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REGIONAL MEDICAL PROGRAMS

STATUS REPORT

 

February 16, 1968
TABLE OF CONTENTS

SUBJECT

Grants Awarded . . «1. « «+ » « «

Regional Size and Population .

Sponsorship of Regional Programs

Regional Advisory Groups... -

Program Coordinators .... «+ +
Program Staffs . . + «+ «+ «
Planning Activities .....

Operational Programs . . +. + + «+

Operational Program Activities .

Categorical Emphasis ..... -»

PAGE

Table

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*

February 1968

REGIONAL MEDICAL PROGRAMS
STATUS REPORT

Grants Awarded

Nineteen months have elapsed since the award of the first ten planning
grants, effective July 1, 1966, Planning grants have now been made to
all but one (Puerto Rico) of the 54 Regional Medical Programs and this
application is presently under review. In a majority of the Regions
(34), planning has been underway for a year or longer.

Initial operational grants have also been made to eight Regions. In
addition, seven other Regions have submitted operational grant appli-
cations which are currently under review. And it is anticipated that
another 8-10 Regions may submit operational grant requests by June 30,
1968.

Funds awarded to date for planning grants total over $37 million; and
approximately $10.5 million has been awarded for operational grants.
Pending requests -~ operational and planning, new and continuation --
amount to over $14 million.

The largest first year planning awards have been made to the California
and Greater Delaware Valley Regional Medical Programs -- between, $1.5
and $1.6 million each, The Texas and Michigan Regional Medical Programs
received the next largest first year planning awards -- close to $1.3
million each.

Over-all, the amount per capita funded for the 53 first year planning
grants averaged about 11 cents. For the eight operational awards made
to date, the average per capita funding is about 50 cents.

The percentage of the Nation's population covered by these eight
operational awards is about 10%. The seven additional operational
applications which are now under review include an additional 17% of
the population. (See Table 1)

Regional Size and Population

The 54 Regions vary widely in size and population. The largest, in
terms of population, is California with 19 million persons. The

smallest is Northern New England with about 600,000 persons. The average
size is 3.7 million persons and the median is 2.7 million. (See Table 2)

As initially defined for planning purposes, 31 Regions are essentially
coterminous with State boundaries. Twelve Regions include all or parts
-2e

of two or more States. Eleven Regions are parts of single States; six
of these are in New York and Pennsylvania. There continues to be substantial
overlap among the Regions as tentatively defined.

Sponsorship of Regional Programs

In almost every Region medical schools were principal participants in the
development of the planning applications; in about 20 cases, medical
societies were key early contributors; and health departments were also
involved in a similar number of instances. Both hospital associations
and individual hospitals were also early contributors.

University medical schools have emerged as the coordinating headquarters
for 30 Regional Medical Programs. A newly organized non-profit organi-
zation has assumed this responsibility in 15 instances and medical
societies in 5. (See Table 3)

At this stage in the development of Regional Medical Programs, it is

possible to pinpoint the nature and extent of the many participating
institutions and organizations in a general way. For this type of analysis
to be meaningful, participating organizations must include more than

those agencies which actually receive Federal grant funds. Organizations and
- institutions are participating in the planning process by serving on

Regional Advisory Groups and task forces and subcommittees, by conducting
special planning and feasibility studies, by developing operational

projects and by directly participating in operational projects. |

Studies of current available data show that over 1700 organizations are
participating in one way or another in Regional Medical Programs. They
include the Nation's medical schools, State and local medical societies,
hospital associations, and official and voluntary health agencies.
Hospitals make up the largest single group of participating institutions
(about 800). A more detailed breakdown appears in Table 5.

As planning proceeds and operational programs develop, more specific
information will become available. A preliminary analysis of the first
five awarded operational programs indicates that approximately 25% of
the hospitals, with 40% of the beds, in those Regions were participating
in the program.

Regional Advisory Groups

Total membership of Regional Advisory Groups has risen from about 1600

in mid-1967 to 1900. The average size of membership of Regional
Advisory Groups has steadily increased. It is now 36. The largest Advi-
sory Group has 111 members and the smallest only ll.

The most notable change has been the percentage of public members. In
the early groups, this was about 10% and it is now about 15%. Approxi-
-3-

mately half the present membership is physicians. The remainder includes
hospital administrators and other health workers, voluntary health agency
representatives, and public health officials. (See Table 4)

Chairmen of the Regional Advisory Groups include medical school officials,
practicing physicians, public members, and others, which include State
and county health officers, officials of voluntary heaith agencies, and
hospital officials.

Program Coordinators

To date, 44 of the Regions have full-time leadership, either as Program
Coordinators or Directors. These men.come from a variety of source and
backgrounds. Approximately 36% come from the world of medical education;
27% come from the private practice of medicine; about 22% come from
various segments of public health administration; and the remaining 15%
come from voluntary health and professional associations.

