ini : 11 - .1-mimpi PROFILE: NORTHEAST OHIO REGIONAL MEDICAL PROGRAM Grantee: Northeast Ohio I;DLP (a not for profit corporation) Current Chief Executive: Barry Decker, M.D. Profile originally prepared by: Michael J. Posta Original date: December, 1969 Updated: TABLE OF CONTENTS Map of the Northeast Ohio Regional Medical Program I. Geography 11. Demography Data Population Land Area Health Statistics Facilities Statistics Personnel Statistics III. Politics IV. H storical Review V. Core Staff VI. Organizational Makeup VII. Grand Design (to be completed when Region becomes operational) VIII. Operational Projects 2 NORTHEAST OHIO REGIONAL MEDICAL PROGRAM 12 Counties and Principle Cities Population: 3,781,772 - 1960 Census 4,178,000 - 1967 Estimate 4,517,000 - 1970 Estimate A.6htabuU ASHTABULA CO. ChaAdon GA CO. etand t EtyAia GA CO. e6iEEd TRUMBULL CO. LORAIN WaA&en MEDINA w Medina SUMMIT 0. PORTAGE CO. Akkon K ent Revenna Wact6wo@ i Youngstown MAHONING CO. STARK CO. Ea6t Pateztine COLUMBIANA CO. Ma,s,siUon Canton bon GEOGRAPHY 1) The Northeast Ohio Regional Medical Program is comprised of the twelve counties located in the extreme Northeastern section of Ohio. 2) Principal cities include Cleveland, Akron, Youngstown, Warren, Ashtabula, Lorraine, Painesville and Salem. (see map on pre- ceeding page) 3) The grantee (Northeastern Ohio Regional Medical Program) was incorporated as "a not for profit" Ohio corporation simultaneously with the approval of the initial planning grant award. 4) The Case Western Reserve University School of Medicine is the sale Medical College located in the Northeast Ohio Region. 5) Six geographical sub-regional areas have been established which provide for local planning and participation in many program activities (see Organizational Chart - Section VI). 6) Thirty-seven defined 'subregional postal zones have been utilized in establishing demography, mortality and hospital utilization data. 4 II. DEIAOGRAPHY 1) Population: Estimated 4, 178,000 (1967) a) Roughly 70% urban; Cuyahoga County is nearly 100% while Geauga County is only 9.3%; Others range-,from 43 to 79%. b) Roughly 88% white; Cuyahoga County is 17% non-white; Mohoning County is 12% non-xiliite; other counties range from 1 to 8%. 2) Land area: 5,784 Square miles 3) Health Statistics: -31100,000 a) Mortality-rate-for Heart Disease@ b) Rate for Cancer--164/100,000 c) Rate for CNS Vascular Lesions--90/100,000 4) Facilities Statistics: a) Medical School: Case Western Reserve University, Cleveland, Ohio; enrollment - 340 b) There are seven schools of nursing c) There are eighteen schools of medical technology; six schools of cytology (5 at hospitals) d) As of 1967, there were 72 hospitals with approximately 18,290 beds; two are long-term with 505 beds; 10 are osteopathic hospitals. 5) Personnel Statistics: a) As of 1969, there were 6,570 MDs practicing in the Region.. Also 345 osteopaths were active.. b) As of 1969 there were 19,523 registered nurses (12,885 were employed) c) Dentists - 2,150 d) Physical Therapists - 189 e) Occupational Therapists - 49 f) Social Workers 107 (hospital employed, only) III. POLITICS As of August 1969 Senators: Stephen M. Young (D) - Special Committee on Aging, Aeronautical and Space Sciences, Armed Services, Public Works William B. Saxbe (R) - Aeronautical and Space Sciences, Labor Public Welfare, Special Committee on Aging Representatives J. William Stanton (R) - District 11; Banking and Currency, Select Committee on Small Business Charles Mosher (R) - District 13; Merchant Marine & Fisheries; Science & Astronautics Frank T. Bow (R) - District 16; Appropriations,.Joint Committee on Reduction Wayne L. Hays (D) - District 18; Foreign Affairs, House Adminis- tration, Select Committee on Parking Michael J. Kirwan (D) - District 19; Appropriations, Joint Committee on Reduction of Federal Expenditures Michael A. Feighan (D) - District 20; Judiciary, Merchant Marine and Fisheries; Joint Committee on immigration and