w I A %u B&B lt4@Rm^,riom & IMAGE MANAMEME@ 300 @eftcz M=nu@s aoulzv UP-golen M@$tL=Ono, MAR Pto Z077Z 6 USA 0 (201) 24@l 10 HISMFff OF REGIONAL MEDICAL P (Public Law 89-239) Prepared As Requested for President Johnson Library August 289 1968 INDEX HISTORY @e Backgromd . . . . . . . . . . . . . 0 # . . 0 . . 0 1 Conferences (Regional Medical Prograin) . . . . . . . . . . . . . 10, 11 Divisim of Regional Medical Programs . . . . . 0 0 0 . . . . . 6, 7, 18 Fiscal Information . . . . . . . . . . . . . . . . . . . . . . . 6, 8 Guidelines . . . . . . . . . 0 & 0 0 0 0 0 0 70 10 Legislation, see Public Law 89-239 Legislation (prior), see Backgromd Marston, Robert Q. . . . . . . . . . . . . . . . . . . . 0 . . 0 6., 12 National Advisory Council on Regional Medical Programs . . . . . 72 14, 24 Olsm, Stanley W . . . . . . . * e * 0 0 0 * . 0 . 0 0 6 . . . * 11 Operational Grants . . . . . . . . . . . . . . . 0 . * 0 . 0 . 0 8, 31 Planning Grants . . . . . . . . . . . . . . . . . . . . . . . . 7, 8, 31 President's Commissim on Heart Disease, Cancer and Stroke . . . 3g, 4 Program Coordinators . . .. . . . . . . . . . . . . . ... . . . . 27, 31 Public Law 89-239 . . . . . 0 . . . 0 * * . 0 . 0 . 6 6 . 0 1, 4, 6 Regional Advisory Groups . o . . . . . .. . . . . . . . . . . . . 8,' 9, 2S Regional Medical Program Review Comdttee . . . o . . . ... . . 7, 24 Regional Medical Program Staffs . . . . . . . . . . .. . . . . . 9,, 31 Regional Medical Programs . 0 0 0 . * 0 * 9 0 . 0 0 0 6 0 . 0 *1 23, 27, 31 Regionalization (concept) . 0 * 0 . . 0 0 e * 0 0 0 0 0 0 . . 0 11, 5 Regions (geographical) . . . . . . . . o 0 0 0 a 0 6 a 0 0 0 0 6 9 Report to the President . . . . . . . . . . 0 * 6 0 0 0 0 0 0 109 11 INDBX, continued APPENDICES Page 1. Public Law 89-239 . . . . . . . . . . . . . . . . . . . . . 14 2. Directory of Divisim of Regional Medical Programs . . . . . 18 3. Listing of National Advisory Council and Review Committee . . . . . . . . . . . * . 21 4. Chronology of Regional Medical Programs . . . . . . . . . . 23 S. Regional Medical Prograrns Regional Advisory Groups . . . . . 25 6. Map of Regional Medical Programs and Listing of Program Coordinators . . . . . . . . . . . . . . . . . . . . 27 7. Directory of Regional Medical Programs . . . . . . . . . . . 31 8. Excerpts of Testimony and Materials (H.R. 15758) . . . . . . 47 . Report on funded projects and activities in first 12 Operating Programs . . . . .. . . . . . . . 48 . Televisim, radio and telephme networks for continuing education . . . . . . 61 0 Statement m efforts directed against the health problems of the inner city . 62 e Statement m operational projects affecting rural areas . . . . . . . . . . . . . . . . 64 . Statemnt m effectiveness of Programs . . . . . ... . 71 HISTORY OF REGIONAL NEDICAL PROGRAMS (Public Law 89-239) On October 6, 1965, the President signed'Public Law 89-239. It authorizes the establishment and maintenance of Regional Medical Programs to assist the Natim's health resources in making available the best possible patient care for heart disease, cancer, stroke and related diseases. This legislation, which will be referred to in this History as The Act, was shaped by the interaction of at least four antecedents: the.historical thrust toward regionalization of health resources; the development of a national biomedical research c ty of unprece- dented size and productivity; the changing needs of society; and finally, the particular legislative process leading to The Act itself. The concept of regionalization as a means to meet health needs effectively and economically was not new. During the 1930's, Assistant Surgeon General Joseph W. Mountin was one of the earliest pioneers urging this approach for the delivery of health services. Ihe Na- tional Comihittee on the Costs of Medical Care also called attention in 1932 to the potential benefits of regionalization. In that same year, the Bingham Associates PLmd of Maine initiated the first comprehensive regional effort to improve patient care in the United States. This program linked the hospitals and programs for continuing education of physicians in the State of Maine with ;Mfts University School of @cine and, through that school., to the other university centers of Boston. Advocates of regionalization next, gained national attention more,than -2- a decade later in the report of the Comission on Hospital Care and in the Hospital Survey and Construction (Hill-Burton) Act of 1946. Other proposals and attempts to introduce regionalization of health resources can be chronicled, but a strong national mvement toward regionalization had to await the convergence of other factors which occurred in 1964 and 1965. One of these factors was the creation of a national biomedical research effort unprecedented in history and unequaled anywhere else in the world. The effec-C-of this activity was and continues to be intensified by the swiftness of its creation and expansion: at the beginning of World War II the national expenditure for medical research totaled $45 million; by 1947 it was $87 million; and in 1967 the total was $2.257 billion -- a 5,000 percent increase in 27 years,. The mst significant characteristic of this research effort is the tremendous rate at which it is producing new knowledge in the medical science, an outpouring which only recently began and which shows no signs of decline. As a result, changes in health care have been dramatic. Today, there are cures where none existed before, a number of diseases have all but disappeared with the application of new vaccines, and patient care generally is far more effective than even a decade ago. It had become apparent in the last few years, however, that new and better means must also be found to convey the ever-increasing volume of applicable research results to the day-to-day use of the practicing physician as well as to the growing complexities in medical and hospital care. Included in this latter group are physician specialization,, increasingly intricate and expensive types of diagnosis and treatment,, and the most effective distribution of scarce health manpower, facilities, and other related resources. The -3- degree of urgency attached to the need to cope with these issues is heightened by an increasing public demand that the latest and best health care be made available to everyone. This public demand, in turn, is largely an expression of expectations aroused by awareness of the results and promise of biomedical research. In a sense, the national comitment to biomedical investigation is one manifestation of the third factor which contributed to the creation of Regional Medical Programs: the changing needs of society in this case, health needs. The decisions by various private and public institutions to support biomedical research were responses to this societal need perceived and interpreted by these institutions. In addition to the support of research, the same interpretive process led the Federal Goverment to develop a broad range of other programs to improve the quality and avail- ability of health care in the Nation. The Hill-Burton Program which began with the passage of previously mentioned Hospital Survey and Construction Act of 1946, together with the National Mental Health ,Act of 1946, was the first in a series of post-World Wa-i II legislative actions having major impact on health affairs. When the 89th Congress adjourned in 1966, 25 health-related bills had been enacted into law. Among these were Ntdicare and Medicaid to pay for hospital and physician services for the Nation's aged and poor; the Comprehensive Health Planning Act to provide funds to each state for non-categorical health planning and to support services rendered through state and other health activities; and Public Law 89-239 authorizing Regional Medical Programs. For the text of Public Law 89-239, see Appendix.l. The Report.of the'President's Cofinission on Heiirt-Disease-,, Cancer, and Stroke, issued in December 1964, focused attention m societal needs and led directly to the introduction of the legislation -4- authorizing Regional Medical Programs. Many of the Commission's recommendations were significantly altered by the Congress in the legislative process but The Act was clearly passed to meet needs and problems identified and given national recognition in the Commission report and in the Congressional hearings preceding passage in The Act. Some of these needs'and problems were expressed as follows: * A Program is ne.eded to focus the Nation's health resources for research, teaching and patient care on heart disease, cancer,, stroke and related diseases because together they cause 70 per- cent of the deaths'in the United States. * A significant number of Americans with these diseases die or are disabled because the benefits of present knowledge in the medical sciences are not uniformly available throughout the country. * There is not enough trained @awer to meet the health needs of the American people withing the present system for the delivery of health services. * Pressures threatening the Nation's health resources are building because demands for health services are rapidly increasing at a time when increasing costs are posing obstacles for many who require these preventive, diagnostic, therapeutic and rehabilitative services. * A creative partnership must be forged the Nation's medical scientists practicing physicians, and all of the Nation's other health resources so that new knowledge can be translated more rapidly into better patient care. This partnership should make it possible for every ty's practicing physicians to share in the diagnostic., therapeutic and consultative resources of major medical institutions. They should similarly be provided the Op- portunity to participate in the academic enviornment of research,, teaching and patient care which stimulates and supports medical practice of the highest quality. Institutions with high quality research program in heart disease, cancer, stroke, and related diseases are too few, given the magni- tude of the prqblems, and are not uniformly distributed through- out the country. There is a need to educate the public regarding health affairs. Education in many cases will permit people to extend their own lives by changing personal habits to prevent heart disease, cancer,, stroke and related disease. Such education will enable individmls to recognize the need for diagnostic, therapeutic or rehabilitative services, and to know where to find these services, and it will motivate them to seek such services when needed. During the Congressional hearings on this bill, representatives of major groups and institutions with an interest in the American health system were heard, particularly spokesmen for practicing physicians and co ty hospitals of the Nation. The Act which emerged turned away from the idea of a detailed Federal blueprint for action. Specifically, the network of "regional centers" recommended earlier by the President's Commission was replaced by a concept of "regional cooperative arrangements" among existing health resources. The Act established a system of grants to enable representatives of health resources to exercise initiative to identify and meet local needs within the area of the categorical diseases through a broadly defined process. Recognition of geographical and societal diversities within the United States was the main reason for -6- this approach, and spokesmen for the Nation's health resources who testified during the hearings strengthened the case for local initiative. Thus the degree to which the various Regional Wdical Prograw meet the objectives of The Act will provide a measure of how well local health resources can take the initiative and work together to improve patient care for heart disease, cancer, stroke and related diseases at the local level. The Act was intended to provide the mans for conveying to the mdical institutions and health professions of the Nation the latest advances in medical scienr-e for diagnosis, treatrwnt, and rehabilitation of patients afflicted with heart disease, cancer, stroke, or related diseases--and to prevent these diseases. The grants authorized by The Act.are to encourage and assist in the establishment of regional coopera- tive arrangements among medical schools,, research institutions, hospitals,, and other medical institutions and agencies to achieve these ends by research, education, and demonstrations of patient care. Through these mans, the prograus authorized by The Act are also intended to improve generally the health manpower and facilities of the Nation. The Supplemental Appropriation Act of 1966 provided initial ftmding for the program, making available $24 million for grants and $1 million for the Division for fiscal year 1966. The Department of Health, Educatim, and Welfare Appropriation Act of 1967 provided $42 million for grants and $2 million for the Division for fiscal year 1967. Shortly after the Law was signed by President Johnson on October 6, 1965, the Division of Regional Nbdical Program was established at the National Institutes of Health. To direct its activities, Dr. Robert Q. Marstm accepted the invitation to leave his post as Dean of NL-dicine and Vice Chancellor of the University.of Nfississippi and become Associate -7- Director of the National Institutes of Health. Prior to the arrival of Dr. Niarston, Dr. Stuart Sessoms, Deputy Director of the National Institutes of Health, was -responsible for the development of plans and policies for the new program. 7he Division of Regional Medical Program was established in February 1966. A listing of the chief staff of the Division in the spring of 1968 is Appendix 2 of this History. The National Advisory Comcil m Regional Medical Progrars, established by the Law, was named from outstanding expert s in heart disease, cancer and stroke and from the leaders in medical practice, hospital and health care a&dnistration and public affairs. The Comcil met with Dr. Marston for the first time in Deceinber 1965 to advise m plans and policies. In early February 1966, the Council met again to review and approve the first issue of the Program Guidelines. Quickly printed, this publication was given its initial distribution the follow- ing month. Members of the National Advisory Council as well as the renbers of the Review Ccmittee who do thorough review of projects and make reconmndations to the Comcil prior to Council consideration and action are listed in Appendix 3. During the spring of 1966, some 20 applications for planning grants were received and reviewed first by initial review groups selected from ammg the comtry's health leaders, and then by the National Advisory Council. By July 1, the first 10 planning grants were recommnded for approval, and inmdiately awarded. Between July and DeceTnber 1966, another 40 applications were reviewed. Many of these were returned for revision or additional information to conform with the requirements of The Act. Twenty-four of these were approved and funded -8- so that when 1966 ended, a total of 34 Regional Nbdical Prograns had received awards for planning programs. These Regions represented areas that included som 60 percent of the population of the country. The first applications for operational grants had also been submitted by that date. In February 1967, the first four operational and 10 additional planning applications had been through the review process and were -reconwnded for approval by the National Advisory Comcil. At the Comcil meeting in May,-five additional planning applications were recommended for approval. In June, the first continuation grants were awarded to 10 Regions for the second year of planning. By the end of 1967, the total of Program in the planning state had increased to 53 and included the entire country with the exception of Puerto Rico. Also, by that time four more operational grants had been made for a total of eight. By July 7, 1968 Puerto Rico had its planning grant bringing the total Regional Medical Programs to 54 of which 23 had become operational. In terms of dollars expended these activities represented gome $75 million--$41 million in planning funds and $34 million to support operational activities. A chronology has been developed to show the time sequence in the developmnt of the Program . It is Appendix 4 of this History. I In terms of people, Regional Advisory Groups are comprised of hospital administrators,, public health officials, practicing physicians, voluntary health agency representatives, medical center and medical school officials and other members of the public. A pie chart was developed to show the overall distribution and numbers of these categorical Groups in April 1968 and is included as Appendix S. In July of 1968 the overall total of individuals m Regional Advisory Groups had risen to 2,034. Subcommittees of-these Groups involved another 3,132 persons. On the staffs of the 54 Regional Wdical Programs in July there was also a total of 1,539 full and part-time people involved in planning activities and another 908 involved in operational activities throughout the country. Appendix 6 lists the 54 Regions and the Program Coordinator or Director of each. It also gives a visual representation of the approximate geographical locations of the Regions. Appendix 7 is a Directory of Regional Nbdical Programs compiled in April 1968 which gives more detailed information m each Regional Nbdical Program, including preliminary planning area, estimated population covered, coordinating headquarters, Program Coordinators and Directors, Chairmen of the Regional Advisory Groups, and amounts of planning a!id operational grants and their effective starting dates. The 54 Regions encompassing the Natim's population had been formed,by organizing groups using functional as well as geographic criteria. These Regions now include combinations of entire states (e.g. the Washingtm- Alaska Region), portions of several states (e.g. the Intemountain Region which includes Utah and sections of Colorado, Idaho, Montana, Nevada and Wyoming), single states (e.g. Georgia), and portions of states around a metropolitan center (e.g. the Rochester Region which includes that city and 11 surromding counties). Within these Regional Programs, a wide variety of organization structures have been developed, including execu- tive and planning c@ttees, categorical disease task forces, and ity and other types of sub-regional advisor)r conidttees. -10- In accordance with The Act, Regions first received planning grants from the Division of Regional Wdical Progrars, and then a growing number were awarded operational grants to fund activities planned with initial and subsequent planning funds. 