iu e © tt (C My thesis...has been that the concept of a cammunity trusteeship is the most viable element in Our society, and Government must be willing to deal on a local basis with issues that can be identified and corrected locally. My responsibility is to make it possible for that to happen. ! believe we should move away from Federally directed activities and towards really autonomous responsibilities on the part of the Regional Medica! Programs. Harold Margulies, M.D. Acting Director, Regional Medical Programs Service from a talk on “Trends in Health Care,” given at the Annual Meeting of the lowa RMP on June 26, 1970. ae TABLE OF CONTENTS D i CHAPTER PAGE 1. OVERVIEW OF THE REGION (0.0.0... 1 Features and Services 20... cc 2 Relationship with Neighboring Regions . 2... ee 2 Housing of RMP for WNY 20. 2 Geography 0 ee 3 it. RELATIONSHIP OF RMP FOR WNY TO OTHER HEALTH-RELATED ORGANIZATIONS ....... 5 ltl. ORGANIZATION AND STRUCTURE .. 0.00. 7 The Volunteer’s Contribution 0 0 8 Regional Advisory Group 6. ee 8 County Committees 2... ee 8 Standing Committees 2... 0 8 Core Staff. 000 8 IV. CORE STAFF ACTIVITIES 0.000 13 Data Collection 2.0. 14 Community Health Information Profile Data System 2... 6 ee ee 14 Ambulance Service 2... 14 Kidney Disease Service, Facilities, and Programs in the United States .......-..--55 14 Manpower Problems .. 0... 0 ee 15 Buffalo Summer Student Program 6 ww ee 15 Rural Externship Program... 15 Research and Evaluation 2... ee 15 Coronary Care Unit Nurse Profile 2... ee 15 Telephone Lecture Network System Evaluation... 0. 2. ee 16 Communications 2.00 16 Continuing Education 2.0. ee 16 V. EVALUATION 200 es 19 Program 6. 20 Projects 6k 20 Studies 2. 0 20 Vi. THE PROGRAM 1.0. 21 New Legislation 2.0 ee 22 Grand Design 20. ee 22 Developmental Component .. 0... ee =SO©MNAARWN PROGRAM OPERATION . 0... ce FIManceS © oo ee 26 Financial Management . 6.6. 26 Financial Statement: March 1, 1970- February 28,1971 2.2... 6.6 eee ee ee eee eee 26 Proposal Review Process... 6 ees 26 Operational Projects 2... ns 27 Funded and On-Going 2. 27 Component No. 1 - Telephone Lecture Network «2... ee ee es 27 Component No. 2 - Coronary Care Training Program... ee ee ee 29 Component No. 3 - Chronic Respiratory Disease Program ww ee ee 29 Component No. 4 - Immunofluorescent Service and Training Program . ot ee 29 Component No.5- Tumor Registry 2.62 ee 30 Approved but Unfunded by Regional Medical Programs Service (Locally supported for one year through carryover or rebudgeted funds.) ......-... 30 Component No. 13 - Topical Chemotherapy Treatment for Precancerous Lesions and Cancer of the Skin 2... ee 30 Component No. 14 - Information Dissemination Service 2... es 31 Component No. 16 - Hematology Center, Blood Coagulation Reference Laboratory... 0. ee 31 33 Status of Proposals 6... es TABLE OF FIGURES FIGURE PAGE Regional Medical Program for Western New York Map... ee 3 RMP for WNY Relationship to Other Health-Related Organizations .. 1... 6 60 e eee eee 6 Composition of Board of Directors of the Health Organization of Western New York, Inc. ......... 9 Board of Directors, Health Organization of Western New York, Inc. «2... eee ee 10 County Committee Chairmen 2... 11 Standing Committees ©... es 12 Continuing Education 20. 0 17 24 New Legislation . 0... ee Financial Statement: March 1, 1970- February 28,1977 2... ee 26 Proposal Review Process . 6... Status of Proposals 2. Overview of the Region Features and Services The estimated population of the nine-county area of RMP for WNY is two million. Over half of this population resides in Erie County (N.Y.), and one-quarter of the total population, or one-half million people, reside in the city of Buffalo and its immediate suburbs. Personnel-population ratios are a dramatic illustration of the disparities in distribution of health personnel within the area. For instance, the number of staff nurses available varies from two nurses per 1,000 population in the metropolitan Buffalo area to less than one-quarter of a nurse per 1,000 population in a disadvantaged area south of the city. Rural areas lack personnel in many job categories, suggesting that residents of these areas must necessarily travel considerable distances for many health services. This variation in accessibility necessitates careful planning to insure better health care for a// persons in the region. Relationship with Neighboring Regions TO THE NORTH - The southwestern penninsula of Ontario, including the two major towns of Hamilton and Toronto, is our nearest northern neighbor. Our relationship with the Canadians is most cordial, especially in the area of continuing medical education. The RMP for WNY’s Nursing Program in