@l Lakes Area Regional Medical Program lnc- Theme A Challenge - A Response The theme of this Annual Report is "Challenge and Response". The Lakes Area Regional Medical Program, Inc., in common with its counterparts across the country, has faced a series of problems that have threatened the very existence of the program. Funds have been uncertain, instructions as to their application have been difficult to fulfill; the morale of staff and the large body of dedicated volunteers has been strained. This unsettled environment has not, however, prevented the continuance of our program, despite the reduction in staff and the decrease in project development. Arnold J. Toynbee pointed out that people and nations prove their mettle by the way they respond to a new challenge. Like Toynbee's nations or individuals, the Lakes Area Regional Medical Program, Inc. - its staff, its Board of Directors and its constituents have responded admirably to the challenge with confidence and forebearance. Witness to this are the projects outlined in the body of this report. As we move into an era of reorganization, we have consolidated our capabilities to serve in the health care delivery system of our region. Whatever the future holds for the Lakes Area Regional Medical Program, Inc., we can look with pride at our many achievements over the past several years. We have defined needs, documented them and developed programs to respond to them. Our ability to do this is proven - how this function can be continued is the challenge for the coming years. Regional Advisory Group Officers Chairman Vice-Chairman FATHER COSMAS GIRARD, OFM, Ph.D. THEODORE BRONK, M.D. Secretary Treasurer BERT KLEIN, DPM JOHN PATTERSON, M.D. Contents 1 Theme 2 Regional Advisory Group Officers 4 President's Message 5 From the Executive Director 6 LARMP Purpose Goals and Objectives 7 People Directly Served Expanded Manpower Capability 8 Area Served Legislation - How RM Ps Began - Where They are Now 9 List of Members 12 Regional Advisory Group - Program Committee The Grantee Institution, Business 0 ice 13 County Committee Chairpersons Health Information Systems Unit, Field Staff Public Information 14 Continuing Education Programs 15 Evaluation 17 Allocation of Resources 18 Financial Report 20 Status of Projects 21 Projects 22 Allegany County Mobile Health Unit 23 Ambulatory Care Service Planning Cattaraugus County Household Survey of the Elderly Centralized Relocation Service for the Aging 24 Emergency Medical Services 25 Grant Shared by Two Libraries 26 Hypertension Project 27 I n-Service Training Program for Domiciliary Facilities Lake Area Health Education Center Lakes Area Regional Tumor Service Registry 28 Minority Health Education Delivery System Niagara County Ambulatory Medical Care Study Prevention and Treatment of Regression in Older Persons Primary Care Nurse Practitioner Faculty Training Program 29 Regional Program for Aphasia Rehabilitation Regional Laboratory Improvement Project Regional Medical Genetics Project Shareco 30 Rural Externship Program 31 Telephone Lecture Network 32 Two County Nutrition Project LARM P Staff Listing April 1975 3 President's Message The National Regional Medical Program was established by Congress in 1965 under Public Law 89-239. The over-all purpose was to close, insofar as possible, the gap - a large and disturbing gap - that exists between the knowledge and capability of medical science and the application or actual delivery of health care to the vast majority of the American public. During the past eight years the Lakes Area Regional Medical Program's Board and Staff have devoted their time and talent unstintingly to the developmental function, producing practical and performance-tested projects that have supplied the nucleus for an effective health care delivery system for our entire region. Now we have new legislation, Public Law 93-641. Many knowledgeable health professionals feel that a great deal of what has been achieved since the inception of the Regional Medical Programs may now be lost. Nevertheless, we are challenged to create out of this legislation the best possible pp- health delivery system within our capability. The utmost emphasis must be given to the fact that the over-all essential goal for all health professionals remains the same, namely, to bring into being a health care delivery system which will insure the "achievement of equal access to quality care (for all Americans) at a reasonable cost." Therefore, our attitude and approach in facing up to the challenge of Public Law 93-641 must not be negative, but rather positive; it must not be pessimistic, but rather optimistic; it must not be biased or partisan, but rather truly non-partisan, collaborative and cooperative. With sincerity, honesty, and professional integrity, let us take up the task of creating the kind of health care system our American people deserve and have the right to expect from our richly endowed society. Fr. Cosmas Girard, 0. F. M. 4 From the Executive Director In 1967 when I first assumed the role of Executive Director of the Regional Medical Program, we used the slogan ... "Communication, Cooperation, Science to Service." There has been little doubt in my mind that continued improvement, patient management, and quality of care depended heavily upon the transfer of information from the scientist to the provider of health care services. This led to our first two projects - the Telephone Lecture Network and the Coronary Care Training Program for nurses and physicians. Over the years, many of LARMP's projects have been designed to improve the quality of patient care through a variety of continuing education activities. As a program originally designated under the categorical labels of heart disease, cancer and stroke, priority funding requirements were established. These included community need as determined by local review groups, technical quality and potential impact in relation to planned expenditures. These factors are still given primary consideration in the community-based decision making process. We have been subjected to a number of site visits and examinations over the years. One of these resulted in our development of a private corporate structure and the saving of approximately $500,000 a year in overheads. Change in our structure has occurred. Our program staff has been refined. Evaluation, fiscal management in all its aspects, data collection and processing, project development and quality assurance are preeminent. The new legislation creating the Health Systems Agencies (H.S.A.s) has absorbed much time during the last two years and has influenced the trend in the current pattern of the Lakes Area Regional Medical Program staff. We are confident of our ability to continue serving the Lakes Area, and contend that the roles we currently discharge will be required of us in the structure of a new agency. The experience and talent within the staff is unquestionable. The professional and support staff have weathered the difficult months of 1974 and it is my conviction that their capabilities should be to the benefit of the community in the years to come. John R.F. lngall, M.D. 5 LARMP Purpose The Lakes Area Regional Medical Program, Inc. is To encourage coordination among government, voluntary, and designed through grants and contracts to encourage and private agencies to (a) maximize the impact of preventive assist in the establishment of regional cooperative services and (b) assist public health agencies in responding to arrangements among medical schools, research community needs. institutions, and hospitals for the promotion of research and To encourage expanded programs in health education. training, medical data exchange and demonstrations of patient care in the fields of heart disease, cancer, stroke Goal No. 2 - To develop and improve and kidney disease, and other related diseases. primary care services. It strives to improve the personal health care system in the nine-county region it represents in Western New York and Objectives Northwestern Pennsylvania. The program affords to the To continue defining the need for additional, altered or new medical profession and medical institutions, through such primary care services in each sub-regional area, based on a cooperative arrangements, the opportunity of making data profile of resources and services, an assessment of available to their patients the latest advances in the community characteristics and health problems, and on the prevention, diagnosis, treatment, and rehabilitation of receptivity of the pattern of services to the community. persons suffering from these diseases. It also promotes To maximize the role of existing health personnel in delivering and fosters regional linkages among health institutions and primary health care by (a) improving distribution of health seeks to strengthen and improve primary care and the personnel, lb) encouraging the expansion of ambulatory care relationship between specialized and primary care. within or associated with community hospitals, (c) using an inter-disciplinary approach to the delivery of primary care, (d) By these means, the program attempts to improve the encouraging the development and evaluation of innovative quality and enhance the capacity of the health manpower methods of health care delivery, and (e) promoting improved and facilities available to the region and to improve health referral patterns to assure continuity of care. services for persons residing in areas with limited To encourage general and family practice and other forms of resources. primary health care. To stimulate development of already defined new roles of The program attempts to accomplish these ends without health personnel. interfering with the patterns or the methods of financing of To seek feasible solutions to the problems of distance and patient care or professional practice, or with the lack of transportation as barriers to utilization of primary care, administration of hospitals, and in cooperation with preventive and rehabilitation services. practicing physicians, medical center officials, hospital To promote consumer education regarding availability and administrators, and representatives from appropriate utilization of existing health services. voluntary health agencies. Goal No. 3 - To encourage the Goals and Objectives development, expansion and