I ii ii Ii I i 1 i @ illi III! 1, iiii ..@i i * I!,, I * PN Stewart, William H.///1921- CN United States. Public Health Service. Office of the Surgeon General TI Report on regional medical programs to the President and the Congress/G TC ; submitted by William H. Stewart, Surgeon General, Public Health Service. IM - [Washinton,/For sale by the Supt. of Docs., U. S. Govt. Print. Off.]/1967. CO - 105 p. SE - Public Health Service publication,/no. 1690/G CA - WA 540 A P899r 1967:02NLM EL - FULL LEVEL IT - MONOGRAPH MT - CORPORATE NAME MAIN ENTRY DA - 680103 UI - 0124733 RT REGIONAL MEDICAL PROGRAMS TO THE PRESIDENT AND THE CONGRESS Slibiiii'lled by T@1,7iiii.an7, H. Steu.,ai-t, Sio-geoiz Geiiei-al Piibli'c I-Icalth Sei-z,l'ce U.S. DEPARTME.A"T OF HE@ALTH, ED UC, @-I TIO J@l, A.A"D J 1,7T,, L F, i I R E julic 1967 CONTENTS Page FOREWORD SECTION ONE Summary ........................ I ,SI,"('I'ION TWO The Essential Nature ............... 5 SECTION THREE Activities and Progress ............. 9 SECTION FOUR Issues and Problems................ 19 SECTION FIVE Conclusions and Recommendations. . 31 Page Page SUPPLEMENT: Regional Medical Programs in Action.... 37 VII Consultants to the Division of Regional Medical Programs. 77 EXHIBITS VIII 1rogriiii Coordiii@itors for Regional Medical 1'rograitis ..... f@] I Steps in Preparation of the Surgeon Gcneral's Report on IX 1'rocedurcs for Review and Approval of Operational Grants. f37 Regional Medical Programs to the President and the x Principal Staff of the Division of Regional Medical Programs. 93 Congress ............................................. 60 XI Complementary Relationships between the Comprehensive 11 Surgeon Gencral's Special Ad Hoc Advisory Committee to Health Planning and Public Health Service Amendments of Develop the Report on Regional Medical Programs to the 1966 and the Heart Disease, Cancer and Stroke Amendments President and the Congress ............................. 61 of 1965 .............................................. 94 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 Amendments of 1965) .................................. 98 XIII Regulations Governing Grants for Re ional Medical 9 v National Advisory Council on Regional Medical Programs.. 75 Programs ................................. I .......... 100 VI Regional Medical Programs Review Committee ........... 76 XIV Selected Bibliography .................................. 103 HEART DISEASE, CANCER AND STROKE AMENDMENTS OF 1965 On or before June 30, 1967, the Sur- geon General, after consultation with the Council, shall submit to the Secretary for transmission @ to @ the' President and then to the Congress, a- report of the activities under this title together with (1) a statement of the relationship between Federal fi- nancing and financing from other sources of the activities undertaken pursuant to this title, (2) an @apprais- al of the activities assisted under this title in the light of their effectiveness in carrying out the purposes of. this title, and (3) recommendations -,vith:@ respect to extension or modification of this title in the light thereof, Public Law 89-239 Section 908 -FOREWORD This Report on Regional Medical the time-consuming process of ini- tional conference of some 650 per- commitment to this pj-o-ram must be Programs is required by Section 908 tiating organizations at both the na- sons, representing a broad spectrum clear. of Public LaNv 89-239, the Heart Dis- tional and re-ional levels, assembling of health and related groups through- If these conditions are met and ease, Cancer and Stroke Amend- key operating staff, and developing out the Nation, was held in January the potential of the prooraxn is ments of 1965. The significance of program guidelines. 1967 to discuss and exchange views realized, health resources of the Na- this requirement was highlighted by These tasks have been accom- on the development of this program. tion will move forward, region bv the Senate Committee on Labor and I)Ilshed with dispatch. However, the This conference provided the back- re-ion, in buildin- new patterns o'f Public Welfare in its Report on the period of actual operations has been ground for the initial drafting of the collaboration, and people suffering Heart Disease, Cancer, and Stroke so limited that firm conclusions can- Report; the Proceedings: Conference from these diseases will receive the Amendments of 1965: not yet be drawn concerning some of on Regional Medical Proarams have care they need, more promptly and the issues emphasized in the Con- been published (PHS Publication No. more efficiently. The Committee views this require- gressional directive. 1682). ment for accomplishments and On the other hand, the general The essence of this Report, I am William H. Stewart, M.D. recommendations for further devel- shape and direction of program de- pleased to note, is that Regional Surgeon General opment as an important and integral velopment has clearly emerged dur- Medical Programs have made a sub- Public Health Service part of this legislation. This program ing this period. The quick and stantial and impressive beginning. U.S. Departmcnt of provides the opportunities for major enthusiastic response it has received But it is only the beginning. The task Health, Education, and Welfare innovations . . . The impressive en- indicates that it can fill an impor- ahead 'is to bring to fruition a truly dorsements of the concept of the tant national need. The great op- unique and promising venture de- Program give a basis for launching portunitics this innovative program signed to advance the effectiveness the program as soon as possible, but presents, and the critical issues with and quality of medical care available the final form in all its particulars is not, and cannot be clear at this tz.me. which it is confronted, have been to those who suffer from cancer, heart Therefore, the need for careful and brought into sharper focus. disease, stroke and related diseases. continuous reevaluation assumes a To be certain that full considera- Critical issues remain, and eftcc- tion was given to all aspects of this tive regional programs are not yet special importance for this program. initial Regional Medical Programs completely realized. But as we enter This Committee urges that the 'pro- experience and to assist in forging the period of full operation, the gram be administered at all times the conclusions and recommenda- prospects for success appear highly with a view toward the identification tions in this Report, we sought views favorable. of productive modifications for sub- and advice of a wide range of in- Looking to the future, the sin,-le mission to the Congress when the ex- dividuals expert in medicine, health, most important condition for furthei@ tension ZS considered in the future. and public affairs (Exhibit 1). Last progress is to stistain the enthusiasm, For the most part, this Report fall, I appointed a Special Ad Hoc vigor and cooperative spirit of the describes progress and experiences Subcommittee of the National Ad- many individuals who have volun- during the 20 months that have visory Council on Regional Medical tarily undertaken this pioneering ef- elapsed since the enactment of this Programs to help in the development fort in the Regions throughout the I("@isl.itioti. of tll(- IZ(-I)ot't (I-'Ixliil)it I 1). A ii,,t- (@ollitir.y. 'I'o (I(Y tills (II(- rl:ttloll:ll Summary Regional Medical Programs have made an impressive beginning. But it is only a beginning. Much is yet to be done. Many problems and is- sues are yet to be resolved. How- ever, if the future is marked by the same enthusiasm and cooperation and our national commitment is sus- tained, a major change may well be wrought in the workings of Ameri- can medicine. This change will benefit the health professions and bring great benefits to the American people. SECTION ONE Summary In October 1965 President Johnson planning grants; the 47 first year gram, appointing and convening the tion, to meet the special requirements signed Public Law 89-239, the Heart awards total about $20 million, and Regional Advisory Group, and re- of Regional Medical Programs and Disease, Cancer and Stroke Amend- 10 second year awards about $4 mil- cruiting staff. to enhance cooperation with related ments to the Public Health Service lion. (Exhibit III) The geographic The initial experience described in programs. Act, authorizing grants to help es- Regions encompassed in these awards this Report demonstrates the pro- tablish Regional Medical Programs contain about 90 percent of the Na- gram's potential for improving the An effective mechanism should be found to assist interregional and other to combat heart disease, cancer, tion's population. The beginning health of the American people. To supporting activities necessary to the stroke, and related diseases. stages of program operations have be- fulfill this potential, the following development of Regional Medical This program had its origin in the gun in 4 Regions with the support of recommendations are clearly indi- Programs. This assistance will facili- recommendations of the Presidenes grants totaling $6.7 million. (Exhibit cated: tate the worl, and implementation of Commission on Heart Disease, Can- IV) Additional applications for @ The program should be estab- individual Regional Medical Pro- cer and Stroke, presented in Decem- grants to support planning covering lished on a continuing basis. There is grams. ber 1964. Its ultimate goal, like that the remainder of the country are every indication that the approach of the Commission itself, is to help now under review or development. authorized by Public Law 89-239 is Patients referred by practicing make the best in modern medical sci- On this record, progress in the valid and promising. Extension of th(! dentists sho'ul-d be included in the rc- ainin(, and demonstration ence readily available to all people development of Regional Medical program, building upon the initial .@earch, ir who suffer or are threatened by these Programs is substantial. It is partic- planning and pilot projects, will lead activities carried out as necessary major diseases. ularly impressive when viewed in the to realization of its potential and will parts of Regional Medical Programs. To accomplish this purpose, Public context of the initial tasks that had to contribute significantly to the attack F7 Federal hospitals should be con- Law 89-239 proposes the establish- be performed. These included the on these major diseases. sidered and assisted in the same way ment of direct and continuous link- creation within the Public Health @ Adequate means should be found as community hospitals in planning ages between the patient, his physi- Service of a new administering orga- to meet the needs for construction of and carrying out Regional Medical cian, his community hospital, and the nization and the assembling of staff. such facilities as are essential to the Programs. Nation's centers of scientific and Program guidelines had to be devel- academic medicine. It seeks. to unite oped and promulgated; criteria and purposes of Regional Medical Pro- Underlying this program and the the health resources of the Nation, mechanisms for review of grant ap- grams. A limited amount of new con- recommendation for its extension is region by region, in close working plications had to be established. The struction has been found to be es- the broad national concern over the relationships which will speed the many issues and problems presented sential to achieve the purposes of the extent to which new medical know]- by this new departure in Federa. Programs; priority ne edge and technology is brought rap- transmission of scientific knowledge I eds are educa- tional facilities, particularly in corn- and methods to the people whose lives health action were widely and in- idly.and effectively into use in health depend upon them. tensively discussed with individuals munity hospitals. Authority to assist services and medical care throughout The first stages in the development from all parts of the country. In cacti the construction of new facilities, the Nation. The legislation proposes which was requested in the initial bill regional frameworks for accelerating of the Regional Medical Programs Region, initial tasks included working in 1965, was set aside during the con- this transfer. It envisions twoway are now well underway. As Of June out the 1)@iscs for developing regional sl(l(-ritiozi (.if tli(,. bill in the Congress. flows of tis(-ftil science and technology 30, 1967, planning is moving fonvard (,cooperation among major health in- II'lils modification should be carefully between academic and scientific cen- in 47 Regions with the support of terests, designing the planning I-)ro- designed, in amount and administra- t(!rs and agen(-ics and individuals who 3 deliver medical care in the local ment of a Regional Program. Thus that characterize the American Regional Medical Programs comple- ment other Federal health programs, communities of the country. the character of the individual pro- health scene. Some of the questions To accomplish these purposes, the grams will vary as they reflect the are generated by the particular terms particularly the Comprehensive Law authorizes the award of grants differing needs, resources, and pat- of the legislation under which the Health Planning Program initiated for the planning and then for the terns of relationships. program operates. Still others emerge under Public Law 89-749? operation of regional arrangements, The experience gained in the year from certain broad changes which are F-1 How can local programs over- designed to stimulate new patterns since the first grant was made has inherent in the further development come lack of space to carry -out cer- of cooperative action among physi- provided considerable evidence that of these programs. tain of the activities and functions cians, hospitals, university medical new cooperative arrangements can be Significant among these questions are being engendered by Regional Med- centers, public and voluntary health developed among institutions and in- the following: ical Programs, particularly space for agencies. Each regional arrangement dividuals involved in health and F-I Can the character, quality and training and continuing education? should help to create a coordinated medical affairs. Regional groups rep- availability of health and medical In addition, it has been difficult program encompassing research, resenting a wide variety of interests care services in the area of heart thus far to obtain more than a tenta- training and continuing education, and functions have come together in disease, cancer, stroke and related tive commitment from many insti- patient care demonstrations and re- an unprecedented fashion to plan diseases be significantly and meas- tutions and individuals because of un- lated activities. Its goal is to advance and work cooperatively on common urably modified? certainties over the national intention- the accessibility and the quality of needs and goals. Over 1,600 individ- health services available throughout uals, including physicians, medical Are the regional administrative and the limited duration of authoriza- the region for heart disease, cancer, educators, hospital administrators, entities developed for these programs tion for grants for Regional Medical stroke and related diseases. public health officials and members viable and durable over a long period Programs. Assurances of longer sup- The emphasis in this program, re- of the general public arc serving on of time? port are essential to maintaining the flccting the legislative background Regional Advisory Groups. They are @ Can voluntary professional and vigor and achieving the objectives of from which it emerged,- is on local performing an important role in the . . . I institutional compliance be obtained this program. initiative and local planning. This planning and development of the in- in the efficient disposition and use of Many of -these issues and prob- approach is intended to sustain the dividual Regional Medical Program. critical manpower, facilities and lems will be resolved in the future essentially private and voluntary It seems reasonable to anticipate that other resources on a regional basis? conduct of the program. Others will character of American medicine. At workable mechanisms for accomT)Iish- F-I How will the activities generated require either executive or legislative the same time, it permits the use of ing the goals of the Heart Disease, under Regional Medical Programs af- action. Ff-(Ier,il funds to stimulate tn(i sup- Ganc(@r and Stroke Amendments of port innovative al)i)i-oaclics to coiii- I!)(i5 will ])I-ogl-(.Sslv(.Iy 1);Is(.(l (@osts ;III(] ilinliclic.(, ]'\(-gioiial Medical Programs have mon problems under local leadership. on these initial cooperative efforts. the extent to which such costs can made an impressive beginning. But An advisory group, representing There are, however, uncertainties be met by normal financing methods it is only a beginning. Much is yet to the regional health interests in each and problems still to be resolved in versus direct support through Re- be done. Region, including those of the con- the further evolution of this program. gional Medical Programs? sumers of service, is required by law In part these questions arise out of F-I What long-term relationships as an essential step in the develop- the diversity and complexity of forces should be established to assure that The Essential Nature "The objective of this legislation is to build from strength and to, pro- vide those mechanisms which can link the source of strength with the needs of the community . . . We. would hope that the proposed new program could have its greatest in- novative effect . . . as a significant new extension of the capability of existing programs in bringing to bear on patient needs the benefits of sci- entific medicine." Excerpt from the Report of the Senate Committee on Labor and. Public Welfare on S 596 (P.L. 89- 239). SECTION TWO The Essential Nature BACKGROUNI) the benefits of science to all the groups and areas not sharing fully in aratc and independent components of The Report of the President's Com- people. the overall progress. Efforts to meet the health enterprise, and the lack of mission on Heart Disease, Cancer Along with great benefits, these these demands for services have been financial resources in sufficient and Stroke in 1964 was the imme- advances have brought new prob- complicated by manpower and fa- amounts and duration to assure con- diate stimulus for the legislation that lems. Increasing specialization has be- cility shortages and increases in costs tinuing stability. became Public Law 89-239. That come necessary for mastery of rapidly of medical care. The present day circumstances of report, issued in December of 1964, advancing knowledge and technol- More efficient and effective use of the practice of medicine and the de- made a series of recommendations ogy. While specialization has raised health services has been sought livery of health services may provide aimed at the development across the levels of expertise, it has also increased through regionalization for many more suitable conditions for the nation of regional complexes of med- the fragmentation of services, thereby years. It has also been viewed as a growth of the reoional approach. The ical facilities and resources. These complicating the process of delivering means to broaden the availability of physician is the part of a com- would functickn as coordinated svs- medical care. At the same time the high quality health services. In 1932, plex system involving closely related tems to provide specialized services advance of science threatens the the Committee on the Costs of Medi- facilities and ancillary services. The for the benefits of physicians and pa- heavily burdened physician with cal Care focused attention on this hospital has become the central in- tients in the several geographic areas. rapid obsolescence of knowledge. approach. In the same year, the stitution in the community medical In the longer perspective, however, This threat in turn raises new prob- Bingham Associates Program of the scene. Prepayment plans and group the Regional Medical Program con- lems in communication and educa- Tufts University-Ncw England Mcdi- health programs contribute to coordi- cept is the result of many ideas and tion. New patterns of relationships, cal Center initiated the first comprc- nation and common action. Federal trends that have evolved over a pe- systems of service, and mechanisms hensive regional medical effort in the programs committed to social prog- riod of years. These include some of are critically needed in medicine, as United States. About 15 years later, ress provide a pervasive force for the social, economic, and scientific in other fields, to cope with and ex- similar ideas were included in the action. changes affecting all of modem soci- ploit advances of science for the well- Report of the Commission on Hospi- Thus the regional concept emerged ety, as %vell as developments in the de- being of the people of the Nation. tal Care and were, in turn, reflected again in a new form, in the major livery of medical and health services. Other important forces have also in the Hospital Survey and Coiistru(,- recommendations of the President's The progress of science has exerted contributed to the conditions and tion Act of 1946 (Hill-Burton Pro- Commission on Heart Disease, Can- a powerful force for change. Since needs which set the stage for Regional gram). While other regionalization cer and Stroke which proposed the World War II great strides have been Medical Programs. Many factors plans have @een advocated and at- development and support of "region- made in extending the frontier of have raised the public's expectation tempted from time to time, these ef- al medical complexes". This proposal Tile(lic,ii knowl(-cfg(- ,tn(i (-.tl).,il)ility for health: tli(! rising (!(7onoini(-, (,.al),t- forts w(@i-(- largely isolat(-(] in(] for substantial and sustained through 'I'Iiis :t(lviiiic(t has I)ility of' tli(- N;ttioij, tlt(! Iiigll(.I. g(!Il- Iiiiijt(.(I. slil)l)ol'l ;he (-S.%(-Iltl;il (.oil- greatly strcn-thcneci the armamen- cral level of education of the public, I-'Ifl'orLs to aciiiev(- regional oz,gaiii- (.11tioll of, silcc(.Ss. tarium of medicine available to con- the rccorcl of success in the control of zation of private and voluntary health tend with the problems of health and the major communicable diseases, services have not been notably suc- ll'ISSI-'N'I'[Al, disease. It is providing a fundamen- and other social progress. In addi- cessful. The reasons vary, but in NATL'RE tal impetus for progress in health, tion, national concern has focused on general they reflect the difficulties of President Johnson, at the signing of stimulating intensified efforts to bring the special problems of disadvantaged inducing common action among sep- Public Law 89 239 on October 26, 7 1965, said, "Our goal is simple: to operation with, practicing physicians, The program design inherent in design is defined in the Congressional speed miracles of medical research medical center officials, hospital ad- Public Law 89-239 derives from a declaration of purpose: from the laboratory to the bedside." ministrators and other health work- series of basic concepts: "Through 7rants, to encourage and The bill he signed into Law on that crs, representatives from appropriate The best in modern diagnostic assist in the establishment of regional occasion, the Ilcart Disease, Cancer voluntary health agencies and mcm- and treatment methods is not readily cooperative arrangements amona and Stroke Amendments of 1965, bers of the public. The law specifies accessible to many Americans suffer- medical schools, research institutions, stated the same goal in slightly differ- that there shall be no interference ing from or threatened by heart dis- and hospitals for research and train- ent terms: to afford to the with patterns or the methods of fi- cer, stroke, and related ing (including continuing educa- ease, can medical profession and the medical nancing of patient care, or profes- diseases. tion) and for related demonstrations institutions of the Nation . . . the sional practice, or with the adminis- of pati .ent care z.n the fields of heart opportunity of making available to tratioii of hospitals. F-] There is ite@cd for iiicrt!asliiL, i?ztcr- disease, cancer, stroke, and related their patients the latest advances in Because this broad range of co- action betwee?i the diagnostic and diseases the diagnosis and treatment of [heart operation is the central concept of therapeutic capability in the major disease, cancer, stroke and related Regional Medical Programs, each medical centers, where an effective Thus, Public Law 89-239 repre- interplay between research, teaching, sents a Federal investment in regional diseases] program is required to establish an and patient care can bring rapid and initiative. It invites and supports the 'f'o accomplish these goals, P.L. advisory groul) representing the vari- efifcctivc application of new medical creation of new patterns of coopera- 89-239,ititlioriz(-cl;t3-yeat-,$310ini I- (),Is II(,;Iltll 1.(,Sotll-(@(.s of tll(! 1.(.gioll .11)(I kllotvle@,,,4!, and the medical capabil- tive tctioii aii-ion" I lion program of grants foi- tti(! plan- physicians, allied ning and establishment of Regional including constiin(-i- participation. ity in many co?7zinziitzty wttitigs. health workers, hospitals, medical Medical Programs. These grants pro- 'I'lils group has the important func- [7 The progress of science will con- centers, universities and research in- tion of assuring full collaboration and stitutions, public and voluntary health vide support for cooperative ar- advising all the participating insti- tinue to increase the complexity of agencies, and the consumers of health rangements which ,vould link major ritaking available to all the potential services. medical centers-usually consisting tutions in planning and carrying out benefits of ?iioder?t medicine. of a medical school and affiliated the program. @ The complete realization of these THE CONDITIONS tcaching hospitals-@vith clinical rc- The ultimate objective of Regional potential benefits 7-equires the co- AND QUALITIES search centers, local community hos- Medical Programs is clear and iiti- operative involvement of the full EMPHASIZED pitals, and practicing physicians of equivocal. The focus is on the patient. range of each region's medical and Regional Medical Programs put into the Nation. Grants are authorized for The object is to influence the present related resources. practice the principle that essential planning and feasibility studies, as arrangements for health services in.a @ The diversity of local health responsibility and power for the im- well as pilot projects, to demonstrate manner that will permit the best in needs and resources calls for the as- provement of health services should the value of these cooperative rc- modern medical care for heart dis- sumption of responsibility by each be exercised locally. The basic policy gional arrangements and to provide a ease, cancer, stroke and related dis- region for the design of a pattern of of the program is designed to en- base of experience for further'devel- eases to be available to all. The scope collaborative action best suited to its courage innovation, adaptation and opment of the program. of the program is nationwide, encom- own special circumstances. action at the regional level. The objectives of the legislation passing the great cities, suburbia, and The role of the Public Health Serv- Freedom and flexibility to do those are to be carried out by, and in co- rural areas. ice in developing this broad program things necessary to achieve the goa s a of each program has been provided. New systems are being sought amid When the Regional Medical Pro- The achievement of any one objective diverse geographic and social circum- grams are fully developed across the of a Region may require a combina- stances that will make available to nation, they Nvill help to asSLire every tion of activities, such as research, all the people medical services for individual, ,vhcrever he lives, that: specialized training of allied health heart disease, cancer and stroke and 7 His physician has readily avail- personnel, continuing education of related diseases that are excellent in able the knowledge, skills and techn' physicians, experimentation to find quality and adequate in quantity, the best methods to achieve desired while preserving the diversity and cal support that permit early diag- results, and demonstration of the most largely private character of our med- nosis of these diseases and prompt effective patient care. The Law does ical care process. The responsibility initiation and appropriate follow through for the most effective known not allow support of isolated projects, of achieving these desirable ends does preventive or curative action. however meritorious, whether they not devolve upon Regional Medical be in continuing education, research, Programs alone. They must operate 7 His community hospital is equip- patient care demonstrations, coopcr- in conjunction with other programs I)cd and staffed to provide the full ative arrangements or training. Thus having related objectives. But Re- range of services his condition rc- the success of a Regional Program will gional Medical Programs, properly quires, or is part of a system -,viiicli depend upon how effectively the Re- developed, can serve as a keystone of makes this range of services available gion brings to bear its unique combi- a structure which will permit the de- to him. nation of institutions, agencies and livery of the type of medical care serv- In short, every person whose life and organizations to define and meet its iccs desired by all. well-i)eiti@, may 1)(@ in .'I(@ol)itr(ly from In accomplishing this goal, it is own needs and opportunities. essential to find ways to harmonize one of these diseases should have the Critical to future progress is ttic the values of personal and scien- full strength of modern medical willingness of members of the medi- 'fie freedom Nvith the clcritands for science available to him through the ti cal profession to accept their full efficient use of resources and nation- cooperative efforts of the medical and share of leadership in this effort. wide availability of services. Re- related resources of the region in Equally important is the willingness gional Medical Programs offer the which he lives. These are the -oals to of university schools of medicine to private and public institutions and which Regional Medical Programs become involved in cooperative ef- the health professions of the country are dedicated. forts to apply the fruits of research opportunities to demonstrate that, on efforts. $milar challenges and new a voluntary cooperative basis, given responsibilities are presented to hos- adequate resources and flexibility to pital administrators, health officers, use -them, it is possible to work out voluntary health agencies, schools of effective regional and local systems to public health, and the allied health bring the benefits of scientific prog- professions. ress to all. A-ctivities and Progress the Surgeon General ... shall submit ... a report of the activities ... together with (1) a statement of the relationship between Federal fi- nancing and financing from other sources ... (2) an appraisal of the activities assisted ... in the light of their effectiveness .... Public Law 89-239 Section 908 SECTION THREE Activities and Progress REPORT OF ACTIVITIES opment has taken place in a time of for the Division for fiscal year 1966. resenting areas that included some 60 During the 21 months from the time widespread manpower shortages and The Department of Health, Educa- percent of the population of the Public Law 89-239 caxne into being in conjunction with parallel demands tion, and Welfare Appropriation Act country. The first applications for until June 30, 1967, 47 Regions re- from many other health programs, of 1967 provided $43 million for operational grants had also been ceived grant funds to aid their plan- such as Medicare and Medicaid. In grants and $2 million for the Division submitted. ning activities and 4 of these Regions this context the progress reflected by for fiscal year 1967. Subsequently, in February 1967, also initiated the operational phase the present state of activity represents The National Advisory Council on the first four operational and 10 ad- of their Regional Medical Programs. a considerable achievement in a rela- Regional Medical Programs, estab- ditional planning applications were (Exhibits III, IV) These programs tively short time. How this was ac- lished by the Law, was named from recommended for approval by the received awards of about $24 million coinl)lished provides a gauge of the outstanding experts in National Advisory Council. At tli(- for planning and $6.7 million for (Ilre(,,tion and potential for the future. cancer and stroke, plus to,) lead(-rsliii) Council rri(-(-ting in Mty, fiv(- add]- operations. (Table 1) The regional in medical practice, hospital and tional planning applications were areas to which the awards for plan- The Initiating health care administration and pub- recommended for approval. In June, ning relate contain about 90 percent Actions lic affairs. (Exhibits V, VI) It rn(-t continuation grants were awarded to of tl)c Nation's population. )i- til(@ first tiiii(@'ri 1065 to 10 R(- 'oris for til(, s(-(-ori(i y(@.ir of f( I @l Additional ;kl),)Il(-;ttlolis foi- ,,.;,,Its Shortly ;tftt-l- tll(-. 1,;tw wts signed '[(IVIS(! oil to Support the planning of Regional by President Johnson on October 6, February 1966, the Council met again Medical Programs covering the re- 1965, the Division of Regional Medi. to review and approve the prelimi- Broad Participation mainder of the country are under cal Programs was established at the nary issue of the Program Guidelines. in Planning review or development. Overall, a National Institutes of Health. To Quickly printed, this publication was total of about 54 Regional Medical direct its activities, Dr. Robert Q. given its initial distribution in March. The promptness and manner with Programs are anticipated. It is likely Marston accepted the invitation to During the spring of 1966, about wlii(-Ii I)rograrit proposals were de- that by the late summer or early fall leave his post as Dean of Medicine 20 applications for planning grants veloped reflect the interest this new of 1967 Regional Medical Programs and Vice Chancellor of the Univer- were received and reviewed by the program has generated in the nation- covering the entire country will be sity of Mississippi and become Asso- initial review groups and the Na- al health scene and give heartening 'dence of the willingness of diverse either in the initial planning or initial ciate Director of the National Insti- tional Advisory Council. By July 1, evi operational stages. tutes of Health. Prior to the arrival 10 grants were recommended for ap- interests in the health field to coop- Progress in the development of of Dr. Marston, Dr. Stuart Sessoms, proval and awarded. Between July erate in this new framework. The in- Regional Medical Programs thus far Deputy Director of the National In- and December 1966, approximately terest and enthusiasm generated must be measured against the tasks stitutes of Health, was responsible for 40 applications were reviewed. Many throughout the country is the result involved in launching a new and the development of plans and policies were returned for revision or addi- of a number of factors, not the least of innovative venture dependent t@ a for the new program. tional information. Twenty-four were which was widespread participation of many individuals and groups, both very high degree upon local enter- The Supplemental Appropriation approved and funded. As a result, in the formulation of policies at the prise. The establishment of many Act of 1966 provided initial funding 1966 ended with a total of 34 Re- national level and in setting up and new relationships and activities has for the program, making available gional Medical Programs receiving planning their own Regional Medical been required. Moreover, this devel- $24 million for grants and $1 million awards for planning programs, rep- Programs. I I TABLE 2 the development of these Regional TABLE I Medical Programs. All of the Na- AWARDS FOR PLANNING AND OPERATIONS oi.- REGIONAL MEDICAL PROGRAMS, MEMBERSHIP OF ADVISORY GROUPS tion's existing medical schools and JUNE 30, 1967 FOR REGIONAL MEDICAL PRO- their affiliated hospitals and most of the schools under development have Nurnbcr Ainount CRAMS, JUNE 30, 1967 participated. In virtually every pro- $30,946,907 gram, representatives of State medi- TO'I'A L.. @ ..... .. ........ ......... . ..... 61 Num- llcr- cal societies, health departments, can- Category bcr cent- cer societies, heart associations, hos- ing Awards ......................... ..... 57 $24,277,174 age Plann' - -- pital associations or hospital Planning For I St Year Activities ........................ 47 19,822,153 agencies have taken part- For 2d Year Activities ........................ 10 4,455,021 TOTAL ......... 1634 100 In addition, many programs have - - already developed links with univer- operational Awards ............................ 4 $6,669,733 - - Practicing Physi- sity resources outside the medical For Ist Year Activities ........................ 4 6,669,733 cians ............. 356 22 schools and with other State and local private and public agencies having Medical Center related interests. Examples of these About one hundred consultants Officials .......... 281 17 are Schools of Dentistry, Nursing, Activities in tli(- ii(-%v I)Ivision by providing the Rc,,Ioll Social Work, Business Administra- ;Itl(l (@otills(.l oil v@ti-iolis as- Mci-i-ibcrs of Public. . 260 16 pects of the Program during the ini- ns,the wide- Voluntary Health tioii, I,'Icliicatioii and Public Health Similarly, in the l@egio and Departments of Vocational Re- tial period. These advisors repre- spread participation of concerned in- Agency Represent- habilitation, Welfare, Education, and sented a broad cross-section of the dividuals as members of Regional Ad- atives ............ 196 12 Hospitals. Community Councils, leaders in American medicine and visory Groups and as Coordinators Hospital Admin- planning councils, Blue Cross and (I(.Vot(!(l intensive ;tn(i staff is infusing the Programs sit-nilar groups are also bein- involved %vitli vitality and (Character. Over istrators .......... 170 10 efforts to the review of Program pro- in many instances. Representatives of posals and grant applications. Some 1600 individuals are participating as Other Health Veterans Administration and Public of these people sat on technical re- members of Regional Advisory Workers .......... 142 9 Health Service Hospitals are also groups. Others contributed Groups. Membership in these groups Public Health frequent participants. tficir thinking to the development of ranges from 12 to 1 1 1, averaging 32. such specialized activities as continu- The members include a variety of pro- Officials .......... 122 7 Regional ing education, community health f essional backgrounds and rcpresenta- Other ............. 107 7 Organizations tion of a broad cross-section of insti- ing, plann' S% stems analvsis, data col- tutions and organizations. (Table 2.) Several kinds of institutions have lection, communications, evaluation, Includes 51 Regions, of which 47 In fulfillment of the intent of the assumed responsibilities as coordi- and the preparation of this Report. program, the ma'or health agencies had received planning grants and 4 had nating headquarters for Regional i applications under review. (Exhibit VII) of the regions have been involved in Medical Programs. Since the legisla- 12 tion does not designate these agencies, These coordinators are building cern, have not materialized in the TABLE 3 they must be decided upon by the staffs with a wide ran,,c of com- initial planning proposals. various institutions and interests par- COORDINATING HEADQUARTERS AND petencies. As of June 30, 1967, there ticipating in the development of the GRANTEES FOR REGIONAL MF-DICA L were some 600 staff people working TABLE 4 Programs. The agency so selected acts PROGRAMS, JUNE 30, 1967 in these programs. These include over for all involved in these cooperative 300 professional workers with train- NUMBER OF PERSONS IN PRELIMINARY programs. ing in medicine, hospital administra- PLANNING REGIONS FOR REGIONAL Among the 47 Regions receiving Coordi- tion, and other health disciplines as MEDICAI- PROGRAMS nating planning grants, 28 university inedi- head- Grant- well as in related fields such as sta- cal schools have assumed responsi- Type of Agency quarters ccs I tistics, economics, sociolog Poptilation range Regions I y, systems TOTAL ................ 5 1 bilities as coordinating headquarters. FOTAL ...... 47 47 analysis, education, communications Seventeen are private nonprofit agen- - and public relations. Special coordi- cies, 10 of which were newly orga- Universities .... 28 33 nators or consultants for heart dis- Less than 1,000,000 ......... 4 nized for this purpose, 5 are medical - ease, cancer and stroke are commonly 1,000,000 2,000,000 -------- I 0 societies, and 2 ii-t- iiitilti-iiistittitiotiii Stite ....... 23 25 iticiii(Iccl. 2,000,000 3,000,000 ........ I,] 't - ititei, agencies. One State and on(. - 1'rivatc ..... 5 @3 3,000,000-4,000,000 ........ 5 state agency have also undertaken Nature of Preliminary 4,000,000-5,000,000 ........ 8 this task. (Table 3) Nonprofit Planning Regions Agencies .... 17 12 More than 5,000,000 ....... I 0 Program Coordinators The applications for Regional Medi- and Sta Medical cal Programs plannina grants have Includes 51 Regions, of which 47 had ff Societies. . 5 6 received planning grants and 4 had appli- defined the geographic areas in The Program Coordinators and Newly which the initial planning efforts will cations under review. Directors holding key leadership po- Organized be focused. It has been recognized Agencies. . 10 3 sitions in the administration of the Other that these definitions are preliminary In 30 cases, the preliminary plan- Regional Medical Programs come Agencies. . 2 3 and will be refined during the plan- ning regions approximate State lines, from a variety of backgrounds. Abou-. ning process and by operatin- due principally to the existing respon- half previously held important posi- State and experience. sibilities of many of the key groups tions in medical education, such as Interstate The individual Regions have participating in the preparation of university vice-presidents, medical Agencies.... 2 2 ranged in population from less than the initial plannino, orant application. school deans and professors. Others 1 million to over 18 million. (Table Inasmuch as none of the Regions is have come from private practice of 4) The median is 2.6 million persons. bound by State lines, many o ese medicine and from positions of The grantee differs from the coordinat- Collectively, the preliminary plan- I)r(!Iliyiiiiary definitions are likely to administrative leadershil) in hospitals. i@,a headquarters when the Region re- iiing regions encompassed in pro- I)c itioctifie(.1 oti the basis of (-riteria The rest previously held key rolcs in quested, this arrangement or the latter grams now in being or proposed cover more specific to health needs. voluntary health and governmental agency did not have the capabilz'ty to assume the entire country. Gaps in geographi- In 1 1 Reoions, the initial Region agencies. (Exhibit VIII) formalfiscal responsibility. cal coverage, which was an early con- includes parts of 2 or more States 13 and in 10 it is part of a single State. tinuing education programs and un- ditions. Methods of carrying out TABLE 5 Sorn(- regions primarily (@ovcr urban met educational needs are also rc- demonstrations of patient care and metropolitan areas. Otficrs follow ceivirig widespread attention. applying evaluation procedures are MAJOR PLANNINC; STUDIES UNDER lines previously established for plan- The patterns of occurrence of also being tested. WAY OR PROJECTED By 44 R EGION- ning health facilities. heart disease, cancer, stroke and re- In addition to analytical activity, AL MEDICAL PROCRAMS, MARCH lated diseases are also being studied planning for Regional Medical Pro- 1, 1967 Plannina by many regions. Most are analyzing grams involves major efforts directed - Activities patient referral patterns and existing toward the strengthening of the rela- Subject Under Study Regions iriettiods of providing diagnostic, tionships and communications among The planning activities of each Rc- treatment and laboratory services. health and related agencies within the Pitient care gional Medical Program are directed Present and possible communication l@egion. Various approaches arc at tfic design of operating programs and transportation patterns relating being used to further these cool3era- Specialized Clinical Facili- and the steps for their establishment. to these services are also receiving tivc relationships. The establishment tics ..................... 