P R 0 F I L E ROCRESTER REGIONAL NEDICAL PROGRAM Grantee: University of Rochester Scbool of Medicine and Dentistry Coordinator: Ralph C. Parker, Jr., M.D. Originally Prepared by: Ray Maddox Operations Of fi cer Original Date: October 1969 Updated: ROCHESTER REGIONAL MEDICAL PROGRAM PROFILE Table of Contents I. Geography II. Demography III. Politics IV. Historical Review V. Core Staff VI. Organization VII. Operational Project History GEOGRAPHY. The Rochester Regional Medical Program includes ten counties in the Western part of New York State. It is bordered on the West by the Western New York Region and on the East by the Central New York Region. The Region presents a spectrum of health care situations, including rural practice, small community health problems, the medium-sized city with its more sophisticated health care, and finally, the complex relationships of a metro- politan area with its medical schools and affiliated hospitals. Despite these differences there is easy communication and wide acquaintanceship among administrators and physicians because of the long standing medical society-medical school-hospital council relationship. Lake Ontario 0 ter m Wayne FA $4 :0 t 0 z $4 0 Pennsylvania Land Area: 6,836 Square miles II. DEMOGRAPHY A@ Population: Roughly 1,060,000 1. Roughly 66% Urban 2. Roughly 97% White 3. Median Age: 33.1 years CN. Y. State) U. S. Average 29.5 B. Land Area; 6,836 square miles -C. Health Statistics: 1. Mortality rate for heart disease 428/100$000 2.. Rate for cancer - 162/100,000. 3. Rate for CNS vascular lesions': - 112/190$000 D. Facilities Statistics: 1. University of Rochester School of Medicine and Dentistry 4-year school, enrollment of about 286 2. There are 12 schools of nursing in the Region 3. There are two schools of medical technology, one school of cytotechnology, and 10 schools of X-Ray technology 4. There are 30 hospitals within the Region (2 Federal,, 28 non- Federal (two State operated), containing 12,,272 beds E. Personnel Statistics: 1. As of 1962,, there were 1,,973 physicians (including DO's)in the Region for a rate of 185/100,000 2. As of 1962, therewere a total of,9,,108 (5,589) nurses in the Region for a rate of 823/lOOsOOO III. POLITICS A. Governor: Nelson A. Rockefeller (R) Five year term with no limit B. Senators: jacob, K. Javits Committee Menberships: Labor and Public Welfare Joint Economic Committee Select Committee on Nutrition and Human Needs- Charles E. Goodell C. Representatives:* 1. Howard Winfield Robison (R), Th.irty-Third District (Counties: Broome, Chemung, Tioga, Tompkins) Committee Meirbership: Appropriations 2. Samuel S. Stratton (D), Thirty-fifth District (.Counties: Cayuga, Chenango, Cortland, Montgomery, Ontario, Otsego, Seneca, Yates) 3. Frank Hor ton (R), Thirty-Sixth District (Counties: Parts of Monroe, Wayne) 4. Barber B. Conable, Jr., OZ), Thirty-seventh District (Counties: Part of 14onroe, Genesee, Livingston, Orleans, Wyoming) 5. James F. Hastings (R), Thirty-eighth District (.Counties: Allegany, Cattarugus, Chautaugua, Sch-uyler, Steuben) Includes only those Representatives who have a portion of their District within the Rochester Region. 4. Dr. Parker speaks at Annual :,@eetina of Districts 7 0 and 8@ranches of the 'fiedical Society of State of New York. ,T for Bulletin of the Dr. Parker writes article on R'- Y,onroe County @'ledical Society. Dr. Dickinson W. Richards, EFeritus Professor of'!,@'edicine, Colurbia University, visits University of Rochester Medical School to discuss Regional needs and planning in the field of pulmonary disease and related -oroblems .in Regional planning for cardiology. A feasibility study of a registry of patients in and, discharged from coronary care units is in proo-ress. 8. Dr. Chloe Alexson, Cardioloaist in the DeFartn.--nt of Pediatrics of the University of Rochester School of Iff@edicine, starts survey on the handling of nevTborn infants-vtith congenital heart disease, and on current management of congenital heart disease in the Region. 9. Dr. Siris A,-airi, Department of Pediatrics, conducts survey of the effectiveness of rheumatic fever propliyl.axi.s.pro--rams in the Region. 11. Weekly Orcoloo- Conference organized at Stro-n@ I.,-'emorial .Y ID Hospital. 12. A Syllabus on Clinical Oncology: A Multidisc approach -v.-as proposed by the Clinical Cancer Training Conmit'uee.. 13. Dr. llar-Lon Emerson and Dr. David Rush cond@,cti-rm an - extensive study of Evaluat-2Lon of RehabA-litation in stroke patients. 14. The recruiting stage of the pro@ram is p.hasin@ into C) C> C) the stage of intensified planning. 