Coronary Care has attracted many Canadian nurses. Sponsoring Canadian institutions have paid the full costs for their participants, foreshadowing a self-supporting status for the nursing project. The Telephone Lecture Network has received, though not yet accepted, a number of applications for outlets from Ontario hospitals. We seek to encourage this relationship which transcends artificial territorial borders. TO THE SOUTH AND EAST - The Coordinator of the RMP for WNY has maintained friendly, personal relationships with Dr. Ralph Parker and Dr. Robert Carpenter, his counterparts in Western Pennsylvania and Rochester. The Telephone Lecture Network has provided outlets in hospitals of both these neighboring regions. The implementation of RMP for WNY has coincided geographically with the establisnment of three different Comprehensive Health Planning "hl agencies--Western New York, Rochester and Pennsylvania. Such overlap is inevitable since RMP has a flexible, regional perspective whereas ‘’b’”’ agencies tend to be restricted within state boundaries and funding mechanisms. Also, the same planning area is not necessarily optimal for both organizations. We have made specific contacts with the CHP of Erie, Pennsylvania and representatives of the adjacent Comprehensive Health Planning agencies overlapping our region. It is too early to give a detailed description of this relationship, since these agencies have yet to define themselves operationally. However, it is apparent that more formalized and tangible working relationships will be evolved in the near future. ACROSS THE STATE - Discussions with neighboring RMPs across the state have been very important to good inter-regional cooperation; these discussions can be extended through the Northeastern group of RMP coordinators. Housing of RMP for WNY The core staff is housed at 2929 Main Street in Buffalo, New York. We now possess two conference rooms which are heavily used by committees of the program, both official and ad hoc, and which have immeasurably improved our role as an enabling agency. Furthermore, core staff offices provide housing for the Telephone Lecture Network (TLN). As the vehicle for information, both academic and administrative, TLN has been the means of maintaining continual community involvement. The RMP headquarters now has the capacity through TLN to link with all communications media in the Western New York-Pennsylvania region. THE TORONTO HAMILTON GEOGRAPHY The Regional Medical Program for Western New York (RMP for WNY) now includes nine counties: Niagara, Genesee, Erie, Wyoming, Chautauqua, Cattaraugus, and Allegany counties in Western New York, and Erie and McKean counties in Northwestern Pennsylvania. Our latest addition was McKean County, officially admitted in April 1970. DUNKIRK ECHANISM Grants, with two-year availability of funds. Adds contract authority as well as RMP grant authority and permits regions to obtain services in-kind from federal agencies. One-year availability of funds. _ -EGIONAL . NVISORY - UPS Composition: There must be included practicing physicians, medical center officials, hospital administrators, representatives from appropriate medical societies, voluntary health and other health-related agencies, and members of the public familiar with health needs. Figure 8. New Legislation A Requires official health and health planning agency representation on such advisory groups; requires that public members include persons familiar with the financing of as well as the need for, services, and that such public members be sufficient in number to insure adequate community orientation. Also includes a representative of the Veterans Administration as an ex officio member, if there is a VA institution in the region. Program Operation 25 Finances Financial Management Under the concept of level funding developed by the Regional Medical Programs Service about a year and one-half ago, the Regional Medical Program for Western New York can anticipate no increase in funds. At present new projects can be financed only by making existing ones self-supporting or by phasing out those that have achieved their purpose. Thus the effectiveness of projects must be reviewed and expenditures examined in relation to the program asa whole. It is the responsibility of the H.O.W.N.Y. Board to pass upon recommended transfers or to initiate transfers of funds from one approved project to another, in such a way as to best attain the goals of the Regional Medical Program for Western New York. Proposal Review Process The author of a project idea or proposal may approach RMP via the county committees, Dr. John R.F. tngall, or liaison staff. Alternatively, RMP may invite the