ona e ca este etv ]to unna e R E G I 0 N A L M E D I C A L P R 0 B R A M F 0 R W E S T E R N N E W Y 0 R STATE UNIVERSITY OF NEW YORK AT BUFFALO - SCHOOL 2929 MAIN STREET BUFFAW, NEW YORK T@hone (Area Code 716): 835-0728 JOHN R. F. rNGM4 MJ[). Director COUNTY COMMITTEES REPORT Over the past year our program has exemplified greater in- volvement on the part of all our 9 counties. This direction has been deliberate, in keeping with the concept of regionalization and its particular applicability in this geographical area. Our December federal site visit team recognized this capability, and urged its fuller implementation through expansion of liaison staff, and development of a County ChairmenIs conuiittee. The expansion of our liaison staff and capabilities is in pro- c6ss. Miss Jean Hanna, recruited in March, serves Erie and McKean Counties in Pennsylvania, and Chautauqua County, New York. Several other applications are now being interviewed and assessed for tLle liaison staff, which will, after development , be recognized as a de- partment of our program charged with the maintainance of communi- cations and visibility in each of our counties. During the past year our program has developed an increased concern for the health care needs related to the minority segments of our region In demonstration of this, various conferences of inner city needs have taken place at staff and executive levels be- tween RMP and various inner city organizations and representatives. In the interests of studying, implementing, and maintaining some program structure for relating more effectively to the inner city, Mr. Michael Miller, formally of Model Cities, will join our liaison department on May lst. A third and significant direction reflected by our program over the past year is a closer alliance with Comprehensive Health Planning, RMP's "sister agency". While certain interlocking aspects have pre- viously been featured by CHP and PIV in this region, greater local de- definition of this direction has in recent months been demonstrated by closely related CHP and RNP county committees, usually under the model of an umbrella County Health Organization. Two of our counties COUNTY COMMITTEE REPORT PAGE 2 are already into an RNP-CHP conjoined arrangement within which dis- tinct roles will be enacted and coordinated. Five county committees are intently developing such a coordinated base. Such conjoined efforts appear to have a particular appeal in our less populous or rural counties. While some apprehensions have been expressed re- garding the dangers of diminishing individual program identity, the involved counties do themselves feel that a close coordination of RMP and CHP is essential for the well being and functioning of both at the local level. In the context of these directions and developments, we feel the past year has been realistically productive, and we anticipate even more productive articulation of RNP throughout our region in the coming year. Clifford L.M. Carpenter Chairman, RAG Committee for County Committees Z)f T. Sur#eti; Associate ft County Committees .m Lakes Area P. rjp Our theme is New Directions for RMP/WNY-our emphasis is Involvement. In transmitting the 1972-1975 Triennial Grant Application of the Regional Medical Program for Western New York (RMP/WNY) to the Director of the Regional Medical Programs Service, the President of the Health Organization of Western New York, Inc. commented: Dear Dr. Margulies: ... It is my personal view that the Regional Advisory Group (RAG) for the Regional Medical Program for Western New York, namely the Board of Directors of the Health Organization of Western New York, Inc., has discharged its advisory role to Dr. lngall with the utmost industry and enthusiasm. The members of this group are fully cognizant of their increased authority in the conduct of the program. They are, likewise, very sensitive to the need for continuous and unflagging involvement. I am proud, as Chairman, to report that we have met on a monthly basis during the last year and that this alone has been an educational exercise for all of us. You must be aware that the transition from a categorical program to one which embraces an attempt to facilitate the health care delivery system is difficult. I believe this has been achieved. Furthermore, at a recent workshop in which we clarified our goals and objectives, the role of the program in the future was well clarified for-the participants. The priority of projects approved but unfunded was much easier to decide upon in the frame of our new approach and our statement of goals and objectives. It is quite obvious that there are areas of program deficit. Action in these areas will be formulated and encouraged as a most important feature of the Regional Medical Program for Western New York in t e coming year ... Irwin Felsen, M.D. President Health Organization of Western New York, Inc. A-- The Annual Report of the Regional Medical Program for Western New York is not a document to support a piano leg or balance a bookcase. It is designed as a record to be read, to provoke comment, and above all to indicate the direction in which we hope to move. An organization that can be considered viable and lively is one that has the capacity for change, that can respond to constructive suggestions and inf luences in a positive fashion. Those familiar with the old heart, cancer, and stroke program, heavily categorical and often interpreted as yet another funding agency, now should see the Regional Medical Program as an enabling organization, inviting the involvement of all intelligent participants irrespective of the label "consumer" or "provider." I decry the perpetuation of these two labels in any legislation. We should be involving all those who can provide comment and support to the fundamental principle of improving the health and treating the illnesses of our region. ro e Director Medical Program for Western New York Table Contents CHAPTER PAGE Workshop Telegram from Dr. Margulies ................................ inside front cover Letter of Transmittal .......................................................... i 1. WHAT IS THE REGIONAL MEDICAL PROGRAM ................................... 1 Nationally ............................................................... 2 Purpose of Regional Medical Programs ..................................... 2 Legislation .......................................................... 2 The RMP Mission ..................................................... 4 Locally ................................................................. 4 The Western New York Region ......i ................................... 3 The Workshop - New Directions for Western New York ........................ 4 Triennial Grant Application ............................................ 4 Health Activities Goals and Objectives ..................................... 5 2. WHO MAKES UP THE REGIONAL MEDICAL PROGRAM ............................. 7 Regional Advisory Group ................................................... 8 Core Structure ........................................................... 10 The Volunteer Component .................................................. 14 3. HOW DOES RMP/WNY WORK ................................................... 15 Staff Functions ........................................................... Planning ............................................................ 16 Proposal Review and Development ........................................ 16 Evaluation .......................................................... 16 Financial Management ................................................. 18 Communications ...................................................... 19 The Enabling Role .................................................... 19 Projects and Proposals ...................................................... 19 Operational Projects ................................................... 19 Financial Statement .................................................... 22 Status of Proposals ................................................... 23 How RMP/WNY Works With Other Health-Related Organizations .................... 25 4. SPECIAL CONCERNS OF RMP/WNY .............................................. 27 Manpower Development .................................................... 28 Area Health Education Centers ............................................... 28 Rural Health Problems ...................................................... 30 Inner City Problems ....................................................... 31 Health Maintenance Organizations ............................................ 31 List o igures PAGE FIGURE 2 1 Current Legislation: P.L. 91-515 ................................................ 3 2 Map - The Western New York Region ............ ................................. 3 Health Activities Goals and Objectives ............................................. 5 4 Organization of RMP for WNY ......... ................ I ........................ 9 5 Composition of the Board of Directors of the Health Organization of Western New York, Inc . ........ I ....................... 1 1 6 Board of Directors of the Health Organization of Western New York, Inc . ................. 12 7 Employees of RMP for WNY ..................................................... 