EON aN PROFILE NORTHLANDS REGIONAL MEDICAL PROGRAM RM 00021 ~ GRANTEE: Northlands Regional Medical Program, Inc. = COORDINATOR: Winston R. Miller, M.D. i i ! Originally Prepared by; Sam 0. Gilmer, Jr. j- Operations Officer > i i Original Date: July 1969 Updated: NORTHLANDS REGIONAL MEDICAL PROGRAM, INC. II. Til. Iv. VI. VII. ~ . PROFILE Table of Contents Geography Demography Governmental Considerations Historical Review Core Staff Organization Operational Projects History Appendix Additional Projects History Project Review Flow : I. 2 7 | Suly 1965 ‘NORTHLANDS REGIONAL MEDICAL PROGRAM GEOGRAPHY _ as oo The boundaries of the Region are those of the State of Minnesota ; although earlier plans for the Region envisioned the possibility of involvement of parts of adjacent States, coinciding with the Ninth Federal Reserve System boundaries. The initial grant, for planning, was made for two and one half years, to begin in January 1967. The Minnesota State Medical Association was the Grantee agency for the planning award and the Mayo Foundation was listed as the fiscal agent. Most activities during the first year of planning vere the result of volunteer committees -—- specific planning studies were devel- = oped by available resource persons. As a result of this approach to plan- ' ning, in the second year continuation application the Region requested an expansion in the level of committed support to pay for planning studies as well as core. staff which had been recruited. “Me continuation award for the second year was for $527,250, plus $81,200 from unexpended funds. It permitted support of five studies: . Regtonwide Intensive Coronary Care Program - Rural Health Care Study . Study of Postgraduate Education in Pediatric Cardiology . Proposal for’ Financial Support of Local Medical Doctors Being . Trained for Home Dialysis . Study to Determine Feasibility for Collecting Data and Integrating. Care of Pediatric Solid Tumor patients UI fw ‘To the April-May 1968 Review Cycle, the Region presented a Supplementary _ Planning Grant Application requesting support for four additional studies. One, the St. Paul Heart, Cancer and Stroke Project, was recommended for funding by the Review Committee, which requested clarification of the relation between the existing planning group (this was originally a PHS-CHS grant) and Northlands. The other three proposals were not recommended for funding. , ~ffo the January-February 1969 Review Cycle the Region submitted its initial operational grant application, consisting of a request for the funding of eleven projects, six of which were recommended for funding. The other five were not considered appropriate for funding (detail follows in section relating to projects and their history). Prior to this Review Cycle a Site Visit had been made to the Region (December 16-17, 1968), for details of - which see Regional Chronology. In April 1969 the Regrion submitted clarification of its organizational structure, one which is delineated in the sections which follow. RET eT eck Grr a Ras: LAKE co P es ~, is +* ee er 148 ae * Hsing oO Toate C~ pL LION we a 4 oo no mh caine ne - a . a ne we ee a : OS SACI aR CEE ; KHISON, ~ ROSEAU A \ nd ‘a r LAKE oon rks C Y gw y MARSHALL ° woos KOCO 2OiNS — A SELIRAME . py aacrE | <1 sat (Rivarniells ee Thie RAs C Ss WATER < ENE . SE Te ee tre wi y geet’ my rand “car | Ra pir ics S| Fa wey. one2d aia # ALGO Retro oit ao CROW Wins> an 4 ‘ i ore need 7 Lt ? alls (cere =| VA Giant [eeueens ance . rm oe 4 Little 3 y Palle sve fs ape ag ‘Tkab sires ay . civ a or ns ; Suly 1969 ' NORTHLANDS REGIONAL MEDICAL PROGRAM:PLANNING AREAS WITH REGIONAL HOSPITALS Minor Canters : Rogional zr rand &. Hospirals iI. DEMOGRAPHY - Land Area: State of Minnesota - 80,009 square miles Population: (in thousands) 2960 Total an - 3,414 Cointies: 87 Density: 42.7 per square mile Metropolitan Areas: (1960) 3,865 (in thousands) . oe Duluth — Superior, Minn.-Wis. 277 Fargo - Moorhead, N. Dak.