I @l,l EXCERPT OF TESTIMONY AND MATERIALS Presented On MARCH 26 AND 27, 1968 Re: Sections Of H.R. 15758* Relative To REGIONAL MEDICAL PROGRAMS Before The SUBCONMTREE ON PUBLIC HEALTH AND WELFARE Of The COMMITTEE ON INTERSTATE AND FOREIGN C04ERCE HOUSE OF REPRESENTATIVE NINETIETH CONGRESS SECOND SESSION *A Bill to ainond the Public I-Icaltli Service Act so as to extend and improve the provisions relating to Regional Medical Programs... CONTENTS li(!](l Oil Plig 2(;, ------- @l i-(@ii 27, ---------------------------------------- -------- --------------------------- 2 7 'hr T't, lir,,ttrti(le, Di-. Aiiios, @Vtsliiiigtoii (Sttte) Associttioii ,tii(i Association of General Practitioners ---------------------------- 197 Breslo@N-, Dr. l,ester, I)resi(leiit-clect, American Piiblic Ilealtli Asso- ciitioii ----------------------------------------------------- 168 lirill, Dr. Ilenry, rncml)er, Committee on Alcoliolisiii iii(I Dr@ig De- American 'i%l(!dical As.-,ociatioii ---------------------- 147, 150 ae b e, I ; 4; I A Dr. 131@tiicl NV., inciiii)cr, Cotiiicil oil Mc(lical At@i(@ric,,tii @Nle(lictil Association ----------------------------------- 147, 148 J. W., I of (:(.ol.gi:t 208 l@., As.-io(,-iittioii of Aiiii-i-i(@;Liw (!olli@g(!s- 12:i of Siii-g(@i-y, ll:tylor Iiiiiv(@r.,iit,y (,oll(,g(! of Ifoiistoii, 1. A J4" Dr. Si(iii(@y, (lir(@et,or o reseal 1, Ciiii(ireii"S CLiic(!i- I"ot (ILtiol), liostoll, Mass ----------- I:ii) 147 f v - - ... @ @ 1, @', @ L'- 'tl '- 7 @-L @ I., @, - - ",L"@@ @ -@ f 77" IV AssistiLiit @ecr(,t:i,ry for @iii(i S(!i(@iitific AIT@tirs, of ii(!:ilt,ll, ]"(IIIC@ttioii, :111(l l,iliolT, I)t-. Willi@iiii, 1):is@ Aiii(@ri(,;Lll College of (':tr(liology - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - I C) I IMP 1)1-. It@ill) I (@., I)ir(@(:t.or, I)ivisioll of I',(@gioli@Ll Nli!(Iie@il [Iro- gl.:Lllls, 11 1, of lle:ilt,li, l@diictit,ioii, :iii(i ------------ i) Nlillik:tii, I)i-. Cl;trk, cli:tiriii:Li), Coiiticil oil J)isetse, -------------- ------ 16:i A - --------- N(@llig@iii, Willi@irit 1)., execkitive director, AiiiericLii Coll(@g(! of Ctr(li- ologly ---------------------------------------------------------- 161 I)r. NVilli.Liri, director, Divisioii of Me(licti Alliericiiii Associtt@ioii ------------------------------------------------ 147 1)(@ti-oit Al'( L 0 )it I 218 Addit,i li(@ record I)v it,@il Associ:tt.ioii, fi-oiii Willitiii.Soll, Ir 2t)!) 4)1@ l@(!giollil l'i-ogi-i@ills, of ])I-. III.(.Nlolv ------ 171 Ir AdditioiiLl iiiforiiiat,ioji siil)ttiitt(@(I fol' II)(', I)y-Cont@in iod Joill-11:11 of i,li(! A@;so(!iit-ioii, "lio-;I)it:ils :11)(I lt(@gioii@ll l'i-ogi,@tilig: A III(,;i, for 222 11;Ii@II)toll, :304 -oil) Will(isol. C. of, @.llt)ol of fl ('tit t itl)4', :10:; fol. 1,11(@ l@f 84 ol)lit!:Liioll 1 5 7.r') 8 roi. fis(.:ii I!)(i@) -.77 (t:i I)Ii@) of oil-- 12 1 liosi)it;kl ill ]'(@giotl:Ll lll(!(Iic:il I)I-o- III('II t O - -------------------- (@2 of t,li(@ liosl)it.11 ill tll(,, Mi.,isoiiri ).Cgioliil lll(!(Iicil I)rogi-:tiii,.,it:i,t i oil ------------------ 85 igi-,ti I (, liciltli I)rogr@tiii st!ztt,t is, ',\I @t r(@li I @)(iS, stttteiiiciit oil ------- 87 ;Nligr:tiit li(!:@lt,ii I)i. ojects @issist,(,([ 1)3' IICLltll Service gr,,tiits, ------------- (lireclory of -------------------------------- 88 \,Iigrajit liospitiliz,,itioii, stiteiiiezit oil ------------------------ 115 Ol)ci-.itioii,,Ll projects tffcctiiig ritr@tl itroas, stat(@iriciit oil ---------- 76 Pttictit care costs supported Nvitli regional medical program grant funds -------------------------------------------------- 65 Professional involvement in regional medical programs, stttcincnt on ------------------------------------------------------ 64 Piiblic Ifealtli Serviec report oil 12 operating regional medical programs ------------------------------------------------ 46 Television, ra(lio, and t(,Iel)lioiie networks for continuing (,(itic,ttioli ------------------ ----------------------- 61 report, for lictrt lt(,tgiotilLI ille(lic,,Il 1)rogrzttiis, 1)i,o, I"(,gioll@ll illf-(Ii(@ill I)rogl-:Ltll (,Irol't", t'll(@ 1)1-01)1(-Ills of ci (,N , 'it,:Lt oil ---------------------- 7:@ of rt@gioititl i)j-i)gt-llllls, 66-72 ------ in i-(@gioii,,@l I)rogrtiiis I)y iii- ------------------ J))(!(iic;ll tot.@ti ol)ligtit,ioll of ritil(is, fiscal L d -NI is@ @til(i lt)5 IITI:LL -Y s :10 1 tiF Ni6@iot liw-povi is, i(@i I III(] 111(@l It. of it It -i @lio 4@i- ii@i r(-ot it! ,t(] (II(-(i(i II ol, gl.;Iiit iiil(14@l, Iiiis 1114, (-o'l lo 1)1' tll(@ (1111.@itioll (If I)ol'(ioll (It' ill(' Kl.;tljt@ ill@itil)ll.,Z, ])(I 11.4 tilf@ligii 11)(@ gl-,Iiitl (,g of @y ])Dart, 1), ill tll(@ e,,i @e los I- tll(, iir@N,.(@litioIl 41:1(1 of, -Olt (:08'1' 01@' @(,(.tioll I 0:@f ii,til@il ioll (,I, illl.V :11lotill(@lit oi- 'IllotrIi(@ sii(-Ji Si@tt(, iiii(i@@r 1)@ii-t. 't of, I:il[4, If 1)1. -to 1):Iy It I @l 11(@i- SI I @ I I.(@ ;Is t 11(@ @(; IIt@ 11141.N' F(Il I(? I' III L. (-X 1)(@ II( Ifo III I (I foi- 111(@ (1111-ifig stl(.Il Y(,:Il, (11, 1. iticpi-(@ t ]III it 2 [till @of ill(' Total] (II, tili@ itlli)ljltl,lls of, sll(.Il S:Ilq. foil III- :,s5O,OO(@, l'ol- Itiii-lito@(' f4)1. Sit(-II I'llylil(.Ilts of :ill) ilil(. I)iis Italy 1)(@ ill@141(@ iii ol- li@@-iiy of i-eiltilliirs(, 11 (I I 11 SI I('] Li I Is I ('IItS, :is t 1)(@ "(2) @iiy :irll(Plll;r, (1) to Italy Sti@itc@,fi)r iiiy fol- ye:ir,,fi)r I(ilililli',tr.,iti4)ii of Ili(@ St@it(@ I)I:iii iil)l)rov(,(l iiii(ler sii(,Ii it ot tliad the total Illioulit exl)eii(le(i for sii(@li I)url)oses frolli Sliell S( @LLtilig tIlrI. yeir cii(Iiii, Jiiii(- 30, I)L;PA)tT-\Il-,NT Ol-' Ill,',AT,Tll, 1,DUCATION, AND Wi-@,I,FAItF, IVa87tiizgto)i, D.C., Alai-c7t 18, 1968. 1-1011. l@IA]iLl,,Y 0. STAG(;I@R,',, Coilli)littcc OIL coi)l)ilcl.cc, 11(i?INC of li'C))@-escilt(ifil7cm, itiglo)t, D.C. CIIAI[t.-,[A',N : Tljis letter is !it r('.@-poii.@e to your request of 6. for i report oil 157i!8, t ])ill ... I'll the Ptil)lic II(@,iltli @Service ,ket @o ,i,, to e%t(,,ii(I iii(I iiiil)rove tl)e 1)roN-i,,ioii.,; i-(,I:itiiig to r(,gioliil iiie(licii] I)rogr@iiii,,;, to (,xt(,ii(I ill(! atitliorizttioii (If foi- Of iiiigratoi-y iigri- (@iilttir,,il worlwr.,;, to I)rovi(le for for iilcolioli(-,,- liti(I narcotic fiii(i for t)tli(@r ill-ol)oslll (-olltllill(@(I iii :I (ira.ft, I)ill this to tll(@ oil @t, lo tlit@ oil exl(,Il.,4ioll ;Ill(] or I.(.gi(illill ille(li(-Itl I s I- (ill 'I'lie lilil also J)I'oj)os:ll III lli:i( ili-;irt I)ill i-(,Iittiiig to t(,.jiil)oi-;try (@xt(,Ii- Sit)ti 4pr fli(@ ill-ogi."ijil or gi-iiills fol' l'oi- iiiigr;tfoi-.N@ ili,;Ii'l I)ill 11.@, lili,, to Ill(' oil 7, .11)1;8 OIL iil','Ili.illg I'll(- @ilill 1114'('Iilig till@ 4.111111(,Ilgl. of I Tli(@ of tli(@ Itti(lg(-(@ tli:it 4)f this I)Vol)oS(@(I legisiiitioil @voiild Ile it) it(-cord witli the progriiiii (@f the Siiiecrely, WXLBUlt J. C011rN, Actiiig Scci-etai-y. 17" REGIONAL MEDICAI, PROGITAAIS; ,kL(',OIIOLI()'S AND NARCOTICS AI)Dl(',TS FA('111,ITIES; HEALTH SERV- ICES FOR D031ESTIC AGITICIJLTIJRAL 311GRATORY@ WOIIKI'@,RS TUESDAY, MARCI-I 26, 1968 Sujic4)mi%ti,rn,L ON Pullf,IC AND NVFLl@',kllE. COM-,NflriLE ON IN'IEltST,%'171-, AND Foiwiow C031miitcL, 1,Va,37tington, D.C. The subcommittee )net at 10.1.iii., pursuant to notice, in room 2"122, Raybuni lIouse Office Building, Iloii. Paul G. Rogers presiding (floii. John Jarman, chairman). iAfr. ICYR The subcommittee will please be in order. The heai on I-I.R. 15758, introduced by Chairman StaLyzers ,It t-he,,tdministratioii. 'ties bill ,tnd expand the existiiitr authorizations for yegional medical pro rams, would extend the pro(-rrtm of health serv- ices for domestic aoTicultural migratory worke@,'aiid would provide i-natcliing (-rrants f@r construction and stiffing of facilities for preveii- tion of @l@holism addiction and for treati-n@iit of alcoholics and iiar- cotic addicts. REGIONAL '.NIEDICAL PROGRAMS In 1965, the Congress considered legisl;ttioii prol@osiiiL,, the establish- @liie,iit, of medical 1)ro,,rriiiiS'ilesialle(I to ii-nl)@@ve the Health (!are of the Aiiioriclii I)eol)]@ in the fields disease, strolie itii(I related dise:ises. Tli@ (,oiigi-(@s substantial revisions ill this proposed I)rogriiiii l@t-ovi(Iiii(r-ill -foi- it iiiitxiiiiiiiii of de(-ei utilization of the (le(!Isiollllltl(ili,r 1)1.o(@(",.,s and eii(,oiti.@itgriiig liiitxi- failure feiisil)I(N cooperation I)e,(,W(@ell I)III)Iic, and I)riN,itte @rroiil)s iiit(,@recited in tii(@ li(iilt'li of the Aii)ericiii people. It is iiiit)ossil)lo to riv(@ t (Ies(..I.il)tioll of it i-elrioiiiil medical] I)ro,-,,r,,tiii Since eve )Iislle(l,is (lilrerelit, i@itli eteli pro- (rr:i i ttilor(-(l spe(lirl, e(@(Is of tile, re(,rioii served. Over 90 per(-,eiit, or I of tll(@ IT]Iit-cil Rotates is ol. will be covered ],)y re@rioiiil, :tills established Oil tile locl] level either oil all OI)Cl-,Itl oi- tiii-oti;,rli. I)rogriiiii,, currently ill the iti,-e. Eveiitutill I 0 I)ei-(,etit of our population will 9 be covered by these programs. Ak@ iiy f@. i-s tii(I -reservations were expressed itt the time the Coll- ress was considering the initial legislation. It is my understanding, 9 ,rroiii)s which had rese@- ioiis about th however, that many of the vat c initial proposals have since -modified tlieii- positions, in large Yneasure 2 1-w(,,aiiso of the iiio(iiii(,@tt@ioiis i.iik,t ill the by tl)o (14)11(,ro,-s :111(t illoilillilit@i, ill wlil(!Il ]ills to (1:1 I s I' iiiidei-st:iii(I tlio bill to ils, 110 illtioi- pro- I)Os(,.(I. 'I'lio I)riiicil) 1.1 ])Ill-])O@o of the, le-islatioli is to extend tl)e Pro- griiii beyond its sclic@litled expiration ditt-, of .1-une 30 this y(@ar, with minor iiiiprol-elllellts tll,-tt experience lits slionvii to be iiece-Ns,.try or de- sira,ble. In regard to the section on (loin@ticigricLiltiir,,tl ii-ii@r,,itory worriers, the ])ill proposes to extend for two additional y@-ii-S tli-o existing of ,-riiits for liciltli services to (.Ioine,,tic tgriciiltiirLl illiLru,ttol-V worriers. 'the existing pi,ogi-@itil is 11,,o wliediile(l tlo exl-)irt@, J'tiiie 30 this yeir, so extension is it this t-iiii(,, if tli(@s(@ worried-, ivlio ire ',Iilloilg the today, ti-e to continue, to receive the services they need. AL(jOIIOT,T(@ ANI) NATtCOTI(',S kl)I)ICTS Title II of this bill woti](I establish t 1)ro@rr@iiii (lesi-lied tl() provide ill i'llo treat iiielitiii(I rehabilitation of, ,Ileoll()Iic :ill(l )),ll-cotic Tli(@ 1)ro(rrtiii pi-oposekl is ,tti extension of tl)o principles 11- ],(lady embodied tili the coiiiii-iiiiiit,.y iiici-ital lic,@titli centers -iiid iiieiit,,t] facilities acts tl-)I)i,oved by this (-oiiiii-iit@tee in 196,3. The bill I)I.Ovi(les griiits foi- c(>iistrtictioii 'Lli(I operation of facilities which :ire part of ,t complex providing essential -eleiiiejits of coinl)re- lielisive month health services in order to provide services for the pi-e- veiitioii and treltii-iciit,of -tlcoliolisni. Grtiits tro tlso tiitliorized for coiigtriietion iiid op",Itioii of special residential ii)d other facilities for treal,iiient of harmless ,tlcoliolics; frraiits for construction iiid operation of fwilitic-9 for prevention and treatment of iitreotic addi(,,tioii; tiid graiits for training and eiT,,tlua- tioii to I-,lie 1)rei,eiitioii and tre.,ttii-iciit of narcotic addiction. ;11.o it parallel. of witnesses Avllo ]I,-tV(', the ol)])ol-tlllllit,v t4) ]le 4)11 t-Iii-, le,rislttioii, which is indicative of the to 1,110 needs NV]ii(-Il %Vill 1)(@ served by the of, t,iiis bill. I've 1101)(', to 1)(', able to exl)(@(litle these, igs,iii order that I-,lie Icais- lilt ioll early 1-t@:leli t li(@ I ])OKiil)l(t ill illeNv ol@ t'll(@ I.(,]:ItiN!(@ly brief I-eiiiliiiiii,, 1)(@rol-t@ two of t@)I(@ I)t@)(rrilms (.olll ii,ille(t ill lllo [),ill ztt.os("]Ie(lllle(i t@o expire. bill iiiid(@r consideration, all(I -Igelicy reports Oil the bill, will be i,(@I)oii,,i thereon, follow:) L II.R. 157r)S, f)Otli Coiig., second scsg. I A lllf,T, To aiiien(I tli(- I'@il)llc Itealtli S(,rvice Act so as to CXtPll(l and iinprove the provisions r4,]iitlzig to regional iii4,ijical i)rogrniii4, to extend the iiiitiiorlzfktion of graiitm for Health of migratory iigrictiltiirni Avorkei-s, to provide for specialized facilities for alcoholics and narcotic addicts, and for otlier I)iirpo-,,es 13'e it c@nacte(l, bli the an(l, IloitN(,@ of of the Uttite(I States of A))tcrica iii Congress asset)? blc(l, TITLI@, I-REGIONAli AIEDICAL l'ItOGRAAIS EXTENSION OF REGIONAL MEDICAL PROGRAI.18 SEC. 101. Section 901(a) of the Public I[Icaltli Service Act (42 U.S.C. 299a) is amended by striking out "and" before 11$200,000,000" and by Inserting after 3 ".Tiiiie @0, 11)68," - the following: "$6,-i,000,000 for the lisi@al year ei)(Iiiig Jtin(- 30, @,iii4l @-iieli its iiiiiv I)(- foi- t,ii(, ii(,xi@ four fiscal ()I' lti,'.GlONA], ',I [-,'I)ICAT, I'ItO(!ItA?.iH 102. St,etioji ()Ol(jt) of tli(, Ilitl@li(- Ili@.iltli is ftirtli(,i- I)y ills(@l,liilg lit fit(, ('11(l tlli,r4,of ti)(@ follon%,iiig "14'or iiiiy ils(,iil y(-.ii, :10, 1)oi-ii4iii of tlif, ;il)i)i-oi)riiitioiis to this I)iit (-(@iittiiii t, i('i,(@o -Ii:lll tire li,viiil:il)l(" lo tll(@ for (@v;tltiiii@ioji or by gr4iiit.,i or coiitrtct,4) of the 1)rogi-@iiii iiiitlii)riz(@(i I)y tlii,4 INCI,I-TtiloN Ol-' 'I't,;Iil@TTOI?TES 10:1. S(,(,t:ioii ()02(it) (I.) of Ili(, ket (42 ii.s.c. 2@)91)) is tiiieii(le(I I)y iiis(,rtiiig iifl(,i- tli(- following: "(Nvlii(-Ii for I)iir- )lo.-;(,.,i 4)1' t,lii,,@ fill(' ill(-Itlql(@s tlk(@ of til(@ (,'ollllllo]INV(@;ilt@ll of I'lierto Itico, tlk(@ N@il-giii lsliill(l,,, kiii(@ri(-iiii Sjijiio;t, iiii(i the Trust 'I'er- 1-itory of the I'liciti(' Isi@lit(IS) ". CONIIII.NATIONS Ol,' Itf-@OIONAf, MI@;[)ICAI, IlitO(iltAill AGI@NCIEs i)03(iL) ;iii(I s(,(-tioii ',)Ot(:t) of @tli(@ lliil)lie Ileiltli Sei,vic(. Act (4'-) U.S.C. 21)9e, 21)9d) are (@ii(:Ii itiii(@it(le(i liy iiis(,rliiig after "otlit@r I)tililie or nonprofit private agencies and institutions" the following: ", and coml)ina- tions thereof,". AI)VISORY COUNCIT, AIENIBERS @i,@,c. 105. (a) Section 00,-P(a) of the l'iil)lic Health Service Act (42 I;.S.C. '-199c) is aii)eii(letl by striking out "twcli-(@" and inserting iii lieu thereof "sixteen". (1)) Section ',)05(l)) of such Act is by @,tril@ilig out "-,Ilid four it the end of the third year" iiii(I iiisertiiig iii lieu thereof "four at the end of the third year, and four at the cii(I of the fourth year". '.k[ULTIPIIOG]tAll SI,:RVLCES Si,-c. 10C). 'I'itle IX of the lltil)]!(! Ile@iltli Service Act is further amended 1).)' ,)(](Iitig it the (@iiil tit(@reof tile following ii(@w section (i]tAN'I'H ],'Olt SE[TVICIIH )IO. Fiiii(is iiii@lt-v this fill(, sliiill also 1)(@ for gi-iiiils i(o @iiiy I)iil)li(- oi, tioiil)r4ifill iii-iN,itlt@ iigi,ii(-y oi- institution fo)r services by (it- -%Vjii(-Ii Nvill I)(- (Of siil)stiiiil iiil to, itiiy two or iiior(@ i,(@giotiiil (if,Altll,'YINO Olt 'I'l@OIINI(IAL AA(ENDTIFNI'S 107. (it) Sef,t.ioii 1)01((-) of t.li(@ lliil)li(@ Ilealtli Service Act 14 iiiiieiideil by iiis(@i'tiiig before tli(@ IK!i-iotl lit, the (@ii(I thereof "or, iil)l@rol)riitte, it I)rit(-- ti("Illg (rental". (1)) 1)01 of sti(-Il is further @iiiieii(le(I by adding lit tile end thereof tile following new : I "(d) Grants under this title to tijy a,-eii(-y or institution for a regional inedical pro,-miii may be used by it to assist iii m@tiiig the cost of participa- tion in such prograni by any li'ederal hospital." nil l@-@ l@.)-Ros. I understand our witness this morning will ]X., Dr. Pliilil) IZ. I", Assistttiit SC(@,ret@itryfor lle,,tit,li :111(l Scielitifi(-, AfTttii-s of lleiiltli, :111(l Welfare. Dr. STATEMENT OF DR. PHILIP R. LEE, ASSISTANT SECRETARY FOR HEALTH AND SCIENTIFIC AFFAIRS, DEPARTMENT OF HEALTH, EDUCATION, AND WE, LFARE; ACCOMPANIED BY RALPH x. HUITT, ASSISTANT SECRETARY FOR LEGISLATION; DR. RAI;PH Q. MAR- STON, DIRECTOIL, DIVISION OF RL- GIONAL MEDICAL PROGRAMS DR. STANLEY F. YOLLES, DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH; AND HELEN JOHNSTON, CHIEF, MIGRANT HEALTH BRANCH, BUREAU OF HEALTH SERVICES Dr. Tliaii]@ you, Mr. Cliiii-iiiiiii. Mr. Rociits (presidiii-). I iyii,,-Iit say tll:lt, tllC' COIIIDlitteC is pleased to have -you with iis,,tiid I)articitlarlv siiic-P, your new duties litve been stated b- the Secret-,try to'be coordii@, tor fo@ health, and "Mr. Health" y for the Goveriiinent. We are delighted to have you with us in this capacity today, and we are pleased to have your associates. We will be glad to hear your statement. Dr. lrE. Tli-,iiik you, sir. Accoinl)anying iiie are Miss Johnston, Dr. Marston, and Dr. Yolles. Nfr. Ralph Huitt is with us this morning -,ilso. Mr. Ro(.i.,its. IVe are glad to see Mr. I-Iiiitt, here. Dr. Mr. Cliaii-miii -,iiid iiiciiil)ers of the SUI)COlilillittee oil I-lealtli,,tiid Welfare it (,Tives i-ne greit pleasure to appear before you today in siii)i)ort, of the I-Ieitltli Services Act of 1968, which colitiiiis .ill exteligi(;ii tiid iiiil)roveiileiit,,, to the ITeii.,t, Ciiieer, and Strolce Aiiieii(iiii(@iits of 1965,;tii extension of tli(@ Migi-itiit",Ilealtli Act of 1962, :Is itill(@11(te(I ill 1965 the ti-;iiigfel- of ;authorities now in sect@ioii 402 of the Ntrcotic Addict Reliibilitatioii Act 'of 19C)O to the Community Ife@ilt-li (eiiters Act, and the e,.,itiblislii-neiit of ;i, I)rograiii to :assist, communities to iml)rove treiti-neiit services to tlcollolics, the I.,tt t er t wo I)rogriii-ns to be known @,is the Alcoholic and Narcotic Addict P,,(@li;il)ilit,itioii Aii-ieiidineiits of 1968. These I)roirr,,ti-ns arc,,tll designed to cti-i-y foi-wtrd our commitment, to make tli@best health services iv,-tiltble to ill Americans. In his sl)e(-iit] message to Congress oil health in 1965, President Tohiison stated: Our firFt concern must be to assure that the advance of medical knowledge leaves none behind. We can-and must-strive now to assure the availability and accessibility of the best health care for all Americans, regardless of age or geography or economic status. @kltliougli much has been accomplished in the last 3 years, much remains to be done. We must rei-nove the barriers of discrimination that ]live so long barred the alcoholic and the narcotic addict from receiving trtil -Y comprehensive care-a discrimination based on diag- iiosis, which i@ just ii,3 intolerable as discrimination based on race. rlle migrant worker suffers from not only t-he disadvantazes of Iftiiguage, poverty, and geography, but of teii the even mom Ciffieult @7 10 of i(rnoriii(,,e, iiii(i of ii.io(lerii iiiedi- Tlio, i-oiiioN-:il of ;t :kill(] of time, lig dis(-oN-ei-y iiicl of iie%v kno%vle,(I,-(,@is a goal f the 0 re(,@ioii:ll iiit@(lie:ll I)I.Ogrll-ll,. ill iliS lietltli ItleSS,,I(re this yetr, Pr@ideiit Toliiisoii stated Its I)tirpose iq to t@rnii@l@ite resc-,,,ircit into action, ,;o fliat all of tli(', 1)(,ol)le (ye car nation (.:Ill 1)4.lleflt Is rilpi(Ily as Ix)ssil)le froin the tclii(--veii)ent of ino(lern Title. I of lf.IZ. r)8 extends tlie, i-e,,Ioiial iiie(lictl program through fis(,:Il ye@ii- Ill(l (@,Iirities ,Ill([ iiiil)roves cci-t.,,,tiii Lipe(-ts of the )II WI fl'ol)l yolit- (!ollsi(lel.:ttioll of tl)is le,@isltt.ioll ill til Stiililiiei- of I')05 it, introduced t of ili(@ findings of ('oiiiiiiissioji oil t,iid Sfr-olce. (@reftte(l the, I)ot@4oli- t@i:i,l to tilo lie,@tvy I-olis of (lise@ises but, that, this pof(@,iitiil ]lot 1)(kill" I.(@:Lljz("(l l'ol. )Italy of our I '('oiiiiiicroo ("oiiiiiiit I)ILyiod :t )iitj'or in (,Clarifying I)ot,it t,li(@ ii,,tt.iirt@ of tli(@ I)ro,-riiii all([ the direc- ,riie. b:isi(., of tIlis I)rogrtill is to t,,-,ur(, that, t-lic people, of tllis 'i\'.Itioll, iiiity 1-@, evil] 1)(@iietit fi,oiii the, .t(lv.,tnees of iiie(lie"tl science tile threats of lieti-t. disei@ ctiicer strol.:e relatp,(l diseases. .iks,,tit id(litioii-,tl dividend, this I)ro,,,,riiiii %vill li(Lveiii iiii act extend- p Ing far beyond the control of sl)eciiic diseases. 'I'lic physicians and other health -,vori@e-i-s involved in the regional medical programs ivill be tpplyilig their iic-%v, l@iio-,vledge iiid new techniques to patients being treated harder the inedic,,ti(l, iiiedicire, and otlier Health progrtms. Tile, lessoiis ill the regional ii-iedical progrtiris ciiiiiot help but el illAlleo tile quality and efficiency of these Other -Le-tivities. Tile t]rG@adv ina(le ]its just,it ed our (@xl-)ect.atioii that this NVOIII(L Si(,'Ilifvlc.@llitly I-,Iio of (.,Il.o fol. illost@, Nvll() ft-olli. tile ]major diseases. I)I-iligiiig (livel.,;(t 4'rolll)s ill the iii:i.iiiiei- t,iiitt, re- :I. of (11(@ lififili(,(l or iii(@ tire I)reseiit of iti:iiil)olv(@l-, Ill(', tlii.oll"llolil, tile I)ei,soiis lo airline, firiii career to goals of (II(' lolillit:it-y, llt,'Illo ilitt,iollill @ti)(I I-(@4,'ioll:Ll l(@,V(@ls. v 11(@l 1)(!(t ox I N Ili @@li have (@xiste(I liiis :1 J)osit@i@'(@ I'(@SI)o]IS(@, to tllis 1111111- (I:Lto ill 11)(@ ol.i",illll That, tllls 1)1,0(rl,,Ilil Woll](I 1)(@ (!Olllllillllit@y li@it tile -for i)],Iiiiiijio- tii(I oiLr-,tiiiziii,r tile opera- t,ioii of tile, I)ro(,riiii would clear to tli(@ region, iiot to tile Ft@de-riii As evidence of this response tlii-iost 1,000 inedical institutions are participating ill the regional medical pro'grtiiis, including every med- icil ,cliool ',tlid hundreds of ]Hospitals. This involvement-, of ilic(lic@t] S(.]Iool.,; @ll)(I ot'lle,,I. ikii(I institutions helps (lovelol) clo"o @ill(I continuous eollt,.tct, twtweeii itic@(licil advances tnd their tl)- pli(,at ioii iii the community. Almost 900 health or(-,,aiiizttiotis tre 1).til,icit),Iting, iiiellidilig@y r@, St;tt-,o iiic@(lie'll society, licil-t,li (Iel)iti-titiciit, Sttte lictrt associt- tioii,,,tiid State, cancer sooie)i,y. Over 7,000 iioii-Fedei-,t]-coiiiieotp(l individuals ,tr(@ iio8v .tet@ively engaged iii t@lie progi-:iiiis, including 1,800 eiyil)loye(I either full- or part-time b@ the regional pyo-rams, over 1,90@) illei-nber.-, of the re-ioii.il advisor -roilps required by the law who must advise oil the y de'velopiiiei-it of the progrtnis and Ll)l)rove tll o@ritioiitl tctivities before 'they call be funded, and memi)ers of various subcoi-nmittees, task. forcei, .iiicl local -,irtioii -roups, who ,tre contributing their time. This represents all involvement, not only of the experts ill the re,,,,ion but tlso tlic lieailtli personnel tt the grassroots ]ever, ,tnd this is illus- tr.ited iii I-,,tble I (I-). 33) -,which is submitted with the testimony. These people, institutions, ',tlld organizations -are the forces which, Nvitli yoiii- ,iil)poi,t, evil] carry to fulfillment the high expectations for till-, The of the I)i-o,rriiii is the i-e(,rioiifti (-rroiips to t, 9 thoroughly t@lto lick@(IS Ill(l within their ivilt 'the tliltt, 1)(@ I.,]lo (Illinois k)l(i ol, i,ll(. lli:tjol. eso 111-01)1(@iiis oil IL ].V(riotilli (]lo -rrolli),4 iti-o 111) the most, list) ( f i-esoiil-t-@ fol. from t Ii(@ I@t I-, ri@ I I I ?I (Is , ( I i (! I I 0 t,li(@ also] IV( e(I I i-egioll@ llllN,o foill)(1. that many t'vi)(@.-,, ol II ivities Call (,@oiit.riliiiite lo ol)ie(-t,iye,-, sii(.-,It as (I(@lyloii,,(i-,tt@ioiis @)i advanced (11,,I,(r ti(-, technique-,, t,i-:tiiiiiig,,tii(I coiitiiiiiiii,,- edu(-,ttioii of telit of communication -.tiid I);tticiit date lict,wol@l@s, ,il)pli(@ttioii or coiiil)tit(@r tii(I other modern t(@e-liliology Io health care, -.laid research into better means for orgaiiiziiigtild deliver- iiig improvements iii Health care. The first, plateauing grLiit was -,-Lwtrded less than 2 years ,-tgo. Today there ,ire 53 troaioiis which litve received planning graiits and include co, ,tild ,tn -application. from the entire pol)i-il,,ttioii, exceil-)t Puerto Iti tli,,tt,Coiiiiiioll-N..ettItll is now being reviewed. Eleven region-, ]live received griiits to siLi-I)y)ort initial operational 1,; other j-(@,gioiLs litve stibniitti;(l iT)plic.,ttioiis to begin t@llo 1)11,tse of I.)]I(,4ir I)ro(-rrtins. To finance tliinw, itctiviiies t,liel.(l li;tsl)(Til :1@ III the 4jl)li-,Y-Ittioii of funds, tti(I 'this is Tli(@ iiivo]N,(,iiieiit@ iii t@lio 1)1'oL'I-.Illls I)V lo(',-,II ill,",ti- iii(livi(itillis ll;is @Villilili t)i(t next. year it]] (@f' (lio lo (@f their I)I.ogl..I,lll. 'J.'Il(@y iti-t@ to (-,olit,ilitlo t'lie wol-Ic t.11(@y ]leave 1)(trtll to extending t,ii(@ -I)ll,si(.. authorities of-t,lie i-egi( l@l tll;lle(l- i.ii(i ))ill I)(.,fol,.o You (countries IL]IICII(11)1(!Ivts to itil- ilioi-C eirwtively. It it provision t)liat Nvoiti(i assure proper ovaliia- treat of the accomplishments of the piv(,rritm by provicfiiig-that up to lo@53 0-08-2 12 1 percent-, of tlie, apl)ropriitioii for a)iy year beginning with 1970 I'll, 1)(@ b try for t.lio Ilyll(@ bill iyi,,tlies cleir that regioii,-tl iiiedic,-ti (rrtiit,,i etn be ulvtr(led to t coiiibiliat-.ioii of regioiiti @'edic,,tl I)ro,,Yralli agencies for carrying on ,t Also, It IIONI added wliioli would Ivi-iiiit the aavardi "Ig of gFIllts to I iionprofit,.-Lgefiey or institution for sorn,ices -%iliicl value and use to any tNvo or more regional medical programs. Such services mi,-Iit include producing education materials, developing evalu,-ttioii techniques, creating uni- form d,,tt,,t-gatlieriiig systems, ,tnd ot-lier types of activities @vhich CLllllot Ilw-,iys be developed most efficiently 4;ii the basis of the needs of I siii(,Yl@rc@on. The @ict is -Liso amended to %iitliorize the use of reaioiial medical @l)orso@l@'I'll, @riiit fluids to I)Crjllit the full 1)articiptti-Oli of Federal I t in I g il medi tiiis ,is the important community Lioii, C, I progr, r@tire@ -Nvllicii they in fact,.Lrc@. tnieiidiliciit clarifies that t 1)r,.tcticiiiix dentist as -%voll as YSICIIIII ilillt'V refer -L I)atieiit to t flt out research, by oiial or (lei@ioiistratioil @ivities wlii, all program funds. Dentists e-tii I)Iq 0 in- such trelis is the early identifip,.,ttioii of or,,tl ic ainendm(@,nt ioli does not corrects tii unforeseen Iii-nit,.tti.oii in tli(@ or g iia i;ct I)crii-iit such referrals. Ali in t.lio A(Iviioi- y Couli(,il iiieiiiI.)ei-sliij), from 12 mein- to '16, is provided ill the bill, Lli expulsion iylitde ii tr by y the ii-Lei-ea-siiia -%vorltlo,,td of the Council in reviewingtpplicati s and l@y of having members Nvlio reflect t broad diversity of on t@ii.o desir@il' interests. The bill -,tlso extends the provisions of the programs to Gutm, American Sai-not, tnd t io Trust Territory of the P-.icific Islands. The H,.twaii reLioii,,tl @edict prograi-n has iii(lictted t,litt it would be inter- estp,(l in in'@luding these areas in it-, I)roaraiii. These provisions wil strengthen rcaioii,,t] itiedictl i)rogr,%i-ns and will provide the flexibility their, will t@(i in ilia.Icilig the- mast efficient Use of Ill the health elements of the community ill the prolrrain. The committee has received copies of the S@rgeoii C;eiieWal's report Oil 1 egiontl medical 1)rozr,),iiis, which (lescril)cw in detail the ii@itial c -or the record material which adds I would Iiii' t6siibinit f pro to and which will I)riiiL, voii up to date on the accomplish- intents of the regional inedict I pro@@a may I sul)mi@ that for tli(,3 Chairman? rcc()rcll Mr. Ro(ii.,,its. Without objection, it be received. (The document referred to follows:) @!7@!7 13 PRN"GRESS REPORT U.S. I)EIIARTMENT OF IJEALTH, EI)UCA'riON, AN[) WELFARE Public Health Service % 14 30 53 >Regional Medical Programs have been awarded planning grants*... 4 to develop operational proposals through . . . survey,; of needs and resources feasibility studies organization and staffing Regional Medical Program is currently under development 77 15 47 Q42 Re i4)iiil Nit@(lictil Pro,,rani@9 have received opera- ti,nalgratits* 0 to improve patient care through research, ct)ll- iii,,, education, training, a@d demonstration projects * to (ICVCIOI) better metlio(I.-i for the exchange of information kmo " medical schools, medical n, 41 centers, community hospitals, practicing phy- sicians, and other health institutions, organi- z,itions, and personnel o to continue to develop new and expanded plans for further improvement of patient care *As of February 29, 1968 16 REGIONS AND PROGICAM COOIIDINATORS Olt Dlltl,,CTORS I AI,AIIAR*IA 10 FI,OLIIDA 19 LOUISIANA Wells, AT.D. S. P. Mitriin, M.D. J. A. Sailo2itier, M.D. Provost, J. flillis Claiborne Towers Roof U. of Ala. Med. Ctr. 1919 7tit Ave. S. Miller Med. Ctr. 119 S. Clail)ornc Ave. New Orleans, La. 70112 Birmingham, Ala. 35233 U. of Florida Gainesville, Fla. 32601 2 ALBANY, N.Y. 20 MAINE 11 GEORGIA F. M. Woolsey, Jr., M.D. M. Cliatterjec, M.D. Assoc. Dean J. G. Ilarrow, M.D. 295 Water St. Albany ille(l. Coll. M(!d. Assoc. of Ga. Augusta, Me. 04332 47 New Scotland Ave. 938 1'e@iciltree St. N.E. Atlanta, Ga. 30309 21 MARYI,AND Albany, N.Y. 12208 W. S. Spicer, Jr., M.D. 12 GIIEATEII 550 N. Bro4idway 3 AIIIZONA I)],'I,AWAIIE 13@,illimore, Md. 21205 4M. K. I)uViii, id.D. VAI.LEY Dean, Coll. of Med. W. C. Spring, Jr., M.D. 22 MEMI'llIS [J. of Arizona Wynnewood house MEDICAL Tucson, Ariz. 85721 300 E. Lancaster Ave. Wynnewood, Pa. 19096 J. W. Culi)ertqon, M.D. 4 ARKANSAS Coll. of Mcd. W. K. Stiorcy, M.D. 13 HAWAII IJ. of Tennessee Dean, Sch. of Med. W. C Cutting, M.D. 858 Madison Ave U. of Arkansas Dean, Sch. of Med. Mcmpliis, Tenn. iBI03 4301 W. Markham St. U. of Hawaii Little Rock, Ark. 72201 2538 The Mall 23 METROPOLITAN Honolulu. Ha. 96822 WASHINGTON, D.C. 5 BI-STA,RE T. W. Mattingly, M.D. W. II. Danforth, M.D.. 14 ILLINOIS D.C. Medical Society V. Chan. for Mcd. Affairs Wright AtiamFi, M. D. 2007 Eye St. N.W. Washington U. 112 S. Michigan Ave. Washington, D.C. 20006 660 S. Euclid Ave. Chicago, 111. 60603 St. Louis, Mo. 63110 24 MICHIGAN 15 INDIANA A. r!,. Ileustis, M.D. 6 CALIFORNIA G. T. lukemcycr, M.D. 1111 Michigan Ave. Patti D. Word Assoc. Dean East Lansing, Mich. 48823 655 Siittcr St. #302 Indiana U. Sch. of Med. San Francisco, Calif. 94102 1 100 W. Micilig4in, St. 25 MISSISSII'PT Indianapolis, lii4i.4,6207 M.D 7 ('I,'N'I'IIAI, ct'. NIIIW YOI(K 16 IN'I'I-'ItMOIJNTAIN II. (',agile, M.D. 251)0 N. State Ct. It. II. Lynn%, M.D. Jackson, Miss. 39216 state U. of N.Y. Assoc. Dean U. of Utah 750 E. Adams St. 26 MISSOURI Salt Lake City, Ut. 84112 Syracuse, N.Y. 13210 V. E. Wi]Aoii, M.D. 8 COT,OLIADO- 17 IOWA Executive I)irtTtor WYOMING W. A. Krelil, M.D., Ph.D. for ll(!alth Affairs 308 Melrose Ave. U. of Alissouri P. R. Hildebrand, M.D. U. of Iowa Columbia, Mo. 65201 U. of Col. M(@ti. Ctr. Iowa City, la. 52240 4200 E. 9tlt Ave. 27 MOUNTAIN STATES Denver, Col. 80220 18 KANSAS K. P. Bunnell, Ed.D. C. E. Lewis, M.D. Assoc. Director 9 CONNECTICUT Chairman Western Interstate 11. T. Clark, Jr., M.D. I)epL of Preventive Med. Comm. for Higher Ed. 272 George St. U. of Kansas Univ. E. Campus New Haven, Conn. 06510 Kansas City, Kan. 66103 Boulder, Col. 80302 17 37 NOItTlIWESTrRN 46 TENNESSEE 28 Nl.'IlIIASKA- 01110 MID-SOUI'll S6UTII DAKOTA C. It. Tittle, Jr. M.D. S. W. Olson, M.D. 11. Morgan, M.D. 1408 Sh lildg. Medical College f Ohio 110 llakcr Bldg. 110 21,t Ave. S. Neb. 68508 at Toledo 3r Lincoln, Nashville, Tenn. 37203 29 NI",W JEltSI,Y 38 OHIO STATE It. I- Mcilitig, M.D. 47 TEXAS A. A. Fl(.riii, llq.l). ; N. J. State I)t!Pt. of filth. Dean, Coil. of Med. S. C. 'I'lloiitpson, M.D. Ollif) St@ll(: U. Suite 724 St. E. Orange, N.J. 07018 410 W. joth Ave Sealy-Smitit Prof. Bldg. Colombo." Ollio 4@i2lO Galvcston,fex. 77550 30 NEW MEXICO 39 01110 VAIIL,,Y 48 Till-STATE Rcgiiisll,i Fitz, M.D. Dean, Scii. of Nied. W. 11. Melletkill,,M.D. N. Stearns, M.D' U. of New Mexico 1718 Alexandria I)r. 22 The Yepiway Albuquerque, N.M. 87106 Lexington, Ky. 40504 Boston, Mass. 02115 49 VIIIGINIA 31 NIW YORK 40 OKI,AIIOMA AIETII. AIIEA K. M. Wcmt, M.D. E. R. Perez. M.D. V. del'. [,Arkin, M.D. IJ. of Ok. Med. Ctr. Iliclimond Acad. of Med. N.Y. Academy of Med. 800 N.E. 13tli St 1200 E. Clay St. 2 E. 103d St. Oklahoma City, bk. 73104 Richmond, Va. 23219 New York, N.Y. 10029 41 OIIEGON 50 WASHINGTON- 32 NORTH CAROLINA M. R. Grovcr, M.D. ALASKA M. J. Musser, M.D. Director, Cont. Med. Ed. D. R. Sparkman, M.D. Teer Ilouse Sch. of Med. Sch. of Med. 4019 N. Roxboro Rd. U. of Oregon U. of Washington Durham, N. C. 27704 3181 S.W. Sam Jackson Seattle, Wash. 98105 Portland, Ore. 97201 33 NORTH DAKOTA T. H. Harwood, M.D. 42 PUEIITO ]tico @l WEST VIRGINIA Dean, Sch. of Mcd. A. Nigaglioii, M.D. u. L Wilbar, Jr., M.D. U. of Nortli Dakota Chancellor, S II- Of Med. W. Va. Univ. Med. Ctr. Grand Forks, N.D. 58202 c Morgantown, W. Va. 26506 U. of Puerto Rico San Juan, P.R. 00905 34 NORTHEASTERN 52 WESTERN 01110 43 IIOCIII-"S'F]-'.11, N.Y. NEW YOIIK F. C. llobl)ins, M.D. @. it. F. Ingall, M.D. It. C. ilarker, Jr., M.D. Dean, Scii. of Med. Sch. of M,-(J. and Dcnt. Z)Cil, of MC(l. Western Reserve U. U. of Rocll(!Stcr State U. of N.Y. at Buffalo 2107 Adelbert Rd. Cleveland, Ohio 44106 Rochester, N. Y. 14620 Buffalo, N.Y. 14214 44 SOIJTII CAROLINA 53 WESTERN 35 NOIITIIERN I%NNSYIVANIA C. 11. Stiiiinterall, III, MD NEW I-NGLAND I)ept. of F. S. Cliecver, M.D. J. E. Wennherg, M.D. fqcd. C4,11. hospital Dean, Sch. of Mcd. U. of Vt. Coll. of Med. 55 Douglity St. U. of Pittsburgh 3530 Forbes Ave. 25 Colchester Ave. Charleston, S.C . 29403 Burlington, Vt. 05401 Pittsburgh, I'a. 15213 45 SUSQUI--,HANNA 54 WISCONSIN VALLEY 36 NOWrIlLANDS -,M. Stickney, M.D. R. B. McKenzie J. S. Ilirsclil)occk, M.D. Minn. State Med. Assoc. 3608 Market St. Wisconsin RMP, Inc. 200 Ist St. S.W. P.O. Box 451 110 E. Wisconsin Ave. Rochester, Minn. 55901 ckmp Hill, Pa.'17011 Milwaukee, Wise. 53202 *Associate Coordinator other factors which occurred in 1964 and 1965. One of these factors was the creation of a national biomedical lied anywhere research effort unprecedented in history ;ltl(l une(iiia tivity was and continues to be else in the world. The effect of this ac intensified by the swiftness of its creation an(] expansion: at the ])Cl,iTiiiiiig of World War 11 the national cxi)(-ii(litijrc for medical re. It totaleti $45 inillioFi; by 19,1.7 it was Si@7 million; and in 1967 scai,(@ tile total was $2.257 I)illion-a 5,000 percent increase in 27 years. The most significant characteristic of this research effort is the tre- meti(loki.,; rate at which it is producing new knowledge in the medical tti oijtl)oiiriii,,, wlii(@,li only recently began and which shows no signs of ](@(,Iine. As a result, in health care have I)ct-n dramatic. l'i)(lay, tia(tre are (!tires wli(-,re none existed before, a number of discast@s li:tvc all but disappeared with the application of new vaccines, and patient care generally is far more effective than even a decade ago. It has become apparent in the last few years, however, (despite substantial achievements), that new and better means must also be found to convey the ever-increasing volume of research results to the practicing physician and to meet growing complexities in medical and hospital care, including specialization, increasingly intricate and expensive types of diagnosis and treat- ment, and the distribution of scarce manpower, facilit ics, and other resources. The 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. mitment to biomedical investigation In a sense, the national corn 0 I I : is one manifestation of the third factor which contributed to the creation of ilegional Medical Programs: the changing needs of society-in this case, health needs. The decisions by various private public institutions to support biomedical research were responses and to this societal need perceived and iiiterl)rete(I by these institutions. In addition to the support of research, the same interpretive process led the Federal Government to develop a broad range of other pro. grams to improve the quality and availability of health care in the Nation. The Iiiii-Burtoii Program which began with the passage of the previously mentioned] Hospital Survey and Construction Act of 1940, together with the National Mciital Health Act of IW, was the first in a series of post-World War II legislative actions havin- major impact on health affairs. When the 89th Congress adjourned in 1966, 25 health-related bills had been enacted into law. Among these were Medicare 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 Medi- cal Programs. 20 Ile report of the Presi(letit's Commission on I-leart Disease, Cancer, and Stroke, issued in December 19(A., focused attention on societal needs and led directly to introduction of the legislation au. thorizitig Regional Medical Pro,,rams. Many of the Commission's recommendations were significantly entered by the Congress in the legislative process but The Act was clearly passed to meet needs and problems identified and ,,iven national recognition in the Corn- mission's report and in the Congressional hearings preceding pas- sage in The Act. Some of these needs and problems were expressed as follows: 0 A program is needed to focus the Nation'.-3 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. 0 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. 0 'Mere is not enough trained manpower to meet the health needs of the American people within the present system for the delivery of health services. 0 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. 0 A creative partnership must be for-e(l among the Niition's medi- n @,;,@. cal ,i(@ientists, practicing physicians, and all of the Nation's other heitltlk resources so that new kiiowl(!dgc can I)(- translated more rgkl)i(ily into better patient care. 'I'Iiis partnership should make it liossil)l(- for every (,4)inmtitiity'ii I)Ikysiciiiiis to share in the diagnostic, therapeutic and consultative resources of major medical institutions. They should similarly be provided the ol)- I)<)rtunity to participate in the academic environment of research, teaching and patient care which stimulates and supports medical practice of the highest quality. Institutions with high quality research programs in heart disease, cancer, stroke, and related diseases are too few, given the magni- tude of the problems, and are not uniformly distributed through- out the country. 0 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 diseases. Such education will enable indi- viduals to recognize the need for diagnostic, therapeutic or re- habilitative services, and to know where to find these services, and it will motivate them to seek such services when needed. 21 During the Con,,ressionil hearings on this bill, representatives of major groups and institutions with an interest in the American health system were heard, particularly sl)okesm(@n for practicing physicians and comniunity 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 Presi(lent's Commission was replace(] by a concept of "regional cooperative arrangements" among existing health resources. The Act establishes a system of grants to cnttl)lc representatives of health resources to exercise initiative to identify and meet local needs within the area of the categorical (liscases'tlirough a broadly defined process. Recognition of geographical and societal (liversitict; within the United States was the main reason for this approach, and spokes- men 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 Medical Programs 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 is intended to provide the means for conveying to the medical institutions and professions of the Nation the latest advances in medical science for dia-nosis, treatment, and rehabilitation of patients afflicted *with heart disease, cancer, stroke, or related di- seases-and to prevent these diseases. The grants authorized by The Act are to encourage and assist in the establishment of regional cooperative arrangements among medical schools, research institu- tioiis, hospitals, and other medical institutions and agencies to achieve these ends by research, education, and demonstrations of patient care. Through -these means, the programs authorized by The Act are also intended to improve generally the health manpower and facilities of the Nation. In the two years since the President signed The Act, broadly representative groups have organized themselves to conduct Regional Medical Programs in more than 50 ltegioiis which they themselves have defined. These Re,,ions encompass the Nation's population. They have been formed by the organizing groups using functional as well as geographic criteria. These Regions include combinations of entire states (e.g. the Washington-Alaska Region), portions of sev- eral states (e.g. the Intermountain llcgion includes Utah and sec. tiong 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 the city and 11 surrounding counties). Within these Regional Programs, a wide variety of organization structures have been developed, including executive and planning committees, categorical disease task forces, and community and other types of subregions] advisory committees. Re-ions first may receive planning grants from the Division of Regional Medical Programs, and then may be awarded operational grants to fund activities planned with initial and subsequent planning 22 gr,iiits. 