30 Initial planning activities have gen- wi(icsi)z-(.-a(i attentioii.'I'Iiesc planning of working task forces and commit- Disease Patterns ....... .... 28 erally been of four major types: studies have, in most instances, been tees, the conduct of conferences and Patient Referral Patterns 28 Organi-lation and staffing for based on previous data collection ef- workshops, and the employment of Patterns of Services ..... ... 25 forts and have, in turn, contributed liaison personnel are common. Nu- planning and coordination to the development of cooperative mcrous programs are schcdulina con- Laboratory Services ........ 25 Stren-thenz'ng relationships and Transportation Patterns ..... 21 arrangements among the partici- ferenccs at community hospitals and liaison among institutions and Z'ndz'- i)ating organizations. with other local groups to explain viduals throughout the Region About one-half of the planning al)- and discuss the purposes and nature Manpower Developtnent of plannz'ng data plications proposed the undertaking of the prospective Regional Program. Physician Manpower ....... 30 of specific feasibility studies aimed at Working together in planning and .1 Nursing Manpower ......... 29 n Preparation of designs for pilot assessing the workability and utility of initiating planning and feasib@ ity operate .onal programs particular program elements. Many studies has been found to be one of Dental Manpower .......... 25 A principal effort in the planning are exploring better ways of advanc- the most effective methods of estab- Other Allied Health Man- of Regional Medical Programs is the ing educational and training activi- lishing and implementing common power ................... 26 careful study and analysis of many ties. Particular attention is being objectives. relevant factors: demographic and given to improvements in continuing Although each Regional Medical Training and education biostatistical characteristics of the education programs for both practic- Program is in many ways unique, - kontinuing Education Pro- Region, the manpower and facilities ing physicians and allied health per- some flavor of what Public Law 89- grams ................... 28 resources, the adequacy of and sonnel. The effectiveness of tele- 239 means in action is revealed by Training Resources ......... 28 needs for specialized clinical facilities phone, radio and television networks reports of certain programs that are and problems of manpower supply in linking community hospitals to uni- Medical Library Resources. . 26 and distribution. Surveys of training versity medical centers is being in- I As reported by individual R@gional Medi- Communications Patterns and library resources, on-going con- vestigate(] under differing local con- cal Pr@grams. and Resources ........... 26 14 presented as a supplement to this Re- titioners to use these capabilities most cation systems joinin(i medical cen- ommendation; these committees draw port. What is happening in six Re- effectively in treating patients. ters and community hospitals. upon both community and academic gions is discussed against a back- Use of modern communication F-1 The development and demonstra- resources. In line with the specifica- ground of previous activities. In addi- tions of the Law, the Reorional Ad- technology. tion of improved methods and ar- tion, excerpts from the first annual rangements for providing detection, visory Group itself must approve all reports submitted by ten Regions that F-1 Research on and exploratory de applications for operational funds. - diagnostic, treatment and rehabilita- received grants as of July 1, 1966 are velopment of new methods for the tion services includin,, such activities The review process at the National also presented. organization and delivery of high Institutes of Health involves technical as: quality services for Patients with Demonstrations of coronary care in review by both expert nonfederal con- Operational heart disease, cancer, stroke and teaching and community hospitals. sultants and the staff of the Division Activities related diseases. and other offices with relevant ex- The four grants that have been made Each Itegloii will ]lave difl'ering Expa?isl()7i of ce,re-b?-(il 7)(isciiliir (lia,,,- 1)(@rtis(- tot(@tioll I)y tli(, Nationil for operational programs are based requirements and approaches toward nostic resources. Advisory Council. This process is largely on planning activities started upgrading its capabilities for the Demonstrations of improved methods focused on evaluating the organiza- prior to the passage of Public Law diagnosis and treatment of heart of utilizing computers in monitoring tion and conceptual strategy of the 89-239 (Exhibit IV). During the disease, cancer, stroke and related physiologic data and in providz' :1 Regional Programs and making avail- ng able the benefits of expert professional consideration of the legislation, it was diseases. In general, the designs of data for the use of practicing physi- recognized that there were several the initial Regional Medical Pro- cians and hospitals. analysis of project proposals. It seeks areas of the country where consid- grams provide for the following spe- @ Development of information pro- to preserve for each Region a large erable effort had already been di- cific kinds of activities as examples of grams to further communications, measure of the responsibilities and rected toward improved regional rela- the basic ingredients of comprehen- understanding, and cooperation opportunities for deciding on prior- among the institutions, organizations ities for action. A detailed statement tionships among health resources. In sive operating programs: these places sufficient planning had and individuals of the Region. of the review process is contained in already been accomplished so that The exchance of personnel be- Exhibit IX. operational activities could be initi- tween medical centers and commu- The Review aticd early. nity hospitals and the provision of Process SUPPORTING ACTIVITIES OF In the beginning stages these oper- consultation and other assistance to THE DIVISION OF REGIONAL ational programs will encompass practicing physicians by medical cen- The review of applications for opera- INIEDICAI, PROGRANIS four principal types of activities: ter and other specialized personnel. tional grants has been designed to en- As support for Regional Programs, a @ Application of the latest knozt,,I- F-1 Continuin,, education proarams sure careful consideration of the number of activities have been under- edge and technolo,, to improve Z, strategy and soundness of the pro- @y for medical practitioners and allied posal for a Regional Program. Many taken by the Division of Regional capabilities for diagnosis and treat- healt'h workers, at both local facilities Regional Advisory Groups have es- Medical Prograitis to develop needed ment. and medical centerv including the tablished subcommittees to analyze. information and resources which can Specialized trainin, and contz'nu- development of learnin(7 centers at the validity and significance of pro- facilitate regional program develop- b t, ing education to enable health prac- community hospitals and communi- posals prior to their review and rec- ment. (Exhibit X) 15 the National Board of Medical Ex- avoid duplication of effort and there- formation and data affecting the Continuing Education aminers, the Association of American by concentrate on studies of coopera- development of Regional Programs. A conference in September 1966 of 16 Medical Colleges, American Public tive arrangements and other issues This medium will also help speed the leaders in the continuing education of Health Association, American Physi- and needs unique to Regional exchange of reports of significant physicians and allied health person- cal Therapy Association, Association Programs. progress and problems among the ne'i identified needs critical to the de- of Hospital Directors of Medical Ed- Regions. velopment of more effective activ- ucation, Inter-University Conimuni- Listing Facilities FINANCING FROM OTHER ities in this field. The meeting cations Council (EDUCOM) and SOURCES other professional and public groups. Section 908 of Public Law 89-239 re- documented a national shortage of quires the Division to ". . . estab- Substantial contributions have been professional health workers capable lish and maintain a list or lists of made to the development of Regional of conducting and evaluating pro- Systems Analysis facilities . . . equipped and staffed Medical Programs by hundreds of grams in continuing education. To The use of systertis analysis has been to provide the most advanced meth- individuals and institutions through- fiell) meet this need, a contract was cricouz-zkged in l@egiorial Medical ods and techniques in the diagnosis out the country. Leading officials of developed with the Center for the Program activities as an integral and treatment of heart disease, can- medical schools, hospitals, research Study of Medical Education at the component of program development. cer or stroke. . . ." As a first step institutions, voluntary health agencies College of Medicine of the University Exploratory efforts have been under- to fulfill this requirement, the Divi- and members of the public have de- of Illinois to study the feasibility of taken to make broader use of systems sion has contracted with the Ameri- voted effort and resources to plan for expanding graduate programs lead- analysis skills in studying specific can College of Surgeons for its Corn- these new programs. In many areas, ing to a degree of Mastcr of Educa- problems oi improving medical serv- mission on Cancer to undertake a local funds have been made available tion and also short term training pro- ice. As part of this effort, the Divi- study of appropriate standards to specifically to aid in the initial plan- grams in the area of continuing sion has entered into a contract with provide the highest level of diagnosis ning. For example, in Vermont, the education. In addition, other univer- the Department of Industrial En- and treatment of cancer patients. State legislature appropriated $10,- si@ty groups have submitted proposals gincenng of the University of Michi- Such standards may then be useful as 000 to help defray planning expenses. for assistance to extend their pro- gan to study how to apply operations measures by which medical care in- In Oregon the University Medical grams in these fields. In January and research and systems analysis meth- stitutions of the country can evaluate School, the State Medical Associa- May 1967 representatives from six ods to problems of regional medicine. their own capabilities, and by which tion, and the members of the Re- universities, including staff from the individual Regional Medical Pro- gional Advisory Group donated schools of medicine and education, Data Collection grams can estimate where additional met to examine possibilities of ex- support may be needed. $6,000. The Mountain States Re- panding programs to train educa- Conferences of specialists met in gional Medical Program received a tional manpower. March and May of 1967 to identify Disseminating Information grant of $13,700 from a private The Division staff 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 has been established through March 1, 1967, more than cation. They include committees of data collection. By taking advantage to disseminate to Program Coordina- $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 ESTIMATED AMOUNT OF FUNDS FROM NON-FEDERAL SOURCES FOR PLANNING REGIONAL MEDICAL PROGRAMS, THROUGH MARCH 1, 19671 Region Total Cash Services Region Total Cash Services TOTAL ................... $1, 497, 300 $287,800 $1, 209, 500 Missouri ........................ $48, 900 $3, 900 $45, 000 Mountain States ................. 15, 000 13, 700 1, 300 Alabama ....................... 21, 200 3, 800 17, 400 Nebraska-South Dakota ........... 9, 000 1, 400 7, 600 Albany, N. Y ................... 96, 800 24, 500 72, 300 New Jersey ..................... 17, 800 12, 000 5, 800 Arizona ......................... 2, 800 100 2, 700 New Mexico .................... 25, 200 5, 700 19, 500 Arkansas ....................... 5, 100 600 4, 500 New York Metropolitan Area ...... 11, 000 1, 000 10, 000 Bi-State ........................ 13, 200 1, 500 11, 700 North Carolina .................. 38, 100 .......... 38, 100 California ................................... (1) ............ North Dakota ................ i .............. (1) ......... Central New York ............... 12, 000 6, 000 6, 000 Northern New England ........... 134, 200 10, 000 124, 200 Colorado-Wyoming .............. ............ (2) ............ Northlands ...................... 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 6, 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 Tennessee-Mid South ............. 20, 400 3, 400 17, 000 Iowa ........................... I 9, 500 11, 100 8, 400 Texas .......................... 82, 000 10, 000 72, 000 Kansas ......................... 125, 000 .......... 125, 000 Tri-State ................................... (1) ............ Louisiana ................................... (2) ............ Virginia ........................ 25, 000 .......... 25, 000 Maine .......................... 16, 200 1, 500 14, 700 Washington-Alaska ............... 4, 000 .......... 4, 000 Maryland ....................... 7, 000 .......... 7, 000 West Virginia ................... 11, 000 1, 000 10, 000 Memphis ....................... 20, 000 9, 700 10, 300 Western New York ............... 38, 300 2, 100 36, 200 Metropolitan Washington, D.C .... 2, 000 300 1, 700 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. 2Not reported. 17 profession and the medical institu- continuing evaluation. A principal development of Regional Medical II%' tions of the Nation, through such strength of these programs is the op- Programs from non-Fcderal Sources. A listin(, of these amounts, by l@egion, (-Ool)el,ative arrangei-nents, the Ol)- 1)ortLiiilty to build up resources for ii'ty of making available to their continuous evaluation; this is par- is set forth in Table 6. I)ortLI 1 Only a tentative appraisal of the patients the latest advances in the ticularly appropriate and necessary Procedures are being developed effectiveness of lzcglonal Medical diagnosis and treatment of these in light of the concentration on in- and implemented in the Regions so Programs in carryin- out any of the diseases." Much of the planning novation and experimentation. Eval- that these cooperative programs are cstablisheci objectives is possible this effort is focused on identifying the uation mechanisms are generally financed from a variety of sources. soon after enactment of the legisla- types of "opportunities" that are most being established as part of the In some areas, total responsibility for tioll. On tli(-, basis of this limited ;appropriate and practical to provide planning process so that essential the support of the activities will I)(- period of observation there seems to and strengthen capabilities. As re- baseline data will be accumulated assumed by local funds after an ini- be clear evidence that overall prog- ported above, a broad spectrum of and capabilities developed to assess tial period of study, testing and dem- ress has been substantial. The pros- potential approaches to this obj'cc- continuing progress and problems. In onstration. In many Regions, volun- I)ects for the future are positive and tive are being explored in planning, this way, the Regional Programs will tary agencies and foundation funds auspicious. feasibility studies and pilot projects. be better able to modify their direc- are being enlisted. The first objective of the Regional Progress to date indicates that the tion and speed, on the basis of actual At this stage in the development of Medical llrograiiis is "the establish- basic (,,oiicci)t of looking to regional experience, and progressively im- Regional Medical Programs, it is not iiient of regional cooperative arrange- groups for ideas and initiative is well prove their effectiveness. possible to ascertain the longer term itictits." Accomplishment in respect founded. The long-term effectiveness of Re- relationships of Federal and non- to this ob'cctivc has been outstand- The third purpose specified in the onal Medical Programs will be i 191 Federal funding of the activities un- As iiot(.-cl above, the health in- Law is "to improve generally the demonstrated by evidence of ad- der this program or to assess tfie tercsts of the Regions as well as re- health manpower and facilities avail- vancement in the quality of services nature of their impact upon medical lated agencies and members of the able to the Nation, . . ." Regional for these diseases, by extensions in I I I - public have (-oni(,- together in an un- planning holds the potcntiali service costs. If this program is suc ty of ac- periods of productive life, and by re- ce.ssftjl in (I(@v(,-Iol)lng ri(-(-(](!d a(l(ll- 1)rcc(,d(@nt(@(i fashion to consider tli(-. (@oiiil)llsiilng this objective also. Better dLICtiOll in mortality and morbidity. tional elements in the community most appropriate local ways of meet- ways of utilizing and traininz health I 09 health scene that are parts of im- ing identified needs under this pro- manpower, including many types of Initial pr 'ress has established a proved services, the extent to which grain. Maintaining the continued allied personnel, are also being ex- promisiii- foundation for such gains. these services can be financed coitimitment of these groups with di- plored. More efficient methods of These goals will not be accomplished through regular cost and payment verse goals and interests to (Continue extending the effectiveness of exist- (Iiii(-kly or easily, lio%vcvcr. The full processes or other local fundin- to work together in establishing and ing and new facilities, through shar- frtiltion will depend, in largest part, on the continuing commitment of mechanisms and the extent to which lml)lementing Regional Medical Pro- ng and cooperation, are being up permanent or temporary Federal grams will be crucial. initiated. regional health resources, the succes- assistance will be required arc issues The second purpose of Regional Most importantly, Regional Medi- ful recruitment of high quality per- that will call for critical examination Medical Programs specified in the cal Programs themselves are develop- sonnel, and the sound support of op- as the program progresses. legislation is "to afford the medical ing resources and procedures for crating programs. Issues And Problems SECTION FOURIssues And Problems The initial experience with Public diverse interests that exist in the com- Specific provisions of Public Law tain a sufficient consensus of the Law 89-239 has raised a number of munity health setting. 89-239 and its legislative history re- major medical interests concernin- issues and problems which face the flect this prevailing pattern by stress- the means being used to achieve th'e Regional Medical Programs as they Re(yional Medical Pro,,rams Z, ing the voluntary, cooperative nature objectives of the program. The im- seek to achieve the ultimate purposes and the General Problems of the Regional Medical Programs. portance of this consensus gives spe- of the Law. The prospects for proo,- of the National Health Scene These programs, therefore, face the cial significance to the progress ress toward the objectives of the legis- challenge of influencing the quality already achieved in establishing what lation and the rate of that progress The 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 against the magni- Nation have generated immediate activities. To achieve its objectives, Evidence of this progress is con- tude of the challenges. Thus a clear issues for the conduct of Regional each Regional Meaical Program will siderable. However, it is still too early understanding of the issues and prob- Medical Programs. These 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 are to evaluating the initial progress de- They have affected and will continue of a variety of medical institutions, faced with difficult decisions. The scribed in the report. This under- to affect the manner 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 conclusions drawn and recom- to better health. sensus on the distribution of special- that thegoals of the Regional Medical mendations made, ized facilities and manpower required Programs could not be achieved in a Some of these issues and problems Voluntary to meet the needs of heart, cancer voluntary medical system without the are derived from the particular char- Health System and stroke patients at the most rea- progress toward the necessary con- sonable cost; determining the char- sensus that is now underway. acteristics of the health care activity Health activities in this country are acter and conduct of continuing edu- Leadership is obviously of vital im- in this country and the dynamics of predominantly private and vojuritary cation programs that utilize the portance in achieving voluntary co- its growth and change. Other issues in nature. With some exceptions, such resources of both University medical operation. The I.,aw does not specify derive more specifically from partic- as treatment of the mentally ill, the centers and community hospitals; and the source of leadership for the Rc- ular provisions of Public Law 89-239. medical program of the Veterans Ad- applying technological innovations gional Medical Programs. This has These latter problems have special ministration, and the care of indi- such as techniques for diagnosis and permitted leadership to develop in a relevance to the policies already de- gents, most medical care in the patient monitoring using centralized variety of ways. Flexibility in the veloped and bear directly on the rec- United States is not a direct govern- computer facilities. choice of the leadership focus has ommendations for its extension an I mental responsibility. Recent years a have seen a rapid rise in the provi- Such decisions must be made within been cited by several regions as a key modification. Many of these issues sion of public funds for a broad range the rc-gional setting. Indeed they are to achieving the necessary consensus and problems are interrelated in a of health activities; however, the already being made by many of the of the major health interests. This complex manner. They reflect the terms.and conditions under which Regional Medical Programs. To do flexibility, however, carries with it the general problem of reconciling na- these funds are provided have sought so in the context of the voluntary risk that decision-making mechanisms tional needs and objectives with the to preserve the voluntary and private medical system, the Regional Medical may develop which are not strong values, patterns of action and the nature of United States health care. Programs must establish and main- enough to deal with important pr(>b- 21 is and issues. For this reason the ety of patterns of medical care. A arrangements will survive in a vol-. a period characterized by shortages 'iew of grant applications is con- program concerned with the wider untary form. of health manpower necessary to ned not only with the development availability of advances in heart On the one hand both patients provide high quality health care to workable cooperative arrange- disease, cancer, str@, and related and health resources will need to an expanding population. The Pub- nts but also with the effectiveness diseases %vill inevitably Encounter the recognize that the Regional Medical lic Health Service has assumed a decision-making mechanisms and full range of this complexity. Thus Programs cannot solve all the prob- major role in assisting in the expan- der.-b-,p. the facts of this size and complexity lems in these disease fields. Neither sion of the supply of trained health raise many problems for the devel- can they become a mechanism for manpower. This is being done p 0 zgnitude and Com lexity opment of the Regional Medical paying for each medical institution's through many proorams including Our Total Health Resources Programs. priority needs identified on an iso- construction of training facilities, The diversity of health resources, lated basis. scholarships, training grants, and Lother characteristic of health ac- together with the relative lack of On the other hand each Regional other forms of training support. ities in this country vvhich compli- organized relationships among them, Medical Program will need to de- However, most of these programs s the development of any new presents each Regional Medical Pro- velop a plan which illustrates both to have been implemented in the last al,th program is the magnitude and gram with a formidable task in es- the potential participants and to their several years. Their impact in terms tablishing regional cooperative ar- .nplexity of the health resources. patients, the rationale for selection of of increased training capacity is only ch gross statistics as 288,000 active rangements and carrying out priorities and phasing of program. It begining to be felt. Meanwhile the ysicians, over 600,000 nurses, 7,000 operating programs. As a conse- will need to generate confidence in needs continue to increase and are spitals, 100 schools of medicine (luence planning will involve the the fairness and capability of the de- accelerated by the implementation of d osteopathy, and a total annual establishment of priorities of action cision-making process for making the large scale programs of health care alth expenditure of approximately and careful phasing in the develop- necessary program determinations, financing such as Titles XVIII and 3 billion give some indication of ment of the program. Selectivity and and the relevance of program plans XIX of the Social Security Act. e magnitude of the total health phasing are made necessary by limits and activities to the needs of the Manpower shortages are relevant deavor. The ultimate goal of Re- on resources, other institutional com- people in the entire Region. to the Regional Medical Programs )nal 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 . impact on the health of patients ance by health personnel, and the the Regional Medical Programs being constraint on the rate of implemen- reatened or afflicted with these importance of careful testing of new planned and established will meet tation of some program activities. ;cases. Its accomplishment will mechanisms. This necessity for phas- these tests. There is early evidence, This is already being reflected in the entually involve a staggering num- however, that initial steps are being r and variety of health resources. ing, however, will place strains on the taken which will enable the Regional difficulties some regions are expen- 'f'o the iiiagnitii(l(.s of this tinivers(,. arrang.ciiicnt,; for the Voluntary co- Medical Programs to (lo the job. encing in acquiring the initial plan- for (II(- Is ke(-Il ('01111)Ctitioil (oilll)lf.xily (,I, ill- casing sliecializatioii of personnel Uiil(-ss 1)ai'Lici- Manpower id facilities, acceleration of change pants in the program accept the Limitations leadership capabilities. The man- the nature of medical practice due necessity for selective action and power constraint also applies to the the advances of science, social phased development, it seems un- The Regional Medical Programs are setting of priorities and the rate of id economic changes, and the vari- 'likely that the regional cooperative being planned and carried out during progress of operating activities. This 22 constraint has been cited by some of gional Medical Programs may con- Medical Programs will have to de- current data and techniques. How- the Regional Medical Programs as a tribute to development of new ways to velop and modify techniques as the ever, useful approximations can be major factor in establishing priorities use health manpower. Applications of programs are initiated. They will not developed in some areas. The tech- for action. these analytical and management be able to rely entirely upon estab- niques of operations research and Manpower limitations also affect tools are already under development lished data-gathering and analytical systems analysis being used by some Regional Medical. Programs by in- in a number of regions. The Regional mechanisms. Initially, the assessment Regional Medical Programs can be creasing the relative emphasis given Medical Programs may create an en- of needs and the choice of program helpful in making these assessments. to training activities in both the plan- vironment and a mechanism for ex- strategies will depend heavily upon The major determinants of medi- ning and operational phases of the ploring many approaches to the informed judgment. Regional Medi- cal care costs seem to be beyond the Regional Medical Programs. Man- efficient use of health manpower, as cal Programs will need to strike the scope of Regional Medical Programs. power shortages are real, and high well as the opportunity to evaluate difficult balance between the initia- Nonetheless, Regional Medical Pro- priorities are being assigned to train- those new approaches under many tion of activities on the basis of in- grams can contribute to the efficiency ing activities to help meet these different conditions. The future formed judgment about effects on of program implementation and to a shortages. It seems likely therefore evaluation of the effectiveness of patient care, on the one hand, and greater awareness of the cost impli- that the emphasis on training i(,tivi- IZ(@gionii M(@(li(-al Programs sliotil(i II)(. of t))(. (]:It;l (,;Itlofl.,; of lttil)rov(,(l tif-S %Vill I)(- III III(, liilti;kl st;lgf,s lii(A@ 1);Is(. %vlil( II %Vill II,- than in later periods. 'I'his likelihood to the solution of these triatil)ower direction of effort based on ol)'ective needs, resources, and prograryi activi- could create the false impression that problems. analysis of experience. ties through a planninc@ process which the Regional Medical Programs are includes all major elements of the primarily training programs. Data Gatherinf, Increasing Cost health-care system; (2) develop- A third relevant aspect of man- and Evaluation of Medical Care ment of cooperative decision-making power limitations could be the as- frameworks that may speed accept- signment of higher priority to activi- The lack of objective data and meth- The general public is deeply con- ance of efficient means of delivering ties which increase the efficiency of ods for using data may hamper the cerned about the rapid and continu- care; (3) opportunities to explore manpower utilization. These would launching of programs which require ous rise in the cost of medical care. and evaluate the usefulness of new include: (1) the development of new planning, selection of target objec- The Secretary of Health, Education technologies and new types of health tives, priority setting, and evaluation and Welfare has indicated the personnel which will contribute to the techniques for diagnosis and treat- of effectiveness in terms of the ulti- importance of due attention to more efficient improvement of the ment that increase the productivity mate objective of better health for moderating the price of medical care quality of patient care. The Regional of existing manpower; (2) the devel- persons threatened with heart dis- in developing Regional Medical Pro- Medical Programs will need to make opment of new types of manpo@er - I ease, cancer, stroke and related grams. The measuring of cost against cost analysis an integral part of pro- and (3) the more efficient division of diseases. Techniques are not highly benefits is very difficult in health gram planning and evaluation. labor among different levels of man- developed for acquiring and analyz- care. Inadequate knowledge of the power and among the several parts ing data which provide the basis for effects of changes in alternative Regional Diversity of the regional framework. The use measuring cause and effect in terms methods of diagnosis and treatment of operations research and systems of improved patient care. As in many render an accurate cost- benefit as- The diversity of this Nation is re- analysis in the development of Re- other areas of activity, the Regional sessment practically impossible with flected not only in the health problems 23 and resources but also in the patterns Consequently, the development of At the same time it must preserve a appropriateness of this flexible ap- of medical care in the various Re- effective cooperative arrangements meaningful and continuing policy proach. Comparative evaluations of gions. The problems and appropriate has been especially difficult in the role for the Regional Advisory Group specific program accomplishments responses in a sparsely settled rural largest cities. It has proved more with its broadly representative base. over a period of years offer the op- area with difficulties in attracting difficult to develop a meaningful The multiple administrative patterns portunity to refine techniques and physicians and transporting patients focus of leadership which can pro- which are emerging in the regions approaches. over long distances are very different vide the basis for cooperative action. would seem to be an appropriate re- ISSUES ASSOCIATED from those in the crowded metro- The juxtaposition of great resources sponse to diverse situations. The WITH THE LAW politan areas with both great con- and great needs not only creates sig- effectiveness of the various patterns centrations of medical resources and nificant opportunities but also gen- remains to be tested. How the various pressing needs, particularly in the erates real tensions. The mechanisms Regions manage to cope with their Understanding core city slums. which evolve for the metropolitan diverse situations will probably bring Program Purposes Perhaps because of the relative areas may prove to be quite different about a different rate of development From the time the legislation to au- simplicity of the medical resources, from the more simple models appro- of Regional Medical Programs and thorize these grants was first intro- Regional Medical Programs seem to priate for less complex Regions. Vol- will lead to wider variations in the - untary cooperation in such an urban approaches developed by the various duced in January 1965, there has be developing more rapidly in pre environment will be put to a stem regions than would be appropriate been some misunderstanding about dominantly rural areas and smaller were the nature and purposes of the pro- cities. Paradoxically, it has been test. Planning for Regional Medical if the patterns of medical care gram. This misconception was based particularly difficult to develop the Programs is now underway in all more uniform throughout the Nation. initial steps toward effective Regional these areas, however, and the new This diversity, and the develop- largely upon the mistaken idea that Medical Programs in the metropol- patterns of relationships and respon- rnent of appropriate strategies in re- the objective of the law was to build itan areas where the greatest con- sibilities are being explored to over- sponse to diversity, make more a national network of Federal centers centration of medical talents and come these special metropolitan difficult the communication of a gen- to give care to heart disease, cancer, facilities is to be found. Their added problems. eralized concept of a Regional Medi- and stroke patients. To help clear up complexities begin with the large The Regions are now facing the cal Program. They complicate the this misunderstanding, the Congress populations to be served. They in- challenge of creating under these development of responses to needs made changes in the legislation to erceived at the national level. They further emphasize local initiative and clude also high concentrations of diverse circumstances an administra- p disadvantaged groups. These com- tive framework which not only serves hamper the widespread use of new involvement of practicing physicians, plications are multiplied by the large the objective of regional cooperation techniques and approaches devel- community hospital administrators, numbers of institutions, including but also provides sufficient focus of oped in one set of circumstances. and the many other relevant interests medical schools, hospitals, and other administrative responsibility to per- On the other hand this diversity including the public. health agencies and their long-stand- mit effective decision-making and is one of the strong arguments for In spite of these efforts to clarify ing habits of autonomy and even program operation. This framework the flexibility in the provisions of the understanding of the purposes rivalry. Added to these difficulties are must provide sufficient authority and authorizing legislation. Given the and mechanisms of the Regional the multiple social, economic, and responsibility for good management facts of this diversity in the early Medical Programs, fears and misun- political complexities that charac- by the full time program staff with stages in the development of the pro- derstandings were a major impedi- terize modern urban life. day to day operating responsibilities. gram, it seems too early to reassess the ment to be overcome in initiating the 24 Programs. Speeches, articles, and the lated diseases." These disease prob- diseases. The approach is practical- needed for educational purposes Program Guidelines issued by Divi- lems, which cause more than 70 per- are the activities to be undertaken an which are basic to specific educa- sion of Regional Medical Programs cent of all deaths in the United States inte(yral and essential part of a tional programs for heart disease, emphasized the utilization of exist- and afflict millions more, constitute coordinated effort to advance the cancer, stroke and related diseases. ing institutions and manpower re- an appropriate nucleus for the devel- attack on heart disease, cancer and Moreover, the cooperative arrange- sources, the participation of prac- opment of effective broadly based stroke and related diseases? Review ments and relationships initiated ti@n I I I .111 1)livs'c'.tns, tli(, for ?-(-.@ionil IZ(@i 'oyi;il Prof@riij)s ilill)l(-Ill(-Iltlttioll ;It tll(, l@(.(-;ttls(! of- (II(. ti-t-ii)(.Il(lotis s(@ol)(! of A(Ivisoi-y (;t-()til)s :tii(I ili(- N;t(l()ii:tl I)]()Vi(l(- III(.t.ll;illisllls tli;tt Slioill(I 1)1- regional level, the (-ool)eration of all these disease problems, they have a Advisory Council on Regional Medi- useful in dealing with other health major health interests and the ulti- ma'or impact upon the total range of cal Programs and related tccflnical T)roblems. If regional cooperation is mate common focus of all activities personal health services. To plan ef- committees, evaluate applications effective in meeting problems of heart on improving the care of patients. f ectively for heart disease, cancer, and against this standard. disease, cancer, stroke and relate Progress in understanding has been stroke, and related diseases, it is Regional reports indicate many diseases, it can also be useful made. However, tendencies toward often necessary to consider the entire activities supported under and 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 have personal health services. For example, gional Pro(,rams will contribute to rams have already indicated an in- 0 9 made it more difficult to overcome effective programs of continuing edu- other health goals. It would not terest in working on other health apprehension and suspicion. Clearly, cation must be based on broad be possible to achieve the legisla- problems, enlisting other sources of the initial achievement of trust and analyses of the capabilities and inter- tive objectives efficiently if attempts support for this work. its reinforcement through action is ests and attitudes of medical and were made to sort out the frac- an essential ingredient of success. allied practitioners toward all types tions of indirect effect. In some Definition of The steps taken thus far can be of continuing education activities; instances, activities which have a the Reaz'on judged successful in the context of only in this way can the particular more general impact extcn ing c- the difficulty of the task. It would be role and place of programs concerned yond the specific problems of heart, Public Law 89-239 provides consid- misleading either to underestimate with specific categorical diseases be cancer, stroke and related diseases crable latitude for the definition of this difficulty or to assume that the determined. may need to be supported because cc regions . . . appropriate for carry- programs can be carried out without The criteria governing the award they are essential to the achieve- ing out the purpose@' of the Act. However, the Surgeon General has a significant level of common under- of a Regional Medical Program grant ment of the purposes of Regional the responsibility for insuring that all standing. It is expected that under- are whether or not the activities in Medical Programs. Without the full parts of the country are served and standing will grow through experi- the program are necessary for achiev- support of these basic activities that inappropriate overlap is avoided. ence in working together. ing the established statutory objec- by Regional Medical Programs, im- An early policy decision was to tives and whether they reflect a portant underpinnings of the attack place initial responsibility for delin- Categorical Nature coherent whole centered upon ad- on heart disease, cancer, and stroke of the Program eatin- the "Regions" upon local vancing the quality and availability and related diseases would be missing. groups developing the planning appli- Public Law 89-239 is directed at of services in the areas of heart An example of this situation is the cations. It was foreseen that many "heart disease, cancer, stroke, and re- disease, cancer, stroke and related financing of personnel and equipment considerations would need to be 25 taken into account in arriving at tionships. It seems likely that a num- In the development of many of which have been accustomed to a these decisions, and that their rcla- ber of l@cgions will be modified. the applications for planning grant considerable degree of autonomy. tive weight would vary in different No single definition of a Region can funds, participation was largely con- Achieving wider participation and areas. The Program Guidelines pro- serve all of the program's purposes centrated in this limited group of communication also requires in some vided that the Regions should be: with equal effectiveness. Therefore, leaders because of the necessity to cases the modifying of attitudes based "an economically and socially cohe- determination of any Region is a work out the initial acceptance of on prior experiences, misunderstand- judgmental balancing of benefits and regional cooperative arrangements ings of the purposes of the program, save area takz'ng into consideration such factors as present and future liabilities. Consultation among among representatives of the major and fears of domination and control population trends and patterns of neighboring Regions, as between Mis- health interests. However, the award by the large medical centers. In some OLiri and Kansas, helps to identify of planning grants has provided the regions the split between "town" and I-rowth; location and extent of trans- IC portation and communication facili- the most effective division of rc- funds and staff time to mount con- gown," frequently the source of past ties and systems; and presence and sponsibilities. In some areas it may be certed efforts to extend the scope of tensions, has to be overcome. The distribution of educational and health best for individual hospitals and participation. Reports from the Re- progress reports, however, present groups to participate in different as- gions indicate that programs and encouraging evidence that the pro- facillizi,,v and pro,,ram.