~NEW FILE BEGINS Doe #/7 B&B INFORMATION & IMAGE MANAGEMENT 300 Pence Qeorec'’s Boui.evarpd UPPcR MARLEBDRS, MaRYLanpD 20772 ° UBA * (3D1) 249-D1 13 v HISTORY OF REGIONAL MEDICAL PROGRAMS (Public Law 89-239) Prepared As Requested for President Johnson Library August 28, 1968 HISTORY Background ..... INDEX e ° e e e e e * e 6 e Conferences (Regional Medical Program) . . Division of Regional Medical Programs .. Fiscal Information oe eo wee Guidelines Legislation, see Public Law 89-239 Legislation (prior), see Background Marston, Robert Q. . National Advisory Council on Regional Medical Programs Olson, Stanley W. s ° * e e s e ° ° « ° ° Cd e ° ° . e Operational Grants . . 1... 2 ee ee ee ee ee ewe Planning Grants President's Commission on Heart Disease, Program Coordinators . .. «ss «ee eee Public Law 89-239 . Regional Advisory Groups . . e © #8 @ e e 6 ee e« 8 @ Regional Medical Program Review Committee Regional Medical Program Staffs Regional Medical Programs Regionalization (concept) Regions (geographical) ..... Report to the President e Cancer and Stroke 7, 18 10 12 14, 24 31 8, 31 31 4,6 .9, 25 24 31 27, 31 INDEX, continued APPENDICES 1. Public Law 89-239 . 2... 2 2 wee we we we wens 2. Directory of Division of Regional Medical Programs 3, Listing of National Advisory Council and Review Committee . . 2. 56 «ee ee © we ee wee 4. Chronology of Regional Medical Programs ..... 5. Regional Medical Programs Regional Advisory Groups 6. Map of Regional Medical Programs and Listing of ‘ Program Coordinators . . «6 «+ «eee ee eo @ 7. Directory of Regional Medical Programs . . . 6 « « 8. Excerpts of Testimony and Materials (H.R. 15758) . Report on funded projects and activities in first 12 Operating Programs . ...%. - . Television, radio and telephone networks for continuing education . .... +. s«-eee . Statement on efforts directed against the health problems of the inner city .... .» . Statement on operational projects affecting rural areas . 1. 6 6 ee ew oe . Statement on effectiveness of Programs .. . Page 14 18 21 23 25 27 31 47 48 61 62 64 71 HISTORY OF REGIONAL MEDICAL PROGRAMS (Public Law 89-239) On October 6, 1965, the President signed Public Law 89-239. It authorizes the establishment and maintenance of Regional Medical Programs to assist the Nation's health resources in making available the best possible patient care for heart disease, cancer, stroke and related diseases. This legislation, which will be referred to in this History as The Act, was shaped by the interaction of at least four antecedents: the historical thrust toward regionalization of health resources; the development of a national biomedical research community of unprece- dented size and productivity; the changing needs of society; and finally, the particular legislative process leading to The Act itself. > The concept of regionalization as a means to meet health needs effectively and economically was not new. During the 1930's, Assistant Surgeon General Joseph W. Mountin was one of the earliest pioneers urging this approach for the delivery of health services. The Na- tional Comhittee on the Costs of Medical Care also called attention in 1932 to the potential benefits of regionalization. In that same year, the Bingham Associates Fund of Maine initiated the first comprehensive / regional effort to improve patient care in the United States. This program linked the hospitals and programs for continuing education of physicians in the State of Maine with Tufts University School of Medicine and, through that school, to the other university centers of Boston. Advocates of regionalization next gained national attention more than a decade later in the report of the Commission on Hospital Care and in the Hospital Survey and Construction (Hill-Burton) Act of 1946, Other proposals and attempts to introduce regionalization of health resources can be chronicled, but a strong national movement toward regionalization had to await the convergence of other factors which occurred in 1964 and 1965. : One of these factors was the creation of a national biomedical research effort unprecedented in history and unequaled anywhere else in the world. The effect of this activity was and continues to be intensified by the swiftness of its creation and expansion: at the beginning of World War II the national expenditure for medical research totaled $45 million; by 1947 it was $87 million; and in 1967 the total was $2.257 billion -- a 5,000 percent increase in 27 years. The most . Significant characteristic of this research effort is the tremendous rate at which it is producing new knowledge in the medical science, an outpouring which only recently began and which shows no signs of decline. As a result, changes in health care have been dramatic. Today, there are cures where none existed before, a number of diseases have all but disappeared with the application of new vaccines, and patient care generally is far more effective than even a decade ago. It had become apparent in the last few years, however, that new and better means must also be found to convey the ever-increasing volume of applicable research results to the day-to-day use of the practicing physician as well as to the growing complexities in medical and hospital care. Included in this latter group are physician specialization, increasingly intricate and expensive types of diagnosis and treatment, and the most effective distribution of scarce health manpower, facilities, and other related resources. The -3- degree of urgency attached to the need to cope with these issues is heightened by an increasing public demand that the latest and best health care be made available to everyone. This public demand, in turn, is largely an expression of expectations aroused by awareness of the results and promise of biomedical research. In a sense, the national commitment to biomedical investigation is one manifestation of the third factor which contributed to the creation of Regional Medical Programs: the changing needs of society -- in this case, health needs. The decisions by various private and public institutions to support biomedical research were responses to this societal need perceived and interpreted by these institutions. In addition to the support of research, the same interpretive process led the Federal Government to develop a broad range of other programs to improve the quality and avail- ability of health care in the Nation. The Hill-Burton Program which began with the passage of previously mentioned Hospital Survey and Construction Act of 1946, together with the National Mental Health Act of 1946, was the first in a series of post-World War II legislative actions having major impact on health affairs. When the 89th Congress adjourned in 1966, 25 health-related bills had been enacted into law. Among these were Medicare and Medicaid to pay for hospital and physician services for the Nation's aged and poor; the Comprehensive Health Planning Act to provide funds to each state for non-categorical health planning and to support services rendered through state and other health activities; and Public Law 89-239 authorizing Regional Medical Programs. For the text of Public Law 89-239, see Appendix, 1. The Report of the President's Commission on Heart Disease, Cancer, and Stroke, issued in December 1964, focused attention on societal needs and led directly to the introduction of the legislation -4- - authorizing Regional Medical Programs. Many of the Commission's recommendations were significantly altered by the Congress in the legislative process but The Act was clearly passed to meet needs and problems identified and given national recognition in the Commission report and in the Congressional hearings preceding passage in The Act. Some of these needs and problems were expressed as follows: . A Program is needed to focus the Nation's health resources for research, teaching and patient care on heart disease, cancer, stroke and related diseases because together they cause 70 per- cent of the deaths in the United States. - A significant number of Americans with these diseases die or are disabled because the benefits of present knowledge in the medical sciences are not uniformly available throughout the country. - There is not enough trained manpower to meet the health needs of the American people withing the present system for the delivery of health services. | . Pressures threatening the Nation's health resources are building because demands for health services are rapidly increasing at a time when increasing costs are posing obstacles for many who require these preventive, diagnostic, therapeutic and rehabilitative services. - A creative partnership must be forged among the Nation's medical scientists practicing physicians, and all of the Nation's other health resources so that new knowledge can be translated more rapidly into better patient care. This partnership should make it possible for every commmnity's practicing physicians to share in the diagnostic, therapeutic and consultative resources of major -5- medical institutions. They should similarly be provided the op- portunity to participate in the academic enviornment of research, teaching and patient care which stimulates and supports medical practice of the highest quality. . Institutions with high quality research programs in heart disease, cancer, stroke, and related diseases are tod few, given the magni- tude of the prqblems, and are not uniformly distributed through- out the country. . There is a need to educate the public regarding health affairs. Education in many cases will permit people to extend their own lives by changing personal habits to prevent heart disease, cancer, stroke and related disease. Such education will enable individuals to recognize the need for diagnostic, therapeutic or rehabilitative services, and to know where to find these services, and it will motivate them to seek such services when needed. During the Congressional hearings on this bill, representatives of major groups and institutions with an interest in the American health - system were heard, particularly spokesmen for practicing physicians and community hospitals of the Nation. The Act which emerged turned away from the idea of a detailed Federal blueprint for action. Specifically, the network of "regional centers" recommended earlier by the President's Commission was replaced by a concept of "regional cooperative arrangements" among existing health resources. The Act established a system of grants to enable representatives of health resources to exercise initiative to identify and meet local needs within the area of the categorical diseases through a broadly defined process. Recognition of geographical and societal diversities within the United States was the main reason for this approach, and spokesmen for the Nation's health resources who testified during the hearings strengthened the case for local initiative. Thus the degree to which the various Regional Medical Programs meet the objectives of The Act will provide a measure of how well local health resources can take the initiative and work together to improve patient care for heart disease, cancer, stroke and related diseases at the local © level. The Act was intended to provide the means for conveying to the medical institutions and health professions of the Nation the latest advances in medical science for diagnosis, treatment, and rehabilitation of patients afflicted with heart disease, cancer, stroke, or related diseases--and to prevent these diseases. The grants authorized by The — Act are to encourage and assist in the establishment of regional coopera- tive arrangements among medical schools, research institutions, hospitals, and other medical institutions and agencies to achieve these ends by research, education, and demonstrations of patient care. Through these means, the programs authorized by The Act are also intended to improve generally the health manpower and facilities of the Nation. The Supplemental Appropriation Act of 1966 provided initial funding for the program, making available $24 million for grants and $1 million for the Division for fiscal year 1966. The Department of Health, Education, and Welfare Appropriation Act of 1967 provided $42 million for grants and $2 million for the Division for fiscal year 1967. Shortly after the Law was signed by President Johnson on October 6, 1965, the Division of Regional Medical Programs was established at the National Institutes of Health. To direct its activities, Dr. Robert Q. Marston accepted the invitation to leave his post as Dean of Medicine and Vice Chancellor of the University. of Mississippi and become Associate -7- Director of the National Institutes of Health. Prior to the arrival of | Dr. Marston, Dr. Stuart Sessoms, Deputy Director of the National Institutes of Health, was responsible for the development of plans and policies for the new program. The Division of Regional Medical Programs was established in February 1966. A listing of the chief staff of the Division in the spring of 1968 is Appendix 2 of this History. The National Advisory Council on Regional Medical Programs, established by the Law, was named from outstanding experts in heart disease, cancer and stroke and from the leaders in medical practice, “© hospital and health care administration and public affairs. The Council met with Dr. Marston for the first time in December 1965 to advise on plans and policies. In early February 1966, the Council met again to review and approve the first issue of the Program Guidelines. Quickly printed, this publication was given its initial distribution the follow- ing month. Members of the National Advisory Council as well as the members of the Review Committee who do thorough review of projects and make recommendations to the Council prior to Council consideration and action are listed in Appendix 3. During the spring of 1966, some 20 applications for planning _ grants were received and reviewed first by initial review groups selected from among the country's health leaders, and then by the National Advisory Council. By July 1, the first 10 planning grants were recommended for approval, and immediately awarded. Between July and December 1966, another 40 applications were reviewed. Many of these were returned for revision or additional information to conform with the requirements of The Act. Twenty-four of these were approved and funded -8- so that when 1966 ended, a total of 34 Regional Medical Programs had received awards for planning programs. These Regions represented areas that included some 60 percent of the population of the country. The first applications for operational grants had also been submitted by that date. In February 1967, the first four operational and 10 additional planning applications had been through the review process and were recommended for approval by the National Advisory Council. At the Council meeting in May, five additional planning applications were recommended for approval. In June, the first continuation grants were awarded to 10 Regions for the second year of planning. By the end of 1967, the total of Programs in the planning state had increased to 53 and included the entire country with the exception of Puerto Rico. Also, by that time four more operational grants had been made for a total of eight. By July 7, 1968 Puerto Rico had its planning grant bringing the total Regional Medical Programs to 54 of which 23 had become operational. In terms of dollars expended these activities represented some $75 million--$41 million in planning funds and $34 million to support operational activities. A chronology has been developed to show the time sequence in the development of the Programs. It is Appendix 4 of this History. In terms of people, Regional Advisory Groups are comprised of hospital administrators, public health officials, practicing physicians, officials and other members of the public. A pie chart was developed to show the overall distribution and numbers of these categorical Groups ¢ | voluntary health agency representatives, medical center and medical school -~9- in April 1968 and is included as Appendix 5. In July of 1968 the overall total of individuals on Regional Advisory Groups had risen to 2,034. Subcommittees of these Groups involved another 3,132 persons. On the staffs of the 54 Regional Medical Programs in July there was also a total of 1,539 full and part-time people involved in planning activities and another 908 involved in operational activities throughout the country. Appendix 6 lists the 54 Regions and the Program . Coordinator or Director of each. It also gives a visual representation of the approximate geographical locations of the Regions. Appendix 7 is a Directory of Regional Medical Programs compiled in April 1968 which gives more detailed information on each Regional Medical Program, ' including preliminary planning area, estimated population covered, coordinating headquarters, Program Coordinators and Directors, Chairmen of the Regional Advisory Groups, and amounts of planning and operational ’ grants and their effective starting dates. The 54 Regions encompassing the Nation's population had been formed. by organizing groups using functional as well as geographic criteria. These Regions now include combinations of entire states (e.g. the Washington- Alaska Region) , portions of several states (e.g. the Intermountain Region which includes Utah and sections of Colorado, Idaho, Montana, Nevada and Wyoming), single states (e.g. Georgia), and portions of states around a metropolitan center (e.g. the Rochester Region which includes that city and 11 surrounding counties). Within these Regional Programs, a wide variety of organization structures have been developed, including execu- tive and planning committees, categorical disease task forces, and commmity and other types of sub-regional advisory. committees. ~10- In accordance with The Act, Regions first received planning grants from the Division of Regional Medical Programs, and then a growing nunber were awarded operational grants to fund activities planned with initial and subsequent planning funds. These operational activities provide the direct means for Regional Medical Programs to accomplish their objectives. Planning not only moves a Region toward operational activity, but is a continuing means for assuring the relevancy and appropriateness of operational activity, It is the effects of the operational activities, however, which are beginning to produce results by which Regional Medical Programs are being judged. ' In July of 1966 there was a second printing of the Guidelines. These were up-dated in July of 1967, and revised again in May of 1968. Two Significant events during the first two years of the Program's ' existence were the National Conference held January 15-17 » 1967, and the Conference-Workshop of January 17-19, 1968. _, The first meeting had been called by the Division of Regional’ Medical Programs to obtain information from a representative group of knowledgeable individuals, which could be used in the preparation of the required Report on Regional Medical Programs to the Congress (PHS Publication No. 1690), and further to provide an interchange of infomma- tion on the planning of the Programs. Devoted principally to the problems of definition and elaboration of, the concepts of cooperative arrangements local initiative, and evaluation, that first meeting as reported in its Proceedings: Conference on Regional Medical Programs (PHS Publication No. 1682) did mich to characterize the Programs in their early stages. -ll- The January 1968 Conference-Workshop grew out of a specific request of the Program Coordinators at their meeting of June 1967. Planned by the Program Coordinators themselves, it was significant in content and purpose, and marked a milestone in the development of Regional Medical Programs. Its stated purpose was to provide those directly involved in developing Regional Medical Programs with the opportunity of exchanging ideas and | information which would be of benefit in the further implementation of the Programs at the regional level. The focus was on on-going activities in the Regions, particularly as they related to quality and availability of health care for heart disease, cancer, stroke, and related diseases. All Regions were invited to present papers on their activities and ideas; - to submit exhibits which reflected their activities, and to participate actively in panel discussions. The invitation resulted in the presentation of 60 representative papers and some 40 exhibits and virtually every invited speaker accepted the opportunity to discuss the major issues of the Conference- Workshop. All of this material was reproduced in the Proceedings: Conference- Workshop on Regional Medical Programs, (PHS Publication No. 1774). A key figure in the development of both meetings was Dr. Stanley W. Olson, former Dean of Baylor University Medical School. In 1967, as a consultant to the Division of Regional Medical Programs, he organized the Conference and acted as its chairman. In 1968, as Coordinator of the Tennessee Mid-South Regional Medical Program and Chairman of the Coordinators' Steering Conmittee, he worked closely with Dr. John A. Gronvall of the Mississippi Medical Center in developing the Conference-Workshop. It was this extensive experience with Regional Medical Programs that was a strong factor in his subsequent selection by the Secretary of Health, Education, and Welfare and President Johnson as ‘ -12- successor to Dr. Robert Q. Marston when Dr. Marston was named to head the new Health Services and Mental Health Administration created as part of the 1968 reorganization of the Department of Health, Education, and Welfare. The previously mentioned Report on Regional Medical Programs to the President and Congress was another landmark in the History of Regional Medical Programs. Required by Section 908 of Public Law 89-239 this publication was noteworthy as it records the accomplishments of the Program _ from its beginning until June of 1968 and it recommended the further develop- ment of the Program and extension of it beyond the June 30, 1968 limit set in The Act. In addition to its value together with both Conference Proceedings as a source of reference and history it served an important . legislative function. Prepared by the Surgeon General of the Public Health Service, it was submitted to the President through the Secretary of the Department of Health, Education and Welfare, and was transmitted by the President to the Congress on November 9, 1967. His letter transmitting the Report to the Congress was at once encouraging and exhortative when it said, in part : ''Because the law and the idea behind it are new, and the problem is so vast, the program is just emerging from the planning state. But this report gives encouraging evidence of progress -- and it promises great advances in speeding research knowledge to the patient's bedside." Thus in the final seven words of the President's message, the objective of Regional Medical Programs is clearly emphasized. As this History is being written, the legislation extending Regional Medical Programs is in conference between the House and the Senate. Infor- mation on the Programs, developed as part of.the testimony of the hearings, provided the Congress with a good understanding of the progress of the Programs both specifically and in selected areas. This information is -13- contained in Appendix 8. With a series of minor amendments developed to meet the needs of the growing Programs, it is expected that the legislation will be passed to permit the continued development of the Regional Medical Programs as part of the country's forward movement toward providing the highest possible quality of medical care to all of its citizens. -14- APPENDIX 1 PUBLIC LAW 89-239 -15- PUBLIC LAW 89-239 89TH CONGRESS, 8. 