'niese operational programs are the direct Yneans for Re- gional Ale(iical 1'rogriins to accoinl)liih their objectives. Planning moves a ]ic,,ioii toward ol)cratioiiil activity and is a continuing means for assuring the relevancy an(] appropriateness of operational activity. It is the effects of the operational activities, however, which will produce results by which ltegional Medical Programs will be judged. On November 9, 1967, the President sent the Congress the Report on Regiottal Medical Progrants prepared by the Surgeon General of the Public Health Service, and gul)ziiitte(i to the President through the th The Secretary of Health, Education, an(] Welfare, in compliance wi Act. The Report details the progress of ltegional Medical Programs ,ind recommends continuation of the Programs beyond the June 30, 1968, limit set forth in The Act. The I)rcsidcnt's 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 Pro- grams is clearly emphasized. THE NATUITE AND POTENTIAL OF REGIONAL MEDICAL PitOGItAMS GOAI-IMI'ltOVEI) I'Al'IEN,r CAltE The Goal is describer] in the Surgeon Gencral's Report as cleir and unequivocal. The focus is on the patient. The object is to influence the present arrangements for health services in a manner that will permit the best in modern medical care for heart disease, cancer stroke, and related diseases to be available to all." MEANS-TfiE PROCESS OF REGIONALIZATION Note: Rcgionalization can connote more than a regional cooperative arrange- ment, but for the purpose of this publication, the two terms will be used interclian cal)ly. The Act uses "regional cooperative arrangement," but 9 "regionali7,ation" has become a more convenient synonym. A regional cooperative arrangement among the full array of available health resources is a necessary step in bringing the benefits of scientific advances in medicine to people wherever they live in a Region they themselves have defined. It enables patients to benefit from the inevitable specialization and division of labor which ac- company the expansion of medical knowledge because it provides a system of working relationships among health personnel and the institutions and organizations in which they work. This requires i 17 2@3 a comniitmciit of individual a,,,l institutional spirit and resources which must he worked out by each llcgional Medical Program. It is facilitated by voluntary agreements to serve, systematically, the needs of the public as regards the categorical diseases on a regional rather than ;orne more narrow basis. Itegi4)iiiiliziition, or a regional cool)(!riitive arrangement, within the context of lte,,ioiial Medical Programs has several other iml)or. tajit facets: 0 It is both functioiiil and -cographic in character. Functionally, regioiialization is the mechanism for Iiiikiii,, patient care with health research irid (-(Iucatioii within tl)c entire region to provide a mutually beneficial interaction. 'I'Iiis interaction should occur within the operational activities as well as in the total program. The geographic boundaries of a rc,,ioti serve to define the pol)ula- tion for which each Ile-iotial 1'rogritin will be concerned and responsible. rhis concern and responsibility should be matched by responsiveness, which is effected by providing the population with a significant voice in the Regional Program's decision- making process. 0 It provides a means for sharing limited health manpower and facilities to maximize the quality and quantity of care and service available to the Region's population, and to do this as eco- nomicaily as possible. In some instances, this may require inter- regional cooperation between two or among several Regional Programs. 0 Finally, it also constitutes a mechanism for coordinating its catc,,orical program with other health programs in the Region so that their combined effect may be increased and so that they contribute to the creation and maintenance of a system of comprehensive health care within the entire Itegion. Because the advance ol knowledge claingcs the nature ol medical regio7tali.-ation can best be viewed as a continuous process care, rather than a plan ivhich it totally developed and then implemented. This process of re,,ionalization, or cooperative arrati-ements, con- sists of at least the following elements: involvement, identification of needs and opportunities, assessment of resources, definition of ob- jectives setting of priorities, implementation, and evaluation. While these seven elements in the process will he described and discussed separately, in practice they are interrelated, continuous and often occur simultaneously. Involvement-The involvement and commitment of individuals, organizations and institutions which will engage in the activity of a Regional Medical Program, as well as those which will be affected by this activity, underlie a Regional Program. By involving in the steps of study and decision all those in a region who are essential to implementation and ultimate success, better solutions may be found, the opportunity for wider acceptance of decisions is improved, and implementation of decisions is achieved more rapidly. Other 77 24 attempts to or,,anize health resources on a regional basis have ex- pcricii(,,ed dilriciiity or have been (livcrte(i from their objectives because there was not (his voluntary involvein(!iit and commitment by the neceisiry individuals, institutions an(] organizations. The Act is quite to this necessary involvement in liegional Medical I)i-o,,@,ritins; it (if!fiiies, for (!xiiiil)l(i, the minimum cotni)()gi- tioii of ltt!lioiiiil Advisory Groups. Act states theme ltt!gioiiiil A(Iviiory rziu8t include practicing I)Iiy.,iiciiiiis, in(!(Iicjil center offi(!iiil-.i, lio)sl)ittil a(imiiiistra- It)rs, representatives front nl)lir(il)ri,,iii, iii(!ili(@al societies, voluntary health and (if )ilicr organizations, iiiititii. tions ikii(i agencies concerned with activities of tli(,- kind to be carried on unoler the program and members of the 1)tjlili(! familiar with the need for the services provide(] under the 1)ro,,ram." To ensure a maximum opportunity for success, the composition Of the Rc,,ional Advisory Group also should be reflective of the total spectrum of health interests and resources of the entire llc,,ion. And it should be broadly representative of the geo-ral)hic areas and all of the socioeconomic groups which will be served by the liegional Pro-ram. The Regional Advisory Group does not have direct administrative responsibility for the Regional Program, but the clear intent of the Congress was that the Advisory Group would ensure that the Regional Medical Program is planned and developed with the continuin- advice and assistance of a group which is broadly representative of the health interests of the Re-ion. The Advisory Group must approve C, all proposals for operational activities within the Regional Program, and it prepares an annual statement giving its evaluation of the effectiveness of the regional cooperative arrangements established under the liegioiial Medical Program. Identification of Needs and Opportaizitie.,;-A Regional Medical Program identifies the needs as re,@,irds heart disease, cancer, stroke and related (liscakes within the entire lie-ion. These needs are stated in terms which offer opportunities for solution. This process of identification of needs and opportunities for solu- tion requires a continuiii- analysis of the problems in delivering the best medical care for the target diseases on a regional basis, and it goes beyond a generalized statement to definitions which can be translated into operational activity. Particular opportunities may be defined by: ideas and approaches generated within the Region, ex- tension of activities already present within the )legion, and ap- proaches and activities developed elsewhere which might be applied within the Region. Among various identified needs there also are often relationships which, when perceived, offer even greater opportunities for solutions. In examining the problem of coronary care units throughout its Region, for example, a Regional Program may recognize that the more effective approach would be to consider the total problem of the treatment of myocardial infarction patients within the Region. This broadened approach on a regional basis enables the Regional 7 77 25 Program to consider the total array of resources within its Region in relationshil) to a comprehensive program for the care of the myo- car(lial infarction patient. Thus, what was a concern of individual hoql)itals about how to introduce coronary care units has been trans- foi@ine(i into a 1)i-oj(@(@t or group of related projects with much greater I)ot('iititil for effective itii(i (!fli(@ierit utilization of the legions re. sotir4-cs to itni@rov(, patient care. "Issi!ssrlictit of It't-sources-As part of tll(,. process of rep,,iotializatiort, a ltegioil Colitilkuously Update"; its ii)veiitory of existing resources ill terms of function, size, ritiml)cr ail(] quility. l,',vei-y effort is iiiiifl(! to i(ii-iitif), and tiie existinl,, inveiit )ries, filling in the gal)s as riitli(!r entire st-itijil, out oil a loiil;, cxl)eiisiv(! process of all entirely new itiv(@jitory. Information sources include state flill-iturton jigt!it(@ies, liosi)it@il ail(] medical associations, and voluntary a,,cncies. 'I'lic inventory provides a basis for informed judgments and priority setting oil tictivitie,4 proposed for develop- ment under the Regional 1'rograni. It can also be used to identify missing resources-voids requiring new investment-and to develop new coiifi-urations of resources to meet needs. Definition of Objectives-A Regional Program is continuously involved in the process of setting operational objectives to meet identified needs and opportunities. Objectives are interim steps toward the Goal defined at the be@inning of this section, and achieve- ment of these objectives should have an effect in the Region felt far beyond the focal points of the individual activities. This can he one of the greatest contributions of Regional Medical Pro-rams. The completion of a new project to train nurses to care for cancer patients undergoin- new combinations of dru@ and radiation therapy, for example, should benefit cancer patients and should provide additional trained manpower for many hospitals in the Region. But the project also should have challenged the Region's nursing and hospital communities to improve generally the continuing and in- service education opportunities for nurses within the Rc-ion. Setting of Priorities-Because of limited manpower, facilities, financing and other resources, a Region assigns some order of priority to its objectives and it) the steps to achieve them. Besides the limitations on resources, factors include: 1) balance between what should be done first to meet the licgion's needs, in absolute terms, and what can be done using existing resources and compe. tence; 2) the potentials for rapid and/or substantial progress toward the Goal of Regional Medical Programs and progress toward re- gionalization of health resources and services; and 3) Pro-ram balance in terms of disease categories and in terms of emphasis on patient care, education and research. Implementation-l'he purpose of the preceding steps is to provide a base and imperative for action. In the creation of an initial op- erational program, no Region can attempt to determine all of ihe program objectives possible, design appropriate projects to meet all the objectives and then assign priorities before seeking a grant to 26 ii I)ri Nylli(,)i encompasses all or (tvcti implement iii ol)critioti, most of the liiii)l(!iiiciitatioii can occur with an initial ol)t!ratioii@il program (!iicoinl)@issiti, ;t sitiitll [Surlier of well- desigii4-(l projects i%,Iiicii will iiiov(! iii(, lt(!,ioii toward the attainment of valid 1)ro,,,riiTn objectives. 13ccitis(,- r(,,gionzilization is a continuous process, a ltegion is expected to continue to submit supplemental and additional operational proposals as they are developed. Evaluation-Eacii planning and operational activity of a Region, as well as the overall Regional 1rorani, receives continuous, quan- titativt- and qualitative evaluation wlierever possible. Evaluation is in terms of attiiiittit,,iit of interim ol)j(!(!tives, the process of regionali- zatioll, and [lie Goal of llegiorial Medical Pro;,,ranis. -live ev;iliiition is simply a reasonable basis upon which to 0I)j(@(, determine wlt(!tlicr an i(!tivity should be continued or altere(l, and, tiltitnat(@ly, whether it achieve(] its purposes. Also, the evaluation of one activity may stig,,est modifications of another activity which would increase its effectiveness. Any attempt at evaluation implies doiji- whatever is feasible within the state of the art and appropriate for the activity being evaluated. Thus, evaluation can ritige ill COIIII)I(!Xity from simply countin- num- I)crs of people at meetings to the most involved determination of behavioral changes in patient management. As a first step, however, evaluation entails a realistic attempt to desi-n activities so that, as they are implemented and finally con- eluded, some data will result which will be useful in determining the de-ree of success attained by the activity. REVIEW COMMI=E K. P. BUNNELL, Ed.D. G. E. MILI,ER, D. D. E. ROGERS, M.D. M Assoc. Director Director, Off. of Research Prof. and Cliaiman Western lnicr,4tate Comm. in Me(l. Educ. Dept. of Mc(l. for Higher Ed. Coll. of M.!(I., U. of Ill. S(@liool of Mcd. Boiiltlcr, Colo. Cliicago, 111. V4kiiderbilt IJ. Niiblivill4@, Tenn. C. J AM FS, M.D. P. M. MORSI-" I'li.D. (Cli:tiriii:iii) Director, OI)t!rlttiolis C. II. W. 111111E, M.D. Niotilit Sinai Itcg(,;ircii (:tr. Assi-,itint St,(@r(!tary SI-11001 Of M4@(1, Nl;tsfi. ln.4t. of'recia. oil Nf(!(I. Ed. New York, N.Y. Cainl)ridge, Mzi,.4.9. Aiiii.-ric@iii M(!d. Atisoc, ('Iiictlgo, Ill. ]I. W. Kl-"NNI@',Y, M.D. A. I)ASCASIO, I)li.D. I)iri!(@tor Assoc. Prof. It. J. SI,ATEII, M.D. Ji)liti A. Aiiilrew Memorial Nursing S(!Iifiol, U. of I)ir(@iitor Assoc. for tli(! Aid of Iiit;tititte l'itttil)urgii, Pa. Cril)l)lt-d (:Iiii(Ircn Tusko!gt@o!, A]Li. New York, N.Y. S. II. lll(o("Il"li, M.1). F. J. KOWALFWSKI, M.D. 1'r(if. and (:114iil'llLan J. 1). IrliOMI'SON 1)1!1)1. of mt!(I. and Of lltililic, Ifith. (@f I,',tiviron. Mcd. I'laysl(-iiiii-iii.Cliicf Seliool of llublic Hlth. A(@a(l. of Gen. Practice Tufts N.I,'.. Mcd. Ctr. Yale U. Akron, Pa. Pres., Bingiiiim Assoc. Fund Now Haven, Conn. Boston, Mass, 7 77 27 F. V FN Ts ACNON 1964 DECEMBER It,-port the CoinniiKmioii on il.!i@ Disease, Cancer. and Stroke 1965 FEBRUARY TO Congressional hearings JULY OCTOBER Enactment of P.L. 89-239 DECEMBER National Advisory Council meeting Initial policies and pre. liminary Guidelines reviewed 1%6 FEBRUARY Establishment of Division Publication of preliminary Guidelines National Advisory Council meeting Policy for review proc- ess and Division activities set APRIL Review Committee meeting National Advisory Council meeting 7 planning grants awarded JUNE Review Conunittee meeting National Advisory Council meeting 3 planning grants awarded JULY Publication of Guidelines Review Committee meeting AUGUST National Advisory Council meeting 8 planning grants awarded First of 5 meetings of Ad Hoc Report material SEPTEMBER Committee for Report to the discussed President and Congress OCTOBER Review Committee meeting NOVEMIIER National Advisory Council meeting 16 planning grants awarded 1967 JANUARY Review Committee meeting National Conference National views on Programs & information for Report provided FEIIRUARY National Advisory Council meeting 10 planning and 4 opera. tional grants awarded k APITIL Review Committee meeting MAY National Advisory Council meeting 5 planning and I opera. iiona, grant awarded JUNE Report to the President & Congress JULY Review Committee meeting AUGUST National Advisory Council nweting 2 planning grants awarded OCTOBER Review Committee meeting NOVEMBER National Advisory Council meeting 2 planning and 3 opera. tion., grants awarded 1968 JANUARY Confemnee-Workshoi) Regional activities and lideam presented t)8-453 0-68-.'l 28 PUBLIC LAW 89-239 'Mrough grants, to afford to the medical profession and the medical inatitu- tions of the Nation the opportunity of planning and implementing programs to make available to the American people the latest advances in the diagnosis and treatment of heart disease, cancer, stroke, and related diseases by estab. lisbing voluntary regional cooperative arrangements among . . . 0 Physicians 0 Voluntary Health Agencies * Hospitals 0 Federal, State, and Local 0 Medical Schools Health Agencies * Research Institutions 0 Civic Organizations R'JvUGIO'ivNAL ADVISORY COULN.CILS The activities of Regional Medical Programs are directed by fulltime Co- ordinators working together with Regional Advisory Groups which are broadly representative of the medical and health resources of the Regions. Membership on these groups nationally is: Hospital Administrators Practicing Public He& Physicians Officials Other Health Workers Voluntary nter- Health Ag ials Members of the Public 7 33 0 c@I)i(]Vliliolotri<-, iiii,it, to study d of tlltt coiniiiiiiiity's addiction p the, 1)i-ol)osc@d @iiii the Community ,@ct, are ilitell( the roots of an intensely traaic \-tiiatioii. In most mmunities, alco- lioliesiiid iii@(,oticN(li(!ts-aiid their UiTer with them- 1)@t %-e I'(@w 1)1,ices to ttirSJoi- I)i-ofessiolill' f these people could I)c ].(@stol,e(l to within reach. (,,oi)iiiiiiiiity inciit:tl liN eritiiia ill cities with ,t illei(ICIl,ce of .11(@oll( dictio'@i. Ifowever, the ("olillillillitv ',,Nf(@,iltal Ifeil t, now offers no special induce- lliciit to wisliiill(r t critical ,tiid difficult pr(@l)lcins. tn Tlip- 1)i-ol)o e the necessary ,Lll do flie, jol), ts I)efol-C t today will serve -is I 1110(le, s in devclol)i wn voiiilliill)it,y alcoholism, This the ii-nl)ort,,tncc r the c) it, i iiid treatment, of Ilcolic, ito t;lic community Rental health center ci ribiitioii toward ,Iellievill,r I)reveiitioii and contr( to Ilisei-filit-liol.(@.ol.(Itwotll)le slioNviliLy participation in the regionti medical rogr-.tiii, :In( total 0 gation 6f'funds. ('I'Iie documents referred to follow:) TA)ILF-, I.-Participatia?b i,)@ rcgio?tal t@tcdical programs by ittd@duals an(i organi.-aliotis lndivi(iiialg ------------------------------------------------------- 7,200 '4taffi of 5-1 progranit4 ------------------------------------------ I., 800 of regional advisory groiiji.-4 ---------------------------- .1,900 8111)(@ollil)iitt(,p )iic-iiiberi4 ----------------------------------------- 2,500 JAH-al ictioii groiip lumbers ------------------------------------ 1,000 Iiist,itiltiolis ------------------------------------------------------- f)lli ----------------------------------------------------- Soo ----------------------------------- 103 I)elitjil wlioolg ------------------------------------------------- 18 S(']I(>01.4 of lieiiltli ---------------------------------------- 1'.3 Orgiitil7.ittloiis ----------------------------------------------------- 779 State ine(lical ,40(.I(.ties ----------------------------------------- 152 ('olllity itle(ll(.Ill ---------------------------------------- 90 ------------------------------- 152 licilth del):irtiiiezit,4 -------- St@ite cancer societies ------------------------------------------ 1 51 State lie,,irt association ----------------------------------------- 152 St.ite. hospital association -------------------------------------- 40 AreiLNvi(le Health facility planning agencies -------------------- 30 State octal association ----------------------------------------- 29 -tee, L-tc --------- 383 Otlier professional qoeieties, local voluntary agene 100 percent participation. 7 34 TAliLE II,-PcgiotiaZ itwdical progrants, total obligation of fund8 y(,iir: ---------- $2,500,000 --- 28, %O, O(X) 1 !)C)7 --------------------------------------------------- 153,800,000 1 (W)8 ------------------------------------------------------ of), 800, ow tllis ol)l)orttiliit,y to explain yoll, Mr. Clllirlll;lll, fol to tliis.,illl)collllliittt!e our views oil 11.11. 157.")8. Mr. lfiiitt, Dr. Marstoii, tiiy questions )@'olles, iiid Miss Toliiistoii will be liil)py to Ill,,Nver oil rally litvc. y IZocins. T]i@iiik you very mucli, Dr. Lee, for your statement covering the proposed legislation. I think Nve will start our questions by -.,Mr. Kyros. Mr. KYRO,-,. Tli,,tiik you, Mr. Chiirmaii. I want to coiiiiiieiid you, Dr. I,", oil ,i very excellent statement and to welcome you here. I would like to sttrt w@tli the last thing you stid oil page 18 of- your st,,,Lteiiieiit.. I-lo-sv will (,oiniiiuiiity iiieiital lictltii center 'coi-npletioiis, wliere 'Von -ircoticid(lic- will li;tN@e facilities for treit iiieiit. of tlcoliol isiii iiid ill -iioil, iii;ilw:t vital contribution toward preservation of such 1)rol)lenis?, 1)'V. ]'would like to -,t-,3]c Dr. Yolles to coiiiiyieiit oil that, itil(I then T will (!oiiiiy)eiit,,Ilso. Dr. )'oy.r,is. 'I' le 1)),Ovelltlloll r(@fei-i-ed to ill teriii@ of tli(@,se I)i-ogriLiiis, -il@ i)oiiit(@d to treatment, wlii(!Ii ti of iticoliolics:tiid,,id(licts, re- ioii. '.riie s(!coji(l:ti-v i)rcveiit)ioii -r(,,rs to @-oiidlir 7 )proteli is, y ir(Iii,@r' pttliology om occur- ill (,@jr("Ct, etri ii tcllv(@ll 11 to prevent fi I g We would hope tli:tt t@lic preventive coiislilt-,i- t,ioii Nvitli other lig(,@iicics, AV()tild Ile li@iiidled under other legislation, Public Law 89-749 the Ptrtiiersliij) foi- Tlctltlt Act, which also will detl with these problems. Mr. Kyito,,. Will tli(,,kse centers be sii-nilar to some of the iiieiit,,tl health centers in Mttssacliusetts? Will they tr@, t people is outpatients? Dr. YOLLr!,s. Depending oil tile type of c,-Lse,.Y@u mty have -it v,,tria- tion in types of treatment. If someone came in in an acute state, lie would be hospitalized, L,,enerallv in a general hospital, and then go Oil to Pe],liil)s transitional dty care or nigl-it care ,i'nd then outpatient care,,Ilid followtip thereafter. Mr. KyRos. Let me -risk a question generally about the regional medi- c,:tl I rogr. As 1-iiii(lerstiiid it, it liar, been in operation iieti-ly 2 years, is that ,)r. is correct. Mr. lCyito,,. li@ive you been able to lit@tl increase ttiis through the regional medical programs. 36 Tlic) Nortli Ciroliii,,t I)i,ogi-@tiii no w 0 11@ysi accord- lll(-r to .1 I'L'I)orl, ( f 1)1.o(ri.ess, all ililli','Il:lily L(@t@ive Coo])Cl-l,tiv(@ itri-,tii@re- t le itiijor (ri-oill)s -tiiiiiiig find !Ilellt wit-II tll0 1 led Nvitli )I, ilill)leiiieiii iiig c,,tiicerteti%,ities.L 'rlie cancer .subcommittee of tile I.(.gioiitl Idvisory LYI'OIIP I-ovi(les :1 iiie(-,Iiini-,iii whereby alTort,-, c,:iii be I)et,toi- (@,oordiiiit@ed-,tnd tft"@cs ii,iore il:ll)i(lly Ill(l Cil'O(@tively 'I'liey @ti@)Ollt to illiti:tte I central caii(!er re,-Yistrv ,tiid t central c-,iii(@er iiiforinttion service. Tileii- (Toal is to establish t @vell-coordititte(l, comprehensive ciiiicei- program with full participation of Stite tgeiicies, academic at-reiicies. coin- illuiiitv lio@T)itals;and professional tiid voluiit,,ti7 organi@,-,tiolis'. This 9 rating g@oups also includes it special cancer commission the Governor soi-ne yeirs ago, before tlie,,tdvent of the r in. The Noi,t I ri program reports that rnucl-i less has been ac- coml)lislied iii the of stroke their iii the other disease categories, but there is aii emphasis in this statement thtt there is aai intent to tiii into balance. bring the progr, Knowledge sufficient, to ],,ttiiicli and i-n.,tiiit,,tiii a meaningful stroke I)roaram in both iirl)aii ,tiid rural Nortli Carolina communities is,,ivail- able tiid they litve ,tii tpplic, ttioii before us for development of a coniiiiiiiii(y stroke program. I Wealth[ Iii(e to just mention oil(,, otli(@,]. t,liilllgl ]lot ill L categorical dire@r for hospitals. In tli(@, western ]@itit of the St:tt(@ SeNlell 110',I)i;ttls ill :I,-, many tre facing (.011 I Ill 11 11 tries t'll"tt 1)rol)lellls-tliitt fire, fl(.Ii])Lr t@lic of lip. I)'r. Aiiios Toliiisoll, Who is it of the Aineri@@ii Aet(l- einy of General Prtctice, told the l@C)8 Wtsliiii@rtoii (-onfpreiice work- sliol) oil i-(@gioiitl i-tiedictl I)ro(rriiiis tlitt these ,(3veii hospitals Nvill be brought together in t coordinated pi-o(ri,iiiii by the people ill the I.e(-Yioll. 'I'liese llo.'il)itils itre, I)reptre(I to go so fitris to apply as it Lrroul) for :L smile icereditatioii under the, Toiiit Commission oil Ac@@dita-- tioli of I'fosl)it@tis. Thus, Noi-tli Carolina is in the raiders of testing tlie concept of a iiiii(Ille 1-(@;zlollal liosl)it,.tl organization where, no one liospital'is able to rovide' the full r,-tn,-e of n try capabilities. Kyitos. Think you Dr. LFr There has bee;i in the, last ii yetr.,,-aiid we want to make it (-]ear we do not t?,il@e credit for this with rc@ ect to the region,.tl medical p ))rogl.:Ilns-,,I, significant decline in deaths from Itiali blood pressure. Tt, is about, it 20-I)erceiit. decline. ovei- (I)(. past, 3 yeiii-,,i. I think there is no qii(@@tioii tli'ltt its tile )-O(rioll:tl ll(,Ilit@ll I)IloLI.@Illis (Iev("Iol) activity find tile, of ei 1.1-V (let (',(-t ioii of liyl)ei-i find early ti-eittiyieiit 1)(@(.,ollles lllol.(. :ivililill)f(@, we will See fill of t-Iiis very s'lgiiifi- (le(. -,oiii-se, will part -1 Nvliiell, of icitl@ii y tli(i stroke I)rob- ]cut .11)(1, tot (@X(Clit, tile, (I(@:ttlis f I-oil) (!or0iiitry (liscitse. Mr. Kyitos. l,ce, pursuing tile, qttest ioll of tile effectivell(@,ss of tile iln, let's tliilili for it lylolylellt:II)olit cost-S. I)rogr, A s I iiiidei@stiiid it f voiii your t;il)le I f, "lZe(,rioiiiii Medical Pro,(,,raiiis, II obligation of fuii(I-S foi- the fiscal you t tot, -v(mii-, 1(,)OO tliroiigrli 1968, approximately $85 million, citli(@,r- iii planning or operittionit] slioV 37 asiired against that $85 million, ]live ou inside any kind 'i\'ow as me, y of III @ill',Ilysis 01- eviillitt,ioli Wlli(!]I.Sllows that., foi- that kind of money, we litve,,Ieliieve(i soltie significant, advance through the regional medical program? I)i,. TrF. The I)rogriiii to date priinii-ily li@is been one of i)lanninL,,,tnd 'e,lol)iiig tli(@ in (@(,.Illklllsiiis wlii(li then c@iii be evtltiitted. i4or ex,,t'-M' ple, W(, were developing the dita b@ise Nvliicli in many areas is seriously After we develop such t (iitt base in the regions, we will carry forwird the evtlii,.ttioiis for which we -,ire asking spezific earmarked funds. I think it is really too early to be able to state ,vith any degree of ceitLiiity t cost-to-beiiefit effect. I thick that we should reco(_niize what I think is goina to be one the spin of the ii-iost significtiit contributions of the program. That is olT of benefits, well beyond the program itself, not only iii torms'of people whose care is paid for through medicate or medicaid. For (,Xlliiil)le, is improvement takes place in coinniiiiiitv hospitals the w.@y I)i-. 'iN,[,,trstoii (Described it, is physicians ire abl; to Participate in these ])I'Ogrlli-is ill community hospitals, the I)rogritiii is bound to have ii,sigiiific,,iii l,iiiiptet,oii iiiiproviiig(iiiitlity. ',St@ II)IIY ill itic@(ii(.Itl A.;Il,(@ I,, ,'oo(I care, liigli-(Iiiitlit,y, tiid to 11)(@, is L'oil)L' to 1)(" oil(. or I,114@, latest., important (!oil tril)'Iit-,ioiis of the program. And I Lima]( trial i,,-Oii(@ of tli(@ i-ei,soiis ill I fit NN,e s(@(@ l(iiiii of (@litlilisiiisti(-, Sill)l)ort@, itillolig physicians in iii@iiiy 1):ii-ts of cotiii(i-y N%,Iio w(@i,(@, itt@, transit really very suspicion,.; of t@lle I)rogri III. As tli(@y liii,v(@ :Is tli(@y li:Lv(@, they llltve (!]it INr(" will 1)(@, (Ievu,]()I)iliLr for tii,i-s st)ili- oil, ,,olllo tk@A@iiiii(Iiies for measurement, so tiitt we call determine the ,L(I(Iitioll,t] (@)iiiiiiioiis of t lit-, 1)rogi-:Liii. .1@yizos. I)r. l,ce, ill cars bill list it is I)rol)o,@d, I iiiiderstitiid that $6,@) i-riillioii is -x)iiglit, for the fiscal year calling Julie 30,1969. I)r. That, is correct,. @Nlr. ICYROS. IVII"tt ctrryover of funds will we ql"tve for this program? I)r. l,i,-,E. The carryover is,%30 million. @Nfr. 1,CyRos. So of the tpproxii-nttely $95 million we are talking -il)oiit,, vou li(tve $30 million iinobligated as yet. I)r. !,,iF. Yes. That is held in r@rve,,,actutlly, by the Bureau of the Iiiidcret -Nir. l@YIZOS. My )Iext question is t zeiieraloiie about your program. Ills t-li(3 Ainericitii Medicil Associttloii now eiidorsp-,& this -progrim ,Ls it@ is ctrried out?, 1)1'. I think the 1)("St Iliswer to tjiftt, is .t ).,tl)er t-li,,tt I)r. I)%N-iLrlit IVill)ur (rLve ittt ivc)rl@,iliop-wllicq Ills I)CCII Pill)- iii the current, issue of, .[AillA. It is very sitl I)ortive of the ;Nll.. ]@yitos. What does tli-i,, (to for it general practitioner, Say @ ill, IL illivi-tl aret like, in i-ny owii of Maine?, 1)1-. I might IUI(L oili inner. f@f the, AINIA. litts eiidoi@ it, tli@ so :ti-P, ;tctioiis tli4tt would have to be, tltl@eii by the liou of delegates. 'Ili(-,y would Iiitve to vo te oil I resolution saying they endorse iC, and I am not stire that action has bwii t.-,-tkeii. 38 l@ylzo"@. ]lilt, t Ile I I @-I)II tell iis I)ONN- :1 gets S:ly t. is 11 I-(@,giolliti I)I.ogi.-Itill ill I)ilt 11(@ is ill t t@o@%,Ii limit (lovsil't to it :tire iii) wlic@re I left@ off- )i-ol)lciii-ii-gaiii in Nort]) (,':troliii:t, to t I of ;I, (.ollllllllllit. y t,liit AV',IS -,Il)otit to Ile, N%-Itliollt t I)IIysi(@,itll, tll(l tile 1)(@o- I)lo ill tile (@oll)iiiiiiiity ttii-iii@(I to tile re,rioiiil pro(rrttiii for ,assist, -,e. Tlio re(-,ioiit] 1)ro@rrtni was tl)le to exiiiiiii(@, wliitt. the I)rol)lenis were in Li,trtetiiig to tliit community tii(i growing Out of that, tii(@,i-e, li.Li (lvvelol)ed -it rttlier m,,tjor study !or tJi;tt region in tilp, prol)- leiiis of the rural tmt. riie ),-iiciptl example, I think, is tii eisy One,: The trqdition of the Bii-ii-iiiigliaiii Associites which its you will rec,.tll from testiji-iony 16ad- to I),ISSIge of this le(risittioii, was held iii) as,,t model of ]low various -institutions and resources cvii li:iN@e t li(.41.lt,li relationship through tii or(r@tiijzttioii such as the -,tssocittes. The activities of the 13irmii@lliam kssocittes ire beiii expanded ',til(I CV'Tied further I)y tl-ie regional 9 medical proor,,tiiis. 'I'll(@i-otre ft jr.,triety of other things I)ciiig done to -,is-,i-,t, the I)hysician ill arets where no liosl-)itil exists. There ti-e opportunities for liysici,,tii,, from one pvrt, of Wtsliinatoii St,ittc@ to come into -,iiid tlly spend tii-n(3 in liosl)it,,,tls:'Tliis includes ftii ex I i g, ,total, c )'it I (' ,o t,liit Someone ltrr,.-Liiges to ttljcct will expand an existing two-way radio iietavork to incltide @)7 -tals and '14 high wliool,4, It will provide eotitiniiiiig e(lue.,,ttioii for liosl)i 1)11Nsicians iiii(I allied iiiedi(-al personnel. It will ilso 1)rovi(le information and education Pro- griiii,4 for i(IiiiiiiiN-trator.% meiiil)(-rs of I)oir(Is of treaty, voluntary health agen- eie.,4, adtilt (@(Iticatioii (-Ia@ -.,4, nn(I sel@q@ed civi(! groups. ioifor;it(jtion coo?,dipiato@-m, coRt-$73,800 will Ile lis(@(I to local Pll)%'4i- 1114@iii III)f)lit, It(.giollill lll,ogiitill,,4 liti4i t@o (Evaluate tlitlr ittti. ill-i)Kl-lllli to ]lliv(@ (-XIK.I.Illl(.Iltlli little groups or to l@(- to the t@n,(,(!tlve. I list (,foiiit)tiiiiilll hospit(it t!(ovt---.$75,800 %%,Ill I'-41:11@li-411 l(@iirlillig liot4l)ittll@s Using "Self units" iiii(i ii.iiilio@-i-isiijil I,(ki. I-III)itl (Ii,"(,Illlllll.lloil (@f ll(-W (til'(4'tOll.'4 (@r this 101-0j(-('l 1101)(@ @tO (-,Vlklllltte joliysi(-iiiii I)rogr"-.,i. Iiiiiisilly, 8 li(K4l)iilils %Vill 1)(@ illvolv(@(l. 5. Alb(itill corollary (,,a;r(,, trai)i,ioig (iii(I (ti)-cet (@oxt-$125,200 A eol.olk;l.ry -are Hart will IK' ('.itliti4isil(@(I II;(, jkll)tjiiy C4)11(@;!(@ to Kcrve it-4 it iijotiol iiii(I training iiijit for training loliysi(-iiiii,; iiii(i Nl-ll() %Vill tilelk Ile i"o to siiiiiliir tinit.4 at eoiiiiiiiiiiity liosl)italls. 'I'his I)r(@jtet will alig- lateral the exis titig Coronary Intensive Care Unit at the Albany Medical Center. 47 G,.t aii(I 61?. Coiiiiiiiiiiitil Hospital roi,oila;'Il cai-c traiiii)ig and dc)non8tration Pro- (Iii@c(-t cost- $5,5,400 'I'Iiis N%-ill 1)roj(@(-t -45 Jay coi,fjiiitry ciir(@ units of t@lirce iit tiirt,i- (,oiiiiiiiiiiit@- li4).@I)itiiis l'ittsli(,I(l St. and Vassar x%-ill its iiii(I (-(Iii(@iitiotiail projects for other iii the region. A continuing educational program will sc@rve the perma- iieiit. ITilit St@iff tii(I ,tiff.,;from siiiiillerlio@I)itals. 7. Ti-aiiiiiig a)t(l (Iciizoitsti-atian 1)2-ojcct, ititot.@ii@c cardiac care unit Ilcrkitner Ilospital, direct cost-43,500 'I'li(- initial of tlii.,4 l@rojt@(-t is to tr@iiii (; or 8 fears" from small coinmtinit.V it :tii;ttoiiiv and pliy.,4iolog3,, coroii@iry the principal,; and o@'llit;kls I starting (If t cir(li;i(, cire unit, iiii(I In liaii(llliig the complex equipment. lie sent to All iiiir,4@s ivill also )tiny ("enter for active training with sl)(,(-iilize(I equipment. 'ItTfOUNTAIN RI-'(;IO-NA INTI,, T, Mi@f)l(@Al, PItOGItANf '['II(, Iiit(@i-iiioiiiitiiin lt(!gioiiiil 11(@(licii] Ilro,,r,,ttii j-(@(-eive(I its firit opcrationil gr.iiii. oti April 1, ],!)67 ;III(] its ol)(-r.,itiollil iwir(I totitls $I,,832,800. 80 ,(;iff members iir(@ III tli(, (@1)(@ritioiial project,,, ibotit III (,oiiiiiiiii)itv I)t@.,I)it;ils Nvorliiiig together with tii(@ Re- otit,-tliit-(l of kA-lioiii fro gioll:ll Ilrogi-4iiii staff from tli(@ they sire I)riiigiiig to local @iii(I hospital,, tlii,(@iigliotit ill(, r(@gioll iilo(Icni techniques for Al)lkroxiiii:it(-].v thirty hospital,, iir(@ participating in tli(@ Program. lt(@gioll:ll k(lvi"orvGroiij),aii(Iiiiiiiostcvcry ll;t.ior lios1iil.,il in than r(@gioii III,, ('st:ll)lisli(,(] it lo(-;tl ultimate group to study local field to a-, li;list)ll with tll(, IltNII) staff. Seventeen hospitals iiii-ti(-il@.iiiiig in tli(, ol)er4iti(oii;il 1)roj(@(.t" olltlill(.(l I)el(-)w, and as the program (.oiitiiiii(@s to grow, it is aziticil).itt@(I tliitt@ :ttltlit ioii:kl hospital,; will I)ecojiie involved. Operational Projects 1. Regional facitlty and corc-staff sciiziiiarl direct C08t-412,600 of I't.@ili -.Nle(lic.11 S(.Ilool will liol(I it .eries of quarterly seminars oii ]it-.iltli (,,ire, continuing edii(-.,itioti, contemporary learning the- al)(I iticilsAir(@iii(@iit technology. The faculty, ex- from ii(-r(>s-., the country, will a(l(lr(@.,;s all audience of health professionals in- VoIN-4@(I ilk II 2. Netivor7o for coittiiiiii)ig editcatio)i, iii. licart disease, cancer, 8troke, and related diseases, direct coit-$2113,000 ol).i(@(-tiv(,s (if this l@ro;,,riiiii iir(@ t4) a (!Oll)ltllllii(-,Iltioiii ll(-tworic be- hall itist-it-iitif@iis to (,ii(,oilr: gc, Iiiii.,;oii between health in tlio- :ir(,ii. t-iii-i-i@iitly 4@xistiiig 2-wity radio including in 7 (-annihilates in tii- @iilt l,iili4@ will 1)(@ tlo re- illot(@ hospitals to sel.v(@ II.,; (@i)o Iiiilc. 'rV and use of KVFD (IJiii- I'llili (.(Illt.lltioll ['N') is ill@o ']'his may 1)1(- (-Ollllllllllity )lips-I)it3il its til(@ lo(-IISI)f(-(@litilillillg('(Ili('Iktiolk. 3. liifi)i-i)i(itio)t all(/, (it)-cet cost-4110,000 is it rt@gioii-wi(l(- Iii)xis(@ for information about lltillr. Staff will i)(@ ))lit, ill loe,,il (.olllillllllltl(@', to it(-t ii,4 i-t-Ijitioii,; r(,I)res(@iitiitiveq ITTI(I ills(@ (o (list I.il)llt(@ illf(@i-iiiii maturity i loii t@o I ))(,rsoiiii(,) and t@lic I)til)lic. ']'lie (@oi ,;tlklT will also g;itli(-r ii,roi-iii;ti@i(oi, II,, 4-oiiliiililiit@y needs and reqoiirces and re- and serve ii,4 it stitl@ioii for data. JI. (,'at,(Iioi)iiltitonat-y i-ciiiscitatiopt ti-ai7lill!l coqt-$f),3,1100 'I'll(, liiiversity of (Ji@,ili will give it :I-(lity (-otir,;e in resiiwitativ(@ techniques to S(qeci.(@(@l)liysician,4 from siiiiill physician will then be respoiisi- bl(! for te:iching the techniques to health I-K@rsonnel In his community. rnils "r(,siis(-itittloii coti.,4iiltiiit" will also collect data about the number of times ref3uscitation is employed and the results. 48 5. ,I in i)ltcltsiil(, (Iii,(-(!t co-it-$118,600 f@t(.Iilty of experts in using (!art- I"iiits itti(I diagnosing and treat- ifig Iit,;Ii-t will ,Iiort in tli(,ii- siii).I(,(!ti. Tli(@ ,tti(](,iits will I)t, all(] iiiirs(@s from (-t)itiiii@iiiity hospitals building coronary cire units. t;. 7'i-(iiiii@irl fo)- in care (i)i(t, (-(it-(liol)iilittonary rc.,iii8ritation, (lirc(!t (-o.,it,@34,000 I'Iii@ is ,III integral of both tli(@ car(- find ('ILr(liopulmonitry r(@su.4- (.it:itioi) l@i,ogr:iiiis for pliysi(-i:iiis (#4. #5). Niir,,(,s trained in Salt l,iik(! City Nvill to their (,oiiiiiiiiiiiti(@s to s(@i,vt, its it (@or(@ ftt(!iilty for reaching tli(- %Vill work (-Ios(-Iy with the sliyiilttrly tr@iiiie(I physicians. 7. Cti),iic(il tt-(ii@ico program, tit cat-(Iiolotly, direct cost-$65,700 This program ]its two iiit(,riiist'4 find cair(liologist.,4 with training I)rogriiiii,4 tit li4@iirt tiiiilor made to their llidivid- (2) To the number of formally trained clinical citr(liologlst-4 through it tritiiiizig l@(-rio(I (.'@ iiiojitli4 to one year) tit the existing cardiology s(-Iiool tit the University of lJtaii. S. co)tsiiltants an(/ teacher lirogratit for 8ntall comniiinity IL08Pital8, direct rost-4111,800 Sxy@;ill cf)iiiiiiiinities will be given the option of requesting one or two-day elitii(@s. A iiiiiiit)itiiii iiiiiiil)(@r of four car(lite patients will be required. These (!Iillies will ill@gi-@l(le the level of (-.ire to N,ictiiiis of heart (Ii."ase living in remote :ireii.,;. l'isitizig 1)liy,;Ieitins will ,issist tli(@ local physician in it I)rec,!,4c diagnosis In :i precise (Iiigiiosis of his liatients. 9. A 7-cgioiial conipittcr-ba8cd sy.,itct)t, for ?;ioi@itoi-ing physiologic data on-line fro?)@ i-c))iote hoipitals in the regional t)ic(lical program, direct cost-$637,100 This I)roject's purpose is to test the feasibility of using a central computer to I)ro(,ess i variety of physiological signals g(@iieriite(I by patients In remote hos- I)itils, feediiig the results of calculation,; from these sigiiils back to stations within the hospitals, and iisiDg the information for diagnosis. 10. Cancer teaching project, direct cost-$911,300 Tlii.,; project attempts to upgrade the le%-el of (-are available to local coiiiniul)i- ties. The coordinator will direct a 1)rogriiii of physician education to create trained cancer specialists who in turn, will 1)(,coiii(@ c(@iit(@rs of cancer information lit their rocket] (-oiiiiiitiiiities. The I)Iiysi(-Iaiis "-ill receive it siiiill.,;tipcild for t(@acliiiig and cil)t@:iiiiiiig information. A regioii-NN,i(](@ tiiiiioi- i-(@gi.,itry will be started, as will a training I)rogriiiik lit new t(@cliziiqii" for I)iit@liologists. 11. Stroke (laid related )tcitrological direct co,,It-$.98,700 'I'Iiis I)roje(!t will (,sllil)li,41i cliziic,4 to bring (-ojisiiltiitioii ;ervice in ,;trolce ;iii(I ii(,iirologi(-jil (lis(!iis(,s to lot,:il will provide (!oiitiiiiiiiig adulator) to local I)II.Vsi4.iiiii,, iji(i Niii-st-s; Nvill (-oll(@(-t data about sti-olc(@ I)ilti(-ilt,4 tli(@ ti)(@y if) trial A 2.1-lioitr (-oli- s(-rvi(,(@ an(] liil'oi-iiii1tioll library will to(- ]uninitiated lit the Iltitli (-olli-lkillllity I)II.N.:4i(-Iillks IN'itli III ll(](Ii- %Vill 1)(@ triiiiii@il itt@ tli(@ iii(@411(-iil lit (II(- liti(@st flijigiio.,itit! and lr(@ailiiit@iit Will last froiki 4 wt,(.Icm to 1)11(" .V(,Iii tlict-(ipy foi- I)hltRi(-I(itis atttl ntit-s(,s, direct To train physician-, iti(I iitirses to iitiliz(@ the t(@cliiiiqiiem and (mtiij)- iiieiit in respiratory tlieril@y. Five day s(@iiiiiiir8 and follow-up 2 dtiy refre.,41ier courses will train participants to administer therapy and to teach others. 13. Regional o)i(locri7ic t)ictabolic laboratory, direct cost-$,2.77,900 To provide service facilities where practicing physicians can obtain laboratory data essential to the diagnosis and treatment; to create awareness among I)Ily.@;i- clans of the possible presence of metabolic and endocrine abnormalities; to 49 Iiii co rii IIItio II. 'I'l I 1,11)orlltq)ri eswi II 1)(@ (!St,:Il)l I ml) (@(i : it IIIinnIII I) o- I;ilioritti)ry, it laboratory to) till(I IL I:il)orittorv to i-eiiiii@ ti!(-Iiiii(iiii,s. @(!itiiii@irs will 1)(! held I)Otll iiisi(l(@ i-(@I)orte(i to the refct-- iiiitl otit,,i(](, of tli(@ I,,iboriit@orii-s. AI)iiorii)ai liti(iiiig.,i will 1)(@ riiig l)li3,sicittii by telephone by it I)Iiysici@ill Wil(@ is Competent to offer consultation. KANSAS REOION'AL, lfLDICAL PROGRAM The ol)er,,ttioii,.il ii(!tivities of the I<,iii,,4as lt(!gioiiil Ale(lical Program began oti June 1, I()(@7, and tire currently fund(,(] at tli(@ level of $691),852. Al@I)roxiin;it(!Iy So iii(livi(IiitLs with viiri(-(l coitil)ri,,e tl)e (current staff, of which ,ibout physicians, oiic@-Jiftli are Ili(i an additional oii(--ilfth ftre otlici, tYI)e.,i of;tllie(l health personnel. rei@iiiiiiiiig ,itiiff lii(!Iitdcs related health personnel, ,;ticli as communications and so(-iiil scientists, :in(I general support; personnel. kl)oiit half the st,-itT ii).(@ from the medical center and the otli(-r half are from community hospitals. 'rog(@tlier they tire working on programs to iitil)rove community (capabilities foi- tr(@,,itiiig the (!categorical (Ilselt"4c,4, ,kl)i)roxiiii@itely 20 (!ojiiiiiiiiiity hospitals iii-(@ etirr(!Iltly involved in the Kansas Ilrogriiiii, tried it is ;iiiticil@ iite(I tiiit additional liosl)ititi.,i will become Involved its e,,I)arlsioii (Iiirizi- the iie-,t few y(@,ir4. TeiL of tlies(@ llospitalt; iir e directly involved in operational projects, two tire represented on the Advifiory Conunittee, and eight tire involved la on-goiiig planning activities. Operational Projects '(Ziicational progra)tz,?-(Ircat Bc@i(l, Kaii 1. l@ S.-$261,000 (direct cost) 'I'o (lev(@lop a iiioilel I)ro,,r,,tiii in t@Iii.,; ;iii-all community a full-time f,l(@lilt,Y, iviii(!Ii ivill 1)(@ iillili;tt(,,(i ivitli tlit- K2iii,,ii,4 Aledictil Center, will be In Iii(-Iiitle(I in tlii,; cojiil)r4@ii(@iisiv(, program lire plai)!s for continuing I)Iiy- si(!iiiii and jitir.@ 4-,(Iiieiitioii and clinical for hcath-reliite(I personnel. ,tde of community resource,;, etc. %vill be in. 2. 1IC(lltlt Scic?zces Coz)i;ti,ii?tfcatio?b and Infori)iation Ceitter-$77,000 (direct cog t This project I,; ei)gige(I in conducting studies to determine the feasibility of establishing communication linkiges vital to education, service, and research -I)rogriiiis. S@ific -4t.udies to be undertaken are it physician communication sys- teiii, '.PV reaching, ele(-tr(@iiie Iiiikitg(@s, and NliNlljtrs search capacity. S. Stit(IY of the qitality (in(l, ai)ailability of ittrdical carc-$11,9,000 (direct cost) I'(j (I(,t(@riiiiiie iiiiiiit@t it(-(,(Is of I)ikti(@iits, lo(-iit@loiis, l@rof(@.,.iional education, and -working tirriitkg(,iii(@jits of I)Iiysi(!iiiiis and those !it I'lit@ health rel;ittd dincipliiies. 