I I I 0 B&B ImFoRmikriom & ImAmE MAN^MEMENT moo @eftoz M=R=VU SOUL"AMO Uomfncn MARLBORO, "A 040 ZD'77Z 0 UK^ 0 tac 1) 24@ 1 1 0 I 1 G03 RM 00012-01 SITE VISIT REPORT OREGON REGIONAL MEDICAL PROGRAM February 19, 1968 SITE VISITORS: Alfred M. Popma, M.D.,.I-',egional Director, Regional Medical Program, Boise, Idaho Dr. Stephen Abrahamson, Director of Research in Medical Educa-tion, University of Southern California School of Medicine, Los Angeles, California Carl Lyle, Jr., Yi.D., @ssistant Director, Division of Education and Research in Community Medical Care, University of North Carolina, Chapel Hill, North Carolina DP,LviP STAFF: Alexander M. Schmidt, M-.D., Chief, Continuing Education and Training Branch Vincent J. Carollo, M.D., Operations Officer Frank Karel, Public Information Officer, Division of Regional Medical Programs Mrs. Patricia McDonald,'Public, Health Advisor@, Grants Reviela Branch OREGON Rt-v.P STAFF: M. Roberts Grover, Jr., M.D., Program Coordinator Edward Vance Yung, M.D.-, Director, Survey and Planning Mrs. Barbara Gaines, R.N., Assistant Director, Continuing Education Mr. Jerry 0. Elder, Assistant Director, Survey and Planning Miss Susan Rich, R.N., Assistant Director, Survey and Planning Mrs. Da-'Le Caldwell, Director of Information Mrs. Judy Halterinan, Executive Secretary REGIONAL ADVISORY GROUP: HerL7,an A. Dickel, M.D., Chairman PROTECT PERSONNEL: Mr. Dick Herron, Director, Instructional Aids, University of Oregon Medical School D R A F T 1 G03 RM 00072-01 SITE VISIL" iZEPORT OREGON REGIONAL MEDICAL PROGRAM February 19, 1968 GENERAL The meeting was directed by Dr. Myron R. Grover, Program Coordinator, and was attended by his staff and the Regional Advisory Group Chairman. It was obvious to the site visitors that this is a competent, enthusiastic, and active grouD. Considerable progress has been made by the staff since the submission of the cra-Lit request, and the documentation of the preparedness of the Region to become operational. Planning seems much more comprehensive and sophisticated. This is probablv due at least in part to the participation by the staff and Regional Advisory Group in a recent management workshop, put on by well known management consultants. Equally obvious was the fact that the Regional Program has elicited wide spread interest and support. A few days prior to the site visit, a workshop conference was held which involved individuals from throughout the Region (Note the appended discussion of this meeting by Dr. Sloan). The @'irsl- part of the visit was spent re-examining the evidence that the Region was ready to become operational. Dr. Grover indicated that they had done considerable're-thinking of their program in the past few months, especially in light of the recent revision of the guidelines, and the concepts of regionalization expressed therein. The Oregon Regional Medical Program recently devoted considerable time to consideration of: a) needed staff; b) assuring involvement of the proper elements in the region in the planning and decision-making processes; c) adequate assess- Lae-,it of the medical needs of the R'egion; d) the setting of proper priorities for action-in the Region,'and e) adequate evaluation of the program. ]Zccrul.tiii(-,nt of staff has continued, and two young physicians, who are interested and apparently skilled in education and evaluation, are to be adclcd to the staff within the next few months. Regional involvement is L)ein@ r(-,-assessed, with studies.being made of the composition of the Reaional Advisory Groi4'p, task forces, etc. All health resources, socio- economic groups, and geographic areas ate to be included in the program. The staff travels a great deal to build interest in the Program, and a newsletter has a circulation of approximately 12,000. The Program seems to have good support throughout the-region. '.he Oregon Regional Medical Program will continue planning while operational activities are in progress. The staff is currently preparing a county-by- county analysis of man ower, facilities, transportation, educational pro- .P @rams, minority groups, and private and professional organizations. A cooperative study with the Washington & Alaska Regional Medical Program is bein- made of patient origin. These studies will provide information on the actual system of health care in the Region. The subcommittees of the Regional Advisory Group are determining goals for the delivery of health care. The function of the Oregon Regional Medical Program is seen as 1 G03 @M 00012-01 D R A P T -2- X4 developing projects to bridge the gap between the e sting health care system and the desired system,. Doubts raised by the Review Committee about the Oregon Regional Medical Proaram's readiness to move into the operational stage were removed during the site visit. Major advances have been made in the decision-making mechanism since the application was submitted. The Region now has a workinry list of objectives for operational projects and a scheme for setting priorities a-inona projects. Conscientious review is given by the Regional Advisory Group to the submitted projects, as shown by the fact that it refused to approve several projects in the form submitted. Several