'Ihese operational activities provide the direct means for Regional Wdical Prograns to accomplish their objectives. Planning not only moves a Region toward operational activity, but is a continuing mans for assuring the relevancy and appropriateness of operational activity, It is the effects of the operational activities, however, which are beginning to produce results by which Regional Medical Progr @ are being judged. In July of 1966 there was a second printing of the Guidelines. These were up-dated in July of 1967, and revised again in Nlay of 1968. Two significant events during the first two years of the Program's existence were the National Conference held January 15-17, 1967, and the Conference-Workshcp of January 17-19, 1968. .The first meeting had been called by the Division of Regional' Nbdical Programs to obtain information frm a representative- group of knowledgeable individuals, which could be used in the preparation of the required Report on Regional Medical Programs to the Cmgress (PHS Publication No. 1690), and further to provide an interchange of informa- tim m the planning of the Programs. Devoted principally to the problems of definition and elaboration of,,the concepts of cooperative arrangements local initiative, and evaluation, that first meeting as reported in its Proceedings: Conference m Regional Nbdical Prograins (PHS Publication No. 1682) did much to characterize the Pmgram in their early stages. The January 1968 Conference-Workshop grew out of a specific request of the Program Coordinators at their meeting of June 1967. Planned by the Program Coordinators themselves, it was significant in content and purpose, and marked a milestone in the development of Regional Medical Programs. Its stated purpose was to provide those directly involved in developing Regional Medical Programs with the opportunity of exchanging ideas and information w@ich would be of benefit in the further implementation of the Programs at the regional level. The focus was m on-going activities in the Regions, particularly as they related to quality and availability of health care for heart disease, cancer, stroke, and related diseases. All Regions were invited to present papers on their activities and ideas;' to submit exhibits which reflected their activities, and to participate actively in panel discussions. The invitation resulted in the presentation of 60 representative-papers and some 40 exhibits and virtually every invited speaker accepted the opportunity to discuss the major issues of the Conference- Workshop. All of this material was reproduced in the Proceedings: Conference- Workshop on Regional Medical Programs, (PHS Publication No. 1774). A key figure in the development of both meetings was Dr. Stanley W. Olson,, fomer Dean of Baylor University Medical School. In 1967, as a consultant to the Division of Regional Medical Programs, he organized the Conference and acted as its chairman. In 1968, as Coordinator of the Temessee Mid-South Regional Medical Program and Chairman of the Coordinators' Steering Comittee, he worked closely with Dr. John A. Gronvall of the Nississippi I&dical Center in developing the Conference-Workshop. It was this extensive experience with Regional Medical Programs that was a strong factor in his subsequent selection by the Secretary of Health, Education, and Welfare and President Johnson as -12. successor to Dr. Robert Q. Marston when Dr. Marston was named to head the new Health Services and Mental Health Administratim created as part of the 1968 reorganization of the Department of Health, Education, and Welfare. The previously mentioned Report on Regional Medical Programs to the President and Congress,was another landmark in the History of Regional Wdical Programs. Required by Section 908 of Public Law 89-239 this publication was noteworthy as it records the accomplishments of the Program from its begimink until June of 1968 and it reconmnddd the further develop- ment of the Program and extension of it beyond the June 30, 1968 limit set in The Act. In addition to its value together with both Conference Proceedings as a source of reference and history it served an important. legislative function. Prepared by the Surgeon General of the Public Health Service, it was submitted to the President through the Secretary of the Department of Health, Education and Welfare, and was transmitted by the President to the Congress on November 9, 1967. His letter transmitting the Report to the Congress was at once encouraging and exhortative when it said, in part : "Because the law and the idea behind it are new, and the -problem is so vast, the program is just emerging from the planning state. But this report gives encouraging evidence of progress -- and it promises great advances in speeding research knowledge to the patient's bedside." Thus in the final seven words of the President's message, the objective of Regional Medical Programs is clearly emphasized. As this History is being written, the legislation extending Regional Medical Programs is in conference between the House and the Senate. Infor- matim m the.Programs, developed as part of the testimmy of the hearings, provided the Congress with a @ understanding of the progress of the Programs both specifically and in selected areas. This information is -13- contained in Appendix 8. With a series of minor amendments developed to meet the needs of the growing Programs, it is expected that the legislation will be passed to permit the continued development of the Regimal Medical Programs as part of the comtry's forward movement toward providing the highest possible quality of medical care to all of its citizens. APPENDIX 1 PUBLIC LAW 89-239 ail m ts to -4 0 t, a t3 PV to, tIr S. ts 'r Cs o OE 2 .10.Z 1.11 0 ts 0rr 0 m " m . ;, t, Po 0 t, is Cs -MO. -P- tr 0 -0 IV to ts OR a -00 a. C6 0 CL 93 J4 t, 00 W4 eq ts a'o0t$ C, ti " "9 oqo 0 ts 0 0 cb .0 ts t3 'C' C6 C, to, CY, tr r.-r V; !I - a k @ .3 ts rr a 9. 19 CM-6 F:l .0 g fo 04 S. rz 5L eb co 34 'I C-1 Ig 0 Po no 0 'o " - , 9. @, C tr SL t-r ,40 tr' m It al gI , 1 @ -, 'o, 2, 1 ,- , .; g . a @ m0 0@. to el# M El t.1' td ts tb 0. com CL. 0 ti a M rr !,4 4 r ; @ to cl 04 ts t2 CL s - C: -,M D.4 . i , - 11 IC:, ir t:r @ i" . S- 1; ot Cs tr 0. c i;c, IM ; - I .- I to a m2 y I E; 13 m 0 m I ft " ae, tms 14, 10 I., pa c (tm 0 IR 0 tr r-r 0 Cs (D 0 10 0spar -1 C3. t-I rr 0 cr I ci .0 aq cb C in t, oar 0 0. 0 n CL i; Ir to P!to@i CC39 0 -- -0 Oa - to It m i -- :i 00- Pr- ti-C$ - , ml --a 0 - aZ @ Is r. cps' o- C.@r 0 A 0, - aim tr 0 1, ck, ti 0 - 0 C6 oOa z - n .2 ;. OH Om ;L mtr F @ - 0 0 o trl a- 1 @ t-r -. ;. , - tr a - 11 D = 0 tb I., 1--i R 13 e5 CD aa 0 C46 0"7 0 n tr 0C, ri 0 , , a i t, ir Cs ta 2 @:9 C.: t., to M to, o CL, c't n n - I r, P- ti 0 Pr 0 ts o Pr is iv tr rr 0 lp_ td t4 a t, C, 019, tr 0 Oa Logi*Wive History: House Report No. 968 accompanying H.R. 3140 (Comm. on Interstate and Foreign Commerce). Senate Report No. 868 (ComnL on LiLbor and Public Welfare). Congressional Record, Vol. 111 (1965): June 25: Considered In Senate. June 28: Considered and pan" Senate. Sept. 23: H.R. 3140 considered In House. Sept. 24: Considered and passed Room amended. in lien of R.R. 8140. Sept 29: Senate Concubine In House ameadmentL APPENDIX 2 DIRECMRY OF THE DIVISION OF REGIONAL MMICAL PROGRAM 0 0 tE EE EOE 0 0 u =i co Z: .0.0 E3 cn 0 0 0 x rj .:g .9 z F4 eol- 0 0 cn io cn > .09 B,.g ew, I 04 -be,) Pk irk 0 ]logo @l @i 1 II -20- OFFICE OF ASSOCIATE DIRECTOR FOR PROGRAM DEVELOPMENT AND RESEARCH Richard F. Manegold, M.D ....... Associate Director for Program Development and Research. Continuing Education and Training Branch: Alexander M. SchrrLidt, M.D ...... Chief. Phyllis E. Carnes, Ph. D .......... Education Specialist. Veronica L. Conley, Ph. D ........ Education Specialist. Cecilia C. Conrath ................ Assistant to Chief. David W. Goldc, M.D ........... Training Consultant. Frank L. Husted, Ph.'D .......... Head, Education Research Group. Elsa J.'Nclson ................... Health Services Officer. Herbert 0. Mathewson, M.D ...... Training Consultant. Marjorie L. Morrill .............. Public Health Adv@. Rebecca R. Sadin ............... Public Health Adv@. Sarah J. Silsbee .................. Public Health Adv@. Jack J. Schneider, M.D .......... Training Consultant. John C. Tapp, M.D .............. Training Consultant. Charlotte F. Turner .............. Education stnd Training S@isL Regional Health @es Brawk: Philip A. Kli@, M.D...,.. Head, @cal hWamB Seetkm. -21- APPENDIX 3 LISTING OF NATICNAL ADVISORY COTJNCIL AND REVIEW CMWTTEE .22- NATIONAL ADVISORY COUNCEL E. L CROSBY, M.D. J. R. IIOGNESS, M.D. E. D. PELLEGRINO, M.D. Director Dean, School of Med. Director of ti3c Med. Ctr. American Hosp. Aum U. of Washington State U. of New York Chicago, 111. Seattle, Wash. Stony Brook, N.Y. M. E. DEBAKEY, M.D. J. T. HOWELL, M.D. A. M. POPMA. M.D. Prof. and Chairman Executive Director R(-gional Director Dept. of Surgery Henry Ford Hosp. Mountain States Regional Baylor U. Detroit, Mich. Medical Program Houston, Tex. Boise, Idaho C H. MILLIKAN, M.D. 11. G. EDMONDS, Ph.D Consultant in Neurology M. 1. SHANHOLT7, KD. Dean, Graduate SCIL Mayo Clinic State Hlth. ComnL No. Carolina CoBege Rochester, Minn. State Dept. of Hlth. Durham, N.C. __ G. F. MOORE, M.D. Richmond, Va. B. W. EVERIST, JR., BLD. Director, Roswell Park W. H.'STEWART, M.D. Chief of Pediatrics Memorial Institute (Chairman) Green (3inic Buffalo, N.Y. Surgeon General Ruston, La. Public Health REVMW COMMRME G. JAMES, M.D. P. M. MORSE, Ph.D. D. E. ROGERS, M.D. (Chairman) Director, Operations Prof. and Chairman Dean, Mount Sinai Research Ctr. Dept. of ?*led. School of Med. Mass. Inst. of Tech. School of Med. New York, N.Y. Cambridge, Mas& Vanderbilt U. H. W. KENNEY, M.D. A. PASCASIO, Ph.D. Nashville, Tenn. Medical Director Assoc. Research Prof. C. H. W. RUHE, M.D. John A. Andrew Memorial Nur,,in Assistant SecretarY, pitt.t School, U. of Hosp. urgh Council on Ated. Ed. Tuskegee Institute Pittsburgh, Pa. American Med. As@ Tuskegee, Ala. Chicago, 111. S. H. PROGER, M.D. F- J. KOWALEWSKL M.D. Prof. and Chairman R. J. SLATER, M.D. Chairman, Dept. of Med. and Executive Director Committee of Environ. Med. Physician-in-Chief The As@ for the Aid of Acad. of Gen. Practice Tufts N.F. Me& Ctr. Crippled Children Akron, Pa. Pre#., Bingham Fund New York, N.Y. G. E MILLER, M.D. Bostot4 Mae& J. D. THOMPSON Director, Off. of Research Prof. of Public HIDL in Med. Educ. Yale U. Med. School ColL of Med U. of IIL New Haven, Conn. C6icam IIL April 1968 -23- APPEMIX 4 CHROMLOGY OF REGia"MMICAL PROGRABS -24- ACNON EVENTS I Report of the President's 1964 DECEMIIEI Commission on Heart Disease, Cancer, and Stroke 1965 FEBRUARY TO JULY Congressional hearings @ODER Enactment of P.L 89-239 DECEMBER National Advisory Council meeting Initial policies and Guidelines reviewed Establishment of Division 19,66 FEBRUARY- Publication of preliminary Guidelines National Advisory Council meeting l'olicy for review proc- ess and Division activities set APRIL Review Committee meeting National Advisory Council meeting 7 planning grants awarded JUNE Review Committee meeting National Advisory Council meeting 3 planning grants JULY' Publication of Guidelines awarded Review Committee meeting AUGUST National Advisory Council meeting 8 planning grants awarded SEPTEMBER First of 5 meetings of 4d Hoc Report material Committee for Report to the discussed President and Congress OCTOBER Review Committee meeting NOVEMBER National Advisory Council meeting 16 planning grants awarded 1967 JANUARY Review Committee meeting National Conference National views & information for Report provided ]FEBRUARY National Advisory Council meeting 10 planning and 4 opera- tional grants awarded APRIL Review Committee meeting MAY National Advisory Council meeting 5 planning and I opera- tional grant awarded JUNE Report to the President & Congress JULY Review Committee meeting AUGUST National Advisory Council meeting 2 planning grants awarded OCTOBER Review Committee meeting NOVEMBER Natibnal Advisory Council meeting 2 planning and 3 opera. tional grants awarded 1968 JANUARY Conference Workshop Regional activities and Review Committee meeting ideas presented FEBRUARY National Advisory Council meeting 5 operational grants -25- APPENDIX 5 REGIONAL MEDICAL REGIML ADVISORY GEM .26- REGIONAL ADVISORY GROUPS The activities of Regional Medical Programs arc directed by fulitime Co. ordinators working together with Regional Advisory Groups which are broadly representative of the medical and health resources oi the Regions. Membership on these groups nationally is: Hospital Administrator cing Public He ysicians Officials 22 Other Health Workers 16(Yo Voluntary Medical Cente Health Age 157o r. &hool Officia6 Total: 1929 Members of the Public -27- APPENDIX 6 MAP OF REGIONAL MMICAL PROGRAYS AND LISTING OF PROGRAM OOORDINA7M -28- .-29- REGIONS AND PROGRAM COORDINATORS OR DIRECTORS I ALABAMA 10 FLORIDA 19 LOUISIANA B. B. Wells, M.D. S. P. Martin, M.D. J. A. Sahatier, M.D. U. of Ala. Med. Ctr. Provost, J. Hillis Claiborne Towers Roof 1919 7th Ave. S. Miller Med. Ctr. 119 S. Claiborne Ave. Birmingham, Ala. 35233 U. of Florida New Orleans, La. 70112 Gainesville, Fla. 32601 2 ALBANY, N.Y. 11 GEORGIA 20 MAINE F. M. Woolsey, Jr., M.D. M. Chatterjee, M.D. Assoc. Dean J. G. Barrow, M.D. 295 Water St. Albany Aledj, Coll. Med. Assoc. of Ga. Augusta, Me. 04332 47 New Scotland Aye. 938 Peachtree St. N.K Albany, N.Y. 12208 Atlanta, Ga. 30309 21 MARY'LAND 12 GREATER W. S. Spicer, Jr., M.D. 3 ARIZONA DELAWARE 550 N. Broadway D. W. Melick, M.D. Baltimore, Md. 21205 VALLEY Coll. of Med. W. e Spring, Jr., BLD. 22 MEMPHIS U. of Arizona Wynnewood House MEDICAL Tucson, Ariz. 85721 300 E. Lancaster Ave- REGION 4 ARKANSAS Wynnewood, Pa. 19096 J. W. Culbertson, M.D. W. K. Shorey, M.D. 13 HAWAH Coll. of Med. Dean, Sch. of Med. U. of Tennessee W. C. Cutting, M.D. 858 Madison Ave. U. of Arkansas 4301 W. Markham S Dean, Sch. of Med. Memphis, Tenn. 38103 L U. of Hawaii Little Rock, Ark. 722011 2538 The Mall 23 METROPOLITAN Honolulu, Ha. 96822 WASHINGTON, D.C. 5 BI-STATE T. W. Mattingly', M.D. W. H. Danforth, M.D. 14 ILLINOIS D.C Medical Society V. Chan. for Med. Affairs Wright Adams, M.D. 2007 Eye St. N.W. Washington U. 112 S. Michigan Ave. Washington, D.C 20006 660 S. Euclid Ave. Chicago, M. 60603 SL Louis, Mo. 63110 24 MICHIGAN 15 INDIANA A. E. Heustis, M.D. 6 CALIFORNIA R. B. Stonehill, M.D. 1111 Michigan Ave. Paul D. Ward Indiana U. Sch. of Med. East Lansing, Mich. 48823 655 Sutter SL #302 1100 W. Michigan Street San Francisco, CaliE 94102 Indianapolis, Ind. 46207 25 MISSISSIPPI G. D. Campbell, M.D. 7 CENTRAL 16 INTERMOUNTAIN U. of Miss. Med. Ctr. NEW YORK 2500 N. State CL R. H. Lyons, M.D. C. U. Castle, M.D. Jackson, Mis& 39216 Assoc. Dean State U. of N.Y. 750 E. Adams SL U. of Utah Syracuse, N.Y. 13210 Salt Lake City, UL 84112 26 MISSOURI V. E. Wilson, M.D. 17 IOWA Executive Director 8 COLORADO. WYOMING W. A. Krehl, M.D., Ph.D. for Health Affairs 308 Melrose Ave- U. of Missouri P. R. Hildebrand, M.D. U. of Iowa Columbia, Mo. 65201 U. of Col. Med. Ctr. Iowa City, la. 52240 4200 E. 9th Ave. 27 MOUNTAIN STATES Denver, Col. 80220 18 KANSAS K. P. Bunnell, Ed.D. C. E. Lewis, M.D. As@ Director 9 CONNECTICUT Chairman Western Interstate H. T. Clark, Jr., M.D. DepL of Preventive Med. Comm- for Higher Ed. 272 George St. U. of Kann& Univ. E Campus New Ha@ Conn. 06510 Kansas City, Kan. 66103 Boulder, CoL 800 -30- 28 NEBRASKA- 37 NORTHWESTERN 46 TENNESSEE SOUTH DAKOTA OHIO MID-SOUTH H. Morgan, M.D. C. R. Tittle, Jr., M.D. S. W. Olson, M.D. 1408 Sharp Bldg. 2313 Madison Avenue 110 Baker Bldg. Lincoln, Neb. 68508 Toledo, Ohio 43624 110 21st Ave. S. 29 NEW JERSEY 38 OHIO STATE Nashville, Tenn. 37203 A. A. Florin, M.D. R. L Meiling, M.D. 47 TEXAS N. J. State Dept. of lUth. Dean, Coll. of Med. *S. G. Thornpaon, M.D. 88 Ross St. Ohio State U. Suite 724 E. Orange, N.J. 07018 410 W. 10th Ave. Sealy-Smith Prof. Bldg. 30 NEW MEXICO Columbus, Ohio 43210 Galveston, Tex. 77550 1. E. liend4son, M.D. 39 01110 VALLEY 48 TR[-ST,4TE U. of New Mexico W. H. McBeath, M.D. N. Stearns, M.D. 900 Stanford Dr. N.E. 1718 Alexandria Dr. Albuquerque, New Mex. Lexington, Ky. 40504 22 The Fenway Boston, Mass. 02115 31 - NEW YORK 40 OKLAHOMA METR.AREA K. M. West; M.D. 49 VIRGINIA V. deP. Larkin, M.D. U. of Ok. Med. Ctr. E. R. Perez, M.D. N.Y. Academy of Med. 800 N.E. 13th SL Richmond Acad. of Med. 2 I- 103d St. Oldahoma City, Ok. 73104. 1200 E. 4May SL New York, N.Y. 10029 Richmond, Va. 23219 32 NORTH CAROLINA 41 OREGON 50 WASHINGTON- M. R. Grover, M.D. ALASKA M. J. Musser, M.D. Director, Cont. Med. Ed. Teer House Sch. of Med. D. R. Sparkman, M.D. 4019 N. Roxboro Rd. U. of Oregon Sch. of Med. Durham, N. C. 27704 U. of Washington 3181 S.W. Sam Jackson Portland, Ore. 97201 Seattle, Wash. 98105 33 NORTH DAKOTA T. H. Harwood, M.D. 42 PUERTO RICO 51 WEST VIRGINIA Dean, Sch. of Med. U. of North Dakota A. Nigaglioni, M.D. C. L Wilbar, Jr., M.D. Chancellor, Sch. of Med. W. Va. Univ. Med. Ctr. Grand Forks, N.D. 58201 U. of Puerto Rico Morgantown, W. Va. 26506 34 NORTHEASTERN San Juan, P.R. 00905 OHIO 52 WESTERN F. C. Robbins, M.D. 43 ROCHESTER, N.Y. NEW YORK Dean, Sch. of Med. R. C. Parker, Jr., M.D. J. R. F. Ingall, M.D. Western Reserve U. Sch. of Med. and Dent. Sch. of Med. State U. of N.Y. at Buffalo 2107 Adelbert Rd. U. of Rochester Cleveland, Ohio 44106 Rochester, N.Y. 14620 Buffalo, N.Y. 14214 35 NORTHERN 44 SOUTH CAROLINA 53 WESTERN NEW ENGLAND C- P. Summerall, III, MD PENNSYLVANIA Dept. of Med. F. S. Cheever, M.D. J. E. Wennberg, M.D. Med. Coll. Hospital Dean, Sch. of Med. U. of VL Coll. of Me& 55 Doughty SL U. of Pittsburgh 25 Colchester Ave. Charleston, S.C 29403 3530 Forbes Ave. Burlington, VL 05401 Pittsburgh, Pa. 15213 45 SUSQUEHANNA 36 NORTBLANDS IVALLEY 54 WISCONSIN R. D. PdcKenzie J. S. lenchboeck. M.D. W. R Miller, BLD. 3906 Market St. Wisconsin RMP, @ 375 Ja@kson SL P.O. BO S41 110 F. Wisconsin Ave. St. Pa@ Minn. 55101 C&mp @0a. 17011 Milwaukee, wiw- SM @@ator -31- APPENDIX 7 DIRECRW OF REGICNAL-NEDICAL PROGRANS -32- DIRECTORY, OF REGIONAL MEDICAL PROGRAMS The Directory lists Regional Medical Programs for which planning or opera- tional gmnts have been awarded or which are in earlier stages of development. Regions were defined for planning pur- poses in the planning applications. State designations do not necessarily indicate that the regions arc coterminous with State boundaries. The original definitions of the regions may be modified on the basis of experience. Region Pago Awarded as of April 26, 1968. NEW JERSEY (see also Greater Delaware ............... 410 INDEX NEW ........... N ov@, Region "'an@ Central A' YORK sea Id Pogo EW N. Yrk M. -itita. ALABAMA N Y rk Y.'k r (son also Tennessee M 0,0,.,. R NEW YORK -1-IR ;I.E South) ................................ : -v ALASKA, see Washington-Alaska. NORTH CAROLINA .................. 4(* ALBANY ................................. i NORTH DAKOTA ................... li NORTHEASTERN OHIO ......... ARIZONA a ARKANSA@*iie'o"iis;;M,o,m,.p,h,i.s,),.,.."-.", 35, NORTHERN NEW ENGLAND....:::..:.. BI-STATE ................................ NORTHLANDS ........................... IALIIORNIA,, NORTHWESTERN OHIO ........... CENTRAL N OHIO STATE (see also Northo@i"",- COLORADO.WYOMING .................. Ohio; Northweitem Ohio; Ohio Valley).. YA CONNECTICUT.. OHIO VALLEY ........................... DELAWARE VALEtY."i"'ij#4iiir"biiii' OKLAHOMA ............................. OREGON ....................... iiii war Valley. ijo6@ @ FLOR'I'DA ................................ PENNSYLVANIA. see Greater GEORGIA. ............... il@ Valley; Susquithanne Valley; Western GREATER '6ifCAWXAt VALLEY ........... IS- Pennsylvania. HAWAII. PUERTO RICO .......................... ft IDAHO, RHODE ISLAND, see Tri-State. States. ROCHESTER ......................... . SOUTH CAROLINA ...................... ILLINOIS esalsoBi-stafe)... INDIANA a SOUTH DAKOTA, see Nbraska-South I T Mo@as tso Ohio Valley) N ER NTAIN ....................... Dakota. IOWA .................................... 