-—Minn. : 106 Minneapolis - St. Paul, Minn. | 1,482 . Percent Urban: 62% Age of Population: (1960 U.S. Median Age 7 29.5 Minnesota | . - Number - 4n Thousands Under 15 a 1,122 15-24 a KG 25-4 7 816 45-64 «676 65 and over 354 Total 3,414 ' Race: a Number in Thousands otal = 3M White 3,372 Negro 22 Other - 20 “A auyhis69 Minnesota 28.6 Percent 33 13 oy 20. . _10 ~ 100 ‘Percent 100.0 98.8 1.2 . DEMOGRAPHY (Continued) aa “Vital Statistics: (1964) Death Rates per 100,000 -All Diseases ~ Diseases of the Heart Malignant Neoplasms Vascular Lesions, CHS General Arteriosclerosis Diabetes Mellitus Other Diseases of Cir. System "Facilities: Medical Schools: July 1969 ' U.S. Minnesota gho 940 366 — 355 151 156 104 _ 126 19 — 23 17 15 14 15 University of Minnesota Medical School Fnrolliment 590 Mayo Graduate School of Medicine - (Univ. of Minn.) Rochester, Minn. “Schools of Nursing 3 " 673 27 - 10 are college or university based Schools of Medical Technology: 13 - 1 at University of Minnesota hospitals Other Types of Paramedical Training: Cytotechnology: 1 X ray Technology: 37 Physical Therapy : 2 Med. Record Librarians 1 ‘Hospitals Hospitals _ Total Hederal ’ Non-Federal Total Federal Non-Federal Rochester, Mayo Clinic 6 give college credits; 2 degree granting 1 University of Minnesota; other at Mayo Clinic Duluth, Total 202 6 196 34,969 2,475 32, s49h College of St. Scholastica Long Term Short Term (including 1 V.A. Hospital) 21* 179 *7 are long term and other special (V.A. gen. 1,014 beds) 2, 964% 19,656 * Long term ztreval and other special 6 a = July 1969 _..._» DEMOGRAPHY (Coritintied) oe Physicians and Nurses - Ts ae - oo : ne | Physicians and Osteopaths (1967) Number ’ per 100,000 ) Total : an 5 148 , 147.4 Physicians* Ce 5,073 ~ 745.3 Osteopaths a 5 - 2.1 *Physicians and Osteopaths®* in private practice 3,303, ratio - 93 (1965 PHS data). ®*NRMP in special survey report dated Dec. 1968, stated there are ’ about 42 Osteopaths in the State with one on RAG. Nurses (1962) Number | per 100,000 | * * gotal | | | 97,361 4O7.4 Active 13,346 | 382.4 ITI. AL ¢ . Ray 1969 GOVERNMENTAL CONSIDERATIONS : The State of Minnesota, whose boundaries comprise those of Northlands Regional Medical Program, is made up of eighty-seven counties and eight Congressional Districts. The Governor of the State, elected to serve to January 1971, is Republican, the Honorable Harold LeVander.. To the 9ist Congress, Minnesota elected to send the following: Senators: -Honorable Eugene J. McCarthy, D. (1959-1971) St. Paul; Social Scientist; Finance; Foreigh Relations ; Select Committee on Standards ” and Conduct . Honorable Walter F. Mondale, D. (1964-1973) Minneapolis; Lawyer; Aeronautical and Space Sciences; Agriculture and Forestry; Banking and Currency; Special Committee on Aging. Representatives: (All returned to office in 1968 elections) 1. 2. Honorable Albert H. Quie, R. (1958-1971) Dennison; Farmer; Education and Labor; House Administration. Honorable Ancher Nelsen, R. (1959-1971) Hutchison; Farmer; District of Columbia; Interstate and Foreign Commerce. Honorable Clark MacGregor, R. (1961-1971) Plymouth; Trial Lawyer; Judiciary Honorable Joseph E. Karth, D. (1959-1971) St. Paul; Mim. M. & M. Co.; Merchant Marine and Fisheries; Science and Astronautics. ilonorable Donald M. Fraser, D. (1963-1971) Minneapolis, Attorney and Former State Senator; District of Columbia; Foreign Affairs. Honorable John M. Zwach, R. (1967-1971) Walnut Grove ; State Representative and Senator; Agriculture; District of Columbia. Honorable Odin Langen, R. ( 1959-1971) Kennedy; Farmer; Appropriations , Chairman, House Minority Task Force on Agriculture. , ‘Honorable John A. Blatnik, D. (1947-1971) ‘Chisholm; Teaching and School Administration; Government Operations; Public Works. D. Congresstonal Inquiries Date - 4721/65 LV/E/E5 1/6/66 1/26/66 5/16/67 1/31/68 12/16/68 Ve27/69. 2/6/69 2/12/69 2/12/69 2/12/69 2/14/69 2/24/69 Senator Walter F. vl aer tbat From Congressman John Blatnik Mondale Senator Mondale (Memo) Wilbur J. Cohen's letter to Senator Mondale Phone call from Mr. Tonat (Office of Rep. Karth) Senator Mondale to Dr. Shannon Sp Reply from Dr. Olson to inquiry from Congress- man MacGregor Letter from Dr. Olson to Rep. Nelson Phone call from Mr. Segermark (Office of - -Rep. Nelsen) Letter from Dr. Chadwick ‘to Rep. Odin Langen Letter from Dr. Chadwick to Rep. Donald M. Fraser Letter from Dr. Chadwick to Sen. Walter Mondale ' Call from Rep. MacGregor | Letter from Dr. Olson to Rep. Ancher Nelsen “g . . July 1969. Action Inquiry of NRMP Re: Information on the applicability of RMP to Minnesota Referred to Mr. Cohen, for consider- ation for P grant Explanation of DRMP to Mondale's inquiry Interested in progress of construc- tion activities of RMP Study of Memorial Hospital, Duluth, re: health facility planning project _and requesting comments Inquiry on operations of NRMP Inquiry answered about current availability of RMP funds Inquiry on when NRMP would receive operational award Information concerning