nationality Policy Louis Stohes (D) - District 21; Education & Labor, Internal Security Charles A. Vanik (D) - District 22; Ways and Mea.ns William E. Minshall (R) District 23; Appropriations 6 IV. HISTORICAL REVIEW Spring, 1966 Deans of eight medical schools (Cincinnati, Ohio State, Case Western Reserve, Pittsburgh, Indiana, Kentucky, West Virginia and Louisville) met and determined that the geographical area to be served by these eight shcools was too extensive and too heterogeneous to be organized into a single regional medical program. Fall, 1966 1) The Academy of Medicine of Cleveland ex- pressed initial interest in establishing a RMP in Northeast Ohio. 2) An advisory group of 162 members was formed: Composition include representatives of the Academy of Medicine of Cleveland, the Case Western Reserve University School of Medicine, presidents from adjacent county medical societies, the Heart and Cancer Association of Northeast Ohio and various voluntary health, lay, labor and business groups. 3) Dr. Ivine Page, Emeritus Consultant, Division of Research, Cleveland Clinic was elected Chairman of the advisory group. February 3, 1967 I).-,-.E:kecutive Committ ee appointed from above Advisory Group to further explore feasibility of potential program. 2) Dr. Frederick C. Robbins, Dean, Case Western Reserve University School of Medicine was designated Chairman. August 3, 1967 - Health officials of the twelve county area en- dorsed the planning grant application. October 10, 11, 1967 - Initial planning grant approved by DRMP. 1) Reviewers were impressed with the intent of the application. a) "Medical facilities are extensive with many outstanding general hospitals" b) "Cohesive quality is strengthened by the fact that most of the physicians are graduates of Case Western Reserve or undertook residencies and/or intern- ships in one or another of the hospitals in the Region. 7 January 1, 1968 - First year planning grant awarded for $267,911 (D.C.). June 1, 1968 - 1) A "not for profit" Ohio Corporation was established. 2) Former Executive Committee becomes the first Board of Trustees. 3) Dr. Barry Decker (present Program Coordina- tor) was employed. 4) Until this date, Region experienced problems in recruiting qualified personnel; therefore: July 1, 1968 1) No planning activities were undertaken 'during the initial five months. 2) A six-month extension to the 01 planning grant was requested; approved by DRMP. Progress of 01 year planning (111 years): 1) 350 volunteer physicians, nurses, allied health professional and interested members of the public representing hospitals, agencies, institutions and communities were organized in a interdependent committee structure. 2) Data collection needs were identified and five well-conceived publications on health related data were com iled and distributed. .p Quantitative studies included: a) regional inventories of manpower, facili- ties and training programs. b) physician attitudes toward continuing education. c) demograpby, mortality and hospital utilization in 37 defined subregional zones. d) study of hospital use in relation to medical need. 3) Internal organization of the Region was developed (see Organization, Section VII). 8 4) Strategy (route towards achieving goals) of the NEORW established to include: a) pre-planning 1967 June 1968 b) organizational development December 1968 c) data gathering - through June 1969 d) Input-output design - August, .September 1969 e) Categorical project design based on available data f) operational transition - January 1970- through June 1970 g) project design from September July 1970 May 1969 - National Advisory Council approves - planning grant for 02 year $462,662 (D.C.) for 7/l/69 - 6/30/70. July 1969 - Division approves expenditure of $10,000 (subcontract) for Library network feasi- bility study. August 1969 - DRMP staff approve expenditure for feasi- bility study concerning laser beam tele- vision service. ($3,000) November 5, 1969 - Regional Advisory C@roup met and formally voted approval for: - 1) The priorities established 2) The initial operational grant request including 10 projects. 