a re iona i[nec-ica ro raiins I mi6c, Institittes Marvliiid i4 i:@ -- . I. . . . . I. 3 9m is Regional Medical Programs have been awarded Re-ional Medical Programs have received opera@ planning grants*... tional -rants*... 0 to develop operational proposals through ... to improve patient care through research, con-@ * surveys of needs and resources tinuin- education, training, and demonstration 0 feasibility studies proj ects * organization and staffing to develop better methods for the exchange of information among medical schools, m@dical centers, community hospitals, practicing phy- sicians, and other health institutions, organi- Regional Medical Program is currently under zations, and personnel development to continue to develop new and expanded plans for further improvement of patient care r 19 REGIONS AND PROGRAM COORDINATORS OR DIRECTORS I ALABAMA 10 FLORIDA 19 LOUISIANA 28 NEBRASKA- 37 NORTHWESTERN 46 TENNESSEE B. B. Wells, M.D. S. P. Martin, M.D. J. A. Sabatier, M.D. SOUTH DAKOTA OHIO MID-SOUTH U. of Ala. Med. Ctr. Provost, J. Hillis Claiborne Towers Roof H. Morgan, M.D. C. R. Tittle, Jr., M.D. S. W. Olson, M.D. 1919 7th Ave. S. Miller Med. Ctr. 119 S. Claiborne Ave. 1408 Sharp Bldg. 2313 Madison Avenue 110 Baker Bldg. Birmingham, Ala. 35233 U. of Florida New Orleans, La. 70112 Lincoln, Neb. 68508 Toledo, Ohio 43624 110 21st Aye. S. 2 ALBANY, N.Y. Gainesville, Fla. 32601 20 MAINE 29 NEW JERSEY 38 OHIO STATE Nashville, Tenn. 37203 F. M. Woolsey, Jr., M.D. I I GEORGIA M. Chatterjee, M.D. A. A. Florin, M.D. R. I- Meiling, M.D. 47 TEXAS Assoc. Dean J. G. Barrow, M.D. 295 Water St. N. J. State Dept. of Hlth. Dean, Coll. of Med. *S. G. Thompson, M.E Albany Med. Coll. Med. Assoc. of Ga. Augusta, Me. 04332 88 Ross St. Ohio State U. Suite 724 47 New Scotland Ave. 938 Peachtree St. N.E. E. Orange, N.J. 07018 410 W. 10th Ave. Sealy-Smith Prof. Bldg. Albany, N.Y. 12208 Atlanta, Ga. 30309 21 MARYLAND Columbus, Ohio 43210 Galveston, Tex. 77550 12 GREATER W. S. Spicer, Jr., M.D. 30 NEW MEXICO D. 39 OHIO VALLEY 3 ARIZONA 550 N. Broadway 1. E. Hendryson, M. 48 TRI-STATE D. W. Melick, M.D. DELAWARE Baltimore, Md. 21205 U. of New Mexico W. H. McBeath, M.D. N. Stearns, M.D. Coll. of Med. VALLEY 900 Stanford Dr. N.E. 1718 Alexandria Dr. W. C. Spring, Jr., M.D. 22 MEMPHIS Albuquerque, New Mex. Lexington, Ky. 40504 22 The Fenway U. of Arizona Wynnewood House MEDICAL Boston, Mass. 02115 Tucson, Ariz. 85721 300 E. Lancaster Aye. REGION 31 NEW YORK 40 OKLAHOMA 4 ARKANSAS Wynnewood, Pa. 19096 J. W. Culbertson, M.D. METR.AREA K. M. West, M.D. 49 VIRGINIA Coll. of Med. V. deP. Larkin, M.D. U. of Ok. Med. Ctr. E. R. Perez. M.D. W. K. Shorey, M.D. 13 HAWAII Richmond Acad. of Med. Dean, Scb. of Med. U. of Tennessee N.Y. Academy of Med. 800 N.E. 13th SL W. C. Cutting, M.D. 858 Madison Ave. 2 E. 103d St. Oklahoma City, Ok. 73104 1200 E. Clay SL U. of Arkansas Dean, Sch. of Med. New York, N.Y. 10029 Richmond, Va. 23219 4301 W. Markham St. U. of Hawaii Memphis, Tenn. 38103 Little Rock, Ark. 72201 2538 The Mall 41 OREGON 50 WASHINGTON- Honolulu, Ha. 96822 23 METROPOLITAN 32 NORTH CAROLINA M. R. Grover, M.D. ALASKA 5 BI-STATE WASHINGTON, D.C. M. J. Musser, M.D. Director, Cont. Med. Ed. 14 ILLINOIS T. W. Mattingly, M.D. Teer House Sch. of Med. D. R. Sparkman, M.D, W. H. Danforth, M.D. D.C. Medical Society 4019 N. Roxboro Rd. U. of Oregon Sch. of Med. V. Chan. for Med. Affairs Wright Adams, M.D. 2007 Eye St. N.W. Durham, N. C. 27704 3181 S.W. Sam Jackson U. of Washington Washington U. 112 S. Michigan Ave. Washington, D.C. 20006 Portland, Ore. 97201 Seattle, Wash. 98105 660 S. Euclid Ave. Chicago, Ill. 60603 33 NORTH DAKOTA St. Louis, Mo. 63110 24 MICHIGAN T. H. Harwood, M.D. 42 PUERTO RICO 51 WEST VIRGIM) 6 CALIFORNIA 15 INDIANA A. E. Heustis, M.D. Dean, Sch. of Med. A. Nigaglioni, M.D. C. @ Wilbar, Jr., MJ) R. B. Stonehill, M.D. 1111 Michigan Ave. U. of North Dakota Chancellor Sch. of Med. W. Va. Univ. Med. Ctr. Paul D. Ward Indiana [J. Sch. of Med. Grand Forks, N.D. 5820-L W. Va. 265 655 Sutter St. #302 1100 W. Michigan Str(!i!t East Lansing, Mich. 48823 U. of Puerto Rico Morgantown, San Francisco, Calif. 