110,41)ifal (I(lt(t f(l(,ilitic,@--$67,500 (direct co.,it) (.oll(lll(.t, within tlit! I.(.gioll various aspects of community (@l)!(I(@iiiiologi(- 4]iit@it and 1)iirti(!!I)iitioti of ]return care per- .Solili(@l ill (.maintaining e(ill(.Iitloiiitl I)i,ogriiiii8. iL computer syqtctn will 1)(! used, 5, ']'o all tt-jkiiiijig iii-ogi-iiiii to prepare wli(o Iranian silly (of (-i@i-otiiiry Ill i-olikililillil,'m 114)Sl)illi]S. with I)IISI(! ])IIYSI(>Iogi(-.Itl in li(piii(, itit(i filiikiltitril,y with t4o(!Iiil 4igc)ncle.4 that 6. 11(oNl)itat --- $.@5,000 (direct cost) (of t.lit@ (,'itiieer l')ett.,Ctioik Center now i)l@(-i-4ititig Its III) t-(-ft!ri-iil iik lio@l)lt@il la NarLins City, 'I'lit@ of 1)ttt.i(@iits will I)(- si@ii(114-(l to Nlio%v etT(,etiveii(-.,;s and yieltl of t(@s('r(@siilt 's, tylx- of lo(-rsoiiii(-l who lijiv(- xis(@(I illic (-Iitiie unit their ,4oiirce of reforr@ll, and eff(@ctiv(@ii(kss of 7. Cat-flioi,(tscularicorkevalitatio)t-4.11,100 ((Iircctco8t) 'I'lils project will (leiiion,4trate the C@ir(liqe Work Evaluation Unit and show its usefulness for the evaluation and rehaiiiiitation of the patient. It is developing all effective technique for %howing physicians and the community at large the ai)ility of patients to return to work after receiving the appropriate rehabilita. tion. 71:@ 50 ,NfE'rROPOLITA'@\' DISTILICT OF COLI@NtillA ItrOlO.-NAT, ',ItEI)ICAT, PROGRAM r(-gioii its 1, 1968, with all award of ,tiiff of 47, iii(!Iii(iiiig iil)otit 11 I)Iiysiciitis, two iiiirs(@s, s(weii other 11(@,iltli 1)(@i-sollilel, and 27 otli4@i- tyl)(-s of I)ersoiiiii@l its (-fiiiijoiit(,i, (-oiliiig (,I(-i-lis :iiiil will worlc tog(@tli(-r t(i Ali(iiit Iiitlf of t)i(@ 1.4 fr(pill (.ojllllltltlity lio.,il)lt;ils 1111(i otli(-I- ll(,:Iltli 'I'lliS ('01111@illiltif)li 4sr it ;tii(i titis iiiiiiii)(,r will :is ')I(' l@l-ogi-itili (@l)giiitis over fli(@ iii-xt@ i'l,w y(@iti-s to r(@ii(-Ii otit t@o t@ii(, (,iitir(- I-i,gil)ll. of I)oS])it4ll,'4 ill'(! (111'(@('tly ilk tile l@rOj(@('18 Otillill('(l I)t@lo%v, two :it](litioii.,tl li(@,,I)itiiis fire oil Ili(@ lt(@gioiiiil A(li,isory (@;roiip, ftit(i two are .@(-rvitig oil 1)1@iiiiiijig s(@v(,r:il ,i(l(liti(oii@iti lio,41)itllls will front tli(@s(@ 1)i-ogriiiiis its they "'Vll(l tii('il- to lie trained fit the I)rogr@im,,; outlined I)elow. Operational Ilrojects c Di(igizosis, Trcatmcnt, aizd lit- I,'?-ccd))iaii,'s Ilospital St)-o7cc Statio)t fo?- th t,(,Sfiga-tion of Cci-cbi-(il Vaqculai- Di.,?case, dii-ect co,3t-$181,889 This project is a al)pro:tcli to strol@e, from diagnosis and treat- talent to home (-are and rehabilitation in qn iirl)@,iii Negro area. Based in the Free(Iiiiiii's llosl)ital, a community hospital in the region, the stroke station will serve as t teaching componeDt for I)Iiysiciaiis and medical students. Related epidemiological and socioeconomic studies will be undertaken. 2. The TVasititigton, D.C. Regional Cerebrovasculat- Di8ea8c Followitp atid Stir- veilla?ice SVitent, direct cost-$9]i,200 17ii4it@r the spoiisorslill) of Georgetown IJiiiv(!rsity, this I)roject 1,4 titteiiil)ting to P.,4tiil)lisli a iiiiifoi-iii system for iiieisiiriiig an(] eN,;tliiit,iiig in(@(licitl care given to I)jiti(-zits in t@lie jir(@ii, ilk oi-(I(@i, to fii(-ilit4it(@ nursing and follow-iiii It I)rovi(It- information Iii-II)fiil !it 41(-t(@riiiiiiiiig (-ojiiiiiuiiitv iii4-(Ilc;il 1,(,flklireiii(,iits, and in (!iirryiiig out, or il(-iiiogritplile (,titt,riiig tli(@ syst(@iii through tli(@ viirloti.,4 community li(osl)ltjtl.,4 III I lie region will r(@(!eiv(@ ft)llow-iij) tittt@iitioii all(] therefore greater continuity of 3. ,[ ti-aiiiii?g progi-aiib for cardioiia-8citlar direct coit-$71i,707 -ire 1)(@iiig triiiii(,([ at tli(, Wiisliijig(oli I Qiiiililie(l slii(lejxt.,4 lo.41)ital Center in III :tr(@jis of iiit-(Ii(-itl ol),,,(@rvittioii and 1)roec(Iiire.4 to cojii- 1)1(!ii)eiit jitirs(-s' tetiviii(-s. III addition to listening I)ersoiiiiel for work in lios- 1)it;ils throughout tli(@ rt-gi(iii, this I)roje(-t liolK@.,i to I)ro(itic(@ it material for training tlies(! t(@eliiii(,i:iiis in the other r(@gloiijil lio,,41)il,jils. in oil AI)ril 1, 19()7, and current (il)(-ra. tioiiiii fiiji(l,,4 iiiii(otitit it) $2,('oll),OOO. Title ('Stifillit('41 I(',O '4tilfr I)eol@le, wit' ]I (livi,rm@ 1);i(-Icgroiiii(L,4, art, s(,r%-iiig i@ii Ili(! llr4)griiiii, lii4-Iii@lliig iilyi)roxiiiijilely I)Iiysi(-iiiis, four iitir,,(-s, l(o iiiii(,(i tlir(@(@ social s4@leiitist.,,, -ir siij@l@(@rting I)ersoiiiiel. The ikii(I @il)l)r(oxiiii@it(,Iy (;O ci)jiil)titer sl)(@(-iiiiists and tli( reiii4iiiiiiig staff I)i-ovi(l(@ overall Is resefir(!Ii and ii.,isistitiits IMP (](@velol)iixeiital al)l)rot(,Ii 1)(@iiig I)y this region ;iii(i outlined it) liroje(-t b(@low siigg(@sts that hospital involvement increase ral)!(Ily over tli(@ next two,yeirs. Ctirr(@iitly, iiin(,@ lio,31)itals fkre involved in the I)rogr@iiii, including two lio,;I)itil-s wlii(-Ii are represented oil the Regional Ad- visory Committee. OI)erittioiiil Ilrojects 1. St)tithville coiotiiiiinitil hcaltlt metric(! I)royrat)i--flii-cct cost $200,9.57 Tli(@ of this I)ri)ject is to establish 11 1114)(It@l (14)lilllltlllitv lit@ititli s(@rvl(-(@ ))together iii(!Iti(litig (@()iiliiiiiiilg education Trial training I)rogriiiiis and li(.Itllll (,(III(.Iltioll for tll(@ (-Iii(-rg(-ii(-y I)rogriiiii.4; I)tiioli(- I)rt@veiit:iv(@ and Fx@ii(x)l ll(,411til; (m or(Iiiiiitt,(l with voluntary health iigeiit,iet4. llrogriiiik around SiiiitliviII4 51 ,and to ijl('Ikl(l(l ;,I)Ollt 50,000 persons ill (@oillity (Clay). Activities are centered llosl)it@,11 itii(i the groul) practice clinic as a 1-1. llilltil)ll(tqic, t(-.'itii?g of all ao)tbillfllit (!oRf, $/,,"./,/17] !es of (linglio4tic to (@siliii)lilili for iii.,.r(@riiiiiig ,,(,r t4@st", to iii(@litlfv till(@ likokt, for i-ceniiig Ifirgc, ,Plains for Ill and 11(@jtltl)Y 1-111-1kl I)o])Illlliioll grolilps; ti viol, (If :is lilt aid ill will II(, ,it 111(@ ljiilv(,r4lt@y M(@(11(!Iil (.1iiii(,Itl silig4,s, NIO(14,1 tt-st (It, Ilosilitill it, Missouri. A tl)ir(I is 1113111114'41 fol- the. @tilitlivill(. (,oiili)tttct. fact cost $27-1),3(;5 ']'his 1)1,oje(!t I.,; to (levelol) Jill(] ill)l)ly for (](@liv(!riiig latest iiif(iriii;itioti oil diagnosis iiii4l (-itr(@ of illilli(@lits with strolc(@ and itlli(@il diseases to tll(@ local tl;itit ijiforiiiii[ioii storiig(! and retrieval system will 1)(@ developed at the University Metli(-til Center (Coltiixibiii, Missouri) and later extend to include Smitliville and other communities in the region. sci,eciii?ig-i-(i(liology-(Iircct cost $511,8111 '.1111ii.,; I)roje(!t will liell) iiiil)rovo the of 1-ii(l.iol(@gic dingno,,i,4 of li(-art (!iiii(!cr iiit] stroke through elect roiii(, (,t)iiiiiiiiiii(.:It@iolis iiie(litt. Three ,4niall rural liosl@ittls will be hooked into the Uiiiv(@rsit,.,y of ilissotiri computer itnd Depiirtiti(@nt of Ridiology to evaluate diagnostic eflici(@jicy and determine applic- ability of ultrasound and thermograpliy in diagnosis and therapy. 5. Coi)iprchcitsive cardiovascular care iinits-Springficld, Afo., 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 re(juire close cardiac observation is being develol.)ccl. The project Is to be under- taken at hospitals without a house staff, where it 1,; hoped that grouping of -sc.,4 oil general medical and surgical patients will relieve the workload for niii w@ir(lq. @St. Jolin's Ilo.,tpital medical st@iff iiid County Medical Society ar e coordinating activities with :1 local lio.4pit@ttlq !it S'I)riiigfield. 6. Co)tlt)lltnic(itio)t research iiiiit-dircet co,;t $61,711,'i Supporting research unit for program to identify piil)li(! attitudes and kiiowl- and stroi((-; to understand iiiotiviitioii,,4 for seek- about heart (11, itig health (!tire and to determine and (lov(,It)l) (@ffective itiettio(],4 for couiiiiunicat. iiig with and lead them to seek iii(!dicit-I (!iir(@. 7. I)ata evaluation, coniptitct- sintitlatio)t all(/ silstcliis (Icsiglt-(Ii).Cct cost $329,712 ans This I)rogr:iiii will liell) to determine data fr4)iii file public and I)IIY,4tel for (fairly (I(@tk@ctioil of lk(@art diseiis(@, ciiii(-t@r and ;tlr(klc(@ tlir(@ugli oil the foriii of data, mechanisms for cla"ifyliig, titoriiig and retrieving data most effectively. 8. llioc?lgiilccl-iizg projcct-$229,129 'I'ii(@ aiiii of t@lik ik(!t@ivitly is wi(ler distribution !it rural areas of Sensor traiis for early of 11(@.irt disease, and stroke and to 1,,eiierate more iziforiti@itioii oil physiological 1):ttteriis of t'lies(@ i). lli-ograi)@ cvttlitatio)t ccntcr-dircct cost $103,899 Through t multidisciplinary research approach accumulate data in two SCPI itritt(! (-oi)ijiiuiiities about lietitli care, needs and attitudes as iL base for developing iii.,itriiiki(,-iit,4 for measuring (juality of i@ttre and levels of health in terms of an iii(livi(Iti"tl,sfuiietion in ]ii,4 community. 10. Alito@o)i(itc(l, 1)ati(,,tit hiRfory-(Iircct cost $77,56/ 1)roj(@(!Il is t@estizig the -teiii for obtaining feltl,l))ility of oil alltOl'nllte(I t4y., and iiiiiilyz(@ (-()iiijklitijits prior to examination by I)Iiysi(!Ians, as itiL aid in early 11, (cost $@t6.'),OOO 'I'(o I)I.tjvi(ii, I)oSl)ltllis fill([ I)Iiysi(-iiiii.4 fit rural %vil@ii ittitoitilit(@(i fitellill(@s rtir triiikstiiitlilig itil(I gill illitolilltl(-ti '4y.'41,(@lli tOV allitlYS(@S 0 f t4) (leitiolist-eiti(i t@ll(, f4@lisil)ility of Sll(-Ii SYSI.4'1)IS wlier(@ Iti)IH service is and t,t) (IOV(@101), t('st ltil(I 11111)1(-Iilt'llt 'the IIH(@ Of I)I(K@1191- ii(@riiig signals as aid In diagnosis. 52 01)(,r(itioits (,o.4/ $39,055 ()I)ernt@ioiiiil iiit@tlio(Is of early (](@t(,(-t@loii tests for a Ilirgi- lisiiig Ntttloii;il 11@titli Survey (iiie,,,t,ioiiiijiir(! factors contributing to as(, of lit@:tltii ;(,rvic(,s iii qiiiill t:owiit, With oil tli(- lliflilell(@-0 of livailitiollit.Nl of (,are. 13. .@littokittilcel lioii)itat )-cco)-ti, (-oil $@;'-"IOO 'I'Iiis activity is testii)g the aiitom@it 'iozi of liosl)itiil record data through iis(- of eoinl)iiter systej)is to organize a ready reference service and easy access to lios- I)ital dita as i base for iiieasuridg effectivene.,is of changes. 15. Coi)il)zttet- As8c)izblcd O)i-Goi)tg 3faiitiul of a)td Ilara)ttcdic(it ices-dii-cct cost $26,8112 16. Central core adlllilli8tration, planning and coor(lination-direct co8t $238,805 (University of '@%lissouri M@cal Center, Columbia, Missouri) MiEwourf Re- gi()nal medical Program. ,kfOUNTAIN-STATES REGION'AL lkfEDICAT, PROORAM 'I'Iii,4 foiir-stata, region (I(Itilio, Nfoiitait,,i, INryoiiiiiig nii(I Nevada) began its OIK-,r@itioii,il ,i(-tivities on 'in[areli 1, ]()GS i%,itli tii ol)erjttionil award of $2(@(@,1)13 to oil(, activity in coronary (-far(,. Ali ol)erati(@ii;tl ,4tiiff of itl)l)roxiiii@ttely eleven will serve in the I)roject, and iiicliid(-s live I)liirsici@iiis an([ six niirs(-.,4. 'I'lie IIO.Sl)it.11'4 involved will include 'the coiiiiiiiiiiit@y lioil)itiil in wlii(-Ii the it(!tivity is telling it's well 21'3 those liosl)itftls wli(@ %vill ,ieii(i t@lieir staff to the unit for training. The Itegioi),il Advisory Group iii.4o liielti(l(@s tw(@liospital representatives. Operational Projects litietz8ive coronary care i?t qt@iall hospiffil.,; i;i. the rcgion-rlirect coit $206,913 Ilosl)itiil,, at true Region will send Itegistere(I Niir.,;(@ iiitf) St. Ilittricl@',4 liosl)lttil, !%Ioiitiiiia for (-oroiiary care tt4iiiiiiig. Fiat,, t w(@(,.]@ (!oiirs(@ will 1)(@ ()ff(!r(-(l tlir(-(- tiiii(,s it v(@itr for 21 iiiirs(@s, find tliel.(" will 1)(@ follow-lil),i lit tll(' liolil(- I)oSl)i- f@tis four times it y(@iir. lit it I-(Ijiy training program (designed :: @ for siiiitll town l@liysici:tti.4 will be held lit t)i(, Iiiiii,(@i-.Alty of iN[(?iit,4iiiii four it year, NORI'll CAltOl,INA lll@(ilONAI, ',Il',[)ICAI, I'R(XIltAht Ott 1, Ilk@S, the North (',jii,oliiiii 111-ogi-iiiii received it Colill)ill('(l find 4)1)(,i,iitioiiiil award totaling 01)(@ritiloji;il of jiNN-iir(I tot.,ill(@(i $7.@j:1,7r'DO in (-osiK oiily. 'rli(, (@lienitioiltil stiff ill(.Ill(les 4il)l)roxiiiiately forty iiitlivi(Iiiiil.,;, lii(-Iijdiiig one ntir.,;(,, ;ix other ii.Ili(-(l lieilt@li I)ersoiiii(@l, and five geii(@ritl I)er.,if)niiel. .Nortli (,;troliti;t li;i.4 already iiivolv(41 t%v(@iity-.seveii of it,,; lio,.41)itals in the Pro- grain. Tli(@ ,Advisory Groiij) includes four hospital rel@r(-s(@jitii,tives and l@Iiiiiiiiiig siil)e,ollllll,i@,es all ndditioii@il it-ii Alil@roxiiiiiitely tnveitty-oiie iir(@ lxirtiell)@itiiig Ili iii(@ ol)(-rittloiuil I)roj(,vts oiiltliiic4l below: 4 01)(@riltioiiiii Ilroj(@(@ts II C4) I, 1 1-ii I I k II kg III I.41 I(.III it II (I it1114.(] iiii4li(.Ill ,4t II([(.] I t.,4 4-4111(.Ii i.i4kikil 1 4-N 11 Trial l@(- I'll fill ly I(-(' lifiv(@ it Iii-ogi,@iiii Ill. Ill(- illi@411(.Ill 14)(01 I t) SI I,i('t4 I lll@ Ill('(] i('Ik I retail I(-i lig I)IIY. (.ollillllllilly jollilillilig rt),. improving iiii@ 4iiiiiiii,.v t,ii(I availability of (-are. l@,v tlilt4 I)rt)j- itrt@ tli(@ ft)lli@%viiig git)iilk4: ii)(@ l@iiivt,],slty tlli@ (,'(@ililty Itiii-4ii ifi@iilt@lt Services ilrojt@(!t; ilit(@ It(-gioziiii II(,Iiltli (Ioilll(!il of l@,iit;l-eriL Al)l)ii. of 14'riiiikliii Ili-iii(li i@lt),4(-s Coii(@ M(,,iiioritil lf()t4l)ital, Greeii8t)(Yro; and the Dorothea I)lx N(,,uroiiiedical Servi(-e. 53 2. Coroiiarll carc traiiii;ig and dcvclol)iiic)lt, (ii?-crt en-it-$56,938 l'o tli(@ 1)rojei-t ,is a ille(iiiiiii for (-ool)(,riitiv(@ arriitig(@iiietits (-(@ilillilillity. lilit@ilil and (-ont,itlllillg (!(II,(.:It,ioli will IK' lirovi(]('(l to iiiirs(,s laid ill (!ollll)lllllity 11(@stoititl'4, Coll- sultiitioii will be available to lio,;I)itAlls ill establishing CCtl's, and ;t coxiil)iiter- 1);ise(I ,iysteiii of iiieclical record keeping will be Tlii,,,4 project liaf, led to iiew Nvorliiiig trrajigeiiieiits tli(- University centers; (2) I)(!- t%N-Lcii and iiiirse ediicitors; doctors ;tri.d in commu. iiity liosf)itiils; (4) b(!twc@,n I]Diversity iiie(li(-al centers and community liovital& 3. T)iabctic co)i8iiltatioib and cditcational direct co8t-$132,081 To establish three iiie(li(!al tcai)i.,j to deliver s(,rvi(,e,4 throughout -the -,tate ; to :t.,isist in (Expansion of (liabetic c(--PiistiltAii.ioris ,iii(i te.,tcliijig clinics; to provide s(-iiiiii@ir.,i for physicians and t,(,itcliiiig s(,s.,iiojis for iitirbes and lifitiezit.,4 to sin(I I(>(-iii chapters; to test ;issist ill oi,g4iiiiz.,ttioii of iL State A., or (I"tf;i Many joe(olol(@ of ill partly Coal- iiitit)itie-4 are involved la tlii,,4 iii-()Jcet. /1. I)cvcloplilcibt of (t ccttti'al Cancer regi,31i-y, dircct cf)Rt-$66,615 ,t iiiiiforiii regioil-wi(le reloort,in syrteii), lntegrat(..(l with the To devise . g c(@iiij@iit@r-stor(!(l (iita froizi wlii(-Ii (!all I)(- retrieved to serve ii. broad range of (@(Iii(-atioii,,il, research, all(] other The folloin-ii)g ,ir(@ participating in the first y(@:ir of ill(- project : I)til@ ljniver,,4ty ',Nled- ic.il C(@iiter, North C@,irolintL M(@iiiorial lIosl)i.tikl, North Carolina 13111)tist (',Ii,,irlotte Ateiiiorial Ilosl)ital, Veterans A(Iiiiiiiistratioii WatL,; 110@I)it;il, Hanover 'i%,I(@iiioriiil llosl)i,t;4i], Southeastern (@eneral Ilo.,;pitAil, Craven County -c In @.stib,,,queiit. years the registry will be ex:l)anded to include all hos- I)it@i@i and physicians in the region. 5. ifcdical lib)-ary cxtcitiio?u service, direct cost-$25,839 To bring medical librtry facilities of the three iiie(lical school,, into the daily work of those engaged in inedical practice. l,ocal hospital personnel will be trained to assist inedical ,taff; libraries will be organized into a functional unit for responding to requests for s@ices. liii)liogril)hic request service will be established. 6. Cancer l@ifori)tatio)t Center, direct cost-4111,716 To provide pricticiiig physicians with iiiiiiie(liitte consultation by telephone and follow-111) literature. of tli(! tlir(@(@ medical schools will be responsible for I(x providing service in its gt,<)grttl)lii(, The iiiII14 of this project iir(@ two-fold; (1) to assist I)IIysiciiiiis in lDrovi(Iiiig ol)t@iiiiiiiii (-ilr(@ of l@titi(@lits with cililcor; an(] (2) to continue tli(@ (@(Iii(-ittioii of tli(- physicians by giving new Information In I)itti(!iit-eviit(@re(I Co?ttiniting c(lite(itiott, in internal (tirt@ct cost-$33,313 To bring 1)r;teli(-iiig iiit(@riiist.,; front all over tli(@ Kiiit(@ to the Al(-(Iictkl Center for II month of til)-to-(].it(@ training lit tli(@ir sliire re,;I)oiii4i- i(-igllim and N@,tr(i roiiii(I-9 with staff, I)iliti(@s %vitli ittt(@11(jilig I)IIYS tioti in the lliiiversi-ty, and This should the itl)l)reciii 1)4)tll lit f4l(tillt,y and Stll(l(!Iltl lt-v(@ls, for the (Expanding role of the in(@dical center for tli(@ qu@ility of care lit the coiiiiiiuiiity. 8. Coittittit-ing c(litc(itioi@ itt dentistry, direct (!oi"67,500 To I)rovi(](@ PIlysi(.!;il)s ilik(l Nvitli til(@ knowledge of mutual concern wlii(.It will tij(@iii to I)t- iiior(- iii(@iiii)(@rs or the health t(-iiiii. Cotir.,4(,.,.4 will 1)(@ given lit tli(@ lTiiiv(@r.,41ty of Ni)i-fli itil(I Ill (,olllllllllllti(@m. studies %I-Ill 1)(@ ill:[(](! of to ])Vo%'I(I(- (I(@iitikl (!itr(, lit lio.,q)ltiilt. Tli(@ I)tirl)os(! of this Is to ltisiii'(- Iltitt, ii,,4 iii:%"Y ])Itti(')It,4 118 l@Ossitol(@ N%@lio siiffer from or it r(@littq,il (Iis(,:Is(@ 1,(,(.eiv(@ iii)l)roliriiite (I(,iitiil care rest joitrtof for direct coqt-$27,838 To (Iev(qol) and establish regional (-outlining (!(Iucatioll programs for physical tli(!r;il)i.,;ts in order to strengthen I)Iiysi(-al tli(@riipy tiervices for preheats la all parts of the Plate. Subregioii4 will be delineated where needs and interests will be Identified and committees will be organized to arrange local activities. 77@ 7- 54 10. 7'h(@ Cvt(tbli.@Iii)i('iit of (t of rot-o@ift;-Il c(li'(,, itilitq in -Riiiall cot)toiiiinitil liovl)it(its i;), A'oi-th (!fit-oli)t(t lillit.4 ill llosl)itills Ill tills Itlil' N%-ill Ill(- (1114' lio',I)illil ll(l(-ijililli-Iv ti,4jiii(-41 I)livsi(-Iiiiis iiii(I jitirs(@s iii-(@ N%-ill 1)(@ gi-.iiiiii(, regioii, tti(l (,fiiitiiiiiiiig (@(iii(,iitioit 1)i,ogi,iiiiis Nvill 1)(' 111-ogi-itill its it(-Iivil@i(-S Witil 11 ol' $2.-)rt,,187. N%,ill ;Ill(l C%Vo ;Illi(@(i lit@:illli A iiiii.lority of tll(. :irt@ from (.(@illillilility I)oSl)illl]S, lit](I Ill.(, %@'ol-iiiilg i-lo.'4('IY llie(li(-Ill froiii tli(, i-(@gioii @ir(- ii(jNN, 1),irti(-Il)itfiiig la the I)rogr.iiii, ,Iil(l tlii.,i will exl),.iii(I its fli(! I)i-ogi-,jtli iiii)v(@s over tli(@ ii(,xt few Foiirlio.Kpital,4itre initially li:irti(,il),itijig iii tlieol)(@r;itioiiiil I)ro.Jeets.Tliree of tli(-,,e four i.re r(,I)res(,nt(-(] oil tli(@ lt(@gioji;il @k(lvisory S(@veii a(l(li- tioii.,il lio,,I)itils ire ,;ervjjig oil the A(Ivi,,,-ory (,otiiiiiitt(,e -laid planning sul)coiii- Operitioiiil Projects 1. Piot-ovritiott and cqitil)ping of faciliticR fo*- a 'center fol- p@-ojected trai?tiiig programs related to heart di8ca8C, cancer, and stroke, direct co8t- $26,1100 The iwarcle(I ire for the I@url)o.,* of altering iii)(I rt@nov:itiiig iii Helen Ivoo(I ivliicli 11011.-4(@ tli(@ Dep,,irtiii(@iits of Ntir.,;ii)g ,it the ITijiver.,-,ity of Rocliester. It is pLiiiiied to e(jilvert five rooiiis, itito two r4)otii.,4 for s(@lf-iii,,@triietioziitl le.,iriiitig. Tlies(, fficiliti@ initially Nvill 1)(, for four (Corollary care training (-oiir,,e.,; for iii(I ill l@lie i-(,gioii. N(@w I:e(-Iiiii(ju(@'4 tll:lt tire I)Y 11)(1-1,11is of tile,,(- (-oiirs(,.,; will tlt(,ii 1)(@ to tli(@ viirioiit4 jikiiijity liosi@i@titl.,; iiii(I rural ill-(-Il'4 ill tile I-(@giq)li I)Y Ill(- ir4killilig(.otlrf4(@ I)III.tiell)llllts. 2. I)-flillitig foo- flit, I)hll.Ni(I-i(i,)iv let th(@ Ito(,,heqtci- 10-coil)tty (@ost-$8.11,900 of (lit,; 1)roj4.(.l, III'(' $il-oilll(l 111(@ of it I)osigi.lt(liilt.l. I)I'ogl,iillk Ill i-lil.(Iiology. f,iiil-liiiig will 1)(' iiiii(it@ tl'v;iil- (,@irill4iloglsi,,4 I('Ilgl.ll fl'olll oil(--Ii:ilr (Illy 14) two 11 is it (If Ili(- I)III'li(-Ilyli,llllg Ill.4-liS. flio#i(ll ()]I(- !V(@ of' iiii,,4 .(@gisi ..v I,, ito it iii,ir(ot-it, (i@itit loll SYHI('Iil l'i-tolli N%,Ilif.il I)otli llifol-lii:ltlflll its Its loligilli(lilliti itillily.,i(-H rally 1)(@ liifoi-iiiiii4ill its to lit'(@Klifosisill)(I 'to iiiii-ti(.il):Iliiig 114).@liil:ils all(] (-IO(OIK@i,iilillg ill 111(@ I.(,gioli. Sli-ioiig N(,Av Ili tills I)roj(@(-ti, 4 .@ii(I it, is 114)Sl)itiLls, ('81)eciltlly those -it it r(@;i iii rare will sooii :i,iso Ill- I);irti(-iloitiiig. Ili-ol)osal foi- citablimli?ii(7it an(/ xitl)l)ot-t of (i i-(,flioot(it f(iboi-(tfo)-y fo)- the (@duca- cat,io2t all(l, t?.aill@ing in the of I)afiejtt.,; it@ith th@-opiibotic and hctiiot-- rhagic di.,ior(lei-m, (li@rect cost-$69,)iOO 'tt tile I)r(, eiit tiiiie iio siiigle, (neutral fi(,ility (-oii(-(-rii(@(I witli tli(- diagnosis aii(I s tll(-I-llpy of iktti(!Ilts ivitli tlil-oiiil)oti(- or lieiiit)rrliiigi(- exists Ili tli(- Ito- (-Iiester r4-gioii. T,,il)oriitory t(,cliiiiciiiiii froiii the regional will lie iiivit(-(l to ,;I)eiid tlire(@ (@r four (ltys Ili tile iie%v fit(-Iiity. Ili Ai(l(litioii, file I)Iiysi(!Iaiiis dire(-it- I 11, t II I s I)roj oet; wi I I v I s I t I lie 1). I rt I (,I 1)a t I I ig (-oi I I all I i I I t I (@s ,4o t II it t I t (-oil t It I i I I i ig e(I a- (-it t I (Ili it I 1) i-ogrii it I for I @rs I (-t I (- i iig I @liys I (@i ti)i s I it t lit, (-it ri, o t I n I t I (,I i'l s wi I It tlir4)iii I)otle (Iiseits(.s will 1)(@ iiiiiiiltiiiil(.(]. Atli)-HOXJ'I'll ]tFAIJONA), lfleI)IOAI, Ill?O(ii(ANI ()it I,'(-Ioril4kry 1, l)68, Ill(- iNti(I-84iiit)L lt(@gii)iijil J.'rogritiii I)t@gaiii Its ol)(@rittloiiiil il(!I@lvities witli it (Iivt-rse sirriiy of lirogriiiiim (losigii(-(l t@i) proi,i(](@ lo(,iii health practilioitel's :I]'(] liosl)iflll,, willi :I(Ivlliice(I teeliniqiie,4 and for (iiiiilif@y lifl.N, are (!iirr(,.iitly serv- i,ig on iii(@ -;t:ifr (or fli(@ 4)1)(,rittioiiitl 1)rogr@iiii, ill(-Iii(lilig approximately fliirty-ilve JIN-E iixirs(@, liv(@ otli(@r;illi(,(l li(@itltli personnel, and iiiiiegener.,Il stipport AI)oiit oiii@-fotirtli of tli(@ stiifr are front (-oiiiiniiijity hospitals and the r(@iiiiiiiiiiig are medical center st,,tlT Nvlio iir(@ %vorlciiig on the community oriented 1)1-4)jt,cts ])Clow. S(!veiit hospital,, are currently I)iirticil)@iting in the operational projects, representing broad geographic spread t@liroijgli4)tit the region. Teri of these bos- I)itils ;ire ilso represented oii t@lie Itegional Advisory Group. Operational Ilrojects 1. Coiitiiiiii)ig i)ic(liral c(l.,ttcatioit--Ifch(irry, (Iii-cct coqt-$44,800 (,'ollt@ge Is izifoi-iiiiiig Negro ])IiYSICIIIli8 11) tli(t region about for tr(-iii.ijig )i(@iiri@ and 'I'eitilis %Vill two-%v(,(,k (-oiirs(,s in tli(- llir(,(@ area,, iti@ the @ll. I(,r, using v4tri(iiis iiii(lio-vi.,iiiiil :ii(is an(], wli(,i-(! I)rogr@ilriiiie(I ]rise 'reaction. (,)a(! of I)Itii's ]zitA@r(,sting I)rovi.Qoiis is s(-,jidiiig itseii.lor r(@.,ii(leiit from MeliiLrry to (,are for tl)e 1)liyqiciiin's practice wliil(,, li(@ is itt.t(!ii(ling the Course. 2. Coitti)iiti?ig c(litcatioit-Van(icrbilt, direct cost-$Ilil,600 Vanderbilt proposes to establish continuing e(Iticqtioii (Tnters at community hospitals Iiiilied to a proposed I)ol).,irtiiieiit of Coiit@iiiiiii)g lt,(Iii<-at@joii tit Vaii(ler- I)il(@. libraries and iiiforiii:it@ioii centers jit@ the local liosl)ital.4 will bring Vander- I)ilt's information resources to tlic@ local physician. 'I'lie 1)ro,,,raiii, though planned and by Viiii(leriiilt, will fiiiiet@ion through the local centers and em- I)Iiiisi7(! bringing information to the physician at the times he needs it. a@t(I li, Ilop7zin8ville Editca-tiott Cont(,r and Chattanooga Edticatiot@ Center, ([,it-(,Ct cost-@73,700 'I'liese ire tli(@ first of the local continuing c(lu(-.,itioii (!eiiter.9 sl)ecilled in the I'ariderbilt plan. At each hospital, a fiill-tiiiit@ I)irector ,i,itli all appointment at Vanderbilt and an -,assistant director will ,ul)ervis(@ resident and physician edu- catioii in their ,irea. Their services %Vill be available to physicians at smaller community hospital.,; in Pacli irea, as will the enlarged hospital library facilities. The Chattanooga iiid I-loplciiisvillc locations proi,i(le the basis for looking at problems in continuing education in urban tii(I rural settings. 5. HI)ccial t)-ai)tittg foi, practici'@ig radioloqist,,f-17a-tidcrl)ilt, dircct co8t-$50,1100 This plan focii,,es oii developing 1)riieti(-iiig i-ii(liologl-4ts' skills in vascular radiology, but might Iiit(@r 1)(@ I)roii(l(-ii(@(i to all nspectm of diagnosis all(] tlit,riij)(@iit'ic radiology. ',Vivo (,(Iti(-ii.t.ioiial iiietl"Lg will lx@ iL-3e(l. Oji(@ to) llire(@ itioi@tli (-oiii-,,i-.4 for %Vill 1)(i offered. III addition, eini- tit!iit, rit(ii4)logis(.s %%,ill 1)r(-sl(le at t.%vo-lioiir monthly s(@iiiliiiirH to which all riiiliol(@gisti in r(-gloji will be invited. 6. C(ir(liae franc ti-(tiiii,)tg progra)i@3[i(l,-Htatc Ilaptist lloipitat-yaqltville, co.,it-$J,9,600 l@(,y fii(!I(,)r In re(iii(-iiig mortality fi,oiii itrr(@.,4t@ is the ]iiiiii(@(ilitt(i itvltil.-Iloilil,Y of it 1)(,rsiiii to iiiitiitt@(@ r(,stis(@ilitt,ioii. Mi(I-Sotitli ltiijiti.,4t, l@rol)ost@s t.4@ iii.4trii(!t@ (-jtr(Iiiie iktirs(,,; !it by )i4)1(liiig foiir-wt,(-Ic (-otiri(@. Tlies(@ will tli(,@ii 1)(@ itvjiiltkl)le to liosl)ltalm tiiroiigliotil. trial i-(@gloii. 7. School of X-?-ay atttl, tcehiiology-Alchai-i-y, (lircot coi"19,500 lkllllls to (@.stit'lolisli it two-year 1)rogi-ikiii for tr4t'iiiliig at least tell X-ray it(@r y(-iii-. Tlit- facility will 1)(@ !%It?lijtrrv'm I?Ai(llology staff. for establishing nuclear medicine and rit(liollicral@y programs will be ]@,(i(liolotly tcchitologist training 1)t-ograiii-Va@i(tei-I)itt, direct colt@1-430,300 l'iiii(l(,rlfilt I)rol@os(,,.4 to increase the iiiiiiilx@r of X-niy technologists, improve the initially of tli(-ir training, and iiier(@tttc their opportunities for (.Annealing c(Iiieii- tioti. Three miii,.ill hospital training programs in the area will be discontinued its sel)4irittc@ (@iitities and subsumed by a new school of X-ray technology at Vaii(ler'uilt. Practical clinical experience will be both at Vanderbilt and the tiiii,aller hospitals. 77 56 Nt--$25,300 litilgli(, I)y I)jir;iiii(@(liciii itii(I iiiN]I(@-itl Nvill 1)(', to to tli('il- sliill ill IVII(@ll fit(- I)II.1'sielill all(I Ili,; t('(!Ill)Ologist will @,11(l triiiiiiig t.illl(' I:oget,])Pr to w(@rli oiit' ]@r(x@(,(Iiir(@s siiite(i to their sittintlioll. Ti-,,tiiiee,4 will 1)(@ front siiiitller (-oillillliiiity I)Itiniting, t(o (@.4tal)lisli services. 10. of School of Ilc(lir(il 7'celtiiologll-B(ii-otiess ],,'rlaiigct- Itovpital--- Oliatta)ioo!l(t, (lircct co,3t-435,400 To @iiigiii(!iit iii(,die,,il t(-,Miiiology lit tli(@ iir(@it, this 1)14tii iii;ili(@s t%v(j I)ropo.,;iils: (1) tli(@ lt;iroii(-ss 1,;rl:iiiger 1)rogriiiii for inc(][(!iii t(x.-Iiiiologist,4; .111(l est@ill)lisll 'k School for ]:it) ii."ist;iii(s NN-lio (-oii](I free t(@(-IiiioIogist.4 front iiiore routine worli for inore (-oiiipl(,x 11. Va)t(lc@-bilt Coronary Care Utiit, (lircct coit-$51,600 This I)roject's I)tirpose 'is to estil)lisli it network of corontry cire units with equipment, staffL,(l I)y well trained personnel. Vaii(lert)ilt will I)e t)i(@ training tir)tl information center for the region ; a demonstration unit there will provide @t foeil I)oiiit for continuing c(lu(!.itioii. In ,id(litioii, comixiiini(-@,itioii ,;yst ll)S will I)(! set 111) l'O fl(-ilitilte ili(@ flow of Iiiforiiiittloii front to the (-oinniiiii.ity 110.141)it@lls. Stildie,4 ire I)elng made to ,m if the rniall hospitals coiiii(@(-te(I NN,itli Viiii(lorl@ilt (!an in turn, (!(,iiter,.4 for local networks of Coronary care facilities lit still siiitiller liosl)ittils. 12. Ft-a,)tllin, Co;-onarl/ Care Unit-lVilliaiitiott Coitntll I108Pital-Franklin, direct cost-$31,JIOO If,iiis is (@ti(i of ill(,, -,itl)sl(liary units attention(-(] lit tti(@ Viiii(lerl)il,t,.I)rfyl)o.,4til. Tlilfi I,,, I)ri)iiixrily it iiili)tl I)r(yj(-<,tl t-o .4fil(ly tii(@ f(@jltiil@ilit,.V lit)(I iii4eflillies,4 of ent'lll)limllillg it ill it William (.01111111111111Y Ivo"l)itlill. J3, ltol)k;)?,,ii@ille Ot)r(@oiat-11 C(ir(,, tltiit-l(?2t)iic Stit-at,t Alctitot,lat Hoqpital-Itop- cost--$J,9,500 li,lkl,4 ])talk is f4illlll,lll. to (11111, It (@.stltl)li.4]iilig ]liters to hospitals liy )i(@ilviiig 8@@t, lit lh(@iii, I liiis I)i-io%,i(iiiig for lit(- grt)til)iiig (of rural (-Ollllllllllitly jiioi-(- (@lliel(!nt 4 list- (@f (.Xisf liig 14. Clap-ksi)illc C(,Pro)zai-il Care Unit-CI(irkRville 3[(,-))zo)-ial I[oRl)ital, direct coal- $,19,000 As Uli(@ Fr@iii]@iiii 1)rogrniii, this I)rt)j(,(,t. Is it stil)sl(li@irv of the Viiii(lei-I)ilt I)ro- I)o.'4111. Sill(!C trials II-iosliltilil 1)(-(-n 4kl)(@r;itiiig it iiiii,t, tli(@ I)Iiiii calls for it.4 exl)all- sioii, coiitiiiiiii)g I)Iioile lrool(-tip to VAI)(lerbilt. 15. Xa87tville Gcizct-al Cot-(,4tat-y Care llttit-Na8hi;illc Aletropolitan Geitcral Ilo8- pital direct co8t-$42,100 Agaii), this is like tlie Fra7ikiiii I>Iaii. Niir.,;e.,4 here will be iiiclii(letl lit the in- s(@rvi(!o traiiiij)g l@rogriiii.4 initiated ;throughout -the ly:irticipating hospitals. 16. Ifcha?-t,ll 3[eflical College Coronai-11 Care Uiiit, direct ci)8t-$85,800 facilities wlii(!Ii %N,ill serve its it <-Oiitiiiuitig ceitt(@r for miiiiiller lio,;pittilfi lit its 4 17. (Kll,) (.,Ioitoity Hospital, (lit-cf,l (Country 11(isl)lliil, ilit- training for '.Nliiri-iiy 8titt(@ (fill- will ])A- (@Silli)118114-(l with ViiiiII4.1-1)llt, Willi-II ri.oiii its st-lio@4@l 'I'llis liiisili(@ .4yr I-(-Illtijig Ill(- Nliii-i-iiy Niii-siiig 1)rogi-iiiii (i) all (-stiil)lislie(I I)ri)vi(iiiig r(-glotiiil training t(o it 0(ii-e Uitit-Itat-oticqs I,,'t-laiigcr Hospital, (li)-(!rt cost- $,14,Ji 00 t II l@o (@mt,iii)lisli it (-are unit iik a I)rogriiiii of (olm@rii!t@ii)jL Willi Viiii(l(,rl)iit, ll()tll 111111 ilintil- I @ ivitli Vililglerl)llt will 1)(@ instant. 'niiH unit will t4ei-ve tire it (-(@ijt(@r for the Kiiijiller lioil)ItAil" lit '77@ 57 19. Baptist Iro8pital Cot,o?iary Care U)tit-,Ifid-State Baptiqt Ho8pital, Vash- direct cost-$51,000 'Vlii,4 I)Iiiii ii sitiiiljir to tli(, iiielti(l(-d fit the V,Ll](leri)ilt plan. Ilo.@I)IC@il will (,xltiiii(i its I)rese]Yt f:l(.iiiti('.S and ai(i est.'Il)l!Slllll(@lit of stiinllcr eclil- ttrs at 'I'lilliiiioziii and Crossville. Tennessee. I)Ircet,teleplione lines will be estab- lislie(I for The unit director will have a clinical faculty i,ppoint- iiieiit it Vanderbilt. lIc will devote approximately 2Wo of his time to the unit. @@0. C?-os,3vilto Coroitai-y Care U-nit-Upland8 Ctimbcrland Medical Center, Cro88- i-ille, direct cost-,V28,300 This 1)roject has two pi3rpo.,;es: (1) to establish a two-bed coronary care unit In tli(@ hospital ; and (2) to determine the feasibility of operating acute coronary (-.ir(, unit,, In rural areas. The hospital will cooperate with Mid-State Baptist Ilosl)it4il and Vanderbilt. Cop-otiat-l/ Care UtLit-ilai-ton Afentorial Hospital, Tultahottia, 7'cn?t., di)-cet cost-$28,800 Sc,(@ liil)tist Ilospitnl Ilrograin. Jfchap-t-y Riii)ct-i.-ollagc Iii,crapy I)rograi)t, direct cos@58,300 'I'kiis I)rojt-(-t is s]@ecifl(,jilly at improving cancer tli(-rapy for it large in- ilig(@lit ih)])Illittoii. ',Nleliiirry will use Its ftiii(I.,4 t.() obtain it (-Ol).-tlt, Cio Iligii liiiergy for l@ii(,rgil)y and i computer, liook--iij) with Vanderbilt. These facilities will iklso li(@ used to Improve undergraduate and graduate radiology training programs at Nleli.@irry. 23, Ilrojrct to I)aticitt care iit a rc)itote t)intintain coinntunitli bit rccrilit- itig aii(l ti-aiiii)ig lic(iltli, aides for a netv extc@iide(i care facilitli-Scolt Coitnty lftox))ita[-Oiici(la, 7'c)tn., direct coRt@10,300 l[iiiil)oNN-ei- ;Iiortiig(@ In this isolate(] iiioiijitiiii hospital Is critical. Personnel to an care facility now under construction will be ol)taiiie(I by two (1) Iii-,gervlcc training for hospital 1)(@rsolinel; (2) an (-dileational tlir(-(-tor (an IZN) to serve as a liaisoit to tli(@ high schools to (!tieollrage young people to enter the medical field all(] come, back home to practice. In addition a training program leading to the LPN would be initiated. Clinical training will be supervised by the Educational Director while local high schools provide basic training. 24. ll'caZt7b cvaluatioi@ stttdic8 on a defined population grou@mtiltipha8iC 80reen- iitg-)Icharry Afcflical College, direct C08t-$436,000 Ifeliarry will determine the effectiveiie&,; of a comprehensive health progrim and iiiultil)liasic screening examinations in early (liagno.4is of heart disease, call- c(@r, stroke and their To run this exl-wriiiierit, a neighborhood medical supported by OEO will ,4erve @t selected I)ol)iilition of 18,000. The test and a control 1)o])tiliitioii will be (,valitiit(@(I with ref(@rexice to morbid- Ity, (-Iiiiiiges !it ]i(@altli attitudes and iitiliziit@loii I)jitterii,,4, effectiveness of the ,4cre(@niiig procedure and tit(', cost per patient diagnosed or treated. 25. I,,'xl)ct,ii)ic@it to te8t ati(I intplctit(,,itt a t)zodcl of patient care-Vandcrbilt Uiti. activity Ilospital, direct roNt stairs Is @iii ii(@teinl)t to (leflii(N a ii(@w @triiet@itr(@ for patient (,-are. New I)er,;oiiiiel ste%vir(](@ss(,s will be trained to titk(,@ Liver tlit@ iioii-cliiiien] duties. Niii'se,4 @voii](I then I)t, free to spend more little. with the patient itiid 'to keep iij) tli(-Ir After tli4@@ izio)(lel 19 refined tit Vanderbilt, it will be tested ill (paramilitary liosl)ititls-si)(@,iJlcally lliiptist and St. Thomas. 26. A. stirgical ntirse specialist graduate progratit to ititprot)c ntirsing care of patic)Lti letter. h(!art (lisca,,tc, canccr, and, stroke-Vandcrbilt Vnivcr8ity S(@hool of Afe(licin(!, direct (.-o,,tt-$23,f)'OO Vikii(l(-rliilt is (leveli)l)liig it program to train medical surgical niirst, slwciali.,.;tti to iiiil)rov(@ nursing care of heart, (,iiii(!er, iii)(I stroke patieiitm. It will be a inaster's degree program shared by I)Iiy.,;iciniis and clinical (.1 calendar year) plus one year of clinical cxlK-rieii(-e half tit Vanderbilt and half at the community Ito,ypital. Stipends will be provided during the first year only. WAGIIINGTON-ALASKA REGIONAL NFZDXCAL PRGGBAIL With all operational grant award of $1,032,003 oil February 1, 1968, this two- state region began its efforts to bring quality care to the dispersed populations of (his AI)oiit, forty ol)(,rit@ioiial , iii(.,mbers nre currently serving on th(, iii(@iti4iiiig il)oiii, liliysi(,Iiiti,;, six other aill(@(i iiiiii foiii-l(-4,ii lii-jiltli iiii(I g(,ii(@ritl siil)l)ort. I)o,i-soiiiii@l. ti,4@ sitin, is I ]it, iiii4illif-i, ililr(l Is rr(iiii cOlyk. ilitillit.1' llosl@it:ils :kill[ lill@ litst@ lliii-il Is l'i-oiii ot'li(@r li(-jilili an(] iii(@411(-jtl orgiijilzil- tioiis. 'Vli(@ sf.@iff Is %vori- gr,-iiii begin Its ol)(-i-ittioiial program oil M,@ir(!Ii 1, 11)(;8. The (!iirrozit operational staff of I)IIYHI(-IjlllH, oil(! and two s(.,cretji.ri(!s will be expanded to over 20 tli(@ ii(-xt s(@v(@riti iiioiit@iis. Over forty Iii)sl)ltitls are currently In- Ili falls I)rt)gi,iiiii, silitiosl@ jilt of wlil(-Ii jtrt@ Lo 1)4@ part of the @ievel- obtain I.(.glolilll Two-way 'I'V 11(@t.wori@ for (!obtaining (!(Itlcjltloll. Iglev(@ll 110.'41)ltftls are oil the It(-gloiiiii A(Ivls<)i-y Groul), mail all additional two hos- I)ittils @tre,4ervlixg Oil planning f4ubcolilltiitt(!(!.4. OI)eraitiotittl Ilroj(@(!(s 1. 7'tvo-,it,-(tV (!oittkitittticatiotis nctii@orh-., dir(wt cost-$170,519 A two-way communication network will link hospital§ of Western Now York and lilric County, Pennsylvania to the Continuing IDducation Departments 93-453-68-5 60 of iii4, iTiiiN,(,i-.sity of New Y(orl@ @it lttift'itlo :111(l tll(@ ltosw(,]] I'lli-Ic Meinoriil will Serve much R.4 continuing c@(luca- nor) for IVIlysi(-Itlll,4 iiii(I (,)it, ilrofe",Sioll'4, public (!(Iliclltioli, a(]- iiiiiii,,Ir,.ttive (,oiiiiiiiiiii(,.ti,ioii, ct)tistilt:itioii witlk experts, all(] coi)ta(!t,14 among I)IIIIIis. It Nvill lk"isist both the I)Iiysi(-itiri iiii(I (@orniiiiiiiity liosl)iiiil in either Ili(@ i,kii,;tl or (@iiviroiitk)(,iit in I)aviitg at ili4@ir the litte,4t i(lv,,iii(- .4 e iii tli,(@ (iiiigiiosi.,; tiii(I trejititi(.Iit of ii(,:trt str(ilc4,, and llitrticiiiqr will 1)(@ lll)oii iiiv(kln,iiig rtir@il in this progr4iin there- 1),N- iiiilirovitig both ttivir(11(14tc!tic tii(I fklilctioil. ('(ot-oi?(zt-y cat-(@ iii-for)ii.(tti(iii, coot-(Iiii(itot-s, (iii-cct covi--$I,',17,rA4.@ 'I'liis will test a training le(-Iiiiiqiie for I)rovi(Iiii,, qualified nlIrSe.4 who will be r(@tliiire(I to staff (levelol)iiig (,t)roiiLi,y fire units in the lt(,gion. Al)loroxi- iii;ttel.v 80 iitir,,(,s will li(@ froiii ill 1),irts of the Region for a (-Oiiibined @ica(leiiiie and clinical course, It is I)Itii)ied that the iitirs(% receiving this train- iiig will return to both rural and urban hospitals for the purpose of I)rovid- ing a diagnostic and didactic fui)ctioii. NN'Ixile the program will he housed at the iiic,(Iical center, the coiiiii-iuiiity hospitals of this region will be the bene- -ictoi,s of the project. Siii(-e there ire few iiurses tr4iiii(@d to work in coronarY ire particularly in tli(! rural ciiviroiiiii(,rit, ,.itteiition will be paid C, to itttr;t(,titig iiiirses who will return to tll(" collillillilit@y hospital. WISCONSIN REGIONAL All,'I)ICAL PILO(;ITAM IVI,,4t-oiisiii ilrogriiiii began its ol)(@riitiorial activities oil Sel)teiliber 1, .I!)('o7 %vli(@ii it tli(! first lt(!,ioti;il M(@(licitl I:Irogi,attii, to be awarded a OI)CI-fitiollill grant. futiil(@(i with $(@:)10,147, i)ii(@ third of Is for ol@i@riLt.loiiiii ik(@tivitli(@s, the oj)(!riii'loiittl 14tlkfr iiiim- )(-tN 20. AI)4)iit of ill(! Hi@iil'C tire I)IiyHl(!itiiis, atiolli(!r third are failed health I)ersoiiiiel, trial tile lilht one t@lilrd tire Htilil)orLive itikd other type of per- Ajil)roxiiiiitt@ly 20 hospitals tire involved fit the current plias(@ of the 11'ro- 9).:Ilil. 1111(@v(,Il of I'lk(@e hospitals lire (live(.(,Iy involve(] ill tile ol)(@t-iti,iolitil I)].oj(!Ct,4, 14'iv(@ art, relwi,t,selit.(,(l ill the Iti@,ioiijil Atlvlsot-y Gi-oiii) and use, r(@iniiiiiiiig tire ill I)III[ilillig As the j)rogr:kiii (](@v(.@lop4 additional activities (itirli)g the ii(@xt fimv years, it Is iiiit,leiiiittt,d tlijtt iiiiiiiy additional 11041)itzil,,3 will be illvolvt-@(l. -al)l/ cvftlll(ltion, (7,ir(!ct coNt-$11.0,100 @lit(ly 1)),ograat foi- itt(,,rino c(,tncer th(@? iii,,4 pilot ])roject, is 41oqigii(@(i to review ;iii(i ev:iliiai,(@ radiotherapy for Nvit-li it,,., first I)Ii@tse it will involve Iiiforiiiilti()Il (-X- cliaiig(@ tii(I (losiiiietry Standardization. ilosl)ItAtls at Alitrqii(,Lte and the Uiii- ver.sity of Wis(!oiisin will be coiiiiect(@ti to it central, coiiil)itiei-iz(-(] data bink Ili Milwaukee which will coiiil)ittt@ radiation classes. Wll(!li tile )t(-(!(@s.,iry Collitilit@er tr(@ develol)(,(I, IL is I)ro.i(,ct(@(i that the central facility will be linlied to other liospitil4 outside the Alilwa,ul(ce and Madison areas with similar treatment programs, and the long-term result will be to iiiij rove local medic I il)abilities for the treatiiient Of all utiE@rili(,, ciiieer pati(@ii,Ls in the Region. C. 2. A pilot (1cnion8tration program for ptzl?itonary throtitboembolist)t, dircct cost- $811,600 Ili tlii.-; l@roje(@t a center Is l@(@iiig -at ATiirslifle](I Ilosl)it:il in 4 Wis(!oi@,,iii, foi- tli(!viil)y for ])iiiiiioji.,ti-y iiiiolisiii. I)ro,i(@(-t; liit,.4 :i (-oiii,iikiiiiig ('olkil)oll(-'Iit wlii(@ll Nvill illkysi(-Illlis fr(@iii reality !It fit(' Itegioli. will lni@4)lv(, ,t 2.1-liotii, tli(@ I)r(-I)iiriitioik (@f a iiiovlc fi)r grolil@,4 of j@liy4l(-Itiiiq. Nvill a I)rogi-ttiti wlii(-Ii Will ciicoinpas.4 1111(i I't'lllll)illl@llt!Oll for it riii@iii ti-iiii,,41)orl,:vt,loii syst,eiii for 1)itil(@ii(s front Northern of Lll(, Still(" :111(l (!ool,)4,rittioii between the ciiiiic and other liosliltal.4 (ii(st t(riw til)t,(ei-y ratio tli(@ fit,t!(ts of hc(rt,t dis(,,a$C, Can- e(:I', 4t?'Ol,'@C, Utt(l. rCI(ft(!(t COM 1, -,V 1 8,.') r) stii(ly N@,111 j)(@ (-iirrit@(I t@iit by tli(,. ITitIV(@r.,;ity of ll'i,,,consili ivlii(-Ii will final store ,4]iort, ]-(I affiliate, oil Vill-ioti.S of fulfilling l@iitit,jits with tli(@ Any 1)hvslcirtn niiywii('rt, Ill the 61 Itegioli Call (Iiii the lil,,rary it any time tin(I re(ju(,,,t n ttpe relevant to a problem iiL wlii(-Ii lie;,s II. Nllii-siiig telephotic (ii(tl late ?'CCO?-(Iit?tl libl'(Ii'll it& t7tc lica)-t stroic(,,, (zgt(i 1-claic(i cost-.-$18,800 stii4ly, sii)iil.,ir to t@li(! oti(@ N%'Ill (@still)ii"li it little N@,itli iiiforiii:iti4tri r(,col..(Ii@41 oil new ])I-o- ,Iiid ('(Illll)lki4@lit, ;Ill(l in )Aiir.@iiig. Niii-s@, front any !it fli(@ r(@gioit will I)e 411)14, to (.:Ill :tl Italy tilil(,' to Iiii.ve a tAll@c@ I)IIIY('(i to til(@iii. tof iii(,-(Iical (tiad lic(ilili, siiitll(@ coitcept fllt)t pi'( /it )!It a ?it lio.,fl)itals, direct cost-$";;;,@)50 ("(Itleatioii f(!iisil)ilitv 1)roj(!(-t iiivolv4,,.,, t(,i'i coiiiiiiiiiiitly !it its fillll.'; Oil iiii(I strol@e, N%,Ill be (](,velol)(-(I. 4111(l (,I](, ailing will I)e 4(iiyicl at their ciiii- ill tile 110!41)itfils for use by hysterias )ii(i (it@li(@r li(@:ilt,h per. ) a,, ,t continuing education (I(@vice. After four -to ,4ix months the ina- t(@ri.,tls will I)(,, reloc,@ite(I in te)i.,i(l(litioilill liosr)it@ils. VISION, ITAI)IO ANi) Ti,.i,rpjioxi@, FOI@ (@ONTINUIQG li',DUCATI0,N TFLF OI'EJtA'1'10,XAI, l'ICO.IIIC'I'S 1. Albiiiy Regional -iN[edical Program 7'ico-i(I-ay )radio co))i@nitin,icatio)b systcii&-Dii-cct cost, $lJ,//,IOO This project will expand an existing -two -way rti(lio network to Include 57 hospitals and 24 highwl'Ools. It will r@rovi(le constraining education for physicians .iii(I Filled ii-ie(lic@,il personnel. It will also proi,i(le, iz)foriiiittlon and education l@rogr,iiiis for a(Iiiiiiii,,t@r.,ttors, of of II-listees, voluntary health [agencies, 'I(Illlt education :tn(i Reelected civic groups. 