14 8 Volunteers' Contribution ....................................................... 14 9 Proposal Review Process ........................................................ 17 10 Financial Statement: March 1, 1971 - February 29, 1972 .............................. 22 11 Status of Proposals ............................................................ 23 12 Proposals Submitted to Washington ............................................... 24 13 RMP for WNY Relationship to Other Health Related Organizations ...................... 25 14 Programs in Continuing Education - 1971 ........................................... 29 iv VV t'pu the Regional Aft" NATIONALLY Purpose of Regional Medical Pr@,rams Legislation The RMP Mission LOCALLY The Western New York region The Workshop - New directions for Western New York Health Activities Goals and Objectives Triennial Grant Application NATIONALLY PURPOSE OF LEGISLATION REGIONAL MEDICAL PROGRAMS . Regional Medical Programs were initiated in The Regional Medical Programs seek to October 1965 under Public Law 89-239. The concern strengthen and improve the Nation's personal health was for attacking heart disease, cancer, stroke, and care system in order to bring more accessible, related diseases with emphasis on making available efficient, and high quality health care to the the latest advances in diagnosis and treatment. American public. To accomplish these ends, the Cooperative arrangements for research, training, and RMP'S promote and demonstrate among providers related demonstrations of patient care were also new techniques and delivery patterns; support stressed. training which results in more effective utilization of health manpower; and encourage the regionalization of health facilities, manpower, and other resources. The RMP's develop their programs through a consortium of providers who come together to plan and implement activities to meet health needs which cannot be met by individual practitioners, health professionals, hospitals, and other institutions acting alone. The RMP provides a framework deliberately designed to take into account local resources, patterns of practice and referrals, and needs. As such it is a potentially important force for bringing about FIGURE 1. CURRENT LEGISLATION: P.L. 91-515 and assisting with changes in the provision of personal health services and care. In October 1970, P.L. 91-515 was signed into The initial concept of Regional Medical law. he new legislation: Programs was to provide a vehicle by which scientific (1) adds kidney disease. knowledge could be more readily transferred to the providers of health services and, by so doIing, improve (2) adds prevention and rehabilitation. the quality of care provided with a strong emphasis (3) e m p h a s i z e sprimary care and on heart disease, cancer, stroke, and related diseases. regionalization of health care resources. (4) emphasizes health service delivery and The implementation and experience of RMP over the manpower utilizatio.n. Directs RMP past five years, coupled with the broadening of the attention specifically to improvement of initial concept-especially as reflected in the most services in areas with limited health recent legislative extension-has clarified the nature services. and character of Regional Medical Programs. Though (5) provides additional authority for new RMP continues to have a categorical emphasis, to be construction. effective that emphasis frequently must be subsumed (6) requires that public members of advisory Within or made subservient to broader and more comprehensive approaches. RMP must relate primary groups include persons familiar with the financing of, as well as the need for, care to specialized care, affect manpower distribution services and that such public members be and utilization, and generally improve the system for sufficient in number to insure adequate delivering comprehensive care. community orientation. Also includes a re p resentative of the Veterans Even in its more specific mission and objectives, Administration as an ex officio member, RMP cannot function in isolation. Only by working if there is a VA institution in the region. with and contributing to related federal and other (7) requires review of RMP applications by efforts at the local, state, and regional levels, areawide Comprehensive Health Planning particularly state and areawide Comprehensive Health Agencies. Planning activities, can the RMP's achieve their goals. 2 THE WESTERN NEW YORK REGION The RMP/VVNY is one of 56 federally funded, locally controlled programs in the United States. The Regional Medical Program for Western New York is made up of nine counties: Niagara, Genesee, Erie, Wyoming, Chautauqua, Cattaraugus, and Allegany in Western New York, and Erie and McKean counties in Northwestern Pennsylvania. It covers an area of 7100 square miles with a population of approxi- mately 2,020,000 according to the 1970 census. FIGURE 2. THE WESTERN NEW YORK REGION 3 LOCALLY THE RMP MISSION THE WORKSHOP - NEW DIRECTIONS, FOR WESTERN NEW YORK A recent document of the RMP National Advisory Council provides goals and guidelines for The RMP/WNY Workshop, held on September Regional Medical Programs. 23-24, 1971, was a great step forward in region-wide involvement in program planning. About 50 health What the RMP mission has become: The broad professionals from throughout the region, including goals are to increase the availability of care, enhance Regional Advisory Group (RAG) members, project the quality, and moderate the costs. Specific missions directors, proposal authors, and others met at the are: Holiday Inn in Fredonia, New York. At the E3 to promote and demonstrate new techniques Workshop, the mission of the RMP was reviewed in and delivery patterns its new context, the framework for future decisions 0 to expand the capacity of existing and new was established, and priorities were set. Participants personnel to fill needs of underserved areas worked with the new concepts of the RMP mission 0 to stimulate regionalization and discussed the needs of our own region in the light @ to improve standards and quality control. of this understanding. As a result, in the final session of the Workshop, a RAG executive group was able to How RMPs are judged: RMP's will be judged select from the previously approved proposals those on (1) program, (2) performance, and (3) process. most pertinent to the goals and objectives that had been developed. (1) Criteria for judging program related to the RMP's provider action-plan with emphasis on The RMP/WNY Health Activities Goals and Objectives 1972-1975 were accepted by the Health (a) increased and more effective utilization Organization of Western New York, Inc. of health facilities and manpower (H.O.W.N.Y., Inc.) Board of Directors on October 14, lb) health maintenance, disease prevention, 1971. early detection, and expanded ambulatory and out-patient care (c) an improved relationship between primary and secondary care. WE NEED YOUR IDEAS Other considerations include the extent to Ideas for projects and activities which meet which activities will link multiple institutions or needs within the region and which help fulfill the professions and will tap outside funds or support health activities goals and objectives are being actively other federal efforts. sought. RMP/WNY invites the participation of (2) Performance is judged by whether goals, everyone in the region who is interested in t e objectives, and priorities have been established, delivery of health care. productivity of program activities, and the degree to which RMP-supported activities have been assimilated by the health care financing system. TRIENNIAL GRANT APPLICATION (3) Process criteria include organizational effectiveness, active participation of those interested On November 1, 1971, the Regional Medical in health problems in the region, translation of Program for Western New York submitted a triennial assessed needs and resources into continuously grant application for March 1, 1972 - February 28, evolving plans and priorities, and the self-evaluation 1975, to Dr. Harold Margulies, Director of the process. Regional Medical Programs Service in Washington. Accomplishments and problems of the last three i There are few organizations with challenges of years were reviewed and plans for the next three this magnitude. years presented. 4 FIGURE 3. HEALTH ACTIVITIES, GOALS AND OBJECTIVES Goal No. 1. To stimulate and promote preventive services in health maintenance. OBJECTIVES 1 . To continue defining the need for additional or new preventive services in each sub-regional area, based on a data profile of resources and services, an assessment of the community's characteristics and health problems, and on the acceptability of the service to the community. 2. To encourage delivery of preventive services through sources of primary care with emphasis on the role of allied health personnel. 3. To encourage coordination among government, voluntary, and private agencies to (a) maximize the impact of preventive services and (b) assist public health agencies in responding to community needs. 4. To encourage expanded programs in health education. Goal No. 2. To develop and improve primary care services. OBJECTIVES 1 . To continue defining the need for additional altered or new primary care services in each sub-regional area, based on a data profile of resources and services, an assessment of community characteristics and health problems, and on the receptability of the pattern of services to the community. 