and evaluation of potentially effective alternative health care systems with particular attention to the rurel, inner city, and elderly medically disadvantaged.” . 2. "Increasing the availability, efficient utilization and capacity of health care personnel while providing for their continuing competency.” 3. “Strengthening regional cooperative arrangements in order to make maximam use of available resources." ce re cae ne earner cama mine 8 ee -8- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 1. GOALS, OBJECTIVES, AND PRIORITIES (8) (Contd) Although these objectives are listed in priority order, the Planning and Priority Committee hopes to formalize explicit priorities by the end of the calender year. , “ In addition to a lack of explicit priorities, the gite visit team found no evidence that the program had established short or long-. term goals. The final statement of the goals and objectives was mailed to 5000 health professionals in March 1972, at the time the requests for grant applications for 1973 were circulated. Approximately 57 letters of intent were submitted. Of these, only 15 failed to fail within the CNYRMP's goals and objectives. This was an indication that the health providers had understood and accepted the region's program and a further indication of the broad nature of the stated objectives. An examination of the CRYRMP grant application reveals that 52% of the region's requested operational activities are directly related to their highest priority objective of improving primary patient ne care for the medically deprived rural, inner city and elderly residents of the region. The region has made an honest attempt to revise its goals, objectives, and priorities; however, it has been handicapped by the resignation ‘ of its former Coordinator, operating for the petter part of the year 7 with an interim Coordinator, @ smell staff, a RAG which requires restructuring and a number of other disadvantages which have combined to make progress aifficult. Now that the new Coordinator has been named, the situation should begin to stabilize and the coming year should see the evolution of more specific and more meaningful goals and objectives. Once this has been accomplished the program should pegin to take on & more positive outlook. ee ee ee ee Recommended Action ~9- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 2. “ACCOMPLISHMENTS AND IMPLEMENTATION (15) It should be recognized that this program had only three professional staff members for most of the year since the last site visit; however, the site visitors were able to ddentify some noteworthy accomplishments. The RMP's new Spanish-speaking Health Planner worked closely with the Ny-Penn HMO Coordinator and Model Cities staff in Binghamton. Her work resulted in the development of a proposal to Model Cities to fund an Ambulatory Care Clinic. = The Library Coordinator stimulated hospitals to apply for library improvement grants. As a resuit of her efforts, three hospitals each received $3,000 grants. The Emergency Medical Syetem Consultant developed an Information Guide to be used in working with the New York State Bureau of Emergency Services and the CHPs in the development of local and regional plans for the delivery of Emergency Health Services. The CNYRMP program steff planned and implemented two training programs. The purpose of the first program, Medicetion Education Program, was to update nursing home personnel with respect to the proper utilization of recently developed medications. The second program will take place in September 1972, and will address itself to the training of nursing home personnel to enhance their skills as activities leaders. Some activities initiated by the CNYRMP have been extended or repli- cated throughout the region. The site visit team noted that the Pulaski Model Rural Ambulatory Care Center, operated in conjunction with the Family Practice program at St. Joseph's Hospital in Syracuse, is being replicated by the C. S. Wilson Hospital in Johnson City, New York. This hoepital has submitted a proposal to create a compre- hensive rural health care system at Barnes-Kasson Hospital in Susquehanna, Pennsylvania. Thia development is a tribute to the efforts of the CNYRMP to move its expertise to areas outside Syracuse. The Nurse-Clinician program psovides another example of a project being extended throughout the region. Two-thirds of the participants of the first class were from Syracuse while less than one-fourth (227.) of the participants in the second class came from Syracuse, The regionalization aspect of this program effort was viewed positively by the site visitors. -10- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 2, ACCOMPLISHMENTS AND IMPLEMENTATION (15) (Contd) In addition, the region plans to work with the other New York State RMPs in such joint efforts to enhance its activities in public relations, program evaluation, and cancer registries. " A unique coordinating board has been developed in which the RMP program staff and members of the NY-Penn Health Management Corperation work together to insure integration and cooperation of all planning and implementation of programs in that subregion. In this way the CNYRMP is fulfilling, in part, its role as a coordinating health agency. ' A mini-contract has been given to the Neighborhood Health Center in Utica. This has resulted in making health care more readily accessible to inner city residents and in moderating health costs by providing primary care outside of a hospital emergency room. This had been the nO only other alternative left to these inner city residents... The Pulaski Rural Ambulatory Care Center has increased the availability and accessibility of care for people living in Northern Oswego County. Many of the 200 patients per week which are seen in this center had formerly been patients of a Pulaski general practitioner who is now retired. The Librarian, EMS Consultant, and Health Planner have given pro- fessional assistance to those people in the region who have requested their help. For example, the Medical Consultant, who recently joined the CNYRMP, is providing professional asgistance and consultation to , those engaged in family practice care. Up until now, the CNYRMP has not been involved in peer review mechanisms and has not specifically examined the quality of health care being rendered in this region. However, the minutes of the Executive Committee meeting held on May 25, 1972, states the following: "The Executive Committe directed the staff to consider the problem of quality of care as 4 priority for the next program year and to direct efforts of the program staff in the establishment of means of measuring quality care and upgrading that care when it is found inadequate." In light of this mandate, the program can be expected to address this aspect of health care in the near future. oe eee ee ee ~_ we = = oo me Om ‘Recommended. Action EE -1li- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 3. CONTINUED SUPPORT (10) All proposals submitted to the CNYRMP must give evidence of possible sources for continued funding. In the course of examining the projects presently being funded, the site visitors observed that © during the evaluation of the Nurse-Clinician project, the phasing in of tuition was strongly emphasized. The Model Rural Ambulatory Care Center is expecting that patient fees and local fund raising will aid in phasing out RMP support for this activity. Thus, the recycling of funds is being accomplished and the need to accomplish this is recognized by the region. On the negative side, the site visitors noted that the Dial Access project will not be self-sustaining since it is having problems in finding sources of continued support. The region will be forced to find alternate means of supporting this activity or will need to accept the fact that it has failed to demonstrate its value to the users. The St. Regis Reservation Clinic, Project #31, has not shown evidence that the CNYRMP staff has adequately negotiated formal agreements with funding institutions which define the extent of their present © and future participation. This must be done if the region is to avoid problems which can arise when there are misunderstandings of responsibilities and authority. a A major problem which has confronted the Home Dialysis Training project has been its lack of success in locating financial support for each patient. Of the sixteen proposals submitted for funding, very few had realistic plans for continued support. This was a major factor in several CHP reviews. For this reason, the region faces a true need to recruit a full-time staff person who is skilled in administrative negotiations which will result in the acquisition of continued support for the . worthwhile activities initiated in the region by the RMP. ee ee ea ee ee ee me ee Re ee Recommended Action -12- RMP; Central New York PREPARED BY: Jerome Stolov | DATE: 10/72 4. MINORITY INTERESTS (7) | . As mentioned in the section on goals, objectives and priorities, the number one priority of the CNYRMP relates to improving the system for health care delivery to rural, inner city, elderly medically disadvan- taged, and etc, To accomplish this, the region will need to add minority members to its staff who will bring the insights and linkages necessary to work with the ménority groups. . The population of the entire 17 county region is about 3%, minorities. The site team observed that only three out of 17 mini-contracts were targeted to the inner city populations, while the majority of projects appear to serve rural residents. The CNYRMP has not significantly improved the quality of care delivered to the black minority populations. However, the region's highest ' priority project was the St. Regis Reservation Health Clinic for Indians. .An example of RMP supported activities that resulted in training members of minority groups was the funding of the training of a nurses aide and a LPN for the Utica Neighborhood Health Center. The St. Regis” Reservation Clinic, Project #31, also has a training component for local manpower development from among the local Indian population. In January 1972, a Spanish speaking Health Planner was added to the CNYRMP program staff. Her assignment was to work with consumers, model city agencies, community action programs, and the Spanish Action League. She has also made contact with the Mohawk Nation which resulted in CNYRMP funding a mini-contract to this group. It is fair to assume, based on her early accomplishments, that this staff member will make a significant contribution to the future efforts of this program. “ : As of June.1, 1972, the Central New York professional program staff had three females and three male members. One of the females represents the Spanish speaking minority group. a -13- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 _ 5. COORDINATOR (10) The present Director has been with the CNYRMP since 1968; however, he has only been in his new position since, July 1, 1972. From October 1, 1971 through July 1, 1972, he was serving as the region's Acting Director. While he was the Acting Director he was successful in expanding the RAG's minority membership and in gaining the sppoint- ment of the directors cf the region's three CHP "b"' ageacies to the RAG. He employed a management consultant to help him develop an organizational chart which was consistent with the new CNYRMP direction. In this process the duties of program staff members were redefined through the development of job descriptions. This resulted in changes for several of the staff members and provided a guide to the type of competencies the program needed to seek in its future recruitment efforts. A paragraph in the annual report of the RAG states, "John Murray, Assistant Coordinator, was named Acting Coordinator and has done a remarkable job in adapting our program to the evolved RMP national mission, as well as local needs. He has instilled in all. of us a new enthusiasm for RMP." It was apparent that he had acquired the respect of the local health community and, on this basis, was appointed to the role of Director in July. The site visitors were concerned because he has failed to establish an effectively functioning program staff. The visitors questioned the Director's failure to delegate authority and his strategy in not filling the Associate Director, Assistant Director for Program Planning and Development and the Assistant Director for operations positions. The Director planned to consider existing program staff as potential candidates for the above positions. The team felt that the program needed these positions filled with well qualified health professionals in order to establish an effective staff. On the basis of the Coordinator's views toward the delegation of authority and his failure to seek highly experienced. health profesaionals for the key program positions mentioned, the site visitors believed there is a need for the Director ; to rethink: his approach and to attempt to strengthen the program through improved administrative procedures, The Director's good working relationship with RAG is attested to by the fact that the RAG's Ad Hoc Selection Committee nominated him to be the program's Director., and the full RAG unanimously voted to approve this nomination. In summary, the site visitors viewed the Director. with ambivalence. ~14- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 5 COORDINATOR (10) (Contd) | They perceived him as a man who related well with people, groups, and institutions throughout the region and, in so doing, represented the CNYRMP in an excellent fashion. On the other hand, they saw him as a man who lacked the managerial skills to recruit and properly utilize the program staff. This reinforced the need for an "in-house" Assistant Director for Operations who could effectively build and properly utilize the staff. ee ee ee ee ee ee ee Tm Recommended Action 6. PROGRAM STAFF (3) The former Director and many of the staff have left in the past year. This has left the program vastly understaffed. Both the new Director and his remaining staff are to be commended for the heavy work load they have carried in recent months. It is also quite apparent that it is impossible for them to continue at this pace. Unquestionably, the top priority this program faces is the enlargement of the program staff with qualified individuals to fill the key staff vacancies which have been mentioned repeatedly throughout this report. The site team noted that a physician associate director has not been appointed as recommended in the 1971 Advice Letter. The team learned that at the present time a member of the program staff has been designated to serve in the dual roles of Assistant Director of. Operations and Coordinator of Emergency Medical Services. This practice is contrary to RMPS policy and is obviously too much for one man to handle effectively. In addition to those positions requested by the region, the site visitors recommend that consideration be given to hiring a well qualified nurse and an allied health pro- fessional to balance the range of competencies of the program staff which is expected to carry out a broad-based public health program consistent with its stated goals and the overall mission of the RMPS. ba ee we ee we ee ee ee ee ew mR Rm mm Recommended Action -15- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 7. REGIONAL ADVISORY GROUP (5) The present CNYRMP RAG breakdown is as follows: 13 practicing physicians, 14 members of the public at large, 7 hospital admin- istrators, 5 educators, 4 goverment officials, 3 CHP "b" agency directors, 2 lawyers, 2 nurses, 1 dentist, and 1 head of a social Service organization. The RAG has good geographic representation. There are five minority members on the CNYRMP RAG. In light of the program goals, there needs to be greater representation from these groups. Four out of the five minority RAG members are black; the fifth member is a representative of the Spanish-speaking community. There are no Indian representatives and this must be corrected in light ‘of the program's need for input from this segment of the population. The site visitors also noted that there,were only three female members on the RAG and felt that this should be increased. The Binghamton Model City Agency, the Oswego County Migrant Health Care Committee, and the Community Action Program of St. Lawrence County each have representation on the RAG and this was viewed as an excellent means of getting inputs from throughout the region, Four of the five minority members serve on CNYRMP Technical Review Committee and one minority member serves on the. Executive Committee. Minority representation on the Executive Committee needs to be increased, With the establishment of a new Planning and Priorities Committee, along with a new Review and Evaluation Committee, more RAG members are going to be more directly involved in the decisionmaking. This increased involvement and decentralization of the decisionmaking process was viewed as a step in the right direction. The Executive Committee meets bi-monthly and not less than one week prior to each RAG meeting. The recommendations of the Executive Committee are presented to RAG and are subject to questioning and reversal by the RAG. The RAG Chairman is knowledgeable and involved in the program and, as such, is an aid to enlightened actions which will strengthen and coordinate the program's activities. The site visitors learned that the RAG exercised its authority in at least one instance by approving a project which had not been recommended for funding by the Executive Committee. The site visit team was unable to determine whether the RAG provides guidance to the program staff. However, it was noted that the Chair- man of the RAG is in telephone contact with the CNYRMP Director. . -16- RMP: Central New York 7. REGIONAL ADVISORY GROUP (5) (Con on a weekly basis. and the. Director established a pridg enable them to work in.a more The reorganization of CNYRMP's RAG © the following standing committees: and Priority, Fvaluation, Manpower, nating Board for the N¥-Penn area. committees there are Ad Hoc Committe disease, emergency medical services, In summary, past year and has way to go to acqu as defined by RMPS. The process of the News, Information and Data (NID August 30, 1972 should serve as the revitalize this body. made some pregress ) eee Recommended Action PREPARED BY: Jerome Stolov This close communication betwe was viewed as constructive in e between two segments 0 coordinated fashion. esulted int Nominating, Executive, Primary Patient Care and Coordi- the RAG has undergone some dr fre a RAG which can restructuring must continue and DATE: 10/72_ td). en the RAG Chairman the sense that it f the CNYRMP which will he establishment of Planning In addition to the standing es on matters related to kidney and cancer. amatic changes during the there is still a long ly fulfill its mission ; however, effective pulletin issued by RMPS on guide to the future efforts to Doe ee ee ee 8. GRANTEE ORGANIZATION (2) The Research Foundation provides sup Center Business Office in the areas grants administration. special assistance in areas such as negotiation. The region plans to ut Office more for additional legal preparation of salary schedules descriptions which have emerged 0 result of the management consultat study this aspect of the program. Lo The bylaws, however, relationships required by RMPS betwe has been forwarded to all regions in Information, and Data (NID). Accord the responsibility of selectin current bylaws specifically give the responsibility to appoint RAG member -—a_ wae ewer er eee They have als m advice, pe which are consistent with the job n the new organization chart as a need to take into acco g and appointing its own members port through the Upstate Medical of purchasing, personnel, and o assisted the region by giving {ni-contract formulation and ilize the Upstate Medical Center's rsonnel recruitment, n which had been contracted to unt the recently formalized en the grantee and RAG. This policy an August 30, 1972 issue of News, ing to the RMPS policy, the RAG has . The Council of Upstate Medica s and this must be modified. 1 Center the’ -L7- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 9. PARTICIPATION (3) The CNYRMP Program Director meets with staff and board members of the four CHP organizations in the region on a monthly basis to - discuss program activities and plans. Both the Binghamton and Syracuse Model Cities agencies elected me delegate each as members to the CNYRMP RAG. In addition, there are also members from the Board of Directors of the Community Action Programs. Many CNYRMP RAG physicians serve in official capacities in various committees of the New York State Medical Society. Still another indication of participation is the 134 applications which were requested for the mini-contracts and the 57 letters of intent which were actually submitted to the CNYRMP. In previous years, proposals numbered from 5 to 10 per year. The use of mini- contracts, although they have many drawbacks, do serve to involve and interest more people in the activities of the program. Although four out of seven members of the Executive Committee are from the Syracuse area, the mini~contracts and proposed projects which were approved for funding resulted in a program with geographical © balance. No major interest group appears to be exercising arbitrary. control over the program's activities. ae tema mmm mmm mame comarca tame meme testa tame cree une nte Recommended Action 10. LOCAL PLANNING (3) When the RMP receives an inquiry or letter of intent for a proposal the CHP is immediately contacted. Joint meetings are then held with both the RMP and the local CHP planning groups to further develep the proposal. When the proposals are completed, the request is sent to the representative CHPs for them to review in light of their role in regional health planning. In the past this procedure was carried out in the month preceding the submission of the CNYRMP's annual application; however, the CNYRMP is currently attempting to — give the CHPs and their own RAG more time to act on CHP comments by having the proposals reviewed on a continual basis throughout the year. \ ~-18- “RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 10. LOCAL PLANNING (3) (Contd) The CNYRMP plans to work closely with the local CHPs on a major project for Emergency Medical Services. Supplemental funds have recently been provided to the CNYRMP to conduct such an activity. The current plan is to contract with the local CHPs for setting up EMS councils and hiring local EMS Coordinators. It is interesting to note that the region hopes to utilize this project effort as a_ vehicle for the establishment of a CHP "b" agency in an area which = does not have one at this time. There is evidence to suggest that the CNYRMP has been successful “in its attempts to gain participation from other health agencies in the region. , ee ee eee Recommended Action — ~19- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 11. ASSESSMENT OF NEEDS AND RESOURCES (3) As cited in the section on goals and objectives the region uses five sources to identify its regional and subregional needs. However, the site visitors failed to see how these sources of identifying needs could be integrated to provide the information required to generate a well directed programmatic thrust. In addition, the site visitors found only a few examples of present program staff activ- ities which were in anyway related to the health care problems which had been identified by the five input sources. It is hoped that the recently established Planning and Priorities Committee will be able to synthesize this information in such manner that they will be able to establish priorities and refine the objectives in light of the current information. This is crucial to the CNYRMP if it is to be successful at re-orienting its program 80 that it can effectively implement activities which will alleviate the region's most pressing health needs rather than continue to pursue the path of doing "good works" in a fragmented, isolated, and uncoordinated fashion. its designated subregions and also a health system planner. It is hoped that the above personnel will help in the assessment of needs and in the identification of resources, so the program can develop a meaningful plan of action for the program's future activities. @ The region also plans to recruit four community coordinators for ee ew wwe we ewe ee em ee ee eee Recommended Action eA 12, MANAGEMENT (3) With the small staff that has been available to the Director, the CNYRMP has been engaged in an impressive number of activities. However, the site visit team observed that program staff activities did not appear well coordinated. It was observed that the Learning Resource Center personnel and the Librarian were people who could have been used to assist the manpower coordinator in his tasks. There were no indications that such a working relationship existed or was developing. -20- RMP: Central New York PREPARED BY: Jerome Stolov _ DATE: 10/72 12. MANAGEMENT (3) (Contd) As was mentioned in the section related to the Coordinator, the proper utilization of staff appears to be one of his major weaknesses. It is hoped that experience and confidence will help him to improve his management skills. : The region requires a monthly financial report and a bi-monthly progress report. In the past they required quarterly financial reports and semi-annual progress reports. This procedure should eventually aid the program to have current fiscal data which can be used for effective rebudgeting and enhancing its capabilities to capitalize on opportunities to move rapidly into activities which will advance the program. However, at this time, the region has an unexpended balance of $417,339 which speaks to the need to improve its fiscal management capabilities. Each project and mini-contract has been assigned to a program staff member. The program staff member was assigned to the project ‘or contract when the initial letter of intent was received. In addition, the staff member arranges for technical review and is also required a to give the results of the technical review back to the project ey director and to assist him in making changes which are required as a result of the review process. This approach places a heavy work- load on each staff member and prohibits him from utilizing his time to assist in program planning and development. It is on this basis that the mini-contract approach is viewed as an ineffective approach to project development by this region at this time. It reduces staff to a role in which they are forced to react rather than act on matters related to program planning and development. Further, the volume of contracts under review results in a workload which tends to delete staff time to the point that activities can become fragmented, disjointed, and uncoordinated rather then synthesized into a solid program which addresses the region's needs. Job descriptions have been developed without stating the required qualifications. It was noted that the Assistant Director for Administration was appointed to this position and there are indications that she does not have the qualifications and abilities to perform eftectively in this role. This is evidenced by the fact that the program has accrued $417,339 in unexpended funds during the past year. The team consequently recommended that a Management Survey Visit be scheduled early next year to provide the region with constructive ‘assistance in the handling ot its fiscal management activities. ee ee ee Recommended Action -21- RMP: Central New York. PREPARED BY: Jerome Stolov DATE: 10/72 .13. EVALUATION (3) The site visitors observed that the region followed last year's advice and designated a program staff person as its evaluator. However, the training and experience of the evaluation director was in the field of education and not in analysis. The CNYRMP RAG report recog- nizes the program's weakness in this area by stating the following: © "Evaluation has been an extremely difficult problem for this RMP, although we believe that the problem is shared by many others through- out the region. We are hopeful our two-pronged effort to correct this problem will bear fruit: (1) Reorganize our Evaluation Committee along subregional CHP area lines and involve RAG members on site visits; (2) Institute an interregional RMP effort in evaluation, spearheaded by our organization, to bring standardization and more expertise to all of the evaluation efforts in the Upstate New York's The site visitors expressed concern that only one project had been evaluated prior to the RAG's approval of the submission of the CNYRMP's annual application to RMPS. Although, the visitors recog~- nized the evaluation of the Nurse-Clinician project, it was felt this © process should have been done prior to the deadline for submission. The evaluation of this activity was viewed as quite superficial and, in fact, was no more than progress reporting and discussion. The new charge to the Review and Evaluation Committee is to site visit each project twice during a 12-month period. In addition to the pro-. jects, the Committee must also assess program staff activities and RAG functions. A task and a timeline plan for the Review and Eval- uation Committee has been established. The region is to be encouraged to implement the plan of the Evaluation Committee as portrayed in the task and timeline chart given to the gite visitors. There is also to be involvement of total staff in the evaluation process, so that all proposals can be continuously evaluated for continued funding or termination. The track record for evaluation is quite poor; however, there are signs that the future will see a substantial improvement if the current plan is successfully implemented. we mmm mmm mmm mmm mt meee Recommended Action -22- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 14, ACTION PLAN (5) As stated earlier, 52% of the project requests are related to the CNYRMP's first objective, to improve the health care delivery of the rural, inner city and the medically disadvantaged, but there is a need for greater community involvement and commitment. The site visitors felt that the newly proposed activities were not realistic in view of the types and numbers of program staff presently on board. They further felt that the utilization of the mini-contract approach was unrealistic at this time and, in a sense, placed the cart in front of the horse. In this approach the RMP was asking the region-at-large to develop its program rather than developing its own program which it could present to the region's residents for their ratification. The region's involvement in the formulation of the program is viewed as rightfully originating from the RAG members who should represent the region's health interests and not directly from people in the region seeking financial support to “do his thing" through a mini-contract. In view of the region's request to recruit ten key program staff “embers and recognizing that their planning and evaluation committees are undergoing reorganization, the CNYRMP's application which requests funds to manage 16 projects and 20 mini-contracts appears to be more than they can successfully accomplish during the next program year. Most of the current action plan is focused on “Projects” and does not involve the implementation of a coordinated, integrated program. In summary, it appears the region needs to find a new approach to program development and it is hoped that new staff will alleviate the need to look for short-cuts and will permit the development of a well constructed action plan which effectively and methodically attempts to alleviate the health problems of the region. ORT TOR BE is NE pes aramn ae Recommended Action 15. DISSEMINATION OF KNOWLEDGE (2) An example of program staff disseminating skills is represented by the work of the Library Coordinator. Requests for inter-library loans were increased to 5,127 or 56.5% over the previous year. The Biomedical Communications Network handled 343 computer searches or -23- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 15. DISSEMINATION OF KNOWLEDGE (2) (Contd) or 64.9% more than last year. She also taught hospital personnel throughout the region some of the means they might employ in order to obtain additional funding to enhance their operations. Three hospitals have received National Library of Medicine improvement grants as a direct result of the work and training done by the CNYRMP Librarian. ee em mmm eee ee es Recommended Action 16. UTILIZATION OF MANPOWER AND FACILITIES (4) Increasing the availability, efficient utilization, and capacity of health care while providing for continuing competency is a major objective of the CNYRMP. Several projects, namely, the Generalist © Nurse Practitioner Training Program, health service/education activities, medical emergency technician training and Heaith System North directly address this objective. These projects represent 34% of the total requested project funds. Examples of approved mini-contracts for the current funding year which include the utilization and/or training of allied health personnel are: 1) Creation of a Neighborhood Health Clinic (an LPN and a community worker/nurses aid was hired with RMP funds). 2) Training professionals and paraprofessionals to work as a team in remotivation and reality orientation. 3) Geriatric Day Care Center. 4) Homemaker service for the Madison Company. 5) Establishment of satellite medical centers. 6) Expansion of Volunteer Childrens' Clinics to rural areas. 7) Comprehensive Home Care as a follow-up to Pulmonary Rehabilitation. -24- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 * 16. UTILIZATION OF MANPOWER AND FACILITIES (4) (Contd) - it is difficult to determine how much these activities will benefit the population in underserved areas. In an attempt to reach the underserved areas, the region is setting selectivity standards for applicants to the Nurse-Clinician Program. These standards will attempt to insure that applicants from rural and ghetto areas will receive high priority in. terms of being the beneficiaries of the training provided in the Nurse- Clinician Program. , The region through its health service/education: activities is attempting to involve the health education institutions. ‘The site visitors learned that CNYRMP is involving the Maxwell School of Government by having its Masters Public Health Administration candidates participate in evaluation and planning studies. The idea of training interns from the Maxwell - School is commendable, providing the staff can adequately supervise this endeavor. A bibliography on geriatric patients with chronic respiratory disease has been assembled by CNYRMP staff. Overall, the region is making a sincere attempt to utilize existing manpower and facilities and, in this instance, the mini-contract approach may have been somewhat helpful to them in their efforts. On the other hand, the approach to this problem is handicapped by the shortage of program staff and the need for a more systematic approach which a larger staff could make possible. ee ee Recommended Action 17. IMPROVEMENT OF CARE (4) The CNYRMP has utilized studies and data supplied by the CHPs. The ALPHA CHP "b" agency, for example, has established improved ambulatory care as its main priority. Both proposals, #19 - Pulaski Model Rural Ambulatory Care Center and #40 - Satellite Clinics Serving Rural Areas, address the problem of improving ambulatory care which the CHP agency, from its vantage point, recognizes as the area's major health problem. -25- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 17. IMPROVEMENT OF CARE (4) (Contd) Attempts to exploit transportation services are best shown by the CNYRMP mini-contract to the Geriatric Day Care Center in Canton. This proposal has enabled the contractor to bring patients to and from the day care center. There is no public fransportation in this area. Thus a simple, but highly significant problem has been resolved by the CNYRMP intervention. The CNYRMP should be commended on this effort. The CNYRMP is currently working with a Neighborhood Health Center in Utica, the Pulaski Model Rural Ambulatory Care Center and the Rural Urban System of Health Care in an attempt to amplify the capabilities of each of these programs to being better ambulatory care to the areas they are serving. eee eee eee ee ee ew eer Re ee STS eee Recommended Action © 18. SHORT-TERM PAYOFF (3) The St. Regis Reservation Clinic appears to promise early access to improved health services within the next year. The Pulaski Clinic is already making additional services available to its rural population and is receiving assistance from the CNYRMP in this effort. It is too early to evaluate the impact the Nurse Practitioner Training Program will have on moderating costs of health care; however, it appears that this effort will add to the efficient utilization of personnel and result in an increase in the accessibility and availability of health care services in the region. There is reason to believe that the EMS project will enhance the availability and quality of health care in the next two or three years. The region has already begun activities which are designed to attract individuals and agencies to participate in its Emergency Medical Service (EMS) project. It is hoped, that through involvement in the EMS activity, the people and organizations in the region will develop linkages with the CNYRMP which will result in additional activities which can be worked on in cooperative fashion. In the overview, the CNYRMP has been making a contribution to the improvement of care in the region; however, this contribution will become more significant as the program continues to restructure and -26- RMP: Central New York PREPARED BY: Jerome Stolov - DATE: 10/72. 18.°* SHORT-TERM PAYOFF (3) (Contd) increases the size and competencies of its program staff. The over~ ‘riding problem faced by the CNYRMP is the shortage of program staff and, until this is resolved, the programmatic efforts will suffer. Under the staffing circumstances this program has faced during the past year, the accomplishments in this area are commendable. — sw ee ee Recommended Action -27- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 19, REGIONALIZATION (4) Both the EMS project and health services/education activities are examples of activities aimed at multiple provider groups. Although the Nurse~Clinician project is located in a single provider insti- . tution, the students come from all parts of the region. The CNYRMP plans to assign program staff to each of the four CHP subregions. These coordinators, by proper exchange of information, will be in a position to encourage sharing of facilities and manpower on a regionwide basis. The Health System North project is an example of how new linkages are being established with the University Health Science Center in Syracuse by providing for an on-going rotation of medical students, interns, and residents throughout the CNYRMP's northern area to provide health care in a section which is particularly short of physicians. This has proven to be an effective means of providing health care services to the underserved residents of this isolated portion of the region. New linkages between northern Oswego County and St. Josephs Hospital Health Center in Syracuse, and between the rural Susquehanna County in Pennsylvania and C. S, Wilson Hospital in Johnson City, New York are also being established. The region believes these preliminary negotiations will assist it to extend its program more effectively throughout the region in the future. The EMS project is expected to create a regionwide and ultimately a statewide network for communication and transportation for the enhancement of Emergency Medical Services and Ambulance Transportation Centers throughout all of New York. The region appears to be making headway in the extension of the benefits it can bring to the Central New York area. Recommended Action -28- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 20. OTHER FUNDING (3) The CNYRMP has attracted other funds when planning Project #46, Health System North. The E. J. Noble Foundation paid for the sumer fellowship program because RMP funds could not be used to pay for this type activity. As mentioned earlier, three hospitals have received National Library of Medicine improvement grant funds as a result of assistance provided by CNYRMP staff. The team, however, was disappointed to note that several of the new projects being proposed appear to be mere extensions of activities normally conducted by other agencies. In spite of this, the CNYRMP approved them for RMP funds. For example, Project #28, The Well Baby Clinic and Project #45, A Coordinator for the Spanish Speaking Coummunity, appear to be services that should be provided by the County Health Department and the County Mental Health Board respectively. Thus, the CNYRMP program staff and the RAG appear to be in need of closer contact with RMPS and to become more familiarized, with the specific nature of the RMPS mission. The Dial Access project is being terminated in September 1972. Reports from the CNYRMP staff indicate that the hospital is exploring other governmental or commercial sources of funding; however, it does not appear that this program will be able to become self sustaining. Once again, it is possible to speculate that this project could be sustained if the CNYRMP program staff was sufficiently large and had the competencies required to provide the necessary assistance to the project director to help him find alternate sources of support. This has apparently been a useful service to the region and may be the victim of inadequate RMP staffing. The Nurse-Clinician Training Program, which is entering its second year of CNYRMP. funding, has been encouraged to charge tuition for the training being rendered and thus become independent of the need for RMP support. It is hoped that this can be done successfully so the activity will not collapse when RMP funds are withdrawn. The development of the St. Regis Reservation Clinic gives no evidence of having generated funds from any sources other than RMP. The Home Dialysis unit is also failing to meet its funding needs because there has been no success in having the A. C. Silverman Hospital incorporate the expenses of the unit into its per diem rate. The CNYRMP, in light ~29— RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 20. OTHER FUNDING (3) (Contd) of the failure to secure the backing of the A. C. Silverman Hospital, is attempting to organize a Dialysis Buyers' Cooperative as an aid to renal patients. There is concern over the Pulaski Rural Model Ambulatory Care Center which has been funded by the CNYRMP for one year, It has been unable to generate patient fees. It is encouraging to note that a local fund raising program has provided some funds and that five acres of land have been donated to it. These are temporary steps and the major funding problem still remains unresolved. The mini-contracts, on the other hand, as a precondition to funding, have been generating other private, local, state and federal dollars. For example, one mini project is utilizing National Health Service Corps personnel to provide family centered primary medical care is also receiving CNYRMP support. Overall, the CNYRMP has not been successful at acquiring other sources of funding for projects they have initiated. Until such time as the program addresses the need for administrative/fiscal competence and is successful in bringing this expertise to bear on the development of projects in their formative stages ~-- the ability to sustain activ- ities will be limited, as is now the case. : emer ema eee Recommended Action -30- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 Renal Disease Activities The CNYRMP has funded the Home Dialysis Training program, Project #6, and two feasibility studies which are currently in operation. It is requesting support to initiate Project #22, Cooperative Organ Bank of Central New York. The Dialysis Buyers‘ Cooperative feasibility study was found to be lacking specific objectives. The study also lacks evidence of a working relationship between the patients and a local Kidney Foundation. At this time, the region lacks a Kidney Foundation and an effort should be made to encourage the establishment of such an agency which once established, could be helpful to the region's entire kidney program. The Comprehensive Areawide Kidney Service feasibility study for the Nv-Penn area appears to dovetail its objectives with those of the Dialysis Buyers' Cooperative feasibility study. It too has no specific objectives that could be measured at the end of one year. This group could also benefit if it were able to work with a local: Kidney Foundation. Since most of the region's proposed activities are directly related to the functions conducted by the Kidney Foundation, they would be well advised to place high priority on efforts to get the placement of a local Kidney Foundation activity in their area to supplement the entire kidney program. a ' The Home Dialysis project goal of training 12-15 patients per year appears to be non-specific. The end stage renal population of Central E New York is in the range of 60 to 75 patients per year. The training capacity of the Home Dialysis two-bed unit and the stated number of personnel far exceeds the anticipated number of patients who need to be trained. In addition, the training facilities are now located in high cost, high overhead hospitals. The site visitors believe the region should take cognizance of cost factors in all future decisions. The goals of the Cooperative Organ Bank, Project #22, are too general. It was reported that only six to nine transplants will be done in the first year. The project proposal leads one to believe that there would. be a far larger number of organs potentially available and therefore it follows that a greater number of transplants should be possible. The past year only three transplants were performed and only 14 trans- plants have been done in the past four years. Unless the goals are elevated and unless the numerous organizations who are involved such as the Hemodialysis Committee, the Transplant Committee, the Consumer -31- RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 Renal Disease Activities (Contd) Cooperative Committee and the Organ Retrieval Committee are coordinated, the region will be unable to care for its renal failure patient pop- ulation. .No kidney program can expect to be successful in light of this type of fragmentation. It was therefore recommended that a Regional Kidney Proposal be developed with a time goal that is realistic and related to the com- munity needs. Any future kidney planning should include provision for care of patients throughout the entire Central New York region and not be limited to the urban areas, i.e., Syracuse, etc. The Central ‘New York area is uniquely suited for Home Dialysis and for this reason this aspect of the region's kidney program should be expanded. With regard to the Organ Donor Program, it was suggested that this program needs to relate to other CNYRMP programs in the region. As. an example, the Organ Transplant Center should utilize the Emergency Medical Care program to relate to communications and transportation of the organs. The trauma surgeons and neurosurgeons working in emergency services represent the greatest resources for donor kidneys. They must be included in the planning for the program in order to capitalize on the advantages they can bring to increasing kidney donations. The Organ Donor Program needs to develop a procedure list, permission forms, develop sterile containers for organ trans- portation and develop a perfusion device which can be placed in a centralized location and in a location which is well known to all potential users. A cost and recovery schedule should also be developed. lLastly,there needs to be lay education in regard to organ donation which will further increase the supply of organs needed for the region's renal failure patients. -32— RMP: -Central New York PREPARED BY: Jerome Stolov DATE: 10/72 SUMMARY The sense of the site visit team was that this program made a valiant effort during the past year to remedy the deficiencies noted during the 1971 site visit; however, the obstacles which they faced were i insurmountable. For most of the year the program was forced to work with an Acting Coordinator and this was a difficult arrangément for him and an even more severe handicap to a program making an attempt to bring about required changes. Under the circumstances, the Director (now officially appointed) and his small staff must be commended for their personal commitment and sacrifices made during this period to improve the program. , The future for this program is viewed as promising in light of some positive developments noted during this visit. First and foremost, Mr. John Murray has won the confidence of the RAG and has earned the role of Director and, in this sense, can now begin to operate more effectively. Although the site visitors are convinced that Mr. Murray needs to sharpen his administrative skills, they share the respect and admiration of the local officials who selected him for this new role. Time and experience will bring him confidence and his dedication and determination to generate an outstanding RMP in Central New York will, in all probability, be realized to the benefit of the ‘region's residents and RMPS. The program has added three new staff members and they will certainly reinforce the efforts of the currently overworked small staff. . The region is requesting ten new professional staff members and, in this request, the site visit team lends a strong endorsement. A selective recruiting program should bring the competencies Mr. Murray needs to . build the effective program he desires. There is little doubt that the program needs to enhance its planning. It must specifically identify where it wants to go and determine the best way to proceed. To effectively accomplish this, the: Director must receive help from the established Priorities Committee, Evaluation Committee, his RAG, and from the new staff he is planning to recruit. It ig essential that he make maximum use of these resources to develop a sound plan. In the area of fiscal management, the program faces a definitive need to strengthen its competencies. This must be recognized as a priority matter which needs to be addressed and resolved at the earliest possible moment. Effective planning will be an aid to the resolution of this deficiency. ~33- RMP; Central New York PREPARED BY: Jerome Stolov DATE: 10/72 SUMMARY (Contd) ‘In all, the program faces a challenging year ahead; however, the site visitors feel the potential for success is on hand and are optimistic that the CNYRMP will have success in their efforts. eo Review Cycle: Uctoper/ivie (of 7 7 pes BRIEFING DOCUMENT vt poston? “ CNYRMP OPERATIONS BRANCH: asterm Operations Brancl NUMBER: 0050 NX Frank {Nash COORDINATOR: Mr. John surrey. . ( Staff for RMP: \ Jerome J. Stolov LAST RATING: 226 x - TYPE OF APPLICATION: ‘, 3rd Year Regional Office Representative: f] Triennial / / Triennial . Robert Shaw y ‘, 2nd Year Management Survey (Date): 7 / Triennial {xi Other y ~ Anniversary Befor A Triennial res atin icted: None or Last Site Visit: x Scheduled: 1973 \ ast a de . June 3, 1971 fle uuyd Effie 0, Ellis, M.D., Chairman, Special Assistant to Executive Wice- President, American Medical Association; Member_of RMP Review Committee §=#§= = |... a Henry Lemon, M.D., Member of RMP Review Committee, Professor of Medicine “fp Nebraska Medical School “val, Alfred L. Frechette, M.D., Commissioner of Public Health, Massachusetts 7, , . aA e Department of Public Health P< F. M, Simmons Patterson, M.D., Executive Director, Association for the North Carolina RMP, Durham, North Carolina William Lawrence, M.D., Chairman RAG, Alabama RMP, Internal Medicine- Cardiology, Birmingham, Alabama Miss Jean Schweer, R.N., Director of the Division of Continuing Education, University of Indiana School of Nursing Chairman IRMP RAG Committee i Staff Visits in Last 12 Months: June 13-16, 1972 - Jimmy Roberts, M,D.and Jerome Stolov Staff assistance regarding health service/educational activities. June 8, 1972 Robert Shaw CNYRMP RAG Meeting April 12, 1972 Marian E. Leach, P.HD, DPDT, Staff Assistance regarding health service /education activities March 22-24, 1972 J. Stolov, Executive Committee Meeting February 2-5, to observe mini contract negotiation December 1971-J. Stolov RAG meeting and Staff Assistance followup of advice letter Recent events occurring in geographic area of Region that are affecting RMP program: 1. July 1, 1971 Experimental Health Services Delivery System Funded for the NY Penn Area (southern tier of CNY) $275,000 -2- nal Health Service Corps Sites (Cato Meridian, Chenago — - Memorial, Barnes Kasson, W. Winafield [Little Falls Hospital] Faxton Hospital Chateaugay, N.Y.) 3, Transfer of Neighborhood Health Center transferred to Medical Center (Upstate Medical Center) 4, Maxwell School in Public Administration offers degree in Public Health Program 7/72. 2. Approved Natio OSWEGO. 100, 897 6,513 “S106 221 815 BROOKE DEMOGRAPHIC INFORMATION Population characteristics: rural, urban, minority, income level, age distribution Health education institutions Pertinent health data Geography: The Central New York Regional Medical Program is comprised of 15 counties in Central New York, plus two counties in adjacent northern Pennsylvania. The boundaries were determined by Medical Trade Areas, Medical Education and part graduate educational patterns and to conform with the boundaries of the State Health Department regional efforts. The Region is approxi- mately 96 miles wide in its East-West perimeter and 271 miles long from the Pennsylvania State Line on the south to the Canadian Border on the north. Geographically, it is ore of the larger but relatively thinly populated Regions in New York State. The total land area is 26,016 square miles. Population: Approximately 1,800,000 Population density 68/square miles Approximately 60% Urban Approximately 97% white INCOME - Average Income per Individual, 1969 State (of RMP) $4421 (NY) *--SMSA - $3154 United States $3680 AGE DISTRIBUTION - Median Age Approximately 30 Percent of Total by Specified Age Group, 1970 Age Group State U.S. (NY) Under 18 yrs. 33 35 18 - 65 yrs. 57 55 65 yrs. & over 10 10 METROPOLITAN AREAS Name of SMSA Population (in 000's) Total 1,263.0 Binghampton NY~Pa. 298 .0 Syracuse, NY aX 629 .2** Utica ~ Rome, NY 335.8 kk ~ 1976 Census for Metro area ~ increased _ from 564,000 in 1960 City of Syracuse — 197,000 total population, incl. 21,000 Negro (about 10.8%) FACILITIES Hospital Data In New York State there are 48 hospitals with general medical and surgical beds or a total of 7,564 acute care beds and four hospitals with extended care facilities with 472 beds, in the Central New York region. It is significant that more than 60 per cent of these institu- tions have less than 125-bed rural character of the area, and the need for smaller hospital units to serve large geographic areas. The largest portion (60%) of beds is, of course, predominately in the group of hospitals which have a larger than 200-bed capacity. In Pennsylvania there are five hospitals in the area with a total number of beds of 475. Four of these have under 50 beds and the Robert Packer Hospital hac 305 beds. There is associated directly with the Robert Packer Hospital. the Guthrie Clinic which has approximately 50 full-time practicing physicians organized in a group practice. Personnel Physicians - There are approximately 2,700 M.D.s (133/100,000 and approximately 55 D.0.s8 Nurses - There are approximately 15,000 registered nurses of which only about 9,000 are active. Pertinent Health Data MORTALITY RATES, CY 1967 MORBIDITY - ILLNESS RATES (1965 - 1967) Deaths per 100,000 Population Rates per 100 persons, by Age Group Cause RMP (State) U.S.196 Age Pergons w, % with Group acute cond. chronic cond. Heart Disease 437.4 364.5 Age N. Ease N,East — Group Geog. Reg. U.S. Geog.Reg.U.S. Cancer 186.4 157.2 All Ages 194.5 190.2 47.0 49.5 Vasc. lesions 88.8 102.2 (aff. CNS) 45-64 yrs. 119.9 124.5 64.5 71.1 All causes, 1019.4 (935.7 65 & over 107.9 103.4 80.6 85.6 all ages 45-64 yrs. 1143.9 1143.5 65 & over 6168.8 6042.5 HEALTH EDUCATION INSTITUTIONS COUNTY-INSTITUTION St. Lawrence Clarkson College St. Lawrence University SUNY ** College at Potsdam SUNY Agriculture & Technical Institute at Canton Madison Colgate University Hamilton College SUNY Agriculture & Technical Institute at Morrisville Cazenovia College Tompkins Cornell University Ithaca College Broome SUNY University Center at Binghamton Broome County Technical Institute Onondaga LeMoyne College Syracuse University Onondaga Community College SUNY Upstate Medical Center PROGRAM (Special note of paramedical programs) Technical Institute Liberal Arts Liberal Arts Nursing (2-year program) Liberal Arts Liberal Arts Nursing (2-year program) Practical Nursing Medical Laboratory Technology Nursing (2-year program) Sloan Institute of Hospital Administration Graduate School of Nutrition Physical Therapy Health professions programs in planning stage Medical Technology Dental Hygiene X-ray Technology Liberal Arts School of Nursing, Special Medical Education Programs Dental Hygiene, Medical Laboratory Technology Medicine, Nursing, X-ray Technology, Medical Laboratory Technology, Graduate School ~7- Cortland SUNY College at Cortland Oswego SUNY College at Oswego Oneida Utica College (of Syracuse University) Mohawk Valley Technical Institute Cayuga Auburn Community College Jefferson Jefferson Community College Health Education Liberal Arts Medical Technology Nursing Associate Degree Program Associate Degree Program Hospital Schools of Nursing (Three-Year Diploma Programs) ‘ COUNTY -HOSP ITAL St. Lawrence A, Barton Hepburn St. Lawrence State Cayuga Auburn Memorial Broome Binghamton General Binghamton State Charles S. Wilson Onondaga Crouse-Irving St. Joseph's Oneida Marcy State St. Elizabeth's Utica State Jefferson Mercy House of Good Samaritan cITY Ogdensburg Ogdensburg Auburn Binghamton Binghamton Johnson City Syracuse Syracuse Marcy Utica Utica Watertown Watertown COMPGNENT AND FINANCIAL SUSAR BEFORE T TAN ANNIVERSARY APPLICATION 5 ARY RIENNTUM Current Annualized Level 04 Year * Request For °. 05 Year Request Funding F __ — Year /_/ SARP /__/ Review ee Tete nae aes or S ~ whe wid a ‘CONTRACTS VEVELCPAENTAL COMPONENT : * [PERATIOGNAL PRCJECTS ° hs/ea Pediatric Pulmonary Oth Cher TOTAL DIRECT COSTS COUNCIL-APPROVED LEVEL 196,000 {= 489,102 653,205 ( 44,660 ( 91,062 (142,320 A Oe ws ke F-0; oF/ 537,745 $ 850,000 x - per award dated 12/3/73 i iF 40 w-~eew ~~ a AUGUST 2.41972 REGICK 50 CENTRAL NY RMP SUPP YR C4 OPERATIONAL GRANT (DIRECT COSTS CNLY) REGIONAL MEDICAL PROGRAMS SERVICE FUACIAG FISTORY LIST lM RYPS=CSw-JTCRHU“ 2S 5 ALL RECUEST ANC AWARCS AS CF JUNE 30 197 8 ? a 3 pT) w 2 pee Cpe eg nes Bad AWARCEC —- AWARCEC AWARE AWARDED AWARCEC ¥* REQUESTED FeOteeee RECLESTED RECUESTEC ———"“EGMPCNENT 61 c2 c3 ~—" 64 ** 05 C7 KC TUTE destin d2e72_ TOTAL #* CL /T3~ ~12/73 ons T4<12/ 7% OL/75-12/75 = TOTAL 7 — — — 7 ~ ae ~ ¥e COOO PROGRAM STOFF 462500 244ECC 426575 1293575 #* 489102 485102 Gti CORET RURE TELC 164160 201800 14440€ Sic3acc #* C02 REFAR CONSUL SE vesicc, —_s_sbeanec SCC #20800 88 gos ~cNerca Cty TURc Yeo. 7100 720€ 216CC ee OC& FAPELY PRACT LE 3ec00 =< 43800 33000 | _ _Lasecc #4 005 ~ wo N SUPERV CC 1e2cc 18300 e+ . 606 HCRE CIALYSIS T 43200 1460C 48228 we1ze +e 35259 35259. “Goa NY SiGKOID DERE 41200 41200 *¢ coo CIAL ACCESS © z12co. i 30€ 15cCC __ &7400 ## OLE REG LRAG fESGR OCS 90600 14800 105400 ## 018 AREA FEALTE ECU ee 7687C_ T4870 #4 oo 7 OLS RCCEL BLRAL APE ©2423 £3433 4# Stee? 58687 O21 NURSE CLINICTAN 43632 437632 99 56355 £0165 “278 EMERGERTY PECTIC C22 aC33C oe 35312 35312 0228 EVERGEACY.MECIC _ 87320 _ 51320 +* 22066 22690 —“922C EMERCENCY MEDIC 107250 107250 «# 10000 1906C6 0220 EWERCERCY PECIC 259cC 255CC #8 17200 17200 ~o22E EMS PUBLIC EDLE 6000 £000 4% _O226 EvsS FUPLIC ECUC 2095 205C5 # 6460 6460 G23. HEALTH S¥STEM N ZLECT 21507 %¢ 024 FESLTR SYSTEM N - 1€25¢ 10250 4 "0267 KEALTR SYSTEM & z92C 252C ¥# 027 FEALTR SYSTEM N ee _ _. «8000 goog +* oo. "928 “HEALTH SYSTEP A ~~ 36CC 35CC #@ 7672 7672 _026__HEALTH SYSTEM N 400¢ 4cco_¢¢4 —~Oid” FEELTF SYSTEM N 24445 24445 $e O31 _REALTR SYSTEP A ' ETERE ETSER ¥F 128300 _ . 136300 O32 tEALIF SYSTEM KO 33526 32526 46 033 CCYPUNITY FEALT ee 6135 eS ee . ; O37 RBUFAL LRESDA SYS e 84882 64582 0368 COOPERATIVE ARG oe 44660 2 ~ 6466C “O35 BKEALTR PASTATERS rr) 24631 248 3t O40 SATELLITE CLIKT __ _ oe ** (64730 64730 oar CCCECINATCA FOR ~— ae 14990 : 14560 _042__ WELL BCWAN CLIK _ _ 43sese 19685 “gay CERIATAIC DAY C oe 2288 25268 044 CEATRALLY ACP F “+ 44840 44840 045 HEALTH SYSTEM E my) 14232¢ 4 142320 046 HESLTH SYSTEM N ee _.. ve 84036 i 84016 ee . - TOTAL = 3724C0. =—_-«1812800 645100 1135796 _—«- 3266096 we 14203465 1420349 y JULY ay L972 BREAKOUT OF REQUEST 05 PROGRAM PERIOU ast aot REGION ~ CENTRAL NY RM 00050 LO/72 PAGE 2 RMPS-OSM-JTOGR2-1 .. Beech As PEATE oe se eee eabek Uae fo ctu eee rare eg etek vies weeranel arores, Oblae Poiterw, snot 1 ‘ ut VE AM t tsb VU AR t ' | APPhe PERIL LE APPRe PEKLUL) PREVEQUSLY } rpkeviuusey tf vikecl } oo anuikeel t TOtAL ‘ | ] LF suPPORT | UF SUPPORT | FUNDED 1 APPRUVED 7. casts cosTs j { | 7 Gd PRUGRAM STAFF { { 1 1 1 | Ji Cove PRUG st | \ 5496.102_1 i 1 $4H92102_1 $L17298L1 $on7,.023 1 34) HUM ALYSLS THAINING P t | ! | } j J ee euahan aaah ‘ i 1 £3592259 1 I l $352.259 4 $93,028 1 $44,287 1 G19. RODEL RUvAL AMBULATORY C ' a) ! $ t ; j 1 ' see CERIEM : 1 $5Be SAL l 1 $59,687 1 $172059_1 $752746_! ~~ - AENING { ( i j } Ozt MUKSE CLINICIAN TRAL 1 i \ 950.255 ' i 356} i $50,355_1 ~ TION 1 i . | i i bo O22A EKS COURDINATI . l ! $352312 i l $35.312_1 $15,255.1 $ 500587) es ~"" $336 CHP AREA EMS COUNCIL CCHI 4 \ . | f ‘ PONENT. } } $222.090 $22.090 ond £222990 } G22 EMS RADIO CUMMUNICATION | t ‘ SYSIEM L I $10.900 $10.000 (£102000 Gz2v EM> MET TRAINING MUDEL | | j ! { { 1 j i ! £17.200-1 i 1 £17,700. { 2 17a209 4 Ol2F EMS PUBLIC ED CGMP HEARTI ‘ I | t j i j - . ASSOUCIALLUA UE UPSTAIL j | $6.460_1 j j $65460.1 L bs h60_1 O22 _COMPOUREUL IUTAL i tt $912062) | 1 A $9k2002Z 11 $152220bt s10os dT) O2e WELL BACY CLINIC { I l i cae ! ! 4 I i i $72h12_1 | j $1.h12_1 i £72572) O31. ST REGIS KESER VATION cil | | | t j | ' Ble : it j £138.300_1 j f- $3.38.300_1 L $139.300 ! _ G37) KURAL UnsAN SYSTEM CF Hel 1 _— J J i . | ! 1 ELIH CARE L | ! } $84,582 1 $84,5h2.1 j $64,59H2 1 . O25 COLPESATIVE URGAN BANK ul ! } ! 4 ! j } E CENIPAL is_Y¥ i j i} t $4436600 1 $44260600_1 £25a086 1} 2690746 5 _ 039 HEALTH HAIATENANCE TESTIS I i { l | i I HG PELGKAS_—.. L i 1 $242831_1 $242431 1 1 W£24s8i_t 060 SATELLE Sec CLINICS IN RURE . \ _- | 1 | i { i AL AKESS L 1 ] 1. £442730.1 $642,130) 1 36407301 Osi CCORDENATCP FUR SPANISH i J i | | | i I SPEAKING CMMI TY L j i 1 $34,990_1} $14,990 1 i _£$14.990 1 O42 WELL WOAsh CLENIC t { { | { t i i j ] i 1990855 £29,605 1 j £19.085 15 _ 043 GEREATRIC LAY CAKE CENTE] { - | i. t 1 ! 1 j BS i 1 j 5 i $255258 1 $250258-1 {$2522 98_ 1 . O24 CENTRALLY ALM PT DISCHAK} t j i t 1 i ' GE PRKUGRAM 1 lL l j $440840 4 $442840 1 L $44,860 1 Oe5 HEALTH SYSTEM EDUCATION | { i ts, i J { t ACTIVITIES i 1 i 1 $1422320_1 91422320) $162272_1 $1582592_1 G66 WEALTH SYSTEM NORTH | t ’ _ 1 i j i 1 j j $84,016 1 l $84.0)6 1 $1823323 $302.348_] | ! as Lt . 4 i i. \ TOTAL | | $9545453 | i $465,896 | . $124205349 | 2792013 | $106992362 | "i Region: Central New York RMP Review Cycle: 72 HISTORICAL PROGRAM PROFILE OF REGION In March 1966, the Upstate Medical Center Council, appointed by the Governor of New York, selected a 15 member RAG and approved the Research Foundation of the State University of New York as the Fiscal agent for the applicant institution. Dr. Richard H. Lyons, was ap- pointed as acting Program Coordinator. In December 1966 the Region's planning grant application was approved for two years support at the amount requested. In November 1967 the Region submitted its continuation application for 02 year of planning and requested additional funds to expand Core and Planning activities. In addition, the Region requested three years support for 4 projects: Project 1 - Continuing Education in Nursing, Project 2.- Rehabilitation Consultation Service, Project 3 - Oneida County Tumor Conference, and Project 4 - Family Practice Pro- gram. Both the continuation application andthe four operational activities were approved and an award granted. At the recommendation of the RMPS Committee, a site visit was conducted to this Region in March 1968, by Dr. Edwin L. Crosby, Dr. Stanley W. Olson, Dr. Dan A. Mitchell, Dr. Philip A. Klieger, DRMP, Dr. Veronica L. Conley, DRMP, and Mr. Robert EF. Jones, DRMP. In their assessment of the Region the site visitors had difficulty in determining the overall strategy of the Region which appeared to consist of identify- ing perceived needs, especially those of physicians and hospitals, to take steps such as epidemiological surveys and meetings that would identify the most critical needs, and then to call upon the resources of the State University of New York to meet those needs. The RAG seemed to be representative of the Region and the medical professions endorsed the regional medical program concept. The Region submitted in August 1968 a renewal planning grant applica- tion requesting support for core and planning activities for a five- year period. At the recommendation of RMPS National Advisory Council a site visit was conducted to this Region in January 1969, by Dr. Henry Lemon, Dr. M.J. Musser and Mrs. Sarah J. Silsbee, DRMP. During this phase of development it appeared that the RAG was representative of the medical needs and interests of the Region. The visitors, however, believed that representation from the 34,000 underprivileged people of Central Syracuse should be added to the RAG from the Neighborhood Health Center Council. Bylaws for the RAG were being developed and a study of the practice of making the Upstate Medical Center President the RAG Chairman had been requested by Dr. William Bluemle, President SUNY Medical Center. The visitors believed that a major defect in RAG organization was the lack of a functional executive committee that could help the RAG develop policy guidelines and act: on behalf of the RAG on decisions requiring immediate attention by. the Coordinator. Procedures for ~12- the review of grant proposals and defined responsibilities in the review and decisionmaking process had not been well developed. Although a large number of RAG subcommittees had been organized, few were active. It was apparent from the operational projects submitted that there had been insufficient coordination to date. There did not appear to be a regional plan or an obvious strategy for further development of programs in the Region. The visitors found difficulty in clearly identifying those physician continuing education activities related to the Upstate Medical Center from those of the RMP. There also ap- peared to be little integration between the nurse in-service training program at the Genter and the RMP's nursing continuing education project. The visitors recommended that the University Medical Center (U.M.C.) give priority to the recruitment of physicians for core staff (there were none other than the coordinator). The UMC responded that until. vacant departmental head positions were filled it would be difficult to interest physicians in faculty appointments. That once vacant departmental head positions at the Center are filled, top priority would be given to filling the Regional Medical Program positions. In June 1969, the Region was granted an award combining the planning and operational grants which consisted of Core and 8 projects. Support for an additional project (#12 - Prevention and Effective Recovery from Cardiovascular Ilinesses Through Knowledgeable Nursing Instruc- tion) was requested. In February 1970, the Region requested funds for a continuing Medical education project in Rural. Pennsylvania but no additional funds were recommended. During the July 1970 review cycle Council approved at a reduced level, project 45 - Medical Library and Information Service. The Region submitted a supplemental operational grant application in November 1970. The National Advisory Council recommends funding of the Mobile Stroke Rehabilitation Service - project 2R for an additional year. Two other projects were not recommended for funding. On April 1971 the Region had to reduce its funding $59,507 since RMPS had a reduc- tion in our apportionment. In May 1971, the Region submitted a triennial application, and requested for its 04 year of operation $1,413,928 d.c. Consequently on June 3-4 the Region was site visited by Effie 0. Ellis, M.D., Henry Lemon, M.D., Alfred Frechette, F.M. Simmons Patterson, M.D., William Lawrence, M.D., Jean Schwer, R.N., and RMPS staff. Major recommendations of the site visitors were: the, appointment of an associate director, the RAG to expand its membership, a program priority and decisionmaking process to be developed, and a program plan to be + recommended only one year funding: After receiving developed Geumcili the Gavice letteD Dr. Lyong resigned. Mr. Murray was appointed Acting Director. \ RSS - 13 - In December 1971, $537,745 d.c. was awarded to the Region for 10/1/71 - 9-30/72. Later that month staff visited the Region to follow up on the August advice letter. The turning point in this Region's history appeared to be when the I Region requested from its constituency, ideas for mini contracts of ~ yw, less than $5,000. It received 134 préposals. In February, staff was - Le able to observe the negotiation process involved in awarding these contracts. On March 1, 1972, the Region moved into new quarters. . Under the implementation of the 3 cycle review system the Region has been extended an additional 3 months. At the request of thé approved a level o over a 15-month period equa é was the need to implement Health Systems North Projects 23, 24, 25, 26, 27, 28, 29, and 30 and to aid the Mohawk Nation through support of Project 31. The Region was also permitted to expand its area health education cooperative efforts in Projects 18 and 30 (Project. 30 was part of Health System North). This decision was based on recommendations from a member of the Professional Technical development staff following a special consultation visit April 12, 1972. Since the Region received funds to expand its health service/educational activities, Reviewers felt that the Region's request for special education monies for Projects 34, 35, and 36 were duplicative. Con- sequently, staff requested to visit all the sub-regions to review health service/educational planning efforts. The decision to have a site visit team review efforts to date was recommended. Although staff Felt the Southern Tier could utilize funds, this decision would have to be delayed until after the site visit. The Region did, however, receive approval of its "Emergency Medical Service Activity Project” 29A-F for $261,705. This amount was awarded June 21, 1971. —. / 7 1,135,796 d.c. for its 04 a The Region, as of August 1972, now has year which terminated December 31, 1972. Recently .we were informed that Mr. Murray, in|June 1972 was made ger executive director. ow Zoo © eee STAFF OBSERVATIONS Principal Problems: 1. 2. 3. 4. 5. Region: Central New York RMP 7 14 - Review Cycle: October A program plan must be better defined and measurable over time Better project monitoring is needed The Program staff coordinating health service/education activities needs to be more effective The goals and objectives need to be wre specific Continued support of ongoing projects appears weak Principal Accomplishments anurPwn rk ee © ee 7. New Coordinator appointed RAG expanded New organizational structure Active CHP-B participation Greater access to RMP funds for disadvantage groups Participation of many groups in CNYRMP as observed through the mini contract and project proposal submission The review process appears workable and equitable Issues requiring attention of reviewers 1. 2. 3. What is the program plan for CNYRMP? What data was used to aid RAG in its decisionmaking? vi Is the Executive Committee balanced in terms of representation and effectively functioning? What is the recruitment plan of the coordinator? Will expenditures be lapsed as in the jast? Since, as reported on p. 80 of the CNYRMP Anniversary application only one project evaluation was completed, the program's evaluation process should be thoroughly reviewed. A special effort should be directed to correlate the relationship between program planning, operational programs and the inter- action of program and staff activities. Projects still appear to have been developed spontaneously rather than based on need and a regional plan. REVIEW CYCLE: October 1972 _ RMPS © STAFF BRIEFING DOCUMENT Region: COLORADO/WYOMING Operations Branch: MID-~CONTINENT Number: RM 00049 Chief: Michael J. Posta Coordinator: THOMAS A. NICHOLAS, M.D Staff for RMP: . (Executive Director) Mary E. Murphy, MCOB Oper. Officer * Harold O'Flaherty, MCOB, Back-up Last Rating: 294 Charles Barnes, GMB x Robert Walkington, OPE TYPE OF APPLICATION: Regional Officé Representative 3rd Year (Program Director) f7J Triennial /"7 Triennial Daniel Webster Man t ey: tive-early ' [x7 ae [7 other agement Survey: Tenta ive-early '73 Last Site Visit: (Dates, Chairman, Camittee/Council Members, Consultants) September 9-10, 1971: Philip T. White,M.D., Chairman Review Committee Mrs. Florence R. Wyckoff, National Advisory Council Jessie B. Barber, Jr. M.D. ,Consultant Humphrey H. Hardy, Jr.,M.D., Consultant . Staff Visits in Last 12 Months: (Date & Purpose) April 10, 1972: Consultation on Educational Centers May 22-26, 1972: RMP Orientation - RAG Meeting June 6-18, 1972: Evaluation Visit August 1971 ~- July 1972: Technical Consultation & Site Visits (ROR ~ Program Director) - 20 Recent Event Occurring in Geographic Area of Region that are Affecting RMP Program: 1.'. New Coordinator (Executive Director), Thomas A. Nicholas ,M.D. as of 7-1-72 Interim Coordinator, Robert Jones, M.D. continues as Assistant or Program — Director. 2. HMO Continuation Grants (910) to: Alamosa Cammmity Hospital, Alamosa, Colorado Rocky Mountain HMO, Inc., St. Mary's Hospital, Grand Junction, Colorado Poudre Valley Foundation for Medical Care, Fort Collins, Colorado 3. Pediatric Hemodialysis Center Grant Award of $102 ,000(in cycle) to serve Rocky Mountain Region. 4. Pediatric Pulmonary Project refunded as supplemental grant of $40,000. 3. Harry P. Ward, M.D., newly appointed Dean, University of Colorado Medical School . Totten aan frevty | hie 6 a faa ibn a Re ee = ‘ 4 ue ‘onan be! y —h @} Wi, 1 fie , te be Waanota por desvy I . % . ae f, , Ct tts eee! Ae “ ae beyenne Pte. Spe “NS Amma a grees ‘ mies bs ‘ i Peet, ¢ a Seale Geeks aie et ANS atado Springs TA goat *)) pe st . nou” . ye ma LOL te} wks _ “~ wee ak a4 HEW Region VIII Two entire States, overlap with Colorado portion of Intermountain overlap with Wyoming portion of Mountain States Count ies: Colorado 63; Wyoming 24 ‘ angressional Districts: Colorado 4; Wyoming 1 at large REVIEW CYCLE: October 1972 REGIONAL CHARACTERISTICS GEOGRAPHY ~ Colorado/Wyoming RMP encampasses the entire states of Colorado and Wyoming (201,400 square miles) Colorado - 97,400 Wyaming - 104,000 POPULATION (1970 Census) Total: 2,539,700 Density: Colorado ~ 2,207,300 Colorado - 20 per sq. miles Wyoming - 332,400 Wyoming - 3 per sq. miles % Urban: Colorado - 78.5 Wyoming: 60.5 . % Non-White: Colorado - 4.0 Wyoming: 3.0 AGE DISTRIBUTION - INCOME (1969) : % Under 18 yrs: Colorado-36; Wyaning-37 Average/per individual % 18-65 yrs: Colorado~55; Wyoming-54 Colorado - $3,680 % 65 yrs. & over: Colorado-9; Wyaning-10 _ Wyoming - $3,447 MORTALITY RATES ~- Per 100,000 (1969) : Colo. eh U.S Heart Disease 291.0 312.4 364.5 Cancer 125.2 130.2 157.2 Vascular Lesions (Aff.Cns.) 82.1 91.4 102.2 All Causes, all ages 828.1 881.0 935.7 FACILITIES AND RESOURCES SCHOOLS ~ Medical School ~ Univ. Colorado, School of Medicine 1969/70 - Student enrollment: 398 1969/70 - Graduates: 80 Pharmacy Schools 2 Schools - Student enrollment: 117 ( Colorado-113; Wyoming-64) Nursing Schools Professional Nursing - 13 schools; (Colo. - 12; Wyo. - 1) 1969/70 Student enrollment: 1,551 (Colo. 1,379; Wyo. - 172) Practical Nursing - 15 schools (Colo. - 13; Wyo. - 2) - Accredited Schools for Health Professionals Cytotechnology: Colo. - 2; Wyo. - 0 Medical Technology: Colo. - 16; Wyo. - 1 Radiological Technology: Colo. ~ 16; Wyo. - 2 Physical Therapy: Colo. - 1; Wyo. - 0 HOSPITALS ~ Commmity General and V. A. General - No. of Beds Colo. Wyo. Colo. Wyo. Short term 74 27 9497 1825 Long term 5 2 679 | 698 _V.A. General 2 1 593 174 REVIEW CYCLE: October 1376 -4- REGIONAL CHARACTERISTICS 7 NURSING AND PERSONAL CARE HOMES oS : No. of Beds ae : . Colo . ; ° Colo . q e Skilled Nursing Homes 113 S _ 9576 oT Personal Care Homes (with nurse. care) 18 7 1475 330 Long texm Care Units 22 5 565 95 pace nee Physicians Non-Federal M. p.'s and D. O'S (1967) Active: Colorado - 3248; Wyoming - 297 tmactive: Colorado ~ 258; Wyoming ~ 29 Ratio: Colo. 165 Active per 100,000 pop.; Wyo. ~ 94 active per 100,000 pop. U. S. Rate: 132 per 100,000 population M.D. Group Practices (1969) Colo. Wyo. 104 Single Specialty 10 General Practice 13 4 Multi Specialty 40 4 Professional Nurses Active 8208 1204 Inactive 2619 410 Ratio: Colo. - 425 actively employed; Wyo. ~ 379 - per 100,000 population Licensed Practical Nurses Colo. ‘Wyo. Active 3697 2t7 Inactive 809 9 Ratio: Colo. - 181 actively employed; Wyo. - 80 - per 1.00 ,000 population Region: COLORADO /W? * ) 4 " Review Cycle: ~ "RM 000 40 COMPONENT AND FINANCIAL SUMMARY . ANNIVERSARY APPLICATION DURING TRIENNIUM Current Council- Recommended Recommended Annualized Approved Region's Funding For Level For . ; Funding Level For Request For © TR Year Remaindcr Component TR Year 04 TR Year TR Year 95 _ of Triennium , aa] /_/ SARP /_/ Review Committee PROGRAM STAFF 492 ,506 636 ,916 _ ; é . a) CONTRACTS 107 ,260 DEVELOPMENTAL COMP. 96 ,000 110,000 /_}xes /_/ Xo OPERATIONAL PROJECTS 406,580 565,275 , ; i Kidney (€ 91,800 ) ( ) EMS C ) C i) “hs/ea ( >| ¢ ) »\ ; m Pediatric Pulmonary C ) ( » Cther ( dy} ¢ ) 2 mee — mC TOTAL DIRECT COSTS - 1,102,346 1,403,991 ot COUNCIL-APPROVED *NAC level raised by $150,000 (Special action NAC 6/72) 2 LEVEL 1,292,346* Supplemental funds of $40,000 for Pediatric Pulmonary Project continuation. _. « . XL ~~ : JULY 16,1972 BREAKOUT OF REQUEST ne 05 PROGRAM PERIOD vw iv RKPS~GSMJTOGRE~3 (5) 42) (4) a LOENTIFICATEON OF COMPCNERT | CCKT. WITHIN] COAT BEYONO| APPR. NOT 1 NCW, NOT ' cyarent t current | i | APPR. PERLOCL APPR PERICO} PREVIOUSLY } erevicusLy | cirtct 3 INDIRECT 1}. TOTAL t j ce suppcrt | CF SLPPCRT | FUNDED | AEFRLVED \ costs i costs \ _ { od, . coco PROGRAM STAFF CHRMP 1 j \ { t \ j ] . O00 POTN ee eee 1 1 | geggashg | ——$59.052 188924868} Doco DEVELCPMENTAL COPVFCKEAT J ' | { 1 | 1 \ . Doe e eee nee edd DLA ODF 1 j j ey ee ae C17? ULTRASCNIC TRAINING PROGt i | a, { t : | j _ OM ahh = <2 me PAT J I era tL b cen i $4,392 1 $76:163 j _- O21 RADLATICN THERAPY PLANATS | {- { On Mey TIEE SHEPIEGCOELUL 1 —-4202836-4- L 1 1 gpgsha fate L282 G25. PHYSICIAN SUFPLFT FERSCKI t 1 1 1 | wb Fe en ant cece eec eet J 4 Vgagana5_1_———--——- bere 2822 ss 526 NURSE TRAINING FOR EXPAN 1 | { j ; | 1 ee DEQ BOLES.