lop *p REPORT ON REGIONAL MEDICAL PROGRAMS June, 1967 z@ -@ r,@, 1 @7 @ I t ... I ON REGIONAL MEDICAL PROGRAMS- TO THE PRESIDENT AND THE CONGRESS Subtizitted by Pvillt,alll H. stetva?,t, M.D. Sit?-geoti Getieral Piiblic I-leallh Se@-,)zce U.S. DEPARTML,'JVT 0 I,- I-JE@ A L TH, L,-DUCATION, AIVD P17L,:LFARE junc 1967 CONTENTS Page FORR,,NVORD SECTION ONE Sumi-nary..... I SI-"C'I'ION 'I'NVO The Essential Nattii,c ............... 5 I r[ON A tivities and Pi-ogress ............. 9 s I,, c,. c SECTION ]OUR Issues and Prol)lci-ns ................ 19 SECTION FIVI," Conclusions and IZecoiiii-neiidations.. 31 I'ilgc I'ag SUPPI,I,,Ml,"Nl.': Regional Medical Programs in Action.... 37 N7[[ C.oi,siit;ijlts to the Division of l@cgioiiil Medical 1rograiiis.. 7 EXHIBITS N'llt Program Coordinators for Regional Medical Programs ..... 8 I Steps in Preparation of the Surgeon Getieril's Rcl)ot-t on I\ Ili-oct-ciiir(-.g for R(,-viewiii(I Al-)proval orol)criti(iiiil Griiits.. f@ Regional Medical Progriiiis to the 1'r(!si(lent ;in(] the x l'i-iticipil Staff of the T)ivisic)ii of Itegioyiil Mcdicit 1'rogrlins. Congress ............................................. 60 xi Complementary Relationships between the Comprehensive 11 Surgeon General's Special Ad Hoc Advisory Committee to Health planning and Public Health Service Ai-nendTncnts of Develop the Report on Regional Medical Programs to the 1966 and the Fleart Disease, Cancer and Stroke Amendment-, President and the Congress ............................. 61 of 1965 .............................................. III Planning Grants for Regional Medical Programs ........... 62 XII Public Law 89-239 (Heart Disease, Cancer and Stroke IV Operational Grants for Regional Medical Programs ........ 74 At-nendments of 1965) ........................ I ......... c XTIT Regulations Governing Grants for Regional Medical V National Advisory Council on Regional Medical Programs. . 75 Programs ............................................ I( VI Regional Medical Programs Review Comi-nittce ........... 76 XIV Selected Bibliography .................................. I( CANCI,'Ilk AND S'I'ROKI-" ANII-"NDMENTS Ol.' 1965 Oil or before June 30, 1967, the Stir- geon General, after consultation with the. Council, sliall subiiiit to the Secretary foi- transmission to the l,rcsicierit and then to the Congress, a i-cl)ort of the activities under this title together Nvitli ( 1) a statement of the rclitionsliij) bctnvccn Federal fi- iiciiig and financing from other ]la sources of the activities undertaken ])Ursuatit to this title, (2) all al)prais- al of the activities assistcd under this title iii the light of their effectiveness iii (-,ii-ryiiig out the I)url)oses of this title, and (3) recommendations with respect to extension or modification of this title iii the light thereof. Pziblic Law 89-239 section 908 'I'Iiis l@cl)ort on ]Regional Medical the time-consuming process of itii- tiojial conference of sonic 650 pcr- commitment to this program must be Programs is j-(,(Iuirctl by Section 908 tiatitig organizations it both the, iia- sons, representing a broad spectrum clear. of I)til)lic. L-.t%v @39-239, the fleart ])is- tiotial and i-c,,-ioilal le%,cls, issciiil)liii.@ of licilLli itid i-cl@tted grOLIIJS through- If these conditions arc met and ("Ilse, Ciiicci- an(] Stroke Aiiien(l- key operating shift, iii(I (lc%,clol)iiig otit the Natioii, A,as held in January the potential of the program is 11)(Itits of 1965. 'I'lic significance of ])I.Ogl-iiiii guidelines. I!)67 to discuss and exchange views reali7cd, health resources of the Na- this i-e(.iuiremeiit was highlighted by 'I'liese tasks have. 1.)(!eti iccoiii- oii the development of this program. tioti will move forward, region by the Set;-.ite Cojiimittce oii Labot- and 1)listic(l %%,itli the 'I'Iiis conference provided the back- region, in building new patterns of I'Lil)lic Welfare in its ltcl)ort oti the 1)ci,io(I of ;i(-ttial aberrations has been ground for the initial di-aftiiig of the collaboration, and people suffering 11(@art I)iscase, Cancci-, and Stroke so limited that firm conclusions (.-.an- l@I)ort; the I)roccedings: Conference from these diseases will receive the Amendments of 1965: not ),et be drawn concerning some of on Re ioital Aledical Pro@ra?tzs have care they need, more promptly and 9 the issues emphasized in the Con- been published (PHS Publication No. more efficiently. The Co??z?)zittcc views this reqzitre- gl-(,.Ssiotial (Iii-ecti,,,(- 1682). William H. Stewart, M.D. ?11(,Ilt for acco?piplish?tir?tts aiz,,l C)li tll(! otlict. hand, the 'I'lie c,.sclice of this l@cl)ort, I am Surgeon General ri,cotpt?ptc?tdatioiz.f for fitrthrr (level- sli@ii)e. and direction of program (le- I)Icase(i to ?iote, is that Itegional Public Health Service optii(@ytt as an ittipo?-Ia?tt aiiii t?itcLyral , I V(-.iol)iiiciiL (!It,,tz-ly (iiii-- Nle(li(-.,tl Ili-ogt-.iiiis litvc made a sub- U.S. Departyiie?zt of I)ai-t of this Irgi.51titioti. 7'his prot!i,ai?l .1 provides the opportunities for itzajor itlg this (ILlick and sLaiitiiil ;iiid impressive beginning. Health, L,ducatio?t, and lYelfare innovations . . . The impressive c?z- enthusiastic response it has received 13tit it is only the beginning. The task (lorsciiie?it.v of the co7icept of the indicates that it call fill all iiiil)ot-- ali(-a(i is to bring to fruition a truly p?o.t!?-aiii gizit- (i basis for leiiiytchi?ig tatit national great ol)- iiiii(Itic iii(I promising venture de- the pi-ograipt as voo?t as pof.Tible, but I)ol.ttllliti(-S this illl)oV,'Iti%.(. signed to advance the effectiveness the final fort?t in all its particulars is presents, itici the criti(-;il issues Nvitjl and (juality of medical care available not, and cannot be clear at this ti.Inc. Nviiich it is coiifi-oiite(l, lia%,c been to those Nvlio suffer from cancer, heart 7'ht@refore, the need for careful and brought into Silai-l)ci- focus. 'disease, strokc and related diseases. continuous reevaluation assuptics a . To be (-.ci-tain that full coti-,idcra- Critical issues remain, and cffec- special i?iiporia?zc(! for this progra@ii. tioli Nvas given to all aspects of this live regional programs arc not yet 7'liiv Co??z?)ilttre urges that the f;ro- initial ltegioiial NIcdicil I)rogi-atns completely realized. But as we enter (!XI)Ci-ictict! arid to assist in foi-,giiig tli(- I)eriod Of full operation, the .@reit?t. be adiiiiyiivtcrctl at all t'??Irs the conclusions arid recotyiiiicii(la- 1)rosl)c(-,ts foi- success appeal- highly @(,ith a view tozvarel the i(ic?ttifictioll notes in this ]reports we sought views favoi-,il)](-. of productive ?tio(lificatioizs for .(Itb- arid :I(Ivi(@(@ of .1 %vi(l(! range of ill- I,Ook-iiig to the future, tile single t)tl'.isl'ott to the,- Co?tgy-(-.(s when the ex- (livi(ltt;ils in health, iiiost important condition for ftirtlici- :111(l I)III)li(: (I-'Ixliil)iL 1). ],east I)t-ogi-ess is to siistaiii the enthusiasm, I"ot- 'tile illo-,t ratio ltel)ol-t fall, I appointed t Special Ad lIo(: %pigoi- atiti (-ool)(,-rative spirit of the describes progress and experiences Sul)coiiiiiiittc(-, of tlit- Niti(mial Ad- iii@iiiy individuals who have volun- (hiring the 20 months that have visory Couii(-il Oil Regional Medical tai-ily undertaken this I)ionIcering ef- elapsed since the enactment of this Programs to licil) in the development forL in the Regions throughout the i(.Ilisk-itioii. 'ritis period (encompassed of tli(- It(-I)oi-t (I-'Ixiiil)it 11). A iia- (country. 'I'o (lo this tli(- national Summary Itcgioiial I\'Icclical 1'rogi-ains liavc made an iiiil)rcssivc beginning. But it is only -.t beginning. Mucli is yet to be (]one. Many I)robl(@ins and is- stics are ),et to be resolved. I-IoNv- ever, if the future is iiiarke(I by Llic sainc ctitliusiasiti iiii(I cooperation and our national cojiiiiiitiiicnt is sus- taiiicd, a major change relay Nvcll be ,%,rouglit in the Nvorkings of Amcri- can iilc(licitic. This change -,vill benefit the licaltli I)rofessiotis iiii(i I)i-ing great 1)(@iief-its to the Aiiiericaii I)COI)IC. SECTION ONESumi-nary tion, to meet tile special requirements the 47 fii-qt Y(!ar gr-,iiii, ,,,),)Oilltiiig ,itid convciii,ig thr oi-y Gi,oill), -111(.1 rc- of ]regional Mcdic@al Progrims and 11, October I()65 President .1011"sO" tNv;ti-(Is LoL;li ,I)Otit $20 illillioll, ;"'(I A(Ivi,,, Lo c witli related 89-2.39, tll('. S(,(.011(l .tl)ottL $ I)rograiiis. Ill(l @tl'oke Aiii(,,,(I- initial cxl)(!riciice described in lioll. (]"%Ilii)it eff ect've nzccliani-57n should be Sc,rvic(! t cicilioiistrates the I)ro- An I iiiciits to tile IleiltIl , csc -L@@,,trds iiiis l@(@I)OI, itd other l@ecrioiis enc()iiil)a,;Scd ill ing the found to assist interregional a Act, aLltliorizing grants to hcll) cs- contain ,ibotit !)O I)cr(,ciit of tli(- N,,i- I)otclitiil for iinl)rov cessary to the licalLI1 Of tile Aiiiet-icaii people. To ities ?te tili)lisli R gioll-,ti Medical Prograiii tioll'S i)Ol)iil,-Itioli. ',',IC 1)(,gilillilig supporting activ egional Medical to cotiil)at licart disease, cancer, II-,ivc be- fulfill this I)Otcntial, tile following develop?nc?tt of R stages of I)t,ograiii ol)ci-atiotl,; clearly indi- Proara?its. This assistance will facili- sti,oke, and related (.Iisc,,lscs. 4. l@egiol"; witil tile S'll)l)ort of recoiniiiendations are, rk and i,@Tlplcmcntation of 't'llis 1)rogr.-iiii li,-td it.-, origii, ill tile totaling $6.7 million'. (Exilil)it catcd: -tatc tile wO nal Medical Pro- i,ccolillt)Ctidations of tile tioti-,tl al)l)licatiolis foi- program should be estab individual Rcgio ioii on Ilcart Disease, Can- \7) A(.I(li llti?tiiiiz,, basis. There is gi-anis. coiiilliiss grants to 11111)1)01,t )Illlllillg (covering ii.5lied oil a co icing (-c,i- and I)tr(jkc,, I)rcsclitcd in Dcceill- of tile Country (@,vel,y indication tll,,It tile al)l)roacil n Patients referred by pract Its alternate goal, like that iw 119-239 is YC,Itists should be included in the re- if, is to liell) lill(i(ll, ,evic%v ol' (.Icvclol)lll(.Ilt. authorized by Public L, omisitig. Extensioil of tile earcli, traini?i,r and dcrtto?tstratiO?L Of tile Coillillissioll itsc oil this record, i)rogrc,;,; in the valid and I)r s iii,ike tile best ill iiio(lcllll lncdi(,@,al sci- It of ltegioll,,il Tvicdic-il I)t,ograiii, buil(.1iig upon the initial activities carried out as necessary COI)IC (I(@velol)in(-i pilot projects, will lead parts of Re,,ioiial Medical Programs. eticc readily available to Ill 1) substantial. It is I)art'c- planning and who ,u[Tcr or ,'cc threatened i)y these 1'rogr, -carnation' of its potential and will .cs- r7 Federal hospitals should be co?z tilarly iiiii), ,ive %when vienvcd in the to I c attack iii-,ijor diseases. (011text of. the initial task@-, that to contribute significantly to th Videred and assisted in the sa?nc way ,ro accolliplisil this I)url)ose, Public I)C I)CI-foriiic(l. iliclil(l(-(, tile oil these iiiajor diseases. as COT?z??IU?Lity hospitals in planning Law 119-239 proposes tile establish- within tile Health Adequate ntea?is should befou?td and carryin,, out Regional Medical iiient Of direct tiid colititil'Ot'-s liiik- (-rcitioll uctio?l Of Progra?ns. Servi(-e of , iienv a(linillist(!I-illg orga to 77icet the needs for co?tstr ,,sciiiblilig of ,talT. this program and the agcs between the patient, his PIIY' 'izatioti -tllci tile SUCIL facilities as are essential to the TJnderlying cvcl- iii,, community hospital, and the gui(Iclitl(.,,@; liid to be d primroses of Regional Medical Pro- recommendation for its extension is Natioil'.'; Cclltc@ of scientific and oi)cd and I)roiliulgated; criteria and gra?rts. A limited amount of new con- the broad national concern over the academic medicine. It seeks to unit,- mechanism,; for review of grint al)- strliction has been found to be es- of the Natioii, extent to which new medical knowl- the licaltl-i resources (-stablislied. Tile of the )Iic,,itions had to be scritial to achieve tile purpose, edge and technology is brought rap region by regalia in close working iiiaiiy issues -.iiid I)i,ol)lcrn-s )t-t-scritcd Programs; priority needs arc cduca- idly and effectively into use in health relationships wliiclk will speed the by this it, federal y in Corn- ughout title knowledge,, north facilities, particular] ' services and medical care tliro transmission of I;cic" I)IC NVIIOSC lives Health action :111(i iii- itilitlity Authority to assist the Nation. Tile lcgislatiot, proposes to the I)CO tile construction of new facilities, telisively (lis regional frameworks for accelerating depend upon tile'''- ctis,,ed ,vitil iiclividtials itial bill 'I'lic first stages in the development from all 1)arti of tile. Country. Ill each %viicli -a,; rcciticstcd in the ill this transfer. it envisions two-way s Ite,@1011, iiiitiil ta,;ks incurred %working in 1965, was set aside during the co''- flows of useful science and technology of the ]regional Medical Program :n f the bill in the Congress. r,,vay. As of June ollt tile base, foi- developing regional ,idct-.ition o between academic and scientific cp-n- arc now Nvcll uiide Illlollg iii,,ijor li(".iltll 'I'liis Tilodificatioii should be carefully gencics and individuals who 10, 1967, planning is moving fornvai-(l (I(,sigzictl, in iiiiotint and a(linini,,;tra- tars and a of 4.7 Itegions %vitil tile -,til)l)ort 3 ll\etriotial Medical Pro,@i'am-9 colyiple- litis that ciiir-,ictcrize ill(! Aiilc"icill e- local mcnt of a Regional Program. T me of tile, (Iti(lstiolls iiielit Other 17e(lcral lic',tltll program,;, iver medical care in tb the character of the individual pro- health seen(,. So partictilai, terms the Cornl)rchcn-,i%,c,, nmunities of the country. t tile are generated by ill I iliiti',Itccf ,Is they rcflcc the graTns will vary NN'llicil ill(.. ll(-altli I'laniling ro ,Iccompli-,h these purposes) (lifTcring iiccd,,, rc,;olircc,;, and I)at- of ill(. ic-gislatioil iiii(l(!r labile l,a%v Sf)-749? w authorizes tire awtrd of grants in ol)ei,at(,s. Still others (!merger I)rogi-,, the planning and then for the terns of relationships. from certain I)roid changes %viiicii ai7c E] I-loxv call local programs over- ,il arrangements, The experience gained in tile year illel- (I(!vclol)mcnt (@ollic l,"Cl, of Space to carry out cer- oration of region, cc the first grant was made has inherent ill the flIr and functions signed to stimulate new pattern,.; sin that of these progrlms. tain of tile activities rovidcd considerable evidence ngen(lerc(l by Rei,ional M(!rl- cooperative action among PhYsi-p Tlt 'll,lollt! till.,s(, (,,,(.stion% being c nivcmity medical new cooper.,ttivc ,trr,-tngcmelits cin 1)(, Significi i(.;ll 111-of si):'C,(! fol 'ttiOll? ins, hospitals) health (lev(.Iope(I among institutions '111(l ill- ill,'. follon@'ifill inLr liters, public and voltint,' (tivi(Itials involved in Health tn(I Claii tilt-! cotitinit , ccitic- ,encies, racii regional arrangement s of health in(i medical In a(-ldition, it has been difficult medical afTairs. Regional group reP- ivailai)ilit' cl ttc a coordinated y tould h p to cre, IC area of heart thus far to obtain more than ,t tcnta- resenting a wide variety of interests ti rogram encompassing research care sel-@,ic(,s in t I @l I (,(I t'Vt, ('0111111itT]it-nt front ,,Italy insti ,,(I functions ]live colll(', tOgc ll(" 'I' Stl'Ol@(! :111(i I'('l I - -aining and continuing education, .1 111(lits- is because of 11 'I- s and rc- Ilii iiiii)recc(l(-.nte(I fashion to 1)1,"" (tisc;lscs 1)(! "igilifi(-,Illtly ;Ill(, ttitioiis and indivi(itia ,tticnt care demonstration and work coopcrttively oil (common Illy (Certainties over the ii,,itional intention i,ted activities. Its goal is to advance needs and goals. Over 1,600 iii(livi(l- lira he accessibility and the quality of iedic-,il Are ill(' I-egiollii i(iiiiinistriti%,(! and tile limitetl duration of.,,,ttlioriza- tial,,, including physicians, n is fol- it(-gional r\,I(@(lical tiiroiig litities (I(. for tli(!s(! J)rof I",Illls tiol, foi, gr'.ITI icaltli service,.; available , holit educators, hospital administrator,,,c .\,Clol)(-(l - he region for heart disease, cancer, viai)l(- an(I o%,(@r:t long period llrogi,aitis. Assurances of longer Sill) ;troke and related diseases. public health officials tnd members of time? port are essential to maintaining it'(' The emphasis in this program, rc- of the general public are serving on Can voluntary ),.Ofession,,il and vigor and achieving ill(- objectives of a,ckground Regional Advisory Groups. They are El Iccting the legislative b performing ,tn important role ill the institutional compliance be obtained this i-)rogram. prob- from whicli it emerged,, is on local and use of planning. This planning and development of tile in- in tile efficient disposition Many of these i,-;ucs and initiative and local ividtial Regional Medical Program. critical iii@inpo,,%,(,r, facilities ,ind lcms will be resolved in the future approach is intcndml to sustain thed . . atc that other resources oil a i,(-gion,,ii basis? conduct of the program. Others will essentially private and voluntary it seems reasonable to anticip tivc or legislative (-Ilaracter of American medicine. At workable mechanism,; for accomplish- Ej tlit! activities gcn(,,rat(!cl require either cxecu it permits the use of ing the goals of the Heart Diseasei under itegion,,il 'Nlcdical Programs af - action. the same time, -Cancer anci Stroke Amendments Oft care costs incl influence ]Zcgion,,il Medical Programs have federal funds to stimulate and sup 1965 wiI11 progressively emerge based [cc can made an impressive beginning. But port innovative appro',tc'ncs to Corn- on these initial cooperative efforts. the (-xt(',Ilt to Nvllicll -"tell costs )tily a beginning. N'turil is Yet to rnon problems under local leadership. be met I)y normal financing rn(!thocls it is An advisory group, representing 'I'licrc are., J,oNvc!v(,r, uncertainties'; stli)l)o"t still to be ,e., ,Olv(.,(l in the regional ]learn' interests in cacli in(I problems gioiial -se of the con- the further evolution of this program. il)S Region, including tho ise out of service, is require(] by law In part these questions ar stimers of slioill(i I)(. t-still)lisll(.(l I() ,,is ,in essential step in tile develop- ill(- diversity ,in(i complexity Of "'I'Iie ol)jectivt- ol' tills legislttioli is to I)IIii(I fl-()Ill sit.(.Il!!.Ill .111(l to I)t@0- N,I(I(. tIlosi! Illc(.11:11lisnIs (."ill ill(! ,otir(7(t of streii il,tli ill(, (if ill(,. coiiiintirlity . . . NV(' NV(@ill(I llol)C tli;lt III('. . . . iis t ;ifriliflc,,iiit ol, ill(.. of to oil I)ati(,tit ol, "(.i- I,iitili(7 fit,,,, (;Ottllllittl,,. oil, ],(zboi- o7 SEC'T'IUN The Essciitial Nature ;It( ) I INI) of to .111 tll(@, grotil)s and areas not sharing fully in aratc and independent components of l@(!I)(Art of tii(- Goiii- the overall progress. Efforts to iiicct the health enterprise, and 'the lack of illissioll ()II 11(@.ti-t I)is(.;Is(., Along %viiii gi-(-;it tli(,s(@ tli(-s(@ (leiiiaiicls for set-vices have been financial resources in sufficient N%,,ts tli(- I)I.ol)- by iiiiiil)onver and ft- tiiiotints and duration to assurc con- (1i;Lt(.. stiliiiilti,, fol- tll(.. I(.gisiitioll tli;it I(.Ills. I (@ility shortages an(] increases in costs tiriuiiig stability. I)e(-aiiie l'ul)lic I.a%v II!)-23!). 'I'liat foi- of i-al)i(II), of medical care. 'I'lle present (lay Circumstances of I-CI)ol-t, isstt(,(l ill of 19(i,l, ktiox%,I(-(Ig(@ ;laid moi-c efficient and efrcctiv(! use of the I)i-.icticc of medicine and the de- ;t of ogy. NVIIII(- Sl)(.(.i;tliz@itioll ]),'IS Ill% been sought livery of health services inay provide ;Iiiijt!d at the (lev(!Iol)iii(,iit ;t(,i-oss tll(! lt'V(-IS of it li,,isil.@o tlii-otigii i-(@gioiiilizitiori for itiaiiy itiorc suitable conditions for the nation of regional cojiii)lexcs of iiic(l- tli(- frigiii(,iiiitioti of set-vi(@cs, )-ctis. It has also I)ccii viewed as t growth of the regional approach. The ic.il facilities and resources. 'I'I)csc the I)t-o(,css of (lelivet@iii means to I)i-oadcii the availability of physician is the part of a coni- 9 ivoill(i function as coordinated sys- iii(-(Iical (-are. At the siiii(@ tljii(, the high quality health services. In 1932, 1)lcx system involving closely related tents to provide specialized st,-rvic(-s I(Ivallcc of scicllc(,. tlil,("Itclls the tile Committee oil the Costs of Mccii- facilities and ancillary services. The for the benefits of physicians and 1),t- heavily burdened ])Iiysi(:iaii with (-al Care focused attention oil this hospital has become the central in- ticiits in the several geographic -treas. I-;Il)i(I ol)soles(-.cii(.-e, of ktioxvlcdge. tl)l)roacii. In the same year, tile slitutioii in the community medical In tile longct- perspective, liow(,-%7e I., tlii,(,,tt in ttit,i) i,,iis(l@s I)C%V ))I.ob- ]3iiigliatTi Associates Program of the scene. Prepayment plans and group the ]@cgioiial Mcdi(,,;il l'i-ograiii (-oil- I(-iiis ill (-i)iiiiiiiiiii(-atioii all(] (,-citica- 'I'lifts Uriivei-sity-Nc%v England Mcdi- health programs contribute to coordi- ccl)t is the result of many ideas and tioii. Ne%v patterns of relationships;, cal Gentct- initiated the first coiiipre- nation and common action. Federal trends that have evolved over a I)(-- s)-stciiis of service, and mechanism.-, liciisive regional medical effort in the programs committed to social prog- '11'(! Cl'i 1-iocl of years. These include some of I nearly needed in iii(.(Iicitic, as United States. About 15 years later, i-css provide a pervasive force for the so(-ial, ccotioiiii(-, ttid sciciitiri(: in otlier fields, to co[)c %vitli and ex- similar ideas %vcre included in the action. change% -.Iffcctillq -.111 of ,;oc@i- 1)loit advances of science fc)t- the Report of tile Commission on I-lospi- Tlius tile regional concept emerged (.t%-, ;Is %vt.ll ;Is (I(!V(-Iol)lll(-Ilts ill tll(- (I(.- of tli(- 1)c!oj)lc of the Natioii. til Care and kv(!rc, in turn, reflected again in a nc%v form, in the major livery of iii(-(Iical and health services. ()tli(-i- important forces II-,Lvc also in he(-. I losl)iL2tl Stit-v(!v and COIISLI-Ll('- recommendations of the Prcsidcnt's The progress of science has exerted contributed to tile (-auditions and tioii Act of 1946 (Ilill-liurton Pro- Commission on Heart Disease, Can- ;I J)Owcrftil force foi- change. Since needs xviiicii set tli(,-.stage for ]@egional graiii) - Wliil.c other regioriali7atioii ccr and Stroke which proposed the "'oi-l(l War II great stricies lia%,c I)CCII JNIC(]iCll I'l-ogi-,iliis. factors plans have been advocated and at- development and support of "region- ill extending tilt! fi-olitict- of lia%-(, tli(-. 1)ul)lic's (,%I)ectatioil t(!iril)tc(l from time to time, these ef- al medical complexes". This proposal ii.icclic,il ktio%vlcdge arid capability fol. Heart]): the rising (.(.oiioinic c-,il)a- forts Nv(@t-(! largely isolated and called for substantial and sustained 'I'Iiis t(lvaiic(! ]],-is I)ilit), of tli(@ N;itioii, the liiglici- geii- Irritated. Federal support as an essential con- Of ('(IlIC.ItiOll Of tile I)Ltbli(-, I-'Ifl'oi-ts to achieve regional organi- ditioil Of Success. tly tai,ittlii of medicine to (@Oll- tlii- 1.(,(@ol.(l of sti(.(.(.Ss ill tile (.olltl.ol of zillion of I)i-ivat(-, and voluntary health t(@ll(I with the problems of licaltli aiic) tll(! iiiijoi- Colilliltlliical.)I(- diseases, sci-vic(-s liav(,, not been notably suc- I."SSI-"N'I'IAI, disease. It is providing a ftiii(laiiicti- otlict- ocial I)i-ogi-ess. ]it ad(li- cessriii. 'riie. reasons vary, but in N A'I'U R I:, t-ii illiberal% for progress in health, tioll, iittioll.11 has focused oil general they reflect the difficulties of President Johnson, at the signing of .,tilIlLilat'ii,g intensified cfrorts to bring the si)(!(:iil 1)i-ol)l(@iiis of disadvantaged Inducing common action among scl)- Public La@v 89-239 on October 26, 1965, saici, "Otir goal is simple.: to operation ivitli, 1)r.,i(-.ticiiig The, program design inherent ill is (Icfiiie(i in tli(-, Congressional in id -i-i%,(,s fi-otit :t of ])III-[)OS(.: speed iracies of medical research medical center oflicials, hospital . - iltil)lic 1,;t%v ll!)-2'@!@ (](. from the laboratory to the bedside." iyiinistritors -,in(I other health xvoi-l@- series of 1),Isic concepts: traizts, to 4!itcoit?'a,,t' e7?1(1 The bill lie signed into Law on that crs, representatives from appropriate 7'he boost itt (lia,,?iostic assist lyz the rstablish??ti-?it of i-(,,,io?ze7l occasion, the T-Teart Disease, Cancer voluntary health agencies and i-n(,ni- ?it(-tliotlv iv ?iot and Stroke Amendments of 1965, I)cn of the public. 'I'lic law specifies ?tz,,,(Iical school.v, r(.-,@(.,arch in.@tilittioll.v, stated the same goal iTi slightly differ- that there sliall be no interference i?lg fp.otli or b lica?-t (lis- a@i(I hospitals for research a?id tr(7i?i- cnt terms: to afford to the with patterns or the methods of fi- I:i7.@(', c(itict,r, .@t)-ok(@, nit(I itt(, (I?ictridi?ig co?iti?ziiing (,ditca- medical profession and the medical nancing of patient care, oi- profvs- tio?z) aizd for related dc"toyzstratio?i.@ institutions of the Nation . . . the sional practice, or with the of p(iti(!?it car(., i?t the,- )f heart opportunity of making -tvailablc to tratioii of hospitals. capic(,r, stroke, e7?z(l a,7tio?i tht- their patients the latest advances in 13ecatis(- this broad i-itilg(- of (-o- the diagnosis and treatment of [heart operation is the (-(,iiti-al of tllt,?-e7petitic capabilit'1, i?z tlt(., ??zajor (-i.,?ite@'s, r(,ht,re aii (,ffrctiv,., 'I'litts, I)ttl)lic Law 89-239 i-epre- disease, cancer, stroke and related Itcgional Medical Programs, (@,icli Piterplal, bcfzc,t,(,?i rt,.v(,arcli, lenClli?l(r, investment in i-egionii diseases] program is required to -iii ?id pat .'(,?it care ca?i bi-ip?,, rapid a?id initittivc. Tt invites and suliports the l'o ,iccomplisli these goals, P.L. advisory groul) representing the x,ari- a I I (,i-catiori of new patterns of (,oc)pcra- 89-239 authorized t 3-ycar, $340 inil- effectit,(, application of earn ttzcdical lion program of grants for the plan- otis health resources of tli(- region and a@id ili(@ ?ti(-dical capabil- tiv(,- :ictioti itnong physicians, allic(l incltitling constinict- participation. workers, liosi-)it-.tls, medical nin,g and cst-,Yl)lislimcnt of Regionil 'I'Iiis group has the important fiii-ir.- (@(-ntei-s, universities incl research in- Medical Progrims. 'I'liese grants pro- E] 7'ltt@ it,ill co?'- tion of aSSLiring f till collaboration an(] to th(, co?iipl(..Vit), of stittitions, in(I voluntary health vidc support for cooperative ar- I . . . r.ingcments which would link major advising ill the participating insti- Pnnki7ig (available to (711 ill,, potential Urgencies, and the. constii-ner- of health ttitions in planning iTicl cii-r),ini!, otit Services. medical centcrs-tistially consisting b(:?zefits of t)io(l(,i-it of a me(licil school in(] tfliliate(I tli(-, program. F-I of reaching liospitals-Nvitli clinical i-(-- '['lie Ultimate (-,I)je(-tiv(- of lzcgiori,.if search centers, local community lios- Medical Progriiiis is (-Icir in(i i,ii- of thf, Iiill pitals, an(] practicing physicians of equivocal. 'I'lic focits is on the rate(,(, of ?-e,gioii's ?tie-dice7l find It(-,gioiiii Medical Programs put into the Nation. Grants arc atitliorizc(i for The object is to infitien(,c the present @(lintt,(/ I I planning and feasibility studies, -,is arrangements for health services in i practice tli(@ tliit (@ssent'.-it 0 'I'he- iliz,i-t,sit of local II,-nltll responsibility in(i 1)o%v(@i- foi- tli(! iiii- @vcll as pilot projects, to demonstrate manncr that will permit the best in atill resources i'altv for th(.- eiv- 1)i,ov(!Tii(@tit of health services slioti](I the value of these coopcr,-ttivc rc- modern medical (-at-(- foi- licirt (lis- viii).tl)tl'ott of bli (,(I('h (@x(-t@cis(-(] In(-ally. 1).isi(, I)olicv .gion-,tl -irrangcments and to provide i else, t'..Incer, stroke in(i related (]is- fee tht, of (I of Ill(' is (I('SigT)('(l to ('tl' base of experienc(-, for further dcvcl- cases to be available to ill. 'I'lic scol)(@, coll(71)o@(itti,i, actio?t bi-@t te) I't@ (-Oiti-.i -titiov, ,qe I ttiori, t(lzti)tatio?i -iii(i opment of the program. of the program is n-,itiori%vi(Ic, cilcoin- tcti( ii ;it ill(- regional level. The objectives of the legislation passing tlieqrcat cities, suburbia, and The role of tli(@ Ptil)li(-, 11(@altli Ser@-- Ft-c(@(loryi incl flexibility to (lo those 'ire to be carried out by, and in co- rural areas. ic,(,. ill (](!V(@lol)illg this ))I-ol(l things tie(-.(.ssiry to a(-Iiieve ill(, of (,'.ICII J)I-ogl..till liis ])I-ovi(](@(l. soti,,Iit arrii(I Wli(,n tli(! l@cgional Medical Pro- ofiiiy oil(' @ll)(I So(@i:il gi-;iiii-, filliv (](,-V(@iol)('(l across tll(- of ;I I",(.gioll early to tIle), N%'ill to (@vel-y tioii of activiti(@s, sticii ,is i-escai-cli, III ill(! 1)(-ol)l(- S(@f.",i(.(.s fol' iii(livi(Iti;tl, lit-. lives, tliat: '.,I)ecialize(I training of tllicd li(@,ii-L iii(i "'(1 El Ili, 1)liysiciiii lias i,ca(lil), avail- ])Crsoiiiiel, (Containing (-(Itic-itioii of (]Is(.;I%(.s tli;it ;11.(, tiie ktioN%-](-(Ige, si@ills and t(.-ciiiii- I)Iiysiciatis, cxl)criiticiitatioii to find (Illilit%. Ifl(l ]it (limit tv, C.11 SLII)I)Ol't that I)eriiiit early diag- tll(, I)CST iiictllo(l-, to I(:Ilicv(. (Icsil.e(l X%-Ililg- til(@ (li%'(@i-sity : 11(i iiosis of tlicse diseases and I)i-oinl)t ]'(,.stilts, and (I(,Illolisti,.ttiori of the itio.-,L of otil- ille.(]- initiation aii(i itpproi)z-i-,ttc follow (,.frc(@tive, I),Itielit 'I'lic I.,aw (loes i(!,Il I-f-sl)ollsli)ility tllrotigii foi- tli(,@ iiio-,t (-fl'cctive ]@tio\vti not allow support of isolitcd I)i-ojects,, of 1(71lic\.illg tli(-SC does ot- dilative action. lio%\,evei- iiici-itorioiis, wlictlict- tIle), not (IC\-ol%,c tli)oll l@(@gioll.11 Nlcclic,-Il [)c iii continuing cciti(-@itioti, Ili-t).gr;titis ilozie. iiitist ol)ci-ate F] Ilis coiiiiiiiiiiity Hospital is equip- I)atictit care dci)iojisti'atioiis, COOI)Ctl-- iii (-oiijtiyictiori ivitit otli(@i- I)rogi-,,itii% I)ecl and to 1)rovide the full att%,e or ]living I(,];Itcd 0I)j(,Ctiv("S. I@Lit range of sci-vic(-.s Ili-, condition rc- oft IZC'giollll I'l-Ogl-,-Illl %\'ill glotial Ili-ogt-.iiiis, I)i-ol)ez-ly (iiiires, or is I)-,irt of a system which i)o%v (.fr(.ctiv(.iy tji(. it(.- s(,i,v(, ,is ;I k(.@ystoii(, of iii;ik(,s this i-@iiig(, of sci-%,ices avtilal)le gioit I)riiiqs to I)eat- its iiiii(iti(-. (-oiiii)i- sti,ti(@tiit,(! %vlii(-It will the de- to Iiiiii. iiation of institutions, -iii(i li%,(.I.y of tllf! t)?[)C of -,Iior-t (-v(!i-y I)ci-@ori %vliosc life and ol-,g.inizaLioiis to (](-fine tti(I iiit,v.L its i(-(,s I)Y ;Ill. iii;iy I)c in icol)ar(ly from fit i(-(--oiiil)lisliitig thin; goil, iL I.,; t, ol%.]l I)(.(!(Is Ill(l ol)l)of.tulliti('S. to fill(] %vi),s to liii-iiioniz(@ oii(@ of tli(-s(@ (liscases sl)otil(I have the Critical to ftittit-(- ])I.ogl.e"s is tll(' fitll sti-eii.L,,tli of itio(l(-i-ii medical of members of tli(, in(,(Ii- tile of and scicti- sci(!ricc available to Iiiiii through the tifi(., ft-(,(-(Iotti \%-Itli then. for cooperative efforts of the medical and I)I'Oft-,-,.sioil to I(-.C(@I)t til(l@il- fill] (efficient Its(. of .111(l ilitioll- sliai-(! of I(!a(let-sliii) ii'i this t-froi-t. ;lviilil)ilitN, of sel-vi(.(,S. ]Zc- related resources of the region in L(Itially important is the giotial I\,I(,(Ii(-al ofTcr tile which he lives. These are the goals to which Regional Medical Programs of iii-iiversity schools of to I)t-i\-at(, ,ttid I)ttl)lic institutions and -ii-c dedicated. I)ecoiiie involved in cool)erttivc ef- the li(-.iltli I)i-of(@--ioiis of the cotintr), fol-ts to tll(- fl.(Iit,.; of to that, oil (.froi-(s. (.11@tlivii,@es itl(l lic%V ;I Vollitlt;ll.y I i-t@sl)oiisibilities are I)i-esetitecl to lios- -Itl(l flexibility to I)it;il Idlllillistl,.Itol.%, Health ofli(@ei-s, iise tli(,iii, it is to work out Voltint-,iiy liciltli ag(@ticies, schools of .111(i lo(..,II S)'Stell)S to 'Ill(l tll(! Illie(l ll(!"Iltll I)I.illg tll(. of I)I-og- ))I.ofcssiol]S. Activitics aiicl Pi-oo,rcss t 11(@ ti t roil slil)lllit . t ?'('I)Ol't of tll(@ :I(.tivill(IS tofy(,Illf,f, ivilli ( I ) I st:lt(@lfl(-Ilt of I.(.],Itiolisilil) fi- iiaiiciyif,, tn(i Iiii;tiiciri,, fi-oyii (-)tliet- (2) tii of tili- of I,(zttl .@t,ctio?l !)OR -u @ JL JL '@'-L 'I JL Activitics and Progrcss ltl:llolt'l' 01: ol)jii(-iit li;is taken I)Iacc iii ,t tiiiie of for tli(! I)ivisioii for fiscal year 1966. resenting areas that included some 60 the 21 months from the tiziie widespread iti@iiil)ower shortages and 'I'lic 1)el)artiiierit of Health, Educa- percent of the population of the I,,txv l@o,-23!) (-aiii(-, into in (-oii.iiiii(-tioti %vitli I)ay-.ill(-] (I(!iiiaii(is tioti, and Welfare Appropriation Act country. ']'he first applications for until June 30, 1967, 47 Regions i-c- fi-olli illil)Y otll(![. lic@iltil I)I-Ogl-;Iiils, of 1967 provided $43 million for operational grants had also been c(-ivc(i funds to aid their plan- sticli as NI(@(licitre azici Nlc(licai(l. In grants and $2 million for tile I)ivisiori submitted. lung ;I(.tiviti(.s ;Iil(l I. of tll(..Se (Ili.,; (,otlt(!Xt tile, I)I.ogl.(.Ss reflected by for fiscal year 1967. Subsequently, in February 1967, also initiated tile ol)(..I.;Itioll;tl I)II.Its(I tilf- st;lt(' ofi(@tivity I 'I'lic National Advisory Council on the first four operational and 10 ad- of tlieil- ltegioilii Nlc(lit-..Il I)I.ogl.;Illls. l@(-giotiil M(-(Ilcii Programs, estab- (litioiial planning applications were (Lxliit)iLs III, IV) 'I'lies(t programs ti%!CIY slioi-t tilil(-. ]low this xvzls ;IC- lislied by the La%v, was named from recommended for approval by the re(-@ive(i ;twar(is of tl)otiL $24 million I)t-ovi(les t gaii.Lc of the outstanding experts in heart disease, National Advisory Council. At the for planning iii(I $6.7 million for ciii-(-,(-.tioti tii(t I)otetiti@il for the future. caticcr;tnd stroke, plus top lcader.-,Iiii) Council meeting in May, five addi- ol)cj-atiotis. 1) t-(.-gioiial in medical practice, hospital and tional planning applications were areas to which tile awards for I)Iiii- 'I'he Health (-.arc i(Iniinistratioji and I)Lib- recommended for approval. In June, iiing i-clate contain tljout 90 percent Actto?l.@ li(-. afrairs. (exhibits V, VI) It met continuation grants were awarded to of tli(! Nitioil'-, population. foi- the first tiTij(! in I)eccttib(!r 1965 to 10 Itegioiis for the second year of Additional for grant.- Slioi-tly tft(-t- tli(- 1,@t%v Nv,-is sigii(,@d idvise oil and policies. In early planning. to slil)l)oi,t tli(.! planning of l@c!lioii.,tl by I)r(-sideiit Joliiisoii oil October 6, February 1966, the Council met again Ilt-o to review arid approve tile 1)rclimi- Broad Participation I gi-.tiiis covering tli(-- i-e- I!)(')5, tli(! I)ivisloii of ltegioiial Mc(li- iii.tiiitlet- of the country are uii(](!r (-.tl I)i-(@gi-aiiis %v;is at the ii,.try issue of the Progra?iz Guidelines. in Plannitz,, revic%v or development. Overall, i Nitioii@il Institutes of II(-altli. ']'o Quickly printed, this publication was total of about 5,1. ltegiotial Mccli(7a] direct its t(-tiviti(-s, I)j-. l@ol)crt Q. given its initial distribution in March. 'I'lic promptness and manncr with Programs are anticipated. It is likely N,Iii-.qoii iccel)tc(l tile invitation to During the spring of 1966, about which I)rograiii proposals were de- that I)y tli(@- Iitt! stiiiiiiiei, oi- (-,trly fill I(-.IV(- his post @is ])call of xfc(iicille 20 applications for planning grants veloped reflect the interest this new of I!)(;7 It(- ioit-,tl l'i-ol,t-.tiiis ;iti(I Vi(-(- Ciiztii(-(!Ilot- of tli(- Univei-- were received and reviewed by the I)rograiii has generated in tile nation- 9 I al health scene arid give heartening ('OVCI'itlg tile entire country N%'ill I)(,' sity of Nlississil)l)i ,iiici Asso- initial rcvi(-w groups and the Na- (!Videzice of the willingness of diverse either in the initial I)].-tiinitig or initial (-i;tte I)ir(@ctot- of the National Itisti- tioiial Advisory Council. l@y July 1, interests in the health field to coop- 0I)el-,Itioti@ll st@iges. ttit(,s of Ilcaltli. I)i-ior to the arrival 10 grants were recommended for ap- crate in this new framework. The in- Ilrogr(,-ss in the development of of I)r. Iviarstoii, I)r. Stuart Scss(mris, I)r-oval arid awarded. Between July t(,rest arid enthusiasm generated Itegiorial Mcdi(,-al Programs thus ftr I)cl)uty ].)ire(-.tot- of the National In- arid December 1966, approxiinatel y throughout the country is the result iiiiist 1)(! measured tgainst tii(- tasks stittites of I Iciltli, wis responsible for 40 applications were reviewed. Many of a number of factors, not the least of illvolv(.,(l ill lttilicliiiig .1. new Ill(l (hit d(-vclt)l)iiieiit of plans and I)oli(-,ics were returned foi- revision or a(ldi- which was widespread participation iiiiiov@itive venture dependent to t foi- iiii- new I)i-ograiii. tiotial information. Tweiity-four were of many individuals and groups, both very high degree upon local 'I'lic Stil)l)l(-tiierital Appropriation approved arid funded. As a result, in the formulation of policies at the I)i-ise. 'I'lic establishment of many Act of 1966 provide(] initial funding 1966 ended with a total of 34 l@c- national level and in setting up and ii(!%v relationships iii(i activities has for the 1)i-ogi-.itzi, making available gional Medical Programs receiving planning their own Itcgional Medical rvlol.(.ov(.I-, this $2,1 million foi- iii(I $1 ;twii-(Is for- planning I)rofrraiiis, rel)- Programs. I I tli(@. ('('.VelOI)Tn(,iit of these Regional TABLE I TABLE 2 All of the Na- itiefli(-al s(-Ilools "'(I AWARDS FOR I'l.ANNTNC', ANT) OprRATIONS OF RrcIONAT, Ml--Ir)TCAI, Ai)vis(-)ItY Gitotil's ill('S(. of .IUNR@ 30, 1967 I.-Oft l@l'(;TONAT, Ml,"I)T(',Al, I)Ito- % (ICV('IOI)TTI('Ilt lltVc Ntttnl)cr Aniotillt I)articil)ate(l. In virtually every pro- ',10, 1967 grain, representatives of State incdi-: TOTAL ...................................... 61 $30,946,907 Ntim- Ilcr- cal societies, health department,,, can- C.,itegory 1)(!r celit- cer societies, heart associations, hos- Planning Awards ............................... 57 $24,277,174 ;age I)ital associations or hospital planning 47 19,822,153 agencies have taken part. For I st Year Activities ....................... 4,455,021 1634 100 -t(l(litioli, iniTiy programs have For 2(t Year Activities ........................ 10 TO'I'A I,, - . - - - - - . . III . ------- - ali,(@.icly (lev(-Iol)ecl links Nvitit iiiiiver- operational Awards ............................ 4 $6,669,733 - Practicing I'lly-si- sity resources outside tile medical For I st Year Activities ........................ 4 6,669,733 ciai)s ............. 356 22 schools and with otlier,itate and local I)rivtt(! an(] public agencies having Mc(licil Centel- interests. i,,,xiiiil)ies or ti,es(! About one hundred consultants Onicials .......... 281 17 Actit@ities iii Schools of I)eiitisti-v, Nursing, aided the nc%v Di%,isioti I-)v providing tlte Re,,io?z Mellll)cl-s of Pill)lic. . 2Cio I C) So(-ial Work, Business A(itilinistra- advice and counsel on various as- (location tii(i Public I-Tealtli Voltiiitat-y Health tioli, I-, pects of the Program during the ini- Similarly, in the I'legioris, tile -tTi(i I)PI)artrncnts of Vocational Re- tial period. These advisors reprc- spread participation of concerned in- Agency l@cpi-esciit- habilitation, Welfare, Education, and sent@cl a broad cross-scction of the (-Iivi(Itials as members of Regional Ad- ftospitals. C,oiniiiiinitv Councils, atives ............ 19c) 12 leaders in American medicine and visory Groups all(] as C,ooi-dinators )I,-iTiniTIg ('OtlllCilS, Blue Cross and I-lospit,il Actriiin- 1. health fields. They devoted intensive and staff is infusing the Programs istI."Itol,.s .......... 170 to SIT]Iillll' groups are also being involve(] efTorts to the rcvicn%, of Program Pro- -,vitli vitality and ciiiira(-,tcz-. Over in Tiny instances. TZel)res(@iitativcs of 1600 individuals are participating as Otlict- I lctltli A(lTyiinistritioil and Public posais and grant applications. Some of these people sat on technical rc- members of l@egional Advisory Workers .......... 14.2 If(,,tltli Service hospitals ire also view grotips.-Others contribute(] Groups. Mcinbei-silil) in these groups Piil)lic Flealtli fre(IticTit their thinking to the development of ranges from 12 to 1 1 1, averaging '12. 'I'lic int@nll)crs inciiiclct v,,iri(-tv of 1)t-o- Oflici;lls .......... 122 7 Reqio?ial such sl)ecializeci activities as continu- fcssional backgrounds and rcl)rcsent-,i- Or,,aitizatio?zs ing education, community health Otlici .............. 107 7 tion of a broad cross-section of insti- planning, svstems analysis, data col- Several kinds of institutions have tittions and organizations. 2.) lectioii, communications, evaluation, II fillfilim(@lit @f tll(. intent of tll(. Ittclii(le,.@ 51 R@gl'on.v, of it)hich 17 assiiin(-(] responsibilities ',-ts coor(ii- ,in(] the preparation of this I'lel)ort. Program, the major health -,igcn(,.i(!s ha(l released I)Iaiinti@g gra?zt.@ an(I I lend ii,,xtitig for ]Zcgion,-tI (Exhibit VII) of tile regions have been involved ill al)plicatio?i,v tender revieiv. N4c(li(-;tl I)rogr-,iTiis. Since the I(!gisla- have not materialized in the 'ri,csc coordinators are building ccrn, TABLE 3 @tafTs Nvitli a N@,idc range Of Corn- initial planning proposals. t,oll does . lot designate ttic,,c agencies of June 30, 1967, there They must be dec-dcd iil)on by the 1)ctcncies. As people working TABLE 4 11-@,AD@)t3AIt'I'l-.RS ANO ,vcl,c Sol,,, 600 staff various institutions itid interests I)ai (,Ooltl)INA -,DICA 1, S. 'riiesc include over S IN PRELIMINARY 9 ir, tll(" (ICVCIOI)Illcllt of tile, GitAN'L'EE., I.'OR L@EGIONAI, Mr III these I)rograin 13FR OF PERSON ticil)atin I)Ito(-,RA?,IS, JUNE 30, 1967 joilat workers ,vitli train- Num I 'I'lic agency.,o selected act,; . 00 profess PLANNING REGIONS FOR REGIONAL Progriiiis. SC cool)critive iilg in medicine, hospital administra- MEDICAL PROGRAMS for all involved ill the tion, and Other licaltli disciplines as late(I fields such as sta- Rcgions I)rogroLiiis. tngc 9 vell as in re Poptilatioti r. Aiiiollg tire @7 Itegiol", rvc("lvlllg Gr,,int- tis lics, sociology, syslcnll 51 ,)I,Itillilig t,,raiits, 2@@ University itle,(Ii- I,ype of Agcl,cY ces tics, CCOIIOII unications TOTAL ................- -ilools leave assumed 47 cdt,catioll, cOnIm 4 ....... 47 and I)tiblic relations. Special coordi Less than I,OOOIOOO ......... c,oordiii,,itilig 33 liators Or consultants for heart dis- (.cti,irc I)rivat(! lioiiprofit',Igell- 28 rnonly 1,000,000-2,000,000 ........ 10 SCVCllt re newly orga- Universities .... case, cancer and stroke arc corn 14 cics, 10 of wliicll WC -- 21000)ooo-3,000,000 ........ 5 25 included. iii7,c(l for this I)lll,,)ose, 5 are ille(li(!al 3,000,000-4,000,000 ........ State ....... 23 s ulti-institutioiial Ill-iv;ltc ..... 5 00-5,000,000 ........ 8 ocieties, and 2 ,tnd oll(' illt('.r- -- -- Nature Of Prelir?zi?zary 4,000,0 10 One State ....... ISO undertaken Planning Regio?ls N4orc than 5tOOOtOOO state tgcll(,,y have Noill)rolit 17 12 olial Medi- of which 47 had this task. ('I".Iblc 1) Agencies. 'File application'; for l@cgi , ,,cludes 51 I?egiotts, ad al)Pli- (.1,11 J)i-ogriiiis planning 91",Itlts ""lvc received planning grants and .4 h Pro(,ratit Coordinators M(.(Iictl cogral)liic areas ill .ons under revicu). 5 6 (refined the 9 g c[T,rts will cati area Staff Nvilicli the initial I)Iaiinir 1 recognized -y plan- i(I Newl@' 13c focused. it has I)CC, in 30 cases, the I)rcliminar ool,(Iill,ltoi,,, ai Ol'i tiiiz(-.d 'rile I)roc,rain G y )CI(lcl.sllil) 1)0- Agcllcle';. 10 3 that these definitions arc preliminary ning regions approximate State lines, I-)irectors holding k c refined during the plan- to the existing respon- 3 and will b operating due principally sition., ill the administration Of other 2 ,ind by Medical I)i-ogriiiis cOlilL; Agcilcic'; - - ,illg process sibilities of inany of the key group, fro,in a variety of back,,roLili(-Is. AI)oul exl)ciicn,,c. giolis have participating in the preparation of TI(i 'rile individual Re placation. I)-,Ilf I)rcviot'%IY held important I)OII- State ' rom less than the initial planning grant ap lions it, ,Acdic,.il education, sucil a-., interstate 2 2 ranged ill population f Inasmuch as none of the Regions is vice-I)i,esid(,nts) iiiedi(:.il Agencies.... I million to over t8 i-nillion. (Table bound by State lines, 1-nany of these Llilivel-SiLy I)rofessol@. Otilcl@ 4) 'I'lic incdian is 2.6 illillioll persons- preliminary definitions arc likely to s "'(I inary plan- ,ciloot dezitis private practice of lie coordinat- collectively, the prclim in Pro- be modified on the basis of critclia II- I -I-Ie graiiiee. differs all, sed ,Ive, c .0i,ic froiii fT earth needs. icille itid fro,,, positions of I.719 headquarters zvheit the I?egioit re- nizig regions cncompas more specific to h at Region filed s low in being or proposed cover administrative leadcrsliii) in hospitals. this arrangement or the latter gram country. Gaps in gcograplii- In I I Rcgions, the initi re States . . (7uested The rest previously held key rolcs ill I I fine the entire s an early con- includes parts or 2 or MO agency did not have the caliabil'ly to assi rich wa voluntary lic',Iltll and governmental formalfiscal evlonsz'bi'lity. (-at coverage, w -,Igclicics. ,in(i in 10 it is part of a single State. tiniiing education 1)i-ogriins and ii?i- (litiolls. Nl(,@tilo(]" of olit Some regions primarily cover iirl)-,in Tiiet educational needs are also t,(-- (I(@itiniisti-@itiolis of 1)@iti(-Ilt lilt(] metropolitan areas. Others follow iciviiig .vi(lesl)rca(l .Itteiltioll. .11)1)lyillg (-V.Illl;lt,toll MA.I()It I'f.ANNIN(: lines previously established for plan- 'I'lic patterns of o(-(-.tirreti(-(-, of .11',o 1)(@lilg tested. %VAN' ()It ning health facilities. heart disease, (:anc(!r, sti-ok(- and t-(!- III t(l(litloll to .111;tlyti(.,Il ;I(.tlvl,ty, Al, Ml-'I)T(:Al. l'ItO(:ItAlt@, NlAl@(:Il late(] diseases arc also I)eitig stti(lic(i planning for R(-gloii@it Ili-o- 1, 1967 Plannine, fly many regions. Most ;ire ti)alyzitig griiiis iiivolv(@s iiii.joi- t-fl'ot-(s (]it-ect(-(] Activities patient referral patterns and existing to%vzil.(l Ili(., stl-eligtllciiitig of tll(! I-el;l- Stil)iect 1,Jiicl(!r Stti(ly The planning activities of each Rc- methods of providing diagnostic, tiolisliil)s Ill(l (.oll)zlllllli(.,Itiolis ,IlI 19 P(itie?it c(ire .1 I 1:01 treatment and laboratory services. heart) -.111(i I I Nvitl i t gional Medical Program arc directed Present and I)ossil)l(@ cortitni.ini(,-atioii V;it.iolis .11(@ at the design of operating programs and transportation patterns relatiiig I)c-iiig itse(i to ftii-tli(@r (,ool)et-;t- and the steps for their establishment. to these services are ilso receiving tiv(" I.(.IItiorlsllil)s. 'I'll(! (!St,'Il)lisllTlletlt I i(.s ..................... 30 Initial planning activities have gcn- wi(l(!sl)rci(i tttentioii. 'I'lies(- I)Iitinitig of @vorl@iiig t;isk for-(,(-s ;iti(i (-oiiiiriit- [)is(.;Is(- ............ 213 crally been of four major types: studies have, in most itistan(-cs, 1)(!(-ii te(,S, ('oll(lll(.t (if Ill(l 2@l [] Organization and staffing for based on previous data collection cf- %Vot.l@Sllol)S, @it)(I tile (@illl)loyll.lellt of 1);l tt(-i-ns of Set-vices ...... 25 planni?ig and coordination forts and have, in turn, contributed liaison it-(! (-otiiiiion. Nii- I,;Il)ol-;Itol-Y Sei-vic(,s ........ 25 to the development of cooperative ailerons I)i-ogy-,iitis ii-c s(,,Ii(!(Iiiiii g (.