temporary "freeze" of RMP funds Reply ‘to letter cf 1/28/69 in which they urge approval of operations | grant request. in NRMP Information concerning temporary " "freeze" of RMP funds 7 Inquiry about a reduced funding for the NRMP application Inquiry concerning current status of initial operations grant request of RMP Date | 2/26/69 5/20/69 6/9/69 6/11/69 - ee Letter to Senator McCarthy fron Dr. Olson Letter from Dr. Olson to _ Congressman Nelsen: Call from Eric Nathanson irf Representative . Fraser's. office Letter from Dr. Olson to Representative Nelsen 2 _ Tuly 1969 Action Reference to letter of 2/18/69 in which Senator McCarthy requests every appropriate consideration ‘Reply to letter of inquiry of 5/8/69 | Requested brochures explaining RMP Concerning the RMP and Comprehensive Health Planning questions » Oct. 6, 1965. Jul. 1, 1965 May 17, 1966 — July. 1969 “HISTORICAL REVIEW President signs PL 89-239 Dr. Robert B. Howard, Dean, University of Minnesota College of Medical Sciences, Minneapolis, called at NIH ' Director's office to discuss proposed program of medical complexes, as related to the "Minnesota State Plan for Hospitals, Public Health Centers and Related Medical Facilities." Dec. 23, 1965 - In a letter to the Surgeon General, Dr. J. Minott Stickney (as President of the Minnesota State Medical Association and Chairman of the Committee to Implement PL 89-239 in Minnesota) advised that the Minnesota State Medical Association had been requested by officers of the Minnesota Department of Health, /University of Minnesota College of ~ i Medical Sciences ! Mayo Clinic and Foundation j Minnesota Hospital Association “to; serve as the organization to coordinate the planning for implementation of PL 89-239 in the State of Minnesota. A committee of representatives from each of the above organizations formed to proceed with this planning. Invitations to additional repress entalives for this Committee were extended to Minnesota Heart Association Minnesota Chapter, American Cancer Society American Rehabilitation Foundation and to those medical associations of States in the region which do not plan to establish similar groups within their own states. This planning committee was to then begin the selection of a regional advisory group and prepare a planning grant application. Initial Planning Grant Application received in DRMP; it received review by a Special ad hoc Review Group in’ early June and Council review toward the end of the month. The consensus was that the application could not be recommended for approval; major revision seemed indicated, with staff . communication and a project site visit (by DRVP staff). It was a deferral action. . Jul. 11, 1966 Sep. 27, 1966 Nov. 14, 1966 - 3. Compensation of participants from institutions as di “auay 1969 Because of an airlines strike, Council's recommendations and deferral for hore information was by telephone conference betests DRMP . | NRMP Drs. Marston Dr. Stickney - Sloan (Minnesota Medical Association Fdn.) Brewer - Dr. Frantz Hazen | (University of Minnesota) Mr. Coffin Dr. Whisnant (Mayo Clinic) : Areas or topics discussed: 1. Further efforts to delineate the region . 2. Broadening advisory group personnel rather than consultants 4, TRW Systems Analysis be eliminated or limited in approach ($200,000). 5. Budget needs phasing 6. Legal status of applicant organization -Minnesota Medical Association Foundation 7. Institutional salary schedules apply to personnel budget : \ 8. Clarify relationship between Program Coordinator, Program Director and Advisory Group 9. Budget items need justification 1 Evidence that individuals from University. of Minnesota and Mayo Clinic will indeed participate as listed 11. Information about existing health resources for diagnosis and treatment of heart disease, cancer and stroke 12. Make explicit effort to involve community and rural hospitals, health institutions and organizations , ° working together. Revised application received in DRMP; it was considered by Review Committee on 10/17-18/66 and recommended for deferral for project site visit to clarify many many points; it considered this application as an improvement over the original. Combined Council and Review Committee Project Site Visit. was made by following: ° ‘ Couneil - Dr. Hogness and Mr. Cumming "- ‘Committee -— Drs. Kenney, Popma and Rogers. ’ DRMP Staff - Mr. Whaley and Dr. Hazen The visitors recommended approval with some concerns stated specifically. Council concurred in