I iiiiii l@illill l@lipl@ilill I I MH - Regional Medical Programs/*// KW - 20C CN - United States. Division of Regional Medical Programs TI Progress report: regional medical programs f or heart disease, cancer, stroke, and related diseases./G IM Bethesda, Md.//(1968] CO (16] p. CP 02NLM:WA 540:A:D5p::1968 CA WA 540 A D5p 1968:02NLM Yl S/1968/ LP Eng LA Eng MT CORPORATE NAME MAIN ENTRY RO O:MED RO C:MED DA 680807 EL FULL LEVEL IT MONOGRAPH Ul 0147320 re iona iinec -ica ro rains Heart Dii Division of Regional so 042 ional Medical PrOarams have received opera- Regional Medical Pro@rams have been aivarded Re@ tD tional -rants*... plannin- orants*... 0 to develop operational proposals tbrouh . . . 0 to improve patient care tbrou-h research, con- tinuin@ education, training. and demonstration 0 surveys of needs and resources t) 0 feasibility studies projects * organization and staffing 0 to develop better methods for the exchange of information amon@ medical schools, medical centers, communit hospita practicin- phy y In sicians, and other health institutions. or-ani- , t) zation-q, and personnel Regional Medical Program is currently under 9 to continue to develop zieiv and expanded ,Ipvp.lnnment * plans for further improvement of patient care REGIONS IkND PROGIt,kM 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 C. R. Tittle, Jr., M.D. S. W. Olson, M.D. Miller @ed. Ctr. H. Morgan, M.D. 110 Baker Bldg. 1919 7th Ave. S. 119 S. Claiborne Ave. 1408 Sharp Bldg. Medical College of Ohio Birmingham, Ala. 35233 U. of Florida New Orleans, La. 70112 Lincoln, Neb. 68508 at Toledo 110 21st Ave. S. Gainesville, Fla. 32601 38 OHIO STATE Nashville, Tenn. 37203 2 ALBANY, N.Y. 20 MAINE 29 NEW JERSEY F. M. Woolsey, Jr., M.D. 11 GEORGIA M. Chatterjee, M.D. A. A. Florin, IVI.D. R. L. 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.D. Albany Med. Coll. Aled. 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. 070,18 410 W. loth 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 3 ARIZONA 550 N. Broadway Reginald Fitz, M.D. 39 OHIO VALLEY 48 TRI-STATE M. K. DuVal, M.D. DELAWARE Baltimore, Md. 21205 DeWn, Sch. of Med. W. H. MeBeatli, M.D. N. Stearns, M.D. Dean, Coll. of Med. VALLEY U. of New Mexico 1718 Alexandria Dr. 22 The Fenway U. of Arizona W. C. Spring, Jr., M.D. 22 MEMPHIS Albuquerque, N.M. 87106 Lexington, Ky. 40504 Boston, Mass. 02115 Tucson, Ariz. 85721 Wynnewood House MEDICAL 300 E. Lancaster Ave. REGION 31 NEW YORK 40 OKLAHOMA 49 VIRGINIA 4 ARKANSAS Wynnewood, Pa. 19096 J. W. Culbertson, M.D. METR.AREA K. M. West, M.D. E. R. Perez ?*I.D. Coll. of Aled. V. deP. Larkin, M.D. U. of Ok. Med. Ctr. W. K. Shorey, M.D. 13 HAWAII Richmond Acad. of Med. U. of Tennessee N.Y. Academy of Med. 800 N.E. 13th St. 1200 E. Clay St. Dean, Sch. of Med. W. C. Cutting' M 'D. 858 Madison Ave. 2 E. 103d St. Oklahoma City, Ok. 73104 Richmond, Va. 23219 U. of Arkansas Dean, Sch. of Med. Memphis, Tenn. 38103 New York, N.Y. 10029 4301 W. Markham St. U. of Hawaii 41 OREGON Little Rock, Ark. 72201 2538 The Mail 23 METROPOLITAN 32 NORTH CAROLINA 50 WASHINGTON- Honolulu Ha. 96822 M. R. Grover, M.D. ALASKA 5 BI-STATE I WASHINGTON, D.C. M. J. Musser, M.D. Director, Cont. Med. Ed. D. R. Sparkman, M.D. W. H. Danforth, M.D. 14 ILLINOIS T. W. Mattingly, M.D. Teer House Sch. of Med. Sch. of Med. D.C. Medical Society 4019 N. Roxboro Rd. U. of Oregon U. of Washington V. Chan. for Med. Affairs Wright Adams, M.D. 2007 Eye St. N.W. Durham, N. C. 27704 3181 S.W. Sam Jackson Washington U. 112 S. Michigan Ave. Washington, D.C. 20006 Portland, Ore. 97201 Seattle, Wash. 98105 660 S. Euclid Ave. Chicago, 111. 60603 33 NORTH DAKOTA St. Louis, Mo. 63110 24 MICHIGAN T. H. Harwood, M.D. 42 PUERTO RICO 51 WEST VIRGINIA 15 INDIANA A. E. Heustis, M.D. Dean, Sch. of Med. A. Nigaglioni, M.D. C. L. Wilbar, Jr., M.D. 6 CALIFORNIA G. T. Lukemeyer, M.D. 1111 Alichigan Ave. U. of North Dakota Chancellor, Sch. of Med. W. Va. Univ. '.%fed. Ctr. Paul D. Ward Assoc. Dean East Lansing, Nlich. 48823 Grand Forks, N.D. 58202 U. of Puerto Rico Morgantown, W. Va. 2650 655 Sutter St. #302 Indiana U. Sch. of '-%led. San Juan, P.R. 00905 San Francisco, Calif. 