development of a proposal to redress a recognized deficit in the region. The entire core staff reviews the proposal to advise what is allowed under the new legislation and how well the proposal might fit into priorities established by the Regional Advisory Group. A staff member then assists the author in developing the letter of intent, a one-page lay summary which represents an understanding between staff and author of the intent of the proposal. Staff members continue to assist the author as he further develops and organizes his proposal, and sees it through the RMP for WNY review process. The proposal begins its review process in the county committees. The author must be prepared to appear before the county committees to further their understanding of his proposal. After a thirty-day aging process, county committee recommendations are forwarded to the Proposals Committee. The Proposals Committee has become a very strong body representing the region at large, with liberal co-option of experts in areas under discussion. It benefits from the expertise of a number of outside agencies as well as the independent review of the New York State Health Department. Following the Financial Statement: | March 1, 1970 - February 28, 1971 For the year March 1, 1970 - February 28, 1971, the Regional Medical Program for Western New York was awarded $1,962,097, including carryover | funds. i From this total, the following projects were budgeted: | I Core Program $569,884 | | | Telephone Lecture Network 202,207 Coronary Care Training Program 191,041 Chronic Respiratory Disease Program 743,945 Immunofluorescent Service and Training Program 45,994 Tumor Registry 70,760 Topical Chemotherapy Treatment for Precancerous Lesions and Cancer of the Skin 59,830 Information Dissemination Service 40,246 Continuing Education 38,190 $1,962,097 The following were financed from Core funds or re-distribution of project funds: Hematology Center, Blood Coagulation Reference Laboratory $27,700 Community Health Information Profile | Data System 58,667 Ambulatory Care Services Study 15,000 Buffalo Summer Student Program 20,800 Figure 9. Financial Statement: March 1, 1970 - February 28, 1971 26 suggestions of a federal site-visit team, RMP for WNY plans to bring in even more outside consultants to the Proposals Committee. These experts will be available to help the county committees in their deliberations. Criteria for proposal evaluation include relevance to RMP, relation to a documented need in the region, technical competence of the region to fulfill the proposal, lack of duplication, contribution to improvement of patient care, presence of an evaluation component, compatability with existing health-care patterns, promotion of regional caoperation, and possibility of becoming self-supporting. The proposal must be submitted ina form that is amenable to federal review. The Proposal Committee has reviewed thirteen proposals this year. Of these, six have been approved and recommended for new funds. Recommendations of the Proposals Committee are submitted to the Board of Directors of H.O.W.N.Y. for final RMP for WNY approval. Operational Projects Our mission is to engineer change. The RMP for WNY is an “enabler,” an. organization that helps initiate projects and encourage cooperative arrangements which will improve the delivery of health care in our region. Although certain categories of disease (heart disease, cancer, stroke, kidney disease, and related diseases) are emphasized, we have always considered individual projects as part of our total program. Inter-relation between projects and the kinds of cooperative, regional arrangements which they foster have been primary considerations. Increasingly we stress our overall goals: to 1) facilitate access, 2) improve quality, and 3) decrease cost of health services to all persons in our region. 1. Funded and On-Going Component No. 1 - Telephone Lecture Network The Telephone Lecture Network (TLN) is the voice of the RMP for WNY program. The unique feature of the network is that it allows two-way communication--what is said at one point is heard at all points. A pilot study was conducted in the spring of 1968 to determine the feasibility of using the 27 telephone to expand existing continuing education programs at the Health Sciences Center, State University of New York at Buffalo. Fifteen representative hospitals of the region were involved. Twenty-six lectures were presented, seventeen for physicians and nine for nurses. A telephone network appeared to be the most suitable means of communication for the compressed geographic area served by the RMP for WNY. The most distant location is approximately one hundred miles