()II- Stren,,thening relationships and arrangements among tit(,- 1)arti(,i- f(@reti(-(-s it (-oiiiiiiiiiiity liosl)iti I iti(l I'l@,ilisl)ol-titioll 1',itt(-riis. 21 : s liaison amon-, institutions and indi- elating o@gtnizations. %vitli otll(.I. lo(,;II 1-olil)s to (.Xl)l;lifl I .9 viduals throughout the Region About one-half of tit(! planning all- aii(I (]is(-iiss tit(! I)iii-I)os(-s ;tii(i A,I(itil)ott)er D(,r)elop?pie!ytt t)f planting data 1)lic-.itions 1)rol)os(,-(] tit(! tirt(l(@t-t@ikitig or ill(! I'livsi(.I;lll of specific feasibility studies IiTtied -.it Ivol-l@iiii, toI,'t-tll(-I- ill 1)1;11)llillg @ll (I Preparation of designs for pilot Niii-siiig N,I;itil)ow(7i .......... 2() ,assessing the workability and utility of maturing ;ill(l f(.;Isil)ility operational progrartis I [\,I;ll)l)oW(-l ........... 25 I)I.ogl.,Illl Many stti(li(-s lias foiiii(I to I)t-, oii(@ of A principal effort in the planning are (!xploritig I)ctt(.,t, ,viys of a(lviii(-- Ili(.. illost lll(!tli(@(Is of (.S(.1i)- fair (,Olllllloll of Regional Medical Programs is tile ing educational and training activi- l'Isliiilg Ill(] I)OW@-I .............. 2(i careful study and analysis of many ties. 11'artictilar attention is I)cing objectives. relevant factors: (]'(!tnograpliie and given to improvements in continuing Alilioiigii It(-,gioii:il 'I rairil'?@ry (end eeltireitioli I)iostatistical characteristics of tile education 1)t-ogritris foi- I)otli l'i-ill,f-:iiii is ill ili:illnl %v;i@'S tit I([ ing physicians and allied health I)ct-- Itegion, the manpower ancl facilities gi.@ltils. .I....... ......... 211 resources, the adequacy of an(] sonncl. The effectiveness of tele- 2'i@) iii(-;tiis in ;t(,tioii is I I y needs for specialized clinical facilities phone, radio and television nctworl@s r(-I)oi-is of that i:(@ ......... 2f@ and problems of manpower supply in ranking comintinity'liospit-,ils to tini- l@(-'.,ollt-c(.S. 2 and distribution. Surveys of training versity medical centers is being in- reliort,-tl /I, iii,lit,i(hiil Re,@it)n(il ifedi- ,in(] lil)rary resources, on-going coii- v(@stigate(i iiii(ler dancing local (.Oii- clit .............. 2 lit oll,iiieti(tatioii; tilese col,iiiiittecs driw JOZ?Illlll ??Iedical ci,?t- I c(Itio7t. Upon I)Otll colllliiutiily in(i acadctnic I)[ -iiLt-tl Is -.1 to til's I Ills. t(,,?,s (irid co?)I??IllylitY hospitals- III resources. in line wid, tile spccifica- I)OI't. 'It is )II SIN [,/.Vf- .of I?lo(li'lll ']'he dcvrlop?l?eitt a@id de?tioilstra- t tile l@egioiial Ad- is :1 1),"( jolis of the L tioll of lillp?,Ovcll tiel.llio(Is a?id ar- vi@sol-y (;,.Olll) itself iiitist approve all II,(, /III o to:,, s for Iii-oili(Iiii" (ict(.Ctt'oll, ? [III fit- III I,'?It .1 -1)1', fi-olli tilt. (II-St :Ali 'fill applications for.ol)crational funds. oyl (I?Itl 1 (11(1,,Itostic, ti-eat?izeiit a?td rehabilita he National Stll)lllitt(!(l by tell It(,.giofl% til'.1t I_-] cit activities The revic- process at t receive( f July 1, I,)()(' v(-Iol)lllf'?Il of ??I(',/'O(,S for tll(. tio'll SC?-Vic,,s I?zcludiitg su Institutes of Health involves technical -1 grant,, a,, o of Ilil'It review by bod, expert nonfcdcral con- -tiso (Itialili- Wlrlicrv for carrots of coronary care iii sLiltaiits -,lllcl tile staff of the Division OP('ratio?tal II (,a, I aiiel Dri?zo?zst trachiii(y a?td coi?zitzunity hospitals. and thcr offices witli relevant ex- ior to action by the National I)crtise 1)r Activities l@(,t,"Oil Nvill dilr(.I,lllg I;"Xpayisio?t of cc?-rbral z)ascular dia,, Advisory Council. This process is I 710stic 'r('SO?t?'CCS. tll;tt have. valuating the organiza. focused oil c fol. operational I)i-ograiiis "11-(! Deiizotiitratioyis of improved "ictitods y of the fol of Iltilizi?,(, coy?zplitels jet itlo?titoriizfr tion and conceptual strateg itig -ictivit ell't Regional Programs and iiiaking avail, largely oil of 11 It Provi(lilig I)rior to tlit! 1)@issagt, of I'lil)lic l@v "Iii(i I'viitc(l I)II),si,ol(,gi(: (lat(7 ati(I I able the 1.)cncf!Ls of expert professional .I!) IV). l)tl1.illi4 ilit, disease, (".III cei-, tl'o of data for the Ise of practicing PILYsi- analysis of project proposals. It seeks ,Itioll, it cia?ts aii(I hospitals. (,oiisi(It!i*atio?i of tll(! legist, initial ,National I)i,o- to preserve for each Region a large (11-It til(ll'(! ),,vclopille?lt of i?ifor??zatioll PI iticasut,e of the responsibilities and ])I.ovi(l(-, Col. (II(.. following SI)C- F-1 I ,.% of tile country tills fira?izs to fitrtlit,r co,itipiii?ticatio?ts, It ll:t(l -tir(-a(ly I)ccll (ii- (-ific kinds of I(.tiviti(,s ;Is of .1 a?td cooperatioit opportunities for deciding on prior- 'I.%i(,. iTlgl-(!(Iicllts of tizatioizs itics for action. A detailed statement aptiotify the institutions, orga? ctc(,l towat,(,l improved 1 tile. 1). of tile rcvicnv process is contained in tit)llsllil)-, -,xitiong li(,;iltil aitd i?tdividiials of the I?c(rio?'. Lxhibit IX. ti,es(! places ,ufficiel't 1)1-1"llillg I'"(' n 7. he rxcliaii,,e (If pcrsoii?tcl be- b(-cii ,lccollil)iisllc(l go ticice?,. medical ce?ite?-5 tried conitilu- ']'/te Reviezu sUI)POR'rTNG Ac,rIVITIES OF Operational activities could be ii,iti- iosp'tals died tli(! P?'Ovis'O?L Of Process ,-tte(I early. ?lit)' I I I I,llE I)IVISION Ol,' REGIONA], III tile beginning stages tlic%e ol)cr- colisliltatioyi a?i(I other assista'Lct! to -itiozial itif, /)Iiv iciaiis 1)), ?tzedical c(-?t- 'I'll(! review of applications for opera- Nil-"I)ICAI, IIROGRAMS I)t-ogt-,tiiis %%-ill I)ractic , s fotit- principal types of activities: f(.Y. (17111 (Ili.-cel persoiz?icl. tiotial gr-,itits lias been designed to en- As support for Regional Programs, 2 stire c-ii-eful consideration of tile number of -.activities have been under. , oCIl- E] edzicatioyz I;ro(l?,arlls 0 Applicatiort of tli(- latest ./@?, I strategy and soundness of the I)ro- taken by the Division of Regional' a?id teciiitolo,,), to zrt,Pl'Ol't' rogram. Many .S .1 for t?i(,(Iical practill()?iry-s a@id allied 1)osal foi- a Itegional P Medical Progranis to dcvelol) needed capabilities for dia,,,itosis aiid t?-(-al- It(-altli it-orkci-s, at both local facilities Regional Advisory Groups have cs- ci,@itt,i-s iticliidl?i,,, ilir ttl)lislied sLii)coininittces to .tnaly7c information and resources which can, facilitatc regional program developer Sli(@ci(iliz(,d ii-aiyiiii,,, (i?itl (,-Ollfilltl- of II',7?-?Iilllll at tli(- validity and signific.-tiicc of 1)io- I)OSals I)I-ior to their revic%v and i-ec- Talent. (Exhibit X) COI)I?illl?lit), llosl)ltell,% (III(I Co?@l??Illlli- i?i,,, t,(Izicatioit to t-iiabl, health I)i(ic 15 the National Board of Medical Ex- avoid duplication of effort tnd there- formation and data affecting the Continuing Education aminers, the Association of American by concentrate on studies of cool)cra- development of Rcgionil Programs. Medical Colleges, American Public tive arrangements and other issues 'I'Iiis meditim will also help speed the A conference in September 1966 of 16 Health Association, American Pliysi- and needs unique to Regional exchange of reports of significant leaders in the continuing education of Cal Therapy Association, Association Programs. progress and problems among the Physicians and allied health person- of Hospital Directors of Medical Ed- Regions. nel identified needs critical to the de- ucation, Inter-University Communi- Listi?ig Facilities velopIment of more effective activ- cations Council (EDUCOM) and ].TNANCIN(.; FRONT OTITI,"R I in this @cld. The meetinL, other professional and public groups. Section 908 of Public. Law 89-239 re- SOLIR(',ES documented a national shortage Of quires the Division to estab- Substantial contributions have been Omfessional health workers capable of conducting and evaluating pro- Systems Analysis lish and maintain a list or lists of made to the development of Regional grams in continuing education. To facilities . . . equipped and staffed Medical Programs by hundreds of The use of systems analysis has been to provide the most advanced metli- individuals and institutions through- hop meet this need, a contract was developed with the Center for the encouraged in Regional Medical ods and techniques in the diagnosis out the country. Leading officials of Study of Medical Education at the Program activities as an integral and treatment of heart (lisc.L%e, can- medical schools, hospitals, research College of Medicine of the University component of program development. cer or sti-oke. . . ." As a first stcl) institutions, voluntary health agencies of Illinois to study the feasibility of Exploratory efforts have been under- to fulfill this requirement, the Divi- and Members of the public have de- expanding graduate programs lead- taken to make broader use of systems sion his contracted with the Amcri- voted efTort and resources to plan for ing to a degree of Master of Educa- analysis skills in studying specific can College of Surgeons for its Corn- these new program%. In many areas, 'don and also short term training pro- problems of improving mcdicii serv- i-nission on Cancer to undertake a local funds have been made available grams in the area of continuing ;cc. As part of this effort, the Divi- study of appropriate standards to specifically to aid in the initiii plan- education. In addition, other univer- sion has entered into a contract with provide the highest level of diagnosis ning. For example, in Vermont, the .sity groups have submitted proposals the Department of Industrial En- and treatment of cancer patients. State legislature appropriated $10,- for assistance to extend their Pro- gineering of the University of Michi- Stich standards may then be useful as 000 to help defray planning expenses. grams in these fields. In January and gan to study how to apply operations measures by which medical care in- In Oregon the University Medical May 1967 representatives from six research and systems analysis mcth- stitutions of the Country can evaluate School, the State Medical Associa- universities, including staff from ods to problems of regional medicine. their own capabilities, and by %vhicii tion, and the members of the Re- the individual Itegional Medical Pro- gional Advisory Group donated schools of m.edicine and education, Data Collection grams can estimate where additional $6,000. The Mountain States Re- ,met to examific possibilities of ex- support may be needed. *ding programs to train educa- Conferences of specialists met in gional Medical Program received a iional manpower. March and May of 1967 to identify Disseminating Infori?iation grant of $13,700 from a private The Division stafT has also worked and discuss data available for plan- foundation. closely with national organizations to ning and evaluation of Regional A device for sending periodic reports Altogether, it is estimated that broaden resources in continuing edu- Medical Programs and problems of to the Regions his been estal)lislic(i through March 1, 1967, more than caftbn. They include committees of data collection. By taking advantage to disseminate to Program Coor(lina- $1.5 million in cash and services has the American Medical Association, of available data, Programs can tors and other interested persons in- been contributed to the planning 16 TABLE 6 AMOUNT 01@ ]"IINI)S I'-RONT NON-FEDF.RAT. SOURCES FOR PLANNINC RI--IGIONAL MEDICAL PROGRAMS, TIIROUGII MARCIL 1, 1967' Region rotat Cash Services Region Tot@ Cash Services '170TAL ................... $1, 497, 300 $21@7, t;00 $1, 209, 500 Missouri ........................ $48 $3, 900 $4,5, 000 Mountain States ................. 15,000 13, 700 1, 300 Alabama ....................... 21, 200 3, 800 Nebraska-South Dakota ........... 9, 000 1,400 7, 600 Albany, N. Y ................... 96, 800 24, 500 New Jersey ..................... 17, 800 12, 000 5, 800 Arizona ......................... 2, 800 100 New Mexico .................... 25, 200 5, 700 19,500 Arkansas ....................... 5, 100 600 New York Metropolitan Area ...... 11, 000 1, 000 10, 000 Bi-State. - @ ..................... 13, 200 1. 500 Nortli Carolina .................. 38, 100 .......... 38, 100 California ....................... ............ (2) ............ Nortli Dakota ............................... (2) ..... I...... Central New York ............ I . . 12, 000 000 6, 000 Northern New England ........... 134, 200 10, 000 124, 200 Colorado-Wyotiiing ........... ........... .. ............ Nortlilaiids ...................... 30, 900 5, 400 25, 500 Connecticut ..................... 33, 800 .......... 33, 800 Ohio State . .................... 37, 200 6, 600- 30, 600 Florida ......................... 7, 500 .......... 7, 500 Ohio Valley ..................... 10, 600 2, 100 8, 500 Georgia ........................ 2, 300 900 1, 400 Oklahoma .... ................. 50, 000 .......... 50, 000 Greater Delaware Valley .......... 174, 500 70, 100 104, 400 Oregon ......................... 18, 000 G, 000 12, 000 Hawaii ..................... 6, 900 .......... 6, 900 Rochester, N.Y .................. 53, 500 40, 900 12, 600 Illinois ...................... 48, 000 3, 000 45, 000 South Carolina .................. 3, 000 1, 500 1, 500 Indiana ........................ 76, 900 4, 500 72, 400 Susequehanna Valley ............. 6, 000 .......... 6, 000 Intermountain .................. 53, 500 5, 000 48, 500 Tcnncssec-Mid South ............. 20,400 3, 400 17, 000 Iowa ........................... 19, 500 11, 100 1, 400 Texas .......................... 82, 000 10, 000 72, 000 -iiisas ......................... K, 125, 000 .......... 121, 000 Tri-State ................................... (2) ............ Louisiana ................................... (1) ............ Virginia ........................ 25, 000 .......... 25, 000 Maine ...................... I ... 16, 200 1, 500 14, 700 Wasliington-Alaska ............... 4, 000 .......... 4, 000 Maryland ....................... 7, 000 .......... 7, 000 West Virginia ................... 11, 000 1, 000 10, 000 MCIIII)IIis ....................... 20, 000 9, 700 10, 300 Metropolitan Washington, D.C .... 2, 000 300 1, 700 Western New York ............... 38, 300 2, 100 36, 200 Michigan ....................... 4, 500 .......... 4: 500 Western Pennsylvania ............ 7, 000 1, 000 6, 000 Mississippi ...................... 15, 000 9, 000 6 000 Wisconsin ....................... 37, 500 8, 500 29, 000 As reported by individual Regional Medical Programs. 2 Not reported. 17 velopmcnt of Regional Medical AN APPRATSAT, Ol-' 'I'lil' I)i-of(-.ssioti iii(i the iyic(lical itistitti- continuing evaluation. A principal c)grams from non-Fcderal sources. ACTIVITIES A@SIS'Fl-"I) iN tioris of the Nation, throug)i such strength of these programs is the op- listing of these amounts, by Region, rllr-, I,[Gl[T OF I'lil-'.]R (-ool)erati%,(,- irraiigeiiients, the ol)- 1)orttinity to build Lip resources for wt forth in Table 6. EFFECTIVENESS I)orttitiity of making available to their (-ontintiotis evaluation; this is par- Procedures are being developed Only a tentative appraisal of the 1),iticiits tli(! lit(-st advances in the ti(-.ttlarly appropriate and necessary d implemented in the ReLions so effectiveness of lzegiorial Medical (iiigilosis Itl(l treatment of tll(,%C, in light of tile concentration oTi in- Programs in carrying out any of tile diseases." Niticii of the platinin- iiovition anci experimentation. l,'Ival- at these cooperative programs are "I lanced from a variety of sources. established objectives is possible this efTort is focused oil i(i(-titif),ing tli(- iiition mechanisms are generally . somc areas, total responsibility for soon after enactment of the legislt- tyl)(-s of "opportunities" that ire most being established as part of the c support of the activities will be tion. Oil the basis of this limits(] tii(i 1)ra(-ti(--,i] to provide planning process so that essential sumed by local funds after an ini- I)erioci of observation there seems to ;iii(I str(-iigtli(@ii As i@(,- I)as(-Iine (latt will be acctit-niiiatc(l ii period of study, testing an(] dcm- be cleir (!vi(lence that overall 1)rog- I)ort(!(] tl)ov(-, t I)i-oa(i si)(-t-ti-iiin of til(l capabilities clcvclol)c(l to assess istration. In many Regions, voltin- r(-ss has stil)stiiiti;il. 'I'll(! 1)ros- 1)ot(,Tlti,'il to this ol)i(.(.- (,oll(iiiiiitit4 I)t-(igrt-ssiii(i I)i-ol)l(!Tiis. In ry agencies and foundation funds I)Ccts for the future are positive and tive are 1)(-iiig cxl)lot-(-.(l in planning, this way, the Itegionil Progi-ariis will .c being enliste(l. -Iuspicious. feasibility Studies and pilot I)M.iCcts. be better able to modify their clirec- 'I'lic first oi)jcctiv(-. of the lzegionil ]'rot, iion -,in(i speed, on the basis of actual At this stage in the development of ,i-(!ss to (I;tt(! that tli(! egional Medical Programs, it is not Mc(licil 1'rograiiis is "tile establish- 1)@isi(- of looking to regional itti(i progressively im- )ssible to ascertain tile longer term merit of regional cooperative ar-r-ang(@- groups foi- 'ideas all(! initiative is Nvell prove their effectiveness. merits." Accomplishment in respect founded. 'I'lic long-term cftectivencss of ]Ze- lationships of Federal and non- to this objective has been oxitstan(l- 'I'he third purpose sl)(,-cifiecl in the gional Medical Programs will be !dcral funding of the activities un- ing. As noted above, the health in- Law is "to improve generally t)ic demonstrated by evidence of ad- ,r this program or to asses,, the tcrcsts of the Regions as well as re- health manpower and facilities avail- I vanceiiicnt in the quality of services iture of their impact upon medical lated agencies and members of the able to the Nation. Regional for these diseases, by extensions in rvice costs. If this program is suc- public have come together in an iin- planning holds the potentiality of ac- 1)(-rio(is of productive life, anci by rc- -ssful in developing needed addi- precedente(i fashion to consider tli(! (-oiril)lisliitig this objective also. liettcr (itictioil in mortality and morbidity. onal elements in the community most appropriate local %vays of meet- ways of utilizing and training health Initial pro 'res-s has established a earth @ne that are parts of im- ing identified needs tinder this pro- manpower, in(-Iticling many types of 9 roved services, the extent to which gram. Maintaining the contintieci allied personnel, arc also being ex- promising foundation for such gains. lese services tan be financed commitment of these gmiips with cli- plored. More efficient methods of 'I'liese goals -,vill not be accomplished trough regular cost and payment verse goals and interests to continue extending the effectiveness of exist- quickly or easily, lio%vever. The full recesses or other local funding to work together in establishing and iiig and nc%v facilities, through shai-- fi-iiition will in larfrst part, iechanisms and the extent to which implementing lzcgional Medical Pro- ng an(] cooperation, are being iil)oTi the (-entraining roiiiiiiitnient of entiancnt or temporary Federal grams will be crucial. initiated. regional ti(!altli the sticces- i,ittiierit of high quality per- ssistancc will be required arc issues The second purpose ;of Regional Most importantly, Regional Mccli- fit] r(@cr iat will call for critical examination Medical Programs specified in the cal Progratiis themselves are (levelol)- sonnel, and tli(- sound support of op- s the program progresses. legislation is "to afforcl the medical ing resources and procedures for cratiiig 1)i-ogrirn,,. Issues And Pr'oblems" 3@@ 1 IkJiN j'U kJ U JL@ ISSUCS Alict rroL)Icms 'I'lic initial experience with Public (liversc interests that exist in the corn- Specific provisions of Public Law tain a sufficient consensus of the L.i@v 89-239 his raised t number of ii)tjiiity li(!altli s(!ttiiig. 89-239 and its legislative history re- r-najor medical interests concerning issues and problems %which face the flect tiiis prevailing pattern by strcss- the means being used to achieve the Regional Medical Ilrograins as they Re,,I()?ial Medical Pro,,ra?7zs irig the voluntary, cooperative nature objectives of the program. The im- seek to achieve the ultimate purposes atid the G(!?ze?-al Proble?iz.v of the Regional Medical Programs. portancc of this consensus gives spc- of the Law. The prospects for 1)rog- of the Natio?ial I-Icalth Sceizc 'J'Iicsc programs, therefore, face the cial significance -to the progress rcss toward the objectives of the lcgis- challenge of influencing the quality already achieved in establishing what latiozi and the rate of that progress 'I'lic fundamental principles and of services without exercising admin- the Law calls "regional cooperative can only be realistically assessed when processes of health activities in this istrative control over current health arrangements." they are measured -,igainst the inagni- Nitioii have generated immediate activities. To achieve its objectives, Evidence of this progress is coii- tilde of the challenges. Tiitis a cleir issues for the conduct of Itegional each itegiotiil Mcaical Program will siderable. I-lowcvcr, it is still too early understanding of the issues and I)rob- Medical Programs. 'I'liese conditions have to undertake many activities to assess the effectiveness and stability lems encountered thus far is essential have imposed certain constraints. which require the active involvement of these mechanisms when they arc to evaluating the initial progress de- 'I'licy have affected and will continue of t variety of medical institutions, faced with difficult decisions. The scribed in the report. This under- to affect the iiiaiiiicr and extent to personnel, and organizations. Such first steps cannot be considered defin- standing also provides the setting for which these programs may contribute activities include reaching a con- itive, but it is reasonable to assume the (-.oiiclusiozis (Jr-,i,,vn and rccoin- to better health. sensus on the distribution of special- that the goals of the Regional Medical iiiendations made. ized facilities and nianpowcz- re(juircd Programs could not be achieved in a Volii?ziar), to meet the needs of heart, cancer voluntary medical system without the Some of these issues and problems Ilealth Sy.@t(-?Yt and stroke patients at the most rea- progress toward the necessary con- are derived from the particular cliar- soziablc cost; determining the cliar- scnsus that is now underway. acteristics of the health care activity tlcaltli activities in this (,country arc actcr and conduct of continuing edu- Leadership is obviously of vital im- in this country and the dynamics of predominantly private and voluntary cation programs that utilize the portancc in achieving voluntary co- its growth and change. Other issues in nature. With some exceptions, Such resources of both University medical operation. The Law does not specify derive more specifically from I)artic- as treatment of the mentally ill, the centers and community hospitals; and the source of leadership for the Re- ular provisions of Public Law 89-239. itiedical program of the Veterans Ad- applying technological innovations gional Medical Programs. This has These lattcr problems have special iiiinistration, and the care of iiidi- such as techniques for diagnosis and permitted leadership to develop in a relevance to the policies already de- gerits, most medical care in the patient monitoring using centralized variety of ways. Flexibility in the vclol)cd and bear directly on the rec- United States is not a direct govern- computer facilities. choice of the leadership focus has otiiiricjidatioiis for its extension iiiLl itictital responsibility. Recent ycan Such decisions must be made within been cited by several regions as a key modification. Many of these issil(@s liivc seen i rapid rise in the 1)rovi- the i-(-gioiial setting. Indeed they are to achieving the necessary consensus and I)roblet-ns arc interrelated in a sioti of public funds for a broad range already being made by many of the of the major health interests. This complex inatiner. 'I'licy reflect the of health activities; however, the Regional Medical Programs. To do flexibility, however, carries with it the tt!t-ttis and conditions under which so in the context of the voluntary risk that decision-making mechanisms ,general problem of recoilcilin- ii-,i- these ftiii(Is it-e. provided have sought to the voluntary tti(I private ciii, the Regional Medical may develop which are not strong tioiial needs and ol) ectivcs %vital the medical syst values, patterns of action and tli(! iiattir(- of United State,.; health circ. Programs must establish and main- enough to deal with important prob- 21 ety of patterns of medical care. A arrangements will survive in a vol- a period characterized by shortage.,, lems and issues. For this reason the of health manpower neccssiry to review of grant applications is con- program concerned %with the Nvicier iintary fol-iii. ide liiali quality health care to cemed not only with the development availability of advances in heart On the one hand both patient.,; I)rov of workable cooperative arrange-- disease, cancer, stroke, and related xn(i )le-.Iltli i-esotirc(-s ,vill need to an expanding population. The Pub- diseases will inevitably encounter the recognize that tile Regional Medical lic, I-lealth Service has assumed a ments but also with the effectiveness full range of this complexity. 'Fill's Prograi-ns cannot solve ail the 1)roli- i-riajor role in assisting in the expan- of decision-making mechanisms and the facts of this size and coi-nplexity lems in these disease fields. Neither sion of tile supply of trained health leadership. for manpo%ver. 'I'llis is being (lone raise many problems for the devel- can they become a mechanism opment of the Regional Medical paying for each medical iiistitittion's through many pro@rams including Magnitude and ComplexitY constriction of trainina facilities, of Our Total Health Resources Programs. priority needs identified on kn iso- sources, lated bisis. scholarships, training grants, and The diversity of health rc fomis of trainin,, support. health ac- together @vitli the relati%,c lack of On the other hand each Regional other Another characteristic of tionships among them, N4edical Pro(l,rati, will need to de- Ffo%vevcr, most of these programs tivities in this country which compli- organized rcla vclol) a plan %vliicit illustrates I)otil to have been implemented in the last cates 'the development of any new presents each l@cgional Medical Pro- I years. Their impact in terms health program is the magnitude and gram with a formidable task in cs- tile potential participants and to their severa - patients, tile rationale for selection of of increased training capacity is only complexity of the health resources. tablishing regional cooperative ar ram. It begining to be felt. Mcanw)lilc the Such gross statistics as 288,000 active rangemcnts anci carrying out priorities @iiid pliasin(,Ir of I)rog operating programs. As a conse- will lee(] to generate confidence ill needs continue to increase and are physicians, over 600,000 nurses, 7,000 the fairness and capability of the de- accelerated by the implementation of hospitals, 100 schools of medicine quence planning will involve tile s of health care and osteopathy, and a total annual establishment of priorities of action cision-making process for making the large scale program health expenditure of approximately and careful phasing in the develop- necessary program determinations, financing such as Titles XVIII and . dication of ment of the program. Selectivity -.in(] and the relevance of program plans XIX of the Social Security Act. $43 billion give some in by limits and activities to the needs of the Manpower shortages are relevant the magnitude of tile total health phasing are made necessary endeavor. The ultimate goal of Re- on resources, other institutional com- people in the entire Region. to tile Regional Medical Programs gional Medical Programs is to have mitments, the need to gain accept- It is still too Soon to say that all in several ways. First, they place a an impact on the health of patients ,tnce by health personnel, and the the Regional Mc(ii(-,il Progi@ams being constraint oil tile rate of implcmen- threatened or afflicted with these importance of careful testing of new planned and established Nvill meet tation of some prorram tctivities. these test,,. riiere is early evidence, This is already bcin,, reflected in the diseases. Its accomplishment will mechanisms. This necessity for pilas- eventually involve 'a staggering num- ing, however, will place strains on tile honvever, that initial steps are being difficulties some regions are cxperi- ber and variety of health resources. arrangements for tile voluntary co- taken Nviiicii %vill enable tile ]regional encitig in acquiring the initial plan- To tile magnitudes of this universe operation necessary for the Regional Medical Progi@ams to (10 tile jOl)- ning staff. 'There is keen competition itli 1)lannin- and must be added the complexity of in- Medical Program. Unless partici- for 'rianpo@@,er %v maizpozver l(@a(icr- creasing specialization of personnel ,Ili,) The man- pants in the program accept tile LirizitatiOll-V 1)o%ver constraint also applies to the and facilities, acceleration of change necessity for selective action and tting of priorities and the rate of in the nature of medical practice due SC to the advinces of science, social phased development, it seems tin- The Regional N4e(lical Programs are ffrcss of operating activities. This and economic changes, and the vari- 'likely that the regional cooperative being planned and carried out during 1)1'01 22 constraint has been cited i)y sonic of gioiial Nlcdical Programs miy con- Medical. Programs will have to de- current data and techniques. How. es as the ever, useful approximations can b( the Regional Medical Programs as tribute to development of ne%v ways to velop and modify techniqu iiiajor factor in establishing priorities use health manpower. Applications of programs arc initiated. They will not developed in somc areas. The tech. foi- -Ictioli. these iiialytical tii(I management be able to rely entirely upon estab- niqucs of operations research anc ManpoNver limitations also affect tools arc already tinder development lislied data-gatlicritig and analytical systems analysis being used by somi Regional Medical. Programs by iii- in a number of regions. 'I'lic Regional mechanisms. Initially, the assessment l@cgional Medical- Programs can bi creasing the relative emphasis given Medical Programs may create an cn- of needs and the choice of program helpful in making these assessment, to training activities in both the plan- vironmcnt and a mechanism for ex- strategies will depend heavily upon The major determinants of mcdi ning and operational phases of the I)Ioring many al)l)z-oiciles to the informed judgment. Regional Medi- cal care costs seem to be beyond th Regional Medical Programs. Mail_ efficient use of health manpower, as cal Programs will need to strike the scope of Regional Medical Program! well as tile opportunity to evaluate difficult balance between the initia- Noncthelcss, Regional Medical Prc power shortages are real, and high priorities are being assigned to train- those iic%v approaches under many tion of activities on the basis of in- grams can contribute to the efficienc ing activities to help meet these different conditions. The future formed judgment about effects on of program implementation and to shortages. It seems likely therefore evaluation of tile effectiveness of patient care, on the one hand, and greater awareness of the cost impl that the emphasis on training activi- Regional Medical Programs should the continued refinement of the data cations of improved medical car ties will be greater in the initial stage.,; take into account their contributions base which will essentially permit re- They can provide (1) definitions i than in later 1)criods. This likelihood to the solution of these manpower direction of effort based on objective needs, resources, and program activ could create the false impression that I)roblcriis. analysis of experience. tics through a planning process whi( the Regional Medical Programs arc includes all major elements of ti primarily training programs. Data Gatiteri?t- I?zcreasing Cost health-care system; (2) develo of Medical Care ment of cooperative decision-makii A third relevant aspect of man- a?td Evaluatio?t frameworks that may speed accel power limitations could be the as- cliveri ctivi- The lack of objective datt @ind iiieth- The general public is deeply con- ancc of efficient means of d signment of higher priority to a ods for using data may hamper the cerned about the rapid and continu- care; (3) opportunities to explc ties which increase the efficiency of launching of programs .vhicli require ous rise in the cost of medical care. and evaluate the usefulness of ni manpower utilization. These would planning, selection of target objec- The Secretary of Health, Education include: (1) the development of new technologies and new types of heal techniques for diagnosis and treat- tivcs, priority setting, and evaluation and Welfare has indicated the personnel which will contribute to t rnczit that increase the productivity of i!lft,-ctivetiess in terms of tile tilti- importance of due attention to more efficient improvement of t of existing manpower; (2) the devel- iiiite objective of I)Cttel. health fol. rii(.)derating the price of iriedical care (Itiality of patient care. The Regior OI)MClit of new types of nianl)oivcr, persons threatened with heart dis- in developing l@egional Medical Pro- Medical Programs will need to ma ,and (3) the more cfliciciit division o@ case, t-aiicei-, stioke iiid related grams. The measuring of cost against cost analysis an integral part of p diseises. 'I'ecllniqtics are not highly benefits is very difficult in health gram planning and evaluation. labor among difrei-etit levels of man- developed foi- acquiring tiid analyz- care. Inadequate knowledge of the power and among the several parts iiig data which provide the basis for effects of changes in alternative Regional Diversity of the regional framc%vork. The use measuring cause and efTect in terms methods of diagnosis and treatment of operations research and systems of iinl3rovcd pitient cii-e. As in many rendcr an accurate cost- benefit as- The diversity of this Nation is analysis in the development of Itc- other areas of activity, the Regional scssnient practically impossible with flected not only in the health proble 23 icsources but also in the patterns Consequently, the development of At the same time it must prc%crve a appropriateness of this flexible ap- edical care in the various Re- effective cooperative arrangements meaningful and continuing policy 1)i-oacii. Comparative evaluations of . The problems and appropriate has been especially diflictilt in the role for the lzcgional Advisory (.,rotil) si)(!ciric I)t-ogr.-ttn accomplishments ,nses in a sparsely settled rural largest cities. It has proved more @vit)i its broadly representative base. over -t period of years offer the op- with difficulties in attracting difficult to devclol) a meaningful The multiple administrative patterns 1)orttinity to refine techniques and cians and transporting patients focus of leadership which can Pro- %vhicii are emerging in the regions approaches. long distances arc very different vide the basis for cooperative action. would seem to be all appropriate re- ISSI,ll,'S AI;SOCTA'I'ED those in the crowded mctro- The juxtaposition of great resources sl)onse to (livct-s(- situations. Tile 1,ANV an areas with both great con- and great needs not only creates sig- efrectivt.,,(...ss of the various patterns ,ations of medical resources and nificant opportunities but also gen- remains to be tested, I lo%v the various with their [Jnderftatidi?zg ,ing needs, particularly in the crates real tensions. Tile mechanisms Regions manage to rol)e Pro(,ram Piirposes city slums. which evolve for the metropolitan (tivcrsc situations will probably bring !rhaps because of the relative areas may prove to be quite different about a different rate of development )Iicity of t.he medical resources, from the more simple models appro- of Regional Medical Programs and From the time the legislation to au- ion,,tl Medical Programs seem to priate for less complex Regions. Vol- will lead to wi(ler variations in the thorize these grants was first intro- leveloping more rapidly in prc- tintary cooperation in such an urban appro,-tcli(!s cl(@vclol)cci by t)ic various (Itice(i in J,-tntiary 19C)5, there has tinantly rural areas and smaller environment will be put to a stern regions than woi.ii(i be appropriate been some misunderstanding -,ibout s. Paradoxically, it has been test. Planning for Regional Medical if tile patterns of medical care were the nature and purposes of the pro- :icularly difficult to develop the Programs is now underway in all more iini form throughout the Nation. grain. This misconception was based al steps toward effective Regional these areas, however, and the new This diversity, and the develop- largely upon the mistaken idea that iical Programs in the metropol- patterns of relationships and respon- n-4cnt of appropriate strategies in re- the objective of the law was to build . areas where the greatest con- sibilities are being explore(i to over- sponse to diversity, make more . a na.tional network of Federal center.,, tration of medical talents and come these special metropolitan difficult the comnitinicatioil of a gen- to give care to heart disease, cancer, lities is to be found. Their added problems. eralized concept of a Regional Medi- tnd stroke patients. To help clear up iplexities begin with the large The llcgions are now facing the cal Program. 'I'licy complicate the this i-nistinderstanding, the Congress Dilations to be served. They, in- challenge of creating tinder these development of responses to needs made changes in the legislation to de also high concentrations of diverse circumstances an administra- perceived at the national level. They further emphasize local initiative and idvantaged groups. These corn- tive framework which not only serves hamper the widespread use of ne%v involvement of practicing physicians, .-ations are multiplied by the large the objective of regional cooperation techniques and approaches cievel- community hospital administrators, in one set of circumstances. and the many other relevant interests ,nbers of institutions, including but also provides sufficient focus of opcd dical schools, hospitals, and other administrative responsibility to per- On the other ]land this diversity including the Public. ilth agencies and their long-stand- mit effective decision-making and is one of the strong arguments for In spite of these efTorts to clarify htbits of autonomy and even lie provisions of the understanding of the purposes program operation. This framework the flexibility in t 'alry. Added to these difficulties arc must provide sufficient authority and authorizing legislation. Civcn the -,iii(i mechanisms of the Regional multiple social, economic, and responsibility for good management facts of this diversity in the cirly Medical programs, fears and mistin- litical complexities that cliarac- by the full time program staff with stages in the development of the pro- (I(!i-stiii(litigs %N,(,re i major itnpe(li- i7,c-mo(Icrn urban life. day to day ol)(-.rttitil, it S(-(-Ill.% too (-.'It.ly to tllf- to I)(, ovf.t-(@otyit- in itiitioinr, tli(- I Programs. Speeches, articles, and the latcd diseases." 'I'liese disease prob- diseases. The approach is practical- needed for educational purposes Pro leiiis, %viiicii cause iiiore than 70 per- Ire the activities to be undertaken an which are basic to specific educa- ,grant Gitideliiies issued by I)ivi- -ogt-aiii-1; cent of all deaths in the, United St,-ites iiiteg@al and essential part of a tional programs for heart disease, sioii of Itcgional Medical I)i c, constitute coordinated effort to advance the cancer, stroke and related diseases. emphasized the utilization of exist- in(I afflict millions iiior itig institutions and manpower i'c- an appropriate nucleus for the devel- attack on heart disease, cancer and Moreover, the cooperative arrange- sources, the participation of I)rac- ol)incnt of effective broadly based stroke and related diseases? Review ments and relationships initiated regional cooperative arrangements. procedures, including the Regional through Regional Medical Programs ticing physicians, the necessity for liecause of the tremendous scope of Advisory Groups and the National provide mechanisms that should be planning and implementation at tli(- regional level, the cooperation of all these disease problems, they have a Advisory Council on Regional Mcdi- useful in dealing with other health major health interests and the iilti- iiiajor iitil)act til)oll tlic. total range of cal Programs and related technical problems. If regional coopcra'tion is ,I,o plan ef- committees, evaluate applications ffcctive in meeting problems of heart lii,,Itc collision focus of III activities personal services. c on improving the (-.tr(! of f(!ctiv(-Iy for li(!arL (-..iticer,,,iii(I against this standard. disease, cancer, stroke and related progress in iiiidci-suiti(Iiiig lii@% I)c(-Il -ti-c)k(-, it is lt(@gion-,il reports indicate many diseases, it can also be useful made. Ilowever, tendencies toward often necessary to consider, the entire activities supported under tnd in accomplishing other health ends. .fragmentation and insularity of spectrum of resources available for essential to the development of Re- A number of Regional Medical Pro- health activities in this country liav(- personal health services. For example, giotial Programs will contribute to grams have already indicated an in- itia(ic it itiore difl'jcult to overcome effective program-, of continuing c(iti- other health goals. It would not terest in working on other hcalte apprehension and suspicion. Glearly, cation iiiti%L be base(] on I)ro,,-t(.l be possible to achieve the lcgisla- problems, enlisting other sources ol the initial achievement of trust and an-,t@-ses of the capabilities -tn(i inter- tivc objectives efficiently if attempts support for this work. its reinforcement through action is ests and ittitti(-Ics of iii(@(lical in(.1 were made to sort out the frac- all essential ingredient of success. allied practitioners toward all types tions of i-ndirect effect. In some Definitiott of 'I'lic steps taken thus far (,all be of continuing cdLIC.ItiOll activities; instances, activities which have a the Regioii .Sflll ill tll(.. (.ollt(.Xt of only in this way cin tli(@ particular more general impact extending be- .iuclgc(l Public Law 89-239 provides consid the difficulty of the task. It %votild be role and I)Iic(- of programs concerned yoilti the, sl)ccific problems of heart, misleading either to underestimate Nvitli -,I)eciric categorical diseases be cancer, stroke and related diseases crable latitude for the definition c this difficulty or to assume that the determined. may need to be supported because t,rcgions . . . appropriate for carr) I)rograriis call be carried out %without 'I'lic criteria governing the award they arc essential to the achieve- ing out the purposes" of the Ac, However, the Surgeon General 112 a significant level of common under- of a Regional Medical Program grant talent of the purposes of Regional the responsibility for insuring that a standing. It is expected that under- are -,whether or not the activities in Medical Programs. Without the full parts of the country arc served an standing %vill grow through cxl)cri- the program are necessary for aciiiev- support of these basic activities that inappropriate overlap is avoidc( ciicc in working together. itig the established statutory objec- by Regional Medical Programs, ini- An early policy decision was t tives and %whether they reflect a 1)oi-tant underpinnings of the attack place initial responsibility for delii Categorical Nature coherent %vliolc centered upon ad- on heart disease, cancer, and stroke eating the "Regions" upon loc@ of .the Pr@,orani ' vanciiig the (juality and availability and related diseases would be missing. groups developing the planning appi Public LaNv 89-239 is directed at of services in t)ic areas of heart An example of this situation is the cations. It was foreseen that mar "heart disease, cancer, stroke, and re- (liseise, cancer, stroke tnd related financing of personnel and equipment considerations would need to I 25 ftken into account in arriving at tionships. It seems likely that a ntim- In the development of many of which have been accustomed to a these decisions, and that their rela- her of Regions will be modified. tli(! tpl)li(,ations for planning grant considerable degree of autonomy. tive weight would vary in different No single definition of a Region can funds, participation was largely coii- Achieving wi(ler participation an(] areas. The Pro@ram Guidelines pro- serve all of the progriin's purposes c(-ntrate(i in this limited grotil) of conimi.inication also requires in soi-ne vided that the Regions should be: with equal effectiveness. Therefore, l(@a(l(,-rs because of the necessity to cases tile modifying of attitudes based lean economically and socially cohe- determination of any Region is a work out the initial iccel)tance of on prior experiences, misunderstand- @ve area taking into consideration judgmental balancing of benefits and regional cooperative try-iingements ings of the purposes of the program, such factors as present and future liabilities. Consultation a m o n 9 among representatives of the major and fears of domination and control population trends and patterns of neighboring Regions, as between Mis- health interests. @IoNvever, the award by the large medical centers. In some growth; location and extent of trans- souri and Kansas, helps to identify of planning grints his provided tile !