1-5. Since the neec3. for pilot pro4ects under operatj-nr, rants is becoriina apparent, operating grant applications 9 are b,--iria prep@-red. July, 1,067 - Josephine Cray, Associate Professor of Nursinp,, and. irember of the Planninr- Committee, joins Rl,,T staff. July, igo'7 Dr. Barbara Bates joins staff to direct plannino- for a triul@@.P'fie-sic screening proo,-v-am. September, 1967 Second, year Plannint Continuation Application is submitted to ERI,-T. September, 1967 A new Operational A placation is submitted to p ed the fine DP,@T. The application contain operational projects listed beloii: 1. Professional Nurse Trainin- in Coronary Care. 2. Physician training in Coronary Care and General Adult and Pediatric Cardiology. 3. Registry of patients in and discharged from Coronary Care Units. 4. Regional Prouram in Problems of Coaaulation and. t> C) Anti-i-oaaulation. 5. Developrent of Comm,-inity Hospital Application of Determina'tion of Cardiac Output '6y Electrical Im,L,edance Plyth"ofpraphy. November, 1967 Second. year planning continuation at.:arded of $218,255 (dc) for the period. ii/i/67 through 10131168. Nove.,nber, 1967 Site visit to the Re ion for the purpose of 9 discussi.nv new operational application. Dr. Clark Millikan of 14ayo Clinic represented the National Advisory Council. liarth, 1968 First year Operational Award.is T-ade in part to the Revioti. Approval is given for projects number 1 thru,4. Project No. 5 was disapproved.. Pro-;ect period 3/l/68 to 2/28/69. @rch, 1968 Supplet),ental Operational A-vTird is rrp-d.e to support a training procram of Coronary Care C, Unit Yanagers - $71,339 (dc) Pro4ect No. 6 July, 1968 - Suppleruental Operational Award of $324,295 is made for Proiects No. 7, Early Disease Detection, No. 8, Continuin- Education Proc-ram in Cerebravascialar Disease in Rochester Area, No. 9, Reoioral Cleax--Ln-,house on Cancer, No. 10, Statistical and Evaluation Unit. An operational Supplement containing Auaust, 1968 0 bight new projects is submitted to The supplement contained the folloirin-- projects. Project #11 Telephone EYG Consultation Project #-12 Automated Cancer Registr-y Project 7'rl3 Decentralized Reaional Cancer Education Proara?-n Project 4@14 D--veloprqent of a Stroke Team Project 415 Meurolo-ic and Rehabilitation Nursin@ Project +16 Physician Training in Chronic Renal Disease Project -il7 Chronic Renal Disease Nursing Project 4-18 A Pro-aram for patients witq Diabetes t@ielli LIUS November, 1968 Supplemental Operational Award. This award is actually the 03 Planning Year. (core only) It was chan"ed to an Operational Supnlement andaiven a 16 month Award so that the Planning and 0 rational Proaram could merge together Pe on 2/28/70. Total 16 month Award - $11-03,209. January, 1969 Site visit to the '.Region to review Operational Projects.11 thru 18. February, 1969 Council reviews and recommends aplnrocal for Supplemental Projects Nos. 11 (part A only) 13, 14, 15, 16, 17 and 18. Part B of Project Nos. 11 ancl.12-are definecl'. ITO new funds are made available for the projects. l,larch, 1969 02 Operational Continuation Al,,-ard,-$577,732 (dc) August, 1969 Coancil reviews and reconitends approval for Project 11B - Transmission of EKG's for remote -- co@Tputer analysis an.:I Project No. 12 - Auto- -nated Cancer Re,7is'Llry. Project No. 19 - a La Evaluation of !,.Iethods of Breast Cancer screening in high-risk populations was disapproved. No new funds were available for the approved projects. V. CORE STAFF A. Core Staff kddress: Rochester Regional Medical Program University of Rochester School of Medicine and Dentistry 260 Crittenden Boulevard Rochester, New- York. 14620 Phone: Area Code 716 275-4540 B. The Core Staff provides for overall coordination of all Regional Medical Program activities. C. The current Core Staff consists of a total of twenty-five positions, ,of which fourteen are full-time and the remainder part-time. The per cent of effort for the part-time persons ranges from 20 to 75 per cent. D. Of the 25 positions on the Core Staff budget, 18 are administrative and the remainder secretarial. E. As of August 1, 1969, there were six unfilled positions on the Core budget. These unfilled positions include four administrative and tw o secretarial. F. The great majority of the Core Staff are also affiliated with the Medical Center. G. The next page diagrams the members of the Rochester Regional Medical Program Core Staff, and the percent of time with RNP. BIOGRAPHICAL INFORMATION 1) Ralph C. Parker', Jr., M.D. Director a. Born'- 1910, Batavia, New York b., B.A. Union College - 1933 t. M.D. Harvard Medical School - 1937 d. Internship - Norfolk Naval Hospital, Portsmouth, Virginia e. Retired U.S. Navy, Rear Admiral - 1957 f. Medical Director, Rochester Regional