596 OCTOBER 6, 1965 AN ACT Heart Disease, Cancer, and Stroke Amend- ments of 1965 To amend the Public Health Service Act to assist in combating heart disease, cancer, stroke, and related diseases, Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That this Act may be cited as the “Heart Disease, CANCER, STROKE, AND RELATED Src. 2. The Public Health Service Act (42 U.8.C., ch. 6A) fs amended by adding at the end thereof the following new title: “TITLE IX—EDUCATION, RESEARCH, TRAINING, AND DEMONSTRATIONS IN THE FIELDS OF HEART DISEASE, CANCER, STROKE, AND RELATED DISEASES “Purposes “Src. 900. The purposes of this title are— “(a) Through grants, to encourage and assist in the establishment of regional co- operative arrangements among medical schools, research institutions, and hospitals for research and training (including con- tinuing education) and for related demon- strations of patient care in the fields of heart disease, cancer, stroke, and related diseases : “(b) To afford to the medical profession and the medical institutions of the Nation, through such cooperative arrangements, the opportunity of making available to their pa- tients the latest advances in the diagnosis and treatment of these diseases ; and “(c) By these means, to improve gen- erally the health manpower and facilities available to the Nation, and to accomplish these ends without interfering with the pat- terns, or the methods of financing, of pa- tient care or professional practice, or with y _the administration of hospitals, and in co- operation with practicing physicians, medi- cal center offictals, hospital administrators, aud representatives from appropriate volun- tary health agencies. “Authorisation of Appropriations “Sec. 901. (a) There are authorized to be appropriated $50,000,000 for the fiscal year ending June 20, 1966, $90,000,000 for the fiscal year ending June 30, 1967, and $200,000,000, for the fiscal year ending June 30, 1968, for grants to assist public or non- profit private universities, medical schools, research institutions, and other public or nonprofit private institutions and agencies in planning, In conducting feasibility studies, and in operating pilot projects for the estab- lishment of regional medical programs of research, training, and demonstration activ- itles for carrying out the purposes of this title. Sums appropriated under this section for any fiscal year shall remain available for making such grants until the end of the fiscal year following the fiscal year for which the appropriation is made. “(b) A grant under this title shall be for part or all of the cost of the planning or other activities with respect to which the application is made, except that any such grant with respect to construction of, or provision of built-in (as determined in ac- cordance with regulations) equipment for, any facility may not exceed 90 per centum of the cost of such construction or equipment. “(c) Funds appropriated pursuant to this title shall not ‘be available to pay the cost of hospital, medical, or other care of patients except to the extent it is, as determined in accordance with regulations, incident to those research, training, or demonstration activities which are encompassed by the purposes of this title. No patient shall be furnished hospital, medical, or other care at any facility Incident to research, training, or demonstration activities carried out with funds appropriated pursuant to this title, unless he has been referred to such facility by a practicing physlctan. “Definttions “Src, 902. For the purposes of this title— “(a) The term ‘regional medical program’ means a cooperative arrangement among a group of public or nonprofit private institu- tions or agencies engaged In research, train- ing, diagnosis, and treatment relating to heart disease, cancer, or stroke, and, at the option of the applicant, related disease or diseases; but only if such group— “(1) is situated within a geographic area, composed of any part or parts of any one or more States, which the Surgeon General determines, in accordance with regulations, to be appropriate for carry- ing out the purposes of this title; ; “(2) consists of one or more medical centers, one or more clinical research cen- ters, and one or more hospitals; and. “(8) bas in effect cooperative arrange- ments among its component units which the Surgeon General finds will be adequate for effectively carrying out the purposes of this title. “(b) The term ‘medical center’ means a medical school or other medical institution involved in postgraduate medical training and one or more hospitals affiliated there- with for teaching, research, and demon- stration purposes. “(c) The term ‘clinical research center’ means an institution (or part of an instito- tion) the primary function of which is re- search, training of specialists, and demon- atrations and which, in connection therewith, provides specialized, high-quality diagnostic and treatment services for inpatients and outpatients, “(d) The term ‘hospital’ means a hospi- tal as defined in section 625(¢) or other health facility in which local capability for diagnosis and treatment is supported and augmented by the program established un- der this title. “(e) The term ‘nonprofit’ as applied to any institution or agency means an institu- tion or agency which is owned and operated by one or more nonprofit corporations or associations no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual. “(f) The term ‘construction’ includes alteration, major repair (to the extent per- mitted by regulations), remodeling and renovation of existing buildings (including {noftial equipment thereof), and replacement of obsolete, built-in (as determined in ac- cordance with regulations) equipment of existing buildings. “Gronts for Planning “Sec. 903. (a) The Surgeon General, upon the recommendation of the National Ad- visory Council on Regional Medical Pro- grams established by section 905 (hereafter in this title referred to as the ‘Couneil’), is authorized to make grants to public or noa- profit private universities, medical schools, research institutions, and other public or nonprofit private agencies and institutions to assist them in planning the developmeat of regional medica] programs. “(b) Grants under this section may be made only upon application therefor ap- proved by the Surgeon General. Any such application may be approved only if it com tains or is supported by— - “(1) reasonable aseurances that Fed eral funds paid pursuant to any such grant will be used only for the purposes for which paid and in accordance with the applicable provisions of this title and the regulations thereunder; : “(2) reasonable assurances that the applicant will provide for such fecal cou- trol and fund accounting procedures as are required by the Surgeon General to assure proper disbursement of and sac counting for such Federal funds; “(3) reasonable assurances that the ap- plicant will make such reports, in suck form and containing such information as the Surgeon General may from time te time reasonably require, and will keep such records and afford such access thereto as the Surgeon General may find neces sary to assure the correctness and verifi- cation of such reports; and (4) a satisfactory showing that the applicant has designated an advisory group, to advise the applicant (and the institutions and agencies participating in the resulting regional medical program) in formulating and carrying out the pian for the establishment and operation of such regional medical program, which advisory group includes practicing physl- cians, medical center officials, hospital ad- ministrators, representatives from appro- priate medical societies, voluatary health agencies, and representatives of other organizations, institutions, and agencies concerned with activities of the kind to be carried on under the program and members of the public familar with the Ae pasar be emits sett lL ee et ana nett AT TR on a rte ee ee) t ‘oO 7 need for the services provided under the. program. “Granta for Establishment end Operation of Regional Medical Programa “Sec, 904. (a) The Surgeon General, upon the recommendation of the Councll, is authorized to make grants to public or nonprofit private universities, medical schools, research institutions, and other public or nonprofit private agencies and institutions to assist in establishment and operation of regional medical programs, including construction and equipment of facilities in connection therewith. “(b) Grants under this section may be made only upon application therefor ap- proved by the Surgeon General. Any such application may be approved only if it is ree- ommended by the advisory group described in section 903(b) (4) and contains or is sup- ported by reasonable assurances that— “(1) Federal funds paid pursuant to any such grant (A) will be used only for the purposes for which paid and in ac- cordance with the applicable provisions of this title and the regulations thereunder, and (B) will not supplant funds that are otherwise available for establishments or operation of the regional medical program with respect to which the grant is made; “(2) the applicant will provide for such fiscal control and fund accounting proce- dures as are required by the Surgeon General to assure proper disbursement of and accounting for such Federal funds; Records. (3) the applicant will make such re- ports, in such form and containing such information as the Surgeon General may from time to time reasonably require, and will keep such records and afford such access thereto as the Surgeon General may find necessary to assure the cor- rectness and verification of such reports ; and “(4) any laborer or mechanic employed by any contractor or subcontractor in the performance of work on any construction aided by payments pursuant to any grant under this section will be paid wages at rates not less than those prevailing on similar construction in the locality as determined by the Secretary of Labor in accordance with the Davis Bacon Act, as amended (40 U.S.C. 276a—276a—5) ; and the Secretary of Labor shall have, with respect to the labor standards specified in this paragraph, the authority and func- tions set forth in Reorganization Plan Numbered 14 of 1950 (15 F.R. 3176; & U.S.C. 1332-15) and section 2 of the Act of June 18, 1984, as amended (40 U.S.C. 276c). “Netional Advisory Council on Regional Medical Programe Appointment of members, “Sec. 905. (a) The Surgeon General, with the approval of the Secretary, may appoint, without regard to the civil service lawa, a National Advisory Council on Regional Medi- cal Programs. The Council shall consist of the Surgeon General, who shall be the chair- man, and twelve members, not otherwise in the regular full-time employ of the United States, who are leaders in the fields of the fundamental sciences, the medical sciences, or public affairs. At least two of the ap- pointed members shall be practicing physi- cians, one shall be outstanding in the study, diagnosis, or treatment of heart disease, one shall be outstanding in the study, diagnosis, or treatment of cancer, and one shall be out- standing in the study, diagnosis, or treat- ment of stroke. Term of office. “(b) Each appointed member of the Coun- cil shall hold office for a term of four years, except that any member appointed to fill a vacancy prior to the expiration of the term for which his predecessor was appointed shall be appointed for the remainder of such term, and except that the terms cf office of the members first taking office shall expire, as designated by the Surgeon General at the time of appointment, four at the end of the first year, four at the end of the second year, and four at the end of the third year after the date of appointment. An appointed mem- ber shall not be eligible to serve continuously for more than two terms, Compensation. “(c) Appointed members of the Council, while attending meetings or conferences thereof or otherwise serving on business of the Council, shall be entitled to receive com- pensation at rates fixed by the Secretary, but not exceeding $100 per day, including traveltime, and while so serving away from their homes or regular places of business they may be allowed travel expenses, including per diem in lieu of subsistence, as authorized by section 5 of the Administrative Expenses Act of 1946 (5 U.S.C. 73b-2) for persons fn the Government service employed intermit- tently. Applications for grants, recom- mendations, (a) The Council shall advise and assist the Surgeon General in the preparation of regulations for, and as to policy matters arising with respect to, the administration of this title. The Council shall consider all applications for grants under this title and shall make recommendations to the Surgeon General with respect to approval of applica- tions for and the amounts of grants under this title. “Regulations “Src. 906. The Surgeon General, after consultation with the Council, shall pre- scribe general regulations covering the terms and conditions for approving applications for grants under this title and the coordina- tion of programs assisted under this title with programs for training, research, and demonstrations relating to the same diseases assisted or authorized under other titles of this Act or other Acts of Congress, “Information on Special Treatment and Training Oenters “Src. 907. The Surgeon General shall establish, and maintain on a current basis, a list or lists of facilities In the United States equipped and staffed to provide the most advanced methods and techniques in the diagnosis and treatment of heart disease, cancer, or stroke, together with such related information, including the availability of advanced specialty training in such facilities, as he deems useful, and shall make such list or Msts and related information readily available to licensed practitioners and other persons requiring such Information. To the end of making such list or lists and other information most useful, the Surgeon Gen- eral shail from time to time consult with interested national professional organiza tlona, . Report to President and Oongrese “Sec. 908. On or before June 30, 1967, the Surgeon General after consultation with the Council, shall submit to the Secretary for transmission to the President and thea to the Congress, a report of the activities under this title together with (1) a state ment of the relationship between Federal financing and financing from other sources of the activities undertaken pursuant to this title, (2) an appraisal of the activities as- sisted under this title in the light of their effectiveness in carrying out the purposes of this title, and (3) recommendations with respect to extension or modification ef this title in the light thereof. “Records end Audit “Sec. 909. (a) Each recipient of a grant under this title shall keep such records as the Surgeon General may prescribe, includ- ing records which fully disclose the amount and disposition by such recipient of the proceeds of such grant, to total cost of the project or undertaking in coanection with which such grant is made or used, and the amount of that portion of the cost of the project or undertaking supplied by other sources, and such records as will facilitate an effective audit. “‘(b) The Secretary of Health, Education, and Welfare and the Comptroller General of the United States, or any of their duly authorized representatives, shall have access for the purpose of audit and examination to any books, documenta, papers, and records of the recipient of any grant under this title which are pertinent to any suck grant.” Sec. 3. (a) Section 1 of the Public Health Service Act is amended to read as follows: “SEcTION 1. Titles I to EX, inclusive, of this Act may be cited as the ‘Public Health Service Act’.” (b) The Act of July 1, 1044 (58 Stat. 682), as amended, is further amended by re- numbering title IX (as in effect prior to the enactment of this Act) as title X, and by renumbering sections 901 through 914 (as in effect prior to the enactment of this Act), and references thereto, as sections 1001 . through 1014, respectively. APPROVED OCTOBER 6, 1965, 10:15 A.M. Legislative History: House Report No, 968 accompanying H.R. 3140 (Comm. on Interstate and Foreign Commerce). Senate Report No. 868 (Comm. on Labor and Public Welfare). Congressional Record, Vol. 111 (1965): June 25: Considered in Senate. June 28: Considered and passed Senate. Sept. 23: H.R, 3140 considered tn House. Bept. 24: Conaldered and passed House, amended, in lieu of H.R. 3140. Sept. 29: Senate concurred in How amendments. ‘ aha en -17- -18- APPENDIX 2 DIRECTORY OF THE DIVISION OF REGIONAL MEDICAL PROGRAMS ahi E Blermemee o emeeew Sa SemNet eee te t \ | i. pea ct apy py sueuey | suo2g suorroudg snewsgy’ : “20s1APY WEOH SGN qezees “gq osef ‘yhpeuy weaSo1g °° °°’ puensoy UEA “4S UEUMAT ‘qUeIsy MUEID WBNwp_ As2Ue17.0 “A PeseH | “wshrewy wreBorg af ‘zyu00y “J D0poaqy, ssOsIApy eo oNgNg “co Preuoq—*py ‘Wepmeg | ij shpeuy wesBoag “608 peseeeeees SHUTY FEWOUL ‘JosIApY YIyeoH ayqng souof q woqoy | ‘prgp occ uosiaeg “] puppy ‘sOsIADY yyeayy onqng wwe mec nane seen nddapp ‘Vv HRI i younig 1 SMonsIIy aanany STueLD ‘uonenfeag pue Suruueyg soy sopong awpomwy uewnspy “f vaqdag i PEO amd “T W OILVNIVAT GNV ONINNVTd WOdI WOLOAAIAG ALVIDOSSV JO AAO ‘ysupig mnaiy Ssqubsy) , N - ‘ysipersodg quawioBeueyy uRI) Cos xOJ ‘Wh preuog | ‘sompg ccs wang ‘q vou “ynerpedg yuowaSeueyy mrueasy coor Aum) anquy “wwyepedg uoneusoyuy onqng pep ‘dq Dry “s201yQ JuowaSeuey que coo 2pqUTET “gy 982005 “mpeedg uoneuuoyuy oyqng oo syne “f pipet ‘DIWO quouaSeuep] gueay coo S329], “I pre2y ; “IYO UONEULOUT ByqNg “oc Ill Prey yes ‘OO woursBeuepy ues coe BINPW ‘f sewoqy, \ ‘UONEUIIOJUT OQhY pure a “pay Bae eem ee een ese e esas ameog souef suopeorunuruto;) Jo} 3079 03 quepiesy eos eeeeees sapere “W preapy . 