-cgions the split between "town" and the most effective division of re- funds and stifT time to mount con- 'gown," fre(luently the sckurcc of past portation and communication facili- sponsibilities. In some areas it may be certed efforts to extend the scope of tensions, has to be overcome. The ties and systems; and presence and best for individual hospitals and participation. lzcports fi-oiti the Re- progress reports, however, present distribution of educational and health groups to participate in different as- gioris indicated that programs iii(i encouraging evidence that the pro- facilities and programs. The region pects of several programs. In adcli- pi-ol)<)sils arc now being (]is(-tiss(-(l grim is, in fact, bringing the neces- should be functionally coherent; it tion, continuing arrangements for in- with ni(@ml)crs of l'icaltli professions, sary groups together, Region by Re- should follow appropriate existing terregional cooperation will help to gion. ']'rue collaboration will gener- relationships amone, institutions and institutions, and ni(!nibers of the ptib- serve the. effectiveness of individual ally involve stress, trial and error for existing patterns of Patient referral Region,;. li(- qt lai-4(! through workshops, meet- each Region to arrive at the most and continuing education; it should ings at coinititinity hospitals, confcr- suitable procedures and mechanism,, encompas.r a suflicient population Achieving Widespread ences Nvitli other local groups and to meet its needs. base for eff ective planning and use of Participation medical societies, and through State expensive and complex diagnostic conventions of health organizations. and treatment techniques." Role of the Regional Public Law 89-239 and its lcgisla- I-lowever, in many l@gions there Advisorv Groups It was recognized that original derini- still remains the substantial job of tions would necessarily be prelimi- tive history emphasize involvement of medical centers and practicing reaching many interested heiltli The (-omposition and role of the nary and might be modified by physicians in Regional Medical Pro- practitioners and other local groups. Regional Advisory Groups has re- findings from planning studies, re- grams. This emphasis has stimulated In some areas limitations of man- ceivcd considerable attention both finements in critcria and changing the active participation of the medi- ponvcr in(I time have not yet per- -,within the Regions and in the review conditions. cal schools and the leadership of mitteci sufficient investment in the of grint applications. This concern is Therefore, one principal objective physician organizations. The statit- complex in(I time-(-onsuining activity justified by the attention given in the of the initial planning is a more tory requirements for i-nembership on of developing new mechanisms for La%v and the legislative history, which precise definition of the preliminary planning Regions. The award of the the regional advisory groups has ex- cooperation. Tli(-, pace of progress is stressed the importance of these planning grant has been the begin- tended participation 'to ]elders of slowed by the frequent lack of exl)e- groups is mechanisms for both ning of the efTort to determine the other major health organizations and i-ience in %vorking tog(-tlier oil tli(@. icliif-.ving and monitoring the cffcc- Tilost appropriate current intcrrela- agencies. part of organizations and institutions tivcness of regional cooperative ar- 20 rangcments in meeting the needs of of kc(-I)itig current increasingly diffi- Programs are to help the medical pro- the people in the Region. The Law Coiitlitut?t,,, Educatioit cult for all involved in health care. fession and the medical institutions requires that these groups be broad- for Patie?tt Care regional Medical Programs are pro- of the Nation make available to their vi(ling new opportunities to develop patients "the latest advances in the ly representative of the major health Continuing education is an essential the essential linkages between edtica- diagnosis and treatment" of heart resources of the Region. It also insists Component of Itcgiotial Medical Pro- that members of the public familiar grains. It contributes in a iTiost direct tiori and practice, as an important disease, cancer, stroke and related with health needs be included. The way to the primary purposes of the means of diminishing professional ob- diseases. A narrow and rigid interprc- Law makes their approval of applica- Regional Medical Programs. Im- solcscence which is the inevitable tation of this section would seriously tions for operational grants a condi- corise(luciice of rapid scientific ad- hamper the cffcctivc accomplish- I)roveriients in patient care require tion of Federal grant Support. the primary participation of 1)rac- van(,e. Studies of better ways of pro- iiient of the purposes of the program. To carry out the full intent of the vidiiig health services, deiiioiistra- Improved health for patients threat- Law, the Pro-ram Guideli?zes and ticing physicians and other members tions of patient care, and educational encd or afflicted with these diseases of the health team in their daily prac- and training for all types of health requires emphasis on prevention the National Advisory Council have tice. Therefore, if the advances of personnel are joined together in a and rehabilitation as part of diagnos- stressed the importance of the con- biomedical research are to be made iiiiific(i effort. In continuing educa- tic and treatment procc@s. It rc- tinuing role for the Regional Advisory -ivailal)](- C i-oul) and the necessity for iiidel)(-@t (I- , to patients, tli(,. means must tioll, ;is ill otll(-T. (.ollll)otlcllt% of the (juires dissemination and widespread I I)c I)rovid(-.(l (-otitiiitiou-,Iy to cncc of its functions. As evidence unit the performance of all health 1)t-ofes- ])I.Ogl.,Illi, attention is focused directly rise of all relevant knowledge in the advisory grotil) is performing its sionals and supporting personnel. oil tile cluestioii, "Will this effort order to achieve the benefits of the role and is not a pro forma or sub- Ilo-,vcvei-, l@egiotial I\/Ic(li(-al Pro- (-.Iiaiig(,- beliavioi- and will this change "latest advances." serviciit group, an annual report is grains ai-(- riot exclusively nor even result, in fact, in the patient rccciv- The Public Health Service has required from the Advisory Group primarily a continuing education -f- ing the benefits of advances in heart encouraged the Regions to consider itself giving its evaluation of the cf- -- disease, cancer, and stroke?" health functions as a continuum and fcctivcness of regional cooperative fort. Continuing education is one t of Progress reports show Itegional not a set of isolated functions. This a number of iTicaris of %voi-king o- Medical ProgralTIs are proving to be continuum involves the environment arrangements. ward their total objectives. Continu- a strong catalyst to the entire field of research and teaching, where the The importance and composition I of these Advisory Groups have been. lllg CGucation projects, no i-nittcr how of (-continuing education and training latest advances in diagnosis and given further attention in a recent meritorious, are supported from Ite- of the health professions. They are treatment are most readily intro. policy statement of the Secrcta of gioiial Medical Program grant funds providing mechanisms for the coop- (luccri, as well as the other institution! ry only when they arc part of integrated, crativc relationships that can make the Department of Health, Educa (..Ollll)rclictisiv(-. approaches of cii- and groups involved in prcvcntinf tion, and Welfare on "Medical Care (-oiitinuiiig education more effective and caring for victims of these . I li;iii(-iiig i-t-giotiii for the Prices." This policy calls for sl)cciai (iiat'liosis and treatment of heart in improving patient care. diseases. To overcome existing gaps emphasis to be given to adequate and :I cffectivc consumer representation in disease, (-.aticet-, stroke, and relatc(i Latest Advances itt it is necessary to overcome problem the administration of Rcgionatt Mcdi- diseases. Diagnosis and Treatment of organization, distribution, man cal Programs. The Regional Advisory 'I'lic accelerating rate of advance power, cost, attitudes of the public o Groups arc a logical locus for that ill tile biomedical sciences and re- Section 900 (b) of Public Law 89- the health professions and evaluatioi representation. latc(i technology makes the problem 239 states that the Regional Medic.-ii of the effectiveness of activities ii 27 nstitti- I'lliat attain?ne?tt of this (ioal depends iiing. A diversity of patterns ,tn(i ianging the health status of the and serious commitments of i ?i (!gective partnership, iizvolt)i?t,, priorities, (leteriiiiii(-(l lay tll(' 1)('01)1(' tions and personnel. On a community call opulation.- clofe i?zter(loverillizeitial collabora- of ,i l@cgion, State, or rts, ii(.Il) to match programs to particular tzo?i, official a?td i.,olzi?itarv effo I Relationships to plan imposed by a ,imitations on Institutiona Other Programs and participation of ipi(lividital@v an(! needs. No master nd Personal Commitments I authority can be sensitive organizations; ccntra The great trends of accelerating sci- ',that Federal financial assistance or responsive- to the multiplicity of practical issue is raised by the cntific advances and rising public niiist be directed to support the mar- local conditions and requirements. iitial authorization of the program lllanning is to aid foresight and ra- n a 3-year exploratory basis. If the expectations in health have gener- of all health rcso?trci,s-?za- tional action, not dictate solution-,. activities and pro- tioital, State, ayid local-to ass?iril irogram is to succeed, institutions ated many new The second is that decisions in- ,nd organizations must commit them- grams to stimulate and support con- co?@ipreltt,?isivt, liealtlt se?-z)ices of volving health involve the whole of elves to participation in regional co- ccrtcd action for health across the qii,71ity for everi) person, bar ivitliolit so(,icty, not just a few public or pri- Nation. Regional Medical Programs existiytg patterns of yperativc arrangements which may interference z(,itli v;ttc ]'\atlit,r all those af- nvolve somc lessening of their in(ic- are part of tli(, response to tlics(! firii@ati! I)rof(,S.@ional practice of ??led- I)y the.%(! I)rogratns-I)rovidcr.-, function. Many of these forces. Other major actions relate to icillc, (it.,ntistr3, and related lzi!alill,, )cndence of .1 and (-onStITners, public and private nstitutions arc under continuous financing the costs of medical care, arts." groups, educators and practitioners- inancial pressures. Full commitments education for the health profession%, iiiatiy and (ii-,,crs(-. li(-altli pro- must participate actively in decision @ new patterns of relationships in- delivery of mcntal health service,; it, .0 grains, both nationally and in the IZ(!- making. I)ivision and fragmentation s in attitudes. For these the community, ;trcngthening public volve change golfs, States and (communities, iTnl)air progress tnd eftcctiveness. reasons it is very difficult to obtain health services and planning and con- contribute to these goals. I-To%veve" 'Flicsc two principles are demon- this full commitment on the basis of struction of hospitals and other various thrusts must 1)(-. iziterrclat(!(l strated with special clarity in two a limited authorization of the pro- facilities. to achieve maximum implicit and ef- major new Federal programs designed gram. In the preamble to the most recent fectiveness. Utilizing resources wisely to pull together a number of efTorts Similar problems apply in recruit- of the major Federal enactments, tile in the many promising avenues (,)f whose impact has been difTused in the ing talented manpower. High caliber Comprehensive Health Planning and health activity calls for planning an(] past: the Regional Medical Pro- people are reluctant to make career Public Health Services Amendments 0 peration at many levels and the s, and the Comprehensive of 1966 (Public Law 89-749), the 0 cc of grain ttithorized changes when the permanency of the Congress made the following state- recognition of the preponderan total Health Planning Program , program is under question. The de- nonfc(l(!r-.tl financing for tile by Public Law 89-749. The first seek.,, mitment already achieved ment of national health purpose: health function. to gree of corn "The Congress declares that /?Ilfill- 'I'%vo fundamental principles, both . stimulate the development of co- in the initial phases of the program ment of our national purpose depends implicit in the Congressional dcclara- operative arrangements for programs is the b,-tsis of hopeful expectations. II tile directed toward enlarging the avail- on promoting and assitrin, the hieh- tion of purpose, just cited, gover g the qutlity of However, it will be difficult to obtain I ability and cniiancin -,t valid trial on which to base judg- est level of health;attainable for everv I-eder-,it 1)arti(-il)atiozi in health pro- care provided for major disca%c prob- ments of the ultimate effectiveness if person, in an environment iviiich con- grams. o local, ]cm% on a regional i)asis; the second tile nature of the program autlioriza- tributes positively to healthful indi- 'I'lle first is a commitment t to stimulate effective planning tion does not cncoiltragc voluntary vidual and family livin-; broadly based initiative and plan- seeks .1 28 Cancer Institute, National Institute program with other activities suP- Federal grant funds, while they for the use of all existing resources d- ported pursuant to the authority con- can provide only partial support, and the sound further development of Neurological I)iscases and Bliii I tained in the Public I-lealth Service must be adequate to stimulate tile of health resources by the States, liess, National Institute of Genera - continuing technological and social ,s, National Libriiy Act and other Acts of Congress in metropolitan areas and local coin- Medical science eluding those rclating to planning innovations Lo translate the latest inunitics. The two programs are in of medicine, National Center for and use of facilities, personnel, and scientific advances into the daily conccl-)t complementary and mutually Chronic I)iscase Control and the equipment, and training of man- practice of medicine at the commu- National Center for Health Statistics. nity level. The "venture capital" for supportive. de- power." A policy statement has been issued W(.)rking relationships arc being such.innovative efforts must, in large vclol)c(l %vitli the lic%v ]@ureau of . . . c)onccrning these two programs which be- IZelatio?zship Between Federal measure, be supplied initially frorr@ outlines general areas of rclationsliii) I-lealtli Maiii)oNver tii(i plans are itfe(leral Firianci?z,, public funds. The potential return i, and support. (Lxliibit XI) Practical ing made for collaboration wit]' tile and No high and will accrue to individuals operating methods under these con- I)rol)os(!d Nitional Center for I-lealtli d I)cvelopment. l@cgional Nlcdical Programs can throughout the Nation. A relatively being refined. Di,;- Services Research an ccpts arc now serve as an integrating force to bring small amount of new money, wisel, cussions arc taking place through- Similar cool)e-ritiot, is being dcvcl- to bear all the resources required to and flexibly applied and fully coordi out the country, at the levels where OI)C(L with Igciicics Outside the Pill)- reduce tile toll from heart disease) natcd with related efforts, can hel] the coordination must be put into lic llciltli Service, such as the Voca- cancer, stroke and related diseases. assure that benefits from the "cuttin practice. These arc tile most critical tiotial Rehabilitation Administration, t funds under Public Law 89- edge of science" are realized bot' decisions of all, for, as Secretary tile Veterans Administration and the Gran ill necessarily provide only a now and in the future. Gardncr has pointed out: "We are, Department of I-lousitig and Urban 239 w the total funds As noted previously the impa@ Development. 'riiis partial listing of very small fraction of beginning to understand that iilticli the programs %vilose illissiotis relate necessary to meet all the identified of this program on medical cai of tile problem of coordination iiitt%L otial Medi6al Pro- needs. 'I'llc costs of these diseases costs has yet to be ascertained. be solved at the local level. If the to that of tile Itegi ni- constitute a large portion of the Na- the benefits of this program do resu Federal Government tried to coordi- grains is all indication of the inag tion's $43 billion health care cxpendi- in warrantable additions to heal natc all its programs at the Washing- tilde of the coordinating task. turcs. The f Lill application of medical services costs, the extent to whi( ton level, it would end ul) imposing t The need for and responsibilities . tific advances it, the diagnosis sucil costs can be met by norm scicn tc and local govern- of Regional Medical Programs to pattern on Sta of anct treatment of heart disease, can- financing methods versus direct Fe mcnt. More important, only State and identify tile most effective %vays cer, stroke and related diseases will cral support through Regional Me( local leadership has the knowledge linking programs at the regional level require additional support from many cal Programs will require carcl of local needs and resources that will arc emphasized in tile Pro(,ram R(,,,,,,- s. Regional examination. I)Ilblic and private source enable them to put all the programs tilatio?ts and Giii(irli?tes. These indi @edical Programs will ill fact provide together in a way that makes sense." Cate, that in a%vat-(Iing graiits, tile only a minor share of financing for The Role of Arrangements arc being made to Surgeon General %vill take into con- tile full range of activities relevant University Medical Centers insurc close coordination between sidcration "the extent to wilicli tile to accomplishing the purposes of the - Regional Medical Programs and applicant or tile participants in the La%v, even though formal matching Public Law 89-239 does not SPCC other Federal activities. Continuing -in to (,oor(iiii.,xte or li,,tvc requirements arc limited to construe- the role of the university medical cl liaison is tilaitltlill(,(l %viti, tli(- Ni- I)I.ogriiii 1)1. tllc I)I-ograiiis. tei-s in the dtvclol)iiict)L of Rcgio I ill(@ regional tioll ;isl)c(:Lli of tional IleirL IIIStittitc, the, Nitt'oll:tl 29 lical Programs. Yet the nature of total health resources of the Region cooperative program; (4-) the estil)- from the increasing sophistication and functions to be carried out by the with an ultimate focus on improving lisbment of new nonprofit corpora- experience gained in the course of ional Medical Programs has the quality of patient care. tions with boards of directors rel)- full program operations. Others will I(- the university medical centers a Since university medical centers resentative of the major health require further evolution of national [ resource in most areas for ac- have played prominent leidcrsliii) interests iii(i having as their major health policies and attitudes. Certain plishing the objectives of the roles in the initial development of responsibility the planning and ad- arc dependent upon clear executive r. In many Regions the university most of the Regional Medical Pro- ministration of the Itcgional Medical or legislative action and form the [ical centers have played leader- grams, these concerns about diver- Program. basis of the recommendations con- sion, dominance, and administrative The creation of new administra- tained in the following section. roles in initiating the develop- it of the Regional Medical capacity deserve careful attention. tive structures outside of tile iiniver- gmms. Solutions to these problems require sity medical center framework, as de- ome medical leaders have scri- new forms of relationships between velope(I in a number of Regions, seem y questioned whether the uni- the university medical center,.% and to offer a most attractive solution ;ity is an appropriate focus for the other health resources of the to the problems noted. These new en- leadership of these cooperative Regions. titics, however, create other I)n-)))Icms ,rts. These doubts are raised from related to the provision of sufficient !ral points of view: (1) Some Coordination and Leadership status and stability to attract the high hear school faculty members and caliber I)cisonnel rcqtiired for the Various mechanisms are being planning and administration of the ,iinistrators have concerns that rional Medical Program respon- tested for administering and coor(ii- Region Medical Programs. If these lities might divert medical school nating regional efforts: (I) the de- innovative approacii(-.s to the admin- )tirces from carrying out their vclopment of new administrative istt-,ttion of coopcrativ(- health a,(7tivi- @hing and research functions. (2) frameworks within the university and ties prove effective, they may be a ier health representatives have ex- formalized administrative relation- useful rtieclianisni for broader health ssed concern that medical school ships with the other primary health purposes. I'licy may, in fact, provide lership will result in domination resources; (.2) the use of executive a useful prototype for relating the re- absorption of other health re- coordinating committees representa- sources of tile university to broader rres b the medical schools to tivc of major health interests which social needs without tindtic diversion .y ve their educational and research can serve as decision-making bodies of the tiniver-,ity's attention from 2rests. (3) Questions have been closely related to day-to-day opcrat- functions of teaching and research. ;cd from many sources about the ing problems, reserving for the large )acity of university medical centers Regional Advisory Groups a more IZ(-gioiiil Medical Programs will expand their administrative general advisory and policy-making (,continue to contend with this art-ay of meworks to encompass the plan- function; (3) the utilization of exist- problems listed, as they continue ig and administrative implementa- ing nonprofit corporations as frame- their development. The resolution of n of a ma .or effort involving the works for administration of the most of these matters will derive 2(39-(149 O-(;7-:t us C'onci Recomr SECTION l@"IVEConclusions and Recommendations A 5-year extension should attract On the basis of the initial experience operative arrangements. These initial about the Regional Medical Program rm commitment of the in the implementation of Public Law efforts re(Iiiire ail environment of concept. Most have been reassured on the long-te people, and d rcc- stability and status ill %which per- the value of this approach as major kind and quality of 89-239 certain conclusions an inancnt eftectivc co-operation can regional interests have come together the full participation of all affected oinmendations are indicated. scntial to the to determine locally the most appro- institutions which arc es flourish. priatc and effective ways of moving program's success. This requirement (:ON(,i,tisioNS [7 'I'lic initial progress provides solid the program forward in their Regions. calls for an authorization that, in both 13 An cftective beginning has been evidence for continuing tli(! program Groups throughout the Nation are its duration and its level of funding, made in the creation of cooperative without modification of its essential coming to recognize that through Re- will indicate a national intent to arrangements among the health re- nature and purposes- gional Medical Programs, local plan- maintain this eflort until the job is sources on a regional basis for im- A more effective means for meet- ning, decision-making, initiative, and done. plementing the purposes of the Law. the special space needs generated capabilities to meet the needs of Funds for Regional Medical Pro- ing be a critical factor, even ange- by this program is requisite to the full patients with heart disease, cancer, grams can The regional cooperative arr iseases can be though they are only a small fmction ments being established and the plans achievement of the purposes of the stroke and related d being developed and implemented legislation. enhanced significantly. of the total national expenditures for show great promise for providing the Individuals undertaking regional heart disease, cancer, stroke, and re- es. For these funds, effec- benefits of the advances of medical planning have reported that uncer- latcd discas science to persons threatened or af- Exte?tsion of the Act tainty about the program's future is a tively used, can be a fulcrum in rais- flictcd with heart disease, cancer, serious obstacle in recruiting well ing the quality of care generally stroke, and related diseases. . qualified persons for leadership and throughout the country as well as in The Regional Medical Programs As discussed in the earlier sections of key staff positions. Some institutions significantly enhancing the diagnosis the Itcport, the surn of experiences in and agencies have been reluctant to tmcnt of these diseases. will be seeking to accomplish their the development of Regional Mcdi- and trca mission during a time when many embark upon a course of action, what- Experience gained thus far indi- major problems beset our health pro- cal Programs throughout ilic country ever its promise and potential, with- cates that the annual cost of operationI fcssions and institutions. The Re- demonstrates the validity and poten- out reasonable assurance that the for each Regional Medical Program gional Medical Programs seem to tial of these new cooperative ar- program will be continued. There- may be as much as $10 million or provide a relevant and useful tool in rangcincnts in I)otli planning and fore, extension of the program will more. There are several bases for this the search for better solutions to action. 'I'lic needs are pressing and prevent a loss of momentum and estimate. The initial operational these health problems. the opportunities promising for mak- enthusiasm already achieved and will grants and the plans being developed ing available the benefits of medical T)rovide a firm basis for strengthening around the Nation indicate that there The extension of this program research advances. The establishment and the indication of substantial of the Itcgiotial Medical Programs as and building upon the beginning are myriad opportunities for improv- further national support arc needed, continuing instrui-ncnts in the health efforts. The importance of this ing the diagnosis and treatment of to sustain and nurture the individual field %vill contribute significantly to momentum and enthusiasm for the heart disease, cancer, stroke, and re- and institutional commitments as well the fulfillment of these opportunities. success of a voluntary cooperative lated diseases by bringing the latest as the enthusiasm which give vigor Many groups and individuals initi- endeavor should not be underesti- advances into the daily practice of and substance to the regional co- ally expressed uncertainty and doubt iiiated. medicine in all parts of the Nation. 33 The number of potential partici- facilities. It thus i(lentific(i the need obtained froyti Regional Medical Pro- lag between identifying a need for pants-institutions, groups, agencies, for facilitating construction in tii(- grain Coordinators @iii(i key stiff, IZ(-- construction and the -.tvailil)ility of and health personnel-is very great. successful development of Regional gional Advisory Group Members, and the facility is so great, this coliipcti- All must contribute if the benefits of Medical Programs. others iii%,olve(i tvitli programs tivc position might seriously cl(!Iay the the programs are to be widely avail- In enacting Public Law 89-239, at the regional level indicates that inipl(-inentation of the Itcgional Med- able to the population of the Nation. however, Congress amended that pro- there are major needs in a number of ical Program. Frequently, sophisticated and ex- vision to limit construction authority areas. These inadequacies will ham- It is also important that the types of pensive equipment is required be- to "alteration, major repair, remodel- per activities within the next several needs cited below be given adequate cause of the high order of technolo gi- ing and renovation of existing build- years as Regional Medical Programs consideration during the general ex- cal innovation entailed by many ings" during the initial period of move into tli(@ operational phase and T)ansion of health facilities of the recent medical and related advances. authorization' In so doing, the Report their range of activities increases. Nation. Only then %vill tfic activities This equipment will advance clinical, of the Ilouse Committee on Inter- 'I'lic likelihood of significant litnita- represented by them become an communication and computing serv- state and Foreign Commerce stated: tions on Itegional Medical Program integral part of the functions of the ices, Many technological innovations "The lack of this authority for new tctiviti(@s froy-n sl)ac(-. sliortag(-s is in(-dicii institutions of the Rej:tions: should be rapidly introduced to bring construction should create no serious increased by the ov(!rwli(-Iiiiing (I(!- n Space for continuing education to pitients the benefits of the ad- problems during the three years an- man(I for nc%v health facilities gen- prograitis and trnt?ting pitrpo.@rs iv vances. This will require effective rc- thorized in this legislation and when erally in the years immediately n(,t,ded, including class- @onal planning with the cooperative a request is made for extension of ahead. The demands of an expanded roontq a?itl conference room space, involvement of full-ran9c medical this legislation in the future, the com- population and its (Icsircs for high resources. It will also require sources mittce will review this question quality medical care, tli(- expansion learnin,,a center facilities, and medical of funding to be spent on the basis of again." of medical education facilities and reference! and audiovisual facilities. 'this is the need most frequently regional priorities which do not have The lack of authority to assist new the backlog of demand for health cited by ltegional Programs and to compete with pressing needs of the construction has not presented serious research facilities all indicate very other groups, such is the Association individual institutions. obstacles to the initial planning -in(I great coy-nl)etition for funds to fininc(- of I losl)ital I)ire(-tors of Medical Edii- It is recommended that the pro- development of Regional Medical the necessary facility expansion. (latioTi.. It is particularly actite in gram be establislwd on a continuing Programs. Thus, the early judgments The types of construction needs ('011]lnunity hospitals. basis. of the Congress have been confin-ned. described below, defined according to Experience, however, has identified regional priorities, will have great (lif- In the past there has been -,a paucity New Construction of several areas in which authority to rictilty in competing successfully with of operational support in both com- essential Facilities assist new construction will be essen- the immediate and ovet-%vlit-Iniing Fzitinity hospitals -,iTi(I medical centers tial to the full development of Re- construction needs to house ad(-- for continuing education activities. The original Administration proposal gional Medical Programs. qtiately the basic functions of the par- same situation his been true to the Congress in 1965 requesting Specific construction needs essen- ticil)ating institutions. Construction with respect to capital expenditures. legislative authority for Regional tial to the work of Regional Medical of facilities needed for tli(- purposes Most of tlit! NatinTi's 7,000 liospit-tis, Medical Programs included grant as- Programs li,-tvc been more clearly de- of the ]regional Medical Program is tli(! sin-,ill(-r oties, simply do sistancc for construction of new as fined and documented (hiring the likely to be (lelay(-d until these tirgent not llav(-. (existing space that ran be ,Nell as the renovation of existing initial planning phase. Information institutional needs arc met. Since the (,otiv(@rteci oi- renovate(] for edtica- 6.4 tional purposes. The same holds true to demonstrate to practicing physi- diagnostic tests and procedures, and be limited to facilities that are essen- for most medical schools, most of cians, nurses, and allied personnel the the fullcr use by practitioners of exist- tial, carefully selected, and designed which cannot significantly expand use of these and similar advanced ing tests, depend upon adequate hos- to meet regional needs. Each such their present postgraduate c(luca- tools and techniques for diagnosis and pital laboratory facilities. Such facili- request will need to be approved by tioti programs without additional treatment. tics will serve as teaching laboratories the Regional Advisory Group which space and facilities. In the past, as for medical technologists and other represents the major health interests documented by the 1962 survey of Only if physicians and the other rnem- supporting personnel. of the Region. This review and ap- bcrs of the health care team Icarn'liow proval process will ensure that an the American Medical Association to utilize these advances "by doing," M The establishment of integrated Council of Medical Education, con- and have the required facilities avail- data banks and commvnications sys- excessive amount of attention and grams have not funds arc not devoted to construc- tinuing education pr@ able to ilictii at the (@oiii,liuiity level, tems for the storage and rapid trans- tion, and that no construction is been a major responsibility and in- will they be able to fully exploit the mission of diagnostic information, undertaken exclusively or primarily icrest of most medical schools; tc- continuing education and training patient records, cte., requires space cordingly, the development of al)l)ro- for the benefit of any single institu- priatc resources (including related afforded them, and bring to their to house the computer and communt'- tion or group in the Region. patients the full benefit of their cations facilities. Similarly, television facilities and space) was usually Icarnitig. and radio transmission of continuing Most community hospitals, mcdi- neglected. Most coriiiiiiiiiity lio-,I)itils do not education programs will require new cal schools, and other institutions In both (-,oinniutiity hospitals and now naive such ft(!ilities. In the case space and facilities. would have serious or insurmountable Is- medical schools, the pressures of 11, of ol(ici- lio-,I)ittis, a(ic(luate provision Most Regional Medical Programs difficulties in raising matching funds itig cxl)cn(littir(-.s for direct patient was not made for the inclusion of are undertaking inventories of exist- for construction of facilities needed (,arc liav(@ made it impossible to stt(-Ii ficiliti(@-, I)c(@atise the iiig facilities for both educational and for.continuing education and demon- allocate suflicicnt funds to the con- underlying advance-, which make specialized clinical care activities re- stration essential to meet regional tinuing education activities that arc continuing education a 'necessity latitig to heart disease, cancer, stroke needs. The regional nature of tht essential to high quality care. 'I'litis, today ]lad not yet been made; ncwcr and related activities. These planning program may make it especially diffi@ the potential impact of continuing hospitals often were unable to in- cfrorts are being closely coordinated cult for any individual agency to ob education and training programs in cltide sufficient space for these 1)ur- with State and arca-widc hospital tain substantial funds for this pur lic.ti-t disease, cancer, stroke, and re- 1)oses because of limited fLIlIfIS (I)ub- planning agencies. Experience in ad- 1)ose. The current matching require latcd diseases will be seriously liam- lic and private) available for initial ininistratioti by the Public Health merit of 10 percent applicable to ren J)cred unless essential facilities are construction. I)cvclol)itig these facili- Service of other recent programs, ovation and aitcration of facilities, re constructed. ties on the basis of regional planning such as the construction of commu- quires a local commitment withou 0 There is a critical need for addi- will permit great educational impact nity mental health centers and mental impeding progress. A larger matchin tional space and facilities for patient at minimal cost. retardation facilities, has developed requirement at this time in the devel care demonstration and training pur- patterns and procedures that can help opment of this pioneering new prc poses. Intensive care units, radium 0 Some community hospitals have a.-,sure necessary coordination of therapy facilities, and specialized sur- ?Iced for additional space for new or effort. gram could be self-defeating. g,cal suites arc, for example, often expanded diagnostic laboratory facili- The construction of new facilities It is recommended, therefore, the .1 necessary in order to provide facilities ties. l@otli the introduction of new for Itegional Medical Programs must adequate means be found to meet IA 35 needs for construction of such facili- Service Act (I lospitat an(] Med- with other lzcgioris. IT]tcrr(!gion,,i] 'I'o licIT) -.1ciii(!V(! (-Otllpltil)ilit .y in out the ical Facilities and I-Icaltli Pro- operative cfl'ort-, involving several communication networks and corn ties as are essential to carry purposes of Regional Medical Pro- fcssions Educational Facilities Regions liav(! tlrca(ly evolved in t systems. grams. Priority should be given to Construction Programs) nunil)(-t- of it-eis throughout tile 'I'o plan -ind conduct joint cpi- facilities required for continuing edu- country. In some instances, tllcs(,- (lemiological an(] research -,tti(:Iics. cafion, training, and related demon- Support of Interregional and Other arrangements arc still informal; in r7 'I'o develop jointly common eciti- Supportin,, Activities others, iiiterrcgional -,agencies -arc be- .tfratt'ons of patient care, particularly cational programs an(] materials. itt community hospitals. The present Act authorizes grants for ing established. To orient and train staff person- In meeting these needs, the follow- These interregional activities have El ing considerations should be taken the planning and opcrttion of inili- ariscii in t-(-.%Tx)nsc to real Tl(!C(ls. It(.- ll(,I. vidual Regional Medical Progriins. ik soiti(!wliat similar situation lia.,; into account: No consideration was given during gions liive identified t iiiityiber of 1. Construction undertaken for objectives that can be best served been identified with respect to cer- Regional Medical Programs the development of the legislation to and activities carried out in this wiy. t-,iin specialized needs common. to all should be directly supportive of support for other activities which or ,t number of Regions. '['he support the operational programs and might contribute to the implemcnt-,L- Among the principal potential I)cnc- of a limited number of facilities and should be broadly distributed tion of the Regional' Medical Pro- fits in! tile following: prograTiis is needed to develop tecii- grams. These activities include both n To facilititc communications for maximum impact. This niques and prepare personnel to might be done by (1) limiting cooperative efforts among several Itc- among Regions, including exchange IIacilitatc the work of individual Re- the amount available for con- gions and other activities supported of information on approaches to and ional Mcriical Programs. The sup- centrally which make available to all problems in plinning ind rogram 9 struction to no more than 15 or several Regions specialized skills development. p I)ort of such activit@ in agencies percent of the total appropria- and rcsotirc s which are not general that can serve a number or all of the tion for operational activities; c ly F-1 'I'o help in defining r(@sl)onsibili- Itegions will avoid unnecessary delay distributed throughout the Regions. - and (2) restricting grants for The desirability for extensive co- ties and coordinating efforts in "in- and duplication of effort and make such construction to no more operation among Regional Programs terfacc" areas between Regions. the best use of specialized facilities. than $500,000 for any single Fl To fostcr consistency in -,ip- Central support for these activities project. was foreseen. However, the extent of proaches to the conduct of planning will enibic the Division of Regional 2. The special space needs of the and rapidity with which cooperative studies. Medical Programs to make avail- program. can be met either arrangements among Regions would -tl)le to some regions skills and re- through additional authority to develop was not fully anticipated. Fl To achieve comparability in data aid new construction as part of Nor, in turn, was the corollary need collection and program evaluation. sources which are not available with- in the Region. This assistance at a grants for Regional Medical for additional funding for this ptir- To develop and apply better and crucial time in the development of a Programs under Title TX of the pose apparent. more comprehensive int!tlio(is of pro- regional program could improve the Public Health Service Act or During the first year of the pro- gram evaluation. qtiality.-inci accelerate the pace of the through other mechanisms, such gram, individual Regional Medical @ To titilizc more effectively skilic(l r(-gion's -,tctivitics. as amendments to Title VI and Programs devoted considerable at- manpower, specialized facilities inci For example, continuing education Title VII of the Public Health tcntion to coordinating their efforts resources in(] training programs will require 36 significant numbers of specialized or demonstration activi tics carried out Region. The effectiveness of the I)ro- such an approach is identified as the professional personnel (e.g., educa- %vitli funds appropriated pursuant to grams operated by Federal hospitals most desirable way to strengthen the tion specialists, comniunication and this title, unless he has been referred can be enhanced by close cooperation total Regional Medical Program. As information specialists). Many of to such facility by a practicing 1)liy- and sharing of effort and resources in the case of all other projects pro- these categories of personnel ar(! in sician." with other health facilities in neigh- posed for support as part of Regional scarce supply and the facilities in In certain instances, in carrying out boring communities. Medical Programs, such requests which they can be trained are the programs authorized by the lcgis- The Congress recognized and en- must be part of tl-e overall regional limited. lation, a (icntal practitioner may as- dorsed this principle in enacting the program and will need to be approved There are also numerous studies suiiic responsibility for the referral of Veterans Hospitalization and Medi- by the Regional Advisory Group and and demonstrations that need to be a patient. For example, a patient with cal Services Amendments of 1966, the National Advisory Council on Re- carried out in such areas as motiva- oral cancer may be diagnosed by a Public Law 89-785 'enacted Novem- gional Medical Programs. tion, learning theory and evaluation dentist and referred by him for treat- ber 7, 1966. Among other provisions, It is recommended the Federal hos- affecting both continuing education iiient and rehabilitation. It is dcsir- this legislation authorized the Vet- pitals be considered and assisted in and other aspects of Regional Med- able to clarify the Lay to cover this crans Administration to enter into the same ways as community hospi- ical Programs. In many instances, type of situation. cooperative agreements for the shar- tals in planning and carrying out Re- these studies will call for resources in It is rccoy?i?@zettdcd that patients ing.of medical facilities, equipment gional Medical Programs. This m(>di- one Region to study these issues in a referred by practicing dentists be in- and information with medical schools, fication will, in effect, increase the number of Itcgions. '['lie-,c iziterre- clritled in research, training and hospitals, research centers and oLliers. flexibility, discretion and capabilities gional efrorts, too, will substantially tlc"zoristratiott activities carried out 'I'lic Law required that, to the maxi- of Itcgiotial Programs. assist and expedite work of the iiidi- as necessary parts of I?cgional Mcdi- iiiutn extent practicable, such pro- vidual Regional Medical Programs. cal Programs. This modification is in grams should be coordinated with It is recommended that an effective line 6vitil the original intent of the Regional Medical Programs. A somc- mechanism be found for the support legislation in this regard and Would what similar provision is included for of interregional activities necessary correct the original oversight. Public Health Service Hospitals in to the development of Regional Mcd- legislation now pending before the ical Programs. This assistance will Funding of Activities Congress. facilitate the work and implcmcnta- In Federal Hospitals While the staffs of Federal hospitals tion of individual Regional Medical may now participate directly in plan- Programs. Veterans Administration and Public ning Regional Medical Programs, Health Service Hospitals in many those institutions are not eligible to Referrals by areas have been involved in the plan- receive funds from the grants author- Practicing Dentists ning of Regional'Medical Programs. ized by Public Law 89-239. Thus, a The participation of these institu- technical modification is necessary to Section 901 (c) of the Act provides tions has been particularly helpful and authorize Federal hospitals to receive that "no patient shall be furnished desirable in light of their significant such funds on the same basis as other hospital, medical, or other care at any role in providing diagnosis and treat- hospitals. In this way, programs can facilitv incident to research. traininc,. nicnt sem-iccs to man,,- residents of the be developed in these facilities when egi ent pa po@u @.@ganiia se es oun iti ihis" -,Exciip SW am @@ @ VW S-UPPLEMENT Rcgional Mcdical Programs in Action Itcgional Medical 11'rograins are best Collectively these reports reveal, in bcr of directions since the receipt of a habilitative groups, and members of defined by the particular actions and some detail, the accomplishments and planning grant in December 1966. the public. This Group has met seven activities being undertaken across the problems of individual Regional Even with this previous experience times through March@r almost country. In this Chapter, outlines of Medical Programs. It is through of cooperative arrangements, how- monthly since its creation in mid- a number of individual Programs arc these individual efforts and actions ever, there was need to plan for an 1966. presented. that Itegioiial Medical Programs will Iowa Regional Medical Program. The goals which the Iowa Re- r-i Four reports sunit-narizc what has be more precisely defined and ulti- 'this preliminary planning involved gional Medical Program has set for iiately will serve the needs of the Na- coo)cration between the Medical itself, with the advice of the Regional happened in the plallizin,, of the I. I tion's medical I)rofcssions, institutions Center and three other major health Advisory Group, a-re to: (1) aug. Iowa, Nortli Carolina, Washinzton- ;Ilici patients. planning groups-thc Health Plan- ment present education and training .Alaska, and Western New Yor@ Re- gional Medical Programs. They surn- ning Council of Iowa, a voluntary capabilities; (2) improve continuing marizc salient developments in the I'I,ANNIN(; (;It,,\N'I'S agency organized to coordinate state- education programs; (3) expand re- 1)rciii-ninary and initial planning loiv,a Itegional wide health care planning; the Coun- search programs; (4) broaden re- phases and the interaction among Medical Ilrograiii cil on Social Agencies of Des Moincs; gional communication to promote various institutions and groups that and the Des Moincs Health Planning dissemination and interchanges of has occurred. 