--—o en l 125.914 5 1 Lewewe dd 50515 gt 2s g3isi79 1. . O27? LABcRATORY TRPRCVEPERNT Pi ! an | { | } 08 EE EE BIEELBG wm nena ne beeen RGB ZF i tL 4 $232425.1 $6934 1. --220a 252 k 028 AULPSE PRECTITICHERS FRCEI i TY t j ! PNLEM_OB JENIEC HER -PECCEDS—-1 $1OL.2144 1 4 f. 210ia216-1 415.8872 $121.162-1 026 PeECUATAIC PEPCOLALYSIS Cl i 1 \ ; . j ‘ { ~ w ENTER BECKY BCVRISIN BEE $91,800) i } 4 s91,f00 t $19.720. 1 $1)1.520 1. ° . Bac FeRAL ANC URBAR GENETIC | j t 1 1 t-: i j © CCULSELIBG 0D SCBELUINS } 1 1° $121.820-4 1 61 3 a1 $134.289-1 O31 WYCHING- FCSPITAL SFAREC | i -t i ne i 22058 i t , w_INEQRHAILONSYS1E4 it 4 i $52,033.) $62,0111 } 452,01) J" > O32 HEALTH PRUGRAM FOR BIGKA] t 1 t ° t y. eee WORXEBS RUBAL LECB i 1 $1195 2Zi—1- 1 i €129s2221 $7,074 1 $128,292.14 _ whe TOTAL |] $14069,402 f $119,221 |... $7177 t $163,837 | 81y403059R J. 1479785 $ $1~5525776 be” ~: : e . . . ne omen cence nee weg mm me ces cement - ome ee eee Loa meee ress ae . a in hE , X . ~ ‘te be ~~ oe “3 ml caeeemnmrenetiarmemanans +re am ernment ome ee tee me enme wneee - a -” ne cate em eenee neat ccm me _ - ee men ce eee en aes eS ore. nr ad cee aaa ns eatin cee . 7 - im te m . . ° << ‘ + 2 me 2 cae eee ceeeernnennemnrenemaene mane aoe ama de een eer ce ren semen ee cece gorertcn oom rs femme te ee a cq cena Tm eee wn went mera mi oe ne rtateree meer senernneonmmtene IT : : = ‘ . - 4 . ’ oO ‘ . =, oy —_ _e oO ae 7 . cor por a ~ se . “ = rt- t. dees rmmen oe ne nmanesansins eemenomnmeneots wat et vec we cme seatectnres 4088 eee ee aoa wee ee | 2161 4aqow0: 2 woe JULY 16,1972 (5) a) COAT. WITKEIAY CONT. BEYGNDE APPR. NOT tN he NET (2) REGION ~ COLN-NwYORG BREAKCUT OF REQUEST 06 PACERAM PERIGD (4) Re 00040 10/72 PAGE 2 RRPS-CSN~JTCCP2-1 EDENTIFICATICA CF CCNPORENT + f aneet YFAR | I TCTal i § APPR. CERELUE APTA. PERILEL PREVIUUSLY § PRE WICUSLY 1 CLRECT 1 f ALL YEARS i {1 CF SUPPORT | CR SUFFCRT | FUNDED “} APPROVED t costs i JOLRECT COSTS | . . ‘ 1 I | i | j ! COOO PROGRAM STAFF CwRMP j { i J | | j f I $673.481_4 i i i $472.48) 1 i $1.310.397_ 1 DOOD DEVELGPRENTAL COMPCKENT } j i t i t t ' ‘Cueee 1 £116.06 1 1 I t $110,000 1 } $220,000! O17 ULTBASGNIC TRAINING pRocl | { | } ' i i snes i 1 $55,788. 1 l £55,788 1 L $127.553_) OZ1l RADIATION THERAPY rane} I ‘y I I { { wow 6 BY LIME SHARIAC € peu __sztasos.t. i | 1 $282505 1 i $49,060.10 O25 PHYSICIAN SUPPORT BErethi ‘4 i | 5 1 i NEL. i a3eacet i j 1 j $38,090. 1 $2724251 G26 NURSE. TRAINING FOR Eapant i j t t 1 ! i BP FCLES £2721B1.! i 1 $2718) 1 I $53,095 1 O27 LABCKATORY IMPRGVEXENT Ft i ! | 5 { ‘ GRAM WYOBING $220262 1 r l $222282.1 i $45,707. 1 O28 NURSE PRACTITIONERS sate } | j “4 i ~4 t LEM CHEENTED MED PECCEDS f $117,794] { ! lL $1173295_) l $219.910 1 O29 PEDIATRIC Pmeap ci t ‘ ! t t I i ENTER FCCKY YOURTAIN £EC f 374245054 ! 4 i $71.900. 3 i £163:200_1 O30 RURAL ANC UREAN terete i t ! 1 | t i t nm a QUA SEL IN _SCREEBING 1 ] i i $134.515_1 $114,515) i $226.34) 1 G31 WYOMING FOSPITAL SHARED i i | i j i { t ion DHE QRKATION SYSTEM i l l $52,185.) $52,185 1 L $104,196 1 O32 HEALTH PECGRAM FCR mia j ' t ' ' | t I cwwiil WORKERS. RURAL POOR i L A i i i $115.22)! ! { ' " ' . { i { TCTAL $10088,732 | . 4 $55,768 | $166,700 | $159311,220 | 1 $2.7155221 | cASa + a SANDAD M3 20 O43 f 4 45g CfE4 e i eee TT ALGLET 21972 RECIGNAL KECICAL PROGRAMS SER VILE pe EET TE EQRDING HISTCRY LIST Me prem ee TT anrolues Ss REGICN 46 copt-wycec — Avr SUPP YR 04 CPERATIONAL GRANT (OIRECT CASTS ONLY} __ Ath pECUEST ANC AWARCS AS CR JUNE 30 197 ‘ . 7 AWAFCED ARWAROEL AWAETES AWARCES pwarcec ## REQUESTEC REQUESTED REQUESTED RECUESTED a mC CNECHENT wR teem ey OTT be ee gat 8 go OT : NG “TETLE OlsT2~ 12/72 TOTAL &* OLS TIT NSE y Cl/ 74-12 /74 ols7s<12/75_ TCTAL 19 Nee TLE nnn EE rr $8 OM TS-12/75_ Ey coco FRCGRAR STAFF 4e2ccc 5256CC 4ETECC EG4GE4T 2147641 *F O3A916 673681 1310397 2 SH OGUTOEVELCFPERTAL — TECe OT occa” ae COOE == FOO OT ooz ecre st Ce acst £56CC §030C q7ecc 154000 *® ~ eee ectiy recta eo 45900 oA 100 Ee TCO cos FOE DIALYSIS T 2¢56G 367 27300 106900 ** igen yR eR PL RES INT 120266 Zecrce BmeCOT OO SOS~« TCU 8 a : Cod oTRAIKIAG FROGRA 269ca 58300 70200 57831 213231 **# ° _oeT_TRAUNING fpeg eter ECE 61260 ¥* oat ces CCMEC CORFE ERG 62200 70560 5490¢ pescco ** f —o16 ~ CONED STARR CELE gcice 69700 — 322000 48 O13 xP FECTE FEC PU SB1CC Tocce 2326CC LETSCC ** —~ Qa STAT O% FRCG CA aa] 3300 7800 —— 21100 98 615 REGICNAL PECTAT 737CC 24SEC A34e. 152001 ** are caREe CBE azeoo ~+i166 ao BC HE ° ee C17 ULTRASONIC TRAT oo W771 £5788 127859 orgs KEFSE SN RIMINGTTIITOSOCS~S~«S pert STE SCTE ae ~~ Cig CHR GIS EVAL PT 41600 37700 ‘ 79300 ** . g7477 REC EAT IRN” THERA 77 24464 peang ee 20556 S28 O woke” POO —-g2h) PHYSTCTAR S5S1S 4l1et G11ET ** 39338 38090 77425 B26 TRURSE TRAINING 24732 P4T32 ** 2E9T4 27iet ° “$5065 t O27 «LeeCRaTMRY TreR 21457 ° 21457 VF 23425 - 22282 45 TCT a7 27 028° KLESE prec FO g3048 wae lare «NAT 794 219010 z 7029 FECTATRIC HENOE 1¢20C0 102000, ** 91800 71400: 163266 i —o3O " RLAAL eo — os — , ra asisOS~™~C ng i C3L RYOMING rOSPITA of 52011_ €2185 104155 t 932 FEALTH CERE FOR ses OC SOE #F 119227 Tys22l os O33 - PECTATAIC PUL c ' 40000 40000 ** . 1 7 OR Ce ee 00 MCN em . Tre a = stenee "EES “cmon asses Ge ane BBE , . rr ie “4 . . t a 7 ee ne on ——— annem. are win ce ee ee amen ST ee ma ren ~ wy < : _ks m " : ‘ . f = . . a ~ - — aa ~~ a oe . ” ‘ OQ .* < ry Al ki 20 m7 | 2261 490% Region: Colorado/Wyaming . Review Cycle: October 1972 HISTORICAL PROGRAM PROFILE OF REGION Initial Planning Grant set boundaries of the proposed region as co-terminal with those of states of Colorado and Wyoming. Rationale was that University of Colorado Medical Center, with other referral facilities and Health Services of Greater Denver Area, serve as nucleus for most of Colorado and Wyoming. Since 90% of region population resides in Colorado, the boundaries of Colorado will be followed for data-gathering purposes. Adoption of political boundaries of Colorado simplifies the collection of data and coordination of the Regional Medical Program with other state health programs. Another factor in this decision is that portions of Wyoming fall under influence of three Regional Medical Programs: Intermountain, Mountain States and Colorado- Wyoming. Studies show that patient referral patterns in some Wyoming com mmities reflect allegiance to all three regions. First Planning Application submitted September 1966. Funded at $297,678 (D.C.) first year (1/1/67 - 12/31/68). Commitment for 02 year in same amount. Committee and Council recommended approval. However, concern expressed re- garding Region's geographic overlap in Wyoming with Intermountain and Moun- tain States RYP s. Pre-operational site visit in September 1968. Visitors confident regarding development of regionalization concept. Became operational 1/1/69. Awarded $849 ,053(D.C.) for support of Core and seven operational projects. Continuation application review 12/69. Three project progress reports showed weaknesses. Requests for use of carryover fumds vague and poorly justified. Related educational projects lacked coordination and evaluation was limited. Problem later corrected. Site visitors (12/70) concluded CW/RMP had not obtained anticipated sophis- tication. Program project oriented, RAG input limited, and data resources not utilized. Region not acting as project stimulator, but rather as project broker for ideas from health organizations. Developmental component vetoed. Need to become Program oriented, rather than project oriented. Previous goals, objectives and priorities general and not related to specific time frame. Throughout Colorado and Wyoming, primary effort in rural areas directed toward manpower and commnity organization. | Greatest impact of CCRMP from 1969-71 has been in area of continuing pro- fessional education. RMP met needs of regional physicians, nurses and allied health personnel, especially those in rural areas. - Awarded triennial status 11/71. “10- Region: __COLORADO/WYOMING Review Cycle: - October 1972. STAFF OBSERVATIONS Principal Problems‘ 1. Minority and "True Consumer" representation on RAG needs increasing. 2. Increased minority representation on staff, especially in professional category, needs attention. 3. CWRMP Program Staff is small (20). RMP has indicated need to increase staff. 4, Evaluation of Program Staff activities needed, as 51% of budget is used. for program activities. 5, RAG lacks involvement in the evaluation process. 6. Overlap of regional activity with Intermountain and Mountain states. Principal Accomplishments 1. Program Staff has peen stimulating project activity to a greater degree, rather than waiting for project proposers to initiate activity. 2. Evaluation process in regard to project activity has considerable vigability and impact. 3. CWEMP Staff has excellent cooperative working relationship with other health agencies. 4. Program has changed emphasis from categorical approach to that of improving the quality, quantity, and accessibility of health care services in Colorado and Wyoming. - 5, Subregionalization is underway, with offices active in Canon City, Colo. and Dubois, Wyoming. Offices are ready to open in Casper, Wyoming and Alamosa, Colorado. Tentative plans are for an additional subregion in Grand Junction, Colorado. , 6. Former RAG Chaimman, Thomas A. Nicholas, M.D., appointed new Coordinator W172. Issues requiring attention of reviewers For information only 1. Need for RAG to appoint an Evaluation Camittee. 2. Consider "Turf Probien" (overlap BYP s) recommendations as presented at 7/20/72 meeting. a. That an Inter-Regional Executive Council be established 1) to approve by majority vote all new program concepts proposed for overlap areas. , 2) to review regularly and infommally evaluate on-going programs in overlap areas. b. That IRMP's boundaries be re-aligned and areas of overlap among three RMP s be identified. c. That each RAG expand its membership to include the Coordinator (Executive Director) of each of other two RP s. For attention CkRMP is requesting an increase in funding above NAC approved level. Additional funds will allow for potential growth needed and will assist in meeting Cefined, unmet neeus. -ll- Colorado/Wyoming RMP Continuation Application Staff Review August 4, 1972 Mary E, Murvhy, R.N., M.P.H., Chairman Participants: Michael J, Posta (MCOB) James Smith (WOB) Harold O'Flaherty (M0OB) Peggy Noble (WOB) Yvonne Green (MCOB) Annie Dicks (GMB) Richard Reese, M.D. (DPTD) Eva Spell (OSM) Julia Kula (DPTD) Recommendation: Staff recommended funding of the Colorado/Wyoming application at the National Advisory Council approved level of $1,292,345, This amount represents a reduction of $111,645 below the - application request of $1,403,991. At the request of the MCOB and by special action of the June 1972 National Advisory Council, the approved funding level for the Program was raised from $1,102,346, The approved request of $150,000 plus the $40,000 supplemental funds for the Pediatric Pulmonary Project (#13) raised the funding level to $1,292,346. This substantial increase, it was felt, would provide Colorado/ Wyoming RMP sufficient latitude for expansion. Concern was expressed regarding two new projects: 1) Rural and Urban Genetic Counseling and Screening, #30, and 2) Health Program for Migrants and Rural Poor, #32, The Rural and Urban Genetic Counseling and Screening Project requests funding in the amount of $111,826 (d.c.). Major emphasis: of the genetic screening is on Tay~Sachs Disease, peculiar to the Jewish race, and on Sickle Cell Anemia, peculiar to the Black race. The areas of concentration were thought to be too limited, The budget was thought to be too large, especially in view of the small segment of the population which would be included, With such widespread national interest on Sickle Cell Anemia, the question was reised as to the availability of other resources, Developmental component funds have already been used to initiate project planning. It was later learned that Denver's black population has been stimulating interest and fund-raising, with a substantial goal, in order to further the project. -~{[Z- Page 2 The genetic and counseling clinic is to be located in Denver. However, staff with modest screening equipment will travel throughout the area. Patients will be referred to the Denver clinic for specific tests which cannot be done by the mobile staff. Staff recommended that if the project becomes operational, screening be extended to include a broader spectrum of disease categories. The Health Program for Migrants and Rural Poor raised concern regarding the stipend Ttem of $75,000 on Form 34-1 (page 16). The stipends are to be paid to nursing and medical students who deliver health services to the target group. The activity was interpreted as stipends for "basic education" which is adverse to RMPS guidelines. The project is worthy of merit and should become operational, The funds allotment to stipends requires re-evaluation. Questions were also yaised regarding the previously approved, but unfunded, Project #17, Training in Diagnostic Ultrasound in Community Hospitals. Concern was expressed as to the need of smaller hospitals. for as refined a technique. Such a technique would require very experienced personnel for equipment operation and result interpretation. A low priority, as given the project by the RAG, was staff concensus. Radiation Therapy Planning by Time Sharing Computer, Project #21, is planned for extensive expansion. Dr. Keese questioned the feasibility of costly expansion in training in relation to the actual need for such facilities. Relative to the application, it was noted that the priorities are more finite in scope than are the objectives. Why have the objectives not been prioritized? An apparent reason for this basic incongruity could be the fact that the priorities are consonant with the proposed projects, The region has been successful in securing local funding for continuation of projects whose funding has been terminated by RMP. The CWRMP is broadening its horizon through subregionalization and several key areas have been identified through regional plenning needs. Generally speaking, the RAG composition is satisfactory, although it was felt that more "true consumer" representation, as well as minority types, is desired. -13- tT Page 3 Evaluation of the Program Staff and activities is of high priority, as 51% of the RMP budget Is allotted to this area, In view of the concerns expressed, staff recommended that funding remain at the present WAC approved funding level of $1,292,346, RMPS /MCOP 8/15/72 HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION ¢ " A fON . DEPARTMENT. OF HEALTH, EDUCATION, AND WELFARE en : PUBLIC HEALTH SERVICE TO FROM SUBJECT: Division of Operations. and Develo t Qo | Director oN, abso DATE: September 7, 1972 men Director Regional Medical Programs Service Action on September 5-6 Staff Anniversary Review Panel Recommendation Concerning the Colorado/Wyoming Regional Medical Program Application RM 00040, 10/72 ag Gf, fe Accepted AS Oe} MYT Le (date ) Rejected ’ aatey Modifications; CONC ine but fuely eore c Ni ne , Ve - ise d by pie rhe Gee SAE REVIEW CYCLE: October 1972 TYPE OF APPLICATION: Anniversary within triennium RECOMMENDATIONS FROM RATING: _ 290 [x] SARP [7] REVIEW COMMITTEE f/ SITE VISIT /-7 COUNCIL FUNDING: RECOMMENDATION: The Staff Anniversary Review Panel (SARP) recommended funding for the Colorado/Wyoming RMP in the amount of $1,292,346 for the 05 operational year. This amount includes $91,800 for the kidney project #29, Pediatric Hemodialysis for the Rocky Mountain Region. The recommended amount ($1,202,346) rerlects a reduction of $111,645 below the application request of $1,403,991. RATIONALE: SARP felt that the recommended amount would provide the Program ufficient financial latitude for the projected expansion of Program Staff and activities within the Region. The National Advisory Council's approved funding level far CW/RMP was raised in June 1972, from $1,102,346 to $1,292,346 as the result of a special action by Council. CRITIQUE: SARP concurred with Staff regarding its assessment of the Colorado/ Wyoming RMP. The new Coordinator, Dr. Thomas Nicholas, a former active rural General Practitioner, is well known to most staff meibers having served as RAG Chairman for CN/RMP. He is also a RAG member on the Intermountain RMP. Dr. Nicholas! interests, talents and knowledge of RMP are in his favor. It will be with interest and anticipation that the CW/RMP is observed during the coming year. The priorities as established by the RAG appear consonant with project activity Concern was expressed that the RAG did not have its own Evaluation Committee. In view of the fact that 51% of the CW/RMP budget is spent on Program Staff and staff activity, an evaluation by’ RAG was considered top priority. — The RAG should place more emphasis on increasing its minority representation. "True consumer" representation could also be improved. Although the RAG lists thirteen "public members", the majority represent public leaders, top managemen etc, The need for representation froni the allied health field was also stresse The CW/RMP is very much aware of RMPS' urgent request regarding increased minority representation on the RAG and committees, as well as on Program Staff. Although in compliance, re-emphasis is needed. Subregionalization has made significant progress during the past year. Cooperative working relationships exist with CHP(a) and (b) agencies and should continue in view of the establishment of subregional offices. Caution should b exercised on the part of CW/RMP in avoiding duplication of service or in assuming CHP functions. Sharing of subregional coordinator's time with universities or planning agencies raised concern. Kidney project #29 - Pediatric Hemodialysis for the Rocky Mountain Region, has made satisfactory progress and presents no problems at this time. As more emphasis is being placed on outside sources of support, during RMPS funding Colorado/Wyoming De period, as well as following, third party payment resources require indepth exploration. The exact source of such support should be explicitly stated. New Project #17, Training in Diagnostic Ultrasound in Community Hospitals, previously approved but unfunded, was considered a most sophisticated and expensive procedure for general use in community hospitals. Documented evidence of the participating hospitals' actual need for such a procedure should be provided. Project #21, Radiation Therapy Planning by Time Sharing Computer, raised concer as to the need for extensive expansion. Participating hospitals should documer their need and desire for such services. Project #30, Rural and Urban Genetic Counseling and Screening, was recently revised. Study emphasis will be on families with coronary disease for evidence of hyperlipidemia, families with pulmonary emphysema for alpha trypsin inhibitor deficiencies, and families with a high incidence of cancer. Lesser emphasis will be placed on the detection of sickle cell hemoglobin and Tay-Sachs carrier states. Staff was unenthusiastic regarding the project in relation to the Region's priorities. One area given as a target for deve lopmer was Scottsbluff; Nebraska. In view of past "turf" problems and in order to: prevent any future ones, a documented request from the area, as well as from tt Nebraska RMP should be available. ‘ RECOMMENDATIONS: 1. Encourage CH/RMP RAG to establish an Evaluation Committee >. Evaluate Program Staff and Program activities. 3. Emphasize the need for more minority representation on RAG, committees, and Program Staff. 4. Appoir more “true consumers" and allied health representatives to RAG. 5, Consider CHP functions in relation to subregionalization and proceed cautiously. MCOB 9/7/72 Region: _Colorado/Wyoming . ) Review Cycle: Qctober. ) , COMPONENT AND FINANCIAL SUMMARY ANNIVERSARY APPLICATION DURING TRIENNIUM Current Council- Recommended | Recommended ' Annualized Approved Region's Funding For Level For Funding Level For Request For TR Year 05 Remainder Component TR Year 04 TR Year TR Year 05 of Trienniun [RX SARP /__/ Review Committee PROGRAM STAFF - 492 ,506 f 636,916 : CONTRACTS 107,260 / oO fe. DEVELOPMENTAL COMP. 96 ,000 7 110 ,000 Utes [/ No a . OX. . | | : / . OPERATIONAL PROJECTS 406 ,580 965,275 Kidney } ( 91,800) | ¢ 91,800 | ) a '. Es C y | ) | / A hs/ea Z C ) C ) / \ Pediatric Pulmonary L .. Other \ f CLG 7” ( dr} ( | \ - TOTAL DIRECT COSTS 1,102,346 1,403,991 1,292,346 COUNCTL-APPROVED 1,292 ,346* *NAC level raised by $150,000 (Special action NAC 6/72) LEVEL Supplemental funds of $40,000 for Pediatric Pulmonary Project continuation. ) Review Cycle: 10/72 Oe een ne Nett ear RNPS STAKE BRIEFING poceMrNy REGION: Georgia ; “OPERATIONS BRANCH: South Central RUNBER: ' 00046 = ‘ “Chick: Lee E. Van Winkle COORDINATOR: J.'Gordon Barrow, MD. . ‘Staff for RMP: _ ~ | Joseph Jewell — SCOB LAST RATING: 399 (4/12/72) . Eugene Nelson - P.&E. Lawrence Pullen ~ G.M.B. TYPE OF APPLICATION: / 3rd Year, ' Regional Office Representative: ~"/ Triennial /—! Tricnniet Theoda H. Griffith —— eee ' / . 2nd Year \ Management Survey (Date): / X/ Triennial {—/ Othér ..-- Conducted: - or ry Scheduled: Not Scheduled Last Site Visit: June 23-24, 1972 ee ER ema ar calP eto yn Philip T. White, M.D. - Chairman John R. F. Ingall, M.D. -W. Lester Henry, Jr., M.D. Jurij Savyckyj, M.D. Staff Visits in Last 12 Months: 3/7/72 ~ PURPOSE: i. Indoctrination 6f newly assigned operations staff member to the Georgia RMP. 2. To attend a portion of the region's facilities and services task force. 6/8-9/72 - PURPOSE: | Verification of review process. 8/15-18/72 ~. PURPOSE: Visit to selected “projects, health access stations, area . facilities, etc. Recent eventa occurring in geographic area of Region that are affecting RMP program: During the early spring of 1972, the State government was reorganized which has created a Board of Human Resources. The board is comprised of the State Health Department, which includes the CHP (a) agency, Vocational Rehabilitation, Mental Health and the Department of Public Welfare. This is a different group of people from those whom the region had to plan with previously. Physicians in the state are having much less to say about directions taken by public health than prior to the reorganization. Therefore, GRMP has to involve a totally new group of people in planning. -2- The Governor is personally very interested in the health access stations and is exploring ways in which he can supplement these activities with state funds. The 18 area planning development commissions in the state have, for the - first time, been designated the official planning groups for health for | their portion of the state. ‘Their turf have been finalized and there’ . have been assignments of health planners who are supported from other than GRMP funds. Since these groups have previously done primarily economic and recreational type of planning, it is essential that public health planning input is obtained as early as possible in each area. The region's five subregional offices tie in with these area planning development commissions boundaries. There is increased utilization of the Governor's planning office, which is separate from the CHP(a) agency. A new CHP (b) agency has become operational in Southwest Georgia. “engroneny T ein ie ene pe me + Alia ‘ aay Aas od ‘ Stunna j estarun f Foal @or eau Sao Ghaor ms fomseTe S ~ ETT {~ as \ “| bor conquitt STATE OF GEORGIA —GRMP AREAS e Area OSS ices ! ane cis a came 6 ; [ vatinas : ~ “ ‘ 4 . # eoreizc TA a PrEnce sun? Sits Sn GRANTLEY nes en ae ony Se a sane 0 colle o ae 1 i . a } 7 tous, it arcons as _ by _ 4 : 4 rcnas ? i 4 ; rf is 1. O Concer (10y e ardiovascular (7) OQ Gont. Ed. 3 (3) R Renal (3) @ Respiratory (3) % cont. Ed. rr (7) A Stroke (2) AREA EACCLITLES eit ome we eh & Oe herrea ern CLEARTYP! . ase . cs r Wi inste Coptsl A County Sroh COUNTY -Tows me . Ms amow os, 4 comme GEORGIA aN “ = Over 10) 000 +8 $000 te 10,000 a Ho ‘}. basen k a Seale? Moa auanar Seen ly Toone) } sg RH Mi Salhi W000 1007S ty 1.000 te . Ahoy r Y Lumen’ yeaa Fee toMy, PWa 000 FT ode TY War Noa! on (ph eteyg ? mages o a . eee corre nae ‘ - "eles" os SO ee ve 2, STEPHENS | snag —* 1G) 10,000 fe 20 000 asd A AMERICAN MAP Company, ANE ue mt he ~~ ~ | ran fiers 8 Under 280 wee Storehet Sane TUS Cae IF won vie - BARTas . Colommetit Br « ono tion “N ~ = Y FULTON p coast : toons ol Mian My ) C~ OwinneTT . oN LRT , ee, oy we a 8, eT - sore f ae ¢% he - Chome « : yy OGLETHORFE ~ “A, "A as rome . - feat AINE Higa "Ke % 3 Shae {WILKES LINCOLN SS. 4 er 4, Deaf ct pcan Paver PY moran bee 9 4 a at Warrenton Sp emtar toa oe Pork coherent Pa, ’ Men tet Lane Otome 4 WARR! o 3 , cue, * | en Yams, olivenioe i CLAYTON J ¢Stobedge Winynasbore comm Gone Se, wen was saad Oat ~ exon later Norman ete Yue vile WASHINGTON Vi katy b por | evant . Grange yMrres Ei shney rer BA nw we) Ke caawir ono - “ GStotarbore + me us Ce ogettin MARION \, : + en Beater Fisica a _¢ chem tae t a tay | boeng me r mee ? a att sara Te Pomoc nt siy. ma vat RYAN “ vehia-g, | meesian™ . DOOLY g vers & sate Java . . ane TATTNA! gc SUMTER pt LL ! ‘ Ghranvile laeey wet Deimen fdewrea aaron y® "eaMcoLeM ‘ . 1 cee yf TERRFL m3 ti Gone ase oe Ibany. i? Bee : : ‘ ovglat A, s a A McINTOSH . . —— 7 inns HORT Tae i GARLY F carnoun aa : a. nae + : Aotngion BAKER a we — - ae : { Antes Pete “ i a Binchshear *y metre bane GLYNN : * i i wee wiTemenk re wieN fom gitebardetle 7" amanteey { ut 5 ore rane a ED aaa Ee oe : One ony FP cork tunctens, 1 jp UL ER f % 7 Moullne nswick © ae “So | Folge , wah fae 2D “ nota N, : Pele covouirr ~ “ w S ' OF SUPPCRT ; GF SUPPORT | FUNDED {| APPROVED costs ' - costs i 1 t ~ _COO0 PROGRAM STAFF ACTIVIES | j 1 { { | I { . i £1705.704_1 } t j 97053794 1 $992$54.1 970521681 _ 9000 CEVELOPPENTAL COMPONENT ; : i i { | . { I : 21772986 1 j L ! $177.5A61 i -$177.786 1 22 Ola CORE FER IMPROVING PT se | t j J , { “4 { /: BVICES GEM? £10,000 5 I I j $10.090 J i £10.9599_1 _ OOL8 CCNF FOR IMPROVING PT sel t t 1 { t i 1 «gma ¥LCES EMORY 310,000 _! i 1 1 $10.000 1 1 $19,909 5 GOIC CUNF FUR LMPROVING PT EI { { ( ' t | t ee BYECES PCG $10.,000_] i ! $10,000 5 L 910:990 4 “QQ COMPCHEDT_ ICT AL i SIC COCIL 1. Le $30, 0c0l1l v7 #3O,0Co)! COA VISTIIAG CONSULTANT oe ' { { , ' 1 i ” nei GP PP : $30,000 1 f t 1 $30,000 1 t 2302000_! OG38 VISITING CONSULTANT FACE i t t } | t t PA CY IRY £15200C_1 J i $15,000 L $20l22 bo ket Z2 b DOR Ghee CNT Tr aL. i $55,000)! ! it $43.00)11 32a1220bt-.-242e12221-_. _. GISA STATEWIDE CAICCR PRUGRAMI t- t t { t . "cen ABER EACILLILES GRKP ! $1222550_) i Trea oin L $1222559 $4.328 i $126:878 ) OLZE STHU CA FREGRAM MCG MACOI } ( { { ° ft t- ah $5,000) { I i £5,000 J $5,000 1 ~ OL3F STATEWIDE CANCER PREGRAN i j 1 i t { ' we SEAL FAC BM OCENTIER COLUM £7.000 1 j 1 \ 37.0001 L $7anec_i - =o L3G SThD-CA PACG AREA Fact yy : 4 1 1 t { i sewer LES SAVGNNAH. “S$ 5a 06 l =< I =. L $5,000 1 L $5,009 boo Gi3!l $TWO CA PROGRAM AREA Fat | t 1 t i L- wed LLILES fb fAny $5,000.) 1. i L £5,000 4 j $52200 1 O13J STKE CA PROGRAM AREA Fel : t t 1 ! 1 t t LITLES ALLANTA MEO CIR $52.006 J i $5,000. 1 I 45,900 1 _ OESL STWD CA PRUGRAM AREA FAC ¥ i | t : t zecfh Iles. AUGUSTA... $5,000.1. { L £5,000. l 45,009 |. 0 OLat $iko CA eacSRAM AREA Fac t t 1 { oe 4 i “SLATES. ST UJDES ATLANTA. of $5.00C 1 i ' | $2,000 1 I $52000 1 OLS STKD CA PROG AREA FACILI] ! t t | I f { a AES ULUSGLMEY ESP ATLANIA | $2450. 4 f J L $52490.L. GisY S1ThD CA PRUG AREA FACILI { { ! t { ' elo — LIES LP CRARGE. 1 $5,000 4 1 ! j $5,000. J 1 $5000 21 OL3Z STwWO CA PRCG AREA FACIL IF t ft { I t t 7 LIES ROME. 25,.90¢ 1 | a $52000 L ~ £$520002 4 Gil. COOPONLET JOTAL t... 278,000)! { ££... L795 .N00P LE $4,283) 4. 912223282... O14 KEG PEDIATRIC RESP CENTE 1 t 1 “f af zt R805 l $33,200 1 l it ul $22,200: 1 $80316 4 $4lsolo.d i. 20268. AVEA FACALITICS FOR ccRET | ( a7 { t I a 1 OD ftcery $19..200_1 j ! 1 $19.200. I #1907001... O00 ARPA FACTLITIES FER CON i { ( ‘ j I { COLATPLNS GEN MUSA Tab. wach enneeh 20D 00 LW ee bin ee ne hewn een Ln eee De U0 bo ee bh DOD eames eo ANLAPAGELETILS FUR CON f t ‘ es { { t. ED _MCIR CENT GEORGIA £51,700.1 ad 1. i 2512700 3 L. -asia200-1 ; ~ G208 ARES FACILITIES FOR CON i { j { “oe at i I i 33522001 i $2542.00 | wok KCTR COLUMBUS $35,200.) SULY 2051972 __. BREAKQUT OF REQUEST RM 00046 10/72 PAGE. 2 To eee eee wrens comer eee '~ 95 PROGRAM PERIOD ~~ — REPS-CSM- STCGA2-1 © q5) (22 (4) qa) ‘ ‘ 7 JOENTIFICATICN OF COMPOAENT [ CONT. WITHIN| CONT. BEYOND] APPR. NOT | NEW, NOT i CURRENT { CURRENT { ss { . ] APPR. PERICOL APPR. PERICD] PREVIOUSLY | PREVICUSLY 1 CIRECT { «aNorrect | TOYAL 1 : CR suPPCRAT | CF SUPPORT { FUNDED { APPROVED { costs ' costs I | . 1 1 ' 1 ~~ 0206 AREA FACILITIES FOR CON J ! { | { I i { ___FO_PEP_¥ED_CEBTER 1 $53,000 1 i i i $53.000 1 i $53,000 1... OZO01 AREA FACILITIES FCR CCN | i I I I t \ { EDU PECOZE MEM MSP L $12,200 1 ji j i $12,200 1 L $122290.12 O205 ARCA FACILITIES FOR CON J : I | | I j j ! ED IFT PEM PCSPITAL 1 $13,800 4 l i i £13,600 1 i Siissoo ft G2C¥ AREA FACILITIES FOR CON J . { i t t | { t we fD SENSESTCU MEE HOP 1 $5.800 5 \ i 3 £53200) 1 $52209_1_ 020 COMPcsisyL IGTeb If $206,500)1 I fl i $206,500.14 Si. $204s5001L O27K A CCPRUNITY IVPERT ERS IGN i | } t. 1 j j eee BH OLR AM CADP 46726601 1 i I $672200_1 22.792 1 €75a762_1 O30L FACILITY PLAN AND DEV aa { | { i j { t ___GUSTA_BAD_JHPY_ CIB $25,000_] 1 L J £25,009 1 fo 8252 PL. Q31A CVA ARCA FACILITIES cre i 1 1 i { t i 427.600.) 1 i i $272620_1 fo 4272 bQ0 1 31D CVA AREA FACILITIES aie t t t t t i j __-NS_GEN USP 1 $15,800 5 f 1 i $1.92890_ 1 i $152,200 4 O3IF CVA ARLA FACILETIES MED | i 1 1 I I i ! EIT RCSL US ) $32,4600_1 i! ! i $312000_f 1 $31.£20.1---- O31G CVA AREA FACILITICS MEM I t I ' 1 i : | i MEQ CIP SA YAN SEL { 217.400 1 f 1. $1224200 4 I $12,409 i - O31J CVA ARCA FALILITIES ATLA] 1 { { | | 1 i — ae NIA MED CTP ! 942,300_} ! L $42,300 4 $42,200 | 2. O31M CVA AREA FACILITIES UNIV] | r ! { I | . { ww LSP AUGUSTA ‘ $13,400 ) 1 ! i $132400_ 1 t $1225C0. 1... O31P CVA AREA FACILITIES ARCHI | | l | I i t- we BELO NIOM USP. THOMSYILLE I $212200 1 { f l $21,500 1 j $212902. 1... O3LS CVA AREA FACILITIES TIFTI { { t i I t j we CEN ECS LIT AL i £2225C6_1 1 l i $222509 1 L $12,500_1 O3L cCoPPenent JOU SL Lt 3186250011 1! L | S16 625001 1 LE $1452560)1 0 O324 STRCKE AREA FACILITIES 7 ' I { t J 1 i Pie $5,600) f i l $5.6000 4 t $5,400 1 032% STROXE ANCA FACILITIES z \ \ f ‘ t { | _ ANCLOS SEN BSE SAYANNAB I $27,900 1 l f 322,200 1 1 $27e802 1 O32T STROKE AREA FACILITIES = i | { | | I t : aw TOE IH ELATLANTA $26,600 J j j L $2620990_ 1 L $2ts490 LL 032. COMPCHESIT_IUTAL iT $60,000)) i i ik $£0,909014 EL $29.¢221 1 - 0368 REGILNAL NEPRPRULUGY cenTt | ! -f j . | coed j EB LE RCBY $22 0.467 4 i L L $222167_L $4404 I sao. O3&C REGIONAL KEPHROUCGCY cia { I { { b { ER FCG AUGUSTA $22,167) J } I $22,167 4: $43735_f “s20,902-1_. O36F RLNAL SPEA FACILITICS aI 4 § i I 4 L oo. i aD CIR COLUPAUS 1 $35,000 1 a L j $352.000. 1 j 435,000 tu. O3EX RCNAL AREA FACILITIES | { { 1 1 { ' \ ce eee ee ee ee een ewe hoe ee $35n000L- eee eee Done ee need ee ee S320 900.0. ti ...835.cc0 ! .. Oj¢. CUMCUNLULLIIULAL Jee Ah added aad) ae J TITTA CLITA sae adda sa LE ehh Sde tL t ney O37L RLS DIS AREA FACILIFIES | whe: I | ay 4 : to MED Cle CENTBL GA I $135400_1 L i J $13,400. 1 sand $13.400 5 REGION - GEORGIA. 5 . . . SULY. 2001672 , REGION = GEORGIA . BREAKOUT OF REQUEST RM 00046 10/72 PAGE 3 or rt crise ora en mcm oe ee mee eee eee " 95 PROGRAM PERIOD ~~ 7 mr RAPS -CSH-STOGR2°f : (5) (2) 14) ai. IDENTIFICATION OF CORPONENT | CONT. WITHIN] CONT. BEYOND! APPR. NOT { NEW, NOT i CURRENT [| cuarent =f : t . { APPR. PERIGO| APPR. PERTCD] PREVIOUSLY | PREVIOUSLY § Cirect ¢ fNOIRECT | TOTAL { co ! CF SUPPORT ‘ CF suPPCRT | FUNDEO t APPROVED ' casts t costs | ; a \ O37S RES OLS AREA FACILITEES | | t { oe 1 { oA AILAETA PEC CTE i 314.000] 1 } 4 £14,000 ! J $14.200! C37TT FCS? CIS AREA PACTEITAESI i ! t t { { ' ww SD AE INE IE MARY $25,000 f i i i $152000 1 t $is.cee to O37X RESP OS AREA Caititiest j i f t j { i ! $172400_5 j 1 $27.600 1 : i 417.4001 —-— 7 C3T._ CCR CHINI _IOCIStL : if SECA OCC) 1 I It $60,000}! 0 th seco O32! CYLAG CARE FOR SC GA ANOI i | | { | j ewe -BO_ELA.SO.GA_MEC_ CIR -t———-99.34000 j l i { $93,000 1 t $23.000. 1 OSI1B COTEC ANE ELIFIAA ELECTRI t 4 | ' | i I oo POA Para os ewoay j tase t i I 1 2229094 $3n.226_ 6... $12,936.15. | “". Q428 PLAY SINC. SYSTEM CAPE a | t t i I t I _™ CK Sf wacpy evcey $17,000_1 4 | | $17,000 1 $53924 1 $220784 2 O42C PLAN StWO SYSTCM CARE 7 i { i { { t ! ow GX CEWBIEN BED COL GA j $55,700 | } i $55.790_ 4 $13,810 1 $69, 5101 O42. COMPCUCML TOTAL Li $722790)1 i i t 272,700 16 $19n794) LE $9244741L GO3A PATICAT BND FARILY etueal { I | | . ! f° mo ETON GREP, $15.00¢ | ' 1 I $25,990 | L aw tl Se0f6. 2 ~ O43F PATIONT AND FAMILY eaucn { 1 I t i t i eI CN MER CIS COOLEY AUS { $16,000 1 i I 1 £10.000_] ! $10,000 J. G43G PATIENT AND FESKILY CDUCAL i 1, I i t f t TL ON MEM MED CIR SAVSENAE J $12,000 | 1 1 I $12,000 1 i g22,000 1 _. O43" FATTCNT AND FAMILY CoucaAl * ! ' i i ( i i i TLON NOSIDE_HSP ATLANIA.~ 3 $13,000 j - -_t i $12,000_1 t $13,000 1.007 7 ‘ O42. COMCCNENT JOTAL it £03 096) 4 1... Lt S50.cOO.L aso, ogo OSAA SAI EC ALLIES HEALTH seri j | } t ' t YICE GEXP $50,000 1 I I I $50,000 } f 259,060.) - C45& HEALTH CCCUPATIONS cans t I | t ( i | we ee EL ING GBP $15. C0C_f i 1 t $25,009 1 I $15.909 1 “" OSOF PUY ASSISTANT COVELCE oT] t j | 1 5 t t ~ wwe hG LEQ CIB COLUMBUS i $30,000 1 i L i $30,000 1 i $30,006 1 OSIB COLCATIONG HEALTH PROFS f f 1 ' I { 1 j eee lPIIBAL LISS CAGE cecey oot $10.00¢_L i t I £10.900 1 £3.791_1 $12.791.1 OS2H IMPRCY PRIM CARE ACCESSA i { , I i oF { ! J URILUTY ATLANTA i $52,500) I i t $522500 2 i $52,800 1 Tr" G82P IMPROV PRIM CARE BCCE Sst t 1 i I 1 t ef 7 ma BLLLIY SE. GEQEGLIA $54,000 4 1 J ] $44,000. 5 i $44,000 1 OS2R IMPROV PREM CARE acct Seni t ! I t ot I ' ie LOLTY WILCOX COUNTY i $46,600.15 I 1 i $46s 600 1 1 $465600 J 0000 0525 IMPACV PRIP CARE ACCESSA] : j t t f . 7 OF t i ° = BILIEY PENS Y COUNTY 1 £70,.0CC_1 1 J i $70,000. 1 i $70,000.10 O52. CCRPLNEMI_TuTébi stk a hood Ld L if $213,100)! it 2213410011 _. OSG RUESE MLLWTEE you mune 1 | 5 { j . ee ort -LGUWHIY ALA URUNSHICK O00 Jbl $340000.4 2 nano Nn nen nnn dna nnn nnd = 2 899 O00. nn nee need ne ‘sansbec - 054% SheD PHUF HEALIM cOLEATLI | j { i ~ 4 Ch SYSIEP i £75,990.) l i } $25,000. 1 i 75.000 1 asst EMER PEO SERVICE SAVANNA| i 1 | | | I i _ k L $294,006 4 J l i $224,090 L £294,000 1 SULY 20,1972 ‘ REGION — GEORGIA en nk BREAKOUT OF REQUEST RK 00046 10/72 ‘PAGE & _ 7 . ‘~" "95 PROGRAM PERICO =~ mm . REPS-OSM-JTOGR2-1 ~ . ts) «2 4) 11) 1 IDENTIFICATION CE COMPONENT | CONT. WITHINE CONT. BEYOND] APPR. NOT I NEW. NOT i CURRENT | CURREAT | 1 . 1 APPR. PERIOO! APPR. PERICOL PREVIOUSLY § PREVIOUSLY [ OLRECT ( INOTRECT ( ToT aL i] _ oo. / \ OF SUPPORT ! CF SUPPCRT | FUNDED 1 APPRCVEO ’ costs | costs ' ; “ ' ee ‘ | { ~ OSS5U EMER MED SERVICE COLUMBU! } t I { { 1 I Ss. __I 3184.000 1 1 i L $184,000 1 I $124,000. 1 O85 CCEPONENY TOTAL it. 3478,0cc2 1 1 I 1{.__3$478.000)) tt $47sencall _ ~ : f t j i { i i { oo TOTAL LE, 8300210824 1 _ | ee See [$3,021,624 | $164,062 § $391850686 § e - Sc - see cee ~ . ee ee ee ce mgm me en eee ee oe me em | eee meme enynnemit oe ess miu | rae ae campy areumrepmsnptsllnantgbenenmamientie 5 a - - eee | ee ee ee . t ec eee ee ve ee _- = - ~, ~ = es af - a —— = serene tee een “ . . _°OT- SULY 20,2972 REGION ~- GEORGIA i $3£:000) t / BREAKCUT CF REQUEST — RM 00046 10/72 PAGE 5 ™ “ — ~ ° 06 PROGAAM PERIOD ~~~ AMPS ~-CSM-JTOGR2-1 — (53 2? 4) 1s : IDENTIFICATION OF COMPONENT § CONT. UITHENI CONT. BEYCND! APPR. NOT NEW, NOT 1 avo', Year ! { TOTAL { F APPR. PERIGO] APPR. PERICO] PREVIOUSLY previousty ft DIRECT 1 J Att years 1 i OF SUPPORT CF SUPPORT | FUNDED - APPROVED j costs ! jorrect casts ' j § ~ COO PROGRAM STAFF ACTIVIES 1 1 ! { i i ' ! $734.7627_1 i i $7242787_ 1 b.8:154402491 1 (O00 DEVELOPMENTAL COMPONENT : 1 t i 1 t ! $177,986) l i $1772906_1 l $255.972_1 _ GOLA CORF FOR TMPROVENG Pr set ' ! { j t 5 RYICES Come gic,occ | I i $10,000! 4 $20.00C_ Lo. OOLS CCAF FUR TFPROVIANG PT aH i t 1 { { i BV ICES EMORY £16,000, 1 i I $10,900 3 i a2c.00c 1b. OO1C CONF TOR IMPROVING PT SE 1 1 ‘ I ' - f __ABVICES Ce $10,000. 1 L ! $10,090 1 I $20.000_1. .. QoL. Corpcress Terer Tl £30-N0Cit t ? 1 it deoscocit | j | ( { | 1 ' l { i { i { i i OQ2A isi CONSULTANT eRcet t { . ! t em BAP CREE 220.0206.) i { i $3292000 J I $£0,009. 1. _- 0038 VISITING CUNSUL TANT rive i | i t ' j i ee BAM CEM DCY £15.009 1: i I j $152990_1 L tic.coa_f OOP COV CuCuL TGTab i $45,000)! I 1 it $45,000) t if 490s90011... OL3ZA STATEWIDE CANCER PROGRAMG . i { t t 1 { 1 _ eee OP FACEACILITIES GREP } $122,550 1 j - I _l $222.550_1 j s245stao 1 O13€ STwO CA PRUGRAM ¥CG nacat i ! t i t t j owen tl $5,000 5 j tl l $5,000.45 i $10,000 1 - OL2F STATEWIDE CANCER srcenint i “| | t ' t { uw APEAL EAC BU CEUTER COLUM de 32,000. 1 f j 1 $72000_1 1 $14,000 1 ~- O13G $T#O CA rroG AREA Fac Tutt ( | ! i t i | wow LES. SAYS s? $5,000 1 j 1. $5.009_1 1 $19.090_1 ~ OL31 SIRO Ca SaeeAn AREA zict { 1 t ! j ' JLLTIES ALBAAY $5.009 l t ! £6,900 1 i 219,009 1 O1345 STC CA PROGRAM AREA FAC ' t { t t | ww TL SLIES ATLANTA MEO CISL $5,008. J i j $5,000 1 i $10,000 to O13L $TWO CA PROGRAM ARES Fag ee 1 { 1 | 1 i _ ee fLP TIES PEGEST A £52000 i ! t $5.0¢0 ! { $10,000. 1. Di3t STRD CA PRUGRAM AREA FACT i 1 i t ' } i we ALILIES SE LOLS ATLANTA 1 $5. COC} L Jj i $52090_) 4 $102909_) O13 STHU CA PRUG ARCA FACILE] i t | { ' { | we KLESILCbG MERLUSE BILANTA SL $5.550 i j : i t $52450 1 i $10,900-1 “OL3Y¥ STWD CA PROG AREA FACILE! ' j t { i { t ‘ i _ LAGRANGE 45.0001 j I i 45.900. 1 410.000 0132 STWO. CA-PROG AREA sail ( 4 t l { | 2 ALES ROME $5,000 1 ! j { $5,000 1 j _$105900. QL2. COVECECAT IOLA ti $115..005) 1 i i tL 9175,0001) 8 OC. GLC HLG PLOLATHIC KESP CENTES I { | t ! t { RUACG. $132332.1 1 1 1 $130332_1 Sihah321 VLUN AKLA FACHLIILES FER Cones { ( t { t ob . www old EMULE eee bere ee Bh Se NO bk ee oe beer enw wed ow wemee eee eb nee Bb de 300. Tyne wwenee cen be. wee 4300864 to. O20C AREA FACILITIES FOR CCN f i 4 { 1 . 4 . ( | ED AIHENS CEN HCSPITEL i $15,700.13 i I I $15,700.13 j $31.400 1... O20£ AREA FACILITIES FCR CCN f 1 b 1 i { | www EDU MCT BR CENT GCECRGLA { $52,760 1 L { j $51,700 4 $203.46G 1 O20F AREA FAC HETICS CON. CON | “of { { | \ i woek PGIS COLUMBUS $25.200. 1 i I A $35,200 1 $20.590.1.... -TI- ol. BREAKOUT OF REQUEST RM 00046 10/72 PAGE 6 wm me eee 7 - - 06 PROGRAM PER1U0 — , RMPS-CSH-STOGR2-f 7 (5) (2) 4) a IDENTIFICATION CF CCRPCNENT § CONT. WITHIN{ CONT. BEYOND! APPR. NOT | NEW, NOT { ADD*L vEaR ft 3» -TeTat t { APPR. PERICOL APPR. PERICOL PREVIOUSLY | PREVICUSLY | CIRECT Jj } ALL YEARS | i CF SUuPPCRT CF SUPPGRT {1 FUNDED { APPROVED { costs { Hanah costs i ~~ j “ t j t ~~ 0206 AREA FACILITIES FOR CCN J ( ( ! t i t ! a ED MES PEO CENTER i $53,000 J} { ! 1 $53,000 } j 2196,000 1 O20l AREA FACLLITIES FCR CCN ft i § t I t | j EQ PPC LPE_ MEM SOP i $12.200 5: i ! l “$122200 4 t $252.4090_ 1 0205 :FEA FACILITIES FCR CON | t j i | 1 1 1 SEL SEY ECSPLTAL 1 $13,600) L J } $13.400 | I $272200 1. -- 7” O2C¥ AREA FACILITIES FOR CCNY 7 1 { ! t i 1 i we ED KELLESICH MEM HSB i £52800 1 i L 41 $5,809 1 i $11.560 £0 Q20. coMotyisr Torél ——ii__.22060.500)1 { 1 it 220655001 | ________Li__- 4412409011 O27K A COPRUNITY hYPCRTERS ICR] 1 I t ' t { — we P2002 24 GSORH L ! ! Jj L { eevee tl Q30l FACILITY PLAN ARO DEV Aut 1 ! ! { a I J 7 =—-GUSIA_EAO_ JNPY CIB ! i l L l t j 425,009 | O31A CVA AREA FACILITICS GRYPJ 1 i j I 1 i: | 1 $272600 1 L i j $27,600 } i $55,290 L O310 CVA SREA FACILITIES ATHCI i { { t J t- I wt NS GCSE 1 $19,900 1 4 { { $192,800 1 1 335.660 4 O32F CVA AREA FACILITIES MED | : { ! t t | t t — w_CIBCOLUReUS I $31,600 1 i ' J 1 $322620_1 4 $632200 } O3IG-CVA AREA FACILITIES MEP | { I { {- 1 ! { Cle SASSENSH i $12.409_1 i i ! $17.409 1 } $34,200 1 03143 CYA LREA FACILITIES ATLA} I ! { ! { ! I ww SL ABER CTS { £42300 1 i. i l 3422300 } L $84,600 Loo O31M CVA AREA FACILITIES UNIVE « - i t t t | | j ~ aH S2_AUGUSTA 1 “£13240 1 i j j $12.400 1 if £252200 1 —. O31P CVA ARCA FACILITIES ARCH | i ! t 1 { woo BLO MEW SP _IPOPSVYILLE 222900 1 L I t $21.900 | 1 exec. _O31$ CVA AREA FACILITIES TIFT] - ; t I t | ' mann L EN LOSEETAL t £125,500 5 1 1 i £12.509_1 1 s2.0cn t__ _- G3l LecercuenlicrAl {feasdA@hs 40041, } } de 186.5900) iL 2422.00011-——- : O3Z4 STRCKE AEA FACILITIES Ef { { | 1 t _piip I $5..h00 ! t £52600 L i #12.200 O32N STRCKE AREA FACILITIES Ch { ! ( | | ! : ___ANELE? GEN FSP? SAVYASNAM. OL $21,800. 4 I f 1 $27,890 1 t a LL. O32T STRCKE AREA FACILITIES St { ! { i t ! TUJQE IME ATLANTA L $26.£00 ) 1 . I { 226.0001 L 82 aazco b O22. CO*PCNENT ICIAL mw $50, 90031 | i Jf $40,900) Lt rere ooo) 0368 REGIUNAL NEPHAULOGY centy t 1. i t , I t } wo fB EY SEY 210.333 3 { i } £102333 1 J $32,590 | O36C REGICNAL NEPHROLOGY cea 1 | { | j ! i ER_MCG_AUCUSTA $20.2331 1 1 1 41023223 1 1 $32,500 1. O3GF RLNAL AREA FACILITIES rel oe { { 1 { 1 { | OL CIB_COLUY AUS : 1 1 { 7 sok 335,000 J @36X RENAL AREA FACILITIES { I | | ! t een eee ----.-d low. i weed ee eee ede 2 ss t.000. Lo. 0a6_.CCMPUNLNI_10LAL___.___ 11D azu.eoal ll ween ee been eee AIT ak 20s bob ae. O37E RES GIS AREA FACILITIES | i { { j at { $232400_1 1 l i $13.400_ f j 2608001 SULY 2051972 REGION = GEORGIA MED CIB CENTEL GA 1 -Z1- REGION = GECRGIA it 4 _. . _. _ BREAKCUT OF REQUEST RM 00066 10/72 PAGE 06 PROGRAM PERICO ~~ AMPS OSe- JTOGRE- I — : (5) (2) ~ LOENTIFICATION OF COMPOKENT # CONT. WITHIK] CONT. BEYCAO] APPR. NOT ADC'L YEAR t Tovar t 1 APPR. PERICO) APPR. PERIOC! PREVIOUSLY DIRECT { sul Years ft . Ce . ' OF SUPPORT : OF SUPPORT costs {DIRECT COSTS ' . . i ee O3TS RES OLS AREA FACILITIES | t 1 { ATLANTA YEO CIS i $14,006 ft 414.006 j $28,096 3 O3TT RESP OLS ARES FACILITIES! 1 { i t S7_JCE INELEWApY $15,000.) $15,090. ! $29.000 1... O37x RESP DLS BREA rit Tet I t { gie.400 f $162490 { $34,000 1... ~~ ¥PCEEET. ieia.._. $58,800) 5 $52 200) Le. g318.00021 OFSH EMERG CARE FCR SO GA AND I ‘ j ww NO FLAW SO.GAMED CIS... fg93.000. f $23,000 i J gies,cco 1 0416 CEYCC AnD CLIMINA ELECTRE j { ’ wm LT CAL HAZABLCS_ EOCey j i $9,500} C228 PLAN STHWC SYSTEK CAFE si { ! t { ~ wehS BEC DSRS EMORY ! $2722378.1 i $340.252 1 O42C PLAN STWD SYSTEM CARE sit { i t i CK BEPICEN MED COL GA { j $25.255_) t $£4:755 1. R42 CCKECHENT IOI AL i r 146245321 it. $119.352)1 . ' 0624 PATENT AND FAMILY EoucAl | 1 { \ | ta IN Gaus $46,100 4 L $44,109 i $412100 1 _ 1 O43F PATIEKT AND Favily eeucat { i 1 I ee LICN YED_CIB-COLIMSUS __L_____ tea j sd $15400 | $l1ls6cc! O43G PATIENT LNG FAMILY LCOUCAL i { ' 1 LL CN MEN MED CIR SAvshN suf £23,200 1 | $2,300 l $14,300 1 ~ 04624 PATIENT ANDO FAMELY ECUCAT | { t wcoml ESMOSICE PSP ATLBSIA I i $12.008_1 G42. COePCEreE OTM $50,000} i $56,000) Lt. .a100,06011. O4SA SHSAEC ALLIEO HEALTH SER { { { woektICE COMe. $tPaloc d I $69,100 L $11h82i021 0492 FLALTH GCCUPATIONS eeu! | { t ot ewELISG:G £48 j j ! $25,000 1 “CGSCE PHY ASSESTANT CEVELCE aa I | ! : t we fGMED CIB CCLUSEUS 1 220,090 1 i $30,000 1 $40,000 1 00 O515 LCUCATIONG HLALTH PREFS 4 : : ! 1 I ! OPTIMAL DIAS CARE EMOSY j I Du alc sooc i. OScH IMPROV PRIM CARE ACCESSAI : { { bt - t CE BILITY. AILASTA $55,250 1: ! $5.5.250 i 107s.750.5 OS2e IMPRCY PRIY CARE acetseat t \ i ' ww PILATY NE GENSGLA I $45,600 t j $4%s.800 eas.ecol O52R IMPRCY PREM CARE ACCESSA | t J BLLIDY WILCCE COLNTY i £48,000 f i $4P,000 $545600 L.0. 0525 IMPROV PRIP CARE ACCESSAI { 1 7 i i = PRUITY. HINSY_ COUBTYL WL 8S en BOG LL ! —— fl sen00 j 4 £144,800 .L... Wa2 SU CSUUNLAL. tl AL. dats bed wl 22ab5011 db and Sabato ul T= O20 AVE LI OME bREEt SUNY PULTE 1 ' t OE CEUALY AREA BRUNSWICK L £20,000 i 1 $282000 t 4 $07,000 O54 STWO PROF HEALTH eCucatit { t I t oe ON SYSTEM $38722560. 1 \ $2272560_) i $462,580. 1 O357 EMER MCD SERVICE Savanna i | t | i S2ude]sit I 4223.242.1 g. g902aT43 J... JULY 20,1972 REGION - GEORG}, | ee ck ee enn SREAKCUT OF REQUEST RM 00066 LO/720 0 PAGE 8 06 PROGRAM PERIOD ~~ ORME SAC MITER RZ fl (5) (2). 1“) a an IOENT IFICATION OF COMPONENT { CONT. WITHIA} CONT. BEYOND] APPR. NOT {| NEW. NOT i. abot year ft f . TOTAL i : ] APPR. PERICOI APPR. PERICC] PREVICUSLY | PREVICUSLY |[ olrect § { ALL YEARS 1 oe tee eee ek CF SUPPORT | OF SUPPORT { FUNDED | APPROVEO ' costs t pornect costs ; F 4 OF. ) ; oN a 4 - 4 a —— ~ OS5U EMER MED SERVICE CoLUMEU! j ' I 4 { i i p Ss : 1 21712899! ] tL i $171,892. 1 I £3255.859 | O55. COMPONENT JOTAL Li. _$465.652)1 1 1 tt... £665,662) 1 it $253.84211 * : : i i { i i i : TOTAL | 8320540523 | $460653 1 I 1 $30lQlo176 Eo —$ $6e1229800 Fo : ‘ ~, . th -tI- a » : —— - wae ee a best 291972 warn ct Seige meee oe RECICAAL PEDIC AL AMS SERVICE FURDIAG HIy.cd¥ LIST . CPEPAT {CAML GRANT (CIRECT COSTS ONLY) i @PS=O ST Tce, LOS EN > feet ame ee oe So ee ee ne a em ce een oe ‘bret S eroes 2406 SHER REGIGA 466 GEOFGIA BMP SLPP YR 04 ALt REQUEST AXE AWARCS AS CF JUAE 30, 157 ‘ . 7 AWARDED AKARDED_ AWARDED AWARLEE AWARCEC ss RECUESTED RECUESTEC REQUESTED REQUESTED ° CCHPENENT ol 02 02 C4 — ee os Cé OT ® O TITLE _ CO/TL-L2772_ TCTAL OLS 7312/73 CL/T4-12/74 CL/TS1Q/IS IC TAL 10 ee mW _CCCO PROGFAPY STAFF 770000 761300 648400 8&44C7 3CEGICT ¥e IC27C4 234787 1440691 a ~Ci90 CEV AREA PaG HS " €k2CC 8A200 es ” O000 CEVELCFREAT AL F 420500 120500 +e 177986 177986 355972 “POOL IMPROVED PRiwaR ° ~ "22284 21284 98 0002 4&4 AUFSE MITWIFE _ #e > ““OCC3 IrERCVEO Faiiar 1057@ 10576 +« 000% IPPROVFD PRIWAR _ 10530 10530 +0 | “Oocs CCRMLAITY FEALT 7926 1920 oe . 0006 IMPROVED PRIKAR __. an 9315 _ OTIS Oe “GOl” CCAFEFENCES FOR ~~ 0500 TG 7ece 4icc’e 26731 238231 e¢ OC1A CCAF FCR IvPRoy _ . +? recoc 10000 20000 “0018 CONF FCR IMPROV * 10000 10000 | 20¢6¢¢ OO1C CCAF FOR Ivfecy : . ‘ es 20000 ooo 20000 O02 POST RESIO TR P 10400 20060 20600 9 " _ 003 VISITEAG CANSUL sa6o 24ECC zicec 43333 97833 o6 _ ““CO3A VESITIAG CCANSLL . ae 3c00c 30000 60000 00328 VISITING CONSUL —_ ; oo + 15000. ° 15000 ._300C¢ “006 “ENTERLI® SERV F 23100 23200 1e0c 482CC ve i 005 COLMALS “C EwGR 367C¢ 42800 28000 107500 ¢ COPMUNTCET [ONS S$2ZECE 38SEC 14eEce 1027000 ** - rsd CCCAD Cvé LAB E 66800 805100 _. 12600 204500 oe _ 27010 CPRT PRG STKNE “€96CG” liz7¢¢ 7270¢ 256000 *e = 012 CC ECUIP SP HCS 19700 24200 _ oooc €35CC #0 a _. “OL3 STATEWIDE CANCE 325560 ~~ 401300 234100 219 133. 1080033 +e ; _ OL34 STATEWICE CANCE . ee 122550 122550 2451C0 “OL3E STHE CA FPCGRAP * €a0c 5000 10000 O13F STATEWIDE CANCE oe _ . we _ 7000 7aco _4eGce “OL3G STRC CA FRCG BRO , ° * 5000 5000 loooa = * O131 STRD CA FROGRAPY : . eo a ee ee 8 800 CS 10000 . O13 STWE Cé# PROCRAM oo Te — ae §000 $000 19¢C0 —OL3L STWC CA FRCGPR AK : ‘ h So0c 5000 .__10000 ““O13T SThE Ca PROGRAP +e §C00 5c60 " ceca WHOL} STRE CA FREE ARO — a woe 8650 450. 109¢0 C13Y STeO CA FRCG aR ° oe £000 socc 10000 0132 STWC CA PROC aR . ee ee _ oe C5000 t—“‘ié‘“‘CS : locce_ O14 PREG FECISIRIC 133606 'y70a00 0s aaod 73322 491823 os _014C_REC PECIATRIC R ‘ ee 333CC 13332 46622 “O15 TPAG P&G MEC SP 387CC 68566 442CC IS1£00 +* “4 _O1€ PLAR CLT HEP § 28200 _ __ eae 28200 . a te “ORT COMC PUB INFO A zcecC —~—SO CEE 43600 +s 026 AREA FACILITIES _ 84200 . €81CO _ 2495C6 ach ece oe . SO . O2CB AREA FACILITIES * 19300 193¢C0 38600 O20C AREA FACILITIES . e 15760 15700 31460 we O2CE eee FACILITIES e E170c 51700 * %03400 . _G2CF AREA FACILITIES _ 7 oe 3s2cc = 820C _.. 104€0.. 10 O2CG AREA FACILITIES ay $3000 §3000 1ceoce 9 C2Cl AREA FACILITIES _. oo wee ee OH 2 2EO. 12200 24400 _ # O208 ARE FACILITIES - . os 13600 13600 272€0 7 _O2CV_ AREA FACILITIES os £eoc $800 11600 ¢ 02: CEV SYS CF CC T £37C¢ 420 5C 102750 es : $_022) PHYSTOLCGY FCR 26100. V4ha¢ AC2CE ae . t | “ST- ce 8 ee oer wats 82 wit 10 s s ? ‘ ww 5 4 1 a 8 | aucusTt REGICK AL MEDICAL FREGRAMS SERVICE tate Ray j. 251972 ta ““BUNGING HISTORY UIST , , RMPS= - “wot REGION 46 GEOFGIA RMP SLPP YR 04 CPERATICAAL GRAKT (CURECT COSTS ONLY) ALL REQUEST AND AbAROS AS CF JLAE 305 197 ‘ . ? __. AWARDED AWARCEC ARARDED AWARDED ARARCEC ee REQUESTED RECUESTEL REQUESTED RECUESTET e “COPPCKERT ~~ O02 “ey TT 04 0 meneame ng ES Cé oT” * a TITLE ~ O9/71-12/72 TCTAL «= #9 -01/73-12/73 Os Th 12/T4 CLT LA/TE TOTAL ie e* roe % 023 REN FAIL TAN DE 37800 29400 é7200 94 a O26 TCH THN CEM FY Q3elC 3e6cC ——" 39200 #* O27 CCRFYLNITY HYPER 84000 2133333 217333 ** < 027K COMMUNITY HYP ; . oe S100 SCTE 028 CEV CCRPR STATE 37000 1410C€ ELLCC oe "629 CCCP ED SERV CH Tt6G6 6800 iseog ¢¢ ' O30 FACILITY PLANNE s7c¢ 3242C€ 38120 ** . “Cael FACILiTy Ftak 3 " +F 22000 25066 O31 CARCIOVASCULAR 63056 179560 242610 24 : a, | : ¢ —os_a Cvs bres FACILI a — oT eee ** 27600 27600 $526 0310 CVA AREA FACILI ot 1SeECG 19800 39600 —“QULF CVA AREA FACILE se $1600 3160C 622c0°°— O31G CVA #REA FACILE . oe 17400 17400 34800 “OVID CVA AGED FACILI ; 7 “S29 6o FICC Beg0d O31m Cvs AREA FACILI os 13400 13400 26800 € —OULP CvATaREA FACILI 7 21S0C- 21600. 43800 O31S CVA AREA FACILI - oe 12500" 125C0 2ecc0 "632 “STROKE AREA FAC 1oeat—«*wS897G—~C~C“‘:‘«i TI VP! ~ ’ O32& STROKE AREA FAC . oe £6cc 560C 11200 —“OYIN STROKE SETA FSC +e 27800 27600 556CC : C32T STROKE AFEA FAC ‘ oe -2€ECC 266C0 53200 i "036 “A KICNEY OISEAS LL127T SS TTZTT 04 ° z O36B PECICNEL NEPFRC ' +e 22167 10333_ 3250 3 — 0280 REGICKAL KEPHRC = ow 22167 10333 32500 i. O3EF RENAL ERE? FACT * 35000 -asoco aad —“OUEX RERAL BREE FATT ; ¥% F000 35000 n O37 AREA FACILITIES 41291 44291 #¢ a S. —O37E PES CIS EREA FA — - See gg OEE OO 13400 26ace. O37) REE DI§ AREA FA *s 14066 14060 28000 “—"O37T RESP O15 AREA FO 7 ow 16000 15000 3ccco * i O37K RESP CIS AREA F ++ 17600 16400 34000 ——~gik” CrERGY CARE SOU 186455 186455 44 O3B8H EVERC CARE FOR ee 93000 ___ 93000 . 1860C€0 a “Gal CETECT ANC ELIM * s026¢7 777 «102460 Fe 7 0418 CETEC AND ELIVI _ 98 ~ §60c - 95C0. 042 “FLahs Stwl S¥S Co 4a28C 4e2ec ## — ” . . . C42B PLAN §1KC SYSTE «* 170¢¢ 17298 34398 ° ““Oa2C FLAN STwO S¥STE ve 55700 29255 €4655 O42 PATIERT AKC FAY $0232 #0332 #6 oo . 043A PATIENT AND FAM wenn ee reer —a ee “yeace 4@6ico “4 61100 O43F FATIEAT ENC FAM : ae 10000 1600 * L160. —C43G PATIENT &C FA¥ “— — coe ege OCG 2300 , 14300 ran 0434 PATIENT AND FAM oe 13000 1 13¢c¢ O45 PREG TC EXPARC 1466¢ "T4ccc #* . 04@ SHARED ALLIFO FH _ _ 27227... 2722748 eo: — ; wo: u “Q4BA SHAREC ALLIEC F ae 50000 68ic0 "418100 C45 BEAL TR CCCLPATI 1$0S2 _ 19092° ¥# . cs —~QagA FEAL TR OCCLUPATI. ne Te "gee 18006 © “—~ ysoce L 050 PHYSICTAR ASSIS 19978 ISSTE 4&8 csce bHY BSSTSTANT C ee * 3co0c socce 60600 OS1 ECUCATIONG FEAL oe 29867 «ss 29867" 98 ee CT) Mn eee ae sae “ae pond cae? a Ne vr + ’ ai * : eee st +4 = ) 4 AUGLET 201972 Bn REGICAAL PEDICAL PROGRAMS Service he i ) =e : woe cee i oe ES ea FURDIAG HISTORY LUst RMP S-0 SH JICFHL- ew ® REGION 46 GECRCIA RMF SUPP_YR 04 CPERATIONAL GRANT (DIRECT COSTS ONLY) ALL RECUEST AAC AWARCS AS CE JUNE 300 197 6 = ’ _- oe AWARDED ____ABARCEO __.. seonceo.__awancer, __muanoee_ve,neQugsreo__.peOuESTED._AeOpGSTED SECA TS ® CCPPCNENT ot o2 c2 c4 ~ ## cs. 06 , o7 > ) TITLE 09/71-12772 TOTAL ee 01773-12473 C1/TEH 42/74 CLLTSAAZITS TCYAL__ 10 a eee pin — 7 7 : . et . ~ . - ” ~ ow __ 0518 ECUCATICAC FEAL ** 10000 1¢c0co 82 O52 UVPRCVED FRIM € P33t71 £33171 #4 . 052H IMPRCV PRIM CAR oe __* §2500 $5256 107750 —os2e teeecy PRIM can a ° ¢ 44C0C 45400 69600 O52R IMPROV PRIM CAR 7 oo. FL &E6CC 480CcO saecc 9525 IWFFCV PRib CAP $$$ oe 7oo00 74800 1446CC6 cf Cf3 A NURSE MIDEIFE 32806 226CE ** —O530 RUBSE MITWIFE 3 ** 39000 28000 ercce _ 054 STATEWICE PREF ee sooce ___ecece #*_ eign ‘ 054% STbO PROF HEALT +e 7500C 307560 462560 _ 055 EvERCERCY PECIC _ s7vese «ss VTESE SF ee oe OssT EMER MED SERVIC : ae 25400C€ 293743 5at743 C ossv Ewen MEC servic ee 184000 LILES 395899 O56 IMPROVED ERERGY 26787 2€757 ee een «26 25 ee _ Coes _ of. __ ee - YoOTrat-=- 2044600 262360C 32779800 3617328 9965228 ** 3021624 3101176 6122806 —_ a * . Cc g eee ae _ anna weet ee 24C a z < z < . ts Fo oe ee oe oe ee 7 | . _ _ _. _ _ __. a € e ee __ - _ ae eee ee C ta ee eee — q “ nar _ ee ee mT ee w I ee ee — cee ee ce I TT RE a - . wy 2 ' > a an ie _ a = = eee eee a a KR 19 : va Tae es enn ee a 2 e a Sanna ee oe _ . ; - 6 ee en . 4 | | ro) wie, Region: Georgia Review Cycle: HISTORICAL PROGRAM PROFILE OF REGION Georgia Regional Medical Program's initial planning year began on January 1, 1967, the region became operational on July 1, 1968 and it obtained triennial status on September -1,- 1971. GRMP includes the largest geographic area east of the Mississippi River, and is characterized by large rural areas sparsely populated with small hospitals and generally inadequate health facilities and services. This region is looked upon as one of the more progressive regions, and has a good concept of the problems and resources existing within its boundaries. No really serious problems have plagued this region. One concern during GRMP's early stages of development was {ts weak evaluation process. The region responded extremely well to this concern - and now has an excellent evaluation process. An evaluation specialist wag added to the staff. New directions now allow each approved program element to have a specific evaluation plan drawn up by the program. assessment coordinator and the project director at the time of project design. Implementation of the plan occurs shortly after funding. Last year, program involvement with other Federal programs (CHP, Model Cities, Appalachia and OEO) was rather limited and consisted of cross—representation on advisory groups and cross-review of applications. GRMP is now participating with these agencies in developing their health programs in addition to reviewing their applications and serving on the advisory groups. 7 ‘The primary care problems of the underserved urban population was one area 6£ concern that GRMP has not, until recently, addressed to any degree. Developmental component money is now being channeled into projects centered around health care delivery to the rural and urban poor. Four access stations make use of allied health professionals to assist physicians to better serve patients in their geographic areas that are remote from the physicians’ office. Originally, the Steering Committee consisted of six members of which © only one was a non-physician. In order to correct this situation, the Bylaws Committee recommended that the membership be increased from six to nine members with at least four of the nine being non-physicians. This recommendation will become effective in the fall.of this year. Lack of stimulation of activities at the Local Advisory Group level is a problem that the region dealt with through its subregionalization process. GRMP developed the “area facility" concept which basically provides mirtimal - financial support to selected larger community hospitals for the purpose of expanding and extending appropriate health services to the smaller ~19- hospitals and health professionals in their area. Thirty area facilities for continuing education and categorical disease are presently supported. The Area Facility Concept is explained on pages 1 thru 7 of the present application. Staff, at the request of GRMP, plans a visit to the region during the week of August 14-18 and will be available to report on this phase of the total program along with the region's health access stations, etc., when the application is considered. Twelve projects have successfully been terminated by either receiving support from other sources or having had elements that were absorbed into new projects. The Physiology for Nurisng Instructors Course (Project #22) was terminated by Council because it was difficult to see the relevance of this project to the goals and cbjectives of the program and how it could relate to increasing the availability and accessibility of health care. The duration of most of the terminated projects was two and three years. GRMP has been considered by Staff, Committee and Council to be a strong program with good management and organizational strengths, excellent leadership, involved and committed State and local relationships. Excellent cooperation exists between the two medical schools. , The emergence of Emergency Medical Service activities through $100,000 supplemental funds to provide the planning for a total EMS system represents a new departure for GRMP. The region's review process was the subject of a June 8-9, 1972 visit. They. were found to exceed the minimum standards. -20- Region: Georgia Review Cycle: 10/72 STAFF OBSERVATIONS Principal Problems: Recommendations from last year's review cycle revealed GRMP's problems “ to be those of a weak evaluation process, lack of program development to serve the health needs of the underserved urban population, the need for broader lay representation on the Steering Committee and lack: of staff assistance to other Federal programs in developing their health programs. . Principal Accomplishments GRMP has the capacity to adjust readily to changing priorities. The present application reflects definite response to the specific recommendations in last year's advice letter. There has been a task force reorganization to allow greater responsiveness to the new mission of RMP and reflect the three major program areas of interest to GRMP, additions to and change in the Steering Committee structure, and some slight reorganization of program staff to permit the setting up of an operations division. GRMP has matured to the point where emphasis is now being placed upon working with larger community groups responsible for local and area planning, such as CHP (b) agencies and Area Planning and Development Commission of which there are 18 in the state instead of working with the Local Advisory Groups. GRMP staff is cooperating with the National Health Service Corps in site selection and in obtaining medical and dental society approvals for placement of health professionals in areas where health services are inadequate because of medical personnel shortages. Three program areas which reflect GRMP's thrust for meeting local and national priorities are manpower development and ultilization, specialized services, and primary health services. Task forces in these areas of competence develop goals, objectives and priorities. They also recommend: appropriate atrategies for reaching these goals and objectives. GRMP should be noted for the rapidity with which it was able to move into primary health care by ultilizing developmental component money for planning and implementing the access station concept, a regional midwife service and planning a multicounty rural primary care system. Overall, GRMP is characterized as being one of the better managed and organized regions. No previous problems have existed to decrease its funding during the past year. ~21- Issues Requiring Attention of Reviewers GRMP has an approved triennial program of which it is requesting the second year funding. The request does not exceed the N.A.C. level. Staff's recommendation after reviewing this application is to fund the region at the approved level for ass second triennium year. SCOB/DOD/RMPS 8/10/72 AACR A NED U M DEPARTMENT OF HEALTH, EDUCATION, AND WELPARE aa? 4 4% DIN N4 4 PUBLIC. HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION rE . Director Co TRO ! DATE: September 7, 1972 Division of Operations and Development FROM: Director Regional Medical Programs Service SUBJECT: Action on September 5-6 Staff Anniversary Review Panel Recommendation concerning the Georgia Regional Medical Program Application. Accepted Dper . Hy Pha (Date) , Rejected (Date) Modifications Semte at tte he ta AB AL NE PELE nant EDEN, Se cama ante Pata a mune recommended i648 L Advis t medical 7 involyed | tom networ mittee by the They have addition direction of a full-time evaluator, ations in the , evaluation is now under the a game i gee Progr who is also the direc staff component. of anew division of op 972, the region's review proce ' m ; trac at fe Was ryct gs RMP keyview Process 36 During June L s was reviewed. Lt: to exceed the eles © at T 4+ " 4 * VE yements and Standards. } 4ncelude two members of sub into the decision makers fron the The composition of the region's the RAG. This provides for direct in echnical Review Conmigtees. The. continuation application was found to be an exceilent docun outlines the mission of a high rated Regional Medical Program. COWES we y oh ¢ ea nny ca oe ani a Bow to as : a “So , u So 43 oD : “4 yak : Gi > os ft ee oe + s he + Ps i wh res au 2 or il: £ ser Sa oF ot Boy Bo ue & Sg ge g = Neu El oa i 7 a ane a cD oe re WA y wd hi -; VMET URS bn hoe ANT a oe red ad ‘ ce wi bes wt go hy ra Nae ate BAN Somat NIN ey dese vn ‘at or a ~ ea sn at baal om saeco wd Lease od Level. wT a ty oO Ss c 3 i eon vor Region HAWAII RM 00001 Reivew Cycle October 1972 Type of Application_Triennium Rating 309 ‘Recommendations From / _/ SARP . {x / Review Committee / / Site Visit {f. / | Council Recommendation: The Committee agreed with the site visitors and recom- ‘ mended that the RMPH's triennial application be approved. Funding Levels 05 Year 06 Yéar 07 Year (1/1/73--12/31/73) (1/1/74--12/31/74) * (1/1/75--12/31/75) Program Staff & Projects ~ $1,805,488 $1,689,213 _ $1,670,577 .-Developmental ~ | Component o i/ 150,000 150,000 Total 2/ $1,805,488 "$1,839,213 $1,820,577 1/ Because the RMPH has not completely satisfied the management * and review process requirements of RMPS, the developmental request for the 05 year was not approved. 2/ Total funds recommended for RMPH include earmarked funds for kidney project #47 and the Pacific Basin Area. The funding recommended for the kidney project #47 is $15,000 less than the site visit recommendations. Critique: Committee endorsed the site visitors recommendations that , RMPS earmark funds from the RMPH's three-year recommended funding levels in the following amounts for the Pacific Basin Area. 05 Year $299,700 06 Year $288,221 07 Year $299,110 Committee was impressed with the site visitors! favorable report on the progress of the RMPH during the past year. There has been a significant change in the direction of the program along with increased productivity. RMP of Hawaii a RM 00001 This is in part due to the strong leadership the coordinator (Dr. Hasegawa) provides to the program, Because of the satisfactory progress the program has made, both Committee and the gite visitors believe that the region is capable of managing a three-year program. There was some concern that the proposed triennial plan might be coo ambitious and could overextend the Regional Medical Program's capabilities. However, it was agreed that during the coming year the RMPH should have adequate opportunity to demonstrate that it has the efficiency and strength required of a mature and stable organization, ~ Areas of progress and accomplishments noted by the Review Committee are: f & rh erams and categorical disease saith delivery 1, Most of the continuing education pro activities have ended. New priorities focus on h systems to meet local and national goals and objectives. 2, The RMPH has established its own identity as a community leader in an extremely complex social environment. nt 3, The criteria for setting priorities on projects and staff activities are in line with the state's CHP efforts, especially those relating to the accessibility of better health service to the medically underserved areas of the region. — &, With the exception of allied health interest, the key heaith interests, institutions and groups are actively participating in the RMPH, Dr. Masato Hasegawa has been instrumental in bringing these many groups into the program, , 5, While there was no evidence of a scientific approach to assessing needs and resources, the Committee noted that the RMPH seemed to know what needs to be done. 6, The RMPH has established priorities for project funding. First priority is given to ongoing projects and second priority to new projects, Also, priorities have been set within each of the two groups. 7. The Committee commended the increased involvement of the RMPH in ‘the Pacific Basin. The goals, objectives and priorities of the Basin are reflected by the funded projects. Also, the representatives of the Basin are beginning to consider themselves a part of the RMPh, and are attempting to see how the Basin can relate to the program of Hawaii. Areas of concern requiring RMPS attention during the coming year are: 1. In reevaluating the RMPH goals and objectives, the RAG should be realistic in terms of what can actually be accomplished. EMP of Hawaii ~3- . RM COOOL we e a ve 10. Ll. ‘The director should -be encouraged to more effectively uti The PMPH should require grant applicants to incorporate plans ine other sources of funding for successful activities from the inception of the project. deration should be given lity of decremental funding to the projects in the Llize ibility and authority the deputy's role be fully and program staff, his deputy, and delegate more accordingly. it is recom clarified and documented for A concentrated effort be made to commit ff efforts in a ngthen the RMPH program coordinated ae to further development as reflected in all its major project activities, The RMPH be encou 2d to continue to vefine its revised bylaws, giving close attention to me iss raised in the management survey and review verification reports. Special attention should be given to peri the role of the Executive Committee to insure that it acts in behalf of, and not instead of the RAG. ' The RMPH review process should be finalized with special attention given to the issues raised in the review process verification report, There should be more active involvement of the allied health groups im the RMPH The RHPH should continue to develop new techniques to evaluate project activities and to assess how they will contribute to regional goals and objectives. Special attention should be given to providing Information on progress ane eval uation results to program management, the RAG, and othe The PMPH carefully reevaluate the magnitude of its triennial plan, giving special attention to the RMNPH's full responsibility to its major program components to determine how best to utilize organizational resources, especially program staff, A mechanism be developed to utilize the findings of the Inter-~ Socicty Commission for Heart Disease Resources in establishing the EMS system, 2 evision of RAG bylaws was recommended by the management survey and review process verification visit reports of May 1972, These revised bylaws should establish the RAG 4s the res sponsible body for formulating program policy, and as the decisionmaking body for all program matters, Also, other program areas would be clarified, 7 a RMP. of Hawail ~ Gu ‘ RM OOOOL 1972, the site visit team was advised that a committee of the oes Sromca and had drafted a revised set of bylaws. The revised s would require edditional work, and the need for advice from someone knowledgeable in bylaw prenaration was evident. “We Proeram of Hawaii were elas ees. ‘nitial ygeading of th I cine Grant ylavs for the Regi » 1972, for eo eeted some deviation from Regional Advisory Group Resp rc wudations Recon the recommendation that in the advice letter. of the RECH triennial applicat above cotcerns be communicated to WOB/RMPS 9/29/72. “ Region: COMPONENT AND FINANCIAL SUMMARY TRIENNIAL APPLICATION Hawaii RM 00 _ Review Cycle: Octobe Committee Recommendation for Current Annualized Request for Triennial Council-Approved Level Component Level - 04 Year lst year | 2nd year | 5rd year lst year | 2nd year | 3rd year (05) (06) (07) (05) (06) (07) PROGRAM STAFF & PROJECTS $1,405,185 $1,886,223 |$1,780,1501 $1,420,276 {1,730,000} 1,650,000 1,650,000 DEVELOPMENTAL. COMPONENT, ~O- 287,583 287,583 287,583 -0- 150,000 150,000 _ Kidney | € 90,488) 39,213 20,577 75 ,488 39,213 20,577 ~ EMS © ( ) hs/ea ¢ ) Pediatric Pulmonary ( ) _ Other C 4) TOTAL DIRECT’ COSTS $2 ,875,830%* $2,264,294 $2,106,946 $1,728,436 1,805,488 [1,839,213 41,820,577 COUNCIL RECOMMENDED LEVEL $1,102,000 *Includes $1,470,645 direct cost for EMS project. These : funds are for two years but were totally awarded during the 04 year for RMPS administrative purposes, S SITE VISIT REPORT REGIONAL MEDICAL PROGRAM OF HAWAII, AMERICAN SAMOA, GUAM AND . THE TRUST TERRITORY OF THE PACIFIC ISLANDS August 7-8, 1972 Site Visit Participants: Leonard Scherlis, M.D., Chairman; Member of the. Regional Medical Programs Review Committee; Professor of Medicine and. Head, Division of Cardiology, University of Maryland School of Medicine, Baltimore, Maryland Mr. Edwin C. Hiroto, Member of the National Advisory Council on Regional Medical Programs; Administrator, City View Hospital, Los Angeles, California Mr. Kenneth Barrows, Bankers Life Company; and Chairman, Regional Advisory Group, Iowa RMP, Des Moines, Iowa William I. Holcomb, M.D., Private Practitioner; and Member, Regional _ Advisory Board, Oregon RMP, Eugene, Oregon RMPS Staff: Mr. Richard L. Russell, Acting Chief, Western Operations Branch, DOD Mr. Calvin Sullivan, Western Operations Branch, DOD Mr. Ronald S. Currie, Program Director, RMP, Office of the Regional Heaith Director, DHEW Region IX, San Francisco, California Edward J. Hinman, M.D., Director, Division of Professional and Technical Development RMP of Hawaii Staff: Masato Hasegawa, M.D., Executive Director MezrOmar A. Tunks, Deputy Director Alexander Anderson, M.D., Consultant in Medical Care and Quality of Medical Care Mr,d@lyde Winters, Consultant in Medical Information System Misa Susan Chandler, Assistant Director, Commmity Health Mrs. Rosie K. Chang, Assoc. Director, Allied Health Manpower Miss Manolita DeJesus, Office Manager Satoru Izutsu, Ph.D., Assoc. Director, American Samoa, Guam & Trust Territory Kanae Kaku, M.D., Biostatistician/Epidemiologist Mr. Ross Rammelmeyer, Assoc. Director, Planning and Systems Analysis Miss Florence Katz, Assistant Health Planner Mr. Michael Rodolico, Assistant in Systems Analysis and Evaluation Mr. Norman Kuwahara, Assoc. Director in PPBS and Comptroller Page 2 - RMPH Site Visit Report, RM 00001 at RAG Members in Attendance: __ Mr. Edward C. Bryan, Chairman, RAG; Executive Committee Member; Castle § ; Cooke, Inc., Honolulu, Hawaii an _ Mr. Ollie Burkett, Vice-Chairman, RAG; Executive Committee’ Member ; Jaf Hospital Association of Hawaii, Honolulu, Hawaii & William M. Peck, M.D., RAG Representative from Micronesia; Trust _ Territory of the Pacific Islands, Office of the High Commissioner, Saipan, Mariana Islands " Mrs. Betty S. Guerrero, RAG Representative from Guam; Department of Public Health, Agana, Guam : Mr. Curtin A. Leser, RAG Member; Hawaiian Electric Company, Honolulu, Hawaii Mr. Stanley B. Snodgrass, RAG Member; Administrator, Convalescent Center of Honolulu, Honolulu, Hawaii . Mr. Albert Yuen, RAG Member; Admin. Vice Pres:, Hawaii Medical Service Association, Honolulu, Hawait Mr. Harold H. Ajirogi, Sr., RAG member and Executive Committee member; Program Officer, East-West Center, Honolulu, Hawaii , 8 Mr. Ligoligo K. Eseroma, RAG Representative from American Samoa; District #1 House of Representatives, Legislature of American Samoa, Fagatogo, _ American Samoa i oo Herbert Y. H. Chinn, M.D., RAG member, Alexander Young Building, Honolulu, Hawali ers: William E. Iaconetti, M.D., President, Hawaii Medical Association, Honolulu, Hawaii Mrs. Sylvia Levy, Officer, Comprehensive Health Planning, Department of Health, Honolulu, Hawaii Miss Edith Anderson, Dean, U. H. School of Nursing, Honolulu, Hawaii Mr. David Pali, President, Waianae Coast Comprehensive Health & Hospital Board, Inc., Waianae, Oahu Mrs. Claire Ho, President Elect, Hawaii Dietetic Association, Nutrition Branch, Department of Health, Honolulu, Hawaii Mrs. Mary Lee Potter, Executive Director, Hawaii Nurses Association, Honolulu, Hawaii ference Rogers, Ph.D., Dean, U. H. School of Medicine, Honolulu, Hawaii Mr. James Bunker, Exec. Vice President, American Cancer Society, Hawaii Division, Honolulu, Hawaii . Livingston Wong, M.D., Alexander Young Bldg., Honolulu, Hawaii Mr. Jerrold M. Michael, U. H. School of Public Health, Honolulu, Hawaii Mr. Mark Sperry, Assistant Director, Health & Community Services Council of Hawaii, Honolulu, Hawaii Mr. George Moorhead, Assoc. Director, Health & Community Services Council of Hawaii, Honolulu, Hawaii . Mr. Pat Boland, Asst. CHP Officer, Comprehensive Health Planning, Honolulu, Hawaii a Miss Margaret Makekau, Asst. CHP Officer, Comprehensive Health Planning, Honolulu, Hawaii Page 3 - RMPH Site Visit Report, RM 00001 Others, Cont.: H. Tom Thorson, Exec. Director, Hawaii Medical Association, Honolulu, Hawaii Mr. Raymond Lilly, Administrator, Waianae Coast Comprehensive Healt Center, Waianae, Oahu . Mr. Robert W. Rhein, Asst. Administrator, Waianae Coast Comprehensiv Health Center, Waianae, Oahu ; Mr. Alexander Charter, Project Director, RMPS; Vice President, Syracuse University, Syracuse, New York . Miss Jane Arakaki, Consultant Dietitian, Hawaii Dietetic Association, Maunalani Hospital, Honolulu, Hawaii Mr. William Coops, Administrative Officer, Research Corporation of the University of Hawaii, Honolulu, Hawaii ‘ INTRODUCTION The main section of this report follows the RMP Review Criteria and concerns primarily the activities of the RMPH in the State of Hawaii. A separate section is included on the RMPH activities in the Pacific 1. GOALS, OBJECTIVES, AND PRIORITIES (8) The current goals, objectives and priorities were established in 1971 and represent a change from an emphasis on categorical diseases to the development of a program to assist in the improvement of the health care delivery system. The goals are broad and allow the RMPH considerable flexibility in programming. The criteria for setting priorities on projects and staff activities are in line with the State's CHP efforts, especially those relating to the accessibility of better health service to the medically underserved areas of the Region. The RMPH RAG plans to reevaluate the current goals and objectives and update them Lf necessary. The team was extremely encouraged by the current program direction of the RMPH. There was, however, concern that the RMPH might well find itself overextended in terms of its organizational capabilities. The team emphasized that the RMPH must realize its full responsibility for successful programs, a responsibility which includes more than financial support and RMPH goals. RMPH grant recipients should be made. aware that their projects are part of the RMPH and must conform to the established RMPH procedures and reviews. This concern will be discussed further under the Action Plan. Page 4 ~ RMPH Site Visit Report, RM 00001 Recommended Action: In reevaluating its goals and objectives, the RAG should be realistic in terms of what can actually be accomplished rather than what it would like to have accomplished. Loe 2. ACCOMPLISHMENTS AND IMPLEMENTATION (15) The RMPH's efforts of past years are now resulting in concrete program results. The RMPH has definitely established its own separate identity as a community leader in an extremely complex social environment. In the process of development, the program has gained support and involvement of. the community's power structure, or “establishment ," and the community itself, or the ‘“nonestablishment." A competent, dedicated and enthusiastic staff has been developed. There has not been, however, adequate involvement of all key staff in some of the major program areas. The change in’ direction, enthusiasm, and productivity of RMPH is impressive. Further, considerable progress has been made by the RAG in taking corrective measures in response to the Review Process Verification and Management Survey Visits conducted by RMPS staff in May 1972. Recommended Action: The RMPH be encouraged to continue to build on its experiences and successes thereby strengthening its administrative and review processes to develop a fluid and adaptable structure so that the RMPH is able to be flexible to meet the different needs that arise in achieving its goals. 