3. syoupag junuaTounyy Syepegy suorpuuofay 2 1qng pun suororununuer fo sf an ‘poYO FuoneRndg ~"""7 ett: ppoypensg ssvoydry ssonandng morag YQ goeusogoyw “f Ley ‘TOYO suoperdgQ “-"""""* a'W ‘ue ag. ‘W904 ‘queyusy sAneQRUTUpy soysnyy fy ouTew07 “BIYO suoneiadg tee ee aw ‘TIE ‘uo TUE "u ugof : ‘yshpeuy y3png a JOSPUT AA "A wauy "321YO suoneIdg = C'W ‘oyorep “Pywsoury | | ‘DIO Puuosmg “TT af ‘sourag “gq URUTIO “I291YO suonedG rrr uosppuy ‘) WIqOY ' : “DIO oanegsupupy “oc aaeng) “| woqoy ‘BIO suonepdoO weer mee ne rene r esr eee woody a eay “23291 quawoSeuryy Jepueuty . Ty007eAE_ **y sepa ' , fag sunsourdg | “DOO BANMOog TOMA EY HED *suore19dQ 303 3039021q BIEIDOBSW 7 GW ‘uosusydaag *g preqory | wn sarmoy fo 20 . : “soDoM kxeyamog cirri Dima ‘a yeaenya SNOILVaadO AOI UOLOAUIA ALVIOOSSV AO FOLIO ' ‘220 yuowoSeueny sonranoy cee ecegeceseeers on "Wl wag “yrpersodg oro, d ures802g pee e cece tee reoes wewrpjoy “5 hox¥] “yoeysissy eamsmMEg “oot Teywussoy "WY oppef “eye WaTeo}y 30} OOM OV yWEMSY “OTT Yosopo “q sounEyy ‘shfeuy yyeoy oqng Te PWIUHY Yer] UOMEV] [CUOHEZIULZIO 4J0J JOPING WeDosy ** CTW ‘UROg "Py wee ‘ysAjeuy wppeoH omqng occ uOs IPH ‘C w2307T ssopang Aindag ‘oft c tte ttt {px ‘Gd BEY ‘ysdreuy wypeay oyqng ‘ccc woqs1ay *A Arey soon *7tt Cry ‘woureyy ‘B 19908 symunig siskyouy puo smsseig s9nQo sroxpoucmy ea bed meaene veeteteceneteees sie -y Aye YOLIUIG FHL JO FOAO “whpeuy wei80ig eee ae ave rosso nae asnoug sf emey *yshpeuy wres801g Pome er rcrrrsrvrases [neg a) ouuezng ‘whyjeuy wesBorg “oo af Her ‘g snyy SWVeDOUd TVOICAN “ysATeuy ures801g re ee ee suviqy epony IVNOIODGY jo NOISIAIG ‘ymupig: uowonjoag 10 AYOLOATIG OFFICE OF ASSOCIATE DIRECTOR FOR PROGRAM DEVELOPMENT AND RESEARCH Richard F. Manegold, M.D....... Continuing Education and Training Branch: Alexander M. Schmidt, M.D Phyllis E. Carnes, Ph. D Veronica L. Conley, Ph. D........ Cecilia C. Conrath David W. Galde, M.D........ tee Frank L. Husted, Ph. D Elsa J.“Nelson : Herbert O. Mathewson, M.D..... Marjorie L. Morrill........ veces Rebecca R. Sadin Sarah J. Silsbee. ........... eee Jack J. Schneidef, M.D.......... John C. Tapp, M.D....... 046. eee Charlotte F. Turner......... saves Regional Health Services Branch: Philip A. Klieger, M.D et eoes eee nae nes wear eseone Pe ee samme eee reoneee eoeee beoseee . Associate Director for Program Development and Research. Chief. Education Specialist. Education Specialist. Assistant to Chief. Training Consultant. Head, Education Research Group. Health Services Officer. Training Consultant. ‘ Public Health Advisor. Public Health Advisor. Public Health Advisor. Training Consultant. Training Consultant. Education and Training Specialist. Head, Clinical Programs Section. ee ee te ee et ne ee ee a erecta eee i RR AAS LSS APPENDIX 3 LISTING OF NATIONAL ADVISORY COUNCIL AND REVIEW COMMITTEE E. L. CROSBY, M.D. J. R. HOGNESS, M.D. Director Dean, School of Med. Amcrican Hosp. Assoc. U. of Washington Chicago, Ill. Seattle, Wash. | M. E. DEBAKEY, M.D. J. T. HOWELL, M.D. Prof. and Chairman Executive Director ~ Dept. of Surgery Henry Ford Hosp. Baylor U. Detroit, Mich. Houston, Tex. C. H. MILLIKAN, M.D. H. G. EDMONDS, Ph.D Consultant in Neurology Dean, Graduate Sch. Mayo Clinic No. re College Rochester, Minn. urham, N.C. G. E. MOORE, M.D. B. W. EVERIST, JR., M.D. Director, Roswell Park Chief of Pediatrics Memorial Institute Green Clinic Buffalo, N.Y. Ruston, La, REVIEW COMMITTEE G. JAMES, M.D. P. M. MORSE, Ph.D. (Chairman) Director, Operations Dean, Mount Sinai Research Ctr. School of Med. Mass. Inst. of Tech. New York, N.Y. Cambridge, Mass. H. W. KENNEY, M.D. A. PASCASIO, Ph.D. Medical Director Assoc. Research Prof. John A. Andrew Memorial Nursing School, U. of osp, Pittsburgh Tuskegee Institute Pittsburgh, Pa. Tuskegee, Ala, S. H. PROGER, M.D. E. J. KOWALEWSKI, M.D. Prof. and Chairman ' Chairman, Dept. of Med. and ; Committee of Environ. Med. Physician-in-Chief — Acad. of Gen. Practice Tufts N.E. Med. Ctr. Akron, Pa. Pres., Bingham Assoc. Fund Boston, Mass, G. E. MILLER, M.D. , ‘ Director, Off. of Research in Med. Educ. . . Coll. of Med., U. of TIL Chicago, IIL. NATIONAL ADVISORY COUNCIL E. D. PELLEGRINO, M.D. Director of the Med. Ctr. State U. of New York Stony Brook, N.Y. A. M. POPMA, M.D. Regional Director Mountain States Regional Medical Program Boise, Idaho < M. I. SHANHOLTZ, M.D. State Hlth. Comm. State Dept. of Hith. Richmond, Va. W. H. STEWART, M.D. (Chairman) Surgeon General Public Health Service D. E. ROGERS, M.D. Prof. and Chairman Dept. of Med. School of Med. Vanderbilt U. Nashville, Tenn. C. H. W. RUHE, M.D. Assistant Secreta Council on Med. Ed. American Med. Assoc. Chicago, IIL. R. J. SLATER, M.D. Executive Director The Assoc. for the Aid of Crippled Children New York, N.Y. - J. D. THOMPSON Prof. of Public Hlth. Yale U. Med. School New Haven, Conn. April 1968 -23- APPENDIX 4 CHRONOLOGY OF REGIONAL MEDICAL PROGRAMS EVENTS 1964 DECEMBER @f Report of the President's Commission on Heart Disease, Cancer, and Stroke 1965 FEBRUARY TO JULY Congressional hearings OCTOBER Enactment of P.L. 89-239 DECEMBER § National Advisory Council meeting § Initial policies and Guidelines reviewed 1966 FEBRUARY.§ Establishment of Division Publication of preliminary Guidelines | National Advisory Council meeting APRIL Review Committee meeting National Advisory Council meeting . JUNE Review Committee meeting National Advisory Council meeting JULY’ Publication of Guidelines Review Committee meeting AUGUST National Advisory Council meeting SEPTEMBER § First of 5 meetings of Ad Hoc Committee for Report to the President and Congress OCTOBER Review Committee meeting NOVEMBER § National Advisory Council meeting 1967 JANUARY f Review Committee meeting National Conference FEBRUARY § National Advisory Council meeting APRIL MAY JUNE JULY AUGUST OCTOBER NOVEMBER §@ National Advisory Council meeting Review Committee meeting National Advisory Council meeting Report to the President & Congress Review Committee meeting National Advisory Council meeting Review Committee meeting Policy for review proc- ess and Division activities set 7 planning grants awarded 3 planning grants awarded 8 planning grants awarde Report material discussed 16 planning grants awarded National views & information for Report provided 10 planning and 4 opera- tional grants awarded 5 planning and 1 opera- tional grant awarded 2 planning grants awarded 2 planning and 3 opera- tional grants awarded 1968 JANUARY Conference Workshop Review Committee meeting FEBRUARY National Advisory Council meeting Regional activities and ideas presented 5 operational grants awarded —w APPENDIX 5 REGIONAL MEDICAL PROGRAMS REGIONAL ADVISORY GROUPS , ' REGIONAL ADVISORY © ; GROUPS The activities of Regional Medical Programs are directed by fulltime Co- ; ordinators working together with Regional Advisory Groups which are broadly representative of the medical and health resources of the Regions. Membership on these groups nationally is: —w Hospital Administrators Practicing Public Health Physicians Officials Other Health Workers . Voluntary Health Agencies Medical Center- School Officials Total: 1929 Members . - of the Public APPENDIX 6 MAP OF REGIONAL MEDICAL PROGRAMS AND LISTING OF PROGRAM COORDINATORS ot — AW + fae : i oe i , : ca me ee ie ean ie enemies camera: for tmane nai Ro Ae SO * -29- REGIONS AND PROGRAM COORDINATORS OR DIRECTORS 1 ALABAMA B. B. Wells, M.D. U. of Ala. Med. Ctr. 1919 7th Ave. S. Birmingham, Ala. 35233 2 ALBANY, N.Y. F. M. Woolsey, Jr.. M.D. Assoc. Dean Albany Meds Coll. 47 New Scotland Ave. Albany, N.Y. 12208 3 ARIZONA D. W. Melick, M.D., Coll. of Med. U. of Arizona Tucson, Ariz. 85721 4 ARKANSAS W. K. Shorey, M.D. Dean, Sch. of Med. U. of Arkansas 4301 W. Markham St. Little Rock, Ark. 72201: 5 BI-STATE W. H. Danforth, M.D. V. Chan. for Med. Affairs Washington U. 660 S, Euclid Ave. St. Louis, Mo. 63110 6 CALIFORNIA Paul D. Ward 655 Sutter St. #302 San Francisco, Calif. 94102 7 CENTRAL NEW YORK R. H. Lyons, M.D. State U. of N.Y. 750 E. Adams St. Syracuse, N.Y. 13210 8 COLORADO- WYOMING P. R. Hildebrand, M.D. U. of Col. Med. Ctr. 4200 E. 9th Ave. Denver, Col. 80220 9 CONNECTICUT H. T. Clark, Jr., M.D. 272 George St. New Haven, Conn. 06510 10 FLORIDA S. P. Martin, M.D. Provost, J. Hillis Miller Med. Ctr. U. of Florida Gainesville, Fla. 32601 11 GEORGIA J. G. Barrow, M.D. Med. Assoc. of Ga. 938 Peachtree St. N.E. Atlanta, Ga. 30309 12 GREATER DELAWARE VALLEY W. C. Spring, Jr., M.D. Wynnewood House 300 E. Lancaster Ave. Wynnewood, Pa. 19096 13° HAWATI W. C. Cutting, M.D. Dean, Sch. of Med. U. of Hawaii 2538 The Mall Honolulu, Ha. 96822 14 ILLINOIS Wright Adams, M.D. 112 S. Michigan Ave. Chicago, Ill. 60603 15 INDIANA R. B. Stonehill, M.D. Indiana U. Sch. of Med. 1100 W. Michigan Street Indianapolis, Ind. 46207 16 INTERMOUNTAIN C. H. Castle, M.D. Assoc. Dean U. of Utah Salt Lake City, Ut. 84112 17 IOWA W. A. Krehl, M.D., Ph.D. 308 Melrose Ave. U. of Iowa Towa City, Ia. 52240 18 KANSAS C. E, Lewis, M.D. Chairman Dept. of Preventive Med. U. of Kansas ‘ Kansas City, Kan. 66108 oy 19 LOUISIANA j. A. Sabatier, M.D. Claiborne Towers Roof - 119 S. Claiborne Ave. New Orleans, La. 70112 20 MAINE M. Chatterjee, M.D. 295 Water St. Augusta, Me. 04332 21 MARYLAND W. S. Spicer, Jr., M.D. 550 N. Broadway Baltimore, Md. 21205 22 MEMPHIS MEDICAL REGION J. W. Culbertson, M.D. Coll. of Med. U. of Tennessee 858 Madison Ave. Memphis, Tenn. 38103 23 METROPOLITAN WASHINGTON, D.C, T. W. Mattingly, M.D. D.C, Medical Society 2007 Eye St. N.W. Washington, D.C. 20006 24 MICHIGAN A. E. Heustis, M.D. 1111 Michigan Ave. East Lansing, Mich. 48823 25 MISSISSIPPI G. D. Campbell, M.D. - U. of Miss. Med. Ctr. 2500 N. State Ct. Jackson, Miss. 39216 26 MISSOURI V. E. Wilson, M.D. Executive Director for Health Affairs U. of Missouri Columbia, Mo. 65201 27 MOUNTAIN STATES K. P. Bunnell, Ed.D. Assoc. Director Western Interstate Comm. for Higher Ed. Uniy. E. Campus Boulder, Col. 80302 ae sersmee Peeps -30- 28 NEBRASKA- SOUTH DAKOTA H. Morgan, M.D. 1408 Sharp Bldg. Lincoln, Neb. 68508 29 NEW JERSEY A. A. Florin, M.D. N. J. State Dept. of Hith. 88 Ross St. E. Orange, N.J. 07018 30 > NEW MEXICO I. E. Hendryson, M.D. U. of New Mexico 900 Stanford Dr. N.E. Albuquerque, New Mex. 31 -NEW YORK -= METR. AREA V. deP. Larkin, M.D. N.Y. Academy of Med. 2 E. 103d St. New York, N.Y. 10029 32 NORTH CAROLINA M. J. Musser, M.D. Teer House 4019 N. Roxboro Rd. Durham, N. C. 27704 33. NORTH DAKOTA T. H. Harwood, M.D. Dean, Sch. of Med. U. of North Dakota . Grand Forks, N.D. 58201 34 NORTHEASTERN OHIO F. C. Robbins, M.D. Dean, Sch. of Med. Western Reserve U. 2107 Adelbert Rd. Cleveland, Ohio 44106 37 NORTHWESTERN, OHIO C. R. Tittle, Jr.. M.D. 2313 Madison Avenue Toledo, Ohio 43624 38 OHIO STATE R. L. Meiling, M.D. Dean, Coll. of Med. Ohio State U. ; 410 W. 10th Ave. Columbus, Ohio 43210 39 OHIO VALLEY W. H. McBeath, M.D. 1718 Alexandria Dr. Lexington, Ky. 40504 40 OKLAHOMA K. M. West; M.D. U. of Ok. Med. Ctr. 800 N.E. 13th St. Oklahoma City, Ok. 73104: 41 OREGON M. R. Grover, M.D. Director, Cont. Med. Ed. Sch. of Med. U. of Oregon 3181 S.W. Sam Jackson Portland, Ore. 97201 42 PUERTO RICO A. Nigaglioni, M.D. Chancellor, Sch. of Med. U, of Puerto Rico San Juan, P.R. 00905 43 ROCHESTER, N.Y. R. C, Parker, Jr., M.D. Sch. of Med. and Dent. U. of Rochester Rochester, N.Y. 14620 46 TENNESSEE MID-SOUTH S. W. Olson, M.D. 110 Baker Bldg. 110 21st Ave. § Nashville, Tenn. 37203 47 TEXAS *S. G. Thompson, M.D. Suite 724 Sealy-Smith Prof. Bldg. Galveston, Tex. 77550 48 TRI-STATE N. Stearns, M.D. 22 The Fenway Boston, Mass. 02115 49 VIRGINIA E. R. Perez, M.D. Richmond Acad. of Med. 1200 E. Clay St. Richmond, Va. 23219 50 WASHINGTON. ALASKA D. R. Sparkman, M.D. Sch. of Med. U. of Washington Seattle, Wash. 98105 51 WEST VIRGINIA C. L. Wilbar, Jr., M.D. W. Va. Univ. Med. Ctr. Morgantown, W. Va. 26506 52 WESTERN NEW YORK J. R. F. Ingall, M.D. Sch. of Med. State U. of N.Y. at Buffalo Buffalo, N.Y. 14214 , 44 SOUTH CAROLINA 53 WESTERN 35 NORTHERN C. P. Summerall, II, MD PENNSYLVANIA NEW ENGLAND zaues - Dept. of Med. F. S. Cheever, M.D. J. E. Wennberg, M.D. Med. Coll. Hospital Dean, Sch. of Med. U. of Vt. Coll. of Med. 55 Doughty St. U. of Pittsburgh 25 Colchester Ave. Charleston, S.C. 29403 3530 Forbes Ave. Burlington, Vt. 05401 Pittsburgh, Pa. 15213 45 SUSQUEHANNA 36 NORTHLANDS VALLEY 54 WISCONSIN . R. B. McKenzie J. S. Hirschboeck, M.D. W. R. Miller, M.D. 3806 Market St. Wisconsin RMP, Inc. 375 Jackson St. P.O. Box,541 110 E. Wisconsin Ave. St. Paul, Minn. 55101 Camp Hii, Pa. 17011 Milwaukee, Wisc. 53202 . mo de Bo. . aa ‘ "Associate Coordinator Ri ¢ Fe a eee ee atte atleast entatiaitndtie APPENDIX 7 DIRECTORY OF REGIONAL MEDICAL PROGRAMS DIRECTORY OF REGIONAL MEDICAL PROGRAMS The Directory lists Regional Medical Programs for which planning or opera- tional grants have been awarded or which are in earlier stages of development. Regions were defined for planning pur- poses in the planning applications. State designations do not necessarily indicate that the regions are coterminous with State boundaries. The original definitions of the regions may be modified on the basis of experience. Awarded as of April 26, 1968. INDEX Region page ALABAMA (see also Tennessee Mid-- Sout ALASK. ALBAN BI- CALIFORNIA CENTRAL NEW YORK........ COLORADO-WYOMING oo eeee CONNECTICUT... 00... escapee ese ren eees DELAWARE VALLEY, see Greater Dela- ware Valley. HAWATL. 0.0... eee ee IDAHO, States. ILLINO!S (see also Bi-State, _ INDIANA (see also Ohio Valley)........++ Re HA daided NTAIN KANSAS : KENTUCKY, see Memphis; Ohio Valley; ’ Tennessee Mid-South. LOUISIANA MAINE = > a < Cc > 2 o = > a g Zo ar c ua m “| a In 5° 3 Oo c ~4 > 2 = > n z z Q ~4 ° 2 9 Qo CHIGAN 0... cease neces eee rane enaee NNESOTA, see . SSISSIPPI (see also Momph SSOURI (see also Bi-State; INT ANA, see Intermountain; Z2Z2R SRSSSZE Ono wok ee Region 1 NEW JERSEY (see also Greater Delaware ve Vall NEW one AO _ NEW YORK, see Albany; Central New York: New York Metropolitan Area; : — Rochester; Western New York. - NEW YORK’ METROPOLITAN AREA..... sa NORTH CAROLINA....... 2c eeeerer cones y NORTH DAKOTA......... - §/ , NORTHEASTERN OHIO £ NORTHERN NEW ENG x NOR NDS.......... ¥/ ‘ NORTHWESTERN OHIO. >) OHIO STATE (see also lortheastermn Ohio; Northwestern Ohio; Ohio Vatiey).. 42 OHIO VALLEY.........cceer cree cceneeunere Bnten ene eeeeeeee REGON ' PENNSYLVANIA, see Greater Delaware Valley; Susquehanna Valley; Western Pennsylvania. 2 x 3 9 m G bo zo o a 3 of = a 2 - = a HESTER, .......0--0 SOUTH CAROLINA SOUTH DAKOTA, see Nebra Dakota. SUSQUEHANNA VALLEY..............-- Y.. ‘ TENT ESSEE MID-SOUTH (see also Mem- ESD ccc rcsveccceavcvcccesersnes teveese TEXA TRI-STATE ‘ UTAH, see Intermountain. VERMONT, see Northern New England. 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Currently funded with $755,605, the region has approximately 43 operational staff members, including approxiniately 14 physicians, 17 nurses, 5 other allied health personnel, and 6 general support personnel. Over two-thirds of the staff are from the community hospitals, and they are working closely with the local medical center and RMP staff to increase the capabilities for quality care at the local hospitals. Approximately 60 hospitals from the Albany Region are participating in the program. Approximately 30 of these hospitals arc directly participating {n the operational projects outlined below. Two hospitals are represented on the Ad- visory Committee, and the remaining are involved tn on-going planning activities. ° Operational Projects I. Tio-way radio communication system, direct cost—$144,100 This project will expand an existing two-way radio network to include 57 hospitals and 24 high schools. It will provide continuing education for physicians e and allied medical personnel. It will algo provide information and education pro- grams for administrators, members of boards of trustees, volantary health agen- cies, adult education classes, and selected civic groups. 2. Community tnformation coordinators, direct cost—$78,800 Former pharmaceutical representatives will be used to contact local physi- cians to tell them about Regional Medical Programs and to evaluate their atti- tudes towards RMP. 3. Postgraduate Instruction Development Panel, direct cost—$102,600 This program proposes to have experimental and control groups of doctors to : determine their educational needs. These doctors will then participate in in- ' structional programs. Afterwards they will be tested to determine the effective- . ness of the instruction. t t. . 4. Community hospital learning centers, dtrect cost—$75,800 This project will establish learning centers at community hospitals using “Self , | Instruction Units” and audio-visual equipment for rapid dissemination of new medical knowledge. Eventually, the directors of this project hope ¢o evaluate physician progress. Initially, 8 hospitals will be involved. 5. Albany Medical Center coronary carc training and demonstration programa, : direct cost—$125,200 . A coronary care unit will be established at Albany Medical College to serve ' as a model and training unit for training physicians and nurses who will then be able to establish similar units at community hospitals. This project will aug- ment the existing Coronary Intensive Care Unit at the Albany Medical Center. 6A and 6B. Community hospital coronary care training and demonstration pro- gram, direct cost-——$55,400 This will complement project #5 by establishing coronary care units of three beds each at three community hospitals: Pittsfield General, St. Lukes, and Vassar Brothers. These will xerve as demonstration and educational projects for other hospitals in the region. A continuing educational program will serve the perma- nent Unit Staff and staffs from smaller hospitals. 7. Training and demonstration project, intensive cardiac care unit Herkimer . Memorial Hoapttat, direct cost-—$3,500 ‘ The initial phase of thix project ix to train 6 or 8 nurses from small community hoxpitals in cardiac anatomy and physiology, coronary disease, the principals and staffing of a cardiac intensive care unit, and in handling the complex equipment. Theve nurses will also be sent to Albany Medical Center for active training with specialized equipment. . ot . , -49- INTERMOUNTAIN REGIONAL MEDICAL PROGRAM The Intermountain Regional Medical Program received its first operational grant award on April 1, 1967 and its current operational award totals $1,832,800. Approximately 80 staff members are serving in the operational projects, about one-third of whom are from community hospitals working together with the Re- gional Medical Program staff from the medical center, they are bringing to local health practitioners and hospitals throughout the region modern techniques for treating patients with the categorical diseases. ‘ Approximately thirty hospitals are currently participating in the Program. Three hospitals are represented on the Regional Advisory Group, and almost every major hospital in the region has established a local planning group to study local needs and to serve as liaison with the Central IRMP staff. Seventeen hospitals are participating in the operational projects outlined below, and as the program continues to grow, it is anticipated that additional hospitals will become involved. Operational Projects I. Regional faculty and core-staff seminar, direct cost—$12,600 The University of Utah Medical School will hold a series of quarterly seminars on comprehensive health care, continuing education, contemporary learning the- ory, behavioral sctence principles, and measurement technology. The faculty, ex- perts from across the country, will address an audience of health professionals in- votved in IRMP. 2, Network for continuing education in heart disease, cancer, stroke, and related discases, direct cost-——$248,000 The objectives of this program are to develop a communications network be- tween patient-care and research institutions to encourage Haison between health enre personnel in the area. The currently existing 2-way radio system, including 11 hospitals in 7 communities in or near Salt Lake City, will be extended to re- mote hospitals to serve as one link. Closed circuit TV and use of KVED (Uni- versity of Utah education TV) is also planned, Thix may establish the community hospital as the locus of continuing education. 3. Information and communications cechange servicc, direct cost—$40,000 The CIES is a region-wide clearing house for information about IRMP. Staff will be put in local communities to act as public relations representatives and also to distribute information to medical personnel and the public. The community staff will also gather information on community needs and resources and re- sources and serve as a station for collecting economic, social, and medical data. 4. Cardiopulmonary resuscitation training program, direct cost—$638,400 The University of Utah will give a 3-day course in resuscitative techniques to selected physicians from small communities. Fach physician will then be responai- ble for teaching the techniques to health personnel in his community. This “resuscitation consultant” will also collect data about the number of times resuscitation is employed and the results. 5. A training program tn intensive cardiac carc. dircct cost—$118,600 A core faculty of experts in using Cardiac Care Units and diagnosing and treat- ing heart disease will teach short courses in their subjects. The students will be interested physicians and nurses from community hospitals building coronary care units. 