A PROFILE: WESTERN NEW YORK REGIONAL MEDICAL PROGRAM Grantee: Research Foundation of the State University of New York Chief Executive: John R. F. Ingall, M.D. profile originally prepared by: Spencer Colburn Original date: October 1969 Up-dated: -_ ee te amneneeecn I. II. ii. Iv. Vi. Vil. Viti. TABLE OF CONTENTS GEOGRAPHY . Pr DEMCGRAPHY. « 2 ¢ 0 © © eo 6 POLITICS. « « «© «© «© © ee ow HISTORICAL REVIEW .« « 6 © «© © CORE STAFF. «6 2 e ee ew ew ORGANIZATION « «2 2 «© « we eo PROPOSAL - REVIEW PROCESS . . FUNDED OPERATIONAL PROJECTS . 10 43 15 tome bee roy ~ cite Vw Bre wee ~ N =m Comestoze a we 3: - Ithg ° a HALTON at Croc ar OO . . OO x Iaxed’s Vannes an do oo Donel a? A, LS baw > . ie obtidgenon Milica West Lh . . 1 clei . : all : : i Oorexteu © - , ‘I. EOGRAPHY = ‘ Presently, eight counties represent the ge ser’! : Fv gt i! geographic confines of the Western New ot nee gF Nis oNawfons it . York Regional Medical Program.. Seven . ‘ ar | SHnastOrh soci i - . . of the counties are New York's western- ‘ 7) NIAGARA cafaecitPote ' . . 4 t oe most. counties and is, in fact. the Eighth . | i ‘aves waa eer re . >. ra 7 oe . tri yt _ District Medical Sociéty of the State. . .- id cdeouig, (REET MINE erty ‘ . : : . 7 : . Ns volcotisville . . Erie County, Pennsylvania is the other L& Ca GGS 5 ° oAlobome ts ooo ed : - _ . . . aS ef: roa county completing this Region. . nt ~: REL ofren 8 field es.cyea : . . Ne we an ’ . wt . wes oe oe rome tek . This is a natural forming Region,as it is 2g gO™ areege Cerier [OT og ony an O oo” i boarded by the Great Lakes to the West and Butfale: Eis Snyder ofsmecsit Sorte ee . . ooh. aepmey fee Cat . North and by the Allegany National Forest a Zp a BSloncaster gAldan g Maes . wl . fe Oy 7 ton a ithe ue to the South. :Medically, the trend GREER & wa Wwe eCons Teac Line {ten te woe . . . 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There are two metropolitan areas ~ Buffalo, 600,000 and Erie, 150,000. a) Roughly 77% urban. b) Roughly 94% white, c) Median age: 30.3 years (U.S, average 29. 5) Land area: 7,200 square miles Health statistics: a) Mortality rate for heart disease--461/100,000 (high) b) Rate for cancer--180/100,000 (high) c) Rate for CNS vascular lesions--107/100,000 (average) Facilities statistics: a) School of Medicine, State University of New York, Buffalo - 381 students. b) Roswell Park Memorial Institute - 300 bed Cancer Institute c) Fifteen Schools of Nursing - 4 degree granting d) Six Schools of Medical Technology e) One School of Cytotechnology f) Eight Schools of Xray Technology g) One School of Pharmacy h) There are 54 short term hospitals with 8,500 beds, four Veterans Administration Hospitals with a total of 3,100 beds, and two State Hospitals with nearly 6,000 long term beds. Personnel statistics: a) There are 2,623 (138/100,000) MDs in the Region- b) There are 8,350 (439/100,000) active nurses in the Region. In all there are 13, 000 nurses, ; UI, POLITICs 1) Governor ‘\ Nelson Rockefeller (R) 2) Senators a) Jacob K. Javits (R) 1956-1975, Member Foreign Relations, Government Operations, Labor and Public Welfare, Joint’ Economic Committee, Select Committee on Nutrition and Human Needs, and Select Committee on Small Business. b) Charles Goodell (R) 1968-1975, Member Banking and Currency, Commerce, and District of Columbia. 3) Congressmen a) Thaddeus J. Dulski (D) 1958-1970, Member Veterans Affairs, and Post Office and Civil Service (Chairman) b) Richard D. McCarthy (D), 1964-1970, Member Public Works Committee IV. HISTORICAL REVIEW November, 1965 ~ . The Interim Coordination Committee is : formed. This committee is a group of seven professional health and health planning people concerned with the development and implementation of a Regional Medical Program in Western New York. - Dr. Douglas M. Surgenor, Dean, School — ; of Medicine, New York State University at Buffalo sends “Letter of Intent" to NIH. December, 1965 - Dr. George Moore, Director, Roswell. Park Memorial Institute, Buffalo, and member of the Interim Coordination Committee is named to the NAC. January, 1966 - Organizational meetings continue, progress is excellent and involvement is expanding. April, 1966 ~ Dr. Douglas M. Surgeon, Program Coordina- tor submits application for planning grant. December 1966 - 01 Planning Award $117,026 DC April, 1967 - John R. F. Ingall, M.D. became Program Coordinator. September, 1967 - Planning supplement is submitted and request funds for the addition of three new activities to its planning grant. The three activities are: 1. A two-way telephone communication network. 2. A coronary care program. 