@. 7'h(- ri,.@toll I 1)('('tS Of S('V('I-;Ll I)I'Ogl-.'I]IiS. III now 1)(@iiig (Iis(.Ilss(!(l gi-aiii is, in fict, bringing the zieces- shoiil.l bt- ftitictioti,,illy it 11(@ll, ('(@lillillillig fol. ill- with ol' I)(.;Iltll I)I.ol,(@ssiolls, %:try L, should follozv appropriate i,xi.@t, .it tog(-tli(-r, lzegioii by IZe- tei,regional cooperation will rich) to institutions, and members of the pub- gion. 'I'rue collaboration will gener- relationships among institutions and ally involve stress, trial and error for existing patterns of patient referral serve the effectiveness of individual lic at large through workshops, meet- and continuing education; it should Regions. ings at community hospitals, confer- each Region to arrive at the most encompass a sufficient population cnces with other local groups and suitable procedures and mechanisms base for eff ectlue planning and use of Achieving Wz'despread medical societies, and through State to meet its needs. expensive and complex diagnostic Participation conventions of health organizations. Role of the Regional and treatment techniques." However, in many Regions there Public Law 89-239 and its legisla- Advisory Groups It was recognized that original defini- tive history emphasize involvement still remains the substantial job of tions would necessarily be prelimi- of medical centers and practicing reaching many interested health The composition 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- ceived considerable attention both finements in criteria and changing view conditions. the active participation of the medi- power and time have not yet per- within the Regions and in the re ' cal schools and the leadership of mitted sufficient investment in the of grant applications. This concern is Therefore, one principal objective physician organizations. The statu- complex and time-consuming activity justified by the attention given in the of the initial planning is a more precise definition of the preliminary tory requirements for membership on of developing new mechanisms for Law and the legislative history, which planning ReLrions. The award of the the regional advisory groups has ex- cooperation. The pace of progress is stressed the importance of these echanisms for both planning grant has been the begin- tended participation to leaders of slowed by the frequent lack of expe- groups as in monitoring the effec- ning of the effort to determine the other major health organizations and rience in working together on the achieving and iveness of regional cooperative ar- most appropriate current interrela- agencies. part of organizations and institutions t 26 rangements in meeting the needs of of keeping current increasingly diffi- Programs are to help the medical pro- Continuing Education the people in the Region. The Law for Patient Care cult for all involved in health care. fession and the medical institutions requires that these groups be broad- Regional Medical 1'rograins are pro- of the Nation ryiake available to their ly representative of the major health Continuing education is an essential viding new opportunities to develop patients "the latest advances in the resources of the Region. It also insists component of Regional Medical Pro- the essential linkages between edu(@.a- diagnosis and treatment" of heart that members of the public familiar grams. It contributes in a most direct tion 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 interpre- Law makes their approval of applica- Regional Medical Programs. Im- solescence which is the inevitable tation of this section would seriously tions for operational grants a condi- provements in patient care require consequence of rapid scientific ad- hamper the cffective accomplish- tion of Federal grant support. the primary participation of prac- vance. Studies of better ways of pro- merit of the purposes of the pro-ram. To carry out the full intent of the ticing physicians and other members viding health services, demonstra- Improved health for patients th@reat- Law, the Program Guidelines and of the health team in their daily prac- tions of patient care, and educational ened or afflicted with these diseases the National Advisory Council have tice. Therefore, if the advances Of and training for all types of health requires emphasis on prevention stressed the importance of the con- biomedical research are to be made personnel are joined together in a and rehabilitation as part of diagnos- tinuing role for the Regional Advisory available to patients, the means must unified effort. In continuing educa- tic and treatment processes. It re- Group and the necessity for independ- be provided continuously to update tion, as in other components of the quires dissemination and widespread ence of its functions. As evidence that the performance of all health profcs- program, attention is focused directly use of all relevant knoxviedge in the advisory group is performing its sionals and supporting personnel. on the question, "Will this effort order to a(-Iiieve the benefits of the role and is not a pro forma or sub- However, Regional Medical Pro- change behavior and will this change "latest advances." servient group, an annual report is grams are not exclusively nor even result, in fact, in the patient receiv- The Public Health Service has required from the Advisory Group primarily a continuing education ef- ing the benefits of advances in heart encouraged the Regions to consider itself giving its evaluation of the ef- fort. Continuing education is one of disease, cancer, and stroke?" health functions as a continuum and fectiveness of regional cooperative a number of means of working to- Progress reports show Regional not a set of isolated functions. This arrangements. ward their total objectives. Coritinu- M(.(Ii(..Il IIIogt..Ittls I)I'ovill.@ to 1)(' (,ollt,lltllllll ilivol\"(.% tll(. (.Flvll,ofllll(,Ilt The importance and composition ing education projects, no matter how a strong catalyst to the entire feel(] of rsearch and t(,aclitng, where. the of these Advisory Groups have been. meritorious, are supported from Re- of continuing education and training latest advances in diagnosis and given further attention in a recent gional Medical Program grant funds of the health professions. Thev are treatment are most readily intro- policy statement of the Secretary of only when they are part of integrated, providing mechanisms for the coop- duced, as well as the other institutions the Department of Health, Educa- comprehensive ap.preaches of en- crative relationships that can make and groups involved in preventing tion, and Welfare on "Medical Care (-otitintiing (-(Iti(-atioti irior(@ (@ff(-.(-tive Prices." This policy calls for special li@iii(-iiig r-(-glotiti (-al)al)illty foi- tti(! ill , .11 ;in(] for vl(-tirns of these emphasis to be given to adequate and diagnosis and treatment of heart ilill)l.ovi g patient diseases. 'I'o over(-,oziie existing gaps, effective consumer representation in disease, cancer, stroke, and relate(] Latest Advances in it is necessary to overcome problems the administration of Regionall Medi- diseas@s. Diagnosis and Treatment of organization, distribution, man- cal Programs. The Regional Advisory The accelerating rate of advance power, cost, attitudes of the public or Groups are a logical locus for that in the biomedical sciences and re- Section 900(b) of Public Law @39- the health professions and evaluation representation. late(i te(-Iiiiology makes the problem 23() states tliit the R(@.gionif M(-(Ii(-;il of tli(- (-ff(-(-tlv(-n(-ss of ;1(7tivities In 27 changing the health status of the and serious commitments of institu- "that attainment of this goal depends ning. A diversity of patterns and population. tions and personnel. on an effective partnership, involving priorities, determined by the people close intergovernmental collabora- of a Region, State, or community can Limitations on Institutional Relationships to tion, official and voluntary efforts, help to match programs to particular and Personal Commitments Other Pro,rams and participation of individuals and needs. No master plan imposed by a organizations; central authority can be sensitive A practical issue is raised by the The great trends of accelerating sci- "that Federal financial assistance or responsive to the multiplicity of initial authorization of the program entific advances and rising public must be directed to support the mar- local conditions and requirements. on a 3-ycar exploratory basis. If the expectations in health have gener- shallz'ng of all health resources-na- Planning is to aid foresight and ra- program is to succ(-c(l, institutions ated many new activities and pro- tio?ial, State, and local-to assure tioiial action, not dictate solutions. and or anizations must commit them- grams to stimulate and support con- The second is that decisions in- 9 cortiprehe?zsive health services of high selves to participation in regional co- ccrted action for health across the quality for every person, but without volving health involve the whole of operative arrangements which may Nation. Regional Medical Programs society, not just a few public or pri- involve some lessening of their inde- are part of the response to these interference with existing patterns of vate agencies. Rather all those af- pendence of function. Many of these forces. Other major actions relate to private professional practice of med- fected by these programs-providers institutions are under continuous financing the costs of medical care, icine, dentistry and related healing and consumers, public and private arts." financial pressures. Full commitments education for the health professions, The many and diverse health pro- groups, educators and practitioners- to new patterns of relationships in- delivery of mental health services in grams, both nationally and in the Re- must participate actively in decision volve changes in attitudes. For these the community, strengthening public gions States and communities, all making. Division and fragmentation reasons it is very difficult to obtain health services and planning and con- impair progress and effectiveness. this full commitment on the basis of struction of hospitals and other contribute to these goals. However These two principles are demon- a limited authorization of the pro- facilities. various thrusts must be interrelated strated with special clarity in two gram. In the preamble to the most recent to achieve maximum impact and ef- major new Federal programs designed fectiveness. Utilizing resources wisely Similar problems apply in recruit- of the major Federal enactments, the in the many promising avenues of to pull together a number of efforts ing talented manpower. High caliber Comprehensive Health Planning and health activity calls for planning and whose impact has been diffused in the people are reluctant to make career Public Health Services Amendments cooperation at many levels and the past: the Regional Medical Pro- changes when the permanency of the of 1966 (Public Law 89-749), the recognition of the preponderance of grams, and the Comprehensive program is under question. The de- Congress made the following state- nonfederal financing for the total Health Planning Program authorized gree of commitment already achieved ment of national health purpose: health function. by Public Law 89-749. The first seeks in the initial phases of the program "The Congress declares that fulfill- Two fundamental principles, both to stimulate the development of co- is the basis of hopeful expectations. ment of our national purpose depends implicit in the Congressional declara- operative arrangements for programs However, it will be difficult to obtain on promoting and assuring the high- tion of purpose just cited, govern the directed toward enlarging the avail- a valid trial on which to base judg- est level of health attainable for every Federal participation in health pro- ability and enhancing the quality of ments of the ultimate effectiveness if person, in an environment which con- grams. care provided for major disease prob- the nature of the program authoriza- tributes positively to healthful indi- The first is a commitment to local, lems on a regional basis; the second tion does not encourage voluntary vidual and family living; broadly based initiative and plan- seeks to stimulate effective planning 28 for the use of all existing resources Cancer Institute, National Institute program with other activities sup- Federal grant funds, while they and the sound further development of Neurological Diseases and Blind- ported pursuant to the authority con- can provide only partial support, of health resources by the States, ness, National Institute of General tained in the Public Health Service must be adequate to stimulate the metropolitan areas and local com- Medical Sciences, National Library Act and other Acts of Congress in- continuing technological and social munities. The two programs are in of Medicine, National Center for cludin those relatin to planning innovations to translate the latest 9 9 concept complementary and mutually Chronic Disease Control and the and use of facilities, personnel, and scientific advances into the daily supportive. National Center for Health Statistics. equipment, and training of man- practice of medicine at the commu- A policy statement has been issued Working relationships are being de- power." nity level. The "venture capital" for concerning these two programs which veloped with the new Bureau of such.innovative efforts must, in large outlines general areas of relationship Health Manpower and plans are be- Relationship Between Federal measure, be supplied initially from and support. (Exhibit XI) Practical ing made for collaboration with the and Nonfederal Financin, public funds. The potential return is operating methods under these con- proposed National Center for Health hi,,h and will accrue to individuals cepts are now being refined. Dis- Services Research and Development. Regional Medical Programs can throughout the Nation. A relatively cussions are taking place through- Similar cooperation is being devel- serve as an integrating force to bring small amount of new money, wisely out the country, at the levels where oped with agencies outside the Pub- to bear all the resources required to and flexibly al)j)li(-(] and fully coordi- the coordination must be put into lic Health Service, such as the Voca- reduce the toll frorii heart disease, nated with related efforts, can help practice. These are the most critical tional Rehabilitation Administration, cancer, stroke and related diseases. assure that benefits from the "cutting decisions of all, for, as Secretary the Veterans Administration and the Grant funds under Public Law 89- edge of science" are realized both Gardner has pointed out: "We are Department of Housing and Urban 239 will necessarily provide only a now and in the future. beginning to understand that much Development. This partial listing of very small fraction of the total funds As noted previously the impact of the problem of coordination must the programs whose missions relate necessary to meet all the identified of this program on medical care be solved at the local level. If the to that of the Regional Medical Pro- needs. The costs of these diseases costs has yet to be ascertained. If Federal Government tried to coordi- grams is an indication of the magni- constitute a large portion of the Na- the benefits of this pro-ram do result nate all its programs at the Washing- tude of the coordinating task. tion's $43 billion health care expendi- in warrantable additions to health ton level, it would end up imposing a The need for and responsibilities tures. The full application of medical services costs, the extent to which pattern on State and local govern- of Regional Medical Programs to scientific advances in the diagnosis such costs can be met by normal ment. More important, only State and identify the most effective ways of and treatment of heart disease, can- financing methods versus direct Fed- local leadership has the knowledge linking programs at the regional level cer, stroke and related diseases will eral support throu-h Regional Medi- of local needs and resources that will require additional support from many cal Programs will require careful enable them to put all the programs are emphasized in the Program Reg- public and private sources. Regional examination. together in a way that makes sense." ulations and Guidelines. These indi- Medical Programs will in fact provide cate, that in awarding grants, the Arrangements are being made to Surgeon General will take into con- only a minor share of financing for The Role of insure close coordination between the full ran,,e of activities relevant Unz'versi'ty Medical Centers Regional Medical Programs and sid@ration "the extent to which the to accomplishing the purposes of the other Federal activities. Continuing applicant or the participants in the Law, even though formal matching Public Law 89-239 does not specify liaison is maintained with the Na- program plan to coordinate or have requirements are limited to construc- the role of the university medical cen- tional Heart Institute, the National coordinated the regional medical tion aspects of the programs. ters in the development of Regional IL'Y Medical Programs. Yet the nature of total health resources of the Region cooperative program; (4) the estab- from the increasing sophistication and the functions to be carried out by the with an ultimate focus on improving lishment of new nonprofit corpora- experience gained in the course of Regional Medical Programs has the quality of patient care. tions with boards of directors rep- full program operations. Others will made the university medical centers a Since university medical centers resentative of the major health require further evolution of national vital resource in most areas for ac- have played prominent leadership interests and having as their major health policies and attitudes. Certain complishing the objectives of the roles in the initial development of responsibility the planning and ad- are dependent upon clear executive Law. In many Regions the university most of the Regional Medical Pro- ministration of the Regional Medical or legislative action and form the medical centers have played leader- grams, these concerns about diver- Program. basis of the recommendations con- ship roles in initiating the develop- sion, dominance, and administrative The creation of new administra- tained in the following section. ment of the Regional Medical capacity deserve careful attention. tive structures outside of the univer- Programs. Solutions to these problems require sity medical center framework, as de- Some medical leaders have seri- new forms of relationships between veloped in a number of Regions, seem ously questioned whether the uni- the university medical centers and to offer a most attractive solution versity is an appropriate focus for the other health resources of the to the problems noted. These new en- the leadership of these cooperative Regions. tities, however, create other problems efforts. These doubts are raised from related to the provision of sufficient several points of view: (1) Some Coordination and Leadership status and stability to attract the high medical school faculty members and caliber personnel _required for the administrators have concerns that Various mechanisms are being planning and administration of the Regional Medical Program respon- tested for administering and coordi- Region Medical Programs. If these sibilities might divert medical school nating regional efforts: (1) the de- innovative approaches to the admin- resources from carrying out their velopment of new administrative istration of cooperative health activi- teaching and research functions. (2) frameworks within the university and ties prove effective, they may be a Other health representatives have ex- formalized administrative relation- useful mechanism for broader health pressed concern that medical school ships with the other primary health purposes. They may, in fact, provide leadership will result in domination resources; (.2) the use of executive a useful prototype for relating the re- or absorption of other health re- coordinating committees representa- sources of the university to broader sources by the medical schools to tive of major health interests which sociaJ needs without undue diversion serve their educational and research can serve as decision-making bodies of the university's attention from int(-r(!sts. (3) Qii(-stioris liav(- 1)(-,(-,n (-Ios(-Iy r(-Iat(@d to day-to-day operat- functions of teaching and research. raised from many sources about the ing problems, reserving for the large capacity of university medical centers Regional Advisory Groups a more Regional Medical Programs will to expand their administrative general advisory and policy-making continue to contend with this array of frameworks to encompass the plan- function; (3) the utilization of exist- problems listed, as they continue ning and administrative implementa- ing nonprofit corporations as frame- their development. The resolution of tion of a major effort involving the works for administration of the most of these matters will derive 268- (;-I') 0-4;7-:' Conclusions and Recommendations 3@U I IkJiN JE I V -E Conclus-lons and Recommendations On the basis of the initial experience operative arrangements. These initial about the Regional Medical Program A 5-year extension should attract in the implementation of Public Law efforts require an environment of concept. Most have been reassured on the long-term commitment of the 89-239 certain conclusions and rec- stability and status in which per- the value of this approach as major kind and quality of people, and ommendations are indicated. manent effective cooperation can regional interests have come together the full participation of all affected flourish. to determine locally the most appro- institutions which are essential to the CONCLUSIONS @ The initial progress provides solid priate and effective ways of moving program's success. This requirement n An effective beginning has been evidence for continuing the program the program forward in their Regions. calls for an authorization that, in both 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 effort until the 'ob is sources on a regional basis for im- A more effective means for meet- ning, decision-making, initiative, and done. i plementing the purposes of the Law. ing the special space needs generated capabilities to meet the needs of Funds for Regional Medical Pro- The regional cooperative arrange- by this program is requisite to the full patients with heart disease, cancer, grams can be a critical factor, even ments being established and the plans achievement of the purposes of the stroke and related diseases can be though they are only a small fraction 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- benefits of the advances of me@ical RECOMMENDATIONS planning have reported that uncer- lated diseases. For these funds, effec- science to persons threatened or af- tainty about the program's future is a tively used, can be a fulcrum in rais- fficted with heart disease, cancer, Extension of the Act 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 As discussed in the earlier sections of Fl The Regional Medical Programs key staff positions. Some institutions significantly enhancing the diagnosis will be seeking to accomplish their the Report, the sum of experiences in and agencies have been reluctant to and treatment of these diseases. mission during a time when many the development of Regional Medi- embark upon a course of action, what- Experience gained thus far indi- major problems beset our health pro- cal Programs throughout ihe country ever its promise and potential, with- cates that the annual cost of operation fessions and institutions. The Rc- demonstrates the validity and poten- out reasonable assurance that the for each Regional Medical Program gional Medical 1'rograiiis seeiii to tial of th(-s(-. new cool)erativ(- -.tr- I)rogi-;ttii will 1)(! (,oiitiriti(@(l. iiity I)(- is ilitl(.Il Is $10 illilliot) ot- provide a relevant and useful tool in I-itlig(.Illcl)ts ill both planning :iii(I l'ore, extension of the I)r-ograiii will more. 'I'here are several bases for this the search for better solutions to action. The needs are pressing and prevent a loss of momentum and estimate. The initial operational the opportunities promising for mak- these health problems. ing available the benefits of medical enthusiasm already achieved and will grants and the plans being developed Fl The extension of this program research advances. The establishment provide a firm basis for strengthening around the Nation indicate that there and the indication of substantial of the Regional Medical Programs as and building upon the beginning are myriad opportunities for improv- further national support are needed, continuing instruments in the health efforts. The importance of this ing the diagnosis and treatment of to sustain and nurture the individual field will 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 mated. medicine in all parts of the Nation. 33 The number of potential partici- facilities. It thus identified the need obtained from Regional Medical , Pro- lag between identifying a need for pants-institutions, groups, agencies, for facilitating construction in the gram Coordinators and key staff, Re- construction and the availability of and health personnel-is very great. successful development of Regional gional Advisory Group Members, and the facility is so great, this competi- All must contribute if the benefits of Medical Programs. others involved with these programs tive position might seriously delay the the programs are to be widely avail- In enacting Public Law 89-239, at the regional level indicates that implementation of the Regional 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 technologi- ing and renovation of existing build- years as Regional Medical Programs consideration during the general ex- cal innovation entailed by many ings" (luring the initial period of move into the operational phase and 1)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 will the activities This equipment will advance clinical, of the House Committee on Inter- The likelihood of significant limita- represented by them become an communication and computing serv- state and Foreign Commerce stated: tions on Regional Medical Program integral part of the functions of the ices. Many technological innovations "The lack of this authority for new activities from space shortages is medical institutions of the Rep-ions-. should be rapidly introduced to bring construction should create no serious increased by the overwhelming de- F-1 Space for contz'nuing education to patients the benefits of the ad- problems during the three years au- mand for new health facilities gen- programs and training purposes is vances. 'I'his will require effective re- thorized in this legislation and when crally in the years immediately urgently needed, includz'ng class- gional planning with the cooperative a request is made for extension of ahead. The demands of an expanded roo?tis and confer(!nce room space, involvement of full-range medical this legislation in the future, the com- population and its desires for high resources. It will also require sources mittee will review this question quality medical care, the expansion learning center facz'lities, and medical reference and audiovisual facilities. of funding to be spent on the basis of again.)' of medical education facilities, and 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 Regional Programs and to compete with pressing needs of the construction has not presented serious research facilities all indicate very othei- groups, such as the Association individual institutions. obstacles to the initial planning and great competition for funds to finance of Hospital Directors of Medical Edu- It is recommended that the pro- development of Regional Medical the necessary facility expansion. (,ation. It is particularly acute in gram be established on a continuing Programs. Thus, the early judgments The types of construction needs community hospitals. basis. of the Congress have been confin-ned. described below, defined according to Experience, however, has identified regional priorities, will have great dif- In the past there has been a paucity New Constructz'on of several areas in which authority to ficulty in competing successfully with of operational support in both com- Essential Facz'll'ties munity hospitals and medical centers assist new construction will be essen- the immediate and overwhelming tial to the full development of Re- construction needs to house ade- for continuing education activities. The original Administration proposal gional Medical Programs. quately the basic functions of the par- 'riie same situation has been true to the Congress in 1965 requesting Specific construction needs essen- ticipating institutions. Construction with respect to capital expenditures. legislative authority for Regional tial to the work of Regional Medical of facilities needed for the purposes Most of the Nation's 7,000 hospitals, Medical Programs included grant as- Programs have been more clearly de- of the Regional Medical Program is especially the smaller ones, simply do sistance for construction of new as fined and documented during the likely to be delayed until these urgent not have existing space that can be well as the renovation of existing initial planning phase. Information institutional needs are met. Since the converted or renovated for educa- 34 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 fuller 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 educa- tools and techniques for diagnosis and pital laboratory facilities. Such facili- request will need to be approved by tion programs without additional treatment. ties 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 thIe 1962 survey of Only if physicians and the other mem- supporting personnel. of the Region. This review and ap- the American Medical Association bers of the health care team learn how The establishment of integrated proval process will ensure that an to utilize these advances "by doing," excessive amount of attention and Council of Medical Education, con- and have the required facilities avail- data banks and communications sys- funds are not devoted to construc- tinuing education programs have not able to them at the community 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 terest of most medical schools; ac- continuing education and training patient records, etc., requires space for the benefit of any single institu- cordingly, the development of appro- afforded them, and bring to their to house the computer and communi- priate resources (including related patients the full benefit of their cations facilities. Similarly, television tion or group in the Region. facilities and space) was usually Most (@otrirnutiltv hospitals, niedi- learning. and radio transmission of continuing I neglected. Most community hospitals do not education programs will require new cal schools, and other institutions In both community hospitals and space and facilities. would have serious or insurmountable now have such facilities. In the case difficulties in raising matching funds medical schools, the pressures ot ns- of older hospitals, adequate provision Most Regional Medical Programs ing expenditures for direct patient was not made for the inclusion of arc undertaking inventories of exist- for construction of facilities needed care have made it impossible to such specialized facilities because the ing fa(,.ilitics for both educational and for (Continuing education and demon- allocate sufficient funds to the con- underlying advances which make si)(-.(-ializ(@l (@ar(@ activities re- stration essential to meet regional tiniiing education activities that arc tic(.cis. regional tiitture of tll(- continuing education a necessity 12it1iig to li(!art (liscas(-, (,.;tn(!er, stroke essential to high quality care. Th.us, today had not yet been made; ncwcr and related activities. planning program may make it especially diffi- the potential impact of continuing hospitals often were unable to in- cfl'orts are being closely (-.oor(linatcd cult for any individual agency to ob- education and training programs in clude sufficient space for these pur- with State and area-wide hospital tain substantial funds for this pur- heart disease, cancer, stroke, and re- poses because of limited funds (pub- planning agencies. Experience in ad- pose. The current matching require- lated diseases will be seriously ham- lic and private) available for initial ministration by the Public Health ment of 10 percent applicable to ren- pered unless essential facilities are construction. Developing these facili- Service of other recent programs, ovation and alteration of facilities, re- constructed. ties on the basis of regional planning such as the construction of cot-nmu- quires a local commitment without n There is a critical need for addi- will permit great educational impact nity mental health centers and mental impeding progress. A larger matching tional space and facilities for patient retardation facilities, has develo ed at minimal cost. p requirement at this time in the devel- care demonstration and training pur- patterns and procedures that can help opment of this pioneering new pro- poses. Intensive care units, radium n Some community hospitals have assure necessary coordination of therapy facilities, and specialized sur- need for additional space for new or effort. gram could be self-defeating. gical suites are, for example, often expanded diagnostic laboratory facili- The construction of new facilities It is recommended, therefore, that necessary in order to provide facilities ties. Both the introduction of new for Regional Medical Programs must adequate means be found to meet the 35 'eds for construction of such faciii- Service Act (Hospital and Med- with other Regions. Interregional co, R To help achieve compatibility in ,s as are essential to carry out the ical Facilities and Health Pro- operative efforts involving several communication networks and com- @rposes of Regional Medical Pro- fessions Educational Facilities Regions have already evolved in a puter systems. ams. Priority should be given to Construction Programs). number of areas throughout the uct joint epi- -ilities required for continuing edu R To plan and cond country. In some instances, these demiological and research studies. tion, training, and related demon- Support of Interregional and Other arrangements are still informal; in 'ations of patient care, particularly Supporting Activities others, interregional agencies are be- R To develop jointly common edu- community hospitals. ing established. cational programs and materials. In meeting these needs, the follow- The present Act authorizes grants for These interregional activities have R 'I'o orient and train staff person- considerations should be taken the planning and operation of indi- 1. arisen in response to real needs. Re- ne @o account: vidual Regional Medical Programs. gions have identified a number of A somewhat similar situation has 1. Construction undertaken for No consideration was given duiine been identified with respect to cer- Regional Medical Programs the development of the legislation to objectives that can be best served tain specialized needs common to all should be directly supportive of support for other activities which and activities carried out in this way. the operational programs and might contribute to the implementa- Among the principal potential bene- or a number of Regions. The support should be broadly distributed tion of the Regional'Medica.1 Pro- fits are the following: of a limited number of facilities and for maximum impact. This grams. These activities include both R To facilitate communications programs is needed to develop tech- cooperative efforts among several Re- niques and prepare personnel to might be done by (1) limiting gions and other activities supported among Regions, including exchange facilitate the work of individual Re- the amount available for con- centrally which make available to all of information on approaches to and gional Medical Programs. The sup- struction to no more than 15 problems in planning and program or several Regions specialized skills port of such activities in agencies percent of the total appropria- development. tion for operational activities; and resources which are not generally F-I To help in defining responsibili- that can serve a number or all of the .and (2) restricting grants for distributed throughout the Regions. ties and coordinating efforts in "in- Regions will avoid unnecessary delay such construction to no more The desirability for extensive co- terface" areas between Regions. and duplication of effort and make than $500,000 for any single operation among Regional Programs the best use of specialized facilities. project. was foreseen. However, the extent of R To foster consistency in ap- Central. support for these activities and rapidity with which cooperative proaches to the conduct of planning will enable the Division of Regional The special space needs of the studies. Medical Programs to make avail- program can be met either arrangements among Regions would able to some regions skills and re- through additional authority to develop was not fully anticipated. E] To achieve comparability in data sources which are not available with- aid new construction as part of Nor, in turn, was the corollary need collection and program evaluation. in the Region. This assistance at a grants for Regional Medical for additional funding for this pur- Fl To develop and apply better and crucial time in the development of a Programs under Title IX of the pose apparent. more comprehensive methods of pro- regional program could improve the Public Health Service Act or During the first year of the pro- gram evaluation. quality and accelerate the pace of the through other mechanisms, such gram, individual Regional Medical R To utilize more effectively skilled region's activities. as amendments to Title VI and Programs devoted considerable at- manpower, specialized facilities and For example, continuing education Title VI[ of th(,- Public II(-;tltli t(,ntiori to (-oor(linating their (efforts r(,..sotirc(,s. in(] training programs will require 36 significant numbers of specialized or demonstration activities carried out Region. The effectiveness of the pro- such an approach is identified as the professional personnel (e.g., educa- with funds appropriated pursuant to grams operated by Federal hospitals most desirable way to strengthen the tion specialists, communication 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 phy- and sharing of effort and resources in the case of all other projects pro- these categories of personnel are 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 legis- The Congress recognized and en- must be part of the overall regional limited. lation, a dental practitioner may as- dorsed this principle in enacting the program and will need to be approved There are also numerous studies sume 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, leaming theory and evaluation dentist and referred by him for treat- her 7, 1966. Among other provisions, It is recommended the Federal hos- affecting both continuing education ment and rehabilitation. It is desir- 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 erans 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 recommended that patients ing. of medical facilities, equipment gional Medical Programs. This modi- 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 Regions. These interre- cluded in research, training and hospitals, research centers and others. flexibility, discretion and capabilities gional efforts, too, will substantially demonstration activities carried out The Law required that, to the maxi- of Regional Programs. assist and expedite work of the indi- as necessary parts of Regional Medi- mum 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 with the original intent of the Regional Medical Programs. A some- 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 Med- --- legislation now pending before the ical Programs. This assistance will Funding of Activities Congress. facilitate the work and implementa- 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 facility incident to research, training, ment services to many residents of the be developed in these facilities when Regional Medical Pro ams in Action gr "One of the strengths of the bill is that it provides the flexibility neces- sary to accommodate the many differ- ent patterns of medical institutions, population characteristics, and or- ganizations of medical services found in this Nation." Excerpt from the., Report of the House Committee o@@iiiterstate,@,and@ Foreign Commerce @on@ H. R (P.L. 89-239) SUPPLEMENT Regional Medical Programs in Action Regional Medical Programs are best Collectively these reports reveal, in her 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 are these individual efforts and actions ever, there was need to plan for an 1966. presented. that Regional Medical Programs will Iowa Regional Medical Program. The goals which the Iowa Re- be more precisely defined and ulti- This prelimina planning involved aional Medical Program has set for r7 Four reports summarize what has ry mately will serve the needs of the Na- cooperation between the Medical itself, with the advice of the Regional happened in the plannin@ of the tion's medical professions, institutions Center and three other major health Advisory Group, are to: (1) aug- Iowa, North Carolina, Washington- and patients. planning groups-the Health Plan- ment present education and training Alaska, and Western New York Re- gional Medical Programs. They sum- ning Council of Iowa, a voluntary capabilities; (2) improve continuing maiize salient developments in the PLANNING GRANTS agency organized to coordinate state- education programs; (3) expand re- preliminary and initial planning Iowa Regional wide health care planning; the Coun- search programs; (4) broaden re- phases and the interaction among Medical Program cil on Social Agencies of Des Moines; gional communication to promote various institutions and groups that and the Des Moines Health Planning dissemination and interchanges of has occurred. 'riie Iowa Re-ional Medical Pro- Council. Other localities are also or- knowledge and techniques; (5) de- gram 0 ganizing planning groups that will velop programs for public education; Two reports indicate the nature @ like a number of others, is be related to the Regional Medical and (6) develop demonstration units of the initial operational activities of built on a significant base of past re- Program. and systems. the Intermountain and Missouri Re- gional activities. Extensive interrela- The Regional Advisory Group, To accomplish these goals, the Pro- gional Medical Programs. They high- tionships between hospitals and prac- designated to guide the expanded ef- gram has been organized into four light how these activities will benefit titioners have developed over the last fort now being embarked upon, is sub-areas: an Education Program, a the practicing physician and his 50 years. By an interchange of pa- broadly representative of all of the Research Program, a Comprehensive patients. tients, physicians throughout the Region's health professions and Patient Care Program, and a Com- [] In addition, excerpts are pre- State have become, in effect, inte- agencies. It includes the Dean of the munications Program. sented from the annual progress re- grated with the activities of the staff College of Medicine, the Commis- Within the Education Program, for Po-rts of the 10 Regional Medical Pro- of the University of Iowa Medical sioner of Health, Past Presidents of example, studies have been initiated grams for which the first grants were Center. Continuing education pro- the Iowa State Medical Society, to develop basic 2-year curricula for effective July 1, 1966-Albany (New grams have been developed over the Heart Association, Cancer Society post-graduate 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 cluded are 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 throiil-h a coordinated 'I'enncssee Mid-Sotitli, tii(I 'I'exas. (7tlit television (.(Itl(..Itiollill O.Stt-ol)lttlli(: I)IIYSI(.Itlls;tll(l Sillg(.()Ils, of tll(. (,oll(.g(- of M(!