3) The budget with provision for review by the Board of Trustees before the newly budgeted positions are filled. November 20, 1969 - Writer visited Program Coordinator for details necessary for the preparation of this profile. December 1, 1969 - Initial operational grant application sub- mitted to DT.UIT. 9 THE "CORE STAFF" OF THE NEOPMP The "core staff" Of the NEOPMP is described by the following table of organization wM. newly requested positions starred: PWGFM COORDINATOR 'vi COORDINATOR* -DEPUI'Y PROGPA DIRFCFOR OF DIRECROR OF AEMINISTRATION COYI\IUNICATIONS@ -SUPPORT SERI[ICE CATEGORICAL DISEASE F)IREcrop's SUBREGIO RDINATORS HEART EDUCATION DISEASE NORTHERN AREA RESPIRATORY PUBLIC EDUCATION LORAIN AREA DISEASE EASRERN AREA RESEARCH STARK AREA 7 CANCER EVALUATION* AND CENTRAL AREA STROKE NLJRSING AND CUYAHOGA ARF-A ALLIED HEALTH The persons employed, their location, committee and other responsi- bilities'are described in the following table followed by curriculum vitae for currently employed staff and the chairmen of the RAG and E3oar.d of Trustees. % C@.MI'I'FFES AND PbsiTiON PERSON TIME LOCATIOIN OTHER RESPOINSIBILITIES Board of Trustees Regional Advisory Gr Program Coordinator Barr/ Decker, M.D. 100% NEOR'AP Prog-fain@irection an-i coordination., liaison to RWS: and other local agencies Project review activ- Deputy Program (to be employed) ities, assume coordi- Coordinator 7/l/70 100% NEORMP nator's responsibility in absence of coordi- nator Fiscal management, Director Ri@- rd Meloy 100% NEORNP supervision of affil- Administration :Lati@g relationships, office management Director (to be employed) Publications Comm- ations 7/l/70 100% NEOP,,MP Internal commmications Public relations Director E. Bart Johnson, 100% NEOP,,MP Education Committee Education M.A. and Subcomnittee Director Lowell Bernard Cleveland Public Education 50% Public Education M.P.H. Health Museum Subcommittee C+ ct Health Service @ I C+ Director Comnittee cn James Suter, M.S. 100% NEORNP pj. Ct .Research Health Data 0 C+ ;o @. C+ Comdttee CD CD C+ tn - v Cy 0 )irector (to be employed) Project and Program 0 100% NTOPLN4P 2-valuation 7/l/70 Evaluation C+ CD cn 01 0 CD )irector Nursinc, FJ- .5 (to be employed) Allied Health n md Allied flealtli 100% NEORNIP Cl+ CD "rograms 1/l/70 Subcon-mittee C+ (A. CD CD tA Artlitir Lifson Heart Disease Director M.S. s 100%. NTEORVIP Northern Area COMITTEES AND -)SITION PERSON TIME U)CATION OTHER RESPONSIBILITIES Niartha McCrary, R.N. Respiratory Disease -q Assistant Director 100% NEORMP 0 M.A. Lorain Area C+ C+ Hiram Nickerson Cancer &@, Assistant Director 100% NEOW ib M.A.,, M.P.H. Stroke o:i 00 cn 0 rt Po Assistant Director Mary Wheeler 100% NEORW Cuyahoga Area C+ Pb C+ O,(6n 0.0 Mahon'ng Valley Eastern Area 0.@ 0 Assistant Director Jean Baird'. R.N., 100% Health Planning Stark Ar Fi ;I ea M.S. Corporation 10 0 H Summit-Portage (to be employed) I Assistant Director 100% Health Planning Central Area 12/l/69 Corporation 12 BIOGRAPHICAL INFORMATION 1) Barry Decker, M.D. - Program Coordinator 6) Born New York City, 1928 b) AB, Columbia College, 1948 c) M.D., N.Y.U. College of Medicine, 1952 d) M.S., Minnesota, 1958 e) Director, Medical Education, Richmond, Virginia, Memorial Hospital, 1961 - 1966 f) Private Practice, Internal Medicine & Pheumatology, 1961 1964 g) Medical Director, Chief of Staff, Youngstown, Ohio, Hospital Association, 1966-1968 2) Richard C. Meloy - Director of Administration a) Born Detroit, Michigan, June 12, 1911 b) BS, Trinity College, Hartford, Connecticut, 1932 c) Customer Research Staff, General Motors, 1933-1939 d) Supervisor of Customer Research, Dayton, Ohio, 1939-1944 e) Manager, Market Research, Delco Division of General Motors, 1948-56 f) Marketing Director, Gray Inn Founders Society, Cleveland, 1956-63 g) Proprieter, National Auto Dealers Service Franchise, Rochester, New York, 1963-1968 3) E. Bart Johnson - Director of Education a) Born Clinton, Iowa, March 10, 1926 b) AB and MA, State Univ. of Iowa, 1951 c) Ed. D.