2. To maximize the role of existing health personnel in delivering primary health care by (a) improving distribution of health personnel, (b) encouraging the expansion of ambulatory care within or associated with community hospitals, (c) using inter-disciplinary approach to the delivery of primary care, (d) encouraging the development and evaluation of innovative methods of health care delivery, and (e) promoting improved referral patterns to assure continuity of care. 3. To encourage general and family practice and other forms of primary ea t care. 4. To stimulate development of already defined new roles of health personnel. 5. To seek feasible solutions to the problems of distance and lack of transportation as barriers to utilization of primary care, preventive and rehabilitation services. 6. To promote consumer education regarding availability and utilization of existing health services. Goal No. 3. To encourage the development, expansion and integration of rehabilitation services into the continuum of medical services. OBJECTIVES 1 . To continue defining the need for additional altered or new rehabilitation services in each sub-regional area, based on a data profile'of resources and services, an assessment of the community's characteristics and health problems, and on the acceptability of the patterns of service to the community. 2. To promote the continued development of a variety of facilities and programs to assure placement of patients at the appropriate level of care. 5 For the f irst budget period (1972-73), (c) the opportunity to use staff competence RMP/WNY requested $1,821,626 from the federal in the enabling role. government for the program. In accordance with the federal mandate, several of RMP/WNY's projects are The Lake Area Health Education Center moving into self-support. Income thus received plus (LAHEC) was the first center to be funded by the local contributions to the program in dollars and in Veterans Administration. The monetary investment kind will bring the total resources available to by RMP/WNY has been $10,000-the return, $50,000 RMP/WNY during 1972-73 to a value of $2,419,600. invested in LAHEC by the Veterans Administration and the local E rie, Pennsylvania hospitals. DEVELOPMENTAL COMPONENT RMP/WNY's investment of approximately $12,000 in The triennial grant application includes a the Rural Externship Program released contributions request for a developmental component. A sum equal of $9,100 from participating rural physicians, to 1 0% of RMP/WNY's appropriation for direct costs hospitals, and local governments and $20,000 from during 1971-72 can be awarded to the program for the Appalachian Regional Commission. The industry the coming year. This same sum can also be granted and time of the Rural Health Manpower Committee, in each of the remaining two years of the triennium. the preceptors, and the enormous TV, press, and The developmental component provides an journal coverage of this venture show how a opportunity to support needed activities without developmental commitment can catalyze active delay. Modest funds from this component can be public interest. assigned directly by the Regional Advisory Group. RMP/WNY looks forward to accomplishing During the year 1971-72, core and project even more with funds specifically earmarked for funds have been used in a developmental manner development. Uses planned for the developmental which has achieved: component include: (a) the ability to respond quickly, while (1) capitalizing on the positive approach community interest is high, in being taken by inner city groups cooperative ventures to develop new (2) promoting greater involvement by the approaches to health care problems county committees. (b) a major financial return for funds invested 6 2 o #-intakes up the a regional Afedt'cal Prog Regional Advisory Group Core Structure The Volunteer Component 7 REGIONAL ADVISORY GROUP The Health Organization of Western New York, Inc. (H.O.W.N.Y., Inc) is a group of over 220 persons who by-and-large meet monthly in county committees. The H.O.W.N.Y., Inc., Board of Directors, which serves as Regional Advisory Group to the RMP/WNY, meets monthly to direct program development. The Telephone Lecture Network is used to insure maximum participation at Board and committee meetings. Those who are unable to leave their part of the region can still participate in important deliberations and decisions. A continuing effort is made to involve the counties in a greater role in defining their own needs and priorities. Complacency must be eradicated and a high level of interest maintained within the constituency. A staff member is following a regular schedule of liaison with the county committee members and their chairmen to promote committee identification with the goals and objectives of the program and develop more active involvement. Concomitantly, staff working in the counties can be appraised of local efforts and problems. The visibility of staff in each county affirms the reality of RMP/WNY's thrust towards regionalization. This summer, staff members have met with each member of the Board of Directors and with numerous members of the Regional Advisory Group at-large in the various counties. These meetings have brought to the attention of RAG members the new purposes and directions of RMP and the opportunity for developing new approaches to problems in health care. Important insights of practicing professionals and health administrators in all the counties have involved the RMP/WNY more closely with the needs of each county. ,,;;-E 4. ORGANIZATION OF RMP FOR WNY ),W.N.Y. BOARD OF DIRECTORS Constitution and By-Laws Executive Search Proposals COUNTY WNY-RMI COMMITTEES Standing Committees OFHOWNY Coronary Care Cancer Stroke Kidney and Dialysis Lak Pulmonary Planning Hea Cardio-Pulmonary Edu Allied Health Ceni Rural Health Manpower Allegany TLN Advisory Group Cattaraugus Evaluation Chautauqua Erie, Pa. Erie, N. Y. Genesee Ad Hoc Committees McKean, Pa. Health Careers Niagara Family Management of Wyoming the Chronically III Programs for the Aged CORESTRUCTURE Each staff member has a well defined role in the organization and a voice in the development of t e tota program. To promote the greatest possible community involvement, RMP/WNY's philosophy is to use the small core to staff expert committees. Thus, grants management staff works with the proposals committee, evaluation staff with the evaluation committee, county liaison with the county committees, and the Director for Nursing and Allied Health Affairs staffs our categorical committees and implements their programs throughout the region. In addition, staff members work with other committees in the community. The Executive Director has worked very closely with his staff, establishing the program and increasing our involvement in and usefulness to the community. He has been able to bring leaders together to define health problems and set policy for their solution. A measure of the status of RMP/WNY in the community is that the Executive Director holds an associate deanship in the School of Medicine of the University and serves on the medical school's executive committee. In the last year, a growing percentage of the Executive Director's time has been spent working with other RMP directors. He is chairman of the Northeastern group of directors and their elected two-year delegate to the National Steering Committee. From these contacts the Executive Director has brought to the Board and his staff a much more sophisticated understanding of health events of national importance, direct communication with other regional programs, and the possibility of learning from their experiences. 10 FIGURE5. COMPOSITIONOFTHEBOARDOFDIRECTORSOFTHE HEALTH ORGANIZATION OF WESTERN NEW YORK, INC. 100 - oe 00 00, 40 30 - 25 - ui ui 20 0 I- LL 0 I- 15 - z ui ui 10 - 5 - 0 A B c D E F G H I i COMPOSITION OF THE BOARD A 9M.D.'s representing the 9 county medical societies 8 9members representing the 9 county committees G 1 member representing the Regional Health Director, C 2members representing the School of Medicine at the Department of Health, State of New York State University of New York at Buffalo H 1 member representing the Commissioner of Health, D 2members representing Roswell Park Memorial Institute Erie County, New York E 1member representing the Western New York Hospital Association I 1 member representing the Veterans Administration F: 2-embers representing the Comprehensive Health Painning Council J 5 members at large, including 1 legal counsel of Western New York, Inc. 33 total membership FIGURE 6. BOARD OF DIRECTORS OF THE HEALTH ORGANIZATION OF WESTERN NEW YORK, INC. INSTITUTION AND/OR CATEGORIES OF NAME OCCUPATION REPRESENTATION EXECUTIVE COMMITTEE President: 1. Irwin Felsen, MD Physician Allegany County Medical Society Vice President: 2. Father Cosmas Girard, OFM St. Bonaventure University Cattaraugus County Committee Secretary: 3. H. Gregory Thorsell, MD Surgeon Chautauqua County Medical Society Treasurer: 4. John C. Patterson, MD Roswell Park Memorial Institute Roswell Park Memorial Institute Chairman, Proposals Committee: 5. Harry Sultz, DDS, MPH School of Medicine, State