integration of rehabilitation services to the continuum of Goal No. 1 - To stimulate and promote medical services. preventive services in health maintenance. Objectives Objectives To continue defining the need for additional or new preventive To continue defining the need for additional, altered or new services in each sub-regional area, based on a data profile of rehabilitation services in each sub-regional area, based on a data profile of resources and services, an assessment of the resources and services, an assessment of the community's community's characteristics and health problems, and on the characteristics and health problems, and on the acceptability acceptability of the patterns of service to the community. of the service to the community. To encourage delivery of preventive services through sources To promote the continued development of a variety of facilities of primary care with emphasis on the role of allied health and programs to assure placement of patients at the personnel. appropriate level of care. 6 People Directly Served Expanded Manpower Capability LARMP continues to have a major impact in broadcasts lectures to health professionals and others serving personal health care needs of consumers. throughout Western New York and Pennsylvania via a closed While LARMP does not ordinarily provide direct circuit telephone line. During 1974, over 22,500 persons health services, there are instances where direct representing at least 14 health disciplines attended these services are provided as part of a demonstration programs. Over 13,718 continuing education contact hours project. were certified. Over 2,300 persons throughout the region More than 35.000 people received direct health attended 16 continuing education programs for health care services in LARMP funded projects in 1974. professionals arranged by the continuing education unit of An estimated 1 million additional persons the LARMP. benefitted as a direct result of the use of new skills Increased access to primary care services has remained an acquired by local health professionals in LARMP important focus of activity. The development of new types of training programs. health care professionals specifically trained to provide primary Table 1 provides a summary of the numbers of health care as "mid-level practitioners" with close physician people directly served in the course of LARMP supervision or backup has proved to be an innovative, promising funded activities. method of increasing access to needed health services. Several LARMP projects are specifically designed to train new types of Table 1: health professionals. The Regional Hypertension Education People Receiving Direct Health Services Project has trained hypertension technicians who provide follow- up and patient education; the Emergency Medical Services in LARMP Projects Project has trained over 4,000 Emergency Medical Technicians; 1975 and the Primary Care Nurse Practitioner Faculty Training Type of Project 1974 (est.) Program is aimed at implementing a faculty development Primary Care 2,700 2,400 program to prepare nurse faculty members on the expanded role of the nurse. Emergency Medical LARMP has also trained health care professionals in techniques Services 22,000 11,000 to assure high levels of quality care available to patients in the Categorical Disease community and local health care facilities, such as-. and Improvements in The Regional Laboratory Improvement Project designed to Secondary and Tertiary improve the performance of clinical laboratory personnel in Care' 11,000 6,000 rural and small hospitals, and Total 35,700 19,400 The Regional Tumor Service Registry which trains medical 'Includes Cancer, Stroke, Hypertension, Dentistry, Genetics, and records personnel in new quality audit techniques. Nutrition. Table 2: Expanded Manpower Capability Members of Existing Health Professions Trained in New Skills LARMP has worked with existing health manpower to 1/1 - 6/30 provide opportunities to acquire specific new skills aim- Types of 1975 ed at improving care. New skills is an RM P program Health Manpower 1970 1972 1973 1974 (est.) category which includes organized efforts aimed at the Doctors 0 0 0 140 70 acquisition of essentially new skills by persons already Nurses 244 250 411 1,929 950 educated, licensed, or certified. A summary of the numbers of local health care Others Including 9 336 622 370' 200* providers trained in new skills by LARMP is shown in Medical, Laboratory, 415*' 200** Table 2. and Other Technicians 348 150 Extensive continuing education activities are also carried out by the Telephone Lecture Network. An Totals 253 586 1,033 3,202 1,570 educational communications network, the TLN 'Technologists and Technicians "Health Administrators 7 Area Served Legislation-How RMPs Began- Where They Are Now The Lakes Area Regional Medical Program, Inc. is one Regional Medical Programs were established by Congress of 52 federally funded locally controlled Regional in 1965 under Public Law 89-239. Under this legislation, Medical Programs in the United States. categorical emphasis was placed on heart disease, cancer, stroke and related diseases. Emphasis was placed on Nine counties comprise the region, seven in Western New making available the latest advances in diagnosis and York and two in Northwestern Pennsylvania. The counties treatment. Cooperative arrangements for research, are: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, training, and related demonstrations of patient care were Niagara and Wyoming in Western New York and Erie and also stressed. McKean Counties in Northwestern Pennsylvania. In October, 1970, the legislation was amended to include The region covers an area of 71 00 square miles with a kidney disease and other related diseases as Public Law population of 2,036,610 (according to the 1970 census). 91-515. This legislation promoted through grants, the development of regional cooperative arrangements among the nation's health professions and institutions in order to improve regional organization of health resources and IAGARA COUNTY services and to enhance health care by supporting the providers at the community level'Emphasis was placed on COUNTY health service delivery and manpower utilization. RMPs were directed to pay particular attention to improving services in areas with limited health services. :OUNTY N. New Law Combines Agencies CATTARAUGUS COUNTY ALLEGANY On January 4, 1975, President Gerald Ford signed Public CHAUTAUOUA COUNTY COUNTY Law 93-641, the National Health Planning and Resources Development Act of 1974. The law calls for the establishment of state health planning and development IE COUNTY. PA 'OP D agencies and local Health Systems Agencies (HSAs). It includes new authorization for health facilities construction M@KEAN COUNTY. PA. and modernization and for funds to allow HSA's to develop health resources as they implement their plans. The law replaces Regional Medical Programs, Comprehensive Health Planning Councils, Hill-Burton and Experimental Health Service Delivery System authorities. It continues the authorization for these agencies until such time as the new HSAs can be established. The Governor of each state will recommend to the Secretary of Health, Education and Welfare a designated health service area. With the designation of approved health planning areas, non-profit corporations, public planning bodies, and units of general local government can present applications to the Secretary to become the HSA for each area concerned. The law clearly places a heavy responsibility on the Governor of each state. List of Members of the Regional Advisory Group and Steering (Executive) Committee Name and Address Institution and/or Occupation Categories of Representation Chairman: Father Cosmas Girard, OFM, Ph.D.*' Sociologist-Anthropologist Cattaraugus County Olean, New York St. Bonaventure University Committee Vice-Chairman: Theodore T. Bronk, M.D.'* Physician Niagara County Mt. St. Mary's Hospital Director of Laboratories Medical Society Lewiston, New York Secretary: Bert Klein, D. P.M.' Podiatrist Chautauqua County Jamestown . New York Committee Treasurer: John C. Patterson, M.D.* Physician Roswell Park Memorial Buffalo, New York Institute Other Members: Sister Bernadette Armiger, R.N., Ph.D. Dean, School of Nursing Member of the public Niagara University Niagara University Niagara Falls, New York Bernard Asher, M.D.' Physician Genesee County Batavia, New York Committee Virginia Barker, R.N., Ed. D. Dean, School of Nursing Member of the public Alfred University and Health Care Alfred, New York Alfred University Norman Berg Executive Director Member of the public Jamestown, New York Lutheran Social Services Lester H. Block Attorney Legalcounsel Buffalo, New York Mrs. CharlotteBruner Tonawanda Indian Member of the public Basom, New York Reservation LaVerne Campbell, M.D. New York State Health Official health agency Buffalo, New York Department - Regional New York State Health Health Director Department Robert C8puti, M.D. Physician Erie County, New York, Buffalo, New York Medical Society Mrs. Ramona Charles Tonawanda Indian Member of the public Basom, New York Reservation Francis Cole Attorney Erie County, New York, Buffalo, New York Committee Mrs. Ann Confer' McKean County Society for McKean County Bradford, Pennsylvania Crippled Children Committee Mrs. Carolyn Daughtry Erie County Department Member of the public Buffalo, New York of Mental Health (continued) 9 List of Members Name and Address Institution and/or Occupation Categories of Representation Donald Ervin, M.D.' Physician Chautauqua County Jamestown, New York Medical Society Irwin Felsen, M.D." Physician Past President, RAG Wellsville, New York Allegany County Medical Society Craig Fisher, M.D. Physician Niagara County Niagara Falls, New York Medical Society John Foster Martin Luther King Member of the public Erie, Pennsylvania (Bayfront NATO) Center C. Marshall Fuller* Executive Director Erie County, Pa., Erie, Pennsylvania American Cancer Society Committee William Gaiter Director Buffalo, New York BU I LD Organization Member of the public Buffalo, New York Larry J. Green, D. D. S. State University of New York Upstate Medical Buffalo, New York at Buffalo - School of Dentistry Alliance Herbert Joyce, M.D. Physician Member at large Buffalo, New York Past President, RAG Eugene