94102 Indianapolis, Ind. 46207 25 MISSISSIPPI 34 NORTHEASTERN San Juan, P.R. 00905 52 WESTERN G. D. Campbell, M.D. OHIO 43 ROCHESTER, N.Y. NEW YORK 7 CENTRAL F. C. Robbins, M.D. NEW YORK 16 INTERMOUNTAIN U. of Miss. Med. Ctr. Dean, Sch. of Med. R. C. Parker, Jr., M.D. R. F. IngA M.D. B. H. Lyons, M.D. C. H. Castle, M.D. 2500 N. State Ct. Western Reserve U. Sch. of Med. and DenL Jich.of Med. State U. of N.Y. Assoc. Dean Jackson, Miss. 39216 2107 Adelbert Rd. U. of Rochester State U. of N.Y. at Buff a 750 E. Adams St. U. of Utah Cleveland, Ohio 44106 Rochester, N.Y. 14620 Buffalo, N.Y. 14214 Syracuse, N.Y. 13210 Salt Lake City, Ut. 84112 26 MISSOURI V. E. Wilson, M.D. 44 SOUTH CAROLINA 53 WESTERN 8 COLORADO- 17 IOWA Executive Director 35 NORTHERN C. P. Summerall, III, MD PENNSYLVANIA WYOMING W. A. Krelil, M.D., Pli.D. for Health Affairs NEW ENGLAND Dept. of Med. F. S. Cheever, M.D. 308 Melrose Ave. U. of Missouri J. E. Wennberg, M.D. Med. Coll. Hospital Dean, Sch. of Med. P. R. Hildebrand, M.D. U. of Iowa Columbia, Mo. 65201 U. of Vt. Coll. of Med 55 Doughty St. U of Pittsburgh U. of Col. Med. Ctr. Iowa City, la. 52240 25 Colchester Ave. Charleston, S.C. 29403 3@30 Forbes Ave. 4200 E. 9th Ave. 27 MOUNTAIN STATES Burlington, Vt. 05401 Pittsburgh, Pa. 15213 Denver, Col. 80220 18 KANSAS K. P. Bunnell, Ed.D. 45 SUSQUEHANNA C. E. Lewis, M.D. Assoc. Director 36 NORTBLANDS VALLEY 54 WISCONSIN 9 CONNECTICUT Chairman Western Interstate R. B. McKenzie J. S. Hirschbomk, M.] H. T. Clark, Jr., M.D. Dept. of Preventive Med. Comm. for Higher Ed. W. R. Miller, M.D. 3,qG6 Market St. Wisconsin RMP, Tnf@. 272 George St U. of Kansas Univ. E. Campus 375 Jackson St. P.O. Box 5_41 110 K Wisconsin Ave. New Haven, Conn. 06510 Kansas City, Kan. 66103 Boulder, Col. 80302 St. Paul, Minn. 55101 Camp Hill, Pa. 17011 Milwaukee, Wisc. 53202 *Associate or al HISTORY AND PURPOSES OF REGIONAL ment, and the distribution of scarce manpower, facilities, and other MEDICAL PROGRAMS resources. The degree of urgency attached to the need to c@ with these issues is heightened by an increasing public demand that the On October 6, 1965, the President signed Public Law 89-239. It latest and best health care be made available to everyone. This authorizes the establishment and maintenance of Regional Medical public demand, in turn, is largely an expression of expectations Programs to assist the Nation's health resources in makin@ available aroused by awareness of the results and promise of biomedical the best possible patient care for heart disease, cancer, stroke and research. related diseases. This legislation, which will be referred to in this In a sense, the national commitment to biomedical investigation publication as The Act, was shaped by !be interaction of at least is one manifestation of the third factor which contributed to the four antecedents: the historical thrust toward regionalization of creation of Regional Medical Programs: the changing needs of health resources; the development of a national biomedical research society-in this case, health needs. The decisions by various private community of unprecedented size and productivity; the changing and public institutions to support biomedical research were responses needs of society; and finally, the particular legislative process leading to this societal need perceived and interpreted by these institutions. to The Act itself. In addition to the support of research, the same interpretive process The concept of regionalization as a means to meet health needs led the Federal Government to develop a broad range of other pro-, effectively and economically is not new. During the 1930's, Assistant grams to improve the quality and availability of health care in.'the Surgeon General Joseph W. Mountin was one of the earliest pioneers Nation. The Hill-Burton Program which began with the passage of'@ urging this approach for the delivery of health services. 