'I'lle lo%vt ltegiozial M(-@flical Pro- Council. Other localities are also or- knowledge and techniques; (5) de- n Two reports indicate the iitLtire grain, lik(! a number of others, is ganiziilg planning groups that will vclop programs for public education; of the initial operational activities of built on a significant base of past re- be related to the Regional Medical and (6) develop demonstration units the Intermountain and Missouri Itc- gional activities. Extensive intcz-rcia- 1'rograni. and systems. giotial Medical Ilrograiiis.'ricy high- tionsltil)s between hospitals and prac- 'I'lic Regional Advisory Group, To accomplish these goals, the Pro- light how these activities will benefit titioiiers have developed overrate last designated to guide the expanded cf- gram has been organized into four fort now being embarked upon, is sub-areas: an Education Program, a the practicing physician and his 50 years. By an interchange of 1)a- broadly representative of all of the Research Program, a Comprehensive patients. tictits, physicians throughout the Itegion's health professions and Patient Care Program, and a Com- n In addition, excerpts arc I)rc- State have Ibecome, in effect, intc- agencies. It includes the Dean of the munications Program. gratcd with the activities of the staff College of Medicine, the Commis- Within the Education Program, for scntcd from the annual pro,,rcss re- .S of the University of Iowa Medical siorier of I-Icalth, Past Presidents of example, studies have been initiated portsof the 10 Itcgional Medical Pro- Gctiter. Continuing education pro- the Iowa State Medical Society, grams for which the first grants were to develop basic 2-year curricula for cffcctivc July 1, 1966-Albany (New grams have been developed over the I-Icart Association, Cancer Society postgraduate education on heart York), Connecticut, Hawaii, Inter- last 30 years and include courses at and League for Nursing; also in- disease, cancer and stroke. These mountain, Kansas, Missouri, North the Medical Center, programs at eluded arc representatives of the Iowa curricula, once developed and tested, Carolina, Northern New England, community hospitals, and closed cir- Hospital Association, Society of will be taught through a coordinated Tennessee Mid-Soutli, and Texas. cuit television educational programs Osteopathic Physicians and Surgeons, program of the College of Medicine These excerpts provide further in- between the Center and a number of I)cntal Associations, Nursing Home and regional hospitals, utilizing live sights into specific aspects of the Re- these hospitals. As a result, it has been Association, Nurses Association, State conferences and video-taped mate- gioiial Programs. possible to move forward in a iiuni- Department of Social Welfare, re- rials. Extension of this endeavor to 39 tile University of North (lental, nursing, pharmaceutical, .ind -r II(.,Vltll professional e community level for individuals Nortli Carolina CIroliil"t ;(,.Ilool of plll)li(., Health otli(. . . I)iiysi(-ian,,, tile, ,ins using Society of North sociatioiis, small groups of phyqici, is also Regional Medica-I Program and tile. N,fe(lical North Carolina Ilcaltli Council, tile inescopc presentations Carolina. It has adopted Articles of (leans of tile, three medical school,;, a )ntemplated. In North Carolina, as in many other Association, an(] es .tablisile(i t ]3oarci ciministritor, -.tn(i Other pi-,inning activities or T)roi- states and region,, in tile country, of T)ii-ectors %wind, has been actively leading hospital a cts in the other progm, m sub-arcas planning for regionalized ineclicil ,vorking Nvitil the Program Goor(ii- IllelTll)crs of tile public. They have ave also been initiated. These in. and health programs has been Tiator and Advisory Council. met monthly since August 1966, and ber of different agencies rail have conducted intensive reviews of ,olve a num underway for over twenty years. To provide leadership and ove )r groups. For ccample: However, limited resources and other direction to its Program, North Caro- project applications. rtmcnt Of local factors have resulted in incom- lina selected as Program Coordinator, Subcommittees Of tile Council have The Iowa State Dcpa Musser, a I)I-iysici,,in @vitli also been organized to focus on and n. 4ealth is planning program elements lete implementation of these pla s Dr. Marc, j p ,which concern public health gcner- Passage of the regional Mccit- extensive (experience in medical e(,Itt- provide expertise in specific problem illy, professional and public com- c-,tl Program legislation 1)rovidcci in catioli, itic(lic,-tl research and a(iminis- areas, such as heart disease, cancer, munications, d@ase entity report- opportunity for North Carolina to trition. Ilis prior position as Deputy ,troke and dentistry. ]represented on ing and health manpower. move ahead quickly and build upon Chief Ntc(lical T)irector of the Vet- these subcommittees are all the lead- its past experiences in eievclopin,@ a (@rans A(itriiiiistr-,itioii and his I)rcvi- iiig organization-, and expert,; in the The University of Iowa Depart- Regional Medical Program. oils 25 years as Professor of Medicine respective fields in North Carolina. ment of Economics is involved in re- The Program wis established with at tile University of Wisconsin School For example, the Subcommittee on search on the economic stnicturc and performance of th.c medical care- in- the anvard of one of the first plan- of Ivic(licinc provided background Cancer is composed of rcpresentativvs. dustry in Iowa. One of its first proj- ning grants effective on July 1, 1966. and stattirc invaluable to tile from the Cancer Society, all the offi- ects is the delineation of the Iowa Even before the legislation was Program. cial relevant State agencies, practic- signed into La%v, the deans of the A '-)5 iiiciril)cr Advisory Council, ing physicians, the experts from the Medical Care Region, considering three medical schools in the State levant North Carolina Division of the economic and demographic factors, met with the President of the Mcdi. representing tile. major re ollege of Surgeons, the traditional service areas and political Executive I.Ic-,tltli interests in tile State, was Aiiicric,-tti C nd the State Medi- cal Society to form an advice medical schools, a boundaries. Committee to make preliminary organized to provide overall . eir discussions im- plans. The Executive Council of the and guidance to the Program. Its cal Society. Til eci the need for a The Iowa Central Tumor Rcgis- Medical Society approved the plans Chairman is past president of the mediatory reveal stry %vllich would try is providing planning information emerged State NI(!clical Society and its iiietil- state cancer r(!gi and anilysis guidance concerning for cooperation from which ei I)crsiiii) includes the Director of the itigiiient, coordinate, and make rnorc,' disease registries. a new, non_profit organization to State ]3oar(I of Ilealtli, tile I)irectors effective Ilse of tile several on-going carry out the purposes of the Pro- At the same time, the participation gram. The Association for the North of the North C,arolitit Public Health independent (-ancer registries in the of the Colleges of Dentistry, Nursing Carolina regional Medical Prograi-n Association, 1-1(-art Association, and State. 'I'Iiis led to recommendation.,; and Pharmacy of the 'University and was officially established in August Cancer So(.i(@ty, otli(-.T- voluntary .IS- of ;t I)roj(.(.t proposal .viiicli was sub- other health care and educational in- 1966, and is made tip of the tlircc sociatioiis, tli(- current ])resident of iiiitt(.,(l to the Advisory Council, cou- ctitiit;nns'is beinz developed. public and private medical schools in the State Medical Soci(-,tv, tile State I)Iing the resources of the Regional 14U other region%, tacLcd. iiiierest has been expressed of I)tik(! Ulli'-'('rsitY Sc,"Ool I lei-e, a.,; ticipation by tile I-leart Associations and the ill(! oil-goilIg there was widespread par f both Washington wit... 0, tile otll('I' of Medicine des(;rii)e(l tile I)IIellolllc- I,)Ianning and Cancer Societies 0 cancer registry a(,,tivit, noti when lie said: "Gli-ittlicls for co- in the preliminary and Alaska; their programs of re- I, iiiati(:ial contribu- cavors have preparation of an application. An search, professional and public edu- health agcllc@ics. IC 1)itrtlcii)ating operation for many end c initial conference, held only one Lioiis from iliaiiy of ti icil)atc(l a,; part 110%v been opened. Altlioligil we liav month after Public Law 89-239 had cation, community service, . trainee- great deal before, hips and direct patient services will agencies were also ain't talked together -a more c[Tcc- been enacted, included some 35s we now have tvailablc of Wasli- be coordinated in a joint effort. I of the Program iiici-nbers of the University The Program Coordinator for the In the field of heart disease a ;Illl- tive channels of communications and iligtoll Medical School faculty, ap- Washington-Alaska Regional Medi- ilar process took place wili('Il result("(' i'lliaii(,ial resources to ilili)l(.-iiient su('11 proximately 50 I)racticilig )Iiysicians, study now underway I)rogi,,-tills, ,lot only witli Other inedi- and representatives of the Washing- cal Program@ Dr, Donal Sparkman, is as i-ned his position on March 1) in a feasibility cal schools but ao, with all other ospital Association, State De- Su to (levelol) a regional plan for 1)i,(, health agencies." As tile North Caro- ton H f 1-Icaltli, and tile Seattle- 1966, six months prior to the begin- viding on-going educational service l,ca(l, it will be partmcnt o nt of Health. ning of the planning grant. Thusy the to corollary (7,arc units. other pro- lina program ,i,vcs adesigned and King County Departmc Program has had the benefit of over- . North Carolina a program conccived@ rilougli the planning proposal that grams underway in ind for tile people all administrative direction since its include planning for a statewide dia- implemented by , - lcadill(r official of eventually resulted was formally sub- planning phase. D, rvice; planning of the State. As one r., n,ittcd by tile University of Washing- preliminary ive expe- bctic constiltatioll SC ll(.y put it-. had the ap- Sparkman has had extens for education and research in coil'- I voluntary health 'age ton Medical School) it f both rience in the practice of internal ; studies and sur- ,WC liol)c to weave it so that it won't proval of the Governors 0 the Uni- inunity medical care illy program, - n and Alaska) the Prcsi- nip-dicine, in teaching at and with veys of education program needs and be your program, or Wa.,hingLo of Washing- versity's School of Medic7ine f relevant health but our program." deiit of the University partrnent of Vocational resources; surveys 0 and ton; the Washington and Alaska State the State De professions needs and resources; Wasliington-Alaska Medical Associations,.Dental Asso- 12,ehabilitation- studies of patterns of illness and care. Nurses Associations, and Other key staff, including a co- -Regional Medical Program ciations, Washington @late The impact of tile itcgional Med Heart Associations; tile e American ordinator for Alaska, an ical Program is already being felt in tile Washington-Alaska and Alaska Divisions Of th director, a cardiologist, a hospital ad- the health affairs of the State. Witli Altliougll d little regional Cancer Society; the Washington rninistrator, and a systems analyst, the State Medical Society taking an l@egioii previously lia ka, ,vhicli has Health Department, Alaska Depart- have been recruited since the Re' health activity, Alas clfare and the early leadership role in developing no large medical center, is naturally mcnt of Hcaltli and W gion's planning grant was awarded, the program witil the medical ton by transpor- Divisions of Vocational Rehabilita- effective September 1, i966. In . . g physicians are related to Washing . . both States. schools, pract,cin tion in addition, a widp- variety of consul, actively involved in tile planning tation, communication, economic Many of the health installations in tants, including epidemiologists cis of cominuiiica- and social ties and traditional pat- volved in the economists phase. The cliann terns of medical referral and colll;ulta- tile region arc-, being in statisticians) and com, tions which have opened ul) at -ill asiiijigton-Alaska Regional Medical Program. Repre- niunications specialists, arc beinj tion. The joint W ally all of the 130 levels and among all health group, l@cgional Medical Program is being sentatives from virtu utilized. are quickly leading to fruitful disciis- hospitals in tile region have been con- sions on a multitude of problems. developed on this basis. 41 other major hospitals in the area to agencies, public. health and nursing The Program stratcg , y of the Wash- tinuing education, and the early de- ington-Alaska Region is to concen- tcction and care of coronary disease. build on ind strengthen the existing representatives, as well as education tmte first on the following: good relationships. personnel were also present. A total Western New York In November 1965, follo%ving I)as- of 78 persons representing 70 organi- Assess the existing disease problem Regional Medical Program sage of Public l,a%v 89-239, -tti zations, institutions, and groups ,tt- in the region. Interim Coordinating Committee tended. C] Delineate resources and needs in composed of key people concerned This group, originally invited to patient care, education, training and Western New York is a comparatively with health and health care %vas participate in the formation of the small and compact but heavily popu- research. latecl Region. It is essentially urban formed to study the bill and "to program, evolved into'the Regional [] Investigate the effectiveness of and dominated by metropolitan promote as rapidly as possible re- Advisory Group. This was no simple current programs and how they can BufTalo. There had been relatively gional interest in the establishment of task. For the first time in the history be improved by regional planning .ind little regional .in(i cool)(,ritivc -.ic- % r(-giori.-ii program" for heart (lis- of Western New York, an assemblage cooperative efforts. tivity among the resources an(] ease, -xll(l strol(c. 'I'li(! colli- fi-otii iii(- above groups met ivith a interests in this -area in the pist. sill)- iiiittce, as initially constitute(], in co??iyrio?t objectii)(!. In an atmosphere Initial planning studies now tin- stantial an(] rapid progress has b(!cn cltide(i tll(! I)exii of the Me(li(--ii 1);trill(-Iiyig that of a town meeting, derway trc focused on identifying made in creating a regional health School, Director of Roswell Park, the each force presented its particular needs of physicians, I-)artictilarly organization and framework for de- I-'Ixecutivc Director of the Western point of view. As the clay wore on, needs for continuing education and )irit of understanding and cision-making since the enactment of New York Hospital Reviciv and a unique sl the best use of medical consultants Public Law 89-239. T)Itnning Council, the Past President cooperation evolved. it was unani- visiting smaller communities. Partic- The development and creation of of the I-ric County (N.Y.) Medical motisly agreed that it is the patient ular attention is being given to phy- a Western New York Regional Me(li- Society, I-'Iric County Health Corn- tvho must benefit from the Law. sician manpower needs in Alaska as cal Program has been characterized missioner, and the Regional Officer Wholehearted support was expressed %vell as transportation and communi- from the very beginning by the wide- for Western New York of the State for a Western New York Regional cation patterns in that part of the spread participation by nearly all of Health 1)(-I)artinent. Medical Program. region. In January 1966 this committee Several meetings were held by the Planning studies rclating to the the major health institutions, groups, coordination of coronary care facili- and agencies in the eight-county rc- called together representatives from group during the spring of 1966. The ties and services, a postgraduate prc- gion covered by it (Allegheny, Cat- the medical, hospital, and other otitcotTic of these meeting,.; was the taraugus, Chautauqua, Eric, Genesee, hcaltil-relatcd I)rofessions, practicing formation of a new nonprofit organi- ceptorship program, and the estab- physicians and voluntary health agen- Niagara, and Wyoming Counties in zation called Health Organization of lishment of a regional medical library New York, and Erie County in Penn- cies. From each of tile eight counties Western New York, Inc. (HOWNY) system have also been inaugurated. sylvania). The Regional Medical came the health and hospital commis- ' f its 1 1 1 mem- Other planning studies soon to be Program has been received by the sioners, the medical society repre- and the designa.tion 0the advisory initiated will concern methods of practitioners. with unexpected en- sentativ(!s, chairmen of the Iloards of her representatives a.,; pooling data from cancer registries, a thusiasm following .the WCII-I)Lli)li- Supervisors, the hospital a(iministra- body. feasibility study of open channel tele- cized interest of the State University tors, and the American Cancer -Their initial grant application, vision, a survey of physician and nurse of New York at Btiffalo, (SUNYAB), Society and Heart Association Chair- looking toward the development of participation and interests in con- Roswell Park Memorial Institute and men. Individuals from social welfare a sound and workable Proposal, in- corrx)ratcd i six-I)oint planning the 1)z-acti(@ing physicians in the re- care unit feasibility studies had al- ing) to improve the care of his program. gion. Initially they had been quite ready been launched prior to his ap- patients: F-I A (-oronary care unit feasibility wary and somewhat suspicious of tile pointment; the remainder of their C] He will have available at his corn- study medical centers and the "cooperative proposed planning activities have got- munity hospital a communication n The feasibility of mttlLiplia.-,ic arrangements" approach embodied tcn underway since then. network-, including radio and tele- screening in Western New York by Regional Medical Programs. This 'rhc HOWNY Board of Directors, vision facilities,'which will provide view has altered with their increasing with members from each of the par- education programs and opportu- n Health care team planning involvement in and better under- ticipating countics@nc representing nitics for interchange and discussion n A medical communications study standing of the program, so that now, the county medical society, the other with consultants at the medical 0 A planning survey for a local con- in the judgment of many, including usually from a health related field- center. sultation program the Regional Advisory Group Chair- as well as SUNYAB, Roswell Park, Fl He will have available at his com- F-1 A health care manpower survey man, who is himself a private prac- the Western New York Hospital Asso- munity hospital for himself, nurses titioner, a majority of them support ciation, the area-wide hospital plan- By the time a planning grant was it. ning group, and official public health and other personnel, a training pro- awarded in I)cccmbcr 1966, some Since the award of its planning agencies, has already set up proce- gram in the resuscitation of patients other important and parallel dcvcl- grant, the Western New York Re- dures for reviewing proposed pilot with heart disease, and the necessary OI)Mcnts had also taken 1)la(-e. gion.-ii Medicil Program has obtained projects. These include, in addition equipment to make it.possible to carry F-1 New channels of communication t full-time Program I)ircctor, I)r. to a numlier of tentative proposals out these techniques. He will also had been opened among the ryiany John R. F. Itigall, formerly an associ- generated by local communities, pro- have on call a medical consultant who diverse health institutions and groups atc cancer i-"carcii surgeon at Ros- 1:)osals for the establishment of a has been specially trained to head in the region. well Park. '1'lic I)irector has begun regional hematology reference labora- hospital cardiopulmonary arrest alert Fl A parallel organizational frariic- visits to all the medical communities, tory and a regional blood bank corn- programs. work was established .it the corn- large and small, to explain the rc- intinication system. 0 He may have tested at his hospital intitiity level. rlirougli these local i(l- giorial (-oiicel)t of the program and to the feasibility of a system that tmns- visory coniiiiittcf--s, broadly represent- -,t.ress the need for coordination. He (,ItAN'I'S inits, in a 24-hour day operation, ative of the health interests in the airns personally to discuss with I)hy.si- physiological infon-nation on heart communities and including (!i-,ins all(] the health scrvi(-c agencif-,s Intermountain disease patients to a computer facility members, the intent and area-, of tile -.Iiiii of the Regional Mc(li(7,il Regional Medical Program in Salt Lakc City and transmits gioiial Medical Programs were more l'i-ogi-aiii to support -ill itivolv(:(l ill fully and accurately conveyed to tile giving tiiedical caxe; the patient is 'I'lic initial operational activities of promptly back to stations within his practicing physicians and others at most important in(I his needs can the Intermountain Regional Medical hospital information for diagnosis the community level. In addition, only be met by action in concert. The Prograi-n will provide the following and treatment. communities had been prompted to patient in turn, as consumer, is being opportunities to a medical practi- [] He will be able to attend training examine their own needs. informed by radio and television of tioner in this Region (which encom- courses in the intensive care of heart n Ilerliaps most significant was the tile objectives of the Program. 'I'lic passes Utah and parts of Colorado, patients and will have available for decided change ill tile attitude of health care iiiii)l)o%ver and corollary Idalio, Montana, Nevada and Wyom- consultation medical and nursing spe- 43 cialists who have completed such change service that will provide in- tion throughout tile Itegion. T)iis time not non-nally available to the training. formation on the prevention an(] con- project is exploring the benefits to busy practitioner. He may participate in seminars trol of these diseases to public groups practicing physicians of having avail- 1-fe -,vill, if the result of cxpcri- led by local, regional and national ex- as well as to professional and alliecl able automated clinical laboratory merits being initiated arc successful, perts in order to better understand health workers. testing for mttltil)liasic screening and have direct access by means of corn- trends which are influencing medical @ He, along with other health %vorlt- .1 computer fact bank displaying t)ie I)tit(-.r terminals in his office to a Corn- care practices as well as new methods crs and members of the public, will results to liirii ;iti(lio-vistially; in ati- I)titer l,act liaiik providing the best of maintainin - and extending his I iiate(i patient history -,ysteni pro- and latest information conccrnin- the .g have opportunities through a formal toT medical skills. feedback System to coint-ntinicate with vidirig him %vitli a I)atictit's complete diagnosis and care of strok(! patients. Ile will have available at his lios- the 1)latiyit-rs an(] It-a(lers of the lt(t- it. history before S(-Citl!,r tile I),I- '['his information will not only be -hour con- -tvxil- pitat both continuous 24 gional Program to in(licit(! his r(!ac- to individual suhtion by telephone and visits by tions, needs and recommendations for coiine(-te(i %vitli the University Mc(li- patients wliilc in tli(! 1)liysician's office special consultants knowledgeable in developing new program activities. cal Center for r;il)id, accurate traris- but will make possible discourse with the latest information in the (liag- mission, tri(i ititei-l)t-(@tatioti of tli(,- (-amputee so that the cxl)@cnce clectro(-at-(Iiogratils; specialists coti- nosis and treatment of cancer. Missouri colistittites an integral part of his con- Itegional Mcclicil llrograni stiltatio?i frofii iii(! medical (,(-nt(!r by training t-clitcition. 0 Through tile use of L computer- telephone; and an integrated (,on- [] I [tt will have the use of a miilti- ized tumor registry, lie %vill be able to 'I'lic initial operational endeavors of tintiing iq(liiration I)t-ogriTii at his lios- 1)liasi(-. screening center to be cstab- analyze and compare his own cancer this Program arc "oriented toward I)ital for- himself and the health lislic(l to provide him and his patients patients with local, regional and na- maximizing the amount of- diagnosis personnel stii)l-)orting Turn. %vitli I I blood cli(!inistry tests, corn- tional standards. -inci care Nviiich can be delivered in He may, through tli(- (7onyl(.Ct,on plr-t(- blood (-otint, iirin,-tlysis, stool [I Consultants will visit his hospitti the . . . community by the liiiysi(@iaii of his (.ofllttltltlity I]oS[)it;il %vitli tile-, .tri(i I'al) srnear. (if it is in a community with less than and the local medical resources wliilc Medical Center's I)cl)artincnt of E] Ile tnd )iis colleagues in the 10,000 persons) periodically, to as- maintaining and improving the qual- ]Za(liology and computer facility, ob- Ozark area will have available at St. sist him in tile diagnosis and care of ity of medical effort. . . ." As the tain computer aided ra(liologic (liag- heart disease patients by working at program is implemented in the fit- nosis that will help improve tile ac- john's Hospital in Springfield, and the bedside of his patients. ture, a medical practitioner in the (-tiracy and reliability of his diagnosis later at other small hospitals, a re- Fl He may apply for a special clini- Missouri Region may have the fol- of bone tuinors, gastric tilcers, and fiiie(I and more comprehensive car- cal tra'inceship in cardiology that will lowing opportunities available to as- congenital heart disease. (liovasctilar care unit that will demon- involve specialized training at 5 co- sist in the care of his patients: F-I He may, after t period of pilot strate tile feasibility of an intensive operating medical institutions in pro- 17 He will benefit from the develop- testing and validation, have at his care program without house staff. grams d@signe(i to meet the individual ment and demonstration of a compre- disposal an iiitoriiatc(i patient history @ Ile and others will have available interests and problems of the par- hensive health care system that is acquisition system through %vliicli lie to them as a result of the establish- ticipating physicians. being testeci in Smithville, a stil)ur- can obtain a complete medical his- Tnetit ind sampling of population [] Ile will have available a corn- ban-rural community north of Kansas tory of a patient before seeing him. study groups, more current and ac- munication and information ex- City, with a view to eventual replica- Presently this requires an amount of ctirate information about tile true allows us to intensify the effort by the citizens of each local I),'(-'v(..Iltiotl -tti(i (tirly (Ietcc- ; planning ictivity as the community. The i n t c n t is to rates of disease incidence and I)rcva tioii. continuous munity medicine and lence in the Region. conduct of our Pilot Projects reveals strengthen corn ul)ity service opportunities. thus improve patient care. . . . IT(- and tile, coil"" td(litiotial planning L benefit He and his patients wi Igclicic- and others will I)(' provided W(! believe tile ''lost eftectivc plan- "'rhe Albany Medical College was front ,II, operation', research arid ;ys- with -I (.Iil-cctory of the names, ning will result as we relatc the plan- involved in a great deal of advanced csign project aimed at (I ) s -esscs of all medical ning to the conduct of our operational planning in anticipation of its in- tctns d ction of heart crvices and a(ldi olvemcnt in Regonal Medical Pro- improving early dctc and paramedical service,; in the State program. . . . v disease, cancer and stroke and (2 to facilitate tile referral of patient.,; "However, since the initial proj- grams. This resulted in extensive ac- optimizing the utilization of tile re- between agencies and the full use of e(,.ts of our operational program are tivities prior to the planning grant I award. . . . sources committed to these disease, available resource,;. not intended to result in a complete rc experienced physi- 'II obviously be neces- "Five matu in terms of the effectiveness of tile program, it -1 ed relative to their medical services provided. I.Itorl sat-y to continue planning supple- cians were contact I iti."i,OR'l") iii further interest in becoming full-time Mem- I-Ic and his patients will benefit ANNtiAl, I'Ro(;Itl:SS mental projects which w t Of Post- increase the capability for diagnosis hers of the Departme-n has the from improvements in I)ioenginceriiig Albany and treatment of heart disease) can- graduate Medicine$ which for the techniques utilizing -,cnsor-tran,,;- Regional Medical I)rogriiii cer and Stroke. III particular, we con- p r i in a r y responsibility of the duccrs for early detection of li(!art xtclisive pasturing of con- administrative direction disease, cancer and stroke. "In our operational Grant Appli- template c raining for Program. - - - ill (.atioll it was iiicntionc(i that 'there education and t ,(Ie(l nonprofessional ad, 1-ic and his patients similarly w tiniiing stand to I)cneCit from stit(ii(!s of tilt! is lio (itiestioll I)ut tll(., (.I(!V(.Iol)- Ill(.(Iic.,Il Ifl(l ll(!.Iltll I)roft!ssiotis. ... I'lic II Program Lvaluatioii C;ciiter, a itiul- talent of tile Albany ltcgioii-,tl MC(li- ,,riic purpose of the Albany Itc- iniiiistrativc 1)(-,rsonncl were sought tidiscil)linary research unit of the cal Program has produced very im- gional Medical Program is to utilize and excellent individuals were ac- now our Di- Missouri Medical School, dealing 1)ort,,xnt effects, both in the surround- research, education, training and (tuired. One oi these is with tli(,- problems of tile distillation' iiig communities and -tt ill(, demonstration care in all organized rector of Community Information of health services tn(I medical f-,icili- Medical Center. predominant (cooperative ind effective approach Coordinators. 1-ic has three co6rdina- ties. Priority will be givell to dev(,Iol)- attitude is one of interest, enthusiasm to tile prevention, detection and tors working with him. These men are- ing instruments for evaluating the and cooperation. Relative to need management of heart disease, cancer experienced former phan-naceutical quality of care and level of health, the program is ideally timed. Ali and stroke. Although leadership and house representatives who have both individual and community-wide. early addition of operational support tile di@setiiiiiition of scientific infor- proven their ability to relatc well to 0 I lis patients %vill 1)(! tll(! tittiiii;lt(. slioxii(I .1114)w us to full :I(lvlll- illtti(.)tl @xliiotig the itnl)t-)rtatit rc- physicians and be successful in their beneficiaries of t communications I'C- t-.igc of tile momentum of our SIX)II.Cii)ilities of the Medical College, contacts with 13liysicians. . . . t i, "Itegional Medical Program staff search project aimed at better under_ initial progress. tile ititcli , to promote interrelation- standing public attitudes, opinions, ",I,0 this statement should be add- ships among all relevant institutions, have met with the administrators and and knowledge about heart disease, ed the fact that the April 1, 1967, agencies and individuals in a man- stafT of many of the hospitals in the cancer, and stroke, in order to en- -,ii),I)rovil of our operational grant ticr which will produce a sustained Region. To date, 58 bospit2LIs have 45 en contacted; and formal presenta- PROGRESs REPORT ON cancer investigative program which being set and the action program was ons on the Albany Regional Medical SELECTED PLANNING PROJRCTS would result in i-nijoi- dividends Nvitli being formulated, the primary work ,ogram have been made to the Project to I?rzprovc regard to %%,itli regard to involved the ITMP staff, the Plin- @dical staffs -tnd/or boards 0 (liagnosti(, iii(i tliei-.Il)ctltic I)roc(.- iiiiig Coriiinittee and the Itc-ion,,tl f trust- and Expand Cancer 0 s of 25 of these. All of the latter Detection and Therapy dtires and with regard to general Advisory 13oar(l. Good coinmiinica- ,ve indicated, by votei their desire cancer education. . . . tions were maintained by frequent participate in the Program. . . . inc(!tings, which were well attended, "A major project preparation has Cardiopzilr?zonary Laboratory an(] by circulating fall follow-up "In general all of the hospital ad- been prepare(], involving the efTorts Develop?izciit minutes. . . . inistrators, staff physicians, and of physicians and administration at ,ard members have indicated their Vassar Brother.s I-lospital at Potigh- "It is proposed to establish a car- Plinning I)esign, as finally apathetic ,tgreemcnt with the con- kccpsic, New York. ]'he study is (Ii- diol)tilnionat-y physiology and (Iilg- a(lopte(l, is concerned with sticii pts of Regional Medical Programs. rectcd towards the objective of en- iiostic laboratory at the Pittsfield Af- fundamental elements as )ie-.iltli per- instances there were mis- Ibling more effective early diagnosis filiited I-lospitals, PittsCie](1, Massi- soniiel, facilities, tn(i fininc(,,,-an(i t Some Siicli ,I laboratory W()Ill(l their efTc(-,tive I)Icn(i into -.t coordi- nccptions abotit the Program based and treatment of cancer in tli(, provide accurate (Iiigiiosti(: facilities iiatcd regional medical program serv- )on the Report of the Prcsident's Poughkeepsie area. . . . in licirt (lis(-ase, (lis(-,tses of he(,, blood iiig all the people of Connectictit. . - -. commission on FIcart Disease, Can- Vainal Cytolo.-Y vessels and I)tilinotiat-y disease. In t(l- "it involved the creation of nine r and Stroke; these were quickly I'ask I,'oi-ces to steady specific compo- Screenin,, Pro-ram (lition, its' establishment Nvill lead to id easily dispelled. The administra- b iicilts of the Connecticut health care ts and staff of many of the hospitals "This project proposes to develop improved local physician continuing system, to determine deficiencies, to :pressed the desire, long felt, for a amodel for cytological screening of education in this field. cliart action programs and tilti- Dser working relationship with the all female patients in a given com- Cardiac Care Unit at inately to work for their implcmcnta- lbany Medical College and Center, mtlnity for cervical cancer. Continti- Iferki?tzer Alet?iorial I-lospital tioti. A serious effort was made to pccially with respect to patient con- ing study is unilei-way to csttblisli the have various segments of the licalti, "Thi-.; project I)i-ol)os(-s the estal)- community represented on each Task Itations with specialists; increased most effective coordinate(] approach lisliment of a firmly based Cirdiac Force, as well as to obtain -t reason- )portunities for continuing educa- to the objective, combining the ca- ("are Unit building upon tli(! liosl)i- able geographic distribution. T-,,icli :)n in the physician's home com- 1),tl)ilities of the Regional Medical tals existiii,, embryonic 'lioiii(!iii, ill(.Itl(l(.s 1-(-I)f.es(!Iltatives or various Lunity; assistance in updating their Programs with the ol)-j-)orttinities iowlcdge and ability to diagnose which other State and Federal efforts one. Such a unit %Vill I)CI-illit allies(. points of vi(,@@v al)prol)T-i-.it(-. to tile cart disease, cancer, stroke and provide. . . . training in intensive coronary care in topic under consideration, (IrtNvil this loc,-ility." from private (,(Iticitioti, vol- !Iated diseases; guidance and aid Miiltiple Ilospitat Prospective tititai-yigeiicies, governni(@ntal service i the training of riiore nurses and Cancer Invest@(,,atio?t Pro@rartz Connecticut and the prepare -.it large. thcr allied health personnel; and Itegional Medical 1'rogriiii I'li(!s(@ 'I'ask Forces are concerned dvicc as to whether or not to engage "This project proposes to establish Nvitli tlit- (I) supply an(] distribution i research activities as well as the a sub-regional and eventually a i-c- "T)tiriiig tli(-. 'tooling iij)' of I)Iiysiciins and (lentists; (2) re- nature thereof. . . . gional approach to a pmsl)ectivc .v)ien tli(@ T)i-ogriiii ol).i(-ctiv(-s %ver(! criiitm(!nt, training, distribution and O-(,@7 I staffs and or collimutiication links between seg- tivcly little contact in the past g-,iiliz;ltiolls, NVILII llo';I)ita between tile medical and- social sci- continuing education of litti-scs ;Ill(l iiicllts of the health system; (c) tile vcrsitics. These need allied health professional,,; ,vitli iiiaiiy interested individuals, shortage Of experienced health plan- crircs in the uni other t-oll of I)lly-,i- both froiii tile, llic(liciLl -,tii(I lay ranks. archers in the delivery to work together to chart overall (3) continuing cduca i irc 'I'llus, tile, I)Otellti',Il of l@(,giolial Mccl- iiers and rcs(, lapping social progress in the health field. cians and dentists; (4) extended c, i(--,tl I)rograiiis is becoming kiio@vil in of health care; (d) tile over considerable 'town facilities and programs; (5) ullivcr and uncertain jurisdiction of related There has been a @l %vi(l(,Ilitlg (!it-Cie; and communica- Health planning organizations; and and gown' riva@ between clinicians sity-hospital relationships; (6) tile ol tiotis along various segments of tile nity set- ganization of special services within (e) tile shortness of time available in the university and commu Colill(,(7ticut health (@ollilllutiity ,irc tings. There has been too little cOn' hospitals; (7) impicmcntatioil of a to achieve Illeasurable results. inuing contact in the past between -wide library system; (8) financ- improving . . . ,Witli regit,(l to tile complexityt educa- state ,,I,Ilc l@egiotiil A(I%,isol'Y lioai-(l ing of medical care; and (9) dcf'tili- of the subject fields under study, it is health spokesmen from the cut region arid has assumed responsibility for tile tional and voluntary segments, on the tion of the Connccti i)ivotal (-Iccisioiis relating to the de- pertinent that tile Connecticut Re- 'rom its subregions. . . . giotial Medical Program is probing one hand, and flocal and state "The RMP staff is responsible for VCJOI)Illclit of tile I)rograiii, e.g. tile (lue'stiolis which have perplexed lead- government, on the other. The plan- information al)l)roval of tile ,)Irving grant rc- tile fields of medical edu- ning e[Torts of the Connecticut Re. assembling tile complete i- (luest, the appointment Of the Plan- crs from gional Medical Program depend ir on the health resources in Conziect (-Ic)l)tioii of tile cation arid medical care alike in rc- cut needed by each Task Force in it-, iiing I)irccior, the atli(, al)l)oillt- (-,cut arid past years. There are no great measure on full collaboration subject Field in order to go ,ibotiL it, I'laiiiiitig 1)(",igll -ITI(l eady atis%vc,"s, for example, on how between rcprcscntacives of the hf-'ald work.'I'o fi'.tte, li;iv(.. 111(@ilt Of III(. ii,eiilber-r faiiiily medical care to all establishment drawn from cducatior in what data is Sllil).... to provide I been taken to asccrta "It is I()I(.%vot-tliy that regional Ad- citizens in tlic, years ahead, or how from the voluntary community an, available through a tiuitibcr of c;tal)- to recruit arid educate the necessary from government. Some Of the nect lished health organizations. Fortu- visory Board members are now scrv- nurses and other supporting healthI iiig as Gliairiiiell Of eight of the nine CCL communications links are havin natcly, the assembly of health infor- every Board personnel and make them a part of to be forged as a part of the Co] mation by such organizations as the Task I-orccs and that I oil one of a true health team, or how to imple- State I-Icaltli DcpartiTicnt, the Con- member ]la,.; a J)Ositiol -illcllt c(Tectivc programs of continu- nccticut Regional Medical Progm necticut Hospital Associatioil@ the them. 'I'llis iiicans that l@oard inem-ing education for all health practi- planning process itself. . . . volved in plan "Despite the major problems e Connecticut Hospital Planning Corn- bers will be deeply ill trotters, ctc. it is even difficult to . of i will provide much iiing activities, that they will be in structure planning studies to lead to countered and the cnorn,ty mission and others It re- good )Ositiolls to %veigli proposals for licsc important task ... a sound organizational fraiT of the information needed. tile operating I)rograill one .iiid two the best solutions to t work for planning has been cst2 niains, however, for the RMP staff to at they ,Vill have issues. Yet, the Program has chosen has bc nd, years lielice, arid tli lished; broad consensus carry out some special studies atile background knowledge needed to to conccril itself with those very Is- reached on the progr@s Planni ultimately, to compilc much of tile push their implementation. . . .sucs it, the health field which are of a large number of I health resources data in a central the people Of design; and 1110, leaders from the Connecticut hu ,,,riic ;t difficult problems en greatest concern to profile. coutiterc(l to date arc tile following: Connecticut. . . . scene have become involved in "There have been many ol)l)ortuni- Ile complexity Of the subject ',It is pertinent that in Connecti- ties to discuss tile Planning Design (a) t Ss cut, as elsewhere) there has been rcla- planning process. fields ull(le with boards of directors of health Or- r study; (b) the weakiie bring these specialists in close touch "Planning is under way for a pro- "On February 26, 1966, -t regional lawaii with private practitioners. . . . gram directed to%var(i the hematolog- workshop was field at the University regional Medical Program "Additional progratiis of 1).it@ticiti-ii- i(- aspects of tile care of licii-t, cancei, of Utili Me(licii Center in Stit T,,-tkc interest ire the Stroke Re "The assessment of the over-.ill sitti- qisti-v and iTi(i sti-ok(- 1).iti(-iits. 'I'Iiis A%,ill City, %-.,Iiicii %%,.is attended I)v tile I-'.irilities studies. Oil ?%reach 1, fi-olli ;ill six Ltion, anci the estal3lisliivicnt of cotii- nunication with the participating 1967, exploration of tli(! F(!:isil)ility c,-ttioti, (-oilstiftitive sei-vi(:(- iii(I Ill)- ill tilt! J)IX)I)oS(-(l region -,Illtl @ill of the establishment of a Stroke Reg- oratory and investigational activity sions, organizations and institutions L,gencies have been the major items istry was begun. Consultations with (lirccte(i toivar(i assisting physicians concerned about heart disease, cancer )f activity since November 1966, physicians and with medical recorcl in diagnosis and patient care. and stroke. The purpose of the meet- vhcn a full-time Deputy Program librarians have I)rogressc(l most satis- ing was to begin to define a RcFion )irector (General W. D. Graham, factorily. Field testing of method- Intermountain which could work together a.-, -.t unit vf D.) arrived in T-Tawaii. Informal ol@gy will commence about May 1, Regional Medical ProtZrini an(] to obtain ideas as to regional Conferences %vith members of the Rc- 1967, in selected hospitals. . . . resources and needs, and how a pro- ,ional Advisory Group -.ind their rcp- "Tile project for stroke relial)ilit;i- "Orgiiiize(I efToi-ts to clevelol) a Re- grain should develop. Ideas expressed -esentcd agencies and with other tion education involves i plan to set gionil Mc(li(-al Program for this tt this meeting served as a foundation Participants have been held, and the iii) a trtining I)rogi-.ttii foi- variotis ]region I)t@giii in ill(- fall of 1965. for the planning grant applicttion tatits of tile ptil)lir,, private, -.end r..it(,gori(!s of i,elltl)iiit;ttinti personnel I-fToi-ts %v(@i-(- early to (-Yilist ill(! stil)iyiiltc(l in May 1966 in(] twir(le(I ioltint-try i-)rn,@rims in tlic)iv..xlt)i field -it ' i'it(!r(!st tii(I qtil)l)oi-t of org;tyiiz(-(] i-fTt!(@tiv(! July 1, 11)66. . . . i,-Lve been studied. the Itelial)ilititioii of i "Since July 1966, the major efforts "Local asscssmcnt,.ind the detailed Hawaii in Honolulu, at otitlying lios- medicine. . . in planning have been in recruiting a Consideration of the content and pitals on Oaliti an(] on the neighbor "In October 1965, Dean Castlcton :oncepts of programs under way in islands, in order to augment stroke and Dr. Castle of the University of planning staff, establishing lines of )tbcr rcgions, lead to the conclusion rehabilitation capabilities, -,vhicii arc Utah School of Medicine met with communication with all elements :hat tangible progress in the program at present at the fill] capacity of tlic, the Utah State Medical Association within the region and with other re- icre is contingent upon projects in Center stafT. Executive Committee to gulf their gional progrims in the country and -ontintiing education. There is at "The goal of a facilities study by interest and support foi- a regional developing systems for sustaining the I-Tawaii Heart Association is to program. Subsequent inectin!,rs active interaction -tmong these )resent no fully-staffed, on-going determine equipment status in facili- held with representatives of the Uttli, aroiips, explaining the purpose of the icademic clinical teaching center in tics which provide diagnosis and Idalio an(] Nevada State Medical As- 'Taivaii. Those highly qualified pcr- treatment to patients with heart sociations, ,in(i county medical soci- program to professional and lay corn- ;onnel currently engaged in the train- disease. A questionnaire has been eties in Renoin(I l,as Vegas, Nevada; iiiiinitics, developing methckis for @ng programs of the teaching hospital collecting data relttive to heart dis- directed to hospitals an(] rlitiics an(] Grand junction, Colori(lo; Idaho ire engaged to full capacity, and arc the returns will be preliminarily Falls, Pocatello, Twin Falls and case, cancer and stroke, identifying augmented by 'visiting professors'. By evaluated, using volunteer services. Boise, T(li)io; and Btitte, Great Falls needs which cin be met by Regional locating full-time teaching specialists Coll,,ition, analysis, an(] subsequent ind Billings, Moiit-,ina. Meetings ako Medical Program legislation, and in teaching hospitals, significant ad- development of the information will were no-](] Nvitli iii(-mt)crs of the lio.9- formulation of proper procedures for ,Iitional construction or pilot projects and support for postgraduate require RMP support, -,in(] will begin I)ital stiir in all tile lttajor hospitals training proqrims will result -tn(i will tl)oiit Jim(- 1, 1967. . . . in tile, region. . . . m(-tlio(Is for their review anci ap- 48 proval by reacting panels and the certain institutions, organizations and in the Wichita area. This was done within the state and also to increase Itegional Advisory Group. . . . individuals in an active way were since this metropolitan area contains representation from the Wichita "Progress has been made toward identified early in planning. . . . 