3. A model comprehensive pulmonary care facility. The November 1967 Council felt that all the proposals presented in this application are worthy of support. However, after full and thorough discussion of this application, the questions: raised and the appropriate use of planning and operational funds, it was determined that a site visit be necessary so as to ~ sere tem gat att Re rare gE rar rae meee em Nt ? i ee Te = + : oa December, 1967 February, 1968 March 1968 May, 1968 identify those facets which could be funded. (See February 1968 and March 1968) 02 Planning Continuation - $117,026 DC Site Visit: Drs. Slater, Hirschboeck, Prior, and Hall. , The site visit team felt that: 1. Official representation on the RAG and special committees is well balanced. 2. Administrative arrangements for planning and program are beginning to be well developed. 3. Administrative - advisors relationships had been more formalized since sub- mission of application. The three project activities were reviewed in detail and it is suggested that the Communications Network and the Coronary Care Program be funded as operational pro- jects 1 and 2 respectively. (SEE March 1968 It was recommended that the proposal for a Regional Model Comprehensive Pulmonary Care Facility be a planning activity. (See March 1968) 01 Operational Award - $289,063 DC funds the Two-Way Communication Network and the Coronary Care Project. 02 Planning Supplement Award - $153,559 DC To accomplish the project Planning for Pulmonary Care and to HOWNY to hire and support additional core staff. The first operational supplemental grant application is submitted and presents six new operational activities and core activi- ties as follows: #3 - Chronic Respiratory Disease #4 - Immunofluorescence Service and Training #5 - An Integrated, Computer-Based Regional Poison Control Program #6 - Pilot Study Program in Nuclear Medicine #7 - A test of Two Continuing Medical Education Techniques #8 — Dialysis and Kidney Program #9 - Core Program Council recommended: a) Approval of Projects #3 and #4 at a decreased level of $607,159 in direct cost for the first year with December, 1968 f March, 1969 July, 1969 August, 1969 recommended future support for each in the second and third years as requested; » b) provision of up to $50,000 each for projects #7 and #8 for one year of planning, the actual amounts to be negotiated by the Division; and. c) disapproval of projects #5 and #6 $405,689 DC award This award provides support for core program activities only. Operational Continuation Award for $777,763 DC, and a supplemental award of $79,738 is granted. These awards align core activity and operational projects with the intent to enhance fiscal management for the program. Supplemental award of $563,006 for remaining nine months of budget period. This award is to accomplish renewal of project #2 ~ Coronary Care Program and the implementation of project #10 - Tumor Registry. Reviewers considered project #2 to a standard CCU training program but expressed concern that there was no indication of long range goals or when a saturation point would be reached. Project #10 was clearly establishing a need. In the August review cycle two projects were under consideration #11 ~ Medical Genetics Clinic; #12 - Provide Mass Med Health Information to Improverished Res of the Region, a well written proposal ia idents Project #11 was deferred for further study by Council. Project #12 was disapproved and reviewe The wtajor concern is "relevency." rs expressed reservation regarding priority for funding this type of proposal. Lanner mmm rene “7, CORE STAFF Coordinating Headquarters Program Director Staff *Chief Executive Officer ao Western New York Regional Medical Program 2929 Main Street Buffalo, New York 14214 (Tel.: 716/835-0728) *John R. F. Ingall, M.D. Associate Director Jerome I. Tokars, M.D. (30%) Administrative Associate for Grants Management Leonard Kaye Administrative Associate for Business and Personnel (Mrs.) Marion Sumner Administrative Associate for Assessment. and Evaluation Elsa Kellberg Administrative Assistant for Area Liaison Donald Meyers - Director, Nursing Affairs (Miss) Patricia Shine, R.N. Director of Communications Anthony Zerbo, Jr. Project Directors Coronary Care Program (Mrs.) Betty Lawson, R.N. Telephone Lecture Network Joseph Reynolds a a BIOGRAPHICAL INFORMATTON woo €, 1) John R. F. Ingall, M.D. a) Born England, 1929 b) Medical Schools: - Kings College, London University - 1947-49 Westminster Medical School - 1949-52 c) Bachelor of Medicine, London ~ 1953 d) Bachelor of Surgery, London - 1953 e) Royal Army Medical Corps - 1954-56 £) Senior Residency - Westminster Hospital - 1956-57 _-- g) Junior Attending Surgeon - 1958-62 h) Senior Cancer Research Surgeon, Roswell Park Memorial , Institute - 1966-67 '2) Jerome I. Tokars, M.D. a) B.S., University