University Erie County (N.Y.) Committee of New York at Buffalo Member-at-large: 6. Theodore T. Bronk, MD Physician Niagara County Medical Society Member-at-farge: 7. Edward E. Kemble, MD Physician Erie County (Pa.) Medical Society OTHER BOARD MEMBERS 8. Lester H. Block Attorney at Law Legal Counsel: Member-at-large 9. LaVerne E. Campbell, MD New York State Department of New York State Department of Health - Regional Health Director Health 10. Lloyd Cannedy, PhD Bradford Hospital - Administrator McKean County Committee 11. Clifford L.M. Carpenter Co m p reh e nsive Health Planning Co m p r e h e n sive Health Planning Council of Western New York, Inc., Council of Western New York, Inc. Executive Director 12. Max Cheplove, MD Physician Erie County (N.Y.) Medical Society 13. Kenneth H. Eckhert, MD Surgeon; Co m p re hensive Health Co m p r e h e nsive Health Planning Planning Council of Western New Council of Western New York, Inc. York, Inc. - Chairman 14. William H. Ennis* Hamot Hospital - Administrator Erie County (Pa.) Committee 15. Ivan Harrah Western New York Hospital Associ- Western New York Hospital Asso- ation - Executive Director ciation 12 16. Herbert E. .Joyce, MD Nysician Member-at-large 17. Bert S. Klein, PodD Podiatrist Chautauqua County Committee 18. Edward F. Marra, MD &-hoof of Medicine, State University School of Medicine, State University of New York at Buffalo - Chair- of New York at Buffalo man, Department of Social and Preventive Medicine 19. Elizabeth Moore Executive Director, American Red Member-at-large Cross of Genesee County 20. William E. Mosher, MD Physician, C o u n t y Health Com- Commissioner of Health - Erie missioner County, New York. 21. Gerald P. Murphy, MD Roswell Park Memorial Institute - Roswell Park Memorial Institute Director 22. William C. Niesen, MD Physician Niagara County Committee 23. Mary S. Northington C o m p r e h e nsive Health Planning Member-at-large Council of Western New York, Inc. 24. LeRoy Pesch, MD** State University of New York at School of Medicine, State University Buffalo - Dean, School of Medicine of New York at Buffalo 25. John R. Rowan Buffalo VeteransAdministration Veterans Administration Hospital - Director 26. Fred 0. Rush B a y f r o n t Development Program Member-at-large Gannon College - Director, Erie, Pennsylvania 27. Patricia Stopen, RN Registered Nurse - Wyoming County Committee Wyoming County Health Depart- ment 28. George E. Taylor, Jr., MD Physician Allegany County Committee 29. Donald R. Watkins, MD Physician McKean County Medical Society 30. Paul Welsh, MD Physician Genesee County Committee 31. R.T. Williams, MD Surgeon Wyoming County Medical Society 32. Duncan C. Wormer, MD Physician Cattaraugus County Medical Society 33. George S. Young, MD Physician Genesee County Medical Society Resigned September 1, 1971 Resigned January 1, 1972 The Buffalo and Batavia, New York and Erie, Pennsylvania Veterans Administration Hospitals will shortly all be represented on the HOWNY Board. 13 FIGURE 7. EMPLOYEES OF RMP/WNY Professional Staff Employees John R.F. Ingall, M.D., F.A.C.S., F.R.C.S. - Executive Director Sandra K. Berlowitz, B.A. - Administrative Associate, Writer Gene A. Bunnell, A.B., M.C.P., M.P.H. - Administrative Associate for Planning Floyd Cogley, Jr., B.S., M.P.H. - Administrative Associate for Grant Development Patricia Shine Hoff, R.N., B.S., M.A. - Director of Nursing and Allied Health Affairs Elsa R. Kellberg, B.A., M.A. - Research Associate for Evaluation Gary L. Reynolds, B.S., M.B.A. - Administrative Associate for Business and Personnel Marion R. Sumner, B.A., M.B.A. - Administrative Associate for Business and Personnel Gerald J. Surette, B.A., M.A. - Administrative Associate for County Committees Anthony Zerbo, Jr., B.A. - Director of Communications Staff Employees Jean L. Andrianoff, B.S.Ed. - Secretary Alice J. Bragg - Secretary Maria M. Dick, A.A.S. - Secretary Elizabeth M. Eberl - Statistical Clerk Barbara C. Lamberg - Secretary Kathleen C. McCron B.S. - Receptionist and Secretary Rosetta J. Parker - Secretary Joan L. Philipps, B.S. - Secretary Urban Batt - Clerk (part time) FIGURE 8. VOLUNTEERS'CONTRIBUTION in 1968 the RMP/WNY engaged in a study to find out what was being contributed to the RMP/WNY operation in terms of money by the many volunteers who take part in its activities. This included the use of such resources as 704 - meeting rooms, services, time spent in meetings on RMP business and other !-much factors. The 1968 study of the volunteer time contribution to 601 - RMP/WNY was updated in 1971 and the expected level of volunteer time contribution was projected through 1974. < In 1968, community time volunteered to RMP/WNY equalled -i -i 50e - 231 for every federal dollar spent. By 1971 this figure had w risen to 40@ for every federal dollar. By 1974, it is projected CL that local participation will increase to 67.54/federal dollar. F- < 401 - z fr :) w 0 0 :->w 30e - < LL 20e - 1968 1970 1972 1974 COOPERATIVE CONTRIBUTIONS TO RMP/WNY YEAR PROJECTED PER FEDERAL DOLLAR EXPENDITURE 1968-1974 14 Chapter3 Aou,ne lffotv W,,v RAfPoVVIVY im STAFF FUNCTIONS Planning Proposal Review and Development Evaluation Financial Management Communications The Enabling Theme PROJECTS AND PROPOSALS Operational Projects Financial Statement Status of Proposals HOW RMP/WNY WORKS WITH OTHER HEALTH RELATED ORGANIZATION o 15 STAFF FUNCTIONS PLANNING RMP/WNY programs. The detailed proposal review protocol and criteria for RMP review are part of the RMP/WNY is an operational program with a RMP/WNY Kit and are available to everyone in the planning component. It has been moving in new region. This process of involving the entire region in directions, identifying deficits in health care in the proposal review reveals possible duplication of efforts region and developing priorities for dealing with these and encourages cooperation of those actively problems and needs. Stronger working relationships interested in a concept from every part of the area. with the Comprehensive Health Planning (CHP) The proposal author is in personal contact with the Council of Western New York have been developed. series of groups who review his proposal. In Their overall plan for the region was taken into particular, he must be prepared to explain to the consideration in establishing RMP/WNY's goals and grassroots organizations, the county committees, his objectives. concept and its applicability to their particular situation. The H.O.W.N.Y., Inc. Board of Directors The Western New York program participated in (Regional Advisory Group to the RMP/WNY) has the the Information Support System of Harvard final authority. Proposal review serves an educational University, a system designed to help RMP's develop function. The review mechanism promotes: program activities which more clearly meet objectives specified in the legislation. Data generated from the (a) involvement of the sub-regional groups interviews conducted in Western New York by the lb) education of author and reviewers Information Support System have been used to help (c) equity of review. identify problem areas and incorporate program activities to solve those problems. The Proposals Committee will seek projects that address themselves to the greatest needs of the The research and data acquisition capability of region as documented in the RMP/WNY priorities of the RMP/WNY has been both significantly increased goals and objectives. and established as a regional resource through the employment of the Community Services Research A major objective is to involve the entire region and Development Program of the Department of in one unified system of grant proposal review. This Social and Preventive Medicine of the State would emphasize the community's need for a University of New York at Buffalo. Community common data base and a coordinated consideration Health Information Profiles (CHIP) of county-wide of health care goals and objectives. Proper investment geographic areas for long-range planning of health of resources available to the region would be insured; services and facilities have been instituted projects receiving funding would have the benefit of collaboratively with the Comprehensive Health area-wide involvement and support. Planning Council of Western New York and the Mid-State Committee on Area-Wide Health Planning, Inc. In each case supplemental funds either from county government or one of the comprehensive EVALUATION health planning agencies have been committed to support the additional field staff required for data RMP/WNY has developed evaluation tools to collection at the local level. The first efforts of the assure that (1) health activities goals and objectives CHIP program are being directed to the rural counties remain flexible and respond to the documented needs of Cattaraugus, Genesee, and Allegany. Plans are of the region, (2) the contribution of activities to the underway to develop health information profiles for program's goals and objectives are measured and (3) most of the communities in the RMP/WNY region. the activities themselves are well-conceived and well-executed. At the end of each operational year, goals and objectives will be revised. PROPOSAL REVIEW AND DEVELOPMENT County committees will report their activities The proposal review process has been a most in defining and meeting their