7le na- the previously mentioned Hospital Survey and Construction Act of tional Committee on the Costs of Medical Care also focused attention 1946, to-ether with the National Mental Health Act of 1946, was the in 1932 on the potential benefits of regionalization. In that same first in a series of post-World War II legislative actions having year, the Bingham Associates Fund initiated the first comprehensive major impact on health affairs. When the 89th Congress adjourned regional effort to improve patient care in the United States. This in 1966, 25 health-related bills had been enacted into law. Among" program linked the hospitals and programs for continuing education these were Medicare and Medicaid to pay for. hospital and physician: of physicians in the State of Maine with the university centers oi services for the Nation's aged and poor; the Comprehensive Health, Boston. Advocates of regionalizatioii next gained national attention Planning Act to provide funds to each state for non-categorical health more than a decade later in the report of the Commission on Hospital planning and to support services rendered through state and.other Care and in the Hospital Survey and Construction (Hill-Burton) health activities; and Public Law 89-239 authorizing Regional Medi. Act of'1946. Other proposals and attempts to introduce regionaliza- cal Programs. tion of health resources can be chronicled, but a strong national The report of the President's Commission on Heart Disease, movement toward regionalization had to await the convergence of Cancer, and Stroke, issued in December 1964, focused attention on ,3ther factors which occurred in 1964 and 1965. societal needs and led directly to introduction of the legislation 'au,. One of these factors was the creation of a national biomedical thorizing Regional Medical Programs. Many of the Conunission's research effort unprecedented in history and unequalled anywhere recommendations were significantly altered by the Congress in the else in the world. The effect of this activity was and continues to be legislative process but The Act was clearly assed to meet needs p intensified by the swiftness of its creation and expansion: at the and problems identified and given national recognition in the Corn- beginning of World War 11 the national expenditure for medical re- mission's report and in the Congressional hearings receding pas- p search totaled $45 million; by 1947 it was $87 million; and in 1967 sage in The Act. Some of these needs and problems were expressed the total was $2.257 billion-a 5,000 percent increase in 27 years. as follows: The most significant characteristic of this research effort is the tre- 0 A program is needed to focus the Nation's health resources for mendous rate at which it is producing new knowledge in the medical research, teaching and patient care on heart disease, cancer, sciences, an outpouring which only recently began and which shows stroke and related diseases, because together they cause 70 per- no signs of decline. As a result, changes in health care have been cent of the deaths in the United States. dramatic. Today, there are cures where none existed before, a 0 A significant number of Americans with these diseases die or are number of diseases have all but disappeared with the application of disabled because the benefits of present knowledge in the medical new vaccines, and patient care generally is far more effective than sciences are not uniformly available throughout the countr even a decade ago. It has become apparent in the last few years, I . - y- however, (despite substantial achievements), that new and better 9 There is not enough trained manpower to meet the health needs of means must also be found to convey the ever-increasing Volume of the American people within the present system for the delivery of research results to the practicing physician and to meet growing health services. complexities in medical and hospital care, including specialization, 0 Pressures threatenin- the Nation's health resources are building require these preventive, diagnostic, therapeutic and rehabilitative patient care. Through these means, the programs authorized by Ile services. Act are also intended to improve generally the health manpower and 0 A creative partnership must be forged among the Nation's medi- facilities of the Nation. cal scientists, practicing physicians, and all of the Nation's other In the two years since the President signed Tle Act, broadly health resources so that new knowledge can be translated more representative groups have organized themselves to conduct Regional rapidly into better patient care. This partnership should make it Medical Programs in more than 50 Regions which they themselves possible for every community's practicing physicians to share haie defined. These Regions encompass the Nation's population. in the diagnostic, therapeutic