Lippschutz, M.D.' Associate Vice-President State University of New York Buffalo, New York for Health Sciences at Buffalo - School of Medicine Murray S. Marsh W.C.A. Hospital Member of the public Jamestown, New York Administrator C. Conrad Monroe Banker C.H.P./N.W. Pa. Corry, Pennsylvania Marine National Bank Elizabeth Moore Director, American Red Member of the public Batavia, New York Cross Chapter, Genesee Unit William E. Mosher, M.D. Commissioner, Erie County Erie County Health Buffalo, New York Health Department Department Gerald P. Murphy, M.D., D.Sc. Director, Roswell Park Roswell Park Memorial Buffalo, New York Memorial Institute Institute Joseph Paris Director, Veterans Administration Veterans Administration Buffalo, New York Hospital, Buffalo, New York Robert S. Pepiot' Director Veterans Administration Erie, Pennsylvania Veterans Administration Hospital, Erie, Pennsylvania J. Warren Perry, Ph-D@ Dean, School of Health Related Faculty of Health Sciences, Buffalo, New York Professions, State University State University of New of New York at Buffalo York at Buffalo Patricia Stopen, R.N. Wyoming County Health Wyoming County Warsaw, New York Department Committee Professor Earl Stopfel Chairman, Medical Services Member of the public Alfred, New York Department, State University of New York, Agriculture and Technical College, Alfred George E. Taylor, Jr., M.D. Physician Allegany County Cuba, New York Committee Joseph F. Turner, Jr.' Director, Western New York Western New York Buffalo, New York Hospital Association Hospital Association (continued) 10 List of Members Name and Address Institution and/or Occupation Categories of Representation Donald Watkins, M.D. Physician McKean County Bradford, Pennsylvania Medical Society Paul Welsh, M.D. Physician Genesee Countv LeRoy, New York Medical Society Richard T. Williams, M.D. Physician Wyoming County Warsaw, New York Wyoming County Community Hospital Medical Society Eugene Wiiczewski Director, Comprehensive Health C.H.P./W.N.Y. Buffalo, New York Planning Council of Western New York, Inc. Duncan Wormer, M.D. Physician Cattaraugus County Portville, New York Medical Societv * indicates new member since May, 1974 * indicates member of Executive Committee Regional Advisory Group Alternates Gerald Farmer, Director (Representing Conrad Monroe) Comprehensive Health Planning Erie, Pennsylvania Dominic Falsetti, M.D. (Representing Dr. Craig Fisher) Niagara Falls, New York Patrick Flaherty (Representing Joseph Paris) Ass't Hospital Administrator V.A. Hospital Buffalo, New York Ms. Marilyn Gibbin, Director (Representing Dr. Duncan Wormer) Cattaraugus County Nursing Homes Olean, New York Gordon E. Graves, Exec. Director (Representing Mr. C.M. Fuller) N.W. Penna. Lung Association Erie, Pennsylvania Ms. Suzanne Grossman, R.D. (Representing Mr. Francis Cole) Erie County Health Department Buffalo, New York Mrs. Fleeta Hill (Representing William Gaiter) BU I LD Organization Buffalo, New York Gerald Schofield (Representing Dr. Gerald Murphy) Deputy Director for Administration Roswell Park Memorial Institute Buffalo, New York Alex Thompson (Representing John Foster) Martin Luther King Center Erie, Pennsylvania Regional Advisory Group Program Committee The Regional Advisory Group, usually referred to as RAG, is A program committee composed of Regional Advisory a 42-member group broadly representative of the Group (RAG) members provides continuous assessment of geographic areas and social groups served by LARMP, all LARMP operational projects and program staff which guides the development, planning, and coordination activities. The committee examines these efforts in terms of all projects supported by the Lakes Area Regional of their relationship to present goals, objectives and Medical Program. priorities of LARMP. The committee usually meets each month prior to the regular RAG meeting, or in special The group includes physicians, medical representatives session if necessary. The committee serves as the RAG's from medical societies, health and related professions, principal sub-committee for program planning. voluntary and public agencies, and representatives of other organizations, institutions, and agencies. Also included are members of the public who are concerned with the need for services provided under this program. The Grantee Institution Members-at-large provide representation on the board for A Board of Directors for the Lakes Area Regional Medical provider and general population groups such as labor Program, Inc. was established in 1972. This board bears leaders, businessmen, minority groups and women. the responsibility for the management of program funds. It receives, administers and accounts for Federal Grant funds The group usually meets on the second Thursday of every used in implementing programs to be supported by the month at 7:30 P.M. at the Lakes Area Regional Medical Lakes Area Regional Medical Program according to federal Program Offices, 2929 Main Street, Buffalo, New York. regulations and policies. In addition, LARMP makes use of numerous volunteer The Board includes: committees for program and project development and Chairman - Allan Korn, Associate Professor, technical review. Together with these volunteers, LARM P Environmental Consumer Studies program and project staff provide local communities with a Department, State University College at wide range of skills, training, and experience necessary to Buffalo, Buffalo, New York develop and manage workable solutions to complex health Herbert Bellamy, Businessman, Community problems. Tables 3 and 4 provide LARMP volunteer and Leader, Buffalo, New York staff profiles for 1974. Irwin Felsen, M.D., Past president, Regional Advisory Group, Lakes Area Regional Table 3: Regional Advisory Group and Major Committees Medical Program, private physician, Wellsville, New York No. of Persons as of 7/l/74 Maynard Parker, Retired executive, R.A.G. Committees previously with the Hooker Chemical Doctors (e.g. MDs, DOs, DDs, DPMS) 19 105 RNs, Allied Health 4 75 Corporation, Niagara Falls, New York Health Administrators 7 39 Peter Zaleski, Senior Vice President, Buffalo Elected Officials 0 5 Savings Bank, Buffalo, New York Members of the Public & Others 1 2 145 Total 42 369 Norman Slawinski, Branch Manager, Marine Midland Bank-Western, Buffalo, New York (resigned Jan., 1975) Table 4: Program and Project Staff No. of Persons as of 7/i/74 Business Office Project/ Program Contrac The Business Office deals with grants management, Doctors (e.g. MDs, DOs, DDs) 1 1 budgets and contracts. This office prepares and maintains RNs, Allied Health 2 15 all financial transaction records. Social & Behavorial Scientists 17 16 Suoport Staff (secretarial and clerical) 17 17 Its three main functions are finance, purchasing and Total 37 49 payroll. 12 County Committee Chairpersons Field Staff Allegany Irwin Felsen, M.D. - Physician The field staff of the Lakes Area Regional Medical Program Cattaraugus Ms. Marilyn Gibbin, Director served as the liaison between the nine counties comprising Division of Nursing Homes the region and the LARMP headquarters. Chautauqua Murray Marsh - Hospital Administrator Members of the field staff assisted in the development of Erie, N.Y. Francis Cole - Attorney proposals from the areas in which they worked, and kept Erie, Pa. C.M. Fuller, Unit Director good communication open between county committees, American Cancer Society other constituents or organizations, and the LARMP Genesee Sidney Sherwin - Insurance Broker Central Office. The field staff also worked toward the promotion of a regional approach in the development and McKean, Pa. Ray Curtis - County Commissioner implementation of health services. A continuing effort was Niagara Mrs. Joan Wolfgang - Housewife made to involve the counties in a greater role in defining Wyoming Richard Williams, M.D. - Physician their own needs and priorities. Keeping the individual county committees informed of LARMP activities and developing ideas that can improve the availability and quality of health care were among the prime functions of this staff. With the passage of new Public Information legislation, PL-93-641, a reorganization of the program necessitated the disbandment of the field staff. Activities and accomplishments of LARM P and its funded projects have received wide dissemination and visibility through the communications media. News releases have been circulated to all newspapers, radio and television stations in the region. Feature stories about LARMP activities such as the Rural Externship Program and the Allegany County Mobile Health Unit and Health Information Systems Unit others have appeared in the newspapers of the region. Television and radio have been used effectively for special The Health Information Systems Unit is a derivative of the interviews, press conferences, and news coverage of Community Health Information Profile (CHIP), a project LARMP sponsored teaching days and other events. which previously received financial support from the Lakes Area Regional Medical Program, Inc. FORUM, the official newsletter of the LARMP is distributed to over 15,000 health professionals, institutions, legislators, The unit provides assistance to projects and is the data media and others. In addition, brochures, pamphlets, analysis for the central Lakes Area Regional Medical special booklets, stingers and the Annual Report are Program administration; for program development, prepared by the information unit. A well-maintained mailing planning, project evaluation, and special purpose research list assures a continued flow of pertinent program and analysis for other community agencies and institutions. information to the many target groups it serves. Computer based files of sociological, demographic, economic, and health related information available to Maintaining good working relationships with the mass Health Information System users provide important data for media has proven to be of significant benefit in sound planning and evaluation. The information systems disseminating information about LARMP activities. within the unit have been designed to meet both general and specific data collection, storage and analytic needs. A new series of radio programs entitled, "Health - Where I t's At", was produced by the information unit and is Since the inception of the CHIP project, computer currently