health needs, helping effective mechanism for involving the entire region in the Regional Advisory Group base health activities 16 FIGURE 9. PROPOSAL REVIEW PROCESS AUTHOR RMP-WNY HEADQUARTERS Staff Review and Comment Technical Review AUTHOR COUNTY COMMITTEES PROPOSALSCOMMITTEE EVALUATION COMMITTEI OFHOWNY OFRMP BOARD OF DIRECTC OFHOWNY WASHINGTON (as part of the RMP-WNY total program) 17 objectives upon real county needs. Using the EVALUATION WORKSHOPS reporting form which has been developed will help On February 11, 1971, Donald A. Schon, each county subunit measure the effectiveness of its Ph.D., Organization for Social and Technical activities and define its own priorities for investment Innovation, presented a discussion on the evaluation of RMP resources. The form should also facilitate of the effectiveness of regional medical programs. communication among the county committees by Board and staff members as well as representatives of giving them a clearer picture of each other's needs. various community organizations participated in the day-long program at the Buffalo Statler Hilton Hotel. Project reporting forms have been developed to aid the project directors in reporting needed A proposal evaluation workshop designed for information. This will allow close supervision of members of the proposals and evaluation committees project efforts as well as provide data for the project and members of the RMP/WNY staff was held April site visit teams. The teams, which consist of at least 23, 1971, at RMP headquarters in Buffalo. Key two consultants, two Board members, and one speakers were Dr. Frank Husted, Dean, College of RMP/WNY staff member, have provided the Regional Allied Health Professions, Temple University and Dr. Advisory Group an independent assessment of our Harry Sultz, D.D.S., Associate Professor, Social and active and funded projects. These visits are devoid of Preventive Medicine, State University of New York at punitive or federal overtones and have been very Buffalo School of Medicine. informative. Yearly site visit reports will therefore continue to be used as one source for measuring project ef f activeness. FINANCIAL MANAGEMENT In its fiscal policy the Regional Medical The measure of core staff activities can be derived from a summary of members' monthly Program for Western New York has been operating reports. This provides an easy summation of activities under a programmatic approach for several years. The for the anniversary review document, reveals excesses fiscal management of all funds has been in the Core or deficiencies in staff activities in light of overall office with no direct assignment of monies to affiliate program objectives, and serves as a means of institutions. It is the policy at the end of the first six communication among core staff personnel and months of a fiscal year to formally consider between the staff and the Regional Advisory Group. redistribution of funds to strengthen the program as a whole and to seek seed money for projects which have been approved but not funded. A cost analysis of the entire program will be undertaken yearly, taking into account projects and When the budget was prepared for 1971-72, the core staff activities. on-going components were reviewed in the light o their effectiveness and the recommendations of Appropriate evaluation techniques for potential project site visitors. In 1971-72 funds were diverted and operational activities are assured by the (1) to support a summer student extern program Evaluation Committee and RMP/WNY staff. designed to acquaint students in the health fields with rural practice and (2) to the planning and Evaluation efforts will be used to (1) measure implementation of the Lake Area Health Education the dimension of achievements in meeting goals and Center. Projects which were deemed ready for objectives in a specified period of time and (2) self-support were moved more quickly into that provide the information needed to effectively guide support, and funds so released were assigned to other RMP/WNY program development. Information facets of the program. derived from measures of program effectiveness will The grantee institution for Regional Medical be used to periodically reassess goals and objectives, Program for Western New York is the Research determine the level of support for ongoing activities, Foundation of the State University of New York, a and actively seek out projects and activities which private non-profit corporation established for the address themselves to as yet unmet objectives. express purpose of handling federal funds for all branches of the State University of New York. 1 8 COMMUNICATIONS been excursively RMP operations. (2) County medical societies and hospitals contribute funds to the RMP/WNY activities are brought to the RMP/WNY advisory group (Health Organization of attention of the public via the news media, exhibits Western New York, Inc.) to meet expenses that could displayed at conferences and meetings, brochures for not be paid for by the Federal dollar. (3) RMP'S our special programs, and published articles. investment in the Lake Area Health Education Center Television and radio have been used to cover program led to investment in the Center by the Boards of activities. A newsletter brings news of important Trustees of two Erie, Pennsylvania hospitals and by events in the health field, both regional and national, the Veterans Administration (4) The Rural to the 13,300 people on the RMP/WNY mailing list. Externship project was able to attract private The Western New York RMP brochure and annual contributions from hospitals, physicians, and local report have been widely circulated. Currently in governments of $9,1 00. preparation are (1) proceedings of the Workshop together with the goals and objectives of RMP/WNY The acquisition of two excellent conference for the next triennium and (2) the RMP/WNY Kit, a rooms has defined the RMP as a facility used by the compilation of material describing the RMP mission, community. The communications devices and guidelines for development and submission of grant audio-visual requirements are available. In addition to proposals, and the proposal review protocol and use by those directly related to the program, meetings criteria. have been held in the rooms by such groups as the Urban League, Buffalo's Blue Ribbon Ambulance Committee, CHP, the local podiatrists, and Parents of Diabetic Children. THE ENABLING ROLE Participants at the RMP/WNY Workshop, e The core staff has emphasized RMP's enabling role in all program activities RMP/WNY serves as a on September 23 and 24, reaffirmed the crucial importance of RMP's enabling function. They asked broker for the community. Help is given where that, in pursuing specific health care goals and required. If RMP cannot help, other appropriate objectives, RMP/WNY not forget that it provides a organizations are contacted. The staff is seeking to territory in which individuals and institutions can increase its effectiveness in counseling proposal come together, avoiding wasteful duplication and authors by learning more about funding agencies and encouraging a large, regional approach to health their areas of concern and becoming more expert in problems. the development of excellent grant proposals. PROJECTS AND PROPOSALS Another aspect of the enabling role has been insistence that projects have a viable marketing OPERATIONAL PROJECTS strategy. RMP resources are invested as seed monies for activities that can be integrated into the During the year March 1, 1971, through health-care pattern of our region. Centralized fiscal February 28, 1972, five operational projects were control has allowed easy shifting of funds from supported by RMP/WNY. activities that are developed enough to receive community support to new areas of investment. The Project No. 1 Telephone Lecture Network (TLN) requirement for a marketing strategy is clearly defined in the guidelines for proposal development Primary Purpose: General continuing which are distributed to all prospective authors and in education the reporting form that has been developed for Health Care Focus: All types of health project directors. care RMP/WNY has been successful in attracting Target Group(s): All health professionals additional monies to RMP-supported activities: (1) and special primary target population Voluntary agencies and other groups have committed groups, i.e., parents of diabetic children, monetary investment to what otherwise would have and the chronically ill 19 Geographic Scope: Seven counties in Project No. 2 Coronary Care Training Program Western New York and three counties in Pennsylvania Disease Category: Heart Disease Objectives: To meet the growing need for Health Care Focus: Treatment training and education in health care for providers and consumers by increasing Target Group(s): Registered Nurses and the knowledge and skill of health care Physicians personnel and to be a resource for community health education. Primary Purpose: Training existing health personnel in new skills During the three year funded period,the TLN increased in size from a network of 15 hospitals to Geographic Scope: National and one of 56 hospitals (as of June 1970). In September Canadian 1968 the network offered two hourly programs per Objectives: To improve care of heart week - one lecture series for physicians and another patients by training nurses and physicians for nurses. The current educational component consists of 244 hourly programs scheduled in 20 in operating intensive care units. separate lectures series and provides for 15 identifiable career fields. Nineteen agencies, This program for nurses and physicians has institutions and organizations provide voluntary been operational since March 1968. Through June support to the educational component of this project. 