Program Staffs

The staffs of the Regional Medical Programs are increasing rapidly. It
is estimated that they now number about 1800. On the basis of the
available information it is estimated that about a third of the total are
professional personnel, another third are technical and other supporting
personnel and another third are secretarial and clerical.

About 40% of the professional staff are full-time. Over 70% are devoting
more than half their time to this work.

In addition, most Regions are heavily involving consultants in this
activity. These come from university departments and schools, and
official, professional and voluntary agencies.

An analysis of the backgrounds of the principal ‘staff personnel indicated
that about half are from the medical center, a fifth from private practice
of medicine and 10% each from other university departments, official health
agencies and voluntary health agencies.

Planning Activities

Previous reports have indicated that the original planning applications
essentially anticipated three major areas of activity, in addition to the
organization of the RMP planning and administrative resource itself:

». Strengthening of communications and relationships among
the participating organizations. ,

. Collection and analysis of data on resources and problems.

» Design of initial operational approaches.
-4~

The first annual reports indicate that these approaches have generally.
been followed, although there have been alterations, in particular as
staff was recruited and conditions changed.

A great deal of the first year's effort was focused on developing
"cooperative arrangements". Most of this work included large numbers

of conferences and discussions. Most Regions reported visits by staff
personnel to local hospitals and other community agencies to discuss the
nature and objectives of the program. In some cases, members of the
Regional Advisory Groups participated significantly in this effort.

The development of task forces and subcommittees of the Regional Advisory
Group has been a key mechanism for achieving broader participation in
planning. About 45 Regions report such committees, with an average of
six committees per region. It is estimated that approximately 2500
people other than Regional Advisory Group members and RMP program staff
are serving on these subcommittees. About 24% of the individuals are
practicing physicians, 41% are from the medical centers, 10% are allied
health, 7% are hospital administrators, 7% are public officials, 6% are
from voluntary health agencies, and 5% are members of the public.

Local, community-oriented planning groups are being developed to sutdy
and propose activities to meet community needs and to strengthen regional
relationships among and between local institutions and with the medical
center. Approximately 250 such groups have been identified to date.

Most of these are based out of community hospitals and include repre~
sentatives of the hospitals, health professions, and other community
leaders. About 40 of these groups are based out of county medical
societies which are working with other community leaders in developing
local plans and studies.

The first annual reports and continuation grant applications indicate
that the Regions are doing or plan to do studies of the distribution

of physicians and nurses, specialized clinical facilities, and disease
patterns, patient referral patterns and continuing education and training
programs and resources. Many Regions list dental manpower studies

and analyses of allied health manpower. Library and communications
facilities are also under study. In some cases, these activities

are facilitated by the use of data available from one or more of the
participating groups.

Feasibility studies are increasingly being developed by the Regions to
test the efficacy of certain types of activities, Progress reports

and second year continuation applications received to date from 34 Regions
indicate over 170 such studies are underway or planned. Approximately
48% of these studies are in the area of continuing education and training,
39% are related to demonstrations of patient care and 13% are in research
and development area.
Operational Programs

Eight Regions have been awarded operational grants totaling $10,471,994.
(See Table 1). Seven additional Regions have operational grant appli-~
cations now under review. Thse requests, including two supplementals,
total approximately $9.5 million.

In the eight Regions with operational grant awards, the aggregate of
operational projects and activities being undertaken indicate the
following distribution of funds in terms of functional categories:

Functional Category Percent of Award
(100%)
Training and education 37%
Demonstrations of patient care 34%
Research and development 18%
Planning, coordination and administration 112

It should be recognized that many of the operational activities do not
fall neatly into one or another of the above functional categories since
many of the activities combine program efforts. However, the above
breakdown reflects the identifiable major emphasis of the activities.
Taken as a whole, the operational projects within the eight Regions repre-
sent a broad scope of interrelated activities designed to help improve

the organization and delivery of health services and to improve the
medical and health capabilities and resources of the regions.

Operational Program Activities

A previous analysis of the program activities of the first five awarded
operational grants (Albany, Intermountain, Kansas, Missouri and Wisconsin)
indicated that in the Training and Education category, approximately 22%
of the activity was geared to continuing education of physicians, and

8% was for nurses. Approximately 37% was for programs which utilize
communications media (TV, radio, telephone), and 19% was for multi-
professional training programs. The remainder of this category included
library and information retrieval programs, consultation programs, and
training of health technicians.

In the Demonstrations of Patient Care Category, about 60% of the effort
was in the area of heart disease and about 26% was for multi-phasic
screening. Projects relating exclusively to cancer or stroke constituted
about 14% of this activity. .

