R. BLANTON DISTRICT 7 JACKSON TENNESSEE MID-SOUTH REGIONAL MEDICAL PROGRAM The ennessee Mid-South Regional Medical Program was one of the first reg@onal programs to enter the operational phase. A large regional adv sory group in conjunction with the decentralized staffing at Cha anooga, Knoxville and Hopkinsville assures the broad involvement of 1 regional interests, The program is currently-being funded in the@amount of $2,155,042. Sev ex al of the operational projects will provide the necessary experience -@- I greater insight into the development of improved patient .,:,ire for rur I areas. These operational projects include increased trl.i.nina in radiology and continuing education for medical personnel. Dr. Stanley Olson is Program Coordinator and Dean D. T. Rolfe of Meharry Medic@xi Co Icge and Dean Randolph Batson of Vanderbilt are on the Advisory Comm ttee.:@@The program is characterized by innovation and variety. For exVnple, o e project aims at improvement of patient care in a remote *6untain community; a Meharry Medical School project studies the effective- ess of multiphasic screening in on urban population group served by an OEO Neighborhood Health Center. Anoth6r imaginative project experiments with the training of a medical "stewardess" to take over the non-clinical duties of a nurse to get more effective utilization out of health manpower. Mote specific information on the Tennessee Mid-South Regional Medical Program follows. March 1968 R. BLANTON DISTRICT 7 JACKSON Tennessee Mid-South Regional. Medical Program REGION: Eastern and Central Tennessee and contiguous parts of Southern Kentucky and Northern Alabama COORDINATING HEADQUARTERS- Vanderbilt University Nashville, Tennessee STARTING DATE: July li 1966 FUNDING: Current Award: $2,155,042 Current Request: Projected Next Year $2$400,000 Received an operational grant on February 15, 1968 (list of projects is attached) 0 PROGRAM COORDINCATOR Stanley W4 Olson, M.D. ADVIS RY GROUP: 1. Chairman: Thomas P. Kennedy 2. Membership: Total 58, Practicing physicians 8, Medical Society Representatives 5, Medical Schools 7, other university officials 2, hospital administrators 8, Hospital Association officials 1, Hospital Planning Association 7, Cancer Society Represbntatives 1, Heart Society 1, State Health Officers 1, other Public Health officials 2, Nurses 4, Dentists 2 other health professionals 1, Bussinessmi 1, labor 1, other public representatives 4, elected officials 3. Preplar,ning activities were carried out during the period February through June, 1966 at which time an application grant was forwarded to the National Institutes of Health. During that time various individuals who later were appointed to the -P,e,-,ional Advisory Group, including Dean D.T. Rolfe, M.D. of Nleharry Medical College nd Dean Randolph Batson, M.D. of Vanderbilt University School of Medicine, rticipatdd in conferences and discussions to determine policy, decide on the undaties of the region and clarify problems. ness@e @lid-South ORGANIZATION AIN'D STAFFING: The program has offices in six locations. The core staff consists of the Program Coordinator and the Sections of affiliated Health Science, Community Health, Hospital Planning and Administration, Nursing, Biostatistics, and Education Research. Personnel for plannina and operations are also located at Meharry Medical College Van4erbilt University, Hopkin8vil.le, Chattanooga, and I',noxville. Interested groups have@ been formed in each of these areas and are wbrk-ILn@, closely with program staff. Planning has proceeded rapidly and intensively. Goals and priorities @,,o-re formalized and an operational application has emerged and a grant awarded. REGIONAL ADVISORY GROUP: The Regional Advisory Group is a relatively large one with 58 members representing the key health interests and the public in Mid-South region. SUBREGIONALIZATION: bregibnalizatioh consists of the area offices in Hopkinsville, Chattanooga, and &noxville. A Project Coordinator is located in each of these offices. ANNING ACTIVITIES: Planning thus far the Program has concentrated on developing the operational projects for which an award has bean given. Other planning studies and data gathering activities are being carried on in the fields of medicine, nursina an hospitals, A subcontract was negotiated with the Institute for Social Research of the University of Michigan to study the possiblity of developing and implementing an improved patient care model at Vanderbilt University Hospital and one or several community hospitals. RELATIOi4SHIP TO 0-0.