94102 1100 W. Michigan St. 34 NORTHEASTERN 25 MISSISSIPPI 52 WESTERN Indianapolis, Ind. 46207 G. D. Campbell, M.D. OHIO 43 ROCHESTER, N.Y. NEW YORK 7 CENTRAL F. C. Robbins, M.D. J. R. F. Ingall, M.D. NEW YORK 16 INTERMOUNTAIN U. of )Iiss. -Nled. Ctr' R. C. Parker, Jr., M.D. C. H. Castle, M.D. 2500 N. State Ct. Dean, Sch. of Med. Sch. of Med. and Dent. Sch. of Aled. R. H. Lyons, M.D. Jackson, @liss. 39216 Western Reserve U. State U. of N.Y. at Buff al4 State U. of N.Y. Assoc. Dean 2107 Adelbert Rd. U. of Rochester Buffalo, N.Y. 14214 750 E. Adams St. U. of Utah Cleveland Rochester, N.Y. 14620 Syracuse, N.Y. 13210 Salt Lake City, Ut. 84112 26 MISSOURI Ohio 44106 V. E. Wilson, M.D. 44 SOUTH CAROLINA 53 WESTERN 8 COLORADO- 17 IOWA Executive Director 35 NORTHERN C. P. Summerall, 111, MD PENNSYLVANIA WYOMING W. A. Krelil, M.D., Pli.D. for Health Affairs NEW ENGLAND Dept. of Med. F. S. Cheever, M.D. 308 Alelrose Ave. U. of @Nlissouri J. E. Wennberg, M.D. Med. Coll. Hospital Dean, Sch. of -,Nled. P. R. Hildebrand, M.D. U. of Iowa Columbia, @fo. 65201 U. of Vt. Coll. of Med. 55 Doughty St. U. of Pittsburgh U. of Col. Aled. Ctr. Iowa City, Ia. 52240 25 Colchester Ave. Charleston, S.C. 29403 3530 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 9 CONNECTICUT C. E. Lewis, M.D. Assoc. Director 36 NORTULANDS VALLEY 54 WISCONSIN Chairman Western Interstate J. M. Stickney, M.D. R. B. McKenzie J. S. Hirschboeck, M.D H. T. Clark, Jr., M.D. Dept. of Preventive '\led. Comm. for Higher Ed. Alinn. State Med. Assoc. 3608 Market St. Wisconsin R-NIP, Inc. 272 George St. U. of Kansas Univ. E. Campus 200 lst St. S.W. P.O. Box 451 110 E. Wisconsin Ave. New Haven, Conn. 06510 Kansas City, Kan. 66103 Boulder, Col. 80302 Rochester, Minn. 55901 Camp Hill, Pa.'17011 i@lilwaukee, Wisc. 53202 *Associate Coordinat( NATIONAL ADVISORY COTWCIL other factors which occurred "n 1964 and 1965. One of these factors was the creation of a national biomedical E. L. CROSBY, M.D. J. R. HOGNESS, iNI.D. E. D. PELLEGRINO, M.D. research effort unprecedented in history and unequalled anywhere Director Dean, School of Med. Director of the Med. Ctr. else in the world. The effect of this activity was and continues to be American Hosp. Assoc. U. of Washington State U. of New York intensified by the swiftness of its creation and expansion: at the Chicago, 111. Seattle, Wash. Stony Brook, N.Y. beginning of World War II the national expenditure for medical re- M. E. DEBAKEY, M.D. J. T. HOWELL, M.D. A. If. POPMA, M.D. search totaled $45 million; by 1947 it was $87 million; and in 1967 Prof. and Chairman Executive Director Regional Director the total was $2.257 billion-a 5,000 percent increase in 27 years. Dept. of Surgery Henry Ford Hosp. infountain States Regional Baylor U. Detroit, Mich. Iledical Program The most significant characteristic of this research effort is the tre- Houston, Tex. Boise, Idaho C. H. MILLIKAN, M.D. mendous rate at which it is producing new knowledge in the medical If. G. EDMONDS, Ph.D Consultant in Neurology M. 1. SHANHOLTZ, M.D. sciences, an outpouring which only recently began and which shows Dean, Graduate SCIL Mayo Clinic State Hlth. Comm. no signs of decline. As a result, changes in health care have been No Carolina College Rochester, Minn. State Dept. of Hlth. dramatic. Today, there are cures where none existed before, a Durham, N.C. G. E. MOORE, M.D. Richmond, Va. number of diseases have all but disappeared with the application of B. W. EVERIST, JR., M.D. Director, Roswell Park W. H. STEWART, M.D. Chief of Pediatrics Memorial Institute (Chairman) new vaccines, and patient care generally is far more effective than Green Clinic Buffalo, N.Y. Surgeon General even a decade ago. It has become apparent in the last few years, Ruston, La. Public Health Service however, (despite substantial achievements), that new and better means must also be found to convey the ever-increasing volume of HISTORY AND PURPOSES OF REGIONAL research results to the practicing physician and to meet growing MEDICAL PROGRAMS complexities in medical and hospital care, including specialization, increasingly intricate and expensive types of diagnosis and treat- On October 6, 1965, the President si@ned Public Law 89-239. It ment, and the distribution of scarce manpower, facilities, and other 0 resources. The degree of urgency attached to the need to cope with authorizes the establishment and maintenance of Regional Medical these issues is heightened by an increasing public demand that the Prourams to assist the Nation's health