6. Training for nursce in cardiac carc and cardiopulmonary resuacitation, dircct cost—$3 4,000 This is an integral part of both the cardiac care and cardiopulmonary resus- citation programs for physicians (#4, #5). Nurses trained in Salt Lake City will return to their communities to serve as a core faculty for reaching the techniques at the local level. The nursex will work closely with the similarly trained physicians. 7. Clinical traince program in cardiology, direct cost—$65,700 This program has two emphases— (1) To provide general practitioners, internists and cardiologists with training programs in heart disease techniques tailor made to their individ- ual situations. (2) To increase the number of formally trained clinical cardiologists through a training.period (3 months to one year) at the existing cardiology school at the university of Utah. & Visiting consultants and teachcr program for small community hospitals, direct cost—-$14,800 Small communities will be given the option of requesting one or two-day clinics, A minimum number of four cardiac patients will be required. These clinics will upgrade the level of care to victims of heart disease living in remote areas. Visiting physicians will asalat the local physician in a precise diagnosis in a precise diagnosis of his patients. : ee a te eh eed dare. dee et 4 * -50- 9. A regional computer-based ayatem for monitoring phystologic data on-line from remote hoapitats tn the regional medical program, dircct coat—$6.37,100 This project's purpose fs to test the feasibility of using a central computer to process a variety of physiological signals gencrated by patients in remote hos- pitnis, feeding the results of calculations from these signals back to stations within the hospitals, and using the information for diagnosis. J0. Cancer tcaching project, dircct cost—$94,800 This project attempts to upgrade the level of care available to local communi- ties. The cootdinator will direct a program of physician education to create trained cancer specialists who In turn, will become centers of cancer Information in their local communities. The physicians will receive a small stipend for teaching and obtaining information. A region-wide tumor registry will be started, as will a training program in new techniques for pathologists. 41, Stroke and retatced neurological discaaca, direct cost —$98,700 This project will establish clinics to bring expert consultation service in stroke and related neurological diseases to local communities; will provide continuing education to local physicians and Nurses; will collect data about stroke patients seen and the problems they present to the practitioner, A 24-hour telephone con- sultation service and information library service will be maintained at the Utah Medical Center to provide community physicians with immediate advice, In addi- tion, practicing physicians will be trained at the medical center in the latest diagnostic and treatment techniques. The courses will last from 4 weeks to one year. 12, Educational program in respiratory therapy for physicians and nurecs, dircct cost —$25,300 a To train physicians and nurses to utilize the special techniques and equip- ment in respiratory therapy. Five day seminars and follow-up 2 day refresher courses will train participants to administer therapy and to teach others. 13. Regional cndocrinc metabolic laboratory, dircet cost—$237,900 To provide service facilities where practicing physicians can obtain laboratory data essential to the diagnosis and treatment; to create awareness among physi- cians of the possible presence of metabolic and endocrine abnormalities; to derive statistical information. Three laboratories will be established: an immuno- assay laboratory, a chemical laboratory to measure steroid hormones, and a developmental ‘laboratory to refine techniques, Seminars will be held both inside and outside of the laboratories. Abnormal findings will be reported to the refer- ring physician by telephone by a physician who is competent to offer consultation. / KANSAS REGIONAL MEDICAL PROGRAM f The operational activities of the Kansas Regional Medical Program began on June 1, 1967, and are currently funded at the level of $699,852. Approximately 80 individuals with varied backgrounds, comprise the current staff, of which about one-sixth are physicians, one-fifth are nurses, and an additional one-fifth are other types of allied health personnel. The remaining staff includes related health personnel, such as communications specialists and social scientists, and general support personnel. About half the staff are from the medical center and the other half are from community hospitals. Together they are working on programs to improve community capabilities for treating the categorical diseases, Approximately 20 community hospitals are currently involved in the Kansas * Program, and it is anticipated that additional hospitals will become involved as expansion takes place during the next few years. Ten of these hospitals are directly involved in operational projects, two are represented on the Advisory ~ Committee, and eight are involved in on-going planning activities. Operational Projects 1. Educational programs—Great Bend, Kana—$261 000 (direct coat) To develop a model educational program in this small community a full-time faculty, which will be affiliated with the Kansas Medical Center, will be in residence. Included in this comprehensive program are plans for continuing phy- sician and nurse education and clinical traineeships for heath-related personnel. Studies will be made of community needs, resources, etc. 2. Health Sciences Communication and Information Center—$77,900 (direct cost) This project is engaged in conducting studies to determine the feasibility of establishing communication linkages vital to education, service, and research ‘programs. Specific studies to be undertaken are a physician communication sys- tem, TV teaching, electronic linkages, and Medlars search capacity. “8. Study of the quality and avatlability of medical carc—$149,000 (dircct cost) To determine unmet needs of patients, locations, professional education, and ~working arrangements of physicians and those in the health related Gisciplines. eee -Sl- 5. Hospital information ayatem and data facilitica—$67,500 (dircct cost) To conduct studies within the region concerning various aspects of community resources and needs, epidemiologic data and participation of health care per- - sonnel in continuing educational programs. A computer aystem will be used. 5. Cardiovascular nurac training—$98,500 (dircct cost) To develop an in-service training program to prepare nurses, who are the main. stay of coronary care units in community hospitals, with basic physiological knowledge of coronary care, ability to use instruments and equipment in coronary eare units, experience in home care, and familiarity with social agencies that ean aid in the rehabilitation of patients. 6. Cancer detection program—Providence Hospital—$25,000 (direct coat) To evaluate the strengths and weaknesses of the Cancer Detection Center now operating as an area referral center in Providence Hospital in Kansas City, Kansas. The records of patients will be studied to show effectiveness and yield of test results, type of personnel who have used the clinic and their source of referral, and effectiveness of follow-up. : 7. Cardiovascular work evaluation—$21,100 (direct cost) This project will demonstrate the Cardiac Work Evaluation Unit and show its usefulness for the evaluation and rehabilitation of the patient. It is developing an effective technique for showing physicians and the community at‘large the ability of patients tc return to work after receiving the appropriate rehabilita- tion. “2 METROPOLITAN DISTRICT OF COLUMBIA REGIONAL MEDICAL PROGRAM This region began its operational activities on March 1, 1968, with an award of ‘ $418.318. A staff of 47, including about 11 physicians, two nurses, seven other allied health personnel, and 27 other types of supportive personnel such as computer programmers, coding clerks and secretaries will work together to improve local medical capablities and resources. About half of the staff is from the medical center and the other half is from community hospitals and other local health agencies. This combination of medical center-community personnel helps assure a quality, community oriented program. Seven hospitals are currently participating, and this number will increase . as the program expands over the next few years to reach out to the entire region, Three of these hospitals are directly participating in the projects outlined below, two additional hospitals are on the Regional Advisory Group, and two are serving on planning subcommittees. However, several additional hospitals will benefit from these programs as they send their personnel to be trained in the programs outlined below. Operational Projects J. Freedman's Hospital Stroke Station for the Diagnosis, Treatment, and In- vestigation of Cerebral Vascular Disease, direct cost—$181,889 This project is a comprehensive approach to stroke, from diagnosis and treat- ment to home care and rehabilitation in an urban Negro area. Based in the Freedman’s Hospital, a community hospital in the region, the stroke station will serve as a teaching component for physicians and medical students. Related epidemiological and socio-economic studies will be undertaken. 2. The Washington, D.C. Regional Cerebrovascular Disease Followup and Sur- veillance System, direct cost—$94,200 Under the sponsorship of Georgetown University, this project is attempting to establish a uniform system for measuring and evaluating medical care given to stroke patients in the area, in order to facilitate nursing and follow-up services. It will provide information helpful in determining community medical facilities requirements, and in carrying out epidemiological or demographic studies. Patients entering the system through the various community hospitals in the region will receive follow-up attention and therefore greater continuity of care, 8. A training program for cardiovascular technicians, direct cost—$7§,707 Qualified students are being trained at the Washington Hospital Center in Washington, D.C. in specific areas of medical observation and procedures to com- plement nurses’ activities. In addition to training personnel for work in hos- pitals throughout the region, this project hopes to produce a manual for training these technicians in the other regional hospitals. -52- MISSOURI REGIONAL MEDICAL PROGRAM Operational activities began in Missouri on April 1, 1967, and current opera- tional funds amount to $2,619,000. An estimated 160 operational staff people, with diverse backgrounds, are serving on the Program, including approximately 15 physicians, four nurses, 16 allied health personnel, three social scientists, and approximately 60 computer specialists and thelr supporting personnel, The remaining staff provide overall support, such as research and staff assistants and administrative and clerical personnel. oo The developmental approach being employed by this region and outlined fn project descriptions below suggests that hospital involvement will increase rapidly over the next two years. Currently, nine hospitaix are involved in the program, including two hospitals which are represented on the Regional Ad- visory Committee. Operational Projects 1. Smithville community health serviec program—dircct coat $200,957 The purpose of this project is to establish a model community health service program including continuing education and training programs and health education for the public; emergency intensive and restorative care facilities; home care programs; public health, preventive medicine, and school health; co- ordinated with voluntary health agencies. Program centered around Smithville | and to include about 50,000 persons in county (Clay). Activities are centered : around Smithville Community Hospital and the group practice clinic as a ‘ . nucleus. 2, Multiphasic testing of an ambulant population—dircct cost $421,471 This project is designed to establish centers for performing series of diagnostic laboratory tests to identify the most useful tests feasible for screening large rural population groups; determine the different patterns for ill and healthy populations as an aid in detection of heart disease, cancer and stroke in pre- ‘ clinical stages. Model test centers will be established at the University Medical] Center, Columbia, Missouri, and the State Mental Hospital in Missouri. A third is planned for the Smithville complex. 3. Computer fact bank—direct cost $279,365 This project is designed to develop and apply techniques for delivering latest information on diagnosis and care of patients with stroke and allied diseases to the local physicians. Electronic data information storage and retrieval system will be developed at the University Medical Center (Columbia, Missouri) and , later extend to include Smithville and other communities in the region. §. Mass screening-radiology—dircet cost $54,814 This ‘project will help improve the accuracy of radiologic diagnosis of heart disease, cancer and stroke through electronic communications media. Three small ' ‘ rural hospitals wiil be hooked into the University of Missouri computer and Department of Radiology to evaluate diagnostic efficiency and determine applic- ability of ultra-sound and thermography in diagnosis and therapy. 5. Comprehensive cardiovascular care units—Springfield, Mo., direct cost $69,347 A comprehensive care unit for grouping patients with heart disease or other circulatory system illness or who have been admitted for other purposes but require close cardiac observation is being developed. The project is to be under- taken at hospitals without a house staff, where it is hoped that grouping of patients will relieve the workload for nurses on general medical and surgical wards. St. John’s Hospital medical staff and Greene County Medical Society are coordinating activities with 3 local hospitals in Springfield. 6. Communication research unit—direct coat $61,743... .. , . aa Supporting research unit for program to identify public attitudes and knowl- edge about heart disease, cancer, and stroke; to understand motivations for seek- ing health care and to determine and develop effective methods for communicat- ing with public and lead them to seek medical care. 7%. Data evaluation, computer simulation and aystems dcsign—direct cost $329,712 This program will help to determine data needed from the public and physicians for early detection of heart disease, cancer and stroke through studies on the cmantivn . mechanisms for classifying, storing and retrieving data most effectively. 8. Bioengincering project—$229,129 . The aim of this activity is wider distribution in rural areas of sensor trans- ducers, for early detection of heart disease, cancer and stroke and to generate more information on physiological patterns of these diseases. : 9. Program cvaluation center—dircct cost $103,899 Through a multidisciplinary research approach accumulate data in two sep- arate communities about Health care, needs and attitudes as a base for developing instruments for measuring quality of care and levels of health in terms of an individual's function in his community. ‘ : : we ee ee nee de Lhasa elke la me bead ow ee be AT ee tthe ee ~-53- 10. Automated patient history—direct cost $77,561 This project is testing the feasibillty of an automated system for obtaining patient history and analyze complaints prior to examination by physicians, as an nid in early disease detection. 11. Automated clectrocardiography in a rural area—dircet cost $369,000 To provide hospitaly and physicians in rural areas with automated facilities for triinsmitting electrocardiograms and an automated system for analyses of ECG's; to demonstrate the feasibility of such systems where this service is limited or non-existent, and to develop, test and implement the use of bioengi- neering signals as aid in diagnosis, 12. Opcrations research and systems design—direct cost $39,055 This activity will help develop systems concerned with testing “early detec- tion” hypothesis-develop operational methods of early detection texts for a large rural population. . 13. Population study group survcy—direct cost $65,200 Using National Health Survey questionnaire study factors contributing to use of health services in small towns, with emphasis on the influence of avallability of care. | : 14. Automated hospital record system—direct cost $52,100 This activity is testing the automation of hospital record data through use of computer systems to organize a ready reference service and easy accexs to hos- pital data ag a base for-measuring effectiveness of changes. 15. Computer Asecmbicd On-Going Manuat of Medical and Paramedical Sert- tces—direct cost $26,842 16. Central core administration, planning and coordinatton—direct cost $238,805 (University of Missouri Medical Center, Columbia, Missouri) Missouri Re- gional Medical Program. MOUNTAIN-STATES REGIONAL MEDICAL PROGRAM This four-state region (Idaho, Montana, Wyoming and Nevada) began its operational activities on March 1, 1968 with an operational award of $206,913 to include one activity in coronary care. An operational staff of approximately eleven will serve in the project, and includes five physicians and six nurses. The hospitals involved will include the community hospital in which the activity is taking place as well as those hospitals who will send their staff to the unit for training. The Regional Advisory Group also includes two hospital representatives. Operational Projects . 1. Intensive coronary care in small hospitals in the region—dircct cost $206,913 Hospitals in the Region will send Registered Nurses into St. Patrick's Hospital, Missoula, Montana for coronary care training. This 3 week course will be offered three times a year for 21 nurses, and there will be follow-ups at the home hospi- tais four times a year. In addition, a 4-day training program espectally designed for small town physicians will be held at the University of Montana four times a year. NORTH CAROLINA REGIONAL MEDICAL PROGRAM On March 1, 1968, the North Carolina Regional Medical Program received a combined planning and operational award totalling $1,485,341. The operational ‘component of this award totalled $753,759 in direct costs only. The operational staff includes approximately forty individuals, including twenty-eight physicians. one nurse, six other allied health personnel, and five general support personnel. North Carolina has already involved twenty-seven of its hospitals in the Pro- gram, The Advisory Group includes four hospital representatives and planning subcommittees include an additional ten hospitals. Approximately twenty-one . hospitaly are participating in the operational projects outlined below : Operational Projects 1. Education and rescarch in community medical carc, dircct coat—$209,200 To develop resources for training more .medical and allied medical students; to provide new types of educational experiences which will make family practice more attractive; to have a post-graduate education program at the medical school; to strengthen ties between the medical school faculty and practicing phy- sicians; and to have the medical school become involved in community planning for improving the quality and availability of medical care. Affected by this proj- ect are the following groups: the University Community; the Caswell County Rural Health Services Project; the Regional Health Council of Eastern Appa- lachia, Inc.; the State of Franklin Health Council, Inc.; the Charlotte Memorial Hospital; the Moses Cone Memorial Hospital, Greensboro ; and the Dorothea Dis Neuromedical Service, ©... : .. Lo ~ : a : y : t rey tg ter -54- 4. Development of a central cancer registry, direct cost—$66,615 % To devise a uhiform region-wide cancer reporting system, integrated with the PAS, the computer-stored data from which can be retrieved to serve a broad range of educational, research, statistical, and other purposes. The following hospitals are participating in the first year of the project: Duke University Med- ical Center, North Carolina Memortal Hospital, North Carolina Baptist Hospital, Charlotte Memorial Hospital, Veterans Administration Hospital, Watts Hospital, Hanover Memorial Hospital, Southeastern General Hospital, Craven County Hospital. In subsequent years the registry will be expanded to include all hos- pitals and physicians in the region. trained to assist medical staff; libraries will be organized into a functional unit for responding to requests for services. Bibliographic request service will be established. 