and consultative resources of major They have been formed by the organizing groups using functional as medical institutions. They should similarly be provided the op- well as geographic criteria. These Regions include combinations of entire states (e.g. the Washington -Alaska Region), portions of sev-' portunity to participate in the academic environment of research, eral states (e.g. the Intermountain Region includes Utah and see- teaching and patient care which stimulates and supports medical tions of Colorado, Idaho, Montana, Nevada and Wyoming), single practice of the highest quality- states (e.g. Georgia)', and portions of states around a metropolitan 0 Institutions with high quality research programs in heart disease, center (e.g. the Rochester Region which includes the igity and 11 cancer, stroke, and related diseases are too few, given the magni- surrounding counties). Within these Regional Programs, a wide tude of the problems, and are not uniformly distributed through- variety of organization structures have been developed, including out the country. executive and planning committees, categorical disease task forces, 0 There is a need to educate the public regarding health affairs. and community and other types of sub-regional advisory committees. Education in many cases will permit people to extend their own Regions first may receive planning grants from the Division of lives by changing personal habits to prevent heart disease, cancer, Regional Medical Programs, and then may be awarded operational stroke and related diseases. Such education will enable indi- grants to fund activities planned with initial and subsequent planning viduals to recognize the need for diagnostic, therapeutic or re- grants. These operational programs are the direct means for Re.- habilitative services, and to know where to find these services, gional Medical Programs to accomplish their objectives. Plannin- and it will motivate them to seek such services when needed. 0 moves a Region toward operational activity and is a continuing During the Congressional hearings on this bill, representatives of means for assuring the relevancy and appropriateness of operational major groups and institutions with an interest in the American health activity. It is the effects of the operational activities, however, which system were heard, particularly spokesmen for practicing physicians will produce results by which Regional Medical Programq will be and community hospitals of the Nation. The Act which emerged judged. On November 9, 1967, the President sent the Congress the Report turned away from the idea of a detailed Federal blueprint for action. Specifically, the network of "regional centers" recommended earlier on Regional Medical Programs prepared by the Surgeon General of by the President's Commission was replaced by a concept of "regional the Public Health Service, and submitted to the President through the cooperative arrangements" among existing health resources. The Secretar.y of Health, Education, and Welfare, in compliance with The Act establishes a system of grants to enable representatives of health Act. The Report details the progress 'of Regional Medical Programs resources to exercise initiative to identify and meet local needs and recommends continuation of the Programs beyond the June 30, within the area of the categorical diseases through a broadly defined 1968, limit set fortb in The Act. The President's letter transmitting process. Recognition of geographical and societal diversities within the Report to the Congress was at once encouraging and exhortative the United States was the main reason for this approach, and spokes- when it said, in part: "Because the law and th@ idea behind it are men for the Nation's health resources who testified during the new, and the problem is so vast, the p@?gram is just emerging from hearings ;trcngtbened the case for local initiative. Thus the degree the' planning state. But this report gives encouraging evidence of to which the various Regional Medical Programs meet the objectives progress-and it promises great advances in speeding research of The Act will provide a measure of how well local health resources knowledge to the patient's bedside." Thus in the final seven words can take the initiative and work together