resources in makin- available C, t) latest and best health care be made available to everyone. This the best possible patient care for heart disease, cancer, stroke and public demand, in turn, is largely an expression of expectations related diseases. This legislation, which will be referred to in this aroused by awareness of the results and promise of biomedical t' publication as The Act, was shaped by the interaction of at least research. four antecedents: the historical thrust toward regionalization of In a sense, the national commitment to biomedical investigation health resources; the development of a national biomedical research is one manifestation of the third factor which contributed to the@ community of unprecedented size and productivity; the changing creation of Re-ion Medical Programs: the ch al an@in@ needs of 0 0 needs of society; and finally, the particular legislative process leading society-in this case, health needs. The decisions by various private to The Act itself. and public institutions to support biomedical research were responses The concept of rationalization as a means to meet health needs to this societal need perceived and interpreted by these institutions. effectively and economically is not new. Durin- the 1930's, Assistant In addition to the support of research, the same interpretive process Sur,-eon General Joseph W. Mountin was one of the earliest pioneers led the Federal Government to develop a broad range of other pro- ur@ing this approach for the delivery of health services. The na- n grams to improve the quality and availability of health care in the tional Committee on the Costs of Medical Care also focused attention Nation. The Hill-Burton Program which be@an with the passage of 0 in 1932 on the potential benefits of rationalization. In that same the previously mentioned Hospital Survey and Construction Act of "I year, the Bin@ham Associates Fund initiated the first comprehensive 1946, together with the National Mental Health Act of 1946, was the t) re-ional effort to improve patient care in the United States. This c first in a series of post-WorId War 11 legislative actions having pro-ram linked the hospitals and pro-rams for continuin- education major impact on health affairs. When the 89th Con-ress adjourned t) of physicians in the State of Maine with the university centers of in 1966, 25 health-related bills had been enacted into laiv. Among Boston. Advocates of rationalization next gained national attention In these were Medicare and Medicaid to pay for hospital and physician more than a decade later in the report of the Commission on Hospital services for the Nation's aged and poor; the Comprehensive Health Care and in the Hospital Survey and Construction (Hill-Burton) Planning Act to provide funds to each state for non-categorical health Act of 1946. Other proposals and attempts to introduce re@ionaliza- planning and to support services rendered through state and other tion of health resources can be chronicled, but a strong national health activities; and Public Law 89-239 authorizing Re-ional Medi- Movement toward rationalization had to await the convergence of t) LI n cal Programs. @ @T of During the Congressional bearings on this bill, representatives The report of the President's Commission on Heart Disease, major groups and institutions with an interest in the American health Cancer, and Stroke, issued in December 1964, focused attention on societal needs and led directly to introduction of the legislation au- system were beard, particularly spokesmen for practicing physicians thorizing Regional Medical Programs. Many of the Commission's and community hospitals of the Nation. The Act which emerged recommendations were significantly altered by the Congress in the turned away from the idea of a detailed Federal blueprint for action. legislative process but lle Act was clearly passed to meet needs S icifically, the network of "regional centers" recommended earlier p and problems identified and given national recognition in the Corn. by the President's Commission was replaced by a concept of "regional mission's report and in the Congressional hearings preceding pas- cooperative arrangements" among existing health resources. The sage in The Act. Some of these needs and problems were expressed Act establishes a system of grants to enable