3. CONTINUED SUPPORT (10) The team found this to be a particularly weak segment of the program and could not identify a clear RMPH policy aimed at developing other . sources of funding for successful activities. Further, there was no evidence that decremental funding had been considered in reviewing proposals. It is expected that the cancer chemotherapy project will be funded by the American Cancer Society and the National Cancer Institute upon completion of its fourth and Last year of RMPH support. The Medical Care Review Organization project has been supported since June of 1971 by the NCHSRD, HSMHA, as an experimental project. In discussing long-term funding of this project, RMPH representatives reported that eventually the participating hospitals would share the cost. Whether or not the private physicians would be willing to share the costs is not clear at this time. Recommended Action: The RMPH should require grant applicants to incorporate plans for developing other sources of funding for successful activities from the inception of the project. Further, consideration should be given to the possibility of applying decremental funding to the projects in the triennial application. Page 5 - RMPH Site Visit Report, RM 00001 4, MINORITY INTERESTS (7) It is difficult to address “minority interests" in Hawaii as the term is defined on the mainland. Of the 750,000 people of the State, 150,000 are Hawaiian or part Hawaiian, most of which are at the bottom of the social and economic scale. Other minorities include descendants of the people brought in from China, Japan, Puerto Rico, Portugal, and the Philippines to work in the plantations. These minorities are land oriented but unable to obtain land. The team believed that the RMPH is addressing. the "minority interests" by placing high priority on making better health care accessible to people in medically underserved areas, as evidenced by the RMPH support of the Waianae Coast Comprehensive Health Center project. The Waianae District historically has had one of the poorest health profiles in the State, according to standard measures of heaith, including incidence of serious communicable diseases and chronic health conditions, incidence of restricted activity and bed days, lack of prenatal care, and incidence of infant mortality. Recommended Action: The RMPH should be encouraged to pursue its interest in addressing the problems of the medically underserved areas. , 5. COORDINATOR (DIRECTOR) (10) There was no doubt of Dr. Masato Hasegawa's dedication to the RMPH. A significant amount of the program's accomplishments was attributed to the strong leadership he provides in the community and his ability to bring together diverse groups. Further, Dr. Hasegawa relates well with the RAG, especially its chairman, with whom he has regular and frequent meetings. Prior to the visit, one of the concerns of the team was that the Director was not allowing his deputy to function in an effective manner. RMPS staff members noted a marked change in the degree of responsibility _ the deputy had assumed in implementing changes in response to the manage- ‘ment survey and review process verification visit reports, and in the conduct of the site visit. Dr. Hasegawa openly admitted that in the past he had not delegated appropriate authority and responsibility to the deputy. Further, he stated that he realized appropriate delegation was necessary. While the team was encouraged with the Director's change in attitude, there was some evidence that it might be some time before the deputy's responsibilities and authority would be fully established. A conflict, apparently one of personalities, exists between the deputy and comptroller. Further, the deputy, in a private session with RMPS staff, reported that he does not have access to fiscal information from the RMPH comptroller. The arrangements are that if the deputy needs fiscal Page 6 - RMPH Site Visit Report, RM 00001 information, he must ask Dr. Hasegawa who in turn gets it from the comptroller. Representatives of the Hawaii Medical Association, in a separate meeting which will be discussed later, also voiced concern about not being able to get information from the RMPH comptroller. The withholding of information by the comptroller appears to be condoned by the Director as a way of controlling the type of information he wants released to various individuals. Recommended Action: The Director should be complemented on his decision to use more effectively the deputy and for recognizing the need to delegate more responsibility and authority accordingly. It is recommended that the deputy'’s role be fully clarified and documented for the RAG and program staff. The team sees an effective deputy as a mechanism for improving communications between RMPH staff and the RAG and strengthening coordina~ tion of effort and communications among the program staff. 6.° PROGRAM STAFF (Formerly known as CORE STAFF) (3) The team found a competent, dedicated and enthusiastic staff. Although it was reported that the staff consulted with one another on individual projects and program areas, the team did not believe that staff involvement was adequate in 4 number of key projects, especially the Emergency Medical Service System, Hawaii Medical Care Review Organization, Waianae Coast Comprehensive Health Center, and the Pacific Basin Program. In view of the nature and significance of these programs, there is a need for total commitment of much of the staff. Along these lines, the team wondered if Dr. Alexander Anderson, Project Director of the Hawaii Medical Care Review Organization, was or would be actively involved in other RMPH activities. As noted earlier, the team was pleased with the increased involvement of the deputy, and believes that he should be able to assume greater responsibility in the coordination of staff activities in program development. If not already being done, perhaps periodic formal staff meetings should be held so all staff members have a general idea of the total RMPH program. Recommended Action: A concentrated effort be made to commit staff efforts in a coordinated manner to further strengthen the RMPH program deve lopment as reflected in all its major project activities. 7. REGIONAL ADVISORY GROUP (5) The team was extremely impressed with the RAG chairman, Mr. Edward Bryan. There is no question of his commitment to and involvement with the program. RMPH is fortunate to have his leadership. The discussions with Mr. Bryan and other RAG members convinced the team that the RMPH RAG is well aware that it should have the responsibility for setting the general direction of the RMPH and formulating program policies, objectives, and priorities. ¢ ° Page 7 - RMPH Site Visit Report, RM 00001 Confusion exists, however, about the role of the Executive Committee, especially in the RMPH's review process. Mr. Bryan indicated that the Executive Committee may be relieved of its current responsibility of review and approval of applications. The team was pleased to note that the RMPH process plans for early involvement of CHP. Further, the team was impressed with the willingness and ability of the RAG to assign relative funding priorities to projects. The team reaffirmed the findings of the management survey visit and review process verification visit. The reports of these visits included the recommendation that the RMPH revise its bylaws and strengthen its review process. The team was pleased to learn that a committee of the RAG had been formed and had drafted a revised set of bylaws. In addition, efforts to strengthen the review process had already begun. The revised draft of bylaws will require additional work, and the need for advice from someone knowledgeable in bylaw preparation was evident. The visitors realized, however, that this first draft had been prepared in a short period of time. There was evidence that the program staff is increasing its efforts to keep RAG members better informed of the overall administrative and program operations. The team stressed the need to continue this effort so that all RAG members have access to an adequate system of two-way communications. As the body which has the responsibility for setting program direction, policies, and priorities, the RAG must have access to an effective mechanism to commumicate its decisions to the program staff. Also, and equally important, there must be an adequate mechanism by which the program staff transmits to the RAG and its Commi thees the information they need to make decisions. A major concern expressed over the composition of the RAG was a lack of adequate allied health representation. Of the 37 RAG members from the State of Hawaii, 34 are from Oahu and the remaining three represent the Maui, Hawaii and Kauai county medical societies. Approximately 25 percent of the State of Hawaii representatives on RAG are hospital administrators or serve on the board of a major hospital. In addition, most of the physicians on RAG have at least one hospital affiliation. As a result,., Kuakini Hospital, for example, appears to be represented by at least four RAG members, including three members of the Board of Trustees and the Chief of Surgery. In contrast, voluntary health agencies and allied health interests are not represented and there appeared to be minimal consumer representation. The acceptance of the Pacific Basin Council .by the RAG and the increased involvement of the Council is commendable. Page 8 ~ RMPH Site Visit Report, RM 00001 Generally, the team was pleased with the strength, involvement and commitment of the RAG and was extremely encouraged with the administrative and programmatic changes which have occurred since the last site visit. There was evidence that the RAG as a whole is assuming some of the authority previously held by the Coordinator and Executive Committee. The direction which the RMPH is taking can only be commended and encouraged. Recommended Action: a. The RMPH be encouraged to continue to refine its revised bylaws, giving close attention to the issues raised in the management. survey and review verification reports. Special attention should be given to clarifying the role of the Executive Committee to insure that it.acts in behalf of and not instead of the RAG. Consideration might be given to seeking professional guidance in the wording and structure of the bylaws. Perhaps legal council could assist. : po b. The RMPH review process should be finalized with special attention given to the issues raised in the review process verification report. Attention should also be given to eliminating unwarranted duplication in the process. : ¢, Additional allied health personnel be added to the RAG. “di «~The adequacy of representation by voluntary health agencies and consumers be explored. _ . e. The RMPH continue its efforts in strengthening communication between the RAG and program staff. 8. GRANTEE ORGANIZATION (2) Dr. Richard K. C. Lee, Executive Director, Research Corporation of the University of Hawaii, the grantee, was not present during the visit. The team assumed that he was heavily involved with two major Federal site visits to the University's Medical School. Mr. William Coops, the grantee's administrative officer, however, actively participated during most of the visit. Prior to the site visit, the grantee had notified RMPS of its favorable acceptance of the management survey report, and a willingness to work with RMPH in implementing the report's recommendations. The primary concern of RMPS was that the RMPH Executive Committee had usurped some authority of the grantee. This had been sanctioned by the grantee since Dr. Lee served as an ex officio member of the Executive Committee. During the visit, Mr. Coops stated that the grantee finds the RAG to be a very active and concerned group and, as a result, feels comfortable in permitting the RAG to do some of the grantee's work. Page 9 - RMPH Site Visit Report, RM 00001 The team found no evidence that the issues raised by the management survey report would not be satisfactorily settled. The clarification of the role of the Executive Committee, as noted. earlier, should further clarify the relationship between the RMPH and the grantee.. Recommended Action: The recent "RMPS Policy Concerning Grantee and Regional Advisory Group Responsibilities and Relationships" should be considered by the RMPH in revising its bylaws. 9, PARTICIPATION (3) With the exception of allied health interest, the key health interests, institutions, and groups appear to be actively participating in the program. The team believed that Dr. Hasegawa had been instrumental in bringing these many groups into the program. Representatives of a number of professional, voluntary, governmental, and consumer groups attested to their involvement with the RMPH. Included were the Hawaii Medical Society; Hospital Association of Hawaii; Hawaii Nurses Association; The University of Hawaii's Schools of Medicine and Public Health and East-West Center; the American® Cancer Society; the Health and Community Services Council of Hawali, a private agency which represents 115 public and private groups, Waianae Coast Comprehensive Health Center; and the Health and Community Services Council of Hawaii. As indicated earlier, the team believed that the RMPH - has involved the "establishment" and "nonestablishment." , Recommended Action: There should be more active involvement of the allied health groups in the RMPH. 10. LOCAL PLANNING (3) As reflected in the Review Process Verification Visit Report, the area of cooperative endeavor with Hawaii CHP agency is one that requires increased attention. Planning to date appeared to be ona fragmented — basis. The team was encouraged, however, by the RMPH plans to involve CHP early in the review process as recommended by the review process verification visit report. Although there are no CHP "B" agencies, the CHP "A" agency does have county committees on all but two of the Hawaiian Islands. CHP in Hawaii is preparing a budget proposal for the next fiscal year which, if funded, will more than double the existing CHP agency staff of three professionals. As presently proposed, all personnel will be part of the A agency staff. Page 10 ~ RMPH Site Visit Report, RM 00001 The proposal would add one full-time staff person, a research _ associate, to Mrs. Levy's immediate staff. In addition, the proposal would establish what are being termed as State Assisted B agencies. Under this concept, full-time planners will be assigned to the counties of Hawaii and Maui, the windward side of Qahu and a half-time planner would be assigned to Kauai. This staff will assist with the development of a statewide health plan for Hawaii. Over a period of years, it is anticipated that the State Assisted B agencies will develop into full-fledged independent B agencies. In May 1972, RMPH employed and Associate Director for Planning and Systems Analysis for the purpose of developing long and short-range plans. The systems approach at this time is in the embryonic stage, and appeared. rather confusing. Hopefully, this approach coupled with the involvement of CHP and other appropriate community groups, and the coordination of RMPH program staff in program development will result in an effective planning mechanism. Recommended Action: The RMPH be encouraged to continue its increasing efforts to develop an effective planning mechanism. Future staff and/or site visits to the RMPH should pay special attention to the systems approach. “ 11. ASSESSMENT OF NEEDS AND RESOURCES (3) Dr. Hasegawa reported that the data available from CHP had been gathered primarily by the RMPH. While there was no evidence of a scientific approach to assessing needs and resources, the team noted that the RMPH seemed to know what needs to be done. The participation of the RMPH in the Management Reporting and Evaluation System (MRES) being conducted © by the University of Washington through a RMPS contract, should strengthen the RMPH's planning and assessment practices. MRES is a group of processes that serve as mechanisms for directing, planning, monitoring, and reporting the effects of a RMP...its personnel, its efforts, its resources. The major output of the system is the productiort of timely and practical information which enables coordinators and Regional Advisory Groups to effectively apply the decisionmaking processes. ‘ Recommended Action: RMPH should continue its efforts to work more closely with CHP in assessing needs and resources. 12. MANAGEMENT (3) In view of the recent Management Survey Visit, the team did not believe it necessary to question the fiscal management of the program. The need for better coordination of program staff in programs and project development has already been discussed. The monitoring of projects appeared adequate. Page 11 - RMPH Site Visit Report, RM 00001 13. EVALUATION (3) Evaluation was considered to be a serious deficiency of the program. The new Associate Director for Planning and Systems Analysis is also responsible for evaluation of project and program activities. RMPH is recruiting for a medical economist to insure a relationship of the RMPH to the total economic system of Hawaii and provide measures of cost effectiveness and cost benefit to insure that the delivery system has a measurable economic component built-in. An evaluation subcommittee of the RAG has been established and is currently in the developmental stage. Another subcommittee of the RAG, also in the developmental stage, is the Implementation Committee, which about five months ago initiated the site visit mechanism to ongoing and potential projects. There is a need for the program staff to provide project progress and expenditure reports: to the RAG and its committees at each of their respective meetings to aid in the evaluation of projects. , Recommended Action: The RMPH should continue to develop new techniques to evaluate project activities and to assess how they will contribute to regional goals and objectives. Special attention should be given to providing information on progress and evaluation results to program management, the RAG, and other appropriate groups. 14, ACTION PLAN (5) The RMPH has established priorities for project funding. First priority is given to ongoing projects and second priority to the new projects. Also, priorities have been set within each of the two groups. While all of the projects have a sense of reality to them and are in keeping with both RMPH and national objectives, the team believed that the magnitude of the program proposed would seriously tax the current capability of the RMPH. Some of the RMPH's key projects, such as the Emergency Medical Service System, have been rapidly thrust upon the RMPH, which has responded admirably. There was a question, however, as to whether RMPH had had adequate time to evaluate the significance of their potential involvement: with the EMS, Waianae Coast and Pacific Basin activities. Although these individual programs represent different types of joint involvement with a number of other agencies, they are the primary responsibility of the RMPH, and, therefore, will require the total commitment of much of the program staff. The EMS program at this point is only a "paper system," and the full impact of RMPH's responsibility of making it a truly comprehensive system may not be fully realized. The RMPH has a responsibility of seeing that the EMS Advisory Council must be broadly represented to include those interests which are necessary to the successful development Page 12 ~ RMPH Site Visit Report, RM 00001 of a quality operational system. RMPH should assure that the system— gives appropriate attention to the trauma, drug, psychiatric, and medical elements. Regarding the latter, advantage should be taken of the Inter~ Society Commission for Heart Disease report on myocardial infarction. Also, the relationship of the Physiological Data Monitoring System project to the EMS project should be carefully examined and coordinated. The overlap between the two projects must be compatible. The RMPH plans to fund the EMS project, which is sponsored by the Hawaii Medical Association through a contract. Currently, the HMA and RMPH are having some difficulty in negotiating a4 contract. The morning following the site visit, RMPS staff was asked to meet with the following representatives of the HMA: Livingston Wong, M.D., Project Director, EMS Project; : Herbert Y. H. Chinn, M.D., Member of RAG, Past President of the Hawaii Medical Association and Chairman of the HMA-EMS Executive Committee; Thomas Y. K. Chang, M.D., Assistant City and County of Honolulu Physician, Director of the City-County Ambulance System, and Assistant Director for Equipping Ambulances in the EMS Project; George Mills, M.D., Member of RAG and Executive Committee of RMPH, Past President of HMA, and Hawati State Senator; and H. Tom Thorson, Executive Director, HMA. One of the problems seems to be that the HMA is hesitant to be placed in a position of having to answer to the RMPH. Dr. Wong, the project director, is concerned that the RMPH plans to hire a physician on its program staff to "keep an eye on him." HMA representatives said they were unable to get information from the RMPH comptroller regarding the RMPH fiscal policies. There was much discussion as.to who would resolve the differences between the HMA and RMPH in contract negotiation. Dr. Mills suggested that this would have to be worked out between the HMA and the RMPH Executive Committee. Although the RMPH will support about 15 percent of the Waianae - Coast's total program, the team believed that the RMPH has a ma jor responsibility in working with the development of the total program. 2 The future of the Waianae program can be potentially exciting, oF potentially troublesome, for the RMPH. Based on the testimony of Mr. David Pali, President, Waianae District Comprehensive Health and Hospital Planning Board, Inc., the RMPH has been an exceptional stimulus and catalyst toward the development of the total program. The role that RMPH has played seems to be well recognized and appreciated by the community. If the project continues to develop successfully, RMPH, no doubt, will receive much of the credit. On the other hand, if the progress of the project should be thwarted and the provision of health services should be delayed, the commmity may look to RMPH for explanation. It seems, therefore, that the RMPH would want to provide close surveillance and assistance to the other segments of the project. While support of this nature may well absorb a considerable amount of program staff's time, the team believed the investment would be most beneficial to the community and, therefore, the RMPH. Page 13 - RMPH Site Visit Report, RM 00001 Another concern of the team was the lack of any clear relationship of the Hawaii Medical Care Review Organization project to other projects.. It appears that many of the MCRO activities might be applied to the other projects. It was noted that the CHP- Review Group pointed out the’need to relate MCRO to the Oahu Patient Origin and Utilization Study. In discussing the RMPH's plan for renal disease, the team noted that there seemed to be a problem of two competing hospitals, each wishing to perform identical functions. The RAG chairman assured a member of the team that the problem had been solved and there would be no duplication. Recommended Action: a. The RMPH carefully reevaluate the magnitude of its triennial plan, giving special attention to the RMPH's full responsibility to its major program components to determine how best to utilize organizational resources, especially program staff. . b. A mechanism be developed to utilize the Report of Inter-Society Commission for Heart Disease Resources in establishing the Emergency Medical Service System. c. That the RMPH and RMPS provide close surveillance and assistance as necessary on the progress of the EMS project. d. The relationship of the Hawaii Medical Care Review Organization to other RMPH activities, and the relationship of the Physiological Data Monitoring System project to the EMS project be explored further. 15. DISSEMINATION OF KNOWLEDGE (2) The team expressed no concerns over this segment of the program. Provider groups and institutions and education and research institutions have been contacted and involved. 16. UTILIZATION MANPOWER AND FACILITIES (4) Existing health facilities will be more fully utilized through projects such as the EMS, and Monitoring of Physiological Data projects. Productivity of physicians and other health manpower should be more fully utilized as a result of projects such as Manpower Utilization and Restraint of Costs in Hospital System, Hawaii Medical Care Review Organization, and Upgrading Bedside Nursing Care in Rural Commmity Hospitals. The use of |. allied health personnel is demonstrated to some extent in the Dietary Counseling and Outreach Service and the Waianae Coast projects. The team Page 14 ~ RMPH Site Visit Report, RM 00001. believed that there was a need for greater allied health activity in the program related directly to Hawaii. (The use of allied health personnel in the Pacific Basin program is clearly demonstrated.) In addition, the manpower programs of the RMPH could be strengthened through a better : integration of programs. Recommended Action: The RMPH should reevaluate allied health involvement in its programs as related to the State of Hawaii. Further, the coordina- tion. of manpower programs for physicians, nurses, and allied health | personnel should be explored. . - 17. IMPROVEMENT OF CARE (4) All of the projects, in various ways and degrees, are aimed at the improvement of care. 18, SHORT-TERM PAYOFF (3) It is reasonable to expect that some of the projects will increase * the availability of and access to services. The Waianae Coast project is: a prime example. The Medical Care Review Organization is to establish an ongoing system for quality of medical care review. As noted earlier, a medical economist is being recruited to address the economic component, of the delivery system. . 19, REGIONALIZATION (4) In view of the geography of Hawaii and the fact that the majority of the population is in Honolulu, the team expressed no concerms over this aspect of the program. One example of joint effort and multi-agency coordination is the Waianae Coast Health Center Project. The membership of the Regional Advisory Group and its standing committees indicate regional involvement. Major health, business, labor and educational organizations are represented. Of the 24 performance sites shown in the application, 13 are outside of Honolulu. Further, there are program staff activities and operational projects which are specifically directed to Hawaiian Islands other than Oahu. The Pacific Basin program, of course, is‘an example of successful regionalization under most unusual circumstances. 20. OTHER FUNDING (3) The only two concrete examples of other sources of funding were the -American Cancer Society's intent to support the chemotherapy project and the support of the Waianae Coast project by state and Federal funds. The team was disappointed, as noted earlier, that there was no clear RMPH policy aimed at developing other sources of funding. Recommended Action: The RMPH should develop a clear policy regarding continued support which could be used in the review and evaluation processes. Page 15 - RMPH Site Visit Report, RM 00001 PACIFIC BASIN The team was extremely pleased with the increased involvement of the RMPH in the Basin which by its very nature presents an unique challenge. The Basin covers a geographical area of over three million square miles, is populated by 228,000 people who speak ten languages and live on 105 of the 2,147 islands. Guam, American Samoa and the Trust Territory are distinct and separate in regards to people, culture, and government. More than 50 percent of the population have no ready access to health care. The goals, objectives and priorities of the Basin are reflected by the funded projects, Constant Care Unit on Guam, Health Assistant Training, Improvement of Health Services through Otology, and Health Information System on Guam, In developing priorities for project selection, the specific health needs, availability of resources and the problem of vast distances were taken into account. Perhaps the most significant accomplishment to date, excluding the results of individual projects, is that the representatives of the Basin are beginning to consider themselves as a part of the RMPH, and are attempting to see how the Basin can relate to the program of Hawaii. Mrs. Betty Guerrero, the RMPH RAG representative for Guam, for example, wanted to know if Cuam could become part of the Hawaii EMS program. Dr. Wong, the EMS project director, said "we will have to talk." The earmarking of funds by RMPS as part of the RMPH award, has definitely helped close the credibility gap between the Basin and RMPH, The Basin was "tired of planning." The RMPH is supporting operational projects. The team commended the enthusiastic leadership provided by Dr. Satoru Izutsu, Associate Director for the Pacific Basin. His ability to provide | program direction and to identify with the cultural diversity of the area is impressive. The vast territory Dr. Izutsu covers requires that he spend between 10-15 days a month in the Basin. The RAG for the Pacific Basin is the Pacific Basin Council which is composed of ten RMPH RAC members from Guam, American Samoa and the Trust Territory and 12 members of the now disbanded Pacific Basin Advisory Committee. Key health organizations are represented. Deliberation of Pacific Basin matters are solely the prerogative of the. - Council and its representatives in the RMPH RAG are the primary contacts for Dr. Izutsu. Because of the cost of travel, one member from each area of the Basin is designated, by fellow Council members, to attend RMPH RAG meetings in Honolulu. Page 16 ~ RMPH Site Visit Report, RM 00001 The three representatives from the Basin, Mrs. Guerrero from Guam, Dr. William Peck from Saipan, and Mr. Ligoligo K. Eseroma from American Samoa indicated that the Pacific Basin Council had adequate input in the RMPH. Mr. Eseroma, in a note to the Chairman of the team, questioned the possibility. of changing the. RMPH title to "Regional Medical Program Area." He said such a change would satisfy the Government of American Samoa. The Council finds meeting in Honolulu a practical and desirable arrangement. It is intended that Council members will convene a day prior to RAG . ‘ meetings so that RAG members from Guam, American Samoa, and the Trust Territory may attend both meetings. . Travel costs per Council meeting are $5,500. It appeared that the key health interests of the Basin were becoming actively involved in the program. Comprehensive Health Planning is established in each area of the Basin. A CHP plan has been completed for Guam. American Samoa's CHP is not really activated--there have been three CHP planners in the last three years. Just recently, American Samoa got a new planner who previously was the assistant to the CHP planner on Guam, Mrs. Guerrero. Mrs. Guerrero believes it will take American Samoa about three years to develop its CHP plan. Dr. Izutsu is actively involved with the Comprehensive Health Program Council for the Trust Territory which involves representatives from all consumer, provider, and governmental groups. ‘In general, the site visitors were highly impressed with the development of the Pacific Basin Program, and believed much had been accomplished with. limited staff and budget. ee The team recommended that the Pacific Basin Program be approved in the amount requested ($299,700). Further, the team endorsed the specific identification of funds by RMPS for the Pacific Basin Program. CONCLUSIONS AND RECOMMENDATIONS The team was favorably impressed with the change in direction, enthusiasm, and productivity of the RMPH. While the team believed that the program is capable of managing a three-year plan, they were concerned with the magnitude of the proposed plan, The RMPH is currently in the midst of a transitional stage of organizational as well as programmatic development, © and the proposed program might overextend the present capabilities of the RMPH. The team believed that during the coming year the RMPH will have adequate opportunity to demonstrate that it has developed the efficiency and strength required of a mature and stable organization. Since the RMPH has not completely satisfied the management and review process requirements of RMPS, it would have been inappropriate for the team to consider a developmental component request for the initial year of the triennium. Page 17 - RMPH Site Visit Report, RM 00001 The team recommended that the RMPH be approved for triennium status, including the Developmental Component, for the second and third year of the triennium, provided: I. It. IIl. IV. The amounts requested for each year be reduced. (See page 18 for detailed amounts.) The RMPH be site visited prior to the beginning of its next operational year. RMPS provide close surveillance and assistance to the EMS program. The following advice and recommendations be relayed to the RMPH. A. In reevaluating its goals and objectives and the magnitude of its triennial plan, special attention should be given to the RMPH's full responsibility to its major program components. B. The RMPH is encouraged to continue building on its experiences by strengthening its administrative and review processes, C. Consideration be given to developing other sources of funding for successful projects, and decremental funding of projects be applied where appropriate. D. RMPH be encouraged to pursue its interest in addressing the problems of the medically underserved areas. E. The Coordinator be complemented on his efforts to more effectively use his deputy. F. A concentrated effort be made to commit staff efforts ina coordinated manner. G. RMPH be encouraged to continue to refine its revised bylaws and in doing so, consider the RMPS Policy Concerning Grantee and Regional Advisory Group Responsibilities and Relations. H. The review process be finalized with special attention given to the issues raised in the RMPS review process verification report. I. Efforts to strengthen communications between, the RAG and-.program staff should be continued. REGIONAL MEDICAL PROGRAM OF HAWAII SITE VISIT TEAM RECOMMENDATIONS * Pending RMPS acceptance ‘of RMPH technica * eyo 1 review of kidney application, see page 20. 05 06 07 “$V Sv sv Request Recommends Request Recomnends Request Recommends Initial Application $2,173 ,806 $1,730,000 $2,067,733 $1,800,000 $1,707,859 $1,800,000 Kidney 90,488 90 ,488%* 39,213 ~ °39,213% 20,577 20,577* GRAND TOTAL $2,264,294 $1,820,488 $2,106,946 $1,839,213 $1,728,436 $1,820,577 Initial Application Program Staff and Projects $1,886,223 $1,730,000 | $1,780,150 $1,650,000 $1,420,276 $1,650,000 Developmental Component 287 ,583 -0- 287 ,583 150,000 287 ,583 150,000 “Subtotal 2,173,806 1,730,000 2,067,733 1,800,000 1,707,859 © 1,800,000 Kidney 90,488 90 ,488* 39,213 39,213* 20,577 20,572* GRAND TOTAL $2,264,294 $1,820,488 $2,106,946 $1,839,213 $1,728,436 $1,820,577 Hawaii Program : . Program Staff and Projects $1,586,523 $1,430,300 $1,491,929 $1,361,779 $1,121,166 ‘81,350,890 Developmental Component 287 ,583 -0- 287,583 10 ,000 287,583 150,000 “Subtotal 1,874,106 1,430,300 1,779,512 1,511,779 1,408,749 1,500,890 Kidney 90,488 90,488* 39,213 39, 213* 20,577 20,577 TOTAL $1,964,594 $1,520,788 $1,818,824 $1,550,992 $1,429,316 $1,521,467 Pacific Basin Administration $ 107,700 $ 107,700 $ 110,880 $ 110,880 $ 114,219 $ 114,219 Projects 192,000 192,000 177,341 177,341 184,901 184,901 TOTAL $ 299,700 $299,700 $288,221 $ 288,221 —§ 299,110 $ 299,110 Hawali (Excluding Kidney) $1,874,106 $1,430,300 $1,779,512 $1,511,779 $1,408,749 $1,500,890 Pacific Basin 299 700 299,700 288,221 288,221 299,150 299,110 TOTAL 2,173,806 1,730,060 2,067,733 1,800,000 1,707,859 1,800,000 Kidney 90,488 90 ,488* 39,213 39,213* 20,577 20,577* GRAND TOTAL $2,164,294 $1,820,488 $2,106,946 $1,839,213 $1,728,436 $1,820,577. at A] & 70 ° ba rt wn pte e o d poe e pte et 3 © ie) 5 0 ~ SI efed Page 19 = RMPH Site Visit Report, RM 00001 J. RMPH be encouraged to continue its efforts in developing an effective planning mechanism, including closer association with CHP. K. Continue to develop new techniques to evaluate project activities and to assess how they will contribute to regional goals and objectives. L. A mechanism be developed to utilize the findings of the Inter- Society Commission for Heart Disease Resources in establishing the EMS system. mo M. The relationship of project activities be further explored. N. Additional allied health personnel be added to the RAG, and reevaluate the allied health involvement in programs relating to the State of Hawaii, and explore the coordination of man-~ power programs for physicians, nurses, and allied health personnel. O. The adequacy of representation of voluntary health agencies and consumers on the RAG be explored. P. Develop a clear policy on continued support of successful projects which could be used in the review and evaluation processes. RATIONALE FOR FUNDING As noted earlier, the team believed that the Pacific Basin program should be funded in the amounts requested. The team could not endorse a developmental award for the first year of the triennium, but believed that in a year's time, the RMPH will have reached a stage of maturity which would justify a developmental award. The recommendation for support of a "Triennial Award" is believed necessary to encourage the RMPH to continue in the direction in which it is moving. In view of the rejection of the previous triennial application, the team believed a second rejection could hinder the progress being made. For the Hawaii segment of the RMPH 05 year, the $1,730,000 recommended for program staff and projects represents a $842,445 over the current $887,555 for the same purpose. The team had to consider that the RMPH has already been awarded $1,470,645 for the two-year EMS project; the administration of the EMS project will require considerable RMPH staff effort. Page 20 - RMPH Site Visit Report, RM 00001 In arriving at the total amount of $1,730,000 it was understood that the x amount requested for the kidney project would be added, if RMPS accepted “ the RMPH technical review of that project. L/) the amount recommended was - not based on the deletion of individual project budgets. However, the team did specifically include in the 05 year amount, funds for the Pediatric Pulmonary Center at the suggestion of RMPS staff, in view of the history of Pediatric Pulmonary funding by RMPS and its effect on the RMPH. The amount recommended for the 06 and 07 years permits an $80,000 increase over the 05 year, and includes $150,000 for a developmental component. 1/ (Project #47--Dialysis_and Transplant Center Since the site visit, RMPS staff has determined that this project conforms to the Kidney Guidelines, received favorable outside renal technical review and has supportive RMPH RAG and CHP comments. The RAG, however, did not resolve differing recommendations of the renal technical reviews regarding the procurement of a liquid scintillation system. Two of the technical site visitors recognized the research potential of mixed leukocyte culture as a retrospective measure of incompatibility, largely in a living related donor population, but doubted that this procedure is essential to the overall success of the -— cadaveric transplant program. Deletion of the liquid scintillation | system, which would be principally used for leukocyte culture studies was recommended. The third technical site visitor recommended funding of the liquid scintillation system, on the basis that from the use of some equipment there will result direct service-related advantages for patients with respect to both donor/recipient selection and post-transplant management. RMPS staff noted the existence of liquid scintillation equipment at the University of Hawail. The amount budgeted for similar equipment in this project is about $15,775. Further, it was noted that there has been some conflict regarding the reluctance of Kuakini Hospital, which has done only. two transplants since 1971, to agree to support St.Francis Hospital as’ the only PHS funded tertiary center for the treatment of end-stage renal disease on the Islands. Before funds are made available the relationship of both hospitals to the project should be clarified.) RMPS /WOB 9-19-72 * Review Cycle: OCT, 1972. _ RMPS STAFF BRIEFING DOCUMENT REGION: HAWAII ‘ _ OPERATIONS BRANCH: Western NUMBER: 00001 oo “Ghieg; Richard Russell COORDINATOR: Masato Hasegawa, M.D. - Staff for RMP; Calvin L. Sullivan - LAST RATING: TYPE OF APPLICATION: 3rd Year Regional Office Representative: /X7/ Triennial /__/ Triennial __ 2nd Year __. Management Survey (Date): /__/ Triennial /_./ Other Conducted: May 15-18, 1972 or Scheduled: Last Site Visit: (List Dates, Chairman, Other Committee/Council Members, Consultants) August 7-8, 1972 Mr. Edwin Hiroto RMPS Advisory Council Leonard Scherlis, M.D. RMPS Review Committee Mr. Kenneth Barrows Consultant William I.- Holcomb, M.D. Consultant Staff Visits in Last 12 Months: i “ yw oe OTe LYEBCS Met with RMPH RAG, November 1971. “Mr. Richard Russell and Mr. Ron Currie - Met with RMPH Program Staff, November 1971. , Management Assessment Visit - May 15-18, 1972 Review Verification Visit - May 15-18, 1972 DPTD site visit to limited care facility of St. Francis Hospital, Honolulu £H, S$ l.of Medicine to discyss RMPH plans for kidney diseases. net Sven? obeuseeee in geographic area Of Region ‘that are affecting ° RMP program: io KAULA 1 olso incl xtluding Mid We KMGLONAL, CHARACTERESTICS —- F= GEOGRAPHY AAA ee mde semi e ee ts eee ne ee eo nh wee 2 PART udes all the northwest : way tslands - r: 2 ae Ne nen ene tm ee te ae me Hl 2 PART t LU Vey 7 . O cK HAWAL HEW Regional Office IX Regional Delineation: State: Hawaii, American Soma,.Guam:and Trust Territory Counties: 5 (Hawaii) Congressional Districts: 2 Subregions: Territories Overlap/interface DEMOGRAPHIC INFORMATION Population Hawaii 769, 900 Guam 86 ,900 approximately 900,000 American Samoa 27,800 Trust Territories(approximate 97, 600) Age Distribution Population Density 104 per sq. mile Percent of Total by Specified Age Group, 1970 % Urban - 83° % Non-White - 61 Age Group Hawati U.S. (mainly polynesian) Under 18 yrs. 38 35 Metropolitan Area Populatic 18 ~ 65 yrs. 56 55 *Honolulu - 613.1 65 yrs. & over 6% 10 INCOME - Average Income per Individual, 1969 & 1970 1969 1970 State (of RMP) $3882 $4530* United States 3680 3910 *State of Hawaii ranks 6th MORTALITY RATES, CY 1967 & 1968 Deaths per 100,000 population ** Cause oo RMP (Hawaii) U.S. 1968 1967 Heart Disease . 168.3. 162.8 364.5 Cancer 98.5 98.5 157.2 | Vasc. lesions 46.3 44.2 102 .2 (aff. CNS) All causes, all ages 519.4 935.7 45-64 yrs. 827.6 1143.5 65 & over 5102.6 6042.5 ** Rates generally atypicat because of age distribution (much younger population). b RMOOO O1 © REGIONAL CHARACTERISTICS (Cont'd) FACILITIES AND RESOURCES ' SCHOOLS Schools No. Enrollment Graduates» Location - (1969/70) (1969/70) Medicine (and. Osteopathy) (1) University of Hawaii 75 -_ . Honolulu Sch. of Medical Sciences -~ (2 yr. school of basic med. sci.) . 1970/71 86 -- Nursing Schools Professional Nursing Number 2:1 at Univ; 1 at community college. Practical Nursing Number 3:1 at community college. Allied Health Schoola (Approved Programs)* Cy totechnology Number in Medical Technology : Number 5 (inel. 1 at Army MC-Tripler) Radiologic Technology Number 2 (Honolulu - Physical Therapy Medical Record Librarian -——- RM 000 01 I. REGIONAL CHARACTERISTICS (Cont'd) FACILITIES AND RESOURCES (Cont'd) HOSPITALS Non Federal Short and Long-term general hospitals, 1069 & 1970 Number Number’ of Beds 1969 1970 1969 1970 Short term 21 22 2384 2453 Long term (and special) 7 6 932 * 872 V.A. General hospitals 0 Number of Hospitals with Special facilities # of facil. Intensive CCU 8 Cobalt therapy 3 Isotope facility 6 Radium therapy 7 Renal Dialysis 5 “ dn patient Rehab-in patient 3 Source: Amer. Hospital Assoc. 1970 Guide Issue August 19° NURSING AND PERSONAL CARE HOMES, 1967 . ’ Number Number of Beds Skilled Nursing Homes 12 909 Personal care Homes with Nursing Care 24 178 Long term care units 8 541 Source: NCHS - A Master Facilities Inventory County and Metropolitan Area Data Book PHS - Number 2043 - Section 2, Nov. 1970 I. REGIONAL CHARACTERISTICS (Cont'd) FAGILITIES AND RESOURCES (Cont'd) MANPOWER Profession Physician - active (pt. care) general practice medical specialties surgical specialties other (active) Physician - inactive Osteopath Total active MD & DO Professional nurses active - y{nactive Lic. Pract. Nurses actively empl. in nurs, not empl. in nurs. Medical technologists Radiologic technologists Physical therapists Medical record librarians GROUP PRACTICES Number 934 82 2334 204 1319 244 RM 00001 Ratio %Total ~~ per 100,000 100.0 20.0 21.0 27.0 130 321 176 Sources: Distribution of physicians, Hospitals, and Hospital Beds in the U.S., 1969; American Medical Association, Chicago, 1970. Health Manpower Source Book, Section 20, PHS-NIH-BEMT, 1969 © “ negauns RM GOOD. a) , Review Cycle: Oct. 1:7 COMPONENT AND FINANCIAL SUMMARY TRIENNIAL APPLICATION ° ; a Committee Recommendati Current Annualized Request for Triennial Council-Anproved Leo. Component Level 08 Year Ist year | 2nd year | Sra year Ist year | 2na yesr i: . ! a 3 ROGRAM STAFF (Pacific Basin) $ 517,297 S 692,244 $ 717,456) $ 743,929 . (107,700) (110,880)} (124,219) INTRACTS 24,705 0 0 0 4 EVELOPMENTAL COMPONENT 0 287,583 287,583 287,533 | PERATIONAL PROJECTS . $37 5353 . 1,254,467 1,101,907 696,924 Kidney (90,488 1/)} (39,213) (20,577) EMS ( wv.) hs/ea ( 70- j Pediatric Pulmonary ( 32,285) | (77,335) Other (192,007 ) _ OTAL DIRECT COSTS - $1,079,555 $2,264,294 [$2,106,946; $1,728,436 OUNCIL RECOMMENDED LEVEL I/ Application submitted August 1, 1972. 2/ $1,470,645, currently aveilabie for a 2eyeer poriu.. AUGUST 18,1972 REGION - HAWAII BREAKOUT OF REQUEST RM QOO01 10/72 PAGE 1 05 PROGRAM PERIOD : RMPS-CSK-JTCGR2-1 (5) (2) (4) a IDENTIFICATION OF COMPONENT | CONT. WITHIN| CONT. BEYOND] APPR. wot | NEW, NOT | St YEAR [ LST YEAR I t { APPR. PERIOD APPR. PERIODL previousty § Prevtousty | pirect § InNOIRECT | TOTAL 1 1 OF SUPPORT } OF SUPPORT FUNDED | | APPROVED ! costs t costs t t _-- - rn \ ! I ! C000 PROGRAM ADMINISTRATION | 1 t est 1 ~ 1 L $584.544_ 1 i I $584254% l $78,948 1 £$6632492 l C001 PACIFIC BASIN ADKINISTRA l | t 1 t l TYLON 1 l $1072700_) i l £107.700 1 $112395 1 $119,095. 1 COO. PaoG STFE ICTAL i Lf $692224421 i if $692,244) 11 $9003423)1 if $7820c8211 _ 9000 DEVELSPBENTAL COMPONENT | j | 4 / 1 i { t ! L i I $287. 583.1 $287,583 1 j $287,583 1 O11 A REGICNAL APPROACH TO PI { { { | i I EDIAIRIC PULMCNARY CARE I i $82,285. 1 i i $82,205 1 $21,617. 1 $103,942 I O15 COOPERATIVE CHEMCTHERAPY | 1 j | 1 t 1 t _ PROGRAM. { $6420456 1 j } l $64:046 1 217.905 1 $83.85)! _.020 CONSTANT CARE UNIT i J t f . | . { | \ $212866 1 L 1 * 991, 866-4). = $21.866-}--—- ~ O27 KOCLAULOA DIETARY COUNSE] { { { ‘ - AND. OUTREACH SERVICE 1 ] l $41,587 1 $41,587 $43,587 1 028 HEALTH INFORMATICN NETWO} { \ i t J \ RK OF JHE PACIFIC l J $62283)_1 j } $622831_1 I $62283)3 1 _ 029 INTENSIVE CARE NURSING | { 1. woe be. a Sb. { .. { j \ $43.232 1 j j $432232-1 $6,528 1 $49,760 1 030 WAIANAE COAST COMPREHENS | \ | | ‘ | 1 { TVE_HLIH CENTER 1 ] $169,916 1 i bf $169:9}.6 1 j €1690916 33} UPGRADING CF RURAL NURSI | I | | t ! ij ARE i l $142300 i j i $142300_1 } $34,300 1 _ 532 PHYSIOLOGICAL DATA MONITI { 1 dt | 1. | { ORING SYSTEM L i $63,178 1 lL $63,178 1 I $63,178 t _ 037 LMPROVEMENT CF HEALTH CAl t t t } | t ! RE THROUGH OTCLOGY ft { $262148_1 j t $26.148 1 j $262148 1 038 HEALTH ASSISTANT TRAINING I t { \ j ! i : -G-PHASS Il j j -$101,695. 4 I i $1012695 1 j $101.495 j __. 039 HLTH INFO SYS FOR COMPRE 1 ! { ! . oon. ne cee ae bee ! HENSLYE PERS PLTIH SERY j j $422298_1 1 | $42.298 1 I $421298_1 O41 HAWAII MEDICAL CARE REVI! t ! i | t I I EHO LZATICN i 4 i ! $2453990_1 $245,000 1 369.934 1 $31429341 042. HEALTH SCREENING FOR THE | i ! | - 4 | | | ELDERLY { i L 1 $66,196 5 $68,196 1 L $68:i96_1 __. 043 MOLOKAL HOME HEALTH servi | | l | { ~o . t ICE i l j i $48,531 4 $48,531) 1 l $48.53) 5 044 OAHU PATIENT ORIGIN AND | . ! I | i i { l UTILIZATION sruey i l 1 1 $13,820 ! $13,820 1 1 $132820 t Gas IMPROVED MANPOWER UTILIZI { \ t t j | J ATION INA HOSP SYSTEM j i { i $85,050 1 $95,050 1 I 385,05¢_1 _ 047 REGIONAL RENAL OTALYSIS | { dbo. _4 . Ae... 1 It , J ___AND TRANSPLANT CENTER I j } j $90,488. 1 $202488_1 $152596 i $106,084 i | ! t | ‘ i $85,912 | $10296,127 | $41,587 | $830,668 | $29264,294 | $221,883 | $294860177 | TOTAL AUGUST 18¢1972 © REGION - HAWAIT : BREAKOUT OF REQUEST RM 00001 10/72 PAGE 2 Seen anne eee 06 PROGRAM PERIOO _. ee __ RMPS-OSM-JTOGR2-1 (5) (2) m) qa IDENTIFICATION OF COMPONENT | CONT. WITHIN CONT. BEYOND! APPA, NOT | NEWs Not 1 2No YEAR 1! { APPR. PERIOD] APPR. PERIOD} PREVICUSLY | PREVIOUSLY | DIRECT f ' OF SUPPORT | CF SUPPORT {| FUNDEC | APPROVED costs t . | ' : t CO0O PROGRAM ACMINISTRATICN J f 1 { 1 ' . j L $606,576. j I $606,576 COOL PACIFIC BASIN ADRINESTRAT j j $110,880 J } $110.820 SIFE.IOTAL : { 7172456)! { $717.456) _ oo DEVELOPMENTAL COMPONENT 1 _. . I $287,583.) £2872583 - O11 A REGTCNAL APPROACH TO PI ' I __EDIAIBIC PULMCNARY CARE It $1272235_1 1 J $773335 O15 COOPERATIVE CHEMOTHERAPY] 1 | ' PROGRAM 1 l 1 i 020 CONSTANT CARE UNIT . . _ | . ; 027 KOOLAULOA DIETARY COUNSE} . - LENG AND QUIREACH. SERVICE $47,350 $$740350 078 HEALTH INFORMATICN NETWO| PACIFIC $43,581 1 $413,582 ___.029 _ INTENSIVE CARE NURSING i | t a e _ . _ i $432232_1 $43,232 '. . -030 WAIANAE COAST CONPREHENS} ! } | ___ LYE HLTH CENTER $1782412_1 | $1782412_1 O31 - UPGRADING OF RURAL maT | t ! NG CARE i l I _.032. PHYSIOLOGICAL DATA mon . t { cee BO a ee Pee _— . G_SYSIEM $655041_3 _ $652.04) O37 IMPROVEMENT OF HEALTH cm { } ! | CUGH_CICLCCY $260148.1 $262148 1 038 HEALTH ASSISTANT Tea t } G_PHASE IL - J $106,780 1 $106. 780_1 _..039 HLTH INFO SYS FCR CORPRE | i rn | Po | - : we wHENSTVE PERS ELI. SERY { $442413_1 i i $44,413. 1 : 041 HAWAII MEOICAL CARE REVI] i ( a~aFlt ORGAHILATICN I ! $2492457 $2492452 042 HEALTH SCREENING FOR THE! 1 a ELDERLY I 270.895 $702895 _ 043 MOLOKAI HOME HEALTH sel 1 _- _. _ vee Ice { j $25.000 $25,000 044 OAHU PATIENT ORIGIN AND j i i : { “UTIL IZALIICN. STUDY l ] ] 045 IMPROVED MANPOWER uTiiTH | ! ' - wu ATION IN & HOSP SYSTEM } t i $872050 $87,050 J __.O47_ REGIONAL. REWAL DIALYSIS |. — I. a. | Ao SF - ——SNDIBANSPLANT. CENTER J X j $392213- $292213_1 vcs pace vee een I . t t t “TOTAL ' $1,3005398 | $47,350 | $7599198 | $29106,946 | XS AUGUST 1631972 REGICN - HAWAIT BREAKOUT OF REQUEST RM 0000) 10/72 PAGE 3 vee cen O7 PRCGRAM PERINO oo, RMPS-OSM-JTOGR2-1 05) (23 (4) qu) IDENTIFICATIGN OF COMPONENT | CONT. WITHIN] CONT. BEYOND! APPR. NOT | NEWe NOT 1 3RO YEAR 3 1 TOTAL { APPR. PERIOD] APPR. PERIOOL PREVIOUSLY | PREVIOUSLY [| omRect } { ALL YEARS } GF SUPPORT ' OF SUPPORT 4 FUNDED APPROVED ccsts paineel costs COOO0 PROGRAM ADMINISTRATION | } | | ! | t { : { { $629,710 j j I £629,710 1 LL. _$1.820,830 | COO1 PACIFIC SASIN ADMINTSTRAT t 1 | 1 i ___ILON J $114.219 1 i l $114.229 i $3322192 COO. PROG STEFF TOTAL {i $743,929) 1 l Lt. 37432929) MC. $25153.625) _ DOOG DEVELCPRPERTAL COMPONENT 1 { { i _. t . t 1 i l $287,583 1 $287.583_) i $862.75S_1 OlL A REGIONAL APPROACH TO 7 t | | | t ( | __-EDJATRIC PULMCNARY CARE I 1 i I 1 I $159,620 J 015 COOPERATIVE CHEMCTHERAPY | | ( 1 t t 1 PROGRAM _i 1 j j 1 I $642046 1. Q20 CONSTANT CARE UNIT t t | { { { { 1 i l i f 1 $21.866_ 5 027 KOOLAULOA DIETARY COUNSE § I | | t ! I __-LING_ AND CUIREACH SERVICE ft 1 $552540 $55.540 | i $1442.477 1 028 HEALTH INFORMATION NETWG) | t | | RK OF THE PACIEIC I 1 l 1 £104,412 1 _.-029 INTENSIVE CARE NURSIKG t 1 I | t t : ' ! l 1 } L i l 1 $862464 1 "030 WAIANAE COAST EORFREHENS! i | ! | I t | VE_HLIH CENTER j j ! 1 j l $348.328.1 O31 UPGRADING OF RURAL wae t ! | ! | { t ——NG CARE 1 1 I | i ] £142300_1 032 PHYSICLOGICAL DATA mR t l { ! | i t —_ORING SYSTEM ! L 1 l 1 J $128.219 1 037 IMPRCVEMENT OF HEALTH ay { | | { | | | ~~ E_ITpg OUCH DICLEGY 1 1 $26.148 1 t l $26,148 1 l $782454_ 1 036. HEALTH ASSISTANT eT | | | ! t l | G PHASE Il i $112,119 1 l 112.119 - ] $3202594_1 _ ..039 HLTH INFO SYS FCR cOnPRES ( i i . to... ! 1 HENSIVE PERS HLIW SERY. 1 l $462634_1 i $46,634 1 lL $1332345_ 1 O4L HAWAIL MEDICAL CARE Revit { | { | t J ! ___EW_ORGANIZATICN i Ll I $256,881 ) $256,981 1 1 $7512238 1 042 HEALTH SCREENING FOR THe i 1 i { | aan | | ELNESLY I zl 1 $73,975. 1 $732975 1 I $2132066 1 043 MOLOKAI HOME HEALTH sel I t | | | ! | Ice f j $15,900 | $15,000 1 j $88,531 4 044 OAHU PATIENT ORIGIN AND ( { { j | | | WIILIZALIQN STUDY { i 1 | I Ll $13.820_1 045 IMPROVED MANPOWER att | | ! | t t ! A_HOSP. SYSTEM I I I _i $90,050 } $90,050 4 1 $2622150 1 _._-047 . REGIONAL RENAL DIALYSIS | i | a i | . {.. _ .t j AND IRANSPLANT CENTER 4d I i I $20,577 1 $20:572_1 1 $150,278. 1 wee j j i t | t | { TOTAL t | $926,830 | $555,540 | $744,066 | $12728-436 | 1 $6,099,676 | ' AUGLST RECICAAL MEDICAL PROCRAMS SERVICE | #51972 2 is : FUADIAG HESTCRY LIST ~ RNPS-OSM>JTOFHL- ZO s REGION OL KAWATS “RYE SUPP YR 04 CPERATIONAL CRANY (DIRECT COSTS ONLY) ALL REGUEST ane SWARCS AS CFE JUNE 305 197 6 Y ee AWARDED ARARCEC AWARDED «ss AWARCEL— AWARCEC #* REQUESTED REQUESTED REQUESTED RECUESTEC 6 CCWFCKENT 1 c2 62 C4 : ee eS Oe “OT : ~ a NO CTETLE — 104 71- 12/72 TOTAL «= *# OL/73-12473 OL/ 7412/76 CL/TSA12/75 TET AL 0 . se Ve COOO PRCGRAP STAFF 3929CC 3e3£CC 2eCccc 571712 1734112 *# 584544 606576 e2971c 1820830 "2 CCOL PACIFIC EASIN A §016C 50160 ** 10770C 1io0eed 116219 332789 __ 0000 CEVELCFMENTAL C _. — ny 287582 : 287583 207582 662749 © Cc2> TRAG REKAE CAST 403606 76200 €2ccC Tiascc os ° : CO? PROMOTION AND E __leocc_ 1S3¢C __yes0c _ _ __ 45800 #8 ““9Oq “COAEC RUFS KUAK ZS5CC™ “Zezce— a : ~ 4S7CC #* CCT CARNIC@FULMCNSE 48760 70000 55600 174200 ** “O08 CO TR FD N CUEE S3CCC 12c3CC $7 10C 270400 ** 00S CCU ECLIP AnD T 38900 9€00_ _ 4TECC ¥e ' “G1 CCL EQUIP TRN # 446CC 1iccc 5560C #9 : : O11) REGICRAL AFFRCA 2106¢6 i146cc ez7cc_— S4RE2— ECICSS 82285 77335 15962C ““O1T “RHAB CATSTRPHC - 2100 3700 5800 +4 : OLS PEG CCCPERATIVE 37700" $2ccc 123375 253079 ** 64046 | E4C4E ““€ZE” _CENSTART CARE U 50200 | 4eicc S114 155414 o* Z21e&E 21866 SO2b CERVICAL CANCER __. _. BOB 4BE 26848 HL oe ee oe O22 FEALTE &SSESTAN 23862 23862 #4 O27 KCCLALLO# CIETA - oe we 41887 47356 55540 144477 O28 “MECICAL LI@RARY 46808 46808 ** 62831 41561 104412 e 029 INTERSIVE CARE asé1e BEELS &8 43232 43232 86464 030 wAf4Wae COAST C ° 154593 154592 #9 165916 178412 348328 O31 UFCRACING OF RU «B4T15 146715. *# ~~ - 14300 _44300 2022 “PHYSITLCGICAL C 47274 47214 ** €217€ 65641 126219" Z = 037 IMPROVEMENT OF 8 a 15252 15252 26148 28148 26148 78444 3 O38 “HEALTH ASSISTAK éocce €CCCC #* 101695 ‘106780 “T2119 "320594 g _€3¢ HLTH ENFG SYS F 25000 25000 +9 42298 44413 46634 133345 z O40 EWERCENCY “ECIC 147645 1470645 +# : CGE PAWATT MEDICAL ++ 24*CQC 249457 256881 751338 — 042 “FEALTE SCREENIN ey 68196 70855 T3675 21306€ -O43 PCLCKAT FCRE FEO __ wee 8531 25000 5000) | 8853R "044 "CARU PATIENT CR os 1282C 13820 045 IMFRCVEC MANPOW ** 85050 9o05c 262180 047 ~~ Kidney se GOSS. 39313 20577 = TOTAL - _ £675C0 924700 @3570C 2875830 5494130 ** 9964994 2106946 ~ 1728436 6099676 —— ve oe a a. . . . ene Eee oe athe f - 1? - Review Cycle: HISTORICAL PROGRAR_ PROF UE OF REGION The RMP of Hawaii, Trust Territories, Guam and American Samoa was . established with a planning grant under the University of Hawaii School of Medicine in July 1966. Little progress was made in the first year as the Coordinator, Dean Windsor Cutting, was unable to . - spend time on RMP activities. During the 02 planning year, the RMPH ‘offices were moved out of the University's Leahi Hospital and into a "neutral" building at the Queens Medical Center. The need for a new Coordinator became apparent. In April 1968, Dr. Masato Hasegawa became Coordinator. Dr. Hasegawa is a pedia- trician and prominent member of the medical community with an interest in community medicine. In October 1968, the grantee changed to the Research Corporation of the University of Hawaii, since the developing school of medicine did not have the staff and time to devote to establishing a fully operative RMPH. The RMP became operational in September 1968, and had continuing education as its major thrust, using regional resources in the absence of a fully developed medical school. The RMPH goals also included development of “advanced health systems" which would im- prove the delivery of health care. Dr. Hasegawa, in only a few months, began to involve diverse elements, overcome earlier hostility and develop a separate identity for RMPH, At the end of the first operational year increased involve- ment of the medical society, hospitais and paramedical personnel had been accomplished. Further, program staff had become stronger, but it was evident that the Coordinator required administrative assistance. The RAG had become more representative, however, there was diminishing involvement of the previously vigorous chairman. Planning activities in the Pacific Basin had been initiated as a result of a $30,000 award specifically for activities in the Basin. During its first two years of operation, (9/68-9/70), the RMPH made considerable progress. The RAG's role and influence, however, was stillnot clear. Established policies and procedures plus an Ad Hoc Evaluation Committee provided hope that RAG effectiveness would be improved. The Executive Committee was the strong force, as were the categorical committees which appeared to have veto powers that weakened the role of the RAG. Progress continued to be made toward developing the general principles of regionalization. The RMPH had developed a frame work for planning the achievement of goals and objectives. Methods of evaluation were being developed. Also, there was increased sophistication, which allowed the RMPH to look at program rather than projects and to real- istically consider program priorities. There appeared to be a broad- ening and deepening involvement of RMPH with providers of health - 13- services and with the community. In 1971, however, RMPH appeared to be making little progress toward the solution of problems noted during the previous year. It appeared that the RMPH had failed to follow through on past recommendations from RMPS. In August 1971, therefore, the National Advisory Council recommended that the RMPH not be approved for triennial status. Funding was approved for one year only to support program staff and operational projects. Although, a developmental component had been approved for the previous year, the Council believed it should not be approved again until the following conditions were met: 1. The region identify specific objectives and priorities that relate to the health needs of the region. That the objectives delineate anticipated accomplishments in terms of a realistic time schedule. 2. The RAG develop its bylaws and assume their responsibility for directing the planning and operational activities of the RMPH. 3, That a deputy or associate director to help administer the day- to-day operations of the RMPH be employed. 4. That the RAG Technical Review Committee and categorical committees be given an opportunity to have input in the planning and operational activities of the RMPH. Clearly defined operating procedures and responsibilities of these committees should be clearly delineated. 5. That evaluation mechanisms to be implemented to relate to projected accomplishments indicated in specifically identified objectives. 6. That the RMPH clearly identify its commitment to the Pacific Basin and develop a feasible plan of action for this area. 7. That a feasible regional plan of operation be developed that will meet the health needs of the region, based on measurable accomp- lishments at specific periods of time of program development. In November 1971, as a result of a visit by the Director, RMPS, the RAG bacme more aware of its role and new directions and responded by re- budgeting some of its funds to provide greater support to activities more in keep¢ng: with its goals and priorities. In May 1972, RMPS staff conducted a Management Survey Visit and a Review Process Verification Visit to the RMPH. Staff found that both the review proeess and the management process would require considerable strengthening before they could be fully certified by RMPS. , - Wh - There was a clear need for revised bylaws which would spell out the duties and responsibilities of the RAG and each of its committees, in- cluding a clear statement on the role of the RAG as the policy and decisionmaking body of the program. In June 1972, the RMPH was awarded $1,470,645 for support of a two-year Emergency Medical Services System Project to be conducted by the Hawaii Medical Association. The RMPH may participate in the testing and evaluation of the Management Reporting and Evaluation System (MRES ) developed by the Washington/Alaska RMP. MRES is designed to aid the RMP in identification of health needs and plans; evaluation and fiscal and technical procedures. ; The RMPH submitted a kidney. proposal to RMPS on August 1, 1972. An extended deadline was granted for this submission. r ? -~ - 1 Region _ 00001 _ Review Cycle: Yetooer LQ’ Historical Profile: Pacific Basin By invitation of the RMPH in 1968, the governments of Guam, American Samoa and the Trust Territory joined Hawaii in creating a Pacific Basin Area. A chief of Planning and Operation was added to program staff in - January 1969. The proposal to implement RMPH in the Pacific Basin was not totally funded by RMPS, instead $30,000 was earmarked for planning _ purposes. With a small budget and a staff of one, the thrust during the first three years was to ascertain whether the Pacific Basin areas could utilize RMP programs, Five project proposals were submitted. One was funded, Constant Care Unit-Guam. The project "Rehabilitation in Catastrophic Diseases" was extended to Guam and the trust territory. In 1971 the RMPH RAG approved funds for two previously approved, but | unfunded projects (#21,22). $156,412 were made available in April 1972 for the Pacific Basin Area. The future thrust of the RMPH in the Pacific Basin will be to improve total health care services. Problems areas might be seen as the level of funding and how this money is shared by the sub-regions of the Pacific Basin, recruitment of qualified personnel for funded projects and the distance between the island units. Further, there appears to be some reluctancy on the part of the RMPH RAG to allocate funds for the Basin. CHP-RMPH relationships on Guam are strained. In April 1972, the Pacific Basin Council was created. Program directors and priorities are made in gonsultation with this group. Resien: 00001_ Review Cvele: Octcbe: 197% - 16 - : : LF ese eg STAKE OBSERVAT LON ‘Principal Problems: | nS 1) Management and. REview Process needs considerable strengthening: -— Bylaw revision b) Definition of role of RAG and of committees (see reports) 2) Cooperation with CHP agencies Prineipal Accomplishments : 1) Increased prograning in Pacific Basin 2) Coordination of the’ development of an EMS ‘system 3) Strengthening ‘of ‘Staff conpentencies 4) Changing emphasis: of program from categorical to a total health care systems 2 ei 5) Strengthening RAG Issues Requiring Attention of Reviewers: 1). Issues of concern per MSV and RVV reports © mey submit site vi $200,060 $200,000 é This anc the :duLled ¢ A site hi, an August wisit ¥ fo valid reason: ive April 30, 1972. sistance really the as sent a three snded to the application ‘of a coordinator, year plan, region tha would lead to a has been done. ea glication, wivich thi ay ear, and this much str bd a) a oy } OG/ gn ] Fa ch : a VARY LON PRTENNIUM ' * ! Curr . . | ane t | BA ake } \ ' | “4 i PATO 1 € 270 449 ee Dhar ph hy Boe 5 » . i i | i } i — i cee a i PON Weak { ' i i rae : + . a AF i SOS 641,969 603,896 | - ; x { 77 5 i I Ste, “ ah ce ” : : “ . i r ‘ ( 5 fae oo j Se i 2, . fo: . ' i - hs/fea C4 } Lk ne we } . i, , ; ‘ 4 - owe . a f \ ! ¢ } a ; 4 ry " en a me it i ‘qrut sw ana sou ” i. ‘ Poanatric rulmonery a, we ’ / . ) Qther ( , 4 ay ~ I GAL sex $ . ; . DIP CT COs fir’ 5 . q ‘ tt i “ coe pee rT TAA Ane ! tes : APPROVED LEVEL $1, 109,000 * Cont . e 3 ao : ent . ce a ; . REGION: Indiana NUMBER: RM 00043 ACTING oo LAST RATING: 244 | TYPE OF APPLICATION: , 37d Year ff Triennial /—_/ Triennial ~— 1 and Year a / / ‘Txiennial f Xf, Other a ‘| | Anniversary Prior to Triennium ‘Last Site Visit: September 30 - October 1, 1971 Review Cycle Sept/Oct. 1972 ® RNPS SAFE VRUELRG DOCUMENT “OPERATIONS BRANCH! South Central... “"ChieL: Lee E. Van Winkle Staff for RMP: William Torbert Lorraine M. Kyttle, PHA, SCOB Charles Barnes - Grants Mgmt. Eupene Piatek - P&E _, PHA, SCOB Regional Office Representative: Maurice Ryan Management Survey (Date): Conducted: or Scheduled: April 6-8, 1970 Alexander Sopmidt, M.D. - Chairman - Member of Committee C. H. Adair, Jr., PH.D.~ Consultant Luther G. Fortson, Jr., M.D. ~ Consultant W. Fred Mayes, M.D. - Consultant Staff Visits in Last: 12 Months: DATE _— PURPOSE Apr. 4-5, 1972 Staff: Assistance May 2-3, 1972 _ Staff Assistance ‘July 27-28, 1972 Staff Assistance Recent Events Occurting in Geographic Area of Region that are Affecting RMP Program: - Dr. Stonehill, Coordinator, resigned, effective April 30, 1972 = Dr. Steven Beering became Acting Coordinator May 1, 1972. ~. Acceptance and growth of the AAGs (Area Action Group) around the State. This has incorporated many kinds of health providers throughout the region. Formalization of relationship with the 5 existing CHP(b) agencies, the Tuberculosis and Respiratory Disease Association and the Indiana Heart Association. Formation of 2 new CHP(b) agencies with IRMP assistance. Expansion of Statewide plan for Medical Education to include new center around the State (&n increase from 7 to 9 with the 10th projected), Increase acceptance of IRMP by-various Health agencies, especially the Indiana State Medical Association. A large influx of health dollars in Indiana (several million) especially in Indianapolis and Gary. Transfer of large funded projects to local funds, e.g., coronary care and stroke projects. DEMOGRAPHIC INFORMATION The region encompasses the entire state; interfaces with Ohio Valley to the south; Counties: 92 Congressional Districts: 11 Population: (1970 Census) - 5,193,700 Urban: 65% Density: 143 per sq. mile Rural: 35% U.S. Age Distribution: Under 18 - 36% 35% 18 - 65 yrs. 542% 55% 65 & Over 10% 10% Average per capita income - $3,691 (Compared with $3,680 for U.S.) Metropolitan Areas: (8) Total Population - 3,061,000 Anderson ~ 137.5 Lafayette ~ 108.3 230.7 Muncie 127.9 f Evansville Gary Hammond East Chicago ~ 629.0 South Bend 277.9 Indianapolis - 1,099.6 Terre Haute - 172.7 Race:. White -— 4,830,141 932 Non-White - 363,559 7% Resources and Facilities 1969/70 Enrolled Gradute Medical School ~ Indiana University School of Medicine 885 214 Indianapolis Dental School - Indiana University School of Dentistry 391 89 Pharmacy - Purdue at Lafayette and Butler at Indianapolis Allied Health School - Indiana University Medical School, Division of Allied Health Sciences Indianapolis Accredited: Cytotechnology - 2 Medical Technology. - 20 Radiologic Technology - 26 Physical Therapy - 1 Medical Record Librarian ! = Professional Nursing Schools Practical Nursing 28-(17 are University of College Based) 17-(@ostly Vocational and Technical) INDIANA ~4- Qo ’ spy —_ CAST CHICAGO “ JAICHIGANM a oO ELKHART e - > 6 sourli “etND? _ORUSHAVEAKA a LAG ANGE STLErtN 4 KH HAMMOND GARY ‘ : 53 La reue gp. re eee ene enema iene re 5 PORTER “1 a (MARE _— re al ne RLE. CE ALB MARSHALL . — STADE Pe cence nell ne “ROSCIISAO fe ene” wee ee an eevee craven’ . . WHITLEY FORT VAATNE "1 O atth FULASI fuLios Jase wee a WEWIGH _| . . WARASH HUNTINGION we eh . CASS MiMi mete WHILS AbAWS BLKTGN . ~ “MARION i pen ee egeg CARPOIL hie cee reed ° oa oe ate KOKOMO r RANT LAFAYETTE NOWanD on ei ac nroRD : . — gay WARREN HPPE CANOE seme om ed a , | noe J cele _ MUNCIE —— _. FRANKFOR} anne DELAWARE a MONTGOMERY ~ MADISON BAROOLPH FOUNTAIN . ANDER SON 3 BOONE HAMILTON ———~—-— CRAWFORDSVILLE ee ee gy (ene ee a g * z gnc eNaY 3 s r z “a Me ! WAYNE - s “+ | PARKE ENDRICKS 4 HANCOCK Feuer Rene A " Que [ANAPOUS “cu oxo | sweep PUTKAK [ 1 aan nf ‘eevmcsooccnl) : Ruse FAYETTE Utiton TERRE HAUTE | ° : SHELAY oon Ruri eee be MORGAN JOHNSON vIGo g NNSA NE : CLAY | r FRAKYUN OWEN ‘ “pecatun ee] 4 BARTHOLOMEW BLOOMINGTON 0 cee eed o bROWN COLUMBUS MOLROE eh CEAREOHS SULLIVAN RIPLEY GurEne er smanenanarraseh ‘ GENNINGS or + JACKSON LAWRENCE SRITZFRLAND ; JEFFERSON Daviess MARTIN / . WASHINGTON won ORANGE . PIKE P , c DUBOIS GIBSON CRAWIORO ; | NEW ALBANY TEITERSONVIUE HARRISON PERRY SPENCER < 7 ~5~ Planning and Development Regions Stete of Indiaoan nnn none ween ee poe IN ae re - ! vapan’t | | { rian sane stat pum | wasasn MU mincton D pia Lig pecates ATL EE 1 aut TTS Pashincton Fetablished by Executive Order No. 18~68 and Approved by Governor Roger D. Branigia on Dee. 4, 1968. COMPONENT AND FINANCIAL SUMMARY ANNIVERSARY APPLICATION BEFORE TRIENNIUM Roviow Cyclo: Sept./Oct. 1972 Current Annualized Level ‘ Request For Request Funding For Component 04 Year 95. Year __ — Year /_/ SARP /__/ Review Comnittee PROGRAM STAFF 379 ,442 417,890 CONTRACTS 100 ,000 505 ,000 | DEVELOPMENTAL COMPONENT ---- --~~ [_/ Yes [_/ Xo OPERATIONAL PROJECTS 641,969. 603,806 Kidney | : ( 11,532. ) ¢ ) EMS (oo) ( > hs/ea Cg o--- } | ( ) a Pediatric Pulmonary (i) C ) | Other (eee .) ¢ ). 7 TOTAL DIRECT COSTS 1,121,411 . 1,526 ,696 " COUNCIL-APPROVED LEVEL 1,100,000 e a“ Fy 71 annualized level AUGUST 21,1972 REGION ~- INDIANA BREAKOUT OF REQUEST RM 00043 10/72 PAGE 1 we : O05 PRUGRAM PERIOD ~ . . . . RMPS-OSN-JTOGRZ-1-— — - : (5) (2) 4) 1) IDENTIFICATION OF COMPONENT { CONT. WITHIN] CONT. BEYOND] APPR. NOT f{ NEW, NOT | 1ST YEAR | LEST YEAR | { | APPR, PERIOD[ APPR. PERTOO} PREVIOUSLY | PREVIOUSLY f{ DIRECT | INOIRECT | TOTAL I | OF SUPPORT f OF SUPPURT I FUNDED } APPROVED 1 costs I casts { ‘ leet ors '- - - we | ' t. t - 1 —— " €O000 PROGRAM STAFF { | | | { { 1 ! l i $922,990. 1 l il $9222820_1 $176,700 1. -£120992590 1... G09 NEIGHBORHOOD HEALTH CENT] | | { 1 I - ESS 1 l $190,000 1 L i £150,000_1 i $1502000 1 024 . RENAL ALLOGRAFT 1 j i 4 t | j I ~—— l j $112532 1 awece sess diez }... -$112.532- b..- $2724 $122304 1. .——- 025 NURSE PRACTITIONER j { t | 1 j t j i £225165 l $92516_1 $4.800 1.-_-_8142316.1--.. O27 PROGRAM DEVELOPMENT Sour | { t I j { : t _=-Hd EST INOLANA I l £232150_1..--82432152_1 $ £23..150! 028 COMAUNITY PLANNING raat i 1 t i j | t ins AYN j bes aaecisiedd - $50+900_1_. $50.000 1... . i $502900_ fener -929 SICKLE CELL MANAGEMENT a { ~y J j 1 IL i L L $86.634%.1 $86262%.14 $220 362. 4... Si0Ra 9 $6. = 030. HOME CARE OEMONSTRAT I9N 1 1 t ‘ ' j i i $63.856_1 $6326886_1 $633686. L. O31. DCCUPATIONAL THERAPY cari i | t 1 . | ——- SULTANGY. \ a a 1 $645585_1 sosssa5 |. 422-9001 —s924863 1 oo G32 EMERGENCY BEDICAL seavict { | \ 4 i { meee LGD COUNT L 1 L $440220.1 $44,600. L shban00_! 033 EMS TING peAansTaATIN t . t | t t | - aw a 1 i l £472416_1 $4722416_1 Ll $$70616_1 - 034 CONTINUING EDUCATION rect | { t | { t i —~ 5C0G 275090 ** 904, FE ALTR RAZARE ee 2079 _ 25000 457100 ** 009 NETCR®CRHECN HE 159600 LéESECC 110700 449900 ** 150000 150000 019 _Ffas CA SGSTe C 1260) 72400 #* OLD AURSTAG ARE Ott 51400 445090 20cco 115900 *#* O13 *sRSING IN Coat 12009 40400 22000 A115 LLOSLS #* 014 EXPARSTCA CF ME 26700 21ec0 27153 75193 ** O14 CEAANIC PELMONA Lecce 15900 ** O21 RACTATICN THER 34000 34000 ** 524 WFENAL ALL CGPAF 12250 13250 %# 11532 _11532 925 SNRSE PRACTITS $an 2 12932 #* 9516 9516 _O?n Gal endy FEALTE 9700 9700 ** 027 PREGRA* IE VELNP +* 23150 23159 02d COMMUNITY PLENN oe oe 59000 §00n0_ 079 SICKLE CELL MAK ** Ab634 85634 _O4)__FOME CAKE ECFMON ‘ vee OK, 63686 636%6 O31 CCCURATICNAL TH . +k A4S85 64595 O12 EMESCERCY MELCIC kk 44609 44690 033 EVS TeAINING CE am 47416 47416 034 COATIAUING ECUC _.. 526R? _... 52687 ee 2 JotAtL - 1363600 1912700. 1061842. tl2iel1, 5060553 ** 1526696 1526694 Phe HORNE ND “2 - ~9- Region: Indiana ‘ Review Cycle: Sept/Oct. '72 HISTORICAL PROGRAM PROFILE OF REGION AND PRINCIPAL PROBLEMS ~ Indiana Regional Medical Program's initial planning grant was awarded January 1967. The operational grant was awarded January 1969. ~ The region requested triennial status to begin January 1972, but was denied this request by the Oct./Nov. 1971 Committee and Council. The application submitted had been written before the region had developed its data base and a set of objectives. The action plan for subregionalization had not been described and discrete activities could not be evaluated. There was a lack of overall planning and the activities and projects proposed did not constitute a sound program. - The region is currently funded at $1,121,411. - The region has always been weak in the areas of planning and evaluation, and this weakness still remains. ~ There has been a lack of involvement by IRMP with other health agencies in Indiana receiving federal funding. There is concerted effort by the staff to rectify this situation. ) - The program staff has been small and very fragmented, but RMPS staff feel confident this will be resolved by the new leadership of IRMP. ~ The RAG has never been as committed to or involved in TRMP as is required. The RAG needs to be restructured. ; | - Proposed activities and projects were never based on a/scientific study of needs and resources. The region has always relied on the "bubbling up" of activities and projects. | -~ There has been a lack of strong leadership and supervision for the program staff. | - IRMP has, in the past, been dominated by the Medical School. ~ The region's review process is inadequate and does not meet all of the RMPS minimum standards and requirements. However, the staff has already begun to revise and update the review process. - The region submitted a triennial application for this burrent review cycle. RMPS staff reviewed the application and| concluded that it did not present a 3 year plan. Staff recommended to Dr. Margulies that the August 1972 site visit be cance led and -10- that the region be advised that instead of going with a weak triennial, they should resubmit a strong anniversary application _ that would lead up to a much stronger triennial request next year. Dr. Margulies concurred with staff's recommendations. and the region was so advised. (It should be noted, however, that the triennial application was prepared without the direction of a coordinator.) IRMP and the Indiana Regional Advisory Group accepted our advice and resubmitted an anniversary application. Accomplishments: - The subregionalization effort is taking Indiana RMP out from Medical School domination. i The region has begun to move from being a categorical program to activities addressed to health care delivery and regionalization. A new and much stronger working relationship with the State Medical Society is beginning to develop. Appointment of Dr. Steven Beering as Acting Coordinator. Reorganization of program staff, currently underway. Issues Requiring Attention of Reviewers: ~ The region is requesting continuation funding for one year based on RMPS staff recommendations. They are currently funded at $1,121,411 which is the NAC approved level. The region is requesting $1,526,696 which includes an increase for program staff salaries, continuation of three projects and request for funding of eight new projects. Contractural services in the amount of $505,000 in the program staff budget for feasibility studies, central region services and planned programs to support the subregionalization activities and to build for a strong triennial application next year are also requested. ~ RMPS staff feel that the region should not have funds to support sickle cell projects other than small amounts for planning and feasibility studies. ~ An increase is needed in program staff salaries to hire staff to fill some key vacancies. ~ Staff recommends a funding level of $1,200,000 for the one year continuation. A suggested breakdown is: $500,000 for salaries and wages, fringe benefits etc. 300,000 contractural services 200,000 for continuation projects 200,000 for new operational activities Review Cycle: October 1972 RMPS STAFF BRIEFING DOCUMENT REGION: Maine OPERATIONS BRANCII: Eastern NUMBER: 00054 10/72 “Chief: Frank Nash COORDINATOR: Manu Chatterjee, M.D. Staff for RMP: Constance Woody Spencer Colburn LAST RATING: 373 Lyman Van Nostrand Charles Barnes TYPE OF APPLICATION: 3rd Year Regional Office Representative: /-_/ Triennial /_/ Triennial William McKenna 2nd Year _. Management Survey (Date): f#/ Triemial /_/ Other | Conducted: or Scheduled: Last Site. Visit: (List Dates, Chairman, Other Committee/Council Members, Consultants) October 26-27, 1970 ’ Sister Ann Josephine, Review Committee, Chairwoman Bt. Michael Brennan, Council Dr. William Vaun, Consultant Staff Visits in Last 12 Months: {List Date and Purpose} May 1-2, 1972 - Verification Review Process May 17, 1972 ~- RAG meeting Recent events occurring in geographic area of Region that are affecting ‘seapgr mmncmnnen RMP program: The MRMP complete involvement in the College of Physicians terminated in March 1972. The State Legislature granted an additional $72,000 to continue the Program until the University of Maine takes complete leadership. The Lubec activity was funded at $20,000 as a developmental component and funded at a level of $85,000 for the first year of planning. MAINE REGIONAL MEDICAL PROGRAM Six Subregions AROOSTOOK COUNTY © BANGOR ATERVILLE LEWISTON AUGUSTA PORTLAND @ @ MEDICAL TRADE CENTER it 1 rd III. DEMOGRAPHY 1) 2) 3) 4) 5) 6) Population: The estimated 1970 population is 992,048 a) 51% urban b) Roughly 99% white c) Median age: 31.6 (U.S. average 29.5) Land area: 31,012 square miles Health statistics: a) Mortality rate for heart tisease--463/100,000 (high) b) Rate for cancer--182/100,000 (high) c) Rate for CNS vascular lesions--126/100,000 (high) Pacilities statistics; 4) No medicai schools b) Seven Schools of Nursing, one is university-based and one is based at a junior college. c) Three Schools of Medical Technology d) No Schools of Cytotechnology e) Eight Schools of Xray Technology £) There are 58 hospitals, five are federal and 53 are non-federal. Of the non-federal hospitals, 45 are short term with 3,508 beds and eight are long germ with 4,802 bede. The five federal hos- pitals have a total of 1,189 beds. Personnel statistics: a) There are 1,078 MDs (110/100,000) and 221 DOs (22.5/100,000) in Maine. b) There are 3,856 active nurses (393/100,000) in Maine. Per Capital Income (1970): $3,257 1970 Population Maine U.S. 992,048 203,211,926 COMPONENT AND FINANCIAL SUMMARY ANNIVERSARY APPLICATION DURING TRIENNIUM Roszion: Maine Review Cycle: October 1. Current Council- Recommended Recomended Annualized _Approved Region's Funding For Level For Funding Level For “Request For TR Year Remainder Component TR Year 04 TR Year 05 _- TR Year 05 __ of Trienniun " #__/ SARP /__/ Review- 960,000 Committee PROGRAM STAFF (462,492 $785,720 CONTRACTS 2,000 (75,000) SEVELOPNENTAL COMP. 78,653 96,000 [}vés /_/ No OPERATIONAL PROJECTS 416,855 796-376 j ‘Kidney . C | ¢ ) EMS ( ) C ) hs/ea C ) C ) Pediatric Pulmonary C ) C ) other C. ) .C ) TOTAL DIRECT COSTS $960,000 $1,676,096 . ? COUNCTL-APPROVED LEVEL 1,503,872 $1,646,394 “y ” - Cy ~ 12 tt We * AUGUST 211972 RECIONAL MECICAL PROGRAMS SERVICE “FUNDING HISTCRY LIST 13 ia RRPS-OSM=JTOFHL- ZO ss REGION 54 PSERE AME SUPP YR 04 CPFRATIONAL GRANT (OTRECT COSTS ONLY) ALL RECUEST ANC AWARCS AS CF JUNE 305 197 s T eee oo AWARDED AWARDEC AWAPCEC AWAPCEL AWAPCEL © REQUESTEC REQUESTED REQUESTED ~ REQUESTED ?. ECKFCKENT 1 G2 c? C4 ee cs 06 ate aie PSTEC . NOL __TLILe LO/TI- 12/72 TOTAL O/T 12/73 OLA TA 12/74 OLPTS$12775 TOTAL 0 we 4 __€000 PROGFAY ECL4CC S61L3CC 278SCC GESECE Z1CICCe ** 785720 864292 1é5c022 n CécP PROGRAM FEASTOE 10706 10700 #4 C004 MAINE MECICSL § 4acce 40000 #s DCCO CEVELCFRERTAL 40238 20236 ** $eacd $6660 192000 __GO1B COMPUTER PROGRA _ 8000 8000 #¢ OO1C COMPUTER PROGRA 1961 19¢1 #@ COZA REHAGILETATICN 12800 1Z2£00 #¢ todas WratATItn TRER 36000 J00d ¥e BOSC YAPRCUTH RCOEL _ — aco ecce *e DOSA FACJECT LUPE zoacc. — 20000 #* __DG6A FENCUIS CENTER . 