to improve patient care for of the President's message, the objective of Regional Medical Pro- heart disease, cancer, stroke and related diseases at the local. level. grams is clearly emphasized. The Act is intended to provide the means for conveying to the medical institutions and professions of the Nation the latest advances in medical science for diagnosis, treatment, and rehabilitation of patients afflicted with heart disease, cancer, stroke, or related di- seases-and to prevent these diseases. The grants authorized by The Act are to encourage and assist in the establishment of regional cooperative arrangements among medical schools, research institu- tions, hosp itals, and other medical institutions and agencies to THE NATURE AND POTENTIAL OF REGIONAL so that their combined effect may be increased and so that they contribute to the creation and maintenance of a system of MEDICAL PROGRAMS comprehensive health care within-the entire Region. Because the advance of knowledge changes the nature of medical GOAL-IMPROVED PATIENT CARE care, regionalization can best be viewed as a continuous process The Goal is described in the Surgeon Gencral's Report as rather than a plan which it totally developed and then implemented. . . clear and unequivocal. The focus is on the patient. The object This process of regionalization, or cooperative arrangements, con. is to influence the present arrangements for health services in a sists of at least the following elements: involvement, identification of manner that will -permit the best in modern medical care for heart needs. and opportunities, assessment of resources, definition of ob- disease, cancer, stroke, and related diseases to be available to all." jectives, setting of priorities, implementation, and evaluation. While these seven elements in the process will be described and discussed MEANS-THE PROCESS OF REGIONALIZATION separately, in practice they are interrelated, continuous and often No e: Regiona,ization can connote more than a regional cooperative arrange- occur simultaneously. t ment. but for the purpose of this publication, the two terms will be used Involvement-The involvement and coriimitment of individuals, interchangeably. The Act uses "regional cooperative arrangement, but activ "regionalization" has become a more convenient synonym organizations and institutions which will engage in the ity of a Regional Medical Program, as well as those which will be affected A regional cooperative arrangement among the full array of by this activity, underlie a Regional Program. By involving in the available health resources is a necessary step in bringing the benefits steps of study and decision all those in a region who are essential of scientific advances in medicine to people wherever they live in to implementation and ultimate success, better solutions may be a Region they themselves have defined. It enables patients to benefit found, the opportunity for wider acceptance of decisions is improved, from the inevitable specialization and division of labor which ac- and implementation of decisions is achieved more rapidly. Other company the expansion of medical knowledge because it provides a system of working relationships among health personnel and the attempts to organize health resources on. a regional basis have ex- perienced difficulty or have been diverted from their objectives institutions and organizations in which they work. This requires because there was not this voluntary involvement and commitment a commitment of individual and institutional spirit and resources by the necessary individuals, institutions and organizations. The Act which must be worked out by each Regional. Medical Program. It is quite specific to assure this necessary involvement in Regional is facilitated by voluntary agreements to serve, systematically, the s composi- needs of the public as regards the categorical diseases on a regional Medical Program : it defines, for example, the minimum- ' tion of Regional Advisory Groups. rather than some more narrow basis. t, within The Act states these Regional Advisory Groups must include Regionalization, or a regional cooperative arrangemen "practicing physicians, medical center officials, hospital administra- the context of Regional Medical Programs has several other impor- tors, representatives from appropriate medical societies, voluntary tant facets: health agencies, and representatives of other organizations, institu. 