being broadcast over ten readio stations in the programs have been developed to handle a variety of data region. The media has provided good local coverage to our processing functions for analysis of data provided by the continuing education programs for health professionals user or with data available from the Health Information throughout the region. Systems Unit. 13 Continuing Education Programs 1974 Over 231 0 persons attended these programs during the year. ......... ...... I h, "Hypertension The Medical Volcano" NYPER rEpvs Date Program Location Registrants Co-Sponsors March 2 "Nutrition and the Sheraton East 151 Western New York Dietetic Outcome of Pregnancy" Buffalo, New York Association April 16 "The New Dimensions Sheraton East 250 of Hypertensive Buffalo, New York Cardiovascular Disease" April 18, 19 @'Health Policies for Holiday Inn 194' Comprehensive Health Planning the 1970s" Grand Island, New York Council of Western New York April 24 "Multidisciplinary Villa Maria College 145 Approaches to Erie, Pennsylvania Patient and Family Education" May 1 "Hypertension - Holiday Inn 31 7 Heart Association of Western The Medical Volcano" Batavia, New York New York May 29 "The Nurse Practitioner's Executive Motor Inn 250 In conjunction with Role in Health Care" Buffalo, New York The Erie County Medical Society New York State Nurses Assoc. (District 1) School of Nursing and Continuing Medical Education, SUNYAB June 6 "Diagnosis and Treatment Wellsville Country Club 100, American Cancer Society of Lung Cancer" Wellsville, New York Allegany County Unit June 8 "Hypertension - Sheraton East 65' After Screening What?" Buffalo, New York June 18 1'Current Trends in Health Holiday Inn 143* Services for Women" Olean, New York In conjunction with Erie Post Graduate June 19 "Hypertension - A Gannon College 20* Medical Institute and Northwest Pennsylvania Capsule Approach" Erie, Pennsylvania Chapter of the American Heart Association June 26 "Hypertension - A Villa Maria College 80* Challenge to the Erie, Pennsylvania Health Professional and the Community" October 16, 17 "Health Team Services Erie County Home and 9O.. Supported by a contract Right of the Elderly" Infirmary, Alden, N.Y. from HEW, Region 11 October 24 "Current Concepts in the Wellsville Country Club loo. American Cancer Society Treatment of Uterine Cancer" Wellsville, New York Allegany County Unit November 1 "Hypertension - The Niagara University 195 Silent Intruder" Niagara Falls, New York November 6 "Crisis: Death in First United Methodist 160 WCA Hospital, Jamestown, the Hospital" Church, Jamestown, New York New York November 14 "Rehabilitation Holiday Inn 150 American Cancer Society Considerations of the Batavia, New York Genesee County Unit Cancer Patient" 'Approximately Limited Registration Total Registrants 2310 14 Evaluation Unit Activities Evaluation of health programs is a basic need if their impact is to be determined and sound decisions are to be made for future action. Program management is made more effective through the feedback of regular evaluation. Careful definition of objectives, establishment of success criteria, and collection of necessary baseline data permits early determination of a program's weaknesses and strengths. The Lakes Area Regional Medical Program's activities are reviewed regularly to assess their impact on the health care of the region. Information regarding program effectiveness is used periodically to reassess goals and objectives, to determine the level of support for on-going activities, and to seek out projects which address themselves to unmet health needs in the community. -M Evaluation Activities- Support Services Proposal Development The Evaluation Unit provides a variety of services to Staff members work closely with proposal authors to program staff, project directors, and community groups. ensure well designed evaluation components. This This may involve questionnaire development, data analysis, includes: or the provision of census information. o Documentation of the extent and degree of the problem; The County Data Source Book was developed and oIdentification of the target population; published in 1974 through the combined efforts of the Evaluation and Health Information Systems Units. The oStatement of operational objectives; major purpose of the Source Book is to provide a sound -Establishment of success criteria; data base which reflects the changing needs of the community. Population and socio-demographic eDevelopment of appropriate techniques of data analysis; characteristics of seven counties of New York State in the oSelection of quantitative or objective measures of project Lakes Area region are presented by township and census outcomes. tract. In addition to the seven volumes of individual county data, a summary volume was developed which provides Systematic Project Review data from each LARMP county, New York State, Pennsylvania, and the United States for comparative Funded projects are monitored on a regular basis. purposes. Quarterly activities are prepared by project directors and The County Data Source Book has been distributed to RMP reviewed by the Program Committee which makes county committee chairpersons and others in the region recommendations for action to the Regional Advisory who are responsible for meeting the health education and Group. Recommendations approved by the R.A.G. are then health services needs of the community and who are forwarded to project directors for implementation. developing plans that will be responsive to future needs. In addition, yearly project site visits are conducted by In 1974, sixteen LARMP Teaching Days were evaluated to R.A.G. members to review progress, identify problems, and determine the extent to which they met their objectives. suggest changes in policy direction. Following each site Written reports, based on evaluation forms completed by visit, a report is prepared by the site visit team and participants, were submitted to planning committees to aid submitted to the Regional Advisory Group for action. The them in the development of future workshops. Three R.A.G. informs the project director of any suggestions or conferences sponsored by other health-related groups modifications. The primary intent of a site visit is to provide were also evaluated in 1974. the basis for determining continued funding. (continued) 15 Project related evaluation activities included- A survey was conducted of hospitals, nursing homes, and health departments in the Southern Tier region to deter- *A Telephone Lecture Network survey of member and mine the need for intensive and coronary care training non-member institutions within a 200-mile radius of for nurses. The results of the survey, which was sponsored Buffalo. The survey was designed to determine by the Alfred University School of Nursing and Health Care, programming preferences of current and potential were analyzed by staff and presented to the Planning network participants. Survey results will be used in Committee for action. planning for the 1975-76 TLN programs. Staff also assisted the Southwestern Tier Association for aCoding of completed interview forms used in the the Blind in conducting an analysis of staff activities in Cattaraugus County Household Survey of the Elderly, order to better allocate limited resources. In addition, an Approximately 1,000 interviews were conducted. inventory of client needs was done to assist in the planning of future program activities. 9An analysis of records of patients treated at Rich Stadium medical aid stations in 1973-74. The study was Consultation was provided to the Chautauqua County Office done to aid in planning the first-aid needs of spectators at for the Aging in its development of a demonstration future stadium events. This activity was undertaken as program of in-home care for indigent elderly. part of an overall effort to evaluate emergency medical services at the stadium. Buffalo General Hospital's Nursing Service plan to evaluate the operating room nurses' training program was similarly oA study of the change in attitudes of health science assisted. students participating in the 1974 Rural Externship Project towards rural health care delivery systems. Pre and post tests were used to determine, in addition to attitude changes, intentions of students towards practicing in a rural area. 9Tabulation and analysis of pre and post tests completed by participants in the Regional Hypertension Education Program. Brief tests were administered to church groups, senior citizens clubs, etc. before and after each educational program to determine the effectiveness of the program in increasing knowledge of hypertension. The programs were conducted by the Hypertension Nurse Coordinators in Erie County, New York; Erie County, Pennsylvania; and Niagara County, New York. LARMP evaluation staff assisted in the organization of the Alfred Area Health Planning Committee, (AAHPC) formed to assess community health needs in the face of a critical physician shortage. With the assistance of LARMP staff, the AAHPC documented community health resources, received recognition as a legitimate health planning group, and implemented a plan to expand existing health services. As a result of these efforts, the AAHPC formalized arrangements with area provider groups to expand and improve existing health services. In addition, the Committee was instrumental in attracting at least one, and possibly two, full-time physicians to the Alfred area. 16 Allocation of Resources LARMP funds are allocated to priority areas of program effort: & More effective use of health manpower a Improved accessibility and availability of primary medical care, including emergency medical services oRegionalization of secondary and tertiary care &Quality of medical care assurance Table 5 presents a breakdown of allocations as a percentage of the total award for program years 1970, 1972, 1973, 1974, and 1975. In response to a substantial reduction in the 1974 grant award, LARMP placed increased emphasis on regionalization of secondary and tertiary care and reduced program efforts in other areas. Of notable interest is LARMP's continuing effort to lower its administrative costs from 20% in 1970 to 5% in 1975. Table 5: Allocation of Resources Category 1970 % 1972 % 1973 % 1974 % 1975 % 1 .More Effective Use of Manpower $ 679,500 41 $ 748,500 