6. Cancer Information Center, direct cost—$41,716 To provide practicing physicians with immediate consultation by telephone and follow-up literature. Each of the three medical schools will be responsible for providing service in its geographic locale. The aims of this project are two-fold: (1) to assist physicians in providing optimum care of patients with cancer; and (2) to continue the education of the physicians by giving new information ina patient-centered experience. %. Continuing education itn internal medicine, direct cost—$33,313 To bring practicing internists from all over the state to the Medical Center for a month of up-to-date training in their subspecialities, They will share responsi- bilities with attending physicians and make ward rounds with students, staff, and together, This experience should enhance the appreciation in the University, both at faculty and student levels, for the expanding role of the medical center for the quality of care in the community. 8& Continuing education tn dentistry, direct cost—$67,500 To provide physicians and dentists with the knowledge of mutual concern which will enable them to be more effective members of the health team. Courses heart disease, cancer, stroke, or a related dixease receive appropriate dental care asa part of their comprehensive treatment. . 10. The establishment of @ neticork of coronary care units in amall community hospitals in Appatachia, North Carolina This is a proposal to develop coronary care units in seven hospitals in this rural, mountainous area. RMP will supply the monitoring equipment (the hospital pro- vides suitable space) when adequately trained physicians and nuraes are ayall- able. An intensive training course for physicians will be conducted in the geo- graphic region, and continuing education programs will be conducted when necessary. oo. 2 ee ee le St cteee camer ck ene at eg ae : -55- ROCHESTER REGIONAI, MEDICAL PROGRAM On March 1, 1968 the Rochester Program began its operational activities with a modest operational grant award of $255,487. Approximately 15 people are cur- rently serving on the staff which will expand with additional recruitment. The current staff includes 13 physicians, and two allied health personnel. A majority .of the staff are from community hospitals, and are working closely with medical center and RMP staff to improve the quality of local patient care. Approximately eleven hospitals from the region are now participating tn the program, and this will expand as the program moves forward over the next few years. Four hospitals are initially participating in the operational projects. Three of these four are represented on the Regional Advisory Committee. Seven addi- tional hospitals are serving on the Advisory Committee and planning subcom- mittees. ‘ Operational Projects 1. Renovation ‘and equipping of factlitics for a learning center for projected training programs related to heart disease, cancer, and stroke, direct cost— $26,400 The awarded funds are for the purpose of altering and renovating space in Helen Wood Hall, which houses the Departments of Nursing at the University of Rochester. It is planned to convert five rooms into two rooms for self-instructional learning. These facilities initially will be used for four 4-week coronary care training courses for nurses and physicians in the region. New techniques that are disseminated by means of these coursex will then be caried to the various com- munity hospitals and rural areas in the region by the training course participants. 2. Postgraduate training program for the physicians in the Rochester 10-county region, direct cost—$838,900 . The objectives of this project are centered around the further development of a postgraduate program in cardiology. Learning opportunities will be made avail- able for general practitioners and internists, as well ax cardiologists practicing in the region. Several different prograins are planned and vary in length from one-half day to two weeks. It is anticipated that a number of the participating physicians will represent community hospitals in rural areas, &. Registry of patients with acute myocardial infarction in the Rocheatcr re- gional hospitals, dircct cost—$21,200 One objective of this registry is to provide a uniform data collection system from which both periodic information as well as longitudinal analyses may be extracted. Appropriate information as to prognosis and treatment will be dissemi- nated to participating hospitals and cooperating physicians in the region. Strong Memorial Hospital in Elmira, New York is already participating in this project, and it is anticipated that several other community hospitais, especially those in rural areas, will soon also be participating. 4. Proposal for cstablishinent and support of a regional laboratory for the cduca- cation and training in the carc of paticnta with thrombotic and hemor- rhagic disorders, dircct cost—$69,400 At the present time no single, central facility concerned with the diagnosis and therapy of patients with thrombotic or hemorrhagic disease exists in the Ro- chester region, Laboratory technicians from the regional hospitals will be invited to spend three or four days in the new facility. In addition, the physicians direct- ing this project will visit the participating communities so that a continuing edu- cational program for practicing physicians in the care of patients with thrombotic. diseases will be maintained. TENNESSEE MID-SOUTH REGIONAL MEDICAL PROGRAM On February 1, 1968, the Tennessee Mid-South Regional Medical Program began its operational activities with a diverse array of programs designed to provide local health practitioners and hospitals with advanced techniques and facilities necessary for quality health care. Over fifty people are currently serv- ing on the staff of the operational program, including approximately thirty-five physicians, five nurses, five other allied health personnel, and nine general support personnel. About one-fourth of the staff are from community hospitals and the remaining are medical center staff who are working on the community oriented projects discussed below. Seventeen hospitals are currently participating in the operational projects, representing broad geographic spread throughout the region. Ten of these hos- pitals are also represented on the Regional Advisory Group. Operational Projects i. Continuing medical education—-Meharry, direct cost—$44,800 Meharry Medical College is informing Negro physicians in the region about more effective techniques for treating heart disease, cancer, and stroke. Teams of physicians will teach two-week courses in the three areas at the Medical Cen- ter, using various audio-visual aids and, where feasible, programmed instruction. One of this plan’s interesting provisions is sending a senior resident from Meharry to care for the physician's practice while he is attending the course. ’ ot -56- 2. Continuing educatton—Vandcrbilt, direct cost—$141,600 Vanderbilt proposes to establish continuing education centers at community hospitals linked to a proposed Department of Continuing Education at Vander- bilt. Libraries and information centers at the local hospitals will bring Vander- bilt’s information resources to the local physician. The program, though planned and coordinated by Vanderbilt, will function through the local centers and em- } phasize bringing information to the physician at the times he needs it. 8. and 4. Hopkinavtlic Education Center and Chattanooga Education Center, dircct cost—$78,700 These are the first of the local continuing education centers specified in the Vanderbilt plan. At each hospital, a full-time Director with an appointment at Vanderbilt and an assistant director will supervise resident and physician edu- cation in their area. Their services will be available to physicians at smaller community hospitals in each area, as will the enlarged hospital library facilities. The Chattanooga and Hopkinsville locations provide the basis for looking at problems in continuing edtcation in urban and rural settings. 5. Special training for practicing radtologists—Vanderbilt, dircct cost—$50,400 This plan focuses on developing practicing radiologists’ skills in vascular radiology, but might later be broadened to include all aspects of diagnosis and therapeutic radiology. Two post-graduate educational methods will be used. One to three month courses for technologists will be offered. In addition, emi- nent radiologists will preside at two-hour monthly seminars to which all radiologists in the region will be invited. 6. Cardiac nurse training program—Mid-State Baptist Hospttal-Nashviiile, direct cost—$49,600 : The key factor in reducing mortality from cardiac arrest is the immediate availability of a knowledgeable person to initiate resuscitation. Mid-South Baptist proposes to instruct cardiac nurses in new resuscitation techniques by holding three four-week courses. These nurses will then be available to hospitals throughout the region. 7. School of X-ray and technology—Meharry, direct cost—$19,500 Meharry plans to establish a two-year program for training at least ten X-ray technologists per year. The faculty will be Meharry’s Radiology staff. Feasibility studies for establishing nuclear medicine and radiotherapy programs will be conducted. 8 Radiology technologist training program—Vanderbilt, dircct costs—$3$0,300 Vanderbilt proposes to increase the number of X-ray technologists, improve the quality of their training, and increase their opportunities for continuing educa- tion. Three small hospital training programs in the area will be discontinued as separate entities and subsumed by a new schoo] of X-ray technology at Vanderbilt. Practical clinical experience will be both at Vanderbilt and the smaller hospitals. 9. Nuclear medicine training program—Vanderbilt, dircct cost-—$25,300 A new series of courses taught by paramedical and medical personnel will be | made available to physicians and technologists to increase their skill in nuclear medical techniques. When possible the physician and his technologist will spend some training time together to work out procedures suited to their aituation. Trainees will be accepted from smaller community hospitals planning to establish or improve nuclear medicine services. 10. Expansion of School of Medical Technology—Baronesa Erlanger Hospital— Chattanooga, direct cost—$85,400 To augment medical technology capabilities in the area, this plan makes two proposals: (1) Expand the Baroness Erlanger program for medical technologists; and (2) establish a school for certified lab assistants who could free technologists from more routine work for more complex procedures. 11. Vanderbilt Coronary Care Unit, direct cost—$51,600 This project's purpose is to establish a network of coronary care units with adequate equipment, staffed by well trained personnel. Vanderbilt will be the training and information center for the region; a demonstration unit there will provide a focal point for continuing education. In addition, communication systems will be set up to facilitate the flow of information from Vanderbilt to the community hospitals. Studies are belng made to see if the smal! hospitals connected with Vanderbilt can become, in turn, centers for local networks of coronary care facilities in still smaller hospitals. 12, Franklin Coronary Care Unit—Williamaon County Hospital—Franklin, direct cost—$3$1,400 This is one of the subsidiary units mentioned in the Vanderbilt proposal. This is primarily a pilot project to study the feaaibility and usefulness of cotablishing a ecenter ins a small community hospital. ~57- 13. Hopkinavtile Coronary Care Untt—Jcnnte Stuart Memorial Hoapttal—Hop- kinartlic, Ky., direct cost—$49,500 This plan is similar to the Franklin plan, except that it mentions establishing links to smaller community hospitals by helping set up smaller care units In them, thus providing for the grouping of rural community hospitals for more efficient use of existing resources. 14. Clarksville Coronary Care Unti—Olarksville Memortal Hoapital, direct cost— $19,000 As the Franklin program, this project is a subsidiary of the Vanderbilt pro- posal. Since this hospital has been operating a unit, the plan calls for its expa.- sion, continuing education and a phone hook-up to Vanderbilt. 15. Nashvtile Gencral Coronary Care Unit—Nashville Metropolitan General Hoa- pital, dircct cost-—-$42,100 Again, this is like the Franklin plan. Nurses here will be included in the in- service training programs initiated throughout the participating hospitals. . 16. Meharry Medical College Coronary Care Unit, direct cost—$35,800 Meharry intehds to establish a demonstration unit of coronary care facilities which will serve as a continuing education center for smaller hospitals in its region. 1%. Murray Coronary Care Untt—Murray—Calloway (Ky.) County Hospital, direct cost—$3$8,800 Murray-Calloway County Hospital, the training center for Murray State Uni- * versity School of Nursing, will serve as a demonstration center for the sub- region. Direct phone communication will be established with Vanderbilt, which will send consultants from its school of continuing education. This project has the dual objective of relating the Murray State Nursing program to an established medical center and providing regional training resource to a remote area. 18. Chattanooga Coronary Care Unit—Baroness Erlanger Hospital, direct cost— $14,400 Baroness Erlanger plans to establish a coronary care unit in a program of co- operation with Vanderbilt. Both telephone communications and electronic main- tenance systems connected with Vanderbilt will be installed. This unit will serve ns a center for the smaller hospitals in Chattanooga. 19. Baptist Hospital Coronary Care Untt—Mtd-State Baptist Hospital, Nash-. ville, direct cost—$51,000 This plan is similar to the others included in the Vanderbilt plan. Baptist Hospital will expand its present facilities and ald establishment of smaller cen- ters at Tullahoma and Crossville, Tennessee. Direct telephone lines will be estab- lished for consultations. The unit director will have a clinical faculty appoint- ment at Vanderbilt. He will devote approximately 25% of his time to the unit. 20. Crossville Coronary Carc Untt—Uplands Cumberland Medical Center, Cross- ville, direct cost—$28,300 This project has two purposes: (1) to establish a two-bed coronary care unit in the hospital; and (2) to determine the feasibility of operating acute coronary care units in rural areas. The hospital will cooperate with Mid-State Baptist Hospital and Vanderbilt. 21, Tullahoma Coronary Care Unti—Harton Afemorial Hospital, Tullahoma, Tenn., direct cost—$28,800 See Baptist Hospital Program. 22. Meharry supervoitage therapy program, direct cost—$58,300 This project is aimed specifically at improving cancer therapy for a large in- digent population. Meharry will use its funds to obtain a cobalt 60 High Energy Source for therapy and a computer hook-up with Vanderbilt. These facilities will also 7 used to improve undergraduate and graduate radiology training programs at Meharry. 23. Project to improve patient care in a remote mountain community by recruit- ing and training health aides for a new extended care facility—Scott County Hospital—Oneida, Tenn., direct cost—$10,800 Manpower shortage in this isolated mountain hospital ts critical. Personnel to man an extended care facility now under construction will be obtained by two methods: (1) In-service training for hospital personnel; (2) an educational director (an RN) to serve as a liaison to the high schools to encourage young people to enter the medical field and come back home to practice. In addition a training program leading to the LPN would be initiated. Clinical training will be training. by the Educational Director while local high schools provide basic tra! whdeadetede abe aba Bane oeeres te ed ke ake ee ee Ae em te -58- 24. Health craluation studics on a defined population group—multiphasic ecreen- ing—Mecharry Medical College, direct cost—$ 436,000 Meharry will determine the effectiveness of a comprehensive health program and multiphasic screening examinations in early diagnosis of heart disease, can- cer, stroke and their precursors. To run this experiment, a neighborhood medical center supported by OEO will serve a selected population of 18,000. The test population and a control population will be evaluated with reference to morbid- ity, changes in health attitudes and utilization patterns, effectiveness of the screening procedure and the cost per patient diagnosed or treated, 25. Experiment to test and implement a model of patient care—Vanderbilt Unt- versity Hospital, direct cost—$110,400 This is an attempt to define a new structure for patient care. New personnel called stewardesses will be trained to take over the nurses’ non-clinical duties. Nurses would then be free to spend more time with the patient and to keep up their specialized skills. After the model is refined at Vanderbilt, it will be tested in community hospitals—specifically Baptist and St. Thomas. 26. A medical surgical nurse specialist graduate program to improve nursing carc of paticnts with heart discasc, cancer, and strokc—Vandcrbdilt Oniversity School of Medicine, direct cost—$23,600 Vanderbilt is developing a program to train medical surgical nurse specialists to improve nursing care of heart, cancer, and stroke patients. It will be a master's degree program staffed by physicians and clinical nurses (1 calendar year) plus one year of clinical experience half at Vanderbilt and half at the community hospital. Stipends wiil be provided during the first year only. WASHINGTON-ALASKA REGIONAL MEDICAL PROGRAM With an operational grant award of $1,032,003 on February 1, 1968, this two- . State region began its efforts to bring quality care to the dispersed populations of this area. About forty operational staff members are currently serving on the program, including about seventeen physicians, three nurses, six other allied health personnel, and fourteen related health and general support personnel. About one-third of the staff is from the medical center, another third is from com- munity hospitals and the last third is from other health and medical organiza- tions. The entire staff is working in concert to bring up-to-date medical tech- niques to communities throughout the region. Strong hospital involvement in the Washington-Alaska program is evident in the project descriptions below. Approximately 86 hospitals are currently partici- pating in the program, almost 20 of which are directly involved in operational activities. Six of these hospitals are represented on the Regional Advisory Groups, and an additional four of these are on planning subcommittees, The re- maining participating hospitals are involved in current planning activities. It is likely that these, and the many other hospitals in the region, will become in- creasingly involved in operational activities. Operational Projects ' 1. Central Washington—Communication system for continuing education for are Deaconess Hospital and Sacred Heart Hospital. physicians—$18,181 (direct cost) This project is designed to bring the medical resources of the University of Washington to physicians and community hospitals in Yakima, who in turn will act as consultants to surrounding smaller communities through seminars and conferences, educational TV, other audio-visual instruction; and exchange of teachers and practitioners. It will also connect internists in Central Washing- ton to Yakima cardiologists via EKG telephone hot-line, to permit quick analysis (starting with 5 community hospitals). Three general hospitals in Yakima in- volved are: St. Elizabeth’s, Yakima Valley Memorial, and New Valley Osteo- pathic. Nine other community hospitals to be reached initially are located in Ellensburgh, Moses Lake, Othello, Toppenish, Prosser and Cynnyside. 2. Southeastern Alaska—Postgraduate education—$27,062 (direct cost) This program will help improve communication between Seattle Medical Com: munity and University to alleviate problems of the isolated physicians in south- east Alaska cities and communities: J uneau, Sitka, Ketchikan (3 largest). As in Central Washington several methods will be used such as telelectures, consul- tant services, seminars and the EKG hot line to hospitals in Juneau, Sitka, and PHS Native Hospital at Mt. Edgecumbe and Ketchikan community hospital. 