0 It is both functional and geographic in character. Functionally, tions and agencies concerned with activities of the kind to be carried regionalization is the mechanism for linking patient care with on under the program. and members of the public familiar with the ne am." To ensure -a health research and education within the entire region to provide ed for. the services provided under the progr a mutually beneficial interaction. This interaction should occur 0 on gi maximum opportunity f r success, the composite of the Re onal within the operational activities as well as in the total program. Advisory Group also should be reflective of the total spectrum of The geographic boundaries of a region serve to define the popula- health interests and resources of the entire Region. And it should tion for which each Regional Program will be concerned and be broadly representative of the geographic areas and all of the responsible. This concern and responsibility should be matched socioeconomic groups which will be served by the:Regional Program. by responsiveness, which is effected by providing the population nistrative The Regional Advisory Group does not have direct admi with a significant voice in the Regional Program's decision- responsibility for the Regional Program, but the clear intent of the making process. Congress was that th a 0 e Advisory Group would ensure th t the Regi nal 0 It provides a means for sharing limited health manpower and Medical Program is planned and developed with the continuing facilities to maximize the quality and quantity of care and service ro advice and assistance of a group which is b adly representative of available to the Region's po the health interests of the Re-ion. The Advisory Group must approve .pulation, and to do this as cco- nomically as possible. In some instances, this may require inter- all proposals for operational activities within the Regional Program, regional cooperation between two or among several Regional and it prepares an annual statement giving its evaluation of the Programs. effectiveness of the regional cooperative arrangements established I under the Regional Medical Program. 0 Finally. it also constitutes a mechanism for coordinating its Program identifies the needs as regards heart disease, cancer, stroke Setting ol Priorities-Because of limited manpower, facilities,' and related diseases within the entire Region. These needs are financing and other resotitces, a Region assigns some 'order of- .rity to its objectives and to the steps t achieve them. Besides stated in terms which offer opportunities for solution. prio . 0 This process of identification of needs and opportunities for solu- the limitations on resources, factors include: 1) balance between tion requires a continuing analysis of the problems in delivering the what should be done first to meet the Region's needs, in absolute best medical care for the target diseases on a regional basis, and terms, and what can be done using existing resources and compe- it goes beyond a generalized statement to definitions which can be tence; 2) the potentials for rapid and/or substantial progress toward translated into operational activity. Particular opportunities may be the Goal of Regional Medical Programs and progress toward re- defined by: ideas and approaches generated within the Region, ex- gionalization of health resources and services; and 3) Program tension of activities already present within the Region, and ap- balance in terms of disease categories and in terms of emphasis on; proaches and activities developed elsewhere which might be applied patient care, education and research. within the Region. Implemeniation-The purpose of the preceding steps is to provide Among various identified needs there also are often relationships a base and imperative for action. In the creation of an initial op- erational pro ram, no Region can attempt to determine all of the which, when perceived, offer even greater opportunities for solutions. 