its meeting on Novenber 27-29, 1966 Jan, 1, 1967 - Initial Planning Grant Awarded . Year Direct Costs Only | Period 01. $344,998 “VA1/6T - 12/31/67 02 469 ,080 ~ _ 03 - 234,700 = A negotiation meeting was held on January 17, 1967, at the Washington Hilton Hotel, involving fiscal and program representatives. Mayo Foundation to act as fiscal agent until a new corporation could be formed (probably within six months). Apr. 20, 1967 - Drs. O'Bryan, Dyson, Husted and Mr. Anderson made a "progress visit" to NRMP. - Aug. 28, 1967 - Dr. Winston R. Miller appointed full time Program Director, “primarily responsible for the planning, coordination and — administration of the Regional Program and its relationship to other regional programs." Assumes duties in November. Dec. 15, 1967 - Site visit to NRMP by Dr. O'Bryan and Mr. Anderson prior to review of renewal planning grant application (02 year) by DRMP staff on 12/21/67. Dec. 21, 1967 - Staff recommended $549 ,643 in direct costs for 02 plenning renewal; this allowed use of carryover funds and was more than committed amount, so authorization was sought from February 1968 Council. Council concurred and above amount awarded for period 1/1/68 - 12/31/68. Feb. 1e-13; » 1968 -Dr. Miller and Mr. Wilkins visited DRMP, because their Executive Committee and RAG were much disturbed about the disallowance of carryover funds from 1967 year for funding essential elements of NRMP accomplished during its first year. They were aware of the budget presentation Feb. Feb.. Apr. Jun. Aug. Aug. Oct. Oct. 26, 1968 28, 1968 18-19, 1968- 18, 1968 1, 1968 7, 1968 16, 1968 21, 1968 . . . . ; : 7 : ‘13 * : vee July 1969 | for their crosrem to be considered by Council on February 26-27. They reminded the DRMP officers that NRMP _4s in the process of "self-renewal" organizational revision, ‘including. separate incorporation, formulation of complete by-laws, and revision of the RAG. NRMP Executive Committee set the goal of June 1 for Submis ton of an operational grant request. NRMP submitted to DRMP a supplemental planning grant request for four studies: 1. Telephonic Transmission and Computer Analysis of Multi-chamnel Electrocardiograms 2.. Coronary Artery Disease Proposal 3. Changing Food Habits and Serum Cholesterol Levels 4, St. Paul Heart, Stroke, Cancer Project Review Committee found this plaming supplement to be four distinct projects (the first three appear to be more clearly operational projects), and not presented as plan. This application seems to be a deviation fron the real purpose of the planning grant which was to develop the base for a regional medical program. It recommended the St. Paul Heart, Stroke and Cancer Project pending clarification of the relationship of the. existing planning group and NRMP. Council concurred with the Review Committee's recommenda— _ tion on the supplemental planning request and an award for $27,849 d.c.o. was made for the St. Paul project. Onerationel grant application received in DRMP; it consisted of eleven projects, including core support , and requested about $2.5 million d.c.o. It is pending final recommendation by February 1969 Council. Mr. Kinser and Mr. Koontz visit NRMP for planning study. Telephone conversation - Dr. Clark Millikan and Mrs. Martha Phillips,(Chief, Grants Review Branch) about status of NRMP. Associate Director visits DRMP about delayed review and continuity of program funding after December 31, 1968. 14 > Suly.1969 Nov. 27 » 1968 Associate Director requests extension of NRMP-02 planning year two additional months to February 28, 1959, without additional funds. | | Request granted by letter of 12/16/68. — obey Dec. 11, 1968 Mr. G. W. Lewis and Miss Joyce Finnegan visit NRMP for financial accounting of new nonprofit organization. ‘Dec. 16-17, 1968- Project site visit to NRMP to review Operational Grant Application; visitors were Dr. J. Gordon Barrow, Chairman; Drs. Gersten, Paul, and Allen, consultants; Mrs. Phillips and Miss Dona Houseal as staff. TY oe ery V. CORE STAFF - . A. Core Staff address: Northlands Regional Medical Progran, Inc. _ Fifth Floor - Farm Credit Banks Building _ 375 Jackson Street St. Paul, Minnesota 55101 - Phone -— Area 612 224-4771 NRMP, Inc. _ eee a wr Te OF July” 1969 Pe ne - ‘ Se malar gar me _ § c Board of Trustees Regional Advisory Group CENTRAL ADMINISTRATION Coordination Fiscal Management Communications Committee Support Project Develepment Categorical Disease Support FUNDED OPERATIONAL "PROJECTS Project Directors