from Buffalo, New York. The Telephone Lecture Network, a dedicated” network, became operational on September 17, 1968. Thirty-six hospitals were interconnected to participate in hour-long continuing education programs. At the present time the network interconnects sixty locations in eight Western New York counties and three Northwestern Pennsylvania counties. Each receiving location is provided with a loudspeaker and a telephone handset. The loudspeaker amplifies the incoming program and the handset permits the listening audience to comment on the program or ask a question of the lecturer. Programs normally originate from studio facilities located in the Regional Medical Program for Western New York offices at 2929 Main Street, Buffalo, New York. However, programs can and do originate from locations on the network. Lectures can also be conferenced via a long distance telephone connection. Each lecture is accompanied by visual aids in the form of 35 mm slides and/or handout materials. Since the start of the Telephone Lecture Network, over three hundred specially designed programs for professional and technical personnel in health related fields have been presented by leading teachers and practitioners. The network is currently involved in three types of educational programs: 1. continuing education of health profes- sionals 2. courses for academic credit 3. patient, family, and community education. A number of our projects are now dependent on the TLN. Core staff and various committees have come to rely on it for surveys, meetings, and regional conferences. The Telephone Lecture Network is the communication mechanism that has underscored the regional nature of the RMP for WNY. *Closed circuit audio network available 24 hours a day. PROPOSAL REVIEW PROCESS AUTHOR WNY-RMP Headquarters County Committees . As in the past, proposals Proposals Committee will be considered in order of of H.O.W.N.Y. submission from steps A through E. However, effective November 1, 1970, proposals are processed as a group from steps F through H, once a year. Board of Directors of H.O.W.NLY. At State University of New York at Buffalo: Dean of School of Medicine, Provost of Health Sciences, Vice President for Research Research Foundation of State University of New York at Albany Washington: Division of Regional Medical Programs, U.S. Department of Health, Education and Welfare Figure 10. Proposal Review Process 28 Component No. 2 Coronary Care Training Program NURSES The program seeks to develop skilled approaches to patient and family care through the synthesis of medical and nursing knowledge. The Coronary Care Training Program for nurses has been operational since March 1968. From March 1968 through December 1970, two hundred and sixty-one registered nurses have completed the six week course on intensive care of patients with acute cardiac problems. The basic format encompasses three weeks of classroom instruction and three weeks of clinical application of nursing principles and practical skills taught in Buffalo area hospitals. Objectives for 1970 were: 1. Evaluation of the curriculum and the prac- ticum 2. Increase in the number of courses presented yearly 3. Admittance of Canadian nurses to the teach- ing programs in late 1969 and in 1970. Goals include offering advanced programs in cardiac nursing care for registered nurses who have completed the basic courses of instruction. PHYSICIANS Three separate programs in ‘Modern Concepts in Coronary Care” were offered to physicians during 1969-70. Each prograrn was greatly over-subscribed; the third presentation was the result of requests and over-subscription. A total of about 200 physicians and some medical students and nurses attended the presentations last year. At least 300 physicians have been trained since the project’s inception. The status of the extremely popular Coronary Care Training Program is currently under discussion; it may. become the first self-supporting project of the RMP for WNY. Component No. 3 Chronic Respiratory Disease Program Fully funded in July 1969, this many-faceted, comprehensive project has experienced rapid development in the past year. Five physicians serve on the guiding committee, representing the five participating hospitals. The Erie County Health Department (especially the Visiting Nurses), Erie Community College, the health-related departments of the State University, and the voluntary 29 Tuberculosis and Respiratory Disease Association of Western New York all cooperate in various facets of the project. Sixteen thousand people were screened this year at a cost of $40,000 or $3.00 per screening. Hospital personnel are being trained in a general intensive care unit