@IPREHENSIVE HEALTH PLANNING (P.L. 89-749: The Tennessee Department of Public Health has recently been designated the official agency of the state of Tennessee to carry out the comprehensive health planning authorized by the Conates8 in P.L. 89-749. The Tennessee @lid-South Re-ional ,@,2d-'@cal Program will work closely with the agency and will@utilize the data that emeraes from its plannin- activity. SU@,MRIES OF TENNESSEE MID-SOUTH OPERATIONAL PROJECTS 1. Continuin@, %f(-,dical Education--Mc!lizirry @,leharry @ledical College proposed to inform Negro physicians in the region about more effective techniques for treating heart disease, cancer, and stroke. Teims of physicians will teach 2-week courses in the three areas at the Medic al Center using various audio-visual aids and, where feasible, programmed instruction. One of this plan's interesting provisions is sending a senior resident from Meharry to care for the physician's practice.wiile he is attending the course. 2. Continuiig Education--Vanderbilt In contrast to Meharry's approach of bringing the physicians to the Center, Vanderbilt proposes to establish continuing education centers at community hospitals. Libraries and information centers at the local hospitals will bring Vanderbilt's information resources tothe local physician. The program,though planned and coordinated by Vanderbilt, will function through the local centers and emphasize bringing information to the physician at the times he needs it. 3. & 4. Hopki.nsville Education Center and Chatt@inoo@a Education Center These are the first of the local continuing education centers specified in the Vanderbilt plan. At each hospital, a full-time Director with an appointment at Vanderbilt and an assistant director will supervise resident and physician education in their area. Their services will be available to physicians at smaller community hospitals in each areai as will the enlarged hospital library facilities. 5. Special Training for Practicing Radiologi8ts--@,landerbilt This plan focuses on developing practicing radiologists skills in vascular radiology, but might later be broadened to include all aspects of diagnosis and therapeutic radiology. Two post-graduate educational methods will be used. One to three month courses for technologists will be offered. In addition; eminent radiologists will preside at twb-hour monthly seminars to which all radiologists in the region will be invited. Cardiac Nurse Training Program-Mid-Scate Baptist Hospital Nashville The key factor in reducing mortality from cardiac :Ls the immediate availability of a knowledgeable person to initiate resuscitation. ',,lid-south Baptist proposes to instruct Cardiac nurses in new resuscitation techniques by holding 3 four-wee ourses. -2- 7i School of X-Ray Technology-Meliarr_y meharry plans to establish a two-year program for training at least I X-ray technologists per year. The faculty will be the Meharry Radiology Staff. Feasibility studies for establishing nuclear medicine and radiotherapy programs will be conducted. 8. @Rvcad-4@ology Technologist Training Program-Vanderb4-lt Vanderbilt proposed to increase the number of X-ray technologists, improve the quality of their training, and increase their opportunities for continuing education. Three small hospital training programs in the area will be discontinued as separate entities and subsumed by a new school of X-ray technology at Vanderbilt. Practical clinical experience will be gained both at Vanderbilt and the smaller hospitals. 9. Nuclear @ledicine Training Pr6gram--Vanderbilt A new series of courses desianed to increase the skill of physicians and tech- nologists in nuclear medical techniques. When possible the physician and his technologist will spend some training time together to work out procedures suited to their situation. Trainees will be accepted from smaller hospitals planning to establish to improve nuclear medicine services. 10. Expansion of School of Medical Technology--Baroness ErlAn@,er Hospital-- Chattanooga To augment medical technology capabilities in the ,,rea., this plan makes two proposals: (1) Expand the Baroness Etlanaer program. for medical technologists; and (2) establish a school for certified lab assistants who free technologists from more routine work for more complex procedures. 