pera -CORE COUNCIL Program Director Associate Directors: Central, University and Mayo BUS JAL PROGRAM EVELUPHENT ~ (Univ. ) e SERVICE PROGRAM DEVELOPHENT - (Hayo) S806 -izte Diractor, NRMP . Hursing *OORDINATOR Coordinato?” [ED.SOCIOL. Secretary- 9FFICE OF EDUC, Librarian- SECRETARY Secretary- Assoc. Dir., Mayo | Continuing Educ. Associate Director, NR EVALUATION PROGRAM DEVELOPMENT - (Centra?) _ Assoc. Dir. Allied tlealth - Assoc. Dir. Med. Pract. Div. Assoc. Dir. "Comm. Pealth Div. _Assos. Dir. “Reg. Lab. Facility Secretary Ins | | Rehab. Coord. ! A.R.F. Secratary: _§ 77 Director | ~m Researcn Associate r Research Assistant de Secretary UNO a cen MTTTEES OF ALLIED HEALTH CATEGORICAL DISEASE INPUT Neue FRIFESSIONALS | | . . tealth Sonnevar Nursing Voluntary Heajta inalth Services Developnent Othars Associations Sducetion ne ee et etme. ene cece, tners . oe . a oo : ce - . a co : - ‘July 1969 | “ORGANS ZATION CHART NORTHLAHOS REGIONAL MEDICAL PROGRAM tm NINE . SPORSORING ORGANIZATIONS | sro SATE et BEE OS SEE OES RTA TET TE _ : Ga WARE 2 OP ae Pe RSS { NRHP, THC. | PES. 8" SNR Da EEE I | _ REGIONAL ADVISORY . GROUP _ omen Ret Jose. I RD hy i SRP WE MS SS ay BOARD OF TRUSTEES yreeeresereree: CHATRMAN \ {9 Voting Members } | | i. Lop cM TSI tS TAT Be. erusenesseme ret NESTS 6B aah PMI A TT oo EE CR asa ae BIE OE a RSET NR SVR SETS q FWA aE e's Te ea Se ’ i REGIONAL MEDICAL. PROGRAM seers creemcessaumaraceunsser amancuesna nmcnere ne SSOCIA TRECTOR COMMITTEES AT CENTERS ASSOCIATE DIRECTOR | ee 7 es CENTRAL STAFF ; PROGRAM DIRECTOR : . {__ 7 j Bx .26eR UA WSLS TMTETS REN INT EER TRY TITIES ar Vem or. teers went ect f oe SS Peete ee. : - | | untversi TY y MAYO CLINIC ; OE TUE em EE i BOF oH, LEELA EE © aT PAE TT | P TTT ETS SWEEP ae RPT WE TD EE EAE ET OE A ELLE, SOE AME OE SE BES TOR OTS pe aera aes" ———y ests Semirws wen} meet aes Re Ie rs ane meee Se LTE EE RE, TU IMT FASEB he EERE - AD HOC COMMITTEES FOR | ee STANDING CONNTYTEES | PEVELOPHENT OF OPERATIONAL GRANT | iememen tenance er nmine meee! HEART SO PERSONNEL CANCER a NOHINAT LNG STROKE a CONTINUING COUCATION COMMUNICATIONS NETYORK LABORATORY SERVICES ” Oo ee cee oo 4g. duly 1969 NARRATION: ORGANIZATION AND OPERATTON CHART Central Administration is the executive arm of the Board of Trustees and the Regional Advisory Group. I¢ manages the opera- tional and Planning program -(core activities). - - * . The Central Staff includes: a. Personnel for overall administration (1) coordination, (2) _ . fiscal management, (3) communications ‘b. Personnel to Support NRMP personnel operating in the Center (1) Educational Program Development (headed by an NRMP Associate Director at the University of Minnesota) (2) Service Program Development (headed by an NRMP Associate _ Director at Mayo Institutions) - - C. Personnel to develop programs in evaluation and data collection for the NRMP region. The "Core Counc" is a joint management mechanism to coordinate and manage the continued Planning and development efforts of the Core the primary administrative directors for RMP activities within the respective institutio . Additionally , they are members of the Core Council for joint management of Core activities. 19 . : oe July 1969 VII. OPERATIONAL PROJECTS HISTORY _ 4. Core Projects Central. Core; Reviewers thought the core staff request generally reasonable, The excep- tions included the assistant director of planning in 1969; medical directors for heart disease, cancer and stroke; the commercial artist and printer and the part-time directors of continuing education. Since it is unrealistic to expect to get quality people without university affiliation, the medical directors for the categorical diseases would be better utilized at the University. The regional coordinators would probably be better suited at the central level. Concomitant cuts were recommended in equipment and supplies. f Reviewers also felt that evaluation should be supervised by the central core staff, assisted by staff of the other institutions and outside consultants. Continuing evaluation should be established to provide indirection of the need for modifications in the projects as they progress. The need is recognized for expertise in operations research, computers or biostatistics on the core staff in order to strengthen the systems analysis portions of the various projects, but a job description for the hiostatistician should be provided to insure his proper utilization. To keep the major institutions responsible to