pending establishment of a model seven-bed pulmonary unit. The fully-equipped hospital pulmonary function laboratory trains students, physicians, and nurses of the entire area. Outpatient service has stressed home inhalation therapy. A home care program and an emphysema club were started in 1970. Education is a vital part of the project. An associate degree program in inhalation therapy has been developed at Erie Community College. Six different multi-disciplinary teaching days held in outlying hospitals have attracted a total of 922 nurses and allied health personnel. Twenty-three of the twenty-four nurses who participated in an intensive four-week course in pulmonary disease are working in the field. Forty additional nurses will complete the course by March 1, 1971. The program’s scope has been enlarged to encompass preventive care and rehabilitation. A major accomplishment was the post-graduate course in emphysema, offered for physicians. Over 200 physicians attended this year; a similar program will be offered again next year. TLN programs and support of two pulmonary fellows this past year and four fellows next year are also included in the continuing education program for physicians. Training programs, consultation, and regional teaching days held under the aegis of this project provide a tong-needed service and have contributed to improving the region’s approach to respiratory disease. Component No. 4 immunofluorescent Service and Training Program Between three and six percent of all hospital patients within our region suffer from diseases for which either the only, or the best, laboratory diagnostic tests entail FA (fluorescent antibody} analyses for tissue antibodies. One of the important FA tests, the ANF (antinuclear factor) is being requested about twenty times per week per 1000 hospital beds. The project was first funded in June 1969. In addition to providing a regional laboratory service, project staff have been involved in teaching activities. The education of physicians as to the diagnostic utility of the project continues, as does the training of laboratory technicians from throughout the region in procedures involving immunofluorescence. One hundred persons were instructed in the use of immunofluorescent tests for tissue antibodies; ten hospital technologists received individual bedside instruction; two teaching programs for pathologists were presented, one at Pathology Society meetings and one over the Telephone Lecture Network; seven pathologists and/or laboratory directors received personal conferences on specialized problems; thirty-seven practicing physicians participated in clinical pathologic conferences. Consultation with the laboratory staff is increasing as the program becomes better known. Cooperative relationships are now starting to yield geographic coverage for tissue immunofluorescent test services and training. Direct service by the central reference laboratory is provided, as well as cooperation with interested regional hospital laboratories in improving their own performance. Component No. 5 - Tumor Registry This project is seen as a major catalyst to regionalization and a means of improving the quality of patient care. The overall objective of the Regional Tumor Registry is to improve cancer control in the nine counties which are presently serviced by the Regional Medical Program for Western New York. The objective will be accomplished by: 1. Promoting improved patient care through regular, periodic follow-up 2. Assisting physicians in determining the efficacy of treatment modalities 3. Providing a valuable resource for continuing cancer education. The Registry has accessioned approximately 300 patients. With this minimal case load it has already become apparent that the Registry will serve as a valuable tool in determining areas where continuous physician and allied health education is needed. Review of these cases indicates the wide range of quality of medical care presently being given to cancer patients. The input to date is inadequate to arrive at any meaningful statistics and the time lapse has been insufficient to warrant patient follow-up. Completion of the Registry Abstract Form by personnel in the participating hospitals has resulted in a general upgrading of the hospital charts of cancer patients. The project was compromised in its initial phase by constraints on funds and the need for 30 extensive modifications of the original proposal prior to implementation. The registry is expected to be functioning fully by the end of February 1971, and self-supporting by February 1972. Twenty to twenty-five hospitals and 6,000 new cases are expected to be handled in the next year. The project has regional hospital support and the assistance of the Management Engineering Program of the Western New York Hospital Association. 