15503 15503 ¥« DCI CCMPLIER ASSIST 99465 " qa4as we : __EOGA CANCER STUCY CE 3000 3000 9% GOi ELVEST PES ICEST 47266 56460 1esce TCZECT 8 002 KENNEPEC VALLEY 23980 241700 15060¢ S12100 v¢ OOZA KEANEBEFC VALLEY 68483 68483 ++ $7333 $7333 CO2B KEAKEBEC VALLEY . 39556 36550 ##. "9020 KENNEBEC VALLEY 270966 20566 a6 O04 S¥CKIAG COATACL 313¢6 48606 3e1ce LLECCe ¥* “Ses” CORONARY CARE 26560 195500 131860 353000 + ¢ OOSA CCORCKSFY CARE _ _.37660 37680 He z ““OCEB CCRCKARY CARE “31to7 ~ 21107 ¥e z OC5C CORONARY CARE ne _ . 55779 $5719 ¥e we , 5 “906 PRYSTCEAPS CCAT t17cc 762€C £010C L2eicc ** $ CO6BR PHYSICIAKS CCKT 7350 13S¢¢ ed i “Doe PRVSTE PANS CONT 23704 23704 ¥8 35000 36500 73566 CC@ €ST THIRE FACUL _. 27100 2710C #¢ re ; . ~ eoaC CIPECTORS OF ME ee 3csac 3923580 64056 009 REGICNAL LIBRAF 42ECC Rocce. _. 8 e2eCE 8 ““CCEB REGICNAL LEG@R AR &636 E626 ¥F : . OO9C FECICNAL LIER SA 22364 22364 4% 29195 32115 é1310 OLTA DEPARTPERT CFC res LLSEC 9% __.O178_CEPARIMENT OF C _ eee 3050 _ 850 4 445CC 44500 ““DLTC CEPARTMENT OF C 3e590 2850 #0 ° . CLEA KLPSIAG FAC Ath . ee _.. 4667? 4b] ¥* . vee “O18B NUFSING AND ALL 4467 446) OF 25000 2750¢ 525¢¢ _ OLBC_ALFSERG 2n0 Ott 13462 124¢2 #4 : a ““C16R INTERACTIVE TEL 45606 456CC 08 - 28000 i7e8Ca of 435000 _G198 INTERACTIVE TEL ee NCO p1400 #* : “O2C FARILY NCFSE 4S 27900 27900 ** i 0244 APEa PEALTH EDU oe _ _ . “O248 AREA HEALTS ECU ** . 0260 AREA HEALTH EOL +s : O2EA FECTCNAL BLOOL eccce 20000 ** “4 C268 EXERGERCY PECIC Ce cece . Less 2¢ 165S2¢ #8 _ _ eee we O278 MAINE FEALTH ED 102225 102225 44 - O27C FSEA FLTF €C IK _ _ 102227... 802227 #8 ““QZEB HSEA HEALTH SCI 17326¢ 1732EC +6 O28C_FSEA FEALTR SCI 123250 173250 +*¢ 0298 HSEA FAPTILY PRA VEd110 LELLLO ¢¢ 0308 HSEA PEDIATRIC #5000 65000 4 * ? 4 4 1 4 | oe ~ AUGUST 291972 + REGION €4 MAINE RMP SUPP YR C4 REGIONAL MFOICac FRCGRAMS SERVICE =" BUREIAG KISTORY LIST CPERATICKAL GRANT (cipect CCSTS ONLY) ALL RECUEST ANC AWARCS AS OF JUNE 3by 657 RYPS=TSM: T7lO™ 3° l. & 7 3 9 io at 12 bwarCec AWARCEC SwARCEC AWARNED AWARDED #* REGLESTED REQUESTED RECLESTEC RECUESTEC “——"" COMPONENT oT C2 i 040 ge ce c? KC TITLE CT/T2- 12/74 TEAL «#1 /73-12773 OL/T4-12/74 OL/TS=12/75 TOTAL — se Fee Ge egy 318 FSES FAMILY NUR 181526 181576 —“OI28-FSER RURTE VICh V3576 YES C Fe 033B SEA TEA™ NUPST 31791 21751 #9 S340 FEGICNAL” FPPROE 97667 Q1EEY ¥e CEC HSEA YARMCLTH F 2166C 31660 ** —~OVECESEA REALTR EDU 903845. 203845 ** O37C KSEA FEALTE ED. $1260 £1250 +* / _ ~DOUEC COMPUTER PROGRA x] 2ccud 22000 42056 0398 REFABILITATION we 50083 50051 160174 “~CIUGCREFARICITATICN ae ecooe 50092 100092 C4CB INFALATICN THER 7 36579 25526 T2105 —DaLa VECICALINTEAST ~ oe 123325 T1OSt1 233876 O41B FEDICAL INTENSI at 10CS02 110511 2hba13 ““OQ4Zzk FENCUTS CENTER ee Zb0TS SOCCE B6c1s O43A PROVECT PAACCCK oe #0120 40nd _$608de Dash OPERATION REACT oe 330CC 363CC é93cc 045A FAMILY PLAAAIRE *¢ 24764 24764 wr »~ TOTAL =~ es79Cc0 122650C 865000 2866465 5918865 ¢4 LETECSE . 1704068 3280164 eae Ln meneame oe ae ee een yom tpn en vel Ete w Ju 0 ° 7 wow eves - — for ear Pe A Bee Ge ee ret to caret wool Ari, Welt ! Wt we feed | fie WE | LEE NE t é { Avine PoKiund APPa. PerluL PREVEUUSLY PREV EI SOLY vbRoud INVERTLE i Bu tAL i jour surPGRt | uF SUPPORT | FUNDED APPROVED casts costs t l \ COuG PRUGRAM STAFF i t | | | i t | L $ld5s720_1 1 L 1 $7 2527201 i £2 2527201 DOG, DEVELELPM: TAL i | | i | | i i S26 2000 L 1 £200000_1 i ~$96.000 GO2A KENNELEC VALLEY REGIONAL j | Poo ALIB_AGL ALY £97234) ] $57-333 i $572333 GOot PHYSICIANS CUNFINUENG EDI | j 1 i t i 4 meni LLON.. 1 $35,000 1 i j I $35.000_1 \ $35,000_! Goat DIRECTORS CF MEDICAL EQUI | i 1 l j t . 1 cee AL UIA ee j $30,500 1 ] I $20,520) } $20,500 1” GOI KREGIUNAL LIBRARY | | j | i | | : | $290195 1 1 ew $290195-1 $3.0011 $322196.1 C178 DEPARTHENT OF CUMMUNITY t | i ‘ St \ t 1 ee MEDICINE MIG j $441590 1 1 1 L $44,500.) j 844,500) Glos NURSING SAD ALLA-U HEALTI ‘ j | { . i i t wath PESSUNHEL Egucar bus f $252000.1) f 1 l $252.000.1 i $25,000.) DIGA INTERACTIVE TeLEVESiun | I t | j j i ! . i £282900_1 j j j $28,000.1 i $28,900. 1 anc COMPUTER PRUGRAPMED EDUC] 1 ! I | ! | t ALL AGH. i i | 1 $292,000.41 $20.000_1 i $20,000 1 G37 KEHAGILETATIUN PRUGRAM NI ! j I . t i i : ASLERS HALLE j j ] 4 $50,083_1 $50,083.14 l $50,083 1 O35C PEHAGILITATIUN PRUGRAM Wi 1 i | , 1 1 1 UBHIEASIERs HALiC 1 j 1 1 $50,000.) $50,.000_4 4 $50,000 5 3% CCHPULELL 1uLaL i j L tt. $100,0832i14...3100.08321 Li... .£$100,983)1 G40d EPNHALATIUN THeRAPY EDUCAL j j | 4 i bs io. weed LOWY. i i L l ~$:360579_1 $36,579.41 j $362579_1 DsiA MEDICAL INTENSIVE CARe | 1 I | i in. i i i i j $3.230225_4 $1232325-1 i $123.325-1 2... O8 EB MEUICAL INTENSTVE. CARE 1 } . J { i 1 - l i $100.902 $100,902 $1.003902 Pel. CCUPUBEDI ural rl | t. S226a227iii..._$2242227) (.. $224s221) O42A PENQUIS CEATE# FORK HEAL 1 1 _ x f i 4 i $462075 1... £460075 $46,015.1 O43A PROJECT HANCUCK t j 4 j i t t j j i 5 $60.120.! $60.120_1 $602120.1 O4Gk OPERATIUG HEALTHMOBILE | { i } . i j t i j j j £23,000. 1 $33,000 i $323.000_) O45A FAMILY PLANNING i | b | i i. I i 1 i l $24016%.4 $24:764 4 i $2%:164_1 i i -4 | i } \- od : YGTAt { $ie131-248 | a _— t $5446848 | $1e676,096 | { $145679,097 |. tee JULY LT, bote a p web hp cored, BAEAKQUT OF FEQUEST 05 PROGRAM PERLUD ant HEGIUN = MAINE km 00054 LOsTZ. eye FaAGE 4 RHP S~OSN-JTOGR2-1 eevee: amma toe “ $3,001 en JULY 2794972 wot : REGION - MAINE ‘ BREAKOUT OF REQUEST ' RM 00054 10/72 PAGE 2 06 PRUGRAM PERLOD . RMPS- OSM JTOGRco1 ery 1 4 tat tue daste PER EC AG Deae Ud Het tocrat tel i phat, web breperg borate isd Wihateee Aen. Ut { atte thel ALESe hove AD pepe a | ' ponver. EC bod ait erga PREVEOUSLY og ree Wduuotl®. t vik | ALL YEAKS 1 LF suppukT | GF SUPPORT | FUNDED | APPROVED t COSTS | {OIRECT COSTS | _ i - ! ! —. 1 {. | | J - 4 COOO PRCGRAM STAFF | | | 1 i { 1 1 L $o4a292 1 1 t | $8642292_1 L.$12.650.012 1. 000u DEVELCPME Ws TAL | | ! | | I i | 1 subandot -j ij ) $90.000_1 1 $192.000_1 OO2A KENNESEC VALLEY weGLONALI t i t 1 | | i _. WEALTH sGEScy L j 1 ] 1 £57,333) QO6C PHYSICIANS CUNT INULNG zi t ! | [. | j : _ UGCALLON $382500_3 i L j $36.500_) 1 $.73.500_1 OO8C DIRECTUKS CF MECICAL eal . t i | { \ j ! LID. $332550_4 i j i 33.5501 1 264.050 1 COSC REGIONAL LIBRARY | | t { ! j 7 4 L $3201151 i Ll I _ $32s1151 { $461.3101 O17 CEPARTHENT UF COMMUNITY ' Hl ( | . | | { 1 . _ MEDICINE MMC I l L L ——$453500-1___. Oldd NURSIMe AND ALLiCD went 1 1 { 1 . H PERSOBUEL EMUCATION $222500 1 i I $27,500. $$20500 } OLGA ENTEKACIEVE TELEVISION | | J | | | { ; _ i $107,000.) 1 1 l $107,000.14 i $125,000 0360 COMPUTER PRLGRAMMED ELUCI I | i | t j ! eh DIB GR j J i £$22.000 1 $22.000.1 i 34220001 O39 REHABILITATIUN PRUGRAM m1 1 J 1 i J | zIHEASIERY MSISE i i 1 $50209)_1 $50,091 1 i glooet74 1 O39 REHABILISATIUN PRUGRAM nt \ ! | : t j | __ —CeHIEAST E26 PAINE 1 l i } $502092_1) £50.092.1 1 $100.092_! 039 COMPOLENT IULAL 1 l l TL..$100s183111_ . 100.18324 Li. ..$200s26511 C408 JHHALATI Ul THERAPY EDUCA | i ‘1 | . | j Ll. LLUN L i : L $352526 1 $352526.1 1 $1222105_4 _ OTA MEDICAL IhTehSIVE CARE { - t { | 4 Jj j { i | L ld £110.511_5 $110051) 1. L $233:836_1 __. OHIB MEDICAL INTENSIVE CARE t ! _ 1. . | . I ! { 1 . 1 j 1 i $1100.51) 1 $110,511 1 1 $211.613_1 gal COMPOSE MI JOLAL lL 1 4 Ait $221. 2022111 221.0221) it $445024911 042A PENQUIS CENTER FUR HEALTH t i j i ' t. Lo 1 l 1 l $50,000 1 $50,000 1 i _$962075_1 0434 PRUJETCT HANCOCK 1 - t -- 1 { t ' 1 4 . L ! $40,080 $40,080.41 L $100,200] 0444 OPERATION HEALTHMOBILE 1} | | od i “. $363300.1__. £362300 : $692,300.10 0454 FAMILY PLANNING . . : _ . - $240 7h4 : ' | i j i } b . t TOTAL __ 98957 Ee a | $505,111 | _ $b_704,068 | 1. $39360,264 |. cme mesa mee eenahaiemneennier semana men weer we . semen en ney can arm a . : ~ ~ -~9- Orin CAL_PROGRAM PROETIE OF REGION 1966 Repion: Maine Review C¥CTCy” perober 1972 The possibility of Maine's becoming part of a New England RMP was discussed, when early interest regarding Regional Medical Programs was generated. Maine chose autonomy and an appropriate grantee organization was formed, Medical Care Development, Inc. The Bingham Associates Fund and the Maine Medical Center were particularly active in pre-planning phases. The first planning request was submitted to the Division of Regional Medical Programa in December. It designated Medical Care Development, Inc., as the applicant organization; Bingham Associates Fund as the fiscal agent, and the Field Director of Bingham Associates (on loan 100% to Medical Care Development) as planning coordinator. 1967 Under the 01 planning grant the program's professional staff was assembled and Dr. Manu Chatterjee was appointed full-time program coordinator. Periodic meatinge with regional health and education agencies became established practice, hospital coordinators (or acting coordinators) were appointed in 56 hospitals and held meetings, two feasibility studies were initiated, the RAG membership was completely divorced from the grantee organization to eli- iminate the possibility of legal problems and an overlap of membership, and an operational proposal was developed. 1968 “The first operational request was submitted in February. A May site visit team was satisfied as to the Region's readiness for an operational award. It was noted that, initially, emphasis was given to development of the regional medical program rather than to establishment of priorities among unmet needs. 1969 ~ During the 02 year the Region continued to fund program staff and the original projects, The Region rebudgeted and utilized unexpended funds to initiate new projects; the Directors of Medical Education activity and the Regional Library project for which supplemental funds were not available. The Region re- quested continued funding for program staff and six ongoing projects and developmental funding for the 03 operational year. e et -~10- 1970 . . _ The Region was site visited in October to assess its readiness for a developmental component. Developmental funds were approved by the November Council. The site visit team considered, the evolution of Maine's Regional Medical Program was being consistent with that of . the program at the national level. The RMP started with a categorical | emphasie but expanded to include a commitment to the development of an integrated system of medical care to provide access to medically depressed populations, as well as improvement of availability of care to the community at large. The six program objectives reflect this emphasis, and are also geared to the unique needs of Maine itself. 1971 The August Council recommended triennial status for the RMP and develop- | 7 mental funding be approved. The increase in program staff was a concern of the Review Committee and Council. RAG decided that the three broad operational objectives should be given priority as far as the Maine Program. 1972 The RMP submitted an emergency medical services and health services/ education activities (MEHEIA) proposals for supplemental funding. The EMS proposal developed, which is regionwide in scope, as 4 result of . the close working relationship between CHP Ageneies and the program , staff. The program staff stimulated the MEHEIA project by working with the University of Maine. The June Council approved both of these Proposals for supplemental funding. The VA has supplemented partial funding for the MEHEIA Proposal. During the verification review visit on May 2, the team found the Maine RMP Review Process exceeds the ninimum standards in some areas, but there are others in which it does not meet them. The RMP's review process was conditionally certified until the areas of concern have met the requirements: (1) The bylaws of the RAG be revised to reflect the responsibility of the Board of Directors of the Medical Care Development, Inc. in the review process as being limited to fiscal and admini- gtrative affairs, and the RAG being fully responsible for program policy and decisionmaking; (2) A more specific outline of the review process be developed and made avaikable to applicants, and a conflict of interest gtate- ment be developed which coincides with Federal policy; (=u - © eo (3) A priority ranking and funding system which is applied by the RAG to all approved operational activities be established; (4) An evaluation capability, which includes assis&ance and sur- veillance, be established. ; -12- . Region: | Maine ee Review Cycle: Qeteber. 1972 MEE STARVE ORSERVATTONS: Principal Problams: ie The RAG bylaws are to be revised to reflect the responsibility of the Board of Directors of the Medical Care Development, Inc, in the review process as being limited to fiscal and administrative affairs; and the RAG being fully responsible for program policy and decisionmaking. The grantee has been requested to provide the rationale for the projected staff increase. The RMP should establish a priority ranking and funding system. The RAG needs to establish a conflict of interest policy. Principal Acconp)ishments As a result of a close working relationship with VA, Model Cities, CHP Agencies and the University of Maine; the RMP developed (1) MEHEIA, (2) EMS, (3) Kennebec Valley Regional Health Agency, (4) Lubec, (5) Com- munity Action Program, and (6) The Summer Student Program for further development of primary care in underserved areas. The RMP was completely involved in the study of the College of Physicians until March 1972. The MRMP received $400,000 in funds from other sources to help develop these activities. - The negotiated contract with Harold Keairnes, M.D. for evaluation supervision. Issues requiring attention of reviewers Maine's RMP should continue systematic studies of the interest, use, and adap- tation of problem oriented medical records. There are no minorities involved in the program in any capacity. There is no specific policy in the application delineating a MRMP policy or long-term support. , ME M O KR A NI Py UM DEPAICLMENE Ol 9 FSA Ltd, MIP E LRN, SENDS VY tabs cand ai WE. ah BY AL hh FROM SUBJECT: PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION DATE: September 7, 1972 Director Le wr Ny 1 Division of Operations & Development (7% Director, Regional Medical Programs Service Action on September 5-6 Staff Anniversary Review Panel Pecommendation Concerning the Maine's Regional Medical Progrem Application RM 00054 10/72. 7 Accepted Hen (date) Modifications. COMPONENT AND FINANCIAL SUMMARY ANNIVERSARY APPLICATION DURING TRIENNIUM Region Maine Review Cycle 10/72 Current Council- Recomnended Recommended Annualized Approved Region's Funding For Level For . Funding Level For Request For TR Year 62 _ Remainder Component TR Year Q1 TR Year 02 TR Year 92 __ of Triennium /_/ Review Committee PROGRAM STAFF $ 462,492 $ 785,720 + . . CONTRACTS 2,000 (75,000) DEVELOPMENTAL COMP. "78,653 96,000 [xfXés [_/ Xo OPERATIONAL PROJECTS 416,855 794,376 i Kidney C ( ) EMS ( ( ). ; ‘hs/ea ¢ ( ) Pediatric Pulmonary C ¢ » Cther C C ) / TOTAL DIRECT COSTS $ -960,000 $1,676,096 $1,200,000 COUNCIL-APPROVED LEVEL $1,503,872 $1,646,394 ° Region Maine ee Review Cycle 10/72 Type of Application: Anniversary within Triennium Recommendations From {-X/7 SARP /_/ Review Committee {~7/ Site Visit [77 Council The members of the Staff Anniversary Review Panel recommended that Maine's Regional Medical Program be supported at the level of $1,200,000 direct costs for the second year of triennium. ‘These funds will provide support for program staff, operational activities and a developmental component. This represents an increase over the Region's current annualized level of funding. An increase was considered justified by the SARP because of the Region's current stage of development. The Staff Anniversary Review Panel was impressed with the Region's continuing to refine its objectives to: (1) conduct experiments in new methods for deliv- ering health services; (2) develop new health manpower; and (3) update level of medical knowledge for health professional and public. The objectives are directed toward solving Maine's unique problems, and yet are still in keeping with national priorities. The priorities reflect a realistic assessment of needs and appear to be functional as guidelines for operating the program, These reflect input from providers, consumers, and low-income members of the RAG. MRMP has continued to establish its leader- ship role throughout the State. The Program has been successful in providing services to underserved, urban and rural areas of the State. A substantial amount ($1,666,465) was awarded during the latter part of the current year to support supplemental activities in emergency medical services and health services/education activities over a three year period and although this was a plus for the Region, reviewers were somewhat concerned about the capability of program staff to adequately manage such a tremendous increase in the Region's overall budget. Although their fears were somewhat relieved by the information that one member of the staff would be responsible for the administration of the hs/ea (MEHEIA), staff was urged to express this concern to the Region. Somewhat paradoxically, there was concern about the large projected staff increase from 25 to 32 positions; and the lack of information supporting the rationale for the projected increases. The SARP showed concern for the one to one ratio of professional and clerical positions; and the Coordinator's salary as being disproportionate to the remainder of staff. RMPS Management Assessment Unit will work with the Region to reselve these issues. Maine RMP “= 2 = . _ RM 00054 Maine includes 6772 racial minorities, and there are no minorities presently on program staff or the RAC. The SARP members were interested in knowing whether an effort had been made for the intlusion of minorities on staff or RAG and to pursue this issue with the Regio The Region readily admits its efforts to develop an evaluation capability have not been very productive. As a result of its lack of productivity, the Region is planning to augment a contract with Narold Keairnes, M.D., Tri-State RMP, and a recommendation was made to RMPS staff to keep a close surveiliance on the process. Generally, SARP's impression of the Region was favorable but showed concern with the points raised above, RMPS staff was urged to work closely with MEMP during the coming year. EOB: 9/7/72 saw hd to = e ety oy fg te solut re ewly my atin yf cs ims, ts) he Copoonent POLE i PPT AT ‘ 4 Up eceth a Phat a ee fect Ale mate! a Lem mre EMA Nee Thee Dee on “ Pu MOnaLyY Other with ge det Bau ve TOTAL DIRECT Cos de eet ae ET Bat el cee a at Toad a AUN CTI AS . i i i i 1 ' tan enone eo ‘ 7 4 aD? 1 i 1 ! i i i 4 4 ~ : oe . 4 Pow i 4 : f po | . 5 Se a } he t ra . ' ’ AAA ‘ i f ‘ on . VP ‘i ‘ Ae ¢ i 1 f a ' rf t JOY of i i Me TENE NE g | | \ \ ‘ ’ . : Zé \ : f : f és : i é i é i ; ; t i . } f ™ ‘ { Yoo ¢ i oy s i 4 i i i , : t 44 | a4 ‘ oo f - t + t ‘ wat Review Cycle: Qctober 1972 © : RMS STAPF. ERIEFENG! DOCUMENT REGION: Memphis | “OPERATIONS BRANCH: — South Central RUMBER: ~ 00051 Saye ope Mr. tee EL VanWinkle | > CooRDINATOR: James Culbertson, M.D. Staff for RNP; Lorraine Kyttle (SCOR) ; , Bill Torbert (os) » LAST RATING: 285 Larry Pullen (GMB) Gene Nelson (P & 5) TYPE OF APPLICATION: 3rd Year ~ Regional Office Representative: a | Triennial / / Triennial Ted Griffith _ and Year __ Management Survey (Date): fx! Triennial /__/ Other ; | Conducted: none or my Scheduled: early 1973 Mrs. Florence R. Wyckoff (National Advisory Council) Bruce Everist, M.D. (National Advisory Council) Robert R. Carpenter, M.D., Director, Western Pennsylvania RMP Paul Dygert, M.D., private practitioner, Vancouver Washington @ Site Visit: June 1971 (in response to triennial application) Staff Visits: March 28, 1972: To explore the relationships between MRMP and the Mid South Medical Center Council (MMCC). The organizational structure of these two bodies was cited by previous reviewers as a complication that prohibited granting developmental component authority. April 20, 1972: (1). To meet with members of MMCC board to ascertain if question of MRMP's Regional Advisory Group could be brought before full MMCC membership at its May meeting. . (2) To discuss funding plans for extended 04 operational year. Recent events occurring in geographic area of Region that are affecting RMP program: The Higher Fducation Commission in its second study (1971) again recommended that the need for a new medical school was not substantiated at that time. The study also found that Knoxville should be the selected site when the need was further developed. The Trustees of the University of Tennessee have formally adopted the findings of the report. co | e need to clarify the geographic relationships involving the programs fn Arkansas, Mississippi and Western Tennessee {Memphis RMP) is under —™ discussion by Dts. Silverblatt, Lampton and Culbertson. Se MID-SOUTH POPULATION CENTERS AND MEDICAL TRAINIAMG PROGRAMS Messoors Ny STODDARD 2 6 ZA NSGiS> ect sippt CARLISLE] GRAVES @ NEW HICKMAN MADRID ° . _— Say mancotpe | cay A —7oBion LAAN e PEMISGO WEAKLEY SHARP | GREENE - : , ee DYER // " {LAWRENC! DUNKLIN Sarno. (BENT Gh MISSISSIPPI oo IY, CROCKETT / ed ” UDERDALE, Lyf 7 NENCERSON lennessee. exon POINSETT AavwooD Y . *O j - A DE- TIPTON _ ° eR Le CHESTER 4 CROSS {FAYETTE IMU: Yj a HARDEMAN HARDIN WOODRUFF 66 Wy ST. FRANCIS KO “ _* Kx OO _ ZAR ARSHR lene" ALCORN LEE TISHO- - Fema MINGO Ml Tiered | OvATE PRENTISS | ‘ONROE PHILLIPS | k UNION * PANCLA LAFAYETTE 7, &Mississ/por 0} ITAWAMBA / pontotoc Ve o’7 ox Gu: TIAN yp ISHA “4 baictald CALHOUN Lo — BOLIVAR TALLAHATCHIE CHICKASAW * De; FLOWER yp Uf GRENADA * = Population Centers (over 70 people/ square mile) €3 Medical Schools * Nurse Training Programs ® Allied Health Training Programs : ue Comprehensive Health Planning @ B Agencies th Me > 3: ZC RRO aa SS SANA . is re . “VARLISLE ee Sh UPON Goh Ba Beothee.! ee | i Maye Yi Health. he - Coonel Po facil: Scant SAY Counet ‘ er Hue) ray § “ MANDOLPH |, CLAY. -/ BION MENT oo . i | ion. WEARLEY oo SHARP ff ON PREENE Le CN thn es ee —>NW ete { i —h, og % Ee ae eth . Heh on LAWRENGE @ duel Re “ BSon health 7s ! DUNRLAN 5. rrou {BEN J ee LY: AR versie Hum. \ . ROL : Coune?} ioe il WIBSIGSIP ‘Se ume Pa : Oe B e4 % . oe fb ae 3 1 oc ert Jones rp | vil] A DERDAL S K ne HENDERSON * Ly POINSETT ' { ee Bo wk " - sf JACKSON ah on we mie mockgogh. : ho | preaee a oN ‘s SON OY No, (aur oss “ ON 8 page CRESTER 2 | RiT- x a ee ' OHOE | SHELEN, [eaverte “[panbewan Zouanee’ HARDIN T. FRANCIS; eq VR Bo pe Le \ A TP qhCe. 4 G 1 focte aphis AP 7 rest C a | Noesard. ARSHALL se mo sree S tistics ul E , ig ‘, . : . is Rs | PAL WINGO . vs bad : a tO repad Coti rath aft i wt ware Bg pe ES TPRENTISS |. | eatlt MONHOE i Ee O , oat . i t ‘ tf j ; ” BPHILLIPS | iad omg Ut Plg Counes el GRE VAIN po Los Panola see 7 “flee elenwf Yo -- a Clarks {ourrmany ” oxtora | y 3 \ yee of ad > Disted ALC ¢ . bone . s : ‘ , wo . . ALOBUSHA E- Ach HW ealth BOLIVAR | TALLAHATCHIE ~y Plg. eb al Cleve- SGRENAD A aid SUN- _ |LEFLORE WASHINGTON FLOWER |Green\ ‘ood reer note GES | jatth F Comprehensive Health Planning B Agencies TSP STOREY T eae The Bootheel Council (Missouri): This is MRMP's Area Advisory Council b aS well as the funded CHP(b) agency. Through contract funds and : program staff subsidy, MRMP assisted with identification of needs f and development of priorities. , : The Jackson Purchase Council (Kentucky): MRMP provided data base as this council was forming. NW Tennessee Council: MRMP prepared portions of this council's application; did the leg work to start the office; presently is budgeting contract dollars to assist in identification of needs. MMCC: Formerly MRMP's Regional Advisory Group; new Regional Advisory Council has excellent overlap; products of joint efforts have been outstanding and are expected to continue under new arrangement. District #1 Council (Mississippi): Not yet funded for operations-- MRMP did leg work in establishing; budgeted $15,000 contract dollars through A agency to catalyze. District #2 Council (Mississippi): Still in process of organization. Activities under requested Developmental Component include completion of work in this area. District #3 Council (Mississippi): Funded through Appalachia-- MRMP contribute , or survey work; included in MRMP's EMS plans. NE Arkansas Council: MRMP assisted with planning funds and development of data base. SULY 25, 1972 nate aKCLT CF REQUEST REGICN ~ MEMPHIS pm 0CO51 16/72 pace . . Os PROGRAM PERICO _. RMPSH + a 2 x ‘ 5 6 2 CANADA ro newstaae CANADA poo w) enna ydan eee ALPERA ERA ERAN BEEPLIE ESSELTE z RA PSN ORES aR BRE : ddiliak) 94990 @f | Cr) xe ee CIT Bat TSAR eeeSTTPDTTEEEE * a : awreek ES fF t WISCONSIN HOT te Pert ery ered Pisoni ay Hf ii IH tt i 4 ik jatwatea atone erriewy c d 35,1 Aas . City Vee a porsedinaw 117,0 220,00 ; sai WY in Boks stegkeeice ay fale ied . oi ° ‘ i boo} 2 or 36 7B ahaer savas 56 Wyorhipg® pnyeeey t t aasera Fy i ues vee ng Ponti __ | Msleepos 47 QEREESEQGERSEDESPLTTT ERE LEZ ET : t eaTRE or aii nea ‘Rigo J 20200 att. P Jacks Teh eyes He "25,009 FE Scaescan er de k, et ervepats wena 2, (esereteyvescatearian wie ST ILLINOIS raene } ont oToledo 722,000 -o- 1 abe oon al ee be Pe datateat a deh a® te ei nre Hea a e A d A ais it Bw ue bes dite eat tkaed OR ee MRLs gee EIEN , : - ‘ “ . ae ) are . : wet : mo, : wwe os . : aoe wee . : Hod te tee Lah eM 5, pyro i eninge Bg, BNGMORs : vw ti, ' "FACILITIES AND RESOURCES 4 » va i Schools . Noe, Enrollment “Graduates | Location —_ a (1969/70) "1970- (1969/70) 70/ * Medicine ane (Osteonathy. (42 at UOT to 2 612) | ae a "(189)" 20L7 Spa AEDOR 1° Serene ate, a Uaiv. be “Michi. vA Mods éénocl” | 8 : Hayne State Univ. Sch. of Hed. (O37) 570. - (3) 3 Lal. Detroit : 109 | een! _, Be Lansing pn “Mich. State’ Univ. College of “( 85) Human Medicine “ _ Mich, Coll. of Ostco- Med. Lat ye EO - Lansing a 1 Dental! 2 696" _ 339 ann Arbor _ vere es fame . —_ oe - Detroit ee ee | - oe " Pharmacy (1967/68) _ 3 486. 152 i Norsing schools os Professional Ni rs ; pe a Ty “4+ Number Ni Ing 39 te 22 collesc or. Et te — ~—- _vniv—be 0d. Practical wureling So Co Ct Many at Junior Numbex ie OO 32 : Sot St Colleges; some : ee : — Bd. of Education 7 cts . f as . : . "OA . a Aldied Health § Schools _ ' (Approved Programs) * te ea Pagtn' Gh Univ. Based- “Northern Miche Ue! os motown Marquette Oe Molee: . Te . * umber ( - 3 ist ¢ * - 37 ¢ incl. Lat V.Ae Hosp. Alten Pk.) ee ne a te SM a - ~ SS | Medical technology Rumber __ mae oa wee : . : wo Radiologic Yechnolog; a4 Number C ARPES 1970) __ = Lo a : = 'U. of Mich. . Physical ‘therapy ~ - . 2 Wayne State” __ Number _ ~ Medical Record teat: ~] i j : ee mee NO ee ow at iba ms feet ; — ence rene et a Medical Record Technician 1 M 00053 5 . REGIONAL CHA RACTERTSTICS (Cont'd) FACILITIES AND RESOURCES (Cont'd) " MANPORER Ratio Profession Numbers. 4 Total per 409,009 Physician -\ active 9515 general practice » 1635 medical specialties 1448 surgical specialties 2190 other specialties 1313 Physician - inactive 598 Osteopath. i 1932 Total. acl MD & DO.” 11,447 proiesesonell nurses ‘ actives 23,441 inact ike 13,212 Lic. Pract.},Nurses activdly empl. in nurs. 19,781 not cpl. in nurs. 3,218 .-—---— . Hedical technologists Radiologic technologists X-ray 2427; nucl. technel. 423 radiation Physical therapists 390 FT therap. 14 Medical xeserd yibrerions . at GROUP P} RACTTCES ¢ Total + 260 Single specialty - 156; general practice - 24; malti- specialty- 80. Michigan RMP COMPONENT AND FINANCIAL SUMMARY Review Cycle October/72 ANNIVERSARY APPLICATION DURING TRIENNIUM OO - Current - . ~~ Council- ft Recommended -_ Recommended Annualized - Approved - Region's Funding For Level For : Funding ‘Level For Request For TR Year 05 Remainder Component . TR Year 04 TR Year 99. TR Year 05 on of Trienniun . —- oo 7 /__/ SARP 2,100,000 (7) Review ~~ Committee 4 PROGRAM STAFF 280,184 ae yon0 ; . a -O0- CONTRACTS -0- a ; : . an f° °192,350 © “Wés [7 DEVELOPMENTAL COMP. .| 160,598 = , | Ades /_/ No . 2,379,189 . OPERATIONAL PROJECTS 1,483,784 . ' Kidney C -0- ) C a) EMS €( . -0- ) C ). ‘“hs/ea C ~0- ) ( ) Pediatric Pulmonary C -0- ) ( . Other C -0- ) ¢ ) | 1 : 2,997,479 TOTAL DIRECT COSTS 924,566 . { COUNCIL-APPROVED. ~— | 2,100,000 2,100,000 LEVEL roe ; “The Region identifies two projects (#45 §& #46) as Health Service Education Activities, when in fact they do not meet RMPS' definition of such an activity. The titles of these projects wil ¥i > changed. aS b De “AUGUST 8919720 os a BREAKOUT OF REQUEST ~- center _ O05 PROGRAM PERIUD _. REGTON - MICHIGAN. _ RM 00953 LO/T2 _—~# PAGE 1 -ecen, RMPS-OSM-JTOGR2=-1_ (5) (2) (4) fl) - ee i “TOENTIFICATION OF COMPONENT | CONT. WITHIN] CONT. BEYOND! APPR. NOT {| NEW, NOT i CURRENT § CURRENT | i . | APPR. PERTOD! APPR, PERIODL PREVIOUSLY | PREVIOUSLY } DIRECT { INOIRECT. | _.. TOTAL f[_~ . } DF SUPPORT {| OF SUPPORT | FUNDED | SPPROVED { COSTS ! cosTs { ! _ . i = - 1 4 — fe - 1. a 1 C000 PROGRAM STAFF ! 1 j I 1 { t { __ L $425.940 1 l ! 1 $4252940.1 ji $425.940 1 in D000 DEVELOPMENTAL COMPONENT | | i j i | i | _ I $1922350 1 1 j i $192,352_1 i $192,350 | | 005 MSU PLANNING i { | j I I | } : _ ] £163,275. [ i 1 i $163,275 1° $422397 1 £205.4672 : | O14. WAYNE ST PLAN i i i I | { 1 a i £125,200 J i i i £125.200_] wh 5704631. $1822453_ La — O15 ZIEGER BOTSFORD HOSP PAR] 1 ! ! } I j i _ Lic Parlor i £128:472 1 L L l $128.472_ 1 £$192300_1 $1470722 i — ; O17. STROXE BASE CENTER | ] } { I 1 t 1 ; _. L $522410 | \ 1 L £52,410 1 $i0sZ30.1.. $63,149 bo 019 STROKE DEMONSTRATION UNI] { ! I i i { __ L I $95,000 J 1 L i $275.000 1} £16.720_1 $i122720.3 _— O21 PUBLIC EGUCATION FOR STRI ! j I I j ' | | _ Oxe L $502125 J l i L $50.225.1 £44226 14 £56,352 4 O27 COMPREHENSIVE HEALTH CARI I t | I ! { j eee BN BBAN_ POOR $207,000.) j 1 l $207,000] $41.508 1 $248;435 1 029 COJPERATING STROKE cenTEl | | j | j | j B £145:886 1 l L ! $145,886 L $13,579 1 £159,465 1 aie “030 SOUTHEASTERN MICHIGAN aE} j Il. I i ! 1 i _ =ewG CANCER PROGRAM L $209,620 1} L 1 Lt £209.620_1 $452,374 1 £253,994 1. an 031 MODEL NEIGHBOURHOOD HLTH } ! i - 4 { 1 i i ‘ ~-~SE3¥_0£2723D_ L $173a7727_) L l 1 $173,777) 1 $172:7771 1 032 LAKESIGE CCMPRE HLTH SER] i i ' 1 ! i i ° _ Y_JEL_SYSIEM L $150,900 1 L L j £150,000 1 $48,000 1. $193,399 J]. 2 SS 033 STROKE DAY CARE CENTER | | j j I | I i. L $129,000 J L l i $129.000_1.____$22.283 1. s151,083 [ 039 IMPROVE THE CALIBER OF 7 1 | | j ! i 1 ao -ADOPLATORY_wORBK 1 j I $22.240_} $272240_1 $62180_1 $33.420_1 “O46 COMPUTER LINKAGE TO com I ! j | j t . . j w—-UNLIY HOSPLTALS. 1 Ll i $922492 1 $922492_1 £22.352 1 $114,344 ] oN O41 NEW BORN CARE IN coununtr | i 1 j i | . t _.. we LYLHOSELIALS L { { tL $7222624_1 $22.694_) £332323_1 $105,017 1 . 042 MUDEL BURN CARE TRAINIK | i I i | | I —aw~-PBOGBAM. : tL a | L 2.2 81022049_ 3 $1092049. 1. $552929 1 $164,978 FO "044 TELEPHONE INFORMATION SY] | | j I j | j SIEM L ! weewe end nn ew meee enndane Sl 5b2SL2_1 $151,512 1 i $151,412 4 La "045 GRAND RAPIDS HLTH SERV Et t ! | { I { 5. wae QD ACTIVITY { L J £105,000 } $105,000 } 1 £105,200 1 _ 046 UPPER PENNISULA HLTH samt | ! I { i t i —-—-¥£0UC ACTIVITY L L 1 $752537_1 $75,537. 1 t $2732537 } ~~047 UPGRADING NURSING HOME ct { J | I | j ! . ARE L I l j $116.200_) $116,200.) I $1164200.! ! | | | | | | - | oo. _ TOTAL }. $2,247,855 J . j | 1 $229972479 | $437.76) | | $35435.240 |. $749 9624. AUGUST 841972 BREAKOUT OF REQUEST 06 PROGRAK PERIOD REGION - MICHIGAN. — RM 90953 10/72 PAGE 2 . - “RNP S= OSM=JTOS R221. es (5) (2) (4) av _. . a ee [DENTIFICATION OF COMPONENT | CONT. WITHIN] CONT. BEYOND] APPR. HOT } NEW, NOT | ADO'L YEAR | | TOTAL i ee ine _ | APPR. PERIOOL APPR. PERIOD] PREVIOUSLY { PREVIOUSLY | .. OIRECT | ..----- __} ALL YEARS --| -——_— Reet 1 of support | OF supporRT | FUNOED { APPROVED t costs I jpirect casts | detiky ern ns C000 PROGRAM STAFF 1 1 1 \ 1 I 1 l eee eee L $4562000 4 L i $456,000_1 L $381.240.5 __ BO00 DEVELOPMENTAL CGMPONENT | j 1 i | 1 1 | eee i $195.000_1 } =o 1 $199,000! L $387,350 1 woe 2 005 MSU PLANNING 1 J 1 } 1 } I- 1 peewee L_---$L522200 1 i 1 $1592000.5 l $322.279-4 O14 WAYNE ST PLAN | | | | i i \ q_ oe eee l $100,000 1 1 | OMe AOL \ $225,000! : O15 LIEGER BOTSFORO HOSP PARI j t } i , j ! t 4%. _--LICIPALLOS $323,000 1 L \ l $123.020_1 i s251s4221 a . D1] STROKE BASE CENTER ! 1 1 j 1 1 i 1 4Q_-----2--=-5755eTA eee hon 88200 \ l 1 L $58.700 O9sabLlo 1 —— ; B19” STROKE DEMONSTRATION UNII | 1 l | { \ } ‘ ‘40 _.1----- 1 4 l 1 i L_ i $95.000_] O21 puBLIC EDUCATION FOR STR 1 1 1 j I ! 1 42 A DKE L j L i i} { j $50.125_1 ~ O27 COMPREHENSIVE FEALTH CAR} J t- 1 1 ° t 1 -EUESON 2008 j $300,900 1 } i } $300,000. i $507,000.) 529 COOPERATING STROKE CENTEI 1 i 1 | ! | ) 8 . Ll $146,000. Lo 1 sol $146,000 1 i $2912226-1 030 SOUTHEASTERN MICHIGAN Réel I | i- ! 1 { j oe g CANCER PROGRAM 1b __-£242.108 | { i ! 2420100 |_-------—-—— 1 8 220 O31 MODEL NELGHBORHCOD HLTH | : } I | t . | It \ 08h caged bn 2 Dm newer Loo wee eee eb L $1792000 1 | $352,777. 1... O32 LAKESIOE COMPRE HLTH SERI l \ | { t \ | Oe DEL SYSTEM en hab 92000 } 1 a 1 1 $150,000] 1 $300,000 |. * B33 STROKE DAY CARE CENTER \ i 4 1 \ I f° L--8106s0n0_4 aaah 1 ai __ 106.000 | -------—-L_ 823520001 — O39 IMPROVE THE CALIBER oF tl | | ! | I t : __ ABO SALORY WORK —_ \ _~l I $282668 ] ~$2B82068 1 l $55,908 ] O40 COMPUTER LINKAGE TO corm] I i | ! | I . | 4G uni ty_voserrsis _- ! t | __- i i L $92.492_1 L “O41 NEW BORN CARE IN COMMUNI t | I | | 1 t L It _voseilals I } fete L870 t i $119.694.1 042 NODEL BURN CARE TRAINING] i | | ' | ! 1 __ PROGRAM Leer } L ! $1102000-1 $1102900 1 L $219:0491 O44 TELEPHONE INFORMATION sy} . | 1 1 ! | ! \ 419 stem __--_-— _ i L [822403101 821423201 [842527821 045 GRAND RAPIDS HLTH SERV el | | | | 1. | L' puc ACIIViTY a i L 1. £105s200_1 $1052100_1 { $210,100. 1 pp 046 UPPER PENNISULA HLTH SER} 1 ! 1. 1 } ; L& ___¥ EDUC AcILyiTy i - } . L l $96,500 f $96,500 lL l $172,037 L 047 UPGRADING NURSING HOME Cl 1 ! ! i | I 1 nce \ ! L + §) 6504001. 816524001 1 ___$282.6001 { 1 l | : ! | { otaL, =F $29213 400 bo. { \ $827,038 |.,..$31040.438 | -. a, $6 003TAILT Lj —_—— ~O1-. ALCUST. 21572 _ ~ REGION 53 HICRICAR FMF SUPP YR C4 PrCION st MEDICAL PHOGRAYS SFRVICE FUACIAG BESTCRKY LEST CPERATIONAL GRANT COTRECT COSTS CALY) Sil RECUEST AAT 1s? ' RRPS@CSH=JICFHL "SO 8 AWARCS AS CE JUNE 30, s ’ s : “« ul 12 my Pewe R MEE EE PH ots AWARCEC AWAPDEC _ AWARCED = AWARCEC = AWARTEC 06** REGLESTED RECLESTED REQUESTED = REQUESTEC __. COMECR ENT een, c? C4 ~ oe oo o€ ? —— NO VEMLE * Geo OS/IC@CHSTL CSO/TA~ 12/72 TAYAL «© OL/TB-“22/73 OL/7T4-12/74 OCL/VTS<12/75 TCT AL fog -6fb9 — Wl e3-8/ 70 | *¢ ¢ OL/TS<12/75 TCT AL COCO FFCGEAY STAFF 2€€8ce 349C0C 2452776 374678 1238657 #8 425940 4560CC 681940 “CCL kL Im CET FL CNG 441060 44106 #* OCCO CEVELGS4ER TAL _. __ ‘B93TA BG 276 oe 162350 1sSOCC 28T3EC “POOL SICKLE CELL SKE 2cce zcce &e - DO02 SLBREGICKAL APP _. 2978€ ASTEE OF C003 FaCGrsew TO [HSA 3eecc 36800 46 OCC4 FPAKACEPEAT CF OS ILECC Lisce #¢ EGGS NUTARE #000 acod +9 G06 WANAEFREKRT OF § «eee 12000 +s “HCOD ANTI-CANCER CRE — ° 545¢ £45CG oF 0908 TeNER CITY BEAL _ . _ 7216 7216 oe 03 CATA COLLECTICN ~~ 252900 334200 227€CC z2c0CcC €2466CC oe 004 CORONARY CARE $4300 171100 163000 368490 *¢ * oo5 Fe CeCP eka et 196406 2667CC Vé710C 1632685 783985. #6 163275 1599000 322275 tte ES. CIR wo ED H 25800 €33CO . _. B71CC +e oo7 CoOR Cir U MICH SOTCC E22C¢ 2350¢ 166460 ¢s O08 PG NLR EC Sev FT SticG 6 BI2600 7700 «4286800 ## OOS PILCT CRuc infa =asce 1zZaEco ISECC 262900 «# CLC DEV TR PPG TECH 27700 | 277C0 4+ OID PILET Eval Der er2ece VEEECC 2i3acd G12 CATA TR KEEDS © 244aCe 3os00, asec . SCECC #* LOLS “MO ATTLITLCE CON €47CC §0900 115600 *¥ : O74 SUR FECICRAL PL tie7cc | se 7ECC _ A4ESEC 21666 641826 #9 125000 =. 100000 2250cC 18 4707 CSTEC sc Cc” 65600 ~~ #5700 é4eoc 1£4423 260623 #6 126472 123000 251472 OLS SLOVY. ELECTRON 124C¢ 3GECC_ §300C BA25 113825 #8 “TOLT STROKE BASE CEN 134CC 1eocc 46724 73734 ** $2410 56700 WC9LIS OL@ CETRCIT GENERAL b64400 0 | e0000 224400 06 oe _ . “TO1S “STROKE CEvrn ete —" 1isecc B4ECC L1L666 FL1L266 ve 95000 95000 C2C SPAPREw FCSPITA 104460 66552 1ECSG2 He ee ee _ “32a PLELIC ECtCATIC’ ~ “esece ~ = 83246 29708 ~— 77954 44 EOL2¢ £0125 O22 CBERCICVASCULASR 344CC 2asce 1€£2C WEIL *e . “CRS” COMPAEPENSIVE # 265006 295000 *# O28 WESTEPA PECEIGA oe. ; 39226 35 EC 74229 #8 _ . O2E “TRAER CLTY FeYS 112800 TICS VESELS e# O27 FEAL TH CARE 10 sac __ _.. 150000 *# — acrcce _. 26606 _ sorece “O29 CARE OF STROKE. GEE 123628 Le342€ &e 145886 146900 291886 C2C SCLIMEASTERA ¥T 228566 228SES #4 2csé2c 242700 452320 “ORL “ECVE RERERSTIVE F yeocc 165728 LEL72Ze «« L7va77T 179000 a52777 322 LAKESICE CCMPRE _ cee ee LL 69G62 _ 1634k2 #8 LECOCO Seco accece “O33 CORPREFEASIVE § E1358 1E1355 «6 129000 106009 235000 034 HEALTH CARE CEL _ Bo 45666 45000 44 _ __ 7 ee “O39 INPRCVE TRE CAL we 27240 28668 55908 C40 CCOMPLIFR LINKAC +e 92492 . 92492 z” O4f KEW ECGPN Cant 1 +s 72694 47000 “1isess 1 942. MCCEL. CURA CARE ae _ . __ + 109066. _ 1la0co 219049- 2 O44 TELEPECNE INFOR Pr 1§14l2 274370 425762 % 045 GREKC REPICS tL ee ee _. oo wee besGao 105100 2101¢co 8 C4 LPPER PENKESULA ae TESRT $6500 172037 > O47 UPCRADING NURST : San 116200 165400 2e16ce & we ‘ = ETAL 16$5200 2662000 AG9B82E 2846087 8e22113 ee 2997499 3649438 8037 UAT § , aj ‘. Nov. '65 ~ Dec. '65 - June '66 - June '67 - Sept.'67 - June '68 - June '68 - July '69 - -1|2- HISTORICAL PROGRAM PROFILE OF THE MICHIGAN ASSOCIATION FOR REGIONAL MEDICAL PROGRAMS Governor's Council on Heart, Cancer, and Stroke met to discuss PL 89-239; Albert Heustis, M.D., Chairman. Dr. Marston, NIH, met with health providers to discuss a RMP in Michigan. The Michigan Association for RMP was incorporated. The region's first planning award was granted. Albert Heustis, M.D. was appointed full-time Coordinator. A pre-operational site visit was conducted. The region was considered to be viable, cooperative arrangements were being formed and operational projects were likely to lead to desirable regionalization. (No negative findings were revealed.) The region became operational. The first year operational program consisted basically of the Central Planning Staff, subregional planning projects (at Wayne State, Michigan Dept. of Health, Michigan State Ufiv. and Univ. of Michigan) and continuing education activities, a large portion of which were sponsored by the University of Michigan. The ten operational type activities were almost entirely sponsored by major health institutions (medical schools, Department of Public Health and the Heart Association). Zieger/Botsford Hospitals sponsored a continuing education project which was to become, in the 03 year, identified as a subregional planning activity. The overall program placed no emphasis on a particular disease category. The region was awarded Ind year operational funding. National reviewers found the region had exhibitied growth and maturity under excellent leadership. The region's review system appeared superb. No negative findings were revealed. The second year operational program continued along the lines of the first, but with some exceptions. Support of the Department of Public Health subregional planning project was discontinued and stroke began to emerge as a major emphasis with the funding of four related projects. Sponsorship of projects remained with major health institutions. ~13- Aug.'70 - The region was awarded 3rd year operational funding. The June. ' 714 Sept. '71- reviewers believed MARMP was on target. Program staff was considered too small. Both the region and the reviewers expressed concern regarding the contributions and the relationship to the Central office of the four subregional planning offices. Quantitative project evaluation needed strengthening. While the third year program remained basically the same as the second, the region took more interest in the underserved and funded a related project. Also, more projects sponsored by other than the traditional institutions were funded. The continuing education project at Zieger/Botsford was identified as a subregional planning project under the central program. A pre-triennium site visit was conducted. The region received a favorable review by the site visit team, Committee and Council, and was approved for trienntum and developmental component. Issues raised by this review are elaborated on in the Staff Observation Section of this document. The region began its 04 year of operation with an award of $1,923,509 for program staff, detelopmental component, three subregional planning projects (University of Michigan is dis- continued) and 11 operational projects, most of which were initiated in 02 and 03 years. Additional emphasis was placed on delivery of services to the underserved with the funding of three related projects. Also, the MSU planning office took on the new look of a project designed to improve services to a specific underserved population. Sept. 1, ~Albert Heustis, M.D... resigned as Coordinator and Gaetane 1971 Jan. 1, 1972 May 1, 1972 June'72 July 6, 1972 ' Larocque,Ph.D., the Association Coordinator, became Acting Coordinator. Gaetane Larocque, Ph.D. resigned and Theodore Lopushinsky, Ph.D., a Program Representative, became Acting Coordinator. Robert Tupper, M.D., Director of Medical Education at Pontiac General Hospital ,became permanent Director. (Title changed from Coordinator to Director.) The region's 04 program period was extended 4 months (9/71-12/72) and with supplemental funds the region's award is increased to $2,566,087 for the 16 month period. Region submitted current application for RMPS review. =14- STAFF OBSERVATIONS Principal Problems Previously Identified & Achievements toward their Solution The site visitors'concern of a year ago regarding the future of the program upon Dr. Heustis' resignation was justified. It took the Board of Directors eight months to recruit and hire a new Director, during which time the program progressed at a slow rate due to a lack of leadership, resignations of staff (at one point there were only two professionals on staff) and an accompanying morale problem. Since Dr. Tupper's appointment and the hiring of additional staff, ‘there is a new enthusiasm and vitality throughout Michigan RMP. After being aboard only a short time, Dr. Tupper became aware of how accurately the national reviewers of a year ago identified the more significant problems of the Region which demand immediate attention. Following are concerns identified a year ago and relevant comments. Concern: Goals and objectives were not stated explicitly in quantifiable terms nor were they related to identifiable time-frames. The retreat scheduled for a year ago to deal with this problem never took place. The new planner/evaluator has worked out with Dr. Tupper a specific concept to deal with the problem. This concept was presented to and accepted by the RAG at a June '72 retreat. The RAG has identified some general areas of possible program direction. Based on these staff is presently developing a specific program, with alternatives, to be presented to the RAG for endorsement. - Concern: A need was identified for a more systematic evaluation system. A new planner/evaluator has been hired who has an excellent background in evaluation. He is currently site visiting every project and in cooperation with the Project Director is working out an agreeable evaluation mechanism. His concept for planning and the development of goals and objectives has program evaluation built into it. Concern: A lack of depth of program staff was noted particularly in the areas of allied health. Three people have been added to the professional _ staff which now totals five. Of these, two are specialists, the other three are generalists Dr. Tupper tentatively sees a total of about 13-15 professional staff most of whom will be generalists. Specialists and allied health people will be considered in relation to the new program look once it is developed. Concem: 6} Concern: Cencern: Recommendation: Recommendation: © ccrierion : “15+ The salary structure for central program staff should be more equitable to that of institutional program staff. Central program staff salaries have been increased in an attempt to make them more equitable. Salaries are for the most part now equitable with those of institutional positions with the exceptions of the Director at Wayne State ($32,000) ,his Deputy ($27,000) ,and the Director at Zieger/Botsford at ($30,000). Most salaries are comparable to those of other regions. The relationship of CHP to MARMP was unclear. In June 1972, MARMP and CHP held a combined retreat to improve dialogue and planning efforts. Since that time, Dr. Tupper and the CHP (a) Director have established close working relationships as have the two staffs. They are working closely in the development of a state kidney plan and a state emergency system plan which will be jointly funded. Dr. Tupper has attended CHP (b) meetings which appears to be the first step in continuous dialogue. Plans include assigning staff members as liaison to specific (b) agencies. The Yegion should refine its mechanism to insure more realistic budgeting and financial control of funds. Dr. Tupper is aware of the problem in this area, and he expresses his awareness of the need to frequent- ly monitor program expenditures so as to use rebudgeting more fully in promoting efficient program expansion. Consideration should be given to how MARMP might improve its image and visability to both the professional and lay constituency. New organization plans include a Director of Communications. Responsibilities of this position will include the publication of periodic newsletter and other, unspecified means of promoting MARMP and its mission. Staff supported in the three subregional planning offices be identified with MARMP and be identified with programs and activities which are directly related to MARMP goals, objectives and priorities. The budgeting for subregional personnel and functions be separate from other programs which may be carried on in the institution. A line of authority be established between the central office and the staff of the subregional offices and be so reflected in an organizational chart. During the past year considerable change has occurred with respect to the functions of the subregional offices and their relationships to the central office. This change represents a phasing out of subregional planning as it has been functioning in the past. The Michigan State University planning component has been -altered so that it no longer serves aS a subregional office conducting many diffuse activities, which due to overlap, confuses evaluation. While it maintains the same title it in fact is a project having the specific mission of developing, in cooperation with 314 (e) grant; a family health center, and continuing care models for the underserved of a rural area, Cass County. Thig,in turn, will serve as a model for the rest of the state. Project staff includes personnel serving in the center. The project is consistent with the regions goals and objectives and will be considered as any other project including the expectation that it will terminate by 8/74. With the submission of this year's application, the Wayne State Planning Component now represents a specific project designed to develop prototype family- centered, hospitalrbased, primary health care organization in Mt. Sinai Hospital, which has the potential of becoming an HMO capable of serving a low-income population of 10,000. As with the MSU component, while the title remains the same, the project will be subject to the same conditions and evaluation as any other operational project and will be expected to terminate by 8/73. The Zieger/Botsford Hospital participation activity has not undergone much change. It remains basically the same emphasizing an effort to document the quality of care being delivered to the underserved, and through the use of PAS and peer review improve services. To date, no progress has been made to incorporate this activity as a part of program staff or completely isolate it as a separate project with a limited period of support. Dr. Tupper has a strategy for terminating the project, but it will necessitate a trade off for a smaller staffed osteopathic subregional office which will be directly responsible to him. Problems Not Previously Identified but which are Recognized and being Resolved by the Region. Problem: The region's bylaws are in bad disarray and are not consistent with the RMPS statement on Grantee-RAG relationships. -l7~ Dr. Tupper, the board and RAG are working together to develop bylaws which do comply with the RMPS statement and incorporate other suggestions made by RMPS staff. Problem: Few minorities (1) and no women are employed on program staff in professional positions. Dr. Tupper is aware of the problem and intends to make special efforts to recruit both minorities and women: to professional positions. Problem: MARMP activities are limited to the southern and particularly the sourtheastern part of the state. Dr. Tupper is aware of the situation and will be making special efforts to develop activities relative to the needs of the northern rural communities. Issues Requiring the Attention of Reviewers The basic issue is whether or not the reviewers believe the Michigan program is deserving of having its NAC approved level raised from its current level of $2,100,000. If the region is approved and awarded the amount requested, it will allow it to continue its basic program outlined for this triemium, employ additional program staff, and initiate eight new activities which forthe most part relate to the region goal #IV- General Professional Continuing Education to Improve the Quality of Health Services. Since the vegion is almost funded ($1,924,566) at its current NAC level ($2,100,000) an increase in the NAC level would allow RMPS more flexibility in the future to raise the region's level of support. There does not appear to be any other issues which are not already spoken to in this document,however, a staff review of MARMP is scheduled for August 29 and any issues resulting from that review, not previously identified, will be the subject of a separate document. AND WELVAE (Date) toa Modifice 1 Cc 7 +t a se tions ey ae + Or L as i : aie {i> ‘ ae : : oat r : : Bod DA Are EG oes ibitp 4 bight rebdy 4 FIV ga teh 1. Theat. the year at py eh de « ae pes ee a fn ob with the pYrogran 6 The tram Livector G Linpy since Dr. Tupper became Progr i n the former Director, resdened as September J, the region wa ; r ecaderahip fox , of the - rol L OTL be etaff, mecessary reorsanization, etc, era na LLs Ct y . to be reasonab] promise which will allow MARHP to continue its ; U ongoing prog provide an additional sus tO expand progrem stafil. In addition, Jevel may provide incentive for NARMP to speedup the phasing out of inetitutional phemming offices and to recoup dollars for use in initiating new activities CRITIQUE: While slippage in pregramming andinitiative have occurred over the past year, the Michigan proayen remains basically sound and consistent with national priorities, ‘eins for delivery of heelth services to the underserved remains as HARM basic program thrust, an emphasis to which most project activities relate. ‘Activities being undertaken for the most part involve communication, transportation, and discasa nonents. In addition, they more fully use Ping if] prevention ce sash fiw ufo end lay constituency. out by the es, which will be s wild have . Institutional subregionel planning offices are being pl end of the 05 basically free a direct Line be replace the central The region is taking action to resolve other progx . Dr. Tupper and a bylaws committee of the RAG, to be consistent with and responsibilities. ylavs 2a hue PS policy regarding 2 2e@nRAG relatic . A special effort is to be made to assess the needs of the residents of horthern Michigan and to develop grams. Consideration is being piven to establishing ficld offices to s this area. £ NIUM 4S yt meine eset + cy bo Pr oO wd OC) ff, f4 sed Le oh Ora fp tke Oe cl Pe O 7% OO 4 Qo PLICATION Region: Review Cycle: eesieo ae MLE e $321,053 for continuation. year to 10/72. ** Ten month Budget qv Committee Recomnerniation ror Current Annualized Request for Tricnnial Council-Approved Level Component Level 03 Year lst year j 2nd year | Srd year, lst yea 2nd year ; srd yea 7/71 = 67728 ROGRAM STAFF " $411,097, $ 513,823 | $_633,842) $_666,387_/§ 513,823) § 633,8421§ 666,38 ONTRACTS oe = —— a= ; | fea oete eee a. 250,000 EVELOPMENTAL COMPONENT “ae 96,315 se6ree8 250,000 90,000 100,000 100,,0C PERA TION .L PROJECTS 485,133 ’ 1,750,480) 1,555,746 1,529,504 896,177; 1,376,158} 1,559,5¢ Kidney ( 183,634) | (161,915) | (120,403) EMS ( =~ 3 wee TT ns/ea o (116,745) | (137,743) | (150,341) . Pediatric Pulmonary C nee fF nee , Other On ~-- _ : , KR te OTAL DIRECT COSTS $896,230 $2,340,618 + $2,439,583 $2,445,891 $1,500,000 $2,110,000|$2,325,85 OUNCIL RECOMMENDED LEVEL $1,095 ,428 * Region requested a four month extension and was awarded This extended their 03 operational SITE VISIT REPORT MISSISSIPPI REGIONAL MEDICAL PROGRAM JACKSON, MISSISSIPPI JUNE 29-30, 1972 Site Visitors Joseph W. Hess, M.D., Detroit, Michigan, Chairman, Site Visit Team, Member of RMPS Review Committee John P. Merrill, M.D., Boston, Massachusetts, Member of RMPS National Advisory Council Claude E. Nichols, Jr., M.D., Harrisburg, Pennsylvania, Practicing Physician, Member of Susquehanna Valley RAG Mr. Donald Trantow, Evaluation Consultant, Director of Assessment, Georgia RMP Regional Medical Programs Service Lee Van Winkle, Acting Chief, South Central Operations Branch William Torbert, Public Health Advisor, South Central Operations Branch Vernie Ashby, Public Health Advisor, South Central Operations Branch Eugene Nelson, Office of Planning and Evaluation Earle Belue, Division of Professional and Technical Development T. H. Griffith, HEW Region IV Representative for RMPS Mississippi Regional Medical Program Staff T. D. Lampton, M.D., Coordinator Pat L. Gilliland, Assistant Director for Administration Guy T. Gillespie, M.D., Assistant Director for Planning and Evaluation James B. Moore, Ed.D., Assistant Director for Community Liaison and Program Development Bob Cotten, Communications Specialist Betty Zimmerman, Grants Management Officer Jack Gordy, B.S., Planning and Evaluation Assistant Tom Brooks, M.A., Health Planner Nita Gunter, M.A., Sociologist - Demographer Al Betts, Program Specialist Carlyle Baker, Program Specialist -2- Mississippi Regional Medical Program Regional Advisory Group Lewis Nobles, Ph.D., President of Mississippi College, Chairman of Regional Advisory Group Guy D. Campbell, M.D., Member of RAG David B. Wilson, M.D., M.P.H., Chairman of RAG Planning , , Committee Participants Robert E. Blount, M.D., Dean and Director, University Medical Center Charles W. Flynn, Mississippi Hospital Association Cyril A. Walwyn, M.D., Mississippi Medical and Surgical Association, Minority Group Representative Richard E. Barba, Mississippi Division of American Cancer Society Miss Lucile Little, Mississippi Heart Association Frank M. Wiygul, M.D., Mississippi State Board of Health Arthur A. Derrick, Jr., M.D., Mississippi State Medical . Association mo Miss Wynema McGrew, Mississippi Nurses’. Association Alton B. Cobb, M.D., M.P.H., Medicaid Commission Representative Phil Laird, CHP "A" Agency Purpose of the Site Visit The site visit was to review the Mississippi Regional Medical Program's Triennial Application request and to ascertain the progress made by the region since the previous staff assistance site visit of September 1971. This site visit report is a compilation of observations and conclusions from all members of the site visit team and follows the outline of the RMPS Review Criteria. A. Performance Since the Staff Assistance Site Visit of September 1971, the Mississippi Regional Medical Program has taken many positive steps in developing a program that is now a major contributor and a very important leader in the delivery of health care to the people of Mississippi. The goals and objectives were expanded and delineated during a retreat of the Regional Advisory Group in December of 1971. These are the basis for the new direction MRMP is now moving. The RAG and program staff were also restructured during that retreat which has resulted in a cohesive and dedicated working group. MRMP has not only answered and dealt with all of the criticism and recommendations of the 1971 site visit team, but has moved forward in the accomplishment of other goals. The coordination between the University Medical Center and the MRMP appears extremely good. MRMP has been instrumental in setting up a School of Allied Health at the University Medical Center for which a Dean has just been appointed. The number of midwives in the County Health Improvement Program has increased, resulting in a reduction of neonatal deaths in Holmes County. In 1968 the neonatal death rate was 28.0 per 1000 live births. This was reduced to 19.8 in 1970 and 7.0 in 1971. Previously, the neonatal death rate was the highest in the country. Also in Holmes County, a number of pediatric nurse assistants have been trained under the auspices of MRMP and medical care has reached out to the urban community with the establishment of a satellite medical clinic in a trailer. Renal satellite units have been set up around the state which has significantly reduced the cost of dialysis. In the University Medical Center the approximate cost per patient is $19,500 per year. In the trailer units (4 currently operational), the cost per patient dialysis has been reduced to $3,500 for units with 3 or more patients. Similarly, heart clinics have been set up which have resulted in care being given to patients outside of the hospital, again resulting in cost moderation. The initial establishment of a stroke care demonstration center has been expanded and clinics outside the hospital have now been set up where neurologists are available for consultation. An average of 100-150 patients per year are being treated. Courses have been developed for physicians and they have been invited to spend 5 days on the ward with a neurologist in the stroke care demonstration center. Some 20 physicians attended the course last year. In addition, nursing care for the stroke patient has been implemented by the development of courses for nurses. Some 15-20 nurses from various parts of the state attended courses last year. A pulmonary training program in inhalation therapy has been established and a number of inhalation therapy aides trained, who may now function effectively outside hospitals. The 20-week program has trained 38 aides and was designed for the disadvantaged unemployed persons with 30 percent of the ones trained being minorities. The original coronary care unit, funded by MRMP at UMC, which at the time was the only one in the state, has trained 120 nurses in coronary care. This has resulted in the establishment of a number of other units in hospitals around the state staffed by individuals trained at UMC. Some 4,000 individuals have been trained in emergency cardiopulmonary resuscitation. An extremely important activity is the program for the training of dental hygienists. This program appears to be particularly effective since there is no dental school in Mississippi. MRMP staff feel that perhaps this program may contribute to the establishment of a dental school. In addition, real effort has been made at establish- ing an adequate third party payment base to take over the cost of patient care when RMP monies are phased out. There is a close rela- tionship with medicaid since the present head of medicaid is a member of RAG. Another example of continued support is with the Hollandale Midwifery Project in which medicaid money is paid into a pool which is to help support service costs of the program. One possible drawback has been the fact that much of the effort of MRMP has been undertaken by faculty members of UMC. This has been possible through MRMP support, but since other sources of funding to support contributions to continuing education by these individuals is slim, it seems unlikely that in the future they can continue their efforts in this area. There are specific goals, objectives and priorities dealing with the improvement of health care delivery for underserved minorities. MRMP activities have made primary health care services available in heart clinics, neurology, and active stroke programs in which over 50 percent of the patients in attendance represent minority and underserved groups. This type of care has improved services throughout the state bringing the health care team to the patient in settings close to their home and only those patients who need the more extensive work up in the medical centers are referred. This has resulted in the specialty clinics not being swamped with routine patients that can be seen, diagnosed, and treated in the local area. The training of inhalation therapy aides has attracted minority groups and other project activities which have employed minority members. Minority patients have taken advantage of all patient activity services funded by MRMP. Dr. Lampton and staff have assisted minority professionals in obtaining hospital privileges in several instances. When the Black Hospital was closed in the Yazoo City area and patients were referred to the previously all white hospitals, they assisted in getting the black professionals accepted on the staffs, and have also worked with the hospitals in becoming certified for medicaid and medicare programs. The program staff has one minority professional and one minority secretary. Further efforts are being made to employ competent minorities in unfilled vacancies. One outstanding program the MRMP staff are involved in is with Black medical students that are attending school outside of Mississippi. Seminars are being held in which these students are brought back to Mississippi in an effort to interest them in returning to the state upon completion of their studies. The RMP has been instrumental in assisting minority groups throughout the state in obtaining access to health care services, and access to schooling that is available. B. Process Coordinator On the basis of previous visits by RMPS staff and the comments of a number of MRMP program staff and RAG members, the Coordinator has provided strong leadership and appears knowledgeable and exhibits enthusiasm. There was further evidence of this in the large number of organizational changes that have occurred since the September 1971 site visit. The program has developed a sense of direction and cohesion, and the Coordinator has succeeded in gathering about him a young, dedicated program staff who appear to have the potential for functioning effectively. There is evidence that some further maturity as Coordinator is yet to be developed, but there seems to be little question that Dr. Lampton has made substantial progress as a program manager. The working relationships with the RAG seem to be cordial and satis- factory as determined from the formal and informal statements of members of RAG. A position of Deputy Coordinator has been created but has not been filled. Dr. Lampton indicated that he is concerned about finding a well-qualified person to fill this position. Program Staff The program staff does reflect a relatively broad range of professional and discipline competence although some of them are new and as yet untested in an RMP setting. Unquestionably, there has been substantial improvement in this regard since the September 1971 site visit. A number of the older members of the staff have demonstrated effective administrative management capability although there is substantial room for improvement, particularly in the area of planning. The Assistant Director for Planning and Evaluation is a physician who is half time with MRMP, the only half time position on program staff, and he does not appear to be very sophisticated in the area of program planning. His Chief Planning Assistant is a recent graduate with a master degree in Urban and Rural planning and lacks the necessary experience to provide strong support at this time. The program staff appears to be adequate, except for the planning section. There was concern on the part of the site visitors regarding the salary level for several key members of the program staff. It was felt that the level was too low to retain competent staff for a long period of time. The new goals and objectives and the general orientation of the program staff appear to be appropriate, but projects which have evolved out of the goals and objectives have yet to be developed. Regional Advisory Group The site visitore felt that most of the key health interest in institutions within the region are represented on the RAG, and RAG members appear to be geographically distributed on the planning and executive committees and the task forces. Dr. Nobles, Chairman of RAG, is the president of Mississippi College and has a broad background in pharmacy. His presentation to the site visitors exhibited intelligence, experience, and practicality. He also has maintained contact with the State Legislature and has been active in lobbying for legislation to increase support for training paramedical personnel. Most impressive has been the restructuring of RAG. They have become more involved in the activities of MRMP. The RAG is scheduled to meet 3 times per year, but in the last 6 months more frequent meetings have been held with a special retreat in December 1971, to reorient the program based en recommendations of the September 1971 site visit and to develop the current set of goals and objectives. Attendance at RAG meetings have been running over 50 percent. There is a bylaw's requirement that if a member misses more than 3 meetings he is dropped from RAG membership. ‘There are ll RAG members classified as consumers out of a total of 37. The consumers actively participate in the deliberation as shown by the RAG minutes. Since the 1971 site visit, there has been a marked change in the role which RAG plays in the decisionmaking process. The RAG is much more actively involved in planning committee and task force work, and a system is being implemented that involves RAG members on monitoring teams estahlished for each project that is approved and funded. The Executive Committee meets between RAG meetings, and the RAG has delegated to it authority for approving small projects and grants not over $2,000. The Executive Committee is geographically represen- tative of the total RAG. Grantee Organization The grantee organization (University Medical Center) provides adequate administrative support and there appears to be a good working relation- ship with MRMP. In general, it permits sufficient freedom and flexi- bility and does not appear to be interfering with RAG's policy making role. However, MRMP may need some special consideration by the University in terms of personnel policy and the establishment of salary levels for program staff in order to assure appropriate working conditions to retain competent program staff. Participation The major health interests in the state appear to be participating and working well with MRMP. Members of these health interests, including the Nursing Association, Medical Association, Black Medical Community, Heart Association, Cancer Society, State Board of Health, Veterans Administration and general practitioners from the rural community, were unanimous and enthusuastic about the aims and accomplishments of MRMP. Local Planning MRMP has worked closely with CHP in developing "b" agencies. There are currently 3 operating "b" agencies in Mississippi and MRMP has been involved in getting each of them operational. One of the program's stated objectives for the coming year is to assist in developing Nhe agencies in other local areas. With the cooperation of MRMP, 10 local planning areas throughout the state have been identified. Much of the data used in defining these areas was supplied by MRMP. Active discussions are going on concerning organizations in 9 of the 10 areas and 5 of these are in the active planning stage at this time. There is an adequate mechanism for obtaining CHP review and comment, and the existing "a" and "b" agencies have input and comment on program proposals. Assessment of Needs and Resources The MRMP has participated in and/or has available to it a rather large data base documenting the health needs and resources of Mississippi. However, there has been, thus far, an apparent lack of the expertise needed to move From available data to program develop- ment. "The needs of Mississippi are so extensive in the health area, that almost any type of project could find some rationale or justification. This situation would seem to make it even more urgent that a careful review and analysis of the available data be made to provide the context for an overall program plan of action which will be most cost effective and efficient in addressing the unmet health needs of the people as a whole. A systematic planning activity remains a weak point in MRMP at this time. All of the projects in the current triennial application were developed concurrently with the rethinking of the goals and objectives and the restructuring of the RAG and program staff. Consequently, the current set of projects have not evolved as a result of the rethinking which has gone on during the last 10 months, although several of the projects are compatible with the directions expressed by the new goals and objectives. Management The coordination of program staff activities has improved substantially since MRMP moved into its new quarters in which staff are in one location and in close physical proximity to one another. None of the dissatis- faction which characterized the program in September 1971, and was rather freely voiced by program staff at that time, was found on this site visit. However, an exception to this general rule was the concern of the site visitors in having a half time person as Assistant Director for Planning and Evaluation. Since this is the one weak area of the program, it was felt that this position should be full-time since new staff members working in this section will need guidance and consultation in directing the activities of the program. A plan has been developed for regular systematic monitoring of individual projects by both written reports and by site visits of project monitoring teams, which include program staff, RAG members, and other consultants as necessary. Periodic progress and financial reports are also required. Evaluation The program has a full-time evaluator who appears to have the potential to improve the evaluation activities of MRMP. He had been with the program only 4 months prior to the site visit. The projects which are currently ongoing, and the new projects in this application, did not have the benefit of his expertise, and the site visit team did not have a basis upon which to judge his performance, although their prognosis was optimistic. His plans for evaluating and monitoring projects, as well as for organizing total program evaluation, appears well conceived and practical. The site visit team was impressed with his presentation and felt that his input to the region will have a positive effect. He plans to build more effective evaluation into new projects, including those which are proposed in the triennial application. A particular problem which was identified in the application is the difference in evaluative criteria between the stated objectives, project development guidelines, technical review criteria, develop- mental component priorities, the RAG rating form, and the program evaluation statement form 14. This was called to the attention of the region during the site visit. C. Proposal The priorities of MRMP have been established and complement the need for health care in Mississippi. The priorities were established during a retreat of the Regional Advisory Group in December of 1971. The priorities are congruent with the national goals and objectives. In general, the activities proposed for the triennial application relate to the stated goals and objectives, although, for the most part, they were initiated prior to the RAG retreat. The methodology for monitoring and evaluating the current list of activities were outlined by the Program Evaluator during the site visit. The approach the region has chosen to pursue is both realistic and practical and the site visit team has confidence that the intended results proposed in the activities will be accomplished. In view of the fact that the University Medical Center is the only institution of higher medical training in the state, and with their program of continuing education, it is felt that the knowledge gleaned by MRMP will be adequately disseminated to the medical and allied health fields throughout the state. -10- The communications specialist of the program staff has developed methods to keep RAG members, health care providers, and the general public informed on the various activities and the mission of MRP. His input to the triennial application and his presentation to the site visit team is evidence that his knowledge of the region and of MRMP's mission will be a great asset to MRMP in the area of information and communication. The program staff feel that because of the paucity of manpower and facilities, the maternal and childcare facilities, which are the spin off of other projects, will help to improve the utilization of manpower and facilities. The project for black physicians preceptor- ship will be a very necessary prerequisite, since 37% of the population in Mississippi is black, with 41 black physicians practicing in the state. In the view of the inherent problems of "separate but equal," which are not maintained on the surface but are, however, maintained in the mores and customs of the people, programs of this nature have an increasing beering on the welfare of the entire state. With the School of Allied Health at UMC and active recruitment of both black medical students and allied health personnel, there can be marked improvement in the number of physicians and allied health personnel who will be serving the community. MRMP has shown, through the midwifery program, that. individuals can be taken care of in outlying areas and that paramedical facilities will be developed, as proposed in the ‘current application to increase the availability of care. There are ten planning and development districts in the state. MRMP recognizes the fact that health care generally follows trade patterns in Mississippi and that these ten districts form the basis of any approach to improving the health delivery systems, as well as the care that people receive in the region. MRMP is actively involved with CHP to regionalize the health care in Mississippi. The current list of projects proposed in the triennial application is by no means the utopia for regionalization, but the site visit team believes that plans and methods for doing this can be achieved by MRMP. Although the performance generally has been good, there is. a’ lack of agreement on the part of the program staff, with the precept that "evidence of support for continuation of successful activities in program by community organization or other Federal or State agencies after RMP funding has been phased out," should be provided. In many instances, staff argued that even though no evidence for continuing support is available and in all probability will not be available, the project should be launched and supported in and of itself. ~li- A number of projects, particularly the kidney project, have been partially funded by agencies other than MRMP, and it is felt that each project will, in turn, be reviewed and evaluated with other funding sources being investigated. 1. Recommendations The site visit team recommends that the Mississippi Regional Medical Program be awarded triennial status, and that the triennial application be approved for funding as follows: 04 Operational Year $1,926,984 05 Operational Year 2,200,000 06 Operational Year 2,445,891 The triennial application includes a request for developmental component. Strengthening of the Planning Staff: a. There should be a full-time director of the planning and evaluation section. b. Extensive training is needed for the new planning staff, including training visits to RMPs which have well organized and operational planning. Suggested RMPs are: Florida . Georgia Northlands Ohio Valley Tennessee Mid-South Emphasis should be placed, in the immediate period ahead, on the development of written program statements for each of the goals, 1 through 5, with priority and implementation schedules based on the goals and objectives agreed upon. Then these statements could be used as the basis for reevaluating currently developed projects and assessing the need for new project development appropriate to the goals and related program statements. Better documentation of need, based on need assessment studies appropriate to local areas, which relate to program goals and objectives, is necessary. Improved Technical Review input to the RAG and its subcommittees with greater emphasis on Technical Review in the decisionmaking process is essential to the program. -12- ‘ The program staff and the planning committee of RAG should coordinate the evaluative criteria with the stated objectives, project development guidelines, technical review criteria, developmental component priorities, the RAG rating form, and the program evaluation statement form 14. The following is a list of the statements that should be coordinated: Guidelines--page 83-~1st paragraph, Items 1~7 Technical Review and Rating Form--features 1-5 Developmental Component Priorities--page 100,1-5 Goals and Objectives--page 72A & B, I-V Criteria #2--page 146, "New Modalities." RAG rating form criteria Application information for project applicants, 1-3 General Principles--page 82,1-5 e so eh Dp an oO bh MRMP should work to obtain CHP and State funding of ongoing health planning data collection and movement toward placing the data collection project into the State Board of Health or the CHP (a) agency. MRMP program staff salaries should be reviewed with the UMC administration to see if a mechanism can be developed for more adequate program staff compensation. ellen A Verh “William A. Torbert REGION: NUMBER: COORDINATOR: LAST RATING: {x / Triennial one TYPE OF APPLICATION: RMPS STAPE ee nee ee na a Mississippi RMP RM 00057 Theodore D. Lampton, M.D. 3rd Year. ff Triennial j— 2nd Year / / Triennial \—/ Other @-:: Site Visit: ae co September 16-17, 1972 - Staff Assistance Chairman - Dr. Joseph Hess, Committee Dr. Anthony Komaroff, Council Dr. McCall, Consultant - Hr. Levenson, Consultant Dr. Vaun, Consultant Staff Visits in Last: 12 Months : " OPERATIONS BRANCH: ’"¢éhiel: Revicw Cyele:Sept.