36 $ 794,500 35 $ 388,702 25 $ 189,932 19 2. Improved Accessibility and Availability of Primary Medical Care a. Primary 62,500 4 438,500 22 575,000 25 137,089 9 104,062 10 b. EMS -0- 256,500 12 363,500 16 255,468 16 149,974 15 3. Regionalization of Secondary and Tertiary Care 515,500 31 218,000 1 1 90,500 4 471,405 30 372,292 36 4. Quality of Medical Care Assurance 63,000 4 205,000 1 0 272,000 1 2 1 76,387 1 1 155,11 7 1 5 5. Administrative Costs 321,000 20 194,500 9 200,000 8 116,933 8 53,697 5 Total Sl,641,500 100 $2,061,000 100 $2,295,500 100 $1,545,984 100 $1,025,074 100 1 7 Lakes Area Regional Medical Program, Inc. Balance Sheet February 28, 1975 (unaudited) Assets Federal Fund Income Fund Special Fund Total Cash $ 92,679 $ 42,222 $ 14,856 $ 149,757 Federal grant receivable (Notes 1 and 2) 832,805 - - 832,805 Accounts receivable 5,413 38,626 44,039 Due from income fund 5,841 - 5,841 Total assets $936,738 $ 80,848 $ 14,856 $1,032,442 Liabilities, Reserves and Fund Balances Federal Fund Income Fund Special Fund Total Liabilities: Due to federal fund $ - $ 5,841 $ - $ 5,841 Employee withholding deductions 720 - - 720 Other accruals 13,533 13,533 Reserves: Reserve for encumbrances 75,138 - - 75,138 Fund balances 847,347 75,007 14,856 937,210 Total liabilities, reserves and fund balances $936,738 $ 80,848 $ 14,856 $1,032,442 Lakes Area Regional Medical Program, Inc. Statement of Revenues, Expenditures, Encumbrances and Fund Balances Year ended February 28, 1975 (unaudited) Federal Fund Income Fund Special Fund Total Revenues: Grants awarded (Notes 1 and 2) $1,753,643 $ - $ - $1,753,643 Service fees 120,113 777 120,890 Miscellaneous - 5,375 54 5,429 Total Revenues 1,753,643 125,488 831 1,879,962 Expenditures and Encumbrances: Expenditures 1,468,153 134,358 2,676 1,605,187 Encumbrances 25,698 - - 25,698 Total expenditures and encumbrances 1,493,851 134,358 2,676 1,630,885 Excess revenues (expenditures and encumbrances 259,792 (8,870) (1,845) 249,077 Fund balances at 2/28/74 587,555 83,877 16,701 688,133 Fund balances at 2/28/75 $ 847,347 $ 75,007 $ 14,856 $ 937,210 Note 1 Note 2 Grants from the Department of Health, Education and Additional grants were received from the Department Welfare for the period March 1, 1974 through June 30, of Health, Education and Welfare for Lakes Area Emergen- 1975 amounted to $1,645,681 allocated by components as cy Medical Services Project for the following components follows: Program Staff $ 685,525 and periods: Rural Extern Program 81,500 Planning, July 1, 1974 to June 30, 1975 $ 45,000 Telephone Lecture Network 75,000 Training, October 1, 1974 to Tumor Service Registry 82,120 September 30, 1975 -62,962 Allegany County Mobile Health Unit 27,000 $107,962 Emergency Medical Services System 172,000 - Lake Area Health Education Center 29,985 Rural Laboratory Improvement 19,700 Note 3 Two-County Nutrition Program 12,000 The National Health Planning and Resources Develop- Regional Hypertension Education 159,400 ment Act of 1974 provides for transitional continuation of Health Related Facility Staff Training 5,200 the Regional Medical Program through June 30, 1976, or Ambulatory Care Service Planning 57,000 until a Health System Agency (successor agency) has Household Survey of the Elderly 25,000 been established. Funds will be available to continue Regionwide Medical Genetics 55,000 Program Staff functions, but the amount is unknown. The Aging Relocation Service 34,608 continuance of project funding is also unknown. Primary Care Nurse Practitioner 36,488 Domiciliary Staff lnservice Training 15,228 Rehabilitation for Aphasia Patients 31,545 Minority Health Education Delivery System 41,382 $1,645,681 19 Status of Projects (Those active and completed) The following projects received funding from the Lakes Area Regional Medical Program during 1974- Current Projects Status Director Telephone Lecture Network Will be self-supporting by 6/30/75 Joseph Reynolds Tumor Service Registry Funded to 6/30/75 John Patterson, M.D. Allegany County Mobile Health Unit Funded to 6/30/75 Virginia Barker, R.N., Ed.D. (Alfred University thereafter) Margaret Connolly, R.N., B.S. Regional Hypertension Education Funded to 6/30/75 Michael Miller (and thereafter if funds available) Emergency Medical Services Funded to 6/30/75 James H. Cosgriff, Jr., M.D. (and thereafter if funds available) Lake Area Health Education Center Funded to 7/31/74 Michael C.J. Carey Ambulatory Care Services Model Phase I - completed 12/31/73 Richard Chalmers Phase II - funded to 6/30/74 Gunter Schmitz Ambulatory Care Study for Niagara County Funded to 6/30/74 Peter Forster 'completed) Rural Laboratory Improvement Funded to 6/30/75 Sara Marie Cicarelli (to be completed) SHARECO-Genesee and Wyoming Counties Funded to 6/30/74 John Sifling (to be completed) Two County Nutrition Program - Funded to 6/30/75 Kathryn Child Chautauqua and Cattaraugus Counties (may be continued by the 2 counties) Rural Externship Project Funded to 9/30/75 William D. Crage Prevention and Treatment of Funded to 6/30/75 Richard F. Hartnett Regression in Older Persons (to be completed) Household Survey of the Elderly Funded to 6/30/75 Marilyn Gibbin, M.S.S. (to be completed) Ambulatory Care Services Planning Funded to 6/30/75 Robert L. Dickman, M.D. (Buffalo General Hospital thereafter) Rehabilitation for Aphasia Patients Funded to 6/30/75 Robert J. Buck (W.C.A. Hospital thereafter) 'Faculty Development Program for the Funded to 6/30/75 Onalee Johnson, R.N., M.S. Enhancement of Expanded Role Skills 'Regional Medical Genetics Funded to 6/30/75 Robin M. Bannerman, M.D. *Centralized Relocation Services Funded to 6/30/75 Robert lilig 'Domiciliary Staff In-Service Training Funded to 6/30/75 Barbara Boies *Minority Health Education Delivery System Funded to 6/30/75 Bruce Behringer 'These projects have no definite sources of funding beyond 6/30/75. 20 I I Allegany County Mobile Health Unit One of the most visible projects funded by the Lakes Area Regional Medical Program, Inc. during the year has been NIT the very popular Allegany County Mobile Health Unit based at Alfred University, Alfred, New York. The unit travels from unity to community and provides health assessments Comm and education. The referral rate of patients serviced by the unit shows a dramatic increase since the unit first became operational in 1972. 74 over 445 new adults sought the services of the During 19 unit@ A 90.3% referral rate for further examinations and treatment was reported. The high referral rate was attributed to the fact that oral examinations produced many referrals to dentists for treatment of dental caries. A record number of electrocardiograms were taken by the unit. Mobile Unit Personnel Well Child Conference Clinics accounted for 113 new children being examined by unit personnel. Some 123 children revisited the unit for various reasons, i.e. shots, etc. The overall referral rate was 19%. Currently some of the physicians in Allegany County are referring their patients to the unit for such tests as ECG, blood pressures, vital capacity breathing tests, etc. The unit was funded by the Lakes Area Regional Medical Program, Inc. in 1972 at a cost of approximately $52,000. It was provided in response to the county's documented health needs and serves a population of over 46,000 people. It provides access to medical care for many people w ho live in this rural county who otherwise would not have the opportunity to obtain good health care for themselves. The unit is being operated by the Alfred University School of Nursing and the Allegany County Public Health Nursing Service. Nurses doing a Health Assessment 22 Ambulatory Care Service Planning This project's goal is to establish a comprehensive Prize Winner continuous Ambulatory Care service at the Buffalo General The Ambulatory Care Services Model - Phase 2 Project, Hospital, Buffalo, New York, which will assume major developed by the project team from the State University of responsibility for the health needs of the patients it serves. New York at Buffalo's School of Architecture and A study was conducted by the School of Architecture and Environmental Design, was the recipient of a first prize Environmental Design, State University of New York at award given by the Progressive Architecture Magazine. Buffalo in 1972, which reviewed ambulatory care services The award was for creating a system for obtaining and with the intent of planning new hospital-based facilities. The using data to be used in designing outpatient medical care project was divided into two phases. centers using Buffalo General Hospital as a site. Phase / involved developing a model of ambulatory care A project team leader said, "We believe in basing a design service delivery. The model in the first phase output of the on the needs of people. We're not interested in building a two-phase project was designed to enhance the decision- building, we're interested in solving a problem." making capabilities of professionals in the health care field. The model provides hospital administrators, architects, or health program supervisors with information about detailed Cattaraugus County Household Survey of workings of an ambulatory care facility so they can make the Elderly sound decisions concerning such things as: ways to improve health care delivery, criteria for designing new This survey was designed to determine the health needs of ambulatory facilities, and ways to evaluate existing health Cattaraugus County's rural elderly as well as the care services. The model, operated by means of a constraining factors which prevent or discourage them computer program, stores and retrieves detailed from obtaining needed health care services. A data base information about the costs incurred, the time expended, consisting of a series of indicators of the elderly the personnel utilized, and the space required for every populations is under development. About 963 people were task performed in the ambulatory care facility. The user of interviewed. the program can employ this information to attain a better understanding of the way an ambulatory care facility works, It is expected that the results of the survey will tie into the and in order to make intelligent judgements concerning county planning process and assist county officials in ways in which ambulatory care can be improved. Other developing a strategic