3-7 SUS@UEHANNA VALLEY .......... KANSAS. TEN ESSEEMID-SOUTH(sooa-.Im--nkii;;.. KENTUCki(.. i@ i;iiiii" 57 Phis) .................. Tonnesseei Mid-South. TEXAS .................. LOUISIANA ...................... TRI-STATE .............................. UTAHbseTe Intermountain. MAINE .......................... ::,:: -:: N MARYLAND VERM see Northern Now England. MASSACHU@'tfti;"s,e, 'o"T'ri'-'S't'a'f'e .......... VIRGINIA ................................ lw MEMPHIS of WASHINGTON-ALASKA ....... METROPOi:iyAi4,wAiii4iiidy6i4, 6 c WASHINGTON, D.C., see Me' I MICHIGAN ..................... Washington. D.C. MINNES( WEST VIRGINIA Ohio Valle mississ is) ........ WESTERN INTEPS"ToAaT'E-commlssflti missoui FOR HIGHER EDUCATION (WICHE), MONTAH see Mountain States. States. WESTERN NEW YORK .................. *4lr MOUNTAIN STATES... WESTERN PENNSYLVANIA ............. NEBRASKA-SOUTH DAkt WISCONSIN NEVADA sea lntermountal WYOMING NEW HAIAPSHIRE, "a Tr -33- c c re4 c c orb-10 C214 :Z@:;z 0 0 tuc it! -b 0, c C 2 fe4 0 f.) a c m C;d 0 c , !-7 U DC a WCr c -0 in co 0 0 U 0 w ch In In -C c c ;3,4 oite c in 0 N c C CO a 0 .2 c c 0 ,co c ci E c >0:c rL I.c'.c 0 zoi U c 6-2 lop I . 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S .8 E E 0 0 C', VI u 'I 03C tz CO r ki- to in CO to v ot ,r fi & 12 c .0 r 0 9 0.0 cm W, =CL MIL c r CC CL E ro Z. -47- APPEMIX 8 OF AND MATERLAIS (H.R. lS758) -48- DEPARTmrNT or HEALTH, EDUCATION, AND WMYAPZ (PUBLIC HEALTH S=VICZ) REPORT oiq 12 OPERA77lqG @IOIQAL MEDICAL PRWRAMS ALBANY RIDGIONAL MEDICAL @RAM The Albany TWonal lkfedical Program was one of the first regions to receive an operational award on April 1, 1967. Currently funded with $7;-)7),60.-), the region has appro,.ximntely 43 operational iKt-aff meniben, including approximately 14 physicians, 17 nurses, 5 other allied health personnel, and 6 general supporit personnel. Over two-thirds of the sWff are from the community hospitals, and they are working closely with the local medical center and R.%IP staff to Increase the capabilities for quality care at the local hospitals. Approxinia,tely 60 hospital-; from the Albany Region are participating In the program. Approximately 30 of these hospitals are directly participating In the operational projects outlined below. Two hospitals are represented on the Ad- visory Committee, and the remaining are involved In on-going planning activitleoL Operational Projects 1. Ti@way radio communication 8y8tetn, direct cost-4144,100 ngs project will expand an existing two-way radio network to include 57 hospitals and 24 high gehool& It will provide continuing education for physicians and allied medical personnel. It will also provide information and education pro- grams for administrators, members of boards of trustees, volnntary health agen- cies, adult education classes, and selected civic groups. 2. Community information coordinators, direct co8t@73,800 Former pharmaceutical representatives will be used to contact local physi- clans to tell them about Regional Medical Programs and to evaluate their atti- tudes towards RBIP. S. Po8tgradtiatc Iii8truction Development Panel, direct co8t-$102,600 This program proposes to have experimental and control groups of doctors to determine their educational needs. These doctors will then participate In In- structional programs. Afterwards they will be tested to determine the effective- ness of the instruction. Cottinitinity ho8p(tat learning centers, direct cost-475,800 This project will establish learning centers at coimnunity hospitals using "Self Instruction Units" and audio-visual equipment for rapid dissemination of new medical knowledge. Eventually, the directors of this project hope to evaluate physician progress. Initially, 8 hospitals will be Involved. 5. Albany Medical Center coronary care training and demonstration prograpiiB, direct co8t-$125,200 A coronary care unit will be established at Albany ',%Iediml College to serve as a model and training unit for training physicians and nurses who will then be able to establish similar units at community hospitals. 'I'his project will aug- ment the existing Coronary Intensive Care Unit at the Albany Medical Center. 6A and 6B. Community hospital coronary care training and demonstrate pro- gram@, direct co8t@55,400 THIR will complement project *5 by establishing coronary care units of three eit(-Ii at three (-oijiiiiiiiitty hosl)itaim: IlittAfleld General, St. Lukes, and Vaenr firotliers. The.,-p will t4erve am demonstration and educational projects for other hospitals In the region. A continuing educational program will Nerve the perma- nent Unit Sftff and @ffg from smaller hospitals. 7. Training and demonstration project, intcn8ive cardiac care ftnit Herkimer 3fentortat Ho8pital, dir6at co#t@3,500 The initial I)hnme of this project 1*4 to train 0 or 8 iiurmes from small community hospitals la cardia(- anatomy and phyi4fology, coronary disease, the principals and o4taffing of a cardiac Intensive care unit, and in handling the complex equipment Theme nurses will also be Pent to Albany Medical Center for active training with specialized equipment. -49- INTERMOUNTAIN REGXO'QAT, MEDICAL PROGRAM The Intermountain Regional Itedical Ilrogram received its first operational grant award on April 1, 1967 and its current operational award totaIF; $1,832,800. Approximately 80 -4taff members are ;erving in the operational projects, about one-third of whom are from community hosliftals working together with the Re- giotial %Iedl(-nl Program stnff front the iiie(li(-nl center, thev are bringing to local lienlth 1)rii(-titiotier,.4 nnd hospital-; throughout the region modern techniques for treating patients with the categorical diseases. Approximately thirty hospital.% are currently participating In the Program. Three hospitals nre represented on the Regional Advisory Group, and almost every iiinjor ho.--I)itnl la the region lint4 e-Atal)lish(-(l a local planning group to study local ii@4 and to serve as liaison with the ('entral IRi%fP staff. Seventeen hospitals tire I)nrticil)ntitig In the operatioiinl I)rojeett4 outlined below, and as the program coiitititie-4 to grow, It is anticipated that additional hospitals will become Involved. Operational Projects 1. Regional facility attd core-staff 8emiotar, direct cost-$Ii,600 The l'itiv(-rqltv of I'taii '.%Ie(licnl School will hold a series of quart(.-rly@eminare nit h(-tiltli (-are, continuing eiliiention, contemporary learning the- i)r.v, behavioral nit(I iii(,nmtirt-iiient technology. The faculty, ex- Ix-rt-4 from it(-rom th(, country, will address nit audience of health professionals In- volved in IRAIII. 2. Network for cotifinuf;g education in heart disease, cancer, stroke, and related diseases, direct co8t-4Z43,OOO The obj@re-4 of this program are to develop a communications network be- tweett lintietit-(-are and r(-s(-nrch Institutions to encourage liaison between health (-are personnel fit the aren. The currently existing 2-way radio syAem, Including 11 In 7 communities In or near Halt I.ake City, will be extended to re- mote hospital-; to serve as one link. Closed circuit TV and use of KVED (Unt- ver.41t.v of I'tah e(iii(-ntioii Tl') is also planned. Tbim may establish the community ho.-I@ital as the local of (-otitizittizig education. 3. Infort?iation and conintunication8 exchange service, direct co8t-440,000 The CIES Is a region-wide clearing house for Information about IR?41P. Staff will be put in local communities to act as public relations representatives and also to distribute Information to medical personnel and the public. 7%e community staiff will nlso gatber lnformntion on (-oiiiniunity needs and reqotirces and re- sources and serve as a station for collecting economic, @al, nnd medical data. 4. Clardiopfitnionary resuscitation training program, direct co8t@63,400 The University of Utah will give a 3-day course In resuscitative techniques to selected physicians front small comninnities. Each physician will then be responsi- ble for teaching the techniques to health personnel In his community. This "r(-sus(-itjitioti (-on,4tiltant" will also collect data about the number of times resuscitation is employed and the results. 5. A training program in intensive cardiac care. direct co8t-$118,600 A core fnetilty of experts In itt4ing Cardiac Care Units and diagnosing and treat- Ing heart disease ivill teach tihort courses in their subjects. The students will be int@sted physicians and nurset; from community hospitals building coronarr care units. 6. Training foi- ntir8c8 in cardiac care and cardiopulmonary rcsoiitcftation, direct cost-$34,000 This Is an Integral pnrt of both the cardiac CRre and cardiopulmonary resus- (-Itation programs for physicians (*4. *5). Nurses trained In Salt Lake City will return to their comnitinitte.-4 to serve as a core facitlty for reaching the teelinlqtiem at the local level. The iitirsem will work closely with the t4imllarlv trained physicians. 7. Clinical trainee program in cardiology, direct coB@65,700 Tbia program has two emphases- (1) To provide general practitioners, Internists and cardiologists with training programs In heart disease techniques tailor made to their Individ- ual situations. (2) To Increase the number of formally trained clinical cardiologists through a training.period (3 months to one year) at the existing cardiology school at the university of Utah. 8. l'isiting consultants and teacher program for small community hospital#, direct cost@.t4,8oo Small communities will be given the option of requesting one or two.-day clinics. A minimum number of four cardiac patients will be required. These clinics will upgrade the level of care to victims of heart disease living In remote areas. Visiting physicians will assist the local physician In a precise diagnosis In a precise diagnosis of his patients. -so- 9. A regional computcr-bascd sysictit for monitoring physiologic data on-line front remote hotpital8 in the regional medical program, direct cf.#Rt-$G.17,100 This 1)roject's purpose lm to test the fenqil)illty of timing a central computer to I)roc(,s-; a variety of physiological signals generated by patientm In remote box- I)itals, feeding the results of calculations from these Signals back to stations Nvitliln the hospitals, and using the Information for diagnosis. 10. Cancer tcachitigproicct, direct comt-$94,300 This project attempts to upgrade the level of care available to local conimuni- ties. The coordinator will direct a program of physician education to create trnined cancer sliecialists who in turn, will 1)@iiie centprm of cancer Information In their local communities. The physicians will receive a small stipend for teaching nn(I obtaining Information. A region-wide tumor r(-gimtrv will be mtarted, am will a trniiiing program In new techniques for pathologimtq. 11. Stroke and related neurological di8ca8r8, direct co8t-$98,700 This project will establish clinics to bring expert consultation service In stroke and related neurological diseases to local communities; will provide continuing education to locnl lihystelnns nnd Ntirst@m; will collect data about stroke patients seen and the problems they I)r(,t4etit to the practitioner. A 24-hotir telephone con- 14liltnti(;ii service and Information librarv service will he maintained at the Utah Aledical ('enter to I)rovl(l(- (-omniiinity physicians with Immediate advice. In addi- tioit, practicing physicians will be trained at the medical center In the latest diagnostic nnd treatment techniques. The courses will last from 4 weeks to one year. '@;ogra"t in respiratory therapy for phyqirians and nitr8cs, direct 12. ],,'discatiotial rost@2j,.IOO To train I)Iiysicintim and nurses to Utilize the iqlwc-fal te chniquem and equi@ illent in respiratory therapy. Five day seminars and follow.-up 2 day refresher courses will train participants to administer therapy and to teach others. 13. Rri7ional endocrine metabolic laboratory, direct cost-$237,900 To provide service facilities where practicing physicians can obtain laboratory data essential to the diagnosis and treatment; to create awnrenes'.4 among phrqi- clans of the I)os.%Ible I)re.Retice of iiietnbolle and endocrine abnormalities; to derive statistical Information. Three laboratories will be established: an lmmuno- assay laboratory, a chemical laboratory to measure steroid hormones, and a developmental'laboratory to refine techniques. Seminars will be held both Inside and outside of the laboratories. Abnormal findings will be reported to the refer- ring physician by telephone by a physician who is competent to offer consultation. KANSAS @ONAL MEDICAL PWMRAM The operational activities of the Kansas Regional Medical Program began on June 1, 196T, and are currently funded at the level of $699,852. Approximately 80 Individuals with varied backgrounds, comprise the current staff, of which about one-sixth are physicians, one-fifth are nurses, and an additional one-fifth are other types of allied health personnel. The remaining @ff includes related health personnel, such as communications specialists and social scientists, and general support personnel. About half the staff are from the medical center and the other half are from community hospitals. Together they are working on programs to improve community capabilities for treating the categorical diseases. Approximately 20 community hospitals are currently Involved in the Kansas Program, and it is anticipated that additional hospitals will become involved as expansion takes place during the next few years. Ten of theme @itals are directly Involved in operational projects, two are represented on the Advisory Committee, and eight are involved In on-going planning activities. Operational Projects 1. Educationalprogranw-GreatBend,Kan8.@261,000 (directoo8t) To develop a model educational program in this =all community a full-time faculty, which will be alMliated with the Kansas Medical Center, will be In residence. Included In this comprehensive program are plane for continuing phy- sician and nurse education and clinical traineeships for heath-related personnel Studies will be made of community needs, resourem etc. S. Health Sciences Communk0ton and InformaMn Center-477,900 (d@ C089) This project Is engaged in conducting studies to determine the feasibility of establishing communication linkages vital to education, service, and @rch -programs. Specific studies to be undertaken are a physician communication eye- tem. TV teaching, electronic linkaget% and Mediars search capacity. Study of the quality and availability of medical care-4149.000 (di"a cm) To determine unmet needs of patients, loeikUons, professional education, and -working arrangements of physicians and those In the health related diedplineL 4. Hospital information System and data facilifirs@67,500 (direct cost) To conduct studies within the region concerning vnrioiig aspects of community resources and needs, epideitilologic dnta and participation of health care per- Fionnel la continuing (-(Iiientioiial programs. A coppiptitcr system will be used. 5. Cardiot-aiteular n tirsc traittitig-$98,500 (dircct cost) To develop nti lii-serviee training program to prepare nurse.-;, who Rre the main- stay of coronary care units in community. hosl)ital-4. with basic physiological knowledge of coronary care, ability to use instruments and equipment in coronary care units, exl)erleii(-e In home care, and familiarity with social agencies that can Rid in the rehabilitation of patients. 6. Caficcr detection prograiii-Providcnm Ho8pitat@5,000 (direct coot) To evaluate the strengths and weakneq4m of the Cancer Detection Center now operating as an area referral center in Providence Hospital In Kansas City, Kan-a,.;. The records of patients will be studied to show effectiveness and yield of test results, type of- personnel who have used the clinic and their source of referral, and effectiveness of follow-up. 7. Cardiovascular work evatuatio"21,100 (direct cost) This project will demonstrate the Cardiac Work Evaluation Unit and show Its usefulness for the evaluation and rehabilitation of the patient. It Is developing an effective technique for showing physicians and the community attlarge the ability of patients to return to work after receiving the appropriate rehabilita. tion. METROPOLITAN DISTRICT OF COLUMBIA REGIONAL MEDICAL PROGRAM This region began its operational activities on March 1, 1968, with an award of $418.318. A staff of 47, including about 11 physicians, two nurses, seven other allied health personnel, and 27 other types of supportive personnel such an computer I)rogramnierq, eMing clerks and secretaries will work together to Improve local medical capablities and resources. About half of the staff is from the medical center and the other half is from community hospitals and other local health agencies. This combination of medical center-community personnel helps assure a quality, community oriented program. Seven hospitals are currently participating, and this number will Increase as the program expands over the next few years to reach out to the entire region. Three of these hospitals are directly participating In the projects outlined below, two additional hospitals are on the Regional Advisory Group, and two are serving on planning subcommittees. However, several additional hospitals will beneflt from these programs as they send their personnel to be trained in the programs outlined below. Operational Projects 1. Preedman'8 Hospital Stroke Station for the Diagnosis, Treatment, aotd In- restigation of Cerebral Vascular Disease, direct co8t-4181,889 This project Is a comprehensive approach to stroke, from diagnosis and treat- ment to home care and rehabilitation in an urban Negro area. Based In the Freedman's Hospital, a community hospital In the region, the stroke station will serve as a teaching component for physicians and medical students. Related epidemiological and socioeconomic studies will be undertaken. P. The Washington, D.C. Re@al Cerebrovascular Disease Pollowfip and Sur- veittatice System, direct cost-$94,200 Under the sponsorship of Georgetown University, this project is attempting to establish a uniform system for measuring and evaluating medical care given to stroke patients in the area, In order to facilitate nursing and follow-up services. It will provide information helpful in determining community medical facilities requirements, and In carrying out epidemiological or demographic studies. Patients entering the system through the various community hospitals in the region will receive follow-up attention and therefore greater continuity of care. S. A training prograin for cardiovwcular technicians, direct cost-$74,707 Qualified students are being trained at the Washington Hospital Center in Washington, D.C. In specific areas of medical observation and procedures to com. plement nursen' 'activities%. In addition to training personnel for work In bon- pitals throughout the region, this project hopes to produce a manual for training these technicians in the other regional bospit ahL -52- MISSOURI REGIONAL MEDICAL PROGRAM Operational activities began In Missouri on April 1, 1067, and current ol)era- tional ftindm amount to $2,619,000. An t@stiiiiate(i l(R) operational staff lwople, with divim backgrounds, are serving on the Ilrogram, lnt-iii(ling approximately l.-) plty.