(Ii(@ill(- These excerpts provide further in- between the Center and a number of 1)(!ntal Associttioris, Nursing floTri(t tti(I regional hospitals, utilizing ]IV(, si tits into specific aspects of the Re- these hospitals. As a result it has been Association, Nurses Association, State conferences and video-taped mate- 9 I gional Programs. possible to move forward in a num- Department of Social Welfare, re- rials. Extension of this endeavor to 39 the community level for individu.als North Carolina the State, the University of North dental, nursing, pharmaceutical, and or small ,rotil)s of I)Iiysi(@i;itis using Carolina School of Public I-le@th other allied health professional as- It(-gioii;il Mc(ii(-,iii 1'rograiii kinescope presentations is also and the Medical Society of North sociatioiis, practicing physicians, the contemplated. In North Carolina, as in many other Carolina. It has adopted Articles of North Carolina Health Council, the Other planning activities or pro' Association, and established a Board deans of the three medical schools, a j- states and r@ions in the coun ects in the other program sub-areas !r@, of Directors which has been actively leading hospital administrator, and planning for regionalized meciicai have also been initiated. These in- work-in- with the Program Coordi- members of the public. They have and health pro-rams has been volve a number of different agencies nator and Advisory Council. met monthly since August 1966, and or groups. For example: tinclenvay for over twenty years. To provide leadershil) and overall have conducted intensive reviews of However, limited resources and other direction to its Program, North Caro- project applications. The loA,a State Department of local factors have resulted in incom- lina selected as Program Coordinator, Subcommittees of the Council have Health is planning program elements plcte implementation of these plans. Dr. Marc J. Musser, a physician with also been organized to focus on and which concern public health gener- Passage of the Regional Medi- extensive experience in medical edu- provide expertise in specific problem ally, professional and public com- cal Pro,ram Ic-islation provided an catioii, medical research and adminis- areas, such as heart disease, cancer, munications, disease entity report- opportunity for North Carolina to tration. His prior position as Deputy stroke and dentistry. Represented on ing and hcaltfi manpo%ver. move ahead quickly and build upon Chief Medical Director of the Vet- these subcommittees are all the lead- F] The University of Iowa Depart- its past experiences in developing a erans Administration and his prcvi- ing organizations and experts in the mcnt of Econoirilcs is involved in re- onal Medical Pro-ram. ous 25 years as Professor of Medicine respective fields in North Carolina. search on the cconoml(,, structure and 'I'hc Pr@,rain was estal.)Iislied with at the University of Wisconsin School For example, the Subcommittee on performance of the medical care iii- tli(! zi@vtr(I of on(! of the first plan- of Medicine provided background Cancer is composed of representatives nin,, grants effective on July 1, 1966. dustry in Iowa. One of its first proj- .1 and staturc invaluable to the from the Cancer Society, all the offi- ects is the delineation of the Iowa I-'Iven before the legislation was Program. cial relevant State agencies, practic- Medical Care Region, considering sil-ncd into Law, the deans of the A 25 merDber Advisory Council, ing physicians, the experts from the economic and demographic factors, three medical schools in the State representing the major relevant North Carolina Division of the traditional sen,icc areas and political met with the President of the Medi- health interests in the State, was American College of Surgeons, the I cal Society to form an Executive organized to provide overall advice medical schools, and the State Medi- boundaries. Committee to make preliminary and guidance to the Program. Its cal Society. Their discussions im- R The Iowa Central Tumor Regis- plans. The Executive Council of the Chairman is past president of the mediately revealed the need for a try is providing planning information Medical Society approved the plans for cooperation from which emerged State Medical Society and its mem- state cancer registry which would and analysis guidance concerning a new, nonprofit organization to 1.)crsliij) includes the Director of the augriicnt, coordinate, and make more disease registries. carry out the purposes of the Pro- State Board of Health, the Directors effective use of the several on-going At the same time, the participation gram. The Association for the North of the North Carolina Public Health independent cancer registries in the of the Colleges of Dentistry, Nursing Carolina Regional Medical Program Association, Heart Association, and State. This led to recommendations and Pharmacy of the University and was officially established in August Cancer Society, other voluntary as- of a project proposal which was sub- other health care and educational in- 1966, and is made up of the three sociations, the current President of mitted to the Advisory Council, cou- stitutions is being developed. public and private medical schools in the State Medical Society, the State pling the resources of the Regional Medical Program with the on-going The Dean of Duke University School Here, as in many other regions, tacted. Interest has been expressed cancer registry activities of the other of Medicine described the phenome- there was widespread participation by the Heart Associations and the health agencies. Financial contribu- non when he said: "Channels for co- in the preliminary planning and Cancer Societies of both Washington tions from many of the participating operation for many endeavors have preparation of an application. An and Alaska; their programs of re- agencies were also anticipated as part now been opened. Although we have initial conference, held only one search, professional and public edu- of the Program. talked together a great deal before, month after Public Law 89-239 fiad cation, community service, trainee- In the field of heart disease a Sim- we now have available more effec- been enacted, included some 35 ships and direct patient services %vill ilar process took place which resulted tive channels of communications and members of the University of Wash- be coordinated in a joint effort. in a feasibility study now underway financial resources to implement such ington Medical School faculty, ap- The Program Coordinator for the to develop a regional plan for pro- programs, not only with other medi- proximately 50 practicing physicians, Washington-Alaska Regional Medi- cal schools but also with all other and representatives of the Washing- cal Program, Dr. Donal Sparkman, viding on-going educational services health agencies." As the North Caro- ton Hospital Association, State De- assumed his position on March 1, to coronary care units. Other pro- lina program moves ahead, it will be partment of Health, and the Seattle- 1966, six months prior to the begin- grams underway in North Carolina a program conceived, designed and King County Department of Health. ning of the plann'n rant. Thus, the I 99 include planning for a statewide dia- implemented by and for the people Though the planning proposal that Program has had the benefit of over- betic consultation service; planning of the State. As one leadino, official of eventually resulted was formally sub- all administrative direction since its for education and research in com- a voluntary health agenocy put it: mitted by the University of Washing- preliminary planning phase. Dr. munity medical care; studies and sur- "We hope to weave it so that it won't ton Medical School, it had the ap- Sparkman has had extensive expe- veys of education program needs and be your program, or my program, proval of the Governors of both rience in the practice of internal resources; surveys of relevant health but our program." Washington and Alaska, the Presi- medicine, in teaching at the Uni- professions needs and resources; and dent of the University of Washing- versity's School of Medicine and with studies of patterns of illness and care. Washington-Alaska ton; the Washington and Alaska State the State Department of Vocational The impact of the Regional Med- Regional Medical Program Medical Associations, Dental Asso- Rehabilitation. ical Program is already being felt in ciations, Nurses Associations, and Heart Associations; the Washington Other key staff, including a co- the health affairs of the State. With Although the Washington-Alaska and Alaska Divisions of tli(,- American or(linator for Alaska, an associat(,. the State Medical Society taking an ltcgion previously bad little regional Cancer Society; the Washington director, a cardiologist, a hospital ad- early leadership role in developing health activity, Alaska, which has Health Department, Alaska Depart- ministrator, and a systems analyst, the program with the medical no large medical center, is naturally ment of Health and Welfare and the have been recruited since the Re- schools, practicing physicians are related to Washington by transpor- Divisions of Vocational Rchabilita- gion's planning grant was awarded, actively involved in the planning tation, communication, economic tion in both States. (.fl,(.Ctiv(. S(.I)t(-Tlll)(-r 11 1966. In phase. The channels of communica- and social ties and traditional Pat- Many of the institution% in addition, a wi(l(- %,,irl(-ty of consul- tions wlii(-Ii have opened iii) at ill t(-i-tis of iii(-cliciii :Liid (,oristiltt- the region at-(-. I)eliig iiivolv(-(l in tii(- taiits, including (-I)ld(@iiilologists, levels and among all health groups tiori. The joint Washington-Alaska Regional Medical Program. Repre- statisticians, economists and com- are quickly leading to fruitful discus- Regional Medical Program is being sentatives from virtually all of the 130 munications specialists, are being sions on a multitude of problems. developed on this basis. hospitals in the region have been con- utilized. 41 The Program strategy of the Wash- tinuing education, and the early de- other major hospitals in the area: to agencies, public health and nursing ington-Alaska Region is to concen- tection and care of coronary disease. build on and strengthen the existing representatives, as well as education trate first on the following: good relationships. personnel were also present. A total F] Assess the existing disease problem Western New York In November 1965, following pas- of 78 persons representing 70 organi- in the region. Regional Medical Program sage of Public Law 89-239, an zations, institutions, and groups at- @ Delineate resources and needs in Interim Coordinating Committee tended. patient care, education, training and Western New York is a comparatively composed of key people concerned This group, originally invited to research. small and compact but heavily popu- with health and health care was participate in the formation of the lated 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 Buffalo. There had been relatively gional interest in the establishment of task. For the first time in the history be improved by regional planning and little regional and cooperative ac- a regional program" for heart dis- of Western New York, an assemblage cooperative efforts. tivity among the health resources and ease, cancer, and stroke. The com- from the above groups met with a Initial planning studies now un- interests in this area in the past. Sub- mittee, as initially constituted, in common objective. In an atmosphere derway are focused on identifying @,tantial and rapid progress has been eluded the Dean of the Medical paralleling that of a town meeting, needs of physicians, particularly made in creating a regional health School, Director of Roswell Park, the each force presented its particular needs for continuing education and organization and framework for de- Executive Director of the Western point of view. As the day wore on, cision-making since the enactment of New York Hospital Review and a unique spirit of understanding and the best use of medical consultants Public Law 89-239. Planning Council, the Past President cooperation evolved. It was unani- visiting smaller communities. Partic- The development and creation of of the Erie County (N.Y.) Medical mously agreed that it is the patient ular attention is being given to phy- a Western New York Regional Medi- Society, Erie County Health Com- who 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 well 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 Department. Medical Program. region. the major health institutions, groups, In January 1966 this committee Several meetings were held by the Planning studies relating to the and agencies in the eight-county rc- called together representatives from group during the spring of 1966. The coordination of coronary care facili- gion covered by it (Allegheny, Cat- the medical 3 hospital, and other outcome of these meetings was the ties and services, a post-graduate pre- taraugus, Chautauqua, Erie, Genesee, hea.1th-related professions, practicing formation of a new nonprofit organi- ceptorship program, and the estab- Niagara, and Wyoming Counties in physicians and voluntary health agen- lishment of a regional medical library New York, @iii(i I-'Iric County in Penn- (@ics. From each of the eight counties zatioii (-.allcd Health Organization of syst(-rri li,,tv(- tlso 1)(-(@n %ylv;liil;t). lz(.gioll:ll M(-(Il(@;tl tll(. II(..Iltll;ttl(l lio.Sl)it;il (..olitilli.%- W(-st(@t-ii New York, Inc. (HOWNY) Other planning studies soon to be and the designation of its III iiicm- I)rogram has been received by the sioners, the medical society rcpre- initiated will concern methods of practitioners. with unexpected en- sentatives, chairrnen of the Boards of her representatives as the advisory pooling data from cancer registries, a thusiasm following the well-publi- Supervisors, the hospital administra- body. feasibility study of open channel tele- ciz(-(] inter(,st of the State University tors, and the American Cancer Their initial grant app ica vision, a stirv(-y(@f I)Iiysi(@laii and iiui-,(- of Nt-w Yot-l@ ;it l@till'alo (SUNYAI@), Society and I l(@ai-t Association Cliaii-- looking toward the development of participation and interests in con- Itoswell Park Memorial Institute and men. Individuals from social welfare a sound and workable proposal, in- 42 corporated a six-point planning the practicing physicians in the re- care unit feasibility studies had al- in,a) to improve the care of his program. gion. Initially they had been quite ready been launched prior to his ap- patients: F-I A coronary care unit feasibility wary and somewhat suspicious of the pointment; the remainder of their F-I He will have available at his com- study medical centers and the "cooperative proposed planning activities have got- munity hospital a commur&ation ph arrangements" approach embodied ten underway since then. network-, including radio and tele- The feasibility of multi as'c by Regional Medical Programs. This The HOWNY Board of Directors, vision facilities, which will provide screening in Western New York view has altered with their increasing with members from each of the par- education programs and opportu- F-I Health care team planning involvement in and better under- ticipatino, counties@ne representing nities for interchange and discussion 0 0 F-I A medical communications study standing of the program, so that now, the county medical society, the other with consultants at the medical Fl 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, F-1 He will have available at his com- man, who is himself a private prac- the Western New York Hospital Asso- munity hospital for himself, nurses Fl A health care manpower survey titioner, a majority of them support ciation, the arca-wide hospital plan- and other personnel, a training pro- By the time a planning grant was it. ning group, and official public health awarded in December 1966, some agencies, has already set up proce- gram in the resuscitation of patients other important and parallel devel- Since the award of its planning (]tires for reviewing pilot with ti(-art (ii-,Pas(-, ttid the necessary tli(- W(-st(@y-n N(-w York l@(-- - lo (@:tf I'@, ol)in(.iits ltt(l ,tlso tik(-ii 'I'll(-St- III gloll:ll M(-(Ii(.;Il li;is oi)(:Illl(.(l F] New cliinti(-Is of (-oitiiiitiiilcatioil flill-tiyll(. III-o"l-,Illi I)il-(!(-tol-, 1)1.. to @t of I)I.ol)os;tls II(' will @tiSo nsultantwho had been opened among the many John R. F. Ingall, formerly an associ- generated by local communities, pro- have on (-all a medical co diverse health institutions and groups ate cancer research surgeon at Ros- posals for the establishment of a has been specially trained to head in the region. well Park-. The Director has begun regional hematology reference labora- hospital cardiopulmonary arrest alert Fl A parallel organizational frame- visits to all the medical communities, tory and a regional blood bank (-orn- programs. work was established at the com- large and small, to explain the re- rnunication system. R He may have tested at his hospital munity level. Through these local ad- gional concept of the program and to the feasibility of a system that trans- visory committees, broadly represent- stress the need for coordination. He inits, day operation. in a 24-hour ative of the health interests in the aims personally to discuss with physi- physiological information on heart cians and the health service agencies Intermountain communities and including public the aim of the Regional Medical Regional Medical Program disease patients to a computer facility members, the intent and aims of Re- in Salt Lake City and transmit-, Program to support all involvcd in gional Medical Programs were more giving medical care; the patient is The initial operational activities of promptly back to stations within his fully and accurately conveyed to the hospital information for diagnosis practicing physicians and others at most important and his needs can the Intermountain Regional Medical the community level. In addition, only be met by action in concert. The Program will provide the following and treatment. communities had been prompted to p .atient in turn, as consumer, is being opportunities to a medical practi- 0 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 F-1 Perhaps most significant was the the objectives of the Program. The passes Utah and parts of Colorado, patients and will have available for decided change in the attitude of health care manpower and coronary Idaho, Montana, Nevada and Wyom- consultation medical and nursing spe- 43 @alists who have completed such change service that will provide in- tion throughout the Region. This time not normally available to the 'aining. formation on the prevention and con- project is exploring the benefits to busy practitioner. Ife may participate in seminars trol of these diseases to public groups practicing physicians of having aval - He will, if the result of experi- as %vell as to I)rof(-,ssional and allied able automated clinical laboratory ,cl by local, regional and national ex- -alth workers. testing for multiphasic screening and merits being initiated arc successful, lilv(, direct access by means of corn- (-rts in or(l(@r to b(-tt(-r tin(l(-rstan(-] h( lit-;iitli f;i(-t. bank displaying tli(-. I)Ilt('I' I('I'Illill;lls III Ills office tot Coill- I.(.Stilts to liiiii tii(! best I)I'ii( tl('('S ;IS IS III('tllo(]S (,IS @til(I II)(! ',Vill toiiiated patient history system pro- f maintaining and extending his have opportunities through a formal and latest infon-nation concerning the iedical skills. feedback system to communicate with viding him with a patient's complete diagnosis and care of stroke patients. He will have available at his hos- the planners and leaders of the Re- medical history before seeing the pa- This information will not only be gional Program to indicate his reac- tient; an automated EKG service available for application to individual @ital both continuous 24-liour con- connected with the University Medi- ,jltation by tel(-,I)Iion(- and visits by tions, needs and r(-(,.oinmendations for patients while in the physician's office 1)(@cial consultants knowledgeable in (Icv(@lol)ing new program activities. cal Center for rapid, accurate trans- but will make possible discourse with he latest information in the diag- mission, receipt and interpretation of the computer so that the experience electrocardiograms; specialists con- losis and treatment of cancer. Missouri constitutes an integral part of his con- Regional Medical Program sultation from the medical center by tinuing education. Through the use of a computer- telephone; and an integrated con- R He will have the use of a multi- (,(,(I ttirrior registry, II(- will be al)](- to 'I'll(! li)itl@il ol)(!ritioii;tl (!ri(leavors of tiniiing education program at his lios- I)II@isi(-@ SC[-eeiiiii,, center to be estab- ;Ili(l Ills Own this I)i-ogi-@xj)i "oi-l(-nteci toward J)It@ll fol. himself -.111(t tll(,. health lislicd to provide him and his patients )atictits with local, r(@,glotial and iia- maximizing the airiount of- diagnosis personnel supporting him. with 1 1 blood chemistry tests, com- ional standards. and care Nvhich can be delivered in He may, through the connection plete blood count, urinalysis, stool -1 Consultants will visit his hospital the . . . community by the physician of his community hospital with the guaias, and Pap smear. if it is in a community with less than and the local medical resources while Medical Center's Department of F-I He and his colleagues in the 0,000 persons) periodically, to as- maintaining and improving the qual- Radiology and computer facility, ob- Ozark area will have available at St. ist him in the diagnosis and care of ity of medical effort. . . ." As the tain computer aided radiologic diaz- john's Hospital in Springfield, and icart disease patients by working at program is implemented in the fu- nosis that will help improve the ac- later at other small hospitals, a re- he bedside of his patients. ture, a medical practitioner in the curacy and reliability of his diagnosis fined and more comprehensive car- -] He may apply for a special clini- Missouri Region may have the fol- of bone tumors, gastric ulcers, and diovasctilar care unit that will demon- @al trainecstill) in (Cardiology that will lowing opportunities available to as- congenital heart disease. strate the feasibility of an intensive nvolv(- sl)e(-ialized training at 5 co- sist in the care of his patients: F-I He may, after a period of pilot care program without house staff. )perating medical institutions in pro- F-I He will benefit from the develop- testing and validation, have at his ,rams de igned to meet the individual R He and others will have available , s ment and demonstration of a compre- disposal an automated patient history nterests and problems of the par- hensive health care system that is acquisition system through which he to them as a result of the establish- icipatin,, 1)IiNsicians. being tested in Smithville, a subur- can obtain a complete medical his- ment and sampling of population Ile will lia@@(-, available a corn- ban-rural community north of Kansas tory of a patient before seeing him. study groups, more current and ac- -nunl(-ation and information ex- City, with a view to eventual replica- Presently this requires an amount of curate information about the true 44 rates of disease incidence and preva- hance prevention and early detec- request allows us to intensify the effort by.the citizens of each local lence in the Region. tion. continuous planning activity as the community. The i n t c n t is to Fl He and his patients will benefit n He and the community service conduct of our Pilot Projects reveals strengthen community medicine and from an operations research and sys- agencies and others will be provided additional planning opportunities- thus improve patient care. . . . with a directory of the names, We believe the most effective plan- "The Albany Medical College was tems design project aimed at ( ill result as we relate the plan- involved in a great deal of advanced services and addresses of all medical ning w improving early detection of heart and paramedical services in the State ning to the (,ondtict of our op(@ritionil 1)1;iniiing in ;tnti(-]I);ition of its in- disease, cancer and stroke and (2) program. . . . volvcment in l@egional Medical Pro- optimizing the utilization of the re- to facilitate the referral of patients "However, since the initial proj- grams. This resulted in extensive ac- sources committed to these diseases between agencies and the full use of ects of our operational program are tivities prior to the planning grant in terms of the effectiveness of the available resources. not intended to result in a complete award. . . . medical services provided. program, it will obviously be neccs- "Five mature experienced physi- EXCERPTS I-ROA4 sary to continue planning stifyplc- (@ians were contacted relative to their E:] He and his patients will benefit ANNTJAI, PROGRESS REPORTS mental projects which will further interest in becoming full-time rnCM- from improvements in bioengincering increase the capability for diagnosis hers of the Department of Post- techniques utilizing sensor-trans- Albany ducers for early detection of heart Regional Medical Program and treatment of heart disease, can- graduate Medicine, which has the disease, cancer and stroke. cer and stroke. In particular, we con- p r i m a r y responsibility for the "In our Operational Grant Appli- template extensive planning of con- administrative direction of the n He and his patients similarly will cation it was mentioned that 'there tinuing education and training for Program. . . . stand to benefit from studies of the is no question but what the develop- medical and allied health professions. "The needed nonprofessional ad- Program Evaluation Center, a mul- ment of the Albany Regional Medi- "The purpose of the Albany Re- ministrative personnel were sought tidisciplinary research unit of the cal Program has produced very im- gional Medical Program is to utilize and excellent individuals were ac- Missouri Medical School, dealing portant effects, both in the surround- research, education, training and quired. One oi these is now our Di- with the problems of the distribution ing medical communities and at the demonstration care in an organized rector of Community Information of health services and medical facili- Medical Center. The predominant cooperative and effective approach Coordinators. He has three coordina- ties. Priority will be given to develop- attitude is one of interest, enthusiasm to the 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. An and. stroke. Although leadership and house representatives who have both individual and community-wide. early addition of operational support the dissemination of scientific infor- proven their ability to relate well to E] His patients will be the ultimate should allow us to take full advan- ination are among the important re- physicians and be successful in their beneficiaries of a communications re- tagc of the momentum of our rapid sponsibilities of the Medical College, contacts with physicians. . . . search project aimed at better under- initial progress. . . .' the intent is to promote interrelation- "Regional Medical Program staff standing public attitudes, opinions, "To this statement should be add- ships among all relevant institutions, have met with the administrators and arrd knowledge about heart disease, ed the fact that the April 1, 1967, agencies and individuals in a man- staff of many of the hospitals in the cancer, and stroke, in order to en- approval of our operational grant ner which will prodii(-(- a sustained IZ(-,(,ion. To (],it(-, 58 tiosl)ittis 11,Av(- I 45 been contacted; and formal presenta- PROGRESS REPORT ON cancer investigative program 'which being set and the action program was tions on the Albany Regional Medical SLLLCTI--,D PLANNING PROJECTS would result in major dividends with being formulated, the primary work P rarr) have been made to the - - regard to research, with regard to involved the RMP staff, the Plan- rQg 1'ro]ect to Improve medical staffs and/or boards of trust- and Expand Cancer diagnostic and therapeutic procc- nin- Committee and the Regional ees of 25 of these. All of the latter Detection and Therapy dures and with regard to general Advisory Board. Good communica- have indicated, by vote, their desire cancer education. . . . tions were maintained by frequent to participate in the Program. . . . "A major project preparation has Cardiopulmonary Laboratory meetings, which were well attended, "In general all of the hospital ad- been prepared, involving the efforts Development and by circulating full follow-up ministrator-s, staff physicians, and of physicians and administration at minutes. . . . board members have indicated their Vassar Brothers Hospital at Pough- "It is proposed to establish a car- "The Planning Design, as finally sympathetic a,,,rceinent with the con- kccl)sic, New York. 'I'hc study is di- diol)ultnonary physiology and diag- adopted, is concerned with such ccpts of Regional Medical Programs. rccted towards the objective of en- nostic laboratory at the Pittsfield Af- fundamental elements as health per- In some instances there were mis- abling more effective early diagnosis filiatcd Hospitals, Pittsfield, Massa- sonnel, facilities, and finances-and conceptions about the Program based and treatment of cancer in the chusetts. Such a laboratory would their effective blend into a coordi- upon the Report of the President's Poughkeepsie area. . . . provide accurate diagnostic facilities nated regional medical program serv- Commission on Heart Disease, Can- in heart disease, diseases of the blood ing all the people of Connecticut.... Va,,Inal Cytology "It involved the creation of nine .1 vessels and pulmonary disease. In ad- ccr and Stroke; these were quickly Scre(,,niii(, Pro,ram rask Forces to study specific compo- and easily dispelled. Tfic administra- I clition, its establishment will lead to nents of the Connecticut health care tors and staff of many of the hospitals "This project proposes to develop improved local physician continuing system, to determine deficiencies, to expressed the desire, long felt, for a a model for cytological screening of education in this field. chart action programs and ulti- closer working relationship with the all female patients in a given com- Cardiac Care Unit at mately to work for their implementa- Albany Medical College and Center, munity for cervical cancer. Continu- Herkimer Memorial Hospital tion. A serious effort was made to especially with respect to patient con- ing study is underway to establish the have various segments of the health sultations with specialists increased most effective coordinated approach "This project proposes the estab- community represented on each Task lishment of a fin-nly based Cardiac Force, as well as to obtain a reason- opportunities for continuing educa- to the objective, combining the ca- Care Unit building upon the hospi- able geographic distribution. Each tion in the physician's home com- pabilities of the Regional Medical tals existing embryonic 'homemade' includes representatives of various munity; assistance in updating their Programs with the opportunities one. Such a unit will permit nurse points of view appropriate to the knowledge and ability to diagnose which other State and Federal efforts training in intensive coronary care in topic under consideration, drawn heart disease, cancer, stroke and provide. . . . this locality." from private practice, education, vol- related diseases; guidance and aid Multiple Hospital Prospective untary agencies, governmental service in the training of more nurses and Cancer Investi,,ation Program and the public at large. . . other allied health personnel; and Connecticut Regional Medical Program "These Task Forces are concerned advice as to -,vhether or not to engage "This project proposes to establish with the (1) supply and distribution in research activities as well as the a sub-regional and eventually a re- "During the 'tooling up' phase, of physicians and dentists; (2) re- nature thereof. . . . gional approach to a prospective when the program objectives were cruitment, training, distribution and 46 continuing education of nurses and ganizations, with hospital staffs and of communication links between seg- tively little contact in the past other allied health professionals; with many interested individuals, mcnts of the health system; (c) the between the medical and- social sci- (3) continuing education of physi- both from the medical and lay ranks. shortage of experienced health plan- enres in the universities. These need cians and dentists; (4) extended care Thus, the potential of Regional Med- ners and researchers in the delivery to work together to chart overall facilities and programs; (5) univer- ical Programs is becoming known in of health care; (d) the overlapping social progress in the health field. sity-hospital relationships; (6) the or- a widening circle; and communica- and uncertain jurisdiction of related There has been a considerable 'town ganization of special services within tions among various segments of the health planning organizations; and and gown' rivalry between clinicians hospitals; (7) implementation of a Connecticut health community arc (e) the shortness of time available in the university and community set- state-wide library system; (8) financ- improving. . . . to achieve measurable results. tings. There has been too litt c con- ing of medical care; and (9) defini- "The Regional Advisory Board "With regard to the complexity tinuing contact in the past between tion of the Connecticut region and has assumed responsibility for the of the subject fields under study, it is health spokesmen from the educa- its subregions. . . . pivotal decisions relating to the de- pertinent that the Connecticut Re- tional and voluntary segments, on the "The RMP staff is responsible for velopment of the Program, e.g. the gional Medical Program is probing one hand, and from local and state assembling the complete information approval of the planning grant re- questions which have perplexed lead- government, on the other. The plan- on the health resources in Connecti- quest, the appointment of the Plan- ers from the fields of medical edu- ning efforts of the Connecticut Re- cut needed by each Task Force in its ning Director, the adoption of the cation and medical care alike in re- gional Medical Program depend in subject field in order to go about its Planning Design and the appoint- cent and past years. There are no great measure on full collaboration work. To date, preliminary steps have ment of the Task Force member- ready answers, for example, on how between representatives of the health been taken to ascertain what data is ship.... to provide family medical care to all establishment drawn from education, available through a number of estab- "It is noteworthy that Regional Ad- citizens in the years ahead, or how from the voluntary community and lished health organizations. Fortu- visory Board members are now serv- to recruit and educate the necessary from government. Some of the need- nately, the assembly of health infor- ing as Chairmen of eight of the nine nurses and other supporting health ed communications links are having mation by such organizations as the Task Forces and that every Board personnel and make them a part of State Health Department, the Con- member has a position on one of a true health team, or how to imple- to be forged as a part of the Con- necticut Hospital Association, the them. This means that Board mem- ment effective programs of continu- nccticut Regional Medical Program Connecticut Hospital Planning Corn- bers will be deeply involved in plan- ing education for all health practi- planning process itself. . . . mission and others will provide much ning activities, that they will be in tioners, ctc. It is even diffi,cult to "Despite the major problems en- of the information needed. It re- good positions to weigh proposals for structure planning studies to lead to countered and the enormity of the mains, however, for the RMP staff to the operating program one and two the best solutions to these important task ... a sound organizational frame- carry out some special studies and, years hence, and that they will have issues. Y(@t, tli(- Prograiri has (-Iioscn work for planning has been estab- ultimately, to compile much of the the background knowledge needed to to concern itself with those very is- lished; broad consensus has been health resources data in a central pi4sh their implementation. . . . sues in the health field which are of reached on the pro-ram's planning profile. "The most difficult problems en- greatest concern to the people of design; and a large number of key "There have been many opportuni- countered to date are the following: Connecticut. . . . leaders from the Connecticut health ties to discuss the Planning Design (a) the complexity of the subject "It is pertinent that in Connecti- scene have become involved in the with boards of directors of health or- fields uiicl(-r study; (b) the weakness cut, as elsewhere, there has been rela- planning process. 47 bring these specialists in close touch "Planning is under way for a pro- "On February 26, 1966, a regional Hawaii with private practitioners. . . . gram directed toward the hematolog- workshop was held at the University Regional Medical Program "Additional programs of particular ic aspects of the care of heart, cancer of Utah Medical Center in Salt Lake interest are the Stroke Registry and and stroke patients. This will also City, which was attended by repre- The assessment of the overall situ- the Facilities Studies. On March 1, have components of continuing edu- sentatives from all six states involved ation, and the establishment of com- 1967, exploration of the feasibility cation, consultative service and lab- in the proposed region andall profes- munication with the participating of the establishment of a Stroke Reg- oratory and investigational activity sions, organizations and institutions agencies have been the major items istry was begun. Consultations with directed toward assisting physicians concerned about heart disease, cancer of activity since November 1966, physicians and with medical record in diagnosis and patient care. and stroke. The purpose of the meet- when a full-time Deputy Program ..' Director (General W. D. Graham, librarians have progressed most satis- ing was to begin to define a Region M.D.) arrived in Hawaii. Informal factorily. l,'ield testing of method- Intermountain which could work together as a unit conferences with members of the Rc- ology will commence about May 1, Regional Medical Program and to obtain ideas as to regional 1967 ' in selected hospitals. . . . - resources and needs, and how a pro- ,alonal Advisory Group and their rcp- "The project for stroke rehabilita- "Organized efforts to develop a Re- gram should develop. Ideas expressed resented agencies and with other tion education involves a plan to set gional Medical Program for this at this meeting served as a foundation participants have been held, and the up a training program for various Region began in the fall of 1965. for the planning grant application status of the public, private, and categories of rehabilitation personnel Efforts were made early to enlist the submitted in May 1966 and awarded voluntary programs in the health field at the ]@(-Iiabilitation Center of interest and support of organized effective July 1, 1966. . . have been stucliccl. 1-fawaii in Honolulu, at outlying hos- medicine. . . "Since July 1966, the major efforts "Local assessment, and the detailed I)itals on Oaliu and on the neighbor "In October 1965, Dean Castlcton in planning have been in recruiting a consideration of the content and islands, in order to augment stroke and Dr. Castle of the University of planning staff, establishing lines of concepts of programs under way in other regions, lead to the conclusion rehabilitation capabilities, which arc Utah School of Medicine met with communication with all elements at present at the full cal)a(@ity of the the Utah State Medical Association within the region and with other rc- tli@it I)t-o,,r(-ss in tii(.- I)ro,,r;tiji Center staff. ]executive Committee to gain their gional programs in the country and here is (:ontiri(,crit upon projects in "The goal of a facilities study by interest and support for a regional developing systems for sustaining continuin- education. There is at the Hawaii Heart Association is to program. Subsequent meetings were active interaction among these presenc no fully-staffed, on-going determine equipment status in facili- held with representatives of the Utah, groups, explaining the purpose of the academic clinical teachin- center in ties which provide diagnosis and Idaho and Nevada State Medical As- Tf.t%v;til. 'I'lios(! highly i)ei-- t, program to professional and lay corn- treatment to patients with heart sociations, and county medical soci- sonnel currently engaged in the train- disease. A questionnaire has been eties in Reno and Las Vegas, Nevada; munitics, developing methods for in- programs of the teaching hospital collecting data relative to heart dis- directed to hospitals and clinics and Grand junction, Colorado; Idaho are engaged to full capacity, and arc the returns will be preliminarily Falls, Pocatello, Twin Falls and ease, cancer and stroke, identifying au,@cnted by 'visiting professors'. By evaluated, using volunteer services. Boise, Idaho; and Butte, Great Falls needs which can be met by Regional locating ftill-tljii(@ tea(-Iiln,,, sl)e(@ialists Collatioti, analysis, and s@ibsequcnt and Billings, Montana. Meetings also Medical Pro,-ram legislation, and in tea(-,Iilng hospitals, si,,nifi(-arit ad- (](-v(-Iopiri(@.nt of the inforriiation will were held with members of the hos- formulation of proper procedures for ditional support for postgraduate require IZMP support, and will beuin pital staff in all the major hospitals construction of pilot projects and training programs will result and will about June 1, 1967. . . . in the region. . . . methods for their review and 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 Regional 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 devel- the state of Kansas as well as 357 "Considerable discussion has taken planning grant application, but none oped by the Intermountain Regional physicans and 1,825 nurses. Mr. place with the Missouri Regional have been completed and will require Medical Program are being used by Dallas Whaley, the previous execu- Medical'Program regarding coopera- an intensity of planning similar to the Mountain States Regional Medi- tive-secretary of the medical socie' ty tive planning efforts, particularly with what has been established within the cal Program and the community com- in Sedgwick County (Wichita) was regard to data pooling and evalua- last few months for at least another mittees to be formed in Nevada, Wy- approached and hired. . . . tion. Special attention and coopera- year. One major obstacle to more oming, Idaho, and Montana, will "In addition to the Regional Ad- tive planning have been directed to rapid progress within the region has serve as liaison to both programs over- visory Council, two additional groups the complex Kansas City mctropoli- been the slow process inherent in ob- lapping these areas." have been appointed to serve as staff tan area which crosses the Missouri- taining outstanding people to serve in advisory committees. One of these Kansas State boundary and six key positions on the planning staff. ansas is the Professional and Scientific Re- county boundaries. . . . Although the Intermountain Re- Regional Medical Program 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, su(-Ii as the been established to advise and assist outstanding, dedicated, hardworking tion of Regional Medical Programs Heart Association, the Cancer So- with the planning for this area. This staff, the process of bringing them with relation to Public 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 resentative's of both the Missouri and time to understand the program and school had become somewhat clari- School Medicine, etc. . . . Kansas Regional Medical Programs, to define their role, has taken much fied. Dr. Charles Lewis, professor "The .(,.cond group ipTx)inted is i will consider all proposals of either ili;lil ;It III(' otl(S('[. ;Ilt(l of (II(. 4)f I)IIysi(.i;lfls, l@; ;Ifl iflil):Il,l III lieu of people with I-),i(-k,,rotjii(i 1,1.(,.V(.Iltive medicine :Iii(l collillill- ol' @L gi-otil) of' I)IIYSI(.i@tiis S(@l(.