regional needs and interests, a strong core staff and central administration should be fostered. University of Minnesota Core: Perhaps earlier, the University group was "center-oriented", but have evolved into one more education-oriented. The University's role is seen as more significant in the allied health sciences. Committee membership has been broadened to include allied health interests other than nursing. There appears a changing orientation of the Medical School from faculty "bench-type research" to more community contact. This institution apparently sees core staff as educators with a home base at the University and involved with the central office ina number of ways less than explicit. Again, the relationship of the core projects to the other contin- uing education projects and the need for three different "sets" of administra- tion, including thirteen full-time people in the core alone is not easily answered. In order to strengthen the leadership and planning capability, reviewers recommend that a full-time professional person be employed who would be located in the Office of the Associate Dean but responsible in planning to the Program Director of NRMP. This person would be responsible for providing take. oe cee tee © Slates dle a | | oe 20 an te | oe ee 2 7, +” July 1969 ‘Jiaison between the University and central staff. The Program Director might have more planning responsibility. Reviewers objected to the use of funds in the "Other" category for services and consultation from the Audiovisual Education Service, the Department of Radio and Television and the graphic and illustration services on campus on the basis that. this would allow the initiation of operational activities by the core staff without RAC approval. Reviewers were concerned also, that the School of Public Health was not represented and recommended its involvement, as well as the Schools of Dentistry, Nursing and the Clinical Department of the Medical School. in Line with these concerns, it was recommended that personnel costs be reduced to $50,000, an amount which would enable the staff to develop a proposal which would indicate the planning directions the University would aoa Mayo Core: “Mayo sees its primary contribution to RMP in continuing education and improving health services, and will stimulate and carry out projects along this line. \ Reviewers. questioned the relationship of the Mayo core ‘staff to the Mayo Clinic and RMP core staff. The Mayo core staff would be responsible to the central Mayo RMP committee, which is an arm of the Board of Governors of the Clinic, and not to the RMP central core staff. In order to make this more . yesponsive to the central staff, it is recommended that it be understood that in the area of planning, the Mayo personnel are responsible to the Director of RMP. There were objections to the use of planning staff to initiate operational activities in the core portion without RAG approval. Because only three full-time associate directors were deemed sufficient, it was recommended that personnel costs and office equipment be reduced accordingly. American Rehabilitation Foundation Core: The Foundation's function in RMP is to get at the distribution problem in the organization of rehabilitation services, and in the general areas of continuing education and training of personnel who provide such services. Reviewers questioned the necessity for the coordinator to have a separate office rather than be a member of the central core staff where more effective liaison might be maintained. There is also the danger that in establishing this separate core, a precedent may be established for other voluntary health agencies. Fo See Sul 2969 (a. Core Project discussed separately . ) Multidisciplinary Improvement in Medical Care of Myocardial - Infarc- . tion in Minnesota There was “evidence of cooperative arrangements with a admin-— istrators, nurses and practicing physicians, and the Heart Association. _ The budget was realistic with no large equipment requests. Stipends were for subsistence which would not be paid unless the trainee must leave home. The local hospitals would continue nurses' salaries. Besides training physicians and nurses and teaching the limitations of certain drugs, the project would engender enthusiasm among the hospital's ICCU team members. we A reconmended reduction was in the personnel category for lag in recruit- ment. Postgraduate Education in Pediatric Cardiology The aims: (1) to improve the effect