representatives of health as follows: resources to exercise initiative to identify and meet local needs within the area of the categorical diseases through a broadly defined process. Recognition of geographical and.societal diversities within 0 A program is needed to focus the Nation's health resources for the United States was $the main reason for this approach, and spokes- research, teaching and patient care on heart disease, cancer, men for the Nation s health resources who testified during the stroke and related diseases, because together they cause 70 per- hearings strengthened the case for local initiative. Thus the degree cent of the deaths in the United States. to which the various Regional Medical Programs meet the objectives 0 A significant number of Americans with these diseases die or are of The Act will provide a measure of how well local health resources disabled because the benefits of present knowledge in the medical can take the initiative and work together to improve patient care for sciences are not uniformly available throughout the country. heart disease, cancer, stroke and related diseases at the local level. 0 There is not enough trained manpower to meet the health needs of The Act is intended to provide the means for conveying to the the American people within the present system for the delivery of medical institutions and professions of the Nation the latest advances in medical science for diagnosis, treatment, and rehabilitation of health services. patients afflicted *with heart disease, cancer, stroke, or related di- 0 Pressures threatening the Nation's health resources'are building seases-and to prevent these diseases. . e grants authorized by The because demands for health services are rapidly increasing at Act are to encourage and assist in the establishment of regional a time when increasing costs are posing obstacles for many who cooperative arrangements among medical schools, research institu- require these preventive, diagnostic, therapeutic and rehabilitative tions, hospitals, and other medical institutions and agencies to services. achieve these ends by research, education, and demonstrations of 0 A creative partnership must be forged among the Nation's medi- patient care. Through these means, the programs authorized by The cal scientists, practicing physicians, and all of the Nation's other Act are also intended to improve generally the health manpower and health resources so that new knowledge can be translated more facilities of the Nation. rapidly into better patient care. This partnership should make it In the two years since the President signed The Act, broadly possible for every community's practicing physicians to share representative groups have organized themselves to conduct Regional in the diagnostic, therapeutic and consultative resources of major Medical Programs in more than 50 Regions which they themselves medical institutions. They should similarly be provided the op- have defined. These Re@ions encompass the Nation's population. portunity to participate in the academic environment of research, They have been formed by the organizing groups using functional as teaching and patient care which stimulates and supports medical well as geographic criteria. These Regions include combinations of practice of the highest quality. entire states (e.g. the Washington-Alaska Region), portions of sev- 0 Institutions with high quality research programs in heart disease, eral states (e.g. the Intermountain Region includes Utah and sec- cancer, stroke, and related diseases are too few, given the magni- tions of Colorado, Idaho, Montana, Nevada and Wyoming), single tude of the problems, and are not uniformly distributed through- states, (e.g. Georgia), and portions of states around a metropolitan out the country. center (e.g. the Rochester Region which includes the city and 11 0 There is a need to educate the public regarding health affairs. surrounding counties). Within these Regional Programs, a wide Education in many cases will permit people to extend their own variety of organization structures have been developed, including lives by changing personal habits to prevent heart disease, cancer, executive and planning committees, categorical disease task forces, stroke and related diseases. Such education will enable indi- and community and