(:te(i [)Y ill the gje;itei- K@trisas City area. . . . and experience in developing the nity Health, who had been 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 lic Law 89-239, it has been necessary preparing the operational grant ap- practice, and age. This panel of evaluation was held May 22-23, to recruit personnel with a variety of plication, agreed to take full-time names will be submitted to the presi- 1967, at the University of Kansas career commitments and ask them to responsibility as director of the Kan- dent of the Kansas Medical So- Medical Center. Representatives of make major changes in their careers sas Regional Medical Program. He ciety. . . . the Oklahoma, Missouri, and Kansas in pursuing this new national pro- assumed this role on March 15, 1967. "The Regional Advisory Council Regional Medical Programs partici- gram. . . . Since this time considerable progress was recently enlarged with the addi- pated with outside experts. The pur- has been made with regard to a prin- "To meet some of the most pressing cipal 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 mal organizational structure. . . . largement was accomplished in or- define basic core information which Program, specific projects to provide "In addition, a Regional Medical der to gain further representation of must be recorded on all professionals training for personnel and to involve Program office has been established o t h c r non-health-related groups (having decided what disciplines will 49 ;Ill(l it) tl(-Vi-l()I) ;I ;Ill(l lll()I.I;Iliiy (1:11;1, tillllz;tlioIi (hl, i I II I)II'L I14-1 II @l I fol III; I,V(. iiioii dat@t I)asc foi- the tlii-(!e ltcgloiis I)cds, iiiiiiil)ci-ol-oflice visiLs, costs, ctc. simultaneously during the y(-ai-. 'I'lic, 'I'lils iiit,itiis lcai-iiiiig more about the for the transmission and comparison By comparing two or three different Advisory Council, with advice from needs of practicing physicians and of manponver data, and (2) to em- types of medical care systems in its Scientific Review and Liaison other health professions, the con- phasize the importance of proper different parts of the state, we will Subcommittees and the Metropolitan sumer, and State and local health evaluation rather than developing ar- have a better idea of the means by Kansas City Coordinating Commit- resources. Missouri Regional Medi- tificial indices which mean nothing in which we can evaluate changes and tee, serves as the governing body, de- cal Program aims to assist the prac- terms of health delivery systems. . . . variations on the original theme of termines policies, and approves (or ticing physician in providing optimum "It should be noted that feasibility delivering health care to patients and disapproves) and sets priorities patient care as close to the patient studies will soon be under way in the improving the quality of care for among proposals for pilot projects. as possible, with equal access to any Wichita regional area. A group those with heart disease, cancer, and The Scientific Review Subcommittee needed national resource. According- representing the hospitals and physi- stroke. . . . advises the Council relative to sci- ly, Missouri Regional Medical Pro- cians of that area is now making "Another development which will entific problems, including the merit gram stresses prevention and early plans to develop a non-profit corpora- be completed before the end of this of pilot project proposals. The detection, continuing education, pub- tion in order to seek non-federal fi- planning year is the attempt to de- Liaison Subcommittee serves as a two- lic education and information, and nancing from private industry to sup- velop a health data bank. To this way medium of communication be- appropriate demonstrations of patient plement funds from Regional Medi- end the University of Kansas Medical tween the member organizations and care. . . . cal Program resources. . . . Center, the Kansas Regional Mcdi- the Missouri Regional Medical Pro- "The Missouri Regional Medical "It is hoped by the first of Scl)tcm- cal Program, the Kansas State Board gram. The Kansas City Metropolitan Program staff is confident that the her that manpower data recording of Health, Kansas Blue Cross-Blue Coordinating Committee reports to splendid interest, concern and con- for the state of Kansas will be al- Shield, and Kansas Health Facilities the Advisory Councils of the Kansas tributions of the Advisory Council most complete. It is also projected Information Service, Inc., have all Regional Medical Program and the are, in important part, related to its that during the summer of 1967- agreed to pool data on manpower, Missouri Regional Medical Program decision-making 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 tributions of Regional Advisory professionals' attitudes toward cur- morbidity, mortality, vital statistics, proposals among institutions, hospi- Groups to a certain extent parallel rent systems of health care. A proba- economic development, outpatient tals and other agencies of Metropoli- their responsibility for decisions.) - - - bility sample of consumers will be utilization of office visits, etc." tan Kansas City. All the organiza- "Since July 1, 1966, the staff have interviewed, comparing their atti- tions and institutions represented on taken steps to strengthen inter-agency tudes toward medical care. In addi- Missouri these Committees have an active role cooperation and communications. tion, physicians, nurses, hospital ad- Regional Medical Program in planning, and two have submitted The Program Coordinator and staff ministrators, etc., will be similarly pilot projects now under considera- consulted. The purpose of this is to "Under the leadership, guidance tion and three are preparing pilot have made speeches at society meet- describe the system in as many ways @iti(i (lire(-tioii of the lzcgional Ad- project proposals. . . . ings, meetings of other health profes- as possible and to correlate this with visory Council, planning for the "The Advisory Council made an sion organizations and lay groups. other information regarding param- Missouri IZegional Medical Program early and crucial decision to place The staff has also conducted seven site eters of health care, i.e., morbidity and development of pilot projects for primary emphasis on maximum use visits with reference to pilot projects 50 proposed by various communities; apply them to the results achieved by ment (including health). A new Of. Central Administration has been in communication with six various funded programs. The staff's fice of State and Regional Planning Comprehensive Cardiovascular Care other communities relative to possible activities have been spent in attempt- and Community Development has Unit (Springfield) pilot projects; has consulted with nu- ing to conceptualize comprehensive been designated by Governor Heames Manual of Services merous official health agencies and coordinated community health serv- for administration of these two laws "Staffing arrangements for these other organizations and individuals; ices in terms of 'schemes of action' in Missouri. In order to effect proper projects are underway and are ex- has discussed plans, projects and ac- rather than 'schemes of arrange- coordination between Missouri Re- pected to be completed in major part tivities with numerous visitors. . . . ment.' Thus, the model will be de- gional Medical Program and the Of- within the month." "Thus far all agencies, institutions, fined in such terms as access, corn- fice of State and Regional Planning organizations, and individuals asked munications, and end points. . . . and Community Development, a new North Carolina to cooperate have responded favor- "Pilot projects proposed I)y Mis- senior stafr position (Liaison Officer) Itegional Medical Program ably. . . . souri Regional Medical Program in- has been established. . . . "However, some practicing physi- clude built-in evaluative mecha- "Up to this writing, Missouri Re- "Very early in the consideration of cians need to be informed that Mis- nisms. . . . gional Medical Program has consid- the North Carolina Regional Pro- souri Regional Medical Program is "A study is being conducted in a ered approximately 40 pilot project gram it became clear that in order to primarily patient oriented and not i-tirii Missouri community, Glasgow, proposals. Of these, 27 were for- fully iiril)lerii(,r)t tli(-. provisions of Medical Center oriented, and that tl)l)roxiiiiately 4-0 miles from Coltiiii- warded to the I)jvisioii of R(-giotiti l,ul)li(: Law 89-239, it was necessary Public Law 89-239 emphasizes co- bia, to examine some of the decisions Medical Programs in the form of to develop a core concept which operative arrangements, continuing made and the systems used by mem- three operational grant applications. would make possible the coordination education, and demonstrations of pa- bers of this community in seeking If current negotiations are confin-ned, and augmentation of an already large tient care within the present system medical care. . . . 15 of these will be initiated during number of existing health activities, of medical practice. . . . "In keeping with the 'scheme of April 1967, as follows: interests, and institutions and in the "Missouri Regional Medical Pro- action' concept, this one has looked at Smithville Project process enhance the ultimate effec- gram may face problems when agen- (1) routes of access to care which Communication Research Unit tiveness of each component element. cies present pilot projects for fund- have been used; (2) critical coordi- Multiphasic Testing This unifying conceptual strategy ing and a choice must be made. How- nation and comunication points in Mass Screening-Radiology called for the mobilization, through ever, we are developing Guidelines the systems used; and (3) endpoints Automated Patient History comprehensive planning and cooper- on which funding decisions will be or reference pbints in the health Data Evaluation and Computer Sim- ative enterprise, of all health care based and explained to interested service system. ulation knowledge and resources for a con- agencies. . . . "Missouri Regional Medical Pro- Computer Fact Bank certed attack upon the problems of "The Missouri Regional Medical gram will continue to coordinate its Operations Research and Systems heart disease, cancer, stroke and Program emphasizes the importance planning and pilot projects with other Design related diseases. . . . of evaluation of results. The Program health and related programs. This F,valuation Center for the University applies especially to Public Law Population Study Group Survey "The program has the unique op of Missouri School of Medicine is be- 89-749 and a new State law relating Automated Hospital Patient Survey portunity chf being in a position to ing used to developwhatever meas- to State and regional comprehensive Program Evaluation Center bring together the talents of th' is uretuent devices are required and to planning and ccomm@ty develop- Bioengineering Project hitherto widely diffused leadership 51 by exercising its own leadership to degree to which the skills and man- cine, the Buncombe County Mcdi- gram for diabetic patients is being mount is con(-(-ntr;it(,-(l and t-fT(-(-tivf- I)OW(-I. I)Y III(.S(.. ilit(@l.(.Sts (-;tl Society and the Stitc M(@.@lical tested. Scheduled clinics in commu- an assault upon heart disease, caricei- can be iiiol-)Illzcd. . . . Society. It includes a des(@ril)Lioii of nity hospital or similar settings and and stroke as may be possible in terms "The Planning Division has made the characteristics of its patients and also at the university medical centers of the resources of the State of North good progress in assembling survey staff. Also included are ideas of key are included. These activities will be Carolina. On the basis of these prem- data essential for program planning hospital personnel as to the desira- supported by a home nursing service ises the Regional Medical Program and to provide overall baseline data bility of developing the affiliation to assure proper follow up and sus- of North Carolina has evolved a de- against which future impacts may be with the Bowman Gray School of tained patient contact. The educa- cision-makin@, mechanism which 'Is gaugcd. Medicine, suggestions as to programs tional program will be directed to both responsible and rational, and "One study which has been com- of continuing education, and sugges- community groups of diabetic pa- which will maximize the effectiveness pleted has explored the dimensions of tions as to what other elements might tients and will be coordinated with of the wealth of leadership which is an affiliation between the Memorial be included in an affiliation between community health organizations. . . . available. . . . Mission Hospital at Asheville and the the two facilities. It also includes the "Participating Organizations: The Bowman Gray School of Medicine. viewpoints of the county's physicians Continuing Education 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 and needs, continuing education programs for support of the participating organi- will serve to teach us how to organize and paramedical personnel needs professional and ancillary personnel, 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 beween Medical that were distributed to all Bun- numbers and characteristics of indi- North Carolina Heart Association Schools and community hospitals. combe County physicians in Febru- viduals attending is being collected and the North Carolina Division of Surveys have been made of practic- ary and March, 1967. the American Cancer Society. ing physicians in Buncombe County through a monitoring system involv- "The staff of the Association for and of other staff members of the Diabetic Consultation ing obtaining of registration forms the North Carolina Regional Medi- Asheville Hospital aimed at securing and Education Service from program chairmen. When this cal Program has devoted much time their ideas of the general utility of "This study was begun January 1, monitoring process was first initiated, and energy to the orientation of such an affiliation and their specific 1967 and participants include rep- the researchers attempted to gather health interests throughout the region recommendations of what such an data only from those organizational in terms of the nature and objectives affiliation should strive to provide, resentatives of Bowman Gray and meetings with program content re- of the Regional Medical Program, especially in the way of continuing Duke Medical Schools, the Univer- lated to the categorical diseases. How- and as it has been possible to identify education. sity of North Carolina School of ever, it was often difficult to draw a appropriate functional roles, an in- "A report on this study was devei- Public Health, the State Board of line between those meetings that creasing number of them have be- oped by the Planning Staff for the Health, Community Board of either did or did not fall within this come active participants. This effort Association for the Regional Medi- Health, practicing physicians, and provision. As a result an attempt has will continue to be a dominant feature cal Program with the assistance and public health nurses. and will continue to be made to moni- of the Program since to a large ex- guidance of Memorial Mission Hos- The feasibility of a regional consulta- tor all of the major medical meetings tent its success will depend upon the pital, Bowman Gray School of Medi- tive service and an educational Pro- unless the program content clearly 52 indicates no relevance to the RMP. a@encies, and other organizations "Since contini-iin, professional been made to determine the numbers In a statewide study of this nature an concerned with health and welfare education is an irit(!,qral asi)(-(@t of tnd types Of Such personnel in the analysis of any part of the continiiin- throughout the Region. . . . Rcffional Medi(-al Programs, an ad cfl,io n. . . . education process becomes an analy- "Determining the planning ap- hoc committee has been appointed "Health education for the public sis of the total on-.going system. Con- proach has been complex because WC for continuing education of alli(,.cl has emer,,Cd as a top priority objcc- sequently, the findings will be more have attempted to shape our program health professionals with rcl)t-escntl- tive, and re(-.ruittrient of a full-time relevant and meaningful if the in response to the requirements of tives from the Vermont Division of information specialist to be respon- widest possible representation of the the systems approach to planning. the American Cancer Society, the sible for this aspect of the Pro,-ram education system is obtained." This approach provides for the appli- American Red Cross, the State is currently underway. . . . cation of advanced mathematical and Health Department, the Department "Dissemination of recently ac- Northern New England computer techniques in analyzing of Physical Medicine and Rchabilita- quired medical information to the Regional Medical Program alternative solutions to problems. It tion of the College of Medicine, the practicing physician has also been a also includes cost-benefit studies. Vermont Heart Association, the Ver- concern of the Northern New Eng- "The Northern New England Some cost estimates of the training of mont Pharmaceutical Association, land Rc,,ional Medical Program and Regional Medical Program and core allied health personnel and coronary the State Mental Health Depart- our proposed Pilot Project in Coro- nary Care is an illustration of how we staff have been organized along care training for nurses have been ment, the Office of Continiiin(, Eclu- functional lines-medical economics, made. Since there arc no precedents, cation of the College of Medicine and intend to accomplish this task. the Rc ional Medical Proaram's Through cooperative arrangements education, information systems, dis- some experimentation has been nee- 9 ease prevention, and patient care essary. . . . staff. This group has defined specific between health personnel at the Cen- services. All planning and program "'ne development of a Model of objectives for continuing education ter and their counterparts in the re- efforts, in turn, are organized ac- Patient Care is the major initial and is gathering information on exist- gion which are described in our cording to a systems approach planning effort. To develop the edu- ing activities and personnel needs for proposal, we intend to promote ap- which provides continuous feedback cational aspects of the Model, an carrying on these activities. . . . plication of the latest techniques in of information and assessment of Education Committee has been ap- "The potential use of various progressive coronary care at the local progress. . . . pointed which will be concerned with modes of communication and trans- level. . . . "We have made good progress in lay health education continuing portation to augment continuing "The proposed Pilot Project in determining the scope of participa- education for all health professionals, education pro,-rams is being ex- Progressive Coronary Care involves tion of various health related groups and basic education in the allied plored. Two-way television connec- research related to the regional as- in Regional Medical Programs. From health professions. . . . tions between the Medical Center pects of the management of coronary the beginning we have made every "A meeting held in February 1967 Hospital and community hospitals in disease. One such study will be a effort to include representatives from with representatives of some 25 or- the Region and the use of the Uni- determination of modifications in all interested groups in our planning oanizations which operate a variety of versity's airplane are two possibilities equipment and personnel require- 0 ide intensive effort. . . . health education proarams was a first for future education pro-ram sup- ments necessary to prov "A number of steps have been step in coordinating the existing port. . . . coronary care in small community taken to develop cooperative Work- health education pro-rams with Rc- "Assessing basic education needs in hospitals. Using the data collected ing relationships %vith health profes- gional Medical P the allied health professions has been through the Heart Inventory, which sions groups, hospitals, health ties. . . . rogram activi a prime concern; and surveys have the Northern New England Regional 53 Nfe(lic,al Program is developing, it ing li(@.altli agencies, i-)til)lic an(] voltin- seemed desirable to explore with the design of projects a mechanism for will be possible to identify other tary, and of the wide spectrum of faculties of the two medical schools evaluating their results. . . . potential research projects related to health personnel on which good 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 Hospital and Chair- "Our planning efforts must neces- ture on a screen as steps have been ous 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 tee for Regional Medical Programs portation affccts the delivery of planning for specific action to deal communities in the region which had for Heart Disease, Cancer and Stroke, health care. Thus, we currently are ,vith 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 Med- 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 members of the Board of effective it Is." stancl'n Trustees. It was apparent that the I g about its purposes and agencies in Nashville and other areas iii(!tlio(Is tli@it li@is t;tk(!ti in the of tll(! region. . . . "I'OLII) was anxious to establish corn- .1 Tennessee Mid-South past year. 'I'lle basis for most of the "On January 10, 1967, the Direc- munication with the Regional Medi- Regional Medical Program achievements to date is the willing- tor met with a group of approxi- cal Program and was particularly in- ness of many persons, acting on their mately 12 hospital administrators terested in the field of continuing "Understanding of what the fun- own behalf or that of their institu- from the Nashville area. The ro education. The potential of televi- damcntal concept of a Regional tiotis and organizations, to study new @ up sion and other communications Medical Program is and how to best to tin(l(-t-tak(! new rc- was l@tiowlc.(Ig(@al)lc about the OI)JCC- media Nvas discussed. The staff indi- develop and establish it in this region sl)onsibilitics to assure the continued tives and procedures to be followed cated that it would be greatly inter- has proceeded steadily from the improvement of medical care in the in developing a Regional Medical ested 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. . . . ested in finding out how the Regional for periods of one or two days at a evitably, such understanding has de- "In developing the strategy to be Advisory Group would function and time. They expressed interest also in velopcd in an evolutionary fashion followed, the Director of the Ten- the basis for establishing priorities for the possibility that a full-time chief of since it is, in fact, a reflection of a nesscc Mid-South Regional Medical projects which might come from a medicine might be appointed in order growing awareness of the medical Program has sought consultation variety of sources. Questions were to help organize an educational pro- faculties of ways in which they can from Dean Batson (Director, Medi- raised about the establishment of grain of some substance which could serve as resource agencies for im- cal Affairs, Vanderbilt University), coronary care units in hospitals and serve not only the Hopkinsville proved medical care, and of practic- Mr. Kennedy, (Chairman of the Re- particular inquiry was made about group but the 8 or 10 smaller hospi- ing physicians that the primary aim gional Advisory Group), and from the eligibility of hospitals for funds tals which are located within a I 0 of the program is to help 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 formulating policy for this kind. A discussion was held about "A meeting was also held with the cal area. Similarly, the role of exist- Meharry Medical College). It the importance of building into the staff of the Erlanger Hospital in 54 Chattanooga on March 8, 1967. We "Similar developments arc taking Center sponsored by Meharry and jectives in an area where existing fa- discussed the problem created by the place at two hospitals in Nashville, funded tllrougll the Office of E(,o- cilities and personnel are desperately fact that Chattanooga serves areas St. Thomas, and Mid-Statc Baptist nomic Opportunity, believes that the needed. . . . not only in Tennessee but also in and in Knoxville and the Tri-City Regional Medical Program could be "Acquisition of information about Northern Georgia. The Director as- area. . . . of considerable value in supplement- the health resources of the region is sured the staff that the Regional "In addition to visits with hospi- ing the services that Neighborhood underway and will be continued and Medical Program would in no way tals, the Director has met with many Health Center would ordinarily make expanded during the year. Using the interfere with the relationships with of the medical societies in the re- available. . . . resources of the biostatistical division established groups. We then discussed spective communities and they have "The demands made by the Re- of the Department of Preventive ways in which the hospital could now established liaison committees gional Medical Program have focused Medicine and Public Health of Van- proceed to become actively engaged to consider ways and means of foster- the attention of the professors of derbilt University, data has been put in an operational project. The follow- ing activities under the aegis of the medicine, surgery, and radiology at on computer tape regarding physi- ing suggestions were made-that a Regional Medical Program for Heart Vanderbilt University on the need to cians, nurses and the hospitals. Using committee be appointed within the Disease, Cancer and Stroke. In most make a major revision in the facili- this basic information a health re- hospital to coordinate suggestions instances, it was found that these ties for diagnosis and treating sources profile will be'developed for made by the various services and to committees while expressing interest, patients with surgically correctable each county and later certain coun- cooperate with the already appointed had been unable to focus their ef- cardiovascular disorders. The evident ties will be grouped into areas to de- committee of the medical society. The forts on specific programs. It was only strengths of the institution have not termine the characteristics of these individual chiefs should be encour- through discussion of possible been used as effectively as they might, larger areas. Demographic data will opera- aged to draw up a rough draft of pro- tional projects for which grant funds and the requirements for a pene- also be used as a basis for determining posals relating to their own depart- might be made available that the ac- trating assessment of the problem has the size of the population to be served ment. The Director indicated that tivities began to achieve some degree been a beneficial experience. in the respective counties and areas. the Regional Medical Program staff of substance. . . . "Planning is underway to deter- Valuable correlative data has also would work with the various groups "Dr. Frank Perry, Associate Pro- mine how best to develop a rehabili- been obtained from the statistical di- to help refine the proposals, make fessor of Surgery, is coordinator for tation facility to serve the needs of the vision of the Tennessee Department sure that mechanisms for evaluating the Meharry faculty and will devote region. A gift in the amount of of Health. . . . the projects were incorporated and a major sliar(- of his tirn(@, to (@xl)lora- $2,000,000 from a Nisliville family that specific budgets relating to per- "In (-oopcration with th(-'f'(-nnesse(- tion of continuing education pro- has insured the funds for construe- Nurses Association and the Tennessee sonnel, supplies, equipment, etc., grams for Negro physicians. He plans tion. Intensive effort is needed, how- were properly drawn. It appears to coordinate his activities with the ever, to coordinate the project for League for Nursing, we are making a likely that the Regional Medical Pro- parallel efforts being made in con- maximum involvement of faculty, study leading to the preparation of a gram will work through this grotil) to titittiiig (-(Itj(-.ttion by tile f;i(-tilty @it (@,omrtititiity tg(-ri ' ,tate-wide plan for n timing education. Irl(l ,ttt(. "tri(I est.-tblisli an c(iti(-.ttioiiti If is lli:lt in iiii% (-j)(I(-,tvt)r will I)(- this area anticipating that the group "Di-. Leslie l,'itlk of the University tile institution will S(.I-vt! lilll)of,t;tiit Miss Aiiii(- II(-:i(i (yf ill(. St;i- at the hospital will reach out into the of Pittsburgh School of Health, who educational and research purposes. tistical Division of the Tennessee De- surrounding areas to establish closer is serving as chief consultant for the Th-is appears to be an excellent ve- partment of Public Health. The time contact for the training purposes.... planning of a Neighborhood Health hicle for achieving regional ob- seems ripe for just such a study to 55 help focus on the total problem of sicians. We need to know the future habilitation, will have high priority evolve from the collaborative efforts nursing." patterns of medical practice. The in developing an operational program with the Galveston Community Col- gradual shift of general practitioners in the immediate future. . . . lege. . . . Texas into specialties and into population "In Area 11, many physicians were "The planning staff became acute- Regional Medical Program centers is leaving many areas without skeptical, suspicious, or hostile to the ly aware that the health practitioner younger physicians. Several counties Regional Medical Program on initial and the hospital at the community "The Project Director in Area I has have no young men coming into their contact. The hostile response, how- level had little knowledge of the exist- conducted meetings with various communities. In order to examine ever, was not uniform. Many physi- ence, the intent or the potential of educational health agencies. Meet- regional problems Area I has been cians, and a majority of many of tht Regional Medical Programs. Efforts ings were held to determine mcth- divided into six divisions and studies district and county medical societies, to establish written communication odology and to enlist the help of dcd- are now underway to define the phy- looked favorably and hopefully upon proved less than satisfactory; there- icated individuals interested in the siclari's role in each community. . . . the program. They saw in it an ol)- fore, a more direct approach was .goals of the l@egional Medical Pro- "Within the regular teaching pro- I)ortunity for continuing education deemed essential. On February 25, grams. Outside the Medical School gram for medical students, residents, for themselves, for training of allied 1967, the president of each county community, the Council of Medical and intems at the University of Texas health professionals, for supplemen- medical society in the Gulf Coast Society Representatives appears to be Southwestern Medical School and tary special medical care facilities, Area was invited to Galveston to en- the most significant body to reach affiliated teaching hospitals there are and other measures that may alleviate ter into a dialogue on Regional community physicians. Two meetings conferences, seminars, lecture-,, and a feeling of isolation. . . . Medical Programs. It was hoped of the Council of Medical Societies clinics that are maintained on a "Certain difficulties have been that each of these individuals would Representatives have been attended regular basis and arc available for encountered in Area III in commu- return to their respective communi- by 28 physicians and 12 hospital ad- physicians interested in continuing nicating with peripheral points at ties and would, in turn, create addi- ministrators from 16 of the 44 Coun- postgraduate education. There are which health care services are dis- tional dialogue at the local level. Rep- ty Medical Societies of Area I. There several institutional grants in both pensed. Full-time personnel are still resentatives from seven county socie- was a favorable attitude expressed to- heart disease and cancer supported being sought for the professional posi- ties, the Texas Medical Association ward the Regional Medical Program by Public Health Service grants. tions now filled on a part-time basis. and planning staffs from each of the and a desire expressed for the need These programs are oriented to co- A full-time Assistant Planning Direc- several components of the Texas Re- of the early development of an In- operate with the Regional Medical tor will concentrate his efforts on gional Medical Program attended. tensive Care Unit Training Program Programs. . . . hospitals and other health care cen- While the physicians present repre- for nurses and physicians. The in- "Stroke: Significant programs are ters. It is obvious that the circuit- sented only a small part of the geo- volvement of hospital administrators being developed in the medical rider technique must be employed to graphic area, this meeting provided individually or through the I-losl)ita school community, especially the effect an appropriate response at the considerable information that verified Council, has been most worthwhile Presbyterian Hospital, to develop a community level. . . . the essentiality of a continuing inter- since the eventual improvement of significant demonstration unit involv- "The feasibility study for develop- change between a planning office and health services must generate from ing all of the disciplines of medicine ing a School of Allied Health Sci- the health practitioner. The meeting the community hospitals. . . . necessary to bring this program into ences has progressed very well. Em- also demonstrated the difficult task "There are many facts to be un- one cooperative effort. A total pa- phasis will also be placed on studying that lay ahead in establishing such a covered by making a survey of phy- tient care program, including re- mutual relationships that could dialogue. . . . 56 Intensive Care Unit dissipating as further information is other health professionals in the con- "At the Division of Allied Health provided. . . . ferences, clinics, and ward rounds of Science at South Texas junior Col- "The planning director has collab- "In the early phases of this pro- the Medical Center. . . . lege (Houston, Texas) feasibility orated with the administration of the gram it is the primary objective of "A study of the applicability of studies are in process in the develop- University of Texas Medical Branch the Division of Continuing Education closed circuit television communica- ment of curricula in nursing, inhala- and the Medical Branch Hospitals of the Graduate Medical School of tion with one or a few local com- tion therapy, X-ray, medical records, in developing a modem intensive care Biomedical Sciences to determine munity hospitals is of considerable in- physical and occupational therapy as- training unit which will contain four how educational roles may be dis- terest. This institution will participate sistants, medical monitoring and elec- beds for postoperative care of patients charged within the framework of in- with others in the region to prepare tronics, ophthalmic assistants and die- with cardiovascular disorders. The dividual needs and goals, while at formal postgraduate training pro- tary supervision. . . . planning director is currently arrang- the same time providing practical and grams for television presentation. In "At this writing, we have the pros- ing for partial funding through non- applicable information which will be addition, it is proposed to utilize this pect of a cooperative feasibility study federal sources. This unit will be de- both convenient and accessible to the medium for individual consultations for a multiphasic screening pilot proj- veloped in such a manner that will physician and others who deliver with patients who can then remain ect in conjunction with the Baylor permit the training of nurses and health care, and which will ultimately in a familiar environment with their University College of Medicine com- physicians to man intensive care units result in better patient care. . . . own physicians. . . . puter science program and the De- in other hospitals. . . . "An attempt will be made to con- "A general planning study and sur- partment of Biomathematics of the "Many interested individuals and vey the concept that the medical vey has been undertaken in the allied University of Texas at Houston. This groups are taking an active part in school not only awards an M.D. de- health professions education field to would involve a multiphasic automa- gathering information and are par- gree, but provides annual opportuni- identify needs, trends, problems, and tion and computer project in patient ticipating in studies, such as the ties to appraise the practicing phy- resources necessary to implement diagnosis. This would also bring into Houston Area Hospital Personnel As- sician of current attitudes and grant proposals and program goals in focus projects for continuing educa- sociation and Houston Dietetic As- techniques, to support the physician advancing, through education, train- tion of physicians in outlying hospitals sociation. They have worked with the in his need for lifelong leaming.... ing and demonstrations, the care of and allied health education and train- staff in designing questionnaires and Regional Training Program heart-cancer-stroke patients. . . . ing needs and programs. . . . gathering information. . . . in Cardiovascular Disease "In brief, findings indicate: a gen- "A major introductory activity in- "The program is serving as a cata- eral awareness that a perilous short- volved recognition and visitation of lyst in encouraging dialogue and co- "The initial study of personnel age of allied health personnel exists rehabilitation settings within the operation between institutions, in- available within the Medical Center in both numbers and quality . . . Texas Medical Center and in terest groups, associations and for postgraduate training programs physicians want and need to delegate Houston community agencies. Pro- individuals. Progress in carrying out in the area of cardiovascular disease more to allied health personnel to grams in these institutions pertinent free themselves to serve more pa- to the development of the Program planning studies and surveys is being has been productive . . . initial con- tients . . . a closer liaison is evolv- were explored and an attempt was made. Misconceptions and erroneous siderations have led to plans for re- ing between educational institutions made to build with these institutions conclusions about the purposes and fresher courses lasting three to five and hospitals in the education and appropriate collaboration. These or- goals of the program arc being cor- days and providing for the participa- training of all levels of allied health ganizations include: the Methodist rected. Resistance to the program is tion of practicing physicians and personnel. . . . Hospital, the Ben Taub General Hos- 57 pital, the Physical Medicine and Re- ical Association, the various county habilitation Service of the Veterans medical societies, specific practition- Administration Hospital, Houston, ers, hospital administrators 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- cerned with a number of cancer pa- going programs under diverse aus- tients, and there is considerable expe- pices. Before a statewide registry can rience with restoration of the mouth, be projected, all aspects of existing face, nosc and cars. Prostheses includ- programs must he reviewed to fit into ing artificial eyes are fabri(-,atecl. the larger effort in an harmonious 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 linfx)i,taiil I)ositiori. We have felt it 'expedient to evaluate the needed adjustments between the Texas Med- Preparation of Report Ad Hoc Advisory,co@ttee Planning Grants IV Operational Grants V National Ad VI eview Con R vii Consultants viii Program Coordinators IX Review of Operational Grants x Division Staff. xi Relatio ships@of Public IL n 89-239 and 89-749 XII Public Law 89L239 XIII Regulations XIV, Selected Bibliography EXHIBI'-I"S EXHIBIT I steps to be followed in preparing the cussion groups of about 25 indi- Report. viduals each that met three times First, an outline of discussion items during the Conference. The results Steps in was prepared and reviewed at a of this meeting are published in the Preparation of the meeting on November 7. From these, Proceedings: Conference on Re- Surgeon Gencral's the key issues relating to the three gional Medical Programs. Report to Congress areas specified for consideration in The wealth of information on Regional Section 908 of the Act and other as- developed by the Conference was Medical Programs pects of the program were identified supplemented by letters and other ma- and analyzed. teriaI, voluntarily submitted by par- To assist in the preparation of the Subsequently, a national forum ticipants following the Conference. report required by Section 908 of was scheduled at which these issues To gather additional information, the Public Law 89-239, the Surgeon were presented for consideration and Division staff made a series of visits General appointed a Special Ad Hoc reaction from health and related in- to on-going Regional Medical Pro- Committee of non-federal consult- tcr@ts representing all sections of the grams and held discussions with Pro- ants. The nucleus of the committee country. This forum took the form of gram Coordinators and others en- was four members of the National a Conference on Regional Medical gaged in the development of regional Advisory Cowicil on Regional Medi- Programs h e I d in Washington activities. A "14-point" survey form cal Programs. Eleven other persons (D.C.) on January 15-17, 1967. was also distributed to all Program with diverse backgrounds and inter- Nearly 850 medical, health and civic Coordinators for their use in for- ests in health and public affairs @ leader-, were invited. This group in- warding up-to-date data on the status joined the group. In addition, six cluded persons from both regions of their activities and plans. All of other individuals with extensive ex- ',where planning activities were al- this material was analyzed and used perience in medical education and ready underway and from other in the preparation of this Report. governmental administration agreed areas where proposals were still un- A preliminary draft of the Report to serve as consultants to the Ad Hoc der development. In addition, many was reviewed by the Ad Hoc Corn- Committee. (The members of and others with related interests received mittcc on March 10, 1967. It was consultants to the Committee are invitations. More than 650 persons .subsequently revised in accordance listed in Exhibit II.) attended the Conference. with its recommendations and re- The Committee met five times. At submitted to them on April 14. the initial meetings, on September 16 Four Issue Papers were prepared After consultation with the members and October 7, 1966, issues ix-.rtain- by the Division of Regional Medical of tti(! National Advisory ('otiii(,ii on ing to the (:Ievelol)iiietit III(] tdiniti- t'i-ogi-.tiiisiii(i (listril-)titc(l ill;t(lvittl(!C. l@(-gioii-ti Me(li(@,ii l'i-ogrtitis, tli(! l@e- istration of Regional Medical Pro- Seven papers were presented at plc- port was submitted to the Secretary grams were presented and discussed. nary sessions and two panel sessions of Health, Education, and Welfare From these deliberations came a were conducted. These presentations for transmission to the President and series of recommendations for the provided background for the 26 dis- Congress. 