other projects have been approved by the Regional Advisory Group and will- be submitted as an operational supplement by March 1, 1968. BEART, CANCER, STROKE',CIRCUIT POSTGRADUATE PROGRAM There was evidence of substantial support in the Region for this project. The Chairman of the Regional Advisory Group was especially enthusiastic about its potential. The site visitors felt that the major weakness in this Drooosal is the technique for evaluation, but that the Uni ersity has talent available which the ORMP'should utilize. The site visitors addressed themselves to the following issues raised by the Review Committee: 1. Personnel: The site visitors were reassured that the personnel budget is appropriate. Persons have been designated to fill most of the positions, but were not asked to make commitments until funds are available. The department chairmen involved have indicated willingness to employ the halftime people for the rest of their time. The budget does not include persons expert in television production, but the talent at the Univer- sity will be available to the ORMP. 2. Transportation: The site visitors felt that there is an obvious noed for a station wagon to transport videotape and slide projection equipment and that the amount requested for its pur- chase is reasonable. 3. Conti-@-.-.t. '-r-,.c;,:ruction and consultation: The Region is aware of the need i@or contact beyond that provided during this circuit course. Other circuit courses are being prepared; one on coronary care, and another concerning carcinoma of the cocoa. The circuit courses will provide the opportunity to gain the interest and involvement of practitioners in the Regional Medical Program, and to determine the types of continuing education programs needed by the physicians and others in the Region. For example, previous experience with the circuit course has suggested the need for short courses on inserting intervenous pacemakers and interpreting-electrocardiograms. D l@ A P T -3- 1 G03 R.LM 00012-01 4. Emphasis on t-.eaching methods: The Region recognizes the need to identify the',educational interesfs'.and needs of the physicians, as noted above. They seem to havea realistic sense of the difficulty o@ this, and will seek 'way@@ to accomplish this objective. RECO@@IENDATION The site visit team concluded that the Oro al Medical Program is .gon Region' d that the circuit course pro- ready to move into the operational stage a)a ject should be supported. The Region should b@ encouraged to arrange for assistance from the C'lle-e of Education 'f,th'e University ol Oregon for better evaluation of the pro'ect. M E M 0 R A N D U @i February 25, 1968 to: For the Record, from: Associate Director for Organizational Liaison, DRMP subject: Attendance at Workshop-C-onference 'of Or egon Regional Medical Program, Febru@ry 15-16, 1968 On February 15. @..i968 Irepresente@.the',Division in a Workshop- Conference of the Oregou,Re-ional Medical Prlp grami. The audience consisted of about 150 people,-rostly physicians and hospital directors or administra- tors, and a few nurses, From all partsof Or@go'n,.five members of the Regional Advisory Group, and the headquarters ORIT stai@f..'@@I was'responsible for pre- sentin@ a ".4ational Viewof Regional Medical'Progrims.'@ Dr. Herman A. Dickel, Chairman of the Regional.'.'Advisory Group of trip OaT " described the history of organization of the Oa!P and-said that, o:,f..alT'the agencies and institutes involved, the University'.,qf Oregon. Medical S,tlxooi- had given up-the most in malting Dr. vi. Roberts Grbvpr available as a..@ll'-,time Program Coordinator. Dr. Grover the:r.:told @hat had actually:been accomplished so far, the cooperative arrangements established, the'@r recruitment program, organi- zatioral pattern, the de--i@ion-inaking procei-s-bei-ng used, the first operational proposal to support circuit courses 3.n community'@ospit'als by teams sent out from the medical schools,i,and the reasons f6,r:expectations of this workshop. The Workshop @ag.designed as a two@way excharige; 1), orienting hospitals and hospital directors from all p@res'o'f Ore'on regarding the 9 'ials of the Oregon.-ilegi6nal Medical Program, and nature, c,,oalsl and potent staff and'members of thd RAG as to the specific needs 2) orienting the OM as perceived by doctors and hospital administrators in the eight sub-regional districts into which Ore-@o:n has:been divide& for,organizational purposes. Dr. Hilmon Castle addressed the luncheon meeting on "The Pains of k, Bec @4 .Greg Operational"--@ery entertaining anct-.info'rmative, and excellently presented. He isafine speaker ;and has, I know, been very helpful to Regional Medical Programs whereveir-@e has consulted o'r'made a presentation. For the first one and-a half hours.:of the afternoon, the partici- panLs met in their sub-@egional.groups with"'an assigned moderator who was a member of the Re-ional Advisory Group or thd.