of teaching methods by utilizing _ patient demonstrations , ease conferences, exhibits, and formal didactic lectures; (2):to improve cooperation in postgraduate education; and (3) to involve the physician in the community in pediatric cardiology. This last had been the most difficult to accomplish. The eight Pediatric Cardiology Clinics, already given, reached in a limited way the general- : ist and internist in peripheral areas where there are no pediatricians. The program is regional in character with evidence of planning and strengthened dialogue among the local doctors, nurses and welfare workers. The American Association of General Practice accepted the program for continuing education credit. A suggestion was for a program director at not less than half time. A Collaborative Basic Regional Information Network for Fducation and _, Clinical Evaluation Applied to Coronary Artery Disease . This project sought to develop a mathematical model of coronary artery disease to be used for clinical evaluation and comparison of a cardiac patient with a large number of other patients with the same diagnostic classification. The inmediate value of this project might be to peripheral hospitals through the personal commitment and resources of the center, but the project appears weak and unimaginative. More ekpert: biéstacistical consultation is recom@ed. This project is ‘still in the research phase, far from providing any direct help in the care of cardiac patients. ' Recommended: No funds for all years. aaa . oe . ; _. a oe : . ; “22 July 1969 tee at Diabetes Regional Center This would extend an existing center to two hospitals (Methodist in Minneapolis, and Miller in Saint Paul). The program, already begun with experienced personnel, would require minimal funds for expansion. It could be a prototype for’ education programs for patients with other chronic diseases. , There was concern over the proportion of RMP funds (as they represent’ the degree of commitment) to the total assets of the corporation. Questioned was $4,000 in the "Other" category for tuition (80 in-service directors and students). These costs are said to represent the course costs, not per diem living expenses. There was concern that much of the personnel costs of the two hospitals were charged to the grant. Therefore, funds for the Directors of Medical and Nursing Education and the Directors of the School of Nursing should be deleted. Northlands Regional Service-Oriented Cancer Registry The purpose sought to assess the standard of care in order to improve it. This was a one-year request because the director felt he would have difficulty getting approval for five years from local committees which had expressed skepticism earlier about the "systems approach." The community hospitals were to pay for the medical records technician. Personal follow-up by the project director of patients who have moved was questioned as to whether it is a realistic one. If ever resubmitted, the project should be rewritten as a three~year proposal with broader support and evidence of involvement beyond that of one man. Administration of the project by the central RMP office is inappropriate. It should be co-sponsored and perhaps located in the offices of some other service-oriented groups, such as the Minnesota Chapter of the Cancer Society or the State Board of Health. There was . concern over the amount of money requested. It was recommended that the project director consider demonstrating the effectiveness of the registry for only a limited number of types of tumors or in only a few counties on a pilot basis. Recommended: No funds for all years. Improving Stroke Rehabilitation through a Regional Program of Continuing Education , . Concern was noted about the elaborate budgeting, particularly the large amount of staff requested and the per-student cost. Such an intensive course for nurses and social workers was believed unnecessary; 4 a yee tat .