61 .Jon(-s Storni Whaley (Chtirmin) Charles Kidd, Ph. D. I."X I I I II)I'I' I I Director Vice President of Health Sciences Executive Secretary Emily and Ernest Woodruff Foundation University of Arkansas Medical Center Federal Council for Science and ,Sul--(-@oii (@ctier@tl@s Special Atlanta, Georgia Little Rock, Arkansas Technology Ad Hoc Ad@,isor%, Office of Science and Technology I Charles E. Odegaard, Ph. D. Paul N. Ylvisaker, Ph. D. Washington, D.C. Cominittc(- 'fo Dex-clop President Commissioner Jack Masur, M.D. the Report on R(-,gional University of Washington New Jersey Department of Community Associate Director for Clinical Care ,Nlcdlc@il Programs to Seattle, Washington Affairs Administration Trenton, New Jersey Office of the Director tiie President and Edmund D. Pellegrino, M.D.' National Institutes of Health the Con,@,,ress Director Bethesda, Maryland Medical Center Consultants to the State University of New York Joseph S. Murtaugh Ray E. Brown, L.H.D, Stii-g,(-on Geri(-I-al's Speci@il Chief Director Stony Brook, Neiv York Ad A(Ivisol,v Office of Program Planning Office of the Director Graduate Program in Hospital (.';trl I I(-riry Williiiii little, M.D. (:olllllllll(,(! ']'o National Institutes of Health Administration Assistant Secretary the Report on Regional Bethesda, Maryland. Duke University Medical Center Council on Medical Education Durham, North Carolina American Medical Association Medical Programs to Michael E. DeBakey, M.D.' Chicago, Illinois the President and Professor and Chairman Department of Surgery Cltrk K. SI(-eth, M,D. III(. ("01)(,I-(.Ss College of Mellicitic I)e(lit Baylor University School of Medicine Norman Beckman, Ph. D. Houston, Texas West Virginia University Director Bruce W. Everist, Jr., M.D' Morgantown, West Virginia Office of Intergovernmental Relations and Urban Program Coordination Chief of Pediatrics Ray E. Trussell, M.D. Department of Housing and Urban Green Clinic Director Development Ruston, Louisiana School t)/ l'iiblic Ilcalth and Washington, D.C, James 'I'. Ilowcll, M.D.' Administrative Medicine Executive Director Columbia University Ward Darley, 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 James, M. D, Associate Professor University of Colorado Medical Center Dean Department of Economics Denver, Colorado Mount Sinai School of Medicine University of Wisconsin New York, New York Madison, Wisconsin Kermit Gordon Vice President 'Member, National Advisory Council Robert E. Westlake, M.D. The Brookings Institution on Regional Medical Programs. Syracuse, New York Washington, D.C. 268-649 O-C,7-5 62 EXHIBIT III Plannin- Grants for Regional Medical Programs, June 30, 1967 0 REGIONAL DESIGNATION ALABAMA ALBANY, NEW YORK ARIZONA ARKANSAS PRELIMINARY Alabama Northeastern New York and Arizona Arkansas PLANNING REGION.' portions of southern Vermont and Western Massachusetts POPULATION ESTIMATE 3,500,000 1,900,000 1,635,000 1,960,000 1965.2 COORDINATING University of Alabama Albany Medical College of College of Medicine University of Arkansas HEADQUARTERS. Medical Center Union University, Albany University of Arizona Medical Center Medical Center. 3 GRANTEE. Same.5 Same.5 Same.5 Same.5 EFFECTIVE STARTING January 1, 1967 July 1, 1966 April 1, 1967 April 1, 1967 DATE. PROGRAM PERIOD 3 2y, (YEARS). AWARD $318,046-Ist $373,254-Ist $119,045-Ist $360,174-Ist (AMOUNT AND YEAR). $384,244--2nd RECOMMENDED FUTURE $286,750-2nd $252,486-3rd $287,00(@2nd $421,682-2nd SUPPORT $143,375-3rd $67,750-3rd $97,300-3rd (AMOUNT4 AND YEAR). Preliminary regionsfor planning purposes as delineated in the original applications. State designations 3 The Grantee differsfrom the Coordinating Headquarters when the Region requested this arrangement 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 of planning and experience. 4 Direct costs only. 2 Population estimates include overlap between regions. As preliminary regional boundaries are evaluated 5 Indicates the Grantee Agency and the Coordinating Ileadquaritys are the same organization and clarified during the planning process, inappropriate overlap will be eliminated. 63 REGIONAL DESIGNATION BI-STATE CALIFORNIA CENTRAL NEW YORK COLORADO-WYOMING PRELIMINARY Eastern Missouri 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 18,600,000 1,800,000 2,300,000 1965.2 COORDINATING Washington University School California Committee on Upstate Medical Center, University of Colorado HEADQUARTERS. of Medicine Regional Medical Programs State University of Medical Center New York at Syracuse GRANTEE.3 Same.5 California Medical Education Research Foundation of State Same.5 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, 27/3 2 2y, (YEARS). AWARD $603,965- 1 st $1,511,381-Ist $289,522-Ist $361,984-Ist (AMOUNT AND YEAR). RECOMMENDED FUTURE $547,989-2nd $2,198,452-2nd $211,206-2nd $326,114-2nd SUPPORT $135,993-3rd $961,982-3rd 3 I 70,662-3rd (AMOUNT I AND YEAR). Preliminary regionsfor planning purposes as delineated in the original applications. State designations 3 The Grantee differsfrom the Coordinating Headquarters when the Region requested this arrangement 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 assume formal fiscal responsibility. the hasty (,f pitiritti@i,, and experience. 4 Direct costs on@Y. I Population estimates include overlap between regions. As preliminary regional boundaries are evaluated 5 Indicates the Grantee Agency and the (,oordittatir@g Ifeadquarters arc the same organization. and clarified during the planning process, inappropriate overlap will be eliminated. 64 REGIONAL DESIGNATION CONNECTICUT GEORGIA GREATER HAWAII DELAWARE VALLEY PRELIMINARY Connecticut Georgia Eastern Pennsylvania and Hawaii PLANNING REGION. portions of Delaware and New Jersey POPULATION ESTIMATE 2,800,000 4,400,000 8,800,000 800,000 1965.2 COORDINATING Yale University Medical Me,(Ii(,;tl A-,so(-i:ttioii of I JIlivi-i-si(y (!ily i llli%,(.Isity (,I I [:[W.,Iii Scliool:iti(I L)iiivci-sity off I(-;iltli Scien(:(-s of Connecticut School of Medicine GRANTEE .3 Yale University School of Same.' Same.-" Same.-5 Medicine EFFECTIVE STARTING July 1, 1966 January 1, 1967 April 1, 1967 July 1, 1966 DATE. PROGRAM PERIOD 3 2 (YEARS). AWARD $406,622-Ist $240,098-Ist S 1,531,494-1 st s 1 08,006- 1 st (AMOUNT AND YEAR). $338,513-2nd $119,122-2nd RECOMMENDED FUTURE $312,761-3rd $203,207-2nd SUPPORT $104,749-3r(I (AMOUNT' AND YEAR). 'Preliminary regions for planning purposes as delineated in the original applications. State designations 3 The Grantee differsfrom the Coordinating Headquarters when the Region requested this arrangement 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 of planning and experience. 4 Direct costs on4y. 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 will be eliminated. 65 itE(;IONAI, DI,-,Sl(;NAI'fON ILLINOIS INDIANA INTERMOUNTAIN IOWA Illinois Ut;ili;tti(i I)oi-tioiis of Colorado, Iowa III.ANNIN(; Illl(.I(),%" I(I;tiio, Motit;tii;t, Wyoming POPULATION ESTIMATE 10,700,000 4,900,000 2,200,000 2,800,000 COOlti)iNA'l IN(; Coordinating Committee of Indiana University School University of Utah School University of Iowa College IIEADQUAI"I'l-@]tS. Medical Schools and Tc;iciiing of Medicine of Medicine of Medicine Hospitals of Illinois Indiana University Foundation Same.' Same.5 GRANTEE.' University of Chicago EFFEC'F IV I" July 1, 1967 January 1, 1967 July 1, 1966 December 1, 1966 PROGRAM PERIOD 2 2@' 2 2 2 YEARS AWARD $336,366-1 st $384,750-Ist $456,415-ist $291,348-1 st (AMOUNT AND YEAR'. $363,524-2nd RECOM,NLENDED FUTUIIL $244,175-2nd $373,710-2nd $230,218-2nd SUPPORT $152,295-3rd (AMOUNT I AND YEAII@. Preliminary r@gionsjor planning purposes as delineated in Ike original applications. State designations 3 The Grantee differsfrom the Coordinating Headquarters when the Region requested this arrangement do not indicate they are coterminous with State lines. 'I-he3e 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 experience. 4 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 will be eliminated. 66 REGIONAL DESIGNATION KANSAS LOUISIANA MAINE MARYLAND PRELIMINARY Kansas Louisiana Maine Maryland PLANNING REGION.' POPULATION ESTIMATE 2,200,000 3,500,000 1,000,000 3,520,000 1965.2 COORDINATING University of Kansas Louisiana State Department Medical Care Steering Committee of the HEADQUARTERS. Medical Center of Hospitals. Development, Inc. Regional Medical Programs for Maryland. GRANTEE.3 Same.5 Samc.,@ Samc.,'@ The Johns Hopkins University EFFECTIVE STARTING July 1, 1966 January 1, 1967 (;7 DATE. J;tnutry 1, 1967 PROGRAM PERIOD 2 (YEARS). 2 AWARD $490,448- 1 St ]St $518,443-Ist (AMOUNT AND $293,080-2nd RECOMMENDED $514,251-2nd 2nd SUPPO@RT $431,821-2nd (AMOUNTIAND Preliminary regions for planning purposes as delineated in the original applications. State designations 3 The Grantee differsfrom the Coordinating Headquarters when the Region requested this arrangement 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 assumeformalfiscal responsibility. the basis of planning and experience. 4 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 will be eliminated. 67 REGIONAI, DESIGNATION MEMPHIS METROPOLITAN MICHIGAN MISSISSIPPI WASHINGTON, D.C. PRELIMINARY Western Tennessee, Northern District of Columbia and Michigan Mississippi PLANNING IZEGION.' Mississippi, and portions 2 contiguous counties in of Arkansas, Kentucky, Maryland, 2 in Virginia, and Missouri and 2 independent cities in Virginia. POPULATION I:STIMATE 2,400,000 2,050,000 8,220,000 2,320,000 COORDINA'I'IN(; Mid-South Medical Council District of Columbia Michigan Association University of Mississippi HEADQUARTERS. for Comprehensive Medical Society for Regional Medical Medical Center Health Planning, Inc. Programs, Inc. GRANTEE.." University of Tennessee Same.-5 SaMe.5 Same.5 College of Medicine EFFECTIVE STARTING April 1, 1967 January 1, 1967 June 11 1967 July 1, 1967 DATE. PROGRAM PERIOD 2y, 2@12 2 tYEARS). AWARD $173,119-Ist $203,790-Ist $1,294,449-Ist $322,845-Ist AMOUNT AND YEAR). RECOMMENDED FUTURE $140,000-2nd $169,658-2nd $295,825-2nd SUPPORT $54,825-3rd $84,829-3rd fAMOUNT I AND YEAR). Preliminary regions for planning purposes as delineated in the original applications. State designations 3 The Grantee difersftom the Coordinating Headquarters when the Region requested this arrangement 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 assume formal fiscal responsibility. the basis of planning and experience. ' Direct costs only. I 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 will be eliminated. 68 REGIONAL DESIGNATION MISSOURI MOUNTAIN STATES NEBRASKA-- NEW MEXICO SOUTH DAKOTA PRELIMINARY Missouri Idaho, Montana, Nevada Nebraska and South Dakota New Mexico PLANNING REGION.' and Wyoming POPULATION ESTIMATE 4,500,000 2,200,000 2,200,000 1,000,000 COORDINATING University of Missouri Western Interstate Commission Nebraska State Medical University of New Mexico HEADOYA)t-l-ERS. School of Medicine for Higher Education Associitioii School of Medicine GRANTLE.:@ Samc.,5 Same.5 Same.' University of New Mexico EFFECTIVE STARTING July 1, 1966 November 1, 1966 Jtnuiry 1, 1967 October 1, 1966 DATE. PROGRAM PERIOD 3 2 2 2y, 'YEARS). AWARD $398,556-1 st $876,855-Ist $350,339-ist $449,736-Ist (AMOUNT AND YEAR). $324,254-2nd RECOMMENDED FUTURE $368,125-3rd $761,983-2nd $281,450-2nd $729,285-2nd SUPPORT $545,491-3rd AMOUNT I AND YEAR Preliminary regions for planning purposes as delineated in the original applications. Slate designations 3 The Grantee differsfrom the Coordinating Headquarters when the Region requested this arrangement do not indicate they are coterminous with State lines. 7hese preliminary regions may be modified on or the latter agency did not have the capability to assumeformalfiscal responsibility. the basis ofplanning and experience. I Direct costs only- 2 Population estimates include overlap between regions. Aspreliminary 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 will be eliminated. 69 REGIONAL DESIG@NAI ION NEW YORK NORTH CAROLINA NORTHERN NEW ENGLAND NORTHLANDS METROPOLITAN AREA PRELIMINARY New York City, and Nassau, North Carolina Vermont and 3 counties in Minnesota PLANNING REGION-I Suffolk and Westchester Northeastern New York. Counties. POPULATION ESTINIATE 11,400,000 4,900,000 550,000 3,600,000 (,OORI)INA'I'ING Associated Medical Schools Association for the North Carolina University of Vermont Minnesota State Medical fiLAD@)UAItTLItS. of Greater New York. Regional Medical Program. College of Medicine. Association Foundation Same.-5 Duke University Samc.5 Same.5 Jeff N(. 1, I!)67 I)A I 1, 111to6i'A.Ni I'llf',101) 2 2 @YEARS@. AWAIII) $967,010-1,;t $435,851-Ist $316,186-Ist $370,904-Ist AMOtiN I'A@NI) Yi-,All $600,944-2nd $377,701-2n(i JILCOMMENDED FU'I'Ultl; $961,957-2nd $234,872-3rd $469,080-2nd SU-PPORT $234,700-3rd AMOUNT I AND YEAR,. Preliminary regions for planning purposes as delineated in the original applications. State designations 3 The Grantee differsfrom the Coordinating Headquarters when the Region requested this arrangement do not indicate they are coterminous with Slate lines. 7hese 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 experience. I Direct costs on@. I Population estimates include overlap between regions. As preliminary regional boundaries are evaluated 5 Indicates the Grantee Agency and the Coordinating Headquarters are @ same organization. and clarified during the planning process, inappropriate overlap will be eliminated. 70 REGIONAL DESIGNATION OHIO STATE OHIO VALLEY OKLAHOMA OREGON PRELIMINARY Central and Southern @i of Greater part of Kentucky and Oklahoma Oregon PLANNING REGION.' Ohio (61 counties excluding contiguous parts of Ohio, Metropolitan Cincinnati Indiana, and West Virginia. area). POPULATION ESTIMATE 4,500,000 5,900,000 2,500,000 1,900,000 1965.2 COORDINATING Ohio State University Ohio Valley Regional University of Oklahoma University of Oregon HEADQUARTERS. College of Medicine. Medical Program. Mcdictl Center. Medical School, GRANTEE.3 Same.5 University of Kentucky Same.5 Same.5 Research Foundation EFFECTIVE STARTING April 1, 1967 January 1, 1967 September 1, 1966 April 1, 1967 DATE. PROGRAM PERIOD 1 2 2 2@i (YEARS). AWARD $109,417-Ist $346,760-1 st $1 77,963- I st $2I9,168-ist (AMOUNT AND YEAR). $2:12,:@71---2ii(i s 1 7 $44,078-3rd (AMOUNT 4 AND YEAR). Preliminary regions for planning purposes as delineated in the original applications. State designations The Grantee differsfrom the Coordinating Headquarters when the Region requested this arrangement 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 assume. formal fiscal responsibility. the basis of Planning and experience. 4 Direct costs only- 2PoPulation 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 will be eliminated. 71 PI..(,I()NAL ')LSIGN'i IION ROCHESTER, NEW YORK SOUTH CAROLINA SUSQUEHANNA VALLEY, TENNESSEE MID-SOUTH PENNSYLVANIA Rochester, N.Y., and I I South Carolina 24 counties centered around Eastern and Central Tennessee surrounding counties. Harrisburg and Hershey. and contiguous parts of Southern Kentucky and Northern Alabama. 2,100,000 2,600,000 1-1,S'li,'YIA'I'L 1,200,000 2,500,000 University of Rochester Medical College of South Pennsylvania Medical Society. Vanderbilt University School k!LAD( School of Medicine and Carolina. of Medicine and Meharry ZUARTERS. College of Medicine. Dentistry. l@ A N'l I,, I-,.' Saine.5 Vanderbilt University. Octoij(:I- 1, I!)(;(; j @in u;try 1, 19(i7 June 1, 1967 July 1, 1966 PROGIZAM PERIOD 2 2 2 (N'EAltS). AWAIII) $2(i:i,5:tO -I ,t $2(-@5,it4l-lst (AMOUN'I'A.Nl) YEA]t). $393,458-2nd RECOMMENDED FUTURE $329,364-2nd $249,550-2nd SUPPORT $259,900-3rd (AMOUN'I' I ANI) Yl-"All). Preliminary regions for planning purposes as delineated in the original applications. State designations The Grantee differsftom the Coordinating Headquarters when the Region requested this arrangement do not indicate they are coterminous with State lines. These preliminary regions may be modified on or the latter agency did not have the cabability to assumeformalfiscal responsibility. the basis of planning and experience. 4 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 will be eliminated. 72 REGIONAL DESIGNATION TEXAS VIRGINIA WASHINGTON-ALASKA WEST VIRGINIA I PRELIMINARY Texas Virginia Alaska and Washington West Virginia PLANNING REGION.' POPULATION ESTIMATE 10,500,000 4,500,000 3,200,000 1,800,000 1965.2 COORDINATING University of Texas Medical College of Virginia and University of Washington West Virginia University HEADQUARTERS. University of Virginia School School of Medicine. Medical Center. of Medicine. GRANTEE.3 Same.' University of Virginia School of Same.5 Same.5 Medicine. EFFECTIVE STARTING July 1, 1966 January 1, 1967 September 1, 1966 January 1, 1967 DATE. PROGRAM PERIOD 3 2 2@/6 2@@ (YEARS). AWARD $1,271,013-Ist $291,454-ist $266,248-Ist $150,798-Ist (AMOUNT AND YEAR). $1,260,181-2nd IIECOMMENDED FUTUIIE 3 133,987-3rd $254,000-2nd $230,934-2nd $175,250-2nd SUPPORT $241,795-3rd $91,250-3rd (AMOUNT I AND YEAR). I Preliminary regionsfor Planning Purposes as delineated in the original applications. State designations The Grantee differsfrom the Coordinati@iZ Headquarters when the R@,-ion requested this arrangement do not indicate they are colerminous with Slate lines. These preliminary regions may be modified on or the latter agency did not have the capability in avvitme.formal fi.vcal rrvf)onsibility. the basis of planning and experience. 4 Direct costs ottly. 2 Population estimates include overlap between regions. As preliminary regional boundaries are evaluated 5 Indicates the Grantee Agency and the (,oordinalirkg Headquarters are the same organization. and clarified during the planning pr"ess, inappropriate overlap will be eliminated 73 ITEGIONAL DESIGNATION WESTERN NEW YORK WESTERN PENNSYLVANIA WISCONSIN PRELIMINARY Buffalo, N.Y., and 7 surrounding Pittsburgh, Pa., and 28 Wisconsin PLANNING REGION.' counties. surrounding counties. POPULATION ESTIMATE 1,900,000 4,200,000 4,100,000 1965.2 COORDINATING School of Medicine, State University Health Center Wisconsin Regional HEADQUARTERS. University of New York at of Pittsburgh. Medical Program, Inc. Buffalo in cooperation with the Health Organization of Western New York. GRANTEE.:' The Research Foundation of Same.5 Same..5 State University of New York EFFECTIVE STARTING December 1, 1966 January 1, 1967 September 1, 1966 DATE. PROGRAM PERIOD 2 2 (YEARS). AWARD $149,241-Ist $340,556-Ist $344,418-Ist (AMOUNT AND YEAR,). RECOMMENDED FUTURE SUPPORT $1 17,626-2nd $260,484-2nd $341,000-2nd (AMOUN 'I' 4AND YEAlt). $137,618-3rd I Preliminary regions for planning purposes as delineated in the original applications. State designations 3 The Grantee differs from the Coordinating Headquarters when the Region requested this arrangement 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 assume formal fiscal responsibility. the basis of planning and experience. 4 Direct costs on4y- 2 Pepulation 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 will be eliminated. 74 EXHIBIT IV Operational Grants for Rc ional Medical Procyrams, June 30, 1967 9 REGIONAL DESIGNATION ALBANY,NEW YORK INTERMOUNTAIN KANSAS MISSOURI ITEGION. Northeastern New York and Utah and portions of Colorado, Kansas Missouri, exclusive of portions of Southern Vermont Idaho, Montana, Nevada, Metropolitan St. Louis. and Western Massachusetts. and Wyoming. POPULATION ESTIMATE 1,900,000 2,200,000 2,200,000 2,400,000 1965. COORDINATING Albany Mcdicid College of University of Utiii School University of K:tnS:LS University of Missouri HLADQUARTEIIS. Union University, Albany of Medicine. N4c(li@il Center. School of Medicine. Medical Center. GRANTEE. Same. I Same.' Same.' Same. I EFFECTIVE STARTING April 1, 1967 April 1, 1967 ,June 1, I!)67 April 1, 1967 DATE. PROGRAM PERIOD 2 2@@ 2 2 (YEARS). FIRST-YEAR AWARD. $914,627-Ist $1,790,603-Ist $1,076,600-1 st $2,887,903-1 st RECOMMENDED FUTURE $750,000-2nd $1,162,049-2nd $1,000,000-2nd $2,625,000-2nd SUPPORT $1,036,378-3rd (AMOUNT 2 AND YEAR). Indicates that the Grantee Agency and the Coordinating Headquarters are the same organization. 2 Direct costs only. 75 t'onal James T. Howell, M.D. University of Vermont Liaison Meniber for Na i EXHIBIT V Executive Director Burlington, Vermont Advisory NeuroloGIcal Diseases Henry Ford Hospital Cornelius H. Traeger, M.D. b Detroit, Michigan New York, New York a?id Blindness Council National Advisorv Council on w J. Willis Hurst, M.D.-' A. B. Baker, M.D.' Re ional Medical Procrams ex officio 9 Professor and Chairman Professor and Director Leonidas H. Berry, M.D. Department of Medicine Division of Neurology Professor School of Medicine William H. Stewart, M.D. (Chairman) University of Minnesota Cook County Graduate School of Medi- Emory University Surgeon General Minneapolis, Minnesota l'itblic Health Service l@ethi@sd(i, Maryland A. Earl Walker, M.D. .@enior Attending I'hy3iciaiL Clark 11. Millikaii, M.D. Professor of Neurological Surgery Michael I?eese Hospital Consultant in Neurology Johns Hopkins University Chicago, Illinois Mayo Clinic Liaison Members to Baltimore, Maryland Mary I. Bunting, Ph. D.' Rochester, Minnesota the National Advisory Council Liaison Menzber for National President on Re ional Medical Programs Radcliffe College George E. Moore, M.D. 9 Advz'sor), Heart Council Cambridge, Massachusetts Director Roswell Park Memorial Institute L'I'(i I s 0 71 Meiizber for National John B. Hickam, M.D. Gordon R. Cumming-' Buffalo, New York Advisory Cancer Council Professor and Chairman Administrator Department of Medicine Sacramento County Hospital William J. Peeples, M.D .2 Indiana University Medical Center Sacramento, California Commisszoner Sidney Farber, M.D.' Indianapolis, Indiana Maryland State Department of Health Director of Research Michael E. DeBakey, M.D. Baltimore, Maryland Children's Cancer Research Foundation Lzaiso?l Alc7izber for tlzc Professor and Chairman Department of Surgery Edmund D. Pellegrino, M.D. Boston, Massachusetts Veterans Ad?izznzstration School of Medicine Director Murray M. Copeland, M.D. Benjamin B. Wells, M.D. Baylor University Medical Center Associate Director Assistant Chief Medical Director Houston, Texas State University of New York M.D. Anderson Medical Hospital Stony Brook, New York and Tumor Institute for Research and Education in Bruce W. Everist, Jr., M.D. Texas Medical Center Medicine Chief of Pediatrics Alfred M. Popma, M.D. Houston, Texas Department of Medicine and Surgery Green Clinic Regional Director Veterans Administration Ruston, Louisiana Mountain States Regional Medical Washington, D.C. Program Lzaz'soii Me?,Piber for National Charles J. Hitch Boise, Idaho Advisory General I Resigned January I967. Vice President for Administration Medical Sciences Council 2Membership terminated November University of California Mack 1. Shanholtz, M.D. 1966. Berkeley, California State Health Commissioner Edward W. Dempsey, Ph. D. Appointment expired September 1966. John R. Hogness, M.D. State Department of Health Chairman Dean Richmond, Virginia Department of Anatomy School of Medicine Robert J. Slater, M.D .2 College of Physicians and Surgeons University of Washington Dean Columbia University Seattle, Washington College of Medicine New York, New York 76 George E. Miller, M.D. John D. Thompson EXHIBII'VI Director Director, Program in I-Iospital Center for Medical Education Administration Rc-'oiial Mcd'cal Pro,r@im College of Medicine Professor of Public Health University of Illinois School of Public Health Revlexv Comi-nittee Chicago, Illinois Yale University New Haven, Connecticut Mark Berke Director Anne Pascasi(>, Ph. D. Kerr L. White, M.D. Mount Zion Hospital and Associate Research Professor Director Medical Center Nursing School Division of Medical Care and San Francisco, California University of Pittsburgh Hospitals Pittsburgh, Pennsylvania School of Hygiene and Public Health Kevin P. Bunnell, Ph. D. Johns Hopkins University Associate Director Samuel H. Proger, M.D. Baltimore, Maryland Western Interstate Commission for Higher Education Professor and Chairman Boulder, Colorado Department of Medicine Sidney B. Cohen' 7'ufts University Management Consultant School of Medicine Silver Spring, Maryland President Bingham Associates Fund Edwin L. Crosby, M.D. Boston, Massachusetts Director American Hospital Association Davi -d E. Rogers, M,D. Chicago, Illinois Professor and Chairman George James, M.D. (Chairman) Department of Medicine Dean School of Medicine Mount Sinai School of Medicine Vanderbilt University New York, New York Nashville, Tennessee Howard W. Kenney, M.D. Medical Director Carl Henry William Ruhe, M.D. John A. Andrew Memorial Hospital Assistant Secretary Tuskegee Institute Council on Medical Education Tuskegee, Alabama American Medical Association Edward J. Kowalewski, M.D. Chicago, Illinois Chairman Committee of Environmental Medicine ltol-)crt J. Slater, M.D. Academy of General Practice Executive Director Akron, Pennsylvania The Association for the Aid of Crippled Children 'Deceased, April 1967. New York, New York 77 Norman Beckman, Ph. D. Nemat 0. Borhani, M.D. Leonard Chiazze, Jr. M.D. LXHIBI'I' VII Director Head, Heart Disease Control Program Assistant Professor of Community Office of Intergovernmental Relations Bureau of Chronic Diseases and International Medicine Coii,,,ult@iiits to Lhe and Urban Program Coordination California Department of Public Health Georgetown University 1)1,,-Is'loll of lkcgloii@ll Department of Housing and Urban De- Berkeley, California Washington, D.C. .Nlt--dical Pro(rr@ims velopment Paul Brading Sidney B. Cohen Washington, D.C. Director of Research in Medical Management Consultant Stephen Abrahamson, M.D. A. E. Bennett, M.D. Education Silver Spring, Maryland Director Department of Clinical Epidemiology and Albany Medical College John D. Colby Office of Research in Medical Education Social Medicine Albany, New York Chief University of Southern California St. Thomas' Hospital Medical School Kevin P. Bunnell, Ph. D. Research Training Branch Los Angeles, California London, S.E. 1, England Associate Director Division of Research Western Interstate Co?izrtzission for and Training Dissemination Roy Acheson,. M.D. Robert Bcrg, M.D. Higher Education Office of Education Epidemiologist Professor and Chairman Boulder, Colorado Washington, D.C. School of Medicine Department of Preventive Medicine and Warren H. Cole, M.D. Yale University Community Health Mary I. Bunting, Ph. D. Emeritus Professor and Head New Haven, Connecticut University of Rochester President Department of Surgery Radcliffe College University of Chicago Alexander Andcrson, M.D. I?ochestcr, Nciv York Cambridge, Massachusetts Director Chicago, Illinois Training Progrartis for Center of Medical Donald II(-rgstroiii l@ay E. Brown, L. ' .-I. D. Murray M. Copeland, M.D. Education Assistant to State Health Commissioner Director Associate Director College of Medicine Vermont Department of Health Graduate Program in Hospital M. D. Anderson Medical Hospital and University of Illinois Burlington, Vermont Administration Tumor Institute Chicago, Illinois Mark Berke Duke University Medical Center Texas Medical Center William Anlyan, M.D. Director Durham, North Carolina Houston, Texas Dean Mount Zion Hospital and Medical Center Hugh Butt, M.D. Edwin L. Crosby, M.D. Medical Center San Francisco, California Professor of Medicine Director Duke University Mayo Clinic American Hospital Association Durham, North Carolina Leonidas H. Berry, M.D. Rochester, Minnesota Chicago, Illinois Norman T. J. Bailey, Ph. D. Professor Gordon R. Cumming Professor Cook County Graduate School of Medi- Donald J. Caselcy, M.D. Administrator Biomathematics Depart-meht cinc Associate Dean and Medical Director Sacramento County Hospital Cornell University Medical School and Senior Attending Physician College of Medicine Sacramento, California Sloan-Kettering Institute for Cancer Michael Reese Hospital Universities of Illinois Research Chicago, Illinois Chicago, Illinois Anthony Curreri, M.D. Nezv York, Nezv York Professor of Surgery A. B. Baker, M.D. Mark S. Blumberg, Ph. D. Hilmon Castle, M.D. Director Professor and Director Special Assistant to the Vice President for Associate Dean Division of Clinical Oncology Division of Neurology Business and l,in(i?tce College of Medicine Cancer Research Hospital University of Minnesota University of California University of Utah University of Wisconsin Minneapolis, Minnesota Berkeley, California Salt Lake City, Utah Madison, Wisconsin 268-(;4!) 0-67-(; 78 Frederick Cyphert, Ph. D. Sidney Farber, M.D. James E. Heald, Ph. D. George James, M.D. Assistant Dean Director of Research Director Dean School of Education Children's Cancer Research Center School for Advanced Studies in Educa- Mount Sinai School of Medicine Ohio State University Boston, Massachusetts tion New York, New York Columbus, Ohio Michigan State University Hilliard Jason, M.D. Charles D. Flagle, M.D. East Lansing, Michigan Chairman Michael E. DeBakey, M.D. Professor Professor and Chairman Public Health Administration John B. Hickam, M.D. Department of Medical Education, Department of Surgery School of Hygiene and Public Health Professor and Chairman Research, and Development Baylor University Johns Hopkins University Department of Medicine College of Human Medicine Houston, Texas Baltimore, Maryland Indiana University Medical Center Michigan State University Indianapolis, Indiana East Lansing, Michigan Edward W. Dempsey, Ph. D. John G. Freymann, M.D. Charles J. Hitch, Ph.D. Boisfeuillet Jones Chairman Medical Director Vice President for Administration Director Department of Anatomy Boston Lying-in Hospital University of California Emily and Ernest Woodruff Foundation College of Physicians and Surgeons Boston, Massachusetts Berkeley, California Atlanta, Georgia Columbia University Herbert P. Galliher, Jr., Ph. D. Howard F. Hjelm Richard D. judge, M.D. New York, New York Professor Acting Director Assistant Professor- McCormack Dctmcr Department of Industrial Engineering Elementary and Secondary Research Department of Internal Medicine Assistant Director University of Michigan Bureau of Research University of Michigan Ann Arbor, Michigan Office of Education Ann Arbor, Michigan Division of Longterm Care Washington, D.C. American Hospital Association Kermit Gordon Howard W. Kenney, M.D. Chicago, Illinois Vice President John R. Hogness, M.D. Medical Director The Brookings Institution Dean John A. Andrew Memorial Hospital E. Grey Dimond, M.D. Washington, D.C. School of Medicine Tuskegee Institute Director University of Washington Tuskegee, Alabama Scripps Clinic and Research Jack Haldeman, M.D. Seattle, Washington Foundation Executive Director James T. Howell, M.D. Charles V. Kidd, Ph. D. Hospital Planning and Review Councit Executive Secretary La Jolla, California Executive Director Federal Council for Science and for Southern New York Henry Ford Hospital Technology Robert Dyar, M.D. New York, New York Detroit, Michigan Office of Science and Technology Chief of Research John Hammock, Ph. D. J. Willis Hurst, M.D. Washington, D.C. California Department of Public Health Professor Professor and Chairman Berkeley, California Department of Educational Psychology Department of Medicine Charles E. Kossman, M.D. School of Medicine Professor Paul M. Ellwood, Jr., M.D. University of Georgia Emory University Department of Medicine Executive Director Athens, Georgia Atlanta, Georgia New York University Medical Center American Rehabilitation Foundation A. McGehee Harvey, M.D. Ralph Ingersoll, M.D. New York, New York Minneapolis, Minnesota Chairman Director of Research in Medical Educa- Edward J. Kowalewski, M.D. Bruce W. Everist, Jr., M.D. Department of Medicine tion Chairman Chief of Pediatrics School of Medicine School of Medicine Board of Directors Green Clinic Johns Hopkins University Ohio State University Academy of General Practice Ruston, Louisiana Baltimore, Maryland Columbus, Ohio Akron, Pennsylvania 79 Peter Lee, M.D. Richard L. Meiling, M.D. Anne Pascasio, Ph. D. John Rosenbach, Ph. D. Assistant Professor Dean Associate Research Professor Director Department of Pharmacology College of Medicine Nursing School State University of New York at Albany School of Medicine Ohio State University University of Pittsburgh Albany, New York University of Southern California Columbus, Ohio Pittsburgh, Pennsylvania Carl Henry William Ruhe, M.D. Los Angeles, California C. Arden Miller, M.D. Jack Lein, M.D. Vice Chancellor for Health Sciences joye Patterson, Ph. D. Assistant Secretary Assistant Dean and Director for University of North Carolina Publications Director Council on Medical Education Continuing Education Chapel Hill, North Carolina Medical Center American Medical Association School of Medicine George E. Miller, M.D. University of Missouri Chicago, Illinois University of Washington Director Columbia, Missouri Paul Sanazaro, M.D. Seattle, Washington Center for Medical Education William J. Peeples, M.D. Director E. James Lieberman, M.D. College of Medicine Commissioner Division of Education Director University of Illinois State Department of Health Association of American Medical Colleges Audiovisual Facility Chicago, Illinois Baltimore, Maryland Evanston, Illinois. Communicable Disease Center Clark H. Millikan, M.D. Edmund D. Pellegrino, M.D. Raymond Seltser, M.D. Public Health Service Consultant in Neurology Director Professor of Medicine Atlanta, Georgia Mayo Clinic Medical Center School of Hygiene and Public Health Abraham Lilienfeld, M.D. Rochester, Minnesota State University of New York Johns Hopkins University Professor and Chairman George E. Moore, M.D. Stony Brook, New York Baltimore, Maryland Department of Chronic Diseases Director Alfred M. Popma, M.D. School of Hygiene and Public Health Roswell Park Memorial Institute Chief of Radiology Mack 1. Shanholtz, M.D. Johns Hopkins University Bu§alo, New York State Health Commissioner William D. Nclligan St. Luke's Hospital and School of Nursing State Department of Health Baltimore, Maryland Executive Director Boise, Idaho Richmond, Virginia Robert Lindec American Institute of Cardiology Samuel Progcr, M.D. Assistant Dean for Administration Bethesda, Maryland President Cecil G. Sheps, M.D. Medical School Charles E. Odegaard, Ph. D. Bingham Associates Fund General Director Stanford University President Boston, Massachusetts Beth Israel Medical Center Palo Alto, California University of Washington Fred M. Remlcy New York, New York Samuel Martin, M,D. Seattle, Washington Chief Engineer Arthur A. Siebens, M.D. Provost Stanley W. Olson, M.D. Television Center Director College of Medicine Program Coordinator University of Michigan Rehabilitation Center University of Florida Tennessee Mid-South Regional Ann Arbor, Michigan University of Wisconsin Hospital Ganesville, Florida Medical Program Madison, Wisconsin Nashville, Tennessee David E. Rogers, M.D. Manson Meads, M.D. John Parks, M.D. Professor and Chairman Robert W. Sigmond Dean Dean Department of Medicine Executive Director Bowman Gray School of Medicine School of Medicine School of Medicine Hospital Planning Council of Allegheny Wake Forest College George Washington University Vanderbilt University County Winston Salem, North Carolina Washington, D.C. Nashville, Tennessee Pittsburgh, Pennsylvania 80 Robert J. Slater, M.D. Emmanuel Suter, M.D. Burton Weisbrod, Ph. D. George A. Wolf, M.D. Executive Director Dean Associate Professor Provost and Dean The Association for the Aid of Crippled College of Medicine Department of rcono?nics @chool of Medicine Children University of Florida University of Wisconsin University of Kansas New York, New York Gainesville, Florida Madison, Wisconsin Kansas City, Kansas Adrian Terlouw Benjamin B. Wells, M.D. Richard M. Wolf, Ph. D. Vergil N. Slee, M.D. Educational Consultant Assistant Chief Medical Director for Re- Assistant Professor of Education Director Sales Service Division search and Education in Medicine School of Education Committee on Professional Hospital Ac- Eastman Kodak Company Department of Medicine and Surgery University of Southern California tivities Rochester, New York Veterans Administration Los Angeles, California First National Building John D. Thompson Washington, D.C. Alonzo S. Yerby, M.D. Ann Arbor, Michigan Professor of Public Health Kelly West, M.D. Head Clark D. Sleeth, M.D. Director Chairman Department of Health Services Program in Hospital Administration Department of Continuing Education Administration Dean School of Public Health University of Oklahoma Medical Center School of Public Health School of Medicine Yale University Oklahoma City, Oklahoma Harvard University West Virginia University New Haven, Connecticut Cambridge, Massachusetts Morgantown, West Virginia Rol)(@rt I-. Westlik(@, M.D. Cornelius If. '1'r;icg(-r, M.]). Syracuse, Neiv l'o?,k I'@tul N. Ylvistk(-r, Ph. D. John M. Stacy Neiv York, New York Director Director Storiii Whaley Public Aff airs Program Medical Center Ray E. Trussell, M.D. Vice President Ford Foundation University of Virginia Director Health Sciences New York, New York Charlottsville, Virginia School of Public Health and Administra- University of Arkansas Medical Center Lawrence E. Young, M.D. tive Medicine Little Ptock, Arkansas Robt-rt I-". Stake, Pli. D. (:olitriibi(i University Kt-i-r I,. Wliit(-, M.D. Department of Medicine Assistant Director Neit, l'ork, Neu) York Diri!ctor School of Medicine (:enter for Instruction, I?esearch, and A. I-arl Walker, M.D. Division of Mcdic(it Care (fuel flovpital.5 University of Rochester Curriculum Evaluation Professor of Neurological Surgery School of Hygiene and Public I-Iealth I?ochester, New York College of Education Johns Hopkins University Johns Hopkins University University of Illinois Baltimore, Maryland Baltimore, Maryland Urbana, Illinois James V. Warren, M.D. Jacinto Steinhardt, Ph. D. Chairman Kimball Wilcs, Ph. D. Scientific Advisory to the President and Department of Medicine Dean Professor of Chemistry College of Medicine School of Education Georgetown University Ohio State University University of Florida Washington, D.C. Columbus, Ohio Gainesville, Florida Max H. Weil, M.D. Lorcn Williams, M.D. Patrick B. Storey, M.D. Associate Professor of Medicine Director Professor of Community Medicine School of Medicine Research in Medical Education Hahnemann Medical College University of Southern California Medical College of Georgia Philadelphia, Pennsylvania Los Angeles, California Iugusta, Georgia 81 EXHIBI'I' VIII Program Coordinators for Regional Medical Programs, June 30, 1967 l@,-gioIliil ])(-Sit 1'r(-Iiiiiiti;ki-v Pl;iiiiiinv I't-ogi-;iiii (,:oor(iiii@itor l@cgional Designation Preliminary Planning Program Coordinator Region ALABAMA. Alabama. Benjamin B. Wells, M.D. CALIFORNIA. California. Paul D. Ward University of Alabama Medical Executive Director Center California Conunittee on Re- 1919 Seventh Avenue, South gional Medical Programs llirniingli;tiii, Alal.)@ti-ni 3253:3 Room 302 655 Sutter Street ALBANY, N.Y, Northeastern New York, Frank M. Woolsey, Jr., M.D. San Francisco, California 94102 and portions of Associate Dean Southern Vermont Albany Medical College of and Western Union University CENTRAL NEW Syracuse, New York, Richard H. Lyons, M.D. Massachusetts. 47 New Scotland Avenue YORK. and 15 surrounding Professor and Chairman Albany, New York 12208 counties. Department of Medicine State University of New York Upstate Medical Center ARIZONA. Arizona. Merlin K. DuVal, M.D. 766 Irving Avenue Acting Dean Syracuse, New York 132 1 0 University of Arizona College of Medicine Tucson, Arizona 85721 COLORADO- Colorado and Wyoming. C. Wesley Eisele, M.D. WYOMING. Associate Dean for Postgraduate ARKANSAS. Arkansas. Winston K. Shorcy, M.D. Medical Education Dean, University of Arkansas University of Colorado School of Medicine Medical Center 4301 West Markham Street 4200 East Ninth,&vcnue Little Rock, Arkansas 72201 Denver, Colorado 80220 BI-STATE. Eastern Missouri William H. Danforth, M.D. CONNECTICUT. Connecticut. Henry T. Clark, Jr., M.D. and Southern Illinois Vice Chancellor for Medical Program Coordinator centered around Affairs Connecticut Regional Medical St. Louis. Washington University Program 660 South Euclid Avenue 272 George Street St. Louis, Missouri 631 1 0 New Haven Connecticut 06510 iiiiiiiary Planti rain Coordinator Region ry I'Iztiiiiin@ egion a. Martin, M.D. ovost . Hillis Miller meyer, M.D. Medical Center Associate Dean University of Florida Indiana University School of Gainesville, Florida 32601 Medicine Indiana University Medical GEORGIA. Georgia. Center J. W. Chambers, M.D. II 00 West Michigan Street Medical Association of Georgia Indianapolis, Indiana 46207 938 Peachtree Street N.E. Atlanta, Georgia 30309 IN'I'ERMOUN'I'AIN. Utah and portions of C. I filmon Castle, M.D. Colorado, Idaho, Associate Dean and Chairman GREATER Eastern Pcnnsylvinia William C. Spring, Jr., M.D. Montana, Nevada, and Department of Postgraduate DELAWARE VALLEY. and portions of Greater Delaware Valley Wyoming. Education Delaware and Regional Medical Program University of Utah New Jersey. 301 City Line Avenue Salt Lake City, Utah 84112 Bala-Cynwyd, Pennsylvania 19004 - .- -- - - IOWA. low;t. Willztr(i Krefil, N4.1)., flit. 1). HAWAII. Hawaii. Windsor C. Cutting, M.D. Director, Clinical Research School of Medicine Center University of Hawaii Department of Internal 2538 The Mail Medicine Honolulu, Hawaii 96822 University Hospital University of Iowa ILLINOIS. Illinois. Leon 0. Jacobson, M.D. fowa city, Iowa 52240 Dean, University of Chicago School of Medicine KANSAS. Kansas. Charles E. Lewis, M.D. Chairman, Coordinating Com- Chairman, Department mittee of Medical Schools and of Preventive Medicine Teaching Hospitals of Illinois University of Kansas Medical 950 East 59th Street Center Chicago, Illinois 60637 Kansas City, Kansas 66103 83 Regional Dcsignatioil Ilreliminary Planning Prograiii (:oor(Ainator Regional Designation Preliminary I'laiiiiiiig Program Coordinator Region Region LOUISIANA. Louisiana. Joseph A. Sabatier, M.D. MICHIGAN. Michigan. D. Eugene Sibery Louisiana Regional Medical Executive Director Program Greater Detroit Area Hospital Clairborne Towers Roof Council 119 South Clairborne Avenue 966 Penobscot Building New Orleans, Louisiana 70112 Detroit, Michigan 48226 MAINE. Maine. Manu Chattcrjec, M.D. MISSISSIPPI. Mississippi. Guy D. Campbell, M-D. Merrymeeting Medical Group University of Mississippi Medical Brunswick, Maine Center 2500 North State Street Jackson, Mississippi 39216 MARYLAND. Maryland. Thomas B. Turner, M.D. Dean, The John Hopkins University MISSOURI. Missouri. Vernon E. Wilson, M.D. School of Medicine Dean, School of Medicine 725 Wolfe Street University of Missouri Baltimore, Maryland 21205 Columbia, Missouri 65201 MEMPHIS. Western Tennessee, James W. Culbertson, M.D. MOUNTAIN STATES. Idaho, Montana, Nevada, Kevin P. Bunnell, Ed. D. Northern Mississippi, Professor and Cardiologist and Wyoming. Associate Director 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, Tennessee 38103 30th Street Boulder, Colorado 80302 METROPOLITAN District of Columbia and Thomas W. Mattingly, M.D. WASHINGTON, D.C. 2 contiguous counties in Program Coordinator NEBRASKA-SOUTI-I Nebraska and South Harold Morgan, M.D. Maryland, 2 in Virginia District of Columbia Medical DAKOTA. Dakota. Nebraska State Medical Associa- and 2 independent cities Society tion in Virginia. 2007 Eye Street N.W. 1408 Sharp Building Washington, D.C. 20006 Lincoln, Nebraska 68508 Regional Designation Prelin,.inary Planning Coordinator regional 1)(, 1'rcliiiiiiiary Program Coordinator l@e,ion Rcgic NEW JERSEY. New Jersey. M.D., M.P.H. NORTHERN Vermont and tl I,. Wennberg, M.D. New Jersey State Department of NEW ENGLAND. counties in Health University of Vermont Health-Agriculture Building Northeastern College of Medicine P.O. Box I 540, John-Fitch New York. Burlington, Vermont 05401 Plaza Trenton, New Jersey 08625 NORTHLANDS. Minnesota. J. Minott Stickney, M.D. Minnesota State Medical Associ- NEW MEXICO. New Mexi Reginald H. Fitz, M.D. Itioli Dean, University of N(-w M(.Xi(:o 200 I,'irst Street, Southwest School of Medicine ]Rochester, Minnesota 55901 Albuquerque, New Mexico f@71 Of, OHIO STATE. Central and Sou Richard L. Meiling, M.D. NEW YORK METRO- New York Vincent de Paul Larkin, M.D. two-thirds of C Dean, Ohio State University POLITAN AREA, Nassau, Su New York Academy of Medicine counties, excIu College of Medicine Wcstcheste 2 East 103d Street Metropolitan Cincin- 410 West 10th Avenue New York, New York 10029 nati area). Columbus, Ohio 4321 0 NORTH CAROLINA. North Care Marc J. Musser, M.D. Executive Director OHIO VALLEY. Greater part of Kentucky William H. McBeath, M.D. North Carolina Regional Medi- and contiguous parts of Director, Ohio Valley cal Program Ohio, Indiana, and Regional Medical Program Teer House West Virginia. 