-41ciaii,4, four nurses, 16 allif-(l health personnel, three social scientists, and al)proximntely 60 computer specialists and their stilil)orting 1K-monnel. The remaining titaff provide overall stipl)r)rt, such it-; rel4eareli and staff nxt4ixtuntig and administrative and clerient liersotinel. The developmental nl)proti(-Ii being employed by this region and outlined In project descrilwtiotig Ix-lo%i, stiggt-stm that hospital Involvement ltif-reap;e rapidly over the next two,years. Currently, nine hosliftals nre Involved In the program, Including two hosl)ititlt4 whl(-Ii tire represented on the Regional Ad- visory Committee. OI)erationnl Proj(Tti; 1. Stiiithvillc community health ire#-vice I)rogratii-(Iit-cct c(@itt $200,957 The purpose of thin project is to establish n niod(@l Community health 4ervi(-e progrnni including continuing education and training I)rograiii,.4 and health education for the Iiiiblic; emergency ititeiisive nii(I restt)rntive (-nr(, home care -prograiiiR; l@ul)li(- litnith, 1)reveiitli-P iiie(li(-Iiie, and @.ho()l health ; C()- or(iiiiated with voluntary health agencies. Program centered around Smithville and to Include about 50,000 persons In county (Clay). Activities are centered around Smithyllle Community Hospital and the group practice clinic as a nucleus. 2. Ntiltiphasic testing of an atptbulant population@irect cost $421,471 This project is designed to establish centers for performing Series of diagnostic laboratory tests to Identify the most useful tests feasible for screening large rural population groups; determine the different patterns for ill and healthy populations as an aid in detection of heart disease, cancer and stroke In pre- clinical stages. Model test centerswill be established at the University Medical Center, Columbia, Missouri, and the State Mental Hospital in Missouri. A third is planned for the Smithville complex. 3. Conipit tcr fact bank-direct cost $279,365 This project Is designed to develop and apply techniques for delivering latest information on diagnosis and care of patients with stroke and allied diseases to the local physicians. Electronic data information storage and retrieval system will be developed at the University Medical Center (Columbia, Missouri) and later extend to include Smithville and other communities In the region. 4. Mass 8crcening-radiology-direct cost $54,814 This'project will help Improve the accuracy of radiologic diagnosis of heart disease, cancer and stroke through electronic communications media. Three small rural hospitals will be hooked into the University of Missouri computer and Department of Radiology to evaluate diagnostic efficiency and determine applic- ability of ultra-sound and thermogmphy in diagnosis and therapy. 5. Comprehensive cardiovascular care unit8-Springllcld, Mo., direct cost $69,347 A comprehensive care unit for grouping patients with heart disease or other circulatory system Illness or who have been admitted for other purposes but require close cardiac observation Is being developed. The project Is to be under- taken at hospitals without a house staff, where It Is hoped that grouping of patients will relieve the workload for nurses on general medical and surgical wards. St. John's Hospital medical staff and Greene County Medical Society are coordinating activities with 3 local hospitals In Springfield. 6. Communication research unit-dircct cost $61,743 Supporting research unit for program to identify public attitudes and knowl- edge about heart disease, cancer, and stroke; to understand motivations for seek- ing health care and to determine and develop effective methods for communicat- ing with public and lead them to seek medical care. 7. Data evaluation, computer simulation and systems dc#igot-dircci cost $329,712 This program will help to determine data needed from the public and physicians for early detecUon of heart disease, cancer and stroke through studies on the form of data, mechanisms for classifying, storing and retrieving data most effectively. 8. Bioetegincering project-$229,129 The aim of this activity Is wider distribution In rural areas of sensor trans- ducers, for early detection of heart disease, cancer and stroke and to generate more Information on physiological patterns of these diseases. P. Program evaluation ccsitcr-dircct cost $103,899 Through a mulUdisciplinary @rch approach accumulate data In -two sep- arate commnnities about Ifealth care, needs and attitudes oLs a base for developing Instruments for me asuring quality of care and JeW* of bmlth In term of an Individuals toncuou In his Guilty. -53- 10. Atitomatcd patient hirtory-dircct cost $77,501 This project Is testing the feasibility of an automated system for obtaining patient history and analyze complaints prior to examination by pbysictilng, an an aid In early d @se detection. 11. Aiitottiatc(i clcctrocardiograpliy in a rural a;-ca-Mrcct cost $369,000 To provide hospitals ntid 1)bysicianm In rural areas with automated facilities for transmitting electrocardiograms and an automnted system for analyses of ECG'S; to demonstrate the feasibility of such systems where this service In limited or nonexistent, niid to develop, test and Implement the use of bioengi- neering signals as aid in diagnosis.. It. Operations research and systems dc8ign-direct cost $39,055 This activitv will help develop systems concerned with testing "earlr detec- tion" hypotliesis-develop operational methods of early detection tests for a lnrge rural population. 13. Ilopulation study group surucy-dircet cost $65,200 ITsing National HWlth Survey questionnaire studv factors contributing to lisp of health services In small towns, with einpbasim on the lnfluen(-e of arnilitl)illty of care. 14. Auto niatcd hospital record, 8y8tcni-direct cost $52,100 This activity Is testing the automation of hospital record data through use of computer systems to organize a ready reference service and easy access to lion- pital data as a base for-taeasuring effectiveness of changes. 15. Computer Assembled on-Going Ma"ual of Medical a;id Paramedical Scrr- ices-direct cost $26,842 16. ectttrat core administration, planning and coordinatio@irect cost $238,805 (Unive@, ty of Missouri Medical Center, Columbia, Missouri) Missouri Re- gional Medical Program. MOIUNTAIN-STATES REGIONAL MEDICAL PROGRAM This four-st@ region (Idaho, Montana, Wyoming and Nevada) began its operational activities on March 1. 1968 with an operational award of $206,913 to Include one activity In coronary care. An operational staff of approximately eleven will serve in the project, and includes five physicians and six nurKes. 'ne hospitals involved will Include the community hospital In which the activity la taking place as well as those hospitals who will send their staff to the unit for training. The Regional Advisory Group also Includes two hospital representatives. operational Projects 1. Intensive coronary care in small hospitals in the rcgion-dircct cost $206,913 Hospitals In the Region will send Registered Nurses into St. Patrick's Hospital, Missoula, Montana for coronary care training. This 3 week course will be offered three times a year for 21 nurses, and there will be follow-ups at the home hospi- tals four times a year. In addition, a 4-day training program especially designed for small town physicians will be held at the University or Alontann four times a year. NORTH CAROLINA REGIONAL MFDICAL PROGRAM On March 1, 1968, the North Carolina Regional Medical Program received a combined planning and operational award totalling $1.4@,),341. Tie operations) component of this award totalled $T53,759 in direct costs only. The operational staff includes approximately forty individuals, Including twentr-eight physicians. one nurse, six other allied health personnel, and fire general support personnel. -- North Carolina hag already Involved twenty-seven of its boxotals In the Pro- gram. The Advisory Group Includes four hospital representatives and planning Hubcoiiimit)tees include an additional teii hospitals. Aplkroxiiiiately twenty-one lio,.41)itals are participating In the operational projects oirtlined below: Operational Projects 1. Education and re8carch in community nicdical carc, direct rnqt-$209,200 To develop resources for training iiiore-iiiedical and allied medical students; to provide new types of educational experiences which will make family practice more attractive; to have a postgraduate education program at the medical school; to strengthen ties between the medical school facultv and practicing 1)hy- sicians; and to have the medical school become involved In comnitinitv planning for improving the quality and availability of medical (-are. Affected br this proj- ect are the following groups: the University Comniunity; the Cne4ivell County Rural Health gerviem Project; the Regional Health Council of Eastern A14*- lachia, Inc-; the State of Franklin Health Council, Inc.; the Charlotte Memorial H@tal; the Moses Cone Memorial HoWtal, Greensboro,, and the Dorothea Dix Neuroinedi(al Service. r -54- 2. Coronary care training and developmcplt, direct co8t-456,93,9 To Use the project tLg a medium for developing cool)erative arrangements among the various elements in the health care community. Initial and continuing education will be provided to nurses and physicians In community hospitals, con- multation will be available to hospitals In establishing CCU'X, and a computer- based system of medical record keeping will be developed. Ills project has led to new working arrangements: (1) between the university medical centers; (2) be- t%i-eeii inedicnl and nurse educators; (3) between doctors and nurses In commu- iiit,v hospitals; (4) between university medical centers and emmunlty ho@pital& 3. Diabetic consultatiott and educational services, direct co8t-$132,081 To establish three medical teams to deliver services throughout the fitate; to assist in expansion of diabetic consultations and teaching clinieFo; to lde pro,v seminars for 1)liy.4icians and tenchfng sessions for nurses and patients to assist In organization of a State Diabetes A@tation and local chapters; to test techniques of data collection. Many people of different disciplines in many (!om- munities are Involved In this project. 4. Development of a central cancer registry, direct cost@66,6.t5 To devise a uhtforni region-wide cancer reporting system, integrated with the PAS, the comput-er-stored data from which can be retrieved to serve a broad range of educational, research, statistical, and other pu . 'Me following hospitals are participating In the first year of the project: Duke University Med- lcal Center, North Carollitit Memorial Hospital, North Carolina Baptist Hospital, Charlotte Administration Hospital, Illatts Rom4tal, Hanover ern General Hospital, Craven County H@pital. stry will I>e expanded to Include all hos- pitals and 5. Medical@ library extension service, direct co8t@5,839 To bring medical library facilities of the three medical schools Into the daily work of those engaged In medical practice. Local hospital personnel will be trained to assist medical staff; libraries will be organiz@ Into a functional unit for responding to requests for services. Bibliographic request service will be established. 6. Cancer Information Center, direct co8t-441,7.t6 To provide practicing physicians with Immediate consultation by telephone and follow_up literature. Each of the three medical schools will be responsible for providing service In Its geographic locale. The alms of this project are two-fold: (1) to assist physicians In providing optimum care of patients with cancer; and info (2) to continue the education of the physicians by giving new rmation In a patient-centered experience. 7. Continuing education in internal medicine, direct co8t-$38,313 To bring practicing Internists from all over the state to the ',%"Ical Center for amonth of up-to-date training In their subspecialities. They will share responsi- bilities with attending physicians and make ward rounds with students, staff, and together. This experience should enhance the api)re(!Iation In the University, both at faculty and student levels, for the expanding role of the medical center for the quality of care In the community. 8. Continuing education in dentistry, direct co8t-467,500 To provide physicians and dentists with the knowledge of mutual concern which will enable them to be more effective members of the health team. Courses will be given at the T'niversitr of North Carolina and in communities. Studies will be made of facilities needed to provide dental care In hospitals. The purpose of this project Is to ltiNure that as ninny patient-; as possible who suffer from heart disease, cancer, Ktroke, or a related dixt-ame re(-t,fre nl)l)rol)riate dental care as a part of their comprehensive treatment. 9. Continuation education fop- physical therapists, direct cost-427,838 To develol) and establish regional continuing education programs for physical therapists In order to strengthen I)hyt4ical therapy services for patients In all I)art.-t of the state. Subregion,4 will be delineated where needs and Interests will be identified and committees will be organized to arrange local activities. 10. The establishment a'f a victicork- acoronary care unitit in Small community hospitals in Appalachia, North Carolina This Is a proposal to develop coronary care units In seven hospitals In this rural, mountainous area. R31P will supply the monitoring equipment (the h(wl)ltal pro- vides suitable space) when adequately trained physicians and nurses are aritil- able. An intensive training course for physicians will be conducted in the @ graphic region, and continuing education programs will be @d@ When n@rY.., ROCIIESTER REGIONAL MEDICAL PROGRAlt On Iklarch 1, 1968 the Rochester Ilrograiii began Its operational activities with a modest operational grant award of $255,487. Apl)roxiiiintely 15 people are car- reiitl.v serving on tli(- Rtaff which will exl)niid with additional recruitment. The current staff includes 13 physicians, and two iiili(xl health personnel. A majority ,of the ,;taff are from community hospitals, and are working closely with medical center and RI%IP staff to Improve the quality of local patient care. Approxiiiintely eleven hogpltalm from the region are now participating In the progrniii, and this will expand an the program titovei4 forward over the next few years. Four hospitals are initially participating In the operational I)roje(.ttq. Three of these four are represented on the Regional Advisory Co'mmittee. Seven addi- tional hospitals are serving on the Advisory Committee and planning subcom- mittees. Operational Projects 1. Renovation and cqiiippi"g of facilities for a I(-arning rcttfer for projected training programs related to heart disease, canmr, and stroke, direct cost- $26,400 The awarded funds are for the I)urliose of altering and renovating sl)n(,e In Helen Wood Hall, which houses the Dej)artineiitR of Nursing at the tiliversity of Rochester. It Is planned to convert five rooms into two rooms for self-inaructional learning. These facilities initially will be used for four 4-week (-Oronarr care training courses for nurses and physicians In the region. New techniques that are disseminated by means of these courses will then be caried to the various coni- munity hospitals and rural areas In the region by the training course participants. B. Postgraduate training progrant for the phynfcians fit the Rochester 10-county region, direct cost@83,900 The objectives of tbiF4 project are centered around the further development of a postgraduate program in cardiology. TAmrning opportunities will be made avail- able for general practitioners and lntenilt4tiq. as well nm cardiologists practicing in the region. Several different programs are planned and varv In length from one-half dav to two weeks. It im nnti(-Il-mted ttmt a number of the paill(-ipating phv,4icians will represent community hoi;l)ital,.4 la rural areas. .1. Registry of patients icitit acute myocardial ittfaretion in the Rochester re- gional hospitals, direct cost-$21,200 One objective of this registry IL% to provide a uniform data collection RyLqtem from which both periodic information am well as longitudinal analyses may be extracted. Appropriate ltiformation am to prognosis and treatment will be dimenif- nate(I to particil)nting hospitals and (-oolwmting phyt4iclunm la the region. Strong lieniorial Hospital in FIiiiira. New York fm already I)artieilxating In this project. and It Is anticipated that several other community hospitals, especially those In rural areas, will soon also be participating. -f. Proposal for establishment and support of it reginitat laboratory for the educa- cation and training In the care of paticntit telth thro?)ibntie and Acmor- rhagic diqordcr8, direct ro8@6.9,400 At the present time no miiigle, central facility coii(-ervied with the dinglionin and therapy of Imtientm with throiiibotic or hemorrhagic disease exlmtt4 la the Ro- (-hester region. Lql)oratory techniciaiim from the regional ho.-q)ituls will be ltirit(-d to spend three or four days In the new facility. In addition, the 1)byt4i(-Iaiis direct- Ing this project will visit the participating communities so thnt a (-Otitiniting P(lu- eational program for practicing physicians In the car(- of I)ntientm with throiiibotic. diseases will be maintained. TENNESSEE I[ID-BOUTH REGIONAL MEDICAL PROGRA.%T Oil February 1, 1968, the Tennessee I%Iid-South Regional Program began Its operational activities with a diverse nrra.T of programs designed to provide local health practitioners and hospitals with advanced techniques and facilities necessary for quality health care. Over fifty people are currently serv- Ing on the staff of the operational program, Including approximately thirty-five physicians, five nurses, five other allied health personnel, and nine general isupport personnel. About one-fourth of the staff are from community hospitals and the remaining are medical center staff who are working on the community oriented I)rojects discussed below. Seventeen hospitals are currently participating In the operational projects, representing broad geographic spread throughout the region. Ten of these bon- pitals are also represented on the Itegional Advisory Group. Operational Projects 1. Continuing medical educati@Meharry, direct omt-444,800 Mebarry Medical College Is Informing Negro physicians In the region abodt more effective techniques for treating heart disease, cancer, and stroke. Teams of phytilelans will teacb two-week courses In the three areas at the Medical Cen- ter, using various audiovisual &Ids and, where feasible, programmed Instruction. One of this I)Ian's I provisions In sending a @or nddent from N to care for the physician's practice while he Is attending the course. -56- 2. Continuing cducat(on-Vandcrbilt, direct co8t-$141,600 Vanderbilt proposes to establish continuing education centers at community hospitals linked to a proposed Department of Continuing FAucation at Vander- bilt. libraries and Information centers at the local hospitals will bring Vander- bilt's Information resources to the local physician. The program, though planned and coordinated by Vanderbilt, will function through the local centers and em- phasize bringing Information to the physician at the times he needs It. S. and 4. Hopkitm@ic Education Center an(t Chattanooga Education Center, dircct cost-473,700 These are the first of the local continuing education centers specified In the Vanderbilt plan. At each hospital, a full-time Director with an appointment at Vanderbilt nnd an assistant director will supervise resident and physician edu- cation In their area. Their services will be available to physicians at smaller community hospitals In each area, as will the enlarged hospital library facilities. The Chattanooga and HopkIT;BviIle locations provide the basis for looking at problems In continuing education in urban and rural settings. 