15.75 percent of the population of area. . . . meeting all objectives outlined in the "The community profiles dcvcl- the state of Kansas as well as 357 "Considerable discussion has taken planning grant al)l)liciLioii, but iioti(- ol)c(i by the ]ntei,i)iouiit,,iiii Regional 1)liysicans and 1,825 nurses. Mr. place with the Missouri Regional have been completed and Nvill require Medical Program arc being used by Dallas Wlialcy, the previous cxccu- Medical Program regarding coopera- an intensity of planning similar to the Mountain States ]Zegioiial Mcdi- tive-sccretary of the i-nedical socie'ty tive planning efforts, particularly with what has been established within the cal Prograii-i and the community com- in Sedgwick County (Wichita) was regard to data pooling and evalua- last few months for at least another inittces to be fon-ncd in Nevada, Wy- approached and hired. . . . tion. Special attention and coopera- year. One major ob5ta(,,Ic to more oniiiig, Idalio, and Montana, will "In addition to the Regional Ad- tive planning have been directed tc r;il)i(I progress within the i-(-gioii li;is s(,rv(-,xs liilsoii to both programs over- visory Council, two additional groups the complex Kansas City metropoli- been the slow process inherent iii of)- lill)l)ilig tll(-S(! have been al)ix)inted to sci-m as staff tan area which crosses the Missouri. taining outstanding people to serve in advisory committees. One of these Kansas State boundary , and sim key positions on the planning staff. Kansas is the Professional and Scientific Re- county boundaries. . . . Although the Interi-nouiitain Re- ltcgionil Medical Ilrograiii view Committee. This is made up of "A special Metropolitan Kansas gional Medical Program has been individuals nominated from various City Coordinating Committee has particularly fortunate in obtaining an "By the first of the year the I)osi- organizations and groups, such as the been established to adV= and assist outstanding, dedicated, liardworking tioii of lzcgioiial Medi(-al Pr-ogi-anis licart Association, the Cancer So- with the planning for this area. This staff, the process of bringing them Nvitli rclatioii to I)ul,)Iic Law 89-749 ciety, the state Medical Society, committee, which is made up of rep. into a new program, allowing them and other efforts of the medical those from certain sections of the rescntatives of both the Missouri and time to understand the program aiici school had [x@(@oitic soiii(-wliat clari- School of Medicine, etc. . . . Kansas Regional Medical Programs, to define their role, has taken much tied. Dr. Charles Lewis, ])rofcssor "The second group appointed is a will consider all proposals of either longer than anticipated at the outset. and chairman of the Department of ,physicians' panel. This is composed Region which would have an impact In licu of ])copic with background Preventive Medicine and Commu- of a group of physicians selected by in the greater Kansas City area. . - - and experience in developing the iiity Health, who had I)cci-i active in stratified random sampling with re- "An interregional conference on type of program outlined under Pub- both the planning grant body and in gard to geographic area, type of health manpower data recording and preparing the operational grant ap- practice, and age. This panel of evaluation was held May 22-23, lic Law 89-239, it has been necessary I)IicaLioll, igrecd to take full-time names will be submitted to the presi- 1967, at the University of Kansas to recruit personnel with a variety of responsibility as director of the Kati- Medical Center. Representatives of career commitments and ask them to sas Regional Medical Program. Ile dent of the Kansas Medical So- nsas make major changes in their careers -ISSLIJIIC(I this role on Mar(-Ii 15, 1967. cicty. . . . the Oklahoma, Missouri, and Ka "'I'he Regional Advisory Council Regional Medical Programs partici- III pursuing this new national pro- Since ti-is time considerable progress was recently enlarged with the add!- pated with outside experts. The pUr- gram. . . . has been made with regard to a I)rin- "To meet sonic of the most pressing cil)al staff and development of a for- tion of eight new members. This en- poses of this conference were (1) to needs in initiating a Regional Medical iiial organizations] structure. . . . largei-ncnt was accomplished in or- define basic core information which Program, specific projects to provide "In addition, a ltcgioiial Medical der to gain further representation of must be recorded on all professionals training for personnel and to iii,.,olvv Pi-ogi-aiii ofl'i(-(- has been established o t li c r non-hcalth-related groups (having decided what disciplines will 49 )c covered) and to develop a com- and mortality data, utilization of ityll)lci-nentation have I)i-occecieci an(] refinement of present resources. mon data base for the three Regions beds, number of office visits, costs, etc. simultaneously during the ),car. 'I'lic 'I'Iiis means learning more about the @.or the transmission and comparison By comparing two or three different Advisory (,'oiiiicil, @%,itli aclx,ic(@ from needs of practicing plivsiciins and )f manpower data, and (2) to em- types of medical care systems in its Sciciitifi(-. lzcvimv and Liaison other health profession s, the con- ,)hasize the importance of proper different parts of the state, %ve Nvill Stil)coTnmitt(@es and the Metropolitan Selmer, and State and local health --Valuation rather than developing ar- have a better idea of the means by Kansas City Coordinating Commit- resources. Missouri lzcgional Medi- tificial indices which mean nothing in which we can evaluate changes and t(!e, serves as the governing body, (le- cal Program aims to assist the prac- terms of health delivery systems. . ' . variations on the original theme of teriiiines policies, and approves (or ticing physician in providing optimum "It should be noted that feasibility delivering health care to patients and clis-,ii)l)rov(,s) -,iii(I sets priorities patient care as close to the patient studies will soon be under way in the improving tltc quality of care for among I)rol)os-,ils foi- pilot 1)rojc(-.ts. is possible, with e,(Itial access to any Wichita regional area. A group those with heart disease, cancer, in(i 'I'lic Scit@litific lt(@vi(@Nv Sill)(.ollltllitt(,e national resource. According- representing the hospitals and physi- stroke. . . . advises tll(,' COLin(7it i-el@itive to scl- ly, Missouri Regional Medical Pro- cians of that area is now making "Another development which will ciitific. prol)lciris, including the Tnei-it gi-aTn stresses prevention and early plans to develop a non-profit corl)ora- be completed before the end of this of pilot project proposals. '['Ile (]election, continuing education, pub- tion in order to seek non-federal fi- planning year is the attempt to (IC- T,iaison Subcommittee serves as a two- lic. education -,in(i information, and nancing from privttc industry to sup- vclol) a beilt)i data bank. 'I'o this way i-nc(iiiiiii of (-oiiiiniini(-,tti(-)ti li(@- al)l)rol-)riat(- (ICTiloiistratiotis of patient plemcnt funds from ]Zcgional Mccli- end the University of Kansas Medical t%v(,(,ti tli(- iyieiiii)(@t- org,-iiiiz,,itiotis and Care. . . . cal Program resources. . . . Center, the Kansas Regional Mc(ii- the Missouri Itegioriil Mccli(-al Pro- "']'lie Missouri ]Zcgioiial Medical "It is hoped by the first of Scptem- cal Program, the Kansas State Board gram. The Kansas City NIctt-ol)olitan Ilrograin staff is confident that the her that manpower data recording of Flealth, Kansas Blue Cross-Blue Coordinating Comniittee reports to splendid interest, concern and con- for the state of Kansas will be al- Shield, and Kansas I-Tealth Facilities tile Advisory Coiincils of the Kansas tributions of the Advisory Council most complete. It is also projected Information Service, Inc., have all ]Zcgiorial 1\4cclical Program and the are, in important part, related to it.-, that during the summer of 1967- agreed to pool data on manpower, Missouri Regional Medical Program (,Iccision-m,-tking authority. (There several field investigations will be postgraduate training, resources for and works to encourage cooperation appears to be evidence that the con- carried out on consumer and health health care, facilities, utilization, and avoid duplication of pilot project tribiitions of Regional Advisory professional attitudes toward cur- morbidity, mortality, vital statistics, proposals atiiong institutions, liospi- (;roiips to a certain extent parallel rent systems of health care. A proba- economic development, oiitp,-tticnt tals and other igeiicies of Metrol)oli- their responsibility for decisions.) ... bility sample of consumers will be utilization of office visits, etc.." t;izi City. All tli(! orf,,aiii7,.t- "Sitic(-. July 1, I()66, the st-.ifT have interviewed, comparing their atti- tioiis iTi(I institutions oil taken steps to strengthen interagency tudes,toward medical care. In addi- Missouri tlies(! Coiiityiitt(,(,s liav(! ;in i(-tiv(! ?'(,I(! ('Ooperation -in(] communications. tion, physicians, nurses, hospital ad- Regional Medical Program ill i-)IanniTig, in(i two IlaV(' Slli)]Tlitt(-(l 'I'he Program Coordinator and stafT ministr,ttors, etc., will be similarly pilot J)I.o.i(.(.ts tioNv under (-onsi(](.ra- have made speeches at society meet- consulted. The purpose of this is to "Under the lei(lersliii), guidance tion and tlii-ct! are preparing pilot describe the system in as many ways ancl direction of tile' lzegional Ad- project proposals. . . . ings, meetings of other health profes- as possible and to correlate this with visorv Council, planning for the "'I'lic Advisory Council made in sion organizations and lay groups. other information regarding param- Missiiri ]Zeqioiial Medical Program e,-iriv -,iii(I (-i-ii(-ial (I(@(-isioti to ])lace The staff has also conducted seven site eters of liciltli cire, i.e., morbidity an(] (IVV('IOI)Tii(-nt of pilot liro.i(@(-ts for I)i-iiii@ti-y (-tTil)liasis oil iiia\lt@itilli its(! visits with reference to pilot projects 6ioJ 6,A 6.8 proposed by various communities; apply them to the results achieved by mcnt (including health). A new Of- Central Administration has been in communication with six various funded programs. I'lie stafl's fice of State and Regional Planning Comprehensive Cardiovascular Car, other communities relative to possible activities litvc been spent in attempt- and Community Development has Unit (Springfield) pilot I)rojc(,fs; has consulted with nii- ing to conceptualize comprehensive been designated by Governor Hcarncs Manual of Services incrous official health agencies and coordinated community health scrv- for administration of these two laws "Staffing arran ments for these other organizations and individuals; ices in terms of 'schemes of action' in Missouri. In order to effect proper . ge has discussed plans, projects and ac- rather than 'schemes of arrange- coordination between Missouri Re- projects are underway and are ex tivitics with numerous visitors. . . . iiicitt.' 'I'litis, the model %vill be de- gional Medical Program and the Of- pected to be completed in major pai "Thus far all agencies, institutions, fincd in such terms as access, corn- fice of State and Regional Planning within the month." organizations, and individuals asked iiiunications, and end points. . . . and Community Development, a new North Carolina to cooperate have responded favor- "Pilot projects proposed by Mis- senior staff position (Liaison Officer) Regional Medical Program ably. . . . sotiri Regional Medical Program in- has been established. . . . "However, somc practicing 1)liysi- clu(ic btiilt-iii evaluative inecha- "Up to this writing, Missouri Rc- "Very early in the consideration i cians need to be informed that Mis- iiisitis. . . . giotial Medical Program has consid- the North Carolina Regional Pri souri Regional Medical Program is "A study is being conducted in a ercd approximately 40 pilot project gram it became clear that in order primarily patient oriented and not rural Missouri community, Glasgow, proposals. Of these, 27 were for- fully implement the provisions Medical Center oriented, and that -,approximately 40 miles from GolitiTi- wardcd to the Division of Regional Public Law 89-239, it was necessa Public Law 89-239 emphasizes co- bia, to examine some of the decisions Medical Programs in the form o to develop a core concept whi( operative arrangements, continuing made and the systems used by mcin- three operational grant applications. would make possible the coordinate( education, and demonstrations of pa- bci-s of this community in seeking If current negotiations are confirmed, and augmentation of an already larl tient care %within the present system medical care. . . . 15 of these will be initiated during number of existing health activiti4 of medical practice. . . . "In keeping with the '-scheme of April 1967, as follows: interests, and institutions and in tl "Missouri Regional Medical Pro- action' concept, this one has looked at gram may face problems when agen- (1) routes of access to care which Smithville Project process enhance the ultimate effc cics present pilot projects for fund- have been used; (2) critical coordi- Corizmunication Research Unit tivencss of each component elemej ing and a choice must be made. How- nation and comunicttion points in Multif)hasic Testing This unifying conceptual strate Mass Screening-Radiology called for the mobilization, throul ever, we are developing Guidelines the system,, used; and (3) endl)oints on which funding decisions will be or reference points in the health Automated Patient History comprehensive planning and coops based and explained to interested service system. Data Evaluation and Computer Si?tt- ative enterprise, of all health ea agencies. . . . "Missouri Regional Medical P iilatio?t knowledge and resources for a cc 7- Co??t uterFactBank ccrted attack upon the problems "The Missouri Regional Medical grain %vill continue to coordinate its p Program emphasizes the importance planning and pilot projects with other Operations Research and Systems heart disease, cancer, stroke a Destgn related diseases. . . . of evaluation of results. The Program health and related programs. This Evaluation Center for the University applies especially to Public Law Population Study Group Survey "The program has the unique c of Missouri School of Medicine is be- 89-749 and a new State law relating Automated Hospital Patient Survey portunity of being in a position ing used to develop whatever mcas- to State and regional comprehensive Program Evaluation Center bring together the talents of t urenicnt devices are required and to planning and car-nitiunity develop- BioengiiieeTin,, Project hitherto widely diffused leaders[ 51 by exercising its own leadership to degree to which the skills and man- cinc, tile Buncombe County Mcdi- gram for diabetic patients is being mount as concentrated and effective power represented by these interests cal Society and the State Medical tested. Scheduled clinics in conmnu- an assault upon heart disease, cancer can be mobilized. . . . Society. It includes a description of nity hospital or similar settings and and stroke as may be possible in terms "The Planning Division has made the characteristics of its patient-, and also at the university medical centers Df the resources of the State of North good progress in isscml)ling survey staff. Also in(-Iti(lc(l -,ire i(it-as of L-(@y tr(! included. These activities will be Carolina. On the basis of these prem- data essential for program planning hospital personnel is to the (lesir;i- supported by a home nursing service ises the Regional Medical Program and to provide overall I)aselinc data I)ility of developing tile, ifriliation to Itssurc proper follow tip and sus- )f North Carolina has evolved a de- against which future impacts may be with the Bowman Gray School of t,-dncd patient contact. The educa- cision-making mechanism which is gauged. Medicine, suggestions as to program-% tional program will be directed to both responsible and rational, and "One study which his been corn- of continuing education, ind stiggcs- community group,; of diabetic, pa- which will maximize the effectiveness pletcd has explored the dimensions of tions as to what other elements might tients and will be coordinated with Df the wealth of leadership which is an affiliation between the Memorial be included in in affiliation between community health organizations. available. . . . Mission Hospital at Asheville and the the two facilities. It also includes the ditcation "Participating Organizations: The Bowman Gray School of Medicine. viewpoints of the cotinty's physicians Continuirig 1, North Carolina Regional Medical In addition to collecting data perti- toward affiliation, continuing educa- "Data on the number and types of Program has received the enthusiastic nent to this situation, this experience tion, diagnostic resources inci needs, continuing education programs for support of the participating organi- will serve to teach us how to organize and paramfflical personnel needs professional and ancillary pcnonnel, zations. -Particularly outstanding and communicate the data needed to through an analysis of questionnaires their geographical outreach and the have been the contributions of the provide linkages bcween Medical that were distributed to all Bun- numbers and characteristics of indi- North Carolina Heirt Association Schools and community hospitals. combe County physicians in Fcbrii- viduals attending is being coliccted and the North Carolina Division of Surveys have been made of practic- ary and March, 1967. through a monitoring system involv- the American Cancer Society. ing physicians in Buncombe County Diabetic Consultation ing obtaining of registration fon-ns "The staff of tile Association for and of other staff members of tne and Education Service from program chairmen. When this the North Carolina Regional Medi- Asheville Hospital aimed at securing monitoring process was first initiated, cal Program has devoted much time their ideas of the general utility of "This study was begun January 1, the researchers tttemptcd to gather and energy to the orientation of such an affiliation and their specific 1967 and participants include rep- data only from those organizational health interests throughout the region recommendations of what such an resentatives of Bowman Gray and meetings with program content re- in terms of the nature and objectives affiliation should strive to provide, Duke Medical Schools, the Univer- of the Regional'Medical Program, especially in the way of continuing sity of North Carolina School of rated to the categorical diseases. How- and as it has been possible to identify education. ever, it was often difficult to draw a appropriate functional rolcs, an in- "A report on this study was dcvcl- Public Health, the State Board of line between those meetings that creasing number of them have be- opcd by the Planning StAff for the Ifeilth, Community Board of either did or did not fall within thi- Association for the Regional Medi I-lealtli, practicing 1)liysi(-i,@ins, @iti(i come active participants. This effort provision. As a result an attempt ha.,; public health niii-,(,,s. cl(- toinoni- will continue to 1.)c a dominant fc,-ttu re c,-tl Program with tile i,,sistance in(I of the Program since to a large ex- giiidance of Memorial Mission Ilos- Tile feasibility of a regionil constilti- toy, ill of the riiajor itic(lical meeting.,; tent its success will depend upon the pital, Bowman Gray School of Medi- tive service and an educational pro- unless the program content clearly indicates no relevance to the RMP. a-en(:ics, and other organizations "Since continuing professional been made to determine the number. In a statewide study of this nature an concerned %vitli health and welfare education is an integral aspect of and types of such personnel in tht analysis of any part of the continuing throughout the l@cgioti. . . . Regional Medical Programs, an ad Region. . . . education process becomes an analy- "Determining the planning ap- hoc committee has been appointed "Health education for the publi( sis of the total oii-going system. Coii- I)i-oa(,Ii has been (-otiil)lcx because we for continuing education of allied has emerged as a top priority objec. scquciitly, the findings will be more have attempted to shape our program health professionals with representa- tive, and recruitment of a full-tim( relevant and meaningful if the in response to the re(iiiireinciits of tives from the Vermont Division of information specialist to be respon. widest possible representation of the the systems ai)l)i-oicii to planning. the American Cancer Society, the sible for this aspect of the Prograrr, cdu(,.ation system is obtained." 'I'llis approach provides for the appli- American Itcd Cross, the State is currently underway. . . . cation of idvaticed mathematical tnd Healt!i Department, the Department "Dissemination of recently ac. Northern New England computer techniques in analyzing of Physical Medicine and Reliabilita- quired medical information' to tht ltcgional Medical I-rograiii alternative solutions to I)roblei-ns. It tion of the College of Medicine, the practicing physician has also been a also includes cost-bciiefit studies. Vermont Heart Association, the Vcr- concern of the Northern New Eng- "The Northern New England Some cost estimates of the training of iiiont Pharmaceutical Association, land Regional Medical Program and Regional Medical Program and core allied health personnel and coronary the State Mental I-lealth Depart- our proposed Pilot Project in Coro. %taff have I-)ccil organized ;tloi)t, care training for nurses have been anent, the Office of Continuing Edu- nary Care is an illustration of how we functional c(-ojioiiii(@s, ]Tilde. Since nice.(! ,ii-c no precedents, cation of the College of Medicine and intend to accomplish this task. education, information systems, (.]is- Some C.,X])(!I-iiiielit;itioil ]).is l@)CCII iicc- the. Itcgioiial Medical Pr@gram's Through cooperative arrangemenU case prevention, and patient care essai-y. . . . staff. This gi-oul) has dcfitied specific between health personnel at the Cen- services. Al] planning and program "The development of a Model of objectives for continuing education ter and their counterparts in the re. efforts, in turn, arc organized ac- Patient Care is the major initial and is gathering information on exist- gion which are described in out cording to a systems approach planning effort. '1'0 develop the CdLl- ing activities and personnel needs for proposal, we intend to promote ap- which provides continuous feedback cational aspects of the NIodcl, an carrying on these activities. . . . plication of the latest techniques in of infon-nation and assessment of Education Committee his been al)- "The potential use of various progressive coronary care at the local progress. . . . pointed which will be concerned with inodcs of communication and trans- level. . . . "We have made good progress in lay health education, continuing 1)ortation to augment continuing "The proposed Pilot Project in determining the scope of 1)articil)a- education for all health professionals, education programs is being ex- Progressive Coronary Care involves tion of various health related groups and bisic education in the allied plored. Two-way television connec- research related to the regional as- in Regional Medical Programs. I-roiii health professions. . . . tions between the Medical Center pects of the management of coronary the beginning we have made every "A meeting licici in lcbruary 1967 Hospital and community hospitals in disease. One such study will be a effort to include representatives from with representatives of somc 25 or- the Region and the use of the Uni- determination of modifications ir all interested groups in oui- 1)laiiiiii),, gaiiizatiojis operate a variety of versity's airplane arc two possibilities equipment and personnel require- effort. . . . health education 1)i-o,,raiiis was a first for future education program sup- ments necessary to provide intensive "A number of steps have been stel) in coordinating the existing i)ort. . . . coronary care in small communiq taken to develol) cooperative work- health education i)i-o,,raiiis with Rc- "Assessiii- basic education needs in hospitals. Using the data collected iii.@ relationships with health 1)t-of(-s- gioii,,tl Medical Program activi- the allied health professions has been through the Heart Inventory, which sions groups, hospitals, health ties. . . . a 1)i-iiiie concern; and surveys have the Northern New England Regional 53 Medical Program is developing, it ing health agencies, public and voltin- seemed desirable to explore with the (1@si,n of projects a mechanism for will be possible to identify other tary, and of the wide spectrum Of facilities of the two medical schools evaluating their results. . . . potential research projects related to health personnel on Nvilicii goo(] their interest in the general -areas of "On February 22, 1967, Dr. Faxon various aspects of the incidence and health care depends so heavily has continuing education, the training of Payne, radiologist at the Jennie treatment of heart disease. . . . gradually come into focus like a pic- affiliated health personnel, and vari- Stuart Memorial Ilospital and Chair- "Our planning efforts must neces- ture on a screen as steps have been otis aspects of heart disease, cancer man of the Medical Society Commit- sarily take into account how trans- taken to promote discussion and and stroke. Visits were made to key tec for Regional Medical Programs portation affects the delivery of planning for specific action to deal communities in the region which had for I-leart Disease, Cancer and Stroke, health care. Thus, we currently are with real problems. given evidence that they were ready arranged a meeting of the Director conducting with the State Medical "This first progress report of the to develop cooperative arrangements. with the chiefs of medicine, surgery, Society a survey to determine which Tennessee Mid-South Regional Mcd- In addition, it was deemed essential pediatrics and pathology, with the towns have emergency ambulance ical Program attempts to chronicle to establish communication with the Administrator of the hospital and service, how it provided, and how the widespread growth of under- various voluntary and public health several mcmbcrs of the Board of effective it is." standing about its purposes and agencies in Nashville and other areas Trustees. It was apparent that the methods .that has taken place in the group was anxious to establish corn- of the region. . . . Tennessee Mid-South past year. The basis for most of the "On January 10, 1967, the I)irec- munication with the Regional Medi- Regional Medical Program achievements to date is the willing- tor met Nvitli i group of api)roxi- cal Program and -.vas particularly in- ness of many persons, acting on their niately 12 hospital -i(lyninistrators terestcci in the field of continuing "Understanding of what tilc fun- own behalf or that of their institti- from tli(! Nashville irct. '['lie group education. 'I'lic potential of televi- damental concept of a Regional tions and Organizations, to study new was l@noNvlc(lgeal)le il)otit the ol)jc(@- sion ind other communications Medical Program is and how to best tpproaches and to undertake new re- iii(@(lia was discussed. 'I'lic staff indi- develop and establish it in this region sponsibilitics to assure the continued tivcs and procedures to he follow(!(l (rated that it %voijl(l be greatly intcr- has proceeded steadily from the improvement of medical care in the in developing a Itegional Medical csted in having medical school faculty earliest discussions which led to the fields of heart disease, cancer and Program. They were greatly inter- members come either for lectures or application for a planning grant. In- stroke. . . . este(i in finding out how the Regional for periods of one or two days at t evitably, such understanding has de- "In developing the strategy to be Advisory Grotil) would function and time. They expressed intcrest also in veloped in an evolutionary fashion followed, the Director of the Tcn- the basis for establishing priorities for the possibility that a full-timc chief of since it is,' in fact, a reflection of a ncssee Mid-Soutli Regional Medical projects Nvliicii might conic from t medicine might be appointed in order growing awareness of the medical Program has sought consultation variety of sources. Questions -,vci-c to liell) organizc an educational pro- factilties of ways in which they can from Dean Batson (Director, Mc(li- raise(] il)oxit tile establishment of grain of soi-ne substance which cotil(I serve as resource agencies for im- cal Affairs, Vanderbilt Univenity), coronary cire units in hospitals in(I s(-rvc not only the flopkinsvillc proved medical care, and of practic- Mr. Kennedy, (Chairman of the Re- particular inquiry was made ii)oitt group but the 8 or 10 smaller liospi- ing physicians that the primary aim gional Advisory Group), ancl from the eligibility of hospitals for funds tals Nvliich arc located within a 10 of the program is to hclp them in Dr. Anderson (Chairman of the to conduct renovation for projects of to 15 mile radius of Hopkinsville.... the care of patients in their own lo- Faculty Group fon-ntilating policy for this kind. A (lis(,,tission .vas lie](] about "A mcetin(i -,vas also held with the cal area. Similarly, the role of exist- Mcharry Medical College). It the importance of building into the staff of the T-,riangcr I-lospital in Gliattaiioog.i on March 8, 1967. We "Siiiiiiii- ;it-e takii)g Center sponsored by Mcliarry and jectivcs in an area where existing fa discussed the problem created by tli(-@ 1)lac(@ ;it two liosl)it@ils in Nashville, funded through the Office of Eco- cilities and personnel are despcmtcl, fact that Chattanooga serves areas St. 'I'lioinas, and Mi(I-State Baptist iiomic Opportunity, believes that the needed. . . . not only in 1'enticssec but also in and in Knoxville and the 'I'ri-City Itcgional Medical Program could be "Acquisition of information abou Northern Georgia. I'lic Director as- area. . . . of considerable value in supplement- the health resources of the region i surcd the staff that the Itegional "In addition to visits with liospi- ing the services that Neighborliood underway and will be continued ani Medical Program would in no way tals, the I)ii-ector has met with many I-lealtli Center would ordinarily make expanded during the year. Using th interfere with the relationships with of the medical societies in the re- available. . . . resources of the biostatistical divisioi established groups. We then discussed sl)cctiv(@ communities and they have "The demands made by the Re- of the Department of Preventiv ways in which the hospital could now establislicti liaisoii committees giozial Medical Program have focused Medicine and Public Health of Var proceed to become actively engaged to consider ways and means of foster- the attention of the professors of derbilt University, data has been pt in an operational project. The follow- ing activities under the acgis of the medicine, surgery, and radiology at on computer tape regarding ph@ ing suggestions were inade-tliat a l@cgional Medical Program for Heart Vanderbilt University on the need to cians, nurses and the hospitals. Usin committee be appointed within the Disease, Cancer and Stroke. In most make a major revision in the facili- this basic information, a health rc hospital to coordinate suggestions instances, it was found that these ties for diagnosis and treating sources profile will be developed fc made by the various services and to (committees %viiilc expressing interest, patients with surgically correctable each county and later certain cour cooperate with the already appointed had been unable to focus their ef- cardiovascular disorders. The evident ties will be grouped into areas to dc committee of the medical society. 'I'lic forts on specific programs. It was only strengths of the institution have not tcrmine the characteristics of thcs individual chiefs should be cticour- through discussion of possible opera- been used as effectively as they might, larger areas. Demographic data wi agcd to draw ul).i i-ougli draft of pro- tioiial 1)i-oj(-.(!ts foi- wlii(-Ii grant funds and the requirements for a I)cnc- also be used as a basis for dctenminin 1)osais relating to their own depart- iiiiglit be iiia(l(! available that the ac- tratiiig assessment of the problem has the size of the population to be serve mcnt. The Director indicated that tivities began to achieve some degree been a beneficial experience. in the respective counties and area the Regional Medical Program staff of substance. . . . "Planning is underway to deter- Valuable correlative data has als Nvould work with the various groups "Dr. Frank Perry, Associate Pro- mine how best to develop a rchoubil-i- been obtained from the statistical.d to help refine the proposals, make fcssor of Surgery, is coordinator for tation facility to serve the needs of the vision of the Tennessee Departmer sure that mechanisms for evaluating tile Mcliari-y faculty and will devote region. A gift in the amount of of Health. . . . the projects were incorporated and a major share of his time to cxl)lora- $2,000,000 from a Nashville family "In cooperation with the Tenncsse that specific budgets relating to per- tion of continuing education pro- has insured the funds for construe- Nurses Association and the Tennessc sonnel, supplies, equipment, ctc., grains for Negro physicians. He plans tioii. Intensive effort is needed, how- League for Nursing, we arc making were property drawn. It appears to (-oor(Iiiiite his activities with the ever, to coordinate the project for ]i.kely that the Regional Medical Pro- 1),ii-ailt!l efforts being iiit(lc in cort- maximum involvement of faculty, study leading to the preparation of grain will work through this groul) to turning education by tile faculty at community agencies and state and statc-wide plan for nursing education establish an educational sub-cezitcr in Vanderbilt University. . . . regional agencies. It is expected that Cooperating in this endeavor will b this area anticipating that the groul) "Dr. Leslie Falk of the University the institution will serve important Miss Anne Dillon, Head of the Su at tile hospital will reach out into the of Pittsburgh School of I-lealtli, who educational and research purposes. tistical Division of the Tennessee D( surrounding areas to establish closer is serving as chief consultant for the This appears to be an excellent ve- partment of Public Health. The tim contact for tile training purposes.... planning of a Neigliborhood flcaltli hicle for achieving regional ob- seems ripe for just such a study t Iligil priority C.V(-)Iv(@ from tile coilai)or,,itivc efTort.,, I to kno,%v tile ftittire II,-Il)ilitatioii, will I sicians. We nee( .-Iiii v. ('.ilvestoti -11 I)I.ogi, N%,itli ti !lp focus on the total Problem O[ I'lic ill (I('VCIOI)il)tf III oi)('I'iltioll, patterns of medical practice. arsing.' t of general pra(,,titiolici-, ill tile. iiiiiiie(ti-,Ite "The pi-,inning .taff became acutc- gradual shif "III At-tt;l IT, iiiany )Ilysiciilis wcr(,, into specialties and into population o tile. ly aware til',It tile health I)t..,(,titiont-.r 'ex.ts itliolit ol' 'lost"(" areas w centers is leaving many , joll"ll N'le(I!Cll I)I.Ogl,alll oil Initial Ill(l tile hospital at tile (,.oiittitttnity ,regional Medical Program younger I)hy@icianq. Several cotintie% IZ(!g SC, how- level liid little knowledge of tile exist- (loritact. riie hostile rcsl)on I (4ne ProicctDirector in Arco- I has have no young men coming into their ever, was not uniform. T-vf-.I?ly I)IIysi- @.n(-(-., the intent or tile potential (,, ,ous ommtinities. In or(if-r to ('xaiiiin(-. ll%t-.gionai Medical Program,,. l,',(Tort,, meetings with var' c 'lily of till-- onducted regional i)rol)leins Area I ciaTi,,, Ill(l I iiiliol-ity of ill, to (.-,tll)lisll NVI'itt(!tl coinintini(,,,.ition ducation,.tl Health agencies, Meet- divided into six divisions mind St. (lisll,i(,t %,,(I (.0111,t iiie(ii(-,al ine metil- I(Iic% Iy proved than %,satisfactory; there- -term lie I)Iiy- looked favorably and liol)(.ftllly lll)otl c n were held to (]( t Ipl)ro,,Icli was )dology and to enlist the help of ded- are now underway to (telific t tile program. 'I'li(-,y saw in it all oil- forc, -.1 "'or(! (tire l@'el)riiary 25, ,ommtinity. . . . (.(I essential. On cated individual-, interested in the sician's role in each c (-.Olltilll]iTig ('(Iti(7atioll d(@eiii - -"Within the regular tea(,,Iiing pro- 1)ortitnity for 1967, tile ),,esi(It!nt of e,,Icll County ional Medical Pro for training ('f . ,oals of the Rca r tlieTlls('Ives, tile. (',,,If Coast gram for medical sttitlents, resident,,, fo )I,ofessioll,.Ils, for stil)l)ieiii(!,,- medical, ,Yrams. Outside the Medical School altli ;o(,,icty in :1 ) the Council of Medical -,tnd interns -it the University of lie Ai-ea was invited to (;alvcston to en- community ppcars to be Solltilwesteln Medical school ,in(] ttry special In(,( t(!,, into ., dialogue on lt(!giof"-Il Society Representatives a 01)(-tl tile most significant body to reach affiliated reaching hospitals there .ir(-, tn(i other that ill'.1y - Mc(li(-.al 1'rogr,,ttns. It was 11 meetings conferences, seminars, lectures, ,in(I ,'feeling of isolation. . . . clcll of tiesc individuals would community physicians. Two d on a"Gertain difll(.,tlltiel; lave been that n to their respective commiini- of the Council of Medical societies clinics that are maintains Area Ill ill Commit- rettir 'Ltc tddi- encountered in es have- been attended re lar basis and arc available for in(] would, in turn, crc, Representativ gu (I in continuing ,creating %vitil peripheral point,, at ties II local level. ]Zell- by 28 physicians and 12 hospital ad- Physicians interests wl,icil health car(! set-vices .Ire tionat dialogue at t c en county locic- are res ,oun- education. There ellt;ttivcs from sev ministrators from 16 of the 44 C postgraduate I)ensc(l. ll'till-tilTIC 1)(,r.%otiii(,l .ti't, ty Medical Societies of Area 1. There several institutional grints in I)otli being %Oscar 'II ties, tile Medical A-,,,miatioll exi3rcs.w(l to- heart disease and cancer ;,IPPOrtc(l ,lit for tile I)"Ofessioll, and platinin!v, ;taIT-, from sell Of tile a favor tions now filled oil ,t I)ai-t-titll(! was -,ii)lc attitude several components of tile Texas Re- cgional Medical Program by P,tblic lie-,'It]' s(!rvicc grants. ward the R _ A filli-tiiylc Assistant Planning I)irec- and a desire expressed for the need These programs are oriented to co- tor will (@nc,(!iitrite his efforts on gional Medical Program attended. of the early development of an In- operate with the Regional Medical hospital.,; and other lie-ilt), care cen- While the physicians present repre- Programs. . . . s that tile circuit- settled only a smill part of tile gcO- re Unit Training Program rs. It is i(le(I tcn@ivc Ca icians. The in- "Stroke: c)ignificant programs are te . ol)viotl iiic. -,trci, tlli'; meeting prov for nurses and phy, developed in tile medical ri(ler tc(..Illli(ltlc Tyll,st lie (!Tllploy(!d to steel) i(leril)ie information that verific(i . pital administrators, being community, especially the efl,e 'It tile volvement of hos -1@. pital ct ,iii r(-.sl)oil'e - tile essentiality of ,t continuing intcr- individually or tliroug@ the I chc)ol ommiiliity ]eV(',. . . . planning ofTtce-,,tnd Council, has been most worthwhile Presbyterian hospital tc) develol) -1c"'-rh(- feasibility Stil(IY fol. (ICVVIOI)- change 1)(,tweent riie meeting rovcmcnt of ,ignificant demonstration unit involv- tile ],(Militia practitioner. since tli c eventual imp liscii)lines Of medicine ing Sc)lool of Allied If(!;' I e- must generate from' ing all of tile (' .(I V(- Ilso (it,iliotistr:tt(-(l tile (franc It task l clic(!S II',," 1)1'()91,CSS(@ I-y NVCII. ticii -.I ,It 1, .ty Illc, .,crvic(, ,(I it, (!s .,.ry to bring tiii,; program ilitt') 11(lyi1if replanning s nec(,s., tile community 11 a- will 'ISO 1)(! I-)]',Ice(] On St "There are many facts to be iin- one cooperative c.(Tort. A total 1) mutual r(!Iatiollsllil)s that co'll(I (litlogtle. . . . (-,ovcrc(l I,)y making a -survey of 1)1'Y- tient car(, program, including re- I?zteitsive Care Unit dissipating as further information is other health professionals in the con- "At the Division of Allied Hca t provided. . . . fcrenccs, clinics, and ward rounds of Science at South Texas junior C 'The planning director has collab- "In tile. early 1)liases of this pro- the Medical Centc@ . . . lcge (Houston, Texas) feasibi@ oratcd with the administration of the grain it is tile primary objective of "A study of the applicability of studies are in process in the develo University of 'I'cxas Medical ]3raticii the I)ivisioii of Continuing Education closed circuit television communica- anent of curricula in nursing, inha and the Medical Branch - Hospitals of the (,raduatc Medical School of tioii with one or a few local corn- tion therapy, X-ray, medical recoi in developing a modern iiitcnsive care Ilioiiie(lical Sciences to determine iiiunity hospitals is of considerable in- physical and occupational therapy training unit wlii(-,Ii will contain four ]tow educational roles may be dis- terest.'I'Iiis institution will liarticipate sistants, medical monitoring and el bcds for postoperative care of patients charged within the fratitc%vork of in- with others in the region to prepare tronics, ophthalmic assistants and with cardiovascular disorders. 'riie (lividtial needs and goals, wliilc at formal postgraduate training pro- tary supervision. . . . planning director is currently arrang- tile .,aiiii! there providing practical and gi-aiiis for television presentation. In "At this writing, we have the pr ing for partial funding. through noti- applicable information which will be addition, it is proposed to utilize this pcct of a cooperative feasibility stc federal sources. 'this unit will be de- both convenient and accessible to the medium for individual consultations for a multiphasic screening pilot pr vclol)cd in such a inanner that will physician and others %vlio deliver with patients who can then remain ect in conjunction with the Bay permit the training of nurses and health care, and which will ultimately in a familiar environment with their University College of Medicine co physicians to man intensive care units result in better patient care. . . . own physicians. . . . puter science program and the I in other hospitals. . . . "Ali atteitii)t will be made to con- "A general planning study and sur- partment of Biomathematics of I "Many interested individuals and vey tilt! COTI(-Cl)t that the medical vcy has been undertaken in the allied University of Texas at Houston. T groups are taking an active part in school not only awards an M.D. de- health professions education field to would involve a multiphasic auton gathering information and are par- grec, but provides annual ol)portuni- identify needs, trends, problems, and tion and computer project in patio ticipating in studies, such as tile ties to appraise the practicing I)Iiy- resources necessary to implement diagnosis. This would also bring it Houston Area Hospital Personnel As- siciazi of current attitudes and grant proposals and program goals in focus projects for continuing edui sociation and Houston Dietetic As- techniques, to support the physician advancing, through education, train- tion of physicians in outlying hospit sociation. They leave worked with the in lii% need for lifelong learning.... ing and demonstrations, the care of and allied health education and tra staff in designing questionnaires and licart-canccr-strokc patients. . . . ing needs and programs. . . . Reaioital Training Progra?iz ,gathering information. . . . "In brief, findings indicate: a gen- "A major introductory activity "The program is serving as a cata- in Cardiovascular Disease crat awareness that a perilous short- volved recognition and visitation c .tg of allied health personnel exists rehabilitation settings within I lyst in (!jicout-aging dialogue and co- "'I'I)e initial study of personnel in both numbers and quality . . . Texas Medical Center and operation between institutions, in- available wi(iiiii the Medical Center physicians want and need to delegate Houston community agencies. Pi terest groups, issociatioiis and for postgraduate training I)rograitis more to allied health personnel to grams in these institutions pertin( individuals. 1'rogrcs.-, in carrying out in the of (-at-(Iiovis(@tilai- disease free themselves to serve more pa- to the development of the Progr, planning studies and surveys is being has been I)i-o(Itictiv(-. . ' . initial (:oil- ticiits . . . a closer liaison is evolv- were explored and an at-tempt v made. Misconceptions and erroneous sideratioiis have led to plans for re- ing between educational institutions made to build with these institutic conclusions about the purposes and freslici- courses lasting three to five and hospitals in the education and appropriate collaboration. These 4 goals of the program arc being cor- days and providing for the 1)articipa- training of all levels of allied health ganizations include: the Method rcctcd. ]resistance to the program is tion of practicing physicians and personnel. . . . Hospital, the Ben Taub General Hi 57 pital, the Physical Medicine and Re- ical Association, the various county habilitation Service of the Veterans medical societies, specific practition- Administ@tion Hospital, Houston, crs, hospital administrator and this the Visiting Nurse Association of cancer program which largely has Houston, the American Cancer So- been designed and planned through ciety, Harris County Unit, and Good- the University's biomedical units. It will Industries. The Texas Woman's has been considered essential that University, although relatively new, understanding and agreement be at- has a distinctive curriculum with tained in an atmosphere of good will early patient contact. The school is in order to project further progress. geared to agency collaboration and is Therefore, time has been required to constructively interested in Regional make this adjustment and to reach a Medical Program participation. . . . consensus as to goals. In the case of "At the University of Texas Dental some existing activities, such as the Branch restorative dentistry is con- cancer registry, there have been on- cemed with a number of cancer pa- going programs under diverse aus- tients, and there is considerable expc- pices. Before a statewide registry can rience with restoration of the mouth, be projected, all aspects of existing face, nose and ears. Prostheses includ- programs must be reviewed to fit into ing artificial eyes are fabricated. the larger effort in an han-nonious Closed circuit television has become a and agreeable fashion." part of the teaching technique. . . . "It is apparent that new methods and new techniques must be utilized to attract those who do not now par- ticipate in continuing education. . . . "Progress in the first year of plan- ning at the M. D.