1718 Alexandria Drive 4019 North Roxboro Road Lexington, Kentucky 40504 Durham, North Carolina 27704 OKLAHOMA. Oklahoma. Kelly M. West, M.D. NORTH DAKOTA. North Dakota. Theodore H. Harwood, M.D. University of Oklahoma Dean, School of Medicine Medical Center University of North Dakota 800 N.E. 13th Street Grand Forks, North Dakota Oklahoma City, Oklahoma 58202, 73104 85 F)(-si,@ii;itioil Pi-ciiininary Pliniiing ilrogriiii Coordinitor Regional Designation Preliminary Planning Program Coordinator Region SUSQUEHANNA Block of 24 counties Richard B. McKenzie OREGON. Oregon. M. Roberts Grover, M.D. VALLEY. centered around Harris- Executive Assistant Director, Continuing Medical burg and Hershey. Council on Scientific Advance- Education ment University of Oregon Pennsylvania Medical Society School of Medicine Taylor Bypass and Erford Road 3181 S.W. Sam Jackson Park Lemoyne, Pennsylvania 17043 Road Portland, Oregon 97201 TENNESSEE MID- Eastern and Central Stanley W. Olson, M.D. SOUTH. Tennessee and contigui Professor of Medicine ous parts of Southern Vanderbilt University ROCHESTER, NEW Rochester, New York and Ralph C. Parker, Jr., M.D. Kentucky and North- Baker Building YORK. I I surrounding Clinical Associate Professor of ern Alabama. 110 21st Avenue, South counties. Medicine Nashville, Tennessee 37203 University of Rochester School of Medicine and Dentistry TEXAS. Texas. Charles A. LeMaistre, M.D. Rochester, New York 14620 Vice-Chancellor for Health Affairs University of Texas SOUTH CAROLINA. SouthCarolina. Charles P. Summerall, III, M.D. Main Building Associate in Medicine (Cardiol- Austin, Texas 78712 ogy) Department of Medicine TRI-STATE. Massachusetts, New Norman Stearns, M.D. Medical College I-Iospital Ilampshire and Medical Care and Educational 55 Doughty Street Rhode Island. Foundation Charleston, South Carolina 22 The Fenway 29403 Boston, Massachusetts 02115 86 Regional Designation Primary Planning Progrim Coordinator R(-gioiiit I)csiqii;ttioii 1'rirn;krv Plzititiiiig I)rogram Coor(Iiiiator Itegion VIRGINIA. Virginia. Kinloch Nelson, M.D. WESTERN NEW Buffalo, New York and 7 Douglas M. Surgenor, M.D. Dean, Medical College of YORK. surrounding counties. Dean, School of Medicine Virginia State University of New York at 200 East Broad Street Buffalo Richmond, Virginia 23219 101 Capcn Hall Buffalo, New York 14214 WASHINGTON- Alaska and Washington. Donal R. Sparkman, M.D. WESTERN PENNSYL- Pittsburgh, Pennsylvania Francis S. Cheever, M.D. ALASKA. Associate Professor of Medicine VANIA. and 28 surrounding Dean, School of Medicine University of Washington counties. University of Pittsburgh School of Medicine Flannery Building Seattle, Washington 98105 3530 I-orl)(-rs Avenue l'ittsl)urgil, I'(-nnsylvania 1521:i WISCONSIN. Wisconsin. John S. Ilirschboeck, M.D. WEST VIRGINIA. West Virginia. Charles L. Wilbar, M.D. Wisconsin Regional Medical West Virginia University Program, Inc. Medical Center Room I 103 Morgantown, West Virginia II 0 East Wisconsin Avenue 26506 Milwaukee, Wisconsin 53202 87 fectiveness of these procedures dur- cooperation and 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. crational applications. As a result of lationships of the proposals to the @ During the review process the Rcvl(-@%- tti(i Ar)pro,,,@il of these considerations, the resulting re- responsibilities of many other corn- staff of the Division of Regional vii-w .111(i :11)1)1.ov;Ll I)I-o('(-SS is to tll('. J)oll('Ilt.% of 111(@, Plll)lic S(.I.vi(,,(, Ki,(!aLust I)ossil-)Ic extent keyed to the ati(.1 otli(!r Federal programs; (5) Llit! This exhibit outlines review and ap- groups must be concerned with the proval procedures for use in review- anticipated nature of operational characteristics of these initial pro probability of effective implementa- I grant requests and to the policy issues posals as the first steps in the more ing grants for the establishment anct inherent in the Regional Medical complete development of the Re- tion of the proposed at6vities in ad- operation of Regional Medical Pro- Programs concept. gional Medical Program, guided by a dition to the inherent technical merit grams authorized by Section 904(a) continuing planning process. of the specific proposals. of Title IX of the Public Ilealth Service Act. Characteristics of F-I The review process must provide Operational Grants Objectives of the opportunity for the reviewers to assure a basic level of quality and Background In designing this review process, at- Review Process feasibility of the individual activities tention has been given to the follow- The objectives sought in the develop- that will make an investment of grant These procedures were developed ing characteristics of applications for merit of this review process arc based funds worthwhile. after extensive consideration of: ( 1 ) Regional Medical Program grants: on a careful assessment of the goals F-I The. review process must have the philosophy and purposes of Title (1) complexity of the proposals with of the Regional Medical Programs sufficient flexibility to cope with the IX; (2) the initial experience :.n re- many discrete but interrelated activi- and how the achievement of those variety of operational proposals sub- viewing the planning grant applica- ties involving different medical fields - goals can be most effectively furthered mitted, allowing for the tailoring of tions awarded under Section 903; (2) the diversity of grant proposals by the process used in making deci- the review to the needs of the par- (3) consideration of the first opera- resulting from encouragement of tional grant Proposals, including site initiative and determination at the sions on the award of grant funds. ticular proposal. visits to the regions involving mcm- regional level within the broad Consideration of these basic policy E] The review process should en- hers of the National Advisory Council parameters provided in the Law, issues led to delineation of the follow- able the staff and reviewers to view a on Regional Medical Programs and Regulations, and Guidelines: (3) the ing objectives of the review process: Regional Medical Program as a con- the Regional Medical Programs Re- many different attributes of the over- F-I The operational grant applica- tinuing activity, rather than a dis- view Committee; (4) preliminary all operational proposals which need tion must be viewed as a totality crete pro'ect with time limits. There- i discussion of the issues involved in to be evaluated during the review rather than as a collection of discrete fore, the review process should have the review of operational applica- process, including not only the merit and separate projects. continuity during the grant activity tions by the National Advisory Coun- of highly technical medical activities -1 The decision-makino, process for and should provide the opportunity cil on Regional Medical Programs at in the fields of heart disease, cancer, F 0 to judge the development of Regional its November 1966 meeting; and (5) stroke, and related diseases but also the review and approval of opera- Medical Programs on the basis of extensive discussion with both the the effect of the proposal on improved tional grants must be developed in results and evaluation of progress, in Review Committee and the National organization and delivery of health a way that stimulates and preserves addition to the evaluation of the prob- Advisory Council concerning the cf- services and the degree of cffcctivc the essential goal setting, priority able effectiveness of initial proposals. 88 Criteria in the Public Health Service Act and comprehensive and potentially ef- clude both the nature and the ef- other Acts of Conaress including fective Regional Medical Program: fectivencss of the proposed coopera- those relating to planning and use tive arrangements. In evaluating the The basic criteria for the review of I F-1 The first focus must be on those Regional Medical Program grant re- of facilities, personnel, equipment, elements of the proposal which iden- effectiveness of these arrangements, quests are set forth in the Regulations and training of manpower. tify it as truly representing the con- attention is given to the degree of in- as follows: "(d) Thepopulationtobeservedby cept of a re-ional medical program. volvement and commitment of the h resources, the role of "Upon recommendation of tile Na- the Regional Medical Program and The review groups have determined major healt the Re-ional Advisory Group, and tional Advisory Council on Regional relationships to adjacent or other Re- that it is not fruitful to consider spe- Medical Pro-rams, and within the gional Medical Programs. cific aspects of the proposal unless the effectiveness of the proposed ac- tivities in strengthening cooperation. limits of available funds, the Surgeon "(c) The extent to which all the this first essential determination con- Only after the determination has General shall award a grant to those health resources of the rc-ion have cerning the core of the program is been made that the proposal reflects positive. li-i making this dctermina- applicants whose approved proarams I)c(-,ti tak(!ii into (-onsi(](,,rition in tli(-. tioll, (@oi)s'(I(@ritioiis such ii)(-.(Iical progr@trii con(TI)t will in his 'LICII@IIICllt best ])i'oiiiote tile 1)laniti,, Ltiicl/ot, establishment of tile questions a,': "Is there a unifyin- con- arid that it will stimulate and purposes of Title IX. In awarding Program. strengthen cooperative cfforL-, will a ce.j)ttial strategy wlil("Il will 1)(-@ tile grants, the Su @,,coii General slial I take more detailed evaluation of the spe- into consideration, amon- other re- "(f) The extent to which the par- basis for initial priorities of action, cific operational activities be made. 0 ticipatin- institutions will utilize evaluation, and future decision mak- levant factors the following: existing resources and will continue ing?" "Is there an administrative If both of the two previous eval- "(a) Generally, the extent to which to seek additional nonfederal re- and coordinating mechanism involv- uations are favorable, the operation- the proposed program will carry out, sources for carrying out the objectives ing the health resources of the regions al activities can then be reviewed, through regional cooperation, the of the Regional Medical Program. which can make effective decisions, individually and collectively. Each relate those decisions to rcoional activity is judged for its own intrin- purposes of Title IX, within a geo- CC (g) The geographic distribution of needs, and stimulate the essential co- sic merit, for its contribution to the graphic area. o cr ,,rants throughout the Nation." operative effort among the major cooperative arrangements, and foi- b (b) The capacity of the institutions In utilizing these criteria in the health interests?" "Will the key lead- the degree to which it includes the or agencies within the program, in- review process, it was determined that ership of the overall Regional Medi- core concept of the Regional Medical dividually and collectively, for re- the sequence of consideration of the cal Program provide the necessary Programs. It should also fit as an in- search, training, and demonstration guidance and coordination for the de- tegral part of the total operational activities with respect to Title IX. various attributes of the proposal velopment of the program?" "What activities, and contribute to the over- would be important if the objectives is the relationship of the planning al- all objectives of the Regional Medi- "(C) The extent to which the appli- of the review process listed above ready undertaken and the ongoing 9 cant or the participants in the Pro- were to be achieved. The review proc- planning process to the initial opera- cal Pro rams. grain plan to coordinate or have co- ess, therefore, must focus on three tional proposal!" Review Procedures ordinated the Regional Medical Pro- general characteristics of the total r-l After havin- made i positive de- gram with other activities supported proposal which separately and yet tei'miiiation about this (:ore activity, l@(,Iow is a (-Iiart whl(-fi describes pursuant to the authority contained collectively determine its nature as a the next step widens the focus to in. the various steps in the review process 89 which will be applied to initial oper- viding information and comments which is required for the assessment project from making a meaningful ational grant proposals from each for the guidance of the site visit team, of the various components of the ap- contribution to the objectives of the region. The first four operational utilizing staff analyses of the plan- plication. The site visit is not a sub- Regional Medical Program. Techni- grant proposals were subject to the ning grant experience, considerations stitute for the investment of this effort cal reviews also consider the justifica- various steps of this process. Those of gross technical validity, policy is- but provides the opportunity to evalu- tion for the particular pro'ect budget i steps were not carried out in precisely sucs raised by the particular applica- ate the cooperative framework of the as presented. This aspect of the re- the order and sequence provided tion, and initial input on relation- Regional Medical Program and the view process presents the opportunity in this chart since the first four ap- ships to other Federal programs. overall probability of the success of to consider possible overlaps and itua- the proposed program. duplications with other Public Health plications were used as a test s' Site Visit-I n i t i a I experience Service programs which can be a tion for the development of this op- has indicated that a site visit by mem- Intensive Analysis and Technical factor in determining how much sup- crational procedure. It is also likely hers of the Review Committee and Reviews-If the site visit report jus- port should be provided for the par- that further experience will lead to the National Advisory Council is es- tifics the investment of additional ef- ticular activity from the Regional appropriate modification of these sential for the assessment of the over- fort in the review of the application, Medical Program grant. The oppor- procedures. The following comments all concept and strategy used by the the Division staff proceeds with an tunity to raise these questions is not may help to explain this review proc- Regional Medical Program in de- intensive analysis of the specifics of limited to Division of Regional Medi- ess, which has been agreed to by the veloping the operational proposal and the application. This analysis pro- Regional Medical Programs Review for assigning priorities to specific proj- vides the framework for obtaining cal Programs staff initiative since Committee and the National Advis- ects included in the proposal. It also specific comments from other com- copies of all applications are distrib- ory Council on Regional Medical provides the opportunity to assess the ponents of the Public Health Service uted to the interested National In- Programs. The complexity of these probable cffcctiv(-ness of cooperative and other Federal health agencies stitutes of Health, to all Bureaus of grant requests and the steps in the arrangements and degree of commit- with related programs, detailed com- the Public Health Service, and to the review process which seems al)l)ro- iiient of the many elements which ments from the various components National Library of Medicine at the priate for their review will require as will be essential to the success of a of the Division of Regional Medical time of receipt. Representatives from much as 6 months for the completion Regional Medical Program. As the Programs staff, technical site visits on all these organizations are invited to of the total review process in most meetings of the Review Committee. discussion above points out, favor- specific projects within the overall cases. able conclusions on these aspects of application when considered neces- F-I Second Review by Review Com- n Initial Consideration by Review the Regional Medical Program must sary, and for the assimilation of ad- mittee and Recommendation for Ac- Committee-The first steps of the re- be reached before it is justifiable to ditional information from the appli- tion-The Review Committee con- view process involve preparation for begin the major investment of the cant as a result of the site visit. The siders all of the information available the site visit which will be conducted time of the Division staff, technical technical review of specific projects concerning the application. In addi- for each operational grant applica- reviewers in other parts of the Pub- should not only evaluate the intrinsic tion to the application itself and the tion. The first consideration of the lic Health Service, technical consul- merit of the project but should help site visit report, a summary of all application by the Review Commit- tants, and the Division of Regional to identify specific problems on any available information is presented to tee will be for the purposes of pro- Medical Program review groups, project which might prevent that the Committee in a staff presenta- 90 Flow Chart Operational Grant Review and Approval Process OPERATIONAL GRANT APPLICATION RECEIVED STAFF REVIEW COMMITTEE MEMBERS REVIEW COMMITTEE MEETING Guidance for Site Visit Team FOR INFORMATION AND COMMENT Initial Staff Information re: a. Planning grant experience b. Gross technical validity c. Policy issues d. Relationship to other Federal programs SITE VISIT judgments re: 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 SITE support warranted (Prepared 2d day by site team) VISIT 5. Quality of projects where REPORT appropriate 91 In addition to application and REVIEW COMMITTEE MEETING Actions: FOR CONSIDERATION AND ACTION site visit report: 1. Recommendations I .Additional information from a. Approval applicant b. 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. Recommendation 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: 1. Review Committee recom- FOR CONSIDERATION,AND ACTION 1. Recommendations mendations a. Approval 2, Further Staff information 1). Approval with conditions per Gi,iriiiiittcc instructions c. Deferral (,I. 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 MEETING BETWEEN DIVISION grant amount i(i 2 STAFF AND APPLICANT Al)l)li(-.ant a(-.lion: 2, Recommend (,vcrall budget (@cilijig REPRESENTATIVES Submission of revised proposal for grant within reconnnended overall bu get 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 DECISION Action: revised proposal a. Award of Grant or b. Further negotiation with applicant 92 tion. The Review Committee then grams-The National Advisory staff also presents the recommended activity were raised during the re- makes its recommendation concern- Council considers the Review Com- overall budget ceiling for the grant view process. The applicant includes ing the application. Because of the mittce recommendations. It has avail- along with a summation of all the such an activity with the under- complex nature of the applications, able to it the full array of material comments derived from the review standing that the progress of the the Review Committee can divide its presented to the Review Committee process concerning particular activi- activity will be followed with special recommendation into several parts re- and a staff summary of that material. ties contained within the application, interest by the review groups and will lating to different parts of the appli- Further information obtained by the including criticisms of specific proi- be judged in the future on the basis cation. If there is an overall favor- staff on the instructions of the Re- I of results. able recommendation on the readi- view Committee may also be pre- ects and comments about the budget sented. The National Advisory Coun- levels proposed for specific projects. Final Award Decision-Follow- ness of the Regional Medical Program cil makes the require(] legal rccorri- The staff also indicates if any I)roj- ing staff review of the revised pro- to begin the operational program, the ccts included in the application arc I)osal, the final decision on the award Review Committee recommends an mendation concerning approval of not to be included in a grant award is made by the Division Director. overall grant amount based on a dis- the application, including recommen- because of Council recommendation Additional negotiations with the ap- cussion of the specifics of the applica- dations on the amount of the grant. or Division decision based on nega- plicant may also take place. tion. This amount takes into (-oTisi(]- The Council may delegate to tlic.%taff tiv(@ ft(,tol.sls (Ils(llss(.(l 11)ov(@. ju?zc 1967 ei-.Ltiori I)t-ol)l(-iiis i-ais(@(I by t(-(-Iiiil('al tll(. tlitlloT,ity to ll(,goti@tt(@. tll(! finite I -1 Stil),tlissioll of ]"(.'v's(!([ I'I-ol)os- reviewers, ovei-lal) -,vitli other pro- grant amount within set limits. A F gains, feasibility of the proposals, recommendation of approval applies al-On the basis of this meeting, and other relevant considerations to all projects except when indicated the applicant submits a revised pro- by the Council, even though the grant posal within the recommended over- raised during the revie%v process. all budget ceilin(@, utilizing in the I-(-- While the overall amount recom- amount recommended may I)(- less :I than tll(. @iii1olitit vision tli(@ (,otiirri(@nts tti(I (-i-iti(@isitis inende(I is 1).ise(i on (Iis(-tissioji of til(I Iclvi(:t,- i-estilt'llg fi-olli if](@ (.01111)011(@lits of the total al Of tll('@ JLI(Iglli(-tits applied (hiring the Spec review of the application or because the review process. This step of the placation, the recommendation does process requires the applicant to not in most cases include specific ap- of overall limitations of funds. proval or disapproval of individual reconsider their priorities within the projects except when a project is Meeting with Representatives of recommended budget level and to judged to be infeasible, to be outside the Applicant-Following the Na- assume the basic responsibility for the scope of Regional Medical Pro- tional Advisory Council meeting, the making the final decisions as to grams, to be an undesirable duplica- staff of the Division meets with rep- which activities will be included in tion of ongoing efforts, or to lack es- resentatives of the applicant and the operational program. Unless a sential technical soundness. presents to them the recommendation project has been specifically excluded and comments of the Council. If the from the approval action, the appli- Review by National Advisory recommendation is favorable and the cant may choose to undertake an Council on Regional Medical Pro- Division intends to award a grant, the activity even if doubts about the 93 EXHIP41'F X The Development and Assistance Branch serves as the focus for two-way communi- cation between the Division and the in- 1'rincipal Staff of th(,- dividual Regional Medical Programs. i)f Rc,,,Ional -\4ccllCal Progi-ams. Margaret H. Sloan, M.D. June 30, 196/- Chief Ian Mitchell, M.D. The Office of the Director provides pro- Associate for Regional Development gram leadership and direction. The Grants Management Branch inter- Robert Q. Marston, M.D. prcts grants management policies and re- Director views budget requests and expenditure Karl D. Yordy reports. Assistant Director for Program Policy James Beattie William D. Mayer, M.D. Chief Associate Director for Continuing Education The Grants Review Branch handles the Charles Hilsenroth professional and scientific review of appli- Executive Officer cations and progress reports. Maurice E. Odoroff Assistant to Director for Vystems Martha Phillips and Stall;@li@ Edward M. Friedlander Assistant to Director for Communications The Planning and Evaluation Branch ap- and Public Information praises and reports on overall program goals, progress and trends and provided The Continuing Education and Training staff work for the Surgeon Gencral's Rc- Branch provides assistance for the quality port to the President and the Congress. development of such activities in Regional Stephen J. Ackerman Medical Programs. Chief William Mayer, M.D. Daniel I. Zwick Chief Assistant Chief Cecilia Conrath Roland L. Peterson Assistant to Chief Head, Planning Section Frank L. Husted, Ph. D. Rhoda Abrams Uead, Evaluation Research Group Acting Head, Evaluation Section 2('@4-- (;4!) O@@i ---7 7-r cration for about a year. Public La@v Formula grants to States for pub- I)hasize the exercise of initiative and EXHIBIT XI 89-749 is yet to be implemented. lic health services; responsibility at the regional level in The purposes of P.L. 89-749, de- Project grants for health services identifying problems and opportuni- Complcmciitarv Relationships scribed in Section 2 (b) arc: to estab- ties in seeking these objectives and in I development Bet"-cen the Compreliensi%,e lish "comprehensive planning for developing specific action steps to Health Planning and health services, health manpower, The purpose of P.L. 89-239, as set overcome the problems and exploit Public Health Service and health facilities" essential "at forth in Section 900(b) of the Pul)- the opportunities. t 1 Amendments of 1966 and every level of government"; 0 lic Ilealth Service Act, is ... l'o afford The Public Health Service sees P.L. the Heart Disease, Cancer, strengthen "the leadership and ca- to the medical profession and the 89-239 and P.L. 89-749 as serving pacities of State health agencies"'; and medical institutions of the Nation, the common goal of improved health and Stroke Amendments to broaden and make more flexible through . . . cooperative arrange- care for the American people alon,, of 1965 mcnts, tli(@ opportunity of making :I Federal "support of health services available to their patients the latest Nvitli other Public I fealtli Service and provided people in their communi- non-Public Health Service grant Pro- A Fact Sheet from the Office of the ties." advances in the diagnosis and treat- b grams such as community mental Surgeon General, Public Health P.L. 89-749 asserts that these objec- ment of (heart disease, cancer, stroke, health centers, mi-rant health pro- and related) diseases. . . Service, March, 1967 tives will be attained through call ,,i-ains, airl)OllLltion control, programs ilivolviiiq (.Ios(. I)I.o(-(@ss for I)III.- II.,kllllli!. ()f II(.:Iltll lilt(-i- I)OS( tli(- iiciglil-)ot-liood health Centers Llil- 7-l!), tli(! Goiiil)i-c-licii- (.ollltl)ol.;Itloll, of- @ is to ('still)lisli (7ool)el,@l- sive Elcalth Planning and Public ficial and voluntary efforts, and par- tivc arrangements ainon- science, cier the Office of Economic Oppor- Health Services Amendments of 1966, ticipation of individuals and organi- education, and service resources for tunity, the medical programs of the establishes mechanisms for compre- zations. . . ." The Act establishes a health care . . ." for research and Children's Bureau, and State and new mechanism to relate varied trainina (including continuing educa- local health programs. In the States hensive areawide and Statc--.vide 0 T)Iannin- and health programs to tion) and for related demonstrations and communities, P.L. 89-749 ,%,ill health planning, training of planners, . . and evaluation and development ef- each other and to other efforts in of patient ('are in the fields of heart provide a vehicle for effective Intel,- achievement of a total health liur- disease, cancer, stroke, and relate(] action amon,, these programs, recoff forts to improve the planning art. n pose. diseases. (Section (a) nizin,- as it does that the diversity of Public Law 89-239, the Heart Dis- The law has five major sections: This law focuses on the cooperative the various States and areas of the ease, Cancer, and Stroke Amend- Nation is considerable, and that the ments of 1965, authorized grants to Formula grants to the States for involvement of university medical specific relationships between and comprehensive health plannin- at the centers, hospitals, practicing physi- assist in the planning, establishment, amonc, 1)ro-rams will have to be clans State level through a (icsi-natcd , other health professions, ancl and operation of regional medical voluntary and official health agencies %vorke(I out at these levels rather than programs to facilitate the wider avail- State agency; in seeking Nvays to build effective link- through a specific Federal mandate. ability of the latest advances in care F-I Grants for comprehensive health ages between the development of new The planning resources created at the of patients afflicted with heart disease, planning at the areawide level; knowledge and its application to the State and local level under Public cancer, stroke, and related diseases. F'l Grants for training health plan- problems of patients. The law pro- Law 89-749 are expected to afford Public Law 89-239 has been in op- ners; vides flexible mechanisms Nvhich em- valuable assistance in the achieve- 95 mcnt of the objectives of Public LaNv their full potential by the close and and resource needs, relates the activi- @@1) 2"),I, of lilt. 1)[Il)li(. of (-oill- Characteristics of These ties of othei- planning ind health I icaltli tit.(I title,' I'(';Lltll III( II( '@ LI t II ( 'II([(';LV( )I-. A 'I'Nvo liiil)oi-lkiii A(,Is I)I,ogi,itlll%, to the l@iectilig of these deavors in cacti of the States. Public vital partncrsliij) must be developed health objectives, and provides as- LaNv 89-749 provides, however no between the Federal government, the The complementary relationship 01 sistancc to State and local officials, authority for these planning resources universities, local and State govern- the programs established by P.L. 89- private voluntary health organiza- to impose their conclusions or rccom- mcnt, the voluntary health interests 239 and P.L. 89-749 to foster de- tions and institutions, and other pro- incndations on any other programs, and individuals and organizations de- velopmcnt of a "Partnership for grams supported by PHS grant funds 11(@ziltli" is illustrated by the follow- I,'(,-deral oi- (-x(:(@I)t lot sign(-(I to (I(-v(-Iol) (-i-(,aLiv(-, i(@tioll fol' in achicvln(l@ the iyiorc effective al- activities (-arric(i out under Section health. ing Outline of some of their major location of resources in accomplishing (d) and parts of Section (e) of the The Con@ress reco,-nizcd the rela- elements. 0 the objectives. Law which must be in accordance tionship of comprehensive health Scope with the comprehensive State health planning to other planning activities. Participants plan developed by the State compre- The Report of the Senate Committee P.L. 89-239: The Regional Medical hcnsivc health planning agency. The on Labor and Public Welfare P.L. 89-239: University medical Public Health Service intends to (No. 1655, September 29, 1966) Program. To identify regional needs centers, hospitals, practicing physi- stimulate effective interaction amon- and resources relating to heart dis- stated: cians, other health professions, vol- these programs, recognizing that the case, cancer, stroke, and related 1 "The comprehensive planning of the untary and public health agencies, diversity of the various States and State health planning agency with the diseases and to develop a regional and i-nembcrs of the public. A re- areas of the Nation is considerable. advice of the (Council @voulci comple- i-ncdical program which utilizes rc- @ional advisory group representing Both P.L. 89-239 and P.L. 89-749 @nent and build on such specialized gional cooperative arrangements to 1-1 provide flexible instruments for es- planning as that of the regional medi- apply and strengthen resources to these interests and playing an active tablishinff productive relationships cal program and the Hill-Burton meet the needs in making more role in the development of the re- between t) these and other programs. program, but would not replace widely available the latest advances gional program must approve any The maintenance of this flexibility in them. . . ." in diagnosis and treatment of these application for operational activities the administration of the grant pro- "The State health plannin,- agency diseases. of the regional medical program. grams will permit each State and rc- provides the mechanism othrough P.L. 89-749: The Comprehensive P.L. 89-749: State agency designated ,,ion to design anci develop a relation- t) Nvhich individual specialized plan- Health Planning Program. To estab- by the Governor does the planning. ship that is appropriate foi- its par- ticular circumstances. Both 1)ro-rams nin,,, efforts can be coordinated and lish a planning process to achieve State advisory council advises on the call for a (:lose priVatC-I)Lll)li(@ related to each other. The agency will comprehensive health planning on planning process. Membership must part- also serve as the focal point %vitlilli nership. Both programs must place the State for relating comprehensive a Statcwide basis which identifies include more than half consumer de endencc on ima,,Inative, reason- health problems within the State, sets representation. Membership will also p - I health plans to planning in areas out- able local apl)roa(,Iics to cooperation side the field of health, such as urban health objectives directed toward im- include %-oluiltary groups, practition- and coordination. Both I)ro(rraiiis redevelopment, public housing, and proving the availability of health ers, public agencies, general planning recognize that they can only achieve so forth." services, identifies existing resources agencies, and universities. 96 The Process programs; regional medical pro- community mental health centers, F] Both regional medical programs grams, mental health, health facili- areawide health facility planning, and comprehensive health planning P.L. 89-239: ties, manpower, medicare - so that and the Hill-Burton programs. These are intended to strengthen creative these programs can be assisted in mak- activities are stimulating the creation Federalism-more productive mech- F] Establish cooperative arrange- ing more effective impact with their of new relationships between health afiisms for partnership and cooper- ments among science, education, and resources. resources and functions as well as as- ation between the national, State service resources. sisting in the creation of additional and local levels of government, the Assess needs and resources. F-I Provide information, analyses, resources in the stimulation of more public and voluntary private health and recommendations which can effective performance of functions activities, and the academic and Develop pilot and demonstration serve as the basis for the Governor, for the purpose of achieving more ef- health services environments. P.L. projects, emphasizing flow of knowl- other health programs and communi- fective attainment of identified health 89-749 will create planning resources edge in uplifting the cooperative ties to make more effective allocations goals. Each of these programs re- at the State and local level. The in- capabilities for diagnosis and care of of resources in meeting health goals. quires participation not only by a formation, analyses, and plans de- patients. R Provide a focus for interrelating broacl range of health professionals veloped by these planning resources R Relate research, training, and health planning with planning for but also by representatives of the con- can provide invaluable assistance to service activities. education, welfare and community surriers of health services. l,'Iacii of State and local authorities, to volun- development. these 1)ro,,ratiis is til)otl tary health organization% and insti- R Develol) effective continuing e(lu- cation 13rograins in relation to other R Strengthen planning, evaluation, the interaction Of the full range of tutions, and to the other health pro- operational activities. and service capacities of all partici- relevant health interests, including grams involved in planning and de- pants in the health endeavor. those in the public sector and the veloping the organization of health R Develop mechanisms for evalu- Fl Provide support for the initiation, private voluntary sector in achieving activities which are supported ating effectiveness of efforts in the integration, and development of pilot the particular progam goals. through other Public Health Service provision of improved services to grant funds. This planning resource patients with heart disease, cancer, proj .ects for better delivery of health Comprehensive health planning created under Section 314(a) will services; develop plans for targeting (P.L. 89-74-9) is (lesi,,iiect to provide thus contribute to the more effective stroke and related diseases. flexible formula and project grants assistance in the development of more P.L. 89-749: at problems and gaps identified by the effective relationships among such accomplishment of health objectives health programs and to provide a and the setting of priorities in achiev- Establish State and areawide planning process. better basis for relating these pro- ing those objectives through the ac- health goals. Specific Planning Relationships grams to the accomplishment of over- tivities supported under the other see- all health objectives at the State and tions of this Law. In addition, the R Define total health needs of all There are a variety of ongoing local level. Based on similar prin- resource will contribute to the deter- people and communities within area health planning and community ciples of broad participation, it calls mination of priorities for action not served for meeting health goals. health organization activities. Many for the stimulation of all parties to only by those with public responsi- Fl Inventory and identify relation- are supported in part by the Public contribute to the goal of insuring the bility and accountability for health ships among varied local, State, na- Health Service, such as Regional availability of comprehensive health services but also by the many other tional, governmental and voluntary Medical Programs (P.L. 89-239), services to all who need them. health organizations, institutions, and 97 personnel which bear the direct rc- themselves to the problems of extend- tion, and delivery of health services. Operating Grants sponsibility for the delivery of health ing hi-h-quality personal health Many of the planning and imple- services for most of the population. services which fully benefit from the mentation activities under the Re- Section 314(d) of P.L. 89-749 au- P.L. 89-749 recognizes that the ac- developments in new medical knowl- gional Medical Programs will have thorizes formula grants to State complishment of improvements in the edge, the cooperative involvement of implications and applications to a health and mental health authorities for comprehensive public health quality and coverage in health serv- these health interests in both the Rc- broader range of health problems ices, both personal and environ- (,Ioiial Medical Program planning stroke, service. The Act brings together a than heart disease, cancer, mental, depends upon the voluntary and development and in the I)Iannin- h group of previously compartmented and related diseases. The nice anisms or categorical Public Health Service participation and energies of both and evaluation activities under P.L. created by the Regional Medical Pro- grants. Grant awards will depend on the private and public sectors of the 89-749 will make an essential con- gram can be useful in achieving the a plan submitted by the health health endeavor. tribution to productive relationship broad goals of comprehensive health agency which reflects the way in The planning, operational pro- between these activities. stated under P.L. 89-749. which the State intends to use the grains, and organizational frani(,@- Fl 'rii(@, (,oiiii)reliensiv(- health plan- funds as part of an effort to provide works being created under the iiin,,, activities will use data available Traininy Health Planners adequate Public Health Services. Regional Medical Programs, commu- from many sources including that This plan, in turn, must be in accord nity mental health centers, and area- aencrated or analyzed by the Region- Section 314(c) of P.L. 89-749 au- with the State's comprehensive health wide health facility planning groups, al Medical Programs, particularly thorizes grants to public or nonprofit planning. including the advisory -roups estab- on health status of populations ef- organizations for "training, studies, - 6cction 314(c), authorizing project lished for other 1)ro,,rams such as the f(-(-t(-d, li(!altli r(@sotir(-(!s, atict health to ad- and demonstrations," in order rants for "health services develop- Re,ional Medical Pro,,rams, should problems and needs. The coml)rc- 9 vance the state of health planning art serve as sources of strength and fiensivc health I)Iannin,, activities ment," broadens and consolidates a and increase the supply of competent valuable assistance for the areawide can also benefit from the experience health planners. series of Public Health Service proj- and State-wide health planning coun- obtained under the Regional Medi- ect grants, making possible Federal c7ils created under P.L. 89-749 and cal Programs Nvhich have represented For the first years, emphasis will be support for new and innovative proj- for the planning resources created an exploratory effort of considerable placed on increasing health planning ects, locally determined, t(> meet under this Law. importance in developing an en- manpchwer. (Until now, Public health needs of limited geographic F] The broad range of health inter- vironment for concerted planning by Health Service effort has been lim- scope or specialized regional or na- ests represented in Re@ional Medical many elements of the health en- ited to ad hoc short courses or in- tional significance; stimulating and Program planning efforts, along with deavor and in the implementation, service training.) This new activity initially supporting new programs of other appropriate health interests, development and evaluation of new will help meet a critical shortage health services, and undertaking studies, demonstrations, or training will be essential participants and con- systems for the facilitation of the de- faced by regional medical programs, roved tributors to the State health planning livery of the benefits of medical ad- medical centers, operating health designed to develop new or imp . council and to the activities of the vance in specific disease areas through agencies, as well as comprehensive methods of providing health services. health planning a-enc),. When the more effective means of communica- health planning agencies about to @e The first two of these categories of activities of that agency address tion, education, training, organiza- launched. health service development grant 98 must conform to objectives, priorities, other health programs including to the N:ttioii, :tnd to accomplish these ends without interfering with the pat- and plans of comprehensive State those supported under P.L. 89-749. EXHIBI'F XII tern,;, or the methods of financing, of pa- health lanning. Other programs supported by Public tient cire or professional l@ritctice, or with p th administration of hospitals, and in co- With the exception of the statutory Health Service funds such as mental Public l,a\v 89-239 opecriition with practicing physicians, medi- health, migrant health, and air pollu- S. 51)6 (,:it center ofFt(-i;tIs, lit@.Kipit:tl :t(liiiiiiitrator.,,,, requirement that the programs sup- and representatives from :ilol)i-ol)riate voluzi- tion can have the same type of pro- Octol),@i- 6, 1 96@) tary health agencies. ported by these grants must conform ductive interrelationship with the Ali Act "Aittlioi-i--atio?t ofAI)pi-opriatio?is to comprehensive State health plan- comprehensive health planning pro- "SFC. 901. (11) There ire ,tuthorized to ning, P.L. 89-749 formula and proj'- grams. Iletirt Disease, be appropriated $;-)O,000,000 for tlif! fiscal ect grants bear the same relation to Cancer, and year ending Jtirii, :10, $!10,000,00(@ for Stroke Atit(@Tt(]- the comprehensive health planning The Public Health Service has a re- It)(.Tlt4 of 1!@f;5. process as do, for example, the opera- sl)onsibility to prevent waste of scar(@c .10, for grant., to assist or ii(iii tional grants under regional medical resources through useless duplication. 