of Buffalo - 1944 b) M.D., University of Buffalo - 1947 c) Private Practive, Internal Medicine ~ 1951-52; 1954 - present d) Chest Clinic Physician, Erie County Health Department - 1955-64 oo ee Vo Cette ar ng I A Yr REET eae ma Vi. C nee nes 2 NE Am ORGANIZATION Board of Directors 1) 2) 3) 4) 5) 6) There are 28 members who are chosen as follows: two members from the counties of Allegany, Erie, Cattaraugus, Chautauqua, Genesse, Niagara, Wyoming, and the county of Erie, Commonwealth ° of Pennsylvania, one of whom shall be a physician selected by the County Medical Society and one to be a non-physician to be selected by the county committee for each of said counties; two members representing the School of Medicine at The State University of New York at Buffalo, one of whom shall be the Dean of the Medical School or a person selected by him and one to be chosen by the Faculty of Health Sciences at large; two members representing the Roswell Park Memorial Institute; one member representing the Western New York Hospital Association; one member representing the Comprehensive . Health Planning Council of Western New York, Inc.; one member representing the Regional Health Director, Department of Health, State of New York; one member representing the Commissioner of Health, Erie County, New York. The foregoing persons shall then choose three members at large from the Voluntary Health Agencies not above represented; and three members at large from members of the public. The members are appointed by RAG (HOWNY). Each of the directors shall serve for one year or until his successor is chosen. Chairman - Meetings are held as needed. Function: To conduct the business and affairs of the corporation, approves all proposals, defining program objectives, determines priorities for implementing these objectives, and review and evaluation of program activities. Regional Advisory Group (HOWNY) 1) ‘The Health Organization of New York (HOWNY) is the Regional Advisory Group to the Western New York Regional Medical Program. The Organization is made up of the regional advisory group in cach of the RMP's eight counties, we eee Rte meen ROR Rn ORR COCR RIE RE SRE PARR SCE ORT ARN NT ei em Pe caetme ome 8 2) sf 3) 4) 5) 6) 1) 2) These, county groups vary in membership from 10 to moxe than 120 and HOWNY membership is now approximately 250. ‘the by-laws are constructed in such a manner that membership can be flexible to allow for greater representation as interest increases. Membership must however, include practicing physicians, medical center officials, hospital administrators, representatives from medical societies, other health and . health related professions, voluntary and public health agencies, and representatives of other organizations, institutions and agencies and members of the public familiar with the need for the services provided under the program. HOWNY is also the Comprehensive Health Planning Advisory Council. Members serve until replaced by the organization or interest they represent. The Chairman is William Chalecke, M.D., a practicing physician. Each county group meets monthly and they meet as a body annually. Functions: Elect a Board of Directors for HOWNY and to review all proposals for funding by RMP. Proposal critiques by RAG are sent to the Board of Directors and the proposals committee to insure that regional views are considered in the review process, A ne a cc The proposal committee has 14 members and they are appointed by The Board of Directors from the RAG membership. This committee has four responsibilities: 1) To receive recommendations on proposals from the county committees, 2) to enlist experts as consultants on proposals requiring a technical review, 3) to review all proposals and inform the Board of Directors their recommendations, and 4) to review evaluation reports on operational projects and recommend continuation support in light of the review findings. Categorical and Other Committees 1) 2) the following committees have been formed: Coronary Care, Cancer, Heart, Stroke and Stroke Education, Dialysis, Constitution and By-Laws, and Long Range Planning. The responsibilities of these committees are to set priorities, establish objectives, make recommendations and continue to be an he Rta. Se ee er ae am A bts a ao, integral part of the RMP's activities. 