Hospital Council 1957-65 g. Clinical Association Professor of Medicine, University of Rochester and Dentistry, and Sr. Assoc. Physician, Strong Memorial Hospital - 1957 h. Coordinator, Rochester Regional Medical Program - 1966 2) Thomas Christopher Hall, M.D. Director, Cancer Program a. Born 1921 - New York, N.Y. b. Harvard College and Harvard Medical School 1940-49 (Magna Cum Laude) C. Intern in Medicine - Peter Brighham Hospital, Boston 1949-50 d. Clinical and Research Fellow, Massachusetts General Hospital Boston 1951-53 e. Teaching Fellow in Medicine, Harvard Medical School, Boston f. Director, Oncology Division, Medical Services, Lemuel Shattuck Hospital, Boston 1957-62 g. Director of Career Program, RREP and Professor of Medicine (Oncology) 1968 3) Thomas E. Cardillo, M.D. - Director, RRNP Heart Disease Program a. Born 1924 - Rochester, N.Y. b. B.A. - University of Rochester 1949 c. M.D. University of Rochester School of Medicine 1951 d. Intern - Strong Memorial Hospital 1951-52 e. Assistant Resident - University Hospital of the Good Shepard 1952-53 f. University of Rochester School of Medicine and Dentistry, Cardiopulmonary Lab. 1954-65 g. Director of Heart Disease Program, RRMP 1968 4) Gaetano F. Molinari a. Born 1936 - New Jersey b. B.S. Holy Cross College 1953-57 C. M.D. - New Jersey Medical College 1961 d. Medical Intern - Buffalo General Hospital 1961-62 ei Assistant Resident - Medicine Cleveland Metropolitan General Hospital 1962-63 f. Director of Stroke Program, RRNP 1968 2. -There are a total of Vi w-apiL-ers on the three corrniittees- Heart - 18 Cancer - 16 Stroke - 12 Yenbership is determines by the Chairrran of the Planning Cotlaittee, the Coordinator, and tiie program director with the advice from the Planning Coyraittee. The Chair-TAn of the Stu@ Committees are ex officio ,members of the Planning Comiiittee. VII. OPERATIONAL,PROJECTS SUPPORT OF RECONSTRUCTION AND EQUIPPING OF FACILITIES FOR USE AS A LEARNING CENTER FOR PROJECTED TRAINING PROGRAMS RELATED TO HEART DISEASE, CANCER, AND STROKE - Helen Wood Hall (Project #1) To renovate space for training nurses and physicians to use coronary care units, and other continuing education programs that might be'developed. Self- instructional equipment, resuscitation models, furniture, etc. would be purchased. POSTGRADUATE TRAINING PPOGRAM FOR PHYSICIANS (Project #2) To provide continuing education for physicians in the latest techniques and equipment for preventing and treating cardiac patients. In-service training, short- term graduate courses, circuit consultation, conferences, etc. will be supported. REGISTRY OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION (Project #3) To analyze the information listed on a standard form re- garding persons admitted to hospitals with acute myocardial infarction. This data will be discussed during train ng programs and used in evaluating other projects. IBM computer time will be rented. ESTABL,ISHMENT AND SUPPORT OF A REGIONAL LABORATOlff FOR THE EDUCA- TION AND TRAINING IN THE CARE OF PATIENTS WITH THRONBOTIC AND HEMORRHAGIC DISORDERS.- ROCHESTER GENERAL HOSPITAL (Project,#4) To establish a center where physicians and technicians will receive training and a well-qualified consultancy staff will be available. INTENSIVE COURSES IN CORONARY CARE NURSING FOR PROFESSIONAL NURSES (Project #6) This project will provide training courses for nurses in the management of-coronary care units. Four intensive courses of four weeks duration c:ach will be offered annually. These courses will be conducted at the Univer- sitY of Rochester Medical Center by the Department of Nursing. Nurses will be trained both to staff C-CU's as well as develop training programs in CCU's within the Region. Instruction will include didactic content, lab- oratory,,demonstrations and practice, and clinical experience. EARLY DISEASE DETECTION (Project #7) To provide multiphasic screening for selected populations throughout the Region. Initial efforts would be imple- mented at Strong Memorial Hospital and be based in the Outpatient Clinic on a pilot or demonstration basis. The applicant outlines the service, educational, and research and evaluation objectives of this proposal. A methodology for implementation is also presented. It is estimated that 5,000 patients will be screened during the first year. CONTINUING EDUCATION PROGRAM IN CEREBROVASCULAR DISEASE FOR PHYSICIANS IN THE ROCHESTER AREA (Project #8) To provide six or more different educational opportunities for practicing physicians in the pathophysiology, symtoma- tology, physical and laboratory diagnosis, complications,, management, rehabilitation and prevention of the common