11. litt(!rzjiotiti@taill Regional M(@(lic,,il Ilrogrttm edite(ttiott ill h(,,(it-t ca?tcct,, 811-oke, a)t(l latc(l disco,@s-Dii,cet cost, $243,000 01) -.Liv(@,4 of this 1)roriiiii iir(@ t@o it (@olillillilliclt(:Iorlq ll(,.tw oric ii",titilli(oiii to 4)ii(!oiir@ig(@ Ilitisoll between (Existing l@wo-wi).y radio t4yqit-m, C 1108))Itiils in 7(!oiiiiiliiiiitl(.,,4 in or ii(@.ir 4jtlt It@y ])its I)een to 10 additional 'I'lik '4.1,81eill will I)t@ (@xl>llli4l(,(l l@(o additional liosi)ltlils Ill to v nine Its(. ill, ]@Vlill) or 17.1@11.11 c(Iii(!tiil@loti TV) Is also q H 11 focus of continuing I)Iixiiii4@41. This iiiity (establish tile colillilillill@y 110. I)IIIII 11 t lt(@gloilitl Ale(li(-itl Program Ifealti@ icicnccs all,(l t coit, $77,900 Tlii,4 project Is engaged In con(Iii(!till,@ st I (li(@ l@o d(q(,riiiiii(- the f(!iigibility of communication litil(figes Vital to c(lil(-Iltloil, service and research -til(li(@s to ))(@ I I)i,(ogr4iiii.q. Specific are a physician (,,oinniuiilcatioTi sys- t(@iii, Illv t,(!acltillg, clectrt)iii(! linl@.ig(@, (@al),t(!Ity. T,Inkage,,4 will -bar- and l@angas city. be cqtal)li,@;hcd at hospitals in Gr(@fit Ileiid, l'itt,, IV. Wit@,4]iington-Alill.;]34 -------------- 434,156 -------------- Do. rounding counties. Woreo-Viyoming-States of Colorado and Wyoming ------- do --------------------- 339,605 -------------- 488,359 .............. Initial operational grant request anticipated in fiscal year 1969. ---------- 41 932 Initial operations Connect!cLt-State of Connecticut ------- July 1, 1966 -------------- 338, 513 -------------- ------------ I grant request unde@ review. Flofida-State of Florida --------------- 240, CCO -------- '@ ODO ---------- I n - r ------------ Nov. 1, 1967 -------------- ------ 24 itial operational grant equest anticipated in fiscal Year 1969. Georgia-State of Georgia ---------------------- Jan. 1 1967 -------------- 341,824 -------------- 694 427 ---- --------- I ni'tial Operational grant re4uest under re@@m. Greater DelwareValley-Philadelphia-Camden Apr. I" ----------- 1,534,494 -------------- 1, 534:494 -------------- Initial o bonal grant request anticipated in fiscal ;era. 1967 --- 69 metropolitan area and adjacent areas of eastern year Pennsyl,@ania, southern fie@v Jersey, and State of Delaware. Hawai@State of Hawaii ---------------------------- July 1, 1966 -------------- 194 771 -------------- 212,781 --- ---------- Do. Illinois-State of Illinois ------------------------------- do---- ---------------- 336:366 Indiana-Stale of Indiana. 496 013 ---- 33: 366 ------------ - Do. ------------------------- June 1,1967 --.. - 706 889 -------------- Do. Intermountain-Utah and portions of Colorado, Idaho, July 1, 1966 Apr-.' 363:524 2, 038, 123 608,615 2, 038, 123 Montana, Nevada, and Wyoming. low2-State of Iowa ---------- -------------------- Dec. 1 1966 -------------- 290, 591 -------------- 552,939 ------------ Initial operational grant request uider reiiew. Kansas-State of Kansas --------------------------- July 1: 1966 June 1, 1967 281, 627 699, 852 371-,240 699,852 Louisiana-State of Louisiana ----------------------- Jan. 1, 1967 -------------- 454,445 -------------- 710,290 ............... Initial operational grant request anticipated in fiswi Year 1969. Maine-State of flaine ---------------------- May 1 1967 ------------- 193,909 -------------- 193,909 -------------- Inftial operational &rant request under review. -State of rlary land ------------- -- ----- Jan. 1 1967 ------------- Maryland 770,230 -------------- 967,459 -------------- nitial operational grant request anticipated in fi=i year 1969. See footnotes at end of table. STATUS OF REGIONAL MEDICAL PROGRAMS (AS OF MAR. 30, 1968)-4onUiued Begj,,i,,iir.g date Funding Regional medical program Currently available Cumulative awards Operational status Planning Operational Planning Operational Planning Operational Meml)his-Western Tennessee, northern @issizs',pi AV,. 1,19-7 -------------- $173,119 -------------- $173,119 -------------- Initial operational grant request under and portions of Arkansas, Keitucky, aid t,',issuri 1,1968 527,089 $418,318 651,171 $418,318 co Metropolitan Washington, D.C.-District of Jai. 1, 1957 Apr. and surroupdiigsuburbancounues in @',.3ryl3,,d and Virginia. Michigan-St3te Of Michigan ------------------------- June 1,1@067 -------------- 1,294 449 --------- 1, 294, 449 -------------- Do. Missi;sippi--S,ale of Mississippi ------------- J;-- I! 1, !z',57 ------- 322:845 -------------- 322. 945 -------------- Do. V,issour; state of flissouri excluding me'ro@,L , an do :-ii ------ ------- pr. 1, 1967 324, 254 2,887,903 635,967 2, 987, SG3 St. Louis. f?ountain States-States of Idaho, Ni-,ntara, v. 1, 1956 '@,ar. 1, 1968 1, 082, 107 206,913 1, 747,370 206,913 and Wyoming. Nebraska-S,)uth 03kOta-States of rlebras@.a and Jai. 1, l@7 -------------- 349,367 -------------- 597,609 -------------- Do. South Dakota. New Jersey-State of tiew Jersey ------------------- J.@ly 1. I @,7 -------------- 2'7y. 466 -------------- 297,466 -------------- Do. New NlexicD-Sta,e of ,,lexica ------------------ co CI, i@ - ----------- 55 270 -------------- W3, 866 ------------- Initial operational grant request under revis@y. 'a- - rk City, tias-2u, J-j-e 1, .1%7 New York metropolis @i area Crew Y. --------- 967,010 -------------- 967 010 -------- Initial opertional grant fE@Ue$t 3.itiCip3tOd in @.sal Suffolk, aid Westchester Counties. year 1969. North Carolina-State of r@ort.i Carolina -------------- Jj ty 1, 1966 hl3r. 1, 1968 773, 674 1, 652,164 -1, OnO, 374 1,652 164 North Dakota-S' ale of tiorth Dako@ --------- J,@iy 1. ' 937 -------------- 188 010 -------------- 188@ 010 ---------- --- Do. Northeastern Ohio-Cle,@eland and surrourdi-n-g--i@-- I an. 1, l@@59 -------------- 285: 783 -------------- 385,783 -------------- Do. counties@ Norther w 723,920 -------------- $93,695 -------------- Do. @e EnR!and-St-@te of Verrroit and 3Ju!y 1, 135.5 -------------- je in north@aster.,i r@ew York. coun Northlands-State of Minnesota --------------------- Jz.,L 1, 1 %7 -------------- 629, 887 .............. 1, 000,791 -------------- Do. tiorth@,,e@'eri O@io-20 counties in n@hviestern Ohio, Jan. 1, 1968 -------------- 309,180 -------------- 309,180 -------------- Do@ urta.,Ed a.-cund Toledo. 0.@;,j St-,Ie-Certf2i and s:uthern 3i of Ohio (61 Apr. 1, 1967 -------------- 136, 771 -------------- 136, 771 -------------- Do. t,,UIties) c-2.ite,,ed around Columbus, excluding r,-Et.@opolitan area. Va@lay-Gre3@er Dayto,,i-Cinci,.irati, Ohio, areas Jan. 1, 1967 -------------- 346, 797 -------------- 472,096 -------------- Do. and couit;ei and part of Kentucky. O@,la@om@Sta',e of Okleorra ---------------------- Sept 1, 1966 -------------- 282,100 ---- --------- 330.318 ----------- Do. 53'760 -------------- Award of initial operational grant pend, Crego.--State of Oregon --------------------------- Apr. 11 1967 -------- - 231, 125 -------------- 3 , l' Z. Pi:ert-) R;@ommon@o;ealt@'i of Puer,o Rico ---------- ---------------------------------------------------------------------- Initial onrational grant request anticipated in fiscal year IF9. RDc@ster-Roc@es,er, ti.Y., and 11 surrounding Oct 1, l9S6 ?,Iar. 1, 1968 318, 286 255, 487 500,425 255,487 counties. So-,t@', Carc,!ina-State of South Carolina -------------- Jan. I 1 967 -------------- 379, 246 -------------- 502,773 ------------- Initial operational grant request under review. Va!@y-2. counties, centered around lure 1, 1967 -------------- 263, 530 ----------------------------------------- nft;al o,-eaftoral grant request anticipated in fi@i Harri@lurg-He,-@,ey ir,. ce@tral Pennsylvania. y@ar 1969. Tet,.@ee-,.!'d-So,-th-East-2rn and certral Tennessee ard counties of southern Keituc.Ky and scrther;l At @ari3 ------------------------------- July 1, 1966 Feb. I, 1968 523,738 1,63D 304 673 421 1,630,304 Tex3s-S'@ta'acf Texas ---------------------------------- do --------------------- 1, 260, 181 -- --------- 67: 194 ---------------- Initial operational grant request uider revie Tfi-St@-to-States of Massachusetts, there Hanpshire, and Rhc,,e Island -------------------------------- Dec. 1, 1967 -------------- 439,037 -------------- 439,037 -------------- Initial operational grant request anticipated in fiscal year 1969. Vfrgi,,ii3-S!ste of VirZiri3 -------------------------- Jan. 1, 1967 -------------- 254,000 -------------- 545.454 -------------- Do. co Washii,.gt,,-,-A!aska-Stales of Viashirgton and Alaska- Sept 1, 1966 Feb. 1. 1968 655,148 1,032,003 937@ 948 1,032,003 West Virgii@a-Stat,3 of 'Nest Vir i-ni'a ---------------- Jan. 1, 1967 ---------- 208,910 -------------- 282@ 663 -------------- Do. 9 -West-2r,-i ?lev York-Bu.@la arid 7 surrounding r4e-ei Dec. 1,1966 Plar. l,i§ii' 2&3" 717 357,761 313" 033 357,761 York c3-,@ities and Erie, Pa. West-2ri @n.,sy;@nia-Pittsburgh, Pa., and 28 sur- Jan. 1, 1967 -------------- 34D, 556 -------------- 340, 556 -------------- Do. toindl,.g c3:jr.-ties. Wixonsin-State of Wiscorsin ---------------------- Sept. 1, 1966 SepL 1, 1967 -------------- 2 630,149 344,418 630, 149 I Initial planning grant application has been received and is under review. 2 Combi;ied planning and operational grant; includes some $340,OVj for planning, 70 ILLUSTRATIVE EXAAIPI,F:S OF (,'LT)tltFNT 8'r,@'I'tfS to 'tells list@ill@ of gi-iiiit 1)r(j.i(@(!t(,d iiiiti,@i.tion of olit@l,ii1ioli.,tl licti%@iii(@s I)Y tli(,' :,)[ (II, II(.tivitil.,4 (!Ilrl to illti@ti-:Ito ,4t;iills of ill tll(t ]t(@gioilill 1:11.f)gl.tlltl ')Il(i to ll(.Iki(!I'ijig 801114@ of tll(! l])IIJ(or of t'll(,. iiiitlt,i- it. Ill.(. i(o 1)(, of, :Iiiil to tii(@ evollifloll of 11 sysli-iii ('stillolisli(@,4 iiii(I '41ri'ligl@114'114, Olk ;I I'lltl(!I.iollill ilitiolig 1,11(@ ]:INV tillit; oilly I Lll(@ ll(.1.01111)liq i,itt@ 114,@iltli illii(,IltS of ()I. give I)I-Olllisf) or I)t.ilig (.rf(!fl.ljv(@ ill iiifill(@1)(@-ijig I.Iie (iiiiililv of li(-iiltli (-are iiii(ler l@114@ follo%@-iiig Ari-iijig(-iiit!iits; 2) lt(!Iatioiislill) of and 'I'r;tiiiiiig; 4) 1)('Ill()]I.'itrittioris of llliti(,Ilt @4ii(I Llrojects. Ilrogriii)s itr(! I)itse(l iil)oii v(pliiiii:ii-y (,ool)erat@ive arr;tiige- til(i it(t@ilill in (,-ool)er,,tlivc ar- r.,i? I the tl'l)C of 1-4!gioll4tli/,Iltioll %%-itli this I)rograiii is The NA7ord "r(@gloiiilizttioji" ill Llie content of lt(@gioiitil Aledi(-al Ilro- I)o gr,iiiis does not. refer to the dei,clof)iiient of i rigid plan Nvliicli has I)f-eii iin -sell froi)i :i))oA,e. it stresses the I)t-o(@cs8 whereby locil resources are joiiie(I together to identify needs ikii(I ol)portiiilitit!s, t@o resources, to defiiie ol)jec- tives, to ,zet priorities, and tli(@ii finally to iiiir)leinciit t program and to est@ablish methods of @c@lf-evlluitioii. Here ti-e soine exiiiiples of how stich tirr;iiige- iii(,Iits ciii be c-,pecte(I to iffect 1):tti(@nt service.,; directly. Foiir hospitals in I,,,ifayette, Louisiana, are pooliiig resources in cooperation with the Stite I-leitrt Associ@itioii and one of the in(@(lictil schools, to improve the care Of PLtielItS With niyocartlial iiifiretioii in flat area of the Region through the @-t-ibli,,Iitiieiit: of it corollary care deiiioilstz-.,tt,ion find tritiliillg iiiiit. The local d(.ei.,4!on NN,;Is to oil a iii;,,Ii (Iiiiilit:y corozitiry care Unit ill a single liosi)it:tl. 'I'Ikeso Vftrle(I joined with I-lie I)iil)lic to raise fililil'4, and II-iiiii find 1'411111) (.fit) trial.. Aitlioiigli I'lie liiv(@sf;- lti-gii@ilill i@!I(@(li(@,11111-(@gi-iiiii 10.@, 1114-, 111-4@gi,@illi ]lot; 4)fily bill; 11184) IlitS 14(!rV(@41 14.4 it illo(l(@l or (-oiiiiiiiiiiif@y (tf Aii4-liot-iig(@, AI)i.-41(ii, III lo t.li(! 1(1(@iiiiil(,41 by title lt(@gio)llltl Ill,ogi,iiiii l'ol- it lilgli 4.11(@i-gy radiation thank NV:I,,ilililgl.oll, Is llo%V (,ipii(iii(-Iliig it fiiii(i riii,,ii)g (,iitik. I)jiigii. S4)li(,It(@fl I)rivile ftiii(I.,q will 1)(@ to lii)tisitig for like iiii@iit, will be 1)iir(-Iiitsi,41 by I:li(,, It(-gii)iiiil Ili@ogriiiii. TJk(@ tlr(@tltjii(!iit NN-ill 1)(i .1'4 it I.(.gil)]):Il l@y 1,11(@ lfo"41)11111, it.,] itil(i 111)1)1,ovecl by iiii4l I-t,gii)lilll naively gi-olll)4. (14@ei.,4ioll to tells it(-I.ivil..v Iiiv(ylv(!.4 iiil-i-iiiig(@iii4,iii:8 itt@ ittiol.li(-r f(ii- tli4,, N:it,ioii:il Itistlitlitt(! (II(! visit wheat gitv(i it,,,-silr- Illit-e (of t'll(@ @)IIII(I iii)(I i)l' (his I)i-oj(,,t-t. Aii(!Iioriige l@iiii(iii@g @iii(I soiiie 14 ijikloiis li@ive titl@(,ii oil tl)e coiistrii(@tioti of ill(! I)iiii(iiiig as it project, thus contributing iiiore t@li:iii oi)i half the tot,:tl cost froin i:lii.,4 early ,,oiirce. Out,, of the mo.,4t lll(!alliligfiil issoei@itiolis Sponsored by no,-ioiitl Ale(lical Pro- gr,,tiiis is between Vanderbilt TJiiiversity School and Moliarrv Medical (college oil the 4)iie iii(i the Neiglil)orliootl Health C(@iit(@r supported by the Ofrice of E(,onoiiiic 01@IK)rl:iiiiity, 10@LI(@(I lielli- @%leli@irry oil -t@110 otli(@r. Coil,,4ultllrlts -bill, -ulty (of Aleh,,irry and the stiff of the froiii V.911(1(@i are working with the fa( Center to provide coiiij@reliensive health (@.ir(@ for iiiil)overiglic(i (!oitiiiiu- fotit)erly without ,i(leqtiiite care. III iklaiiy other Rc,7!ojts similar collitbo- rittiolis 1)(@tw(,ell iristitiit@ions of varying iiiitttirity and streiigth have resulted in ft(-Iiiei,c@iii(@iits lt(@r(,@tofore (litricult, if not impossible. 2. Tire ]@cl(itioit8liip of Sci(4nee to Sc?'vice Tli(, complex I)rol)leiu of retailing -the nior(@ sophisticated and advanced ac- tivilies available ill only a few institutions within it Region to the broader n'cc& of 1)1'01)le of, the Region Is it gigiiificaiit mandate for tlio programs. Tlils task is being carried out In it variety of ways. 79 71 colill)llte Nliqsoiiri tiia tile facilities of tile 171)iversity of Nvorl< of Ili(! llitblii,, Ile.,illli Niiii(iii,,ii Center for (',Iiroiiie J)is- (,olltl.ol, being by lo(-III 11) i(@,,t file (,fft!ci; of tll(', gt,@iiiis oil I lii.@ (@:tr(- of ](4-gioll has itii oiit.,4(iiiiiiiiig gi-oill) iliv(",Iig@itill, al)l)li4@;ili(iii 10 ('Iiliif'lll I)IIY- (.'Ity t@o four O)tll(!r liosl)il:tls in I lead lt(@gioii, l,iii-oiigii of r(@i)iote 4@ of C('Jlill)lltl.l. :Illo%villg it ill this c@IS(-, as ill ability tile (ii,v(@loi@iii(,iitnl w(@rlc w@i..; siij). I)oi,[(,(] l@y fill, National lf(!Ilrt nictitate., wlii(.ll ]low 1.4 jointly fill)(lilig %%,Itli Itc- -4ii,ioji "I(! gi(iii:tl Ilrogriiiiis Llit! itloi)lj(l 111140 Ill lll.4tit,iltiotlli other thin -ilt,4 -oill Hall r(,se. -II Wis(-oii.,4iii li:iH II (](Bull I - f] Avis(@olisill Itegioliiil 1'rogriiiii is stii)lii)rtiiig fi unit, :kt the 'Iiiiic for the cl(!iiionsirition of tile best for diagnosis find iioii-.@iii-giefLi iiiati.igenit@iit of patients with I)tiliiionary ciiil)olisiii. Tlit, I%l@ir(,Iiiiel(l esliii)iisli(@(I referral routes froiii five I)osl)itals in the Region for emergency car(! -pected of having pulmonary enil)oliszii. 'Pile effect of tills unit of patients sus already been nia(l'e apparent by the increased demand froin I)Iiysiciiii.,; throiizli- out the Region for educational services there. The unit already has trea@e(i -a distinct iiiore than 30 patients, with results I)et@ter than the national average improvement in patient care. Iteseirch institutions are anxious that nip(licil fnacti(!e I)eneflt froiii research efforts. l@or several years, tITe I%Iet)ioriiLl Sloan-Kettering Cancer Center has ex- toned Its consultation and reaching progriiiii.4 out I:o the practicing community in six hospital,;. Now, through the New Yoric M(-tror)olitaii Regioli,,Il %re(lical Pro,-rani it is able to expand it,4 coverage to surrounding areas, find Is planning to 28 n(l(lition@il lio.,4pitiils ;o that tile linoNN,le(ige and lateral of the '.Nfeiiio- riil Sloiii-Kcteriiig Cancer Center call Ile made available to practitioners tliroiig)i- out the area. In funny siniiiar projects, Regional serves as n vehicle for i.rili,411lis,,41011 of tll(, i4) II k(@ I. II(Iii(i(itioit, o)tfl Pi-ai)tittg a.ii(I Triiiiiiiig have been Irii(litit)ij,,il of liiil)i-ovliig (Itl:illtv 'I'lie t,.iiil)liasi.,4 Ili Regional Ili-ogi-iiiii,; lin,4 t-o (Iiieiii@ioii ,iiid training, not as ,;(,Tytrate, i,,,oliii(@(I ill tei-iii..4 of r(,(,ogiiiyi,(l for the. lii)proveiiieiit of 1)ittl(@nt care service. 8 find as all !II- i)ftrt of otli'er,,ictiviti(-s. Al) (@Nitlill)le of tile (IOVClol)lll(@ll.t. of tili.'4 IVl)(' of training limit]. (.(lllenfloll@ll pro- gi,:iiii RI-0'4(@ ill ill(' Itegioti, wli(@i,(, 21) lio,,41@itiils w(,i-t, I)ri@l)lf@iii of (,.stnl)li.@iing corollary care iiiiitt. 'I'Iii-oiigli i-.Ii(-Ir Regional Ilrogrtim, fli(@y li,,iv(@ been able to focii,4 iii,4te,,i(I oil tlt(- l@i,ol)]4iiis of giving tile ,iii(I tretttt)iez)t to fill lpiii@i(,,Iifs with illfill'(ttioll ill tllt- Jt4@gioii. A re(-(-iitly awarded operatif)ijal grant; will siii)lyort. Training aiiil coii- aiitl nitr@(@s to .4taff flags failures I)rogrfitns for pliysi(,!,,iii.4 of evaliintion technique,, and establishment of a congilintiorl resource in a community hospital. Tll(,. C.,iliforiiit Ttegiozi plans to aiitieii),,itt, tli(@ needs for education find training in i ii(,iv e(@iiiniiiiiit..v li,(.@ital tA) @1)(, conil)l(,I@t@(I wit.Iiiii th(@ next lJi@rL,(, year.,; in t-lie W,,itt.,4 area of l,os Angeles. A Po,;t-Grq(lii,,tte Nvill be reeriiit-NI now nn(i ,;Iw)ii.,zored jointly by the Charles Drew Society, the University of Call- fo)-iiiq in T,().Q Angel(-,, ind the ljniverqity of Sotifli(@rii On(,(@ built, the lio.'41@itl] will support the facility, but Regional Medical Program funds are being for int(-rini assistance. Niiiii(@rous progi-ni)is ii-e ,;eeking to provi(l(, expert con,'4iiltal@ion oil reoiieqt. Tlit,.-c Include mnking con@-iiltntlon avallqi)l(, by telephone or two-way radio on it 24-tioiir I)asli;, a dial access teleplit)n(,-nil(lio tape F4y8t(@in In WL,4consiii, ind a ni(-(]I(-al juk(,Iyox la Albany 'watch will show a variety of ,41iigle concept films oil domfind. 7F7l 72 4. Dettio)?,vt;-atio)is of llaticitt Care 1)(,iiioii,,Iritioii4 of l@ittif,iit, are ]Proving to I)+@ in serving the goals of the I)rogrtiii, and have it iii.,tjor i@xlpr(@,41oil of cooperative itrrang(@ments for the I)ett(-Iriiieiii. of it 1)@i@rtictilitr situation. R(,@-oikre@ in for t@lie iii.,iii:ig(@iiieitt of sti-oli:c patients ire limited. I;otir intensive cire t)e(is for the of latest advttlic", and modern potential of qtroko care have been e,,;t@tblished tinder Regional M@cal Programs. The tisii@il hospital cost,,; are being siil)l)or@l from other sources but with this newly ftinded demonstration uiiit, J)hysiciins. nurs(-,s, and all allied health pro- f@sioiials have access to excellent tra@iiiing. The resitlt of such training and "on line" experience is already leading to improved care for 4troke patients. fit lowi, a different demonstration pattern is being used. Through the Iowa Regioiiit Al@icil Ilrogra,ni, a .,troke tf-,qtin with pliy%iciaiis iLnd allied health I,-. Ivziil.,il)14LI for ozi@site coii,@ititatioii. This unit, taken to the patient, I)roviol(-,4 c-diietktion for those responsible fol- (.4)lltillllill" In 1,4iiiiijiville, an ciitiie (4(@iiiiiiiiiii(,y liii,4 1)(.")qne a "d(@iiioiist:j@iii,ioii I)i-oj(4!t" IVit-ii trials funding of t i)i@(-ili@d T('1111I)iiII41tioli unit III Halt town of NN'lill-li it of r)O,O(X), t;lif@ imagination of 11)(@ (.ojlllllllllit@y W.1.4 liy fine Itegiojiitl AI(4lical t-lic t@i)wii leaders ,;oiiglit Intel it "(I(,inon@trittloii siil)-rf-gioii" for 111(@ 'PILir4, ovt@r a dozen r(@gi<)iiiil proje(.,ts are now I)eiiig Sliiit:liviil(,. iiiaiiy (,x:irn-l)li,& of iiyiit,.4 (i(@iiit)iistral.ilig care of -I)a@ti(,nts with -a(-Iite niyo(.,.itr(iiitl iiifaretioii. 'I'lie iinitt4 tire vitri(,(I. @ottic are in -4iti@ill and some III ljtrg(@ hospitals. @(ollic ji(iiiit cIT4)rl,,; I)i@twe(!ii "Mtdicsil Ceiit(@r',9" and outlying 11(i@I)it:ils. Soill(@ by joliy.,4iciiiii,4 while are adminl,4tc-r(,41 lay Tli(,@i@ iiio(l(!I@s r(@ogiiizi-- the r(@.ilitios of manpower shortages, and of the sigiiijicitzit difTer(@tic(@ in tlic, locales where patients are treated. 5. li,'j@pct-iinental Projects R(!;,ioll:ll 111-ogi-aiiis are oIT(@riiig an (-Excellent (opportunity i@(pi- tli(, tl,-,e of illfOl-111,Lt,iO]l out of re,%ettreli into better in(,@thods for making -.available the adviiie(-s of in(@dical science. iNorth Caroliiit is piyii)g considerable attention to the special problein.,4 of an in the part of the statle known as the "State of Franklin." For e seven hospitals in as many different communities are testing the fea- x sjl)ility of a common Board of Trustees and a coordinated program to the extent thit they will request aceretlitation as one hospital by the Joint Oommission on Accreditation of Hospitals. Separately these hospitals, pligiied with manpower and facility shortages, face not only an uncertain future, but the knowledge that they will have increasing difficulty in iii:iiiit@iiiiiiig quality patient care. As a result of tli(, Regional Medical Program, these hospitals are now testing the concept of a iiiii(lue regional hospititl organization which will make possible the iiiil)l(@iiieiitRtioxi of improved care in beirt disease, cancer, and stroke. 'I'lie University of Miclilgaii School of It,iigiziecriiig Is cooperating with the Iikt(!rziioiiiitaiii Regional Medical Program in a mysteins and operations study of coronary care. Ilere we see recognition of the area,(] for the health syt4teiii to In- t@ixe (@rrectiveii(@sg ,,,a of car(,, iito(ltliti(@s. In this crit when iiii- noun attention is dir(,-te(I to rising medical care costs, many resources and tyl)c@4 of exl)(@rtise will be needed to minimize needless expense. Vermont is in- volve(I in It iii4Oiile(l cost iiiitilyqi,4 of several health :Ictivities being lni- ti4it(,il. 'I'lic data collected should provide not only Clio Vermont Itegioniil Mc(liciti Ilrogriiiii, but the health Industry In general with informittion upon which deel- sioiis can be made on substantive rather than intuitive bases. Mr. P-.OGEIZS. Is thero,,tny particular emphasis given in the regional rograms to the core city T-)rol)lcin? p l@r. MARS'LON. Yes, sir. '.rfi more slowly in the very large, complex Ur for the same reason soi-ne other programs But there are some Itcy ex In the Califoi Watts group is working on a DrogTam with UCLA, tb of the-Nat7lonal Medial Association, and USC. 7:1 slivill(@ is Stll),)ortiiig a I)ro- ive voli a of those. voiild g Nvitll 0 )I-,Iv(l it list" (:)f t,lies(", :tll(l @llftt lioipitttls in these :11,(, lllv()Iv(.Cl itil(I (]IC J)el'.Iollllcl illvolv("d. i'ii w,,ts received by the committee:) (Tlio folloiviii(v iilforiyiat o I)FPILR'I'Nil,,NT OF I;,[)UCA'I'[O.N, ANI) Wrl,]-'Altil TATIIMI?NT OI-I ItEGIOPfAL Dilti s,r Tllb IlrALTIL OF TIIN NILIDICAL l'ItOGItA,%f 14;FFOICTS ',(7rl;j) AGAIN I-JNEit CITY III Auguit I()67, the Nitionil Advisory (,ouji(@il oil It ')nal Programs egl( is,@tic(i a st,,iteinent which gave consid(@rnt,ioii to i,h(@ h(!tilth I)robleins of metro- -Ls and their ilin(@r cities. While r(-cogikizizig the cotiil)l(,,xities of the I)olit.in ar(,@ lirl).iii eiivironiiiejit, the Coiiiicil stressed the i-(!SI)Ollsil)ility of Itegionil llr(o,L,nkiiis C4) t@o the sf)ltitioii of ll(,4tlllli prol)lejns there. In fiti(lition, it ttiit all il)l)rol)riittlc gi-otil) or i)ittioziitl ))c iiiiine(i and ciill(@ft t@og(@tli(!r to (!t)tx.,;ider how the iitt4.,Ilt,ioll of Itegioiial M(,@(li(-Iil Ilrogritins coill(I I)CST, 1)(! focils(@d oil 1,114! i.,Stlf,. Ill to tli(@ stilt(!Illellt al)(I to tli(,. Siii-g(,oii meinorin(Iiini of Of,.,tol)er i) 11)07 "lizil)roviiig tii(@ lle:iltli St:tt.iis of iii(@ I,Irl)iiii Iloor," it iiii,t!l@izig I(l it Novt-iiii)er 16, 1.)(;7 to the lorol)l(@iii Aiiiozig I)er,,ojis il)vit(@(I to :it.teii(I Nv(,re lio.,41oitiil ltl%IP coordinators froiii xirl),tii aij-(t:ts, li(,:iltli @vitli re,,pon4il)ilitly for t@lie lir vi,.,i(iii t)l' care to the ilrl)ttii poor. The front Ol,,(), ine(lic,,il 9(!Iiool oiliciiiis iii(I iie(@(i for :i(!tioii lo re(Iti(!e tli(@ )i(@alt,li stiitii.4 ditT4@i-(,Yiti@il Nviii(-Ii ]low ill(, for ill tile iiietlio4l..4 of (I(-Iiv(@riiig li(@:tltli (-fire, fill(] the ii(@'(1 for (.ool.(Iiiiiitiiig tit(, tctiviti(@ of diverse groill)s N%.Iii(,Ii I)r4)vi(Ic lie:tll@ii care s(!i-vi(,e4 in t,ii(@ iiiiier city as Well its HI)e(!illc I)roj(@ets wlii(!Ii iiiiglit lie Al, t,iii! local lev(!I, Ilegioiiiil M(@4]icitl Ilrogriiiiis wlii(!It include in,.ijor iiietro- I)olit;ili li@iv(@ (I(-v(@lol)(,(l viri(,d to solving these lirol)l(@iiis. These (!fforts iii(@Iii(it@ cool)(,ritiv(@ arri.iigeiiieiit-s I)otwe(.,n liosl)itils, health (Iel)itrtiiieiit.,3, seliool,4, voluntary agel)ci(@.,; .11)(I I)ract@icing physicians to iiie(@t the health needs of the poor. Exiinples of these itl)proit(@lies flow under develol)inciit or in ol)er@illion can he suiniii,,trized as follows: California Re,,ioiiil Medical Ilrogr-.1iii his @-til)lislied a siii@)re.@loii covering the W-,Itts-Willowl)rool@ irea of l,os Angeles which will facilitate the develop- iytejit of activities :iiined it IUCOtiDg tile 11(le(114 Of ill(-. people tli(@rc@. Through i.ii(, Itegioiial Ilrogritin, the Uiiiv(-i-,,ity of Southern California @@cliool of 'NIC(licill(, .111(l tile IJ(,T,A S(-Iiool of fire cooperating )vit.ii the local CliLrl(,s It, I)r(@w Me(li(!iil '4o(!iet..v (fill annually of the National Ate(liciii A.4socia- l,ioii) tit (@.,4ttl)lisliitig a postgraduates S(@llool fit tile @otitliellit C,(@iieriil lf(psl)it:il now uil4l(ir ill Witi,(.s. rlli,4 S(!IIOOI will provide bii(!Ic-iip services to tlk(@ Of@,O ii(@iglil)oi-lioo(I li(-iiltli tit the tir(@it, (lev(,Iol) training I)rogr4iiiis for allied lit,:tlt@ii i)i-ovl(l(@ st@ii)iiiIii4 for ii(](Iit@ioiitil I)Iiy.,;I(!iiiii4 programs to eii((@r t,II(, 1)r@t(. tli(@ coiiiiiiiiitit..y find will (](@velol) i,i for ljliysi(-i.,tiis already tli(!re. (,:ilif(iriii;t It(-gii)liltl Alt!dl(!Iil Ilrogriiiii Iiix,4 fund,; for partial support of the s(,Iiool la tli(@ early .4tilge4 of (Ivv(!Iol)lllellt. Ill 41(14]il.lon, work is now underway tit the IJiiiv(,@rsit,y of 1.4otit@ii(,rii California S(-Iiool of 'iNI(@(liciiie oil the application of (-ittic(.-r ease finding methodology to poverty groill).'4. New Jersey Itegioji@il Alediciil Program has organized fill tirl)iiii health unit within tlkeir of]!(!(! find hit,-, it 'I'lisk oil TJr)).tn Service.,i iiii(i(@r tli(@ (chairmanship Of Mrs. Anne Sojii4@i-s, it of tli(@ir Itegloiiitl -Inl)erslilp (@ritative.,4 of t@lic Advisory Groiii). 'i%l( on tli(@ ii'oi-(-(@ rel)r(@ NeNv Jersey A,.4so(,iiitioii, t,li(@ N(@Nv Jersey Stiiti(@ Del)@it-t@iii(,jit of Corn- affinity Affiirs, county lo(!iil OleO.CAP programs find other grotil)4. 'L'Iie function of the grotil) will 1)(@ t@o find r(,@vieNv 1)roj(@(-ts for improving the availability of health t4(,rvie(,s to 1)(!r.,4oiis living ]it iii-bfiii of tit(! ,tite, particularly low Income gi-otil)s. q'lie groiij) currently is woi-i@itig on the development of hospital I)ased group I)ract@i(!(@4 at Middlesex Gei)ertil I lo.'Il)it.11 in NeNv liruiiskN,Iclc and at West Jersey I-losl)it:il !it Ctinden, as demonstrations of improved systems for patient care for heart disease, cancer and stroke. The NeNv Jersey Regional Medical Program will assign a coordinator/plaiiner oken. The function of to the Model Cities offices in Trenton, Newark, and Ilob 77 74 %%-ill 11(@ to 911(i)(@l. (I:lf:l Ill) f.,Iciliti(@ available for g J'I-IP]lk to I)I-ovi(](! 11,11.@oll I)(,- -I I I I I s 11 I I (I I I I.1 I f 14 1 4 -1 i I i4 -S 1) i,og I'll I I is ; I I I I (I t o it Ss I -St Ilrogi I)I,ogi 0I)jectiv(!14 Of tile iegiollil I,I,Ogr,,Illl has developed a iiiiiiib(,,r o pi.ojc.(.ts :iffe(.t tile c@tre of tli(@ l@oor fix Corollary care l(@liel-iii Ilo.,31)itii and ub- iiijil,4 %Vill 1)(@ 1),itiel)(8 Ilirg(@ly (11,.,%vil front all Indigent ljol)ulttion. (,'-Oll('ge Nvill (,oti(Iii(@t coitl@iiiiiiiig e(lucittion programs for Negro anti will establish a radiation unit to improve cancer tjl(@l'.11)Y ill tile colkiiiiiiiiity anti liiilirove grit(iiinti-- and undergraduate rt(liology I (I i I i (Pi], t II (@ I-(@ I 8Iro.i t (, t, Io t(,,S I. file Of IIIUltil)il,'I',iC (@itillill@itioll'; ill flip (Fairly tli:i;,,iiosi.,4 of ciiil(!er fill(] \I(@li@iri-y will C,,4i@iii)lisil 't s(@r(@eiiitig (-ejit(,r Nvlii(!Ii %vill ]it fiii))I)ort of a 11(@iglil)l)l.lioo(i health by (')I",O find evil serve it I)ol)- til@itioli ol'.18,000 li(,ol)lc. Tli(! (i@, 1; population fill(] it (-oii(Irol group will be evaluated %%,itli to (!Ii:iiig(,s !it jilol-I)i(lit.y, of utiliv;ltioii of heiltli ,;crviceq, lic@ilt@liiftitud(@ and cost Tier patient di:igilo'.,-c,(]. 'I'ri-@Stitte lt(@gioii,'Il Ilrogr;titi received it I)Iiiiiiiiiig@ grant la late 19()7 find I.,., only iio%i, becoming completely orgiiiiz(@(.1. Since tli@it time Dr. Norman Steiriies, I'vogr@iiii Coor(Iiii.,ttor, his been iiii,olv(!(l in a number of meetings N\-Iiere II(, ]),is made kllo\vll national Medicit Ilrogr@.iiii's interest !it working to improve the tvailil)ility of liciltli services to the urban poor. Ile also Is serving on an ad hoc coniiiiitte(, formed in Boston by Blue Shield to discuss the plai)ilillg of home services tii(I will sit oil the Health Services Advisory Committee to the Bostoil City Del),,trtiii(@iit of Ileiiltli tii(i I-To.,41)itils. At this tim(@, there are two projects for etritiarl@(!d fluids under development in the Boston area, -I stroke project at the Neiv lejiglaii(I Me(liesil Center which will have a tie-in with the C-oluiiibit Point, N(@igiil)orlioo(I Ilealtli Center and it hypertension project being developed 1)3, Dr. Ktss of the Cli@iiiiiiiig laboratory, Iloston Department of Health and I-lospitals. Illinois )[(,(Iicll Ilrograiii his e.,;tAil)li.,;Iied a number of formal and informal contacts with persons in the Clil(@,igo area responsible for providing health to the inner city including Dr. David Greeley, Associate Direc- tor, Chicago Iloii-d of I-leilth ind Dr. iNIirk f,el)per, Vice President, Presbyterian- St. T,iilce's Ilosl)itil which operates all OEt 0 Induced neighborhood healtil cen- ter. Now !xi tli(,- planning stage at Pre,:byteriiii-.@t. f,iike's Ho,4p!tal is a com- iiiiiiiity (]election program wiii(!Ii Avill Ile focused oil the Mil(@ Square t of Chicago, Included would be evaluation of c@ise finding methodology ef- of Avilli p:iti(,@iits find all analysis of the of file I)I-o"l.;Illl to t@11(@ (!olllllltlllity. iNli(@ilig:tli It(.giollill 1%14,41ielil I.Irt)graiii : At Ili recent l@I)riiary the Re- gioiiikl Ailvis(@i-y (.rotil) of l,iiiq program formally ii(lol)l.(@(I it statement for i.irlor- lt,i(@8 for l@("ioll;il IIIV(li(.:Il Ilrogriiiii %viki(,Ii iik Iiiii-(, Iii,st@ insularity for ft(-gloji@il ill(,ilit,:il Ili,()griiiii Nvill 1)(! given l@o those projects which fire iN,i(,Ii [lie iiiil)roveiii(@iit@ of t@lit@ sysi@(,iii of Health care tiieltitllilg Stl(-Il its (it) iiiil)rov(!iii(@lit of tli(@ systi(,jii of li(@filtli (-Iir(- if) low ii)(-olli(@ groups: 2iii(l. (1)) innovations ;iii(I Ili tile utilization of is it planning Jointly by Tt(@giOI)III I'l,ogi,illik", :11141 tells Sl,;i(.e ]it,:iltli (ilro.j(!ct: ft)i,g@itlier- ilig (121111 (Oil 1114' health liceils Ili (-)C Wayne County, Ali(!Iilgitil. Wtiyii(- ('Iotiiii@y Ilosl)itiii has siil)iiiit,t(@(i it to faulty the use of Kill@lwofe,ssit)llllt \vo)rlc(,rs t@o lis,,ist l@i)(@ ill 1):Ifit@iii; field \Vill ,izk(i (@ A stiil)lisli tlt-:iiiiiiig for such persons from file local community. AV@iyji(@ ('binary Ilosl)it,:il .,(@rv(@,; the iiiill;,(!iit trepanation of Wayne (,Totally find is loe@ii@t.(l @i(Ijiieciit to a large refulgent groul) Ili western and qoiitliern Wtiyiie Collilt,N,. Ill Itl(lit@ioll, Itegioll:tl 31C(Iicql Progrxiii -4:iff ,it W,,iyii(-, ' Atatt- ljziiv(!rsity School of Afe(liciii(@ is worl@iiig to liaisoii with urban health programs Ili Detr(iit in(.-ludizig OEO and 'iNiodel Cities. The 14',xecutive Director of tile Detroit Urt)@iii League has been named to the Wayne State Advisory Group. Indiana Regional Ifedical Program is working with Flanner House,, a volun- tary community agency in Indianapolis to develop a multiphasic health ,icreciiing program for low income population groups. With State and local support the 75 Regional illedicai rro,-raiii is conducting pli?iziizig and f(@,i.,;Iioility to determine the tvl)(@ of scrt-eiiiiig procedures which will most rea(,Ii tirget I)oliuiitioii -rotips iiid which can in part be a(Iiiiii)ist,er(@(I by uiitr.,iiii(@(I lier.,ioiis from tl)e comniiinity who liive received oii-tiie-jol) training. New York Aletrol)olitan Regional Ale(licitl Ilrogi-am has made iii(,Ilt,4 to of tlk(-ir core s(@.,iff for maintaining ]iitisoii with community health I)I.ogl.:Illis, ()]@.0 III)(] Model (cities. ]ills ]tied(! to (I(-V(,Ii)ly II wi)rl(iiig r(,Iitl-it)iislli]l %vitli tll(! .11roviii(@lit, @o(-i(@l,y, tliq@ llio%'- Ilroolilvii iiiit] a,, ,i r(@.,ttlt Iii4- iii-4-si(li@lit of tiara org.,illizfl(il)ll 11414 il)l)oiiitt,(l to ilif@ It(,gioiini A(Ivi@oi-y t@lit@ It(,glotiil M(@(lie@il Progi-@iiii is I)rii(-ti(!Illg Nvitli r(,I)r(@s(,iitiitiv(@s of the Nikt,loii@il Asso(-i@itioti, (,i)lititii)iii Uiiiv(@rsity Col- li,,,e of I'llysi(.!@ilis .111(l @ill,g("Olls, 'inloillit Siilai S(.Ilool of all(] St. IloSI)it@ll ill l@lit@ of f!olil@illiiiilg c(ltl4:ltioli Programs f(ii- Iril(' lt(,giolllll AIP(II(@ill Ilrogi-itill Is also titl@ijig iii f-o-,41-Kiii- soriiig It Oil (-iire(@rq for tli(@ to I)j-liig tog(-tli(@r all forces in the to (](,v(@lol) a coor(Iiiiil(-(l lirogi,@iiii. Al.'44) ill the? Htllgo, are several projects for fluids iikeiii(Iiiig -t 1)(,(iiiitri4- I)illriioititry center at llal)le.,4 Ilospitiii, it study for (](-Vt@iol)lii(@iit of.,;(!reciiijig and treittirk(@ilt of stroke ))aticiit,,, it lliirleiii lIosloit,,i], :,I iiiol@il(@ (-4)ro?tftry unit to operate out of St. Viiie(@iit's Ilosl)it.,il Ili Gr(@eiiwicli Village. iN[cti,opolitaii Washington, D.C., Regional AIM!cll Program will establish a strol@e station at Pree(iiiiiii's I-lo,-,pitil, the reaching hospital of I-lo%vitr(I Uni- ver,ilty Af(,(Iical School. The project will idiprove the care of l@.Itielits from a predominantly N(-.gro population group by setting up an inteilqive care stroli(s unit in the hospital and by developing extensive follow-up services for stroke patients. 'I'lie unit will be used for training inedletl students, irea physiciin,4, niii-ses and paramedical personnel In the latest techniques of stroke management. There will be reseirch -;tiidies undertaken on diagnostic methods, epidemiology nii(i the etill@iiral, behavioral and socioeconomic consequences of sl@rolc(@. Also submitted for review are gtroke projects to be ol)eritte(I at George Washington IJDiversity ]).C. Ilosl)ltitl -iii(I Glenn T)ttl(@ Ilosl)ltil which woll](I (,Oiikl)ltit@ iiiiiN,4@i-.sity niid I)PI)itrt@iiieiit of Ilulille health (@frort@,t. Alissotirl ]regional Program will :it Nitii,;ii.,4 City Ifo.,;Ilit@ll ;L (li:lgl]oSlic iiiiil unit for I)jtl@it,iits with (-.(@r(@I)i-ovikF;- (-Illlxr ;-POO it real' will 1)(@ ref(-i-r(-(l from t,lic (-Iiiii(-itl (,iLy IfoHI)IIAil serves 111(@ llill.!(ki-ity of indigent ill i@1)(@ Kansas (,'ity, Alissolti.1 lir(.Il Jill(] will tilt@ Ito all 01@,O iieigIII)oril(@o(i ))truth lionv earlier lll(,Iit ill ('11(@ 4-olillikililil.y. I%Iissoiirl Aft@(lic:tl Ili,ogi-aiii and gioll4il ].,Vogl-iiiii larval lki,,i) estiil@lis)ie(I a gr(@.tl.(@r (',Ity Iiiiisoii (@otii- to review and co(ir(Iiiiiiie, the ii(,tivlties of both I)rogritnis Ili the m(@tropoli- G,@(@r,,iii Ito,-iojial Me(licil Program lia-4 siil)iikltt(.'(l for review a project for the or a. col)lj)lllliity hyl)(@rtezisive control program, to determine the most efr,(@Tt,ive Ill(.tllo(ls to id(@iitifv gyitiptoiji.Atic hypertension in titi urban racially iiiixe(i community Ili Atlanta. The project which woill(i be conducted by the (.e(@rgit St@ite Health would assess the most citective methods to achieve good blood pressure control in tljes(@ liypertensive,4, train lny blood pres- sure iii(I (it@tei-iiiiiie whetlipr a community I)rogrtiii in hypertension control Is (Tonoinically feast e 11 ilig pit c ea t met o s. Itoei@its. Wli,%t,,tbout the rural areas?, Dr. ill,klt.STON. I tliiiik tbings h-ttve tended to move more rapidly iii the rtiril -areas. Af i-. Let us have a, breakdown "S "ler' (The f ollowing inf ormation was reserved '@ytot'h"el)co('@ (m'.ittee:) 1);i 4 53--O,@-6 7(3 OF IIFAI,Tll. l@,'[)U('A'I'ION, ANI) @,"J'ATIrM.FNT ON OPEITATIONAL IttijtAi, A]TFAS AT,IIANY lti-',(IIONAI, ilit(Xl[tA@i )Iikity of Ili(, All)@iiiy ol)(-ratiojiitl act@iviti(,.4 will serve to ellhiiilc(,' the cal)tlblll- ties of health I)rof@sioiittls in the rural iir(Nts. lly bringing professionals from siiiill coiiiiiiuiiiti4@s into t@lie medical center for continuing education and by iiii- Ironing (-otjiiiiiiiiientions between the medical center and the communities they liol)(@ to raise the level of patient care in th(.@ comtiiuniti(-I. The following proj. eeL-i involve ruril areas: Operational Projects 1. Ti(-o-,tvay Iladio Comnizin@ication Systeiii: Direct Co8t, $1411,100 11' 'his project will expand an existing tw@way radio iietworli to include 57 tii(I 24 high schools. It will provide continuing education for physicians -iii(I ,tllie(l medical personnel. It will ilso provide information and education pro- grains for administrator.-,, members of boards of trustees, voluntary health agen- cies, adult education classes, and selected civic groups. 2. Coiiz?ttunity Information Coordinatoy,s: Direct Co,@t, $73,800 Former pharmaceutical representatives will be used to contact local physicians to tell them about Regioxiil Medical ProAriiiiis and to evaluate their attitudes tow,ird,i ITIIP. S. Cot)itititnity Hospital Learning Ce?itc)'s: Direct Ooit, $75,800 This I)ro.iect will esuiblisli leiriiii)g centers at coix)ziiunity hospitals using Iiistrii(,-tioii I)jilts" and ati(lio-vi.,itial (,,(Iiiil)iiieiit for rapid dissemination of ll(,%v medical kiiowl(,-d,,,(!. ll,v(,iituallv, the (lircet@ors of this project liop(@ to e@iltuLL(@ physician progress. likitially, 8 liosl)lttlls will be involved. 4. Ilo.,il)ilal Cut-ott(try Care 2',i-aitiiitg and D(,iito@ot8ti,ation Pi-ogi-atit: ])it-cet Coit, $55,400 I)roj(,(!t NN'llI establish coronary car(! iiiiit.,i of tlii-(@o cii(!Ii at three c(oiiiiiiiiiiit,y Ilitt,411cl(I Gititeritl, St. itti(I Vii4.,ittr Ilrol@liers. Tti@ will serve its (ii-iiiozi,4triilioyi and I)r(oj(!cl.H for ot:li(!r hospitals In the region. A (!oiiiiiiiiiiig e(Iii(-Ittioii-al lorogriiiii will servo the permanent Unit Staff I,?.oj(!Ct, flit(@itsii7c Ca?-(Iiao Care Unit Ilcrkimer iloxpit(it: oot4t, $3,r)00 nation of tiara I)roje(-(-, is to train 6 or 8 Tiiir,4(@q from ginall (!oiiiintiriity v and 1)liysiolt)@y, (-)rotiiii-y tlxL, priticil)itlm and sitting of it e@ir(Iiiie iiiteiisive care unit, iiii(i in Iiii?i(llliig the complex e(Iiiil)inent. Tlie.s(@ i)iirse,4 wili ;tlso be seat to Albany i)lc(liejtl Center for active training with specialized equipment. INTERMOUNTAIN REGIONAL MR[)ICAL rItOGRAM 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 sl)ccialists from the me(lici.1 center to the small communities to aid local I)Iiysi(-iaiis with ,4pecifte areas of patient care. A third type involves the use of (q(@l,rojiie monitoring equipment which -transmits liliy.,41ological signals from j)liii,i(,ii@t@s in r(@inote 4iri@its to the iii(!(Ileiil c(@iiter for Interpretation. A listing of fli4@(t I)roj(@et,.4 follows. 01)(@riLtioiial Projects for Co)iti)tiii)ig f@l(lii(!itfiott in ])Ii(@aRe, 0(inecr, Stroke and Ro- cost, (@f t@Iiis 1)r4)griiiii iii,(@ to 4]t,v(@iol) it (!oiiiiiiiiiil(!ittii)zis ii(@twork be- tWe(!Ii 1):Itrii'll(@-(,ftt-(@ itiitl r(,-s(,3treli to (!Il(!Ollrllg(@ lllki'4oll (-iirt@ in tli(@ 4ire@l. (-iirrt-iii.ly (@xi8t@iiig 2-wal, radio systems, iii(!Iiitliiig 11 hospitals in 7 coiiiiiiiiiiiti(@,4 in (@r iit@iir Suit: ralco City, will be (@xtetid(t(I to ot(@ litwl)ititis to servo as one lliilc. Closed circuit TV and use of KVIPI) (Uni- reiki ver,,;it of Utah education TV) Is also planned. This may establish the community hospital as the IOCU,'4 of continuing education. 7@ 77 [@ifot'lli(itioll, (ilift Direct Cost, $110,'OO ']'lie is ;I regioji-wi(le (-Ieiring house for liiforiiiiiiiion tboiit I]tM].'. St,4tft will I)i, put in local (-Oziiiiiiiiiitics to ict a,,; public relait@ion.,4 r(@lor(@.sf@ijttitiveF4 and -I I so to distribute Itiforiiiiiti(i II toiiii@(I!Cl II[) (I tileI)III)Ij C. ']'lie coin III un I ty st@iff will til.,4o information oii coiiiiiiiiiiity and re.,;oiircej and serve @t.4 :I station for collectitig eeotioziiie, socitil, nikd medical data. S. Ca?-dioi)tilt)io-nai-li Rc.,tuficitatioi& 9'raini?ig Ilrogi-a,@n: Dit-cct Cost, $1;3,1100 'Vlit, lliiiversit@y of lit@:ili will giv(, :I 3-tlaty (!oiLrse in to I)Iiysi(,itik@ froiii Sunni (-oiiiiiiiiiiities. l@iiysiciiiii will lii(@it 1)(! r(, 1 Pt I- s Ft is I)IC., for t(@:I(.]Iillg tile te(.Illli4lll4@ to lk(,4iltli 1)(,r.@oititel in lii4 coiiiiiiiiiilt.y. 'I'Iiis re- .411scitiitt,iori cori-;iiltitlit will also collect data about tli(@ number of tljnes r(@stiscita- tioii I-, L@ii)l)loy(@41 and the results. J;. A Trai,@iitig Pi-ograiit in Int(!?t.@ivc Cardiac Care: ])irect Cost, $118,600 A (,or4- f@t(!iilty of in Cardiac Care and (Iiiign(witig and ti-(@itt- itig 11(@:lrt will te:leli courses in tik(@ir sul)j(@et.,;. The stii(l(@iitt3 will be 4 physicians and iiurs(-s from cotiimtinity hospitals building coronary car(, units, 5. Ti-ai@ii@igfot-.Viirses iit Cardi(ic Care and Cardiopiili)toptai-VReitescitation:Dircct (,ost, $34,000 This is an ijite.