11. Vanderbilt Coronarv Care Unit This ptoject's purpose is to establish a network of coronary care units with adequate equipment, staffed by well trained personnel. Vanderbilt will be the training and information center for the region; a demonstration Unit there OV4 will rp @de a Z'ocAl point for continuing education,. In addition, communication systems will be set up to facilitate the flow of i-@lomation from Vanderbilt to the community hospitals. Studies are being made to see if the small hospitals connected with Vanderbilt can become centers for local networks of coronary care facilities in still smaller hospitals. 12. Franklin Coronary Care Unit--Williamson Count-N,. Hospital--Frahkl.j.n This is one 041 the subsidiary units mentioned in the Vanderbilt proposal. This is primarily a pilot project to study the feas@Lbility and usefulness of establishin- a center in a small community hospitzi -3- 13. liopki-nsville Coronary Care Unit- ennie Stuart Memorial Hos L pitaL H6pkinsville, Kentuckv This plan is similar to the Franklin plan, except that it mentions establishing links to smaller community hospitals by helping set up smaller care units in them. 14. Clarksville Coronar Care Unit--Clarksville Memorial Hospital As is the case with the Franklin program, this project is a subsidiary of the Vanderbilt proposal. Since this hospital has been operating a unit, the plan calls for its expansion, continuing education and a phone hook-up to Vanderbilt. 15. Nashville General Coronary Care Unit--Nashville Metropolitan '@eneral Hospital See the Franklin plan. Nurses here will be included in the inservice traininc, programs initiated throughout the participating hospitals. 16. veharry Medical College Coronary Care Unit Meharry intends to establish a demonstration unit of coronary care facilities which will serve as a continuing education center for smaller hospitals in its region. 17. Murray Coronary Care Unit--Murray--Calloway (Kentucky) County Hospital Yiurray-Calloway County Hospital, the training center for Murray State University School of Nursing, will serve as a demonstration center for the,sub-region. Direct phone communication will be established with Vanderbilt, which will send consultants from its school of continuing education. 18. Chattanooga Coronary Care Unit- -Baroness Erlanger Hospital Baroness Erlanaer plans to establish a coronary care unit in a cooperative program of cooperation with Vanderbilt. Both telephone communications a-,id electronic maintenance systems connected with Vanderbilt wi-,-l be installed. This unit will serve as a center for the smaller hospitals in Chattanooga. 19. BaDtist Hospital Coronary Care Uiiit--LNlid-State BaDtist Hospital. Nashville This plan is similar to the others included in the Vanderbilt plan. Baptist Hospital@ will expand its present facilities and aid in the establishment of smaller centers at Tullahoma and Crossville, Tennessee. Direct telephone lines will be established for consultations. The unit director will have a clinical fatuity appointment at Vanderbilt. Ile will devote approximately '45% of his time to the unit. -4- 20. Crossville Coronary Care Unit--Uplards Cumberland @@ledica-11 Center Crossville This project has two purposes: (1) to establish a two-bed coronary care unit in the hospital; and (2) to determine the feasibility of operating acute coronary care units in rural areas. The hospital will cooperate with Y,.id- State Baptist Hospital and Vanderbilt. 21. Tullahoma Coronary Care Unit-Ha.-to-,i Memorial Hospital, Tullahoma, Tennessee See Baptist Hospital Program. 22. @leh,-.rry Super-volta5,xc-, Therapy Program This project is aimed specifically at improving cancer therapy for a large indigent population. ivieharry will use its funds to obtain a cobal,,@-- 60 High Energy Source for therapy and a computer hook-up with Vanderbilt These facilities will also be used to improve undergraduate and graduate radiology training programs at %I'eharry. C) 23. Proposal to Improve Patient Care in a Remote Mountain Co=unitv b-v Recruitin@ and Ttainin@ Health Aides for a New Extended Care Facilitv-- Scott County Hosoital--Oneida, Tennessee Manpower shortaae in this isolated mountain ho,-Dital- is critical. Personnel to man an extended care facility now under construction will be obtained by two methods: (1) in-service training for hospital personnel (2) an educational director (an Rli) to serve as a liaison to the hich schools to encourage young people -Lo enter the medical field and come back home to practice. In addi@.iol a training pro-ra-,ri leading to the LPN would be initiated. Clin'ical -training will be supervised by the Educational Director while local high schools provide basic 'training. 