~Oct./72 BRLEFLNG DOCUMENT South Central Lee E. Van Winkle Staff for RMP: _ William Torbert — PHA — SCOB Eugene Nelson - P. & E. Lawrence Pullen - Grants Mgmt. d Regional Office Representative: Theoda H. Griffith Management Survey (Date): Conducted: 1972 or May 22-25, Scheduled: DATE PURPOSE Dec. 1-3, 1971 - RAG Retreat and Staff Assistance Mar. 22-24, 1971 - - RAG Meeting of Project Review April 1972 - Staff Assistance May 18-19, 1972 ~ Verification of Review Process - Recent events occurring in geographic area of Region that are affecting RMP program: Highlights of activities during the past year involving MRMP program staff: 1. e In June 1972, "Governor Waller appointed Dr. Risher as head of CHP (a) agency. ey, An EMS statewide planning council was established with all agencies involved in Emergency Medical Care participating. Creation of the new School of Allied Health at the University Medical Center. A new Dean was appotnted on July 1, 1972. 10. il. 12, 13. 14. 15. 16. 17. 18. The new Riverside Psychiatric Hospital opened -~ only privately owned Psychiatric Hospital in Mississippi. Maternal and Infant Care project in Holmes County under the County Health Improvement Program has been expanded to 3 other counties ~ Warren, Sharkey, Isaquena. Applachian Project became operational and was funded at $2.4 million. Three Regional Vocational Centers established in Mississippi that included some training for health careers. A New School of Nursing established at the Mississippi State College for Women in Columbus, Mississippi. Legislation has been passed and the Board of Trustees have approved a new dental school for Mississippi. A’Nurse Anesthetist program was established at the University Medical Center. The Legislature passed a sickle cell screening program for the public schools. Moorehead Junior College, in the Delta, has initiated a new program for upgrading LPNs. to RNs. Tri County Comprehensive Health Program (Yazoo, Madison and Leake Counties). = funded at $416,000 under the Experimental Health Delivery Services. Five National Health Corp personnel assigned to Mississippi. Full-time director of family planning appointed in the State Board of Health. First class of dental hygenists graduated in June 6f 1972. New Helicopter ambulance service in Hattiesburg. The only one in the state. MRMP was the sponsor of Mississippi's first "Health Expo" held during the first three days of October, 1971, which drew throngs of interested people from all areas of the state. ; s : aS | a ths . curnapen suet ravens Peewsiee [op 0004 qeememanemeenanenae Gh Babe MAM SALE woo purraa ALL OMe Leer EMane eee { WsHOMmMCO ti 5] oN * Tunica cou een a , re Pas ae een nae | rc . TAWA oo , aUtMAK y . te r Oxford, , COAHOMA ARON ARZANSAS : : Lk ceed ny _C . meme PT ALOSUS HA ZALWOUN BisKa “eativan ‘+ : cs FAULAWATCHI . ——— ie cHICRASAW iar TURFLOWE® . SREMAOE Lend . CEFLONE CLAY wERSTER reac CARRS : WOHTGOMERT Lownoes a J ace . CeTaBC HA —_——— wal Bes a umbys*"* CHOCTAW . HOLMES . HUMPHREYS ATTA wins tor RSKUBL SHARAET . . : . : eS te net at x ‘ PITT RITIENY , . _ Sumter ThI90 . + ERR RESHODA rrr MARIO . ALABAIA ee a 4 pean Ren scart weet PAUDEROALE . — MACISON HINDS RANKIN d i vVycksbiirg © . ewan vw . TENGAS, an Gateex* eLamne LOUISIAHA EL AspOAne coma HEVELESON WATRE s COVINGTON concoana) : fe ener a ea rence ee LINCOM Mu « WASHINGTON . ADAMS eaamKL In en r : in KE wartnauc’ WH RINSOM , ~~. omit ; COUPER west FELICIA (“* FELICIARA en HELENA [ranciraroe yrasneros PEARL RIVEE LOUISIANA . a, 7 - SAINT TARMART * . “ >. DEMOGRAPHIC INFORMATION POPULATION: (1970 Census) Total Population: 2,216,912 | % Urban: 44.5 Population Density 46.9 per sq. mile % Non-white: 37° ETROPOLITAN AREAS AGE DISTRIBUTION Name of SMSA _ Pop. in 000's Percent of Total by Specified — Age Group, 1970 Total (2) 393.5 Age Group State U.S. Bi loxi-Gul fport 134.6 Under 18 yrs. 38 34 18 - 65 yrs. 52 56 daeKSON hae 65 yrs. & over’ 10 10 Source: Bureau of the Census - PC(1)-A26 and PC(1)-B26 1970 - 1970 Census of Population; - State and County #26 INCOME - Average Income per Individual, 1969 State (of RMP) $2,192 United States - $3,680 Source: State data from Statistical Abstract of the U.S., 1970 (Dept. of Commerce) , HOSPITALS Non-Federal Short and Long-Term General Hospitals, 197! Number Number_of Beds Short-Term {15 . 9,262 Long-Term 0 0 V.A. General Hospitals 2 1,576 (One has long-term unit) Source: Mississtpp! Hospitals With License Status and Governing Bodies, February |, 1971, Mississippi Commission on Hospital Care COMPONENT AND FINANCIAL SUMMARY * TRIENNIAL APPLICATION AN ¥ dows wyveowe TC IEEE Current Annualized Request for Triennial Committee Recommendation fo Council-Approved Level Component Level 03 Year Ist year | 2nd year | 3rd year, Ast year | 2nd year 3rd ye 7/71 - 6772 ., . PROGRAM STAFF 411,097 513,823 633,842 “666,387 CONTRACTS - ---- a ---- ——- 4 . . 7 DEVELOPMENTAL COMPONENT ---- 96,315 | 190,000 250 ;000 OPERATIONAL PROJECTS 485,133 - 11,730,480 11,555,746 | 1,529,504 Kidney (183,634 ) | (161,915)| (120,403) EMS ( Df —_ | hs/ea (116,745 ) | (137,743); (150,341) Pediatric Pulmonary ( ---- ) — ——— ‘ other C-—- fom oo - TOTAL DIRECT COSTS 896,230 2,340,618 |2,439,588 | 2,445,891 COUNCIL RECOMMENDED LEVEL 1,095,428 *Region requested a 4 month extension and was awarded a ‘$321,053 for continyation. This extended; thetr 03 operational ‘year to 10/72. JULY 17,1572 i, REGION ~ MISS . BREAKG’ ; = REQUEST RM 00057 10/72 PAGE 1 a 04 PRL | PERIOD. ns ee . -- RMPS-OSM-JTC — ads. yy? (3) (2) (4) a es : IDENTIFICATIGN CF COMPONENT | CUNT. wETAtN| CONT. BEYONO} APPR. NOT | NEW, NOT t 1ST YEAR | 1ST YEAR |} 1 | APPe. PERICOL APPR. PERIOD] PREVIGUSLY | PREVIOUSLY | DIRECT | INDIRECT [- TOTAL 1 - { OF SuPPGRT | CF SUPPURT |. FUNDEO | APPROVED 1 casts ] cosTs 1 J : a an . t | - i j t io. t. Lola C000 MISS REGIUNAL MEDICAL P2] J | I ] { { 1 LGcA¥ 4 j $513,823 1 Ll L $5132823_1 $662130_1 $5.79:253 1 OOO MAMP DEVELOPMENTAL COMPUT { \ i . | 1 | | SES { 1 ! 1 £92315.) $96,315 1 1 $962315_1 . : COl STROKE CARE OCMUNSTRAT LU 1 ! | ! 1 j . | : . oe. 4 AND SALINE i 21222.95)_] j L } $122:953_1 $4Jal181 $1702669 1 , O13 EFEKGENCY NUASING IN CRI . i | { i { i 1 ~ TIGAL ILLIBES > L $352400 1 ! 1 j £352400 £52897 1 $41.297 1 OLS CenvICAL CYTELUSY Screen | | | j 1 1 . ! ino l | L $42,707_1 L $422707.1 $63,087) $492794 1 : DITA PENAL DIS TaNo CLALYSIS | i ! ! { | i - i . CIES ! $1032029_] 1 1 L $103,039 1 $34.226_1 $141.2465 1 _ OLIB PENAL GIS TENG TRANSPL ANI 1 | | I | | j LAr ___. L ! 1 L $02595_ 1 $80.595_) £342510_1 $1152195.1 OL. bticbtett Tete it LL03s03s)4 1 di “$3025S9) 14 $lp3s034) 16 hi2.136)10 $256,370 )4 viss Com sunt TY realIn Hakunk | ! 1 1 . | \ \ 1 -- 46 UPS ts ties AL 1 j j { $1162745 1 $116.745_1 $2459) } $1412336 1 7 REL oF inkcCTiugss Und | j { ! 1 I oe LU SPELT ALS | 1 \ 1 $322.405. 1 $322465_1 $23528_1 £39,993 4 OZ FEGIUNAL CANCER PRUGTAM | | 1 | | | j | . : _ I l ! $812850 1 $81.850_1 $33,806 | $115,736 1. O22 FaeylthK bec& Urilbudtn SFLI I | | J J | \ ee ee an hep on oe L I 1 1 $502734_1 £50s734_1] oe ! $59,734_1 . . CZs Coa tuserTden fa matical { ! I j l i 1 ify ches i i 1 {282302261 1 $220,281 J: 1957151 $2976 | ute 'io> Cuce HeAitn sTATIST | s | J l | I > to Scobie ! \ i i $97.45) 1 $872451_4 $252739_1 $113.190 1 O25 rp ULMLRARY THERAPY PRGO a | | l J | 1 I a” SUS LLY USP ETALS i i l $88.259 4 $88.259_1 £252230 1 $133,489 1 : oo OZG FEGTOCRAL KuGAL HATER AL j 1 1 | 1 I | aa ” Lar an Csie 1 1 J $80.2784 1 $80.784_1 ! $20s784_1 ee UZT gtaunE KeaAdELLintiuNn i I { | { | \ | wee LE L 1 1 259.8081 £50.08 1 | $58,408 | UZs Cell aku Insesvide ccCUCal i 1 t { ( | I DLepouder vei iiss j ! 1 $462.087_ 1 $462087_1 1 $442087_ 1 ow O22 KEG LWAL heWouRka CAR Cc 1 t | } { . t | a } I 1 $1442362_1 $144.362_] $325¢61_1 $176.523_1 C30 ELECTRICAL HAZAGUS SAFETI } | | t | - t : a“ Yeas -__t j i l $79.2364_1 $792344_] $222136_1 $102,500 1 OSL aeoLUTHIAAPY TRT PLANN IAL | \ } | | | | - - WG ee SELL L { ! ! $30.04) 1 $80,041 1 £32025 1 $832486 1 . O32 eeVeATIGN wLauliy SERVIC] . | od | | i j a ee poe SOUPALLY 2 ET Suse ! I ! $38,938 1 $38,935_1 L $38,938 1 "G33 PreCEPTSh TKnG 2LACK vec } of | . | ( { 1 ICAL 2,0 Oo ate. STE SSS. L 1 1 $20,220 1 $202220_1 l $202220_} 034 PATIENT AND STAFF EDUC St | | | . | i | i. SLELLLO ChbEbIC pisiASes ob j ! ! $672149_1 $672149_) $82452_1 $75.60) 1 _. ,035 SUNT eB HLTH PRoV ust | { 4 j i ! | 1 _ 4 t t \ $42,270_1 $42.270_1 £1324131 $552583_ 1 1 {i 1 ! l 1. 1. | TCTAL j $2617390 | $513,623 | $42,707 | . $105229698 |. $27340,618 | - $4159344 | $237550962 | 218 JULY 17 21972 BREAKOUT OF REQUEST 05 PROGRAMA PERIOO REGIGN = MISS RM Q0057 10/72 PAGE 2 RMPS-OSM-JTOGR2-1 i} (2) (4) aL) LUENTLIFICATLUN CE ClreoaiNT oJ CONT. WITHINE CCNT. SEYOND] APPR. NUT | NEw, NOT i 2ND YEAR | { APPR. FERTGD) APPR. PEKIOD] PREVIOUSLY |} PREVIOUSLY | DIRECT | | CE support | GF SuPPGRT | FUNDED | APPROVED j casts | ae cou. ! Po. I | ! t wee COOG MISS FEGIGNAL MEuTCAL Pal I I i 1 ! CGR AM 1 i $6332642 1 t 1 $6334842_1 DOOD MRMP DEVELCPSCATAL CumPel | I { ! j Sey i i l I $2592000_1 $250,000 1 Oui STAKE Cane Cer uno TRaAT itl t i | ! t 7 NAb Ieslils l | l | i i 013 KGENCY nensThs in tnd] } | } j ! IiCsaL ILLISLS 1 $322596 J 1 1 i $392596.1 CL5 CERVICAL CYTULEGY aUREENI t | I j | Jhs i L $502441 1 l $50.541_1 OLTA RENAL OLS TENG ULALYSIS ft | 1 \ , i 1 . 5 L 1092279 3 l i t $100,276.) Teg feahorlaad | { t 1 t 4 j $61,639 1 1 j $612539_1 Teich i S1G9e2 TOV I $612039)1 1 Li $261291521 Fe. tLTh MuPLnk | { | { ! : L ! ! j $1372743 1 $1372743_1 020 COnTRUL uF Iweectlons lel J ! | . | j LtUSPLTALS 4 } 1 J £352738_1 $35,738 1 U2L KEGLONAL CANCLR FPruuedi | t j { t { i { L 4 £1032455 1 $108.455 1 022 Fistie durc onflouach Srl t { | | ‘ | Cokie ees L i 1 ! $1032034 1 $1032034 1 023 GENT covesTius La sateen! ! | 1 ! j LLY_CAKE L { 1 $663732_1 $663732 1 624 MISS CUUP FEALTH STATISTI 1 1 | | | ICS SYSTEM 1 1 t 1 $1212218_1 $1212218 1 O25 PULMUAARY Ther APY Peco Cl j | j j | Lesuciiy duseLtas i 1 L £964920_] £953,929] OZo <2GIChAL RuaAL MATERNAL | I I ! 1 } Teese Cat I i t 1 £14 2059_1 $74,059 1 O27 STPcRE RENACILITATIGN SY] | j | t $ SIi4 l i { 1 $37al57_1 $37.157 1 026 CONT ANU INSERVICE ELUCA j i ‘ i | Tips Alps ! i 1 1 $413924_1 $472924_1 029 8 eGIGRAL & | ! ! j ! | L i { $169,078 1 £169:078 1 O30 =¢€ | t | I | | y 2% j t j ! $1004459_1 $100.459 1 O31 « aa i l { 1 t GC ut. I l 1 1 1 _. 032 DDUCATICN CUALITY SeRVICI i. { | 1 ! ES Fup KEeIALLY melasuey 1 1 L 1 $39,774! $39,774 1 O33 PFECEPTOR TANG BLACK MEG] | | | ! j ICAL AND DENTAL STUDESTS 1 I ! 1 $503%40_1 $505.440 ) 034 PATIEKT ALO STAFF EDLC SI { ! I . { } ELECTEC Soi mlC Disrascs 1 | i L $252395_ 1 $842395 1 635 CONT ED ALTA PREV Use. I 1 | | i j L { 1 l $312668_] $31,668 1 : t | | IL | j i TGTAL ! $139,872 § $695,481 | $50,441 | $155539794 | $204399588 | 219 ae Lay JULY 17,1972 oe, REGION = KISS . AT ed BREA... «IF REQUEST ' RM 00057 10/72 PAGE | ‘ meee fet Me / oo . ; ; Q6 ¥°\" AM PERIOD oo oo oe RMPS“OSM@“u 0 hd wo (5) (2) (4) CL) . cow iat 7 IDENTIFICATION CF CGMPONENT | CUNT. WITHIN] CONT. BEYOND] APPR. NOT { NEW, NOT | 3RD YEAR | { TOTAL t ho’ | APPR. PERIGU| APPR. PERLODI PREVIQUSLY | PREVIOUSLY | DIRECT | { ALL YEARS j - i ] UF SUPPURT ! OF SUPPURT | FUNDED ! APPROVED — | cosTs |OIRECT cosTs 1 — | COCO KISS REGICNAL MEQICAL PRI I J { ! | 1 | _ Lb AM | j $666,387 | ! ij $666,387 1 LL $1.8142052 1 _ * GOOO MXAP DEeVELGPMENTAL CLmPcl { 1 | 1 t | . | bool l 1 i 1 $250:000.1 $250,000 1 | $5962315.1 oo OC] SIFOKE CAmke GcHCASTFal Tul { I | | I . i | “4 _. bane TkAbs lio ! \ 1 L I l L $2223951_ 1 ‘ UL3 EMERGOALY KiaSinG Ih CRI | l | | ( Lt. 1 . Lliab Jlibsc $$ L_: | 1 I 1 \ j $742996_1 . O15 CERVICAL CYICLGGY SCAEENL 1 t ! 1 | | . | Li i 1 1 $382310 1 l 2380310 1 i $1312458 1) OLTA nENAL OL> Yrhu CLALYSIS | | | ! j | | io, ee cI:$ 1 { $98,099} i ‘ 1 $28,099 1 1 $201,414 1 _ Oliv AGaAL OLS nse IeAaSPLAN 1 I | ! 1 { - LiT120% i \ L L -$222304_1 $222304 1 1 $1643938_1 OL? Chabert Iits! } Li £982,099)! Lt $223304114 $120.403)1 tC ..$465:952)1 O19S COMMUNITY REALTR MNPCWR | } j | 1 ho. - t : ns SYSTEMS preston | { I 1 $1505341_1 $150.34) 1 I £4042829_1 . S 020) COMTREL UF InrecT uns IN] 1 | | \ ! I | a rUSPITALS I 1 l ] $372642_1 $372642_1 ! $105,545 1 . O2L wEGlUAL CANES PRUGRAM TE J I i | | { i - : : ! L ! $)174779_) $117;:779_1 $308,024 1 , idituesh Stel { i 1 . ! : j 1 ! ves i | L I $150,553 1 $150:553_] j $304,321 1 : ty mATeRSS 1 1 ! ! { t ! aoe oe Ly bane i \ 1 1 $70.482_1 $70,482 1 } $3672475_1 ~ 024 MISS CUUP RCALTH STATISTI | i ny ! | i | - - C5 8¥5ai- l } 1 i $1303440_] $1302440 1 j $339,109 1 a C25) PULNObAY Urce ary PRUG CI I \ I | | i { 4 at LEY bse las i | _i {t 1 } i $2.86e179.) - we OPE SetLhAL surah wATEenAL f j 1 { | | i . 1. ‘ bye Doi! 1 L L } “$622919_1 $622919_1 j $2172762_1 O27 Sie tne wwHASILIPATICN SY¥t 1 1 ! t { 1 | . wl 1 } i 1 $17,579 1 $272979_1 $113,544 I oe O26 CUNT ANU ENSEnRVICE EUUCAL ! { J . t | 1 1 - a Les ad ee bd L L lL $442424_1 $44.424_ 1 } $1322435_1 - 7 O24 FE LULUTAL Gen cebh CASE I | t J i | { . i a i } L L 62412505] $2471.505_1 j $560,945 1 : O30 EcLEUTPIUAL RAdéngd SAFETI 1 | | | ! { t Oe Y oeioeas f i i ! $1022.650_4 $101.650 1 l $2813473_1 wt C3L opaciulnckary Tel eLabnaind ! | | i i ! | i 3 : GOL SULT I j 1 { l 1 j $80.041 1 OFZ «EUUTATHG CUSLETY SerVICl - _ 1 | 1 . | 1 i t _— ES bh MCUTALLY cb Anucy. | ! L 1 $38.92) 1 $392921 1 t $2172633 1 033 PRECEPIUA TANG BLACK MEDI I ! J I { l | - LAL ALL OLNTAL SIisulo of t 1 i £702660_1 $70.660.1 { $1412320_1 “ 034 PATIENT AND STAFF ecUC i { { | q ! i 1 ” _ ELEGEED Seto Uisrascs 1 1 1 i £10231291 $102.129 1 t $2532673_1 . 3 O95 CONT ED HLTH PRUV USE j | Lt. t owt { } . : | ‘ i ! L j $27 s1h71 $27,767_1 L $201,705 1] a . { i | ! | . ! i. . ! - 7 TOTAL ! i $764,486 | $38,310 | $17643,095 | $29445,891 | | $72226,097 | we, 200 tone _ Be mn ~ * “ SUNE 81972 J) REGION 57 KISS RMP SUPP YR O39 —"" QPERATIONAL GRANT (OLRECT COSTS ONLY) — REGIONAL MEDICAL PROGRAMS SERVICE FUNDING HISTORY LIST RMPS-OSK-JTOFHL #20 "ACL REQUEST AND AWARDS AS OF MAY 3%, 1972 rat t . tet AWARDED AWARDED AWARDED AWARDED ** REQUESTED REQUESTED REQUESTED REQUESTED _ COMPONENT oe OL 02 3 + 04 05 66 . nO TITLE 07/71-06/72 TOTAL +** TOTAL ~ _ . a ee eee o* eee ce eee ee eee = eee vee mente ee ene PTT COOO PROGRAM STAFF 3c6900 4c1aco 411097 1119797 = # +t ~ 901 COMPR STRK DET - 62606 1198C0 $1627 274027 90 ## oo ee 052 IRN DXRX CHR PU 200306 178000 93784 472084 _ 003 MISS PG INST IN 38500 57200 62796 158490 #* ee . 004 RECRT HLTH MNPW 70000 7c0CG | #8 \ 055 CVA CLNCS INDIG _ _ 29000 _3h2co_--s—=si83592 93792 ——C HH 06 EST COORD sys C 164600 169366 54470 3283700 # ™ = gca COMPR PRG CPR T 39000 47000 B6000 +9 tee ett ee oly) RAD RX TRN CONS 264900 45460 31110 281410 -#* _ GLE REG COMPR NEURO 67569 71000 52332 190832. +* _. . _ 7 _ cece ‘ G22 COMPR REN OIS T 46300 34700 81006 # CO - J QL3 EMRGY N CRICL To. ce ee BHA LL 2SZLO _, HH "7" “GAT RENAL DIS PROG 30218 30218 #3 ™ 918 HYP CONTL DEM A 10004 1occo = #* oo ee eee OO ae . - TOTAL = 1229¢€00 1095400 - 896230 3221230 **# e ee __ _ ' Na _ - we ee a eae — tit . ~ my 7“ - - moo wor seein x ey ne en ee . ne © nO ems nena eee sont wen nt OO Monee a oe eG 2 " " - se Oy “ ee ” oe a n on. ee oe eee oo. ee ee npn eee c ee eee . . en eee me ~ , . HISTORICAL PROGRAM PROFILE OF REGION . Region: Mississippi RMP Review Cycle: Sept/Oct.1972 One Medical School located in Jackson serving the entire state. For the most part, medical care is availabie to afl citizens, but the. real problem is in educating the people to take. advantage of medical services. Upgrading and increasing health manpower is the major goal for this region and positive steps are being takeh to alleviate this problem. The region was awarded supplemental funds to begin planning for health services/educational activities. Mississippi has only one physician per 1,350 people, which is half the average for the U.S. This figure includes all urban areas. In many rural districts of Mississippi, the ratio reaches almost astronomical proportions. The region's emphasis in the past has been categorical in heart, cancer, and stroke,-and in continuing education with activities ~ centering around the Medical School. ' The new thrust is regionalizing the activities with the major emphasis on improving the health care delivery system access ca and availability to all persons. ns Projects being submitted by the region have been designed for outreach into all areas of the state. The region is requesting funds for 2 continuation projects. All other projects are new. Ten old projects are being terminated. The developmental component is intended to provide MRMP with funds to move rapidly and expenditiously in responding to emerging or unique program development activities. ; The internal problems that plagued the region a year ago no longer exist. ~ , The program has moved to new quarters outside of the Medical School complex. ~ The program staff has been reorganized. and new staff, have been hired to fill needed vacancies. The RAG has been restructured and is no longer a reactionary group but now exert good leadership and strong influence on the program and are actively involved in directing the activities of MRMP. The Mississippi RMP, a year ago was just beginning to turn the corner in becoming a strong and important leader in the development and delivery of health services to all people of Mississippi. During the past year they have "put it all together" so to speak and are now a cohesive, dedicated and enthusiastic group who are looked on by the health professionals of Mississippi as strong and reliable leaders in developing programs that are innovated and challenging, but are designed to meet the health needs of the region. Review Cycle: Sept/Oct. 1972 me ' a & 4 Wy é ae an STAFF OBSERVATIONS b Principal Problems: Review of .the region during last year's review cycle revealed the following problems: 1. Goals and objectives were broad, giving the region little direction. 2. No Black professionals on program staff. 3. Program staff needed further strengthening in both planning and evaluation skills. 4. RAG needed to be restructured and become more involved in directing the program. 5, The region was relying quite heavily on the "bubbling up" technique as opposed to a balance between this and a RAG and program staff stimulated system of project development. 6. Evaluation had not consisted of more than progress reporting. Principal Accomplishments: 1. Program staff has moved to new facilities away from the Medical Center, resulting in a new identity for MRMP throughout the State. 2. RAG and program staff has been restructured and reorganized and RAG is now more involved and is directing: the program instead of being a reactionary group. 3. Goals and objectives have been refined and further delineated, and RAG and program staff are developing programs to meet the goals and objectives rather than waiting for activities to bubble up. 4. Additional staff have been hired to fill vacancies in planning . and evaluation. A Black professional has also been hired to work in the program development area. 5. Evaluation techniques have been developed for evaluating projects and overall programs. Issues Requiring Attention of Reviewers: The region is requesting triennial status and developmental component. Much of the effort of MRMP has been undertaken by faculty members of the University Medical Center. This has been possible through MRMP support, but since other sources of funding to support contributions to continuing education by these individuals is slim, it seems unlikely that in the future they can continue their efforts in this area. MRMP may need some special consideration by the University in terms of personnel policy and the establishment of salary levels for program staff in order to assure appropriate working conditions to retain competent program staff. . o Region New Mexico . a . Review Cycle Sept/Oct, 197 Type of Application Irienr Rating - 294 RECOMMENDATIONS FROM £7 SARP - La Review Committee [_j Site Visit fj Council RECOMMENDATION: The Review Committee concurred with the site visit team's recommendations regarding: 1, The RMP's readiness for triennial status. 2. The approval of a developmental component. Committee rejected the site visitors’ recommendations. on the total amount of funds to be recommended for each of the three years of the triennium as well as the funding level of the developmental component. Committee recommended reductions in both project and program staff funding requests. Reasons for the overall reduction are included in the critique section of this report. The following summarizes the Committee's recommendation for the fifth operational year compared with’ the Region's request and the site visit team's recommendation: 7 . Recommendation ~ Program's Review Request (05) Site Team Committee Program Staff $1,319,722* ~$ 830,000 Operational Projects 232,305 350 DoD" $1,070 ,000 Developmental Component 138,228 120 ,000 80 ,000 6 no . . 1 ens TOTAL. * $1 ,690 ,255 $1,300 ,000 $1,150,000 nw *Cancer registry funds were transferred from the program staff to the operational project budget category. Committee recommended totals of $1,200,000 and $1,250,000 for the sixth and seventh program years respectively, including a developmental component of $80,000 for each of these years, The site visitors had recommended $1.3 million including $120,000 for the developmental component for each of the three years, - “ CRITIQUE: Committee believed that the $120,000 recommended by the site visit team for the developmental component was too ambitious for a Program that has undergone so many changes throughout the past year. Even though Committee recognized the significant progress made since Dr. Gay's appointment as Coordinator, which included a number of changes in program staff, the expansion of the RAG from 41 to 116 members, the establishment of 9 standing committees consisting of the RAG membership, the revision of the bylaws, the development of a unique computerized financial system and the involvement of both provider and community groups in establishing the goals and objectives for the triennial Region __ New Mexico . OO , | 7 ‘Review Cycle Sept/Oct, 197 RECOMMENDATIONS FROM REVIEW COMMITTEE . Page 2 application request, they suggested that more time is needed to concentrate on initiating comprehensive activities and programmatic thrusts. Review Committee noted that the Program has made excellent progress in increasing minority involvement on the Executive Committee, RAG and its committees. The Coordinator has already responded to the site visitors concerns regarding the employment of minority members on program staff. It was noted that the Coordinator has hired three additional minority ‘ staff members thus resulting in a total of six minority program staff members. Committee noted that the NMRMP's program objectives are commendable. However, the proposed use of funds appeared to be a continuation of old-line activities. Concern was expressed regarding the proposed continuation of ongoing activities for a fifth consecutive operational year. In this connection, there was - extended discussion concerning the request for continued funding for the cancer registry. The site visit team had dealt with this issue and had strongly urged the Program as well as the project director to seek other sources of support for this activity during the next year. Reviewers agreed with site visitors that the $118,000 requested should be budgeted and monitored as an operational project rather than as a program staff activity. Reviewers were made aware of several of the outstanding qualities of this particular program and were informed of the partial support being made available from the National Cancer Institute. Reviewers also noted the request for a substantial increase in the number of personnel needed to implement project activities under program staff direction. It was felt that this strategy should be discouraged since it would probably lead to further prolongation of activities beyond a maximum three-year time- limit, They recommended that the Region should consider supporting additional] staff through the use of operational project funds rather than pursuing continued assistance through its program staff budget. Review Committee disagreed with the site visit report statement "if the Program is interested and seriously intends to facilitate HMO planning, it should bring onto the program staff people with appropriate experience in the managerial and financial aspects of HMO planning. Committee noted that two organizations in Albuquerque have funded HMO activities and could be called upon to offer consultation to other applicants upon demand. Committee further discussed the overall staff complement and agreed that the Community Health Services Response System was particularly outstanding. Recognition was made of the number of demands from communities which were . being responded to from this section. In spite of this commendable effort, reviewers believed that this staff should concentrate more of its efforts in stimulating programmatic activities rather than responding solely to the. incoming single, isolated project requests. > . La =. Region New Mexico oo oe _ Review Cycle Sept/Oct, 197 e RECOMMENDATIONS FROM REVIEW COMMITTEE Page 3 Even though the health related resources of the Region were recognized as being limited, major emphasis should be exerted for developing other sources of support for the continuation of activities initiated by the Program. Decremental funding concepts should be encouraged at the inception of each activity. The reviewers also suggested that more input and assistance could/should be recruited and exchanged with the Lovelace Foundation. " Finally, Committee noted that RMPS policy, adopted in August 1969 by the NAC, does not permit support of basic training in established health professions. Therefore the proposed activities for dental assistants, medical lab technicians and inhalation technicians were considered to be ineligible for RMPS operational grant support. COMPONENT AND FINANCIAL SUMMARY TRIENNIAL APPLICATION Region: Review Cycle: 2€Pt/ WOW FIDATLYU J AL. é Current Annualized Request for Triennial Committee Recommendation for Council-Approved Level COUNCIL RECOMMENDED LEVEL Component ' Level 04 Year Ist year | 2nd year | 3rd year lst year | 2nd year | 3rd year 1,036,719 05 06 07 | | 1,201,263 | 1,381,452] 1,441,515 PROGRAM. STAFF © . 610,682 118,459 84,825 56,550 , ale. - , 1,319,722 | 1,466,277] 1,498,065 {1,070,0007]'1,120,000 | 1,170 ,00C _ {CONTRACTS | DEVELOPMENTAL COMPONENT 138,228 158 ,968 165,974 80 ,000 80 ,000 80 ,00C€ OPERATIONAL PROJECTS 426 ,037* 232 5305 135,906 55,390 Kidney | ( ) | EMS ( ) hs/ea ¢ ) Pediatric Pulmonary ( ) “Other ( 4) TOTAL DIRECT COSTS 1,036 5719 1,690,255 1,761,151] 1,719,429 1,150,000 1,200 ,000 1,250 ;00€ *Includes Project #6 - Emergency Medical Services funded at $61,274 **Program staff and operational projects combined. Review Cycle: 10/72 | AMPS STAPP BRIEFING DOCUMENT - REGION: NEW MEXICO - OPERATIONS pracy: MED-CONTINENT NUNBER: RM 00034 | Chicf: MICHAEL J. POSTA COORDINATOR: JAMES R, GAY, M.D, Staff for RMP: FRANK G. ZIZLAVSKY ,MCOB ace : Rebecca Sadin, DPTD; Joan Ensor and LAST RATING: C (176) St Kathy Scurlock, OPE; Charles Parnes, Grants Management. TYPE OF APPLICATION: __. _.. 3rd Year Regional Office Representative: /x / Triennial / / Triennial Dale Robertson __ 2nd Year _ Management Survey (Date): /__/ Triennial /__/ Other ’ , Conducted: May 5-7, 1971 i or . . + Scheduled: Last Site Visit: 5 (List Dates, Chairman, Other Committce/Council Members, Consultants) June 8-9, 1971 - Sister Ann Josephine, Chairman, Review Committee } Anthony J. Komaroff, M. D. - National Advisory Council George E. Schreiner, M. D. - 7 " " Morton C, Creditor, M. D. - Consultant Arthur M. Rogers - Consultant Jehn Gramlich, M. D. - Consultant Staff Visits in Last 12 Months: ms (List Date and Purpose)October 17-20, 1971'- Frank G. Zizlavsky-Introdugtory January 21-22, 1972 - Harold Margulies, M.D. Director - Speech to State Medical . Society April 19-22, 1972 - Frank G. Zizlavsky, Attend RAG meeting and Technical Assistance ay 972 1972 - Edward Bloomquist - Kidney Technical Assistance y 4-18,°1972 - Frank G. Zizlavsky - Attend Chicano Cultural Awareness Program July 25~28, 1972 ~ Frank Zizlavsky, Joan‘ Ensor, Kathy Scurlock-Veri fication of Review Process Recent events occurrins in geographic area of Region that are affecting RMP program: 1. New Coordinator James R._Gay, M.D. as of July, 1971 2. Coordinator has completely reorganized program; hired new staff; ‘enlarged RAG; increased committees; changed Program from traditional program staff and projects to Developmental Program Staff & Community response. 3. June, 1972 ~ National Advisory Council approved $425,675 for 01 year and $139,046 for 02 year for project #18 - STATEWIDE EMS and $82,000 for project #'s 19-22 for 01 year health service education activities. REGIOC' AL CHARACTE 2LSTICS . CECGRAPHY : . NEW © MEXICO _ COMPAR ‘ tan juan RIO ARRIBA TAOS _—_—_ TD ney . ey wORA sanoine tos woe EE __ ™ \ . SANDOVAL 8 wemnees SANTA FE SANTA TE SAN RIGUCE A LERNALRLO ld | , ~ “ALBUQUERQUE . e TORRANCE ed SOCORRO “LINCOLA GUADALUPE oe eo Lor 6 CHAVES | ROS WELLE a €ouy en ans VALENCIA w Oo; / Ay a) te cas CLTROW t * SIERRA a count t 3, : f | | Qthea I 5 i HDA Od ! | i i { Ss mama : . i e ! | i i | Resicnal Delineation; BREW Counties . 32 Conoressional Districts- SuDY T€210NS «ae Overlap / interface- with portion of 2 EL PASO Regional Office VI State/ States - State of New Mexico “ CE RACA } —_—_— “L —_— i ROOSEVELT Te | CUBRY wet so TERE Lea cetera ne tran Navajo Indian Reservation, Arizona I. REGTONAL CHARACTER VTCTIOS (Couttd) Scheels of Higher Kducatieus Tetal Li 8 Public;3 private. PACILITIES At RESOURCES ROG Be 2yr but less than & yr. beyend high scheels 2 € Public) Schools No. Enrollment 1970+ Graduates 19?9Lecacior - (1969/70) _ 7% (1969/70) 71 _ Medicine and (Osteopathy). University of Nw. (1) (115) > 154 "(243 26° Albuquerque School of Medicine Dental —_ ° a _ _ , Unive of Roi. Pharmacy (1967/68) 1 162 32 “ALboauanaue Nursing Schools Professional Nursing all Univ. __Number 3 291 32 ‘ based). Practical Nursing . Number 6 (4 callege Or Utriate-trased)} Allied Health Schools (Approved Programs) * I Univ. of NUM, Cy tuotechnology Albuquerque Number 1 Medical technology Nunber Radiologic Technology Number Physical therapy Number a 5 (lat VeAs hospital) Note: See Manpower Table for sources - page 8. _ Sourcesi* Directory of Approved Allied Medical Educational 7 (1 at PHS Indian MC, Gallup) Programs , Council on Medical Education, Amer. Med. Assoc. Chicago 1971, I. REGIONAL CHARACTERISTICS ( Cont'd) DEMOGRAPHY POPULATION: Total Population ; 1,016,000 | % Urban ~ 69. Population Density, 8 per sq. mile — % Non-white - 10 (large proportion METROPOLITAN AREAS Indian and SP. surname) Name of SMSA Populakaeay Total _ AGE DISTRIBUTION Percent of Total by Specified Age Group, 1970 Age Group State U.S. Under 18 yrs. 42 : 35, 18 = 65 yrs. ; 52 55 65 yrs.& over 7 10 Sources Bureau of the Census- PC ( Vl & V2) 1970 - 1970 Census of Population; State and County #33 Burcau of the Census - PC (23) - 3, U.S, Population of Standard Metropolitan Statistical Areas, 1970. INCOME - Average Income per Individual, 1969 & 1970 State ( of RMP) NeM. $2894 | 1970_ United States $3680 NM 3044 4 ranks 44th Us 29030 Sources State data from Statistical Abstract of the U.S., 1970 (Dept. of Commerce) ~4= RM 000 34 © REGION, CHARACTERTS®TCS (Cont td) FACILITIES AND RVEOURCES (Cont'd) pt a, HOSPITALS Non Federal Short and Long-term eeneral hospitals 11969 & 1970 me a ee nan eee + mma aes - , a _Nunber 1970 Nuwier_of Beds 1970 Short term “AL 39 - 3423 3351 Long teri ~ 9 3 | + 430 462 . a VA. General hospitals 1. ° 7 489 4307 : ft Lote 430. ” Bed- size C general hos picele) tnels steep. Number of hospitals with Of h : L wEbes ial facititics Under 50 12 "fof facil. 50 ~ 100 13 . ~ Intensive CCU “a! 100 - 200 7 . Cobalt therapy 4 . 200 - 300 3. , Radtum therapy g — 300 ~ 400 — L 7s Renel Dialysis - i 400 - 500 din patient | 690 and over an neee - Rchab-in paticnt - 6 (ethers newly registered; ne data) Isotope facility 10 © Source Ane mae pgTgtal Agsoc. ae Guide Issue NURSING AND PERSONAL CARE HONFS, 1967 Namder. Numbex” oF Vicds~ Skilled Nursing Homes “39 1358. ~CSC~S~S one bey pr care units 14 49 3. a eS, 188 with Nursing Care Sources NCHS - A Master Facilities Inventory County and Metropoliten Area Data Book PHS- Number 2043 - Section 2, November 1970 ~ 5 Me oT RM 000 34 REGTONAT, CHARACTER SPICE (Cont'd) FAGILITIES AND RESOURCES (Cont'd) - MANPOWER _ 7 | ___ Profession Numbor | % Total | = _Ratio | “ : | ~— per 100,000 . Physician - active 895 ___ 100.0 peneral practice 235 20.0 | wedice lL_snecialty 204 17,0 ; ‘ |_surgical soecialty 281 25.07 POT ramecruee ene ef ene bee te ee eee __. Date Ope th - - actin 7 ~ _ : a 279 AZO Bays Avian’. faactive.. 800. a : cece ate enn cee mee renee ere is Us + ec tive 344 _ oe nurses ee . - active 25th nr ee | angetive ~ {1095 | -- i cPract. Nurees . active ft 712 70 “inactive . pfedical technolocists 2 i = - OB, ‘Radiologic technologists 223 te ae Physicel therapists. Medical record libra aviers ot _ [ # Gnu) FRACTICES- Total 12 26. a | Single Specialty 7 9 General practice , 4 : | Multispectaley 007. 13. ene * Medical Groups in the U.S., 1969 ; AMeA., Chicage, 1971 Sources: Distribution of Physicians, Hospitals, and Hospital Beds in the U.S. 1969, Amer. Medical Assoc., Chicago, 1970. Health Manpower Source Book, Section 20, PHS-NIH-BEMT, 1969 The Health Professions Educational Assistance Program, Report to the President and the Congress, Sept. 1970 (PHS -NIH-BEMT) RMPS ; hes -6- "May 1971 po COMPONENT AND FINANCIAL SUMMARY Region: Review Cycle: =I 10/72 = COUNCIL RECOMMENDED LEVEL NEW MEXICO TRIENNIAL APPLICATION ; Committee Recommendation for Current Annualized Request for Triennial Council-Approved Level Component Level 04 Year Ist year | 2nd year | 3rd year Ist year | 2nd year + jrd year 1,036,719 05 06 07 1,201,263 /1,381,452 | 1,441,515 ' ae . 610 682 118,459 84 , 825 56,550 PROGRAM STAFF ? 1,319,722 |1,466,277 | 1,498,065 CONTRACTS : DEVELOPMENTAL COMPONENT 138,228 | 158,968 | 165,974 OPERATIONAL PROJECTS 426, 037* 232,305 135, 906 55,390 ' Kidney ( ) EMS C ) . hs/ea ( ) . Pediatric Pulmonary C ) , Other C ) - TOTAL DIRECT COSTS 1,036,719 1,690,255 11,761,151 1,719,429 *Includes Project #6 4 A Nom Oo Emergency Medical Services funded at $61,274. JULY 1891972 REGICN = NEW MEXICC HREAKCTUT CE PLourst PM ANNs VOSA Pace + OB FRAC KAM PERTED eb ce ee bee § 5) (2) (4) . a1) . IDENTIFICATION CF COMPONENT [| CONT. WITHIN| CONT. BEYCAD] APPR. NOT tf NtW, KOT t IST YEAR f[{ 1ST YFAR [ . ! } [| APPR. PERICG] APPR. PERICC] PREVICUSLY | PREVIGUSLY | DIPLCT | INOIRECT { TCTAL f [ CF SuPPCRT ! CF SUPPORT | FUNDEU | APPROVED ! cCSts 1 COSTS t : ! I t t ! ! I COCO PRCGRAPY STAFF i I 1 \ 1 t i wah L2812201n2621 i $..82a20 40209 120.0 8272,01 8. L--S1aatsa2vl— Lo DCOO CEVELCEMENTAL CUMPONENT | | i t I t | A | 5 1: 1 $138.228 1 t2es2201___s320035 | __suzs.z6r 1 OCLA TLPCR REGISTRY | { ! I ! x 1 1 $118s459. 1 i f siege | s24sezn | snsneoeo O04 LAPCRATCKY SCIENCES KANPI j t I | { . GOWER DFYVEL 1 I $33,052 1 ! Ju £33.052 4 $101547 i $42,956 1 006 PRIORITY KEOCICAL SERVICE] j : § t ! i t ! seve | i $632969_) 1 ¥ i $63,505 J $19s098 1 $832067 | QO7 CONTINUING ECUCATICK | | | I t. . | I 1 : J L $20.46) J ! 1 $20046)_ 2 $1,801 1 $223262_1 OO8 FEALTE SCIENCES INFOREAT! i t i 1 I t t 1GN_GENIES i $36sB46 J J ! $36,846 ) $l2sf£67 | $466,512 b OLO CARDICPULMUNARY evaciaiit ‘ { ! { I t I —CH LABCPATCRY 4 110.00C 1 JS 1 $30,000 1. L297 J Shi s0o7 tf O15 STREPTCCCCCAL THROAT CUL 7 i \ j t. 1 { i -. « FCSECL 1 i $232241 1 i J $235247_1 $6.41) 1 $25,658 | Qi LEUKEMIA LYMPHOMA I t { i t I j | : I I $44e730_1. { f ~£442730 4 $15: 787.1 $6C2517. 1 : . { i t i | t i TOTAL I { $155525027 \ 1 $136,228 } | $4130386 | $2,102,641 | $1690, 255 JULY 14,1972 REGION ~- NEW MEXICO BREAKOUT OF REQUEST RM 00034 LO/T2 PAGE 2 Ob PREP PAP FEP ren Hers ee TOMS Y to) 2g 4) (1) IDENTIFICATION OF COMPONENT § CONT. WlTHEN] CONT. BEYCADI APPR. NOT { NEWe NUT 1 2ND YEAR f f SPPR, PERIUL] APPR. PERIODS PREVIUUSLY | PYLVICLSLY j DIeICT | | CF SLPPURT {| CF SUPPCRT | FUNDED 1 AFFROVIC ! CCSTS | _ j | ! I | COCO FACGRAM STAFF i | t . | ! ! ; 1 4 $029h S52 do 2_$123812452_1 OOCO DEVELCPMERTAL COPPCKENT f ! | t f t l l i i $152,968 1 £158,968 J COLA TUMCR KEGISTRY i | j | i { _. i i $242825 J j 1 $84,825 ) 004 LABORATORY SCIENCES manel i j { { 1 _ DWER DEVEL 1 i i 1 1 006 PRIORITY MECICAL SERVICE 1 Lo j I I ' i $47,925.1- I 4 $4722925. 3 sat CONTINUING EDUCATION i ' i ‘ ! | : 1 1 OCE HEALTH SCIENCES IRFCRRAT| { | i { ! IOA_CEATER 1 $42,286 I 1 I $4223266 I .01G6 CARO IC PULMONARY EvacuaTit t { I 1 { ___ON_LABLRAICRY i 1 1 I 1 015 veer cenoeeeeet THREAT cat i af { { { . EC t $22025C 3 ] 1 $23,250 1 017 LEUKEMIA LvAPIORE i i { i | i l 1 $2233651 i I $222365.1 1 ( | t | . “4 TOTAL i i $12602,183 | i $1565968 | $12761,151 | -9- ol + \ BREAKOUT GF REQUEST O7 PRRGMAY FRETED REGION ~ NEW KEXICC ee 00034 1LO/T2 PAGE 3 PRO S.Ncre. FTN? Y : ca €.t tat tee IDENTIFICATION OF COMPORENT [| CCKT. wWITHINE COAT. BEYCAD! APPR. NCT L Nth, HOF { 3RD YEAR | I ICTAL 1 . | APPR. PERILE] APPR. PERSOC] PREVICUSLY P erivicecty | DIRECT | 1 fle vrers | { oF SupPpuRT [| CE SUPFLRT | FUNDED } APPROVED ' costs { {OIRECT COSTS | i; t ! | It !. COOO FRCGRAM STAFF i ! \ I I | i 1 143544125191 i b$29441.515 Lo ee a OP ZS DOGO DEVELCFMENTAL CCPPCHENT | { | | t t ‘I t i Lou. J i $l £59574 1 $1652.97 fo et TOL COLA TUMER FEGISTRY J t { t t | i j 1 ! $563550 I i J $562550 4 j $2595524 1 004 LABURATURY SCIENCES MAKPI t 1 t ! i t OWER CEYEL j } t _t i t f $23,052 1 006 FRIGRITY FECICAL SERVICE| I 1 ! d t i | -§ : l i i j } i i $122,894 1 OO? CONTINUING EOUCATICK t I I 1 . ! t { _ j { I i { 1 I $20.44) 5 000. HEALTH SCEENCES INFCRRATI t 1 | 1 | ! t TGs CENTER 1 I $445208 1 4 i 9442208 1 po 83230420. O10 CAROIGLPULMCNARY CYALUATII | j | | j { t CN LABCOSICRY i de I i L ! j $10,00Cc_1 Gis STREPTCCCCCAL THRCAT Celt t { | I \ 4 l _ JUSE PEOIECT i i I 1 j t L $4£2497 3 OLT LEUKEMIA LYMPEUMA I i ' i | t i { i ! $115182 ! i t $212182 1 1 478.277 1 t t | | . ! a I t t TOTAL a | 1 $395539455 } t $165,974 | $k57195429 1 | $5,170,835 | =10- — AUGUST 251972 REGIONAL PEDTOCAL PROGRAMS SFRVICE FUNCTIAG BISTORY LIST I pEPSS =CE¥-ITCFAT-QS RBECIGN 324 NEW MEXICO BMP SUPP YR 06 CPERATION¢L CRANT LOIRECT COSTS CALY) ALL RECUEST ANC SWARCS AS OF JUNE 30, 197 ‘ 7 AWARCEC WARCEC AWARCEC AWAROFD AWAPDED #* REQLESTED REQUESTED REQLESTED Récutster é ——"" COMBOKENT or ¢27 C3 04 ee OT QB To gg cr” - 2 NC THILE CG/71-12/72 TOVAL = ## CLATBW12/73 OL/74—12/76 OL/TS-12/95 TOTAL 10 we PATE fee eG be , COCO FRCGELM STAFF 2£43C6 4EECCE © 28520¢ 651473 1868973 #4 1201263 1381452 1441518 4024230 42 COOL PEC SECT VPI YE2774 Te2774 4% COCO CEVELCPMENTAL C ¥e 130228 1£8S68 LE5S74 463170 ““OOLA” TUPCR REGISTRY ve YT845¢9 84825 56550 "259834 CC2 KCNEL CAPCIAC C 143900 170400 97600 lésar- 42048) we “O03 “CORONARY CAPE NO ~€ELSCE €3€CC 42300 §721 173721 ## ° 004 LAPCESICEY SCIE 104200 $8600 POECC S0275 323575 #* 33052 33052 OCS STROKE PEIGREY “TT BOLE “T44600 89432 528535 49 00S EMERCENCY MECIC 306C0 598CC CeCe e713 227703 o* 83969 $7925 Liiess OCT ILAS LIT RICENG 44700 Ea4co 19RD0 £330€ 1762Ca #6 20461 20461 COA -FEALTR SCIENCES Ze0CC 287CC 332c¢ 50694 147554 * 36846 42366 44208 1234z¢ 6397 PECEATPIC FULRO 86 6ce 95700 7370¢ 66S5CC6 2555CC se C1G CASOECPEULMCNARY 15¢CO 21000 17500 21086 T4586 be 1¢000 _. 10000 OLS PEORITCRIAKG REND ELOCT Z33Cz 14302789 Q1f StREPTCOCCCAL T i91icc 29994 “44004 #6 22247 23250 46497 “TOLE “hESS T SOLNG and ~~ 16000 19070 35070 ee” , O17 LEUKERIA LYRFF 247CC. S47TE TS41S ¥% 44730 22365 tlis2 78277 “Ole 7 E w SEN RURAL 5e4721 S$€4721 08 CS. Ar EC 2 CCPMUNIT 2c5c¢ -20500 #8 TE ETM ES EC CP PCRTY ZOsCE 2c5C0 46 7 O21 AFES Z COMPUNIT _. 20500 _——-20500-48 } 277022 “arec 2 CORKURIT™ . ~ ome ~ ~"" 205¢¢ “ 2céCcC +e ? : . os . z . Torre sessto Te Escce TC4s90€ 2029009 5293109 #8 ye 9e255 YVETTSI TIVSS25 SVvCays i ; : , i i . i ? comet ¢ ioe | i wm ma eR oe Review Cycle: October 19/2 HISTORICAL PROGRAM PROFILE OF REGION The University of New Mexico School of Medicine was designated by the Governor to plan and operate a Regional Medical Program, and a planning grant application. was submitted to DRMP on July 1, 1966. Planning was to be carried out by disease-oriented committees set. up by the Regional Advisory group. The Dean of the School of Medicine was appointed RMP Director, as well as chairman of the Executive Committee of the RAG. The first planning grant was awarded for the period October 1, 1966 to November 30, 1967. A seven month grant period was awarded for the second year planning continuation because of disapproval by the National Advisory Council of the Region's first operational application. Reasons for disapproval were? | 1) no justification for expe ditures of 01 year funds; 2) over commitment of Dr. Fitz, the Coordinator; 3) planning activities for the 02 year were vague and seemed operational in nature; and : 4) no RAG involvement. The Region resubmitted an improved operational application described as "Phase I" program with five operational projects. The Review Committee (January 11-12, 1968) recommended deferral and a site visit-to determine the real needs of the region with appropriate translation into a unified comprehensive proposal with a truly regional orientation. Prior to the site visit, the NM/RMP submitted a Phase I supplement © =~ which included a number of changes in the proposal. The National Advisory Council of May 27-29, 1968 recommended approvai in a reduced amount and a grant was made in the amount of $665,305 for Core and seven projects. The progress report for the first year indicated some organizational improvements with a. notable shift away from the medical school. The region identified $355,612 in unspent balances and was granted , $.,252,911 (D.C.) for a fourteen month period. The continuation application for the 03 year requested Core and nine projects ($1,053,537) and carryover balances in the amount of $174,902. The continuation award for the third operational year was made cfifective September |, 1970 for twelve months with a direct cest amount of $1,170,171. On May l, 1971 the New Mexico RMP submitted its triennial application (including a developmental component) request for the 04 year, $1,003,503, for the 05 year $985,603 and for the U6 year $886,971. -12- Region: New Mexico Review Cycle: October 1972 On June 8-9, 1971 the NM/RMP was site visited. The site visit team identified the major strengths to be the good relationships that exist between the NM/RMP and other professional groups, and the Dean of the Medical School supportive role in the RMP. However, major weaknesses in the Kegion still existed. These were: 1) an excess dependency of the Medical School on the resources of NM/RMP; 2) lack of a good coordinator; 3) need for strengthening of Program Staff; 4) better representation of the Executive Committee of the RAG; and 5) lack of _progress in the kidney disease area. The program received $796,312 for its 04 year (only one additional year) with a follow-up site visit in a year to evaluate a revised triennial application. In July 1971, James R. Gay, M.D. became new Coordinator. During the past year, Dr. Gay has reorganized the New Mexico RMP, hired new Program Staff, enlarged the New Mexico RAG from 41 to 116 members, increased the number of its committees, revised by-laws, and revised organizational structure from traditional mode (vertical hierarcnaial pattern) to matrix system where everyone is in a co-equal position on an organizational chart. In April, 1972, the budget period for the program was extended an additional four months to December 31, 1972. An amount of $1,382,288 was made available for the 16 month period (9/1/71-12/31/72). The June, 1972 RMPS National Advisory Council approved Project #18- Statewide Emergency Medical Services for $425,675 for O01 year, and $139,046 for 02 year. Also projects #'s 19-22 were approved for $82,000 for only one year. The Program is presently supported in the amount of $2,029,009 for the 04 year budget period. On July 1, 1972 the New Mexico RMP has submitted its revised triennial application (including developmental component) request for its 5th, 6th and 7th years of financial support. -13- Region: __NEW MEXICO Review Cycle 10/72 STAFF OBSERVATIONS _ _ ee Principal Problems: 1, Program Staff budget request is large 'i.@. requesting 34 additional staff members. , 2, Large proportion of Program Staff budget for equipment — . | 3, Program Staff being project directors could become conflict of interests. , 4. Other areas of continued financial support after the withdrawal of RMP support. — , 5. Why does NM/RMP continue to fund Project #1A- Tumor Registry when on pze. 10, item 9 - it states... continues objections to Tumor Registry... 6, Does a three year plan really exist? 7. Program did not submit any new projects as part of its triennial application %&. RMPS policy prohibits more than 5 years of financial support for projects 46 and #8. , Principal Accomplishments: 1. Assisted Home Education Livelihood Program (H.E.L.P.) to assume responsibility for the Migrant. Health Program in New Mexico. 9, WNM/RMP has reorganized total Program. 3, Provided assistance to small clinics throughout New Mexico.. 4, Provided excellent assistance to communities for obtaining National - Health Service Corps placement of assignees. 5 Program Staff has responded to many community requests for assistance 6, Excellent representation of minorities on Executive Board, RAG, and Committees. [ssues requiring attention of reviewers: }. RMPS policy, adopted in August 1969 by NAC does not permit support of -asie training in "established health professions. Therefore, training proyrams for dental assistants (9.45), medical laboratory technicians (p.95) or inhalation therapy technicians (p. 119) are ineligible For RMPS operational grant support. 2, 2M/RMP states on p. 42, item 10, that it plans program disengagement ‘and recycling of funds. How does the transfer of some of the staff - nesitions and activities of the Community Rehabilitation activity at ~ cost of $95,000 fit in with this plan? -14- Region: NEW MEXICO _ Review Cycle. 10/72 STAFF OBSERVATIONS (continued) Part 5 + Regional Characteristics Three outstanding features of these publications are the instructive nature of the content, the easy readability of the style of writing and the ingenuity in analysis of sociological factors. Part 5, Appendix I and II provide a beautiful education on social factors, their relation tc disease, and their use as indices of health especially where direct measures of health are not available, The discussion on infant mortality, longevity, and educational level lay the foundation for their use as indicators of health, Appendix III and Appendix IV are based on a mathematical technique known as Factor Analysis. The entire analysis and interpretation is based on the assumption that the sociological concept of "Factors" is valid. A more serious question can be raised about the "statistical significance" of some of the findings. In Appendix III, they use County Data which are gross and in Appendix IV they use Enumeration District Data which are in- adequate and the results in the two reports differ as a result. Part 10 - Manpower Development The New Mexico RMP states that the State Senate Bill 71, which requires M.D.'s and 0.D.'s to participate in continuing education activities, has given new impetus to RMPS's continuing education activities. The stated pupose of the Act is to “protect the health and well being of the citizens of the State." If continuing education is to have an effect on people's health, continuing education needs should be determined by identified deficits in patient care rather than on what the provider would like to learn, and evaluation of continuing education activities should focus on provider performance and changes in care rather than on provider satis- faction with the program, New Mexico RMP mentions hospital medical audit procedures as one kind of input into program planning. | There should be increased emphasis on this and similar kinds of need determination, On page 8 of the Manpower Development section, Part 10, the applicant mentions that a proposal to develop evaluation criteria and a controlled study of outcomes has been submitted but does not elaborate any further.. The Nursing component of the Manpower Development section states that the New Mexico RMP is reinforcing efforts of health care organizations in measuring quality of care provided, How are they doing this? ~15- STAFF OBSERVATIONS (continued) The Allied Health Component of Menpower Development mentions team approach to management of health problems as one of its functions, The Nursing Section does likewise. Do the teams consist of mixtures of educational levels of nursing or allied health personnel or are they talking about teams made up of several different disciplines? Elaboration igs needed. ‘hat are the interrelationships between the many educational activities - proposed in this triennial application? For example, how does the health aide training described in the Home Health Network (page 49, triennial application) fit in with the Community Rehabilitation proposal on page 43? Will the planning for dental health training, et Eastern New Mexico Uni- versity (page 46) be coordinated with or incorporated into the planning for a health education system for that section of the State, a health services/education activity which was approved June 1/72 for supplemental funding? Indeed, how does the RMP plan to relate all of its already. — existing education activities to the four consortia for health services/ education activities being planned throughout the State? If manpower development is to be considered as extending along a continuum of recruitment, production, distribution, utilization and continuing education, then the region should be considering the interrelationships and coordination cof all of its ongoing and projected educational activities. This kind of coordination would also help fulfill one of the Region's stated objectives-- ro manage programs more efficiently and moderate costs. Part 11 - Health Care Delivery Systems Staff was impressed with the comprehensiveness 25 well as the direction of the initiative. This activity is entirely appropriate for an RMP and indeed, is very optimistic. in scope. Part 12 - Selected Characteristics of New Mexico Culture Selected characteristics of New Mexico culture stresses the sociological factors in discussing the health problems because of the three different cultures within the state, namely Anglo, Chicano and Indian. Part 14 - Cancer Programs These documents are descriptions of plans and activities. In order to evaluate their proposals as segments of a program one needs more information -16- STAFF OBSERVATIONS (continued) about the problems they address, the alternative solutions to those problems from which these approaches were chosen and the reason for the priorities accorded these plans. For example, the ratio of annual cancer deaths to annual incidence or new diagnoses appears to be 1100 to 2500. Perhaps New Mexico already is approaching the American Cancer Society goal of saving 50% of cancer patients. A total of 2500 cases, even without correction for patients with multiple cancers is .0025% of the population, perhaps somewhat lower than the national average. The forthcoming development of new unusual radiation therapy resources and a related cancer center are calling attention to cancer in New Mexico, It is clear that these facilities will require patients and that their existence will change the patient referral patterns in the state and adjacent areas. The new centers will not reduce the State's medical resources, and they will pick up only a small fraction of the workload of the existing medical care system, For all of these reasons, one , must question the RMP priority of projects whose principal beneficiaries ‘to date seem to be future University-related oncological activities, and drug testing. The plans for both projects appear to have been designed along admirabie lines. Both strive to involve practicing physicians and existing hospitals. Both are thoughtfully detailed in procedure, The leukemia-lymphoma program seems to be developing its own registry, which seems to suggest that the Statewide registry cannot serve all the needs of therapists. The registry project seems to be rather costly, With a dozen accessions, and fewer than half as many deaths per working day, and its basic, tabu- ‘lations and printouts designed, the organization seems over-staffed at thirteen full-time and two part-time people. The account of the registry program gives little information on its performance. The usability and reliability of the data collected by its field workers, the performance of hospitals in providing the records, the trends in accession and losses to follow-up would be helpful parameters for assessment of the registry's chances of success. It would also be useful to know whether any changes in stage at diagnosis or patient referral patterns have occurred in the hospitals that have participated for two years or more. . The leukemia-lymphoma project also is costly. It would add $90,000 to an unknown current annual expenditure for a patient load of 225 now -17- STAFF. OBSERVATIONS (continued) registered to an estinated 400 or so. Not all of these patients would nenefit from this added cost, and much of the treatment would be experi~ mental, with investigational new drugs. It appears that the project mist rely heavily upon its clinical trial and research valves to justify its costs. If this is true, should it not be supported by research ‘ jnterests, rather than by a Regional Medical Program? Part 15 - Priority Health Care Wo information is presented regarding several critical areas: Methods to provide continuins support following expiration of RMP grant; uffectiveness of existing model system in addressing the target health problem; Local verification of the acceptability of the proposed approach; svaluation criteria. part 16 - Health Information Center ~ provides general information. part 17 - Community Rehabilitation Program This program seeks to enlarge the awareness of rehabilitation among. existing social and medical workers. To do this, it employs a five- specialist team which seeks to impart. both awareness and skills to local york-forces, on a community-by-community basis. In one area the team nas demonstrated to its own satisfaction that it can improve a community's awareness and utilization of consciously planned and administered rehabi- litative techniques. No before and after data are given to show the situation the fean found and the changes that allowed it to disengage with conviction that its mission was accomplished. The objective is admirable. As an improvement of the performance of existing resources, it appears to be a legitimate RMP objective. There 5s some doubt that the approach employed in the experiment recounted snould be continued, because it seems to this reviewer to be one that vould take a Long time Co cover the State. . The State-directed agencies should have been performing this function ail along. Could not the RMP reach more localities sooner by concentrating jes of forts on helping the State agencies tc be more aggressive. a -18- * I. SITE VISIT REPORT _ NORTHERN NEW ENGLAND REGIONAL MEDICAL PROGRAM AUGUST 9-10, 1972 CONSULTANTS William Thurman, M.D., Chairman; Review Committee Member; Professor _ and Chairman, Department of Pediatrics, University of Virginia School of Medicine, Charlottsville, Virginia 22901 Mrs, Florence Wyckoff, National Advisory Council Member, 243 Corralitos Road, Watsonville, California 95076 : Thomas Nicholas, M.D., Executive Director, Colorado-Wyoming RMP, 2045 Franklin Street, Denver, Colorado 80205 Mr. Roger Warner, Director of Planning & Evaluation, Arkansas. Regional Medical Program, 500 University Tower Building, 12th at __University, Little Rock, Arkansas 712204. | RMPS STAFF Miss Cecelia Conrath, Associate Director for Continuing Education and Manpower, Division of Professional and Technical Development Miss Sandy Flythe, Public Health Analyst Trainee, Eastern Operations Branch, Division of Operations and Development “ Mr. Spencer Colburn, Public Health Advisor, Eastern Operations Branch, Division of Operations and Development Mr. William McKenna, Jr., Program Director RMPS, Office of the Regional Health Director, Boston, Massachusetts 02203 Lyman Van Nostrand, Acting Chief, Planning Program, Office of ___. Planning and Evaluation NNERMP STAFF Mrs, Evelyn Biddle, Administrative Assistant Donald Danielson, Director NNERMP Edgar Francisco, Ph.D., Director of Planning & Evaluation Barbara Higgins, Community Health Research Associate Rayburn Lavigne, Assistant Director for Program Development Robert Liversidge, Assistant Director for Continuing Education . erine Lioyd, Research Associate ee Hat Gener! Regional Health Development Project Manager-Respiratory Michael Quadland, Community Health Development Activity Anthony Robbins, M.D., Director, Community Health Development Mrs. Mary Taylor, Manager, Cancer Program -Consultant to NNERMP _ Milton Nadworny, Ph.D,, Chairman of Department of Economics, University of Vermont NNERMP Regional Advisory Group Members Mrs. Priscilla Allen, M.D., Assistant Director Public Health Nursing for. state - Richard Bushmore, M.D., Welfare Department, State of Vermont _ Gerald Errion, Director, N.E. Kingdom Mental Health Services Reverend William Hollister, Consumer * Edgar Hyde, M.D., Private Practice, Northfield, Vermont * William Luginbuhl, M.D., Dean of University of Vermont Medical School, Burlington, Vermont * * John Mazuzan, M.D., Private Physician, Chairman of RAG ok, Hilda Packard, R.N., Director, Nursing Service Brattleboro, Vermont * Robert Richards, M.D., Private Practice, Springfield, Vermont Lois Smith, R.N., Hospital In-Service Educator, St. Albans, Vermont Barbara Taft, Housewife, Springfield, Vermont a M, Dawson Tyson, M.D., Represented RAG Member, Yasinsiki, Director, - WA Hospital, White River Junction, Vermont Joel Walker, Administrator, Central Vermont Hospital, Varre, Vermont ‘Keith Wallace, Consumer * Members of the Executive Committee - Others Sinclair Allen, M.D., Co-Director, RMP Respiratory Disease Management Committee oo Joan Blankenship, R.N., Project Director, Ambulatory Pediatric Program; Executive Director, St. Johnsburg Home Health Agency Richard Bouchard, M.D., Director RMP Heart Management Committee Stanley Burns, M.D., Director RMP Cancer Management Committee Garath Green, M.D., Co-Director RMP Respiratory Disease Management Committee | : David Miller, Executive Director, Vermont VHSI Jan Westervelt, Director Vermont Comprehensive Health Planning © Northern New England RMP ~3- RM 00003 Tl. IFRODUCTION The gite visit was in response to 4 triennial application from the HWERMP. The purposes of the site visit were to agsess the program's overall progress, its current quality, ite readiness for triennium status and a developmental component, and to arrive at a funding recommendation for consideration by the Rational Review Committee and the National Advisory Council on RMPs. Prior to January, this program devoted 4 great majority of ite time and energy to developing a deta bese for health planning and also in planning a single management system for RMP end CHP. With the data base, problems of accreditation and utilization continually occurred. With the management syetem complicated adminiatrative structures were considered but no administrative structure could be created that would allow linking the two organizations in & manner which would preserve each program's intended purpose, at least in the opinion of the Federal Government. To complicate the organi- zational problems even further, Vermont was the recipient of an _ Experimental Health Services Delivery System contract in excess of $900,000 for a two year period. ‘ Realizing that an acceptable management system could not be readily developed and that continued RMPS support for such a massive data. collection effort was unlikely, the program began formulating a more “traditional” RMP in January under the new jeadership of Mr. Danielson. A reader of this document should keep in mind the infancy of the. nev program at the time of this site visit and the influence this stage . ‘of maturity has on the findings, opinions, suggestions, and recom- mendations contained within this report. ITI. PERFORMANCE l. Goals, Ovjectives and Priorities Due to the infancy of the HWE Program as & "program", goals, objectives and priorities have not yet been developed and explicitly stated. The bylaws of the RAG, and the application for triennial support refer to program goals as being. ones of improving accessibility to medical care, enhancing quality of care, and increasing efficiency and efficacy of medical care delivery. These are considered as areas of concern stated in a very broad and global sense thet cannot be interpreted, or accepted, ee standards against which to make policy and funding decisions. Northern New England RMP -4. RM 00003 ‘It is considered, however, that the program 4s now on the fringe -of making a constructive move in this area and a significant impact within the next 90 to 120 daye should occur. They have deta from which a problem list is presently being developed, the "beginnings" of what appears to be necessary for the establishment of an active and effective RAG, and a program staff cognizant of the immediate need for explicit but appropriate goals, objectives and priorities. These are all positive factors which should lead to improvement goon in this area. This is not to say, though, that the site team ‘4s not without concern for in discussing this subject during the visit, it became apparent that RAG, the technical committees as well as steff in the region, do not share a common concept of how goals, objectives and priorities are to function. The program staff seems to understand how goals, objectives end priorities should be used in policymaking, decisionmaking, evaluation, ete., but some (the Chairman of the RAG in particular) did not appear to have this game understanding. There was extensive discussion about this point both during the formal and informal sessions and there is reason to believe that a unanimity of understanding will soon develop. Even though it is mentioned above that the RAG has the "beginnings" of being an effective group, it also is not an area without concern. As discussed later in this report under Regional Advisory Group and Minority Interest, there igs. concern that the present RAG membership . : is not. representative of all desired factions. Notably, consumer — and community groups, and allied health personnel are lacking representation. If the goals, objectives and priorities are to accurately reflect the region's needs and problems, all desired factions should be represented in their formulation. 2. Accomplishments and Implementation The major accomplishments have been the development of the Regional Disease Management approach and the development of a deta base for - health planning. Regional Disease Management is a committee approach to heart disease, cancer, and respiratory disease. Of these three committees, heart is the most developed, data has been.collected, professionally analyzed, and standards and guidelines have been developed for treatment for coronary care- When considering the effectiveness of the disease management commit- - tees, it is encouraging to note the acceptance of the committee's recommendations by providers as well ag acceptance of “updating” changes recommended by the committees through their continuing eval- vation and updating of etendards process. Borthern New England RMP ~5= RM 00007 Eech committee is free to organize itself into subcommittees and task forces, but generally develop along the lines of standards and guidelines for treatment, educational requirements, and information systems. Additional committees in emergency medical service systems, kidney disease, and other problem areas of disease and health care delivery are planned. The Regional Disease Management approach is considered a substantial program accomplishment because it serves as mechanism for stimulating worthwhile activities, provides a vehicle through which to replicate successful accomplishments, and functions as a means for promoting wider application of new knowledge and techniques. However, these committees need a functional operating plan, bylaws, and a definite scheme for approaching their mission. In the past, the management committees have been the influential force in the RMP advisory structure so it is anticipated that with their predominate catagorical emphasis, difficulties will develop as the "new" RAG now begins to assume its leadership role in formulating a total program designed with a comprehensive emphasis. In the absence of a functioning RAG, these committees were the only way of obtaining “provider” input in the RMP. It is important that the management committees understand the strengths and limitations of their role in policy development and decisionmaking. fhe data base for health planning unquestionably holds a potential for enabling more rational decisions as to how the health care system should be managed and what standards and guidelines for treatment are more efficacious. The data base has been the source for many reports, papers, and the like, published by the program (a list of which is appended to this report). Also, there is evidence that the data has-been used by others concerned with health _ care problems such as Comprehensive Health Planning "a" and "bp" agencies, the Experimental Health Services Delivery System (HSI), @ developing HMO, etc. Yet, in this same connection there is evidence thet a number of parties concerned with health care delivery pro- blemsa are not users of the data and in fact in some inetances may not even be aware of its existence. : The site visit team is awere that the data will soon (September 1972) be funded and maintained by a separate independent organization; but, nevertheless, believe the RMP has to assume some continuing respons- ibility in solving the problems of developing a utilization strategy for the data. In many ways this program is considered to be one in which Northern Hew England RMP -6- RM 00003 “accomplishments have peen few; there has been Little effect on . > monitoring costs, and aside from the program emanating from the management committees, there has been little impact on the improve-~ ment of the quality of care. Again, however, the site team is comfortable with the impression that progress will be achieved in the future. 3. Continued Support There is not 4 firm policy on continued support. The issue of continued support is formally addressed in the technical review criteria and there is substantial evidence thet emphasis is given to continued support during the planning, developing and reviewing of proposals. k. Minority Interests Due to the fact that there is no significant ethnic minority in Vermont, the reviewers chose to use the tern "minority", divested of racial connotations, and to refer to the poor and medically underserved sector of its population. The total minority population (Blacks, Indiens, Japanese, Chinese, and others) constitutes 0.4 of 1% of the total population. From census data it is estimated that one-fourth of the population of the State have French as their first and in many cases, only language. ‘Regardless of the small number of minorities, the site visit team feelea that the RAG should- pe more representative of the total population served by the program. It was indicated by the RMP that the membership of the RAG will probably be increased by ten in the near future. The team, there- fore, suggested that these additions should pe chosen with the idea of adequate representation of all aspects of the population as well as other local interestea in mind. On the program staff there are no minorities and there are no women in top-level decisionmaking positions. Probably more surveys have been done in this region than in any other to assess the health needs, problems, and utilization of services of minority groups, but very few "true" consumers have been consulted in formating study designs of interpretation of the data, or in action plans. o Northern New England RMP -T- RM 00003 IV. PROCESS lL. Goordinator Considering the process of transition through which the Northern New Engiand RMP has been going, the new Coordinator seems to have done a commendable job. Donald Danielson was appointed Director of NWERMP in January of 1972. The previous Director, John Wennberg, resigned to become Director of Research and Development of Health Systems Incorporated, the recipient of HSMHA Experimental System's contract. During the following months, Mr. Danielson has reorganized the Regional Advisory Group to make it a separate functioning body for RMP, hee revised the program staff structure and begun to hire some new people, and put together the current application. He seems to have developed a good working relationship with the Regional Advisory Group and there was generally good interaction with the Chairman of the RAG, Dr. John Mezuzan. 7 It did seem apparent to the site tean that a deputy director was ‘needed. Mr. Danielson said he was in the process of recruiting for such, and that he would be a health professional rather than _ & management-type, a8 this seemed to be where the staff structure © needed strengthening. 2. Program Staff The program staff has been reorganized to reflect the movement of the large data effort to Health Systems, Inc. The data pase staff of 11 people plus secretaries has been dissolved, with some moving into other positions in RMP and some going to HSI. fhe reorganized structure now includes two major staff functions and two major line functions. Staff functions include planning and evaluation, making use of the date base built by the RMP, and educational activities support, which will help in educational design and evaluation in support of local project efforts. ‘fhe two mjor line divisions are: (a) Health System Development and Demonstration Staff - Designed to put together a commmity health development support Northern New England RMP -8- RM 00003 capability which can work with local areas in developing coordinated health services. A young M.D., Anthony Robbins, has been hired to head this division. (b) Regional Program Development Staff - Responsible for staffing the disease management committees and task forces, which currently include heart disease, cancer, and respiratory disease. Others proposed are in emergency medical systems and kidney disease. This staff is also responsible for the program management of the projects in this area. The site team felt that the program staff at present is heavily manage- ment-oriented, and that there is a significant need for nursing and allied health personnel on the staff, to provide a broader range of professional and discipline competence. The team also thought that staff was needed in the areas of health system development and community organization, to provide a stronger alternate. focus to the categorical interests. Efforts at keeping the medical com- . munity and public informed of RMP activities might also be strengthened. The program staff currently employed was essentially full time. 3. Regional Advisory Group The process of reshaping the Regional Advisory Group seems to be moving along well. The RAG was merged with the State Comprehensive Health Planning Board in December 1970, to form a single planning and manage- ment decision group for the state. This proved to be unacceptable to RMPS at the national level, so that in the latter half of 1971, RMPS and HSMHA specifically indicated that functions assigned to RMP, CHP, and the Experimental Delivery System (HSI) must be separated so that each could be given appropriate attention. An RMP Study Committee then went to work to re-establish a separate RMP Advisory Group, and adopted bylaws for the new RAG in February 1972. . O The. new RAG currently has a membership of about 30, with the expectation that it will be expanded to 40 in the near future, The site team noted that specific areas of representation that need strengthening are nursing and allied health personnel, consumers, VA Hospital and possibly some of the economic and local political interests, and _representation of the areawide CHP agencies. In this connection, the site team also brought up the question of the status. of the three New York counties around Plattsburgh which the Vermont RMP sometimes claims responsibility for. The team stated that Northern New England RMP ~9= RM 00003 1f this area was to be considered part of the NNERMP, then they should be represented on the RAG, On the other hand, if it was determined that they really related more to the Albany RMP, it might be better to make that clear, so the situation did not remain in limbo, The team made it clear that from a-RMPS standpoint, there was no objection to the NNERMP releasing its partial claim to that New York area. The RAG is structured to meet four times annually and to-date the meetings are very well attended. The new RAG has played a very active role in setting program policy. The site team made it clear, however, that both the RAG and the staff needed to initiate a much more defin- itive process of setting specific objectives and priorities. Otherwise, the objectives are tending to be set by the Regional Disease Management Committees, which are strictly categorically-oriented, rather than looking at the problems across-the-board. The RAG does have an Executive Committee which has been meeting frequently and which has a wide base of representation. 4, Grantee Organization The University of Vermont is the Grantee Institution for the NNERMP. Relationships seem to be generally good with the grantee permitting sufficient freedom and flexibility to the RMP. There was some question raised about the policy of submitting the names of proposed RAG members to the President of the University for concurrence, especially in light of the new RMPS policy statement on RAG/Grantee relationships. : The RMP, concerned about the overhead charged the program (currently 70.2% of salaries and wages), is moving its offices to an off-campus site to achieve a lower rate (46.7% of salaries and wages). The grantee supports this move. The site team also noted errors in the method of filling out Form 15 (Operational Activity Summary) and Form 16 (Financial Data Record) of the RMPS application form, On most of these forms, the NNERMP listed the University of Vermont as the sponsor institution, and on many listed a program staff person as project director. This gives the: distorted picture that most funds are flowing to the University of Vermont, which is not the case. The RMP was requested to correct these forma to.show who was actually running the project. a An additional question was brought up on the advisability of asking for specific medical school review and comment on project applications. This seemed to duplicate in some ways the work of the technical review committee structure. Northern New England RMP -10- . RM 00003 5. Participation There seemed to be evidence of close interaction with some health groups and interests, but a lack of involvement with others, It was noted that particularly on the Regional Disease Management Committees, physician influence was dominant. It was suggested that these groups in particular needed a broader range of repre- sentation, including nursing and allied health interests, and possibly some public or consumer involvement, Although the volun- tary health agencies are participating, it was felt that this aspect could be’ strengthened, as well as greater involvement of the State Health Department. It was also felt that the economic and local political elements could be more significantly involved. 6. Local Planning The NNERMP seems to have developed good working relationships with the two areawide CHP agencies that exist in Vermont: the Northern Counties Health Council (Northeast Kingdom), and the Connecticut Valley Health Compact. It is expected that three more planning areas will be developed in the future. The large data base which RMP developed proved to be a helpful rationale ¢ in the definition of medical trade areas. The data on patient’ flow : patterns and utilization of services was particularly useful in defining appropriate sub-regions for planning purposes. There seems to be an adequate mechanism for obtaining CHP review and comment on RMP proposals. Both the State CHP agency and the two. area~ wide agencies provided comments. It is not quite certain the extent to which the RAG took these comments into account in making their final priority rankings. * 7. Assessment of Needs and Resources The data base developed by NNERMP is probably one of the best in the country. The general analytical approach was the development of the following indices: population needs and characteristics; community characteristics; resource investments (manpower, facilities, expen” ditures); utilization of services; and end results. This base has provided a good source for identification of problem areas and resources available. It has been particularly useful in development of categorical programs by disease management committees, particularly 80 in the area of heart disease. © Northern New England RMP ~ll- RM 00003 The major concern is now that the data effort is being moved into Health Systems Incorporated, will the RMP develop a working linkage so that the data continues to be available for a more action-oriented approach to using it. The site team mentioned that some mechanism should be established to make certain that the data continued to prove useful to the RMP in its planning and development activities. 