8. Postgraduate preceptorship for physicians—Coronary care—$17,610 (direct cos A pilot project to provide opportunity for practitioners from isolated com- munities to spend a week or more under a preceptor at major medical centers to study advances in care of coronary heart disease. The 4 major medical centers in Seattle are Providence Hospital, Swedish Hospital, Virginia Mason Hospitals and Medical Center, and University Hospital and Medical Center; two in Spokane penne eb hae bake oh ee mes tame aoe ee ee -59- WESTERN NEW YORK REGIONAL MEDICAL PROGEAM With an award of $357,761, the Western New York Regional Medical Pro- gram began its operational program on March 1, 1968. The current operational staff of seven physicians, one nurse, and two secretaries will be expanded to over 20 during the next several months. Over forty hospitals are currently in- volved in this program, almost all of which are slated to be part of the devel- oping regional two-way TV network for continuing education. Eleven hospitals are represented on the Regional Advisory Group, and an additional two hos pitals are serving on planning subcommittees, Operational Projects 1. Two-way communications network, direct cost—$170,519 A two-way communication network will link hospitals of Western New York and Erie County, Pennsylvania to the Continuing Education Departments of the State University of New York at Buffalo and the Roswell Park Memorial Institute, The network will serve several purposes, such as continuing educa- tion for physicians and the health-related professions, public education, ad- ministrative communication, consultation with experts, and contacts among blood banks. It will assist both the physician and community hospital, in either the rural or urban environinent in having at their fingertips the latest advances in the diagnosis and treatinent of heart disease, stroke, and cancer. Particular emphasis will be placed upon involving rural hospitals in this program there- by improving both their didactic and restorative function. 2. Coronary care information coordinators, direct cost—$127,645 This project will test a training technique for providing qualified nurses who will be required to staff developing coronary cure units in the Region. Approxt- mately $0 nurses will be selected from all parts of the Region for a combined academic and clinical course. It is planned that the nurses receiving this train- ing will return to both rural and urban hospitals for the purpose of provid- ‘ing a diagnostic and didactic function. While-the program will be housed at the medical center, the community hospitals of this region will be the bene- factors of the project. Since there are few nurses trained to work in coronary care units, particularly in the rural environment, special attention will be paid to attracting nurses who will return to the community hospital. WISCONSIN REGIONAL MEDICAL PROGRAM The Wisconsin Program began its operational activities on September 1, 1967 when it became the first Regional Medical Program to be awarded a combined planning and operational grant. Currently funded with $630,147, about one third of which is for operational activities, the operational staff num- bers 20. About one-third of the staff are physicians, another third are allied health personnel, and the last one third are supportive and other type of per- sonnel. Approximately 20 hospitals are involved in the current phase of the Pro- . gram, Eleven of these hospitals are directly involved in the operational projects. Five are represented in the Regional Advisory Group and the remaining are represented in planning subcommittees. As the program develops additional activities during the next few years, it is anticipated that many additional hospitals will be involved. 1. Study program for uterine cancer therapy and evaluation, direct cost-—$40,100 This pilot project is designed to review and evaluate current radiotherapy for patients with uterine cancer. In its first phase it will involve information ex- change and dosimetry standardization. Hospitals at Marquette and the Uni- versity of Wisconsin will be connected to a central, computerized data bank in Milwaukee which will compute radiation classes. When the necessary computer techniques are developed, it is projected that the central facility will be linked to other hospitals outside the Milwaukee and Madison areas with similar treatment programs, and tbe long-term result will be to improve local medical capabilities for the treatment of all uterine cancer patients in the Region. 2. A pilot demonstration program for pulmonary thrombocmbolism, direct cost— $84,600 In this project a center is being established at Marshfield Hospital in Marsh- field, Wisconsin, for demonstrating diagnostic techniques and the available therapy for pulmonary thromboembolism. The project has a continuing educa- tion component which will reach physicians from many hospitals in the Region. This will involve a 24-hour consultation service, the preparation of a movie on the topic, and special training sessions for groups of physicians. The project will demonstrate a comprehensive program which will encompass diagnostic, preventive, therapeutic, and rehabilitation procedures for patients, postgraduate education, a rapid transportation system for patients from Northern sections of the state, and cooperation between the clinic and other hospitals and medical schools in the State. $. Telephone diai access tape recording Kbrary in the areas of heart disease, can- cer, stroke, and related diseases, direct cost—$18,950 This feasibility study will be carried ont by the University of Wisconsin which wifl record and store short, 4-6 minute, tapes on various aspects of _ treating patients with the three diseases. Any physician anywhere in the ae -60- 4. Coronary carc unit coordination—$70,255 (dircct cost) This activity will serve as coordinating unit for CCU relnted projects—their development, Improvement of operations, and training activities. A mock-up coronary care unit will be used in the educational programs for nurses and physt!- cinns ; audio-visual self-instruction materials will be produced and evaluated. .3. Cardiac pulmonary technician training—$41,554 (direct cost) This program will help develop a formal program for training cardio-pulmo- nary technicians to perform non-critical functions in coronary care units and free physicians for other duties. Four larger general hospitals in Spokane will parti- cipate with Spokane Community College. The 4 hospitals are Deaconess, Holy Family, Sacred Heart and St. Luke’s Hospital. 6. Information and education resource support untt—$522,304 (direct cost) This program will help provide medical communities with the skilled assist- ance which will help identify their educational needs and serve as a support unit in developing programs to meet them; to establish a central production unit, to coordinate audio-visual projects and the distribution of materials, to penetrate the entire region. = Two-way radio conference and slide presentation—$8,445 (direct cost) Six pilot programs on heart, cancer and stroke topics to be transmitted via two-way radio-telephone slide conferences, to physicians and hospital staffs on topics selected by a panel of physicians, starting with 20 hospitals in Washington are underway. It will explore potential for continuing network series with local and remote regionsr 8. Continuing cducation and on-the-job training of laboratory personnel—$53,446 (direct coat) Primary purpose of this activity is to train technical personnel in newer clinical laboratory procedures, and shorten gap between availability of advance in techniques and actual use. First phase is to be directed at 5 local designated training centers in Washington (cities of Seattle, Tacoma, Spokane, Yakima and Vancouver) and Anchorage, Alaska. University of Washington will select from a list of available Iab procedures, arrange training courses for technicians in specific ones at designated facilities and establish quality control criteria ; they will follow through with education of physicians in newer and practical tests for better diagnosis and treatment. 9. Alaska medical library factlitice—$21,754 (direct cost) This activity will help develop a community medical library located at the PHS Alaska Native Medical Center, Anchorage, for Alaska physicians and health related staffs and agencies. It will have close ties with community col- leges, Arctic Health Research, University at Fairbanks and to supplement con- tinuing education projects for Southeast Alaska and the Anchorage cancer project. 10. Anchorage cancer program—$51,450 (direct cost) This project will aid in providing a supervoltage therapy unit for cancer patients to be located in an addition to Providence Hospital in Anchorage. It involves training of radiologist and technical staffs, consultant clinical confer- — ences and accumulation and analysis of dianogstic data. Presbyterian Com- munity Hospital in Anchorage will be participating. 11. Oare of children with cancer (study)—$28,080 (direct cost) - This is an epidemiological study to determine the impact of different methods of care for children with cancer, focusing on differences among children treated in local communities and at major centers; to be conducted by the staff of Children’s Orthopedic Hospital and Medical Center, Seattle. 12. Radiation physicist consultation program for radiologists in Washington and Alaska—$56,898 (direct cost) This project will provide consultation services of a radiologist-physicist for smaller hospitals, in dosimetry and other problems of radiotherapy. To enhance postgraduate education for radiology residents and paramedical trainees outside of the University system. 13. Computer-aided instruction in heart disease, cancer, and stroke and related diseases—$58,890 (direct cost) To develop and evaluate the effectiveness of computer-aided instruction for teaching medical techniques. Participants will be instructed in the use of com- pater terminals. : . as . . eee mee te nee ee de meen dene ee ee me IT St . a -61- Region can dial the brary at any time and request a tape relevant to a problem in which he is interested. 4. Nursing telephone dial access tape recording Ubrary in the arcag of heart discase, cancer, stroke, and related discaszes, direct cost—$18,800 This feasibility study, similar to the one nbove, will establish a central tape lHbrary with information recorded on nursing care in emergencies, new pro- cedures and equipment, and recent developments {n nursing. Nurses from any hospital in the region will be able to call at any time to have a tape played to them. 5. Development of medical and health related single concept film program in community hospitals, direct cost—$38,259 This education feasibility project involves ten community hospitals in its first phase. Fifteen films on procedures and techniques used in treating heart, cancer, and stroke, will be developed. Projectors and the filme will be installed in the hospitals for use by physicians and other health personnel at their con- venience as a continuing education device. After four to six months the ma- terials will be relocated in ten additional hospitals. Teievisiony Ranio AND TELEPHONE Networks For CONTINUING Epucation OPERATIONAL PROJECTS 1. Albany Regional Medical Program Two-way radio communication system—Dircet cost, $144,100 This project will expand an existing two-way radio network to include 57 hospitals and 24 high schools. It will provide continuing education for physicians and allied medical personnel. It will also provide information and education programs for administrators, members of bourds of trustees, voluntary health agencies, adult education classes, and selected civic groups. II. Intermountain Regional Medical Program Network for continuing education in heart disease, cancer, atroke, and re- lated diseases—-Direct cost, $243,000 The objectives of this program are to develop a communications network between patient-care and research institutions to encourage Haison between health care personnel in the area. The currently existing two-way radio system, including 11 hospitals in 7 communities in or near Sait Lake City has been expanded to 10 additional remote hospitals to serve as one link. This system . will be expanded to additional hospitals in response to physician requests. Closed circuit TV and use of KVED (University of Utah education TV) is also planned. This may establish the community hospital as the focus of continuing education, IIft. Kansas Regional Medical Program Health sciences communication and information center—Direct cost, $77,900 This project is engaged in conducting studies to determine the feasibility of establishing communication linkages vital to education, service and research programs. Specific studies to be undertnken are a physician communication sys- tem, TV teaching, electronic Hinkages, and Medlars search capacity. Linkages will be established at hospitals in Great Bend, Pittsburg and Kansas City. IV, Washington-Alaska Regional Medical Program Central Washington—Communication system for continuing education for physt- ctans—Direct cost, $18,181 This project is designed to bring the medical resources of the University of Washington to physicians and community hospitals in Yakima, who in turn will act as consultants to surrounding smplier communities through seminars and conferences, educational TV, other audio-visual instruction; and exchange of teachers and practitioners. It will also connect internists in Central Washington to Yakimn cardiologists, vin EKG telephone hot-line, to permit quick analysis (starting with 5 community hospitals). Three general hospitals in Yakima tn- volved are: St. Flizabeth’s, Yakima ‘Vsiley Memorial, and New Valley Osteo- pathic. Nine other community hospitals to be reached initially are located in Ellensburgh, Moses Lake, Othello, Toppenish, Prosser and Sunnyside. Southeastern Alaska—Postgraduate education—Direct cost, $27,962 This program will help improve communication between Seattle Medical Com- munity and University to alleviate problems of the isolated physicians in south- east Alaska cities and communities: Juneau, Sitka, Ketchikan (3 largest): As in Central Washington several methods will be used such as telelectures, con- sultant services, seminars and the EKG hot line to hospitals in Juneau, Sitka, and PHS Native Hospital at Mt. Ddgecumbe and Ketchikan community hospital. a i ‘ Tico-way radio confercnce and slide prescntation—Direct cost, $8,445 Six pilot programs on heart, cancer and stroke topics to be transmitted via two-way redio-telephone slide conferences, to physicians and hospital staffs on topics selected by a panel of physicians, starting with 20 hospitals in Washing- ton are underway. It will explore potential for continuing network series with local and remote regions. VY. Western New York Regional Medical Program Two-way communications network—Dircet cost, $170,519 . A two-way telephone communication network will link over 40 hospitals of Western New York and Erie County, Pennsylvania to the Continuing Education Departments of the State University of New York at Buffalo and the Roswell Park Memorial Institute. The network will serve several purposes, such as con- . tinuing education for physicians and the health-related professions, public ed- ‘ . ucation, administrative communication, consultation with experts, and contacts among blood banks. . ‘ DEPARTMENT OF HEALTH, EpUCATION, AND WELFARE STATEMENT ON REGIONAL MEDICAL PROGRAM H\rrorts Direccrep AGAINST THE HEALTH PROBLEMS OF THE . INNER CITY we In August 1967, the National Advisory Council on Regional Medical Programs issued a- statement which gave consideration to the health problems of metro- politan areas and their inner cities. While recognizing the complexities of the urban environment, the Council stressed the responsibility of Regional Medical . Programs to contribute to the solution of health problems. there. In addition, . it recommended that an appropriate group of national leaders be named and called together to consider how the attention of Regional Medical Programs could best be focused on the issue. In response to the statement and to the Surgeon General’s memorandum of October 9, 1967 “Improving the Health Status of the Urban Poor,” a meeting was held on November 16, 1967 to consider the problem. Among those persons invited to attend were hospital representatives, RMP coordinators from urban areas, health planners, representatives from OEO, medical school officials and physicians with responsibility for the provision of care to the trban poor. The discussion concerned the need for immediate action to reduce the health status differential which now exists, the need for experimentation in the methods of delivering health care, and the need for coordinating the activities of diverse groups which provide health care services in the inner city as well as specific approaches and projects which might be undertaken. At the local level, Regional Medical Programs which include major metro- politan arenas have developed varted approaches to solving these problems, These + efforts include cooperative arrangements between hospitals, health departments, medical schools, voluntary agencies and practicing physicians to meet the health needs of the poor. Examples of these approaches now under development or in operation can be summarized as follows: . California Regional Medical Program has established a subregion covering the Watts-Willowbrook area of Los Angeles which will facilitate the develop-- ment of activities aimed at meeting the specific needs pf the people there, Through the Regional Medical Program, the University of Southern California School of Medicine and the UCLA School of Medicine are cooperating with the local Charles R. Drew Medical Society (an affiliate of the National Medical Associa- tion) in establishing a post-graduate medical school at the Southeast General . Hospital now under construction in Watts, This school will provide back-up ' . services to the OEO neighborhood health center in the area, develop training \ : programs for allied health personnel, provide stimulus for additional physicians to enter the practice within the community and will develop training programs for physicians already there. California Regional Medical Program has requested funds for partial support of the school in the early stages of development. In addition, work is now underway at the University of Southern California School of Medicine on the application of cancer case finding methodology to poverty groups. ‘ New Jersey Regional Medical Program has organized an urban health unit within their office and has established a Task Force on Urban Health Services . under the chairmanship of Mrs. Anne Somers, a member of their Regional ‘ Advisory Group. Membership on the Task Force includes representatives of the New Jersey Hospital Association, the New Jersey State Department of Com- munity Affairs, county medical societies, local ONO CAP programs and other groups. The function of the group will be to stimulate and review projects for improving the availability of health services to persons living in urban areas of the state, particularly low income groups. The group currently is working on the development of hospital based group practices at Middlesex General Louspithl in New Brunswick and at West Jersey Hospital in Camden, as demonstrations of improved systems for patient care for heart disease, cancer and stroke. The New Jersey Regional Medical Program will assign a coordinator/planner to thé Model Cities offices in Trenton, Newark, and Hoboken. The function of -63- these persons will be to gather data on services and the facilities available for people suffering from heart disease, cancer and stroke; to provide liaison be- tween Regional Medical Programs and the Model Cities programs; and to assist the Model Cities offices in developing a program of health services for the com- munity which will be consistent with the overall goals and objectives of the Regional Medical Program. Tennessee-midsouth Regional Medical Program has developed a number of projects which affect the health care of the poor in Nashville. Coronary care units will be established at Nashville Metropolitan General Hospital and Hub- bard Hospital, which serve patients largely drawn from an indigent population. Meharry Medical College will conduct continuing education programs for Negro physicians and will establish a supervoltage radiation unit to improve cancer ' therapy in the community and improve graduate and under-graduate radiology training. In addition, there is a project to test the effectiveness of multiphasic screening examinations in the early diagnosis of heart disease, cancer and stroke. Meharry will establish a screening center which will operate in support of 4 comprehensive neighborhood health center funded by OEO and will serve a pop- ulation of 18,000 people. The test population and a control group will be evaluated and compared with reference to changes in morbidity, patterns of utilization of health services, health attitudes and cost per patient diagnosed. Tri-State Regional Medical Program received a planning grant in late 1967 and is only now becoming completely organized. Since that time Dr. Norman Stearnes, Program Coordinator, has been involved in a number of meetings where he has made known Regional Medical Prograni’s interest in working to improve the availability of health services to the urban poor. He also is serving on an ad hoc committee formed in Boston by Blue Shield to discuss the planning of home services and will sit on the Health Services Advisory Committee to the Boston City Departinent of Health and Hospitals. At this time, there are two projects for earmarked funds under development in the Boston area, a stroke project at the New England Medical Center which will have a tle-in with the Columbia Point Neighborhood Health Center and a hypertension