(Candidate) 1961 - present, Case Western Reserve d) Instructor and Admin. Assistant, Medical College of Ga., 1957-59 e) Research Assoc. & Director, Health Studies Program, Case 1959-63 f) Assoc. Professor & Counselor,, Cuyahoga Community College, 1963-69' 4) James Suter, M.S. - Director of Research a) Born London, England, January 30, 1932 b) AB and MA, Psychology, George Washington U. - 1958 c) Ph.D. Candidate (expected 1970) d) Personnel Management Specialist - office of S.G., USPHS, 1959-60 e) Chief, Intramural Research, Div. of Hospital & Medical Facilities Bethesda - 1966-1968 f) Chief, Regional Health Facilities & Services Section, Bethe sda, 1968-1969 13 5) Charles L. Hudson, M.D., Chairman, RAG a) Born Merrill Michigan, 1904 b) AB, Alma College, Michigan, 1924 c) M.D., Univ. of Michigan, 1930 d) University Hospitals of Cleveland, 1930-1962 e) Director, University Health Service, Western Reserve Univ., 1958-61 f) Assoc. Professor Medicine, Cleveland Clinic Educational Foundation, 1962 to date .6)- Frederick C. Robbins, M.D., Chairman, Board of Trustees a) Born Auburn, Alabama, August, 1916 b) AB and BS, University of Missouri, 1938 c) MD, Harvard, 1940 d) Intern, Resident, Research Fellow, Harvard, 1940-1950 e) Pediatrics, Harvard, 1951-1966 f) Associate Pediatrician, University Hospital, Cleveland, 1952-present g) Dean, School of Medicine, Case Western Reserve Univ., i966-present 15 A. Categorical Disease Committees: 1) The Heart, Cancer, Stroke and Respiratory Desease Committees (See above chart) are composed of disease experts from throughout the twelve county Region. 2) They consist primarily of physicians who are c harged with problem identification and project design within their respective disease concerns. 3) Diabetes and renal disease are assigned to the Heart Committee. B. Horizontal Committees: Because problems of Medical Service, Education and Health Data Collection transcend beyond disease borders, separate committees, which are broadly representative of the twelve counties, have been developed to establish problem identification and project design in their titular areas of con- cern. 1) The Medical Service Committee is composed of public health officials hospital or clinic administration representatives, community service. agencies and medical staff administration personnel. 2) The Education Committee is composed of university teachers, hos- pital directors of medical education, nurse educators and voluntary health agency personnel. 3) The Health Data Committee integrates the skills of the statisti- cian and data processor with the perspective of the physician and the community or hospital service agency administrator. C. Area Committees: 1) Twelve counties of the Region have been subplivided into six areas having "natural trade and professional relationships." 2) The percentage of the Region's total population, to each of the six areas, are noted on the chart above. 3) Committees were established by local agreement to more effectively involve the local professionals arid their institutions and to more adequately recognize "grass-root" problems and needs. 4) The six committees represent the health providers of the area. The above three types of committees (A, B & C) functions are: a) roblem identification and project design p b) review of projects submitted by affiliated agencies c) consultation for other committees 16 D. Program Coordinator and Regional Office Staff (Core): 1) The program coordinator is the primary agent of the Board of Trustees and, as chief executive officer, is accountable to the Board for the proper functioning of the NEORMP. 2) The Core staff is included in the previous Section (V). 3) Total expenditures for personnel was $300,000 during the 02 planning grant year. (7/1169 - 6/30/70) E. The Board of Trustees: 1) Consists of 14 annually appointed members who elect their chairman. 