24. Health Evaluation Studies on a Defined Popula@ on Gr Scracning--@leharry @ledical C ee imeharry will determine the effectiveness of a comprehensive health program and multir,hasic screening examinations in early diagnosis of heart disease, cancer, stroke and their precursors. To run this experiment, a neighborhood medical center supported by OEO will serve a selected population of 18,000. The test population and a control population will be evaluated wit,i reference to morbidity, chanaes in health attitutes and ut ilization pattens, effectiveness of the screening procedure, and the cost per patient diagnose@ or treated. 25. ExDeriment to Test and Implement a Nlodel of Pat4.-e-it Care--Vanderb-'Lit U.ni-vers4Ltv 'ros7pital This is an attempt to define a new struc@ure for patient care. New personnel called stewar,,:csscs will be trained to take over nurses' non clinical duties. Nurses would then be free to spend more time with the -DiL;-o-nt and to keep up their spcc4-alized skills. After the model is ref4iic at Va:,.do-rbi'Lt -5- it will be tested in community hospitals--specifically Baptist and St. Thomas. 26. Patient Care 4odels--St. Thomas Hospital (See i,-' 25) 27. Patient Care Modcl--Mid-State Bantist HosDital (See # 25 and. # 26) Graduate Program to Ir,.).vrc@ve @ii 28. A @fedical-Surgical Nurse Specialist Care of Pitients with Heart Disease, Cancer, and Stroke--Vanderbi7c University School of @@@,dicine speci Ls Vander'.3i!t is develoD-Lng a Drogram to train medical surgical riursr al' ts to i, Drove nursing care of heart, cancer, and stroke patients. it will be a ma8ter's de-ree program, staffed by physicians and clinical nurses (,l calendar yeAr) olus 1 year of clinical experience half at Vanderbilt and half at a -i 'ded during the firs- year only. cou-.ii:,i,- ty hospital. Stipends will be provi 29. '-ollegc Bioinedical Science Summer Program--Meharr:L Medical- College This Cooperative Droaram between '.,Ieharry and Fisk University is aimed at interesting culturally disadvantaged students in health careers a-.id providing them adoropiate educational background. Thirty freshmen students Fisk will attend enriched science and humanitics courses for 3 summers at Yeharry and Fisk. Counselling will also be provided. At the end of the program the students will be eligible hopefully, to attend Meharry or any other professional school. 30. @led4@cal Data Processi.nR--Vanderbilt University Hospital Vanderbilt Hospital will establish a central, computerized data bank continuing lab, physical airL medication reDorts on each patient. This will provide I easy access to data for the physician,, prevent duplication and aid in early detection of diseases. ADVISORY CO,@4ITTEE FOR PLANND.'G F@P, REGIO@,IAL MEDICPL PPOG@S IN TMIT-LSS-LE MID-SOUTH Cha4-rman Thor,,as P. Kennedy Health and Hospital Planning Nashville, Tennessee I Dr. William Vau,7,rlan Tennessee State Medical Association Nashville, Tennessee B. A. Phillips Vanderbilt University School of Medicine Nashville, Tennessee Leslie Van'urease Yie'-Llrooolitan General Hospital ,Nashville, Tennessee Dr. A'"disor, Scoville and Hosoital P18nnin-- Council @l u Nashville, Tennessee Harrison join Health and Hosoital Planning Co@icil I Nashville, Tennessee Walter Robinson Healt'- and Hospital Planninp, Cour LI I cil Yashville, Tennessee jobn Sloan Vanderbilt Uiiivers4-ty Medical Center Nashville -L ) Tennessee Robert Taylor Tennessee State Senator Nashville, Tennessee David Sp4tal Health and Ho Plqnn@@-nc, C@,icil Tennessee Dr. William F. @,ieacham @4ashv-.'Llle o.Ll i,.edib-'Lne C'n 1'L e 2 Dr. Harrison H. Shoulders @oao@ist Hospital Nashv@L-@.Le, Tennessee Dr. Euoepe Kilgo--e Pan-De-tal Associa@Llion Johnson City, Tennessee Frank P Dr. erry Volunteer State Medical Associa'u-,,on Tennessee Nl a si-I v ie Dr. Charles A. McGinnis La. F. Boyd Medical Society Nashville, Teinessee D.-. D. T. Rolfe iv;ehar,-y College Nashville, @ennessee Dr. Randolph Batson Vanderbilt University School of Medicine Nashville, Tennessee Dr. Harold D. West Yieharini Medical College Nashville, Tennessee Dr. Lloyd H. Ramsey Vanderbilt University School of Medicine Nashville, Tennessee Dr. Gadson Jack Tarieton, Jr. Meharr,y Medical Colleae Nashville, Tennessee "Ima E. Gault u V&nderb4L'L 'U Ur.-'Ve si'y School of Nursing Nashville., Tennessee N Mrs. North-O@e.-i'-ural Tennessee Lea.@@ for Nurses Nashville, Tennessee Dr. I;oseph '@-s'uow@-sh Nashville Health Department L u u e a shv Tonessee -arer @sma,- Dr. -,ce '@ro, -T '.ear-U "Mssocia'L,-7.0r. m Nas,