project being developed by Dr. Edward Kass of the Channing Laboratory, Boston Department of Health and Hospitals. , : IHinois Regional Medical Program has established a number of formal and informal contacts with persons in the Chicago area responsible for providing health services to the inner city including Dr. David Greeley, Associate Direc- tor, Chicago Board of Health and Dr. Mark Lepper, Vice President, Presbyterian- St. Luke's Hospital which operates an OKO financed neighborhood health cen- ter. Now in the planning stage at Presbyterian-St. Luke’s Hospital is a com- munity hypertension detection program which will be focused on the Mile Square area of Chicago. Included would be evaluation of case finding methodology, ef- fectiveness of treatment, nurse interviews with patients and an analysis of the interaction of the program to the community. Michigan Regional Medical Program: At its recent February meeting the Re- gional Advisory Group of this program formally adopted a statement for prior- ities for Regional Medical Program action which reads in part “the first priority for Regional Medical Program support will be given to those projects which are concerned with the improvement of the delivery system of health care including such aspects as (a) improvement of the delivery system of health care to low income groups; and (b) innovations and improvements in the utilization of manpower . . .” Underway is a planning project supported jointly by Regional Medical Programs and the State Health Department (Project ECHO) for gather- ing data on the health needs in depressed areas of Wayne County, Michigan. . Wayne County General Hospital has submitted a project to study the use of -subprofessional workers to assist the physician in patient care and will design and establish training for such persons recruited from the local community. Wayne County General Hospital serves the indigent population of Wayne County and is located adjacent to a large indigent group in western and southern Wayne County, Michigan. oot ‘ - In addition, Regional Medical Program staff at Wayne State University School of Medicine is working to establish liaison with urban health programs in Detroit including OFO and Model Cities. The Executive Director of the Detroit Urban League has been named to the Wayne State Advisory Group. Indiana Regional Medical Program is working with Flanner House, a volun- tary community agency in Indianapolis to develop a muiltiphasic health screening program for low income population groups. With State and local support the Regional Medical Program is conducting planning and feasibility studies to determine the types of screening procedures which will most effectively reach target population groups and which can in part be administered by previously untrained persons from the community who have received on-the-job training. New York Metropolitan Regional Medical Program has made specific assign- ments to members of their core staff for maintaining Haison with community mental health programs, OKO and Model Cities. Particular effort has been made to develop a working relationship with the Provident Clinical Society, the mov- ing force behind an OEO health center in Brooklyn and as a result the president of this organization has recently been appointed to the Regional’ Advisory Group. In upper Manhattan, the Regtonal Medical Program is practicing with representatives of the National Medical Association, Columbia University Col- lege of Physicians and Surgeons, Mount Sinai Schoo! of Medicine and St. Luke's Hospital in the development of continuing education programs for unaffiliated physicians. The Regional Medical Program is also taking leadership in co-spon- soring @ conference on health careers for the underprivileged to bring together -64- all interested forces in the area to d developmental stage, are several p evelop a coordinated program. Also in the rojects for earmarked funds including a pediatric pulmonary disease center at Babies Hospital, a feasibility study for the development of screening and treatment of stroke patients at Harlem Hospital, and a mobile coronary care unit to Greenwich Village. operate out of St. Vincent's Hospital in Metropolitan Washington, D.C., Regional Medical Program will establish a stroke station at Freedman’s Hospital, the teaching hospital of Howard Uni- versity Medical School. The project will improve the care of patients from a predominantly Negro population group by setting up an intensive care etroka unit in the hospital and by developing extensive follow-up services for stroke patients. The unit will be used for training medical students, area physictans, nurses and paramedical personnel in the latest techniques of stroke management. There will be research studies undertaken on diagnostic methods, epidemiology and the cultural, behavioral and socio-economic consequences of stroke. Also submitted for review are stroke projects to be operated at George Washington University Hospital, D.C. General Hospital and Glenn Dale Hospital which would combine university and D.C. Department of Public Health efforts, Missouri Regional Medical Program will establish at Kansas City General Hospital a special diagnostic and treatment unit for patients with cerebrovas- cular disease. Approximately 500 patients a year will be referred from the emergency room, outpatieht departme nt, clinical services of the hospital and from physicians in the surrounding communities. Kansas City General Hospital serves the majority of indigent patients in the Kansas City, Missouri area and will provide the back-up to an OEO neighborhood health center now under develop- ment in the communfty. Missouri Regional Medical Program and Kansas Re- gional Medical Program have also established a greater Kansns City Maison com- mittee to review and coordinate the activities of both programs in the metropoli- tan area. Georgia Regional Medical Program has submitted for review a project for the development of a community hypertensive contro} program, to determine the most effective methods to identify symptomatic hypertension in an urban ractally mixed community in Atlanta. The project which would be conducted by the Georgia State Health Department would assess the most effective methods te achieve good blood pressure control in these hypertensives, train lay blood pres- sure aids, and determine whether a community program in hypertension control is economically feasible using public health methods. . . DEPARTMENT OF HEALTH, RoucATION > AND WELFARE STATEMENT ON Orrzationa, Prosects Arrectina RuzAL AREAS ALBANY REGIONAL MEDICAL PROGRAM Many of the Albany operational activities will serve to enhance the capabili- ties of health professionals in the rural areas. By bringing professionals from small communities into the medical center for continuing education and by im- proving communications between the medical center and the communities they hope to raise the level of patient care in those communities. The following proj- ects involve rural areas: Operational Projects 1. Two-way Radio Communtoation System: Direct Oost, $144,100 This project will expand an exis hospitals and 24 high schools. It will also provide information and education pro- grams for administrators, members of boards of trustees, voluntary health agen- _ cies, adult education classes, and selected civic groups. 2. Community Information Coordinators: Direct Oost, $73,800 Former pharmaceutical representa: tives will be used to contact local physicians to tell them about Regional Medical Programs and to evaluate their attitudes towards RMP. Ss. Community Hospital Learning Oenters: Direct Oost, $75,800 This project will establish learning centers at community hospitals using “Self Instruction Units" and audio-visual equipment for rapid dissemination of new medical knowledge. Eventually, the directors of this project hope to evaluate physician progress. Initially, 8 hospitals will be involved. 4. Community Hospital Coronary Care Training and Demonstration Program: Direct Cost, $55,400 community hospitals: Pittsfield General, St. Lukes, and Vassar Brothers. These 5. Training and Demonstration Proj Memorial Hospttal: Direct Cost, ject, Intensive Cardiac Care Unit Herkimer $3,500 The tnitial phase of this project is to train 6 or 8 nurses from small community hospitals in cardiac anatomy and physiology, coronary disease, the principals and atafling of a cardiac intensive care unit, and in handling the complex equipment. These nurses will also be sent to Albany Medical Center for active training with | specialized equipment. -65- INTERMOUNTAIN REGIONAL MEDIOAL PROGRAM The Intermountain Regional Medical Program has essentially three types of projects for remote communities. Several projects are educational involving the training of health professionals who are brought into the medical center. Other projects send specialists from the medical center to the smali communities to aid local physicians with specific areas of patient care. A third type involves the use of electronic monitoring equipment which transmits physiological signals from patients in remote areas to the medical center for interpretation. A listing of these projects follows. . Operational. Projects 1. Network for Continuing Education in Heart Disease, Cancer, Stroke and Re- lated Diseases: Direct Cost, $245,000 The objectives of this program are to develop a communications network be- tween patient-care and research institutions to encourage liaison between health care personnel in the area. The currently existing 2-way radio systems, including 11 hospitals,in 7 communities fn or near Salt Lake City, will be extended to remote hospitals to serve as one link. Closed circuit TV and use of KVED (Unt- versity of Utah education TV) is also planned. This may establish the community , hospital as the locus of continuing education. 2. Information and Communications Exchange Service: Direct Cost, $40,800 The CIES is a region-wide clearing house for information about IRMP. Staff will be put in local communities to act as public relations representatives and also to distribute information to medical personnel and the public, The community staff will also gather information on community needs and resources and serve asa station for collecting economic, social, and medical data. 3. Cardiopulmonary Resuscitation Training Program: Direct Cost, $63,400 The University of Utah will give a 3-day course in resuscitative techniques to selected physicians from small communities. Each physician will then be responsi- « ble for teaching the techniques to health personnel.in his community. This re- suscitation consultant will also collect data about the number of times resuscita- tion is employed and the results. : 5. A Training Program in Intensive Cardiac Care: Direct Cost, $118,600 A core faculty of experts in using Cardiac Care Units and diagnosing and treat- ing heart disease will teach short courses in their subjects. The students will be interested physicians and nurses from community hospitals building coronary care units. . 5. Training for Nurses in Cardiac Care and Cardiopulmonary Resuscitation: Direct Cost, $34,000 . This is an integral part of both the cardiac care and cardiopulmonary resuscita- tion programs for physicians (#3, #4). Nurses trained in Salt Lake City will re- turn to their communities to serve as a core faculty for teaching the techniques at the local level. The nurses will work closely with the similarly trained physicians. 6. Visiting Consultants and Teacher Program for Small Community Hospitais: Direct Cost, $14,800 Small communities will be given the option of requesting one or two-day clinics, A minimum number of four cardiac patients will be required. These clinics will upgrade the level of care of victims of heart disease living in a remote area. Visit- -ing physicians will assist the local physician in a precise diagnosis of his patients. 7. A Regional Computer-Based System for Monitoring Phystologic Data on-line from Remote Hospitals in the Regional Medical Program: Direct Cost, $687,100 This project’s purpose is to test the feasibility of using a central computer to process a variety of physiological signals generated by patients in remote hos- pitals, feeding the results of calculations from these signals back to stations with- in the hospitais, and using the information for diagnosis. 8. Cancer Teaching Project: Direct Cost, $94,800 This project attempts to upgrade the level of care available to local communl- tles. The co-ordinator will direct a program of physician education to create trained cancer specialists who, in turn, will become centers of cancer informa- tion in their local communities. The physicians will receive a small stipend for teaching and obtaining information. A region-wide tumor registry wlll be started as will a training program in new techniques for pathologists. 9. Stroke and Related Neurological Dtseases: Direct Cost, $98,700 This project will establish clinics to bring expert consultation service in stroke and related neurological diseases to local communities; will provide continuing education to local physicians and nurses ; will collect data about stroke patients seen and the problems they present to the practitioner. A 24-hour telephone consultation service and information library service will be maintained at the Utah Medical Center to provide community physicians with immediate advice. In addition, practicing physicians will be trained at the medical center in the — diagnostic and treatment techniques. The courses will last from 4 weeks one year. ce Ce te . -66- - ’ *ANSAS EEGIONAL MEDICAL PROGRAM The Kansas Region 1s emphasizing cardiovascular care in its rural programs. In addition it is setting up a comprehensive model training program in a small community. The project descriptions follow: Operational Projects 1. Education Programa-—QGreat Bend, Kansas: Direct Cost, $261,000 To develop a model educational program in this small community a full-time faculty, which will be affiliated with the Kansas Medical Center, will be in residence. Included in this comprehensive program Are plans for continuing physician and nurse education and clinical traineeships for health-related per- . sonnel, Studies will be made of community needs, resources, ete. 2. Cardovascular Nurse Training: Direct Cost, $98,500 To develop an in-service training program to prepare nurses, who are the : mainstay of coronary care units in community hospitals, with basic physiological ‘ - knowledge of coronary care, ability to use instruments and equipment in coro- nary care units, experience in home care, and familiarity with social agencies that can aid in the rehabilitation of patients. 8. Cardiovascular Work Evaluation: Direct Coat, $21,100 - This project will demonstrate the Cardiac Work Evaluation Unit and show its usefulness for the evaluation and rehabilitation of the patient. It is developing an effective technique for showing physicians and the community at large the ‘ability of patients to return to work after receiving the appropriate rehabilitation. MISSOURI REGIONAL MEDICAL PROGRAM * The Missouri Regional Medical Program operational activities involve projects directed toward improved screening techniques, early disease detection and rapid diagnosis, and more effective delivery of services. These are coordinated with automated systems for transmission of information and health data to aid physicians and community hospitals in the treatment of patients with heart disease, cancer, stroke and related diseases. Six projects focus on the health needs, the care of patients, and training of staff for rural communities. Operational Projects 1, Smithville Community Health Service Program: Direct Cost, $200,957 To establish a model community health service program including continuing education and training programs and health education for the public; emergency intensive and restorative care facilities; home care programs; public health, preventive medicine, and school health; coordinated with voluntary health agen- cies. Program centered around Smithville (population of 3,500) and.to include about 50,000 persons in Clay County. Activities are centered around Smithville Community Hospital (15 beds), and the group practice clinic as a nucleus. 2. Multiphasic Testing of an Ambulant Population: Direct Cost, $421,471 To establish centers for performing series of diagnostic laboratory tests to identify the most useful tests feasible for screening large rural population groups; determine the different patterns for ill and healthy populations as an aid in detection of heart disease, cancer, and stroke in preclinical stages. Model test centers will be established at the University Medical Center, Columbia, the State Mental Hospital and a third is planned for the Smithville complex. 8. Mass Screening—Radiology: Direct Cost, $54,814 To improve the accuracy of radiologic diagnosis of heart disease, cancer and stroke through electronic communications media. Three small rural hospitals will be hooked into the University of Missouri computer and Department of Radi- ology; to evainate diagnostic efficiency and determine applicability of ultra- sound and thermography in diagnosis and therapy. : : 4. Comprehensive Cardiovascular Care Unita—Springfleld, Missourt: Dircct Cost, $69,847 : To develop a comprehensive care unit for grouping patients with heart dis- ease or other circulatory system illness or who have been admitted for other ‘ purposes but require close cardiac observation. The project is to be undertaken at hospitals soithout a@ house staff, where it is hoped that grouping of patients will relieve the workload for nurses on general medical and surgical wards. Springfield (a community of over 100,000) has 4 general community hospitals -67- ranging in size from 84 to bil (a total of about 1,200 beds). St. John’s Hospital medical staff and Greene County Medical Society are coordinating activities with 8 local hospitals in Springfield. 5. Automated Electrocardiography in a Rural Area: Direct Cost, $369,000 To provide hospitals and physicians in rural areas with automated facilities for transmitting electrocardiograms and an automated system for analyses of ECG's; to demonstrate the feasibility of such systems where this service is Nmited or non-existent, and to develop, test and implement the use of bioengi- neering signais ag an ald in diagnosis. 6. Operations Research and Systems Design: Direct Coat, $39,055 To develop systems concerned with testing “early detection” hypothesis- develop operational methods of early detection tests for a large rural population. MOUNTAIN STATES REGIONAL MEDICAL PROGRAM Operational activity in the Mountain States Region is specifically designed to benefit small hospitals in rural areas and to train health professionals from rural areas, Operational Projects 1, Intensives Coronary Care in Small Hoapitals in the Regton: Direct Cost, $206,913 Hospitals in the region will send registered nurses into St. Patrick’s Hospital, Missoula, Montana, for coronary care training. This three-week course will be offered three times a year for 21 nurses, and there will be follow-ups at the home hospitals four times “fi year. In addition, a 4-day training program especially designed for small town physicians will be held at the University of Montana four times a year, NORTH CAROLINA REGIONAL MEDIOAL PROGRAM In North Carolina there are 10 funded operational projects all of which have a direct effect upon hospitals, health professionals, and patients in rural areas. Some are concerned with education and training of physicians and allied health personnel, and others with patient care. All of them are designed to bring the ae scientific advances down to the community level. The projects are listed as follows: Operational Projects 1. Education and research in community medical care—direct cost, $209,200 To develop resources for training more medical and allied medical students; to provide new types of educational experiences which will make family practice more attractive; to have a postgraduate education program at the medical school; to strengthen ties between the medical school faculty and practicing physicians; and to have the medical school become involved in community plan- ning for improving the quality and availability of medical care. Affected by this project are the following groups: the University Community ; the Caswell County Rural Health Services Project; the Regional Health Council of Eastern Appa- lachia, Inc.; the State of Franklin Health Council, Inc.; the Charlotte Memoria] Hospital; the Moses Cone Memorial Hospital, Greensboro; and the Dorothea Dix Neuromedical Service. . 2. Coronary care training and development—direct cost, $55,988 To use the project as a medium for developing cooperative arrangements among the various elements in the health care community. Initial and continuing educa- . tion will be provided to nurses and physicians in community hospitals, consulta- tion will be available to hospitals in establishing CCU’s, and a computer-based system of medical record keeping will be developed. This project has led to new working arrangements: (1) between the university medical centers; (2) be- tween medical and nurse educators; (3) between doctors and nurses in commu: nity hospitals; (4) between university medical centers and community hospitals. 