8. Management A RMP staff member is assigned management responsibility for each project. Each manager must work with the project director and the Director of Planning and Evaluation to develop a work schedule and the points at which project acitivity may be measured and evaluated. Periodic progress and expenditure reports are required at least quarterly for all projects. If difficulties are noted in development of the project, the Director of Planning and Evaluation and other staff are to provide assistance to get these solved. If the rate of expenditure is low for a project, funds will be diverted to other uses. It is difficult to tell at this point how well the program staff activities are coordinated. This component of the program may be analyzed more easily after the RAG sets some more specific objectives and priorities, and after exieting staff vacancies are filled. 9, Evaluation In addition to the management reporting process, an evaluation process has also been designed. It has not really been tested to date, how- ever, so it is rather early to judge it. The program does have a full-time staff person for planning and evaluation, and will probably be hiring an assistant in. this area. Two mechanisms are used to provide feedback on progress to:RAG and other appropriate committees. The first is that a project director submits a quarterly report to the RAG stating progress made concerning project ovjectives for that period. The second involves peer review site visits which may be called for by: (a) the Director of Planning and Evaluation; (b) a disease management committee; (c) the Executive Committee; or (d) the RAG. There is also an annual evaluation of each project, whether or not the project is subject to renewal during the following year. On the basis of the proposer'’s annual report and materials provided by staff, evaluations will be made by the appropriate disease management Northern New England RMP o12- - RM 00003 committee and the Executive Committee. These groups, after examining characteristics of. the project which contributed to its success or failure, will be asked to recommend whether or not such activities should be replicated in the region, and whether similar projects ~ should be considered for future funding. There appears to be no line of direct responsibility from those con- ducting the overall ongoing evaluation to the Director of Evaluation. Such an organizational arrangement would clarify the responsibility for the continuing evaluation activity. Considering the reorganization of the NNERMP review process and RAG, it is too early to determine whether this mechanism will convert unsatisfactory results into program decisions and modifications’. The RMP needs to develop for both its own benefit and for that of project directors, a specific procedure relating to the phasing out of unsuccessful or ineffective activities. V. PROGRAM PROPOSAL 1. Action Plan The NNERMP has not, as yet, established goals, objectives and pri- orities. However, they recognize the need and understand the importance of developing a framework of goals, objectives and priorities. The site visit team stressed the need to convert to a program related to the RMP's mission statement. Mr. Donald Danielson, Director of NNERMP, stated that ranking of priorities will occur in the very near future and that these priorities will be congruent with national goals and objectives. The activities now being proposed by the region do relate to their approach toward new priorities, objectives and needs. However, the team is concerned that though the 20 proposed projects have several common objectives, there is need to tie these related efforts together so that the resources have a greater potential for changing the health. care system than if they are left as isolated activities. For example, all seven cancer proposals have a high proportion of effort devoted to cancer education of the health professions and the public, but they are proposed as seven separate independent activities. Likewise, the five heart proposals have a high proportion of effort to education of health manpower and the public, but they are also independent of each © other as well as of other RMP proposed activities. Infant and Mother Care which carries the top priority ranking by the region does not relate to other RMP activities. . Northern New England RMP -13- RM 00003 Seven discrete categorical areas are to be used as part of a. consumer education program using the extension serivce network, but there is no consolidated approach or stratégy by the heaith providers to use this resource to achieve maximum benefit. In four categorical areas, i.e., respiratory disease, cancer, heart, and cerebrovascular rehabilitation plans are proposed to establish and adopt procedures to improve patient care management within com- munity hospital. No interface, exchange, or strategy is suggested or considered. In summary, this RMP is in danger of fragmenting its staff effort and its resources by its heavy concentration on cate- _ gorical approaches and thereby loosing the promise of a program change to improve the system of health care delivery. Attention to the whole instead of individual bits and pieces is essential if the change promised in the reorganization is going to be fulfilled. The Regional Management Committees on a categorical base must interface and inter- lock with RMP goals and objectives or there is danger of a traditional old-line chronic disease progrem being developed. The program might well consider consolidation of some of its proposed activities when the actual program to be implemented is determined. The planned and proposed activities are realistic in view of the resources available and past performance. Abundant data exists on the region's health problems and resources so that criteria for setting priorities becomes all the more important in this regione yo The team was told that methods for reporting accomplishments and assess- ments have been proposed. Evaluation teams plus managers have a commitment to the reporting process So that accomplishments and results can be easily measured. The Director also indicated that though 4 priorities had not previously been viewed and updated periodically, it will be done in the future. . 2. Dissemination of Knowledge. In regard to including other groups or institutions that will benefit from data, the team finds that these groups have been targeted and that they will be further involved in the future. Knowledge, skills, and techniques to be disseminated have been identi- fied in some areas, but not yet developed in relationship to community affairs with the exception of the ambulatory pediatric program. Once implemented and developed, there is little doubt that they be dissem- inated in the region. . The site visit team is concerned that the RMP seems to be operating singularly and not in conjunction with other organizations and research ’ Northern New England RMP ~14- RM 00003 institutions in the area excepting the University of Vermont and those hospitals with coronary care units. Other health and edu- cation providers have not yet become involved and there is evidence that they had not really been interested in becoming so. This, most likely is because the past RMP strategy has been preoccupied with data gathering and not action, Improvement is expected in this area under the new program thrust. . The team is in concordance in thinking that while the RMP has not shown any evidence of improving quality of care other than in coronary care or moderating costs, this will be a by-product as the program moves on. The approach to dissemination of knowledge about applicable, practical techniques is very significant at this point in time. For example, the use of referral centers has been well established and help by RMP should continue in the future. 3. ‘Utilization Manpower and Facilities Utilization programs are not yet far enough along within the region to comment on except to say that there are a limited number of pro- grams in a limited number of. community health facilities. These are all well utilized and will most likely improve in the future. We saw no evidence that there has been increased productivity of health manpower other than physicians and possibly the utilization of ‘nurse practitioners. The region, however, understands utilization problems and is beginning to move in this area, although, implemen= tation has net actually occurred. 4, Improvement of Care The RMP has identified the. problems of expansion of ambulatory care and the geographic areas requiring attention. Current and proposed activ- ities will expand ambulatory care and other needs. In reference to communication, transportation services, and others, the RMP is doing well as can be expected. They are available but often are not well used nor do people understand how to use them. The EMS is an excellent example of what can be done. Problems of access have been jdentified and solutions are in project form. Current and proposed activities will strengthen primary care. Underserved areas are beginning to receive attention in one or two projects. As the RMP moves more fully into a services, more involvement of the underserved areas will occur. ‘ There are some health maintenance and disease prevention components, but these are not yet a major emphasis in this particular RMP. We Northern New England RMP -15~ RM 00003 can see that they will be in the very near future. Health mainten- ance and disease prevention components and plans are considered realistic in reference to the present state of the knowledge. 5. Short-Term Payoff Operational activities will increase the availability and access to: services over the next two to three years. The need for feedback to measure payoff is understood, is documented, and is well estab- lished in the new evaluation mechanism. It is reasonable to expect that RMP support can be withdrawn over the next three years in most instances. 6. Regionalization With respect to regionalization, the team found that plans and activities are aimed at assisting provider groups and institutions. Greater sharing of facilities, manpower and other resources is definitely envisioned in their planning and projects at this point in time. Existing resources and services will be extended and made available to other areas. New linkages will be established among health practitioners and institutions. Progressive patient care is also a definite part of their planning and has already’ been demonstrated with coronary patients. 7. Other Funding There is little question but that the region has already attracted funds other than RMP and will continue to do so. Most of those have been state and federal, but some local and private funds have been involved. The region has, it was indicated, definite plans for bringing in others. RMP activities have been definitely related to other federally funded health programs and have furnished the’ base for much of their activity to date. This is particularily evident with Comprehensive Health Planning, Experimental Health Service Delivery Systems, Health Maintenance Organizations, and the Federal-State-Local Health Statistic Center. Cope Northern New England RMP — l6= RM 00003 SUMMARY | Taking into consideration the history of this program with its preoccupation on data gathering and efforts to organizationally merge RMP and CHP, the site visitors were favorably pleased with developments since January when the RMP decided to devote its energy to developing a viable RMP. The site team recognized the infancy of the program reviewed, the fact that many elements of the program are untested, and that for the most. part the NNERMP is a "paper" organization. Yet, based un the quality of the materials assembled and with an insight to the management capabilities of the program staff, the visitors were impressed with the progress to date and believed prospects for continued development are good. . . In light of the above remarks, however, the site team has the following suggestions: - _ The goals and priorities need to be further defined- and more. explicitly stated. Ideally, the time frame on this is for . accomplishment in the next 90-120 days. . | The Regional Advisory Group needs to expand its membership to include better representation of youth, minorities (as interpreted under Minority Interests of this report), the medically underserved, areawide planning agencies, allied health, and representatives from the bordering areas of New Hampshire and New York if it is established that these areas are indeed appropriate territories of the NNERMP. Con- sideration should also be given to the appropriateness of the economic and local political interest having representation. . ' ‘The RAG should consider establishing a subcommittee structure aligned with goals, once goals have been developed. . | The composition of the disease management committees, ad hoc i groups, and technical review committees should be examined } closely to insure appropriate representation. At this time, | there is concern for over representation of physicians,. thus limiting constructive input from other providers or persons . knowledgeable on health care problems. . | Also, measures should be taken to assure that these groups are supportive of the program's evaluation plan. The disease management committees should have bylaws, or another ' similar management tool, to align their functional operation plans with the total program. Northern New England RMP -17- RM 00003. . Consideration should be given to developing management com~ mittees for non-disease areas of interest to RMP such as community health. . The approval and disapproval mechanisms for projects should be more clearly delineated. , The evaluation scheme should be re-examined to give further assurance that the RAG and program staff each understands its respective roles in review, evaluation, and feedback. This should minimize potential conflicts. Also, organizational changes should be made coordinating all program staff performing any evaluation with the Director for Evaluation. . The vacant program staff positions should be filled with persons that will provide the program with a broader range of professional and discipline competence. Nursing, allied health, health system development, and community organization are specific suggestions. e . The program should look at all their proposed projects and relate common objectives so that the resources have a greater potential for effecting constructive change of the health care system. The RMP still needs to assume some continued responsibilities for making the region aware of available data, and to assist in the development of a data utilization strategy. A formal policy on continued support should be established. The surveillance and monitoring devices of projects should | include a method for prematurely phasing out unsuccessful or ineffective projects. Each of the above points were discussed at the feedback session at which the Program Staff, the Dean of the Medical School, the Chairman of the RAG and several other RAG members were in attendance. In addition to presenting the above points at the feedback session, the following advice was given with the belief that it may serve to improve the program's presentation in future applications: , The forms 15 and 16 should each reflect the same project sponsor, and this should not necessarily be the grantee institution but the institution or agency at which the project is being coordinated and actually implemented. Program staffs' discipline, professional competency, speciality, or area of interest be identified. Northern New England RMP -18- RM 00003 . A problem-solution chart be included in the program report. ‘ - The role of the project managers and the project directors be clearly identified so that potential areas of conflict for decisionmaking are handled in advance. RECOMMENDATION It is the site visit team's recommendation that triennial status not be granted at this time, but that the program receive two-year approval, with developmental component rights, at the level of $850,000 each year. It is further recommended that there be a site visit next year to determine progress, re-evaluate the second year funding level, and again determine the program's readiness for tri- ennial status if in fact triennial status is again requested. With this recommendation there is one restriction and it is with the continuation request for Project #6, .A Program in Kidney Disease. The presently approved levels for this project's second ‘and third years are $37,900 and a $25,400 respectfully; the requested levels are $78,740 and $70,000 respectfully. Because there is ac change of scope of the activity and there has been no re-evaluation by a technical review group, that would satisfy review-of-kidney- proposal-requirements as set forth in the May 3, 1972 NID, it is the recommendation of the site visit team that the present level of approval remain. If RMPS wishes to investigate this situation further «nd it is decided further evaluation of this situation is merited, the site visit team has no objection. Northern New Engiadd RMP -19- RM 00003 © APPENDIX I Northern New Engtadd RMP -20« RM UUUUD NORTHERN NEW ENGLAND REGIONAL MEDICAL PROGRAM PUBLICATIONS LIST A. Published by the Program "A Comparison of Utilization of Selected Health Services . by Various Age, Income and Education Groups in the CVHC Area." January 1971. A Connecticut Valley Health Compact Report. "A Layman's Look at the Working Paper of Health and Medical Care Resources." Spring 1970. . "A Report on Cancer in the Vermont Region." February 1971. "A Report on Kidney Disease in-the Vermont Region." 1971. May. 1. A Report on Prepayment in Vermont 2. A Report on Respiratory Disease in the Vermont Region 12/71 3. A Report on Stroke in the Vermont Region 4, A Report on Vermont Hospitals 7/71 "A Report to the State Health Planning Advisory council." April 1971. Basic demographic data. "A Working Paper of Health and Medical Care Resources." November 1969. Connecticut Valley Health Compact Report. 1. An Inventory of Health Manpower in the State. of Vermont 6/72 2. an Inventory of Health Related Educational Programs in The State of Vermont 6/72 "Background and Methodology of the CVHC Area." August | 1971. A Connecticut Valley Health Compact Report. "Children's Immunizations in the CVHC Area." August 1971. A Connecticut Valley Health Compact Report. "CVHC Results: Mental Retardation." July 1971. A Connecticut Valley Health Compact Report. "Coronary Care Network Newsletter." Published bimonthly; first issue: October 1970. "Demographic Characteristics of the CVHC Area." January 1971. A Connecticut Valley Health Compact Report. “Pamily Planning Patterns in the CVHC Area." August 1971. -A Connecticut Valley Health Compact Report. l. Identification of Major Health Problems and Needs in Vermont 5/72 2, Thixteen Individual Home Health Agency Reports’ 9/71 3. Eighteen Individual Hospital Reports Northern New England RMP -21- RM 00003 "Infant Mortality in the CVHC Area." August 1971. A Connecticut Valley Health Compact Report. 1. Inventory of Health Care Services and Facilities in Vermont "Knowledge, Need and Use of Home, Health, Mental Health and Related Services." January 1971. A Connecticut Valley Health Compact Report. "NNE/RMP Health Planning Data Base." Winter 1970. "Northern New England Regional Medical Program" (newsletter). Published bimonthly; first issue: February 1967. "Patterns & Utilization of Health Services and their Economic Implications in the CVHC Area." August 1971. A Connecticut Valley Health Compact Report. "Patterns of Use of Hospitals & Preferences for Hospitaliza- tion," April 1971. A Connecituct Valley Health Compact Report. 1. Physician Manpower in Vermont 10/71 "Projected Impact of Health Maintenance Legislation in Vermont." May 1971. Le. Report on Health Care in Vermont (Layman's Version of "Status Report..") 8/72 Revised 2.: Report on Vermont Home Health Agencies 9/71 "Setting of Health Goals in Vermont: Problem in Political Science and Technology of Planning," presented at the llth Annual Institute of Management Sciences, Los Angeles. October 1970, "Smoking History and Behavior of the CVHC Population." August 1971. A Connecticut Valley Health Compact Report. -l. Standards & Guidelines: Vermont Coronary. Care | Network "State Health Planning Advisory Council By~Laws." January 1970. For the Combined Regional Medical Program and Comprehensive Health Program Boards. "Status Report of the Community Health Systems of ‘Vermont." (Technical Version) August 1971. "The Consumer's View of the Health Care System and Health Insurance." April 1971. A Connecticut Valley Health Compact Report, Northers New Engkadd RMP 1 2bee RM 00003 "The Northern New England Regional Medical Pregram Health Planning Data Base."’ Paper presented at the ‘Northern New England Regional Medical. Program Conference and Workshop on Evaluation, Chicago;,September 1970. 4 “Utilization of Dental Services in the CVHc." January 1971. A Connecticut Valley Health Compact Report. . "variations in Patterns of Medical Care in the Vermont Region for the American College of Surgeons, Regional Meeting." September 10, 1971.- Burlington, Vermont. B.. Published Nationally and. Locally "HMO Hearings Begin," Legislative Roundup. July. °23, 1971. . a . "HMO Strategy Would Increase.Cost of Care in Vermont, Study Shows," NHI Newsletter. ‘June 7, 1971. . "How One Regional Program Looks," Modern Medicine. March 1966. 4 Lo Oe Review Cycle: 10/72 RMPS STAFF BRIEFING DOCUMENT REGION: Northern New England OPERATIONS BRANCH: Eastern NUMBER: 00003 Chief: Frank Nash COORDINATOR: Mr. Don Danielson Staff for RMP: Spencer Colburn LAST RATING: Unrated TYPE OF APPLICATION: 3rd Year /-X7 Triennial / _/ Triennial Regional Office Representative: . William McKenna 2nd Year 1_/ Triennial {7 Other Management Survey (Date); Conducted: or Scheduled: October 1972 Last Site Visit: (List Dates, Chairman, Other Committee/Council Members, Consultants) October 1968 ~ (Program Site Visit) Dr. Proger, Chairman, Dr. Storey, Robert Lawton December 1970 - (Technical Assistance Visit) Dr. Mark, Chairman, Drs. Delon, . Keller, and Komeroff Staff Visits in Last 12 Months: (List Date and Purpose) February 1972 ~ To establish a channel of communication with the new coordinator, discuss regional development plans as well as coming site visit. June 1972 - To attend first meeting of new RAG, and to clarify questions, regarding the scheduled August site visit, review verification visit and management assessment visit. Recent events occurring in geographic area of Region that are affecting RMP program: EHSDS Contract F-S-L Statistic Grant (presently under eonsideration) - 2? - Region: Northern New England. Review Cycle: — Octon: October “19 gee “ I. REGIONAL CHARACTERISTICS * — = SSOGRAPHY ro 7 et | 7 ¥ FRANKLIN oe ORLEANS . , : ¢ ‘ § ESSEX _ LAMORLLE CALEDONIA WASHINGTON MONTPEUER ene cease —s ORANGE TEP TEE. ADDISON ONE ATLARGE~ (Mary Hitchcock Hospital- Mav ef Gor Center Hospital) i , " , - @Hanover, N.H. fi Map 0 ngressiona istrict } RUTLAND L, WiNDsoR Counties, and Selected Cities ay * . Mt il (1 At Large) is u ak pv NY | wi SENRINGTON WINDHAM HEW Regional Office 1 Regional Delineation State/ Statess Vermont and 3 N.Y. counties Counties: 14 Congressional Districts: 1 Puwnawtanl takawFaane A anuntine Alhany RMP. POLITICAL INFORMATION Governor: Deane C. Davis (R) George D. Aiken (R) Robert T. Stafford (R) Senators : Representative: Richard Mallory (R) DEMOGRAPHIC INFORMATION Population characteristics: Total: 444,732 % Urban: 32 % Non-white: 0.4 of one percent Age Distribution (%) VT. Under 18 yrs. 35 18-65 yrs. 54 65 yrs and over | 11 Average Income per Individual $3,267 Mortality Rates (CY 1967) Heart Diseases 435.5 Cancer : 173.9 Vasc. Lesions 117.5 All Causes, all ages _ 1085.4 Facilities and Resources: Schools Number Enrollment (71/72) Region: Northern New England Review Cycle: 10/72 _ U.S. 35 55 10 $3,680 364.5 157.2 102.2 1143.5 Graduates (72) Medicine (UVM) Nursing Practical. Nursing Cytotechnology Medical Technology Radiologic Technology NEE SE k * * * * k Hospitals Nonfederal Short Term 18 Nonfederal Long Term 3 V.A. General Hospital 1 288 66 523 ; 108 106 94 (Med. Center Hospital, Burlington) _ (UVM) * *® * * * Number of Beds 2,244 2,325% 200 *Plus 42 beds in respiratory disease unit at the Med. Center Hospital, Burlington. x x *& *& & * Special Hospital Facilities Number Intensive CCV - di Cobalt Therapy ~ | Isotope Facility 3 Radium Therapy 3 " Renal Dialysis, in patient 1 i Rehabilitation, in patient 3 ;| £4 x x x zt ok x * x * x i Nursing and Personal Care Homes (1972) . ; e Number of Beds : Skilled Nursing Home 869 i Personal Care Homes with k -Nursing Care 1311 . . Long Term Care Units 1043 E * x & * * * * * * * Manpower Profession one “Number Physician - Active 644° _ Inactive 32 General Practice 218 Medical Specialties 150 Surgical Specialties 69 Other 207 Osteopath 33 Nurses - Active 2373 Inactive 955 LPN. - Active 1067 Inactive 316 COMPONENT AND FINANCIAL SUMMARY TRIENNIAL APPLICATION Region Northern New ©: Review Cycle 10/72 . Comaictee Recomachacciun for Current Annualized Reauest for Triennial Council-Apnroved wowed Component Level 03. Year Ast year | 2nd year | 3rd year, ist year | 2nd year ; sre yea OGRAM STAFF $ 397,578 $ 462,368 | $ 480,000]$ 500,000 NTRACTS - . ¢ VELOPMENTAL COMPONENT 114,617 | 114,617} «114,617 ERATIONAL PROJECTS 328, 389 “c1. 683,804| 451,720, 416,636 Kidney ( 78,740 | ( 70,000) ; ‘ i, _ EMS ( ) hs/ea C ) Pediatric Pulmonary ( ) , Other C JT . - ; T ct TAL DIRECT COSTS 725,967 $1,260,789 [$1,046,337 | $1,031, 253 JUNCIL’ RECOMMENDED ‘LEVEL af a ; t | ; Ty oe aia hin a ata nine oe eee see ec arene ne ee rma ———— AyGuUsT 251972 REGICAAL MEDICAL pHLCRANS SLFVICE ; le > ~ a moe = FUNDING HISTORY UT st a REPSHOSPHITCEFE ZO 5 REGION 03 N NEW ENG RMF SLPP YR 03 CPERATICKAL GRANT (CIRECT COSTS CNLY} ALL REQUEST AND AWARDS AS CF JUNE 20s 187 ‘ ? = AWERCEC AWARCED AWARDED AbayUED ** RECUESTEC RECLESTEL REQUESTED FECUESTEL a ———egepcnen CEC gu oe ee eg oe ‘ AC TITLE . CO/T 1-12/ 72 TCTAL oe OL/T3-12/732__O1/74- 12/74 C1/75<12/75 TOTAL 10 —_—h— — i ~ n CCCO PROGRAM STAFF $S67CC 389200 659978 1645878 —#* 4623€8 480CCC eccccc 1642368 2 —DOOO TEVELTFN ERT AT C ¥4 T1467 TV4617 TV4617 345857 oc2 PRCGRESSIVE CCR 194400 120000 1£6423 470823 0047 PROJECT IN CONT T2eECv erect" "96261 3OlT6Y #8 : cos KICAEY FFCJECT £526C Ee26C #8 78740 70000 148740 — OCT ENS TNCHEPSING : — 200 12060, —** ~e ~ ~~ : , 009 #IGH RISK INFAN : ae _ T0298 §525C 46402 172056 : V1 MECTCKALTZED CE at 33200 3OS27 38440 110567 : Ol1 AECICNALIZEO RE bad A5752- a5216 5341 224378 oo OL APBULATACY FECT +e 47616. 47616 013 CANCER PROTOCOL o* 11065 11655 1a REGIONAL TZEC RE oe 19714 37285 31559 66556 ‘ O1§ AP SMEAR FEAST oe 26228 29238 SYS CONTINUITY OF © - + sCK27 20 3eT 2CCES ycese O17 RECICNAL CARCER + 47204 28199 29952 104355 ere TPLALIC ECLCATIC , ae 24364 35726 ~~—«3L4S2 a5595—OSOCSCS~S~S OL9 ELECTRICAL SAFE oe 31797 : 31797 —p2e7 Eariy 1C CF CBA . —'# 2264E “4Z5C6 6T152 132306 O21. PROFESSIONAL ED 4 50229 40522 43416 134577 G20 UPGRFITIRT EFERCT ae 26030: 39515, «22959 82504 ‘ 023. KEW TECHNICLES _ - we 80520 $0920 3 077020 TCOMMUN ICATIONS - re 7 4 1750 ° 1759 3 3 ozs stRertcccccat c _ __*t. 368C 3690 z —o267Carnorec TC CAR ~~ oe 3060 74CCC 7650 i 027 rEALTr ECUCATIO ‘8 22082 29654 31790 - 83556 i . ee - TOTAL =~ $15606 590200 | (1040012 2545812 oe 260788 ____ 4216337 1031253 3468379 - A . 4 1Z . “ eo eee wee —_—— . em eee ee em es ems = 2 1c . $ =~ s . ~ _ . 7 ; - $ oo 4, ~ ~~ ~ ~— , FF : if JULY 1791972 REGIUN © N NEW ENG HREAKOUT OF FF OUI ST RM 00003 16/72 PAGE 1 Wy PH A ree dine rir a ohare eters 8 5) (4) 62) ; LOSUTYPPOATION CE COMPINENT oF Cont. WwITutng conte FRE YOND| APPR, NOT fo NT Wy NIT J EST YFAR | UST yrar i I LpPae PERILU| APP. PERIOD] PREVIUUSLY | PREVIOUSLY | DIRECT | INDIRECT | TOTAL 1 } Uk sUPPUKT [ ub SUPPURT | FUNDED | APPROVED I CUSsTS | cusTs i | ! ! ! ! ! | I | OGuy P eC ORA4 STARE ‘* eee ees ee | eRe 1 r 4 Bebee Gh Ll scloavol Li. se 22ad in bo cULu DEVELUPAL Tal CUMPUNLNT 4 \ j { t j J 1 , 1 L | L $ll4sbi7_i $114.61] 1 j £1152617_1 O06 KEONEY DI SLASE i j | | | { j i L 3142740 1 L l 1 $182740_1 $282782_j £107:522 1 ; | j I OOF ete pecenae Ano mar | i | $102298 I $102298 1 $182051 1 $88.339 1 O1G REGIUNALE ZE0 ScucBRAYAEEI | | 1 | i | | ULAR DISEASc. PED UBS l ! lL l $33.200_1 $33,200) $172550.1 $50«750 1 oll -REGIGMALE ZEL BES? FRATURY] | ! J / J j i I 1 ULSEASE 22 UGE AM L l l $63,752. 1 £852752 1 $220324_L $108,076 1 O12 AMGULAT#.¥ Pou TATRIC cat 1 | { I I | t t 1 i lL i $42sb]0_ bof anoeebhlebliat eee sa7.ni6 |} O13" CANCE® P-ULILCULS FUR part | | ! { t } we LET MADAGL VELL i 1 i $112055 2 $222055 J $i23221 $122382 1 O14 KEGIUBALT ZEB venabic atl I ! j | | | LON PEDURAY I i L $19,714 1 $19,714 1 £10,600 J $30,314 1 O15 PAP SMtAe FEASIBILITY iT | | i : | j ~ 4 | ugy i j 1 $292238 £29,238) £1,813 1 £37,051_1 Ol6 CONTINUITY CF CARE FUk cI ' ‘ ! . ' j J ABDIAC PATLLNIS 1 j 1 $303427 $30.427 1 $2,161 1 £39.588 1 OL7 REGIUNAL CAKCiR aCeTSTAYt i | i ! | i t i j 1 i $472204 } $57:204_1 $18.7222_1 $65,926 1 Olso PUBLIC cCUUCATIUN CANCER } 1 | I 1 1 1 . L L L I $242364 1 $242364_1 £82245 $332209_ OLs CLECTRICHL SAFETY i i { | t 1 1 i L 1 $315797_ 1 $31,797 1 $1$a777 1 $462574 | O2U FARLY 10 UF CAarCIACS i i i j | | i i 1 L l i $222048.1 $222648 1 $7051) 1 $30.159 |} OZ) PROFESSILNAL ECUCATION ct i | j : | 1 { i ABCER i i ! $502239_) $502239_1 $1522%2 1 $66.) 81 1 O22 UPGRALIN. EeceGENCY rr j ! j | | j i CAPDLAC SsdiLs i i I $202030_ 1 £20.030 1 $62669 2 $262699.1 O23 NEw TECA.IGLES CF cancel | i j . I I J 1 DETECT I US L j i $503920_1 $50,920_1 i= $50,920 1 024 CCMMURICATIONS SYSTEM zat i | | j i | I b C Au CEr L 1 1 L $1,750 1 $1.750-1 lL $13,750 1 O2% STKEPTUCUCCAL CunTROL PII I | { j 1 j i jdt CL j i i i $326580 $3.880 | l £32080 1 026. CARDIAC 1 0 CARC j | } | . j ! t i l 1 i $32,050 [I $3,050 i i $3,050 i O27 HEALTH EDUCATION FUR VER] } j i i t HuINTERS 1 41 1 i £22,082] sz2son2 L___siaeaa L__aanaszs | j j ! I j 1 TOTAL { $78,740 | $462,368 | | $71%968) | $15260,789 I $416,474 |. $12677, 263 JULY Llsisle REGION - N New ENG roott Ayoted abe aoe oratde 1 areg sb@eresa d yas FT pave Y Vo PRULKAM ret but KAY 9- USM- SE UORS kb (") (?) (4) WW TO. TPFICATI ots Lf Coteunthd of cenr. WITHIN] CONT. BEYOND} APPR. NOT | Nba, NUT } 2ND YEAR | . | Apex. PERLOUE APPR. PERIOD] PREVIOUSLY [| PREVIOUSLY | OIRECT i | 1 ce SuPFURT | OF SUPPURT | FUNDED | approveo | casts ! 1 | COU) GENERAL ee Lue AM STAFE ' | i j / | nn ee ne ene ewe eb ne ene een n- de paulaQuu L-band) ee ee ee en Dons DEVEL Gen bet COMPattE | , t 1 ! ! i \ i 1 $li4e617 i $114,617.) 006 KIONLY UISEASE | | | } | } j $70,000 _J 1 j I $70.000_1 009. HIGH RISK INFANT ANO mur | i | , I~ | HERS PRUGRAS i | i $952350_1 $55.350.1 O10. MEGIURALS Zt CNTY TESA | j ' i 1 UA DISEASE PeubsaAs dl i i $382927_1 ~$38.927_1 O11 REGIUNALITZEL RESPIRATORY | J | t { { DESEASE P2UGS44 L l l $852216 1 $852216_1 vlz ARDULAT HUY FrULATKIC cart J | { { { L l j L j Lowers os CANCEF PY CTLGUL> FUR rail { I wt | | LENT Mase ci “EbT Ll L- l 1 1 O14 mEGIURALL LEu pcaaaTC TT aT i 4 { , t i “8 { 1 1 $373285_]) £37,285 1 O15 PAP SHEAR FEASIGILITY s71 j | | | | uecy i 1 1 l 1 Olo CCNTINUESTY UF CAKE FCR cl | 1 | j | oexpIAC PALL: urs 1 l : $222361_1 $20.3472_1 O17 REGICHAL CALCEK eEcistry) ! } j | __l 1 I $203199_] $282199.1 Cle PUBLIC ELUCATIGN CANCER J | | J | | 1 j 1 1 $292739 1 $292739_1 O19 ELECTFICAL SAFETY j j j | | { 1 1 1 1 L G20 EAPLY EO GF CAaUTACS 1 ' | | i j j L I 1 $42,506 1 $$22506_1 O21 PRUFESSFUNAL ECUCATION ct i 1 | | j AyCER j i }. $402922_! $402922_1 O22 UPLPAUInG EMLiICGLNCY iim i { i i 1 GAsulac SSILLS l 1 i $392515 1 £392515_1 O25 MEw TECH GUcS UF CANCER i i i 1 | eee AETECT duit i lL 1 l 1 026 CUMMUNICATIUNS SYSTEM ra i I | | | & CANCER l 1 i l } 025 SIKEPTGCULCAL CONTROL rit ! ' J j I LOI PROJECT 1 3 j l : 026 CARDIAC I C CARD i t } } | | . = I l 1 l $4,000 1 $4,000_1 O27 HEALTH EUUCATICN FOR VER] i | 1 I { MONIERS i l 1 1 $29249%_} $292694 1 i ' i I | ! TOTAL j $70,000 | $480,000 | j $566,337} $191162337 | JULY Lie lle heweae te oteen ome . BREAKOUT fF PROUES 1 em OCOO003 LAs TF PAGE 3 ane Pa dbs vee 2 tee Rip ag ebare Ptiteoa. 1 (5) (2) (4) a TULSPERACATLGs Gb CUMPURLIE | CUNT. Wifi GUND. BEYUNDE APPR, NUT 1 NtWe NUT | 3RD YLAR | | fur ab { APPce PERLUUY APPk. PERIOD] PREVIOUSLY | PREVIOUSLY | DIRECT ! YALL YEARS ! f Cr SupeGeT | oF SUPPUFT | FUNDED [ APPROVED custTS porRect costs |} | I I i / COCD GEREPAL PRLUKAM STAFF j | | | 1 j j | eee ee ee boo wee i __. $200,000.10. 9 ON Ld $8 2 Oe Wede FE NE ts edad GEL eb i t i i t 1 t i i i 1 $1igaQ@li_l gliasO,7_b l £34i2501 1 00S KIDNEY vISEASt j I J | | | j j i 1 i l L ] $148,740 1 OO HIGH RISK. INFANT AND MOTI 1 | | | | } 1 HERS PRUGKEAM i 1 N l $462402_ 1 $46.402_) 1 $172,050 } OLO REGIGNWALIZED CLREURAVASC] | | { to | i 1 ULAR ULSEADE PRLUGBAM 1 1 1 $382440 1 £382449.] $110,567 1 Cll REGEUMALIZEL PESPIRATORY! | | J. i | | GLab ase Po OE AM l L i $530410 1 $53,410 4 $2242378.1 olZ MOULAT©UY PULEATRIC CAF 1 | I i j | j { & i i 1 1 at 1 ! $472616 | OLS CANCER PruTULULS FUR PATI { | | j { j ; LIEN 4AbAur MEN L j -_t 1 1 1 sii.055_i O14 REGIUNALT ZED HEHABILITAT| ! | | | i i iGh PkUGRAS i l $31,559) $31,559 1) L $88,558 }) 01> PAP SMEAv FEASIBILITY sr | | t I I j | _o WDY i 1 4 j i i $292238 1 Oliv CumTINullY GF CAKE Fur 7 | | { . J | j | —_-dzWLAC_PALILEIS— i 1 l 1 $202.064.1 $20.064_1 1 $70,858 1 Ol/ REGALNAL CAncekK REGIaTRYI ! J | I | i | . 1 1 1 1 $293952_1 £292952_1 1 $105.355 1 Old PUBLIC EVUCATION CANCER | { | J i t | j 1 1 J I $312492 1 931.492) i $852995_] O19 ELECTFICAL SAFLTY j 1 | j | | { i L 1 l i i i 1 $31,797_1 Ogu EARLY IU UF LARDIACS i | J 1 | j | i I 1 l $672152_1 £$672152_1 i $2322306 1 O21 PHLFESSIUNAL LUUCATION ct 4 | 1 i { J | ALCEn i 1 1 $432416_! $43.416 1 i $134:.577_3 OZ2 UPGRADING EMERGENCY SCuRt | j | | j | i CARDIAC sKILLS i L 1 1 $222959_ 1 $222959_1 i $82.504 ! O23 teew TECH. 1GULS CF CANCERS I J I | j 1 i DELL CIIUL 1 1 l 1 l L $50,220 2 OZ4 CUMBUNMELATELNS SYSTEM 1] | | { t i ! : | & CANCLE i L L i i L 1 $1,750 1 O25 STREPTUCILCAL CONTROL PII i 1 j | { J ' LOI Pe2OsEGL l 1 1 l L l i $3,080 1 Ozo CAROIAC Et v CakD i | I | | § i \ L i { i L j l $7,050 1 O27 HEALTH LUUCATION FOR VER i J j j I i t ___ MONIERS l L I 1 $31:790_1 $31,790 1 i $83,566 1 i I J ' j { 1 TGTAL 1 } $500,000 | I $5312253 | $1,032,253 | | $32408,379 j - 10 - Region: NOTUMeELL wew taipsaim Review Cycle: 10/72 HISTORICAL PROGRAM PROFILE OF REGION July , 1967 ~ John E. Wennberg, M.D. became Program Coordinator (100% time). Site Visit: The role of systems analysis activities in RMP is discussed. Visitors felt that systems had helped them organize the planning process but questioned its use in other than planning activities. Fiscal Year 1968 - During FY 68 the RMP accomplishments were: 1) Participated in development of the Connecticut Valley Health Compact whose overall goal is to examine the possi- bilities for the provision of total health care in the Connecticut Valley Health Compact region. 2) A physician attitude study is initiated. 3) Heart inventory is completed. 4) A survey was made of existing medical records to evaluate time involved in history taking and recording of data from the viewpoint of completeness and retrievability. 5) A state-wide education program is con- ducted in external cardiopulmonary resuscitation. 6) Possibilities of a cervical cancer screening program are explored. 7) Involvement with three projects related to information systems, June, 1968 ~ First Operational grant request received requesting support of four projects as follows: RMP office Progressive Coronary Care Emergency Health Care Continuing Education for Health Professionals Project #1 Project #2 Project #3 Project #4 In early September a project #5 - Evaluation Protocol for Coronary Care System Inclusive Emergency Health Services was submitted and October, 1968 November, 1968 December, 1968 February, 1969 May, 1970 -1l- Site Visit to discuss 01 operational request: Major concerns of the visitors: 1) Slow rate of maturity; 2) Lack of involvement of RAG - especially in the decisionmaking process; 3) Degree of influence of Executive Committe or RAG; 4) Lack of Medical Society involvement in generating program ideas; 5) Lack of a clearly defined conceptual strategy for the region. All projects were reviewed and visitors felt this had merit but additional planning was needed. Council concurs with site visit team and Review Committee and 01 operational grant is deferred for additional information and clarification. Dr. Wennberg request (granted) permission _.to meet with DRMP to discuss November Council's recommendation. He asked for permission to revise the operational application and be allowed to submit it for the January-February 1969 review cycle. His justification for requesting this was that a delay to the April-May cycle would be extremely detrimental to NNERMP. Council approved operational request and authorized funding of Projects Nos. 2-- Progressive Coronary Care, and 4-~-Continuing Education for Health Professionals. The RMPS staff review of the 02 year operational request found the progress reporting so sketchy, the future plans so nebulous and the financial reporting so unjustified, that the application was deemed unreviewable. . There was also considerable discussion about the region's first year of operational experience resembling its planning its planning experience, i.e., concentrating on problem identification, epidemiology studies, data analysis, etc., without a clear-cut operational plan of action. August, 1970 December, 1970 ~ 12 - Lous sdat RMPS staff reviewed a revised 02 operational request, approved it, and recommended a site visit to investigate: 1) Whether the region actually has systems analysis capabilities. 2) Whether the region's strategy and its incorporation into the CHP planning structure was consistent with RMP goals and also evolving a Regional Medical Program. 3) Whether there has been any major reallocation of regional resources. Site Visit: The findings and recommendations were generally as the following: The major emphasis on data acquisition and analysis strategies was reasonable, however, some of the region's resources should now be allocated to RMP activities which would give the RMP some visibility in the region. The data techniques had been used effectively in some instances, but some plans for utilization, including a systematic data utilization strategy, should now be developed. Particular - attention should be paid to problems encountered in preparing or "marketing" the data for specific organizations. In addition, the region should broaden the base of understanding of the data system among regional groups and perhaps add someone not integrally involved with the program and with expertise in preventive medicine and public health to the Study Committee of the RAG. Although in the early plan- ning days, there was evidence of support from the Medical School and the State Health Department, these visitors reported problems in communication with members of these institutions. The relationship with the practicing community was also a question. Ne May, 1971 August, 1971 October, 1971 January, 1972 13 RMPS staff was unable to grasp accom- plishments of the region and requested that the National Review Committee and Council be requested to assess its program approach before the region begins preparation of its three year application. National Advisory Council expressed concern over the program of the region and requested a staff assistance visit to the region. Dr. Margulies, Director RMPS, sent a letter to Dr. Luginbuhl, Dean, College of Medicine, UVM, expressing concern over the status of RMP in Vermont, the portion of RMP resources going for support of the Experimental Delivery System and conversely the portion going toward program development consonant with the Mission Statement. Mr. Don Danielson is appointed Program Coordinator and the effort to rebuild NNERMP along "traditional" lines is started. - 14 = Region: Norther New England Review Cycle: 10/72 STAFF OBSERVATIONS Principal Problens: The priniciple problems have been this program's failure to: 1) establish a RAG active in- decisionmaking, 2) develop a clear-cut operational plan of action, 3) coordinate RMP, CHP and EHSDS into one management system acceptable to both Vermont and the Federal Government, and 4) develop a systematic data utilization strategy for RMP or other potential data users. Principal Accomplishments: The principal accomplishments have been: 1) development of the Regional Disease Management approach 2) development of a data base for health planning, and 3) publishing of reports in heart, cancer, kidney and respiratory diseases. Issues requiring attention of reviewers: 1. ‘Present and future organizational relationships between RMP, CHP and EHSDS? 2. Relationships with the medical school with particular attention to the Medical Review and Comment provision in the review process? 3: Correlation between the activities and the stated program's goals, objectives and priorities, and determination of which is the product of what? 4, Composition of the RAG (CHP a and b?) and its Executive Committee? 5. The RMP plans for future support and/or utilization of the data base? 6. Compliance with the CHP review and comment regulations? 7. The plans for involvement and development of the three counties in New York State considered a part of this region? Region: Northern New England RM 00003 Review Cycle: October 1972 Type of Application: Triennial Rating: 282 Recommendations From / f SARP fk / Review Committee Council ~ | —~ ™— Site Visit RECOMMENDATION The National Review Committee concurred with the recommendation of the August 9-10 site visit team. That is, it recommended: (a) The request for triennial status be denied and that the program be approved for its 04 and 05 years at the level of $850,000 each year; (b) Within the $850,000 a developmental component in the amount of 10% of the program's previous annualized direct cost level be awarded; (c}) A site visit be conducted prior to the 05 year to completely reassess the program. , With continuation request for Project #6, A Program in Kidney Disease, it is recommended that the presently approved levels of $37,900 and $25,400 for this project's second and third years.remain. The requested support levels of $78,740 and $70,000 for these two years should not be approved. The Total Request (d.c.) Review Committee Year Request Recommendation 04 $1,260, 789 $850,000 05 $1,116,337 $850,000 06 $1,031,253 -0- CRITIQUE ’ Taking into consideration the history of this program with its pre- occupation on data gathering and efforts to organizationally merge RMP and CHP, the Committee was favorably pleased with developments — since January when the RMP decided to devote its energy to developing a viable RMP. , The Committee recognized the infancy of the program reviewed, the fact that many elements of the program are untested, and that for the most part the NNERMP is a "paper" organization. Yet, based on the quality of the materials assembled and with an insight to the management capabilities of the program staff, particularily the , new Director, Mr. Danielson, it is believed prospects for continued development are good, The following suggestions emanated from the review: . The goals and priorities need to be further defined and more explicitly stated. oo . The RAG needs to expand its membership to include better representation of youth, the medically underserved, areawide planning agencies, allied health, and representatives from the bordering areas of New Hampshire and New York if it is established that these areas are indeed appropriate territories of the NNERMP. Consideration should also be given to the appropriateness of the economic and local political interest having representation. .- The RAG should consider establishing a subcommittee structure aligned with goals, once goals have been developed. . The composition of the disease management committees, ad hoc groups, and technical review committees should be examined closely to insure appropriate representation. Also, measures should be taken to assure that these groups are supportive of the program's evaluation plan. The disease management committees should have bylaws, or another similar management tool,.to align their functional operation plans with the total program. Consideration should be given to developing management committees for non-disease areas of interest to RMP such as community health. . The evaluation scheme should be reexamined to give further assurance that the RAG and program staff each understands its respective roles in review, evaluation, and feedback. This should minimize potential conflicts. Also, organizational changes should be made coordinating all program staff performing any evaluation with the Director for Evaluation. The vacant program staff positions should be filled with persons that will provide the program with a broader range of professional 3 and discipline competence. Nursing, allied health, health system development, and community organization are specific suggestions. The program-should look at all their proposed projects and relate comnon objectives so that the resources have a greater potential for effecting constructive change of the health care system. . The RMP still needs to assume some continued responsibilities for making the region aware of available data, and to assist in the development of a data utilization strategy. A formal policy on continued support should be established. The surveillance and monitoring devices of projects should include a method for prematurely phasing out unsuccessful or ineffective “projects. It was emphasized that the transition the NNERMP is presently going through is not the traditional project~to~program transition most RMPs experience, but one of changing from an organization primarily interested in data collection to one more in concert with the present RMPS mission statement. In fact, the few categorical activities of the program have a comprehensive flair with definite considerations for broader problems. Dr. Luginbuhl of the University of Vermont was not present during these deliberations. EOB/DOD/9/29/72 + Region: Northern New ©: Review Cycle: October SiR . COMPONENT AND FINANCIAL SUMMARY TRIENNIAL APPLICATION RM 00003 Committee Recommendation for Current Annualized uest for Triennial Council-Approved Level Component Level 03. Year 2nd year | Srd year lst year | Znd year | ard year PROGRAM STAFF $ 397,578 $ 462,368 }§ 480,000; $ 500,000 CONTRACTS | DEVELOPMENTAL COMPONENT 114,617 114,617 114,617 10% 10% OPERATIONAL PROJECTS 328,389 683,804 — 521,720 416,636 Kidney A( 78,740 ) (70,000) . (37,900) (25,400) EMS C ) hs/ea ( ) Pediatric Pulmonary . LC ) Other ON ( ) TOTAL DIRECT COSTS 725,967 1,260,789 1,116,33% 1,031,253 850,000; 850,000 COUNCIL RECOMMENDED LEVEL Region Rochester Review Cycle 10/72 Type-.of Application: Anniversary before Triennium Rating 269 Recommendations From / 7 SARP , / X/ Review Committee /./ Site Visit / 7 Council RECOMMENDATION: The Committee agreed with the site visitors in recommending an approved level of $935,000 for the Rochester RMP's 05 operational year. In arriving at this level it was necessary to balance the numerous and promising changes made during the year against the considerable work yet to be done. The base level of ‘$900,000, plus $35,000 earmarked for the kidney program, was considered appropriate because it would represent an increase over the current approved level and a moral encouragement to the Region and would “permit the RRMP a sufficient allocation for program staffing, develop- mental and planning activities, as well as an increase in project activities beyond those initiated during the 04 extension period. Requested ~ Recommended $1,035,000 $935,000 Critique - The Committee agreed with the site visit team that over the last year the Rochester Regional Medical Program has seen dramatic organizational, functional, and programmatic changes, particularly: 1, The resignation of the previous Coordinator and the hiring of Dr. Peter Mott. 2. The dissolution of the previous large program staff in terms of functions and people and the beginnings of the new. 3. The change in the character of the program with the termination of sixteen ongoing projects. and the initiation of new directions in concert with newly-established goals, 4, The change in RAG composition, interest, and responsibility. 5. ~2- The closer working arrangements with the CHP (b) agency. Time has not yet permitted the Region to complete the change process, however, and many areas still need a substantial amount of work; especially: 1. The further development of goals, short-term objectives, and priority setting mechanisms, Completion of the organization of RAG committees and delineation of their functions, with an awareness of the need for minority representation. There is a necessity too, which the Region recognizes, to diminish the power of the Executive Committee and increase the responsibilities of the RAG, Development of program staff as a high program priority. There was the suggestion that the Region may wish to increase program staff over that now projected. The immediate development of by-laws and procedures, with the proviso that these documents must he furnished to RMPS staff for review, and that the January lst award be contingent on their completion. It was stressed that there must be a clear definition of the differing roles of program staff and RAG. The Committee agreed, too, that the numerous other points of advice the site visitors relayed to the Region (which are contained in the site visit report) be formalized and relayed to the Region after Council consideration, EOB/DOD 9/26/72 COMPONENT q D crn SUMMARY . > ’ ANNIVERSARY APPLICATION BEFORE TRIENNIUM . Current Annualized Level “ Request For Reques Funding For Component 04 Year ___05_ Year __ — Year /__/ SARP /X_/ Review Committ ° PROGRAM STAFF $ 259,855 | $ 415,000 $935,000 combined CONTRACTS -- Oe DEVELOPMENTAL COMPONENT | — -0- - /_/ Yes [Z No " OPERATIONAL PROJECTS 598,951 | 620,000. | | Kidney _ | " ( 35,000 ) 9 y | + © 35,000 ) EMS ( | -0- ¢ ) i hs/ea ( 4 70- ) ( ) Pediatric Pulmonary (.- -0- ) ¢ ° a) Other ( ~0- ) ( ) ° ‘ TOTAL DIRECT COSTS $ 858,806 $1,035,000 - . $935,000 $ 871,308 x COUNCIL-ARPROVED LEVEL * Only Coun cil approval for the 05 year ij s $35,000.for the Regional Kidney Program. $ ’ ‘i = eview Cycle: 10/72 f / Can" ap ed REGION: Rochester OPERATIONS BRANCH: Easter AG NUMBER: RM 00025 Chief: Frank Nash COORDINATOR: Peter Mott, M.D. Staff for RMP: Eileen Faatz LAST RATING: "or TYPE QF APPLICATION: 3rd Year Regional Office Representative: /_] Triennial fT Triennial __Robert Shaw 2nd Year Management Survey (Date): (7 »=6Triennial (%/ Other oe Anniversary prior Conducted: November 1970 to Triennial-05 or Operational year Scheduled: Last Site Visit: June 1971 ‘(List Dates, Chairman, Other Committee/Council Members, Consultants) Alexander M. Schmidt, M.D., Dean, Abraham Lincoln School of Medicine, . University of Illinois - Review Committee Member Robert Lawton, Deputy Director, Tri-State RMP - Consultant Richard Cross, M.D., Chairman of NJRMP RAG - Consultant Richard Haglund, Associate Coordinator for Administration, Intermountain RMP - Consultant Staff Visits in Last 12 Months: (List Date and Purpose) October 1971 - Dr. Orbison (Dean, Med. Sch.) and Dr. Saward (Assoc. Dean Extra- mural Affairs) visit Rockville to discuss RRMP problems with Dr. Margulies. February 1972 - Dr. Pahl, Mr. Peterson, Mr. Simonds, Mr. Shaw, Ms. Faatz - to review the changes/progress made since the June 1971 site visit, discuss the Rochester situation with all key people involved, and recommend necessary changes for the Region in the future. June 1972 - Ms. Faatz ~ review recent progress and-discuss upcoming application and site visit . - Recent events occurring in geographic area of Region that are affecting RMP program: All year. Continuing conflict between Blue-Cross sponsored pre-paid group practice plan and many area physicians who oppose the idea - with Blue Cross the victor. , Fall 1971. Unsuccessful attempt by CHP (b) agency and others to establish a Rochester health authority. Winter-Spring 1972. Employment of Assistant Director of CHP (b) agency and. concomitant increase in close working relationships between CHP. and RMP. « June 1972. Tropical Storm Agnes wreaks havoc on the Corning-Elmira area - both cities inundated - possibly two of four community hospitals beyond repair and many private physicians’ offices wiped out. Since this area has been rife with duplication and gaps in health delivery system, there aviere tha naaathilitv for some restructuring of the system in the & & oO | 3° ‘leans m, Monroe Wayne § Ontario} « mn a be e ‘?¢ Yates} o i?2) ‘Steuben |& oc Rochester RMP - : Geographic Relationships Of Six RMPS In New York State And Detail of Rochester RMP , Tp. eat Central. New York RMP e Syracuse ~ Albany ¢ Albany Metro NY RMP raTad) mapaay: <2: suo; say Ia} Sayooy ~36 Region: Rochester Review Cycle: 10/72 DEMOGRAPHIC INFORMATION The Rochester Regional Medical Program is composed of ten counties in the western portion of New York State. It is bordered on the west by the Lakes Area RMP (Buffalo) and on the east by the Central New York RMP (Syracuse), on the north by Lake Ontario, and the south by Pennsylvania. The city of Rochester is the third largest in New York and is the industrial, commercial, educational, and cultural center of the area covered by the RRMP. More than half the city's people earn their livings in manufacturing industries. Eastman Kodak and the Xerox Corporation employ large numbers. The second largest city in the RRMP area is Elmira, a manufacturing center in the south-central part of the State. The remainder of the Region can be characterized as small town/rural, including the beautiful Finger Lakes area, and has fruit growing, truck gardens, dairy farms, and vineyards. The approximate population served by the Region is 1.2 million. Although statistically the population of the ten-county area is 66 percent urban, this is a result of the large urban population in the two most populous counties of the area: Monroe County (Rochester) and Chemung County (Elmira). The other eight counties in the Rochester Region are over- whelmingly rural. The non-white population of the area comprises 5.5 percent of the total, with the largest concentration in the city of Rochester where 17.5 percent of the population (52,115) is non-white. Many Blacks and Puerto Ricans in Rochester, though, feel that the census figures are considerably lower than the actual population figures. The RRMP area contains 271 registered migrant camps - one-third of the New York State total - and during the peak season there are somewhere between 12-15,000 migrants in these camps, mostly Blacks. The median age of the area is approximately 28 years with eleven percent of the population over 65, There is a generalized out-migration in the age ranges 20-35 and an in-migration at ages under 20 and over 65. The average family income in the area is somewhat lower than that of the rest of New York State and the percentage of people eligible for public- assistance is higher. There are 27 general acute care hospitals in the Region with a total of 4,153 beds. Of these, seven hospitals and 50 percent of the total beds are in the Monroe County (Rochester) area. Elmira has two hospitals of about 250 beds each. The remaining eight counties contain at least one community hospital each. The Region houses 1,798 licensed and registered MDs and 10,435 RNs, with 70 percent of the physicians and 50 percent of the nurses in Monroe County. Appendix A to the RAG Report shows, though, that in the ten counties there are only 800 active, non- institutional primary care physicians (GP, internal medicine, pediatricians, and OB/GYN) under 65 years of age. The health education institutions in the area include the University of Rochester School of Medicine and Dentistry, eight professional nursing schools and three for practical nurse training, one cytotechnology and six radiologic technology programs, as well as two hospital-based programs for medical technology. COMPONENT. AND FINANCIAL SUMMARY . ANNIVERSARY APPLICATION BEFORE TRIENNIUM Ba Awa acter en een eee BoM LOR, Review Cyele: Current Annualized Level ® Request For’ ~ Request Funding For ‘COUNCIL-APPROVED LEVEL * Only Council approval for the 05 year ig | Component 94 Year ‘95 Year Year “{__/ SARP / ~_/ Review Com.i vice 20s STAFF $ 259,855 $ 415,000 (CON? RACES =- : -0- eve SLOPXENTAL COMPONENT . -- -0- /_/ Yes /_/ Xo OPERATIONAL PROJECTS « 598,951 : 620,000 Kidney "( 35,000 ) “¢ ) “ENS “ ¢ 201,500 ) ( ) 1 $ hs/ca (,, 70- a C ) ' Pediatric Pulmonary —( 70- ) ( ) Ocher CO ) {TOTAL DIRECT COSTS — . ~ $ 858,806 $1,035,000 $ 871,308 * $35,000 for the Regional Kidney Program. yauts A AUGUST 2943972 REGICASL MFAICAL PRCGRAMS SERVICE . . , FUNCING BISTTRY LIST AMPS-OSMeSTCEML- ae? BEGTO™ 25 SOCHEST FS RMP SuPP YR 34 CPFRATICNAL GOANT_(CTAFCT COSTS ANLYD ALL REQUEST AND AWARDS AS OF JUNE 30, 197 AWARDED AWAgrEL AWARCEG AWAT DED AYAPOED _** REQUESTED RECUESTED REQUESTED RECUESTED COMPONENT Oi : 62 a3 Q4 * 05 C6 aT ht CTITLE . _ OS47L-12777 _) TETAL em OLS TAL 2/73 OLS TH L20TS OLS P57 12075 TOTAL - ae OOID POCGRAM STARE 2a CITE QMmearg SAAC ASL TSG et 415900 445900 QOL FECCASTR ECUIP 26490 : 26400 *# , - . 952 POS TCIADUATE TR 82°09 77009 419600 $4209 375709 _4*# 003 &GST GAL HS? AC 21200 9300 11000 410C0O *# C4 PEGISAAL CCAGUL 69499 45100, 456000. sd EERE dE TAL O05 CARNICVASCULAR 71300 #2160 82490 33339 250139 ¥* Qe7 FeeLy PISSASE € 202299 262293 REVICS 127652 ST7H92_@e ocg CONE #98 CSM S 299902 CECE 54600 12450) 8° 099 CANCE® CLPAGING 19503 Z5CC. 32300 _ 22696 FTIGS ¥F _ Clo STATUSTICar ANC “71600 - 58400 23906 ' 420l2 255912 #* a OLLA TELEPRONE CKO C 32C ite 43206 3342 76642 #2 “O12 CECEATHALEZEC C 36909 fyCcC 1467G - . 104779 © O14 For STse TEAMS 25762 27799 GAO) +8 O15. ASEUPCLEGIC ANC J GEES 17109 8557 3LiST a mi OL6L PHYSIC TAY TRATA ica 29709 _.. OTVAS 22ghs ae cee eu ne Ol? CrecsiC &ENAL O - 3106 1100) L6E13 SOTLS ee OLA_ELASSTES MELAIT 2ctca 43800 26675 eae +e _ ook Q?, HKESTCAGL CRGAN - a 35009 35099 Q2te PLE CREAN FROCL 9546 9546 “O213 REC GRGAN FROCU i - 220687 22067 ¥* _O21C SFE COGAN FROCK . ee, QTd PTE : .. G22 PRIMARY CARE an . . 50476 “504676 ** | 37500 37590 O23. FAMILY COUNSEL ' ee TEED LL RT 33 OH 13000 : 43099 “O24 CUNSLLTANT SERV 24484 24493 #6 O75 HEYUTR EnuUcATIC 20744 30244 *¢ O26. Ch2ONTC. NELPC4U : 59374 SG37G ee ; OFA T¥§ SouTPeey TH ee - 7 AFARB 93333 RL 200009 : roses Os EVE SCUTHERN TE , LEKOT L66H7 ** $0900 , 59099 ooze £48 BFALTH INFO ot. S4ESO 8 S54 TAO &e 515090 : “ _ SLSto _ O300 ES PLONNIAG SN } E172 BTLT2 **. . O21 SPET_EOUEATIONS : Lecce 16009 *t 49990 4899074 $32 RUYEL FAMILY ME 26492 : 264692 %¢ . . 033. SUR STAG COATING . een eae _.4ccnd _. 4on00 ee 8GNG0 69077, O44 FINGER LAKES HO: , L1667 Li667 #8 50000 : s90c0 033 PUPAL PECTATREIC ee oe TAT TTA Ae Lo oe. oie OFLIVERY SYSTEM 16667 16647 &* 80905 82099 Qay Pusat SUSSE pon : B33} BURA ee 35909 as¢70 0373 PILENCUAL ALLIE : 12765 12705 #¢ ; 039. ENRICHMENT. PECG. oe : cnc ne eevee tee 30900 39999 a 36009 46070 O60 ANCLESCENT MATE ww oye Txt - 6 6461205 ~—CCLocetO8 “"T457000 1266610 45eR123 2 1935005 , 7o3sseon OO Der soimoen re Ded -6« JULY Lig iG7e . . : . REGION = ROCHESTER pert ariaee fee Pb eee poe ame ck Ease? Pane 1 Ui itn AM ob bene Kiveta- tearn J bine 8 (") (2) (4) (1) $35,000 $1 4035,000 LubNTIFICAT£ 06 GF CORPUALKT [ CUNT. WITHIN] CUNT. BEYUND| APPR. NOT | NEW, NUT | IST YEAR f IST YEAR I { J Atpe. PEATE APPR. PERTODE PREVIMUSLY [| PREVIOUSLY | DERECT f INDIRECT j TUTAL j 1 GF surPurnt | OF suPPURT } FUNDED | APPRUVED | cusTs i CUSTS i | : i { | | | | | J Clore PRGGE AM .TADE bab titel fj j I \ J t I ' wee eee ~ ce boone eee | babeapun dc eee ede eh UWL edd a a0 ad LOL ~~~ Oct KEUIURAL LrUAG Bulent wtf | | | | I , ' J NT SHALISG [rpaunPbaulalleul 235.0001 l \ J $45,000 1 $103944 1 $510444 1 O22 PRIMARY LAKE ANALYSIS | | ! ! | . i i ' i i $372500_1 I ! $37.500_) $82414 1 -$452915 1 023 FAMILY CUUNSELOR PROGRAM] } j { j i { I l $13,000_1 i Ll £13,000 1 $3.809_1 $16,809 1 030A SOUTHERN TItK EMERGENCY | j t I i : 1 j { EL UK } $100,900_1 i 1 $100.000 + l $100,000 ft O3uu SOUTHERN TIE CRISIS PUL | | } L. | | j 2 SEEVICL 1 $50:000 1 I 1 £50,000 i J $50,000 1. UsG0 MUbKUL Ce dslos Phuitl wit j ‘t { | \ I LCE L ! $512500. 4 i L s1s500-1 j $51:900-1_—.. Q3u_ _CusPubE st Jupab i Lt _$201.500)4 ~~ dc s2ols saudi Ad 8202292011 O31 EGUCATIvxAL ALLIANCE | i | { | | ! | 1 j $48.000 1. - I = $58,000 1 i 248.000 1 - 033 NURSING LUNTINUING ELUCAI i - 1. - ! ] , i ! i / Luss 1 } 460,000 | - : L 4 $60,000_1 $272333_1 $97.333. 1 034 FINGEF LAKES HUME CARE 1 | !- J j . j t | . 1 1 $50,000 1 i 1 $50,900.) 1 £50,000 1 O50 OELIVERY SYSTLUMS EVALUAT! i 1 r i j | j 1c j $80,000 1 Ld 1 $80.000_1 $19.890_1 $99.9°0 |} O37 RURAL NUX a wee tawanas KUNOALL anne AU Te wanes . parwestes vat vines sus coma alpwiit) AaNaten COLdAAdd cuaparure pout ane > ~ eexar contauts | ayaca peony wrandt EDINA weaaron aaarosta Whos SPR 18 a Xcp JACKION matacoes MAYER sAvalA m0 ATALCONA KALE yicroaia . COUP . . tan we . estas N a aaa nsryoro RI APT SUB REG Il ONS suamet La date Bacau . uve Oak ‘“ . ws Nantab SPR V7 eoe STATE PLANNING REG ne 4 epi | (CHP''b"') pet - waht wie euvas wurees . . { mucase foamS PR 29 . ~ / t SPR 19 mapata | sh HOOD BOOKS winney Fraea wiast ARN a1 TEXAS POPULATION 1970: 11,196,720 10 de © TEXAS CITIES with 100,000 or more population (1970) and % change since 1960 CITY POP.(1970) % CHANGE a Amarillo 127,010 - 7.9 b Lubbock 149,101 +159 Cc El Paso (322,261 +16.5 d Fort Worth 393,476 +10.4 e Dallas 844,401 . +24.2 © _f Austin 251,808 +35.0 g Houston 1,232,802 +317.4 h Beaumont 115,919 - 2.7 i San Antonio 654,153 +11.3 j Corpus Christi 204,525 +22.0 NUMBER OF OTHER CITIES OR TOWNS BY SIZE POP. RANGE - NUMBER | 2,500- 9,999 249 10,000-49,999 100 | 50,000-99,999 17 RDB 5/71 DEMOGRAPHIC, FACILITIES AND RESOURCES STATISTICAL SUMMARY a 07 REGION: TEXAS Geography and Demography Encompasses entire State; several subareas» Counties: 254 Congressional Districts: 23, Population (1970 Census) - 11,197,000 Urban: 80% Density: 43 per sq. mile Age Distribution: Texas ‘Us. Se Under 18 years 37% 35% 18 - 64 years 54% 55% 65 and over 9% 10% Metropolitan Areas: 17 SMSA's — Total Population 6 268,.600' Abilene Dallas | Galveston Odessa Brownsville ' El Paso Laredo san Angelo * _ Corpus Christi Fort Worth Lubbock Sherman Denison ~ Sherman Texarkana Tyler Waco Wichita Falls Houston Race: 87% White; 13% non-white Vital Statistics Vital star Mortality - deaths per 100,000 population, 1967 Age specific - Texas U.S. death rates _ (all causes) # Heart Disease 275.3 364.5 5 Malignant neopl. 130.2 | 157.2 45-64 yrs.-1081.4 Vascular lesions 92.2 102.2 65 & over. 5518.8 (aff£.CNS — stroke) All causes 798.6 : 935.7 Other Federal Programs , cup - A Agency ~ $495,000 (13 prof. staff) (4). B Agencies — Arlington, Austin, McAllen, San Antonio , Total funding $410,000 (11 prof. staff) |, _ SP #07. Region: Texas Resources and Facilities 1969/70 Graduates Enrollment Medical Schools - , Baylor U. College of Med., Houston 362 88 U. of Texas, Med. Br., Galveston 598 147 U. of Texas Southwest Med. School 426 107 oF Dallas U. of Texas So. Texas Med. School 216 33 San Antonio Medical School, U. of Houston - - (developing) Dental School 3 - Baylor, U. of Texas, Houston and U. of Texas, San Antonio Pharmacy 3 - U. of Texas, Austin; Texas So. U.'& U..of Houston, Houston Professional Nursing Schools , Practical Nurse Training 51--32 are college or University 153- majority at college or based special vocational and technical schools Allied Health School -~ University based: University of Texas, Med. Br. at Galveston ‘School of Allied Health Sciences, Galveston Public Health University of Texas, Houston - School of Public Health Accredited Schools Cytotechnology - 9 (five affiliated with University or Med. Sch. including one at Brooke Army Med. Center) Medical Technology — 57 (one at VA Hospital and one at Brooke Army). Radiologic Technology - 60 ‘(oné at Brooke Army Med. Center) Physical Therapy - 4 (one at Brooke Army Medical Center) #07 Region: ‘Texas - 5/71 - Hospitals - Community General and V.A. General tf Hospitals with selected special -# Beds facilities Short term 490 44,587 Intensive Care ~ 139 Long term (special) ~ 14 2,857 X-ray therapy —~ 78 Vy. A. (general) 7 2,532 Cobalttherapy ~~ 33 , ‘= Isotope - 84 Skilled nursing homes 441 31,587 Renal dial - 48 (in pt.) Rekab. (in pt.)~ 24 Manpower Physicians* ~ Non-Federal M.D.'s (1967) Active - 11,279 / 481 Inactive Osteopaths (p.0.'s) . 721 Ratio of active M.D.'s (per 100,000 pop.): 106 ‘Percent py specialty: General practice - 312. Medical spec. - 21% Surgical spec. ~ 33% Graduate Nurses, 1966 i Actively employed in nursing - 20,167 Not employed in nursing 9,955 Licensed Practical Nurses. (1967) Total employed in nursing (adj.) 13,386 Not employed in nursing - - Ratio per ‘100,000 es. 188 5/71 RDB COMPONENT AND FINANCIAL SUMMARY ® TRIENNIAL APPLICATION - Region: ' Texas Review Cycle: Sept /oct 1972 Committee Recommendation for Current Annualized Request for Triennial. Council-Approved Level 2nd year 3rd. year COUNCIL RECOMMENDED LEVEL | Component Level _oh_ Year -Ist year’ |. 2nd year {| 3rd year Ist year PROGRAM STAFF “$579,999 /$ 754,129] $ 822,764 $ 877,970 - CONTRACTS . 138,280 = fe \ _ DEVELOPMENTAL COMPONENT 90,000 “160,000 200,004 225 ,000 _. _ GPERATIONAL PROJECTS "771,761 . 1,264,341 1,317,474. 1,297,538 | 24, , Kidney , 3374157 , EMS —— ) | hs/ea _ 153,200) \ Pediatric Pulmonary — ) . Other | 773,984 - TOTAL DIRECT COSTS $1,580,040 $2,178,470| $2,340,23 $2,800,508 —— | JULY 1721972 : REGION = TEXAS BREAKOUT OF REQUEST nm 00007 10/72 PAGE 1 __ ee een __ 05 PROGRAM PERIOD oo , . _RMPS-OSM-JTOGRZ-E . (5) 2). (4) qh) . IDENTIFICATION OF COMPONENT 1 CONT. WITHIN! CONT. BEYONDI appr. NOT. NEW, NOT ' CURRENT | CURRENT 1 1 . | APPR. PERIUDI APPK- PERIODI previously | pREVIOUSLY | orrecr } INDIRECT 1 TOTAL i } GF SUPPORT { OF SUPPORT | FUNDED | APPROVED { costs | costs 1 ; meee J l i 1 ! 1 CO00 PKOGRAM STAFF \ 1 { \ j ' i. i $154s122-J 1. \ ! $154s1291 _g105a120_-} 28500282} pooo DEVELCPMENTAL CCMPONENT | i | i t t ‘ j $160,000 1 } j 1 $140,000 1 202009 tL 0544 GRO t t \ { j J { . _ fale dt fn J J pipaate | ————-8de22L——-B224083-7-—— 0543 GRC { 1 I | { } j { 0548 GRO RT J _L Lt 1 sipeth {--—---S2aSSob———e2Le021 t— 0540 GRO j j | t \ | 1 i O56c GRO aT j ! l £18.476-1 __. i $18.57o-1 054D GRO { } l \ t i \ t . i $192.572-1 } L $19s522—4 1 $1925121 O54E GRO . t { 1 t 1 : [44722001 J 1. 1 $3 15a795 1 2522623 1 —— eS Lt faba hroags ae ah a8 —— 055. ELECTRICAL SAFETY SERVICI en, 1 \ \ t 5 055, ELECT a 1 J $50,900) ___s4aT 0h 142702 | —— o OSTA COMPREHENSIVE RENAL PROG! j | i 1 1. t . DSTA Courrenen TTT Gonna | stan} szsant O5738 CCMPREHENSIVE RENAL PROG i { \ | | | \ 4 j i Lanegan | —-tszazen | —nateaazs tA O57C CUMPREHENSI VE RENAL PACGI | . | l i i t cai _ i i L } £312975-1 “gayaszs | #10800 -|__—_B820172-f— _, 9670 COMPREMCNS EVE “RENAL pPxrccl 1: . $ a | . ‘ - oe AL. Lo i L $5554651 $550403 1. $254498-1-——~-£802203-1———~ O57E CUMPREHENSIVE RENAL PROGE l ! \ BAM L 1 j $312575.1 $31557 £30,000.) $412512 SBPUNENT TULA le ———— nae 055 AREA HEALTH ECUCATIGN REL | { t { t | »_SOUBGES PEWEAHLBGY : j $48,3h1—4 j 1 $30,281) j $38,381 1 059 west TEXAS S$ c NtA MEX Al t 1. \ \ | . l HESP l $39s200 i h j ee es ee 060 SUUTH TEXAS AREA HEALTH i t | j | 1 i EDUCATION RESO: i $462748 1 1 i $46,148 1 i _$46.148_1_ 061i MANO t | j \. ( 1 j a L } $1)42270_h I j 61141701 jl $114,170 -)-—— — 062 UCHILORENS HEART PROGRAM | \ 1 \- \ \ ESD EXAS L J $A60175-1 1 1 veg. Th pe 063 AREA HEALTH RESOURCE AFI { | t- | i : | __G CESIEE___- I aL 624,07) 1. } } $24,071 1 920565 | —B2bsb6-L—— bos STL TECHNIGUES Fua nuMe | 1 1, | J t I “ete eceatcugg eye Meme | a | i 35.000 [---eee nnn BS 065 &eACH 1 | ; ¢ 1 i t | vaca L l $29.5001 66-887 [| ———-—-& 3022872 l O66 OEXO UNIT IN MEDICAL REH) - 4 | | \ ! \ eT CH es ee J J ee ee O67 GASIC REHAB NUFSING TECHI 1- \ \ | t cee LOUES. L . \ 1 i L $27,2001 : l $272200.1 prepreg ET Cee eng et > SETS JULY 1752972 BREAKOUT OF REQUEST REGION ~ TEXAS RM 00007 10/72 | 8 PAGE 2 oo . _. 05 PRUGRAM PERIOD RMP S-OSM-JTCSR2~1 5) (2) 4) qt) IDENTIGECATIUN CF COMPONENT | CUNT. WITHINI CONT. BEYOND] APPR. NOT § NEW, NOT i CURRENT { CuRRENT J i } APPR, PERICOL APPA. PERIOD] PREVIOUSLY | PREVIOUSLY }. orrect { INOURECY |} TOTAL i } Ur SuPPORT {| OF suPPCRT | FUNDcD } APPROVED ! costs t costs j j t | I | , | ! { i 048 DEV AUTU AKEA FEALTH RES] § ! I 1 j } i GULOE ThE CeoIes L j $45,000. | 4 i $452200 1 $113949_1 $54124%23 C&S HEARD { ! t { j { i t t i { I $1132816_1 $113,216 1 I $1132°:5_! O70 FAFELY MCDICAL KESGURCE | i i { I } i ; Chait i } i 1 $15..840 1 $142840 1 i $14,542 O71 AVEA HEALTH CUUCAT Lite REL { ) ! i { ! ! _SEUELES PruuSan CESLILx ft j j 1 $42,000. 1 $42,000! 1 $42,972} G72. TY¥Ltk SMITH GUUnTY HeALT! t | j 4 | 1 } EB CeUSCUL l i ! ! $252.375_1 $252375_ 1 i $25s235! O73 CONTINUING MELICAL EDUCA] 1 t j ' I i i ; Lins t j i i $20,000 1 £20,000_f $3al63_1 S23aest UNSPECIFLED GKCwTH rUNUST | t t ! t } i : i i | i j 1 I i . l ‘- { | | l I i TOTAL © { $2077,029 } $5485253 | ! $553,188 | $221762470 t $242¢312 1 $25420-782 | peer ne enenen eeme meS —_- JULY 17,1972 BREAKOUT OF REQUEST 06 PROGRAM PERLOO REGION - TEXAS RM 00007 10/72 3 . . a RNPS-OSM-JSTOGRZ~1 _- PAGE : (3) 42) (4) qi) IDENTIFICATION CF COMPONENT ] CONT. WITHIN] CONT. BEYOND] APPR. NOT 1 NEWs NOT } aood'e year | 1 TOTAL l _. | APPR. PERIOD! APPR» PERIOD] PREVIOUSLY | PREVEOQUSLY |. orrect§ | acc years tt. | GF SUPPORT | OF SUPPURT | FUNDEO {| APPROVED t costs i jOrRECT COSTS I ee i t. 1: \ l 1 } COOU PRUGRAM STAFF j t | b | { | ! t. . ; i $82221h24 } j $5222762-1 1 $22554:861 1. D000 VEVELUPMENTAL CCHPUNENT 1 ! | ! | | b i i } $200.000 1 lL i $7900,000_1 L $585,000 L_ 054A GKO i ( | ! ] { ! \ ee {L i $16,750 j l i $182789 i j $372228 } 0548 GKO 1 ! . { i j , I 1. I L i $182750 1 1. L $18.750_1 { $3722281 054C GRO j i { 1 1 i { . | j $182720 1 L j $1627501 J $373226 1. G54 GRO I 1 | ! | | | § ——- lL } $18,750 1 J j $) 8.7901 j $36,322 1 . 054- GRO \ | t 1 J i { lL \ $392920_1 j i $395920_1 i $77,820.1 054 CUMPUNF of IUTAL i tC. -.$1142920)1 l LL... £2142920)! qi $227.820l1 055 ELECTRICAL SAFETY SERVIC] { | j | | I ES L J j I 1 f i $50,000 1 ' _. OSTA COMPREHENSIVE RENAL PRCul ! i j | I i t _- RAM L j \ L $138sl42-1 $138,742_-4 j $443,163 1 OQ 3578 COMPREHENSIVE RENAL PKCGI ! | | { I i | ' KAM i f Li: j $52.283_1 $522283.1 l $104,566 1 G57C CUMPALHENS IVE RENAL PRCOl { { 1 l | t \ EAM L i | ij $3)2575_1 $3)2575_1 j $632152-1 VW 5TD CUMPREHENSIVE ®ENAL Prtol i ! | | | t l gam { i L Le $552465_ 1 $552469_5 \ $1102930 1 O57£ COMPREHENSIVc RENAL PRCGI ! j | \ | } i BAM \ j j to $9 a5 TS $31,575_1 H $632150 1 CMPLDENT_IpLAb 1 1 Li $309, 640111 $309264021 (L..3646079T)1 058 AxEA HEALTH ELUCATIUN REI ! | t t | i eee __SEUKCES PEUGBOE. LBuY i 1 j \ 1: l $38,381_1 059 acdT TEXAS Sb wit Mcx Al | 1 { \ ! j 1 HERP J f j } j j L $39,209 1 060 SUUTH TEXAS AKEA HEALTH |} i 1 I { \ j oe EDUCATILN BESCUECES i \ J } | | j $46,758) 061 MANO } | ! ! } I 1 - i L j $1022100- 1 } $102:100 1 1 $285,925.) _ 062 CHILDRENS HEART PROGRAM | | $ J j t \ . I OF _SOUTH JEXAS 1 l $85.000_) j 5 $85,000 {2 §285.673 D - 063 AREA HEALTH RESOURCE INF I J { { t t t . O_CENIER Il 1 1 \ 1 L $24,071 1 064 STD TECHATGUCS FUR Heme | { ! i ! | i 1 _ __ ULSLID boek stpylte— _L $342 800) | I $352600_) L $952,500 1 06> wcAtH 1 ! | ! ! J t I Z L \ i l 1 L jl $26.500.1 066 DEMO UNIT IN MEDICAL SEH t { | 1 { 1 1 bo : 1 l | L L i i $66,808 1 Det ASIC REHAB NUKSING TECH 1 | 1 { . { | | tives. } i $24,700_1 i i $24,700). j $51,2900.1.. - JULY 17,1572 REGION ~ TEXAS BREAKGUT UF REQUEST : RM 00007 10/72 PAGE 4 _ . 06 PRUGRAM PERIOD ce RMPS- OSM 5 TOGRZ-1 (51 (2) (4) q3) IDENTIFICATION OF COMPUNENT | CUNT. WITHIN] CONT. BEYONU) APPR. NOT | NEW, NOT } AOD*L YEAR | I TOTAL I J APPR. PERIOD} APPR. PERIOD] PREVIOUSLY | PREVIOUSLY ! OLRECT { { ALL YEARS | 1 GE SUPPURT | UF SUPPORT FUNDED APPROVED costs JOIRECT cost: | . { . we Doe DEY AUTU ARLA HEALTH &ESI t ! j j f ' } Losce [Lito CEALL 2 1 i $46.8990 1 I L $46.890_1 1L $9128 223 G69 Behn } | j i I t i t . L } t i $118.623_1 $i162623_L 1 $22622787 1 G7TO TAMSLY MELICAL RESUUNCE | { } ' | ! i t GeuyeR i lL l 1 l L j $14,852 3 OTL AREA HEALTH EGUCATELN Fe} i i 1 J I i t guebes ee GhAM ELEP FAS 1 | L l 1 i £42.00 G72. TYLLE SULEH CULNTY HLALTY { i t | l i. i by ie ot _L i j i } 1 32523753 Gli. CEMTINUING MELICAL EDUCA } 1 j } ! ! Tle ! ! { a4 ‘4 1 $20,002! . UNSPECEFLED GkUsTH FURS] I 1 t } - ot i i L. } i t $490,000 1 $420,000 3 f_.$2.240.009 | i J | 1 t j f i TCTAL - j } $1e431-972 | | $908 9263 | 3223400235 } -{ $69763,315 ! JULY 1851972 REGION = TEXAS BREAKOUT CF REQUEST RM 90997 19772 PAGE 5 oo _. . O7 PROGRAM PERIOD ee RMPS=OSH-JTOGR2=-1 (5) (2) (4) a) IDENTIFICATION OF COMPONENT [ CONT. WITHIN] CONT. BEYOND] APPR. NOT J NEW, NOT [ ADD'L VEAR | { TOTAL ! ] APPR, PERIOC! APPR. PERIOD! PREVICUSLY | PAaEVIOUSLY | pirectT | } ALL YEARS | OF SUPPORT { OF SUPPORT | FUNDED APPROVED { costs 1 {DIRECT costs |! . . | ! | | I C090 PRCGRAM STAFF i | } } { | [ | ! l $877.970_) j J $8772979_4 L_ $224542 853 1 007) DEVELOPFRENTAL CCHPCNENT | 1 1 I { : ! 4 I l 1 $225,008 | j I $225,902 1 L $585.990 1 9544 GRC i } [ t { | I I : 1 j ! L L 1 j $372226_1 _. 0548 GRC { t t ! 1 t t af ! i 1 1 1 i J $373226_] 954C CRO ! | | | | { f 1 I 1 ! t j 1 1 $372226_1 - 0§40 GRC t t I | I I ! l : L } L J : j I [ $38,322) . OS546E GRC | J \ ! i 1 l. { I ! i ! toe Il l { $272222_1 954. ~ERYBENERT— TOTAL i 1! 1 J [ i LL $227252911 055 ELECTRICAL SAFETY SERVIC! I J | | l ! { £5 I 1 } { ] 4 $57,970 1 G574 CCMPREHENSIVE RENAL aoe! I | | { ; I ! ! 7 ~-~BAM i | I 1 $138.742_] $138,742) } $443,743 J 0573 COMPREHENSIVE RENAL PROGI t | ! | 1 1 : { 4M 1 ! ! } $49.535_1 $482535_1 L $2532191_] O57C COMPREHENSIVE RENAL PRCGI | ! | I ! | ! QAM J 1 i { $272824 1 $275824.1 ! $90,974 1 057D COMPREHENSIVE RENAL PROG! I l 1 | ‘ | ! i _ RAY 1 . L { I $512735.4 $51s715 1. I $162.85 1 OS57E COMPREHENSIE VE RENAL PROG]. 1 } ' { 1 { ! BAY l i J L$ 272824_) £$27282%_) L $99,974 1 052. CCOPPCNENT TOTAL j i j Li $294.6420 14 $296.642) 1 LL 89410439701 058 AREA HEALTH EDUCATION REI | { ! I I { I _--S0U2LES_ PRCGRAM LEGy 1 L f 1 1 j I $39.381 1 059 WEST TEXAS S E NEW MEX Al { | | | 1 | . 4 HEBP I ! i l I L i $3922°9_1 N60 SOUTH TEXAS AREA HEALTH | | | ! | ! ! ENUCATION PESOURCES i 1 1 ! 1 Lo. $46:748 1 661 MANO | ! ! ! | | t 1 1 $692655_1 L ! $692655_h L $295,925) 062 CHILDRENS HEART PROGRAM | t J { { | f | WOE _SQUIN TEXAS . 1 $84,5929_1 L { $84,533] j $255,675 t 063 AREA +ZALTH RESCUPCE it | I | { 1 4 1 1CENTE? 1 { 1 ! ! i $24,971 J] (064 STO TECHNIQUES FOR HOME i { I | { 1 | ! HEALIH CARE SEPVICE J 1 $242908_1 ! } $24,902 J l $95.5890 1 a 065 REACH { ' ! 1 | { | I i | i 1 L 1 i $25,504.) l 066 DEMO UNIT IN MECICAL REF] l t I. ! { | | Ag i I I 1 L L 1 $68s978_ 1 067 BASIC &EHAB NURSING TECH! { ! I | | ! ! NISUES ! l L Ll l L $512920_ 1 -ZI- JULY, 1691972 : REGION - TEXAS BREAKGUT OF REQUEST RM OATAT 19/72 PAGE 6 - 37 PROGRAM PERIND RMPS-OSM-JTOGR2-1 {5} (2) (4) (1) IDENTIFICATION OF COMPONENT | CONT. WITHIN] CONT. BEYOND] APPR. NOY | NEW, NOT J apof'e YEAR I 1 TOTAL | | APPR. PERICC] APPR. PERTOL! PREVIOUSLY | PREVIOUSLY | preecr | 1 atl years | | OF SUPPORT -} OF SuPPaRT | FUNDED ! APPROVED 1 COSTS pees costs ' ! t { to 1 068 DEV AUTO AREA HEALTH RES! | j 1 ! | ! ! __ URGE INFO CENTER i { J i ! i ! $91,899 J 069 HEARD t ! 1 | ! | ! , ! : i i 1 J $632943 1 $53.843_] i $296.292_1 O73 FAVELY MEDICAL RESCURCE | { | vf I" | ! | CENTER 1 IL lt ! J ] 1 $34.96 5 O71 AREA HEALTH EDUCATION El j t j t J 1 t aS MUBCES PSCGEAM CENT TEX L j J tL j 1 i $422209 T- 572 TYLER SMITH COUNTY HEALTI 5 I t { { t { H_COUACIL i ] L \ f 1 ! $25,375 1 073 CONTINUING MEDICAL EQUCAI 1 J | “1 ! | | I i ! i { ! I $29,000 5 UNSPECIFIED GROWTH FUNDS! ! 1 | ! { ! t j 1 L I $7692999_ 4 $769.99] 1. $2.22402790.1 t 1 ! ! ! J 1 1 TOTAL i 1 $1+2822925 1} J $1y91169483 | $24497,593 | 1 $64919.213 | -€lI- ———EEEEE REGIONAL MEDICAL PROGRAM OF TEXAS SERVICE FUNDING HISTORY LIST OPERATIONAL GRANT (DIRECT COSTS ONLY) May 15, 197@ Component Ol 02 03 oux Total No Title 7/68-9/69 10/69-9/70 10/70-8/71 9/71-8/72 9/72-12/T2 co00 Coordinators office $ 232 386 . $$ Tal 9249 $ $ 527 ,OL7 $1,481 yaee C001 Planning for Renal Disease 20 ,000 20 ,000 coo2 Feasibility of Pastex —— 4,000 4,000 C21A Program Staff — 580,140 ;580 140 C21B Planning Renal 15,000 15,000 C21zZ Feasibility Study 4,743 1,743 c220 Planning So. Texas Med. 60,135 15,000 75,135 C230 PP2anhing So, West Med. 62,596 3,260 65,856 C20 Planning Galveston U. T. 95,194 349 99 543 C250 Panning Dental Inv. 42,194 42,194 C260 Planning Multi. Med. 45,386 11,500 56,886 Z C270 Planning Reg. Ca. Program 37,622 9,500 - WT ,122 c290 Planning Baylor Fea. 180,117 27,125 _ 207,842 Subtotal 755,630 792,553 596 ,883 551,617 2,696 ,683 po0d Developmental Component 87,334 87,334 001 Medical Genetics 25,149 26,748 | 12,570 64,467 003 East Texas Hosp. Teaching | . Chain 4o ,164 . 40,164 004 Comm. Hospital Inhalation 47,500 50,000 97,500 005. Regional Consultation in Radiotherapy — 47,500 60,000 ~ 30,000 137 ,500 006 Medical Physics 28,500 4g ,584 45,000 20 ,000 143,084 007 Cancer Incidence and Resources in Texas 76 446 76,446 008 Statewide Cancer Registry 38,000 80 ,000 91,123 108 ,000 317,123 014 stroke Demonstration Progressive Program 141,045 141,045 Stroke Demonstration 63,419 63,419 O14A Page No O14B 015 016 O17 _ OTA 017B 018 019 020 030 031 033 035 036 037 038 039 O42 © 043 O45 - 046 O46A O46B o46C 2 - Funding History List Component | OL Title 7/68-9/69 Stroke Demonstration $ Area-wide Respiratory 174,388 Regional Rehabilitation 107 ,007 Regional Rehabilitation : San Antonio 60,709 Regional Rehabilitation Regional Rehabilitation Univ. of Texas Dallas Co. 40,873 Rehabilitation Cardiac Work 41,181 Eradication of Cervical Cancer 80 ,083 Planning for Allied — Health Training 51,870 Long Distance Consultations Extended Coronary Care Nursing Training Reduce Complications Serial Control System Health Careers Dial Access Annual Tumor Clinic Continuing Education for Occupational Therapists Instructional Program for Allied Health Educators Community Action Maxillofacial Prosthetic Maxillofacial Prosthetic Maxillofacial Prosthetic Maxillofacial Prosthetic a wo q 02 10/69-9/79 $ 2H2 955 127 ,063 67 ,607 74,620 90,000 13,000 35,000 84,00 37 ,000 28 ,000 29,801 16,500 15,000. 24 ,000 17,500 160,000 100 ,000 03 10/70-8/71 $ 80,000 67 5708 46,185 45 ,049 86,700 19,395 62,550 38,566 28,001 65,762 19,963 11,520 22,826 90,977 106,217 o4® 9/71=8/72 $ 36,581. 