@taff, and discussed the problems they 'Laced in making avdilable'to their pat@@n'ts'.the highest quality of medical care in the field of he"t disease. They t@eA broke and reconvened in plenary sessions to review the rfe@ds expressed by ea'ch re'ion. The similar pattern was to be followed the next day.. for cancer and' s@roke,:and I can recommend 2 this as a good format fo'r such workshops in bther'regions. I was able to a-Li stay only for the session on heart disease, d the most urgent needs ex- ,as follows: pressed in this area wer6 for all parts of Oregon: 1) Continuing'.'education .Lor doctors and nurses. 2) Training df physicians a-Lid nur.§es in the map,-.fement of patients with myocard,'-al:infarction and the Operation of coronary care units. 3) Development of methods for lon.'&-,di.4.tance-.consultation and analysis of electrocardiograms for any unusual p'r@oblbms which may arise. .4) The provision of loan nurses w;io could be sent to various hospitals freein up a nurse to go to a center f6,r training in coronary 9 care nursing. 5) Development.of means for transporting the severely ill myo- cardial in-@carction patient wit@,the possibility 6f cardiopulmonary - resus C4 tat4on and continuance electrocardio am monitoring enroute. Great gr - interest i-7as expressed i:zl.the use of helicopter @mbulances to cope with the large distances of easte;rn Oregon. Dr. Grover has,'Promised to send to.-the.Division the summary of needs identified and exp@essed by sub-regio-@;'E; for:.heart disease, career, and s@-roke. These should be of general inte-rest.%.to the Division and its Advisory Groups. My overall im@@ession of this workshop': was that the O.T2 has succeeded remarkably well in making its pote@tial known to the practicin- pi,,,-sicians, hospital directors, a-,.id administrate.ts of Oregon. The grass- roots have been frank a-i'd eloquent in the ex'pres'd-ion of their needs, and cooperative arrargements.'-are being fostered:to "t things done. One type of cooperative arran-em@t demonstrated in this.'ideeting was that each mar, there usually represented three or four othe"rs back- home who were covering his practice while he was ax,7ay,.and counting gn him to report back to them the proceedings of this @meeting. Mart g ret.@. Sloan, M.D.- I G03 M 00012-01 OREGON REGIONAL MEDICAL PROGRAM OPERATIONAL GRANT OBJECTIVES The following objectives for operational grant requests were developed by members of the Oregon Regional Advisory Board and its subcommittees. These objectives are currently being studied and re- fined. As the program develops.? it is anticipated that further changes, modifications and additions to this list will be made. Many of the objectives were abstracted from u@idelines for Regional @e i@@Zr@r@s. published by the Division of Regional Medical Programs, National Institutes of Health, U.S. Department of Health, Education and Welfare, Public' Health Service, and are contained in Public Law 89-239. in the Oreo oppratinnal arant applications must meet the followim c 1. Meet a need identified by the community, Oregon Regional Medical Program date., or subcommittee information. 2. Demonstrate availability of facilities to implement project. 3. Demonstrate availability of personnel required for implementation of the project. 4. Demonstrate a high probability of improving patient care. 5. Provide a method of objective evaluation. 6. Demonstrate compatibility with existing patterns of health care* 7. Demonstrate relationship of any research activities to goal of improved patient care through regional cooperative arrangements* 8. Identify revelance to heart,, cancer, stroke and related disease categories. 9. Identify that funds requested are for project based within the Oregon region. 10. Demonstrate that applicant is.not a proprietary of federal agency. 11. Demonstrate comparability with concept of regionalization. 12. Assure participation in project by both purveyors and consumers. 13. Demonstrate inherent technical merit. 14. Provide for cooperative arrangements, 15, Avoid duplication of existing effective efforts. I G03 R14 00012-01 .Qperational grant applications iqrg strengthened when the following t,bjectives are met by iLh I -@ grant,, 1. Provide maximum results with least costs* 2. Create no new manpower hardships. 3. Avoid misuse of manpower* 4. Provide for voluntary eff'ort.and contributions'. 5. Demonstrate a type of program that will ultimately attract support from other than Regional Medical Program. 6. Consider all health resources of region in planning. 7, Utilize existing resources* 2/13/68 sef I G03 RK 00012-01 PRIORITY CRITERIA A, THEETAPEUTIC EFFECTIVENESS Rating: 12 1. Early diagnosis to prevent complications and/or'cure the disease. @2. Return to productive life, @3. Adapting to conditions imposed by the disease or its treatment, @4. Death B, INCIDENCE @l. Very cm=nly occurring disease. @2. Comonly occurring disease. @3,, Uncommonly occurring disease* @4. Rarely occurring disease. C, AGE @l, Occurs in patients mostly under 40 years. @2. Occurs in patients mostly 40-65 years. -90 years. @3. Occurs in patients mostly 65 @4., Occurs in patients over 90 years, I)* DISTKNCE FR(*l AN ACRIKVABLE GOAL IN OREGON @l. Very far @2, Moderately far @3. Near @4. Very Near I G03 R14 00012-01 E. DIFFICULTY IN ACHIEVING GOAL @l. Easily obtained @2. Moderately easy @3. Difficult 1 4. Very unlikely 0 5. Impossible A+B+C+D+E Priority A grant with the highest priority in each categoryvill receive the numerical rating of 28. 2-13-68