2. Approved but Unfunded by RMPS (Locally supported for one year through carryover or rebudgeted funds) Component No. 13 Topical Chemotherapy Treatment for Precancerous Lesions and Cancer of the Skin Each year in the United States four thousand people die from skin cancer. There is an annual incidence of 100,000 new cases of skin cancer and at least five to ten million cases of pre-malignant karatoses. Topical anti-cancer agents, which are about 90% effective for treatment of pre-malignant karatoses and 80% effective for superficial skin cancers, have been developed at Roswell Park Memorial Institute in Buffalo. Topical chemotherapy is diagnostic as well as therapeutic; it picks up the very early lesions that are not yet recognizable clinically. Replacing a laborous surgical procedure, application of cream containing an anti-cancer drug, topical 5-Fluorouracil, and cures skin lesions in four weeks or less. Since this simple procedure is readily usable by the community physician, the RMP for WNY is supporting a project funded as of March 1, 1970 to disseminate the method and materials on a large scale throughout our area, and through analysis of data received, to develop this region as a model in skin cancer treatment for the entire nation. The project is to be developed in three phases: 1. The Buffalo-Rochester Dermatologic Society has formed a “Liaison Committee’ of six members. 2. Liaison Directors are now being oriented to link regional physicians with the Buffalo center. 3. Although topical therapy as a treatment method was to be deferred until the completion of phases one and two, a number of physicians in various parts of the region who already have specialized training with topical chemotherapy have requested the materials and offered to provide the information required for evaluation. This initial approach will be useful as a pilot project for providing information to guide the more general implementation of phase three. implementation of the initially proposed plan is proceeding more rapidly than envisaged, largely due to the interest and support of the physicians in the RMP for WNY region. Component No. 14 Information Dissemination Service This project was approved and funded for the period of March 1, 1970 through February 28, 1971. The objective is to establish in the RMP for WNY area an information dissemination service to provide physicians and allied health professionals with printed information from a broad spectrum of medical and scientific journals and books, and to alert them to new developments in their field of interest through a current awareness service. The existing Telephone Lecture Network is the communication link used to receive requests. The Health Sciences Library at the State University of New York at Buffalo is designated as the resource medica! library. High speed duplicating machines provide copies of journal articles, which are sent by mail on request. Material not available at the Health Sciences Library is secured through referral to other libraries. Although mailing of journal articles answers the bulk of requests, a bibliographic service utilizing the facilities of the SUNYAB Biomedical Communications Network is also available. Seven thousand requests per year were originally envisioned. The project director's policy of personally visiting all institutions linked to the TLN, to acquaint them with services and means of operation, has resulted in 5,000 requests for informational material in the period between June and November. Requests from nurses and _ allied health personnel, as well as physicians, testify that the service is reaching the entire spectrum of medical personnel. The deluge of requests indicates that the Information Dissemination Service is meeting a previous deficit in the community. 31 Component No. 16 - Hematology Center, Blood Coagulation Reference Laboratory This project was started with partial funding on September 1, 1970. A laboratory has been organized which is capable of diagnosing all--including the rare--hemorrhagic and thromboembolic problems on a twenty-four hour day basis. Between September 1 and December 29, diagnostic work-ups have been performed for 111 patients. In September, for example, a total of 662 blood coagulation studies were carried out for the thirty-two patients referred to the center. Two nurses care for patients who come to the Center and handle follow-up procedures. Physicians associated with the Center were available for consultation on hemorrhagic and thromboembolic problems twenty-four hours a day in person