1971, 302 registered nurses have completed the A Spoken English course for foreign born health care course of instruction in the intensive care aspects of personnel was developed to alleviate the patients with acute cardiac problems. The basic communication problem that exists between the format of the teaching programs encompasses three patient and those attending him. TLN programs meet weeks of didactic instruction and two or three weeks the Continuing Education requirements of 6 pro- of clinical experience for the practical application of nursing principles and skills which have be fessional associations and one state agency. en taught. Nine metropolitan Buffalo hospitals provided the The results of the 1970 TLN Survey were in clinical facilities utilized for nurse practical general positive with regard to content, format, and experience in Coronary Care Units. Two-day acceptability of TLN presentations. The survey programs for physicians were conducted each year, in accurately predicted hospital participation on the cooperation with the Office of Continuing Medical network for 1971-72. Education of the School of Medicine, State University of New York at Buffalo. Thirty six hospitals registered in September 1971 under the new fee structure. The yearly fee MAJOR PROGRAM CHANGES ranges from $1400 for a hospital with 125 certified IMPLEMENTED - September 1971: beds or less to $1900 for hospitals with over 400 beds. The educational component of the network is (1) Tuition fee charged: $350 per session per nurse now supported by the member hospitals. registrant. (2) Discontinued reimbursements paid to hospitals. The TLN also serves health and administrative Commitments to participate, without pay in the groups by providing a means of information exchange program, have been received from many of the at regular meetings and conferences, via the network. cooperating agencies. Additional evening programs are directed to certain (3) No lecturer reimbursement fees being paid, groups concerned with the education of relatives of (4) School of Nursing, SUNY at Buffalo, assumed persons with chronic health problems. the Director's salary. As of March 1, 1972, this project will be supported by the Department of Continuing Education, School of Nursing, SUNY at Buffalo. 20 Tuition fees will be continued. A pilot study is established which includes one active and responsible underway which will allow combination of the representative from each of the participating, Coronary and Respiratory Care Training Program into affiliated hospitals and which also includes wide a Cardio-Pulmonary Care Training Course. representation from the outlying communities. This advisory committee has determined that the Home Project No. 3 Chronic Respiratory Disease Program Care and Rehabilitation Programs, established as models, should now be extended into the region. Disease Category: Pulmonary Target Group(s): Allied health professionals, physicians, nurses, and patients Project No. 10 Tumor Service Registry Primary Purpose: Education and Disease Category: Cancer development of health care facilities Health Care Focus: Diagnosis and Geographic Scope: Western New York Treatment and Northwestern Pennsylvania Target Group(s): Physicians, medical re- Objectives: Provide home care and cords personnel and cancer patients rehabilitation programs for patients throughout the region; provide Primary Purpose: Part training and part educational programs about chronic patient services respiratory disease for nurses, physicians, allied health personnel, and patients. Geographic Scope: Western New York and Northwestern Pennsylvania The following components of the program have been instituted: Objectives: To provide better care to The Screening Program cancer patients by improving (1 ) quality The School of Respiratory Therapy of care by hospital and physician and (2) Pulmonary Physical Therapy access to care through follow-up Continuing Education for Nurses procedures. Continuing Education for Physicians Model Pulmonary Care Facility A tumor registry has been established as a tool Respiratory Intensive Care Unit for improving the quality of care for cancer patients. Pulmonary Function Laboratory Tumor Registry activity has been initiated in eleven Respiratory Therapy Service hospitals where none had existed. The efforts of all Home Care Program member hospitals have been coordinated, with Rehabilitation Program continuous training of hospital tumor registrars. This assures improved uniformity and quality of data The first three years have been but a beginning. abstracted, since each registrar follows mutually Development of staff, a team approach, and lines of agreed upon procedures. A follow-up procedure has communication has been the major achievement so been established through letters to physicians far. The bulk of this program will be self-supporting requesting follow-up information on their cancer by March 1972, in the estimated amount of $345,000 patients. This encourages continuing periodic annually. monitoring of the patient's condition. Statistical reports which reflect regional experience and that of Based on the recommendations resulting from a the individual hospitals have been prepared and project site visit, the regional aspects of the program distributed. An advisory committee has been formed are being stressed. At the further suggestion of the to provide the professional guidance required for site visitors, an advisory committee has been routine Registry operations. 21 Project No. 14 Information Dissemination Service Four basic services are available: Target Group(s): Health institutions, 1. Photocopy and mailing of journal articles health professionals and loan of books 2. Preparation of subject bibliographies Primary Purpose: Provide library service 3. Reference service to health professionals and health 4. Library management consultation service institutions to hospital libraries. Geographic Scope: Western New York During the first year of operation (June 1970 - and Northwestern Pennsylvania July 1971) a total of 12,393 requests were received Objectives: Provide library services to and processed. These included: health professionals; encourage hospital libraries to develop their own services; Photocopy of journal articles - 10,812 provide consultation service to hospital Journals loaned - 285 library personnel. Books loaned - 854 Bibliographies prepared - 359 I m plementation of the Information Reference requests - 83 Dissemination Service began in June 1970. An advisory group was selected and a policy statement A questionnaire was used to evaluate the formulated. Between June and September 1970 the project in April 1971. As a result of interest indicated project director met with the personnel responsible through the questionnaire, two workshops were for library service in the hospitals in the region. conducted for members of the hospital library staffs Publicity was prepared and mailed to all health in August 1971. Subjects presented for discussion professionals in the region. included reference tools used in medical libraries, biomedical communication networks, and principles of library management. Fifty percent of the requests have come from health professionals in hospitals serving the inner city population. FIGURE 10. FINANCIAL STATEMENT - March 1, 1971 February 29, 1972 For the year March 1, 1971 - February 29, 1972, the Regional Medical Program for Western New York was awarded $1,363,440, including a re-award of $197,108 for the development of an intensive care unit for the Respiratory Program. From this total the following projects were budgeted: Core Program $ 453,100 Telephone Lecture Network 122,678 Coronary Care Training Program 50,795 Chronic Respiratory Disease Program 423,771 Intensive Care Unit - Respiratory Program 197,108 Tumor Service Registry 65,050 Information Dissemination Service 50,938 $1,363,440 The following special activities were financed from Core Funds: Rural Externship Program $ 12,000 Migrant Health Program 14,500 10,000 Lake Area Health Education Center Continuing Education (Teaching Days) 4,500 22 STATUS OF PROPOSALS FIGURE 1 1. STATUS OF PROPOSALS The following proposals went through the RMP/WNY review process during 1971-72: Result of Title Author HOWNY review Period Postgraduate Training for General Practi- Thomas Aceto, Jr., M.D. Approved 1 year tioners and Pediatricians in a Pediatric Sub- Specialty Acquisition of Psychomotor Skills in Surgery Gavriel Saivendy, Ph.D. Not Approved 1year Master Plan for Planning and Articulation Phyllis Higley, Ph.D. (1972) Approved 1year of Allied Health Education in the WNY Region Allegany County Mobile Health Clinic Virginia Barker, Ph.D. Approved 3 years Provision of Homemaker Services in Niagara Howard Patton, M.P.H. Not Approved 1 year County Hospital based Continuing Health Care Pro- Norman Courey, M.D. Not