9 In examining the problem of coronary care units throughout its program objectives possible, design appropriate projects to meet all Region, for example, a Regional Program may recognize that the the objectives and then assign priorities before seeking _a grant_ to more effective approach would be to consider the total problem of implement an operational pro- am which encompasses all or even ,,r the treatment of myocardial infarction patients within the Region. most of the projects. Implementation can occur with an initial This broadened approach on a regional basis enables the Regional operational, program encompassing even a small number of well- Program to consider the total array of resources within its Region in designed projects which will move the Region toward the attaixunent relationship to a comprehensive program for the care of the myo- of valid program objectives. Because regionalization is a continuous cardial infarction patient. Thus, what was a concern of individual process, a Region is expected to continue to submit supplemental and hospitals about bow to introduce coronary care units has been trans- additional operational proposals as they are developed. formed into a project or group of related projects with much greater Evaluation-Each planning and operational activity of a Region, potential for effective and efficient utilization of the Re-ion's re- as well as the overall Regional Program, receives continuous, quan- sources to improve patient care. t3 titative and qualitative evaluation wherever possible. Evaluation'is Assessment of Resources-As part of the process of re-ionalization, in terms of attainment of interim objectives, the process of regionali- tn zation, and the Goal of Regional Medical Programs. a Region continuously updates its inventory of existing resources and capabilities in terms of function, size, number and quality. Objective evaluation is simply a reasonable basis upon which to Every effort is made to identify and use existing inventories, filling determine whether an activity should be continued or altered, and, in the gaps as needed, rather than setting out on a long, expensive ultimately, whether it achieved its purposes. Also, the evaluation of process of creating an entirely new inventory. Information sources one activity may suggest modifications of another activity which include state Hill-Burton agencies, hospital and medical associations, would increase its effec'tiveness. and voluntary agencies. The inventory prov-des a basis for informed Any attempt at evaluation implies doing whatever is feasible within judgments and priority setting on activities proposed for develop- the state of the art and,appropriate for the activity being evaluated. ment under the Regional Program. It can also be used to identify Thus, evaluation can range in complexity from simply counting num- missing resources-voids requiring new investment-and to develop bers of people at meetings to the most involved determination of new configurations of resources to meet needs. avioral changes in patient management. Definition of Objectives-A Regional Program is continuously As a first step, however, evaluation entails a realistic at'temp@ tb involved in the process of setting operational objectives to meet design activities so that, as they are implemented and finally con. identified needs and opportunities. Objectives are interim steps cluded, some data will result which will be useful in determining the toward the Goal defined at the beginning of this section, and achieve- degree of success attained by the activity. ment of these objectives should have an effect in the Region felt far beyond the focal points of the individual activities. This can be one of the greatest contributions of Re-ional Medical Programs. The completion of a new project to train nurses to care for cancer patients undergoing new combinations of drug and radiation therapy, for example, should benefit cancer patients and should provide additional trained manpower for many hospitals in the Region. But the project also should have challenged the Region's nursin@ and NATIONAL ADVISORY COINCEL EVENTS ACTION E. L. CROSBY, M.D. J. R. IIOGNESS, M.D. E. D. PELLEGRINO, M.D. 1964 DECEMIlElt Iteport of the President's Director Dean, School of Med. Director of the Med. Ctr. Co-nimissioii on Heart Disease, American Hosp. Assoc. U. of Washington State U. of New York Cancer, and Stroke Chicago, El. Seattle, Wash. Stony