5. Special training for practicing radiologistg-V(mderbilt, direct co8t-$50,400 This plaip focuses on developing practicing radiologists skills In vascular radiology, but might later be broadened to Include all aspects of diagnosis and therapeutic radiology. Two postgraduate educational methods will be t@. One to three month coum" for technologic will be offered. In addition, emi- nent radiologists will preside at two-hour monthly seminars to which all radiologists in the region will be invited. 6. Cardiac itur8c training program-Mid-State Bapti8t Ho8pital-Nashville, direct co8t@49,600 The key factor In reducing mortality from cardiac arrest is the Immediate availability of a knowledgeable person to Initiate resuscitation. Mid-soutb Baptist proposes to instruct cardiac nurses In new resuscitation techniques by holding three four-week courses. These nurses will then be available to hospitals throughout the region. 7. School of X-ray and technology-Meharry, direct 008t-4.t.9,500 Meharry plans to establish a two-year program for training at least ten X-ray technologists per year. 'Me faculty will be Meharry's Radiology staff. Usability studies for establ@ing nuclear medicine and radWffierapy ms will be conducted. 8. Radiology technologist training progrant-Vandcrbilt, direct oo8t8-$30,300 Vanderbilt proposes to Increase the number of X-ray technologists, improve the quality of their training, and Increase their opportunities for continuing educa- tion. Three small hospital training programs in the area will be discontinued as separate entities and subsumed by a new school of X-ray technology at Vanderbilt. Practical clinical experience will be both at Vanderbilt and the smaller hospitals. 9. Nuclear medicine training progratii-Vandcrbilt, direct coBt-425,300 A new series of cours" taught by paramedical and medical personnel will be made available to physicians and technologists to Increase their skill In iiii(-Iear medical techniques. When @ble the physician and his technologist will spend some training time together to work out procedures suited to their rAtuation. Trainees will be accepted from smaller community hospitals planning to establish or improve nuclear medicine services. 10. Expan8ion of School of Medical Tecitnology-Barone8s Erlanger Ho8pital- Chattanooga, direct co8t-$35,400 To auginent medical technology capabilities In the area, this plan iiinket4'-two proposals: (1) Expand the Baroness Erlanger program for medical technologists; and (2) establish fL school for certified lab assistants who could free technologist" from more routine work for more complex procedures. 11, Vanderbilt Coronary Care Unit, direct cost@51,600 This project'.s purpose Is to establish a network of coronary care units with adequate equipment, staffed by well trained personnel. Vanderbilt will be the training and information center for the region; a demonstration unit there will provide a focal point for continuing education. In addition, communication systems will be set up to facilitate the flow of Information from Vanderbilt to the community hospitals. Studles are being raade to am If the small hospitals connected with Vanderbilt can become, in turn, centers for local networks of coronary care facilities in still smaller ho6pital& 12. Franklin Coronary Care Unit-WitUamson County Hospital-Franklin, direct C&8t-431,400 Tbix to one of the subsidiary units mentioned In the Vanderbilt aL This In primarily a pilot p@ to study the feasibility and @Iness of lshing a center In a mnall cmmunity hvWt&L -57- 13. Hnpkiiiiii,itte Coronary Care tlnit-4cnnic Stuart .4fcmorial Hoqpital-Hop- kinst,ille, Ky., di"(It coBf-$49,500 Thin plan Is similar to the Franklin plan, e@ that It mentions establishing links to sniniler @inunity hospitals by hellflng set up Fnnaller care units In them, thus providing for the grouping of rural comnyunity hospitals for more efficient use of existing resources. 14. Clarksville Coronary Care Unit-OlarkstiUe Memorial Hogpital, direct cost- $19,000 As the Franklin program, thin project Is a subsidiary of the Vanderbilt pogal. Since thin hospital has been -operating a unit, the plan calls for Its expa.i- tqion, continuing education and -a phone I"k-up to Vanderbilt. 15. Nashville General Coronary Care Uttit-Nashville Metropolitan Getterat Hos- pital, direct cos@42,100 Again, this Is like the Franklin plan. Nurses here will be included In the In- service training programs Initiated throughout -the participating hospitals. 16. Meharrti Medical College Coronary Care Unit, direct cost-$35,800 .%Ieharr.v lntehds to establish a demonstration unit of coronary care facilities which will derve an a continuing education center for smaller hospitals In Its region. % 17. Aturray Coronary Care Uttit-Aturray-Calloway (Ky.) County Hospital, direct cost-438,800 ,%Iurray-Calloway County Hospital, the training center for %Iurray State Uni. renlty School of NifFilng, will serve as a demonstration center for the sub- region. Direct phone communication will be established with Vanderbilt, which will send consultants from Its school of continuing education. This project has the dual objective of relating the Alurray State Nursing program to an established medical center and providing regional training resource to a remote area. 18. Chattanooga Coronary Care Unit-Darone8a Brlanger Hospital, direct cost- $14,400 Baroness Erlanger plans to establish a coronary care unit In a program of operation with Vanderbilt. Both telephone communicationn and electronic main- tenance systems connected with Vanderbilt will be installed. Ttin unit will serve as a center for the smaller hosotals In ChaUnnooga. .t9. Baptist Hospital Coronary Care Unit-Mid-State Baptist Hospital, N"h-, vilk, direct oo8t-451,000 Thin plan Is similar to the others Included in the Vanderbilt plan. BaptW Hospital will expand its present facilities and -aid establishment of smaller cen- tem at Tullahoma and Crossville, Tennessee. Direct telephone lines will be estab- litAhL-d for consultations. T%e unit director will have a clinical faculty t- meat at Vanderbilt. He will devote approximately 250/o of his time to the uniL 20. Crossville Coronary Care Uttit-Uplatid8 Oumberiand Medical Cen@, Cross- vfllc, direct cost@8,300 This project has two purposes: (1) to establish a two-bed coronary care unit in the hospital; and (2) to determine the feasibility of operating acute coronary care units In rural areas. The hospital will cooperate with Mid-State Baptist Hospital and Vanderbilt 21. Tullahoma Coronary Care Unit-Harton Memorial Hospital, TuUaho@ Tenn., direct co8t-428,800 See Baptist Hospital PrWam. -02. Meha"y supervottage therapy program, direct oo#t@58,300 This project Is aimed specifically at improving cancer therapy for a large In- dlgent population. Meharry will use Its funds to obtain a cobalt 60 High Energy Source for therapy and a computer hook-up with VanderbilL These facilities will also be used to Improve undergraduate and graduate radiology training programs at 'Aleharry. 23. Project to improve patient care in a remote mountain community by recruit. ing and training health aides for a new extended care facility-Scott County Hospital-Oneida, Tenn., direct cost-410,300 Alanpower shortage in this Isolated mountain hospital Is critical. Personnel to man an extended care facility now under construction will be obtained by two methods: (1) In-service training for hospital personnel; (2) an educational director (an RN) to serve as a liaison to the high schools to encourage young people to enter the medical Held and come back home to practice. In addition a training program leading to the LPN would be lntUated. Clinical training will be supervised by the Educational DirftWr while local high schools provide basic training. t4. Health ci-aluatiot& studies an a dcftncd poPula@ft grou ultiphasic ocree". ing-.Vcharry Medical College, direct co8t-$436,000 .%Ieharry will determine the effectiveness of a comprehensive health program and multlpliaric screening examinations In early diagnosis of heart disease, can- cer, stroke and their precursors. To run this experiment, a neighborhood medical center supported by OBO will serve a selected population of 18,000. The test population and a control population will be evaluated with reference to morbid- lty. changes In health attitudes and utilization patterns, effectiveness of the screening procedure and the cost per patient diagnosed or treated. 25. l,.rperit?zcnt to test and implement a model of patient carc-Vapgderbilt Uni- rcr8ity Itompital, direct cost-4110,400 This Is an attempt to deflne a new structure for Imtlent care. New personnel called stewardesses will be trained to take over the nurser;' non-clinical duties. Nurses would then be free to spend more time with the patient and to keep up their specialized skills. After the model Is refined at Vanderbilt, It will be tested In community hospitals-specifically BaptiFit and St. Thomas. 26. A titcdicaL surgical nurse specialist graduate progrant to improve nursing care of patients icith heart disease, cancer, and 8trokc-Vandcrbilt University Soltoot of Medicine, direct co&t-423,600 Vanderbilt Is developing a program to train medical surgical nurse specialists to improve nurdng care of heart. cancer, and stroke patients. It will be a master's degree program staffedby physicians and clinical iittrse..4 (I calendar year) plus one year of clinical experience half at Vanderbilt and half at the community hospital. Stipends will be provided during the flrst year only. WASHINGTOlq-ALASKA REGIOITAL MEDICAL PROGRAlf With an operational grant award of $1,032,003 on February 1, 1968, this two- state region began Its efforts to bring quality care to the dispersed populations of this area. About forty operational staff members are currently serving on the program, Including about seventeen physicians, three nurses, six other allied health personnel, and fourteen related health and general support personnel. About one-third of the staff Is from the medical center, another third is from com- munity hospitals and the last third is from other health and medical organiza- tions. The entire staff is working in concert to bring up-to-date medical tech. nfques to communf ties throughout the fegf on. Strong hospital Involvement In the Washington-Alaska program is evident In the project descriptions below. Approximately 86 hospitals,are currently paruef- pating in the program, almost 20 of which are directly involved in operational activities. Six of these hospitals are represented on the Regional Advfsory Groups, and an additional four of these are on planning subcommittees. The re- maining participating hospitals are involved In current planning activities It to likely that these, and the many other hospitals In the region, wW become In- creasingly involved in operational activities. Operational Projects 1. Central Wa8hington-Communication system for continuing education for phy8ician8-$18,181 (direct cost) This project is designed to bring the medical resources of the University of Washington to physicians and community hospitals in Yakima, who In turn will act as consultants to surrounding smaller communities through seminars and conferences, educational TV, other audiovisual Instruction; and exchange of teachers and practitioners. It will also connect internists In Central Washing- ton to Yakima cardiologists via EKG telephone bot-line, to permit quick analysis (starting with 5 community hospitals). Three general hospitals in Yakima In- volved are: St. Elizabeth's, Yakima Valley Memorial, and New Valley Osteo- pathfc. Nine other community hospitals to be reached Initially are located' in Ellensburgh, Moses Lake, Othello, Toppenish, Prosser and Cynnystde. S. Southeastern Ala.Bka-Postgraduate education-$27,062 (direct cost) Ibis program will help Improve communication between Seattle Medical Com- munity and University to alleviate problems of the isolated physicians In South- east Alaska cities and communities: Juneau, Sitka, Ketchikan (8 largest). As in Central Washington several methods will be used such as telelectures, consul- tant services, seminars and the EKG hot line to hospitals in Juneau, Sitka, and PHS Native Hospital at Mt. Edgecumbe and Ketchfkan community hospital. S. Postgraduate preceptor8hip for physician&-Ooronary care-417,610 (direct cost) A pilot project to provide opportunity for practitioners from fsolated com. i munities to spend a week or more under a preceptor at major medical centers to study advances In care of coronary heart disease. The 4 major medical centers In Seattle are Providence HoopftaL Swedish Hospital, Vfrginta Mason Hospitals and Medical Center, and University Hospital and Medical Oenter; two In Spokane are Deaconess Hospital and Sacred 11@ttil_HoWttL_ -59- WESTERN NEW TORK REGIONAL MEDICAL PROGRAM With an award of $35T,761, the Western New York Regional Medical Pro- gram began Its operational program on March 1. 1968. The current operational staff of seven physicians, one nurse, and two secretaries will be expanded to over 20 during the next several months. Over forty hospitals are currently In- volved In this program, almost all of which are slated to be part of the devel- oping regional two-way TV network for continuing education. Eleven hospitals are represented on the Regional Advisory Group, and an additional two hos- pitals are serving on planning subcommittees. Operational Projects .1. Two-way commtinfcations tictwork, dircct cost-4170,519 A two-way communication network will link hospitals of Western New York and Erie County, Pennsylvania to the Continuing Education Departments of the State University of New York at Buffalo and the Roswell Park Memorial Institute. The network will serve several purposes, such as continuing educa- tion for physicians and the bealtb-related professions, public education, ad- mini-itrative communication, consultation with experts, and contacts among blood banks. It will assist both the physician and community hospitaL in either the rural or urban environment in having at their flngertips the latest advances in the diagnosis and treatment of heart disease, stroke, and cancer. Particular emphasis will be placed upon Involving rural hospitals In this program there- by improving both their didactic and re-;torati ve function. 2. CorottarV care ittforniatfon coordinator, direct co8"127,5.f4 This project will test a training technique for providing qualified nurses who will be required to staff developing coronary care units in the Region. Approxi- iufttel.v 80 nurse.4 will be selected from all parts of the Region for a combined academic and clinical course. It is planned that the nurses receiving this train- liig will return to both rural and urban hospitals for the purpose of provid. ing a diagnostic and didactic function. While -the program will be housed at the medical center, the comniuiiity hospitals of this region will be the bene- factors of the project. Since there are few nurses trained to work In coronary care units, particularly In the rural environment, special attention will be paid to attracting nurses who will return to the community hospital. WISCONSIN REGIONAL MEDICAL PROGRAM The Wisconsin Program began its operational activities on September 1, 1967 when it became the llrst Regional Medical Program to be awarded a combined planning and operational grant. Currently funded with $630,147. about one third of which is for operational activities, the operational staff num- bers 20. About one-third of the staff are physicians, another third are allied health personnel, and the last one third are supportive and other type of per- sonnel. Approximately 20 hospitals are involved In the current phase of the Pro- gram. Eleven of these hospitals are directly involved In the operational projects. Flive are represented in the Regional Advisory Group and the remaining are represented In planning subcommtttee& As the program develops additional activities during the next few years, It is anticipated that many additional hospitals will be Involved. i. st@dv program for uterine cancer therapy and evaluation, direct co8t-440,100 This pilot project is designed to review and evaluate current radiotherapy for patients with uterine cancer. In Its first phase It will Involve lnformation ex- change and dosimetry standardization. Hospitals at Marquette and the Uni- versity of Wisconsin will be connected to a central, computerized data bank in Milwaukee which will compute radiation classes. When the necessary computer techniques are developed, it Is projected that the central facility will be linked to other hospitals outside the Milwaukee and Madison areas with similar treatment programs, and the long-term result will be to Improve local medical capabilities for the treatment of all uterine cancer patients in the Region. .0. A pilot demonstrdtion program for pulmonary thromboembolisnt, direct co8t- $84,600 in this project a center Is being established -at Marshfield 11@pital In Blamb- field, Wisconsin, for demonstrating diagnostic technique.-; and the available therapy for pulmonary thromboembolism. The project has a continuing educa- tion component which will reach physicians from many hospitals in the Region. This will Involve a 24-bour consultation service, the preparation of a movie on the topic, and special training sessions for groups of physicians. The project will demonstrate a comprehensive program which will encompass diagnostic, preventive, therapeutic, and rehabilitation procedures for patients, postgraduate education, a rapid transportation system for patients from Northern sections of the state, and cooperation between the clinic and other hospitals and medical schools In the State. S. Telephone dial access tape recording Ubrary in the areas of heart di&ease, can- cc)-, stroke, and related diRease8, direct cost-$18,050 This feasibility study will J)e carried out by the University of Wisconsin which will record and store short, 4-6 minute, tapes on various aspects of treating I)ntients with the three dipen*eR. Any physician anywhere in the -60- (,Ioronarli care tittit coordi"atio"70,255 (direct cost) Tlii;nctivlty will serve nm coor(linntlng unit for CCTT related project*-tbeir development, Improvement of operations, an(] training activities. A mock-up coroiinry care unit will l@e used la the educational programs for nurses and pbyst- claii-4; audio-visual self-instruction materials will be produced and evaluated. .5. Cardiac pulmonary technician training-$41,554 (direct cost) Itiq progrnm will help develop a formal program for training cardio-pulmo- iiary technicians to perform non-critical functions In coronary care units and free physicians for other duties. Four larger general hospitals In Spokane will parti- cipate with Spokane Community College. The 4 hospitals are Deaconess, Holy Family, Sacred Heart and St. Luke's Hospital. 