Research aimed at gaining a better understanding of the organization and
delivery of health services, including how health care delivery might be
improved, and testing of bioengineering techniques, accounted for most
of the activity falling in the Research and Development category.
Categorical Emphasis

 

An analysis of the eight operational grants awarded to date indicates
that about three-fourths of the projects and activities have a distinct
categorical emphasis. The breakdown between single and multi-categorical
activities is roughly equal.

Disease Category . Percent of Awards
(74%)
Single Disease 38%
Heart
Cancer
Stroke

Related Diseases

Multi-categorical (combined heart, 36%
cancer, stroke, and/or related
diseases)

The remaining 26% of operational funds are for activities undergirding
entire Regional Programs. This includes providing basic facilities and
resources, such as computer and communications networks, learning centers,
information exchange programs, and programs in public education. It

also includes a small percentage (11% of total funds) for coordinative
and administrative functions.
TABLE 1
RMP AWARDS AND APPLICATIONS
(February 10, 1968)
Pending
Funds Awarded Applications
Planning:
lst year $21,730,300 $ 246,307
2nd year $15,638,173 $5,530,842
(Net New Money)* ($ 9,481,591)*
Operational:

Albany $ 921,510 Central New York § 251,775
Intermountain $ 2,038,123 California $3,500,000
Kansas $ 1,076,600 Missouri (Supplement) $1,251,818

Missouri $ 2,887,943 Metropolitan District
of Columbia $ 696,328
Rochester $ 255,487 Kansas (Supplement) § 446,671
Tennessee Mid-South $ 1,630,304 Mountain States $ 206,913
Washington-Alaska $ 1,032,003 New Mexico $ 634,974
Wisconsin $ _ 630,149 North Carolina $1,570,067
Oregon $ 179,242

$10,471,994

$8,737,788

 

* This figure represents the net amount of new second year planning
funds awarded. Carryover funds from first year awarded planning
grants, totaling approximately $6.1 million, bring the second year
computed awards to $15.6 million.
+

TABLE 2

POPULATION OF PRELIMINARY PLANNING REGIONS

FOR REGIONAL MEDICAL PROGRAMS

Population Range
Less than 1,000,000

1,000,000 - 2,000,000
2,000,000 - 3,000,000
3,000,000 ~ 4,000,000
4,000,000 - 5,000,000

More than 5,000,000

TOTAL

Regions

10

15

10

54
REGIONAL MEDICAL PROGRAMS
COORDINATING HEADQUARTERS AND GRANTEES

TABLE 3

 

 

Coordinating
Type of Agency Headquarters Grantees 1/
Universities 30 35
State (25) (26)
Private . =). ( 9)
Nonprofit Agencies . 22 17
Medical Societies ( 5) ( 6)
Newly Organized Agencies (15) ( 8)
Other Agencies ( 2) ( 3)
State and Interstate Agencies 2 2...
TOTAL 54 54.

 

1/ — The grantee differs from the coordinating headquarters when the
Region requested this arrangement or the latter agency did not
have the capability to assume formal fiscal responsibility.
-10-

TABLE 4
REGIONAL ADVISORY GROUP MEMBERSHIP
’ (January 1968)
Number Percent
Practicing Physicians 474 21.9
Medical Center Officials 306 15.6
Hospital Administrators 252 13.1
Vol. Health Agency Reps. _ 226 11.7
Public Health Officials 135 7.0
Other Health Workers 156 8.1
Members of Public 295 15.3
Other | 135 7.0

 

 

TOTAL 1,929 100.0%
_1/

a,

-ll- TABLE 5

1/
INSTITUTIONS PARTICIPATING IN REGIONAL MEDICAL PROGRAMS.
February, 1968 .

 

 

Number Participating Percentage
Institution in RMP Total Participating in RMP
TOTAL 1743
Medical School 103 103 100%
School of Public Health 13 16 81%
School of Dentistry 18 50 364%
Hospital 800 5700* 14%
State Medical Saoieties 52 52 1002
State Cancer Societies 51 51 100%
State Heart Associations . 52 52 100%
State Hospital Associations 40 50 80%
Areawide Hosp. Plg. Agencies 30 80 38%
State Health Department 52 52 100%
State Nursing Association 30 52 584%
State Dental Association 29 53 552%
County Medical Societies 90 ~ -
Other** 383 -.. -

For this analysis, "participating" is defined as membership on Regional Advisory
Groups, subcommittees, and local planning groups. The only exception to this

definition relates to participating hospitals, where participation was broadened

to include operational projects.
*short-term, non-federal, general hospitals.

*kk The category "other" covers a wide variety of institutions which participating

in RMP but which do not fall within the major categories listed above. They

include such institutions as local hospital associations, county heart and cancer
societies, allied health schools, Blue Cross=Blue Shield, professional organizations,

and other public agencies, such as Department of Education,