or through the telephone, and have participated in forty consultations during the past months. Research projects initiated in the Center include: 1. Development of diagnostic methods to dif- ferentiate between disseminated intra- vascular coagulation, fibrinolytic hemor- rhage, and combinations thereof 2. Study of changes in the blood coagulation, fibrinolysin and kinin systems during attacks of hereditary angioneurotic edema 3. Development of diagnostic methods to pre- dict susceptibility in women to hyper- coagulable states induced by oral contra- ceptive agents 4, Development of improved methods for the purification of human fibrinogen as a reagent for diagnostic tests to determine members of the fibrinolysin system. The Center trains both technicians and physicians. Inexperienced technicians work several weeks to months in the laboratory, being trained by the staff and involved in all laboratory activities. In addition, a one-week advanced refresher course will be presented in March 1971. Physician training includes support of one hematology fellow in the laboratory who cares for patients and gives consultations in other hospitals. A postgraduate course for physicians will be given this spring. Two film strips, Hemorrhagic Disease One and Two, have been prepared. Reference standards and reagents not commercially available have been prepared for Center use. The Center hopes to be able to provide these standards and reagents free of charge to other hospitals and laboratories in the region. The Blood Coagulation Reference Laboratory serves as a continual contact and reference center for the entire region. OPERATIONAL PROJECTS uy 8 [LV eee he SREB - i TELEPHONE LECTURE NETWORK CHRONIC RESPIRATORY DISEASE PROGRAM mSN - TOPICAL CHEMOTHERAPY il 3, oY INFORMATION DISSEMINATION SERVICE HEMOTOLOGY CENTER 32 ee STATUS OF PROPOSALS Submitted Proposal No. Staff H.O.W.N.Y. for Federal Title Author Work-up Review Review Amount Period No. 33 Cooperative Kidney and Dialysis Complete Approved Tentatively Approved Reduced to $250,000 3 years Dialysis Program Committee: -unfunded for the (Direct Costs) for W. Staubitz, M.D. first year initial budget period. S. Anthone, M.D. Amount of funding R. Anthone, M.D. not specified for J. Lasher, M.D. remaining two years. J. Hodson, M.D. J. Gerbasi, M.D. G. Murphy, M.D. et al No. 46 Prevention and C. Ambrus, M.D. Complete Approved September 1970 $388,534 3 years Treatment of the Respiratory Distress Syndrome Due to Hyaline Membrane Disease in Infants No. 47 A Model Program for E. Haynes, M.D. Complete Approved September 1970 $588,677 3 years Comprehensive Family Family Health No. 48 Computer-Based E. Gabrieli, M.D. Complete Approved November 1970 $437,017 2 years Area-Wide Health Data System No. 49 Demonstration C. Bishop, M.D. Complete Returned to Not applicable $206,234 3 years Laboratory author for Computer System major revision No. 50 Comprehensive E. Wagner, M.D. Complete Approved November 1970 $750,099 3 years Continuing Care E. Noble, M.D. for Chronic Illness ve No. 51 Health Planning and H. Patton Complete Returned to Not applicable $906,193 3 years Resources author for Development major revision No. 52 Choriocarcinoma and M. Hreshchyshyn, M.D. Complete Approved November 1970 $210,758 3 years Related Trophoblastic Disease No. 53 Screening of R. Moesch, M.D. Complete Returned to Not applicable $467,719 3 years Indigent Hospital author for Dependent Women major revision for Cervical Carcinoma No. 54 A Regional Bone E. Mindell, M.D. Complete Approved November 1970 $205,317 3 years Pathology Laboratory No. 55 Endoscopic L. Berman, M.D. Complete Returned to Not applicable $95,954 1 year Techniques for the author for Diagnosis of major revision Esophageal and Gastric Diseases No. 56 Hospital Based N. Courey, M.D, Complete Returned to Not applicable $657,429 3 years Comprehensive Care author for Clinic for Women Major revision No. 57 Mobile Health Clinic V. Barker, R.N. Complete Returned to Not applicable $164,638 3 years for Allegany County author for major revision $382,000 3 years Not applicable E. Hinman, M.D. in Progress Pending Smail Community Hospital Becomes a Regional Comprehen- sive Health Center: (Wyoming County) Allentown D. Breen In Progress Pending Not applicable $150,000 3 years Community Health Center Figure 11, Status of Proposals The Regional Medical Program for Western New York gratefully acknowledges the support of the Division of Regional Medical Programs Service, Health Services and Mental Health Administration, U. S. Department of Health, Education and Welfare. The findings and conclusions in this publication do not necessarily represent the views of the sponsoring agencies. 35