3) With the exception of the Long Range Planning Committee all have conducted at least one planning study and have reviewed a project. eo ite rn mm mw PROPOSAL ~ REVIEW PROCESS This process is schematically diagramed on the following page. Proposals are usually first received at the RMP coordinative head- quarters and from here they are sent to each of the county advisory committees, — The county committees have 30 days to review each proposal before they send their critiques on to the Proposals Committee. The Proposals Committee reviews the project application incorporating recommendations of RAG (HOWNY) and technical reviewers, if such is performed. The Proposals Committee may elect to obtain a technical review from experts in the field of which the application is written, The Board of Directors now reviews the application with the aid of all past reviewers recommendations, and arrives at a final decision regarding subject material. The remaining steps in the review process concern themselves only with budgeted line items such as salary scales, etc. aero 2 EA FO SRO A NERO AA, AR Na AUTHOR ON EE TRIE ROL roe: RMP OFFICE lL COUNTY COMMITTEE 27 PROPOSAL COMMITTEE REVIEW | BOARD OF DIRECTORS © DEAN. SCHOCL OF MEDICINE PROVOST HEALTH SCIENCES VICE-PRES FOR RESEARCH GRANTEE FISCAL AGENT RESEARCH FOUNDATION OTATE UNIV. Or NeW YORK WAS Maar TL SHEE SS flO ABS = PS RAE SNESION OF RMP PE Li q t | FR hy OME AE ATE SA OTE AM Ge TE MRS REL VINE IIE ARE WE Sa RP MR TE Pas eet a v _VITL, FUNDED OPERATIONAL PROJECTS #1 -- TELEPHONE LECTURE NETWORK Objectives: A two-way tleephone communication network would 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. Equipment would be leased from the New York Telephone Company. The network could serve several purposes, such as continuing education for physicians, nurses, and the health-related professions, public education, administrative communication, consultation with experts, and contacts among blood banks. #2 -- CORONARY CARE PROGRAM Objectives: The proposed coronary care program would test a training technique for providing qualified nurses who will be required to staff developing coronary care units in the Region. Approximately 80 nurses (4 groups of 20) have been selected from all parts of the Region for a combined academic and clinical course. Additional nurses will be trained. In addition, physicians would receive a condensed course to include that given to the nurse plus an opportunity to study physical, legal and administrative requirements of coronary care units. ~ #3 -- CHRONIC RESPIRATORY DISEASE PROGRAM Objectives: ' Funds are requested to develop a model regional comprehensive pulmonary care program. A nine point program is presented, including correlated educational activities for physicians, nurses, and allied health personnel. Other selected program aspects are: early case finding, out-patient and in-patient care, rehabilitation services, intensive care for acutely ill patients, and extended care services. Maximum use would be made of existing service, teaching and research resources. Four major hospitals will participate in this cooperative program, A site-team which can be any combinations of chest physicians, respiratory nurse specialist, and/or a blood gas technician will be available to all hospitals in the region upon request. This will act as support consultation for problems of diagnosis, management, in-service education, staff conferences, or whichever will serve the local purposes. #4 -~ IMMUNOFLUORESCENCE SERVICE AND TRAINING Objectives: This proposal would make available immunofluorescent antibody tests for diagnostic purposes on a regicnal basis. Physicians in the region would be given information on the applicability of. these tests. A teaching program for pathologists and laboratory personnel from regional hospitals would be offered so as to decentralize routine tests away from the host facility. #6 -- PILOT STUDY PROGRAM IN NUCLEAR MEDICINE Objectives; This is a pilot or feasibility study of cost- effectiveness and patient service aspects of a nuclear medicine unit in a small community hospital. Funds are requested to equip such a program. Program objectives include provision of diagnostic services, educational programs for practitioners as to the potential of this procedure, and the development of a training program for isotope technicians. #7 -- A TEST OF TWO CONTINUING MEDICAL EDUCATION TECHNIQUES Objectives: The purpose of this proposal is "to define a research strategy which will measure the effectiveness of the central tape library and the medical juke box as teaching and consultation tools for physicians and subsequently fox paramedical personnel... This study will evaluate the educational advantages and cost-effectiveness of: (a) central tape medical library, (b) juke box medical recording, _and (c) central tape versus juke box," #10 -- TUMOR REGISTRY Objectives: To contribute to epidemiological research, obtain clinical/pathological mortality correlations, aid in a diagnostic/treatment method evaluation, and to establish a guide for future educational programs.