20,000 5 4b 14,556 | 20,000 35,000 9,001 77,000 17 ,000 259 3900 34 ,878 30,062 35,060 Total 9/72-12/72 $ 36 ,581 497 ,303 321,778 174,501 5,444 14 556 160,542 41,181 276,783 64,870 54 395 146,550 110,566 65,002 172 563 53,463 26,520 46 ,826 17,500 305977 206,217 34 878 30 ,062 35,060 -¢T- ——————_——— page 3 - Funding History List Component 01 02 03 O4x Total No Title 1/68-9/69 10/69-9/70 10/70-8/71 9/T1-8/72 9/72-12/72. 051 Inhalation Therapy — $ $ -$ 26,900 & 26,900 054 Project GRO 75,000 75,000 055 Electrical Hazards 68 ,583 - 68,583 . Total $1,615,000 $2,220,891 $1,708,040 $1,390,435 $6,934 366 % 04 Year Extended to 16 months (9/71-12/T2) _ See Revised Budget next page- 1 em an i) -17- Regional Medical Program of Texas O04 Yr. Extended 16 Months (9/71-12/72) Program Staff Planning Renal Disease Subtotal Developmental 06 Medical Physics 08 Cancer Registry Bexar Co. 14 Stroke Demonstration 16 Demonstration Unit 17A Demonstration Unit-Registry Rehabilitation 17B Demonstration Unit-Registry Rehabilitation 20 Cervical Cancer 35 Radiotherapy Complications 36 Serial Control System 37 Health Careers 38 Dial Access 45 Community Action 46 Maxillofacial Prosthetic 51 Inhalation Therapy 54A GRO - Tarleton State College 54B GRO - Sam Houston State University 54C GRO - Tyler Junior College 54D GRO - Del Mar College 54E GRO - Graduate School of Biomedical Sciences 55 Electrical Safety Services 58 Area Health Education Resources Program 59 S. E. New Mexico Health Resources Program 60 S. Texas Area Health Education Resources 61 MANO - Family Health Service Program 62 Children's Heart Program 63 Area Health Resources Information Center 64. Standard Tech. for Home Health Care 65 REACH _ 66 Demonstration Unit in Medical Rehabilitation 67 Basic Rehabilitation Nursing Technician Direct Costs $ 926,818 26,500 120,000 20,000 131,939 100,000 20,000 5 way 8,556 20,000 35,000 9,001 77,000 24 5555 55 ,000 100 ,000 48,100 | 22,247 22,247 22,847 4 992 45,912 5B 580 15,000 21,000 15,000 50,000 30,000 8,000 . 12,000 8,000 22,270 9,000 68 Dey. Auto Area Health Resources Information Center’ 17,712 Total $ 953,318 $2,106,720 -18- REGIONAL MEDICAL PROGRAM OF TEXAS HISTORY FUNDING (DIRECT costs): Planning Grant Period Period Amount Funded 01 7/66-6/67 (12 mos.) $ 969,541 02 7/67-6/68 (12 mos.) 1,039,295 Operational 01 7/68-9/69 (15 mos.) 1,615,000 02 10/69-9/70 (12 mos.) . 2,220,891 1/ 03 10/70-8/71 2/ (11 mos.) 1,708,040 3/° 5/ oy 9/71~-8/72 (16 mos.) 2,106,720 4/7 ~ V/ Included $444,178 Carryover from Ql year. 2/ Award for 11 months at request of RMPS to accommodate anniversary . review scheduling. 3/ Included $549,344 Carryover fran 02 year; also, ineludes 12% budget reduction placed on Texas FY 1971 appropriation. 4/ 04 periods extended from 9/71~8/72 $1,390,435 to 9/71-12/T2 $2,106,720 to accommodate Three Cycle Review. , . 5/ Reflects a 12% budget reduction imposed in April 1971. REGIONAL DEVELOPMENT: In December, 1965, various academic, State and private health representatives met to discuss the potentials of the then newly enacted legislation calling for Regional Medical Programs. A State Coordinating Committee was formed which later became the Regional Advisory Group. After first attempting to establish three separate Regions, the applicants comprémised on three subregions in North Texas, South Texas, and the Gulf Coast. Seven schools in the Houston area represented the Gulf Coast subregion, while the UISW in Dallas represented the Northern subregion and UT San Antonio represented the Southern subregion. The University of Texas at Austin was designated the applicant organization, while the Texas Medical Center in Houston was. designated the fiscal agent. In June 1970, the fiscal agency was transferred to the Office of the Compproller of the University of Texas System in Austin. The initial planning grant was awarded in July 1966, but progress, including staff recmuitment was relatively slow. Baylor (Houston) repgpted some progress in planning for an Allied Health Training Program and in starting a Cancer Registry; San Antonio reported resistance problems with private practitioners; -19- Regional Medical Program of Texas RM 00007 10/72 while Southwestern (Dallas) reported good progress in surveying resources and personnel needs in the categorical diseases. Dr. C. LeMaistre was serving as Program Coordinator in Austin, and Dr. Spencer Thompson was appointed Associate Coordinator and was stationed in Galveston. During the second planning grant year, staffs from the various institutions began joint planning meetings, task forces were created in the categorical diseases, the RAG began to develop its Review Process and the Texas Council of Health Science Libraries was created. This planning group submitted its ee operation application which led to a site visit conducted in June 1968. The major concern of the site visitors was the apparent lack of central direction and coordination of the program, This was illustrated by the uneven progress made in the development of the nine subregional planning units and by the fact that operational proposals appeared to be "based on . institutional interests and strengths with very little regard for community needs and goals ~ either regionwide or local - and only a few demonstrated evidence of true cooperative arrangements or unilateral peripheral involvement." The site team observed that the Regional Advisory Group, though under strong leadership, had not been active in the identification of program goals and the development of program plans. The RAG was weak in its representation of minority groups, consumers, allied health professions, and the practicing community. Because of these apparent shortcomings, Council recommerided a one-year approval of the Texas operational application, including continued planning support, with future funding contingent upon demonstrated improvement in the areas mentioned by the site visit reviewers. Accordingly, a one~year operational award was issued. These funds were divided evenly between operational and planning activities. A subsequent site visit was held in April 1969 to access the progress made in fulfilling the conditions laid down the year before as necessary for further funding; that is, strengthening central administration and expanding the RAG. The reviewers were satisfied that these reqkirements were being met; a new coordinator, Dr. Charles McCall, had been appointed and had presented his plans for tightening up the organization. The RAG was expanded to include nine new interested groups. On that basis, the _ Region received an 02 award including carryover, as well as commitments , for the 03 and 04 years. The 03 continuation application, reviewed by RMPS staff, indicatédr that Dr. McCall's plan appeared to be working: ‘The Planning bases were phased out by January 1970 (except for development of a subregional office in Houston) and for the first time the Region had a multidisciplinary program staff in Austin. Functional differentiations between the RAG and the program staff had been delineated. The RAG had adopted a set of “bylaws and seemed to be involved in program development. Five task forces, with primary review responsibilities, had been made agents of the RAG rather than of the Coordinator. Financial management procedures had been altered with RMPS assistance. Planning and evaluation functions had been -20- Regional Medical Program of Texas RM 00007 10/72 consolidated in the Coordinator's office. Close relationships between TRMP and the Texas Hospital Association and a formal working arrangement with CHP had been initiated. Subregionalization was being pursued. On receipt of the Region's Triennial Application for the o4, 05, 06 years, another site visit was conducted during June 1971. The visitors were convinced that TRMP had made considerable progress during the past two years, but in the absence of specific proposed activities for funding for the second and third years of the request, three year funding was not recommended. The Region was complimented on its concerted efforts to develop program activities outside the confines of the medical institutions without losing the support and commitment of these necessary resources. It was recognized that there are still strong proponents for the categorical medical center approach in Texas, but in the opinion of the site visitors, these interests had been neutralized by the support for a program emphasizing the needs of commmnity hospitals and practicing physicians. The focus on subregionalization was also commended. The decision to employ indigenous workers with firsthand knowledge of their respective working areas indicated that action oriented planning and implementation of program activities can be initiated more quickly and be more concentrated on the real health needs in the respective geographical areas. The central office staff of the RMP of Texas was acknowledged to be highly qualified, enthusiastic and well directed by its Coordinator and Regional Advisory Group. Also noteworthy was the involvement and participation of practicing physicians at both the decisionmaking level and in the area of ongoing projects, especially those which have assisted the physician with upgrading patient care. It was noted that other key health groups, 4ncluding CHP, the State Health Department, the nursing association, the hospital association and voluntary health agencies are supportive of the RMP of Texas. As recommended by the gite visitors, the August 1971 Council approved the Region for two years support, including a developmental component. at re ee Ao EEE oh 0 “ba -21- . MEMOR ANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION TO THE RECORD DATE: July 24, 1972 STAFF OBSERVATIONS mRoM Operations Officer Mid-Continent Operations Branch Comments agreed upon at RMPS Staff Meeting July 18, 1972, regarding the Triennial Application from the Regional Medical Program of Texas and the Site Visit scheduled August 1-2, 1972. SUBJECT: Participants: * Michael J. Posta, Chief, Mid-Continent Operations Branch % Luther J. Says, Jr., Mid-Continent Operations Branch # Joseph L. de la Puente, Office of Planning and Evaluation # Jimmy Roberts, M.D., Division of Professional and Technical Development . 7 Harold White, Grants Management Branch © * Denotes staff members of the proposed site visit team. Summary: The meeting began with a brief review of the references prepared for the site visitors with particular attention to the history of TRMP, previous site visit, advice letter, Management Information System printouts on previous funding, breakout of the proposed three year spending, and descriptor summary. Staff noted the funding of current 04 year to be as follows: Date of Award Period Amount _(d.c.) Activities — 9/3/71 g//Ti-8/3V/72—=«$15274,565 Program Staff $523,081 : 15 Projects $751,484 1/20/72 «OW /A/TAH8/31/72-—S«#$1,390,435 Program Staff $551,617 (Amended ) Developmental $ 87,334 15 Projects $751,484 6/26/72 9/1/71-12/31/T2 $2,106,720 Program Staff $953,818 (Amended - 4 mo. ext.) Developmental $120,000 31 Projects $1,032,902 -22- Page 2 - THE RECORD The proposed triennial funding (d.c.) plan is as follows: 05 06. OT. Program Staff Activities $ 754,129 $ 862,762 $ 877,970 Developmental Component 160,000 200 , 000. 225,000 Projects (27) 1,264,341 (16) 796,960 (9) 537 ,538 Unspecified Growth Funding -0- 480,000 760,000 Total $2,178,470 $2,339,722 "$2,400,508 The renal disease and GRO components consists of five projects each. It was interesting to note that support of 13 projects will be phased out during the current O04 period. Continuing support for two more year's is requested for the five GRO projects which began at the beginning of the current 04 period. Continuing support for one more year is requested for the Electrical Hazards project now completing its first year. Continuing support is requested for eleven new projects which began during the last quarter of the current extended 04 period. Ten new activities are proposed, five of which represent the renal disease component. Of the 21 new activities (11 began in the current period), ten are currently budgeted for one year only, two for two years and nine for three years. Staff was favorably impressed that most of the project sponsors are other than medical schools and most of the activities are subregional. The primary activities are continuing education, training new and existing health manpower, patient care and coordination of health services. Only two projects are categorical disease oriented. Mexican-Americans are the primary target population of five projects (four in the Rio Grande Valley and one in the San Antonio area). Blacks are the secondary target population of two projects. Other special target groups include: 1 for the inner city poor, 14 for rural areas, and 2 for other poor. Primary health care delivery methods represented by. the projects: ambulatory care, extended care, home health care, in hospital care, and mobile units. Primary elements include access, area health education (4), medical consultation, health team approach, joint services, patient and public education, and safety. The health professional target groups include physicians, nurses and almost all categories of allied health personnel. Issue Requiring Attention of the Site Visitors: The site visitors should specifically explore TRMP's progress relative to the six constructive criticisms enumerated in the RMPS advice letter of August 11, 1971. Page 3 - -23- THE RECORD Other issues should include: 1) 2) a) 4) - 5) 6) 7) 8) 9) Utilization of consumer groups in establishing objectives and priorities. Relationships with CHP "a" and "b" agencies in planning and project development; particularly since only 5 of 21 "b" agencies have been funded and TRMP local advisory groups have not been activated. Why are no planning and/or feasibility studies included in the application? What is the current status of emergency medical services and what is TRMP's role? Of those projects where TRMP support is to be phased out in the 04 year, how many will continue? Proposed budgets indicate only minimal support from other sources. If successful, what are the assurances of their contimiation after cessation of TRMP support? , In the long range planning, what will the relationships be between GRO projects and Area Health Resource Information Centers? With regard to GRO projects, what are the cost-sharing services other than education? Explore rationale of funding of the many new projects for one year only, as well as unspecified growth funding in the 06 and O07 years. Luthey J. Says, Jr. 2 no, Region Virginia RM 00049 .. eo . Review Cycle 10/72 Type of Application: Triennium © co . Rating 287 Recommendations From f_/ SARP . / X/ Review Committee / /. Site Visit ” / 7 Council _ RECOMMENDATION: The Rgview Committee accepted the recommendation of the site visitors that the Virginia Regional Medical Program be approved for: 1. Triennial status at a $1,800,000 direct cost level. for each of three years. -2.. A developmental component in the requested amount to be funded within the total $1.8 million level. Critique - The Chairman of the site visit team presented the findings of the team to the Review Committee. Progress of the Program since s the last site visit was illustrated both by reference to the Region's | — change in attitude and the favorable response by the Regional Advisory Group, the Coordinator, and Program Staff in regard to past concerns -and recommendations of review groups. The site visitors’ evaluation of programmatic achievements, current concerns and recommendations emanating from the August 1972 visit were presented. Committee discussion focused upon the recommended funding level for the Program, Clarification of the requested amount within the Program Staff budget for central staff services was provided. The Program's capability to effectively allocate and utilize the recommended funds was. discussed. The Chairman of the site visit team “reported that the Program had attained a maturity of judgment and a demonstration of competency (in the way it had moved and in the way. it anticipated it was going) that qualified it for triennial status at this point in time. ‘Dr. William G. Thurman was not present during the discussion. EOB/DOD 10/2/72 COMPONENT AND FINANCIAL SUMMARY TRIENNIAL APPLICATION Review Cycle: Q¢ Region: Virginia sg RM30004 Current Annualized Request for Triennial - Committee Recommendation for Council-Approved Level — COUNCIL RECOMMENDED LEVEL - * -Included in Component Level 03 Year lst year | 2nd year | 3rd year Ist year | 2nd year | 3rd yea PROGRAM STAFF $ 501,225 57,016,407 |$1,054,027 $1,159,429 CONTRACTS * (41,802) (376,769) _ - DEVELOPMENTAL COMPONENT -0- 80,000 80,000 80,000. OPERATIONAL PROJECTS 536,566 1,893,136 1,574,982 1,169,137 Kidney #x (136,996) | (142,675) - EMS 0 #e (128,045) | ¢ 52,094) hs/ea #4 ( 48,660 ) - - Pediatric’ Pulmonary C ) " other Cc f ) TOTAL DIRECT COSTS $1,037,791 $2,989,543 $2,709,009 $2,408,566 $1,800,000 $1,800,000} $1, 800,0 $1,010,000 Program Staff Total xx Earmarked + Included in Operation Projects ~ Total & SITE VISIT REPORT VIRGINIA REGIONAL MEDICAL PROGRAM August 3-", 1972 I. SITE VISIT PARTICIPANTS Consultants Sister Ann Josephine, Chairman, Administrator Holy Cross Hospital, Salt Lake City, Utah Benjamin W. Watkins, D.P.M., 470 Lenox Avenue, New York, New York Morton C. Creditor, M.D., Coordinator, Illinois Regional Medical Program, 122 South Michigan Avenue, Suite 939, Chicago, Illinois William Vaun, M.D., Director of Medical Education, Monmouth Medical Center, 300 2nd Avenue, Long Branch, New Jersey Staff, Regional Medical Programs Service Mr. Frank Nash, Acting Chief, Eastern Operations Branch Mr. Clyde Couchman, Program Director, RMPS - DHEW Region IIT Ms. Joan Ensor, Program Analyst, Office of Planning & Evaluation Ms. Marjorie L. Morrill, Health Consultant, Division of Professional & Techni¢ali Development Mr. George Hinkle, Public Health Advisor, Eastern Operations Brarch Staff, Virginia Regional Medical Program Eugene R. Perez, M.D., Executive Director Jack L. Mason, Ph.D., Asst. to Fxecutive Director for Evaluation Ms. Ann S. Cann, Communications & Community Affairs Ms. Tandy Shields, Assistant to Communicatipns & Community Affairs Officer Mr. Freeman H. Vaughn, Program Development & Operations Officer Mr. Sam Kalman, Planning & Technical Services Officer Mrs. Barbara Peace, Records and Registries Administrator Mr. Archie Nelson, Jr., Assistant Allied Health Officer General W. C. Haneke, Business Administrator Mr. Arthur L. Burton, Assistant Business Administrator Mrs. Mildred Brown, Community Liaison Officer Mr. Fred Beamer, Community Liaison Officer Mr. Henry Kauffelt, Community Liaison Officer Mrs. Wilma Schmidt, Community Liaison Officer Mrs. Norma L. Doeppe, Executive and Administrative Secretary Representatives of the Virginia Region A, Regional Advisory Group - Members Anthony J. Munoz, M.D., Medical Society of Virginia, Private Practice, Farmville, Virginia, Chairman of the RAG and Executive Committee Virginia RMP -2- RM 00049 Representatives of the Virginia RMP (continued) A. Regional Advisory Group — Members (continued) Mack I. Shanholtz, M.D., Commissioner, Virginia State Health Department, Richmond, Virginia, Executive Committee of RAG, Bylaws Committee : Mr. Hunter A. Grumbles, Hospital Administrator, Memorial’ Hospital, Danville, Virginia, Executive Committee of RAG, Program Committee Mr. Bernard W. Woodahl, Executive Vice President, Virginia Division American Cancer Society, Richmond; Virginia, Cancer Committee, Executive Committee of RAG , L. A. Woods, M.D., Vice President for Health Sciencés, Virginia Commonwealth University, Richmond, Virginia, Executive Committee of RAG. Frank A. Wade, M.D., Chairman, Medical Society of Virginia, Private Practice, Roanoke, Virginia, Review & Evaluation Committee R. A. Mackintosh, M.D., Private Practice, President-Virginia Academy of General Practice, Review & Evaluation Committee Thomas C. Barker, Ph.D., Dean, School of Allied Health Professions, Virginia Commonwealth University, Review & Evaluation Committee Mr. James WM. Stone, Executive Director, Virginia Heart Association, Richmond, Virginia, Heart Disease Committee Robert T. Manning, M.D., Dean, Eastern Virginia Medical School, Norfolk, Virginia. Mr. D. Joseph Moore, Executive Director, Tidewater Regional Health Planning Council, Norfolk, Virginia Mrs. Jane B. Nida, Director, Department of Libraries, Arlington County, Arlington, Virginia B. Board of Directors -— Members Daniel Mohler, M.D., Associate Dean, University of Virginia, School of Medicine, Charlottesville, Virginia . Charles Townes, M.D., Ph.D., Medical Director, Memorial Hospital, Virginia State College, Petersburg, Virginia Kinloch Nelson, M.D., Assistant Chief Staff for Education, Veterans Administration Hospital, Richmond, Virginia C. Ad Hoc and Standing Committees John C. Hortenstine, M.D., Director of Medical Education, Winchester Memorial Hospital, Winchester, Virginia, Chairman, Heart Committee Walter Lawrence, Jr., Division of Oncology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, Chairman, Cancer Committee James C. Pierce, M.D., Medical College of Virginia, Surgery Department, Richmond, Virginia, Committee on Kidney Disease © Virginia RMP -3- RM 00049 . D. Organizations/Institutions Daniel Mohler, M.D., University of Virginia* Warren H. Pearse, Virginia Commonwealth University (VCU) L. A. Woods, M.D.} Vice President of Health Sciences, vou * Robert T. Manning, M.D., Eastern Virginia Medical School* Raymond P. White, D.D.S., School of Dentistry, vcu Mr. James Moore, Medical Society of Virginia Frank A. Wade, M.D.; Chairman, Medical School of Virginia * Charles Townes, M.D., Ph.D., Old Dominion Medical Society* R. A. Mackintosh, M.D., Virginia Academy of General Practice* Mrs. Barbara Walker, Virginia Nurses Association Mr. Earl Willis, Virginia Hospital Association Mr. Herbert Seal, Virginia Nursing Home Association F. B. Wiebusch, D.D.S., Virginia Dental Association Mayer Levy, D.D.8., Virginia Dental Association Mr. Keith Kellum, Virginia Pharmaceutical Association Ms. Barbara Gibson, Virginia Pharmaceutical Association Mr. James H. Stone, Virginia Heart Association* Mr. Bernard Woodahl, American Cancer Society, Virginia Division* Mr. Edgar J. Fisher, Jr., Va. Council on Health & Medical Care Miss Ann McNeill, Tuberculosis & Respiratory Disease Association Mr. Henry.Harmon, Model Neighborhood Mrs. Poe, Model Neighborhood oe Mr. David Benson, R@AP (0.E.0.) | Mr. W. H. Brower, CHP (A) Mr. D. Joseph Moore, CHP (B)* - Kinloch Nelson, M.D., Veteretrans Administration* Mack L. Shanholtz, M.D., Virginia State Health Department* Others . Mr. Beverly Orndorff, Science Writer, Richmond Times Dispatch — Ms. Alberts Clayborn, Richmond News Leader Mr. Gene A. Pieree, MCV, Renal Disease 'Mr. Robert Youngerman, Southeastern Inter-regional Exchange Program Mr. John Taylor, Congressman Satterfield's Assistant -. *Dual Listing Virginia RMP ~4- RM 00049 INTRODUCTION: ° _ TI. PURPOSES OF THE SITE VISIT The Virginia Regional Medical Progran - will have completed its first three r years as an operational program on December 31, 1972. The purpose of the August 3-4, 1972 site visit was to assess the region's ; » overall progress, the quality of the current program and its prospects for the next three years. The site visitors reviewed the Virginia RMP's decisionmaking and review processes, administrative and evaluation capabilities, and the current planning, involvement and accomplishments with respect to program directions of the Regional Medical Programs Service. The new review criteria and Mission Statement were used by the site visit team as a guide in evaluating the overall program and arriving at programmatic recommendation. III. SITE VISIT OBSERVATIONS Goals and Objectives The Virginia RMP goals and objectives were developed after the newly established Program Committee had reviewed national, state, and local health priorities and received input from state and local health planning councils, the various health societies and associations, other RAG members, and the Virginia RMP staff. These goals and object- ives reflect the latest mission statement of the RMPS and are explicitly stated even to the extent that activities to be directed toward implementation and accomplishment of the stated objectives are delineated. They are considered to reflect regional-needs and problems to the extent that the activities identified with the goals and objectives evolved from need identifying conferences and feasibility and planning studies. It is considered that they have been accepted by the health providers and institutions of the region as signified ‘ by formal endorsement of the Program health provider groups, and membership of health providers and consumers on the RAG, the Board of Directors and various RAG committees. However, it does appear that community and consumer group participation in the development of the goals and objectives has been limited to their representation on VRMP review and decisionmaking groups.. The region has endeavored to prioritize the goals and objectives as well as proposed program activities. A very thorough numerical rating system has been devised for establishing relative priorities of individual projects/activities at the time they are reviewed by the RAG. Rating sheets are utilized that measure ten positive elements (need-intensity need-extent, potential benefit success probability, resource use and generation, scientific/technical characteristics, Virginia RMP -5- RM 00049 evaluation, educational strength, budget analysis, and program balance) and one negative element (adverse reaction or effects). These elements are rated on a scale ranging from 0 to 5 and adjusted by assigned "yeighing factors" that reflect the relative importance of each of the elements evaluated. Although the procedures followed, and the goals, objectives and priorities established appear to be adequate, evidence was found that there is no clear plan for utilizing the ranking system in establishing funding priorities. It is the consensus of the site visit team that confusion exists as to the purpose and potential benefit of priority ranking as a mechanism for funding determinations and decisionmaking. It ie suggested that members of the Program need to more fully discuss and understand the intended purpose and method envisioned for utilization of the goals, objectives and project ranking system in future funding and policy determinations. | Accomplishments and Implementation The VRMP is in its third year of operational activity, having been awarded operational status effective January 1970. There is evidence that provider groups are looking to VRMP for consultation and assistance and that the involvement of physicians, nurses, allied health professionals, hospitals, universities and other agencies in efforts to improve health care throughout the region is making a difference in ‘the total health care system. Evidence of significant program staff activities was manifested by involvement directed toward improved care for stroke patients in underserved areas, development of skills in utilizing medical audit as an educational instrument to improve quality of patient care, and activities related to rehabilitation consulting teams for nursing homes, pro- grams in sickle cell anemia and many other areas. Program staff has assisted in the establishment of the Virginia Medical Information System as a Statewide Biomedical Library service which is currently planned for expansion to a subregional level. The coronary care evaluation project” that originally began with five participating hospitals was expanded to eleven; now that RMP funding is to be discontinued, it is anticipated that the effort begun by the VRMP will continue at some hospitals and be discontinued at others where the original objectives have been accomplished. Current plans provide for continuation and/or expansion of successful efforts associated with consultations in discharge planning, community hospital based physician education, and improved care for stroke patients in underserved areas. Program staff activities have stimulated or directly resulted in greater involvement of dentists, pharmacists, and allied health personnel. Activities have resulted: in better utilization of manpower through the continuing education efforts and dissemination of new knowledge and techniques through training. programs for myocardial infarction, cardiopulmonary resuscitation, Virginia RMP -6- RM: 00049 emergency coronary care, and continuing education training for nursing personnel. There is a measure of accomplishment in the building of - relationships in the five subregional districts staffed by the Community Liaison Officers. This process has been continuously evolving through- out the development of the VRMP. Areas of planned development that should have a direct effect on the quality of care and better utilization of manpower include proposed project activities associated with family nurse practitioners, career opportunities for hospital personnel, obstetric training for nurse practitioners, automatic patient history development and translation. Progress toward cost moderation is anticipated by program staff's discharge. planning effort and the proposed project for development of — shared services, facilities and personnel for rural health care institution of Virginia. Minority Interest It is not clear to what extent the Region has identified and analyzed existing data that could permit the RMP to assess its role in meeting health care needs of the underserved areas. However, the response in supporting sickle cell anemia education and screening activities and the measurable model cities involvement by program staff would indicate positive action in meeting the needs of minority groups. The site visitors were apprised of other endeavors to stimulate a greater response for serving minority needs that were unsuccessful primarily due to this group's preoccupation with employment and housing deficiencies. It was suggested that the VRMP should seek a more positive input in this area from minority members of the RAG and Board of Directors. It is believed that this input could result in stimulation of ideas that could then be more fully developed by program staff with continued consultation provided by these members. Minority groups are represented on the Board of Directors (2 of 12), the RAG (4 of 34) and professionally on the program staff (3 of 19). However, the representation on standing committees and on other committees of the VRMP was not viewed as favorable. Increased minority group representation should be considered, not to arrive at an equitable percentage relationship, but to reflect the magnitude of the problem and to better serve the minority group population in the VRMP area. Virginia RMP -7- RM 00049 Continued Support There is an established policy for withdrawing RMP financial support ‘at the end of the initial three year support period. Although it was reported that it is actively seeking other sources of funding upon termination of RMP support, past efforts do not appear to have been very successful - a situation that ig not uncommon to the VRMP. Currently, ten projects are ongoing: three are still in the initial year of support and without any positive indication of a future source of funding and two are being discontinued; one is being expanded on a subregional level with two of the three medical schools providing continued support for the ongoing portion, and two others are being continued either partially or completely by other funding sources; the two remaining ongoing activities are to be continued as central staff activities, only one of which has a positive commitment for continuation by other sources. The 15 proposed new projects in the triennial application relate more positively to this issue: The VRMP is currently seeking support from the National Center for Family Planning Services for two proposes sickle cell anemia activities and — addresses the issue in a positive manner for ten of the remaining 13 project proposals. Of the remaining three, one is a short-term assistance type activity without any long-term qualities, one is reported as positively selected for continuation although the source of funding is not mentioned, and the issue is not addressed in the final one. The Program is strongly advised to continue devoting this accelerated attention to all program elements (including program staff continuing activities) and to consider incrementally decreasing funding of activities over the approved support period to facilitate the use of RMP dollars for initiation of new activities directed toward accomplishment of goals and objectives. Coordinator . Dr. Eugene Perez, the Program Coordinator, although he has a tendency to overreact must be described as a strong, competent leader that relates well with the RAG, the Board of Directors, members of his staff and other professional organizations. He has organized an effective and functioning etaff that appears to be well qualified and highly motivated. Even though the administrative mechanisms are present for effective communication with the RAG, the presence of ideal communication was questioned by the site visitors and refinement of these processes is considered necessary. It is strongly recommended that the Region be advised to accelerate its current ongoing effort to locate and hire an effective deputy éirector. Not only is a deputy coordinator considered essential to Virginia RMP -8- , RM 00049 insure continuity of the program, it would relieve Dr. Perez of many of the daily time consuming routines thus permitting an even greater involvement in overall program management and an intensifi- cation and improvement of daily communications both within and without the VRMP organizational structure. Program Staff The program staff is all full time, impressive, competent personnel with an adequate range of professional disciplines and management capabilities, Individual employees appear to be highly knowledgeable with respect to duties and responsibilities and very involved in activities to strengthen relationships and foster involvement of communities throughout the area. Site visitors, although not concerned with the flexibility and dedication of members of the staff, were apprehensive about the capability of the staff to adequately absorb the increased work load with respect to monitoring, evaluation and RAG liaison that is inherent in the proposed expanded program. (It is noted that the current application provides for seven secretarial positions and five other positions for a planner, assistant planner, Statistician, health educator and a registrar.) The site visitors were especially cognizant of substantive program activities placed under the Management of program staff and encouraged the region to secure a firm commitment of the RAG for developing mechanisms for control and provision of necessary support for the management and program monitoring required of these activities. The VRMP plans include the opening of subregional offices in each of the five areas of the State delineated by the Virginia Hospital Association. Each office is to be staffed by an area coordinator (currently employed and designated as a Community Liaison Officer) and a secretary. The responsibility of the area coordina'or will be to work and plan -:ith health care institutions, educational | institutions, health professionals and subprofessionals and other interested personnel and programs for the improvement of the 'calth : delivery system through manpower development. {[t is also planned to establish Local Advisory Groups within each of the five areas to more adequately determine local health needs and methods for successful attainment. Regional Advisory Group The RAG is considered to be adequately representative of ali key health interests, institutions and groups within the region and ene . : that is actively participating in setting program policies, estab- ns Virginia RMP Ae RM 00049 lishing objectives and priorities, and providing overall guidance and direction to the program activities although the site visitors sensed that a greater degree of guidance and direction may be needed with respect to program staff activities. The RAG meets at least quarterly and the meetings are considered.to be well attended, especially when one views the wide geographical distribution of the membership. An Executive Committee of the RAG has been established to act for the RAG between meetings, subject to subsequent approval of the entire group, but the visitors considered this six-member group small in comparison to the proposed expanded program and too provider dominated. It is recommended that the group be enlarged, preferably by the addition of consumer-non-provider type representation. The Virginia RAG has made extremely significant progress in regard to orientation, indoctrination and active participation of its members since the last site visit. Members interviewed during the visit appear to be very capable and dedicated with the common goal of making the VRMP a viable and recognized health care source in Virginia. During the past year, the group's bylaws have been rewritten to (1) more effectively state its responsibilities and the responsibilities of the Executive Director to the group, (2) provide for more frequent meetings and (3) establish a new Program Committee, Bylaws Committee, an Ad Hoc Committee on Allied Health and an expanded role for the Review and Evaluation (R&E) Committee. The RAG membership in line with the expanded role of the R & E Committee, has participated in local site visits to ongoing projects and an increase in this type of effort is planned. However, as more fully discussed under the heading of "Management", it was the consensus of the team that the workload envisioned is too great for this five member R & E Committee. Improvement in this area, more effective channels for communication between the RAG and program staff as previously stated, and minor changes in the RAG composition and committees (such as lay consumer interests on the Executive Committee and more adequate (b) agency - representation) are recommended to complement the already significantly improved RAG. Grantee Organization : . The Virginia RMP is an incorporated entity governed by a 12-member Board of Directors. The grantee organization was originally composed of 18 former RAG members who were very active and knowledgeable concerning the purposes and working mechanisms of a Regional Medical Progran. Since incorporation, three of the original Directors have once again accepted membership on the RAG, thus assuring knowledge and understanding of the separate functions of each of the two groups. Virginia RMP -10- RM 00049 The grantee organization provides adequate administrative support, _ the needed freedom and flexibility, and recognizes the RAG's policy- making role as set forth in the RAG bylaws. To further facilitate efforts to expand daily communications between the Board of Directors, the Executive Director, his staff, and the RAG, it is strongly recommended that ex-officio Board of Director membership on the RAG be provided, and vice-versa. Participation The Virginia RMP has established close interrelationships with major health oriented organizations within the State, it is in communication with Model Cities programs in Norfolk and Richmond, Virginia, and it has demonstrated effort toward developing relation- ships with CHP (b) agencies. Although the relationships with- CHP (b) agencies have not been sufficiently accomplished, the Program appears to be cognizant of this need and has expressed its intent to continue efforts in this direction. In this connection, the need for adequate representation from all (b) agencies on the RAG was stressed by the site visitors, Cooperative efforts and liaison with health oriented organizations are exemplified by interlocking memberships on the VRMP Board of Directors, the RAG's various standing and ad hoc review committees, and program staff. The State medical society has reviewed the new goals and objectives of the VRMP and has once again endorsed the program, The Region has established a working relationship with the newly emerged Eastern Virginia Medical School and has continued its involvement and mutual cooperative arrangement with the other two existing medical schools, It would appear that the political and economic power complex is actively involved with the participation of all three medical schools, CHP (a) and (b) agencies, the state and local health departments, both the Medical Society of Virginia and the Old Dominion Medical Society, Virginia Academy of General Practice, and others. In view of the Program's interest in continuing education activities, it is encouraged to continue to improve relationships with the medical schools and the community colleges, but cautioned not to ignore hospitals in its continuing education efforts. Local Planning The VRMP has demonstrated achievement toward developing relationships with CHP (b) agencies. Although, the relationships have not been sufficiently developed, the Region appears to be cognizant of this Virginia RMP -ll- RM 00049 need and has expressed its intent to continue its efforts in this direction. In this connection, the degree of success varies in each of the five subregional areas of the VRMP. Active project par- ticipation by the Tidewater CHP (b) agency and membership of its Executive Director on the RAG tends to be indicative of opportunities of early planning input from this area, although the actual quality of the input could not be determined. Of the remaining five CHP (b) agencies in the region that are considered operational, positive ‘relationships were reported by only one of the program staff Community Liaison Officers. The Program has established a mechanism for obtaining CHP review and comment, but it would appear that the action is not completed with sufficient lead-time for the comments to be considered by the RAG. It was suggested to the site visitors that the "stepped-up" (one month) submission date for the current application did not provide sufficient time for receipt and consideration of comment during this submission cycle. , The VRMP's plans for Subarea Coordinator Officers and the establishment of Local Advisory Groups (LAG) are envisioned as providing a workable mechanism for greater local involvement in the development of program proposals and program direction. It is recommended that the Region be advised to consider representation from these LAG's (e.g. Chairman) as active members of the Regional Advisory Group to ensure local input into the decisionmaking and policy determining process. , Assessment of Needs and Resources At the present time there is no systemmatic continuing method of identifying needs, problems and resources that has resulted in program decisions based on an analysis of data, but representatives of the Program have stated their intent to assess needs as identified by the emerging CHP process. Goals, objectives and priorities are largely designed to be consistent with national priorities and are in agreement with the RMPS mission statement for regional medical programs. The - RMP has utilized group discussions, staff visite into the area, and the activities of the Community Liaison Officers in the five subareas of the VRMP to determine the immediate needs of the population. The Virginia Council on higher education has been given the respon- sibility of compiling a complete inventory of all health care personnel and facilities within the region. The VRMP will cooperate with the Council in the survey activities and the publication of the results, and is actively collecting a data base (Central Tumor Registry) with the ultimate goal of providing better care for present and future cancer victims in Virginia. Virginia RMP -12- RM 00049. we An improved health data base is stated as one of the goals of. the VRMP. Congruent with this goal is a planned survey to determine educational needs of health professionals and health care institutions to facilitate effective planning for continuing education of health’ care personnel, . Management The management "blueprint" followed by the Virginia RMP appears to be conceptually adequate in that periodic progress and financial reports are required, provisions have been made for monitoring of projects and other activities by program staff and members of the RAG, and personnel are considered professionally qualified and competent. However, as stated elsewhere in this report and repeated here for both emphasis and quick reference, this is the area in which the site visitors believed a greater refinement and strengthening of procedures would most significantly improve the Program. a. The Review and Evaluation Committee (R & E) in its expanded role reviews and reports to the total RAG as to the efficiency of the various program activities, in addition to its primary responsi-. bilities for (1) performing or causing to be performed all required technical reviews of new applications and (2) establishing a recommended priority for funding when reporting to the RAG. In this regard, especially with escalation of R & E Committee members’ participation on site visits, it is the consensus of the team that the work load and responsibilities should be delegated to a larger base of technical and scientific expertise. b. Communications should be improved both within the VRMP organi- zational structure and with other health interests throughout the region. Emphasis for improved communications within the organization is placed upon the need for more timely and complete involvement of the RAG in the day-to-day. activities with possibly the program staff preparing briefs to facilitate absorption of the data by the RAG Chairman and other committees and members. In regard to other health agencies, improved communications and working relationships with the existing and emerging CHP (b) agencies are recognized for primary emphasis, especially with respect to determination of health needs in underserved rural and urban areas and for improved coordination with resultant mini- ‘ mization of duplication and dilution of health improvement efforts within the region. c. The Executive Committee should be enlarged and be truly repre- sentative of the RAG composition, In this connection, non-provider representation should be included. Virginia RMP , ~13~ RM 00049 Evaluation | The VRMP is experiencing problems common to many RMP's in the development of an effective evaluation process. It has a full-time evaluation staff member, but the site visitors have concluded that it is too early to judge the evaluation program under way except to state that the techniques and evaluation data being obtained need to be improved. The evaluative system provides for progress reporting and review by project directors, site visits and routine monitoring by program staff and members of the RAG with provisions for feedback to appropriate groups. However, there is no indication that these evaluation efforts have resulted in program modifications or that ineffective activities have been discontinued or scaled down. Discussions with the Region in regard to its evaluative efforts and among members of the site visit team during executive sessions, high- lighted the urgent need for all regional medical programs to improve evaluation methods and techniques. It was the consensus of the team that a greater effort needs to be directed toward facilitating exchange of ideas, methods and even "peer" review of evaluative techniques utilized by all regional medical programs in assessing both project and program effectiveness. Action Plan Since the last site visit, the VRMP has established a RAG Program Committee whose responsibility is to review and update goals, objectives, strategies and concepts for the VRMP along with the _ primary responsibility of providing guidance to the Executive Director for program activity and project development. The RAG has recently accepted new goals and objectives formulated by this Committee which enables them to move from a heretofore categorical emphasis. These are considered to be congruent with the national objectives and in agreement with the new RMPS mission statement. Administrative procedures for reporting accomplishments, monitoring the progress and assessing and evaluating results have been — established, but a greater refinement of these efforte is considered essential. Dissemination of Knowledge VRMP has been actively participating on the Coordinated Health Survey © Committee with CHP and the Virginia Council on Health and Medical Care in surveying health manpower, facilities and services in the State and has assisted in. the dissemination of the results. This survey will become an annual activity to establish a common data base “Virginia. RMP ~14- RM 00049 eventually to be transferred to a State Center for Health Statistics— ' A Health Data Library, established in the VRMP office, provides ‘services primarily utilized in program staff operations. However, . ‘these library resource materials are available to other agencies and . ‘other individuals upon request. Se SBR The Virginia Medical Information System project has provided ready access to medical information obtainable from regional and national sources. It is currently planned to establish two information sub-centers at community hospital libraries that will cooperate with the ongoing system that is to be continued by the two medical school participants. It is proposed that this endeavor will be supplemented by a Virginia Drug Information and Consultative Service . project during the next triennium. Provider groups and institutions that will benefit from the proposed activities have been determined to some extent, although, knowledge, . . skills and techniques to be disseminated, in most instances, are yet to be determined and are included as objectives of the activity. Many of the proposed activities are to be based in health education and research institutions of the region and are designed to provide better care to more people by improving the skills of physicians and dentists and by providing for the assumption of time consuming routine procedures by specially trained allied health personnel. These efforts, if successful, could result in improved availability and accessibility of health care accompanied by a moderation of , health care costs. Virginia RMP” ~15- . RM 00049 Utilization of. Manpower and Facilities Improvement of the quality of health manpower and the efficiency and economy of health care services in Virginia are identified priority areas for the VRMP. Activities directed toward the develop- ‘ment of shared services, facilities and personnel in rural areas, the provision for new types of allied health personnel such as the proposed obstetric and family nurse practitioner training programs, and efforts toward the expanded role for pharmacists and new career opportunities for hospital personnel will result in increased pro- ductivity of physicians and other allied health personnel. Although many of the activities are directed toward greater utilization of manpower and facilities in rural areas and will undoubtedly benefit the areas in which the activity is to be conducted, the immediate overall regional benefit is viewed as one that would be relatively insignificant, Improvement of Care By intensified utilization of local workshops, group discussions, activities of the Community Liaison Officers, staff visits throughout the area, and planning and feasibility studies the RMP has made progress in identifying problem areas and developed methods by which ambulatory care might be improved. Many of the program staff activities and project activities should measurably expand ambulatory and emer- gency medical service care. Health maintenance and disease prevention components realistically based on present knowledge are included in the application. However, in the opinion of the site visitors, the proposed objectives appear to be overly ambitious. It 49 antici- pated that the activities could lead to improved access to primary care and health services in underserved rural areas, but that the improvement in underserved urban and ghetto areas will be minimal. As stated before, representatives of the VEMP were encouraged to increase staff efforts in the latter areas. Short-term Payoff Short-term payoff is inherently a part of the continuing educational and training proposals and will be realized if these activities are successful in accomplishing their stated objectives. In addi- tion, program staff activities directed toward discharge planning, Virginia RMP ~16- ‘RM 00049 the quality of medical care assurance based on chart audit and-con- tinuing education, rehabilitation consulting teams, and improved care for stroke patients all have the quality and potential for immediate benefit to recipients of the services. If one can assume that manpower savings realized by more efficient techniques, the use “of less highly skilled personnel for routine services, and improved productivity of hospital: and allied health personnel by providing greater career opportunities and incentives could lead to moderation of health costs, then the proposed activities will moderate health costs. However, short-term payoff does not appear to be the primary goal of the proposed program. The VRMP did not demonstrate to the site visit team that sufficient time had been devoted to the develop- ment of short-term goals, although the policy for withdrawing support after three years is well established and indications are that it can be done successfully. Regionalization The program plan should assist in creating new linkages among health ‘providers and institutions, and it is aimed at assisting multiple provider groups and institutions. The Kidney Disease proposal, the Drug and Medical Information network projects, the Radiation Therapy Consultant Service activity, and the proposal for Development of Shared Services in Rural Health Care Institutions are specific examples of items included in the plan that have this underlying quality. Each of these is capable of insuring sharing of facilities and manpower and extending the capabilities to a larger area of the population. While a wide range of health providers are tar- geted and varied project activity is proposed, the site visit team was greatly concerned about the seeming. absence of coordination between similar and related activities. It was suggested by members of the site visit team that consideration be given to combining some of the education and training activities proposed. Other Funding The Region has been reasonably successful in attracting funds for ongoing activities from local and State sources. The current application indicates other sources of funds totaling $198,172 or 6.6% of the total requested direct cost amount. Furthermore, the VRMP has indicated that it is actively seeking other federal funds for support of the two sickle cell anemia activities included in ‘Virginia RMP -17- RM 00049 the current application. It is also noted that great strides have been made and more positive results are anticipated toward obtaining commitments assuring activity continuation from other funding sources ‘once RMP funding is withdrawn. Please refer to the section Continued Support for a more detailed analysis of this area. Conclusions The site visit team was generally impressed with the progress of the VRMP since the last site visit. Indoctrination of the compara- tively new RAG appears to have been successful in that the members - are actively participating in the decision and policymaking processes. The development of this group has been further enhanced by the reappointment of three former RAG members who had resigned to accept appointment on the Board of Directors for the VRMP. ‘ The VRMP has refined its organizational and managerial structure to provide for more frequent RAG meetings for execution of its responsibilities and greater involvement of RAG members in the _ evaluative and monitoring aspects of the program. The. concept of using RéView and Evaluation Committee (R&E) members for monitoring of operational activities by reviewing progress reports and participating in site visits for evaluation (with the assistance of program staff and RAG members who live in the vicinity of the project) should be more workable if the R&E Committee is expanded to lessen the work load on individual members. The VRMP bylaws have been rewritten to more positively state the functions of the RAG and the responsibilities of the Executive Director and his staff to the RAG. A new Program Committee has been established for regular review and modification of the goals, objectives, and priorities of the VRMP so that they may effectively ‘reflect the needs of the region and still remain congruent with the mission of Regional Medical Programs as reflected by national needs and priorities. The planned establishment of Subregional Area Coordinator offices in the five geographical subdivisions of the region and the formation of Local Advisory Groups (LAGs) to more positively determine local needs and priorities should provide an even firmer foundation for the program expansion etivisioned in this application. While focusing on the improvements and latent potential of the VRMP, one must also consider the need for further refinement (as noted Virginia RMP -18- RM: 00049 throughout this report) of the areas in which progress is so note- worthy with special consideration being given to the need for improved communications between the primary managerial components of the region: the RAG, Executive Director, members of the program ' staff (including the subarea coordinators) and the Board of Iirectors. The Region needs to develop improved coordination of fragmented efforts in similar and related type activities such as those directed . toward pharmacists, dentists, and other allied health personnel. Isolated activities proposed in the area of emergency care systems need to be coordinated and developed on a regional basis with greater participation from interested groups. In this regard, since the August 3-4 site visit, word has been received from Dr. Perez, the -Program Coordinator, that a meeting of representatives of health organizations and groups interested in emergency medical services was convened on August 9, preliminary to development of a Coordinated EMS: System for the State of Virginia, (Progress was made and a follow-up meeting is planned.) Recommendations The proposal, as submitted, is viewed as an ambitious undertaking that might very well overburden the small though well qualified and administratively efficient program staff and place too great a monitoring and evaluative load on the maturing RAG and its Committee structure. Accordingly, the site visit team recommends that the VRMP be approved for: (1) Triennial status at a $1,800,000 direct cost level for each of three years; (2) A developmental component in the requested amount to be funded within the total $1.8 million level. In the opinion of the site visit team, while permitting expansion and growth to a viable region, funding support at the reduced level will make necessary greater program coordination among the various activities (program staff ad projects) and closer monitoring of daily progress to obtain the most effective utilization of available funds. Review Cycle: 10/72 RMPS STAFF BRIEFING DOCUMENT ay IN| [Re REGION: Virginia OPERATIONS BRANCH: Eastern NUMBER: RM 00049 Chief: Mr. Frank Nash COORDINATOR: Eugene R. Perez, M.D. Staff for RMP: George F. Hinkle . Marjorie Morrill LAST RATING: 246 Joan Ensor Charles Barnes TYPE OF APPLICATION: __ __._ 3rd Year Regional Office Representative: / X/ Triennial / / Triennial Mr. Clyde Couchman _.._ 2nd Year __. Management Survey (Date): /_/ Triennial / _/ Other Conducted: July 1971 a or Scheduled: Last Site Visit: September 14-15, 1971 Sister Ann Josephine, Review Committee, Chairman Bruce W. Everist, Council Member Louis K. Collins, M.D., Consultant, Private Physician William C. Fowkes, Jr., M.D., Consultant, California RMP, Region III Fred Shapiro, M.D., Consultant, Renal Disease Staff Visits in Last 12 Months: April 6, 1972 - Attend RAG meeting and discuss recent developments at the National VRMP level. April 17, 1972 - Provide staff assistance in resolution of a proposed (subsequently approved/funded) Emergency Medical Services Project. June 7, 1972 - Attend RAG meeting for review and approval of Triennal Application. Recent events occurring in geographic area of Region that are affecting RMP program: (a) In 1972 the General Assembly of Virginia amended and re-enacted legislation relating to exemption from tort liability of persons rendering emergency medical services in Virginia. After July 1, 1972, paramedics who are properly trained may perform more advanced emergency procedures such as initiating intravenous fluid therapy, administering medications to relieve pain and prevent cardiac arrest, and perform cardiac defibrillation. (b) Legislation has been passed that permits dental students entering their senior year to accept summer employment in state supported and government institutions in the community when supervision is provided “by a Medical College of Virginia (School of Dentistry) faculty appointee. VIRGINIA REGIONAL MEL": PROGRAM SUB REGIONS. (FIVE) + PERFORMANCE SITE DATA we TRIENNIAL APPLICATION, é Culpeper / #37* ~ Harrisonburg #27 Charlottesville i #13, 23, 24, 26, 30, i 32, 33, 34. Richmond fra3, 18, 19, “26, 21%, 22, 23, 26, 28, 29, 31, 7 Roanoke, va *Also at numerous undetermined sites petersburg 7 nts. 35,39) / within the Region. ’ ~ . Virginia Beach kkSome projects will be active at wes De ten tn nteane DEMOGRAPHIC INFORMATION © Population (1970 Census): 4,648,500; Approx. 63% urban, 19% non-white and a median age of 25.9. State U.S. , Under 18 years 35% 35% 18-65 years 57% 554 65-over 8% 10% Land area: 39,838 square miles Population Density: 117/square miles Population RMP Major SMS Areas: (000) Sub-Region Lynchburg 121.8 If Newport News-Hampton 289.3 V Norfolk-Port smouth 633.1 — V - Richmond . 515.6 IV Roanoke 179.4 iI (Metro DC Area) (350.0) (III) Health Statistics: Mortality rate per 100,000 population for Heart Disease is 312, 128 for cancer and 85 for CNS Vascular Lesions all of which are from 15-19% below the National average. Deaths per 100,000 for all causes is 820.9 whereas the U.S. average 7 for all causes is 935.7. @ Facilities: The State has two major medical facilities, the Virginia Commonwealth University (Medical College of Virginia) and the University of Virginia School of Medicine. Within the State are 34 nursing schools that offer Registered Nurse programs and 44 nursing schools which offer L.P.N. programs. There are eleven schools of medical technology, four cytotechnology facilities and 23 Radiologic technology facilities within the State. One school each in the disciplines of Dentistry, Pharmacy, and Allied Health and Physical Therapy are located within the State at the Virginia Commonwealth University, Richmond. The American Hospital Association (1970 Guide Issue) reports 102, short term hospitals and two long term general hospitals with 16,385 and 434 beds, respectively plus two V.A. General hospitals with total bed capacity of 1,493. There are 82 skilled nursing homes, 59 personal care homes with nursing care and 20 long term care units with respective bed capacities of 6,862, 2,873 and 925. The State of Virginia has 4,900 physicians (106/100,000) and 28 osteopaths. There are 16,487 professional nurses of which 4,975 are inactive and 5,843 licensed practical nurses of which 959 are inactive. The Virginia region has approximately 949 radiologic technoligists, 2,611 pharmacists, 2,552 dentists, and 433 dieticians. 7A 8 weve haar emberToct. 0 fdr ans batter $ hey COMPONENT AND FINANCIAL SUMMARY TRIENNIAL’ "APPLICATION - ; AG ke arb pone tb Gu , ° oS . ee NN . Comittee Recomaend..cicn for Current Annualized\ | Request for Triennial Council-Approved | svel Component Level 03 ~ Year Nt year | 2nd year srd year Ast year | 2nd year | ord year ROGRAY STAFF $ 501,225 51,054,027 ($1,159,429 ONTRACTS * (41,802) -- —— /EVELOOMESTAL COMPONENT oe Oe gD ,000 anno SPERATICNAL’ PROJECTS 536,566 1,893;136 | 1,574,982 | 1,169,137 arcacy ** ( 136,996 | (142,675) -- | EMS =* ( 128,045 ( 52,094) ns/2a ( 48,660 -- -- Pediatric Pulmonary ( ) , - fe | Other C ) : | | “ TOTAL DIRECT COSTS $1,037,791 $2,989,543 $2, 799,ANG $2,408,566 - COUNCIL RECOMMENDED LEVEL | - | $1,010 ,000 : * Included in Program Staff total ” ww Earmarked ~ Inclludéd in Operational Projects - fatal i 5 « the | SUCUST 291972 RECION 49 VIRGINIA RwE SUPP YR C3 REGICAAL MEDICAL PRCGRAFS SFRVICE ‘ FUNLING HISTORY LIST CPERATICAAL GRAAT (CIPECT CCSTS CNLY) JUNE 30, 167 13 Ie REPS STS F=STCFREN AE 5 ALL REQUEST ANO AWARDS AS CF ‘ ? * s 12 WW 2 yO aetna beta goreew SWARCEC ARARDEO AWARDED AWARDED ¢*# RECLESTED REQUESTED RECUESTEG . RECUESTEC "CE OMPCRERT ci” 02 o.0U ge QQ TTT ge ce 7 aC TITLE O3/71-2zZ/71 C14 72212772 ICAL ee OL/73-12/73 OLS T4212/74 CLS TSA124 75 TOTAL ee Payee bas 3 wae ste ge COCO PRCGRAM STAFF 3754C0 364979 §C1225 1241404. o* 101€4C7 1064C27 11L€S425 3229863 ““pOOO DEVELTEMENT SE CT ° ee “oe” 80000 86000 86000 240000 CCL WYCCARDIAL IAFS 116300 80000 78570 274e7C = at —OO7 CORONARY CARE FE SELCT 341CC 40200 127700 #8 003 CARCICPULMCNSEY 4750C 27100 210CC rcfeecc |= ee BUCH STROKE IN A SVK 62506 32506 39166 134666 °° #8 OOT VIFGINIA MECTCA- éZ£0C 44100 ©2872 155672 ¥# ’ CUE STIETERINE TUPCR T4303 OREO Te[er + 009 CONT £0 FOR NUR 7219¢ 758CC 1€0320 249220 ** OLS CTCATOCL CF ERE tzcece 12ccte” 4 13€556 142675 — 2TS6T1 O14 “EFERGENCY CORON 53588 53588. +e 61311 59267 120678 "9187 EMERCENCS MECIC 262¢¢ 30250” «ss 128045 $2CS4 180139 Olé CLFRIC DEV FCR ee SOSEE 52567 65324 158877: “GIT POPLCATITR BTC se 134335 —“UT66tc Ti4ét¢ 3é5555 Ol8 VIRCIATA CRUG I ** 139719 125264 120564 385547 C1SCHRCAIC CISEASE ~ ae 4S9CC6 . 449900 020 #CCEL NE ICREORE * 95770 15722 78247 245735 ——“O2E-EvERC MEC TECE oe isocd t2ccc 9000 36060 022 CONTINUING EDLC oe 36622 28254 4C972 1LeEes S275 Sch FETICHAUL FE + 38636 33555 ° T1591 024 TRALAIAG PROGRES oe $9819 $98c2 103565 303611 “O26 FACTATICON THERS — ee To«1i3 46E25 61476 212221 = O27 ALTRITICN ECLCA ory 12148. 13360 25535 C28 ~ CAREER DPPGRILN - Torre ee oe TG 74NE 1684C 174256 C29 EXPEACEC CLE F ** 136413 130863 110848 373124 ere CCAT FOU FRCG P +e SIEVE S7EST 29153 T1séizZ O3% FILCT FRTG CANT se LIOIS LUELS “O32 FREHCSF ERERC F - e864 TeETS T8674 245782 033 CO PD RERAE P ae 214C0 16SCC 1éSCo 55200 . 6364 —TKG CENTRE” SUX ee 77060 15124 16075 168259 * "935 ALTO PATIENT HI o- 45164 1228C52 IS6111 333327 DIE UBSTETE TX TRATH o* 67587 601i2 61cs2 1seeit O37 SHS2EC SERV PUR _ #* 93261 72890 38870 20502! 0387 SYSTEM FCR MCAT ~ ~ a 41522 Seece 24C29 124217 039 FarILy ECUCAT IO s 29818 31¢00 33200 94018 “Cat COMMUNITY HEALY _™ — aw &€€€0 48660 : ee - Yrrriagvt <- TEETTE 6TZS ES meets? eeetias %F ~ 2985543: 2709009 2408566 erariis 1S W we we new ‘ SULY 1691972 APE AyTAT OT Pour 4% PREAMP Peet RECIGN - VIRGINIA ne ANNMAT TNF? CALE 1 wees UES Dotter. F ‘ . . (5) 23, 4) . a. , IDENTIFICATION OF COMPOKENT | CCNT. wITHINY CCAT. REYCAD[ APPR. NOT | NEW, NOT ! IST YEAR 1 1ST YEAR ! I | #PPR. FERILC] APPR. PERICD! PREVIOUSLY { pREVICUSLY | OFRECS t INCTREC | TCTAL | 1 : } OF SUPFURT | CF SUPPCRT FUNDED { AFFRGVED ! CCSTS t costs I i . . | j : { 1 i ! | COOO FRCGRAM STEFF 1 I. | t i i { t { L. $32016.4507 1 J bo $12016.4074 1 $3.014 2407 4 0000 DEVELUPMENTAL CUPPCAERT | ( | | i t ( i j l guc.ooo_l $50,000. t L apo. t O13 CCMP PCG CCNIR ENC STAC ! | | j ' t | , EY DISEASE ; $13¢.55£ 1 J ! j $1362996_ 1. $:342£05. 1 $1712.61 1 O14 EMERGENCY CORUNARY CARE | | ; I ! f | t 1 PB ; EACH . i 1 $61,411 1 i fhlezlit l $61,311 1 O15 EMERG WED SERV SYSTEM | 1 ‘ ! 1 t I I t . ] i $122,045 1 ] j $1282.045_1 1 $1282.045_t 016 CURRIC DEV FOR TRANG O1RSI i j j j j | i AND ALLIEG BLIH PERS 1 1 r L $40,984 } 340298} $12,043. 1 $53,049 _} O17 PCPULATECN STC SCREENING! { j 1 j 5 t ! ____ COUSSELING SICKLE _CELL___1 i t i $134.335.4 $134,335 1 $25s¢61_4 $199.994 4 OLS VIFGINIA CKUG IAFCERATICS i j { J 1 § t ___N_ ANE CONSULIALIYE Syste! 1 i { $139.719_ 1 $1352719.1 $22.882.1 $ibT.601 1 G19 CHRONIC CISEASE PREVENTII t j t 4 { \ i ON PRO. SECPLE CELL ANEP j ) t $492900_1 3452500! i $652900 3 020 PUDEL AEIGHBCRHCCO HEALT| t j t ‘| t “4 t b PLAN i 1 j { $65,127¢ J £95,170_! £72661! $302.$31_1 O2k EMERG NEC TECH TRNG PROC] I 5 I . j : | t : L i j j $15,000.! #1520001 1 £15,006} O22 CONTIKUING EDLCATICK Ih | j ! 1 1 1 1 t iCal PReesracy j lL L 1 $362623.1 $36.6223. 1 $21,123 1 $473746 1 023 SUB REGECAAL PECICAL INF I § \ 4 { t t ' CovaTICn NETHOOY { { { i $38,036 1 $39,036.) $5:71).1 $42,747 1 O24 TRAINING PROGRAM FOR FAMI | J j J . t i i LY_SUBSC PRACILILCNER i ] 1 l $992819_ 1 $99,819 1 $22,525 _1 $122.338 1 026 RACIATION THEPAPY CONSULT i ' | j t : { i. SERY VA i L i i $1642113 1 $104.113 1 235,779 1 $139.92 1 ‘G27 NUTRITION ECUCATICA FCR I { i i | ! | ' 2 LIMUM HEALIV 1 i 1 1 $122145 1 $12,145 1 $2,708 _1 214.2531 O28 CAREER OPPURTUNITIES DEVI | i J i J ( j ECR HOSP FP EL i 1 1 i 29724161 $97.416 1 £7,792.) 81055209 | G2$ EMPAADED RCLE FOR PHARMA t I j I i | j Gist . i i i I $33624513_ 1 $1362413 1 i 9136.4127 1 O30 CCRT EDU PROG PERINATAL | 4 1 { i 4 t t MEC COM HOSP 1 _i i j $37,578) $372578 1 $13,506 1 $5i2078 t O31 PILUT PRCG CUNT EDL DEAT] i { 1 | I 1 t AL PRACTITICNERS LCC j i i $11.015_1 $11,015 $2325.) $13.250 1 O32 PREHCSP EMERG PEC Av TRI | I j ' t ! ' NG L } } 1 $892434_) 9992434 | $2esS6e 1. $126s500 1 033 € 0 P DO REHAB PRCGRAM 1 t | i I | { i j i j $21,400) $213400 1 1 $21,400 ! 034 ING DENTAL ALX Ih FREVER| 5 | | | ! “4 YE C_RsD i 1 1 l $71,060 1 _..$772060.1 $20,702.31 $972762_1 O35 AUTC PATIENT HIST CEV ANI i I I . a | I i I — 2 JEANS £80 i 1 J L $4521645_1 $492164_1 i $45216%_4 JULY 16,1572 . REGION ~ VIRGINIA HOTA t HF Bees pe ANKnAD IAITI PALE ? 14% Pat RAM Bee tess HEPES Sm atte 5) iz) (4) ao IDENTIFICATION CF COMFCRENT | CONT. WETHIAE CONT. BEYOND} APPR. NOT = { Neb, NOT ' 1ST YEAR | 1ST YEAR t ! J APPR. PERTOLI APPR. PERICDE PREVIOUSLY [ PREVICUSLY { CIRLCT J TNOIRECT | TCTAL | 1 CF SUPPORT | CF SUPPCRT {| FUADED | AFFRCVED | costs | costs i j i 7 4 ! ! t | ' 036 GBSTETRIX TRAINING PROGR! j I ‘ | ! | i { Au i i 4 1 $67,587_1 $67,587 1 £72528 1 $75s115 1 O27. SHAKED SEHY KUKAL HEALTE] 1 ‘ t ( | t i CARL INST i A L J £2 2261 4 AQUZaLt i ijszer il O38 SYSTEM FLAP PLNITCRIAG Wh | \ | | j t ‘ s L i 1 j $41:532 1 $41,532 1 i $41,532 1 _ 039 FAMILY EDUCATICN PROGRAM j 1 t t 4 t i . 1 1 1 1 $25.838_1 $29,818 1 i $25,818 1 O46 CCNMUNITY HEALTH EDU CON{ 1 i { { ! t { SORTIUA i i I __ $48,660 1 948.4601 i $48.460 1 - i i } ' , j i 1 i TOTAL . j $136,996 { $19205,763 IL... . | $1,646,784 | $22985,543 | $2725496 | $35262,C39 | SULY 16,1572 ppFaKnuT OF ROVE ST BO PRAM HOR bite ao ter LDENTIFICATION OF CCPFCAENT 9 CONT. WITHIA] CCNT. BEYOND! APPR. NOT : aia { NEW, NUT REGION - VIRGINIA RY 0008S 10/72 PAGE hears 63M 3 bau. I ZhND YEAR J | APPR. PERIOC] APPR. PERIOD! PREVIOUSLY |] PREVICUSLY | CIRECT 1 1 CE SUPPLRT [| Ch SLPPCRT | FUNDED | AFPREVED 1 tus TS | | | j | | | | COGO FROGFAM STAFF 1 | | I | I } 1_2$12984:027.1 —_L - 133299425271 DOU0 DEVELCPMCATAL CCPPCHENT | t t ! i I —— L weer enenwh } 1 g20.0cu 4 $bQ.000.1 —_— O13 CCHP PROG CGATR ERC STAG] i ' ! | I £_KIONEY DISESSE 1 $147,675 1 j 1 1 $1422675_1 O14 EMERGENCY CORCNARY CARE | | { ! i | PROGRAR VA BEACH I i $5$226]_1 { ] $59,367 1 OLS EPvERG MEO SERV SYSTEM j ' | | { t : 1 l $52,094 1 i l $522024_1 O16 CURRIC DEV FCR TANG CIRSI { | ! | 1 ND_ALLIED HLTH PERS i i j $52:567 25225412 1 Ol? POPULATECH STC SCREENING! { | 1 i L t $116:610 £116,630) OLE VIRGINIA CRLG IKFCRRATICI i j I | | N_ AKL CONSULTATIVE SYSTEM 1 zt J $1252264 1 $1252264_1 O19 CHOLNIC LISEASE PREVENT I I j i | i 5 PROJ SICKLE CELL ABER. £ 1 j \ 4 j 020 MUCEL NE IGHBLRHCCO HEALTI i ! | | 1 ___H_PLAN : J 1 1 1 $752722_) $75.722_1 O21 EMERG PEO TECH TFEAG PRCCI i J I | ' . j i 1 } $12,000 5 $12,000 1 O22 CCATINUING ECUCATION IN | t { i 1 t ___CLINICAL PHAPMACY _ 1 1 I 4 $382294_ 1 $382295 1 O22 StU@ REGICNAL PEGICAL INF I { { i I j CEFAILCA DEIWCEK i j L i $33,555 1 $330555 1 O24 TRAINING PRCGRZY FCR FAM) t ! t j j "_JLY ny2S6 PPACTITIINER i i l 1 229,803. 1 $992803_1 O26. RACIATION THERAPY CCKSULE j f i j \ SERY VA ] 1 { $462625_L $46,625_3 O27 WUTIRITICN ECUCATICA FCR t { ! { ' __- OPT eue_vsé ALIB i j J $132390_ 1 $13,390 1 O28 CAPEER OPPLRIUNITIES CEVI I i i | 1 j ECR_HCSP_ FEPSCNNEL i 1 1 $76,850. 1 $76.840_1 025 EXPANDLCO RCLE FCR PHARBA] j | 1 i I CLSI 1 ! i } $1320.863 3 $120,863 5 O30 CUNT EOQU PRCG PERIASTSL 1 i t t I t méo com rose L J l j $37.841_1 $37.14) 1 O31 PILOT PROG CONT EDU DENT | i t | { AL PRACIITICAERS LCC j 1 j i L { C32. PREHCSP ERERG MEC scy TRI { j j 1 { tts. 1 j J Jj $782674 1 $78.674_1 033 .-C O P © WEHAE PROGRAM { j | 1 { ! . i 1 j i $16,900.) $16,S¢C 1 034 TNG DEATAL ALX IA PREVEN| | I ( | i AAD RAO. - i 1 L l $153124_! $15,124 1 035 AUTO PATIENT HIST Civ ANI i i f : t { 2 TRANS. PRO 1 1] i I $328.052_1 $126.052_1 JULY 18,1972 REGION. VIRGINIA PREAKOUT OF RFQUEST RK G0049 10/72 PAGE 4... OS PPCGRAM PERIUL RMPS-CSH-JTCGR 2-1 (5) q2) 4) a IDENTIFICATION CF CCMECKENT 1 cCCAT. WETREA] COAT. BEYGAC] APPR. NOT 1 NEW, NOT i 2N0 YEAR { 1 apPR. PERIOLI APPR. PERTCOJ PREVIOUSLY | PREVICUSLY i CIURECT 1 i CF SLPPURT ( CF SLOPCRT 1 FUNDED 1 AFPRCVET t costs { i . | I , | ! 036 OBSTETR IX TRAINING raocal j t ! I I AM j j 1 -$602112_4 $60si72_ 1 o3T SHARED | a RURAL aEatie i i i 1 di i l $72:850 3 $72,890 1 038 eater To FERITCRING qu i ' ( : i . 1 $58.656 $56,656. 1 039 FAMILY EDUCATION PaCSRARL 1 i t $3),000 1. $31,000.) 04C. CCKMLAITY KEALTH ECU cnt ! { i SCELIUA. I | i i i 4 “4 ' | TCTAL i 91429675 Sls 1659488 | J $2,400,646 | $25,709,009 | 10 - ae JULY LEs1972 . : REGION - VIRGINIA . PPEAKCUT CF REQ ST am 00049 10/72 PACE $s eG Pda e ee ed [ i were! eure tPtrenme 4 . ct) (2) 4) m@ LOENTIFECATICN CF CCMFLAENT J CUNT. withant Lunt. BLYUND} APPR. KUT’ | Ais ACT 1 30 vrar f { IPTAt ! | 1 APPR. PERICCE APPR. PERICDI PREVIOUSLY | PREVICUSLY | CIRECT 1 f ALL YEARS | Cr SupPcRE 1 CF SUPPORT | FUNCED [| APPROVED 1 COSTS 1 JOIRECY CCSTS J ! 1 | t I | j I CCCO PRPCGRAM STAFF { t { { ! { t We epee ee ee cee en eee ns - bene ene eee L,.$d016%2525_1...----- =. be --- --------- J Sl0lh50429 1.00 de 22s bes be DUGO GEVELCPAERTAL COMPORINS ‘ ‘ i | 1 | i I i 1 ad sro, 000_1 $403000 1 i $24Cs0Cu 1 013 CO¥P PROG CCNTR END STAGI I | | l I | I F_KICAEY DISEASE 1 l L i t 1 1 $2792 621) O14 EMERGENCY COPCAARY CAPE | | i | | | } | PBO EACH i l } ij 1 j 1 $120.678.3 O15 EMERG MED SERV SYSTER 1 { { ! ! 1 | { = i j t i i \ I $}802139.1 016 CURRIC DEV FCR TRAG CIFSI | | ! | I | t : JEC_rLIH PERS L 1 i I $65.2324_1 $652324 1 i S15Rsf77 1 D1? FCOULATICN STC SCREENING) 1 t j | I ! ‘ CUNSELING SICKLE CELL j L $114,610. 91242610 1 1 $365,555 1 OLE VIRGINIA CRLG IKFCRRATICH | | | | i ! | \ #hD CONSULTATIVE SYSTER_} i ] ‘ 1 £120.544 1 $1202564 1 1 $285.547 1 O19 GHACNIC CISEASE PREVENTSI i i | i “4 { { ON PROJ SICKLE.CELL AkEe j 1 j I l j $45,900 1 O20 MCOEL NEIGHBCRHOGO HEALT} { | | 1 i i i HFLAD L 1 l l $182247_1 $78,257 1 i $249 27391 O21 CMERG YEC TECK TANG PRCCI \ ( t . t t I i . : } i l 1 $9,000 1 $9,000 1 i $36,000 L O22 CCNTINUING ECUCATION IN | { | I i | i I CLINICAL PHAP MACY t ! 1 1 $40.972_3 $402972_1 l $115.299 3 O23. §UB REGICAAL. PECICAL IAF] 1 ! 1 { | 1 t ___CERALICN NETHCoK dt i J 1 ] 1 1 $72), £91_1L O26 TRAINIAG FRCGFAP FCF FAR i i i { 1 ' t [LY NLSSE PESCIITIGNER L i i _t $1032289.1 £103.989.1 1 $202,411 1 OZé AACIATIUN THERAPY CCNSLEI { | i ! j t | SERV. vA j 1 l L $612475 3 $61,479 1 i £212s221_1 O27 ALTRITICN ECUCATICA FCR } { ' | | i | l OPTIMUS EFALTH lL 1 i l 1 i 1 $25,525. 1 028 CAREER OPPORTUNITIES DEVI J | | 1 I | ' FOR HCSP FEPSCENEL L i l i I j i 9174.256_! 025 EXPANCED RCLE FCR PRAPMA { 1 | { { 1 1 CLSL. i i i i $110,848 1 $130,848 1 1L £378.124 1 030 CENT EDU PROG PERINATAL | i j i | en | 1 i MED CCH HESP i ] i i $29,193. 1 $392193_1 i $114.612. 1 O3L PILGT PRCG CCAT EDL DENT! i | 5 ! j 1 J : CIITICANEES LCC i lL l L t J i $1),015_1 C32. PRENCSP EMERG PEC acy TRI ! j t t t { 4 NG ! i 1 i $78.674 2 $78,674 } I $246,782 1 033 C€ 0 P D REHAB PRCGRAN { j t j I | { i i 1 L 1 416,900.) $ié,900 3 I $55,200 1 034 ING CENTSL ALX 1m PREVENT i 1 j , ' 1 t { AND_BAL L l l I $16,075 1 $16.075 1 Ll $108,255 1 035 AUTC PATICNT HIST CEV AN] 1 i | 7 4 { 1 i i i Lg 1S6e232-4 $1562111_1 i $333.327 ) D IKASS PRED i 11 SULV beeleicz BREAKOUT OF REQUEST KEGION - VIKGINIA RM 00049 10/72 “PAGE 6 06 PROGRAM PERIAN RPPS-CSP-SECGR2-] qs) (2) (4) a1) IDENTIFICATION CFE CCMPCAENT { CONT. WITKIN| CONT. BEYOND] APPR. NOT | NEbs NOT { 3RD YEAR | t TCTAL t ] APPR. PERICO] APPR. FERICCL PREVIGUSLY | PFEVICUSLY | CIRECT { f ALL YEARS i 1 CF SUuPPCRI § CE SUPPCRT § FUNDED ( aperoven I costs ' POURECT Cusis 4 t i ’ ! i | I ( 036 GBSTETRIX IRAINING PROGR I 4 I j I i j j imi i { 1 1 $61,052 14 $61:052 100 ta BL 1 037 SHARES SERV RURAL HEALTEI ! i | ' | I 1 SI I at i J 328.870.) $38,870 Jo £288,021 | O30 SYSTEP FCR MCKITCRIAG Cul I 4 i 5 fl t t moved ITY CE.WCABE. JN eNOS. 1 i ad. 4 £242029. 1 ....$242029_ 1} i $1240217 i 039 FAMILY ECUCATION PADGRAM) 1 i i j { ! i t $32,200 1 £323%200 I £94,018 2} 046 COMMUNITY HEALTH ECU CCA ‘ i i. . t ! Soextiun i l LL di. $48.650.4 i t 1 t { { TOTAL ! 