Approved 3 years gram for Women Continuation of Chronic Respiratory Disease John Vance, M.D. Approved 3 years Program Short-term Group T h e r a p y for Cardiac Lawrence Golden, M.D. Not Approved 1 year Patients 23 FIGURE 12. PROPOSALS SUBMITTED TO WASHINGTON AS PART OF RMP/WNY'S TRIENNIAL GRANT APPLICATION FOR MARCH 1, 1972 - FEBRUARY 28,1973. Proposals approved in 1971-72; proposals approved in previous years but as yet unfunded; and currently operational projects were all reviewed by the Regional Advisory Group. The following activities were judged to be most germane to the new RMP/WNY goals and objectives and were included in the triennial grant application as part of RMP/WNY's program of activities for March 1, 1972 - February 28, 1973: Amount requested Title Coordinator (for 72-73 period) Telephone Lecture Network Joseph Reynolds 108,117 Tumor Service Registry John Patterson, M.D. 78,052 Information Dissemination Service Jean Miller, R.N., M.S., M.L.S. 54,947 Chronic Respiratory Disease John Vance, M.D. 151,853 Program A Model for Comprehensive Family Ernest Haynes, M.D. 217,689 Health Comprehensive Continuing Care for Earl Noble, M.D. 243,290 Chronic Illness Evan Calkins, M.D. Master Plan for Planning and Ar- Phyllis Higley, Ph.D. (1972) 18,542 Educa- ticulation of Allied Health tion in the WNY Region Allegany County Mobile Health Virginia Barker, Ph.D. 151,853 Clinic matters in the counties, are serving both RMP and Those interested in health care problems in the CHP. CHP currently provides written comment on all region often wear multiple hats. The presence on the grant proposals that are processed through the H.O.W.N.Y., Inc., Board of members who also serve RMP/WNY review mechanism. At the September with other health-related organizations is often an Workshop, RMP/WNY profited from the involvement informal, but highly effective arrangement. It permits of CHP staff and Board members in the definition of information exchange and collaborative planning and RMP/WNY's goals and objectives. discourages inefficient and costly duplication of effort. A number of consumer groups - Parents of Diabetic Children, Hemophiliac Foundation, and There is staff cooperation in committees that others - have benefited considerably from RMP help. serve both the Comprehensive Health Planning RMP has supported their efforts in education and Council of Western New York (CHP) and RMP, as information dissemination, made their programs well as a strong relationship between the two known to the community, and provided them with a directors. The sub-regional county committees, since communication mechanism through the Telephone they involve those actively interested in health Lecture Network. 24 FIGURE 13. RMP FOR WNY RELATIONSHIP TO OTHER HEALTH RELATED ORGANIZATIONS VOLUNTARY HEALTH AGENCIES PROFESSIONAL SOCIETIES COUNTY APPALACHIAN HEALTH REGIONAL H ORGANIZATION COMMISSION STERN NEWYORK, INC. UNITED COMPREHENSIVE HEALTH VETERANS HEALTHPLAN FOUNDAriON MODEL ADMINISTRA- CITIES MEDICAL SOCIETIES ER I E COUNTY RI K MEMORIAL INSTITUTE HEALTH DEPARTMENT 40 COMMUNITY SERVICES AMERICAN RESEARCH AND HOSPI7 DEVELOPMENT CANCER SOCIETY ASSOCI I HEART ASSOCIAriON SUNY SCHOOL STATE HEAL OF DEPARTMENT WESTERN OF MEDICINE NEW YORK, INC. RESPIRATORY AND TUBERCULOSIS ASSOCIATION FORMAL RELATIONSHIP LOCAL GROUPS M. WORKING RELATIONSHIP r-I INFORMAL The relationship between Working relationships in- Those organizations with various health-related organiza- volve a continuing cooperation in which RMP has informal relation- tions and the RMP for WNY may areas such as awarding continuing ships are a rather broad group. be divided into three categories: education credit for participation Concerned agencies tend to band formal, working, and informal. in TLN programs, co-sponsorship together to deal with a particular Formal status entails representa- of teaching days, or joint planning program or problem. tion on RMP's Regional Advisory for community health. Group, the Board of Directors of the Health Organization of Western New York, Inc., as mandated in the by-laws of the Regional Medical Program. 25 r4 Spec'soal Conce s RAfPm'VVIVY Manpower Development Area Health Education Centers Rural Health Problems Inner City Problems Health Maintenance Organizations 27 MANPOWER DEVELOPMENT Projects funded by RMP/WNY have aimed to manpower problems. For example, alleviate Nursing and allied health professionals have a inhalation therapists, coronary and respiratory care strong voice in RMP/WNY. The needs of the health unit nurses, and medica.I record librarians have been professionals of the region are regularly assessed in trained under the auspices of various projects. The order to establish objectives that will assist them in Telephone Lecture Network offers a program of providing better health care. An allied health continuing education for the entire spectrum of committee, recently formed under RMP/WNY health professionals. (see figure 14) auspices, has established goals for the proper use of allied health manpower and presented a position AREA HEALTH EDUCATION CENTERS paper on allied health participation in the development of the area health education center Early in 1971 discussions were initiated with concept to the Lake Area Health Education Center. representatives of Erie, Pennsylvania. hospitals concerning the establishment of an area health RMP/WNY is exploring ways to alleviate the education center. RMP/WNY acted as a liaison severe shortage of health manpower: (1) Staff between this group and the State University of New members have attended conferences held to stimulate York at Buffalo. Initial understanding and subsequent the development of new types of health manpower, commitment to the center concept was obtained in and consultants have visited the program. (2) Existing writing from participating groups. A composite manpower could be better utilized if health workers document contains a record of progress i6 the received basic training in a unified core curriculum establishment of the Lake Area Health Education which would allow them to work in whichever area Center (LAHEC). has the greatest need, and advance through more specialized training after the basic program. (3) The center concept was based on four broad Students are encouraged to consider health careers. goals: RMP/WNY is currently cooperating with the United 1. Conduct basic and continuing Health Foundation and CHP to plan a summer education programs under the experience in health agencies for local graduate supervision of the faculties of the students who are interested in pursuing careers in the c o I I e g e a n d u niversity administration of health programs. health-science centers with which it is affiliated and in cooperation with Highly trained specialists of the region have local professional associations involved themselves with RMP/WNY through 2. Provide guidance to comprehensive categorical committees. Committees have defined the colleges and community colleges in promotion of educational programs held throughout the area in the development of the region as their primary role. A small investment training programs for allied health of RMP funds has allowed cooperation with other professions agencies to meet the needs of local practitioners for 3. Promote the existence of education and consultation in their own home areas. community-hospital services of These educational activities of the categorical outstanding quality and cooperate committees have brought RMP visibility in the region with health-care f aci I ities, and the good will of practitioners. They have institutions, and agencies in the contributed to better utilization of existing planning and development of a manpower in that: (1) Specialists are brought from health-care delivery-system that is their ivory towers and through lecturing, consulting, more effective, efficient, and answering questions they have been provided economical, accessible, and access to the community. (2) Knowing about acceptable to all levels of society improved modes of treatment has given local 4. Conduct research programs physicians the opportunity to practice better concerned primarily with the medicine. (3) Problems stated and help given not only evaluation o f health-care inf I u ence referral patterns but the personal delivery-systems as well as involvement has a major role in education and appropriate surveys of health-care ultimately in quality of care. manpower and their utilization. 