-ral part of both the car(liic care and cardiopulnioiiiry resuscita- tion I)rograins for physicians (#3, #4). Nurses trained in Salt Lak(@ City will re- turn to their communities to serve as a core faculty for teq.ehing tile techniques at the local level. The nurses will work closely with the similarly trained physicians. 6. Visiting Co;tsiiltants and Teacher Program for Small Community Uospitals: Direct Cost, $14,800 Sitiill coiiiiiiiiiiities will be given the option of requesting one or two-(Itly Clinics. A number of four car(liac pwtieiits will be required. These clinics will ar, upgrade ill(,- level of of vi(!tiiiis of heart disease living in (,Mote fircit. Visit- iiig will t"ist t lie local phyticlaii III a prceise diagnosis of his patients. 7, A l@(,Ilio)iat Sll.,?tcm for Afonitoring Pitysiologio Data on-line front ]@@ciotole lioqpital,,t in the I?,cgioital Atcdical llrogram: Direct Cost, $637,100 ll'iii-,4 l@roj(@(-t@',.4 I)tirlios(- is to @t,(@st@ (,II(, fk,it.-4il)ility of iikijig it c(,iitritl computer to 11 V:ii.i(.ty 4)c ipilyhjologi(,iii :qigiiiiis g(-ii(,riii@(,(l by patients in reiiiot4- lio.,i- III(! I-t-siilt.,4 of (.Iil(!Illi)tliolis fallen migtiltls i)li(!Ic to 14tiltloilH with- ilk tile lio',I)lt@itis, 4111(i noting L11(@ iilftirililit,ioll for diagnosis, S. ll'lki8 joi,ojo@(.t, iiii-4@llilol.s lo tlit@ level of ltvitilili)l(@ to (!olliilltll)i- will it 1)rt)gi,siiii of (@(Iiit-itlioii to tr4ilii(@(i sl)i@(-iiilisls wlito, III Ciii,ii, will I.ioil ilk their lo(.II] 'I'lie 1)liysi(!Iatiis will it iiiijill t4t,il)t,aifl for ti@jt(!Iiiiig still obtaining ixiforiiiiit,i(@ii. A regl4)ii-wl(l(,, I tiitior rt@gi.4try will be stitrta@d its will it training I)i-ogriiiii Ill new t(!(,Iiiiiqiie.4 for lottiliologists. .9. St-i-oko and Ilelated Nourological Disca.@.s: Direct Cost, $98,700 This I)roje(,t will establish clinics to bring expert conf3ultittloii service in stroke and related neurological diseases to local containment,; will provide continuing education to local physiciiins,aixd iiurt3es; will collect data about .@roke lwi,tients seen and the problems they present to the practitioner. A 24-bour telephone consultation service and Information library service will be maintained at the Utah Medical Center to provide comniunity physicians with immediate advice In addition, practicing physicians will be trained at the medical center in the latest diagnostic -and treatment techniques. The courses will last front 4 weeks to one year. li:ANSAB ICFGIONAL MEDICAL PItOUItAM The Kansas Itegion is emlyha.,4izln,,, cardlovat4cuIttr care in Its rural programs. III addition It is setting up it comprehensive model training progratki ill a '4111all community. The proj@ descriptions follow: 7" 78 Olli@l-,Iti@)11;11 Ilroj(,Cts A'(tiis(im: I)ii'cf!t Cost, $,?6,1,000 facility, NN-Ilii-)l NA-111 1)(@ :illlli;lte(l xN,illi file l@ikii,@its Center, will 1)(@ in are plans for continuing :Iii(I (-Iiiiif-:il for liellill)-r( I tt I per- soilil(!]. stil(lit'.,4 %%-ill 1)(t (Pr colillillillit,y r(.Stollr(,Cs, etc. to liul,si!,14, Nvilo ill.(! tll(@ iii:iiiist::iN, of co)r@)ij@try iiiiiis in ivit'll I)I-LSIC I)ll@'siologi(-Ill kiio%vl(ilge of Utility to ii.,;e and e@(iiiil)jti(-iit la (.-oro- ii@try care units, in lioiiie c:trt,, itii(I f@iiiiiljiiritly with sociii agencies that call ii(i in the r(-Ii:kl)ilitiitioll of lv(f),k lilhi.,; project will deiiioiisLritt,o Lli(@ ]@%,iiiii;ttjozj IJ)iit and gl)i)@v its for the evaluation ikii(I reli@il)ilit:iti4)il of ill(! patient. It 1,4 (lev(@ol)lllg ;in effective technique for showing physicians and ['lie community at large the ability of patients to return t@o worlz -after receiving tli(@ appropriate rehabilitation. MISSOURI RLGIONAL @NfEI)ICAT, PRO(IltAlf The Missouri Re,,ional Medical Prograi)i operational activities involve projects directed toward iuiproved screening techiii(Ities, early disease detection all(] rapid diagnosis, and more effective delivery of services. These are coordinated with automated ,,Ystems for transmission of information and health data to aid physicians and community hospitals in the treatment of patients with heart disease, cincer, stroke and related diseases. Six projects focus on the health needs, the care of patients, and training of staff for rural communities. Operational Ilrojects 1. Stititltl)ill(" 00))Illlli)iity lf(,'ttltlb Sci,,i)ico Di?,(@ct Oo,@t, $200,957 ll'o eit@,li)lisll it lito(l(.l colillillilili.y ll(!Iiltll lorogiitill tilellillilig (!olltillllll)g I)rogt'.,Ijlifq ,Iil(l li(4111.11 for the I)III)Iic; (@ill(.I.g(@licy care ]orogi-2iiii,,4; I)iilollc Health, find sell(k@l witli Voillilt'ill-.V health ,tr(oiiii(I 4iiiillivill(! typ t,500) @ill)(I to ill('Itl(le 111)(@ilt 50,000 ill (,'Iiiy (,oijii(.y. A(-Ilvilit-.q ill,(- around Hittitltvillo llo$l)it.(Il (75 be(I.,i), Suit[ than gi,(itil) (!Iiiiie iii4 a 2. Atoilli'phti-ilo Pe.,iti-)tg of (tit Al)'.bltt(ilit $4,@1,471 To for I)t@i-fol.lililig iq (Illigiloqcie lst))4)vllt@ory tests to latest; IIS('flll for litrg(@ rural I)t)i)iiliktiott grOLII)14; Hatteras for ill @iii(i healthy I)ol)utqtloiis ii.,4 an aid ill (let(@ctioll of heart ciiii(!er, and in I)reclliiical stag@-. model tf-.st will be at t)ie lJiiiv(@)-,,;Ity iN,[(,tlical C(@iit:ei-I Ctoltiiiibit, the State NI(.Iltlll IIOSI)itill and IL third Is for t@lio Stititltville cotiil)l(@x, 3. 111(iqs Set-cei@,i)tg-l@(tdiology: Dit-c(@t Cost, $5,@,,@14 To iiiij@rov(@ the jte(-tii,,icy (if ri(liologio of heart @.ine(T find strol@t@ t.lLroiigli (!Ii@etroiiie coiiiiiiiini(!,,ttioiis itie(lia. Three ,jiitill rural will be I)ool(ed into the Uxiivti-,@ty of Alis@)tiri computer and Deliirtiiieiit of It.ti(ii- ology; to ev,,iluite di;i;,,iiostic eflicieiley tn(I determine applicability of tiltrt- sound and tlierinography in diagnosis and tlierttl)y. 11. Cot?tpre7i(,,nsii)e Cardiovascitlat- Cai-c Ultit8-SPI-ingf(eld, Alis8ofiri: Diicct cost, To (](!v(@lol) :t coijil)r(,@lienslve car(! unit for groiijiltig l@tieiit.,i with heart (]is- cii.@ or other eir(!iil:itory syst@eiii lliziesi or ivlio have been admitted for other I)iii-I)ose4 but rt,(Iiiiro close t!itr(lia(! observation. The project is to be undertaken -it Itoq7)it(ili illiberal a hoiisc 8taff, wlit!re it is liol)e(l tlirtt grouping of I)aticiktg will relieve the workload for iitirs(-4 on general iii(4]lcitl and surgical wtir(114. Springfield (a community of over 100,000) has 4 general community hospitals @7 77 79 !II Si7,@ frCIll @,.l to 511 (,q total (of til)(Piii 1,200 St. Jolin',4 (',@iiiity So(@ii@ty tire coot-(Iiiintiiig aetivil@i(-,@4 @vitli ti $,'?()!),OOO fi,i- tr;iiisi.,iiiiiiig i!lil(@lti-4)(.;Ii.til"gf-jll)l" ,ifk(l all SY$t('Ill for aiiitly.@(@s of Ili(. fel.@ii)ililv of ;ti(.Ii wli(,i-o tlii,'4 14(,rvi(!(@ is and to) ili,vt!lol), t@@-t and iiijl)l(-iiieii,t the use of bioeligl- 6. Cli), Di)-(!ct (,Io.,?t, $.,I.9,05r@ colic(@rn(!@l Ni,illi "(@@irly detection" liypotliesis. of early ioll tests- for a Itii,ge rtirgil population, @IOUNTAI,N' STATFS ltll,(,'IONAT, ',\frI)T.CAL PR.OGICANE II ,Ictivity in t -itt,s Itei, lie 'INIolilit"l,ill St,, Iort is -.I)eciflcally designed to 1)(-iielit siDqll liospi@-ils Ili rural areas and to train licaltli professionals from rural ,treas. Operational Ilroi(@(!ts O())-ottat-y Care iii, Si)iall Ilospitali in the Itegion: Direct C08t, II(@sl)ilils Ili the region will s(,ii(I regist(!re(l iitirw..g iiiito St. P4itriclc's Hospital, 'infoiitaiia, for corollary (!tire Ili,;iiiiing. This -tlirce-we(@Ic cotir,-R will be times t yeir for 21. iiiirses, aiitl there will Ile follow-ups at tl)e horiie hospitals four entries a year. Ili ttdditioii, a 4-(Itiy Planning program eil)eeittlly for siilitll town lkliysiciaiis will Ile li(@l(I at the Univert4ity of Montana four tiiii(@s a year. NORTJF CAlt0l.TNA ltil,(IIONAT, Ille,[)IOAF, IlitOOltAht Ili North Cirol[iia l@liere are 10 opei-gtti(piiiil I)roj(@(!ts all of wlii(!It have upon liosiill,jtls, Ili rural iir(!iis. I ijilikA,, of physicians and nili(@(I health Some iai-t@ coi)eei,iie(i wil I e4litcttlloit and trit personnel, and oiliers with patient care. All of are (.1e.41giie(I to Turing,, t@lic latest 4(-i(iiitiflc advances (Iowa to the (!oiiiiiiiiiiity level. The l@rojects are listed as follows: 01)(@riitioiiiil 1'roji'Tts 1. E(Iti(-(ttio,)t a)?(I, rcscai-c7@ ill, colizi)blioiitll t)ic(lical (,-itt-c-(Iircct C08t, $.'09,P,100 To develop resources for training iiior(@ medical @iii(I allied medical students; to 1)roi-!(Ie new types of educational exl)erience.,i which will inike family practice more ,tttr.,icLive; to have a postgraduate education program at the medical school: to strengthen ties between the medical school faculty and practicing become involved In community plan- physicians; and to have the medical school nin@- for approving the quality and availability of ni(@dical care. Affected by this I)roj(@ct,-@re the following groups: the University Community; the Caswell County al Health Council of Eastern Api).,t- Riii-fLI Health Services Ilroject; the Region laebi.,i, Inc.; the State of Franklin I-Icaltli Council, Inc.; the Chfirlotte Memorial -pit.,Il; the I%IOS(!.,; Coiie I%Ieiiiori:xl Ilo.,Al)ltjil, Greensboro; and the Dorothea Dix Service. 2. ('e@ro)i(ii-li training drift co8t, $55,938 To 11,4@ til(@ 1114 11 for (Iev(,Ii)l)iiig (,o4)li(!i-iitiv(@ ftri-iiiig4@iii(@iits among car(, (-Oiil.iiiiiiiig e(iii(-n- Taipei N%,Ill Ili- l@o llti(I Ill (!(Immunity I)oSiiitllls, (-ollstllllt- tii)ti II(, I,() Ill ("41111)11,'41iillg lil)41 11 II 11: i ,tyhl@@itt o@f iiit,41i(,itl r(,(,oril %Vlll 1)(' li'(] to new N%,(ji,ki)ig llkt@ iiiil%-4,i,sity iiii,tli(,jtl (2) 1)(@- t (:") (10)(-I@ors 4til(i Ill lilty hospitals; (4) I)etw(,(@ii titiiv(@r,;ity iii(@tli(-til and colillillillllv S. DI(ib(,,Iie constitution aiitl educational cost, $13'-),08.1 To es(@at@lish three medical t,eikiiis to deliver services throughout the state; to assist Ili expansion of (Iitil)ctic consultations and teaching clinics; to provide so seiiiiiifir.,; for find f(@,iciiiiig for and I)atl(@nts ; to assist in organization of a Siftte I)ijil)eteq Association jt)i(I local chtipters; to test tech- iiii-lii4,,,i of (I,,iti collection. Many people of different (lisciplincti in many communi. ties are involved in this project. 4. D4,,)@(,Iop?)ic)it of a cctit),at caitecr rcflistrlt-(Ii?,cct cost, $66,615 i iiiiiforin regloii-wi(le (-,iiiic(,.r r4@poi-t@iijg Hystetyi, itit(@grtite(I Willi the froiii %vlil(,Ii (,-all 1)(,. i-(@t'ri(!v(@(i to s(@rv(@ a bron(i ,,itioii,il, find otli(r I)Iirl)os(@, life following I)III(cullivel'sity M(@(@li- N(@i-ili C,,Lroliiit Meitiori:il Ilosl)ii@al, Noi-tit (,jirolliia Tifipt@ist lfosl)itlil, ('Iiiirlot@t(- lio.,41)itfti, V(@ter.,ins' A(Iiiiiiii,,tration Ilospitfil, W@li@t@s Ilospi- t@,il, Ifitiov(@r 'iN;I(@iiiori:tl I-lo,,I)ital, Sotitheasterii Geiiei-gil Ilosl)ital, Craven Coiitity In years tli(@ registry will be expanded to include all lios. I)it@.ils ii)(I I)li."-ici;iiis in the region. 5. lf(,,(Iical llbi-aril extcnvion service-direct cost, $25,839 'I'o bring in(@(lical library facilities of tli(, three iTic(lical schools into the daily woi,lc of tlios(! (-engaged in practice. Lo(@.,il hospital perSOTIliel will be -ist medical stiff'; lil)rari(@- will triiii)(,(l to ii@ be org:kiiized into a fiiii(,ti(piiil iinit foi- r(@lioii(liikg to re(IiiestH for services. Itil)liogritplii(! request service will be anec)- i@ifor)iiatio@i ccntcr-(],ii-ect coqt, $Iil,716 6. c To provide I)IiysiciiiII4 Willi immediate consultation by telephone .11)(I folliw-lll) I",ii(-h of ill(. tlii,e(, iilt@(ii(.Ill H(!Ilools will be responsible for providing in its g(!ogriil)iiie locale 'I'lic films of J;Iiis project are two- fol(l: (1) l@o,'IS@i.,41,1)liysiciiiiisiiil)rovidingol)tiiiiiiiiicareofpittientswitliefiiicer; all(] (2) to(@oyititilictli(@(@(ilielitiolloftli(,@l)I'Ysicittilsl)ygiviingiiewiiiforitiation 7. in iittcrnal ittc(liciitc-ili)-cet cost, $83,313 To bring ljit@(@riiist@4 from all ov(@l, the ,4tate to the M(!(Ii(-iii Center for @i 111(@iitik of up-to-date l@riiiiiiig in t,li(@ir Tb(@y will f4liiire resl)on- Sil)iliti(,.14 I.Vitil attending Physicians tkll(l lilltiCe wrr(i rounds with students, staff, and tog(@ilier. ']'his t4liotil(I the appreciation In the IJiliverRity, both at faculty in(I stu(l(@iit levels, for the expanding role of the medical center for tli(@ quality of ciro in tli(@ community. S. CO?Itillfling c(l,?traliott in dc)ttkvtril-dii-cct cost, $67,508 knowledge of mutual coii(@orti which To provide pliysici@iiis and dentists Willi the will enable them to be iiior(@ effective members of the health teiiii. Course% will will be given at the TJniversity of North Carolina and in communities. Studies be made of facilities needed to provide deiital care la hospitals. The purpose of this project is to ensure that is many patients as possible who suffer from heart disease, cancer, stroke, or a related disease receive appropriate deiital care as a part of their comprehensive treatment. D. Cov,tiniting education for pltysical thei-apists-(Iirect cost, $27,888 To develop iiid establish regional (-oiitiiiiiiii,- education progrim.9 for physical in <)r(ler to strengthen physical tli(@riil)y services for ill till part.,; of ill(@ stiii@c. Subregioii,.4 Nvlll I)c- (lellite@ite(I where iiec(l.,4 and iiitq,re.4t,,4 will be ideiitlill(@(I iiiitl (!oniiliit,te(,s will I)(. orgtiijiz(@d to tirriii)ge local activities. 10. The ct;tablisitviciit of a network of cot-o,)iarli c(tre itnits in small conintitnitil hoipitals in AI)pal(iclt@i.(t., Noi-tlt. Cat-oliiia-(Iircet cost, $93,019 lilillm is it proposal to (I(w(@iol) (@oroii;iry (@itre mania in Novell 110,141)11:11114 Ill this rural, mountainous It,'i%lll %Vill siil)l)ly t)i(@ monitoring (@qilif)lllollt (the ho,41)i- I)rovl(le,4 SI)ll(-C) Wil(@ll 1141(@(Ilillt,(@ly i i-ii iiit-(l I)Iiy,4i(,Ittii,4 and training Ill the Ali f(ii- I)IIY@it-iiiiis will be C(Oll(lii( be coll(lilt!te(l when gei)gi-iil)liie r(!;,ioii, aiiil continuing e(Iiii-iii'loil Iit-ogriiiii-4 iviii '1)11(@ to tilt, g(4)gl,ltlllll(.Ill (Iiv(!I-.'41ly of iii4@, r(,gif)ii, ilit@ 11 IL(@gi@)IIIII AI(@iII4,111 Intestinal 1111.4 iviiii piston the lle;il(li ol, til(@ poor as wt,ll its the neither tor r(,tiiot(, rural itrt-as. The program Ikiim sought soltitioiim to and other regional I)rogriiiii4 till'oligli a of. Iiiih.,iges the iiiq-(Iiciil ceiit-.(!rs and tli(@ rural ireii,4. In :141(litioll to I)rovi(iiii,@, l@t,ogrtiii.9 to ii1ioNv itie(licftl personnel ni)ti I)Iiysi- eit7is from rural ei)iiiiiiuiiii,y Iii).sl)itill,,4 to come to tli(! iii(@(liciil (!Piit(@r for training program hit.,; cii(leikvoi-(!(], through the ii,,,c of iiio(](,@rri Coal. Inundation to (-reiite education resour(,- " la the rur4ii aretit4. The 11(@l)liiii.,;ville dealer, ,ti)d the deployment of Coronary care units ire two ( i xit iiij@l(,@,i of I)I.oj4@(-t',. 2. lfoi)kiiisvitto L'etticatioit Cctit(!t- aitd Chattaitooga Bducation Center- (!Ost, $711,'@oo Tii(,s(@, jirc@ tli(@ lii-,@t of tli(@ lo(-;tl (-oiitiiiiiiii;c e(Itieaii@ioii (!(,liters In the Viittti(,i-l@ilt Julian. At vii(-Ii it ftill-iiiii(@ I)ii-(@(-Ior with all jiloin)jiii,iticiit at jissist@iiiit (lir(,(-t@or will resi(l(@jit and tioii la 'I'li(-ir will l@(@ to l@liysi(-iiii.4 it smaller coiii. )]reality hospitals III its hospital library Tile (',Ii@it,ililoi)glt 'III(] llol)iiiiisi,iii(t lo(-:it.lipii.,4 provide I:Iit! I)itsi,,i for looking at probit-iiis ]it (-oii(,iiiiiiiig e(lti(-iit,ioii In iirl)iiik and i-itritl set,tiiigs. J. le'i-a?ikliib Coroiifz,)-il Caro linit-lvilliaiiison County Ilospital-rfranlcliit- dii-cct cost, $31,)IOO This is one of the subsidiary units mentioned III the Vttii(terbilt I)rolxmil. This is primarily a pilot project to ,,:tudy the feasibility itnd usefulness of establishing a center In a sniill community hospital. 4. Clarksville Coronary Care U?tit-Clark8ville Me-niorial Hospita@direct Cost, $19,000 As the Franklin program, this project is a subsidiary of the Vanderbilt pro- Since this lio,.;I)Ititl has been operating a unit, the plan calls for its expan- sion, continuing education and a phone book-up to Vanderbilt. 5. Alvrray Coronary Care Unit-Murray-Calloway (Ky.) CotintV Hospital: Direct Cost, $38,800 '.Nliirrtiy-Callowiiy County hospital, the training center for 'I\Iurray State Ulli- v(,rsity s(-Iiool of will ,;(,.rv(! :is it (I(,iiioiistr4itiOlk c(@iit(-r for the stil@-regi4)11. I)Irect phone (-()ijiiiiiiiiie4itioti will be estAit)li,,Iie(I with V.11)(]('rliiit, whi(.-Ii will send coiisiilt@iijitq from its F;cli(iol of continuing education. This project has the dii.11 ot).i(,(,tive of r(@Ijititig t.li(@ 'i%tiirriiy StAit(@ Nursing I)rogi-iiiiL to all (@.Htjil)lislied iii(,-di- cal c(@itter and providing r(@gioji,,tl training r(-soiire(!s to It remote area. 6. Cro.-t,,;villc Cot-oitary Caro T7ttit-Upla@id8 Cuniberlatid 2fedical Center Cro,,48- villc: Direct Goit, $28,300 This iii-oject has two purposes: (1) to establish a two4)(,d (-oroillkry en r(@ unit ill tli(@ ; and (2) l@i) (I(@t(@riniiie ill(, feasibility of ol)erfl.ting acute cor(oiiiiry care- failing Ili riir;kl The liospititt will cooperate, with @litl-Stiitc Baptist Ilosl)ltal V4iii(leri)ilt. 7. Tiill(i7i()t;)rt Coi-o@i,(ti-li Care 17ttit--Itai,ton @f(,t)torial Ito.-epital, 7'itltahot)ta, Tenn.., ])it-cct coqt, $1@,800 See Bil)t.ist Ilosl)it,,tl Progriiii. 8. Ili-ojcct to Ii)ipi-oiie 11(iti(-iit Care Ili a I?c)i?otc 3loitiit(,,iit Conii)iitnity ?)y I?ccruit- (itid, Ai(lc8 for a, New Care lf'acilitll-Scolt Cotinty Direct Cost, $10,.IOO Nf:tiil)ower sl)4)i-tnge !it isolated mountain hospital is critical. to 111,1111 till cir(@ f:t(!ility tio%v iiii(](@r construction will 1)(@ (obtained by two Iii-s(@rvi(!e traiiiiii,- for lio,,;I)itnl (2) 4in ill- ri,(-14@r (till ItN) to sqii-v(@ as a linisoii to tli(@ high Feliools to young 1)co- 1)1(@ to (@iit(@r tli(t iii(,411cii) li(-](l all(] coiii(@ loit(!Ic home to I)riieti(-e. Ili ii4l(ll@lioii a training l@r4igi,iiiii le@t(Iii)g to the LIIN would II(, !nitrate(]. (,Iiiij(!Ill training will l@e by the ]@,(Iiientiotiiii I)ir(@(!tor while lo(,jil lilgli scliools, provide ti-illillill". liolil,.iti,'47lill(! (,are Sletat-t Kll.: Cost, $Iil),500 plan Is similar to the li'r;tnliliti plan, (@cel)t i-litLt It iil(-i)tlollm O.,4till)limllillg Iiiiii.4 to sii).,tllt@r community liospit4ils by helping set III) smaller care units Ili them, 82 ))rovi(Iiii;,, for the groiii)ing of rural community Hospitals for more efficient iie of existing resources. NVASIII',GTO.N-AT,ASKA AIFI)ICAL PitOC-RANI Tli(- IV,,i,-Jiin@toii-Al,,i,;]@a llr(@,riiii op(li-,itiozit] coii- I.,iri.,,(@ly witli eoiii@iiiuiijg ati(I training iictivit@i(!s to t@ii- Ilic iiie(II(Nil all(] C:il):Ii)ilit,Y. '1'11('Y focus Oil COI)IIIltilil(!IltiOlIS iiii(i iii,,I:riiet@loii fiji(I iii(,tlio(it)logi(@s wlii(-Ii tire ii(ljil)tiil)le 110 tlic@ far filing iiii(I r(,iiiotc communities in t)t(, east St.,tt(, of Alit.,;Iitt fill(] many rural (Communities, in Wiisititigtoii S(!v(!i,,,il I)roj(!ets Coll- to iiiil)ron,e Llic iii@iiil)ow(,@r ill (!4)llilllllllitl(!s witli limited or no ,4(!rvice.4, art, (Iist4iiit-, from it major iii(@(licjil c(@iit(!r. fot- Owiti-iiititig ],,ditcatio?@ for I)ii-ect Co-vt, $18,181 To bring tit(@ medical ri@soiirces of Lli(@ lJitiv(@i-,,ity of Witslilligt,(jii to I)Ikysi(!Iiiiis ill Y.,tliiiii@t, %vlio ill turn will act ,t,4 to ,;tir- y I'l)tlli(lillg @:lii,@illor communities tliroiigli educational TN', 4)lii(@r instruction; aii(i (,xeli,,iiige of and I)rtt(@titioiier,4. To ef,)iliiect intervals in Central Wasliijigtoii to Yiiiiiii,,t c@ir(liologist.,3 via 14,KG tele- j)))one li(@t-line, to permit quick analysis (.,4.irtin,, ivitli 5 community lio,,I)itils). Y:il@iiii@i i-, ,t community of ,ibout 45,000. The total I)opiil.,ttiou in 6 Central W,,ish- c(@iiiiti(@s exect,,ds "AO,000. In addition to tliree general bospitnls in Yik- iiii:i-St. Elizil)etli, Yakima Valley ',Nteiiioriil, ind New Valley Osteol)atlile-nine otlier community bogpittls to be reaclic(l initially are located in small rural colli- 'tie,,; of 11' iiiiiii Ileiisl)urg, '.Nfoses Otliello, Toj)i)enisb, Prosser and Sunnyside, ol)iil.itioii ranges front @I)OO in ',Nfoses City -to "iii(- 8,() in 14rlleii.,,,I)urg.) 00 2. Soiitheast Alavka-Pogtgt-a(litate I,,'(Iitcation,: Di?-cct CO.RT, $27,062 To iiiil)r(@v(, coiniiiiiiii(.-tition S(-iittl(, Nfe(li(,itl Community find ttio uill- N,(,r.,;ity to jill(@viittc I)i-ol)leins of fit(! isolated([ ltliysi(!iatis In soutli(@it4t Al@isk.,t cities Jiiil(@illi. 1,4itiiii, l@et(-Iiiliitjk (,t Iiii-g(,.,;t). As Ili Central Wlisliiiikl- toll iiii@tilo(is %-.,ill be Its consultant Iii)(@ t(i lio,41)itjil,4 Ili artificial @iticii and l(@lilliaii. Tli(@ 1)01)u- Ili l@(itiils iil)oiit, 1.7,000. S. Poktfl)-(t(?,itate Ili-cc(!I)torRhil) for Pli,ysici(i,,)is-Coronai,V Care: Direct C08t, $17,6.10 A I)ilot. 1)i,o.i(,ct, to ))rovi(le ol)lx)rttiiiit-.y for I)rii(,tjtioii(@rs from reiiiote and i.,4o- ])tell colikilillititi(',.4 to it weeic or iikore iiii(l(@r it I)r(,cel)t@or tit major centers to stti(ly a(lvitiic(,,., Ili care of corollary li(@iirt flis(@itse filed carry out these in flicii- (,oii)iiiiiiiit,i(@s. q'li(@ 4 iiiiij(oi- iiie(ii(@til (!(,iiter,4 Ili Seattle tire Ili-ovl- Virgiiiit 'iNIiisoii Iloql)itjtl and Medical C(,zit(.,r, -tied (Jiiiv(@rsity Ilo.,4))it@il kiid Center and two Ili Spoliiiiie are Deaconess itzi(I Siier(,(l lf(!iirt, Ilosi)ititl. $111,554 t fi)riit:tl for training (-fir(Ilo-lotiltiii)iiitry te(-Iiiiicinii.9 to 1)er- form noncritical fiiii(,tion !it (!oroiiary care tiii]tA ,iii(I free ))Iiy,,4iciiin,4 for other (litti(,,,4. Four larger g(@iieral hospitals in @'poliiii(,-Defteon(@ss, Iloly Iramily, Stei-ed Ileart,, iii(I St Liike's-will participate in tli,is training program with SI)olt4iic- Coiiiiiiiinity College. 5. Tico-tcay Iludio C(Ynfcrcnce an(l, Sli(7c Pi,cse)z.fation: Direct Cost, $S,,@115 -trolcc, tol)icq to be transmitted via Six pilot programs on heart, caiie(!r and two-way radiotelephone slide conferences, to pliysi(!i,,tiis and hospital staff.9 on topics s(@lecte(i by ptnel of 1.)Iiysiciins, ;tirtiiig with 20 lio@,;I)Itftls in Niltisliiiigton. To explore potential for continuing network scrie.,4 with local and remote regions. 6. A lail,-,alfcdical Lib@-arll Facilities: Direct Co.Rt, $21,754 To (I(@v(,Iop a community medical Iii.)rnry for Alaska at the PI-IS Ala.,ilca Native Aii(-Iioriige for Alitsi@it 1)liysiciiin,4 and health r(@Iiit(,(] t4(@arfs and to have (!lose ties Wallis community agejicie,4, Arctic II(@altli Res(@itreli, lliiiversity at; Fairbanks niid to 4111)plelll(@nt colktliiultig education I)rojcvt for Soiit,ii(,ai4t Alaska and the Anchorage ciiiicer l@rojc(!t. 7 83 iNl,'@W YOliK ItLP(41ONAL Ilti@I)ICAL I-RO(litANt Itotli of tlit@ l@rogr.,iiiis in tli(@ Western New York- region direct (@IT.(@t upon liekltll I)rof"sioii@ils, and in tli(@ rural areas. Ilarticiiljir eitil)litt- sis will be 111)4111 involving community liosl)itrtl,.4 and On training nurses from community li(osl)ititl,4 In rural The liro e(!t,.4 are listed ii.4 follows: (,Ioiitiotl(?)i(-fltioti.4 N(-t $170,;# /!I A Di@t%V(@rIC Will link Of N(-w York (country, I't@illisylvtiiiii to tlit,, Continuing I it,l)iirtiiii,iits of tli(@ ol' Yoj-l@ at ltiifi':iico ,iiid tli(@ iNt(,iiioi-ijil I fietAl-ol-Ic will S,(,I.V(@ iiiii-liose,,4, @itclk as (,obtaining for end the Ikill)li(! I(Iljlilli'413-sttiv(.' coiiilililiii(.@itiol), (-oll',Iiltlltioll Nvii,ll said among lp:liilis. It xvill both tiit, I)Iiysi(,j:kii and (-oiiiiiiiiiiit..v lio@I)itil in 4,.itli4,r the rural or urliill ('11vir(tilill(@iit: in living at tlieii- t@li(! advances in the of heart (Iiqease, st'rol@c@, and particular eitililitisis will be Upon iii),olN,Iiig rural liosl@it.,ils in this I)rogrttiji thereby improving both their an(] restorative function. 2. Coi-o@iai-y Ca?-c P2-(@i,at)t: I)ii-ect Co.4t, This project will test i training technique for providing (Iiialitie(I nurses who will be required to --taIT- developing coronary care units in the Region. AI)proxi- iuttely @ nurses will be selected from -ill parts of the Region for a combined academic and clinical course. It Is planned that the iiiirzes receiving tlii,, train- iiig will return to both rural and urban hospitals for the purpose of providing a (Iiigno.,;tic and didactic function. While the program will be housed at the iiiedi- cal center, the conii)iAiiiity hospitals of this region will be the benefactors of the project. Since there are few nurses trained to work in coroii,,try care units, par- ticularly in the rural environment, special attention will be paid to attracting nurses who will return to the community hospital. WISCONSIN R@,GIONAL AIFE)ICAL PROGRAM I-otir of the Wisconsin projects have relevance to the Improvement of care fit a rural setting, through the provision Of education and infor- iiititioii. Pliysl(-Iitiiq and jilli(-(l health personnel in community hospitals will I)eti(,Ilt front the following projec(t3: 01)(-rti(@loiiiil Projects J. A. pilot (letti(ni8ii,atioi@ program for pittittoitai-It throtktbocittboli.,tiib: tiost, $811,1;00 In tlii,4 project it center 1.4 being tit Mitr.,;))Ilel(l Ilospital In Mairsli- fl(@1(i, Wisconsin, for demonstration (li@igiio.4tic te(!Iiiii(iiies and the available therapy for pulmonary rl'ii(@ project has a continuing edii- (-atioii component which will r(@2ielk 1)liyqi(-i:tiiq from many lu)si)ltjtls In the Re- 't:ttioii , gioii. This Nvill iiivolv(, it 24-hoiir cotiitii ;(@rvice, the preparation of a ni(ivi(, on the t@ol)ie, and sl)(@(:Jal training s(@s,,ioits for groups of physicians. The lirt)j(-et will (leiii(@iistriit@ a (-oznl)reli(-iisivt, program which will elicom- I)a.,;.-4 diagnostic, pi-eveiitiv(@, therapeutic, laid rehabilitation procedures for pa- ti(,iits, p(wtgra(Iiia@tion education, a rapid txtngportittlon syst@ein for patients from Northern s(,(!tioiis of this Fititte, iiik(l cooperation between the clinic and other Ito,,41@itil8 and medical schools in the @9tii t4!. 2. (li(?l acccqs t(lpe recording lil)rat-11 air, the a)-ca-9 of heart diRease, stroke, and related discaics: direct cost, $18,950 9'liis feftsil)ility study will be ettrrl(@(I out by the Uiilvt@rsity of Wiscoiiqill which will kiiii Store short, 4-6 initial(!, tiil)(,.H on various aspects of treating I):it lt@ni s ivil@ii (@li(! tlir(T ADV I)Iiysl(,Iitii ntiywli(!rt) fit the Region cttn dial iii(- liliriiry at tiny time and request a tape relevitnt to a I)rol)leui In which lie Is S. Nitrsi)ig tclcpltonc dial access tape rc(,ortlit?g library in the areas of heart (iiscut?c, c(i,)ircr, sti-o7co atilt retorted diseases: direct cost, $18,800 This f(@iisil)tllty rtii(ly, similar to the one above, will e@blIF;li a central tape library with Information recorded on nursing care tit emergencies, new Rro. 84 Ce,(Iiire,g -iiid equipment, and recent (Iovelol)iiient.9 in nursing. Nurses from any- hospital in the region will be able to call at any tiirie to have a tape I)Iayed to t@liciii. D(,il-c,7ol)iit(.,iit of tii(,(Iir-al a?i(I hc(ilth t-(!I(ttcd ,?i?igle coizeept fittit Program in lioipital8: direct cost, $33,250 f(-asii)ility l@roj(@ct involves t(@ii (!oiiiiiiiiiilty hospitals in its loift(,Vll films On nii(I t(,,eliiii(Iiie,,4 iis(!(l In treating heart, and will be (levelol)e(]. Ilro.jector.9 iiii(i f@lie llliii.4 will lw, inst@fille(I III foi- iise by health 1)(@rsoiin(,.l at their con- 418 11 ('Olit@iiiiiiii, e(Iii(-Itlloii (I(-vi(l@e. Al'i@(-r four to six months tile tritt- in t(@ii it(](Iitioiijil lit)sl)it@ills. I i Wli(@,ii do you expect-, to li;tve yt)ili.- first evitlitittioll of ? 11, ],'(@gioll tl)[)]iCs fol'.t .111(l NV(' tll :1,111111,,Ll I)roLrl.(",3,4 I ig to g(@,t-, lip to L III oll(@, of r(,Lriolis. Is the fill was tt ii -t([(Iitiol t,l) tli(@,se liot-iiitl reviews tilt Nv(. 81,011](I Illollili-, 11 sl)ecitl site visit :tll(l evtllll,to the reffioll's status from t'lic still(li)oillt of the i)roLri-,titi. We now tre (toiii@ this all of I-,]IC tillic, I)icl@iii.,,r out times grlm niOvelTI(lilt i)arficul,,trl the y Iiift fr(;iii I)],,tiiiiing I grtiit and Pon rece t of a s u lp supplemental request activity. we go back and re- VICNV tli(@ entire Iiistoi-_V rOGrIZS. Wll,.Lf oi-t ? I)r. MARSTON. The first four operational l@rograms were funded at al)])roximttely the same time, Interiiiouiittin, Kansas, Missouri, and All):iiiv, N.Y. Mr. Could you let us have your evaluation of how effOctiVe these liai,(,- I)ecn, for the record. (The followiii(, iiiforiiiittioii w,,i,-, received by the committee:) DF,I-AILTMI-,'NT Or Illi;AUrli, li,'I)UCATION, ANI) WIPf,l@Aill@ @T@t'rl-NiENT ON 10,lelTCTIVENESS or ItF(;rONAL NIFI)TCAL ll[LOGItA?618 of Ftegiotial 'infe(licill Ilrogrtiiis is (let(!riiiiiie(l !II tllf-@ following ways: U, valuation, of tile effectiveness of each Regioiiil Medical Program is a con- tiiiiioii.s process NN,Iii(-Ii Involves review by the li'e(ler.11 Government, its non- advisors, said the griijitee itself. Tlii-,,;(-@ review activities are specifically to d(-(@eriiiiiie the extent lo %vl)i(,Ii l@lic r(tgioii liti,-4 I)ro(!- ess of r(@,ioiiiliv@itioii wlile.1 (!Ielllellts: illv(.)Lv(@iliciit, identification of needs and opportunities, asstssinejit of resources, definition of ol)j(@(:Ilives,, setting of prlorities, implementation of program activities, and self. evaluation. li,iiis of i-(,gi4)ii:ilizatioii is tli(@ 1).v wl@i(-Ik the region moves toward its ultimate ol)jective-tlic assurance of easily improved patient care for heart cancer, stroke, tncl related A systematic coinl)rt!heiisive review of the scientiflc and administrative of (@,icli lt(,.gionil Medical Ilrogritin has been tlesigiled in order to deter- illilit, the to wIli(.Il (.Rell liegloii,,it I.lr4)gi-:iiii implements tlii.'4 proc- -lio.@ of a(-Iiievii);,, its go@il of improved p@itieiit e.14.4 of regi(pjiiliz@itioii for the I)ui revie%v I)roc(,q,4 at the, regional in(] Federal level, all(] is (,on(lileted )).I, both itt)ti-Fe.(It!rjtl and F(@(](-r.,il Ity law eacli opera- tioiiiii ii(!tivilly iiiiist 1)(,@ approved by the. Regional Advisory Groiii) prior to Its siiioiiii,,4sioii lo fli(@ for review and ,ipprovjtl. Irripquent.],v the r(-glori.,4 naive elaborated oil this requirement by est@ablishiiig loefil, in ii(iolitioii to regional, n(lvlsorv I)o(liet4 and/or scientific review bodies whiell til.140 (Carefully examine I)rol)osed tietivltleti, 85 )Inittee and t@ti(, National Advisory A ;Ite visit I)y iii(,,iiiiiers of tli(I lzevi(!w Col ,,(led 114 all ilit,(!gral @"oilll(.Il oil lt(@,iollill 13rogr,,iiiis to t@)@c r(@gioii 114 ili(,'l 1)411.t of III),),.Ovillg all oli(,i-at@ioiial I)r4)gritlll foi, II r(,aioii. A.4 t@1)(@ OI)el-ltt@ l(@iiitl I)ro- gr@ii)l (](@vt@lol)s @111(i is exl)ltlided additional site visit's are li'ijiitlly (@ach 1'rogr:tjii Is rf@qiiir(@d to f4iil)i)iit tin annual I)r(@gv(.-sf4 r(!I)ort in (I(@titil tile r(@gioTi's 1)rogriiin. Any j@i-iol)osi@d iiio(lifi(,itti4)jk in I)ro,,i-iiiii (lir(,(.(@io]) I)Y iii(@ gr3iljte(. latest ])O JI)Still(@(I III NVI-it@ilig @111(i to tli(,s(! review pro(-(!dtir(@,.4. Iviil)ill tll(@ (!olitlext of this (@oitipreliciisiv(@ i-evicav I)ro(-egs it Is to d(@ter- iiiiiit-, Nvlieflicr or not a rekioii.,tl I)rograiii is !II filet evolving a regional system to iiiil)rove 1):iti(@i)t (-are. All)jiny, Ne@v York, ikii(I Intermountain Itegioiiiil I)j-ograiiis were the first to enter the ol)ei-lLt@iOll:ti Of (I(@velt)l)itient. The tl(!t(!rjtiiii,itioii of tli(-ir t:o begin ol)(,ration.,4 AN,a,; a resnlt of the review I)roe(@ss (les(-ril)e(l tl)ove, including a sit(, visit by ilicilil)ers of the Nqtlon,,il Ad- vi,@ry Council and inciiil)(!rr4 of lie staff of the I)ivisloii of Regional Medical ie I)rogress of tted during Prograiii,4. TI these regions has been further evalu, 'the review of supplemental rant requests which have been received from all 9 four re,;,ioi),-tl ])rogrini.,4. Fiirtl)er ,4ife visits by C(oiiii(,il -iiid/or sttiff. to review tile first y(@iir's I)i-ogress have either just been carried out or are scheduled for the it@t@ fiitur(!. The results or t'll(@so reviews e:irri(41 out. to (Ifite iii(li(,itte tliitt 'Nlcdic,,il Prograiiis ire iiiii]@i these lt(@gioii:tl i ng 8111)', towartl tile goal,,; set forth a year ago as the I)a,-js for the operational grant award. The Ditjor prol)lezii,4 encountered have been difficulties in recruiting personnel and slowii"s in the (I(!Iivery of important equipments. These factors have caused some in implementing I)itrticular projects. In audition to this evaluation ,it the national level, the regi onal programs are n- s"bifl st@ iitly expanding respon i ties in the health field. He went on to say: -ikes it clear that the I)rofes,.,ioiial and institutional relations "his exi)eri(@iiee ni, ire coii)l)lex and delicate. It also makes it clear tliftt it is painfully difficult to proeiire and maintain an adequate supply of trained manpower. A functioning re;,ioiial complex ... would make the etrorts of the practicing physician more effective, but the development and ol)erii@tion ... will require a marked In- cre.i se in trai ncd manpower. 1.1p, tlso noted trait the success of t regional coi-nl)lex is lietvily (I(@p(-iid(,.iit@ oil the continued laid growiiiy @rectiveness'of the medicil school iii-id the medical center. At this tinie@ 3 years later, we consider these observations still highly pertinent. litit ill we I)eliev(@, eirects of Public Law 81)--2,",!) to It li@i,; it )lle(.,Ilttllislll by ]items of file \',itioll@.,i s(@llool" liitv(@ 'begun to with inti) to coll)lllllllity ill(l (..Oll"llll,icr 11(@:tltli :I'll([ to ivol liiv tll(l Pi-of,o"%Sioiiil zi-oiti),, in ii(!NN, methods of coping witT, needs. It has ii@itiaie(i the of the Natioii into ilc- (Y: I I S, for the purpose of d el i N,e i-y o f I I eil [II servi ces, very effectively. Aii4l although this oi.-ganizttioiitl process ]iu not Yet T)roceeded to completion, the results to ditp, more than jiistifi tli() Plislillt(re Of tli(@, I aw. AVe %re well lware that efforts to implement the legislation ha-%lo been associated with iiiiiiv i)rol-)Iems. Reziont] orbital @,,Ltioiial struc- ttii-es for tiliftt matter tlie defiiiii-,i(ii@'of re(-rioi@tLl;boujidtries, ,tre in soiiie installed initially coiiip](@x iii( cliiin-,.y. Some I)rofe--,- .sioii@tls complain tl)ttt@ t,liey do not, iiii( ei.-Stit,ii(I the intent of (-,lie law Ill)(] ,Ai-o Suspicious OT. it. I.,,'LY ill)(] I)I-of(,@Sioillll grotil)s Ni'llieli, Ill SOI)IO i.-eglolII4, tire ittteinl)t;ing to reach joint deoisi6im for the first 124 time, iro li.,Ivi lig some dililetilties. Aii(I oceisioii@illy one heal-s the of (,Lillillo-collti.-oloft-,IieNitilioti'slie:titlic:tl.L@, ',YSL(kiTi. 131it ill'-Olll. viewl these difliciilties were to ,iii. extent-, 1.)i-edicttl)le tiid iiilpoi-titiit point is tliit t,])e by iti(ybiliziiiv local @,t (,ool)@-i-ittiv(@, @tt,t:lclc oil proI)I(@ills"Wlli(,]I, ,.,Llt,lloll"ll Iii,@-lily necessary, not 01)(@.I.@itivo 1)(,.I,or(@. III olir view ilie (yellertl consensus lty ,tiid I)i-ofessioii@tl is Iiiglily ftvoi-,tl)lo to t,lic, IILNV. The iii(@dic:tl scliools tli(@ilISCIVeS ll:l(l (,Iiffi(@LiltiV@S ill tli(,ir oblio-,ttiojis iiii(ler tlip, Iiw. A.L:tiiy of When Llie ].tNv wall laid no tdii)iiiistr:tt,ive wi,,, -),-tble of witli t,lies(, new rc@sl)oiisibilities. Ill soiil(, instances ill,, iiiiclc@r trip, ]'INV- involved coniliiitli)ont of prol that is tlretdy ftilly committed. Far fi-oi-n -ttt(@,m] over coilt,rol of t-lie 1)1,ogriii-i nitliy, .tn(I pei-li:tps nio.9 iools naive, b(@ii slow to become involved 1,11.g(;fy owi of This li:is beeii especially -icute I,, t,])c SCI)OO]" move to e"'in to meet tll(- shortage of pllvsicitlis. Y(,@t there is ]lo (I.Oub@i-n-our iyiinds icil selloo tliitl oiir ille(i Is wisli to be involved as effectively as possible, ]lot, to grain control I)Ilt,, ill ]@OCl)illg l@lle, illi@elit@ of the law, to i-n,,tke their more, to,,tll who need them. lit,it@ t.iiis viil:tl iiittter, ,tii(I the cqit:tlly vital mutter of illiprovii)g ex,j):I,ll(@liiig out- (constitute ,Ill ol)li- Lrttioll tlliitt, c,.ui iiiot-, 1)(3 iriet ol)ti iii:tlly iii. t few. ifiontlis. or even 1)erli s fair 2 or il -years. The medical schools swlc no sl)ccitf privile&y-c uli@lle)r til(I r(,,giolltl iiie(lic-@ti pro)4_,i-:tin I:tw but, ivisli, on the contrary, to as- Si ill AVo the ori,,,iiiil I:tw ol)ei,;i;(,ed ("XceediiiLrlv,,iiiiootlil li(@ I)Itiiiiiiig T)roe(@,,i(@s it ]I ? y Its initiated. IVe li(3 of t I also b(@liev i:it Clio e been or soon will b(i few ill tl :tltei,,Itiolis. When the I.tw first b leiiieii:l 110 .4)"Clloltlly applicable Protot@pe@ types specined. A number have now em e more effective tli,,tii others. m,,Li,, in our view, soon b( r ii-iore defini- tive org,,tiii@ on,@l'guidelines to be pro ivision or Re gioiial !NIcdicil Programs. It will ,,Is b( in the future to 0 reconsider critic,,tlly the geo(,Yi ai-ious regions. The responsibility and autlioi of which IT gi-ou ps@ are too (11 to function effezt cletrer (lei And the iii:tiji t@lirLiSt@ of the in our view, to be restated and I)e(@ii frequently iiotkd that, its central focus Of. the Itw is the p:tt@ieiit-, ',tied his '.Vliis is iiii(Itiestiol1ql)lv ti-ii(,. ]@itt -.t iliore role- VLlli@ NV,@y of s;tvi))Lr t.,Ilo ;.tillo t@litt t@,lie litw proposes to"* of tll(@, Nll,i,ioll, (,o(>I)",ttivo t@lle opi-)or(-,tiiiity of t@o ill the (littAIlosis of t'lit@ (Iise:tses ll!tlrlt)(I ill the, law.,, III o(-,Ii(,r woi-(Is, the litw provides us wall the and authority to t3icittiis and otlier health workers to pro- fill(@l wtys of tssisting plly 125 vi(it) Aiiioi.-ic@iii 111(@v iiitv 1)0, with better health cli-O itii(t to 1)1-ovide tlitt care iiii@re lily ,ill(l I)rof,(",iiioll:tl not-, iiivi,riably L)c(,.ii idea]. food I':til,ii iiid between sll(,Il ',VI-ottl)S Cannot 1)(@, 0110 of the m@'t stril@ing )Iellts of tll(3 ori@in-,-tl ltw is tli@tt, it has set the for the develol)ii-ieiit of effective c7ool)er,,itioii between these grou p Tiie ori(yintl ],%-%v is ,tceon@l-)Iisliilig iwhat it set out to do but the It which such develo meiits call ])i-ocec(l must be viewed retl- AVe are not in I those, who s, tll(tt, the PLce Ity is unsatisfactory; oil til ie rtte tt which i@laiiiiii1cr- li as proceeded has, to drive, sive, owing in no siiiall to the uii.derst,.t which litvo characterized tllo,t(iiiiiiii,@t-,r-,itioii of the law. J,Iio next 3 years will 1)(3 critical ones in that whit been done itiust, then @,ill I, ve to 1) el-itict]ly evtlli@ite(l; tlllbt wlii@Oll is successful that which is iiielyeetiv(@ disc,.trded. At this sti-tze. as ill til(3 1)1,'Ljiiiiiiz i)li,,tsc,,, the iiiedictl schools ctii ,tiid no doub@ @viii r(@,ii(ler sigiitl se vice. Wc@ Mr. (,',Iitii-iiian, file ltw should continue to operate for the I)res(@,iit, WiLliolitcitil)stllltive but that the results ig it is pro(Iiicii iliusL Soon to be el-iticd]V eN7,,@l i-iai e(i tii(I set-iit@inized. The Nitilion's @(,,IioOls -,ti-c now iiiv@lve( foi- t@-lie iyio,,(@ to extent of )lo(-, ill @ill (@il'ol-il to (r:i,ili (!outlets but-, to 11(@ll) to (lie N;t(,ioii,,t service. Aii(I its we go 'I,I)ollt, meeting our ol)li'-',Itioll'4 header the Itw, we t-ii(@, iiii(lei'st@i'lidijiL, of our (francs; those Nvlio feel tliitt, we ire r(@acliijig for @loiyiiiitiice, no less thin tlioso fist oi, viL,,orouslv (@,iioii, who feel (-,I itt -sveii-c not moving gli oil the other. We,,tro-,AIr.CliairiTi,,tii l-,tced@quti-el i@tlieni@(ldlel)utwerecogiiizc II) - y that the essence of the re,,-,ioiitl ii-iodictl I)rogrtin activity is vittl io the welftir(i of the Natioii. It'is oil(, of several iytajor obligdiioli.,i which wo Mr. ftiilc you, Dr. (11 itl)ii i;tii, -for ftii (,,xcolleii (-, start eni(,,ii t,. T iiii,rlit@ sity, tot), t,ii:Lt, 11(@("itil talent. ]letter (If y@ii@ wero i(II(@(tl)i,(@(II)YI,Ili',(-.olilillitl(t@.(@iiii,ii(@wi-it,iii,,o@i@ col-igililtl'i@NV.YOUWCVC (111(@tioltill", if NVO eotil4.1 it froin ])v. Lloyd I 1'. l@, f,A rf. A@f 1'. Cl 1:1, i i'l I I it it, I I I y 11 it I I Iis ]',I o y (I I",] 11 I I 1. T final 1) I-esi4iolit 0 f I)osii,ioi@, I Nv@is clittirjyiti'l of tlit,, of Psycliiitt@ry at Meliirry ai)(I for a I)t@ief (I(@;lii of III(" S(@'llool of I SI)e:tl< to(l,,ty ts iii ofl'teiii rel)i-es(@iit,,tt,ive of the A-,-,ociition of 'c,tii Colleges tii(I -svisli to coiiii-neiit si)ecificall oil rel,,t- y tiolisilil)s between re(,ioii:tl I)i,ogi,.iins ,tiid medical schools. I (loans, before You to(lty ,ts olle Who has ]it(l direct OXI)CI-iclice with I re,("ioll,tl I'lle(lic.,Il pi-ogr.Liii, t pi,oLri-,tiii ivliieli is itlre,,tdy entering tlio p ol)er.tt,ioii,il I)Iiase ,tf t@et ro_"ress in bringing to(-,,Ptlier various liciltli in tl)e'@Nf idsoutli are,@(Iiiriiiz its T)I-,iii- nii@ig pliise. I liavet deep concern ,tboiit the ,tvail-,ibility and'iiialfty of health care among the poor, especially in our cities; I am particularly critical call (10 ill (Claim area. f@i(!t tliaL. iiiv iiist,itiit'oii, -..Nlell@irry -.Nfc(licil Coll(@,,(',, Illo\@'S )Ile to Clill)lllsizL@ the J)olllt Nvf" ;I, Oll OLII' fillilll"('S 01- 0111- .LS NN'e of our i@(@(,ioll, l'o ll(,:Il.t '1114' "I , I , -, \\'(t (14) ',o N\'itlli)ilt j(,ol):Il.(Iiz,li" our (Iticl. tioll:tl ol)li"@it,ioll. Ill(l tll(,' otli(@r 111(@(licil @,11001'i of tll(@ N,@t,tioll Nvi--Ji lo it st@l,ollfr of i,(@,I)oii,;il)ilit@y for tile of' ill)(', stii-rotiii(i II,,. ],'(@,(,@ioiial iii@i- oti'L@r:i.ix ol)l)ort,uriity for sii(,Ii iiivolveiiic,.ikt,. ill file, I)o','Sil)ilitv for our (,@olleg(@ to ctr@y out tlielr iiiii(Illo ill colliliiiiliity esl)ecitlly ill tile devi3l- o )Illellt, of [)Of i@(,,r wtys to al)r)ly iiew -.tii(I a(lv,,iiiee(I proce(litres tiid im- pro@,ed ways of ediic,-ttiiig li6,tli@li I)crsoiiiiel for this taslc. I-A@,t, ii-ic briefly liow tlie'Peiiiiessee, Nfidsotitli re(,,ioii:il medical i I ill tile next i,oiri:,tiii ciiii(@, nt,o I)eiii- niid Nvli:it we exl)(@ct to,,tccoliipi sl tn It?