2) Meets monthly. (Hope to have a Board member from each of the six sub-regional areas and representation for the major disciplines of medicine, nursing and hospital administration). 3) The Board was originally the Executive Committee of the RAG and assumed trustee responsibilities when NEORMP became a not for profit corporation of Ohio. The Board: a) establishes policy and supervises the Program Coordinator's implementation of these policies. b) continues to function as Executive Committee of RAG. c) recommends priority rating of specific projects. F. The Regional Advisory Group: 1) Is representative of health disciplines, disease interest and geographical areas. 2) Includes- a) Chairman and two additional members from each of the 13 committees (A, B, C) = 39 b)'-14 Members of the Board of Trustees c) 18 at-large members 3) The 71 member RAG meets 4 times a year to: a) receive progress reports b) review projects and priorities submitted by the Board of Trustees 17 projects which allows 4) All members have detailed prior knowledge of for greater involvement of these participants. 5) Consists of: 7 Practicing physicians 5 Medical Center Officials *13 Hospital representatives 15 Medical Societies 4 Other Health Professions 12 Comm. Health Welfare Hosp. Planning Agencies 5 Voluntary Health Agencies 9 Public 1 Health Departments 71 TOTAL *Two are hospital administrators - balance are M.D.'s, chief's of hospital staffs and one Director of Medical Education. Project Initiation and Review Process: Projects can be initiated by any of the Committees of the NEORMP or by any non-profit agency or health organization in Re ' .gion. All grant requests have the same review process: 1) Staff will initially review all applications to insure the inclusion of necessary and pertinent material. 2) Referred to appropriate expert Committee or Committees. 3) All go to area Committees for opinions regarding local applica- bility. Following review, modification and re-review, projects'. 4) Are submitted to Board of Trustees for approval, priority rating and referral to 5) RAG; all approved are submitted to 6) Division of Regional Medical Programs in order of RAG priority. Worksheets are used in the evaluation of all project applications. This Grant Evaluation Form is used by staff, appropriate Committees, the Board and the RAG. Form requires comment on project',s a) concept, b) feasibility, c) need, d) interrelations, e) region- alization, f) relevance to PL 89-239, g) relative value, h) adequacy of proposed evaluation. This form creates a cover sheet for each application and permits each visualization of projects through a multi-stage evaluation. VIII.- SUMMARY OF PROPO', PERATIONAL-PROJECTS NEOVR PROJECT PRIORITY GRANT RECIPIENT FUNDING DURATION 1) NEORMP "Core" Support NEO@ 3 Years 2) Hospital Library Consulting Services I Cleveland Health Sciences Library 3 Years Case Western Reserve University Northeast Ohio Regional Program for 3) Continuing Education of Nurses in II American Heart Association, 3 Years Coronary Care Northeast Ohio Chapter 4) Rheumatic Fever Prevention by a II American Heart Association, 3 Years Streptococcal Culture Program Northeast Ohio Chapter 5) Organization for University II Metropolitan Health Planning 2 Years Cooperation in Health (OUCH) Corporation Physical Therapy Graduate 6) Continuing Education for Physical II Curriculum, Case Western Therapy Reserve University 3 Years 7) Televised Postgraduate Medical III Cleveland Academy of Medicine 3 Years Educat-i-on Programs 8) A Comprehensive Out-Patient Stroke III Lake County Society for 3 Years Rehabilitation Demonstration Crippled Children and Adults 9) Dial Access Lectures III NEOM4P 3 Years 10) Summer Workshop in Career IV Cleveland Health Museum 3 Years Development Kent State University 11) Medical Taxi Services for Residents of Rural Geauga IV Geauga County Medical Society 2 Years County 00