28 During 1971, programs in continuing education have been held throughout the region for physicians, nurses, and allied health professionals. Several of the programs were aimed at multi-disciplinary audiences. "Family Management of the Chronically 111" was also attended by interested individuals from the community at large. FIGURE 14. PROGRAMS IN CONTINUING EDUCATION, 1971 DATE PROGRAM LOCATION NO. REGISTRANTS CO-SPONSORS 2/25/71 "Family Management of the Statier Hilton Hotel 350 Continuing Medical Education Chronically 111" Buffalo, New York School of Medicine S.U.N.Y.A.B. 3/4/71 Cancer Teaching Day "Cancer Buffalo Mercy Hospital 300 Department of Surgery, Buf- Chemotherapy - 1971 " Buffalo, New York falo Mercy Hospital, Buffalo, New York; American Cancer Society, Erie County Unit, Buffalo, New York 4/20/71 "From Study Into A6tion" Sisters of Charity Hospital 200 - - - - - Jerome P. Lysaught, Ed.D., Buffalo, New York Director, National Commission for the Study of Nursing and Nursing Education 4/29/71 Pulmonary Teaching Day "Re- Holiday Inn 150 Tuberculosis and Respiratory habit itation Care of the Patient Olean, New York Disease Association, Olean Unit with Pulmonary Disease" Olean, New York 5/19/71 Pulmonary Teaching Day "New Ramadalnn 130 Northwestern Pennsylvania Trends in Pulmonary Disease" Erie, Pennsylvania Tuberculosis and Respiratory Disease Society 5/26 and Stroke Workshop "A Multi- Veterans Administration Hos- 165 Veterans Administration Hos- 5/27/71 disciplinary Approach to the pital, Buffalo, New York pital, Buffalo, New York Rehabilitation of- the Stroke Patient" 6/3/71 Cancer Teaching Day "Modern Castle Inn 175 American Cancer Society, Cat- Trends in the Treatment of Olean, New York taraugus County Unit, Olean, Breast Cancer" New York 8/27 and "Therapeutic Work with Older Campus School, State Univer- 150 School of Social Work 8/28/71 Persons and Their Families" sity College at Buffalo Syracuse University Buffalo, New York Syracuse, New York 9/20 and Pulmonary Workshop "Care of Statier Hilton Hotel 75 Tuberculosis and Respiratory 9/21/71 Patients with Pulmonary Dys- Buffalo Disease Association of WNY function: Nursing Makes a Dif- Erie County Unit ference" Buffalo, New York 9/23/71 Cancer Teaching Day "Progress Holiday Inn 150 American Cancer Society in Cancer Therapy" Batavia, New York Genesee County Unit Batavia, New York 12/4/71 Cancer Teaching Day, "Some Showboat Restaurant 100 Doctors Hospital, Tonawanda, Aspects of C u r r a n t Cancer Buffalo, New York New York; American Cancer Treatment" Society, Erie County Unit, Buffalo, New York 9/27, 10/4, Inservice Pulmonary Teaching Veterans Administration Hos- 51 Veterans Administration Hos- 10/18, II/l/71 Sessions pital, Batavia, New York pitat, Batavia, New York 11/4, 11/11, Inservice Pulmonary Teaching W.C.A. Hospital, Jamestown, 62 W.C.A. Hospital, Janwstown, 11/18, 12/2/71 Sessions New York New York 29 In its role as an enabling agency RMP/WNY Manpower Committee expanded the program during brought together the various agencies initially the summer of 1971. An eight-week interdisciplinary m involved students in necessary for the creation of LAHEC. RMP is rural externship progra facilitating the close cooperation of these agencies in medicine, dentistry, and the health-related such a fashion that all are equal partners in this professions. A total of 20 students were placed with enterprise. The Telephone Lecture Network will play preceptors in 12 communities within the region. an integral role in fulfilling some of the educational Central objectives of the program were (1) to requirements of the Center. encourage health science students to pursue careers in rural areas and (2) to contribute to better RMP/WNY staff members were present during communication between the University center and the site-visit of LAHEC on July an y a joint rura communi ies. federal team from the Veterans Administration and the Department of Health, Education, and Welfare. Flexibility in arranging schedules for individual RMP has supported the concept that LAHEC should externs allowed the maximum orientation to, and n - p r o f i t involvement in, the unique aspects of the rural o p e r a t e a s a p u b I i c , n o corporation-for-education-and-scientific-purposes; community. A I iaison network of faculty such an incorporation seems the most effective and representatives, the student coordinator, the project efficient manner both for reaching the goals sought directors, and RMP/WNY staff assured smooth by the LAHEC committees and for managing the administration of - the program. The externship funds it will receive from a broad category of sources, program is currently being evaluated from the student both local and federal. diary, preceptor record, personal interviews, and questionnaires distributed at the orientation and at RURAL HEALTH PROBLEMS the de-briefing sessions. A measure of local interest is the $9100 contributed to the Rural Externship Program by hospitals, physicians, and local Since the 9 counties are predominantly rural, RMP/WNY has always had a special interest in rural governments. health problems. The Rural Health Manpower Committee is comprised of a broad spectrum of Community leaders in rural Allegany, the acad em ic ians, practitioners, representatives of smallest of the nine counties, have established a community groups, and health departments. Is committee which surveyed the health needs of the committee asked to meet under the aegis of county and, based on these well-documented needs, RMP/WNY to consider ways in which the training of developed with their local university a proposal for improving health education and service in Allegany health professionals can be more pertinent to rural County. health care needs. RURAL EXTERNSHIP PROGRAM The salary of a director of clinics for migrant During the summer of 1970, the Student workers was assumed part of this year as a American Medical Association, under contract with developmental enterprise. RMP/WNY proposes to the Appalachian Regional Commission, and in support the RMP Rural Health Manpower Committee cooperation with the Western New York Regional in its activities; work closely with county health Medical Program, developed a nine-week summer officers and county public health committees in program in which a total of nine students, from meeting migrant workers' health needs; work with schools of medicine, dentistry, and nursing, were other groups concerned with rural health such as placed with preceptors in various rural communities Appalachian Regional Commission, the Office of Planning Services, OEO, and SAMA; and assist rural in three western New York counties-Allegany, Cattaraugus, and Chautauqua. The students had the 'people in making their voice heard in RMP and opportunity to participate in rural medicine and to developing proposals and implementing projects to experience, firsthand, the pattern of health care in meet their needs. these communities. RMP/WNY placed students with their individual preceptors. As a result of the successful 1970 summer experience, the Rural Health 30 INNER CITY HEALTH PROBLEMS Positive action has been taken through many and tested. It behooves the Regional Medical channels to assist inner city residents. Two major Program, which reflects many of the interests of proposals for next year involve two hospitals which providers, to involve itself in the efforts which are located in and serve the inner city. One involves a validate the concept. RMP will participate in those family practice training center and the second is an efforts supported by the medical societies and the attempt to minimize the in-hospital episodes in State University of New York at Buffalo. long-term illness. The current status of the concept in this region The Cooperative College Center at Buffalo is a is as follows: preparatory institution for students whose prior academic experiences do not meet the demands of 1 . The RMP/WNY Director, together with college admissions. RMP/WNY's Health Careers CHP, the University, and others in the Committee is helping the Center in developing Health health field, are exploring means whereby Careers Days, serving as a liaison between the Center the new university campus can be the and the health community. RMP is assuring the basis for an HMO. presence of faculty and students from area colleges 2. The Urban Development Corporation, in and SUNYAB, as well as representatives of county consultation with one of the RMP/WNY and state health departments and local hospitals. Board members and a group in the health field, is devising a plan to provide an On June 23, 1971, a meeting was held in the HMO for a new population development RMP conference rooms between RMP/WNY core area on the Buffalo waterfront. staff and representatives of inner city organizations. 3. The staff of RMP have been closely It was organized at the request of the inner-city involved in the development, submission, groups to seek specific short-term commitments of and rewrite of the HMO for Wyoming RMP. Specific proposals to be submitted to RMP are County. This complicated document was being constructed by inner city groups, in response to proposed under the leadership of one of this meeting. A staff member represents RMP/WNY the RMP/WNY county committees. It on Model Cities Health Committee. provides an opportunity for the current HEALTH MAINTENANCE providers to participate, but does not ORGANIZATIONS eliminate the possibility for conducting medical practice in the long established The concept of HMO's has raised a number of pattern. This document was not subjected to the RMP/WNY regional review process. questions and has yet to be empirically documented 31 Director of the Regional Medical Programs Service Harold Margulies, M.D. Executive Director for the Regional Medical Program for Western New York John R.F. Ingall, M.D. Regional Medical Program for Western New York 2929 Main Street Buffalo, New York 14214 Telephone: (716) 835-0728 The Regional Medical Program for Western New York is affiliated with the School of Medicine of the State University of New York at Buffalo. As of March 1, 1972 the name of the program was changed to Lakes Area Regional Medical Program, Inc.