plan to meet the needs of the elderly. objectives are to develop and assess the use of nurse practitioners and other allied health professionals in a A "Registry of the Elderly" is being developed. comprehensive ambulatory care setting, and to stimulate the development of several innovations in delivering health Centralized Relocation Services for the services including problem-oriented medical records and computer-based information systems. Also, to develop a Aging teaching model for training primary care physicians and This project demonstrates the feasibility of providing allied medical professionals, including the possibility of centralized relocation services for elderly persons. It allows establishing formal relationships with rural and other inappropriately placed elderly persons to move from their ambulatory services and to establish linked networks of present living arrangement to a more appropriate setting comprehensive ambulatory care services including, without suffering from relocation trauma. This involves sharing of services. counseling of persons from hospital to nursing home or private home, or from private home to hospital or nursing Phase 2 is working to improve a simulation model of home. The staff is also receiving training in Gerontological ambulatory health care services developed by Phase I. Counseling Techniques. The project also seeks to increase the number of available beds through a better utilization of existing beds. The project is sponsored by the Erie County (N.Y.) Office for the Aging and f unded by the LARMP. 23 Emergency Medical Services The Emergency Medical Services project was inaugurated in the Spring of 1972 with funds provided by the Lakes Area Regional Medical Program, Inc. More involvement by the area's individual EMS County Councils and the Regional EMS Coordinating Council has strengthened the organization. The project has initiated the responsibility of training Emergency Medical Technicians and registered nurses who work in emergency rooms. Each county has been provided with a "training kit" of equipment to be used in the EMT courses or other related training programs. The equipment includes resuscitation manikins, splints, 00 stretchers, portable suction units and slide presentations. In addition to the kits maintained in each county, about $10,000 worth of additional equipment and audio visual aids are available from the project's central store. Ambulance attendant notifies a hospital emergency room he has a patient on the way. Radio equipment purchased by the Lakes Area Emergency During 1974 about 1486 EMT's were trained thereby Medical Services Proiect. providing the region with over 4,000 certified Emergency Medical Technicians since the inception of the training programs. In addition 163 EMT students were recertified after taking a refresher course via the Telephone Lecture Network. The TLN refresher course consisted of seven major lessons, involving 21 hours of classroom training and practical experience. They were broadcast by the TLN to outlets in hospitals, nursing homes and health education facilities throughout the region. Planning has been initiated for a 40 hour EMT Senior Instructors Training Program in anticipation of New York State EMT Instructor requirements. The addition of a Research and Evaluation unit has strengthened the Project. The research staff is currently working on techniques to evaluate the Medical Emergency Emergency room physician and nurse receives radio message from ambulance. Radio System and EMT performance in addition to providing consultation to the staff regarding evaluation considerations in other activities. Emergency Radio System The project has been involved In county surveys of EMS The Medical Emergency Radio System (MERS) was resources in hospitals and ambulances to help the counties implemented at a cost of approximately $160,000. This in their own assessments. The completed surveys become service ties in 47 ambulances, 1 0 hospitals and various a valuable planning tool for the counties to use In service coordinators. formulating system changes. The Project is awaiting response from Department of Transportation on an application for funding of a Digital Data Communications Demonstration Project, and from the Appalachia Foundation for UHF radio systems for four counties of the region. 24 Additional funding for Project activities has been facilitated Coordination of I nter-regional activities in the form of by the award of two grants. disaster preparedness and planning is a specific area A Title VI I grant for $67,000 is being used to develop and which is being coordinated with the neighboring region. Staff from both the Lakes Area and the Rochester Region implement various professional and paraprofessional are exchanging information and implementing possible training programs. improvements in disaster planning.-This awareness of A grant award under Section 1202 of the EMS Legislation in neighboring project activities will hopefully be expanded the amount of $45,000 for EMS System Planning is being and continued. used to develop an application in April of 1975 for implementation of this proposed EMS System. Public information is continually disseminated In an effort to educate the general public in the EMS provision. A great deal of planning and preparation for submission of the grant proposal for EMS Systems Implementation has taken place. The counties have worked to assess their Grant Shared By Two Libraries needs and establish priorities on both an individual and a Two Allegany County hospitals shared equally a $5000 regional view. grant from the L.A.R.M.P. to help improve their respective A symposium was held in January of 1975 for hospital librar es. administrators and physicians of the region to discuss Jones Memorial Hospital in Wellsville, New York at Cuba approaches to patient referral systems and groundwork for Memorial Hospital in Cuba, New York received sets of formation of committees to address these and other clinical journals and books for their libraries paid for with the components of the 1203 application. LARM P grant. 25 Hypertension Project In response to the 1973-1974 national focus on High School Blood Pressure, the Lakes Area Regional Medical Program Task Force accepted as one Of its top priorities, the development and funding of the Regional Hypertension Education, Screening and Follow-up Project. The project has three basic goals: (1) to inform the general public of the dangers of uncontrolled hypertension; (2) to identify and encourage hypertensives to seek medical care; and, (3) to follow up known hypertensives for purposes of encouraging their continued compliance with a treatment plan The central purpose of the project is to assist the medical practitioner by establishing a mechanism for follow-up and retrieval of known hypertensives. Essential to the success of the project has been the follow-up mechanism consisting of "personalized counseling" and "education sessions" provided by trained paraprofessionals. Although Phase I emphasized publicity and education, with support to potential screening agents, the project has Community Organizations provided service to over 17,956 persons during its operation. In spite of the paraprofessional training program Niagara Frontier Association for Sickle Cell Disease, conducted during Phase 1, direct beneficiaries (persons BUILD of Buffalo, 1490 Jefferson Enterprises, Inc. attending both professional and lay education sessions; as (Community Center), Buffalo, New York, Urban League of well as those actually screened by staff) numbered 6,685. Buffalo, Community Action Organization of Erie County, In addition, the provision of direct staff support to screening New York, Nia-Cap, Community Center of Niagara Falls, sessions conducted by the Heart Associations and/or New York, Tract II Community Center of Niagara Falls, Health Departments of the target areas, as well as support Planned Parenthood of Niagara Falls, Martin Luther King of data control and analysis has resulted in service to Community Center, Booker T. Washington Community 11,271 persons. Center, John F. Kennedy Community Center, Hamot Medical Center, St. Vincent Hospital, Doctor's Osteopathic Over 98,290 brochures, pamphlets, stingers, etc., on Hospital (all of Erie, Pennsylvania). hypertension have been printed and distributed. More than 20,000 brochures have been obtained from drug Public and Voluntary Agencies companies for distribution. Thirty-five newspaper articles Erie County New York Health Department, Heart were published in regard to the program's activities in the Association of Western New York, Erie County, region. Pennsylvania Health Department, Visiting Nurses A great many organizations and individuals at many levels Association, Erie County, Pennsylvania, Veterans have been and are involved in the hypertension project. Administration Hospital, Erie, Pennsylvania, Heart They include: Association of Northwestern Pennsylvania, Mayor's Office of Community Affairs, Erie, Pennsylvania. As part of the Public Education aspect of the project, Medical Organizations Professional Education Teaching Days have been planned Upstate Medical Alliance, Inc., Medical Advisory Group to by physicians, nurses, and allied health professionals. Lay the United Organization of Neighborhood Facilities, Inc., education sessions for community organizations, schools, The Health Association of Niagara County, Inc., Practical churches, and block clubs have also been planned. and Registered Nurses (Black Nurses) Club. Publicity has been provided to support existing screening activities and public education. 