other types of sub.regional advisory committees' viduals to recognize the need for diagnostic, therapeutic or re- Regions first may receive planning grants from the Division of habilitative services, and to know where to find these services, Regional Medical Programs, and then may be awarded operational and it will motivate them to seek such services when needed. grants to fund activities planned with initial and subsequent Planning grants. These operational programs are the direct means for Re- gional Medical Programs to accomplish their objectives. Planning which must be worked out by each Regional Medical Pro.,-ram. It is facilitated by voluntary agreements to serve, systematically, the moves a Region toward operational activity and is a continuing needs of the public as regards the categorical diseases on a regional means for assuring the relevancy and appropriateness of operational rather than some more narrow basis. activity. It is the effects of the operational activities, however, which Regionalization, or a regional cooperative arrangement, within will produce results by which Regional Medical Programs will be the context of Regional Medical Programs has several other impor- judged. tant facets: On November 9, 1967, the President sent the Congress the Report on Regional Medical Programs prepared by the Surgeon General of 0 It is both functional and geographic in character. Functionally, ,the Public Health Service, and submitted to the President through the regionalization is the mechanism for linking patient care with Secretary of Health, Education, and Welfare, in compliance with The health research and education within the entire region to provide Act. The Report details the progress of Regional Medical Programs a mutually beneficial interaction. This interaction should occur and recommends continuation of the Programs beyond the June 30, within the operational activities as well as in the total program. 1968, limit set forth in The Act. The President's letter transmitting The geographic boundaries of a region serve to define the popula- the Report to the Congress was at once encouraging and exhortative tion for which each Regional Program will be concerned and when it said, in part: "Because the law and the idea behind it are responsible. This concern and responsibility should be matched new, and the problem is so vast, the program is just emerging from by responsiveness, which is effected by providing the population the planning state. But this report gives encouraging evidence of with a significant voice in the Regional Program's decision- progress-and it promises great advances in speeding research making process. knowledge to the pafient's bedside." Thus in the final seven words 0 It provides a means for sharing limited health manpower and of the President's message, the objective of Regional Medical Pro- facilities to maximize the quality and quantity of care and service grams is clearly emphasized. available to the Region's population, and to do this as eco. nomically as possible. In some instances, this may require inter- regional cooperation between two or among several Regional Pro-rams. t5 THE NATURE AND POTENTIAL OF REGIONAL Finally, it also constitutes a mechanism for coordinating its MEDICAL PROGRAMS categorical program with other health programs in the Region so that their combined effect may be increased and so that they GOAL-IMPROVED PATIENT CARE contribute to the creation and maintenance of a system of The Goal is described in the Surgeon General's Report as comprehensive health care within the entire Region. ". . . clear and unequivocal. The focus is on the patient. The object Because the advance of knowledge changes the nature Of medical is to influence the present arrangements for health services in a care, regionalization can best be viewed as a continuous process manner that will permit the best in modern medical care for heart rather than a plan which it totally developed and then implemented. disease, cancer, stroke, and related diseases to be available to all." This process of regionalization, or cooperative arrangements, con- sists of at least the following elements: involvement, identification of MEANS-THE PROCESS OF REGIONALIZATION needs and opportunities, assessment of resources, definition of ob- jectives, settin@ of priorities, implementation, and