(" w A@(111irl.4. Tli'(3 wis iiiiti@tlly estil)li,,Iied fliroii,,-Ii the Co- 01)(?r,ll,iv(@ ell(le:lxors of ,t wide VI,riet,y of iiitei-estk@d -rotips in Ten- tn 'rlie involved Afeli:ii-i-,y Colle-C, Vanderbilt Ui-ii- @("1104)] of A lfoSI)it.11 Ill(l Council of' LNasliviii(,,, I)riv:kt,(@ lio.@l ')i(:t.ls, 1)1.11)lic I'll(] Volillit..il,y oi-g,,t,iiiz;ifiotis. A re-ioii,@il',,tdvi- ,-i-olll) w;ts itil(I I)I:lli)liiiig funds NN,er(3 received in 11 our or, for I)I:tlllllll(r ]la,, I.(,Islllt@(,(l ill -,til (,II- of ll('llk.1111 l@l,ol)l(tilis of 1,11(@ re"ioll iiii(I of I)(.,%v -ess by I l(l@ II i II,), ways to Solve talent. I cin ilidi(,iititlio extent of our I)i-ogi voti tli@it, in 19C)71 liloi,(@ t-,Ii:tii 10 iiioiiiiis litei-, it request, foi-:11 pr(>.i(@(-,t,s to be out, in tile V:kl.i(@(I wi(tely in :iii(I in s,@ol)(@, but-, Nvitll solving It oil st i-ol@(@ Nviii(@li li@i(i been i(leiii iii(@d (iiii-ifi(r ties I)Iaii- ()II(!, ])I.Ojet-t, IVI)i(,Il typifies ill(', iii(I allows film to sl)e:llc to ,-t P@i,i-(;i(',UIIV PROI)ICITI t-liit. we at,infeliirry ai-c@,.tddressiti(,, is tll)o progi,,i in I)i-oject concerned witit ]on,,-teriii CN,aluttioil of IIll(-" liezl,ltli -,ttiiis of @',O,000 underl,)rivile(re(I persons iii all urban pov- ert\y aretkiiowi-i.L,3 nortJi N,,tsliville. Oi r del),irt.-neiit of famil)r and community licall@h, in conjunction Avitli tile Office of Eco uiiity, is-est,.tblisliiiia a nei,-Iibor- lioo(I li(Ntltli c(@,iitor for iieeay peol)le. Tliis'@,3, as you can I:tl"o-,o iijide, no iviiieli re(Iiiir(!,g ,t grott deal of ii'lid eifoi- s is to (Iot(,rniiiit,, ex- ;it,-t,ly NVIIlt; ,;.Yl)o of, (,fLi-o is 21 Ile,(] by tlies(@ Allotll(,,],, or (!olil.s(@, is lo 111(@:I,slli@o (,] (,.iti,o and to iiii(i out, i I' it is Avian, it-, so ]i(@ ro,,ioiiil iiioclictl 127 issilp i(@ii of I'an(i ']:tl)ori,toi--v i.,; .iii adiiiiiet to the nei(-YIil)orliood liealtli ceii@r. Tllo co- iiivolve,,i cojisiilt-,,Ltioii ftzid coinptiter serv. lees ii(,t,(I(@d for tlio autonitt,ed laboratory procediir(@s and recordlceep- iii,, inedictl i)ro@i-.ti-n supl)o@t, @vill ii-, iineovor I)ctrt stil-ok@-in this I)OI)iili-ttiozi in-tlio earliest stftges, (lo(-,iiin(!iit:ttioii of t-lie type of illiese disor(l(@rs, as- ce in tli(@ initiation of iie ssaiy treatment, and aid in eV. ti,f@;itn@i(!iit, tli(,,se, I-):tticiits rece.,ive,,it, the ii(,iffliborltood lie,,tlth centei.- 'I'lle ])Otelit-i@ll of t coopci,,itll@e al,i,@tligeiii(,,iit 1)(,twe,(Iln a miiltipliasic S(,i-(,t@iiiiig ],,il)orator _y for the identification of need for ii-iedicil t])]-oii@rli (@,li-lv (Iiigii-osis aii(I of t n(@iglil)orlioo(I lie,,tltli-ccxitei- for meet- ill- flat is @ry great. Tlii-i wiivity would hive been difficult, if 0 u,,(,crt@ not t wit-lioiit. t,lie lielp of rooioiiil nic(lic,%l pro- (rilli@ill.@. @11--tiiy of i-lic ,iiid iiiij)oi,laiit clei-noiit-, of rexi6iiil ill(II(Iic:tl I)roLI.;Lllls Present ill this olto I)rolec Ig to t: Tlie, ot- 1)i:@,i,ioiisly di.;I)a,i-ate elei)ieiits of ilie'iiiedica], @stein- I)jlovi(iiiiLy of iii:Lllpowei- 'I'Llid funds t@ tliiiiL,@, (loiic-iiiid the coniiil(,Y to l@itli the i-ei@lly si,@iiific,,tn;t, is -@ies of our i-caion. 'I II(,. involvement in rarrioii@il I)t-o,,,ri-aiiis (if and ll)e(lic:tl qcliools i.ii(I of iiiiiiy ofli(@r inedi@e,,tl schools I'll this coiiiiti-y, is fair fi-oin siil)erficiil. ljiolee(l, iii. iiittiy iriedict] S(@llool in tlii3 P-stLl of ilic regioiii.1 iyiedici] I)rof,)-i,,tiii ;aid tli(@so institutions leiit tli(@ir expert ill t,ii is i-nt jor ne,-sv proariiii. Tlievti,o itceOI)tilia responsibilities 1)(,Nroii(I tli(@ traditional ones (y@ iiiedic-,t] students ii-ii(I conduct- Tl)(@,v li.-Lv(3 I)ef,,tiii new 1)1-ogi-,iiiii to ti-iiiisltte iiiore t'll(@ fi-iiiifs of n-tedi-c,,tl research into improved ctre for the 1)(@i wit ]I ill t@lle I-eaiolis that t])@y serve. lil@(" y by (serving iriy -.iiid entliu@siutic support; to the iis pyo,-rani -rcer(, I sii ly hope tli,%t you will 1 estiiii,,ttion of its grett importance. Thank you of speaking before you today. lani. .Nfr. RoGFR,-,.' Are tliero,,qny qiies ions @lir. I-Zi-ros. I have oil] .v a. few questions. Dr. Cli,%I)iii,,iii tnd Dr. Elani, I want to welcome you here %nd thank r your statements. Yo@froCIiapiiiaii, gn @@cre 2 of your st,-(itenient you include in your re- inai-ks that, @c,%sion,-tiiy one lie,,trs the view tfi,,tt the medic,%f Schools ioii-,tl medical pro(,Yrtin for the purpose of n slie,,tltli cii-e,-,ystein. i illiit, ,L little @it? What is the prol)lein tli )loin t'li.,tt lirgelv bcztin to dis- @t] when tile ],,i@v was Cti-.st IPI)(Vill, I illiililc. We hefted this a froo(I (IC, p,Lss(@,cl. lit ti(](Iitioii, we ]ttv(3 heard fears expressed tliitt the medical lliig] I-, siixil)ly like !fluids fill(, were tvitilit))Io iiiid(@r this law itii(I use then, for ongoing school Of colii-.@l this -is not I)ossible tire litw, aiiil I think I call sblto with Laurance that no ),nedical school is doing that. Most of us have 128 ;III-iotllli"s of fluids in order I)rovi(lo(I til(@, tii:tl-, we tieed(@,(l to cli@ible to us tl) be ilivolve(-l effectively in this I)rogj,,iin, but I don't think, Mr. Kyl-os, tli:tt tlies(, critlicisiyi,;.,tre at the iiioiiielit V(31-Y ,(,,rious. l@A-IOS. .1.11 the, ,3t,:Lte, Of 1. IliLV(@ tol(.'l by doctors that one of tlie, i@,tliitbli3 b(@,iiofiti of tlii.,i I)i-oLr,.Lin is tl),tt in @,,t Stat-,e where you (loil@t, li@LN-0 I. ]lie(] ictl school, ,is in I iin,,tirine there, are other @'t,at@es in i@lio United tljLt -don't )i,,tve ,t me(Ti.ea.1 school- you serve t,ii educational function by disseminating vital and cur- reiit, iiifori@nitioji to doctors who iioriii,,tlly would ii@t have that kind Of I'liforilil,t.ioll. 3)1'. CIIAI.IIfA@N. YINS Sir; and n-I'Lily of us ivlio,,tre (le;tns regt!-(l niliiy of t-li(@, iiio,3(@ i)iil)orttnt %sl)ects of tliii tctivit;y to be the colitiiiiiation education f(@,.ttui-e for physicians) and in our own northern tier of Kyi-os-of course, we three regi ns there Mtiiie @ittid" Verii)oiit are septi-ate re,,,,ioiis, and Al.,tiiie is tioed in with Now IN,'o trc, inm@iiig regularly with the Mtiliciiid (-,lie Vermont regional ine(li@1.1 program otlici,.tls, ;iid one of the i-ntiii things is this: ti@ con- tiiiii,,ttioii of ine(lictl education. -Nfr. Kyi@@os. Oil pige 4, you talk about t@l i ic desire, perhaps, in the act to obtain ,t more definitive orginizatioii,,tl guideline ,tnd to reconsider critically the str@ctur(3 of the various regions. What spe- cificlllv,.tre Von s i@-g@sting?, L 'Llld is a good cLso in point 1)1'. @]fAl@31AN. New l@,ii I, As you well ]@iiow, sir, New Eii(,rltnd @r a long time Was b(,,(,@ii working if,,Clf ts I re(,rioii with the northern tier of St,,,ttes focusing for many purposes oil 13ostoii and to -come extent oil Albany ts well. Our present regioiitl structure, will undoubtedly have to undergo modification. Ill i,@t, I would sty it alre@Ldv is in-a functional sense. The northern t@ier of States is a -,finiltr ill terms of population$ ('00("]'.tl)liy,,.tiid ineclictl licilth problems. Mr. ].:Yltos. 0 11 ri page 4 ,tg,,i' ol)erttion between I.,ty and- ! I you,sfty co aroul)s,iii desiLriiiiiL-.gucit iii(lillo(Is-tl)!,It is of setting the in@,,tetion for t@lic )live been most iml)r@-sive, but the bitlttnce has not been (VI-olil@s iiev(3r 1)1'. Cl l-,IrAN. I think it is i of I said earlier, tlicr I)e@foi-(3,ire itoNv li:tviii,, to (lo so,,tii([,,t ill tll(@ State, sonic such clifl'iculty was inevitable and indeed I)reetict,@ible. In our own area, the bil.,tnce is coiiiiny ,ti-oiind very iiicolv, as I see ("liz 'togetli@ the operating in the advisory (rioup, ivliicil has brou, r POOI)IC who Tiftd certainly never ,tpproaclied any serious proposals tog@,tlier ioiiitlv. Alr. IC@os. !)o I understand your testimony this morning to be en- tirely in favor of the program that is set forth in the acicbefore us today 9 Dr. CI-IAPMAN. Yes, Sir. We would consider it verv distressing in- deed if it were not continued. It is at the point now where we Will begin to obtain the critical information we need in order to bring forth a program that will really do the job, and will really carry out the intent of the original act. 7 7 129 iN[i,. l@ytzos. Are you satisfied with the $6,-) million provided for 1)1'. CIIAI-TIAN-. I aiii really in iio position to spetk to that. I believe under the circumstances it will take us the next step. I -1@ -ii n @Ali-. l@) os. ])I-. I understand your iiiiili,ipliti,sic screci till-li('(l 111) iitei,iiio cancer III I)iiticiits that would not otherwise litiv(3 Yes@ @ir; Valid the, results of the sci-(,@eiiing will be sent to t (lo(@tor in the ;anticipation of turning up such things. you. @ARTI@,']I. No questions. iNIr. IZOGEIZS. It has been helpful to have your testimony, Lnd -,Vo ,tpl)r(T,i,,ite -your sharing your l@iioivled(,Ye with the comynitfee. I hope that @,our uzze or ,tTiy improvement thtt Ive s sel6n f -you 'vill lot us 11@ you tliiilc ih@, pro,,rtiij -,Iiould @idert,-,ilce. Ptrficul,,t-rly I am con- @tl)out bringing in more hospittl people. I think maybe tl-iis balance tli@it you are tallcina tbout the p(,,ople in tl-ic pro(yram, along with the ii-iedicil I)eoplc-l think it lia@ g6t to involve more people, and I would lilce t@ g6t more dettils if you could submit that to us, on your c@x,,iiiiiiittioii prorrrtm. I think this could be most helpful to the coniii-iittee. !)r. C.IIAP.-,rAN,. Tli,,tnlc you, Mr. Chairman. I\Tr. r@,ooi,,Rs. Thank you. The committee stands ,idjourned. (IA'Iiereupoii, at, I'-)i:,IO p.m., the coiiii-nitt'ec ,tdjotirned, to reconvene :at 10 Wednesday, March 27, 1968.) ITEGIONAI, IIE@DICAL PROGIZAilIS; ALCOHOLICS AND NARCOTICS ADDICTS FACILITIES; IlriALTII SERV- ICES FOR DOMESTIC AGRICULTURAL MIGRATORY WORKERS WEDNESDAY, MARCH 27, 1968 I-lousn or Rrl'RE,,4ENTATIVIS, SUBco@Nf ON P'UBTIC I-IFATTll AWD Wr@,irA'RIO, CO@t,Nfl'l-rFF, ON INTFRST@,@TF AND FORPIGN CO.@IrRrr, Was7bington, D.C. The subcommittee iyiet it 10 piirstiaiit to notice. in room 2322, Ra3,burii I-louse Office Iiiiil(ling, Iloii. Ptul G. Rogers presidiiig (Flon. Toliii I r ntii-iiie licariii(_,s oli 11 dticed I -ii:,,4;rs of V ,tnd ol-ir oi @ieliarcl I)iLley, lit wllo.,;o statement W: Nvllo is tl it-,i%-O(Iir(,ctor of Clii Al,,() i,i d ve you w s Miss Siiyd will be I)l eii s(@d I11 io iiiayor's sttt-,eii,ictit. STATEMEN CHARD J, DALEY, MAY 0, ILL., PRESEN IS K. SNYDER. EXEF, DIRECTOR, MAYOR'S COMMISSION R THE TION OF PERSONS AND CHICAGO'S ALCOHI SN-I-I)]-'.R. 1',Alr. Cli,.Ii this opportunity to add m for i)assaae of fitle 111, p t Reli,,LbiliCatioii Act of 1968. n ellici,,o ]live long I, in adequate Pro- grain Of -,tlcoliolisn-L care ,tnd, y =of the fine roI. '%N Ic beinz done tt C a muni.ci- )'tl y Sill)];,Orte(I ficili 11 72 rn,,iles and out- ll),,Itlieiit services tA) In( II. has been operating since 1957. 4".\fy Collilli@ lit ioll, 22 very :ibl(,, dedi- is alco- citizens, 11 liolic 1) needs to Come 55. Our tl,e,ttirii rect result of their re of this commission ll,,tvo eoiifii-nie, within oill, fi,, to ii-nplei-nent the lcincl of coi am cess,,try. Inasmuch as Chicago and 00 alcoholics, more tliaii oiie-hftlf of tlii 131 133 III(I sill n- iII13 coiilinitt(',(. if you (,O c ver.)r interested types if tr(@a,iment t this coinni ttee, I)r. Michael (,,iit of Surgery, 13,tylor Uiiiver- s ii, Tex. as oil the President's Coi-nmission was really the (,rui(lincy force f, 9 to receive @nd we vre pleased youi t i-iiony,.ttthistime. STATEMENT OF DI[t MICHAEL De BAKEY, CHAIRMAN, DEPAIELTMENT OF SURGERY, SITY COLLEGE OF MEDICINE, BAYLOR UNIVER HOUSTON, TE@ X. YOII. :iiii, irriti,o@fiil for t@ii(@ I)I)oi@i,illiity t 0 tr:tlll 11 I)f)o,:tr -ol-o i@iiis ii@ @l@ (li(I oil Tilly 7, il,!(I)5 ill slip- ii i(I to oil i@ii(@ir Avoill(i lilce, I() iiiy thinks -foi, @%,l Iiti@ (@lli)il,o CoillilliLt.,eo oil Iiitvc doii(@ to develop this I)ro4yrtiii, ti I)rogl.:Ljll wili(..,Il is ,ilrctdy Sot.i-,ill(" -,I pattern el II' ,i@] I fol "ti-O I coiiie, before you ill -,t-,rOD(,r Fill@t)pOrt', of I of II.R. 15758, intro- Mr. St,,(i,g y t-,Ii(3 chairman of your fill] c g(@ i@-. " f tli(i Nttioii,,il, Advisory Coiin(,ii oil Re- li:tv(@ ])taii t iyierribcr 0 ,tms siiim, its creation, -,iii(I 1, tli.cre,for(l, have had ises, ,tiid see pro,,) ni iTi it-, pit iiiiig ph, ry ts IV6 1-toped it would. I b, n tve been @uilty of imj),,ttic co, but I thi@k, at a normal pace bqs developed and in a very soun way. Now we are at ,b r oint where I think we will be(-rin to see the first fruits of this pro,-r,,tm in ternis of its original obj@iive which was to provide the best possible care, for the T),,tti@nt at.,ill levels'of our society, ,in(-.I to extend this Iciiid of care to every eitizen. This was a need we have but were not -,il)lo fully to tcliiove ill the past. 1)(@lio,v@ this progr.,tni will achieve its initial objective-"., ceit-,Iil-kly ill tll(i of I)CILI-T citii(,,er itii(I stroke, and liope-ftilly ill all the trets. At@ tliis I-.iii-io iti-t) f the let-"i-,Ititioli I would lilce to dis(I'li,,s in moro,,pecific t(,rins. You will recall, Mr. CIiiiii-i-nftTl, ill the 01@llalll,tl. @'Stiii-ioiiy, ,tii(I in the ori in:tl bill there was much discussion 9 of milsi,,i-iiction authority. I think the committee was Nvise in pointin out that without this I"Il' type of autliorizittion for now consti-tiction-tiiere was authorization 134 for 1-ciio%,;tt.ioii-tliit the program would not 1)(3 jeopardized in the we are iii the ti-eit of a(.-,tiitl operation, tiid tli,e@ld \,ow, ,ii,() II 1)ro-i,-,tins fiiiictioiiiii,,. I would say bv the next several, itiolit-llq, 40 or r)O percent of the wiil be in some Phase of ol)er;ttioii. So we, tro morning, you see ite I-'tT)idly. qii -,ks we movie into this (!oiisi i-ii(@tioii iilgly illol.(@ 'tire[ tlreit(ly we ll:tN,e Of tl)iS IteANI. is ftirly sl)ccifi(, iii i-L)i(I f:tit-ly lityiited iii is ]lot-, oil tile s:tiil(, existiii4r n c l'i co)isti-ii(!tio n Nvitiiiii tile iii(@dictl e(,,ii@r.,@eoilstli-itetioit for wliicfl'the c(,@nt(,,i-stlt-etdy Iiiti-o tile, ittitlioi,iz-.ttioii if not, the i-noii(@y. NoNv, the (-oiisti-ii(-tioii itiitliori(-,v we for t@lic I)rogi.,-Ll-ns ;tl)l)lies I)I-illl'tl-i]Y to the (@011111111i)ity and to the lliol.(@ units, where tile I),Ist (@olistriief,'Ion has xiot..tnticil),,tted this t@ @ of )roLy-riiii. 11 lo is (lo(-iiiii(@iitittioii and oiitliii- Of tile, A-It],Iolis t, I -VI)es of e-oiiqti-iietioii needed. I slloiildlik-@to do,Mr. Chairman, i,;itliertlitnt,,il@e yoiirtime now, is to subi-nit ,t formal -,tateiiieiit for the record within- t]-ie next few d-,tNs. I had liol)ed to have this reidv for voti tod.%y, but I got ini-oli-eA iii t series 'of emergencies over tl@, weell-eiid. roGF.R,%. IVe understand, and without objections your form,,tl statement will be made t p,%it of the record, following v6u'r testimony. Dr. T)El3Ai,,ry. This is-tlie limited but well-defii@d need for new coiisti-ii(@tioii. I leave to the coniniittee's jtid(,iiieiit, ts to how this best slioii](I be ',]lo-%v me, to I)oiiii@ out tli,-ii- it- is i:il for t ]to future <) f t]) ro- cri.,l II I t,o f i 11 (I )I IC,,I )I,, o f II I(,(@t i I II liese ll(,e(Is o l@ tile Coll III) 11 11 i I-,y lios )i tS. I :11 I; @ : , -Y of ]:Ll)ol.:It ol of ].(@,ti ill,,- to ]lo List (list,@ all([ out- II siiiil)ly (It) iiot, this t-yl)e of sl)itce ,-tnd ll:i%,(" of fii)(Iiii(r 111(@'I'Iiiids to provide, I,Iiis'kin(I y of (.ol I Si auction. Nf t-. ivoill(I I i:i.ve the s I IC el iii fail pr<)gi-.tin where we must. look to the full( i ig v s ov r tll(,. (,.o..,(, of will retcli tile we Visualized in our of-igillii coll(!(@I)ts -Ill(i tile ori-iiltl 1)1-01)0,S-,, Is ill the Com- ii Ii,@-ioii',, i-(@l)ort. )-oil Ali]] recill fliqt we (-,xy)ect, tiara to reach ititliorizatioii levels of over $4.@)O million by tli(;eii(:l of -) years. Now we %re I)e,.yoiid tli,%t oint iii our tliiiilciii- aiid we iio-,N, better evidence of wliit the p needs ire goiii(,r to be. I would say they will al.)I)roxim,,i,to $5 or $10 within tile, next. r) yeirs. Therefore,, I would hope -its -ititliori at ioii It@iT]s of some $500 in'l- tile, (.committee will coilt@lyll)], z riiis level ivill' iiot@ ]lo Soon, r)f coiii-so. .1loNN,Cvor, I ivoill(I their]( 1).Y I f)71. NN'C, Nvolll(l be (,]O'.4) to @tlie $'IOO million level. I Nvo;il(l Iloilo by their, triple tile ol)l)oi-I iiiiit@i(@s ix) 1)rovi(lo f training at this level Nvotild 1)@ reform reitdily av'jt-illtl)](3 truth itt"t@Iiis iiioill(@lit. 135 :iiiv qlie,,,tiolis @'oll iyl;,(l to for criviiig us Tii-,iiil,: you N,(@ry I'llic@ILI your vlel\!])Olllts oil this pi-ogra@ii a@@d its inil)ort,,tiice. ('oil]([ 3-oit giN,e us all ol 01113 you ])IIY be ',IWtre of, or iiityl)e you would wiiit to do this in your st-,ttp-iiieiit. y it, 1(,t III I)I'ovi(le this -,vo;[](l lil@e to dis(,ti.,,s @iii ily LGUI)tC(l tire to(,@ll of tll(3 )lot oi bi@it Eric ii@iliziii,,,, 1)rogl--,Ilik ill ;t ))lost iN,,ty to I)rovi([(. the cii]@ir tliree eleiiielits tll-,it. I tliiiilc I-),tt,iciit care. 'I ,Iles(, tlll.e(" cieliieiit,,i lylll",t be conibiivcl it the lev(.,Itt -vnrllicli tli(, I)hysiciaii n)eets the i)(,tticiit. tiid I This li-,ts been iii@, Nvitli the 1)rogi-,,tiii, r(@:1-liz(@ it is still very Yolill','. l@lit. I Ilil 1)(@giiiiiijig t@ L,(@t, is ]lot, ,iig tll(@ 1) -.tcti yet. It is not (-IO"N,Ilt,otlioliospit,il.Itliasstopl)e( ,I,,It @t little li'i,,rlier level, iit the (Icaii's ollice. IlAici,y. This is ,tt the pl,,tiiiiillg st',I- - Only .tt the 0I)er,,Ltin,-, staae will they be@,iii to feel the 1)rograin. ,rll(@ latest ilill-)Ortl,lit tlii]iL,7 to iiie is tli fict that t-be i)ro@r,-tiii is l@)pl- coiniiig ]letter understood by the i)liisiciaii, "Iii(I there is deve,l(;i)iiig tii ciit,litisitsiii for tli(,, I)i-ogriLiii It, tll(@ gr,,tssi-oots level that re,,i,lly 'is in striking coiiti-@ist to ,-oiiie. of the earlier experiences. IZo(.i@its. Tlitt is right. I reiii(@iliber very vividly. re )tlou f(tel t I I1) I -og I -,I lig (, .1 ive t-o the coiiiiiiiiliity lio., 11, I)eol)](@ iii the (-oiiiiiiiiiiiiy tri, 1,(N-Llly begiiiiiiii,,, to r(keeivo t NN,oiil(t I)(. liell)f ill t@o tll(@ (@ollililli@t,ce, to so that, other, iil.(@@ts (.,Itll "(@,o Whitt, is illos(, I )I-. ])I,; li,@ I evil] be very to (lo this rl)(I include it, ill the I %%,ill file witlil you. il,t(@(:,,:,,s.,rii;tiiic you. I-. l@.v 1-os'?, Wo:tl.e, litil)l)y to I I:)i@ rt that, You are ttill@ill(-Y' ',I.I)oll(, AN still li,,IV(3 to I)o )Illt,itted ,it the loc:tl level iiid @ii by the A(I- vi.Sol-Y (@Illicil. Yes; Vll(l they NVoill(I also leave to '4110W jll"tiric"ttioli in Yuideli @.,, ,is bein,r essential to the eflicacy of ,is I)eiii(,- within cert,,t 11 this progr. ,Else "Ill l@iii(Is of construct ioii needs, but -%v(3 have various tvi)es of colist@rtl(,tioii ai-itliorities, ,tiicl I -,i-otild think the important thing is that we liii-iit t;lie, coiistri-ictioii to the neec.Is of this progr,,tl-n - that is, wlierc@, it can be deiiioiisti-ate(I unequivocally that without the C'Oiistruc- tioii sli,@e the proarLiii couldn't be effective, eoiildD.'t be inil)lemente(l. -.,Nfr.-Kyllos. I know ]low familiar you are, sir, -%with the money re(iiiii-eiiients of the I)rograiii; but the fi(_rures Yesterday were that it Avoill(I 1)0 II)Ollt $,Oo million (@;irryover from tRe last -fiscal year, Iiid tl I(" I)i II this ye,%rc,,vrries$(;5 ]Ili II ioll. you think $05 -million -%vill be enough for this kind of plftiiiiing this c4)iniiig year?, I . @ r@ : TiI:,: I @ r ,; 136 lArelli if I read tli(@, ion within the next, year -%N'oill(l sly NN'O WOIII(-L (,Olllo (-,Io',.O tl() tll@it) Certainly; I (Io] l't IIII II lz i I.@is (,-()i -.ii)oiit, is wl)(@-,ii @@e get into the ol)oi-,ttioiiftl I)II:I,@o NN'it'llill the 6,t@V by 11)71. 1 would sly,%vitliiii this 2- to -io(I "Oill" to real ioii ill .t(@tivity and, i,liill]CYOII very much. Ali-. Nc,].@ii? @Nfr. I have 110 (IlleStiOlIS. It iSIll 1101IOr 7 Dr. Do Bil-:(,y, to ]live, you ])ere. You are so well luioA%,ii to Ti-i,,tiiy of us ts being @bsoIutely dedicated to the serv- ice of liuiiiiiiity. Wo,,tre lioiiored to litvo you here. I -%voiild I am to -tsli: ,tl)out bow the funds that you wiiit-ftro tli ey to be for something similar to intensive care units in ditroreiit, lio,-,plt@LIS? Dr. Di7 BAIIEY. Yes. Well, some of tlieiii would be used in tliit,\vay. For example, let us take the community hospittl that is ill ,t pFO(rrlin. 'They need tnd can use, ,,tnd in L sense m, n I 11 ill)oi-t@ all i ii tensi i,p- care unit; but the hospital is built in such t wty tilit they can't even reiio- Youaref,Lii,iiliarfroiiiyoiirownexperience,I,tiiisure ijiyotirown area of Keiituclqr, where hospitals, even those built with Itill-Biirton funds,.ii-c now so jai-nined treat it would be dei-iyin- the use of tlip, space for some VCI-N- purpose. So they licc@'d tdditioiit'l space. To I)iiil(-,l this, they late to Iiitv(, i-iioii(-.y. It may be t relatively sii-itll. siiiii. It iniy amount 110 t hundred thousand (Ioll:trs, but it is still money tlitt is hard to find for this Pli@ll)oi,,(,,. I tciisii,o care unit would be one wiii(,r. Ajiot@lier would I)e-I liol)o my colle,,ttrlio will point this out in his testiii-ioiiv to voii-iii terms of aciitle strolc(3 units. Thei@o will be dii,(Yliostic facilities ;f certain specific We I)oii-it, out in the Surgeon Geiier,-tl's report, which the Council had the oi)i)oi-tiliiii-,.y to review, the tyl)p-,3 of spice They will need Classroom This is the ]@ind of Space that is essc@iiti,-tl. to c:k.i-i-y- ing out the, I)roartin. We ]live SC(@ll illiit-, many of our 11(@Sf)itltls ill ill)(@, siii:tll(,r 'I-ii(i T@ im sili@-0 it-, is I,I-Ilo ill 1-111.1@t, ill the few ye:l@i-S has but, still it is I)i,, ]iA)II,,Y. Coii-il)let(,Iy it, doesn't t,,Ll@e into coii,,,ider@itioii these ]finds of needs. They didn't even visliftlize, these ]acres in tli(3 early pliiis. Their concern wis with imi-nediate n@d,,3 that they had to nit,,et. ,Af r. CAltl-11,R. I SOO the ll('P-Cl of tliese thinas. Dr. DI@', BAIZl@,Y. Ally I say to you, Dr. Otrter, that it wts part of your un(ler@t,,tn(-Iillgy t,@iLt helped produce this program, and I want to ,tin for your insi,,,I-if into this whole pro-ram. think you a,r, Mr. Tlii,iilc you, ;ir. .Dr. 1)1,' ]@AICIOY. It. wi,; i, tremendous help -to us. Mr. infi-. 13]cul)itz? Mr. Sicljiii.,i,,7. Tliftnlc you, Mr. Cliitirinitn. 137 r. I)o lit]@ey, I)itt I want to jo in my liti,@re iio D yoii liere today. I tiil lool@ii)g forward to receiving your J)].,, I want to my itl)l@recitltioii to t'lie commit- ]@ill(lilp-"s:iiid g(@i tl)ey liav(,@ iliown, and tee, -for tlio ivi,,(Ioiii t,iid i it, is roo([ i(@ lilio%v 111(@l-o are I)III)Iic, Iii(o Yotil-,Solv(",i. l'ollo@vs:) Ole ;'%IICIIAII:Y, I'l@ole],,Ht4OlL ANI) CIIAI[t,%fAN, 1.)I-;I'A[Vr- Ole MI@;1)1(;JNIJ;, I iotlf4,j,4),4, 'I, @;x. NE[-:NT 01@ Stilt(jl,:itY, BAYIi)lt UNIVII:Itl@31'rY (@ol,l,l ,\II-. ('Iiiiiriiitiii :iii(I members of the I sun 1)(@ ft;tk(!y, l'i-of(@,4.@or ,iii(i ciiiiriii:iii Or the I)ei)iii-ti@i(,iit of Surgery, Baylor IJiiiv(,i-,.,ity Cot- l(@ge of )Iediciike, in Iloustoii, I had tii(,@ iiozior or i)(,iiig xitiiii(-@(i ))y President Jolii)soii a,,; the Chairman of the Coiiiiiii.,isioii on Ifetirt Cancer, and Stroke, whose report led to the initial re(!oiiiiiieii(lat@io)li of the Regional 'i\le(lical Programs )(Coalition which tl)i,4 coiniiiii@le(@ (I(,@velol@(@(I and passed in Since it,, (,i-(,,,ition, I have a member of the Natioiiit Adi,isory Council on Regional @Nledleil Programs and im also a member of the Itegioii;tl Advisory Group of the Texas lt(-@gioiiii Me(ii(,al Ilro,-rim. I testify today in ,4troiig support of Title I of II.R. 157@-)8 introduced I)y the distinguished Chairman of your full committee, -iN[r. Staggers. If enacted, Title I world extend the authorizing legislation for Itegiorial Me(licil Prog 'Iliis for an r additional five years as well -as clarify certain technical aspects of P.L. 89-239. I would like briefly to reiterate the basic concept of the Regional 'infedical rrogriiiis, the future of which this subcommittee is presently considering. The Regional Medicil Programs comprise a group of units added-wherever I)o.@,,ible-to already existing medical centers in regions throughout the country. The units are part of the overall research, teaching, and medical care going on within the medical centers in regard to heart disease, cancer, and stroke. units together iii:tlie nl) t national n(,hvorlc for research, for teaching lieNv (levelol@nieiit,4 to doctors iii(I nurses, itid for care of patients under iiivcsti- g.,itioii. Thus ci(-Ii physician served by this network has, readily accessible to him for his patient.,;, LI)e full range of knowledge and skills developed tliroii,,Ii nntioii-wi(Ic At tli(@ s@iiiie time the doctor contributes to re- his ol),,ervitt,ioii,4 add to the total ](Yiowle(ige. search, for 14' a(,Ii of these units we trc@ discii,,,ii a,, has its own facilities and staff, though they function as part of the existing medical work force, to pull together and otirces now in existence. the medical res The Regional Medical Programs as initially aiil@.liori/e(l, placed principal em- pli:isis on regional voltiiittrism, as the means by which their goal might be achieved. To(lty I can rel,)ort that your confidence In this approach has been well priced. Within the last three years r)4 Regional Medical Programs have been brought into being. By this summer approximately one-hfllf of these will have elitA.r(.(l tLe operational phase. The remaining regional programs will shortly thereafter begin operation. With its emphasis on voluntary cooperation the Regional Medical Program n has managed to birness the creative energies of practicing physicians, niecliatilsi pitnl,.4, iiie(li tl school.-; -tary, state and local h he,, c. , voltin eiltli agencies. All too e creative energies have been isolated from one another frequently in the past tlies or, even wor.@, in competition. Regional Medical Programs make it I)orsible for ill providers of health ,,erviecs to combine their strengths to improve the care of patients with lictrt disease, cancer, or stroke. Thus our aspirations of 1065 today are worl@ing entities. One of the most important developments is the large and increasing involve- merit of the medical profession. In a recent speech the Ilresident-elect of the American Ale(liciil Asso(,iiitioii said, "As a ivhole, the medical profession at the beginning of the year li)68 is probably more deeply involved In the planning I)rocesFi to (lel@eriiiin(- tlic,nitiire of the Itegloi)al Medical Programs than It has be(tzi in the planning of any previous 10e(lerill i)rogritiii.11 Now in considering t@lle future of tlie.4e Ilrograins, Mr. Chairman, I would committee. I was disappointed to like to discuss the legislation before your tlifit Till(@ I of tli(@ ])ill (lo(,@ not I)i,oi)(@(@ to I)ro@t(](-Il tli(@ (-ojistriiet'loii tititliority for lt(@gioititl Ili-ogr.-tilis. I)iii-iiig tli(@ iiiit,i:il li(,iiriz)g8 before tlk(@ Iiiter- :ite nii(I 1,701,(,jll Coiiiiiieree Coiiiiilitte(,@ oil lt(,gioll.'il '@k .,t Ie(lic.,tl Ili-ograiiis Ili i%-:ts iiiu(-Ii testimony t)i.,it coiistructiori iiitlioi-ity NA,oii](I be iiecessarv if ti)(, re(itilr@,iiieiits of tlif, legislation @v(@re fiiIIN, to be iii(@t. The in ])ill (](-It@ted (110. authority for iiew coti.,41@rtiction. In its report on ill(- bill file e<)iiiiiiii@tee reasoned that the. 1)rogi-.iiii N%,oul(I not be jeopardized by the ]Seek of site]) @tiit@lloi-it,Y ill its itiili:il Ftirth(,,rinore, the Ili which new coii.,;trii(,-tion iniglit be required for lt(,gioilil Ale(lical I)ro,-r:iins, ot'li(,r F(!(Ier.,il of funding should be S<)Iigllt. Filially the coiillalitcec ill it4 rel)ort indicated its Intention to revlew thin,; (1110.@tioli fit the time of the legislations (.Xtell,-ioll. I NN,oiil(l lilie ti) Ilit@ (,oiniiiitte(,,'t4 wi,,;doin oil this Ili f@ict, tire. lt(@,ioli@il Ili-ogr@iiiis Iiitv(,@ not; been jeol@tir(liz(@d (Iiii-ilig I):Ist three y(@,,Irs, during ivlii(-Ii Ili(-y lk:i%,e organized tliei)iselv(@s, tlii,, sitti:ttioii is r4ijoi(Ily (-Iiiitigiiig. -12 of fli(@ 1)4 lt(@gloiisil Ilrogrttiti,, are ol)(@r@it@ioiiil ;iii(I wit,liiii tli(- iio@xt y(-itr or so fill of tlieiii will have l@(@giiii ol)(-riiiotis. i@(-(,()r(Iiiigly, t.ii(@ir for st(I(IiLloli:il ftt(!Ilities will rapidly Stirg(@o-,i ltel)ori@ to the Ilresi(](@iit find Congress oil Itegiotiil -:II 1,1,(igi-tiii)s I IC ("tse for Iiiiiit(-(l liegioijitl inle(liciil Ilrogr@iiii coiisl@1-11(@tioll 'Itilliorit.Y. IL is ext@r(@iii(@ly iiiil)ort;iiit t,o understand that these facilities NN,otild I)riticipally be locat(@d Ili coiiiiiiiiiiity hospitals, not our ine(lical schools. ],,xaziil)l(!s of cozi)jiiiiiiity hospital (,oii,,tru(-tioii described Ili the report (-Itss iii(I r(joins for regional continuing education programs, space for (](@niot).,4tr.,itioiis of coiiiiiiiiiiity patient care, and expanded diagnostic ]Laboratory f:iciliti(!s. These i)(@(@(Is ii-c not now being iiiet under exi.'4tilig Federal construction I)ro- raiii,4. Tli(,r(! are t%@,o interrelated i,eisoiis for t,liis: 9 (i (.oitil)etitioii for l,'e(lei-al fuii(l@ for the construction of health fa(.Ilities grown (!jioriiiously as it r(@siilt of fill overNylicIiiiing (I(@iiiaii(i for such facilities. 133, definition, tii(@ iitture of Regioti:tl Ale(li(-al Prograiii constrii(-ti4)ii needs goes beyond tli(@ of .1 sillgle institution to tl)e needs of the region. Accordingly, it is unreasonable to as,,uiiie that any .4itigle institution ,N-ould be willing to (Iii-ert its soiree funds for iiiitt.(@Iiii)g purposes when the benefits of the ft(-ilitv are intended for nearly ii)sfitiiti(@iis. lsil)CC it j,14 C.@elltill tll,'It tiler(@ be no substantial distillation of the coii(,el)t of ]Regional Ilrogriins, I coii(-ur that ritlier stri(-t Iiiiiitations should be oil this virility (-oiist@i-tt4-tioii :iii(.Iiority. Iciii(Is of Iiiiiitiitioiis 0114) finds ill ill(. Surgeon I-(@llol-t, lllIN-ilig to (10 @N@itli the material of funds fLvllil.,Il)l(@ fol, iii(@. lililltlktil@lls, wil@if@ loan([ of Itt@gifill,,Il Ill-(@gl-,ilii s claim ANI(@ %Nlol-l@ilig lo Iti)Ni, il4)(- sti(-Ik it N%,oi-)(? Ali exiiiiil)l(@ (if 1-110 of ill(! I)I,ogi.@illi ill%-f)]Vitlg (,ojlllllllllillv Is I)I-o- Iii-(igt,;iiii Ili Ili(@ is (](@sigii(41 tf) iiii,(,t or 1)1(@ (I(tliv(@rv of (-Ill-(! It) 11)(@ Oil(- %%-Ill for iiisls %%']lo NVI)iO-ll itilik(' fill @Jils I-(@gi(Oll. (retailing X%'ill 1)(@ 1;4) !IS 14) 114'81 Ili(! I ol, Nviil I)rogi.@illi IS 1)(@iilg to Ili(- or roi. this of otie I)II:ls(, (it this ])).ogl."Iln vi.'4i(lilioll.4 I-o lios1ii1illm by tile, efir(li- ologisis %%,]lo %Vill ])I-ol'i(it! f,iiis will be hospital', for C(Olilillll('(] Ill, file 10(-ftl I)Ilysi(@qlill. A iiiteiisivi- lateral']) long .s to I)reli,,ire I)i-o- iiiirs(@,; Ili the iiialiigeiiioiit of (!oronary care units. I'lip, groatii fit the number of coroii,,ii-y care units which l@rovi(le iik(hlical care during the acute I)li,,tses of cardiic hfis created all urgent need for an increased liuiii- her of well trained nur.%s; the latest advances In nursing techniquesand modern life-saving equipment demands specialized Instruction In the nursing skills re- @77 139 tli(@ region have Ilrc-IdY their i,iteiit to have iiilrsc.9 I)arti(,-il)ate in this I)rogrllll as Soon as it is The (Objectives of this 1)(@ i:illy tr@iiiii@ I iiiirses for coroii@try c@irc- progrtiui go beyond that of sul)l)lyii)g .; e units in general every effort will be made to train coronary care unit nurses from the smaller coluiiiuility hospitals as %@'ell, eveil though they iiiay iiot:is yet h@ive such a unit. Tlii-(!o a(l(litioii-,il iet,ivities will also be -Lliis ii)ltiil ol)eritit)ii:it I)i-ogritlit. A ri@@ioii:tl laboratory will be estal)lisite(I for e(lue@itioii 8114LI trliiiil)9 of 1)(!rsollncl in LI)(! care of 1):tii(@iits NN,iitli lliroitil)oti(! and hemorrhagic klisoi-(Iers. Tiii-, is t-li(@ first sll(.Ik fil(-.ilit.V ill 11)(@ 1.4,gioll and will 1)(@ I),I@,d ill one of ill(! llo.Sllit:ils 1).Irti(,ilyttiiig in the lt(,gloiiiil @l%ledical Pro- -itr(Iiiil A i-f-gioii-wi(le r(-gi@ti,y of %%@iiii iiin,o( iiifiirelloii will be %Vill g.,tt.lier iiiiifi)riii itifoi-iiiii(@ioii from the corollary units of liosj)itikis ,iilil jol'Ol'i4ll@ Its NN'4'11 118 10119itil4lill@ll t, or 1:11II(Is ]ills 1)(@ell iiiii(le -giviiii;ki)l(@ (Illt,:l for A r(@iiitiv(@ly siiiiill :alumina t,() train I'(@gioll t@4) (It@V4'i 11) the first. li-:ti-iiiiig in l,ii(@ i@i@gloii of I)ri)gr.:.iis lit li(!itrt e@iik4!4,r, iAii4l L;Ilroic(@ fully I)L@ first Year Lwiirtl for this iiiiili.ifiie(@t(!(l I)rogriiiii in (@,,kr(liology Is $:343,749. d(-s(,i-ii)ed tit exiiiiil)l(@ of ivliiit we ,tr(@ I)iiil(liiig, Mr. Clitiriiiiiii, J should lil@e liiifilly to say fL Aord or two 11)4)llt the I(.Vel of fLill(iiil;, I believe essential if ii(@v(,- their goal. lte-,ioii@il Nlvtlictl 1'rogrtin,; ,ire to have a f@iii- cli,,iii(-o to tl(!l We :ill rt@-ilize tliit the maiixt(!ijajice of health is assuming all increasingly important role in our socioeconomic trea of concern and activities, The health industry today accounts for an expenditure of $50 billioii but it is scheduled sooii to iiicr(@ase to all expenditure of $75 billion. If the Regional Medical Program is to fulfill its function as the Interface be- tweeii the moving pirts of this health care mechanism, it must continue to be il)le to influence that increasingly expensive device. We would be short-sighted engineers, Indeed, to derive authorization ceilizigs for the next live years of this program by looking backward at the cost of these prograi-n,3 at the time they were being planned. The cautious development of those programs has iiiileased a chain reaction of operational activity which will ised funding levels. It is already clear that oil lie(, substantially inere, the ity(@rtige these I)rogi-;iiiis will be ol)(@rittiilg It 11 level of between $5 million find $10 million each within the next five tirs. It Is, therefore, necessary that ye tiii iittli(@rizatioit level of roughly @)OO million be u.4;(,d iLs the yardstick with Which Oilk@ the funding levels of the program contemplated by this extel)sioll. Mr. Cli@iiriyian, I am I)rivileg(-(] to noun have the opl)ort@iiiiitv to present lily views to the cojtiinitlt(@(,. %vliicii (]()a(, so iiiu(-Ii to sli.,tl)(! health legi.,ila- tioii in general and the Regional Medical Programs In particular. Mr. RoGi,,.jts. Our next -%vitiiess is Si(Iney F,,irber, director of research Clxil(lreii's Cancer Researeli Foiiiidit@1011, Bost@oli, Mass. Dr. Farber is also an old friend of the committee tnd he was helpful in the formulation of the original lelislatioli, having served as cliair- mail of the Cancer Panel of the Presiclent's Commission. Welcome back, Dr. Farber. STATEMENT OF DR. SIDNEY FARBER, DIRECTOR OF RESEARCH, CHILDRE, N'S CANCER RESEARCH FOUNDATION, BOSTON, MASS. Dr. FANBLR. Thank you. It is t Lrreat lionor to be once more before this coiiiii-tittm, wli(@re my iiion@loi-ie,,i :Is 11(@,,irtwiiriiiina as ,iiiy iiiein- ori(,,s I liive joiti'!)r. T)eBakey ,,i,ii(I ,t]] our c, priNgs1iig ar,%titiide to this committee and for the most important program fic](I o@ ry f our count that is applied dil-L@ct@Iv to the care of tl,, I SI)Z@:IIC strongly in favo the urpose of which is, railcar other things, to ameiid the ubl I-Ieolt@i Service Act so as 71 to ()xtell(I "'(I ',,I)Provo the provisions relating to re oiiil ifi(',dicil I join Illy ill st@i-oi)(r l'or coilstriietio;i funds, and I will ,ive one of this later, which will illustrate the need for construction funds in this pro(ri.-,ti-n. NN,o l@o(l@t.y is -for i,lie, next, 5 ye,,),i-s for l'iiiitl@s) Nvitll t,jl(,"jlol)o fill)(ts NN-Ill 1)(, -:iv.,i;ii:tl)](@) from Other sources, NN'lliell wiii the ',Ill)l)ol,i., of t,])' Is ])I-Ogt.,Illl and so ii):iiiy ot.li(,i- ,N,ortliy 1)('fol-C the (Congress I)OS.,iil)le. I would lil@o to sav iiisL L few woi-(Is ibout tli(,@se pro-rtms. There li@is been ,t iiii(rnificeiit begiiiiiin- tlre,,tdy. I want to giv6 evidence that (;Ii(, @i(IiiiiiiiLs(,i,,(i,tioii I.,i excellent, under Dr. -iN,Itrst,oii i@the division of re,"ioii@tl medical I)ro,),ranis, and tli@it the Council ,Ind advisory boards are composed of wise and courageous men who Ire not ,ifriid to s,,t no, nor are they not afraid to say yes, in -the approval of y I)roo,r,tnis tli at deserve approval. I have the I)rivilege, as a member of the N(itional Advisory @iincil to represent (,hit -.ouiicil to the r@gioii,,tl M, dic,,tl Progrtins Council; this is lily second year of tn(I ]is @enin with gre,.tt api-)re- I l@1), L ions :iii(I were i I tii-i islced for i(,@ in the doliber t of t,@ie-so tdvisory L)o,,i,i-ds. Ylio ])].ogi.@illi trial(', ill tll(', history of medicine Nvliere all of soeiciy 1, ivilli the, of our I)eol)](@ liav(@, t@o-o,(ttlict- to tcliieva t common t(roal of I I)r(@S(']'VLtioii 'Of live,,, tiid the I)rolongttioii of 4VOO(I life l@or I)eol)lo Nvlio @tifror from t'li@,3 dread dis'(@,:tses. Tliiq is a -to@it, Li-iiii)il)li in itsel@f, ti)d would 1)(', Wol't]IY of the cost. of this pi-o(,ra;iii if this ive,].-(,, the only sl)iii-ofr of -,vii:tt has been done. 'I'lle iiie(lic@tl programs quite) simply, ,tre, coiie,(,riied with I)riii,viliz to (@v("I-v net, Nvonitii and child siiff(@ ing from tlieso dread o-v@iitiiii]@y, I hope, from ,tll dise@ises, that is l(nowii hit lives or 1)roloiity (,Ood life. This is tccomplislied to( ill sli li'll)lest terms ill tnvo Ways. lve'be(,,in with the community liospittl tnd the doctor in practice. We -ive, added streiitrtli first i@ man ower in trained personnel in p those community hospitals, and, second, technical facilities for -,vli,,Lt is Itcl;:ing. And we link these community hospitals with so-called centers." These centers ire not buildings in oil(, I)],-tce. They are not in one buildiii(,,, but they rel)l-eseiit -t I)ortioii of t given region wlier(, there is or expertise ill s(-,Iiools, telcliiii- hospitals ,Lnd tr(@, facilities and manpower and If we ctii two i-noiii's of tli(, co]l-illiiiliity to- "ethical., t'll(@ eolilliiiillit 110SI)it:i,ls and tli(@se and y Nvit,lk "oo(I iiie:tils of (@,oiiiiiiiiiiic:tt-ioi) in the modern idiom l'or rendering Issisl-,ill(@o .In(] tilt',Vtl)Olltic NV(', will ,icliieN,o Some- that in the liel(I of and other Cie](1s, will bring ("reat T Nvtiit to mention rigilt-(,s that I had the priN,ile,,-e of inciitioiiing once before before this committee. 14i]. and child every- In cancer, if we coiild I)rill(-Y. to every )iiai)@ woman today, there would I)c 'vii(I to il"e of ccncer this @,,tviiig of 100)000 to ')OO,i)i)o %veto :ti-e d i ill tile fi(,Id of of st@rolI-igiil:tl legislation, ,tii(I fi-ozii li(,;irijig tliiiii i.(Id ,l, I)iii-(Ieii to i iiiil)ower, woill(i sei-vo Is all C.ISill- of 1 ilill)ower I)OOftilA, tlle tll(@( 1%"IS tlilt. yoti (-,oiil(,l qiii(,.Iily -(@t to the (.Io(,,tor in Iiis own ](Wtl,ity til(l@llitest tlio ilifol-iiiitioll of t-lio latest ti-e@it@111(@litsi Ill(l so fol-tli. "kii(i teityis coill(I 1)(@ I)].oll,yiit, in froiii tl)e, iiiii%,vt,,,itv to woi-ic i\-itit ili(,iii in t wliert@ it (lidiit til(@@ till)e, of tlit@ lo(.@itl iiitii to liztv(@ to go foi, 2 ill the stillijil(-r to (lo oil ]lo\\'. ('()Itlllltllli(.:ttiolis Wolil(I t Iiis was, I tll(kll"lli@) :1 lio)l)(@fiil N%.Ilv of liell)ilig to ease IVII:lt-, is yoiiv Oil t.li:tt,? t- I)r. (IAN'No.4. .1 tliii)lc yotii- 1)oiiit is iv(,]] taken. I'lie tv(@i-,iLre iiig lyliysiciaii is soiiienvliat in -t box for tiiiie. ITe I)oiiiiees l@io@ii(I -.iii(I it CIL)I tiny ,iway froin ,tii educ,,ition@il experience. Tfowover, niaiiy iiieii, is yoti ]@iioiv-I -\would -sty iiiost of tliem- tire (lodic.,tted to C'oiibiiiiiinz self-imliicition. Wli(,tt, I lit(l reference to li(@r() Ni!,ts t,lie iiiiiiil)er of I)ei-soiiilel, the oil tll ,w,,tree coiiiiiio(lity li@is been iiiet@eitsed, aii(i the lti-,iliz-1t@-ioli of those 1)(,ol)le, Nvlko lease in iii(@di(-al care to 1)1-0,riltilis to ill to to set ill) Units. Ilre li@l,v(@ @ti'ly bill. W(' ill'(@ !Nfi,. I ,till ill liltl,ill(r ilifol-illjltioll illoll(r illi,,i lill(@ I wolil(I see it, jilst. tll(@, ol)])osite, itil(I 1. %\.oil]([ llol)e 1)1'. (ANr,,oNr. Nf:tv I' isli I)i-. I'lille, I%'Iio is (Iil-(!('tol' of oill' T)iN.-isioll oil to I I)VIieNe IN-lilit-@ yoii Said will liltililli.(@l 1)(@ the case. Ill ol)el.lltiolll,l st@l(rils, lioni,evel" it, ])as b(@vii .1 S;i ry local of the regions to iceiiiiiiilitte large stairs of 1)rofes- ot it. ioiiil 1)eopl(,., to adiiiii)ister the I)rogriiii-i ,iiid to dire' 156 As I recall, and I am not certain this is the exact number, but I rwOl one of t@lie larger regions estimated that it would -need tpl)roxi- iii,itely 90 professio-ntl people. Alr. All doctors", I)i.-. ltujii@,. Not iiece-,isitrily A,'[.D.'S, but, I)ersoli.9 ,tt that coiiij-)artl)lo in order to cirry oil tli(@ a(fiiiinist'rtt-,ive work and tile of tile I)i-ograiii. T]IIIS, one, of the iii;llile,(Iitte oir("Cts lifts been ill t he (-oiiii-)ct,it,ioti for-tilit isn't ])ell- ri(,'Iit iNor(I-I)tit in t.lic ,ivitil:tl)le ol)])ol-tiiiiit@,ics foi, employ- ill(' it, of 1)1-0.fessiolitl people It the I,(Ilniiiisil.lLtivc level. I Alle ]live noticed t]Cis alret(ly. I tliitik it has been noticed iii t-lio s(,Iiools which li.