26 In-Service Training Program Lakes Area Regional For Domicillary Facilities Tumor Service Registry The development of an in-service training program for In its five years of development, the Regional Tumor domiciliary faculty staff in specific restorative techniques Service Registry has progressed from a five-hospital pilot and therapies is the main focus of this project. A series of study to a viable program currently including twenty-four reality orientation, sensory remotivation, and team hospital participants. Each member hospital reports approach to care services are being coordinated in the information on its cancer patients to the Registry where it is region. A Trainer's Manual has been produced and made checked for quality and consistency before being included available to area agencies. in the data base. This data base currently includes 13,500 cases, with more than 65 per cent of these requiring active Audio-visual training materials for workshops and general ol owup. communications were developed. The project hopes to improve the quality of care available to residents of This data collection system has been organized to provide intermediate care facilities. Facilities staffs providing these lifetime followup of all registered cancer patients and to services are encouraged to become more aware of the provide a tool with which the medical community can problems of older people and their actual needs, and to evaluate its efforts in the area of cancer control. Data are develop skills to make their efforts more effective in dealing collected in a consistent manner by this registry and with the resocialization of the elderly. include such variables as primary site of disease, treatment, extent of disease and demographic information. This project is in conjunction with the Erie County (N.Y.) Reports based on this Information are periodically prepared Office of the Aging. for dissemination to the medical community, with requests for specialized studies being handled promptly. The immediate future planning for the registry includes end results and survival analyses, anticipating that these will be included as a part of its next annual report. Lake Area Health Education Center Dr. John C. Patterson, Project Director, oversees the daily The Lake Area Health Education Center, based in Erie, clerical, statistical and data processing efforts of his staff. Pennsylvania, served as a community-based regional Modification and development of computer programs are carried out by the Health Information System Unit of the system of education and training programs (basic and continuing). It worked toward coordinating and developing Lakes Area Regional Medical Program Inc., core staff. area resources to meet needs in health care manpower. Recognizing the need to work together, the central registry LAH EC worked toward development of seminars, staff, the tumor registrars at participating hospitals and workshops, etc. and other educational programs for others within the region have organized the Lakes Area numerous health disciplines in order to help maintain the Regional Tumor Registrars Association. competence of many health professionals both within and With the primary intent being to provide a forum for the outside the LAH EC area. exchange of information and ideas regarding Tumor However, LARMP withdrew financial support for LAHEC Re.gistry work and to provide continuing education for existing and newly-em.ployed personnel, this group meets in July, 1974 following a site visit. quarterly for programs which include speakers One of the projects developed by LAHEC and still receiving knowledgeable in the area of the cancerous diseases and Tumor Registry activities. LARMP funding is the Minority Health Education Delivery System which relates to the Spanish-speaking migrant and sedentary populations along the tri-state shores of Lake Erie. 27 Minority Health Education Delivery System Niagara County The Minority Health Education Delivery System program is Ambulatory Medical Care Study a health education and advocacy project meant to improve A study concerning the ambulatory care needs of Niagara the usage and delivery of primary and secondary care County was conducted by the Health Association of services to the Spanish-speaking min6r!ty residents and Niagara County, Inc., (HANCI) under a grant from the migrant workers in Chautauqua (New York), Erie LARMP. (Pennsylvania) and Ashtabula (Ohio) Counties. More Under study were the ambulatory care needs in the county specifically, it brings health care to several groups of as they relate to physical debility, including pediatrics, Spanish-speaking individuals living in the tri-county area. general medicine, obstetrics, surgery (limited to out-patient They can be identified as: migrants, settle migrants, and surgery), family practice and geriatrics. The survey began residents. MHEDS implements an intervention model including a health education plan and active referral to November 1, 1974. Data utilized in the study was primary and secondary service providers. Group and developed primarily through two procedures: individual health education sessions are given for specific 1. Family Health Survey - 359 families, comprising disease conditions found within the case families. Case 1,1 95 individuals, were interviewed via telephone by histories will be compiled for each family. A part of the total senior nursing students at Niagara University. patient care plan, active referral and follow-up visits will be 2. PhysiciansSurvey-10ONiagaraCounty initiated. MHEDS cooperates with area health care Physicians responded to a questionnaire developed providers to increase the utilization of health services by with the cooperation of the Medical Society of the minorities and analyze the maintenance or improvements of County of Niagara. the target groups "health status". Consultative relationships will be formed between MHEDS and Additional information regarding the utilization of community health education organizations in order to emergency rooms and other sources of ambulatory care impact upon the community the minority population. was provided from local hospital sources, the Niagara MHEDS is a project of the St. Martin Center, Inc., Erie, County Health Department, as well as regional information Pennsylvania. from CHPC/WNY and LARMP. Part of the study showed a serious physician to population The three target groups for the MHEDS program are: the manpower shortage. However, it was found that consumers Spanish-speaking minority and migrant workers; the tri- were able to obtain health care services with relative ease county area primary and secondary health providers; and, in the county. community health education organizations servicing the area. Prevention and Treatment of Regression In Older Persons Primary Care Nurse Practitioner This comprehensive training program is being conducted to Faculty Training Program help prevent and treat regression in older persons. It hopes This project alms to implement and evaluate a faculty to help the elderly enjoy a more happy and worthw ife time development program to prepare nurse faculty members in of life. the expanded role of the nurse with emphasis on the The training program, under the Cameron, Elk, McKean, enhancement of assessment and intervention skills. The Potter Counties Mental Health, Mental Retardation, Drug program plans to help faculty members to understand the and Alcohol Abuse Program, enables those serving the basic principles and procedures of assessment and the elderly to become more effective in dealing with senility in logic of application to client-oriented settings. It integrates older personsi and to acquaint them with some basic the components of blo-phychological assessment with techniques in geriatric rehabilitation. The program directs appropriate nursing action and provides students, patients itself to the staffs, administrators, board members and and families with the aspects of a health maintenance other local authorities serving both private and public program. Faculty define this new role to students, other nursing homes and health facilities. The program's health professionals and the community. objectives include an emphasis on the improvement of existing rehabilitation techniques and the development of Currently participating are nurse faculty members from new ones. Also, through the use of films, lectures, Villa Maria College, State University of New York at Buffalo discussions and role playing, the program hopes to educate and Niagara University. the personnel of other health related facilities about the needs of the elderly, Improve communication among the. agencies involved with older persons, and promote better utilization of existing facilities. 28 Regional Program for Regional Laboratory Aphasia Rehabilitation Improvement Project Lakes Area Regional Medical Program, Inc. has provided This project is designed to help improve health care in rural funds to help develop a regional center at W.C.A. Hospital, and small hospitals by improving the performance of Jamestown, New York, to treat aphasia patients from clinical laboratory personnel. throughout the LARMP region. The center will have a language laboratory and a therapy program coordinated One of the prime objectives of the program is to develop with family orientation for continued practice at home. The short-term courses in compensory education such as center's staff assists in speech therapy and problems workshops, covering the topics of bacteriology, related to the stroke victim. The center provides a physical hematology, clinical chemistry, and blood banking. setting to accommodate numerous patients for a wide variety of activities. Materials for workshops such as preparation of manuals, hand-outs, slides and tapes were prepared to help improve educational workshops on the subject. National accreditation for these workshops is being applied for from the American Society for Medical Technology for Professional Education (P.A.C.E.). A redesign of the pre- and post-testing materials which should improve methods of evaluating the workshops was undertaken. A three-day workshop on Enzymology to include participation by small and rural hospital laboratory personnel was set up. Video tape recording equipment is used as a patient takes the Porch Index at Communicative Abilities Test. SHARECO IV SHARECO is a plan that emphasizes the sharing, among cooperating members, of all types of educational resources for continuing and in-service education. Participants include Genesee Community College, Batavia, New York k and Genesee Memorial and St. Jerome and Veterans Administration Hospitals in Batavia; Wyoming County Testing new laboratory equipment. Community Hospital, Warsaw, New York; Arnold Gregory Hospital, Albion, New York and Medina Memorial Hospital, Medina, New York. The program began on December 12, 1973 with a $25,000 Regional Medical Genetics Project grant from the LARMP. Objectives of the project are to increase the quality of programs offered by making In order to facilitate the application of new medical available more educational resources to the hospitals genetics knowledge this project is providing education and involved through sharing of audio-visual equipment, media, special diagnostic and counseling facilities in the region. and personnel expertise. The project also develops programs of general or special interests which can be The objectives are to enable community health providers to presented in a central location such as Genesee identify persons at risk, to educate community health Community College, in the hospitals, or video taped for providers in needs and potentialities in relation to heredity distribution to the participating institutions. diseases, and provide services, metropolitan and regional, for diagnosis and counseling. Sharing of educational software (films, tapes, etc.) continues to take place among the cooperating institutions Genetic clinics are being set up and consolidated wherever on an informal basis. appropriate in metropolitan areas. 