evaluation. While 0 Note: Regionalization can connote more than a regional cooperative arrange- these seven elements in the process will be described and discussed ment, but for the purpose of this publication, the two terms will be used separately, in practice they are interrelated, continuous and often interchangeably. The Act uses "regional cooperative arrangement," but "regionalization" has become a more convenient synonym. occur simultaneously. A regional cooperative arrangement among the full array of Involvement-The involvement and commitment of individuals, available health resources is a necessary step in bringing the benefits organizations and institutions which will engage in the activity of of scientific advances in medicine to people wherever they live in a Regional Medical Program, as well as those which will be affected a Region they themselves have defined. It enables patients to benefit by this activity, underlie a Regional Program. By involving in the from the inevitable specialization and division of labor which ac- steps of study and decision all those in a region who are essential company the expansion of medical knowledge because it provides a to implementation and ultimate success, better solutions may be system of working relationships among health personnel and the found, the opportunity for wider acceptance of decisions is improved, institutions and organizations in which they work. This requires and implementation of decisions is achieved more rapidly. Other Program to consider ttie totat arra or resourue5 WILILIII LLn IICFIIIII ... attempts to organize health resources. on a re,@i,)nal basis have ex- 'Y relationship to a comprehensive pro-ram for the are of tli& c perienced difficulty or have been diverted fr(@)iii tbeir objectives cardial infarction patient. Thus, what was a concern of indi%@itluiil 4 @O because there was not this voluntary involvement and commitment @m ? hospitals about how to introduce coronary care units has been tr..ins. by the necessary individuals, institutions and organizations. The Act formed into a project or group of related projects with much greater is quite specific to assure this necessary involvement in Regional Medical Programs: it defines, for example, the minimum composi- potential for effective and efficient utilization of the Region's re- sources to improve patient care. tion of Regional Advisory Groups. Assessment of Resources-As part of the process of regionalization 44 The Act states these Regional Advisory Groups must include a Region continuously updates its inventory of existing resources practicing physicians, medical center officials, hospital administra- and capabilities in terms of function, size, number and quality. tors, representatives from appropriate medical societies, voluntary made to identify and use existing inve tories, fillin- health agencies, and representatives of other organizations, institu- Every effort is n . 0 tions and agencies concerned with activities of the kind to be carried in the gaps as needed, rather than setting out on a long@ expensive on under the program and members of the public familiar with the process of creating an entirely new inventory. Information sources need for the services provided under the program." To ensure a include state Hill-Burton agencies, hospital and medical associations, maximum opportunity for success, the composition of the Regional and voluntary agencies. The inventory provides a basis for informed Advisory Group also should be reflective of the total spectrum of judgments and priority setting on activities proposed for develop- health interests and resources of the entire Region. And it should ment under the Regional Program. It can also be used to identify be broadly representative of the geographic areas and all o t e missing resources-voids requiring new investment-and to develop socioeconomic groups which will be served by the Regional Program. new configurations of resources to meet needs. The Regional Advisory Group does not have direct administrative Definition of Objectives-A Regional Program is continuously responsibility for the Regional Program, but the clear intent of the involved in the process of setting operational objectives to meet Congress was that the Advisory Group would ensure that the Regional identified needs