8. Diavetic consultation and educational services—direct cost, $132,081 To establish three medical teams to deliver services throughout the state; to assist in expansion of diabetic consultations and teaching clinics; to provide seminars for physicians and teaching sessions for nurses and patients; to assist in organization of a State Diabetes Association and local chapters; to test tech- niques of data collection. Many people of different disciplines in many communti- ties are involved in this project. 4. Development of a central cancer registry—direct cost, $66,615 To devise a uniform region-wide cancer reporting system, integrated with the PAS, the computer-stored data from which can be retrieved to serve a broad range of educational, research, statistical, and other purposes. The following hospitals are participating in the first year of the project : Duke University Medt- cal Center, North Carolina Memorial Hospital, North Carolina Baptist Hospital, Charlotte Memorial Hospital, Veterans’ Administration Hospital, Watts Hospi- tal, Hanover Memorial Hospital, Southeastern General Hospital, Craven County Hospital. In subsequent years the registry will be expanded to include all how pitals and physicians in the region. beste oo . lee ee -68- §. Medical library ca tension aervice—direct coat, $25,839 To bring medical library facilities of the three medical schoola Into the daily work of those engaged in medical practice. Local hospital personnel will be trained to assist medical staff; Hbraries will be organized into a functional unit for responding to requests for services. Bibliographic request service will be established, 6. Cancer information center—direct cost, $41,716 To provide practicing physicians with immediate consultation by telephone and follow-up literature. Each of the three medical schools will he responsible for providing service in its geographic locale. The aims of this project are two- fold: (1) to assist physicians in providing optimum care of patients with cancer; and (2) to continue the education of the physicians by giving new information in n patient-centered experience. %. Continuing education in internal medicinc—direct cost, $38,318 To bring practicing internists from all over the state to the Medical Center for a month of up-to-date training in their subspecialties. They will share respon- sibilities with attending physicians and make ward rounds with students, staff, and together. This experience should enhance the appreciation in the University, both at faculty and student levels, for the expanding role of the medical center for the quality of care in the community. t 8 Continuing education in dentistry—direct coat, $67,508 To provide physicians and dentists with the knowledge of mutual concern which will enable them to be more effective members of the health team. Courses will be given at the University of North Carolina and in communities. Studies will be made of facilities needed to provide dental care in hospitals. The purpose of this project is to insure that as many patients as possible who suffer from heart disease, cancer, stroke, or a related disease receive appropriate dental care as 8 part of their comprehensive treatment. 9. Continuing education for physical theraptste—direct cost, $27,888 . To develop and establish regional continuing education programs for physical therapists in order to strengthen physical therapy services for patients in all parts of the state. Subregions will be delineated where needs and interests will be identified and committees will be organized to arrange local activities. 10. The establishment of a network of coronary care units in emall communtty hospitals in Appalachia, North Carolina—direct cost, $98,019 This is a proposal to develop coronary care units in seven hospitals in this rural, mountainous area. RMP will supply the monitoring equipment (the hospi- tal provides suitable space) when adequately trained physicians and nurses are available. An intensive training course for physicians will be conducted in the geographic region, and continuing education programs will be conducted when necessary. TENNESSEE MID-SOUTH REGIONAL MEDICAL PROGRAM Due to the geographical diversity of the region, the Tennessee Mid-South Regional Medical Program has been coneerned with both the health problems of the urban poor as well as the health problems of remote rural areas. The Tennessee program has sought solutions to these and other regional programs through a system of linkages between the medical centers and the rural areas. In addition to providing programs to allow medical personnel and practicing physi- cians from rural community hospitals to come to the medical center for training courses, the Tennessee program has endeavored, through the use of modern com: munication techniques, to create medical education resources in the rural areas. The Hopkinsville Education Center and the deployment of coronary care units are two examples of such projects, Operational Projects 1 and 2. Hopkinsville Education Center and Chattanooga Education Center— direct cost, $73,700 These are the first of the local continuing education centers specified in the Vanderbilt plan. At each hospital, a full-time Director with an appointment at Vanderbilt and an assistant director will supervise resident and physician educa- tion in their area. Their services will be available to physicians at smaller com: munity hospitals in each area, as will the enlarged hospital library facilities. The Chattanooga and Hopkinsville locations provide the basis for looking at problems in continuing education in urban and rural settings. 8. Franklin Uoronary Care Untt—Witliamson County Hospital—Franklin— direct cost, $31,400 This is one of the subsidiary units mentioned in the Vanderbilt proposal. This is primarily a pilot project to study the feasibility and usefulness of establishing a center in a small community hospital. 4. Oe pon Coronary Care Unit—Olarkevtile Memorial Hosptial—direct cost, , As the Franklin program, this project is a subsidiary of the Vanderbilt pro- posal, Since this hospital has been operating a unit, the plan calls for its expan- sion, continuing education and a phone hook-up to Vanderbilt. SSSA EAA Oe -69- & Murray Coronary Care Unit—Murray-Calloway (Ky.) County Hospital: . _ Direct Cost, $88,800 Murray-Calloway County Hospital, the training center for Murray State Uni- versity school of nursing, will serve as a demonstration center for the sub-region. Direct phone communication will be established with Vanderbilt, which will send consultants from its school of continuing education. This project has the dual : objective of relating the Murray State Nursing program to an established medi- , cal center and providing regional training resources to a remote area. 6. Oroasville Coronary Care Unit—Uplands Cumberland Medical Center Crosa- ville: Direct Cost, $28,800 This project has two purposes: (1) to establish a two-bed coronary care unit in the hospital ; and (2) to determine the feasibility of operating acute coronary care units in rural areas. The hospital will cooperate with Mid-State Baptist Hospital and Vanderbilt. ‘ %. Tullahoma Coronary Care Untt—Harton Memorial Hospital, Tullahoma, Tenn.: Direct Cost, $28,800 See Baptist Hospital Program. &. Project to Improve Paticnt Care tna Remote Mountain Community by Reerutt- . . ing and Training Health Atdces for a New Extended Care Facility—Scott County Hoapital—Oncida, Tenn.: Direct Cost, $10,300 Manpower shortage in this isolated mountain hospital {s critical. Personnel to man an extended care facility now under construction will be obtained by two methods: (1) In-service training for nospital personnel ; (2) an educational di- rector (an RN) to serve as a liaison to the high schools to encourage young peo- . ple to enter the medical field and come back home to practice. In addition a training program leading to the LPN would be initiated. Clinical training will be supervised by the Educational Director while local high schools provide basic training. 9. Hopkinsville Coronary Carc Unit-—Jennie Stuart Mecmortal Hospital—Hop-. hinsville, Ky,: Direct Cost, $49,500 ; This plan is similar to the Franklin plan, except that it mentions establishing . links to smaller community hospitals by helping set up smaller care units in them, thus providing for the grouping of rural community hospitals for more efficient use of existing resources. 3 ' WASHINGTON-ALASKA REGIONAL MEDICAL PROGRAM i The Washington-Alaska Regional Medical Program operational projects con- ‘ cern themselves largely with continuing education and training activities to en- : . hance the medical and paramedical capability. They focus on communications : techniques and instruction materials and methodologies which are adaptable to e the far flung and remote communities in the vast State of Alaska and the many ‘ scattered rural communities in Washington State. Several projects are being con- ducted to improve the health manpower resources in communities with limited or no specialty health services, which are distant from a major medical center. Operational Projects 1. Central Washingiton—Communication System for Continuing Education for Physicians: Direct Cost, $18,181 To bring the medical resources of the University of Washington to physicians and community hospitals in Yakima, who in turn will act as consultants to sur- - rounding smalier communities through seminars and conferences, educational TV, - other audio-visual instruction; and exchange of teachers and practitioners. To connect internists in Central Washington to Yakima cardiologists via EKG tele- phone hot-line, to permit quick analysis (starting with 5 community hospitals). Yakima is a community of about 45,000. The total population in 6 Central Wash- ington counties exceeds 300,000. In addition to three general hospitals in Yak- ima—S8St. Elizabeth, Yakima Valley Memorial, and New Valley Osteopathic—nine other community hospitals to be reached Initially are located in small rural com- munities of Ellensburg, Moses Lake, Othello, Toppenish, Prosser and Sunnyside, (population ranges from 500 in Moses City to some 8,600 in Ellensburg.) 2. Southeast Alaska—Postgraduate Education: Direct Cost, $27,062 To improve communication between Seattle Medical Community and the uni- versity to alleviate problems of the isolated physicians in southeast Alaska cities and communities: Juneau, Sitka, Ketchikan (3 largest). As in Central Washing- ton several methods will be used such ss telelectures, consultant services, semi- nars and the EKG hot Hne to hospitals in Juneau, Sitka and Ketchikan. The popu- lation in these 3 cities totals about 17,000. 8. Postgraduate Preceptorship for Physictane-—Ooronary Care: Direct Oost, $17,610 A pilot project to provide opportunity for practitioners from remote and_iso- lated communities to spend a week or more under a preceptor at major medical centers to study advances in care of coronary heart disease and carry out these practices in their communities, The 4 major medical centers in Seattle are Provi- dence Hospital, Swedish Hospital, Virginia Mason Hospital and Medical Center, : and University Hospital and Medical Center and two in Spokane are Deaconess v ' ‘ Hospital and Sacred Heart Hospital. a NN On ee -70- 4. Cardiac Pulmonary Technician Training: Direct Oost, $4 1584 ! Develop a formal program for training cardio-pulmonary technicians to per- : form non-critical function in coronary care units and free physiciana for other duties. Four larger general hospitals in Spokane—Deaconess, Holy Family, Sacred Heart, and St. Luke’s—will participate in this training program with Spokane Community College. 5. Tico-way Radio Conference and Stide Presentation: Direct Cost, $8,445 Six pilot programs on heart, cancer and stroke topics to be transmitted via ae 6. Alaska Medical IA brary Facilities: Direct Oost, $21,754 To develop a community medical Nbrary for Alaska at the PHS Alaska Native Medical Center, Anchorage for Alaska physicians and health related staffs and agencies; to have close tles with community agencies, Arctic Health Research, University at Fairbanks and to supplement continuing education Project for Southeast Alaska and the Anchorage cancer project. i WESTERN NEW YORK REGIONAL MEDICAL PROGRAM oS . Both of the programs in the Western New York region have a difect effect upon hospitals, health professionals, and patients in the rural areas. Particular empha- sis will be placed upon involving community hospitais and on training nurses from community hospitals in rural arenas, The Projects are listed as follows: “~~ Operational Projects J. Two-Way Communications Network: Dircct Coat, $170,519 A two-way communication network will link hospitals of Western New York and Erie County, Pennsylvania to the Continuing Education Departments of the State University of New York at Buffalo and the Roswell Park Memorial Insti- tute. The network will serve several purposes, such as continuing education for y physicians and the health-related professions, public education, administrative environment in having at their fingertips the latest advances in the diagnosis and treatment of heart disease, stroke, and cancer, Particular emphasis will be . Placed upon involving rural hospitals in this program thereby improving both . , their didactic and restorative function. £. Coronary Care Program: Direct Cost, $127,544 This project will test a training technique for providing qualified nurses who will be required to staff developing coronary care units in the Region. Approxi- ing will return to both rural and urban hospitals for the purpose of providing a diagnostic and didactic function. While the program will be housed at the medi- cal center, the community hospitals of this region will be the benefactors of the project. Since there are few nurses trained to work in coronary care units, par- ticularly in the rural environment, special attention will be paid to attracting nurses who will return to the community hospital. WISCONSIN REGIONAL MEDICAL PROGRAM - Four of the Wisconsin projects have relevance to the improvement of health care in a rural setting, through the provision of education and infor- mation. Physicians and allied health personnel in community hospitals will benefit from the following projects: Operational Projects 4. A pilot demonstration program for pulmonary thromboemboliam: direct cost, $84,600 . ‘ “In this project a center is being established at Marshfield Hospital in Marsh- field, Wisconsin, for demonstration diagnostic techniques and the available therapy for pulmonary thromboembolism. The project has a continuing edu- cation component which will reach physicians from many hospitals in the Re- gion. This will involve a 24-hour consultation service, the preparation of a movie on the topic, and special training sessions for groups of physicians. The project will demonstrate a comprehensive program which will encom- pass diagnostic, preventive, therapeutic, and rehabilitation procedures for pa- tients, postgraduation education, a rapid transportation system for patients from Northern sections of the state, and cooperation between the clinie and other hospitals and medical schools in the State. 2. Tcicphone dial accese tape recording Ubrary in the areas of heart disease, cancer, stroke, and related diseases: direct cost, $18,950 This feasibility study will be carried out by the University of Wisconsin which will record and store short, 4-6 minute, tapes on various aspects of treating patients with the three diseases. Any physician anywhere in the Region can gist pad library at any time and request a tape relevant to a problem tn which / - : ie erested, , : . .. . : 4 Pome ed Sate Rg Me cae beeen ee -71- 8. Nursing telephone dial access tane recording Ubrary in the areas of heart digcasce, cancer, stroke and related diseases: direct cost, $18,800 This feasibility study, similar to the one above, will establish a central tape library with information recorded on nursing care in emergencies, new pro-. cedures and equipment, and recent developments in nursing. Nurses from any hospital in the region will be able to call at any time to have a tape played o them. 4. Development of medical and health related single concept film program in community hospitals: direct cost, $33,250 This education feasibility project involves ten community hospitals in its first phase. Fifteen films on procedures and techniques used in treating heart, cancer, and stroke, will be developed. Projectors and the films will be installed tn the hospitals for use by physicians and other health personnel at their con- venience as a continuing education device. After four to six months the ma- terials will be relocated in ten additional hospitals. DEPARTMENT OF HeALTH, EDUCATION, AND WELFARE STATEMENT ON EFFECTIVENESS ‘ or ReatonAL MEDICAL PROGRAMS £ The effectiveness of Regional Medical Programs is determined in the following ways: valuation of the effectiveness of each Regional Medical Program is a con- tinuous process which, involves review by the Federal Government, its non- Federal advisors, and the grantee itself. These review activities are specifically intended to determine the extent to which the region has implemented the proc- ess of regionalization which includes seven essential elements: involvement, identification of needs and opportunities, assessment of resources, definition of objectives,, setting of priorities, implementation of program activities, and self- evaluation. This process of regionalization is the means by which the region moves toward its ultimate objective—the assurance of easily accessible improved patient care for henrt disease, cancer, stroke, and related diseases. A systematic and comprehensive review of the scientific and administrative aspects of each Regional Medical Program has been designed in order to deter- mine the extent to which each Regional Medical Program implements this proc- ess of regionalization for the purpose of achieving its goal of improved patient care, This review process includes surveillance at the regional and Federal level, and is conducted by both non-Federal and Federal experts. By law each opera- tional activity must be approved by the Regional Advisory Group prior to its submission to the Federal Government for review and approval. Frequently the regions themselves have elaborated on this requirement by establishing local, in addition to rertonal, advisory bodies and/or scientific review bodies which also carefully examine proposed activities. A site visit by members of the Review Committee and the National Advisory Council on Regional Medical Programs to the region is included as an integral part of approving an operational program for a region. As the operational pro- gram develops and is expanded additional site visits are made. Finally each Regional Medica! Program is required to submit an annual progress report which describes in detail the region’s program. Any proposed modification in program direction by the grantee must be justified in writing and subjected to these review procedures. Within the context of this comprehensive review process it is possible to deter- mine whether or not a regional program is in fact evolving a regional system intended to improve patient care. The Missouri, Kansas, Albany, New York, and Intermountain Regional Medical Programs were the first to enter the operational phase of development. The determination of their readiness to begin operations was a result of the review process described above, including a site visit by members of the National Ad- visory Council and members of he staff of the Division of Regional Medical Programs. The progress of these regions has been further evaluated during the review of supplemental grant requests which have been received from all four regional programs. Further site visits by Council and/or staff to review the first year's progress have either just been carried out or are scheduled for the immediate future. The results of these reviews carried out to date Indicate that these Regional Medical Programs are making substantial progress toward the goals set forth a year ago as the basis for the operational grant award. The major problems encountered have been difficulties in recruiting personnel and slowness in the delivery of important equipment. These factors have caused some — delays in implementing particular projects. In addition to this evaluation at the national level, the regional programs are developing their own capabilities for self-evaluation. Special ataff has been added to the central staff of the regional programs with specific competence in © evaluation techniques. These techniques are being further developed and ap- plied to the operational activities. ss - — ‘ : Lo .