6. Information and education resource support unit-$522,304 (direct cost) This program will help provide medical communities with the skilled assist- ance which will help Identify their educational needs and serve an a support unit in developing programs to meet them; to establish a central production unit, to coordinate audio-visual projects and the distribution of materials, to penetrate the entire region. 7. Two-ivtiy radio conference and slide presentati@8,445 (direct cost) Six pilot programs on heart, cancer and stroke topics to be transmitted via two-%ray radiotelephone slide conferences, to; physicians and hospital staffs on topics selected by a panel of physicians, starting with 20 hospitals In Washington are underway. It will explore potential for continuing network series with local and remote regions, 8. Gotitinititig education and on-the-job training of laboratory personne"53,446 (direct cost) Primary purpose of this activity Is to train technical personnel In newer clinical laboratory procedures, and shorten gap between availability of advance be directed at 5 local designated in techniques and actual use. First phase Is to training centers in Washington (cities of Seattle, Iftcoma, Spokane, Ynlrfma and Vancouver) and Anchorage,. Alaska. University of Washington will select from a list of available lftb procedures, arrange training courses for technicians in specific ones at designated facilities and establish quality control criteria; they will follow through with education of physicians in newer and practical tests for better diagnosis and treatment. S. Alaska medical lWarV @acilitiet-4.-1,754 (direct cost) This activity will help develop a community medical library located at the PHS Alaska Native Medical Center, Anchorage, for Alaska physicians and health related istaffs and ageucim It will have close ties with community col- leges, Arctic Health Research, University at Fairbanks and to supplement em- tinning education projects for Southeast Alaska and the Anchorage cancer project 10. Anchorage cancer progra@51,450 (direct cost) This project will aid In providing a supervoltage therapy unit for cancer patients to be located In an addition to Providence Hospital In Anchorage. It involves training of radiologist and technical staffs, consultant clinical eonfer- ences and accumulation and anillysia of dinnogstic data. Presbyterian Com- munity Hospital in Anchorage will be participating. 11. Care of children with cancer (8tudy)-428,030 (direct cost) This Is an epidemiological study to determine the impact of different methods of care for children with cancer, focusing on differences among children treated in local communities and at major centers; to be conducted by the swff of Children's Orthopedic Hospital and Medical Center, Seattle. 12. Radiation physicist consultatiott program for radiologists in Washington and Ala8ka--$56,393 (direct 0089) This project will provide consultation serriem of a radiologist-physicibt for smaller hospitals, in dosimetry and other problems of radiotherapy. To enhance postgraduate education for radiology residents and paramedical @neen outside of the University syswm. 13. Computer-aided instruction to @ disam, oa@, and stroke and related diseases-453,390 (direct cost) To develop and evaluate the effectiveness of comput@ided chose for teaching medicd queiL Partici@to wiU be chid In the no of Vater termb=bL -61- Region can dial the library at any time and request a tape relevant to a problem In which he is interested. Nursing telephone dial access tape recording library In the arras of heart diseases cancer, stroke, and related di@camcm, direct coit-$18,800 This fea,,41bility study, similar to the one iil)oi-e, will estnblimh a central tape library with information recorded oil nursing f-are- In emergencies, new pro- cedureg and equipment, nnd recent developments In nursing. Nurses from any hospital in the region will be able to call at any time to have a tape played to them. S. Development of medical and health related single cottcept flint pt-rgi-a)it In comtttunitv hospitals, direct coBt-$SS,P,50 This education feasibility project Involves ten community h4wpitals ill its first phase. Fifteen films on procedures and techniques used In treating heart, cancer, and stroke, will be developed. Projectors and the films will be InFtalled In the hospitals for use by physicinns and other health personnel at th(-Ir con- venience as R continuing education device. After four to six months the ma- terials will be relocated In ten additional hosl)ital.,4. TELVVXBIOlql RADIO AND Ti@:LF.PIIONll iNETWOItKii FO)t CO.NTINuima EDUCATION OPFRATIO,'IAL PitOJECTO 1. Albany Regional Medical Program Tico-tvay radio compittitifcation aV8tc@Direct cost, $144,100 This project will expnnd an existing two-witv radio network to tnclnde 57 hospitals and 24 high schools. It will provide continuing education for physicians and allied medical personnel. It will also provide Information and education programs for administrators, members of bolirds of trustees, voluntary health agencies, adnlt education classes, and selected civic groups. 11. Intermountain Regional Medical Program Network for conti"uing education in heart disease, cancer, stroke, and re. latcd disea8e#--Direct cost, $243,000 The objectives of this program are to develop a communications network between patient-care and research institution.,; to encourage liaison between health care personnel In the area. The currently existing two-way radio system, Including 11 hospitals in 7 communities in or near Salt @e City has been expanded to 10 additional remote hospital!; to serve as one link. This system will be expanded to additional hospitals In response to physician requests. Closed circuit TV and use of KVED (University of Utah education TV) In also planned. This may establish the community hospital as the focus of continuing education. 111. Kansas Reglonnl Medical Program Health sciences communication and information ocnter-Direct cost, $77,900 This project Is engaged In conducting studies to determine the feasibility of establishing communication linkages vital to education, service and research Programs. gpeciflc studies to be undertaken are a I)IIY*tician communication syn- tem. TV teaching, electronic linkages, and Ikledlars search capacity. Linkages will be established at hospitals In Great Ilend, I'littsburg and,Kansas C@. IV. Waqbington-Alaska Regional Medical Program Central 'Wa8hington-Communication 4yitem for continuing education for phy8i-- cians-Direct coit, $18,181 This project Is demigned to bring the medical resources of the Uiiit-er.'4ity of Washington to physicians and community boqpltals In Yakima, who In turn will act as consultants to surrounding smnller communities through seminars and conferences, educational TV, other audiovisual Instruction and exchange of teacberr and practitioners. It ivill also connect Internists In ('(,ntral Washington to Yaklmwi cardiologists via EK(l. telel'ibone hot-line. to 1)4,rtilit (Illi(-k analysis (starting with 5 community hospitals). Three genernl hoqliitnls in Yakima in. volved are: St. l,',Iiztibetli's, Yakini.,i '%It,'inortal, and New Valley Osteo- pathic. Nine other community hospitals to be reached Initially are located in Ellensburgh, Moses Lake, Othello, Toppenis. h, Prosser and Suniiyside. Southeastern Ala8ka-Postgraduate iducat@I)irect cost, $27,062 Thisprogram will help Improve communication between Seattle 3tedical Com. munity and Univers@ to alleviate problems of the Isolated pbytticians in south- east Alaska cities and eominuniUes: Juneau, Sitka, Ketc!hlkati (8 largest)@ An in Central Washington several methods will be used such as telelecturei% con- oultent server seminars and the EKG hot Una to hospitals In Juneau, Sitka, and PHS Native Hospital at ML Edgftmbe and Ketchikan community hoapit&L -62- Tico-way radio conference and slide prcicntation-Direct cost, $8,443 Six pilot programs on heart, cancer nrid Stroke topics to be transmitted via two-way radio-telephone slide conferences, to phyalcians -and hospital @ffe on topics selected by a panel of I)hyalciantq, starting with 20 bo-tpitals ID Wapqblng- ton are underway. It will explore potential for continuing network series with local and remote region& V. Western New York Regional Medical Program Tit,o-i4,ay comtitunications network-Dfrcct cost, $170,519 A two-wny telephone communication network will link over 40 hospitals of Western New York and Brie County, Pennsylvania to the Continuing Education Departments of the State University of New York at Buffalo and the Roswell Park'Atemorial Institute. The network will serve several purposes, such as oon- tinning education for physicians and the health-related professions, public ed- UCRtion, administrative communication, consultation with experts,, and contacts among blood banks. DEPAnTl.[ENT OF HEALTH, EDUCATION, AND WELFAITE STATEMENT ON REGIONAL MEDICAL PROGRAM E)rmnTs DIRECTED AGAXIQST THE HEALTH PROBLEMS OF THN INNER CITY -- In August 1967, the National Advisory Council on Regional Medical Programs issued a. statement which gave consideration to the health problems of metro- politan areas and their Inner cities. While recognizing the complexities of the urban environment, the Council stressed the responsibility of Regional Medical Programs to contribute to the solution of health problems there. In addition, It recommended that an appropriate group of national leaders be named and called together to consider how the attention of Regional Medical Programs could best be focused on the Issue. In response to the statement and to the Surgeon Generalls memorandum of October 9, 1967 "Improving the Health Status of the Urban Poor," it meeting was held on November 16, 1967 to consider the problem. Among those persons Invited to attend were hospital representatives, RMP coordinators from urban areas, health planners, representatives from OBO, medical school officials and physicians with responsibility for the provision of care to the tirban poor. The discussion concerned the need for Immediate action to reduce the health Status differential which now exists, the n@.for experimentation In the methods of delivering health cnre, and the need for coordinating the activities of diverse groups which provide health care services In the Inner city as well as specific approaches and projects which might be undertaken. At the local level, Regional Medical Programs which Include major metro- I)nlittin nreas hnvl- develol-Kd varied approaches to solving these problems. These efforts include cooperative arrangements between hospitals, health departments, medical schools, voluntary agencies and practicing physicians to meet the health needs of the poor. Examples of these approaches now under development or In operation can be summnrized as follows: California Regional Medical Program has established a subregion covering the Watts-Willowbrook area of @q Angeles which will facilitate the develop-, ment of activities aimed at meeting the specific needs of the people there. Through the Regional Medical Program, the University of Southern California School of Medicine and the UCLA School of Medicine are cooperating with the local Charles R. Drew Medical Society (ftn affiliate of the National Medical Associa- tion) in establishing a post-graduate medical school at the Southeast General Hospital now under construction in Watts. This school will provide back-up services to the OEO neighborhood health center In the area, develop training programs for allied health personnel, provide stimulus for additional physicians to enter the practice within the community and will develop training programs for physicians already there. California Regional Medical Program has requested funds for partial support of the school In the early stages of development In addition, work Is now underway at the University of Southern California School of I%Iedicine on the application of cancer case finding methodology to poverty groups. New Jersey Regional Medical Program has organized an urban health unit within their office and has established a Tnsk Force on Urban Health Services under the chairrbanabip of Mrs. Anne Somers, a member of their Regional Advisory Group. Membership on the Task Force lnclndes representatives of the New Jersey Hospital Association, the New Jersey State Department of Com- munity Affairs, county medical societies, local 014,'O CAP programs and other groups. The function of the group will be to stlmtilnte and review projects for improving the availability of health services to persons living In urban or(-as of the state, particularly low Income groups. The group currently is working on the development of hospital based group practices at Middlesex General liospitm in New Brunswick and at West Jersey Hospital in Camden, as demonstrations of Improved systems for patient care for heart disease, cancer and stroke. The New Jersey Regional Medical Program will assign a ewrdinator/planner to the Model Cities offices in Trenton, Newark, and Hoboken. The function of -63- - these persons will be to gather data on services and the facilities available for people stifrering from heart disease, cancer and stroke; to provide liaison be- tween Regional Medical Ilrograme and the I%Wcl Cities programs; and to as-41st the Model Cities oflices in developing a program of health services for th 'e com- muiifty which will be consistent with the overall goals and objectives of the Regional Medical Program. Tennessee-midsouth Regional Medical Program has developed a number of projects which affect the health care of the poor In Nashville. Coronary care units will be established at Nnshville Metropolitan General Hospital and Hub- bard Hospital, which serve patients largely drawn from an indigent population. Mebarry Medical College will conduct continuing education programs for Negro physicians and will establish a stipervoltage radiation unit to Improve cancer therapy in the community and Improve graduate and under-graduate radiology training. In addition, there is a project to test the effectiv(mess of multiphasic screening exntniiiations in the early diagnosis of heart disease, cancer and stroke. ',%Iebarry will establish a screening center which will operate in support Of A comprehensive neighborhood health center funded by CEO and will serve a pop- ulation of 18,000 people. The teat population and a control group will be evaluated and compared with reference to changes in morbidity, patterns of utilization of health services, health attitudes and cost per patient diagnosed. Tri-State Regional Medical Program received a planning grant In late 196T and is only now becoming completely organized. Since that tifne Dr. Norman Stearnes, Program Coordinator, has been involved in a number of meetings where he has made known Regional Medical Program's Interest In working to Improve the availability of health services to the urban poor. He also Is serving on an ad hoe committee formed in Boston by Blue Shield to discuss the planning of home services and wtll'f;it on the Health Services Advisory Committee to the Boston City Department of Health and Hospitals. At this time, there are two projects for earmarked funds under development In the Boston area, a stroke project at the New England Medical Center which will have a tie-in with the Columbia Point Neigbborhood Health Center and a hypertension project being developed by Dr. Edward Kass of the Channing Laboratory, Boston Department of Health and Hospitals. I Illinois Regional Medical Program has established a number of formal and informal contacts with persons In the Chicago area responsible for providing health services to the inner city including Dr. David Greeley, Associate Direc- tor, Chicago Board of Health and Dr. Mark Lepper, Vice President, Presbyterian- St Luke's Hospital which operates an OEO financed neighborhood health cen- ter.'Now In the planning stage at Presbyterian-St. Luke's Hospital Is a com- mtinity hypertension detection program which will be focused on the Mile Square area of Chicago. Included would be -evaluation of case finding methodology, ef- fectiveness of treatment, nurse interviews with patients and an analysis of the interaction of the program to the community. Michigan Regional Ikledical Program: At its recent February meeting the Re- gional Advisory Group of this program formally adopted a statement for prior- lties for Regional Medical Program action which reads in patt "the fl@,t priority for Regional Ikledical Program support will be given to those projects which are concerned with the improvement of the delivery system of health care Including such aspects as (a) Improvement of the delivery system of health care to low income groups; and (b) Innovations and improvements in the utilization of manpower . . ." Underway is a planning project supported jointly by Regional Medical Programs and the State Health Department (Project ECHO) for gather- Ing data on the health needs In depressed areas of Wavne County, Michigan. Wayne County General Hospital has submitted a project to stady the use of subprofessional workers to assist the physician In patient care and will design and establish training for such persons recruited from the local community. Wayne County Genernl Hospital serves the Indigent population of Wayne County and Is located adjacent to a large indigent group In western and southern Wayne County, Michigan. In addition, Regional Medical Program staff at Wavne State University School of Medicine Is working to establish liaison with urban health programs In Detroit Including ORO and Model Cities. The Executive Director of the Detroit Urban league bRs been named to the Wayne State Advisory Group. Indiana Regional Medical Program is working with F]Rnner House. a volun- tory community agency in Indianapolis to develop a multiphasic health screening program for low Income population groups. With State and'local support the Regional Medical Program is conducting planning and feasibility studies to determine the types of screening procedures which will most effectively reach target population groups rind which can In part be administered br previously untrained persons from the community who hnve received on-the-job training. New York Metropolitan Regional Medical Program has made specific assign- ments to members of their core staff for maintaining liaison with cotwuunity mental health programs, OEO and Model Cities. Particular effort has been made to develop a working relationship with the Provident Clinical Society, the mov. Ing force behind an OEO henith center in Brooklyn and as a result the president of this organization has recently been appointed to the Regionitl, Advisory Group. In upper Manhattan, the Regional Medical Program In practicing with representatives of the National Medical Association, Columbia University Col- lege of Physicians and Surgeons, Mount Sinai School of Medicine and St. Ltike'x Hospital in the development of continuing education programs for unaffiliated physicians. The Regional Medical Program In also taking leadership In @ripon. soring a conference on health careers for the.underprivileged to bring together -64- all interested forces III the area to develop a coordinated program. Al-,o In the develol)ni(-ntal stage, are several projects for earmarked funds including a pediatric pulmonary disease center at Babies Hospital, R feasibility study for the development of screenitig'azid treatment of stroke patienti at