- . sep Te oT a Tee mee a shorter course with follow-up consultation for the participants might be preferable. Evaluation Gf the courses would be in order. The emphasis on rehabilitation, rather thari on prevention and detection _ @oes not reflect priority setting, but rather that the resources in rehabilitation are more ready for the operational stage. The recommen- ‘dation, therefore, was to reduce the personnel to $50,000. Pilot Program of Regional Postgraduate Medical Education There were questions raised about staffing. Because there has never ‘yeally been any coordination of the postgraduate continuing education at May, support for a full-time director was requested joint with RMP-Mayo support. Some reviewars felt that this project could be co- ordinated out of Mayo core staff. a . The alternative of sending Mayo representatives to the periphery may warrant an attempt after the pilot phase. -+» Apparently physicians were interested. This was the subject of a questionnaire. Use of teaching cubicles was commended. The project . needed better evaluation and followup fron its peers, hospitals and the community. There should.be better region-wide coordination of all continuing education activities. Postgraduate Education in Diseases of Cardiovascular and Nervous S ystems and Neoplastic Disease in Childhood ~ This, a continuing education project within the Department of Pediatrics of the University of Minnesota, would utilize faculty in the University Hospital and others with which they are affiliated. Personnel costs were based on the number of staff to be added to the University of Minnesota in order to replace the time of those involved in this project. NOTE: Final review yielded recommendation that neither Project 8 or 9 ' be funded. If they are resubmitted, there should be evidence of 10. coordination of each with the other, with the continuing education programs at each 4nstitution and with the RMP Core Program. Allied health group involvement should be evidenced. In summary, Mayo and the University should work toward a j oint proposal reflecting NRMP's over- all approach to continuing education. a mo , Telephone Dial Access Medical Library A revised budget, based on more realistic cost expenditures, which reflected the increased demand for the service, was submitted to the site visit team at the time of the visit. It included an increase in. the shared costs of the Wisconsin Regional Medical Program; in the costs of the publishing brochures; the purchase of cartridges and atidiotapes ; tape production costs; studio recording service and the addition of an unlimited Band One for In-wide Area Telephone Service. : 10 . (Continued) — St aoe ne ee mag. Dae Salty 1969 we - © - ‘This system, an extension of the one in Wisconsin, would provide . needed information and is in use by the physicians now. There is a possibility that two years of use may warrant establishing a tape Library in Minnesota, which will also take into account nursing and allied health needs. All tapes are reviewed at least annually and suggestions and evaluation concerning them will go before a special - board composed of representatives of Mayo, the University of Minnesota, the State Medical Society, the Academy of General Practice and the practicing physicians. Reviewers felt this project was worthwhile and _ should be supported at the $29,000 level required in the revised budget. The Development of a Stroke Rehabilitation Management Simulator The project would determine, by use of the simulator, if the patient will recover; how much he will recover and how soon. Although models can be of great value in assisting the physician to make a prognosis in the complex problems with which rehabilitation is concerned, the | nature of this project was such that no immediate benefits to patients could be visualized. Also, because the scientific merit is weak, re- viewers recommended no funds. Agencies which focus more on the research approach might more appropriately be involved. \ Recommended: No funds. Foregoing based on Review Cycle January-February 1969. ee ae TNS COENEN | a “APPENDIX an TTA Oi 7 Ta. { fdons Suggested by “taceis oO: btactives fe me ee a ee ee ener ete osama JULY yo. nd were 9 SO ree 2 wt ememe pment ee oe ee ewe fees Bronosad f+ 77. inal ov Le. ae ne ee nem etme eee oe Ideas Sucgested Praesent Ac t ee Px [ e | (4) Doge vl: - — ° . oo NRME ‘ : { (2) Poze th have 202! , tnvolveincint? LOCAL | 4 i REVIEW a . : a ° . [Beard o£ Trustees | (3) Is tt "p tpt ” {| "eperattoas.”; f od uo iRecional or b J — opitniit as [sedate a as Opera- Hold Fox Higher ming Projec ‘tional P coject Prioxity to ny i . = ; a yo: . Develop —— ty ve ONAL ay Tas ea \ . : 7. oe Behe Vi! . Vv ennai “Wandatory for Cy os ions — Optional fox Planni ny Pro; 4 waticnal Region: vO TT DE ADBPLOVA Rework Reyacn i : . Oe, Sor see tT ay cope . . teae veel thay 2ff appxevad, Budget is established. Acca . is back to Board of Yrusiees and Regional suvice-s Group via pregcess ceports, plus avaluatioa and . financial ¢¢ EPOLES