and opportunities. Objectives are interim steps Medical Program is planned and developed with the continuing toward the Goal defined at the beginning of this section, and achieve. advice and assistance of a group which is broadly representative of ment of these objectives should have an effect in the Region felt the health interests of the Region. The Advisory Group must approve far beyond the focal points of the individual activities. This can be all proposals for operational activities within the Regional Program, one of the greatest contributions of Regional Medical Programs. and it prepares an annual statement giving its evaluation of the The completion of a new project to train nurses to care for cancer effectiveness of the regional cooperative arrangements established patients undergoing new combinations of drug and radiation therapy, under the Regional Medical Program. for example, should benefit cancer patients and should provide Identification of Needs and Opportun@s-A Regional Medical additional trained manpower for many hospitals in the Region. But Program identifies the needs as regards heart disease, cancer, stroke the project also should have challenged the Re,-,ion's nursing and hospital communities to improve generally the continuing and in- and related diseases within the entire Region. These needs are service education opportunities for nurses within the Region. stated in terms which offer opportunities for solution. Setting of Priorities-Because of limited manpower, facilities, This process of identification of needs and opportunities for solu- financing and other resources, a Region assigns some order of tion requires a continuing analysis of the problems, in delivering the priority to its objectives and to the steps to achieve them. Besides best medical care for the target diseases on a regional basis, and the limitations on resources, factors include: 1) balance between it goes beyond a generalized statement to definitions which can be what should be done first to meet the Region's needs, in absolute translated into operational activity. Particular opportunities may be terms, and what can be done using existing resources and compe- defined by: ideas and approaches generated within the Region, ex- tence; 2) the potentials for rapid and/or substantial progress toward tension of activities already present within the Region, and ap- the Goal of Regional Medical Programs and progress toward re- proaches and activities developed elsewhere which might be applied gionalization of health resources and services; and 3) Program within the Region. balance in terms of disease categories and in terms of emphasis on Among various identified needs there also are often relationships patient care, education and research. which, when perceived, offer even greater opportunities for solutions. Implementation-The purpose of the preceding steps is to provide In examining the problem of coronary care units throughout its a base and imperative for action. In the creation of an initial op- Region, for example, a Regional Program may recognize that the erational program, no Region can attempt to determine all of the more effective approach would be to consider the total problem of program objectives possible, design appropriate projects to meet all the treatment of myocardial infarction patients within the Region. the objectives and then assign priorities before seeking a grant to This broadened approach on a regional basis enables the Regional v EN'l ACTION implement an operational program which encompasses all..:)r even most of the projects. Implementation can occur with an initial 1964 DECEMBERR e President's operational program encompassing even a small number of well- 1 on Heart Disease, Cner, ad Stroke. designed projects which will move the Region toward the attainment of valid program objectives. Because regionalization is a continuous process, a Region is expected to continue to submit supplemental and 1965 FEBRUARY TO Congressional hearings ,additional operational proposals as they are developed. JULY Evaluation-Each planning and operational activity of a Region, OCTOBER Enactment of P.L 89-239 as well as the overall Regional Program, receives continuous, quan- DECEMBER National Advisory Council meeting Initial policies and pre titative and qualitative evaluation wherever