Harleni ll()Iqpital, and a niol)ile coronary care unit to operate out of St. Vincent's lloil)it2i in Greenwich Village. Metropolitan Washington, D.C., Regional M(,fflcal Program will establish a stroke station at Preedintin's Hospital, the teaching hospital of Hoivard Uni. versity Medical School. The project will Improve the care of patients from a predominantly Negro population group by setting up an Intensive care Ptrokq unit In the hospital and by developing extensive follow-up services for stroke patients. The unit will be used for training medicnl students, area physicians, nurses and paramedical personnel In the latest techniques of stroke management. There will be research studies undertaken on diagnostic methods, epidemiology and the cultural, behavioral and socioeconomic consequences of stroke. Also submitted for review are stroke projects to be operated at George Washington University Hospital, D.C. General Hospital and Glenn Dale Hospital which would combine university and D.C. Department of Public Health efforts. Missouri Regional Medical Program will establish at Kansas City General Hospital a special diagnostic and treatment unit for patients with cerebrovas. cular disease. Approximately r)00 patients a year will be referred from the emergency room, outpatient department, clinical services of the hospital and from physicians In the surrounding communities. Kansas City General Hospital serves the majority of Indigent patients In the Kansas City, Iklissourt area and will provide the back-tip to an OEO neighborhood he-Rlth center now under develo@ ment In the conimun-fty. Missouri Regional Medical Program nnd Kansas Re- gional Medical Program have also established a greater Kansas City liaison coni- niittee to review and coordinate the activities of both programs In the metropoli- tan area. I Georgia Regional Medical Program has submitted for review a project for the development of a community hypertensive control program, to determine the most effective methods to Identify symptomatic hypertension In an urban racinlly mixed corumunity in Atlanta. The project which would be conducted by the Georgia State Health Department would assess the most effective methods to achieve good blood pressure control in these hypertensives, train lay blood pres- sure aidt;, and determine whether a community program In hypertension control is economically feasible using public health methods. DzPARTmICNT Or HEALTH, BDUCATION, AND W@ARE STATICUENT ON OM=TIONAL PRwzcTo AFmmiNa RuxAL Amus AURANY REGIONAL MEDXCAL PROGRA36C Many of the Albany operational activities will serve to enhance the capabiu- ties of health professionals In the rural areu. By bringing professionals from small communities into the medical center for continuing education and by im- proving communications between the medical center and the communities they hope to raise the level of patient care In those communities The following proj. Involve rural areas: Operational Projects 1. Two-way Radio Communication Syo@: Direct Oo#t, $144,100 This project will expand an exi ting two-way radio network to Include 5T hoqMtals and 24 high schools. It will provide continuing education for physicians and allied medical personnel. It wiU also provide Information and education pro. grams for administrators, members of boards of tru@ voluntary health agen. cles, adult education classes, and selected civic groups. B. Community Informatiott Coordinators: Direct Cost, $73,800 lPormer pharmaceutical representatives will be used to (!on@ local physician to tell them about Regional Medical Programs and to evaluate their attig7degs towards RMP. S. Community Hospital Learning Centers: Dire;g Cost, $75,800 This project will establish learning centers at community hospitals using "Self Instruction Units" and audio-visual equipment for rapid disomination of new medical knowledge. Eventually, the directors of this project hope to evaluate physician progress. Initially, 8 hospitals will be Involved. Community Hospital Oorol"ary Care 2raining and Demo"ttration @gram: Dircci Cost, $55,400 This project will establish coronary @re units of three beda each it three community hospitals: Pittafteld General, St Lukes, and Vassar Brothem Ilese will serve as demonstration and educational projects for other hoop@la in the region. A continuing educational program will serve the permanent Unit @ff and staffs from smaller hospital& 5. Training and Demonstration Project, Intex*ive Cardiac Oare Unit Herkimer Memorial Hospital: Direct Oo#to 13,600 The Initial phase of this project in to train 6 or 8 n@ from mnall community hospitals In cardiac anatomy and physiology, coronary disease. the principals and otaffing of a cardiac lntendve care unit, and In handling the complex equipment Theme nurms will also be sent to Albany Medied Oenter for aeUve @ing wkb, Caused equipment. -65- INTERMOUNTAIN REGIONAL MEDIOAL PROGRAM The Intermountain Regional Medical Program has essentially three types of projects for remote communities. Several projects are educational Involving the training of health professionals who are brought Into the medical center. Other projects send specialists from the medical center to the small communities to aid local physicians with specific areas of patient care. A third type Involves the use of electronic monitoring equipment which transmits physiological signals from patients in remote areas to the medical center for interpretation. A UsUng of these projects follow& Operational.Projecto 1. Nctwork for Continuing Ediication in Heart Disease, Cancer, Stroke and Re- latcd Diseases: Direct Cost, $243,000 Tqie objectives of this program are to develop a communications network be- tween patient@e and research institutions to encourage liaison between health care personnel In the area. The currently existing 2-way radio systems, Including 11 hospitals. In T communities In or near Salt Lake City, will be extended to remote hospitals to serve as one link. Closed circuit TV and use of KYED (Uni- versity of Utah education TV) in also planned. This may establish the community hospital as the locus of continuing education. 2. Inforpitation and Cominitnications Exchange Scrtqce: Direct Cost, $40,300 The CIES is a regi@n-wide clearing house for information about IRMP. Staff will be put in -local communities to act as public relations representatives and also to distribute lnfornifition to medical personnel and the public. The community staff will also gatlier information on community needs and resources and serve as a station for collecting economic, social, and medical data. S. Cardiopulmonary Resuscitation Training Program: Direct Cost, $63,400 The University of Utah will give a 3-day course In resuscitative techniques to selected physicians from small coinmunitie& Each physician will then be resl)onfd- ble for teaching the techniques to health personnel.in his community. This @ auscitation consultant will also collect data about the number of times resuscita- tion is employed and the results 4. A Training Program in Int6sive Cardiac Care: Direct Cost, $118,600 A core faculty of experts in using Cardiac Care Units and diagnosing and treat- Ing heart disease will teach short courses in their subjects. The students will be interested physicians and nurses from community hospitals building coronary care units. S. Training for Nurses in Cardiac Care and Cardiopulmonary Re8u8ottation.,Di@et Cost, $34,000 This Is an integral part of both the cardiac care and cardiopulmonary resuscita- tion programs for physicians (*3, *4). Nurses trained in Salt Lake City will re- turn to their communities to serve as a core faculty for teaching the'techniques at the local level. The nurses will work closely with the similarly trained physicians. 6. Vi8itiHg Consultants and Teacher Program for Small Community Hospitals: Direct Cost, $14,800 Small communities will be given the option of requesting one or two-day clinic& A minimum number of four cardiac patients will be required. These clinics will upgrade the level of care of victims of heart disease living in a remote area. Visit- Ing physicians will assist the local physician In EL precise diagnosis of his patient& 7. A Regional Comptitcr-Ba8cd System for Monitoring Phy)tiologie Data on-line from Remote Hospitals in the Regional Medical Program: Direct Cost, $637,100 This project's purpose Is to test the feasibility of using a central computer to process a variety of physiological signals generated by patients in remote boa- pitals, feeding the results of calculations from these signals back to stations with- in the hospitals, and using the Information for diagnosis. S. Cancer Teaching Project: Direct Cost, $94,300 This project attempts to upgrade the level of care available to local communi- ties. The coordinator will direct a program of physician education to create trained cancer specialists who, In turn, will become centers of cancer Informa- tion In their local communities. The physicians will receive a small stipend for teaching and obtaining Information. A region-widk, tumor registry will be started ,'a will a training program In new techniques for pathologies 9. Stroke and Related Nourologioat Diseases: Direct Cost, $98,700 This project will establish clinics to bring expert consultation service in stroke and related neurological diseases to local communities; will provide continuing education to local physicians -and nurses; will collect data about stroke patients seen and the problems they present to the practitioner. A 24-hour telephone @ultation @ce and Information library service will be maintained at the Utah Medical Center to provide eommunity physicians with immediate advice. In addition, practicing physicians will be trained at the medical center in the latest diagnostic and treatment techniques. The couna will last from 4 weeks to one year. -66- 'KANSAS REGIONAL MEDICAL PROGRAM The Kansas Region Is emphasizing cardiovascular care In Its rural p ma. In addition it Is netting up a comprehensive model training program In a small .community. The project descriptions follow: Op(,rational Ilrojects 1. Edticatioto Pi-ogi-anto-Ot-cat Rend, ICatt8a8: Direct Cost, $261,000 To develol) a model educational program In this small community a full-time faculty, which will be affiliated with the Kansas Aledit-al Center, will be in residence. Included in this comprehensive program are plans for continuing physician and nurse e(lu(-at.ion niid clinical traineesbips for henitli-related per- nonnel. Studies will be made of community needs, resources, etc. 2. Cardovascular Ntit-8e Training: Direct Coat, $98,500 To develop an lii-servim, training program to prepare nurses, who are the mainstay of coronary care units in community hospitals, with basic physiological knowledge of coroiinry care, ability to use Instruments and equipment in coro- nary care units, experience In home care, and faiulliarity witif Social agen(.-ies that can aid in the rehabilitation of patients. S. Cat-dfova8citlar Work Pvalitation: Direct Covt, $21,100 This project wjll deiiionstrate-the Cardiac Work Evaluation Unit and sho%v its usefulness -for the evaluation and reliabllitntion of the patient. It Is developing an effective technique for showing physicians and the community at large the ability of patients to return to work -after receiving the appropriate rehabilitation. MISSOURI REGIONAL MEDICAL PROGRAM The Missouri Regional Medical Program operational activities involve projects di toward improved screening techniques, early disease detection and rapid diagnosis, and more effective delivery of services. These are coordinated with automated systems for transmission of Information and health data to aid physicians and community hospitals In the treatment of patients with heart disease, cancer, stroke and related diseases. Six projects focus on the health needs, the care of patients, and training of staff for rural communit@. Operational Projects 1. Smithville Community Health Service Program: Direct Cost, $200,957 To establish a model community health service program Including continuing education and training programs and health education for the public; emergency intensive and restorative care facilities; home care programs; public health, preventive medicine, and school health; coordinated with voluntary health agen- cies. Program centered around Smitbville (population of 3,500) and-to Include about 50,000 persons In Clay County. Activities are centered around SnzithviVe Comntti"ity Hospital (75 bcds), and the group practice clinic as a nucleus. Ll. Mttitiphasic Testing of an Ambuta"t Population: Direct Cost, $421,471 To establish centers for performing series of diagnostic laboratory tests to identify the most useful tests feasible for screening large rural population groups; determine the different patterns for III and healthy populations as an aid in detection of heart disease, cancer, and stroke In preelinical @ges. Model test centers will be established at the University Medical Center, Columbia, the State Mental Hospital and a third Is planned for the S"iithvitte complex. 3. Mass Screening-Radiology: Direct Cost, $54,814 To improve the accuracy of radiologic diagnosis of heart disease, enncer and stroke through electronic comniunicatlojis media. Three small rural hospitals will be hooked Into the University of Missouri couipnter anQ Department of Radi- ology; to evaluate diagnostic efficiency and determine applicability of ultra- sound and thermogmphy in diagnosis and therapy. Comprehensive Cardiovascular Care Units-Springfleld, Missouri: Dirc,et Cost, $69,347 To develop a comprehensive care unit for grouping patients with heart dis- ease or other circulatory system illness or who have been admitted for other but require close cardiac observation. The project Is to be undertaken U=als without a house staff, where R is hoped that gro p at uping of patients will relieve the workload for nurm on general medical and surgical wards. Springfield (a community of over 100,000) has 4 general community hospitals -67- ranging In size from 34 to 511 (a total of about 1,200 beds). St. John's Hospital medical stalT and Greene County Medical Society are coordinating activities with 8 local hospitals In Springfleld. 5. Atitoo?iatcd Electrocardiography in a Rural Area: Direct Cost, $369,000 To provide hospitals and physicians in rural areas with automated facilities for transmitting electrocardiograms and an automated system for analyses of ECG'S; to demonstrate the feasibility of such systems where this service Is limited or nonexistent, and to develop, test and Implement the use of bloengi- neeriiig signals as an aid In diagnosis. 6. Operations Research attd Systems Design: Direct Cost, S.1.9,055 To develop systems concerned with testing "early detection" hypothegin- develop operational metli@ of early detecCon tests for a large rural population. MOUNTAIN STATES REGIONAL MEDICAL PROGRAM Operational activity in the Mountain States Region is specifically designed to beneflt small hospitals in rural areas and to train health professionals from rural areas. Operational Projects 1. Intensive- Coronary Care in Small Hospitals in the Region: Direct Cost, $ZO6,913 I Hospitals In the region will mend registered nurses into St. Patrick's Hospital, Missoula, Montana, for coronary care training. This -three-week course will be offered three times a year for 21 nurses, and there will be follow-up@ at the home hospitals four times --ii year. In addition, a 4-day training program especially designed for small town physicians will be held at the University of Montana four times a year. WORTH CAROLINA REGIONAL MEDICAL PROGRAM In North Carolina there are 10 funded operational projects all of which have a direct effect upon hospitals, health professionals, and patients In rural areas. Some are concerned with education and training of physicians and allied health personnel, and others with patient care. All of them are designed to bring the latest scientific advances down to the community level. The projects are listed an follows: Operational Projects 1. Education and research in comtnuttity medical care-direct cost, $209,200 To develop resources for training more medical and allied medical students; to provide new types of educational experiences which will make family practice more attractive; to have a postgraduate education program at the medical school;. to strengthen ties between the medical school faculty and practicing physicians; and to have the medical school become Involved In community plan- ning for Improving the quality and availability of medical care. Affected by this project are the following groups: the University Commun@; the Caswell County Rural Health Services Project; the Regional Health Council of Eastern Appa- lachia, Inc.; the State of Franklin Health Council, Inc.; the Charlotte Memorial Hospital; the Moses Cone Memorial Hospital, Greensboro; nnd the Dorothea Dix Neuromedical Service. 2. Coronary care training and development-direct cost, $55,938 To use the project as a medium for developing cooperative arrangements among the rarious elements in the health care community. Initial and continuing educa: tion will be provided to nurses and physicians In community hospitals, consulta tion will be available to hospitals in establishing CCU'S, and a computcr-based system of medical record keeping will be developed. This project has led to new working arrangements: (1) between the university medical centers; (2) be- tween medical and nurse educators; (3) between doctors and nurses In commu- nity hospitals; (4) between university medical centers and community hospitals. S. Diabetic consultation and educational ocrotce"irect cost, $132,081 To establish three medical teams to deliver services throughout the state; to assist In expansion of diabetic consultations and teaching ellnies; to provide seminars for physicians and -teaching sessions for nurses and patients; to assist In organization of a State Diabetes Association and local chapters; to test tech- niques of data collecUon. Many people of different disciplines in many communi- ties are Involved in this project 4. DeveMpment of a central cancer registry-direct cost, 166,615 To devise a uniform region-wide cancer reporting system, integrated with the 'PAS, the computer-stored data from which can be retrieved to serve a broad range of educational, research, statistical, and other purposes. The following hospitals are participating In the first year of the project: Duke University Medi- cal Center, North Carolina Memorial Hospital, North Carolina Baptist Hospititlt Charlotte Memorial Hospital, Veterans' Administration Hospital, Watts Hoopt- taL Hanover Memorial Hospital, Southeastern General HospitaL Craven County HospitaL In subsequent years the wiU be @nded to include all Mw petals and physicians In the region..,,.,. -68- S. Ifcdirat libi-arli ca-triiRion meri.,ire-dircct rogt, $25,R.19 To) bring medlcnl library facilities of the three medical sclioolm Into the daily work of tlioqe engng(,(l Iti medical practice. @(,nl hompiffl] permonnel will he, trained to assist medical staff; libraries will he organized Into a functional unit for rerponding to requests for services. Bibliographic request service will be estnblish(-d. 6. Ca"ccr informatOn cettier-dircet cost, $41,716 To provide practicing phyRicinnR with Immediate consultation by telephone and follow-iii) literature. Each of the three medical scboola will be responsible for providinr service In Its geographic locale. The atmg of tbIF; project are two- fold: (1) to assist physicians In providing optimum care of patients with cancer; and (2) to continue the education of the physicians by giving new information In a I)ntient-centered experience. 