-Lve been ictivoly involved in the r(@gioil:ll Ict,ivit-,ies. It Ill-, been iieem,;ivry for to it(l(l additional facility iii(I administrative personnel ii-i order to discharge their respoii-,ibill- ties under the program. These 1)eol)le have to coiyip, f roin -,oil-iewlipre. The _y were not, ill gre@it stil;l)li before. A number of then, have come ;iit of I)ractice, and while we feel ultimately this may result in more effiGiolle iitiliza- tioii of health care sales, we think there is an immediate effect here ill e competition for manpower in the health field. This basis-for this statement. Afr. now, what I wondered was this: For instance, I envisioned the feet tlizt you would ctri-y oil a continuing educ4itioii p(@rlit@, tlii-otigl@ television wlierv- you li,%ve I.II expert ill It )i-iedic,,tl ekiitor giviiia ii@trtictioii to your liospittLIS in a coi-t@tili their, Ill,,IV l@,'tve just COIII(', out,; so thirty you (ton't litve to send iii,,t rll(",tol-, out, to oi- have ci(-Ii doctor come in and talic that, i,iii1o 'to ('@oll)(@ to til(@ 131it tile irollilli.iiiiielitioll is olle of tli(@ iii(@ll,l)S that, You 1.1-0 goill(r to Out, (lo'NNll oil tile use of 'I Woll](I I (11 t.Iiis eli%,isiolill( 'i, ])I-. Yes; it, is. iNfi-. So there, so iii:iny t-Iiii)as -,vliei,o I think you Would be @@.Lvill(, t,lie time of tile, locil doctor; -o 'on don't Iiitvo -t-,o littv(@ fi\,(, t, y do(,,t4)rs wli(@re one doetK)r may (lo t.])c waste of two (I(@l@-for in- ivliere lie J)erfoii-ns liis'exaiii find wtnts a rettdiii.@r oil an X-ray, .11-L(I ]IC manicuring that is wrong, but lie eatii get it in the iiiedie4-ll center where it carries' iiyiiiie(lifttcly with i coim-nuiiicat@ioii on the dii 'nl'osltsliat going to save Iiiii-i time and enable I,,n t him to see more patients? Di-. r,,.ujiF,. I think ill time it will. 'Nlr. P-tcx,,El ng is. Ri(,rht; -,tiid this is wb at we ire concerned with, getti the lielt@Itli to the people, ,tnd this is the reason this program was en- visioi-ie(l,-tnd adol-)@,-I think. @Nll'. CA'R'I'l@it. Mr. Cliviiiiian, will the -Plitlemin yield? Afr. 'CAlt'r]'P,. I WLllt t@,O Say something in bL-Iitlf of the general rac- tit-ioii@i- in this case,, if Xo@.I)Itse. I don't think we sli@uld sel?liiiii too short. I fe is t mail wlio is j@iiowii by the, f fault,-, of his labor. If lie (lo(@il't 1)rodu@, certainly his prlct-,ice i;. (Yoiii,-r to fall off, iiid he doe s t.11@o tin s a iin(@ ber of the Apa(felily of Gen- %(School-,. 110 goes a ni er.-LI i-.tktice. I-To is required re(,rultirly to go to school. 777@T@ 157 too, in cooT)erttioii witl, tli(, iiiedi Ical asso(,i,,it.ioii.,;, aid t I t5 (lo , I (I Vi"itill(y who Come to our Iii),.,I)itals- t@lli-oll',"Ilovlt rural Aiii(@i-ic:t to tc,@i(,,Ii us, ijid we lzl-,id foi- )r-,tetitioiier in most cases if lie is (@flic"ient and efT(,c@tivel lie, liis"(Ievp,]oT)ed cliiiinels of communication with universities, ,tnd sur@oiis and dignost-iciaiis who ciii be of help to him. @,NI'ost of- otir community hospitals, I would s,.tv, hire I qualified 1,:i.(tiolo,,rist %N,Iio read their films fi-oiTi time, to time. So we, II-,tve Most of tli@ ,tlretdy. They have alreidy @i-L developed by private illitit@tive, forced by t@lic iimessity of d@ing the best type of worl@. And I should say tli@tt most iieril I)ri(@titioiiei-s do these tliiilffs. tin ,Is I see it is to Collil)](!Illcllt the pi-ogrititi wliich"is .11 I -,, y i n clr Alr. RoGiits. I am not trying to run down the general practitioner. I tliiiil,: lie li@is done ,t (rr,,ind job. We -,vaiit to help him to- do ,t better jobfoi-t.lie iiieric,,tnpeol)le. I agree ivitli --Von. 1 tliinii lie his done a great job. We Nv,,iiit to lielp Ili t I)ett@ job with tl-iis I)roor,,iiii. This is a program re,(iliv. In (10 , I foi- the doctors so I would understand kvll the, Americiii 'infedic@i I y As-,oci,-Lt,ioii would siii@)port it. It is r(@,illy I)Ilsictlly for the doctors, to 1)(?, lie] I)fU] to talent ill "iViDg good ti-e@itiiieiit. 1)1-. CA.N@NoN-. ivfr. Chairman may I comment oii your stateil'ieiit? Di-. CANNON. This is, in essence i%-Iiy we believe in the expansion of the A(IN,isol-Y Council. We bc@iievc@, it is wise to tike two new ilieiyibei,,, f real tliepi-,icticilig Pi-of@ssioll. -.\fr. ROGIMS. I think it is it good sugLr(,,stioii. -1 think we should have practicing pwple, and I don't tIliDk- We ,il-c getting enough hospital ople ill there, either, Dr. C,,iniion. I Pe think we are ('rettiiig too )fully C(iticttors. This is natural at first, -,laid we need them. 13ut we have overlool@d in this pro(,r@,.im, @o d,.i I think, briiiginr, in ,t more active pai-ticipttion by pricticii)g pitysicia)is find by hospital ,tdministr@ tors, -,Ind soi c of them, people who are actually involved with provi(Iiii- sonic of tlies(@ services ,tnd wli(-,re tli(@ critical units should be. IV(@ ,t more 1)i-itcticitl iti)])I-Oltcll in file implementation of wliit .i,i @t "oo(I program in t,li(ioi,y, I your suggestion is good. oilly gi@oill) tliltt, filing ]flight-, settle flat(, I 1,I)ililc the 1'4 Your gi-olli) of (I()(@@13 it, 110(,?, Your (-oiitillititi(r e(iii(-iitioji. ]lei-Iiitl)s iii(@y will. This w i V()o(t. 1)1'. (",ANNOX. Ily 0111- li(;triti@ivo i-(@Aviii-d ili(@y re(iiiii-t@ i(,.. I full stil'o ill (lo(.to)", t,[,y to l@(@op 111) its best, I'lley (!:Ill )'oil t,lli,,; is not, goiii(,r to go for ol)t@ii-eii(led fitil(lill". w(@ ll,,Lv(@ ]radio it it as ll:ts by in y l@r(3 will sit ,t ,tiiii to be authorized, and our 1101 ts beeii,,t 3-yeti- litroli, I,(@,t Ili(., just tslc ,L couple of questions quickly, since our time i s run ii iiig out. Doctor, I wonder if, oii the alcliolic and the narcotic provisions of this legislation, you endorsed building the se residential areas, the qtiar- s f6@ hoii-iele'ss alcoholics and bonieress narcotic addicts. ter 158 Yes, Sir. I)o )'oil clivisioll this ,Is of t,lie (',Olylllilliiity II)Cllttl it ctii It (-,Ill f:t(.ility. it, is I)o 1)@tri, of' the I)Iltl it, (.,Ill also 1)(., associated witli the iiieiittl ,N II-, I-,' IIo NV (..III NV(., or 1)('I'Soll',, of tliii tyl)(@ NN,ll() NN-ill "ti1v N'oillllt:tl-ii if sil(@lt(.r is ft(@,ility into it Coill- If 1.11(@y(,olliefl-olliit I )I-. Yes. 'I'll(@y Wolil(I St-,ill ll:tk,e t@o go to @l tr(@,,Itiiieiit center or to I)r. This ctii 1.)e ii.,ied iii t flexible NN@@ty. It (@,111 I)c IISC(I for tIlo,@ ii't fiiid their way blit iiec(l slieitei-ed care for a period NN,Iio of ti III(,. -%%r iiiaiiy i il[r. Are fliere -,illy est-iiii@Ltes oil ]Io ieed this type of I would tppreciati;it if yoti coiild provide that for the con-i- (Tlie follo-,N,iii(,r letter wis received I)Y tlle coi-riiiiittee:) A,-tip@,itICA,-, 'INfF.I)T(!Af, ASSOCIATION, (,'I(ic(igo, Ill., A 1)),il 3, 1968. 11011, T(@tiN TAI(NIA',, oit Ilitbli(.@ lt(,filfh@ (t;i(l, II'(,-If(ii-C, (Iotill)tittrc 02? ,cs, flot(SC of $lift(! ],'oi )ttaiii, @hitigtolt, D.('. I)i@,AI4 Alit. FAIC,-,IAN' : I)iiritig t(@stilliol).V oil 11.1t. oil Afitr(-Ii '2-i, 1(X')S, of like Aiii(,i-it-iiii A."oi-i:itioil 1).V :: @ I to stil@l@ly itifol-ill:iti4)lk ll.'4 to t]14@ for iiiiir-wity iiotises for aico- lit l(@ I I I of tli(t I)i 11. of til(t iiiiiiiim-r of it](-t)lioli(-s %%-]IO @N,oul(I I)Pnefit, frt)iii tit(@ II%-:iilliloilily of liillf-Nvly llolls(!s riiiig4@s 1.@jO,000 iiii(I 200,(X)O. 'I'li(,ir (Its- trillilti(@ii is go,ii(,r:tlly tliroiigliotit the Iiiiite(i St,,tt@(@s, wit@ii the gr(,ftttst ii(@(-d I)eitig iii of I)oi)tiiatt@loii. e,.,tiiiilite of iiir(-otle wilo wolil(i 1)(@iielit froiii the ivailitl)ility of iii(lividiiiiis ;ii-c Io(-at(-(l iii Ni-w Y4)t-k (.,ity, Nvitli tit(, r(-iiiiiiii(l(,r Io(,iiig tliroitgliotit tlit@ ctiiters of ioll. lit slii(-i-r(-Iy liol)t@ lliat tli(@ tiliov(,- iiiforiniiiioii will prove il,4efitl to yoiir Sulwoin- ii@it t(,e iii its ioiis oii'l.'itic III of 11.1t. I,-)-i 58. 10. J. Ti. 111,Af4lN(IANti@:, ii,.,(Ts?, Are there tibotit 00,0()O? ,Nfr. IVII, ])I-. I,)Izli.l,.(iO,000kiiowjiones. ly I I)r. The iiir("Ot.ics prol)leiii is in h,%If a doze,, @;g cities. r. Yoii don't envisioi-i doiii(v this in evel-Y coini-aiiility -Cry 9, No. I don't tliiiilc tl)"I,t is f w ,I I)oA I t :1 I (,ol lo] i@s ?, is di fritsed. ,Ill (VO, ill(,@y -)50,000 'A'fI,Y I say llilti-, (1)(@ total I)IIIIII)(@v or 111(@olioli(','4, of (-olir.,4o, it iiiiiiii)(,r ol, 1)(@ol-)Io NN'Ilo Nvotll(lll,t, need tells sort of Iit ii(I(@rstiiii(I itis (@l 'III I;II (.41 i II t II (@oti IIti-Y I 'I ltt, t I '-)()(),()Oo t 0 "I(X),Ooo. :L fl.i)lil Illilloi',, wlio )III ]Below y oiir dis- iiiilioi,it,y Oil til(@, Colillililtee, :III([ 11(@, itiiy ,tve sol)le 011(@ or twol Alr. Cli,,iiriiiiii. I)oct@<)i-, were you any part of the ik@AfA structure Lt the tinier WPI the I)eait, otrolce,, bill? I)r. CANION. If ".,,tru(!tiire" is iii ill-iiicliisive to@i-iii, T certainly wts. litit, 1. i@-,is iiot one of the spol@e.,;iiicii it, t:liat, tiiiie,. I aill ,twi,re of t@lle -Art-. will I tlie lestiriioiiv of invoiie wlio (-o)ii(,s 1)(,foi@(@ tlii,; coii)iiiit,tee, is all oil 2t I)roll;r,,Illl ii@itil I full t:]):It., tiiiie. It-, ovei- ]lease, fi-olit tli(@ witli oil(" ,Iil(l it ]);III' of tt $970 iiiii1ioll, '11111OSt stii-t a, 1)i-o4ri-, ;I I)illiOll dollars t4-) 1,111, never se(@ll Sil(lit :111 :11,1"ly I ill(@(I 111) -for transit, I)] @iiiiio,,t,,%vti]oNved it-,, until I went about-, it.. 'I'licii I ]list-, I)e,-, III to lii,,Ll(e soiiie @Ill(I (I(@I)it-0 all tlle 11)(@ill t@ilifigs 1'r]llt Nv(,I.e, .said about, t.110 diqiii- (riiis I(,([ front l@lorida, -,,i.iid )lie, too, diiri)ig tli,,tt tiin(,, tli,,tt, W(l, W(,I.e I((',(@I)illg trial, bill f roin Collins to the floor, we finally got it out at, ,@'120 million. We didn't let it out ui@til they agreed in the other body trial tli(,@y woii](I pass our bill. If lily fi@'lli-esire correct, weireilinost at tli(@, end of .3 years, tend out of tli(@y t piddly little $,320 million, I-liey line been able to sl)(tild 1,)851200)000 to dite. liiii eoziiii)gbt(-Ic to this foi- one. Oll]Y, .111(l fruit is that you 'll.-e iionv asiciti,, for $(').,-) iiiillioji fol. tilt-, fisc:ll Y(@:11- 190,0, tii(I iiotlil)ig lias Ce!l Sli(l, f tilce it, Nfi-. Nvitli to ikily I)ossil)l(! i.c- It, ]its 1)0(@ii Said, :III(] t@11(@y ;ti-e .9111)lliit@(ilig tll(-, figiil,(!S. I (@oill(@ i,rilili to lily III s:iyill(,r tlitlft, lit" t'lic little You oil t.iji.,4 yolii- (Iolll)t-(@(I tariff-, t,])i-., W("Iit, oil ;iii(l I)oil)l('(l Out, wily, ill 't(@l-@)IS of y so oil. I' :till t]l.Lt., %Vlilt, You s:ti(I and I s@ii(I tti(i Mr. Itogei-s sai(],, ,ill(l ;t few ot'll(@i-s oil tlki.,; Coilllllit,t(@e,, 1)@is C(Ylll(@ true. Oil y it liis colll( )Iloilo ti-ii(@ tliiii NN.0 'I'Iiis is about, tlio oil] little we y 'I'llis w@is 'L 1)1-( I-,till that I Sill)l)ol-t(@(i once I tlloll,rllt t it, was @%@itlliii Sol)](,. 111(@alls. Iiii@t, I 11)(@l-(@ly point tells out li:it. of .111yollo wlio (-ollles@ before 11.4 witli ligiii-es t@11(@v cli@ be justified. 'I'llis wis, 1-11:iy I sty, I considered to be, II)c best f,egtiinoiiy in ilic (-ottiit-i-.y. litit you oiiglit to go back and see tliit t@t-iinoiiv. fioiii I)r. I)eBttl,((,@y oil down. It wis priN@iite(I before t,iiis cojiiiiilttee. to iustif y t prog wllicli turned out 3 yctrs later @o liilv(l ,raD'I-Fortbilliondollars,, spent $8,5 ii-iillion. 77 177 7 160 I ii",( IN'@ilit t@o II)iit, t@liit on the r(-,eorcl@ I)M.,tuse I tliirilc it, ought to be I)Vollgllt, out, 11(ve, that, wlitit" we Lrt"t ill the way of landslide t,ullitiniony is :L jol) and siiow job cli),iiiiiiig tlitit s(omiu@tliiiig c4tii be done Mr. Si@IJI@ITZ. Mr. Cliairiii,,tii, will my colleague yield? @l[r. Yes. I Mr. Sj,:uBi.Tz. IVis $320 inillioli authorized and $320 i-nillion itppro- 14'ifty-iiine and 200. -Nf r. SKLTIIITZ. Bllt liow niuch i-noney was appropri@? $85,200,000. -Nf 1'. @ S.lill]tITZ. Tliit is all busy spent. 1-low could they spend [lily 'I'I)o is they di(Iii@t spend till tlittt,w&s tippi-o- Tli(,,)rtl)l)rol)riited iiiore thin $8@1) million. 'I'li;tiilc yo@t, Mr. Cliiit-ziian. Nfi-. I'@o(,iits. Tlitiilc you. I (lo think it, iiiif,)-lit, be I)roii-lit out it this point that I would coin- iiieii(I the idiiiiii@@ti-atioii of the progriii-I in the fact that they iiist. zone out-, and spent iiioiiey. So I think this is rather coin- lliell(l,ll)fe,, tl@,@t. they have held iij) soiiie 8 million on last year @,%iise they felt, they were iiotit a stage to spend it. So this is coliiiiieiid-,ible, and I would wijit to put that on the record, too, that, we don't, want, tlie)ii, just I)e,(@ause we iiii-y authorize somet,liidg oil it iiiay be ippropriited, tliit expect tliein t@) go ot-it and spend it liiile,,.,3s they ti-e at that point where it could be do@i'e effectively: So I tliiiili whether we reach goals that we inty have set is not ne@- the det,eriiiiii@itioii on fli@ spending of the money. We want to iiiake sure that it is appropriately spent and even though the goals illav 1),ive above tliit. @o I think the adiiiiiiistrtitioii of it his not been in error in tliit i)i-. IZI-ifi@. iNfty I coilkiiieiit Oil tlltt?, I tliiii]@ %ve would support this ftct. We ]live been reassured and eii(-otii-,ig(,,d by the @viy'fliis has I)m-ii administered. I thin]< ill (lefeli.@(" of the, program, oiie, thing call be said, that in the etrly stages, eery ctrefiil @itteiitioii has been given to the 1)1,,tiiiiiiia ,iiid the preparation for the ol)ei,.tt.ioiiil stage of tli(,, i)t-oardiii. Tliis"lia-, been one of the trials which has kept the exl)ciidit,l-li-c@s'@(.Iowii at the present t 1)1'00'1',,Illl gets ])loving iii(o t@lle ol)er@itioilt] I to exl)t@(@t tliit the costs would AVe feel tliit, (lie I)i-ogi-iiiii his been [tdiiiiiiist(',l-Cd very wcll,,Iiid witli rf--sti-.tiiit Ljid good ludgiiieiit. you. @Afl'. SlitYllITZ. TlitC ])rings me back to the question I riise(I t few illol)lellt,s (Igo, the ll(-C@sit.Y of Iiiilitiii&,r tlie.,.,e,,tiii@lioi-izttioiis and lifLVill,r t@lio itgreneics coii-ic and I)reiciit tliei r case and prove their Y>oiiit. If -%vetiitliorize for 3 years, they don't litN,o to come back. From that moment oil they go before the Appropriations Committee Mr. Pt,@ERS. This is ri o@lit,. Dr. RuiiF. There is oi@ problem in that) if I may. That is, from the standpoint of the region @Nliieh is attempting to recruit personnel, if 161 is @iiiv qiit@t-ioii %%-Iiet,lier tl)(@ I)r( I-,till is goilig (.4@ i)o eoiiti[iiie(I )91 rot. it %N'olll(l 11)(@ oxt,roil)(@ly to get good I)o(.t )I, )II tlio t-illio 11,11(i we lilli,,t lilLvo iL or 4-y(@:tr 01, %%,o (,,. it (rt@,t, tli(@ 1)(@ol)lt). ]@tit l'or soiiio t'lio (iov- .11, ili:iy 1)(k tllt@ Nviii@t, ]ijtly to oii only t -)-yeir III)([ lie is (Iisltl)l)oilitt@(l. I would lilce to coijiiii(@iit, oil Mr. Sltibitz' question, Nvoiild generally if it ivit.-, the comill.it)tec,.@ good 'Lll alitliorizitioii for ,t siii@ri(,@ yetr while would rp,- quite, t.lko pr tila o&-r,iiii l@eople to come btck , (_;ive the cominitt@ all ol)l),L)I.t.tilitiy to examine the pro,-r,-,tm If that was your judge, iiieiit, and we would sul)])Olt, that movement. Mr. SK-UltITZ. YOU ll"td @better st.ay wit-II the chairman. I am the low ii-lan On the toteni pole. Mr. As t matter of filet? Nfr. Sl@ttl)itz, you MiL'Ilt be iliter- ested to ]@iioNx- tlitt we did a speciil s(iidy oil IIEW ttiid i'Wojiiiii(3iided yt,-:il.],v Llltllol.izttiolis. I:iin gl,,t@d to li.e,:ir tliat. @@Nl v. lz(xll",IL,;. w(@ t.o iliov(3 it ill colli,illitt(@ Yet,. yoll V(NI-Y Your t,('%Stilliolly lil),S most helpful. (@@@-;NON. You, Mr. Clitiriiiitii. Nf I-. Oil I- ll(,Xt, .vitiiess is ])I-. Ivillil-ill l'ili(yfr, illilll('Alil@to I)IIst Aiiieri(-.,tii (,oil(--c of -froiii, fietliesda, Md. I r, Y) V(-@1-Y to liltl%le you with us, I)V. liilcofr. STATEMENT OF WILLIAM LIKOFF, M.D., IMMEDIATE PAST PILESI- DENT, AMERICAN COLLE, GE OF CARDIOLOGY; ACCOMPANIED BY WILLIAM D. N-ELLIGAN, EXECUTIVE DIRECTOR I)i-. .1111 to iiitt.(Kltlco Williltiii NelligiLii, executive di reactor of tlieeolloge. 1 tl)l)recitte the privilege of before this committee to the views of the Aiiierical-I Colle(r'o of Cardiology regarding bill 15758. '19, (lie I)rogress '.I'Iio goals :tiid 1)liilo,,iol)liy of T,.tw 89 ileeor(l(,.(l by tJic iii6dic:tl I)i-ogi-:tiii ditriii,, it sli rt li@f and the fitt,itro I)roiiiises (@itibodic(l iii (liis-eii(l(@:tvor itre our cur- (,-olisid(@rttioii-, tlierefoi-e-, I)IO)III)t til s@iciiec in tells Country i f, 'red I S tvo coili- tii(i tbuiidttit resources. This coiyiini t@ictil-,trly t\vtre that the distribution of these te,riiis of ctre,, is sliai-nefully uneven. 'riie as c ily-ott I,,tNv 89-1-139, the itiithority for the regional medical program, is to bridL,-e this Unequal between itiiclservice and to I)rovide an (4liciellit liealt@ll care system which will assiire the transmission of the best in scientific Iciio@lcd&re to all peol)le of this couiitrv sufferin(-, f roiii heart diseue, caneeri and stroke or struggling 'to ovoi& these c,,tt-.tstrophies. @77.1 I (i2 tile I)i,o(,i-ary) is :11)1 v s i ii i 1) I e i I i (I i ii t I I c best tj-:i (I i I i oil o f t I I i s (@ol I I I t ry's geii ills for effee- iiio(ici,ii ii,i,,ide to ,III I)eoi)le wlit@ c ]I ili,(@ i(lelitifi(@(I It, it I- giollil level iii(liN,i(iii,,tls i-ii,,,olNed ill rei,ioii:il til'iiirs @i-ii(i wlieti ttvtilal)l(@ rul- soiii,@,,,,, ii)(I ii-iaiil)owcr trc, i)i-ol)(@i-lv oxl)loite(I tliroiigli cool)er,,ttive lilif@ill',' (Iis(,ovel..y wit@ll iii;llysis of tile :I(@t-@ivit-,ies of the I.(,(rioll:tl ])I,ogI."Iln all lliitisii:il ].(@(.ol.(l of tonviii-(l that goal over sl)oi-t I)ei-io(i of li:tv(" tile I)Iitillliii@,- -foil I lie:iltii (.:Il.e, sysi(@iii iii r)O r(,glolls (,ncoyll- 'tll)ollt )O or- tliii (.olill(].Y", I)ol)lll:ttioIl. Oper@ttioll,,Il 'Solicitillii)lls -]'or I)IIII)Ilillg ,til(I gi,@ilit', fol- areas iiot yet@ Ilivolve(I Alto (tolist:lilt,ly Tile witli iviii(,Il I'iil)lic T,,,tw 81)-2'))9 lias exei,(,ise(i its iiiir)a(@t-, tire Ivi(le itill< of its iii@ittiriilg is iiiost iriil)i.-essive tliiio.,,-t dellyiilg tile coliij-)Ioxitie-,i of estiblisliiii,, t ii(@,w a(Iiiiiiiisteritig or ,ttiiz-,it,ioji iiii(,l l@ 'I 9 ,3ttj]'Nvitliii) the I'til)lic Ilei tli Service aii(I the difficulties ill -isseml)l iii(r foi- I)I:lllliillg .tii(I t(-tioii rel)i-eseiit(itiv(@,,i of diverse scieiitift(, iiii(I o siiiiier ,roiil)s iiii iiiyi.-iid of local coiiiiiiiiiiities. 'I'lle lii-st (IYIIIll)l(-, (@ll',,:Igeitieiits iN-itli t tie 1)i-ol)leiiis of or(rtiilz@ttioii, (]('iillil)g I-egioll.11 ll(-(@(IS ill 11(@:iltli :111(l il)l el.rk@llit@ill;z 10(-,Vi I - Pq 0 1 1 I- (.'. c s -foi. t II (@ I i@ i oil II t@(I :1 IIIIII lose NV] Io t -ilillost. witliolit exeel)tioll se)li(" tlllt itisti I tioll'i Iil(l meii I-el)].eselltillg ,iiid coiistiiiier iiit(-i,(@ts Nvelcoiiie t,he cliillell(re aii(I ol)l)oi-tiiiiity to serve. They ,ii-P i,I)I)Iyillg I liciriselves ilii.,iti)lt,ingly to tlic@ @ai-eli for soiiii(I adiniiiisti-atiN,e, sti-iietiires ,tiid for efTective V()Iiiiitai-y coopei-;itive. ti-raiiaeiiieiits wlii(-Ii will ,tssiire the success of the ])],ogi., @I'lipy sli,,Il-o I I)OSitil@e view al)oiit t,lie likelilioo(I of ol)litet-atiiig the void iiow the coiiver,,ioii of l(iiowledre, to 'I'lik" local ,ill(l ti)(@y iii to Ili( l@i tll(' ftill(lillY I)I-o@-isiol)Sof (]I(! @111(i tli:lt tlli@ ITLNItItli S(@l-vi(!e is til(@S(-, ftill(is jil(li(!iolisly :111(l ill witli tile iieeds iiii(i sol)llisti(@'Itioll of tli(@ill)l)lic:ttiolis fl-()Ill tll(@l)etilioIllllfr I-CIrlolls. :Ill(] ill (.0111 to "olli(@, of fli(@ in:l(le to tlii,,, I)oi I I I i(@ (.4)11 1 1 1 ill (y i s ('N I I-(@ilie-ly S(@iisi I i N@ t 4) i I 10 1 ill) it'llt,i oils ilill)o,;(@(i I)v file f:l(.t I liilt. tile, I)I,ogl.;Illl ]its ]lot I)V(@ii estiil)lisll(@(,l O)i ,I (Iolitillilitig ]):Isis. I)III.,I(Iox of (.olliestillg witli lolig-t(@i-ill 11(@(@(.1s Ill(l lolig-i-@ilig(" itil(It'l- tllt@ of' it Silol-t-i(,i-iii :let- is I(, tile liai,liessiii,-r of it, (@oli'Ati-iCt.S to tile (le(ii(.:ItioIl is (iiiiiiiiisil(@(i ii potential of Piil)lic'T,itN%, 89- 2.'@!) Ills (@vol@(!(l tile tVI)e of 1-ol)ilst 1-esi)ollse, tli@tt of (.olltiiiilil)trstl )I)oi@f:ltl(l iilclilsioll ()if lo@"i(.:Il :11-eit-,of involveil-iclit-. ]lot, 0 liol,et fol (@ii ce(l. @;kt least it I)oi-t ioii of t lie,,c ,ire, recognized iii TT.R. ('ei-tiitily the provisions to ii)volveii-eas ()iitsi(le of the @")O States is coii,,istelit, ,vitli otill- ti-,t.(Iit,iollll ol)ligitioiis, tllose iml)lovlllg IIIP f,@- iii(@iitatioii tlll.olgll ilifel-le!rioylal cooperitive, those se(.I,.iiig involve-' ]Heart of Fe(ler@i lio,,I)ittils aiid I)rovi@Iiiig for coiistructioii fuiids are lo(risti -,illy aiid fliiietioill]]Y. 163 @kiiloi,i(@iii of Ctl'(Iiol()Oy ilie ol)jv(.IiN'('S :11)(I I)Ililo.-iol)]IY of tlie, regional l)IC(Iie"ll rogr-,ttii l'o ol)IY 1-t@l(,:is(l itil(I (@ool-(Iill@@ioii. IVe siil)port, t-lic I)Itiiiiiii(r tii(I opera- tioii of every I)ro(yraiyi wlici-o we possess manpower and The colle,re, is cert,,tiii the I)ro(,,rLiii will cIcN,,tte the lieiltli of tile It I)let(ls for a l@,tvor@il)le it(-,tioii oil bill I.I.R. 157.-)8. This aii-icii(l- iiietit, to the liil)lic Ife,-tltli Service Act extends ,xnd expiiids the iiie(lic,tl i,(,gioii@il I)ro,-riiii to it new and ,tiiiplified I)oteiititl and liope- fi@lly to (II(-, -,t-,Ittls of tlle i-nost distil@(,ruislied i-ncaical program con- ceived :iiii l'oi-tli(@opl)orttiiiityof expi-@,;iiigtlieseviews. @Nf I.. I'liitilc you very i-nueli, Doctor. NVe appreciate your test illioiiy. Did yoiiv Iiii-ve any st-,iteii-ieiit? iAf r. No, sir. Izo("]@its. Doctor C,,trter. "\I r. !A Iti'l@R. No q tiesti oiis. '\fr. toGi,,its. Mr. Skiibitz? @\[r. S KIT]IITZ. No questions. -@\I'r. I iiii,,rlit siy tli,.tt tl-ic con-iiiiittee, in adopting t 3-year 1)i-o-i-aiii i-:ttlier tliiiit 5- or 10- r program, feels that this is one way l'ol.,(-Iiis coiiiii-iittee, to carry oittyites, responsibilities to the Congress iiid tli(-, Aiii(@riciii I)eople, because otliernvise we leave no review of the pi-o(rraii-i. Dr. LIKOFF. I understand trust I)Ililosoplly,.k\lr. Cli,,,Liriiiaii, but I do wisli to tell the coiiiiiiittee, ,tnd particularly Mr. Sktil)itz, tliit we in the field naive found it diflicult to coiist riiet long-range, orga- ilization@tl progr-.-ciiis and planning iii view of the uncertainty froi-n tilll(,@ to tilli-e of the funding i.-efliiired to support these ventures. Soiiie,,tiiiii- we. I)Ian for v decide cannot, be on 2 Ifow you -@t (,-xoveri)iiieiit, workers under these C()Il(litiolis l(loii'tkiio,,v.1@'otroli,,tN,iiigdifficiilty. t iiiii it, would be (tesiritl)le to set progi-iiiiis for is tilli(@, I,, NN't" wtiit(.(l witli .is iiili(.Il iiioll(,y as wits witiite(l, but we to i,li(@ C(,ollol tiy of (@ii(% Nittioii. li@it. this is the coiiiiiiit-,t(le,@8 fi III(.Iiol),!I II (it Ii:lt. isWI) II i@ II(to. gl-:ttt@i'lil for Y4)(11. t(.Si,iiii4@lly.iii slil)l)ort, of this- legislation. I)() I I (@, I 1) 1, t I I t o I I s i I II - c o I I s i ll(,Xl, Nvi(ll(";,i is Milliliitillo.f tlio'Nl'ityo wlio will gi%,o Dr. Millil@:tii, (refigured to IiitN-e you an([ Nvill be I)](-,t.@d t o I 1: I N'e y ot I I- I- (@@s I I 1 o I I Y. if you Nvoiii(I like. to put, your statements in tli(,, record and just sliin III) for lisi it would be oi- if you prefer, reitd it. STATEMENT OF DR. CLARK MILLIKAN, CHAIRMAN, COUNCIL ON CEREBROVASCULAR DISEASE, AMERICAN HEART ASSOCIATION Dr. AliLiiicAN. Mr. Roaers ,tnd iiieiiibers of the subcommittee, it is not only an hoiior, but a responsibility, to tal,-e part in the construe- 164 tioll of the colitiniiin,-r legislation. I would prefer, actually, to ill, t malc soine comments. 'Nfl its. "rhit will be done. Without ob-cetioii, Dr. Milliki 8 r',OGF st@itelliciit will be placed its part of the record following his reinirks. I the Aiii(@,ri(!.iii lf(@,ui-t A-.,;ovittion, I)ILtill'r (711"til.lll:tll of t,'Iio colill(.il oil oii,t to I)e t 1.e(!ogiiizable eiii,it,y for cool)eil:ttlive uiid colltl)oi-,tt.ive tr- )lot, only (,eiit,(,,i-s find 1)rt(,,ticiiig but I)et-we(@ii III(] Jf(@irt Asso(-i,,ttioi), -for has iii extraoi-(Iiiiii-il -let ivo I)iti-L fll ovei- the N-.ttio I, not, only tt, the of r(@Ariojitl i(ii, y .1@,A)I.y coitilTlitt,,@. but ill slii,,Iller coiiiniiiiiit,.y Last -,veelc tliej.(, iv:tst meeting in New Yoi.-k.,tt Ni,liieli over 400 voltii)teers were present, Itil(I one of tile fii-jii (I(@ci-,ioiis -arrived i,t it tli,%t iiie(It-ilig to Clik- cotii-ii(,re further the 1),ii-ticil),,ttioil of Ifeai-t. As.@iitioii which ciii t)i-iiiz (i to the ii)ipleiiieiltation and t@lle This exemplifies the ]Third of feeling Ilid the for iii,-,taii(-e, tll,, l@y the very wise provisions of this ict, and we rse, the coiitiiiiittioii of t-li@e basic prilicil)]P-g,, of oi-i!,,iiiivtiiiz ideas fit, the @-11 level ttiid li-.ii,iii,y ad] 4. (,ollllll("]Itilig 'LI)OIlt t,lie iiiittel- of tile filiill("(,,S, $C)r) ]million is it sii,,- est-ioii for fi-x..Ll 1961), Iti)(I its is brought Out, there is to be 9 liol(IoNrer. You iionv i,(-tiiitlly iJ)oiit I 1. I))-o- 3 I,ll(l NN-it,iiiii, t'll(@, next. few ]Health.,; will 1)(, 'L lot..I] of @(') 110 ft is extraordinarily ilill)ol-ill,lll@ to Co])Si(lel, iii-o t-li@itilciti(,r Ili lt@i-i!is @)f t of (-4)iitiiiii-ity A)i(I -I@ loll)(@litillil it is lill),]I(I:Ito -Y filing I%,o ])lit, it ill front, of it filly offer ill t@iiiie with tile f 'I'liis NN'.Ilo]O I)I-o"l-lllll t.@) 1)('ol)lo, at t,lio %-(I (.,Il(l of. t'll@ oi- fit, tii(-, I)iLti(@itt A Ili] if Nvo (lo -,oinet.Iiii l@'11]Cll Clit,'@3 the IIIOI]Ielltlllli ill 1',Ilo y(@lLr 19(;8 to 19(;9, we ]live iiioi-e, than 1 yetr of I)i-o,-i-ess, and '30 1 WO[l](I tli@, ii(@(I for the, colitil)tlity of fise;ll Support for tells wll()](@ business. Noiv, oil I-.]IC of (.ollst,l.llctioii money, t-liit has Colll(-, li@1) ill scelyl Iii(,rllly,illlpol.tilit, t'litit tlieI.L" 1)(',Ilitllorizttioii foi- this-. inciitioii(A @id Di-. Ftiil)er added, there are trei.@ As Dr. I)e]Ltl@ey of ictivity for which i)ew construction fluids will'ijiicloiil)tedly be ii-, tile, level of 2, I, or 4 yoii-s froin now, which sitolif@l be evaluated at trait point iii'tinie. It does not, iiewl to be cloiie now ill of .i.&,iiziiing ,in amowit of inoiiey. But it should be loolcel at l@lit iiltellsive care unit, or a sti-olce unit, or a matrix wliieli spite@tliat is not the issue at the iiioiliciit,. Iiiit for t(leqlltlte 'planning ii-i the future there should be the authorization for the I)oteiititil of including new construction soniewlier(@ ill the course of tii-ne. NoNv, ti (,-oinmeiit in the area of strolic, this is t-lic area of iiiy pti-ticillitr interest. 'I'lic Ani(@riciii Iletrt Associtt-ioii been in ,,,troke @fol-ille(i ,t colill(@.ii oil (liseise, itzi(I lias been tjie lvol.(l ill Collitillilliti@-. I that oil'(trs its iiii ol)l)oil-iiiiit,,v tx) produce t ,i-eittA-r iii@trix where we are really ,,,oillg to (to sonletfliiig :tl)oiit ,itroice,. '@oii ire aware of the need foi- in teriiis of fl(.il it i(@,,i for r(,,Iial)ilit,ttiOD, I'(',,OIltry of the ]),itieiit iiit4) the COIIITIAUllity, but we i.re iionv beginning to wlii(@ii, if we ct act the iiifor- illtt-ioll to til(3 I)OI)Ultt,ioll and to tll(@, -%Vill Siglli@fl(',ILIII@ly itIT(!4,t stroke, prevent ioii. And this is the Ic@ii(I of thing t,litt l@MI) is d'esigneal to (lo,,tnioiigotliertliiii(-r-,. One of the inost iiite@(,,stiii(-r it,eiiis t,liat is Coillilig oil t.lif,@ -,I(reiid-,i i)ow )7 LI is the word '@liyp@,rt@iis!Oll,. or high blood I)r(@slir(", 'Ill(l -,V(" ]low have defiiiiw epideiniolo,-,icaL evidence through I,)rogi-aiiis which have been -,iil)l)ot-t-@d and ori-@rinite(I b you I-)eople that, hypertension is -.is iiii- y in stroke is it is in heart disease,, certain i&,tte(-rories of heart in particular, ,ilid that via t,lic detection -land treatment of hypertension, we may @ut -,i@nificantly down on t-lie incidence of strol,-e. The I-Icait Association is (resigning DroErraii)s to interrelate to R'@NIP and provide screeiiina and detection ii-iecf@-iiiisins to find there people. Soiiie 20 perCODt Of li7yperteiisives are not even detected at this' point to the, very i)nportaiit subject of hypertension, the J-(@@)-ioll:l,l medical oirer all (NCellt-,Ilt D),Itt-ix for t,li(@ en-itliiit-ioii to, . As pi,oo),raiiis for (Ioti,(@tioii iiid I)OI-t,(@lisive ;irt s 0 f IiiLll blood 1)ressiirc.,tre li ,,iloslso f should I %,Ili]- itt)]o fee.. ()Vltlll@iioll fti)(f coitil),,ti-iiiive t@ritis of drug ii(,r(@iits; (1111ILrs IL]i-e,,,tdv known tii(I those wliielt will coyiie out of develol)iiieiittl Tlies(@,i,ro si,iiil)],y stiiiiiii@ti-i(,,s of soi-yi(, of the coi-niii(@,tits that .tre in ill(- foi-iii.11 accord. I (ioll't -%want, to belabor tlies(,, but to )iie,, we ti-c de,.tliii,r Nvit.li t.lie ii,-ttioiiii] the lietltli of our people, and we couldn't 1)(" (liscll"k,;ilirt iiiore important ciubject. I colirl-,tttilitte and codiine-iid you oil all Of the thrillers tliat, you have (1011(',, -.111(l in tli.is particular fr,-ti-no of ref-c@reiiec your wl" "(Ioiii i I giiidinz RMI) lits been unique. (I)r.Millikan's -reparedstawment follows:) p I%IILLIXAlq, CirAIRlfA-;, COTT-,CIL ON CrItEBROVASCITI.AR STATEMENT or DR. (',T.ARX DISEASE, AMERICAN IIEART ASSOCIATION I am Dr. Clark Millikan, Chairman of the American I-leart Association's Coun- cil oil Cerei)rovascular Disease. Representing the Aq@iation I welcome the o@ I)ortiiiiity Of testifying in support of IT.R. 15758, the five-year extension of the Itegiolial Medical Program (11. r,. 89-231)). As one of the organizations instru- mental in promotiiig the original Regional Medical Program In l..061, we are pleased with tli(t signifleant contribution it has made to the application of new medical knowledge to the diagnosis and treatment of heart (liseaF;e and stroke. We ii-e, I)atrticulitrly piezi@tl that the Regional Medical Program has I)rovitled, as intended, an effective vehicle for governmental and nongovernmental co- operation in combatting the three diseases taking the greatest toll of life in oil lo(.,Il I(, liliv(, ll(!Iiv(@ oil ,Ililio.,4t ')III It(.giol),'Il gilll(.I.illg (111(ii oil lli;ilil)oNvl.r @iii(i :iiiiilyziiig ti-ilil4il)l(@ 11(@illtli iiii(I S(!rvi(.(@,4. We 4]iiriiig the flv(@ yt@,11-s of t'lle 1)1,01)osecl r(@ii(!wttl am the (@iii- I)li:i,,js (if t)ie l@rogi-@ti)i sliifl,4 front the 1))@iiiiiijkg to the ol)(@i-jitioiiiil I)Iiiise. in N(@w Yorl@ City 100 An)(@i-iciii llf!art As,,;oci.,ttii)ii voliiiii 'cer,,4 aii(I Stiff fi-oiii ,L(,ro,,s t@lic 1)1.,iiiiie(I wiiys in Nvlii(-Ii %ve (@an ii)il)rove oiir I)ro- gr@iiii. Ot)(@ (li.,4cii.4s!oii groxil) was (levote(I to tli(@ iiit(!rr(!Iatiolislilp of the IZ(@.iotial Ili,ogriiii -,iii(I the Aiii(@ri(,:iii ll(,@ii-t Asso(!iitioii. We (lisciisse(I tli(@ w:iys in tli(@, relillioiisiiij).,; 1)(.qwt@(,ii Ileii-t As,,,o(@iiitioiis in the vftriotis (!otil(l 1)(,. reinforce] It wits @it (Iiis 114itioll:li II)(.(,t,iiig (li:il (@f oitr rtil.iir(@ lirt)gr@iiii woii](I I)(- to (@flt(-gioliiil AI(@olle@il (Pill- to ti 1'rogi-iiiii.,;, @o tli:tt, %voiil(l Ile 1)14tyiiig their iiiaxiiiiiiiii role to Ii%v over it gi-itil(is of front $50,000.00t) It) $20(1,(K)0.00() for llii@ fis(-iii v(@iir (,iiqli)ig Jtiiie, INI(@ not(, th@tt 11. Ik. slit,(-ili(,s $(;;-P,000,00f) for fis(,@il I!)(;9 @iii(I ,iiiiiis ii.4 iii;iy 1)(@ 7 s:ii-3, for tit(@ ii(,xt@ ft)iir NV(@ tire tli:il ' ii(@;trly $2, ),000,000 of filli(ig iivliilil)le ill I(I(Iit,ioii to Ili(! $(,).-),O()O,000 I)rovid(,(] in this bill for file ]text tiw@il y(-,Iir. lIoNi-ev(@r, we %%@oiil(l pref(@r tliit sp(,(@ific ftiji(lijig for y(@14ir.,; I!)70 tliroiigii ]S)7.'i ]it(] been iiieltid(@d in tliis@I)ill to as.,;tire the iiiixi- iiiiiiii gron%,tli of this 1)i,t)graiii. If tli(@ $(;5,000,000 for fis(!.il 1961) is aii4l iiiitliorized, Nv(@ iiii(l(-r- st.,iii(i 30 of the 5-1 Regioikal Ilrograiiis will Ile receiving their initial olo(@i-:itioii.ii griiits iiii(I 14 will Ile in their s(!eoji(I or tlilr(I ye:tr of ol)(,i-iitioiial gi-iiiit-I I(-til'ity. It, is to fie talent Ili file following toiii- y(,itrg ol)(,r,,itioji,,tl r(,(Iiiii-eiiieiit.,; will Net the legislation iiii(ler eoiisi(loratioii li(@r(@ tocl.,ty tii(! l@rogr;iiii to the iiiii@iiown qti.,tntity of Congressional tipprol)ria- tiozis ift.(,r fi@(-iil 1901). We li;ive soine res(,rvqtlioiis is to the wisdom of this .1 r)- I)ro,,icli li)z)g-rizige 1)1.,iiining is P.,Aseiitiil to the ,4iiecesq of this progriiii. One fiiiql NN-4)r(I -.I.,; to we ,f@res,, the niiniin.,Il iiec(@ssity of the ftill $65,000,006 re(Iii(,sted in 11. R. 15758 for 11)60. Aiii(@iig the I)rojiii.,;ing development,; in the R(-gioixil ',Nle(lical Prograiii of I)ar- ti(!til-ir interest to ii.,4 has been the recent eiiipl)asis oil exteii(ling,tbe develol)tiieiit of (,,ii-c iiiiits tnd the necessary tr.,iiiie(I p(@i-sotinel to hospitals not now having these It is (@iir i)ii.(Ier.,4t:tii(ling thitt the %Ie(li- e:il Pi-ogriin has iii,-iiiy il)l)lientions for fiii)(Is for this joiji-I)o.4p, We tIlol-oliglily tll(@ of tli@,o lif(,-qiivitig fi(,ilLtiol@iiig foi-Nvtrd to taking Of the (!Ori)iit.ry (,,,tro unit, ti-@iiiiiito- that are etir- ix@,ilt,]Y Find estftl)lislic(l @1.)y our i@kiiia forward to many otlie@-be-ilefit,-, from it. I think t,lie, Point tlllt f would like to airline. so strongly is trill flags, r-t'.LNIP ]its offered t@lic first ol)l)ortutiity for local medical communities to feel that it is worthwhile @ get iii- volvedind iii@r@tecl in @:).,us(@ their ol)iiiioiisi-nd problems ar'e-'beiiig certainly has I)eeii t coiisidei-.tl)l(, clitiiae in of the r(@,@rird to Gov(@i-iiiiiiiit, ill Tli.,;t it. few i, -s a,ao no (X)ol)("I-:1-tioll would be ofl'c%i.(@d, -tii(I if I)i-ef-eril)lo no in( er- we Find t@llo-ii:vorlg(@ I)II.Vsicil,ll the will .1)(@ involved ill @ille(li(-Iiie and of sollio kill(] N%,Oill(l be l@ll'ost 'I'll(i witfl it,,, (@ililyliltsii on i-(,,(,Yioiinlizatioti has, Iciiii(-Ylit t@lie -(@s. As 1. t-riiv(!] faii(Iy of tli(,, iiie(li'et] cori)iiii iiiii(-s of the ITiiit(@(I Stii( t@o V:Ll.iolis Tn(@-,i@intrs with who iti,o scattered across tlio coun- try, T find tllltt, Of(A)I'l 1111VO Ill'.1,liv fiLvort@I)IO colylilielit-s eon- (!C.I fair ti)(@ final and "rf)llls of this PI-O"llltl"ll. I think t,@llitt if this pro- to be siaiijfl(,.Iilltlv cllrt'llilt,(l ol- (irol).I)ed, you Sti-ollt-" Itill@p is going to oi)'Lll most of us feel tli(,i,e is a f tii(5 Goveriiiii(@lit :III of us liell) .911(i COOI)(,I.zlti oil otir loc@il iiiedical-I)rol)](,,i@is. I tlliiilc tl)at-, if it I)Ossible.to' I,,Ilo II.Alp could t@ i(@,ii do sig- @t loi)g I)erio(l, sitell I tl)(3 (-ollltntlnity would ki)ow that flitiii-o )flLllllillg NVIS I I(. I.(,, t4) ,t:t Y. ol! coillilig to Wii,,,Iiiiif,,ton, f ]),Lv(@ eel-t:iiiily e)ljoIye(l the, ex 0 pl)oi '.I'li:lliic you Very is telex tyl)e I tliiiilc l@-lic colnitiittt.(, to licir, froirl :1 plivsici,-tii. We ire, (I(@,li(,rlited that you tooli ti file to pres(@,lit t] I i s t (@st i IYI@iiy to the committee. F 'Dr. C-,irter? Mr. CARfl@Il. I e-ert--iiiilv -%Naiit to the eiiiliil III)OII I-IiST)rcseiit,,Ltion.1-leisoii oftliei-neiiwi@oal)pliest]14&EOO"Itslwllieli II-,Ive e bee ziven him, and in ,tddition will e use what other tool.-, ionol groups. I am impressed by his paper, are given him by our reg an(l,t]le depth of what he says. i am happy to ]lave such a young li),siai,,Ln @fore us today. p Mr. Roe.Eizs. let iyie -,i-,k if - You say you .tre the, only general. p!-ac- titioiier oi-i the Advisory 0 'IL Ycooiiiiiiittee for your i-egi n, or is this subre-,ion? I)r.@-1111ATIIUDI-'. I I,Iii the, only off(,, for tli(@ meet- We litve six pr-,i.eticiiig SI)CCi:xlists from vtti-igii,, disciplines; in ',I(I(Iit-,ioll, of coiii,- e, to many I-)@lysi(,ialis ill tll(@ ililiv(@r.-,ities. s Afr. lliit tlic@re are ,ix Out of @,O Whom you Would (-,I',I@-,Sify How many hospital tdiiiiiiist.i,ators do you liav(@? Dr. BiiATRUD-P!,. Two. ,',RS. -voii tl -',\fr. IZOO] Do iir)lctliis is -.i,rood ratio? Dr. BIA,rjttTDI-'. It is difficult to put eN,er)il)odv tliere. We ]lave six or.@,ven I,,Ly people, -%ve have two nurses, we live 'I dentist; tii(I by the time you done, we really li(!:tvily ltdeii witli t,lit- iiieclieal School I-)eople. Mr. 11'6ocl-i@iis. Woiil(-l it be more of ,t problem -,iwiy if you were not in T),Lrtiici-sllil)? uj III(I lil@e to SI) Dr. Bizjkln )I.,. I "vo e,,,tlc about this a bit. I think the 0 ire f the practicing physician is changed ,oinewli,,Lt,. As we train today, we -.ire tot-,illy convinced tliai'we ]lave to Stay current,; Liid I think,' as we set ourselves into pi-.i(,tice, many of my colleagues in our couiiiv ,ire in independent practice, such as -Bill Henry, one, of t -nt enou(rh lie doctors there. He feels it is imports -Lild has ediin-ited his ptticiits enough thtt he gets aw,,t-v for wurses@. I believe that grotil) -rrolIT),tl-lis @-,tliewq,-v if-is goiii(,;tobe in the future. or 110 <, no(;r,,rts. You don' think it call be brought down to the hospital Dr. BIIAntui)it,,. I don't mean that. We bftvo hospital staff meetings find visiting professors -,vlio come for gcmiiiars, and the rciitlcil-Lail 200 fi-A)III 'Alissolil'i, ',olil(@ of ]its ,;olll)(Ie,(i olitst@111(iiii". IVII(@,11 You tiiiiilc itiloll(, 11(@ll) You is iii iiioriiiiil, iiiil voij you I to you sollie, It like this of his wts 'I'li;tiik you so t,ii(@ of Yolli- is 1'roiiL iiiy owii lioiyie, (-ottiity of lliiiii B(@,teli Cotilit lolls kll jol), ',tll(l y soille of t-li(,@ pilot It II @tl car 1)("fol.(@, tlk(@ (@ollill)it,t(,T I)Cctuse you ]II I)rev o legislative li(m, nity p L L. BRUMBACK. IVIEMBER, BOAR PUBLIC HEALTH ASSOC ION I)r. Bitu.Nt Tlip, Auto: Publi le,,ilth Associatioii apprSs tes this oppor- tiiiiity to pi-eseiit our vie-, of I-I.R. 157,)S. I iiii lkre, as tii executive I)oird iiieinber of thisissoc ioii -which now haAver 20,000 inenibers. I liaie,.i prep-,tre(I st.-ttenie which has been/lriveii to the ',Ind -Irlcs. I%voti](I lilce to li@tvc your poi-i ize these reiyi, Mr. C(@,i-li,iiily, tii(I iteiiieiit. will be rilt(le ol@ tit(,, fol]onvill(r Y( My I)ol.tioll or the bill. -11, is that I([ II 1)4)ii III i,rritiit, labor to (-.I-o[)S. We:ill II I I. -rol. liiiit,,Ii of our Coo(]. iiiillioll )11(tli @ii ilii,,i,,ttc to I,Ikis All lioii@,ii 1)(@,ol)l(@ iii(,,oiiie, 1)(@l, Wol-i@et to rise itl)ove the level. Fiirtli(,i-iiioi,e, (ii(@ ii(.,Ii tli live Ill.(, Usually [,:Ll@ Treat) soitl-(@.,,- ol@ Health 1)(I (still :11.(A IISIIK,]IY held it. :1 tilli(@ Nvll(@ii til(@v wol-Iiill(,', :Lll(t tll (I I i l'y till(IOV NV(-,I- i-esid(@ii, is fol, fol-I "ri-e-,xtnieii -,oiiies difli(-u it. Actually, the I gi-.-iiits' ii(@ed or health c tli-,tii tliit of the rest of tl -treatments e(liSI)OSO them to il@Iiiess ,t el.: of diic,.ttioii a of where to tiirii for liell t roblems. S isties 4 I rin the fact tliit iiiigriiits earth I)rol)lems the rest of the I)opulitioii. Iiif,.Ili@-lort(llity wts over 30 I)er thousand live births iii I()()4.1 i-,Iie illiRi.,Illts, C.Oini),i.re(I with less tli.-tii 2r) for the ii:itit)ii,.il qi-era fl.-Olli wis tltoy',tiid, -%Nrit@ii 10 -1@ot,tlii(, @N:tt-,ioii itsL wliol(@. y 208 ilililzli(@,, ()I' oill' lli('@ o, of of W(@St Vii-,,iiii:i ,ti-e )v t.iii,,, i-V for tlie, Niti(iii. (I giviii,,, lis tll(,- 'I'li:illlc volt i,er I to yoii 'Ill(] NVO l@llo1v of yoli,illl..()Iio"ll Yolit- (r )Ofl gi@t. j(r)ll:r]);Il @fol. tile I woiil(l like, -to it (.()I)y of Izo(;I.lls. Alri't-liolit, 0I)j(@etioii, IV(' NN'ill Tile, joili'llil for t@lie files. I)III)li(-,Itioii t,,o, "Joiii-iiil of tii(@ AT(@dic:il Associatioii of A I)i-il 11)67, w:is pla(-(-(l it) t li(@ (,oiiiiiiittee files.) ,A,fr. Yoti i)iiy Di-. STATEMENT OF DR. S. W. CHAMBERS, REPRESENTING THE MEDICAL ASSOCIATION OF GEORGIA Di-. :Hill of the (-oiiiiiiit,tee, I aiii I?r:t(,,tice of iiiedi(@iii(, ill T,,i Cxi,,Iiit(nye, Gll., ,issociiited Ni-itli t isiisili@ill (.itv of,-).@).OOO pol)itla,tioii )0,000 ',)ol)llliltioll. is 011(@ I)oSl)it@ll ill ill t of olir coiiiiiiiiiiity; it@ lits approxiiiiitely 220 I)e(ls tiifl is ,tii tc(@i-e(lite(I liospit,,Il. I reei.,Lt(, Ili(- (-oiii-t(ry of!tliis (,c)tiiii@iittee, ill lie@li-ili,.r ,I Voi(.e fi-oill 0 siil)l)oi-t,17 of TI.I@. l,t@ ii iiiy I)elicf I-li:it tile- tli ])I-Ofes"ioll,-Ils ill oiir (.()Ilsidei- tile oi-igiii:tl logi,;].ttioil., Ptii)li(, Tj;iNi, 89-2'))(), Its its ;iiiN, lli;tt. II-,is I)Y title Olli- Is WI of ill(" Iiool of oi@ ('(V()I.giii i;l ilit@ (,(4 i-gii (x( I)i%,isioii of Y. to itl(.Itlll(@ tile I'l-olli 111(@ kqso- As,,,o- ei:ttiol (,(@ol. i,;I. 1)(@,iital Asso(-,i;:ttit)]), (,'(!ol.gill tioll, I)ivisioil of \rocitlioll@ll I,k(@llll)ilittitioii, State in,iii-ses 1-i,li@tiiie,iit, of F,,i@,,iiily aiid Cliildi-eli SC]-Vi(TS, (",ollllflllllity Colli@(-il of Atl,t.ii,t@.t Are,,L ii,jid t@li(,, ll']:iiiiiiiig Cotiiieil. oi- 'Af(@,ti-opolitaii In,,tdditioii, tli(, Georgia iNiii-siii,-, Iloi-ne A@-,ociatioii and kiiowled" able -tii(I interested Iiiymen Were inelti(led. From such discusgloi'is, 209 ilivoIN-ilig iii(@Sk@ L 1)1,111 N\',IS fol. ill(@ ol.".Illlzil- tioll of :I. :I(Ivi@oi- 12r) y I)c@iisoiis I)ro:t(tly of oiir zn roo,ioii. of if) 11(@ of t'lic, (if i 114@ I)IIY ()I@ t@lio jotii-ii:il of t,l)(@ Asso(@i:i,tioii of (leo)-gi:l 'was (ICN,ol t otII I is joll 1-11:1 I I 11 o 1)(@ I)II II i(@ Alt,lioti,,li i lie li:t,(] -oi)ly ofii(-i@iliv oil .):tiiii:ii-y 1, If)(;7, ilie 1-(@,,I)oii,,ibility l'oi- I)v I III fktct,, t'llo of iiii-iiiiiiioli,,Iy I)v 11 lio i(lvisf@r gi-oiii) t4) ll\,el :I.-i tiie Geol,,,-It y ilfay Iqiiot(,, I)i-ieHy fi-oiii ,t)i entitled "A 1-iiiqiie, Oppor- -y for AN iii tli(@ AI)ril joiii-iial. The regional iiie(iic:tl program f(pi- (..(@orgii I)rovi4l(@s the iii(-iiili(,rsliip (@f i,lie Avso(,,!;ttioii of (.vorgit t iiiii4iiii@ olil)ortiiiiit,y for le@i(It-rsliiii in "pro- illolilig 11)(@ till(] al.( of @ill(I tII4, (4 tli(@ I)IIIIIie lieiltli." tll(@ ]-oil, of loo ;is pily.,;iciliii.4 'I'lie ](,gisl:klioll %Vlli(,Il this i)rogi-.iiii w;i,,; the r(,siilt of tli(@ r(,Ikort or t.lie llrt,siilelii's (@ollitilissioti (@ii all(] @(t-ok(!, (,oiiiiiioiily (!oiigi-(-"@ giiv(@ tii4@tiglitfiil iii:iiiy -iii(I oi-g@iiiiz:iiitpii,, I,.iw 8f)-2119 A,, a, r(@siiii. t.ikis ]nNN, )irovi(l(@,, foi- iii4@(liciil I)ro,,r.,ii@is (.@iii ilik(l ivill 1)4, lay ]i(@ol)lt@ iii tii(@ iiiv(olv(,(l for tl)(@ ))(@ol)le tli(@ :tr4@jis li@ 1)(, ,erv(@41. 