Brook, N.Y. M. E. DEBAKEY, M.D. J. T. HOWELL, M.D. A. M. POPMA, M.D. 1965 FEBRUARY Prof. and Chairman Executive Director Regional Director TO JULY Congressional hearings Dept. of Surgery Henry Ford Hosp. Mountain States Regional Baylor U. Detroit, Mich. Medical Program OCTOBER Enactment of P.L. 89-239 Houston, Tex. C. H. MILLIKAN, M.D. Boise, Idaho H. G. EDMONDS. Ph.D Consultant in Neurology M. 1. SHANHOLTZ, M.D. DECEMBER National Advisory Council meeting Initial policies and Dean Graduate Sch. Mayo Clinic State Hlth. Comm. Guidelines reviewed No. @arolina College Rochester, Minn. State Dept. of Hlth. Durham, N.C. Richmond, Va. 1966 FEBRUARY Establishment of Division G. E. MOORE, M.D. Publication of preliminary B. W. EVERIST, JR., M.D. Director, Roswell Park W. H. STEWART, M.D. Guidelines Chief of Pediatrics Memorial Institute (Chairman) National Advisory Council meeting Policy for review proc- Green Clinic Buffalo, N.Y. Surgeon General ess and Division Ruston, La. Public Health Service activities set APRIL Review Committee meeting National Advisory Council meeting 7 planning grants awarded JUNE Review Committee meeting National Advisory Council meeting 3 planning grants awarded JULY Publication of Guidelines Review Committee meeting REVIEW COMMRME AUGUST National Advisory Council meeting 8 planning grants awarded SEPTEMBER First of 5 meetings of Ad Hoc Report material G. JAMES, M.D. P. M. MORSE, Ph.D. D. E. ROGERS, M.D. Committee for R'eport to the discussed (Chairman) ' Director, Operations Prof. and Chairman President and Congress Dean, Mount Sinai Research Ctr. Dept. of Med. OCTOBER Review Committee meeting School of Med. Mass. Inst. of Tech. School of Med. New York, N.Y. Cambridge, Mass. Vanderbilt U. NOVEMBER National Advisory Council meeting 16 planning grants Nashville, Tenn. awarded H. W. KENNEY, M.D. A. PASCASIO, Ph.D. I Medical Director Assoc. Research Prof. C. H. W. RUHE, M.D. 1967 JANUARY Review Committee meeting John A. Andrew Memorial Nursing School, U. of Assistant Secretary National Conference National views Hosp, Pittsburgh Council on Med. Ed. information for Tuskegee Institute Pittsburgh, Pa. American Med. Assoc. Report provided Tuske-gee, Ala. Chicago, Ill. FEBRUARY National Advisory Council meeting 10 planning and 4 opera- S. H. PROGER, M.D. tional grants awarded E 'J. KOWALEWSKI, M.D. Prof. and Chairman R. J. SLATER, M.D. APRIL Review Committee meeting Chairman, Dept. of Med. and Executive Director Committee of Environ. Med. Physician-in-Chief The Assoc. for the Aid of MAY National Advisory Council meeting 5 planning and 1 opera- Acad. of Gen. Practice Tufts N.E. Med. Ctr. Crippled Children tional grant awarded Akron, Pa. Pres., Bingham Assoc. Fund New York, N.Y. JUNE Report to the President & Congress Boston, Mass. J. D. THOMPSON I G. E. MILLER, M.D. JULY Review Committee meeting Director, Off. of Research Prof. of Public Hlth. in Med. Educ. Yale U. Med. School AUGUST National Advisory Council meeting 2 planning grants Coll. of Med., U. of Ill. New Haven, Conn. awarded Chicago, M. OCTOBER Review Committee meeting NOVEMBER National Advisory Council meeting 2planning and 3 opera- tional grants awarded 1968 JANUARY Conference Workshop Regional activities and RIeview Committee meeting ideas presented FEBRUARY National Advisory Council meeting 5 operational grants Through grants, to afford to the medical profession and the medical institu- tions of the Nation the opportunity of planning and implementing programs to make available to the American people the latest advances in the diag- nosis and treatment of heart disease, cancer, stroke, and related diseases by establishin- voluntary regional cooperative arrangements among 0 0 Physicians 0 Voluntary Health Agencies 0 Hospitals 0 Federal, State, and Local Health Agencies 0 Medical Schools 0 R -@arch Institutions 0 Civic Organizations REGIONAL ADVISOAL%'.VX GROUPS The activities of Regional Medical Programs are directed by fulltime Co- ordinators workin- to@ether with Re@ional Advisory Groups which are Z) C, Z) broadl-.- representative of the medical and health resources of the R"ions. Membership on these @roups nationally is:' Hospital Admi Practicin@ Public Health 13'7o sicians Officials 22 7o Other Health Workers 170 Voluntary Health A-en Medical Center School Officials Ot Total: 1929 Members of the Public