'ro @iiiic@ti(I tli(@ Ilublic IIealtli Service Act to profit private universities, medical schools, assist in combating heart disease, cancer@ research institutions, and other public or To assure the most effective inter- ,trole, and related diseases nonprofit private institutions ind agencies programs, air pollution control, or in I)Iitnnin,, in conducting feasibility studies, community mental health center relationship among these and other Ilc it citacte(I by the Senate attil Itouse of :tyi(I in ol)(-rating pilot projects for the. P,;tat)- staffing. Public Health Service grant pro- Reprcv(!titafii@cs, of the Uitite(I States of lislijti(@nt of regional iii,-tli(-iii i.ri,griim,,, of grams, the Public Health Service is America iib Go?tg),c.,f.4 (isvcmblc(l, That till@4 r(@,,,earcli, training, Dan(] tletiioiitration Ictiv- Act may be cited -.I,, the "Heart Disease, !ties for carrying out tlip purposes of tliiq The operational grants under P.L. currently developing informational, Cancer, and Stroke Ain(!tidiii(@nts of 19C,5". title. Sums ,tlwpropri;ite(i under this section 89-239 will support an interrelated and review systems to promote effec- Si.,,c. 2. The Iltiblic [lefdtli Service Act (42 for any fiscal year ,h,,ill remain available for program of activities which utilize U.S.C., cli. 6A) is amended by ,id(ling at the making ,iieli grintq tint!] the end of the fiscal tive coordination between all of its end thereof the following'new title: yeir following the fiscal year for which the regional cooperative arrangements appropriation is made. varied grant programs. "TITLE IX-E@ DUCATION, RESEARCH, "lb) A grant tin(lpr this title sliall be for to accomplish the objectives of that TRAINING, AND DEMONSTRATIONS IN part or all of the cost of the I)Itnning or law in the fields of heart disease, can- THE FIELDS OF IIEART DISEASE, other activities with respect to which the CANCI@R, STROKE, ANI) REI,A.rE- D application I,; made. except that iny such cer, stroke, and related diseases. The DI SEA SES grant with respect to construction of, or cooperative arrangements and the "Plirpoqcs provision of built-in (as determined in ac- specific program elements are viewed cortlance with regulations) equipment for, @SFc. 900. The purposes of this title ,ire- by many regions as providing useful "(a) Through grants, to en(,Olirage and iiiv f;ieilitv may not P,,eped 90 per ei-iittim of assist la the establishment of regioiik I co- train cost of qiicii construction or eqtillinient. models for application to a wide operative :trrangeniciits among medical "(c) Funds al)l)rolirj:it(-d 1)tirii.,int to tell.-; spectrum of health problems which schools, research institutions, and hospitals title sli@ill not be ;available to l@iiv the cost for research and training (including con- of lioql)ital. iiietlicil. or (@tlier care of patients can be implemented through other tinuing education) and for relited deinon- except to the extent it is. ,i,, determined in means and which will have close strations of patient care in the. fields of :accordance with regulations, incident to heart disease, cancer, stroke, and relate(] rest@4ircii, or demonstration relevance to the achievement of many diseases :activities, wlii(-Ii ire by tbo@ of the activities supported under "(I)) 'I'o afford ti) III(- itrof(@ssiois (@r this No :III(] 1114- iiisli(litit.lis If tie Nation, P.L. 89-749 and other health pro- through sij(-Ii iii4! :it :ttiy facility to training, grams. Conversely, the regional med- ol)l)ortuj)ity of in.,Lliing itv:iiliil)lf@ to their 1):i- or d(-inoyi,,,tr:iti(iti activities (-:irri(@41 )iit with tient,.; tlt(@ latest ,i(lv:inces in title diagnosis ical programs can benefit from the and treatment of these diseases; and funds iiiir,@ii@int to this title. 11(c) By these means, to Improve gen- unless lie has been referred to such facility planning and operational activities of Prally the health manpower in(] facilities by :I I)r;t(-tieln, 99 t (,riii 'Construction' includes for the establishment tiid operation of will keel) such records and afford such "Szc. 502. l,'or the 1)url)ost!s of this titlt!- :iIL4!rsit,i(jii, iii:ij,)r repair (i.c) l,li(@ extent 1)(@r- such regional 1114@41IC;ll I)i,ogritiii, wlii(-Ii access tlif@reto ;I-, tlie Surgeon General mitted by regulations), remodeling and advisory group Includes practicing I)hysi- may find necessary to assure the cor- "(a) The term 'regional medical program' renovation of existing buildings (including clans, medical center officials, hospital ad- rectness and verification of such reports; means a cooperative arrangement among a initial equipment thereof), tnd replacement ministrators, representatives from appro- and group of public o r nonprofit private institu- of obsolete, built-in (as determined in ac- priate medical societies, voluntary health "(4) any laborer or mechanic employed tions or agencies engaged in research, train- cordance with regulations) equipment of agencies, and representatives of other by any contractor or subcontractor In the ing, diagnosis, and treatment relating to existing buildings. organizations, institutions, and agencies performance of work on any construction heart disease, cancer, or stroke, and, at the concerned with activities of the kind to be aided by payments pursuant to any grant option of the altl)llc;iiit, related disease or "GralLt$ for lltaitittrig carrlctl on under the program and iiiem- under this section will be paid wages at diseases ; but only if such group- "SF,,c. 903. (a) The Surgeon General, upon hers of the public familiar with the need rates not less than those prevailing on "(1) is situated within a geographic the recommendation of the National Ad- for the services provided under the similar construction In the locality as area, composed of any part or parts of visory Council on Regional Medical Pro- program. determined by the Secretary of Labor in any one or more States, which the Surgeon grams established by section 905 (hereafter accordance with the Davis-Bacon Act, as "Grants for Estab@hment and Operation of amended (40 U.S.C. 276a-276a-5) ; and General determines, in accordance with in this title referred to is the 'Council'), is Regional Afedical Programs the Secretary of Labor shall have, with regulations, to be appropriate for carry- authorized to make grants to public or non- Ing out the purposes of this title ; profit private universities, medical schools, IISFC. 904. (a) The Surgeon General, upon respect to the labor standards specified in "(2) consists of one or more medical research institutions, and other public or the recommendation of the Council, is au- this paragraph, the authority and func- centers, one or more clinical research cen- nonprofit private agencies and institutions thorized to make grants to public or non- tions set forth in Reorganization Plan ters, and one or more hospitals; and to assist them in planning the development profit private universities, medical schools, Nuinbered 14 of 1950 (15 P.R. 3176; 5 "(3) has in effect cooperative arrange- of regional medical programs. research institutions, and other public or U.S.C. 133z-15) and sectioia 2 of the Act ments among its component units which "(b) Grants under this section may be nonprofit private agencies and institutions to of June 13, 1934, as amended (40 U.S. C. the Surgeon General finds will be adequate made only upon application therefor ap- assist in establishment and operation of 276c). for effectively carrying out the purposes of proved fly tlit,, Surgeon General. Any such regional medical programs, including con- "National Advisory Council OIL Regional tills title. application may be tt)prov(!(l only if it coii- strijetioti and equipment of facilities ill call- "lb) Tit(! term 'medical center' means ,t tiiii.4 or is supported by- iiectioii therewith. Medical Programs "(1) fli;il: IOP(I- "(1)) Grants iiii(l(!r this section may be itiv,jlve,i in 1)ostgrii(lij:it(! jii(!(Ilcal training (!r@il fiiii(ii ]fail to any stela grant i)iiiy upon iil)l)li(!;tt.ioii flit@t,(-ror ;it)- Alil)@)ititiii(@iit. or and one or more hospitals iffiliate(I there- will 1)(! usb,(l only for the purposes for proved by the Surgeon General. Any such ineiiibl@rs. wlii(!Ii liai(I and in accordance with the application may be ipproved only if it Is rec- "SEe. 905. (it) The Surgeon General, with with for reaching, research, and demon- al)plic:il)lt@ l@rovisions of this title an(] the ommended by the advisory group described the approval of the Secretary, may appoint, stration purposes. "(c) The term 'clinical research center' regulations thereunder; in section 903(b) (4) and contains or is sup- without regard to the civil service laws, a means an institution (or part of an institu- 11(2) reasonable assurances that the ported by reasonable assurances thit- National Advisory Council on Regional Medi- tion) the primary function of which I.,; re- applicant will provide for such fiscal con- "(I) Federal funds paid pursuant to cal Programs. The Council shall consist of search, training of ,iri(i denion- trol an(] fund iccotintiiig procedures is are any such grant (A) will be used only for the Surgeon General, who shall be the chair- i;tr,,ttiori,4 ;kill] wlji(-Ii, in connection tlier4!witli, require(] by the Surgeon Geiieri] to the purposes, for which paid and in ;ic- earth, and twelve members. not otherwise In provides @lieci:tliz,!,], liigli-(Iti@ility ili;igtif,sll(! I)r(,I)t,r (1141)tirs4@iii(-itt of :hill :t(,(-oiijitirig foi, (!or(];iii(,(@ with tile @ll)l)llcjil)le provisions of ill(! regular full-time employ of tile United and treatment services for inpatients and such Federal funds ; this title and the regulations thereunder, States, who trc leaders in the fields of the outpatients. " (3) reasonable assurances that the ap- and (B) will not supplant funds that are fundamental sciences, the medical sciences, "(d) The term 'hospital' means a liospi- plicant will make such reports, in such otherwise available for establishment or or public affairs. At least two of the ap- tal as defined in section 625(c) or other form and containing such Information as operation of the regional medical program pointed members shall be practicing physi- health facility in which local capability for the Surgeon General may from time to with respect to which the grant is made; cians, one shall be outstanding in the study, diagnosis and treatment Is stilpf)orte(I :in(] time reasonably require, and will keep 11(2) the applicant will provide for such diagnosis, or treatment of heart disease, one augmented by the lirtygr;iiii such r(!cor(is :tji(i tfror(I sti(-Ii tli(!re- fiscal control and fund accounting lproce- shall be outstanding in the study, diagnosis, der this title. to is tile Surgeon General iniy find ncees- dures as tr(! required by the Siirgeoii or treatment of cancer, and one shall be out- "(e) The term 'nonprofit' as applied to sary to assure tile correctness and verifici- General to assure proper disbursement of stinding in the study, diagnosis, or treat- any institution or agency means an institu- tion of such reports ; and and accounting for such Federal funds inent of stroke. tion or agency which is owned and operated "(4) a satisfactory showing that the Records. Term of office. by one or more nonprofit corporations or as- applicant has designated an advisory sociations no part of the net earnings of group, to advise the applicant (and the 11(3) the applicant will make such re- (b) Each appointed member of the Coun- which inijre@, or 31)aY lawfully inure, to tile institutions ,ind ,igencies participating in ports, in such form and containing such (!it shall hold office for a term of four years, I)e,ii(-fit of any i,riv;if,- sli:irt-liol(if,r or ill(- resulting regional medieval lirogriiin) information i4 the Surgeon General may t@xeol)t that any member ;xl)lkointed to fill a individual. in formulating and carrying out the plan from, time to time reasonably require, ttid vacancy prior to ill(- expiration of the term loo for which his predecessor was appointed "rnfo),matio@t 07@ Special Treat)ncnt aii(i the United States, or any of their duly au- shall be appointed for the remainder of ,,I, Training Centers thorized representatives, shall have access term, and except that the terms of ofrl,, "SEC. 907. The Surgeon General shall es- for the purpose of audit in(i ex@iniinati,, to EXHIBIT -KIII of the members first taking office shall expire, as designated by the Surgeon General 'it the tablish, and maintain on x current basis, a any books, documents, papers, @incl records time of appointment, four at the enci. list or lists of facilities in tile United States of the recipient of iny grant under this title of tile first year, four at the end of the second year, equipped and staffed to provide the most ad- which are Pertinent to any sucIi grant." r - SEC. 3. (a) Section I of tile Public Heal ,ind four at the en(] of the third year afte vanced methods and techniques in the (ling ill Rc(,ulatioiis the date of appointment. An appointed mem nosis and treatment of heart disease, cancer, Service Act is aniLn(le(I to rea(l as follows her shall not be eligible to serve continuously or stroke, together with such related Infer- "SECTIO.N 1. TitILs I to IX, inclusive, of Rt,,(,'oizal Ile for more than two terms. matlon, including the tvailability of ad. this Act may be cited i,; tile 'Public ill Pi-o "?-(Il??s ,uch facilities, Service Act'.,, vance(I specialty training in r I Compensation. as he deems useful, and shall make ,,Ii list \Iarcli If;, 1967 or lists and related information readily (b) The Act of July 1, 1944 (5S Stat. "(c) Appointed members of the Council, available to licensed practitioners ,,l other 682), as amended, is further imen(led by re- while attending meetings or confercn(!c,.,; persons requiring such information. To the numbering title IX (as in effect prior to tlic, thereof or otherwise serving On business of en(] of making ;iieli list or lists :11](I otll(,,I. (,,ziaetnient or this Act) @is iiilc, X, and I).,, SUBPART E-GRANTS FOR the Council, shall he entitled to receive colit- itiforiti@itioii most lis('fill, tll(@ StirToii G,@ll- s('(ItiOlls !)(@l IIII-ougli 914 (:Is IZEGIONAL MEDICAL l@IZOGItAMS i)en.,4ation at rates fixed by the 1.3cerctar3-, eral shall from time to time consult will, in- ill effect prior to tile efficient of this Act), but not exceeding $100 per day, including terested national profe,,sionil or,@,iiiizttion,. ln(I references thereto, :Is sections 1001 traveltime, tnd while so serving Iway from through 101,t, their homes or regular places of business they -'ZePoi-t to P),csidelit and Co;ig;-c8s (A(Ifle(I 1/18/67, 32 -PR 571.) may be allowed travel expenses, including APPROVED oc,robrit per them In lieu of subsistence, -is authorized "SEC. 908. On or before June --o, lgr,7, @k.Af. 'KUTTIORITY: The provision,, of this 'iub- by section 5 of the Administrative pes,,, the Surgeon General after consultation will, li@irt I-,, issued under see. 215, 5,4 Stat. 690, Act of 194r, U.. '3@2) r per_ I)(, Council, qll,,Ill ,;Ill)mit to tile S(,cretirv Lcgi.4i,itit'r Iiivio),y: N'cc. 906, 79 Stat. 930 ; 42 U.S.C. 216, 299f, (5 g.C. 7, to Ilit(@rj)r(@t or se(". ')Oo, ')Ol, !)02, !)O.:, sons fit tile Gov(@riiiii(@jit ;ervie(- i-lilplo.,,e(i ior ;,,,(I fill.,, ]Tons(. ')Ol, !)05, !)Oil, 710 St;tt. 1)2(;, !)27, 1)28, 921), t intermittently. 0 the Congres,,;, L report of the :3140 (Coillill. (,II Ilit(,rst@tt(, and ilol.(@1,11 Applications for under this title together iritli (1) a state- Commerce). 1)30, 4-t U.S.C. 299, 2991). '-'9qe, 299(i. grants, recom- ment bf the relationship between Fder,,,l Senate Report No. 3r,.,, (Colill". oil Labor 9-99e, 299i. mendations. financing and financing from other sources Public Welfire). 54.401 AIIPLICABILITY. of the activities undertaken 1)ursutint to this Congressional Itecor(l, %fol. ill "(d) Tile Council shall "(Ivise and assist title, (2) :in apprai,,,,ii Of tile ,ictiviti("4 ;I. ']'lie I)roiisioll.,; of tills ,ubl),,irt ,ipl)ly to . ;- 2r,: ('Ollsideri,(] grants, for 1)1,'tliliillg, (Establishment, in(] the Surgeon Gener@,il in the preparation )f s'istctl under this title it, tile light of t,leil. June 28 : Considered and li@iss(,d S(,jiitt(,. regulations for, :'nil its to iiiitter, (fr@'etiv(lfle.,.,, in out tile ),, Nel)t. 2:,: Jr.1t. '@140 t)l)(@r:xtioyi of rc,,ioii:il 11)(Idicl] program.,-, as ,irtsiiig with respect to, file administration tills, title, and (3) recoii)iiiell(littiolls Ivitli 24: 0 _ IX of tile Iltibile Iff@.iltil Jr ilsi-, ittitlioriz(@d by Title Of this title. The Council shall consider all respect to extension or modification of tills ill ]let' of Ir.It. ",140. @ervic(! %et, ;is :Irllell(le,l l,y applications for grants tinder this titiL, and title ill tile light thereof. Sept. 29 Senate coneiiri-(,(] 89-239. .ihall make recommendations to the Surgeon -I- "Records and Audit General with respect to approval of applic, El .1)4.402 DLPINITIO.NQ. tions for qn(I the amounts of grant.,, tin(jel- @'-SFc. 909. (a) Each recipient of , grant (a) All terms not dLflned herein shall this title. ]'live the meaning given them in the Act. tinder this title Ilillll keep ;iiell record,; is the (1)) "Act" means the nubile ire.,iiti, Scri-- "Regitiatio)zs -Surgeon General ina3, prescribe, including ice Act, as amende(l. records which fully disclose the m,u,t and (e) "Title IX" means Title IX of the "SEC. 906. The Surgeon General, ifter disposition by such recipient of the proceeds Public Health 'service Act as amended. ,consultation witil the Council, ;Iialit.pre- of such grant, the total cost of the project or (d) "Related diseases,' means those dis- (-,ases which can reasonably be considered to scribe general regulations coverng the rms undertaking in connection wit], ],jell such bear L direct relationship to lieirt diseise, 'trill conditions for approving applications for grant is made or ln(I tile ainOlITIt Of or strolie. ,rants under this title -'Ind the coorflinatioll that Portion Of tile cost of tile project or (e) "Tit](@ IX diseases,, '''calls heart di,,- of programs assiste(i under tlii.,; title will, undertaking supplied by other sources, and (,:Ise, cancer, stroke, and related diseases. i,rogr.tms for training, research, in(I demon- such records as will facilitate all effective (f) "Program" means the regional medi- strations relating to the same diseases audit. cal program 'Is defined in section 902(a) of tissisted or authorized under other titles of "(b) The Secretary of Health, Education, the Act. this Act or other Acts of Congress. tnd Welfare and the Comptroller General of Physician" mean, any (9) "Practicing Pll.vqici.,tn licensed to practice medicine in 101 :icef)r(lancot iviiii ii@jolic;ible State laws ,ifiil :irl@:L to 1)(! the cooper:itive. ;tri,;iiig(,,- stielk exception.,; are not iii(,oii.,iistojit ivitli.tli(' under section 904 or the Act, as the Surgeon (r.-:il Iil,-Ills ill lo I)(, lil:ifl(@ ('r- \c.i. :,ad iiii. or iiii@ lpr(igi,:ttti. may prescribe. 1114-111@ ,f %vi(iiiii lit@, (II(- jilst.ilii-:Itii)ll (;t) Ils(: of fii)t(li. griiiit(,t- will a,(, (i-) l,(,coi,(Is )-ctc)itio)t. kll construction, (Ill ",Ilajor rel).tir" includes restoriitioji supported 1)@' !L liti(igt!t or other (litt@i, for the ,rtiiit fluids solely for the purposes for which financial, ,ixitl other records relating to the of an existing building to a sound state. :iniount of the funds requested, izicl financial the grant was made, as set forth in the kl)- use of grant funds shall be retained until (i) "Built-in equipment" is equipment or other data demonstrating that grant funds, proved application and award statement. In the grantee has received written notice that affixed to tl)e facility and customarily in- will not supplant funds otherwise available the event iDy part of the amount paid L the records have been audited unless a differ- cluded in the construction contract. for establishment or operation of the regional grantee is found by the Surgeon General to cat period is permitted or required in writing (j) ",kdvisory great)" means the groijj) medical program. have! been expended for purp'oses or by any by file Surgeon General. (losign,,ite(I ((]) (-oiiti,@iry to the Act, the r(@gtil@itioti@ (f) lecspoitviblc official. The official or A(-(, lc)t(:(,. Ali fill' :L grant: 1111(ii-V of this subpart, or contrary to :iiiv (condition (I(,.,;igiiitte(i in the application is re,@I)oziqil)le final !)O:@ ,I' Ill,- A--l@ retailer (@i- 1),! stil)- I(, lit(! Haiti grjtiit(@i-, upon I)vitig for llii- (-oor(Iiii:Ltlt)i) of the prorajik shall tli:tt ill,- Stirg a I r(,,(t by (,r lit(@ 4-s- liolifif.il 4)r and ill ;Itl(litioll to continue to be responsible for the duration all economic and socially related r(-gioii, t!Lblisliiit(-iit of iii great) to provide :tiiy other requirement, shall pay ,Lii equal of the period for which grint fuiids are made t@iking into consideration such factors :is ;t(lvice in foriiiiii@iting ;in(l carrying out the @iiiiount to the United States. Changes in available. The grantee shall iiotify the Sur- present and future population trends and establishment and operation of a program. grant purposes may be made only in accord- geon General immediately if such official be- 1)@itterns of growth ; location and extent of (e) A(lui8ory g),oitp; ittentbcr8ltil) ; (Icsci-il)- ,ince with procediir@- established by the comes unavailable to discharge this respon- tr@iti,,I@ortatioil in(I communication facilities tioiz. The ipplicLtion or supportiii, material Surgeon General. sibility. The Surgeon General may terminate ,in(i (listril)ijti(,ii of all(] (1)) Ol)ligatioit of fititdn. No fluids may be the grant wlienever such official sliill become ;11141 11(@@iltli Iiowitig against the grant for services per- thus unavailable iinles% the grintee replace.,4 all(] l@rograiiis, :la,] )tljf@r :t(@tiviti(!s ivliielk in i,xi(.I)t of ittelilsii)jl ill groilli of formed or iiizit(@rl;tl or equipment (Ioliveteti, such oflici@il with aiiotlier official found by the opinion of the Surgeon General :tre :it)- lpr;tcticifig ii)eiiii)(@rs of otli(,t, I)tirsti@int to it contract or agreement entered the Surgeon Generil to be qualified. propriate for carrying out file purposes of health professions, medical center officials, Into by the applicant prior to the effective Title IX. hospital administrators, representatives from date of the grant. El 54.406 AWARD. -appropriate medical societies, voluntary Upon recomniendation of the National Ad- (c) Inventioit8 or discoveries. Any grant E] 54.403 ELIGIBILITY. agencies, representatives of other orgaiiiza- tward hereunder in whole or in part for re- visory Council on Regional Medical Pro- In order to be eligible for a grant, the none;, Institutions in(I agencies concerned search is subject to the regulations of tbL grams, and within the limits of available sli,,ill : with ,ictivitic,; of ill(! kind to be c.,irrie(I oil D(,I):trtin(-nt of Ilealtli, Ildtication, and Wel- fall(],;, the Surgeon General shall award a '.%Ieet tlii@ r(-qtiir(-jii(@iits (,f s(!ctit)ii !)O:@ iiii4l(,r title program, ;la(] of the fttr(! ;is set forth In llarts 6 and 8 of Title 45, grant to those applicants whose approval] or 904 of the Act ; lie familiar with the need for II)e 4is amended. Such regulations shall apply to programs will in Ills judgment best promote (b) Be located la a State lirovidc(l under the program. @iny program activity for which grint funds the purposes of Tile IX. In Lwarding grants, (c) Be situated within ,t geographic area (f) Coltst),Ilctioil; purposes, 1)la)ls, and ire in fact used whether within the scope the Surgeon General shall take into con- 'f stdcration, @imon,- other relevant factors the -appropriate under the provisions of this sub- Spec. icatio)is; narrative description. With of the program as approved or otlienvise. part for carrying out the purposes of the Act. respect to ,in ,ipplicatioti for funds to be Appropriate measures shall be taken by the following: used in whole or part for construction :is de- grantee and by the Surgeon Generil tc- assure (a) Generally, the extent to whiell the E] 54.404 API-LICATION. lined in Title IN, the applicant shall furnish that no contracts, assignments, or other Lr- proposed program will carry out, through (a) Forms. An @ipplication for ;t grant ill sufficient (retire I,Itns an(] @p(@eiflcation.1; r:ingements inconsistent with the grant obli- regional cooperation, the purpoes of Title shall be submitted oil such forms and in such as Nvell as a narrative description, to iii(licat(, -ation are continue(] or entered into an([ IX, within a geogrtphic area. i)ianner as the Surgeon Gene.-.Ill may the need, nature, :iii(I purpose of the pro- that all personnel involved in the supported (b) The capacity of the institutions or lirescribe. I)ose(I construction. activity are aware of and comply with sue], agencies within the program, individually (b) Exectitio)t. The application sliill be (g) Advisory group; ilceolpillle)i(latioii. @kii obligation. Laboratory notes, related tech- and collectively, for research, training, and executed by an individual authorized to ict ,Ll)l)licition for a grant under section 904 of nical datt, and information pertaining to in- demonstration activities with respect to Title for tile applicant :iti(I to :i."ujiie oil I)ehilf the Act shall contain or lie supported 1).i, it veiition,,i or discoveries made through activi- ix. (,f the applicant all of the oblig@itions sj)eci- (-ol).N, of the written of' tile ties supported by -rant funds shall be (e) The extent to which the applicant or tied in the terms ind conditions of the grint :i(lvisory -roup. ilinintaine(I for such I)eriods, and filed with tile participants in the program plan to including those contained in these regiiii- or otherwise made available to the Sur.-con coordinate or have coordinated the regional @ 54.40@ TER@NIS, CONDITIONS, General or those lie may designate at suell " al program with other activities suP- tions. AND ASSURANCES. times and !it such manner as he may deter- me@ic (e) Dcsct,iption of p),ogi,a@)t. In addition In addition to -iny other terms, conditions. mine necessary to carry out such Department I)Orted pursuant to the authority contained to any other pertiiieiit itifordiation that tli(@ regulations. in the Public Health Service Act and other Surgeon Generil falls, require, the ,il)plicaiit ,ijitl @tsstiratic(@s required by law or impose(] @kets of Congress including those relating shall submit L (I(-,cril)tioii of fill, program fly the Surgeon General, e@icli grant shall 1)(@ (it) Rcportv. The @raiite(@ ;Ii:ill,.uiaiiitiin to planning and use of facilities, personnel, in sufficient detail to clear]3- identify tried subject ill the fellowman terms, conditions, ind file with the Surgeon General ,ticli prog- nature, nee(], I)iirliosi,. and of itti(I to be furnished 1).N- ill(! ress, fise@il, and other report,, including and equipment, and training of manpoiver. the program, the nature :tr)fl functions of grantee. The Surgeon Geiieril may ;it any r(,I)orts of meetings of tile advisory groul) (ill The population to be served by the the participating institution.,, the geographic time approve exceptions where lie finds that convened before and @ifter award of a grant regional medical program and relationships 102 to adjacent oi, other regional medical vide Federal financial issistance subject to may be prescribed by titp Surgeon General. (1)) Diffe)-citt iiqc or transfer; notification. programs. the Civil Rights Act and the regulations. Grant fiinil,, sli@,ill not be ivitli tli(@ 'I'lie grantee @liall promptly notify the Sur- (e) The extent to which :ill the health I,,acli grant is subject to the condition that rest of- g(@oii in writing if.,it any time during resources of the region have been taken into the grantee -,]jail comply with tli(@ (1) ('are for iiitt,i,ctij,ri,tit coalitions ((@x- its useful life file facility or equipment for consideration in the planning ,tn(l/or estiib- iiients of Executive Order 11246, 30 F.It. (,el)t of an emergency nature wit(@re the later- construction or procurement of wine], grant lishment of the program. 12319, and the applicable rules, regulations, current condition results from the care for funds were charged is no longer to be used (f) The extent to which the participating and procedures prescribed pursuant thereto. which the patient was idmitted for treit- for the purposes for which it wts constructed institutions will utilize existing resources ment) that unduly Interrupt, postpone, or or procured or is sold or otherwise and will continue to seek additional non- El 54.400 D-XPENDITURES federal resources for carrying out the objec- BY GRANTEE. terminate the conduct of such activities. transferred. (2) Inpatient care If other care which (c) Forgive)tess. The Surgeon General lives of the regional medical program. (a) Allocation of cost8. The grantee would equally effectively further the pur- may for good cause release the grantee or (g) The geographic distribution of grants shall allocate expenditures as between di- poses of the grant, could be provided at a other owner from the requirement of can- throughout the Nation. rect and indirect costs In accordance ivitli smaller cost. generally accepted and established account- -tinued eligibility or from the obligation of 54.407 TERMINATION. (3) Bed and board for inpatients in excess continued use of the facility or equipment Ing practices or as otherwise prescribed by of the cost of semiprivate accommodations for the grant purposes. In determining (a) Termination by the Surgeon General. the Surgeon General. unless required for the effective conduct of whether good cause exists, the Surgeon Gen- Any grant award may be revoked or termi- (b) Direct costs in general. Funds such activities. For the purpose of this eral shall take into consideration, among nated by the Surgeon General In whole or granted for direct costs may be expended by paragraph, "semiprivate accommodations" other factors, the extent to which- In part at any time whenever he finds that the grantee for personal services, rental of means two-bed, tbree-becl, ,intl folir-be(I (1) The facility or equipment will be de- In his Judgment the grantee has failed in a space, materials, and supplies, and other accommodations. voted to research, training, demonstrations. material respect to comply with requirements Items of necessary cost as are required to of Title IX and the regulations of this sub- carry out the purposes of the grant. The Fl 54.410 IAY.)IENTS. or other 'Ictivities related to Title IX disease,;. part. The grantee shall be promptly notified Surgeon Generil may Issue rules, instruc- The Surgeon General shall, from time to (2) The circumstances calling for t of such finding in writing and given the tions, interpretations, or limitations sur@- time, make payments to a grantee of all or change in tl)c Ise of the facility tvere riot reasons therefor, plementing the regulations of this subpart a portion of iny grant award either in ad- known, or with reasonable diligence could (b) Termination by the grantee. A and prescribing the extent to which parti- i,,,ince or by way of r imbtir"'Iiiieiit for ex- not have been known to the applicant, at tlit, grantee may at any time terminate or cancel cular types of expenditures may be charged I)enses to be incurrede or incurred to the time of the application, and are circum- its conduct of an approved project by notify. to grant funds. extent he determines such payments neces- stances reasonably beyond the control of the ing the Surgeon General In writing setting (e) Direct costs; personal services. The sary to carry out the purposes of the grint. applicant or other owner. forth the reasons for such termination. costs of personal services are payable from (e) Accounting. Upon any termination, grant funds substantially in proportion to (3) There are reasonable assurances that ,ill expenditures the time or effort the Individual devotes to utilized for the grantee shall account for. 0 54.411 DIFFERENT USI-', OR other facilities not previously TRANSFER: GOOD CAUSE Title IX purposes will be so litilizk,(l in(] ir,, and obligations charged to grant funds: carrying out the purpose of the grint. In FOR OTIIER IJSY-,. .,u stantially the equivalent in iiiti,r(@ in,] Provided, That to the extent the termination such proportion, such costs may Include ill is due in the judgment of the Surgeon Gen. direct costs Incident to such services, such (a) Compliance by grantees. If, it any extent for such purposes. eral to no fault of the grantee, credit shall as salary during vacations and retirement time, the Surgeon General determines that Fl 54.412 PUBLICATIONS. be allowed for the amount required to settle and workmen's compensation charges, in ne- the eligibility requirements for a program Grantees may Publish materials relating at Costs demonstrated by evidence satisfac- cordance with the policies and accounting are no longer met, or that any fte!Iity or to their regional medical program without tory to the Surgeon General to be minimum practices consistently applied by the grantee equipment the construction or procurement prior review provided that such publication.,; settlement costs, any noncancellable obliga- to all Its activities. of which was charged to grant funds is, dur- carry a footnote acknowledging ,issistance tions incurred prior to receipt of notice of (d) Direct C08t8; care of patients. Tile Ing its useful Ilfc,, no longer I)ein,- used for from the Public Ilealtli @Senice, and indi- termination. cost of hospital, medical or other care of the purpose.- for which it was constructed] cating that findings and conclusions do not patients is payable from grant funds only to or procured either by the grantee or any represent the views of the Service. El 54.408 NONDISCRIMINATION. the extent that such care Is incident to the transferee, tile Government shall have the Section 601 of Title VI of the Civil Rights research, training, or demonstration -,ictivi- right to recover Its proportionate share of n 54.41:, COPYRIGHTS. Act of 1964, 42 U.S.C. 2000d, provides that ties supported by t grant hereunder. Such the value of the facility or equipment from Where the grant-supported activity result,, no person In the United States shall, on the care shall be Incident to such activities only either the grantee or the transferee or any in copyrightable material, the author is free ground of race, color, or national origin, be If reasonably associated with antl require(] Institution that is )sing tile facility or to copyright, but the Public Health Service excluded from participation in, be denied the for the effective conduct of such activities, equipment. The Government's proportionate reserves t royalty-free, nonexclusive, irrevo- benefits of, or be subjected to discrimination and no such care shall be charged to such share shall be the amount bearing the same cable license, for use of such materials under any program or Ictivity receiving Ped- funds unless tlic- referril of the patient is ratio to the then value of the facility or El 54.414 INTEREST. (Iral financial assistance. Regulations imple- documented with respect to the name of the equipment, as determined by the Surgeon Interest or other income cirned on pay- menting the statute have been issue(] .Is Part practicing physician making the referral, General, as the amount the Federal partici- ments under this subpart shall be paid to 80 of the Title 45, Code of r, ederal Regula- the name of the patient, the date of referral, pation bore to tile cost of construction or the United Stit@s ,is iieli interest is receiver] tions. The regional medical programs I)r(,- and any other relevant information which procurement. by the grantee. 103 Flcxner, Abraham, Medical Education in Price, D. K., Government and Science: II. Publications on the United States and Canada. A Report Their Dynamic Relation in fmerican Regional Medical Programs to the Carnegie Foundation for the Ad- Democracy. New York, New York Uni- vancemcnt of Teaching. New York, 1910. versity Press, 1954. "Georgia Regional Battey, Louis, L., Kidd, C. V., American Universities and Price, D. K., The Scientific Estate. Cam- Medical Program," journal of the Medi- 1. Selected Historical Documents Federal Research. Cambridge, Massa- bridge, Massachusetts. Belknap Press of cal Association of Georgia, Vol. 56, No. and National Reports chusetts. Belknap Press of Harvard Uni- Harvard University Press, 1965. 4, p. 141-142. April, 1967. versity Press, 1959. Sheps, C. G., Wolf, G. A., Jr., and Jacob- Burgess, Alex M., Jr., Colton, Theodore, Citizens Commission on Graduate Medi- Mountin, Joseph W., Pennell, Elliot H., son, C., editors, Medical Education and Peterson, Osler L., "Categorical Programs cal Education, The Graduate Education and Hoge, Vane M., Health Service Medical Care-Interactions and Pros- for Heart Disease, Cancer, and Stroke," of Physicians. Chicago, Illinois. Council Areas-Requirements for General Hospi- The New England journal of Medicine, on Medical Education, American Medical tal and Health Centers. Public Health pects. Report to the Eighth Teaching In- Vol. 273, No. 10. September 2, 1965. Association, 1966. Service Bulletin, No. 292. U.S. Govern- stitute, Association of American Medical Coggeshall, Lowell T., Planning for Medi ment Printing Office, Washington, D.C., Colleges, Evanston, Illinois, 1961. Callahan, Barbara, "Those Regional Medical Programs: Where the Action cal Progress Through Education. Evan- 1945. Somers, Herman M., and Somers, Anne Will Be," Hospital Progress, Vol. 47, p. ston, Illinois. Association of American Mountin, Joseph W. and Greve, Clifford R., Doctors, Patients and Health Insur- 57-64. December, 1966. Medical Colleges, 1965. H., Public Health Areas and Hospital ancc. Washington, D.C., The Brookings Commission on Hospital Care, Hospital Facilities. Public Health Service Bulletin Institution, 1961. Callahan, Barbara, "Regional Medical No. 42, U.S. Government Printing Office, Programs taking Giant Steps," Hospital Care in the United States. New York. Washington, D.C., 1950. U.S. Congress, Senate Committee on Progress, Vol. 48, No.,.3, p. 78-83. March, Commonwealth Fund, 1947. Appropriations, Federal Support of Medi- 1967. Committee on the Costs of Medical Care, National Commission on Community cal Research. Report of the Committee of Castle, C. Hilmon, "Regional Medical Medical Care For the American People- Health Services, Health Is a Community Consultants on Medical Research to the The Final Report (28). University oi Affair. Cambridge, Massachusetts, Har- Subcommittee on the Departments of Programs," Rocky Mountain Medical Chicago Press, 1932. vard University Press, 1966. Labor and Health, Education, and Wel- journal. January, 1967. Consultative Council on Medical and President's Commission on the Health of fare; 86th Congress, 2nd Session. U.S. Clark, Henry T., Jr., "Shaping the Hos- Allied Services, Interim Report on Future the Nation, Building America's Health: Government Printing Office, Washington, pital for its Future Role," Hospitals, Vol. Provisions on Medical and Allied Serv- A Report. U.S. Government Printing Of- D.C., 1960. 40, p. 49-53. February 1, 1966. ices. The Right Honorable Lord Dawson fice, Washington, D.C., 1952. U.S. Department of Health, Education Clark, Henry T., Jr., "The Challenge of of Thames, Chairman. London, England, President's Commission on Heart Disease, and Welfare, The Advancement of Medi- the Regional Medical Programs Legisla- His Majesty's Stationery Office, 1920. Cancer and Stroke, Report to the Presi- cal Research and Education. (Bayne- tion," The journal of Medical Education, Council on Medical Education and Hos- dent: A National Program to Conquer Jones Report). U.S. Government Printing Vol. 41. April, 1966. pitals, Money and Medical Schools. Heart Disease, Cancer and Stroke. Vol. 1. Office, Washington, D.C., 1958. Clark, Henry T., Jr., "Regional Medical Chicago, Illinois. Aiii(-ri(-.tn M(!dic,,ii As- U.S, Government Printing Offic(,, Wash- Hospital Practice. March, 11)(i7. Dryer, Bernard V., Study Director, Life- PrcsidenL's Commission on Heart Disease, ;Ill(i Welfare, SLII'gCOll (;ciicral's Consul- time Learning for Physicians: Principles, Cancer and Stroke, Report to the Presi- tant Group on Medical Education, Phy- "Conference on Regional Medical Pro- Practices, Proposals. joint Study in Con- dent: A National Program to Conquer sicians for a Growing America (Bane grams Examines Plans for Heart Disease, tinuing Medical Education, journal of Heart Disease, Cancer and Stroke. Vol. 2. Report). Public Health Service Publica- Cancer and Stroke," The Modern Hos- Medical Education, Vol. 37, No. 6, Pirt U.S. Government Printing Ofric(-, Wasli- tion No. 109. U.S. Government Printing pital, Vol. 108, No. 2, p. 79-80. February, 2. June, 1962. ington, D.C., February, 1965. Office, Washington, D.C., 1959. 1967. 104 "Continuing Medical Education-Does it journal of the Medical Association of Marston, Robert Q., and Mayer, William Page, Irvine H., "The Gestation of Med- Matter?" (Editorial), Journal of the Georgia, Vol. 56, No. 4, p. 154-155. D., "The Interdependence of Regional ical Complexes," Modern Medicine, p. American Medical Association, Vol. 197, April, 1967. Medical Programs and Continuing Edu- 89-92. June 21, 1965, No. 6, p. 505-506. August 8, 1966, Huston, Phillips, "Do We Need Those cation," The journal of Medical Educa- Dempsey, Edward W., "The Case for Regional Complexes?" Medical Econom- tion, Vol. 42, No. 2, p@ 119-125. Febru- "Regional Complexes Gain Momentum," Regional Medical Complexes," Medical ics. June 28, 1965. ary, 1967. Medical World News. February 3, 1967. Opinion and Review. October, 1965. he President's Commission," "Innovative Plans for the Georgia Re- Marston, Robert Q., and Yordy, Karl, "A Report of t Dodge, Harold T., "Regional Medical gional Medical Programs," Journal of the Nation Starts a Ptogram: Regional Mcd- The New England Journal of Medicine, Program for Heart, Cancer and Stroke," Medical Association of Georgia, Vol. 56, ical Programs, 1965-1966," The Journal Vol. 272, No. 18. May 6, 1965. The Journal of the Medical Association No. 4, p. 149-151. April, 1967. of Medical Education, Vol. 42, No. 1, p. of the State of Alabama, Vol. 36, No. 7. 17-27. January, 1967. Ross, Robert A., "The Regional Medical January, 1967. James, George, "Implications of the Heart 9 Program: An Opinion," North Carolina Disease, Cancer and Stroke Programs, an Mattin ly, Thomas W., "The Regional Medical journal, Vol. 28, No. 5, p. 125. Ebbert, Arthur, Jr., "A Look at Public Interpretation," Medical Opinion and Medical Program of Metropolitan Wash- May, 1967. Law 89-239: The Heart Disease, Cancer, Review. October, 1966. ington," Medical Annals of the District and Stroke Program," Connecticut Med- of Columbia, Vol. 3C), No. 'i, 1). 186 lf@8. Rtiss(!]I, John M., "N(!w Fed(-r;ii Regional irine, Vol. :30, No. 9, 1). .,I. (if N,-,(, Etil.,I,lylil fh,- N,-ic, ) 5').I. June, 19(i7. -I:t, N(,. (i, 1). 52' M;Iyt-l-, Willi;llji 1)., MC (li @ll ",Oo "Evolution or Revolution in American 1'rograiris-A Progress lteport," journal August 11, 1966. Jones, Frank W., "The Medical Society of the Medical Association of Georgia, Schechter, Mal, "Planners Work Today Medicine," Modern Medicine, p. 8-16. and the Regional Medical Program in Vol. 56, No. 4, p. 143-147. April, 1967. on Medicine of Tomorr June 21, 1965. North Carolina," North Carolina Medi- ow," Modern "Get Together If You Want a Regional cal journal, Vol. 28, No. 5, p. 173-175. McCormack, James E., "The New York Medicine, p. 33-52. February 13, 1967. Grant," The Modern Hospital, Vol. 107, May, 1967. City Story," Bulletin of the New Yo rk No. 2. August, 1966. Academy of Medicine, Vol. 43, No, 6, p. Schmeck, Harold M., Jr., "National Cam- Kissick, William L., "Regional Medical 515-521. June, 1967. paign Against Disease to Begin with Four Guidelines for Regional Medical Pro- Programs". Address delivered at the Pack Regional Programs," The New York grams, Division of Regional Medical Pro- Forest Conference on Regional Medical Morgan, Ralph S., "Development of a Times. April 15, 1967. grams, National Institutes of Health, U.S. Programs, La Grange, Washington, No- Regional Medical Program in Western Department of Health, Education and vember 6, 1965. North Carolina," North Carolina Medical Shannon, James A., "The Advancement Welfare. July 1, 1966. Lyle, Carl B., "Education and Research journal, Vol. 28, No. 5, p. 195 197. May, of Medical Research: A Twenty-Yeai- in Community Medical Care: University 1967. 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Office, Washington, D.C,, September f", Woods, James W., "Intensive Coronary 1965. Care Units in Community Hospitals," U.S. Congress, Senate Committee on North Carolina Medical journal, Vol. 28, Labor and Public Welfare, Combating No. 5, p. 185-187. May, 1967. Heart Disease, Cancer, Stroke, and other Major Diseases; Hearings Before the Subcommittee on Health, 89th Con- gress, Ist session, S. 596. U.S. Govern- ment Printing Office, Washington, D.C., 1965. U.S. Congress, Senate Committee on Labor and Public Welfare, Heart Disease, Cancer and Stroke Amendments of 1965; Report No. 368, 89th Congress, Ist scs- sion, U.S. Government Printing Office, Washington, D.C., June 24, 1965. Wakerlin, George E., "Missouri Regional U.S. GOVERNMENT PRINTING OFFICE: 1967 C-268-649 Medical Program," Missouri Medicine (journal of the Missouri State Medical ten(lent of Docunionts, U.S. Governiiient Printing Office For sale by the Superin Association), p, 90-94. February, 1967. Wasbington, D.C., 9-0402 - Price $1 (paper cover)