'I'Iiis is iii ](-,isi@itioii iiii,4)xigii talk iin- gll:lg(@ or ;@lill "Williolit@ tll(' lint- t(,i-iis, or tliL, iii(@lliotl,4 of liii:iii(,iiig. of or or of I)I-f)gi-:tiii for G(@i)i-gi:i li:is 1)(@eii cai-efiilly liy ill it II-iily (Iiii-iiig the 15 ik)(@ntlis. l@t@ Iii(lg(@(I liy tli(@ of tl)(@ I)i-ogi-iiiii's lifivis4)ry gi,4@iii). I)i-(ogr:itii is @iii(I iN-ill I)i-ovi4l(, the f(iols f(@r i@N-(,j-y I)i-netiti(piier to liol@ olity ])IS (Own 111(@ili(-Itl I)iit@ itls(@ to iiiil)i-oN,c the qiiality of ftyi- @ill(I every ()lie of Ilis 'I'Iiis is it for of t@lie Asso(-Iiitioii of Ceoi-gia .911(l Well 11(@ oill' o]il)oj-iiiitily !it i)iir tiiiie for exliil)ii.ii)g responsible Aiiotli(@i- i';it,t<)r Nve. f(,el tll(@ (@xt(@lisioll of tll(, is fill(' :111(l ([alone)., lio@ o]IIV Illloll(r "(.Ilools, 'Ill(l 1)@it, :11.,o .11)loll" ;ill of tll(, 11(@:lltli toI)(@ ])];Ill f(@l- io]) ilifo :I(!(@oillit fligil-, ]@lioNVIO(ig(,, I'l-4)lil i@lie iiiii,,t flo\\. to C\.el.y of iiii(I ('(Ill;llly ;Ill(l 11(@(@(IS of (110. it ioii(@i- all(] ot.lit@i,s iii t.,]I(@ Sill.111 t.o\N'll', little fl(@NV to ill(', fol. 111(@ (Extension of tliii ])I.ogl.:I.Ill, we li@is 1)(@eli the fol. 1)1-0- (rl,:Alll Of I)III)L i(-, ioli to stilliiilitte lily I)et)i)le to what iii)(I to seek roo(I care. Tlieie are iiitny (@c olloiiii(@illy (Iisttdviiiitared I)C()I)le 210 liol)13 to to NVLIIL :I(le lii:IN 1)(@ list is 111,111Y illcl(lictllv I)eople totally itilrelit(@(I to e(lolloillic cir(,@iiiiistiiie(@s. Iiielt@ie(,l ill tliii gi-oi.il) tre intiiv of our iiio-lit seek mcitical care that ("(I citizens who Silill)IY (10 iiot, (Iolild b(, classified as,,i(le(iiiit(@,. l@iiiillv. Mr. Cliiiriii..ti.i, Nv(@ I)Cli(,Ve @liit, tli(@, l@ey to the of the lyie,(Iicll I)rogl.,Ilyl iii Geor(,@i,(t is the involveiiieiit of coiliiiiuiiity re,-Y-ion in the country to a This, iio doiti)[, is true iii every or lesse' exteiit. Very early iii t li@ (.t(@v@fol@)ji-ient of pl,,tiis for the p arlize(I thitt the vast ilil,ij<)rlty ot ptiysiciaiis, iiurses,,tii(i ot:))ers iii@-olve(I Ill the regioii,,il pro- to olie or iiiore liosl-)itils. Therefore, Ikosl)i- tell ill tile re(yi0ii lii,, :I vit,,tl role ill the Lil(l ill the, f iiture of iie(ii(@iiie. TI)i,@ iiiclll(les the ],Lrtrv i@ii(@ siii:tll aiid tli(3 -,I)it;tl iii t@lto iiiedi(@,tl cc It -(@inote to t@l c later ii(I tli(@ liosf)it:tl I I lli(,(Iicll At title I)i-esciit tiiiie [here :line 11)ollt@ -I.(),500 liosl)it@,'Il ])C(:k ill (tisi @iiyioiig 178 @ill(I lilllit-(@(I S('I-Vic(@s liosl)il@IIIS of @ilf siz(@s. ONr(@r @,000 oil 1,11(" ,t,:tfr@ of tll(@e liosl)itils. t is lio.,;I)it:il will 1)(!('olil(" I I-;II f tlll-Ollo,'Il Wili(@ll tll(3 of, the J-e,,ioil;tl 1)(@ (!Itrri("(l ()tit. l@,@-ery ]Joe )it;tl -%N-ill t t(@:tcllii liosl)@till. 'I'liis (loe.,; liot, illil)]Y tl),'It ille(li@-:11 St-iitl(kilts -,iiid lioii,,P, star to be Pr("Seiit; but, it do'CS'imply t It ])I i(@ i , dentists, 1)li.,ti-in, I -L(l I l@ @ :, ;ilis, iitirses L("isl@s , ministi-ators iiieitibei-s of tl@(! ttid ftll of [lie :Illie'(1 I)eitltli professionals Sliall oi-@,,Iiiize i lieliiselviN-3 iiito -ttii edii@, tioiitl I)rogriiii. li,acli hospital ]la.-, I)ceii @tslced to siil)irlit the names of a group of 1)er.4;oiis to serve ,ts % local advisory ted that a physi- ,youl@) to the regional me(fictl pro,,,-i-,.iii-i. It wis suzzes clean -(a-, cliiirma r, n), a ho@pit,,tl a(Iiiiiiiistr,,tto a iwirse, tnd a niember of the public be the i-iiiiiimuiii number to comprise each designated arou I'llis locLl advisory group In,,iy be is large ts the local hospital or Colillillillity desires, but it must be named by and through acceptable ,I(Illl iiiistritive mechanisms. These L,,rotips of loci,l hospi t,,il representatives are f iinctioiiing well. Of Geor(,rl"t,s 178 hospitals, !I-)l tl)I)Oilltecl local advi m ",Oly gro'l -(,,iit, -iiy t This fii)i)i-o-, I:lt(@,lv ()O or -II(,, goiiertl I Cliff ,,I'll, oil lo(,,t]@,t(lvi,-.o@y gi-oiii),, iiiet in oil Siiii(Ifty, March 2 1968, for.It (i@l@v of According to n 87 t-ti@.ives w(@i-o present,. Sin-iilii,r iiie,( ved )itlis @fol, (,T(@ol.gl:L 1.(,ifloll. '%Nllll be twic(3 (1111 @ir lo(,,itl dii-(@,etioii at the II the ov(-rtil of I)e.Llt,li I)Iitliiiill(y isi in our OI)i id ell'cctive itl)l)i-oaeli. Altlio I hear pli,nning ]la% been goil)g oil ill our region for many Y(!Ill-S, t, is tli first time trials ro])resciiL:ttiv(@,s froi-fi ill] interested (,,,rou 's ]live deliberated tog(@,tlier in' an ,ttteirii)t to coordiyiftte their p health car I)Itni-iiiig into a unified plan for T)roaress. Both interest ,tii(I -P,,trticiTi,,ition of the prap-ti(-in_" physi -s, local hospitals, and se] excellent. ose comm inicttion with other medical iools have been 01 I agencies, oro,,anizations, institutions, and Government programs is 77 !@r7 I @ I ii I . 211 complete coordination Of Lll activities in tile area of lie, t I and tile purposes of Public L@tw 89-23@) ai, ill tli(3 Geoi-git refrioll, e bear i 11, Air. for this ol.)portunity. collent statement. I liotic(3 tlitt o'il)il@ll i-(@,present,,ttives were pi-c.,;eiit, It yoi I- Iiist@ ly 178. 0 r t liit, ii iiii il)er 1.21 littv(@ iL] 111) tllo loctl Idvisory groups. ones wlio ]leave not I)x-ii-viti,rily tlle (,xt reii (,Iy siiiill hospitals, Mr. Cli-,tiriiiari, ii'llllyl)e as f -,is 15 to 20 I w feel, tlieill:tjoi@ lioSI)it@tls ill t@,lie St@ttell,.tvc? r-to(3iits. But you We 0 of the I)O(ls c vei-c(l. ,Air. E%,eii tlioii(,Il tliey (I()Il,t it@t(!Ild tile inectiii,, tliev I)tti-c lip @fol- tllis? Yes. These s@i)n(@, oii(@s ti-C not the, ones wlio were at, previous ilic(@tiiigs, @ieces@;.trily, t)tit, t,liis I)erceiitag(,, is a pretty good atteiid:LiiccA,for,,iregioiiour,,ize. Dr. CIIA-,NfprRs. No, we do liot@@ tliiiik so. We (tre beginning to get sub- re@ion,,iliz,ttion now. This is what we, hope to accomplish. !'Jr. P%,oGi,@is. How long have you -,ictu,,illy ]'aid the region foriiied Dr. CIT.A@1113ERS. Our grain, Mr. Chairman, act7uilly began J,,iii- pro u, C)7, so we,,ti-e only tbotit 15 month,, old. I 1 0 -N r. RocipRs. You prese ur i,.t i-it a very eiico otiire. I)r.CIIA-@NI:BIt',IZS.W(3fee,lwellavcA,lc(@01)'T)Iislie tlotini.5ii-ioiitlio,,sir. 1-1@ iii(@, coiiiiiiiit(@o wolil(i I)e sir, I would be (wild to leave @Nl I-. I,ko(Ili,],,s, 'I Nx-oill(I lil@(@ i@ei-v to tli:tt -for (lie colylillit.te(,@ of AI(@oliolisi)i, Tells. OF THOMAS P. CARPENTER, PRE@ NATIONAL ALCOHOLISM, INC.; ACCOM11AI WILLIAM E L- DI @TOR comes to fe-,ti-t, Asso(@,i@itioii. I'@liow tll(@, I)].(@vi Illy ,i.Sl')ect@-, of tlie, roi,)](,Ill. Al,(, leave i ourselves Ill(l our You)yitypr@ (I.@ICI-I,;,NTEn. T ,II C oholisiii is the i-oluii- ary liciltli t with 82 ,tflili,,ttes ser%,-- bit,. tll(l iiitic (yroii, alle,], coiiiiiiiiliitiels Ea( I tlril tte ias i iiteer board of (Iil.(, n ']:Iiese I)oards, li lie iittt-ioii,,il I)o"ll e(,tors, iti-(@ rel)r(@,seiititt-i@,es of the legal, 111(@ ediie-,t- -,Ili(i iiidtist-Iriitl iiiteres s NV %7is(@r wolil(I 1)(, -tilllt@. Tii @l(l(litioll tlicre slioi f till title I-ilti.-iilti;ig ,t4iff olle olic@ l@sY(']] es(, I ).,I I't-I !III e C(Il I', I'll t: III t,S N@-ol II (II)(! (Ii@lgilt),S I IC Wo I' I' t,r(@:ttineiit. All I)ersoiiiiel wiist I)c equil.)I.)cd Nvi the of tlit@ @liotil(I I)e lylii(T(i on e:i.si ig tlif! lit(lill- r)rOt(@('t.Cfl Sitll@it,ioll ill t,l)(! COIIIIIIIIIlit.Y. Iiiiiited to !,IO (lays. I-, iLe)t all irl)itrii,@fig that 3 iiioiitlis is ill ill@iiiy NN-,Iy" ll(,@ ol' ol, It is II stil@l)le perio(I for tile iiiiijoriiv ; it @lvoi( xec.,4sil I)olllt o foi- i iNotiiit of tiii,jiov(@. - Jeff (]('Pt'll(lilig (Yll iii(li,,Yltl(i@il Ali for tlt(@ ii,,(! i@N,;Iil4tl)l(t to of 111 C-i'lpi,(Igl.;Itfl, -@f) t@lill l@il)(I of (kri(,itt@it lt@ is it filli(@ Of 1111(i lt@nl@ilig, I)ossil)l(@ to ltv(.I.(, r:lillll.i.. l@,@fl slii-iillt II(. at, filitlilig 11(@lisill@. family, r(@ligii)ti.4, till(] iotlii 111141 t,!Y(I"ilglflN)Iifig all (ff r(,Illt(Igrittioll ill N(@l for r-%v giii(i II)i@.,;t,,. T,(j4-jil ive, t@ioll I)(. t ('rill gi); I fit:-It NN,o (@ollillit@iicl PK iily Ilillf-wily 1101 Il]-olig r(,-li:,@liilitiLtion. ']'hroiigli fill,,, tli(,y gi,. Aitli ;file pre(!Iii(le the ii,,(@ of :11(,oll(@l. rli(,@reby dignity, 1 @'4tore their ii,@fuli I)s tii(I eveiituilly (-.a.,;e the lietvy btire, I,, is ne ti.@,?aeh,,ble.,, t.ness todty is Eii@iie Siber-v. '@Nfty I say we will make your stiteinciit t @ait of the record, follow-, iiiLt your reniarks. Noiv, if you would give us your comnionts, it would, 1)@h@lpf ul. OF D. EUGENE SIBERY, EXECUTIVE DIRECTOR, STATEMENT GREATER DE- TROIT AREA HOSPITAL COUNCIL @lfl-. sill)"Ity. I sliall go tli@it T. sli@tll t ct)iitiii(,iit.;Ii.-v oil it 7-illilitit,O 'fol-I)Iltl I am Ai-'t Ifo- -)iiii- Si )('I- executive dii-(,cl-,or of t,@li() (I i-t@:i tei- I)et I 0,@ I-)Ititl CA (,,i]. Llso servo - ts ch,,iii-iyi.,tii of tlio 'llosi)itil A,,so(-,ii,tioii'si (!oiiiii,-,il on -,tn(I ll'litiini ilr, and ]':ill) tlla of the ik,-;- sedation of lfe,,tlth Pliii !z A I (-,ool.(,Iill@,itor In l@ 'Nf regional ;IC (111riii -, it,, of tli(,, i me, 'I L 1.)el.io(l, -,Lll(l now servo (ii.tllltt I(Ivisov y I tni here today to sl)etlc in supl)oi-t@ of title T, 15758, to extend the ,tutliori -o(yrims for he,,t z,-ttio;i for re(,ion,,vl ine(lictl. I)i rt disease, cliiicei-, and stroke. As a health planner -involved with tlie coordinated i)lanninLy ae -a hit of the Nation's inost h@Vily tivities of ndred hospitals, in- one :@77 219 (,I I)y l@lie potential of ret,n,iojial ill) )i-essed 1) I li(@ii- I)t-ogr(@ss. y ]to st,i-eiigtli of t,lies(@ 1)i-ogri,iiis steiii,; from the spirit of voluntary cooI)(@i-iit-ioii underlies them, and ivliicli ivas written into t@lic Tlii,; @-oliiiiitry, lo I)i,ol.)Ieiii ,;olviii,,- isiil(, as :I. illol.(3 to 1)07 but, l@ llol)C, that it, is -fi,i- iiioi-(', Lr(@ ;Ociety ti fol.("(@s ill oitr i(@ ifig(,Iillity of the par- Tlie,.y ti-o be(-oiytiii,-, st;i-oiiL,,:kii(I forces in ()Ill, so- t 11(@y exist@ t,i lo(!:Il liol@, s ito i,o,l)(i li,,tt@ioll;tl I)I-ob- ](Calls. @vii(I fliitllyz I)ecoi-riixig strong tjid fol@(,e"i ill our ,w, they iiT)on I)Itiis and (leci,.4ioiis ii,itdo by those 1 out the plans and decisions, ,I II (I 1)3, t,l lose who wil I be @,,tfrected by them. 'rlic@, last poiiit-bro,,td-bised iiivol@7eiiient, for CO<)I)erLtiie plin- iiiiig and tction-is title paramount reason regional medical proffraii-is ii-ilt ultimately succeed in the inner cities of America. It is -,t-l)ro(rraiii that lietltli planners hire lon(r ,tw,,iited, ,t program to draw together the hospitals, physicians public health ,iffenci@s. ,tnd all of the'-other elements necessary to provide efficient elYective, -tnd economic health services. It is %]so t T)rozram which must incorporate the opinions and tlioil(,rjlts of the pii@iie to be served by tli(@@ge lictlth resources, tn(I this too ist. terribly iliflictilt 'Plie 1)oi)ii],@itioii of our inner cities is (lo- in iiiiii(I tiid -by l@telc of c(lii('Iltioll .Ill(l opportunity, in(I ill but by I)ovei-ty lived. 'I'liis II)ll"t not, ('[(@ter us. Without the cooperation @iii(I tl)(.) support of ill )lo C'@se 1)(!Ol 110 1)1.-Oiyl."Illl ci ii succeed. ol' iii(,di(-.,tl I-)i-ogt,;tiiis has s(@eiiie(I slow in It"s not unlike the con- st@i-il(..tioll of ,I, I)IIi](Iiii(ly. TT]itil t'lle, is ]Gloriously diig and I)iiilt, find t-ii(, iiiiiii beffiiis to I)ro(-Y).-CSS is not, ti@ir foiiiidtiti;@s wit@li ,t 1) 1-o(!(,S.,; o f I I 1) Ii ii ii i i i fr, ai i d tli c st i- i e tti i,(!s I)ogi nii i n L, to mei,- be all sounder- itiid stronger for this ("N-Ol-Y (@lYoz-t. li@ielly Stated, l'i-oin ill(, iittioliitl view,,tlie progress ol@ teetotal] 111(t(tic:ll has been Less than 2 years t,yo, flici-e w(@i-e no iyiedict] proo'i-,iiyi,-,; today there tre 53 and at ivoi-Ic. is olle fi@il,i-,Iier reason wl)y 1. view the period of planning ,is wish to .;fre so esseitt i]. Tiie experience in this I)i-oL Ss I)oijif,-f-oi- lie,,-trt disease, @;t@rok@,-Lii serve as 1% g@ii(le to p it, far easier for ot,l)er liciltli I)i-o(ri-@iins to in C"t the needs of oi ir coilliti@v's (Ilitii-o I)OI)IIIItioll, ill(-,Ill(liil(r out, ilill)"I.ll re must I)L) s ill jr)(@illo(is of CT will I)rovi(I.0 t@lic isle l'ol. ilk(@ ]))-o(,Vssioll:tls to illipt-ov(3 the I)fttteriis Of ol-t@,@i@liz"ktioll 220 I (lo t@llilll( 0111- ill i@ I . .I ol@ 1,11(@ I)I,ogl"llil it is l'ol' 11', to ill 9 !Ill of, tile I)III[illilig ll(-(ivitli(@@s ill t,l)(@ foul)(1-1- @it, tills I)oilit-, ill tiirl(,. tioll fol- ill(, 1)1.(14rl.,Illl is i)(@i ivol (I 1)1-0",I,; ils, of oil tll(, lie(.(I fol. (1)(@. 4@ool)(@i,ittiV(l regional a]-- @111(i t Act t 0 lill(lel.,tlle, Ate(lie'ti pl.0'r.alll be @iiid in (@oiifo"),Iit,Y. itll to L,,o,,ils and ,i(,tiviti", -il'y -\N' I t@llilil@ they 11-0 Coilll)l(-Illellt@ 10 evel'y@l'i,,Lr possible to be it. the- local level we ]"list think , , t do cooperate and siip- ,e are not ill conflict, but in fac eel.tlill tliit, the i-t, e,,i(,Ii other. Po I do I)Oieve there is t real iieed,,,is the statement indicates, for limited C()ilstrii(@ ioii funds, ,tii(I I would liol)e tliit, ,is ,t p,,trt of the intro(lu(-,- t tioii ( f illy follri,,tl statement, in the record that you -%voiild also include tile I )])e;@de,(l a@i-ticle entitled "I-lo-,I)it;ils and Reaional Medical Pro- ,t I'le:i, for (Coordinated Action," wis in the Dexei-nber 0 ssiie, of Tl'osl)it;tlsiiiig, This wis written by my g od friend, IZol)(@,t-t. T@,vliis, and T thin]( 4.tiiil)lifies elo(illel)tlv Oil tile I)Oillt that I -,would iiii'ke, is:t real foi- Iiiiiite(I (Instruction dollars. I eel-t:i,'iilv liol)o tlitt this I)ill Nvill l@)t) supported by yolli Ill(l -%Vill) 1)@, I think the I)rogi-e@.-so far is Sound, W(@ li:lv(@ gone (,-,'Illtloilsly. I tile pro- Sl)(@(@(I tli(' (Illy tll@it, %Vt, %Vill (Y-et to every %rP,,t ill Miellik@ll, t? e%,t@i-y (!It lzell ill tile I)CII(@fits t]),it-, this progrttii-i wits (IC- I o ].)I-il) .1 should 1)(@ to @ll)SWCI- any (itiestioiis you iiiig@it It has follows:) STATIINIFN'R (@F 1). litl(ll',NIP SilillitY, (',It)-'AT]rit DFTITOIT AitrA Ili)si-i,rA], COTINCII,, ])]--,TltOt'r, of til(@ fill) 1). li'iig(@ne of t-li(! (,r(-jit(-r 1)(, r(@it Ar(,it llo,.,])itil 1 ill'.40 ,4el-ve as t ebiiriii,,iii of the hospital A.,;so(-i@itiotil,., oil Re,,,t,.nreli aiitl I'litil- iling, -,in(I I an-i t@lie I)r(,@i(l(@nt: of tli(@ Aqso(-intioii of 11(@iiltli 1114iiiiiiiig Agt@ncies. I Nv.,Is file @i(-tilig (coordinator of tile @kii(-Iiigiiii it(,gii)iliti Prog@raiii dtiriiig its initial, (?rgiiiiizatioll.11 i)erioti, ati(i now serN-c oil tliitt 1'rograni's Rf-gloiinl Ad- T :fail it(@r(@ to(]:iy to iii sliiii)oi-t (@f Tjtl(@ 1, 11.1t. lr,758, to (Extend tlit, oil- Clioriz:ttioii for iti-gioii,,ti i,-r(Igriiiiif4 for iiii(I 4ti,olce. A,; it health 1)14iiiii(@r iiivoli,t-(] wait ,III, (.ool.(Iillllt(-Il 1)1;17@iiiiig ft(,tivitit@q of a liiiii- iii oil(, of tli(@ Nitioll's lilost, II(.Zivilv I iiiii strongly Ili i)y iii(- I,oot.(@iii'lill of lt(,gioli;il M(@(li(-Itl Ili-ogrjilvis iiii(I by tli(@ir Pt 11 it I.,. legal) of tll('S(@ 111-ogi-allis ',t('Iiis fi-oiii tli(@ similarly of voluntary cool)(-rntioii iii)(I wlii %vit-, litto iii(@ ift%v largely by Yoiir (-oiii- ilgo. %,(limitary - il)l)roiii-li to solviiig isti't as sN%,Ift. As a (.ool)(@r;itiv( illegal lii)l)(Nir to 1)(,, I)ilt I liol)c That yoii Ai-ill I)t@ lier- ]:Iil(,Ol third lt@ is f;ii t, l@('(-olllillg Stl-i)llg filter fol-(-(',4 !II oiir til(@y tile ilig(,Iillit@y (of tll(@ Tii(ly iir(@ llig ;tl.ollg .111(i for(-es iii oitr so(-i(@t@y tlicy exist to I)IC('t specific local protil(@ins, not I)rol)l(@nis tlint Iiiiv(@- beeii reii(l(,r(,(] siifli(!ieiitly Ytig@ie to be 7 221 St I-olig s ill (plir :11.(t 1)@IS(-(l 111)(Pil Julius y iiili(l(@ I)Y tlio@'(@ NN-lio ilill"t, (,;Ilry olit, ill(,- lillifis NV)lo NN-ill 1)(@ I)Y tli('Iil. iiivolv(@i@i(,i@t for I)Iiiiniiig itti(I ,tction- ii)oiitit r(@.isoti lt(@gioiiiil will iiltiixi@it,(']Y ill r tli(@ iiiii(@r iti(,s of It is :t I)i-4)gi,;iiii tli@it li(@@ilth 1)1,,tnii(,rs lx;tve lonf,, iwiit(@(1, @l I)ro,,riiii to (Ir,,iw tog(-tll(!r Ili(@ liosi@it:ils, lpliysiviitji.,,-, lptil)lie li(@tiltli 4111(l ill of the otlier eleiiieiits ii(@c(@sstry to I)rovi(le effi(,,ieiit, effective, it is @ilso ,t I)r(;grim wilicli iiiii,,t illeol.l)oratt(- tll(@ ol)illioll.4 Ill(l tlloiiglits of tlie, to 1)(@ zerv(@d I)y tll(@ tlii, ,4e li(,,,Lltli too is ;t terribly difficult t;isic. of oxir iiiii(@r 4-iti(,s 1,; in iiiiii(I aii(I 41)irit, litti(li- I)y i@t(-k of (!(Iu(,-iitioii aii(I olol)oj-tliiiity, ijitl iill ])tit I)y Igiv(,@rty lie(.(I. must, not (](@ter iis. IVitli4)iit ill(,, cool)eriitioii find stilol)ort of tlicso l@t-ol)l(,, no liro;4riiiii c:iii of lz(,giotiil Ilrogriin,, li@i,4 seciiie(I slow in the inner (-iti(@s, I)Iit hill; be(@ll I)rogress. lt's not iiiilil(c tli(@ coti.,;triietioii. of a building. ITiit,il Lli(@ foundation is lil)orioiisly dtig tii(I Iiiiilt, iiid the main sti-ii(-ture 1)(,giiis to rise. I)i-ogi-ess is ii(it i)l)l).ir(,iit. ll(,gioii@il Ilrograiii,; havc, 1)(@n (ligging tlit,ir follil unions with a loroc(@ss of ]wl@itiiiiiig, tiid the ,,trtictliir(-s 1)(,giii- t@o ol)er;ttioti;tl I)rogriiiis vi)l 1)(@ ill the @',,Oi for this (Daily effort. ltrielly stito-(I, from the national view, the I)rogress of in(ler and stronger lt(,gi4)ii;tl Ilro,.,rii@i,, ]la,; I,t,ss thin two y(@,ir,.A tli(@re NV(4'(@ it@) lt(@gioll@ll 1rogi-@iiiis; to(lity ;ii-(@ ri:@ organized and lit Wol-IC. is oii(@ ftirtli(@ j-(!ilsoll wily I Vi(!N%' the 1)(@riod of jolitililitig 11'4 so t-s,,@erititil. gained in this program for lit-tirt call(, and strolc(@ (!all (,r, Serve "is It giii(i(- to )fill<(! it far for otliei- health l@rogriiiis to iiie(@t the ll(,e(Is of our (-()iiiit@ry's (@iitire 1)( I)III;ti role, i:l(.llltlillg our ur@iiii tireit,4. Sigikifiefint (.11:11ig(@ ill the tl..14iitioll:tl iii(@tl:o(Is of (14@liveriiig health cire must I)(. eff(@te(l. I 1)(@lieve %vitli @i(.tive @ill(I ill(.,illiiigftil ini@(plveiiieiit of all lieilth I)rofes.,;Ionil,4, the lt(@gioiiil ',\Iedical Ilrogrtiii,4 will i)i,ovide the ill(,Til.,Ililsiii for the health pro- fe.ssioli'Lls to markedly improve the 1) nation and distribution of -itteriis of orgiiiiz ,I re. I)e:tltli c. I o@ir exrwrience in '.\Iicliigaii is not a typical. With the $1,294,449 grant -twar(led the \iichigaii ne,.,iontil -,Nl(-dical Program almost a year ago, the Fecl- (-ral Government has essentially I)ougl)t a blueprint for the initial stages of ,ictioii. Most tangibly, this initial blueprint is a 504-page document, our first operational grant reques t, which defines wliit we must do and commits its to (,(I in some ivory tower. It represents a (14)illg it. it; is not a sterile ))hill (levi@ r(-,tliz.itioll tji:lt lir(@Viollily frilgnieitt(@d lit@,,iltli resources call uilite to I)rovi(le c for li(!fkrt and stroke a relli7 lw)ssil)l(@ I)ixt.it@iit. cttl' , AltiOll lo live ill the real world ;Iii(I who have l@ii(@ 4(,or(,s of iii(@ii mail wolii(-" wl :kii(I %vill Lo(.4)lit,ril)lltt, to this I)IIIII]Iillgtnsk. It rel)reFA@tits our (.111 I i-t@ Al i(,Ii lgii II (-(iiiiitrysitit@. iiiiii(,r with tli(, total health lil-olit I iy ll,)illt, of Vi(- %%, its it li@.(@(is :ir(,;i, oil(, of tli(- most. iltll)ol,t;tiil@ fll('('I,H of this Ali(-Iiigiiii .v ilit J,I-o,,riiiik Is iii(@ series (if litil@@ig(.s NN'Iii(.Il travel iii:i(Itt will% it gr(!ttt iiiiiii)@(-r or gri@tilo.,4 and installations (.11glig(,(l Ill 11(@illt.li I)I:iiinitig and lorovi(litig 'tilfrs lit@illi@ii S( Ili our lt(@gioli, I hill)(' tl);It than and A(tvi.,;ory Grotil)s of all IIIY z4@,,ii for (,oot-(IiiiittioIl of ilct@iviti(@s ill tlii.,i Ili-ogi,:iiii,,i and 11(@;tltli emitting lir(igr:tiils, I)otit try l(@gi"4111t,ioll I)Y 8f)tll film maturity siil)l)ort,ive of their activities (,oligll(@ll" ill't@ 4jilit(! )",Very erl'ot.11 siloill@i 1)(@ iiiII41(@ ))Y tli(@ stllffg of tll(!S(! t%V() I)rogriiiii.4, at '11, - iiii,. (!Ooi)t@1-:Iti(itl and (,oor(Iiiiittioii (@ist. tlii@ lot-ill li@v(@ls, to ( ;Iil.( : itior(! I iii,g(@ your of 1, lt(@gi4)11.11 llrt)gritiiii Iiiiiitt@(I ]lit lr,-458, tll( @liltliot-ity fi)r to ri,,,ioii:il ii(@t,41,'4 l@,ri)(irt on to th,e l,rcsitl(,tit aii(l, the (!on- (-Io(Ilit-litly lit ili ilrti(,Ie (@tititle(l, I'llo.'41@itill-.4 and lteglol)lll for ('o(ir(liii,,tt(@(I A(,I'Ioii". This iirti(!le npl)(,iire(I Ili Ilrogr:tiiis : A Issue of flospit(its iiiiglivll)e,. It was written I)y my good friell(l@ Dr. Rol)ert L. liviiiis, I)irect4)r of '@\letliciil E(,Itication at the York (Penn- president of the Association of Hospital Sylvania) Hospital, and Immediate I)a.,it 222 I)ir(,c',Ors of Ile(lical l@,(Iucttioii. Dr. Evans issiste(I nic in prepitrilig iny testi- iiioiiy for t(@day, Nlr. Chairiiiaii, iii)(I I would like to re(iiie,4t that his tirti(@le in the record of till,, hearing. I I)ope, geiitleiii(@n, that Dr. Evans' trticle NN,iii eoiiviii(.c yoii of the need for Itegional Medical Prograin construction ,tiitILority. Tll:tiili you that concludes iiiy 8t,at(-iiieiit. I li@, J4111riiiii of I lit, II ]fosipiliti Ast4i@(,iii tl(jii, Iti(IT I AN[) Itl@,(;IOXAI, I\fl,,I)ICAL A 1'1,1,,A l@Olt (',OO]tl)INA'I't@1) ACTION (Ily Itol)(-j-t T,. l@,viiiis, I,o third ill till' last till-(-(- y(I.Ill's OlIr eftl.(@ his fill([ iiii fililLiiLity of I(]Vi(-(- I.,; l@(@tli tritt! ;iii(I iii-siiiiiel(@ilt, Siti(@e early otir (";tl.o sy,,iti@iri likes existed ill .1 lioloc@ilist of ;iiggestioll, I)ressitr(@,.4 for (!Iiaitge, ii)d iiit(@riiil and c-\terjiiil examination, Nvliieli li;i,,4 involved tlx(! 1'resi(leiit of our nation oil oi)c li,-iii(I and of our n(@iglil)orli4)oti ambulance ciiil),-4 of) (,lie Otli(@r. ilk oill. Ntollilll.,I]..v ;Ran Initially every our national, ,tite, and lwat A@overiiiiieiit.,4 liav(,, had their ,;;ty-@iti(I are. still t@:Llkiii-. Begiiiiiin@, with the C(iggesliall rtport in I(,)65 iii(I I)ro,@@sitig through the DcBil@ev coiiinii@on, the A'I%IA task forces (-Pii education and (-.ire, the Millis tli(, lieii(lin- report;,; of the Ntt,ioiiil Advisory Coniiiii,,;,@ion oil Ileiltli %Ti iil)ower and a siniilar Coziiinissioii on the Cost of Me(licii Care, our system, its voluntary hospitals, organized medicine, medical colleges, Illd the role of our federal iii(I state governments have been stiidictl by so niaiiy groulis and in(bvi(l- iial.,; that often i@liere have seeiiie(I to be niore b-,tctoriolo,-,ists than bacteria (-oin- 1)oqiii,- the culture. There are no indication,, that this, trend will st(@1). TI)ere be no desire for the cessation of these Letivities unless they are t@lireateriiL,(l witi) till,, iiiuiiil)s of iiiiiii..,wulity, froni wlii(-Ii they iiiiy enierge sterile. (.oo(I health is ]low a fliil(lall)(,.iitil right, together wiilk life, liberty, and the lotirsiiit of lixiiiiiinal,ioii of t@lic sygteiii that ensures this heitltii Is now ilk till- I)Ilblic (Iolll,'klli. I.F(IISI,ATIVIe ACTIVITY Stil(ii(@s 'I liost, of l@ills ill oiir nation ]residual iiii(i iii(,tli(-iki (-Sir(' f(@i- tile kgt,(l ;Iiiil f,o]140\v(,(l loy yarding li(@ilitli (,tir(4ti- training III)(] iiioi-e ii)(@ program,,, for 1)12ti)tiiiig oil it regional iiojil@olit@iviil I)Rqt, Ill(l OIL .1 4@ilsiiiiglit; is Iillle(i ill@ I)ro4lll(.ing tile Nvitli ,Iiotglill (,s. No oji(@ state I)rq@(11(-t Nvii'li, any (I(@gr(4@ t@r tl)4! (if, tile II( of till! liiiti-11)(,PO"4 oil our Volume(. I fill intelligent iti@I)i-;iis:il is i .,,14igg(-riiig :III(] Hill)() is W'il 'II only It S'lil.'Ill :Ili(I 1yol-tioll Of t I I St I I (I i f@s--t It (@ 1)1:111 I I I lig I(,gi.'41,1 ti (II 1--il I:Lt, ])()I' l@i oil I(-(I wi (I I t I I(- I t(,gii 01111 I Ill'ol'I."Illli of til(i National Iii.,4tittili,,s (If 11(@tilt,li, colit-likililig ill to (our iii(,fli(-jll t,ll(-ir ]",(,gaining ill tile. bill I)ro(Iii(.!tiv(@ly ]iy World War II, two goN,(,rlllli(@lit.11 funding F;Yst(-Ills ])live liLil 11 vital 11111@lit@t Oil billions Of dollars of federal siil)l)ort tin(I qtl(lil-.ioiiil iii[liloii,'4 of tenantry foilli(laticliq sill@liort have gone into basic biomedical research, all(] (2) ,i(l(litioliftl I)illions have gone into hospital and ficility construction. Wliilo for were l@i-o(lti(-iiig iiliiit)st qiiniitifie.'4 of ll(.Nv ]@lir)wle(igi, to be I)ro(itictivk- !it t@lic I)reveiit@1(iii, treatment of ot@li(@r iiionic,,4 in oiiiili(@r quantity were (levclopli)- a vol- literary syst(,iii of hospitals and ot@lLor cojiiiiiiinity facilities that are Rtrii@turtilly I ltotiort r,. l@yniiq, M.1)., is riti-ectf)r of iiie(lic.,tl education, York (Pa.) Ilospital, an(] pr(,,,,I(Ieiit of tlit,, Association of IloFtpital Directors of Me(llcfil 10(lileation. 223 @111(l IISII:Illy VOI)IJK@l@(-Ilt. ',\('W tiit@ iii;l.iol,ity (@f II(.:Iltlk I),'Is (@(p ipiir tliroiigli IL (IiStillCtlY of (!(ollillillitil@y iii(!(Iical iiistil,iltioils. betnvecii ine(lical ediic,,ition tDd research ceiiters tiiid coiii- iiiiiiiity li(@:iltli e:ir(@ (delivery b(@;,ali to (let(-i-iorat(@ l@efore iiii(I tliiriiig Nvol.l(l NN'@ir It. It li.,is I)CCoille iller(,,isiiigly iii(@ffective tll-roiigli the I,!)i-)Os Ill(l I ")Oos. is becii I)r(i(ltlctliv(@ IJII(lll(@stiol)"Il)ly, the fe(It@ril system of support h, iii t@eriiis of IciioNvlt-(Ige, ])lit, it lizis Llirougli the teii(l(,r ti,,il) of "soft itioii(-.v," to gr(-.itly ill(! (lifli(@tilty iii coi-niiiiiiiicatioii betweeii the iii,- iiii(I r(@seiir(!Ii c(@iiter,-, iiid the coiiiiiiiiiiity liosl)itiils. P@,itterns of I)e- li@ll-iol. llint att iii4livi(Iiiql witli ilie virus of fli,,w4)i-ory-%viii-t@lier I ltritii;,,Ii or siitsioll--;Ill(l jol) iiii(I faiiiily @ill)l)ort tire fl)ll4.tioll.,4 of (!olltiiiiiiiig iii ivill lo.,4i@ iiit(@rest at .1 r:llpi(I :ill(] tli(@ iiiore iiiiiii(laii(@ full(.i,ioll@ll of lii.'A (Iis(.Overiv,4, :is iiiiglit fiii-tlit@r Ilis Ulk(lerst@,iii(litl)ly, .1.4 tli(@ Ifi(i:is toii(,Ii of rest@.ir(-Ii @iil)l)ort I)i,o(iii(,(,(l iiiore fiill-tiiiie ficiill@y tll(.ir iii;ljor fi,oiii iikv(,Illlig@itioii rit.lier tlitiii teilelijiig, less ;iv:ill:tl)le to tr@iiisiiiit, iiii(I v,,iii(Iiite iiifi)riti:itioll fri)lll tll(@ iiie(li(@@il to tli(, fiiii(,-tioii:il iiriii of Clic iiie(liefil care systeiii. :i t t i tre botli ijit@vititl)l(! an(I (I(,feiisil)le t(,-ith in tli c sy,,?tciii tllitt- li:l-, I)ro(lllc(@ll tlietli. -ioi,@ttiiig l@ipeliiic- of (-oiiiiiiiiii -a- At' ilt(@ i-(,(,,eivin,- eii(I of this @(@ler(iti(-:illy (let(,i i( tioll (@(Illeitioll"il aii(i (@,ire 4)tli(!r disrtil)t@ive forces were 4it '.Nlost of the goveriiii-teiit.,il to oiii- Noliiiitjiry iii(,(Iical o,,iire system, I)Y olli- CO)IIIIIII11ity 11081)itill, is (iii,e(!t(,(l nt: I)ed iie(@(is. Ilroval)l(, lel(lillg to 111(lielit(@(I in I)e(l cal),icity, pi-odtice 't@ 1) -iol-it,y of fill)(Ii Very little Sill)l)ort, li;is goii(@ iiiio ili(@ er(@iitioii (yf (lingiiosIA(- or tr(-@itineiit ft(@ilities iiiile,,o ilipy ire iiii- ])Y I)C(t vitlo4t(-ity. Aliiioqt no siij@l-K)rt, bas gone into iioiilyi- ti(@lit ("II.() @tii(I siilil)ortive fiteilitie,,4 of iii evaltiitive, or analytic A(-(-t-(!(Iitiiig loo(lies in IN)ii(](@rotis iii,,inii(,r t,lie necessity for siiiootll iiii(I reeoi-(Iiiig of t'lic tiid functions of a tios- 01) !)itill fill(] its iii(,(Iieil staff, I)tit lwiy tiliiio,,t no iitt@eiition to the tctll@ll qlllllity of tli(@ st@iff, or to tiny ;yst(@ni of as.,;uriiig t@lie contiriii(@(I quality of the staff In teriiiq of 111)(littilig of kilowle(l,-e iiid t(-cliiiiques. Tli(@ (-xeel)tions to this in,;isteiiee oil I(Iliiiiiistriitive itiid (lirective function o(-(,iiri-(@(I In r(@Iiit' ioii to two ,tct@ive forces : (1) incidental to apl)roviil of Itrogl".Illl.4 (ilitei-ii.,4]iii) aii(I Lli(@ Aiiiericiiii oil M(@ili(-al l@,ilii(-ittit)ii does insist oil iiiiiiiiii.,it of gra(Itiate :1.11(i oil evi(l(@liec of ill Ill(yw 101-ogriiiiis; all(] ('-') llie Aiiierictiii A(@iiii(@iiiy of for its iii(@iiiiii-i-sitili, %Vlii(.Ii tlit, itself lily I)O:li-(Is iii)il lily or oiir voluntary lio.,;I)i(ill iiiitl :I iii(livi4ill;ll ii(isi)itltl Nvilo ill (.orl)oritt(! fail eilil)linsi.4 Oil (@olitlilil- I)sy(-Iiology, all(] fol- 111(@ir lll:iil;ig(,jll4,]it@ iii-illi(!r lii4ist@ iii)(iii. iioi- toward. tlii- .4iiiii(@ (@iiil)li:isi@4 oil (,ojiiii4iriill(, (-ollt:iliilil)g P(lil(-Iktio)i @l(-tivitly ill tile ille(lic;)l of iiiiit tire (ii(!ir (-(iiiiiiiiiiiily (-Ii:ii-g(-. (I(@v(,Iol)ilktnt of tili.4 ol.i(@iitit- ti(@ll is :igliti I)otli lill(l(@rstiilitial)lc and it@ithiib the silqfct)t, tlifit Iiiis t(-ii(I to r(@giir(I liol).sit.,ils as and lo slr(@.ss tlivir Iiiisili(!s.4 fiiii(@tion to the n(iiiiiiii,.,tr;ttiye groiij). Gov(@i-iiiii(,iit and it(!cr(!dltlii@ I)o(II(@s under- sti@in(l@il)ly li:ive been reluctant to lini@ose (-maintains education requirement,, on ill(, profession. Many exiiiiijkles jiroiiii(I the country sl)o%i, tlxat when the ii(-ces,4ity for continuing education and Its basi(! purposes In relation to medical practice are explained in a clear and knowledgeable manner, most board members and administrators are quick to recognize its Import, but still may assign 224 illol-ti A'r,ri,i,tji)i.,s op I)V(!Il I)otli [(-tiv(@ @iti(I III @141(lilig to I)oNN-(,r to (,-oiiiiiie their tlioiiglit to tli(@ (!:ir(@ t,,islcs at Wili(-Il :ir(@ ill too tiiii(-., coi)suiiiiiig. llhy,,ici:iii,, ]iitv(@ to regard the ni(@(li(-@il (!ol- si),twiied titeiii, as sol)liisti(-@ttetl joiirv(,yors of it tyrie of intell(-(-tuil exercise that is itlipra(,tical in teriiis of t(,iiil)or:il, I)Iiysi(-jil, aii(I eiiiotioiiil I)res- stires ill the (@(@ilillitillity setting. Nvitli Soljie jii,,tili(-,ttioTi, they look oil iii(@diciii .111(l ftiiictioiis q." coii,,;tiiiiiii,, iiioi-(Iii),tt(@ly ],irg(@ iitittil)ei-s of I)Iiy- la 1)(@tli iiit(-rii ,tii(I ri-sid(@iit I)rogr;tiii.,; @iii(i st@ifj' I)OSitioil,;, 1)1(!tt to tli(@ (@oll(,g(@s too fr(,(Itieiitly lilts 1)0(@ll I)IIS('(l on What tli(-y i@o bf! t (-I(,iii-ly iiet,(] for ,t:tfi' ill tli(- olo4@r@itiozi of tii(-ir liosi@it@ils iii(i foi- @]II)oll-f(@(1, till]('-Collslllllillg (-olltiliuillg ('(Ill(-Ittioll 1)t-ogriiiii.,4. 'I'hiit tllo'.'40 I)IC:ls f:iil(@ii oil (I(@:if :111(l (-@irs is ill VI(, NV of tll(@ (.ollt@4,11t of tll(@ ))Iezl." lead tll(! ii;lt,iil,e of l@lic iiistitutiolis itil(I III- t(i Nylioiii tli(-y tire Altlioii;,,Ix iii.,iz)y otli(@r f@i(,tors have (-oiitril)iit(@(I l@o II of eff(@ctive Coal- iiiiiiii(,atioli I)etl%vecti the soiir(-,(!s of oiir Valid the iiistit,litioll,4 of Its ltl)l)ll- those, wolil(I -Weill to 1)(! the iiiost livil)(ortaiit and relevant to the effe(...ts of f(@4leril sul)l)(irt oil the individuals and iii,4titittions at ekicti end of the "l@iio@N,le(Ige to fil)l)li(,;ition" transport systeitt. Su(](Iellly, iii,t@o, this J)o(IX)tlrl.i of iiiisliii(ler.,ititiidiiig, Internet, -iii(I hit.,; a for(-i@ foi- iii(ol ivtt,iiig (,-bititg(@. Aft(@r (If I)rovi(litig iii.,ijor fiiii(i ,;itl)l)ort for I)otli r(@s(-iireli and (-are ilis',.itiiti(@lis, tll(,@ govi-i-illil(@lit, of thr coiisiiitt(,rs of otii- thirty [ill](.]) of its iitv(-St riient in r@, ai-i-li )la.,; 1)(-en the iliff)l-llllt,i4)11, field sliills l@ro(Iii(-(,d !it the. have not to the itriii of tll(@ ii@c@(ii(:@ll systeiii-t,l I(- Colllllitlliity lio,,,I)ii@il said its stirfs. Wli(@t.ii(@r @tlic failtir(, of Cff('Cti'17C I; (111(' t@(@ @iliil)le lick (if ltiforiiii- 11 tO St@l'iOll.'4 tlioiigii it. is it coiiveiii(@iit tli(4)reiii. tioii triiisft,r is ol)e C,aiiil)))(-It iiinli(-al director of tli(@ Aiii(,ri(-,tii ll(,Iirt -.tl piolkl(,Ill .19 V:Ili(littil)ll (@f l@nowl(@i,-(-tli:tt is, iiull)ility of the I)r;i(,-titi(>tier t lie. r( to itii(I i@lol)t new liiowlf,.4g(, or iiiit !I lie Ilia litL(I the (@xlxrieitee ioii. llerhal)s the "iiiform@itioll gal)" of "seeing" it used and ii.4ing it under direct is r(@@illy t "V.Ili(litioll gltt)," l@iit I)ripl@iil)ly it I.,; I)otIL-certitinly the tlieralty for thin gtkv(-riiiiieiil ilso are iK,,iiii@iiig to r(-<,()gillvA. trial; iiiii(@li (of tile For(!es wi@ Irii(-tioii i)f (,oiiiiiiiiiiil,y lilts sii))Ix)rt to tli(,- (-4oii,41 I(." thin t4@titily ilk l@l-o(itil.-ilig t.jli4.i4.llt and dt@iivt,n, of (-tLre. Intending iii.@lvii4i illi)41ti(@ll.t. (,art! ;tii(I a(likiiiii.,;t:rittioii. 14) tti(@ d(@ti-iiii(,tit (if it sysl,(!iii of 1-git.ii,iit (-itr(- iiiv4)lvitig logical (livisi4)ti (of ililmittelit and olitilati(@lit 3iii(i to t'lit- t@f the (.containing ll.l)dltt.Ltig of I)IIYHI(-Inii kiiowl- NN'it;li tile r(,.<.Oglliti(@ll of it.,4 I("-tikitil sii(-(-(,,;s !it tlio lmt[4t, tile consiiiii(!r grt)iii), by (110 Itegloylill Ill.()grtms, the Nittioiial Iiistititt(,,,4- of Ilimil,tti, and tli(-ir Imireiht I)o(Lv, tti(@ D4@l@,,Lrt@ttt(,iit of lltitlth, FAIii(-tttloti, and W(-.Ifitr(t, li@ive (-(niie Ill) with it v(@t-y hall aliii(mt (*rtain to be effe,(-tive to, c(>rrtw-t (@f tile itill(l(-(Jllllcie.,4. A "[411(nGUI; Silill)]Y, 1110(li(-.tl (-,ir(- nik(l t,(Iii(!itlioit, tii(@ two (,Ii(I-4 (If our I)il)(,Iiiie for tlio,.ti,aiislitis@ioii (of l(tiowl(,41g(- and uit(ler.,4Uttidiiig, are ttl)4oiit t,() be sili)j(,Ct,(,(l to one of our ni(@re (foliation ,oc-ial rel:ttioiislill@@tli(@ Inevitable r@i(@ii froin the pi,(@po,,iti(yii, to the to the engtig(,iileiit jirt)iz I ]@ and finally to the marriage. Coiisi(It-@riiig tli(, (livi,;Iv(- ffictors above, tlii,; I,, cvrtaiii rrny jtuictioii, I)tit it is just as (!ertiiii that it will be coiistunnintext and t(-) be :i sto I)ro(luctive, for it i,.4 a "shotgun weddiiig." The I)eol)le of our nation are holding the k;liotgtui. It is loaded with cak;li-the g-reat@t motivittor in our weietv. Of 225 1)44,t, III t II(, l@i III I lv, I II l,i' I.( -(I, I III (-I Y fil- III, fi J'I IIII (-I-- III-I II NV. 1)(' iii;lv (I(@IX-11(lifig 111HPI) the iiiiiiiiil(,Iit ii Collil)lit-llLi-(l Joy tll(@ f:l(-I. tlii@t 1%,(! iii,4! I)ot (little is tile ;Ill(l NN'll(k is tltq, gl.(H)lll. If :Ll)iiily, I':i(-iiity, iiii(i or N-1 I'll il,.V, t li(!It I 114@ ('Oll(,-gtt 1,Y,t('111 ilill.'41. 11(@ t II all (@ I I I. II @ is (14 0111 )tell II t II:( t t II (- f:t @V I II Iilt 4@ II f4k I' I(Yi)g to III iy (I 4)f @II)ilit@v (of tli(@ gri@ipill to siilil@(irt tli(@ I)ri(li@ NN,Ittiotit ftirtii(@r 4)1' to ll('Il) NN-iiii It itis4k I,, (if@iilptf@il tiiit aliy oil II)(,- l@:ii-t of tilt, (1114- 11.4 to IL(@r il)ility to or ;tjlklyti(- (ilitii-s !II tile 11(olls(,Ill)l(l H(-riotisly %vill-affe(!t the ftiture of tli(@ iii:Lrriig(-. 'Niiiiil(-,4 for Ili(@ iii4)iiiviit,, let iis tili,4 iii1ioll 1)(@tweeii 111(@(li(.al iiiti iiii(I cilr(@ ;tij(l tile factors ii(!(!es,;itry for its r(@(iiiir(- s(-riitijiy (1) the of the (ititility, the tl)il!tY, .111(l the p(@rsoiiiiel of otir e(Iiie:ttioik.,tl and faeilitie.,i; (2) the .sol)])istic,itioii, the qiiility, the ability, the ik@rsoiiiiel, and the functional I)attern of (@iir (,are institution,,; and (3) the (Itiestioll of facilities stil)port and ct)ii.,;tru(-tion stib,-&quexit to a liro(Iii(@t,ive iiiiioii of tilt, educational and research iii,,titiitioii,.-, tiid the iiie(lical care iiistitiitioii,@l)erlitips recognizable as the eventual trringeiiieiits for lioiisiiig tlke finally. college systeiii sit I)r(,s(-iit I,, rich la all three areas, Over the f(-)Ilr it Iiik,, I)iiilt Ill) It large ciidre of (@(Iticiitiojitllly oriented iii(li- N-i(Iiii@ls, III ,51)ite of r"i,itreli (@iiil)liiisis. Tli(! N,(,ry iiittiir(@ and I)riiii:try task of tli(@ college syst(-iii I)ro%,i(les it with classroom, ati(lio-vi.,iiial, iiistrii(-tioii.il, iiitl otli(-r -.ii(Is to c(Iii(@iitioii. Its liosi@ital.,i are t4ltiipl)(xl for tl)(@ iiiost ,;olpliisticiLte(I ear(@ II sigiiifi(-iiiit 1)(@rtioii of it oil a research or re- se,ireli-(!onnect(@d tire largely iii(xl(@riL and relatively well staffed. Altlioiigli the medical college certainly will need soiki(@ a(Itlitioiiiil sul)l)ort to help it ill its new role is the rcsoiitce of both coiit(@iit and sonie instructional ability for the transmission and vaii(l@itioii of kiionvle(lgc, it is relatively well equipl)c@d to (-ol)e with its role as (@(Iiieational I)rea@twiiiner. The (listafe side-tlie coiii- iiiiiiiity liosr)ittl, wlii(,Ii will (,oiisiiiiie and titiliz(,, the educational I)ayelieck-is iiiii(@ii less adequately I)rel).tred. NO,NUNIVFRSITY iiospi,rAT,S -ity iiito tlio,',-(', tllsl Tli(@ iioiiiiiiiv(@r@ t@ have graduate educational 1)rogr;ii@i.s and tlio,4e that (to not. A rc(,eiit ,,,iir%,(!y (conducted by the Association of Ilosl)ii,@il Dir(@(@tc)rs of inf(,dictl Education show,, that although graduate teaching hospitals ire iiiiLi(!Ii siiitill(@r Ili t@litir total bell capacity and total nuniber of stiff I)hysi(,iaii-, are approxiiiiitt(,Iy equal to the total I)ed capacity and total iikeflical ,;taff physicians of the hospitals tlllt (lo not conduct teaching I)rogranis. tliw, hospitals conducting graduate ,file saine survey iii(licate,4 that even aiiioiig I)rogr-inis, less than 50 per cent have -nti*iiiialtil adequate teaching facilities and less than 10 per cent have the services of trained educators, evaluators, or z(wiologists even by consultation. 'I'liere is little (liff(--reiice between the two types of nonuiiiversity hospitals in inost of the important paraiii(@ter,.; we sliill The inajor difrereiiee se.(.Ins to Ile that tlio.,4e hospitals condu(,tiiig grii4ltitit(, I)rogrtzii,4 inay 1)(@ a little further Ili lilill,).,;opliy. Tli(@ir stairs, I)owever, frniiiently are (-oxii- 1)0',e(I Iirg(-Iy of I)Iiysici@iii,.4 who do not ll(.t@iv(,Iy Ili the teaching pro- iii(I tli(,ir e(lil("Itl(@lial fil(-ilitit,s, witl) at few exc(@I)tioii.,4, t(-ti(l to be little (IiIT(@ri-tit front tiios(@ Ili hospitals That (lo not (-oit(Iii(!t gi,ii(iiittt4@ I)ro- gl-:Iiiis. fol- lit(- of tilis title two t@yix,s (Of ])oil- lltlivi,i-,,iity llosi)it4ils 11121Y 1)(@ its it (,duration (,tititv. fact: r(@iiiiiiii,4 that tli(! (-alleging stri4li,iii. for tli4- ii4piiiiiiiv@,j-sity IIOSI)Itltl 1.4 tllltt It ORqll)llOl of (!o)iti)tllillfl f,dti(!atio)t foi- the I)hll.Nioians aii(i alli(,(l Tallith of iti ,Alto.,4t ii(@iiiii@iv4,r,.,ity liosl)illll.,4 Ili.(, illo(l(@rii, and rt@littiv(,Iy to iii4-(Ii(-ail (-area. oiii, (-oiiil)are4 t@li(@in Nvitli the college liosloitii, t@114@ Ili ill(. of (Fair(, 1,4 a 1)(,Ilw(@(In oil tit(@ fruit of iiit)st iioiiiit)lv(-rsitv liosl)itjilh and I)rolK@r t@ll tli(- part of tile iii4-(Ii(,iil (,ollt@ge lioslilttils. This Is a tolerable and al)l)ropriat(, (Ilft(.,reikcc. 22C) INTOLEITABLE DIFFETTE,NCE so gj,(@itt to i)(@ tli(@ii- tiltiiii:it(, (lirv(,tioii in tji(,- iitii(is of boards A. II(] ill IL I)rol)(@r iiii(I the of 01)(@i.;itioii or it@.,4 fi,%v of Ill(! @11141 liliv4@ :11)1(@ to 1114'!V ov(,I.I.Iolljig ]Ill- ('r (-(Illlilillillg (@4111('Ill,ioll 14) ill(' iiii(i Hill-vivill of oiit@ ill)(] it@@ lio.,41oil@il,4. or fli(@ I)Iiiiyj(@ for t-Iii8 fjijliii-(@ t@o iiiii.,;t ill 111(@ l@'llo ))live not II ('Ool'(Ii- ,ill(] (-])able(! Ill I)ie 1)(.Iiiivior is,@ W(-Ii Its I(,jl(,Iiillg llosl)il,;il.,4 liiivt! lool@ iil)oit grti(Iiiiite (iiitel-ii find fil)l)egir t,o like level of iii6lical c;tre, iii(i they provide n(l(litioiial liai)(Is Nvitli wIli(.Il to stilol)ly that iiie(lic@il care. Ilowever, even in rotation to graduate it )I@is been (lifll(!Illt to bring I)o@ir(lq tii(I ii(li)iini-strators to spending l@:iti(,iit e:ir(@ income oil educational facilities,;, or to supply within the hospitals I-)]).Vlli(!Iatls whose base purpose is graduate or continuing education as opposed to l@lic (](@livery of medical care. With the rapidly rising cost of hospitalization, iii(I the clamor this rise has produced, oiic, certainly must have @,iyinpatliy with our hospital boards and administrators in their reluctance to utilize pttlent ctre funds for educational facilities and personnel, even though the dollars s@t on education are the best purchase the patient might make. The concept is stifhciently abstract to make direct continuity of purpose and decision difficult to achieve. PROPOSAR,S AND I'RAC'RICALITIES III addition to being the stibje6t of studies and recommendations by various commissions iiid individuals, our me(li(,al care ,iii(i education system his 1)(@eli exposed to many (lifft-reiit proposals in relation to continuing education. ()lie of universities with ,iii(i without wiillg, iiatioiiNN,i(le closed circuit television, ill)lplieation of tile national edilelitiODal telei,i,,ioii network to iiie(li(,-iiie, tNvo-,.viiy ri(lio, television tape, and a ]lost of ot)ier novelty approaches. When One the vexicer, lie is forced to l@lic (-Oll(-lllsion tlllt, ill Spite of all of I)rol@os,,tlg izk(l the otily I)Iacc to editeate the I)i-(ic- tici,,)ig l@ltyviclaii air a containing atz(l, p)-odii(,,tive is in the ill. ?vhirlt he i(@oi-k8, I)-c(ttv 7iiq 1)(iticiits, a)td hii hospital. IVIiil(@ it, is true trials ill It@,I(lillg I )lot-SC to Water, oil(! Italy i)()I: foi-(,(, I)iiii to drink, the horse is it gi-t@@it lik(@ly to drink if the %i,;it(,r is iiii4l(@r his i)ose coii-,ttiitly. NN'Iiile iiitii,(@rsiti@- iii(I fl)(@ir iiiiiy 1)(@ I' ]i(@ (!(@iitrtil ill I.Irogi,.,iiii.,i, tli(T(@ ()Ill Continuing all(] (of ill(@ lt(@giollil MC(lic lo(- iiiiist doubt that t@lic iloiliiillv(,I..,;ity ('01@illitillity will 1)0 til(@@ of tli(-s(! programs. N@4) portion of l,ii(@ Iciio%vl(@ilg(@ pr(o(lii(-(@(i I)y the 1)[Iti(@iis for sl)t@iit in li;i@i(! III ill(! Iii.'4t: 10 y<,iti,,4 (,all be I)ro(lit(@tiv(, iiiitil 11; is in the of tlj(@ individuals who c;ir(@ for tli(@ )majority of t.li(, 1)('olpl(- of (1111. ii@llioll--tlie (if our (-oiiiiiiiiiill@y ']'lie I)POIPI(- of (Pill- ii@itioii--oiir tile form (if (,ollgl.es,4, ])live ill 11 loll(I of I lie lt(,gioti:il Ilro,,i-zti)is is to knowledge into Cliff] into in a (-ool)(-rjitiv(', i-(@gioit:il, ;@,@ : i tii(I murder. 'I'Iiils, tile :Ill(] initial form of l@114@ of fill, llr(igr:iiiis nitrate 1)(@ r(@ii:ii-ative (@(iii(-gitioli in i(;Il:tls lip to (late. 'I'liis iiiii,.,t be followed ])Y continuing e(III(@ittioll to Oi@(.(@ i@(iii(.;IiioTi Well Avily, 'Itt(-Iltioll lately lie to providing the I'@ti-ilitit-s ill Ni'lli(.Il tile liewly I