-Anderson Hospital and Tumor Institute has been handi- capped by lack of success in recruit- ing a full-time Physician Coordinator having the special combination of qualifications deemed essential to this important position. We have felt it expedient to evaluate the needed adjustments between the Texas Med- llr(@l),It.;ItioIl of I'@F)ol,t I loc A(tvisoi-@, (i)iii,ititte(. v N;ttioiiil Ativisor), Cottiicit VI l@(..Vicw C!ollllllitt(,(, VIT (",ollsllllltlts Vill (!oor(iiii@itor@ I x lZt-vi(-w of( I)ivisioIl X I IZ (.1',] tioll%llil).,; of I)IIi)lic I,.Iw,, I',!) 2'iU iiii(I II!)-7-l!) XI 1. ],,t%v It!)-2',I!) X[If l@(.gtll;ltiollq XIV S(-Icct(:(l llil)liogr;tl)liy "O steps to be follo%vcd in preparing tile cttssion groups of about 25 indi- vidtials each that met three times I-'ir-,t, -.in otitlitie of dis(-.tissioii iteiii.-, during the Conference. The results %V@l; prepared and reviewed at a of this meeting are published in the in(-(@titig oil Noveiiibcr 7. I-i-otti these, Proceedings: Co?ifere?tce on Re- tile key issues relating to the three ,ioital Medical Prograrns. t, l@(-I)ol.l to Specified for consideration in 'riic wealth of information oil S(!ctioti 908 of the Act and other as- developed by the Conference was 1)ect-, of the I)mgraiii were identified Supplemented by letters and other ma- and analyzed. tcrial, voluntarily submitted by par- ro assist in the preparation of the Stibse(IiietiLly, a national forum ticipants following the Conference. rel@rt required by Section 90B of %vas s(-.Ii(-dtil(,-d it which these issue.% 'I'o gatlier additional information, the Public Law 89-239, the Surgeon were presented foi- consideration and Division staff made a series of visits General appointed a Special Ad floc i-e-.i(-tioii front health and related iii- to ongoing Regional Medical Pro- Colliiiiittct. of iion-federal coristill- tcl-(.Sts representing all sections of tile graiiis and held discussions with Pro- .tilt,;. 'I'lic liucl(@tis of tile (-,Ollltllitte(@ (-,oiiiitry. '['his fortiiii took the form of grain Coordinators and others cn- W.L.; four- of tile Nitioii.,tl I oil ltegiotial M@-(Iic-.tl gtgcd in tile development of regional Advisory Cotuicil oil ltegioti@il Mc(li- II i- I d it) Wisliitigtoll x(:tivities. A "14-I)oijiC' survey form (-al Progriiiis. Eleven other persons oil Jiiiii-,ii-y 15-17, 1967. was also distributed to all Program with divers(.! backgrounds and itit(!t-- Neirly l@50 iiie4LIi(-.-if, health .xiid civic Coordinators for their use in for- (,.sts in health -.ijid public i[T,-xit--, tlso I(Iels NV(.I.c invited. '['his gi-oul) it)- Wtl'(Iitig up-to-date data on the status I(., joined (lit! groill). III :I(I(Iitioll, six I)I-I-Solls fi-olit,l)ot.11 I-t-giolis of tlieii- I(!tivities in(i plans. All of individuals %villi (.X- this iiiit(ii-i'tl wis tti(I its(-d .(Iic.tt C(Itl(-.Itioll .111(i ill tile of this It(-.I)ol.t. I)CI-iclict., ill Ill( fi-oill otilet. governments[ administration agreed at-eis %vlivi-c 1)t-ol)o-als %vei-c still iiii- A preliminary draft of tile Report to serve as consultant,; to the Ad I-lo(, (let- III addition, iiiany Nvas reviewed by the Ad Hoc Corn- Committee. ('I'Iic member.-, of and otli(-t-s with interests received riiittec oil March 10, 1967. It was (-OtistilL,tiits to the Cottiiiiitt(-(! tt-c subsequently revised in accordance listed in I-' xliibit II.) invitations. More than 650 persons .witli its recommendations and re- 'I'lle Coiiililittc(! met five At attended tli(! Conference. submitted to them oil April 14. tile. initial meetings, oil SCI)teliil)cl- 16 %vei-t@ 1)r(-I).ii-ed After coitsitltttioii with the members and Octol)cj- 7, 1966, issue% 1)(,i-taiii- by (lie. I)ivisioll of l@(-gioiiit Medical of the National Advisory Council on ing to the development and aciiiiin- Ilrograiiis and distributed in ,idvaiicc. Itcgional Medical Programs, the Rc- istration of Regional Medical Pro- Seven papers Nvcrc presented at plc- port was submitted to the Secretary .gr,iiiis %vere presented and disciisscti. liat-y sessions and two panel sessions of Health, Education, and Welfare I,'t-otti them, cl(-.Iil)critioris t 1)1.(.Sellt,-itions for transmission to the President and series of recommendations for ill(- 1)i-(ivide(I background foi, the 26 (lis- Congress. 61 Boisfeuillet Jones Storm Whaley (Chairman) Charles Kidd, Ph. D. EXHIBIT II Director Vice President of Health Sciences I,'.recutive Secretary Emily and Ernest Woodruff Foui?dation Universit3, of Arkansas Medical Center l@'ederal Councilfor Science and Sui- y Technology ,gcon ('cnei-,il's Special Atlanta, Georgia Little Rock, Arkansar Office of Science and Technology Ad Hoc Advisory Charles E. Odegaard, Ph. D. Paul N. Ylvisakcr, llli. 1). Washington, D.C. Committee To Develop President Commissioner Jack Mastir, M.D. the Report on Regional University of Washington New Jersey Department of Comniunit), Associate Director for Clinical Care Medical Programs to Seattle, Washington Affairs Administration Trenton, New Jersey Office of the Director the President and 1.dmtind D. Pellegrino, M.D.' National Institutes of Health the Congress Director liethes(la, Maryland Medical Center (-Iol)stlftlllts lo III(, Joseph S. Murtaugh State University of New York Stii-g(@.oll Chief Ray E. Brown, L.H.D. Stony Brook, New York Office of Program Planning Director A(i Office of the Director Graduate Progrerm in Hospital Carl Itenry William Riihc, M.D. I,o National Institutes of Health Administration Assistant Secretary Bethesda, Mar)-land. Duke University Medical Center Council on Medical Education Durham, North Carolina American Medical Association Michael E. DeBakey, M.D.' Chicago, Illinois Profe.rsor and Chair?nan tlle Collgl-(.Ss Department of Surgery Clark K. Sleeth, M.D. College of Medicine Dean Norman Beckman, Ph. D. gaylor University School of Medicine Director Houston, Texas West Virginia University Morgantown, West Virginia Office of Intergovernmental Relations Bruce W. Fverist, Jr., M.D' and Urban Program Coordination Chief of Pediatrics Ray E. Trussell, M.D. Department of Housing and Urban Green Clinic Director Develop?nent Ruston, Louisiana School of Public Health and lilashington, D.C. James T. Howell, M.D.' Administrative Medicine Pxecutive Director . Columbia University Ward Darlcy, M.D. Henry Ford Hospital New York, New York Office of the Consultant to the Executive Detroit, Michigan Director Burton Weisbrod, Ph. D. Association of American Medical Colleges George Jtmcs, M.D. Associate Professor [Iniversity of Colorailo 41eilical Center Dean Department of Economics Denver, (:olorailo Mount Sinai School of Medicine Unitiersity of lyisconfin New York, New York Afadison, Wisconsin Kcrmit Cordon Vice President 'Member, National Advisory Council Robert E. Westlake, M.D. The lirookitigs I?tstitutiori on Regional Medical Programs. Syracuse, New York lilashi?zgton, ]).C. 2GS-049 0-67-5 2 ww mm I-'JXHI.-lifT IJ'l 1967 1)1-*Isl(,NA'I'ION ALABAMA ALBANY, NEW YORK ARIZONA ARKANSAS Pit[,',LlMtNAItY Alabaiiit Nortlicistern New York xnd Arizona Arkansas PLANNING ItE(;ION.' portions of Fouthern Vermont and Western Missachusetts l'Ol'UI,A'I'ION I-,S'I'IMA'I'I-" 3,500,(X)O l,!)oO,000 1,635,000 1,960,000 COO]IDINA'I'IN(; University of Alabaiiii Albany Medicil College of College of Medicine University of Arkansas 111--,Al)()UAlt-l-EltS. Medical Center Union University, Albany University of Arizona Medical Center Medical Center. G]tANTEI,' ..-I Saitie.f, Saitic.5 Samc.5 Same.$ Jariutry 1, 1967 July 1, llv;G April 1, 1967 April 1, 1967 I'ROCITAM I'EltlOD 2@f2 3 2y, 2y, (Yl--IARS). AWARD S3113,046-Ist $373,25+-Ist 3 1 19,045- 1 st S360,174-Ist (AMOUN-1- AND Yl--.AR). $384,244-2nd III-'.COMMENDEI) FU'I'Ultl," $28(i,750-2nd $252,486-3rd $287,000-2nd S421,682-2nd SUPPOR'I' S143,375-3rd $67,750-3rd 397,300-3rd (AMOtJNT4 AND Yl-"AIt). I 1reliynittary rpgionsfor planning purposes as tltlitieated in the original al)lplications. @Viate designations 3 ']'lie Grantee differsfrom the Coordinating Ifeadquarters when the Region rtquestd this arranger@ do not indicate thy art coter"iiyiotts with 'Viate lines. 7'lttse prelitni?:ary r@gio?is may be modified on or the latter agency did not have the capability to assume formal fiscal responsibility, the basis of planning and experience. 4 Direct costs only. 2 Population estimates includt overlap between regions. As preliminary regional boundaries are evaluated 5 Indicates the Granite Agency and the Coordinating I-leadquarters are the same organization. and clarified during the planning process, inappropriate orerlap will be eli@ninated. L REGIONAL DESIGNATION DI-STATE CALIFORNIA CENTRAL NEW YORK COLORADO-WYOMING PRELIMINARY Eastern Mmouri and California Syracuse, N.Y., and 15 Colorado and Wyoming PLANNING REGION.' Southern Illinois centered surrounding counties around St. Louis POPULATION ESTIMATE 4,700,000 10,600,000 1,800,000 2,300,000 1965.2 COORDINATING Wmhington University School California Committee on Upstate Medical Center, University of Colorado IIEADQUARTERS. of Medicine Regional Medical Programs State University of Medical Center New York it Syracuse GRANTEE.3 Same.5 California Medic-.it Education Itesearcit I-'t)undation of State Same. and Research Foundation' University of New York EFFECTIVE STARTING April 1, 1967 November 1, 1966 January 1, 1967 January 1, 1967 DATE. PROGRAM PERIOD 2Y, 2y, 2 21,@ (YEARS). AWARD $603,965-Ist $1,511,391-ist $289,522-1 st $361,904-Ist (AMOUNT AND YEAR). RECOMMENDED FUTURE $547,989-2nd $2,198,452-2nd $211,206-2ncl $326,114-2nd SUPPORT $135,993-3rd $961,982-3rd S I 70,662-3rd (AMOUNT 4 AND YEAR). Preliminary regionsfor planning purposes as delineated in the original applications. State designations The Cirantee differs from the Coordinati@g Ileadquarters when the Region requesttd this arra@l!fment do not indicate they ore coterminaus with State lines. These preliminary regions may be ?nodifted on or the latter agency did not hat-e the capability to assume formal fiscal responsibility. the basis of planning and experience. 4 Direct costs only. 2 Polmlation estimates include overlap between regions. As preliminary regional boundaries are evaluated 5 Indicates the (;rantee Agency and the Coorelinati@t- Ifeadqtiarters are the same organization. and clarified during the planning process, inappropriate overlap will be eliminated. LWW IIEGIONAL DESIGNATION CONNECTICUT GEORGIA GREATER HAWAII DELAWARE VALLEY Connecticut Georgia Eastern Pennsylvania and Hawaii PitELINIINARY portions of Delaware and PLANNING REGION. I New Jersey 2,800,0()O 4,400,000 81800,000 POIIULA'I'ION 1965.2 COORDINATING Yale University Medical Medical Association of Georgia University City Hawaii College BEADQUAITTERS. School and University Science Center nces of Connecticut School or Medicine GRANTEE." Yale University School of Siiiic.-@ Stmc.s Samc.5 Medicine EFFECTIVE S'fAit,rIN(. July 1, I!)6(; J;xnutry 1, 1967 July 1, 1966 DATE. PROGRAIVI PEIIIOD 2 (YEARS). AWAIID $406,G22-Ist Ist St (AMOUNT AND YEAR). $338,513-2nd nd RECOMMENDED FUTURE S312,761-3rd $203,207-2nd SUPPORT $104,749-3rct (AMOUNI-4 AND YEAR). Preliminary regionsfor planning purpoirs as delineated in the original applications. 51ate designations 3 'rhe Grantee differsftom the Coordinating Headquarters when the Region requested this arran do not indicate they are coterminous with State lines. 'these preliminary region$ Y?Iay be niodifted opt or the latter agency did not have the capability to assume formal fiscal responsibility. the basis of planning and experience. Direct costs only- 2 Population ettimates include overlap between regions. As preliminary regional boundaries are evaluated Indicates the Grantee Agency and the Coordinating Headquarters are the same organizatiop and clarified during the planning-process, inappropriate overlap will be eliminated. 65' ]TEGIONAI, DESIGNATION ILLINOIS INDIANA INTERMOUNTAIN IOWA PRELIMINAITY Illinois Indi,-tnt Utah and portions of Colorado, Iowa PLANNING REGION.' Ictilio, Niontina, Nev;xcl;t,.tn(i Wyoming POPULATION I-'-';TIMATE 10,700,000 4,900,000 2,200,000 21flOO,000 1965.' COORDINATING Coordinating Committee of Indiana University School University of Ut;iii School University of Iowa College ITEADQUA]TTERS. Medical Schools and Tciciiing or Mc(licin(! of Mcclicill(! of Me(licine Hospitals or Illinois C.RANTI@.-I University or Chicago Indiiii;t Univcrsity I-otiti(litioti S;tlll(l@., EFFECI'[Vl," STARTING Itify 1, 1967 I;tiiti.,xry 1, I!)()7 1, I')(i(; 1, lgr)(; I)A'I'E. PROGRAM PERIOD 2 2@e, 2 2 (YEARS). AWARD $336,366-Ist 3384.,750-ist $456,415-1 st $291,348-1 st (.AMOUNT AND YEAR). S363,524-2n(I ITECOMMENDED FUTURE $244,175-2nd $373,710-2ii(i $230,218-2n(i SUPPORT S152,295-3r(I (AMOUNT4 AND YEAR). Preliminary regions for Planning Purposes as delineated in the original applications. State Designations 3 7'/ie Grantee differsfroirt the (,onrdiiialit@g Ileadqtiariers zvhett the Region requested this arrangement do not indicate they are coterminous toilh Vale lines. 'rhe3e preliminary regions may be ?modified on or the latter tigeyi@y tli(I riot have the capability to assume formal fiscal responsibility. the basis af planning and experience. I Direct cost.r only. 2Population estimates include overlap between regions. As preliminary regional boundaries are evaluated he. same or 5 Iridicrites the Gra?ttt-e ,fgen@v and the (,t)oriliritifirt,, lleaelqriarters (ire t gaiiizntion. and clar@fted during the planni@iZ process, inappropriate overlap ruill be eliminated. 66 ItLGIONAl. 1)1,,';I(,NA-riON KANSAS LOUISUNA MAINE MARYLAND Kansas Louisiana Maine Maryland I'LANNING ItEGION.1 POTIUI.ATic')N LS-riMA'I'I,; 2,200,000 3,500,OOU 1,000,000 3,520,000 19G5.1 Medical Care Steering Comniittee of the (:O()It[)INA'I'IN(; University of K-in@ Louisiana State Department Medical Center of Ilospitals. Development, Inc. Regional Medical Programs for Maryland. Same.-' Same.' Same.6 The Johns Hopkins Universip -inu,-Lry 1, 1967 May 1, 1967 January 1, 1967 July 1, 19fiG J. 2 2 2 AWAltl) $197,945-Ist $490,448-1 st $193,909-Ist $518,443-Ist (ANiOUN,r AND YEAlt). S293,080-2nd $514,251-2nd $204,709-2nd $431,821-2nd SUPI,Olt'l' (AMOIJNT4 AND Yl-"Alt). Preliminary regions for planning purposes as delineated in the original applications. State designations I The Grantee differsftom the Coordinating Headquarters when the Region requested this arrat do not indicate they are coterminous with State lines. These preliminary regions may be modified on or the latter agency did not have the capability lo assume formal fiscal responsibility. the basis of planning and exptrience. 4Direct costs only- 2 Population estimates include overlap between regions. As preliminary regional boundaries are evaluated 5 Indicdtes the Grantee Agency and the Coordinating Headquarters are the same organization and clarified during the planning process, inappropriate overlap will be eliminated. 67 REGIONAL DESIGNATION MEMPHIS METROPOLITAN MICHIGAN Mississippi WASHINGTON, D.C. PRELIMINARY Western Tennessee, Northern District of Columbia ind Michigin Mississippi PLANNING REGION-' Mississippi, and portions 2 contiguous counties in of Arkansas, Kentucky, Maryland, 2 in Virginia, and Missouri and 2 in(lcpcntlcnt cities in Virginia. POPULATION ESTIMATE 2,400,000 2,050,000 13,220,000 2,320,000 1965.2 COORDINATING Mid-South Medical Council District of Coluynl)ii Micliigin Association University of Mississippi ITEADQUARTERS. for Comprehensive mc(licil Society for Itegion,,tl Me(licii Mrclicil (enter Health Planning, Inc. llrogriins, Inc. GRANTEE.3 University of Tennessee Sai-ne.5 Same.' College of Medicine EFFECTIVE STARTING April 1, 1967 Itntiiry 1, 1967 Itinc 1, 11)67 Itily 1, 191;7 DATE. 2 PROGRAM PEITIOD 2 (YEARS). AWARD $173,119-ist $203,790-Ist S 1,294,44!)- 1 st S:i22,845-ist (AMOUNT AND YEAR). RECOMMENDED FUTURE 3 140,000-2nd S169,658-2nct $295,825-2nd SUPPORT $54,825-3rd $84,829-3rd (AMOUNT 4 AND YEAR). I Preliminary r@Cions for planning purposes as delineated in the original applications. State def@gnations 3 'I'lie Grantee d@ffers from the (.oordirtati@g Ilea(Iquarters when the Region requested this arra@Ccment do not indicate they are coterminous with State lines. 'These preliminary regions may be modified on or the latter @getiry (lid not have the capability to assume formal fitcal responsibility. the basis of planning and experience. 4 Direct costs only- I Population estimates include ovtrlab betiveen regions. As preliminary regional boundaries are evaltiaterl 5 Indicates the Grantee Aqency and the (,oordinati@C Headquarters are the same organization. and clarified during the planning process, inappropriate overlap will be eliminated. 68 UNTAIN STATES KA- IIEGIONAL DESIGNA-1-1 RI DAKOTA lio, Montana, N a tnd South Dakot-t Illtl,',LIMINAItY d Wyotnizig I'LANNIN('. ItE(,ION.' POIIULA'I'ION I;S'I'IMA (X)o 00,000 ity of Missouri rstcrn Interstate Comrriission as I a c Medical University of New Mexico Coolti)[NiVI'IN(. I of Medicine r I-liglier I",ducatioii School of Medicine III-'ADQ University or New Mexico 19(')7 cr 1, 1966 July 1, l@)(;6 PitOGItAM :i 1736-ist AWARD 155(@ist lst Ist IAMOUN'I' ANI) YEA 1254@nd 125-3rd $7(i 1,9B3-2n(i nd 29,285-2nd ItECONIMENDI-',D FU' $545,491-3rd suppoiti. (AMOUN'I' I ANI) ordinal' Headquarters when the Region requested this arrang Preliminary regions for planning purposes as delineated in the original alililicatians. State designations I 7'lit Grantee differsfro?n the Co ing do not indicate they are coterminous with State lines. These preliminary regions may be modified on or the latter agency did not have the capability to assumeformalfiscal responsibility. the basis oj planning and experience. Direct costs only. 2 Population estimates include overlap between regions. As preliminary regional boundaries are evaluated 5 Indicates the Grantee Agency and the Coordinating Headquarters are the same organization. and clarified during the planning process, inappropriate overlap "Jill be eliminated. 69 REGIONAL DESIGNATION NEW YORK NORTH CAROLINA NORTHERN NEW ENGLAND NORTHLANDS ?i4ETROPOLrrAN AREA PRELIMINARY New York City, and Nassau, North Ctrolini Verinont an([ 3 counties in Minnesott PLANNING REGION.' Suffolk and Westchester Northeastern New York. Counties. POPULATION ESTIMATE 11,400,000 4,900,000 550,000 :3,600,000 COORDINATING Associated Medical Schools Association for the North Ciroliiit University or Vcriiioiit Miniicsot@t State N4cclic;tl HEADQUARTI-',IIS. of Greater New York. Regionit Mc(licil Progrtrii. (.ollcge of Me(licine. Association I-oundation GRANTEE.' Samc.3 Duke University Saiiic.f, S;Iliie.l EFFECTIVI-".STAIITING June 1, 1967 Tilly 1, 1966 Jtiiii;xry 1, 1967 DATE. PROGRAM PI,"ItlOl) 2 2 2@ AWARD $967,0 1 0- I st $435,1151-ist $:I 1 I 11(i- I St $'i7O,!)O-I--Ist (AMOUNT ANI) Yi-"AR). $600,944-2nd $:377,701--- 2vul IILCOMMENI)]-'.D FU'rUill. $961,957-2n(i $2:i4,1172 -,il.(l $I(;9,0110--2nl SUPPORT $2:i4.,700-:ir(I (AMOUNT 4 AND Yl,'.Alt). I Prtlimirtary regio"s for planning purposes as delineated in the o@ginal applications. .@late designations 3 7/ie Grayitee (liffersfro?yi the lle(idqtiarters itilirn the Rr,,@ion re,7tieste(I this arra".ment do not indicate they are coterminous with @ate lines. These preliminary regions may be modified on or the latter (ipeiicy did riot the capability to a.vsttme.f(;Ymat fi.rcal responsibility. the basis of planni@C and experience. i 4 Direct costs only- 2 Population estimates include overlap between regions. As preliminary regional boundaries are evaluated 5 Indicates the CYayztee Aqency and the Ifeadqrtarlers are the sar??e o@ga?iizntion. and clarified during the planning process, inappropriate overlap will be eliminated. I)["Isl(:NA'I'I()N ofilO STA,ri.,. 01110 VALLEY OKLAIIOMA OREGON l,jit-',I,IMINAlt Ccntrtt -.iti(i Southern 2.3 of (;rcatcr part of Kentucky and Oklahoma Oregon I'LANNIN(, ]tt-"(;TON.' ollio (61 counties excluding contiguous parts of Ohio, m etropolitin Cincinnati liicliiiia, -ind West Virginia. POIIULA'I'ION ES-1-IMA-1-l-" 4,500,000 5,!)00,000 2,500,000 1,900,000 COOltl)]NA'I'IN(; Ohio Stttc University oliio Valley Regional University of Oklahoma University of Oregon III,-.ADQUAII-I-EitS. College of M.c-.dicinc. Medical Program. Medical Center. Medical School. University of Kentucky Same.' Same.' itcscircii Foun(lition September 1, 19G6 April 1, 1967 April 1, 1967 J,-tnutry 1, 19G7 2@i 2 2 (YEAIIS). AWAlti) $10!),417-Ist $346,7GO-ist $177,963-Ist $219,168-Ist (ANtOUN-1- ANI) VI-"Alt). $2:12,371-2ti(I S I 36,168-2nd 3 I 71,998-2nd $44,078-3rd (AM(,)I)N'I" ANI) VI-"Alt). Preliniiiiarv r@cioris for pltinnit@C purposes as delineated in the ar@Citial applications. 'Vtate designations 3 7he Grantee d@ffers from the Coordinatiykq Headquarters when the Region reques(rd this arrangi (lo not indicate they are coterminous with State lines. 7liese prelitnipiary regions may be modified off or the latter @ge?icy did not have the capability to assume formal fiscal responsibility. the basis of planning and experience. 4 Direct costs only. Inflation estimates include aterlap betrt,een @Ciatis. As l,rrlimitiar.v r@Cinrial boritid(trips are evaluated 6 Indicates the Grantee Agency and the Coordinating I-leadquarters are the same organization. antl clarifird elurirkg the planning pr"ess, i?ialpl)rot)riite spi@e?laf) it,ill be eli"ii?P.7te(l. 71 lll,'.(;IONAI, f)],"S](;NA'I'ION ROCHESTER, NEW YORK SOUTH CAROLINA SUSQUEHANNA VALLEY, TENNESSEE MID-SOUTH PENNSYLVANIA PRELIMINARY llocliester, N.Y., and I I South C;trolint 24 counties ccntcrc(I;Lrotin(i Exstcrn tnd Central Tennessee I'LANNING ltl'.GION.' surrounding counties. liarrisl)tirgtnd Ilerslicy. and contiguous p.@ of Southern Kentucky and Northern Alibama. POPULA,rjON I-"S'I'IMA'I'I-" 1,200,000 2,500,000 2,100,000 2,600,000 19r,5.2 I COORDINATING University of Rochester Medical College of South llc-niisylvini;t Nlc(licil Society. Vanderbilt University School III,',ADo_tJAIt-I'LltS. School of Medicine and Carolina. of Medicine tnd Meliirry Dentistry. College of Medicine. Samc.s Stinc.5 Saiiic.5 Vanderbilt University. EFFLCTIV I," October 1, 1966 January 1, 19fi7 1, 1967 Tilly 1, 19ril; DATE. PROGRAM PI,'.RIOD 2@/4 1 2 2 (YEARS). AWAIID $306,98r@Ist S65,906@ist $26:1,5:30-ist $265,84 1 -1 st (AMOUNT AND $393,4511-2n(i RECOMMr,,NI)LI) FU'I'LlitE $329,364-2nd $249,550-2n(i SUPPORT $259,900-3rd (ANIOUNT 4 AND Yl-"Alt). I Preliminary regions for fil4nrtirW purposes as delineated in the &r@ginal applications. @@tate des@gnatinns 3 7-lie Greiritre (1@ffersfraiii the Coordinating lieejelqtiarter.r it)heyi the Recio?t relitesteel this arrangement do not indicate they a" coterminous ivith Vtate lines. 7'liese preliminary regions may be inottified on or the leitter agency (liel ?tot have the capability it) assitryle forr?ial fiscal responsibility. the basis of planning and experience. I Direct costs oitly- I Population estimates include overlap beiiiiien regions. As preliminary regional boundaries art evaliialrd 5 Indicates the Grantee Agency and the Co6relitiati?@g Ilratlqliarlers are the same n@i:ani,-atiort. and clarif:td during the planning process, inapprnl)rialt or,ertap tt)ill be, eliminated. 72 TEXAS VIIIGINIA WASHINGTON-ALASKA WEST VIRGINIA ITEGIONAL DLI;IGNA'I'ION Virginia Alaska and Washington West Virginia PRELIMINARY Texas PLANNING ITEGION.' l'OPULA'I'ION Es,riMA'I'I,'. 10,500,000 4,500,000 3,200,000 1,800,000 COORDINA'JRING University of'l'cxas Medical College of Virginia and University of Washington a University IIEADQ_UARTERS. University of Virginia School School of Medicine. tcr. of Medicine. GItAN'I'EE.1 University of Virginia School of Sainc.5 nine. Medicine. Iaiiutry 1, 1967 r 1, 19GG January 1, 1967 JL)A'I'L. PROGRAM PERIOD 3 2 (YEARS). $1,271,013-Ist $291,454-Ist Ist S 1 50,798-1 st AWARD (AMOUNT AND YEAR). .$I,260,181-2nd ITECOMMENDED FUTUITE $133,987-3rd S254,000-2nd 4-2nd $175,250-2nd SUPPOR'I' $241,79@3rd $91,250-3rd (AMOUN-I@ 4 AND YEAR). I Preliminary regions for planning purposes as delineated in the original applications. State designations 7'lie Grantee differsfrom the Coordinating Headquarters when the Region requested this arrang do not indicate they are caterminous with State lines. 'These preliminary regions may be modified on or the latter agency did not have the capability to assume formal fiscal responsibility. the basis of planning and txperience. 4 Dirtcl costs only. 2 Population estimates include overlap betiveen regions. As preliminary regional boundaries are evaluated 5 Indicates the Grantee Agency and the Coordinating Headquarters are the same organization. and etarifted during the planning process, inappropriate overlap will be eliminated 73 REGIONAL Dr-';IGNATION WESTERN NEW YORK WESTERN PENNSYLVANIA WISCONSIN 1'.k.,;tn(I 211 Wisconsin PRELIMINARY Buffalo, N.Y., an(I 7 surrounding PLANNING RI-GION.' counties@ surrounding counties. POPULATION E.';'I'IMAI@ll 1,900,000 4,200,000 4,100,000 1965.2 COORDINATING School of Medicine, State tJniversity I ictltii (.',(!nt(-r Wisconsin Regional IIEADQUAIITLITS. University of New York at of Pittsl)tirlli. Mc(lic:tl Ilrorritii, Inc. iluffalo in coopcritit)n with tile I Icalth Organi7.ation of Western New York. Sanic.1 GRANTE, The Research Foundation of S-.Imc.l State University or New York EFFECTIVI,'. STARTING December 1, 1966 January 1, 1967 Scptcrnber 1, 1966 DATE. PROGRAM PERIOD 2 (YEARS). AWARD S 1 49,241 -1 st $34 0,55F)- I st In-ist (AMOUNT AND YEAR). RECOMMrNDIr,D FUTURE SUPIIOITT $I 17,f)26-2nd 32(iO,484-2n(i (AMOUNT 4 ANI) YEAR). e eirs@gptejtion.v 3 'I'lie Grantee el@lfo-rs.fr(;ril the lb!atlltiezriers tf)heii the R@gioyi reqtiesterl this arra@,,-einerit Preliminary regions for planning purposes as delineated in the original onsibility. de not indicate they are coterminous tvith State lines. These preliminary r@gioyis may be niodijied on or the latter agency (lid riot have the cap(ibilitv to assume fi)rttial fiscal resl) 4 Direct costt only. the basis of planning and experience. 2 Population estimates include overlap beitt)een regions. As preliminary regional boundaries are evaluated 5 Indicates the Grantee Agency and the Coordinating Ileadqiiarters are the same organization. and clarified during the planning process, inappropriate overlap tvill be eliminated. @74 3(), l')67 ALBANY, NEW YOIIK IN,RERMOUNTAIN KANSAS MISSOURI Nortlictstcrn New York tnd Utah and portions of Colorado, Kansas Missouri, exclusive of portions of Southern Vcriiioiit I(iilio, Montana, Ncvtd;i, Mctropolitkn St. Louis. and Western Mtssaclitisctts. -111(i NVYOI)Iillg. l,f)00,000 2,200,000 2,200,000 2,400,000 All,)atiy Mc(lic;d College of University of Utah School University of Kansas University of Missouri Union University, Albany of Medicine. Mcdict] Center. School of Medicine. Medical Center. It A N'I'I: Saiiie.1 S;Iliic.l Salilc.l Saiiic.1 I I It ['I N AI)i-it 1, I!)fi7 AI)ril 1, I!)67 June 1, 1967 April 1, -1967 2 2,1,/2 2 2 I'l,@ A S'314,(i27-Ist SI,79O,fiO3-Ist SI,076,600-Ist $2,887,903-Ist $750,1)0()-2iid SI,162,049-2ii(i 3 1,000,000-2nd $2,625,000-2nd $1,036,3711-3r(I (A,Nl()(IN'I' ANY) I'l-"Alti. hidictilts Thai thr (;rattlee Agett@v (laid fhe (.'ot)rdi?zati?@C II$-aflqiiarli-rs eire thr Tonle o@gayiiZatio@t. I)ircci coils Only. 75 James T. Howell, M.D. [Iniversity of Verytiorit EXHII31'1' V Executive Director Burlington, Veritiolit Henry Ford Hospital Cornelius I f. Traeger, NI.1). Detroit, Michigan New l'ork, Neu, York N,ttional A(Ivisory Coiincil oii J. Willis liurst, M.D.-' A. B. liaker, M.D.' Professor and Chairman Professor and Director Leonidas If. Berry, M.D. Department of Medicine William II. Stewart, M.I'). ((:hair?tieirt) Division of Neuro gy Professor School of Medicine Universit), of Minnesota Cook County Graduate School of Medi- Emory University Surgeon General Afirineapolir, Minnesota cine Atlanta, Georgia Public Health Service Bethesda, Alar3-lan(i A. Earl Walker, M.D. Senior Attending Physician Clark If. Millikan, M.D. Professor of Neurological Surgery Alichael Reese Hospital Consultant in Neurology Johns Hopkins University Chicago, Illinois Mayo Clinic Baliiynore, Maryland Mary I'Bunting, Ph. D.' Rochester, Minnesota fo?- .%Ietltoll(tl President I?adcliffe College George I-,. Moore, M.1). Director Cambridge, Massachusetts I?oswell Park Afetnorial Institute .John B. I lickain, M.D. Gordon R. Cumming' Buffalo, New York "ftle I "(,II tie Professor and ChairniatL Administrator Department of Medicine Sacramento County Hospital William J. Peeples, M.D.2 Indiana University Medical Center Sacramento, California Commissioner Sidney I-irber, M.D.' Indianapolis, Indiana Maryland State Department of Health Director of I?eiearch Michael E. DeBakey, M.D. Baltimore, Maryland Children's Cancer Research Foiiidatio?L Professor and Chairman Department of Surgery Edmund D. Pellegrino, M.D. Boston, Afasfachitsetis School of Medicine Director Murray M. Copeland, M.D. licnjamin B. Wells, M.D. Baylor University Medical Center 4ssociate Director Assistant Chief Medical Director lloustan, Texas State University of New York M.D. Anderson Medical Hospital for Research and Education in Bruce W. Everist, Jr., M.D. Stony Brook, New York anil 'I'untor Institute Medicine Chief of Pediatrics Alfred M. Popma, M.D. Texas Merlical Center Department of Medicine and Surgery Green Clinic Regional Director Houston, Texas Veterans Administration Ruston, Louisiana Mountain States I?egional Af edical lot- lveishi?tgtoiz, D.C. Charles J. Hitch Prograt)z I?esigned janitar), 1967. Vice President for Administration Boise, Idaho '-,4fe?pzbership terminated November University of California Mtck 1. Shanholtz, M.D. 1966. Berkeley, California State Health Commissioner ----- - Appoi?ttptzent expired September 1.966. State Department oflfealtlt Edward NV. D(-tili)scy, Pli. John R. Ilogness, M.D. I?ichi?iond, Virginia Cliairiiia?t Dean Deptirlitte,rit (@f A?i(itoiti), School of Aledicine Itol)ert J. Slater, N4.D. (:olle!,,e of I'h),sici(tris ayiel Stirgeoti.v University of IVashingion Dean Colittiibifi ll?zitler.tit), Seattle, I'Vashingion College of Medicine Neitp )'ork,Neit, l'ork George I-". Miller, M.D. John D. Thompson VI Director Director, Ilrogranz in Hospital Center /or Medical Eflitcatinit Ad?ninistratioiz College of Alerlicine Professor of Public Health ljniveriity a/ Illinois School of Public Health Yale University Chicago, Illiyzoir Neiv Haven, Connecticut Mark Berke Anne Pascasio, Pli. D. Kerr L. Wilitc, M.D. Director Associate I?esearch Ilro essor Director Mount Zion Hospital and Nursing School f Division of Medical Care and Medical Center Hospitals San Frapicitco, California Ifitiversity of ]Pittsburgh School of llygie?te and Public Health Kevin P. Bunnell, Pli. D. Pittsburgh, Pennsylvania Johns Hopkins University Associate Director Balti?nore, Maryland Western Interstate Commission for Sainticl 11. Progcr, M.D. Higher Education Profcisor and Chairp?2ari Boulder, Colorado I)epartriie?ii of Af ediciiie Tufts University Sidney B. Colicn Vchool of Af edicitir Management Consultant 1'retiflelit Silver Spring, .4larylati(l Bingham Asioci(tirf I-'itiiii I-'Idwiti ],. (Arosl)y, M.D. Director A?Yicricari Hospital Association Dtvitl I-. ]to I gers, M.D. Chicago, Illinois Ilrofessor and Chairman George James, M.D. (Chairt7ian) Department of Medicine Dean School of Mediciytc Mount Sinai School of Medicine Vanderbilt University Netv York, Nerv York . Nashville, Tennessee Howard W. Kenney, M.D. Medical Director Carl Ilefiry William Itulic, M.D. John A. Andreiv Memorial Hospital Assistant Secretar), 7'riskegee Institute CO?illCit OIL Medical Education 7'tiskcgce, Alabama A?ttericayi Medical Association Edw;ird J. Kowalcwski, M.D. Chicago, Illinois Chairman (,'o?ntnittee of Environmental Medicine Robert J. Slater, M.D. Academy of General Practice Executive Director Akron, Pennsylvania The Association for the Aid of (:rippled Children 'Deceased, April 1967. Netv York, Netv York 77 Norman Beckman, Pil. 1). N(,itiat 0. [lot-li:itii, NT.1). E,XHIJ31T VIT Director Ifettel, If,-eitt (:t)yitiot I'to.@@tiryt 1'ri)ft-stot- of (:oyptititinit,i- Office of Intergoi,ei-ititte?ztfil I?el(ttif@nv lttire-ait (,/ (:hyt;yiic Ali-diriti,- and Urban 1'rt)gratit (:o(ir(Iiii(itioyi (:alif(i?tiitt I)epet?tttie'rit of l'iiblii7 lfe@tilth Colistilt,,Ili(s to tll(, Department of Housing and (Irba?t De- lierki,-Ie),, (:(ttifor@iiet ll'tisltittgtoiz, D.(:. Division of lx'c(liollill zi zielopment lltiii liri(Iiiit4 Si(] ll(-Y 11. Cohen ,N,lc(lic,-Il Progritins Washington, D.C. Director of I?ese(ircli in Afcdical Afanagerizent Consultant Eelucatio?t Silver Spring, Alarylanel Stephen AI)rahamson, M.D. A. E. Bennett, M.D. Albany Ale(lical (:ollet!t.- Director Department of Clinical Epi(leytiiology and John D. Coll)y Oflice of Retearch in Medical Education Social Medicine Alban),, Netv )@ork Chief University of Southern California St. Thomas' Hospital Medical School Kevin 1'. Btitinell, Pli. 1). Research Training Branch Los Angeles, California london, S.E. 1, England Associate I)ireclor Divivio?z of Research lf,'esterii Interstate (:f)tiiiiiii5ioyt for and Training Dissc@ttiiiteitio?t Roy Acheson, M.D. Rol)crt Berg, M.I-). lfiglict- I" Iiic(ltioy@ office (if location Epidemiologist Professor fi?t(l Chair-pit(tit lloiil(let, (:,o(loinflo ]),(:. School of Medicine Department ofl'retietitit,,e Afe(licitte (iii(I Witri-t:ti I[. C:ol(-, M.]). Yale University Coni?yzunit IlealilL M:tl-y 1. litilitiiig, I'll. 1). Il'ppierit2is Professor tiytil Ilcad New Itaven, Connecticut y flyesi(letit University of Rochester I?ntlcliffe (:allege Department of Szirger), Alexander Anderson, M.D. Rochester, Nete) )'ork ittetsvercliti.st.-tiv llizitiersit), of Chic(igip Director (:hicet!,,o, Illi?ioiv 7'raining Prograntt for Center (if Afe(lical I-". ltli)%Vll, [,. 'I. 1). N'lill-l.;Iy NI. M.1), Education Assistant to State Health Cotiittiifsiniter Director Asfocititc Director College of Medicine Vermont Department of Ifealth I'toi,,ratit in llospiteil It. D. Anderson ifetlictit Ilosftital and University of Illinois lltirlingloyi, Vermont ,Idittiiii)tyalio@i 'I'iit)tor I)istititti,, Chicago, Illinoic Mirk Berke I)tike (Iiiiioersit), Aft@eliceit (:enter 'I',:x(is Aft,elictil (:entire William Anlyan, M.D. Director I)ttrh(iiii, North Citioliti(i lfolistoll, /,(.X(ls Dean Mount Zion Hospital and Medical Center Thigh Ilittt, Ni.1). I,. (:I-osl)y, Afedical Center Duke University San Francisco, California Professor of ,Ifedicitit! Director Durham, North Carolina T,conitiis 11. Berry, 1%1.1). ilf(l)-O (:Iillic .-I@tto!ric(ipt Ilospiteil .-Issociation Professor ]Rochester, Afiii@iesoltz (:hiceigo, Illinois Norman T. J. Bailey, Ph. D. (;orcloii It. (:titiiiiiitig Professor Cook County Graduate School of Afesti- Doii.-il(i .1. NI.1). Bioriiathentatics Department cine ,Issoci(iti@ I)i!ttpz arm illctlic(il Director Cornell Unitiersity Medical School and Senior Attending Physician College of iteilici?ii! Sloan-Kettering Institute for Cancer Michael Reese Hospital ll?iiversities of Illinois Y(li:reit)teiito, California Research Chicago, Illinois Cllica,!"o, Illi@ioii Anthony C:ttrret-i, M.D. Ner(i York, Net(i York Professor of Surgery A. B. Baker, M.D. M.-irk S. Bitimt)crg, Pli. D. illicit (:;Istl(" Director Professor and Director Special Assistant to the Vice President for Associate Dean Division of Clinical Oticolog3, Division of Neurolog), Business and l,inance College of Atedicitti@ (:ayici,r Ilospittil [Iniversity of Minnesota [Inir)ersity of California [Jtiiz)er.@ity of [half (Iiiii-e).vitj, of Itliscnit@ii@t .Ifinneapolis, Minnesota Berkcle),, California .';(ilt L(tke Cit)-, 111(ilt "C..4-r.4!1 O-(;T---f; 78 J.,iiiies 1. Ile-.Lid, Pli. D. George James, M.D. I-'rederick Cypitcrt, I'h. D. Sidney Dean Director of Research Director ies in I,,duca- Mount Sinai School of Medicine Assistant Dean Citildren's Cancer I?esearcit Center School for Advanced Stud New York, New York School of Eflucation Afassacillisetts lion Ohio State [Inivrrsity Alichigart State University Ililliard Jason, M.D. (:Olu ,Ibtjs, Ohio I-ast Lansing, Michigan Chairman Professor Department of Me dical Education, Michael L. I)cllakey, M-1). I)ublic Health Administration John 1). flickaiii, M.D. Research, and Development Professor and (,hairtilan school nf ity ie,ie and Public Health Professor and Chairman College of Human Medicine 1)4rpart.ittent of Surgery . 9 Department of Medicine Ilaylor University jnliyls Hopkins University Indiana University Medical Center Michigan State University l[ousion, 7'exas ijaltiyiiore, Maryland Indianapolis, Indiana East Lansing, Michigan I-',dward W. Dcmpscy, Pli. D. John C. Frcyjii-.tnn, M.D. Charles J. Ilitcli, Ph.D. Doisfeuillct Jones Chair?tian Medical Director Vice President for Administration Director Boston L,ying-in Hospital University of California Emily and Ernest Woodruff Foundatioi Depart?nent of Anatomy Boston, Massachusetts Berkeley, California Atlanta, Georgia College of Physicians and Surgeons judge, M.D. Columbia University Ilerbert P. Gallilicr, Jr., Pli. D. Howard F. Hjelm R:tchard D. Acting Director Assistant Professor, New York, New York Professor Deparf?itent of Industrial Engineering rieritentary and Secondary Research Department of internal Medicine Mr.Coriiinck Detnicr ljniversity of Michigan ]litreau of Research University of Michigan Assistant Director Ann Arbor, Michigan Office of Education Ann Arbor, Michigan Division of Longter"i Care Kcrinit Gordon Washington, D.C. Howard W. Kenney, M.D. American Hospital Association Vice President John R. I-logncss, M.D. Medical Direct or Chicago, Illinois 7'lie ljrookings Institution Dean John A. Andrew Memorial Hospital I.,. Grey Diniond, M.D. tvasitingtori, D.(:. School of Medicine Tuskegee Institute University of Washington Tuskegee, Alabama Director Jtck I I,-ildetitan, M.D. Seattle, Washington Charles V. Kidd, Ph. D. Scripps Clinic and Ilestarcit ],'Xecutitye Director Jiines T. Ilowell, M.D. Executive Secretary Foundation Hospital Planning and I?eview Council I,,xecutive Director Federal Council for Science and La Jolla, California for Southern New York Ifenry Ford Hospital Technology Robert Dyar, M.D. Nezv l'ork, Neiv l'ork Detroit, Michigan office of Science and Technology Chief of I?esearch John Hammock, Pli. D. J. Willis liurst, M.D. Washington, D.C. California Department of Public Health Professor Professor and Chairman Charles B. Kossman, M.D. Berkeley, California Department of Educational Psychology Department of Medicine Professor University of Georgia School of Medicine Department of Medicine Paul M. Ellwood, Jr., M.D. Emory University New York University Medical Center Executive Director Athens, Georgia Atlanta, Georgia New York, New York American Rehabilitation Foundation A. NfcGehec Ilarvcy, M.D. R;tlpli Ingersoll, M.D. Kowalewski, M.D. Minneapolis, Minnesota Director of Research in Medical Educa. Edward J. Chairi?tan Chairman Bruce W. Everist, Jr., M.D. Department of Medicine lion School of Medicine School of Medicine Board of Directors Chief of Pediatrics Ohio State University Academy of General Practice Green Clinic Johns ltopkins Unitiersify Ruston, Louisiana lialliptiore, Afar),Iand Columbus, Ohio Akron, Pennsylvania 79 Peter Lee, M.D. Richard L. Meiling, M.D. Aruic Piscisio, Pli. D. John Rosenbacti, Pli. D. .Assistant Professor Dean Associate I?esearch Professor Director Department of Pharmacology College of Medicine Nursing School State Unit)ersit), of New York at Albany School of Medicine Ohio State University University of llittsbzjrgh Albany, Neiv York University of Southern California Columbus, Ohio llitisbi4rgh, Pennsylvania C,arl I I(-nry Williim Rulic, M.D. Los Angeles, California C. Arden Millcr, M.D. joye Pitterson, I'li. D. Assistant Secretary Jack Lein, M.D. Vice Chancellor for Health Sciences I)ublicatioris Director Council on Medical Education Assistant Dean and Director for University of North Carolina Medical Center American Medical Association Continuing Education Chapel Hill, North Carolina University of Alissouri Chicago, Illinois School of Medicine George B. Miller, M.D. Colti?rzbia, Missouri Paul Sinazaro, M.D. University of Washington Director Williaiii J. I'(!el)les, NI.D. Director Seattle, Washington Center for Medical Education College of Medicine (:om?nissio7ier Division of Education E. James Lieberman, M.D. University of Illinois State Dcpeirt?tzent of Health Association of A rnerican Medical Colleges Director Chicago, Illinois Baltimore, Maryland ]-.vanstort, Illinois. Audiovisual Facility Communicable Disease Center Clark H. Millikan, M.D. Edmund 1). Pellegrino, M.D. Rayii)on(i Seltser, M.D. Public Health Service Consultant in Neurology Director Professor of Medicine Atlanta, Georgia Maya Clinic Medical Center School of Hygiene and Public Ifealth Rochester, Minnesota State University of New York Johns Hopkins University Abraham Lilienfeld, M.D. George E, Moore, M.D. Stony Brook, New l'ork Baltimore, Maryland Profe.rsor and Chairman Director Alfred fvf. Popina, M.D. Department of Chronic Diseases Roswell Park Memorial Institute Chief of I?adiology Mack 1. Slianholt7, M.D. School of Hygiene and Public Health Buffalo, New York St. Luke's Ilospitat and School of Nursing State Ifealth Commissioner Johns Hopkins University William D. Nelligan Boise, Idaho State Department of Health Baltimore, Maryland Executive Director I?ichmond, Virginia Robert Lindce American Institute of Cardiology Samuel Ilrogcr, NI.D. Cecil C. Sheps, M.D. Assistant Dean for-Administration Bethesda, Maryland President General Director Medical School Charlcs E. Odegaard, Ph. D. Bingham Associates Fund Beth Israel Medical Center Stanford University President Boston, Massachusetts New York, New York Palo Alto, California University of Washington Fred M. ]Zcmley Seattle, lvashingion Chief Engineer Arthur A. Siel)cns, M.D. Samuel Martin, M.D. Stanley W. Olson, M.D. Television Center Director Provost Program Coordinator University of Michigan Rehabilitation Center College of Medicine Tennessee Mid-South Regional Ann Arbor, Michigan University of Wisconsin Hospital University of Florida Medical Program A-ladison, Wisconsin Canesville, Florida Nashville, Tennessee David I-. Rog(!rs, M.]). Manson Meads, M.D. John Parks, M.D. Professor and Chairman IZol)crt W. Sigmatict Dean Dean Department of Afedicitic ],,.vectititie Director Bowman Cray School of Medicine School of Medicine School of Medicine Ilospitat I'lanning Council of Allegheny Wake Forest College George Washington University Vanderbilt University County Winston Salem, North Carolina Washington, D.C. Nashville, 7'ennessee Pittsburgh, Pennsylvania @80 ltt)l)crt J. Siiter, M.D. I-'Iiiini.-iiiiiet Sii(er, M.]-). Ilurton lvcisbrod, Pli. D. George A. Wolf, M.D. Execulit.le Director Dean Associate Professor Provost and Dean 7'he Association for the Aid of Cripplrtl (:ollege of Ale(lici?ie Department of Ecoytor?iics School of Medicine Children Uriii)ersity a/ l,'Iorida University of Wisconsin University of Kansas New York, New York (;ainest-ille, Florida Madison, Wisconsin Kansas City, Kansas Adri.-iii 'I'crlouw licnjiinin B. Wells, M.D. Richard M. Wolf, Ph. D. Vergil N. Slcc, M.D. Educational (Consultant Assistant Chief Medical Director for Re- Assistant Projessor'of Education Director Sales Seri,icc Division search and Education in Medicine School of Education (:ont??tiiiee on Professional ltovpitat Ac- Eastman Kodak Co?pipa?i), Depariy?ieyit of Medicine and Surgery University of Southern California tivitie.f I?oclic.iter, Nei(i )'ork Velera?is Administration Los Angeles, California First National lluildi7ig .John 1). 'I'Ikollll).SOII Washington, D.C. Alonzo S. Ycrby, M.D. Ann Arbor, Michigan Professor of l'itblic Health Kelly West, M.D. Head Director Chairman Department of Health Services (,];irk 1). Sle(!tli, M.]). Administration /)Cflll 1'r(iginiti in Ilovl)it(il A(I"ii?ii.it@atio?i I)cpart?ptepit of Continuing Education School of Medicine Vchool of Public Ile(ilth llytit)erjity a/ Oklaho?pia Medical Center School of Public Health lycsi Virginia University I'alc I.Ittii,rrsit), Oklahoy)ta Cit)-, Oklahopita Harvard University ,Ifoy-l,,eiiilotv)i, ltlrsi Virginia Neity 11(ii.-en, ]@ol)crt I-". Westlake, M.D. Cambridge, Massachusetts (.;ortif-litis 11. S),rrictise, Neif; York Paul N. Ylvisakcr, Ph. D. .JOIIII rvl. Stq(.y Director Director Storiii Wlitl(:y Public Affairs Prograr?z Medical Center 11,;iy Vice ]'resident l,ord Foundation University of Virginia Director Ife,71tlt Sciences New York, New York Charloftsr)ille, Virginia School of Public Health and A(I?iiinist@n- U?tivcrsity of Arkansas Medical Center live Medicine Little Rock, Arkansas Lawrence E. Young, M.D. Robert I-". Stake, Pli. 1). (,'olityribia Uitiversit), Chairman Assistant Director Neu, I't)rk, New l'ork Kerr L. White, M.D. Department of Medicine Director School of Medicine (:enter for Itistrttctio@i, I?rscarch, antl A. I,'Irl Walkt-r, Division of Medical Care and Hospitals University of Rochester (:iirricitifitti Erpaliialion 1'rofestor of Netirological.Vit?.4:er), School of ll),gieite and Public Health Rochester, New York College of Education johiis Ilopki?ts University Johns liapki?ts University University of Illinois Balli??iore, il-laryla?id Baltiptiore, Afaryland Urbana, Illinoit Jttncs V. Warren, M.D. Jacinto Steinhirdt Pli. 1). Chairman Kiniball Wilcs, Ph. D. Department of Medicine Dean Scientific Advisory to the President and College of Aledici?ie School of Education Professor of Cheiiiiftr), Ohio Stale Unit,ersity University of Florida (Georgetown University Columbus, Ohio Gainesville, Florida lYa5hington, D.C. Ni ax I(. Weil, M.D. l,orcii Williains, M.D. Patrick B. Storey, M.D. Associate Professor of Afcdicitte Director Professor of Community Medicine School of Medicine Research in Medical Education Ilahnemann Medical College University of Soritheryi California Medical College of Georgia Philadelphia, Pen?tt),Ivanin l,os Angeles, California Iiigiista, Georgia EXHIBIT VIII Program Coordinators for Regional Medical Prograiiis,,Ititi(-- 30, 1967 Regional Designation llrclitiiintry Planning 1'rogriiiii (:t)oi-(Iiti;ttot- ti;il 1)(Silililli,)Il I'tc-iiii1ifl;lly I'lititililit- ],region ALABAMA. Alabama. Benjamin 11. Wells, M.D. CALIFORNIA. C,-iliforiiit. Paul 1). Ward University of Alabama Medical I?xccutivc Director Center California Committee on Rc- 1919 Seventh Avenue, South gional Medical Progrims Birmingham, Alabima 32533 Itoom 302 655 Stittcr Street ALBANY, N.Y. Northeastern New York, Frank M. Woolsey,.Jr., M.T). Sin Francisco, California 94102 -tnd portions of Associate Dean S(Yuthcrn Vermont Albany Medical College of and Western Union University CEN'I'ItAl, NT,NV Syracuse, New York, Iticliar(i If. Lyons, M.D. Massachusetts. 47 New Scotland Avenue YORK. -iiicl 15 surrounding Ilrofcssor and Chairman Albany, New York 122013 (Counties. Department of Medicine State University of New York Upstitc Medical Center ARIZONA. Arizona. Mcrlin K. DuVal, M.D. 766 Irving Avenue Acting Dean Syracuse, New York 132 1 0 University of Arizona College of Medicine Tucson, Arizona 85721 COLOITAI)O- (:olori(lo ;iii(I Wyotiiiiig. C!. Wesley ],',isclc, M.]). WYOf%4 IN(;. Associate Dean for Postgraduate ARKANSAS. Arkansas. Winston K. Shorcy, M.D. Medical Education Dean, University of Arkinsis University of Colorado School of Medicine Medical Center 4301 West Markham Street 1200 I-last Nintit Avenue Little Rock, Arkansis 72201 Denver, Colort(lo 110220 BT-STATE. eastern Missouri William 11. Danforth, N4.1). Connecticut. C'Itrk,,Ir., M.13, and Southern Illinois Vice Cliinccilor for M(-tlicii 1'rogriiii Coordinator centerc(i -around Affairs Connecticut Itcgion;il Mv(lictt St. Louis. Wisliingtoii University 1'rofriiii 660 South I-ucii(i Avenue 272 (;(.