types of cerebrovascular and related diseases. A curricu- lum is presented for what is described as in-service train- ing to be available at Strong Memorial Hospital. In addition, continuing education progra ms, consultation services, special lectures,, and conferences or workshops would be inaugurated in peripheral hospitals. REGIONAL CLEARINGHOUSE ON CANCER (Project #9) The purposes of this project include the development of a variety of methods for gathering data about cancer, the continuous identification of uno-et needs, and the estab- lishment of different communicative media for the dissemina- tion. of cancer information to health care personnel and other appropriate groups. The data to be gathered will in-- clude a broad spectrum of medical,, consultative, educational, social service, community resources and like information. The Clearinghousc would be administered by the Regional Medical Program with professional staff services provided by the Medical Center. STATISTICAL AND EVALUATION UNIT (Project #10) ..The purposes of this project would be to, gather and analyze health data for use in program planning, assist in the evaluation of the regional medical program in improving medical care, and consult with individual projects in the design. of evaluation protocols. The project would be ad- ministered by the regional medical program and staff would be professional supervised through the Department of Pre- ventive Medicine and Community Health. TELEPHONE ELECTROCARDIOGRAPH CONSULTATION (Project #11) Would provide for long distance transmission of electrocardio- graphs. ATJTOMATED CANCER REGISTRY (Project #12) This project proposes the unification of present fragmented cancer registries through the development of a single automated registry. 'Full utilization of the registry is planned and described in nine different but related areas. These include the collection and analysis of data, identification of need for more intensive diagnostic or therapeutic or educational areas, appropriate return of information to physicians, and the like. DECENTRALIZED REGIONAL CANCER EDUCATION (Project #13) Would support oncology programs in affiliated teaching hospitals. Physician and nursing personnel would be provided to develop activities in tumor boards teaching clinics, consultation services, and the like. DEVELOPMENT OF A STROKE TEAM (Project #14) (Approved but not funded) Stroke teams would be established at Strong Memorial Hospital and at Monroe Community Hospital. to provide for continuity of care from the acute phase throu2:,i re'nabili- tation. NEUROLOGIC AND REHABILITATION NURSING (Project #15) Partially decentralized program would be established at a hospital in Elmira which.would include bedside teaching opportunities in other community hospitals. Short-term courses, circuit,courses, clinical conferences, and other educational programs are planned. PHYSICIAN TRAINING IN CHRONIC ]RENAL DISEASE (Project #16) Monthly, three-day tutorial programs (for one physician each),vould be made available to primary physicians. Information about chronic renal disease,, conservative therapy, dialysis, and transplantation would be given. CH.RDNIG..Rn"iNALDISEASE NURSING (project #17) Two one-week courses in transplantation, and two two-week courses in dialysis will be offered annually. In addition, circuit courses, conference days, and consultation services are planned. A PROGRAM FOR PATIENTS WITH DIABETES YZLLITUS (Project #18) Program of patient education, professional education, and periodic medical evaluation of patients to assess diabetic control would be initiated. Coordinator Ralph, Parke,-, M.D. 100% Administrative Assistant Associate Coordinator Vacant 100% Southern Tier Vacant 100% Director, Multiphasic Screening Barbara Batis, M.D. 73% Assoc. --Pediatric Cardiology Chloe Alexson, M.D,l 40% ,'Director, Heart Disease Program soc. - Community Health Thomas Cardillo, M.D. 100% ion Emerson, M.D. 50% Director, Cancer Program Assoc. - Renal Disease Thomas C. Hall, M.D. 60% Richard Freeman, M.D. 25% Director, Stroke Program Assoc. - Economics Gaetano F. Molinari, M.D. 75% i@ Richard Rosett, Ph.D. 40% Assoc. - Business Administration Nurse Clinical Clinical Clinical Health Care Research Coordinator Specialist Specialist Specialist Planner Bibliographer Edith Olsen Stroke Nurs. Cardiovascular Nurs. Cancer Nurs. Vacant 100% Kathleen Martin, RN 100% Janet L6n%z Rose Pinneo 'RN 100% 1 Vacant -'.OU, inn% RN 100% Secretarial Staff Jean Thomas 75% .Mabel Robisch 100% Linda Ashton 100%. Roberta Chairbers 100% Kathleen Ellis 100% Vacant 100% Vacant 100% APPENDIX Listing of Regional Advisory Group Members Curriculum Vitae of Major Staff