1 $291599429 {,. _. § 821924659137 § $29408) 566 { 1 $6,1GT, tis 4 - 12 - Region: Virginia Review Cycle: Sept./Oct. HISTORICAL PROGRAM PROFILE OF REGION The Virginia Regional Medical Program received its initial planning grant award in January 1967 with the University of Virginia School of Medicine in Charlottesville, Virginia as the Grantee. Congruent with awarding the 02 year continuation grant for planning activities in March 1968, the grantee was changed to the Medical College of Virginia in Richmond, Virginia (now the Virginia Commonwealth University). The first two years of planning activity were marked with concerns relative to the absence of representation cf paramedical personnel and minority groups on the Regional Advisory Group and inadequate Program Staff. In addition, evidence of a cooperative medical school commitment to the Program was not present, planning efforts continued to remain at a minimum level, and sub-regionalization was considered to be at an elementary stage. In July 1968, the Region's operational grant application was disapproved with the awarding of continuation support for an 03 year of planning activities. The Region was advised that core activities be strengthened, that a regional approach be used in project development, and that the Advisory Group be increased in number and that it include representation from paramedical professions and minority groups. The Region resubmitted its operational grant application to the December 1969 Council and a site visit was made to the Region on October 1-2, 1969. The December 1969 Council concurred with the recommendations of the site visitors and the Review Committee that the Region be awarded operational status, Of the seven projects in the application, Council approved five projects for the initial operational status award and then subsequently (March NAC) approved two new projects, one of which was funded during the 01 operational year with additional funds and the other through the rebudgeting mechanism. The Medical College of Virginia remained the grantee organization for the Virginia RMP. Nine additional members had been appointed to the Regional Advisory Group, which brought the total membership to twenty (20) members (current membership is 36). Four outstanding committees on heart disease, cancer, stroke and related diseases were created to replace Task Force members and these were broadened to include dentists, nurses, hospital administrators and minority representation. Regional representation was also taken into consideration in the formation of these committees. An Executive Committee, consisting of six members and exercising all of the authority of the Advisory Group relevant to its functions at interim between meetings of the RAG, was activated. At this time, each medical school established an RMP Committee for heart disease, cancer, stroke and related diseases. Each medical school Committee chairman acted in liaison capacity between the schools and the RMP Central Office and also as an official member of the Coordinating Planning and Evaluation Committee (Medical School Liaison officers have been eliminated in new VRMP, Inc. organization). - 13 - Region: Virginia Reyiew Cycle: Sept. /Oct.. During the February 1971 review cycle the Region's request for a developmental component was denied because the plan of action was thought to be too general and a sufficient degree of maturity had not been attained. Concern was also expressed over the reduction of medical representation on program staff by the deletion of three consultant positions although there was indication that active recruitment for a physician to fill the deputy coordinator position was underway (recruitment for this posi- tion is not included in the current application). The inability to detect a satisfactory plan of action remained a growing concern although it was encouraging to note that steps had been taken to strengthen the. program evaluation and administrative sections. Effective March 1, 1971, the Grantee was changed from the Virginia Commonwealth University to a corporate body, the Virginia Regional Medical Program, Inc. The motivating reason for this change in grantee evolved from what was considered to be inadequate fringe benefits. The Virginia Commonwealth University is a state supported institution, its employees are regulated by the State Merit System and given State retire- ment benefits. However, since the VRMP employees are paid by a Federal grant they were not considered to be State employees and were not eligible for State employee fringe benefits. A Regional Medical Programs Service Management Survey was conducted on July 26-28, 1971 during which the administrative systems, policies and practices were reviewed. Although some areas were considered to need greater administrative and fiscal controls, major deficiencies were not uncovered. The supervisory position for the Division of Admin- istration and Grants Management (Business Administrator) was considered to be the key to providing the necessary controls. In a relatively short time four different individuals had occupied this position. The incumbent during the Management Survey still serves in this capacity. The last review cycle (October/November 1971) included a September 13-14 site visit initiated at the request of the Coordinator. The paramount issues of discussion focused upon the newly established Regional Advisory Group the difficulties encountered by the Region in changing its program direction from one of a strictly categorical nature, and the request for a developmental component. Concomitant with the March 1, incorporation all but two of the existing members of the Regional Advisory Group were organized into an eighteen (18) member Board of Directors. The RAG membership was increased to thirty-six that included two former RAG members and ten members who had functioned in various committee capacities. Reviewers were concerned about the relative newness of the RAG and recommended that extensive orientation measures be taken, the RAG meet at least on a quarterly basis, and a mechanism be developed to enable the RAG to participate in a more meaningful project/program review and evaluation. Furthermore, the Region's goals were considered to be quite diffused, the categorical emphasis of the projects was not favorably reviewed and the developmental - 14 - Review Cycle: Sept./Oct. request was disapproved. It was suggested that another year was needed for the Region to indoctrinate and develop the RAG into an effective decisionmaking group and present a program application along the guide- , . lines of the new Regional Medical Program mission. The newly established RAG had met onily once prior to the last review cycle, but has had four meetings since December, including a two-day retreat for orientation of new members. RMPS staff has attended two: of the recent RAG meetings during which project activities, program goals and objectives were review. The discussions were lively with almost 100% participation from the members. RAG members have reportedly site visited projects for evaluative purposes and indoctrination. The RAG bylaws and VRMP Guidelines for Project Applications have been re-written since the last review cycle and the goals and objectives have been revised from a strict categorical emphasis (heart, cancer, etc.) in an effort to implement the new mission of Regional Medical Programs in a manner designed to be harmonious with national needs and priorities and the needs of the people of the State of Virginia. : - 5 « ; Region: Virginia Review Cycle: Sept/Oct 72 STAFF OBSERVATIONS Principal Problems: The absence of a deputy coordinator and the diminishing physician input to Program Staff. Program Staff turn-over since last review, Apparent fragmentation of project and continuing education efforts. Over-reaction of the VRMP to areas of concern and funding decisions made at the National level. Degree and actual extent of cooperative relationships with other organizations. (CHP Agencies and Medical Schools) Principal problems during last review: 1. Little accomplishment toward establishment of new goals and objectives. 2, Medical school involvement other than through project activity. 3. Need for indoctrination of new Regional Advisory Group ~ more frequent meetings. 4. Inadequacy of meaningful mechanism for RAG to participate in project/program review and evaluation. 5. Need for refinement of role definition and role distinction of the Board of Directors and the Regional Advisory Group. 6. Greater emphasis needed for coordination of the Region's efforts in responding to consumer needs and in programming these activities into the overall goals and plans. 7. Categorical emphasis of projects. Principal Accomplishments Location of nursing coordinators in five educational institutions throughout the State. (Project #9). Establishment of Virginia medical information system as a statewide biomedical library service. (Project #7) Efforts to improve management of stroke patients in rural areas by involvement of medical center with the physicians and other health professionals in the community. (Project #4) Emergency medical service training activities associated with CPR and emergency coronary care procedures for volunteer rescue squads, (Projects #3 & 14) Reported success of a discharge planning feasibility study and its plan for expansion to VRMP subregions. - 16 - Initiation of Sickle Cell Anemia (SCA) education program in public schools and provision of assistance in coordinating SCA efforts ~ throughout Virginia. Involvement of closer working relationships between the three medical schools, the State Health Department and the Virginia Medical Society. The VRMP and the School of Allied Health of Medical College of Virginia conducted the first State conference of allied health in the State of Virginia. Efforts of Program Staff associated with development of skills in utilizing medical audit as an educational instrument to improve quality of patient care. Impressive program of continuing education for nurses and the movement toward expansion to other allied health professions, The establishment of new goals and objectives and its movement in a new direction to improve health care delivery professions. Important steps toward improving the basic organization: incorporation, accelerated efforts to indoctrinate the new Regional Advisory Group, assignment of Review and Evaluation Committee members to projects for review of progress reports, site visits and evaluation, and updating of the RAG By-Laws and Virginia RMP Guidelines for Project Application. Issues requiring attention of reviewers 1. Evaluation of progress toward resolving principal problems as determined by last review. 2. Capability (qualifications and potential) of new Program staff. 3. Policy issues with respect to: (a) Tumor Registry Activity. (b) Sickle Cell Anemia activities (Projects and Central Regional Services Activities). (c) Nature of some activities classified.as Central Regional Services Activities. ot : Ts SITE VISIT REPORT WEST VIRGINIA REGIONAL MEDICAL PROGRAM AUGUST 7 & 8, 1972 SITE VISIT PARTICIPANTS Consultants j Henry Lemon, M.D., Professor ef- Medicine, University of Nebraska, Omaha, Nebraska, Chairman Gladys Ancrum, Ph.D., Community Health Board of Seattle, Seattle, Washington, Review Committee member Bland Cannon, M.D., Memphis, Tennessee, National Advisory Council member Winston R. Miller, M.D., Director, Northlands Regional Medical Program, Inc., St. Paul, Minnesota: Richard Haglund, Acting Director, Intermountain Regional Medical Program. Salt Lake City, Utah RMPS Staff Clyde Couchman, Program Director, RMP, Office of the Regional Health Director, DHEW Region II Joan Ensor, Program Analyst, Office of Planning & Evaluation, Division of Operations & Development, RMPS Martin Greenfield, M.D., Health Consultant, Division of Professional & Technical Development, RMPS Frank S. Nash, Acting Chief, Eastern Operations Branch, Division of _ Operations & Development, RMPS Norman Anderson, Public Health Advisor, Eastern Operations Branch, Division of Operations & Development, RMPS West Virginia RMP Charles D. Holland, Director ' William A. Ternent, Associate Director Norene M. Thieme, Program Analyst Sheila D. Baquet, Office Assistant I David S. Hall, Ph.D., Director, Office of Research & Evaluation Edward M. Bosanac, Data Analyst Peter P. Gallina, Coordinator Field Operations William G. Cooper, Area Liaison Officer Gerard R. Hummel, Area Liaison Officer Larry E. Yost, Ph.D., Program Specialist, Health Manpower William D. Wyant, Program Specialist, Emergency Medical Service Robert B. Williams, Program Specialist, Health Care Delivery Demonstration West Virginia RMP ~-2- RM 00045 — SITE VISIT PARTICIPANTS (continued) RAG Members Jimmie L. Mangus, M.D., Chairman — Frank W. McKee, M.D., Dean West Virginia University of Medicine Charles E. Andrews, M.D., Provost for Health Science, West Virginia School of Medicine Harry S. Week, M.D., President, State Medical Association, Planning and Evaluation Committee member Maynard Pride, M.D., Private Physician, Health Manpower Committee member A, Thomas McCoy, M.D., West Virginia State Medical Association, Health Manpower Committee member Fay P. Greene, M.D., West Virginia State Medical Association, Health Care Delivery Demonstrations Committee member ; Patricia Brown, Consumer Member, Planning and Evaluation Committee, Consultant Representative, State Comprehensive Health Planning Council Committee Members Dr. Ralph Nelson, Planning. and Evalution Committee member, Provost-off- Campus Education, West Virginia University Dr. Harry Stansbury, Planning and Evaluation Committee member, Director, Comprehensive Health Planning ’ Charles Lewis, Member, Health Manpower Committee, Staff member, State Medical Association Daniel Hamaty, M.D., Chairman, Health Manpower Committee Mrs. Geariean Slack, Member, Health Manpower Committee, Associate Professor, West Virginia University School of Nursing, Director, Continuing Education Robert Eakin, Member, ‘Health Care Delivery Demonstration Committee, Administrator, Memorial General Hospital Association Mrs. Carol Cutlip, R.N., Member, Health Care Delivery Demonstration Comm., Assistant Administrator, Fairmont Clinic Leon H. Kingsolver, Member, Health Care Delivery Demonstration Committee, Director, Comprehensive Council of Region VII , a, Fred Parker, Member, Emergency Medical Services Committee, Southern West Virginia Regional Health Council Samuel W. Channell, Member, Emergency Medical Services Committee, ‘Executive Director, West Virginia Pharmaceutical Association, Osteopathic Association Other Resource Persons and Visitors Edward Perrine, Immediate Past Director, Health Planning Association of North Central West Virginia, Region V Walter H. Moran, M.D., Professor, Department of Surgery West Virginia University School of Medicine Lp West Virginia RMP -~3- RM 00045 Other Resource Persons and Visitors (continued) Patrick Hamilton, Attorney for the HYGEIA Foundation James Hart, Consultant for the HYGEIA Foundation, Representative of the Charleston Area Medical Office United Mine Workers Welfare and Retirement Fund Mrs. Joanne Ross, Director, Southwest Community Action Council Joseph T. Skaggs, M.D., Former RAG member, Leadet of a developing group practice in Charleston, West Virginia Barbara Jones, M.D., Professor and Assistant Chairman, Department of Pediatrics, West Virginia University Allen Strum, Project Director, Upshur County School Health Program Larry Thompson, Director, Health Incorporated, Parkersburg, West Virginia Robert Youngerman, Inter-Regional Informational Exchange Program Representative Allen Graham, M.D., National Health Service Corps Assignee to the Crum- Kermit Medical Center , West Virginia RMP -4- RM 00045 - INTRODUCTION: The primary objectives of this site visit were to review progress made by the West Virginia RMP since the last visit and to determine their overall readiness for implementation of a three year program plan. Based upon the evidence and information gained through this site visit, it is concluded that progress has been made and that the West Virginia RMP is truly developing a regionalized program. The strong points of this program are well chosen and clearly recognized objectives around which planning revolves. They are: Health Care Delivery; Emergency Medical Service; and Health Manpower. The site visit agenda was organized primarily around the program objectives. The West Virginia RMP has been guided by an effective combination of the West Virginia Medical Center and the State Medical Association who provide medical direction to.the Ccordinator. The site visit team rated the Coordinator very high for his administrative abilities, ‘energy, and understanding of the needs and practicalities of program achievement in this area. The program staff functions very well with the Regional Advisory Group, reacting appropriately to the health needs of the region. Staff has been very effective in working with other organizations in the State to get matching funds and in particular, to develop structures for comprehensive health care planning ("b" agencies), although these agencies have experi- enced delay in getting under way. The West Virginia RMP has approached the improvement in health care delivery by multiple routes and has developed six subregional offices staffed by regional liaison officers. The regional liaison officers closely coordinate their activities ‘with the "b" agencies and the University's county extension programs and this approach has proven effective in gaining entree to interested consumers and providers in the area. The site visitors reviewed the West Virginia RMP's decisionmaking and review processes, administrative and evaluation capabilities and current planning, involvement and accomplishment with respect to the program directions of the Regional Medical Programs Service. The review criteria and Mission Statement were used by the site visit team as a guide in the evaluation of the overall progran. -~5- 6 RMP: WEST VIRGINIA PREPARED BY: Norman Anderson DATE: 10/72 1. GOALS, OBJECTIVES, AND PRIORITIES (8) For the most part the program has been characterized by exceptional performance in this area. In fact, one of WVRMP's major strengths lies in a well conceived and developed planning process built around clearly defined program goals and objectives. The program has continued to refine and redefine these objectives, and has arrived at three primary goals toward which it will direct its efforts; these address the State's most critical health needs: health care delivery, emergency medical services, and health manpower. The priority concern for all of these goals is creating and improving access to care in the unserved and underserved portions of the region. The question of the degree of provider acceptance of the program's goals and priorities is one that is difficult to answer. It is clear that key provider institutions (e.g., medical school and state medical society) accept and understand the basic tenets of the RMP, but it appears doubtful that the word has been adequately spread to some of the more rural areas, particularly to community physicians and foreign medical graduates practicing in remote locations. There is little question that the stated objectives respond to community needs. and that their formulation was based on perceptive recognition of consumer needs: this program can certainly be described as one whose prime focus is to meet the desparate health needs of the medically indigent. Recommended Action: 2. ACCOMPLISHMENTS AND IMPLEMENTATION (15) Program staff activities have resulted in substantial achievements, including in particular the development of a number of programs directed toward improving the distribution of medical services in the region. These programs, primarily dealing with the establishment of outpatient clinics and group practices in underserved areas of the State, are based upon a thirty-year background of community efforts to increase and maintain physician coverage of the State's population. Although the clinics will probably neither lead to wider application of knowledge and techniques nor to any reduction of medical care costs, there is no question that they are the sorts of program which will meet a critical need in West Virginia, that of providing access for those who now enjoy only limited or no entry into West Virginia's health care system. -6- RMP: WEST VIRGINIA PREPARED BY: Norman Anderson DATE: 10/72 2. ACCOMPLISHMENTS AND IMPLEMENTATION (15) Continued Particularly encouraging is the development of group practice . affiliations in two major medical centers remote from the University. - It is anticipated that these will be sites for expanded residency training programs at some point in the future, and that they will . become subcenters of excellence for. the care. of categorical: diseases. Their establishment should be recognized as one of the outstanding achievements made through the coordinated efforts of the medical school and the RMP, both by virtue of their intrinsic value and because they have resulted in a broader base for physician and other provider acceptance of the Regional Medical Program. Recommended Action: 3, CONTINUED SUPPORT (10) The policy of actively searching out other sources of funding for _activities begun under RMP auspices has been one of the program's major strengths. One must note, however, that West Virginia RMP may. encounter difficulty in pursuing this policy in the future because of the State's limited resources. De ee ee ee we Recommended Action: ® RMP; WEST VIRGINIA _. PREPARED BY: Norman Anderson DATE: 10/72 - 4, MINORITY INTERESTS (7) West Virginia's black minority makes up approximately four per cent of the State's population. Ethnic pockets exist only in the larger cities, notably Charleston (5.6% black) and southern McDowell county (25%). Questioning of the program staff and RAG members brought out the fact that the major focal point of the program has been the poverty level and medically indigent population in general, without attention to specifi¢ minority groups. The program has. a good working relationship with the Appalachia Regional Commission and has been successful in obtaining funds to support projects directed to the | poverty level and medically indigent population. Although the program has apparently given sone thought to the development of activities in the McDowell area, there have been some problems with the project director of the five million dollar health care program, supported by the Appalachian Regional Commission, in the entire nine~county southern portion of the State, including McDowell. Due to these conflicts, this has been the last area to be considered in the RMP's subregionalization plan. While the Coordinator was emphatic about his efforts to recruit © minority employees for the program staff, it was the feeling of the visitors that minority groups were under-represented (currently , minority employment consists of only one black secretary) and that efforts should be continued to recruit both blacks and women to the staff. Another matter of concern mentioned was that of the University's policy in recruiting students for medical training; it is one of accepting only "high achievers," that is, those students with records of outstanding accomplishment in their undergraduate studies, It was brought out in the discussion that the level of educational © services in many of the poverty districts was such that little achievement could be demonstrated, thus creating somewhat of an artificial barrier for minority students wishing to further their. education. It is hoped that the University's admission policy might be modified; until that. time, however, the RMP should continue efforts to recruit qualified minority staff members from outside the State. Recommended Action: -8- RMP: WEST VIRGINIA _ PREPARED BY: Norman Anderson __DATE: 10/72 eee e §. . COORDINATOR (10) The Coordinator has obviously provided strong leadership in the . development of the West Virginia RMP. He has adequate administrative and managerial abilities to deal with the problems with which he is faced. He relates and works well with the RAG and in the last four months has recruited an individual as associate coordinator who appears likely to provide the necessary planning and administrative assistance needed in a larger program. (In addition to the associate coordinator the RMP has hired three. program specialists, a data ‘analyst. and a field representative.) The site visitors feel that it is advantageous to have a non-medical man in this particular position since he has to relate equally diplomatically to the University and to the leadership of the State Medical Association in a manner which will generate’ a minimal amount of friction and a maximal amount of cooperation. This has obviously been achieved. Recommended Action: 6. PROGRAM STAFF (3) The program staff are all full-time and represent a broad range of competence with the exception of the key disciplines of medicine and nursing. A physician and nurse staff position should be established in the program staff at least as half-time positions with authority and responsibility in the areas of planning and evaluation. Recommended Action: 7. -~9- RMP: WEST VIRGINIA PREPARED BY: Norman Anderson DATE: 10/72 REGIONAL ADVISORY GROUP (5) The RAG and its subcommittees have more than adequate representation from providers and other health interests throughout the State. The RAG itself is heavily provider oriented: including alternates, its total membership of 38 (+12 alternates) consists of 24 physicians, four hospital administrators, and five other health professionals, all together accounting for over 90% of the membership. Of the four non-provider members, only one might be considered a "real" consumer, in the sense that she represents the poor and medically underserved population of the region. It was the consensus of the site visit team that the Regional Advisory Group composition should be modified to be more representative of consumer groups (including racial minorities which currently have only minimal representation), the nursing and allied health professions, and community colleges. This modification may well necessitate amending the RAG bylaws, which now call for representation from a specific list of health organizations and interests in the State. The.team was especially impressed by the testimony of one of the RAG members, Ms. Brown . describing her "living room" approach for stimulating consumer interest both in the West Virginia RMP and in health care in general. It is hoped that this approach will do much to foster consumer participation in the program. It was felt that the RAG has an excellent attendance and partici- pation record. Meeting of RAG subcommittees, likewise, seem to be well attended and to have garnered enthusiastic support. While the RAG does play a role in determination of policy and overall program direction, it was the site team's impression that this role is one more of reaction than action. It seems that program staff are responsible for most of the actual planning and program implementation, although the RAG is kept informed of developments. From information presented, it appears ~ also that RAG does not monitor or. evaluate program staff activities. The RAG's Executive Committee, like the larger body, is not broadly representative of the health and consumer interests in the State. This particular group, in fact, numbers no racial minorities or women among its members. It was the visitors' feeling that this group also needs to be expanded to provide for more input from nurses, allied health personnel, and consumer groups. ~ 10 - RMP: WEST VIRGINIA PREPARED BY: Norman Anderson ,DATE: 10/722 7. REGIONAL ADVISORY GROUP (5) Continued Since staff is non-medical and under great influence from the Univeristy it seems appropriate that specific mechanisms be developed to insure that RAG expertise and perspective are utilized in monitoring and evaluating program development. This will help provide a broad ‘conceptual framework for revising or discontinuing specific activities. — = dee - . ~— See eee ee eee eT Recommended Action: ? §. GRANTEE ORGANIZATION (2) Phe Dean of the Medical Center stated that he is the budget of ficer for West Virginia RMP and that he periodically meets with Mr. Holland (although there is no regular schedule for such consultation). The Dean attends most of the Executive Committee meetings. He further stated that it is Mr. Holland's responsibility to keep him informed of West Virginia RMP's activities. Open lines of commu- nications are maintained between the University and the RMP..- There is a Medical Advisory Committee to the Coordinator, composed of the Dean, the Provost for Health Sciences and a Professor of Surgery... Again, no meetings of this group are scheduled. In terms of. contractual procedures the RMP must use the University system, and as a state institution, the University must use state procedures and meet state requirements. “All contracts are processed and approved through the President's office of the University. This system is comp lex but the University is wholly committed to the RMP and its success and has made several significant efforts to eliminate procedural delays that the RMP has encountered. Responding to site visit team questions about the informality of - staff, RAG and grantee relationships, the Dean stated that "it seems to bother you people that we get along so well together." He said “we have 4 compatible marriage and that if the RMP did not have the support of the University 4t would be a disaster because they could not stand alone." This further substantiates other reports such as the Management Assessment Report that the West Virginia RMP is strongly supported by the University. The - site visit team was convinced that the grantee organization does provide adequate administrative support within the constraints of the state government system and permits sufficient freedom for -ll- RMP: WEST VIRGINIA PREPARED BY: Norman Anderson DATE: 10/72 8. GRANTEE ORGANIZATION (2) Continued program development. The University does not seem to be interfering with RAG's policy making role. There is obviously very good commu- nication and liaison between the RAG, the program staff and the University through the crucial presence of Dr. Andrews who has exerted a very strong directional influence in the past. He claims currently not to be directly involved in programs, although his influence is probably still significant in less direct ways. However, West Virginia RMP may need special consideration by the University in terms of personnel policy and the establishment of salary levels for program staff in order to be competitive with other RMP's to recruit and retain competent program staff. meee mmm mae ee eee Recommended Action 9, PARTICIPATION (3) Almost all key health interests are actively participating in the West Virginia RMP and it does not seem to have been captured or co-opted by any major interest. The region's political and economic power complexes are involved but the HYGEIA Foundat ion which provides a significant portion of health care in the State has not yet been brought into active RAG participation. As an example of participation Mrs. Joanne Ross, Director, Southwest Community Action Council stated that the RMP regional liaison officer has provided a great deal of assistance and that "RMP is a mover and a doer." eee ee eee Recommended Action -12- RMP: WEST VIRGINIA PREPARED BY: Norman Anderson - DATE: 10/72 10. LOCAL PLANNING (3) | The State Comprehensive Health Planning Agency is in the Governor's office staffed with a full-time director and a secretary. There are six established (b) agencies and West Virginia RMP has ‘been instrumental in getting each of them operational. As a result of a recent CHP study a total of eleven (11) regions have been certi- fied for planning. This means five (5) more (b) agencies are to be developed. West Virginia RMP will provide assistance in the development of these (b) agencies. The State Agency Birector says he has no problems with matching funds, but the (b) agencies have a lot of problems with matching funds. The State agency provides assistance to RMP staff in developing data. The comprehensive health care agencies have been slow in developing, but we might , anticipate a faster growth in the future. West Virginia KMT has recently developed.and published a report entitled, Guidelines ‘for Proposal, Review and Operations of Activities which adequately describes the review process of the region: The Guidelines specify that the proposal is sent to the . appropriate comprehensive health planning agency for its review ‘ and comment at the same time the proposal is submitted to the West Virginia RMP Technical Review Committee for its assessment. From all indications very. good working relationships exist between West Virginia RMP and CHP. The Guidelines as written more than meet the stated review requirements of applications by CHP. — ore meme me mmm emme Recommended Action: jl. ASSESSMENT OF NEEDS AND RESOURCES (3) The West Virginia RMP has participated with the University and CHP in data collection to identify health needs, health manpower and health resources in the State. Health needs in the State are many and are characterized by the State being the third most rural in the nation, by having the second highest ratio of proprietary hospitals, and by having a very high percentage of physicians who were trained in other countries. The State has approximately 400 unlicensed foreign named physicians working in the State. A method should be developed to provide full accreditation for those physicians and equal participation in the affairs of the medical - community. The need to establish residency training programs in @ RMP: WEST VIRGINIA PREPARED BY: Norman Anderson DATE -13- 10/72. the State is well documented. Over the past few years West Virginia has increased nursing manpower by approximately 30 ‘percent and a corresponding decrease in physician manpower by approximately 30 percent. Many of the remaining physicians will be of retirement age in the next few years. The current triennial application was developed concurrently with the goals and objectives and the restructuring of the technical committee and program staff. In the past the area liaison officers have functioned somewhat inde- pendently in assessing the health needs in their area. Recommended Action: 12. MANAGEMENT (3) The central office program staff was reorganized and expanded to support the work of the field staff. The area liaison officers together with the field operations coordinator make up an organizational] unit which is one of only two activities that report directly to the program coordinator. The other organizational unit is the Office of _ Program and Grants Management which is a standard administrative service organization. In view of the projected program growth this office may need to develop additional strength to provide the coordinator with adequate financial monitoring and control. All three of the other program staff organizationaliwnits report to the Coordinator through the recently established position of associate coordinator. These three organizational components are: Office of Program Research and Evaluation, Office of Program Planning and Development, and Office of Information and Communi- cations. The Office of Program Planning and Development is a new activity that was initiated to assist the field staff. This office is comprised of four staff specialists in the area of Health Care Delivery Systems, Emergency Health Services, and Health Manpower and Medicine. - 14 ~ RMP: WEST VIRGINIA | PREPARED BY: Norman Anderson 12. MANAGEMENT (3) Continued | Changes made following the Management Assessment visit in June, are apparently seen as satisfying personnel and organization structure needs for the future. This may need further review, if the projected program expansion is approved. ‘Position descriptions are not yet available and fiscal procedures have not been written out. With the Management Assessment and — site. visit accomplished, staff plans to take up these tasks. ee ee EE Recommended Action — in? * EVALUATION (3) The Office of Program Research and Evaluation is staffed by a program evaluator, a data analyst and a research assistant. Evaluation is in the process of transition and change and upgrading cannot be adequately evaluated in all phases as yet. West Virginia RMP does require quarterly progress and financial reporting on all operational activities. Field staff members periodically meet with project directors in their areas to discuss progress of a given activity as it relates to the objectives. : eee ee ee ee ee Recommended Act ion oe WEST VIRGINIA PREPARED BY: Norman Anderson DATE: 10/7 Program. Proposal The priorities of the proposed program by the region are well established and understood in terms of objectives, but their use in the selection of proposals to be funded, and in preparation of the developmental component are not spelled out in detail. The activities are highly congruent with national objectives and needs, The proposals appear soundly based and realistic in view of resources. The results can be quantitatively evalu- ated, although we are not sure that enough sophistication has developed in the review and evaluation process to insure this, The reporting methods proposed for three month monitoring of projects seem fairly subjective at present. The region has been quick to modify its objectives when necessary. A decision was made early, in view of their major objectives, to improve health care delivery but to leave to the University the major responsibility for continuing education. Some limited self-evaluation demonstration projects have teen developed for physicians, and a visiting physician program was instituted which was not very successful and is no longer operational. Linkages are being developed for closer cooperation in postgraduate medical education at the residency level. The emphasis is upon delivery of the common rather than rarely required facets of health care, such as emergency medical services, The program generally should have an impact on improvement of facilities for delivery of health care and utilization of present personnel (midwife and pediatric nurse physicians assistants). The planning for this began early in the program, Improvement of clinic care is a major prospect for several portions of West Virginia through the development of new clinics, The total program emphasis deals with the development of improved access to patient care under difficult local conditions, These activities are strongly sub- regionalized and can be expected to have immediate payoffs in better patient care, with increased availability of and access to services, and improved quality of care. However, total medical care costs will probably increase rather than decrease as services are made available to areas where medical care has previously been nonexistent or in, very short supply. Important developments to improve categorical types of health care in the long run appear through: 1. Supporting care linkages between the general group practices in outlying communities (such as Hygeia supported clinics) and multi- specialty groups in urban areas, as in Charleston and Huntington. 2. Development of residency programs in the latter areas, which can increase physician retention in the state from a 40% level at the RMP: ~16- ; | WEST VIRGINIA PREPARED BY: Norman Anderson DATE: 10/7 end of medical school, to a 70% level at the end of residency training. There are no residency training programs now, although one is being started, These two factors will strengthen relations between general and specialty care and should lead to improvement in the quality of care. The region has been outstanding in obtaining outside funding for its pro- grams. This fact alone serves as the most.concrete demonstration of the value and viability of the program plans. The site visitors, however, believe that an official letter from the State Medical Society, endorsing the program as stated in the triennial application, would be helpful. It is the site visitors’ opinion that an action pattern has been established which,. barring unforeseen complications, can improve the quantity 200-300% within the next decade, ‘This impression was substantiated by a visit to the Fairmont Clinic to determine what has been accomplished through strictly local means. Site Visit to Fairmont Clinic, Fairmont, W. Vae3 August 8, 1972. The site visitors terminated their work with a visit to a nonprofit clinic organized 15-20 years ago by the Monongehela Valley Health Association (a lay group) which now offers a full range of health services, including home care, clinic care, and hospital care. The clinic averages 500 patient visits daily from 8 asm, to 10 pem, with a staff of 13-14 full-time physicians, and with its own integral _ pharmacy, X-ray, lab, emergency room, record room, and podiatry service. It accepts all patients, including 50% not covered by third party or personal finances, and operates two satellite clinics in the hills six and 31 miles distant. The average patient visit cost runs from $20-25, Records are all typed and of high standard, with a unit system embracing hospital, clinic, and home care. There is a separate five- story building downtown housing their home health service. This is split into care groups by age (over 56 and under 65), with two separate nursing staffs, and covers the surrounding rural area as well. The Fairmont clinic has one of the new Family Health Center Grants thus far awarded by HSMHA. This clinic, and an even more extensively developed clinic at Elkins, which includes transportation facilities for patients, should at some time receive careful evaluation with respect to actual costs and benefits of operating an areawide health system embracing the home and clinic (but not hospital costs, these being handled by an independent agency). At present there is little linkage between this clinic and WVU Medical Center, since third and fourth year clinical clerks have been with- drawn in favor o£ hospital assignments. RMP assisted materially in ~17 - od WEST VIRGINIA PREPARED BY: Norman Anderson DATE: 10/72 obtaining the Family Health Center Grant, and has established an excellent working arrangement with this clinic. The clinic represents a tremendous demonstation project and local resource SUMMARY The site visit team was very impressed with the energetic program staff, the cooperation and assistance provided to other agencies, the coordinated team approach to health care, the excellent subregionalization and their resourcefulness in garnering funds from other sources, The WVRMP was described as a well oiled machine that is responsive to the health needs of the region. The site visitors were pleasedwith the recently developed and published report entitled: Guidelines for Proposal, Review and Operations of Activities which adequately describes the review process of the region, Everyone agreed that this is a well prepared report and a definite asset to program development. The grantee organization has been responsive to the needs of the WVRMP as was described in the Management Assessment Report in April when the grantee obtained authorization from the West Virginia State Auditor to make operating capital advances to institutions that collaborate with the Regional Medical Program and do not have the capital to implement the agreed upon program activity. During the course of this site visit this continued commitment was restated. © It was felt that there has been adequate flexibility established with RMP under the university structure, however, some problems still exist concerning the fiscal system, salaries, personnel qualification, and acceptance by the university personnel system which are slowly being aired, The team was a little concerned with the informality of the administrative | procedure, but observed that excellent rapport has been established with the key health industry in the state, We did suggest that the administra- tive procedures be adequately described in writing. : It is the opinion of the site visitors that the West Virginia Regional Medical Program has made an impact on the Health Care System. This is a mature region that has performed well and has acquired the necessary skills and organization to continue to improve and influence the health care system in the Wild and wonderful State of West Virginia. RECOMMENDATIONS 1, That the West Virginia Regional Medical Program be approved for triennial status with the following funding levels: 04 operational year $1,500,000 05 operational year $1,600,000 © 06 operational year $1,700,000 RMP: 7. - 18 - WEST VIRGINIA PREPARED BY: . Norman Anderson | DATE; 10/72 The recommended funding levels include the developmental component — request, The site team made these recommendations based upon the. following: (a) that the program is not requesting any major incre- ment in program staff support, even though the visitors felt that the program is slightly understaffdXb) the visitors in particular yoiced concern with regard to two of the proposed operational activities: the first, Voluntary Office Self-Audit Services, because it reaches only a limited number of physicians in the state and its cost benefit relationship seem very high; and the second, the Camden- on~Gauley Medical Center, because the team felt that the RMP should make efforts to obtain matching funds from the Hygeia Foundation, which is sponsoring the program. That nursing, medicine, and social service disciplines be added to program staff as at least half-time positions with major responsibility and authority in the areas of planning and evaluation. That written policies and procedures delineating the respective admin- istrative responsibilities of the WVRMP and the grantee institution be developed. That the bylaws of the Regional. Advisory Group be revised to allow broader representation and specific responsibilities of the grantee, the RAG and the program staff, Rural health care provider institutions, allied health, nursing professions, and consumer interests should be represented on the RAG, Flexibility should be increased by specifying types of representation desired, rather than specific organizations. Currently, any change requires revision of the bylaws. It was felt that addition of representatives from the rural provider insitutions fespecially the UMW-affiliated Hygeia and Ephraim McDowell Foundations) was especially important, since these organizations have contributed heavily in carrying out the RMP goals for broader health care coverage. The RAG could easily reduce its representation among the categorical voluntary health agencies to a single representative member for all of the agencies currently represented. Further, RAG should increase membership from community colleges, nursing, social service, allied health, and consumer groups. ablished program priorities That RAG develop a procedure for applying est This should be part and criteria in project funding determinations. of a comprehensive review and funding process. That efforts to recruit additional female and minority personnel on program staff be continued, and that activities be initiated which will impact on specific minority pockets. That a portion of the developmental component be used to carry out the additional planning and research necessary to develop a residency training program for primary and secondary physician training -~ 19 - © RMP: WEST VIRGINIA PREPARED BY: Norman Anderson DATE: 10/72 in several of the major hospitals in the State. It is to be noted that the State Medical Society has obtained $300,000 from the State legislature to assist in the improvement of the residency training program, The site visitors did not perceive that the developmental component was to be used for anything other than the general objectives and patterns of activities that were described. The site visit team felt it would be appropriate for the West Virginia RMP to utilize portions of this developmental component to obtain maximal physician retention estimated at 70% through assisting in the establishement of the residency training programs outside of the medical center, particularly in Charleston, Wheeling, and other major communities in the region. Review Cycle: 10/72 7 LS OPDSV Ree RMPS STAFF BRIEFING DOCUMENT iS app r\ ued REGION: _ West Virginia NUMBER: RM 00045 COORDINATOR: Mr. Charles Holland LAST RATING: 358. TYPE OF APPLICATION: a _ 3rd Year (.x/ Triennial /_/] Triennial - 2nd Year {] Trtennial ({ / Other Last. Site Visit: OPERATIONS BRANCH: Eastern Chief: Frank Nash Staff for RMP: Norman Anderson Fileen Faatz Regional Office Representative: Clyde Couchman Management Survey (Date): Conducted: April 24-27, 1972 or Scheduled: (List Dates, Chairman, Other Committee/Council Members, Consultants) July 8, 1969 - Anne Pascasio, Ph.D. ~ RMP Review Committee Bruce Everist, M.D. - RMP National Advisory Council Desmond O'Doherty, M.D. - Consultant Staff Visits in Last 12 Months: (List Date and Purpose) September 28, 1971 - Alan 8. Kaplan, M.D. (Staff Assistance) April 24-27, 1972 - Management Assessment (Tom Simonds, Rod Mertker,N. Anderson) April 26, 1972 - Verification of Review Process (N. Anderson, Clyde Couchman) June 23, 1972 = Staff Visit (N. Anderson) Recent events in geographic area of Region that are affecting RMP program: 1. WVRMP has recently redefined and restated their objectives to be more responsive to the needs of the ‘Region. 2. The Technical Review Committee structure has been reorganized. A Technical Review Committee has been established for each of the three objectives. 3. WVRMP has developed and published a report entitled, Guidelines for P¥dposal, Review and Operations of Activities which describes the review process of the Region. 4, Management Survey team report and verification of the review process _ report. a Xgin 10/72 te = ete yele . . West Vi , * Region Review C€ es F e . Megyeheld +, * : ia ‘Ke ry ax t wot ; : Funting: : te perear: Tk oO EN et p Hardy > opel wee a i ‘Mr. Garvey Gilmore Bishop Hill Building Honcogx . 203 Randolph Avenue Wells tig Elkins, West Virginia Mr. Gerald Hummel 258 Stewart Street Morgantown, West Va. Mr. Robert Whitler Route 5, Box 167A Parkersburg, W.Va. ecuelty Sproage ord herkela;s aba rtiasevcg ue A tows Bam Copper Professional Bldg Suotas Braxton Webster WersreChprings Vacant Position 4701 MacCorkle Ave. __Charleston, W.Va. _ \ Pocahontas Greenbrier Lewichurg Mr. Gary Johnson 1422 Main Street ___ Princeton, W.Va. Mercer : eo ey ony Oe ee Rateigh >. : Wiilemsee 4 : . ratte AIBN . McDowall =, EE POLO OI Te EE EES ae on EP Region: West Virginia Review Cycle: 10/72 DEMOGRAPHIC INFORMATION Geography The region conforms to the political boundaries of West Virginia. For planning purposes the region has been divided into nine sub- regional areas. The boundaries of these sub-regional areas are the same as those of CHP "B" and the State Economic Development Department. Land area: 24,079 square miles. Papulation: 1970 Census a. Total: 1,744,200 b. Urban: 39% c. Rural: 617% d. Minority: 44 Income: Average income per individual - 1969-1970 State of West Virginia - 1969 ($2,610) - 1970 ($2,929) United States - 1969 ($3,680) ~ 1970 ($3,910) West Virginia ranks 46th in the U.S. per capita income Age distribution: Age group West Virginia U.S. under 18 years 33 35 18-65 years 56 55 65 years and over 11 10 Facilities and Resources: a. West Virginia University School of Medicine b. Sixteen Schools of Professional Nursing, seven of them college or wiversity based. c. Sixteen School of Practical Nursing Allied Health Schools a. Two schools of cytotechnology b. Seven-schools of Medical technology c. Twenty-four schools of radiologic technology Hospitals a. Short term - 74 - 9,286 beds b. Long term - 2 - 460 beds c. V.A.Gereral Hosp. -4-1,257 beds Total - 1,696 (94 per 100,000) c. Professional Nurses - 4,704 (260 per 100,000) d. Lic. Pract. Nurses - 2,317 (136 per 100,000) 6. Manpower: Active * a, Physicians - 1,596 b. Osteopath ~ 100 * From a study conducted last year, utilizing the West Virginia Medical Association Journal of new members of the West Virginia State Medical Association from 1961-1971, the following data was collected. A preliminary analysis of the data shows that, of all new members of the State Medical Association, a significantly high and growing proportion are foreign medical graduates (9% of these joining in 1961 ve. 65% in 1971). COMPONENT AND FINANCIAL SUMMARY TRIENNIAL APPLICATION Region West Virginia Review Cycle 10/72 3 . Comaittee Recommemeacion ror Current Annualized Reauest for Triennial Council-Apnroved Level Component Level 04 Year Ist year | 2nd year | Srd year, ist year | 2nd year i ° See year )GRAM STAFF $ 577,086 $ 584,725 | 619,197- :656,279 STRACTS 148,466 95,222 i - + * . ‘ELOPMENTAL COMPONENT = * -- 80,000 | 8,000. 80 ,000 - . . . . . . . . * oq. ’ SRATIONAL’ PROJECTS 222,914 = | 1,135;153 1,163,725} 1 2est721 eid 7 - . . # Kidney { 25,000 } “EMS * ( 41,506) | (27,556). (24,105) | ! hs/ea- ( 49,830) Pediatric Pulmonary ( ) . Other C anew ae _ oreo * . TAL DIRECT COSTS x* f 7. : 800,000 $1,799,878 pt90° 000 | $2,000,000 - UNCIL] RECOMMENDED ‘LEVEL | $ 929,810 - * $63,375 **$863,375 - kkk Taclndes Unsvecified Growth Funds ‘3 | ALELST 251972 REGICASL PECICAL FFIGRANS SERVICE he “FUATIAC FISTORY LIST WEES=C ERS ITCFAT s PEGICN 45 W VIRGINIA FHP SLPP YR C3 CPERATICNEL CRANT COIRECT COSTS CALY) ALL RECUEST ANC swARCS AS CF JUNE 305 157 ‘ \ ? PrARCEC AWEECEC fwER CEL AWARDEO 9 RECLESTEC REGLESTED RPECLESTEC FECUESTEC a EC MPCRENT CT C2 Cc “ eg TT EK “OSs cé s AC TITLE ClsTle2e/71 Cls Tee seete TC VAL ee CL“73B-1L2/73 CL/TSH12/74 81s 7S- 12/75 TOTAL we ae no COCG FRCChkSé STSFF Z€27CC 47Z4ES f77CEkE 1233275 ea §34725 619157 ESEZTS yeeC2l 2 OCT CEVECTFFERTST C +¢ eccett EOCTE 65660 240600 CCL EC PRG STAFFIK ° 21CCC 210¢0 oe : : COS _KUFSING CIRE ST ZETCT Sat wtizsy 4 , : CCE AAT LIFE FIST S 3140C 314cc ot # : ~OGE FELICCITER FEES BARRON RUSK \ 7 eo ' LINCOLN , i TLANGLADE 5 | vn fGcoxto rf CHIPPE wa / CROm OUNN | \ MARATHON PPO INEE \ CLARK ree A CAS math sreeaggemanin i pa ratramtan ce ; €Au CLAIRE SHAWANO wO00 PORTAGE WAUPACA . GUTAGAMIE, YGRANT Current- . | —Council- | —— Recommended - Recommended Annualized Approved - Region's Funding For Level For . -| Funding Level For Request For: j TR Year 2nd Remainder Component TR Year 1st TR Year 2nd _TR Year 2nd __. of Triennium . SARP (05 year) (06 year) (06 year) /_f “ [_/ Review Committee DROGRAM STAFF 529,955 | 625,607 - ‘ . : CONTRACTS 64,792 DEVELOPMENTAL COMP. .| 117,822 —_ | 200,08 «=| y¥és /_/ No OPERATIONAL PROJECTS | 1,066,503 | 1,350,110, : fa ; i Kidney ( 312,881 ) ( i ) EMS | (1,265,816) ¢ ). “hs/ea me ) (> ) Pediatric Pulmonary ( } C ) Cther C ,| ) TOTAL DIRECT COSTS “1 1,779,072 2,176,615 COUNCIL-APPROVED © =| 1,779,072 1,779,072 1,779,072 - LEVEL oo a i t DULY 1201972 KEGICN + WISCCASIN neoravenr ne west Ce ANAT ENSTI race x the, OF8 tte Ae Ore wanes BMP Ne SM Pee ort . 5) (2) : (4) qu) IDENTIFICATICN CF COPPONFRT = [ CChT. WITHIN| CONT. BEYOND APPR. NCT 1 NEW, NOT 5 cuareNt { CURRENT 4 . I j APR. -PELETCOE APPRe PERLTOCL PREVIOUSLY { PREVIUUSLY | OLRECT } INDIRECT { TOTAL 1 ! cr suePuRT CFE SUPPORT { FUNDED } APPROVED | costs 1 casts I ; i i ( { i £990 PROGRAM STAFF i l t { j { { I — i $6252.607_1 i i 1 $£252607 1. -8622135. 1___set7e262-1__ yoga Ovi LOPMINTA COPPCRENT ; 1 { { 1 1 4 $20.3 ft f I i e200, hop tf L B200n 854 { O15 COMPREPENSTIVE RENAL race | ' { l . | t RAM $312,831 1 i l i $3122891 1 $5721 17_1 $370,056.) OLfA CEPT CF HLTH MANPGHER in | t ( { { ; { { DCN EGUCATICN 257.065 1 I { j $572965_ 1 $6,625 J $66,800} O22 CONTINUEKG EO IN penne | | i I t - 4 i l LIALION MEDICIAE { I $54.34)_1_ { $542341.1 i $54,341} O23 CAROLAC ANC INTENSIVE cal { f | t - 4 i RE NURSING I } $54.52) 1 1 $54.52) 1 $22.410 } $75,931_1 C24 CANCER REWIER ANC ay 1 t | | . 4 . ILOy CABe Pecceas $37.729_5 l $370,129.14. glia 2 O26 PRIMARY CAKF THE FTERTEL 4 { t - : t D RULE CE_IHE tUPS> $131,616 1 L $L3bs.616 1 $55,206.1 £}86.422_) 328 DIAGNCSTIC éne rigRaPeOT 1 t | ! 4 i IC CRLIERLA PEYISW 1 i $23.900 4 1 $23,000.41 $9,800 1 $32,800 1 O30 ORTH CENTRAL WISCONSIN j { 1 j { oon { . j CUTZEACH i $1.8.592_1t i i $182492_1 $6,268] $25226C_i O31 16TH ST COMPLATTY ECT { : | I i t i . i CENTER HOPE JSC : i $109.15) 1 \ i $109,151 1 i $109a15) 1 D4? RESEARCH ANC PLAANING FI i | i { t { | HEALTH CAPE t j j $90,180 1 $20,180 1 $29,779 1 $115.955_ 1 C33. MED INSTRUMENTATION ANE i | t | j i : 1 ! 7” CORSULIATICN. SERVICE i L ij l $215903)2 1 $15923)2. 1 $56.336 1 $2152642 1 O34 VOLUATEC#S FCR STRCKE rel | | “4 ' 4 . t “ae PABILITATICH i j j $35,800.14 $238.800 1 L $38.20C J D3GA SHARED SFRVICTS PRCGRAM j t | { : | { { ST CROIA PRCUECT 1 i i §25,990_} $252550 1 j $25.250_1 D368 SHARED SFRVICES AREA 5 a i | { { | i t EST WISCONSIN PROJECT I I i j $32.600 1 $322600_) 1 $32,890 1 O36C SHARED SERV PROGRAM nent) J i I i t l i SCN HOSP GecuP j i 4 $15,000 J $15,000 1 $5,400 1 $20.490 1 536. COMPONENT TOTAL t i i j $73,520 14 $7309202 16 $5,400) if s7e.95Cil O37 PRE ACMISSICN TESTING Pal { I \ 1 t 1 . t I 1 1 t $302822 1 $30,922 1 i $320.8221 036 WISCONSIN HEALTH CARE net ! 1 t i i { I YIEW i t I J $92:170_1 $92.170.3 i $92,170 1 041 QUALITY KURSING CARE 1 ! I | { | t { . i 1 L j £65,590 1 $65,580 1 i $65,520 1 —_— . ' | . ( { { | | : i TOTAL 1 $173665656 | $1275643 | ($1312862 | $550,414 | $29176s615 | $324,530 [- $2e50%0145 | ~ SULY 22,1972 REGICN © WISCONSIN CNT aAVCET KE Geo ae nanray 1077? PALE 2 UE Pet tie Am tee tenet PMP D 1M Stuns 0d C4) aaa : LOLNVIFICAVICN CF COPFCNENT — CCNT. WETHING conts * BEYOND! APPR. NOT | NEWs NOT 1 aovo*. vEeaR | 1 era ' { APPs. PTAINh] APPR. PERING] PREVIOUSLY | PREVIOUSLY 3 qrect fj f aLL vearRS = 1 OF SUPPORT § OF SUPPORT {| FUNCED { aApprcveo l costs { (DIRECT Costs | i | i { ' ! { i CG10 PROGRAM STAFF ‘ 4 | § I | { j ~- . : i kGTbe2I6_1 1 4 1 SG 1.276 1________L_$1s226.883 1 ___ 99,9 BEVEL EMINTAL CUFPCRINT | I ‘i 1 4 ! 4 1 $1550455 J t i i $158:454 1 i $2591352 L OLS COMPREFSASIVE SERAL PROG ( { i I i { 1 Rew i i 1 l i I 1 $312.281 1 O134 DEPT CF HLTH PANPCWER AN} . | 1 t { 1 i DCR. EDUCATION i £38.644% I 1 I $38254% t $96,609} O27. CCATINUING £0 IN Renspitt i 1 i ( i _IJIATIOR MECICIBE I $572428 i $5.22428 $173.785 1 O23. CARDIAC ANC INTENSIVE cal { f t { RE SURSING i t $542521 i $54,521 $309:052_1 024 CANCER RiVIEw ANC ERO 1 t 1 i t t : i LICH CASE eerceas J i i i i i $37,723 1 075 PRIMAPY Care THE exitneet i i I { { f. ‘ 2 RULE CE IKE sur se i $l3isbl6 J ul 1 i SL31.616 5 i $2632232_ 1 O24 CIAGSCSTIC #NnT a i ! ( ! t i] t IC CALIEPIA PEVIEW 1 i $23,000 1 j $23,000 1 i $46,606 1 0206 BARTH CEMTS4L WISCONSIN i : 1 ' ' ~ | i CUTZEACH rT $12.592_1 j i $182492 $36,294 1. 031 L6TH ST COMPFUNITY wezcTA | i 1 t 4 CENTER HOPE INC i $109,351! 1 i $109.15) $218:302_1 O32. RESEARCH AAD PLARNING FI 1 1 t 1 1 1 HEALTH CS7E 1 i I $90,120 j $90.190 1 j $1801360 1 033. MCC -ERSTRUPEKRTATION ONE + 1 t 1 i } j i COMSULTASTISN SrPVICE j i 1 ! $1592312.1 $1592.22 1 Ll $318,624.) 034 WOLUNTEE7S FOR STRGKE Ret I j 1 i ' ( j " WHESILITALTICE 1 { ] $38.800 ) $38,f0C 1 j £77,600 1° O35A SHARFO SERVICES PROGRAM t i i ' 1 { i j ST CROIX PYOUECI } i i l $242625_ J $24.625 1 L $50.575 1 O3EB SHARED SERVICES AREA 5 we f j 1 i t j t EST WISCONSIN PROJECT i 1 i j $25,900 1 $25,000 1 i $57,600 1 O3746C SHAPED SFP¥ PROGRAM wADIY i } { { i i : j 2 _SCS_HCSP_ GECUP 1 1 1 j i 1 $25.00¢_) O36 COPPONE'T TCTAL { } it $49,625) 11 $S9262511 Lh 8b23,i 7522 O37 PRE ADKISSICN TESTING Pal j | t t j i I i j $28.652_ 4 $29.652 1 L $592474 J 038 WISCONSIN HEALTH. CARE me | t { j { VIEW l i i $22,170 1 O4E QUALITY NURSING CARE : ( I i { ; i Jj $65,590.) $653590) $131,260 f . 1 | t . 1 i t oO i TCTAL { $9994990 | $127,643 | $134,945 | $4325149 § $29694*e731 | : $329335362 { - 6 ee tt een nt 74 | £UCLST ZeliG72 KEGICAAL PEDICAL FECT RAKS SERVICE la me EYADIKG RISTOFY LIST™ ee semen —— SET EPATTCOFE” RECION 37 WISCONSIN RHP SLPP YR CS CPERATICHAL Great (CIRECT CCS$T§ CALYS ALL REQUEST AND awaRetS AS OF JLNE 3C, 197 _s 7 aBEFCEC AweARCEl AwERCEC awaacec AWARCED AvARCEO .© RECLESTEC BECUESTEC SECLESTEC RECUESTEC e COPPENENT CY Cz C3 Eg OE FEE CT CE s aC TITLE css = TCTAL *® ¢1/73 ~ ousTs - C1/7$ - TOTAL 19 TAFT a 12/773 Te7t4 T2775" un ® wa ~CTCT PRCGFAP STEFF SLSiCo Srogce qssccte Strict €s3 ZiEV437 6 E2EECT EM2T6 T25E88S DOCG DEVELOPMENTAL A . 130920 13CS2C # 2cc698 15€454 355352 ‘. “COZ STCY FRG OTERIR ECIte TSIZTT weecce 33e3cc# OC? FILCT CEM PLL¥ e4ecc 61500 55406 2aciscc ¢# “DOS TS CEEMS BCULTS Stee EF4CT mcecc z3cce 136030 8 oce® FC £0 HLTH PECF 71ccc 58500 : 12S6¢6CC * “OUDER PT EC CTER StaV TESCT : 165cT 4 ocsa8 crear Access tie -16¢CC€ Z4EC1 427€Cl 4 —pO5C STAGLE CONCEPT - TEECC peece F Oot FACICLcGy > 6 y222cC€ 123¢Cé 12694C 374046 —ccis cua ccm ekCTCG S570 saco @ECC ° cece + coc CyA. PET Card cl 2042CC 6e4CC 44C6C 32137CC * —O5 ETF TEZCT EET zeees T1764 ¢ OLL WSSLE TYPING ¥ ecco 51400 43CCC 16z4cc 4 “DID TUTER INE CYICOOO 2sCC 4E7CC a3ECT gsioc * O13 REACT BR TENG Sh. 1310¢ 1a21cc * ~OLISTINACTIVE RUF SE écccce 600004 (0138 CChEC # TFAG SF Le4ce 124cC *# UTS COMPREFENSTVE 2 R5000g EZTS1S TOTTEVE ZTZeet SIZb6T OLS wECECAL LIERARY 17¢ccc peecc ; _ 33500 * , i: oT ULF TAL RSE UTILTZATE 1OG600 TREC TEMSEC™ 2 7C1EC FB : z 2 OL8a VECICAL CCLLESE . , . 97246 . 77290 # §7965 3EES4 . seecs : “O20 ACTA FFG teT FE YEE Ee yces25°% —_ . t C22 CCATIALIAG EC I ‘ 54341 ET42E 62016 1737385 pu “O27 CERCTET FAT INT * 56527 Basel VESC4E oO 024 CENCER REVIEb s 22272 Z2c72 ¢ 3772S 3772S t “DIET RURSE ASSOCIATE ~ 82850 e2esc * Ty2LEVe T21E%E 262232 o28 cCirecacsric anc + 23000 23000 4ecce ‘ PACTRCRIN TEATEAL CT UTE ATED CESS 2 1E462 36984 — o3l scuTek SICE FEAL §5925 565925 * 10Ssi51 1csiéi 2218202 HID WESERRTR SET FU . screc sersc ’ Ya0red C33. MEC INSTRLMENTA 4 15S212 169212 BLEE24 O34 TWELLATEERS FGR . 346800 36800 7 2I6CC CUEA SHAREC SERNICES * 2eS55C 24625— scs7s OVEN SFAREC SERVICES ° * "32600 25ctc e7ece O36C SRARET SERV FEC .. 15000 16000 “OTT FRE BEPTESTCR T ¢ aCeee 2ees2 55474 036 wISCCASIN FEALT at GZ17C ‘ G217C YAO TERS FOR BTECONS "POEL ELE 1ZELELE * : i C4) GQLALITY NLRSIAG : * éesec ESSEC UZiLEC ee Te * 7 +. - ToTrAaAC 548900 11622035 réesséce ro23e1& 3242562 TEETITE 4 2176615 1694731 62016 3933262 2 wo wee eR ww ~~ -il- Historical Profile The Wisconsin RMP's initial planning year began September 1, 1966, was designated as an operational program on September 1, 1967, and received Triennial States on September 1, 1971. The Wisconsin RMP Inc. was formed as a collaborative venture by the Marquette School of Medicine and the University of Wisconsin. It encompasses the entire state of Wisconsin, with the largest concen- tration of its population in the seven Southeastern counties of Wisconsin, which serve as one of the area-wide health planning agencies-- the CHPA for Southeastern Wisconsin (CHPASEW). The Region ranks high nationally in the amount of money spent for higher education. The Health Sciences Unit of the University Extension, University:of Wisconsin in Madison has been a pioneer in the development of continuing education for resources for physicians, registered nurses, and allied health professionals, and has achieved national reputation for the excellence of its work. The WRMP has over the years collaborated with these resources which have resulted in the development of a number of operational programs designed for nurses and physicians and other health professions in the region. During its early years of operation the WRMP has concentrated basically on quality of care in categorical disease areas and post-graduate education programs for physicians and nurses, with principal operational foci in the Marshfield, Milwaukee, La Crosse and Madison areas, and to a much lesser extent in the Central Northeast and Northwestern portions of the state. The northern portion of Wisconsin is characterized mostly by large rural areas sparsely populated with small rural hospitals and for the most part inadequate facilities. Operational programs have recently been developed which do provide some outreach to some of these’ . rural areas. The region through its newly appointed field representative for Northern Wisconsin has been working with hospital administrations in this area and has assisted these hospitals in the development of collaboration and service sharing arrangements. The current application request funds (Project #36A) for support of such an activity. Project #30, North Central Wisconsin, illustrates another example of an outreach program in the Northern Central area for the small rural hospitals. These projects among others in the current application illustrate the region's emphasis on finding ways to extend services to areas out- side the Metropolitan and University centers and the large group clinic settings, and on developing methods for monitoring the quality of care and moderating the costs of quality health care. The awarding of $1,265,816 For a statewide EMS project for the State of Wisconsin also represents — a program which would aid people in the Northern areas and will tie together a number of extremely scattered, smaller services. WRMP is working in close collaboration with a bread spectrum of the health groups in the region and has developed a network of communication and functional activity among medical centers, hospitals, and health agencies in the region. The region has successfully terminated a number of its original three year projects by either receiving support from other sources, or because of unsatisfactory results. Appendix D of the current application describes the accomplishments and sources of funding of these terminated projects. Project #16,Medical Library and Project #20,Action Program in Detection and Management of Gynecologic Malignancy ,are projects “1467 WRMP has improved the extent and quality of its evaluation procedures by the establishment of a Review and Evaluation Committee which has the responsibility for and has been actively involved in conducting project site visits and developing methods to produce "outcome" data rather than theoretical information. Evaluation is now built into projects during the initial stages of their development. The region's review process was the subject of a June 13, 1972 visit. It was found ‘that the mechanics of the WRMP review process generally meet the minimum standards; however, it was recommended that provisional certification be given pending implementation of staff's recommendations and suggestions which relate to: (1) conflict of interest; (2) feedback letters; (3) provi- sion of review criteria to potential applicants; (4) re-examination of the region: s by-laws; and (5) provision of written review criteria to technical reviewers. The region has expanded the membership of the Corporation from its original three to a total of nine members. WRMP reassessed its utilization of developmental component funds in light of its present objectives, and have defined in greater detail its intent and purpose in developing program areas for developmental component funding. During the past year, seven activities were funded; five of these have been approved by the RAG for extended support and appear in the project section of the current application. Areas of activity include delivery of primary health care, and monitoring the quality of health care. During the past year, increased efforts have been made in furthering effective commmnications and collaborative efforts in program planning and development with the state areawide CHP agencies. WRMP provided assistance to the Northeastern HPC in preparation of an application for a project with the Menominee Indians and has consulted with this HPC about cardiovascular surgery needs and neighborhood clinics. Consultation and assistance has also been provided at the request of the CHP agency of Southeastern Wisconsin, on matters relating to require- ments of Cardiovascular Surgery. In collaboration with the Johnson Foundation of Wisconsin, the WRMP convened a conference to identify the components of an effective community action program to deal with the problems of sickle cell disease, established guidelines for such a program, and have since provided consultation to the Medical Society of Milwaukee County and the United Commnity Services of greater Milwaukee about sickle cell community action programs. Issues Requiring Attention of Reviewers: The basic issue is whether the WRMP should be approved and funded The request 1S at the level requested in the current application. for $2,176,615 including $200,898 for developmental component. funds. The region is currently funded at its NAC approved level of $1,779,072. : Recommended funding for the development component should be based on this level. If the region is approved and funded in the amount requested, it wil} be able to continue its basic program, as outlined “in the current application, provide salary increases for program staff and initiate eight new activities which for the most part will provide services a and health care needs to areas of the state which have 1n the. past ne been neglected. A staff review will be scheduled and if additional issues are raised sien lahtart of a separate document. -13- Staff Observations Principal Problems: Prior to the submission of the WRMP's Triennial application, a site visit was conducted which revealed problems related to: (1) the lack of objective methods of evaluation (2) the. inadequate representation of racial minorities on the RAG and a lack of minority representation on program staff. (This stj11 remains to be a problem, as there are still no racial minority program members, and only one minority (black) representative on the RAG) (3) lack of sufficient depth of the program staff (4) the extent of subregionalization efforts, especially in the rural northern part of the State (5) developmental component request too broad and all encompassing, lacking specificity as to how the funds would relate to priority needs. . (6) The three-member corporation is not large or broad enough to govern such a large program as the WRMP, Inc. oo Principal Accomplishments: WRMP's Triennial Application reflected a definite response to the eo specific problems, concerns and recommendations of the reviewers. The region has added depth and strength to the program staff by the addition of a Physician Associate Coordinator for Program Development and Evaluation (Madison WRMP office), a Deputy Coordinator for Regional Liaison (Milwaukee WRMP office), and a field representative who serves WRMP as liaison in the North Central area of Wisconsin. His efforts have been directed towards promoting and providing assistance in the development of collaboration and service sharing among the rural hospitals, particularity in the rural areas of Northern Wisconsin. He has worked successfully with the hospital administrations in the area and has identified opportunities for improved cooperation among these hospitals. As a result of these efforts, seven participating hospitals, working through a non-profit corporation are in the process of merging to share services and to combine health care services in an effort to provide more comprehensive services and to improve the quality of services that is so urgently needed in this target area. : WRMP has improved its subregional efforts by establishing cooperative relationships with some of the large proprietary clinics, namely, . Marshfield and Gunderson. As an example, WRMP and staff members of the Marshfield Clinic have designed a proposal to establish the concept of regionalization by providing a variety of medical and laboratory services to the small rural hospitals in the North-Central area of Wisconsin. It is anticipated that other health care delivery ; systems within the central Wisconsin region will also participate in the provision of outreach services to these rural areas. Ny ERATION Ds] si aro] t : : Med eR MAREE baa ees Fo remem AO ATMS me oe ara ag A PARI Na A DAE E EAA a ch wee ct dN al a male a et ann latin Ath ements Me ghee ame A le mcs | oe ba, . + ’ J roe ary ye 12 4200 ara t Ber PT PTS OOO rid + F my , i 1 Se na “og ae wehiia / “avas o bee 4a its 06 oF serat ional, nad achive j ,052 over PEY an of $1,779,072, he develorr 2. That ¢ al component } et 29% of the current. “amualized level (S1,779 30" 2) for. iL S177 C07 Gehich is inc Luc Jo “ move recommended level) r ather than the Critique: In recom nding: a funding Jevel, the panei noted that the region continues ec to be a strong viable program and has posi tively responded to and taken initiatives in resolving tne concerns of the previous reviewers. Panel was impressed with the ieadership and wmanagenent that exists in WRP and noted that the progran staff has been strengthened by the addition of an Associate Coordinator for Program Planning and Develowne ent and a Deputy Coordinator to assist in the overall operation and adninistration of the program. The region has ta ken Significant steps toward strensthening its evaluation procecures. A Review end Evaluation Committee has been, established and has ¢iven evaluation a great deal of visability. on RG E Committe has implemented an offoctive mechanism for proje revicw and monitoring. The WRMP Director of Evaluation provides the needed assistance to the Committee in carrying ot its task. Evaluation iS used as a manneonea tool to provide quantitative information for consideration in decisions leading to the better conduct of projects and to provide information for consideration in dealing with future support of project activities. The procedural steps in carrying out this process includes initial reviews oF projects to determine the existence of some realistic evaluation procedtiral measures and the resources to carry them out, oneraticnal reviews as a monitorine finctien to insure that projects are necting stated objectives, and terminal reviews to access overall project performance and value to detemine the future direction of PFOPCOES « The region utilizes resources outside the ELAP jn its evaluation process. | 7 | . « ~2- prosram evaluation, the Wisconsin MiP Information Support System contract which is Lamming & Evaluation under the Yho findines of that study were “very isconsin PMP and indicated that the WRMP is addressing 7 ie th problems in the State, as defined by the leaders in the region. . oO c ~ been able to capture the interests and have good working “ith virtually all of the key health agencies and institutions by working YRAPP g with a broad spectrum of health sroups, WR op a network of nuications and functionsl ers, hos} end health agencies to deve) since its inception. In on, WRMP works closely with the eight established and operational areawide health planning agencies in the State. ‘The Regional Advisory a Group adopted a policy. in 1969 regarding collaboration with the of Comprehensive Health Planni ICTS AY _areawide health planning agencies. The stress is on developing projects ‘ in a subregional or areawide context with an appropriate awareness of the aveawide goals and priorities, to share expertise and resources in solving problems of common concern, to provide prefessional and technological consultation to these agencies, and to interrelate committee and staff appointments with these agencies when desirable. WRMP is successfully carrying out this mission. WMP has been very “actively involved in providing consultation and assistance to these agencies in a numbcr of areas. "ay WRMP has also been an important factor in bringing about closer cooperation between the two Medical Schools in Wisconsin. The panel praised the region's "contract offerings approach"! which was: recently approved by the Regional Advisory Group. as an experiment in contract offerings in certain program areas. $100,000 has been earmarked to fund activities which the RAG has defined as high priority areas. This method has provided WRMP with un additional source of projects and contact with 63 different groups from 35 commmities in the state. This has proven to change the focus of attention from the larger cities, large clinic groups and the University centers to the small town hospitals and grass roots health care personnel of many varied types. Three contracts, all in the area of shared services among small hospitals, have been developed as high priorities by the RAG for implementation. One such activity will provide outreach to the northern rural areas of the state and was developed largely through the effort of the WP liaison representative for northern Wisconsin, He has -- successfully promoted and assisted in the development of collaboration and service sharing among hospitals, particularily in the rural and northern areas of Wisconsin. If the program is successful as proposed it is, a quantum leap j stering cooperation among hospitals which can only result in. more cient and better patient care. we involvement in assisting , which was appointed 1 needs and develop a comprchensive in. Its members include > comadttec Dr. Fa ieschboeck ie task force, One 4 , Services work group of the of guality of hoalth care, and have Naintaining the Quality of Health involved in several activities relating mole, $25,000 in 8 a opd ie s vice which hes} recently Por e> ilable to the Wisconsin Health . sd by the State Medical Society, State Derital Society. Wisc onsin Has spital The region is now rem addition, severel oth: in Wisconsin. The and evaluation pro “activity. Three jy ‘this activity. port for this activity. In of care review prams are in existence nic has a healt service delivery research been previ ‘ded by the WRMP for this A aut a ear funding is also being requested by WRMP to continue The pane] in their review of the WRMP kidney proposal, were generally mpressed with the cevelopment of the progran so far, but were concerned with some trends which if not given eerly attention, could restrain the achievement “of full program potential. Sore dispersion of | trans splantatio: and related ‘cepvicos was evident. There appears to be insufficient attention to the development. of third- party sources of patient care support. There also appears to be an inadequate level of effort being focused on increased precurement of organs to support 1 increased kidney transplantation. It might be of interest to note that the WRMP has just won a National award for the 1972 Gerard B. Lambert awards, established to encourage imiovations designed to improve patient care or reduce health casts. It is the first time a RMP has ever received the award. ‘The award is for a WRMP funded activity "Nurse Utilization: A Patient Care Systems Project,'' a system of patient care based on patient needs on the theory that if a patient needs are esigned for, the nurse will be utilized correctly. The system is currently in use at St. Mary's Hospital in Milwaukee-and is in various stages of implenentation in other hospitals throughout the nation. s NNT COMPONENT AND PTD, APPLICATION DUR epoAapy PERSARY ING L SUMMARY TRIENNIUM 1 7 seep ayy hae pene ay Cou meii- Recommended Recommenduan a q Tran ht , vo Yoane ad Tle. ADYLOVCS Region's Fundang Por Loved ri es rs. . oy Damgind, Level For Request For PR Yee 2nd. Romaindst 5 “ r 2 "y ay fo and te ayes Component TR Year 2nd TR Year 2nd (OE $ yea} of Triemiian BAP Ae ATS pace a UA STAI Ayre ye Pe ok new LO aa ee eats et tia VELOPMENT homer, athe LOMA sole ay Other NT AT DIDECE TOTAL VA ANSUE ny rm wy wend [x fes 625,607 /_] Xo (77,907) ~ 1,350 110 ) 312/981 ‘ F SS ee ‘ %. # ig y x v 2,176,615 2,153,624 1,779,072 1,779,072