29 Rural Externship Project Physician preceptor examines a patient as medical student observes. Physical therapy student works with a patient. Fifty-seven health science students participated in the reservations". Many of the externs have asserted they plan Rural Externship Program during the summer of 1974. on a rural practice following graduation. In an evaluation Funded by the Lakes Area Regional Medical Program, I nc., following the end of the session, 42.9% of the externs the program was designed to help alleviate the problem of indicated they are definitely planning on rural health shortages of health care personnel in rural areas. Health practice following graduation, and 97.1 % are considering science students were placed in rural areas under the it. supervision of a preceptor. During the eight-week sess on Initially the pro ram started in 1970 with nine health the student was exposed to rural health care delivery and 9 I science students. In 1974, the enrollment of the program life in a rural community. The program s structure permitted enough flexibility to allow the student to decide expanded to include 57 students. how to spend part of his/her time according to their own Interpretation of the 1974 Rural Externship program to individually developed interests. Students participated in an health professionals and the general public was excellent. interdisciplinary "team approach" to health care by Externs were well received by both the professional and the working with other health professionals in a variety of general community. Many newspaper articles appeared in health care settings. a large number of local papers, and the project was carried Students experienced, first hand, the life style of rural on the news wire services. Articles included several feature community living and how health care is administered in stories of personal interviews with externs and preceptors. these areas. Letters were written to area legislators concerning the Externs were paid a stipend of $75 per week. The program. It received a great deal of favorable visibility and approximate cost of the program for 1974 was $50,300. publicity. Some students expressed their opinion on the program with comments like "The experience, both clinical and patient Externs by Discipline contact, has been invaluable"; "I expected medical Medicine 21 36.8% practice in the rural area to be so mewhat'backwards'and I Pharmacy 10 17.5% found this not to be true at all"; "I feel this is beneficial for Nursing 6 10.5% all students working toward a career in the medical Dentistry 5 8.8% profession - what could be better than working in your Physical Therapy 5 8.8% profession and being exposed to related health Medical Technology 2 3.5% professionals". Podiatry 2 3.5% Other students commented "I personally feel the first-hand Hospital Administration 1 1.8% experience makes the classwork more relevant" and "I Medical Record Technology 1 1.8% think the program is good. It offers the student some Nutrition 1 1.8% practical experience in his aspired discipline and provides a Occupational Therapy 1 1.8% little Incentive along side. I would encourage that the Public Health 1 1.8% program be continued in future years." One student Speech Pathology 1 1.8% emphatically stated "I will practice in a rural area with no TOTAL 57 100.2% 30 Telephone Lecture Network The Telephone Lecture Network of the Lakes Area Regional Medical Program, Inc., is a communications network that broadcasts continuing education programs to health professionals and others either related or interested in health care. The TLN continues to be the focus of continuing education involving many of the leading institutions and organizations in Western New York. Basically a closed circuit private telephone line, the system covers seven counties in Western New York, two in Northwestern Pennsylvania and extends ten counties deep in both states. It reaches the remote area of the Lakes Area region and establishes the essential two-way dialogue between educational institutions and individuals in need of Participants follow TLN lecture with slide presentation. continuing education. Network Strategy Programming is based upon a cooperative arrangement Educational Component Communications Component between the network and the voluntary contributions of @.@,d.d b, .@id.d b, LARMP health agencies, organizations, and institutions throughout the region. Lecture subject matter is based upon requests from the participating hospitals as well as the specialty expertise available from the local providing educational sources. During the first half of 1974 (actually January 1 -May 31), 130 one-hour lectures were offered. Total reported attendance by at least 14 health disciplines for this period was 1 1,21 0. For the whole year reported attendance Telep exceeded 22,500. Thirteen thousand seven hundred eighteen continuing education contact hours were certified for the year. Programming was resumed in October with 35 participating locations. Sixty-five new programs were offered during the 21/2 months up to the holiday break in mid-December. During this period attendance exceeded 5,800 contact hours with approximately 3,200 requests for The following accrediting agencies and organizations have certification, approved TLN programs in 1974. Fourteen separate disciplines encompass the American Academy of Family Physicians interdisciplinary educational needs of health care teams American Medical Association and of the multiple divisions within each disciplines American College of General Practitioners in Osteopathic Medicine & Surgery Accreditation for 1 0,000 hours of continuing education College of Family Physicians of Canada reflects the Network's primary purpose - making American Association of Nurse Anesthetists' continuing education that is relevant to the needs of all American Medical Records Association health professionals available on a continuing basis, at a New York State Nurses Association time, place and cost convenient to the continued delivery of American Dietetic Association health care. New York State Board of Examiners of Nursing Home Administrators Florida State Board of Pharmacy New York State Board for Podiatry Ohio State Board of Pharmacy Pennsylvania Medical Society (continued) 31 Two County Nutrition Project Six components of the Lakes Area Regional Medical Cattaraugus and Chautauqua Counties are participating in Program and two other related organizations conducted a this project which deals with improving the nutritional total of 24 meetings over the Telephone Lecture Network in status of high risk families in these counties through a 1974. In the same period, over 650 hours were devoted to broad and varied program of nutrition education and providing audio visual support services to the Lakes Area services. The sharing of the services of a nutritionist by Regional Medical Program and eleven cooperating both counties was demonstrated as working well. The organizations. nutrition component of public health services was expanded and strengthened by such services as home A Spring and Fall Emergency Medical Technician refresher visits, consultations with nurses regarding therapeutic course was offered over the TLN this past year. One diets, providing information requested by lay persons, and hundred thirty-eight individuals were recertified upon distributing pamphlets to classroom teachers as part of a successfully completing either of the two courses. dental education program. Also presenting classes in pre- natal care, inservice programs for home health aides and By mi.d-1 974, the entire library of network tapes was participation in screening programs for the elderly. reviewed, abstracted, classified and cataloged according to the National Library of Medical standards for non-print material. Subsequently, the volume of tape sales increased from approximately 200 tapes per year to at least 2500 per Professional Staff (Current) year. John R. F. I ngall, M.D. - Executive Director In cooperation with the State University of New York at John B. Clark -Accountant Buffalo radio station, WBFO-FM, the Network developed William Crage - Staff Associate and introduced a pilot SCA system (known as FM Patricia Hoff -Assistant Director multiplexing) for expanding the continuing education Michael Miller - Staff Associate activities currently being conducted. FM multiplexing is an Robert Miller - Assistant Director, electronic technique that places two or more separate Management & Special Projects Benjamin Morgan - Assistant Director, Financial signals onto a single channel assigned to an FM station. Management Thus multiplexing permits an FM radio station to send out Joan Philipps - Staff Assistant several signals simultaneously. To receive the SCA or Diane M. Pinchoff - Assistant Director, multiplex signal a specially manufactured crystal-controlled Research & Evaluation receiver is necessary. Frank Rens - Director, Health Information Systems Unit In the calendar year 1974, the Telephone Lecture Network Gary Smith - Staff Assistant Anthony Zerbo, Jr. - Assistant Director, Communications operated exclusively on income related funds. Support Staff (Current) Carol Butcher James Klein Curt Cashmore Donald McGreevy Elizabeth Eberl Marcia MoUle Lynn Goris Rose Parker Denise Jackson Richard Raeihie Charlene Kane Diane Williams Bonnie Kirisits 32 pl@