7. roittitttiiiag education in Nimmat ittedici"c-direct cost, $33,313 To bring practicing Internists from nll over the state to the Medical Center for a month of up-to-date training In their subspecialties. They will share respon- sil)llities with attending physicians and make ward rounds with students, staff, and together. This experience should enhance the appreciation in the University, both fit Saculty and student levels, for the expanding role of the medical center for the quality of care in the community. 8. Continuittg educati(m in dentistrv-direct cost, $67,508 . Toprovidephysiciniisanddentistswiththeknowledgeofmutualconcernwhich will enable them to be more effective members of the health team. Coun" will be given at the Tniversity of North Carolina and In communities. Studies will be made of facilities needed to provide dental care in hospitals. The purpose of this project Is to leisure that as many patients as possible who suffer from heart disease, cancer, stroke, or a related disease receive appropriate dental care as a part of their comprehensive treatment D. Continuing education for physical therapi8to-direct cost, $27,838 To develop and establish regional continuing education programs for physicil therapists In order to strengthen physical therapy services for patients In all parts of the StRte. Subregions will be delineated where needs and Interests will be Identified and committees will be organized to arrange local activities. 10. The establishment of a network of coro"ary care units in smaU cotnmunitv hospitals in Aplmlachia, North Carolina-direct cost, $93,0.t9 This Is a proposal to develop coronary care units In seven hospitals In this rural, mountainous area. RMP will supply the monitoring equipment (the hompt- tRI provides suitable space) when adequately trained physicians and nurses are available. An intensive training course for pby,4icians will be conducted In the geographic region, and continuing education prognims will be conducted when necesqarv. TENNESSEE REGIO,qAl, PROGRAM Due to the geograpbienl diversity of the region, the Tennessee Alid-solitli Regional Medical Program has been concerned with both the health problems of the urban poor as well as the benlth prolilems of remote rural areas. The Tennessee program has songht solutions to tbef4e and other regional programs through a system of linkages between the medical centers and the rural areas. in addition to providing programs to allow medical personnel and practicing pbygi- clans from rural community hospitals bo come to the medical center for training courses, the Tennessee program has endeavored, through the use of modern com. munictltion techniques, to create medical education resources in the rural area& The Hopkinsville Education Center and the deployment of coronary care units are two examples of such projects. Operational Projects 1 and 2. Hopkinsville Education Center and Chattanooga Bducation Center- direct cost, $73,700 These are the first of the local continuing education centers specified In the Vanderbilt plan. At each hospital, a full-time D@tor with an appointment at Vanderbilt and an assistant director will supervise resident and physician educa. tion In their area. Their services will be available to physicians at smaller com- munity hospitals in each area, as will the enlarged hospital library facilities. The Chattanooga and Hopkinaville locations provide the basis for looking at problems In continuing education In urban and rural settings. S. Franklin V@ry Care Uftit-WiUiameon CountV Hoopita@Frankliw- direct cost, $31,400 This- in one of the subsidiary units mentioned In the Vanderbilt proposal. This Is primarily a pilot pro@ to study the feasibility and usefulness of establishing #L center In a small community hospital. 4. Otark*viUe Ooronary Care Unit-Clarkstgiie Memorial Ho#pita"irect 0089, $19,000 An the Franklin program, this project in a subsidiary of the Vanderbilt ponal. Since this hospital has been operating a unit, the plan caUs for Its expan- sion, continuing educaUon and a phone hook-up to Vanderbilt. -69- S. Murray Coronary Care Unit-Murray-Calloway (Ky.) County H08pital:@. Direct Cost, $38,800 Aturray-Calloway County Ilosl)ital, the training center for %turray State Uni- versity school of nursing, will serve as a demonstration et-ntcr for the sub-region. Direct phone comniiintention will be established with Vanderbilt, which will send consultants from its school of continuing education. This project has the dual objective of relating the Aturray State Nursing progrnm to an established medi- cal center and providing regional training resources to a remote area. 6. Crossville Coronary Care Unit-Uplanda Cumberland Medical Center Cross- vule: Direct Cost, $28,300 This project has two purposes: (1) -to establish a two-bed coronary care unit In the hospital; and (2) to determine the feasibility of operating acute coronary care units in rural areas: The hospital will cooperate with ?,lid-Rate Baptist Ilospital and VanderbilL 7. Tultahotiia Coronary Care Unit-Harton Memorial Hospital, Tu7lahoma, Tcnn.: Direct Cost, $28,800 See Baptist Ilospital Program. S. Project to.It)ip)-ove Pati(,)tt Care in a Rcniote Mottiitaitt Cosittittinity by Re(-tuit- ing and. Trainitip 7[calth Aides for a New Extended Care Fac(lity-Scoft County HoRpital-Oncida, T(,,nn.: Direct Cost, $10,300 .Nlaiipower shortage In this Isolated mountain hospital fq critical. Personnel to man an extended care facility now under construction will be obtained by two methods: (1) In-servire training'for nospital personnel; (2) an educational di- rector (an RN) to serve as a liaison to the high schools to encourage young peo- ple to enter the medical field and come back home to practice. In addition a training program lending to the LPN would be Initiated. Clinical training will be supervised by the Educational Director while local high schools provide basic training. P. Ilopl,-in,-tt,ille Coronary Care U"ft-Jcnnic Stitart Mcmorlal Ho8pital-Hop- 4-in8ville, Hy:: Direct Cost, $49,500 This plnn Is similar to the Franklin plan, except that it mentions establishing links to smaller community hospitals by helping set up smaller care units In them, thug providing for the grouping of rural community hospitals for more eMelent use of existing resource& WASI[INGTON-ALABKA PZGIONAL MEDICAL PROGRAM The Washington-Alaska Regional Medical Program operational projects con- ceru themselves largely with continuing education and training activities to en- hance the medical and paramedical capability. They focus on communications techniques and Instruction materials and methodologies which are adaptable to the far flung and remote communities in the vast State of Alaska and the many scattered rural communities In Washington BUte- Several projects are being con- ducted to Improve the health manpower resources In communities with limited or no specialty health services, which are distant from a major medical center. Operational Projects 1. Central TVashington--Oommuttication System for Continuing Education for Ph ygicians: Direct Cost, $18,181 To bring the medical resources of the University of Washington to physicians and community hospitals In Yakima, who In turn will act as consultants to sur- rounding smaller communities through seminars and conferences, educational TV, other audio-visual Instruction; and exchange of teachers and practitioners. To connect internists in Central W4tshington to Yakima cardiologists via EKG tele- phone hot-line, to permit quick analysis (@rting with 5 community hospitals). Yakima Is a community of about 45,000. The total population In 6 Central Wash- lngton counties exceeds 300,000. In addition to three general hospitals In Yak- tma-St Elizabeth, Yakima Valley Memorial, and New Valley Osteopathie-nine other comniunity hospitals to be reached Initially are located In small rural com- munities of Ellensburg, Moses Lake, Othello, Toppenish, Prosser and gunnyside, (population ranges from 500 In Moses Cityto some 8,600 In Ellensburg.) 2. Roostheast Alaska-Posigraduate'Education: Direct Cost, $27,062 To Improve communication between Seattle Medical Community and the uni- versity to alleviate problems of the isolated physicians In southeast Alaska cities and communities: Juneau, Sitka, Ketchikan (B largest). As In Central Washing- ton several methods will be used such as telelectures, consultant services, semi- nars and the EKG hot line to hospitals in Juneau, Sitka and Ketchikan. The popu- Is tion in these 3 cities totals about 17,000. S. Postgraduate Preceptorship for Physkia oronarv Care: Direct Cost, $17,610 A pilot project to provide opportunity for practitioners from remote and l@ lnted communities to spend a week or more under a preceptor at major medical centers to study advances in care of coronary heart disease and carry out these practices in their communities. The 4 major medical centers In Seattle are Provi- dence Hospital, Swedish Hospftl, Virginia Mason Hospital and Medical Center, and University Hospital and Medical (3enbw and bm in Spokane are Deaconew Hospital and Sacred Heart Hosplt&L - 70- 4. CardiaoPfllmnnarliTcehnic4anTraining:DfrcctCoit,$4[,.554 Develop a formal program for training cardiopulmonary technicians to r, y ther duties. Four larger general hospitals In Spokane-Deaconess, Holy Pa0PL form non-critical function In coronar care units nnd free physicians for mily, Sacred Heart, and St Luke's-will participate In tills training program with Spokane Community College. 5. Tico-tvay Radio Conference and Slide Presentation: Direct Cost, $8,445 Six pilot programs on heart, cancer and stroke topics to be transmitted via two-way radiotelephone slide conferences, to physicians and hospital staffs on topics selected by Imnel of physicians, starting with 20 hospitals In Washington. To explore potential for continuing network series with local and remote region& 6. A lo8ka lfcdical rAbrarV PaciUties: Direct Cost, $21,754 To develop a community medical library for Alaska at the PHS AlaFcka'Native lifedical Center, Anchorage for Alaska physicians and health related staffs and agencieq; to have close ties with community agencies, Arctic Health Research, Unirersity at Fairbanks and to supplement continuing education project for Southeast Alaska and the Anchorage cancer project. WESTERN NEW YORK REGIONAL MEDICAL PROGRAlf Both of the programs In the Western New York region have a direct effect upon hospitals, health professionals, and patients In the rural areas. Particular empha- sis will be placed upon Involving community hospitals nnd on training nurses from community hospitals In rural areas. The projects are listed as follows: Operational Projects .t. Tico-lVay Comt;tunications Nctu.-ork: Direct Coit, $170,519 A two-way communication network will link hospitals of Western New York and Erie County, Ilenn-,ylvnnia to the Continuing Education Depnrtments of the State University of New York at Biiffalo and the Ro.,twell Park 1%lemorial In.-ti- ttite. The network will serve several purposes, such as continuing education for physicians and the health-related professions, public education, adnifnisttrative coramunication. consultation with experts, and contacts among banks. It will assist both the7 physician and community hospital in eitJier the rural or urban environment in having at their fingertips the Intest advances In the diagnosis and treatment of heart disease, stroke, and cancer. Particular emphasis will be placed upon Involving rural hospitals In this program thereby improving both their didactic and restorative function. 2. Coronary Care Prograt)t: Direct Co-vt, $127,544 This project will test a training technique for providing qualified nur@es who will be required to stafr developing coronary care units In the Region. Approxi- mately 80 nurses will be selected from all Parts of the Region for a combined academic and clinical course. It Is planned ihat the nurses receiving this train- Ing will return to both rural and urban hospitals for the purpose of providing a diagnostic and didactic function. While the program will be housed at the medi- cal center, the community hospitals of this region will be the benefactors of the project. Since there are few nurses trained to work In coronary care units. par- ticularly In the rural environment, special attention will be paid to attracting nurses who will return to the community hospital. WISCONSIN REGIONAL MEDICAL PROGRAM Four of the Wisconsin projects have relevance to the improvement of health care In a rural setting, through the provision of education and infor- mation. Physicians and allied health personnel in community hospitals will beneflt from the following projects: Operational Projects .1. A pilot demonstration program for pulmonary thromboenaboti8m: direct cost, $84,600 In this project a center Is being established at Marshfield Hospital In Slarsh- field, Wisconsin, for demonstration diagnostic techniques and the available therapy for pulmonary thromboembolism. The project has a continuing edu- cation component which will reach physicians from many hospitals In the Re- gion. This will involve a 24-hour consultation service, the preparation of a movie on the topic, and Special training sessions for groups of physicians. The project will demonstrate a comprehensive program which will encom- pass diagnostic, preventive, therapeutic, and rehabilitation procedures for pa- tients, poertgmduation education, a rapid transportation system for patients from Northern sections of the state, and cooperation between the clinic and other hospitals and medical schools In the State. 2. Telephone dial access tape recording library in the areas of heart disease, cancer, stroke, and related diseases: direct cost, $18,950 TWo feasibility study will be carried out by the University of Wisconsin which will record and store short, 4-6 minute, tapes on various aspects of treating patients with the three dlxftse& Any physician anywhere in the Region can dial the library at kny time and request a tape relevant to a pmblem In whieb he is interested. S. Fur8i?tg ietcpho"c dial amco8 tape recording library in the areas of hear disease, cancer, stroke and related diseases: direct cost, $IR,800 Thin fen.-tibility study, similar to the one above, will establish a central tape library with lnformntion recorded on nursing care In einergenciefl, new pro.. cedures and equipment, and recent developments in nursing. Nurses from any hospital in the region will be able to call at any time to have a tape played to them. 4. Dcvctopinciit of medical a"d health related single concept Ilim program in comntunity hospitals: direct cost, $33,.t5O This education feasibility project involves ten community hospitals in Its first phase. Fifteen films on procedures and techniques used In treating heart, cancer, and stroke, will be developed. Projectors and the films will be installed In the hospitals for use by pbyF;Iclans and other health personnel at their con- venience as a continuing education device. After four to six months the ma- terlal8 will be relocated In ten additional hospitals. DEPARTMEIFT Or HEALTH, FDUCATIOlq, AND WELrARr. STATrMtl4rT ON Er@r%,lciqicas or REatoiqAL MR.DIOAL PSWRAMS The effectiveness of Regional Medical Programs la determined in the following ways: Evaluation of the effectiveness of each Regional Medical Program to a con- tinuous process whiell involves review by the Federal Government, Its non- Federal advisors, and-ibe grantee Itself. These review activities are specifically intended to determine the extent to which the region his Implemented the proc- ess of regionnlization which Include" seven essential elements: involvement, Identification of needs and opportunities, assessment of resources, definition of objectives,, setting of priorities, Implementation of program activities and self- evaluation. This process of regloiiiilizatlon Is the means by which the r\-gion moves toward Its ultimate objective-the assurance of easily accessible improved patient care for heart disease, cancer, stroke, and related diseases. A systematic and comprehensive review of the scientific and administrative aspects of each Regional Ikiedical Program has been designed in order to deter- mine the extent to which each Regional Medical Program implements tliitq'proc- ess of mo(@nalizatioii for the I)urt)ose of achieving its goal of improved patient care. This review process Includes surveillance at the regional and Federal level, and Is conducted by both non-Federal and Federal experts. By law each opera- tional activity must be approved by the Regional Adv@ry Group prior to its submission to the Federal Government for review and approval. Frequently the regions themselves have elaborated on this requirement by establishing local, In addition to regional, advisory bodien and/or scientific review bodies which also carefully examine proposed activities. A site visit by members of the Review Oommittee and the National Advisory ,Council on Regional Medical Programs to the region is included as an Integral part of approving an operational program for a region. As the operational pro- gram develops and is expanded additional site visits are made. Finally each Regional Medical Program is required to submit an annual progress report which describes In detail the region's progranl Any proposed modification In program direction by the grantee must be justified In writing and subjected to these review procedures. Within the context of this comprehensive review process It Is possible to deter- mine whether or not a regional program Is In fact evolving a regional system Intended to improve patient care. The Missouri, Kansas, Albany, New York, and Intermountain Regional Medical Programs were the first to enter the opeyntional phase of development. The determination of their readiness to begin operations was a result of the review process described above, including a site visit by members of the National Ad- visory Council and members of he @ff of the Division of Regional Medical Programs. The progress of these regions has been further evalnated during the review of supplemental grant requests which have been received from all four regional programs. Further site visits by Council and/or staff to review the first year's progress have either just been carried out or are scheduled for the immediate future. The resultsof these reviews carried out to date Indicate that these Regional Medical Programs are making substantial progress toward the goals act forth a year ago as the basis for the operational grant award. The major problems encountered have been difficulties In recruiting personnel and slowness in the delivery of Important equipment These factors have caused some' delays in Implementing particular projects. In addition to this evaluation at the national leveL the regional programs are developing their own capabilities for self-evaluation. @al staff has been added to the central staff of the regional programs with @fte eompetence tik *valuation tachnioueL These quo an being developed and a@ Vied to the operational acu"tioL