-orgc Street St. Louis, Missouri f)31 IO Ne%v I fitvcn Connecticut 06510 l'i-ciiiiiiii,,Iry I'I;tiiiliiig I't-ogi-atit Coordi iiator ltcgiol) FLORIDA. Florida. Samuel 11. Martin, NI.1). INDIANA. Indiana. George T. Lukemeycr, M.D. Provost J. Ilillis Miller Associate Dean Medical Center Indiana University School of University of Florida Medicine Gainesville, I-'Ioridt 32601 Indiana University Medical Center GEORGIA. Ccorgix. %V. Chambers, M.D. I 100 West Michigan Street Medical Association of Ccorgit Indianapolis, Indiana 46207 938 Peachtree Street N.]-',. Atlanta, Georgia 3030!) INTERMOUNTAIN. Utah and portions of C.-Hilmon Castle, M.D. Colorado, Idaho, Associate Dean and Chairman GREATER Eastern llcntisylviiiia William C. Spring, Jr., M.D. Montana, Nevada, and Department of Postgraduate DELAWAITE VALLEY. ind portions of Greater Delaware Valley Wyoming, Education Delaware tiid Itcgioii,-il Medical Program University of Utah New Jersey. 301 City Line Avenue Salt Lakc City, Utah 84112 liala-Cynwyd, Pennsylvania 19004 IOWA. Iowa. Willard Krchl, M.D., Ph. D. HAWAII. 14awaii, Windsor C. Cutting, M.D. Director, Clinical Research School of Medicine Center University of Hawaii Department of Internal 2538 The Mall Medicine I lonolulu, I lawaii 96822 University Hospital University of Iowa Iowa Ci ty, Iowa 52240 1 LLINOIS. Illinois. Leon 0. Jacobson, M.D. Dean, University of Chicago School of Medicine KANSAS. Kansas. Charles E. Lewis, M.D. Chairmin, Coordinating Corn- Chairman, Department mittcc of Medical Schools and of Preventive Medicine 'reaching Hospitals of Illinois University of Kansas Medical 950 East 59tli Street Center Chicago, Illinois 60637 1 1 Kansas City, Kansas 66103 83 ilrorriiiii (:oni-(Iin;ttf)r y Regional Design inary. ltegii ciiigan. 1). I-'Iugenc Sibery LOUISIANA. a. Joseph A. Sabatier, M.D. MICHIGAN. ]@xecutivc Director Louisiana Regional Medical Creatcr Detroit A-,t Hospital Program Council Clairborne Towers Roof 966 Ilenol)scot Building 119 South Clairborne Avenue Detroit, Michigan 48226 New Orlcans, Louisiana 70112 Maine. Manu Cliatt@lec, M.D. MISSISSII,lll. Mississil)l)i, (:;tinpl)cll, M.D. MAINE. Mcrrymectint, Medical Group University of Mississippi medical Center Brunswick Miin(! 25(X) Nortli State Strcct Itckson, Mississippi 3921(') Thomas B. Turner, M.D. MARYLAND. Maryland. Dean, The John flopkins MISSOURI. Missouri. Vernon E. Wilson, M.D. University Dean, School of Medicine School of Medicine University of Missouri 725 Wolfe Strect Columbia, Missouri 65201 Baltimore, Maryland 21205 s W. Culbertson, M.D. MOUNTAIN S'I'AI'l-S. ld;ilio, Motitina, Nevadl, Kevin P. Bunncit, r,(I. D. MEMPHIS. Westcrn Tennessee, jamc land %Vyoining. Northern Mississippi, Professor and Cardiologist Associatc Dircctor and portions of Department of Internal Medicine Western Interstate Commission Arkansas, Kentucky, University of Tennessee for Higher Education and Missouri. College of Medicine University East Campus Memphis, Tcnnessee 38103 '10tli Street Itotil(ter, Coloraflo 80302 METROPOLITAN District of Columbia and Thomas W. Mattingly, M.D. Harold Morgan, M.D. WASHINGTON, D.C. 2 contiguous counties in Program Coordinator NEBRASKA-SOUTY I Ncbraska iiicl South Maryland, 2 in Virginia District of Columbia Medical DAKOTA. Dakota. Nebriska State Medic-,it Associa- and 2 ind@ndent cities Society i tioli in Virginia. 2007 Eyc Street N.W. 1409 Sharp Iluilding Washington, ]).C. 20006 Lincoln, Ne.])risk;t 68501t I I - I u7 llrclitiiiT,,-try I'l.-Illitilig IlrogTani Coordinator (,:ooi@(Iiiiitor ]@cgiotial Rcf,ioii.-it I)(.'SifTlltioll llcgioii Alvin A. Florin, M.I-)., M.P.1-1. NOR7FHERN Vermont and three John E. Wcnnberg, M.D. NEW,JERSEY. New Jersey State Department of NEW ENGLAND. counties in University of Vermont lfcaltli Northeastern College of Medicine lic,iltli-Agriculturc Building New York Burlington, Vermont 05401 P.O. Box 1540, jolin-Fitcli Plaza ,rrcnton, Ncw,jcrscy 08625 NORTHLANDS. Minnesota. J. Minott Stickney, M.D. Minnesota State Medical As! ation I?,cgin,ild II. Fitz, M.D. 200 First Street, Southwest NEW MEXICO. New Mc3rico. I)ctn, University of New Mexico Rochester, Minnesota 55901 School of Medicine AII)iiqticrque, New Mexico 8710r) iticliard L. Meiling, M.D. oiiio s,rA'I']-". Cctitralind Southern Vincent de ]'Oil I,,-irkiii, M-1). two-thirds of Ohio (61 Dean, Ohio State University NJ-'.W YORK mi.,,,rRO- New York City,. counties, excluding College of Medicine I Nassau, Suffolk, iii(I New York Acadeiiiy of Medicine I)OLI'I'AN ARI'A. Westchester Counties. 2 East 103cl Street I Metropolitan Cincin- 410 West 10th Avenue New York, New York 10029 nati -.trca). Columbus, Ohio 43210 NoitTl-[ CAROLINA. Nortli Ciroliiia. Marc,j. Musser, M.D. 01-110 VALLEY. Greater part of Kentucky William H. McBeath, M.D. Executive ]3ircctor and contiguous parts of Director, Ohio Valley Nortli Carolina Regional Mcdi- Ohio, Indiana, and Regional Medical Program cat Progrant West Virginia. 171 8 Alexandria Drive 'I'ccr I louse Lexington, Kentucky 40504 4019 Nortli Itoxl)oro Itoad I)urlizllli, Nortli C.-irolitit 27704 ------ OKI,AIIOMA. Oklilioiii.,i. Kelly M. West, M.D. NORTI-I I)AKUFA. North Dakota. 'I'licodorc I I. I far%vood, M.D. University of Oklahoma Dean, School of Medicine Medical Center University of Nortli Dakota 800 N.E. 13th Street Grand Forks, Nortli Dikota Oklahoma City, Oklahoma 58202. 73104 1 1 85 - -- ------ ---- itcginti.il T-)esign;itioll llr(,-Iiiiiiniry I'littitiinf@ Ilrol,,r;iiii (:ooi-(Iiii;itol It('LiOtl;ll l@(.gson SUSO_Ul-'l TANNA litock of 24 counties Itichirct 13. McKenzie OREGON. Oregon. M. Roberts Grovcr, M.D. VAT,],]-'Y. t@cr)tcrc(lirotin(i I f:irris- l,,xt:ctitive Assist-tilt Director, Continuing Mc(lictl I)ttrg ;tnct If(-rslicy. Council on Scientific A(Ivanct-- Education merit University of Oregon Pennsylvania Medical Society School of Medicine raylor Bypass and Erford Road 3181 S.W. Sam.jtckson Park i.cmoync, Pennsylvania 17043 Road Portland, Oregon 97201 TENNESSEE MIT)- I-,.istcrii and Centrit Stlnlcy W. Olson, M.]). SOUTI 1. ,1'ennessct- ;IIILI contigtl-. 1'rofcssor of Medicine oiis parts of Southern Viii(icrl)ilt University ROCHESTER, NEW Rochester,NcwYorkand RalphC.Pirkcr,jr.,M.]). Kentucky tiici Nortli- Baker Iluil(Iiiig YORK. 11 surrounding Clinical Associate Professor of (-rn Al;il);ttii;t. 110 21st Avenue, South counties. Medicine Nashville, Tennessee 37203 University of Rochester School of Medicine ind Dentistry TEXAS. Charles A. IxMaistrc, M.D. Rochester, New York 14620 Vicc-Cliancclior for I fciltit Affairs University gf'rcxas SOUTH CAROLINA. SouthCarolina. Charles P. Summerall, 111, M.D. Main Building Associate in Medicine (Cardiol- Austin, 'Texas 78712 ogy) Department of Medicine rRY-SI'A,ri.,. Massachusetts, New Norman Stearns, M.D. Medical College Hospital I Iiml)shire ;tii(I Mc(licit Care and educational 55 Doughty Street Rhode Island. I-oundation Charleston, South Carolina 22 The Fcnway 29403 lioston, M-,macliusetts 02115 1'riiiitry Pl;iiiiii,ig 1'rograni Coordinator Yl,,rk 7 J)'),J;Ilas -M. Suriz M#-Ilif ;II fit enor, M.D. Virginia YOI(K. I)f-,j rj', St fir-wil ff Mo-dicinc 200 East Brioid Strcct State University of New York Richmond, Virginia 23219 Buffalo 101 Capen Hall Buffalo, New York 14214 Francis S. Cheever, M.D. WASIIING'RON- Alaska iii(i Wtsliiiigtoll. I)oli;il It. SI),irkiiiin, M.1). IVES'I'EitN PENNSYL- Pittsburgh, Pennsylvania ALASKA. Associate 1'rofessor of Medicine VANIA. and 28 surrounding Dean, School of Medicine University of Washington counties. University of Pittsburgh School of rvfcdicirl(- Flannery Building Sr.;ittle, %Vi-,Iiiiigtoii 'JlilO5 3530 I-orbers Avenue Ilittsburgii, Pennsylvania 15213 WISCONSIN. Wisconsin. John S. Ilirscliboeck, M.D. WES'I' Vllt(;INIA. Wcst Virginia. ('Itarl(-s I.. Will)ar, M.13. Wisconsin Regional Medical West Virginia Uiiivcrsity Program, Inc. Mc(lical Center Room 1103 Morgantown, Wcst Virginia I IO East Wisconsin Avenue 26506 Milwaukee, Wisconsin 53202 87 fectiveness of these procedures cltir- cooperation ,in(] commitment of the determination, decision making and EXHIBI'R IX ing the actual review of the first op- major medical resources: (4-) the re- evaluation at the regional level. erational applications. As a result of litionsliil)s of the proposals to the [D Diii-in,, the review process the R(.,Vi(,N%, tii(i AI)pi-ov;tl of these considerations, the resulting i-e- l@(@SI)ozl',il)ilities of otil(@r Colit- . . still' of tilt! ]-)i%-isioli of ltcgioll.11 Opei-,ition,.ti Gi-,-iiits vicNv and approval process is to the T)oiients of the I"til)lic I I(-,iltli ;Iiitl' tile greatest possible extent keyed to the @111(i oilit.l. (..-)) tll,, This exhibit outlines review and ap- 91'tltll)S %vitli tile proval procedures for use in review- anticipated nature of operational (@liai-act(-i-istics of these initial pro- 1)i@ol)al)ility of effective inipleiiienti- ing grants for the establishment and grant requests and to the policy issues I)osals as the first steps in the Tilor(-. tion of tile proposed atcivities in ad- operation of Regional Medical Pro- inherent in the Regional Medical complete development of the Re- (lition to the inherent technical merit Programs concept. gional Mc(lic@,il Program, guided I)y a grams authorized by Section 904(a) of the specific proposals. of Title IX of the Public I-lealth oiitiniiirig planning process. Characteristics of 'I'lic review process must provide Service Act. Operational Grants Objective.v of the opportunity for the reviewers to RI'Viciti Process asstire a basic level of quality and Back-ground In designing this review process, at- feasibility of tit(! individual activities These procedures were developed tcntion has been given to tile follo%v- Tile oi)jectives sought it) tile clevelol)- that will iii investment of grant after extensive considerttion of ing characteristics of applications for inciit of this i-cvic%v process ire, based rtin(is worthwhile. : (1) Regional Medical Program grints: the 'philosophy and purposes of Title (1) complexity of the proposals with on a careful assessment of the goals 'I'lic. revic%v process must have IX; (2) the initial experience -'In re- many discrete but interrelated] activi- of the Itcgiotial Medical Programs stiffici(.Ilt flexibility to cope with tile an(] ]low tile. aciiiev(!tiient of those variety of ol)(!ratiorial 1)ml)osals suli- viewing the planning grant applica- tics involving different medical fields, goals call I)c most effe(-.tiv(-Iy further(-(] iiiitte(l, allowing for tit(! ttiic)riti,, of tions awarded under Section 903; (2) the diversity of grant proposals (3) consideration of the first opera- resulting from encouragement of I)y the process use(] in making (leci- the review to the needs of tli(! par- tional grant proposals, including-site initiative and dctcmiination at the sions oil the a%v.-ir(I of grant funds. tictilir proposal. visits to the regions involving mem- regional level within the I)roa(i (,oyisi(l(!r.,ttioii of ili(@se I)oli(,.y 'I'lit! review 1)roc-(@ss should cii- issues ](,.(I to (lefilleitioll of the follo%v- hers of the National Advisory Council parameters provide(.] in the l,aw, ing objectives of the review process: al)l(,- tile stifr and reviewers to view a on Regional Medical Programs and Regulations, and Guidelines: (3) the l@(!gional Medical Program as a con- the Regional Medical Programs Re- many different attributes of the over- E] I'll(! operational grant ipplica- tiniiitig activity, rather than a dis- view Committee; (4) preliminary all operational proposals which need tion must I)t- vi(!%%,e(l as a totality ci-ete project with time limits. There- discussion of the issues involved in to be evaluated during the revienv ritiler than is -,t Collection of (]is(-ret(! fore, tile i-(!vicw process should have the review of operational applica- process, including not only the merit continuity during tile grant activity tions by the National Advisory Coun- of highly tt!clinical iii(@(licil activities ITICI Should I)rovi(l(! tile opportunity cil on Regional Medical Programs at in the fields of licirt,(Iisease, (!atl(,c!r, I)t-c)(-ess for to jti(lg(! tlv(,- (I(-vclol)iiiciit of It(-gioTial its November 1966 meeting; and (5) stroke, anci relat(!(l diseases hot also tli(t i-(-vi(-%v :tyi(I ;ti)l)rovil of ol)4@t-@)- I'l-o!,r.'Irils ri he(! basis of extensive discussion with both tile tile effect of the pmi)os,.tl on inil)rov(-(l tioll,'Il gi-@ill(S leftist 1)(@ I.(.Slllts ;itl(l (.V;Illlttiori of in Review Committee and the National organization an(] (iclivt!ty of health ;t %vay title( stiiiitil;it(-s and i(l(litioTi to the (!variation of the I)rol)- Advisory Council concerning the ef- services an(] the degree of (!fTectiv(! the (-ss(@titi,,il goii setting, priority al)lc effectiveness of initial proposals. it, tli(. iltil)ll(- I S(,i Act ;tii(i Ill(l I)Ot('Ilti.-tily cf- CiLide both the nature and the el IZ(@gioi)al Medical I)rograiii: fectivcncss of the proposed coopcrc /\(-Is of ("oil-,, to I)I@llillillg .111(l I S(! tive arra?tge?ticitts. In evaluating tli n 'I'lic first focus iiiiist be oil those of effectiveness of these arrangement ;Ill(l of the I)i-ol)osal wliicii ideii- attention is given to the degree of ir S(.t fol.tll ill (I)(. lz(,gtil;itiolis tify iL is truly representing the COIL- volvcment and tommitmcnt of th -is follo% I)ol)lll;ltioll to ])(- S(!I.vc(l by cept of a regional medical program. Vs: major health resources, the role of ill(- NI- Pi-ogi-aiii iii(i 'rlic review grotii)s have determined tile Itegional Advisory Group, an -ilitfill to consider sl)c- tioii;il A(]%,isoi)- (,:otiii(-il oil oi, otlif-r ]Zc- that it is iiot ft the effectiveness of the proposed at (,ifi(, asi)(,(,ts of the I)i-ol)osal tivitics in strengthening coopcratioi this first (Essential determination coil- only after the dctcn-nination h, liliiits oflvtillll)l(! f[iii(IS, ilif! cxtvllt to .111 tile (@(!i-iiiiig the core of the I)rograiii is been made that the proposal reflec sliiiii .1w;tl-(l :1 1,11',IIIL to tllo.'iC II(.;Iltll i(llioIll'('(,S of (11(" 11 liave I)ositive. In making this detcriiiina- wliose tl)l)i-ox-(-d I;ik(,ii iii(o (-otisi(l(-i;itiot@ ill tli(@ t'oii, considerations include such a regional medical program concel .1 I and that it will stimulate an I will ill llis I I (itiestic)ii-, as: "Is there a unifying con- I)(!St I)I'olllot(' tll(' ;Ill(l/ot- (-st;il)l'sliiii(-iiL of tll(' strengthen cooperative efforts will I)III-I)os("s of IX. Ill sti.@it(,.gy Nviiicii will be tlic, more detailed evaluation of the sp gt..Ilit,,, tilt! sli;ill take! I)isis foi- iiiitial priorities of action, cific ol)cr@oiial activities be made. (Evaluation, and future decision inak- into (-ojisi(ii-i-;itioii, itiioji.!, otlj(,r If-- ill@littitiolis N%.ill i[Lilize ill,,?" "is tli(-i-c all administrative n if both of the two previous ova ](!V;Illt f;lt-.tol-S t[it- folionvill": tyi(-,cliaiiisin itivolv- tiations arc favorable, the opemtiot t tll(.. II(.;iltli of the r(!gioiis -il -activities (-all then be reviews otit file ol)j(-(-Ii%'(@ tile I)[.ol)oS(-(l %%,ill (-.,Il.ly out, %vliicii call make effective decisions, individually and collectively. Eac of tll(' It(.gioll.11 ]'I-ogl-:Illl. relate ti,ose decisions to regional activity is judged for its own inbii J)til.i)o.SCS of 'I'itl(- IX, N%'itilill .1 il(..o- (ligli-il)iiLit)ii of iii(I stimulate the essential c,-o- sic i-ricrit, for its contribution to t] i-,,iiiis throughout tlt(@ N;itioii." ol)crttivc effort among the major cooperative arrangements, and t licaltli ititCreSLS?" "Will the key lead- the degree to which it includes fl "(1)) 'I'lic capacity of the institutions Ill utilizing These ci-itei-i@t ill tile (@rsliij) of tli(,@ overall Regional Mcdi- core concept of the Regional Medic (@r igcii(-ics tvitiilii the program, iii- [)I-o(.(.Ss, it %%-.Is Liet(!I.lllill(@(i tll;it (..II I)i-ogi-,iiii provide the necessary Progrtins. It should also fit as an i (livi(ill,illy :Iil(l (:oil(.(:Livcly, fol- I.(.- Of (@OliSi(]('I';LtiOll Of til(@ giii(kiiicciii(I coordination for the de- Legral part of the total operation .search, iii(i (I(,,iiioristi-.ttioii vti-ioiis ttti-il)tiL(!s of Ili(@, 1)1'01)OSll veloptiiciit of the I)rogriiii?" "What activities, and contribute to the ovt -I(:Iix,ilics Nvitll to 'I'itl(! IX. %voill(i 1)(@ iiiii@tli-l;ilit if ill(- is the i-(@litioiisliij) of the planning al- all objectives of the Regional Mc( (4) %Vlli(.Il (114-. tl)l)li- Of ill(- I)I.o(.I.ss li%l(-ti .11)o%.(! i-(,;t(ly ;iii(I tilt! ongoing cal Programs. GiiiL ol' (II(- ill (lit-. I)I.o- iv(,,.(. t(i I)c i-evi(!%v 1)ro(7- J)Illltlillg 1)roccss to the iiiitiil opera- gi-.,iiii 1)1;11) to ot. (.o- es@, ititist fo(-tis oil tlil-ce tiollil I)I.ol)oSll!" I?cview Proccdurcs ill(- It(-gioll;li M(-(Ii(-..ki I'l-o- 9011(ll'.Il of the total [] After having made t positive de- grain With other activities supported I)i-t)l)osal iii(I Y(-,t tei-iiiiii;ttioti tbout this core activity, 13clow is a cliart which describ ptir.r,iiaiit to tilt! authority collectively its II.-ittit,c is a the next stel) %vidcns tile focus to in- the various steps in the review procc which will be applied to initial opcr- viding information ind comments wliicll is for the iissessin(,nt f)t-oj(-ct from inaking a i-neaningftil ational grant proposals from each for the guidance of the site visit teat-n, of the v:irioiis cotiii)orients of tile 11)- (,ontril)ution to the ol)j(-ctives of tile region. The first four operational utilizing stiff analyses of the plan- I)li(-.Itioli. site visit is not ;I sit])- lz(-gintill Mt-(Iicil Program. 'I'cclini- grant proposals were subject to tile iiing grant (!xperit@iic(-., considerations stittit(! fol, fit(! illv(.Stlllellt. of this cil'ol-t (-;II I-(..Vi(.Nvs;llso (.(Illsi(it-l- various steps of this process. 'I'liose of gross technical v,.tli(lity, policy is- I)Ilt J)I.ovi(it-S tile ol)i)ol'tll?lit.Y to (.V;Illt- lioll fot. tIlt! steps were not carried out in precisely sues raised by the particular -,tl)l)lica- ate tli(! cool)(!rative of tlit! is 'I'Itis ;isl)(-(@t of tli(t r(!- the order and sequence provided tion, and initial inpitt on relation- ]@egional N,fc(lical Ili-ograiii ;tii(i the view process presents tli(- opportunity in this cliart since the first four ap- ships to other Federal programs. overall I)rol)ll)ility of tli(@ success of to consider possible overlaps and plications were use(] is t test sittia- tile I)I.ol)oS(-(l (Iiil)licitioiis %vitli other Ptil)li(- I lealtli 0 Site Visit-T 11 i t i t I S(-i-vi(!(! I)i-(igriiiis wili(-Il (.;III I)(. I tion for the development of this op- has indicate(] that a site visit by mcni- Ititeiisive Analysis :tii(i llo%v lattice) Sit])- erational procedure. It is also likely ])Crs of the Iteview Cominittc(,- -iTi(i lt(,Vi(!%Vs If tile site visit that further experience will ]cad to the National Advisory Cotinril is (!s- tili(..s ill(! iTlv(.Stlll(@iit of :I(I(Iitiotl.,Il t-f- I)oi-t slioiti(I 1)(-, 1)rovicl(-(l foi- Ili(-. par- trtivity front tli(t It(-giotial appropriate modification of these sential for the asscssttlcnt of the over- foi-t in tli(-. review of the procedures. I'hc following comments all concept and stritegy used by tli(- (II(! I)i%,isioll st;ifl' J)t.o(-(-(!(IS %viiii @IT) N4(-(Ii(,.il may rich) to explain this review it(-gioiiif M(-(Iicii Ili-(iiraiii in (I(!- illf(.llsiv(! iii;ilysis of' (Ill! of Italian, to I-;Iist- Ili(-S(- (Illt'Stlol)S is Tlot to I )ivisioll of, lz(.I,ioll;ll ess, which has been igreecl to by iii(- veiol)itig the proposal ,iii(i 111(t 'I'lli% ;Iii;ilysi-, 1)14)- Rc ional Medical ["ro,,rams ltevi(!w 9 .1 forissigningpi-ioril,i(!stosi)(-cifi(..])I-oj- Vi(l(-S'tll(! rot. ol Committee all(] tit(@ N;ttiotitl A(Ivis- of ,ill tl)l)lit7.itiolis ty't', (lisLi-il)- ects included in tli(, I)rol)osil. It ilso Si)(@(@ifi(. (-otlllll(-Il(S front otil(@l- (-oill- III(. I to tile ory Council on Regional Medical provides the opportunity to fit(! poncnts of the Public I leiltli Service Programs. The complexity of these probable effectiveness of cooperative and other Fc(](,,rii health igencit-s SLittites of to ill lliir(-.itis of gr,.tnt request% and the steps in the arrangements and cl(-.gree of (-ominit- %vitli i-clite(i I)rogr@iiiis, detailed (:oiti- tile pili)li(: I lealtli S(-rvi(-.(!, -.iii(I to the review process which seems apl)t-o- inciit of the many cl(-riients %viii(,Ii ill(,.I)ts front (II(. Various (-ollll)oll(@ilis N,-ttiotiil Initially of MC(licirl(-. -It tile priate for their review will require as will he essential to tli(l, slic(.(@s of ;I or tile i)ivisiot, of it(!irioii,,ii title(. of front ,I -ill tll(.S(. ol. -f-, ill it(-(I to much as 6 months for the completion Regional Medical PrograTti. As the I)i-ogriTiis siifr, terlini(-.-.ti sit(! visits oil ;II v of the total review process in most discussion above points out, favor- projects %kitliiii tli(- ovt-.rill of tile IZ(-Vi(-,%v C,'ollllllitt(@(-.- cases. able conclusions oil these asl)e(-ts of tl)l)lication Nvlien considered n(-(,'CS- of)(I I,(.Vi(-%V fly IZ(-Vi(!%V colyi- I -I St@(. Initial Considerition by Review the Regional Medical Program must siry, and for the issiiiiiiition of .i(l- tilitt(,e til(i foi- A(-- Committec-Ttic first steps of the rc- be reached before it is justifiable to (litioiial information from the t ioyi - - -'I'] I(. ll\(.vi(@%v Coiiiiiiitte(- (,on- view Process involve preparation for begin the major investment of the citit as a i-estift of tli(! site visit. ']']IC si(l(!i,s ;Ill of tli(- information -tviilal)le the site visit which will be conducted time of the Division stifr, t(@c)inical teclifli(!-,Il I-evieNv of Specific I)roj'(-cts tlt(- Ili a(ldi- for each operational grant applic-,i- reviewers in other I)arts of tli(, pill)- slioll](I not only Ill(! tioll to (II(. its(-if ;Ifl(l fir(! tion. The first consideration of the lic Ifealt)i Servic(!, tc(-.Iinical coyisiil- Hallett ol, ill(. I)I.oi(.(.t I)Ilt Sil(lill(i ll(!Il) sit,. @-isi( stiti,iiiit-@, or tii application by the review Commit- tants, an(] the Division of Itegiozial to identify oil ifil'ol-lil;llfoll ill, to tcc will be for tile purposes of pro- Medical Program review groups, I)ro.i(.-(-t %which iiiiglit lir(!veiit tli@it ,I,(. it, , st:ifr 1)r(-senta- Flow Chart Operational Grant Review and Approval Process OPERATIONAL GRANT APPLICATION RECEIVED REVIEW COMMITTEE STAFF MEMBERS REVIEW COMMITTEE MEETING Guidance for Site Visit Team FOR INFORMATION AND COMMENT Initial Staff Information rc: a. Planning grant experience b. Gross technical validity C. Policy ;Ssucs d. Relationship to other Federal programs . ...... SITE,VISIT. judgments rc: Review Committee Guidance (Two days) 1. Concept of Regional Medical Programs 2. Cooperative Arrangements 3. Relationship of projects, one to another and to the total 4. Approximate magnitude of support warranted SITE (Prepared 2d day by site team) 5. Quality of projects where VISIT appropriate REPORT 91 REV IEW COMMITTEE MEETING In addition to application and Actions: FOK,CONSIDFRATION AND ACTION site visit report: I .Itecommenciations 1. Additional information from a. Approval applicant 1). Approval with conditions from Outside Division of Regional c. Deferral Medical Programs, where indicated, d. Return for revision including comments from other com- c. Disapproval ponents of the Public Health Service; may 2. Instructions to Staff have necessitated technical site visit on '.3. Itccommendation of an overall specific project(s) grant amount based on discussion 3. Further Staff information of specifics of the application 4. Discussion by site visitor(s) of additional information obtained subsequent to site visit In addition to above: NATIONAL COUNCIL MEETING Actions: FOR- CONSIDERATION AND ACT16N 1. Review Committee recom- 1. Recommendations mendations a. Approval 2. Further Staff information 1). Approval with conditions per Committee instructions c. Deferral d. Return for revision c. Disapproval Provided to Applicant- 2. instructions to Staff 1. Recommendation and comments of .3. Recommendation of an overall Council; if overall approval grant amount '.-,MEETING BETWEEN DIVISION proceed to 2 STAFF AND'APPLICANT. Applicant action: 2. Recommend overall budget ceiling REPRESENTATIVES Submission of revised proposal for grant within recommended overall budget 3. Summation of all comments derived from the .. ...... . .. ceiling utilizing the comments and review process about particular activities criticism resulting from the contained in application review process Staff review of FINAL AWARD.DECTSION Action: revised proposal a. Award of Grantor 1). I-'tirther negotiation with applicant ctivity were raled during the re -sents tile recommendeda grains-Tlic National Advisory staff also pre view process. The applicant includes oinniittce tllc"l overall budget cciling for the grant with the under- tion. The [review C of all tile such an activity of die makes its recoliliiicll(littioll Council Considers tile l@cvic%v Corn a suminatiot, tanding that the progress Of tile iiiittcc recol,ii,ictidations. it II,-is avail- along will' ei-ived from the reviews e y of material coiiii-nctits d , al)l)li(,atioll activity will be followed with special ing tli x nature of tile al)i)li(:-,Itiolls, ',,)le to it ,he full arra ilar activi- intcrestbythcrlview oupsandwill compic to the Rcvic%v COITInlittec process concerning particL gr cc call clixidc,, it, I)rcseilteLl d within the application, the Review (;Olllll"tt iris re- and a staff summary of that material. tics containe ic, proi- be judged in the future on the basis -iiiicd by the of results. recornt,ictidation into several 1), including criticisms Of specie ,,I I )arts of the .q)l)li- Further itifol-ii",ItiOll ot)t ccts and continents about the bu(.Igct I til g to direct I overall f avo r- staff oll tile instructions of tile, ttc- ific projects. Fl Final Award Dccision-Follow- cation. if there is an view Committee may ilso be prc- levels proposed for Spec ing staff review or the revised pro- able recommendation on the rcadi- sciitcd.'I'lic National Advisory Coun- riic staff also indicates if any proi- posal, the final decision on the award ncsS Of the Regional Medical Program cil makes tile i,c(iiiired legal rccor,'- ccls included in the application are is made by the Division Director at program, tile t award to begin the iiietidatiot, concerning ii)i)roval of lot to be in(-,Iudcd in a gran . ditional negotiations with the aP' , operation lends all Ad iso take place. Review Committee recOl'IT tile application, including r(!coillilicii- because of Council recommendation plicant may a June 196 overall grant amount based oil a dis- dations oil tile amount of the grant. or Divisioji decision based on nega- cussion of tile ' Pccifics ofthe al)l)licllt- -rilc Council itiay dci(,gtte Lo the stair tive factors as discussed above. tion. This amount takes into COIlsid- tile authority to negotiate tile final [] Submission of Revised Propos- ised by technical %vital,, s cration problems ra grant amount et limits. Aat-On the basis of this meeting, reviewers, ovcrial) will, other pro- rccoll'Tilcli(ittioii (,F approval applies the applicant submits a revised pro- of the proposals, iii(ii(:ittefl grains, feasibility to all I)"Ojc(- cel)t %Vll( I)osal within tile recommended over- and other relevant consideration.', by tile, Council, even tIlougil tile grant II budget ccilingi utilizing in the re- raised during the review process. amount recommended may be less vision the comments and criticisms While the overall amount reconi- -(Iucstcd because Iting f rom than the amount re and technical advice resu niended is based on discussion Of tile of tile judgments applied during tile the review process. This step of the SI)CCilic components of the total all- review of tile 2LI)I)Iicatioll or because i)lication, the recommendation does of overall ,intuitions of ,s requires tile applicant to I.c(.,O,tisid(!r their priorities witllill tile not it, stio',t c-tses 'tlclude sl)c('il"(', -'I)- of rccomnicndcd budget level and to ro,,l of i,idivi(.Itial n Meeting will' ])representatives onsibility for 1)roval or disal)l) assume the basic resp -t 15 )I)Iicaiit-l"0110%vitlg the Na- projects except when a I)roicc the A the making tile final decisions as to tiotial Advisory Council "Icet"lg) j,(lg,d to be infeasible, Lo be Outside 11 111crts with rcl)- which activities will be included in tile scoi c of Itegioll, II Medical Pro- Staff of tile I)ivisio tile operational prograi-n, Unless a ,tl,)Ie dul)lic-.'- applicant and granis, to be all titidcsil,. resentativcs of tile has been specifically excluded tion of ongoilig efforts, or to la(,k es- present; to them the recommendation project tion, tile appli- sential technical soundness. and comments of tile Council. If tile from the approval ac u ertake an National Advisory recommendation is favorable and the cant may choose to nd Review by t, the activity even if doubts about the Council on Regional lnlcdical Ilro- Division intends to award a gran EXHIBIT X The Development and Assistance Branch serves as the focus for two-way communi- cation between the Division and the in- Principal Staff of the Division dividual Regional Medical Programs. of Regional Mcclical Programs, Margaret 11. Sloan, M.]). June 30, 1967 Chief Ian Mitchell, M.D. The Office of the Director provides pro- Associate for Regional Development gmm leadership and direction. The Grants Management Branch inter- Robert Q. Marston, M.D. prets grants management policies and re- Director views budget requests and expenditure Karl D. Yordy reports. Assistant Director for Program Policy James Bcattic William D. Mayer, M.D. Chief Associate Director for Continuing Education The Grants Revietv Branch handles the Charles Hilsenroth professional and scientific review of appli- executive Ofl'tcer cations and progress reports. Maurice E. Odoroff Assistant to Director for Systems Martha Phillips and Statistics Acting Chief Edward M. Friedlander Assistant to Director for Communications The Planning and Evaluation Branch ap- and Public Information praises and reports on ovcrill program goals, progress xn(I trends and provided The Continuing Education and Training staff work for the Surgeon Ccncral's Rc- Branch provides assistance for the quality port to the President tnd the Congress. development of such activities in Regional Stephen J. Ackerman Medical Programs. Chief William Mayer, M.D. Daniel 1. 7-wick Chief Assistant Chief Cecilia Conritit Itolanti L. Peterson Assistant to Chief Head, Planning Section Frank L. 1-fusted, Ph. D. Rhoda Abrams Ifead, Evaluation Research Croup Acting I-lead, Evaluation Section 2fl.q-(;.I!) 0-1@7--7 ei-atioii foi- al)otit a year. Ilublic LaNv I,'orniula grants to States for I)ub- I)Iiasizc the exercise of initiative and XI 8!)-7,19 is yet to be iiiil)lciiiciitcd. lic health services; responsibility at the rcg ional level ir identifying problems and opportuni- The purposes of 1'.L. 89-74,.9, de- n Project grants for health services ties in seeking these objectives and ii@ ioIIS]Iil)S ,ci-ibe(I in Section 2(l)) to estab- (ICVCIOI)Illcllt developing specific action steps tc ii,;Ii "comprehensive 1)1.ititiiiig for health services, health manpower-, The purpose of P.L. 89-239, as set overcome the p@oblems and explore es fortli in Section 900(b) of the Pub- the opportunities. I'LII)IIC I-ICIltll and health facilities, senti-,tl ".it lic I lealLli Service Act, is "l'o afford The Public I-Icalth Service sees P.L Ai-ticti(iiiiciits of l@)(i6 tii(I every level of governments'; to to the medical profession and the 89-239 and P.t. 89-749 as servinj ili(@ licai-t I)is(,ase. strengthen "the leadership and ca- medical institutions of the Nation, I)acities of State health agencies"; and the common goal of improved heart] ;Ili(l Sti-ok(@ Aiii(-ii(iiii(-iits to broaden aiicl make iiiorc flexible through . . . cooperative arrange- care for the American people alone of I!)(i5 I-cderal "support of health services nicnts, the opportunity of making with other Public Health Service ani --- provided people in their coiiiiiitiiii- available to their patients the latest non-Public I-lealth Service grant prc A Fact Sheet from the Office of the ties." advances in the diagnosis and treat- grams such as community ment. iiicnt of (heart disease, cancer, stroke, health centers, migrant health prc Surgeon General, Public Ilcaltli II.L. f@9-749 asserts that these obicc- and related) diseases. . . grams, air pollution control, prograrr Service, March, 1967 tivcs -,vill be attained through "an Ic[fectiv(! 1)at-ttici-sliii), involving close 'riie process for achieving this pur- for the training of health manpower Public La%v 89-749, the Coml)rellcll- ititcrgovei-niiiciital collaboration, of- 1)ose is to establish regional coopcra- the neighborhood health centers ur sive Ilcaltli Planning and Ptibli(-. ficial and v(-)Itiiltai-y c(Toi-ts, tiid par- tive arrangements among science, dcr the Office of Economic Oppoi . .i)-itioti of individuals and oi-,gaiii- c(.Iticatioii, and service resources for tunity, the medical programs of th 1-1c,iltliScrviccsAiiicn(ittiezits of 1966, tici . establishes mechanisms foi- cotiil)i-(-.- z-,ttioiis. At-L ('Stll)IiS]ics a health care for research and Cliildrc@s Bureau, and State an . I ll(!%V iiie(-Iiaiiisi)t to t,(,Iate varied training (including continuing cduca- local health programs. In the Stati Incisive arca%vidc and State-Nvi(lc I)iatiiiiii,,, and health programs to tioii) and for related demonstrations and communities, P.L. 89-749 wi health planning, training of I)Iatincrs,- . I provide a vehicle for effective inte eacii other and to other efforts ill of patient care in the fields of heart and evaluation and development cf -achievement of -,i total health 1)Lir- disease, cancer, stroke, and related action among these programs, recol forts to improve the planning art. diseases . . . ... (Section (a)) ilizing as it does that the diversity i I)OSC. Public Law 89-239, the I-Icart I)is- the various States and areas of tt case, Cancer, and Stroke Amend- I'he la%v has live major sections: '1'liis law focuses on the cooperative Nation is considerable, and that ti iiicnis of 1965, authorized grants to Fl I,'oi-inula grants to tile States for involvci-netit of University medical specific relationships between ar assist in the planning, establishment, (-Ollll)i-elicti-,ive health planning at the centers, hospitals, I)r among programs will have to I ciatis. o lic@r health , State level through i designated worked out at these levels rather thz voluntary and officiEkLli@ and operation of regional medical Stit(,- agency; h-agencic& through a specific Federal mandat( programs to facilitate the wider avail- iii'sc-cki'ni,.vays to build effective link- ability of the latest advances in care Cratits foi- comprehensive health agcs bct%veen the development of new IThe planning resources created at ti of patients afflicted .vitli heart disease, planning ;it tile arcawidc level; knowle-i lication to State and local level under Publ (,cancer, stroke, and relatc(i diseases. F-1 (;raiits for training health plan- @l)roblciiis' -of I a icnts. The law pro- Law 89-749 are expected to affoi I'Liblic Law 89-239 has been in ol)- ticrs; vi(Ics flexible mechanisms Nvliicii viii- valuable assistance in the achiev ment.of the objectives of Public LaNv their full potential by the close -"'(I sti(.s of 'I'licst@ tll(- :I(-tivi- 89-239, other programs of the Public, coliil)lctc iiivolx,(@tilt-IIL of otll('I' of oill(,I. I)I;Illllillg ;iil(l II(-;iltll l'ol't'.11tis to III(. lile(. health Scrvicc-., and other health en- 1)oneiiis of III(- lie-litil ('11(1(';Iv )I-. A 'till.@ of 111(@S(@ (icavors in each of the States. Public vital I)ai-ttiersliii) must 1)(@ (level ()I)(-(I ('01111)1(.Illelltii-y 1.(@litiolisilil) of ol)j(.(.tivt,s, III(] I)t-ovi(l@- ;Is- , I)ct%vccn the I,'c(ler;il ,O%,ei-niiiciit, tli(-. sist,,in(-(! to State in(I local officials, Law 89-749 provides, liowcvc 'Sao Z, universities, local and State govcril- t-st@ll)lisli(.(l by I)-l'. l@9 ,,tuthority for these planning resource.,; Vollitit;tl-y ll(-altli (i@(,,aTiiz@t- to impose their (-,oncitisions or rccom- niciit, the vottilit;"'Y ]learn' ilit(.I,(.Sts 2'19 :iii(i ll.l,. 139 7-l!) to l'osti-i- holes .111(i institutions, :111(l otll(-I. I)I-o- men a ions on any other programs, and individuals in(I organizations cl(!- V(@lol)lll('Ilt of I "Pil-ttlL.l.sllil) for stll),)oi-te(i by PITS ,t-ant ftin@1% I,'cdcml or non-Fcderal, except for signed to (levelol) a(-tioii foi- is ilitisti-@it(.(l by til(@ f( -iciii(-vinl under Section health. iiig olitlifit@ of soilit- of tll(-il- iiiijol, , . - tli(-, inoi-t- eflective al- activities carric(i out lo(.,Itioll of resources iii ic(-oinl)lisliiii,,, (d) and parts of Scction (e) of the The Con-rcss i-ec@,-nizc(i the i-cla- the 01) ;I iecti%'CS. Law which must be in accordance tions)iii) of coiill)rclictisin-e Health Ycope. ivitli the comprehensive State health planning to other planning activities. plan developed by ihc State cornprc- 'I'lic Itci)ort of the Senate Coiiiiiiittc(, II.TL. l@o -)30: It(.giollii M(-(Ii(.;Il licnsivc health planning agency. The oil Labor and Ptil)li(-, Welfiti-c University medical Public Health Service intends to I't-orri.,Illl. 'I'o i(](!Ill.ify I-egiont] needs stimulate effective interaction aino?l(, (No. 1655, September 29, 1966) tiici :1 i-(-sotii-c(@s i-el,-itiii@ to li(,-ai-L (lis- (-(-liters, hospitals, practicing I)Ilysi- stated: these programs, recognizing that the otli(-r 1)mfessions, vol- "'I'Iic coml)rcli(-tisiv(! planning of I II(! -.1ii(i I)III)li Ic health ,agencies, diversity of the various States an(] (liseas(-s ,iii(i to (lev(,-Ioi-) -.I areas of the Nation is considerable. State health planning agency %vitli tlitt' ;IT)(] of tile A I-(,- advice of tile (.0tilicil %%'Olll(l (:Ollll)lc- I)I-ogl.;Itll AvIii(-Il liti]iZ(,S I'(,- gioii;il t-ool)(-I.;Iti\.(. .11-1.;ITIgclll(,Ilts to "ioll;ll ;Itlvlsol.y gl.otll) Both P.L. 89-239 and P.L. 89-749 inent ind build on sii(-Ii sl)t,cializ(@(i 'c instruments for es- -11)1)]Y .111(i Stl'(-Ilglll(.Il to provide flcxil)] planning as that of the i-egion,-ti iiic(ii- in@ 1)roclti(,tivt- relationships cal ati(I till! Ilill-Itlit-toll [alumina illol., 1.ol(! ill title t,-tl)lisll , I)ctween these an(] otlict- programs. I)Iogi-.iili, I)Ilt %voill(I not '.Vi(l(!IY tilt! l@it(-St :I(lv;lllf,(,s Iiollii I)I.ogt.,ITII lyllist 'Il)l)t-ov(- iny The maintenance of this flexibility in (liciii. ill (ii;l!,.Ilosis .111(i of, tll(.S(. fol- the administration of tile tyrant pro- of till! Stite li(-,tltli I)Iatiiiiit,, :tg(,ti(-y (Iis(.,Is(...,. grams will permit (-acii State ;tied i-t,- ])?.ovi(l(-S tilt-. ill(.(.Iltflislll till-oll"ll gio?i to design in(I (levelol) a i-t-.],itioii- I .1 II!) 7-l!): ll.l,. @t'i 7-l!): Sl;it(- Nvilicll individual Si)(.(.iliiz(.(l 1)1;111- siiiii that is for its (II(. I)I;llilllft!,. to ;V!, ll(-Y \\'ill call for ;t (-lost- I)rivatc-l)til)li(.. I)al.t- I)I;Illlliltl" lilli(.I.ss. Nil-iillli-isliil) ittiisl ncrship. Ilotli I)ro-rims iiiust place also serve as tit(! foc:tl 1)oit:,t %within Stit(INvi(l(. I);Isis %Vlli(.Il li:flf (.ollslltll(.I, .n tile State for r(-Iatiii,, coiiil)i-(@.lt(-?isiv(! del3en(ICTIC.C Otl iTnigitiativ(,-, reason- .1 11(@,litil I)I.ol)](.Ills \Villlifl tll(' Stitt', S('(S ',Vill I]So health plans to I)Iknnin,, in olit- able local al)l)roa(-Iies to si(l(! tile field of sli(.Il :is and coordination. Both 1)t-o,,raiiis I.C(I(!V(!IOI)Illeflt, Ill(l I)I.o\,itig Ill(- itv;iillll)ilily ol' II(.;Iltll ill'S, I)Itzlllitl!,' recognize that they can only achieve so fortli." i(i(-Iltirl(.s (.Xistillg I-csotll,(,Cs it The Process I)i-ograiiis; regional iiie(lical pro- community mental health centers, Both regional medical prograrn and comprehensive health plannin graiiis, iii(@iitat ll(-,altli, li(!altli facili- areawide licaltli facility planning, ties, .o that and the I-Iiii-ilurton programs. These arc intended to strengthen creativ P.L. lt9-239: these I)rogi-aiiis (,all be assiste(i in iiiak- activities arc stimulating the creation Fedcralism-more productive meet F-I Establish cooperative arrange- itig iiioi-c (!ff(,(-tive iitil)a(-t %vitli Llicir of new relationships between health afiisms for partnership and coopei i-rients among science, education, and resources. resources and functions as well as as- ation between- the national, Stal service resources. sisting in the creation of additional and local levels of government, tt E] fli-ovi(le information, analyses, volunta' private heall F-1 Assess needs and resources. and i-(-(-otiiiiieii(latioiis wili(-,Il call resources in the stimulation of more public and ry demic ar I)cvclol) pilot and dciiioiistratioil Serve as tli(-. I)asis foi- the (,;ovc-.riior, (,ftcctivc performance of functions activities, and the aca cnts. P.] l:] otlier licaltli programs and coiiiiiiiiiii- for the purpose of achieving more cf- licaltli services cnvironm projects, emphasizing flow of kiiowl- fective attainment of identified health 89-749 will create planning resourc ,Itive tics to iiiakc iiiorc eftectivc allocations edge in uplifting the cool)cr, goals. Each of these programs re- at the State and local level. The i: cal)al:)ilitics for diagnosis and care of of i-esotir(.-cs in meeting licaltli goals. (juire.-; participation not only by a formation, analyses, and plans d patients. n Provide .t focus foi- interrelating broad range of health professionals vcloped by these planning resourc training, -11)(I itli planning for but also by representatives of the con- can provide invaluable assistance El iterate research, licaltli planning @ State and local authorities, to volu service activities. education, %vclfarc -iii(I collitritillitY sttiiiei-s of licalth services. I-'Iacii of development. tlics(- programs is dependent ul)oil tary health organizations and ins I)evelol) effective colitilluilig ('(Ill- cation programs in relation to otilel. ' El strengthen planning, evaluation, the interaction of the full range of tutions, and to the other health pr .III(] service capacities of all pirtici- relevant health interests, including grams involved in planning and @ ol)(!ratioiial -activities. tile health ell(lelvot. those in the public sector and the veloping the organization of hcal ate voluntary sector in achieving activities which arc support I)evclol) iiie(-Iiaiiisiiis for cvtlti- Fl Provide support for tile initiation, Health Serv; atizig cftectivcncss of efforts ill tile vclol)iiient of pilot tlic particular I)rogam goals. through other Public provision of improved services to integration, and de Comprehensive health planning grant funds. This planning resoui 1);iti(!iits %Vitli heart disease, projects for better (lelivvry of health (P.I,. 89-749) is designed to provide created under Section 314(a) v gel-vi(.Cs; (Icvclol) plans for targeting thus contribute to the more effect stroke and related diseases. flexible formula and project grants assistance in the development of more accomplishment of health objecti, II!)-749: at problems an(] gills identified by the effective relationships among such and the setting of priorities in achi planning 1)rocesq. health programs and to provide a ing those objectives through the I,',.Stablisli State and arcawi(Ic better basis for relating these pro- tivitics supported under the other s health goals. Spccific Plaii?zittg Relatio7isILips grains to tile accomplishment of over- tions of this Law. In addition, all health objectives at the State and I)cfiiie total health needs of all 'There arc a variety of ongoing local level. Based on similar prin- resource will contribute to the del people and communities within at-ct health planning -,and community ciplcs of broad participation, it calls mination of priorities for action served for meeting health goals. health organization activities. Many for the stimulation of all parties to only by those with public respoi [:] Inventory and identify relation- arc supported in part by the Public contribute to the goal of insuring the bility and accountability for he,, siiil-)s among .varied local, State, iia- Ile-.tltli Set-vice,, such as ltcgional availability of comprehensive health services but also by the many ot tiotial, governments] and voluntary Medical 13rograiiis (I'.L. 89-239), services to all who need them. health organizations, institutions,, 97 to III(-. 1)1'01)lt'llll, of I'Nf('I)(]- tioll, .11)(I personnel Nvl)ici) 1)(!,ir the (lir(,(-.t re- sr)onsil)ilit,y for fit(-, (lelivt-ryof li(,.iltll ifig lli,,Il-(Ill;llity Nt;tiiN, of (I,(- I)I;lllflill!, ;Ill(l iltil)lt.- of ]).I,. :tl) 7.111 ;tit- st@l-vir(.s for. itio-,t of till. J)ol)lllllioll. ff.()Iii tilt- iiii@til@itioii I-;lilts t(i St;lt" 1).[,. Ill)-.74() Its tit ;I tit(! ;11)1)1;(.:Itio I ()]- (-ol 1 1 1) I-(@l I(-l isive I I Cl It I I quality and coverige in health -scrv- tli(-se health iiit(-i-(-st-, ill ])Otll title I'\('- 1-ittige of Iit,:Iltli I)].(Il)l(.[Iis 'I'lle A(-t I)i-itigs togetli(@r a ices, I-)otli personal an(] (-nviron- ,ioti-,il T\lc(lical I)Iaiiiiiii,, titaii 11(@;11'L (IiS(',Ist', ,,.Oil,) of ),,e\,iotisly coml)artinented mental, ttl)on ill(! \,oltintii-y ;ili(l tir iltil)lic Health S(-.rvic(- I)irticip,,ttion in(I (@nergics of I)Otll an(] cv-.illi;itioll I(,ti%iti(.s I)NI tlitt ;I,.vtl-(Is \Vill Oil the private and 1)ttl)lic sectors of till' B(')-7,10 %Vill iii;il@t! :11, (-ss(-lltilil (")II- I)(. list-i'lil ill ti-il)tltioll to J)Io(lit('tiv(. ).(.IItitilisllil) t, :I 1)1;111 stll)lllitt(!(l fly tli(,- li(@aitli health en(ictvor. 1)1-ol(l of I" -11(-Y xviiicli reflects the xvty in I)ct\vcell tllcs(. I(.tiviti(.S. ; l(@ , st;lt(.(l -7-i!). Itt. ?I(ls to II,-,c till. The I)Iaiinitl,-,, operational pro- tll(- St, , itltc, -ims, and organi7.-,itiotiil frim(-- 1)1;111- 1).II-L of Ill (!irort to I)t-ovi(l(, .q r, %vorL-s I)cing ci-(-.ite(I tin(ler till-. iliTig I(-tiviti(@s %Vill Itegion:tl Mc(li(-,-ii Solll.(.t@s ill(-Ill(lifl!' title 'I'liis ill lilt'II, fillist 1)(! ill ol. Ili;iiv./(@(i fly til(@ I\'('('Ioll- se(.Lioil of ll.l,. @(@1) 7.,I!) ;tit- %vill, the Stit(,,'s (-oiriprt-ii(-tisiv(- lie-ill), iiity mental health (:(@rit(,rs, and I wide health facility 1)latiiiiii- grotjl)S, i] N/fe(ii(-al tllot-iZ(-S to including titt@ -advisory ,i-otil)s estal)- oil health of I)ol)ltltiioll.S (-f- fill. stli li(-s, S(.(,tioll lislied for other sticli -.is the II(.;Iltll I giants fol. "Iit-;iltll selvic(..s I"c,,ional Medical 1ro,,rams, shotild I)robleins and needs. colill)"c- VITIC(. till. st;lt(. of 11(@.Iltli I)Iitlllill" 'Il'L 11 I 111(l,it," an(] consolidates a strength and lictisivc Health I)I:itlllill,, I(.Ii\.iti(-S s Stll)i)l@- of (.ollll)(-t(-Ilt .serve as source of S(ll'i(,S of Plii)li(-. IT(,-.tltli Service I)roi- v,tlli,,il)lc ,is%istancc for the -treawi(l(! c,-iii also ])en(-rit fi-niii tlie@ and Stite-wi(le health I-)Iaiiniii,, cotiti- 0I)tiiiie(I till- I\,(.gioll-,Il cils created tincicr 1).L'89-74.9 tii(i c-,ii Pro-i-ains .vlii(-Ii li-tv(- I"ot. till.. first emphasis '.Vill 1)(@ Slil)])of.l fol- II(-N%' .111(l itillov@ltiv(, I)].oi- for the 1)lannin- resources create(] -,tti exploratory efToi-t of place(] oil (icteriiiine(l, to iiiect under this Law. importance in (lev(!Iol-)in,, iri (,Ti- (Until llo%v, of little(] geo-rapliie ),)t@ 01- specialized regional ot, na- The I)ro,-id ran,-c of healtli inter- vironment for concert(,(] I)y ]rental (@frol-t II-,Is 1)(@eii liiii- S('( csts represented i.n Re(,ional Medical inany elements of the li(-aitli (!II- ite(I to :Ill lloc sliol-t (-,ollt.sc@s 01. ill- ti(illt] si,,iiificatice; stiryiiilatiiig iticl ;Ili)llol-till" new I)i-o,,t-aiiis of Pro@r,iTii planning (!rT(ii,ts, nion,r Avitil (I(-,tvor and in till- 'I'llis 11(@ .n ;Iii(i other apl)ml)riat(! health interest,,, (levelol)tii(-tit and will I)c participants tnci (-oil- syst(!TIIS fol- Ill(! fl(-ilitiltioti of tilt- (I(-- ])Y ol. ti'@litilli.Lt (I(.Si"ll(,(l to (11'V(Ilol) ll(.W ol- ilill)l-oV(-(l tril)titors to tli(-. State Tallith li-,'(-I.y of t)l(,- of' council a?i(i to till- activities of till' VIll(-(- ill ,II.