possible. Evaluation is liminary Guidelines in terms of attainment of interim objectives, the process of re@ionali- reviewed zation, and the Goal of Regional Medical Programs. Objective evaluation is simply a reasonable basis upon which to 1966 FEBRUARY Establishment of Division determine whether an activity should be continued or altered, and, Publication of preliminary ultimately, whether it achieved its purposes. Also, the evaluation of Guidelines one activity may suggest modifications of another activity which National Advisory Council meeting Policy for review proc- would increase its effectiveness. ess and Division Any attempt at evaluation implies doing whatever is feasible ivithin APRIL Review Committee meeting activities set the state of the art and appropriate for the activity being evaluated. National Advisory Council meeting 7 planning grants Thus, evaluation can range in complexity from simply countin- num- awarded hers of people at meetings to the most involved determination of JUNE Review Conunittee meeting behavioral changes in patient management. National Advisory Council meeting 3 planning grants As a first step, however, evaluation entails a realistic attempt to awarded design activities so that, as they are implemented and finally con- JULY Publication of Guidelines cluded, some data will result which will be useful in determining the Review Committee meeting degree of success attained by the activity. AUGUST National Advisory Council meeting 8 planning grants awarded SEPTEMBER First of 5 meetings of Ad Hoc Report material Committee for Report to the discussed President and Congress OCTOBER Review Committee meeting NOVEMBER National Advisory Council meeting 16 planning grants REVIEW COMMI=E awarded K. P. BUNNELL, Ed.D. G. E. MILLER, M.D. D. E. ROGERS, M.D. Assoc. Director Director, Off. of Research Prof. and Chairman 1967 JANUARY Revifw Committee meeting Western Interstate Comm. in Med. Educ. Dept. of Aled. National Conference National views on for Higher Ed. Coll. of Med., U. of Ill. School of Iled. Boulder, Colo. Chicago, M. Vanderbilt U. PrograTms & information Nashville, Tenn. for Report provided G. JAMES, M.D. P. M. MORSE, Ph.D. FEBRUARY National Advisory Council meeting 10 planning and 4 opera- (Chairman) Director, Operations C. H. W. RUHE, M.D. tional grants awarded Dean, Mount Sinai Research Ctr. Assistant Secretary APRIL Review Committee meeting School of Med. Mass. Int. of Tech. Council on -Ifed. Ed. New York, N.Y. Cambridge, Mass. American -lied. Assoc. MAY National Advisory Council meeting 5 planning and I opera. H. W. KENNEY, M.D. A. PASCASIO, Ph.D. Chicago, 111. JUNE Report to the President & Congress tional grant awarded Medical Director Assoc. Research Prof. R. J. SLATER, 11.D. John A. Andrew Memorial Nursing School, U. of Executive Director JULY Review Committee meeting Hosp. Pittsburgh The Assoc. for the Aid of AUGUST National Advisory Council meeting 2 planning grants Tuskegee Institute Pittsburgh, Pa. Crippled Children awarded Tuskegee, Ala. S. H. PROGER, M.D. New York, N.Y. OCTOBER Review Committee meeting E. J. KOWALEWSKR, M.D. Prof. and Chairman J. D. THOMPSON NOVEMBER National Advisory Council meeting 2 planning_ and 3 opera- Chairman, Dept. of Med. and Prof. of Public Hlth. tional grants awarded Committee of Environ. Med. Physician-in-Chief School of Public Hlth. 1968 JANUARY Conference-Workshop Regional activities and Acad. of Gen. Practice Tufts N.E. Med. Ctr. Yale U. Akron, Pa. Pres., Bingham Assoc. Fund New Haven, Conn. Boston, Mass. PUBLIC LAW 89-239 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 diagnosis and treatment of heart disease, cancer, stroke, and related diseases by estab- lishing voluntary regional cooperative arrangements! among . . . Physicians 0 Voluntary Health Agencies Hospitals 0 Federal, State, and Local Health Agencies 0 Medical Schools 0 Research Institutions 0 Civic Organizations REGIONAL ADVISORY COUNCILS are directed by fulltime Co- The activities of Regional Medical Programs dinators working together with Regional Advisory Groups which are 0 broadly representative of the medical and health resources of the Regions. Membership on these groups nationally is: Hospital Administrators Practicing ans Public Heal Officials Other Health rs Worke Voluntary Center. Health Ag ol Officials 16 Members of the Public