(,"Is Is \vt,lf 'Is Si%,(. ill(.tllo(is of I)I.ovi(liII!, c,,it(-gori(,.s of )lcaitli ill(.,Ills of rollifiltilli(.il- .11)ollt to I)(. Ill-St t% ,tc.tivitieq or that ;fairly (ion, must cojiforin to objectives, priorities, otlier hcaltli programs including ltvnllal)le to the Nittiott, itntl to nccomplirli L"Xl-flll)l'l' Xii Itiese ends witlioxit lnterf#-ritia wit)i the I)nt. and plans of comprehensive State tiiosc Supported under P.L. 89-749. teriis, or tite tiactito4ig of fitinncing, of I)n- health planning. Other programs supported by Public tl(!iit care or lwrotessional liractice, or will tliqi jifliiiiiii4trntioit of ltoqi)itals, and In co. Witit the exception of the statutory I lealtli Service funds is iiicntal 23!) olierii(loit will% itritctlelng ititymlctttns, iiie(Il. licaltli, iiiigt-;tiit lie-,iltli, and air 1)ollu- (.'@oligl,(,S.S, S. 59(') Cal ectit(@r t@iti(-Iiiis, iioqiittiii liditiltilrtratort(, requircincnt that the programs sul)- Rii(I rejire.44-ittaitlve4 front nlil)rolirlitte voluti- portcd by tlicsc grants niust coiifonii tioii can liave the sainc type of pro- Oct(.)I)(@.i- 6, 19(;5 titry lieziltli ngetieleq.' to comprehensive State licaltli plan- dtictivc ititcrrciatioiishil) witli the Ali Act "Authoriz(tfiott of Appropriations ning, P.L. 89-749 forrnula and pro' comprehensive licaltli planning pro- ll(,itrt !)Ol. (it) Tltere nre nijtliorized to I- graiiis. I)(. iil)l)rolirlitte(I $r,0,000,000 for fit(! flqcnl cct grants bear tlic saiiie rclatioTi to "tr(ikf! Aiiii@itil. year etiqlltig Jittit! :10, IDG(,, $1)0,000.000 for the comprehensive licaltli planning 'I'hc Public Ilealtli Service lias a rc- 1114-tit.4 Of 1965. lit(! lis(-jtl yenr ending Jtint@ tO. 1907, nine si)onsibility to prevent waste of scarce $2011,000,000, for the flKcitl yt-itr falling Jtitte process as do, for example, the opera- 30, 1968, for grnntft to ri-;slstj)tiblic or non- tional grants under regional incdical resources through useless duplication. To aiiietid the labile Ilealtli Service Act to profit private universities, iiie(licil scitools, itmsiqt it% coiiib,,ttiiig iicart disease, cancer, r(,s(-.arcli ltistitiitlonq, and otlier I)tiblic or program-,, air pollution control, or 'ro assure the inost effective intcr- rtroice, and related diReaFt@. jion.l)roflt iirivate Institutions and agencies comniunity mcntal licaltli center relatiorisliij) among tlicsc and otlicr Ite it clinctc(i by the Senate attd flotine of In I)InntitTi;r. lit conducting fi-aftil)liity ottidle.R, and lit operating I)!Iot projects for ttie estal)- staffing. Public I-Icaltil Service grant pro- of the Utiifc(l Rtfitcn of llsltitietit of regloiiiti iii4@ilicitl programs of grams, the Public f Icaltli Service is Amcrictt it& Goityrean (tvicmbleft, riant ti,in reHeRreli, training. an(] desitatif;trittion activ- The operational grants under P.L. Act artery I)(! (-itt!(i its titi! "lie-irt I)iHense, lties for carrying out tli4-- litiri)oiiem of title currently developing iiiformational, Catic(@r, retail Strt)kq! Aineikdiiieitt.); of 1005". title. 9iiiiiR ttl)loroi)rlnt(41 rather title Fiectioti 89-239 will support an interrelated and review systems to promote cffcc- 2. Tite Tillie lleitltli 14ervico Act (42 for any fl-teni year filial) material nvnilnl)ie for program of activities whicli utilize (-It. (,A) Is ititicti4le(I by n(14llilg itt tiic ninking siieli grnitts until file end of the flitcal tive coordination between all of its end thereof tlit! following'new title: y(-itr ff)llowing ttio fist(!nl yenr for watch tile regional cooperative arrangements nl)lirolirintioii to nintle, varied grant programs. "(1)) A grniit iistiler flils title nliall lie for to accomplish the objectives of that 'llitAININ(;, ANI) ])IeNTON.9'11[tA!I'IONS IN 1)nrt or nil Of title c4,.qt of the remaining or Oli' lir-,AltT law in the fields of licart disease, can- li'll@ otlker itetivities wine reRivect to witicit tite CANCI@it, STITOKE, ANI) ItliI,ATED npplication is innde. except t)iat any guelt ccr, stroke, and related diseases. Tilc I)ISIIASES grant witli respect to coniqtritetion -of, or c.ool)er,itivc arrangctricnts and the "Illt?'Po$Cn lirovigion of built-lit (rLst determined lit ne. specific 1)Mgrain elements arc viewed i)oo. 'I'lic iitiriiot4c" of tliIF4 title tir(- corilniiep wltli r(-gitlatlons) equipment for, by intny regions as providing useful "(n) 'J.'Itrt)tigit grantfi, to (@tictitarsige and tiny fitellity iiiity iitot ex(,eed ')O I)tr c(-iitiiiii of nqsltat lit tile emtiil)lisliiiteiit of regional co- the cost of Ftitelt ct)iirtriietioii or eqitllintent. models for application to -t wide toldt-riillvi- ilrriiiigtitievits itnit)iig ieip.(Ilcni "(c) ]tritium jil)l)rolwrlitte(I I)tirFtujiiit to ling spectrum of health problems which 144.1tool.4, res(.nrclt inmtlttttloiis, rural hospitals tltl4l $little licit lie available toD pay the rest for r(-Hettreli and trniiiing (including call- of hospital. tiietlical, or 4itlier care of pittlentft can be implemented through other training c(Itierttloii) all(] for related (lettion- PK(4-lit to tile pxteiit it 1". am detertnlneil In means and which will have close mtrittiotiq of isittleiit cari- lit tile firl(im of stecordniiee witit regtiliitionpi, Incident to lit@art (lisenre, enneer, stroke, and relateol t.iii@se r@arelt, traiiiin,-, or tiemonstrittion relevance to the achievement of many (lisense.,4; netivitle" witicit tire. enconil)aptfted by the of the activities supported under "(I)) 'I,o afford to the inedical profession 1)tjrl)os@ of this title. No patient Filiall be and the medical iiirtittitioiig of the Nation, fiirnisited tiosl)itnl, medical, or other care P.L. 89-74.9 and other health pro- through i4iieli coolierittive arrangements. llic (viifiiirtiiiilty of mandate available to tlielr lost- sit. tiny finally litcl(lprit to rei4earelt, training grain%. Conversely, the rc,i,,ioiial iii(!(I- III-lit" Iiii@ Ittlq.ml. stilvilli@!4," III flio- illtigitomi" Or licilvitlett etirrl4!41 oil( will; ical programs can benefit front tli(- nine tr4qtfiiiesil Of llii!i4q@ ilimeitfif-m , iiiiii (iiii4lm itliliri@I)rlitti-ii iiiirmijfitit it) tlllm title, "(e) Ity tli(-m4- iiieniia, to lvnl)rovo. apit- iitileom II(- Iiiii4 I)epii rq@ferri-(l to such facility planning and operational activiti(!s of t,rtill@, fit(! )ti@itifli innttl)ower nn(i facilities by it liritelicitig ltliysieiitil. "Dellnitions 11(f) friie term 'constritclioyt' Inclii(les for (It(! (-st:il)llslitll(@lit ;Ifltl i)l)(,rittioti tif will ke(-I) s@iieli ri@enr(Ig iii(I itfroril 4iieli alteration, major repair (to the extent per- stieli r(,gi(iiiiil 1-i,(igriiiii, its lit(, ';tirgcoii (.eiiq-riti @SFc. 1)02. For the purposeq of this title- mitted I)y regulatioiii), reytio(li-Ifrig iiiii] nilvist)ry grf,tii) lir:ii!fit.-Iiig Iiii.N-si- may find to ;ts%ur(@ the (,or- "(a) The term 'regional medical program' renovntioit of CXi4tilig I)IIII(IlTI94 (II]Clllfllllg clang, iii(,tlicjil i@ilit-iitls, hospital ii(]- an(] v(-rIII4-iiti(iii (it @iieli reliorts; means a coopera!ive nrrangeirietit among a Jnitijtl equipment titeri@(if), iiiitl reliliti,eiii4,tit. iiilrilstr:tt(irs, ri-I)r(,st@litittiv4-s front :111(l gronr) of poit)llc (ir nonproflt private fnstitit- of (itisolct(!, I)iillt-it) (a4 tie((-riviltie(i lit iie- lirlitte itic(ii(,sil vt-iiiiiisirv lie:tltli "(4) ikiiy liil)4irt,r iir itiecliniil(- eiiijiloye(i tionei or ageiicle-; ei)gttgc(l fit reieitrch, train- cor(l:tn(-o! with r4-gitl;i(loits) 4-f agencies, iiii(i of (illii-r liy tiny 4-otitriieti)r tir sttl)etjiitriketor In tti(@ ltig, dingnt)slm, aiitl tr(@atttiient rclatliig to existing bittliliiigh. ol-glillizliflillln. likstitililf)fis, Intel lIP4.11(.It,s of @voric on tiny coti,,.(riaetlf)ii heart titsenre, cancer, or stroke, and, itt the will, ji(.tivitit.., or tli4- kiii(i l(i lo.! stiii(-(l liy I)iiyiiii-iiis litirstisitit to tiny grant alition of the applicants relitteti t][sense or 1(7ratits for I'laiiiiing cjirrlefl iiii iiii(](!r lli4- I.a-iigriiiii iiiiii matter this section will lii! ll."Iil w:lg(-4 at diseases ; hot only It sticii groiit@ "SFc. 1)03. (a) 'riie Siirgeois iiT)t)it 1)(!rs or fit(- lateral(! familiar ivitli the not tititii tlin@i! 1)rt-vitiltrig on "(I) Is sittinte(I within n geographic the reconiineniiiitioii tif the Nitlioii;il All- tot- I lit, iiii(If@l' flags similar lit fit(- lot-:illty Is area, composcil of any lonrt or 1)jirt.-4 of vitiory C(iiiiiell oill Ilr@o- lor(ogr@iiii. I)y fli(@ Se(!r(@ittry twf l,iii-,)r lit tiny one or more Stnte4, which .the Stargeoit graiiih cHtal)llslie(I by 1)05 (ii(-rt-:itfer %vitli the A(-t, ,t ,4 C.encral determines, lit necordittice with In this tftl(- referred to its fli(t ll(lt'(Ititm fop, (fail iiiii(,ti(leti (40 276ii-'-171'@a-5) ; and It(-gioll(it Ift!tlicttl Willi regulations, to be appropriate for carry- aiitliorizcql to innk(! gr:tii(s to I)til)ll! or I- (lie So-t-ret:iry )r T,ul)(ir shot[ lt:ive, litg otit file pi3rposes of this title profit lirivftte titilvei-sltif!s, schools, "Src. !)II.I. (it) Stirgeoii fertile to lii(@ labor t;tityt4ljircl-4 @lif@cifled fit "(2) coasters of one or iii(kr(! iiiedieni reseiir(-Ii lit-;tlltilloiig, :fall father of, lit(! or tit,! is ,,II- this l@tiriigritlili, tfie stiiflit)ritv ;ttt(i fiin(,- center,(, title (Dr more (-Iltilenl r(!s(!jtreft ceii- iii)viiorolit lit-lvjilf@ find fii4fittillotis tlif)rizi-(l lit iiiiiltt! grititis If, iir it-,tt- (falls roirtli lit ]It,(wrgiititzittinvi l'inii ters, final one or ititort- loosl)ltitln; find (4) iissint 1114-111 III I.I:Illlilflg 111(@ isr,pill. I)riviif,t ijvjlv,-rs]114!s, material Niiiiii@f-r(,.l 14 of 1!1!'.(l (15 :1171@ ; 5 "(3) has In effect coolierittive tirrange- ctr regisonitl iiipill(-Iil 1)rt@gi,iiiiiN. rt-.,o-jtr,-Ik ;fail )Ilj(-r ,i, I:I:tz I!'.) anti 2 if llt,- %(,t mentfj among Its component iinith whl(,Ii "(I)) (.rstitt4 tender iiii4 sectiott may I)i! ll')lll.l,4ifit fig(.Ilf.l,.s Jill(] liililliti,iii I,, (it 3iiii(@ I:;, 1!1:14, its :mandate (.10 (T.S.('. the Surgeon ('.eiieral finds will fie ntleqtiitt(- iiindi@ only iij@oti all- 118.41.'4t III Zillti oi)i'l'lttl4)11 -If for effectively 4!arryleig *tit the of lirovf-ol toy tit4@ Siirg(-Oii Any Nil(-II regional] iii4-iliq-;il lit,-litilliln I'''''- this npl@ll(-ntlc)n itiny be iii,lirov(-.1 )iily If It. s(ritt!ti-iii little fli(,Illll(-s It, A,fl,imnt,y (!I)Itltt'it ')it tititi4 (yr 14 4tipl)orteil liy--- "lb) The term 'medicnl center' viteiinx a "(1) reiisonnl)lc :t@stirnnet-,s that Ft@(1- tititie@r tlil4 s(-(!Itort may lie medical school or other iiiedl@ Institution crat ftint]4 pill(] ptirsiiiiiit to tiny such grant itill)li(.:Itii)ll tllt-ri-f4@r fill- iif involved lit postgraduate medical trititittig 11111(lo only III)OII nn(I one or snore liospltnls nM]Iate(I there- will be tisbtl only for the f(ir proved liy fit(! Stirg(-.@it Ct@tit-riil. iktiy sii(-Ii III(-ltll)el,q. with for reaching, re4o!nrcli, and ileinon- which 1).,ii4l anti In jiec,)r(laiici@ Willi fit,! iiiiiv i)o@ only if it is gor,. (it) rito. Siirgt4iii with stration purl)osei;. nf)l)llenl)lq- lirovii;l(iiim of flilN title final the iitlvlsi)ry gi-(Piii) 41t!st-rit)(@il "(c) The term 'clinical ri-goilsilloii,.4 lit sei-(I(wit (.1) flat[ alienates qir Is stili. %vitlt(,itl lit,- t-lvll so-rvic-P laws, n research center' I)t)rlt-tl Naill,@ittit Ailvis,,ry fill It,-glt)itiil means an Institution (or part of nii ltim(itit- "(2) renioniil)lc tis-4iirittice.4 that III(- tton) the primary function of which lit re- al)pll(!jtyit will I)rovi(ii! file siieli ci)ii- "(1 fiiiiiis I,;iltl 1)iirsti:itit I,) t-jil 1'rtogriiiiiq. 4,411111(.II slt:lll of search, training of mail demon- trol nn(i film] necoiiiifltig lir4i(-q-iltir(,.4 ;it stri! fitly Silt!li grant (@%) Will III! its I fill, will) sli:ill lie fill- elt:tlr- striations anti which, lit connection therewith, reqiilretl by the Siirgo@(iii to ;isqtirt! fill- Will(-II 1111111 find if) ;I(. mail, ikiiil twt-lv,, iii4-iiiii4@r.,, not In provides speclalizeti, lilgii-qtiiillty (Ifitgnostle lirolier (it and iic,v(iiijitliig fill- ivitit tlii@ lirov@.,It)ii., )r flit! regulate riiii-iiiiii@ fairly )r tit4. tit,iti@ii an(] treatment serviet--i for iiiii:Lticist,4 :limit Rticit li'ecieriel funti.4 ; this, fill.- :iit(l ilit@ r@-giil;ill-itis what :ir,- li,:ttlers lit life 11(@tils of fit(- OlitPatiCtitFl. "(3) renmonjil)14@ iismiir:itice.4 that fit(- fit)- %%,III ll.,t stil.1,1,11]t fillift; that ;Iil,@ file III(.(Iff.lll "(41) Tlt(-. term liso.%tiitnl' in(4inA a linql)l- lilictitit will raising! nii(!Ii r,-Iior(m, lit sti@!li jiviiii;il,l,- fill- .,I, .t- Thrift itfrjilr.@. At I(!;iNt two ,f f1t4- fill- tnl as (refined lit mecti(iii Ck25(c) (or other form anti forerunners Nticii iiiforitittfinti its t,r flit@ rt-glf,vt:il i.r,igriiiii mli:ill lit! I)Iiy%i- liertitit facility In which local cnl)nl)lllty for (lie ';tirg(,ott (;etit!r:tl fully from flat(! it) %vitli t,i,slit-i-I it) wlil(-Ii flif- grant. it iiiii(14,; 4-11111s" (1114' affair lit, (lilfgt;lllflltlg III file Stil(IY, ttiTio rei,.;onnbly r4@ilitirt,, :fail ivill ko,i,l) file ,%,,,Hill will rtir sii(-Ii (lingnoiiis and treatment Is supported and i)r ti,(-iiiiiii,rit tif li(-nrt. one augmented by file program estnl)llqlieil fill- such records aiiql nfr(irt] such aree,,q (Ise@il control anti ftiticl Atc(,olllitiyig Stuart Ill. outstanding III tiff- ',fully, (]tugboats, (Ter tl)IFI titiP. to ig the Stirgf@n tiitiy flittl (Iiiri-.4 it., ;Jr.- r4-tlitlrt-ol I).%- tli(@ Sitrgi-,iii or Ir.-iitiii(-ist: i)f akiiii one mliall be otit- "(c) Tlt(! term 'nomproflV nm nl)l)lle(l to Mary to sisstire tlii@ (,orret!ttie@.-4 Jim[ if) :faster(! (li@Iiiirst-iiii@iit tif .fillliililg in III(- slijily, ili;igiposls, or treat- any Institiittoit or agency means nii lltstltii- tIoll of r4,licirlm ; iiiiii ;,,,,I rior ,ii( II fiiii(Is ; .)r tinit or ttgf-nt-y which la cowneil itnti "('I) It ,IIIHfilltt)rv H11I)WIlig that fill- Try one. lie more iiiiyil)ront rorlig)rittloiis or lifl- llt)llll(!Ilflt lifit4 )III il(lVlt4nrv socintionr no 1)nrt (if the net f-itriiiii;,-4 or gr(witli, It) ntlvl-;c file jilil)ll(-jtiit (anti llit@ "(,'I) lill@ will Nil(-II Infinite i,f tti4- ('t,tift- which lniires, or may lawfully laterite to file lnstitittloiiq anti ngen(,Ii,.q reinterpreting lit liort,.4, lit sitc-li ft)riii anti infiltrating sit(-Ii t-ii iii.iii r,,r :I ti-riti of four ye.,trj;, I)cyieflt of iiiy lirivii te. gliaretiol(It@r for file r(-%ttllliig regional itietll(!;tl lir(igriitti) iiiforiiiiiiiiiii :i.-4 lit,- Siii-g(-iiii rally 4,xf-t-l)t Unit ;iiiy iki.-iiii,i-r iil,1,4)ltiteti to fill n lrillivi(Ilini. In formulating find carrying oiit the lil;iii from flat,- It) iiiiii- ri,:ts@iiitil)lv earlier(,, jititi Iii-I.)r fit lliq- f-xlilr:ifl,,ii or the term C== r or iviliell Ifils lir(,(If!ces%,or iv:ts Y'i,r(tO)irlit irliff tile UiilLe4l St.,It(-s, or :lily of titeir iluly all- El XHIBIT XIII tliririz(,(l ri@I)r(--clitatlve,,, "ccLs4 fijr Ili(, r4,jti:iitiil,,r t)f stf,'Il ror fli(@ iiiirl)oli@ of nkillit :11111 (@xnililililtloll in for ,,,;I:(-. !107. Slit'g-li)" fifty I)ofll('.4, tiociiiiii,tit,, 1):ilwers, fail recortis ii-riet, flat flit@ ti,riiis fir III(! itteiiil)(,r-4 fir4(. filling oifi("@ sell ill.illlsll. :,,,(I ill:litil;till 4)tl :1 (-iirr(,tiL 11.11@i,, 11 fir lilt. I,ei!ilil(,iit of niiy grniit iiiiiler tlli% title :lq II(-.41gil:lll!ll I)Y III,, Siirgi-(iii itl I"P ,,, ,r it, tit,, -It iii,i- 14, illy rriijit." rt)iir zil. tlif- (-']if 'or 11 le Nvltlt l@CgUtilLiol]S litill Stilfri@ll :1. (11) Seelloil I or tlil) ilill)lle Ilvililli vi-iir, ri)tiritt@ tiat@t,ii(i ,or Itilli III (114- ill:19- ltlll(,Itlletl to r(,siil :is fOllt)lls I?eglotial Al(,,dical rt)ttr ;it tile 4@Illt 'or tile trt,:itlllt'll(r (Ill;eilstl, Cililc"". ,Ili. (I:Iif. of Ali Or tt.g(@liter wi(it ri@litti@(i lilrt)r- "4t',CTION 1. 'J'Itl@' I t(I IX, iiieltisive, i)f Prograitis tier @lt:ill iiot II(! to %erv(- fll:Lii(wlt" ilkcllillillg 1114- :Lv:lil:illllilv I)r fill- tills Act iii;ly Ili! elt(@d :I% Ili(, 'I'lillilc Ilct'lill ri)r iii(ir(@ I linit livo (priiis. v:lllcell Ir:iililtig lit filellitl('@. Service. Act'." Mtrcli III, 1967 I,.,; iio iis(,riii, iiiiii sii:iii (1)) 'J'Iie Act 4if -fifty ii 194i (.IjS Stilt. for list% :Iittl ro,l:if(-it liirt)riti:tiloll 4,82), am litilell(le(l, is ftirtliel' ,ttiieiidctl by ri,- "(I!) Alil)ol?lte(l itiptiiiier4 t)f tile :Lv:liliillc I,) liceii,;Pil 1)rttctltl(@tif,rs iiiiii otlio,r iiititil)eriiig title l@\ (as lit efrect prior to the ivitile ititeii(ling iiif!t,lil)XN or 1,4-rsniiz re(illiriiig lliell ififol-litati4)11. 'ro III(' pli:lcllllelit of tills Act) its titlf,, X. nii(i by SUBPART E-GITANTS FOR titerf,of or otlierwisf, servitig oil Of Cliff ,or iii:tkiiig sii(-It list: (or li@is :tilil oil,("' tilrougli 1)14 (:t. ITEGIONAL MEDICAL PROGITAMS (,tpilliell, slt:tii fit! (,iititif-ii lo Coill- ,,,net iis(,riii, iitf- 1 I::: ,feet lirl(or to tile efficient (if iiiis Act), iixeii fly fit(- @t-f!rt,[;try. @r:ii frt)iii little ,, fillip ('01'stilt AV -r(!reiices limit at rjitp4 rt . iliercto, its sections 1001 4.xepe(iisig slof) tier iiif-lii(illig If-r(-sl.eil 11.1111011:11 tlli-oiigil 10t.l. I-e,,I)Pctlvely. (.,t(l(lccl 1/18/67, 32 rlt 571.) tritveltjiite, till(i willing sto rervlllg "wily froiii Rc (", 10 :15 AUTIIOIIITY : The provisions of tills Sul tticir liottien or regqilar of btisiiips% tl,eY Ilo)-t to I,)-esitictit aii(i eopitl;,rx-4 kl,l,ltoVl,',]) OCTOBI-',I, titity be iiiioweit travel exiienseq. iii(-Iiifliiig I)ttrt 1-1 issued under sec. 215, 58 Stat. 691 !)os. oil t. 930 ; 42 U.S.C. 1-110, 299 Sec. 906, 79 @ta wl, iiiteriiret Or apply secq. ')Oo, 901, 90'-, ')O: sli:lll Affiliate lot lilt. y of tlit@ Atillileil% or 11).If; (5 tj.S.C. -,;Il@2) fiir tier- itelt(ii-L No). ')(;:I :tccollll,zltlylllg 11.1t. I)OI, 905, !10-.), -,-.) St;tt. 926, 91-7, 928, 1)21 A(,t f(,r fit Ili(, :fall lil('11 1190c, 2094 1.1t)lls lit Ili(- (;ov4@riiiiielit: servict- i-itilil@typti low iii4i if I'lli)ol't of ill(' "(!tivltlP-9 :1140 ((,-Oliliii. oil Itito,r,,Aitte :iii(I I,'orelgii fi3O, 4'-' IJ.S.C. 299. 299a, 2091). iisterillittelitty. tlilt title log(.-illf'r xvitit (1) it state- 29ge, 2991. titent. i,f fill, r(,].,itiolislill, I)(,twveli IOP(ler;il Scrinte iteliort No. ",GS (Coiiiiii. oil Labor nticl 0 54.401 Al-PLICABILlTY. Alililicatioits for iiiiaticiti, :iii(i financing froiii otit(,r 11111)lic Welfare). rant.9, reconi- @r tile :Ictiviiii,% iiiiilerl:tl@i-ii llill'.411111't to fill-.,, Coiigr"-loiinl Itceor(l. Vol. 111 (1965) The provision% of till-; subpart apply I iften(lations. S- Jtiiie 25: ('oiisitlercil lit Senate. grants for lilaiiiiing, establishment, all till4,, (2) :fit itliltrtis:il of ill(! :activities .11 itille -,s : (loiiltlereti nii(i ii;is.%Cti Senate. 4)1)cratioii of regional medical lirograing 1 ,,((I) The Cotiticil sitall :i(irist? ,Itlol sisleol iiiitler Ili]% till" III if,,! iigiii. (or ii,eii, ,:I: 11.1t. '.140 coiisl(lq,re(I ill Ifoll4e. ilif, '4ilrgi@aii lit fill, l@reli:irnti for Or - authorized liy Title IX of tile Public IleRli is ('otisldered find passed 110118(l, Service Act, nit anictitictl by Public Ln ror, niiil if.% fit 11(ollrv Ili tiers 11,14 fill,.. ;iiiot (:t) reeoltillit'liflittioll@ Avi t11 ill licit of 11.1t. :1140. St)-239. Jerking witli to, (lie. ;idiiiiiiis(ritloji rcsl)c(-I: t(i i,xicii,-3oti fir modification or tlll.,4 St@lit. 2!) : Setint(,. coiietirre(i Ill Ilotise Of this title. The Council slinli votisitler ill 0 54.402 DEFINITIONS. til@lilicatiotis for gritits tinder this title .fall title ill fill, liglat tliero@of. :iiiieiidinciitN,. Sierra make recommendations to the Surgeon (a) All terms not defined lierein shi (.Pneral wltli respect to approval (of lll?t-cor(Is a)t(l Ati(lit linvc the meaning given them in tltc Act. floiis for nitti tile iiiiotaiit..4 or grittits, t)(i!). (it) rt,,ciliietit of -I grnilt. (ill "Act" means the Public Ile-titli Set fill,; title. tinder filiq Half. sil.,ill returns its Ill(- Ice Act, n.4 niiien(le(l. lires(-rll)e, li,.clii(illig le) "Title IX" means TiUc IX of t loge tlit@ amount niitl Public Ilenitit Service Act at amended. ri,corfig wlilcli flitlY ili',c ((I) "Itelated ilIF;enscs" uieiins those (I r q-ttses Aviticit caiL reasonatily be considered !)o(,,. Irlip tilslit.sitif,tk toy %ii(,Ii re(,Il,ictif: for (lie (.4)11@llit:tlit)lt iviiii (lip Ct)tiiii-ii. t4linil i,rt,- Or %Title gr:iiil. file total 4,o@t (ir file Iii-oj(,(!t or I)enr a tilrect relatioiislilP to lieart diseni ,-(irllio- gt-itt-rit ri,gtil;ili,iiig (-ov(@riig ltit, I.-ritiq iiii(li-rt:tliiig lit wltlt lvilicli shelf cancer, or stroke. ;fail (.011(tltl()iisfor :tlil)roviiig fi)r street 1, iiiitit@ fir itsell. :ill(l life :111,01"lt Of le) "Title IX (IlSeftsCs" means beart d gr.,iiiis tinder iiiit tillf, iii(I fill- co(triiiii.,itiois iltit 1)(,rtti)ii of tile cost of tile liroject or case, cancer, stroke, and related diseases. to( 1)rogrittir. ts,.ili;teql iiii(14-r Tills ii(It- willi tittilert',ikitig rill)l)lieil by ottier ,,oiirei,q, and (f) "Program" means the regional me lir4)gr,iiii-4 for (Fannie,,. tii(I tleiiioti- siiclt recoril-, -,I,, Nvill f@l(-Ilillte nil Affective! cal program as defined in section 902(a) sir:ttioiis rela(iiig to tlic- Same the Act. :tssif;tetl or tittliorlzetl tinder otlier titles or ']'lit- lceret:try Of Ileiltli, IP(litcatioll. (g) -'Practicing I)Ilysician" means IL tills Act or otiter Act% or :fall Welfare Haiti tii(@ (lottilitrfill(,r Gerieril or 1)liy%lclnti licensed to practice medictne 101 .tccor(l.,tnce witti npplle,,il)lc Stite I.,iivs ,tii(i :irt-a to he seri,e(l, flit,, II.,i f 1-11 I NN' i I11 III(, se,-(Iolt '.)O I or tlit@ k(-I, ;is fill- (-iirr(,ntly eTigie(I fit Ili(! (11-.igiiosts (@r irt-zif- iiii-iii-.4 ill i.ff(.(.f, or it) I,,. Ill.. )tient of pittlf-nts. ri,(!tiv(., wititit, file Ill.- filii,lq. (it) ",%Iijor reliilr" lTiciiitle-4 r4-s(iir;itioti sill)i,4il'teti lie, ;I I,titlg(-l -r II,- I'll :III-[ (itiii,r ro-];tliii;z Ili Ill,, o@r :]II exisfilig lilill(lilig to ;I "olill(I %t:tfo-. :iyli(ollllf or. fil(@ fiiil(ls ;tilil s,-t. is(. t,r gt.:ttti. ftit,tN itti(i (-iisit-iii:trily fit. ttt,i. riiii.i., iiiiflilt.,[ (-Iitilett fit the (,t)tistrii(!Iloti rfor or (j) "Aflylsory grf,iiji" iite:iii,; tli(@ groiij) I,y :1113 ,Iesigtilite(i )it:, (11) (,I ) (,I l@tirsii,i?it it. 1 I Ill,-II .... ir) t-f flit! Act. Ir Ali I t.:, I it pi, r, . I. it I I I it c I. I. lliis (1@) ;irf,:t" ;iny :lr4-@t I it,,, !)I):; f,r fit(- At-t -4ottl:ilii ,t- II,- silli- Ill., tit,,it tli(- Stirgf,oii Ct,ttf,i-:tl tielf-riiiiiie.,4 fc)rviis l@orti@(i 1).I- .... .. r Ill,. ll,,Iifi ... I r(,Iitfett ilf ;Ill sli;tll f:ikiii,- liito coiiqifli-rttiott rziet(ir,., II.,; rtii,tiiiii;itijig ,,it II,,. :ilil,,Illit 1.@ Ill-- 11;ill iii)fir.%- fill- liri,.4(,iit ;fail ftiltiri! fr(-iiiis illiti ;iviii (,r ;, If %II(-II li;ttli-rti% tir -r4w%vlls; li)c:tlliiii iiiiii ;-xfent (Dr -I(li;isory llfl:)V;Iii:ll)li- I-- (list-ii;irgi- flils ri-@I)oii- tt,;iii%l)ortatliiii @in4l coiiiniiitilc;ttlott fsif-iliti(-s tio)i. Tli4! i,r siii@lit)rflli@ iti@tti-f-i;il .I-. :tti4l sy'4teiiiq; Itr@-eoi(-4- ttitl clistrililitinil or @lt:ill iii-@eriiii- fill- of,li!lfiti,)Ii ,f fliti'lq. s,, riiiiii.,; ,,,:is. I,.. gI-:till. sli(.Il inpoii(..ii :,,,,I iie:tiii, riti!iiitit@.,c f'r llli@ lliifs tfii:lv:lil;il,l,- jiTitl I)rogrtillIH, :11111 t)tlit-r ii(-tivitl(!.4 wlileii ill III sti,.Ii file (.T)Iiiioyi of the Stirgeon ;irf! :Ill- Itroltri,,ii(@ for (,;trryltig t)iit flit! lotirl)t)qes i,f li4,:tltlt I.rof(-ssloii.%,, 'I'll](! ]X. El gi,:iill fit ,t- fit i.;ii-I r,.r i,,@ III gir(ii-r 14@ lbf- 4,11giiii,. rt-r ;I griiit, Ill,- lit','Iitlll[411ls ;]fill s,-:Ii-,-Ii is I,, III,- :ti,llll(.:IIIL Mliliff : wiiii sit-fiviti(..q )r fit,. fiitici I,) I... .r :if (it) ',%feet ill(! (,r !)t):: iiiioli,r flit! lwt-,iriiiii, ziitil or II,,, ,,,,I)- r;,,,,, :,., ,.i fit t; ;ititi (ir !10 I nf ttie Act 114! fittiillijir Willi flif. f,.I, III,. Itelocitt-41 ltinstite, I)roviilf-(l iiitflt-r Iii4@ r.,r %vlti4-It ,r IN. III ziiv:trtllitg 13c i4ittiitefl witliiii t gengriplile tre@t (f) Ofliff ;11,., ill r;t,-t lis.-Ii %%-ifliill Ill.. sli:tll I;ili.. limit, ililtroprl;tte iieitl(-r lii(@ Isrovislt)ii-; of iiii-t siil)- miicc.'fi(-fttiopix; AVIIII ,I' tit,, :i., @.i, ,fli(,r rl,-I,,rs fill- ii;irt for cirryiti, otit flip ptirlio@t-s of llii, I,, ;if, r.),, riiiiik I,. I.,. iiii,:Isijf.(.s sli:ili 10.@ I;Ilif,ii 1).%' ill,- itst-il III ivItol4@ tir li;irt r-ii. ;is 4i..- fill- -xli@ill to NVIII(-IL tli-@ C] r)4.40.1 AI'PT,TCATION. fit ix, fit,. i,r,.gi-:tiii Will 4-@tri-y ,iif, llii,,.tigit (a) Fort@rs. An alipllc,,ttion for ;I gr;titt fit stiflif-ii-tit I)I:llls :]fill Willi III,- gi-;Illi. fit.- Nli,,ill lie sttl)iiiltfi-il oil stielt foritim :iii(I !if sii(,Ii is if% ,t iiirratlvt- to ,I, i:lt(, :111:; :I iii:tnn(@r -is I lie Siirgpoti (,Ptier.,tl fit(- :iittl Ill,, si fili(irt.- iii,.ii(titioiis, ,t, l)r(,,.,cribe. lto%t-(] :it-.- :iw@iro, or ;title %%,fill siil-II I-,.rccittiott. 'ri 11 pi,otilt: fillti-.N, f(...Il it, :Ililllfc;ttiolt '411it ,,xectife(I liy ;let lii(Ilvi(Iii:il :iit(lit)riz(,tl I,. ;it!( fi@r if gi,;itil it'll :1, for flit, :iiiljlle:ittl: iiiiil I., I,,, i.t.ji;tir t-(,til:titi ,o- I--- zi or tito@ iiiii-ii(-:iwtt :,it or life i,i.iigitfiqiii,4 .,.,,y or II,,. wi,itff.vi it Iflift,l@@ lt I,,- iti:iiiil;oiil,..l [..I. Willi t.,)iiiiiii,,iis ,r tilt- gr:titf ill(-Iliillflg tilo,,- lit r,-gill@i- ..I, fill- LI 5 .It, li;ii,- III-- (e) I)Cqcl,ipliotL f)f P).Oq),an4. If$ ;Ifl(lillt)vl .%Nl) ;ill.l ill ;I,; lt.@ til;iy ill ;ttiy )Ilt(-r iii;tt II,,. fit I,) :iiiy ttliltl- 11 ......... I,, .Ill ;fit,[ or fit.- l,y Ili,, Sttrl,,,@,it @lo;ill ilt;liiil:iiI. .r lit -siifll(-14,iii. ift-i:ii] I,. i-ii-iiilr@. II,.. I,, Ill,- ;fail fit,, %%ill, II,,- %it " II """ @Ll, tizi(iire, ;fit,[ to.i.tit,,fis .r ztio,l I,, - r I I r I I is I I I -. I1.@@ I II,, lt,:Illtilig or flif@ lirogr:itit, flit, tt:ilttro- :,,,Al riiiii-ii,@lis 1'r lit:i3, @il :il'3' l,y llif@ flit-. l@:trfiq-fli@ititig flit- li,-r(- II,- fititls ll,:if :tii,i .r :%fill to adjacent or other regionit ine(licni %,I(le l@e(ler:tl flii,,iiicinl :tssli;tttnec Kul)j(vt to iiiny I)t! lirescrit)eil by the @tirgeoii General. lb) Different tisc or trattsfcr; notifteation. programs. the (,'Ivll Itiglit.4 Art aiiil the reguintiolis. (;rant fitnt]H sliall not be charged ivilli the The grantee sltnll promptly notify the Sur- (el The extent to Which ;Lit iii(@ lienilli l@iteli grant 1-4 subject to the contrition that cost of- geon (;cnernl lit writing it at any time during resotireen of fit(- region )Iavc! IK!Pit taken Into the grai)t4!1@ 41,nll coival)].v Avitli fit(- i,p(liilre- (1) Care for liilerciirreiit cotitittions (ex- it% iiqcful life the facility or equipment for consideration in the planning -iii4l/or e,,till)- ivicnt,4 (if Or(if,r 1.124r), 30 (-Piit of tiii emergency nature tviiere the later- construction or liroctirement of which grant lislimeitt of the progrnni. I'-)311), and fit(- aliplicnl)lf- rtileq, regulations, current condition results front the care for funds were cliargLd is no longer to be used (f) The extent to which the liartiellintliig :tiiit lvro(-e(liires I)rcRcrll)p4l ptirriiiiikt tlieret(i. which the liatient wag admitted for treat- for the purposes for which It was constructed Institutions will lifilize existitig rem(iiirc#@ El 54.40!@ l-'Xlll,'Nl)l'rUitl@,S iiietit) that unduly Interrupt, postpone, or or procured or Is. sold or otherwise mail will lit[iiiif- it) m(!ek it(lilltlt)linl iiofl- terminate the conduct of such nctivitlc,.;. transferred. "A' (2) ltiliatl(,ttt ritre It other cnre ,viiieli (e) Forgivcitcae. The Surgeon General ri4li,rni resources for (-nrryleig out flip ol)Je('- lives (if the regional nt(-4]lcal program. (IL) Allorfiti,)ii of conts. 'Vii4- griiiitc(! wotilit (,(Itially (Effectively further the litir- may for good cause release the grantee or (g) The geographic (lirtril)titioti 0 grntl is Iinll nlltw,,tte exlientlitureq its I)etw(,i@ii (II- lioseq of the grant, could be I)rovldetl at it other owner front the requirement o con- throughout the Nation. rect aiitt Indirect costs lit necortlntice ivitli f;tn,,tller cost. -tinued eligibility or from the obligation a generally xecrptc4l and eqtnl)llslle(l account- .(3) Bed and bonrd for inpatients lit excess continued use of the facility or equipment 0 54.407 TERMINATION. Ing liractict-s or its otlierwire lires(-rlt)e(l by of the cost of seiiiiprivitte accommodations for the grnnt purposes. In determining (a) Termination by the Surgcoit Gopict-of. the Surgeon Ceiternl. unless requlrctl for the effective conduct of whether good cause exists, the Surgeon Gen- (1)) I)ircct coaf-4 itt gclt("'al. I'lilld% such activities. For the pxirpore of this eral Than take Into consideration, among Any grant awnrd may lie revoked or ter:ki grikiite(I for ollrpct costs may . accommodations" other factors, the extent to which- iiateil by the Surgeon (.enernl lit whaler or be (-NI)Pllflell by liaragrapli, "sciiill)rlvat* lit itart at any time iviienever lie finds itnt, the grantee for I)t,rqoiiill services, reiitnl of mean-; two-lxxl, tlirce-bed, anil foiir-bed (1) The facility or equipment will be de- In liliq judgment the grantee lini; falleti lit It sloitco-, materials, iiiiii supplies, ikii(I other accommodations. voted to rerenreli, training, demonstrations, material respect to comply Witik requirements ltejii% of necessary co).,tt nH tire reqtjlreil to 0 54.410 I'AYNllt',NTS. or other nctivittes related to Title IX ul)- carry out the ])itrpose-; of the grant. The, diseases. of Title IX and the regulations of this s Surgeon niny Issue rules, lnstritc- The Surgeon General mliall, from time to (2) The circumstances calling for a liart. The grantee sliall be promptly iiotlflc(l tions, ititerpretntioits, or Iiiiiltntlozi.4 rup- I.Ime, make paynientq to a gritntm of all or change In the iiuc of the facility ivere not of Rucli flndlng In writing and given fit(, l@leiiif!iitliig the regulntiotir of tlilR sijl)l)tirt it lwortion of Any grant nwar(l. either In ad- known, or with reasonable diligence could rensq)iis therefore (1)) Tcriniti4itiopt I;y (he grti;tter. fail liregeril)iyig the extent ti) which I)arti- %-iiiiri, or by way or reimbtjrkeiitpjit for Px- not have been known to the applicant, at tbe griiiitei@ inny at any time terminally or cal @, !iil:tr (yj)eg of exlteii4llttire.9 itiny I)i- (-Iiiirge(I I,--rist-t4 lo I)t, liiciirre4i (or liicitrreti to tlit! time of the application, and are circum- to grneit fiintl,.4. extent lie determined such payments necer- stances reasonably beyond the control of the Its conoluct of an approved project liy ii(ittry- Ing tit(- Surgeon (;etieral lit %vritin.- setting I)ircrt coqts; lic),oio?tol sci,clocit. Tlii@ rnry to carry out (In- liurl)oses of t1i4- grant. n.ptilicant or other owner. fortil the reasons for such teriniiintioii. (costs of 1)trmoit,-ii services art- liiyalilf,, from (3) There ,ire reasonable assurances that (e) Accounting. Ulion any terinitiillopt, -raiit funds substantially lit lorot,ortit)ii to) 0 54.411 DIFFERENT USI-', Olt other facilities not previously utilized for the grantee t4liAll account for all expenditures tit,- time. or err,,rt ti.e Individual lie'votes t(, rl'ItANSIPJ@lt: GOOD CAUSI,', Title IX purposes will be so utilized and are nii(I obligiLtioiiFt charged to grant funds : carrying flat the. litirlooFte of flip grant. Tit FOIL OTIIElt USI,' . substantially the equivalent In nature and flo,oi,i(Ird, That to the extent the termination Riieli liroliortioti, rtic.11 costs may Include all extent for such purposes. illrect costs incident to such services, such (n) Goiitpliniicc bi/ grantees. If, tit any 14 due In the judgment of (lip Surgeon (;eyi- time, lit(- Surgeon General determines that 0 54.412 I)UBLICATIONS. #@riti to no fat3it of tit(- grantee, credit slinil am qnliir@, iiiiring rjicittloiit iiii(t retir(@iiii-tit eqtjir(,mentm for it I)rogrniii Grantees may publish materials relating lif- itilowe(i for the national required to settle iiiiii wi)rkiiien'H t'Onll)VllSntit)ll (,Iittrges, lit a(,- flip eligibility r tit costs (lenaoijoitrate(i lpy etvlileiice satisfac- with flio- balance Ril(I accounting or(! no longer met, or titnt tiny facility or to their regional medicnl program without blications tory to the Surgeon (:Pneral to be human 11111 trochees (-onqk-teiitly til)lille(i liy fit(- grnrilef- equipment the construction or lirocurement prior review provided that such pu to all Its netivities. of which wng clinrgeft to grant ftin(lq Is, dtir- carry a footnote acknowledging assistaoce settlement costs, stay noiicancellal)le g)l)lil. Ing Its is(.ttii tire, no longer li(-Ing used for from the Public Ilealtia Service, and lndi- hang Incurred prior to receipt or tiotl(,e fir (d) I)irect costs; rfire of liaticpitq. riie (-oRt (if liosliltal, iiipiilcnl or other enre. of the purposes for which It tvnFi constructed eating that flndlngs and conclusions do not I(-rmtnation. patient,; la payable front grant fiiii(IR only to or procured either by the grantee or any represent tile views of the Service. 0 54.408 NONI)ISCRIAIINATION. flip. extent front glitch (-nri- Is lticitlent to trip tr,.tn-;feree, the Government slinli have the 0 54.41@- COPYILIGIITS. resenrelt, training, (ir (leitif)ttqtrittinti tictivi- right to recover its 1)roportiotinte share of .,;Cctiott 601 of Title VI of the Itiglitm 'Allen file value of the facility or equipment front Where the grant-sul)ported activity results Act of 1964, 42 U.S.C. 201)Otl, I)ri)vl(leii tlint firm rtilil)ort(@il by n grant hereunder. . either fit(,, grantee or the trniisferee or any lit col)yriglitable iiirtterial, the author Is free no l@t-ricon In tile Unitetl StnteR sliill, art tli4, (-are sliqll be Incident to such netivities only Institution tlint la uqlng the facility or to copyright, but tile Public Ilealth Service ground of race, color. or nationnl origin, be If renqoiini)lv ass(i(-Irtte(I with and required equipment. The Government's proportionate. reserve-i a royalty-free, nonexclusive, lrrevo. exciiided from liartlelpation In, be tieniefl the f(ir tit(- effective conduct of steel' netivities, the amount bearing tile same cable license for use of such material. nn(i no such cire slinil I)n (,Iiirge(I to such slinre slinil be I)t,nefits of, or be subjected to discriminntioii - . under any program or activity receiving F:@(1- litlitl.; litil(,@q flip r(.ri-rrni (if the lintient Is ratio to tile then value of tile facility or 0 54.414 INTEREST. Prnl financial lFttallce. l@gtilati"llft ]fill I(.- flociiitieiite(l ivitli resl@ect to flip until(. of the equipment, Ls determined by the Surgeon Interest or other Income earned on pay- RAR meriting tile statute leave been its I'nrt I)ricticiiig pliy-ticiiiii ranking tile referrfil, (,fiierni. as the nniount the ll(,deral partlcl- ments under this subpart shall be paid to .'44) of the Title 45, Code of Federal ltpgiili- Ill.- archaic of the patient, flip, 4]atp of referrii], lintion I)orc to tile cost of con-;tructlon or the United States n.9 such Interest ta received tlt)ns. The regionnt inerrant] lirogriiiii, l@r,,- illi.t tiny other relpvityit attenuation which liroctireitient. by the grantee. 03 Flcxncr, AI)rilin .in, jifeelical I,,ditcatio?l ill Price, D. K., (,ot,criti?ietit tipi(I Sciet .ice: 11. llitblicatioiiv of? ic I?elatioit it, ,I?tteric(iii l@e rt 't'heir git)yial Afedicil 1'rograllis H I XTV the United States and Catia(let. A ltc,l)o N(,%v Ne%v 0 'I@ Iffli- to the Carnegie lotinditioti for tile. All- I)e.?Il vanceinclit of 'I'cacilitig. Nt,- York, 1911). v(.,,sity ill,t,ss, 195-1. I,., "(;t-orgi:i ltt'.t4"011;11 r?tal of ilLe Medi- lpily Vol- 5C), No. ties aitti Price, D. K., 'I'lie Scientific l,.itate. (.aiii- Niecti(@:il 1'rogr, JOIJ Kidd, C. V., A?tzericait [Jiiizyersi of (;eorgia. Federal Research. Cambridge, Nlass.-t- I)ridgc, Nl,,Isslcllllsctts. Belknii) I)rcss of cal Afsociatio?, Selected Ifistorical Documents cillisctts. Belknal) Press of Ilarvir(I IJ,ii- ITiiiversi(y llrt,ss, I!)C)5. .1, 1). 1.11--i-12. April, 1967. id National Reports versity Press, 1959. Sl,cl.)s, NVolf, (,. A., Jr., arid Jacob- Ittirgcss, \Iex M., Jr-, Colton, Theodore, atioli anel llt-tcrsoti, Oslcr I,., "(ategorical Programs itizens commission on Graduate Medi- Mountin, Joseph W., Penncli, Elliot It., son, C., eclitorh, Aledical I-'elite for licart Disease, Cancer, .ind Stroke ,I Educition' The Graduate Education and I-loge, Van(! M., Ilealth Service Afedical (are-Ititeractiotiv and Pros- 'I'he Netv l,'?zglaytd lotrnal of Aledicine, is. Council Areas-Requirements for General IlosPi- 1)ects. Report to tile 1.,,igi,tii,rc.,(.tiing Ill- F Physicians. Chicago, Illino n Medicii tal and Health ('eitters. I)ul)iic Ilealt)i 'Itioll of AlTiericati Medical Vol. 273, N(,. in. September 2, 1965. - ducation, America stittite, ,\Sso(@i, ional n Medical L all, liarbara, "Those Reg 1966- No. 292. U.S. Govern tnston, Illinois, 19C)I- ('allah ssociation, Service Bulletin 11, D.C., Colleges, I"V, Nl(!dicii llrograins- Where tile Action :oggeshall, Lowell T., Planning for Afedi- ment Printing Office, Washingto Soin(-rs, lit-riti;iii M., ;,,,(I will II(.," Hospital Progress, Vol. -17, I). al Progress ']'h?,oiigh iditcation. Ivan- 194-5. It., I)ociols, ll,itiepztv ",(I llc(:Ith litstir- 57. 6-I.. 19(i(i. f Atnc;ican Mountin, josepit W. ind Grcvc, C:IifTor(i ton, Illinois. Association o Ac(lical Colleges, 1965. if., Ilublic Ifealtit Areas arid Hospital (i?tce. Wislijil!,,toli, llroc)ldii@,s G;illalii%Ti, lt;tri),-tra, "R(!gioiial Medicii Commission on Ilospital Care, Hospital Facilities. Public Health Service Ilullctili Itistittitioli, 1961. llrogi-aiiis taking Giant Steps," Hospital No. 42, U S. Government Printing Office, 3, p. 78-83. March 'are in the United States. New York. IJ.S. 'C,otigr(-ss, Scnatt! Committee oil ilrogrcss, Vol. 18, No... Washington, D.C., 1950. 'ommonwcaltli I-tind, 1947. I-e(li!rat Siipliort of Ate(li- I!)(i7. National Commission on (,oininxinity c(il I?esf.,(iri7lt. ltt-1)(irt (if tlit- of "Itm-ioti:il Mttclical ,committee on the Costs of Medical Care, Health Services, Ilealth Is a (:o?tiypztiitit), (.,.olistilt:lilts fill ltt-sc;lr(@ii it, ilit@ I?i)Cky A'fOtl.ILttlift Afedical itedical Care I,'or the A?tterican People: Affair. M;tss.'(:Illlst-tts, ll;ll'- Sill)l,oflllllitl(.t! (oil (ill- ts "' ji)it.rit(it. January, I!)67. I'he Final Report (211). Univcrs,ity of vard University I)rcss, 1966. I,,ii)or ;iii(i Health, W.,- ,'hicago Press, 1932. Clark, llcnry T., Jr., ",;haping the lios- Presidcnt's Commissioi-i on the Ilcaltli of fare; 11(itli C:(,iigrt-ss, 2ii(i Session. IJ.S. . "Ilospitals, Vol. Consultative Council on Medical and the Nation, Building Atiterica's Ilcaltli: I,,-ititiiig office, NV;isliingtoyi, flit,-II for its I-uttire Itolc, Allied Services, Interim Report on l,'titurc .10, 1). t9-53. February 1, 1966. Provisions on Afedical and Allied Serv- A Report. U.S. GoveriitTient 1'rintiiig (-)F- I!)(io. iccs. The Right Itonorablc l,or(i Dtwsoil rice, Washington, D.C.., 1952. IJ.S, (.,lark, Henry ']'., Jr., "The Cli-.tllcnge of of Tliamcs, Chairman. london, rnglin(,I, t Disease, A e i- ilit! ]residual @ic(lic;xl 1'rogr:tnis i,egislill- I Prcsi(lent's Commission oil ITtNir ;iii(i Wt-Ifiti-t-, 'I'lie tioli," The journal of Medical ],education, flis Majesty s Stationery Office, 1920. Cancer and Stroke, I?eport to the Presi- cal I?eseeircli eitid (11;iylic- Vol. .1 1. April, I!)(i(i. Council on Medical Education and lios. dent: A National Progrartz to Conquer .Jones ti.S. Ilriii(itig pitils, Money and Aledical Schools. Ileart Disease, Cancer arid Stroke, Vol. 1. oni(-(., 19511. (',lark, Itenry 'I'., Jr., "Regional Medical Chicago, Illinois, American Medical As- U.S. Government Printing Ollicc, wish- llrogrtitis," llofpiial Practice. M.-trcii, sociation, Undated. ington, D.C., December, 1964. I.f.S. T)t,l):trtiTient of 19(i7. Dryer, Bernard V., Study Director, Life- Pres;dcnCs Commission on Ifeart Disease, -.iii(i NVt-lf;trt-, Surgeon Consx:,,, Regional Medical Pro- time learning for Physicians: Principles, Cancer and Stroke, lieport to tlze Presi- t;iiit (:roiii) oil Nl(!(Ii(-al Pil),- "Conference on Practices, Proposals. joint Study in Con- dent: A National Progra?n to Conquer .@icitinv fop et Gpozvilig At?iericti (Iiiti(- griinis Examines Plans for Ilcart Disease, tinuing Medical Education, journal of Ileart Disease, Ca?tcer and Stroke. Vol. '-'. llill)li(, Health Servi(-e Ptil)li(!.t- (-:anc(-r and Stroke," Tlze Modern lios- Medical Education, Vol. 37, No. 6, Part U.S. Government Printing Office, Wasli- tioti No. It@g. LT.S. (;overiiiiient IlriTitillg pilot, Vol, 108, No. 2,I). 79-80. February, 2. June, 1962. ington, D.(,., I-'el)rtiary, 1965. @V;isi,iiigioii, I()59. I!)(i7. "Continuing 1)0('S it j,ptiriinl )f thf! Afrilirat li.iinciatio?z of Marton, ltol)ert itid Mayer, Willititi Page, Irvine It., "Tlic Gestation of Mcd- Matter?" (Etlitori-ii),' Joitrital of 5(i. No. -1, 1). 15,1- 155. 1)., (if R(,gi(,)Yial i(-al Complexes," Modern Medicine, p. Nit-Llic,-Il 1'rogi-;iiiis iii(i Continuing Edii- l@@1-92. June 21, 1965. Ar?lerican Medical Association, Vol. 197, 7'/te joiir?ial of Mrdical Editca- No. 6, 1). 505-50(i. August l@, 196(i. %Vc N(,(-(l 'I'llol(, Vol. I", No. 2, 1). 119-125. Fcl)ru- "Regional Complexes Gain Momentum," Edward W., for Afc(li(,at Ecoito?@l- @try, 19(i7. Aledical lvorld Nctvs. February 3, 1967. oti-,tl Medical Afcdical icv. (- "@l, I!)(;5. Regi Iklll @ Niai-stoii, Itol.)crt Q., -ind Yordy, Karl, "A "Report of, the Prcsldcnt's Commission," Iopinion and I?ct,iett,. October, 196@). ,Iilliov.-Itiv(! III-,,iis for tlif- (;(-orgi.,t R(!- Nation Starts ;t Program: Regional Med- The New England jour?ial of Medicine, ll.,irold 'I'., "Itegioll-11 Medi(-,il jori?iietl of thr Pi-ogriiiis, 19C)5-1966," 7'hc journal Vol. 272, No. 18. May 6, 1965. llrogr.iiii for II(,-.trt, (,;:tiic(-r and Stroke," ii,)ci(itioii of Vol. 5(i@ of Medical I,"(fitcatioii, Vol. 42, No. 1, 1). 7'ILC journal of the Aferlical Association No. I, 1). 1,10-151. April, I!)(i7. 17-27. Jinuary, 1967. Ross, Robert A., "Tilc Regional Medical of the State of Alabayiia, Vol. :36, No. 7. Program: An Opinion," North Carolina of tlit, fiu.-ii-t mittingly, 'I'lioiiias W., "'I'lic Regional Medical journal, Vol. 28, No. 5, p. 125. .I.-iiitt.-tty, 1967. Nic(lic;il Pi-o!,,i-iLiti of Metropolitan Wasli- fvfa),, 1967. ;iviil Stroke I-'I)b(,,rt, Artliiir, Jr., "A Look :it Pill)lic@ Afrilic(il Opiiiioit tilitl iligioll," Medical Aititals of the District @;t,Lv 119-2.i9: 'I'lic II(,.,trt I)i,(,as(-, of (@'olzitptbi(t, Vol. :)(;, No. :1, I). IBC)-IfIB. Russell, joliii M., "New Federal Regional -itid Stroke 1'royrt 1,11 Coyl?zecticitt AIrtl- 1967. Medical Progrims," New England jour- 11 icitte, Vol. 30, No. 9, I). f@-16. Itiiic 21, the Nrit, )'(-rk of Ifr(lici7ir. Vol. Nl:iyer, Willi,,itii 1)., "Itegioii;il Mcdict ittit of Afedicitte, Vol. 275, p. 309-312. 1965. I:i, No. (i, II. 522 .52,1. June, l@lf,7. 1 August 11, 1966. I)rogrittis--A l'i-ogr(,ss ltcl)ort," joitriia "I-',Volution oi- Itcvoltltioll in Aiiieric;iii ii-ty (if the Afedical ATsoci(itinit of (;corgia, Sclieclitcr, M,-,I, "Planners Work Today Sol- Medicine," Modern Medicine, 1). f@-I (i. No. -1, 1). Al)t-ii, 1967. (,it Medicine of Tomorrow," Modern ;Ill(l tilt. ill Vol. 5(;, 21, 1965. N(,i-tli I-., "'I'lic New York Medicine, p. 33-52. Fc4)ruary 13, 1967. '.I'(tgctlicr If Y(,tt Want :1 ltf'f,'iotl;il Vol. 21t, No. 5, 1). 17:1 175. (.:ity Story," Biillrti@i' of the New 3,ork Sciiiiicck, Harold M., Jr., "National Cam- (.'.rant," ']'he )ifotlerit llo(I)it(ll. Vol. io7. Acadri??), of Medicine, Vol. 43, No. (i, 1). 1)aigri Against Disease to Begin witli Four No. 2. August, 1966. Williiiii I,.. "]@('giofl;tl 515-521. June, 1967. Regional Programs," The New York Ati(li-(-ss ;It tilt- l';Ick' Guidelines for I?egioital Aledical I't-0- -gaii, It- I)cvclopiliciit of I Times. AI)ril 15, 1967. oil hfctlic,,-Il Nloi -ill)ll %., " I 1'rf)- It(,-giollii I)i-ogriiii in NVcstern I_)ivisioll of ]regional lAt(-di(,.% NV:i,,;Iiiiigtoll, N Nttioti,,tl Instittit('s of II(';Iltll U.S Not-tlt Alorilt Carolipt(z Medical Sliaiinoti, Jtincs A., "The Advancement 19(;5. of Medical Itescarcli: A Twenty-Ycai- I)el).trtjiiciit of liciltli. Inittyie7l, V(ii. 28, No. 5,I). 195--197. May, View of tiic NIII Role," journal of Med- Welfare. July 1, 19(;6. 19(i7. ical Education, Vol. 42, No. 2. Fcl)ruary, li Carolina I<,c- Ilill, l,istcr, "A Ilrogritii to (,otiil).-tt lleirt of Nt,t-tli (if Nlcdicit)(- Al)- Milss(. .1., .1., "Nort 1967. Disease, Cancer tnd Stroke," 7'he Eit- Noilli (:tltolillfl ilfrolic(li Jt)lll"lfll, gioii;il 1'rogratit," North Carolina qytirt-i@, Vol. 21t, No. r@, I). ]!)2 -I!)-i. Nl.'ty, I!)(i7. Afedic(il Jotirti(il, Viii, 28, No. 5, 1). 17r)-. Sitiitli, Ilarvcy L., "Data-Gathcring Op- 1965. 182. Nl:iy, ]9f)7. cratiotis of the Regional Medical Pro- A it(-%-iew." litfllrtiii (if the "Nttioii;il (:oils for Regional Medicine," grim," North Carolina Medical journal, jolin It., "']'lie Nortliw(-st ]lo-.;- Posigraditaft- Ifeflicine. August, 1966. Vol. 28, No. 5, 1). 190-191. May, 1967. J)it;tl," Biillciiti of the New I"nrk Ar('- Netc, )'t)yk of Afe(liri?lr, Vol. 'I:i, detti), of Medicine, Vol. 1:3, No. 6, I). 195. No. (;, 1). ,Igo I!)(;7. "A National Program to Conquer fleart Snyder, James D. and Enright, Michael 50'.@. fti,tic, 1967. iii(i Stroke," The joiir- J., "Regional Mcdicii Programs: A Prog- Ni.irstoii, ltoliert Q., N-ic(lic:ll "I Hospital Management, p. it(-giii S(-(-oii(i )'rir," II.S. ilfr(l- ?,de of the ,Iiticrica?t Afedical Association, rcss Report litidsoii, Cliirles I,., 7. No. -1. i\l)ril 2(;, 1965. @@(;-311. AI)ril, 19G7. ici)le, Vol. :;, N(,. 1, 19fi7. 'Vol. I!)2 ltl;irks oil Itegiollil Mc(lic-;Il 105 atement of Policy on the Report of the Walker, Jack D., "Regional Medical Pro- sident's Commission on Heart Disease, grams for Heart Disease, Cancer, Stroke iccr and Stroke," Bulletin, American tnd Relitcd Diseases for Kansas," journal liege of Surgeons, Vol. 51, No. 2. of the Kansas Medical Sociel),, Vol. 513, mh-April, 1966. No. 4, p. 161-165. April, 1967. wart, William H., "Regional Medical Wcinerman, E. Richard, "Planning and ,grams," Medical Tribune. July 6, Organization of the Connecticut Rc- i6. gional Medical Program," Bulletin of the New York Academy of Medicine, Vol. 43, Congress, House Committee on In- No. 6, p. 504-514. June, 1967. ;tate and Foreign Commerce, Regional -dical Complexes for Heart Disease, Williams, T. Franklin, "Diabetic Consul- ncer, Stroke and Other Diseases; Hear- tation and Educational Services: A Fca- s. 89th Congress, Ist session, on II.R. sil)ility Study," North Carolina Afedical 10, Scr. No. 89-20. 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